Neonatology最新文献

Introduction: Neonatal linear immunoglobulin A (IgA) bullous dermatosis (NLABD) is a rare, life-threatening, mucocutaneous bullous disorder. The pathogenesis and optimal treatment remain poorly defined and raise critical clinical challenges.

Case presentation: We present a case of a full-term female infant with severe cutaneous and respiratory symptoms due to NLABD. Diagnosis was confirmed by immunofluorescence on the infant's skin biopsy, while IgAs directed against the basement membrane of the skin and mucosa were identified in the mother's milk. The infant fully recovered after nearly 8 weeks of intensive multidisciplinary care, including non-invasive ventilation, nutritional support, wound care, systemic corticoid treatment, and breastfeeding discontinuation.

Conclusion: This case underscores the importance of timely adequate diagnosis and management of this rare and serious condition. Moreover, it adds novel evidence documenting the presence of pathogenic IgAs in breastmilk.

Introduction: Neonatal linear immunoglobulin A (IgA) bullous dermatosis (NLABD) is a rare, life-threatening, mucocutaneous bullous disorder. The pathogenesis and optimal treatment remain poorly defined and raise critical clinical challenges.

Case presentation: We present a case of a full-term female infant with severe cutaneous and respiratory symptoms due to NLABD. Diagnosis was confirmed by immunofluorescence on the infant's skin biopsy, while IgAs directed against the basement membrane of the skin and mucosa were identified in the mother's milk. The infant fully recovered after nearly 8 weeks of intensive multidisciplinary care, including non-invasive ventilation, nutritional support, wound care, systemic corticoid treatment, and breastfeeding discontinuation.

Conclusion: This case underscores the importance of timely adequate diagnosis and management of this rare and serious condition. Moreover, it adds novel evidence documenting the presence of pathogenic IgAs in breastmilk.

Introduction: Moderate and late preterm (MLPT) infants represent a substantial percentage of all preterm infants and frequently need support in the delivery room. Deferred cord clamping (DCC) improves SpO2 and heart rate (HR) stabilization in term infants. However, data on MLPT infants are limited.

Methods: We performed a prospective observational study collecting SpO2 and HR by pulse oximetry in healthy MLPT infants with DDC to construct percentile graphs for the first 10 min after birth.

Results: A total of 96 MLPT infants were monitored for preductal SpO2 and HR, and percentiles were calculated. SpO2 mean was significantly lower for MLPT than for term infants during the first 6 min after birth, and 15% did not achieve SpO2 ≥85% in the first 5 min after birth. HR was significantly lower in MLPT infants in the first 4 min after birth; however, HR consistently remained above bradycardic values (>100 bpm). NICU admission and postnatal complications were not different between MLPT achieving SpO2 ≥85% or not.

Conclusion: MLPT infants with DCC achieved stable SpO2 and HR significantly later, 6 min and 4 min, respectively, than term infants. In addition, 15% of MLPT infants did not achieve SpO2 ≥85% at 5 min after birth. However, admission to the NICU and clinical evolution did not differ from newborns with SpO2 ≥85% at 5 min. Larger studies including long-term follow-up are needed to assess if lower SpO2 in the first 5 min has clinical consequences in non-resuscitated MLPT.

Introduction: There is a broad awareness of shifts in the oxygen hemoglobin dissociation (ODC) relationship associated with fetal hemoglobin (HbF) changes. However, quantification of the shift has been limited. Aim was to quantify the shift of partial oxygen tension (PO2) associated with HbF and with changes after transfusion of adult erythrocytes (TAE) in preterm infants.

Methods: This is a single-center, retrospective observational analysis of blood gas samples. The shifts of ODC and PO2 related to HbF were evaluated in two models. Either HbF or TAE status (0, 1, ≥2) were used as the independent variable. Multivariate analysis was used to correct for confounding effects (gestational age, postnatal age, source of blood gas sample as well as pH, SO2, and PCO2).

Results: There were 3,452 blood gas observations analyzed from 2,464 infants whose median gestational age was 334 weeksdays (IQR 296-363). With SpO2 between 90 and 95%, the ODC was shifted to the left (13 mm Hg, 1.3 kPa). After adjusting for confounding variables, the number of TAEs (0, 1, ≥2), was highly significantly related to a shift (p < 0.001), consistent with the percent HbF level (p < 0.001). Based on the multivariate model (i.e., holding confounding parameters constant), with a SpO2 of 92% the PaO2 could be expected to shift markedly higher with 2 or more TAEs in an extremely preterm infant (7.3 mm Hg, 0.97 kPa).

Conclusion: While preliminary, these data suggest that in vulnerable preterm infants a change to a slightly lower SpO2 target range following TAE could maintain equivalent PaO2 exposure.

Introduction: Delaying clamping of the umbilical cord (deferred cord clamping [DCC]) in preterm infants reduces mortality and the need for blood transfusions. The mechanisms leading to these benefits are not well understood. The TITANS study investigates potential mediators of the reduction in blood transfusions in infants who received DCC.

Materials and methods: Additional patient data was sourced from Australian and New Zealand sites from the Australian Placental Transfusion Study (APTS). APTS randomized preterm infants <30 weeks' gestation to receive DCC (60 s) or immediate cord clamping. We examined whether placental transfusion or initial severity of illness mediated the reduced requirement for blood transfusions for infants randomized to DCC. Peak hematocrit in the first 7 days (Hct) was used as an indicator of placental transfusion quantity. Cumulative blood sampled, mechanical ventilation, and arterial sampling lines were used as indicators of severity of illness. We quantified the natural indirect effect of peak Hct and then for all mediators in a joint model with sequential mediation.

Results: Data from 1,260 (of 1,401) Australian and New Zealand APTS infants were obtained. The effect of DCC on subsequent blood transfusion was mediated through peak Hct (indirect effect OR = 0.85, 95% CI: 0.79-0.93; p < 0.001), which accounted for 37% of the total effect. Indicators of severity of illness did not mediate the effect independently of peak Hct.

Conclusion: Peak Hct mediated some, but not all, of the effect of DCC on blood transfusion, whereas markers of severity of illness were not independent mediators.

Introduction: Congenital anomalies (CAs) are a major cause of newborn mortality and long-term disabilities, especially in developing countries. Research on CAs is limited and inconclusive. This umbrella review evaluates the pooled prevalence, patterns, and determinants of CAs among newborns in low- and middle-income countries.

Methods: We conducted a comprehensive search across databases, including PubMed and Cochrane Library, until 31 December 2024. Study quality was assessed using the AMSTAR checklist. Heterogeneity was measured with the I2 test and Cochrane Q test, while publication bias was evaluated through funnel plots, Egger's, and Begg's tests. The pooled prevalence of CAs and determinants was calculated using the DerSimonian and Laird random-effects model.

Results: Seven studies revealed a pooled prevalence of CAs at 15 per 1,000 births (95% CI: 9.00, 21.00), with the highest rate in low-income countries at 18 per 1,000 (95% CI: 8.00, 27.00). Musculoskeletal and urogenital anomalies were the most prevalent, at 8 and 4 per 1,000 births, respectively. Key predictors include lack of folic acid supplementation (AOR 4.18, 95% CI: 2.35, 6.02), kchat chewing (AOR 3.5, 95% CI: 2.97, 4.03), maternal illness (AOR 3.55, 95% CI: 3.37, 4.73), and drug use during pregnancy (AOR 4.37, 95% CI: 1.21, 7.54).

Conclusion: The pooled prevalence of CAs is significantly higher than WHO reports, with musculoskeletal and urogenital defects being the most common. Key risk factors include maternal illness, unidentified drug use, kchat chewing, and lack of folic acid supplementation. Enhancing folic acid intake and targeting these risk factors are essential for policymakers.

Introduction: The aim of the study was to explore the relationship between near-infrared spectroscopy parameters (cerebral saturation [CSat] and corresponding cerebral fractional tissue oxygen extraction [cFTOE]) with resistive (RI) and pulsatility indices (PI) of the anterior cerebral artery (ACA) obtained simultaneously in neonates with congenital heart defect (CHD) during the first week of life.

Methods: Prospective observational study on neonates ≥35 weeks with CHD was conducted. Cerebral FTOE was based on concomitant pre-ductal oxygen saturation (SpO₂) during CSat measurement. ACA was assessed via Doppler ultrasound (US). Continuous CSat/SpO₂ monitoring was collected during the first week of life. Daily ACA Doppler was obtained from day 1-7.

Results: A total of 142 concomitant measurements of NIRS and US parameters during the first week of life were collected in 34 neonates with various CHD. Mixed effect models showed significant association between CSat/cFTOE and time-corresponding RI-ACA (p = 0.02 and 0.005) and PI-ACA (p = 0.006 and 0.002), respectively. A 0.1-point increase in RI was associated to a 2.3% decrease in CSat and a 3-point increase in cFTOE. A 0.1-point increase in PI was associated to a 0.9% decrease in CSat and 1.1-point increase in cFTOE.

Conclusions: In neonates with CHD during their first week of life, lower CSat and higher cerebral FTOE were associated with elevated RI and PI values of the ACA obtained simultaneously. Future research should assess whether a multimodal bedside approach to monitoring cerebrovascular hemodynamics can facilitate early detection of cerebral hypoperfusion and prevent brain injury, as well as adverse neurodevelopmental outcomes in this vulnerable population.

Introduction: Gas exchange and perfusion are impaired during neonatal cardiopulmonary resuscitation. Continuous chest compressions with asynchronous ventilation (CCCaV) improve oxygenation and hemodynamics in term animal models compared to synchronized 3:1 compressions-to-ventilation (C:V). We hypothesized that CCCaV improves gas exchange and hemodynamics in preterm lambs.

Methods: Sixteen extremely preterm (124-126 days gestation) lambs were asphyxiated to cardiac arrest by umbilical cord occlusion. Lambs were randomized to 3:1 C:V following the International Liaison Committee on Resuscitation algorithm or CCCaV (120 compressions and 40 asynchronized ventilations per minute). Epinephrine was given 3 min into resuscitation and repeated every 3 min until return of spontaneous circulation (ROSC).

Results: All lambs achieved ROSC with no difference in time to ROSC. There was no difference in cerebral oxygen delivery (C-DO₂) in lambs resuscitated with CCCaV versus 3:1 C:V (0.05 [0.041] vs. 0.03 [0.031] mL O₂/kg/min, respectively) during chest compressions. CCCaV yielded higher arterial oxygen content (CaO₂ 2.07 [1.00] vs. 1.07 [0.69] mL O₂/dL), mean arterial pressure (14.2 [2.6] vs. 13.2 [2.3] mm Hg), and diastolic pressure (8.1 [1.8] vs. 7.1 [1.4] mm Hg) during chest compressions compared to 3:1 C:V. There was no difference in plasma reduced to oxidized glutathione [GSH/GSSG ratio] between groups at 10 min post-ROSC.

Discussion: CCCaV in asystolic preterm lambs did not alter C-DO₂, frequency, or time to ROSC compared to standard 3:1 C:V resuscitation but increased CaO₂, mean, and diastolic arterial pressure compared to 3:1 C:V without increasing plasma oxidative stress markers.