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

Authors: Pitlick, Mitchell M. | Orr, Kristin | Momany, Allison M. | McDonald, Erin L. | Murray, Jeffrey C. | Ryckman, Kelli K.

Article Type: Research Article

Abstract: BACKGROUND: Preterm birth is a global public health problem that is a significant cause of infant morbidity and mortality. Congenital cytomegalovirus (CMV) infection has been proposed as a risk factor for preterm birth, but the rate of CMV in infants born preterm is unclear. CMV is the leading infectious cause of sensorineural hearing loss, which will affect 15% – 20% of congenitally infected infants later in their childhood. 90% of infected infants are asymptomatic at birth and are not recognized as at risk for CMV-associated deficits. OBJECTIVE: To determine the prevalence of CMV infection in …a large cohort of preterm infants. METHODS: DNA was extracted from cord blood, peripheral blood, saliva, and buccal swab samples collected from preterm infants. A total of 1200 unique DNA samples were tested for CMV using a nested PCR protocol. The proportions of preterm infants with CMV was compared by sample collection type, race, gender, and gestational age. RESULTS: A total of 37 infants tested positive for CMV (3.08%). After excluding twins, siblings, and infants older than two weeks at the time of sample collection, two out of 589 infants were CMV positive (0.3%), which was lower than the proportion of CMV observed in the general population. All positive samples came from buccal swabs. CONCLUSIONS: Our work suggests that while CMV infection may not be greater in preterm infants than in the general population, given the neurologic consequences of CMV in preterm infants, screening of this population may still be warranted. If so, our results suggest buccal swabs, collected at pregnancy or at birth, may be an ideal method for such a program. Show more

Keywords: Congenital cytomegalovirus, preterm birth, newborn screening, polymerase chain reaction

DOI: 10.3233/NPM-15814057

Citation: Journal of Neonatal-Perinatal Medicine, vol. 8, no. 2, pp. 137-141, 2015

Authors: Mehta, S.

Article Type: Research Article

Abstract: OBJECTIVE: A cross-sectional study was done to assess the size of thymus in term healthy infants using sonography and to assess its variation in size, shape, location, echogenicity and echotexture for both male and female reference population. MATERIAL AND METHODS: A total of 250 term healthy neonates of either sex were subjected to thymic sonography. The shape, size in maximal anteroposterior, longitudinal, and transverse dimensions of both right and left lobes of thymus was evaluated. Their echotexture and echogenicity were determined and standards for reference population were calculated. The results were statistically evaluated. …RESULTS: According to the shape; the thymus was quadrilateral in 156 neonates (62%), round in 37 (15%), bilobate in 32 (13%), and crescent shaped in 25 (10%) in transverse scan. According to the echo texture, the thymus echogenicity was homogeneous and almost similar or slightly less to that of the liver and spleen in most cases 200 [80%] and was coarse in 50 (20%). In all subjects, the echogenicity of the thymus was less than that of the thyroid gland. Variations in location of the thymus were found in 70 (28%) neonates. The range of mean AP diameter was 0.39–2.36 cm (mean 1.43 ± 0.3), that of transverse 1.4 – 4.3 cm (mean 2.16 ± 0.54) and that of thymic index 1.2–5.1 cm2 (mean 2.98 ± 0.64). CONCLUSIONS: A normative range was calculated for standard population, which can be used as a reference for comparing thymus size for both normal and diseased neonates for various immunological diseases. Show more

Keywords: Thymus size, neonates, sonography

DOI: 10.3233/NPM-15814067

Citation: Journal of Neonatal-Perinatal Medicine, vol. 8, no. 2, pp. 143-147, 2015

Authors: Demirel, B. | İmamoglu, E. | Gursoy, T. | Demirel, U. | Topçuoglu, S. | Karatekin, G. | Ovali, F.

Article Type: Research Article

Abstract: BACKGROUND: Vancomycin a frequently used antimicrobial for the treatment of late-onset neonatal sepsis. It can be infused either intermittently or continuously, however, there is no consensus on the optimal dosing regimen. AIM: To evaluate microbiological outcomes, clinical response and adverse events of vancomycin when administered via continuos intravenous infusion. METHODS: The files of preterm infants (<34 weeks), who received either intermittent (group I, n  = 41) or continuous (group II, n  = 36) vancomycin infusion for the treatment of late-onset sepsis, were investigated retrospectively. Clinical and demographic features were recorded. RESULTS: …Clinical improvement rates, Töllner scores and microbiological outcomes did not differ significantly between groups. At 48th hour of vancomycin infusion, 52.8% of infants achieved therapeutic concentrations of vancomycin in group II compared with 34.1% of patients in group I (p  = 0.002). Thirty-nine percent of infants in group I had supratherapeutic concentrations of vancomycin at 48th hour compared with 5.6% in group II (p  = 0.002). Dose adjustment rate in group I did not differ than group II (65.9% vs. 52.8% respectively, p  = 0.3). However, when we subdivide group I into two according to dosing intervals, dose adjustment rates were more common in infants with a gestational age <29 weeks for whom intermittent infusion was performed in 18 hours intervals (92.9% vs 51.9% , p  = 0.014). CONCLUSION: In preterm infants, continuous and intermittent infusions of vancomycin have similar clinical efficacies. Continuous infusion is well-tolerated and require less blood sampling compared to intermittent infusion especially in infants less than 29 weeks of gestational age. Show more

Keywords: Continuous infusion, intermittent infusion, preterm infants, vancomycin

DOI: 10.3233/NPM-15814103

Citation: Journal of Neonatal-Perinatal Medicine, vol. 8, no. 2, pp. 149-155, 2015

Authors: White, L. | Said, M. | Rais-Bahrami, K.

Article Type: Research Article

Abstract: OBJECTIVE: To monitor altered mesenteric tissue oxygen saturation (StO2 ) before and after blood transfusion. METHODS: We placed a 4-wavelength NIRS sensor (FORE-SIGHT, CASMED, Branford, CT USA) on the right lower abdominal quadrant prior to transfusion and measured StO2 for up to 48 hours post transfusion. Pulse oximetry (SpO2 ) data was collected simultaneously, with fractional tissue oxygen extraction (FTOE) and the [SpO2 –StO2 ] difference calculated to normalize for hypoxic episodes. All data was combined and averaged in 30 minute windows for events before, during, and post transfusion to determine long term trends …and analyzed using Repeated Measures ANOVA. 24 infants were enrolled in this study with 36 hours of data collected for 23 subjects and 48 hours for 16 subjects. RESULTS: We found no significant differences in any of the parameters when compared pre and post transfusion values at 3, 6, 12, 24 and 36 hours post transfusion. For the 16 subjects monitored to 48 hours, there was a significant decrease in FTOE and near significant increase in StO2 and reciprocal decrease in [SpO2 – StO2 ] at 48 hours post transfusion. CONCLUSIONS: There are several plausible mechanisms that may explain the relationship between necrotizing enterocolitis and PRBC transfusion; however, mesenteric tissue oxygen saturation changes did not clearly show that ischemia or re-perfusion injury to be one of the potential mechanisms. Show more

Keywords: NIRS, mesenteric saturation, transfusion, NEC

DOI: 10.3233/NPM-15814090

Citation: Journal of Neonatal-Perinatal Medicine, vol. 8, no. 2, pp. 157-163, 2015

Authors: Jaiyeola, P. | El-Metwally, D. | Viscardi, R. | Greene, C. | Woo, H.

Article Type: Research Article

Abstract: Congenital central hypoventilation syndrome (CCHS) is an uncommon cause of apnea in the newborn characterized by the occurrence of apnea predominantly during sleep. Haddad syndrome is CCHS with Hirschsprung’s disease. We report a newborn with Haddad syndrome that had a family history of spinal muscular atrophy and discuss aspects of CCHS and important considerations in the evaluation of apnea in the term newborn.

Keywords: Haddad syndrome, congenital hypoventilation syndrome, Hirschsprung’s disease

DOI: 10.3233/NPM-15814058

Citation: Journal of Neonatal-Perinatal Medicine, vol. 8, no. 2, pp. 165-168, 2015

Authors: O’Brien, J. | Santolaya, J. L. | Townsend, R. | Matta, P. | Canterino, J. | Santolaya-Forgas, J.

Article Type: Research Article

DOI: 10.3233/NPM-15814131

Citation: Journal of Neonatal-Perinatal Medicine, vol. 8, no. 2, pp. 169-170, 2015

Authors: Keypour, F. | Naghi, I. | Naghi, S. | Younesi Asl, L.

Article Type: Research Article

Keywords: Tailgut cyst, ovarian cyst, pregnancy, pelvic MRI, retrorectal cystic hamartoma

DOI: 10.3233/NPM-15814039

Citation: Journal of Neonatal-Perinatal Medicine, vol. 8, no. 2, pp. 171-173, 2015