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

Authors: Stavropoulou, D. | Hentschel, R. | Rädecke, J. | Kunze, M. | Niemeyer, C. | Uhl, M. | Grohmann, J.

Article Type: Case Report

Abstract: Sacrococcygeal teratoma is one of the most common congenital tumors. Its optimal management requires interdisciplinary care by obstetricians, radiologists, pediatric surgeons, and neonatologists. Early surgery entailing complete tumor excision is the main therapy aim, but a substantial risk of life-threatening complications remains, especially uncontrollable intraoperative hemorrhage. To reduce the risk of bleeding in a female neonate with a giant sacrococcygeal teratoma, we successfully coil-embolized the tumor’s main feeding arteries. Her subsequent complete surgical resection was uneventful, and the child is well with favorable reconstructive and functional status of all involved and adjacent organ systems.

Keywords: Sacrococcygeal teratoma, coil embolization, sacral artery, iliac artery, neonate, transcarotid access, Penumbra occlusion device

DOI: 10.3233/NPM-180066

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

Authors: Sawyer, T. | Motz, P. | Schooley, N. | Umoren, R.

Article Type: Research Article

Abstract: BACKGROUND: Positive pressure ventilation (PPV) is the most important procedure during neonatal resuscitation. Providing effective PPV seems easy. However, performing the procedure correctly is extremely challenging. Air way obstruction and face mask large leaks are common. It is estimated that two-thirds of continued neonatal respiratory depression after the time of birth is caused by ineffective or improperly provided PPV. Finding methods to improve PPV performance are critically needed. Performance coaching is a simple and easy method of improving performing in procedural skills, and has been used previously to optimize compression technique. We performed the simulation-based pilot study to evaluate the …impact of PPV coaching during neonatal bag-mask ventilation. METHODS: Randomized cross-over study of nurses performing PPV on a SMART Newborn Resuscitation Training System with, and without, coaching. The PPV coach provided real-time feedback on chest rise, mask hold, and ventilation rate. The SMART system captured data on peak inspiratory pressure (PIP), tidal volume (Vt), mask leak, and ventilation rate. Data were analyzed by a blinded reviewer. RESULTS: PPV coaching resulted in more appropriate PIPs (34 cmH2O, IQR 32-38 vs. 36 cmH2O, IQR 28–37; P  <  0.001), lower Vt (4.7 ml/kg, IQR 4–8 vs. 5.5 ml/kg, IQR 4–13; P  <  0.001), and less mask leak (39% leak, IQR 21–70 vs. 45%, IQR 22–98; P  = 0.005). There was no difference in respiratory rate (P  = 0.93). CONCLUSIONS: Coaching improved PPV performance in this simulation-based pilot study. Further research on PPV coaching during neonatal resuscitation is warranted. Show more

Keywords: Positive pressure ventilation coaching, mask ventilation, bag-mask ventilation, neonatal resuscitation

DOI: 10.3233/NPM-1618119

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

Authors: Julia, J. | Shui, V. | Naveen, M. | Heim-Hall, J. | Blanco, C.L.

Article Type: Case Report

Abstract: BACKGROUND: Microvillus Inclusion Disease (MVID) was first described in the literature in 1978 with presentation of severe watery diarrhea, failure to thrive, and metabolic acidosis. Mutations in the myosin Vb (MYO5B) gene have been identified as causative for MVID, but other clinical manifestations and associations with novel mutations are lacking. METHODS: We report a full-term infant admitted to the neonatal intensive care unit (NICU) with abdominal distension and inability to sustain full enteral feeds. A retrospective chart review and review of the literature was performed. RESULTS: An infant with abnormal, mucoid-like stringy stools was incidentally found …to have severe metabolic acidosis on routine lab monitoring. Acidosis corrected with total parenteral nutrition (TPN), but the infant experienced recurrent episodes of acidosis with enteral feeds. He was also noted to have abnormal ocular movements, fluctuating tonicity, and staring spells. He underwent an extensive workup and the diagnosis of microvillus inclusion disease was made by findings on electron microscopy. The diagnosis was confirmed with whole exome sequencing, showing a rare homozygous mutation in the syntaxin 3 (STX3) gene. This is the fifth reported patient with microvillus inclusion disease with a mutation in this gene, and the first with abnormal neurologic findings. CONCLUSION: It is important to consider MVID in the differential diagnosis of a neonate or infant with abnormal stools, metabolic acidosis, with and without neurologic symptoms for prompt referral and treatment. Show more

Keywords: Microvillus inclusion disease, microvillus atrophy, congenital enteropathy, congenital diarrhea, MYO5B, STX3

DOI: 10.3233/NPM-1852

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-7, 2018

Authors: Rhodes, A. | Neuman, J. | Blau, J.

Article Type: Case Report

Abstract: Biophysical profile (BPP) with ultrasound performed for a 32-year-old G5 P3013 admitted at 31 weeks gestation with preterm, premature rupture of membranes (PPROM) noted an extracalvarial mass concerning for an encephalocele. Fetal MRI demonstrated edema over the occiput with no definable lesion visualized. Preterm labor requiring Cesarean delivery resulted in a live male neonate at 33 weeks gestation. An occipital mass was observed on neonatal physical exam. Postnatal ultrasound and MRI were consistent with cephalohematoma. This was surprising given the lack of vaginal delivery. We hypothesize that the occiput was positioned against the maternal ischial tuberosity and developed chronic …trauma secondary to normal fetal movement over time, resulting in a cephalohematoma. Postnatal imaging confirmed this diagnosis as the mass gradually decreased and ultimately resolved. Although other etiologies are possible, this case emphasizes the need to consider cephalohematoma in the differential of CNS masses during pregnancy without abdominal trauma and/or vaginal delivery. Show more

Keywords: Cephalohematoma, ultrasound, extracalvarial mass, occipital mass, encephalocele

DOI: 10.3233/NPM-1872

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

Authors: Marino, S. | Mariaelena, G. | Chiara, P. | Rossana, O. | Cesare, Z. | Fabio, Torri | Laura, F. | Angela, G. | Enrico, S.

Article Type: Case Report

Abstract: OBJECTIVE: Ovarian cysts are relatively common prenatal findings in female fetuses. The aim of this study is to evaluate the ability of antenatal ultrasound in predicting spontaneous regression or a need for surgery. DESIGN: All cases of fetal ovarian cysts treated in our Department between 2007 and 2016 were included. Patients underwent a sonographic monitoring in utero and after birth until spontaneous or surgical resolution. Subjects were divided into two groups according to their postnatal management. Receiver-operating characteristics (ROC) curves were used to test the predictive ability for postnatal surgery of the cyst’s mean and maximum diameters; their …optimal cut off points were also determined. RESULTS: 38 cases of antenatally-detected fetal ovarian cysts were included. 12/38 cases underwent surgery (Group A). 26/38 cases were resolved spontaneously (Group B). Cyst size of those which were surgically excised significantly differed from those that regressed spontaneously. ROC curve pointed to 45 mm and 47 mm as optimal cut off points for the mean and the maximum cystic diameters, respectively. CONCLUSIONS: Cyst size and echo-structure seemed good predictors for prognosis after birth. The optimal cut off points of the cysts mean and maximum diameters in predicting postnatal surgery have been identified as 45 mm and 47 mm, respectively. Show more

Keywords: Fetal ovarian cysts, ultrasound, postnatal surgery

DOI: 10.3233/NPM-1870

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-5, 2018

Authors: Nakajima, J. | Sunohara, D. | Kawashima, H.

Article Type: Research Article

Abstract: BACKGROUND: The efficacy of macrolide treatment on gastrointestinal motility and acquirement of feeding tolerance in extremely low birth weight (ELBW) infants are controversial. This study aimed to evaluate clinical effects of parenterally administered erythromycin (EM) and clarithromycin (CAM) on gastrointestinal motility in ELBW infants. METHODS: ELBW infants treated in Tokyo Medical University Hospital were retrospectively studied. Several outcomes of ELBW infants treated with EM or CAM were compared with those recognized before initiation of the medication, as well as with those of patients with no macrolide treatment. The primary outcomes included average gastric residual volume that was evaluated …3 hours after enteral feeding. Secondary outcomes were the number of patients who developed feeding intolerance, stool frequency, and other adverse events, such as respiratory comorbidities and pyloric stenosis. RESULTS: Among a total of 53 infants, 20 and 13 were treated with EM and CAM, respectively, whereas 20 infants were not administered macrolides. The gastric residual volume was significantly decreased after initiation of medication compared with before medication in the EM group, whereas that of the untreated group showed no change. When the EM and CAM groups were combined, the gastric residual volume was also significantly decreased after treatment compared with before treatment. An increase in stool frequency and pyloric stenosis were not observed in the groups. CONCLUSION: EM might be effective for acquiring feeding tolerance in ELBW infants. A future prospective study with a larger population is required to determine the efficacy of CAM. Show more

Keywords: Clarithromycin, enteral feeding, erythromycin, feeding intolerance, preterm newborns, macrolide

DOI: 10.3233/NPM-1849

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-6, 2018

Authors: Holm, K.G | Clemensen, J. | Brødsgaard, A. | Smith, A.C. | Maastrup, R. | Zachariassen, G.

Article Type: Research Article

Abstract: OBJECTIVE: Neonatal tele-homecare implies that parents of clinically stable preterm infants can manage tube feeding and establishment of oral feeding in the home. Support is provided from the neonatal intensive care unit (NICU) through a telehealth service. The aim of this study was to compare growth and breastfeeding rates amongst infants being managed in the NICU (conventional care) and by neonatal tele-homecare. METHODS: A total of 96 preterm infants with tube feeding requirements participated in the observational study of neonatal tele-homecare. Retrospective data in 278 preterm infants receiving standard care in the same neonatal intensive care unit prior …to implementation of neonatal tele-homecare were used for comparison. Rates of breastfeeding and growth were monitored during neonatal tele-homecare. Infant weights were converted to standard deviation weight-for-age z-scores based on a reference. RESULTS: There was no significant difference in rates of exclusive breastfeeding between the neonatal tele-homecare infants and the controls. Among the very preterm singleton infants more neonatal tele-homecare infants were exclusively breastfed at discharge compared to the controls (p  = 0.02). There was no difference in median weight for age z-scores at discharge. CONCLUSION: The breastfeeding rates in infants receiving neonatal tele-homecare at time of discharge were higher compared to historical controls. Growth rates remained the same amongst groups. This study demonstrates that neonatal tele-homecare may be an appropriate model of care for the management of preterm infants outside of the hospital environment; with the added benefit of higher rates of breastfeeding at time of discharge. Show more

Keywords: Preterm infant, growth, breastfeeding, telemedicine

DOI: 10.3233/NPM-18143

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

Authors: Semerci, S.Y. | Demirel, G. | Baskan, O. | Tastekin, A.

Article Type: Research Article

Abstract: AIM: Thymus size in neonates depend on many factors. We aimed to assess the thymus size radiographically in preterm neonates and its relationship with respiratory distress syndrome (RDS) and other complications of prematurity. METHODS: Thymus size was assessed by cardiothymic: thoracic ratio (CT/T), measuring the width of the cardiothymic shadow at the level of carina and dividing it by the width of the thorax at the costophrenic angles, from the first chest radiograph in patients less than 34 weeks gestational age. RESULTS: Neonates born between 30–34 weeks of gestation with RDS had smaller CT/T than non …RDS group (0.34±0.1 vs 0.36±0.05, p  = 0.045). Birth weight has positive correlation with CT/T (r = 0.166, p  = 0.03). CONCLUSION: Thymus involution in the perinatal period is a complex process and the response is variable in different clinical situations. Activated hypothalamic-pituitary-adrenal (HPA) axis may be responsible for thymic involution in preterm infants between 30–34 weeks of gestation with RDS. Show more

Keywords: Cardiothymic/thoracic ratio, preterm infants, respiratory distress syndrome, thymus size

DOI: 10.3233/NPM-1842

Citation: Journal of Neonatal-Perinatal Medicine, vol. Pre-press, no. Pre-press, pp. 1-5, 2018