Journal of Neonatal-Perinatal Medicine - Volume 7, issue 2

Authors: Finer, N.N. | Katheria, A.

Article Type: Other

DOI: 10.3233/NPM-14814013

Citation: Journal of Neonatal-Perinatal Medicine, vol. 7, no. 2, pp. 85-87, 2014

Authors: Mintzer, J.P. | Parvez, B. | Chelala, M. | Alpan, G. | LaGamma, E.F.

Article Type: Research Article

Abstract: OBJECTIVE: We sought to characterize the effects of “booster” packed red blood cell transfusions on multisite regional oxygen saturation in very low birth weight neonates during the first postnatal week and to examine the utility of fractional tissue oxygen extraction as an estimate of tissue oxygenation adequacy. STUDY DESIGN: Data were collected in an observational near-infrared spectroscopy (NIRS) pilot survey of 500–1250 g neonates during the first postnatal week. A before-after analysis of “booster” transfusions, defined as empiric 15 mL/kg transfusion following 10 mL/kg cumulative phlebotomy losses, was conducted upon cardiopulmonary, laboratory, and spectroscopy data. RESULT: Ten neonates (gestational age …26 ± 0 wk; birth weight 879 ± 49 g) received 14 transfusions at 3 ± 0 postnatal days. Mean hematocrit increased from 35.2 ± 1.2 to 38.5 ± 1.2 % (P < 0.05) following transfusion; pH, base deficit, lactate, creatinine, and cardiopulmonary parameters were unchanged. Cerebral, renal, and splanchnic tissue oxygenation increased 10, 18, and 16%, with concomitant decreases in calculated oxygen extraction of 27, 30, and 9% (all P < 0.05), consistent with enhanced tissue oxygenation. These findings were not observed in a non-transfused comparison group of nine patients. CONCLUSION: “Booster” transfusions improved indices of regional tissue oxygenation while no departures were observed in conventional cardiovascular assessments. We speculate that NIRS-derived oxygenation parameters can provide an objective, graded, and continuous estimate of oxygen delivery-consumption balance not evident using standard monitoring techniques. Show more

Keywords: Oxygen extraction, oxygen delivery, red cell mass, near-infrared spectroscopy, “booster” transfusion

DOI: 10.3233/NPM-1477213

Citation: Journal of Neonatal-Perinatal Medicine, vol. 7, no. 2, pp. 89-100, 2014

Authors: Mohamed, Walid A. | Aseeri, Mohamed A.

Article Type: Research Article

Abstract: OBJECTIVE: To evaluate fibroblast growth factor-10 (FGF-10) levels in cord blood as a possible predictor of the subsequent development of bronchopulmonary dysplasia (BPD) in preterm infants. PATIENTS AND METHODS: A total of 269 preterm (≤32 weeks gestation) infants (76 infants developed BPD and 193 had no BPD) were enrolled. FGF-10 levels were measured by enzyme-linked immunosorbent assay. RESULTS: Preterm infants who subsequently developed BPD had significantly lower cord serum levels of FGF-10 than those who did not (p < 0.001). Cord blood levels of FGF-10 were significantly lower in infants with severe BPD than those with moderate or mild disease …(p < 0.001). Logistic regression analysis demonstrated that low cord blood FGF-10 level was independently associated with the subsequent risk of BPD (OR = 0.978 [95 % CI: 0.959 – 0.997]; p = 0.02). CONCLUSION: Low cord blood FGF-10 levels may predict the subsequent development of BPD in preterm infants. Show more

Keywords: Fibroblast growth factor, bronchopulmonary dysplasia, preterm infants

DOI: 10.3233/NPM-1476613

Citation: Journal of Neonatal-Perinatal Medicine, vol. 7, no. 2, pp. 101-105, 2014

Authors: Attar, M.A. | Dechert, R.E. | Schumacher, R.E. | Sarkar, S.

Article Type: Research Article

Abstract: AIM: We evaluated the use of prenatal steroids (PNS) and the effect of that practice on hospital mortality of late preterm infants with complex congenital heart defects (CHD). METHODS: Retrospective review of records of late preterm infants with complex CHD infants that were cared for in a single tertiary perinatal center between 2002 and 2009. Multivariate logistic regression analysis was performed to determine which of the risk factors commonly associated with death prior to discharge from the hospital predict the outcome (hospital death). RESULTS: Of the 106 late preterm infants with complex CHD, 31(29%) died and 15 (14%) received PNS. …Endotracheal intubation in the delivery room (42% vs 15%), necrotizing enterocolitis (10% vs 0%) and hypoplastic left heart syndrome (52% vs 25%) were statistically more frequent in non-surviving infants. Non-surviving infants were more frequently treated with PNS (23% vs 11%) but this difference was not statistically significant (p = 0.131). Using logistic regression analysis, delivery room intubation (OR 4.91; 95% CI 1.78 – 13.51) and the hypoplastic left heart syndrome (OR 3.29; 95% CI 1.28 – 8.48), but not prenatal steroids were independently associated with increased risk of hospital death. CONCLUSIONS: In a selected population of late preterm infants with complex CHD, prenatal steroid treatment did not independently influence survival. Show more

Keywords: Late preterm infant, congenital heart defect, prenatal steroid, mortality, counseling

DOI: 10.3233/NPM-1474813

Citation: Journal of Neonatal-Perinatal Medicine, vol. 7, no. 2, pp. 107-111, 2014

Authors: Winners-Mendizabal, O.G. | Orge, F.H. | Di Fiore, J.M. | Martin, R.J. | Kc, P.

Article Type: Research Article

Abstract: BACKGROUND: Retinopathy of prematurity [ROP] continues to be a significant clinical problem in preterm infants. There is a need for animal models to better understand the roles of hypoxia/hyperoxia in the pathogenesis and management of ROP. OBJECTIVES: To test the hypothesis that multiple daily cycles of intermittent hypoxia, followed by brief hyperoxia, would provide a clinically relevant protocol for generation of ROP in a rat pup. METHODS: Rat pups were exposed for the first 14 days to one of three protocols: room air [RA], sustained cycles of hyperoxia/hypoxia [SHH] as previously employed to produce ROP in rat pups, and intermittent …hypoxia/hyperoxia [IHH] in order to more closely simulate clinical conditions in preterm infants. Retinae were obtained at 18 days and imaged for both avascularization and neovascularization. RESULTS: As expected, the SHH group demonstrated significantly increased avascularity [40.9 ± 7.9% of retina] which was minimal in both RA and IHH groups. All SHH exposed pups exhibited neovascularization which occurred in 5/7 IHH exposed retinae versus 0 in the RA group [p = 0.02]. However, mean number of clock hours of neovascularization after IHH was 1.9 ± 2.1 which did not differ from the RA group, and was less than in the SHH group [8.3 ± 1.9, p < 0.001]. CONCLUSION: A more clinically relevant intermittent hypoxia/hyperoxia [IHH] protocol does not produce the same degree of ROP as the traditional sustained hypoxia/hyperoxia [SHH] paradigm. Nonetheless, further refinement of our model may provide a suitable model for understanding the lesser degrees of ROP which predominate in preterm infants. Show more

Keywords: Intermittent hypoxia-hyperoxia, retinopathy of prematurity, rodent model

DOI: 10.3233/NPM-1475613

Citation: Journal of Neonatal-Perinatal Medicine, vol. 7, no. 2, pp. 113-117, 2014

Authors: Al-Alaiyan, S. | Dawoud, M. | Al-Hazzani, F.

Article Type: Research Article

Abstract: OBJECTIVE: our objective is to assess the positive distending pressure generated by high flow nasal cannula and nasal continuous positive airway pressure by measuring the end esophageal pressure in premature infants. STUDY DESIGN: This is a pilot, non-randomized, open label, uncontrolled, crossover assignment study that included neonates born with a birth weight of 1750 grams or less and receiving nCPAP ventilatory support for 24 hrs or more and requiring FiO2 21–50% on nCPAP. Each infant was started on nCPAP at 4, 6 and 8 cm H2 O then on three levels of HHHFNC, 4 L/min, 6 L/min and 8 L/min …with 4 hours interval on each flow level. Esophageal pressure (EP), apnea of prematurity, FiO2 requirements and bradycardia were recorded during the different levels of CPAP and HHHFNC use. RESULTS: The study showed that there were no complications observed during the study such as pneumothorax. It showed that EP created by the three different levels of HHHFNC were slightly higher than that EPs created by the three different levels of nCPAP, but statistically not significant. There was no significant change in the FiO2 requirements during the study. There was a trend towards the improvement of oxygen saturation in HHHFNC at different levels and it was statistically significant when 8 L/min was used (P 0.0214). The rates of bradycardia and apnea in nCPAP and HHHFNC were low and statistically were not significant, however the episodes of bradycardia were less in HHHFNC and they were statistically significant at the level of 6 L/min. CONCLUSIONS: HHHFNC in premature infants was well-tolerated with no adverse side effects such as pneumothorax, desaturation, apnea and bradycardia. The study also showed that HHHFNC was able to deliver distending pressure equal to nCPAP. Moreover, we have observed a significant improvement in oxygen saturation when higher levels of HHHFNC was used, most probably due to the improvement of infant comfort which is a noticeable feature of HHHFNC. Show more

Keywords: Premature infants, CPAP, high flow nasal cannula, respiratory support, esophageal pressure

DOI: 10.3233/NPM-1474113

Citation: Journal of Neonatal-Perinatal Medicine, vol. 7, no. 2, pp. 119-124, 2014

Authors: Schachinger, S. | Stansfield, R.B. | Ensing, G. | Schumacher, R.

Article Type: Research Article

Abstract: BACKGROUND: Internationally, neonatologists are increasingly performing functional echocardiography to evaluate the hemodynamic status and cardiac function in neonates. The purpose of this study was to describe the current prevalence of and attitudes toward the use and training of neonatologists in functional echocardiography in the United States. METHODS: An anonymous survey was sent to United States neonatal intensive care unit medical directors. Neonatologists scored availability of echocardiography and attitudes toward the use and training of neonatologists in functional echocardiography. RESULTS: Response rate was 43.7% (247 of 565 surveys sent) and captured 95% of the neonatal-perinatal training programs. Nine percent of units …had a functional echocardiography trained neonatologist; eight percent of the neonatal-perinatal training programs offered functional echocardiography training. There was no difference in the timely ability to obtain hemodynamic status with echocardiography in units compared by the presence of functional echocardiography trained neonatologists (mean = 3.13 vs. 2.67, p = 0.08) and fellowships (mean = 2.69 vs. 2.72, p = 0.85). Overall positive attitudes (mean = 14.6 ± 3.46) towards the training of neonatologists in functional echocardiography did not correlate with the perceived timely availability of echocardiography support (mean = 2.72 ± 1.43, r = −0.11, p = 0.1). CONCLUSION: Functional echocardiography use and training is not prevalent in the United States. There are positive attitudes toward the training of neonatologists in functional echocardiography that are independent of the presence of fellowships, neonatologists with echocardiography training, and the perceived availability of echocardiography support. Show more

Keywords: Neonatologist, functional, echocardiography, neonate, premature

DOI: 10.3233/NPM-1474013

Citation: Journal of Neonatal-Perinatal Medicine, vol. 7, no. 2, pp. 125-130, 2014

Authors: Kett, J.C. | Woodrum, D.E. | Diekema, D.S.

Article Type: Research Article

Abstract: OBJECTIVE: Fetal care centers have recently emerged in affiliation with children's hospitals throughout the United States. Few studies have evaluated this new multidisciplinary model of care. STUDY DESIGN: We conducted a survey of multidisciplinary fetal care centers in the United States; survey data was analyzed using descriptive statistics. RESULTS: 59 centers were identified; 29 centers (49%) returned completed surveys. Most centers are located in a children's hospital (54%), and the majority of centers (76%) opened in the past 10 years. The majority of centers (62%) are administered by a specialist in Maternal Fetal Medicine or Obstetrics and Gynecology. A specialist …in MFM or Ob/Gyn evaluates every patient at 90% of centers; a neonatologist evaluates every patient at 52% of centers. All responding centers have the capability to perform ultrasounds although fewer centers perform fetoscopic surgery (38%) or open fetal surgery (31%). Many centers (41%) conduct research protocols in fetal medicine. Most centers (61%) considered the provision of information to families as their most important goal. CONCLUSIONS: This is the first study to describe multidisciplinary fetal centers in the United States. It demonstrates variability between centers. More research is needed in order to evaluate the impact of this variability. Show more

Keywords: Fetal therapy, fetal diagnosis, prenatal diagnosis, ethics

DOI: 10.3233/NPM-14814005

Citation: Journal of Neonatal-Perinatal Medicine, vol. 7, no. 2, pp. 131-135, 2014

Authors: Fuchs, E.M. | Sweeney, A.G. | Schmidt, J.W.

Article Type: Research Article

Abstract: Umbilical vessel catheterization is common practice for infants in the neonatal intensive care unit (NICU). Umbilical venous catheters (UVC) although very useful as a means of obtaining vascular access, do not come without risks. Here we will describe three separate cases of infants in the NICU who, during their course of treatment, were found to have hepatic masses attributed to UVC misplacement. Two of the cases presented incidentally and one presented acutely. We believe liver hematomas may be a more common complication of malpositioned UVCs than previously believed. An appreciation of the complications of malpositioned UVCs should alert clinicians to …screen for potential complications and to ensure ideal line placement. Show more

Keywords: Umbilical venous catheter, UVC, liver, hepatic, hematoma, neonates

DOI: 10.3233/NPM-1475113

Citation: Journal of Neonatal-Perinatal Medicine, vol. 7, no. 2, pp. 137-142, 2014

Authors: Jakhere, S.G. | Saifi, S.A. | Ranwaka, A.A.

Article Type: Research Article

Abstract: Intestinal volvulus is a common condition seen in infancy and adulthood, but small bowel volvulus is a rare condition affecting the fetus in utero. Very few cases have been reported describing the ultrasound findings of the same. We present a case report of a case of intestinal volvulus which was diagnosed prenatally based on the ultrasound features of whirlpool sign and coffee bean sign. An emergency caesarian section was performed, small bowel volvulus was confirmed on post-natal ultrasound, and the neonate was subsequently operated. Although these signs have been separately described previously in the literature, in our case both these …signs were seen in the same patient. Our case is a rare presentation with the occurrence of volvulus without malrotation, the contrary being more common. Show more

Keywords: Whirlpool sign, coffee bean sign, fetal volvulus

DOI: 10.3233/NPM-1476013

Citation: Journal of Neonatal-Perinatal Medicine, vol. 7, no. 2, pp. 143-146, 2014