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Volume 3, Number 1, January-March 2024
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EDITORIAL

Akhil Maheshwari, Kei Lui, Mario Motta

To Save Babies, We Need a Team – Let's Build One!

[Year:2024] [Month:January-March] [Volume:3] [Number:1] [Pages:4] [Pages No:iv - vii]

   DOI: 10.5005/newborn-3-1-iv  |  Open Access | 

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COMMENTARY

Joy E Lawn, Danielle EY Ehret, Tendai Mutema, Alex Stevenson, Karen Walker, Linda Storari, Willem P de Boode, Silke Mader, Corrado Moretti, Charles C Roehr, Ola D Saugstad

Every Newborn Counts, Everywhere: Statement from the 2023 Joint European Neonatal Societies’ (jENS) Congress

[Year:2024] [Month:January-March] [Volume:3] [Number:1] [Pages:2] [Pages No:1 - 2]

Keywords: Baby, Global health, Infant, Low- and middle-income countries, Newborn, Neonate

   DOI: 10.5005/jp-journals-11002-0087  |  Open Access |  How to cite  | 

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ORIGINAL RESEARCH

S Mohan, Kalpana Badami, Pavan Kuman, YD Shilpa, BC Hemalata, Kavitha Tumbadi

Prediction of Retinopathy of Prematurity in Single and Twin Babies: The Predictive Accuracy of WINROP

[Year:2024] [Month:January-March] [Volume:3] [Number:1] [Pages:5] [Pages No:3 - 7]

Keywords: India, Retinopathy of prematurity, Twins, Type I ROP, WINROP

   DOI: 10.5005/jp-journals-11002-0084  |  Open Access |  How to cite  | 

Abstract

Aim: To test the effectiveness of WINROP software tool to screen retinopathy of prematurity (ROP) in Indian preterm infant population including twin neonates. Materials and methods: In a retrospective single-center study, birth weight (BW), gestational age (GA), comorbidities, and weekly weight measurements (for 5 weeks) were retrieved from 63 preterm infants born between 01/2014 and 04/2015. The obtained data were entered into the WINROP algorithm to obtain ROP outcomes and WINROP alarm. Results: For a cohort of 63 patients together with twin neonates, the median BW was 1250 gm and GA was 30 weeks. Of the 63 infants, 22 infants developed type I ROP and 39 infants developed type II ROP. WINROP alarm was triggered in 33 (52.38%) infants. Comorbidities, such as malnutrition, respiratory distress syndrome (RDS), blood transfusion, anemia of prematurity, and pregnancy-induced hypertension (PIH) were associated with the development of ROP. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of WINROP to predict type I ROP were 63.6, 53.6, 42.4, and 73.3%, respectively. In twin neonates, WINROP predicted type I ROP with sensitivity, specificity, PPV, and NPV of 100, 60, 33.3, and 100%, respectively. Conclusion: This is the first WINROP validation study in twin neonates from Indian settings. The WINROP model was highly sensitive to detect type I ROP in twin neonates. However, due to low specificity and low PPV, the outcome of this study suggests the use of WINROP algorithm alongside standard ROP screening in infants including twin neonates with WINROP alarm.

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ORIGINAL RESEARCH

Ravi Sahota, Virender Singh, Heena Parveen, Navpreet Kaur, Neha Upreti, Abhay Mahindre, Bharat Bhushan Gupta

Comparison of Transcutaneous Bilirubin with Total Serum Bilirubin Levels Before, During, and Post-phototherapy in Preterm and Term Newborns in Uttarakhand, India

[Year:2024] [Month:January-March] [Volume:3] [Number:1] [Pages:5] [Pages No:8 - 12]

Keywords: Bilirubin, Newborn, Phototherapy, Transcutaneous bilirubin, Total serum bilirubin

   DOI: 10.5005/jp-journals-11002-0086  |  Open Access |  How to cite  | 

Abstract

Background: Neonatal jaundice, although generally benign, can pose a significant threat to a select number of newborns, potentially resulting in severe brain damage or even death. Objectives: To compare the transcutaneous bilirubin (TCB) with total serum bilirubin (TSB) levels before, during the phototherapy on a covered definite spot of skin and after 2 days of post-phototherapy in preterm and term newborns. Materials and methods: A total of 272 babies, who had jaundice, admitted to NICU of Sahota Superspeciality Hospital, Kashipur, Uttarakhand, India, were enrolled in the study during the period March 2018 to February 2020. Transcutaneous bilirubin and TSB were done in all the babies and compared before starting phototherapy, during phototherapy, and after 48 hours of stopping the phototherapy. Results: Before phototherapy (PT)-TCB showed statistically significant positive correlation with before PT-TSB. During PT-TCB showed statistically significant positive correlation with PT-TSB. After PT-TCB showed statistically significant positive correlation. Bilirubin level measured by TCB and TSB method was statistically significantly comparable before, during, and after PT (p > 0.05). Conclusion: There is a significant positive correlation between TCB and TSB in preterm and term newborns who required phototherapy for hyperbilirubinemia, before starting the phototherapy, during phototherapy, and after 48 hours of its stoppage. Clinical significance: Transcutaneous bilirubin is a good tool to do screening for hyperbilirubinemia. TCB can be used as a noninvasive tool to assess bilirubin during and after phototherapy.

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ORIGINAL RESEARCH

Numan N Hameed, Musaab M Khaleel, Ola D Saugstad

Timely Respiratory Support Can Improve Clinical Outcomes of Premature Infants in a Country with Limited Medical Resources due to Chronic Conflicts

[Year:2024] [Month:January-March] [Volume:3] [Number:1] [Pages:6] [Pages No:13 - 18]

Keywords: Baby, Infant, INSURE, Mechanical ventilation, Minimal invasive surfactant therapy, Neonatology, Neonate, Neonatal intensive care unit, Newborn, Preterm infants, Respiratory distress syndrome

   DOI: 10.5005/jp-journals-11002-0088  |  Open Access |  How to cite  | 

Abstract

Introduction: The children of Iraq have suffered greatly from military conflicts and economic sanctions since 1991. Recent years have shown some improvement in neonatal and infant mortality but more efforts are needed; prematurity and associated respiratory distress syndrome (RDS) remain the two leading causes. In this study, we investigated the efficiency of timely institution of nasal continuous positive airway pressure (nCPAP) in stabilizing these infants. These data are needed for the optimum allocation of financial resources to improve the healthcare outcomes of infants. Patients and methods: This prospective cross-sectional study was carried out over 6 months from April 1st to September 30th, 2022. Inborn preterm infants born between 26 and 32+0 weeks’ gestation who required respiratory support after delivery or immediately after admission were included. The data for the initial course of respiratory support and outcomes were assessed. Results: In our cohort of 123 infants, nCPAP significantly increased the likelihood of clinical stabilization in infants with a gestational age (GA) >28 weeks (p = 0.022), birth weight (BW) ≥1500 gm (p = 0.016), use of antenatal steroids (p = 0.002), Apgar score at 5 minutes of life (p = 0.022), mild radiographic findings (p = 0.007), and sepsis without prolonged rupture of membranes (p = 0.027). Nasal continuous positive airway pressure also reduced the need for surfactant (p = 0.001) and mortality (p = 0.0001). Conclusion: Early institution of nCPAP improved the respiratory status of premature infants who were born at a gestational age from >28 to ≤32 weeks, had birth weight ≥1500 gm, had received antenatal steroids, had a 5-minute Apgar score >7, and had sepsis but no PROM. The success of early nCPAP reduced the need for surfactant and mechanical ventilation, and the risk of pulmonary hemorrhage and mortality.

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REVIEW ARTICLE

Akhil Maheshwari, Harshvardhan Mantry, Nitasha Bagga, Adrianna Frydrysiak-Brzozowska, Jargalsaikhan Badarch, Md Mozibur Rahman

Milk Fat Globules: 2024 Updates

[Year:2024] [Month:January-March] [Volume:3] [Number:1] [Pages:19] [Pages No:19 - 37]

Keywords: 1,4-β-N-acetylmuraminidase, Absorbable sphingosine, Acetyl-CoA carboxylase 1, Acyl-CoA synthetase, Acyl-CoA synthetase long chain family member 3, Acyl-CoA synthetase long chain family member 5, Adipophilin, Adipose differentiation-related proteins, ADPF, Alpha-1-antitrypsin, Annexin, Apocrine-like glands, Apolipoprotein A1, Apolipoprotein A-IV, Apolipoprotein C-III, Apolipoprotein E, Apolipoproteins, Arachidonic acid, Arginine-glycine-aspartate (RGD), Bacteroidetes, Bayley Scales of Infant and Toddler Development II, Bifidobacterium, Bile salt-stimulated lipase, Bone marrow stromal antigen 2, C16-ceramide, C18:0, C24-ceramide, Casein micelles, Cathelicidins, C-C motif chemokine ligand 2, CD9 antigen, Ceramidase, Ceramide, Ceramide-1-phosphate, Cerebrosides, Chlorella vulgaris, Cholesterol, Choline, Chordin-like protein 2, Clusterin, Complement C3, Conjugated linoleic acid, Coriobacteriaceae, De Brouckère mean diameter, Dermcidin, Desulfovibrionaceae, Diacylglycerol acyltransferase 1, Disialylated gangliosi

   DOI: 10.5005/jp-journals-11002-0085  |  Open Access |  How to cite  | 

Abstract

Milk fat globules (MFGs) are a remarkable example of nature's ingenuity. Human milk (HM) carries contains 3–5% fat, 0.8–0.9% protein, 6.9–7.2% carbohydrate calculated as lactose, and 0.2% mineral constituents. Most of these nutrients are carried in these MFGs, which are composed of an energy-rich triacylglycerol (TAG) core surrounded by a triple membrane structure. The membrane contains polar lipids, specialized proteins, glycoproteins, and cholesterol. Each of these bioactive components serves important nutritional, immunological, neurological, and digestive functions. These MFGs are designed to release energy rapidly in the upper gastrointestinal tract and then persist for some time in the gut lumen so that the protective bioactive molecules are conveyed to the colon. These properties may shape the microbial colonization and innate immune properties of the developing gastrointestinal tract. Milk fat globules in milk from humans and ruminants may resemble in structure but there are considerable differences in size, profile, composition, and specific constituents. There are possibilities to not only enhance the nutritional composition in a goal-oriented fashion to correct specific deficiencies in the infant but also to use these fat globules as a nutraceutical in infants who require specific treatments. To mention a few, there might be possibilities in enhancing neurodevelopment, in defense against gastrointestinal and respiratory tract infections, improving insulin sensitivity, treating chronic inflammation, and altering plasma lipids. This review provides an overview of the composition, structure, and biological activities of the various components of the MFGs. We have assimilated research findings from our own laboratory with an extensive review of the literature utilizing key terms in multiple databases including PubMed, EMBASE, and Science Direct. To avoid bias in the identification of studies, keywords were short-listed a priori from anecdotal experience and PubMed's Medical Subject Heading (MeSH) thesaurus.

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REVIEW ARTICLE

Brunetta Guaragni, Mario Motta

Hemostasis Assessment in Neonates: Evaluation of Viscoelastic Properties of Blood Clots

[Year:2024] [Month:January-March] [Volume:3] [Number:1] [Pages:7] [Pages No:38 - 44]

Keywords: Activated partial prothrombin time, Developmental hemostasis, Fibrinogen levels, Fibrinolytic activity, Natural anticoagulants, Platelet function, Procoagulant factors, Prothrombin time, Viscoelastic coagulation tests, von Willebrand factor

   DOI: 10.5005/jp-journals-11002-0089  |  Open Access |  How to cite  | 

Abstract

In recent years, a new approach to neonatal hemostasis has been taking hold. The term “developmental hemostasis” refers to the dynamic, age-related physiological changes seen in the hemostatic system in neonates and young infants. Most conventional coagulation tests have limitations as these are focused primarily on the procoagulant factors and do not inform about platelet function and the levels/activity of von Willebrand factor (vWF), natural anticoagulants, and fibrinolytic activity. In this scheme, viscoelastic coagulation tests can rapidly provide a potentially useful, panoramic assessment of the entire coagulation process from the formation to degradation of clots, platelet function, and fibrinolysis. This is a narrative review on the use of viscoelastic tests in neonatal care; we have included information from our own clinical experience and from an extensive literature search spanning PubMed, Scopus, and Web of Science. This review is important because tests can help identify premature/critically ill infants who may be at risk of hemorrhage during routine care or after surgery and may need corrective transfusions with appropriate blood products.

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REVIEW ARTICLE

Akhil Maheshwari, Thierry AGM Huisman

Holoprosencephaly

[Year:2024] [Month:January-March] [Volume:3] [Number:1] [Pages:16] [Pages No:45 - 60]

Keywords: 7-dehydrocholesterol reductase, Alobar, Ambiguous genitalia, Anophthalmia, Arhinencephaly, Asegmentation, pseudotrisomy 13, genoa syndrome (semilobal hpe), and brachial amelia, Azygos anterior cerebral artery, Butterfly sign, Caudal dysgenesis, Cavum septi pellucidi, Ccr4-not transcription complex, Cell adhesion associated, Cell adhesion molecule-related/downregulated by oncogenes, Cerebellar hypoplasia, Chiari I malformation, Chromosomal errors, Circle of Willis, Cleft lip, Cripto, Culler–Jones syndrome, de Morsier syndrome, Delta-like canonical notch ligand 1, Demyer, Dispatched RND transporter family member, Dispatched RND transporter family member 1, EGF-CFC family member, Fibroblast growth factor 8, Fibroblast growth factor 8 (FGF8), Fibroblast growth factor receptor 1, Fibroblast growth factor receptor 1 (FGFR1), Forebrain, Forkhead BOX H1 FOXH1, Forkhead box protein h1, Frenulum, Frontonasal dysplasia, GLI family zinc finger 2, Growth arrest specific 1, Growth arrest specific 1 (GAS1), Hartsfield syn

   DOI: 10.5005/jp-journals-11002-0083  |  Open Access |  How to cite  | 

Abstract

Holoprosencephaly (HPE) is a complex malformation of the forebrain resulting from failed or incomplete division of the forebrain during the embryonic period. It is the most frequently seen developmental abnormality of the forebrain in humans; the incidence is nearly 1 of every 250 human embryos. However, most of these embryos do not survive and are lost to miscarriage. At birth, the prevalence is 1 in 8,000–10,000 live births and stillbirths. In HPE, the cleavage of the forebrain (prosencephalon) into the right and left hemispheres, deep brain structures, and the olfactory and optic bulbs and tracts remains incomplete. These central nervous system (CNS) defects develop during the first few 2–3 weeks of the fetal period. The etiopathogenesis is unclear, although both syndromic and isolated HPE can be heritable. The condition involves multiple systems, including the central nervous system, eyes, hearing, olfactory, gastrointestinal system, and genital tracts can be most severely affected. No specific treatment is known. Careful clinical and genetic evaluation is necessary for symptomatic management and for counseling families. In this article, we present our own clinical and imaging experience and combine it with an extensive search in the databases PubMed, EMBASE, and Scopus. To avoid bias, keywords were identified from discussions in our own group and from PubMed's Medical Subject Heading (MeSH) thesaurus.

166

CASE REPORT

Akhil Maheshwari, Srijan Singh, Varun Sharma, Papagudi G Subramanian, Amita S Garg

Many Term infants with Persistent Patency of the Ductus Arteriosus could be Trisomy 21 Mosaics

[Year:2024] [Month:January-March] [Volume:3] [Number:1] [Pages:4] [Pages No:61 - 64]

Keywords: Anaphase lag, Case report, Copy-number alteration, Fluorescence in situ hybridization, Germinal trisomy 21 mosaicism, High-grade mosaics, Infant, Meiotic errors, Mitotic malsegregation, Newborn, Neonate, Nondisjunction, Postzygotic malsegregation, Somatic trisomy 21 mosaicism

   DOI: 10.5005/jp-journals-11002-0090  |  Open Access |  How to cite  | 

Abstract

We report findings from a term infant with persistent patency of the ductus arteriosus (PDA). His fetal tests had shown some ambiguity for trisomy 21. However, he did not show any of the frequently-seen phenotypic features associated with trisomy 21 in utero or after birth, and the postnatal karyotype was reported as normal. One of our team members decided to request for a repeat karyotype and he was then identified as a mosaic for this aneuploidy. These observations are potentially important because the proportion of affected cells could very well be a determinant of the phenotypic variability seen in infants with Down syndrome. Hence, mosaicism might need to be meticulously excluded in patients who are presented with only one or more phenotypic features associated with trisomy 21. In this report, we have briefly reviewed the need for evaluation in such infants; the diagnosis requires specific evaluation of in-vitro cultured blood lymphocytes from the patients, siblings, and parents for somatic and germinal trisomy 21 mosaicism. The mechanisms underlying the origin of trisomy 21 mosaicism are still unclear; embryonic meiotic errors such as nondisjunction and anaphase lag, and subsequent mitotic malsegregation may be responsible. Uniparental disomy needs investigation. In the absence of somatic recombination, postzygotic malsegregation in an originally unaffected, disomy 21 zygote could also be a cause. The incidence of this condition in the community might be higher than hitherto believed.

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