Journal of Neonatal-Perinatal Medicine - Volume 10, issue 3

Authors: Woods, N. | Gilliland, J. | Seabrook, J.A.

Article Type: Review Article

Abstract: Adverse birth outcomes are associated with neonatal morbidity and mortality, and higher risk for coronary heart disease, non-insulin-dependent diabetes and hypertension in adulthood. Although there has been considerable research investigating the association between maternal and environmental factors on adverse birth outcomes, one risk factor, not fully understood, is the influence of the built environment. A search of MEDLINE, Scopus, and Cochrane was conducted to find articles assessing the influence of the built environment on preterm birth (PTB), low birth weight (LBW), and small-for-gestational-age (SGA). In total, 41 studies met our inclusion criteria, and were organized into nine categories: Roadways, Greenness, …Power Plants, Gas Stations/Wells, Waste Management, Power Lines, Neighborhood Conditions, Food Environment, and Industry. The most common built environmental variable was roads/traffic, encompassing 17/41 (41%) of the articles reviewed, of which 12/17 (71%) found a significant small to moderate association between high traffic exposure and adverse birth outcomes. Show more

Keywords: Birth outcomes, built environment, environmental epidemiology, low birth weight, preterm birth, small for gestational age, physical environment

DOI: 10.3233/NPM-16112

Citation: Journal of Neonatal-Perinatal Medicine, vol. 10, no. 3, pp. 233-248, 2017

Authors: Meyer, Michael P. | Alexander, Tanith

Article Type: Research Article

Abstract: BACKGROUND: Preterm infants remain at high risk of adverse outcomes following necrotizing enterocolitis (NEC) and late onset sepsis (LOS). Meta-analysis of randomized trials has indicated a reduction in severe NEC following use of probiotics and bovine lactoferrin (LF). Overall, however, uncertainty remains over which probiotic, or combination to use. The aim of this study was to compare the incidence of severe NEC and LOS before and after routine supplementation with Lactobacillus GG (LGG) and LF. METHODS: In this retrospective cohort study, infants <32 weeks or <1500 g routinely received LGG and 100 mg lactoferrin daily from 2011 –2015 were compared …with similar infants born from 2004–2008. Cases of NEC were Bell stage 2 or greater and LOS was blood or spinal fluid culture positive after 48 hrs of age. RESULTS: We noted a marked decline in the incidence of NEC from 3% to 1% with a RR of 0.29 (CI 0.1–0.9) and a number needed to benefit of 50. The cost of preventing one case of NEC was estimated to be NZ $2800, considerably lower than the cost of treatment. LOS rates were not significantly different. There was a decrease in retinopathy treatment rates. During the period there was one case of LGG sepsis in a 23 week gestation infant with abdominal pathology and one infant developed NEC after stopping prophylaxis. CONCLUSION: The rates of severe NEC was markedly reduced following prophylaxis. The case of LGG sepsis indicates caution is required in extremely preterm infants. Show more

Keywords: Necrotizing enterocolitis, probiotics, Lactobacillus GG, lactoferrin, preterm infant

DOI: 10.3233/NPM-16130

Citation: Journal of Neonatal-Perinatal Medicine, vol. 10, no. 3, pp. 249-255, 2017

Authors: Arberet, C. | Proisy, M. | Fausser, J.L. | Curt, M. | Bétrémieux, P. | Tréguier, C. | Rozel, C. | Pladys, P.

Article Type: Research Article

Abstract: OBJECTIVE: To study the quality of life at school age of very preterm infants presenting isolated punctate periventricular white matter lesions (IPWL) on late-preterm or term magnetic resonance imaging (MRI). METHODS: In 1996–2000, 16 of the 131 very preterm neonates explored by MRI were found to have IPWL. At the age of 9–14, 12 children from the IPWL group were compared with 54 children born preterm but with a normal MRI (no lesion). Quality of life (Health Status Classification System Pre School questionnaire), school performance, and motor outcome were investigated. RESULTS: Overall quality of life did …not differ between the groups (classified as perfect in 2/12 of the IPWL vs 20/54 in the no-lesion). The sub-items mobility and dexterity differed significantly between the two groups, with impairment in the IPWL group (p  < 0.001 and p  < 0.05). This group also displayed higher levels of motor impairment: they began walking later [20(4) vs. 15(3) months), p  < 0.01], had higher frequencies of cerebral palsy (6/12 vs. 2/54, p  < 0.05), and dyspraxia (4/12 vs. 0/54, p  < 0.001). The rate of grade retention did not differ between the groups (3/12 in the IPWL group vs. 17/54 in the no-lesions group) but, as expected, was higher than that of the French general population (17.4%) during the study period. CONCLUSION: This long-term follow-up study detected no increase in the risk of subsequent cognitive impairment in very preterm infants with IPWL, but suggests that these children may have a significantly higher risk of dyspraxia, and motor impairment. Show more

Keywords: Preterm infants, white matter lesions, quality of life, dyspraxia, motor impairment

DOI: 10.3233/NPM-1691

Citation: Journal of Neonatal-Perinatal Medicine, vol. 10, no. 3, pp. 257-266, 2017

Authors: Mayer, Benjamin | Pohl, Moritz | Hummler, Helmut D. | Schmid, Manuel B.

Article Type: Research Article

Abstract: OBJECTIVE: Hypoxemic episodes commonly occur in very preterm infants and may be associated with several adverse effects. Cerebral tissue oxygen saturation (StO2 ) as measured by near infrared spectroscopy (NIRS) may be a useful measure to assess brain oxygenation. However, knowledge on variability of StO2 is limited in preterm infants at this time, so StO2 dependency on arterial oxygenation (SpO2 ) and heart rate (HR) was assessed in preterm infants using statistical methods of time series analysis. STUDY DESIGN: StO2 , SpO2 , and HR were recorded from 15 preterm infants every 2 seconds for six …hours. Statistical methods of time series and longitudinal data analysis were applied to the data. RESULT: The mean StO2 level was found as 72% (95% confidence interval (CI) 55.5% –85.5%) based on a moving average process with a 5 minute order. Accordingly, longitudinal SpO2 measurements showed a mean level of 91% (95% CI 69% –98%). Generally, compensation strategies to cope with both StO2 and SpO2 desaturations were observed in the studied patients. SpO2 had a significant effect on cerebral oxygenation (p  < 0.001), but HR did not, which led to inconclusive results considering different time intervals. CONCLUSION: In infants with intermittent hypoxemia and bradycardia, we found a mean StO2 level of 72% and a strong correlation with SpO2 . We observed large differences between individuals in the ability to maintain StO2 at a stable level. Show more

Keywords: Arterial oxygen saturation, cerebral tissue oxygen saturation, intermittent hypoxemia, long-term, moving average, prematurity, time series

DOI: 10.3233/NPM-16124

Citation: Journal of Neonatal-Perinatal Medicine, vol. 10, no. 3, pp. 267-273, 2017

Authors: Abiramalatha, T. | Kumar, M. | Chandran, S. | Sudhakar, Y. | Thenmozhi, M. | Thomas, N.

Article Type: Research Article

Abstract: BACKGROUND: Troponin-T is a commonly used cardiac biomarker, which could be useful in perinatal asphyxia. We aimed to analyze troponin-T concentrations in asphyxiated neonates and to correlate the concentrations with clinical outcomes. METHODS: Data were collected from electronic medical records of neonates diagnosed with perinatal asphyxia over a period of four years. RESULTS: There were 63 neonates with moderate to severe encephalopathy, in whom serial troponin-T concentrations had been done on days 1, 3, and 7. 53 (84%) asphyxiated infants had troponin-T concentration >100 pg/ml at 2–4 h of life. The difference in troponin-T concentrations between moderate and …severe encephalopathy was not statistically significant (173 vs. 263 pg/ml, p value 0.40). The difference in the concentrations at 72 hours between cooled and non-cooled neonates was not significant (48.5 vs. 62.5 pg/ml, p value 0.22). Troponin-T concentration was significantly higher in babies with hypotensive shock and hepatic injury, but not acute kidney injury. There was no significant correlation between troponin-T and the extent of resuscitation needed. Troponin-T concentration on day 1 of life was significantly higher in babies who died than who survived (407 vs. 168 pg/ml, p value 0.03). ROC curve for troponin-T to predict mortality had an area under the curve (AUC) of 0.803; the best cut-off value (190 pg/ml) had 82% sensitivity and 80% specificity. CONCLUSION: There was no significant difference in troponin-T concentrations between cooled and non-cooled neonates. Troponin-T concentration had a good predictive accuracy for mortality before discharge. Show more

Keywords: Troponin-T, perinatal asphyxia, hypoxic-ischemic encephalopathy, therapeutic hypothermia, organ dysfunction, outcome

DOI: 10.3233/NPM-16119

Citation: Journal of Neonatal-Perinatal Medicine, vol. 10, no. 3, pp. 275-280, 2017

Authors: Vongbhavit, K. | Underwood, M.A.

Article Type: Research Article

Abstract: OBJECTIVE: To compare demographic data, prenatal and postnatal characteristics, laboratory data, and outcomes in a cohort of premature infants with spontaneous ileal perforation (SIP), surgical necrotizing enterocolitis (sNEC) and matched controls. METHODS: A retrospective case–control study of infants with intestinal perforation with a birth weight (BW) less than 2,000 grams and gestational age (GA) less than 34 weeks and infants without perforation matched for BW (±150 grams) and GA (±1week). RESULTS: 130 premature infants were included, 30 infants with SIP, 35 infants with sNEC and 65 control infants. The median age of onset was 5 days …postnatal age in SIP versus 25 days in sNEC (p  < 0.001) and the peak onset was at 26 weeks corrected GA for SIP and 30 weeks corrected GA for sNEC. Infants with perforation had significantly higher rates of mortality (p  < 0.001) and common morbidities associated with prematurity. Administration of corticosteroids and indomethacin did not differ among groups. SIP was more common among infants born to young mothers (p  = 0.04) and less common in infants receiving caffeine (p  = 0.02). sNEC was less common among infants receiving early red cell transfusion (p  = 0.01). Perforation and sNEC trended towards less common in infants receiving inhaled nitric oxide. CONCLUSION: SIP and sNEC are distinct clinical entities. Potential protective effects of caffeine, inhaled nitric oxide, and early transfusion should be further studied. Show more

Keywords: Necrotizing enterocolitis, spontaneous intestinal perforation, focal intestinal perforation, premature infant

DOI: 10.3233/NPM-16148

Citation: Journal of Neonatal-Perinatal Medicine, vol. 10, no. 3, pp. 281-289, 2017

Authors: Garland, J.S. | Kanneberg, S. | Mayr, K.A. | Porter, D.M. | Vanden Heuvel, A. | Kurziak, J. | McAuliffe, T.L.

Article Type: Research Article

Abstract: OBJECTIVE: We hypothesized that infectious morbidities following percutaneously inserted central venous catheter (PICC) removal would be greater among neonates with central-line associated bloodstream infection (CLBASI). STUDY DESIGN: This retrospective cohort study, included all neonates who required a PICC over a ten-year period. Outcomes assessed following PICC removal included: late bloodstream infection, rule-out sepsis workups, need for a subsequent PICC and antibiotic days and PICC days after PICC removal. Odds ratios (OR) and 95% confidence intervals (CI) were determined for outcomes. Regression analyses were used to control for confounders. RESULTS: Two-thousand nine hundred and thirteen neonates required …at least one PICC during the study period. After adjusting for confounders neonates with CLABSI were 3.4 (95% confidence interval (CI) 2.5, 4.6) and 2.2 (95% CI 1.2, 4.0) times more likely respectively to require a subsequent PICC or develop a late bloodstream infection after PICC removal. Neonates with CLABSI required 1.33 (95% CI 0.77, 1.89) more days of antibiotic treatment and 6.85 (95% CI 5.34, 8.37) more PICC days following PICC removal than neonates without a CLABSI. CONCLUSIONS: Neonates with CLABSI are at risk for additional infectious morbidities after PICC removal. Future intervention studies aimed at reducing CLABSI should evaluate whether morbidities following catheterization are also reduced. Show more

Keywords: Central line associated bloodstream infection, neonate, percutaneously inserted central venous catheter, bloodstream infection

DOI: 10.3233/NPM-16137

Citation: Journal of Neonatal-Perinatal Medicine, vol. 10, no. 3, pp. 291-299, 2017

Authors: Kresch, M.J. | Christensen, S. | Kurtz, M. | Lubin, J.

Article Type: Research Article

Abstract: OBJECTIVES: The aim was to achieve 100% effective handover from the critical care transport team to the neonatal intensive care unit (NICU) medical team. STUDY DESIGN: All patients transferred from referring hospitals by the critical care transport team to the Level IV NICU were included. Data for each infant was collected prospectively. The percentage of transported patients for which medical team and nursing handover occurred was recorded. A quality improvement project was launched using the Plan-Do-Study-Act (PDSA) tool. We implemented several processes including call from the transport team before arrival and the completion of a transfer of care …form on arrival to the NICU. The process measures and the outcome measure of completion of handover were monitored. Run charts of process measures and the outcome measure were analyzed. RESULTS: Completion of medical handover increased from 95% (baseline) to 100% after 3 PDSA cycles and this has been maintained for 18 consecutive months. CONCLUSION: Medical handover from the critical care transport team to the NICU medical staff has been achieved and sustained for all neonatal transports. Show more

Keywords: Handover, medical transport, neonates, quality improvement

DOI: 10.3233/NPM-16111

Citation: Journal of Neonatal-Perinatal Medicine, vol. 10, no. 3, pp. 301-306, 2017

Authors: El-Naggar, W. | Almudeer, A. | Vincer, M. | Yanchar, N.L.

Article Type: Research Article

Abstract: INTRODUCTION: There is little in literature regarding preoperative management of infants with gastroschisis. It is unclear if these infants develop metabolic acidosis as a consequence of prolonged intrauterine gut compromise or dehydration secondary to increased fluid loss. AIM: To assess the frequency of preoperative metabolic acidosis in infants with gastroschisis and investigate whether this acidosis reflects degree of gut compromise. METHODS: All infants with gastroschisis born between May 2005 and April 2013 in a single tertiary care center were reviewed. Metabolic acidosis was defined by the presence of pH <7.26 and serum bicarbonate <18.5 or base …excess < –8.5 mmol/l. Infants with significant birth depression were excluded. Maternal and neonatal data were collected. Frequency of preoperative metabolic acidosis and its association with gastroschisis prognostic score (GPS), time to first and time to reach full feeds were investigated. RESULTS: Sixty infants were identified, 11 were excluded (birth depression/lack of preoperative blood gases). Median preoperative total fluid intake was 130 ml/kg/d. Nine infants (18%) had metabolic acidosis at a median age of 1.2 hours. No association was found between metabolic acidosis or serum lactate and GPS, age at first feed or age at full feeds. CONCLUSION: Preoperative metabolic acidosis was identified in a significant number of patients with gastroschisis despite high fluid intake. It does not appear to be associated with the degree of gut compromise. Using metabolic acidosis as an indication of dehydration in these patients needs more investigation. Show more

Keywords: Preoperative acidosis, gastroschisis, neonates

DOI: 10.3233/NPM-16128

Citation: Journal of Neonatal-Perinatal Medicine, vol. 10, no. 3, pp. 307-311, 2017

Authors: Jensen, T.J. | Shui, J.E. | Finck, C.M.

Article Type: Research Article

Abstract: BACKGROUND: The goal of this study was to determine if exposure to meconium would alter the phenotype of amniotic fluid mesenchymal stem cells (AF-MSCs) and the ability of these cells to be differentiated into distal airway type cells. METHODS: Meconium was collected, lyophilized and resuspended in PBS at 3 different concentrations (high, medium, and low). AF-MSCs were cultured in the presence of this meconium suspension for 8 hours and then analyzed for changes in gene expression. Additionally, AF-MSCs exposed to meconium were differentiated for 14 days using modified small airway growth medium (mSAGM) and gene expression was determined. …As a spontaneous differentiation control, meconium exposed AF-MSCs were cultured in amniotic fluid stem cell medium (AF medium). RESULTS: After 8 hours of exposure in culture, AF-MSCs had increased expression of distal airway genes aquaporin 5 (AQP5) and surfactant protein c (SPC) when cultured in AF medium containing meconium. These gene expression levels were similar to that of AF-MSCs that were differentiated in mSAGM for 14 days. Furthermore, there was an up regulation of pluripotency genes NANOG and OCT4 in response to low meconium concentration for 8 hours. Following 14 days of culture in mSAGM, there was an upregulation of TTF1, SPC and AQP5 expression in the control, as well as in the low and medium meconium exposed groups indicating that these cells were still able to be differentiated. High meconium concentration did, however, appear to influence the level of distal airway gene expression after 14 days in mSAGM. After 14 days in AF medium, there was significant downregulation in pluripotency and mesenchymal markers as well as distal airway gene expression in all groups. CONCLUSION: The phenotype of AF-MSCs is modulated by meconium exposure; however, the cells were still able to differentiate into distal airway gene and protein expression. This result supports the hypothesis that progenitor cells exist in the amniotic fluid and the presence of meconium may affect their initial phenotype. However, these cells were still able to be differentiated to a distal lung phenotype. Show more

Keywords: Meconium, lung, amniotic fluid, stem cell, differentiation, meconium aspiration syndrome

DOI: 10.3233/NPM-16141

Citation: Journal of Neonatal-Perinatal Medicine, vol. 10, no. 3, pp. 313-323, 2017