Pediatrics and Neonatology最新文献

Background: Severe and persistent pulmonary hypertension (PH) predicts mortality and short-term pulmonary morbidity in infants with congenital diaphragmatic hernia (CDH). Intrathoracic liver herniation (liver-up) is a predictor of survival and increased need for extracorporeal membrane oxygenation. There is a paucity of data on the timeline of PH resolution in infants with and without liver herniation. We aim to determine the time to PH resolution in infants with liver-up and liver-down CDH, and to describe the resource utilization among these infants.

Methods: We conducted a retrospective study of CDH infants in a quaternary neonatal intensive care unit between January 2018 and March 2021 who received targeted neonatal echocardiography (TnEcho). Our primary outcome of PH resolution was defined echocardiographically by left-to-right shunting at the patent ductus arteriosus (PDA) or rounded interventricular septum on parasternal short axis view if the PDA was closed. Serial TnEcho assessments were performed every 1-2 days around the perioperative period and then every 2-3 weeks as clinically indicated.

Results: Nineteen CDH infants were evaluated, of which 9 (47.4 %) infants were in the liver-up group. Baseline characteristics such as birth weight, gestational age, and sex were comparable in both groups. The median time to PH resolution was prolonged among infants with liver herniation (20.5 vs. 11.5 days, p = 0.005). The median length of stay and invasive ventilation days were longer in liver-up group (113 vs. 31 days, p = 0.017) and (19 vs. 7.5 days, p = 0.033), respectively. The proportion of infants demonstrating tube dependence for feeding at discharge was higher in the liver-up group compared with the liver-down group (8 [88.9 %] vs. 2 [20.0 %], p = 0.005).

Conclusion: CDH infants with liver herniation experience a delayed resolution of pulmonary hypertension. Furthermore, these infants require longer hospitalization and more days on invasive ventilation.

Background: Preterm birth is associated with immune dysregulation, and bronchopulmonary dysplasia (BPD) is the most prevalent complication affecting preterm infants. However, studies addressing the correlation between immune profiles and BPD severity in preterm infants remain limited.

Methods: A total of 78 preterm infants born at less than 32 weeks of gestation and 46 full-term controls were enrolled. Basic characteristics, including birth data, medical history, and growth, and immune profiles including CD3⁺ T cells and subsets of CD4⁺ and CD8⁺ T cells, along with CD19⁺ B cells, were analyzed and compared across various gestational age (GA) and BPD grading groups.

Results: Extremely preterm infants and those with severe BPD had lower birth weights, lower body weight percentiles, and higher rates of sepsis at 6 months corrected age compared with full-term infants and those with no or mild BPD (P < 0.01). Among preterm infants, extremely preterm infants exhibited higher CD8⁺ T cell percentages with lower CD4/CD8 ratios than very preterm infants (P < 0.05). Infants with severe BPD had the highest percentage of CD4/CD8 ratios below the 25th percentile among BPD grading groups (P < 0.05). Furthermore, males had lower CD4⁺ T cell percentages than females (P < 0.05), but no differences in immune profiles were found between those with or without sepsis.

Conclusions: Extremely preterm infants with severe BPD showed underdeveloped growth, higher sepsis rates, and altered high CD8⁺ T cells with lower CD4/CD8 ratios, which is potentially related to premature pulmonary processes in early infancy.

Background: Neonatal transport is a critical component of regionalized perinatal care and it has played a significant role in improving neonatal survival. However, contemporary clinical practices of neonatal transport in Taiwan remain underreported. This study aimed to comprehensively analyze the characteristics and outcomes of neonates transported to a tertiary medical center in northern Taiwan, with particular focus on those diagnosed with hypoxic-ischemic encephalopathy (HIE) and treated with therapeutic hypothermia (TH).

Methods: We retrospectively reviewed medical and transport records of neonates transported to the neonatal care center at Chang Gung Memorial Hospital, Linkou Branch, between January 2019 and December 2021. A subgroup analysis was performed comparing inborn and outborn neonates who received TH.

Results: During the study period, 835 neonates were transported, accounting for 15.8 % of total admissions. Among them, 550 (66 %) were term neonates, and 39 (5 %) were very or extremely preterm. The predominant reason for transport was respiratory distress (56 %), followed by gastrointestinal (12 %) and cardiovascular (10 %) issues. Endotracheal intubation was required in 13.0 % of neonates during transport, with 44.0 % of these performed by the transport team. A total of 21 (2.5 %) died before discharge, including 14 (1.7 %) within the first week and 7 (0.8 %) within 24 h post-transport. Seventeen outborn and four inborn neonates received TH during the study period. Three outborn neonates initiated TH beyond the first 6 h. Most delays were marginal and associated with longer admission times. Notably, outborn neonates diagnosed with HIE who underwent TH had comparable short-term outcomes to the inborn group.

Conclusion: Respiratory distress remained the predominant reason for neonatal transport, with over half of the cases requiring ventilator support. In neonates with hypoxic-ischemic encephalopathy, timely therapeutic hypothermia was generally achievable, and short-term outcomes were comparable to inborn counterparts.

Background: Early nutrition is essential for the growth and neurodevelopment of preterm infants, especially those with very low birth weight (VLBW). This multicenter retrospective cohort study aimed to evaluate the effects of early parenteral amino acid (AA) administration on growth outcomes, feeding patterns, and short-term neonatal outcomes.

Methods: This study included VLBW infants (<32 weeks of gestation) treated in six tertiary neonatal intensive care units across Taiwan between 2019 and 2023. Participants were grouped based on the timing of parenteral AA initiation (≤24 h or > 24 h after birth) and initial dose (≤2.5 g/kg/day or > 2.5 g/kg/day). Clinical outcomes and nutritional practices were compared across the groups.

Results: Among the 959 infants, who received AAs earlier, the time to achieve full feeding was significantly shorter (23.4 ± 13.3 days vs. 26.2 ± 11.4 days, p = 0.035) compared to those who received AAs later. Among the 973 infants, infants receiving higher doses of AAs reached full feeding earlier (21.6 ± 14 days vs. 25.5 ± 12 days, p < 0.001) and had higher nadir body weights (981.1 ± 247.5 g vs. 941.8 ± 264.4 g, p = 0.028). Short-term outcomes, such as patent ductus arteriosus (PDA) requiring treatment (13.3 % vs. 19 %, p = 0.019), pulmonary hemorrhage (2.9 % vs. 5.7 %, p = 0.036), and moderate to severe bronchopulmonary dysplasia (BPD) (45.6 % vs. 54.3 %, p = 0.01), were significantly lower in the high-dose group. Multivariate logistic regression analysis revealed that the initial AA dose was independently associated with decreased risks of BPD and PDA.

Conclusion: Early initiation and higher doses of parenteral AAs were associated with improved feeding efficiency and reduced morbidities, such as PDA and BPD, in VLBW infants. Further large-scale and long-term studies are required to confirm these findings and determine the optimal dosing strategies.