Background: With scientific and technological advances in intensive care, there is an increasing survival rate among neonates with complex medical problems who experience an extremely prolonged length of stay (EPLOS) of ≥180 days in the hospital. Little is known about the antecedents and characteristics of this particular group of neonates.
Aim: To characterize the risk factors associated with EPLOS in neonates.
Patients and methods: Retrospective study of neonates from the National Hospital Discharge Database for Children, Kids Inpatient Database 2012 (KIDS-2012), maintained by the Healthcare Cost and Utilization Project (HCUP), using data from 4,170 hospitals in 44 states in the US. All neonates with complicated births who were discharged from the hospital other than from the normal newborn nursey during the year 2012 were included. Newborns with uncomplicated hospital stays who were discharged from the normal newborn nursery were excluded. Diagnoses and procedures were retrieved using ICD-9 codes. Descriptive analyses were done to identify incidence and prevalence. Comparisons were made of neonates with EPLOS (LOS ≥180 days) and non-EPLOS (LOS ≤179 days) using univariate and multivariate analyses.
Results: A total of 1,314,066 neonates with complicated births discharged from US hospitals in 2012 were included in the analysis. The incidence of EPLOS was 6.2/10,000 (n = 812). On univariate analyses, neonates with EPLOS were more likely to have the following risk factors: Black race, Medicaid insurance, ZIP codes associated with lower median incomes, and born in the South and Midwest regions of the US. Most were neonates who had a surgical procedure done, especially tracheostomy and gastrostomy, being the most common procedures.
Conclusion: The occurrence of EPLOS is relatively uncommon among hospitalized neonates. The clinical and demographic characteristics of this subset of complicated neonates are distinct and can be anticipated using prediction models. Prediction models for EPLOS may be important for public policy issues and the proper allocation of healthcare resources.
DOI: 10.5005/jp-journals-11002-0071 |
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Alam MZ, Tareq MR, Shapna DS, Maheshwari A, Sohel MH, Rehnuma N, Hamid K, Majumder MM. Epidemiological Study of Congenital Anomalies and Risk Factors in Newborn Infants at a Tertiary Care Hospital in Bangladesh. 2023; 2 (3):185-190.
Background: Congenital anomalies are structural/functional defects in various organs (systems) that are apparent at birth. These anomalies originate prior to birth due to altered embryonic/fetal development. These are significant contributors to stillbirths/infant mortality over the world; the global variation in incidence is possibly related to regional differences in exposure to various etiological factors.
Objectives: To investigate the epidemiological profile of various congenital abnormalities in newborn infants in Bangladesh.
Materials and methods: This cross-sectional observational study was conducted in Central Medical College Hospital, Cumilla, Bangladesh. We recorded 100 consecutive congenital anomalies in 54,800 infant visits in our outpatient clinics. Data were collected from families after informed written consent.
Results: Out of the 100 infants with congenital anomalies, 69 infants were male and 31 were female (gender ratio 2.2:1). Congenital abnormalities were seen in the central nervous system (CNS) in 30, in the musculoskeletal system in 24, gastrointestinal in 24, cardiovascular in 13, and the genitourinary system in 9 infants. Thirty-eight infants had a history of antenatal exposure to radiation, and 35 of them to pesticides. Twenty-two were born to mothers with diabetes, and 18 to mothers with hypertension.
Conclusion: We identified antenatal exposure to radiation, pesticides, maternal diabetes, and maternal hypertension as important predisposing factors for congenital anomalies. Congenital anomalies of the CNS and musculoskeletal/gastrointestinal defects were seen most frequently. Identification of risk factors can help in designing appropriate interventions.
Parvesh M Garg,
Victoria G Weis,
Ricardo Jorge Rodriguez,
Mitchell R Ladd,
Jessica L Rauh,
Anna Greene McDonald,
Muralidhar Hebbur Premkumar,
Padma P Garg,
DOI: 10.5005/jp-journals-11002-0069 |
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Garg PM, Pittman I, Yi J, Weis VG, Rodriguez RJ, Ladd MR, Rauh JL, McDonald AG, Welch C, Premkumar MH, Garg PP, Maheshwari A. Clinical Correlates of Cholestasis in Preterm Infants with Surgical Necrotizing Enterocolitis. 2023; 2 (3):191-197.
Background: We sought to investigate the clinical determinants and outcomes of cholestasis in preterm infants with surgical necrotizing enterocolitis (sNEC).
Methods: Retrospective comparison of clinical information in preterm infants who developed cholestasis vs those who did not.
Results: Sixty-two (62/91, 68.1%) infants with NEC developed cholestasis at any time following the onset of illness. Cholestasis was seen more frequently in those who had received ionotropic support at 24 hours following sNEC diagnosis (87.1% vs 58.6%; p = 0.002), had higher mean C-reactive protein levels 2 weeks after NEC diagnosis (p = 0.009), had blood culture-positive sepsis [25 (40.3%) vs 4 (13.8%); p = 0.011], received parenteral nutrition (PN) for longer durations (108.4 ± 56.63 days vs 97.56 ± 56.05 days; p = 0.007), had higher weight-for-length z scores at 36 weeks’ postmenstrual age [–1.0 (–1.73, –0.12) vs –1.32 (–1.76, –0.76); p = 0.025], had a longer length of hospital stay (153.7 ± 77.57 days vs 112.51 ± 85.22 days; p = 0.024), had intestinal failure more often (61% vs 25.0%, p = 0.003), had more surgical complications (50% vs 27.6%; p = 0.044), and had >1 complication (21% vs 3.4%; p = 0.031). Using linear regression, the number of days after surgery when feeds could be started [OR 15.4; confidence interval (CI) 3.71, 27.13; p = 0.009] and the postoperative ileus duration (OR 11.9, CI 1.1, 22.8; p = 0.03) were independently associated with direct bilirubin between 2 and 5 mg/dL (mild–moderate cholestasis) at 2 months of age. The duration of PN was independently associated with direct bilirubin >5 mg/dL (severe cholestasis) at 2 months of age in these patients.
Conclusion: Cholestasis was seen in 68% of infants following surgical NEC. The most likely contributive factors are intestinal failure and subsequent PN dependence for longer periods. Our data suggest that identification and prevention of risk factors such as sepsis and surgical complications and early feeds following NEC surgery may improve outcomes.
Neonates show considerable variation in growth that can be recognized through serial measurements of basic variables such as weight, length, and head circumference. If possible, measurement of subcutaneous and total body fat mass can also be useful. These biometric measurements at birth may be influenced by demographics, maternal and paternal anthropometrics, maternal metabolism, preconceptional nutritional status, and placental health. Subsequent growth may depend on optimal feeding, total caloric intake, total metabolic activity, genetic makeup, postnatal morbidities, medications, and environmental conditions. For premature infants, these factors become even more important; poor in utero growth can be an important reason for spontaneous or induced preterm delivery. Later, many infants who have had intrauterine growth restriction (IUGR) and are born small for gestational age (SGA) continue to show suboptimal growth below the 10th percentile, a condition that has been defined as extrauterine growth restriction (EUGR) or postnatal growth restriction (PNGR). More importantly, a subset of these growth-restricted infants may also be at high risk of abnormal neurodevelopmental outcomes. There is a need for well-defined criteria to recognize EUGR/PNGR, so that correctional steps can be instituted in a timely fashion.
Context: Neonatal gut ultrasound (US) is an emerging clinical tool for quick diagnosis and prognosis in various abdominal pathologies. In this review, we summarize normal gut US findings and concentrate on the specifications of diagnosing necrotizing enterocolitis.
Evidence: A comprehensive literature search was conducted across numerous sources with relevant keywords along with the specified age group of 0–28 days of life.
Findings: This review describes the normal gut US picture with the basic technicalities needed to master the art of point-of-care (POC) abdominal US. This modality is gaining importance due to its accuracy, applicability, safety, and affordability. Key findings include altered bowel perfusion, decreased peristalsis, and bowel wall thickening with better precision compared to abdominal X-ray (AXR). Many meta-analyses and narrative reviews have already demonstrated their usefulness. The high specificity and positive predictive value could make this tool a guide for early identification and prompt surgical intervention in the dreaded diagnosis of necrotizing enterocolitis.
Conclusion: Emerging evidence and expertise in the field of abdominal US will make it a valuable tool for early diagnosis and prognosis of necrotizing enterocolitis.
Predicting the severity of birth asphyxia-related brain injury in newborn infants is a difficult task. Cord blood gases can be useful indices in the assessment of the impact of peripartum events. Cord blood gas parameters are particularly important because, despite all the progress in fetal monitoring, the time gap between the onset of fetal heart rate (FHR) abnormalities and birth asphyxia-related brain injury has remained difficult to predict. In this paper, we have focused on cord blood gas values in understanding the degree of compromise. These data can help determine the timing of fetal compromise prior to labor, and whether these precipitating events were acute or prolonged. When combined with some adverse clinical markers, the accuracy of low-cord pH in predicting neonatal mortality and morbidity can be even higher. Low-cord pH or eucapnic neonatal pH can also help in the surveillance of at-risk infants and in timely institution of neuroprotective therapies. We present a detailed review on sampling, evaluation, and application of cord blood gas values for clinicians.
John T Benjamin,
Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract infections in young infants. It is an enveloped, single-stranded, nonsegmented, negative-strand RNA virus, a member of the family Pneumoviridae. Globally, RSV is responsible for 2.3% of deaths among neonates 0–27 days of age. Respiratory syncytial virus infection is most common in children aged below 24 months. Neonates present with cough and fever. Respiratory syncytial virus-associated wheezing is seen in 20% infants during the first year of life of which 2–3% require hospitalization. Reverse transcriptase polymerase chain reaction (RT-PCR) gives fast results and has higher sensitivity compared with culture and rapid antigen tests and are not affected by passively administered antibody to RSV. Therapy for RSV infection of the LRT is mainly supportive, and preventive measures like good hygiene and isolation are the mainstay of management. Standard precautions, hand hygiene, breastfeeding and contact isolation should be followed for RSV-infected newborns. Recent AAP guidelines do not recommend pavilizumab prophylaxis for preterm infants born at 29–35 weeks without chronic lung disease, hemodynamically significant congenital heart disease and coexisting conditions. RSV can lead to long-term sequelae such as wheezing and asthma, associated with increased healthcare costs and reduced quality of life.
Aim: To assess the evidence for the use of digital stethoscopes in neonates and evaluate whether they are effective, appropriate, and advantageous for neonatal auscultation.
Methods: A systematic review and narrative synthesis of studies published between January 1, 1990 and May 29, 2023 was conducted following searches of MEDLINE, Embase, PubMed, Scopus, and Google Scholar databases, as well as trial registries.
Results: Of 3,852 records identified, a total of 41 papers were eligible and included in the narrative synthesis. Thirteen records were non-full-text articles, either in the form of journal letters or conference abstracts, and these were included separately for completion purposes but may be unreliable. Twenty eight papers were full-text articles and were included in a full qualitative analysis. Digital stethoscopes have been studied in neonatology across various clinical areas, including artificial intelligence for sound quality assessment and chest sound separation (n = 5), cardiovascular sounds (n = 11), respiratory sounds (n = 4), bowel sounds (n = 4), swallowing sounds (n = 2), and telemedicine (n = 2). This paper discusses the potential utility of digital stethoscope technology for the interpretation of neonatal sounds for both humans and artificial intelligence. The limitations of current devices are also assessed.
Conclusions: The utilization of digital stethoscopes in neonatology is an emerging field with a wide range of potential applications, which has the capacity to advance neonatal auscultation. Artificial intelligence and digital stethoscope technology offer novel objective avenues for automatic pathological sound detection. Further, digital stethoscopes may improve our scientific understanding of normal neonatal physiology and can be employed in telemedicine to facilitate remote medical access. Digital stethoscopes can also provide phonocardiograms, enabling enhanced interpretation of neonatal cardiac sounds. However, current digital stethoscopes necessitate refinement as they consistently produce low-quality sounds when used on neonates.