Journal of Neonatal-Perinatal Medicine - Volume 16, issue 3

Authors: Hu, J. | Ananth, D. | Sethi, S.K. | Taliwal, N. | Govindan, S. | Raina, R.

Article Type: Review Article

Abstract: Neonatal acute kidney injury (AKI) is a common complication, especially in the neonatal intensive care unit, that is associated with long term consequences and poor outcomes. Early detection and treatment is critical. Currently, neonatal AKI is defined with urinary markers and serum creatinine, with limitations on early detection and individual treatment. There have been numerous biomarkers and risk factor scores that have been studied for their ability to predict neonatal AKI. To move towards personalized medicine, neonatal AKI must be categorized into phenotypes and subphenotypes that fully encapsulate the diverse causes and specific treatments. This review aims to advance our …understanding of neonatal AKI detection through the use of biomarkers, subphenotypes, and phenotypes to move towards personalized treatment strategies. Show more

Keywords: Neonatal AKI, phenotypes of AKI, subphenotypes of AKI, precision medicine, AKI biomarkers, neonatal AKI risk scores, and STARZ

DOI: 10.3233/NPM-230120

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 3, pp. 361-373, 2023

Authors: Ahmadzia, H.K. | Wiener, A.A. | Felfeli, M. | Berger, J.S. | Macri, C.J. | Gimovsky, A.C. | Luban, N.L. | Amdur, R.L.

Article Type: Research Article

Abstract: OBJECTIVE: The objective of this study is to develop a model that will help predict the risk of blood transfusion using information available prior to delivery. STUDY DESIGN: The study is a secondary analysis of the Consortium on Safe Labor registry. Women who had a delivery from 2002 to 2008 were included. Pre-delivery variables that had significant associations with transfusion were included in a multivariable logistic regression model predicting transfusion. The prediction model was internally validated using randomly selected samples from the same population of women. RESULTS: Of 156,572 deliveries, 5,463 deliveries (3.5%) required transfusion. Women …who had deliveries requiring transfusion were more likely to have a number of comorbidities such as preeclampsia (6.3% versus 4.1%, OR 1.21, 95% CI 1.08–1.36), placenta previa (1.8% versus 0.4%, OR 4.11, 95% CI 3.25–5.21) and anemia (10.6% versus 5.4%, OR 1.30, 95% CI 1.21–1.41). Transfusion was least likely to occur in university teaching hospitals compared to community hospitals. The c statistic was 0.71 (95% CI 0.70–0.72) in the derivation sample. The most salient predictors of transfusion included type of hospital, placenta previa, multiple gestations, diabetes mellitus, anemia, asthma, previous births, preeclampsia, type of insurance, age, gestational age, and vertex presentation. The model was well-calibrated and showed strong internal validation. CONCLUSION: The model identified independent risk factors that can help predict the risk of transfusion prior to delivery. If externally validated in another dataset, this model can assist health care professionals counsel patients and prepare facilities/resources to reduce maternal morbidity. Show more

Keywords: Blood transfusion, Consortium on Safe Labor, maternal morbidity, maternal mortality, postpartum hemorrhage, risk prediction model

DOI: 10.3233/NPM-230079

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 3, pp. 375-385, 2023

Authors: Nesterenko, T.H. | Pocevic, S. | Elgendy, M. | Mohamed, M.A. | Aly, H.

Article Type: Research Article

Abstract: BACKGROUND: Suctioning of the posterior pharynx immediately after birth during neonatal resuscitation can produce a vagal response resulting in bradycardia or apnea. The feasibility of delaying any airway suctioning and avoiding deep suctioning has not been studied. OBJECTIVES: To test the hypothesis that newborn resuscitation is feasible with the following two guidelines: 1) avoiding any suctioning until the infant establishes spontaneous respiration, and 2) avoiding the use of deep suction with catheters. STUDY DESIGN: A quality improvement project was implemented using these two guidelines. Infants’ mouth was cleaned with a dry cloth. No suction was started …until infants establish spontaneous breathing. Then, bulb suction was used to clear secretions from the sides of the mouth and the nose without reaching the back of the pharynx. Deep suction using catheters was not used. Neonatal staff and physicians received biweekly training to support these changes. Resuscitation data before and after the practice change were compared. RESULTS: A total of 999 sequential cases were compared; of them 501 and 498 infants were resuscitated before and after the implementation of the new practice, respectively. Suction before spontaneous breathing occurred in 12.4% in the first cohort. There were no differences between groups except for less use of oxygen with the new guidelines (12.4% vs 4.4%, P  < 0.001). CONCLUSION: Avoidance of any suction prior to spontaneous breathing and not applying deep suction with catheters are feasible during newborn resuscitation. These practices are associated with decreased exposure to oxygen in the delivery room. Show more

Keywords: Airway, apnea, neonatal resuscitation, oxygen, suction, vagal stimulation

DOI: 10.3233/NPM-230080

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 3, pp. 387-391, 2023

Authors: Ahmed, W.O. | AbuSaif, I.S.H. | Salaheldin, S.A. | Hashem, H.E. | Obaid, O.A. | Obaid, A.A. | AbdElrazik, S.M. | Ibrahim, M.E. | Shinkar, D.M.

Article Type: Research Article

Abstract: BACKGROUND: Weaning from mechanical ventilation is a challenging phase of neonatal respiratory support [1 ]. Choosing efficient and safe noninvasive modality to prevent re-intubation and choosing the optimal time for weaning are key points for weaning success. The aim of the study is to compare the efficiency and safety of noninvasive high frequency oscillatory ventilation (NHFOV) versus noninvasive positive pressure ventilation (NIPPV) as respiratory support after extubation in preterms with respiratory distress syndrome (RDS). Also, the study compared the lung ultrasound findings between these 2 modalities and assessed the use of lung ultrasound score (LUS) as predictor for extubation …outcome. METHODS: This study is a randomized controlled trial conducted on 60 preterm neonates with RDS. Patients were allocated into one of 2 groups: NIPPV or NHFOV as post-extubation noninvasive respiratory support. The 2 groups were compared regarding the incidence of extubation failure within 72 hours from extubation, oxygen needs, duration of application of the noninvasive modality, duration of admission, safety and mortality rate. LUS was assessed pre-extubation and 2 hours post-extubation. RESULTS: The study did not show a statistically significant difference in re-ventilation rate in NHFOV group (23.3%) compared to NIPPV group (30.0%), p  = 0.56. Oxygen needs were significantly lower in NHFOV group compared to NIPPV groups (mean FiO2 31.8±6.09 vs 38±0.55, p  = 0.007). The duration of the used noninvasive modality, CO2 concentration, LUS, and mortality rate showed statistically insignificant difference between both groups. There was a significant correlation between LUS and extubation outcome. CONCLUSION: NHFOV is a feasible noninvasive modality for respiratory support post-extubation in premature infants. LUS is a good predictor of extubation outcome in neonates. Show more

Keywords: Extubation, lung ultrasound, noninvasive high frequency oscillatory ventilation, noninvasive ventilation, preterm neonate, respiratory distress syndrome

DOI: 10.3233/NPM-221199

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 3, pp. 393-402, 2023

Authors: Mohamed, M.A. | Abrams, G. | Massa-Buck, B. | DiBlassio, S. | El-Dib, M. | Aly, H.

Article Type: Research Article

Abstract: OBJECTIVE: To assess the feasibility of sterile water application to the skin of the extremely low birth weight (ELBW) newborns in the first week of life and examine its effects on their skin integrity and outcomes. DESIGN: Pilot randomized controlled trial. SETTING: Open-bay, 18 bed Level III NICU in the Eastern United States. PARTICIPANTS: Twenty-eight ELBW neonates. Two newborns expired, sixteen newborns remained in the intervention group and twelve newborns in the control group. METHODS: ELBW neonates were either assigned to receive frequent sterile water wash to skin or not during care …for the first week of life. Using the Neonatal Skin Condition Scale (NSCS), assessments were performed twice a day during the first week. Fluid intake, serum electrolytes, culture proven sepsis and other morbidities, and length of stay (LOS) were compared while controlling for confounding variables using multiple regression analysis. RESULTS: There was no difference in the demographic or clinical characteristics between both groups. Sterile water wash application to skin was not associated with differences in skin health indices or fluid intake. However, it was associated with higher median sodium level and with early regression of bilirubin level when compared to controls. CONCLUSION: Frequent skin washes with sterile water are feasible and safe. However, they may not be associated with improved skin integrity or fluid intake. Show more

Keywords: Bilirubin, extremely low birth weight infants, fluid requirement, IVH, skin water wash

DOI: 10.3233/NPM-230083

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 3, pp. 403-409, 2023

Authors: Isaac, Thomas C.W. | Odd, Dawn | Edwards, Martin | Chakraborty, Mallinath | Kotecha, Sarah J. | Kotecha, Sailesh | Odd, David

Article Type: Research Article

Abstract: BACKGROUND: Preterm birth and social deprivation are known risk factors for learning difficulties. However there has been little work looking into the interaction between these two risks. We aimed to identify if children born preterm to families with higher levels of social deprivation are disproportionately more likely to have learning difficulties than those with lower levels of social deprivation. METHODS: Data from the RANOPS (Respiratory And Neurological Outcomes in children born Preterm Study) was used to assess prevalence of learning difficulties. The effects of preterm birth and deprivation were reviewed. Multi-level logistic regression models were used to examine …if gestational age and deprivation impacts interacted after adjustment for possible confounders. Primary outcome measure was parent-reported learning difficulties. Secondary outcome measures were parent-reported behavioural problems and a statement of special educational need. RESULTS: We investigated the developmental outcomes of 6,691 infants with a median age of 5 years at time of survey (IQR 5). Deprivation decile (OR 1.08 (1.03,1.12)) and preterm birth (OR 2.67 (2.02,3.53)) were both associated with increased risk of learning difficulties. There was little evidence for any interaction between preterm birth and deprivation (p  = 0.298) and the risk of learning difficulties. CONCLUSIONS: Deprivation and preterm birth have significant associations with learning difficulties. While deprivation does not appear to have potentiated the impact of preterm birth, preterm infants in the most deprived areas have the highest risk of learning difficulties with almost 1 in 3 extremely premature infants with a learning difficulty in the most deprived areas. Show more

Keywords: Child development, epidemiology, neonatology, public health, statistics

DOI: 10.3233/NPM-221151

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 3, pp. 411-421, 2023

Authors: Watanabe, S. | Inoue, M. | Miyata, M. | Boda, H.

Article Type: Research Article

Abstract: BACKGROUND: Focal intestinal perforation (FIP) is a devastating complication of premature birth, and extremely low birth weight (ELBW) infants are at highest risk. This study aimed to evaluate the relationship of the superior mesenteric artery (SMA) and portal vein (PV) blood flow velocities to investigate the association between intestinal blood flow and FIP. In addition, the herbal formula Daikenchuto (TJ-100) is expected to improve intestinal blood flow disorders; therefore, we evaluated its effect. METHODS: We conducted a prospective cohort study of 15 ELBW infants from January 2020 to August 2021. Measured variables included birth weight, 5-minute Apgar score, …time of oral feeding initiation, ductus arteriosus (PDA) closure (percent), diastolic and systolic blood pressure, SMA and PV blood flow velocity, and FIP onset data. Fifteen infants were divided into three groups: a non-surgery group (Group I; 6), a surgery group with FIP (Group II; 4), and a TJ-100 administration group (Group III; 5). The main outcome parameters included SMA and PV blood flow velocities with TJ-100. RESULTS: SMA and PV blood flow differed significantly for the SMA of Group I and the SMA and PV of Group III (P  < 0.01, P  = 0.01, and P  = 0.04, respectively). There was a correlation between SMA and PV in Group III (P  = 0.03). CONCLUSION: TJ-100 may increase SMA and PV blood flow and improve intestinal blood flow in ELBW infants at risk of FIP. Therefore, the effects of TJ-100 should undergo further study. Show more

Keywords: Daikenchuto, intestinal perforation, premature birth

DOI: 10.3233/NPM-230132

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 3, pp. 423-428, 2023

Authors: Anzueto Guerra, D.G. | Winter, L.A. | Moreira, A.G. | Gong, A.K. | Johnson-Pais, T.L. | Blanco, C.L.

Article Type: Research Article

Abstract: BACKGROUND: The optimal composition of lipid emulsions in parenteral nutrition (PN) for premature infants remains controversial. This study examined the effects of a combination of soybean oil-based (SoyLE) and fish oil-based (FishLE) lipid emulsions compared to FishLE as monotherapy on the lipid and fatty acid profiles and clinical outcomes of premature infants requiring prolonged PN. METHODS: 42 premature infants received FishLE+SoyLE or FishLE. Serum concentrations of lipoproteins and 29 fatty acids (FA) were measured at baseline, 4, and 8 weeks of PN and growth and neurodevelopmental outcomes were measured at 3, 6, 12, 18, and 24 …months of life. RESULTS: Lipid profiles were similar between groups. Plasma concentrations of ω-6 fatty acids tended to decrease over time in both groups. Concentrations of most ω-3 fatty acids, in particular docosapentaenoic acid, eicosapentaenoic acid, and docosahexaenoic acid, were significantly increased over time in the FishLE+SoyLE group whereas they did not change in the FishLE alone group. However, serum concentrations of almost all fatty acids were similar between groups at the end of the study period. No differences in growth parameters including weight, height, fronto-occipital circumference (FOC), and body mass index (BMI) were observed up to two years of age. Similarly, there were no differences in neurodevelopmental test scores at 6, 12, 18, and 24 months of age. CONCLUSIONS: No substantial differences in lipid profiles and short clinical outcomes were found in infants exposed to FishLE+SoyLE when compared to FishLE. Show more

Keywords: Fatty acid profiles, lipid profiles, neurodevelopment, parenteral nutrition, prematurity

DOI: 10.3233/NPM-211501

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 3, pp. 429-443, 2023

Authors: Johnson, Mary G. | Suchting, Robert | Scheid, Lisa M. | Holzapfel, Lindsay N. | Chalise, Aditi | Stotts, Angela L. | Chapman, John C. | Khan, Amir M. | Northrup, Thomas F.

Article Type: Research Article

Abstract: BACKGROUND: Hypoglycemia in neonates is common and contributes to 4.0–5.8% of neonatal intensive care unit (NICU) admissions. In utero nicotine exposure is underexplored as a potential contributor to neonatal hypoglycemia. Rat models have shown that in utero nicotine exposure can be associated with a reduction in pancreatic beta cell mass, leading to glucose dysregulation. The primary aim of this work is to study the risk of developing hypoglycemia after birth in a population of in utero nicotine-exposed neonates. METHODS: We conducted a retrospective matched cohort study that augmented an existing dataset of neonates …admitted to a level IV NICU with household-based in utero nicotine exposure (N = 335). Neonates in the control group parents denied household smoking (N = 325), were born within a 6-month timeframe, and were within a birthweight of 50 grams of a nicotine-exposed neonate. Data reviewed included gestational age, growth parameters, maternal history of diabetes, and glucose levels within the first three hours of life per unit protocol. RESULTS: 660 neonates were included in the analysis. In utero nicotine exposure demonstrated a 94.3% posterior probability (PP) for greater hypoglycemia risk (RR = 1.185, 95% CrI = [0.953, 1.445]). A 94.6% PP was demonstrated when neonates who were small for gestational age, intrauterine growth-restricted, and born to diabetic mothers were excluded (n  = 482; RR = 1.271, 95% CrI = [0.946, 1.669]). CONCLUSION: Nicotine exposure in utero was found to be a potential risk factor for developing hypoglycemia after birth. Mechanisms of action should be explored, and additional research on in utero nicotine exposure risks should follow. Show more

Keywords: Late preterm neonate, maternal substance use, neonatal hypoglycemia, neonatology, nicotine exposure

DOI: 10.3233/NPM-230124

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 3, pp. 445-452, 2023

Authors: Desai, R.K. | Bhola, M. | Ronis, S. | Ryan, R.M.

Article Type: Research Article

Abstract: BACKGROUND: Current American Academy of Pediatrics guidelines recommend discharge at physiologic maturity regardless of weight; however, our institution’s neonatal ICU policy requires a minimum weight of 1800 g for discharge even when infant is physiologically mature. So, we wanted to determine if discharge at physiologic maturity (PM), based on national guidelines, would decrease hospital days (HD). METHODS: We reviewed 129 infants with birthweight 1300g– 1800 g. Data were analyzed by paired t -test/ Wilcoxon-rank-sum test. RESULTS: Age at discharge vs. age at PM was 0.55d per infant higher (P -value 0.033) resulting in 71 total HD. For SGA …babies, this difference was 1.47d vs 0.19d in non-SGA babies (P – value 0.0243) and this difference was an average of 2.63d (P -value < 0.001) for those who reached PM < 1800 g, contributing to 50 of 71 HD potentially saved. CONCLUSION: There was a 0.55–2.6-day difference between age at discharge and age at PM, greater in SGA infants and infants who reached PM prior to 1800 g. There might be an opportunity to send infants home earlier to their families if there is no minimum weight required. Show more

Keywords: Prematurity, small for gestational age (SGA), discharge planning, physiologic maturity (PM), family-centered care, early discharge

DOI: 10.3233/NPM-230005

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 3, pp. 453-459, 2023

Authors: Yashima, K. | Noda, A. | Ishikawa, T. | Matsuzaki, F. | Miyakoda, K. | Nishigori, H. | Mano, N. | Obara, T.

Article Type: Research Article

Abstract: BACKGROUND: To investigate the use of calcineurin inhibitors (CNIs) in pregnant Japanese women and to evaluate their safety in infants. METHODS: Data were extracted from the claims database of the Japan Medical Data Center. The prevalence of CNIs was evaluated 180 days before pregnancy onset, during pregnancy, and within180-days post partum. We investigated the characteristics of the infants, including the presence of major malformations and their diagnoses, for 1 year after birth. RESULTS: A total of 91,865 pregnancies in 80,049 women were included. Fifty-three women were prescribed CNIs between 180-day before pregnancy onset and 180-day postpartum; …35 of the 53 women were prescribed the drugs during pregnancy, and 10 of their infants were born preterm. Three were diagnosed with major congenital malformations, such as patent ductus arteriosus. Six preterm infants presented with infant respiratory distress syndrome. CONCLUSIONS: No congenital anomalies were clearly attributable to the use of CNIs during pregnancy. Show more

Keywords: Claim database, cyclosporin, infant, pregnancy, tacrolimus

DOI: 10.3233/NPM-230138

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 3, pp. 461-473, 2023

Authors: Cordero, L. | Stenger, M.R. | Landon, M.B. | Needleman, B.J. | Noria, S. | Nankervis, C.A.

Article Type: Research Article

Abstract: BACKGROUND: Information on exclusive breastfeeding (BF) and BF initiation following bariatric surgery (BS) among obese women with diabetes mellitus (DM) and without DM (non-DM) is limited. METHODS: Retrospective cohort study. Obesity was defined by BMI (kg/m2 ) as grade 1 (30–34.9), grade 2 (35–39.9) or grade 3 (≥40). The 65 women in the DM group (40 women with gestational, 19 with Type 2 and 6 with Type 1) was similar to 84 with non-DM in BS type: Roux-en-Y (51 vs 55%), sleeve gastrectomy (32 vs 35%), laparoscopic gastric banding (17 vs 7%) and gastro-duodenal anastomosis (0 vs 4%). …RESULTS: Women with DM were older (35 vs 33y), of advanced age (54 vs 27%), with higher prevalence of grade 3 obesity (66 vs 46%), chronic hypertension (31 vs 10%), delivery of late-preterm infants (23 vs 10%) and neonatal hypoglycemia (25 vs 12%). Although infant feeding intention was similar: BF (66 vs 79%), partial BF (9 vs 7%) or formula (25 vs 14%), at discharge women with DM had lower exclusive BF (29 vs 41%) and BF initiation rates (68 vs 76%) than those with non-DM. Women with grade 3 obesity (52% were DM) differed from those with grades 1-2 (34% were DM) in exclusive BF (27 vs 52%), and BF initiation rates (66 vs 86%). CONCLUSION: After BS, women with DM, especially those with grade 3 obesity, had higher rates of chronic hypertension and preeclampsia and lower rates of exclusive BF and BF initiation than those who had DM but had less severe obesity. Show more

Keywords: Bariatric Surgery, Breastfeeding, Diabetes Mellitus

DOI: 10.3233/NPM-221085

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 3, pp. 475-483, 2023

Authors: Nadolski, K. | Dodge, P. | Kopkau, H. | Forrestal, K. | Zablocki, V. | Bailey, B.A.

Article Type: Research Article

Abstract: BACKGROUND: The goal of this study was to examine if in utero cannabis exposure predicted reduced birth size and if these effects were evident in specific growth parameters as early as the second trimester. METHODS: Eligible women had an initial prenatal visit between January 1, 2010, and March 31, 2020, completed an anatomy ultrasound between 18–24 weeks’ gestation, and had no self-reported alcohol, tobacco, or other biochemically verified drug use. The two primary study groups were cannabis users (n  = 109) identified through self-report and urine toxicology screens, and a randomly selected control group of non-substance users (n  = 171). …Medical records were manually reviewed for background and medical information, anatomy ultrasound results, and birth size parameters. RESULTS: After controlling for significant confounders, regression results indicated significant (p  < .05) deficits in birth weight associated with cannabis exposure, with a trend for increasing weight effects beginning in the second trimester. A significant decrease in head circumference was evident as early as the second trimester, with differences remaining significant until birth. Significant overall length and specific bone length deficits were not predicted by cannabis exposure, at birth or earlier in gestation, after control for confounding. CONCLUSIONS: Cannabis exposure predicted growth deficits at birth, with some effects evident as early as the second trimester. The biggest and earliest effects were seen for cranial size, with an adjusted deficit of more than 14 percentile points by birth. Overall weight was not impacted until at or near delivery. Show more

Keywords: Birth size, cannabis, fetal growth, in utero cannabis exposure, pregnancy

DOI: 10.3233/NPM-221133

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 3, pp. 485-490, 2023

Authors: Das, A. | Trivedi, M.M. | Bellingham-Young, D.A.

Article Type: Research Article

Abstract: OBJECTIVES: To determine the relationship between Food Environment Index (FEI) and Preterm Birth (PTB) rate at the county level of the United States of America (USA) (primary), while evaluating the interaction of multiple factors within a framework of sociodemographic, maternal health, maternal behavioral, and environmental factors. METHODS: This is a population-based retrospective cohort ecological study from 2015-2018. The study compares the characteristics of the population of the counties of the USA. All counties with complete data on their PTB rate and the independent variables were included in the study. Independent variables with greater than 20% missing data were …excluded from the study. Purposive sampling technique was applied. A total of 2983/3142 counties were included in the study. RESULTS: The median PTB rate of all counties was 9.90%. The highest PTB rate (23.3%) was in Tallapoosa County, Alabama and the lowest (3.4%) in San Juan County, Washington State. After adjusting for variables, PTB rate had a significant association with FEI (coefficient of correlation – 0.36, p  < 0.01, 95% CI – 0.19 to – 0.04). Increase in the rate of unemployment, African American race, adult smoking, obesity, uninsured rate, sexually transmitted diseases (STD), high school education and air pollution was associated with an increase in PTB rate, while an increase in FEI and alcohol abuse rates was associated with a decrease in PTB rate. CONCLUSIONS: FEI can predict the PTB rate in USA counties after adjusting for sociodemographic, health, behavioral and environmental factors. Future studies are needed to confirm these associations and consider them when making policies to reduce PTBs. Show more

Keywords: Ecological study, Food Environment Index, premature birth, preterm, social determinants of health

DOI: 10.3233/NPM-221180

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 3, pp. 491-500, 2023

Authors: Saha, A.K. | Saha, B.

Article Type: Research Article

Abstract: BACKGROUND: Systemic candidiasis is an important nosocomial infection in neonatal intensive care units. The objective of this study was to identify the change in the profile of neonatal candidiasis in a tertiary neonatal intensive care unit (NICU) in eastern India in recent times. METHODS: It was a retrospective review of case records from 2014 to 2019 from a tertiary NICU of eastern India. Data of the fungal sepsis, demographic details, risk factors of fungal sepsis and mortality were collected from 103 neonates. RESULTS: One hundred and three neonates had blood culture positive for fungal species of …which 91 (88.3%) infants weighed ≥1500 g and 66 (64%) infants were term. There was significant higher incidence of candidiasis among outborn (Relative risk of outborn 18.84, 95% CI 10.74–33.05). Prolonged antibiotic usage (>14 days), meropenem usage (>5 days), central catheterization (>5 days), invasive mechanical ventilation (>5 days), surgical intervention were found in 64 (62.1%), 46 (44.6%), 31(30.0%), 40 (38.8%) and 39 (37.8%) infants. Non albicans candida (NAC) was isolated as the predominant species (82/103, 79.6%). Resistance to both of fluconazole and amphotericin B were found in 19 (18.4%) babies. Presence of NAC infection and resistance to both amphotericin B and fluconazole were independent predictors of candida associated mortality in NICU. CONCLUSION: Neonatal candidiasis is found among outborn infants with higher birth weight and gestational age. NAC species are predominant organisms with resistance to common antifungal drugs. Show more

Keywords: Fungal sepsis, neonatal candidiasis, neonatal intensive care unit, newborn, non albicans candida

DOI: 10.3233/NPM-231204

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 3, pp. 501-506, 2023

Authors: Kartikeswar, G.A.P. | Parikh, T.B. | Randive, B. | Kinikar, A. | Rajput, U.C. | Valvi, C. | Vaidya, U. | Malwade, S. | Agarkhedkar, S. | Kadam, A. | Smith, R.M. | Westercamp, M. | Schumacher, C. | Mave, V. | Robinson, M.L. | Gupta, A. | Milstone, A.M. | Manabe, Y.C. | Johnson, J.

Article Type: Research Article

Abstract: BACKGROUND: Neonates admitted to the neonatal intensive care unit (NICU) are at risk for healthcare-associated infections, including central line-associated bloodstream infections. We aimed to characterize the epidemiology of bloodstream infections among neonates with central venous catheters admitted to three Indian NICUs. METHODS: We conducted a prospective cohort study in three tertiary NICUs, from May 1, 2017 until July 31, 2019. All neonates admitted to the NICU were enrolled and followed until discharge, transfer, or death. Cases were defined as positive blood cultures in neonates with a central venous catheter in place for greater than 2 days or within …2 days of catheter removal. RESULTS: During the study period, 140 bloodstream infections were identified in 131 neonates with a central venous catheter. The bloodstream infection rate was 11.9 per 1000 central line-days. Gram-negative organisms predominated, with 38.6% of cases caused by Klebsiella spp. and 14.9% by Acinetobacter spp. Antimicrobial resistance was prevalent among Gram-negative isolates, with 86.9% resistant to third- or fourth-generation cephalosporins, 63.1% to aminoglycosides, 61.9% to fluoroquinolones, and 42.0% to carbapenems. Mortality and length of stay were greater in neonates with bloodstream infection than in neonates without bloodstream infection (unadjusted analysis, p  < 0.001). CONCLUSIONS: We report a high bloodstream infection rate among neonates with central venous catheters admitted to three tertiary care NICUs in India. Action to improve infection prevention and control practices in the NICU is needed to reduce the morbidity and mortality associated with BSI in this high-risk population. Show more

Keywords: Antimicrobial resistance, bloodstream infection, central line-associated bloodstream infection, healthcare-associated infection

DOI: 10.3233/NPM-221110

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 3, pp. 507-516, 2023

Authors: Lumbanraja, S.N. | Effendi, I.H. | Siahaan, A. | Bancin, B.E.P. | Sinurat, T.

Article Type: Research Article

Abstract: BACKGROUND: Preeclampsia is a major cause of maternal and infant mortality in Indonesia. Several studies have investigated the association between SARS-CoV-2 infection and adverse maternal, fetal, and neonatal outcomes. The studies found that SARS-CoV-2 infection during pregnancy is associated with an increased risk of maternal morbidity and mortality related to hypertensive disorders, including preeclampsia. However, the studies did not provide specific information on the morbidity and mortality of newborns from mothers diagnosed with preeclampsia with conjunction SARS-CoV-2 infection. METHODS: This hospital-based case-control study was conducted on 28 mother-infant pairs using a systematic sampling method from February 2021 to …December 2021. Data were analyzed using SPSS software (version 26), and statistical tests including chi-square analysis, Fisher’s exact test, Mann-Whitney U-test and independent t -test were performed to identify factors associated with study variables in a 95% confidence interval (CI). RESULTS: We conducted a prospective study involving the enrollment of 28 pregnant women with confirmed SARS-CoV-2 infection through RT-PCR tests. Within this cohort, a subset of 4 mothers (14.8%) were diagnosed with preeclampsia. Four preeclamptic patients (100%) experienced fatal outcomes. Furthermore, among the infants born to preeclamptic mothers with SARS-CoV-2 infections, two (50%) newborns not survive. One infant passed away shortly after birth at 30 weeks of gestation, while the other had intrauterine demise at 28 weeks of gestation. CONCLUSIONS: SARS-CoV-2 infection during pregnancy is associated with an increased risk of maternal morbidity and mortality related preeclampsia. Show more

Keywords: Morbidity, mortality, newborn, preeclampsia, SARS-CoV-2

DOI: 10.3233/NPM-220002

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 3, pp. 517-525, 2023

Authors: Garg, P. M. | Rebentisch, A. | Zhang, M. | Ware, J. | Pippins, M. | Taylor, C. | Reddy, K. | Lewis, T. | Inder, T. E. | Hillegass, W. B.

Article Type: Research Article

Abstract: BACKGROUND: The potential influence of exposure to analgesic-sedative agents (ASA) before, during, and after surgical NEC and peri-operative clinical status on white matter injury (WMI) in preterm infants has not been fully defined, and a comprehensive evaluation may inform future research and clinical interventions. METHODS: A retrospective study comparing ASA exposure before/during /after surgical NEC and peri-operative clinical status in neonates with and without WMI. RESULTS: Infants with any WMI (grade 2–4, n  = 36/67, 53.7%) had a higher number of surgical procedures receiving ASA (5 [IQR: 3, 8] vs. 3 [2, 4]; p  = 0.002) and had …a longer duration of hypotension during their first (48.0 hours [26.0, 48.0] vs. 15.5 [6, 48]; p  = 0.009) and second surgery (20 hours [0, 48h] vs. 0 [0, 22]; p  = 0.017), received more hydrocortisone (35% vs.13.3%,p = 0.04) than those without any WMI. There were no differences in fentanyl/morphine/midazolam exposure before/during/after the NEC onset in the two groups. Infants with severe WMI (19/67, 28.3%, grade 3/4) had a higher incidence of AKI (P  = 0.004), surgical morbidity (p  = 0.047), more surgical procedures (6.5 [3, 10] vs. 4 [2, 5]; p  = 0.012), and received higher mean fentanyl doses(p  = 0.03) from birth until NEC onset than those without severe WMI. The univariate associations between these factors and severe WMI remained insignificant after multivariable logistic regression. CONCLUSION: Infants with WMI had more surgical procedures receiving ASA and had a longer duration of hypotension during surgeries. A large multicenter prospective study is needed to understand the full impact of ASA. Show more

Keywords: Analgesics-sedatives, brain injury, neonate, outcomes, preterm infant

DOI: 10.3233/NPM-230084

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 3, pp. 527-537, 2023

Authors: Kaur, M. | Phillips, J.M. | Ahmadzia, H.K.

Article Type: Research Article

Abstract: BACKGROUND: Hemorrhage anticipation and management has shifted significantly over the past decade due to evolution of data surrounding management of obstetric hemorrhage. Limited data exists which describe the practical use and clinical application of hemorrhage management. Our goal was to identify obstetric hemorrhage management patterns in a cohort of practicing Maternal Fetal Medicine physicians. METHODS: We administered a survey to Maternal Fetal Medicine (MFM) fellows and faculty that addressed the management of hemorrhage including risk assessment, uterotonic use, antifibrinolytic use, cell saver use, and abnormal placentation management. An email was sent out regarding the survey to a listserv …of all Maternal Fetal Medicine fellow program coordinators to disseminate to their faculty and fellows. Eighty responses were obtained. RESULTS: A total of 78 surveys were analyzed. Participants preferred methylergonovine as a first line agent (n  = 57; 73%, n  = 62; 80%). Most participants would consider using cell salvage when also activating MTP (28, 48%) or during scheduled deliveries who are high risk of hemorrhage (40, 69%). Approximately a third of providers would use TXA (tranexamic acid) prophylactically (n  = 21; 28%). Only 26% of MFM fellows felt comfortable performing cesarean hysterectomy without Gynecologic Oncology. CONCLUSION: In comparison to prior reports, TXA use has increased substantially. Further, when looking at the management of abnormal placentation, the use of magnetic resonance imaging and embolization have both increased. Possibly due to the rise in centers of excellence for treatment of accreta spectrum disorders, Maternal Fetal Medicine fellows still feel largely unprepared to perform a cesarean hysterectomy without Gynecologic Oncology. Show more

Keywords: Antifibrinolytic, cell salvage, cesarean hysterectomy, placenta accreta spectrum, postpartum hemorrhage, risk assessment, survey, transfusion, tranexamic acid, uterotonic

DOI: 10.3233/NPM-221189

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 3, pp. 539-545, 2023

Authors: Milman, N.T.

Article Type: Research Article

Abstract: OBJECTIVE: To define criteria based on iron status parameters for the identification of healthy women who do need/do not need iron supplementation during normal pregnancy. METHODS: Randomized, double-blind, placebo-controlled study of 113 women (62 iron-, 51 placebo treated) and their newborns. Iron dose was 66 mg elemental iron as ferrous fumarate daily from 14–18 weeks gestation to delivery. Hemoglobin (Hb), serum (S)-ferritin, S-transferrin saturation percentage, and S-erythropoietin were measured during gestation, prepartum, one week and 8 weeks postpartum. The women were divided in groups according to S-ferritin levels at inclusion:<30,≥30,≥40,≥50 and≥60μ g/L. Iron deficiency (ID) was defined as S-ferritin < 15μ …g/L; iron deficiency anemia (IDA) as S-ferritin < 15μ g/L and Hb < 110 g/L. RESULTS: Placebo treated women with S-ferritin levels < 30μ g/L at inclusion had a much higher incidence of ID/IDA than placebo treated women with S-ferritin levels≥30,≥40,≥50, and≥60μ g/L. S-ferritin levels≥40μ g/L were associated with a very low risk of ID/IDA and none of the women with levels≥50 and≥60μ g/L displayed ID/IDA. CONCLUSIONS: Women having S-ferritin < 30μ g/L in early pregnancy, have a high risk of ID/IDA and should be recommended ferrous iron supplements in appropriate doses. With increasing iron reserves, i.e., increasing S-ferritin, the need for iron supplements diminishes, and placebo treated women having S-ferritin ≥40μ g/L seldom develop IDA. Women with S-ferritin levels≥50 and≥60μ g/L or higher, have adequate iron reserves and do not need routine iron prophylaxis in pregnancy. The results support the arguments for an individual iron supplementation guided by iron status, to avoid unwanted side effects of unnecessary iron intake. Show more

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

DOI: 10.3233/NPM-231210

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 3, pp. 547-562, 2023

Authors: Kesrouani, A. | Jaber, L. | Daou, L. | Mcheik, C. | Nasr, B. | Saliba, Z.

Article Type: Case Report

Abstract: OBJECTIVE: This study aims to determine the characteristics and outcome of prenatally diagnosed cardiac rhabdomyomas. STUDY DESIGN: This retrospective descriptive study includes cases referred to our university hospital. We studied sonographic characteristics of rhabdomyoma along with the neonatal outcome. RESULTS: Eight cases were included, with a mean gestational age at diagnosis at 31 weeks of gestation and five patients diagnosed after 32 weeks. We noted a male gender in 75%, multiple rhabdomyoma in 50%, mostly situated in the interventricular septum (41%) and valvular regurgitation in 25%. Most patients delivered at term, including five cesareans (62.5%). Six …babies survived (75%); three of them were later diagnosed with tuberous sclerosis (50%). CONCLUSION: Cardiac rhabdomyoma have variable ultrasound features. The usual favorable outcome can however be complicated by neonatal death (12%), valvular regurgitation and cerebral tuber. Show more

Keywords: Fetal, heart, outcome, prenatal, rhabdomyoma, tuberous sclerosis, ultrasound

DOI: 10.3233/NPM-221186

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 3, pp. 563-567, 2023

Authors: Chiyoda, H. | Kobayashi, S. | Yokoi, K. | Iwata, O. | Katano, H.

Article Type: Case Report

Abstract: The most common cause of acquired hydrocephalus in infants is hemorrhage, most often as a consequence of prematurity. Other important causes include neoplasm and infection, usually bacterial meningitis. Hypoxic ischemic encephalopathy (HIE) in term infants usually results in secondary microcephaly. We report an infant with severe HIE at birth treated by therapeutic hypothermia who developed progressive acquired hydrocephalus over 2 months, although no cause of the hydrocephalus was identified. Although hydrocephalus, even intraventricular hemorrhage, is uncommon in term infants with HIE, careful follow-up of the head circumference is important, even if no findings indicating possible causes of hydrocephalus, such as …hemorrhage, are detected on ultrasound or magnetic resonance imaging. Show more

Keywords: Hydrocephalus, hypoxic ischemic encephalopathy, neonate, therapeutic hypothermia

DOI: 10.3233/NPM-210950

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 3, pp. 569-571, 2023

Authors: Morris, H.F. | Sran, S.

Article Type: Case Report

Abstract: BACKGROUND: Clinical collapse in the newborn most often occurs secondary to sepsis, delivery complications, congenital cardiac defects, or inborn errors of metabolism. We report on a neonate with respiratory, cardiac, and hepatic failure, with disproportionate metabolic acidosis and systemic hypertension, found to be caused by a congenital neuroblastoma. CASE DESCRIPTION: A term infant presented to our Level IV NICU via emergent transport at 12 hours of life with clinical and laboratory findings consistent with respiratory, cardiac, and hepatic failure. Typical workup for sepsis and cardiac etiology was unrevealing. The infant was noted to have systemic hypertension despite prolonged …capillary refill. A profound metabolic acidosis led the primary team to pursue a genetics consult. In the course of the workup for disorders of metabolism, a urine organic acids panel revealed an elevated HVA (homovanillic acid) and VMA (vanillylmandelic acid), the metabolites of the neurotransmitters epinephrine, norepinephrine and dopamine. Subsequent abdominal ultrasound and chest/abdomen CT revealed a large heterogeneous mass with internal vascular flow and scattered calcifications arising from the medial limb of the left adrenal gland, consistent with neuroblastoma. CONCLUSION: Although rare, neuroblastomas can present clinically in the perinatal period in a manner requiring immediate life-saving intervention. Providers should consider the diagnosis in the setting of a newborn with a sepsis-like syndrome or profound metabolic acidosis presenting along with systemic hypertension without clear underlying etiology. Show more

Keywords: Congenital neuroblastoma, metabolic acidosis, neonatal collapse, neonatal hypertension, sepsis-like syndrome

DOI: 10.3233/NPM-231219

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 3, pp. 573-575, 2023

Authors: Ryan, M.S. | McIntyre, J. | Bramwell, L & D. | Ojha, S.

Article Type: Case Report

Abstract: BACKGROUND: Intravenous lipid emulsions (ILEs) provide essential fatty acids during parenteral nutrition (PN). Serious adverse events including death can occur from overdose. We report an accidental overdose in a preterm infant. METHOD: On Day 2 of life, a 29-week gestational age (GA) twin was accidentally given 47.5 mL of Intralipid20% (≈3x daily amount) in 50-minutes. RESULTS: No apparent clinical deterioration occurred, although blood samples were lipaemic. Outcomes at 2 years corrected GA were similar to that of his twin. Service changes were made to infusion packaging and administration to avoid similar errors. CONCLUSIONS: Medication errors …in neonates are unfortunately common. Published articles usually focus on poor outcomes, which can increase the distress for parents of children where errors have occurred. Publishing the full spectrum of outcomes instead allows parents and professionals to be aware of all possibilities and lessons learnt, even if serious harm was avoided. Show more

Keywords: Accidental overdose, intravenous lipid emulsion, preterm infant

DOI: 10.3233/NPM-231221

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 3, pp. 577-586, 2023

Authors: Garg, P.M. | Shenberger, J.S.

Article Type: Addendum

DOI: 10.3233/NPM-239007

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 3, pp. 587-587, 2023