Journal of neonatal-perinatal medicine最新文献

BackgroundRespiratory distress (RD) is a major cause of admission to neonatal intensive care units (NICUs), highlighting the need for prompt and accurate assessment. Lung ultrasound (LUS) has emerged as a rapid, non-invasive, radiation-free tool with superior sensitivity to chest X-ray. Thoracic Fluid Content (TFC), measured via electrical cardiometry, may serve as a complementary parameter by reflecting pulmonary fluid load. Consequently, this study aimed to evaluate the predictive accuracy of TFC and LUS in determining the need for surfactant therapy or initiation of positive pressure ventilation in preterm neonates with respiratory distress.Patients and MethodsIn this prospective observational cohort study, 70 preterm neonates with RD were enrolled between April 2022 and April 2024 in the NICU of Ain Shams University, Cairo, Egypt. LUS and TFC were measured on day 1 and day 3 of life. Clinical outcomes, including surfactant need and escalation of ventilation, were recorded.ResultsAn LUS score >5 strongly predicted surfactant need, showing 88.89% sensitivity and 86.05% specificity (AUC: 0.941; PPV: 80%; NPV: 92.5%). TFC values were higher in neonates who received surfactant, though not statistically significant (p = 0.053). A significant positive correlation was observed between TFC and LUS scores (r = 0.311, p = 0.009).ConclusionLUS is a reliable predictor of surfactant need and respiratory support in preterm neonates with RD. While TFC correlates with LUS in assessing pulmonary fluid status, it alone did not independently predict clinical intervention requirements.

BackgroundNeonates are more susceptible to acute respiratory failure than older children. It is unknown to what extent high-flow nasal cannula (HFNC) alters intrathoracic pressure (ITP), potentially decreasing cardiac output (CO) due to cardiopulmonary interactions. This study evaluated the impact of flow titration on tracheal pressure (a surrogate for ITP) and CO via HFNC in an established porcine model of neonatal respiratory failure. Unlike prior research, this study examines both ITP and CO demonstrating that although the ITP increased with higher HFNC flows, CO did not decrease.MethodsTwenty-three neonatal Landrace-Yorkshire pigs (2-4 kg) were anesthetized, and monitoring lines were placed. Baseline vital signs, CO, mean intratracheal pressure (Ptr), and PaO₂ were measured. CO was assessed via computerized COstatus cardiac system. Lung injury was induced using oleic acid (0.08 mL/kg), resulting in ≤50% reduction in preinjury PaO₂ on 1 L/min oxygen. After injury, in random order, pigs received HFNC flows of 1, 2, and 3 L/kg/min at 100% FiO₂ for 30 min each. Measurements were repeated, and data were analyzed via mixed-effects repeated measures ANOVA.ResultsAfter OA injury, PaO₂ significantly decreased (414 to 125 mmHg; p < 0.001). Mean Ptr and PaO₂ increased significantly (p < .001) with increasing HFNC flow rates. CO showed no significant changes; thus, no correlation between CO with Ptr and/or HFNC flow levels was demonstrated.ConclusionsIn neonatal respiratory distress, higher HFNC flows improved oxygenation without negatively impacting CO in this neonatal porcine lung injury model, despite increasing intra-thoracic pressure (1-3 L/min/kg).

BackgroundRetinopathy of prematurity (ROP) is a significant cause of childhood blindness. Since ROP typically presents no clinical symptoms or signs in early infancy, timely screening of preterm infants is essential for diagnosis. However, fundus examinations cannot always be performed at the optimal time. Elevated cord blood cytokines may help identify infants at higher risk for ROP development, enabling earlier screening and potentially predicting the need for treatment. A deeper understanding of clinical risk factors and biomarkers of ROP could aid in preventing abnormal retinal vascularization and its complications. The study aimed to evaluate the predictive efficacy of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-8 (IL-8) in early ROP development and treatment necessity.MethodsThis prospective study included 88 preterm neonates. Cord blood samples were collected immediately after birth, and timely fundus screening for ROP was conducted. Selected perinatal risk factors were retrospectively analyzed. Cord blood cytokine levels were correlated with ROP development and treatment requirements.ResultsAmong the 88 preterm neonates, 33 (37.5%) developed ROP. The key finding was that infants with ROP had significantly higher cord blood levels of IL-6, IL-8, and TNF-α compared to those without ROP.ConclusionCord blood cytokines show promise as early biomarkers for predicting ROP development and the need for treatment.

BackgroundThe limited availability and high cost of human milk fortifier (HMF) in developing countries represent significant challenges. Preterm formula (PTF) fortification of breast milk is a potential alternative, but its safety and impact on growth are still uncertain. This study compares the safety and effect of breast milk fortification with PTF versus HMF on growth velocity in very low birth weight preterm infants.MethodsA thorough literature search was conducted in the PubMed, Scopus, Google Scholar, ClinicalTrials.gov, and Europe PMC databases up to March 24, 2024. Relevant randomized controlled trials (RCTs) studying fortifying breast milk with PTF or HMF were identified and their quality assessed using the Cochrane Risk of Bias 2 tool. Statistical analysis was performed in Review Manager Web, and certainty of evidence was assessed with GRADE.ResultsSix RCTs were included, of which one exhibited low bias risk, three had moderate concerns, and two were classed as high risk. The six RCTs, involving 434 preterm infants, revealed no significant differences in the gain of weight (SMD 0, 95% CI -0.19 to 0.19), length (MD -0.01 cm/wk, 95% CI -0.06 to 0.05), or head circumference (MD -0.01 cm/wk, 95% CI -0.06 to 0.04) between PTF and HMF. There were comparable risks of morbidities.ConclusionVery low certainty evidence suggests that breast milk fortification with PTF may be a safe alternative to HMF, with similar safety profiles and effects on growth.

ObjectiveTo examine the incidence and risk factors for low serum albumin concentrations in neonates evaluated for jaundice.MethodsA retrospective chart review was conducted on inborn neonates who were born at ≥35 weeks gestation and evaluated for jaundice at 3 university hospitals in Thailand from 1 January to 31 December 2023. The neonates' demographics, neurotoxicity risk factors, serum albumin concentrations, and maternal characteristics were analyzed. The neonates were classified into the hypoalbuminemia (<3.0 g/dL) and normal albumin (≥3.0 g/dL) groups. Univariate and multivariate regression analyses were used to identify the factors associated with hypoalbuminemia.ResultsAmong 902 neonates who had jaundice evaluation, 229 (25.4%) had serum albumin <3.0 g/dL. The hypoalbuminemia group had a lower gestational age and Apgar scores, a higher prevalence of male sex, and clinical instability or sepsis compared with the normal albumin group. Neonates in the hypoalbuminemia group were also younger at testing and their mothers were older than those in the normal albumin group. In the univariate analysis, male sex, clinical instability or sepsis, low gestational age, low birth weight, low Apgar scores, and increased maternal age were associated with hypoalbuminemia (p < 0.1). In the multivariate analysis, lower gestational age, male sex, and clinical instability or sepsis remained significant risk factors for hypoalbuminemia (all p < 0.05).ConclusionsAbout one-quarter of neonates evaluated for jaundice had serum albumin <3.0 g/dL. Lower gestational age, male sex, and clinical instability or sepsis were significant risk factors, suggesting that targeted albumin screening in these high-risk groups may be warranted.

BackgroundCardiac thrombus in neonates is an uncommon but life-threatening condition that may result in significant morbidity and mortality. Factors such as invasive procedures, metabolic disturbances, and the use of high-osmolarity fluids can contribute to thrombus formation, particularly in critically ill neonates. This case series aims to highlight the clinical characteristics, potential risk factors, and outcomes of right atrial thrombus in neonates, with particular emphasis on the role of high-concentration glucose infusions administered through umbilical venous catheters.MethodsThis is a retrospective case series of five neonates who developed right atrial thrombus between January 2022 and December 2024.ResultsAll five neonates have a history of receiving high-concentration glucose infusions via umbilical venous catheters for hyperinsulinemic hypoglycemia before the development of right atrial thrombus. Unexplained tachycardia prompted the diagnosis, with echocardiography revealing thrombi. Three of them were successfully treated with anticoagulation, while the other two babies unfortunately succumbed to complications despite intensive treatment.ConclusionLarge cardiac thrombus in neonates leads to high mortality due to the risk of embolization and sepsis. High-concentration glucose infusion via umbilical venous catheter is a potential risk factor for cardiac thrombus formation in neonates. Early detection and appropriate intervention, including anticoagulation and thrombolysis, are crucial for preventing further complications and improving survival rates.

ObjectivesThe rehydration approach for hypernatremic dehydration in newborns is challenging. A new treatment protocol was introduced in the NICU for moderate hypernatremic dehydrated (MHD) newborns to achieve safer and more effective serum sodium (Na+) correction.MethodsA prospective study in a four-level NICU examined term and near term MHD (150-169 mEq/L) newborns. In a novel hypernatremic dehydration treatment protocol, 49 newly diagnosed MHD patients were in group 1, while 54 previously treated control MHD patients were in group 2.Results49 neonates received the novel treatment protocol (group 1), and data from 54 neonates were obtained from hospital records (group 2). Serum Na+ correction rate was significantly lower in group 1 compared to group 2, with a median serum Na+ level of 0.66 versus 1.05 mEq/L/h, p = 0.001. The proportion of patients who were treated with pure oral rehydration was significantly higher in group 1 compared to group 2 (67.3% vs 25.9%, p<0.001). Multiple regression analysis was performed to determine factors associated with use of intravenous rehydration: initial serum Na+ [odds ratio (OR):1.515, 95% confidence interval (CI) 1.17-1.94, p<0.001] and serum uric acid [OR: 1.495, 95% CI 1.092-2.00, p = 0.012] in model 2; belonging to Group 2 [OR: 28.267, 95% CI 10.321-53.69, p<0.001]; each additional delay in the day of postnatal admission [OR: 1.381, 95% CI 1.011-1.888, p = 0.043]; and initial serum Na+ [OR: 1.574, 95% CI 1.216-2.037, p = 0.001] in model 4 were significantly associated with intravenous rehydration.ConclusionsOral rehydration therapy offers slower sodium reduction and has a low treatment failure rate in MHD newborns. It can be the primary treatment approach, while intravenous therapy should be considered based on the patient's overall clinical and biochemical status, not just initial sodium levels.

BackgroundTranscatheter closure of patent ductus arteriosus (PDA) in small, premature infants is increasingly performed in the contemporary practice. Data regarding optimal timing of PDA closure are scarce. We therefore decided to compare morbidity and mortality of early and late device closure in preterm infants.MethodsHospitalizations of 166,583 newborn infants diagnosed with PDA were identified from the Kids' Inpatient Database (KID) in 2009, 2012, 2016, and 2019. Of these, 299 preterm infants (gestational age (GA) ≤32 weeks, birth weight <1500 grams) underwent percutaneous PDA closure. Characteristics and periprocedural outcomes were compared between early (≤30 days) (n = 120) and late PDA closure (>30 days) (n = 179).ResultsMean age (±standard deviation) for early PDA closure was 18.6 days ± 7 and 67.3 days ± 36.5 in late PDA closure. Comorbidities including respiratory distress syndrome/bronchopulmonary dysplasia, heart failure, and pulmonary hypertension were comparable between the two groups. There was no difference in mortality or referral for surgical ligation between early and late closure. Postprocedural vascular complications were low, but higher in patients with early PDA closure (3.3% vs 0%; p = 0.025). While the total length of hospital stay was longer in late PDA closure group (121.1 days ± 51.7 vs 81.5 days ± 48.8; p = <0.01), postprocedural length of stay was paradoxically longer in the early closure group (69 days ± 43.6 vs 57.5 days ± 43, p = 0.03).ConclusionThere was no statistical difference in in-hospital mortality; however, there is a trend toward higher mortality in the early closure group. Major periprocedural complications are comparable between early and late PDA closure, except vascular complications that were higher with early PDA closure.

BackgroundNeonatal jaundice affects 60% of term and 80% of preterm newborns due to high levels of unconjugated bilirubin, leading to significant health issues. Currently, probiotics were used as a promising agent to enhance phototherapy outcomes.ObjectivesThe purpose of this systematic review is to assess the effect of probiotics supplementation in neonatal jaundice therapy.MethodsFour reviewers extracted randomized controlled trial (RCT) studies from Google Scholar, PubMed, and the Cochrane Library as per PRISMA guidelines. The risk of bias will be assessed using the Cochrane risk of bias tool for randomized trials (RoB 2). Inclusion criteria comprised term or preterm neonates diagnosed with any type of jaundice warranting phototherapy, outcome comparison between probiotic supplementation in phototherapy and control group. Study including healthy neonates, prophylaxis effect, non-RCT, and non-English studies were excluded in this study.ResultsNine out of 14 RCT studies showed significant reduction of total serum bilirubin levels with various duration after receiving probiotic supplementation during phototherapy. Some of RCT studies reported significant changes in indirect bilirubin levels, duration of phototherapy, duration of hospital stay. Moreover, there were four studies that found no significant changes on total serum bilirubin levels. No adverse effects or complications are found among those studies.ConclusionProbiotics supplementation in neonatal jaundice therapy was promising beneficial outcome for neonatal jaundice. Further research is required to confirm the consistency of therapeutic effects and adverse reactions.