Journal of Neonatal-Perinatal Medicine - Volume 12, issue 1

Authors: Singh, Ajay Pratap | Lakshminrusimha, Satyan | Thompson, Mark E.

Article Type: Research Article

Abstract: OBJECTIVE: The primary aim of this pilot study was to assess feasibility and to evaluate if peri-operative pain management with regional analgesia resulted in decreased use of narcotic medication and earlier return to preoperative respiratory/nutritional status. STUDY DESIGN: Cases were defined as infants who received regional analgesia as part of their perioperative anesthetic management. Controls were matched for surgical procedures without regional analgesia. RESULTS: Fifteen cases were identified and matched with 17 controls. Infants undergoing inguinal hernia repair returned to baseline earlier and were not intubated. There was no difference in time to …extubation in other thoracoabdominal surgeries. There was no difference in cumulative narcotic analgesia administered between the two groups. CONCLUSION: Postoperative regional analgesia is feasible in neonates. Inguinal hernia repair with regional anesthesia was performed without intubation and returned to preoperative status earlier. No differences were observed with other surgeries. Further prospective, randomized, multicenter studies are needed. Show more

DOI: 10.3233/NPM-1827

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 1, pp. 73-79, 2019

Authors: McMahon, K.E. | Habeeb, O. | Bautista, G.M. | Levin, S. | DeChristopher, P.J. | Glynn, L.A. | Jeske, W. | Muraskas, J.K.

Article Type: Research Article

Abstract: BACKGROUND: Numerous studies have examined the association between ABO blood groups and adult disease states, but very few have studied the neonatal population. The objective of this study was to determine the relationship between AB blood group and the occurrence of common neonatal disorders such as neutropenia at birth, sepsis, respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), and patent ductus arteriosus (PDA) compared to all other blood groups. METHODS: We performed a retrospective review on 3,981 infants born at 22 0/7 to 42 6/7 weeks’ gestational age and compared the relative risk of neonatal …diseases in infants with AB blood group to that of infants with all other blood groups (A, B, and O). RESULTS: When compared to all other blood groups, AB infants demonstrated an increased risk for developing negative clinical outcomes. AB blood group was significantly associated with a 14–89% increased risk of neutropenia at birth, sepsis, RDS, and ROP. Risks for IVH and PDA were not significant. CONCLUSION: We hypothesize that the phenotypic expression of A and B antigens, rather than the antigens themselves, in the AB group may reveal an enhanced susceptibility to injury at the endothelial level resulting in an increased risk for disease development. Show more

Keywords: ABO blood group, ABO antigens, neonatal disease, neonatal neutropenia, neonatal sepsis, endothelial injury

DOI: 10.3233/NPM-17115

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 1, pp. 81-86, 2019

Authors: Humphrey, J.D. | Hagan, J.L. | Suresh, G.K. | Sundgren, N.C.

Article Type: Research Article

Abstract: BACKGROUND: Guidelines exist for counseling expectant families of infants at periviable gestational ages (22–25 weeks), but it is much more common for neonatologists to counsel families at gestational ages beyond the threshold of viability when several aspects of these guidelines do not apply. We aimed to develop an understanding of what information is shared with mothers at risk of preterm delivery beyond periviability and to evaluate communication skills of our participants. METHODS: We developed a checklist of elements to include in counseling based on a comprehensive literature review. The checklist was divided into an information sharing section and …a connect score. The information sharing list was sub-divided into general information and specific complications. Neonatologists engaged in a simulated prenatal counseling session with a standardized patient. Videotaped encounters were then analyzed for checklist elements. RESULTS: Neonatologists all scored well in communication using our tool and two other validated communication tools - the SEGUE and the analytic global OSCE. There was no difference in scoring based on years of experience or level of training. Information sharing from neonatologists more often discussed general information over specific. Neonatologists also focused more on early outcomes over long-term outcomes. Only 12% of neonatologists quoted the correct survival rate for the case. CONCLUSIONS: Neonatologists generally communicate well but share less information specific to prematurity and the long-term sequelae of prematurity. Our tool may be used to test if other interventions improve information sharing or communication. Show more

Keywords: Prenatal consult, simulation, prenatal complications, communication

DOI: 10.3233/NPM-1857

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 1, pp. 87-94, 2019

Authors: Ajayi, O.O. | Davis, N.L. | Saleem, B. | Kapoor, S. | Okogbule-Wonodi, A.C. | Viscardi, R.M. | Sundararajan, Sripriya

Article Type: Research Article

Abstract: OBJECTIVE: To determine the relationships of red blood cell (RBC) transfusion and enteral feeding to changes in intestinal permeability (IP) measured by the relative intestinal uptake of lactulose (La) and rhamnose (Rh) in preterm infants <33 wk gestation. DESIGN/METHODS: Infants 240 –326 wk gestation received La/Rh solution enterally on study days 1, 8 and 15.Urinary La/Rh ratio was measured by HPLC. Hematocrit preceding transfusion, total RBC transfusion volume, volume/kg, and feeding status during each study interval (birth-d1; d1-d8, and d8-d15) were determined. RESULTS: Of the seventeen (40.5%) subjects who received≥1 transfusion during the study period, 12 (70.6%) …infants were <28 wk gestation and 5 (29.4%) infants were≥28 wk gestation, p  < 0.0001. Lower pre-transfusion hematocrit was observed in intervals preceding high IP (La/Rh > 0.05) than in intervals preceding low IP (La/Rh≤0.05) measurements (33 vs 35.8, p  = 0.1051 ). RBC transfusions occurred more frequently in intervals preceding high IP than in intervals preceding low IP (26.8%; vs 8.3%, p  = 0.0275 ) with 5-fold higher total RBC volume and volume/kg in intervals preceding any time point with high IP. RBC transfusion during an interval was associated with a three-fold increased risk of high IP (aOR 2.7; 95% C.I 0.564–12.814; p  = 0.2143 ). Exclusive breast milk exposure and post-menstrual age reduced the risk for high IP following RBC transfusion. CONCLUSIONS: Both RBC transfusion number and volume was associated with subsequent high IP measurements in preterm infants <33 weeks gestation and potentially may contribute to impairment of the preterm intestinal barrier. Show more

Keywords: Red blood cell transfusion, premature infants, intestinal permeability, enteral feeding

DOI: 10.3233/NPM-1828

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 1, pp. 95-101, 2019

Authors: Thakore, P. | Dunbar, A.E. | Lindsay, E.B.

Article Type: Case Report

Abstract: A 710 g male infant was born at a referring hospital at a gestational age of 23 weeks and 2 days via vaginal delivery and was transferred to our facility at 14 days of age. His delivery was complicated by the breech presentation with difficult head extraction. The infant’s initial course was significant for respiratory distress syndrome, grade III-IV intraventricular hemorrhage (IVH), acute kidney injury, and large PDA. On the day of life 29, a gradual increase in serum sodium level refractory to increasing total fluid volume was noted. The combination of persistent hypernatremia (150–160 mmol/l), polyuria (8.4 ml/kg/hr), high plasma osmolality (323 …mosm/kg), hyposthenuria (75 mosm/kg) and an undetectable serum ADH (<0.8 pg/ml) confirmed the diagnosis of central diabetes insipidus (CDI). Serum sodium and urine output decreased and urine osmolality increased after subcutaneous DDAVP administration. CDI is an uncommon cause of hypernatremia in the neonatal period. The diagnosis can be difficult as excessive urine output and high serum sodium can often be attributed to high insensible water loss in the extremely premature newborn. CDI in our patient was thought to be due to grade III-IV IVH complicated by post-hemorrhagic hydrocephalus. In conclusion, the diagnosis of central DI should be considered as a complication of severe IVH in the extremely premature neonate who demonstrates persistent hypernatremia, polyuria, decreased urine osmolality, and increased plasma osmolality. Serum ADH levels can be helpful in confirming the central origin of DI and subcutaneous desmopressin can be an effective treatment in the preterm infant. Show more

Keywords: Central diabetes insipidus, intraventricular hemorrhage, very low birth weight preterm infant

DOI: 10.3233/NPM-1837

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 1, pp. 103-107, 2019

Authors: Davidson, L. | Rawat, M. | Stojanovski, S. | Chandrasekharan, P.

Article Type: Case Report

Abstract: BACKGROUND: Mitragyna speciosa, also known as kratom, is obtained from the coffee plant family ‘Rubiaceae.’ Kratom is available in the form of capsules, whole, processed and powdered leaves, and as liquids. Secondary to its ‘natural herb’ status and opioid effects, it is misconceived to be a safe alternative for the treatment of chronic pain. The use of kratom has increased by tenfold in the United States since 2010. METHODS AND RESULTS: We report a term neonate who was born to a chronic kratom user and required treatment with opiates for neonatal drug withdrawal. CONCLUSION: Physicians should …be aware of these herbal supplements and its potential withdrawal effects in newborn which cannot be picked up by the standard toxicology screen. Show more

Keywords: Kratom, NAS – neonatal abstinence syndrome

DOI: 10.3233/NPM-1863

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 1, pp. 109-112, 2019