Neonatology最新文献

Introduction: Bifidobacteria typify the gut microbiota of healthy, breastfed infants. Altered gut microbiota composition in early infancy characterized by decreased Bifidobacterium abundance has been linked with a heightened risk of non-communicable diseases. Our goal was to assess factors impacting on the gut microbiota composition in infants throughout the allergy and obesity epidemics of the past decades.

Methods: We studied deliveries from a series of clinical studies, grouped by the year of birth into three time periods (1997-2001, 2005-2009, 2015-2022). Altogether, 48 full-term breastfed infants' having fecal samples available at the age of 1-3 months were studied for microbiota profiling by 16S rRNA gene amplicon sequencing. Perinatal factors including mode of birth and antibiotic exposure during pregnancy and at birth were taken into account.

Results: The richness and diversity of the infant gut microbiota decreased significantly over the three time periods. Reduced abundance of the phylum Actinobacteriota and its genus Bifidobacterium was detected in children born in 2015-2022 as compared to those born during the time periods 1997-2001 and 2005-2009. The time period of birth was the strongest determinant of the gut microbiota composition, followed by maternal pre-pregnancy body mass index, antibiotic exposure during pregnancy, and mode of birth. The relative abundance of members of the genus Bifidobacterium was significantly associated with elapsed time (1997-2022) and intrapartum antibiotic exposure.

Conclusions: The depletion of gut microbiota richness and diversity and the selective reduction of relative abundance of the genus Bifidobacterium have occurred parallel to the increase in the prevalence of non-communicable diseases.

Introduction: Advances in neonatology, neonatal surgery, and extracorporeal membrane oxygenation have improved the prognosis of congenital diaphragmatic hernia (CDH). However, CDH survivors are at considerable risk of long-term neurological morbidity. Magnetic resonance imaging (MRI) abnormalities are reported in up to 84% of CDH survivors but have only been rarely compared with neurodevelopmental outcomes. This study aims to investigate whether assessment of postnatal MRI in CDH survivors allowed association with and prediction of long-term outcome.

Methods: Brain MRI was performed in 36 neonates with CDH using the Weeke score, assessing the mammillary bodies, the corpus callosum, cortical folding, and cerebrospinal fluid space (CSF). Outcomes were measured using Bayley-III-examinations at 12 months.

Results: In total, 91.6% of the neonates exhibited MRI abnormalities. Among them, 83.3% showed white matter (WM), 16.6% gray matter abnormalities, 8.3% cerebellar abnormalities, and 20% had an intracranial hemorrhage. A total of 30.5% showed abnormal mammillary bodies, 44.4% enlarged CSF, 5.5% reduced cortical folding, and 8.3% reduced corpus callosum thickness. While the use of the Weeke score was not helpful for outcome prediction, specific MRI abnormalities were associated with adverse long-term outcomes. Based on these findings, a novel MRI-scoring system was developed. This easy-to-perform score effectively predicted adverse outcomes at 12 months.

Conclusion: Interpretation of MRI in neonates with CDH should focus on WM pathologies, CSF enlargement, internal capsule involvement, mammillary body abnormalities, and intraventricular hemorrhage. Our novel simple scoring system helps identify neonates at risk for adverse neurological outcomes at discharge and aids to implement therapeutic strategies at an early point.

Introduction: As many as 40-100% of the neonates admitted to a neonatal intensive care unit (NICU) require peripheral intravenous (PIV) cannulation, for varying reasons. Though unproven, splinting is conventionally thought to increase the lifespan of the cannula. The objective of this study was to determine whether standard fixation without splinting, after cannula insertion near a joint, influences its lifespan.

Methods: This unmasked, parallel group, randomized controlled trial was approved by the Hospital Ethics Committee. Eligible PIV cannula insertions were divided into: "No Splint" and "Splint" group. In the "Splint group" after standard fixation of the PIV, a readymade splint was used. Written informed consent was obtained from parents. The primary outcome was measured as difference in the lifespan of the PIV cannula in both the groups.

Results: We enrolled 341 cannulations in "No Splint" and 344 in "Splint" group. The demographic details of both the groups were comparable. Mean gestational age, age at time of enrollment, and birthweight was 33+3 weeks, 3.4 days and 2,160 g, respectively. The mean (95% confidence interval) life of PIV cannula in the "No splint" and the "Splint" groups were 48.5 (45.1, 52.2) and 47.5 (43.6, 51.3) hours (p value 0.7), respectively. Subgroup analysis showed longer PIV cannula life in "No Splint" group neonates who were term and weighed ≥2,500 g.

Conclusion: In neonates with a PIV cannula placed over a joint, standard fixation without splinting did not shorten the cannula life. Not splinting may be associated with increased lifespan of the PIV cannula in term, normal birthweight neonates.

Introduction: There is a need to establish realistic, rather than idealistic, postnatal growth targets. We aimed to characterize body composition outcomes of preterm infants growing along recently defined individualized growth trajectories.

Methods: In this cohort study, infants born <33 weeks of gestation in the United States, Canada, Germany, and Austria between 2012-2022 were included if they had body composition measurements at term-equivalent age. Growth trajectories for each infant were generated retrospectively based on weight data collected at birth and at term-equivalent age. This allowed for the calculation of the difference between actual and target weight at term-equivalent age or discharge and stratification of infants into three growth trajectories: 1) 100g or further below target, 2) within target (±99g), and 3) 100g or more above target.

Results: A total of 1052 infants were included. The median gestational age and birthweight were 28 weeks and 1060g, respectively. A linear correlation between the actual versus target weight difference and fat-free mass (FFM) z-scores was found (r = 0.34, p < 0.0001). Among infants whose weights remained within the target range (30%), the mean FFM z-score was -1.6 [SD: 1.2] and the mean body fat percentage was 15 [SD: 5.9]. In addition to lower mean FFM z-scores, infants whose weight fell below the target range had greater declines in weight, length, and head circumference z-scores.

Conclusions: Weight trajectories below a recently defined target is linked to lower FFM. Further research is needed to determine whether prospectively targeting these individualized growth trajectories improves FFM outcomes.

Introduction: Azithromycin, with its antimicrobial and anti-inflammatory properties, has been explored as a potential option for preventing bronchopulmonary dysplasia (BPD) in preterm infants.

Objective: We performed a meta-analysis of randomized controlled trials (RCTs) comparing azithromycin with placebo for the prevention of BPD in preterm infants.

Methods: PubMed, Scopus, ClinicalTrials.gov, and Cochrane Central databases were searched for studies comparing azithromycin versus placebo in preterm infants. Outcomes of interest included the composite of BPD and death, BPD, death, grade 2 or higher necrotizing enterocolitis (NEC), grade 3 or 4 intraventricular hemorrhage (IVH), retinopathy of prematurity (RoP), duration of mechanical ventilation, and postnatal corticosteroid requirement. Random-effects model was used to generate risk ratio (RR), mean difference (MD), and 95% confidence interval (CI) (CRD42024558752).

Results: The meta-analysis included 6 RCTs including 1,360 infants (azithromycin n = 680, 50%). The composite of BPD or death (RR: 0.95; 95% CI: 0.83-1.10; p = 0.53; I2 = 50.2%), BPD (RR: 0.98; 95% CI: 0.83-1.15; p = 0.77; I2 = 38.1%), death (RR: 0.88; 95% CI: 0.66-1.19; p = 0.41; I2 = 0%), NEC (RR: 0.94; 95% CI: 0.69-1.26; p = 0.67; I2 = 0%), IVH (RR: 1.22; 95% CI: 0.89-1.68; p = 0.22; I2 = 3.5%), RoP (RR: 1.35; 95% CI: 0.43-4.28; p = 0.61; I2 = 76.3%), duration of mechanical ventilation (MD: 0.13; 95% CI: -1.35 to 1.60; p = 0.87; I2 = 0%), and postnatal corticosteroid requirement (RR: 0.84; 95% CI: 0.64-1.08; p = 0.18; I2 = 34.5%) were similar between the groups.

Conclusion: In preterm infants, azithromycin did not significantly change the risk of adverse clinical outcomes compared with placebo.

Introduction: Intrauterine herpes simplex virus (HSV) infection is uncommon and challenging to diagnose, requiring detection of HSV in skin lesions within 48 h post-birth.

Case presentation: A preterm female infant presented with the typical triad of blisters, microcephaly, and chorioretinitis, but the initial diagnostic approach was elusive due to negative results for TORCH pathogens from vesicles/serum. Referred at 7 months for developmental delay and epilepsy, her brain imaging showed calcification and cortical dysplasia. Polymerase chain reaction (PCR) of her preserved dried umbilical cord detected HSV-2 DNA, diagnosing intrauterine HSV infection. HSV-2 was later found in relapsed blisters at 8 months but not in cerebrospinal fluid or brain tissue. A literature review identified 104 congenital/intrauterine HSV cases; 28.8% presented the typical triad, and 50% were diagnosed using specimens collected 48 h post-birth.

Conclusion: This case marks the first retrospective diagnosis of intrauterine HSV infection via PCR on preserved umbilical cord, underscoring its diagnostic value.

Introduction: The umbilical venous catheter is a vital access device in neonatal intensive care units for preterm and critically ill infants. Correct positioning is crucial, as malpositioning can lead to severe complications. According to international guidelines, the position of the umbilical venous catheter tip must be assessed in real time; traditionally, the catheter is visualized with a thoracoabdominal X-ray, but one of the most effective and safest methods is therefore real-time ultrasound.

Methods: This study compares real-time ultrasound and traditional X-ray methods for assessing umbilical venous catheter tip location in 461 cases. The rate of tip malposition was analyzed retrospectively. The secondary aim was to assess indwelling time of umbilical venous catheters and reasons of removal.

Results: Real-time ultrasound tip location, found to be more reliable and efficient, demonstrated a significantly lower incidence of primary malpositioning compared to X-ray assessments (9.6 vs. 75.9%). The study also highlighted the association of real-time ultrasound with reduced catheter manipulation, fewer radiographs, and higher indwelling times of umbilical venous catheter. The multiple logistic regression showed a high probability of the central safe position of the umbilical venous catheter tip using real-time ultrasound tip location (odds ratio 29.5, 95% confidence interval: 17.4-49.4).

Conclusion: The findings support the adoption of real-time ultrasound in clinical settings to enhance umbilical venous catheter placement accuracy and minimize associated risks. A minimal training investment is needed to attain the proficiency to visualize the umbilical venous catheters, offering a substantial advantage in terms of both cost-effectiveness for the procedure and enhanced patient safety.