Journal of Neonatal-Perinatal Medicine - Volume 2, issue 3

Authors: Als, Heidelise

Article Type: Research Article

Abstract: The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) derives from the conceptualization of the preterm infant as a goal-oriented fetus outside of the womb in the evolutionarily-unexpected environment of the newborn intensive care nursery or unit (NICU). The NICU may be required for survival, yet violates the displaced brain and infant's neurodevelopmental expectations. Detailed behavioral observations of the infant in the NICU become the professional's guide to provide continuously individually-adapted, developmentally …supportive care. The detailed behavioral observations led to the comprehensive dynamic formulation termed the synactive theory of development. It is anchored in sound developmental principles. In turn it provides a framework for the disciplined and systematic study of the infants' behavioral subsystems in their continuous interplay with one another and in turn with the current physical and social environments. Integration of the NIDCAP approach and framework into newborn intensive care reduces the iatrogenic complications of newborn intensive care for infants, parents and staff alike, and in turn enhances the infant's competence, the parents' confidence, and the staff's role satisfaction. The theory-driven and evidence-based NIDCAP model of care involves formal training and education and requires a multidisciplinary commitment to self-definition and growth, as well as systems change within the hospital and the community. Site assessment of the respective nursery and self-assessment of individual professionals initiate the training process and help launch over time a thorough and thoughtful transformation in all aspects of clinical practice and mutual interaction within the NICU. The training consists of a series of individual or paired work sessions with a certified NIDCAP Trainer, made successful by extensive guided independent neurobehavioral practice, study, and observations. Each clinical report based on a detailed infant observation interprets the meaning of the infant's observed behavior within the context of the infant's current and historical medical and developmental course and status, the family's desires, worries, concerns and own development, as well as the NICU staff's care and social interaction skills, and the NICU's physical environment, which all impinge continuously on the infant proximally and distally. The individually adapted care interactions and collaborations with the infant and family, as well as the environment modifications yield significantly enhanced developmental outcomes of newborn intensive care. Survival is only warranted when quality of life and a growing sense of power and effectance make life worthwhile. NIDCAP is a system-anchored relationship-based prevention and intervention model that strives to enhance relationships among the infants, the families and the professionals, who care for them. Show more

Keywords: NIDCAP, preterm infants, newborns, neonatal intensive care, individualized developmental care, NICU environment, staff training, -education and -emotional guidance and support

DOI: 10.3233/NPM-2009-0061

Citation: Journal of Neonatal-Perinatal Medicine, vol. 2, no. 3, pp. 135-147, 2009

Authors: Pappoe, Timothy A. | Wu, Shou-Yien | Pyati, Suma

Article Type: Research Article

Abstract: Objective: To study the effect of aggressive versus conventional advancement of parenteral nutrition in very low birth weight (VLBW) infants. Methods: Forty-two infants weighing 600 to 1200 g were assigned to Study or Control groups. Study patients received 49 kcal/kg/d of non-protein energy (NPE), 2 g/kg/d of amino acids (AA) on D1, and advanced to 75–80 kcal/kg/d NPE, 3.5 g/kg/d of AA by D3. Control patients received 25 kcal/kg/d NPE, 1 g/kg/d AA on D1 with increase to 75–80 …kcal/kg/d NPE, 3.5 g/kg/d AA by D6. Serum glucose, triglyceride and blood urea nitrogen (BUN) concentrations were monitored. Glucose intolerance in the study group was treated with an insulin infusion while the control group was treated by decreasing the glucose infusion. Primary outcomes were postnatal weight loss, weight gain in seven days, and days to regain birth weight. Result: Significantly less postnatal weight loss and greater weight gain in 7 days were observed in the Study group, patients weighing less than 801 g. These differences did not persist beyond the first week. There was an increased incidence of glucose intolerance in the study group. Hypertriglyceridemia was more frequent in Study group infants weighing < 1001 g. There was no difference in the incidence of azotemia among groups. Conclusion: Aggressive nutrition regimen improved weight gain in the first week of life for VLBW infants especially those weighing less than 801~g although there was no long-term weight benefit. There was an associated increased incidence of hyperglycemia and hypertriglyceridemia in the smallest babies.To study the effect of aggressive versus conventional advancement of parenteral nutrition in very low birth weight (VLBW) infants. Methods: Forty-two infants weighing 600 to 1200 g were assigned to Study or Control groups. Study patients received 49 kcal/kg/d of non-protein energy (NPE), 2 g/kg/d of amino acids (AA) on D1, and advanced to 75–80 kcal/kg/d NPE, 3.5 g/kg/d of AA by D3. Control patients received 25 kcal/kg/d NPE, 1 g/kg/d AA on D1 with increase to 75–80 kcal/kg/d NPE, 3.5 g/kg/d AA by D6. Serum glucose, triglyceride and blood urea nitrogen (BUN) concentrations were monitored. Glucose intolerance in the study group was treated with an insulin infusion while the control group was treated by decreasing the glucose infusion. Primary outcomes were postnatal weight loss, weight gain in seven days, and days to regain birth weight. Result: Significantly less postnatal weight loss and greater weight gain in 7 days were observed in the Study group, patients weighing less than 801 g. These differences did not persist beyond the first week. There was an increased incidence of glucose intolerance in the study group. Hypertriglyceridemia was more frequent in Study group infants weighing < 1001 g. There was no difference in the incidence of azotemia among groups. Conclusion: Aggressive nutrition regimen improved weight gain in the first week of life for VLBW infants especially those weighing less than 801 g although there was no long-term weight benefit. There was an associated increased incidence of hyperglycemia and hypertriglyceridemia in the smallest babies. Show more

Keywords: Very low birth weight infants, aggressive parenteral nutrition, conventional parenteral nutrition, non-protein energy, glucose infusion rate

DOI: 10.3233/NPM-2009-0062

Citation: Journal of Neonatal-Perinatal Medicine, vol. 2, no. 3, pp. 149-156, 2009

Authors: McGovern, Angela M. | Greenspan, Jay S. | Webb, David | Kirkby, Sharon | Culhane, Jennifer F. | Desai, Shobhana

Article Type: Research Article

Abstract: Objective: Severe Retinopathy of Prematurity (ROP) is a primary cause of visual morbidity for very low birth weight infants. Known risk factors include short gestational age, low birth weight and supplemental oxygen exposure. Some studies have shown that Black infants are less at risk for severe ROP than White infants, however this finding has not been confirmed in studies designed to look at the risk of ROP and race/ethnicity specifically. The purpose of this study is …to assess the relationship between the race/ethnicity of infants and the risk of severe ROP for a sample of 1,604 infants in 1,189 hospitals located in 39 states. Patients and methods: ParadigmHealth database records for surviving infants born between 1/1/2001 and 12/31/2004 with a birth weight less than or equal to 1250 g were included in this analysis (n=1,604). Multivariate logistic regression was used to assess the association between race/ethnicity and risk for severe ROP. Models were adjusted for birth weight, gestational age, Apgar score, race and measures of illness severity including days on oxygen and mechanical ventilation, sepsis, intraventricular hemorrhage, patent ductus arteriosus, necrotizing enterocolitis and pneumothorax. Results: In the analytic data set, the distribution of maternal race was 47.2% White, 35.3% Black, 14.9% Hispanic and 3.2% Asian. Of these infants, 9.4% developed severe ROP; 6.6% for Blacks, 9.6% for Whites, 13.8% for Hispanics and 15.7% Asians. Compared to Black neonates, the unadjusted odds ratio for ROP among White infants was 1.5 (95% CI: 1.0, 2.3), for Hispanics 2.2 (95% CI: 1.4, 3.7) and for Asians 2.6 (95% CI: 1.2, 5.9). After adjustment for gestational age, birth weight and 1 minute Apgar score, the odds ratios increased to 2.0 (CI: 1.2, 3.2) for Whites, 2.7 (CI: 1.5, 4.8) for Hispanics and 5.3 (CI 1.9, 15.1) for Asians compared to Black neonates. Adjusting for additional markers of illness severity did not alter these results. Conclusions: Results revealed lower rates of ROP among Black confirming findings from earlier studies. Interestingly, relatively high rates of ROP were also found among Hispanic and Asian neonates compared to Black infants. Controlling for possibly confounding morbidities and measures of illness severity did not alter these results. Further research in this area is warranted. Show more

DOI: 10.3233/NPM-2009-0063

Citation: Journal of Neonatal-Perinatal Medicine, vol. 2, no. 3, pp. 157-162, 2009

Authors: Pérez-Muñuzuri, A. | Fernández-Lorenzo, J.R. | Couce-Pico, M.L. | Blanco-Teijeiro, M.J. | Fraga-Bermúdez, J.M.

Article Type: Research Article

Abstract: Introduction: Retinopathy of prematurity (ROP) is the primary cause of blindness in infancy in industrialized countries. There is currently no effective method for the prediction or early diagnosis of the disease. Objective: To test the effectiveness of transocular Doppler measurement of blood flow in the central retinal artery as a method of screening for ROP. Materials and methods: A prospective ultrasonographic study was conducted on 38 premature infants with birth weight less than 1500 g and/or born at 32 weeks …of gestation or less. Transocular Doppler measurements of blood flow in the central retinal artery were performed on all subjects at weekly intervals from birth to 40 weeks corrected gestational age. Mean readings were calculated for both eyes of each subject. Results: A total of 13 (34%) of subjects developed some form of ROP, as determined by ophthalmic examination. All of those scored significantly lower (p< 0.05) in the following: birth weight (mean 1127 g vs 1492 g), length (mean 36.77 cm vs 39.49 cm), cranial circumference (26.15 cm vs 28.36 cm) and gestational age at birth (29.4 weeks vs 30.8 wk). Risk factors that were significantly associated with ROP included bronchopulmonary dysplasia, treatment with erythropoietin, and sepsis (p< 0.05). Mean values of the Doppler measurements showed no statistically significant differences in blood flow in the central retinal artery between subjects with or without ROP, as a function of either corrected gestational age or age post-partum in weeks. Neither were any differences in blood flow recorded for the onset of 'plus disease'. Conclusion: Doppler ultrasonography of the central artery of the retina is not an effective method for the early diagnosis of retinopathy of prematurity. Show more

Keywords: Retinopathy of prematurity, Doppler, ultrasonography, central retinal artery, screening

DOI: 10.3233/NPM-2009-0064

Citation: Journal of Neonatal-Perinatal Medicine, vol. 2, no. 3, pp. 163-167, 2009

Authors: El Raggal, Nehal M. | Mohamed, Maha H. | Atef, Shereen H. | Salem, Fariza A.

Article Type: Research Article

Abstract: Background: Vascular endothelial growth factor (VEGF), a known mediator of angiogenesis, stimulates the survival of endothelial cells in newly formed blood vessels. VEGF exerts its effects by binding to two receptors; VEGFR-1 and VEGFR-2. Soluble VEGFR-1 is a potent inhibitor of vascular endothelial growth factor and placental growth factor. Objective: to test the hypothesis that serum concentration of the soluble receptor sVEGF-R1 is increased in infants with intrauterine growth restriction (IUGR) regardless of …the underlying cause of IUGR. Study design: Serum samples of 30 IUGR and 20 appropriate for gestational age (AGA) neonates were obtained within the first 24 h of life and kept frozen at −80°C degrees until the time of assays. Concentrations of sVEGFR-1 were measured by the enzyme-linked immunosorbent assay double sandwich method. Regression analysis was performed to test the association of IUGR with sVEGFR-1 after controlling for confounding variables. Results: sVEGFR-1 concentrations in IUGR patients were increased when compared to control. Patients with preeclamptic mothers had increased sVEGFR-1 when compared to patients with non-preeclamptic mothers. The latter had increased concentrations of sVEGFR-1 than control. sVEGFR-1 correlated negatively with birth weight, length and head circumference of the studied neonates. Conclusion: Concentrations of sVEGFR-1 are increased in the serum of IUGR neonates when compared to AGA controls. IUGR and preeclampsia are independently associated with increased sVEGFR-1 concentrations. This phenomenon presumably reflects a predominance of anti-angiogenic mechanisms present in IUGR. Show more

Keywords: IUGR, sVEGFR-1, preterm, appropriate for gestational age, preeclampsia, angiogenesis, hypoxia

DOI: 10.3233/NPM-2009-0065

Citation: Journal of Neonatal-Perinatal Medicine, vol. 2, no. 3, pp. 169-174, 2009

Authors: Attar, Mohammad A. | Bhatt-Mehta, Varsha | Hieber, Susan | Schumacher, Robert E.

Article Type: Research Article

Abstract: Introduction: Patent ductus arteriosus (PDA) and its treatment are associated with multiple serious complications in very low birth weight (VLBW) infants. Methods: We retrospectively evaluated the effect of prophylactic PDA treatment with Indomethacin on markers of utilization of hospital resources in a regional neonatal intensive care unit (NICU) between January 1, 2005 and April 30, 2007, including a six month epoch when PDA prophylactic treatment with indomethacin was used in the study site. Infants …with gestational ages less than 28 weeks who survived for more than two days were included in the analysis. Results: Twenty infants received Indomethacin prophylactic treatment (treatment group) and 59 received no prophylactic treatment (control group). Infants in the treatment group had similar median gestational age; 26 weeks, but higher birth weights (mean ± SD); 964 ± 247 vs 838 ± 198 grams, p=0.043 compared to control infants. Prophylactically treated infants needed rescue PDA pharmacologic treatment less frequently (20% vs 63%, p=0.002) but had similar rates of surgical ligation (30% vs 29%) compared to control infants. Prophylactically treated infants also had significantly higher rates of intestinal perforation (25% vs 7%, p= 0.041) and abdominal surgeries (30% vs 8%, p=0.03) compared to control infants. The two groups had similar, duration of support with mechanical ventilation and similar duration of supplement with parenteral nutrition. Treatment and control infants had similar rate of survival to discharge to home, 17 (85%) vs 45 (76%). Surviving treated and control infants did not differ statistically in total observed hospital length of stay (LOS in days, mean ± SD); (96 ± 32 vs 89 ± 29; p=0.43) nor in the difference between observed and predicted LOS (mean observed- predicted ± SD) (10 ± 23 vs1 ± 23; p=0.14). Conclusions: Prophylactic PDA treatment with Indomethacin did not decrease duration of mechanical ventilation or TPN supplementation but was associated with more intestinal perforations and abdominal surgeries. The unfavorable trend in LOS for the treatment group implies that the independent effect of prophylactic PDA treatment on LOS needs to be further explored. Show more

Keywords: Intestinal perforation, indomethacin, length of stay, NEC, sepsis

DOI: 10.3233/NPM-2009-0066

Citation: Journal of Neonatal-Perinatal Medicine, vol. 2, no. 3, pp. 175-179, 2009

Authors: Holder, G.L. | Doherty, D.A. | Patole, S.K.

Article Type: Research Article

Abstract: Objectives: Study the incidence of the unexpected development of necrotizing enterocolitis (NEC) following an elective packed red blood cell (PRBC) transfusion for anemia of prematurity (AOP) in previously stable, growing preterm neonates. Methods: Retrospective analysis (Jan 2001–July 2006) of data on all admissions to our tertiary neonatal unit who received a PBRC transfusion and/or had definite (Stage ⩾ II) NEC. Results: 7935 neonates were admitted over the study period including 4833 (61%) …with gestation <37 weeks (preterm). 793 preterm neonates received 2191 elective PRBC transfusions (median 2, range 1–12) for AOP. Definite NEC occurred in 37 (0.8%) preterm neonates with 7 developing it within 48 hours of a PRBC transfusion. Only 1/7 was a stable, and growing (without oxygen/respiratory assistance, full feeds, otherwise well except for symptomatic AOP) neonate. Conclusion: Unexpected development of NEC following an elective PRBC transfusion in a previously well and stable neonate was rare in our population of high-risk neonates. Given the low incidence of NEC, and the range of possible risk factors (e.g. free radicals, mesenteric ischemia, hypovolemia, proinflammatory cytokines in the transfused product, prematurity, IGUR), designing and conducting large prospective observational studies is very difficult to prove a causal relation between PRBC transfusions and NEC. Show more

Keywords: Transfusion, necrotizing enterocolitis, neonates, preterm

DOI: 10.3233/NPM-2009-0067

Citation: Journal of Neonatal-Perinatal Medicine, vol. 2, no. 3, pp. 181-186, 2009

Authors: Lasisi, Akeem O. | Olayemi, Oladapo | Tongo, Kemi | Arinola, Olatubosun G. | Bakare, R.A. | Omilabu, S.A.

Article Type: Research Article

Abstract: Objective: The aim of this prospective study is to determine the correlation between early suppurative otitis media (ESOM) and cord blood concentrations of retinol, zinc, immunoglobulin G (Ig G) and interferon Gamma (IFN-γ). Patients and Methods: Cord blood samples were obtained from the umbilical vein after delivery of infants. Serum was extracted and stored at −80°C and analyzed for retinol, zinc, Ig G and interferon Gamma (IFN-γ). These infants were clinically followed for 12–18 …months for the development of ESOM. Suppurative OM was defined by the observation of purulent or mucoid otorrhoea at microotoscopy. Results: The study included 186 term infants, of which 69 (37% had at least one episode of ESOM. Of these infants, 40 were males and 29 were females. The age at development of ESOM was 14 ± 6.2 weeks, with a range between 3 weeks and 8 months. The gestational age at birth was 39 ± 0.2 weeks (range=31–43), and birth weight was 3.1 – 0.45 Kg (range=1.25–4.3). The mean neonatal serum concentrations among the cases and control subjects did not differ for Ig G (1180 mg/ml vs. 1370.2 mg/ml, P=0.46), while they differed for retinol (0.95 μg/L vs. 1.08 μg/, P < 0.01), for zinc (0.88 μ g/L vs. 1.05 μ g/L, P=0.01) and for IFN-γ (45.3 pg/ml vs. l70.2 pg/ml, P < 0.01) respectively. Conclusion: We conclude that decreased concentrations of immunobiologic factors in cord blood can be a contributing factor to the development of ESOM in infants during the first year of life. Show more

DOI: 10.3233/NPM-2009-0068

Citation: Journal of Neonatal-Perinatal Medicine, vol. 2, no. 3, pp. 187-192, 2009

Authors: van der Sluijs-Bens, Jacqueline | Andriessen, Peter | Roos, George | Buijs, Jan | Oetomo, Sidarto Bambang

Article Type: Research Article

Abstract: We report a preterm infant diagnosed with a late-onset Pseudomonas aeruginosa sepsis and necrotizing meningo-encephalitis who died at the age of 12 days as a consequence of multiple organ failure. In this case report we show the importance of the application of different advanced MRI modalities. On the basis of the MRI findings, clinical presentation, and laboratory data, the diagnosis of a necrotizing encephalopathy secondary to Pseudomonas aeruginosa infection was established.

Keywords: Newborn, Pseudomonas aeruginosa, brain abscess, MRI

DOI: 10.3233/NPM-2009-0069

Citation: Journal of Neonatal-Perinatal Medicine, vol. 2, no. 3, pp. 193-196, 2009

Authors: Lashkari, Harsha P. | Mukherjee, Samudra

Article Type: Research Article

Keywords: Cutis marmorata congenita telengectatica, adams-oliver syndrome, aplasia cutis

DOI: 10.3233/NPM-2009-0070

Citation: Journal of Neonatal-Perinatal Medicine, vol. 2, no. 3, pp. 197-199, 2009