Journal of Neonatal-Perinatal Medicine - Volume 12, issue 4

Authors: Volpe, Joseph J.

Article Type: Editorial

Keywords: Prematurity, white matter injury, zinc, iron

DOI: 10.3233/NPM-190369

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 4, pp. 365-368, 2019

Authors: Ahmad, M.U. | Farrell, R.M. | Weise, K.L.

Article Type: Review Article

Abstract: In the realm of clinical ethics as well as in health policy and organizational ethics, the onus of our work as ethicists is to optimize the medical care and experience of the patient to better target ethical dilemmas that develop in the course of care delivery. The role of ethics is critical in all aspects of medicine, but particularly so in the difficult and often challenging cases that arise in the care of pregnant women and newborns. One exemplary situation is that when a pregnant woman and her partner consider neonatal organ donation after receiving news of a terminal diagnosis …and expected death of the newborn. While a newer, less practiced form of organ donation, this approach is gaining greater visibility as an option for parents facing this terminal outcome. The aim of our paper is to highlight some of the key ethical issues associated with neonatal organ donation and identify clinical and logistical aspects of implementing such an approach to facilitate organ donation. Show more

Keywords: Neonatal donation, organ transplantation, Donation after Neurologic determination of death (DND), Donation after Circulatory determination of Death (DCDD), pediatric patients

DOI: 10.3233/NPM-1850

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 4, pp. 369-377, 2019

Authors: El Farargy, M.S. | Soliman, N.A.

Article Type: Research Article

Abstract: BACKGROUND: Birth asphyxia is a leading case of neonatal morbidity and mortality especially in developing countries. Hypoxic-ischemic encephalopathy (HIE) attributed to asphyxia can be ameliorated with several remedies, although full recovery is currently not feasible. The aim of this trial on infants with HIE who are receiving melatonin therapy, is to assess the added effect of magnesium sulfate (MgSO4 ) on the expression of S100-B, a marker of brain injury. METHODS: This study is a randomized controlled trial on neonates with moderate HIE (Sarnat grade II). Infants were randomized into 2 groups; group1 who received MgSO4 and …melatonin; and group 2 who received melatonin only. Serum concentrations of S100-B were measured at baseline, and at days 2 and 6 of therapy. RESULTS: The study included 60 neonates of them 30 infants in group 1 and 30 infants in group 2. S100-B did not differ between groups 1 and 2 at enrollment (median = 13.5 vs 13.2, p  = 0.381). However, group 1 had lower concentrations of S100-B at 2 days (median = 8 vs 12, p  = 0.001) and at 6 days (median = 3 vs 10.5, p  < 0.001), respectively. Compared to baseline, S100-B decreased in in group 2 at day 6 (13.2 vs 10.5, p  = 0.011) but did not decrease at day 2 (13.2 vs 12, p  = 0.478). CONCLUSIONS: MgSO4 may have an added effect for the reduction in brain injury in infants with HIE who are receiving melatonin. Show more

Keywords: Hypoxia, neonate, magnesium sulfate

DOI: 10.3233/NPM-181830

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 4, pp. 379-384, 2019

Authors: Odo, K.E. | Odetunde, O.I. | Chinawa, J.M. | Okafor, H.U. | Aronu, A.E. | Adimora, G.N.

Article Type: Research Article

Abstract: OBJECTIVES: The objective of this study is to document and compare plasma electrolytes of asphyxiated newborns of different degree within 48 hours of life. STUDY DISIGN: A comparative cross-sectional study was conducted in the newborn special care unit at the University of Nigeria Teaching Hospital (UNTH), Enugu, South-East Nigeria. Sodium, potassium, bicarbonate and ionized calcium levels were estimated in the plasma samples of neonates with perinatal asphyxia of different degree and healthy newborns (control group) within 48 hours of birth. MAIN OUTCOME MEASURES: The plasma sodium, potassium, bicarbonate and ionized calcium levels were estimated in both, …the study subjects and controls. RESULTS: Mean plasma sodium level was significantly lower (134.93±5.24 mmol/l vs 141.90±3.36 mmol/l; P  < 0.05), mean plasma bicarbonate level was significantly lower (16.98±3.99 mmol/l vs 18.54±2.36 mmol/l; P  < 0.05), and mean plasma ionized calcium level was significantly lower (1.10±0.14 mmol/l vs 1.25 0.11 mmol/l; P  < 0.05) in subjects compared to controls while mean plasma potassium was significantly higher (5.07±0.93 mmol/l vs 4.65±0.51 mmol/l P  < 0.05) in subjects compare to controls. CONCLUSION: The tendency to have hyponatremia, hyperkalemia, acidosis and hypocalcemia is very high among the study subjects which underscores the need for great vigilance in electrolyte monitoring when managing an asphyxiated baby. Show more

Keywords: Perinatal asphyxia, electrolytes disorder, term babies, Apgar score

DOI: 10.3233/NPM-1839

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 4, pp. 385-389, 2019

Authors: Rana, Divya | Pollard, Leann | Rowland, Jonathan | Dhanireddy, Ramasubbareddy | Pourcyrous, Massroor

Article Type: Research Article

Abstract: BACKGROUND: To describe amplitude-integrated encephalogram (aEEG) characteristics of neonates with neonatal abstinence syndrome (NAS). METHODS: This is a prospective observational study. Newborns exposed to prenatal opioids and their gestational matched controls were included. A single-channel aEEG was obtained using Olympic 6000 CFM monitor. The background activity (continuous/discontinuous), the amplitudes (μ V) and the presence of sleep-wake cycle (SWC) were documented. RESULTS: A total of 59 infants, 23 with NAS and 36 controls were enrolled. All aEEG were completed within 48 hours of life prior to initiation of treatment. Birth weight and gestational age were similar in …both groups. An aEEG was abnormal (discontinuous pattern and/or absent SWC) in 78 % (18/23) of infants with NAS versus only 25% in control group (9/36), [OR 10.8, CI (2.7–46.5) P  < 0.001]. 61% of infants with NAS had discontinuous pattern [OR 7.8, CI (2–32) P  = 0.001] and 39% had absence of sleep-wake cycle [OR 7.1, CI (1.4–39.4) P  = 0.007]. CONCLUSIONS: A majority of infants with NAS have abnormal aEEG activity. Show more

DOI: 10.3233/NPM-1834

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 4, pp. 391-397, 2019

Authors: Munoz, J.L. | Bishop CNM, E. | Reider, M. | Radeva, M. | Hsich, G. | Singh, K.

Article Type: Research Article

Abstract: BACKGROUND: Spina bifida is the most common fetal anomaly of the central nervous system, which affects approximately 1:1000 live births in the United States. Myelomeningocele (MMC) is the most common presentation of spina bifida, representing half of these cases. Given the deformation to the spinal cord and the nerve roots, this defect may result in significant morbidity to infants and major life-long disabilities. In this study we aimed to identify maternal and fetal characteristics associated with expectant management or termination of pregnancy in the setting of antenatally diagnosed MMC. We hypothesized that the level of the defect would correlate with …patient’s decision to continue the pregnancy. METHODS: A retrospective cohort analysis was performed with patients who had presented to the Cleveland Clinic Fetal Care Center between 2005–2017. RESULTS: Our data showed 36% of patients with antenatal diagnosis of MMC elected for second trimester terminations versus 64% who chose to continue their pregnancy and deliver either by cesarean section or vaginal delivery. Based on ultrasound findings, there were no significant differences between these two groups. Maternal body mass index was significantly higher in those who continued pregnancies (p  = 0.036). In addition, the fetal diagnostic methods chosen by patients were significantly different. Those who elected to terminate were more likely to pursue amniocentesis (p  = 0.03) and less likely to opt for MRI characterization of the fetus (p  = 0.007). CONCLUSION: We conclude, in the setting of fetal MMC diagnosed during pregnancy, patients often rely less on the associated ultrasonographic findings. Personal decisions likely influence the choice of other fetal diagnostic modalities. Other than BMI, we did not see an association between maternal factors and decisions regarding second trimester pregnancy termination. Show more

Keywords: Spina bifida, termination, expectant management, fetal medicine, maternal care

DOI: 10.3233/NPM-180208

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 4, pp. 399-403, 2019

Authors: Ramadan, Mohamad K. | Fasih, Rana | Itani, Saadeddine | Salem Wehbe, Georges R. | Badr, Dominique A.

Article Type: Research Article

Abstract: BACKGROUND: Fetal well-being is assured during labor and delivery with the employment of electronic fetal heart monitoring (EFHM). In uncommon instances, maternal heart rate (MHR) instead of fetal heart rate (FHR) can be the source of signals on monitors (signal ambiguity) leading to erroneous interpretation and management. Information about MHR characteristics are comparatively inadequate. We aim to analyze and compare MHR and FHR characteristics during the first and second stages of labor. METHODS: A prospective cohort study was conducted in a single tertiary care center during a one year period. Fifty one healthy full term women with singleton …pregnancies during labor were enrolled. Uterine contractions, MHR and FHR were recorded simultaneously during both stages of labor by monitors designed for twin gestation. RESULTS: When compared to FHR, MHR had significantly lower baseline rate during 1st and 2nd stages (p  < 0.0001). It demonstrated also more marked beat-to-beat variability during both stages (p  < 0.0001). MHR showed significantly more accelerations (p  = 0.03 and p  = 0.008) and less decelerations (p  < 0.0001 and p  = 0.021) during 1st and 2nd stages respectively. CONCLUSIONS: All characteristic parameters and patterns produced by FHR could be mimicked by MHR as well, though, at different frequencies. Understanding EFHM patterns suspected to be MHR artefacts and the employment of modern monitors that simultaneously obtain and display FHR and MHR can unmask ambiguity and avert related misinterpretation problems. Similar studies should be conducted in high-risk groups where the potential for fetal hypoxia/acidosis is increased. Show more

Keywords: Cardiotocogram, fetal heart rate, intrapartum monitor, maternal heart rate, signal ambiguity

DOI: 10.3233/NPM-180044

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 4, pp. 405-410, 2019

Authors: Rathi, P. | Messina, C. | Mintzer, J.P.

Article Type: Research Article

Abstract: BACKGROUND: Few studies exist that have evaluated the effects of indomethacin dosing frequency as a factor associated with successful patent ductus arteriosus closure in very low birth weight neonates. The objective of this study is to determine if indomethacin dosing strategy is associated with efficacy for initial patent ductus arteriosus management in very low birth weight neonates. METHODS: This retrospective review compared every 12 hour and every 24 hour indomethacin regimens primarily for efficacy in initial patent ductus arteriosus management, defined as an absence of repeat medical and/or surgical treatment, and secondarily for safety in both univariate and …multivariate models. RESULTS: One hundred three very low birth weight neonates were included: 56 (54%) received every 12 hour and 47 (46%) underwent every 24 hour indomethacin dosing. Repeat medical and/or surgical patent ductus arteriosus treatment rates were similar between groups. Less ligation of the patent ductus arteriosus occurred with every 12 hour versus every 24 hour dosing (11% vs. 26%, p  = 0.05), though this effect was mitigated controlling for birth weight and gestational age. Renal function, respiratory outcomes, feeding outcomes, length of stay, and mortality were similar between groups. CONCLUSIONS: Neither the every 12 hour nor the every 24 hour indomethacin regimen demonstrated inferior efficacy or safety for initial management of patent ductus arteriosus. Further prospective analysis of indomethacin dosing strategy is warranted. Show more

Keywords: Indomethacin, neonate, patent ductus arteriosus, prematurity, very low birth weight

DOI: 10.3233/NPM-180148

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 4, pp. 411-417, 2019

Authors: Rocha, G. | de Lima, F. Flor | Machado, A. Paula | Guimarães, H. | Proença, E. | Carvalho, C. | Martins, L.G. | Martins, T. | Freitas, A. | Dias, C.P. | Silva, A. | Barroso, A. | Diogo, I. | Cassiano, G. | Ramos, H. | Abrantes, M.M. | Costa, P. | Salazar, A. | Vieira, F. | Fontes, D. | Barroso, R. | Marques, T. | Santos, V. | Scortenschi, E. | Santos, C. | Vilela, F. | Quintas, C. | The Hypertensive Disorders of Pregnancy Study Group:

Collaborators: Proença, Elisa | Carvalho, Carmen | Martins, Luís Guedes | Martins, Teresa | Freitas, Alice | Dias, Clara Paz | Silva, Albina | Barroso, Almerinda | Diogo, Isabel | Cassiano, Gonçalo | Ramos, Helena | Costa, Paula | Salazar, Anabela | Vieira, Filipa | Fontes, Dora | Marques, Tânia | Santos, Vera | Scortenschi, Ecaterina | Santos, Celeste | Vilela, Fernanda | Quintas, Conceição

Article Type: Research Article

Abstract: INTRODUCTION: Several studies assessed the influence of a low birth weight on bronchopulmonary dysplasia (BPD), but not all could find a significant association. Our aim was to assess the association between low birth weight and BPD in preterm infants, prospectively recruited at 11 level III Portuguese neonatal centers. METHODS: Obstetrical and neonatal data on mothers and preterm infants with gestational ages between 24 and 30 weeks, born during 2015 and 2016 after a surveilled pregnancy, were analyzed. Neonates were considered small for gestational age (SGA) when their birthweight was below the 10th centile of Fenton's growth chats and …BPD was defined as the dependency for oxygen therapy until 36 weeks of corrected age. Statistical analysis was performed using IBM SPSS® statistics 23 and a p -value <0.05 was considered statistically significant. RESULTS: Out of 614, a total of 494 preterm infants delivered from 410 women were enrolled in the study; 40 (8.0%) infants with SGA criteria. SGA were more often associated with a single pregnancy, had greater use of antenatal corticosteroids, increased prevalence of gestational hypertensive disorders, C-section, rupture of membranes below 18 hours, rate of intubation in the delivery room, use of surfactant treatment, oxygen therapy, mechanical ventilation need, BPD, cystic periventricular leukomalacia, nosocomial sepsis and pneumonia; had lower prevalence of chorioamnionitis, and lower Apgar scores. The multivariate analysis by logistic regression, adjusted for BPD risk factors revealed a significant association between SGA and BPD: OR = 5.2 [CI: 1.46–18.58]; p  = 0.01. CONCLUSION: The results of this study increase the scientific evidence that SGA is an independent risk factor for BPD. Show more

DOI: 10.3233/NPM-180129

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 4, pp. 419-427, 2019

Authors: Kushnareva, M.V. | Keshishyan, E.S. | Balashova, E.D.

Article Type: Research Article

Abstract: BACKGROUND: The frequency of bronchopulmonary dysplasia (BPD) in preterm infants with a “ventilator-associated” pneumonia (VAP) ranges between 7 to 50%. OBJECTIVE: To investigate the features of the etiological structure of neonatal pneumonia complicated by BPD, and to determine the sensitivity of pathogens to antibiotics. METHODS: A retrospective chart review of 194 preterm infants with VAP, birth weight from 780 to 2820 g and gestational age from 27 to 37 weeks was conducted. A microbiological study of washings from the respiratory tract was conducted by standard qualitative and quantitative methods. RESULTS: Respiratory tract infections caused …by E. coli (with hemolytic properties), Enterococcus spp. (with hemolytic properties), Pseudomonas aeruginosa, Stenotrophomonas maltophilia , various types of mycoplasmas , Staphylococcus aureus , and Candida krusei were found 4– 13 times more frequent in preterm infants with BPD than in preterm infants without BPD and more mature infants with or without this complication. BPD developed 7– 11 times more frequent in preterm infants with prolonged VAP and change in pathogens than in preterm infants with VAP without change of agent. BPD developed 5– 7 times more frequent in preterm infants with the association of pathogens than in preterm infants with a monoinfection. Massive colonization of respiratory tract pathogens by 1– 3 days of life (lg4 colony forming units in 1 ml and above) was an unfavorable prognostic factor for the development of VAP, complicated by BPD. CONCLUSION: The reduction in the frequency of BPD is might be possible with timeous and adequate antibacterial therapy of VAP. Show more

Keywords: Preterm infants, pneumonia, bronchopulmonary dysplasia, microorganisms, antibiotics

DOI: 10.3233/NPM-17159

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 4, pp. 429-436, 2019