Journal of Neonatal-Perinatal Medicine - Volume 4, issue 1

Authors: Hentschel, R. | Mohr, T. | Pelz, K. | Zahradnik, H.P. | Beck, K.H.

Article Type: Research Article

Abstract: Objective: Even though red blood cells from cord blood (CB) have been investigated for many years for the purpose of autologous retransfusion to newborns this technique is still far from clinical routine. In severely ill neonates fresh frozen plasma from donors is frequently transfused for volume expansion or as a source of coagulation factors but autologous plasma transfusion has not been described. Methods: We investigated 35 CB preparations of preterm and term newborns for sterility and fast provision of either red blood cell concentrate (RBC) or plasma with respect to quality of both components and time needed for bacterial testing. …CBs and 34 control RBCs from regular blood donors were collected in citrate-phosphate-dextrose solution (CPD). RBCs and plasma were prepared in sodium-adenine-glucose-mannitol (SAGM). Swabs were taken from the placenta for cultivation of bacteria. Quality of stored blood was assessed in RBCs on day 0, 3, 8, 14 and 42, respectively, and tests for activated coagulation were done in thawed plasma. Results: CB harvesting started within 30 minutes after umbilical cord clamping. A mean CB volume of 50.6 mL (range 19.6 mL to 90.6 mL) was collected. None of the bacteria detected in the placenta smear could be detected in the collected CBs. Mean Hct in the RBC was 53 ± 7%. Glucose, pH, ATP and 2,3-DPG decreased over time, while lactate, potassium, hematocrit and hemolysis increased. Sterility of CBs was verified within 72 hours. Prothrombin fragment 1 + 2 (F1 + 2; n = 34) was elevated (3.9 ± 2.5 nmol/L), and high levels of thrombin-antithrombin complexes (TAT) were detected also in the majority of newborns' plasma (>61 μg/L; n = 31). Discussion: Suitability of RBCs from CB must be restricted to 14 days, mainly because of a decreasing pH. Probably, by adding CPD solution at an amount appropriate for the actual volume of CB it will be possible to extend the storage time. However, retransfusion of plasma harvested from CB seems imposssible, due to the activated coagulation process. Show more

Keywords: Cord blood, infant, newborn, erythrocyte, plasma, autologous retransfusion

DOI: 10.3233/NPM-2011-2720

Citation: Journal of Neonatal-Perinatal Medicine, vol. 4, no. 1, pp. 1-8, 2011

Authors: Cordero, L. | Nankervis, C.A. | Coley, B.D. | Giannone, P.J.

Article Type: Research Article

Abstract: Background: Traditionally, orogastric tube (OGt) insertion length is determined by nose-earlobe-xyphoid (NEX) measurement. Minimum insertion lengths have been proposed for prematures but not for extremely low birth weight (ELBW) infants. Objective: To determine minimum OGt insertion length for intragastric placement in ELBW infants using NEX measurements alone and NEX measurements in conjunction with a novel regression formula. Design/Methods: Retrospective phase (83 pts): Correct intragastric placements were identified and a regression formula for predicting insertion length was created. Prospective phase (50 pts): Nurses were instructed to use NEX measurements if they coincided within 1 cm with estimates from the regression formula …(birth weight g × 0.004 + 9.44 = cm insertion length). In cases of discrepancy, measurements calculated by the formula were used. Results: Using NEX method alone, the first OGt placements were in the esophagus (6%) straight in the stomach (6%), reversed in the stomach (4%), in the duodenum (1%) and “correctly” placed diagonal in the stomach (83%). Using NEX measurement and the regression formula, OGt placements were diagonal in the stomach (96%), or straight in the stomach (4%), with none in the esophagus, reversed in the stomach or in the duodenum. The difference in correct placements by the two methods was significant. Conclusions: NEX measurements in conjunction with a minimum insertion length estimated from a formula should decrease the number of malpositioned OGt in ELBW infants. Show more

Keywords: Orogastric, feeding tube, premature infants

DOI: 10.3233/NPM-2011-2717

Citation: Journal of Neonatal-Perinatal Medicine, vol. 4, no. 1, pp. 9-13, 2011

Authors: Paccaud, C. | Vernez, D. | Berode, M. | Charrière, N. | Moessinger, A. | Laubscher, B.

Article Type: Research Article

Abstract: Objective: To analyze the atmosphere inside incubators regarding alcoholic solvent such as isopropanol or ethanol which are commonly used in hand disinfecting solutions. Design: Observational. Setting: The third level neonatal unit of the Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. Patients: Nine neonates with median (range) gestational age of 29 4/7 (25 5/7–39 0/7) weeks and birth weight of 960 (550–3050) grams. All neonates were inside incubators. Interventions: Alcoholic vapors inside incubators were directly and cumulatively measured by photoionisation and gas chromatography respectively after absorption on a charcoal sampling tube. Results: Eleven studies (mean study time: 230 ± 19 minutes) were …performed. Highly variable isopropanol/ethanol concentrations profiles were found inside incubators. Peak value for isopropanol was 1982 part per million and for ethanol was 906 part per million. Conclusions: Incubators' inner atmosphere can be highly polluted by alcohol vapors. To reduce them staff should respect long evaporation time between hands disinfection and manipulations inside incubators. The use of an ethanol-based disinfecting solution, because of its short evaporation time, could be favored. As alcohol vapor toxicity for neonate remains largely unknown, further studies could be welcome. Show more

Keywords: Neonate, isopropanol, ethanol, incubator

DOI: 10.3233/NPM-2011-2727

Citation: Journal of Neonatal-Perinatal Medicine, vol. 4, no. 1, pp. 15-19, 2011

Authors: Francis, J.V. | Padmanabhan, S. | Jaques, L. | Courtot, J. | Sehgal, A.

Article Type: Research Article

Abstract: Background: Ligation of a patent ductus arteriosus could be associated with severe cardiorespiratory compromise in preterm infants. There is limited data on the incidence, profile and temporal profile of post-operative morbidity. Objective: To assess the incidence, profile and temporal occurrence of cardiovascular and respiratory decompensation during the first 48 hours of postoperative period. Method: Retrospective analysis of the cohort over last seven years (2002–2008) was done and charts reviewed to record demographics and haemodynamic/ventilatory indices. Respiratory decompensation was defined a priori as increase in Fractional inspired oxygen by 0.2, Mean airway pressure by 2 cm H2 O, increase in Respiratory …Severity Score by 50% or increase in Ventilation Index by 50%. Cardiovascular decompensation was defined as systolic blood pressure <2 standard deviation, addition of inotrope, increase in dosage of previously started inotrope by 5 micrograms/kg/min or need for hydrocortisone. Data was plotted under 4 time epochs; 0–6, 6–12, 12–24 and 24–48 hours after surgical intervention. Results: Forty eight infants underwent duct ligation during the period. Mean gestational age and birthweight were 26.1 ± 1.3 weeks and 788 ± 181 g respectively. Respiratory decompensation was seen in 14 (29%) babies (increase in Mean airway pressure and Fractional inspired oxygen each) and 23 (48%) babies (increase in Respiratory Severity Score by 50%). Cardiovascular decompensation was seen in 14 (29%) babies (low systolic blood pressure), and 9 (19%) (addition or increased dosage of inotropes or hydrocortisone). Conclusions: Postoperative period after surgical duct ligation is oftentimes complicated by cardiorespiratory instability. Its knowledge could improve care in critically sick infants. Show more

Keywords: Cardiorespiratory morbidity, duct ligation, Haemodynamically Significant Ductus Arteriosus

DOI: 10.3233/NPM-2011-2724

Citation: Journal of Neonatal-Perinatal Medicine, vol. 4, no. 1, pp. 21-26, 2011

Authors: Sehgal, A. | McNamara, P.J.

Article Type: Research Article

Abstract: Background: None of the studies assessing effects of treatment of symptomatic duct on outcomes have considered heterogeneity of ductus arteriosus in terms of clinical and echocardiographic significance. Objectives: To characterize outcomes of neonates who received treatment for a haemodynamically significant ductus arteriosus and were classified according to the ductal staging system. Methods: Neonates were classified according to ductal disease severity score: clinical (C 1–4) and echocardiography (E 1–4) criteria (sum of C-score and E-score) as low-risk (composite score < 6), intermediate risk (composite score = 6) and high-risk (composite score > 6) groups. A comparative evaluation of neonatal demographics, respiratory …outcomes and neonatal morbidities was made between low and high risk groups. Results: Data from 45 evaluations of the ductus arteriosus were analysed. Infants in high-risk group had significantly increased median transductal diameter [3.2 mm (2.7, 3.4) vs. 2.5 mm (2.4, 2.7), p = 0.02] and were more likely to require >1 course of indomethacin or surgical ligation. Infants with a high-risk stage were also more likely to require longer duration of oxygen support, home oxygen therapy and a higher, though statistically non-significant, trend for chronic lung disease. In the short term, at the end of the treatment course, no significant alteration in the ventilatory requirements was noted. Conclusions: Staging the ductus arteriosus may facilitate the identification of neonates at greatest risk of neonatal respiratory morbidity. It may also shed more light as to which babies, if any, benefit from therapeutic intervention. In this cohort, treatment with indomethacin did not reduce the morbidities assessed. Show more

Keywords: Patent ductus arteriosus staging, respiratory morbidity

DOI: 10.3233/NPM-2011-2726

Citation: Journal of Neonatal-Perinatal Medicine, vol. 4, no. 1, pp. 27-32, 2011

Authors: Swenson, A.W. | Becker, M.A. | Donn, S.M. | Attar, M.A.

Article Type: Research Article

Abstract: We report two cases of term male infants with suspected pulmonary hypoplasia, who could not be managed successfully with conventional mechanical ventilation. Both responded to rescue support with high frequency jet ventilation (HFJV) using an optimal positive end expiratory pressure strategy. One infant had the oligohydramnios sequence secondary to posterior urethral valves. The second infant was diagnosed prenatally with a severe right-sided congenital diaphragmatic hernia. We summarize the literature on the use of HFJV to support infants with severe pulmonary dysfunction. Unique air flow dynamics of HFJV may enable better gas exchange with less barotrauma, less volutrauma and ventilation at …lower mean airway pressure. Our experience and the available literature suggest that HFJV appears to offer a unique advantage over conventional ventilation in such infants. Show more

Keywords: Newborn, pulmonary hypertension, oligohydramnios, pulmonary hypoplasia, congenital diaphragmatic hernia, high frequency ventilation

DOI: 10.3233/NPM-2011-2722

Citation: Journal of Neonatal-Perinatal Medicine, vol. 4, no. 1, pp. 33-37, 2011

Authors: Wang, M. | Tran, Tu | Tran, V. | Padilla, L. | Le, Jennifer

Article Type: Research Article

Abstract: Background: Invasive candidiasis is a late-onset sepsis that occurs in infants in the neonatal intensive care units (NICU). Our study aimed to evaluate the risk factors and outcomes associated with neonatal candidiasis. Methods: A case-control retrospective study was conducted at Miller Children's Hospital from January 1990 to December 2008. Cases were matched to controls by birth weight category, birth date and gestational age. Results: A total of 161 neonates, 103 cases and 58 controls, were included. Demographics such as age, sex, weight and underlying disease were similar between groups. Mean time to infection was 38 days from NICU admission. Multivariable …logistic regression revealed that congenital heart disease (odds ratio [OR], 6.35; 95% CI 1.75–23.03, p = 0.005), total parenteral nutrition (OR, 42.97; 95% CI 3.35–550.55, p = 0.004) and abdominal surgery (OR, 6.35; 95% CI 1.75–23.03, p = 0.005) were independently associated with neonatal candidiasis. Mean NICU stay was longer and more patients died in the case group vs. control groups (103 ± 63 vs. 66 ± 27 days, p < 0.001; 13 vs. 2, p = 0.082). Conclusion: The index of suspicion for neonatal candidiasis should be high in those with risk factors, especially if NICU stay exceeds >38 days. Presumptive antifungal therapy should be initiated promptly and antifungal prophylaxis should be considered in these infants. Show more

Keywords: Candidemia, infants, neonates, risk factors, candidiasis, fungal infection, neonatal candidiasis

DOI: 10.3233/NPM-2011-2725

Citation: Journal of Neonatal-Perinatal Medicine, vol. 4, no. 1, pp. 39-43, 2011

Authors: Shepherd, E.G. | Calvert, T.J. | Martin, E.M. | Hitchner, J.C. | Welty, S.E. | Nelin, L.D.

Article Type: Research Article

Abstract: Objective: The outcome of premature infants is negatively impacted by transport, and in Central Ohio every effort is made to transport the mother prior to preterm delivery. Our neonatal intensive care unit is an all referral unit, thus all babies are transported and the referral hospitals include those without neonatology coverage, and those with neonatology coverage. We tested the hypothesis that the outcomes of extremely premature infants (<27 weeks gestational age) admitted to our NICU would be better when the infant was referred from a hospital with neonatology coverage. Patients and methods: We collected data from 227 patients admitted from …December, 2004 to August, 2008; 192 patients were from hospitals with neonatology coverage. Results: The survival rate was greater for those babies referred from hospitals with neonatology coverage than in those referred from hospitals without neonatology coverage (82% vs. 60%, p = 0.007), as was the combined outcome of survival without Grade 3/4 IVH (68% vs. 43%, p < 0.01). When limited to only those patients admitted at <3 days of life, survival was better for infants referred from hospitals with neonatology coverage than those referred from hospitals without it (77% vs. 63%; p < 0.05). Conclusion: These results suggest that for infants born at <27 weeks admitted to an all referral unit delivery in a hospital with neonatology coverage leads to better survival. Show more

DOI: 10.3233/NPM-2011-2728

Citation: Journal of Neonatal-Perinatal Medicine, vol. 4, no. 1, pp. 45-53, 2011

Authors: Pishva, N. | Afrasiabi, A. | Shahbazi, M. | Haghpanah, S. | Karimi, M.

Article Type: Research Article

Abstract: Background: Neonatal sepsis is frequently associated with multiple hematologic abnormalities, including depletion of protein C. The status of protein C is not known in infants who clinically present with a sepsis-like picture without a culture-proven sepsis. The objectives of this study were to determine whether sepsis-like illness is associated with a reduction in protein C. Methods: In this case-control, cross-sectional study, 49 full-term neonates admitted to the neonatal intensive care unit (NICU) with the clinical manifestation of sepsis that was not proven by cultures. Fifty healthy full-term newborns were also randomly selected as a control group. Protein C concentrations were …compared between both groups. Results: There was no difference between the case and control groups regarding sex and gestational age. Protein C concentration did not differ between groups (p > 0.05); mean protein C concentration was 29.4% of the normal adult level in cases with clinical sepsis and 32% in the control group. Conclusion: Protein C deficiency was not related to clinical manifestations in sepsis-like illness. Further studies examining other predictors of sepsis-like illness are recommended. Show more

Keywords: Sepsis, protein C, newborn, full term

DOI: 10.3233/NPM-2011-2551

Citation: Journal of Neonatal-Perinatal Medicine, vol. 4, no. 1, pp. 55-58, 2011

Authors: Gisslen, T. | Nathan, B. | Thompson, T. | Rao, R.

Article Type: Research Article

Abstract: This patient series reports on prolonged hyperinsulinism in four newborn infants without characteristic perinatal risk factors. The condition presented with asymptomatic hypoglycemia soon after birth and was accompanied by inappropriately elevated plasma insulin levels and suppressed ketogenesis and lipolysis. Glucose infusion rates between 11 and 20 mg/kg/min were necessary for correction of hypoglycemia. Sustained euglycemia could be achieved only after starting diazoxide. In all infants, diazoxide could be weaned off within weeks without the recurrence of hypoglycemia. This case series illustrates the varied perinatal history and clinical course of prolonged neonatal-onset hyperinsulinism and highlights the importance of considering this condition …in infants without typical predisposing factors. Show more

Keywords: Diazoxide, hyperinsulinism, hypoglycemia, infants, newborn

DOI: 10.3233/NPM-2011-2731

Citation: Journal of Neonatal-Perinatal Medicine, vol. 4, no. 1, pp. 59-64, 2011