Journal of Neonatal-Perinatal Medicine - Volume 17, issue 2

Authors: Zakerihamidi, M. | Moradi, A. | Ramazani, A. | Boskabadi, H.

Article Type: Research Article

Abstract: OBJECTIVES: Hypernatremia may facilitate the diffusion of bilirubin through the blood-brain barrier and increase the risk of bilirubin encephalopathy. This study was conducted to compare the prognosis of jaundice infants with those with jaundice and hypernatremia. METHODS: A total of 615 term infants with idiopathic jaundice with or without hypernatremia were enrolled in this cohort study with 24-months follow-up at Ghaem Hospital, Mashhad, Iran, between 2010 and 2022. An in-house questionnaire including the laboratory evaluation and neonatal characteristics was used as the data collection tool. The follow-up of neonatal development status was performed using the Denver test II …at 6, 12, 18, and 24 months after discharging from hospital. RESULTS: Normal outcomes were seen in 555 (90.2%) out of 615 studied infants, while 60 cases (9.8%) showed abnormal outcomes. Serum levels of sodium (P  = 0.017), bilirubin (P  = 0.001), urea (P  = 0.024), and creatinine (P  = 0.011) as well as hyperthermia (P  = 0.046) and unconsciousness (P  = 0.005) showed significant differences between the two groups. Approximately 16% of the newborns with both jaundice and hypernatremia, and 9% of those with only jaundice had unfavorable prognoses. Also, bilirubin level had the most predictive power (91.3%). CONCLUSIONS: Our results suggest that hypernatremia or jaundice alone, may affect the prognosis of infants aged 2 years; but jaundice and hypernatremia together, will intensify the developmental problems in jaundice infants. However, the role of hyperbilirubinemia in the incidence of complications is more than hypernatremia. Show more

Keywords: Developmental delay, hypernatremia, hyperbilirubinemia, jaundice, neonate, prognosis

DOI: 10.3233/NPM-230144

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 2, pp. 161-167, 2024

Authors: Cakir, U. | Tayman, C.

Article Type: Research Article

Abstract: BACKGROUND: Previously, not six systemic inflammatory indices were evaluated in the diagnosis of early onset sepsis (EOS) in very low birth weight (VLBW, <1500g) premature infants. OBJECTIVES: We evaluated the effectiveness of systemic inflammatory indices in the diagnosis of EOS in VLBW infants. METHODS: Premature infants with birth weight <1500 g were included in the study. Six systemic inflammatory indices including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), pan-immune-inflammation value (PIV), and systemic inflammation response index (SIRI) were compared in patients with EOS (treatment group) and without EOS (control group). …RESULTS: Of 917 infants enrolled, 204 infants were in the EOS group and 713 infants comprised the control group. NLR, MLR and SIRI values were significantly higher in the EOS group than in the control group (p < 0.001). The AUC value of SIRI for the predictivity of EOS was 0.803. CONCLUSIONS: The SIRI can be used together with other parameters as both an easily accessible and the reliable systemic inflammatory indices in the diagnosis of EOS in VLBW preterm infants. Show more

Keywords: Early onset sepsis, monocyte-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, systemic immune-inflammation index, very low birth weight

DOI: 10.3233/NPM-230174

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 2, pp. 169-176, 2024

Authors: Khan, S. | Coo, H. | Khurshid, F.

Article Type: Research Article

Abstract: BACKGROUND: Guidelines on when to screen for neonatal hyperbilirubinemia apply to infants born at 35 weeks or later of gestation. It is unknown whether infants born earlier would benefit from similar guidelines. Our objective was to examine hyperbilirubinemia screening and phototherapy prescription among early preterm infants during the first 6 days of life. METHODS: We reviewed the charts of 193 infants born prior to 35 weeks of gestation who were admitted to a tertiary care NICU in Southeastern Ontario in 2018–2019. Information on total serum bilirubin (TSB) measurements over each 12-hour interval during the first six days of …life and the treatment decision (no treatment, initiate, continue, or stop phototherapy) was extracted. We also examined what proportion of infants were prescribed phototherapy during each 12-hour interval. RESULTS: Of 1006 TSB measurements performed over the first 6 days of life, 605 were done to determine whether phototherapy should be initiated. Treatment was prescribed in 275 instances (45%). A higher proportion of infants born prior to 28 weeks of gestation required phototherapy in the first 12 hours of life (37%) compared to those born at 28–32 weeks (20%) and 33–34 weeks (5.7%). CONCLUSIONS: Our results suggest that TSB measurements are often poorly timed to detect treatment need in infants born prior to 35 weeks of gestation. This unnecessarily increases the risk of complications from phlebotomy and is an ineffective use of health care resources. There is a need to develop guidelines to optimize hyperbilirubinemia screening among early preterm infants. Show more

Keywords: Hyperbilirubinemia, neonate, phototherapy, preterm, quality improvement, screening

DOI: 10.3233/NPM-230128

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 2, pp. 177-182, 2024

Authors: Boskabadi, H. | Ataee Nakhaei, M.H. | Maamouri, G.A. | Saghafi, N.

Article Type: Research Article

Abstract: BACKGROUND: Vitamin D deficiency has been suggested to be a risk factor for neonatal respiratory distress syndrome (RDS). This study aimed to evaluate the effect of 25 (OH) D administrations in pregnant women with findings of preterm labor on the incidence of RDS in their preterm neonates. MATERIALS AND METHODS: A randomized controlled clinical trial was conducted on pregnant mothers with gestational age (GA) of less than 34 weeks at risk of preterm delivery. 175 subjects were randomly assigned into two groups, including intervention (intramuscular injection of 50,000 units of 25(OH) D during 72 hours before delivery) and control …(no injections). Serum concentrations of 25(OH) D were measured shortly after birth in both mothers and neonates. Then, clinical and laboratory results of mothers and their offspring were recorded (in a checklist). Short-term outcomes and the need for respiratory support were also assessed. Data were analyzed by independent t -test, Mann-Whitney U test, Fisher’s exact test, and chi-square test. RESULTS: Even though gestational age, birth weight, delivery method, and serum vitamin D levels are consistent among both groups, 45% of neonates in the control group and 20% in the intervention group developed respiratory distress syndrome (P  = 0.05). The mean 25(OH) D level in neonates was 17.7±10.5 and 19.29±9.94 ng/mL in the intervention and control groups, respectively (P  > 0.05). CONCLUSION: A single dose of 50,000 units of intramuscular 25(OH)D in pregnant women at risk of preterm labor can lower the risk of RDS in the infant. Show more

Keywords: 25(OH) D, Mother, neonate, premature infant, prematurity, preterm, respiratory distress syndrome, vitamin D deficiency

DOI: 10.3233/NPM-230158

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 2, pp. 183-190, 2024

Authors: Caldas, J.P.de Siqueira | Junqueira, E.de Almeida Orro | de Camargo, J Fernandes | Marba, S.T.M.

Article Type: Research Article

Abstract: BACKGROUND: Hypothermia on admission is associated with increased mortality in preterm infants. Drugs administered to pregnant women is implicated in its occurrence. Since magnesium sulfate has a myorelaxant effect, we aimed evaluating the association of hypermagnesemia at birth and admission hypothermia (axillary temperature <36.5°C) in preterm infants. METHODS: We performed a secondary analysis of a prospective cohort study database including inborn infants <34 weeks, without congenital malformations. Hypermagnesemia was considered if the umbilical magnesium level > 2.5 mEq/L. Maternal and neonatal variables were used to adjust the model, submitted to the multivariate hierarchical modelling process. RESULTS: We evaluated 249 …newborns with median birth weight and gestational age of 1375 (IQR 1020–1375) g and 31 (IQR 28–32) weeks, respectively. Hypermagnesemia occurred in 28.5% and admission hypothermia occurred in 28.9%. In the univariate analysis, the following variables were identified as being associated with admission hypothermia: hypermagnesemia (OR 3.71; CI 2.06–6.68), resuscitation (OR 2.39; CI 1.37–4.19), small to gestational age (OR 1.91; CI1.03–3.53), general anesthesia (OR 3.34; CI 1.37–8.13), birth weight (OR 0.998; CI 0.998–0.999) and gestational age (OR 0.806; CI 0.725–0.895). In the hierarchical regression model, hypermagnesemia remained independent associated with admission hypothermia (OR 3.20; CI 1.66–6.15), as well as birth weight (OR 0.999; CI 0.998–0.999) and tracheal intubation (3.83; CI 1.88–7.80). CONCLUSION: Hypermagnesemia was associated with an increased risk of admission hypothermia, as did tracheal intubation and lower birth weight. Show more

Keywords: Hypermagnesemia, hypothermia, preterm infant, risk factor

DOI: 10.3233/NPM-230130

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 2, pp. 191-198, 2024

Authors: Chahin, N. | Yitayew, M.S. | Shaver, L. | Reed, J.L. | Ridore, M. | Santoro, J. | Moores Jr , R.R. | Soghier, L. | Short, B. | Hendricks-Muñoz, K.D.

Article Type: Research Article

Abstract: BACKGROUND: Unintended extubations remain a common complication across neonatal intensive care units, with very low birthweight infants being the most vulnerable of them all. Ongoing efforts across different institutions exist with the goal of reducing the rate of unintended extubations to keep a median rate of <2 events per 100 ventilator days as defined by the Vermont Oxford Network. Our objective was to reduce unintended extubations in the very low birthweight infant in a large delivery hospital to ≤2/100 ventilator days. METHODS: A collaborative group was formed between two academic health institutions targeting training and implementation of the …Children’s National unintended extubation system, focusing on endotracheal tube securement methods and surveillance protocols. RESULTS: The unintended extubation rate decreased from 3.23 to 0.64 per 100 ventilator days. Changes were implemented from 2018–2020 with a sustained reduction in the unintended extubation rate of 1.54 per 100 ventilator days. Most events occurred between 12 : 00 pm –4 : 00 pm and the commonest cause was spontaneous (25%) followed by dislodgment during repositioning (19%). CONCLUSION: Very low birth weight infants present a challenge to endotracheal tube maintenance due to their developmental and anatomical changes during their neonatal intensive care unit stay. Successful reduction of unintended extubations in the very low birthweight infant can be achieved by adaptation of successful protocols for older infants. Show more

Keywords: Collaborative, unplanned extubations, very low birthweight infant

DOI: 10.3233/NPM-230063

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 2, pp. 199-207, 2024

Authors: Bultmann, Charlene R. | Qiu, Jiaxang | Belmonte, Briana | Fairchild, Karen D. | Sullivan, Brynne A.

Article Type: Research Article

Abstract: BACKGROUND: Chorioamnionitis and early onset sepsis (EOS) in very low birth weight (VLBW,< 1500 g) infants may cause a systemic inflammatory response reflected in patterns of heart rate (HR) and oxygenation measured by pulse oximetry (SpO2 ). Identification of these patterns might inform decisions about duration of antibiotic therapy after birth. OBJECTIVE: Compare early HR and SpO2 patterns in VLBW infants with or without early onset sepsis (EOS) or histologic chorioamnionitis (HC). STUDY DESIGN: Retrospective study of placental pathology and HR and SpO2 in the first 72 h from birth in relation to EOS …status for inborn VLBW NICU patients 2012–2019. RESULT: Among 362 VLBW infants with HR and SpO2 data available, clinical, or culture-positive EOS occurred in 91/362 (25%) and HC in 81/355 (22%). In univariate analysis, EOS was associated with higher mean HR, lower mean SpO2 , and less negative skewness of HR in the first 3 days after birth. HC was associated with higher standard deviation and skewness of HR but no difference in SpO2 . In multivariable modeling, significant risk factors for EOS were mean HR, gestational age, HC, mean SpO2 , and skewness of SpO2 . CONCLUSION: HR and SpO2 patterns differ shortly after birth in VLBW infants exposed to HC or with EOS, likely reflecting a systemic inflammatory response. Show more

Keywords: Chorioamnionitis, early onset sepsis, heart rate, oxygenation, premature infants, very low birth weight, vital signs

DOI: 10.3233/NPM-230093

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 2, pp. 209-215, 2024

Authors: Mendez-Reyes, H.F. | Franco-Olaya, M. | Canon-Cubillos, O. | Uribe-Lopez, J.M. | Delgado-Alvarez, M.C. | Velasquez-Portilla, M. | Olaya-C, M.

Article Type: Research Article

Abstract: BACKGROUND: Exposure to toxins during pregnancy is the main modifiable behavior that affects the placenta and, consequently, the fetus. In particular, smoking is a recognized risk factor for negative outcomes. Our study pretended to examine gross and microscopic placental features in women who reported exposure to tobacco, alcohol, or other psychoactive substances. METHODS: In this observational case-control study, we collected 706 placentas to assess precise substance exposure histological-interaction features of in the placenta. We examined gross and microscopic placental features, and then recorded maternal and newborn clinical conditions. RESULTS: We found that 4.8% …of mothers admitted to consumption of some type of (harmful) substance. The most common pre-existing maternal condition was obesity (20.3%); predominant complications included amniotic infection (32.3%), urinary tract infection (14.5%) and hypertensive disorders of pregnancy (14.5%). In newborns, we discovered positive associations as respiratory distress syndrome. Macroscopically, exposed mothers had heavier placentas, more true knots, and single umbilical artery; microscopically, they were more likely to exhibit fetal vascular malperfusion (FVM). CONCLUSIONS: Until our present study, no research linked umbilical cord defects to toxic substance exposure; our study results do confirm association with adverse outcomes in neonates and alterations in the neuro-cardio-placental circuit through FVM. IMPLICATIONS: The results are confirming the importance of this modifiable risk factor and how its presence may potentially affect the course of pregnancy, as well as the health of both mother and child. Show more

Keywords: Alcohol, cannabis, maternal smoking, opioids, placenta, umbilical cord

DOI: 10.3233/NPM-230104

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 2, pp. 217-224, 2024

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

Article Type: Research Article

DOI: 10.3233/NPM-230195

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 2, pp. 225-232, 2024

Authors: Mansouri, M. | Servatyari, K. | Rahmani, K. | Sheikhahmadi, S. | Hemmatpour, S. | Eskandarifar, A. | Rahimzadeh, M.

Article Type: Research Article

Abstract: INTRODUCTION: Respiratory Distress Syndrome (RDS) is the most common respiratory disorder among premature infants. The use of surfactant has significantly reduced respiratory complications and mortality. There are two conventional methods for administering surfactant: Intubate-Surfactant-Extubate (INSURE) and Less Invasive Surfactant Administration (LISA). This study aims to compare the effects of surfactant administration using these two methods on the treatment outcomes of premature newborns. MATERIALS AND METHODS: In this retrospective cohort study, we included 100 premature newborns with RDS and spontaneous breathing who were admitted to the Neonatal Intensive Care Unit of Besat Hospital in Sanandaj city in 2021. Exclusion …criteria comprised congenital anomalies and the needing for intubation for resuscitation at birth. The outcomes of empirically treated with two methods were compared: the LISA (50 neonates) and the INSURE (50 neonates). Our interesting outcomes were needing for mechanical ventilation, duration of medical ventilation, pneumothorax, pulmonary hemorrhage, severe retinopathy, CPAP duration, and bronchopulmonary dysplasia. Finally, we entered the data into STATA-14 statistical software and analyzed it using chi-square and t -tests. RESULTS: In this study, 69% of the neonates were boys. The LISA group exhibited significantly lower rates of need for mechanical ventilation (P  = 0.003) and ventilation duration (P  < 0.001) compared to the INSURE group. Conversely, there were no significant differences between the two groups (P  > 0.05) in terms of pneumothorax, pulmonary hemorrhage, severe retinopathy, CPAP duration, and bronchopulmonary dysplasia rates. CONCLUSION: The results of this study suggest that the LISA method is a safe and non-invasive approach for surfactant administration. Notably, it resulted in a reduced need for mechanical ventilation and decreased ventilation duration compared to the INSURE method. Show more

Keywords: INSURE, LISA, respiratory distress syndrome, surfactant

DOI: 10.3233/NPM-230194

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 2, pp. 233-239, 2024

Authors: Cianfrone, F. | Cantore, I. | Cazzaniga, C. | Tauro, F. | Chiarelli, R. | Bianco, F. | Di Carmine, F. | Cantiani, A. | Colella, M.G. | Ruscito, P.

Article Type: Research Article

Abstract:  Recent studies showed that COVID-19 infection can affect cochleo-vestibular system. The possibility of a vertical transmission is controversial. Some studies suggested that it is possible but unlikely, others find no evidence of vertical transmission. The objective of this study was to investigate whether exposure to COVID-19 during pregnancy or at birth has an impact on the hearing of the offspring. As part of the national hearing screening program, we performed in all newborns between January 2022 and February 2023, TEOAEs (Transient Evoked Otoacoustic Emissions) at birth and at 3 months. For those “REFER” at the third month test, we …performed aABR (Automatic Auditory Brainstem Response) at 6 months. We analysed separately result between infants born to COVID-positive mothers during pregnancy and those born to COVID-negative mothers. To statistical verify differences we performed “Chi-square test”. We enrolled a total of 157 infants, of whom 16 were born to mothers who had a molecular PCR test positive for COVID-19. In the latter we tested a total of 32 ears and only 1 ear (3,1%) resulted “REFER”. On the other hand, in the control group we tested a total of 282 ears and 22 (7,8%) were found to be “REFER”. Our study showed no significant differences in audiological assessment between newborns exposed to COVID-19 infection during pregnancy or at birth compared to the unexposed group. However, further studies with a larger patient’s sample will be necessary for a more comprehensive evaluation. Show more

Keywords: COVID-19, neonatal hearing screening

DOI: 10.3233/NPM-230179

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 2, pp. 241-246, 2024

Authors: Lin, T. | Shibasaki, J. | Yamamoto, K. | Shimokaze, T. | Toyoshima, K.

Article Type: Research Article

Abstract: BACKGROUND: The prognosis of congenital chylothorax and ascites ranges from spontaneous resolution to death, but no established examination exists to predict the prognosis. We aimed to develop a clinically useful method to evaluate lymphatic abnormalities using indocyanine green (ICG) lymphography in infants with congenital chylothorax and ascites. METHODS: We retrospectively evaluated infants with congenital chylothorax and chylous ascites who underwent ICG lymphography in our hospital between 2012 and 2022. The ICG lymphography findings was evaluated. We defined the dermal backflow in the trunk as the lymphatic flow from the end of the limb back through the …lymphatic vessels on the surface of the trunk. The association between the dermal backflow in the trunk and clinical outcomes, as follows, are investigated: the duration of the drainage period, the duration of endotracheal intubation, and the length of hospital stay. RESULTS: Twenty infants had a dermal backflow in the trunk, and ten did not. Clinical outcomes in infants with and without dermal backflow in the trunk were as follows (median): the duration of the drainage period (20 vs. 0 days, p  = 0.001), the duration of endotracheal intubation (12 vs. 2 days, p  = 0.04), and the length of hospital stay (62 vs. 41 days, p  = 0.04), respectively. In multivariate linear regression analysis adjusted for gestational age, the duration of the drainage period was correlated with the dermal backflow in the trunk [exp(B) = 2.62; p  = 0.003]. CONCLUSIONS: The dermal backflow in the trunk in ICG lymphography was useful in predicting the clinical course of congenital chylothorax and ascites. Show more

Keywords: Ascites, down syndrome, neonate, noonan syndrome, pleural effusion

DOI: 10.3233/NPM-230171

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 2, pp. 247-254, 2024

Authors: Sanchez-Holgado, M. | Bravo, M.C. | Alvarez-Garcia, P. | Lopez-Ortego, P. | Criado Camargo, S. | Pellicer, A.

Article Type: Case Report

Abstract: BACKGROUND: Congenital syphilis is a vertical infection caused by Treponema pallidum . Despite the implementation of preventive strategies during pregnancy, its incidence is increasing, and it constitutes an important public health problem. Most patients with congenital syphilis are asymptomatic; however, a small group may develop severe disease at birth with the need of advanced resuscitation in the delivery room, acute hypoxemic respiratory failure, and hemodynamic instability. Therefore, awareness is needed. METHODS AND RESULTS: This series describes the clinical course of two late preterm infants with congenital syphilis who developed acute hypoxemic respiratory failure, pulmonary hypertension, and …circulatory collapse early after birth. Integrated hemodynamic evaluation with neonatologist-performed echocardiography (NPE) and therapeutic management is provided. CONCLUSIONS: A comprehensive hemodynamic evaluation including early and serial functional echocardiography in these patients is needed to address the underlying complex pathophysiology and to help to establish accurate treatment. Show more

Keywords: Cardiovascular failure, case report, congenital syphilis, hypoxemic respiratory failure, pulmonary hypertension, treponema pallidum

DOI: 10.3233/NPM-230133

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 2, pp. 255-260, 2024

Authors: Abu Zahra, M. | Jaber, Dunia Z. | Badran, Eman F.

Article Type: Case Report

Abstract:  Cyanosis is a bluish discoloration of the tissues due to increased levels of deoxygenated hemoglobin in capillaries. It is a common finding in newborn infants that can be caused by different diseases, including pulmonary, cardiac, infectious, and hematological disorders. Methemoglobinemia is a rare cause of cyanosis, in which hemoglobin is oxidized, changing its heme iron configuration from the ferrous (Fe2 + ) to the ferric (Fe3 + ) state, creating methemoglobin (Met-Hb), a form that does not bind oxygen, leading to decreased oxygen delivery to the tissues and cyanosis. We report a rare case of a preterm newborn, who developed cyanosis and …worsening hypoxemia on day ten of life, she was found to have elevated Met-Hb percentage in blood gas analysis that required treatment with intravenous methylene blue. Her symptoms resolved after a period of maintenance treatment with oral methylene blue and ascorbic acid, and the etiology of her disease remains unclear. Show more

Keywords: Congenital, cyanosis, methemoglobinemia, methylene blue, preterm

DOI: 10.3233/NPM-230163

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 2, pp. 261-264, 2024

Authors: Stewart, J.A. | Culverhouse, E. | Harrell, Mathew

Article Type: Research Article

Abstract:  Streptococcus gallolyticus subspecies pasteurianus is a subtype of Streptococcus bovis (S. bovis ) that has become increasingly recognized as a sepsis-causing pathogen in neonates. It is well documented that S. bovis species have a predilection to both cardiac and gastrointestinal tissue, and in adult populations, isolating these organisms in the bloodstream often triggers further evaluation for co-morbid complications such as colon cancer or endocarditis. However, no such guidance currently exists in neonatal literature. We present a case of a preterm infant with S. gallolyticus subsp. pasteurianus bacteremia presenting as necrotizing enterocolitis (NEC) not previously described in …the literature. Furthermore, through a complete diagnostic evaluation, including an echocardiogram, our patient was found to have the rare complication of endocarditis. Show more

Keywords: Arteritis, necrotizing enterocolitis, neonatal sepsis, premature infant, streptococcus gallolyticus subspecies\\ pasteurianus

DOI: 10.3233/NPM-230089

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 2, pp. 265-268, 2024

Authors: Mohammad Khuzaini, A. | Mohd Baharudin, J.A. | Md Fauzi, A. | Zulkeflee, H.A. | Abdul Halim, H. | Mazli, S.K. | Osman, N.F.B.

Article Type: Case Report

Abstract: BACKGROUND: Tumor lysis syndrome (TLS) is an oncological emergency associated with hematological malignancies or highly proliferative solid tumors, commonly after chemotherapy. It is rarely associated with transient abnormal myelopoiesis. OBSERVATION: We report a rare case of a neonate with transient abnormal myelopoiesis and tumor lysis syndrome, complicated with concomitant heart failure due to an underlying atrioventricular septal defect. Hyperhydration was contraindicated due to heart failure. The patient was managed conservatively with full recovery. CONCLUSION: Tumor lysis syndrome should be suspected in neonates with transient abnormal myelopoiesis with electrolyte abnormalities. Treatment options should be …considered carefully for their risks and benefits. Show more

Keywords: Down syndrome, transient abnormal myelopoiesis, tumor lysis syndrome

DOI: 10.3233/NPM-230146

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 2, pp. 269-273, 2024

Authors: Stanford, A.H. | Chatmethakul, T. | Rios, D.R. | Giesinger, R.E. | Thomas, B. | Bischoff, A.R. | Weiner, L. | McNamara, P.J.

Article Type: Research Article

Abstract: BACKGROUND: Pulmonary vascular disease (PVD) is a major determinant of both morbidity and mortality in extremely low birth weight infants. It is biologically plausible that postnatal cytomegalovirus (pCMV) infection may lead to PVD in premature infants secondary to pneumonitis or via derangement of pulmonary vascular development directly through endothelial dysfunction. Uncertainty remains, however, regarding thresholds for intervention in premature infants with cardiorespiratory instability and presumed CMV infection likely secondary to the limited understanding of the natural history of the disease. METHODS/RESULTS: We describe four cases of premature infants with clinical and echocardiography features of PVD, in …the setting of postnatally acquired CMV. All patients had atypical PVD trajectories, refractory to vasodilator treatment, which improved after initiation of CMV treatment. CONCLUSION: We highlight the need to consider postnatally acquired CMV infection in patients with PVD non-responsive to standard pulmonary vasodilator therapies or disease severity which is out of proportion of the usual clinical trajectory. Treatment of extremely premature infants with CMV-associated PVD may have positive impact on cardiorespiratory health, although duration of therapy remains uncertain. Show more

DOI: 10.3233/NPM-230078

Citation: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 2, pp. 275-284, 2024