Neonatology最新文献

{"title":"Oxygenation of Immature Infants in the Delivery Room and Beyond. A Quest for Future Research.","authors":"Ola Didrik Saugstad, Christian P Speer, Maximo Vento","doi":"10.1159/000543208","DOIUrl":"https://doi.org/10.1159/000543208","url":null,"abstract":"<p><p>This is an editorial without abstract.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866852","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":"Caffeine therapy for apnea of prematurity: single center study on dosing practices and perceived effectiveness.","authors":"Kelly K Storm, Robert B Flint, Wes Onland, Anton H van Kaam, Irwin K M Reiss, G Jeroen Hutten, Sinno H P Simons","doi":"10.1159/000543074","DOIUrl":"https://doi.org/10.1159/000543074","url":null,"abstract":"<p><strong>Introduction: </strong>Caffeine is the registered pharmacologic treatment for apnea of prematurity and is extensively used in the neonatal intensive care units (NICUs) based on evidence from randomized controlled trials. This study aimed to describe the clinical use of caffeine based on real-world data, hypothesizing a divergence from the registered dosing regimen.</p><p><strong>Methods: </strong>A retrospective analysis included infants born before 30 weeks of gestation, admitted to the NICU of the Erasmus MC Rotterdam from 2018 to 2021. Exclusion criteria comprised infants admitted after postnatal day 2, those not receiving caffeine during admission, patients admitted for less than 24 hours, those who spent less than 24 hours on non-invasive support, and cases lacking medication data. The primary outcome was the proportion of patients receiving an average caffeine dose higher than registered in the label.</p><p><strong>Results: </strong>A total of 451 patients with a median gestational age of 28+0 weeks (IQR 26+2-29+0) and birthweight of 1,015 grams (IQR 800-1,218) were included. Of these, 402 infants (89%) received an average daily caffeine dosage exceeding the registered dose range. The median caffeine maintenance dose per patient was 5.3 mg/kg/day (IQR 5.0-5.8), with additional therapy (mini-load, doxapram or intubation) needed in 318 patients (71%).</p><p><strong>Conclusion: </strong>This study highlights the frequent use of higher caffeine dosages in clinical practice than registered and recommended based on long-term safety data. Despite these high dosages and frequent mini-loads, 28% of patients still required additional treatment with doxapram and/or invasive mechanical ventilation, indicating the need for individualized dosing strategies or alternative therapies.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-20"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840175","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":"Gut Pathogen Colonization: A Risk Factor to Bloodstream Infections in Preterm Neonates Admitted in the Neonatal Intensive Care Unit - A Prospective Cohort Study.","authors":"Faiza Iqbal, N Siva, Padmaja A Shenoy, Leslie Edward S Lewis, Jayashree Purkayastha, Vandana Kalwaje Eshwara","doi":"10.1159/000542335","DOIUrl":"https://doi.org/10.1159/000542335","url":null,"abstract":"<p><strong>Introduction: </strong>Gut pathogen colonization, where pathogens disrupt the normal gut microbiota, has been implicated in the development of bloodstream infections (BSIs). This study investigates the association between gut pathogen colonization and BSI, hypothesizing that species causing BSI primarily originated from gut.</p><p><strong>Methods: </strong>A prospective cohort study was conducted in the neonatal intensive care unit (NICU) of tertiary care hospital in Karnataka, India, from January 2021 to September 2023. Inborn preterm infants were enrolled. The study population was divided into two groups: group A (neonates without sepsis) and group B (neonates with sepsis). Demographic details and blood culture results were collected. Stool samples were taken on day 4 and day 14 for group A, and on day 4 and the day of sepsis diagnosis for group B.</p><p><strong>Results: </strong>Group B had a lower mean birthweight (1,649.6 ± 652.1 g) compared to group A (1,757 ± 656 g). Klebsiella pneumoniae was the most common pathogen causing BSIs (44.1%). The analysis revealed a high abundance of potential pathogens in the gut microbiome of group B neonates, with a concurrent decrease in beneficial gut flora.</p><p><strong>Conclusion: </strong>This study provides strong evidence for the association between gut pathogen colonization and BSI development in preterm neonates in NICUs. Gut microbiota modulation may serve as preventive strategy against BSIs, emphasizing the need for further research in this area to improve outcomes in vulnerable population.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-10"},"PeriodicalIF":0.0,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142831593","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":"Growth and cognitive outcome in very preterm infants with postnatal cytomegalovirus infection.","authors":"Elke Griesmaier, Marlene Hammerl, Maria Sappler, Martina Zimmermann, Nina Gande, Ira Winkler, Ursula Kiechl-Kohlendorfer, Vera Neubauer","doi":"10.1159/000542820","DOIUrl":"https://doi.org/10.1159/000542820","url":null,"abstract":"<p><p>Introduction There are conflicting data on the association between postnatal cytomegalovirus (CMV) infection and growth and cognitive outcome in very preterm infants. The aim of the current study was to systematically evaluate the effect of postnatal CMV infection on growth and cognitive outcome in an unselected, contemporary cohort of very preterm infants. Methods Infants <32 gestational weeks (2011-2018) were screened for postnatal CMV infection. We compared head circumference, weight and length from birth to three months corrected age, mental development at 12 and 24 months corrected age (Bayley Scales of Infant (Toddler) Development II/III) and intelligence quotient at five years (Kaufman Assessment Battery for Children-II, Wechsler Preschool and Primary Scale of Intelligence-III or Snijders-Oomen Non-verbal Intelligence Test) between infants with and without postnatal CMV infection. Results The final study cohort consisted of 431 infants with a median gestational age of 29.9 (23.7-31.9) weeks. Of these, 20 (4.6%) infants had a postnatal CMV infection. Median ∆ z scores from birth to the corrected age of three months for head circumference, weight and length did not differ between infants with and without postnatal CMV infection. Continuous and categorized parameters of cognitive development did not differ between the two groups. A subgroup analysis of infants <28 gestational weeks showed similar results. Conclusion We did not observe a negative effect of postnatal CMV infection on growth or cognitive development of very preterm infants. These findings should be taken into account when discussing the use of raw mother's milk in the feeding of preterm infants.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-14"},"PeriodicalIF":0.0,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815393","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":"Urinary lactate-to-creatinine ratio during the first days of life correlates with the degree of brain damage in premature infants.","authors":"Magdalena Zasada, Marta Olszewska, Aleksandra Kowalik, Joanna Berska, Jolanta Bugajska, Paulina Karcz, Izabela Herman-Sucharska, Przemko Kwinta","doi":"10.1159/000542793","DOIUrl":"https://doi.org/10.1159/000542793","url":null,"abstract":"<p><p>Introduction This study aimed to assess the association between the urinary lactate-to-creatinine ratio (ULCR) and brain spectroscopy (1H-MRS) findings in very-low-gestational-age (VLGA) infants with and without preterm brain injury. Methods Urine samples were collected from 54 VLGA infants during the first week of life, after one month of life, and at term-equivalent age (TEA). Urinary lactate was measured via highly selective liquid chromatography-tandem mass spectrometry (LC-MS/MS) with a quantitative Organic Acid Analysis Kit and expressed as the ULCR. MRI and 1H-MRS were performed at TEA. The Kidokoro grading system was used to assess the Global Brain Abnormality Score (GBAS). Results VLGA infants with a GBAS moderate+severe had higher ULCRs on the 2nd and 3rd days of life (DOLs) than those with a GBAS normal or mild. Only the GBAS moderate+severe subgroup presented with a secondary increase in the ULCR on the 3rd DOL, whereas in the GBAS normal or mild, the ULCR oscillated around similar values or gradually decreased. Significant positive correlations were detected between the ULCR on the 3rd DOL and the lactate/creatinine and lactate/N-acetyl aspartate ratios measured via 1H-MRS at TEA (r=0.308; p=0.022 and r=0.334; p=0.013, respectively). Conclusions An increased ULCR during the first three DOLs in patients with a GBAS moderate+severe suggest an energy catastrophe that may play a role in the development of premature brain injury. Serial measurement of the ULCR during the first days of life may help in the early identification of premature infants at risk for moderate+severe brain damage.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-18"},"PeriodicalIF":0.0,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808920","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":"Rationale and approach to evaluating interventions for newborn care in low- and middle-income countries.","authors":"Leila Harrison, Tyler Vaivada, Rahima Yasin, Jai K Das, Zulfiqar A Bhutta","doi":"10.1159/000542754","DOIUrl":"https://doi.org/10.1159/000542754","url":null,"abstract":"<p><p>Introduction The neonatal period is the most vulnerable time in a child's life, contributing to almost half of all deaths in children under 5 years. Many of these deaths are preventable and are mainly caused by preterm birth, birth asphyxia, or serious infections. Over the past decade, the evidence base for interventions to prevent and manage these causes of neonatal mortality and morbidity in low- and middle-income countries (LMICs) has expanded significantly. This growth calls for a comprehensive and systematic approach to synthesizing the available evidence. This paper describes the methodological approach taken before and during the conduct of the systematic overviews and reviews included in this supplement. Methods Alongside consultation with a newborn technical advisory group, the overall evidence synthesis approach began with an extensive literature scoping exercise to establish a universe of interventions that were relevant to neonatal health and survival, and to identify the associated systematic reviews examining their effectiveness. Three main approaches were taken to synthesize the evidence based on the availability of prior evidence. New systematic reviews were conducted for topics lacking an existing comprehensive synthesis. Existing systematic reviews with search dates prior to 2020 were updated. High-quality, up-to-date systematic reviews were used without modification. In all cases, trial data from studies conducted in LMICs were sought and prioritized for analysis. Conclusion A comprehensive approach to summarizing the best available evidence for newborn intervention effectiveness is described.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-15"},"PeriodicalIF":0.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803860","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":"Characterizing the role of left ventricular indices and biventricular interaction in bronchopulmonary dysplasia-associated pulmonary hypertension in extreme prematurity.","authors":"Krishna Revanna Gopagondanahalli, Sreekanthan Sundararaghavan, Teng Hong Tan, Kee Thai Yeo, Shrenik Jitendrakumar Vora, Wei Di Ng, Jonathan Tze Liang Choo, Wai Lin Ang, Nur Qaiyimah Binte Mohamad Taib, Nishanthi Wijedasa Han Ying, Victor Samuel Rajadurai, Abdul Alim Abdul Haium","doi":"10.1159/000542980","DOIUrl":"https://doi.org/10.1159/000542980","url":null,"abstract":"<p><strong>Introduction: </strong>Bronchopulmonary dysplasia (BPD) is a common respiratory morbidity in preterm infants. The onset of pulmonary hypertension leads to worse respiratory outcomes. The contribution of left ventricular diastolic dysfunction in BPD-PH is well reported. We evaluated the serial left ventricular (LV) function and possible ventricular interdependence among BPD-PH.</p><p><strong>Methods: </strong>Single-centre, prospective observational study. Infants <28 weeks of gestation included.</p><p><strong>Results: </strong>80 infants were enrolled. The incidence of BPD-PH was 23%. The BPD-PH group had a high incidence of hemodynamically significant ductus arteriosus (83% vs 56%,p <0.018), longer oxygen days (96.2±68.1 vs 59.35±52,p< 0.008), and prolonged hospital stay (133.8±46 vs 106.5±38 days,p<0.005). Serial tissue Doppler imaging showed prolonged left ventricle (LV) isovolumetric contraction time (IVCT)(31.05±3.3 vs 26.8±4.4ms,p<0.001), and myocardial performance index (MPI) (0.43±0.03 vs 0.37±0.04,p<0.001) from 33 weeks. The changes in IVCT (35.9±6.7 vs 27.9±4.5ms, p<0.001), isovolumetric relaxation time (IVRT) (50±6.5 vs 39.9±5.8ms,p <0.001), and MPI (0.48±0.05 vs 0.36±0.03,p <0.001) persisted at 36 weeks. The receiver operator characteristic curve showed LV MPI >40 has 83% sensitivity and 65% specificity (AUC 0.77, p<0.001) in the diagnosis of PH. The BPD-PH group had a higher LV E/E' ratio (13.1±4.4 vs 11.4±3.4, p <0.02). Pearson correlation test showed a moderate positive correlation between RV MPI and LV MPI (r= 0.585, p <0.001).</p><p><strong>Conclusions: </strong>Significant LV diastolic dysfunction was observed in BPD-PH. This is the first study to show biventricular strain and possible ventricular interdependence in BPD-PH. The prolonged LV IVRT and MPI may be a novel echocardiographic indicator of BPD-PH.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-17"},"PeriodicalIF":0.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782296","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":"Urinary output of very low birth weight infants during the first weeks of life.","authors":"Zülfü Cem Cosgun, Kathrin Burgmaier, Melanie Zeiher, Anna Weber, Ruth Klein, Aynur Aydin, Angela Kribs, Katrin Mehler, Sandra Habbig","doi":"10.1159/000542755","DOIUrl":"https://doi.org/10.1159/000542755","url":null,"abstract":"<p><strong>Introduction: </strong>Daily urinary output (UOP) serves as important tool to identify acute kidney injury (AKI) in preterm infants. However, reference values for UOP, especially stratified for gestational age, are missing.</p><p><strong>Methods: </strong>This retrospective single-center study assessed UOP during the first 28 days of life in 128 very low birth weight (VLBW) infants.</p><p><strong>Results: </strong>VLBW infants exhibit a highly dynamic daily UOP profile in the first 28 days of life with a maximum at day 12 with 4.78 ml/kg bodyweight/h. In the subcohort of 64 extremely low gestational age neonates (ELGAN), the highest UOP is measured during the second week of life. Infants born before 24 weeks of gestation have significantly higher UOP than more mature infants.</p><p><strong>Conclusion: </strong>UOP is dynamic in the postnatal period and differs significantly between gestational age cohorts in the subgroup of ELGANs. These data might point to an adaption of the UOP threshold for neonatal AKI in preterm infants.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-11"},"PeriodicalIF":0.0,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776120","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":"Reply to Letter to the Editor by Maiwald et al. on \"Less Invasive Surfactant Administration for Preterm Infants - State of the Art\".","authors":"Christoph Härtel, Angela Kribs, Wolfgang Göpel, Peter A Dargaville, Egbert Herting","doi":"10.1159/000542819","DOIUrl":"10.1159/000542819","url":null,"abstract":"","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741770","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":"Nutritional Management of Low Birth Weight and Preterm Infants in Low- and Low Middle-Income Countries.","authors":"Maha Azhar, Rahima Yasin, Sawera Hanif, Sharib Afzal Bughio, Jai K Das, Zulfiqar A Bhutta","doi":"10.1159/000542154","DOIUrl":"https://doi.org/10.1159/000542154","url":null,"abstract":"<p><strong>Introduction: </strong>Preterm and low birth weight (LBW) infants are at an increased risk of morbidity and mortality compared with their term counterparts, with more than 20 million LBW infants born each year, the majority in lower middle-income countries (LMICs). Given the increased vulnerability and higher nutritional needs of these infants, optimizing feeding strategies may play a crucial role in improving their health outcomes.</p><p><strong>Methods: </strong>We updated evidence of Every Newborn Series published in The Lancet 2014 by identifying relevant systematic reviews, extracting low-income country (LIC) and LMIC data, and conducting revised meta-analysis for these contexts.</p><p><strong>Results: </strong>We found 15 reviews; the evidence showed that early initiation of enteral feeding reduced neonatal mortality overall, but not in LIC/LMIC settings. Breastfeeding promotion interventions increased the prevalence of early initiation of breastfeeding and exclusive breastfeeding at 3 and 6 months of age in LMIC settings. There was an increased risk of neonatal mortality with formula milk in LIC/LMIC settings. Despite contributing to greater weight gain, there was a higher risk of necrotizing enterocolitis with formula milk overall. Breast milk fortification and nutrient-enriched formula improved growth outcomes. Iron and vitamin A supplementation reduced anemia and mortality rates (LMIC), respectively. The evidence also suggested that benefits of various different micronutrient supplementation interventions such as zinc, calcium/phosphorous, and vitamin D, outweigh the risks since our review demonstrates little to no adverse effects deriving from their supplementation, particularly for a breastfed preterm and/or LBW infant.</p><p><strong>Conclusion: </strong>Early adequate nutritional support of preterm or LBW infant is paramount to averse adverse health outcomes, contribute to normal growth, resistance to infection, and optimal development. Breast milk feeding and micronutrient supplementation are crucial to reduce diarrhea incidence and mortality respectively while feed fortification or nutrient-enriched formula, when breast milk is not available, to enhance better growth especially in LMICs where there is higher population of growth restriction and stunting. This review also highlights need for randomized trials in LMICs at large scale to further strengthen the evidence.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"1-15"},"PeriodicalIF":0.0,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142735455","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}