Journal of Neonatal-Perinatal Medicine - Volume 5, issue 2

Authors: Gimovsky, A.C. | Macri, C.J. | Bathgate, S. | Mohamed, M.A. | Larsen Jr, J.W.

Article Type: Research Article

Abstract: Objective: To evaluate ethnic-based differences in maternal complications following operative vaginal deliveries. Study design: Retrospective, case-controlled analysis of obstetric deliveries over a fourteen year period in a single urban hospital, enrolled in a computerized database. Results: Of 18285 deliveries, 8948 (49.0%) occurred in non-Hispanic (WNH) women, and 7611 (41.6%) occurred in non-Hispanic (BNH) women. Operative vaginal deliveries included vacuum, outlet forceps, low forceps and mid-forceps. Maternal outcomes included incidence of third and fourth degree lacerations and calculated blood loss. The WNH population had 1349 (15%) operative vaginal deliveries and 277 (20.5%) had third and fourth degree lacerations, while in the …BNH population there were 807 (10.6%) operative vaginal deliveries and 114 (14%) third and fourth degree lacerations (p ≤ 0.001). In the WNH group, calculated blood loss in operative vaginal deliveries was 1057 ml for midforceps and 907 ml for low forceps deliveries; the BNH group had 828 ml blood loss in midforceps and 660cc in low forceps group (p < 0.001 for midforceps and p < 0.001 for low forceps). Conclusion: WNH women had more operative vaginal deliveries, maternal morbidity, third and fourth degree lacerations and greater blood loss compared to the BNH women. Show more

Keywords: Operative delivery, forceps, ethnicity, perineal lacerations

DOI: 10.3233/NPM-2012-62212

Citation: Journal of Neonatal-Perinatal Medicine, vol. 5, no. 2, pp. 99-103, 2012

Authors: Moorehead, P.A. | Martin, E.M. | Shepherd, E.G. | Parikh, N.A. | Reagan, P.B. | Gardner, W. | Yeates, K.O. | Nelin, L.D.

Article Type: Research Article

Abstract: Objective: Transport of infants born at the threshold of viability (<27 weeks) may negatively impact outcomes. Our neonatal intensive care unit (NICU) is an all-referral unit, and therefore all patients have been transported. This study examined survival rates and the factors that influenced survival in this specific population of extremely premature infants. Study design: The study setting was at an all-referral tertiary care NICU within a children's hospital. Data were collected from December 2004 to August 2008, and included 227 patients. Results: Overall, the survival-to-discharge rate for these infants was 78%. The primary causes of death were sepsis (41%), necrotizing …enterocolitis (NEC) (27%), respiratory failure (18%), and severe intraventricular hemorrhage (IVH) (10%). By logistic discrete time hazard analyses, patients receiving dopamine (p < 0.01) or insulin (p < 0.01), with NEC (p < 0.05), or of gestational age 22, 23 or 24 weeks (p < 0.01) were more likely to die; while those born in the same county as the NICU (p < 0.01), receiving patent ductus arteriosis (PDA) treatment (p < 0.01) or peripheral intravenous central catheters (p < 0.01) were more likely to survive. Within the group of survivors the rate of cerebral palsy was 9% and the mean scores on the Bayley-III at 18 months corrected age were 95 ± 13, 90 ± 15, and 92 ± 14 in the cognitive, communication, and motor scales respectively. Conclusion: Infection, NEC, and respiratory failure were the primary causes of death among extremely premature infants in an all-referral NICU. New approaches to preventing infection, NEC, and bronchopulmonary dysplasia are needed for this population. Show more

Keywords: Extremely prematurity, threshold of viability, very low birth weight, intraventricular hemorrhage, bronchopulmonary dysplasia

DOI: 10.3233/NPM-2012-55511

Citation: Journal of Neonatal-Perinatal Medicine, vol. 5, no. 2, pp. 105-111, 2012

Authors: Vartanian, R.J. | Attar, M. | Donn, S.M. | Sarkar, S.

Article Type: Research Article

Abstract: Objective: To determine the likelihood of intraventricular hemorrhage (IVH) occurring after the first three days of life and to develop a predictive model for late IVH in preterm infants. Methods: A retrospective study was conducted on very low birth weight infants with grades IVH II-IV. IVH was considered early if detected by ultrasound within the first three days of life and it was considered late if detected beyond this time. Infants with late IVH had at least one documented negative ultrasound scan on or after day of life three. Data were evaluated for associated risk factors using univariate and logistic …regression analyses. Results: One-hundred thirty infants with IVH grades II-IV met the inclusion criteria. Early IVH occurred in 82 (63%) and late IVH occurred in 48 (37%). Infants with late IVH were more commonly exposed to prenatal steroids (OR 4.2, 95% CI 1.5–12.0), cesarean delivery (OR 2.8, 95% CI 1.1–7.0), or had symptomatic PDA requiring medical or surgical therapy prior to IVH detection (OR 12.0, 95% CI 3.8–37.7) compared to infants with early IVH. Conclusions: IVH after day of life three is not rare in VLBW infants. Further exploration of risk factors associated with late IVH compared to infants without IVH through interventional trials is warranted. Show more

Keywords: Very low birth weight, intraventricular hemorrhage, ultrasonography, premature

DOI: 10.3233/NPM-2012-54711

Citation: Journal of Neonatal-Perinatal Medicine, vol. 5, no. 2, pp. 113-118, 2012

Authors: Niforatos, N. | Said, M.M. | Rais-Bahrami, K.

Article Type: Research Article

Abstract: Objective: To evaluate the effects of brief systemic hypoxia on cerebral tissue saturation in premature infants with respiratory disease. We hypothesized that healthy premature infants have a direct relationship between arterial oxygen saturation (SpO2 ) and cerebral oxygen saturation (SctO2 ) and that the nature of the relationship is associated with demographic markers of maturation. Furthermore, we hypothesized that most infants can maintain adequate cerebral tissue saturation during brief periods of systemic hypoxia. Study design: Twenty-four preterm neonates with respiratory disease were enrolled and monitored for 72 hours using simultaneous pulse oximetry (to detect SpO2 ) and cerebral tissue oximetry …(to detect SctO2 ). The relationship between SpO2 and SctO2 and demographic markers of maturation were analyzed, using linear and non-parametric regression methods. Result: As expected, SctO2 decreased linearly with decreased SpO2 . The drop rate of SctO2 significantly increased in relation to SpO2 with decreasing gestational age, corrected gestational age and weight (both birth weight and weight at time of study) but not post-natal age. Conclusion: Healthy premature infants with isolated respiratory disease can maintain adequate cerebral tissue saturations during periods of brief hypoxemia without requiring additional intervention. Each infant has a unique ability to regulate cerebral oxygenation, which appears to be associated with advancing gestational age and increasing weight. Show more

Keywords: Cerebral oximetry, respiratory disease, NIRS

DOI: 10.3233/NPM-2012-54911

Citation: Journal of Neonatal-Perinatal Medicine, vol. 5, no. 2, pp. 119-125, 2012

Authors: El-Ganzoury, M.M. | El-Farrash, R.A. | Ahmed, H.A. | Mohamed, R.A.

Article Type: Research Article

Abstract: Background: Diabetes is recognized as a particular threat to pregnant women and their neonates. B-type natriuretic peptide (BNP) and N-terminal-proBNP play an important role in the regulation of extracellular fluid volume and blood pressure. BNP inhibits myocardial fibrosis and hypertrophy. Aim: To test the hypothesis that cord blood NT-proBNP would be increased in infants of diabetic mothers (IDMs) and linking its concentration to the degree of maternal glycemic control. Subjects and methods: This case control study was conducted on 85 full term neonates born at the Obstetrics and Gynecology department at Ain-Shams University Hospitals. The studied neonates were classified into …3 groups; Group I (n = 30) included IDMs with good maternal glycemic control (HbA1c <6%), group II (n = 25) included IDMs with suboptimal maternal glycemic control (HbA1c ≥6%) and healthy control group (n = 30). The included mothers/infants dyads were subjected to detailed history taking, thorough clinical examination and laboratory investigations which included maternal HbA1c and cord blood NT-proBNP. Results: Cord blood NT-proBNP levels were higher in IDMs with suboptimal maternal glycemic control than those born to healthy mothers, while NT-proBNP levels were comparable between neonates with good maternal glycemic control and healthy controls. NT-proBNP levels were higher in IDMs with suboptimal maternal glycemic control than those born to mothers with good glycemic control. NT-proBNP showed significant correlations with maternal HbA1c and one minute Apgar score. Conclusions: Neonatal NT-BNP concentrations are related to maternal glycemic control and perinatal hypoxia. In infants born to mothers with suboptimally controlled diabetes, NT-proBNP increases. Show more

Keywords: Infants of diabetic mothers, NT-proBNP, glycosylated hemoglobin, maternal glycemic control

DOI: 10.3233/NPM-2012-56011

Citation: Journal of Neonatal-Perinatal Medicine, vol. 5, no. 2, pp. 127-133, 2012

Authors: Faisal-Cury, A. | Lauletta, A.L. | Datti, I. | Oliveira, A.F. | Huang, H. | Menezes, P.R.

Article Type: Research Article

Abstract: Objective: The aim of this study was to prospectively evaluate the relationship between common mental disorders (CMD) during the antenatal and the postpartum period and breastfeeding for less than four months (BF <4). Methods: A prospective cohort study conducted between May 2005 and March 2007 included 701 pregnant women recruited from primary care clinics of the public sector in São Paulo, Brazil. The followings instruments were in effect: antenatal and postnatal CMD were measured with the Self Report Questionnaire (SRQ-20); social support was assessed with a Brazilian version of the scale used in the Medical Outcomes Study, and questionnaires were …employed to obtain socio-demographic, socioeconomic, obstetric, and breastfeeding information. The primary outcome was breastfeeding for BF <4. Crude and adjusted risk ratios (RR), with 95% confidence intervals (95% CI), were calculated using Poisson regression to examine the associations between BF <4 and CMD. Results: BF <4 occurred in 22.8% of the cohort. In the univariate analysis BF <4 was associated with lower maternal age, not having a partner, lower wealth score, having a previous miscarriage, newborn oral tracheal intubation, and CMD in the antenatal and postpartum period. In the multivariate analysis, the following variables were independently associated with BF <4: maternal age (RR: 0.62 (95% CI: 0.39–0.98), newborn oral tracheal intubation (RR: 1.85 (95% CI:1.28–2.65) and CMD during both the antenatal and postpartum (RR: 1.38 (95% CI: 0.98 : 1.95) periods. Conclusion: Among women who have a CMD both during the antenatal and postpartum period, there is a decreased likelihood for breastfeeding longer than 4 months. Show more

Keywords: Common mental disorders, pregnancy, social support, breastfeeding

DOI: 10.3233/NPM-2012-55711

Citation: Journal of Neonatal-Perinatal Medicine, vol. 5, no. 2, pp. 135-142, 2012

Authors: Morinis, J. | Butt, M. | Latchman, A.

Article Type: Research Article

Abstract: Background: The daily calculation of an infant's fluid requirements is a necessary and key component of the care of preterm infants in order to ensure physiological stability and adequate caloric and nutritional intake. However, there is little research on this practice to date. Objectives: To describe the total fuid intake (TFI) prescriptions for 32–35 completed weeks gestational age infants in a Level II nursery and neonatal intensive care unit of a single centre and to examine the impact of the different prescription practices on infant weight gain. Method: A retrospective review was conducted of TFI prescriptions on all 32–35 week …gestational age infants admitted to a Level II nursery and neonatal intensive care unit. In addition, Canadian pediatricians and neonatologists were surveyed regarding their fuid management practice. Data were analyzed using descriptive statistics and a Mann-Whitney U test. Results: A total of 80.3% of infants had TFI calculated using their current weight before surpassing birthweight. Infants that had TFI calculated on their current weight after birthweight was surpassed gained a significantly greater proportion of weight by day fourteen of life than those switched before birthweight was surpassed (p < 0.001). The clinician survey indicated a wide variation in the approach to TFI prescription. Conclusion: Fluid management practice in late preterm infants is inconsistent and may lead to negative outcomes. Further investigation is warranted. Show more

Keywords: Neonate, fluid, calculation, total fluid intake, infant, pre-term

DOI: 10.3233/NPM-2012-55411

Citation: Journal of Neonatal-Perinatal Medicine, vol. 5, no. 2, pp. 143-147, 2012

Authors: Gravari, E. | Radmacher, P.G. | Adamkin, D.H. | Myers, S.R.

Article Type: Research Article

Abstract: Objective: To analyze amino acid profiles and serial blood urea nitrogen values (BUN) in infants <1250 g receiving early amino acid infusion within hours of birth and compare them to previously published values. Design/methods: A retrospective study was conducted on infants <1250 g admitted to the NICU between July 2009 to July 2010. Plasma amino acid (AA) profiles were analyzed by high-performance liquid chromatography and values were compared to previously established reference values. Demographic data, treatment with indomethacin or neoprofen and laboratory results were also collected. Results: A total of 40 neonates were studied. Thirty infants had a single plasma …sample and 10 infants were followed with serial samples. AA profiles were consistent with previously published reference values. Serial samples showed little change over 3 days of infusion. Increased BUN did not correlate with abnormal AA profiles or concentration of AA infused in the infants studied. Conclusions: AA profiles on infants <1250 g on exclusive total parenteral nutrition on DOL1-3 demonstrated no evidence of hyperaminoacidemia with the exception of asparagines, threonine and lysine that were below reference levels. A small subset of infants with elevated BUN, demonstrated similar aminograms to those with lower BUN value even when being treated for a symptomatic PDA. Early TPN appears to be well tolerated by extremely preterm infants. Show more

Keywords: Preterm, TPN, amino acids, BUN, chromatography, PDA

DOI: 10.3233/NPM-2012-02750

Citation: Journal of Neonatal-Perinatal Medicine, vol. 5, no. 2, pp. 149-153, 2012

Authors: Abdelmaaboud, M. | Mohammed, A.

Article Type: Research Article

Abstract: Background: Preterm and growth-restricted babies are at high risk of milk intolerance and necrotizing enterocolitis (NEC). Currently, there is a lack of published literature on ideal feeding practices for this study population. Objective: To evaluate the effects of an “early” enteral feeding regimen at the start of day 2 after birth compared to late enteral feeding and at the start of day 6 after birth in preterm growth restricted babies with abnormal antenatal Doppler studies regarding the incidence of NEC and feeding intolerance. Patients and methods: Babies with gestational age below 37 weeks and birth weight below the 10th percentile …for gestational age, were randomly allocated to an “early” or “late” enteral feeding regimen. Feeds were gradually increased using a feeding protocol used in Neonatal Intensive Care Unit, Women's Hospital, Hamad Medical Corporation. Results: Maternal demographic data as well as cases of NEC and feeding intolerance were all recorded. One hundred twenty-five infants were enrolled in the study: 62 received early feeding and 63 received delayed feeding. The incidence of NEC and feeding intolerance were not significantly different between the two groups. Birth weight was an independent risk factor for NEC in both groups. Conclusion: Early minimal enteral feeding (MEF) of preterm and small for gestational age infants with abnormal antenatal Doppler findings may not have a significant effect on the incidence of NEC or feeding intolerance. Furthermore, birth weight seems to be an independent risk factor for the development of NEC, regardless of the timing of MEF introduction. Show more

Keywords: Minimal enteral feeding, IUGR, necrotizing enterocolitis, abnormal antenatal Doppler

DOI: 10.3233/NPM-2012-57311

Citation: Journal of Neonatal-Perinatal Medicine, vol. 5, no. 2, pp. 155-162, 2012

Authors: Goodwin, A.J. | Reed-Day, H. | Walle-Ramirez, K. Vande | Boulden, T.F. | Pourcyrous, M.

Article Type: Research Article

Abstract: We report a case on a low birth weight infant who developed early onset meningitis with bilateral occipital empyema. The pathogen isolated from the cerebral spinal fluid was Bacteroides fragilis, an anaerobic Gram negative bacillus of the gut, rarely reported as an etiology of neonatal meningitis.

Keywords: Meningitis, empyema, Bacteroides fragilis, anaerobes, preterm

DOI: 10.3233/NPM-2012-56911

Citation: Journal of Neonatal-Perinatal Medicine, vol. 5, no. 2, pp. 163-167, 2012