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

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