Journal of Neonatal-Perinatal Medicine - Volume 8, issue 2

Authors: Solomon, B.D.

Article Type: Research Article

DOI: 10.3233/NPM-15915031

Citation: Journal of Neonatal-Perinatal Medicine, vol. 8, no. 2, pp. 73-75, 2015

Authors: Pinilla, J. Martínez | Ayala-Ramírez, P. | García-Robles, R. | Olaya-C, M. | Bermúdez, M.

Article Type: Research Article

Abstract: Down syndrome is the most frequent aneuploidy in live births, with an overall frequency of 1/600-700 births. The overexpression of cystathionine β-synthase is thought to participate in the presentation of some phenotypes observed in Down syndrome. OBJECTIVE: The aim of this study was to compare the expression levels of cystathionine β-synthase and histopathological observations from placentas of infants with Down syndrome and healthy newborns. MATERIALS AND METHODS: Six placentas of fetuses/infants with Down syndrome and sixteen placentas of healthy fetuses were studied. Cystathionine β-synthase mRNA and protein expression were performed by real-time PCR and …immunohistochemistry, respectively. RESULTS: We observed an increase in cystathionine β-synthase mRNA expression (p  = 0.0465) and protein levels (p  = 0.009) in placentas of fetus/infants with Down syndrome compared with controls. Significantly more circinate edges (p  = 0.0007) and trophoblast inclusions (p  = 0.0037) were observed in the group with Down syndrome compared with control group. CONCLUSION: The results demonstrate overexpression of cystathionine β-synthase mRNA and protein in placentas of fetuses/infants with trisomy 21. Further histological abnormalities were found in placentas of patients with Down syndrome, suggesting an alteration in the development of placenta. Show more

Keywords: Cystathionine β-synthase, Down syndrome, placenta

DOI: 10.3233/NPM-15814092

Citation: Journal of Neonatal-Perinatal Medicine, vol. 8, no. 2, pp. 77-84, 2015

Authors: Ozalkaya, E. | Topçuoğlu, S. | Hafizoğlu, T. | Karatekin, G. | Ovali, Fahri

Article Type: Research Article

Abstract: OBJECTIVE: Antenatal, postnatal follow-ups and laboratory findings of the cases with retained fetal lung fluid syndrome were evaluated to detect prognostic factors. STUDY DESIGN: This study was conducted at Zeynep Kamil Maternity and Children’s Training and Research Hospital including infants retained fetal lung fluid syndrome. Patients were divided into 3 groups according to duration of the clinical symptoms. Cases whose clinical findings resolving within first 24 hours constituted Group 1 (n  = 31), cases with clinical findings persisting between 24 and 72 hours constituted Group 2 (n  = 95) and cases with symptoms persisting >72 hours constituted …Group 3 (n  = 10). Antenatal and postnatal clinical data and laboratory findings of the patients were evaluated retrospectively. RESULT: Pneumothorax, pulmonary hypertension, antibiotic use frequency and hospitalization periods were found to be prolonged in the patients admitted due to retained fetal lung fluid syndrome who were delivered with elective caesarean section, with low birth weight and gestational age, requiring intubation and invasive ventilation within first 12 hours, having low hemoglobin and blood chloride levels. CONCLUSIONS: Low blood chloride level can be a laboratory finding predicting whether malignant tachypnea develops or not in retained fetal lung fluid syndrome. Cut-off chloride value for malignant tachypnea can be determined with new studies which will be performed in the future. Show more

Keywords: Malignant tachypnea, chloride

DOI: 10.3233/NPM-15814043

Citation: Journal of Neonatal-Perinatal Medicine, vol. 8, no. 2, pp. 85-89, 2015

Authors: Robbins, M. | Trittmann, J. | Martin, E. | Reber, Kristina M. | Nelin, L. | Shepherd, E.

Article Type: Research Article

Abstract: OBJECTIVE: Prolonged mechanical ventilation in the extremely premature infant is associated with the development of bronchopulmonary dysplasia (BPD). Clinically, the decision to extubate the extremely low birth weight (ELBW) infant can be difficult. There is continued debate regarding whether it is better for an ELBW infant to remain on the ventilator or to extubate to nasal constant positive airway pressure (nCPAP). It has also been argued that repeated intubations may be detrimental to ELBW infants. We tested the hypothesis that earlier extubation attempts would decrease length of hospital stay and BPD. STUDY DESIGN: A database …maintained on infants born at <27 completed weeks gestation admitted to our all referral NICU for a 36 month period was queried (n  = 224). RESULTS: Day of life (DOL) of the first extubation attempt was inversely correlated with birth weight (p  <  0.001) and gestational age (p  <  0.01). The DOL of the 1st extubation attempt correlated with the need for re-intubation (p  <  0.001), but not with mortality (p  = 0.27). In survivors, earlier DOL of 1st extubation attempt was associated with shorter LOS (p  <  0.001). Earlier DOL of the 1st extubation attempt was associated with less need for supplemental oxygen (p  <  0.001) at 36 weeks CGA, while re-intubation was not (p  = 0.50). CONCLUSION: In our cohort of extremely premature infants, the earlier the first extubation attempt the sooner the patient was discharged home and the less likely to develop BPD. Our study suggests that extubation should not be delayed in extremely premature infants due to fears of need for re-intubation. Show more

Keywords: Extremely low birth weight, bronchopulmonary dysplasia, nasal continuous positive airway pressure

DOI: 10.3233/NPM-15814061

Citation: Journal of Neonatal-Perinatal Medicine, vol. 8, no. 2, pp. 91-97, 2015

Authors: Chan, C. | Bode, L. | Kim, J.

Article Type: Research Article

Abstract: BACKGROUND: Galectin-3 binding protein (Gal3BP) is a glycoprotein isolated in colostrum that may be an immunologically active component with effects on the neonatal immune system. This compound has been found in the blood of term newborn infants, but has not been studied in preterm infants. OBJECTIVE: Compare umbilical cord plasma Gal3BP concentration between preterm and term infants. STUDY DESIGN: Observational study of mother-infant pairs consented at UCSD Medical Center comparing umbilical cord plasma Gal3BP concentration in preterm and term infants. Umbilical cord plasma was collected at birth and stored at −80°C before …Gal3BP analysis by ELISA. This study was powered to evaluate differences in preterm and term infant Gal3BP concentration. The secondary aim was to determine the effect of maternal and infant clinical factors on Gal3BP concentration. RESULTS: A total of 64 preterm and 30 term umbilical cord plasma samples were analyzed. By univariate analysis, Gal3BP concentration was elevated in the setting of prematurity, maternal diabetes, antenatal steroid exposure, and increasing maternal parity (p  <  0.05); and decreased in chorioamnionitis (p  = 0.03). Using a multiple linear regression model prematurity, chorioamnionitis and maternal diabetes remained significant. CONCLUSIONS: Umbilical cord plasma Gal3BP concentration is elevated in prematurity. This may reflect inflammatory states in infant and mother, but further study is warranted. Show more

Keywords: Galectin-3 binding protein, chorioamnionitis, maternal diabetes, prematurity, cord blood

DOI: 10.3233/NPM-15814055

Citation: Journal of Neonatal-Perinatal Medicine, vol. 8, no. 2, pp. 99-104, 2015

Authors: Cordero, L. | Paetow, P. | Landon, M.B. | Nankervis, C.A.

Article Type: Research Article

Abstract: OBJECTIVE: To compare neonatal outcomes (including breastfeeding (BF) initiation) of 170 macrosomic IDM with that of 739 macrosomic nIDM. DESIGN/METHODS: Retrospective cohort investigation of all macrosomic infants born consecutively over a four-year period (2008–2011). Macrosomic (birth weight ≥4000 g) IDM included 100 infants whose mothers had gestational diabetes and 70 whose mothers had pregestational diabetes. RESULTS: IDM were more likely to be delivered by cesarean to obese women while nIDM were more likely to be delivered vaginally to younger women with a higher level of education. Ethnic distribution (60% white, 20% black, 10% …Hispanic and 10% Asian or African) was similar in each group. Forty-nine percent of IDM and 7% of nIDM required NICU admission. Respiratory disorders (mainly TTNB) affected 21% of IDM and 3% of nIDM while hypoglycemia was observed in 36% of IDM and 15% of nIDM. Of the 35 IDM delivered vaginally, 10 were complicated by shoulder dystocia without injury. Conversely, 70 of the 458 nIDM delivered vaginally experienced shoulder dystocia that resulted in 6 limb fractures and 3 brachial plexus injuries. On arrival to labor and delivery, 75% of all women intended to BF; however, at the time of discharge, 65% of women with diabetes and 92% of those without diabetes who intended to BF had initiated BF. CONCLUSIONS: Both macrosomic IDM and macrosomic nIDM are at risk for significant morbidities. Macrosomic IDM carry a higher risk for NICU admissions, leading to maternal-infant separation, and lower BF initiation rates. Show more

Keywords: Macrosomia, diabetes, breastfeeding

DOI: 10.3233/NPM-15814102

Citation: Journal of Neonatal-Perinatal Medicine, vol. 8, no. 2, pp. 105-112, 2015

Authors: Verma, R. | Shibly, S. | Fang, H. | Pollack, S.

Article Type: Research Article

Abstract: BACKGROUND: The implications of early postnatal body weight changes (Δbw ) in the morbidities related to body fluid metabolism in sick preterm infants in not well investigated. The extremely low birth weight infants (ELBW, birth weight <1000 g) have the highest incidence of such morbidities among all neonates. AIM: To determine the relationships between Δbw and neonatal morbidities associated with body fluid metabolism in the ELBW infants. METHODS: In an observational study, the associations between daily weight changes from birth weight (DΔ bw ) and oxygen dependence on postnatal day 28 (BPD28), …patent ductus arteriosus (PDA), intraventricular-periventricular hemorrhage (IVH), antenatal steroid (ANS) and gestational age (GA) were evaluated. Maximum weight loss (MΔ bw ) was correlated with GA, BPD28 and BPD36 (oxygen dependence on postmenstrual 36 weeks). Pearson’s correlation co-efficient and multivariate logistic regressions were performed for analysis. RESULTS: DΔ bw correlated inversely with GA on days 1–8 of life (p  <  0.01 for all, 0.06 for DOL 2). DΔ bw was associated with a lower risk of BPD28 on days 6 (OR 0.87, 95% CI 0.76–1), 10 (OR 0.86, 95% CI 0.76–0.98) and 11 (OR 0.87, 95% CI 0.77–0.99); with PDA on days 8–11 (OR ranging between 0.89 to 0.92 for the 4 days, 95% CI 0.83 to 0.99) and with IVH on day 5 (OR 0.93, 95% CI 0.86–1) after controlling for GA. DΔ bw was not identified as risk factor for the tested morbidities. ANS decreased DΔ bw on days 4 (OR 0.88, 95% CI 0.78–1) and 10 (OR 0.9, 95% CI 0.84–1). MΔbw correlated directly with BPD28 (r  = 0.3, p  = 0.004), which declined after controlling for GA (r  = 0.2, p  = 0.2). CONCLUSIONS: DΔ bw is protective for PDA, BPD28 and IVH, independent of gestational age, whereas, the effects of MΔ bw on BPD are governed by maturation in ELBW infants. ANS decreases DΔbw , which correlates inversely with GA during the first week of life. Show more

Keywords: Extremely low birth weight infants, postnatal body weight loss, patent ductus arteriosus, bronchopulmonary dysplasia, antenatal steroid, intraventricular-periventricular hemorrhage

DOI: 10.3233/NPM-15814104

Citation: Journal of Neonatal-Perinatal Medicine, vol. 8, no. 2, pp. 113-118, 2015

Authors: Al Shafouri, N. | Narvey, M. | Srinivasan, G. | Vallance, J. | Hansen, G.

Article Type: Research Article

Abstract: BACKGROUND: In neonatal hypoxic ischemic encephalopathy (HIE), hypo- and hyperglycemia have been associated with poor outcomes. However, glucose variability has not been reported in this population. OBJECTIVE: To examine the association between serum glucose variability within the first 24 hours and two-year neurodevelopmental outcomes in neonates cooled for HIE. STUDY DESIGN: In this retrospective cohort study, glucose, clinical and demographic data were documented from 23 term newborns treated with whole body therapeutic hypothermia. Severe neurodevelopmental outcomes from planned two-year assessments were defined as the presence of any one of the following: Gross …Motor Function Classification System levels 3 to 5, Bayley III Motor Standard Score <70, Bayley III Language Score <70 and Bayley III Cognitive Standard Score <70. RESULTS: The neurodevelopmental outcomes from 8 of 23 patients were considered severe, and this group demonstrated a significant increase of mean absolute glucose (MAG) change (–0.28 to –0.03, 95% CI, p  = 0.032). There were no significant differences between outcome groups with regards to number of patients with hyperglycemic means, one or multiple hypo- or hyperglycemic measurement(s). There were also no differences between both groups with mean glucose, although mean glucose standard deviation was approaching significance. CONCLUSIONS: Poor neurodevelopmental outcomes in whole body cooled HIE neonates are significantly associated with MAG changes. This information may be relevant for prognostication and potential management strategies. Show more

Keywords: Neonatal, hypoxic ischemic encephalopathy, glucose, hypothermia, treatment outcomes

DOI: 10.3233/NPM-15814107

Citation: Journal of Neonatal-Perinatal Medicine, vol. 8, no. 2, pp. 119-124, 2015

Authors: Chouthai, Nitin S. | Sobczak, Holly | Khan, Reshma | Subramanian, Divya | Raman, Sim | Rao, Raghavendra

Article Type: Research Article

Abstract: BACKGROUND: Therapeutic hypothermia (TH) improves survival and neurodevelopmental outcome in neonatal hypoxic ischemic encephalopathy (HIE). Both, hypoglycemia and hyperglycemia are common in infants with HIE. The relationship between hypoglycemia and hyperglycemia, and immediate outcome has not been well described. METHODS: A retrospective analysis of newborn infants with HIE (N  = 56) was conducted. Blood glucose concentrations recorded during the first 96 hours were noted. Glucose levels of infants who underwent TH (TH group, N  = 20) were compared with those that did not undergo TH (No-TH group, N  = 36). The relationship between blood glucose and mortality and/or …moderate/severe disability was determined. RESULTS: Mean ± SD blood glucose concentration during the first 24 hours of age was significantly higher in the TH group (148 ± 65 mg/dl), compared with the No-TH group (113 ± 50 mg/dl; p  = 0.02), despite a lower glucose infusion rate in the former (4.05 ± 1.77 mg/kg/hr vs. 5.36 ± 2.51 mg/kg/hr; p  = 0.04). One hundred percent of infants (n  = 9) in the TH group with blood glucose levels >200 mg/dl during the first 24 hours of age died or had moderate/severe disability, compared with 54.5% of those with blood glucose <200 mg/dl in this group (p  = 0.03). A similar effect was not present in the No-TH group. CONCLUSION: Hyperglycemia on the first day portends poor outcome in newborn infants undergoing TH for HIE. Show more

Keywords: Hypoxic ischemic encephalopathy, therapeutic hypothermia, hyperglycemia

DOI: 10.3233/NPM-15814075

Citation: Journal of Neonatal-Perinatal Medicine, vol. 8, no. 2, pp. 125-131, 2015

Authors: Holtrop, P. | Swails, T. | Riggs, T.

Article Type: Research Article

Abstract: OBJECTIVE: To determine the prevalence of high TG levels in extremely low birth weight (ELBW) infants and what the risk factors are for high TG levels. STUDY DESIGN: We performed a prospective observational study of triglyceride concentrations in extremely low birth weight infants receiving lipid infusions. Lipid infusions were begun at 0.5 grams/kg/day at age one day and the dose advanced by 0.5 grams/kg/day. Triglyceride concentrations were drawn when the dose reached 1 and 2 grams/kg/day. We compared infants with normal triglyceride levels (≤200 mg/dl) with those with elevated triglyceride levels (>200 mg/dl) with univariate and multivariate …analysis. RESULTS: There were 75 infants included in the analysis. Twenty (26.7% , 95% CI = 16.6–36.7%) had triglyceride levels >200 mg/dl. On multiple logistic regression analysis, lower birth weight was associated with the risk of an elevated triglyceride level. Triglyceride levels >200 mg/dl did not predict future mortality or morbidity. CONCLUSION: Elevated TG levels occur commonly in ELBW infants and are associated with a lower birth weight. Show more

Keywords: Neonates, triglyceride concentrations, lipids

DOI: 10.3233/NPM-15814099

Citation: Journal of Neonatal-Perinatal Medicine, vol. 8, no. 2, pp. 133-136, 2015