Journal of Neonatal-Perinatal Medicine - Volume 15, issue 3

Authors: Volpe, J.J.

Article Type: Article Commentary

Keywords: Congenital heart disease, brain dysmaturation, fetal onset, interventions

DOI: 10.3233/NPM-210942

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 489-494, 2022

Authors: Glass, H.C. | Shellhaas, R.A.

Article Type: Article Commentary

DOI: 10.3233/NPM-210882

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 495-498, 2022

Authors: Volpe, Joseph J.

Article Type: Article Commentary

DOI: 10.3233/NPM-210919

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 499-499, 2022

Authors: Yeung, T. | Shahroor, M. | Jain, A. | Weisz, D. | Jasani, B.

Article Type: Review Article

Abstract: BACKGROUND: Several small randomized controlled trials (RCTs) and observational studies have compared high (15-20/7.5-10/7.5-10 mg/kg/dose) versus standard dose (10/5/5 mg/kg/dose) ibuprofen for patent ductus arteriosus (PDA) closure, with limited evidence on efficacy and safety. OBJECTIVE: To systematically review and meta-analyze studies of high versus standard dose ibuprofen for the closure of PDA in preterm infants. METHODS: Databases were searched for RCTs and observational studies assessing high compared to standard dose of ibuprofen for PDA closure for preterm infants until August 2021. The primary outcome was failure of PDA closure after the first course of ibuprofen. The secondary outcomes …were the failure of PDA closure after a second course of ibuprofen, rates of PDA ligation, all-cause mortality prior to hospital discharge, bronchopulmonary dysplasia, necrotizing enterocolitis, bleeding disorders, oliguria, and serum creatinine after treatment. RESULTS: There were 6 studies with 369 patients (3 RCT, N = 190; 3 observational studies, N = 179). Compared to standard dose, high dose ibuprofen did not significantly decrease the failure rate of PDA closure in preterm infants after the first course (Relative risk (RR) 0.74, 95% confidence interval (CI) 0.53 –1.03, 6 studies, N = 369). High dose ibuprofen significantly decreased the rates of PDA ligation compared to standard dose (RR 0.33, 95% CI 0.16 –0.70, 5 studies, N = 309). INTERPRETATION: Based on low-grade evidence, high dose ibuprofen may more effectively reduce rates of PDA ligation compared to standard dose with no increase in adverse effects, neonatal morbidities and mortality. Show more

Keywords: Ibuprofen, meta-analysis, patent ductus arteriosus, preterm infants

DOI: 10.3233/NPM-210968

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 501-510, 2022

Authors: Zheng, Y. | Gandhi, A. | Sewell, K. | Tumin, D. | Bear, K.

Article Type: Review Article

Abstract: OBJECTIVE: The benefits of point-of-care ultrasound (POCUS) in the neonatal intensive care unit (NICU) have been widely recognized, but education on this area of practice remains variable. We reviewed published educational interventions regarding POCUS use in the NICU and whether they have led to sustainable increases in POCUS use. METHODS: A systematic search of 6 databases was performed for publications from January 2000 to March 2021. Studies with quantitative data related to POCUS educational interventions in the NICU were included. Data on number of participants and roles, educational intervention, curriculum description, and project outcome measures (including sustainability) was …extracted. RESULTS: The search resulted in 686 articles, of which nine studies met the inclusion criteria. Educational interventions included didactic sessions, simulation practice, animal practice, and practice in real patients. The most common assessment was based on the quality and accuracy of the images. At the participant level, the average time to reach proficiency ranged from eight hours and thirty-six minutes to five months, and none of the studies evaluated sustainability of POCUS use after the intervention. CONCLUSION: There is a lack of standardized training modules and assessments for POCUS use in the NICU. Given that none of the studies addressed sustainability or standardized training, we recommend that a standardized training protocol and assessment tool is developed and studied longitudinally; and that barriers to sustainable POCUS use in the NICU (such as billing issues and a lack of POCUS machines and instructors) be systematically addressed as part of this work. Show more

Keywords: Education, neonatology, point-of-care ultrasound, simulation

DOI: 10.3233/NPM-210925

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 511-520, 2022

Authors: Gonzales, D.N. | Brunkhorst, J. | Sherman, A.K. | Dremman, J. | Reed, D.J.W.

Article Type: Research Article

Abstract: BACKGROUND: Little is known about the prevalence, characteristics, and outcomes of neonates needing emergent resuscitation within the level 4 neonatal intensive care units (NICU). Clinical factors prior to and following resuscitation event or characteristics of those who require chest compressions versus those without compressions has not been previously delineated. The aim of this study is to describe characteristics and outcomes of neonates who have compressive vs. non-compressive resuscitative events. METHODS: Retrospective observational study of neonates with a resuscitative event in the Children’s Mercy Hospital level 4 NICU between January 2012 and April 2017. Data were derived from the …NICU Code Blue database and the electronic medical record. Primary outcome was survival to hospital discharge. RESULT: Of the 641 resuscitative events, most were in the non-compressive group (n  = 481). Those requiring chest compressions longer than 1 minute had significantly different clinical characteristics and decreased survival. There was no difference between groups in gestational age or birth weight. CONCLUSION: Non-compressive events are more common in the NICU setting than are compressive events. Neonates requiring chest compressions longer than 1 minute are more likely to have a higher respiratory severity score, need for vasopressors, worse renal function post-event, and decreased survival to discharge. Show more

Keywords: Characteristics, compressions, compressive events, NICU, non-compressive events, resuscitative events, outcomes

DOI: 10.3233/NPM-210956

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 521-527, 2022

Authors: Amer, R. | Seshia, M.M. | Elsayed, Y.N.

Article Type: Research Article

Abstract: OBJECTIVE: To validate the vasoactive inotropic score as a predictor of the severity of compromised systemic circulation and mortality in preterm infants. METHODS: A retrospective study was conducted on preterm infants with Compromised systemic circulation [hypotension±lactic acidosis±oliguria] who received a cardiovascular support, we calculated the vasoactive inotropic score (VIS) and cumulative exposure to cardiovascular medications over time (VISct). Receiver operator curve was constructed to predict the primary outcome which was death & refractory hypotension. RESULTS: VIS had an area under the curve of 0.73 (95% CI 0.85–0.98, p  < 0.001). A VIS cut off of 25 has …sensitivity and specificity of 66% and 92%, and positive and negative predictive values of 78.5% and 83%, respectively. CONCLUSION: High VIS predicts the severity of Compromised systemic circulation and mortality rate in preterm infants. Show more

Keywords: Compromised systemic circulation, hypotension, preterm infants, vasoactive inotropic score, vasoactive inotropic score cumulative time

DOI: 10.3233/NPM-210932

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 529-535, 2022

Authors: Saha, A.K. | Sardar, S.K. | Majhi, B. | Chatterjee, S.

Article Type: Research Article

Abstract: BACKGROUND: In preterm infants, persistence of ductus arteriosus is an important medical condition. Functional echocardiography for patent ductus arteriosus (PDA) may guide clinical decision-making regarding treatment requirement strategies. Objectives of the study were to assess the trends of clinical and functional echocardiographic parameters with evolution of ductus arteriosus in babies≤1250 gm of birth weight and to evaluate whether there is any association of these parameters with persistence of ductus. METHODS: In this prospective observational study, recruited babies were assessed serially for clinical events and functional echocardiography. Babies were classified into three groups: without PDA, with PDA but PDA spontaneously …closed (within 7 days) and persistent PDA. RESULT: We included 143 infants (Birth weight 1017±179 g, gestational age 30.8±2.7 weeks). Out of 60 babies with PDA, PDA failed to close spontaneously in first week in 32 (53.4 %) infants. PDA Doppler flow pattern on day 3 was found to be one of the most significant markers for future ductus. The highest frequency of growing pattern (37.5%) and pulsatile pattern (59.4%) was seen in persistence ductus group. PDA diameter and LA/Ao ratio were found strongly correlated with all other variables except E/A ratio. CONCLUSION: We noticed persistence of ductus in preterm infants had significant clinical and echocardiographic association. PDA doppler flow pattern on day 3 was found to be a significant marker for future behaviour of ductus. Significant correlation was found among individual functional echocardiographic parameters in babies with PDA. This would guide judicious treatment of PDA in preterm neonates. Show more

Keywords: Functional echocardiography, patent ductus arteriosus, preterm, very low birth weight

DOI: 10.3233/NPM-210930

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 537-544, 2022

Authors: Fishchuk, L. | Rossokha, Z. | Pokhylko, V. | Cherniavska, Yu. | Popova, O. | Tsvirenko, S. | Gorovenko, N.

Article Type: Research Article

Abstract: BACKGROUND: Summary data indicate that it has increased attention to the study of the role of the folate cycle and the genes encoding its key components in the complicated course of the neonatal period in premature infants. Therefore, the aim of our study was to investigate the relationship of folate cycle gene variants with the features of the neonatal course in premature infants with severe intraventricular hemorrhages (IVH). METHODS: The study included 24 preterm infants with with IVHs of 3d and 4th degree that received standard clinical, laboratory and instrumental examination. RESULTS: Apgar scores …at 1 and 5 minutes were significantly lower in patients with AA genotype according to variant A1298C of the MTHFR gene. The concentration of total protein on 6th day after birth was negatively correlated with the A66G variant of the MTRR gene. The mean concentration of ionized calcium in the first day after birth was higher in the subgroup of patients with the AA genotype (according to variant A1298C of the MTHFR gene). In the subgroup of patients requiring mechanical ventilation, the frequency of AA genotype according to variant A2756G of the MTR gene was significantly increased. The presence of respiratory disorders and oxygen dependence was negatively correlated with variant A1298C MTHFR . The day of surfactant administration was positively correlated with variant A1298C of the MTHFR gene. CONCLUSION: The results of this study indicate that gene variants MTHFR (C677T, A1298C), MTRR (A66G), MTR (A2756G), RFC1 (G80A) may affect the neonatal course in premature infants with severe IVH. Show more

Keywords: Folate cycle, gene, intraventricular hemorrhage, preterm infants

DOI: 10.3233/NPM-210962

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 545-551, 2022

Authors: Cudjoe, G.A. | Ameley, A. | Ohemeng-Dapaah, J. | Bhatt, P. | Donda, K. | Dapaah-Siakwan, F.

Article Type: Research Article

Abstract: BACKGROUND: Retinopathy of prematurity is a major cause of morbidity in preterm infants but population-based studies to evaluate recent trends in incidence in the United States (US) are lacking. Moreover, previous studies did not include the use of anti-Vascular Endothelial Growth Factor medications. The objective was to examine the recent secular trends in the incidence and treatment of severe retinopathy of prematurity (sROP) in the United States (US) from 2009 to 2018. METHODS: This was a population-based, serial cross-sectional study that utilized data from the National Inpatient Sample. The inclusion criteria were preterm infants with gestational age (GA) …≤30 weeks and length of stay > 28 days. The primary outcomes were trends in ROP surgery (photocoagulation, cryotherapy, scleral buckling, vitrectomy) and intravitreal injection of therapeutic (anti-VEGF) medications. The Cochrane-Armitage test was used to evaluate trends and P-value < 0.05 was considered significant. RESULTS: Out of 279,664 hospitalizations that met the inclusion criteria, 12,942 (4.6%) had sROP. Those with sROP were more likely to have severe intraventricular hemorrhage (12.5% vs 6.1%), bronchopulmonary dysplasia (48.2% vs 25.9%), and pulmonary hypertension (10.7% vs 4.7%). From 2009–2018, sROP significantly increased from 3.4% to 5.3% (P  < 0.001), ROP surgery decreased from 36.8% to 11.9% (P  < 0.001) while intra-vitreal administration of therapeutic drugs increased from 2% to 7.6% (P  < 0.001). CONCLUSION: Surgery for sROP decreased while intra-vitreal administration of therapeutic drugs increased in the setting of increasing incidence of sROP in the US. Taken together, these findings suggest a gradual practice change and the long-term outcomes of intra-vitreal agents warrants future study. Show more

Keywords: Retinopathy of prematurity surgery, severe retinopathy of prematurity, trends, United States

DOI: 10.3233/NPM-210826

Citation: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 3, pp. 553-557, 2022