W. Janjindamai, Nichanan Tiwawatpakorn, A. Thatrimontrichai, S. Dissaneevate, G. Maneenil, Manapat Phatigomet
Background: Hypoglycemia is a serious problem in infants at risk and creates long-term consequences. Therefore, rapid and accurate measurement of blood glucose is of clinical importance. Objectives: The objective of this study was to evaluate the agreement of venous blood glucose measurements from hypoglycemic high-risk neonates, using blood gas analyzer (BGA), compared to central laboratory chemistry analyzer (CL). Methods: A prospective study of all high-risk neonates for hypoglycemia and neonatal intensive care units (NICUs) was enrolled. Point-of-care glucose was performed, and if <40 mg/dL, venous blood would be collected for CL and ABG. For analysis of the agreement of CL and BGA, Bland–Altman (BA) analysis, with multiple observations per individual, including limits of agreement (limits of agreement [LOA] ±1.96 standard deviation [SD]), was used. Results: One hundred and forty-five paired glucose values were analyzed. There were strong correlations between CL and BGA in all glucose measurements and hypoglycemic range (r = 0.81, P < 0.001, and 0.73, P < 0.01, respectively). A weak correlation was demonstrated in hyperglycemic ranges (r = 0.35, P = 0.15). For BA analysis of all glucose measurements and hypoglycemic ranges, LOA (±1.96 SD) of CL and BGA were −9.5 (±46.5) mg/dL and −11.1 (±10.9) mg/dL, respectively. The hyperglycemic range illustrated higher LOA, with LOA (±1.96 SD) of −32.9 (±124) mg/dL. Conclusions: In NICU settings where normoglycemic and hypoglycemic ranges are targeted, venous BGA glucose could be used as a reliable test instead of CL. No similar correlation was found in the hyperglycemic range.
{"title":"Accuracy of neonatal venous blood glucose measurements using blood gas analyzer compared with central laboratory chemistry analyzer","authors":"W. Janjindamai, Nichanan Tiwawatpakorn, A. Thatrimontrichai, S. Dissaneevate, G. Maneenil, Manapat Phatigomet","doi":"10.4103/jcn.jcn_110_21","DOIUrl":"https://doi.org/10.4103/jcn.jcn_110_21","url":null,"abstract":"Background: Hypoglycemia is a serious problem in infants at risk and creates long-term consequences. Therefore, rapid and accurate measurement of blood glucose is of clinical importance. Objectives: The objective of this study was to evaluate the agreement of venous blood glucose measurements from hypoglycemic high-risk neonates, using blood gas analyzer (BGA), compared to central laboratory chemistry analyzer (CL). Methods: A prospective study of all high-risk neonates for hypoglycemia and neonatal intensive care units (NICUs) was enrolled. Point-of-care glucose was performed, and if <40 mg/dL, venous blood would be collected for CL and ABG. For analysis of the agreement of CL and BGA, Bland–Altman (BA) analysis, with multiple observations per individual, including limits of agreement (limits of agreement [LOA] ±1.96 standard deviation [SD]), was used. Results: One hundred and forty-five paired glucose values were analyzed. There were strong correlations between CL and BGA in all glucose measurements and hypoglycemic range (r = 0.81, P < 0.001, and 0.73, P < 0.01, respectively). A weak correlation was demonstrated in hyperglycemic ranges (r = 0.35, P = 0.15). For BA analysis of all glucose measurements and hypoglycemic ranges, LOA (±1.96 SD) of CL and BGA were −9.5 (±46.5) mg/dL and −11.1 (±10.9) mg/dL, respectively. The hyperglycemic range illustrated higher LOA, with LOA (±1.96 SD) of −32.9 (±124) mg/dL. Conclusions: In NICU settings where normoglycemic and hypoglycemic ranges are targeted, venous BGA glucose could be used as a reliable test instead of CL. No similar correlation was found in the hyperglycemic range.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"11 1","pages":"7 - 12"},"PeriodicalIF":0.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47239508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Preterm infants frequently have hemodynamically significant patent ductus arteriosus (PDA). Persistent ductal shunting may result in pulmonary hyper circulation, increasing the risk of mortality and morbidity. The effectiveness of active management, as well as the timing and modality of PDA treatment, is still debatable. Aim: The purpose of this study was to determine whether there was a difference in mortality and morbidity between conservative and pharmacological treatment of clinically significant PDA in preterm infants at <34 weeks. Design: Retrospective study. Setting: Comprised of two neonatal intensive care units (NICUs). Materials and Methods: NICUs medical records from 2017 to 2020. Statistical Analysis: Logistic regression analysis. Results: A total of 1059 medical records were screened for the study, with 106 preterm (PT) infants included. The mean gestational age was 29.2 ± 3.2 weeks, the mean birth weight (BW) was 1267 ± 485 g, and the mean length of stay in the hospital was 30 ± 20 days. Twenty patients (18.8%) received paracetamol, six patients (5.6%) received ibuprofen, one patient (0.9%) received surgical ligation, and one patient (0.9%) received indomethacin. Five patients (4.7%) received multiple courses of PDA medication. Nineteen patients (17.9%) received diuretics. [Table 1] also contains additional data characteristics. After adjusting the confounding variables, intraventricular hemorrhage (IVH) (odds ratio [OR]: 5 P: 0.04) and BW were found to increase mortality (OR: 0.87 P: 0.034). Conservative treatment (OR: 1.4, P = 0.38), paracetamol (OR: 0.87, P = 0.22), and ibuprofen (OR 1.2, P = 0.12) had no effect on mortality. None of the treatment modalities (conservative, paracetamol, or ibuprofen) has a significant effect on morbidities (IVH, bronchopulmonary dysplasia, retinopathy of prematurity, late onset sepsis, pulmonary hemorrhage, or necrotizing enterocolitis). Conclusion: In PT 34 weeks, there was no difference in mortality or morbidity between conservative and pharmacological treatment of hemodynamically significant PDA.
背景:早产儿经常有血流动力学显著的动脉导管未闭(PDA)。持续的导管分流可导致肺动脉过度循环，增加死亡率和发病率的风险。积极管理的有效性，以及PDA治疗的时间和方式，仍然存在争议。目的:本研究的目的是确定保守治疗与药物治疗在<34周有临床意义的PDA的早产儿的死亡率和发病率是否有差异。设计:回顾性研究。环境:由两个新生儿重症监护病房(NICUs)组成。材料与方法:2017 - 2020年新生儿重症监护病房病历。统计分析:逻辑回归分析。结果:本研究共筛选了1059份医疗记录，其中包括106例早产儿。平均胎龄29.2±3.2周，平均出生体重(BW) 1267±485 g，平均住院时间30±20天。对乙酰氨基酚20例(18.8%)，布洛芬6例(5.6%)，手术结扎1例(0.9%)，吲哚美辛1例(0.9%)。5例患者(4.7%)接受了多个疗程的PDA治疗。19例患者(17.9%)使用利尿剂。[表1]还包含其他数据特征。调整混杂变量后，发现脑室内出血(IVH)(比值比[OR]: 5 P: 0.04)和体重增加了死亡率(OR: 0.87 P: 0.034)。保守治疗(OR: 1.4, P = 0.38)、扑热息痛(OR: 0.87, P = 0.22)和布洛芬(OR: 1.2, P = 0.12)对死亡率没有影响。没有一种治疗方式(保守、扑热息痛或布洛芬)对发病率(IVH、支气管肺发育不良、早产儿视网膜病变、晚发性败血症、肺出血或坏死性小肠结肠炎)有显著影响。结论:在PT 34周时，保守治疗与药物治疗的死亡率和发病率无显著差异。
{"title":"Outcome of conservative and pharmacological treatment of hemodynamically significant patent ductus arteriosus in preterm infants less than 34 weeks","authors":"T. Alsafadi","doi":"10.4103/jcn.jcn_6_21","DOIUrl":"https://doi.org/10.4103/jcn.jcn_6_21","url":null,"abstract":"Background: Preterm infants frequently have hemodynamically significant patent ductus arteriosus (PDA). Persistent ductal shunting may result in pulmonary hyper circulation, increasing the risk of mortality and morbidity. The effectiveness of active management, as well as the timing and modality of PDA treatment, is still debatable. Aim: The purpose of this study was to determine whether there was a difference in mortality and morbidity between conservative and pharmacological treatment of clinically significant PDA in preterm infants at <34 weeks. Design: Retrospective study. Setting: Comprised of two neonatal intensive care units (NICUs). Materials and Methods: NICUs medical records from 2017 to 2020. Statistical Analysis: Logistic regression analysis. Results: A total of 1059 medical records were screened for the study, with 106 preterm (PT) infants included. The mean gestational age was 29.2 ± 3.2 weeks, the mean birth weight (BW) was 1267 ± 485 g, and the mean length of stay in the hospital was 30 ± 20 days. Twenty patients (18.8%) received paracetamol, six patients (5.6%) received ibuprofen, one patient (0.9%) received surgical ligation, and one patient (0.9%) received indomethacin. Five patients (4.7%) received multiple courses of PDA medication. Nineteen patients (17.9%) received diuretics. [Table 1] also contains additional data characteristics. After adjusting the confounding variables, intraventricular hemorrhage (IVH) (odds ratio [OR]: 5 P: 0.04) and BW were found to increase mortality (OR: 0.87 P: 0.034). Conservative treatment (OR: 1.4, P = 0.38), paracetamol (OR: 0.87, P = 0.22), and ibuprofen (OR 1.2, P = 0.12) had no effect on mortality. None of the treatment modalities (conservative, paracetamol, or ibuprofen) has a significant effect on morbidities (IVH, bronchopulmonary dysplasia, retinopathy of prematurity, late onset sepsis, pulmonary hemorrhage, or necrotizing enterocolitis). Conclusion: In PT 34 weeks, there was no difference in mortality or morbidity between conservative and pharmacological treatment of hemodynamically significant PDA.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"11 1","pages":"19 - 22"},"PeriodicalIF":0.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46802619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Parappil, M. Gaffari, Ratheesh Paramban, M. Rijims, Smitha Skaria, S. Ahmed
Neonatal hyperglycemia is a common metabolic disorder seen in very low birth weight (VLBW) and critically ill newborns. Hyperglycemia is a recognized cause for mortality and morbidity in the neonatal period. Incidence in preterm infants is around 45%–80%. The mechanism of increased risk of hyperglycemia in preterm infants is not well understood, but different possible mechanisms have been reported. Plasma glucose values more than 180–200 mg/dl (10–11.1 mmol) are of concern as this can lead to complications. Hyperglycemia was found to predispose to severe intraventricular hemorrhage, retinopathy of prematurity, necrotizing enterocolitis, and increased mortality. It is important to recognize and manage this condition early to avoid serious complications. Multiple etiologies with different management strategies are mentioned in the literature. Here, we discuss a complete understanding on practical management of hyperglycemia and we propose a simplified practical approach for the diagnosis and management of neonatal hyperglycemia.
{"title":"Management of hyperglycemia in the neonatal unit: A practical approach to diagnosis and management","authors":"H. Parappil, M. Gaffari, Ratheesh Paramban, M. Rijims, Smitha Skaria, S. Ahmed","doi":"10.4103/jcn.jcn_84_21","DOIUrl":"https://doi.org/10.4103/jcn.jcn_84_21","url":null,"abstract":"Neonatal hyperglycemia is a common metabolic disorder seen in very low birth weight (VLBW) and critically ill newborns. Hyperglycemia is a recognized cause for mortality and morbidity in the neonatal period. Incidence in preterm infants is around 45%–80%. The mechanism of increased risk of hyperglycemia in preterm infants is not well understood, but different possible mechanisms have been reported. Plasma glucose values more than 180–200 mg/dl (10–11.1 mmol) are of concern as this can lead to complications. Hyperglycemia was found to predispose to severe intraventricular hemorrhage, retinopathy of prematurity, necrotizing enterocolitis, and increased mortality. It is important to recognize and manage this condition early to avoid serious complications. Multiple etiologies with different management strategies are mentioned in the literature. Here, we discuss a complete understanding on practical management of hyperglycemia and we propose a simplified practical approach for the diagnosis and management of neonatal hyperglycemia.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"11 1","pages":"38 - 44"},"PeriodicalIF":0.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41792674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Kaplanoğlu, M. Çevik, M. Bulbul, D. Kaplanoglu, H. Bağış
A pregnant woman with no previous routine pregnancy follow-up referred to our obstetrics clinic. Ultrasonography revealed the presence of a fetal heartbeat 26 weeks and 4 days old. Polyhydramnios, omphalocele, a diaphragmatic hernia, left ventricular hypoplasia, an occipital bone defect, a fetal head in severe retroflexion, and exaggerated cervicothoracic lordosis were detected in the fetus. After obtaining parental consent, the board decided to terminate the pregnancy. An examination performed after the termination revealed that the fetus was female and weighed 780 g. The first phalanx of the left thumb was hypoplastic. An X-ray examination showed coat hanger–shaped costal fusions and cranial structures consistent with iniencephaly. Fetus karyotyping revealed a normal 46, XX female karyotype. We speculate that this case represents a variant of Gershoni-Baruch syndrome.
{"title":"A gershoni-baruch syndrome variant or a new association","authors":"M. Kaplanoğlu, M. Çevik, M. Bulbul, D. Kaplanoglu, H. Bağış","doi":"10.4103/jcn.jcn_71_21","DOIUrl":"https://doi.org/10.4103/jcn.jcn_71_21","url":null,"abstract":"A pregnant woman with no previous routine pregnancy follow-up referred to our obstetrics clinic. Ultrasonography revealed the presence of a fetal heartbeat 26 weeks and 4 days old. Polyhydramnios, omphalocele, a diaphragmatic hernia, left ventricular hypoplasia, an occipital bone defect, a fetal head in severe retroflexion, and exaggerated cervicothoracic lordosis were detected in the fetus. After obtaining parental consent, the board decided to terminate the pregnancy. An examination performed after the termination revealed that the fetus was female and weighed 780 g. The first phalanx of the left thumb was hypoplastic. An X-ray examination showed coat hanger–shaped costal fusions and cranial structures consistent with iniencephaly. Fetus karyotyping revealed a normal 46, XX female karyotype. We speculate that this case represents a variant of Gershoni-Baruch syndrome.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"10 1","pages":"245 - 247"},"PeriodicalIF":0.2,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46220760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sudhakar Palanisamy, R. Srinivasan, Thirumal Perumal
Cow's milk protein allergy is the most common food protein allergy in children. We report a neonate on breast feeds and formula feeds presenting on day 9 of life with blood in stools, anemia, shock, respiratory failure with multiorgan dysfunction, and recovered with intensive care. Colonoscopy and biopsy confirmed the diagnosis as allergic colitis. Neonate improved with cow's milk protein-eliminated diet. Food protein allergy can present with protean signs and symptoms; high index of suspicion is needed for the prompt early diagnosis.
{"title":"Unusual presentation of cow's milk protein allergy in a neonate","authors":"Sudhakar Palanisamy, R. Srinivasan, Thirumal Perumal","doi":"10.4103/jcn.jcn_55_21","DOIUrl":"https://doi.org/10.4103/jcn.jcn_55_21","url":null,"abstract":"Cow's milk protein allergy is the most common food protein allergy in children. We report a neonate on breast feeds and formula feeds presenting on day 9 of life with blood in stools, anemia, shock, respiratory failure with multiorgan dysfunction, and recovered with intensive care. Colonoscopy and biopsy confirmed the diagnosis as allergic colitis. Neonate improved with cow's milk protein-eliminated diet. Food protein allergy can present with protean signs and symptoms; high index of suspicion is needed for the prompt early diagnosis.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"10 1","pages":"239 - 241"},"PeriodicalIF":0.2,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47575425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Feeding intolerance in preterm infants can be severe and can lead to clinical suspicion and diagnostic testing for other acute abdominal surgical pathologies and hence delay achievement of full enteral feeds. We present two cases of extremely premature infants who presented with recurrent severe feeding intolerance following fortification of human milk with a bovine human milk fortifier (HMF). Subsequently, both infants had an extensive workup for their symptoms. Each infant was eventually tried on a human HMF which led to the complete resolution of symptoms in each case. This case series highlights that clinicians should consider the use of human HMF for preterm infants with severe feeding intolerance secondary to the use of bovine HMF.
{"title":"Severe feeding intolerance in extremely preterm neonates successfully treated with human milk derived human milk fortifier: A case series","authors":"Patricia Lofiego, Veronica M Samedi, S. Rai","doi":"10.4103/jcn.jcn_210_20","DOIUrl":"https://doi.org/10.4103/jcn.jcn_210_20","url":null,"abstract":"Feeding intolerance in preterm infants can be severe and can lead to clinical suspicion and diagnostic testing for other acute abdominal surgical pathologies and hence delay achievement of full enteral feeds. We present two cases of extremely premature infants who presented with recurrent severe feeding intolerance following fortification of human milk with a bovine human milk fortifier (HMF). Subsequently, both infants had an extensive workup for their symptoms. Each infant was eventually tried on a human HMF which led to the complete resolution of symptoms in each case. This case series highlights that clinicians should consider the use of human HMF for preterm infants with severe feeding intolerance secondary to the use of bovine HMF.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"10 1","pages":"251 - 254"},"PeriodicalIF":0.2,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49627857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Mexitalia, A. Utari, Rina Pratiwi, J. Dewantiningrum
Context: Insulin-like growth factor-1 (IGF-1) and leptin are hormones impacting somatic growth regulation and organ development in early fetal life. Aims: The study aimed to investigate the correlation between IGF-1 and leptin levels with birth weight and fetal weight gain during pregnancy third trimester. Settings and Design: A cohort study included 52 newborns from Semarang, Indonesia. Subjects and Methods: Serum IGF-1 and leptin were taken from the umbilical cord, and the estimated fetal weight in the third trimester was measured by ultrasound. Anthropometric data were plotted to the World Health Organization Fetal Growth Chart 2017. We divided three categories, i.e., weight gain faltering, if the infant decreased of two major percentiles (G1), normal weight gain (G2), and accelerated weight gain, whose increased more than two major percentiles (G3). Statistical Analysis Used: Fetal growth and other parameters were analyzed using Pearson's or Spearman's rho correlation. The comparison of IGF-1 and leptin levels among G1, G2, and G3 was analyzed by one-way ANOVA, least significant difference post hoc test, Kruskal–Wallis, and Mann–Whitney tests. Results: The mean IGF-1 level in G1 was 82.9 (25.9) ng/mL, G2 was 86.2 (28.9), and G3 was 134.8 (33.9), and there were significant differences between G1–G3 and G2–G3. Meanwhile, the levels of leptin among groups were not different. Birth weight was correlated with the level of IGF-1 (r = 0.456, P = 0.001) and leptin (r = 0.39, P = 0.004), and maternal body mass index was correlated with cord blood leptin. Conclusions: This study indicated that a higher IGF-1 and leptin cord blood level is correlated with larger birth weight.
{"title":"Association of cord blood insulin-like growth factor-1 and leptin levels and changes in fetal weight gain in the third trimester of pregnancy","authors":"M. Mexitalia, A. Utari, Rina Pratiwi, J. Dewantiningrum","doi":"10.4103/jcn.jcn_32_21","DOIUrl":"https://doi.org/10.4103/jcn.jcn_32_21","url":null,"abstract":"Context: Insulin-like growth factor-1 (IGF-1) and leptin are hormones impacting somatic growth regulation and organ development in early fetal life. Aims: The study aimed to investigate the correlation between IGF-1 and leptin levels with birth weight and fetal weight gain during pregnancy third trimester. Settings and Design: A cohort study included 52 newborns from Semarang, Indonesia. Subjects and Methods: Serum IGF-1 and leptin were taken from the umbilical cord, and the estimated fetal weight in the third trimester was measured by ultrasound. Anthropometric data were plotted to the World Health Organization Fetal Growth Chart 2017. We divided three categories, i.e., weight gain faltering, if the infant decreased of two major percentiles (G1), normal weight gain (G2), and accelerated weight gain, whose increased more than two major percentiles (G3). Statistical Analysis Used: Fetal growth and other parameters were analyzed using Pearson's or Spearman's rho correlation. The comparison of IGF-1 and leptin levels among G1, G2, and G3 was analyzed by one-way ANOVA, least significant difference post hoc test, Kruskal–Wallis, and Mann–Whitney tests. Results: The mean IGF-1 level in G1 was 82.9 (25.9) ng/mL, G2 was 86.2 (28.9), and G3 was 134.8 (33.9), and there were significant differences between G1–G3 and G2–G3. Meanwhile, the levels of leptin among groups were not different. Birth weight was correlated with the level of IGF-1 (r = 0.456, P = 0.001) and leptin (r = 0.39, P = 0.004), and maternal body mass index was correlated with cord blood leptin. Conclusions: This study indicated that a higher IGF-1 and leptin cord blood level is correlated with larger birth weight.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"10 1","pages":"227 - 232"},"PeriodicalIF":0.2,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45556349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Bawazeer, Raghad K. Alsalamah, Dalal Almazrooa, S. Alanazi, Nada Alsaif, Reem Alsubayyil, Alaa M. Althubaiti, Aly Mahmoud
Background: The neonatal period is important for establishing a strong healthy foundation and is also associated with high mortality and morbidity rates. This study aimed to determine the rate of neonatal hospital readmission and to identify the associations between the neonatal age at readmission and the length of stay (LOS) during readmission, the outcome of readmission, and the associated maternal and neonatal factors. Methods: A cross-sectional study was performed by reviewing the medical records of 570 neonates who were born in and readmitted to King Abdulaziz Medical City, Riyadh, Saudi Arabia, through emergency and outpatient clinics from January 2016 to December 2018. Results: The neonatal readmission rate during the study period was 2.11%. The most common causes for readmission were respiratory diseases (24.9%), jaundice (22.1%), and fever to rule out sepsis (16.7%). Sex and breastfeeding were significantly associated with neonatal age at readmission (P = 0.025 and P = 0.017, respectively), but only breastfeeding was a significant predictor of age at readmission. Males were more likely to be admitted at the age >7 days, and exclusively formula-fed neonates were approximately three times the risk compared to exclusively breastfed neonates to be admitted at age >7 days (adjusted risk ratio 2.9, 95% confidence interval). Neonates readmitted at ages >7 days had double the LOS as those readmitted at ages ≤7 days (P < 0.001). The outcomes (discharge or pediatric intensive care unit admission) had no significant association with neonatal age at readmission. Conclusion: The readmission rate was 2.11% and was most commonly due to respiratory diseases. Age at readmission was significantly associated with sex, breastfeeding, and LOS. Assessment of the factors associated with readmission before discharge may reduce the rate of readmission.
{"title":"Neonatal hospital readmissions: Rate and associated causes","authors":"M. Bawazeer, Raghad K. Alsalamah, Dalal Almazrooa, S. Alanazi, Nada Alsaif, Reem Alsubayyil, Alaa M. Althubaiti, Aly Mahmoud","doi":"10.4103/jcn.jcn_64_21","DOIUrl":"https://doi.org/10.4103/jcn.jcn_64_21","url":null,"abstract":"Background: The neonatal period is important for establishing a strong healthy foundation and is also associated with high mortality and morbidity rates. This study aimed to determine the rate of neonatal hospital readmission and to identify the associations between the neonatal age at readmission and the length of stay (LOS) during readmission, the outcome of readmission, and the associated maternal and neonatal factors. Methods: A cross-sectional study was performed by reviewing the medical records of 570 neonates who were born in and readmitted to King Abdulaziz Medical City, Riyadh, Saudi Arabia, through emergency and outpatient clinics from January 2016 to December 2018. Results: The neonatal readmission rate during the study period was 2.11%. The most common causes for readmission were respiratory diseases (24.9%), jaundice (22.1%), and fever to rule out sepsis (16.7%). Sex and breastfeeding were significantly associated with neonatal age at readmission (P = 0.025 and P = 0.017, respectively), but only breastfeeding was a significant predictor of age at readmission. Males were more likely to be admitted at the age >7 days, and exclusively formula-fed neonates were approximately three times the risk compared to exclusively breastfed neonates to be admitted at age >7 days (adjusted risk ratio 2.9, 95% confidence interval). Neonates readmitted at ages >7 days had double the LOS as those readmitted at ages ≤7 days (P < 0.001). The outcomes (discharge or pediatric intensive care unit admission) had no significant association with neonatal age at readmission. Conclusion: The readmission rate was 2.11% and was most commonly due to respiratory diseases. Age at readmission was significantly associated with sex, breastfeeding, and LOS. Assessment of the factors associated with readmission before discharge may reduce the rate of readmission.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"10 1","pages":"233 - 238"},"PeriodicalIF":0.2,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42116584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Neonatal enterocolitis is the most common gastrointestinal emergency reported in preterm babies. The most common infective organism involved in the pathogenesis includes bacteria such as Escherichia coli and Klebsiella. Until now, severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) as a causative agent of necrotizing enterocolitis (NEC) has not been reported. We report a unique case of multisystem inflammatory syndrome in children (MIS-C) and adolescents in newborn who presented with NEC. A 34-week-old male baby born to COVID-19-positive mother by normal vaginal delivery was admitted since birth in the special care newborn unit due to respiratory distress. Baby was COVID positive within 24 h of birth. He developed NEC at day 8 of life. He developed signs and symptoms of MIS-C. He responded to intravenous immunoglobulin and was discharged on day 16 of life. This is the first case report of MIS-C in newborn in India. Baby had NEC due to SARS-CoV2 which has not been reported until now. This case highlights the possibility of surge in newborn MIS-C postsecond wave of COVID-19 pandemic in India.
{"title":"An unusual case of multisystem inflammatory syndrome in children in newborn due to covid-19 – presenting with stage 11 b necrotizing enterocolitis","authors":"N. Thakur, Narendra Rai","doi":"10.4103/jcn.jcn_78_21","DOIUrl":"https://doi.org/10.4103/jcn.jcn_78_21","url":null,"abstract":"Neonatal enterocolitis is the most common gastrointestinal emergency reported in preterm babies. The most common infective organism involved in the pathogenesis includes bacteria such as Escherichia coli and Klebsiella. Until now, severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) as a causative agent of necrotizing enterocolitis (NEC) has not been reported. We report a unique case of multisystem inflammatory syndrome in children (MIS-C) and adolescents in newborn who presented with NEC. A 34-week-old male baby born to COVID-19-positive mother by normal vaginal delivery was admitted since birth in the special care newborn unit due to respiratory distress. Baby was COVID positive within 24 h of birth. He developed NEC at day 8 of life. He developed signs and symptoms of MIS-C. He responded to intravenous immunoglobulin and was discharged on day 16 of life. This is the first case report of MIS-C in newborn in India. Baby had NEC due to SARS-CoV2 which has not been reported until now. This case highlights the possibility of surge in newborn MIS-C postsecond wave of COVID-19 pandemic in India.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"10 1","pages":"248 - 250"},"PeriodicalIF":0.2,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47957896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Termerová, A. Kuběna, Ráchel Paslerová, Karel Liška
Aims: The aim of the study is to evaluate two different patent ductus arteriosus (PDA) management approaches and their impact on neonatal mortality and/or bronchopulmonary dysplasia (BPD) and 2-year outcomes. Subjects and Methods: For two consecutive periods, data on early mortality and morbidity were obtained retrospectively, while long-term morbidity data in children born before 28 weeks of gestation were collected prospectively. In the early targeted treatment period (TTP), ibuprofen was early indicated on patients with high clinical risk and PDA diameter of more than two millimeters in the first 3 days. In the expectant treatment period (EXP), the expectant approach was used. Results: A total of 201 eligible infants were screened. Of these, 99 were managed in the TTP and 102 in the EXP. From 99 infants in the TTP, 24 patients were treated early and 17 later. From 102 infants in the EXP, 17 infants with symptomatic PDA were treated. Severe BPD and/or death were more frequent in the TTP as compared to EXP (28 and 16 infants, respectively; P = 0.007; odds ratio = 2.12; confidence interval = 1.06–4.23; c = 0.216). Moreover, infants who underwent the expectant approach did not need further cardiological interventions after discharge. Conclusions: Early targeted treatment of large PDAs was associated with an increased risk of severe BPD and/or death. We must pay attention to the side effects of early ibuprofen treatment because these may outweigh the benefits of ductus closure, especially in the vulnerable population of extremely preterm infants.
{"title":"Worse outcomes of early targeted ibuprofen treatment compared to expectant management of patent ductus arteriosus in extremely premature infants","authors":"J. Termerová, A. Kuběna, Ráchel Paslerová, Karel Liška","doi":"10.4103/jcn.jcn_73_21","DOIUrl":"https://doi.org/10.4103/jcn.jcn_73_21","url":null,"abstract":"Aims: The aim of the study is to evaluate two different patent ductus arteriosus (PDA) management approaches and their impact on neonatal mortality and/or bronchopulmonary dysplasia (BPD) and 2-year outcomes. Subjects and Methods: For two consecutive periods, data on early mortality and morbidity were obtained retrospectively, while long-term morbidity data in children born before 28 weeks of gestation were collected prospectively. In the early targeted treatment period (TTP), ibuprofen was early indicated on patients with high clinical risk and PDA diameter of more than two millimeters in the first 3 days. In the expectant treatment period (EXP), the expectant approach was used. Results: A total of 201 eligible infants were screened. Of these, 99 were managed in the TTP and 102 in the EXP. From 99 infants in the TTP, 24 patients were treated early and 17 later. From 102 infants in the EXP, 17 infants with symptomatic PDA were treated. Severe BPD and/or death were more frequent in the TTP as compared to EXP (28 and 16 infants, respectively; P = 0.007; odds ratio = 2.12; confidence interval = 1.06–4.23; c = 0.216). Moreover, infants who underwent the expectant approach did not need further cardiological interventions after discharge. Conclusions: Early targeted treatment of large PDAs was associated with an increased risk of severe BPD and/or death. We must pay attention to the side effects of early ibuprofen treatment because these may outweigh the benefits of ductus closure, especially in the vulnerable population of extremely preterm infants.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"10 1","pages":"209 - 215"},"PeriodicalIF":0.2,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49062448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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