Neonatology最新文献

Introduction: Metalloporphyrins, competitive heme oxygenase (HO) inhibitors, may potentially be used as drugs for preventing neonatal hyperbilirubinemia. Metalloporphyrins that specifically target the inducible HO-1 without inhibiting the constitutive HO-2 are the most ideal. Zinc protoporphyrin (ZnPP) has the most promise. We have derived a plant-based ZnPP (ZnPP-Plant) and evaluated its inhibitory potency and selectivity for the HO-1 isozyme.

Methods: Eleven-µM ZnPP-Plant or technical grade ZnPP (ZnPP-TG) were added to reaction vials containing heme, NADPH, and adult mouse spleen, brain, and liver sonicates. Gas chromatography was used to measure total in vitro HO activity in sonicates. Percent inhibition of control HO activity was then compared.

Results: At a 11-µM concentration, ZnPP-Plant and ZnPP-TG inhibited HO activity in the liver (69.7 ± 9.3% and 74.2 ± 10.3%, respectively); spleen (65.8 ± 17.9% and 46.8 ± 8.7%, respectively); and brain (54.1 ± 13.3%, and 38.1 ± 13.9%, respectively).

Conclusion: ZnPP-Plant has equal inhibitory potency as ZnPP-TG, and thus has potential use for treating neonatal hyperbilirubinemia.

Introduction: Peripheral intravenous catheterization is commonly required in sick neonates but remains challenging due to small vessels, leading to multiple attempts and complications. This review evaluated the benefits and harms of device-assisted techniques versus standard technique.

Methods: We searched MEDLINE, Embase, CENTRAL, Cochrane Reviews, WHO ICTRP, and ClinicalTrials.gov (October 2024) for randomized controlled trials (RCTs). Data collection and analysis followed Cochrane methodology.

Results: We included 12 RCTs (1,251 neonates). Devices were used for placement in 5 studies (417 neonates) and tip confirmation in 6 studies (740 neonates). One study used ultrasound for both PICC placement and tip confirmation (94 neonates). Devices may increase first-attempt success compared to standard technique: risk ratio (RR): 1.18, 95% confidence interval (CI): 1.04-1.33 for placement and RR: 1.20, 95% CI: 1.10-1.30 for tip confirmation. Six studies (528 neonates) reported a shorter time to successful catheterization. Devices likely reduce hematoma (RR: 0.32, 95% CI: 0.13-0.75), bleeding (MD: -0.68, 95% CI: -0.83 to -0.53), and phlebitis (RR: 0.19, 95% CI: 0.06-0.58). Evidence was of very low certainty for thrombosis for placement (RR: 0.33, 95% CI: 0.01-7.99) and tip confirmation (RR: 0.25, 95% CI: 0.05-1.16), catheter-related bloodstream infection (RR: 1.25, 95% CI: 0.34-4.58), and arrhythmia (RR: 0.09, 95% CI: 0.01-0.70).

Conclusion: Device-assisted catheterization may improve first-attempt success and reduce procedure time in neonates. Evidence on safety is limited. Due to variability in study methodologies and outcome reporting, high-quality RCTs with standardized outcome measures are needed.

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: 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.

Introduction: The SafeBoosC-III trial investigated the effect of cerebral oximetry-guided treatment in the first 72 h after birth on mortality and severe brain injury diagnosed by cranial ultrasound in extremely preterm infants (EPIs). This ancillary study evaluated the effect of cerebral oximetry on global brain injury as assessed by magnetic resonance imaging (MRI) at term equivalent age (TEA).

Methods: MRI scans were obtained between 36 and 44.9 weeks PMA. The Kidokoro score was independently evaluated by two blinded assessors. The intervention effect was assessed using the nonparametric Wilcoxon rank sum test for median difference and 95% Hodges-Lehmann (HL) confidence intervals (CIs). The intraclass correlation coefficient (ICC) was used to assess the agreement between the assessors.

Results: A total of 210 patients from 8 centers were included, of whom 121 underwent MRI at TEA (75.6% of alive patients): 57 in the cerebral oximetry group and 64 in the usual care group. There was an excellent correlation between the assessors for the Kidokoro score (ICC agreement: 0.93, 95% CI: 0.91-0.95). The results showed no significant differences between the cerebral oximetry group (median 2, interquartile range [IQR]: 1-4) and the usual care group (median 3, IQR: 1-4; median difference -1 to 0, 95% HLCI: -1 to 0; p value 0.1196).

Conclusions: In EPI, the use of cerebral oximetry-guided treatment did not lead to significant alterations in brain injury, as determined by MRI at TEA. The strong correlation between the assessors highlights the potential of the Kidokoro score in multicenter trials.

Necrotizing enterocolitis (NEC) is a severe intestinal condition primarily affecting preterm neonates. It has a high mortality rate, particularly in infants with a birthweight of below 1,500 g or for those requiring surgical intervention. The European Reference Network for Inherited and Congenital Anomalies (ERNICA) has developed a clinical practice guideline to aid clinical decision-making pertaining to the surgical treatment and management of NEC in preterm neonates. This guideline was developed in accordance with the Guidelines 2.0 checklist and GRADE methodology. A multidisciplinary group of Europe's top experts collaborated with patient representatives to develop this guideline. After selecting critical points in care for which recommendations are required, a systematic review of the literature and critical appraisal of the evidence was performed. The Evidence to Decision framework was used as a guide to structure the consensus meetings and draft the recommendations. The panel developed seven recommendations and three good practice statements on the following topics: indications for surgery, peritoneal drainage, surgical technique, management of extensive NEC, enteral feeding, and neurodevelopmental outcomes in premature neonates with NEC. The certainty of evidence was graded as (very) low for most recommendations. However, the panel weighed up the benefits and harms in light of all relevant arguments and expert opinion. This guideline provides recommendations on caring for premature neonates with NEC. These recommendations can assist clinicians in their care decisions and can inform families on treatment options and relevant considerations. This guideline will be revised every 5 years to ensure it remains up to date.

Introduction: Ideal early postnatal weight loss (PWL) and its association with mortality and morbidity in preterm infants are not well known. This review explored the association between early PWL and outcomes in very premature infants (<32 weeks).

Methods: This is a systematic review and meta-analyses of the observational studies. PubMed, Medline, EMBASE, Cochrane Library, EMCARE, and MedNar databases were searched in April 2024. Outcomes of interest were mortality and morbidities such as intraventricular haemorrhage (IVH), chronic lung disease (CLD), patent ductus arteriosus, necrotising enterocolitis (NEC), retinopathy of prematurity, and long-term neurodevelopmental outcomes. Data were pooled separately for adjusted and unadjusted odds ratios (ORs) using random-effects model. Separate analyses were conducted for case-control and cohort studies. Data were pooled separately for the excess weight loss (EWL) group (>15% from birth weight) and inadequate weight loss (IWL) group (<5% from birth weight).

Results: Eighteen studies (25,158 infants) were included. Pooling of adjusted ORs in EWL group from cohort studies found significant association with mortality (OR 1.39 confidence interval [CI; 1.10-1.75]), severe IVH (OR 1.37 CI [1.18-1.59]), NEC (OR 2.05 CI [1.05-4.03]), and "Mortality or IVH" (OR 1.40 CI [1.10-1.78]). Pooling adjusted ORs from case-control studies showed a significant association between EWL and CLD and between IWL and mortality or CLD. Certainty of evidence was "Low" or "Very-low."

Conclusion: EWL or IWL in very preterm infants may be associated with higher odds of mortality and morbidity. However, cofactors of severity of associated disease, insufficient nutrition, and treatments could not be assessed.