Journal of Neonatal-Perinatal Medicine - Volume 14, issue 3

Authors: Volpe, J.J.

Article Type: Article Commentary

Keywords: COVID-19 vaccination, late VKDB, vitamin K administration, Vitamin K deficient bleeding (VKDB)

DOI: 10.3233/NPM-210732

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 3, pp. 313-316, 2021

Authors: Sethi, N. | Klugman, D. | Said, M. | Hom, L. | Bowers, S. | Berger, J.T. | Wernovsky, G. | Donofrio, M.T.

Article Type: Review Article

Abstract: Precise characterization of cardiac anatomy and physiology through fetal echocardiography can predict early postnatal clinical course. Some neonates with prenatally defined critical congenital heart disease have anticipated precipitous compromise during perinatal transition for which specialized, diagnosis-specific delivery room care can be arranged to expeditiously stabilize cardiopulmonary hemodynamics. In this article, we describe our institutional approach to the delivery room care of neonates with prenatally diagnosed congenital heart disease, emphasizing our diagnosis-specific care pathways for newborns with critical disease.

Keywords: Delivery room, prenatal diagnosis, congenital heart disease

DOI: 10.3233/NPM-200626

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 3, pp. 317-329, 2021

Authors: Taneja, R. | Batra, P.

Article Type: Review Article

Abstract: Lack of a standard definition of neonatal sepsis and a swift diagnostic method has proven detrimental in the management of this serious condition. Biomarkers have emerged as a beacon that might help us detect neonatal sepsis more effectively. The use of point-of-care biomarkers can aid in early diagnosis and timely initiation of treatment. Procalcitonin, presepsin, interleukin-6, highly specific C-reactive protein, and neutrophil gelatinase-associated lipocalin have been proven to aid in early diagnosis and timely initiation of treatment, thereby reducing sepsis-induced morbidity and mortality. These biomarkers have been found to be useful in reducing the duration of hospital stay and monitoring …the response to therapy. When used in combination with each other, or with clinical scores, they have been proven to be advantageous over the gold standard by eliminating the waiting time for blood culture results. The use of biomarkers as a point of care investigation holds a future over the traditional method. We present a state of science review of literature summarizing the current status of these biomarkers in neonatal sepsis. Show more

Keywords: Biomarkers, neonatal sepsis, point-of-care testing, procalcitonin, presepsin, highly specific CRP, IL-6

DOI: 10.3233/NPM-200581

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 3, pp. 331-338, 2021

Authors: Dubey, P. | Shrivastava, J. | Choubey, B.P. | Agrawal, A. | Thakur, V.

Article Type: Research Article

Abstract: BACKGROUND: Neonatal hyperbilirubinemia is a common medical emergency in early neonatal period. Unconjugated bilirubin is neurotoxic and can lead to lifelong neurological sequelae in survivors. OBJECTIVE: To find out the association between serum bilirubin and neurodevelopmental outcome at 1 year of age using Development Assessment Scale for Indian Infants (DASII). METHODS: A prospective cohort study was conducted in the Department of Pediatrics of a tertiary care institution of Central India between January 2018 and August 2019. Total 108 term healthy neonates, with at least one serum bilirubin value of >15 mg/dl, were included. Subjects were divided into …three groups based on the serum bilirubin; group 1: (15–20 mg/dl) –85(78.7%) cases, group 2: (20–25 mg/dl) –17(15.7%), and group 3: (>25 mg/dl) –6(5.5%). Developmental assessment was done using DASII at 3, 6, 9, 12 months of age. RESULTS: Out of 108 cases, 101(93.5%) received phototherapy, and 7(6.5%) received double volume exchange transfusion. Severe delay was observed in 5(4.6%) and mild delay in 2(1.9%) cases in the motor domain of DASII at one year. Severe delay in the motor domain was associated with mean TSB of 27.940±2.89 mg/dl and mild delay with mean TSB of 22.75±1.76 mg/dl (p  = 0.001). On cluster analysis, delay was observed in locomotion 1 score in 11(13%) cases (p  = 0.003) and manipulation score in 6(7.1%) cases in group 1. CONCLUSION: Increased serum bilirubin was a significant risk factor for the delayed neurodevelopment in babies with neonatal jaundice. Even a moderate level of bilirubin significantly affects the developmental outcome. Show more

Keywords: Hyperbilirubinemia, neurodevelopment delay, risk factors, DASII.

DOI: 10.3233/NPM-200511

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 3, pp. 339-344, 2021

Authors: Traub, T.M. | Grabowski, R. | Rais-Bahrami, K.

Article Type: Research Article

Abstract: Background: As neonates transition from a relatively hypoxic environment to extra-uterine life, arterial oxygen saturation dramatically increases. This transition occurs while most organs have not fully matured. The ability for immature tissue to adequately extract and utilize oxygen remains largely unknown. With the development of near-infrared spectroscopy (NIRS), measuring specific tissue oxygen saturation (StO2) noninvasively, clinicians can measure StO2 and determine if adequate tissue oxygenation is maintained. The objective of this study is to determine the relationships of NIRS brain and somatic autoregulation function to patients’ severity of illness. Methods: In this prospective cohort pilot study, after parental …consent, neonates less than 34 weeks with arterial access, were enrolled. The FORE-SIGHT NIRS probe was placed on the forehead and abdominal wall for 24 hours. Continuous arterial blood pressure, SpO2 and cerebral and somatic NIRS were used to derive autoregulation function. Results: Data was obtained from 17 neonates (0.540 to 2.37 kg, gestation 23.0 to 33.2 weeks). The autoregulation function categorizes pressure passive index (PPI) values as good, borderline, or poor. For normal autoregulation function, PPI values tend to be low and fairly constant for a range of MAP. The PPI borderline zone is a hypothetical range of PPI values where autoregulation function transitions from good to poor. Conclusion: Our results show most premature neonates, as long as they maintained normal BP and systemic circulation can autoregulate cerebral perfusion. When BP are above or below the normal MAP for age, the neonate is at risk for losing brain and somatic autoregulation. Show more

Keywords: Neonate, near-infrared spectroscopy, premature, autoregulation, intraventricular hemorrhage

DOI: 10.3233/NPM-200601

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 3, pp. 345-352, 2021

Authors: Casavant, S.G. | Li, H. | Cong, X. | Starkweather, A. | Moore, J. | Rosenkrantz, T.S. | Fitch, R.H.

Article Type: Research Article

Abstract: BACKGROUND: Children born prematurely (<37 gestational weeks) are at risk for a variety of adverse medical events. They may experience ischemic and/or hemorrhagic events leading to negative neural sequelae. They are also exposed to repeated stressful experiences as part of life-saving care within the neonatal intensive care unit (NICU). These experiences have been associated with methylation of SLC6A4, a gene which codes for serotonin transport proteins, and is associated with anxiety, depression, and increased incidence of autism spectrum disorders. The purpose of this study was to examine the effects of altered serotonin levels on behavioral and neuroanatomical outcomes in …a neonatal rodent model with or without exposure to hypoxic-ischemic (HI) injury. METHODS: Wistar rat pups were randomly assigned to either HI injury or sham groups. Pups within each group were treated with a chronic SSRI (Citalopram HBr) to simulate the effects of SLC6A4 methylation, or saline (NS). Subjects were assessed on behavioral tasks and neuropathologic indices. RESULTS: HI injured subjects performed poorly on behavioral tasks. SSRI subjects did not display significantly greater anxiety. HI + SSRI subjects learned faster than HI+NS. Histologically, SSRI subjects had predominantly larger brain volumes than NS. CONCLUSION: SSRI treated subjects without injury showed patterns of increased anxiety, consistent with theories of SLC6A4 methylation. The paradoxical trend to improved cognition in HI+SSRI subjects relative to HI alone, may reflect an unexpected SSRI neuroprotective effect in the presence of injury, and may be related to serotonin-induced neurogenesis. Show more

Keywords: Hypoxic-ischemic injury, methylation, serotonin, stress

DOI: 10.3233/NPM-200418

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 3, pp. 353-360, 2021

Authors: Rohsiswatmo, R. | Azharry, M. | Sari, T.T. | Bahasoan, Y. | Wulandari, D.

Article Type: Research Article

Abstract: BACKGROUND: Late-onset neonatal sepsis (LONS) detection is problematic as no single examinations (blood culture, c-reactive protein (CRP), procalcitonin (PCT)) are reliable. Toll-like receptors (TLRs), which detect the presence of pathogen-associated molecular patterns is a promising novel biomarker, but less studied in LONS. This study aimed to determine neutrophils and monocytes TLR2 and TLR4 expression in LONS and their diagnostic value. METHODS: A cross-sectional study conducted in May and June 2017 involving 52 neonates with clinical late-onset (>72 hours of age) sepsis. We examine complete blood count, I/T ratio, CRP, PCT, as well as TLR2 and TLR4 expression to …compared with blood culture as the gold standard. We classified cases into proven or unproven sepsis. RESULT: The incidence of LONS was 32.6% in the subjects. The expression of TLR2 was low in LONS, while TLR4 was high. TLR4 neutrophil expression has 88.2% sensitivity, 20% specificity, 34.9% positive predictive value (PPV), 77.8% negative predictive value (NPV), and an AUC of 0.541. TLR4 monocyte expression has 92.1% sensitivity, 11.4% specificity, 34% PPV, 80% NPV, and an AUC of 0.528. The AUC of CRP is increased from 0.608 to 0.843 after combination with TLR4, comparable with CRP + PCT (AUC 0.829). CONCLUSION: The increase in TLR4 expression has good sensitivity but low specificity. TLR4 expression, in combination with CRP, could become a reliable biomarker for the diagnosis of LONS. Show more

Keywords: Late-onset neonatal sepsis, biomarker, TLR2, TLR4, procalcitonin, c-reactive protein

DOI: 10.3233/NPM-200411

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 3, pp. 361-367, 2021

Authors: Abushady, N.M. | Awad, H.A.S. | Kamel, D.R. | Fouda, E.M. | Ahmed, N.T. | Dawoud, M.O.

Article Type: Research Article

Abstract: BACKGROUND: This study’s aim is to evaluate lung ultrasound (LUS) efficacy in detecting opening and closing lung pressures and its correlation with the tracheal interleukin 6 (IL-6) level. METHOD: This single-blinded randomized controlled study was done at Ain Shams University Children’s Hospital neonatal intensive care units, Egypt. It consists of 44 mechanically ventilated preterm neonates with Respiratory Distress Syndrome (RDS). Initial LUS assessment was done followed by randomization to one of 2 groups; group I: 22 patients underwent LUS guided RM and group II: 22 patients underwent non-ultrasound guided RM. Tracheal IL-6 level was measured before and after …RM in both groups. RESULTS: The LUS scores showed a sensitivity of 86.7%, specificity of 62.10% and accuracy of 70.45% at the cut-off point >B1 grade. After RM, there was a higher percentage of changes in mean airway pressure (p  = 0.03), FiO2 (p  = 0.01), PaO2 /FiO2 ratio (p  = 0.01), and IL-6 (p  < 0.01) in group I. The duration of oxygen requirement (6 vs.13.5 days, p  = 0.01), invasive ventilation (3 vs.5.5 days, p  = 0.03), non-invasive ventilation (2.5 vs. 5 days, p  = 0.02) and NICU stay (21.5 vs. 42.5 days, p  = 0.03) were less in group I. A positive correlation is found between reaeration score and the duration of O2 requirement (p  = 0.002), duration of invasive ventilation (p  = 0.001), NICU length of stay (p  = 0.002) and negative correlation with PaO2 /FiO2 ratio before RM (p  = 0.012). The best cut-off point for the reaeration score is >21 with a sensitivity of 75%, specificity of 71.43% and area under the curve of 78.1%. CONCLUSION: LUS-guided RM achieved earlier lowest FiO2 , shorter O2 dependency, lesser NICU stay and marked decrease in lung inflammation by decreasing atelectotrauma and shortening the duration of invasive ventilation. Show more

Keywords: Lung ultrasound, RDS, recruitment maneuver, IL-6

DOI: 10.3233/NPM-200605

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 3, pp. 369-374, 2021

Authors: Fiatt, M. | Bosio, A.C. | Neves, D. | Symanski da Cunha, R. | Fonseca, L.T. | Celeste, R.K.

Article Type: Research Article

Abstract: BACKGROUND: Prevalence of extubation failure in neonates may be up to 80%, but evidence to determine if a neonate is ready for extubation remains unclear. We aim to evaluate a spontaneous breathing trial accuracy with minimum pressure support to predict success in neonates’ extubation and identify variables related to failures. METHODS: This is a diagnostic accuracy study based on a cohort study in an intensive care unit with all eligible newborn infants subjected to invasive mechanical ventilation for at least 24 hours submitted to the trial for 10 minutes before extubations. The outcome was failures of extubations, considered …if reintubation was needed until 72 hours. RESULTS: The incidence of failure was 14.7%among 170 extubations. There were 145 successful extubations; of these, 140 also passed the trial with a sensitivity of 96.5%(95%CI: 92.1–98.9). Of the 25 extubations that eventually failed, 16 failed the test with a specificity of 64.0%(95%CI: 42.5–82.0). The negative predictive value was 76.2%, and the positive predictive value was 94%. In stratifying by weight, the accuracy was >98.7%for neonates weighting >2500 g, but 72.5%for those weighing <1250 g. Extubation failures occurred more frequently in smaller (p  = 0.01), preterm infants (p  = 0.17), with longer ventilation time (p  = 0.05), and having a hemodynamically significant persistent arterial duct (p  = 0.01), compared with infants whose extubation was successful. CONCLUSION: The spontaneous breathing trial with minimum pressure support ventilation seems to predict extubation success with great accuracy in full-term and larger neonates. Show more

Keywords: Artificial breathing, airway extubation, neonatal intensive care, validation study

DOI: 10.3233/NPM-200573

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 3, pp. 375-382, 2021

Authors: Sloane, A.J. | Carola, D.L. | Lafferty, M.A. | Edwards, C. | Greenspan, J. | Aghai, Z.H.

Article Type: Research Article

Abstract: BACKGROUND: Based on the most recently published recommendations from the Committee on the Fetus and Newborn (COFN), three approaches currently exist for the use of risk factors to identify infants who are at increased risk of early-onset sepsis (EOS). Categorical risk factor assessments recommend laboratory testing and empiric antibiotic therapy for all infants born to mothers with a clinical diagnosis of chorioamnionitis. Risk assessments based on clinical condition recommend frequent examinations and close vital sign monitoring for infants born to mothers with chorioamnionitis. The Kaiser Permanente EOS risk calculator (SRC) is an example of the third approach, multivariate risk assessments. …The aim of our study was to compare the three risk stratification approaches recommended by the COFN for management of chorioamnionitis-exposed infants. METHODS: Retrospective study of 1,521 infants born ≥35 weeks to mothers with chorioamnionitis. Management recommendations of the SRC were compared to the recommendations of categorical risk assessment and risk assessment based on clinical condition (CCA). RESULTS: Hypothetical application of SRC and CCA resulted in 79.6% and 76.8–85.1% respectively fewer infants allocated empiric antibiotic therapy. While CCA recommended enhanced observation for all chorioamnionitis-exposed infants, SRC recommended routine care without enhanced observation in 44.3% infants. For the six infants (0.39%) with EOS, SRC and CCA recommended empiric antibiotics only for three symptomatic infants. CONCLUSION: The SRC and CCA can reduce antibiotic use but potentially delay antibiotic treatment. The SRC does not recommend enhanced observation with frequent and prolonged vital signs for >44% of chorioamnionitis-exposed infants. Show more

Keywords: Infants, neonatal sepsis, early-onset sepsis, sepsis calculator, COFN

DOI: 10.3233/NPM-200531

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 3, pp. 383-390, 2021