Journal of Neonatal-Perinatal Medicine - Volume 13, issue 4

Authors: Juusela, A.L. | Cordero, L. | Gimovsky, M. | Nazir, M.

Article Type: Research Article

Abstract: OBJECTIVE: To identify laboratory data that correlates with poor perinatal outcomes. METHODS: A retrospective chart review of women with intrahepatic cholestasis of pregnancy (ICP), admitted for delivery between January 1, 2013 and December 31, 2017, was performed. Chi-square, student’s t -test, and ANOVA statistical analysis was performed. The receiver-operator characteristic curves were plotted for the prediction of each category of perinatal outcome and the areas under the curves were determined. All p -values were two-sided, and p  < 0.05 was considered statistically significant. RESULTS: Analysis of the 61 ICP cases showed no occurrence of the intrauterine fetal …demise (IUFD), stillbirth, abruption, or neonatal demise. ROC curve analysis revealed a statistically significant correlation between bile acid and AST levels and perinatal outcomes. A bile acid (BA) level equal to or greater than 37μmol/L strongly predicted spontaneous preterm labor in women affected by ICP with a sensitivity of 100% and specificity of 60.70% (p  = 0.002). A BA level equal to or greater than 42μmol/L strongly predicted meconium-stained amniotic fluid with a sensitivity of 85.70% and specificity of 66.70% (p  = 0.006). AST levels equal to or greater than 62 IU/L strongly predicted NICU admission with a sensitivity of 81.30% and specificity of 62.20% (p  = 0.002). AST levels equal to or greater than 75 IU/L strongly predicted hyperbilirubinemia in the neonates with a sensitivity of 87.50% and specificity of 69.80% (p  = 0.001). CONCLUSIONS: There is a statistically significant correlation between elevated BA and elevated AST levels and adverse perinatal outcomes. Show more

Keywords: Cholestasis of pregnancy, gastrointestinal disorders, hepatic function, hypercholanemia, liver diseases, transaminitis

DOI: 10.3233/NPM-190276

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 4, pp. 513-519, 2020

Authors: Sadeghi, Elham | Yas, Atefeh | Rabiepoor, Soheila | Sayyadi, Hojjat

Article Type: Research Article

Abstract: OBJECTIVE: This study was conducted to determine the relationship between pica and anemia, gastrointestinal disorders, as well as pregnancy outcomes in pregnant women. METHODOLOGY: This study was a prospective study carried out between January 2016 and June 2017 and was performed on 226 pregnant women who attended four different health care centers to receive routine prenatal care. Sampling was done considering the inclusion criteria, in two steps: cluster sampling and random sampling. Data collection was done using a researcher-made checklist. The significance level was set at p  = 0.05. RESULTS: The average age of the participants was …26.10±6.27. The prevalence of pica in pregnant women in the first, second, and third trimesters was 9.3, 8, and 2.1%, respectively. The most common pica craving among pregnant women was for ice and frozen materials (68.2%). There was a statistically significant relationship between gastrointestinal disorders and anemia with pica (p  < 0.001). There was also a significant relationship between birth weights of babies born to mothers with pica and those without pica (p  = 0.005). CONCLUSION: Pica in pregnant women had a significant relationship with gastrointestinal disorders and anemia during pregnancy and pregnancy outcomes. Thus, in addition to providing healthcare services, health care professionals should consider patients’ pica practices and make the necessary interventions. Show more

Keywords: Pica, gastrointestinal disorders, anemia, pregnancy

DOI: 10.3233/NPM-190257

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 4, pp. 521-527, 2020

Authors: Zito, G. | Della Corte, L. | Giampaolino, P. | Terzic, M. | Terzic, S. | Di Guardo, F. | Ricci, G. | Della Pietà, I. | Maso, G. | Garzon, S.

Article Type: Review Article

Abstract: BACKGROUND: Gestational diabetes mellitus (GDM) is a common pregnancy complication characterized by hyperglycaemia with onset or first recognition during pregnancy. Risk factors include family history of diabetes, previous GDM, genetic predisposition for GDM/type 2 diabetes, insulin resistance conditions such as overweight, obesity and ethnicity. Women with GDM are at high risk for fetal macrosomia, small for gestational age, neonatal hypoglycaemia, operative delivery and caesarean delivery. The aim of this narrative review is to summarize the most recent findings of diagnosis and treatment of GDM in order to underline the importance to promote adequate prevention of this disease, especially through lifestyle …interventions such as diet and physical activity. METHODS: The research was conducted using the following electronic databases, MEDLINE, EMBASE, Web of Science, Scopus, ClinicalTrial.gov, OVID and Cochrane Library, including all published randomized and non-randomized studies as well as narrative and systematic reviews. RESULTS: The lack of universally accepted criteria makes the definition of diagnosis and prognosis of this condition difficult. Early diagnosis and glucose blood level control may improve maternal and fetal short and long-term outcomes. Treatment strategies include nutritional interventions and exercise. Medical treatment can be necessary if these strategies are not effective. Moreover, novel non-pharmacologic agents such as myo-inositol seem to be effective and safe both in the prevention and the treatment of GDM. CONCLUSIONS: It is important to promote adequate prevention of GDM. Further studies are needed in order to better define the most appropriate strategies for the clinical management of women affected by GDM. Show more

Keywords: Gestational diabetes mellitus, risk factors, diagnosis, treatment, prevention

DOI: 10.3233/NPM-190305

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 4, pp. 529-541, 2020

Authors: Yahaya, T.O. | Anyebe, D.A.

Article Type: Review Article

Abstract: BACKGROUND: Precision medicine, described as a therapeutic procedure in which complex diseases are treated based on the causal gene and pathophysiology, is being considered for diabetes mellitus (DM). To this end, several monogenetic mutations in the beta cells have been linked with neonatal diabetes mellitus (NDM), however, the list of suspect genes is expansive, necessitating an update. This study, therefore, provides an update on NDM candidate genes and pathophysiology. RESULTS: Reputable online academic databases were searched for relevant information, which led to the identification of 43 genes whose mutations are linked to the condition. Of the linked genes, …mutations in the KCNJ11, ABCC8, and INS genes as well as the genes on 6q24 chromosomal region are the most frequently implicated. Mutations in these genes can cause pancreatic agenesis and developmental errors, resulting in NDM in the first six to twelve months of birth. The clinical presentations of NDM include frequent urination, rapid breathing, and dehydration, among others. CONCLUSIONS: Monogenetic mutations in the beta cells may cause NDM with distinct pathophysiology from other DM. Treatment options that target NDM candidate genes and pathophysiology may lead to an improved treatment compared with the present generalized treatment for all forms of DM. Show more

Keywords: Beta cell, KCNJ11, pancreatic agenesis, pathophysiology, precision medicine

DOI: 10.3233/NPM-190353

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 4, pp. 543-553, 2020

Authors: Abdulrahman, Mahera | Tabatabaei, Zainabsadat | Maqbool, Sadia | Hafidh, Khadija | Husain, Zahra SM | Al Raeesi, Fatima Hussain | Abo Sada, Nour Mazen | Akbar, Madiha | Hubaishi, Nawal Mahmood | Tahlak, Muna Abdul Razzaq | Carrick, Frederick Robert

Article Type: Research Article

Abstract: OBJECTIVES: This study was conducted in order to explore and analyze the status of gestational diabetes (GDM) amongst pregnant women in Dubai, United Arab Emirates (UAE); a country with high prevalence of diabetes. We aimed to describe GDM-associated risk factors and clinical outcomes of pregnant women and their neonates. Our objective was to contribute to the broader literature on reproductive health disparities and to inform efforts to improve GDM care at our region. METHODS: Chart review of case records were used to collect data on both maternal and neonatal parameters and outcomes during the specified study period from …two main maternity hospitals in Dubai. RESULTS: UAE national women with GDM were more prone to be obese or overweight compared to non-UAE women (p  < 0.0001, and p  < 0.0001 respectively). In addition, UAE national women with GDM had higher history of GDM in previous pregnancies (p  < 0.0001) and more family history of diabetes (p  < 0.0001). The neonate admission into NICU was significantly associated with cesarean section (p  < 0.0001), twins (p  < 0.0001), preeclampsia (p  = 0.02), receiving MgSO4 (p  = 0.02), birth weight less than 2500 g (p  < 0.0001), low Apgar scores (p  < 0.0001), baby with congenital anomaly (p  < 0.0001), and neonatal hypoglycemia (p  < 0.0001). CONCLUSIONS: Our results demonstrate that pregnant women with GDM who are UAE nationals and have higher parity need to be under special attention during their pregnancy in order to improve both maternal and neonatal outcomes. Show more

Keywords: Gestational diabetes, women health, neonatal outcome, United Arab Emirates

DOI: 10.3233/NPM-200410

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 4, pp. 555-562, 2020

Authors: Cordero, L. | Stenger, M.R. | Blaney, S.D. | Finneran, M.M. | Nankervis, C.A.

Article Type: Research Article

Abstract: OBJECTIVE: To compare multiparous women with pregestational diabetes mellitus (PGDM) with and without prior breastfeeding (BF) experience and to ascertain their infants’ feeding type during hospitalization and at discharge. METHODS: A retrospective cohort study of 304 women with PGDM who delivered at ≥34 weeks gestational age (GA). Prior BF experience and infant feeding preference was declared prenatally. At discharge, BF was defined as exclusive or partial. RESULTS: BF experience and no experience groups were similar in diabetes type 1 and 2, race and number of pregnancies. Women with no experience had more spontaneous abortions (35 vs …27%), fewer term deliveries (51 vs 61%) and living children (median 1 vs 2). In the current pregnancy, mode of delivery: vaginal (36 & 37%), cesarean (64 & 63%), birthweight (3592 & 3515 g), GA (38 & 37 w), NICU admission (14 & 11%) and hypoglycemia (44 & 43%) were similar. Women with experience intended to BF (79 vs 46%), their infants’ first feeding was BF (64 vs 36%) and had lactation consults (96 vs 63%) more often than those without experience. At discharge, women with BF experience were different in rate of exclusive BF (33 vs 11%), partial BF (48 vs 25%) and formula feeding (19 vs 64%). CONCLUSION: Prior BF experience leads to better BF initiation rates while the absence of BF experience adds a risk for BF initiation failure. A detailed BF history could provide insight into obstacles that lead to unsuccessful BF experiences and may help define appropriate preventive or corrective strategies. Show more

Keywords: Pregestational diabetes mellitus, prior breastfeeding experience, breastfeeding at discharge

DOI: 10.3233/NPM-190308

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 4, pp. 563-570, 2020

Authors: Nazari, R. | Moradi Koosha, F. | Rezaie, S. | Akbari, N. | Qolizadeh, A. | Sabzi, Z.

Article Type: Research Article

Abstract: BACKGROUND: The mother-newborn relationship is more important in neonates hospitalized in the NICU than in healthy neonates. This study was conducted to explore the experiences of the mothers of infants hospitalized in the NICU. MATERIALS AND METHODS: This qualitative study was done in 2016 by adopting a conventional content analysis approach. Thirty-five mothers in the NICUs, Imam Hossein Hospital and Fatemieh Hospital were selected. Their experiences were assessed using in-depth individual semi-structured interviews. Sampling was purposive and was continued until reaching data saturation. RESULTS: Two hundred and nine primary codes were extracted. After removing duplicates and …overlaps, 95 primary codes were categorized in 8 subcategories, 2 accessory categories and 1 main category based on their appropriateness, agreement, and similarity. The accessory categories of “mothers’ worries” and “mothers’ hopes” were merged into a more general, abstract category named “dual feelings about the baby”. CONCLUSIONS: The nurses’ awareness of the mothers’ experiences can help design interventions to promote the quality of care for mothers and infants in the critical period of the NICU admission. Show more

Keywords: Premature neonate, mother, hospitalized, neonatal intensive care unit, qualitative design

DOI: 10.3233/NPM-190205

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 4, pp. 571-579, 2020

Authors: Edison, P.E. | Sanamandra, S.K. | Shah, V.A. | Baral, V.R. | Yeo, C.L.

Article Type: Case Report

Abstract: Trapped fourth ventricle (TFV) as a complication of post-hemorrhagic hydrocephalus (PHH) is widely reported in the pediatric population with a prior history of ventriculo-peritoneal (VP) shunt placement. Characterized by disproportionate dilatation of the fourth ventricle on serial neuro-imaging, it is rarely encountered in the early course of preterm infants and the differentiating clinical features are subtle and non-specific. Clinical alertness and sonographic correlation hold the key to early diagnosis. We report an early emergence of TFV in an extremely low gestational age newborn (ELGAN) following fulminant Pseudomonas aeruginosa meningitis, approach to management, and the neurological outcome. Fourth ventricle entrapment …as a complication of perinatally acquired Pseudomonas aeruginosa meningitis in a surviving ELGAN is extremely rare. Show more

Keywords: Trapped fourth ventricle, pseudomonas meningitis, mastoid fontanel view, neurophysiological assessment of hydrocephalus, ventricular reservoir

DOI: 10.3233/NPM-190258

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 4, pp. 581-586, 2020

Authors: Vinod, S. | Ghaly, E. | Cruz Soriano, P. | Sampath, H. | February, M. | Gupta, A.

Article Type: Case Report

Abstract: Joubert syndrome is a rare neurological manifestation usually present in late infancy or early childhood with characteristic episodes of abnormal breathing pattern along with the neurological and other systemic involvement.We report a case of confirmed Joubert syndrome present in the immediate neonatal period with isolated spells of oxygen desaturations not accompanied by the classically described breathing pattern and absent neurological symptoms causing delay in the diagnosis. Isolated oxygen desaturation episodes could be a presenting manifestation of Joubert syndrome in a neonatal period.

Keywords: Joubert syndrome, hyperapnea, isolated apnea, cyanosis, cerebellum

DOI: 10.3233/NPM-180144

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 4, pp. 587-591, 2020

Authors: Rong, Q. | Abubakar, K.

Article Type: Case Report

Abstract: There are few neonates reported with COVID-19 disease. To date there is no clear evidence of vertical transmission of the virus before birth. We report a 4-day old infant born to an asymptomatic mother who developed infection with SARS-CoV-2, likely from contact with parents during the postnatal period.

DOI: 10.3233/NPM-200489

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 4, pp. 593-595, 2020