Journal of Neonatal-Perinatal Medicine - Volume 12, issue 1

Authors: Farooqui, M.A. | Elsayed, Y.N. | Jeyaraman, M.M. | Dingwall, O. | Tagin, M. | Zarychanski, R. | Rabbani, R. | Abou-Setta, A.M.

Article Type: Review Article

Abstract: BACKGROUND: A clinically significant patent ductus arteriosus (PDA) is associated with significant morbidity and mortality in premature newborns. Symptomatic PDAs are often treated with prostaglandin synthesis inhibitors (PSI), but controversy remains if PSIs should also be used to manage early, asymptomatic PDAs. OBJECTIVE: To systematically identify, critically appraise, and evaluate the efficacy and safety of pharmacological management of pre-symptomatic PDA in preterm newborns after confirmed patency by echocardiography. STUDY DESIGN: Systematic review and meta-analysis. Search methods: We searched MEDLINE (Ovid), EMBASE (Ovid), Cochrane Central Register of Controlled Trials (Wiley), from date of inception to February 2017. …Supplemental searching was performed in Scopus and Web of Science to identify additional relevant citations. We also searched conference proceedings, reference lists of relevant articles and the WHO International Clinical Trials Registry Platform (ICTRP). Selection criteria: We included only randomized controlled trials (RCTs) that compared the use of indomethacin or ibuprofen to placebo for treatment of pre-symptomatic PDA in preterm newborns (<32 weeks gestational age and <1500gms). Data collection and analysis: Two reviewers independently selected trials, assessed risk of bias and extracted trial-level data. Outcomes are reported as risk ratios from random-effects models. Absolute risk reduction (ARR) is additionally reported for significant outcomes. We included seven trials (466 newborns). Targeted medical treatment did not significantly reduce mortality rates (RR 0.85, 95% CI 0.50 to 1.43; ARR –2.38%, 95% CI –8.04% to 3.29%; I2 0% 6 studies; 442 newborns), but it did significantly reduce the overall incidence of developing symptomatic PDA (RR 0.39, 95% CI 0.21 to 0.73; ARR –34.3%, 95% CI –50.8% to –17.8%; I2 0%; 3 studies; 97 newborns) compared to placebo. Other efficacy or safety outcomes were not significantly different. CONCLUSIONS: Targeted medical treatment of pre-symptomatic PDA decreases the incidence of developing symptomatic PDA, but not neonatal mortality. Further studies are essential to confirm these results. Show more

Keywords: Pre-symptomatic, patent ductus arteriosus, echocardiography, hemodynamically non-significant, mortality, systematic review, meta-analysis

DOI: 10.3233/NPM-17130

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 1, pp. 1-7, 2019

Authors: Day, T.G. | Dionisio, D. | Zannino, D. | Brizard, C. | Cheung, M.M.H.

Article Type: Research Article

Abstract: BACKGROUND: Infants with duct-dependent congenital heart lesions are treated with a prostaglandin E1 infusion. We aimed to describe the feeding strategies used at our institution in such infants, and to describe the incidence of necrotising enterocolitis (NEC) in this patient group, investigating whether enteral feeding is associated with a higher risk. METHODS: Patients diagnosed with hypoplastic left heart syndrome, coarctation of the aorta, pulmonary atresia, or transposition of the great arteries born over a defined period were identified. Premature infants, those with pre-existing gastrointestinal disease, and those who never received prostaglandin were excluded. Data were compared using univariable …and multivariable logistic regression models. RESULTS: A total of 177 patients were identified, of them 18 received a diagnosis of suspected or confirmed NEC. There was no association between the diagnosis of NEC and enteral feeding (P = 0.9). CONCLUSIONS: Based on these data, there does not appear to be an association between enteral feeding and NEC in infants receiving prostaglandin. Show more

Keywords: Congenital heart disease, prostaglandin, feeding

DOI: 10.3233/NPM-1861

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 1, pp. 9-12, 2019

Authors: Thavamani, A. | Mhanna, M.J. | Groh-Wargo, S. | Gulati, R. | Shekhawat, P.S.

Article Type: Research Article

Abstract: OBJECTIVE: To analyze safety, tolerance and efficacy of enteral omega-3 fatty acids (FAs) in the resolution of Parenteral Nutrition Associated Cholestasis (PNAC) and postnatal growth among preterm neonates. STUDY DESIGN: This is a single center retrospective case-control study of all neonates born less than 32 weeks of gestation and developed PNAC (Direct bilirubin >2 mg/dl). Infants who received enteral omega-3 FAs supplementation (1 g/Kg/d) served as cases and were compared with gestational age, gender and direct bilirubin level matched controls who did not receive enteral omega-3 FAs supplementation. RESULTS: A total of 48 infants were analyzed, 24 who …received enteral omega-3 fatty acids were matched with 24 controls. The omega-3 FAs and control groups were similar in gestational age (weeks) and birth weight (gram). Overall there were no differences between the two groups in infants’ demographics or clinical characteristics including risk factors for the development of PNAC. Infants who received enteral omega-3 FAs had significantly fewer days of cholestasis (p  = 0.025) and a higher average daily weight gain (grams/day) (p  = 0.011) than their controls. In a linear regression analysis with days of cholestasis as the dependent variable and Ursodeoxycholic acid (UDCA) and Omega-3 FAs as independent variables, enteral omega-3 FAs remained associated with a shorter duration of cholestasis, p  < 0.001. CONCLUSION: Enteral fish oil is inexpensive, safe & well tolerated in preterm neonates with no contraindications to enteral feeding. Enteral omega-3 FAs are easy to administer and help in rapid resolution of PNAC while promoting postnatal weight gain in preterm infants. Show more

DOI: 10.3233/NPM-18138

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 1, pp. 13-20, 2019

Authors: Chung, E. | Lee, S.E. | Abraham, T. | Saad, N.N. | Gad, A.

Article Type: Research Article

Abstract: BACKGROUND: Study aims to evaluate whether vancomycin dosing from published dosing algorithms correlate with the attainment of target troughs of 10 to 20 mg/L. METHODS: NICU patients who received minimum three doses of vancomycin and had a trough level met inclusion criteria. Dosing information was retrospectively evaluated to determine which published dosing regimen was followed. Dosing algorithms used were matched to NeoFax/Harriet Lane, renal-function directed dosing, and weight-directed dosing, in which the latter two can be found in Pediatric and Neonatal Lexi-Drugs. Primary outcome was percentage of troughs within therapeutic (10 to 20 mg/L) and subtherapeutic (less than …10 mg/L) levels. RESULTS: Of 97 troughs evaluated, NeoFax/Harriet Lane accounted for 86.6%, renal-function directed accounted for 5.1%, and weight-directed dosing accounted for 18.5% of dosing algorithms. NeoFax/Harriet Lane, renal-function directed, and weight-directed dosing attained therapeutic levels between 10 to 20 mg/L at a rate of 60.7%, 60%, and 50% of the time, respectively. With respect to initiation of therapy, a higher dose of 15 mg/kg versus 10 mg/kg attained therapeutic levels (p  < 0.001; OR 11.22; 95% CI, 3.96 to 31.81), while a serum creatinine value below 0.5 mg/dL attained subtherapeutic levels (p  = 0.028; OR 0.068; 95% CI, 0.006 to 0.74). CONCLUSIONS: NeoFax, Harriet Lane, and renal-directed dosing from Pediatric and Neonatal Lexi-Drugs achieved target troughs within the 10 to 20 mg/L range more often than weight-directed dosing from Pediatric and Neonatal Lexi-Drugs. Initiating therapy at a higher dose and patient serum creatinine value above 0.5 mg/dL were factors significantly associated with a 10 to 20 mg/L range. Show more

Keywords: Neonates, trough, vancomycin

DOI: 10.3233/NPM-182

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 1, pp. 21-27, 2019

Authors: Silva-Rios, J. | Camargos, P. | Correa, L. | Romanelli, R.

Article Type: Research Article

Abstract: BACKGROUND: The incidence rate of invasive candidiasis in newborns with birth weight below 1,500 g ranges from 2% to 8%, and fluconazole prophylaxis in neonatal units is recommended when the incidence of invasive candidiasis is higher than 5%. This study aimed to compare the effectiveness of targeted prophylaxis and universal prophylaxis with fluconazole in the prevention of invasive candidiasis. METHODS: This was a historical cohort comparing the targeted prophylaxis for newborns weighing less than 1,500 g and the universal prophylaxis for newborns weighing less than 1,000 g. RESULTS: The overall incidence rate of invasive candidiasis was 5.25% and was …reduced from 7.1% to 3.72% with universal prophylaxis (p  = 0.04). In a multivariate analysis, the significant factors associated with the development of candidiasis were birth weight less than 1,000 g, prolonged hospitalization, previous surgery, prolonged use of mechanical ventilation, prior exposure to antimicrobial treatments, and use of targeted prophylaxis. CONCLUSIONS: Universal prophylaxis had lower incidence of invasive candidiasis, and preventive measures considering the risk factors are mandatory to reduce the incidence of invasive candidiasis. Show more

Keywords: Candidiasis, invasive, fluconazole, pre-exposure prophylaxis, newborn, infant, very low birth weight

DOI: 10.3233/NPM-17121

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 1, pp. 29-36, 2019

Authors: Suzuki, S.

Article Type: Research Article

Abstract: To predict the presence of histological funisitis at term, we examined the symptoms of clinical chorioamnionitis in 251 cases of maternal fever of 38 degrees or higher during labor at term. The examined symptoms in this study were clinical maternal findings (uterine fundal tenderness, maternal tachycardia, purulent or foul amniotic fluid or cervical discharge, and maternal white blood cell count) and fetal tachycardia. In these cases, microscopic histopathological analysis of the placenta was performed after delivery. The positive predictive value for histological funisitis in cases of maternal fever of 38 degrees or higher was only 15.5%. In cases of maternal …fever with uterine fundal tenderness and purulent or foul amniotic fluid or cervical discharge at term, the positive predictive value for histological chorioamnionitis was 100%. Therefore, uterine fundal tenderness and amniotic fluid or cervical discharge with a foul odor are important symptoms to predict the presence of funisitis in cases of maternal fever of 38 degrees or higher. Show more

Keywords: Clinical chorioamnionitis, uterine fundal tenderness, purulent or foul amniotic fluid or cervical discharge, histological funisitis

DOI: 10.3233/NPM-17155

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 1, pp. 37-40, 2019

Authors: Beck, K. | Young, R. | Read, S. | Harper, H. | Desireddi, J. | Harper III, C.A.

Article Type: Research Article

Abstract: OBJECTIVES: To evaluate the characteristics and comorbidities associated with ROP in micro-premature infants and their results. METHODS: This is a retrospective chart review involving multiple intensive care units in Central Texas from 2011 to 2016. Infants were included if birth weight (BW) was≤750 g with confirmed ROP by the International Classification of Retinopathy of Prematurity (ICROP). Neonates were examined and treated with laser ablation or intravitreal ranibizumab (IVR) with subsequent laser treatment, guided by fluorescein angiography, if met treatment criteria defined as type 1 ROP by the Early Treatment of Retinopathy of Prematurity standards. Time to regression was defined …clinically. Results were analyzed using chi-squared test. RESULTS: 100 neonates were included in the study. Mean BW was 599 grams and mean gestational age was 24.2 weeks. Forty neonates were classified as type 1 ROP and therefore required intervention; of them 21 received laser alone and 19 required IVR with subsequent laser. Only 2 patients received more than one IVR injection. None of the patients progressed to stage 4 or 5 ROP. CONCLUSIONS: Despite such low birth weights, none of these neonates progressed to stage 4 or 5 ROP likely because of prompt examination and treatment with laser or with IVR and subsequent laser. IVR might serve as a bridge to laser in type 1 ROP allowing some retinal vessel development prior to definitive laser treatment. Show more

Keywords: Retinopathy of prematurity, ROP, ranibizumab

DOI: 10.3233/NPM-17158

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 1, pp. 41-45, 2019

Authors: Olaya-C, M. | Michael, F. | Fabian, G. | Silva, J. Luis | Bernal, J.E. | Research Seedbed in Perinatal Medicine PUJ | Garzon, A.L.

Article Type: Research Article

Abstract: INTRODUCTION: The umbilical cord (UC) is a vital structure; its alterations affect the newborn and neurological impact can be permanent. Paradoxically, factors that determine it remain unknown. We explore the differential VEGF protein expression in the UC's proximal and distal portions in relation to the hypothesis that the UC has differential growth and that VEGF plays a role in it. METHODS: An observational analytical study was performed. One UC segment was taken proximal to fetus and another distal; both were randomly processed; VEGF immunohistochemical analysis was performed; two blinded pathologists read results. RESULTS: Forty-eight …newborns were included. Protein expression between the two edges of the umbilical cord, in any kind of cells, was interpreted. Endothelium, amnion, and stromal cells expressed VEGF; the first two were not different between opposite ends. Stromal cells had differential expression: higher in the proximal to the fetus portion. CONCLUSION: Knowledge of molecular factors is necessary. UC cells widely expressed VEGF, possibly contributing to UC growth. Even though stromal cell expression was different, the interaction with activity close to the fetus must be explored. Show more

Keywords: Umbilical cord, VEGF, umbilical cord length, stillbirth.

DOI: 10.3233/NPM-1795

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 1, pp. 47-56, 2019

Authors: Elmekkawi, A. | Maulidi, H. | Mak, W. | Aziz, A. | Lee, K.-S.

Article Type: Research Article

Abstract: OBJECTIVE: To compare outcomes of peripherally inserted central catheters (PICCs) placed in the upper extremity (UE) versus the lower extremity (LE) in a quaternary medical-surgical neonatal intensive care unit (NICU). RESULTS: We analyzed a total of 365 PICCs of which 250 (68%) were removed for end of therapy and 115 (32%) were removed due to complications. Patients who had UE insertions compared to LE insertions were of lower gestational age (median (IQR)), 30 (26, 35) vs. 32 (27, 37) weeks respectively (p  = 0.014). UE PICCs were more likely to be removed due to complications compared to LE …PICCs (39.9% vs. 26.4%, RR 1.51, 95% CI 1.12 –2.03, p  = 0.007). UE PICCs were more likely than LE PICCs to be removed for the complications of malposition, dislodgement, and pleural or pericardial effusions; while LE PICCs were more likely to be removed for phlebitis. There were no differences in the rates of sepsis at 13.0% vs. 12.8% for UE vs. LE respectively, or causal organisms for sepsis. Survival analysis demonstrated that LE PICCs had a longer time to removal for a complication (p  = 0.031). CONCLUSIONS: LE compared with UE PICCs were not associated with worse outcomes in a medical-surgical neonatal population that included a significant proportion of full-term neonates, and provide a valuable alternate site for central venous access. Increased awareness of the types of complications for UE compared with LE PICCs may help focus preventive and surveillance efforts based on PICC location, to improve safety and minimize the complications of NICU PICCs. Show more

Keywords: Peripherally inserted central catheter, upper extremity, lower extremity, complications, neonate

DOI: 10.3233/NPM-1817

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 1, pp. 57-63, 2019

Authors: Petrova, A. | Karatas, M. | Mehta, R.

Article Type: Research Article

Abstract: BACKGROUND: The purpose of this study was to identify the pattern and factors associated with changes in cranial ultrasound (CUS) -detected findings in infants born at or less than 28 weeks of gestation. METHODS: We compared readings of CUS performed at the end of the first week of life and at 4–5 weeks of age. Alteration of CUS findings was classified as: (i) unchanged , if no deviation was detected (Group 1); (ii) worsening , if there were new findings (Group 2); and (iii) improvement , if there was normalization or reduction in severity (Group 3). Descriptive statistics, …multivariate controlled logistic regression, and kappa (k) statistics with 95% Confidence Interval (95% CI) were reported. RESULTS: Among 510 studied infants, 82.3% (95% CI 78.8–85.4) were in Group 1, 10.0% (95% CI 7.7–12.9) in Group 2, and 7.7% (95% CI 5.7–10.3) in Group 3. Overall agreement between the two scans was moderate (k 0.62; 95% CI 0.55–0.69). Worsening of CUS findings was associated with neonatal morbidities independently from gestational age and birth weight. The probability for worsening of CUS findings was higher in infants with an initial diagnosis of intraventricular hemorrhage (IVH) grade 2, than in those reported as no pathology/IVH grade 1 (Odds Ratio 5.79; 95% CI 2.42–13.91) or IVH grade 3–4 (Odds Ratio 3.81; 95% CI 1.10–13.21). CONCLUSIONS: In very preterm born infants, the initial CUS findings in combination with neonatal morbidities can help predict the brain lesions that are seen at the end of the first month of life and could be useful in their clinical management. Show more

Keywords: Neuropathology, serial cranial ultrasound, very preterm infants

DOI: 10.3233/NPM-1826

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 1, pp. 65-71, 2019

Authors: Singh, Ajay Pratap | Lakshminrusimha, Satyan | Thompson, Mark E.

Article Type: Research Article

Abstract: OBJECTIVE: The primary aim of this pilot study was to assess feasibility and to evaluate if peri-operative pain management with regional analgesia resulted in decreased use of narcotic medication and earlier return to preoperative respiratory/nutritional status. STUDY DESIGN: Cases were defined as infants who received regional analgesia as part of their perioperative anesthetic management. Controls were matched for surgical procedures without regional analgesia. RESULTS: Fifteen cases were identified and matched with 17 controls. Infants undergoing inguinal hernia repair returned to baseline earlier and were not intubated. There was no difference in time to …extubation in other thoracoabdominal surgeries. There was no difference in cumulative narcotic analgesia administered between the two groups. CONCLUSION: Postoperative regional analgesia is feasible in neonates. Inguinal hernia repair with regional anesthesia was performed without intubation and returned to preoperative status earlier. No differences were observed with other surgeries. Further prospective, randomized, multicenter studies are needed. Show more

DOI: 10.3233/NPM-1827

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 1, pp. 73-79, 2019

Authors: McMahon, K.E. | Habeeb, O. | Bautista, G.M. | Levin, S. | DeChristopher, P.J. | Glynn, L.A. | Jeske, W. | Muraskas, J.K.

Article Type: Research Article

Abstract: BACKGROUND: Numerous studies have examined the association between ABO blood groups and adult disease states, but very few have studied the neonatal population. The objective of this study was to determine the relationship between AB blood group and the occurrence of common neonatal disorders such as neutropenia at birth, sepsis, respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), and patent ductus arteriosus (PDA) compared to all other blood groups. METHODS: We performed a retrospective review on 3,981 infants born at 22 0/7 to 42 6/7 weeks’ gestational age and compared the relative risk of neonatal …diseases in infants with AB blood group to that of infants with all other blood groups (A, B, and O). RESULTS: When compared to all other blood groups, AB infants demonstrated an increased risk for developing negative clinical outcomes. AB blood group was significantly associated with a 14–89% increased risk of neutropenia at birth, sepsis, RDS, and ROP. Risks for IVH and PDA were not significant. CONCLUSION: We hypothesize that the phenotypic expression of A and B antigens, rather than the antigens themselves, in the AB group may reveal an enhanced susceptibility to injury at the endothelial level resulting in an increased risk for disease development. Show more

Keywords: ABO blood group, ABO antigens, neonatal disease, neonatal neutropenia, neonatal sepsis, endothelial injury

DOI: 10.3233/NPM-17115

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 1, pp. 81-86, 2019

Authors: Humphrey, J.D. | Hagan, J.L. | Suresh, G.K. | Sundgren, N.C.

Article Type: Research Article

Abstract: BACKGROUND: Guidelines exist for counseling expectant families of infants at periviable gestational ages (22–25 weeks), but it is much more common for neonatologists to counsel families at gestational ages beyond the threshold of viability when several aspects of these guidelines do not apply. We aimed to develop an understanding of what information is shared with mothers at risk of preterm delivery beyond periviability and to evaluate communication skills of our participants. METHODS: We developed a checklist of elements to include in counseling based on a comprehensive literature review. The checklist was divided into an information sharing section and …a connect score. The information sharing list was sub-divided into general information and specific complications. Neonatologists engaged in a simulated prenatal counseling session with a standardized patient. Videotaped encounters were then analyzed for checklist elements. RESULTS: Neonatologists all scored well in communication using our tool and two other validated communication tools - the SEGUE and the analytic global OSCE. There was no difference in scoring based on years of experience or level of training. Information sharing from neonatologists more often discussed general information over specific. Neonatologists also focused more on early outcomes over long-term outcomes. Only 12% of neonatologists quoted the correct survival rate for the case. CONCLUSIONS: Neonatologists generally communicate well but share less information specific to prematurity and the long-term sequelae of prematurity. Our tool may be used to test if other interventions improve information sharing or communication. Show more

Keywords: Prenatal consult, simulation, prenatal complications, communication

DOI: 10.3233/NPM-1857

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 1, pp. 87-94, 2019

Authors: Ajayi, O.O. | Davis, N.L. | Saleem, B. | Kapoor, S. | Okogbule-Wonodi, A.C. | Viscardi, R.M. | Sundararajan, Sripriya

Article Type: Research Article

Abstract: OBJECTIVE: To determine the relationships of red blood cell (RBC) transfusion and enteral feeding to changes in intestinal permeability (IP) measured by the relative intestinal uptake of lactulose (La) and rhamnose (Rh) in preterm infants <33 wk gestation. DESIGN/METHODS: Infants 240 –326 wk gestation received La/Rh solution enterally on study days 1, 8 and 15.Urinary La/Rh ratio was measured by HPLC. Hematocrit preceding transfusion, total RBC transfusion volume, volume/kg, and feeding status during each study interval (birth-d1; d1-d8, and d8-d15) were determined. RESULTS: Of the seventeen (40.5%) subjects who received≥1 transfusion during the study period, 12 (70.6%) …infants were <28 wk gestation and 5 (29.4%) infants were≥28 wk gestation, p  < 0.0001. Lower pre-transfusion hematocrit was observed in intervals preceding high IP (La/Rh > 0.05) than in intervals preceding low IP (La/Rh≤0.05) measurements (33 vs 35.8, p  = 0.1051 ). RBC transfusions occurred more frequently in intervals preceding high IP than in intervals preceding low IP (26.8%; vs 8.3%, p  = 0.0275 ) with 5-fold higher total RBC volume and volume/kg in intervals preceding any time point with high IP. RBC transfusion during an interval was associated with a three-fold increased risk of high IP (aOR 2.7; 95% C.I 0.564–12.814; p  = 0.2143 ). Exclusive breast milk exposure and post-menstrual age reduced the risk for high IP following RBC transfusion. CONCLUSIONS: Both RBC transfusion number and volume was associated with subsequent high IP measurements in preterm infants <33 weeks gestation and potentially may contribute to impairment of the preterm intestinal barrier. Show more

Keywords: Red blood cell transfusion, premature infants, intestinal permeability, enteral feeding

DOI: 10.3233/NPM-1828

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 1, pp. 95-101, 2019

Authors: Thakore, P. | Dunbar, A.E. | Lindsay, E.B.

Article Type: Case Report

Abstract: A 710 g male infant was born at a referring hospital at a gestational age of 23 weeks and 2 days via vaginal delivery and was transferred to our facility at 14 days of age. His delivery was complicated by the breech presentation with difficult head extraction. The infant’s initial course was significant for respiratory distress syndrome, grade III-IV intraventricular hemorrhage (IVH), acute kidney injury, and large PDA. On the day of life 29, a gradual increase in serum sodium level refractory to increasing total fluid volume was noted. The combination of persistent hypernatremia (150–160 mmol/l), polyuria (8.4 ml/kg/hr), high plasma osmolality (323 …mosm/kg), hyposthenuria (75 mosm/kg) and an undetectable serum ADH (<0.8 pg/ml) confirmed the diagnosis of central diabetes insipidus (CDI). Serum sodium and urine output decreased and urine osmolality increased after subcutaneous DDAVP administration. CDI is an uncommon cause of hypernatremia in the neonatal period. The diagnosis can be difficult as excessive urine output and high serum sodium can often be attributed to high insensible water loss in the extremely premature newborn. CDI in our patient was thought to be due to grade III-IV IVH complicated by post-hemorrhagic hydrocephalus. In conclusion, the diagnosis of central DI should be considered as a complication of severe IVH in the extremely premature neonate who demonstrates persistent hypernatremia, polyuria, decreased urine osmolality, and increased plasma osmolality. Serum ADH levels can be helpful in confirming the central origin of DI and subcutaneous desmopressin can be an effective treatment in the preterm infant. Show more

Keywords: Central diabetes insipidus, intraventricular hemorrhage, very low birth weight preterm infant

DOI: 10.3233/NPM-1837

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 1, pp. 103-107, 2019

Authors: Davidson, L. | Rawat, M. | Stojanovski, S. | Chandrasekharan, P.

Article Type: Case Report

Abstract: BACKGROUND: Mitragyna speciosa, also known as kratom, is obtained from the coffee plant family ‘Rubiaceae.’ Kratom is available in the form of capsules, whole, processed and powdered leaves, and as liquids. Secondary to its ‘natural herb’ status and opioid effects, it is misconceived to be a safe alternative for the treatment of chronic pain. The use of kratom has increased by tenfold in the United States since 2010. METHODS AND RESULTS: We report a term neonate who was born to a chronic kratom user and required treatment with opiates for neonatal drug withdrawal. CONCLUSION: Physicians should …be aware of these herbal supplements and its potential withdrawal effects in newborn which cannot be picked up by the standard toxicology screen. Show more

Keywords: Kratom, NAS – neonatal abstinence syndrome

DOI: 10.3233/NPM-1863

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 1, pp. 109-112, 2019