Journal of Neonatal-Perinatal Medicine - Volume 13, issue 1

Authors: Volpe, Joseph J.

Article Type: Editorial

Keywords: Marijuana, pregnancy, prematurity, lactation, brain disturbance

DOI: 10.3233/NPM-190403

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 1, pp. 1-3, 2020

Authors: Hoffman, J.I.E.

Article Type: Article Commentary

Abstract: BACKGROUND: False negative pulse oximeter results occur in new born infants with critical congenital heart disease who have an oximeter saturation ≥95%. Some of these infants have abnormal physical findings but others do not. OBJECTIVES: To determine the causes of false negative results. METHODS: Mathematical analysis of determinants of arterial oxygen saturation and discussion of oximeter bias. RESULTS: False negative oximeter results are not rare; the sensitivity of pulse oximetry screening for critical congenital heart disease is about 80%. The high saturation may be due to a very small right-to-left shunt at the time …of study, a relatively high cardiac output and mixed venous saturation, or to positive bias in oximeter readings. It may also be due to some critical congenital heart lesions that do not show desaturation at the time of testing. CONCLUSIONS: A diagnosis of a normal heart based on a negative oximeter test is presumptive, and requires careful follow-up for 1–2 weeks after birth. Show more

Keywords: Mixed venous saturation, cardiac output, right-to-left shunt, oximeter bias

DOI: 10.3233/NPM-190297

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 1, pp. 5-9, 2020

Authors: Segar, J.L.

Article Type: Review Article

Abstract: Despite the fact that hundreds of thousands of preterm infants receive parenteral fluids each year, study of optimal fluid and electrolyte management in this population is limited. Compared to older children and adults, preterm infants have an impaired capacity to regulate water and electrolyte balance. Appropriate fluid and electrolyte management is critical for optimal care of low birth weight or sick infants, as fluid overload and electrolyte abnormalities pose significant morbidity. This review highlights basic physiological principles which need to be applied when prescribing parenteral fluids and builds upon published literature to outline a rational approach to initial fluid and …electrolyte management of the preterm infant. Show more

Keywords: Fluid, sodium, potassium, premature

DOI: 10.3233/NPM-190309

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 1, pp. 11-19, 2020

Authors: Nour, I. | Elmaghraby, R. | Shehata, R. | El-Refaey, A. | Aldomiaty, H. | Mosbah, A. | Shouman, B. | Nasef, N.

Article Type: Research Article

Abstract: BACKGROUND: The reno-protective effect of therapeutic hypothermia in infants with hypoxic ischemic encephalopathy (HIE) is still debatable. We aimed to study the effect of therapeutic hypothermia on the development and progress of acute kidney injury (AKI) in neonates with HIE. METHODS: Thirty full term infants with HIE were equally distributed between cooling group (selective head cooling) or non-cooling group (late presentation after 6 hours of birth). Serum creatinine, urine output (UOP), serum neutrophil gelatinase-associated lipocalin (NGAL), and serum cystatin C were measured at baseline, day 4 and day 10 of life. RESULTS: The incidence of AKI …as per Acute Kidney Injury Network (AKIN) criteria was comparable in cooling and non-cooling groups (40% versus 53%, respectively). Serum creatinine and UOP were significantly improved on day-4 and day-10 samples compared to base-line samples in both groups regardless of cooling. Therapeutic hypothermia was associated with a significant reduction in serum NGAL, but not cystatin C, level in day-4 and day-10 samples compared to the non-cooling group. Serum NGAL and cystatin C did not show a significant decline in day-4 and day-10 samples compared to baseline samples in both the cooled and non-cooled groups indicating an ongoing AKI. CONCLUSIONS: Therapeutic hypothermia was associated with less renal impairment when compared to infants with HIE who were not cooled. Continuing kidney injury may persist in asphyxiated newborns despite improvement in serum creatinine and UOP. Trial Registration Number: NCT02683915. Show more

Keywords: Asphyxia, acute kidney injury, cystatin C, neutrophil gelatinase-associated lipocalin, therapeutic hypothermia neonate

DOI: 10.3233/NPM-180200

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 1, pp. 21-30, 2020

Authors: Sardar, S.K. | Saha, A.K. | Majhi, B. | Chatterjee, S.

Article Type: Research Article

Abstract: OBJECTIVE: To evaluate the role of functional echocardiography for prediction of patent ductus arteriosus (PDA) closure and development of adverse outcome in very low birth weight newborn. METHODS AND STUDY DESIGN: Functional echocardiography was done in 143 neonates with birth weight less than 1250 g on day 3. Nine echocardiographic parameters were analyzed for babies with PDA for prediction of spontaneous closure and development of one or more adverse outcomes (bronchopulmonary dysplasia, necrotizing enterocolitis≥stage 2 and intraventricular hemorrhage > grade 2) during hospital stay. RESULT: The mean (±SD) birthweight and gestational age of the cohort were 1017 (±17) g …and 30.8 (±2.7) weeks. PDA was found in 60 (41.9%) babies on day 3 among the recruited babies. Binary logistic regression model showed strong prediction ability of early (day 3) functional echocardiography markers in predicting future spontaneous closure of PDA and development of one or more adverse clinical outcome. In multivariate analysis, abnormal flow pattern (growing or pulsatile) was found to have increased risk for persistence of PDA (adjusted OR 22.9, CI 1.97-269) in comparison to PDA with closing/bidirectional pattern. CONCLUSION: Early functional echocardiography, especially the flow pattern, is useful for prediction of PDA closure. Adverse clinical outcome prediction is possible with functional echocardiography markers when combined with gestational age and PDA closure status. Show more

Keywords: Very low birth weight, patent ductus arteriosus, preterm, functional echocardiography

DOI: 10.3233/NPM-190229

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 1, pp. 31-37, 2020

Authors: den Harink, Tamara | Clur, Sally-Ann B. | van der Lee, Robin | van Deutekom, Arend W.

Article Type: Research Article

Abstract: BACKGROUND: Management of a patent ductus arteriosus (PDA) after pharmacological therapy failure in preterm neonates is controversial and shows marked practice variation. To evaluate which factors motivate the decision to ligate a PDA in clinical practice we examined several clinical and echocardiographic variables. METHODS: We conducted a retrospective single center cohort study. We included infants born at less than 37 weeks of gestation, admitted to our neonatal intensive care between 01.01.2008 and 31.12.2015 with a PDA detected on echocardiography after two or three courses of medical therapy. Logistic regression analyses were used to predict surgical ligation for twelve …clinical and nine echocardiographic variables separately. We used the multiple imputation technique for missing values. RESULTS: A total of 89 neonates were included of which forty (45%), underwent surgical ligation of their PDA. In our final multivariate regression model, invasive respiratory support (OR 3.6, 95% CI 1.29–10.03), left atrial/aortic root ratio (OR 5.48, 95% CI 1.66–18.11) and presence of ductal steal (OR 3.82, 95% CI 1.47–9.91) were significant predictors for surgical ligation. The prediction model using clinical and echocardiographic variables explained 9% and 24% of the variability to ligate respectively, indicating significant residual variation due to unmeasured factors. CONCLUSIONS: Our results indicate that invasive respiratory support, increased left atrial/aortic root ratio and the presence of ductal steal were important predictors for surgical ligation in our center. However, this explained only a small proportion of the variability, which emphasizes the need for evidence-based guidelines in the management of preterm neonates after failed pharmacological therapy for a PDA. Show more

Keywords: Surgical ligation, preterm infants, echocardiography

DOI: 10.3233/NPM-180152

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 1, pp. 39-45, 2020

Authors: Tunç, T. | Polat, A. | Özdemir, R. | Kiliçaslan, B. | Can, E. | Çelik, H.T. | Arsan, S. | Kader, Ş | Erol, S. | Uslu, S. | Özdemir, Ö.M.A. | Turkish Neonatal Sepsis Group | Özcan, B. | Hanta, D. | Dilli, D. | Narter, F. | Gültekin, N. | Güzoğlu, N. | Aydemir, Ö.

Article Type: Research Article

Abstract: BACKGROUND: Early onset bacterial sepsis in neonates (EOS) is recognized as an important health condition. Early diagnosis is crucial. However, blood culture results are released in 48–72 hours. Many biomarkers have been investigated but none have been accepted as the gold standard. This study aimed to investigate the diagnostic value of the molecules: soluble form of triggering receptor expressed on myeloid cells-1 (sTREM-1), pentraxin-3 (PTX-3) and pro adrenomedullin (pro-ADM) in EOS and compare with currently used biomarkers. METHODS: In this multicenter prospective study, patients were enrolled from different NICUs around the Turkey. Patient data were collected via …web-based registry system from attending centers. Neonates, hospitalized with a suspicion of EOS were enrolled. Blood culture and routine blood tests were collected and a serum sample was obtained and kept in – 80°C for studying the molecules. According to laboratory results, patients were divided into three groups as; proven sepsis, clinical sepsis and control group. Groups were compared in terms of demographic, clinical and laboratory findings. The primary outcome of the study was to assess any difference between groups in terms of the diagnostic value of the markers aforementioned. RESULTS: A total of 130 patients were enrolled; proven sepsis (n  = 36), clinical sepsis (n  = 53) and control (n  = 41) groups. Groups were similar in terms of demographic findings; mean WBC (P  = 0.445), procalcitonin (PCT) (P  = 0.083) and IL-6 (P  = 0.814) levels. Mean C-reactive protein (CRP) level was significantly higher in clinical sepsis and proven sepsis groups compared to control group (P  < 0.001). Mean PTX-3 (P  = 0.547), pro-ADM (P  = 0.766) and sTREM-1 (P  = 0.838) levels were similar between groups. CONCLUSION: These promising molecules failed to help in early diagnosis of EOS. Their relation to correlation with disease progression may make more sense as they seem to be expressed in higher amounts with the progression of the disease in previous studies. CRP was the most frequently used biomarker for detecting the sepsis in our study population. Show more

Keywords: Key words: Biomarker, neonatal early onset sepsis, pentraxin-3, pro-ADM, sTREM-1

DOI: 10.3233/NPM-180131

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 1, pp. 47-54, 2020

Authors: Niwa, F. | Kawai, M. | Kanazawa, H. | Okanoya, K. | Myowa, M.

Article Type: Research Article

Abstract: BACKGROUND: Developmental changes in the hypothalamus-pituitary-adrenal (HPA) axis during infancy have been reported in term infants, but those in preterm infants have yet to be elucidated. If developmental changes in the HPA axis of preterm infants are modulated by any factors, it may affect their future health. Few studies have examined the lasting consequences of antenatal glucocorticoids on the development of the HPA axis. METHODS: We measured pre- and post-palivizumab vaccination salivary cortisol values in two conforming periods of three-months intervals during infancy, and compared cortisol values and the response of cortisol secretion between groups with and without …antenatal glucocorticoid (AG) therapy. RESULTS: Although the strength of the response of cortisol secretion to palivizumab fell age-dependently (until late infancy) in the Non-AG group, the opposite pattern was exhibited in the AG group. The changes of the delta cortisol values between the 2 groups were significant. CONCLUSIONS: This study suggests that the HPA axis of preterm infants whose mothers receive AG therapy may be upregulated during infancy, possibly leading to long lasting health problems. Show more

Keywords: Antenatal glucocorticoid, cortisol, hypothalamic-pituitary-adrenal axis, infants, preterm

DOI: 10.3233/NPM-180040

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 1, pp. 55-61, 2020

Authors: Yuniati, T. | Judistiani, R.T. Dewi | Natalia, Y. Adelwin | Irianti, S. | Madjid, T. Husnitawati | Ghozali, M. | Sribudiani, Y. | Indrati, A. Rengga | Abdulah, R. | Setiabudiawan, Budi

Article Type: Research Article

Abstract: INTRODUCTION: Vitamin D deficiency and anemia are examples of nutritional problems of global health significance. When these health issues effect pregnant women, they may become a threat to the fetus’ potention for intrauterine growth. It has been known that the first trimester is the golden period of fetal programming which influences the fetuses and their life after birth. This study was aiming to analyze the association between first trimester maternal vitamin D, serum ferritin, hemoglobin level and neonatal birth weight. METHODS: From July 2016 a prospective cohort of pregnant women had been observed in four cities in West …Java, Indonesia. Two hundred ninety four pregnant women were recuited in the first trimester and 203 of them had complete follow up until delivery. Collected data included maternal demography, blood analysis for ferritin, 25(OH) vitamin D in the first trimester of pregnancy and the birth weight of neonates. Associations were analyzed with multiple regression models. RESULTS: Vitamin D deficiency was highly prevalent among pregnant women in this study (approximately 75%) while anemia was found in 7.5 %, a little above the target of 5 %. However, no significant association was found between maternal serum vitamin D, serum ferritin, hemoglobin level in the first trimester and birth weight of the neonates, before and after adjustment for maternal age, pre-pregnancy body mass index, and parity. CONCLUSION: There were no associations found between vitamin D, ferritin, and hemoglobin level in the first trimester and neonatal birth weight. The negative results in this study should not diminish the benefit of nutritional supplementation during pregnancy. The possibility of other explanatory variables that influence these associations warrants further studies. Show more

Keywords: Birth weight, ferritin, hemoglobin, pregnancy, vitamin D

DOI: 10.3233/NPM-180043

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 1, pp. 63-69, 2020

Authors: Darrow, C.J. | Bai-Tong, S.S. | Kang, E.M. | Thompson, C.L. | Walsh, M.C.

Article Type: Research Article

Abstract: BACKGROUND: Use of human milk is recommended for low birth weight (VLBW) infants, but must be safety fortified with sterile liquid fortifiers to be nutritionally sufficient. Due to clinical concern for a high incidence of metabolic acidosis among VLBW infants fed human milk fortified with acidified liquid human milk fortifier (ALHMF), we aimed to retrospectively compare the outcomes of infants fed ALHMF to those fortified with non-acidified liquid HMF (NLHMF). METHODS: Medical records of VLBW neonates admitted to our institution’s neonatal intensive care unit from July 1st, 2013 to June 30th, 2014 were reviewed. 129 patients were included …in the study, 61 of which received ALHMF and 68 received NLHMF. Metabolic, nutritional and clinical outcomes, including growth, were compared between the two cohorts. RESULTS: Of the infants who received ALHMF, 70.5% developed metabolic acidosis compared to only 11.8% in the NLHMF group (p  < 0.001). In addition, infants who received NLHMF had a 10% greater growth velocity during the period of fortification (p  = 0.01). During the full course of hospitalization, no difference in growth velocity was seen between the groups and greater length gains were found in the ALHMF group. CONCLUSIONS: The use of human milk fortified with ALHMF was associated with an increased incidence of metabolic acidosis and poorer growth during the period of fortification when compared to NLHMF-fortified feedings. These growth effects were not apparent when the duration of hospitalization was considered, suggesting a need for further study to better characterize the advantages and disadvantages of each fortifier. Show more

Keywords: Human milk, fortifier, acidosis, enteral nutrition, growth, premature infant

DOI: 10.3233/NPM-180188

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 1, pp. 71-79, 2020