Neonatology最新文献

Introduction: Severe intraventricular hemorrhage (sIVH) remains a significant complication for very preterm infants (VPIs). This study aimed to assess heritable and environmental contributions to sIVH.

Methods: A total of 2,074 twin pairs born at gestational age <32 weeks with known sIVH status were identified. Three statistical methods were applied, including the Pearson χ2 test, intra-class correlation (ICC), and ACE modeling.

Results: Both Pearson's χ2 test (p = 0.224) and ICC analysis (p = 0.534) revealed no significant difference after comparing neither, one, or both of the monochorionic and dichorionic twin pairs who developed sIVH. ACE modeling revealed no contribution of heritability to sIVH risk, while the common environmental impacts on sIVH development were 27.9% (95% CI [23.9%, 31.9%]) and 72.1% (95% CI [68.1%, 76.1%]), respectively. Assisted conception (aOR 1.45, 95% CI [1.06, 1.97]), inotropes (<3 days) (aOR 1.71, 95% CI [1.22, 2.39]), invasive mechanical ventilation (<3 days) (aOR 2.38, 95% CI [1.56, 3.64]), and sedations (<7 days) (aOR 2.25, 95% CI [1.55, 2.06]) had contribution to sIVH, while larger gestational age (aOR 0.77 [0.71, 0.85]) and early surfactant administration (≤2 h) (aOR 0.58, 95% CI [0.42, 0.79]) prevented VPIs from sIVH.

Conclusions: We recognized that environmental factors instead of heritability may play major contribution to the development of sIVH. Quality improvement studies focusing on the potential environmental factors to decrease the incidence of sIVH are warranted.

Introduction: Pulse oximeters may systematically overestimate arterial oxygen saturation in neonates with darker skin pigmentation. We performed a survey in practicing neonatologists to explore knowledge of this bias and the implications for clinical care.

Methods: An email survey was distributed assessing knowledge of melanin-related pulse oximeter bias, perceived clinical significance, and communication practices. Responses were compared to data from emergency medicine (EM) clinicians.

Results: Survey results from 120 neonatologists showed that 45.0% agreed that bias exists in pulse oximetry based on skin pigmentation. Among respondents aware of the bias, less than half correctly identified its direction. Most clinicians reported no change in clinical management for dark-skinned neonates. Compared to EM clinicians, neonatologists changed clinical practice less often and rated discussions with families as less important.

Conclusion: Awareness of pulse oximetry bias related to skin pigmentation remains limited among neonatologists, with low rates of modification to daily clinical practice.

Introduction: Premature infants are predisposed to respiratory failure. Body position impacts lung volumes and pulmonary function. Respiratory inductance plethysmography (RIP) measures thoracoabdominal motion and can provide objective, noninvasive diagnostic measurements of work of breathing (WOB) indices. The objective of this study was to compare WOB indices and oxygen saturation in the semi-reclined position to the supine position for preterm infants with and without BPD at discharge.

Methods: A prospective, observational study of premature infants (<32 weeks of gestation) admitted to the neonatal intensive care unit. RIP is a noninvasive way to objectively measure WOB indices. Measurements (phase angle [Փ]) were made with infants in the semi-reclined and supine positions.

Results: This study included 28 premature infants with both supine and semi-reclined data. Infants demonstrated decreased phase angle (supine vs. semi-reclined Φ deg (standard error of mean [SEM], 65.2 [10.2] vs. 28.5 [5.9], p = 0.027) and LBI (supine vs. semi-reclined, 1.82 [0.27] vs. 1.13 [0.04], p < 0.01) in the semi-reclined position. Saturations were statistically but not clinically lower in the semi-reclined position (supine vs. semi-reclined %, 96.7 [0.4] vs. 95.3 [0.4]). Infants with BPD demonstrated a greater improvement in WOB in the semi-reclined position compared to premature controls.

Conclusion: This is the first study to evaluate and compare discharge oxygen saturation and WOB indices in premature infants with and without BPD in the semi-reclined and supine position. Our findings demonstrate improved breathing parameters and a small clinically insignificant decrease in saturations in the semi-reclined position.

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: The PREMOD2 trial, comparing cord milking (CM) and deferred cord clamping (DCC) in preterm infants, was stopped for increased severe intraventricular hemorrhage (sIVH) with CM. Six of 9 centers had approval for waiver of antenatal consent.

Methods: We examined the relationship of enrollment procedures with characteristics and outcomes of trial-enrolled patients.

Results: A total of 474 infants were enrolled. Participants enrolled at sites with waiver of consent (N = 375, 79% of participants) were less likely exposed to antenatal steroids and magnesium. The overall effect of CM on sIVH was independently observed in sites with a waiver but not observed in sites without a waiver. However, the effects of CM observed between sites based on availability of waiver were not different. Chorioamnionitis exposure also modified the risk of sIVH from CM vs. DCC.

Conclusions: Trial-enrolled infants differed between hospitals with and without access to initial waiver, including in exposure to chorioamnionitis. These observations may be helpful to designing future studies.

Introduction: This study aimed to assess the feasibility of using specific defined daily doses for neonates (DDDn) as a standardized metric for monitoring antimicrobial consumption in neonatal populations, thereby enhancing antimicrobial stewardship programs (ASPs). To this end, DDDn values have been established for those antimicrobials that had not previously been defined.

Methods: This observational study was conducted in the Neonatology Unit of a tertiary-care teaching hospital. Data on antimicrobial use were prospectively collected from January 2016 to December 2023. Both the DDDn values validated in a previous study and the new DDDn values obtained in the present work were used. Antimicrobial consumption was measured quarterly and expressed as DDDn per 1,000 occupied bed days (OBDs). Additionally, a conversion factor was defined to transform DDD into DDDn.

Results: Out of 1,326 prescriptions, 310 met the inclusion criteria. The study successfully validated DDDn for 10 antimicrobials, including piperacillin-tazobactam, cefepime, and amoxicillin-clavulanic acid. However, DDDn for certain antimicrobials could not be established due to insufficient prescribing data. The mean global antimicrobial consumption was 5.271 ± 1.435 DDDn per 1,000 OBDs per year. The most commonly used antimicrobials were cefotaxime, amoxicillin-clavulanic acid, and ampicillin. The conversion factor was established for five oral antimicrobials and 17 intravenous ones.

Conclusion: DDDn proved to be a feasible tool for monitoring antimicrobial consumption in neonatal populations, offering a standardized metric that could improve ASPs and optimize antibiotic usage. More research is needed to validate DDDn across different antimicrobials and clinical settings.

Introduction: Postnatal weight loss in infants is physiological, but excessive loss predisposes for dehydration and other morbidities. Existing nomograms, primarily developed in temperate climates, may not apply to arid regions as environmental conditions influence weight loss patterns. This study aimed to develop hour-specific percentile nomograms for postnatal weight loss in exclusively breastfed, healthy infants (≥36 weeks) from an arid region, facilitating early identification of those at risk of excessive loss.

Methods: A prospective cohort study was conducted between November 2021 and February 2023 at a tertiary center in Western India. Exclusively breastfed infants ≥36 weeks without major morbidities were enrolled and weighed twice daily until 100 h after birth or discharge. Infants with abnormal clinical/biochemical findings or requiring any milk supplementation were censored. Quantile regression was used to generate percentile curves for weight loss.

Results: Out of 2,458 enrolled infants, 29.6% got censored, so 1,730 (1,134 vaginal, 596 cesarean) were included in the final analysis, contributing to 10,346 weight measurements. Median weight loss was 7.4% for vaginal and 8.7% for cesarean births; ≥10% loss occurred in 9.4% and 22.4% of infants, respectively. Distinct patterns and nadirs were observed based on mode of delivery. Compared to existing nomograms, our data showed greater early weight loss but quicker recovery after 48 h.

Conclusions: These nomograms provide region-specific reference standards for monitoring postnatal weight loss among exclusively breastfed infants in a semiarid to arid region, offering a basis for further validation in other arid settings globally.