Journal of Neonatal-Perinatal Medicine - Volume 16, issue 4

Authors: Garg, P.M. | Denton, M.X. | Talluri, R. | Ansari, M.A.Y. | Riddick, R. | Ostrander, M.M. | McDonald, A.G. | Premkumar, M.H. | Hillegass, W.B. | Garg, P.P.

Article Type: Research Article

Abstract: OBJECTIVE: We sought to investigate the clinical determinants of intestinal failure and death in preterm infants with surgical NEC. METHODS: Retrospective comparison of clinical information between Group A = intestinal failure (Parenteral nutrition (PN) >90 days) and death and Group B = survivors and with PN dependence < 90 days in preterm infants with surgical NEC. RESULTS: Group A (n  = 99/143) had a lower mean gestational age (26.4 weeks [SD3.5] vs. 29.4 [SD 3.5]; p  = 0.013), lower birth weight (873 gm [SD 427g] vs. 1425 gm [894g]; p  = <0.001), later age of NEC onset (22 days [SD20] vs. 16 days [SD 17]; …p  = 0.128), received surgery later (276 hours [SD 544] vs. 117 hours [SD 267]; p  = 0.032), had cholestasis, received dopamine (80.6% vs. 58.5%; p  = 0.010) more frequently and had longer postoperative ileus time (19.8 days [SD 15.4] vs. 11.8 days [SD 6.5]; p  = <0.001) and reached full feeds later (93 days [SD 45] vs. 44 [SD 22]; p  = <0.001) than Group B. On multivariate logistic regression, higher birth weight was associated with lower risk (OR 0.35, 95% CI 0.15–0.82; p  = 0.016) of TPN > 90 days or death. Longer length of bowel resected (OR 1.76, 95% CI 1.02–3.02; p  = 0.039) and longer postoperative ileus (OR 2.87, 95% CI 1.26–6.53; p  = 0.011) were also independently associated with TPN >90days or death adjusted for gestational age and antenatal steroid treatment. CONCLUSION: In preterm infants with surgical NEC, clinical factors such as lower birth weight, longer bowel loss, and postoperative ileus days were significantly and independently associated with TPN >90 days or death. Show more

Keywords: Intestinal failure, mortality, necrotizing enterocolitis, outcomes, preterm infants

DOI: 10.3233/NPM-230157

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 4, pp. 589-596, 2023

Authors: Murali, Mithuna | Sethuraman, Giridhar | Vasudevan, Jaishree | Umadevi, L. | Devi, Usha

Article Type: Research Article

Abstract: BACKGROUND: Delayed cord clamping (DCC) is the recommended strategy in neonates not requiring resuscitation, but umbilical cord milking (UCM) can also be used in term babies. DCC has been found to offer advantages more than just placental transfusion. OBJECTIVE: To compare the neonatal outcomes of DCC and UCM at birth in vigorous neonates ≥35 weeks born via cesarean section. METHODS: We included all vigorous neonates born ≥35 weeks of gestation through the cesarean section in this open-label randomized controlled trial. They were randomized into Group-A (DCC-cord was clamped 60 s after birth) or Group B(UCM). For neonates …in Group B, the intact cord was milked at 25 cm from the stump 3 times towards the neonate and then clamped. The primary outcome was hematocrit at 72 h of life. Secondary outcomes were serum ferritin between 6 and 10 weeks of life, serum bilirubin at 72 h of life, need and duration of phototherapy, respiratory distress, hypoglycemia, hypotension, and sepsis. RESULTS: Baseline characteristics were similar in both the groups. The mean hematocrit at 72 h was more in the DCC group compared to the UCM group [(55.60±4.50) vs (53.89±4.44), MD (95% CI) = 1.71 (0.26, 3.16); p  = 0.021]. There was no significant difference in median serum ferritin between the groups [102.88(84.67–173.24) vs 137.93(85.15–230.40); p  = 0.173]. There was no significant difference in clinical outcomes. CONCLUSION: In neonates born via cesarean section, DCC resulted in improved hematocrit levels by 72 hours compared to UCM. DCC results in better placental transfusion. Show more

Keywords: Cesarean section, delayed cord clamping, hematocrit, placental transfusion, umbilical cord milking

DOI: 10.3233/NPM-230069

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 4, pp. 597-603, 2023

Authors: Manzar, S. | Cole, S.R. | Bhat, R.

Article Type: Research Article

Abstract: BACKGROUND: Timely communication is essential in attaining maternal satisfaction, developing an excellent physician-patient rapport, and increasing trust. This study reports a significant improvement in maternal communication rates through the quality improvement method. METHODS: An educational module was developed, and NICU staff was presented with the slides, followed by a performance questionnaire to demonstrate understanding. The first phase was completed by obtaining feedback from mothers through a questionnaire. The first plan-do-study-act (PDSA) cycle, carried out for eight weeks looking at the rates of the maternal update provided within an hour of admission of their neonates to the NICU, was …followed by the second PDSA cycle, carried out for ten weeks. The improvement was calculated using conventional statistics and a statistical process control chart. RESULTS: During the first phase of the study, thirty-six percent of the mothers were updated within an hour of admission of their neonates to the NICU. During the first PDSA cycle, we did not notice a special cause variation or process change. A significant shift, eight consecutive points above the mean, was noted on the control chart during PDSA cycle 2. The mean±SD of the weekly update rate increased significantly during PDSA cycle 2 (76.8±11) compared to PDSA cycle 1 (47.5±14), p -value = 0.0002. CONCLUSION: We improved the maternal update rates through the educational module following the QI improvement model using the PDSA cycles. Show more

Keywords: Healthcare quality, improvement, maternal, NICU, neonatal, patients’ satisfaction, PDSA cycle

DOI: 10.3233/NPM-230050

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 4, pp. 605-610, 2023

Authors: Mamidi, R.R. | MacDonald, K.D. | Brumbach, B.H. | Go, M.D.A. | McEvoy, C.T.

Article Type: Research Article

Abstract: BACKGROUND: The standard of care for respiratory support of preterm infants is nasal continuous positive airway pressure (CPAP), yet practices are not standardized. Our aim was to survey CPAP practices in infants < 32 weeks gestation among the American Academy of Pediatrics Neonatal-Perinatal section. METHODS: A US, web-based survey inquired about the initiation, management, and discontinuation of CPAP, and chinstrap use and oral feedings on CPAP. RESULTS: 857 providers consented. Regarding criteria to discontinue/wean CPAP: 69% use specific respiratory stability criteria; 22% a specific post-menstrual age; 8% responded other. 64% did not have guidelines for CPAP discontinuation; 54% …did not have guidelines for CPAP initiation. 66% believe chinstraps improve CPAP efficacy; however, 11% routinely apply a chinstrap. 22% allow oral feeds on CPAP in certain circumstances. CONCLUSION: There are meaningful variabilities in CPAP practices among neonatal providers across the US. Given the potential long-term implications this can have on the growth and development of the preterm lung, further evidence-based research is needed in relation to respiratory outcomes to optimize and standardize CPAP strategies. Show more

Keywords: Continuous positive airway pressure (CPAP), neonatal intensive care unit, respiratory distress syndrome of preterm infant, chinstraps, enteral feeds

DOI: 10.3233/NPM-230006

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 4, pp. 611-617, 2023

Authors: Lokwani, P. | Gupta, N. | Choudhary, S.K. | Singh, A.K.

Article Type: Research Article

Abstract: BACKGROUND: With technological advancement, Neonatal Intensive Care Units (NICU) have become noisier than ever. Studies have shown the detrimental effects of increasing noise in NICU on growing pre-term and sick neonates. The present study aimed to survey the amount of noise in one of the NICU blocks of a government tertiary care centre and explore ways to control it when dealing with these sick babies. METHODS: A detailed noise survey was carried out, for February 2023, in one of the two blocks of NICU in a government tertiary-care centre. The noise measurements were performed using two …“Sound Ear 3” noise meters. The analyses were done in Leq (equivalent continuous sound levels) A-weighted decibels (dBA). RESULTS: The extracted data analysis revealed that the NICU block was exposed to a mean Leq of 67.78 dBA noise with a maximum of 89.0 dBA. There was a significant difference between the values noted in devices at different locations and across different periods. There were certain instances (57 and 42 for two devices) when there were sudden spikes in the noise levels beyond 80 dBA. It was also seen that noise was more than 65 dBA most of the time (72% and 66% for the two devices). CONCLUSION: The noise survey carried out over one month revealed a considerable amount of noise in the NICU of a government tertiary-care centre. The study also explored ways such as environmental modification, human behavior modification, awareness programs, and neonatal-centered modifications to reduce the noise and lower its detrimental effects on the growth of neonates. Show more

Keywords: Neonatal intensive care unit, noise awareness, noise management, noise survey

DOI: 10.3233/NPM-230031

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 4, pp. 619-625, 2023

Authors: Abd Almonaem, E.R. | Mostafa, M.A. | El-Shimi, O.S. | Saeed, Y.A. | Abdulsamea, Sameh

Article Type: Research Article

Abstract: BACKGROUND: Since iron is crucial for many tissue processes, we, therefore, aimed to assess ferritin and the zinc protoporphyrin to heme ratio (ZnPP/H) as indicators of iron status in preterm newborns, particularly during certain inflammatory episodes. METHODS: From 170 preterm babies, paired ferritin and ZnPP/H measurements were collected twice (on the first postnatal day and six weeks later). To compare these measures and assess the impact of anemia, sepsis, and packed red blood cell transfusion (PRBT), three different scenarios were considered. RESULTS: Compared to the non-anemic group, the anemic patients’ serum ferritin level was considerably lower …(p  = 0.044), whereas the anemic patients’ ZPP/H ratio was significantly greater (p  < 0.001). In neonates with sepsis, ferritin levels were considerably greater in both anemic and non-anemic septic neonates compared to neonates without sepsis (p  < 0.001 for each). Regarding ZPP/H ratio, no appreciable variations were found between the two groups. In addition, serum ferritin significantly increased following each PRBT (p  < 0.001 for each). As a result of each PRBT, the ZPP/H ratio considerably decreased (p  < 0.001). CONCLUSION: As a measure of iron status during particular inflammatory processes like infection and PRBT, ZnPP/H may be more accurate. Show more

Keywords: Ferritin, PRBT, preterm, ZPP/H

DOI: 10.3233/NPM-230161

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 4, pp. 627-638, 2023

Authors: Simon, R. | Shay, R. | Bergam, B. | Katz, R. | Delaney, S.

Article Type: Research Article

Abstract: BACKGROUND: Bowel dilation and bowel wall thickness are common prenatal ultrasound measurements for fetuses with gastroschisis. Data regarding antenatal sonographic bowel findings and postnatal outcomes are conflicting. Our objective was to evaluate the impact of in utero bowel measurements on perinatal outcomes in gastroschisis pregnancies. METHODS: Retrospective cohort study of 116 pregnancies complicated by gastroschisis between 2011 and 2020. We reviewed ultrasounds documenting fetal bowel measurements. To evaluate the association of these measurements with antepartum and delivery outcomes, we ran logistic and linear models using generalized estimating equations. RESULTS: Eleven perinatal outcomes reached statistical significance, although …with minimal clinical impact given small magnitude of effect. Intra-abdominal bowel dilation was associated with a 0.5 week decrease in delivery gestational age (GA) (95% CI –0.07, –0.03) and a 6.93 g increase in birth weight (95% CI 1.54, 28.73). Intra-abdominal bowel wall thickness was associated with later GA of non-stress test (NST) start of 0.22 weeks (95% CI 0.07, 0.37), increased delivery GA of 0.08 weeks (95% CI 0.02, 0.15), 0.006 decrease in umbilical artery (UA) pH (95% CI –0.009, –0.003), 0.26 increase in UA base deficit (95% CI 0.09, 0.43), and decreased odds of cesarean delivery (OR = 0.83, 95% CI 0.70, 0.99). Extra-abdominal bowel wall thickness was associated with a 0.1 increase in UA base deficit (95% CI 0.02, 0.19) and a 0.05 increase in 5-min APGAR score (95% CI 0.01, 0.09). Stomach cross-section was associated with a 0.01 week decrease in delivery GA (95% CI –0.02, –0.001) and increased odds of receiving betamethasone (OR = 1.02, 95% CI 1.01, 1.04). CONCLUSIONS: In utero bowel characteristics reached statistical significance for several outcomes, but with minimal meaningful clinical differences in outcomes. Show more

Keywords: Bowel dilation, gastroschisis, prenatal diagnosis, stomach, ultrasound

DOI: 10.3233/NPM-230159

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 4, pp. 639-647, 2023

Authors: Seyedkalateh, P. | Mirfazeli, A. | Rajabi, A. | Alaee, E.

Article Type: Research Article

Abstract: BACKGROUND: Nutritive disorders like sucking and swallowing problems are common in infants. The necessity for a clinical tool to assess these issues has never been more evident. This study aims to evaluate sucking patterns and standardize them in healthy neonates. METHODS: A cross-sectional study involving 223 neonates breastfeeding in the Maternity Ward of Shahid Sayyad Shirazi Hospital, Gorgan, Iran, from April to September 2021 was conducted. Neonatal swallowing skills (maximum sucking pressure and number of sucking actions) were assessed using a swallowing skill assessment device. The 95% confidence interval for maximal sucking pressure and the number of sucking …actions within a normal distribution were estimated. RESULTS: Out of 223 infants, 112 (50.2%) were female, 176 (74.9%) were delivered via cesarean section, and their mean birth weight was 3154.48±371.48 grams. The maximum sucking pressure was –6.82, with a 95% confidence interval of (–13.21, –3.52) in infants. The mean number of sucking actions within a 15-second interval was 6.74, with a 95% confidence interval of (2.23, 20.37). CONCLUSION: Regarding this data and the high prevalence of sucking disorders in preterm infants worldwide, we can employ this information in conjunction with an oral-motor skill assessment tool to evaluate infant sucking patterns in hospitals, clinics, and during home visits. Show more

Keywords: Breastfeeding, infant, newborn, standardization

DOI: 10.3233/NPM-230008

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 4, pp. 649-656, 2023

Authors: Prince, A. | Wade, J. | Power, M.L. | Gunawansa, N. | Cruz-Bendezú, A. | Schulkin, J. | Macri, C.J.

Article Type: Research Article

Abstract: BACKGROUND: Traditionally, postpartum care is confined to inpatient care immediately post birth and one appointment approximately six weeks postpartum. Data supports a continuum of care model as best for the health of mother and baby. Despite most women having significant concerns about the postpartum period, these concerns are frequently incompletely addressed by providers. We surveyed prenatal and postpartum patients to understand their concerns and experiences discussing postpartum care with providers. METHODS: Cross sectional surveys were administered between June 2019 and May 2021. Principal component analysis was used to show higher than average (positive) or lower than average (negative) …conversations with providers about postpartum care examined by race, education, and parity. Chi squared tests were conducted to examine the significance of specific postpartum concerns. RESULTS: 421/450 patient surveys were analyzed, based on completion. Most patients were White (193), had post graduate degrees (188), privately insured (236), married (248), first time pregnant (152), and used doctors as their primary provider (267). Patients with lower education, higher parity and Black patients without postgraduate degrees reported higher than average postpartum counseling. Additionally, most patients expressed significant concerns about postpartum exhaustion (65.8%), breastfeeding (62.3%), pain (61.2%), physical activity (54.9%) and the baby blues (50.4%). CONCLUSIONS: Postpartum concerns are incompletely and inconsistently addressed amongst patients based on race, parity, and education. A continuum of care approach, beginning in the third trimester, through the postpartum period, may provide better counseling to address all patients’ concerns. Show more

Keywords: Fourth trimester, peripartum counseling, post-partum

DOI: 10.3233/NPM-230167

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 4, pp. 657-664, 2023

Authors: Bezirganoglu, H. | Sari, F.N. | Cetinkaya, A.K. | Dizdar, E.A. | Buyuktiryaki, M.

Article Type: Research Article

Abstract: BACKGROUND: The role of platelet function in the development of intraventricular hemorrhage is still a subject of debate. In this study, we aimed to determine whether there is an association between platelet indices in the first week of life and severity of intraventricular hemorrhage in very preterm infants. MATERIALS AND METHODS: Preterm infants born < 30 weeks of gestation in our hospital were retrospectively evaluated. Platelet parameters, including platelet counts, mean platelet volume, platelet distribution width, and platelet mass were retrieved at two different time points: the initial value on the first day of life and the value closest to …the end of the first week of life. The infants were categorized according to the findings of cranial ultrasonography as; no intraventricular hemorrhage, mild or severe intraventricular hemorrhage. RESULTS: Totally, 1051 infants were evaluated. The mean gestational age and birth weight for the entire cohort were 27.9±1.6 weeks and 1058±247 g, respectively. Infants in the severe intraventricular hemorrhage group had significantly lower gestational age (p  < 0.001) and birthweight (p  < 0.001) compared to other two groups. Furthermore, there were significant differences in platelet count and platelet mass between the groups at two time intervals. However, logistic regression analysis revealed that only platelet count of < 100×109 /L on the first postnatal day was independently associated with the severity of intraventricular hemorrhage. CONCLUSION: There is an association between platelet count of < 100×109 /L on the first postnatal day and severe intraventricular hemorrhage in very preterm infants. Show more

Keywords: Mean platelet volume, neonatal thrombocytopenia, platelet mass, preterm

DOI: 10.3233/NPM-230045

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 4, pp. 665-671, 2023