Journal of Neonatal-Perinatal Medicine

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.

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.

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).

MgSO₄ may have an added effect for the reduction in brain injury in infants with HIE who are receiving melatonin.

The objective of this study is to document and compare plasma electrolytes of asphyxiated newborns of different degree within 48 hours of life.

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.

The plasma sodium, potassium, bicarbonate and ionized calcium levels were estimated in both, the study subjects and controls.

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.

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.

To describe amplitude-integrated encephalogram (aEEG) characteristics of neonates with neonatal abstinence syndrome (NAS).

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 (μV) and the presence of sleep-wake cycle (SWC) were documented.

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].

A majority of infants with NAS have abnormal aEEG activity.

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.

A retrospective cohort analysis was performed with patients who had presented to the Cleveland Clinic Fetal Care Center between 2005–2017.

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).

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

The results of this study increase the scientific evidence that SGA is an independent risk factor for BPD.

The frequency of bronchopulmonary dysplasia (BPD) in preterm infants with a “ventilator-associated” pneumonia (VAP) ranges between 7 to 50%.

To investigate the features of the etiological structure of neonatal pneumonia complicated by BPD, and to determine the sensitivity of pathogens to antibiotics.

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.

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.

The reduction in the frequency of BPD is might be possible with timeous and adequate antibacterial therapy of VAP.

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.

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.

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.

PTX 3 could be used as a new biomarker of neonatal sepsis with high sensitivity and specificity.

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.

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.

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.

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.

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.

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.

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.

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.

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).

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.

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%.

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.

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.

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.

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.

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.