Journal of Neonatal-Perinatal Medicine - Volume 14, issue 2

Authors: Volpe, J. J.

Article Type: Article Commentary

Keywords: Infantile SMA, previously invariably fatal, groundbreaking therapies

DOI: 10.3233/NPM-200680

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 2, pp. 153-157, 2021

Authors: Hoffman, Julien I.E.

Article Type: Article Commentary

Abstract: BACKGROUND: The benefits of closing the ductus arteriosus in very preterm infants have not been convincingly shown in numerous clinical trials. Because a large untreated ductus arteriosus can cause death from congestive heart failure in infants born at term, we need to explain why this might not occur in premature infants born at <28 weeks’ gestation. METHODS: Based on information in the literature, I have commented on the possible relationship between the pulmonary vasculature and the shunt through the patent ductus arteriosus. RESULTS: Many of these infants have bronchopulmonary dysplasia, in which animal and human studies …have shown a reduced number of capillaries and small pulmonary arteries as well as reduction in vascular endothelial growth factor (VEGF) and platelet endothelial cell adhesion molecule-1 (PECAM-1). Both of these import angiogenic factors. Some who do not have bronchopulmonary dysplasia may have a restricted pulmonary vascular bed. CONCLUSIONS: The increased pulmonary vascular resistance in very premature infants may restrict pulmonary blood flow even if the ductus is large, thus reducing the urgency for ductus closure. Show more

Keywords: Angiogenesis, VEGF, pulmonary vascular resistance, bronchopulmonary dysplasia

DOI: 10.3233/NPM-190278

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 2, pp. 159-161, 2021

Authors: Raina, R. | DeCoy, M. | Chakraborty, R. | Mahajan, S. | Moran, R. | Gibson, K. | Kumar, D. | Bergmann, C.

Article Type: Review Article

Abstract: Renal cystic diseases are a clinically and genetically diverse group of renal diseases that can manifest in utero , infancy, or throughout childhood and adulthood. These diseases may be unilateral or bilateral with a single cyst or multiple cysts, or with increased echogenicity of the renal cortex without macroscopic cysts. Certain cystic renal diseases are life-threatening, with many developing chronic kidney and hepatic disease if not recognized early enough. Therefore, due to the prevalence and life-altering complications of this specific group of diseases in vulnerable populations, it is crucial for clinicians and healthcare providers to have an overall understanding of …cystic diseases and how to pre-emptively detect and manage these conditions. In this review, we discuss in detail the epidemiology, genetics and pathophysiology, diagnosis, presentation, and management of numerous genetic and sporadic renal cystic diseases, such as polycystic kidney disease, multicystic dysplastic kidney, and calyceal diverticula, with an emphasis on prenatal care and pregnancy counseling. Show more

Keywords: Cystic disease, perinatal, neonatal, renal, ARPKD, ADPKD

DOI: 10.3233/NPM-200520

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 2, pp. 163-176, 2021

Authors: Go, H. | Saito, Y. | Maeda, H. | Maeda, R. | Yaginuma, K. | Ogasawara, K. | Kashiwabara, N. | Kawasaki, Y. | Hosoya, M.

Article Type: Research Article

Abstract: BACKGROUND: The fetal brain is vulnerable to severe and sustained hypoxia during and after birth, which can lead to hypoxic-ischemic encephalopathy (HIE). HIE is characterized by clinical and laboratory evidence of acute or subacute brain injury. The role of cytokines in the pathogenesis of brain injury and their relation to neurological outcomes of asphyxiated neonates are not fully understood. In this study, we investigated cytokine profile related to cerebral palsy (CP) with neonatal hypoxic ischemic encephalopathy (HIE) and HIE severity. METHODS: Eligible subjects were HIE newborns with a gestational age between 36 and 42 weeks. We included newborns …who was born at our NICU and did not admit to NICU as healthy controls. The study comprised 52 newborns, including 13 with mild to severe HIE and 39 healthy control. Serum cytokine profiles were performed using a LUMINEX cytokine kit (R&D Systems). RESULTS: VEGF, MCP-1, IL-15, IL-12p70, IL-12p40, IL-1Ra, IL-2, IL-6, IL-7, IL-8, IL-10, IFN-γ , G-CSF and eotaxin in the HIE patients were significantly increased compared with the healthy neonates. In the subgroup analysis, IL-6 and G-CSF were significantly increased in CP infants (n  = 5) compared with non-CP infants (n  = 8). Five and eight HIE patients were classified into the mild HIE and moderate-severe HIE groups, respectively. IL-6, 10, 1Ra, and G-CSF in the moderate-severe HIE group were significantly higher than those in the mild HIE group. CONCLUSION: We demonstrated that higher serum IL-6 and G-CSF at birth in HIE patients were associated with CP and moderate-severe HIE. Show more

Keywords: Cytokine, hypoxic ischemic encephalopathy, IL-6

DOI: 10.3233/NPM-200431

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 2, pp. 177-182, 2021

Authors: Bischoff, Adrianne R. | Grass, Beate | Fan, Chun-Po Steve | Tomlinson, Christopher | Lee, Kyong-Soon

Article Type: Research Article

Abstract: OBJECTIVE: Postoperative hyperglycemia has been shown to be associated with higher morbidity and mortality in pediatric patients. Data on risk factors for neonatal patients is limited. The objective of this study was to identify pre- and intraoperative risk factors associated with postoperative glucose in neonates. METHODS: We conducted a retrospective cohort study of neonates after surgical procedures between January and December 2016 in a quaternary neonatal intensive care unit. The primary outcome was hyperglycemia defined as serum glucose ≥8.3 mmol/L during the first 4 hours postoperatively. Secondary outcomes included death and length of stay. We assessed the association of …risk factors with the postoperative glucose. RESULTS: In total, 206 surgical procedures (171 patients) were evaluated, among which 178 had serum glucose values during the first 4 hours postoperatively available. The incidence of hyperglycemia was 54% (n  = 96). The median (IQR) glucose during the first 4 hours in NICU was 8.4 (6.52–10.65) mmol/L. Risk factors for postoperative hyperglycemia were intraoperative glucose infusion rate (GIR) and gestational age. There was a non-linear relationship between gestational age and postoperative hyperglycemia. Mortality occurred in 6 (7%) in the no-hyperglycemia group and 3 (3%) in the hyperglycemia group (p  = 0.31). CONCLUSIONS: Among the risk factors, intraoperative GIR was identified as a modifiable factor that can reduce postoperative hyperglycemia. A non-linear relationship of gestational age with postoperative glucose provides new insights that may help advance our understanding of the complex mechanisms of glucose homeostasis in neonates. Show more

Keywords: Hyperglycemia, neonates, postoperative, surgery, glucose infusion rate

DOI: 10.3233/NPM-200535

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 2, pp. 183-191, 2021

Authors: Hwarng, G. Y. H. | Ereno, I. L. | Ho, S. K. Y. | Allen, J. C. | Moorakonda, R. B. | Yeo, C. L.

Article Type: Research Article

Abstract: BACKGROUND: Parent-completed tools like the Ages and Stages Questionnaire Third Edition (ASQ-3) are important in developmental screening. As a screening tool, a high negative predictive value (NPV) is critical to avoid missing the diagnosis of developmental delay. This study evaluated the NPV and accuracy of the ASQ-3 in assessing the development of preterm infants. METHODS: Infants born at <32 weeks and/or <1250 grams, presenting to the Neonatal Neurodevelopmental Clinic at the Singapore General Hospital for follow-up from January 2014 to June 2017, at 6, 12, and 18 months corrected age, were included. The ASQ-3 and standardized tests – …Peabody Developmental Motor Scale-Second Edition (PDMS-2) and Preschool Language Scale, Fourth Edition UK (PLS-4 UK) – were administered. ASQ-3 gross motor and fine motor scores were compared to PDMS-2 at 6 and 12 months, and ASQ-3 communication scores to PLS-4 UK at 18 months. RESULTS: At 6 months (n  = 145), NPV for gross motor and fine motor were 96.4% (accuracy 80.0%) and 95.4% (accuracy 77.2%) respectively. At 12 months (n  = 127), NPV for gross motor and fine motor were 88.9% (accuracy 79.8%) and 82.8% (accuracy 74.0%) respectively. At 18 months (n  = 113), NPV for language was 56.9% (accuracy 63.7%). CONCLUSIONS: The ASQ-3 showed high NPV and accuracy in screening gross motor and fine motor skills at 6 and 12 months, but not in screening language skills at 18 months. Judicious use of the ASQ-3 may allow for more effective utilization of resources. Show more

Keywords: Developmental, accuracy, ASQ-3, prematurity

DOI: 10.3233/NPM-200449

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 2, pp. 193-202, 2021

Authors: Miralha, A.L. | Chermont, A.G. | Orlandi, P.P. | Rugolo, L.S. | Sant’Anna, G.

Article Type: Research Article

Abstract: BACKGROUND: Brazil is a large country with an elevated incidence of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) during pregnancy and variable access to health care. The objective of the study was to identify ophthalmia neonatorum prophylaxis practices in the country. METHODS: A prospective multidisciplinary survey was conducted using a closed social media group. Fifteen questions were developed after literature review. Specific content included categorization of respondents and practices such as type of medication, age at administration, occurrence of clinical and/or chemical conjunctivitis and microbiology identification. Questions were multiple choice, but some allowed written …response. RESULTS: A total of 1.015 professionals responded, representing 24 states (92%) and 181 cities; mainly neonatologists (64%) and general pediatricians (21%). 96% of respondents reported performing prophylaxis at their institutions, mostly at birth or <1 h of life (99%), and regardless the mode of delivery (73%). Frequently used medications are: 1% silver nitrate (64%), 2.5% povidone iodine (18%) or 10% silver vitelinate (12%), with some regional variations. Occurrence of chemical conjunctivitis was stated by 58% of the respondents and microbiology identification was unusual. CONCLUSIONS: Ophthalmia neonatorum prophylaxis Brazil is almost universal and mainly performed by the use of anti-septic medications, with some regional variability. However, identification and treatment of CT and NG in both parents and newborns is not accomplished. Show more

DOI: 10.3233/NPM-200503

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 2, pp. 203-211, 2021

Authors: Aziz, Khyzer B. | Jelin, Angie C. | Keiser, Amaris M. | Schulkin, Jay | Jelin, Eric B.

Article Type: Research Article

Abstract: BACKGROUND: Congenital pulmonary airway malformation (CPAM) is the most common prenatally-diagnosed lung malformation. This lesion, classified as macrocystic or microcystic, can lead to significant fetal compromise. Management options include observation, maternal antenatal steroid administration, and fetal surgical intervention. Current evidence suggests that microcystic (but not macrocystic) lesions and those with a cyst volume ratio (CVR) >1.6 are responsive to steroid therapy. The objective of this study was to identify patterns of prenatal steroid administration for the management of CPAMs and to identify characteristics of CPAMs prompting steroid administration. METHODS: An 18-question survey was distributed to obstetricians from the …Pregnancy-Related Care Research Network (PRCRN) and the North American Fetal Therapy Network (NAFTNet), from January to April 2019, to capture antenatal steroid prescribing patterns. RESULTS: Response rates were 28.3% (138/487) for PRCRN and 63.3% (19/30) for NAFTNet. Among PRCRN members, 16.8% administered prenatal steroids, with most (77.2%) doing so for both microcystic and macrocystic CPAMs; corresponding percentages for NAFTNet members were 90.9% and 52.6%. Two thirds (65.6%) of obstetricians who administer steroids do so for a CVR > 1.6, without evidence of mediastinal shift or hydrops fetalis. CONCLUSIONS: There is a lack of consensus among obstetricians as to the CPAM characteristics that should prompt administration of prenatal steroids. Many surveyed obstetricians do not use cyst type or CVR to guide decision-making regarding steroid therapy. Show more

Keywords: Survey, CPAM, steroids, CVR

DOI: 10.3233/NPM-200526

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 2, pp. 213-222, 2021

Authors: Elbeely, S.H. | AlQurashi, M.A.

Article Type: Research Article

Abstract: BACKGROUND: Very low birth weight infants born prematurely are at greater risk for growth delays that lead to Ex-utero Growth Restriction (EUGR) during vulnerable periods of organ structural and functional development. There is considerable evidence that early growth failure has adverse effects on long term neurodevelopment in children which often persists into adulthood. METHODS: This is a single-center cross-sectional study on live newborn infants with birth weight ranges from 500 to 1500 grams (VLBW) and gestational age (GA) between 24–32 weeks who were admitted to NICU at KAMC-Jeddah over a 5 year period (2009–2013). This study aims to …evaluate predischarge growth pattern of VLBW infants in terms of weight, head circumference (HC) and length and to identify important variables that have influenced such growth pattern. RESULTS: Of the 135 infants included in the final analysis, 68 (50.4%) were male and 67 (49.6%) were female and the mean gestational age was 28.83±2.064 weeks and the mean birth weight 1166.74±256 grams. Ninety-two infants (68%) had discharge weight at ≤10th percentile and forty four (32%) had their weight >10th percentile. HC was the lowest affected among the anthropometric measurements with 42% ≤10th percentile. In terms of linear growth, 62% had their length ≤10th percentile. Amongst infants born ≤750 grams, 71% and 70% had HC and height at ≤10th percentile respectively, at the time of discharge. BPD was significantly associated with EUGR (p  = 0.026). CONCLUSIONS: This study demonstrates that almost 2/3rd of VLBW infants born at KAMC-Jeddah with birth weight ≤750 grams were discharged home with EUGR as demonstrated by their weight, length, and HC ≤10th percentile. BPD was found to be significantly associated with EUGR amongst post-natal factors influencing EUGR. Show more

Keywords: Pre-discharge, growth pattern, very low birth weight, Saudi Arabia

DOI: 10.3233/NPM-200592

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 2, pp. 223-228, 2021

Authors: Gupta, S. | Patwardhan, G. | Parikh, T. | Kadam, S. | Vaidya, U. | Pandit, A.

Article Type: Research Article

Abstract: BACKGROUND: Umbilical venous catheters (UVC) and peripherally inserted central catheters (PICC) are commonly used in preterms. UVC is cheap, easy to insert but has shorter dwell time. UVC is replaced after 7 days due to the risk of complications. This is associated with increased cost, work, and risk of nosocomial infections. The aim of this study was to determine the antenatal and postnatal factors that predict the need for a central line for more than 7 days, thus helping select between UVC or PICC on day 1 of life in babies ≤1500 grams. METHODS: We retrospectively collected antenatal …and postnatal data of VLBW neonates over a period of 1 year who needed CL during their NICU stay. We then divided them into two cohorts. Group 1: CL ≤7 days. Group 2: CL > 7 days. RESULTS: Sepsis and catheter complications were lower with use of a single CL or duration being ≤7 days. Birth weight, incomplete/no antenatal steroids, need for resuscitation, low Apgar’s, RDS, hs-PDA, and initiation of feeds beyond 24 hours of birth were significant. The score was devised based on factors found significant that had an acceptable AUC of 0.767 on ROC analysis with a score of 1 or above having 74.8% sensitivity and 67.7% specificity for prediction of need for CL > 7 days. CONCLUSIONS: Birth weight ≤1000 grams, incomplete steroids and need for resuscitation at birth were predictive of the need of CL beyond seven days, on day one of life. Show more

Keywords: Preterms, long lines, umbilical line, peripherally inserted central catheter

DOI: 10.3233/NPM-190379

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 2, pp. 229-235, 2021

Authors: Rakha, S. | Elmarsafawy, H.

Article Type: Research Article

Abstract: BACKGROUND: Despite advances in managing nonimmune hydrops fetalis (NIHF), perinatal mortality is still significant. Fetal cardiac failure eventually occurs regardless of etiology. However, no previous study has addressed NIHF from fetal cardiologists’ perspective. Therefore, we evaluated etiology and management of a NIHF cohort requiring fetal cardiologist consultation in a developing country. METHODS: A single-center retrospective cohort study of 70 cases with NIHF that were referred to a fetal cardiology unit over four years was performed. Demographics, etiologic diagnosis, and outcomes of the cases were assessed. Antenatal management was evaluated using cardiovascular profile score (CVPS). RESULTS: The …most frequent diagnosis was Idiopathic hydrops 42(62.6%), followed by hydrops due to cardiac diseases 19(28.4%), and 3 dead fetuses were detected at the first fetal echocardiography. Treatment of fetal tachyarrhythmia (n  = 7) had 100% success rate in terms of antenatal hydrops resolution. Digoxin was used in cases of structural heart diseases, twin- twin transfusion syndrome, and dilated cardiomyopathy with perinatal mortality occurring in all cases (n  = 9). In cases of idiopathic hydrops, 14 fetuses received digoxin with intrauterine hydrops resolution in 2/14 (14%) while non-treated cases had intrauterine or early neonatal death. CONCLUSION: Nonimmune hydrops is the worst complication of diverse etiologies. Limitations in resources for advanced investigations in developing countries increase the possibility of categorizing NIHF as idiopathic. Tachyarrhythmia induced hydrops can be entirely reversed with antenatal therapy while non-tachyarrhythmia fetal cardiac disease outcomes are unfavorable regardless of therapy. On the other hand, idiopathic hydrops shows a limited potential response to digoxin in utero. Show more

Keywords: Antenatal management, fetal cardiology, hydrops fetalis

DOI: 10.3233/NPM-200491

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 2, pp. 237-244, 2021

Authors: Asghar, I. | Khan, I.A. | Hassan, F.

Article Type: Research Article

Abstract: BACKGROUND: Phototherapy is the primary treatment for hyperbilirubinemia in neonates. Hypocalcemia is a lesser known but potential detrimental effect of phototherapy. It has been hypothesized that phototherapy inhibits pineal secretion of melatonin, which blocks the effect of cortisol on bone calcium. Therefore, unchecked cortisol increases bone uptake of calcium and induces hypocalcemia. Covering head during phototherapy in order to prevent light reaching to the pineal gland which eventually leads to the prevention of hypocalcemia is hypothesized to prevent hypocalcemia but it lacks sufficient evidence worldwide. METHOD: It is a prospective, randomized controlled study. 112 neonates were randomized into …two groups of 56 neonates. Group A underwent phototherapy without head cover and group B with head covered by a cap. RESULT: The mean decline in serum ionic calcium after 48 hours of phototherapy in group A and group B was 0.57±0.37 mg/dl and 0.34±0.24 mg/dl respectively. This decline in serum ionic calcium was significantly higher in group A. (p  < 0.001). 26.8% newborns from group A developed hypocalcemia while in group B only 14.3% developed hypocalcemia however it was not found to be statistically significant. Incidence of symptomatic hypocalcemia between the two groups was also not significant. CONCLUSION: There was significant reduction in serum calcium in neonates undergoing phototherapy without head cover as compared to neonates with head cover but risk of hypocalcemia was not significant. Further studies with larger sample size including preterm are recommended. Show more

Keywords: Calcium, head covering, hypocalcemia, neonate, newborn, phototherapy

DOI: 10.3233/NPM-200442

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 2, pp. 245-251, 2021

Authors: AlQurashi, M.A.

Article Type: Research Article

Abstract: BACKGROUND: Newborn infants with birth weight less than 1500 grams defining very low birth weight (VLBW) constitute 1.2–1.5% of total live births and 15–20% of all admissions to neonatal units. Advances in antenatal care, care at delivery, and neonatal practice over the past few decades, have substantially improved outcomes in VLBW infants, and reduced neonatal mortality. METHODS: A retrospective single tertiary care center cohort study of VLBW infants with gestational age between 23–33 weeks admitted to the neonatal intensive care unit (NICU) in King Abdulaziz Medical City, Jeddah (KAMC-J) between January 1, 1994, and December 31, 2019 (26 …years). The trends of survival of VLBW infants and major changes in clinical practice of premature care over a period of 26 years were evaluated. RESULTS: Over a period of 26 years, 1,247 VLBW infants were admitted to the NICU that represents 1.43% (1.25–1.83%) of total live births. 50.80% (n  = 634) were male, whereas the 49.2% (n  = 613) were female. Among them, 1013 (81.2%) were discharged home alive. There was a significant and progressive improvement in the survival rate of VLBW infants over a 26-year period from 66.83% in period 1 (1994 –1998) to 90.0 % in period 5 (2014 –2019), which represents a 34.67% total improvement rate. The improvement in survival rates was observed in all gestational ages between 23–33 weeks, particularly in infants weighing ≤750 grams and ≤1000 grams, and with gestational age between 23–27 weeks. Infants with a gestational age of ≤26 weeks and birth weight ≤750 grams delivered by cesarean section had a higher survival rate. Moreover, female infants with a gestational age of ≤26 weeks and birth weight ≤750 grams had a higher survival rate compared to males but not statistically significant. CONCLUSIONS: The survival rate of VLBW infants had improved significantly over the past 26 years (1994 –2019). This is attributed mainly to the improved survival of ELBW infants (<1000 grams) and gestational age of ≤26 weeks. Show more

Keywords: Survival rate, very low birth weight, low birth weight, premature, prematurity, Saudi Arabia

DOI: 10.3233/NPM-200595

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 2, pp. 253-260, 2021

Authors: Dianova, E. | Fogel, J. | Verma, R.P.

Article Type: Research Article

Abstract: BACKGROUND: The aim was to assess the predictability of transcutaneous bilirubinometry in late preterm and term neonates at risk for pathological hyperbilirubinemia, and to identify the neonatal population in which transcutaneous bilirubin most accurately predicts serum bilirubin level (SB, mg/dl). METHODS: The correlations between transcutaneous bilirubin (TCB, mg/dl) and SB in different neonatal population subsets; and between Δ TSB (TCB-SB) and relevant neonatal variables and clinical groups were analyzed. RESULTS: TCB correlated with SB (r  = 0.82, p  < 0.05) in the cohort (n  = 350) and in population subsets (r  = 0.81–0.9, p  < 0.001). Black infants with gestational age …(GA) >35 weeks and chronological age (CA) >3 days recorded strongest correlation (r  = 0.9, p  < 0.001) followed by Blacks, and non-Black infants with CA >3 days and GA >35 weeks. Δ TSB was positive in Blacks, and in infants with CA <3 days, or with no phototherapy. Δ TSB was negative in non-Blacks, in infants with positive direct Coombs test (DC+) or those receiving phototherapy. Black race [beta (SE) = 1.3(0.33), p  < 0.001] had positive, while CA [beta (SE) =−1.74 (0.36), p  < 0.001], DC + status [beta (SE) =−0.72 (0.25), p  = 0.004] and receipt of phototherapy [beta (SE) =−0.84 (0.21), p  < 0.001] each had negative correlation with Δ TSB. Δ TSB for Blacks was >Whites, Hispanics and Asians. CONCLUSION: SB is best predicted by TCB in Black infants with CA over 3 days and GA over 35 weeks. Variability in SB estimation by TCB is race, CA and immune mediated hemolysis specific. Show more

Keywords: Transcutaneous bilirubinometry, transcutaneous bilirubin, serum bilirubin, neonatal hyperbilirubinemia, predictability, black race, immune mediated hemolysis, gestational age, chronological age

DOI: 10.3233/NPM-200486

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 2, pp. 261-267, 2021

Authors: Aviles-Otero, N. | Ransom, M. | Weitkamp, J. | Charlton, J.R. | Sullivan, B.A. | Kaufman, D.A. | Fairchild, K.D.

Article Type: Research Article

Abstract: BACKGROUND: Increased understanding of characteristics of urinary tract infection (UTI) among very low birthweight infants (VLBW) might lead to improvement in detection and treatment. Continuous monitoring for abnormal heart rate characteristics (HRC) could provide early warning of UTIs. OBJECTIVE: Describe the characteristics of UTI, including HRC, in VLBW infants. METHODS: We reviewed records of VLBW infants admitted from 2005–2010 at two academic centers participating in a randomized clinical trial of HRC monitoring. Results of all urine cultures, renal ultrasounds (RUS), and voiding cystourethrograms (VCUG) were assessed. Change in the HRC index was analyzed before and after …UTI. RESULTS: Of 823 VLBW infants (27.7±2.9 weeks GA, 53% male), 378 had > / = 1 urine culture obtained. A UTI (≥10,000 CFU and >five days of antibiotics) was diagnosed in 80 infants, (10% prevalence, mean GA 25.8±2.0 weeks, 76% male). Prophylactic antibiotics were administered to 29 (36%) infants after UTI, of whom four (14%) had another UTI. Recurrent UTI also occurred in 7/51 (14%) of infants not on uroprophylaxis after their first UTI. RUS was performed after UTI in 78%, and hydronephrosis and other major anomalies were found in 19%. A VCUG was performed in 48% of infants and 18% demonstrated vesicoureteral reflux (VUR). The mean HRC rose and fell significantly in the two days before and after diagnosis of UTI. CONCLUSIONS: UTI was diagnosed in 10% of VLBW infants, and the HRC index increased prior to diagnosis, suggesting that continuous HRC monitoring in the NICU might allow earlier diagnosis and treatment of UTI. Show more

DOI: 10.3233/NPM-200513

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 2, pp. 269-276, 2021

Authors: Patodia, J. | Mittal, J. | Sharma, V. | Verma, M. | Rathi, M. | Kumar, N. | Jain, R. | Goyal, A.

Article Type: Research Article

Abstract: BACKGROUND: Hypothermia at admission to neonatal intensive care units (NICU) is associated with increased morbidity and mortality in newborns. A baseline study at a tertiary care hospital with all out-born babies showed admission hypothermia of 82%. OBJECTIVE: To reduce admission hypothermia (moderate) in newborns at least by 50% in next 6 months. METHODS: A quality improvement (QI) study was planned using WHO Point of Care Quality Improvement Model (POCQI), [17 ] using PDSA (Plan-Do-Study-Act) cycle approach from April 2018 to March 2019, and including 427 term and preterm babies. We educated the staff, reinforced the use …of caps, cling wraps, warm linen, introduced Ziploc bags and ensured adequate use of transport incubator. RESULTS: After 6 months, overall admission hypothermia decreased from 82% to 45%, moderate hypothermia reduced from 46% to <10% (P  < 0.001) and severe hypothermia (3%) was completely eliminated. There was also significant reduction in incidence of Intraventricular hemorrhage (13% Vs 4.7%), Late onset neonatal sepsis (38% Vs 19%) and metabolic acidosis (43% Vs 28%). We were able to sustain this improvement for the next 6 months and is ongoing. The strongest predictor of hypothermia was newborns being in the phase before QI initiative was started (OR 2.36, 95% CI 1.47, 3.23). CONCLUSION: This study is a cost effective approach in reducing admission hypothermia in NICU in a resource limited setting with all outborn babies, and further decreasing the morbidity associated with it. Hence, emphasizing the importance of maintaining euthermia, not only in delivery rooms, but also during transportation. Show more

Keywords: Admission hypothermia, NICU, quality improvement, PDSA

DOI: 10.3233/NPM-190385

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 2, pp. 277-286, 2021

Authors: Harvey, S. | Ryan, S. | Tarrant, A. | King, M. | Hayes, B.

Article Type: Case Report

Abstract: BACKGROUND: Damage to the basal ganglia and thalamus (BGT) can be caused by multiple perinatal factors and may be associated with movement disorders, cognitive delay and visual difficulties. Changes in BGT structure, seen as echogenicity on ultrasound, are difficult to objectively quantify. The aetiology, clinical relevance and developmental outcomes of BGT echogenicity are poorly understood. We aimed to gain a better understanding of the natural history of BGT echogenicity in a preterm population. METHODS: Retrospective review of clinical course, neuroimaging and development in infants born <32weeks gestation over 5 years with evidence of BGT echogenicity. RESULTS: …BGT echogenicity was reported in 18/650 infants (2.7%). Echogenicity appeared at a median of 8 days (2–45 days) and resolved on pre-discharge ultrasound in 50%. Thirteen infants had a term corrected MRI brain with abnormal BGT signal seen in 3 infants (23%). All 3 infants had persisting echogenicity on discharge ultrasound. No infant with echogenicity resolution on ultrasound had changes on term MRI. 14 infants had developmental progress available at 1 year corrected. Abnormal development was reported in four children of whom one had BGT changes on term MRI. Two children with persistent BGT changes but an otherwise normal MRI had reported normal neurodevelopment. CONCLUSION: BGT echogenicity is relatively common on routine ultrasound and resolves in the majority of infants by term corrected. This review suggests that at term corrected, normal cranial ultrasound may obviate the need for MRI where no other concerns exist. BGT echogenicity did not appear to independently influence neurodevelopment. Show more

Keywords: Echogenicity, ultrasound, prematurity

DOI: 10.3233/NPM-190390

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 2, pp. 287-291, 2021

Authors: Kim, Faith | Towers, Helen M.

Article Type: Case Report

Abstract: Central diabetes insipidus (CDI) may occur in the setting of intracranial abnormalities that affect the hypothalamus-pituitary system. It occurs rarely in neonates, especially in the premature population, and represents a challenging disease process to treat pharmacologically. Little is known regarding the treatment options in premature infants, including dose and route of administration of intravenous desmopressin (DDAVP). We present a case of a late premature male infant with gastroschisis and septo-optic dysplasia who developed transient CDI. He was treated with intravenous DDAVP but required frequent laboratory monitoring and a multidisciplinary approach, and ultimately his CDI resolved. Although there are minimal guidelines …regarding the appropriate formulation and dosage of DDAVP for management of CDI in infants, we initiated the lowest dose available and titrated the medication based on close monitoring of urine output and serum sodium levels in order to successfully treat his transient CDI. Show more

Keywords: Diabetes insipidus, septo-optic dysplasia, desmopressin, gastroschisis, prematurity

DOI: 10.3233/NPM-200465

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 2, pp. 293-297, 2021

Authors: Kanike, N. | Hospattankar, K.G. | Marotta, G. | Kumar, D.

Article Type: Case Report

Abstract: Pulmonary interstitial emphysema (PIE) is a severe complication of mechanical ventilation in preterm infants. Selective bronchial intubation is a rarely used treatment strategy, as it is challenging, especially left main stem bronchial intubation. We report our experience in an infant at 24 weeks gestation with bedside left main stem bronchial intubation using flexible fiberoptic bronchoscopy. We also describe in detail the procedural details involved in the selective left main stem bronchial intubation including the helpful technique of gently bending the tip of the endotracheal tube to create “memory” to better direct the tube into the left main-stem bronchus while using …the flexible fiberoptic bronchoscope. A review of the literature regarding selective bronchial intubation in newborn infants is presented. This case report and literature review suggest that bedside left main stem bronchial intubation using a flexible fiberoptic bronchoscope is a viable option to successfully manage even the most unstable extreme premature infant with unilateral right lung cystic PIE. This may potentially prevent a rare but necessary invasive surgical procedure like lobectomy or even death. Show more

Keywords: Pulmonary interstitial emphysema, PIE, selective bronchial intubation, left main stem bronchial intubation, fiberoptic bronchoscopy, extremely preterm infant

DOI: 10.3233/NPM-180178

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 2, pp. 299-305, 2021

Authors: Baller, S.-E. | Reinehr, M. | Haslinger, C. | Restin, T. | Fauchère, J.-C.

Article Type: Case Report

Abstract: INTRODUCTION: In the fetus, the ductus venosus (DV) connects the umbilical vein and the portal veins to the inferior vena cava in order to bypass the high-resistance hepatic vascular network. Via the Eustachian valve, the DV directs umbilical venous blood with the highest oxygen content preferentially towards the myocardium and the brain. An absence (agenesis) or a secondary obliteration of an initially normally developed DV (atresia) is associated with various shunt types and may lead to severe hydrops. CASE REPORT: A routine check-up of a healthy 34-year-old woman at 27 5/7 wks GA revealed a severe hydrops fetalis with …pleural effusions and ascites. After birth at 28 0/7 wks GA, the bilateral pleural effusions needed drainage via thoracic drains. Arterial hypotension was initially treated with volume replacement and dopamine, later on adrenaline and hydrocortisone were added. The initial echocardiography showed normal anatomic structures and normal bi-ventricular function. Despite maximal intensive care treatment, a global respiratory and cardiovascular insufficiency developed. The girl died on fourth day of life. At autopsy, a secondary atresia of the DV was identified, and moreover a pathogenic de novo heterozygous mutation in the KRAS gene was found in the chorion biopsy probe. DISCUSSION: For all cases of non-haemolytic hydrops fetalis, a prenatal or postnatal sonography with Doppler examination of the venous system and of the heart should be performed. Furthermore, testing for RASopathies should be recommended especially in presence of increased nuchal translucency thickness and polyhydramnios. Show more

Keywords: Neonate, Ductus venosus atresia, hydrops fetalis, RASopathy, KRAS gene mutation

DOI: 10.3233/NPM-190398

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 2, pp. 307-312, 2021