Journal of Neonatal-Perinatal Medicine - Volume 13, issue 2

Authors: Volpe, Joseph J.

Article Type: Editorial

Keywords: Erythropoietin, prematurity, neurodevelopmental outcome, pre-oligodendrocytes

DOI: 10.3233/NPM-200444

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 2, pp. 149-152, 2020

Authors: Salama, H. | Al Rifai, H. | Mahmoud, N. | Al Qubasi, M. | Al Obaidly, S. | Sabry, I. | Ben Hadj Khalifa, O. | Mousa, A. | Sabouni, A.

Article Type: Research Article

Abstract: AIM: To evaluate outcomes of a cohort of infants born at 23 weeks’ gestational age after introducing a new selection score for resuscitation in the delivery room (DR). METHODS: This was a retrospective charts review study using data from the maternal and newborn registry funded by the Qatar National Research Fund. Parents were consulted prenatally and their wishes were honored. The plan of resuscitation was based on the new selection score. The seven components of the score were four antenatal and three immediate postnatal in the DR. Each component received a score of zero, one, or two according …to its presence, uncertainty or absence, respectively. Only a score of≥7 would receive active resuscitation unless specified otherwise during prenatal consultation. RESULTS: The study reviewed 60 infants that were delivered over a two year period. The DR death rate was 23 of 60 (38%). Thirty-seven infants (61%) were admitted to the NICU. The score was applied only on 37 infants where all score criteria were reported in their files. Twenty infants had score <7; of them 13 (65%) died in the DR and 7 were admitted to NICU of whom two (29%) survived to discharge. Seventeen babies with scores≥7 admitted to NICU of whom nine (51%) survived to discharge. The survival rate to discharge was 13 of 37(35%). A satisfaction survey included 33 neonatal physicians; 32 neonatologists stated the score was easy to comprehend, 26 voted for easy to implement, and 30 voted for ethical relief and moral comfort. CONCLUSIONS: Using a resuscitation score of seven was associated with improved survival until the discharge of those infants resuscitated. NICU physicians described the score as functional and convenient. Show more

Keywords: Limit of viability, extreme preterm, 23 weeks’ gestational age, mortality rate, outcome, complications, risk factors, death, score

DOI: 10.3233/NPM-190249

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 2, pp. 153-158, 2020

Authors: Dallefeld, S.H. | Smith, P.B. | Crenshaw, E.G. | Daniel, K.R. | Gilleskie, M.L. | Smith, D.S. | Balevic, S. | Greenberg, R.G. | Chu, Vivian | Clark, R. | Kumar, K.R. | Zimmerman, K.O.

Article Type: Research Article

Abstract: BACKGROUND: Given the limited available evidence on chloral hydrate safety in neonatal populations and the discrepancy in chloral hydrate acceptance between the US and other countries, we sought to clarify the safety profile of chloral hydrate compared to other sedatives in hospitalized infants. METHODS: We included all infants <120 days of life who underwent a minor procedure and were administered chloral hydrate, clonidine, clonazepam, dexmedetomidine, diazepam, ketamine, lorazepam, midazolam, propofol, or pentobarbital on the day of the procedure. We characterized the distribution of infant characteristics and evaluated the relationship between drug administration and any adverse event. We performed …propensity score matching, regression adjustment (RA), and inverse probability weighting (IPW) to ensure comparison of similar infants and to account for confounding by indication and residual bias. Results were assessed for robustness to analytical technique by reanalyzing the main outcomes with multivariate logistic regression, a doubly robust IPW with RA model, and a doubly robust augmented IPW model with bias-correction. RESULTS: Of 650 infants, 497 (76%) received chloral hydrate, 79 (12%) received midazolam, 54 (8%) received lorazepam, and 15 (2%) received pentobarbital. Adverse events occurred in 41 (6%) infants. Using propensity score matching, chloral hydrate was associated with a decreased risk of an adverse event compared to other sedatives, risk difference (95% confidence interval) of –12.79 (–18.61, –6.98), p  <  0.001. All other statistical methods resulted in similar findings. CONCLUSION: Administration of chloral hydrate to hospitalized infants undergoing minor procedures is associated with a lower risk for adverse events compared to other sedatives. Show more

Keywords: Comfort drugs, sedative, analgesic, adverse events

DOI: 10.3233/NPM-190214

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 2, pp. 159-165, 2020

Authors: Bandyopadhyay, T. | Saili, A. | Yadav, D.K. | Kumar, A.

Article Type: Research Article

Abstract: BACKGROUND: To evaluate the correlation between functional echocardiography and clinical parameters in term neonates with shock. METHOD: Cross sectional study of 30 full term newborns who were clinically detected to have shock compared to 30 full term hemodynamically stable neonates. For statistical analysis, cases were further sub classified into cardiogenic and septic shock. RESULT: Functional echocardiography revealed inferior vena cava collapsibility index (cIVC), fractional shortening (FS), ejection fraction (EF), cardiac output and superior vena cava (SVC) flow were significantly lower whereas myocardial performance index (MPI) was significantly higher in babies with cardiogenic and septic shock as …compared to the controls. Left ventricular end diastolic area (LVEDA) was significantly higher in cardiogenic shock whereas it was significantly lower in septic shock as compared to the controls. Also, cIVC was significantly lower and LVEDA was significantly higher in cardiogenic as compared to the septic shock. In cardiogenic shock SVC flow correlated significantly with capillary filling time and systolic blood pressure. The correlation between functional echocardiographic parameters of cardiogenic and septic shock showed that EF, FS and MPI were positively and significantly correlated (r 0.742, p 0.022 for EF, r 0.766, p 0.016 for FS and r 0.478, p 0.05 for MPI) whereas SVC flow and cIVC were negatively and significantly correlated between cardiogenic and septic shock (r – 0.655, p 0.045 for SVC flow and – 0.578, p 0.05 for cIVC). CONCLUSION: In the complex environment of neonatal intensive care unit detection of shock continues to be a major challenge. Functional echocardiography provides an adjunct information to the clinical assessment of shock and helps in monitoring the response to treatment. Show more

Keywords: Functional echocardiography, shock, BP, IVC, SVC, neonatal intensive care unit, correlation, IVC collapsibility index

DOI: 10.3233/NPM-180179

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 2, pp. 167-173, 2020

Authors: Dadiz, R. | Nair, J. | D’Angio, C.T. | Ryan, R.M. | Lakshminrusimha, S.

Article Type: Research Article

Abstract: BACKGROUND: We aimed to investigate whether the change in methemoglobin levels (ΔMHb) predicts oxygenation response to inhaled nitric oxide (iNO) in persistent pulmonary hypertension of the newborn (PPHN) with lung disease, with or without pulmonary hypoplasia. METHODS: In this prospective observational study, infants were categorized based on ΔMHb and oxygenation response (ΔPaO2 /FiO2 ) following iNO: ΔMHb ≤0 or ΔMHb>0, and ΔPaO2 /FiO2  < 20 mmHg (Non-responder) or≥20 mmHg (Responder). ΔMHb levels were compared among infants with or without pulmonary hypoplasia. RESULTS: Among infants with pulmonary hypoplasia (n  = 28), ΔMHb was not associated with an oxygenation response to iNO …or survival without ECMO. Among infants without hypoplasia (n  = 29), subjects with ΔMHb>0 following iNO (n  = 21) had a greater ΔPaO2 /FiO2 (median, 64 mmHg; IQR, 127; p  < 0.01) and 100% survival without extracorporeal membrane oxygenation (ECMO) when compared to infants with ΔMHb ≤0 (n  = 8; median 10 mmHg; IQR, 33). CONCLUSIONS: PPHN secondary to lung disease without hypoplasia with increased ΔMHb following iNO was associated with better oxygenation response and survival without ECMO compared to subjects without an increase in MHb. Show more

Keywords: Hypoxic respiratory failure, oxygenation, pulmonary hypertension, pulmonary hypoplasia

DOI: 10.3233/NPM-180082

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 2, pp. 175-182, 2020

Authors: Abu-Shaweesh, J.M. | Khasawneh, W. | Tang, A.S. | Worley, S. | Saker, F.

Article Type: Research Article

Abstract: OBJECTIVE: While non-invasive ventilation (NIV) has been associated with improved extubation rates, its impact on bronchopulmonary dysplasia (BPD) remains unclear. METHOD: In this retrospective, chart review study of infants admitted to the Cleveland Clinic, we aimed to compare the incidence of BPD among extremely low birth weight (ELBW) infants extubated to continuous positive pressure (CPAP) versus those extubated to NIV via RAM cannula or biphasic CPAP. Data collected included demographics, ventilatory modes, extubation data, and presence of complications. Infants extubated to either CPAP or NIV were compared using Wilcoxon rank- sum and Chi-square tests, and data were corrected …using logistic regression models. Data are presented as medians. RESULTS: A total of 120 infants were included, of whom 62% were extubated to NIV. The incidence of BPD was significantly lower in the CPAP group vs NIV (57% vs. 78%, p  = 0.011). Infants in the CPAP group were heavier (birth weight (BWT) of 833 vs 724 grams, p  = 0.005), more mature (gestation age (GA) 27 vs 25 weeks, p  <  0.001) and were extubated significantly earlier (2 vs 8 days, p  <  0.001). After adjusting for BWT and GA, NIV continued to be significantly associated with higher incidence of BPD among those extubated on the first day of life (odds ratio 5.9; 95% CI: 1.2–29.1, p  = 0.029). CONCLUSION: This study concludes that, as compared to CPAP, early use of NIV is associated with higher risk of BPD in ELBW infants. Further investigation using prospective studies is recommended to validate these findings. Show more

Keywords: Non-invasive ventilation, CPAP, BPD, ELBW infants

DOI: 10.3233/NPM-190354

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 2, pp. 183-188, 2020

Authors: Glenn, T. | Ross, K.R. | Trembath, A. | Tatsuoka, C. | Minich, N. | Hibbs, A.M.

Article Type: Research Article

Abstract: BACKGROUND: Oxygen exposure has been associated with increased wheezing and respiratory morbidity after discharge in extremely preterm infants and those with bronchopulmonary dysplasia. More mature preterm infants with less severe disease are also at risk for pulmonary complications, including rehospitalization for respiratory illnesses and wheezing disorders. Our aim was to evaluate associations between respiratory support and morbidity in preterm infants without bronchopulmonary dysplasia. METHODS: A secondary analysis was performed on 300 infants born at 28–34 weeks gestation without bronchopulmonary dysplasia. Exposure included oxygen or positive pressure, (continuous positive airway pressure or mechanical ventilation). The primary outcome was recurrent …wheezing. Secondary outcomes were respiratory medications, emergency room visits, and hospitalizations. RESULTS: 50% of infants who received oxygen experienced recurrent wheezing compared to 42.4% of infants who did not (OR 1.15 CI 0.72–1.85 adjusted OR 1.15 CI 0.67–1.98). 51.1% of infants who received positive pressure experienced recurrent wheezing compared to 38.1% who did not (OR 1.57 CI 0.97–2.53 adjusted OR 1.58 CI 0.90–2.77). There were no significant associations between oxygen and positive pressure exposure and any primary or secondary outcomes in the adjusted analyses. CONCLUSIONS: After adjustment for known risk factors the analyses showed no significant associations between oxygen and positive pressure with respiratory morbidity in this population. Further study of infants with mild disease is needed. Show more

Keywords: Wheezing, prematurity, oxygen, positive pressure

DOI: 10.3233/NPM-190217

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 2, pp. 189-195, 2020

Authors: Guimarães, A.R. | Rocha, G. | Rodrigues, M. | Guimarães, H.

Article Type: Research Article

Abstract: BACKGROUND: Nasal trauma due to nasal CPAP (nCPAP) use is a commonly reported complication in infants under 1500 g of birth weight and 32 weeks of gestation. With the rise of nCPAP as the gold standard for non-invasive respiratory support, preventive measures should be considered. OBJECTIVE: To assess the prevalence and risk factors of nasal injury in very low birth weight (VLBW) preterm infants with nCPAP. METHODS: We retrospectively analyzed neonates hospitalized between 2012 and 2017, with less than 1500 g and 32 weeks of gestational age who received more than 12 hours of nCPAP. Demographic, antenatal and …clinical data, along with information regarding respiratory support and nCPAP complications, were collected. We used Fischer’s classification to grade nasal trauma. RESULTS: A total of 135 infants were evaluated. Mean gestational age was 28 weeks (SD 2) and mean birth weight 1072 g (SD 239). Nasal trauma was reported in 65% of patients and it was of stage I, II and III in 49%, 16% and 1% of patients, respectively. The multivariate logistic regression revealed that the risk of trauma was greater in neonates with a longer duration of nCPAP ventilation (OR = 1.098, 95% CI: 1.055–1.142; p  < 0.001) and in patients submitted to oxygen therapy (OR = 3.174, 95% CI: 1.014–9.929, p  = 0.004). The median of days after nCPAP administration until the onset of an identifiable lesion was 4. CONCLUSION: Nasal trauma is a frequent complication in VLBW preterm infants using nCPAP for long periods. Preventive measures in patients who are at greater risk of skin breakdown are of major clinical importance for a better outcome. Show more

Keywords: Noninvasive ventilation, nasal CPAP, morbidity, mortality, risk factors, neonatal intensive care

DOI: 10.3233/NPM-190269

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 2, pp. 197-206, 2020

Authors: Al-Jebawi, Y. | Agarwal, N. | Groh Wargo, S. | Shekhawat, P. | Mhanna, M.J.

Article Type: Research Article

Abstract: OBJECTIVE: To study whether there is an association between nutritional intake during the first week of life and severity of bronchopulmonary dysplasia (BPD) in extremely low birth weight (ELBW) infants. METHODS: In a retrospective cohort study, medical records of all ELBW infants admitted to our Neonatal Intensive Care Unit (2010–2017) were reviewed for infants’ demographics, clinical characteristics, nutritional intake during their first week of life, and BPD risk factors. RESULTS: During the study period 226 infants were identified of whom 67% (151/226) had moderate-severe BPD and the rest served as controls. Overall infants with moderate-severe BPD …were younger, smaller, and spent more time on mechanical ventilation than their controls [(mean±standard deviation) 24.7±1.7 vs. 26.8±2.0 weeks gestational age (p  < 0.001); 678±154 vs. 837±129 grams (p  < 0.001); and 37.9±23.6 vs. 13.7±15.3 days (p  < 0.001) respectively]. During the first week of life, the average caloric, carbohydrate, protein and lipid intakes were significantly lower, and the average fluid intake was significantly higher in the moderate-severe BPD than the control group. After adjustment for confounders, fluid intake, and days on mechanical ventilation were significantly associated with moderate-severe BPD with an odds ratio [OR (95% confidence interval)] of 1.03 (1.01–1.04), and 1.05 (1.03–1.07) respectively. Daily caloric intake was associated with an increased risk for moderate-severe BPD [OR: 0.94 (0.91–0.97)]. CONCLUSION: Low caloric intake, and high fluid intake during the first week of life are associated with the severity of BPD in ELBW infants. Show more

Keywords: Caloric intake, nutrition, bronchopulmonary dysplasia, extremely low birth weight infants

DOI: 10.3233/NPM-190267

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 2, pp. 207-214, 2020

Authors: Huston, Robert | Lee, Martin | Rider, Evelyn | Stawarz, Melissa | Hedstrom, Dawn | Pence, Melissa | Chan, Vera | Chambers, Jessica | Rogers, Stefanie | Sager, Nadine | Riemann, Laurie | Cohen, Howard

Article Type: Research Article

Abstract: BACKGROUND: An exclusive human milk diet (EHM) including fortification with a human milk-based fortifier has been shown to decrease the occurrence of necrotizing enterocolitis (NEC) but growth velocity may be less for infants receiving EHM compared to a bovine diet. OBJECTIVE: The objective of this study was to determine if growth is improved by earlier fortification of breast milk for preterm infants supported with a human milk based fortifier. STUDY DESIGN: A multi-center retrospective cohort study of the outcomes of infants of 500– 1250 g birth weight whose breast milk feedings were fortified at >60 mL/kg/day (late) versus …<60 mL/kg/day (early) of enteral feeding volume. RESULTS: Median±IQR range for gestational age (27.6±3.4 vs 27.0±2.9 weeks, p  = 0.03) and chronic lung disease (CLD: 42.6 vs 27.6%, p  = 0.008) were higher, and weight gain (12.9±2.6 vs 13.3±2.6 g/kg/day, p  = 0.03) was lower in the late (N = 102) vs the early (N = 292) group. Adjusted multiple linear regression analysis found that early fortification was associated with improved growth velocity for weight (p  = 0.007) and head circumference (HC) (p  = 0.021) and less negative changes in z-scores for weight (p  = 0.022) and HC (p  = 0.046) from birth to discharge. Adjusted multiple logistic regression found that early fortification was associated with decreased occurrence of CLD (p  = 0.004). No other outcomes, including NEC, were associated with early versus late fortification. CONCLUSION: The study results suggested that early HM fortification appears to positively affect growth for infants whose human milk feedings are fortified with a human milk based fortifier without adverse effects. The incidence of CLD was also reduced in the early fortification group. Show more

Keywords: Human milk, fortification, growth, clinical outcomes

DOI: 10.3233/NPM-190300

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 2, pp. 215-221, 2020

Authors: Vereen, Rasheda J. | Dobson, Nicole R. | Olsen, Cara H. | Raiciulescu, Sorana | Kuehn, Devon | Stokes, Theophil A. | Hunt, Carl E.

Article Type: Research Article

Abstract: BACKGROUND: The aim of this study is to assess the effect of age at adiposity rebound (AR) and changes in growth between birth and 6 months on growth status at 8–9 years in children born term and preterm. Age at AR is inversely correlated with risk for later obesity in children born full term, but has not been analyzed in children born preterm. METHODS: Birth anthropometrics, and weight and length/height data from age 6 months through 8–9 years were recorded for 175 children born in 2008 in the military health system. Calculated variables include body mass index (BMI, …kg/m2 ), Z-scores, and age at AR. Results: Age at AR could be calculated for 150 children (32% preterm); average age was 5.4 years and 5.3 years for children born term and preterm, respectively (NS). For children born term and preterm, there was a significant correlation between younger age at AR and higher BMI Z-score at 8–9 years (r  = – 0.685), and a direct relationship between weight Z-score change from birth to 6 months and weight Z-scores at 8–9 years (p  = 0.034). CONCLUSIONS: Younger age at AR correlates with higher BMI Z-score at 8–9 years in children born both term and preterm. Weight gain from birth to 6 months correlates with weight Z-score at 8–9 years. These results emphasize the importance of younger age at AR in addition to greater early weight gain as an indicator of later obesity. Show more

Keywords: Adiposity rebound, body mass index, growth, prematurity, overweight, obesity

DOI: 10.3233/NPM-190219

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 2, pp. 223-230, 2020

Authors: Klemme, M. | Staffler, A. | De Maio, N. | Lauseker, M. | Schubert, S. | Innocenti, P. | Wurster, T.M. | Foerster, K. | Herber-Jonat, S. | Mittal, R. | Messner, H. | Flemmer, A.W.

Article Type: Research Article

Abstract: OBJECTIVE: Nosocomial infections increase mortality and morbidity in preterm infants. Central venous line colonization is a major risk factor for the development of such infections. In adults and children, antibiotic and antimycotic impregnated catheters have been demonstrated to reduce colonization. However, recently published data showed no significant difference in bloodstream infection in neonates when an impregnated catheter was used. We investigated the effect of impregnation of percutaneously inserted micro-catheters (PICC) on colonization in preterm and sick term infants in our unit. METHODS: Neonates were randomly assigned to receive either a standard (S-PICC; n  = 34) or antibiotic and antimycotic …impregnated (IP-PICC; n  = 37) PICC. Catheters were placed and removed according to a standard procedure and subsequently examined by roll-out culture. The primary outcome was the rate of colonization defined as >15 colony-forming-units/ml. Additional outcomes were catheter associated or systemic infections. RESULTS: The rate of colonization was lower in neonates who received an IP-PICC as compared to S-PICC (5.6% vs. 12.1% respectively; p  = 0.42). However, the difference was not significant. In IP-PICC vs S-PICC, catheter related local infection (CRI) although lower was not statistically significant (2.9% vs. 6.1%; p  = 0.60). We observed no difference in catheter related systemic infection (CR-SI) (0% vs. 3.1%, p  = 0.48). The neonates whose catheters were colonized were predominantly of a lower gestational age (median 254/7 , p  = 0.05) and males (100%, p  = 0.01). In addition, the median colony count in the colonized IP-PICC catheters was lower as compared to S- PICC group (53 vs 250, p  = 0.06). CONCLUSIONS: The use of antibiotic and antimycotic impregnated PICC-lines in neonates tended to decrease colonization rates in neonates in our centers but this difference was not significant. Lower gestational age and male sex are risk factors for catheter colonization. Show more

Keywords: Preterm infant, central venous line, antibiotic and antimycotic impregnated catheters, colonization, catheter related infection

DOI: 10.3233/NPM-190273

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 2, pp. 231-237, 2020

Authors: Ma, Cheng | Levin, Garret | Panda, Sanjeet K. | Sambalingam, Devaraj | Singh, Ajay Pratap

Article Type: Research Article

Abstract: BACKGROUND AND OBJECTIVES: Early onset sepsis (EOS) is an important cause of neonatal morbidity and mortality. Timely administration of antibiotics is crucial in management. We initiated a quality improvement project to improve timely administration of antibiotics. METHODS: Primary drivers of change identified by the team were improving delivery of antibiotics from pharmacy and improving time to admit in the electronic medical record (EMR) in order to improve overall timeliness of antibiotics administration. Timings of antibiotics administration was tracked by using a control chart. Timings of antibiotics and outcomes of pre-intervention (December 2016) were compared with post intervention of …PDSA cycles (January 2017–November 2018). RESULTS: There was statistically significant improvement in time to admission in electronic medical records over the time periods of pre-intervention, PDSA I and PDSA II (p -value <  0.05) (Table 1 ). Also, time to delivery of antibiotics from pharmacy was significantly reduced between PDSA cycles from 21 minutes to 9 minutes with improvement in overall workflow. An average time to infusion of antibiotics decreased from 70 minutes to 48 minutes. There was also overall improvement in number of neonates receiving antibiotics under 1 hour of decision making from 37% to 77%. CONCLUSIONS: In our study we were able to successfully implement our “antibiotics under one hour” goal. The ability to achieve this objective can be met across multi-institutions rendering care to newborns if the approach is multidisciplinary. Deleting obstructions in the process that involve admission, registration and entry into the EMR effectively reduced time. Show more

DOI: 10.3233/NPM-190293

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 2, pp. 239-246, 2020

Authors: Kazmi, S.H. | Caprio, M. | Boolchandani, H. | Mally, P. | Bailey, S. | Desai, P.

Article Type: Research Article

Abstract: BACKGROUND: Healthcare spending is expected to grow faster than the economy over the next decade, and the cost of prematurity increases annually. The aim of this study was to investigate the frequency of intervention after routine laboratory testing in preterm infants. METHODS: This was a retrospective study of preterm infants (≤34 weeks) admitted to the NYU Langone Health NICU from June 2013 to December 2014. Data collected included demographics, results of laboratory tests, and resulting interventions. Intervention after a hemogram was defined as a blood transfusion. Intervention after a hepatic panel was defined as initiation or termination of …ursodiol or change in dose of vitamin D. Subjects were stratified into 3 groups based on gestation (<28 weeks, 28–31 6/7 weeks, 32–34 weeks). Chi-square analysis was used to compare the frequency of intervention between the groups. RESULTS: A total of 135 subjects were included in the study. The frequency of intervention after a hemogram was 8.4% in infants <28 weeks, 4.6% in infants 28–31 6/7 weeks, and 0% in infants 32–34 weeks; this difference was found to be statistically significant (p  = 0.02). The frequency of intervention after a hepatic panel was 4.2% in infants <28 weeks, 5.7% in infants 28–31 6/7 weeks, and 0% in infants 32–34 weeks, which was not found to be a statistically significant different. CONCLUSION: No interventions were undertaken post-routine laboratory testing in any infant 32–34 weeks and routine testing in this population may be unnecessary. Further studies are needed to elucidate if routine testing affects neonatal outcomes. Show more

Keywords: NICU, laboratory screening, hemograms, hepatic panel, costs

DOI: 10.3233/NPM-190239

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 2, pp. 247-251, 2020

Authors: Siswanto, J.E. | Ronoatmodjo, S. | Adisasmita, A. | Soemantri, A. | Sitorus, R.S. | Sauer, P.J.J.

Article Type: Research Article

Abstract: BACKGROUND: Risk factors other than supplemental oxygen might play a role in the development of retinopathy of prematurity (ROP). In Indonesia ROP occurs in infants up to 34 weeks and 2000 g. Risk factors for the development of ROP in Indonesian NICUs have not been evaluated. Our aim was to identify other risk factors than the use of oxygen in the development and progression of ROP in preterm infants in Indonesia. METHODOLOGY: Data on 98 preterm infants with ROP and 77 controls were collected from four NICUs and two eye centers in Jakarta, Indonesia, between 2009 and 2014. We …used multivariate logistic regression analysis to determine the relationship between infants and environmental variables and the development and progression of ROP. We obtained variables for ROP severity by using Cox regression analysis. RESULTS: Factors associated with the development of ROP were birthweight (BWt), intrauterine growth retardation (IUGR), exchange transfusion, duration of oxygen supplementation, minimum saturation monitor setting, and socioeconomic factors. Regarding the progression, gestational age (GA), out-born, duration of supplemental oxygen, minimum saturation monitor setting, and socioeconomic factors were identified as risk factors. CONCLUSION: The use and control of supplemental oxygen are the main risk factors for the development and progression of ROP in preterms in Indonesia. Additionally, we confirm that GA, BWt, and IUGR are risk factors. Moreover, we found exchange transfusion to be a risk factor, and we found a lower rate of ROP in infants from a lower socioeconomic background. These risk factors apply to infants with a GA up to 34 weeks and a BWt up to 2000 g. Show more

Keywords: retinopathy of prematurity ROP, neonatal risk factors, oxygen supplementation

DOI: 10.3233/NPM-190233

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 2, pp. 253-260, 2020

Authors: AlRyalat, Saif Aldeen | Al Oweidat, Khaled | Al-Amer, Ahmed | Khader, Ahmad | Ajaj, Abdulla | Alessa, Zeyad | Roto, Allaa

Article Type: Research Article

Abstract: BACKGROUND: Extremely preterm infants are peculiar in regard to their risk of retinopathy of prematurity (ROP). In this study, we aim to study insults that may affect extremely preterm infants, including prenatal, at birth, and postnatal insults and their effect on the development of ROP. METHODS: This study used the data from Prematurity and Respiratory Outcomes Program (PROP). All included infants with a gestational age of 23 0/7 to 28 6/7 weeks using best obstetrical estimate. We included stressful events and/or modifiable variables that may affect the normal development. We used multiple regression analysis in our statistical analysis. …RESULTS: We included a total of 751 infants in our study. The mean birth weight for the included sample was 915.1 (±232.94) grams. 391 (52.1%) Infants were diagnosed with ROP. We found a significant negative correlation between ROP development and birth weight (p  < 0.001), with a correlation coefficient of – 0.374. We found that the need for prophylactic indomethacin (OR 1.67), the occurrence of air leaks (OR: 2.35), ventilator-associated pneumonia (OR: 2.01), isolated bowel perforations (OR: 3.7), blood culture-proven sepsis (OR: 1.5), other infections (OR: 1.44), and receiving ventricular shunt (OR: 2.9) are significantly associated with the development of ROP. CONCLUSIONS: We believe this study included the largest number of factors studied in the largest sample of extremely premature infants. We recommend a screening program for extremely preterm infants that takes into account a scoring system with higher scores for complicated condition. Show more

Keywords: Retinopathy of prematurity, extremely preterm infants, prematurity, regression analysis

DOI: 10.3233/NPM-190336

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 2, pp. 261-266, 2020

Authors: Refaat, Marwan | El Dick, Joud | Sabra, Mohammad | Bitar, Fadi | Tayeh, Christelle | Abutaqa, Mohamad | Arabi, Mariam

Article Type: Review Article

Abstract: Sustained fetal supraventricular tachycardia (SVT) complicated by hydrops fetalis carries a significant risk of morbidity and mortality. While there is no clear consensus on first- and second-line therapy options for the management of fetal SVT with or without hydrops fetalis, there exists significant nonrandomized experience with a number of antiarrhythmic agents that has founded the basis for management. Furthermore, recently published meta-analyses and ongoing multicenter prospective studies have aimed to bridge the gap in the literature. We report two cases of sustained fetal SVT with severe secondary hydrops fetalis managed successfully with flecainide-sotalol combination therapy in one case and sotalol-digoxin …combination therapy in the second and review the literature for the management of fetal SVT. Show more

Keywords: Hydrops fetalis, supraventricular tachycardia, sotalol

DOI: 10.3233/NPM-190268

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 2, pp. 267-273, 2020

Authors: Margulies, Samantha L. | Corrigan, K. | Bathgate, S. | Macri, C.

Article Type: Case Report

Abstract: BACKGROUND: Addison’s disease is an uncommon condition encountered during pregnancy; however, pregnant patients with Addison’s disease are at higher risk for multiple pregnancy related complications. Treatment during pregnancy involves steroid replacement therapy. CASE REPORT: A 34-year-old previously healthy G2P1001 presented with lethargy, skin hyperpigmentation, polyuria, and salt craving. Laboratory evaluation showed hyperkalemia, hyponatremia, elevated ACTH, and low cortisol. The patient terminated the pregnancy due to her symptoms. She was then placed on a regimen of hydrocortisone and fludrocortisone, leading to symptom resolution. On second presentation as a G5P1031, her Addison’s disease was managed with hydrocortisone and fludrocortisone. When …Addison’s symptoms recurred, ACTH levels were checked to determine if her current medications could be optimized. She ultimately delivered a healthy male infant vaginally. For her third presentation as a G6P2032, her pregnancy was managed in a similar manner to the previous pregnancy. CONCLUSION: There is currently minimal cohesive literature on the management of Addison’s disease during pregnancy. Patients can be managed successfully by monitoring for recurrence of Addison’s symptoms and adjusting medication dosing as needed. Show more

Keywords: Addison’s disease, adrenal insufficiency, pregnancy, obstetrics

DOI: 10.3233/NPM-190231

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 2, pp. 275-278, 2020

Authors: Alallah, J. | Mohtisham, F. | Saidi, N. | Almehdar, A. | Anees, A. | Sallout, A.

Article Type: Case Report

Abstract: BACKGROUND: Dengue fever is a mosquito-borne viral illness with 100 million new cases occurring worldwide. The vectors involved are mainly Aedes aegypti and Aedes albopictus . Dengue infection is associated with maternal as well as fetal morbidities, like stillbirth, preterm birth, and low birth weight. THE CASE: We report a case of dengue fever occurring during early pregnancy and subsequent congenital neurologic malformation in the neonate as a result of vertical transmission. To our knowledge, this is the first case of confirmed congenital dengue in Saudi Arabia. DISCUSSION: Dengue infection is not commonly associated with …congenital anomalies and no biologic mechanism has yet been established for its teratogenicity. Congenital dengue in neonates can be confirmed by identification of the dengue virus in cord blood samples. The positive dengue serology within the first week of life, together with the confirmed maternal dengue infection during pregnancy, supports the diagnosis of vertical transmission in the presence of clinical manifestations. A high index of suspicion, early diagnosis, and close monitoring is needed in these cases. Show more

Keywords: Microcephaly, congenital, dengue fever, dengue virus

DOI: 10.3233/NPM-190286

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 2, pp. 279-282, 2020

Authors: van der Lee, D. | de Bruin, C. | Steggerda, S.J. | Vlaardingerbroek, H.

Article Type: Case Report

Abstract: BACKGROUND: Hyponatremia is a common laboratory finding in premature and ill neonates. When the degree of hyponatremia is more severe, the likelihood of a pathologic entity increases. In this case report we describe a premature neonate with severe hyponatremia due to the idiopathic syndrome of inappropriate antidiuretic hormone secretion (SIADH). CASE DESCRIPTION: The patient is a male neonate, born prematurely. He was admitted to the neonatal intensive care unit and received non-invasive respiratory support. After 48 hours of life serum sodium (Na+ ) decreased to 115 mmol/l. Hyponatremia progressively worsened despite aggressive Na+ supplementation. The clinical and laboratory …data were most consistent with severe SIADH. Fluid restriction was initiated which resulted in a gradual normalization of Na+ . A causal factor for development of SIADH could not be identified. CONCLUSION: When a neonate presents with significant hyponatremia that is not responsive to conventional therapy, it is important to perform a diagnostic work-up for SIADH, even in the absence of overt triggering factors. Show more

Keywords: Neonatal, hyponatremia, SIADH

DOI: 10.3233/NPM-180149

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 2, pp. 283-285, 2020