Journal of Neonatal-Perinatal Medicine - Volume 9, issue 1

Authors: Ruangkit, C. | Satpute, Ankita | Vogt, B.A. | Hoyen, C. | Viswanathan, S.

Article Type: Research Article

Abstract: OBJECTIVES: To describe the incidence and associated risk factors of urinary tract infection (UTI) in very low birth weight (VLBW) infants and to determine the value of diagnostic imaging studies after the first UTI episode before discharge from the neonatal intensive care unit (NICU). METHODS: VLBW infants born during 2003–2012 were reviewed for UTI. In a nested case-control study, potential risk factors of UTI were compared between infants with UTI (cases) versus birth weight and gestational age matched controls. Renal ultrasonography (USG) and voiding cystourethrography (VCUG) results were reviewed in cases. RESULTS: During the study period, …54.7% of urine culture specimens were collected by sterile methods. 3% (45/1,495) of VLBW infants met the study definition for UTI. UTI was diagnosed at mean postnatal age of 33.1±22.9 days. There was no significant difference in gender, ethnicity, antenatal steroid exposure, blood culture positive sepsis, ionotropic support, respiratory support and enteral feeding practices between cases and controls. Cases had a significantly higher cholestasis compared to controls (22% vs. 9% ; p  = 0.03). However, cholestasis was not a significant predictor of UTI in the adjusted analysis [adjusted OR 2.38 (95% CI 0.84 to 6.80), p  = 0.11]. Cases had higher central line days, parenteral nutrition days, total mechanical ventilation days, chronic lung disease, and length of stay compared to controls. Renal USG was abnormal in 37% and VCUG was abnormal in 17% of cases. CONCLUSIONS: The incidence of UTI in contemporary VLBW infants is relatively low compared to previous decades. Since no significant UTI predictors could be identified, urine culture by sterile methods is the only reliable way to exclude UTI. The majority of infants with UTI have normal renal anatomy. UTI in VLBW infants is associated with increased morbidity and length of stay. Show more

Keywords: Urinary tract infection, premature infants, VLBW, urine culture, renal ultrasound, voiding cystourethrography

DOI: 10.3233/NPM-16915055

Citation: Journal of Neonatal-Perinatal Medicine, vol. 9, no. 1, pp. 83-90, 2016

Authors: McConaghy, S. | Manuel, V. | Nagji, S. | Ohls, R.K.

Article Type: Research Article

Abstract: OBJECTIVE: The discovery of free fetal DNA in plasma of pregnant women has opened a new avenue for non-invasive prenatal diagnosis. We hypothesized that epsilon (ɛ )-globin gene expression could serve as a positive control for the presence of fetal nucleic acid. STUDY DESIGN: We measured ɛ -globin mRNA in human fetal tissues and compared concentrations with that measured in adult non-pregnant and pregnant samples. Total RNA was isolated from fetal marrow, liver, blood, and placenta (10–24 weeks gestation), from adult peripheral blood mononuclear cells, and from maternal plasma. RNA was reverse transcribed and quantitative polymerase chain reaction …performed for ɛ -globin expression. RESULTS: ɛ -globin gene expression was detected in all fetal samples, was detected in plasma of pregnant women, but was negligible in non-pregnant samples. Relative ɛ -globin gene expression was significantly greater in fetal blood compared to fetal liver, and was minimally expressed in placenta. ɛ -globin gene expression decreased at the highest gestational ages in fetal blood, while expression was greatest at 15–19 weeks in fetal marrow. CONCLUSION: Fetal ɛ -globin gene expression is significantly greater than adult expression and is increased in maternal plasma compared to non-pregnant samples. ɛ -globin gene expression might serve as a positive control when determining the presence of fetal nucleic acid in total nucleic acid isolated from maternal plasma. Show more

Keywords: Epsilon globin, fetal tissues, prenatal diagnosis, nucleic acid, noninvasive

DOI: 10.3233/NPM-16915052

Citation: Journal of Neonatal-Perinatal Medicine, vol. 9, no. 1, pp. 91-97, 2016

Authors: Cheong, S.M. | Totsu, S. | Nakanishi, H. | Uchiyama, A. | Kusuda, S.

Article Type: Research Article

Abstract: OBJECTIVE: In order to evaluate safety and usefulness of peripherally inserted double lumen central catheter (PIDLCC) in very low birth weight (VLBW) infants, outcomes of VLBW infants who had PIDLCC was studied. SUBJECTIVE: Thirty-nine VLBW infants who were admitted to our NICU in 2013 were retrospectively analyzed. RESULTS: Mean birth weight and gestational age was 1042.7 gram and 28.5 weeks, respectively. Total duration of indwelling PIDLCC was 1121 days (mean 28.5+18.2 days) with 85 PIDLCCs used. Dressing at the insertion site was done twice weekly with 10% povidone iodine. Four (10.3% with mean of 48 days) …infants had catheter-related blood stream infection (CRBSI), with a 3.57 infection per 1000 catheter-day. The mean for days of PIDLCC in 35 infants without CRBSI was 26.5 days. Organisms isolated were Staphylococcus epidermidis , Staphylococcus aureus and Staphylococcus capitis ureolytic . Our study showed significant difference in the duration of indwelling catheter (p  = 0.023) and intraventricular hemorrhage (p  = 0.043) between the CRBSI group and non-CRBSI group. Five (12.8%) infants had abnormal thyroid function test, in which two infants required thyroxine supplementation upon discharge. However, duration of PIDLCC and abnormal thyroid function test was not statistically significant (p  = 0.218). One (2.5%) infant died (death was not related to CRBSI). There was no serious adverse effects secondary to PIDLCC. CONCLUSION: It is concluded that the use and maintenance of PIDLCC is safe for VLBW infants, but close monitoring should be observed to detect early signs of infection. Show more

Keywords: Peripherally inserted double lumen central catheter, very low birth weight infants, catheter-related blood stream infection, hypothyroidism, Staphylococcus

DOI: 10.3233/NPM-16915054

Citation: Journal of Neonatal-Perinatal Medicine, vol. 9, no. 1, pp. 99-105, 2016

Authors: DeRoo, S.E. Schaffer | Lumpkins, K.M. | El-Metwally, D.E.

Article Type: Research Article

Abstract: We present the case of an infant born with scrotoschisis and evidence of meconium periorchitis and peritonitis. A scrotal defect was noted with exposure of the left testis and spermatic cord. Meconium peritonitis and periorchitis were confirmed on operative exploration. Given the history, cystic fibrosis was suspected, but initial screening and diagnostic tests were negative.

Keywords: Scrotoschisis, meconium peritonitis, meconium orchitis

DOI: 10.3233/NPM-16915067

Citation: Journal of Neonatal-Perinatal Medicine, vol. 9, no. 1, pp. 107-112, 2016

Authors: Torres, E.B. | Lande, B.J. | Santolaya-Forgas, J.

Article Type: Research Article

DOI: 10.3233/NPM-16915042

Citation: Journal of Neonatal-Perinatal Medicine, vol. 9, no. 1, pp. 113-115, 2016