Journal of Neonatal-Perinatal Medicine - Volume 16, issue 1

Authors: Aghababaie, A. | Zeina, M.

Article Type: Article Commentary

Abstract: The recent British Association of Perinatal Medicine (BAPM) guidance published in 2019 suggested for the first time that we can consider resuscitation of extremely premature infants (EPI) at 22–24 weeks gestational age (GA) on a case-by-case basis in the UK. This has sent waves throughout UK neonatal units, and we believe this arises because we’re now confronted with challenging decisions about whether a foetus under 24 weeks will be viable or not, and whether it’s in their best interests to provide ‘survival-focused’ care (SFC) or ‘comfort-focused’ care (CFC). Despite a robust framework introduced by BAPM, we believe uncertainty still remains.

Keywords: Decision-making, prematurity, survival, viability

DOI: 10.3233/NPM-221079

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 1, pp. 1-3, 2023

Authors: Yao, Si Liang | Smit, Elisa | Odd, David

Article Type: Review Article

Abstract: BACKGROUND: Intraventricular haemorrhage (IVH) is a common problem in preterm infants, being a major cause of morbidity and mortality. Despite many randomised controlled trials comparing interventions to prevent IVH, the best prevention remains unclear. This study aims to review all the interventions which intended to reduce the incidence of IVH and compare them in a network meta-analysis. METHODS: A search on MEDLINE, EMBASE, Emcare, and CENTRAL was performed. Randomised controlled trials which evaluated neonatal interventions with a primary aim to reduce incidence of IVH in preterm infants were eligible. A surface under a cumulative ranking curve (SUCRA) was …produced to indicate the intervention’s likelihood of being the most effective for preventing IVH. RESULTS: 40 studies were eligible, enrolling over 6760 infants. Twelve intervention groups were found, including delayed cord clamping, erythropoietin, ethamsylate, fresh frozen plasma, heparin, ibuprofen, indomethacin, magnesium, nursing interventions, sedation, tranexamic acid, and vitamin E. Vitamin E and indomethacin had the highest probability of being the best interventions to prevent IVH in premature infants, but interpretation of these results is difficult due to study limitations. CONCLUSION: Despite the impact of IVH, we were unable to identify a clearly beneficial treatment to reduce its incidence. Interpretation of the network meta-analysis was limited due to differences within studied populations, wide range of therapies trialled, and underlying advances in neonatal care between units, and over time. Although vitamin E and indomethacin appear to be promising candidates, contemporaneous trials of these, or novel agents, enrolling the most at-risk infants is needed urgently. Show more

Keywords: Brain injury, intraventricular haemorrhage, premature, preterm birth, prevention

DOI: 10.3233/NPM-221048

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 1, pp. 5-20, 2023

Authors: Paulsen, V. | Jakob, M. | Gembruch, U. | Heep, A. | Bartmann, P.

Article Type: Research Article

Abstract: BACKGROUND: ppPROM < 24 + 0 weeks of gestation complicates < 1 % of all pregnancies but is responsible for significant maternal and neonatal morbidity. It is associated with 18–20% of perinatal deaths. OBJECTIVE: To evaluate neonatal outcome after expectant management in ppPROM in order to obtain evidence-based information for purposes of future counselling. METHODS: A single-centre, retrospective cohort study of 117 neonates born 1994 to 2012 after ppPROM < 24 weeks of gestation with a latency period > 24 hours and admission to the NICU of the Department of Neonatology, University of Bonn. Data of pregnancy characteristics and neonatal outcome were collected. …The results were compared to those found in the literature. RESULTS: The mean gestational age at ppPROM was 20.45±2,9 weeks (range 11 + 2 –22 + 6) with a mean latency period of 44.7±34.8 days (range 1–135). Mean gestational age at birth was 26.77±3.22 weeks (range 22 + 2–35 + 3). 117 newborns were admitted to the NICU, the overall survival rate at discharge was 72.6% (85/117). Non-survivors had a significantly lower gestational age and higher rates of intra-amniotic infections. The most common neonatal morbidities were RDS (76.1%), BPD (22.2%), pulmonary hypoplasia (PH) (14.5%), neonatal sepsis (37.6%), IVH (34.1% all grades, 17.9% grades III/IV), NEC (8.5%) and musculoskeletal deformities (13.7%). Mild growth restriction as a new complication of ppPROM was observed. CONCLUSIONS: Neonatal morbidity after expectant management is similar to that described for infants without ppPROM, but carries a higher risk of pulmonary hypoplasia and mild growth restriction. Show more

Keywords: Morbidity, mortality, neonatal outcome, preterm birth, previable pPROM

DOI: 10.3233/NPM-221054

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 1, pp. 21-31, 2023

Authors: Hemingway, M. | Raju, M. | Vora, N. | Raju, V. | Mallett, L.H. | Govande, V.

Article Type: Research Article

Abstract: OBJECTIVE: To evaluate the implementation of a systematic approach to improve the resuscitation, stabilization, and admission of infants < 32 weeks gestation and also to ascertain its effect on organization, efficiency, and clinical outcomes during hospitalization. METHODS: Retrospective study involving a multidisciplinary team with checklists, role assignment, equipment organization, step by step protocol, and real time documentation for the care of infants < 32 weeks gestation in the delivery room to the neonatal intensive care unit. Pre-data collection (cases) period was from Aug, 2015 to July, 2017, and post-data collection(controls) period was from Aug, 2017 to Aug, 2019. RESULTS: 337 …infants were included (179 cases; 158 controls). Increase surfactant use in the resuscitation room (41% vs. 27%, p  = 0.007) and reduction in median time to administer surfactant (34 minutes (range, 6–120) vs. 74 minutes (range, 7–120), p  = 0.001) observed in control-group. There was a significant reduction in incidence of bronchopulmonary dysplasia (27% vs. 39%), intraventricular hemorrhage (11% vs. 17%), severe retinopathy of prematurity (3% vs. 9%), and necrotizing enterocolitis (4% vs. 6%), however these results were not statistically significant after controlling for severity of illness. CONCLUSIONS: A systematic approach to the care of infants < 32 weeks gestation significantly improved mortality rates and reduced rates of comorbidities. Show more

Keywords: Delivery room, golden hour protocol, low gestational age infants, NICU admission, retrospective study

DOI: 10.3233/NPM-210881

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 1, pp. 33-37, 2023

Authors: Natarajan, R. | Duchon, J. | Jassar, R.

Article Type: Research Article

Abstract: BACKGROUND AND OBJECTIVES: Multidisciplinary teamwork during delivery room (DR) resuscitation and timely transport to the neonatal intensive care unit (NICU) can reduce morbidity and mortality for infants born Extremely Preterm (EP). We aimed to assess the impact of a multidisciplinary high-fidelity simulation curriculum on teamwork during resuscitation and transport of EP infants. METHODS: In a prospective study conducted at a Level III academic center, seven teams (each consisting of one NICU fellow, two NICU nurses, and one respiratory therapist) performed three high-fidelity simulation scenarios. Videotaped scenarios were graded by three independent raters using the Clinical Teamwork Scale (CTS). …Times of completion of key resuscitation and transport tasks were recorded. Pre- and post- intervention surveys were obtained. RESULTS: Overall, time of completion of key resuscitation and transport tasks decreased, with significant decreases in the time to attach the pulse oximeter, transfer of the infant to the transport isolette, and exit the DR. There was no significant difference in CTS scores from Scenario 1 to 3. Scenarios led by first-year fellows showed a trend towards improvement in all CTS categories. A comparison of teamwork scores pre- and post-simulation curriculum during direct observation of high-risk deliveries in real time revealed a significant increase in each CTS category. CONCLUSION: A high-fidelity teamwork-based simulation curriculum decreased time to complete key clinical tasks in the resuscitation and transport of EP infants, with a trend towards increased teamwork in scenarios led by junior fellows. There was improvement of teamwork scores during high-risk deliveries on pre-post curriculum assessment. Show more

DOI: 10.3233/NPM-221118

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 1, pp. 39-47, 2023

Authors: Ronan, K. | Hughes Driscoll, C.A. | Decker, E. | Gopalakrishnan, M. | El Metwally, D.

Article Type: Research Article

Abstract: BACKGROUND: Neonatal opioid withdrawal syndrome (NOWS) is a growing public health problem associated with complex and prolonged medical care and a significant resource utilization burden. The objective of this study was to compare the cost of different convalescent care settings for infants with NOWS. METHODS: Retrospective comparison study of infants with NOWS discharged directly from NICU, transferred to an acute care pediatric floor (PPCU) or rehabilitation hospital (PRH). Primary outcomes were length of stay (LOS) and cost of stay (COS). RESULTS: Infants had 1.3 (95% CI: 1.1,1.6) times and 2.5 (95% CI: 2.1,3.1) times significantly longer …mean LOS for PPCU and RH discharges compared to NICU discharges. NICU discharged infants had the lowest mean COS ($25,745.00) and PRH the highest ($60,528.00), despite PRH having a lower cost per day. PRH discharged infants had higher rates of methadone and benzodiazepine and less buprenorphine exposure than NICU/PPCU discharged. Infants born to mothers on marijuana and buprenorphine had a 28% lower mean COS compared to unexposed infants. Median treatment cumulative morphine doses were six-fold higher for PRH than NICU discharge. CONCLUSIONS: Infants transferred to convalescence care facilities had longer and more costly admissions and received more medication. However, there may be a role for earlier transfer of a subset of infants at-risk for longer LOS as those exposed to methadone and/or benzodiazepines. Further studies exploring differences in resource utilization, convalescent care delivery and cost expenditure are recommended. Show more

Keywords: Convalescent care, neonates, opioid withdrawal, resource utilization

DOI: 10.3233/NPM-221060

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 1, pp. 49-57, 2023

Authors: Yangin Ergon, E. | Kivilcim, M. | Colak, R. | Dasci, Y. | Ozdemir, S. Alkan | Calkavur, S.

Article Type: Research Article

Abstract: BACKGROUNDS: It was intended to compare early term babies to term babies by reviewing short-term issues and long-term neurodevelopmental evaluations. METHODS: It was planned as a prospective case-control study. Of the 4263 infants admitted to the neonatal intensive care unit, 109 infants born at early term by elective cesarean section and hospitalized within the first 10 postnatal days were included in the study. As the control group, 109 babies born at term were enrolled. Nutrition status of infants, reasons for hospitalization in the first postnatal week were recorded. When the babies were 18-24 months old, an …appointment was made for neurodevelopmental evaluation. RESULTS: In the early term group, the time of breastfeeding was later than the control group, with a statistically significant difference. Similarly, breastfeeding difficulty, need for formula in the first week postpartum and hospitalization were found to be significantly higher in the early term group. Considering the short-term results; pathological weight loss, hyperbilirubinemia requiring phototherapy and feeding difficulties were statistically significantly higher in the early term group. Neurodevelopmental delay did not statistically differ across the groups, but the early term group’s MDI and PDI scores were found to be statistically lower than those of the term group. CONCLUSION: Early term infants are thought to be like term infants in many ways. Although these babies are similar to term babies, they are still physiologically immature. The short and long-term negative consequences of early term birth are obvious, non-medical elective early term births should be prevented. Show more

Keywords: Birth, breastfeeding, early term, neurodevolepmental, term

DOI: 10.3233/NPM-221076

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 1, pp. 59-66, 2023

Authors: Angert, R.M. | Jones-Bamman, C. | Moon, J.-Y. | Mian, U.K.

Article Type: Research Article

Abstract: BACKGROUND: Laser retinopexy is the current standard treatment for babies with type I retinopathy of prematurity (ROP). No guidelines exist for respiratory management during this procedure. Although neonatologists prefer to avoid intubation to prevent delays in extubation, feeding and discharge, ophthalmologists often request intubation, because sedation alone may lead to respiratory collapse. Little evidence is available regarding which treatment provides the most benefit to vulnerable infants. OBJECTIVE: This study investigated relevant associations or underlying conditions that may help guide decision-making in respiratory management during laser retinopexy. METHODS: A retrospective chart review was performed to analyze data …from babies who underwent retinopexy from 2006 to 2011 at the Montefiore Medical Center. The main outcome measures included respiratory support before, during and after laser therapy; time from treatment to extubation; and time from treatment to discharge. RESULTS: The main outcomes were analyzed in four groups: never intubated (n  = 27), emergently intubated (n  = 7), already intubated (n  = 8) and electively intubated (n  = 28). No significant differences were observed in the number of pre-operative apneic/bradycardic events, postoperative time to extubation, time to discharge and delays in feeding among groups. CONCLUSIONS: No specific comorbid conditions were found to predict a need for intubation. Elective intubation did not cause delays in feedings, extubation or discharge. A selective approach to respiratory support would result in 20% of initially non-intubated patients requiring emergent intubation. Show more

Keywords: Laser retinopexy, NICU, respiratory management, ROP/retinopathy of prematurity

DOI: 10.3233/NPM-210788

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 1, pp. 67-74, 2023

Authors: Aoki, H. | Kawataki, M. | Kim, K. | Saito, T. | Inagaki, Y. | Shimokaze, T. | Ishikawa, H. | Toyoshima, K.

Article Type: Research Article

Abstract: BACKGROUND: There is no consensus on managing pregnancy when the fetus is diagnosed with idiopathic premature constriction or closure of the ductus arteriosus (PCDA). Knowing whether the ductus reopens is valuable information for managing idiopathic PCDA. We conducted a case-series study to investigate the natural perinatal course of idiopathic PCDA and examined factors associated with ductal reopening. METHODS: We retrospectively collected information about the perinatal course and echocardiographic findings at our institution, which, on principle, does not determine delivery timing based on fetal echocardiographic results. We also examined perinatal factors related to the reopening of the …ductus arteriosus. RESULTS: Thirteen cases of idiopathic PCDA were included in the analysis. The ductus reopened in 38% of cases. Among cases diagnosed in < 37 weeks of gestation, 71% reopened, which was confirmed seven days after diagnosis (interquartile range 4–7). Diagnosis earlier in gestation was associated with ductal reopening (p  = 0.006). Two cases (15%) developed persistent pulmonary hypertension. No fetal hydrops or death occurred. CONCLUSIONS: The ductus is likely to reopen when prenatally diagnosed before 37 weeks gestation. There were no complications due to our pregnancy management policy. In idiopathic PCDA, especially if the prenatal diagnosis is made before 37 weeks of gestational age, continuing the pregnancy with careful monitoring of the fetus’s well-being is recommended. Show more

Keywords: Ductus arteriosus, fetal echocardiology, neonatal intensive care, prenatal diagnosis, pulmonary hypertension

DOI: 10.3233/NPM-221013

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 1, pp. 75-80, 2023

Authors: Klymenko, T.M. | Kononovych, M.I.

Article Type: Research Article

Abstract: BACKGROUND: Persistent pulmonary hypertension is a problem that leads to high morbidity and mortality in preterm infants. In clinical studies, oxidative stress (OS) contributes to the development of pulmonary hypertension (PH). The most specific biomarker of OS in preterm infants is urinary 8-hydroxy-2-deoxyguanosine (8-OHdG). The aim of the study was to determine the clinical correlation between the value of 8-OHdG and the level of a mean pressure in the pulmonary artery (mPAP) in premature infants with respiratory distress syndrome (RDS) and asphyxia in the early neonatal period. METHODS: Determination of the urinary 8-OHdG value and PH in 96 …premature infants born at gestational age of 26–32 weeks on the 1st and the 3rd–5th days of life in two groups: group I –52 children with respiratory distress syndrome; II –44 children with RDS associated with perinatal asphyxia. RESULTS: The 2nd group of children had higher average mPAP level, mmHg, both in the 1st and in the 3rd–5th day of life compared with the 1st group. The value of the urinary 8-OHdG correlated with the manifestation of PH that required prolonged respiratory support in group II. CONCLUSION: Perinatal asphyxia in preterm infants with RDS on the 1st day of life complicates the course of PH, as indicated by a higher level of the urinary 8-OHdG and correlated to mPAP. Gender characteristics of the dynamics of 8-OHdG levels in children with perinatal pathology reveal reduced adaptability and reactivity of boys to OS at birth. Show more

Keywords: 8-hydroxy-2-deoxyhuanosine, preterm infants, pulmonary hypertension

DOI: 10.3233/NPM-221005

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 1, pp. 81-85, 2023