Journal of Neonatal-Perinatal Medicine - Volume 10, issue 4

Authors: Odd, David | Heep, Axel | Luyt, Karen | Draycott, Tim

Article Type: Research Article

Abstract: BACKGROUND: Mothers are increasingly given greater control over many of the choices around birth, although there is little robust evidence to inform these choices. After an infant is born with HIE the question of whether it was predictable, or preventable, is often raised. Intrapartum ‘sentinel’ events and antenatal predictors of HIE have been well described, however there is little evidence how antenatal and intrapartum factors interact. This is particularly important when elective delivery by lower segment caesarean section (LSCS) has been shown to be beneficial in high risk groups. AIM: To develop a clinical risk score to identify …women with a higher risk of having an infant with HIE. PATIENTS AND METHODS: This study is based on the Avon Longitudinal Study of Parents and Children (ALSPAC). This dataset was split into two halves: with each infant being randomly allocated to either cohort one or two. The first cohort was used for the derivation of the model, while it was tested exclusively on the second. Logistic regression modelling was then performed to develop a predictive model. The final model was used to predict the outcome of infants in the second cohort and infants divided into four risk quartiles. To give some indication of possible avoidable disease, the proportion of infants with HIE, potentially avoided by earlier delivery, was estimated by assuming that medicalized delivery by elective LSCS at 37 weeks would remove intrapartum risk of HIE for those infants undelivered at this point. RESULTS: In the final model seven covariates remained (parity, preeclampsia, polyhydramnios, prelabor rupture of membranes, gender, concerns over fetal growth and prematurity). When applied to the second cohort, a ROC curve for the prediction of developing HIE in the newborn period showed good evidence for association (AUC 0.68 (0.60 to 0.77)) and the risk score derived was strongly associated with the risk of HIE, resuscitation and stillbirth, and neonatal death (all p  < 0.05). Elective delivery of high risk infants at 37 weeks gestation could prevent 14% of all HIE, with a NNT of 41. CONCLUSION: It is possible to combine routine antenatal findings to identify infants at higher risk of neonatal HIE, thereby recognizing those infants who may benefit most from delivery by elective caesarean section. This work suggests a clinical risk score permits antenatal identification of high-risk infants whose outcome may be amenable to changes in clinical practice to potentially reduce HIE rates, and its devastating consequences. Show more

Keywords: Birth, intrapartum, risk management, hypoxic ischemic encephalopathy, birth asphyxia, Apgar score

DOI: 10.3233/NPM-16152

Citation: Journal of Neonatal-Perinatal Medicine, vol. 10, no. 4, pp. 347-353, 2017

Authors: Khurana, S. | Shivakumar, M. | Sujith Kumar Reddy, G.V. | Jayashree, P. | Ramesh Bhat, Y. | Lewis, L.E.S. | Shashikala,

Article Type: Research Article

Abstract: OBJECTIVE: Methylxanthines are the most commonly prescribed drug in neonatal setups. However, Clinicians show indecision in choosing the right agent for Apnea of Prematurity in most of the developing countries. Present study aimed to compare rate of mortality and survival with normal neurodevelopment outcome at 18 to 24 months of corrected age, between Caffeine- and Aminophylline-treated infants for apnea of prematurity. METHODS: 240 infants were randomly allocated to caffeine and aminophylline for apnea of prematurity during February 2012 to January 2015. Long-term neurodevelopmental assessment was done only from children who had attained corrected age of 18 to 24 …months during April 2014 to February 2016. Cognitive, language and motor deficits were assessed by Bayley Scale of infant and toddler development (BSID – III). Postnatal characteristics such as hearing and visual impairments during NICU stay were noted and same were followed up. RESULTS: Infants allocated to caffeine group showed 83% less risk of getting cognitive impairment (RR 0.16; CI 95% range 0.02 to 1.36), 50% less risk of developing motor deficits (RR 0.50; CI 95% range 0.12 to 1.95) and 24% less risk of developing language problems (RR 0.76; CI 95% range 0.36 to 1.58). However in all the neurodevelopment domains the difference between groups was not statistically significant. Risk of mortality in caffeine group was 9% less over aminophylline group which was statistically non-significant (RR – 0.92; CI 95% range – 0.45 to 1.84; p  = 0.81). Physical growth parameters were found to be similar in both the groups. Risk of developing visual abnormality and hearing impairments was also statistically non-significant between the groups. CONCLUSION: Caffeine and aminophylline showed similar effects in reducing the rate of mortality and improving the survival without neurodevelopment delays; though the clinical significance of caffeine over aminophylline cannot be undermined. Show more

Keywords: Apnea of prematurity, aminophylline, caffeine, cognition, language, motor, neurodevelopment

DOI: 10.3233/NPM-16147

Citation: Journal of Neonatal-Perinatal Medicine, vol. 10, no. 4, pp. 355-362, 2017

Authors: Mohammad, K. | Hicks, M. | Buchhalter, J. | Esser, M.J. | Irvine, L. | Thomas, S. | Scott, J. | Javadyan, J. | Kamaluddeen, M.

Article Type: Research Article

Abstract: OBJECTIVE: To determine the association between hemodynamic instability requiring inotropes and brain injury or death in neonates with hypoxic ischemic encephalopathy (HIE). METHODS: Retrospective cohort study of 221 neonates with HIE. Brain injury was defined using four HIE patterns based on MRI diffusion or T1 changes. The primary outcome was death or brain injury. Secondary outcomes were abnormal MRI, death, and abnormal EEG. Logistic regression was used to examine the risk of death or brain injury with the use of inotropes while adjusting for confounding factors. RESULTS: Brain injury or death occurred more often in neonates …who received inotropes (71.1%, 69/97) compared to those who did not (44.3%, 55/124). The use of inotropes was associated with increased risk of death or brain injury (OR 3.11; 95% CI 1.39–7.004) and abnormal MRI (OR 2.78; 95% CI 1.22–6.34) after adjusting for confounding factors. Mortality was significantly higher in neonates exposed to inotropes (21.6%, 21/97) compared with those who did not receive inotropes (4%, 5/124), P  < 0.001. CONCLUSION: In infants with HIE, hemodynamic instability requiring inotropes in the first 72 hours of life was associated with increased risk of death or brain injury detected by MRI. Show more

Keywords: Hemodynamic instability

DOI: 10.3233/NPM-1816162

Citation: Journal of Neonatal-Perinatal Medicine, vol. 10, no. 4, pp. 363-370, 2017

Authors: Hogue, A.N. | Temple-Cooper, M.E. | Lagzdins, M. | Worley, S. | Scwersenski, J. | Floyd, R. | Saker, F.

Article Type: Research Article

Abstract: OBJECTIVE: We hypothesized that in-utero SSRI exposure affects Apgar scores and immediate post-delivery oxygen requirements. STUDY DESIGN: SSRI in-utero exposure was assessed retrospectively in preterm neonates ≥ 28 weeks gestation and term neonates. Primary outcome was Apgar <7 at five minutes and delivery room oxygen requirements. Secondary endpoints included one-minute Apgar, length of stay, birth weight, and NICU admission. RESULTS: Fifty-one preterm and 117 term neonates were exposed to a SSRI; mostly to sertraline. Pre-term SSRI-exposed neonates had 4.1 times higher delivery room oxygen requirements. One minute Apgar <7 was 3.5 times higher and NICU admission …5 times higher 95% CI (1.3–19) in SSRI-exposed term neonates. Higher doses of sertraline had associated adverse outcomes. CONCLUSION: In-utero SSRI exposure was associated with increased neonatal care at birth, differences in Apgar scores compared with controls, and increased NICU admissions. Higher sertraline doses were associated with poorer outcomes. Show more

Keywords: Citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, neonates, pregnancy, prematurity

DOI: 10.3233/NPM-16133

Citation: Journal of Neonatal-Perinatal Medicine, vol. 10, no. 4, pp. 371-380, 2017

Authors: Clark, M.A. | Stein, R.E.K. | Silver, Ellen J. | Khalid, Sabeen | Fuloria, M. | Esteban-Cruciani, N.V.

Article Type: Research Article

Abstract: OBJECTIVE: Lipid supplementation improves developmental outcomes in preterm infants. Carnitine is essential for lipid metabolism; however, despite high risk for carnitine deficiency, there are no standards for carnitine supplementation in preterm infants receiving total parenteral nutrition (TPN). Our objective was to assess knowledge, beliefs and practices regarding preterm carnitine deficiency and supplementation among neonatal practitioners. METHODS: Cross-sectional electronic survey administered via a nationally representative listserv of neonatal practitioners. RESULTS: 492 respondents participated in the survey. Only 21% of respondents were aware that carnitine is secreted by the placenta. 72% believed that carnitine deficiency was common, and …60% believed deficiency could have serious consequences. Five percent routinely screened for deficiency, and 40% routinely provided carnitine supplementation. Respondents with >5 years’ experience were more likely to report using carnitine supplementation (50% vs. 38%). CONCLUSIONS: Although most respondents believed that carnitine deficiency is common and could have serious consequences, few screened for deficiency and fewer than half routinely supplemented. Thus, many preterm infants remain at risk for carnitine deficiency. Further research is needed to elucidate the risks of carnitine deficiency in these vulnerable infants. Show more

DOI: 10.3233/NPM-16146

Citation: Journal of Neonatal-Perinatal Medicine, vol. 10, no. 4, pp. 381-386, 2017

Authors: Okoye, Helen Chioma | Nwogoh, Benedict | Odetunde, Odutola Israel

Article Type: Research Article

Abstract: OBJECTIVES: To compare the incidence of polycythemia in newborns of women with hypertensive disorders in pregnancy (HDP) with those of normotensive mothers, to determine the incidence of perinatal stress using Apgar scores and to correlate hematocrit with Apgar scores in these newborn. STUDY DESIGN: This was a hospital-based comparative study conducted in the University of Port Harcourt Teaching Hospital, Nigeria. MAIN OUTCOME MEASURES: Apgar scores of 200 newborns- 100 from mothers with HDP (case group) and 100 from normotensive mothers (control group)- were taken at 1st and 5th minute of birth and cord blood samples collected …to determine hematocrit. The subjects were categorized into polycythemic and non polycythemic using a hematocrit ≥65%. RESULTS: Eight percent of newborns of women with HDP had polycythemia while none of the controls did. Apgar scores in the case group with and without polycythemia at one-minute were 4.1±1.8 and 6.6±2.1, respectively and at 5 minutes were 6.9±1.7 and 8.5±1.4 respectively. Hematocrit correlated positively with Apgar scores (both at one and five minutes) in cases without polycythemia (r  = 0.221, p  = 0.034 and r  = 0.255, p  = 0.014). Hematocrit of polycythemic newborns did not correlate with Apgar scores (r  = –0.287, p  = 0.491 and r  = –0.436, p  = 0.281). CONCLUSION: The incidence of polycythemia is significantly higher in newborns of women with HDP and these polycythemic neonates had a significantly higher incidence of birth asphyxia. Therefore, birth outcome as determined by Apgar score is influenced by hematocrit. Show more

Keywords: Hematocrit, polycythemia, Apgar scores, birth asphyxia, hypertensive disorders in pregnancy

DOI: 10.3233/NPM-16151

Citation: Journal of Neonatal-Perinatal Medicine, vol. 10, no. 4, pp. 387-392, 2017

Authors: Lainwala, Shabnam | Kosyakova, Natalia | Spizzoucco, Ann Marie | Herson, Victor | Brownell, Elizabeth A.

Article Type: Research Article

Abstract: BACKGROUND: In preterm infants fortification of human milk with human milk fortifiers (HMF) to optimize nutrition and growth is standard practice. We compared clinical, nutrition and growth outcomes in infants receiving two types of liquid HMF (LHMF). METHODS: Clinical, nutrition and growth outcomes were compared between infants admitted to a level IV NICU, and born with birth weight less than or equal to 1800 grams, between 10/1/2014-12/31/2014 and received human milk with acidified LHMF (ALHMF) and between 1/1/2015-4/31/2015 and received human milk with heat treated LHMF (HTLHMF). RESULTS: Of the 85 qualifying infants, 67 received human …milk and LHMF. ALHMF group had significantly higher incidence of metabolic acidosis and lower bicarbonate and base excess levels relative to infants receiving HTLHMF (P  < 0.001). There were no significant differences by LHMF status in other clinical outcomes and nutrition and growth outcomes. In multivariate analyses, ALHMF use was associated with metabolic acidosis, and lower base excess and bicarbonate levels. CONCLUSION: In our study, the clinical, nutrition and growth outcomes between the two LHMF groups were similar. However, use of ALHMF in preterm infants was associated with increased incidence of metabolic acidosis in our cohort. Further randomized control trials are warranted to evaluate these findings. Show more

Keywords: Premature, feeding, human milk fortifier, metabolic acidosis, preterm, nutrition

DOI: 10.3233/NPM-16164

Citation: Journal of Neonatal-Perinatal Medicine, vol. 10, no. 4, pp. 393-401, 2017

Authors: Begum, Suraiya | Dey, Sanjoy Kumar

Article Type: Research Article

Abstract: OBJECTIVES: To assess the clinical manifestations and pattern of congenital heart diseases (CHD) in infants of diabetic mothers (IDMs) and infants of non-diabetic mothers. METHODS: A prospective cross sectional study was carried out at tertiary care center over a period of thirty months. All neonates were included in this study if CHD were identified by echocardiography within this study period. Chi-square test and Fisher’s exact test were used to compare between groups. RESULT: Out of 62 neonates, IDMs and non-IDMs were equal in number, male and female ratio was 3 : 2, and majority were delivered by cesarean …section (85.5%). Mean gestational age was 35 weeks, 62.3% were preterm, and 37.7% were term. Common clinical presentations were cardiac murmur (61%), and respiratory distress (43.5%). Less common presentations were low SaO2 (27.4%), tachycardia (24.2%), and cyanosis (24.2%). Common combination of presentations were murmur and tachypnea (38.7%); cyanosis and low SaO2 (24.19%); and low SaO2 and tachypnea 15(24.19). The common echocardiographic findings were atrial septal defect (ASD; 72.6%), patent ductus arteriosus (PDA; 45.2%), and ventricular septal defect (VSD; 25.8%). ASD (77.4% vs 67.7%) and VSD (35.5% vs 16.1%) were more in IDMs, and PDA (48.4% vs 41.9%) was more in non-IDMs. These differences were not significant between groups. CONCLUSION: Clinical presentation and echocardiographic findings of CHD were similar in IDMs and non-IDMs. Show more

Keywords: Congenital heart disease, infant of diabetic mother (IDMs), echocardiography

DOI: 10.3233/NPM-170176

Citation: Journal of Neonatal-Perinatal Medicine, vol. 10, no. 4, pp. 403-408, 2017

Authors: Abd El-Fattah, N. | Nasef, N. | Al-Harrass, M.F. | Khashaba, Mohammed

Article Type: Research Article

Abstract: BACKGROUND: Variations exist among the administered pressure and duration of sustained lung inflation (SLI) in the delivery room (DR). We aimed to evaluate the appropriate pressure and duration needed for SLI in preterm infants with respiratory distress syndrome. METHODS: We prospectively randomized 100 preterm (<32 weeks) infants to receive either conventional therapy of continuous positive airway pressure (CPAP) at 5 cm H2 O, or four groups of CPAP plus a single maneuver of SLI at four regimens based on administered pressures and durations; P20D20 (Pressure of 20 cm H2 O for a duration of 20 seconds), P20D10 (20 cm H2 O …for 10 seconds), P15D20 (15 cm H2 O for 20 seconds), and P15D10 (15 cm H2 O for 10 seconds) using a T-piece ventilator. The primary outcome was the need for endotracheal intubation (ETT) in the DR. Broncho-alveolar lavage (BAL) was obtained from intubated infants for interleukin-10 (IL-10) assessment. RESULTS: SLI decreased the need for ETT in the DR (21% versus 55%, p  < 0.01) compared to conventional therapy. ETT requirement was significantly lower in P20D10 (20%), P15D20 (20%), and P15D10 (20%) groups, but not P20D20 (25%) compared to the conventional group (55%, p  < 0.05). Group P20D20 had significant higher BAL levels of IL-10 [713.8 (IQR 611-874) versus 535.4 (IQR 480-563) pg/ml, p  < 0.05] compared to the conventional group, and to other SLI groups. Pneumothorax was not significantly different among studied groups. CONCLUSION: SLI for a pressure and duration ≥20 cm H2 O for 20 seconds is not superior to lower pressures for shorter duration and may be injurious to lungs. Show more

Keywords: Preterm infant, neonatal respiratory distress syndrome, mechanical ventilation, sustained lung inflation

DOI: 10.3233/NPM-171760

Citation: Journal of Neonatal-Perinatal Medicine, vol. 10, no. 4, pp. 409-417, 2017

Authors: Kandasamy, Y. | Rudd, D. | Smith, R.

Article Type: Research Article

Abstract: BACKGROUND: Serum creatinine (SCr) measurement to determine glomerular filtration rate (GFR) in neonates has many pitfalls. Cystatin C (CysC) appears to be a more reliable biomarker. METHODS: We investigated the effect of birth weight on SCr and CysC measurements in a cohort of 74 infants, consisting of both term and ex-premature infants at term postmenstrual age. SCr and Cys C measurements were carried out at the same time. RESULTS: Eighty six infants were recruited into this study out of which complete data were available in 80 infants. The cohort consists of both term and premature infants …at term PMA (31 terms and 49 preterms). The median SCr level was 17 [12–26] umol/L and mean CysC level was 1.64 [0.27] mg/L. SCr had a significant correlation with weight (r  = 0.3; P  = 0.011), whereas serum CysC had no correlation with the infant’s weight (r  = 0.01; P  = 0.95). There were no statistically significant difference in SCr and CysC between male and female infants. CONCLUSION: Unlike CysC, SCr had a significant correlation with birth weight. SCr based GFR measurement may cause a delay in diagnosis of acute kidney injury in smaller neonates. Show more

Keywords: Cystatin C, creatinine, AKI, neonates, renal function

DOI: 10.3233/NPM-171719

Citation: Journal of Neonatal-Perinatal Medicine, vol. 10, no. 4, pp. 419-423, 2017

Authors: Alonzo, Corrie J. | Fairchild, Karen D.

Article Type: Research Article

Abstract: BACKGROUND: Dexamethasone is administered to some preterm infants with chronic lung disease to facilitate weaning from mechanical ventilation. Heart rate characteristics (HRC), including heart rate variability (HRV), may be impacted by glucocorticoids and may predict extubation readiness. A commercially available monitor developed for sepsis detection continuously calculates HRV and an HRC index, which are inversely related. OBJECTIVES: Determine the impact of dexamethasone on HRV and the HRC index, in relation to extubation success. METHODS: We identified 109 preterm infants who received dexamethasone while on mechanical ventilation and had HRC index monitoring data available. Average hourly HRV …and HRC index were compared the day before and the day after initiation of dexamethasone in three groups: infants who remained on mechanical ventilation, those who were successfully extubated, and those who were extubated and required reintubation in < 3 days. RESULTS: There was a significant increase in HRV and decrease in the HRC index the day after dexamethasone was started (HRV 16.2±0.5 vs 27.6±1.1 ms; HRC index 1.51±0.11 vs. 0.79±0.06 mean SE, p  < 0.001). The 63 infants who were extubated within a day of starting dexamethasone had significantly higher HRV compared to those who remained on mechanical ventilation. There was no difference in HRV or its change with dexamethasone in the 45 infants who remained successfully extubated compared to the 18 infants who required reintubation within 3 days. CONCLUSION: Dexamethasone improves HRV and lowers the HRC index in preterm infants with chronic lung disease on mechanical ventilation. Show more

Keywords: Dexamethasone, steroids, glucocorticoids, heart rate variability, premature infant, mechanical ventilation, chronic lung disease

DOI: 10.3233/NPM-16157

Citation: Journal of Neonatal-Perinatal Medicine, vol. 10, no. 4, pp. 425-430, 2017

Authors: Dotters-Katz, S.K. | Myrick, O. | Smid, M. | Manuck, T.A. | Boggess, K.A. | Goodnight, W.

Article Type: Research Article

Abstract: OBJECTIVE: To measure the effect of prophylactic antibiotics given at time of previable prelabor rupture of membranes (PROM) on latency. METHODS: Single center, retrospective cohort study of singleton pregnancies with previable (<23 0/7weeks) PROM. Antibiotics were given at clinician discretion. The primary outcome was latency, defined as duration of time between previable PROM and delivery. Secondary outcomes included delivery at ≥ 23weeks, infant survival, and maternal morbidity. Bivariate analysis compared maternal covariates between women who did and did not receive antibiotics. Antibiotic effect on latency was modeled using a Cox proportional hazards ratio. RESULTS: 213 women …with previable PROM were identified; 77 (36%) remained pregnant and thus were included in this analysis. Forty (52%) of 77 received antibiotics. Compared to women who did not receive antibiotics, those who did had PROM at a later median (IQR) estimated gestational age, EGA, (22.2weeks [20.7, 22.5] vs. 19.3weeks [18, 20.7], p  < 0.01). Median (IQR) latency was not different between women who did and did not receive antibiotics (2.2 [0.7, 3.9] vs. 1.5 [0.5, 4.6] weeks, p  = 0.49). More infants survived to discharge among women who received antibiotics compared to those who did not [17(43%) vs. 3(8%), p  < 0.01]. When adjusted for EGA at PROM, antibiotics were associated with longer latency (HR 0.57 [95% CI 0.33, 0.97], p  = 0.01). Antibiotic use was not associated with differences in maternal morbidity. CONCLUSION: After adjusting for EGA at PROM, antibiotic receipt was associated with longer latency. Larger prospective studies are needed to define the utility of prophylactic antibiotics in previable PROM. Show more

Keywords: Previable PROM, preterm premature rupture of membranes, latency, latency antibiotics

DOI: 10.3233/NPM-16165

Citation: Journal of Neonatal-Perinatal Medicine, vol. 10, no. 4, pp. 431-437, 2017

Authors: Shirai, Yoko | Arai, Hiroko | Tamaki, Kazutomo | Konishi, Hiroe | Kawase, Yasuhiro | Shimizu, Norikazu | Tateda, Kazuhiro | Yoda, Hitoshi

Article Type: Research Article

Abstract: INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) is a common etiological agent of a life-threatening infection in neonatal intensive care units (NICUs). Neonates with very low birth weight and patients with serious diseases are more likely to be exposed to invasive procedures which make them at a high risk of MRSA colonization and infection. Since MRSA colonization is a risk factor for MRSA infection, prevention of MRSA transmission is an important issue in NICUs. NICUs in Japan practice standard contact precautions and active surveillance cultures (ASC) to prevent MRSA transmission. In this report, we analyzed the clinical characteristics of MRSA colonization …and infection between January 2010 and December 2015 in our perinatal care center. METHODS: We conducted retrospective analysis of 1716 neonates hospitalized in our perinatal care center. RESULTS: 120 cases had MRSA colonization (6.99%) and among them 33 neonates were infected. The duration of stay (P ≤0.001) and the birth weight (P ≤0.001) showed statistically significant differences between MRSA-colonized neonates and non-MRSA-colonized neonates. The number of central venous catheterization showed statistically significant differences (P  = 0.001) and the number of digestive system diseases showed marginally significant differences (P  = 0.072) between MRSA-colonized non-infected neonates and MRSA-infected neonates. CONCLUSIONS: As previous reports have shown, we present that the neonates with central venous catheterization were more likely to be infected with MRSA. We also need to pay attention to neonates with digestive system diseases, showing signs of infection, because they may be potentially infected with MRSA. Show more

Keywords: MRSA, NICU, infection, colonization

DOI: 10.3233/NPM-16166

Citation: Journal of Neonatal-Perinatal Medicine, vol. 10, no. 4, pp. 439-444, 2017

Authors: Wood, K.E. | Smith, P. | Krasowski, M.D.

Article Type: Research Article

Abstract: OBJECTIVES: Federal law mandates states to have policies and procedures to identify newborns exposed to maternal substance use during pregnancy. National guidelines for newborn drug testing are lacking; therefore, procedures are variable and determined by state law and local practices. In Iowa, maternal substance use during pregnancy is considered child abuse and must be reported. The objective of this study was to identify newborn drug testing policies and procedures among birthing hospitals in Iowa. METHODS: This was a cross sectional survey of all birthing hospitals in Iowa identified via the Statewide Perinatal Care Program. An electronic survey was …sent to the representative at each affiliated hospital. RESULTS: Sixty-nine of 76 hospitals completed the survey for a 90.8% response rate. Newborn drug testing is ordered in 97.1% of responding hospitals with most testing 25% or less of newborns annually. The majority utilized a risk assessment tool (89.6%), although many (62.7%) also allowed for provider discretion. No hospital performed universal testing of all newborns. 86.6% of hospitals reported all positive newborn drug test results including illicit and/or prescription drugs to child protective services. 35.0% of hospitals notified mothers of the report and 45.5% offered substance abuse services and/or treatment to the mothers. CONCLUSIONS: Most Iowa birthing hospitals perform newborn drug testing and report all positive test results to child protective services. The majority use risk assessment tools. Maternal notification practices and referral for substance use disorder treatment are suboptimal and represent an area for future improvement. Show more

Keywords: Prenatal drug abuse, substance exposed newborn, neonatal abstinence syndrome

DOI: 10.3233/NPM-16153

Citation: Journal of Neonatal-Perinatal Medicine, vol. 10, no. 4, pp. 445-450, 2017

Authors: Lemaire, A. | Bonnin, M. | Storme, B. | Fournet-Fayard, A. | Rosano, G. | Vernis, L. | Cayot, S. | Accocebery, M. | Dechelotte, P. | Boyer, L. | Gallot, D. | Futier, E. | Constantin, J.M. | Bazin, J.E.

Article Type: Case Report

Abstract: Hemorrhages are the first cause of perinatal deaths in French women. Thirteen percent of these deaths are not linked to obstetrical problems but rather to hemoperitoneum. These incidents are under-diagnosed and as a result, treatment is delayed and fetal and maternal mortality increases. We report three cases of patients, all White female in their last trimester of a non-problematic pregnancy presenting with hemoperitoneum and resulting in different outcomes. The analysis of published materials and of our cases leads us to infer that a diagnosis of hemoperitoneum must be considered in pregnant women when abdominal pain, symptoms of shock and a …decrease in hemoglobin are associated. An immediate response and intensive care followed by hemostatic surgery give these patients the best chance to survive. Show more

Keywords: Hemoperitoneum, pregnancy, aneurysm, spleen

DOI: 10.3233/NPM-171659

Citation: Journal of Neonatal-Perinatal Medicine, vol. 10, no. 4, pp. 451-454, 2017

Authors: Al Dakhoul, Suleiman

Article Type: Case Report

Abstract: This is a report of a 36 week male infant who suffered abdominal distension and difficulty opening bowels within first few days of life and showed a pattern of hypoventilation and apnea associated with sleep. His diagnostic studies confirmed the diagnosis of congenital central hypoventilation syndrome CCHS (PHOX2B mutation) and Hirschsprung’s disease and later found a further mutation of BRAF oncogene. This describes a novel association between these mutations and the shared qualities of tumorigenesis between BRAF and PHOX2B.

Keywords: Haddad syndrome, congenital central hypoventilation syndrome, Hirschsprung’s, PHOX2B, BRAF

DOI: 10.3233/NPM-16170

Citation: Journal of Neonatal-Perinatal Medicine, vol. 10, no. 4, pp. 455-457, 2017