Journal of Neonatal-Perinatal Medicine - Volume 6, issue 3

Authors: Papachatzi, E. | Dimitriou, G. | Dimitropoulos, K. | Vantarakis, A.

Article Type: Review Article

Abstract: Nowadays, obesity rates have an increasing tendency, since the incidence of obesity in both developed and developing countries is still rising over the years. Maternal pre-pregnancy obesity seems to have an influence on both obstetrical and neonatal outcomes. Many researchers have focused on pregnancies of obese nulliparous, non diabetic women as well as on the medical profile of their neonates, with conflicting conclusions. Additionally, several studies have followed these neonates through their childhood and adult life in order to observe them for any occurrence towards specific diseases. In our study, literature was reviewed and results are presented, into two groups. …The first group summarizes the correlation of high maternal prepregnancy Body Mass Index (BMI) with the rates of hypertensive disorders, fertility, cesarean section and maternal mortality, while the second group correlates maternal BMI to neonatal Apgar score, neonatal admission to NICU, preterm delivery, congenital defects, birthweight, and weight status after birth, child morbidity, respiratory problems as asthma and children's mortality. Maternal pre-pregnancy obesity tends to have an important negative impact on the above mentioned outcomes. However, further research, in certain fields, needs to be carried out in order to gain a clear image. Show more

Keywords: Body mass index, BMI, pregnancy, complications

DOI: 10.3233/NPM-1370313

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 3, pp. 203-216, 2013

Authors: DeLuca, L.M. | Fox, N.S. | Green, R.S. | Stroustrup, A. | Harris, M. | Holzman, I.R. | Gibbs, K.

Article Type: Research Article

Abstract: OBJECTIVE: To compare the incidence of small for gestation age (SGA) neonates in twin gestations conceived by ovulation induction or in vitro fertilization with that of twins conceived spontaneously. STUDY DESIGN: A retrospective cohort study was conducted. Subjects were delivered by a single obstetric practice between 2005 and 2011 at the Mount Sinai Medical Center. Maternal and neonatal data were recorded. Our primary outcome was the incidence of SGA, defined as birth weight <10th percentile, from the three modes of conception. Chi square, ANOVA, Fisher's exact test, the Kruskal-Wallis test, the Mantel-Haenszel test, and logistic regression were used in the …analysis. RESULTS: In unadjusted analysis, using the records of 756 infants from 378 mothers of twin pregnancies, twins conceived by ovulation induction had an increased incidence of SGA (28.1%) compared to those conceived spontaneously (17.1%) and by in vitro fertilization (16.5%, p = 0.006). In a logistic regression model accounting for correlated responses between twins and adjusting for gestational age, gender, chorionicity, and maternal age, the odds ratio (95% confidence interval [CI]) of SGA for the ovulation induction group compared to the spontaneous conception group was 2.64 (1.38-5.05, p = 0.003). The odds ratio (95% CI) of SGA for the in vitro fertilization group compared to the spontaneous conception group was 1.51 (0.88-2.61, p = 0.135). CONCLUSIONS: When adjusted for gestational age, gender, chorionicity, and maternal age, twin neonates conceived by ovulation induction, but not those conceived by in vitro fertilization, had increased odds of SGA compared to those conceived spontaneously. Show more

Keywords: Fertility treatment, neonatal outcomes, in vitro fertilization, mode of conception, ovulation induction

DOI: 10.3233/NPM-1370613

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 3, pp. 217-224, 2013

Authors: Nili, F. | McLeod, L. | O'Connell, C. | Sutton, E. | McMillan, D.

Article Type: Research Article

Abstract: OBJECTIVES: To evaluate maternal and neonatal outcomes in women suspected to have primary antiphospholipid syndrome (PAPS). METHODS: A cohort from the Nova Scotia Atlee Perinatal Database (n = 211034) was studied. A total of 58 women with antiphospholipid antibodies without a clinical diagnosis of rheumatologic disease were evaluated. We compared them to maternal and neonatal outcomes of women without rheumatologic disease or PAPS who delivered in Nova Scotia 1988–2008. RESULTS: With PAPS, mean maternal age was older; mean gestational age and mean neonatal birth weight were less. With bivariate analysis, maternal colonization and urinary tract infection with group B streptococcus, …thromboembolic disease, thrombocytopenia and Caesarean birth were more frequent in the suspected PAPS group compared to the control. Among neonates, hyperbilirubinemia, anemia, apnea, intraventricular hemorrhage grade I and II, retinopathy of prematurity, bronchopulmonary dysplasia, neonatal intensive care unit admission, and assisted ventilation occurred more frequently with PAPS. Babies in PAPS group had a longer hospital stay (8.7 vs 3.9 days). Logistic regression analysis identified that PAPS was only associated with increased risks of preeclampsia (Odds Ratio (OR) 2.2; 95% Confidence Interval (CI) 1.1–4.3; P = 0.016), urinary tract infection (OR 2.2; 95% CI 1.1–4.6; P = 0.02), and prematurity (gestational age ≤37) (OR 2.2; 95% CI, 1.07–4.3, P = 0.03). Positive predictive values for pregnancy induced hypertension, urinary tract infection and prematurity in women who had suspected APS were 24.1%, 17.2% and 45.6% respectively. CONCLUSION: With suspected PAPS, risks for preeclampsia, urinary tract infection and prematurity are increased. Outcomes for babies are related to prematurity. Show more

Keywords: Antiphospholipid antibodies, antiphospholipid syndrome, pregnancy, newborn, outcome

DOI: 10.3233/NPM-1370113

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 3, pp. 225-230, 2013

Authors: Olaleye, O. Atinuke | Kuti, O. | Makinde, N. Olaniyi | Ujah, A.O. Innocent | Olaleye, O. Akinyemi | Badejoko, O. Olusegun | Akintayo, A. Akinyemi | Audu, R.

Article Type: Research Article

Abstract: AIM: To determine the perinatal transmission risk of hepatitis B virus (HBV) and the maternal characteristics influencing it. METHOD: During routine antenatal screening, women who tested positive for hepatitis B surface antigen (HBsAg) were identified and followed through pregnancy. Maternal and cord blood samples were obtained at delivery. The sera of each mother-baby pair were analyzed for HBsAg, HBeAg, HBeAb, HBsAb and HBcAb using an immunochromatographic 5-in-1 panel kit. Quantitative HBV-DNA was assessed using polymerase chain reaction technique. Intrauterine infection was defined when neonatal blood test positive for HBsAg positivity and/or HBV-DNA. Confidence level was set at 95% (p < …0.05). RESULTS: Of the 716 pregnant women screened 73 (10.2%) were HBsAg-positive. Fifty of these HBsAg-positive women completed the study. Intrauterine infections were detected in 36 (72%) newborns; of them only twelve (24%) had positive HBsAg whereas all of them (n = 36) neonates had detectable HBV-DNA (>100 copies/ml). High maternal HBV-DNA titre was associated with increased neonatal HBV-DNA titre (p = 0.001). Parity, maternal age, and mode of delivery showed no association with perinatal transmission. CONCLUSION: The risk of perinatal HBV transmission in this study was high. Perinatal transmission was associated with high maternal viremia. Appropriate prophylaxis for HBsAg-positive mothers and their newborns is advocated. Show more

Keywords: Hepatitis B, vertical transmission, intra-uterine infection, perinatal, Nigeria

DOI: 10.3233/NPM-1366412

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 3, pp. 231-236, 2013

Authors: Salama, H. | Abughalwa, M. | Taha, S. | Sharaf, N. | Mansour, A.

Article Type: Research Article

Abstract: BACKGROUND: Transient tachypnea of the newborn (TTN) is a self- limited increase in the work of breathing in near- and full-term infants; it is attributed to a delay in the clearance of alveolar fluids. Prophylactic antibiotics are usually administered until blood cultures are reported negative for 48 hours. OBJECTIVES: To prospectively compare outcomes of infants presented with classic TTN who were treated with or denied from intravenous antibiotics. METHODS: A prospective cohort study was conducted on all infants admitted with classic TTN. Pre-set diagnostic criteria for classic TTN were applied in order to exclude other cases presenting with respiratory distress. …Infants with classic TTN were stratified into two groups based on whether they received or did not receive antibiotics. The decision to administer antibiotics solely depended upon the style of the covering physician at the time of admission to the NICU. The following investigations were obtained from infants of both groups: blood culture, C-reactive protein, complete blood count, blood gas profile and chest X-ray. RESULTS: A total of 15146 full-term infants were delivered during the study period; of them 923 were admitted to the NICU. Classic TTN was diagnosed in 168 infants; of them 106 (63%) received and 62 (37%) did not receive antibiotics. Two infants in the treated group and an infant in the non-treated group had microbiologically confirmed bacteremia. Infants in the treatment group stayed longer in the hospital (72 ± 6 vs. 48 ± 3 hrs). No recorded cases required readmission in either group. CONCLUSIONS: With the application of strict criteria for classic TTN and the close observation in the NICU, the empiric use of antibiotics may be avoidable. Randomized controlled trials are needed to confirm the feasibility and safety of such approach. Show more

Keywords: Transient tachypnea of newborn, microbiology, antibiotics, blood culture

DOI: 10.3233/NPM-1367012

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 3, pp. 237-241, 2013

Authors: Mitchell, A.J. | Yates, C. | Williams, K. | Hall, R.W.

Article Type: Research Article

Abstract: BACKGROUND/AIMS: Kangaroo care (KC) has possible benefits for promoting physiological stability and positive developmental outcomes in preterm infants. The purpose of this study was to compare bradycardia and oxygen desaturation events in preterm infants in standard incubator care versus KC. METHODS: Thirty-eight infants 27 to 30 weeks gestational age were randomly assigned to 2 hours of KC daily between days of life 5 to 10 or to standard incubator care. Infants were monitored for bradycardia (heart rate <80) or oxygen desaturation (<80%). Analysis of hourly events was based on three sets of data: standard care group 24 hours daily, KC …group during incubator time 22 hours daily, and KC group during holding time 2 hours daily. RESULTS: The KC group had fewer bradycardia events per hour while being held compared to time spent in an incubator (p = 0.048). The KC group also had significantly fewer oxygen desaturation events while being held than while in the incubator (p = 0.017) and significantly fewer desaturation events than infants in standard care (p = 0.02). Conclusion: KC reduces bradycardia and oxygen desaturation events in preterm infants, providing physiological stability and possible benefits for neurodevelopmental outcomes. Show more

Keywords: Infant, premature, kangaroo care, bradycardia, oxygen desaturation

DOI: 10.3233/NPM-1370513

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 3, pp. 243-249, 2013

Authors: Abu Jawdeh, E.G. | O'Riordan, M. | Limrungsikul, A. | Bandyopadhyay, A. | Argus, B.M. | Nakad, P.E. | Supapannachart, S. | Yunis, K.A. | Davis, P.G. | Martin, R.J.

Article Type: Research Article

Abstract: BACKGROUND: A recent multinational clinical trial in preterm infants has demonstrated pulmonary and neurodevelopmental benefits from caffeine therapy. Indications for caffeine use in that study were predominantly for treatment of apnea and facilitation of extubation rather than prophylaxis. There are no recent studies that describe current practice of neonatologists and regional differences in regards to indications for starting, monitoring and discontinuing methylxanthine therapy in premature infants. OBJECTIVE: To characterize the spectrum of current practice and demonstrate the extent to which methylxanthine therapy varies by location. METHODS: A cross-sectional survey of all neonatologists in Thailand, Lebanon, Australia, and a representative sample …in the USA regarding management of apnea of prematurity. RESULTS: The response rate was 50% (342/681). The methylxanthine of choice varied greatly across study locations. Prophylactic methylxanthine use is common (62%) among neonatologists in all four study locations. Significant variation exists in almost all aspects of apnea pharmacotherapy practice among neonatologists in different international locations. CONCLUSIONS: Prophylactic use of methylxanthine therapy for apnea of prematurity is widespread. We speculate that this expanded use is possibly attributed to the beneficial effects of caffeine therapy in the Caffeine for Apnea of Prematurity (CAP) Trial. Show more

Keywords: Caffeine, questionnaire, premature infants, international health, survey, practice variation

DOI: 10.3233/NPM-1371013

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 3, pp. 251-256, 2013

Authors: Wahab Mohamed, W.A. | Aseeri, A.M.

Article Type: Research Article

Abstract: OBJECTIVE: To evaluate epidermal growth factor (EGF) levels in cord blood as a possible marker for predicting the subsequent development of necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants. PATIENTS AND METHODS: A total of 241 VLBW infants (38 infants developed NEC and 203 had no NEC) were enrolled. EGF concentrations were measured by enzyme-linked immunosorbent assay. RESULTS: VLBW infants who subsequently developed NEC had significantly lower cord serum concentrations of EGF than those who did not (p < 0.0001). Moreover, cord blood concentrations of EGF were significantly lower in infants with stage III than those with stage …II or I NEC (p < 0.001). Logistic regression analysis demonstrated that low cord blood EGF was independently associated with the subsequent risk of NEC (OR = 0.978 [95% CI: 0.959–0.997]; p = 0.02). CONCLUSION: Low cord blood EGF concentrations may predict the subsequent development of NEC in VLBW infants. Show more

Keywords: Epidermal growth factor, necrotizing enterocolitis, very low birth weight infants

DOI: 10.3233/NPM-1370813

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 3, pp. 257-262, 2013

Authors: Parashar, R. | Lysecki, P.J. | Mondal, T.

Article Type: Research Article

Abstract: In this case, we describe a newborn that presented on the first day of life with diffuse, bilateral coronary artery dilatation, in the absence of intrauterine hypoxia or other identifiable causes of coronary artery ectasia. The infant's symptoms followed an acute course before spontaneously recovering. Kawasaki disease, though relatively rare in neonates, may present in this population in the absence of classical criteria. If untreated, the cardiac sequelae of this disease can be serious. Through this case, where spontaneously remitting coronary dilatation is the paramount finding, we entertain the possibility that this may represent the earliest known presentation of Kawasaki …disease. Show more

Keywords: Neonatal, coronary artery dilatation, Kawasaki disease

DOI: 10.3233/NPM-1365612

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 3, pp. 263-266, 2013

Authors: Xiao, N. | Tandon, A. | Goldstein, S. | Lorts, A.

Article Type: Research Article

Abstract: Neonatal systemic hypertension is an underappreciated etiology of cardiac failure. We present a series of three neonates who presented in cardiogenic shock secondary to severe hypertension, recognized after initial resuscitation efforts. Although the underlying etiology of the hypertension varied, all three patients had improved hemodynamics after their blood pressure was controlled. These cases suggest that neonates presenting in cardiogenic shock with hypertension, and without structural heart disease, may benefit from a thorough renal evaluation and institution of anti-hypertensive therapy.

Keywords: Infant, neonate, cardiogenic shock, hypertension

DOI: 10.3233/NPM-1370213

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 3, pp. 267-272, 2013