Intraventricular hemorrhage (IVH) is bleeding into the brain's ventricular system or around the ventricles. The etiology of IVH is multifactorial and is primarily attributed to the fragility of the germinal matrix vasculature and disturbance of cerebral blood flow. IVH is rarely present at birth. Infants born before the 30^th week of gestation and weighting <1500 g at birth are at risk for this type of bleeding. The smaller and more premature, unstable infants are at the highest risk for IVH. It occurs more often in the first several days of life. This situation creates immense burden and dilemma for health-care providers mainly when challenged by family choice to withdraw support or do-not-resuscitate incompatible with country law. Purpose: To reduce the overall incidence of IVH to <10% among preterm babies born <30 weeks of gestation using a neuro bundle of care. Methodology: A quality descriptive improved project was conducted in one government sector hospital in Abu Dhabi, Level III neonatal intensive care unit. It was a retrospective study where the data were collected from 2018 to 2019. A multidisciplinary team was formed to implement the neurobundle. Descriptive statistics were used to describe the demographic and clinical finding of the project. Results: Five out of 32 infants and 1 out of 17 infants developed IVH (Grade IV), respectively, in 2018 and 2019. Conclusion: The IVH rate in premature neonates has reduced drastically from 19% (preintervention) to 6% (postintervention) due to implementation IVH bundle and staff compliance.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Introduction: Neonatal jaundice is a common condition and an important cause of hospital admissions. This report reviews the efficacy of Lactobacillus reuteri and Saccharomyces boulardii in preventing high bilirubin levels and associated phototherapy admissions. Materials and Methods: This was a prospective, randomized study involving three groups. Group 1 was designated as a control and received no intervention. During the first 4 days of life, Group 2 received a concentrated dose of L. reuteri whereas Group 3 received a concentrated dose of S. boulardii. Bilirubinemia levels were assessed on day 4. Results: The sample size consisted of 98 subjects, including 36 in control Group 1, 31 in Group 2, and 31 in Group 3. The mean bilirubinemia at day 4 was 14.7 mg/dl in control Group 1, 13.8 mg/dl in Group 2, and 14.9 mg/dl in Group 3 (P > 0.05). Group 2 accounted for the most subjects (45%) in the low-to-intermediate-risk zone, compared to 30% in control Group 1 and 29% in Group 3 (P < 0.05). Eight subjects required light therapy, including two in Group 2 and three in each of control Group 1 and Group 3 (P > 0.05). Conclusions: The use of probiotics to prevent neonatal hyperbilirubinemia or bring down phototherapy admissions does not appear to be cost-effective.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: Neonatal shock is associated with high mortality and morbidity. Shock index (SI), a ratio of heart rate (HR) to systolic blood pressure (BP), has been evaluated as a simple tool for early predictor of mortality in adult as well as pediatric patients. Objective: The objective of this study was to compare SI and modified SI (MSI) among survivors and nonsurvivors of neonatal shock and healthy controls. Materials and Methods: HR and BP were measured in neonates presenting with clinical shock at 0, 2, and 6 h after admission and in healthy controls. SI and MSI were calculated and compared between three groups. Results: The mean (standard deviation) SI was significantly higher at 2 and 6 h of admission (2.57 [0.54] vs. 2.93 [0.78], P = 0.029; 2.42 [0.41] vs. 3.04 [0.91], P = 0.0005) among nonsurvivors of neonatal shock as compared to survivors. MSI was also significantly raised at both 2 and 6 h of admission in nonsurvivors (3.32 [0.64] vs. 3.78 [1.05], P = 0.03; 3.16 [0.63] vs. 4.10 [1.85], P = 0.005). Conclusions: SI and MSI are significantly higher in nonsurvivors of neonatal shock than survivors and healthy controls. These metrics can be used as bedside tools for early identification of at-risk neonates with shock.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Introduction: The association between maternal obesity and increased neonatal morbidity in infants of diabetic mothers needs to be evaluated. Aims: The objective of the study is to compare the immediate neonatal complications of obese and nonobese gestational diabetic mothers (GDM). Settings and Design: This prospective case–control study was conducted in a tertiary care center in Kerala, South India, between July 1, 2019 and January 1, 2020. Methods: Six hundred and seventy-seven obstetric patient records of deliveries conducted between July 1, 2019 and January 1, 2020 were reviewed. Neonatal outcomes of infants of obese and nonobese diabetic mothers (categorization based on prepregnancy body mass index [BMI]) were compared with the healthy neonatal controls born during the study period. Outcomes studied were neonatal intensive care unit (NICU) admission, NICU stay more than 7 days, hypoglycemia, respiratory distress, phototherapy, and proportion of small for gestational age in infants of diabetic mothers. Statistical Analysis Used: Statistical analysis used odds ratio and Chi-square tests. Results: One hundred and sixty-eight were found to be eligible to be included in the study. Eighty-four GDM cases were matched with 84 healthy control mothers. Hypoglycemia (P = 0.001), respiratory distress (P = 0.002), NICU admission (P = 0.001), prolonged NICU stay, and phototherapy were significantly associated with those mothers who had high BMI. Conclusions: Compared to infants of nonobese GDMs, infants of obese GDMs are at higher risk of hypoglycemia, respiratory distress, phototherapy, and NICU stay more than 7 days.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Sepsis could be a life-threatening organ dysfunction generated due to the dysregulation of the immunological response to infection. An operational definition of organ dysfunction applicable to neonates that predicts mortality within the infection setting is lacking. The neonatal sequential organ failure assessment (nSOFA) score was developed to predict mortality from late-onset neonatal sepsis in term babies (late-onset sepsis [LOS]). Objectives: This study aimed to focus on Vitamin D role in late-onset neonatal sepsis in term babies and to search out the correlation of Vitamin D levels with inflammatory markers, the severity of the disease, and association with nSOFA score and mortality risk. Patients and Methods: We screened all term newborns admitted to the neonatal intensive care unit (NICU) due to suspected or confirmed LOS during the study period. Our final cohort consisted of 148 patients with valid test results and data. Neonates with suspected LOS (Group 1 n = 52) confirmed LOS (Group 2 [n = 74]) or septic shock (group 3 [n = 24]). Baseline clinical data, nSOFA score within the first 24 h, cardiovascular support, the duration of mechanical ventilation, length of the NICU stay, 7^th and 28^th-day mortality recorded, plasma levels of 25-hydroxyvitamin D (25[OH] D), C-reactive protein, and pre- and procalcitonin were investigated. Newborns were followed until they discharge from the NICU or death. Results: Term newborns with late-onset neonatal sepsis had lower levels of 25(OH) D. We revealed a negative correlation between the levels of 25(OH) D and biochemical markers/nSOFA score in all patients with late-onset neonatal sepsis. Thirty-seven (25%) patients with LOS died within 28 days of NICU admission (with a median 25(OH) D level of 18.3 nmol (interquartile range: 8.7–23.8). There were 35 patients (23.64%) who received vasopressors (N-SOFA ≥3) during their NICU stay. These patients had significantly lower 25(OH) D levels.(P < 0.0001). Lower 25(OH) D levels among study groups were independently associated with a higher n-SOFA score. Conclusion: Our results showed that Vitamin D deficiency predisposed to the development of late-onset neonatal sepsis negatively correlated with biochemical markers and nSOFA score.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: A proper evaluation of cardiovascular status, with a view to ensuring early diagnosis of cardiac dysfunction and prompt intervention where necessary, is a recognized approach in the management of asphyxiated neonates. Hence, we determined the levels of a cardiac biomarker (troponin I), its relationship with disease severity, and mortality in asphyxiated neonates with hypoxic–ischemic encephalopathy (HIE). Methods: This was a descriptive study that involved 85 asphyxiated, term appropriate-for-gestational age newborn babies with HIE (subjects) and 85 healthy controls within the first 72 h of life. Asphyxiated neonates were classified into HIE stages using Sarnat and Sarnat staging. Blood samples were collected between 24 and 72 h of life to determine the level of troponin I using enzyme-linked immunosorbent assay. The asphyxiated babies were followed up till discharge or death. Results: The median interquartile range level of troponin I in the subjects was higher compared with the controls, 1.26 (0.97–3.16) ng/ml versus 0.79 (0.79–1.42) ng/ml, P < 0. 001. The levels of troponin I in HIE I, HIE II, and HIE III were 1.26 (1.00–2.37) ng/ml, 1.11 (0.86–2.96) ng/ml, and 3.58 (1.34–5.58) ng/ml, respectively. Nonsurvivors had a higher cardiac troponin I (4.00 [2.30–6.34] ng/ml) compared with survivors (1.21 [0.95–2.37] ng/ml), P = 0.015. Conclusion: Cardiac troponin I was significantly higher in asphyxiated subjects compared with healthy controls. Elevated troponin I was associated with higher mortality. Troponin I levels in the first 72 h can help as a prognostic indicator of HIE in term babies.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: An increase in prematurity and low birth weight (LBW) has been observed worldwide, to which several factors may be associated. This cross-sectional study aimed to evaluate the relationship between gestational age and LBW with oral mucosal lesions in newborns, maternal health conditions, newborn health conditions, and socioeconomic levels. Materials and Methods: The sample was comprised of 431 pairs of mothers-newborns born from a high and medium complexity hospital (CAAE nº: 57295316.3.0000.5149). Maternal health conditions and childbirth information were collected through the medical records and mothers answered a questionnaire on socioeconomic indicators. Oral mucosal lesions were evaluated by oral clinical examination. Gestational age and birth weight were analyzed, together with oral mucosal lesions and related factors, through bivariate and multivariate logistic regression models (α = 5%). Results: Prematurity and LBW were associated with Epstein pearls (odds ratio [OR]: 1.7; 95% confidence interval [CI]: 1.03–3.0; OR: 1.8; 95% CI: 1.1–3.2, respectively) and mucocele (OR: 4.6; 95% CI: 1.3–16.1; OR: 3.7; 95% CI: 1.1–13.1, respectively), but not ankyloglossia (OR: 1.0; 95% CI: 0.5–2.1; OR: 0.7; 95% CI: 0.3–1.6, respectively) or breastfeeding (OR: 0.5; 95% CI: 0.1-2.1; OR: 1.9; 95% IC: 0.2–15.6, respectively). Conclusion: Preterm and LBW newborns were more likely to have Epstein pearls and mucocele than full terms. Breastfeeding and ankyloglossia were not associated with prematurity and LBW.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Context: After being discharged from hospital, most preterm infants need to receive treatments such as gastric gavage, oxygen therapy, apnea control, and medication. Mother's unpreparedness to care for their infants causes anxiety for them. Aims: The purpose of the present study was to investigate the effect of home visit on anxiety of mothers having preterm infant discharged from neonatal intensive care unit (NICU). Settings and Design: This was a experimental control group study on 50 mothers with preterm infant discharged from NICU of Shahid Sadoughi Hospital, an educational hospital with 30 beds in a city in the west of Iran in 2019. Subjects and Methods: Participants with a convenience sampling were randomly assigned in the experimental and control groups. In the experimental group, home visit was done on the 3^rd and 5^th days after discharging the infants, and the mothers received necessary instructions proportional to their needs. Data collection tools included demographic information and Spielberger State-Trait Anxiety Inventory. Statistical Analysis Used: The findings were analyzed by SPSS 20 software using Kolmogorov–Smirnov, independent t-test, and Chi-square. Results: The mean ages of the participants in the intervention and control groups were 30.59 ± 6.38 and 28.67 ± 5.05 years, respectively. There was no significant difference between the mean obvious and hidden anxiety in the two groups (P > 0.05) before the intervention. However, after the intervention, the mean obvious and hidden anxiety in the experimental group was lower than the mean of the control group, and this difference was significant (P < 0.001). Conclusions: Home visit is effective in decreasing anxiety in mothers of preterm infant who have been discharged from NICU.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Necrotizing enterocolitis (NEC) is an inflammatory disorder that affects the gastrointestinal system of the preterm infants (gestational age less than 37 weeks). Cachectin is a cell signaling protein (cytokine) involved in systemic inflammation and is one of the cytokines that make up the acute phase reaction. Aim: To evaluate the level of blood cachectin (TNF-α) in preterm neonates as an indicator for NEC. Material and Methods: The present study was designed as an analytical cross-sectional study that included two groups: i) preterm neonates with necrotizing enterocolitis (NEC) admitted at neonatal intensive care unit (NICU) in Suez Canal University Hospital (n = 25), and ii) healthy preterm neonates (n = 25) who served as a normal control group. All neonates subjected to prenatal, natal and postnatal history, Physical examination, and blood samples were taken from cases once diagnosed as suspected NEC, proven NEC, or advanced NEC and from healthy preterm neonates when taking full oral feeding as a control. Then, measurement of cachectin level was done by ELISA kits. Results: It was found that neonates with necrotizing enterocolitis had significantly higher cachectin level (365.91 ± 260.76 ng/L) than healthy controls (83.92 ± 44.01 ng/L) (P < 0.001) and was also found that cachectin (TNF-α) levels are higher in NEC patients with complications. It was also found that cachectin (TNF-α) level of 116.6 was the best cut-off points with sensitivity of 92% and specificity of 90% for prediction of NEC among preterm neonates. Conclusion: The level of serum cachectin is higher in neonates with NEC than in healthy preterm neonates and it can be used as an indicator for early diagnosis of NEC.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Aim: The aim of this study is to evaluate the predictive value of routine cranial ultrasonography in preterm infants under 32 weeks' gestation with their neuromotor outcome at 2 years. Methods: This was a prospective, single-center, cohort study of preterm infants under 32 weeks' gestation. Each infant had an early (within 1 week of birth) and late (at 6 weeks postnatal age) cranial ultrasound scan performed. Each infant's scan result was independently assessed for the presence of major cranial abnormalities, such as intraventricular hemorrhage Grade 3 or 4, cystic periventricular leukomalacia, and porencephalic cyst. All surviving infants who returned for follow-up at 2 years' corrected age had their neuromotor development assessed using the Bayley Scales of Infant Development. The predictive value of major cranial abnormalities for the neuromotor delay was derived. Results: A total of 134 infants were included over 2 year. Of the 89 children with no major abnormality, 78 did not have a significant neuromotor delay, giving a negative predictive value of 87.6%. Of the six children with major abnormalities, two had a significant neuromotor delay, giving a positive predictive value of 33.3%. Conclusions: The absence of a major abnormality on quality-controlled routine cranial ultrasound scan in preterm infants under 32 weeks' gestation appears to be a good predictor of no significant abnormality in neuromotor development at 2 years of age.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

A 14-day-old baby girl was admitted with fever, profuse bleeding from umbilicus, and encephalopathy. Neuroimaging showed intracranial bleed and coagulopathy remained uncorrected with fresh frozen plasma. Coagulation profile characteristically demonstrated prolonged prothrombin time, international normalized ratio, and normal activated partial thromboplastin time. Factor VII assay was done which showed very low levels of Factor VII. Factor VII deficiency or Alexander disease, an autosomal recessive disorder, is the most common among rare bleeding disorders with a global prevalence of 1/5, 00,000. Defect can be either quantitative or qualitative. Clinical manifestations range from severe to nonsevere. Severe forms manifest in newborns with intracranial bleed. It is the least common presentation. Recombinant Factor VII remains the most effective therapy but is currently unavailable and very expensive even for the affordable considering short half-life of 4–6 h. Prenatal diagnosis with genetic testing remains the only promising preventive strategy.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]