Fetal & Neonatal最新文献

{"title":"Treatment courses and outcomes of oesophageal atresia in patients with trisomy 18: a case series of 271 patients from a nationwide database in Japan","authors":"Mai Kutsukake, Takaaki Konishi, Michimasa Fujiogi, Naohiro Takamoto, Kaori Morita, Ikuta Yasuhisa, Yohei Hashimoto, Hiroki Matsui, Kiyohide Fushimi, Jun Fujishiro, Hideo Yasunaga","doi":"10.1136/archdischild-2023-326354","DOIUrl":"https://doi.org/10.1136/archdischild-2023-326354","url":null,"abstract":"Objective To describe characteristics, treatments and clinical outcomes of patients with trisomy 18 and oesophageal atresia, using a nationwide database in Japan. Design Descriptive study using a retrospective cohort. Setting A nationwide inpatient database including 90% of hospitals with neonatal intensive care units in Japan. Patients Patients hospitalised within a day after birth for both oesophageal atresia and trisomy 18 between July 2010 and March 2020. Interventions Radical surgery for oesophageal atresia. Main outcome measures Characteristics, treatment course and outcomes. Results Among 271 patients with both oesophageal atresia and trisomy 18, 70 patients underwent radical surgery for oesophageal atresia. Patients who underwent radical surgery were less likely to have severe cardiac anomalies (17% vs 32%; p=0.020), but more likely to undergo cardiac surgery (21% vs 9.5%; p=0.012) than those who did not. The overall in-hospital mortality was lower (54% vs 79%; p<0.001) and the median age at death was higher (210 days vs 39 days; p<0.001) in patients who underwent radical surgery than the others. Postoperative mortality within 30 days after radical surgery was 5.7%. Patients who underwent radical surgery were likely to be discharged to home (50% vs 18%; p<0.001), whereas the age at home discharge (median 314 days vs 216 days; p=0.19) and the requirement for each home treatment did not differ significantly by radical surgery. Conclusion This study provides information that will aid the clinical decision-making process for patients with oesophageal atresia and trisomy 18. Radical surgery may be a safe and feasible treatment option. No data are available.","PeriodicalId":501153,"journal":{"name":"Fetal & Neonatal","volume":"267 2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138545914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building a better model: abandon kitchen sink regression","authors":"Stefan Kuhle, Mary Margaret Brown, Sanja Stanojevic","doi":"10.1136/archdischild-2023-326340","DOIUrl":"https://doi.org/10.1136/archdischild-2023-326340","url":null,"abstract":"This paper critically examines ‘kitchen sink regression’, a practice characterised by the manual or automated selection of variables for a multivariable regression model based on p values or model-based information criteria. We highlight the pitfalls of this method, using examples from perinatal/neonatal medicine, and propose more robust alternatives. The concept of directed acyclic graphs (DAGs) is introduced as a tool for describing and analysing causal relationships. We highlight five key issues with ‘kitchen sink regression’: (1) the disregard for the directionality of variable relationships, (2) the lack of a meaningful causal interpretation of effect estimates from these models, (3) the inflated alpha error rate due to multiple testing, (4) the risk of overfitting and model instability and (5) the disregard for content expertise in model building. We advocate for the use of DAGs to guide variable selection for models that aim to examine associations between a putative risk factor and an outcome and emphasise the need for a more thoughtful and informed use of regression models in medical research.","PeriodicalId":501153,"journal":{"name":"Fetal & Neonatal","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138546012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of cord clamping on haemodynamic transition in term newborn infants","authors":"Roberto Chioma, Daragh Finn, David B Healy, Ita Herlihy, Vicki Livingstone, Jurate Panaviene, Eugene M Dempsey","doi":"10.1136/archdischild-2023-325652","DOIUrl":"https://doi.org/10.1136/archdischild-2023-325652","url":null,"abstract":"Objective To assess the haemodynamic consequences of cord clamping (CC) in healthy term infants. Design Cohort study. Setting Tertiary maternity hospital. Patients 46 full-term vigorous infants born by caesarean section. Interventions Echocardiography was performed before CC, immediately after CC and at 5 min after birth. Main outcome measures Pulsed wave Doppler-derived cardiac output and the pulmonary artery acceleration time indexed to the right ventricle ejection time were obtained. As markers of loading fluctuations, the myocardial performance indexes and the velocities of the tricuspid and mitral valve annuli were determined with tissue Doppler imaging. Heart rate was derived from Doppler imaging throughout the assessments. Results Left ventricular output increased throughout the first minutes after birth (mean (SD) 222.4 (32.5) mL/kg/min before CC vs 239.7 (33.6) mL/kg/min at 5 min, p=0.01), while right ventricular output decreased (306.5 (48.2) mL/kg/min before vs 272.8 (55.5) mL/kg/min immediately after CC, p=0.001). The loading conditions of both ventricles were transiently impaired by CC, recovering at 5 min. Heart rate progressively decreased after birth, following a linear trend temporarily increased by CC. The variation in left ventricular output across the CC was directly correlated to the fluctuation of left ventricular preload over the same period (p = 0.03). Conclusions This study illustrates the cardiovascular consequences of CC in term vigorous infants and offers insight into the haemodynamic transition from fetal to neonatal circulation in spontaneously breathing newborns. Strategies that aim to enhance left ventricular preload before CC may prevent complications of perinatal cardiovascular imbalance. Data are available on reasonable request. The data that support the findings of this study are available on request from the authors.","PeriodicalId":501153,"journal":{"name":"Fetal & Neonatal","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138545870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recognising risk of neonatal encephalopathy with advancing gestation in nulliparous women is crucial for case review","authors":"Malcolm Battin, Lynn Sadler, Meghan Hill","doi":"10.1136/archdischild-2023-326203","DOIUrl":"https://doi.org/10.1136/archdischild-2023-326203","url":null,"abstract":"In neonatal encephalopathy (NE), establishing the history includes scrutiny of the perinatal events contributing to the infant’s condition. For births initially considered ‘low risk’ but resulting in peripartum hypoxia, it is crucial to perform interdisciplinary case review. The neonatal perspective (although retrospective) is valuable, but the denominator of healthy babies is not reviewed, only the injured, so hindsight bias should be recognised. Nevertheless, we must consider potential opportunities to act differently and mitigate, particularly if clear risk factors were underappreciated at the time. In Aotearoa New Zealand, the Perinatal and Maternal Mortality Review Committee (PMMRC) collects national data on NE.1 Annual reports include clinical and demographic factors, which facilitate case review to document contributing factors and potential preventability.2 The PMMRC report1 documents …","PeriodicalId":501153,"journal":{"name":"Fetal & Neonatal","volume":"469 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138510567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal treatment with selective serotonin reuptake inhibitors during pregnancy and delayed neonatal adaptation: a population-based cohort study","authors":"Marie-Coralie Cornet, Yvonne W Wu, Heather Forquer, Lyndsay A Avalos, Achyuth Sriram, Aaron W Scheffler, Thomas B Newman, Michael W Kuzniewicz","doi":"10.1136/archdischild-2023-326049","DOIUrl":"https://doi.org/10.1136/archdischild-2023-326049","url":null,"abstract":"Objective Selective serotonin reuptake inhibitor (SSRI) use is common in pregnancy. It is associated with delayed neonatal adaptation. Most previous studies have not adjusted for the severity of maternal mental health disorders or examined the impact of SSRI type and dosage. We examined whether treatment with SSRIs in late pregnancy (after 20 weeks) is associated with delayed neonatal adaptation independent of maternal depression and anxiety. Design, setting and patients Retrospective population-based birth cohort of 280 090 term infants born at 15 Kaiser Permanente Northern California hospitals, 2011–2019. Individual-level pharmacy, maternal, pregnancy and neonatal data were obtained from electronic medical records. Exposure Dispensed maternal SSRI prescription after 20 weeks of pregnancy. Main outcome measures Delayed neonatal adaptation defined as a 5 min Apgar score ≤5, resuscitation at birth or admission to a neonatal intensive care unit for respiratory support. Secondary outcomes included each individual component of the primary outcome and more severe neonatal outcomes (pulmonary hypertension, hypoxic-ischaemic encephalopathy and seizures). Results 7573 (2.7%) infants were exposed to SSRIs in late pregnancy. Delayed neonatal adaptation occurred in 11.2% of exposed vs 4.4% of unexposed infants (relative risk 2.52 (95% CI 2.36 to 2.70)). After multivariable adjustment, there was an association between SSRI exposure and delayed neonatal adaptation (adjusted OR 2.14 (95% CI 1.96 to 2.32)). This association was dose dependent. Escitalopram and fluoxetine were associated with the highest risk of delayed neonatal adaptation. Conclusions Infants exposed to SSRIs have increased risks of delayed adaptation in a type and dose-dependent relationship, pointing toward a causal relationship. Data are available upon reasonable request. The datasets generated for this study are stored at the KPNC Division of Research. Deidentified data can be provided upon reasonable request to the corresponding author, and with permission from the KPNC Institutional Review Board.","PeriodicalId":501153,"journal":{"name":"Fetal & Neonatal","volume":"475 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138510566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to: ‘Herpes simplex virus infection among neonates suspected of invasive bacterial infection: a population-based cohort study’ by Dungu et al","authors":"Georgina Yan, Annalie Shears, Julia R Dudley, Paddy McMaster, Katy J Fidler","doi":"10.1136/archdischild-2023-326551","DOIUrl":"https://doi.org/10.1136/archdischild-2023-326551","url":null,"abstract":"Our recent prospective UK-wide British Paediatric Surveillance Unit (BPSU) cohort study findings echo the increase in incidence of neonatal herpes simplex virus (HSV) described by Dungu et al. 1 We found that the incidence of neonatal HSV infection has tripled over the last three decades in the UK from 1.65/100 000 in 1986–19912 to a minimum of 6/100 000 infants between August 2019 and February 2022.3 General consensus among the UK Paediatric Antimicrobial Stewardship (UK-PAS) network is in agreement with the above authors that not all unwell infants …","PeriodicalId":501153,"journal":{"name":"Fetal & Neonatal","volume":"515 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138510475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurodevelopmental outcome at 5.5 years in Dutch preterm infants born at 24–26 weeks’ gestational age: the EPI-DAF study","authors":"Pauline E van Beek, Monique Rijken, Lisa Broeders, Hendrik J ter Horst, Corine Koopman-Esseboom, Ellen de Kort, A R C Laarman, S M Mulder - de Tollenaer, Katerina Steiner, Renate M C Swarte, Elke van Westering-Kroon, Guid Oei, Aleid G Leemhuis, Peter Andriessen","doi":"10.1136/archdischild-2023-325732","DOIUrl":"https://doi.org/10.1136/archdischild-2023-325732","url":null,"abstract":"Objective After lowering the Dutch threshold for active treatment from 25 to 24 completed weeks’ gestation, survival to discharge increased by 10% in extremely preterm live born infants. Now that this guideline has been implemented, an accurate description of neurodevelopmental outcome at school age is needed. Design Population-based cohort study. Setting All neonatal intensive care units in the Netherlands. Patients All infants born between 240/7 and 266/7 weeks’ gestation who were 5.5 years’ corrected age (CA) in 2018–2020 were included. Main outcome measures Main outcome measure was neurodevelopmental outcome at 5.5 years. Neurodevelopmental outcome was a composite outcome defined as none, mild or moderate-to-severe impairment (further defined as neurodevelopmental impairment (NDI)), using corrected cognitive score (Wechsler Preschool and Primary Scale of Intelligence Scale-III-NL), neurological examination and neurosensory function. Additionally, motor score (Movement Assessment Battery for Children-2-NL) was assessed. All assessments were done as part of the nationwide, standardised follow-up programme. Results In the 3-year period, a total of 632 infants survived to 5.5 years’ CA. Data were available for 484 infants (77%). At 5.5 years’ CA, most cognitive and motor (sub)scales were significantly lower compared with the normative mean. Overall, 46% had no impairment, 36% had mild impairment and 18% had NDI. NDI-free survival was 30%, 49% and 67% in live born children at 24, 25 and 26 weeks’ gestation, respectively (p<0.001). Conclusions After lowering the threshold for supporting active treatment from 25 to 24 completed weeks’ gestation, a considerable proportion of the surviving extremely preterm children did not have any impairment at 5.5 years’ CA. All data relevant to the study are included in the article or uploaded as supplementary information. Other data may be obtained from a third party and are not publicly available.","PeriodicalId":501153,"journal":{"name":"Fetal & Neonatal","volume":"498 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138510477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolution of the Sarnat exam and association with 2-year outcomes in infants with moderate or severe hypoxic-ischaemic encephalopathy: a secondary analysis of the HEAL Trial","authors":"Ulrike Mietzsch, Sarah E Kolnik, Thomas Ragnar Wood, Niranjana Natarajan, Fernando F Gonzalez, Hannah Glass, Dennis E Mayock, Sonia L Bonifacio, Krisa Van Meurs, Bryan A Comstock, Patrick J Heagerty, Tai-Wei Wu, Yvonne W Wu, Sandra E Juul","doi":"10.1136/archdischild-2023-326102","DOIUrl":"https://doi.org/10.1136/archdischild-2023-326102","url":null,"abstract":"Objective To study the association between the Sarnat exam (SE) performed before and after therapeutic hypothermia (TH) and outcomes at 2 years in infants with moderate or severe hypoxic-ischaemic encephalopathy (HIE). Design Secondary analysis of the H igh-dose E rythropoietin for A sphyxia and Encepha L opathy Trial. Adjusted ORs (aORs) for death or neurodevelopmental impairment (NDI) based on SE severity category and change in category were constructed, adjusting for sedation at time of exam. Absolute SE Score and its change were compared for association with risk for death or NDI using locally estimated scatterplot smoothing curves. Setting Randomised, double-blinded, placebo-controlled multicentre trial including 17 centres across the USA. Patients 479/500 enrolled neonates who had both a qualifying SE (qSE) before TH and a SE after rewarming (rSE). Interventions Standardised SE was used across sites before and after TH. All providers underwent standardised SE training. Main outcome measures Primary outcome was defined as the composite outcome of death or any NDI at 22–36 months. Results Both qSE and rSE were associated with the primary outcome. Notably, an aOR for primary outcome of 6.2 (95% CI 3.1 to 12.6) and 50.3 (95% CI 13.3 to 190) was seen in those with moderate and severe encephalopathy on rSE, respectively. Persistent or worsened severity on rSE was associated with higher odds for primary outcome compared with those who improved, even when qSE was severe. Conclusion Both rSE and change between qSE and rSE were strongly associated with the odds of death/NDI at 22–36 months in infants with moderate or severe HIE. Data are available upon reasonable request. Data are available upon request and will be publicly available soon.","PeriodicalId":501153,"journal":{"name":"Fetal & Neonatal","volume":"510 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138510476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of body position on ventilation distribution in healthy newborn infants: an observational study","authors":"Marika Rahtu, Inéz Frerichs, Tytti Pokka, Tobias Becher, Outi Peltoniemi, Merja Kallio","doi":"10.1136/archdischild-2023-325967","DOIUrl":"https://doi.org/10.1136/archdischild-2023-325967","url":null,"abstract":"Objectives Newborn infants have unique respiratory physiology compared with older children and adults due to their lungs’ structural and functional immaturity and highly compliant chest wall. To date, ventilation distribution has seldom been studied in this age group. This study aims to assess the effect of body position on ventilation distribution in spontaneously breathing healthy neonates. Design Prospective observational study. Setting Maternity wards of Oulu University Hospital. Patients 20 healthy, spontaneously breathing, newborn infants. Interventions Electrical impedance tomography data were recorded with a 32-electrode belt (Sentec AG, Landquart, Switzerland) in six different body positions in random order. Ventilation distribution was retrospectively assessed 10 minutes after each position change. Main outcome measures In each position, regional tidal impedance variation (ΔZ) and ventral-to-dorsal and right-to-left centre of ventilation were measured. Results The mean global ΔZ was the largest in supine position and it was smaller in prone and lateral positions. Yet, global ΔZ did not differ in supine positions, ventilation distribution was more directed towards the non-dependent lung region in supine tilted position (p<0.001). In prone, a reduction of global ΔZ was observed (p<0.05) corresponding to an amount of 10% of global tidal variation in supine position. In both lateral positions, tidal ventilation was distributed more to the corresponding non-dependent lung region. Conclusions Prone or lateral body positioning in healthy spontaneously breathing newborns leads to a redistribution of ventilation to the non-dependent lung regions and at the same time global tidal volume is reduced as compared with supine. No data are available. Not applicable.","PeriodicalId":501153,"journal":{"name":"Fetal & Neonatal","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138543645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Late surfactant administration after 48 hours of age in preterm neonates with respiratory insufficiency: a systematic review and meta-analysis","authors":"Gonzalo Solís-García, Sara Elias, Michael Dunn, Bonny Jasani","doi":"10.1136/archdischild-2023-326333","DOIUrl":"https://doi.org/10.1136/archdischild-2023-326333","url":null,"abstract":"Objective To systematically review and meta-analyse the effect of late surfactant administration versus placebo in reducing the incidence of death or bronchopulmonary dysplasia (BPD) in preterm infants. Design PubMed, EMBASE, CINAHL and Cochrane CENTRAL were searched until 30 May 2023, for randomised controlled trials (RCTs) comparing administration of surfactant after 48 hours of age versus placebo in preterm ventilator-dependent neonates. The primary outcome was incidence of death or BPD at 36 weeks’ postmenstrual age (PMA). Secondary outcomes included incidence of BPD at 36 weeks PMA, pre-discharge mortality, use of postnatal steroids, post-discharge respiratory support, treatment with steroids or hospitalisation prior to 1-year corrected age. Results Pooled analyses of four RCTs (N=850) showed no statistically significant difference between groups in the incidence of death or BPD at 36 weeks’ PMA (relative risk (RR) 0.99; 95% CI 0.90 to 1.10; Grades of Recommendation, Assessment, Development and Evaluation (GRADE): moderate). Late surfactant administration significantly decreased the need for post-discharge respiratory support prior to 1-year corrected age (two RCTs; N=522; RR 0.72; 95% CI 0.59 to 0.89; GRADE: low). Other secondary outcomes did not differ significantly between the groups. Conclusions Administration of late surfactant does not improve the rates of death or BPD at 36 weeks when administered to preterm infants with prolonged respiratory insufficiency. Additional adequately powered trials are needed to establish the efficacy of late surfactant therapy in preterm infants. PROSPERO registration number CRD42023432463.","PeriodicalId":501153,"journal":{"name":"Fetal & Neonatal","volume":"480 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138510565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}