Journal of Neonatal-Perinatal Medicine - Volume 17, issue 1

Authors: Phillips, J.M. | Polyakov, D. | Amdur, R.L. | Ahmadzia, H.K.

Article Type: Research Article

Abstract: BACKGROUND: The aim of our study is to describe maternal and neonatal morbidity and mortality in patients undergoing trial of labor after cesarean from the Consortium on Safe Labor. METHODS: This was a secondary analysis of the Consortium on Safe Labor database, a retrospective cohort study over a 7 year study period. Maternal and neonatal outcomes were evaluated based on desired delivery mode: planned elective repeat cesarean delivery or trial of labor after cesarean. RESULTS: Of 9858 patients in our analysis, our study population had 4400 patients (45%) who desired trial of labor …after cesarean and 5458 patients (55%) who desired elective repeat cesarean delivery. Women who attempted trial of labor after cesarean compared to those who had an elective repeat cesarean delivery were more likely to have an obstetric hemorrhage (adjusted odds ratio 1.6; 95% CI 1.3 –2.0) and blood transfusion (adjusted odds ratio 2.3; 95% CI 1.6 –3.2). CONCLUSION: Maternal morbidity in women undergoing trial of labor after cesarean was predominantly hemorrhage-related. Show more

Keywords: Cesarean delivery, maternal morbidity, obstetric hemorrhage, perinatal counseling, trial of labor after cesarean

DOI: 10.3233/NPM-230009

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 1, pp. 1-5, 2024

Authors: Asal, A.E.A. | Oshaiba, Z.F. | Mansour, E.N.A. | Abd Elaziz, O.H. | Nasr, A.A.A.

Article Type: Research Article

Abstract: BACKGROUND: Persistent pulmonary hypertension of the neonate (PPHN) is a serious disorder. The long pentraxin 3 (PTX3) plays an important role in angiogenesis, cell proliferation, tissue repair and cell regulation. The present study aims to assess the diagnostic and clinical value of PTX3 in PPHN. METHODS: The present case-control 60 full-term neonates diagnosed with PPHN by echocardiography within 72 hours of birth. In addition, there were 30 age and sex-matched healthy neonates who served as controls. All participants were subjected to careful history taking and complete clinical examination, Laboratory investigations included complete blood count, C-reactive protein …(CRP), blood culture and PTX3 level. Radiological investigations included plain X- ray and two-dimensional transthoracic echocardiography (TTE). RESULTS: Comparison between patients and controls revealed that patients had significantly higher CRP (6.12±2.18 versus 3.69±1.25 mg/dl, p  < 0.001) and PTX3 levels (2.07±0.67 versus 0.96±0.21, p  < 0.001) when compared with controls. Patients with associated PDA had significantly higher PTX3 levels when compared with patients without (2.58±0.5 versus 2.02±0.51 ng/ml, p  = 0.002). Also, patients with associated PFO had significantly higher PTX3 levels when compared with patients without (2.12±1.05 versus 2.05±0.46, p  = 0.002). ROC curve analysis identified good performance of CRP and PTX3 levels in diagnosis of PPHN with PTX3 showing better performance. CONCLUSIONS: There is a significant association between serum PTX3 levels and PPHN particularly those with associated PDA or PFO. Show more

Keywords: C-reactive protein, patent ductus arteriosus, pentraxin 3, persistent pulmonary hypertension of the neonate, pulmonary hypertension

DOI: 10.3233/NPM-230211

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 1, pp. 7-11, 2024

Authors: Krasity, B. | Hasan, M. | Uppuluri, S. | Prazad, P.

Article Type: Research Article

Abstract: BACKGROUND: Urinary tract infections (UTIs) and antibiotic overexposure are common neonatal problems. Recently, evidence has emerged that a standardized approach to neonatal UTI can reduce unnecessary diagnosis without complications. This quality improvement project aimed to achieve those goals in our neonatal intensive care unit (NICU). METHODS: A UTI diagnosis guideline was adapted from the literature with the goal of maximizing the proportion of diagnosed UTIs that conform to accepted diagnostic criteria: >10,000 CFU/mL of one organism with pyuria, or >50,000 CFU/mL of one organism regardless of pyuria. The guideline was implemented in a level III NICU. Adherence, results, …and complications were monitored for 12 months. RESULTS: Guideline adherence after implementation was favorable, as evidenced by increased adoption of urinalysis with microscopy. There was a non-significant increase in diagnostic adherence to criteria, 87% to 93%, and non-significant decrease in the rate of UTI diagnosis, 39% to 36%. Complications were not significantly changed. Most UTIs were due to gram-negative rods, especially E. coli ; Enterococcus was a common contaminant. CONCLUSIONS: A guideline for diagnosing UTIs can safely increase uniformity. In contrast to previously published results, no significant changes were seen in the rate of UTI or the proportion of diagnoses conforming to the criteria for UTI. It is likely that guideline effects depend on the established practices of NICU providers. Additionally, a consistent pattern was seen in which organisms were more likely to be judged the source of true UTIs or contaminated cultures, meriting further study. Show more

Keywords: Urinary tract infection, neonatology, quality improvement

DOI: 10.3233/NPM-230101

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 1, pp. 13-20, 2024

Authors: Dietrich, L.J. | Gong, A. | Gelfond, J. | Blanco, C.L.

Article Type: Research Article

Abstract: BACKGROUND: Few studies characterize feeding performance in the NICU when predicting neurodevelopmental outcomes. Our objective was to investigate the relationship between time to full oral feeds (FULL-PO) and neurodevelopmental and feeding outcomes in the first 2 years in preterm infants admitted to the NICU. METHODS: This retrospective study included infants born between 01/01/2014-07/31/2017, gestational age < 32 weeks and/or birth weight < 1500 g. We examined feeding difficulties, cerebral palsy, and Bayley scores for those reaching FULL-PO at a post menstrual age (PMA)≤38.0 weeks (EARLY) vs.>38.0 weeks (LATE). Additionally, the oral feeding achieved at various timepoints between 36- and …42-weeks postmenstrual age (PMA) was measured to construct a timeline of oral feeding acquisition. RESULTS: Of 192 infants, 147(77%) achieved FULL-PO EARLY and 45(23%) LATE. Comorbidities and length of stay were higher and unadjusted Bayley scores were lower at 12 months corrected age (CA) and 24 months chronological age (CH) in the LATE group. Feeding difficulties were higher in the LATE group at 24 months CH. Infants born < 27–28 weeks GA were more likely to achieve oral feeding at a later PMA. Infants with bronchopulmonary dysplasia (BPD) had significant feeding and developmental delays. CONCLUSIONS: Establishing full oral feeds by 38.0 weeks PMA may be used as a predictor for feeding difficulties at 24 months CH. Infants born < 27–28 weeks GA and those with BPD are more likely to take extended amounts of time to achieve full oral feeding and need additional feeding support. Infants with BPD are high risk for neurodevelopmental delays. Show more

Keywords: Neurodevelopment, oral feeding, preterm infants

DOI: 10.3233/NPM-230088

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 1, pp. 21-30, 2024

Authors: Hadfield, B.R. | Sawyer, T. | Moreira, A.G. | Farner, R. | Vasquez, M.M.

Article Type: Research Article

Abstract: BACKGROUND: Neonatal Resuscitation is a required competency for pediatric and family medicine residency programs. Simulation-based training can be used to supplement clinical experience. Rapid Cycle Deliberate Practice (RCDP) has been validated as an effective education model and is gaining favor over traditional simulation models. The aim of this study was to evaluate the effectiveness of a simulation-based rapid cycle deliberate practice (RCDP) intervention on extremely low birth weight (ELBW) infant resuscitation. METHODS: Pediatric and family practice residents were randomized to control and intervention groups and participated in pre- and post-NICU rotation simulations. The intervention group received …one RCDP session. Simulations were scored by blinded video review for overall performance, positive pressure ventilation (PPV), endotracheal intubation and behavioral skills. Surveys assessed confidence in ELBW resuscitation. RESULTS: Forty-one residents participated in the study. The RCDP group performed better than the control group at post-rotation evaluation for overall resuscitation performance (65% vs 87%, p  = 0.004), administering PPV (63% vs 88%, p  = 0.006), and validated behavior skills (1.4 vs 2.0, p  = 0.019). Residents in the RCDP group reported greater confidence with ELBW resuscitation. CONCLUSION: An educational intervention using RCDP was associated with improved resident performance and confidence in ELBW resuscitation. RCDP should be considered for NRP and ELBW resuscitation training. Show more

Keywords: Extremely low birth weight, neonatal resuscitation, rapid cycle deliberate practice, simulation

DOI: 10.3233/NPM-230102

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 1, pp. 31-40, 2024

Authors: Da Silva, A.M. | De Lavôr, J.R. | Freitas, V.S. | Vieira, A.R.

Article Type: Research Article

Abstract: BACKGROUND: To investigate if maternal body mass index, diabetes and hypertension are associated with orofacial clefts. METHODS: Case-control study. Information from 53,188 live births with and without orofacial cleft registered at USA Vital Statistics Natality Birth Data between 2017 and 2021. Case group consisted of all affected live births diagnosed with orofacial clefts (13,297 cases). Comparison group consisted of 39,891 live births without clefts or any other congenital malformation. Information about orofacial cleft cases were compared with the comparison group. The unadjusted and adjusted Odds Ratios were estimated to evaluate the strength of association between mother’s …pre-pregnancy body mass index, maternal diabetes and hypertension and orofacial cleft occurrence, assuming a p value < 0.05 and 95% confidence intervals (95% C.I.) for statistically significant differences. RESULTS: Mother’s pre-pregnancy body mass index, maternal diabetes and maternal hypertension are conditions associated with an increased risk of orofacial cleft development in the child (OR = 1.08, p  = 0.004, 95% C.I. = 1.024–1.149; OR = 1.32, 95%, p  = 0.000, 95% C.I. = 1.202–1.444; and OR = 1.35, p  = 0.000, 95% C.I. = 1.239–1.484; respectively). Maternal ethnicity, sex of infant, and cigarette smoking pregnancy remained as covariates after adjustments in all logistic regression models. CONCLUSION: Due to the increased prevalence of obesity, diabetes, and hypertension, and also to their association with congenital malformations, such as clefts, it is recommended that mothers planning to become pregnant to follow healthy habits, maintain healthy weight, and be screened for possible diabetes or hypertension prior to conception and early in pregnancy. Show more

Keywords: Body mass index, cleft lip, cleft palate, diabetes complications, hypertension

DOI: 10.3233/NPM-230118

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 1, pp. 41-48, 2024

Authors: Ovali, F. | Hakbilen, M. | Akalin, I. | Çelik, G. | Yildirim, S.

Article Type: Research Article

Abstract: INTRODUCTION: Retinopathy of prematurity (ROP) is one of the main reasons of preventable childhood blindness. In the development of ROP, MicroRNAs may be effective in the balance of factors that inhibit and activate angiogenic factors. We aimed to determine the changes in the blood levels of miR-146a, miR-143, miR-210, miR-21, miR-126, miR-211, miR-221, miR-106 and let 7f and to investigate their association with ROP. We hypothesed that the level of these miRNAs changed significantly in ROP cases. MATERIALS AND METHODS: This observational study was conducted prospectively in preterm infants with ROP. Serum levels of 8 miRNAs were measured. …The relationship between disease stage and progression with miRNA gene expression was analysed. Preterm infants without ROP were taken as the control group. RESULTS: 47 patients with ROP and 14 controls, were included in the study. In the ROP group, miR-210, miR-146a, miR-21 were statistically significantly lower. In the ROP group the expression level of miR-143 was insignificantly lower, miRNA-221 was insignificantly higher, and miR-106, miR-126 and let 7f were variable. CONCLUSION: It was observed that miR-210, miR-146a, miR-21 and miR-143 were significantly lower in patients with ROP compared to the control group. However, no association could be established between the type of miRNA and stage of ROP. These miRNAs may be used as adjunctive biomarkers for diagnosis of ROP. Show more

DOI: 10.3233/NPM-230029

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 1, pp. 49-55, 2024

Authors: Bennaoui, Fatiha | Lalaoui, Abdessamad | El Idrissi Slitine, Nadia | Soraa, Nabila | Maoulainine, Fadl Mrabih Rabou

Article Type: Research Article

Abstract: BACKGROUND: Nosocomial infections pose a significant health risk to neonates, and traditional biomarkers used for diagnosis often fall short in predicting such infections. In this study, we evaluate the efficacy of the HeRO (Heart Rate Observation score), a novel predictive tool for late-onset neonatal sepsis, in improving neonatal prognosis and reducing morbidity and mortality rates. METHODS: A prospective study was conducted from September 2020 to May 2021, reviewing patient evaluation for all neonates admitted to the neonatal intensive care unit during this period after the implementation of the HeRO score. RESULTS: Of the 100 cases studied, …preterm neonates accounted for the majority (51%), with 65% being born at gestational age greater than 32 weeks and 35% born at less than 32 weeks. A male-to-female sex ratio of 1.56. Perinatal asphyxia was the primary reason for initial hospitalization, often accompanied by pulmonary neonatal infection. The HeRO score showed an increase within 24 hours of the onset of clinical signs of sepsis in 52% of cases and after 24 hours in 47% of cases. In 51% of cases, the score exhibited an increase greater than 2. Blood cultures were positive in 91% of cases. The duration of hospital stays for newborns ranged from 7 to 42 days, with an average stay for newborns whose score rose 24 hours before clinical signs. CONCLUSION: This study highlights the significance of utilizing the HeRO score for predicting nosocomial infections in neonates, despite the possibility of false assumptions. Implementing the HERO score enables early intervention, thereby improving the assumption of responsibility and reducing neonatal morbidity and mortality rates. Show more

Keywords: HeRO score, morbidity, mortality, neonates, nosocomial infections, prognosis, sepsis

DOI: 10.3233/NPM-230060

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 1, pp. 57-62, 2024

Authors: Peña, F.L. | Emanuelson, T.W. | Todman, S.H. | Jones, R.C. | Mahajan, S.

Article Type: Research Article

Abstract: A circular shunt is a poor prognostic factor associated with Ebstein’s anomaly. Targeting the constriction of the ductus arteriosus (DA) in order to limit or resolve the circular shunt, has been shown to improve fetal outcomes. Prenatal non-steroidal anti-inflammatory drugs (NSAIDs) have been known to constrict the DA. Recently, prenatal NSAIDs have been used for that purpose in the treatment of circular shunt. Limited research shows that it may be an effective treatment leading to improved fetal outcomes. In this article, we did an extensive review of literature to describe this therapy’s effectiveness and outcomes. 82% of fetuses were able …to achieve ductal constriction with prenatal NSAID therapy. For fetuses who achieved ductal constriction, fetal demise was less likely (6%) when compared to those who were unable to achieve the same (50%). Of all the fetuses with hydrops, 50% had resoluation of hydrops with prenatal NSAID treatment. Show more

Keywords: Circular shunt, Ebstein’s anomaly, ibuprofen, indomethacin, non-steroidal anti-inflammatory, NSAIDs

DOI: 10.3233/NPM-230040

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 1, pp. 63-69, 2024

Authors: Amer, R. | DeCabo, C. | Elnagary, M. | Seshia, M.M. | Elsayed, Y.N.

Article Type: Research Article

Abstract: OBJECTIVE: To assess the effect of cardiovascular medications on the neurodevelopment of preterm infants, as measured by calculated cumulative time of vasoactive–inotropic score (VISct). METHODS: A retrospective study was conducted on preterm infants who developed significant hypotension defined as a mean BP more than 2SDs below the mean for GA and received treatment with duration > 6 hours for each hypotensive episode, we calculated the vasoactive inotropic score (VIS) and cumulative exposure to cardiovascular medications over time (VISct). The composite Bayley III was reported from the high-risk follow-up clinic for the surviving infants between 18 to 21 months corrected age. …RESULTS: VISct was significantly higher in infants with abnormal neurodevelopment. Cognitive Bayley was the most affected component with median (IQR) VISct 882.5(249,2047) versus 309(143,471) (p -value 0.012), followed by language function with VISct 786(261,1563.5), versus 343(106.75,473.75) (p -value 0.016) when those with Bayley III <85 were compared with those with normal Bayley IIIs. CONCLUSION: High VISct scores may have negative effect on cognitive and language neurodevelopmental outcomes. Show more

Keywords: Compromised systemic circulation, hypotension, preterm infants, vasoactive inotropic score, vasoactive inotropic score cumulative time

DOI: 10.3233/NPM-230077

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 1, pp. 71-76, 2024