Archives of Disease in Childhood - Fetal and Neonatal Edition最新文献

{"title":"Early and extended erythropoietin monotherapy after hypoxic ischaemic encephalopathy: a multicentre double-blind pilot randomised controlled trial.","authors":"Reema Garegrat, Atul Londhe, Swati Manerkar, Sudhindrashayana Fattepur, Laxmikant Deshmukh, Amol Joshi, Savitha Chandriah, Mallesh Kariyappa, Sahana Devadas, Theranirajan Ethirajan, Kalaivani Srivasan, Chinnathambi Kamalarathnam, Anitha Balachandran, Elango Krishnan, Deepthy Sahayaraj, Prathik Bandiya, Niranjan Shivanna, Constance Burgod, Ashwini Thayyil, Annie Alocious, Marianna Lanza, Pallavi Muraleedharan, Stuti Pant, Harini Venkateswaran, Maria Moreno Morales, Paolo Montaldo, Vaisakh Krishnan, Thaslima Kalathingal, Anagha Rajeev Joshi, Ajay Vare, G C Patil, Babu Peter Satyanathan, Pavan Hapat, Abhishek Deshmukh, Indramma Shivarudhrappa, Manjesh Kurupalya Annayappa, Mythili Baburaj, Christina Muradi, Esprance Fernandes, Nishad Thale, Ismat Jahan, Mohammed Shahidullah, Sadeka Moni Choudhury, Sanjoy Kumer Dey, Sutapa B Neogi, Rupsa Banerjee, Vanessa Rameh, Farah Alobeidi, Ellen Grant, Sandra E Juul, Martin Wilson, Enrico De Vita, Ronit Pressler, Paul Bassett, Seetha Shankaran, Sudhin Thayyil","doi":"10.1136/archdischild-2024-327107","DOIUrl":"10.1136/archdischild-2024-327107","url":null,"abstract":"<p><strong>Objective: </strong>To examine the feasibility of early and extended erythropoietin monotherapy after hypoxic ischaemic encephalopathy (HIE).</p><p><strong>Design: </strong>Double-blind pilot randomised controlled trial.</p><p><strong>Setting: </strong>Eight neonatal units in South Asia.</p><p><strong>Patients: </strong>Neonates (≥36 weeks) with moderate or severe HIE admitted between 31 December 2022 and 3 May 2023.</p><p><strong>Interventions: </strong>Erythropoietin (500 U/kg daily) or to the placebo (sham injections using a screen) within 6 hours of birth and continued for 9 days. MRI at 2 weeks of age.</p><p><strong>Main outcomes and measures: </strong>Feasibility of randomisation, drug administration and assessment of brain injury using MRI.</p><p><strong>Results: </strong>Of the 154 neonates screened, 56 were eligible; 6 declined consent and 50 were recruited; 43 (86%) were inborn. Mean (SD) age at first dose was 4.4 (1.2) hours in erythropoietin and 4.1 (1.0) hours in placebo. Overall mortality at hospital discharge occurred in 5 (19%) vs 11 (46%) (p=0.06), and 3 (13%) vs 9 (40.9%) (p=0.04) among those with moderate encephalopathy in the erythropoietin and placebo groups. Moderate or severe injury to basal ganglia, white matter and cortex occurred in 5 (25%) vs 5 (38.5%); 14 (70%) vs 11 (85%); and 6 (30%) vs 2 (15.4%) in the erythropoietin and placebo group, respectively. Sinus venous thrombosis was seen in two (10%) neonates in the erythropoietin group and none in the control group.</p><p><strong>Conclusions: </strong>Brain injury and mortality after moderate or severe HIE are high in South Asia. Evaluation of erythropoietin monotherapy using MRI to examine treatment effects is feasible in these settings.</p><p><strong>Trial registration number: </strong>NCT05395195.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"594-601"},"PeriodicalIF":3.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11503063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140904029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kangaroo mother care improves cardiorespiratory physiology in preterm infants: an observational study.","authors":"Arvind Sehgal, Emma J Yeomans, Gillian M Nixon","doi":"10.1136/archdischild-2023-326748","DOIUrl":"10.1136/archdischild-2023-326748","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate whether kangaroo mother care (KMC) in preterm infants on non-invasive respiratory support improves indices of cardiorespiratory wellbeing.</p><p><strong>Study design: </strong>Prospective quasi-experimental observational study.</p><p><strong>Setting: </strong>Tertiary perinatal neonatal unit.</p><p><strong>Patients: </strong>50 very preterm infants being managed with nasal continuous positive airway pressure.</p><p><strong>Interventions: </strong>Continuous high-resolution preductal pulse-oximetry recordings using Masimo Radical-7 oximeter for 1 hour (incubator care) followed by 1 hour during KMC performed on the same day.</p><p><strong>Main outcome measures: </strong>Measures of cardiorespiratory stability (dips in oxygen saturations (SpO₂)) of ≥5% less than baseline, % time spent with oxygen saturations <90%, SpO₂ variability and heart rate fluctuation and incidence of bradycardias.</p><p><strong>Results: </strong>The gestational age and birth weight of the cohort were 28.4±2.1 weeks and 1137±301 g, respectively. Dips in SpO₂ of ≥5% less than baseline were significantly fewer with KMC, median (IQR) 24 (12 to 42) vs 13 (3 to 25), p=0.001. SpO₂ variability (Delta 12 s and 2 s), (1.24±0.6 vs 0.9±0.4, p=0.005 and 4.1±1.7 vs 2.8±1.2, p<0.0001) and rapid resaturation and desaturation indices were significantly lower during KMC, compared with incubator care. Percentage time spent in oxygen saturations <90% was less with KMC (7.5% vs 2.7%, p=0.04). Mean heart rate was comparable although fluctuations in heart rate (rise by >8 bpm) were lower with KMC (43±22 vs 33±20, p=0.03). Seven (14%) infants had bradycardias during incubator care and none during KMC, p=0.012.</p><p><strong>Conclusions: </strong>KMC improves cardiorespiratory stability in ventilated preterm infants. Regular KMC has the potential to improve clinical outcomes in this vulnerable cohort.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"628-633"},"PeriodicalIF":3.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140304596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vibration-based mitigation of noxious-evoked responses to skin puncture in neonates and infants: a randomised controlled trial.","authors":"Lance M Relland, Caitlin P Kjeldsen, Arnaud Jeanvoine, Lelia Emery, Kathleen Adderley, Rachelle Srinivas, Maeve McLoughlin, Nathalie L Maitre","doi":"10.1136/archdischild-2023-326588","DOIUrl":"10.1136/archdischild-2023-326588","url":null,"abstract":"<p><strong>Objective: </strong>To assess the effect of a non-noxious vibratory stimulus on noxious-evoked cortical responses to skin puncture and to determine whether the presence of certain behavioural components may be used to predict such cortical responses.</p><p><strong>Design: </strong>Randomised controlled trial.</p><p><strong>Setting: </strong>Level IV neonatal intensive care unit at a stand-alone children's hospital.</p><p><strong>Patients: </strong>134 hospitalised infants between 36 and 52 weeks' postmenstrual age and ordered to receive a clinically required laboratory draw.</p><p><strong>Interventions: </strong>Infants randomised to receive the intervention, a vibratory stimulus at the site of skin puncture beginning 10 s prior to a heel stick, or the control, no vibration.</p><p><strong>Main outcome measures: </strong>Electroencephalography and video recording time-locked to the deployment of the lancet for the skin puncture. Noxious-evoked cortical responses were measured by the area under the curve in the somatosensory region contralateral to the skin puncture. Behavioural responses were coded through video analysis.</p><p><strong>Results: </strong>Noxious-evoked cortical responses were significantly reduced in participants receiving the vibratory stimulus compared with the control (frontal, p<0.0001; central, p<i>=</i>0.0088; central-parietal, p<i>=</i>0.0111). There were no significant differences in behavioural responses between groups (all p>0.05).</p><p><strong>Conclusions: </strong>A non-noxious vibratory stimulus presented prior to and continuing simultaneously with skin puncture significantly mitigates nociception in hospitalised infants. The presence or absence of facial expression components is inadequate to reliably predict pain signalling in the brain.</p><p><strong>Trial registration number: </strong>NCT04050384.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"622-627"},"PeriodicalIF":3.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140118574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"State of skin antiseptic choices in UK neonatal intensive care units in 2023.","authors":"Elisabeth Agathos, Carla Kantyka, Paul Clarke","doi":"10.1136/archdischild-2024-326858","DOIUrl":"10.1136/archdischild-2024-326858","url":null,"abstract":"","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"678-679"},"PeriodicalIF":3.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139728783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intermittent sigh breaths during high-frequency oscillatory ventilation in preterm infants: a randomised crossover study.","authors":"Judith Leigh Hough, Luke Jardine, Matthew James Hough, Michael Steele, Gorm Greisen, Christian Heiring","doi":"10.1136/archdischild-2024-327445","DOIUrl":"https://doi.org/10.1136/archdischild-2024-327445","url":null,"abstract":"<p><strong>Objective: </strong>To determine if combining high-frequency oscillatory ventilation (HFOV) with additional sigh breaths would improve end-expiratory lung volume (EELV) and oxygenation in preterm infants.</p><p><strong>Design: </strong>Prospective interventional crossover study.</p><p><strong>Setting: </strong>Neonatal intensive care unit.</p><p><strong>Patients: </strong>Ventilated preterm infants <36 weeks corrected gestational age receiving HFOV.</p><p><strong>Interventions: </strong>Infants were randomly assigned to receive HFOV with sigh breaths followed by HFOV-only (or vice versa) for four alternating periods. Sigh breaths were delivered with an inspiratory time of 1 s, peak inspiratory pressure of 30 cmH₂0 and frequency of three breaths/min.</p><p><strong>Main outcome measures: </strong>Electrical impedance tomography measured the effect of sigh breaths on EELV and ventilation distribution. Physiological variables were recorded to monitor oxygenation. Measurements were taken at 30 and 60 min postchange of HFOV mode and compared with baseline.</p><p><strong>Results: </strong>Sixteen infants (10 males, 6 females) with a median (range) gestational age at birth of 25.5 weeks (23-31), study weight of 950 g (660-1920) and a postnatal age of 25 days (3-49) were included in the study. The addition of sigh breaths resulted in a significantly higher global EELV (mean difference±95% CI) (0.06±0.05; p=0.04), with increased ventilation occurring in the posterior (dependent) and left lung segments, and improved oxygen saturations (3.31±2.10; p<0.01).</p><p><strong>Conclusion: </strong>Intermittent sigh breaths during HFOV were associated in the short-term with an increased EELV in the posterior and left lungs, and improved oxygen saturations in preterm infants.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Premedication for less invasive surfactant administration: a narrative review.","authors":"Claire A Murphy, Kevin Cw Goss, Rebeccah Slater, Shalini Ojha, Peter A Dargaville, Chris Gale","doi":"10.1136/archdischild-2024-326947","DOIUrl":"https://doi.org/10.1136/archdischild-2024-326947","url":null,"abstract":"<p><p>Less invasive surfactant administration (LISA) is an increasingly popular technique to deliver surfactant to spontaneously breathing preterm infants with respiratory distress syndrome. The optimal method of alleviating the pain and discomfort associated with LISA, either pharmacological or non-pharmacological, while maintaining spontaneous respiration remains unclear. There is limited evidence to guide clinicians, resulting in wide variations in practice. The aim of this article is to summarise the current knowledge and evidence gaps regarding the use of premedication prior to LISA.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between early pulmonary arterial pressure measurements and bronchopulmonary dysplasia or mortality in very preterm infants: a prospective cohort study.","authors":"Mustafa Senol Akin, Gökce Kas, Emre Aydin, Aslıhan Kose Cetinkaya, Ibrahim Ece, Fatma Nur Sari, Evrim Alyamac Dizdar","doi":"10.1136/archdischild-2024-327169","DOIUrl":"https://doi.org/10.1136/archdischild-2024-327169","url":null,"abstract":"<p><strong>Background: </strong>Prematurity is a significant risk for bronchopulmonary dysplasia related pulmonary artery pressure.</p><p><strong>Objective: </strong>To determine the association between pulmonary artery pressure in the early days of life and the development of bronchopulmonary dysplasia or mortality.</p><p><strong>Methods: </strong>This prospective observational cohort study included infants born at <32 weeks and weighing <1500 g. Pulmonary artery pressure was measured between postnatal days 3 and 7. Pulmonary hypertension was defined as systolic pulmonary artery pressure ≥40 mm Hg or systolic pulmonary artery pressure/systolic blood pressure >0.5 (pulmonary hypertension criterion-1). Infants were categorised into pulmonary hypertension and non-pulmonary hypertension groups. The primary endpoint was bronchopulmonary dysplasia or mortality. Receiver operating characteristic analysis established a new threshold value for predicting bronchopulmonary dysplasia or mortality (pulmonary hypertension criterion-2). Infants were reanalysed according to new criteria.</p><p><strong>Results: </strong>A total of 329 infants were included in this study. Moderate-to-severe pulmonary hypertension was identified in 24% (n=79) of the infants. The pulmonary hypertension group exhibited a significantly lower gestational age, lower birth weight and a higher incidence of small for gestational age. Systolic pulmonary artery pressure >25 mm Hg or systolic pulmonary artery pressure/systolic blood pressure >0.35 was defined as the pulmonary hypertension criterion-2. Logistic regression analysis identified pulmonary hypertension criterion-2 as an independent risk factor for moderate-to-severe bronchopulmonary dysplasia or mortality (OR 2.67, 95% CI 1.3 to 5.51, p<0.01).</p><p><strong>Conclusion: </strong>Pulmonary artery pressure exceeding 25 mm Hg in the early days of life may be considered a potential risk factor for bronchopulmonary dysplasia or mortality.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral injury and retinopathy as risk factors for blindness in extremely preterm infants.","authors":"Benjamin M Honan, Scott A McDonald, Colm P Travers, Vivek V Shukla, Namasivayam Ambalavanan, C Michael Cotten, Viral G Jain, Hope E Arnold, Nehal A Parikh, Jon E Tyson, Susan R Hintz, Stephen A Walker, Marie G Gantz, Abhik Das, Waldemar A Carlo","doi":"10.1136/archdischild-2024-327707","DOIUrl":"10.1136/archdischild-2024-327707","url":null,"abstract":"<p><strong>Objective: </strong>This study investigates whether and to what extent cerebral injury is associated with bilateral blindness in extremely preterm infants, which has been attributed mainly to retinopathy of prematurity (ROP).</p><p><strong>Design: </strong>Multicentre analysis of children born from 1994 to 2021 at gestational age 22 0/7 to 28 6/7 weeks with follow-up at 18-26 months. Logistic regression examined the adjusted association of bilateral blindness with severe ROP and/or cerebral injury among extremely preterm infants.</p><p><strong>Exposures: </strong>Severe ROP and cerebral injury, the latter defined as any of the following on cranial imaging: ventriculomegaly; blood/increased echogenicity in the parenchyma; cystic periventricular leukomalacia.</p><p><strong>Main outcome measures: </strong>Bilateral blindness, defined as a follow-up examination meeting criteria of 'blind-some functional vision' or 'blind-no useful vision' in both eyes.</p><p><strong>Results: </strong>The 19 863 children included had a mean gestational age of 25.6±1.7 weeks, mean birth weight of 782±158 g and 213 (1%) had bilateral blindness. Multiplicative interaction between ROP and cerebral injury was statistically significant. For infants with only severe ROP (n=3130), odds of blindness were 8.14 times higher (95% CI 4.52 to 14.65), and for those with only cerebral injury (n=2836), odds were 8.38 times higher (95% CI 5.28 to 13.28), compared with the reference group without either condition. Risks were not synergistic for infants with both severe ROP and cerebral injury (n=1438, adjusted OR=28.7, 95% CI 16.0 to 51.7, p<0.0001).</p><p><strong>Conclusions: </strong>In a group of extremely preterm infants, severe ROP and cerebral injury were equally important risk factors for blindness. Besides ROP, clinicians should consider cerebral injury as a cause of blindness in children born extremely preterm.</p><p><strong>Trial registration number: </strong>NCT00063063.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11946922/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fetal haemoglobin and oxygen requirement in preterm infants: an observational study.","authors":"Tommy Ulinder, William Hellström, Christian Gadsbøll, Linda Nilsson, Margareta Gebka, Gustav Robertz, Matteo Bruschettini, Ann Hellstrom, David Ley","doi":"10.1136/archdischild-2024-327411","DOIUrl":"https://doi.org/10.1136/archdischild-2024-327411","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the relationship between the fraction of fetal haemoglobin (HbF(%)) and oxygen requirement as determined by the fraction of inspired oxygen (FiO₂) and alveolar-arterial gradient (A-a gradient). Increased alveolar exposure to oxygen may explain the association between decreased HbF(%) and the development of bronchopulmonary dysplasia (BPD).</p><p><strong>Design: </strong>Longitudinal, retrospective, observational study.</p><p><strong>Setting: </strong>Tertiary-level neonatal intensive care unit, referral centre for southern Sweden.</p><p><strong>Patients: </strong>Four hundred forty very preterm infants born before gestational week 30, 2009-2015.</p><p><strong>Intervention: </strong>Regular clinical practice.</p><p><strong>Main outcome measures: </strong>The FiO₂ and A-a gradient were determined at the time-point of 10 015 arterial blood gas analyses obtained during postnatal days 1-7. The relationship between HbF(%) and FiO₂ and A-a gradient and the modifying influence of other factors affecting haemoglobin oxygen affinity were evaluated.</p><p><strong>Results: </strong>We found a significant relationship between a low fraction of HbF and an increase in FiO₂ and A-a gradient, respectively. These relationships remained significant after adjusting for pH, pCO₂, postnatal age, gestational age and sex.</p><p><strong>Conclusion: </strong>These high-resolution data show that decreased HbF(%) during the first postnatal week is associated with increased FiO₂ and A-a gradient in very preterm infants. Increased alveolar exposure to oxygen and resulting oxidative stress may, at least partly, explain the previously reported associations between decreased HbF, blood transfusions and the development of BPD in preterm infants.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neonatal hyperinsulinism: a retrospective study of presentation and management in a tertiary neonatal intensive care unit in the UK.","authors":"Maria-Sofia Kalogeropoulou, Helen Couch, Ajay Thankamony, Kathy Beardsall","doi":"10.1136/archdischild-2024-327322","DOIUrl":"https://doi.org/10.1136/archdischild-2024-327322","url":null,"abstract":"<p><strong>Objective: </strong>Reports of hyperinsulinism typically focus on infants managed by highly specialised services. However, neonates with hyperinsulinism are initially managed by neonatologists and often not referred to specialists. This study aimed to characterise the diversity in presentation and management of these infants.</p><p><strong>Setting: </strong>Level 3 neonatal intensive care.</p><p><strong>Patients: </strong>Neonates with hyperinsulinism, defined as blood glucose <2.8 mmol/mL and insulin level >6 pmol/L.</p><p><strong>Design: </strong>7-year retrospective study (January 2015-December 2021).</p><p><strong>Results: </strong>99 cases were identified: <i>severe</i>-treated with diazoxide (20%), <i>moderate</i>-clinically concerning hyperinsulinism not treated with diazoxide (30%), <i>mild</i>-biochemical hyperinsulinism (50%). Birth weight z-score was -1.02±2.30 (mean±SD), 42% were preterm, but neither variable correlated with clinical severity. The <i>severe</i> group received a higher concentration of intravenous glucose (27±12%) compared with the <i>moderate</i> (15±7%) and <i>mild</i> (16±10%) groups (p<0.001). At diagnosis, the intravenous glucose intake was similar in the <i>severe</i> (7.43±5.95 mg/kg/min) and <i>moderate</i> (5.09±3.86 mg/kg/min) groups, but higher compared with the <i>mild</i> group (3.05+/2.21 mg/kg/min) (p<0.001). In the <i>severe</i> group, term infants started diazoxide earlier (9.9±4.3 days) compared with preterm (37±26 days) (p=0.002). The national congenital hyperinsulinism service was consulted for 23% of infants, and 3% were transferred.</p><p><strong>Conclusions: </strong>This study highlights the diversity in clinical presentation, severity and prognosis of neonatal hyperinsulinism, irrespective of birth weight and gestational age. More infants were small rather than large for gestational age, and the majority had transient hyperinsulinism and were not referred to the national centre, or treated with diazoxide. Further research is required to understand the breadth of neonatal hyperinsulinism and optimal management.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}