Journal of neonatal-perinatal medicine最新文献

Transplacental infections such as cytomegalovirus, Zika virus, toxoplasmosis, and rubella, especially if acquired in the perinatal period, are well-known causes of congenital anomalies. However, their phenotypic overlap with certain genetic syndromes can pose significant diagnostic challenges during fetal autopsy and prenatal counseling. With an objective to review and highlight the clinical and pathological similarities between congenital infections and genetic syndromes, and emphasizing diagnostic pitfalls in fetal autopsy and the importance of integrated approaches, a comprehensive literature review was performed of articles that discussed congenital infections, fetal autopsy findings, and differential diagnosis with genetic syndromes. We found that several transplacental infections mimic the phenotype of genetic syndromes through features such as microcephaly, intracranial calcifications, cardiac anomalies, and hydrops fetalis. Placental pathology, maternal serology, and targeted molecular testing are essential to delineate the cause. An awareness of overlapping features between congenital infections and genetic syndromes is crucial to avoid misdiagnosis. A multidisciplinary approach combining clinical, histopathological, and molecular insights is necessary to reach an accurate diagnosis, guide recurrence risk counseling, and inform management in future pregnancies.

BackgroundLong-chain polyunsaturated fatty acids (LCPUFAs) are biologically active fatty acids which regulate placental as well as fetal development. Abnormalities in these fatty acids have implications in adverse pregnancy outcomes like preterm birth. In the current study, we examined the maternal and cord erythrocyte LCPUFA levels along with the regional placental LCPUFA levels in women delivering preterm as compared with the women delivering at term.MethodsIn this cross-sectional study, we recruited 93 women delivering at term and 93 women delivering preterm. Fatty acid levels were analyzed from maternal erythrocyte, placental and cord erythrocyte samples. Samples from two different regions of placenta, maternal and fetal region were studied.ResultsWe observed lower (p = 0.001) cord erythrocyte docosahexaenoic acid (DHA) levels, lower (p = 0.000) maternal erythrocyte arachidonic acid (ARA) levels and higher (p = 0.002) cord erythrocyte ARA levels in women delivering preterm as compared to those delivering full-term. The placental DHA levels were higher (p = 0.002) on the maternal side of women delivering preterm as compared to women delivering full-term. There was a positive association (p = 0.000) between cord erythrocyte DHA levels with all the newborn characteristics. There was a negative association (p = 0.000) between placental DHA levels from the maternal side with all the newborn characteristics.ConclusionThe imbalance in the levels of maternal DHA and ARA in addition to differential pattern of DHA distribution across the maternal and fetal regions of the placenta may have affected materno-fetal transfer of these fatty acids, therefore responsible for the adverse fetal outcome.

BackgroundCarbapenem-resistant K. pneumoniae (CRKP) presents a significant challenge for infection control and treatment in the neonatal population. The aim of the study is to identify risk factors associated with mortality of in neonates infected with CRKP in the NICU.MethodsWe conducted a retrospective review of medical records from January to December 2018, including all neonates with positive K. pneumoniae blood cultures. Possible risk factors such as birth weight, gestational age, length of stay, episodes of sepsis, use of mechanical ventilation, parenteral nutrition, central access, blood transfusion, laboratory values, and prior antibiotics use before isolation were recorded.ResultsOf 402 neonates clinically diagnosed with sepsis, 50 had positive K. pneumoniae cultures, with 80% identified as CRKP. Among CRKP cases, mortality was associated with PRC transfusion (100% vs 46.2%; RR 5.5; 95% CI 2.67-11.34; p < 0.001), elevated inflammatory markers (CRP: 58.2 vs 27.75 mg/dL, p = 0.01; PCT: 21.99 vs 2.63 ng/mL, p = 0.03), and prior carbapenem use (77.8% vs 38.5%; RR 5.6; 95% CI 1.33-23.62; p = 0.03).ConclusionThe study highlights that a majority of neonatal sepsis cases caused by Klebsiella pneumoniae in the Indonesian NICU were due to carbapenem-resistant strains (CRKP). CRKP infection was significantly associated with higher mortality, particularly among neonates who had received packed red cell transfusions, showed elevated inflammatory markers, or had prior exposure to carbapenem antibiotics. These findings underscore the urgent need for enhanced infection control measures, judicious antibiotic use, and targeted interventions to reduce mortality from CRKP in neonatal care settings.

BackgroundCoronavirus disease 2019 (COVID-19) in pregnant women and neonates may adversely affect neonatal outcome, but literature remains limited.MethodsThis is a retrospective analysis of all infants born to mothers with and without COVID-19 at an Indonesian national referral hospital between March and September 2020.ResultsA total of 393 neonates were delivered by 389 mothers, of whom 204 (52.4%) had COVID-19. Symptomatic and asymptomatic mothers with COVID-19 had similar seropositivity rates (53.6% vs 69.8%, p = 0.090). Neonates born to noninfected mothers were more likely to experience asphyxia at minute 1 of life (p = 0.005), to be diagnosed with TTN (p = 0.048) and sepsis (p = 0.022) and to require resuscitation (p = 0.008) than those born to infected mothers. Nine (2.4%) out of 377 tested infants were positive for SARS-CoV-2, of whom 4 had noninfected mothers. Neonates of mothers with symptomatic COVID-19 were less likely to be seropositive (30.0% vs 52.4%, p = 0.024) and more likely to acquire COVID-19 (p = 0.026) than those born to asymptomatically infected mothers.ConclusionThis study suggests that maternal COVID-19, particularly when occurring in late pregnancy, was not associated with an increase in acute neonatal complications.

IntroductionCongenital diaphragmatic hernia (CDH) has complex hemodynamic pathophysiology. There is a paucity of literature to predict outcomes based on the type of medications used for hemodynamic support.MethodsThis is a single-center retrospective cohort. Cases were categorized into different phenotypes: No dysfunction, right ventricle dysfunction, left ventricle dysfunction, and biventricular dysfunction. Medications used for hemodynamic support were categorized into inotropes and vasopressors based on type and dose.StatisticsMean, median, standard deviation, and percentages were used as appropriate. Contingency tables were constructed to compare the distribution of outcomes across different groups. Regression models analyzed the link between hemodynamic phenotype and outcomes.Results69 CDH cases between 2011 and 2023 were analyzed. The mean gestational age at birth was 38.0 weeks (SD 2.4), with a mean birth weight of 3109 g (SD 744 g). The distribution of hemodynamic phenotypes was as follows: No dysfunction phenotype: 43 infants (62.3%), RV phenotype: 7 infants (10.1%), LV phenotype: 7 infants (10.1%), and combined phenotype: 12 infants (17.4%). Inotropes were used in 26 infants (37.7%), vasopressors in 16 infants (23.2%), and a combination of inotropes and vasopressors in 19 infants (27.5%). Outcomes of interest were not different across the different hemodynamic phenotypes. Adjusted logistic regression analysis exploring the impact of LV dysfunction with vasopressor use found higher odds for death (OR = 4.8, p = 0.05).ConclusionInfants with CDH with LV dysfunction and vasopressor exposure are possibly at higher risk for mortality. This is an exploratory finding that warrants further investigation and research to establish the prognosis based on medications used for hemodynamic support.

BackgroundNecrotizing enterocolitis (NEC) remains a significant cause of morbidity and mortality in preterm neonates. Identifying early markers of impaired intestinal perfusion may aid detecting an association with the development of NEC. This study aims to evaluate the role of Doppler ultrasound of the superior mesenteric artery (SMA) and celiac artery (CA) and its association with NEC in preterm neonates.MethodsWe conducted a retrospective, single-center case-control study. Eligible infants were born at <29 weeks' gestation; we excluded those with chromosomal abnormalities, major anomalies, and those without Doppler assessments. NEC cases (Bell stage ≥II) were matched to controls on gestational age and birth weight. We compared SMA and CA Doppler parameters-peak systolic velocity (PSV), end-diastolic velocity (EDV) of NEC and control infants obtained at the end of the first and between 2^nd and 3^rd weeks of life.ResultsAmong 44 preterm infants (NEC = 21; controls = 23), Doppler assessment in the 1^st week showed lower CA PSV in NEC versus controls (AMD = -27.7 cm/s [-53.58, -1.81]; p = 0.0371) after adjustment for PDA, birth weight, and gestational age. In weeks 2-3, and before NEC onset, NEC infants had lower SMA PSV (AMD = -35.7 cm/s [-68.5, -3.00]; p = 0.036) in models adjusted for PDA. No significant differences were found in CA parameters.ConclusionsReduced CA PSV during the first week of life, and reduced SMA PSV prior to NEC onset reflects impaired splanchnic perfusion preceding NEC and may be useful to clinicians in stratifying neonates at a risk of developing NEC in advance.

ObjectivesTo validate Vasoactive-Ventilation-Renal (VVR) score in extremely low gestational age neonates (ELGANs) as a predictor of mortality and morbidity by assessing its association with clinical outcomes.Study DesignThis was a secondary analysis of data from a randomized controlled trial including neonates born 23⁰-28⁶ weeks' gestation admitted to a Canadian tertiary-level neonatal intensive care unit between February 2019 and December 2021. VVR scores were measured at set intervals. Outcomes included mortality, intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis, patent ductus arteriosus, retinopathy of prematurity, mechanical ventilation duration, and length of hospital stay. Multivariate logistic regression analysis and receiver operating characteristic (ROC) curves were used to determine the association between VVR scores and clinical outcomes.ResultsData from 132 neonates were analyzed. The mean (SD) gestational age was 26.5 (1.5) weeks, and the mean (SD) birth weight was 933 (243) grams. A VVR score >48 was significantly associated with severe IVH (AOR: 5.8, 95% CI: 1.2-28.9, p = 0.03), BPD (AOR: 8.8, 95% CI: 1.1-72.4, p = 0.044), prolonged mechanical ventilation (>71 days) (AOR: 6.86, 95% CI: 1.6-30, p = 0.01), and extended hospital stay (>150 days) (AOR: 6.19, 95% CI: 1.4-26.4, p = 0.01). No significant associations were observed with mortality or other outcomes. ROC curves analysis demonstrated good predictive performance of VVR score at 7 days for these adverse outcomes.ConclusionThe VVR score at 7 days is a reliable predictor of significant adverse outcomes, including severe IVH and BPD, in ELGANs. Further studies in larger, diverse populations are warranted to confirm these findings.

BackgroundMost cases of respiratory distress in term neonates are due to transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), or air leak syndromes. Genetic surfactant deficiencies are rare causes of respiratory distress. Among these, mutations in the ABCA3 gene disrupt surfactant metabolism and can lead to severe, treatment-refractory respiratory failure. While commonly considered in preterm infants, surfactant dysfunction should also be considered in term infants with unexplained and persistent hypoxemia.CaseWe present a case of a 38-weeks term female infant with fetal growth restriction who developed respiratory distress shortly after birth. She initially responded to continuous positive airway pressure (CPAP) and surfactant but required escalating respiratory support and multiple re-doses of surfactant. Standard infectious and cardiopulmonary evaluations were unrevealing. Given her persistent oxygen requirement and small-for-gestational-age status, genetic testing was pursued. Whole genome sequencing identified bi-allelic pathogenic variants in the ABCA3 gene, consistent with pulmonary surfactant metabolism dysfunction type 3. Despite six doses of surfactant, antibiotics, and inhaled nitric oxide, the patient's respiratory status deteriorated. Lung transplantation was not feasible due to size and clinical condition. The family elected to transition to comfort care.ConclusionThis case highlights the importance of considering genetic surfactant disorders, including ABCA3 mutations, in term neonates with refractory respiratory distress. Early genetic testing can guide management and avoid potentially harmful or ineffective interventions. While some therapies offer transient improvement, outcomes remain poor, and definitive treatment via lung transplantation is limited by size and disease progression. Future research should focus on gene-specific therapies and earlier diagnosis.

BackgroundPreterm labor is a key factor in neonatal morbidity and mortality globally. Therefore, in the crisis of the coronavirus pandemic, it is important to investigate the prevalence of preterm labor in mothers with COVID-19 infection.Materials and methodsWe performed, according to the PRISMA guideline, a search of the PubMed and Web of Science database on September 1, 2022, to identify systematic reviews and meta-analyses that have summarized studies that report the prevalence of preterm labor in pregnant women with COVID-19. Based on the focused search strategy and eligibility criteria, finally, 66 studies were included in this review. After critical appraisal, using Comprehensive Meta Analysis V3 software, data analysis was done. A random-effects model was employed to account for heterogeneity among studies, and publication bias was assessed. Pooled estimates and their 95% confidence intervals were reported using forest plots.ResultsSixty-six meta-analysis studies, involving a total of 335,964 preterm labors among a sample of 2,260,032 women pregnant with coronavirus infection, were analyzed. Prevalence of preterm delivery in women infected with COVID-19 is 18.8% (lower limit = 0.148; upper limit = 0.235; CI = 95%' df = 65; I-Squared = 99.87; Egger test = 0.40).ConclusionsThe pooled global prevalence of preterm delivery in women infected with COVID-19 is higher than the global estimate in the era before the coronavirus pandemic. Given the global burden of preterm birth, efforts should be intensified to improve the quality of care for all COVID-infected pregnant women.

BackgroundHyperthermia related to heat stress appears to be a silent, high-risk condition in hot tropical climates. Less attention being paid even in hottest areas of the world. Threatening global warming will have profound impact in neonates in near future, and the aim of this study was to assess if there was a correlation between high environmental temperature and neonatal outcome.MethodsThe study was a retrospective, cross-sectional study on neonates admitted in Tesseney Hospital from 1^st January 2020 to 31^st December 2020. Data was extracted from the admission cards using a pretested questionnaire, and chi-square was used to identify characteristics associated with neonatal mortality.Results82 neonates were admitted to the hospital during the study period. A majority of the neonates had low birth weight (51%) and delivered at term (71%). Mode of delivery was via cesarean section in 15% of the neonates and 13% were home deliveries. During admission, 60% of the neonates had fever, 59 % were not able to breast feed, and 5% had convulsion. The majority of the neonatal admission and mortality were from May to August, the hottest months of the year. At univariate analysis, preterm delivery (COR: 3.62; 95% CI: 1.28-10.20, p-value 0.015) and home delivery (COR: 4.13; 95% CI: 1.11-15.30, p-value 0.034) had a significant association with neonatal mortality, while neonatal admission from May to August (COR: 1.95; 95% CI: 0.57-6.67 p-value 0.287) had increased risk of adverse neonatal outcome. At multivariate analysis, birth weight above 2.5 kg (AOR: 0.01; 95% CI: 0.00-0.66 p-value 0.031) and hospital stay above 72 h (AOR: 0.05; 95% CI: 0.00-0.59 p-value 0.012) had a significant association with neonatal survival.ConclusionPreterm delivery, home delivery, and low-birth weight had a significant association with neonatal mortality. The hottest months of the year were associated with increased admission rate and neonatal mortality. Maintaining safe room temperature during heat stress of a year is crucial for neonatal well-being, and further large prospective study addressing limitation of the study was crucial.