Journal of Neonatal-Perinatal Medicine - Volume 15, issue 4

Authors: Ben Fadel, N. | Surak, A. | Almoli, E. | Jankov, R.

Article Type: Article Commentary

Abstract: Implementing any new service or program in the health care system is not always straightforward; a multi-stage implementation process is required most of the time. With the advancements in neonatal care and increased survival rates, there has been an increased need for ongoing assessment of hemodynamic stability. At the Children’s Hospital of Eastern Ontario and the Ottawa Hospital Neonatal Intensive Care Units (NICUs), University of Ottawa, Canada, Targeted Neonatal Echocardiography service (TnEcho) was successfully established and has led to improvement in the hemodynamic evaluation and decision making in neonatal intensive care. In this article, we describe our experience establishing this …program and the process of ensuring its success. This review article highlights the ten steps taken by multiple stakeholders to achieve this goal; this may help other centres implement a similar program. Show more

Keywords: Neonate, preterm, TnECHO

DOI: 10.3233/NPM-210974

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 4, pp. 671-676, 2022

Authors: Sharma, N. | Samuel, A.J.

Article Type: Review Article

Abstract: AIM: The aim of this review is to identify available evidence on MSS practices as a pain-relieving intervention among neonates undergoing a repetitive painful procedure. METHODS: Searches were performed in the following databases: PubMed/ MEDLINE, SCOPUS, CINAHL, and the physiotherapy evidence database (PEDro). A total of eight studies were identified, among them; studies related to MSS in relieving neonatal procedural pain were conducted only in three countries only. RESULTS: Data collected from the identified studies were extracted by two independent reviewers, and were synthesized quantitatively, and qualitatively. Eight studies involving six hundred and eighty-six neonates in …three countries were identified in the search. Among them, six were randomized controlled trials, and two were observational studies. The study results highlighted that implementation of MSS as a non-pharmacological pain-relieving intervention follows a similar protocol among the reviewed articles, but varies by who administers MSS (Physiotherapists/ Nurses/Mothers) in neonates undergoing repetitive painful procedures. INTERPRETATION: Standardized MSS protocol should be followed globally along with its implementation for reducing procedural pain among neonates and also to promote good clinical practice in neonatal intensive care unit (NICU) settings. Future research could determine the effects of standardized MSS protocol either with or without other non-pharmacological interventions among neonates undergoing painful procedures. Show more

Keywords: Analgesia, neonates, procedural, pain, physiotherapy

DOI: 10.3233/NPM-221087

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 4, pp. 677-687, 2022

Authors: Lalitha, R. | Surak, A. | Bitar, E. | Hyderi, A. | Kumaran, K.

Article Type: Review Article

Abstract: Optimal fluid management of preterm babies with suspected or confirmed diagnosis of patent ductus arteriosus (PDA) is frequently challenging for neonatal care physician because of paucity of clinical trials. There is wide variation in practice across neonatal units, resulting in significant impact on outcomes in Extremely Low Birth Weight (ELBW) babies with hemodynamically significant PDA. A delicate balance is required in fluid management to reduce mortality and morbidity in this population. The purpose of this review is to lay out the current understanding about fluid and electrolyte management in ELBW babies with hemodynamically significant PDA and highlight areas for future …research. Show more

Keywords: Diuretics, electrolytes, fluid management, patent ductus arteriosus, preterm neonates

DOI: 10.3233/NPM-210943

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 4, pp. 689-697, 2022

Authors: Abiramalatha, T. | Ramaswamy, V.V. | Bandyopadhyay, T. | Somanath, S.H. | Shaik, N.B. | Kallem, V.R. | Pullattayil, A.K. | Kaushal, M.

Article Type: Review Article

Abstract: BACKGROUND: Despite appropriate antibiotic therapy, the risk of mortality in neonatal sepsis still remains high. We conducted a systematic review to comprehensively evaluate different adjuvant therapies in neonatal sepsis in a network meta-analysis. METHODS: We included randomized controlled trials (RCTs) and quasi-RCTs that evaluated adjuvant therapies in neonatal sepsis. Neonates of all gestational and postnatal ages, who were diagnosed with sepsis based on blood culture or sepsis screen were included. We searched MEDLINE, CENTRAL, EMBASE and CINAHL until 12th April 2021 and reference lists. Data extraction and risk of bias assessment were performed in duplicate. A network meta-analysis …with bayesian random-effects model was used for data synthesis. Certainty of evidence (CoE) was assessed using GRADE. RESULTS: We included 45 studies involving 6,566 neonates. Moderate CoE showed IVIG [Relative Risk (RR); 95% Credible Interval (CrI): 1.00; (0.67–1.53)] as an adjunctive therapy probably does not reduce all-cause mortality before discharge, compared to standard care. Melatonin [0.12 (0–0.08)] and granulocyte transfusion [0.39 (0.19–0.76)] may reduce mortality before discharge, but CoE is very low. The evidence is also very uncertain regarding other adjunctive therapies to reduce mortality before discharge. Pentoxifylline may decrease the duration of hospital stay [Mean difference; 95% CrI: –7.48 days (–14.50–0.37)], but CoE is very low. CONCLUSION: Given the biological plausibility for possible efficacy of these adjuvant therapies and that the CoE from the available trials is very low to low except for IVIG, we need large adequately powered RCTs to evaluate these therapies in sepsis in neonates. Show more

Keywords: Adjuvant therapy, neonatal mortality, neonatal sepsis, network meta-analysis

DOI: 10.3233/NPM-221025

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 4, pp. 699-719, 2022

Authors: Afifi, J. | Leijser, L.M. | de Vries, L.S. | Shah, P.S. | Mitra, S. | Brouwer, M.J. | Walling, S. | McNeely, P.D.

Article Type: Research Article

Abstract: OBJECTIVES: To investigate the variability in diagnostic and therapeutic approaches to posthemorrhagic ventricular dilatation (PHVD) among Canadian neonatal centers, and secondary exploration of differences in approaches between Canadian and European practices. METHODS: We conducted a survey among Canadian tertiary neonatal centers on their local practices for managing very preterm infants with PHVD. The survey covered questions on the diagnostic criteria, timing and type of interventions and resources utilization (transfer to neurosurgical sites and neurodevelopmental follow-up). In a secondary exploration, Canadian responses were compared with responses to the same survey from European centers. RESULTS: 23/30 Canadian centers …(77%) completed the survey. There was no consensus among Canadian centers on the criteria used for diagnosing PHVD or to initiate intervention. The therapeutic interventions also vary, both for temporizing procedures or permanent shunting. Compared to European practices, the Canadian approach relied less on the sole use of ultrasound criteria for diagnosing PHVD (43 vs 94%, p  < 0.0001) or timing intervention (26 vs 63%, p  = 0.007). Majority of European centers intervened early in the development of PHVD based on ultrasound parameters, whereas Canadian centers intervened based on clinical hydrocephalus, with fewer centers performing serial lumbar punctures prior to neurosurgical procedures (40 vs 81%, p  = 0.003). CONCLUSION: Considerable variability exists in diagnosis and management of PHVD in preterm infants among Canadian tertiary centers and between Canadian and European practices. Given the potential implications of the inter-center practice variability on the short- and long-term outcomes of preterm infants with PHVD, efforts towards evidence-based Canada-wide practice standardization are underway. Show more

Keywords: Intraventricular hemorrhage, posthemorrhagic hydrocephalus, preterm/premature infant, ventriculoperitoneal shunt

DOI: 10.3233/NPM-221071

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 4, pp. 721-729, 2022

Authors: Milman, N. T.

Article Type: Research Article

Abstract: OBJECTIVE: To assess effects of iron supplementation, 66 mg elemental iron daily as ferrous fumarate, on iron status markers during normal pregnancies. METHODS: Randomized, double-blind, placebo-controlled study of 119 women (62 iron-, 57 placebo -treated) and their newborns. Hemoglobin (Hb), serum (S)-ferritin, S-transferrin saturation percentage (TSAT) and S-erythropoietin (S-EPO) were measured at 14–18, 24–27 weeks of gestation, prepartum, 1 and 8 weeks postpartum. RESULT: From 24–27 weeks gestation to 8 weeks postpartum, the iron group had higher Hb, S-ferritin and TSAT than the placebo group; prepartum, 11% had iron deficiency (ID) and 0% iron deficiency anemia …(IDA) in the iron group, vs 60% and 18% in the placebo group; 8 weeks postpartum 1.6% in the iron group had ID and 1.6% IDA vs 14% and 7% in the placebo group. S-EPO levels in the iron group were lower than in the placebo group (p  < 0.001). Mothers prepartum S-EPO values were correlated to newborns cord S-EPO values (p  < 0.001). Newborns to iron treated mothers had higher cord S-ferritin levels than those to placebo treated mothers (p  = 0.02). Newborn girls had higher cord S-ferritin levels than boys (p  < 0.01). There was no impact of iron supplementation on the length of gestation, placental weight, or newborns birth weight. Birth weight was correlated only with mothers’ body weight, length of gestation and placental weight. CONCLUSION: Iron supplementation had a “positive” impact on iron status and Hb both during pregnancy and postpartum, with a low frequency of ID/IDA and also a “positive” influence on newborns iron status. Show more

Keywords: Anemia, iron deficiency, birth weight, erythropoietin, fetal blood, infant, newborn, iron supplement, placebo-controlled study, pregnancy

DOI: 10.3233/NPM-221014

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 4, pp. 731-744, 2022

Authors: Prince, A. | Cruz-Bendezú, A. | Gunawansa, N. | Wade, J. | Coleman-Cowger, V. H. | Schulkin, J. | Macri, C. J.

Article Type: Research Article

Abstract: BACKGROUND: Genetic screening and testing are technologies historically underutilized in Black populations despite predicting diseases like sickle cell disease (SCD), which is predominantly found in Blacks. We surveyed prenatal patients to understand choices, beliefs and experiences surrounding genetic screening and testing, specifically for SCD. METHODS: In this cross-sectional study, we surveyed 322 women during prenatal visits. Responses were analyzed to identify barriers to care and education about testing and screening for SCD. Patients rated whether they agreed or disagreed with statements regarding sickle cell health behaviors. We used χ2 tests to compare categorical variables by self-reported race. …Binary logistic regression was used to determine the odds ratios and confidence intervals for each outcome. RESULTS: Women were a mean (SD) age of 33.3 (6.1). 42.9% of patients self-identified as White while 41.3% of patients self- identified as Black. Screening questions were adjusted for differences in race, insurance, and education levels to show significant differences in responses between Blacks and Whites for screening for SCD (p  = 0.047, OR 95% CI = 0.455 [0.210–0.989]) and plans to meet with genetic counselors (p  = 0.049, OR 95% CI = 0.299 [0.090–0.993]). The statements “if sickle cell is not in their family, then it is likely not in themselves or their children,” was significantly different between Black and White populations (p  = 0.011, OR 95% CI = 0.207 [0.081–0.526]). CONCLUSION: Our findings suggest gaps in screening, testing, education, and pregnancy management choices between Black and White patients. Research should focus on decreasing these healthcare gaps and improving education that address concerns about SCD for relevant populations. Show more

Keywords: Genetic screening, provider practices, sickle cell

DOI: 10.3233/NPM-221016

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 4, pp. 745-751, 2022

Authors: Friedman, D. | Zubair, N. | Favara, M.T. | Lafferty, M. | Carola, D. | Adeniyi-Jones, S. | Solarin, K. | Aghai, Z.H.

Article Type: Research Article

Abstract: BACKGROUND: Small for gestational age (SGA) infants are likely to have decreased placental transfer of opioids and other substances and lower amounts of fat deposition, hence less severe neonatal abstinence syndrome (NAS). The goal of this study is to correlate SGA status and severity of NAS in infants admitted to the neonatal intensive care unit (NICU). METHODS: This is a retrospective analysis of term and late-preterm infants (≥35 weeks gestation) exposed to in-utero substances, born between September 2006 and May 2021, and admitted to an inner-city NICU for medical therapy for NAS. Indicators of the severity of NAS …(duration of medical treatment, duration of hospitalization, use of phenobarbital, and use of clonidine) were compared between infants characterized as SGA (birth weight <10th percentile for gestational age) to those not categorized as SGA (non-SGA). RESULTS: A total of 992 infants met the study criteria; 205 (20.7%) in the SGA group and 787 (79.3%) in the non-SGA group. The median duration of medical treatment was significantly lower in infants in the SGA group (22 days vs. 26 days, p  = 0.04) and they were less likely to be treated with phenobarbital (19% vs. 26.8%, p  = 0.02). CONCLUSION: SGA infants displayed less severe NAS symptoms as indicated by shorter a duration of medical treatment and decreased need for phenobarbital. Our findings may impact decisions around identifying the optimum treatment protocols catered to SGA infants with NAS. Show more

Keywords: NAS, neonates, neonatal opioid withdrawal syndrome (NOWS), opiates withdrawal

DOI: 10.3233/NPM-221053

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 4, pp. 753-758, 2022

Authors: Gupta, V.S. | Shepherd, S.T. | Ebanks, A.H. | Lally, K.P. | Harting, M.T. | Basir, M.A.

Article Type: Research Article

Abstract: BACKGROUND: While physiologic stabilization followed by repair has become the accepted paradigm for management of congenital diaphragmatic hernia (CDH), few studies have examined the effect of incremental changes in operative timing on patient outcomes. We hypothesized that later repair would be associated with higher morbidity and mortality. METHODS: Data were queried from the CDH Study Group (CDHSG) from 2007-2020. Patients with chromosomal or cardiac abnormalities and those who were never repaired or required pre-repair extra-corporeal life support (ECLS) were excluded. Time to repair was analyzed both as a continuous variable and by splitting the cohort into …top/bottom percentiles. The primary outcome of interest was in-hospital mortality. Secondary outcomes included need for and duration of post-repair ventilatory and nutritional support. RESULTS: A total of 4,104 CDH infants were included. Median time to repair was 4 days (IQR 2–6). On multivariable analysis, high-risk (CDHSG stage C/D) defects and lower birthweight predicted later repair. Overall, in-hospital mortality was 6%. On univariate analysis, there was no difference in the number of days to repair between survivors and non-survivors. On risk-adjusted analysis, single-day changes in day of repair were not associated with increased mortality. Later repair was associated with longer time to reach full oral feeds, increased post-repair ventilator days, and increased need for tube feeds and supplementary oxygen at discharge. CONCLUSIONS: For infants with isolated CDH not requiring pre-operative ECLS, there is no difference in mortality based on timing of repair, but single-day delays in repair are associated with increased post-repair duration of ventilatory and nutritional support. Show more

Keywords: CDH, CDH Study Group, Congenital diaphragmatic hernia, diaphragm repair, registry, repair

DOI: 10.3233/NPM-221072

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 4, pp. 759-765, 2022

Authors: Chioma, R. | Amabili, L. | Ciarmoli, E. | Copetti, R. | Villani, P. | Stella, M. | Storti, E. | Pierro, M.

Article Type: Research Article

Abstract: BACKGROUND: Lung Ultrasound (LUS)-guided Lung Recruitment Maneuver (LRM) has been shown to possibly reduce ventilator-induced lung injury in preterm infants. However, to avoid potential hemodynamic and pulmonary side effects, the indication to perform the maneuver needs to be supported by early signs of lung recruitability. Recently, a new LUS pattern (S-pattern), obtained during the reopening of collapsed parenchyma, has been described. This study aims to evaluate if this novel LUS pattern is associated with a higher clinical impact of the LUS-guided LRMs. METHODS: All the LUS-guided rescue LRMs performed on infants with oxygen saturation/fraction of inspired oxygen (S/F) …ratio below 200, were included in this cohort study. The primary outcome was to determine if the presence of the S-pattern is associated with the success of LUS-guided recruitment, in terms of the difference between the final and initial S/F ratio (Delta S/F). RESULTS: We reported twenty-two LUS-guided recruitments, performed in nine patients with a median gestational age of 34 weeks, interquartile range (IQR) 28–35 weeks. The S-pattern could be obtained in 14 recruitments (64%) and appeared early during the procedure, after a median of 2 cmH2O (IQR 1–3) pressure increase. The presence of the S-pattern was significantly associated with the effectiveness of the maneuver as opposed to the cases in which the S-pattern could not be obtained (Delta S/F 110 +/- 47 vs 44 +/- 39, p  = 0.01). CONCLUSIONS: Our results suggest that the presence of the S-pattern may be an early sign of lung recruitability, predicting LUS-guided recruitment appropriateness and efficacy. Show more

Keywords: Intensive care, mechanical ventilation, neonatal, respiratory distress syndrome, point-of-care diagnostics, respiratory insufficiency, ventilator-induced lung injury

DOI: 10.3233/NPM-221088

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 4, pp. 767-776, 2022

Authors: Dhooria, Gurdeep Singh | Nautiyal, Arushi | Wazir, Sanjay | Agrawal, Gopal | Tiwana, Anupreet | Bajaj, Naveen | Gupta, Naveen Parkash | Mirgunde, Shishir | Sahoo, Jagdish | Balachandran, Binesh | Afzal, Kamran | Shrivastava, Anubha | Bagla, Jyoti | Krishnegowda, Sushma | Konapur, Ananth | Soni, Kritika | McCulloch, Mignon | Bunchman, Timothy | Sethi, Sidharth Kumar | Raina, Rupesh

Article Type: Research Article

Abstract: OBJECTIVE: A rapid AKI risk assessment score would allow for improving management and outcomes. STARZ (Sethi, Tibrewal, Agrawal, Raina, waZir) score was developed for acute kidney injury (AKI) risk stratification of critically ill neonates. This is the first independent validation for the novel score outside the original enrolled centres. STUDY DESIGN: 750 neonates were included in the study. The STARZ score was calculated after 12 hours of admission. Neonates admitted in NICU and receiving IV fluids for at least 48 hours were included. RESULTS: A total of 8.8% neonates had AKI in the first 7 days …post admission. The duration of hospital stay was significantly higher among neonates with AKI [10.5 (7–19) vs. 7 (5–10) days; p  < 0.001]. Mortality risk was 6.4 times higher among those with AKI [8 (12.1%) vs. 13 (1.9%); p  < 0.001; RR (95% CI): 6.38 (2.74–14.83)]. In this study, the STARZ neonatal scoring model showed a sensitivity of 89.4% in detecting AKI with a 90.9% specificity and a high negative predictive value of 98.9%. The area under ROC was 0.958 (0.934–0981) - a high discriminative power. CONCLUSIONS: The STARZ score allows for AKI risk stratification, providing opportunity for therapeutic interventions which may improve outcomes in critically ill neonates. Show more

Keywords: AKI risk, stratification score, Neonatal AKI, validation

DOI: 10.3233/NPM-221044

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 4, pp. 777-785, 2022

Authors: Mohamed, H.I. | ELMeneza, S.A. | EL-Bagoury, I. M.S.

Article Type: Research Article

Abstract: BACKGROUND: Neonatal sepsis is a major cause of morbidity and mortality among neonates. Nod-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome is a core element for innate immune protection. The study aims to estimate the expression of NLRP3 inflammasome in full term newborn infants who suffer from late onset sepsis, in order to assess its diagnostic value. METHOD: This case-control study was conducted in NICU. 40 newborns with late onset sepsis, and 40 control neonates were included. The analysis of NLRP3 inflammasome was done by ELISA. RESULTS: There was a significant elevation of NLRP3 inflammasome in …the serum of neonates with late onset sepsis group than the control group, P values were < 0.001, and the best cut off value of NLRP3 to detect late onset septic was > 3 ng/ml with sensitivity of 92.5% and specificity of 97.5%. Receiver operating characteristic curve showed that the best cut off point of NLRP3 to predict mortality in cases group was > 7.29 with sensitivity of 75.0%, specificity of 91.67%, PPV of 50.0%, NPV of 97.1% and total accuracy of 0.84%. n-SOFA scoring system increased significantly among LOS group and there was positive correlation with NLRP 3 inflammasome, P  < 0.012. CONCLUSION: NLRP3 inflammasome can be used for the diagnosis of late onset neonatal sepsis. The increase of its values was not affected by gender, birth weight, gestational age and postnatal age. It was the novel sepsis markers that were not fully studied in neonatal population. The prognostic values may need further studies. Show more

Keywords: Late onset neonatal sepsis, neonatal SOFA score, newborn infants, NLRP3 inflammasome, non-survival newborn

DOI: 10.3233/NPM-210909

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 4, pp. 787-793, 2022

Authors: Almonaem, Eman Rateb Abd | Almotaleb, Ghada Saad Abd | Alhameed, Mohamed Hussein Abd | El-Shimi, Ola Samir

Article Type: Research Article

Abstract: Necrotizing enterocolitis (NEC) yet remains a leading cause of morbidity and mortality in premature infants. The developmental deficiency of transforming growth factor-Beta (TGF-β) in the intestine is a risk factor for NEC in premature infants.We aimed to investigate the potential utility of serum TGF-β1 in the early diagnosis and severity assessment of NEC. This prospective case-control study was conducted on 102 VLBW neonates aging less than 32 weeks and weighing less than 1500 gm. They were divided into NEC group of 52 preterm neonates with symptoms and signs of NEC and 50 age and sex-matched neonates without NEC as a control …group. All neonates underwent full medical history taking, clinical examination, radiological and laboratory investigations including CBC, CRP, fecal occult blood, and serum TGF-β1. Serum TGF-β1 was tested in NEC patients at the onset of symptoms and signs and 7 days later. Serum TGF-β1 was significantly lower in NEC patients at the onset of symptoms than the control group (P  = 0.004) while after 7 days of onset serum TGF-β1 was significantly higher than at the onset of symptoms (P  < 0.001). In NEC patients with stage I, TGF-β1 was significantly higher than in NEC patients with stage ≥II (P  = 0.027).In conclusion serum TGF-β1 is downregulated in neonatal necrotizing enterocolitis and can be used as a useful biomarker for early diagnosis of NEC and to assess disease severity. Show more

Keywords: Necrotizing enterocolitis, premature infants, transforming growth factor Beta-1, very low birth weight

DOI: 10.3233/NPM-210973

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 4, pp. 795-801, 2022

Authors: Garg, P.M. | Paschal, J.L. | Ansari, M.A.Y. | Sonani, H. | Grey, C. | Chan, S. | Varshney, N. | Hillegass, W.

Article Type: Research Article

Abstract: BACKGROUND: To determine the clinical implications and gestation age-specific diagnostic predictability of pneumatosis in preterm infants with necrotizing enterocolitis (NEC). METHODS: A retrospective study on abdominal radiographs comparing clinical and radiological information in infants with and without pneumatosis. RESULT: Our findings disproved our hypothesis. Pneumatosis was seen more frequently in infants with higher gestational age [28.4 (26.1–32.4) vs. 26.4 (24.3–29) weeks; p  < 0.001] and birth weight [1110 (762–1768) vs. 770 (645–1022) grams; p  < 0.001] and were more likely delivered vaginally (39.1% vs. 21.7%, p  = 0.01). Portal venous gas was seen frequently on radiographs (10.3% vs. 0%, …p  < 0.001), but not pneumoperitoneum (20.7% vs. 36.7%, p  = 0.02). Infants with pneumatosis frequently developed acute kidney injury, with higher serum creatinine (16.5% vs. 4.5%, p  = 0.02) and frequent oliguria (12.9% vs. 2.7 %; p  = 0.043) and had higher C-reactive protein levels at 24 and 96 hours (p  < 0.002). Receiver operating curves for pneumatosis showed GA >28 weeks and birth weight > 1000 gm to have a sensitivity of 58.6% and specificity of 72.5%. CONCLUSION: Contrary to our hypothesis, infants who developed pneumatosis during NEC were more mature with a higher gestational age and birth weight than those who did not. Show more

Keywords: Clinical outcomes, necrotizing enterocolitis, preterm infant, pneumatosis

DOI: 10.3233/NPM-210971

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 4, pp. 803-812, 2022

Authors: Foo, S.X.Y. | Lim, C.S.E. | de la Puerta, R. | Visvalingam, D. | Yung, C.F. | Yeo, K.T.

Article Type: Research Article

Abstract: BACKGROUND: The utility of determining maternal-neonatal surface colonization as detected by standard microbiological cultures around the time of birth is unclear. The aim of this study is to evaluate the association between maternal and neonatal surface colonization at birth and neonatal early onset sepsis (EOS). OBJECTIVE: To investigate the association of white matter hyperintensities (WMHs) present in the brain with AD CSF biomarker levels. METHODS: We conducted a case-control study of newborns admitted to the neonatal department of a referral women’s and children’s hospital from 2009 to 2017. Cases were infants with blood-culture-confirmed EOS (<3 days …of life), and controls were infants without EOS randomly chosen based on the cases’ date of birth. Maternal genitourinary and neonatal ear swab cultures were used to determine bacterial surface colonization status. RESULTS: Fifty-one infants were diagnosed with EOS during the study period, where Escherichia coli (45%), and Group B Streptococcus (23%) accounted for 68% of infecting organisms. Compared to infants without EOS, those infected were more likely to have surface colonization of the mothers (60% vs 40%, p  = 0.048) and infants (90% vs 11%, p  < 0.001). In univariate analysis, chorioamnionitis [7.1 (95% CI 2.9, 16.8)], small-for-gestational-age [OR 0.08 (95% CI 0.02, 0.4)], exposure to antibiotics around time of birth [2.3 (95% CI 1.0, 5.1)], maternal surface colonization [2.2 (95% CI 1.0, 4.9)] and neonatal surface colonization [23.5 (95% CI 7.3, 76.1)] were significantly associated with EOS. Adjusting for potential confounders, neonatal colonization remained significantly associated with neonatal EOS [AOR 15.0 (95% CI 3.5, 64.2), p  < 0.001]. CONCLUSION: In our setting with predominant Gram-negative EOS, neonatal colonization but not maternal colonization was significantly associated with EOS in the newborn. Show more

Keywords: Bacteria colonization, mother, neonatal sepsis, newborn infant, perinatal care

DOI: 10.3233/NPM-210978

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 4, pp. 813-819, 2022

Authors: Boskabadi, H. | Beiraghi Toosi, M. | Darabi, A. | Abadi, J.M.T.

Article Type: Research Article

Abstract: BACKGROUND: Despite the known effect of hyperbilirubinemia in neonates, the effect of phototherapy on electroencephalography (EEG) remains unknown. Therefore, we aimed to determine the alteration of electroencephalography in infants with hyperbilirubinemia before and after phototherapy. METHODS: This cross-sectional study was performed on infants of≥35 weeks of gestation with hyperbilirubinemia. Information including age, sex, birth weight, hemoglobin levels, and treatment measures was recorded. In all studied infants, an EEG was performed before (in the first eight hours of hospitalization) and after treatment (after phototherapy or blood transfusion). The required duration of phototherapy, hospitalization and adverse effects were assessed then …EEG of the neonates was compared before and after treatment. RESULTS: A total of 52 infants (44% female and 56% male) were included in this study. Mean gestational age, weight, and bilirubin were 38.6±1.53 weeks, 3150±625 g, and 23.87±4.36 mg/dl, respectively. The most common findings before phototherapy were Frontal Theta (21 patients, 40.4 percent) and Delta Brush (14 patients, 26.9%), while the most common findings after phototherapy were Frontal Theta (20 patients, 38.5%) and Delta Brush (19 patients, 36.5%). Mean±SD of bilirubin in infants with and without Delta Brush was 21.30±1.67 mg/dl and 19.95±0.94 mg/dl, respectively. CONCLUSIONS: Hyperbilirubinemia in newborns may be linked to altered EEG findings. After phototherapy, the Frontal theta was reduced, but the Delta brush was intensified. Bilirubin levels were higher in infants with Delta Brush in their EEG compared to infants without this finding. Show more

Keywords: Delta brush, electroencephalography, frontal theta, hyperbilirubinemia, neonates, phototherapy

DOI: 10.3233/NPM-221080

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 4, pp. 821-825, 2022

Authors: Delgado, A. | Najaf, T. | Viehl, L. | Fishman, E. | Baiel, J. | Hepler, I. | Vesoulis, Z.A.

Article Type: Case Report

Abstract: Infants in the NICU setting often require emergent bedside surgical procedures, during which, they are at high risk for developing hypothermia. Reasons for hypothermia in infants include poor temperature regulation, decreased fat stores to maintain temperature, increased insensible losses. Neonatal hypothermia is associated with an increased risk of sepsis, cardiorespiratory failure (pulmonary hypertension), hypoglycemia and death. In this case series, we describe the novel use of servo-controlled water blanket system as a method to actively maintain normothermia during three surgical cases. Although water blanket systems are frequently used in the neonatal ICU to provide active hypothermia treatment, to our knowledge …there have been no prior reports of this system being deployed in normal and low-birthweight infants in the perioperative period. Show more

Keywords: Normothermia, water blanket, neonate, hypothermia, peri-operative

DOI: 10.3233/NPM-221022

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 4, pp. 827-830, 2022

Authors: McGill, V.E.

Article Type: Case Report

Abstract: Gaseous distension of the abdomen from the use of continuous positive airway pressure (CPAP) in the preterm population is of increasing concern for its unintended consequences. Methods to treat and prevent CPAP belly deserve further investigation. An intervention to provide abdominal support to address CPAP belly is presented in these case studies.

Keywords: Abdominal binder, CPAP belly, neonatal, premature

DOI: 10.3233/NPM-221047

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 4, pp. 831-836, 2022

Authors: Hisey, J.C. | Patterson, B.M. | Tsai, A.J. | Khan, A.M.

Article Type: Case Report

Abstract: A preterm infant was born emergently at 29 weeks gestation to a mother with active coronavirus disease 2019 (COVID-19). Clinical presentation and evaluation were consistent with in utero transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The neonate experienced progressive, refractory respiratory failure and catastrophic intracranial hemorrhage which ultimately led to limitation of care.

Keywords: Case report, COVID-19, intraventricular hemorrhage, in utero transmission, neonatal death, neonatal intensive care, prematurity, preterm birth, respiratory distress syndrome, respiratory failure, SARS-CoV-2, severe acute respiratory syndrome, vertical transmission

DOI: 10.3233/NPM-221094

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 4, pp. 837-844, 2022

Authors: Boyce, T.G. | Chacko, E.M. | Mascola, M.A. | Joshi, A. | Verwoerd, C.G. | Winder, A.A. | Hale, S.J.

Article Type: Case Report

Abstract: We report the case of a 35-week gestation infant girl born by emergent cesarean section for fetal distress in a woman with recent coronavirus disease 2019 (COVID-19). Tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using polymerase chain reaction (PCR) on the infant at 24 and 48 hours of life were negative. However, at 72 hours of life, the infant’s respiratory status worsened, and a repeat SARS-CoV-2 PCR was positive. The infant developed leukopenia, thrombocytopenia, and progressive respiratory failure, and died on the ninth day of life. Pathologic examination of the placenta revealed findings consistent with COVID-19 placentitis, and …SARS-CoV-2 RNA staining was positive, suggesting intrauterine transmission of the infection. Show more

Keywords: Coronavirus disease 2019, death, histology, newborn, placenta, SARS-CoV-2

DOI: 10.3233/NPM-221002

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 4, pp. 845-849, 2022

Authors: Smith, R.R. | Driver, K.C. | Karber, B.F. | Luciano, A.A. | Berg, M.T. | Prado, I.V. | Teper, J.E.

Article Type: Case Report

Abstract: Severe acute respiratory coronavirus 2 (SARS-CoV-2) is primarily transmitted via respiratory droplet or aerosol route. However, there is mounting evidence for intrauterine transmission. We report on a late preterm infant with suspected intrauterine acquisition of SARS-CoV-2 who experienced birth depression, hypoxic ischemic encephalopathy, multisystem organ involvement, and late onset COVID-19 pneumonia [22 ].

Keywords: COVID-19, HIE, intrauterine transmission, pneumonia, SARS-CoV-2

DOI: 10.3233/NPM-221026

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 4, pp. 851-858, 2022

Authors: Ranjan, V. | Chowdhry, B.K. | Kumar, C.M.

Article Type: Case Report

Abstract: Emphysematous gastritis is a rare and life-threatening condition caused by gastric inflammation and intramural gas formation, most often diagnosed through radiological evidence of a radiolucent shadow in the stomach wall in the clinical scenario of severe sickness. We report a case of emphysematous gastritis secondary to early-onset neonatal sepsis in a newborn which, to the best of our knowledge, has not otherwise been reported. Is it very rare or do we just miss it?

Keywords: Gas shadow, feed intolerance, necrotizing enterocolitis, gastric emphysema, abdominal distension, neonatal sepsis

DOI: 10.3233/NPM-210862

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 4, pp. 859-861, 2022

Authors: Mehdi, M.Q. | Franco Fuenmayor, M.E. | Aly, A.M.

Article Type: Case Report

Abstract: There are multiple manifestations in the neonatal period for infants born to mothers with systematic lupus erythematosus (SLE), ranging from cardiac, hematologic and dermatologic abnormalities. Cardiac complications may arise in utero in the form of heart block with a resulting increase in fetal mortality. The fetal conduction system is suspected to be affected by transplacental maternal antibodies, however additional environmental and fetal factors appear to play a role. We describe a rare case of a dichorionic-diamniotic twin pregnancy in which only one twin developed a complete heart block progressing to hydrops fetalis and fetal demise.

Keywords: Discordance, heart block, hydrops, SLE

DOI: 10.3233/NPM-210819

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 4, pp. 863-866, 2022

Authors: Gurram Venkata, Sujith Kumar Reddy | Bansal, Neha | Al Awad, Essa | Yusuf, Kamran

Article Type: Case Report

Abstract: Classic metaphyseal lesions (CML) or bucket handle fractures are usually associated with child abuse or non-accidental injury. The most common sites affected are the distal femur, proximal and distal tibia, and proximal humerus. Few case reports documented its association with difficult extraction at delivery in term large for gestational age (LGA) neonates. We present a case of CML in an extremely preterm neonate following abnormal presentation and difficult cesarean delivery. Management of CML is usually conservative, and fractures heal without any deformities. Thorough history taking is essential in the diagnosis of CML.

Keywords: Classic metaphyseal lesion, corner fracture, extreme preterm neonate

DOI: 10.3233/NPM-220999

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 4, pp. 867-870, 2022