Journal of Pediatrics最新文献

Objective: To examine the association of a numerical Sarnat score (NSS) and modified Sarnat staging among newborn infants with moderate/severe hypoxic-ischemic encephalopathy and their neurodevelopmental outcomes at 18 to 22 months.

Study design: This secondary analysis included participants with gestational age ≥36 weeks and moderate/severe HIE from the Induced Hypothermia (IH) and Optimizing Cooling (OC) trials. Early (<6 hours age) neurologic examinations were performed by trained examiners to categorize HIE severity by modified Sarnat staging. The NSS was calculated by summing abnormal scores (2 for moderate, 3 for severe) in the six examination categories. The primary outcome was death or moderate/severe disability. Statistical analysis included logistic regression, adjusting for center, trial, and cooling group, and linear regression for continuous scales.

Results: The cohort (n=528) included infants with 71% moderate and 29% severe HIE (37% IH and 63% OC participants). Median (IQR) NSS of infants with moderate and severe HIE were 11 (9-13) and 16 (16-17), respectively. There were significant associations between NSS, NSS tertiles, and modified Sarnat staging and death or disability, but there were no differences found in their area-under-the-curve estimates. Similar to modified Sarnat staging, NSS showed significant associations with Bayley-III cognitive, language, and motor scores and Bayley-II mental and psychomotor developmental indices.

Conclusion: Among infants with moderate or severe HIE, the NSS did not improve the predictive accuracy for death or disability at 18 to 22 months of age, compared with modified Sarnat staging performed in the initial 6 hours after birth by trained examiners.

Multi-strain probiotic formulations (MPF) have been used in infants born preterm for more than 10 years at our institution. Twelve cases of bacteremia with organisms found in MPF were identified out of 2109 exposed infants (0.6%), and no deaths were attributed to bacteremia.

Objective: To determine if timing of first postnatal echocardiogram (ECHO), early vs delayed, affects the use of extracorporeal membrane oxygenation (ECMO) and survival to discharge in neonates with congenital diaphragmatic hernia (CDH).

Study design: We retrospectively reviewed 306 neonates with CDH managed between January 2007 through December 2023. We excluded 21 neonates diagnosed >24 hours age and 14 outborn neonates transferred >12 hours age. Based on initial ECHO guideline recommendation changes, we compared two ECHO cohorts: early (<24 hours, 2007-2015) vs delayed (>24 hours, 2016-2023). Outcomes of interest included ECMO use, survival, rates of cardiopulmonary therapies, and key ECHO parameters.

Results: Median (IQR) age for first preoperative ECHO was 7 (range 4-13) hours in the early epoch vs 40 (range 19-62) hours in the delayed epoch (P <0.001). Despite similar demographics including gestation, birth weight, defect size, and intrathoracic liver, ECMO use (31% v 9%) and survival (70% v 82%) were significantly improved in association with delayed timing of first ECHO (P <0.05). Measures of pulmonary hypertension, ventricular size, and ventricular function were similar, but significantly less inhaled nitrous oxide (iNO) and vasoactive drugs were used in the delayed ECHO epoch.

Conclusion: A delay in timing of the initial postnatal ECHO for critically ill neonates with CDH, as part of a broader series of guideline changes, was associated with less ECMO, improved survival, and lower use of iNO and vasoactive drugs despite similar ECHO measures of pulmonary hypertension, ventricular size, and ventricular function. Randomized studies are needed to define better the optimal timing and interventions related to the initial ECHO for CDH.