Journal of Neonatal-Perinatal Medicine - Volume 17, issue 5

Authors: Wismananda, A.V. | Zahra, A.L. | Lukinanda, R.K.

Article Type: Research Article

Abstract: BACKGROUND: Most neonates have neonatal jaundice, with 5–15% requiring phototherapy. Although phototherapy is beneficial, it can potentially extend hospital stays and cause harm. This study’s purpose was to analyze the effects of fenofibrate and phototherapy on total serum bilirubin (TSB) levels at 24 and 48 hours (primary outcome) after intervention. Furthermore, the phototherapy duration and adverse events were also of interest (secondary outcome). METHODS: The study protocol was registered in the PROSPERO database. Articles were searched on EMBASE, PubMed, Cochrane Library, and Google Scholar. Study selection was done following PRISMA and risk of bias studies were conducted. The …Review Manager 5.4 was used for the meta-analysis. RESULTS: Nine studies, including 610 newborns, were identified and included in the meta-analysis. This meta-analysis discovered a significant change in TSB levels at 24 hours after intervention (mean difference (MD) –0.96 (95% CI –1.09, –0.83), p  < 0.00001) with low heterogeneity and at 48 hours after intervention (MD –1.75 (95% CI –2.26, –1.24), p  < 0.00001) with high heterogeneity. Significant shortening of phototherapy duration was observed in the interventional group (MD –15.28 (95% CI –20.65, –9.90), p  < 0.00001) with high heterogeneities. One of the nine studies reported a non-significant occurrence of abdominal distension and diarrhea in the fenofibrate group. CONCLUSION: Fenofibrate might be applied as an adjuvant in unconjugated neonatal hyperbilirubinemia to reduce the average total serum bilirubin and shorten the length of phototherapy. Show more

Keywords: Neonatal hyperbilirubinemia, fenofibrate, phototherapy, serum bilirubin

DOI: 10.3233/NPM-230189

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 5, pp. 615-622, 2024

Authors: Le, T. | Lee, D. | Brown, L.S. | Payton, B.W. | Sepulveda, P. | Sisman, J. | Leon, R. L. | Chalak, L.F. | Mir, I.N.

Article Type: Research Article

Abstract: BACKGROUND: Our objectives were to determine 1) the prevalence and description of placental pathologic lesions in pregnancies complicated by SARS-CoV-2 infection compared to healthy controls and 2) whether the prevalence and/ or pattern of placental pathologic lesions differed in the few neonates who tested positive for SARS-CoV-2 in the first 48 hours of life at a busy urban county hospital. METHODS: This study included all pregnant mothers who tested positive for SARS-CoV-2 and delivered at our institution from March 2020 to June 2021, while control placentas were collected from term pregnancies without complications. RESULTS: Approximately 90% (n … = 380/425) of placentas from pregnancies complicated by SARS-CoV-2 infections had placental pathologic lesions, compared to 32% (n  = 16/50) of controls. The predominant lesions were acute histologic chorioamnionitis with or without fetal response (n  = 209/380, 55%), maternal vascular malperfusion (n  = 180/380, 47%), and other inflammatory lesions (n  = 148/380, 39%). Only 14 (2.5%) infants tested positive for SARS-CoV-2 within the first 48 hours of life. There were no significant differences in placental histopathology between infants who tested positive vs. those that were negative for SARS-CoV-2. Placental lesions in mothers who tested positive for SARS-CoV-2 during the first vs. second vs. third pregnancy trimesters, were significantly different in the incidence of inflammatory placental pathologic lesions (n  = 9/19, 53% vs. n  = 37/98, 49% vs. n  = 102/439, 31%, respectively; p  < 0.01). CONCLUSION: A significant proportion of women with SARS-CoV-2 infection during pregnancy at a single county hospital have inflammatory and vascular placental lesions at birth, raising questions regarding their downstream effects and clinical consequences. Show more

Keywords: Chorioamnionitis, chronic deciduitis, COVID-19, intervillositis, placental pathology, SARS-CoV-2

DOI: 10.3233/NPM-230177

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 5, pp. 623-636, 2024

Authors: Letzkus, L. | Conaway, M. | Daugherty, R. | Hook, M. | Zanelli, S.

Article Type: Research Article

Abstract: BACKGROUND: Premature infants are at increased risk for cerebral palsy (CP). Early interventions with a motor focus and administered by parents may improve motor outcomes. AIMS: Secondary study evaluating the short-term motor outcomes and risk for CP in very low birthweight (VLBW) infants randomized to multimodal interventions with a motor focus provided by parents versus usual care. STUDY DESIGN: Randomized controlled trial (intervention vs. usual care (control group)) SUBJECTS: Infants (<32 weeks’ gestational age (GA) and/or <1500 grams birthweight) born between March 2019 and October 2020. OUTCOME MEASURES: Short-term motor outcomes and risk …for CP was evaluated using the Hammersmith Infant Neurological Evaluation (HINE, primary motor outcome), the General Movement Assessment (GMA) and the Test of Infant Motor Performance (TIMP) at 3 months’ postmenstrual age (PMA). RESULTS: 70 participants were enrolled (GA 28.3±2.7 weeks, birthweight 1139.2±376.6 grams, 64.3% male). The in-person follow-up rate was 73%, lower than expected, in part due to COVID-19 restrictions, resulting in 25 infants (intervention) and 26 infants (control) with outcome data available for analysis. There was not a significant difference in the HINE, GMA or TIMP at 3 months’ PMA between groups. CONCLUSION: Multimodal interventions with a motor focus and provided by parents need further investigation to determine if they can improve short-term motor outcomes in VLBW infants. These interventions are evidence-based and the evaluation of broader implementation into routine care is also needed. Show more

Keywords: Cerebral palsy, early intervention, neonatal intensive care unit, parental engagement, very low birthweight infant

DOI: 10.3233/NPM-230206

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 5, pp. 637-645, 2024

Authors: Abiramalatha, T. | Govindaraju, G. | Rajaiah, B. | Chandrasekar, P. | Srinivas, U. | Ramakrishnan, S.

Article Type: Research Article

Abstract: BACKGROUND: There is no objective criteria to wean CPAP in preterm neonates. We aimed to assess the accuracy of ‘saturation trends’ to predict successful CPAP discontinuation. METHODS: We included very preterm neonates who required CPAP. Index tests were ‘saturation trends’. Outcome was successful CPAP discontinuation, defined as baby stable in room air for 72 h. RESULTS: We had 120 neonates with mean±SD gestation 28.6±1.8 weeks. 96 (80%) neonates had successful discontinuation and 24 (20%) failed. Neonates with successful discontinuation had significantly greater ‘saturation trends’ during 24 h before discontinuing CPAP compared to those who failed [64.3 (48.1–83.7) vs. …47.3 (23.0–65.0), p  = 0.001]. Saturations > 95% while on CPAP with 21% FiO2 for > 60% time had 63% sensitivity and 70% specificity to predict successful CPAP discontinuation. CONCLUSION: ‘Saturation trends’ is a readily available objective parameter that can be used to guide weaning CPAP in preterm neonates. Show more

Keywords: Neonate, predictive accuracy, pulse-oximetry, saturation trends

DOI: 10.3233/NPM-230192

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 5, pp. 647-651, 2024

Authors: Al Qurashi, M. | Al Qahtani, A. | Al Hindi, M. | Mustafa, A. | Ahmed, A. | Aga, S.S. | Al Khotani, A. | Kandil, H. | Alallah, J. | Sallam, A.

Article Type: Research Article

Abstract: OBJECTIVE: To assess the current practice in using volume-targeted ventilation among neonatologists working at the Neonatal Intensive Care Units (NICU) of Saudi Arabia. METHODS: The questionnaire was provided electronically to 153 practicing Neonatologists working in 39 NICUs. The survey’s results were received and statistically analyzed. RESULTS: One hundred nineteen (119) responses were received with, a 78% response rate. Volume Targeted Ventilation (VTV) was used routinely by 67.2%, whereas 21.8% still use only pressure control (PC)/pressure limited (PL) mode. During the acute phase of ventilation support, Assist Control was the most popular synchronized mode, whereas Synchronized Intermittent …Mandatory Ventilation (SIMV) with pressure support (PS) or PSV were the two most common modes during the weaning phase, 31.8%, and 31% respectively. The majority of the neonatologists used a tidal volume of 4 ml/kg as the lowest and 6 ml/kg as the highest. The major reasons for not implementing VTV were the limited availability of ventilator devices that have an option of VTV, followed by lack of experience. CONCLUSION: VTV is the predominant ventilation practice approach among neonatologists working in the KSA. Limited availability and lack of experience in using are the main challenges. Efforts to equip NICUs with the most advanced ventilation technology, enhance practitioners’ experience and sufficient training in its use are warranted. Show more

Keywords: Neonate, Saudi Arabia, survey, volume targeted ventilation

DOI: 10.3233/NPM-240054

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 5, pp. 653-660, 2024

Authors: Seyhanlı, D. | Gökmen Yıldırım, T. | Kalkanlı, O.H. | Soysal, B. | Alkan Özdemir, S. | Devrim, İ. | Çalkavur, Ş.

Article Type: Research Article

Abstract: AİM: Late-onset neonatal sepsis has a high mortality rate in premature infants. To date, no single test in the evaluation of neonatal sepsis has been demonstrated to be both sensitive and specific enough to assist in timely decision making. The aim of our study is to develop a predictive model that can be applied to all premature babies, using clinical and laboratory findings in premature babies, to recognize late-onset neonatal sepsis. STUDY DESİGN: 65 premature patients diagnosed with culture-proven late-onset neonatal sepsis and hospitalized in Dr. Behcet Uz Pediatric Diseases and Surgery Training and Research Hospital neonatal intensive …care unit between January 2018 and December 2020, and 65 premature newborns of similar age and gender who did not have sepsis were included in the study retrospectively. RESULTS: In our study, feeding difficulties, worsening in clinical appearance and fever were found to be significant among clinical findings, while thrombocytopenia and high C-reactive protein among laboratory findings are the strongest data supporting late-onset neonatal sepsis. In multiple regression analysis, thrombocytopenia, mean platelet volume, C-reactive protein, lymphocyte count and feeding difficulties had the highest odds ratio (p  < 0.05). By converting these data into a scoring system, a nomogram was created that can be easily used by all clinicians. CONCLUSION: In our study, we developed a scoring system that can be easily applied to all premature patients by evaluating the clinical and laboratory findings in late-onset neonatal sepsis. We think that it will help in recognizing late-onset neonatal sepsis and strengthening the treatment decision. Predicting the individual probability of sepsis in preterm newborns may provide benefits for uninfected newborns to be exposed to less antibiotics, not to be separated from mother and baby, and to reduce healthcare system expenditures. The nomogram can be used to assess the likelihood of sepsis and guide treatment decision. Show more

Keywords: C-reactive protein, late-onset neonatal sepsis, nomogram, premature

DOI: 10.3233/NPM-240011

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 5, pp. 661-671, 2024

Authors: Jolley, H. | Boyar, V. | Fishbein, J. | DeAbreu, G. | Ibrahim, Z. | Weinberger, B.

Article Type: Research Article

Abstract: BACKGROUND: Preterm infants are exposed to numerous environmental stressors during their Neonatal Intensive Care Unit (NICU) stay, particularly during the first week after birth. The aim of this study is to assess whether salivary cortisol levels are correlated with Neonatal Infant Stressor Scale (NISS) scores in preterm infants during the first week of life. We also quantified the changes in both NISS scores and cortisol levels in the first week, and whether cortisol levels are associated with gestational age. METHODS: Preterm infants (n  = 38, birth weight <1250 g and/or gestational age <29 weeks) were included. Saliva samples were collected …on day 0–3 (early) and day 4–7 (late), and cortisol concentrations were measured by immunoassay. NISS scores were assessed retrospectively for the six hours preceding each saliva collection. RESULTS: NISS scores were not significantly correlated with salivary cortisol levels at either time point. However, infants born at <28 weeks gestation had higher median cortisol levels than infants born at >28 weeks (p  = 0.0068), and there was also a significant inverse relationship between NISS score and gestational age (p  = 0.04). There was no significant difference between the early and late time points for either NISS scores or cortisol levels. CONCLUSIONS: Cortisol levels are elevated in infants <28 weeks gestation but do not correlate with NISS scores. NISS scores are inversely related to gestational age, likely reflecting increased exposure to interventions and invasive procedures for the smallest infants. Show more

Keywords: Environmental stress, NISS score, preterm infants, salivary cortisol

DOI: 10.3233/NPM-230178

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 5, pp. 673-679, 2024

Authors: Hoseinalipour, Z. | Javadian, M. | Nasiri-Amiri, F. | Nikbakht, H.A. | Pahlavan, Z.

Article Type: Research Article

Abstract: BACKGROUNDS: The abnormal umbilical cord coiling index (UCI) may be one of the ways to predict adverse pregnancy outcomes. This study attempted to determine the association between abnormal UCI and maternal, fetal, and neonatal outcomes. METHODS: This longitudinal study was conducted on 400 women referred for delivery from April to August 2021. UCI was calculated by dividing the total number of coils by the total length of the umbilical cord in centimeters. In eligible cases, the length of the umbilical cord and the number of vascular coils along the total umbilical cord were measured after birth. UCI less …than the 10th percentile and more than the 90th percentile was considered abnormal, and between the 10th and 90th percentiles was considered normal. Data were analyzed using SPSS version 20. P  < 0.05 were considered statistically significant. RESULTS: The mean length of the umbilical cord was 56.12±8.38 cm, the number of umbilical cord rings was 13.70±3.51, and the UCI was 0.24±0.07. In the regression analysis, women with gestational diabetes had a significant association with abnormal UCI (P  = 0.044). Thus, the probability of abnormal UCI was about 3.5 times higher in women with gestational diabetes than in normal pregnancies. Also, the history of stillbirth had a significant association with abnormal UCI (P  < 0.05). CONCLUSION: It is recommended to perform a UCI examination after delivery as part of a neonatal examination to find an explanation for maternal, fetal, and neonatal outcomes. Show more

Keywords: Abnormal, coiling, pregnancy outcomes, umbilical cord

DOI: 10.3233/NPM-230106

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 5, pp. 681-688, 2024

Authors: Juvinao-Quintero, D.L. | Sanchez, S.E. | Workalemahu, T. | Pinto, N. | Liang, L. | Williams, M.A. | Gelaye, B.

Article Type: Research Article

Abstract: BACKGROUND: Preterm birth (PTB) affects ∼15 million pregnancies worldwide. Genetic studies have identified several candidate loci for PTB, but results remain inconclusive and limited to European populations. Thus, we conducted a genome-wide association study (GWAS) of PTB and gestational age at delivery (GA) among 2,212 Peruvian women. METHODS: PTB cases delivered≥20 weeks’ but < 37 weeks’ gestation, while controls delivered at term (≥37 weeks but <42 weeks). Multivariable regressions were used to identify genetic markers for PTB and GA (∼6 million SNPs), adjusting for maternal age and the first two genetic principal components. In silico functional analysis was conducted …among top signals detected with an arbitrary P  < 1.0×10–5 . We sought to replicate genetic markers for PTB and GA identified in Europeans, and we developed a genetic risk score for GA based on European markers. RESULTS: Mean GA was 30 ± 4 weeks in PTB cases (N  = 933) and 39 ± 1 in the controls (N  = 1,279). No associatiosn were identified at genome-wide level. Nominal PTB variants were enriched for biological pathways associated with polyketide, progesterone, steroid hormones, and glycosyl metabolism. Nominal GA variants were enriched in intronic regions and cancer pathways. Variants in WNT4 associated with GA in Europeans were replicated in our study. A genetic risk score was associated with a 2-day longer GA (P  = 0.002) in our sample. CONCLUSIONS: This study identified various signals suggestively associated with PTB and GA in pregnant Peruvian women. None of these variants overlapped with signals previously identified in Europeans. Show more

Keywords: Genetic risk score, genome-wide association study, gestational age at delivery, pregnancy, preterm birth

DOI: 10.3233/NPM-230228

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 5, pp. 689-704, 2024

Authors: Garg, P.M. | Pittman, I. | Yi, J. | Shetty, A. | Taylor, C. | Reddy, K. | Inder, T.E. | Varshney, N. | Hillegass, W.B. | Garg, P.P.

Article Type: Research Article

Abstract: BACKGROUND: The preterm infants are at risk of cerebellar injury and the risk factors for necrotizing enterocolitis (NEC) associated cerebellar injury are not fully understood. AIM: Determine the risk factors of cerebellar injury in infants with surgical necrotizing enterocolitis (NEC). METHODS: Retrospective study compared clinical/pathological information between surgical NEC infants with and those without cerebellar injury detected on brain MRI obtained at term equivalent age. Cerebellar Injury patterns that we identified on MRI brain were cerebellar hemorrhage, siderosis and/or cerebellar volume loss. RESULTS: Cerebellar injury (21/65, 32.3%) in preterm infants with NEC was associated …with patent ductus arteriosus (PDA) (18/21(85.7%) vs. 25/44(56.8%); p  = 0.021), blood culture positive sepsis (13/21 (61.9%) vs. 11/44 (25%); p  = 0.004) following NEC, predominantly grew gram positive bacteria (9/21(42.9%) vs. 4/44(9.1%); p  = 0.001), greater red cell transfusion, higher rates of cholestasis following NEC and differences in intestinal histopathology (more hemorrhagic and reparative lesions) on univariate analysis. Those with cerebellar injury had higher grade white matter injury (14/21 (66.7%) vs. 4/44(9.1%) p  = 0.0005) and higher-grade ROP (70.6% vs. 38.5%; p  = 0.027) than those without cerebellar injury. On multilogistic regression, the positive blood culture sepsis (OR 3.9, CI 1.1–13.7, p  = 0.03), PDA (OR 4.5, CI 1.0–19.9, p  = 0.04) and severe intestinal pathological hemorrhage (grade 3-4) (OR 16.9, CI 2.1–135.5, p  = 0.007) were independently associated with higher risk of cerebellar injury. CONCLUSION: Preterm infants with surgical NEC with positive blood culture sepsis, PDA, and severe intestinal hemorrhagic lesions (grade 3-4) appear at greater risk for cerebellar injury. Show more

Keywords: Brain injury, cerebellar lesions, neonate, preterm infant, surgical NEC

DOI: 10.3233/NPM-240022

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 5, pp. 705-716, 2024