Journal of Neonatal-Perinatal Medicine - Volume 11, issue 4

Authors: Brown, R.A. | Dakkak, H. | Seabrook, J.A.

Article Type: Review Article

Abstract: Maternal drug use during lactation may have adverse effects on the health of their children. Two common drugs used during this period are alcohol and cannabis. A literature search was conducted using PubMed, CINAHL, Nursing and Allied Health, and Google Scholar with the following search terms: marijuana, cannabis, THC, alcohol, ethanol, breastfeeding, lactation, and breastmilk. The search strategy was restricted to papers since the year 2000, and limited to English language journals. Reference lists were also used to capture any articles that were missed from the database searches. In total, 19 articles were found related to alcohol and breastfeeding (n …= 17 original research papers; n = 2 systematic reviews), and 4 articles were specific to cannabis (n = 2 original papers; n = 2 systematic reviews). The most common outcomes associated with alcohol consumption and breastfeeding included changes in sleep patterns, reduced milk production and flow, lower milk intake, and impaired immune function. Maternal outcomes related to cannabis consumption included panic attacks, delayed response time, increased heart rate, reduced short-term memory, dizziness, and impaired motor performance; infant outcomes associated with maternal cannabis use and breastfeeding were reduced muscular tonus, poor sucking, and growth delay and restriction. Mothers should be advised to refrain from substance use during the lactation period for the health and safety of their children. Show more

Keywords: Marijuana, cannabis, alcohol, drug use, breastfeeding, lactation, infants, children, neonatal

DOI: 10.3233/NPM-17125

Citation: Journal of Neonatal-Perinatal Medicine, vol. 11, no. 4, pp. 345-356, 2018

Authors: Cordero, L. | Stenger, M.R. | Landon, M.B. | Nankervis, C.A.

Article Type: Research Article

Abstract: OBJECTIVE: To examine the effects of early breastfeeding (eBF) or early formula feeding (eFF) on hypoglycemia and on BF initiation in infants born to women with pregestational diabetes mellitus (PGDM) who intended to BF. METHODS: Retrospective cohort investigation of 554 women with PGDM and their infants (IDMs) who delivered during 2008–2016. The first feeding (BF or FF) was considered early if given within 4 hours from birth. RESULTS: 282 (51%) IDMs were admitted to the Well Baby Nursery. Of the 134 IDMs whose early feeding was BF, hypoglycemia affected 30% which was corrected with oral feedings …in 78% of the cases. At discharge, 49% BF exclusively while 45% BF partially. Of the 148 IDMs whose early feeding was FF, hypoglycemia affected 40% which was corrected with oral feedings in 69% of the cases. At discharge, 14% BF exclusively while 48% BF partially. There were 272 (49%) IDMs admitted to the NICU. Their early feeding was BF (14%) and FF (86%). Hypoglycemia developed in 50% and 43% of these groups, respectively. Benefits of early feedings on hypoglycemia were masked by the routine use of IV dextrose infusions. At discharge, early BF led to exclusive BF in 45% and partial BF in 50% of the cases. Early FF led to exclusive BF in 17% and partial BF in 42% of the cases. CONCLUSIONS: Early and continued feeding (BF preferably or FF if BF is not feasible) should be the first line of treatment for hypoglycemia. Early BF is paramount for BF initiation. Early FF is an obstacle, albeit not absolute, to BF initiation, thus it should not deter continued efforts to start or resume BF. Show more

Keywords: Early feeding, hypoglycemia, breastfeeding initiation, pregestational diabetes mellitus

DOI: 10.3233/NPM-17145

Citation: Journal of Neonatal-Perinatal Medicine, vol. 11, no. 4, pp. 357-364, 2018

Authors: Crabtree, C.S. | Pakvasa, M. | Radmacher, P.G. | Adamkin, D.H.

Article Type: Research Article

Abstract: OBJECTIVE: The study objective was to explore the relationship between necrotizing enterocolitis (NEC) and packed red blood cell (pRBC) transfusion in very low birth weight (VLBW) neonates (<1500 g). STUDY DESIGN: A six-year retrospective chart review of VLBW infants with NEC (Bell’s Stage > II) and a pRBC transfusion within 48 hours of diagnosis. Prenatal data, postnatal course, transfusion history, and NEC outcomes were reviewed. The transfusion associated necrotizing enterocolitis (TANEC) cases were matched with controls (1:2) who were transfused but did not develop NEC as to proximity of birth date, gestational age, and receipt of transfusion. …RESULTS: Of 1139 VLBW admissions, there were 73 cases of NEC and 30 cases of TANEC (annual NEC rate 6.4%). TANEC cases were matched with 60 controls who were transfused but never developed NEC. Neonatal profiles were similar between all 3 groups, except for a higher proportion of infants <10th percentile in the non-TANEC group. Days of antibiotics and frequency of patient ductus arteriosus (PDA) ligation were lower in controls compared to NEC cases. Lower feeding rate at diagnosis of NEC/match were more common in control infants compared to TANEC infants. However, feeding abstinence rates were similar between the two groups. The number of transfusions prior to diagnosis/match was similar in all groups. There was no significant difference in pre-transfusion hematocrit values between the groups. CONCLUSION: TANEC was common among NEC cases. PDA ligation was similar among TANEC and non-TANEC but lower in controls. Similar pre-transfusion hematocrits were found among TANEC and controls. Feeding abstinence rates were also similar between TANEC and controls. Show more

DOI: 10.3233/NPM-1634

Citation: Journal of Neonatal-Perinatal Medicine, vol. 11, no. 4, pp. 365-370, 2018

Authors: Dizon, Samantha | Hoffman, Suma Bhat

Article Type: Research Article

Abstract: OBJECTIVE: Determine how blood pressure differs in premature infants born small for gestational age (SGA). DESIGN: A retrospective study was conducted on inborn infants 24–32 weeks gestation. Mean arterial blood pressure (MAP) was collected and averaged every 12 h for the first 96 h of life. For each time point, the difference MAP in SGA vs. AGA infants was evaluated with t -testing. Linear mixed-effects modeling was performed to model MAP over time accounting for GA, BW, gender, and SGA status. RESULTS: 356 subjects were evaluated. 52 (14.6%) were SGA. SGA infants were smaller, more likely male, exposed …to maternal hypertension, born via caesarian section, and have chronic lung disease and retinopathy of prematurity. MAP in the SGA group more closely matched the MAP of AGA babies of similar GA for the first 24 h of life. Subsequently, SGA infants had lower MAPs more closely resembling their weight-matched counterparts. Mixed modeling showed GA to be significant, p  < 0.0001 while BW though still marginally significant had less of an effect, p  = 0.049. CONCLUSION: SGA infants have blood pressure that is strongly associated with GA in the first 24 hours of life, but then fails to increase at the same rate as their AGA counterparts. Show more

Keywords: SGA, blood pressure, hypotension, prematurity

DOI: 10.3233/NPM-17141

Citation: Journal of Neonatal-Perinatal Medicine, vol. 11, no. 4, pp. 371-377, 2018

Authors: Watanabe, S. | Kondo, Y. | Naoe, A. | Yasui, T. | Suzuki, T. | Hara, F. | Uga, N. | Miyata, M. | Boda, H.

Article Type: Research Article

Abstract: PURPOSE: Recently, the number of births using assisted reproductive technologies (ART) has increased. An associated increase in the incidence of congenital malformations in babies conceived using this technology has also been reported. Therefore, we aimed to investigate the rate of malformations in babies with neonatal surgical diseases, who were conceived using ART. MATERIALS AND METHODS: Between January 2007 and December 2016, 1737 patients were admitted to our hospital. We analyzed the incidence of congenital cardiac diseases, genetic anomalies, and congenital anomalies of the kidney and urinary tract (CAKUT) in neonates conceived by ART. The χ 2 test …and logistic regression analysis were used to assess the odds ratios (ORs) for congenital malformations. A P- value < 0.05 indicated statistical significance. RESULTS: The OR for CAKUT was 16.94 for the first-birth neonates conceived using ART, [P < 0.05, AUC (area under the curve) = 0.86]. However, for non-surgery neonates, the OR for CAKUT was 5.99 (P = 0.15, AUC = 0.87), compared to 32.27 (P < 0.05, AUC = 0.93) for parallel conditions in surgery-neonates. CONCLUSION: Neonates conceived using ART are prone to develop CAKUT, which will need surgical treatment. Therefore, more management is necessary for associated malformations in these babies, particularly in cases with CAKUT. Show more

Keywords: Neonate, advanced age primipara, assisted reproductive technology, associated malformation, congenital anomalies of the kidney and urinary tract (CAKUT)

DOI: 10.3233/NPM-17131

Citation: Journal of Neonatal-Perinatal Medicine, vol. 11, no. 4, pp. 379-385, 2018

Authors: Nagasawa, H. | Motz, R. | Hamada, C. | Kohno, Y. | Yamada, Y.

Article Type: Research Article

Abstract: BACKGROUND: We had reported on the left ventricular end-diastolic dimension (LVDd) in normal children from the premature/neonatal period to the adolescence period by using two-dimensional echocardiography, and formulated equations to evaluate normal LVDd values by using body height as an index. There was an inflection point at around birth that seemed relevant to the fetal and neonatal periods for the relation of LVDd and body height. METHODS: We aimed to reveal the true inflection point and its meaning by using change point regression analysis. The study group consisted of 421 neonates and infants. The ages at examination ranged …from 24 weeks’ gestation to 1 year after birth. The subjects’ body heights at examination were between 31 and 75 cm. RESULTS: The analysis showed no definite inflection point in height, and a flat bottom was observed between body heights of 48 and 55 cm. The inflection range seemed to mean the duration of the neonatal period, which connects the fetal and infantile periods. CONCLUSION: The results revealed that neonates reach the infantile period slower than usually imagined, and the end of the neonatal period may be at the age when the body height is around 55 cm— in other words, at 2 months after birth. This manuscript might be the first one to consider the definition of the neonatal period using cardiovascular methods. Show more

Keywords: Akaike’s information criterion (AIC), change point regression analysis, definition of the neonatal period, left ventricular end-diastolic dimension, piecewise regression linear analysis

DOI: 10.3233/NPM-1797

Citation: Journal of Neonatal-Perinatal Medicine, vol. 11, no. 4, pp. 387-392, 2018

Authors: Yadav, S.K. | Venkatnarayan, K. | Adhikari, K.M. | Sinha, R. | Mathai, S.S.

Article Type: Research Article

Abstract: OBJECTIVE: To evaluate the efficacy of gastric lavage (GL) in preventing feed intolerance in babies born through Meconium stained amniotic fluid (MSAF). STUDY DESIGN: In this randomized trial conducted at a tertiary care hospital, neonates born of MSAF after 34 weeks period of gestation requiring routine care were randomly allocated to GL with 10 ml/kg of normal saline. The control group did not receive GL. The subjects were monitored for first 24 hours in predefined time epochs. The primary outcome was incidence of feed intolerance which was defined as vomiting or abdominal distension more than 2 cm from baseline …measure. Babies were also monitored for potential adverse events due to GL and total duration of hospital stay. RESULTS: Baseline parameters were comparable. The incidence of feed intolerance was not significant in the GL group [4.6% vs 9.2%; RR 0.92 (0.29–3)]. There were no adverse events secondary to GL. The duration of hospital stay was comparable between groups. CONCLUSION: GL in neonates born of MSAF does not reduce feed intolerance. Show more

Keywords: Meconium stained amniotic fluid, feed intolerance, gastric lavage

DOI: 10.3233/NPM-17154

Citation: Journal of Neonatal-Perinatal Medicine, vol. 11, no. 4, pp. 393-397, 2018

Authors: Yen, E. | Weinberger, B.I. | Laumbach, R.J. | Ohman-Strickland, P.A. | Vetrano, A.M. | Gow, A.M. | Ramagopal, M.

Article Type: Research Article

Abstract: BACKGROUND: Tracheal aspirate is the conventional method to measure biomarkers of inflammation and oxidation from premature infants on mechanical ventilation at risk for bronchopulmonary dysplasia (BPD), but this method is invasive. Exhaled breath condensate (EBC) is a novel, non-invasive method that has been used in older populations. Nitrite, a stable metabolite of nitric oxide (NO), is elevated in inflammatory conditions. We aim to investigate the feasibility of EBC nitrite collection from ventilated premature infants and to quantify EBC nitrite in infants with and without BPD. We hypothesize that EBC nitrite correlates with TA nitrite, and that EBC nitrite in the …first week of life is higher in infants who will develop BPD than those without BPD. METHODS: In a pilot prospective cohort study, TA and EBC were collected in the first week of life from mechanically ventilated premature infants. Nitrite levels were measured using chemiluminescence. RESULTS: EBC nitrite significantly correlated with TA nitrite (r = 0.45, p = 0.025). Of 40 infants, 33 (82.5%) developed BPD. EBC and TA nitrite levels collected in the first week of life had a higher trend in infants with BPD than those without BPD (p = 0.23 and 0.38 respectively). CONCLUSIONS: Higher trend of EBC nitrite in the first week of life was associated with the development of BPD. Correlation of nitrite level in EBC with that in TA (conventional method) highlights the utility of EBC as an alternative, non-invasive method to measure inflammation. Further refinement of conditions and timing may optimize the predictive value of EBC nitrite. Show more

Keywords: Exhaled breath condensate, tracheal aspirates, nitrite, inflammation, oxidative stress, bronchopulmonary dysplasia

DOI: 10.3233/NPM-17106

Citation: Journal of Neonatal-Perinatal Medicine, vol. 11, no. 4, pp. 399-407, 2018

Authors: Dakkak, H. | Brown, R. | Twynstra, J. | Charbonneau, K. | Seabrook, J.A.

Article Type: Research Article

Abstract: The prevalence of marijuana use during pregnancy ranges from 3–30% , and most of this is for recreational purposes. Marijuana exposure during pregnancy has been linked with low birth weight babies and other adverse child health outcomes. Twitter is a popular news and social networking outlet, and is frequently used to access information about population health and behavior. The primary objective of this study was to investigate the types of messages disseminated on Twitter about marijuana use and infant and maternal health. The secondary objective was to describe the reported health outcomes associated with prenatal and postnatal marijuana use. Tweets …were collected from the inception of Twitter (2006) until April 2017. If tweets included links, these links were examined to investigate the source of the message and to clarify the user’s intent. In total, 550 tweets were captured, with most tweets (77.6%) having a neutral tweet tone, suggesting uncertainty about the health effects associated with pre- and post-natal marijuana exposure. The sources attached to the original tweets, however, were more likely to report on negative health outcomes. The most common health outcomes associated with prenatal marijuana exposure were: poor brain development (27.3%), inadequate development of the nervous system (23.6%), low birth weight (23.3%), poor behavioral outcomes (21.0%), and infant memory issues (19.3%). The inverse association between marijuana use and the quality and quantity of milk produced by the mother was the most commonly reported tweet for the lactation period. Show more

Keywords: Social media, twitter, marijuana, cannabis, pregnancy, breastfeeding, child health, maternal health

DOI: 10.3233/NPM-17133

Citation: Journal of Neonatal-Perinatal Medicine, vol. 11, no. 4, pp. 409-415, 2018

Authors: Moore, G.P. | Byrne, A. | Davila, J. | Sarfi, E. | Bettolli, M.

Article Type: Case Report

Abstract: Intrauterine intestinal obstruction complicated by midgut volvulus is a serious life-threatening diagnosis. Immediate surgical intervention is generally the course of action upon diagnosis to prevent morbidity and mortality. We report a case of intrauterine intestinal obstruction where the neonate then presented with an unusual onset of volvulus within the first 12 hours of life. The patient was born with generalized edema, a distended abdomen, and pallor. Unlike many cases, the patient did not present with typical signs of volvulus. Diagnostic imaging preceding delivery and the stable postnatal clinical course did not offer a justification for immediate laparotomy. Less than 24 …hours later, the patient’s hemoglobin significantly dropped leading to an emergent laparotomy. Findings included a volvulus of the terminal ileum and large amounts of intraluminal blood. Our case report includes an analysis of clinical observations that should be considered so that patients presenting with similar signs receive earlier surgical intervention. Show more

Keywords: Neonate, anemia, volvulus, cystic fibrosis

DOI: 10.3233/NPM-17118

Citation: Journal of Neonatal-Perinatal Medicine, vol. 11, no. 4, pp. 417-422, 2018