Journal of Neonatal-Perinatal Medicine - Volume Pre-press, issue Pre-press

Authors: Salama, H. | Al Rifai, H. | Mahmoud, N. | Al Qubasi, M. | Al Obaidly, S. | Sabry, I. | Ben Hadj Khalifa, O. | Mousa, A. | Sabouni, A.

Article Type: Research Article

Abstract: AIM: To evaluate outcomes of a cohort of infants born at 23 weeks’ gestational age after introducing a new selection score for resuscitation in the delivery room (DR). METHODS: This was a retrospective charts review study using data from the maternal and newborn registry funded by the Qatar National Research Fund. Parents were consulted prenatally and their wishes were honored. The plan of resuscitation was based on the new selection score. The seven components of the score were four antenatal and three immediate postnatal in the DR. Each component received a score of zero, one, or two according …to its presence, uncertainty or absence, respectively. Only a score of≥7 would receive active resuscitation unless specified otherwise during prenatal consultation. RESULTS: The study reviewed 60 infants that were delivered over a two year period. The DR death rate was 23 of 60 (38%). Thirty-seven infants (61%) were admitted to the NICU. The score was applied only on 37 infants where all score criteria were reported in their files. Twenty infants had score <7; of them 13 (65%) died in the DR and 7 were admitted to NICU of whom two (29%) survived to discharge. Seventeen babies with scores≥7 admitted to NICU of whom nine (51%) survived to discharge. The survival rate to discharge was 13 of 37(35%). A satisfaction survey included 33 neonatal physicians; 32 neonatologists stated the score was easy to comprehend, 26 voted for easy to implement, and 30 voted for ethical relief and moral comfort. CONCLUSIONS: Using a resuscitation score of seven was associated with improved survival until the discharge of those infants resuscitated. NICU physicians described the score as functional and convenient. Show more

Keywords: Limit of viability, extreme preterm, 23 weeks’ gestational age, mortality rate, outcome, complications, risk factors, death, score

DOI: 10.3233/NPM-190249

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-6, 2019

Authors: Margulies, S. | Corrigan, K. | Macri, C. | Bathgate, S.

Article Type: Case Report

Abstract: BACKGROUND: Addison’s disease is an uncommon condition encountered during pregnancy; however, pregnant patients with Addison’s disease are at higher risk for multiple pregnancy related complications. Treatment during pregnancy involves steroid replacement therapy. CASE REPORT: A 34-year-old previously healthy G2P1001 presented with lethargy, skin hyperpigmentation, polyuria, and salt craving. Laboratory evaluation showed hyperkalemia, hyponatremia, elevated ACTH, and low cortisol. The patient terminated the pregnancy due to her symptoms. She was then placed on a regimen of hydrocortisone and fludrocortisone, leading to symptom resolution. On second presentation as a G5P1031, her Addison’s disease was managed with hydrocortisone and fludrocortisone. When …Addison’s symptoms recurred, ACTH levels were checked to determine if her current medications could be optimized. She ultimately delivered a healthy male infant vaginally. For her third presentation as a G6P2032, her pregnancy was managed in a similar manner to the previous pregnancy. CONCLUSION: There is currently minimal cohesive literature on the management of Addison’s disease during pregnancy. Patients can be managed successfully by monitoring for recurrence of Addison’s symptoms and adjusting medication dosing as needed. Show more

Keywords: Addison’s disease, adrenal insufficiency, pregnancy, obstetrics

DOI: 10.3233/NPM-190231

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-4, 2019

Authors: Sabouneh, R. | Akiki, P. | Al Bizri, A. | El Helou, S. | Zeidan, S. | Al Hamod, D.

Article Type: Research Article

Abstract: BACKGROUND: Central lines can be placed through different techniques, either peripherally or centrally. Although they have the same aim, decision to use one of these modalities depends on the patient outcomes. The aim is to compare pain scores between ultrasound-guided central line insertion and peripherally inserted catheter in neonates in a prospective randomized single center study. METHODS: A randomized controlled trial was conducted in neonates requiring central venous access for any of the following reasons: total parenteral nutrition (TPN), antibiotics treatment for at least 7 days and having poor or difficult venous access. The study compared pain difference, …in neonates, that were randomized between peripherally and ultra-sound guided centrally placed central lines using the validated pain score N – PASS. RESULTS: 61 neonates were enrolled in the study. US-guided CICC was associated with less pain as reported by the statistically significant lower pain score difference (p -value <0.001) than the standard PICC. Additionally, the US-guided CICC had a higher rate of successful first attempt (p  = 0.012), lower overall number of attempts (p  < 0.001), and shorter procedure duration (p  < 0.001) as compared to standard PICC. CONCLUSION: US-guided CICC is a less painful technique than PICC line insertion associated with higher rate of successful first attempt, lower overall number of attempts and shorter procedure duration. Show more

Keywords: Central line, internal jugular vein, peripherally inserted central catheter, preterm neonates, ultrasound, pain score

DOI: 10.3233/NPM-180205

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-6, 2019

Authors: Bandyopadhyay, T. | Saili, A. | Yadav, D.K. | Kumar, A.

Article Type: Research Article

Abstract: BACKGROUND: To evaluate the correlation between functional echocardiography and clinical parameters in term neonates with shock. METHOD: Cross sectional study of 30 full term newborns who were clinically detected to have shock compared to 30 full term hemodynamically stable neonates. For statistical analysis, cases were further sub classified into cardiogenic and septic shock. RESULT: Functional echocardiography revealed inferior vena cava collapsibility index (cIVC), fractional shortening (FS), ejection fraction (EF), cardiac output and superior vena cava (SVC) flow were significantly lower whereas myocardial performance index (MPI) was significantly higher in babies with cardiogenic and septic shock as …compared to the controls. Left ventricular end diastolic area (LVEDA) was significantly higher in cardiogenic shock whereas it was significantly lower in septic shock as compared to the controls. Also, cIVC was significantly lower and LVEDA was significantly higher in cardiogenic as compared to the septic shock. In cardiogenic shock SVC flow correlated significantly with capillary filling time and systolic blood pressure. The correlation between functional echocardiographic parameters of cardiogenic and septic shock showed that EF, FS and MPI were positively and significantly correlated (r 0.742, p 0.022 for EF, r 0.766, p 0.016 for FS and r 0.478, p 0.05 for MPI) whereas SVC flow and cIVC were negatively and significantly correlated between cardiogenic and septic shock (r – 0.655, p 0.045 for SVC flow and – 0.578, p 0.05 for cIVC). CONCLUSION: In the complex environment of neonatal intensive care unit detection of shock continues to be a major challenge. Functional echocardiography provides an adjunct information to the clinical assessment of shock and helps in monitoring the response to treatment. Show more

Keywords: Functional echocardiography, shock, BP, IVC, SVC, neonatal intensive care unit, correlation, IVC collapsibility index

DOI: 10.3233/NPM-180179

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-7, 2019

Authors: Guimarães, A.R. | Rocha, G. | Rodrigues, M. | Guimarães, H.

Article Type: Research Article

Abstract: BACKGROUND: Nasal trauma due to nasal CPAP (nCPAP) use is a commonly reported complication in infants under 1500 g of birth weight and 32 weeks of gestation. With the rise of nCPAP as the gold standard for non-invasive respiratory support, preventive measures should be considered. OBJECTIVE: To assess the prevalence and risk factors of nasal injury in very low birth weight (VLBW) preterm infants with nCPAP. METHODS: We retrospectively analyzed neonates hospitalized between 2012 and 2017, with less than 1500 g and 32 weeks of gestational age who received more than 12 hours of nCPAP. Demographic, antenatal and …clinical data, along with information regarding respiratory support and nCPAP complications, were collected. We used Fischer’s classification to grade nasal trauma. RESULTS: A total of 135 infants were evaluated. Mean gestational age was 28 weeks (SD 2) and mean birth weight 1072 g (SD 239). Nasal trauma was reported in 65% of patients and it was of stage I, II and III in 49%, 16% and 1% of patients, respectively. The multivariate logistic regression revealed that the risk of trauma was greater in neonates with a longer duration of nCPAP ventilation (OR = 1.098, 95% CI: 1.055–1.142; p  < 0.001) and in patients submitted to oxygen therapy (OR = 3.174, 95% CI: 1.014–9.929, p  = 0.004). The median days after nCPAP administration until the onset of an identifiable lesion was 4. CONCLUSION: Nasal trauma is a frequent complication in VLBW preterm infants using nCPAP for long periods. Preventive measures in patients who are at greater risk of skin breakdown are of major clinical importance for a better outcome. Show more

Keywords: Noninvasive ventilation, nasal CPAP, morbidity, mortality, risk factors, neonatal intensive care

DOI: 10.3233/NPM-190269

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-9, 2019

Authors: Gelaye, B. | Kirschbaum, C. | Zhong, Q.-Y. | Sanchez, S.E. | Rondon, M.B. | Koenen, K.C. | Williams, M.A.

Article Type: Research Article

Abstract: BACKGROUND: Chronic hypothalamic-pituitary-adrenal (HPA) axis activity role in the pathogenesis of preterm birth (PTB) remains unclear due to inconsistent measures with limited ability to monitor long-term cortisol concentrations. We explored this relationship using the novel method of assessing cortisol in hair, which is a valid and reliable measure of chronic HPA axis activity. METHODS: 137 participants (40 PTB cases and 97 controls from a birth cohort of pregnant women in Peru) were interviewed and invited to provide a 9-cm hair sample from the posterior vertex position of the scalp (mean = 13 weeks gestation). Hair cortisol concentration (HCC) was determined …using luminescence immunoassay and values were natural-log transformed. PTB cases were defined as women delivered before 37 gestational weeks. Case-control differences were assessed using bivariate and multivariable linear regressions. RESULTS: Overall, combined pre-conception and first-trimester HCC was 13% lower among cases as compared with controls (p -value = 0.01). Compared with controls, maternal HCC among PTB cases were 14% (p  = 0.11), 10% (p  = 0.22) and 14% (p  = 0.08) lower for 3–6 months pre-conception, 0–3 months pre-conception, and first trimester, respectively. After adjusting for putative confounders, a 1-unit increase in HCC was associated with 55% reduced odds of PTB (aOR = 0.45; 95% CI: 0.17–1.17). For a 1-unit increase in HCC in the scalp-intermediate and scalp-distal segments (representing HCC concentrations in 0–3 months pre-conception and first trimester), the corresponding odds for PTB were 0.53 (95% CI: 0.19–1.48) and 0.39 (95% CI: 0.13–1.13), respectively. CONCLUSIONS: Women who deliver preterm, as compared with those who deliver at term, have lower preconception and first trimester HCC. Our findings suggest that HPA axis activation, integral to the adaptive stress-response system, may be chronically dysregulated in women at increased risk of PTB. Show more

Keywords: HPA axis activity, hair cortisol, cortisol, HCC, preterm birth, stress

DOI: 10.3233/NPM-180139

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-9, 2019

Authors: Volpe, Joseph J.

Article Type: Editorial

Keywords: Prematurity, white matter injury, zinc, iron

DOI: 10.3233/NPM-190369

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-4, 2019

Authors: Eissa, A. | Al Rifai, H. | Abdelmaaboud, M. | Eldakrouri, A. | Santos, J. | Pastoral, G. | Furigay, J. | Girish, S.

Article Type: Research Article

Abstract: BACKGROUND: Respiratory support in the form of mechanical ventilation is a crucial intervention in premature neonates, with respiratory problems. However, prolonged mechanical ventilation and endotracheal intubation may be associated with major adverse effects. The ideal time for extubation is based on clinical and laboratory parameters assessed at the time of planned extubation. However, such parameters are not very objective, which makes extubation in NICUs a trial-and-error approach. OBJECTIVE: This work was done to assess the use of extubation bundle including modified spontaneous breathing trial (SBT) (10 minutes) to reduce the rate of reintubation, among preterm neonates≤30 weeks who …were mechanically ventilated and extubated to non-invasive ventilation in the NICU, Women’s Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar. METHODS: A prospective study based on the collection of data regarding preterm neonates≤30 weeks gestation admitted to the NICU, Women’s Wellness and Research Center (WWRC), from January, 2015 to December, 2017, who were subjected to mechanical ventilation (MV) and extubation. When the clinical team decides a newborn is ready for extubation based on the extubation bundle, a modified SBT (10 min) is used. RESULTS: This study included 465 premature babies from 24-≤30 weeks recruited in the NICU, Women’s Wellness and Research Center (WWRC). Extubation bundle with modified SBT was able to predict success of extubation with 95% sensitivity and 90.4% Positive Predictive Value (PPV) in the gestational age (GA) group 24 -≤27 weeks (245) and 95.3% sensitivity and 90% PPV in the GA group > 27 -≤30 weeks (220). As expected, successfully extubated babies had a higher GA and weighed more at extubation, compared to babies who required re-intubation. CONCLUSION: We recommend the extubation bundle with modified SBT prior to elective extubation to be used in predicting successful extubation in premature babies. Guidelines for extubation among premature babies are needed in order to reduce unnecessary exposure to adverse effects of mechanical ventilation. Show more

DOI: 10.3233/NPM-190236

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-8, 2019

Authors: Dadiz, R. | Nair, J. | D’Angio, C.T. | Ryan, R.M. | Lakshminrusimha, S.

Article Type: Research Article

Abstract: BACKGROUND: We aimed to investigate whether the change in methemoglobin levels (ΔMHb) predicts oxygenation response to inhaled nitric oxide (iNO) in persistent pulmonary hypertension of the newborn (PPHN) with lung disease, with or without pulmonary hypoplasia. METHODS: In this prospective observational study, infants were categorized based on ΔMHb and oxygenation response (ΔPaO2 /FiO2 ) following iNO: ΔMHb ≤0 or ΔMHb>0, and ΔPaO2 /FiO2  < 20 mmHg (Non-responder) or≥20 mmHg (Responder). ΔMHb levels were compared among infants with or without pulmonary hypoplasia. RESULTS: Among infants with pulmonary hypoplasia (n  = 28), ΔMHb was not associated with an oxygenation response to iNO …or survival without ECMO. Among infants without hypoplasia (n  = 29), subjects with ΔMHb>0 following iNO (n  = 21) had a greater ΔPaO2 /FiO2 (median, 64 mmHg; IQR, 127; p  < 0.01) and 100% survival without extracorporeal membrane oxygenation (ECMO) when compared to infants with ΔMHb ≤0 (n  = 8; median 10 mmHg; IQR, 33). CONCLUSIONS: PPHN secondary to lung disease without hypoplasia with increased ΔMHb following iNO was associated with better oxygenation response and survival without ECMO compared to subjects without an increase in MHb. Show more

Keywords: Hypoxic respiratory failure, oxygenation, pulmonary hypertension, pulmonary hypoplasia

DOI: 10.3233/NPM-180082

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-8, 2019

Authors: Huston, R.K. | Lee, M.L. | Rider, E.D. | Stawarz, M.L. | Hedstrom, D.M. | Pence, M.M. | Chan, V.L. | Chambers, M.J. | Rogers, S.P. | Seger, N.C. | Riemann, L.A. | Cohen, H.S.

Article Type: Research Article

Abstract: BACKGROUND: An exclusive human milk diet (EHM) including fortification with a human milk-based fortifier has been shown to decrease the occurrence of necrotizing enterocolitis (NEC) but growth velocity may be less for infants receiving EHM compared to a bovine diet. OBJECTIVE: The objective of this study was to determine if growth is improved by earlier fortification of breast milk for preterm infants supported with a human milk based fortifier. STUDY DESIGN: A multi-center retrospective cohort study of the outcomes of infants of 500– 1250 g birth weight whose breast milk feedings were fortified at >60 mL/kg/day (late) versus …<60 mL/kg/day (early) of enteral feeding volume. RESULTS: Median±IQR range for gestational age (27.6±3.4 vs 27.0±2.9 weeks, p  = 0.03) and chronic lung disease (CLD: 42.6 vs 27.6%, p  = 0.008) were higher, and weight gain (12.9±2.6 vs 13.3±2.6 g/kg/day, p  = 0.03) was lower in the late (N = 102) vs the early (N = 292) group. Adjusted multiple linear regression analysis found that early fortification was associated with improved growth velocity for weight (p  = 0.007) and head circumference (HC) (p  = 0.021) and less negative changes in z-scores for weight (p  = 0.022) and HC (p  = 0.046) from birth to discharge. Adjusted multiple logistic regression found that early fortification was associated with decreased occurrence of CLD (p  = 0.004). No other outcomes, including NEC, were associated with early versus late fortification. CONCLUSION: The study results suggested that early HM fortification appears to positively affect growth for infants whose human milk feedings are fortified with a human milk based fortifier without adverse effects. The incidence of CLD was also reduced in the early fortification group. Show more

DOI: 10.3233/NPM-190300

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-7, 2019

Authors: Refaat, M. | El Dick, J. | Sabra, M. | Bitar, F. | Tayeh, C. | Arabi, M.

Article Type: Case Report

Abstract: Sustained fetal supraventricular tachycardia (SVT) complicated by hydrops fetalis carries a significant risk of morbidity and mortality. While there is no clear consensus on first- and second-line therapy options for the management of fetal SVT with or without hydrops fetalis, there exists significant nonrandomized experience with a number of antiarrhythmic agents that has founded the basis for management. Furthermore, recently published meta-analyses and ongoing multicenter prospective studies have aimed to bridge the gap in the literature. We report two cases of sustained fetal SVT with severe secondary hydrops fetalis managed successfully with flecainide-sotalol combination therapy in one case and sotalol-digoxin …combination therapy in the second and review the literature for the management of fetal SVT. Show more

Keywords: Hydrops fetalis, supraventricular tachycardia, sotalol

DOI: 10.3233/NPM-190268

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-7, 2019

Authors: van der Lee, D. | de Bruin, C. | Steggerda, S.J. | Vlaardingerbroek, H.

Article Type: Case Report

Abstract: BACKGROUND: Hyponatremia is a common laboratory finding in premature and ill neonates. When the degree of hyponatremia is more severe, the likelihood of a pathologic entity increases. In this case report we describe a premature neonate with severe hyponatremia due to the idiopathic syndrome of inappropriate antidiuretic hormone secretion (SIADH). CASE DESCRIPTION: The patient is a male neonate, born prematurely. He was admitted to the neonatal intensive care unit and received non-invasive respiratory support. After 48 hours of life serum sodium (Na+ ) decreased to 115 mmol/l. Hyponatremia progressively worsened despite aggressive Na+ supplementation. The clinical and laboratory …data were most consistent with severe SIADH. Fluid restriction was initiated which resulted in a gradual normalization of Na+ . A causal factor for development of SIADH could not be identified. CONCLUSION: When a neonate presents with significant hyponatremia that is not responsive to conventional therapy, it is important to perform a diagnostic work-up for SIADH, even in the absence of overt triggering factors. Show more

Keywords: Neonatal, hyponatremia, SIADH

DOI: 10.3233/NPM-180149

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-3, 2019

Authors: Abu-Shaweesh, J.M. | Khasawneh, W. | Tang, A.S. | Worley, S. | Saker, F.

Article Type: Research Article

Abstract: OBJECTIVE: While non-invasive ventilation (NIV) has been associated with improved extubation rates, its impact on bronchopulmonary dysplasia (BPD) remains unclear. METHOD: In this retrospective, chart review study of infants admitted to the Cleveland Clinic, we aimed to compare the incidence of BPD among extremely low birth weight (ELBW) infants extubated to continuous positive pressure (CPAP) versus those extubated to NIV via RAM cannula or biphasic CPAP. Data collected included demographics, ventilatory modes, extubation data, and presence of complications. Infants extubated to either CPAP or NIV were compared using Wilcoxon rank- sum and Chi-square tests, and data were corrected …using logistic regression models. Data are presented as medians. RESULTS: A total of 120 infants were included, of whom 62% were extubated to NIV. The incidence of BPD was significantly lower in the CPAP group vs NIV (57% vs. 78%, p  = 0.011). Infants in the CPAP group were heavier (birth weight (BWT) of 833 vs 724 grams, p  = 0.005), more mature (gestation age (GA) 27 vs 25 weeks, p  <  0.001) and were extubated significantly earlier (2 vs 8 days, p  <  0.001). After adjusting for BWT and GA, NIV continued to be significantly associated with higher incidence of BPD among those extubated on the first day of life (odds ratio 5.9; 95% CI: 1.2–29.1, p  = 0.029). CONCLUSION: This study concludes that, as compared to CPAP, early use of NIV is associated with higher risk of BPD in ELBW infants. Further investigation using prospective studies is recommended to validate these findings. Show more

Keywords: ??

DOI: 10.3233/NPM-190354

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-6, 2019

Authors: Alallah, J. | Mohtisham, F. | Saidi, N. | Almehdar, A. | Anees, A. | Sallout, A.

Article Type: Case Report

Abstract: BACKGROUND: Dengue fever is a mosquito-borne viral illness with 100 million new cases occurring worldwide. The vectors involved are mainly Aedes aegypti and Aedes albopictus . Dengue infection is associated with maternal as well as fetal morbidities, like stillbirth, preterm birth, and low birth weight. THE CASE: We report a case of dengue fever occurring during early pregnancy and subsequent congenital neurologic malformation in the neonate as a result of vertical transmission. To our knowledge, this is the first case of confirmed congenital dengue in Saudi Arabia. DISCUSSION: Dengue infection is not commonly associated with …congenital anomalies and no biologic mechanism has yet been established for its teratogenicity. Congenital dengue in neonates can be confirmed by identification of the dengue virus in cord blood samples. The positive dengue serology within the first week of life, together with the confirmed maternal dengue infection during pregnancy, supports the diagnosis of vertical transmission in the presence of clinical manifestations. A high index of suspicion, early diagnosis, and close monitoring is needed in these cases. Show more

Keywords: Microcephaly, congenital, dengue fever, dengue virus

DOI: 10.3233/NPM-190286

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-4, 2019

Authors: Loardi, C. | Signorelli, M. | Gregorini, M. | Marella, D. | Torri, F. | Zambelloni, C. Mario | Omodei, U. | Odicino, F.

Article Type: Research Article

Abstract: BACKGROUND: Renal pelvic dilatation (RPD) is a frequent finding in fetal ultrasound. The aim of the study is to correlate the prenatally detected moderate and severe pyelectasis with the postnatal outcome. METHODS: A retrospective analysis involving 90 cases of prenatally detected moderate and severe RPD referred to our prenatal diagnosis centre with 18 months of urological follow-up. Prenatal ultrasound was correlated with postnatal renal function, assessed by plasmatic creatinine and/or renal scintigraphy performed before surgery. RESULTS: Cases were divided between two groups according to postnatal management: group A including 35 newborns (38.9%) that needed surgical treatment …and group B with 55 patients (61.1%) who were managed conservatively. The group A presented higher median RPD (18 mm, IQR 12–25 mm) compared to the group B (11 mm, IQR 10–14 mm). The most common anomaly detected within group A was pelvi-ureteric junction (PUI) obstruction (43%). Within group B 32 cases (58%) showed spontaneous resolution of hydronephrosis during postnatal follow up. In case of moderate pyelectasis the risk of postnatal surgery was 25% and raised to 60% for severe RPD. In our study, 29 newborns showed pathologic scintigraphies: 25 required surgery while 4 did not find indication for surgery due to ipsilateral renal function irreversible damage. 6 patients had high creatinine level (>0.6 mg/dl). 35 cases out of 90 (39%) developed monolateral irreversible renal function impairment. CONCLUSION: Moderate and severe RPD are often correlated with postnatal renal damage, therefore a close multidisciplinary follow-up is required. Prenatal scanning is highly predictive of postnatal outcome and can address properly the prenatal counseling. Show more

Keywords: Fetal, severe pyelectasis, prenatal ultrasound, postnatal outcome, renal function

DOI: 10.3233/NPM-180071

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-6, 2019

Authors: Niwa, F. | Kawai, M. | Kanazawa, H. | Okanoya, K. | Myowa-Yamakoshi, M.

Article Type: Research Article

Abstract: BACKGROUND: Developmental changes in the hypothalamus-pituitary-adrenal (HPA) axis during infancy have been reported in term infants, but those in preterm infants have yet to be elucidated. If developmental changes in the HPA axis of preterm infants are modulated by any factors, it may affect their future health. Few studies have examined the lasting consequences of antenatal glucocorticoids on the development of the HPA axis. METHODS: We measured pre- and post-palivizumab vaccination salivary cortisol values in two conforming periods of three-months intervals during infancy, and compared cortisol values and the response of cortisol secretion between groups with and without …antenatal glucocorticoid (AG) therapy. RESULTS: Although the strength of the response of cortisol secretion to palivizumab fell age-dependently (until late infancy) in the Non-AG group, the opposite pattern was exhibited in the AG group. The changes of the delta cortisol values between the 2 groups were significant. CONCLUSIONS: This study suggests that the HPA axis of preterm infants whose mothers receive AG therapy may be upregulated during infancy, possibly leading to long lasting health problems. Show more

Keywords: Antenatal glucocorticoid, cortisol, hypothalamic-pituitary-adrenal axis, infants, preterm

DOI: 10.3233/NPM-180040

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-7, 2019

Authors: Ramadan, M.K. | Fasih, R. | Itani, S. | Wehbe, G.R. Salem | Badr, D.A.

Article Type: Research Article

Abstract: BACKGROUND: Fetal well-being is assured during labor and delivery with the employment of electronic fetal heart monitoring (EFHM). In uncommon instances, maternal heart rate (MHR) instead of fetal heart rate (FHR) can be the source of signals on monitors (signal ambiguity) leading to erroneous interpretation and management. Information about MHR characteristics are comparatively inadequate. We aim to analyze and compare MHR and FHR characteristics during the first and second stages of labor. METHODS: A prospective cohort study was conducted in a single tertiary care center during a one year period. Fifty one healthy full term women with singleton …pregnancies during labor were enrolled. Uterine contractions, MHR and FHR were recorded simultaneously during both stages of labor by monitors designed for twin gestation. RESULTS: When compared to FHR, MHR had significantly lower baseline rate during 1st and 2nd stages (p  < 0.0001). It demonstrated also more marked beat-to-beat variability during both stages (p  < 0.0001). MHR showed significantly more accelerations (p  = 0.03 and p  = 0.008) and less decelerations (p  < 0.0001 and p  = 0.021) during 1st and 2nd stages respectively. CONCLUSIONS: All characteristic parameters and patterns produced by FHR could be mimicked by MHR as well, though, at different frequencies. Understanding EFHM patterns suspected to be MHR artefacts and the employment of modern monitors that simultaneously obtain and display FHR and MHR can unmask ambiguity and avert related misinterpretation problems. Similar studies should be conducted in high-risk groups where the potential for fetal hypoxia/acidosis is increased. Show more

Keywords: Cardiotocogram, fetal heart rate, intrapartum monitor, maternal heart rate, signal ambiguity

DOI: 10.3233/NPM-180044

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-6, 2019

Authors: Klemme, M. | Staffler, A. | De Maio, N. | Lauseker, M. | Schubert, S. | Innocenti, P. | Wurster, T.M. | Foerster, K. | Herber-Jonat, S. | Mittal, R. | Messner, H. | Flemmer, A.W.

Article Type: Research Article

Abstract: OBJECTIVE: Nosocomial infections increase mortality and morbidity in preterm infants. Central venous line colonization is a major risk factor for the development of such infections. In adults and children, antibiotic and antimycotic impregnated catheters have been demonstrated to reduce colonization. However, recently published data showed no significant difference in bloodstream infection in neonates when an impregnated catheter was used. We investigated the effect of impregnation of percutaneously inserted micro-catheters (PICC) on colonization in preterm and sick term infants in our unit. METHODS: Neonates were randomly assigned to receive either a standard (S-PICC; n  = 34) or antibiotic and antimycotic …impregnated (IP-PICC; n  = 37) PICC. Catheters were placed and removed according to a standard procedure and subsequently examined by roll-out culture. The primary outcome was the rate of colonization defined as >15 colony-forming-units/ml. Additional outcomes were catheter associated or systemic infections. RESULTS: The rate of colonization was lower in neonates who received an IP-PICC as compared to S-PICC (5.6% vs. 12.1% respectively; p  = 0.42). However, the difference was not significant. In IP-PICC vs S-PICC, catheter related local infection (CRI) although lower was not statistically significant (2.9% vs. 6.1%; p  = 0.60). We observed no difference in catheter related systemic infection (CR-SI) (0% vs. 3.1%, p  = 0.48). The neonates whose catheters were colonized were predominantly of a lower gestational age (median 254/7 , p  = 0.05) and males (100%, p  = 0.01). In addition, the median colony count in the colonized IP-PICC catheters was lower as compared to S- PICC group (53 vs 250, p  = 0.06). CONCLUSIONS: The use of antibiotic and antimycotic impregnated PICC-lines in neonates tended to decrease colonization rates in neonates in our centers but this difference was not significant. Lower gestational age and male sex are risk factors for catheter colonization. Show more

Keywords: Preterm infant, central venous line, antibiotic and antimycotic impregnated catheters, colonization, catheter related infection

DOI: 10.3233/NPM-190273

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-7, 2019

Authors: Romanos-Sirakis, E. | Zureikat-Obeid, R. | Chein, T. | Demissie, S.

Article Type: Research Article

Abstract: BACKGROUND: Chronic use of opioids is associated with hematologic and immunologic effects, including lymphopenia. Despite an increase in opioid use during pregnancy, little is known about the potential immunologic effects on the neonate after exposure to opioids in-utero. We aimed to evaluate the presence of lymphopenia among neonates exposed to opioids in-utero. METHODS: We conducted a retrospective chart review of infants admitted to the neonatal intensive care unit (NICU) of a single institution after exposure to opioids in-utero. We compared the lymphocyte counts of this population to a control NICU population. RESULTS: A higher percentage of …neonates exposed to opioids in-utero were lymphopenic compared to our control population (45% vs 24%, p  = 0.029). CONCLUSIONS: This is the first study we are aware of, that investigated an association between neonatal lymphopenia and opioid exposure in-utero. Further studies to explore clinical implications of this finding are needed. Show more

Keywords: Key words: neonatal abstinence syndrome, lymphopenia, opioids

DOI: 10.3233/NPM-190279

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-4, 2019

Authors: Yuniati, T. | Judistiani, R.T. Dewi | Natalia, Y. Adelwin | Irianti, S. | Madjid, T. Husnitawati | Ghozali, M. | Sribudiani, Y. | Indrati, A. Rengga | Abdulah, R. | Setiabudiawan, B.

Article Type: Research Article

Abstract: INTRODUCTION: Vitamin D deficiency and anemia are examples of nutritional problems of global health significance. When these health issues effect pregnant women, they may become a threat to the fetus’ potention for intrauterine growth. It has been known that the first trimester is the golden period of fetal programming which influences the fetuses and their life after birth. This study was aiming to analyze the association between first trimester maternal vitamin D, serum ferritin, hemoglobin level and neonatal birth weight. METHODS: From July 2016 a prospective cohort of pregnant women had been observed in four cities in West …Java, Indonesia. Two hundred ninety four pregnant women were recuited in the first trimester and 203 of them had complete follow up until delivery. Collected data included maternal demography, blood analysis for ferritin, 25(OH) vitamin D in the first trimester of pregnancy and the birth weight of neonates. Associations were analyzed with multiple regression models. RESULTS: Vitamin D deficiency was highly prevalent among pregnant women in this study (approximately 75%) while anemia was found in 7.5 %, a little above the target of 5 %. However, no significant association was found between maternal serum vitamin D, serum ferritin, hemoglobin level in the first trimester and birth weight of the neonates, before and after adjustment for maternal age, pre-pregnancy body mass index, and parity. CONCLUSION: There were no associations found between vitamin D, ferritin, and hemoglobin level in the first trimester and neonatal birth weight. The negative results in this study should not diminish the benefit of nutritional supplementation during pregnancy. The possibility of other explanatory variables that influence these associations warrants further studies. Show more

Keywords: Birth weight, ferritin, hemoglobin, pregnancy, vitamin D

DOI: 10.3233/NPM-180043

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-7, 2019

Authors: Siswanto, J.E. | Ronoatmodjo, S. | Adisasmita, A. | Soemantri, A. | Sitorus, R.S. | Sauer, P.J.J.

Article Type: Research Article

Abstract: BACKGROUND: Risk factors other than supplemental oxygen might play a role in the development of retinopathy of prematurity (ROP). In Indonesia ROP occurs in infants up to 34 weeks and 2000 g. Risk factors for the development of ROP in Indonesian NICUs have not been evaluated. Our aim was to identify other risk factors than the use of oxygen in the development and progression of ROP in preterm infants in Indonesia. METHODOLOGY: Data on 98 preterm infants with ROP and 77 controls were collected from four NICUs and two eye centers in Jakarta, Indonesia, between 2009 and 2014. We …used multivariate logistic regression analysis to determine the relationship between infants and environmental variables and the development and progression of ROP. We obtained variables for ROP severity by using Cox regression analysis. RESULTS: Factors associated with the development of ROP were birthweight (BWt), intrauterine growth retardation (IUGR), exchange transfusion, duration of oxygen supplementation, minimum saturation monitor setting, and socioeconomic factors. Regarding the progression, gestational age (GA), out-born, duration of supplemental oxygen, minimum saturation monitor setting, and socioeconomic factors were identified as risk factors. CONCLUSION: The use and control of supplemental oxygen are the main risk factors for the development and progression of ROP in preterms in Indonesia. Additionally, we confirm that GA, BWt, and IUGR are risk factors. Moreover, we found exchange transfusion to be a risk factor, and we found a lower rate of ROP in infants from a lower socioeconomic background. These risk factors apply to infants with a GA up to 34 weeks and a BWt up to 2000 g. Show more

Keywords: retinopathy of prematurity ROP, neonatal risk factors, oxygen supplementation

DOI: 10.3233/NPM-190233

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-8, 2019

Authors: Segar, J.L.

Article Type: Review Article

Abstract: Despite the fact that hundreds of thousands of preterm infants receive parenteral fluids each year, study of optimal fluid and electrolyte management in this population is limited. Compared to older children and adults, preterm infants have an impaired capacity to regulate water and electrolyte balance. Appropriate fluid and electrolyte management is critical for optimal care of low birth weight or sick infants, as fluid overload and electrolyte abnormalities pose significant morbidity. This review highlights basic physiological principles which need to be applied when prescribing parenteral fluids and builds upon published literature to outline a rational approach to initial fluid and …electrolyte management of the preterm infant. Show more

Keywords: Fluid, sodium, potassium, premature

DOI: 10.3233/NPM-190309

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-9, 2019

Authors: Hoffman, J.I.E. | Hons, B.S.

Article Type: Article Commentary

Abstract: BACKGROUND: False negative pulse oximeter results occur in new born infants with critical congenital heart disease who have an oximeter saturation ≥95%. Some of these infants have abnormal physical findings but others do not. OBJECTIVES: To determine the causes of false negative results. METHODS: Mathematical analysis of determinants of arterial oxygen saturation and discussion of oximeter bias. RESULTS: False negative oximeter results are not rare; the sensitivity of pulse oximetry screening for critical congenital heart disease is about 80%. The high saturation may be due to a very small right-to-left shunt at the time …of study, a relatively high cardiac output and mixed venous saturation, or to positive bias in oximeter readings. It may also be due to some critical congenital heart lesions that do not show desaturation at the time of testing. CONCLUSIONS: A diagnosis of a normal heart based on a negative oximeter test is presumptive, and requires careful follow-up for 1–2 weeks after birth. Show more

Keywords: Mixed venous saturation, cardiac output, right-to-left shunt, oximeter bias

DOI: 10.3233/NPM-190297

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-5, 2019

Authors: Sardar, S.K. | Saha, A.K. | Majhi, B. | Chatterjee, S.

Article Type: Research Article

Abstract: OBJECTIVE: To evaluate the role of functional echocardiography for prediction of patent ductus arteriosus (PDA) closure and development of adverse outcome in very low birth weight newborn. METHODS AND STUDY DESIGN: Functional echocardiography was done in 143 neonates with birth weight less than 1250 g on day 3. Nine echocardiographic parameters were analyzed for babies with PDA for prediction of spontaneous closure and development of one or more adverse outcomes (bronchopulmonary dysplasia, necrotizing enterocolitis≥stage 2 and intraventricular hemorrhage > grade 2) during hospital stay. RESULT: The mean (±SD) birthweight and gestational age of the cohort were 1017 (±17) g …and 30.8 (±2.7) weeks. PDA was found in 60 (41.9%) babies on day 3 among the recruited babies. Binary logistic regression model showed strong prediction ability of early (day 3) functional echocardiography markers in predicting future spontaneous closure of PDA and development of one or more adverse clinical outcome. In multivariate analysis, abnormal flow pattern (growing or pulsatile) was found to have increased risk for persistence of PDA (adjusted OR 22.9, CI 1.97-269) in comparison to PDA with closing/bidirectional pattern. CONCLUSION: Early functional echocardiography, especially the flow pattern, is useful for prediction of PDA closure. Adverse clinical outcome prediction is possible with functional echocardiography markers when combined with gestational age and PDA closure status. Show more

Keywords: Very low birth weight, patent ductus arteriosus, preterm, functional echocardiography

DOI: 10.3233/NPM-190229

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-7, 2019

Authors: Tunç, T. | Polat, A. | Özdemir, R. | Kiliçaslan, B. | Can, E. | çelik, H.T. | Arsan, S. | Kader, Ş | Erol, S. | Uslu, S. | Özdemir, Ö.M.A. | neonatal sepsis study group Neonatal sepsis study group: B. Özcan | Hanta, D. | Dilli, D. | Narter, F. | Gültekin, N. | Güzoğlu, N. | Aydemir, Ö.

Article Type: Research Article

Abstract: BACKGROUND: Early onset bacterial sepsis in neonates (EOS) is recognized as an important health condition. Early diagnosis is crucial. However, blood culture results are released in 48–72 hours. Many biomarkers have been investigated but none have been accepted as the gold standard. This study aimed to investigate the diagnostic value of the molecules: soluble form of triggering receptor expressed on myeloid cells-1 (sTREM-1), pentraxin-3 (PTX-3) and pro adrenomedullin (pro-ADM) in EOS and compare with currently used biomarkers. METHODS: In this multicenter prospective study, patients were enrolled from different NICUs around the Turkey. Patient data were collected via …web-based registry system from attending centers. Neonates, hospitalized with a suspicion of EOS were enrolled. Blood culture and routine blood tests were collected and a serum sample was obtained and kept in – 80°C for studying the molecules. According to laboratory results, patients were divided into three groups as; proven sepsis, clinical sepsis and control group. Groups were compared in terms of demographic, clinical and laboratory findings. The primary outcome of the study was to assess any difference between groups in terms of the diagnostic value of the markers aforementioned. RESULTS: A total of 130 patients were enrolled; proven sepsis (n  = 38), clinical sepsis (n  = 53) and control (n  = 41) groups. Groups were similar in terms of demographic findings; mean WBC (P  = 0.445), procalcitonin (PCT) (P  = 0.083) and IL-6 (P  = 0.814) levels. Mean C-reactive protein (CRP) level was significantly higher in clinical sepsis and proven sepsis groups compared to control group (P  <  0.001). Mean PTX-3 (P  = 0.547), pro-ADM (P  = 0.766) and sTREM-1 (P  = 0.838) levels were similar between groups. CONCLUSION: These promising molecules failed to help in early diagnosis of EOS. Their relation to correlation with disease progression may make more sense as they seem to be expressed in higher amounts with the progression of the disease in previous studies. CRP was the most frequently used biomarker for detecting the sepsis in our study population. Show more

Keywords: Key words: Biomarker, neonatal early onset sepsis, pentraxin-3, pro-ADM, sTREM-1

DOI: 10.3233/NPM-180131

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-8, 2019

Authors: El Moussaoui, S. | Bennaoui, F. | El Idrissi Slitine, N. | Houcar, O. | Maoulainine, F.M.R.

Article Type: Case Report

Abstract: INTRODUCTION: Biotinidase deficiency is an inherited disorder of biotin metabolism that is untreated may present within the first few month of life. OBJECTIVE: We report the exceptional observation of a biotinidase deficiency in Morocco. The rarity of this pathology, its age of onset, its mode of revelation and the lack of treatment in Morocco make the particularity of this observation. OBSERVATION: A newborn child born from a 24-year-old mother, followed by an estimated pregnancy of 37 weeks of amenorrhea according to the Farr score (morphological maturation score used for the dating of the pregnancy term). The …infant presented at 7 days of life with a cutaneous-mucous eruption with icithiosic dry erythroderma of interest to the trunk, the face, the scalp associated with alopecia and depilation of the eyebrow. The biotinoidase deficiency was confirmed by its low serum concentration at 49 nka / l. The newborn died at 20 days of life before starting the specific treatment. CONCLUSION: Biotinidase deficiency is a rare condition requiring early screening and rapid management. The delay in diagnosis and the unavailability of treatment in Morocco can have fatal consequences. Show more

Keywords: Biotinidase deficiency, neonatal death, lack of treatment, death in the siblings

DOI: 10.3233/NPM-180130

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-3, 2019

Authors: Nour, I. | Elmaghraby, R. | Shehata, R. | El-Refaey, A. | Aldomiaty, H. | Mosbah, A. | Shouman, B. | Nasef, N.

Article Type: Research Article

Abstract: BACKGROUND: The reno-protective effect of therapeutic hypothermia in infants with hypoxic ischemic encephalopathy (HIE) is still debatable. We aimed to study the effect of therapeutic hypothermia on the development and progress of acute kidney injury (AKI) in neonates with HIE. METHODS: Thirty full term infants with HIE were equally distributed between cooling group (selective head cooling) or non-cooling group (late presentation after 6 hours of birth). Serum creatinine, urine output (UOP), serum neutrophil gelatinase-associated lipocalin (NGAL), and serum cystatin C were measured at baseline, day 4 and day 10 of life. RESULTS: The incidence of AKI …as per Acute Kidney Injury Network (AKIN) criteria was comparable in cooling and non-cooling groups (40% versus 53%, respectively). Serum creatinine and UOP were significantly improved on day-4 and day-10 samples compared to base-line samples in both groups regardless of cooling. Therapeutic hypothermia was associated with a significant reduction in serum NGAL, but not cystatin C, level in day-4 and day-10 samples compared to the non-cooling group. Serum NGAL and cystatin C did not show a significant decline in day-4 and day-10 samples compared to baseline samples in both the cooled and non-cooled groups indicating an ongoing AKI. CONCLUSIONS: Therapeutic hypothermia was associated with less renal impairment when compared to infants with HIE who were not cooled. Continuing kidney injury may persist in asphyxiated newborns despite improvement in serum creatinine and UOP. Trial Registration Number: NCT02683915. Show more

Keywords: Asphyxia, acute kidney injury, cystatin c, neutrophil gelatinase-associated lipocalin, therapeutic hypothermia neonate

DOI: 10.3233/NPM-180200

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-10, 2019

Authors: Uduwana, S. | Garcia, L. | Nemerofsky, S.L.

Article Type: Research Article

Abstract: BACKGROUND: Every year, about 50 babies in New York City die from a sleep-related injury. The Bronx County ranked second highest rate of sleep-related infant deaths (SRID) at 0.5 per 1000 among the other boroughs. The highest rate was among blacks and the rate of SRID cases were highest in our population at 0.97 (zip code 10466) among all other Bronx neighborhoods which comprises 77% of non-Hispanic black population. Further, Bronx has the highest preterm birth rate at 9.5%. This quality improvement (QI) project aimed to develop and implement an educational initiative on infant safe sleep (SS) to improve “Safe …Sleep Practices (SSP) in a level III neonatal intensive care unit (NICU) for one of the highest risk populations in the country. METHODS: Baseline data was collected prior to initiating the QI project. Multiple plan-do-study-act (PDSA) cycles were completed over a 12 month period. Run charts were utilized to identify improvement and guide interventions. These interventions included education for nurses, crib cards, posters, feedback forms, grand rounds and small group discussions. RESULTS: Approximately 600 crib checks (CC) were performed over the duration of this project. At baseline, 7% of infants were placed in a SS position in the NICU. Following the QI project, SS position increased to 96% of infants. CONCLUSION: Multifactorial interventions significantly improved SS compliance among NICU nurses. Cultivating personal motivation among nurses, consistent empowerment and dedication to culture change by the entire team was crucial for the sustainability of the project. Show more

DOI: 10.3233/NPM-180182

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-13, 2019

Authors: Rathi, P. | Messina, C. | Mintzer, J.P.

Article Type: Research Article

Abstract: BACKGROUND: Few studies exist that have evaluated the effects of indomethacin dosing frequency as a factor associated with successful patent ductus arteriosus closure in very low birth weight neonates. The objective of this study is to determine if indomethacin dosing strategy is associated with efficacy for initial patent ductus arteriosus management in very low birth weight neonates. METHODS: This retrospective review compared every 12 hour and every 24 hour indomethacin regimens primarily for efficacy in initial patent ductus arteriosus management, defined as an absence of repeat medical and/or surgical treatment, and secondarily for safety in both univariate and …multivariate models. RESULTS: One hundred three very low birth weight neonates were included: 56 (54%) received every 12 hour and 47 (46%) underwent every 24 hour indomethacin dosing. Repeat medical and/or surgical patent ductus arteriosus treatment rates were similar between groups. Less ligation of the patent ductus arteriosus occurred with every 12 hour versus every 24 hour dosing (11% vs. 26%, p  = 0.05), though this effect was mitigated controlling for birth weight and gestational age. Renal function, respiratory outcomes, feeding outcomes, length of stay, and mortality were similar between groups. CONCLUSIONS: Neither the every 12 hour nor the every 24 hour indomethacin regimen demonstrated inferior efficacy or safety for initial management of patent ductus arteriosus. Further prospective analysis of indomethacin dosing strategy is warranted. Show more

Keywords: Indomethacin, neonate, patent ductus arteriosus, prematurity, very low birth weight

DOI: 10.3233/NPM-180148

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-7, 2019

Authors: Resch, M. | Bresele, S. | Peglow, U.P. | Griesmaier, E. | Kiechl-Kohlendorfer, U.

Article Type: Research Article

Abstract: BACKGROUND: Preterm-born children are at higher risk for impaired linguistic abilities than are their term-born peers. The aim of the current study was to determine early predictors for delayed linguistic skills in very preterm-born preschool children. METHODS: Between January 2005 and November 2010 all very preterm infants born at <  32 weeks gestation in Tyrol were prospectively enrolled (n  = 421); 248 of them had a detailed examination at the age of five years including cognitive assessment (Wechsler Preschool and Primary Scale of Intelligence, third edition (WPPSI-III) or Snijders-Oomen Nonverbal Intelligence Tests (SON-R)) as well as a screening test for …language skills (Bielefelder screening for early diagnosis of reading problems and weak spelling (BISC)). The association between pre-and postnatal factors and poor performance on the BISC assessment was analyzed by means of logistic regression analysis. RESULTS: Of the 248 children 79 (31.8%) showed delayed literacy precursor skills. Male sex, gestational age, retinopathy of prematurity (ROP) grades 3–4 and low maternal education were predictive for delayed linguistic skills at 5 years of age in the multivariate analysis. CONCLUSION: This study identified predictors for delayed literacy precursor skills. These data support the finding that in very preterm infants pre-and perinatal as well as sociodemographic factors account for linguistic skills in the preschool period. Show more

Keywords: Linguistic skills, preterm infants, predictors

DOI: 10.3233/NPM-1838

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-8, 2019

Authors: El Farargy, M.S. | Soliman, N.A.

Article Type: Research Article

Abstract: BACKGROUND: Birth asphyxia is a leading case of neonatal morbidity and mortality especially in developing countries. Hypoxic-ischemic encephalopathy (HIE) attributed to asphyxia can be ameliorated with several remedies, although full recovery is currently not feasible. The aim of this trial on infants with HIE who are receiving melatonin therapy, is to assess the added effect of magnesium sulfate (MgSO4 ) on the expression of S100-B, a marker of brain injury. METHODS: This study is a randomized controlled trial on neonates with moderate HIE (Sarnat grade II). Infants were randomized into 2 groups; group1 who received MgSO4 and …melatonin; and group 2 who received melatonin only. Serum concentrations of S100-B were measured at baseline, and at days 2 and 6 of therapy. RESULTS: The study included 60 neonates of them 30 infants in group 1 and 30 infants in group 2. S100-B did not differ between groups 1 and 2 at enrollment (median = 13.5 vs 13.2, p  = 0.381). However, group 1 had lower concentrations of S100-B at 2 days (median = 8 vs 12, p  = 0.001) and at 6 days (median = 3 vs 10.5, p  < 0.001), respectively. Compared to baseline, S100-B decreased in in group 2 at day 6 (13.2 vs 10.5, p  = 0.011) but did not decrease at day 2 (13.2 vs 12, p  = 0.478). CONCLUSIONS: MgSO4 may have an added effect for the reduction in brain injury in infants with HIE who are receiving melatonin. Show more

Keywords: Hypoxia, neonate, magnesium sulfate

DOI: 10.3233/NPM-181830

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-6, 2019

Authors: Suppiej, A. | Toffoli, E. | Festa, I. | Cervesi, C. | Cappellari, A. | Manara, R. | Magarotto, M. | Cainelli, E.

Article Type: Research Article

Abstract: The mechanisms of perinatal stroke are poorly understood but preclinical studies point to the crucial role of perinatal inflammation. Carotid artery occlusion represents a very rare and severe cause of perinatal stroke. We describe two cases diagnosed with extensive ischemic stroke due to carotid artery occlusion. In both cases, we demonstrated placental vasculopathy. High levels of C-reactive protein in mother and/or neonates suggested inflammatory mechanism as a potential trigger. Both cases underwent hypothermic treatment without complications because of initial diagnosis of perinatal asphyxia. The prognosis at the time of the last follow up was severe including cerebral palsy, epilepsy and …cognitive impairment. Our cases contribute to the actual debate on pathogenic mechanisms and treatment options for this rare condition. Show more

Keywords: Neonate, inflammation, hypothermia, thrombophilia, seizures, outcome

DOI: 10.3233/NPM-1816

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-7, 2019

Authors: Fahmey, S.S. | Mostafa, N.

Article Type: Research Article

Abstract: BACKGROUND: Neonatal sepsis is an important cause of morbidity and mortality especially in developing countries. As clinical manifestations of neonatal sepsis are nonspecific, early diagnosis and treatment remain a challenge. Pentraxin 3 (PTX3) is an acute-phase protein secreted by various cells in response to the proinflammatory signals. Our aim was to investigate the diagnostic value of PTX3 in neonatal sepsis. METHODS: We studied 90 neonates; 60 with culture-proven sepsis and 30 healthy neonates as a control group. Serum levels of PTX 3 were measured by ELISA. RESULTS: Neonates with sepsis had significantly higher levels of PTX …3 as compared to controls (p  < 0.001). Diagnostic cutoff value of PTX 3 was 5.6 μg/L with a sensitivity of 98.3% and a specificity of 96.7%. PTX 3 was significantly increased in nonsurvivors when compared to survivors (p  < 0.001). PTX3 had better sensitivity when compared with CRP. CONCLUSION: PTX 3 could be used as a new biomarker of neonatal sepsis with high sensitivity and specificity. Show more

Keywords: Diagnosis, marker, neonate, pentraxin 3, sepsis

DOI: 10.3233/NPM-190261

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-6, 2019

Authors: Munoz, J.L. | Bishop CNM, E. | Reider, M. | Radeva, M. | Hsich, G. | Singh, K.

Article Type: Research Article

Abstract: BACKGROUND: Spina bifida is the most common fetal anomaly of the central nervous system, which affects approximately 1:1000 live births in the United States. Myelomeningocele (MMC) is the most common presentation of spina bifida, representing half of these cases. Given the deformation to the spinal cord and the nerve roots, this defect may result in significant morbidity to infants and major life-long disabilities. In this study we aimed to identify maternal and fetal characteristics associated with expectant management or termination of pregnancy in the setting of antenatally diagnosed MMC. We hypothesized that the level of the defect would correlate with …patient’s decision to continue the pregnancy. METHODS: A retrospective cohort analysis was performed with patients who had presented to the Cleveland Clinic Fetal Care Center between 2005–2017. RESULTS: Our data showed 36% of patients with antenatal diagnosis of MMC elected for second trimester terminations versus 64% who chose to continue their pregnancy and deliver either by cesarean section or vaginal delivery. Based on ultrasound findings, there were no significant differences between these two groups. Maternal body mass index was significantly higher in those who continued pregnancies (p  = 0.036). In addition, the fetal diagnostic methods chosen by patients were significantly different. Those who elected to terminate were more likely to pursue amniocentesis (p  = 0.03) and less likely to opt for MRI characterization of the fetus (p  = 0.007). CONCLUSION: We conclude, in the setting of fetal MMC diagnosed during pregnancy, patients often rely less on the associated ultrasonographic findings. Personal decisions likely influence the choice of other fetal diagnostic modalities. Other than BMI, we did not see an association between maternal factors and decisions regarding second trimester pregnancy termination. Show more

Keywords: Spina bifida, termination, expectant management, fetal medicine, maternal care

DOI: 10.3233/NPM-180208

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-5, 2019

Authors: Vasilievna, K.M. | Solomonovna, K.E. | Demyanovna, B.E.

Article Type: Research Article

Abstract: BACKGROUND: The frequency of bronchopulmonary dysplasia (BPD) in preterm infants with a “ventilator-associated” pneumonia (VAP) ranges between 7 to 50%. OBJECTIVE: To investigate the features of the etiological structure of neonatal pneumonia complicated by BPD, and to determine the sensitivity of pathogens to antibiotics. METHODS: A retrospective chart review of 194 preterm infants with VAP, birth weight from 780 to 2820 g and gestational age from 27 to 37 weeks was conducted. A microbiological study of washings from the respiratory tract was conducted by standard qualitative and quantitative methods. RESULTS: Respiratory tract infections caused …by E. coli (with hemolytic properties), Enterococcus spp. (with hemolytic properties), Pseudomonas aeruginosa, Stenotrophomonas maltophilia , various types of mycoplasmas , Staphylococcus aureus , and Candida krusei were found 4– 13 times more frequent in preterm infants with BPD than in preterm infants without BPD and more mature infants with or without this complication. BPD developed 7– 11 times more frequent in preterm infants with prolonged VAP and change in pathogens than in preterm infants with VAP without change of agent. BPD developed 5– 7 times more frequent in preterm infants with the association of pathogens than in preterm infants with a monoinfection. Massive colonization of respiratory tract pathogens by 1– 3 days of life (lg4 colony forming units in 1 ml and above) was an unfavorable prognostic factor for the development of VAP, complicated by BPD. CONCLUSION: The reduction in the frequency of BPD is might be possible with timeous and adequate antibacterial therapy of VAP. Show more

Keywords: Preterm infants, pneumonia, bronchopulmonary dysplasia, microorganisms, antibiotics

DOI: 10.3233/NPM-17159

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-8, 2019

Authors: Rana, D. | Pollard, L. | Rowland, J. | Dhanireddy, R. | Pourcyrous, M.

Article Type: Research Article

Abstract: BACKGROUND: To describe amplitude-integrated encephalogram (aEEG) characteristics of neonates with neonatal abstinence syndrome (NAS). METHODS: This is a prospective observational study. Newborns exposed to prenatal opioids and their gestational matched controls were included. A single-channel aEEG was obtained using Olympic 6000 CFM monitor. The background activity (continuous/discontinuous), the amplitudes (μ V) and the presence of sleep-wake cycle (SWC) were documented. RESULTS: A total of 59 infants, 23 with NAS and 36 controls were enrolled. All aEEG were completed within 48 hours of life prior to initiation of treatment. Birth weight and gestational age were similar in …both groups. An aEEG was abnormal (discontinuous pattern and/or absent SWC) in 78 % (18/23) of infants with NAS versus only 25% in control group (9/36), [OR 10.8, CI (2.7–46.5) P  < 0.001]. 61% of infants with NAS had discontinuous pattern [OR 7.8, CI (2–32) P  = 0.001] and 39% had absence of sleep-wake cycle [OR 7.1, CI (1.4–39.4) P  = 0.007]. CONCLUSIONS: A majority of infants with NAS have abnormal aEEG activity. Show more

DOI: 10.3233/NPM-1834

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-7, 2019

Authors: Odo, K.E. | Odetunde, O.I. | Chinawa, J.M. | Okafor, H.U. | Aronu, A.E. | Adimora, G.N.

Article Type: Research Article

Abstract: OBJECTIVES: The objective of this study is to document and compare plasma electrolytes of asphyxiated newborns of different degree within 48 hours of life. STUDY DISIGN: A comparative cross-sectional study was conducted in the newborn special care unit at the University of Nigeria Teaching Hospital (UNTH), Enugu, South-East Nigeria. Sodium, potassium, bicarbonate and ionized calcium levels were estimated in the plasma samples of neonates with perinatal asphyxia of different degree and healthy newborns (control group) within 48 hours of birth. MAIN OUTCOME MEASURES: The plasma sodium, potassium, bicarbonate and ionized calcium levels were estimated in both, …the study subjects and controls. RESULTS: Mean plasma sodium level was significantly lower (134.93±5.24 mmol/l vs 141.90±3.36 mmol/l; P  <  0.05), mean plasma bicarbonate level was significantly lower (16.98±3.99 mmol/l vs 18.54±2.36 mmol/l; P  <  0.05), and mean plasma ionized calcium level was significantly lower (1.10±0.14 mmol/l vs 1.25 0.11 mmol/l; P  <  0.05) in subjects compared to controls while mean plasma potassium was significantly higher (5.07±0.93 mmol/l vs 4.65±0.51 mmol/l P  <  0.05) in subjects compare to controls. CONCLUSION: The tendency to have hyponatremia, hyperkalemia, acidosis and hypocalcemia is very high among the study subjects which underscores the need for great vigilance in electrolyte monitoring when managing an asphyxiated baby. Show more

Keywords: Perinatal asphyxia, electrolytes disorder, term babies, Apgar score

DOI: 10.3233/NPM-1839

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. -, 2019

Authors: Depoers-Béal, C. | Le Baccon, F.A. | Le Bouar, G. | Proisy, M. | Arnaud, A. | Legendre, G. | Dayan, J. | Bétrémieux, P. | Le Lous, M.

Article Type: Research Article

Abstract: BACKGROUND: The objective of the study was to assess perinatal grief experienced after continuing pregnancy and comfort care in women diagnosed with lethal fetal condition compared with termination of pregnancy for fetal anomaly (TOPFA). METHODS: This was a retrospective observational study which included women who chose to continue their pregnancy after the diagnosis of lethal fetal condition with comfort care support at birth at the Prenatal Diagnosis Center of Rennes Hospital from January 2007 to January 2017. Women were matched with controls who underwent TOPFA for the same type of fetal anomaly, gestational age at …diagnosis and year. Women were evaluated by a questionnaire including the Perinatal Grief Scale. RESULTS: There were 28 patients in the continuing pregnancy group matched with 56 patients in the TOPFA group. Interval between fetal loss and completion of questionnaire was 6±3 years. Perinatal grief score was similar at 61±22 vs 58±18 (p  = 0.729) in the continuing pregnancy and TOPFA groups, respectively. Women in the TOPFA group expressed more guilt. The cesarean-section rate in the continuing pregnancy group was 25% . CONCLUSION: Perinatal grief experienced by women opting for continuing pregnancy and comfort care after diagnosis of a potentially lethal fetal anomaly is not more severe than for those choosing TOPFA. Show more

Keywords: Perinatal grief, continuing pregnancy and comfort care, termination of pregnancy, fetal anomaly

DOI: 10.3233/NPM-180180

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-8, 2019

Authors: Ahmad, M.U. | Farrell, R.M. | Weise, K.L.

Article Type: Review Article

Abstract: In the realm of clinical ethics as well as in health policy and organizational ethics, the onus of our work as ethicists is to optimize the medical care and experience of the patient to better target ethical dilemmas that develop in the course of care delivery. The role of ethics is critical in all aspects of medicine, but particularly so in the difficult and often challenging cases that arise in the care of pregnant women and newborns. One exemplary situation is that when a pregnant woman and her partner consider neonatal organ donation after receiving news of a terminal diagnosis …and expected death of the newborn. While a newer, less practiced form of organ donation, this approach is gaining greater visibility as an option for parents facing this terminal outcome. The aim of our paper is to highlight some of the key ethical issues associated with neonatal organ donation and identify clinical and logistical aspects of implementing such an approach to facilitate organ donation. Show more

Keywords: Neonatal donation, organ transplantation, Donation after Neurologic determination of death (DND), Donation after Circulatory determination of Death (DCDD), pediatric patients

DOI: 10.3233/NPM-1850

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-9, 2019

Authors: Le, C.N. | Sauer, C.W. | Law, C. | Proudfoot, J.A. | Song, R.S.

Article Type: Research Article

Abstract: BACKGROUND: Creation of a clinical guideline to reduce the number of complete blood counts (CBCs) obtained on healthy term infants for early onset sepsis (EOS) evaluation secondary to maternal chorioamnionitis. METHODS: A clinical guideline was introduced at four neonatal intensive care units (NICU) to reduce laboratory tests during EOS evaluation. Measures include frequency and timing of CBCs, culture negative sepsis, length of stay, and readmission rate. RESULTS: Mean number of CBCs per patient significantly decreased (2.31±0.62 versus 1.52±0.65) without increasing trends for patients with culture negative sepsis, length of stay, or re-admission. CONCLUSION: The …clinical guideline demonstrated a significant reduction in the number of CBCs obtained in well-appearing infants admitted to the NICU secondary to maternal chorioamnionitis. Show more

Keywords: Early onset sepsis, neonate, complete cell count, chorioamnionitis

DOI: 10.3233/NPM-180181

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-6, 2019

Authors: Rocha, G. | de Lima, F. Flor | Machado, A. Paula | Guimarães, H. | Proença, E. | Carvalho, C. | Martins, L.G. | Martins, T. | Freitas, A. | Dias, C.P. | Silva, A. | Barroso, A. | Diogo, I. | Cassiano, G. | Ramos, H. | Abrantes, M.M. | Costa, P. | Salazar, A. | Vieira, F. | Fontes, D. | Barroso, R. | Marques, T. | Santos, V. | Scortenschi, E. | Santos, C. | Vilela, F. | Quintas, C. | Hypertensive Disorders of Pregnancy Study Group

Article Type: Research Article

Abstract: INTRODUCTION: Several studies assessed the influence of a low birth weight on bronchopulmonary dysplasia (BPD), but not all could find a significant association. Our aim was to assess the association between low birth weight and BPD in preterm infants, prospectively recruited at 11 level III Portuguese neonatal centers. METHODS: Obstetrical and neonatal data on mothers and preterm infants with gestational ages between 24 and 30 weeks, born during 2015 and 2016 after a surveilled pregnancy, were analyzed. Neonates were considered small for gestational age (SGA) when their birthweight was below the 10th centile of Fenton's growth chats and …BPD was defined as the dependency for oxygen therapy until 36 weeks of corrected age. Statistical analysis was performed using IBM SPSS ® statistics 23 and a p -value <0.05 was considered statistically significant. RESULTS: Out of 614, a total of 494 preterm infants delivered from 410 women were enrolled in the study; 40 (8.0% ) infants with SGA criteria. SGA were more often associated with a single pregnancy, had greater use of antenatal corticosteroids, increased prevalence of gestational hypertensive disorders, C-section, rupture of membranes below 18 hours, rate of intubation in the delivery room, use of surfactant treatment, oxygen therapy, mechanical ventilation need, BPD, cystic periventricular leukomalacia, nosocomial sepsis and pneumonia; had lower prevalence of chorioamnionitis, and lower Apgar scores. The multivariate analysis by logistic regression, adjusted for BPD risk factors revealed a significant association between SGA and BPD: OR = 5.2 [CI: 1.46–18.58]; p  = 0.01. CONCLUSION: The results of this study increase the scientific evidence that SGA is an independent risk factor for BPD. Show more

DOI: 10.3233/NPM-180129

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-10, 2019

Authors: Valadbeigi, T. | Tabatabaee, H. Reza | Etemad, K. | Keyghobadi, N. | Mahdavi, S. | Enayatrad, M. | Saeidinejat, S. | Yaghoobi, H. | Zolfizadeh, F. | Ghasemi, A. | Hajipour, M.

Article Type: Research Article

Abstract: BACKGROUND: Neonates are too vulnerable that low birth weight (LBW) and preterm birth can easily threaten their lives. Demographic, social and environmental factors as well as health care are contributing factors for LBW. The study was conducted in 10 provinces of Iran to investigate the association between LBW and mother’s diseases. METHODS: A case-control study was conducted in 10 provinces of Iran on 2580 mothers (712 cases and 1868 controls) referred to public health care centers. We used a questionnaire to collect data. For univariate analysis we used chi-square test and for multivariable analysis we used logistic regression …model. RESULTS: LBW was significantly associated with living in rural area (OR = 1.4 CI: 1.14–1.71), having body mass index (BMI)<18 (OR = 1.48 CI: 1.14–1.92), being a housewife (OR = 1.65 CI: 1.07–2.53), having high blood pressure (OR = 1.91 CI: 1.26–2.88), and having pregnancy without testing for diabetes (OR = 1.91 CI: 1.44–2.54). Minor thalassemia, hypothyroidism, oral health care and headache were not significant predictors for LBW. CONCLUSION: In this study, we observed that place of residence, BMI before pregnancy, mother’s occupation and gestational diabetes were significant predictors of LBW. It is necessary to improve women’s awareness about prenatal health care before pregnancy to avoid LBW. Show more

Keywords: Mothers’ disease, low birth weight, case-control, Iran

DOI: 10.3233/NPM-180068

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-8, 2019

Authors: Phillips, J. | Blask, A. | Brahmbhatt, A. DiPoto | Lawrence, A. | Timofeev, J. | Badillo, A. | Andescavage, N.

Article Type: Case Report

Abstract: Fetal lung interstitial tumor (FLIT) is a rare fetal malignancy that is typically diagnosed in the postnatal period, or, if recognized prenatally can mimic a benign lesion such as congenital pulmonary airway malformation. We present the earliest case of a FLIT tumor described by ultrasound and MRI at 26 weeks of gestation. Our case highlights features suggestive of FLIT including presentation later in gestation in combination with findings on fetal MRI such as a solid appearance with radiating curved bands of high signal within and along the periphery of the lesion (not as intensely high signal as the typical CPAM), …possibly detailing a radiographic signature for these tumors. The role of betamethasone for these tumors is not known. Show more

Keywords: Fetal lung interstitial tumor, congenital pulmonary airway malformation, immature mesenchymal interstitial tumor

DOI: 10.3233/NPM-180059

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-5, 2019