Journal of Neonatal-Perinatal Medicine - Volume 6, issue 2

Authors: Solomon, B.

Article Type: Other

DOI: 10.3233/NPM-1371613

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 2, pp. 99-100, 2013

Authors: Kochanski, A. | Merritt, T. A. | Gadzinowski, J. | Jopek, A.

Article Type: Review Article

Abstract: The question of genetic alterations resulting from assisted reproductive technologies (ART) in humans is examined within the organization of the human genome. Increased rates of birth defects have been reported among children conceived using ART; however, questions remain and controversy exists regarding how “infertility” predisposes to birth defects. ART has been shown to be associated with an increased number of chromosomal alterations especially in the X chromosome. There is increased risk for embryonal tumors among ART conceived children, as well as, imprinting disorders (Beckwith-Wiedemann and Angelman Syndromes). Genetic studies of children conceived using ART reveal a larger (genome-wide) scale of …methylation defects that encompass hundreds of genes. Genes involved in carcinogenesis and developmental pathways appear altered and may impact on later development of chronic illness, although these data are very preliminary. ART may create novel mutations by different chromosomal and molecular mechanisms; however, these techniques also enable propagation of pre-existing mutations that are associated with impaired fertility. While older maternal age is often associated with female infertility and chromosomal aneuploidy, sperm from older men have more new gene mutations. The prevalence of birth defects is increased when ART is used for conception. These data are summarized by large meta-analyses or from multi-year national registries. Whether the increased number of birth defects is due to ART procedures themselves or are a consequence of the impaired fertility of the parents is discussed. Long-term evaluation of children conceived using ART and/or ovarian hyper-stimulation is needed to determine whether alterations during embryonic development may increase the prevalence of chronic diseases in adulthood. Show more

Keywords: In vitro fertilization, intracytoplasmic sperm injection, imprinting disorders, birth defects, methylation defects, infertility

DOI: 10.3233/NPM-1366812

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 2, pp. 101-108, 2013

Authors: Faro, R. | Santolaya-Forgas, J. | Oyelese, Y. | Di Stefano, V. | Canterino, J. | Ananth, C.V.

Article Type: Research Article

Abstract: OBJECTIVES: Data on rates of cesarean delivery among pregnancies diagnosed with genetic syndromes remains limited. We examined the cesarean delivery rates for Down syndrome pregnancies over a 10-year period in the US. METHODS: We used data from the 1995–2004 US delivery data files to examine cesarean delivery rates in singleton pregnancies (at ≥20 weeks' gestation) with and without Down syndrome. We further examined if the rates of cesarean deliveries in primary and repeat cesarean deliveries among Down syndrome pregnancies differed based on the presence or absence of major structural abnormalities or stillbirth or gestational age at delivery. RESULTS: There were …35 million singleton deliveries of which 19186 were diagnosed at birth with Down syndrome (1 in 2000 births after 20 weeks gestation). The primary cesarean delivery rates were higher among Down syndrome pregnancies (17.5% in 1995 and 21.5% in 2004) compared to non-Down syndrome pregnancies (12.3% in 1995 and 16.6% in 2004). Temporal trends for cesarean deliveries were steeper among Down syndrome pregnancies with gastrointestinal and heart abnormalities than in Down syndrome cases without abnormalities. Higher cesarean delivery rates were also noted among Down syndrome pregnancies ending in third trimester live born than in control. CONCLUSION: In the US, cesarean deliveries in Down syndrome pregnancies increases over time and is greater when Down syndrome is associated with structural abnormalities and delivered during the third trimester of pregnancy. Show more

Keywords: Down syndrome, trisomy 21, congenital abnormalities, cesarean delivery

DOI: 10.3233/NPM-1366512

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 2, pp. 109-115, 2013

Authors: Narchi, H. | Mahmoud-Ghoneim, D. | Skinner, A. | Cogings, P.

Article Type: Research Article

Abstract: BACKGROUND: White matter periventricular echogenicity detected in neonatal cranial ultrasound (US) scans may be followed by cystic periventricular leukomalacia (PVL) or might resolve. Serial US are therefore needed to clarify the outcome. Texture analysis is a computerized method to analyze images and distinguish findings that are undetectable by the human eye. OBJECTIVE: To test whether texture analysis can differentiate echogenicities that resolve from those that develop cystic PVL. MATERIAL AND METHODS: Neonates with echogenicities on their initial US scan were studied; texture analysis was performed on the coronal and sagittal sections. Texture parameters were entered into a linear discriminant analysis …(LDA) to classify the scans along two axes called most discriminant features (MDF) 1 and 2. RESULTS: We studied twenty infants with periventricular echogenicities on initial scans; ten of them later resolved (group A), while the other ten infants developed cystic PVL (group B). The classification accuracy was 66% and 82% for group A and B on sagittal sections, and 75%, and 80% on coronal. In the coronal and sagittal plane respectively, a MDF1 value of 0.98 and 0.24 and an MDF2 value of 0.86 and 0.001 provided the best sensitivity, specificity, positive and negative likelihood ratio. CONCLUSION: Texture analysis is a promising objective tool to early identify which cranial echogenicity that will develop into cystic PVL. Show more

Keywords: Very low birth weight, ultrasonography, image processing, computer-assisted, periventricular leukomalacia

DOI: 10.3233/NPM-1365012

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 2, pp. 117-124, 2013

Authors: Al Tawil, K. | Sumaily, H. | Ahmed, I.A. | Sallam, A. | Al Zaben, A. | Al Namshan, M. | Crankson, S.

Article Type: Research Article

Abstract: OBJECTIVE: To identify the risk factors, characteristics and outcomes of necrotizing enterocolitis (NEC) at our institution. STUDY DESIGN: A retrospective case-control analysis of the charts of all late preterm and term infants, who had NEC of Bell's stage ≥ II from 1995 to 2009, along with infants of the same gestational age. Thirty-two late preterm infants had NEC meeting criteria and 128 late preterm and term infants were chosen as matched controls. RESULTS: The 32 NEC infants were more likely to have the following characteristics: a culture-proven sepsis (p = 0.0001), be small for their gestational age (p = 0.003), …have a congenital heart disease (p = 0.007), and suffer from hypoxic- ischemic encephalopathy (p = 0.04). The presence of hypotension, metabolic acidosis, thrombocytopenia, and pneumoperitoneum was associated with a poor prognosis. Twelve of the 13 (92%) NEC infants who died had a surgical intervention. CONCLUSION: In this study, late preterm and term infants who developed NEC had other underlying clinical diagnoses and had culture-proven sepsis. Mortality rate was high in infants who required surgical intervention, indicating that they were gravely ill from the onset. Thrombocytopenia, hypotension and metabolic acidosis in late preterm and term infant with NEC were associated with poor prognosis. Show more

Keywords: NEC, perinatal asphyxia, sepsis, CHD, SGA thrombocytopenia, metabolic acidosis

DOI: 10.3233/NPM-1365912

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 2, pp. 125-130, 2013

Authors: Bragg, J. J. | Green, R. | Holzman, I. R.

Article Type: Research Article

Abstract: OBJECTIVES: To determine the association between early enteral feeding and the incidence of hypoglycemia in SGA neonates. STUDY DESIGN: A retrospective review to evaluate the association of hypoglycemia and early enteral feeding was performed. Eligible patients were born full-term between 1/1/2008–7/1/2011 and classified as SGA (birth weight <10th percentile). We collected the first two serum glucose values, time to enteral feeds and feeding type. The primary outcome was incidence of hypoglycemia, defined as serum glucose values ≤35 mg/dL (1.9 mmol/L). RESULTS: 203 infants were included in the analysis. 94 patients were fed between the first and second glucose measurement and …109 were not. Although the incidence of hypoglycemia was greater in the group that received early enteral feeds (13% versus 4%; p = 0.02), feeding was not a significant predictor of the second serum glucose in a multivariable regression model (p = 0.078). CONCLUSIONS: This study suggests that early enteral feeding does not predict hypoglycemia in this cohort of SGA neonates. Show more

Keywords: Small for gestational age, neonates, enteral feeding

DOI: 10.3233/NPM-1366212

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 2, pp. 131-135, 2013

Authors: Memon, Z.A. | Khan, M.I. | Soofi, S. | Muhammad, S. | Bhutta, Z.A.

Article Type: Research Article

Abstract: INTRODUCTION: Of annual four million neonatal deaths, majority in the developing world, approximately three-quarters die within the first week of life. Pakistan has one of the highest newborn mortality rates. STUDY DESIGN: We conducted a cross sectional study to assess knowledge, attitudes and practices of women of reproductive age in rural Pakistan. RESULTS: Of 1490 mothers interviewed, prevalence of newborn care practices ranged between 32% (early bathing of newborn) and 69% (use of traditional cord applications). Uptake of antenatal care services was identified as a strong predictor of good newborn care after controlling for skilled birth attendance, socio-economic status, age …of mother and sex of infant (OR = 1.26; 95% CI: 1.00–1.57). CONCLUSIONS: The association of uptake of antenatal care services with good newborn care highlights the necessity to improve coverage of services with the integration of counseling about newborn care in order to reduce the burden of neonatal morbidity and mortality. Show more

Keywords: Maternal health, newborn health, developing country, antenatal care, Pakistan

DOI: 10.3233/NPM-1366712

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 2, pp. 137-144, 2013

Authors: Poulsen, K. P. | Pillers, D. M. | Conway, J. H. | Faith, N. G. | Czuprynski, C. J.

Article Type: Research Article

Abstract: The objectives of this study were to develop an animal model to study Listeria monocytogenes infection during the peri-parturient period and identify sources of maternal shedding of the pathogen. Peri-parturient mice were infected intragastrically with L. monocytogenes that expressed bacterial luciferase. Mice were then imaged in vivo over time. Secreted breast milk samples from mice infected after parturition were enriched and plated for culture and imaging. Bioluminescence imaging technology was able to detect luciferase emitting L. monocytogenes in vaginal secretions and maternal and fetal organs at 72 and 96 h post infection in mice infected prior to, or just after, …parturition. The results from this study clearly show that L. monocytogenes is shed in vaginal secretions and disseminates to the mammary chain, from which it can be shed in the milk of peri-parturient mice. Show more

Keywords: Listeria monocytogenes, breast milk, bioluminescence

DOI: 10.3233/NPM-1366312

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 2, pp. 145-151, 2013

Authors: Lusyati, S. | Hulzebos, C.V. | Zandvoort, J. | Sukandar, H. | Sauer, P.J.J.

Article Type: Research Article

Abstract: BACKGROUND: Cytokines might be helpful to diagnose late onset sepsis (LOS) in newborn infants. Many studies on cytokines did not discriminate culture-proven from clinically-suspected sepsis; however, such differentiation is clinically useful. OBJECTIVES: To evaluate the feasibility to differentiate among culture-proven LOS, clinical LOS and controls using a battery of cytokines. STUDY DESIGN: This prospective study was conducted at the NICU of Harapan-Kita Women and Children's Hospital, Jakarta-Indonesia. Three groups of infants with postnatal age >72 hours of age were enrolled in the study: culture-proven sepsis group (PS) (n = 18), clinical sepsis group (CS) (n = 25) and control group …(n = 34). A battery of 25 cytokines was measured in each infant five times: at enrollment, after 4 hrs, 12 hrs, 24 hrs, and 48 hrs using Invitrogen-immunoassays-Luminex™100. RESULTS: There were no significant differences in gestational age or mode of delivery among the three groups. IL-1β, IL-2r, IL-6, IL-8, IL-10 and MIP-1a were significantly higher at all measurement points in group PS compared to controls. IL-13 was lower at all measurement moments in group CS compared to controls, IL-12 was lower and IP-10 higher between 0 and 24 hrs. IL-1Ra, IL-6, IL-8, IL-13, IL-15, TNFα, MIP-1a and MIP-1b were higher at all the measurement moments in group PS compared to group CS. The ROC curves show that IL-6, IL-8, IL-15, MIP-1a, MIP-1b and TNFα have a sensitivity and specificity between 80 and 85% during the first 24–48 hours after the onset of infection. IL-6, IL-15, MIP-1a, MIP-1b and TNFα showed the best likelihood ratios. CONCLUSIONS: IL-6, IL8, IL 15, MIP-1a, MIP-1b and TNFα are potentially good markers for detecting a proven LOS. In case these cytokines are not elevated in sick infants, other causes than an infection have to be identified. Show more

Keywords: Neonates, late onset sepsis, cytokines, chemokines

DOI: 10.3233/NPM-1364112

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 2, pp. 153-163, 2013

Authors: Mehar, V. | Yadav, D. | Somani, P. | Bhatambare, G. | Mulye, S. | Singh, K.

Article Type: Research Article

Abstract: INTRODUCTION: Neonatal mortality is increasingly recognized as an important global public health challenge. The spectrum of organisms that cause neonatal sepsis changes over time and varies from region to another. This study was conducted to determine the profile, antibiotic sensitivity pattern of bacterial isolates and outcome of confirmed neonatal sepsis in a tertiary care center. STUDY DESIGN: All blood culture reports (n = 285), obtained during the study period (January 2012-September 2012) from the neonatal intensive care unit were analyzed. RESULTS: Blood culture positivity rate was 22.1% (67/285). Seventy-three percent babies were outborn. Sixty-two percent babies were preterm and 80% …were low birth weight. Thirty-six (57%) babies had early onset and remaining 27 (43%) had late onset neonatal sepsis. Blood culture isolates included Gram-negative bacilli (38/67, 56.7%), Gram-positive cocci (20/67, 29.8%), and Candida species (9/67, 13.4%). Staphylococci and Klebsiellae were the most common organisms responsible for infections, accounting for 25.4% (17/67) and 19.4% (13/67) of the isolates, respectively. All Gram positive isolates were sensitive to vancomycin, while 50–65% Gram negative isolates were sensitive to amikacin, ciprofloxacin and meropenem. Fifty-eight percent babies were discharged after completion of the antibiotic therapy, while 28.6% babies expired. CONCLUSION: Multidrug resistant Gram negative isolates pose serious challenge, particularly in setting of emerging resistance to fluoroquinolones and carbepenems. Show more

Keywords: Microbiological profile, antimicrobial sensitivity pattern, Staphylococci, Klebsiellae, Candiada

DOI: 10.3233/NPM-1367312

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 2, pp. 165-172, 2013