Neonatology最新文献

Introduction: For preterm infants, the first two weeks after birth are a time when nutrition and protein intake is variable and often falls below recommended intakes. Our objective was to investigate the relationship between protein intake, including source of protein, during the first two weeks after birth and fat-free mass (FFM) accretion in a group of very preterm infants.

Methods: In this observational cohort study, body composition was assessed using air displacement plethysmography in eligible infants <32 weeks gestational age at two weeks after birth and prior to discharge. FFM accretion was calculated as difference between the two measurements. We collected daily nutrition data for the first two weeks. Multivariable linear regression was used to assess the relationship between protein intake and body composition and weight gain.

Results: Seventy-eight infants were included (mean birthweight: 1408 ± 278 grams). Mean cumulative protein intake of this cohort in the first two weeks was 2.4±0.8 g/kg/day of which 74±19% was enteral (1.7±0.6 g/kg/day). Enteral protein intake was associated with higher FFM while parenteral protein was associated with lower FFM. Total protein intake from both sources during the first two weeks after birth was positively associated with greater weight gain.

Conclusion: Enteral protein intake during the first two weeks after birth is associated with higher FFM and weight in preterm infants. Future interventional studies should investigate the effects of higher enteral protein intake during the first two weeks after birth on growth and body composition.

Background: Little is known about medical research at the Vienna Foundling Hospital during the 18th and 19th centuries.

Summary: The present article focuses on nutrition, medical care, and research concerning newborn infants. In 1784, Emperor Joseph II merged obstetric and foundling hospitals under common leadership with specific statutes. Admissions rose from 1,704 in 1785 to 9,797 in 1859. A third of all infants born in Vienna in the 1890s were "foundlings" - correctly: abandoned infants, illegitimate birth was a prerequisite for admission. Differing from other foundling hospitals, the statutes obliged physicians to research, which focused on the great baby killers of the 18th century: smallpox, puerperal sepsis, connatal syphilis, tuberculosis, and malformations. Researchers included Anton Rechberger, Lucas Boër, Ignaz Semmelweis, Carl Rokitansky, Alois Bednar, and Carl Friedinger. Major scientific achievements were Rechberger's introduction of smallpox inoculation in Austria in 1768; Semmelweis' prevention of puerperal sepsis in 1847, and Bednar's classification of congenital heart malformations in 1852. Mortality statistics were doctored: deaths within 1 year were related to admissions from several years, which yielded maximum "mortality rates" of 76% in 1811, and a minimum rate of 13% in 1829. Actual mortality, however, per number of admissions, was over 90% in the first year of life. The institution persisted for 126 years because of the strict anonymity of extramarital birth, faked statistics deceiving supervisors, and esteem for the imperial inaugurator even beyond the end of the Austrian Empire.

Key message: Despite appalling mortality, successful research was conducted at the Vienna Foundling Hospital.

Introduction: Caffeine is the registered pharmacologic treatment for apnea of prematurity and is extensively used in the neonatal intensive care units (NICUs) based on evidence from randomized controlled trials. This study aimed to describe the clinical use of caffeine based on real-world data, hypothesizing a divergence from the registered dosing regimen.

Methods: A retrospective analysis included infants born before 30 weeks of gestation, admitted to the NICU of the Erasmus MC Rotterdam from 2018 to 2021. Exclusion criteria comprised infants admitted after postnatal day 2, those not receiving caffeine during admission, patients admitted for less than 24 h, those who spent less than 24 h on non-invasive support, and cases lacking medication data. The primary outcome was the proportion of patients receiving an average caffeine dose higher than registered on the label.

Results: A total of 451 patients with a median gestational age of 28+0 weeks (IQR 26+2-29+0) and birthweight of 1,015 g (IQR 800-1,218) were included. Of these, 402 infants (89%) received an average daily caffeine dosage exceeding the registered dose range. The median caffeine maintenance dose per patient was 5.3 mg/kg/day (IQR 5.0-5.8), with additional therapy (mini-load, doxapram, or intubation) needed in 318 patients (71%).

Conclusion: This study highlights the frequent use of higher caffeine dosages in clinical practice than registered and recommended based on long-term safety data. Despite these high dosages and frequent mini-loads, 28% of patients still required additional treatment with doxapram and/or invasive mechanical ventilation, indicating the need for individualized dosing strategies or alternative therapies.

Introduction: Gut pathogen colonization, where pathogens disrupt the normal gut microbiota, has been implicated in the development of bloodstream infections (BSIs). This study investigates the association between gut pathogen colonization and BSI, hypothesizing that species causing BSI primarily originated from gut.

Methods: A prospective cohort study was conducted in the neonatal intensive care unit (NICU) of tertiary care hospital in Karnataka, India, from January 2021 to September 2023. Inborn preterm infants were enrolled. The study population was divided into two groups: group A (neonates without sepsis) and group B (neonates with sepsis). Demographic details and blood culture results were collected. Stool samples were taken on day 4 and day 14 for group A, and on day 4 and the day of sepsis diagnosis for group B.

Results: Group B had a lower mean birthweight (1,649.6 ± 652.1 g) compared to group A (1,757 ± 656 g). Klebsiella pneumoniae was the most common pathogen causing BSIs (44.1%). The analysis revealed a high abundance of potential pathogens in the gut microbiome of group B neonates, with a concurrent decrease in beneficial gut flora.

Conclusion: This study provides strong evidence for the association between gut pathogen colonization and BSI development in preterm neonates in NICUs. Gut microbiota modulation may serve as preventive strategy against BSIs, emphasizing the need for further research in this area to improve outcomes in vulnerable population.

Introduction: There are conflicting data on the association between postnatal cytomegalovirus (CMV) infection and growth and cognitive outcome in very preterm infants. The aim of the current study was to systematically evaluate the effect of postnatal CMV infection on growth and cognitive outcome in an unselected, contemporary cohort of very preterm infants.

Methods: Infants <32 gestational weeks (2011-2018) were screened for postnatal CMV infection. We compared head circumference, weight and length from birth to 3 months corrected age, mental development at 12 and 24 months corrected age (Bayley Scales of Infant (Toddler) Development II/III), and intelligence quotient at 5 years (Kaufman Assessment Battery for Children-II, Wechsler Preschool and Primary Scale of Intelligence-III or Snijders-Oomen Non-verbal Intelligence Test) between infants with and without postnatal CMV infection.

Results: The final study cohort consisted of 431 infants with a median gestational age of 29.9 (23.7-31.9) weeks. Of these, 20 (4.6%) infants had a postnatal CMV infection. Median ∆ z scores from birth to the corrected age of 3 months for head circumference, weight, and length did not differ between infants with and without postnatal CMV infection. Continuous and categorized parameters of cognitive development did not differ between the two groups. A subgroup analysis of infants <28 gestational weeks showed similar results.

Conclusion: We did not observe a negative effect of postnatal CMV infection on growth or cognitive development of very preterm infants. These findings should be taken into account when discussing the use of raw mother's milk in the feeding of preterm infants.

Introduction: This study aimed to assess the association between the urinary lactate-to-creatinine ratio (ULCR) and brain spectroscopy (1H-MRS) findings in very low gestational age (VLGA) infants with and without preterm brain injury.

Methods: Urine samples were collected from 54 VLGA infants during the first week of life, after 1 month of life, and at term-equivalent age (TEA). Urinary lactate was measured via highly selective liquid chromatography-tandem mass spectrometry (LC-MS/MS) with a quantitative organic acid analysis kit and expressed as the ULCR. Magnetic resonance imaging and 1H-MRS were performed at TEA. The Kidokoro grading system was used to assess the Global Brain Abnormality Score (GBAS).

Results: VLGA infants with a GBAS moderate + severe had higher ULCRs on the 2nd and 3rd days of life (DOLs) than those with a GBAS normal or mild. Only the GBAS moderate + severe subgroup presented with a secondary increase in the ULCR on the 3rd DOL, whereas in the GBAS normal or mild, the ULCR oscillated around similar values or gradually decreased. Significant positive correlations were detected between the ULCR on the 3rd DOL and the lactate/creatinine and lactate/N-acetyl aspartate ratios measured via 1H-MRS at TEA (r = 0.308; p = 0.022 and r = 0.334; p = 0.013, respectively).

Conclusions: An increased ULCR during the first 3 DOLs in patients with a GBAS moderate + severe suggest an energy catastrophe that may play a role in the development of premature brain injury. Serial measurement of the ULCR during the first DOLs may help in the early identification of premature infants at risk for moderate + severe brain damage.

Introduction The neonatal period is the most vulnerable time in a child's life, contributing to almost half of all deaths in children under 5 years. Many of these deaths are preventable and are mainly caused by preterm birth, birth asphyxia, or serious infections. Over the past decade, the evidence base for interventions to prevent and manage these causes of neonatal mortality and morbidity in low- and middle-income countries (LMICs) has expanded significantly. This growth calls for a comprehensive and systematic approach to synthesizing the available evidence. This paper describes the methodological approach taken before and during the conduct of the systematic overviews and reviews included in this supplement. Methods Alongside consultation with a newborn technical advisory group, the overall evidence synthesis approach began with an extensive literature scoping exercise to establish a universe of interventions that were relevant to neonatal health and survival, and to identify the associated systematic reviews examining their effectiveness. Three main approaches were taken to synthesize the evidence based on the availability of prior evidence. New systematic reviews were conducted for topics lacking an existing comprehensive synthesis. Existing systematic reviews with search dates prior to 2020 were updated. High-quality, up-to-date systematic reviews were used without modification. In all cases, trial data from studies conducted in LMICs were sought and prioritized for analysis. Conclusion A comprehensive approach to summarizing the best available evidence for newborn intervention effectiveness is described.

Introduction: Bronchopulmonary dysplasia (BPD) is a common respiratory morbidity in preterm infants. The onset of pulmonary hypertension leads to worse respiratory outcomes. The contribution of left ventricular diastolic dysfunction in BPD-PH is well reported. We evaluated the serial left ventricular (LV) function and possible ventricular interdependence among BPD-PH.

Methods: Single-centre, prospective observational study. Infants <28 weeks of gestation included.

Results: 80 infants were enrolled. The incidence of BPD-PH was 23%. The BPD-PH group had a high incidence of hemodynamically significant ductus arteriosus (83% vs 56%,p <0.018), longer oxygen days (96.2±68.1 vs 59.35±52,p< 0.008), and prolonged hospital stay (133.8±46 vs 106.5±38 days,p<0.005). Serial tissue Doppler imaging showed prolonged left ventricle (LV) isovolumetric contraction time (IVCT)(31.05±3.3 vs 26.8±4.4ms,p<0.001), and myocardial performance index (MPI) (0.43±0.03 vs 0.37±0.04,p<0.001) from 33 weeks. The changes in IVCT (35.9±6.7 vs 27.9±4.5ms, p<0.001), isovolumetric relaxation time (IVRT) (50±6.5 vs 39.9±5.8ms,p <0.001), and MPI (0.48±0.05 vs 0.36±0.03,p <0.001) persisted at 36 weeks. The receiver operator characteristic curve showed LV MPI >40 has 83% sensitivity and 65% specificity (AUC 0.77, p<0.001) in the diagnosis of PH. The BPD-PH group had a higher LV E/E' ratio (13.1±4.4 vs 11.4±3.4, p <0.02). Pearson correlation test showed a moderate positive correlation between RV MPI and LV MPI (r= 0.585, p <0.001).

Conclusions: Significant LV diastolic dysfunction was observed in BPD-PH. This is the first study to show biventricular strain and possible ventricular interdependence in BPD-PH. The prolonged LV IVRT and MPI may be a novel echocardiographic indicator of BPD-PH.

Introduction: Daily urinary output (UOP) serves as important tool to identify acute kidney injury (AKI) in preterm infants. However, reference values for UOP, especially stratified for gestational age, are missing.

Methods: This retrospective single-center study assessed UOP during the first 28 days of life in 128 very low birth weight (VLBW) infants.

Results: VLBW infants exhibit a highly dynamic daily UOP profile in the first 28 days of life with a maximum at day 12 with 4.78 ml/kg bodyweight/h. In the subcohort of 64 extremely low gestational age neonates (ELGAN), the highest UOP is measured during the second week of life. Infants born before 24 weeks of gestation have significantly higher UOP than more mature infants.

Conclusion: UOP is dynamic in the postnatal period and differs significantly between gestational age cohorts in the subgroup of ELGANs. These data might point to an adaption of the UOP threshold for neonatal AKI in preterm infants.