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

Authors: ElHassan, N.O. | Bird, T.M. | King, A.J. | Ambadwar, P.B. | Jaquiss, R.D.B. | Kaiser, J.R. | Robbins, J.M.

Article Type: Research Article

Abstract: BACKGROUND: Patent ductus arteriosus (PDA) occurs in 70% of extremely low birth weight (ELBW, birth weight <1000 g) infants. Approximately 34% of ELBW infants with a PDA have spontaneous closure. Failure of the ductus arteriosus to close has been associated with multiple morbidities. OBJECTIVE: To examine variability over time and across hospitals in early therapeutic (2–7 day) use of indomethacin (INDO) vs ibuprofen (IBU) for PDA treatment in outborn ELBW infants and examine the outcomes and side effects of both pharmacological agents in this population. METHODS: Data were extracted from the Pediatric Health Information System. ELBW infants born between January …1, 2007 and December 31, 2010 and admitted on day of life 0 were eligible for inclusion. 732 infants had a PDA diagnosis and met inclusion criteria. We explored the variability in PDA pharmacotherapy over time and across hospitals. We compared outcomes of both agents for in-hospital mortality, need for surgical ligation, intraventricular hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia, periventricular leukomalacia, renal failure, and persistent pulmonary hypertension. Statistical methods included chi square and multivariable regression analysis. Instrumental variable analysis was used to control for selection bias and omitted variables. RESULTS: There was large variability in PDA pharmacotherapy over time and across hospitals. INDO use declined as IBU use grew from 12.8 to 38.9%. There was no difference in hospital or NICU characteristics between high and low IBU using NICUs. Renal failure was more common in infants receiving INDO compared to IBU. CONCLUSION: We noted large variability in PDA pharmacotherapy. Renal failure was more common with INDO use. Until further studies to compare the long-term effects of both drugs, our data support IBU as the preferred medication for PDA pharmacotherapy in ELBW infants. Show more

Keywords: Patent ductus arteriosus, indomethacin, ibuprofen, extremely low birth weight infants

DOI: 10.3233/NPM-14814015

Citation: Journal of Neonatal-Perinatal Medicine, vol. 7, no. 3, pp. 229-235, 2014

Authors: Pivetti, V. | Cavigioli, F. | Lista, G. | Napolitano, M. | Rustico, M. | Paganelli, A. | Ferrazzi, E.

Article Type: Research Article

Abstract: In this case, we describe a newborn with prenatal diagnosis of congenital high airway obstruction syndrome (CHAOS), successfully managed with a cesarean section with delayed cord clamping 180 seconds. In case of prenatal diagnosis of CHAOS, prompt airway intervention at delivery allows survival of this otherwise fatal condition. Ex utero intrapartum treatment (EXIT) is considered the elective procedure to secure the fetal airway before the baby is completely separated from the maternal circulation. In cases where the EXIT procedure is not possible for maternal reasons (Ballantyne's syndrome), delayed cord clamping may serve as an alternative method to manage CHAOS.

Keywords: CHAOS, EXIT, delayed cord clamping

DOI: 10.3233/NPM-14814006

Citation: Journal of Neonatal-Perinatal Medicine, vol. 7, no. 3, pp. 237-239, 2014

Authors: Arias-Llorente, R.P. | Flórez-Díez, P. | Oviedo-Gutiérrez, M. | Suárez-Rodríguez, M. | Costa-Romero, M. | Solís-Sánchez, G. | García-López, E.

Article Type: Research Article

Abstract: Appendicitis in the neonatal period is extremely rare. Its low incidence together with non-specific clinical symptoms often mean the diagnosis is delayed, leading to increased rates of peritonitis and mortality. We report the case of a 33-week premature infant, small for gestational age (1180 g at birth), clinically stable and receiving exclusive enteral feeding, who presented clinical manifestations of necrotizing enterocolitis at 14 days of life. Acute phase reactants were elevated and abdominal radiography showed pneumoperitoneum. Laparotomy revealed acute perforated appendicitis without intestinal involvement and purulent fluid in the peritoneum, for which appendectomy was performed. Neonatal acute appendicitis should be …considered in the differential diagnosis of abdominal sepsis since early diagnosis and treatment significantly reduce associated morbidity and mortality. Show more

Keywords: Neonatal appendicitis, premature, abdominal sepsis

DOI: 10.3233/NPM-14814003

Citation: Journal of Neonatal-Perinatal Medicine, vol. 7, no. 3, pp. 241-246, 2014

Authors: Agarwal, R. | Feldman, G.L. | Poulik, J. | Stockton, D.W. | Sood, B.G.

Article Type: Research Article

Abstract: Persistent pulmonary hypertension of the newborn (PPHN) results from disruption of the normal fetal-neonatal circulatory transition and may be associated with meconium aspiration, group B streptococcal sepsis, pneumonia, respiratory distress syndrome, congenital diaphragmatic hernia and pulmonary hypoplasia. Seventeen percent of cases are considered idiopathic since there is no identifiable cause. Although it is recognized that acidosis and hypoxia from any cause in neonates may produce pulmonary vasoconstriction and maintain pulmonary hypertension, PPHN has not been reported in inborn errors of metabolism (IEM) associated with metabolic acidosis like methyl malonic acidemia (MMA). We report the first case in the literature of …MMA presenting concomitantly with PPHN. Undiagnosed IEMs, like MMA, could represent a subset of idiopathic cases of PPHN. Infants and neonates have a limited repertoire with which to respond to an overwhelming illness. Because metabolic diseases are rare, they are considered only after excluding more common causes of neonatal distress. PPHN is therefore more likely to be attributed to meconium aspiration, sepsis, pneumonia or respiratory distress syndrome than to an IEM. The advent of expanded newborn screening has made pre-symptomatic diagnosis of several IEMs including MMA possible. However, not all IEMs are identified, and in some instances, an infant who has an IEM may become ill before the results of the newborn screen become available. Early diagnosis of IEM is crucial to prevent catastrophic consequences and the awareness of an association with PPHN would lead to an aggressive search of an underlying IEM and its management. Show more

Keywords: Persistent pulmonary hypertension of the newborn, inborn errors of metabolism, organic acidemias, metabolic acidosis, methyl malonic acidemia, lactic acidosis, neonate, newborn screening

DOI: 10.3233/NPM-14814004

Citation: Journal of Neonatal-Perinatal Medicine, vol. 7, no. 3, pp. 247-251, 2014

Authors: Ozturk, M.A. | Bastug, O. | Halis, H. | Korkmaz, L. | Memur, S. | Sarici, D. | Kara, A.

Article Type: Research Article

Abstract: Sirenomelia or the Mermaid syndrome is a rare congenital anomaly with an incidence of one in 60,000 to 70,000 pregnancies. Sirenomelia is characterized by complete fusion of the lower limbs, commonly associated with renal agenesis, absent external genitalia and other gastrointestinal defects. A 37-week, 3040-g infant was born to a 35-year-old multigravida mother with type 2 diabetes mellitus and hyperlipidemia. To our knowledge, this is the first case of sirenomelia with adrenalomegaly.

Keywords: Sirenomelia, adrenalomegaly, infant, diabetes, Mermaid syndrome

DOI: 10.3233/NPM-1476813

Citation: Journal of Neonatal-Perinatal Medicine, vol. 7, no. 3, pp. 253-256, 2014