Journal of Neonatal-Perinatal Medicine - Volume 16, issue 2

Authors: Wolf, B.

Article Type: Article Commentary

DOI: 10.3233/NPM-190372

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 2, pp. 191-192, 2023

Authors: Garg, P.M. | Shenberger, J.S.

Article Type: Article Commentary

DOI: 10.3233/NPM-230048

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 2, pp. 193-194, 2023

Authors: Legge, Nele | Popat, H. | Fitzgerald, D.

Article Type: Review Article

Abstract: BACKGROUND: This review provides an update of the current research related to the impact of extreme and very premature birth on parental mental health and family functioning following discharge from hospital. METHODS: Full-text peer reviewed articles in English, describing parents’ and families’ health and wellbeing after the discharge from hospital of their baby using validated questionnaires, were evaluated. Results of included studies are presented in a summarized format. Embase, Medline and PsycINFO databases were accessed in January 2021. RESULTS: 38 studies were included. Nine manuscripts reported on parental mental health and 13 on stress, which are …a concern after the birth of a premature infant, especially in the first year. Depression, anxiety, and stress are known to measure higher compared to parents of infants born at term. Over several years, these measures of mental health decrease significantly. Four reported on quality of life for parents of premature infants, which is reduced immediately after discharge, but then improves over time. The impact of premature birth on the family functioning was described in ten included studies and was described to have positive and negative consequences. CONCLUSION: The negative impact of the premature birth and hospital journey on parental mental health lessens significantly with time. Show more

Keywords: Family functioning, mental health, parents, premature birth, stress

DOI: 10.3233/NPM-221107

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 2, pp. 195-208, 2023

Authors: Hirides, P.C. | Hirides, S.C. | Hirides, C.

Article Type: Review Article

Abstract: BACKGROUND: Despite evidence on the prenatal pathogenesis of Cerebral Palsy (CP), there are many instances where obstetricians face litigation for malpractice. OBJECTIVE: A scoping review of research on the association of CP with “difficult” delivery in term neonates. DESIGN: For the purposes of this review an internet search was performed using credible electronic databases. RESULTS: There are more than 32,500 citations under the keyword cerebral palsy, the majority of which, focus on diagnosis and treatment. Only 451 citations were included in the final review, associated with perinatal asphyxia, birth trauma, difficult delivery and obstetric …litigations. Additionally, 139 medical books from various specialties were included in the research. DISCUSSION: The sequence of events is hereby presented, through which the original connection between CP and delivery, has gradually been cut off. Meanwhile, all contributing factors of difficult delivery are evaluated. Persistent abnormal fetal attitude seems to be strongly connected to the difficult birth in affected term neonates. Vaginal delivery is accomplished only after sufficient passive flexion of the fetal head, achieved by additional expulsive efforts by both the mother and the assisting personnel. This additional force is perceived by the parents to be as the principal etiology of CP in their infant. In the past decades, there has been increasing evidence pertaining fetal perceptual abilities and cognitive functions. CONCLUSIONS: Difficult birth may be the first, amongst the early manifestations of neonatal encephalopathy. Show more

Keywords: Birth asphyxia, cerebral palsy, difficult birth, obstetric litigations, prolonged labor

DOI: 10.3233/NPM-230043

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 2, pp. 209-219, 2023

Authors: Ito, T. | Kadowaki, K. | Saito, S. | Katagiri, C. | Ishihara, K.

Article Type: Research Article

Abstract: BACKGROUND: A few studies have been reported on the influence of fetal hiccups on umbilical artery. The aim of this study is to clarify the influence of fetal hiccups on Doppler blood flow waveform (DBFW) of some fetal arteries, and to show the difference in these influences among fetal arteries. OBJECTIVE: DBFW of umbilical artery, descending aorta, and middle cerebral artery were recorded at hiccups in normal fetuses between 34th and 40th gestational weeks. The changes on DBFW were classified into three shapes by the direction and the size of the changes. Shape 1: sharp decrease but not …to the baseline, Shape 2: sharp decrease to the baseline (absence), and Shape 3: reverse flow. RESULTS: At all hiccups, the changes on DBFW of these arteries were observed. These changes were classified into three shapes. Changes of umbilical artery were widely distributed in three shapes depending on when hiccup occurred during cardiac cycle. On the other hand, most changes of the descending aorta and middle cerebral artery were Shape 3 whenever the hiccup occurred during cardiac cycle. CONCLUSION: The changes on DBFW of fetal arteries were observed at all hiccups. Changes of umbilical artery were widely distributed in three shapes depending on when hiccup occurred during cardiac cycle. On the other hand, most changes of descending aorta and middle cerebral artery were Shape 3. This is the first study clarified the influence of fetal hiccups on DBFW of some fetal arteries, and showed the difference in these influences among fetal arteries. Show more

Keywords: Blood flow velocity, doppler blood flow waveform, fetal artery, fetal hiccup, umbilical artery

DOI: 10.3233/NPM-210929

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 2, pp. 221-226, 2023

Authors: Reppucci, M.L. | Kaizer, A.M. | Prendergast, C. | Acker, S.N. | Mandell, E.W. | Euser, A.G. | Diaz-Miron, J.

Article Type: Research Article

Abstract: PURPOSE: Infection with COVID-19 during pregnancy has been associated with a hypercoagulable state. It is unknown if maternal COVID-19 infection results in congenital anomalies secondary to intrauterine vascular accidents. This study sought to determine if the rate of in-utero vascular complications (intestinal atresia and limb abnormalities) that may be attributable to the hypercoagulable states associated with COVID-19 and pregnancy increased after the onset of the pandemic. METHODS: Pregnancy, neonatal, and congenital defect data from a single academic medical center and the partner’s children’s hospital were collected and compared to the period prior to onset of the pandemic. …A subanalysis including pregnant woman 18 years or greater with documented COVID-19 infection during gestation between March 2020-2021 was performed. RESULTS: Rates of intestinal atresia did not differ prior to or after the onset of the pandemic (3.78% vs 7.23%, p  = 0.21) nor did rates of limb deficiency disorders (4.41% vs 9.65%, p  = 0.09). On subanalysis, there were 194 women with COVID-19 infection included in analysis: 135 (69.6%) were positive during delivery admission and 59 (30.4%) were positive earlier in their pregnancy. There was one infant born with intestinal atresia. CONCLUSION: We report a low incidence of congenital anomalies in infants born to mothers with COVID-19 infection. It remains unclear if the impact of COVID-19 on the coagulative state augments the normal pro-thrombotic state of pregnancy; ongoing surveillance is warranted. Show more

Keywords: COVID-19, neonatal outcomes, intestinal atresia, limb deficiency disorders

DOI: 10.3233/NPM-221122

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 2, pp. 227-234, 2023

Authors: Ozer, E. | Cagliyan, E. | Cagaptay, S.

Article Type: Research Article

Abstract: INTRODUCTION: The coronavirus disease (COVID-19) has created a serious health problem in pregnant people. We aimed to address whether vaccination can prevent development of placental disease in SARS-CoV-2 infected mothers. METHODS: We reported the pathology findings obtained from routine histopathological examination of placentas of overall 38 cases. RESULTS: We found low prevalence of placental pathology in vaccinated pregnant people with active SARS-CoV-2 infection in comparison to those unvaccinated cases. CONCLUSION: Based on our findings, SARS-CoV-2 vaccination can prevent development of placental pathological lesions and may lower the risk of serious illness in pregnant people.

Keywords: COVID-19, placenta, pregnancy, SARS-CoV-2, vaccination

DOI: 10.3233/NPM-221141

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 2, pp. 235-237, 2023

Authors: Patra, S. | Manerkar, S. | Kaur, S. | Kalathingal, T. | Kalamdani, P. | Bhisikar, S. | Mondkar, J.

Article Type: Research Article

Abstract: BACKGROUND: Poractant administration with thin catheter is gradually gaining popularity compared to the INSURE technique. However, there is little evidence to use thin catheters for administration of beractant. With this background, we compared the effect of beractant administration with INSURE vs thin catheter in preterm infants less than 34 weeks with RDS on death/chronic lung disease (CLD). METHODS: This prospective cohort study was conducted in a tertiary NICU where inborn preterm infants≤34 weeks with RDS receiving beractant by INSURE or thin catheter were studied over two epochs- Epoch1– INSURE (Jan 2020–Oct 2020) & Epoch 2– Surfactant through thin …catheter (Nov 2020–July 2021).The primary outcome was occurrence of death/CLD. Procedure related complications like transient bradycardia/desaturation, pneumothorax, failure of procedure, rates of other outcomes like failure of CPAP within 72hr, duration of invasive mechanical ventilation/ CPAP support, oxygen supplementation, other major neonatal morbidities & mortality were evaluated as secondary outcomes. RESULTS: The combined outcome of death/CLD was significantly lower in the thin catheter epoch (RR 0.56, 95% CI 0.34-0.90, p  = 0.012). When analyzed independently for death/CLD, we found significantly lower number of deaths in the thin catheter epoch (RR 0.44, 95% CI 0.23-0.83, p  = 0.008). Number of infants who failed CPAP within 72 hrs of life was lower in thin catheter epoch (RR 0.59, 95% CI 0.41-0.85, p  = 0.003). Transient bradycardia/desaturation was higher during thin catheter technique (RR 4.17, 95% CI 2.22-7.69, p  < 0.001). Incidence of severe IVH was lower with thin catheter technique (RR 0.13, 95% CI 0.02-0.98, p  = 0.034). CONCLUSION: Beractant administration by thin catheter reduces combined outcome of death/CLD. Show more

Keywords: Beractant, CLD, INSURE, RDS, thin catheter

DOI: 10.3233/NPM-231205

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 2, pp. 239-245, 2023

Authors: Alshafei, Atef | Farouk, Shymaa | Khan, Anwar | Ahmed, Mahmoud | Elsaba, Yaser | Aldoky, Yahia

Article Type: Research Article

Abstract: BACKGROUND: Umbilical venous catheters (UVCs) or peripherally inserted central catheters (PICCs) are routinely inserted in preterm infants for total parenteral nutrition and medications. We aimed to examine whether the rates of severe intraventricular hemorrhage (IVH) or death vary among preterm infants receiving UVCs compared to PICCs. METHODS: This randomized controlled trial included preterm infants < 30 weeks gestation assigned after birth to either UVC placement group or PICC group. RESULTS: A total of 233 preterm infants (117 infants in UVC group, 116 infants in PICC group) were randomized and collected data was available for intention-to-treat analysis. There were …no differences in baseline population characteristics. Severe IVH occurred in 16 infants (13.6%) in the UVC group and 11(9.5%) in the PICC group (risk difference [RD], 4.1% [5% CI, –4 to 12.3]; P  = 0.42). The incidence of death before 28 days of life did not differ significantly between groups (10 [8.5% ] in UVC vs 6 [5.1%] in PICC; RD, 3.4% [95% CI, –3.0 to 9.84]; P  = 0.44). Seventeen percent (20/117) of the UVC group died or developed severe IVH compared with 12% (14/116) of the PICC group (risk difference, 5% [95% CI, –4.01 –14.06]; P  = 0.36). The incidence of necrotizing enterocolitis (NEC) was significantly higher in the UVC group infants than in the PICC group infants (7.7% vs. 1.7%); p  = 0.03. CONCLUSIONS: The incidence of severe IVH or death did not differ significantly among preterm m infants < 30 weeks gestation subjected to UVC or PICC placement. Early inotropic support was a significant risk factor for the development of severe IVH. UVC maybe an additional risk factor for the development of NEC, but further research is required to validate this finding. Show more

Keywords: IVH, mortality, NEC, PICC, UVC

DOI: 10.3233/NPM-221126

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 2, pp. 247-255, 2023

Authors: Batra, P. | Singh, P. | Ahmed, R.S. | Harit, D.

Article Type: Research Article

Abstract: BACKGROUND: Severe perinatal depression is a significant cause of mortality and morbidity in neonates. Vitamin D levels were observed to be low in mothers and their neonates with hypoxic ischemic encephalopathy in some studies, owing to its neuroprotective properties. OBJECTIVE: Primary objective was to compare vitamin D deficiency state in full term neonates with severe perinatal depression and healthy term controls. Secondary objectives were to determine sensitivity and specificity of serum 25(OH)D<12 ng/mL in predicting mortality, development of hypoxic ischemic encephalopathy, abnormal neurological examination at discharge, and developmental outcome at 12 weeks of age. MATERIAL AND METHODS: …Serum 25(OH)D levels in full term neonates with severe perinatal depression and healthy controls were compared. RESULTS: Serum 25(OH)D levels in severe perinatal depression and controls (n  = 55 each group) were significantly different (7.50 ± 3.53 ng/mL vs 20.23 ± 12.70 ng/mL). At cut-off of < 12 ng/mL, serum 25(OH)D could predict mortality with 100% sensitivity and 17% specificity and poor developmental outcomes with sensitivity of 100% and specificity of 50%. CONCLUSION: Vitamin D deficiency status at birth can serve as an effective screening tool and poor prognostic markers in term neonates with severe perinatal depression. Show more

Keywords: Mortality, neonates, neurological outcomes, perinatal depression, predictors, serum 25(OH)D

DOI: 10.3233/NPM-230020

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 2, pp. 257-264, 2023

Authors: Khan, M. | Bateman, D. | Sahni, R. | Leone, T.A.

Article Type: Research Article

Abstract: OBJECTIVE: To compare proportions of target range tidal volumes achieved with the self-inflating bag vs. the T-piece in resuscitation of preterm newborns at delivery. STUDY DESIGN: This randomized controlled trial was conducted at a tertiary Children’s Hospital. 20 preterm infants≤32 weeks’ gestational age with no congenital anomalies who needed positive pressure ventilation after birth were enrolled. Positive pressure ventilation was provided with the self-inflating bag or T-piece resuscitator. The primary outcome was proportion of inflations within a target range of 4–8 ml/kg. Chi-square and logistical regression analyses were performed. RESULTS: In the self-inflating bag (SIB) group 29% …of inflations (117/419) and in the T-Piece (TP) group 51% of inflations (300/590) delivered expiratory tidal volume (TVe) of 4–8 ml/kg (p  < 65.001). In the SIB group 60% of all inflations (254/419), and in the TP group 35% of all inflations (204/590) delivered TVe < 4 ml/kg (p  < 0.001). In the SIB group 11% of all inflations (48/419), and in the TP group, 15% of all inflations (86/590) delivered TVe > 8 ml/kg (p  = 0.18). The OR of having expiratory tidal volume of 4–8 ml/kg using the T-piece was 1.8 (CI 1.1–3.1), p  = 0.02. CONCLUSION: Manual inflations provided by the TP deliver expiratory tidal volumes in the range of 4–8 ml/kg more consistently than SIB. Show more

Keywords: Delivery room (DR), expiratory tidal volume (TVe), peak inspiratory pressure (PIP), positive end expiratory pressure (PEEP), positive pressure ventilation (PPV)

DOI: 10.3233/NPM-210728

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 2, pp. 265-270, 2023

Authors: Rezaei, R. | Sharifnia, H. | Nazari, R. | Saatsaz, S.

Article Type: Research Article

Abstract: BACKGROUND AND PURPOSE: Infants’ sleep disorders and parents’ insufficient sleep are common problems in the infant care. The current study was conducted to assess the effectiveness of infant massage on infants’ night-time sleep condition and mothers’ sleep quality. PROCEDURES: 140 infants were randomly put into two different groups, experimental group with fifteen-minute bedtime messages for two weeks and the control group with normal infant routine care. The Brief Infant Sleep Questionnaire, a personal information submission form, and Pittsburgh Sleep Quality Index for the mothers were the tools used to gather data in this study. RESULTS: Infants …in experimental group showed meaningful differences in variables such as, sleep latency (P  < 0001, eta = 0.099), number of night waking (P  = 0.03, eta = 0.027) and longest continuous sleep period (P  = 0.03, eta = 0.026). As for other variables no meaningful differences were observed. There wasn’t meaningful difference in the mother’s overall night-time sleep quality between the two groups (P  = 0.184, eta = 0.012) except for the duration of the mother’s night-time sleep (P  = 0.028, eta = 0.026) and the reduction of maternal sleep disorder (P  = 0.020 eta = 0.029). CONCLUSION: The findings indicated that infants’ bedtime massages would improve some of the sleep markers of mothers and infants, and therefore, can be suggested as a practical, harmless, and cost-free method to improve sleep. Show more

Keywords: Infant massage, quality of sleep, mother, night-time sleep

DOI: 10.3233/NPM-210964

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 2, pp. 271-278, 2023

Authors: Sundararajan, S. | Abi Habib, P. | Tadbiri, H. | Aycan, F. | Mangione, M. | Chaves, A.H. | Seger, L. | Turan, O. | Turan, S.

Article Type: Research Article

Abstract: BACKGROUND: Factors that determine the need for Gastrostomy tube (G-tube) placement in infants with complex congenital heart defects (CHD) are variable. We aim to identify factors that improve counseling of expectant parents regarding postnatal outcomes and management. METHODS: We performed a retrospective review of medical record of infants with prenatal diagnoses of complex CHD between 2015-2019 in a single tertiary care center and assessed risk factors for G-tube placement with linear regression. RESULTS: Of the 105 eligible infants with complex CHD, 44 infants required G-tube (42%). No significant association was observed between G-tube placement and chromosomal …abnormalities, cardiopulmonary bypass time or type of CHD. Median days on noninvasive ventilation (4 [IQR 2-12] vs. 3 [IQR 1-8], p  = 0.035), time at which gavage-tube feeds were started postoperatively (3 [IQR 2-8] vs. 2 [IQR 0-4], p  = 0.0013), time to reach full-volume gavage-tube feeds (6 [IQR 3-14] vs. 5 [IQR 0-8], p  = 0.038) and intensive care unit (ICU) length of stay (LOS) (41 [IQR: 21 – 90] vs. 18 [IQR: 7 – 23], p  < 0.01) were associated with G-tube placement. Infants with ICU LOS duration longer than median had almost 7 times the odds of requiring a G-tube (OR: 7.23, 95% CI: 2.71-19.32; by regression). CONCLUSIONS: Delay in initiation and in reaching full-volume gavage-tube feeds after cardiac surgery, increased number of days spent on non-invasive ventilation and in the ICU were found to be significant predictors for G-tube placement. The type of CHD and the need for cardiac surgery were not significant predictors for G-tube placement. Show more

Keywords: Cardiac surgery, complex congenital heart defects, feeding difficulty, G-tube, parental counseling

DOI: 10.3233/NPM-230012

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 2, pp. 279-285, 2023

Authors: Alsayeed, A. | Salama, H. | Sayed, G. | Abdullah, L. | Al-Obaidly, S. | Al-Qubaisi, M. | Mansour, A.

Article Type: Research Article

Abstract: Low birth weight (LBW) is an important indicator of maternal health and poverty. This study explored the socioeconomic factors associated with LBW. METHODS: Data was collected from a 4-year maternal-newborn registry. RESULTS: There were 5,316 LBW and 54,029 normal birth weight (NBW). The prevalence of LBW was 9%. The Native women in the LBW group compared to non-native women were 10.4% (1784/5316) vs. 8.4% (3532/5316) with a P -value of 0.001. There were more illiterate mothers in the LBW compared to the NBW, respectively: 8.1% (1597/19497) vs. 7.5% (1763/23230) with a P -value of 0.001. Working mothers …tend to have more LBW infants compared to mothers with NBW, 8.4% (1588/17217) vs. 7.9% (2532/31891) and P -value 0.001. Young mothers (<20 years old) with early childbearing had more LBW compared to older mothers, respectively 12.7% (180/1414) vs. 8.9% (5149/52919) P -value <0.001. Women with no antenatal care reported a high rate of LBW compared to women with regular antenatal care: 14.2% (516/3696) vs. 8.6% (4741/55691) P -value <0.001. LBW babies were born more from assisted conception pregnancies (38% compared to 8.4% of normal pregnancies) P -value <0.001. Smoking mothers scored higher with LBW at 13.6% vs. 8.3% and a P -value of 0.001. There were no differences between the two groups regarding religion, consanguinity, marital status, or family income. CONCLUSION: Risk factors for low birth weight can be improved by providing antenatal care, smoking cessation, optimizing high-risk pregnancy care, and governing assisted reproduction regulations. Show more

Keywords: Low birth weight, maternal, newborn, outcome, socioeconomic

DOI: 10.3233/NPM-221169

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 2, pp. 287-291, 2023

Authors: Alturk, M.R. | Alkhdr, M.O. | Abo Zeed, M.S. | Singh, K.

Article Type: Research Article

Abstract: BACKGROUND: Minimal enteral feeding after birth has been developed as a strategy to enhance the functional maturation of the gastrointestinal tract. This study aimed to examine the relationship between the duration of minimal enteral feeding and time to regain birth weight in extremely low-birth-weight infants. METHODS: This retrospective study included all extremely low-birth-weight infants born between January 2018 and December 2020. Infants with major congenital anomalies and conditions requiring surgery and those who died or received palliative care in the first 10 days of life were excluded from the analysis. Minimal enteral feeding courses were categorized as extended …if the feeding was continued for > 72 hours and short if the feeding was < 72 hours. The primary measured outcome was the time taken to regain birth weight. RESULTS: Of 217 study infants, 180 received an extended minimal enteral feeding for > 72 h. The median time to regain birth weight was not significantly different between the extended and short minimal enteral feeding groups, median (IQR) was 10 (7–13) versus 8 (6–11), respectively (p  = 0.15). Extended minimal enteral feeding is associated with a significant increase in the mean duration of the total parenteral nutrition, (21.3±10 versus 17.2±9.3 days; p  = 0.021). Infants with prolonged minimal enteral feeding courses experienced non-significantly higher levels of necrotizing enterocolitis, late-onset sepsis, and retinopathy of prematurity. CONCLUSIONS: Extended minimal enteral feeding in extremely low-birth-weight infants may not affect the time taken to regain birth weight. Show more

Keywords: Intraventricular hemorrhage, minimal enteral feeding, necrotizing enterocolitis, preterm infants, retinopathy of prematurity, time to full feed, time to regain birth weight

DOI: 10.3233/NPM-221166

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 2, pp. 293-299, 2023

Authors: Caruso, C.G. | Warren, J.B. | Carney, P.A.

Article Type: Research Article

Abstract: BACKGROUND: This exploratory study examined parents’ experiences with “Growing at Home” (G@H), a remote patient monitoring program for stable infants discharged from the Neonatal Intensive Care Unit (NICU) with continued need for nasogastric tube feeding. METHODS: We used classical content analysis to identify and refine emergent themes from 13 semi-structured key informant interviews. RESULTS: The primary emergent theme was the desire to return to normalcy, which was expressed as a primary motivator for participating in G@H. Parents reported G@H assisted them in transitioning from the NICU’s highly medicalized setting to establishing a new normal with incorporation …of their infant into their lives and families. Parental preparation is important, as some parents experienced challenges that indicate the program may not be suitable for all families. CONCLUSIONS: Parental experiences offer insight into benefits and challenges of early discharge from the NICU and highlight opportunities to support families beginning in the NICU and as they transition home. Show more

Keywords: Early NICU discharge, home nasogastric tube feeding, parent perspectives, qualitative interviews, remote patient monitoring

DOI: 10.3233/NPM-221181

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 2, pp. 301-309, 2023

Authors: Al-Omran, A.M. | Shapan, H.A. | Al-Abdi, S.Y.

Article Type: Research Article

Abstract: BACKGROUND: ABO incompatibility is a major risk factor for neonatal indirect hyperbilirubinemia (NIH), requiring treatment. It has been shown that there are racial differences in direct antiglobulin test (DAT) positivity and phototherapy need in the O-–B versus (vs) O-–A incompatibility. The comparison between the O-–B and O-–A incompatibility is not well studied in Saudi Arabia. AIMS: We aimed to compare DAT positivity and phototherapy need in O–B vs O–A incompatibility in Saudi Arabia. METHODS: This retrospective cohort study was conducted in one Saudi hospital. We included a convenience sample of neonates born between 01 January 2013 …and 31 December 2021. We included healthy neonates admitted to the nursery care unit only, born at≥38 weeks gestation, and had normal G6PD levels. Neonates that had no G6PD level measurement or lost follow-up post-discharge were excluded. The data span was the first 14 days of life. RESULTS: A total of 611 neonates met our inclusion criteria. Positive DAT was more prevalent in the O–B than the O–A incompatibility [43.5% vs 29.2%, p  < 0.001). A greater odd of phototherapy need was observed in the O-–B vs O–A incompatibility across various strata. Readmission for NIH, use of 360° exposure phototherapy, or intravenous immunoglobulin administration was more prevalent in the O–B than the O–A incompatibility (13.2% vs 5.0%, p  < 0.001). A logistic regression analysis revealed that the O–B incompatibility modified the association between DAT positivity and phototherapy need. CONCLUSIONS: The O–B incompatibility had a mediator effect on the relationship between DAT positivity and the need for phototherapy in the study population, which emphasizes that the O–B and O–A are not the same from the NIH point of view. Show more

Keywords: ABO incompatibility, ABO isoimmunization, direct antiglobulin test, neonatal hyperbilirubinemia, phototherapy

DOI: 10.3233/NPM-221136

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 2, pp. 311-317, 2023

Authors: Witt, R.E. | Singhal, M. | Vachharajani, A.J.

Article Type: Research Article

Abstract: BACKGROUND: The purpose of this study was to compare the outcomes of infants with giant omphalocele (GO) born in two different epochs over two decades at a single institution. Specifically, it examined whether the utilization of selective pulmonary vasodilators and extracorporeal membrane oxygenator (ECMO) in the management of pulmonary hypertension in the second epoch were associated with improved outcomes. METHODS: The medical records of all patients diagnosed with GO at a large children’s hospital from January 1, 1996 to December 31, 2016 were reviewed and divided into two epochs. Patients were classified as having an isolated GO or …GO with minor or major associated anomalies. GO was defined as a defect more than or equal to 5 cm in size and/or liver in the sac. RESULTS: During the study period, 59 infants with GO were identified. The duration of invasive mechanical ventilation was significantly shorter among the survivors from the second epoch (p  = 0.03), with none greater than seven days. There were no significant differences in the outcomes of survival to NICU discharge and length of stay (LOS) between infants in the two epochs. CONCLUSIONS: Infants with GO who required invasive mechanical ventilation for more than seven days did not survive in the second epoch. Survival did not improve with use of selective pulmonary vasodilators and ECMO. This information could be shared with families during prenatal and postnatal counselling to facilitate informed decision making regarding goals of care. Show more

Keywords: Giant omphalocele, outcomes, mechanical ventilation, pulmonary vasodilators, extracorporeal membrane oxygenator (ECMO)

DOI: 10.3233/NPM-200451

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 2, pp. 319-323, 2023

Authors: Aranha, V.P. | Chahal, A. | Bhardwaj, A.K.

Article Type: Research Article

Abstract: BACKGROUND: Preterm infant experiences neuromotor disturbances and neonatal pain during NICU stay. Optimal brain development and pain tolerance require both sensory and motor experiences. We aimed to explore the effect of multimodal stimulation (MMS) including multi-sensory and movement therapy on neuromotor behaviour and neonatal pain among hospitalized preterm infants. METHODS: 32 recruited preterm infants [gestational age (GA): 28 to 36 weeks] by convenience sampling technique for pre-test-post-test control group, single-center randomized controlled study were randomly allocated into two groups, MMS group, and control group. MMS group received the interventions for 5 days period, totalling five sessions with 30 …minutes/session. Infant Neurological International Battery (INFANIB), Neonatal Infant Pain Scale (NIPS), weight, length, and Occipitofrontal circumference (OFC) were recorded at baseline and 6th day to analyze the changes observed neuromotor behaviour, neonatal pain, and changes in the anthropometric parameters respectively. RESULTS: GA, weight, length and OFC of preterm infants recruited were, 34.4±2 weeks, 2.11±0.48 kg, 45±3.8 cm and 32.3±1.7 cm respectively. INFANIB and NIPS change scores in MMS group were [4 (2, 6); p  = 0.001] and NIPS scores [2 (2,3); p  < 0.001] respectively when compared to INFANIB [– 4 (– 6, – 2); p  = 0.001] and NIPS scores [1 (– 1,1); p  = 0.778] in control group. Significant difference p  < 0.001 in INFANIB and NIPS scores while non-significant difference in weight (p  = 0.166), length (p  = 0.443) and OFC (p  = 0.413) were observed between the groups. CONCLUSION: Administration of MMS has a positive clinically significant impact on neuromotor behaviour and neonatal pain on preterm infants. Show more

Keywords: Early intervention, multisensory stimulation, neonates, preterm neonates

DOI: 10.3233/NPM-210889

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 2, pp. 325-337, 2023

Authors: Yılmaz, A. | Kaya, N. | Meriç, R. | Bayramli, Z. | Öroğlu, B. | Celkan, T.T. | Vural, M. | Perk, Y.

Article Type: Case Report

Abstract: Purpura fulminans (PF) is a rare and fatal complication of septic shock or diffuse intravascular coagulation (DIC) resulting in skin and soft tissue necrosis. PF can be caused by congenital or acquired protein C (PC) or protein S (PS) deficiency. The most common cause of PF in a neonate is sepsis. In our extremely low birth weight preterm case, due to PF that started in the right-hand fingers, examination was made and protein S deficiency was detected as well as MTHFR (A1298C) and Factor V Leiden (R506Q) homozygous mutations. While being unresponsive to fresh frozen plasma (FFP) and unfractionated heparin …(UFH) therapy, we want to highlight the curative treatment with hyperbaric oxygen (HBOT), which has not previously been used in extremely low birth weight preterm infants for this purpose. Show more

Keywords: Purpura fulminans, preterm, hyperbaric oxygen therapy

DOI: 10.3233/NPM-200428

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 2, pp. 339-342, 2023

Authors: Kasai, R. | Toriyabe, K. | Goto, T. | Hatano, M. | Kondo, Y. | Ohta, T. | Suyama, M. | Goto, T. | Koide, W. | Maki, K. | Ushijima, K. | Ban, K.

Article Type: Case Report

Abstract: INTRODUCTION: Although breast milk is considered the optimal nutrition for infants, it is also the primary cause of postnatal cytomegalovirus (CMV) infection. Preterm infants with postnatal CMV infections are susceptible to a variety of life-threatening conditions. CASE SUMMARY: Twin male infants were delivered via emergency caesarian section at 27 weeks’ gestation secondary to maternal complete uterine rupture. The Apgar scores at 1 and 5 min were 1 and 1 for the older twin (Twin A) and 0 and 3 for the younger twin (Twin B). Their birth weights were 1203 g (+ 0.65SD) and 495 g (– 3.79SD) respectively. On day 41, …laboratory blood test results for Twin B showed a moderate elevation in C-reactive protein (CRP), thrombocytopenia. CMV quantitative polymerase chain reaction (qPCR) tests in Twin B’s urine and blood as well as in the mother’s breast milk were positive, but stored, dried umbilical cord CMV qPCR tests were negative. Twin B was diagnosed with a postnatal CMV infection secondary to infected breast milk and ganciclovir was commenced on day 52. Treatment was switched to valganciclovir at 74 days of age, but a negative CMV-DNA level in the blood was not achieved. Postnatal CMV infection in this infant led to an exacerbation of pre-existing bronchopulmonary dysplasia (BPD) and he demised at 182 days of age. CONCLUSION: Postnatal cytomegalovirus infections may lead to exacerbations of BPD. Early use of raw breast milk in preterm infants should be done with careful consideration of this potential complication. Show more

Keywords: Breast milk, bronchopulmonary dysplasia, cytomegalovirus, extremely low birth weight, neonate

DOI: 10.3233/NPM-221130

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 2, pp. 343-348, 2023

Authors: Sodero, G. | Colonna, A. Turriziani | Purcaro, V. | Onesimo, R. | Zampino, G. | Vento, G.

Article Type: Case Report

Abstract: EEC syndrome is an autosomal dominant genetic disease with incomplete penetrance characterized by ectrodactyly, ectodermal dysplasia, and cleft lip/palate; these manifestations can differently occur in the affected subjects and can also be associated with other anomalies, such as in the urogenital tract. We reported the case of a newborn with prenatal diagnosis of EEC type 3 associated with severe cardiac abnormalities (Tetralogy of Fallot), high esophageal atresia with fistula and penoscrotal hypospadias.

Keywords: EEC syndrome, newborn, rare disease, tetralogy of Fallot

DOI: 10.3233/NPM-231217

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 2, pp. 349-353, 2023

Authors: Regaieg, C. | Triki, M. | Cheikrouhou, T. | Thabet, A.B. | Charfi, S. | Dhaou, M.B. | Boudawara, T. | Hamed, A.B. | Hmida, N.

Article Type: Case Report

Abstract: Inflammatory myofibroblastic tumors (IMT) are rare borderline tumors with a variable histological appearance that may mimic multiple mesenchymal tumors. We present a rare case of a challenging abdominal mass discovered in a premature newborn. The histopathology showed a bland myofibroblastic proliferation associated with an inflammatory infiltrate that was positive for smooth muscle actin and desmin but negative for anaplastic lymphoma kinase (ALK) protein. The diagnosis of an ALK-negative IMT was established. The tumor was partially resected. After six months of follow-up, the residual tumor remained stable, and the patient was asymptomatic. The correct diagnosis and subsequent treatment of ALK-negative IMT …require appropriate histopathological, immunohistochemical, and sometimes genetic examination. Further research has to be conducted to help clinicians make an appropriate treatment plan. Show more

Keywords: ALK, inflammatory myofibroblastic, neonate, surgery, tumor

DOI: 10.3233/NPM-230007

Citation: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 2, pp. 355-359, 2023