Journal of Neonatal-Perinatal Medicine - Volume 15, issue 3

Authors: Volpe, J.J.

Article Type: Article Commentary

Keywords: Congenital heart disease, brain dysmaturation, fetal onset, interventions

DOI: 10.3233/NPM-210942

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 489-494, 2022

Authors: Glass, H.C. | Shellhaas, R.A.

Article Type: Article Commentary

DOI: 10.3233/NPM-210882

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 495-498, 2022

Authors: Volpe, Joseph J.

Article Type: Article Commentary

DOI: 10.3233/NPM-210919

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 499-499, 2022

Authors: Yeung, T. | Shahroor, M. | Jain, A. | Weisz, D. | Jasani, B.

Article Type: Review Article

Abstract: BACKGROUND: Several small randomized controlled trials (RCTs) and observational studies have compared high (15-20/7.5-10/7.5-10 mg/kg/dose) versus standard dose (10/5/5 mg/kg/dose) ibuprofen for patent ductus arteriosus (PDA) closure, with limited evidence on efficacy and safety. OBJECTIVE: To systematically review and meta-analyze studies of high versus standard dose ibuprofen for the closure of PDA in preterm infants. METHODS: Databases were searched for RCTs and observational studies assessing high compared to standard dose of ibuprofen for PDA closure for preterm infants until August 2021. The primary outcome was failure of PDA closure after the first course of ibuprofen. The secondary outcomes …were the failure of PDA closure after a second course of ibuprofen, rates of PDA ligation, all-cause mortality prior to hospital discharge, bronchopulmonary dysplasia, necrotizing enterocolitis, bleeding disorders, oliguria, and serum creatinine after treatment. RESULTS: There were 6 studies with 369 patients (3 RCT, N = 190; 3 observational studies, N = 179). Compared to standard dose, high dose ibuprofen did not significantly decrease the failure rate of PDA closure in preterm infants after the first course (Relative risk (RR) 0.74, 95% confidence interval (CI) 0.53 –1.03, 6 studies, N = 369). High dose ibuprofen significantly decreased the rates of PDA ligation compared to standard dose (RR 0.33, 95% CI 0.16 –0.70, 5 studies, N = 309). INTERPRETATION: Based on low-grade evidence, high dose ibuprofen may more effectively reduce rates of PDA ligation compared to standard dose with no increase in adverse effects, neonatal morbidities and mortality. Show more

Keywords: Ibuprofen, meta-analysis, patent ductus arteriosus, preterm infants

DOI: 10.3233/NPM-210968

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 501-510, 2022

Authors: Zheng, Y. | Gandhi, A. | Sewell, K. | Tumin, D. | Bear, K.

Article Type: Review Article

Abstract: OBJECTIVE: The benefits of point-of-care ultrasound (POCUS) in the neonatal intensive care unit (NICU) have been widely recognized, but education on this area of practice remains variable. We reviewed published educational interventions regarding POCUS use in the NICU and whether they have led to sustainable increases in POCUS use. METHODS: A systematic search of 6 databases was performed for publications from January 2000 to March 2021. Studies with quantitative data related to POCUS educational interventions in the NICU were included. Data on number of participants and roles, educational intervention, curriculum description, and project outcome measures (including sustainability) was …extracted. RESULTS: The search resulted in 686 articles, of which nine studies met the inclusion criteria. Educational interventions included didactic sessions, simulation practice, animal practice, and practice in real patients. The most common assessment was based on the quality and accuracy of the images. At the participant level, the average time to reach proficiency ranged from eight hours and thirty-six minutes to five months, and none of the studies evaluated sustainability of POCUS use after the intervention. CONCLUSION: There is a lack of standardized training modules and assessments for POCUS use in the NICU. Given that none of the studies addressed sustainability or standardized training, we recommend that a standardized training protocol and assessment tool is developed and studied longitudinally; and that barriers to sustainable POCUS use in the NICU (such as billing issues and a lack of POCUS machines and instructors) be systematically addressed as part of this work. Show more

Keywords: Education, neonatology, point-of-care ultrasound, simulation

DOI: 10.3233/NPM-210925

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 511-520, 2022

Authors: Gonzales, D.N. | Brunkhorst, J. | Sherman, A.K. | Dremman, J. | Reed, D.J.W.

Article Type: Research Article

Abstract: BACKGROUND: Little is known about the prevalence, characteristics, and outcomes of neonates needing emergent resuscitation within the level 4 neonatal intensive care units (NICU). Clinical factors prior to and following resuscitation event or characteristics of those who require chest compressions versus those without compressions has not been previously delineated. The aim of this study is to describe characteristics and outcomes of neonates who have compressive vs. non-compressive resuscitative events. METHODS: Retrospective observational study of neonates with a resuscitative event in the Children’s Mercy Hospital level 4 NICU between January 2012 and April 2017. Data were derived from the …NICU Code Blue database and the electronic medical record. Primary outcome was survival to hospital discharge. RESULT: Of the 641 resuscitative events, most were in the non-compressive group (n  = 481). Those requiring chest compressions longer than 1 minute had significantly different clinical characteristics and decreased survival. There was no difference between groups in gestational age or birth weight. CONCLUSION: Non-compressive events are more common in the NICU setting than are compressive events. Neonates requiring chest compressions longer than 1 minute are more likely to have a higher respiratory severity score, need for vasopressors, worse renal function post-event, and decreased survival to discharge. Show more

Keywords: Characteristics, compressions, compressive events, NICU, non-compressive events, resuscitative events, outcomes

DOI: 10.3233/NPM-210956

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 521-527, 2022

Authors: Amer, R. | Seshia, M.M. | Elsayed, Y.N.

Article Type: Research Article

Abstract: OBJECTIVE: To validate the vasoactive inotropic score as a predictor of the severity of compromised systemic circulation and mortality in preterm infants. METHODS: A retrospective study was conducted on preterm infants with Compromised systemic circulation [hypotension±lactic acidosis±oliguria] who received a cardiovascular support, we calculated the vasoactive inotropic score (VIS) and cumulative exposure to cardiovascular medications over time (VISct). Receiver operator curve was constructed to predict the primary outcome which was death & refractory hypotension. RESULTS: VIS had an area under the curve of 0.73 (95% CI 0.85–0.98, p  < 0.001). A VIS cut off of 25 has …sensitivity and specificity of 66% and 92%, and positive and negative predictive values of 78.5% and 83%, respectively. CONCLUSION: High VIS predicts the severity of Compromised systemic circulation and mortality rate in preterm infants. Show more

Keywords: Compromised systemic circulation, hypotension, preterm infants, vasoactive inotropic score, vasoactive inotropic score cumulative time

DOI: 10.3233/NPM-210932

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 529-535, 2022

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

Article Type: Research Article

Abstract: BACKGROUND: In preterm infants, persistence of ductus arteriosus is an important medical condition. Functional echocardiography for patent ductus arteriosus (PDA) may guide clinical decision-making regarding treatment requirement strategies. Objectives of the study were to assess the trends of clinical and functional echocardiographic parameters with evolution of ductus arteriosus in babies≤1250 gm of birth weight and to evaluate whether there is any association of these parameters with persistence of ductus. METHODS: In this prospective observational study, recruited babies were assessed serially for clinical events and functional echocardiography. Babies were classified into three groups: without PDA, with PDA but PDA spontaneously …closed (within 7 days) and persistent PDA. RESULT: We included 143 infants (Birth weight 1017±179 g, gestational age 30.8±2.7 weeks). Out of 60 babies with PDA, PDA failed to close spontaneously in first week in 32 (53.4 %) infants. PDA Doppler flow pattern on day 3 was found to be one of the most significant markers for future ductus. The highest frequency of growing pattern (37.5%) and pulsatile pattern (59.4%) was seen in persistence ductus group. PDA diameter and LA/Ao ratio were found strongly correlated with all other variables except E/A ratio. CONCLUSION: We noticed persistence of ductus in preterm infants had significant clinical and echocardiographic association. PDA doppler flow pattern on day 3 was found to be a significant marker for future behaviour of ductus. Significant correlation was found among individual functional echocardiographic parameters in babies with PDA. This would guide judicious treatment of PDA in preterm neonates. Show more

Keywords: Functional echocardiography, patent ductus arteriosus, preterm, very low birth weight

DOI: 10.3233/NPM-210930

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 537-544, 2022

Authors: Fishchuk, L. | Rossokha, Z. | Pokhylko, V. | Cherniavska, Yu. | Popova, O. | Tsvirenko, S. | Gorovenko, N.

Article Type: Research Article

Abstract: BACKGROUND: Summary data indicate that it has increased attention to the study of the role of the folate cycle and the genes encoding its key components in the complicated course of the neonatal period in premature infants. Therefore, the aim of our study was to investigate the relationship of folate cycle gene variants with the features of the neonatal course in premature infants with severe intraventricular hemorrhages (IVH). METHODS: The study included 24 preterm infants with with IVHs of 3d and 4th degree that received standard clinical, laboratory and instrumental examination. RESULTS: Apgar scores …at 1 and 5 minutes were significantly lower in patients with AA genotype according to variant A1298C of the MTHFR gene. The concentration of total protein on 6th day after birth was negatively correlated with the A66G variant of the MTRR gene. The mean concentration of ionized calcium in the first day after birth was higher in the subgroup of patients with the AA genotype (according to variant A1298C of the MTHFR gene). In the subgroup of patients requiring mechanical ventilation, the frequency of AA genotype according to variant A2756G of the MTR gene was significantly increased. The presence of respiratory disorders and oxygen dependence was negatively correlated with variant A1298C MTHFR . The day of surfactant administration was positively correlated with variant A1298C of the MTHFR gene. CONCLUSION: The results of this study indicate that gene variants MTHFR (C677T, A1298C), MTRR (A66G), MTR (A2756G), RFC1 (G80A) may affect the neonatal course in premature infants with severe IVH. Show more

Keywords: Folate cycle, gene, intraventricular hemorrhage, preterm infants

DOI: 10.3233/NPM-210962

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 545-551, 2022

Authors: Cudjoe, G.A. | Ameley, A. | Ohemeng-Dapaah, J. | Bhatt, P. | Donda, K. | Dapaah-Siakwan, F.

Article Type: Research Article

Abstract: BACKGROUND: Retinopathy of prematurity is a major cause of morbidity in preterm infants but population-based studies to evaluate recent trends in incidence in the United States (US) are lacking. Moreover, previous studies did not include the use of anti-Vascular Endothelial Growth Factor medications. The objective was to examine the recent secular trends in the incidence and treatment of severe retinopathy of prematurity (sROP) in the United States (US) from 2009 to 2018. METHODS: This was a population-based, serial cross-sectional study that utilized data from the National Inpatient Sample. The inclusion criteria were preterm infants with gestational age (GA) …≤30 weeks and length of stay > 28 days. The primary outcomes were trends in ROP surgery (photocoagulation, cryotherapy, scleral buckling, vitrectomy) and intravitreal injection of therapeutic (anti-VEGF) medications. The Cochrane-Armitage test was used to evaluate trends and P-value < 0.05 was considered significant. RESULTS: Out of 279,664 hospitalizations that met the inclusion criteria, 12,942 (4.6%) had sROP. Those with sROP were more likely to have severe intraventricular hemorrhage (12.5% vs 6.1%), bronchopulmonary dysplasia (48.2% vs 25.9%), and pulmonary hypertension (10.7% vs 4.7%). From 2009–2018, sROP significantly increased from 3.4% to 5.3% (P  < 0.001), ROP surgery decreased from 36.8% to 11.9% (P  < 0.001) while intra-vitreal administration of therapeutic drugs increased from 2% to 7.6% (P  < 0.001). CONCLUSION: Surgery for sROP decreased while intra-vitreal administration of therapeutic drugs increased in the setting of increasing incidence of sROP in the US. Taken together, these findings suggest a gradual practice change and the long-term outcomes of intra-vitreal agents warrants future study. Show more

Keywords: Retinopathy of prematurity surgery, severe retinopathy of prematurity, trends, United States

DOI: 10.3233/NPM-210826

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 553-557, 2022

Authors: Rana, D. | Garde, K. | Elabiad, M.T. | Pourcyrous, M.

Article Type: Research Article

Abstract: BACKGROUND: Infants with in-utero exposure to opioids are at risk Neonatal Opioid Withdrawal Syndrome (NOWS) and non-pharmacological methods of care, like swaddling, quiet ambient environment are routinely recommended but are not systematically studied. We hypothesized that opioid exposed infants can tolerate whole body massage while hospitalized. METHODS: This is a prospective observational study (August 2017 to January 2019) and infants of mothers having a history of opioids use (OUD) were included. Infants received whole body massage for 30 minutes from birth till discharge home. Infants heart rate (HR), respiratory rate (RR), systolic (sBP) and diastolic blood pressure (dBP) …were recorded prior to and at the end of massage session. RESULTS: The pilot study enrolled 30 infants. The mean birth weight and gestational age were 38±1 weeks and 2868±523 grams, respectively. All massage sessions were well tolerated. There was marked decrease in HR, systolic and diastolic BP and RR, (p  < 0.01) in all study infants post massage, more profound among infants with NOWS (p  < 0.01) than without NOWS. CONCLUSIONS: Whole body massage is very well tolerated by infants with in-utero opioid exposure. Infants with NOWS had marked decrease in their HR and BP from their baseline after massage. Show more

Keywords: Infant massage, neonatal opioid withdrawal syndrome, physiological measurements

DOI: 10.3233/NPM-220989

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 559-565, 2022

Authors: Lamport, L. | Schanler, R. | Weinberger, B.

Article Type: Research Article

Abstract: BACKGROUND: Iron (Fe) is essential for growth, but optimal intake is controversial. Our NICU practice was to supplement 2 mg/kg/d Fe for all preterm infants receiving human milk when they achieved full feeding volume. Adjusting Fe supplementation based on ferritin levels is thought to better address physiologic requirements. Our objective was to assess the impact of therapeutic monitoring of ferritin levels on the initiation and dosing of iron supplementation, hematocrit, transfusions, and oxygen radical diseases in preterm infants. METHODS: Preterm infants (< 32 weeks gestation, n  = 100) were included. Ferritin was measured when full feeds were achieved, and then every …2 weeks. Fe was started at 2 mg/kg/d or continued at current dose for ferritin 40–300μg/L, increased by 1–2 mg/kg/d for < 40μg/L, or discontinued for > 300μg/L. Outcomes were compared with a historical control group. RESULTS: Ferritin levels were not predictable by dietary or transfusion histories. Using the ferritin protocol, 70% of infants received Fe at the time of full feeds, compared to 100% of controls. In contrast, all infants received Fe 4 weeks later, compared to 87% of controls. Mean age at Fe initiation increased (14.8±6.3 to 21.0±11.76 days). Peak doses were higher, with 32% receiving > 2 mg/kg day by 6 weeks, with fewer transfusions. The incidence of bronchopulmonary dysplasia and necrotizing enterocolitis did not change. CONCLUSION: An iron protocol based on ferritin levels results in later initiation, higher doses, and fewer transfusions, without increasing oxygen radical diseases. Show more

Keywords: Iron, neonatal, nutrition, prematurity

DOI: 10.3233/NPM-210912

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 567-574, 2022

Authors: Lu, I-Chun | Chang, Yu-Chia | Chen, Yin-Ting | Lin, Hsiang-Yu | Chiu, Hsiao-Yu | Tsai, Ming-Luen | Lin, Hung-Chih

Article Type: Research Article

Abstract: BACKGROUND: We aimed to explore the epidemiology and evolution of pathogens, antibiotic susceptibility, and mortality rate in cases of neonatal early-onset sepsis (EOS) reported over a period of 12 years in a level III neonatal center in Central Taiwan. METHODS: Patients’ medical records in a neonatal center from 2007 to 2018 were reviewed to obtain information on infants with culture-proven EOS, which included pathogens found in the blood or cerebrospinal fluid cultures. RESULTS: The incidence of neonatal EOS during this period was 2.11 cases/1,000 admissions. Group B streptococcal (GBS) and Escherichia coli were the most …common pathogens. The overall rates of GBS and E. coli infections were 0.68/1,000 and 0.77/1,000 live births, respectively. The incidence of EOS in infants with a birth weight ≥1,500 g decreased significantly with decreasing incidence of GBS-related sepsis. The incidence of EOS remained high in very-low-birth-weight (VLBW) infants and increased over time. There was an increasing trend in of E. coli infection and emergence of drug-resistant strains. In addition, E. coli sepsis had high mortality in VLBW infants. CONCLUSION: Novel screening and prevention strategies against E. coli and reserving broad-spectrum antibiotics for the most critically ill or VLBW patients with maternal chorioamnionitis might help in early diagnosis and further improve the outcomes of EOS. Show more

Keywords: Neonatal early-onset sepsis, Escherichia coli, Group B Streptococcus

DOI: 10.3233/NPM-210938

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 575-582, 2022

Authors: Almeida, André Coelho | Granado, Maria Cristina | Sousa, Patrícia | Vieira, Maria João

Article Type: Research Article

Abstract: BACKGROUND: The lockdowns imposed by countries due to COVID-19 pandemic had enormous impact on healthcare. Our goal is to determine consequences of the COVID-19 pandemic lockdown on neonatal hospitalizations and disease incidence in our hospital. METHODS: Observational retrospective study comparing newborns admitted to the neonatal care unit (NCU) from emergency department (ED). Newborns were distributed in two groups according to the date of the lockdown (22/3/2020): pre-lockdown group (12 month before) and post-lockdown group (12 month after). Categorical variables were compared according to chi square test and continuous variables with Mann-Whitney test. A Bonferroni corrected p-value  < 0.006 was …considered statistically significant. The monthly hospitalization rate between the two groups was analyzed with Generalized Method of Moments – System. RESULTS: We included 99 patients, 65/99 (65.7%) in the pre-lockdown group and 34/99 (34.3%) in the post-lockdown group. Pre-lockdown group: median age at hospitalization 19 (10–26) days, duration of symptoms 12 (5.5–36) hours. Post-lockdown group: median age at hospitalization 16 (6–24) days, duration of symptoms 14 (6–72) hours. The incidence of contagious disease was higher in the pre-lockdown group: 27/65 (41.5%) versus 3/34 (8.8%) in post-lockdown group (p  = 0.001). No statistically significant difference in gestational age, gender, age at hospitalization, duration of symptoms and length of stay. CONCLUSION: Lockdown decreased admissions in NCU due to the decrease in contagious infections. The similar duration of symptoms before age at hospitalization in the two groups might indicate that health care accessibility has been maintained. Show more

Keywords: Accessibility, contagious, COVID19, lockdown, newborn

DOI: 10.3233/NPM-210961

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 583-588, 2022

Authors: Hesse, Hilary | Palmer, Claire | Rigdon, Camille Driver | Galan, Henry L. | Hobbins, John C. | Brown, Laura D.

Article Type: Research Article

Abstract: BACKGROUND: Fetal growth restriction (FGR) is most commonly diagnosed in pregnancy if the estimated fetal weight (EFW) is < 10th %. Those with abnormal Doppler velocimetry, indicating placental insufficiency and pathological FGR, demonstrate reduced fat and lean mass compared to both normally growing fetuses and FGR fetuses with normal Dopplers. The aim of this study was to determine how severity of FGR and abnormal Doppler velocimetry impacts neonatal body composition. Among a cohort of fetuses with an EFW < 10th %, we hypothesized that those with abnormal Dopplers and/or EFW < 3rd % would have persistent reductions in lean body mass and fat mass extending …into the neonatal period compared to fetuses not meeting those criteria. METHODS: A prospective cohort of FGR fetuses with an estimated fetal weight (EFW) < 10th % was categorized as severe (EFW < 3rd % and/or abnormal Dopplers; FGR-S) versus mild (EFW 3–10th %; FGR-M). Air Displacement Plethysmography and anthropometrics were performed at birth and/or within the first 6–8 weeks of life. RESULTS: FGR-S versus FGR-M were born one week earlier (P  = 0.0024), were shorter (P  = 0.0033), lighter (P  = 0.0001) with smaller weight-for-age Z-scores (P  = 0.0004), had smaller head circumference (P  = 0.0004) and lower fat mass (P  = 0.01) at birth. At approximately 6–8 weeks postmenstrual age, weight, head circumference, and fat mass were similar but FGR-S neonates were shorter (P  = 0.0049) with lower lean mass (P  = 0.0258). CONCLUSION: Doppler velocimetry abnormalities in fetuses with an EFW < 10th % identified neonates who were smaller at birth and demonstrated catch-up growth by 6–8 weeks of life that favored fat mass accretion over lean mass and linear growth. Show more

Keywords: Air displacement plethysmography, anthropometry, body composition, fetal growth restriction, intrauterine growth restriction, neonate, small for gestational age

DOI: 10.3233/NPM-210872

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 589-598, 2022

Authors: Mehta, R. | Petrova, A.

Article Type: Research Article

Abstract: BACKGROUND: This study prospectively investigated the levels of energy metabolism hormones in very preterm neonates to identify their change over time and association with intake of maternal milk as well as weight gain velocity. METHODS: We measured and compared the leptin, adiponectin, ghrelin, and insulin-like growth factor I (IGF-1) levels in the urine of 70 very preterm neonates, before the initiation of any enteral feeding (baseline level) and twice within 14 days on full enteral feeding (FEF). Regression models identified the role of intake of maternal milk on the levels of the tested energy metabolism hormones in the …enteral-fed infants. We also analyzed the adequacy of the weight gain velocity defined by the fetal-infant growth reference (FIGR). Additionally, we collected and analyzed the infants’ clinical and feeding characteristics during the birth hospitalization. RESULTS: The preterm infants’ baseline levels of the energy metabolism hormones significantly predicted their increase at the end of two weeks of observation on FEF. The leptin level was associated with increased intake of maternal milk, whereas the feeding volume was associated with increased ghrelin and IGF-1, and decreased leptin and adiponectin. Infants with comparable FIGR had higher leptin levels than those with inadequate weight gain velocity. CONCLUSION: Early postnatal levels of leptin, adiponectin, ghrelin, and IGF-1 predicted the increase of these hormones in the fully enteral fed very preterm neonates. Moreover, greater intake of maternal milk by the study infants contributed to an increased leptin-associated weight gain velocity. Show more

Keywords: Energy metabolism hormones, maternal milk, preterm neonates

DOI: 10.3233/NPM-210936

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 599-607, 2022

Authors: Kumar, D. | Kumar, D.

Article Type: Research Article

Abstract: BACKGROUND: Jaundice is the quite common benign condition in neonates, but due to its potential toxicity, neonates must be monitored. This study was aimed to evaluate the effect of serum albumin level on the transcutaneous bilirubin (TcB) measurements in term neonates with unconjugated hyperbilirubinemia. METHODS: Serum albumin and total serum bilirubin (TSB) of 252 jaundiced term neonates were estimated and simultaneously TcB was measured over sternum and the effect of serum albumin on TcB measurements was evaluated. RESULTS: The correlation between TSB and TcB was linear and significant for the entire cohort. When this correlation was …studied separately in the groups with different albumin levels, maximum correlation (r  = 0.888, R2 linear = 0.789, p  < 0.001) was observed in group 1 with hypo-albuminemia followed by in group 2 with normal albumin levels (r  = 0.854, R2 linear = 0.729, p  < 0.001) and group 3 with higher albumin levels (r  = 0.809, R2 linear = 0.689, p  < 0.001). Bland-Altman plot analysis of whole study population demonstrate good agreement between TSB and TcB [95% CI = –0.038 to 0.493 mg/dL, 17/252 = 6.75% outside the limits of agreement, Mean difference = 0.227]. This analysis in different groups also show good agreement between TSB and TcB. CONCLUSIONS: The correlation between the TSB and TcB may affected by serum albumin level. Therefore, transcutaneous bilirubinometry is not able to replace invasive TSB measurement. However, in the absence of TSB it could be an alternative to measure the level of bilirubin in term neonates. Show more

Keywords: Neonates, phototherapy, total serum bilirubin, transcutaneous bilirubin

DOI: 10.3233/NPM-210958

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 609-615, 2022

Authors: Goldberg, Jessica | Rose, Kelsey | Matthews, Olivia | Boles, Jessika

Article Type: Research Article

Abstract: BACKGROUND: Legacy interventions are standard in most children’s hospitals, but little is known about how bereaved parents understand and describe the concept of legacy that these interventions are designed to Address. The aim of this qualitative study was to understand the legacy experiences and perceptions of parents who have experienced perinatal or early infant (less than three months of age) loss. METHODS: Grounded in constructionist epistemology and phenomenological qualitative traditions, ten bereaved parents completed an in-depth phenomenological interview regarding their perceptions of and experiences with the legacy of their deceased child. Interviews were transcribed verbatim and analyzed using …an open, inductive coding process to illuminate the essence of participants’ experiences. RESULTS: Three themes were identified: 1) legacies are composed of memories and experiences that have a lasting effect on others; 2) healthcare experiences both generate and participate in infants’ legacies; and 3) parents’ legacy perceptions are shaped by cultural conceptions, spiritual beliefs, and grief experiences. Parents described experiences and interactions with community members and healthcare providers that honored or challenged their perceptions of their child’s unique legacy. CONCLUSIONS: In the context of perinatal or early infant loss, bereaved parents describe legacy as enduring, unique to each child and family, and heavily influenced by healthcare experiences and staff relationships. Parent-led, legacy-oriented interventions are needed in maternal/fetal, labor/delivery, and neonatal intensive care settings to support parent coping with loss. Show more

Keywords: Bereavement, legacy, parents, loss, psychosocial, qualitative

DOI: 10.3233/NPM-210897

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 617-626, 2022

Authors: Khorshid, Arian | Mayo, Jonathan | Chueh, Jane | Shaw, Gary M. | Stevenson, David | Ness, Amen

Article Type: Research Article

Abstract: BACKGROUND: Serial cervical length screening is performed in women with a history of preterm birth to determine indication for cerclage placement. Our aim is to evaluate the frequency of cerclage placement in consecutive pregnancies with preterm birth history to determine whether performing serial cervical length screening for women with a history of late (34–36 6/7 weeks) spontaneous preterm birth (SPTB) should be reconsidered. METHODS: Retrospective evaluation of cerclage frequency and gestational age of delivery for consecutive singleton births for 69,671 women whose first birth was a SPTB. RESULTS: History of late SPTB was associated with a …lower frequency of cerclage than history of early SPTB (0.83% vs 4.88%, OR 0.16, 95% CI 0.14–0.18). Rates of recurrent SPTB were lower for women with history of late SPTB than those with history of early SPTB (13.45%, 3.74% early, 9.71% late vs 20.69%, 9.12% early, 11.57% late). CONCLUSION: Women with a history of late PTB have a lower risk of recurrent PTB than those with a history of early PTB but constitute most of those undergoing serial cervical length screening for potential cerclage placement. Practice guidelines for screening women with a history of late PTB should be re-evaluated. Show more

Keywords: Cervical cerclage, premature birth, cervical length measurement, spontaneous pretemature birth, recurrent premature birth

DOI: 10.3233/NPM-210834

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 627-633, 2022

Authors: Vibert, Y. | Capriolo, C. | Mossabeb, R. | Fleishman, R.

Article Type: Research Article

Abstract: OBJECTIVE: Narrative medicine is a tool that may foster compassionate and empathetic practitioners. Pediatric residents completing their intensive care rotations in the Pediatric Intensive Care Unit (PICU) and Neonatal Intensive Care Unit (NICU) may experience burnout and compassion fatigue making empathic communication and compassionate care challenging. Our goal was to examine how residents working in the NICU and PICU at one children’s hospital responded to a narrative medicine curriculum. METHODS: In this cross-sectional qualitative study, pediatric residents participated in two narrative medicine sessions during their NICU or PICU rotation. At the end of each NICU or PICU block, …residents received an IRB-approved anonymous REDCap survey. The survey included four open-ended questions about the sessions. Responses were interpreted by NVivo 1.0 (QSR International). RESULTS: 22 of 36 residents (61%) responded to the survey. Residents noted the sessions provided worthwhile forums for self-reflection and release of emotion. Residents identified empathic witnessing to each other as a strength. The forum for group reflection and shared perspectives was empowering. Reflective writing was a valued skill. CONCLUSION: Pediatric residents rotating in the NICU and PICU endorsed narrative medicine sessions as a fulfilling and meaningful forum for them to share emotions and reflect on the experiences of their colleagues. Show more

Keywords: Empathic witnessing, narrative medicine, resident burnout

DOI: 10.3233/NPM-210923

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 635-642, 2022

Authors: Weimer, K.E.D. | Bidegain, M. | Shaikh, S.K. | Couchet, P. | Tanaka, D.T. | Athavale, K.

Article Type: Research Article

Abstract: BACKGROUND: Late preterm infants are at high risk for medical complications and represent a growing NICU population. While 34-weeks’ gestation infants are generally admitted to the NICU and 36-weeks’gestation infants stay in mother-baby, there is wide practice variation for 35-weeks’gestation infants. The objective of this study was to compare short-term outcomes of 35-weeks’ gestation infants born at two hospitals within the same health system (DUHS), where one (DRH) admits all 35-weeks’ gestation infants to their level II NICU and the other (DUH) admits all 35-weeks’ gestation infants to mother-baby, unless clinical concern. METHODS: We conducted a retrospective cohort …analysis of 35-weeks’ gestation infants born at DUHS from 2014–2019. Infant specific data were collected for birth, demographics, medications, medical therapies, LOS, ED visits and readmissions. 35-weeks’ gestation infants at each hospital (DRH vs DUH) that met inclusion criteria were compared, regardless of unit(s) of care. RESULTS: 726 infants of 35-weeks’ gestation were identified, 591 met our inclusion criteria (DUH –462, DRH –129). Infants discharged from DRH were more likely to receive medical therapies (caffeine, antibiotics, blood culture, phototherapy, NGT), had a 4 day longer LOS, but were more likely to feed exclusively MBM at discharge. There were no differences in ED visits; however, more infants from DUH were readmitted within 30 days of discharge. CONCLUSIONS: Our findings suggest admitting 35-weeks’ gestation infants directly to the NICU increases medical interventions and LOS, but might reduce hospital readmissions. Show more

Keywords: 35 weeks’ gestation, late preterm infant, length of stay, mother-baby, NICU, readmission

DOI: 10.3233/NPM-221015

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 643-651, 2022

Authors: Jasthi, D. | Kollikonda, S. | Karnati, S.

Article Type: Case Report

Abstract: BACKGROUND: Adenosine triphosphate-binding cassette transporter A3 (ABCA3) mutations are recognized as a congenital cause of surfactant deficiency. Clinical presentations of such mutations are largely variable. There are many mutations of the ABCA3 gene, of which, p.E292V is the most common. Despite being the most common ABCA3 gene mutation, there is limited literature on extra pulmonary and long-term outcomes of the affected infants. CASE: We present the case of a Caucasian male infant born at 32 weeks gestation that developed severe respiratory distress shortly after birth, and review published case reports and case series of infants affected with this …gene mutation. He was found to have a heterozygous missense mutation p.E292V of ABCA3 resulting in a chronic lung disease. He required multiple courses of systemic and inhalational steroids. He developed supraventricular tachycardia (SVT), feeding problems and hypotonia during his prolonged hospital stay. He demonstrated mild neurodevelopmental delays on follow up at 18 months of age. The chronic lung disease improved over the first 2 years of life. He continued to have feeding difficulties and supraventricular tachycardia at nearly 2 years of age. CONCLUSION: The infant’s SVT may be associated with this ABCA3 variant. Further long-term follow-up studies are needed to better characterize extrapulmonary manifestations of this ABCA3 mutation. Show more

Keywords: BSID III, neurodevelopment, p.E292V, supra ventricular tachycardia

DOI: 10.3233/NPM-210879

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 653-658, 2022

Authors: Stepanovich, G. | Donn, S.M.

Article Type: Research Article

Abstract: Breast milk feeding is an important late-onset sepsis reduction strategy in the Neonatal Intensive Care Unit (NICU). However, multiple studies have reported transfer of bacteria-contaminated breast milk to infants. We describe a case of culture-positive breast milk resulting in persistent Enterococcus bacteremia in an infant. Beyond the development of an infant’s innate and specific immunity as well as colonization of the gastrointestinal (GI) tract with commensal organisms, the risk of bacterial translocation from the GI tract into the bloodstream is shaped and modified by maternal health, birth history, and an infant’s NICU course. While freezing and/or pasteurizing breast milk …reduces or eliminates its bacterial load, it also diminishes its immunologic and nutritional benefits. Show more

Keywords: Breast milk, late-onset sepsis, neonate, prematurity

DOI: 10.3233/NPM-210851

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 659-662, 2022

Authors: Akhter, A.P. | Donn, S.M.

Article Type: Case Report

Abstract: A preterm female presented with severe respiratory distress in the delivery room and was found to have tracheal agenesis with a tracheoesophageal fistula and a congenital heart defect. Tracheal agenesis is uncommon and is often associated with other congenital abnormalities. Although there are surgical options for repair, mortality remains high.

Keywords: Tracheal agenesis, tracheoesophageal atresia, tracheoesophageal fistula, tracheal reconstruction

DOI: 10.3233/NPM-210846

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 663-665, 2022

Authors: Bhardwaj, P. | Thattaruparambil, V. P. | Vellaisamy, G. | Mahadevaiah, S. | Hegde, S.

Article Type: Case Report

Abstract: Melena is reported in 1 of 350 to 400 new-borns. Significant upper gastrointestinal bleeding in a neonate with an antenatally diagnosed abdominal mass has not been reported before. This case highlights an unusual presentation of a gastric teratoma and proposes a probable embryological explanation for the site of occurrence.

Keywords: Antenatal diagnosis, embryology, gastric teratoma, melena, neonate, newborn

DOI: 10.3233/NPM-210931

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 667-669, 2022