Journal of Neonatal-Perinatal Medicine - Volume 15, issue 2

Authors: Volpe, J.J.

Article Type: Editorial

Keywords: Neonatal seizures, antiseizure medication, early discontinuation

DOI: 10.3233/NPM-210849

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 2, pp. 203-207, 2022

Authors: Kollikonda, S. | Chavan, M. | Cao, C. | Yao, M. | Hackett, L. | Karnati, S.

Article Type: Review Article

Abstract: BACKGROUND: Perinatal practices such as breast-feeding, kangaroo mother care, rooming-in, and delayed cord clamping have varied by institution during the COVID-19 pandemic. The goal of this systematic review was to examine the success of different practices in preventing viral transmission between SARS-CoV-2 positive mothers and their infants. METHODS: Electronic searches were performed in the Ovid MEDLINE, Ovid Embase, Cochrane Library, EBSCOhost CINAHL Plus, Web of Science, and Scopus databases. Studies involving pregnant or breastfeeding patients who tested positive for SARS-CoV-2 by RT-PCR were included. Infants tested within 48 hours of birth who had two tests before hospital discharge …were included. Infants older than one week with a single test were also included. RESULTS: Twenty eight studies were included. In the aggregated data, among 190 breastfeeding infants, 22 tested positive for SARS-CoV-2 (11.5%), while 4 of 152 (2.63%) among bottle-fed (Fisher’s exact test p  = 0.0006). The positivity rates for roomed in infants (20/103, 19.4%) were significantly higher than those isolated (5/300, 1.67%) (P  < 0.0001). There was no significant difference in positivity rate among infants who received kangaroo care (25%vs 9%, p  = 0.2170), or delayed cord clamping (3.62%vs 0.9%, p  = 0.1116). CONCLUSIONS: Lack of robust studies involving large patient population does not allow meaningful conclusions from this systematic review. Aggregated data showed increased positivity rates of SARS-CoV-2 among infants who were breast fed and roomed-in. There were no differences in SARS-CoV-2 positivity rates in infants received skin to skin care or delayed cord clamping. Show more

Keywords: Breast feeding, COVID-19, delayed cord clamping, formula feeding, kangaroo, mother care, novel corona virus, rooming-in, skin to skin care

DOI: 10.3233/NPM-210775

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 2, pp. 209-217, 2022

Authors: Chikkabyrappa, S.M. | Chaudhary, N. | Agarwal, A. | Rastogi, D. | Filipov, P. | Rastogi, S.

Article Type: Research Article

Abstract: BACKGROUND: There remains controversy regarding the outcomes resulting from treatment versus conservative management of patent ductus arteriosus (PDA) among preterm infants. The effects of extreme prematurity, hemodynamic status of the PDA, and age at treatment remain poorly defined. STUDY DESIGN: This retrospective case-control study including infants < 1250 gm who were categorized into 3 groups: Group 1: without PDA, Group 2: with untreated PDA, and Group 3: treated PDA. Diagnosis and treatment of PDA extracted from the medical records. Demographics, clinical characteristics, and outcomes compared using chi-square and analysis of variance. Logistic regression used to estimate adjusted odds ratios. …RESULTS: The study included 734 infants, with 141(19%) in Group 1, 329 (45%) in 2, and 264 (36%) in 3. Group 3 had higher incidence of bronchopulmonary dysplasia (BPD) (aOR, 2.9; 95%CI 1.7–4.8). Infant treated for hemodynamically significant PDA (HSPDA) had higher incidence of BPD (aOR, 1.9; 95%CI 1.0–3.8) and retinopathy of prematurity (ROP) (aOR, 3.4; 95%CI 1.6–6.9). There were no differences in outcome associated with treatment among≤26 weeks gestation and the age when treated. CONCLUSION: Infants with PDA who were treated had higher incidence of BPD. Among those who were treated, those with HSPDA had a higher incidence of BPD and ROP. Show more

Keywords: Extreme prematurity, hemodynamically significant PDA, outcomes, PDA, pharmacological treatment, timing of treatment

DOI: 10.3233/NPM-210814

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 2, pp. 219-227, 2022

Authors: Aranha, V.P. | Chahal, A. | Bhardwaj, A.K.

Article Type: Review Article

Abstract: BACKGROUND: Therapeutic benefits of neonates undergoing neonatal aquatic physiotherapy (NAPT) are evident from the available literature. However complied report on NAPT is not yet available. Hence, we have mapped the available interventions to treat neonates admitted in neonatal intensive care units (NICUs) using NAPT in a scoping review. METHOD: Six databases which includes, MEDLINE/PubMed, SCOPUS, PEDro, CINHAL, EBSCO and Cochrane were searched with predefined keywords specific to or related to NAPT interventions from 1983 to August, 2020 for the full-text English language articles. RESULTS: A total of 6163 relevant articles were identified from the search process. …After duplicates were removed, 6146 articles were screened for inclusion, leaving 809 articles assessed for eligibility criteria. Six (n  = 6) articles met all criteria and were included in the final qualitative synthesis. CONCLUSION: NAPT may be an effective intervention to normalize the muscle tone, to promote active movements, postural organization, improves sleep pattern and quality, promotes the thermal and cardiorespiratory adaptations, and moreover reduces neonatal pain among the neonates admitted in NICUs. Show more

Keywords: Aquatic exercises, aquatic rehabilitation, hydrotherapy, neonatal physical therapy

DOI: 10.3233/NPM-210858

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 2, pp. 229-235, 2022

Authors: Casani, A. | Tozzi, N. | Cocca, F.

Article Type: Research Article

Abstract: BACKGROUND: The main goal of neonatologist performed echocardiography is to timely assess hemodynamic changes in order to properly manage unsteady neonates. Detailed structural heart assessment remains the domain of pediatric cardiologists. Nonetheless, many neonatologists take on an additional role in diagnosis of congenital heart defects, mostly compelled by the lack of in-house pediatric cardiology services. The experience of neonatologist performed echocardiography in an Italian neonatal unit was reported and the risk benefit profile of this practice was discussed. MATERIAL AND METHODS: We retrospectively reviewed the echocardiograms undertaken by the neonatologist on infants admitted to the neonatal unit and …postnatal ward of the Hospital San Pio in Benevento, over a 2-year period. Details of scans and concordance between neonatologist and cardiologist were analyzed. RESULTS: A total of 160 echocardiographic studies were done by the neonatologist on 136 infants. The ECG was requested in a minority of infants. The most common reason for performing the echocardiogram was admission to the neonatal care unit. Around half of the echocardiograms were normal. The remaining scans resulted in functional and structural abnormalities, transitional changes, and doubtful findings. Cardiac anomalies were significantly more likely found in cases of echocardiograms performed for fetal indications. Only 28 patients were eventually referred to the cardiology services. The inter-rater agreement was satisfactory. CONCLUSIONS: The hemodynamic assessment of sick infants, as well as triaging and referral of neonates with structural heart diseases are valuable advantages of the echocardiography run by neonatologists. Collaboration with pediatric cardiologists and robust training and accreditation programs are essential to ensure safety and quality service. Show more

Keywords: Congenital heart disease, neonatal intensive care unit, neonatologist performed echocardiography, pediatric cardiologist

DOI: 10.3233/NPM-210811

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 2, pp. 237-242, 2022

Authors: Nicksic, V.B. | Allen, D.B. | Stanley, M.A. | Baker, M.W. | Eickhoff, J.C. | Kaluarachchi, D.C.

Article Type: Research Article

Abstract: BACKGROUND: Limited evidence exists on whether subclinical hypothyroidism suggested by mildly elevated TSH levels affect neurodevelopment and growth in preterm infants. The objective of this study was to determine the association between gestational age adjusted TSH percentiles and neurodevelopmental outcomes among preterm infants. METHODS: Univariate linear regression analysis was conducted to determine, in infants born less than thirty-two weeks gestational age, the correlation between the TSH percentile on the last newborn screen and neurodevelopmental assessment scores and growth outcomes at eighteen to twenty-two months of corrected age. RESULTS: Seventy-four patients were enrolled in the study with …a mean gestational age of 28.8 weeks. There was no correlation between the last TSH percentile value and Bayley-III cognitive composite score or other neurodevelopmental or growth outcomes. CONCLUSION: In a cohort of preterm infants, higher TSH percentiles suggesting potential subclinical hypothyroidism did not predict any adverse effect on neurodevelopmental or growth outcomes. Show more

Keywords: Neurodevelopment, preterm, subclinical hypothyroidism, TSH

DOI: 10.3233/NPM-210910

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 2, pp. 243-247, 2022

Authors: Tekkeşin, F. | Yurdakok, M. | Gumus, E. | Babaoglu, M.O. | Bozkurt, A. | Caliskan Kadayifcilar, S. | Eldem, M.B. | Korkmaz, A. | Yigit, S. | Tekinalp, G.

Article Type: Research Article

Abstract: BACKGROUND: Our objective in this study was to assess the association between eNOS gene, that achieves synthesis of nitric oxide especially in the endothelial cells known to have an important role in angiogenesis and vasculogenesis, G894T, intron 4 VNTR (27-bp repeat) and T786C functional polymorphisms and retinopathy of prematurity (ROP), which is an important cause of morbidity in premature or low birth weight babies. METHODS: A total of 139 babies who were followed up in our neonatal intensive care unit because of premature birth in our hospital or admitted to our unit. 69 of them had retinopathy of …prematurity and comprised the patients group. The remaining 70 babies who did not have ROP comprised the control group. An additional of 1 ml of blood samples were drawn from babies who were in the study groups during routine laboratory analysis. eNOS gene polymorphisms were determined by using polymerase chain reaction method. RESULTS: eNOS G894T, intron 4 VNTR and T786C gene polymorphisms did not differ between the patient and control groups (p  > 0.05). Using logistic regression analysis; while gender did not differ between two groups; gestational age, birth weight, time on mechanical ventilation differ between two groups. After adjustment for variables other than eNOS gene polymorphisms, we found no significant difference in the genotype distribution of eNOS G894T, intron 4 VNTR and T786C polymorphisms (p  > 0.05). CONCLUSION: We observed no association between ROP and eNOS gene polymorphisms but needs more investigation. Show more

Keywords: Endothelial nitric oxide synthase, polymorphism, retinopathy of prematurity

DOI: 10.3233/NPM-210801

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 2, pp. 249-255, 2022

Authors: Sivieri, E.M. | Eichenwald, E.C. | Abbasi, S. | Wolfson, M.R.

Article Type: Research Article

Abstract: BACKGROUND: Recent in vitro testing of high frequency (HF) oscillation applied to bubble continuous positive airway pressure (BCPAP) using a novel flow interrupter device (HFI) demonstrated significantly improved CO2 washout while not altering delivered mean airway pressure (MAP) in a premature infant lung model. This study’s aim was to evaluate the safety and efficacy of the HFI paired with BCPAP in an animal model of prematurity prior to clinical testing. DESIGN/METHODS: Twelve fetal lambs, 131–135 days gestation, weight 3.51±0.42 kg, were delivered by Cesarean section. The lambs were supported by mechanical ventilation and weaned to spontaneous breathing …with BCPAP at 6 cmH2 O. A combined CO2 /airflow sensor measured end-tidal (EtCO2 ) and tidal volume (VT). Blood gases, heart rate (HR), arterial pressure (Part), minute ventilation (MV), MAP, ventilatory efficiency index (VEI), thoracoabdominal phase angle and labored breathing index (LBI) were recorded over a 10-minute baseline period followed by four randomized 10-minute intervals with HFI set to either 8, 10, 12 or 15 Hz. RESULTS: EtCO2 decreased from baseline by 11.1±2.2SE%, 16.6±4.3SE%, 13.5±4.9SE%, and 19.5±4.5SE% at 8, 10, 12, and 15 Hz respectively (p  < 0.001). Blood gases, SpO2 , HR, Part, MAP, VT, MV, esophageal pressure, phase angle, and LBI underwent no significant change with HF. Respiratory rate decreased, and VEI increased, by 14.9±4.5SD% (p  = 0.037) and 83±22SD% (p  < 0.011) respectively, averaged over all frequencies. CONCLUSIONS: We demonstrated the safety and efficacy of a novel BCPAP flow interrupter device. HF applied to the respiratory system resulted in significantly improved CO2 clearance and ventilation efficiency with no deleterious physiological effects in a pre-term lamb model. Show more

Keywords: Bubble CPAP, carbon dioxide clearance, high frequency oscillation, non-invasive ventilation

DOI: 10.3233/NPM-210899

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 2, pp. 257-263, 2022

Authors: Ismail, R. | Awad, H. | Allam, R. | Youssef, O. | Ibrahim, M. | Shehata, B.

Article Type: Research Article

Abstract: BACKGROUND: Refractory septic shock in neonates is still associated with high mortality, necessitating an alternative therapy, despite all currently available treatments. This study aims to assess the vasopressor effect of methylene blue (MB) in comparison to terlipressin (TP) as adjuvant therapy for refractory septic shock in the preterm neonate. METHODS: A double-blinded randomized controlled trial was conducted in the Neonatal Intensive Care Units at Ain Shams University, Egypt. Thirty preterm neonates with refractory septic shock were randomized to receive either MB or TP as an adjuvant to conventional therapy. Both MB and TP were administered as an intravenous …loading dose followed by continuous intravenous infusion. The hemodynamic variables, functional echocardiographic variables, and oxidant stress marker were assessed over a 24 h period together with the side effects of MB. RESULTS: MB causes significant improvement in mean arterial blood pressure with a significant decrease of the norepinephrine requirements (1.15±0.21μm/kg/min at baseline vs. 0.55±0.15μm/kg/min at 24 h). MB infusion causes an increase of the pulmonary pressure (44.73±8.53 mmHg at baseline vs. 47.27±7.91 mmHg after 24 h) without affecting the cardiac output. Serum malonaldehyde decreased from 5.45±1.30 nmol/mL at baseline to 4.40±0.90 nmol/mL at 24 h in the MB group. CONCLUSION: Administration of MB to preterm infants with refractory septic shock showed rapid increases in systemic vascular resistance and arterial blood pressure with minimal side effects. Show more

Keywords: Methylene blue, neonate, septic shock, terlipressin

DOI: 10.3233/NPM-210824

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 2, pp. 265-273, 2022

Authors: Sullivan, Brynne A. | Ahmad, S. Mazin | Slevin, Claire C. | Sinkin, Robert A. | Nagraj, V. Peter | Fairchild, Karen D.

Article Type: Research Article

Abstract: BACKGROUND: Increased cardiorespiratory events with bradycardia and oxygen desaturation have been reported in very low birthweight (VLBW) infants following stressors such as immunizations. These events are difficult to quantify and may be mild. Our group developed an automated algorithm to analyze bedside monitor data from NICU patients for events with bradycardia and prolonged oxygen desaturation (BDs) and used this to compare BDs 24 hours before and after potentially stressful interventions. METHODS: We included VLBW infants from 2012–2017 with data available around at least one of four interventions: two-month immunizations, retinopathy of prematurity (ROP) examinations, ROP therapy, and inguinal …hernia surgery. We used a validated algorithm to analyze electrocardiogram heart rate and pulse oximeter saturation data (HR, SpO2 ) to quantify BD events of HR < 100 beats/minute for≥4 seconds with oxygen desaturation < 80%SpO2 for≥10 seconds. BDs were analyzed 24 hours before and after interventions using Wilcoxon rank-sum tests. RESULTS: In 354 of 493 (72%) interventions, BD frequency stayed the same or decreased in the 24 hours after the event. An increase of at least five BD’s occurred in 17/146 (12%) after immunizations, 85/290 (29%) after ROP examinations, 4/33 (12%) after ROP therapy, and 3/25 (12%) after hernia surgery. Infants with an increase in BDs after interventions had similar demographics compared to those without. More infants with an increase in BDs following immunizations were on CPAP or caffeine than those without. CONCLUSIONS: Most VLBW infants in our cohort had no increase in significant cardiorespiratory events in the 24 hours following potentially stressful interventions. Show more

Keywords: Apnea, cardiorespiratory monitoring, immunizations, prematurity, retinopathy of prematurity

DOI: 10.3233/NPM-210744

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 2, pp. 275-282, 2022