Journal of Neonatal-Perinatal Medicine - Volume 14, issue 4

Authors: Puthattayil, Z.B. | Moore, G.P. | Tang, K. | Huneault-Purney, N. | Lawrence, S.L.

Article Type: Research Article

Abstract: BACKGROUND: There is no consensus on how to wean infants from Nasal Continuous Positive Airway Pressure (NCPAP). We hypothesized that ceasing NCPAP abruptly would decrease the duration required, compared with a gradual wean. METHODS: This retrospective chart review included preterm infants requiring NCPAP for over 48 hours. Cohort1 weaned NCPAP by cycling on and off, while cohort 2 ceased NCPAP abruptly. The primary outcome was total days on NCPAP. Secondary outcomes included rate of bronchopulmonary dysplasia, weight gain, duration of hospital stay, and compliance with the use of stability criteria. RESULTS: 81 infants met inclusion criteria …in cohort one, and 89 in cohort two. Median days on NCPAP were 17.0 and 11.0 days, respectively, not significant. There was no significant difference in secondary outcomes. CONCLUSIONS: There was no significant association between the two NCPAP weaning protocols and the outcomes studied. Show more

Keywords: Preterm infant, nasal continuous positive airway pressure, wean, bronchopulmonary dysplasia

DOI: 10.3233/NPM-200625

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 4, pp. 537-546, 2021

Authors: Gahlawat, Vivek | Chellani, Harish | Saini, Isha | Gupta, Shobhna

Article Type: Research Article

Abstract: OBJECTIVE: To determine the predictors of mortality following early rescue surfactant therapy in preterm babies with respiratory distress syndrome. STUDY DESIGN: Prospective cohort study enrolling babies between 28 weeks to 34 weeks with respiratory distress syndrome requiring early rescue surfactant therapy. For statistical analysis babies were further divided into two subgroups: survivors and non-survivors. Maternal and neonatal variables were compared between the two groups to find out the predictors of mortality. RESULTS: Out of total 110 babies, 72 (65.45%) survived. The mean birth weight and mean gestational age of the study population was 1614.36 (±487.86) g …and 31.40 (±2.0)1 weeks, respectively. Birth weight < 1500 g, gestational age < 32 weeks, primiparity, vaginal delivery, prolonged rupture of membranes, lack of antenatal steroid cover, bag and mask ventilation at birth, sepsis, apneic episodes and mechanical ventilation were significantly associated with death on univariate analysis. On multivariate analysis, very low birth weight, vaginal delivery, lack of antenatal steroid cover, bag and mask ventilation at birth and mechanical ventilation were found to be independent predictors of mortality. CONCLUSIONS: Some of the identified predictors of mortality are modifiable and can be used to draw up a screening tool to predict the clinical severity and mortality among these babies. Show more

Keywords: Antenatal steroids, outcome, preterm, respiratory distress syndrome, surfactant

DOI: 10.3233/NPM-190244

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 4, pp. 547-552, 2021

Authors: Sullivan, B.A. | Nagraj, V.P. | Berry, K.L. | Fleiss, N. | Rambhia, A. | Kumar, R. | Wallman-Stokes, A. | Vesoulis, Z.A. | Sahni, R. | Ratcliffe, S. | Lake, D.E. | Moorman, J.R. | Fairchild, K.D.

Article Type: Research Article

Abstract: BACKGROUND: In premature infants, clinical changes frequently occur due to sepsis or non-infectious conditions, and distinguishing between these is challenging. Baseline risk factors, vital signs, and clinical signs guide decisions to culture and start antibiotics. We sought to compare heart rate (HR) and oxygenation (SpO2 ) patterns as well as baseline variables and clinical signs prompting sepsis work-ups ultimately determined to be late-onset sepsis (LOS) and sepsis ruled out (SRO). METHODS: At three NICUs, we reviewed records of very low birth weight (VLBW) infants around their first sepsis work-up diagnosed as LOS or SRO. Clinical signs prompting the …evaluation were determined from clinician documentation. HR-SpO2 data, when available, were analyzed for mean, standard deviation, skewness, kurtosis, and cross-correlation. We used LASSO and logistic regression to assess variable importance and associations with LOS compared to SRO. RESULTS: We analyzed sepsis work-ups in 408 infants (173 LOS, 235 SRO). Compared to infants with SRO, those with LOS were of lower GA and BW, and more likely to have a central catheter and mechanical ventilation. Clinical signs cited more often in LOS included hypotension, acidosis, abdominal distension, lethargy, oliguria, and abnormal CBC or CRP (p  < 0.05). HR-SpO2 data were available in 266 events. Cross-correlation HR-SpO2 before the event was associated with LOS after adjusting for GA, BW, and postnatal age. A model combining baseline, clinical and HR-SpO2 variables had AUC 0.821. CONCLUSION: In VLBW infants at 3-NICUs, we describe the baseline, clinical, and HR-SpO2 variables associated with LOS versus SRO. Show more

Keywords: Neonatal sepsis, infection, bacteremia, prematurity, vital sign analytics, predictive modeling

DOI: 10.3233/NPM-200578

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 4, pp. 553-561, 2021

Authors: Sabry, A. | Ibrahim, M. | Khashana, A.

Article Type: Research Article

Abstract: INTRODUCTION: In the developing countries, neonatal sepsis is the most common complication in neonatal period. It is as a systemic inflammatory response because of infection. Laboratory indicators, do not have satisfactory sensitivity. Thus, early identification of sepsis is still needed. Because PTX3 may be a faster acute-phase protein that is not liver-dependent, it is probable that it is superior to traditional biomarkers for mirroring rapid inflammatory courses. METHODS: A prospective case control study design was used to determine the sensitivity of pentraxin 3 in the diagnosis of neonatal sepsis to allow early diagnostic tool. This study was carried …out on neonatal ICU unit in Suez Canal University Hospital and the studied population were divided into two groups, including patients diagnosed with neonatal sepsis, based on clinical, laboratory and positive blood culture results, and control group RESULTS: The study found that there was statistically significant differences between both groups in serum CRP values in diseased and control group (Mean = 49.3±37.4 mg/L, 26.8±17.2 mg/L, p  < 0.05), and pentraxin values in diseased and control group (Mean = 5.2±3.7 mg/L, 2.3±0.78 mg/L, p  < 0.0001). In addition, there were statistically significant correlations between pentraxin and serum CRP concentrations (p  < 0.05) in diseased group. ROC curve showed that serum CRP demonstrated good diagnostic accuracy in predicting neonatal sepsis AUC = 0.875 with sensitivity of 100% and specificity of 92.3%. CONCLUSION: Serum PTX3 may be a promising acute-phase protein for interpretation of affected newborns with symptoms and signs of sepsis. Show more

Keywords: Salt, neonate, granuloma

DOI: 10.3233/NPM-200550

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 4, pp. 563-568, 2021

Authors: Alturk, M.R. | Salama, H. | Al Rifai, H. | Al Qubaisi, M. | Alobaidly, S.

Article Type: Research Article

Abstract: BACKGROUND: Early empiric antibiotic exposure appears to negatively influence feeding tolerance in preterm infants. However, the effect of prolonged antibiotic treatment is unknown. The objective of this study was to investigate whether prolonged antibiotics impact the time to full enteral feed in infants less than 29 weeks of gestational age with negative blood cultures. METHODS: Retrospective data for infants less than 29 weeks gestation age were retrieved from the PEARL-Peristat perinatal registry in Qatar. Exclusion criteria were major congenital anomalies, conditions requiring surgery in the first 10 days of life, positive blood cultures in the first 48 hours …of life, and death within the first week of life. Antibiotic courses were categorized as prolonged if continued more than 48 hours. The primary outcome was the duration of total parenteral nutrition. RESULTS: Of 199 study infants, 185 (92.9%) underwent antibiotic treatment for > 48 hours despite negative blood cultures. The median duration of parenteral nutrition was not significantly different between the prolonged and short antibiotic groups (25 and 22 days, respectively; p  = 0.139). Infants with prolonged antibiotic courses experienced non-significantly higher levels of necrotizing enterocolitis (7.1% and 18.4%, respectively), bronchopulmonary dysplasia (28.6% and 45.4%, respectively), and retinopathy of prematurity (14.3% and 38.4%, respectively). There were no differences in the late-onset sepsis rate (78.6% and 82.1%, respectively) and the in-hospital death rate (7.1% and 7.6%, respectively). CONCLUSIONS: Prolonged antibiotic treatment in infants less than 29 weeks gestation with negative blood cultures has no significant impact on the time to full enteral feed. Show more

Keywords: Preterm infants, prolonged antibiotics, time to full feed, necrotizing enterocolitis, retinopathy of prematurity, bronchopulmonary dysplasia

DOI: 10.3233/NPM-200555

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 4, pp. 569-573, 2021

Authors: Ramaswamy, V.V. | Oommen, V.I. | Gupta, A. | Weerapperuma, N. | Zivanovic, S. | Roehr, C.C.

Article Type: Research Article

Abstract: BACKGROUND: Wide variation in the care practices and survival rates of neonates born at peri-viable gestational ages of 22+0 – 24+6 weeks. This study elucidates the postnatal risk factors for morbidity/mortality, contrasts the care practices and short-term outcomes of this vulnerable group of preterm neonates from a single center with others. METHODS: Retrospective study of neonates born at 22+0 –24+6 weeks in a level 3 neonatal intensive care unit in UK, over a period of 4 years (2016–2019). RESULTS: 94 neonates given active care were studied. Survival until discharge was 51.1%(22–23 wks …–44%, 24 wks –59.1%) and survival with no major brain injury (MBI) [grade III/IV IVH, cystic periventricular leukomalacia] was 38.3%(22–23 wks –32%, 24 wks –45.4%). Of those who survived until discharge, 75%had no MBI (22–23 wks –72.7%, 24 wks –76.9%). Neonates requiring significant respiratory support within first 72 hours as well as needing rescue high frequency ventilation had significantly high risk of mortality or MBI [aOR –7.17 (2.24–25.79), p  = 0.00; 4.76 (1.43–20.00), p  = 0.01]. CONCLUSIONS: Survival rate differed from other centres. MBI was low amongst survivors. Severe respiratory disease in the initial days was associated with a higher risk of death or MBI. Show more

Keywords: Extremely low birth weight, extremely low gestational age neonates, prematurity, survival, threshold of viability

DOI: 10.3233/NPM-200670

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 4, pp. 575-582, 2021

Authors: Cohen, M. | Perl, H. | Steffen, E. | Planer, B. | Kushnir, A. | Hudome, S. | Brown, D. | Myers, M. | the New Jersey NICU Collaborative

Article Type: Research Article

Abstract: BACKGROUND: Micro-premature newborns, gestational age (GA) ≤ 25 weeks, have high rates of mortality and morbidity. Literature has shown improving outcomes for extremely low gestational age newborns (ELGANs) GA ≤ 29 weeks, but few studies have addressed outcomes of ELGANs ≤ 25 weeks. OBJECTIVE: To evaluate the trends in outcomes for ELGANs born in New Jersey, from 2000 to 2018 and to compare two subgroups: GA 23 to 25 weeks (E1) and GA 26 to 29 weeks (E2). METHODS: Thirteen NICUs in NJ submitted de-identified data. Outcomes for mortality and morbidity were calculated. RESULTS: Data from 12,707 …infants represents the majority of ELGANs born in NJ from 2000 to 2018. There were 3,957 in the E1 group and 8,750 in the E2 group. Mortality decreased significantly in both groups; E1, 43.2% to 30.2% and E2, 7.6% to 4.5% over the 19 years. The decline in E1 was significantly greater than in E2. Most morbidities also showed significant improvement over time in both groups. Survival without morbidity increased from 14.5% to 30.7% in E1s and 47.2% to 69.9% in E2s. Similar findings held for 501–750 and 751–1000g birth weight strata. CONCLUSIONS: Significant declines in both mortality and morbidity have occurred in ELGANs over the last two decades. These rates of improvements for the more immature ELGANs of GA 230 to 256 weeks were greater than for the more mature group in several outcomes. While the rates of morbidity and mortality remain high, these results validate current efforts to support the micro-premature newborn. Show more

Keywords: Keywords: Collaborative, ELGAN, micro-premature, morbidity, mortality, neonatology, New Jersey, outcomes, trends

DOI: 10.3233/NPM-200599

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 4, pp. 583-590, 2021

Authors: Zahouani, Tarik | Carter, William R. | Jessel, Rebecca H. | El-Metwally, Dina E. | Crowley, Helena M.

Article Type: Case Report

Abstract: Primary segmental intestinal volvulus is a rare condition that may affect neonates. This condition occurs when a loop of bowel torses around the axis of its mesentery without any other abnormality or malrotation. In the earlier stages, the diagnosis can be challenging due to the lack of specific clinical and radiographic signs. Prompt surgical management is critical as a delay in diagnosis may result in bowel loss or death. We present a series of three cases of extremely low birth weight infants with primary segmental volvulus. A sentinel bowel loop was critical in guiding each patient’s surgical management as there …were no other clinical markers concerning a pending intra-abdominal catastrophe. This case series suggests that a sentinel bowel loop may be a radiographic marker for primary segmental intestinal volvulus in extremely low birth weight infants. Show more

Keywords: Extreme low birth weight, segmental intestinal volvulus, sentinel bowel loop

DOI: 10.3233/NPM-200654

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 4, pp. 591-595, 2021

Authors: Eid, Haytham | Al Awad, Essa | Yusuf, Kamran

Article Type: Case Report

Abstract: BACKGROUND: Diabetes insipidus (DI) is a disease resulting from defects in the arginine vasopressin system responsible for regulating body water homeostasis. It is characterized by polyuria with increased serum osmolality and sodium and can result from congenital or acquired disorders. CLINICAL PRESENTATION: A baby was admitted to NICU for extreme prematurity (25 weeks gestation), extreme low birth weight (900 grams) and respiratory distress. He received one dose of Surfactant and was ventilated using high frequency jet ventilation for development of pulmonary interstitial emphysema. After nine days, he still required high settings with development of early chronic lung changes …in the form of atelectasis. Therefore, he was started on a course of dexamethasone following the DART study protocol (Dexamethasone: A Randomized Trial). However, after six days (cumulative dose of 0.75 mg/kg/day) he developed polyuria (7.4 ml/kg/h) with increased serum sodium (150 mmol/L) and osmolality (348 mmol/L). He lost 85 grams of his weight in 24 hours, which represented a 9.8 %weight loss. The findings were suggestive of DI and given there were no apparent causes other than dexamethasone, it was discontinued. Over the following 48 hours, polyuria and hypernatremia gradually resolved, reaching 3.5 ml/kg/h, and 140 mmol/L respectively. CONCLUSION: The use of dexamethasone is not an uncommon practice in tertiary care neonatal units. To our knowledge, our case is the first report of neonatal DI secondary to the use of dexamethasone. We recommend closely monitoring urine output and serum electrolytes in preterm infants receiving dexamethasone. Show more

Keywords: Diabetes insipidus, preterm, dexamethasone

DOI: 10.3233/NPM-200525

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 4, pp. 597-600, 2021

Authors: Fleiss, N. | Klein-Cloud, R. | Gill, B. | Feldstein, N.A. | Fallon, E.M. | Ruzal-Shapiro, C. | Collins, A.

Article Type: Case Report

Abstract: We describe a rare and devastating complication of a malpositioned scalp peripheral intravenous catheter (PIV) that resulted in subdural extravasation of infused fluids and midline shift in a critically ill neonate who required extracorporeal membrane oxygenation (ECMO). Recognition of increased intracranial pressure was hindered by the hemodynamic changes of being on ECMO and only identified by routine surveillance ultrasonography. Awareness of this complication may lead providers to seek alternate sites for vascular access in such patients, and encourage closer monitoring for this complication when an alternate site is unavailable.

Keywords: Scalp peripheral intravenous catheter, extracorporeal membrane oxygenation, extravasation

DOI: 10.3233/NPM-200610

Citation: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 4, pp. 601-605, 2021