Journal of Neonatal-Perinatal Medicine - Volume 7, issue 3

Authors: Adamkin, D.H. | Radmacher, P.G.

Article Type: Review Article

Abstract: A number of adaptations in total parenteral nutrition (TPN) protocols and practices for preterm neonates have been realized in the past several years, resulting in better survival and developmental outcomes. The early provision of appropriate concentrations of amino acids and energy are now recommended in evidence-based guidelines. Standardized TPN formulations are now available for many patients and may be associated with cost savings and improved adherence to guidelines. Several advantages of these preparations, including promotion of safer administration, consistent adherence to guidelines, and overall best practices, have been well documented. However, careful monitoring is still required to optimize nutrition for …individual patients and to support overall safety as TPN practices continue to change. Additional research is needed to develop new lipid formulations that are tailored for safe use by very low birth weight (VLBW) and extremely low birth weight (ELBW) infants. This review presents recent research and improvements to guidelines, as well as future product needs for VLBW and ELBW neonates. Show more

Keywords: Extremely low birth weight neonates, nutrition, total parenteral nutrition, very low birth weight neonates

DOI: 10.3233/NPM-14814008

Citation: Journal of Neonatal-Perinatal Medicine, vol. 7, no. 3, pp. 157-164, 2014

Authors: Jani, P. | Luig, M. | Wall, M. | Berry, A.

Article Type: Research Article

Abstract: AIM: To audit clinical practice during transport of very preterm infants (<32 weeks) with acute respiratory distress syndrome (RDS) receiving nasal continuous positive airway pressure (NCPAP). METHODS: Retrospective cohort study. RESULTS: Twenty-seven infants were receiving NCPAP before transport team's arrival, and 23 were commenced on NCPAP after team's arrival. Six infants (12%) failed NCPAP before transfer, 2 infants (4.5%) failed NCPAP less than 24 hours, and 5 infants (11.3%) failed more than 24 hours – 7 days following admission. None died or developed pneumothorax during, or 7 days after admission. We did not observe NCPAP failure during transfer. There was …a statistically significant difference between the NCPAP success and NCPAP failure groups for FiO2 at admission (p < 0.05), and the duration of NCPAP (p < 0.05). CONCLUSION: NCPAP is a potentially safe and effective mode of respiratory support for very preterm infants during ground, and air transports. Show more

Keywords: Infant, respiratory distress syndrome, continuous positive airway pressure, emergency medical services

DOI: 10.3233/NPM-1473913

Citation: Journal of Neonatal-Perinatal Medicine, vol. 7, no. 3, pp. 165-172, 2014

Authors: Weiss, M.D. | Tang, A. | Young, L. | Irwin, L. | Brophy, C. | Larsen, V. | Howard, J. | Miller, C. | Douglas-Escobar, M.

Article Type: Research Article

Abstract: OBJECTIVE: The objective of this report was to evaluate a servo-controlled active hypothermia device used during the transport of neonates with HIE. STUDY DESIGN: Retrospective review of all cases of therapeutic hypothermia, both passive and active, using a servo-controlled device in a single regional referral neonatal intensive care unit from 2009-2013 RESULTS: An ambulance (43%), fixed wing aircraft (25%), or helicopter (32%) transported 28 neonates with active hypothermia. The servo-controlled device captured core temperatures in all 28 neonates, resulting in 2,985 minutes of data. All neonates attained a core temperature between 33-34 °C by 33 minutes of the transport. Once …the neonates attained a core temperature, the average temperature for the remainder of the transport was 33 ± 0.2 °C. The neonates maintained the core temperature regardless of the type of transport vehicle. CONCLUSION: Servo-controlled hypothermia enables rapid attainment of targeted temperatures and maintains the temperature throughout the transport process in both ground and air transport. Show more

Keywords: Active hypothermia, neonates, transport, hypoxic-ischemic, encephalopathy

DOI: 10.3233/NPM-14814018

Citation: Journal of Neonatal-Perinatal Medicine, vol. 7, no. 3, pp. 173-178, 2014

Authors: Al Zaabi, A. | Rahmani, A.Y. | Souid, A.

Article Type: Research Article

Abstract: OBJECTIVES: Whole-body hypothermia (to 33.5 ± 0.5°C) is a therapeutic modality that reduces risks of death and neurodevelopmental disability in neonates subjected to hypoxic-ischemic insults. This in vitro study was designed to determine changes in neonatal cellular metabolism with temperature. Its main aim was to compare the metabolic rate at ≤33°C with that at ≥35°C. STUDY DESIGN: Foreskin specimens were used as a source of neonatal tissue. Cellular respiration (mitochondrial O2 consumption) was used as a surrogate biomarker for the metabolic rate. Foreskin specimens from healthy newborns were collected immediately after circumcision and processed within one hour for measuring …the rate of O2 consumption at various temperatures (±0.5°C). O2 consumption was determined as function of time from the phosphorescence decay of Pd (II) meso-tetra-(4-sulfonatophenyl)-tetrabenzoporphyrin. RESULTS: In a vial sealed from air and containing foreskin specimen in phosphate-buffered saline supplemented with 5 mM glucose, [O2 ] decreased linearly with time, confirming its zero-order kinetics. The rate of O2 consumption (μM O2 .min−1 ), thus, was the negative of the slope of [O2 ] vs. time. Cyanide inhibited O2 consumption, confirming the oxidation occurred in the respiratory chain. Cellular respiration at ≤33°C (n = 25) significantly differed from that at ≥35°C (n = 24), p < 0.001. The rate (μM O2 .min−1 .mg−1 ) at 25°C was 0.034 ± 0.006 (n = 11, p = 0.044), at 33°C was 0.029 ± 0.008 (n = 14, reference temperature), at 35°C was 0.062 ± 0.020 (2-fold higher, n = 18, p < 0.001), and at 37°C was 0.061 ± 0.009 (2-fold higher, n = 6, p < 0.001). CONCLUSIONS: Neonatal foreskin cellular respiration is highly sensitive to critical temperatures (33°C vs. 35°C). Show more

Keywords: Cellular respiration, bioenergetics, metabolism, mitochondria, hypothermia, neonates

DOI: 10.3233/NPM-14814021

Citation: Journal of Neonatal-Perinatal Medicine, vol. 7, no. 3, pp. 179-183, 2014

Authors: Garland, J.S. | Alex, C.P. | Johnston, N. | Yan, J.C. | Werlin, S.L.

Article Type: Research Article

Abstract: OBJECTIVES: To determine the frequency of tracheal pepsin in ventilated neonates and whether the angle of head elevation was associated with tracheal pepsin. STUDY DESIGN: Serial trachael samples (at 3, 7, 14, 21 and 28 days of ventilation) were obtained from intubated, ventilated very low birth weight infants. Presence of tracheal pepsin was determined by Western blot analysis using a specific anti-human pepsin antibody. RESULTS: Tracheal pepsin was detected in 35/66 (53%) of the ventilated neonates (birthweight: 798 ± 268 grams [mean ± standard deviation]). Neonates whose head elevation was in the upper quartile (≥14 degrees) during the first sampling …time (day 3) were less likely (4/16 vs 9/10, P = 0.0013) to have tracheal pepsin when compared to neonates whose head elevation was in the lowest quartile (≤8 degrees). CONCLUSIONS: Pepsin, a marker for gastric secretion aspiration, was detected in 53% of ventilated low birth weight neonates; early elevation of the head of the bed was associated with a lower rate of tracheal pepsin. Show more

Keywords: Aspiration, ventilator associated pneumonia, very low birth weight infants, gastroesophageal reflux

DOI: 10.3233/NPM-14814020

Citation: Journal of Neonatal-Perinatal Medicine, vol. 7, no. 3, pp. 185-192, 2014

Authors: AlFaleh, K. | Al-Jebreen, A. | Baqays, A. | Al-Hallali, A. | Bedaiwi, K. | Al-Balahi, N. | AlGhamdi, A. | AlKharfi, T. | Alzahem, A.

Article Type: Research Article

Abstract: OBJECTIVE: To investigate the association of PRBC transfusion and the development of NEC in VLBW preterm infants at a tertiary care neonatal unit. METHODS: A retrospective case-control study was performed. All VLBW infants (gestational age ≤32 week and birth weight <1500 g) born between 1999 and 2013 were included. Cases and controls were divided into four groups: (1) Infants who received PRBC transfusion and developed NEC within 48 hours of transfusion; (2) Infants who received PRBC transfusion and did not develop NEC; (3) Infant who developed NEC and did not receive PRBC transfusion; and (4) Infants who neither developed NEC …nor received PRBC transfusion. Our primary outcome was the association of PRBC transfusion with the development of severe NEC. RESULTS: One hundred fifty two VLBW infants were enrolled. The mean birth weight of enrolled infants was 1042 g and a mean gestational age of 28 weeks. The included four groups were not statistically different with regard to baseline important variables. Infants who had NEC and received PRBC transfusion (group 1) had higher incidence of sepsis and severe retinopathy of prematurity. Overall, Infants who received PRBC transfusion had a lower incidence of NEC (OR 0.39, 95% CI: 0.18,0.84, p = 0.02). CONCLUSION: We observed a lower association of PRBC transfusion and severe NEC in VLBW infants. Prospective, randomized well powered studies are needed to confirm our findings. Show more

Keywords: NEC, necrotizing enterocolitis, preterm, newborn, transfusion

DOI: 10.3233/NPM-14814048

Citation: Journal of Neonatal-Perinatal Medicine, vol. 7, no. 3, pp. 193-198, 2014

Authors: Mintzer, J.P. | Parvez, B. | Chelala, M. | Alpan, G. | LaGamma, E.F.

Article Type: Research Article

Abstract: OBJECTIVE: In extremely premature neonates, data concerning the normal baseline variability of near-infrared spectroscopy (NIRS)-derived regional oxygen saturation (rSO2 ) are lacking. We sought to determine: 1) the quiescent variability of cerebral, renal, and splanchnic rSO2 in clinically stable, undisturbed very low birth weight neonates and 2) the effects of different data averaging epochs on site-specific variability. STUDY DESIGN: In this prospective, observational study, neonates between 500 and 1250 g underwent seven days of continuous, real-time cerebral, renal, and splanchnic NIRS monitoring starting within the first seventy-two postnatal hours. Demographic, cardiopulmonary, bedside care, and rSO2 data were collected. …rSO2 variability was analyzed utilizing data from quiescent periods identified using pre-specified stability criteria. Between- and within-monitoring site comparisons of data averaging methods were made utilizing ANOVA. RESULT: Twenty-four subjects (GA 27 ± 0.3 wk, birth weight 988 ± 34 g; mean ± SEM) were monitored. Coefficients of variation (CoVar = SD/mean) were calculated for each monitoring site using varied data averaging epochs. CoVar was lowest for cerebral, intermediate for renal, and highest for splanchnic rSO2 (P < 0.01). For renal and splanchnic sites, shorter epochs (5- and 15-min) resulted in significantly smaller CoVars [P < 0.01 and P < 0.05, respectively]. Splanchnic variability was highly dependent on epoch length, ranging from 16% over 5 min to 23% over 60 min. CONCLUSION: 1) rSO2 variability differs significantly between monitoring sites and 2) shorter data sampling epochs decrease rSO2 variability. These observations may assist clinicians in operationally defining minimally significant departures to enable medical decision making utilizing this monitoring technique. Show more

Keywords: Near-infrared spectroscopy (NIRS), monitoring, noninvasive, neonate, oxygenation, regional tissue oxygenation, oxygen delivery

DOI: 10.3233/NPM-14814035

Citation: Journal of Neonatal-Perinatal Medicine, vol. 7, no. 3, pp. 199-206, 2014

Authors: Gad, G.I. | Ismail, R.I.H. | El-Masry, S.A. | Gouda, H.R.

Article Type: Research Article

Abstract: OBJECTIVE: To evaluate the diagnostic value of serum apelin in early-onset neonatal sepsis in full term neonates. Apelin is a proinflammatory adipocyte-derived factor that participates in vascular wall inflammation. STUDY DESIGN: Case-control study was conducted on 60 full term neonates, 30 cases with early-onset neonatal sepsis and 30 healthy matched controls. Complete blood counts, C-reactive protein, blood cultures, plasma lactate, and serum apelin concentrations (measured by enzyme-linked immunosorbent assay) were determined initially at the time of sepsis diagnosis and 4 days after starting treatment for cases. Only basal serum apelin concentrations were measured for control group. RESULTS: Apelin was detected …in all neonates and concentrations were positively correlated to sepsis scores, plasma lactate and CRP. Neonates with sepsis had significantly elevated concentrations (8 folds increase) of serum apelin concnetration as compared to controls [median (IQR): 65.16(46.90) and 7.969(11.36) pg/ml, respectively]. Moreover initial serum apelin concentration measured in cases with culture proven neonatal sepsis was significantly higher than those with negative-culture clinical sepsis (mean ± SD: 73.53 ± 31.77 and 45.22 ± 5.9 respectively, p = 0.0001). The best cutoff value of serum apelin to diagnose early-onset neonatal sepsis was 30.225 pg/ml with a sensitivity of 100% and a specificity of 97%. CONCLUSION: Serum apelin may have a diagnostic value in early-onset neonatal sepsis. Show more

Keywords: Apelin, neonate, sepsis

DOI: 10.3233/NPM-14814014

Citation: Journal of Neonatal-Perinatal Medicine, vol. 7, no. 3, pp. 207-212, 2014

Authors: Perugu, S. | Rehan, V.K. | Chow, S.L. | Baylen, B.

Article Type: Research Article

Abstract: OBJECTIVE: Evaluate plasma markers of myocardial function and ischemia [B-type natriuretic peptide] (BNP) and cardiac troponin T (cTnT)] in relationship to echocardiographic indices of left ventricular (LV) function and severity of illness score (SNAPPE-II) in Very-Low-Birth-Weight-Infants (VLBWIs) prospectively. STUDY DESIGN: Serial echocardiography studies, clinical data, BNP and cTnT were obtained in thirty VLBWIs on postnatal days 1, 2, 3 and 7. RESULTS: BNP increased and cTnT decreased significantly day 1 through 3. BNP was significantly associated with patent ductus arteriosus (PDA), but did not correlate with LV function or cTnT and did not reflect use of inotropic medication. Cardiac troponin …T increased with severity of illness, SNAPPE-II, score and was highest in babies receiving inotropic medication; Low cardiac output (CO) was common in the first seventy two hours and correlated negatively with cTnT (p < 0.01). A contractility index, the corrected LV mean velocity of circumferential fiber shortening, (mVcfc) was not related to cTnT. The LV mVcfc was inversely related to LV end systolic wall stress (p < 0.001) in all subgroups, and this index of contractility (mvcfc-ess) did not differ with large caliber PDA or use of inotropic medication. CONCLUSION: Cardiac troponin T exclusively rather than a combined biomarker approach may be useful in assessing myocardial injury. Cardiac output was low in sick VLBWIs with myocardial ischemia. Left ventricular contractile state was apparently preserved in significantly ill babies with elevated cTnT. Further research is needed to define the complex relationship between biomarkers and echocardiographic indices. Show more

Keywords: B-type natriuretic peptide, left ventricular function, PDA, mVcfc, cardiac troponin T

DOI: 10.3233/NPM-14814010

Citation: Journal of Neonatal-Perinatal Medicine, vol. 7, no. 3, pp. 213-222, 2014

Authors: Sampson, M.R. | Bloom, B.T. | Arrieta, A. | Capparelli, E. | Benjamin Jr., D.K. | Smith, P.B. | Kearns, G.L. | van den Anker, J. | Cohen-Wolkowiez, M. | Best Pharmaceuticals for Children Act – Pediatric Trials Network Administrative Core Committee

Article Type: Research Article

Abstract: OBJECTIVES: In premature infants with suspected intra-abdominal infection, biomarkers for treatment response to antimicrobial therapy are lacking. Intestinal fatty acid-binding protein (I-FABP) is specific to the enterocyte and is released in response to intestinal mucosal injury. I-FABP has not been evaluated as a surrogate marker of disease response to antimicrobial therapy. We examined the relationship between metronidazole exposure and urinary I-FABP concentrations in premature infants with suspected intra-abdominal infection. STUDY DESIGN: We conducted an intravenous metronidazole pharmacokinetic study, collecting ≤3 urine samples per infant for I-FABP concentration measurements. We analyzed the relationship between I-FABP concentrations and measures of metronidazole exposure …and pharmacokinetics, maturational factors, and other covariates. RESULTS: Twenty-six samples from 19 premature infants were obtained during metronidazole treatment. When analyzed without regard to presence of necrotic gastrointestinal disease, there were no significant associations between predictor variables and I-FABP concentrations. However, when the sample was limited to premature infants with necrotic gastrointestinal disease, an association was found between average predicted metronidazole concentration and I-FABP concentration (p = 0.006). CONCLUSION: While a predictive association between urinary I-FABP and metronidazole systemic exposure was not observed, the data suggest the potential of this endogenous biomarker to serve as a pharmacodynamic surrogate for antimicrobial treatment of serious abdominal infections in neonates and infants. Show more

Keywords: Necrotizing enterocolitis, biomarkers, pharmacokinetics, premature infants, antimicrobial agents

DOI: 10.3233/NPM-1477013

Citation: Journal of Neonatal-Perinatal Medicine, vol. 7, no. 3, pp. 223-228, 2014