Journal of Neonatal-Perinatal Medicine - Volume 6, issue 4

Authors: Hendrik, H.D.

Article Type: Review Article

Abstract: Sucking pads are hyperkeratotic thickenings of the inner aspect of the vermillion border of the lips of neonates. They develop around the 25th week of gestation and are the result of the primitive sucking reflex which is brain-stem mediated. The presence of sucking pads at birth represents an effective sucking reflex and as such it is recommended as a screening tool that indicates an intact motor neuron function in neonates.

Keywords: Sucking pads, leukoedema, sucking reflex, sucking calluses, neonates

DOI: 10.3233/NPM-1372413

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 4, pp. 281-283, 2013

Authors: Ditzenberger, G.R. | Wallen, L.D. | Phelan, L. | Escoe, S. | Collins, S.D.

Article Type: Research Article

Abstract: BACKGROUND: Providing adequate nutritional support to promote optimal postnatal growth for very low birth weight (VLBW) infants has been a difficult problem to surmount in the NICU. During the past 4 decades, improvements in neonatal critical care have made it possible for more VLBW infants to survive to discharge from NICUs. The NICHD Neonatal Network reported that while intrauterine growth restriction was present in 22% of VLBW infants at birth, 91% demonstrated postnatal growth restriction by 36 weeks post menstrual age. The persistence of this nearly universal growth deficit is associated with the inadequacy of protein and energy intake, which …may account for 45–50% of the postnatal growth restriction. OBJECTIVE: The purpose of this study was to assess whether increasing enteral intake, using supplemental protein, would improve postnatal growth for VLBW infants. STUDY DESIGN: Randomized clinical trial. Sixty-four infants were enrolled (34 in control group with 15 infants <1000 g, and 30 in intervention group with 13 infants <1000 g). RESULT: There were no sustained statistical differences between weekly measurements of weight, length, head circumference, and skinfold thickness between groups. There were no significant differences between laboratory results except blood urea nitrogen at time of peak protein intake for intervention group. CONCLUSIONS: Supplemental enteral protein had minimal to no effect on postnatal weight, length, head circumference, body mass, or length of stay. It may be most important to provide consistent sustained nutritional support with protein from birth to reduce postnatal growth restriction, especially for those infants <1000 g at birth. Show more

Keywords: Extremely premature infants, nutritional requirements, growth restriction, human milk, VLBW

DOI: 10.3233/NPM-1371213

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 4, pp. 285-294, 2013

Authors: Amini, E. | Rafiei, P. | Zarei, K. | Gohari, M. | Hamidi, M.

Article Type: Research Article

Abstract: BACKGROUND: Music is considered a subset of developmental supportive care. It may act as a suitable auditory stimulant in preterm infants. Also, it may reduce stress responses in autonomic, motor and state systems. OBJECTIVE: To assess and compare the influence of lullaby and classical music on physiologic parameters. METHOD: This is a randomized clinical trial with cross-over design. A total of 25 stable preterm infants with birth weight of 1000–2500 grams were studied for six consecutive days. Each infant was exposed to three phases: lullaby music, classical music, and no music (control) for two days each. The sequence of these …phases was assigned randomly to each subject. Babies were continuously monitored for heart rate, respiratory rate, and oxygen saturation and changes between phases were analyzed. RESULT: Lullaby reduced heart rate (p < 0.001) and respiratory rate (p = 0.004). These effects extended in the period after the exposure (p < .001 and p = 0.001, respectively). Classical music reduced heart rate (p = 0.018). The effects of classical music disappeared once the music stopped. Oxygen saturation did not change during intervention. CONCLUSION: Music can affect vital signs of preterm infants; this effect can possibly be related to the reduction of stress during hospitalization. The implications of these findings on clinical and developmental outcomes need further study. Show more

Keywords: Lullaby, classical music, physiologic parameter, preterm infant

DOI: 10.3233/NPM-1371313

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 4, pp. 295-301, 2013

Authors: Cordero, L. | Gabbe, S.G. | Landon, M.B. | Nankervis, C.A.

Article Type: Research Article

Abstract: BACKGROUND: In the United States, breastfeeding initiation (BFI) is reported for 75% of all live births; however, little information is available regarding mothers affected by gestational diabetes mellitus (GDM). OBJECTIVE: To examine feeding practices and factors associated with BFI in women with GDM and their infants. METHODS: A total of 303 GDM (58 late preterm and 245 term) pregnancies were studied. Infant feeding preference was ascertained on admission to labor and delivery. Variables known to influence BFI including maternal age, smoking, obesity, racial and educational characteristics were assessed. RESULTS: On admission 188 women intended to BF, 60 intended to feed …formula and 55 were undecided. None of the women who wished to feed formula and 27% of the originally undecided later initiated BF. Regardless of feeding preference 163 (54%) of all mothers initiated BF. Similar BFI rates were found for 176 Class A1 and 127 class A2 women. Logistic regression analysis showed that intention to BF was the most significant predictor of BFI. Factors associated with BFI failure included African American race, lower education, smoking, obesity and admission to NICU. Following delivery 264 (87%) infants received well baby care while 39 (13%) were admitted to the NICU. Among 188 women who intended to BF, BFI involved 81% of 160 infants receiving well baby care and 61% of the 28 admitted to the NICU. CONCLUSIONS: More than half of women with GDM, who intended to BF, initiated BF. BFI failure remains associated with race, lower education level, smoking, obesity, preference for formula feeding and admission to NICU. Show more

Keywords: Breastfeeding initiation, gestational diabetes mellitus, feeding practices

DOI: 10.3233/NPM-1372513

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 4, pp. 303-310, 2013

Authors: Martín, F. Gómez | Sáenz de Pipaón, M. | Pérez Rodríguez, J. | Jiménez, J. Quero

Article Type: Research Article

Abstract: AIM: To determine risk or protective factors for the development of necrotizing enterocolitis in very low birth weight infants. METHODS: This retrospective case-control study was conducted at La Paz University Hospital including infants with a birth weight of <1500 g for three years. Cases with confirmed diagnosis of necrotizing enterocolitis were evaluated; each one was paired with a control infant of the same gestational age. Statistical analysis included unadjusted and multivariable analyses. RESULTS: A total of 576 very low birth weight infants were admitted; of them 30 infants (5.2%) developed necrotizing enterocolitis. The main clinical and demographic characteristics did not …differ between the two groups. The frequency of infants transfused with packed red blood cells was similar in cases (63%) and control patients (77%). However, a greater number of transfusions increased the odds of necrotizing enterocolitis [OR 1.5, 95%CI (1.01 to 2.24)]. CONCLUSIONS: A greater number of transfusions of packed red blood cells are associated with an increased risk of necrotizing enterocolitis in very low birth weight infants. The other analyzed variables in this study do not identify the infants at risk. Caution is advocated in using transfusions in newborns. Show more

Keywords: Blood transfusion, neonates, NEC, premature infants

DOI: 10.3233/NPM-1371813

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 4, pp. 311-318, 2013

Authors: Radmacher, P.G. | Lewis, S.L. | Adamkin, D.H.

Article Type: Research Article

Abstract: OBJECTIVE: To use real-time human milk macronutrient analysis to calculate final composition following fortification. STUDY DESIGN: Preterm HM (PHM) and pooled donor human milks (DHM) were analyzed by mid-infrared spectroscopy for protein, fat and lactose. Energy content was calculated from macronutrient results. Three lactation stages were constructed. DHM was compared to PHM. Four milk sample profiles were selected to demonstrate individualized fortification results. RESULTS: Lactose was similar in PHM and DHM. Protein in PHM showed the expected decline as lactation progressed. DHM protein was significantly lower vs. PHM. Fat was highly variable and lowest in DHM. Using standard fortification protocols, …not all fortified milks met targets for protein and energy. Individualized fortification resulted in milks closer to target recommendations. CONCLUSIONS: Real-time analysis of HM provides assessment of the macronutrient content of the milk and can guide fortification. Individualized protocols, based on actual milk macronutrient profiles, may need to be considered to avoid unexpected nutrient content. Show more

Keywords: Human milk analysis, human milk fortification

DOI: 10.3233/NPM-1373113

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 4, pp. 319-323, 2013

Authors: Hariharan, S. | Chen, D. | Harry, C. | Ragobar, R. | Boodoosingh, R. | Gangoo, C. | Hector, A. | Reid, J. | Raju, S.

Article Type: Research Article

Abstract: OBJECTIVE: To study the prescribing patterns and usage of antimicrobials in the Neonatal Intensive Care Units (NICU) of Trinidad & Tobago. METHODS: A 3-month prospective observational study was conducted at the three NICUs at the major public hospitals. Data included antimicrobials prescribed, route of administration, culture and sensitivity reports, leukocyte count, length of stay and outcome of patients. RESULTS: 353 patients were studied, 57.5% of the patients were males. Mean birth weight was 2.96 ± 0.94 (Standard Deviation) kg. Admission diagnoses included meconium stained liquor, preterm, respiratory distress, sepsis, etc. Length of stay ranged between 1 to 76 days, (median …4, Interquartile Range 1–8). The mean leukocyte count was 15.7 ± 8.5 × 103 per μL. Overall, 645 culture specimens were sent; umbilical swab (27.6%), throat swab (27.0%) and blood (16.4%) being the most common specimens. 310 (48.1%) showed no bacterial growth. Overall, 16 different antimicrobials were used. First line antibiotic of choice was a combination of ampicillin and gentamicin (85.8 %). Second line antibiotic of choice was cefotaxime. The overall mortality was 7.6%. CONCLUSION: The choice of antimicrobials in the NICUs of major public hospitals is mostly empirical and not primarily dictated by the culture and sensitivity reports, emphasizing the need for antibiotic stewardship programme in Trinidad & Tobago. Show more

Keywords: Antimicrobials, prescription patterns, usage, neonatal intensive care

DOI: 10.3233/NPM-1372113

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 4, pp. 325-331, 2013

Authors: Fleishman, R. | Gleason, C. A. | Myaing, M. T. | Zhou, C. | Mangione-Smith, R.

Article Type: Research Article

Abstract: OBJECTIVE: To test the hypothesis that use of morphine for sedation of ventilated premature neonates has not changed despite evidence-based recommendations. STUDY DESIGN: Retrospective chart review. RESULTS: Of 410 ventilated patients, 129 received a morphine infusion. The annual percentage of ventilated patients started on an infusion did not vary significantly from 2005–2010 (range: 27%–37%, mean: 32%, χ2 test for trend p = 0.60). Patients given morphine infusion had a lower median estimated gestational age at birth (26 0/7 weeks versus 27 6/7 weeks), and a lower median birth weight (762 versus 1010 grams). CONCLUSION: Use of morphine as a …sedative and/or pre-emptive analgesic agent for critically ill, ventilated, premature neonates has not decreased at the study site despite evidence-based recommendations against this treatment approach. This is an area of care that may benefit from quality improvement interventions. Show more

Keywords: Neonatal pain, sedation, opiate

DOI: 10.3233/NPM-1371513

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 4, pp. 333-338, 2013

Authors: Shah, S. | Kaul, A.

Article Type: Research Article

Abstract: AIM: The aim of our study was to quantify arterial carbon dioxide levels (PaCO2 ) achieved by ventilating extremely preterm neonates in volume guarantee mode targeting tidal volumes of approximately 4 ml/kg. METHODS: We performed a prospective trial on preterm infants with gestational age ≤28 weeks, birth-weight ≤1000 grams, postnatal age <48 hours and are supported by mechanical ventilation. All infants were ventilated using volume guarantee plus synchronized intermittent positive pressure ventilation (SIPPV + VG mode). Primary outcome was the average first PaCO2 in neonates and number of these infants with unacceptable first PaCO2 . Pre-specified secondary outcomes were …the average PaCO2 in infants ventilated during the first 48 hrs of ventilation and number of blood gases with an unacceptable PaCO2 in the first 48 hours. Sixty two infants were enrolled and 218 blood gases recorded up to 48 hours of age. RESULTS: The mean PaCO2 on the first arterial blood gas for infants ventilated in VG mode from admission to the nursery was 39.5 ± 6.3. The mean PaCO2 in the first 48 hours was 39.37 ± 6.99 mmHg. In our study, 91% of all PaCO2 values in the first 48 hours were between 35 and 60 mmHg. PaCO2 levels were in the acceptable range in 93% of infants at the time of first ABG measurement and in 91% of blood gases during the first 48 hours of ventilation. CONCLUSION: Newborn infants ventilated with volume guarantee ventilation targeting approximately 4 ml/kg of tidal volume, have acceptable PaCO2 levels at the first blood gas measurement and during the first 48 hours of ventilation. Show more

Keywords: Volume targeted ventilation, hypocarbia, hypercarbia

DOI: 10.3233/NPM-1372713

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 4, pp. 339-344, 2013

Authors: Arzuaga, B.H. | Groner, A.

Article Type: Research Article

Abstract: Extracorporeal membrane oxygenation (ECMO) is an advanced strategy utilized in many neonatal intensive care units for a specific list of indications. This case illustrates a rare but effective use of this therapy for a newborn infant with severe hypertrophic cardiomyopathy induced by maternal diabetes. Such infants who are unresponsive to conventional therapies may benefit from ECMO support, if it is used in conjunction with management strategies that optimize cardiac output.

Keywords: Extracorporeal membrane oxygenation, neonate, diabetes mellitus, hypertrophic cardiomyopathy

DOI: 10.3233/NPM-1372913

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 4, pp. 345-348, 2013

Authors: Hahn, E. | Vincent, J. A. | Kadenhe-Chiweshe, A. | Ratner, V. | Krishnamurthy, G.

Article Type: Research Article

Abstract: A premature infant with Tetralogy of Fallot with Pulmonary Atresia and prenatal compression of the left main bronchus by a large and ectatic patent ductus arteriosus is presented. Survival to surgery was accomplished by transcatheter placement of a coronary stent into the left mainstem bronchus.

Keywords: Bronchial compression, bronchial stenting, Tetralogy of Fallot, ectatic patent ductus arteriosus

DOI: 10.3233/NPM-1373013

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 4, pp. 349-353, 2013

Authors: De Cunto, A. | Paviotti, G. | Demarini, S.

Article Type: Research Article

Abstract: Aspiration of uncontaminated amniotic fluid as a cause of neonatal respiratory distress is scarcely documented. A term neonate who presented with early onset respiratory distress with a radiographic appearance of an aspiration syndrome is therefore reported. Differential diagnosis and implication of this diagnosis in the management of neonatal respiratory distress are discussed. This case highlights amniotic fluid aspiration as a possible cause of severe respiratory distress even in the absence of meconium stained fluid.

Keywords: Amniotic fluid aspiration, aspiration syndrome, neonatal respiratory distress

DOI: 10.3233/NPM-1372613

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 4, pp. 355-357, 2013

Authors: Hanna, M.H.

Article Type: Research Article

Abstract: Necrotizing enterocolitis (NEC) is the most common gastrointestinal (GI) emergency that primarily affects premature infants. In the last decade, there have been significant advances to our understanding of neonatal NEC. The exact etiology of NEC remains unclear, but it is widely considered a multifactorial disease; prematurity, enteral feeding, intestinal hypoxia-ischemia, and bacterial colonization are considered major risk factors. We report a case of a 35 week preterm infant with recurrent episodes of supraventricular tachycardia who developed NEC in the second week of life. This case underscores the importance of being appropriately cautious in the feeding of these high-risk premature infants.

Keywords: Necrotizing enterocolitis, supraventricular tachycardia

DOI: 10.3233/NPM-1372013

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 4, pp. 359-361, 2013

Article Type: Other

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 4, pp. 363-366, 2013

Article Type: Other

Citation: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 4, pp. 367-369, 2013