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

Authors: Jordan, Brian K. | Bernard, Leah | Segel, Sally | Go, Mitzi D. | Schilling, Diane | McEvoy, Cindy T.

Article Type: Research Article

Abstract: BACKGROUND: Premature infants are born with immature lungs that demonstrate abnormal pulmonary function with differences in passive respiratory system compliance and resistance, and functional residual capacity. To our knowledge, no studies have evaluated differences in neonatal pulmonary function based on the type of twin gestation, or chorionicity. Given the effect of chorionicity on outcomes, we aimed to study the effect of twin type, monochorionic monoamniotic (MCMA) vs dichorionic diamniotic (DCDA), on neonatal early pulmonary function tests. METHODS: In this prospective cohort study, 5 sets of DCDA twins were matched to 5 sets of MCMA twins on gestational age …at delivery, latency from antenatal corticosteroid exposure, birthweight, race and gender. Mean values were compared for passive respiratory system compliance and resistance, functional residual capacity, and tidal volume. RESULTS: MCMA infants had a significantly lower compliance (0.64 vs 1.25 mL/cm H2 O /kg; p  = 0.0001) and significantly higher resistance (0.130 vs 0.087 cm H2 O /mL/sec; p  = 0.0003) than DCDA infants. Functional residual capacity was lower for MCMA than DCDA infants (17.5 vs 23.4 mL/kg; p  = 0.17). Further, 80% of MCMA infants required intubation for surfactant administration compared to 20% of DCDA infants, indicating the clinical significance of these objective measures. CONCLUSIONS: Due to the matched case-control design, causality cannot be established. However, we speculate that these differences in lung function may derive from differential exposure to preterm labor and endogenous maternal corticosteroid exposure. Further study is necessary to establish the true causal relationship. Show more

Keywords: Chorionicity, function residual capacity, neonate, pulmonary function, respiratory system compliance, respiratory system resistance, twins

DOI: 10.3233/NPM-221113

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 1, pp. 87-92, 2023

Authors: Garg, P.M. | Paschal, J.L. | Ansari, M.A.Y. | Ware, J. | Adams, K. | Taylor, C. | Reddy, K. | Rosenfeld, C.R. | Mir, I.N.

Article Type: Research Article

Abstract: BACKGROUND: To determine the association of placental pathologic lesions with postoperative outcomes, survival, and white matter injury (WMI) in preterm infants with NEC. METHODS: A retrospective chart review of 107 neonates with NEC (Bell stage > IIa) from Jan 2013- June 2020 was completed. Demographic, clinical, and outcome data were compared between infants with or without placental pathologic lesions. RESULTS: In this cohort, 59/107 (55%) infants had medical NEC, and 48 (45%) had surgical NEC. The infants had a mean gestational age of 28.1±3.7 weeks and a birth weight of 1103±647 g. Maternal vascular malperfusion (82/107, 76.6%) and …acute histological chorioamnionitis (42, 39.3%) were the most common pathological placental lesions. Acute histologic chorioamnionitis with fetal inflammatory response was more common in infants with surgical NEC vs. medical NEC (35.4% vs. 15.3%; p  = 0.02). The NEC Infants with WMI on brain MRI scans had a significantly higher incidence of acute histological chorioamnionitis (52% vs. 27.8%; P  = 0.04). No significant differences in mortality, length of stay and postoperative outcomes in neonates with and without acute histologic chorioamnionitis with fetal inflammatory response were noted. On unadjusted logistic regression, acute histologic chorioamnionitis without fetal inflammatory response was also associated with higher odds of WMI (OR 2.81; 95% CI 1.05–7.54; p  = 0.039). CONCLUSION: Acute histological chorioamnionitis without fetal inflammatory response was associated with higher odds of WMI in infants with NEC, with no significant impact on mortality and other postoperative outcomes. Show more

Keywords: Necrotizing enterocolitis, preterm infants, placental pathology, white matter injury

DOI: 10.3233/NPM-221105

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 1, pp. 93-103, 2023

Authors: Chafik, K. | Aslaou, F. | Barich, F. | Laamiri, F.Z. | Barkat, A.

Article Type: Research Article

Abstract: OBJECTIVES: Analogous to the Near Miss Maternal approach, the concept of Near Miss Neonatal (NNM) is an approach recently developed to identify newborns who survive near-fatal complications during the first 28 days of ectopic life. The objective of this study is to shed light on the cases of Neonatal Near Miss and identify its factors associated with live births. METHODS: A prospective cross-sectional study was conducted to identify factors associated with Neonatal Near Miss in newborns admitted to the National Reference Center in Neonatology in Rabat, Morocco from January 1 to December 31, 2021. A pre-tested, structured questionnaire …was used to collect the data. These data were entered using Epi Data software and exported to SPPS23 for analysis. To identify the determinants of the outcome variable, binary multivariable logistic regression was used. RESULTS: Among the 2676 selected live births, 2367 (88.5%; 95% CI: 88.3–90.7)) were cases of NNM. Factors in women which were significant predictors of NNM included being referred from other health care facilities [AOR: 1.86; 95% CI: 1.39–2.50], residing in a rural area [AOR: 2.37; 95% CI: 1.82–3.10], having less than four prenatal visits [AOR: 3.17; 95% CI: 2.06–4.86], and having gestational hypertension [AOR: 2.02; 95% CI: 1.24–3.30]. CONCLUSIONS: This study revealed a high proportion of NNM cases in the study area. The factors associated with NNM which were found to increase these cases demonstrates the primary health care program must be further improved to avoid preventable causes of neonatal mortality. Show more

Keywords: Apgar score, associated factors, low birth weight, neonatal near miss events, newborn health

DOI: 10.3233/NPM-221167

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 1, pp. 105-110, 2023

Authors: Parappil, H. | Gaffari, M. | Ahmed, J. | Skaria, S. | Rijims, M. | Chandra, P. | Babu, K.T.S.

Article Type: Research Article

Abstract: BACKGROUND: Neonatal hypoglycemia is one of the most common causes of admission to neonatal intensive care unit requiring intravenous dextrose therapy. Administration of IV dextrose and transfer to the NICU may interfere with parent-infant bonding, breastfeeding, and has financial implications. OBJECTIVE: Retrospective study to evaluate the effect of dextrose gel supplementation for asymptomatic hypoglycemia in reducing NICU admissions and intravenous dextrose therapy. METHOD: A retrospective study conducted for eight months each before and after introduction of dextrose gel in the management of asymptomatic neonatal hypoglycemia. Asymptomatic hypoglycemic infants were given only feeds in pre dextrose gel …period and dextrose gel along with feeds in the dextrose gel period. Rates of admission to NICU and the need of IV dextrose therapy were evaluated. RESULTS: High risk characteristics (Prematurity, Large for Gestational Age, small for Gestational Age, Infants of diabetic mother etc.) were equally distributed among both the cohorts. Primary outcome results showed significant reduction in NICU admissions from 396/1801(22%) to 329/1783 (18.5%) (odds ratio, 95% CI 1.24(1.05-1.46, p 0.008). There was significant reduction in IV dextrose therapy requirement from 277/1405 (15.4%) to 182/1454 (10.2%) (odds ratio, 95% CI 1.59(1.31- 1.95, p  < 0.001). Babies discharged on predominant breast feeding showed significant improvement from 237/396(59.8%) in the pre dextrose gel period to 240/329 (72.9%) (odds ratio, 95% CI 0.82(0.73-0.90, p  < 0.001) in dextrose gel period. CONCLUSIONS: Dextrose gel supplementation with feeds reduced NICU admissions, the need for parenteral dextrose therapy, avoided maternal separation and promoted breastfeeding. Show more

Keywords: High risk neonates, parenteral dextrose therapy, transient asymptomatic hypoglycemia

DOI: 10.3233/NPM-221170

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 1, pp. 111-117, 2023

Authors: Garg, P.M. | Denton, M.X. | Talluri, R. | Ostrander, M.M. | Middleton, C. | Sonani, H. | Varshney, N. | Hillegass, W.B.

Article Type: Research Article

Abstract: OBJECTIVE: We sought to determine the clinical and histopathological factors associated with intestinal hemorrhage and its correlation with clinical outcomes in neonates with surgical necrotizing enterocolitis (NEC). METHODS: A retrospective study compared clinical and histopathology information in neonates following surgical NEC with severe hemorrhage and those with mild/moderate hemorrhagic lesions seen on resected intestine pathology. RESULTS: The infants with severe hemorrhage (Grade 3-4, 81/148, 54.7%) had significantly lower exposure to antenatal steroids (52.5 % vs 76.9 %; p  = 0.004), had higher gestational age (28.5 weeks [7.14] vs. 26.58 [2.90]; p  = 0.034), lost more bowel length (p … = 0.045), had higher CRP levels at 2 weeks (p  = 0.035), and had less intestinal failure ([30.3 % vs 52.5 %]; p  = 0.014) than mild/moderate (Grade 0–2, 67/148, 45.2%) hemorrhage group. Those with severe hemorrhage had significantly higher mean inflammation score (2.67 [0.94] vs. 1.63 [0.92]; p  = <0.001), higher necrosis scores (1.95 [1.28] vs. 1.49 [1.35]; p  = 0.037), higher neovascularization (p  = 0.01), higher fibroblasts (p  = 0.023) and higher lymphocyte percentages up to 48 hours (p  < 0.05) following NEC than mild/ moderate hemorrhage group. On multivariable regression, less exposure to antenatal steroids (OR 0.18 [95% CI 0.05–0.58]; p  = 0.005), higher inflammation (OR 3.7 [95% CI 2.09–7.32]; p  = 0.001), and lymphocyte count on the day of onset/24 hours following NEC (OR 1.06 [95% CI 1.02–1.11]; p  = 0.005) were independently associated with a higher odd of severe intestinal hemorrhage. CONCLUSION: The surgical NEC infants with intestinal hemorrhage were less likely to have antenatal steroid exposure but had higher inflammation grade and lymphocyte counts following NEC onset on multivariable regression modeling. Show more

Keywords: Preterm infants, necrotizing enterocolitis, intestinal hemorrhage, outcomes

DOI: 10.3233/NPM-221116

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 1, pp. 119-128, 2023

Authors: Ismail, R.I.H. | Awad, H.A. | Saber, M. | Shehata, B.M.

Article Type: Research Article

Abstract: BACKGROUND: Prematurity is associated with lots of comorbidities. Premature neonates also have lower bone mineral content (BMC) compared to term neonates. Apnea of prematurity is a common complication and caffeine citrate is widely used for its prevention and treatment. Caffeine also affects creatinine clearance, urine flow rate and releases calcium from its storage sites. OBJECTIVES: The primary objective was to assess BMC in preterm neonates treated with caffeine using dual energy X-ray absorptiometry (DEXA). Secondary objectives were to determine whether caffeine therapy is associated with increased incidence of nephrocalcinosis or bone fracture. METHODS: Prospective observational study …on 42 preterm neonates, 34 weeks’ gestation or less; 22 of them received intravenous caffeine (caffeine group) and 20 did not (control group). Serum levels of calcium, phosphorus, alkaline phosphatase, magnesium, sodium, potassium, and creatinine, abdominal ultrasonography, and DEXA scan were done for all included neonates. RESULTS: BMC showed significant lower levels in the caffeine compared to control group (p  = 0.017). Additionally, BMC was significantly lower in neonates who received caffeine for more than 14 days compared to those who received it for 14 days or less(p  = 0.04). BMC showed significant positive correlation to birth weight, gestational age, serum P and significant negative correlation to serum ALP. Caffeine therapy duration was negatively correlated to BMC (r  = –0.370, p  = 0.000) and positively correlated to serum ALP levels (r  = 0.667, p  = 0.001). None of the neonates had nephrocalcinosis. CONCLUSIONS: Caffeine administration for more than 14 days in preterm neonates may be associated with lower BMC but not nephrocalcinosis or bone fracture. Show more

Keywords: Caffeine, DEXA, neonates, osteopenia

DOI: 10.3233/NPM-221172

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 1, pp. 129-135, 2023

Authors: Pereira, S.S.

Article Type: Research Article

Abstract: BACKGROUND: Patent ductus arteriosus (PDA) diameter is a frequently measured echocardiographic parameter when assessing the PDA. Though, there are recommendations to use 2D echocardiography to measure the PDA diameter, there is paucity of data on how PDA diameter compares when measured using 2D and color echocardiography. The aim of this work was to examine the bias and limits of agreement between measuring PDA diameter using color and 2D echocardiography in newborn infants. METHODS: This retrospective study examined the PDA using the high parasternal ductal view. Using colour compare, three consecutive cardiac cycles were used to measure …PDA diameter at the narrowest point where the PDA joined the left pulmonary artery in both 2D and colour echocardiography by a single operator. RESULTS: The bias between PDA diameter using color and 2D echocardiography was examined in 23 infants (mean gestation: 28.7weeks). The mean (SD, 95% LoA) bias between color and 2D were 0.45(0.23, –0.005 to 0.91) mm. CONCLUSION: Color measurements exaggerated PDA diameter measurements when compared to 2D echocardiography. Show more

Keywords: 2D echo, color doppler, echocardiography, patent ductus arteriosus

DOI: 10.3233/NPM-221042

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 1, pp. 137-140, 2023

Authors: Gable, M. | Shaffer, T. H. | Locke, R. | Mackley, A. | Kovatis, K.Z.

Article Type: Research Article

Abstract: BACKGROUND: Kangaroo mother care (KMC) is defined as prolonged skin to skin care between a mother and infant with the infant lying in prone position on mom’s chest. KMC decreases morbidity and mortality and promotes physiologic stability. The aim of this study is to measure work of breathing (WOB) during KMC in very low birth weight (VLBW) infants on non-invasive respiratory support. METHODS: A prospective observational pilot study was conducted comparing WOB indices during standard care (SC) and KMC. Respiratory inductive plethysmography (RIP) measured WOB indices non-invasively: phase angle and labored breathing index. VLBW infants who were stable …on non-invasive respiratory support were randomized to receive RIP measurements during KMC or during SC first. Summary statistics and mixed linear models were used to compare WOB and vital signs. RESULTS: A total of 32 infants were consented for the study, data collection and analysis was completed on 28 infants. There were no significant differences in mean phase angle during KMC or SC (73.5±4.6 SE deg vs 66.8±3.9 SE deg, p  = 0.25). No differences in WOB and vital signs were detected. Controlling for respiratory support or randomization/first location did not change the results. CONCLUSION: In this pilot cohort, infants demonstrated no differences in work of breathing indices or oxygen saturation during KMC or SC while receiving non-invasive respiratory support. KMC appears to be safe and well tolerated with no worsened WOB. Larger studies should be performed to confirm our findings. Show more

Keywords: Kangaroo mother care, phase angle, very low birth weight, work of breathing

DOI: 10.3233/NPM-221068

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 1, pp. 141-150, 2023

Authors: Fernández, C. R.

Article Type: Research Article

Abstract: BACKGROUND: Little is known about preterm infant feeding and growth in the outpatient setting, and there are no standardized post-hospital discharge feeding guidelines. This study aims to describe post-neonatal intensive care unit (NICU) discharge growth trajectories of very preterm (<32 weeks gestational age (GA)) and moderately preterm (32–34 0/7 weeks GA) infants managed by community providers and to determine the association between post-discharge feeding type and growth Z-scores and z-score changes through 12 months corrected age (CA). METHODS: This retrospective cohort study included very preterm infants (n  = 104) and moderately preterm infants (n  = 109) born 2010–2014 and followed …in community clinics for low-income, urban families. Infant home feeding and anthropometry were abstracted from medical records. Repeated measures analysis of variance calculated adjusted growth z-scores and z-score differences between 4 and 12 months CA. Linear regression models estimated associations between 4 months CA feeding type and 12 months CA anthropometry. RESULTS: Moderately preterm infants on nutrient-enriched vs. standard term feeds at 4 months CA had significantly lower length z-scores at NICU discharge that persisted to 12 months CA (–0.04 (0.13) vs. 0.37 (0.21), respectively, P  = .03), with comparable length z-score increase for both groups between 4 and 12 months CA. Very preterm infants’ 4 months CA feeding type predicted 12 month CA body mass index z-scores (β=–0.66 (–1.28, –0.04)). CONCLUSION: Community providers may manage preterm infant post-NICU discharge feeding in the context of growth. Further research is needed to explore modifiable drivers of infant feeding and socio-environmental factors that influence preterm infant growth trajectories. Show more

Keywords: Community pediatric provider, feeding, infant growth, moderate preterm infant, obesity, post-hospital discharge, very preterm infant

DOI: 10.3233/NPM-221156

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 1, pp. 151-164, 2023

Authors: Sidatt, M. | Sghair, Y.M. | Ghaddour, T. | Ahmed, M.S. | Kader, F.A. | Habib, L. | Abass, A.M. | Bounaty, A.

Article Type: Case Report

Abstract: Digestive symptoms have been reported in an important proportion of children with COVID-19, and the clinical expression of critical patients with COVID-19 is thought to result from progressive increase of inflammation and an unusual trend of hypercoagulation. We report a newborn received with abdominal distension, green vomiting and imaging suggestive for enterocolitis. He had a close contact with COVID-19 and the PCR for SARS-CoV-2 came back positive. Despite the supportive measures, his condition deteriorated and a surgery was decided. The surgical exploration found an ischemic bowel. The therapeutic measures were ineffective as the child passed away a few hours after …surgery despite the resuscitation treatment performed. The confirmed enterocolitis happening within the period of acute infection by SARS-CoV-2, the NEC was likely a manifestation of COVID-19. Show more

Keywords: Necrotizing enterocolitis, neonate, SARS-CoV-2

DOI: 10.3233/NPM-210906

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 1, pp. 165-168, 2023