Journal of Neonatal-Perinatal Medicine - Volume 13, issue 4

Authors: Volpe, J.J.

Article Type: Editorial

Keywords: Severe IVH, brain injury, iron, prevention, systemic treatment

DOI: 10.3233/NPM-200539

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 4, pp. 435-439, 2020

Authors: White, Y.N. | Grant, P.E. | Soul, J.S. | Inder, T. | El-Dib, M.

Article Type: Research Article

Abstract: BACKGROUND: To evaluate the feasibility of a protocol using combined magnetic resonance imaging (MRI), clinical data, and electroencephalogram (EEG) to identify neonates with mild neonatal encephalopathy (NE) treated with therapeutic hypothermia (TH) who are eligible for “early exit”. METHODS: Retrospective chart review of TH cases at a single Level III NICU over a 5-year period was used to describe the demographic, clinical, and outcome data in neonates that received early exit in contrast to 72 hour TH treatment. RESULTS: Two hundred and eight TH cases, including 18 early exit cases (9%) and 9 cases (4%) evaluated …for early exit with MRI but continued on 72 hours of TH, were identified. Early exit and 72 hour treatment groups did not differ in demographics or cord gas measures, although early exit neonates had a shorter length of stay (p  < 0.05). Consistent with the early exit protocol, no early exit infants had evidence of moderate or severe encephalopathy on EEG or evidence of hypoxic ischemic injury on MRI at 24 hours of life. Neurology follow up between age 1 and 18 months was available for 10 early exit infants, 8 of whom had a normal examination. CONCLUSIONS: Early MRI at 24 hours of age, alongside clinical and EEG criteria, is feasible as part of a protocol to identify neonates eligible for early exit from therapeutic hypothermia. Show more

Keywords: Neonatal encephalopathy, hypoxic ischemic encephalopathy, therapeutic hypothermia, early exit

DOI: 10.3233/NPM-200458

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 4, pp. 441-447, 2020

Authors: Xu, E.H. | Claveau, M. | Yoon, E.W. | Barrington, K.J. | Mohammad, K. | Shah, P.S. | Wintermark, P. | Canadian Neonatal Network

Collaborators: Shah, Prakesh S | Kanungo, Jaideep | Ting, Joseph | Cieslak, Zenon | Sherlock, Rebecca | Yee, Wendy | Toye, Jennifer | Fajardo, Carlos | Kalapesi, Zarin | Sankaran, Koravangattu | Daspal, Sibasis | Seshia, Mary | Alvaro, Ruben | Mukerji, Amit | Da Silva, Orlando | Nwaesei, Chuks | Lee, Kyong-Soon | Dunn, Michael | Lemyre, Brigitte | Dow, Kimberly | Pelausa, Ermelinda | Barrington, Keith | Lapoint, Anie | Drolet, Christine | Piedboeuf, Bruno | Claveau, Martine | Beltempo, Marc | Bertelle, Valerie | Masse, Edith | Canning, Roderick | Makary, Hala | Ojah, Cecil | Monterrosa, Luis | Emberley, Julie | Afifi, Jehier | Kajetanowicz, Andrzej | Lee, Shoo K

Article Type: Research Article

Abstract: BACKGROUND: Birth asphyxia in term neonates remains a serious condition that causes significant mortality and long-term neurodevelopmental sequelae despite hypothermia treatment. The objective of this study was to review therapeutic hypothermia practices in a large population of neonates with hypoxic-ischemic encephalopathy (HIE) across Canada and to identify determinants of adverse outcome. METHODS: Our retrospective observational cohort study examined neonates≥36 weeks, admitted to the Canadian Neonatal Network NICUs between 2010 and 2014, diagnosed with HIE, and treated with hypothermia. Adverse outcome was defined as death and/or brain injury. Maternal, birth, and postnatal characteristics were compared between neonates with adverse …outcome and those without. The association between the variables which were significantly different (p  < 0.05) between the two groups and adverse outcome were further tested, while adjusting for gestational age, birth weight, gender, and initial severity of encephalopathy. RESULTS: A total of 2187 neonates were admitted for HIE; 52% were treated with hypothermia and 40% developed adverse outcome. Initial severity of encephalopathy (moderate, p  = 0.006; severe, p  < 0.0001), hypotension treated with inotropes (p  = 0.001), and renal failure (p  = 0.007) were significantly associated with an increased risk of death and/or brain injury. CONCLUSIONS: In asphyxiated neonates treated with hypothermia, not only their initial severity of encephalopathy on admission, but also their cardiac and renal complications during the first days after birth were significantly associated with risk of death and/or brain injury. Careful monitoring and cautious management of these complications is warranted. Show more

Keywords: Birth asphyxia, hypoxic-ischemic encephalopathy, brain injury, magnetic resonance imaging

DOI: 10.3233/NPM-190368

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 4, pp. 449-458, 2020

Authors: Mohammad, K.

Article Type: Research Article

Abstract: Examining pupil reaction to light is an important component of the neurological examination in infants with hypoxic ischemic encephalopathy (HIE) to determine eligibility for therapeutic hypothermia (TH) and as part of serial neurological assessment for prognostication. Pupil examination can be challenging in critically ill infants with generalized edema. In this paper I report a simple technique using bedside point of care ultrasound to examine the pupil reaction to light in an infant with moderate HIE undergoing therapeutic hypothermia.

DOI: 10.3233/NPM-190394

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 4, pp. 459-461, 2020

Authors: Alsaleem, M. | Hpa, N. | Kumar, V.H.S.

Article Type: Case Report

Abstract: BACKGROUND: Stridor is one of the rare side effects of neonatal hypothermia treatment for hypoxic-ischemic encephalopathy. We aimed to describe the clinical characteristics of the infants who underwent whole-body hypothermia and developed stridor. METHODS: We reviewed the medical records of 171 infants with moderate or severe hypoxic-ischemic encephalopathy who underwent hypothermia therapy. Demographics, as well as clinical characteristics, were documented. RESULTS: A total of 18 infants developed transient stridor out of 171 infants who underwent whole-body hypothermia (10.5%). The stridor was transient and resolved in all infants. All infants with stridor received treatment with one or …more of the following: racemic epinephrine, dexamethasone, positive pressure ventilation and/or heliox. Two infants required otorhinolaryngologist (ENT) evaluation due to persistent and severe symptoms, of whom one was found to have left vocal cord paresis that improved with time. CONCLUSION: Stridor is a transient complication associated with hypoxic-ischemic encephalopathy and whole-body hypothermia in neonates. The exact mechanism is unclear and most likely multifactorial. ENT evaluation is recommended in the presence of prolonged symptoms or significant respiratory distress. Show more

Keywords: HIE, cooling, stridor, hypothermia, airway, steroid, epinephrine

DOI: 10.3233/NPM-190332

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 4, pp. 463-468, 2020

Authors: Zhu, Y. | Mosko, J.J. | Chidekel, A. | Wolfson, M.R. | Shaffer, T.H.

Article Type: Research Article

Abstract: BACKGROUND: Hypothermia with xenon gas has been used to reduce brain injury and disability rate after perinatal hypoxia-ischemia. We evaluated xenon gas therapy effects in an in vitro model with or without hypothermia on cultured human airway epithelial cells (Calu-3). METHODS: Calu-3 monolayers were grown at an air-liquid interface and exposed to one of the following conditions: 1) 21% FiO2 at 37°C (control); 2) 45% FiO2 and 50% xenon at 37°C; 3) 21% FiO2 and 50% xenon at 32°C; 4) 45% FiO2 and 50% xenon at 32°C for 24 hours. Transepithelial resistance (TER) …measurements were performed and apical surface fluids were collected and assayed for total protein, IL-6, and IL-8. Three monolayers were used for immunofluorescence localization of zonula occludens-1 (ZO-1). The data were analyzed by one-way ANOVA. RESULTS: TER decreased at 24 hours in all treatment groups. Xenon with hyperoxia and hypothermia resulted in greatest decrease in TER compared with other groups. Immunofluorescence localization of ZO-1 (XY) showed reduced density of ZO-1 rings and incomplete ring-like staining in the 45% FiO2 – 50% xenon group at 32°C compared with other groups. Secretion of total protein was not different among groups. Secretion of IL-6 in 21% FiO2 with xenon group at 32°C was less than that of the control group. The secretion of IL-8 in 45% FiO2 with xenon at 32°C was greater than that of other groups. CONCLUSION: Hyperoxia and hypothermia result in detrimental epithelial cell function and inflammation over 24-hour exposure. Xenon gas did not affect cell function or reduce inflammation. Show more

Keywords: Calu-3, hyperoxia, hypothermia, xenon gas, hypoxic-ischemic, tight junction, inflammatory mediator, IL-6, IL-8

DOI: 10.3233/NPM-190364

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 4, pp. 469-476, 2020

Authors: Sardar, S. | Pal, S. | Mishra, R.

Article Type: Research Article

Abstract: BACKGROUND: Transient tachypnea of the newborn(TTNB) is the most common respiratory morbidity in late preterm and term babies and is pathophysiologically related to delayed lung fluid clearance after birth. Mimicking low physiological fluid intake in the initial period of life may accelerate the recovery from TTNB. In a randomized controlled trial, we compared the roles of restricted versus standard fluid management in babies with TTNB requiring respiratory support. METHODS: This parallel group,non-blinded, stratified randomized controlled trial was conducted in a level III neonatal unit of eastern India. Late preterm and term babies with TTNB requiring continuous positive airway …pressure (CPAP) were randomly allocated to standard and restricted fluid arms for the first 72 hours (hrs). Primary outcome was CPAP duration. RESULTS: In total, 100 babies were enrolled in this study with 50 babies in each arm. CPAP duration was significantly less in the restricted arm (48[42, 54] hrs vs 54[48,72] hrs, p  = 0.002). However, no difference was observed in the incidence of CPAP failure between the two arms. In the subgroup analysis, the benefit of reduced CPAP duration persisted in late preterm but not in term infants. However, the effect was not significant in the late preterm babies exposed to antenatal steroid. CONCLUSION: This trial demonstrated the safety and effectiveness of restrictive fluid strategy in reducing CPAP duration in late preterm and term babies with TTNB. Late preterm babies, especially those not exposed to antenatal steroid were the most benefitted by this strategy. Show more

Keywords: Late preterm newborn, term newborn, transient tachypnea of the newborn, restricted fluid strategy, continuous positive airway pressure, antenatal steroids

DOI: 10.3233/NPM-190400

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 4, pp. 477-487, 2020

Authors: Reiterer, Friedrich | Auinger, Julia | Urlesberger, Bernd

Article Type: Research Article

Abstract: BACKGROUND: Non-invasive, radiation free bedside monitoring methods have gained increased popularity in the respiratory field. The aim of our study was to report the experience with electrical impedance segmentography (EIS), a rather new technique, which allows continuous visual and quantitative monitoring of regional lung ventilation. METHODS: Prospective, pilot trial in spontaneously breathing, healthy, non-sedated term neonates between 24 and 72 hours post-delivery using a commercially available EIS-device. Systematic review of the literature. RESULTS: A total of 12 neonates were eligible for complete data analysis in our study. EIS was found to be a safe and easy …to perform method. The median duration of the study time was 25 minutes (16–40). Individual total and regional impedance values, given in arbitrary units and it's percentage of distribution in the upper and lower right and left lung segments (UR, UL, LR, LL), were variable (median total impedance 207 arbitrary units (AU), UR% 17, LR 27%,UL 28%, LL 23%). A number of influencing factors such as body movements, sucking, jawing, and electrode issues have to be considered for correct data interpretation. The literature search revealed two small experimental studies in neonatal piglets and two human studies (one study in preschool children with bronchopulmonary dysplasia and one case report in a neonate with respiratory distress). CONCLUSIONS: EIS is an innovative technique and a potentially useful tool in studying regional lung ventilation in research and clinical care. Show more

Keywords: Electrical impedance segmentography, electrical impedance tomography, neonates, regional lung ventilation, review

DOI: 10.3233/NPM-190347

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 4, pp. 489-494, 2020

Authors: Livingston, M.H. | Elliott, T. | Williams, C. | Jones, S.A. | Rosenbaum, P.L. | Walton, J.M.

Article Type: Research Article

Abstract: BACKGROUND: Glycerin suppositories are often used to facilitate meconium evacuation in premature infants. The evidence for this practice is inconclusive. The purpose of this study was to assess the feasibility of a multicenter randomized controlled trial on the effectiveness of this treatment strategy. STUDY DESIGN: We conducted an external pilot study for a multicenter randomized controlled trial of premature infants randomized to glycerin suppositories or placebo procedure. Participants were included if they were gestational age of 24 weeks 0 days to 31 weeks 6 days and/or birthweight of 500 to 1500 grams. We excluded infants with life-threatening congenital …anomalies, contraindications to receiving suppositories, or signs of clinical instability. Outcomes included cost, recruitment, and treatment-related adverse events. RESULT: A total of 109 were screened, 79 were initially eligible, and 34 consented to participate. Four of these infants were excluded prior to randomization due to thrombocytopenia, 30 were randomized, and 26 reached full enteral feeds. Three infants (10%) experienced rectal bleeding 5 to 43 days after completing study treatments. An anal fissure was noted in two of these patients. There were no cases of rectal perforation but one infant assigned to active treatment developed necrotizing enterocolitis. CONCLUSIONS: Conducting a multicenter randomized controlled trial on the use of glycerin suppositories in premature infants is feasible. Minor modifications to the study protocol are needed to increase participant recruitment and simplify the administration of study treatments. Show more

Keywords: Premature infants, glycerin, suppository, enteral feeding

DOI: 10.3233/NPM-190310

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 4, pp. 495-505, 2020

Authors: Asena, M. | Akelma, H. | Ziyadanoğulları, M.O.

Article Type: Research Article

Abstract: BACKGROUND: The aim was to investigate the maternal and fetal predisposing factors of clavicle fracture locations in newborns. METHODS: A retrospective evaluation was made of 77 clavicle fractures identified from a total of 33,480 live newborns between September 2016 and September 2018 at a single center in Turkey. Fractures were grouped according to the Allman classification: Group I mid third, Group II lateral distal third, Group III medial proximal third of the clavicle, respectively. Demographic features compared between the groups included maternal age, parity and height and infantile gestational age, gender, birth weight and length. Neonatal clinical features …were also compared between the three groups and included mode of delivery, Apgar score, fracture laterality, time to diagnosis, mode of diagnosis, and presence of symptoms of brachial plexus palsy. RESULTS: There were no statistically significant differences between the three groups when the demographic characteristics of the mothers and newborns were compared. In terms of clinical characteristics Group 3 contained a higher proportion of patients with symptoms of brachial plexus palsy than Group 1 (61.5% versus 22%, p  = 0.017). There was no statistically significant difference between Groups 2 and 3 and Groups 1 and 2. CONCLUSION: A significant association was found between the occurrence of brachial plexus palsy and fracture of the medial third of the clavicle (Allman type III). Show more

Keywords: Clavicular fracture, brachial plexus palsy, predisposing factors

DOI: 10.3233/NPM-190321

Citation: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 4, pp. 507-511, 2020