Journal of Neonatal-Perinatal Medicine - Volume 8, issue 3

Authors: Stevens, D. | Thompson, P. | Helseth, C. | Pottala, J.

Article Type: Editorial

Abstract: Controversy regarding the optimal design for neonatal intensive care has existed for more than 20 years. Recent evidence confirms that in comparison with the traditional open-bay design, the single-room facility provides for improved control of excessive noise and light, improved staff and parental satisfaction with care and equal, or possibly reduced, cost of care. Single-room care was not associated with any increase in adverse outcomes. To optimize long term developmental outcomes, single-room care must be augmented with appropriate developmental therapy and programs to actively support parental involvement.

Keywords: Evidence-based NICU design, outcomes of care, single-family room NICU

DOI: 10.3233/NPM-15915035

Citation: Journal of Neonatal-Perinatal Medicine, vol. 8, no. 3, pp. 177-178, 2015

Authors: Brumberg, H.L. | Shah, S.I.

Article Type: Review Article

Abstract: Poverty is associated with adverse long-term cognitive outcomes in children. Poverty is also linked with preterm delivery which, in turn, is associated with adverse cognitive outcomes. However, the extent of the effect of poverty on preterm delivery, as well as proposed mechanisms by which they occur, have not been well described. Further, the impact of poverty on preterm school readiness has not been reviewed. As the childhood poverty level continues to increase in the U.S., we examine the evidence around physiological, neurological, cognitive and learning outcomes associated with prematurity in the context of poverty. We use the evidence gathered to …suggest an Eco-Bio-Developmental model, emphasizing poverty as a toxic stress which predisposes preterm birth and which, via epigenetic forces, can continue into the next generation. Continued postnatal social disadvantage for these developmentally high-risk preterm infants is strongly linked with poor neurodevelopmental outcomes, decreased school readiness, and decreased educational attainment which can perpetuate the poverty cycle. We suggest social remedies aimed at decreasing the impact of poverty on mothers, fathers, and children which may be effective in reducing the burden of preterm birth. Show more

Keywords: Stress, neurodevelopment, poverty, prematurity

DOI: 10.3233/NPM-15814098

Citation: Journal of Neonatal-Perinatal Medicine, vol. 8, no. 3, pp. 179-187, 2015

Authors: Mohamed, I. | Elremaly, W. | Rouleau, T. | Lavoie, J.-C.

Article Type: Research Article

Abstract: OBJECTIVES: To assess the effect of early exposure to O2 and parenteral nutrition (PN) on oxidative stress at 36 weeks post-menstrual age (PMA) and on bronchopulmonary dysplasia (BPD) in extremely preterm infants. STUDY DESIGN: A prospective observational study including 116 infants <29 weeks of gestation. Baseline clinical characteristics, FiO2 on day 7, duration of PN and clinical outcomes data were collected. In 39 infants, whole blood glutathione (GSH) and oxidized glutathione (GSSG) at 36 weeks PMA were measured and the redox potential was calculated using Nernst equation. Student’s t -test, Chi-square, Spearman correlation, …ANOVA, and logistic regression analyses were used as appropriate. P  <  0.05 was considered significant. RESULTS: FiO2 ≥25% was associated with higher level of GSSG (0.29 ± 0.04 versus 0.18 ± 0.02 nmol/mg of protein), a more oxidized redox potential (–191 ± 2 versus –198 ± 2 mV) and more BPD (90% versus 45%). PN duration >14 days was also associated with higher level of GSSG (0.26 ± 0.03 versus 0.13 ± 0.02 nmol/mg of protein), a more oxidized redox potential (–193 ± 5 versus –203 ± 2 mV) and more BPD (89% versus 24%). In logistic regression model, each 1% increase in FiO2 and each day increase in PN duration resulted in an increase in the OR for BPD by1.57 (1.09 –2.28) and 1.17 (1.03 –1.33) respectively. CONCLUSION: Early O2 supplement and PN have additive effects that were associated with prolonged oxidative stress and increased risk of BPD. Strategies targeting judicious use of O2 and decreasing the duration or developing a safer formulation of PN can be targeted to decrease BPD. Show more

Keywords: Oxygen, parenteral nutrition, redox potential of glutathione, bronchopulmonary dysplasia, chronic lung disease, newborn, and extremely preterm infants

DOI: 10.3233/NPM-15814091

Citation: Journal of Neonatal-Perinatal Medicine, vol. 8, no. 3, pp. 189-197, 2015

Authors: Clarke-Pounder, J. | Howlett, J. | Burnsed, J. | Donohue, P.K. | Gilmore, M.M. | Aucott, S.W.

Article Type: Research Article

Abstract: OBJECTIVE: To evaluate the nutritional impact of a feed-holding guideline during transfusion for infants <32 weeks gestation. STUDY DESIGN: A pre-/post-interventional study was conducted after introduction of a guideline to hold feeds during transfusion. Demographic variables in addition to nutritional outcomes were collected on all infants admitted within 48 hours of birth with gestational age <32 weeks. Data was collected during a 6 month period pre-intervention and the 6 month period post-intervention. RESULTS: There were 145 eligible infants. Mean birth weight and gestational age were similar in both periods. In total, 98 …infants received transfusions, and 82 of those had an active feeding order prior to at least one transfusion. Total transfusions per infant and transfusions ordered while an infant had active feeding orders were similar in both periods. Time to full feedings was decreased post-intervention (p  <  0.001). Weight at 34 weeks, incidence of second IV placement, additional IV fluid use, and hypoglycemia were similar between groups. Of 593 total transfusions, 207 were ordered while an infant had an active order for enteral nutrition. Pre-intervention, 64% of transfusions had feeds held during transfusion. Post-intervention, 87% of transfusions had feeds held during transfusion. Feeds were held more often (p  <  0.001) and for a shorter duration (p  = 0.005) in the post-intervention group. CONCLUSION: Implementing a guideline standardizing feeding practices during transfusions in premature infants increases standardization of care and results in decreased variability in practice. Adverse nutritional consequences were not found after the introduction of the routine practice of holding feedings during transfusion in preterm infants. Show more

Keywords: Standardization of care, PRBC transfusion, NICU, Premature infant, nutrition

DOI: 10.3233/NPM-15814113

Citation: Journal of Neonatal-Perinatal Medicine, vol. 8, no. 3, pp. 199-205, 2015

Authors: Thomas, K. | Shah, P.S. | Canning, R. | Harrison, A. | Lee, S.K. | Dow, K.E.

Article Type: Research Article

Abstract: OBJECTIVE: To identify predictors of severe retinopathy of prematurity (ROP) in a large population-based cohort and to examine risk-adjusted variations across units. STUDY DESIGN: Retrospective analysis of Canadian Neonatal Network data on neonates with birth weight <1500 g who were screened for ROP between 2003 and 2010. Characteristics of infants with and without ROP were compared and a risk-adjusted model for severe ROP was developed. Rates of severe ROP were compared between sites. RESULTS: 1163 of 9187 (12.7%) infants developed severe ROP. Lower gestational age, male sex, small for gestational age, patent ductus …arteriosus, late onset sepsis, more than two blood transfusions, inotrope use, and outborn status were associated with an increased risk of severe ROP. Severe ROP rates varied significantly between units CONCLUSION: Younger, smaller and sicker male infants had higher adjusted risks of severe ROP and rates varied significantly among sites. Show more

Keywords: Retinopathy of prematurity, infant, premature, incidence

DOI: 10.3233/NPM-15814128

Citation: Journal of Neonatal-Perinatal Medicine, vol. 8, no. 3, pp. 207-214, 2015

Authors: Sayed, A. | Bisheer, N.

Article Type: Research Article

Abstract: BACKGROUND: Despite recent treatment modalities, mortality from persistent pulmonary hypertension (PPHN) remains significant. In instances where infants do not respond to inhaled nitric oxide (iNO), oral sildenafil could hold promise as a selective pulmonary vasodilator. Further studies are still needed to explore its efficacy and safety in newborns with PPHN. OBJECTIVES: To validate the efficacy of oral sildenafil on oxygenation and its short-term safety in newborns with persistent pulmonary hypertension. METHODS: A total of 27 newborns ≥36 weeks gestational age were admitted to NICU with oxygenation index (OI) ≥15 and confirmed diagnosis …of PPHN with echocardiography. Oral sildenafil given at a dose of 1-2 mg/kg every 6 hours. We monitored improvement in oxygenation, safety and short-term outcomes. RESULTS: Among 27 newborns, oral sildenafil was efficacious in 21 patients (78%) with reduction of OI from 34.9 ± 9.6 to 13 ± 3.2 (p  <  0.001), increase of PaO2 from 42.4 ± 13.5 to 78 ± 11.5 mmHg (<0.001), and reduction of FiO2 from 1.0 ± 0 to 0.3 ± 0.06 (<0.001). OI decreased by 6.3 % from baseline after the first dose of sildenafil and continued to decrease with subsequent doses. In 6 patients (22%) sildenafil did not work; 5/6 patients (18%) transferred to another tertiary NICU and one patient (4%) died of sepsis. None of the patients had significant systemic hypotension. CONCLUSION: Oral sildenafil is a promising pulmonary vasodilator in patients with PPHN, particularly in medical facilities with no available iNO and ECMO. It is well tolerated with no significant short term complications. Show more

Keywords: Newborn, PPHN, pulmonary vasodilator, NICU, inhaled nitric oxide

DOI: 10.3233/NPM-15814137

Citation: Journal of Neonatal-Perinatal Medicine, vol. 8, no. 3, pp. 215-220, 2015

Authors: Sadeghi-Moghaddam, P. | Arjmandnia, M. | Shokrollahi, M. | Aghaali, M.

Article Type: Research Article

Abstract: INTRODUCTION: The most important tool in any infection control program is good hand hygiene. Despite recognizing that hand hygiene is crucial in reducing infection rates, hand hygiene compliance remains suboptimal. This study was designed to determine hand hygiene compliance, before and after an educational intervention and its impact on hospital infection rates. METHOD: The study was done in neonatal intensive care unit of an educational hospital. All healthcare providers working in the unit at the time of study were trained on importance of hand hygiene and methods of hand hygiene observation; after that hand washing …compliance controlled by a physician during postintervention phase. Hand hygiene compliance, healthcare associated infection and mortality rates compared before and after educational intervention. RESULTS: Compliance of health-care workers for all hand hygiene opportunities combined was 30% before intervention and improved to 70% in postintervention. In postintervention phase, healthcare associated infection rates and mortality rates decreased significantly as the hand hygiene compliance improved. CONCLUSIONS: Good control of hand hygiene compliance by physician after an educational program may have good effect in healthcare associated infections control in neonatal intensive care unit. Show more

Keywords: Cross infection, education, hand hygiene, infection control, newborn

DOI: 10.3233/NPM-15915001

Citation: Journal of Neonatal-Perinatal Medicine, vol. 8, no. 3, pp. 221-225, 2015

Authors: El Frargy, M. | El-sharkawy, H. M. | Attia, G. F.

Article Type: Research Article

Abstract: OBJECTIVE: The objective of this study is to evaluate the therapeutic efficacy of melatonin as an adjuvant therapy in treating neonatal sepsis. PATIENTS AND METHODS: A prospective clinical trial study was conducted on 50 infants with neonatal sepsis diagnosed on the basis of both clinical and laboratory criteria. Enrolled infants were divided into two groups. Intervention group (n  = 25) received melatonin and antibiotics, while the control group (n  = 25) was treated with antibiotics only. Melatonin was administered as a single oral dose of 20 mg and antibiotics were administered according to a standard protocol. Both groups …were compared using a predefined sepsis score utilizing both clinical and laboratory parameters. RESULTS: There was no significant difference in sepsis score between both groups before starting melatonin (p -value = 0.99), while there was significant difference in sepsis score between groups after 24 hours, 48 hours and 72 hours of starting melatonin with (p -value = 0.008, 0.006 and 0.002, respectively). There was significant improvement sepsis score in both groups with more improvement of sepsis score in the intervention group. CONCLUSION: Administration of melatonin as an adjuvant therapy in the treatment of neonatal sepsis is associated with improvement of clinical and laboratory outcomes. Show more

Keywords: Neonates, bacteremia, melatonin, premature

DOI: 10.3233/NPM-15814072

Citation: Journal of Neonatal-Perinatal Medicine, vol. 8, no. 3, pp. 227-232, 2015

Authors: McCurdy, M. | Bellows, A. | Deng, D. | Leppert, M. | Mahone, E. M. | Pritchard, A.

Article Type: Research Article

Abstract: AIM: Reliable and valid screening and assessment tools are necessary to identify children at risk for neurodevelopmental disabilities who may require additional services. This study evaluated the test-retest reliability of the Capute Scales in a high-risk sample, hypothesizing adequate reliability across 6- and 12-month intervals. METHODS: Capute Scales scores (N  = 66) were collected via retrospective chart review from a NICU follow-up clinic within a large urban medical center spanning three age-ranges: 12–18, 19–24, and 25–36 months. On average, participants were classified as very low birth weight and premature. Reliability of the Capute Scales was evaluated …with intraclass correlation coefficients across length of test-retest interval, age at testing, and degree of neonatal complications. RESULTS: The Capute Scales demonstrated high reliability, regardless of length of test-retest interval (ranging from 6 to 14 months) or age of participant, for all index scores, including overall Developmental Quotient (DQ), language-based skill index (CLAMS) and nonverbal reasoning index (CAT). Linear regressions revealed that greater neonatal risk was related to poorer test-retest reliability; however, reliability coefficients remained strong. CONCLUSIONS: The Capute Scales afford clinicians a reliable and valid means of screening and assessing for neurodevelopmental delay within high-risk infant populations. Show more

Keywords: Prematurity, neonatology, developmental screener, CAT/CLAMS, psychometrics

DOI: 10.3233/NPM-15814118

Citation: Journal of Neonatal-Perinatal Medicine, vol. 8, no. 3, pp. 233-241, 2015

Authors: Calkins, K. | Roy, D. | Molchan, L. | Bradley, L. | Grogan, T. | Elashoff, D. | Walker, V.

Article Type: Research Article

Abstract: OBJECTIVE: To determine the predictive ability of cord blood bilirubin (CBB) for hyperbilirubinemia in a population at risk for maternal-fetal blood group incompatibility and hemolytic disease of the newborn. STUDY DESIGN: This is a single center retrospective case-control study. Cases received phototherapy; controls did not. Cases were matched 1:3 to controls by gender and treating physician. Inclusion criteria included: ≥35 weeks gestation, CBB, and one or more total serum bilirubin (TSB) concentrations. The primary outcome was CBB. Secondary outcomes were a TSB >75th percentile, length of stay, and neonatal intensive care unit admission. The prognostic …ability of CBB for phototherapy and TSB >75th percentile was assessed using area under the receiver operating characteristic (ROC) curve. Logistic regression analyses were performed to determine predictors for phototherapy and TSB >75th percentile. RESULT: When compared to controls (n  = 142), cases (n  = 54) were more likely to have a positive Coombs’ test (82% vs. 41% , p  <  0.001) and TSB >75th percentile (85% vs. 21% , p  <  0.001). When compared to controls, cases had a higher mean (±SD) CBB (2.5 ± 0.5 vs. 1.8 ± 0.4 mg/dL, p  <  0.001). The area under the ROC curve (±SEM) for CBB for phototherapy and TSB >75th percentile was 0.87 ± 0.03 (p  <  0.001, 95% CI 0.82, 0.93) and 0.87 ± 0.03 (p  <  0.001, 95% CI 0.82, 0.92), respectively. CONCLUSION: In this study, the mean CBB concentration was higher in neonates who received phototherapy compared to those who did not. CBB concentrations may help predict severe hyperbilirubinemia and phototherapy in a population at risk for hemolytic disease of the newborn. Show more

Keywords: Bilirubin, neonates, phototherapy, hemolytic disease

DOI: 10.3233/NPM-15814111

Citation: Journal of Neonatal-Perinatal Medicine, vol. 8, no. 3, pp. 243-250, 2015