Journal of Neonatal-Perinatal Medicine - Volume 17, issue 4

Authors: Elfarargy, M.S. | Alruwaili, T.A. | Ahmad, A.R. | Elbadry, D.H.

Article Type: Review Article

Abstract: Coronavirus disease 2019 (COVID-19) is considered an infectious disease which is caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Neonatal COVID-19 had been occurred in many countries which would indicate the need of effective and safe treatment for these vulnerable group. In this study, we showed symptoms of corona virus in neonates, investigation of coronavirus in neonates and radiological features of neonatal COVID-19. In addition, we discussed management of neonates with COVI-19, antiviral treatment, monoclonal antibodies administration, immunomodulatory therapy, antibiotics, vitamins, and minerals in the treatment of neonatal COVID-19, and also telemedicine in neonatal COVID-19 and feeding …the newborn of COVID-19 mother. We also discussed multisystem inflammatory syndrome in neonates (MIS-N), management of affected COVID-19 neonates and discussion of the complication of the neonatal COVID-19. We further discussed the methods of dealing with COVID-19 neonates and the research done on the neonatal COVID-19 treatment. Show more

Keywords: COVID-19, neonate, remdesivir, treatment

DOI: 10.3233/NPM-230112

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 4, pp. 501-507, 2024

Authors: Fernandes, Matilde A. | Delgado, Lucinda | Almeida, André Coelho

Article Type: Review Article

Abstract: BACKGROUND AND OBJECTIVES: Newborns, particularly premature ones, are vulnerable to bacterial infections and often receive antibiotics, disrupting their normal intestinal microbiota. Probiotics have multiple health benefits and are recommended for restoring balance, but caution is needed due to potential consequences, such as promoting antibiotic resistance. Therefore, this study aimed to conduct a systematic review to assess current knowledge regarding the impact of probiotics on antibiotic resistance in newborns. METHODS: This systematic review is aligned with the PRISMA 2020 statement. The search involved three electronic databases (PubMed, Scopus, and Web of Science) and the keywords used were “newborn”, “probiotic”, …and “antibiotic resistance”. Titles/abstracts were independently analyzed, followed by full-text assessments. Data extraction and synthesis were conducted, assessing outcomes like antibiotic resistance gene and mobile gene elements quantity and quality, vancomycin resistant enterococci colonization, antibiotic-resistant bacteria colonization, and microbiota changes. It was only included randomized controlled trials and cohort studies focusing on human newborns. RESULTS: In the study selection process, 1,970 articles were identified and six were included in this review. The results varied, with two studies suggesting a positive impact of probiotics on antibiotic resistance, one a negative impact, while three others found no significant impact. Microbiota changes were also addressed across four studies, where the findings included promotion of beneficial bacteria and reduction of potential pathogens. Bias risk was evaluated using Joanna Briggs Institute tools. CONCLUSION: Our findings did not allow for clear conclusions to be drawn, due to the observed heterogeneity between studies, highlighting the need for further studies. Show more

Keywords: Newborn, probiotics, probiotics resistance, antibiotics

DOI: 10.3233/NPM-240008

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 4, pp. 509-518, 2024

Authors: Akshitha, E.V.N. | Choubey, B. | Shrivastava, J.

Article Type: Research Article

Abstract: BACKGROUND: Tactile kinesthetic stimulation (TKS) has been the subject of clinical research since the 1960 s, when it was proposed as a way to promote preterm growth and development. OBJECTIVE: To find out the effect of TKS on weight gain in preterm neonates and the factors affecting TKS in relation to outcome. METHODS: TKS was demonstrated to mothers in department of paediatrics. 124 Preterm neonates fulfilling inclusion criteria were enrolled. The time for which they are doing TKS was noted. Their weight was monitored daily by digital weighing scale till discharge and at one month of age …and then average weight gain was calculated and correlated with various factors. RESULTS: There is a significant increase in weight of neonates at discharge (1.73 kg; p  < 0.001) and at one month (1.96 kg; p  < 0.001) when compared to enrollment (1.686 kg). There was a significant positive correlation between TKS session duration and mean weight change at 1 month follow up (r  = 0.269; P  = 0.003) and per day weight gain (r  = 0.889; p  < 0.001), as well as a positive correlation between average TKS session and weight gain when pearson correlation was performed. TKS sessions of 15 minutes or three sessions per day were effective in increasing the weight of preterm neonates. It was noticed that those who received three sessions per day had a shorter hospital stay (7.68 days) than two sessions per day (10.23 days). The education level of the mother, care giver, type of feed, and gender of the preterm have no significant effect on weight gain. Show more

Keywords: Preterm, tactile kinesthetic stimulation, weight gain

DOI: 10.3233/NPM-240018

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 4, pp. 519-526, 2024

Authors: Ionov, O.V. | Sharafutdinova, D.R. | Sugak, A.B. | Filippova, E.A. | Balashova, E.N. | Kirtbaya, A.R. | Karasova, L.Kh. | Dorofeeva, E.I. | Podurovskaya, Y.L. | Yarotskaya, E.L. | Zubkov, V.V. | Degtyarev, D.N. | Donn, S.M.

Article Type: Research Article

Abstract: BACKGROUND: Bowel ultrasound (US) is one of the methods used to enhance diagnostic accuracy of necrotizing enterocolitis (NEC) and its associated complications in premature newborns. AIM: To explore the diagnostic accuracy of bowel US in extremely low birth weight (ELBW) infants with NEC. METHODS: A single-center retrospective case-control study included 84 extremely low birth weight (ELBW) infants. The infants were divided into three groups: Group 1 –infants with NEC (n  = 26); Group 2 –infants with feeding problems (n  = 28); Group 3 –control group (n  = 30). RESULTS: The specific bowel US findings in premature newborns …with NEC (stage 3) included bowel wall thinning, complex (echogenic) ascites, and pneumoperitoneum, p  < 0.05. The diagnostic effectiveness of these sonographic signs was 96.8% (sensitivity 75.0% and specificity 97.6%), p  < 0.05. These findings with high specificity were associated with the need for surgical intervention, poor outcomes, or increased mortality. Stage 2 NEC which did not require surgery showed impaired differentiation of the bowel wall layers, absent or decreased bowel peristalsis, pneumatosis intestinalis, portal venous gas, or simple ascites, with a diagnostic accuracy of 82.9% (sensitivity 55.6%, specificity 91.4%, p  < 0.05). CONCLUSIONS: Bowel US can be used as an adjunct to abdominal radiography to aid in the diagnosis of infants with suspected NEC by providing more detailed evaluation of the intestine. Show more

Keywords: Bowel ultrasound, extremely low birth weight, intestine, necrotizing enterocolitis, premature newborns

DOI: 10.3233/NPM-230201

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 4, pp. 527-534, 2024

Authors: Satar, M. | Erol, A.H. | Özdemir, M. | Özbarlas, N. | Atmış, A. | Özlü, F. | Büyükkurt, S.

Article Type: Research Article

Abstract: BACKGROUND: Delayed cord clamping is the standard of care for both term and preterm infants worldwide. The aim of this study was to evaluate the effect of 60-second or 180-second delayed cord clamping during labor on cerebral oxygenation and cardiac function. METHODS: Healthy newborns were divided into two groups: a 60-second delay in cord clamping (60-s DCC) and a 180-second delay in cord clamping (180-s DCC) at birth. Pulse oximetry and cerebral near-infrared spectroscopy (cNIRS) probes were placed during postnatal care. A total of 84 healthy newborns were included in this study. Preductal oxygen saturation (SpO2 …), heart rate, and cNIRS values were recorded at 5 and 10 minutes after delivery. The cardiac function of the infants was assessed by echocardiography at 3–7 days postnatally. RESULTS: There was no significant difference between the groups in SpO2 and cNIRS values at 5 and 10 min. While there was no significant difference in the number of neonates with targeted SpO2 at the 5th and 10th min and targeted cNIRS values at the 10th min, there was a significant difference in the number of neonates with target cNIRS values at the 5th min between groups (p  < 0.001). Echocardiographic findings showed that pulmonary flow velocity was increased in the 180-s DCC group; the difference was statistically significant (p  = 0.04). CONCLUSION: Our results showed that the number of infants with normal cNIRS values regarding cerebral oxygenation was higher in the 180-s DCC group. The pulmonary flow velocity was significantly increased in the 180-s DCC group in terms of echocardiographic findings. Show more

Keywords: Cerebral NIRS, cord clamping time, echocardiography, neonates

DOI: 10.3233/NPM-230223

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 4, pp. 535-542, 2024

Authors: Mohamed, M.A. | Venkatesh, K. | Abdelatif, D. | Nandakumar, V. | Hoffman, H.

Article Type: Research Article

Abstract: OBJECTIVE: To examine the association of inpatient maternal mortality with variability in healthcare services delivery such as hospital size, urban/rural designation, teaching/non-teaching status, regional location, and insurance coverage. METHODS: This is a pooled, cross-sectional analysis of the National Inpatient Sample (2012–2014). Information on maternal demographics, clinical conditions, and birth outcomes were identified using respective ICD9-CM codes. Bivariate and multivariate analysis using logistic regression models were used to describe maternal characteristics and to calculate the risk of mortality with each independent variable RESULTS: The weighted sample included 12,409,939 hospital records (82.6% are 18–34-year-old and 49.5% are Caucasians). …Maternal death during hospitalization occurred in 1310 cases (12/100,000 live birth). Women with cardiovascular disorders, hemorrhage or sepsis were 33.6, 4.7, and 5.4 times more likely to suffer inpatient maternal mortality. Compared to small-sized hospitals, delivery at medium or large size hospitals is associated with higher mortality, adjusted odds ratios (aOR) 1.8 (1.4–2.3), and 2.2 (1.8–2.8), respectively. Adjusted OR for inpatient maternal mortality in urban non-teaching or urban teaching compared to rural hospitals were 2.2 (1.7–3.0) and 2.9 (2.2–3.9), respectively. Women in the South have higher maternal mortality compared to Northeast, aOR 1.7 (1.5–2.1). Women coved with public insurance experience higher inpatient maternal mortality compared to those with private insurance, aOR: 2.6 (2.1–3.2) and 1.9 (1.6–2.1), respectively. CONCLUSION: Factors related to variability in healthcare delivery may play a role in inpatient maternal mortality. Some could be explained by the case mix and the clinical conditions affecting birthing outcomes. A qualitative analysis is needed to explore how these factors relate to increased maternal mortality in certain hospital settings. Show more

Keywords: Economic disparities, healthcare services delivery, hospital academic status, hospital locality within U.S. geographical regions, hospital rural/urban designation, hospital size, maternal mortality, inpatient maternal mortality, insurance coverage, puerperal sepsis, postpartum hemorrhage and racial disparities

DOI: 10.3233/NPM-240025

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 4, pp. 543-553, 2024

Authors: Dhungana, R. | Chalise, M. | Visick, M.K. | Clark, R.B.

Article Type: Research Article

Abstract:  Perinatal death, a global health problem, can be prevented with simple resuscitation interventions that help the baby breathe immediately at birth. Latter-day Saint Charities (LDSC) and Safa Sunaulo Nepal (SSN) implemented a program to scale-up Helping Babies Breathe (HBB) training in Karnali Province, Nepal from January 2020-February 2021. The interventions were implemented using a hybrid approach with on-site mentoring in the pre/post COVID period combined with remote support and monitoring during the COVID period. This paper reports overall changes in newborn outcomes in relation to the unique implementation approach used. A prospective cohort design was used to compare outcomes of …birth cohorts in 16 public health facilities in the first and last three months of program implementation. Results showed significant decreases in intrapartum stillbirths (23%), and neonatal deaths within (27%) and after (41.3%) 24 hours of life. The scale-up of HBB training resulted in 557 providers receiving training and mentoring support during the program period, half trained during the COVID period. Increased practice sessions, review meetings and debriefing meetings were reported during the COVID period compared to pre/post COVID period. The evaluation is suggestive of the potential of a hybrid approach for improved perinatal outcomes and scaling-up of newborn resuscitation trainings in health system facing disruptions. Show more

Keywords: Newborn Resuscitation, perinatal mortality

DOI: 10.3233/NPM-230072

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 4, pp. 555-564, 2024

Authors: Sisman, J. | Adhikari, E.H. | Black, L.F. | Weiss, A. | Brown, L.S. | Brion, L.P.

Article Type: Research Article

Abstract: BACKGROUND: Several reports demonstrated that perinatal SARS-CoV-2 has significant impact on maternal and neonatal health outcomes. However, the relationship between severity of maternal illness with outcomes remains less clear. METHODS: This is a single-center retrospective cohort study of mother/infant dyads with positive maternal test for SARS-CoV-2 between 14 days prior and 3 days after delivery from 3/30/2020 to 12/28/2021. RESULTS: Among 538 mothers, those with moderate/severe/critical illness were more likely to undergo induction, receive oxygen, mechanical ventilation or ECMO. Mortality was significantly higher among the mothers with severe illness than asymptomatic and those with mild illness …(6% vs 0% and 0%, respectively, P  < 0.05). Neonates born to mothers with moderate/severe/critical illness were more likely to be preterm with lower birth weight, and to be admitted to the NICU (P  < 0.05) but not to be small for gestational age. Mild maternal illness was only associated with NICU admission for isolation precaution and decreased rate of breastfeeding. CONCLUSIONS: Maternal illness severity was significantly associated with prematurity and several adverse maternal and neonatal outcomes. Show more

Keywords: COVID-19, illness severity, neonates

DOI: 10.3233/NPM-230204

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 4, pp. 565-573, 2024

Authors: Assunção, A. | Flôr-de-Lima, F. | Moita, R.M. | Ferreras, C. | Rocha, G.

Article Type: Research Article

Abstract: BACKGROUND: Fetal inflammatory response syndrome (FIRS), the fetal equivalent of chorioamnionitis, is associated with poorer neonatal outcomes. FIRS is diagnosed through placental histology, namely by the identification of funisitis (inflammation of the umbilical cord) and chorionic vasculitis (inflammation of fetal vessels within the chorionic plate). The aim of this study was to identify and evaluate associations between FIRS and neonatal outcomes in preterm neonates. METHODS: We performed a retrospective cohort study at a level III neonatal intensive care unit (NICU), from January 1st 2008 to December 31st 2022, involving all inborn neonates with a gestational age …below 30 weeks. We compared preterm neonates based on whether their placental histology described funisitis with chorionic vasculitis (FCV) or not. RESULTS: The study included 113 preterms, 27 (23.9%) of those had FCV and 86 (76.1%) did not. After adjusting to gestational age, prolonged rupture of membranes and preeclampsia, FCV was independently associated with the development of early-onset sepsis (OR = 7.3, p  = 0.021) and cystic periventricular leukomalacia (OR = 4.6, p  = 0.004). CONCLUSION: The authors identified an association between FIRS and the development of early-onset sepsis and cystic periventricular leukomalacia, highlighting the importance of early detection and management of this condition in order to improve long-term neonatal outcomes. Show more

Keywords: Chorioamnionitis, chorionic vasculitis, cystic periventricular leukomalacia, early onset sepsis, funisitis

DOI: 10.3233/NPM-240017

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 4, pp. 575-582, 2024

Authors: Zakerihamidi, M. | Rakhshanizadeh, F. | Moradi, A. | Boskabadi, H.

Article Type: Research Article

Abstract: OBJECTIVES: Perinatal asphyxia is the main risk factor for mortality and morbidity in neonates and neurological disorders in survived infants. We compared the neonatal and maternal 25 (OH) vitamin D levels in neonates with/without asphyxia. MATERIALS AND METHODS: This cross-sectional research was done on 229 neonates (including 158 neonates [69%] without asphyxia [control group] and 71 neonates [31%] with asphyxia [case group]) from 2020 to 2023 using the available sampling method. 25 (OH) Vit D levels in mothers and neonates were assessed and compared in the 2 groups. The data collection instrument was a researcher-made checklist, containing the …maternal and neonatal characteristics and laboratory evaluations. Data were analyzed by SPSS 23 using the t- test. RESULTS: The mean maternal 25 (OH) Vit D levels in the case and control groups were 16.34±11.87 and 22.80±12.67 ng/mL, respectively. The mean neonatal 25 (OH) Vit D levels in the case and control groups were respectively 12.13±8.62 and 19.55±11.62 ng/mL (P  = 0.002). The case group showed severer maternal and neonatal 25 (OH) Vit D deficiency (P  = 0.000) compared to the control group. CONCLUSIONS: Neonatal and maternal 25 (OH) Vit D deficiency can increase the risk of perinatal asphyxia. Therefore, administration of 25 (OH) Vit D supplements to pregnant mothers may reduce the incidence of asphyxia. Show more

Keywords: Asphyxia, mothers, newborn, prematurity, 25 (OH) Vitamin D

DOI: 10.3233/NPM-230229

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 4, pp. 583-588, 2024