Neonatology最新文献_第8页

Recent Advances in Neonatal Medicine: An International Scientific and Educational Forum. 新生儿医学的最新进展：国际科学和教育论坛。

Neonatology Pub Date : 2024-01-01 Epub Date: 2024-08-05 DOI: 10.1159/000540482

Christian P Speer, Ola Didrik Saugstad

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Erratum. 勘误。

Neonatology Pub Date : 2024-01-01 Epub Date: 2024-01-19 DOI: 10.1159/000536208

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Positive Pressure Ventilation in Preterm Infants in the Delivery Room: A Review of Current Practices, Challenges, and Emerging Technologies. 产房早产儿正压通气：当前做法、挑战和新兴技术综述》。

Neonatology Pub Date : 2024-01-01 Epub Date: 2024-03-11 DOI: 10.1159/000537800

Shivashankar Diggikar, Viraraghavan V Ramaswamy, Jenny Koo, Arun Prasath, Georg M Schmölzer

{"title":"Positive Pressure Ventilation in Preterm Infants in the Delivery Room: A Review of Current Practices, Challenges, and Emerging Technologies.","authors":"Shivashankar Diggikar, Viraraghavan V Ramaswamy, Jenny Koo, Arun Prasath, Georg M Schmölzer","doi":"10.1159/000537800","DOIUrl":"10.1159/000537800","url":null,"abstract":"Background: A major proportion of preterm neonates require positive pressure ventilation (PPV) immediately after delivery. PPV may be administered through a face mask (FM) or nasal prongs. Current literature indicates that either of these are associated with similar outcomes.Summary: Nonetheless, FM remains the most utilized and the best choice. However, most available FM sizes are too large for extremely preterm infants, which leads to mask leak and ineffective PPV. Challenges to providing effective PPV include poor respiratory drive, complaint chest wall, weak thoracic muscle, delayed liquid clearance, and surfactant deficiency in preterm infants. Mask leak, airway obstruction, poor technique, and inappropriate size are correctable causes of ineffective PPV. Visual assessment of chest rise is often used to assess the efficacy of PPV. However, its accuracy is debatable. Though end tidal CO2 may adjudge the effectiveness of PPV, clinical studies are limited. The compliance of a preterm lung is highly dynamic. The inflating pressure set on T-piece is constant throughout the resuscitation, but the lung volume and dynamics changes with every breath. This leads to huge fluctuations of tidal volume delivery and can trigger inflammatory cascade in preterm infants leading to brain and lung injury. Respiratory function monitoring in the delivery room has potential for guiding and optimizing delivery room resuscitation. This is, however, limited by high costs, complex information that is difficult to interpret during resuscitation, and absence of clinical trials.Key messages: This review summarizes the existing literature on PPV in preterm infants, the various aspects related to it such as the pathophysiology, interfaces, devices utilized to deliver it, appropriate technique, emerging technologies, and future directions.","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"288-297"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140103112","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}

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Brain MRI Injury Patterns across Gestational Age among Preterm Infants with Perinatal Asphyxia. 围产期窒息早产儿不同胎龄的脑磁共振成像损伤模式

Neonatology Pub Date : 2024-01-01 Epub Date: 2024-06-05 DOI: 10.1159/000538986

Corline E J Parmentier, Loubna El Bakkali, Elise A Verhagen, Sylke J Steggerda, Thomas Alderliesten, Maarten H Lequin, Laura A van de Pol, Manon J N L Benders, Frank van Bel, Corine Koopman-Esseboom, Timo R de Haan, Linda S de Vries, Floris Groenendaal

{"title":"Brain MRI Injury Patterns across Gestational Age among Preterm Infants with Perinatal Asphyxia.","authors":"Corline E J Parmentier, Loubna El Bakkali, Elise A Verhagen, Sylke J Steggerda, Thomas Alderliesten, Maarten H Lequin, Laura A van de Pol, Manon J N L Benders, Frank van Bel, Corine Koopman-Esseboom, Timo R de Haan, Linda S de Vries, Floris Groenendaal","doi":"10.1159/000538986","DOIUrl":"10.1159/000538986","url":null,"abstract":"Introduction: Brain injury patterns of preterm infants with perinatal asphyxia (PA) are underreported. We aimed to explore brain magnetic resonance imaging (MRI) findings and associated neurodevelopmental outcomes in these newborns.Methods: Retrospective multicenter study included infants with gestational age (GA) 24.0-36.0 weeks and PA, defined as ≥2 of the following: (1) umbilical cord pH ≤7.0, (2) 5-min Apgar score ≤5, and (3) fetal distress or systemic effects of PA. Findings were compared between GA <28.0 (group 1), 28.0-31.9 (group 2), and 32.0-36.0 weeks (group 3). Early MRI (<36 weeks postmenstrual age or <10 postnatal days) was categorized according to predominant injury pattern, and MRI around term-equivalent age (TEA, 36.0-44.0 weeks and ≥10 postnatal days) using the Kidokoro score. Adverse outcomes included death, cerebral palsy, epilepsy, severe hearing/visual impairment, or neurodevelopment <-1 SD at 18-24 months corrected age.Results: One hundred nineteen infants with early MRI (n = 94) and/or MRI around TEA (n = 66) were included. Early MRI showed predominantly hemorrhagic injury in groups 1 (56%) and 2 (45%), and white matter (WM)/watershed injury in group 3 (43%). Around TEA, WM scores were highest in groups 2 and 3. Deep gray matter (DGM) (aOR 15.0, 95% CI: 3.8-58.9) and hemorrhagic injury on early MRI (aOR 2.5, 95% CI: 1.3-4.6) and Kidokoro WM (aOR 1.3, 95% CI: 1.0-1.6) and DGM sub-scores (aOR 4.8, 95% CI: 1.1-21.7) around TEA were associated with adverse neurodevelopmental outcomes.Conclusion: The brain injury patterns following PA in preterm infants differ across GA. Particularly DGM abnormalities are associated with adverse neurodevelopmental outcomes.","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"616-626"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11446294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141263680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Aspects on Oxygenation in Preterm Infants before, Immediately after Birth, and Beyond. 早产儿出生前、出生后及以后的吸氧问题。

Neonatology Pub Date : 2024-01-01 Epub Date: 2024-08-01 DOI: 10.1159/000540481

James X Sotiropoulos, Ola D Saugstad, Ju Lee Oei

{"title":"Aspects on Oxygenation in Preterm Infants before, Immediately after Birth, and Beyond.","authors":"James X Sotiropoulos, Ola D Saugstad, Ju Lee Oei","doi":"10.1159/000540481","DOIUrl":"10.1159/000540481","url":null,"abstract":"Background: Oxygen is crucial for life but too little (hypoxia) or too much (hyperoxia) may be fatal or cause lifelong morbidity.Summary: In this review, we discuss the challenges of balancing oxygen control in preterm infants during fetal development, the first few minutes after birth, in the neonatal intensive care unit and after hospital discharge, where intensive care monitoring and response to dangerous oxygen levels is more often than not, out of reach with current technologies and services.Key messages: Appropriate oxygenation is critically important even from before birth, but at no time is the need to strike a balance more important than during the first few minutes after birth, when body physiology is changing at its most rapid pace. Preterm infants, in particular, have a poor control of oxygen balance. Underdeveloped organs, especially of the lungs, require supplemental oxygen to prevent hypoxia. However, they are also at risk of hyperoxia due to immature antioxidant defenses. Existing evidence demonstrate considerable challenges that need to be overcome before we can ensure safe treatment of preterm infants with one of the most commonly used drugs in newborn care, oxygen.","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"562-569"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11446306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141877058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Inborn Errors of Immunity in Early Childhood: Essential Insights for the Neonatologist. 幼儿期先天性免疫错误：新生儿科医生的基本见解》。

Neonatology Pub Date : 2024-01-01 Epub Date: 2024-08-23 DOI: 10.1159/000540436

Johannes Dirks, Matthias Wölfl, Christian P Speer, Christoph Härtel, Henner Morbach

{"title":"Inborn Errors of Immunity in Early Childhood: Essential Insights for the Neonatologist.","authors":"Johannes Dirks, Matthias Wölfl, Christian P Speer, Christoph Härtel, Henner Morbach","doi":"10.1159/000540436","DOIUrl":"10.1159/000540436","url":null,"abstract":"Background: Inborn errors of immunity (IEI), formerly referred to as primary immunodeficiencies, manifest with a wide range of symptoms such as increased susceptibility to infections, immune dysregulation, and autoinflammation. Although most cases manifest in childhood, onset during the neonatal period is rare but potentially critical.Summary: In this review, we discuss the diverse clinical presentations of IEI and the specific challenges they pose to neonatologists. Rather than detailing every molecular defect, we focus on common clinical scenarios in neonates and young infants, providing practical diagnostic strategies to ensure timely and effective therapeutic interventions.Key messages: Clinical presentations of IEI in neonates may include delayed separation of the umbilical cord, skin rashes such as eczema and erythroderma, and recurrent episodes of inflammation. We also highlight immunological emergencies that require urgent medical attention, such as hyperinflammatory activity mimicking acute neonatal liver failure, sometimes seen in hemophagocytic lymphohistiocytosis. We also discuss appropriate medical action in the case of a positive newborn screening for severe T-cell defects. Early medical intervention in such circumstances may significantly improve outcomes.","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"646-655"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057645","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}

引用次数: 0

Lack of Blinding May Affect Objective Outcomes in Trials on Neonatal Ventilation. 缺乏盲法可能会影响新生儿通气试验的客观结果

Neonatology Pub Date : 2024-01-01 Epub Date: 2024-08-16 DOI: 10.1159/000540604

Matteo Bruschettini, Georg M Schmölzer, Nai Ming Lai, Souvik Mitra, Peter G Davis, Roger F Soll

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Long-Term Neurodevelopmental Impairment among Very Preterm Infants with Sepsis, Meningitis, and Intraventricular Hemorrhage. 脓毒症、脑膜炎和脑室出血的早产儿的长期神经发育障碍。

Neonatology Pub Date : 2024-01-01 Epub Date: 2023-10-20 DOI: 10.1159/000534178

Qi Zhou, Melissa Ong, Xiang Y Ye, Joseph Y Ting, Prakesh S Shah, Anne Synnes, Thuy Mai Luu, Shoo Lee

{"title":"Long-Term Neurodevelopmental Impairment among Very Preterm Infants with Sepsis, Meningitis, and Intraventricular Hemorrhage.","authors":"Qi Zhou, Melissa Ong, Xiang Y Ye, Joseph Y Ting, Prakesh S Shah, Anne Synnes, Thuy Mai Luu, Shoo Lee","doi":"10.1159/000534178","DOIUrl":"10.1159/000534178","url":null,"abstract":"Introduction: Sepsis and intraventricular hemorrhage (IVH) are associated with poorer long-term neurodevelopmental outcomes in very preterm infants (VPIs), but less is known about the long-term effect of meningitis and the combined impact of both meningitis and IVH. Our objective was to examine the long-term neurodevelopmental outcomes of VPIs with late onset sepsis and meningitis, with and without IVH, in Canada.Methods: We conducted a retrospective cohort study of all infants <29 weeks GA who were admitted to 26 tertiary-level neonatal intensive care units in the Canadian Neonatal Network (CNN) and Canadian Neonatal Follow-Up Network (CNFUN) databases, from January 1, 2010, to December 31, 2016.Results: Of the 6,322 infants in the cohort, 4,575 had no infection, 1,590 had late onset culture-positive bloodstream infection (CPBSI) only, and 157 had late onset meningitis. There was a significant (p < 0.05) trend of increasing rates of significant neurodevelopmental delay (sNDI) when comparing infants with no infection (sNDI rate 15.0%), late onset CPBSI (sNDI rate 22.9%), and late onset meningitis (sNDI rate 32.0%), even after adjustment for infant characteristics. Similar trends were observed for neurodevelopmental impairment, cerebral palsy, and individual Bayley-III scores <85 for cognitive, language, and motor development. There was an additive effect of IVH in all infant categories, but there was no multiplicative effect between IVH and late onset meningitis.Conclusion: There was an increasing trend of adverse neurodevelopmental outcomes when infants with no infection, late onset CPBSI and late onset meningitis are compared. IVH had an additive effect.","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"65-73"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49695561","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}

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Clinical Features, Diagnosis, and Treatment of Congenital and Neonatal Tuberculosis: A Retrospective Study. 先天性和新生儿结核的临床特征、诊断和治疗:一项回顾性研究。

Neonatology Pub Date : 2024-01-01 Epub Date: 2023-11-27 DOI: 10.1159/000534786

Yujiao Zhou, Kun Zhu, Xiayi Zhang, Zheyi Zhu, Li Jiang, Linlin Xing, Binyue Xu, TingTing Ai, Quanbo Liu, Ruiqiu Zhao, Ximing Xu, Juan Chen, Zhenzhen Zhang

{"title":"Clinical Features, Diagnosis, and Treatment of Congenital and Neonatal Tuberculosis: A Retrospective Study.","authors":"Yujiao Zhou, Kun Zhu, Xiayi Zhang, Zheyi Zhu, Li Jiang, Linlin Xing, Binyue Xu, TingTing Ai, Quanbo Liu, Ruiqiu Zhao, Ximing Xu, Juan Chen, Zhenzhen Zhang","doi":"10.1159/000534786","DOIUrl":"10.1159/000534786","url":null,"abstract":"Introduction: Limited studies have explored the clinical features, treatment, and prognosis of neonatal tuberculosis (TB). Here, we attempted to delineate the clinical characteristics of neonatal TB, which may help clinicians further understand this disease.Methods: A retrospective analysis of neonates diagnosed with congenital and/or neonatal TB disease from January 2010 to December 2020 was performed. Information on the demographic and epidemiological features, clinical symptoms, laboratory and imaging examinations, therapeutic regimens, and outcomes was collected. Kaplan-Meier analysis was used to present the time to disease onset, time to diagnosis, etc. Results: Forty-eight cases of neonatal TB were classified into congenital (n = 33) and postnatal (n = 15). The median time to disease onset in postnatal group was significantly longer than that in congenital group. Positive results for gastric fluid acid-fast bacilli, TB culture, Xpert MTB/RIF, interferon-γ release assay (IGRA), and tuberculin skin test were detected in 26/48 (54.2%), 14/34 (41.2%), 11/18 (61.1%), 19/29 (65.5%), and 8/24 (33.3%) patients, respectively. For lymphadenopathy, computed tomography (CT) scans showed a higher detection rate than did X-ray (80.0% vs. 0). Of the 48 infants, 44/48 (91.7%) received anti-TB therapy, and 33/44 (75%) were clinically improved or cured after 22.1 months (interquartile range: 12.4-27.7) of follow-up. Drug-induced liver injury occurred in 14/44 (31.8%) patients.Discussion/conclusion: IGRA and Xpert MTB/RIF showed good positive rate in neonatal TB infection/disease. In cases where TB is presumed but etiological evidence is lacking, low-dose CT could be considered. Prompt treatment under careful surveillance is important for preventing mortality and avoiding severe adverse effects.","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"81-88"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138447665","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}

引用次数: 0

Preterm Formula, Fortified or Unfortified Human Milk for Very Preterm Infants, the PREMFOOD Study: A Parallel Randomised Feasibility Trial. 针对极早产儿的早产儿配方奶粉、强化或非强化母乳，PREMFOOD 研究：平行随机可行性试验。

Neonatology Pub Date : 2024-01-01 Epub Date: 2023-12-13 DOI: 10.1159/000535498

Luke Mills, Karyn E Chappell, Robby Emsley, Afshin Alavi, Izabela Andrzejewska, Shalini Santhakumaran, Richard Nicholl, John Chang, Sabita Uthaya, Neena Modi

{"title":"Preterm Formula, Fortified or Unfortified Human Milk for Very Preterm Infants, the PREMFOOD Study: A Parallel Randomised Feasibility Trial.","authors":"Luke Mills, Karyn E Chappell, Robby Emsley, Afshin Alavi, Izabela Andrzejewska, Shalini Santhakumaran, Richard Nicholl, John Chang, Sabita Uthaya, Neena Modi","doi":"10.1159/000535498","DOIUrl":"10.1159/000535498","url":null,"abstract":"Objective: Uncertainty exists regarding optimal supplemental diet for very preterm infants if the mother's own milk (MM) is insufficient. We evaluated feasibility for a randomised controlled trial (RCT) powered to detect important differences in health outcomes.Methods: In this open, parallel, feasibility trial, we randomised infants 25+0-31+6 weeks of gestation by opt-out consent to one of three diets: unfortified human milk (UHM) (unfortified MM and/or unfortified pasteurised human donor milk (DM) supplement), fortified human milk (FHM) (fortified MM and/or fortified DM supplement), and unfortified MM and/or preterm formula (PTF) supplement from birth to 35+0 weeks post menstrual age. Feasibility outcomes included opt-outs, adherence rates, and slow growth safety criteria. We also obtained anthropometry, and magnetic resonance imaging body composition data at term and term plus 6 weeks (opt-in consent).Results: Of 35 infants randomised to UHM, 34 to FHM, and 34 to PTF groups, 21, 19, and 24 infants completed imaging at term, respectively. Study entry opt-out rate was 38%; 6% of parents subsequently withdrew from feeding intervention. Two infants met predefined slow weight gain thresholds. There were no significant between-group differences in term total adipose tissue volume (mean [SD]: UHM: 0.870 L [0.35 L]; FHM: 0.889 L [0.31 L]; PTF: 0.809 L [0.25 L], p = 0.66), nor in any other body composition measure or anthropometry at either timepoint.Conclusions: Randomisation to UHM, FHM, and PTF diets by opt-out consent was acceptable to parents and clinical teams, associated with safe growth profiles and no significant differences in body composition. Our data provide justification to proceed to a larger RCT.","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"222-232"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10994632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138815979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0