Course Of Infants Research Articles

Preadmission Diet and Zip Code Influences the Pediatric Critical Care Clinical Course for Infants with Severe Respiratory Illness ( N = 187).

We examined preadmission diet and zip code in infants with severe respiratory illness in the pediatric critical care unit. Patients aged 0 to 5 months admitted to the Helen DeVos Children's Hospital from January 2011 to May 2017 ( N = 187), as exclusively formula, exclusively breastfed or mixed diet were included. Formula-fed infants ( n = 88; 47%) clustered to zip codes with lower median incomes (<0.005), used public insurance as their payer type ( p < 0.005), and were prescribed more ranitidine ( p < 0.05) on admission.

Endostatin and ST2 are predictors of pulmonary hypertension disease course in infants.

Introduction:Pulmonary hypertension (PH) is a common comorbidity of cardiopulmonary disease. Endostatin, an inhibitor of angiogenesis, is elevated in neonates with lung disease. ST2 is a heart failure biomarker correlated with PH in adults. We hypothesized that these biomarkers may be useful in diagnosing PH and categorizing its severity in infants.Methods:Endostatin, ST2, and NT-proBNP plasma concentrations from 26 infants with PH and 21 control infants without PH were correlated with echocardiographic and clinical features using regression models over time.Results:Endostatin, ST2, and NT-proBNP concentrations were elevated in PH participants versus controls (p<0.0001). Endostatin was associated with right ventricular dysfunction (p=0.014), septal flattening (p=0.047), and pericardial effusion (p<0.0001). ST2 concentrations predicted right to left patent ductus arteriosus flow (p=0.009). NT-proBNP was not associated with PH features.Conclusions:Endostatin and ST2 concentrations were associated with echocardiographic markers of worse PH in infants and may be better predictors than existing clinical standards.

The Utility of Albumin Level as a Marker of Postoperative Course in Infants Undergoing Repair of Congenital Heart Disease.

We sought to examine the role of preoperative and 2nd postoperative day albumin levels as predictors for postoperative course in infants undergoing repair of congenital heart disease. This retrospective, single-center, observational study comprised consecutive infants younger than 1year who had undergone repair of tetralogy of Fallot, ventricular septal defect, complete atrioventricular canal or transposition of the great arteries over a 25 months period. We correlated preoperative and postoperative day (POD) #2 albumin level to vaso-inotropic score (VIS) and intensive care unit (ICU) length of stay (LOS) as markers for degree and duration of postoperative cardiac support. A composite outcome was defined as maximal vaso-inotropic score of > 10 and ICU LOS > 96h. Preoperative albumin level negatively correlated with VIS and ICU LOS. Compared to preoperative albumin level of > 4g/dL, the relative risk of meeting composite criteria was 1.5 for preoperative albumin of 3.1-4g/dL and 2.6 for preoperative albumin ≤ 3g/dL. Compared to POD#2 albumin level > 3g/dL, the relative risk of meeting composite criteria was 1.8 for albumin of 2.6-3g/dL, and 2.5 for albumin ≤ 2.5g/dL. In summary, we found that preoperative and POD#2 albumin levels predicted prolonged and complicated postoperative course. These finding may help clinicians to inform the patient's parents, early in the ICU hospitalization, as to the predicted risks and difficulties of their infant's postoperative course.

The Psychosocial Aspects of Feeding in the Neonatal Intensive Care Unit and Beyond

Purpose Feeding challenges are common for infants in the neonatal intensive care unit (NICU). While sufficient oral feeding is typically a goal during NICU admission, this can be a long and complicated process for both the infant and the family. Many of the stressors related to feeding persist long after hospital discharge, which results in the parents taking the primary role of navigating the infant's course to ensure continued feeding success. This is in addition to dealing with the psychological impact of having a child requiring increased medical attention and the need to continue to fulfill the demands at home. In this clinical focus article, we examine 3 main areas that impact psychosocial stress among parents with infants in the NICU and following discharge: parenting, feeding, and supports. Implications for speech-language pathologists working with these infants and their families are discussed. A case example is also included to describe the treatment course of an infant and her parents in the NICU and after graduation to demonstrate these points further. Conclusion Speech-language pathologists working with infants in the NICU and following hospital discharge must realize the family context and psychosocial considerations that impact feeding progression. Understanding these factors may improve parental engagement to more effectively tailor treatment approaches to meet the needs of the child and family.

Dose-dependent effectiveness of acellular pertussis vaccine in infants: A population-based case-control study

BackgroundPertussis is a vaccine-preventable disease which is most severe in young infants. More than two decades after the introduction of acelluar pertussis vaccines (aPV) in national immunization programs in many countries worldwide, a resurgence of pertussis has been recognized. Suboptimal effectiveness of aPV has been blamed as one major reason but only few studies have evaluated dose-dependent vaccine effectiveness (VE) provided by aPV in current practice. MethodsWe performed a population-based retrospective case-control study by comparing pertussis immunization data of children 2.5 months to 2 years of age hospitalized for pertussis and residing in Switzerland with immunization data of a random control sample of children aged 2 years and residing in Switzerland. VE was defined as the percentage of hospitalizations avoided by number of aPV doses. It was calculated as 1-infection rate ratio (IRR)*100. IRR was calculated by dividing infection rates of vaccinated children and infection rates of unvaccinated children. To get dose specific VE,infection rates were stratified by number doses received. ResultsVE against hospitalization due to pertussis increased significantly with each consecutive aPV dose in a “3 + 1” primary course in infants: 42.1% (95% CI: 11.3–62.6), 83.9% (70.2–92.1), 98.2% (96.1–99.3), and 100% (97.9–100) after the 1st, 2nd, 3rd, and 4th dose, respectively. ConclusionAcellular pertussis vaccines continue to demonstrate protection against hospitalization due to pertussis in infants and young children. Therefore, together with advancing immunization of pregnant women and household contacts, better control of severe pertussis in young infants can be achieved by timely initiation of immunization.

An End in Sight: Shorter Duration of Parenteral Antibiotics in Neonates.

* Abbreviations: GBS — : Group B Streptococcus UTI — : urinary tract infection Prescribing the appropriate duration of antibiotic therapy is at the top of mind for the Centers for Disease Control and Prevention, hospital systems, and individual providers alike because it has a resounding impact on antimicrobial resistance.1 In this month’s issue of Pediatrics , Desai et al2 have taken on the duration of parenteral antibiotics for infants ≤60 days old with bacteremic urinary tract infection (UTI). This is a critical piece of a complicated puzzle that not only includes minimum duration of parenteral antibiotic treatment but also involves bioavailability of antimicrobial agents in infants and total treatment duration, which includes parenteral and oral antibiotic therapy. They have written a methodologically sound multicenter study and propose that a short course of parenteral antibiotics is no less effective than a long course in infants ≤60 days old with bacteremic UTIs. This study uniquely affords granularity with respect to the patient population, including a physician’s documented clinical assessment providing information such as temperature, ill appearance, or presence of a known genitourinary condition, which allowed for ascertainment of critical clinical information that influenced management decisions. Ultimately, … Address correspondence to Hillary L. Copp, MD, MS, Department of Pediatric Urology, University of California, San Francisco, Mission Hall Global Health Sciences Building, 550 16th St, 6th Floor, Box 1695, San Francisco, CA 94143. E-mail: hillary.copp{at}ucsf.edu

The effect of a single 4CMenB vaccine booster in young people more than ten years after infant immunisation: protocol of an exploratory immunogenicity study

Background and rationaleThe four-component capsular group B meningococcal vaccine (4CMenB) was introduced into the national immunisation schedule in the UK in September 2015 for infants in a 2 + 1 schedule at two, four and 12 months of age. A two-dose immunisation schedule for adolescents was also considered but was not found to be cost-effective in view of the relatively low rates of disease in this age group. Uncertainty about the longevity of protection induced by the vaccine and lack of certainty about an anamnestic response in primed individuals contributed to this decision.Methods/DesignThis study is an open-label, descriptive immunogenicity analysis. Up to 113 participants will be recruited, including up to 83 children who are now aged 11 years and took part in previous trials involving the administration of 4CMenB to infants, plus a group of 30 naïve age-matched controls. All previously immunised participants will receive one booster dose of 4CMenB. The 30 naïve participants will be randomised to receive two doses of 4CMenB either at 0 and 28 days or 0 and 365 days. Blood samples will be collected from all participants at 0, 28, 180 and 365 days. The primary endpoint will explore immunogenicity at day 0 and 180 in previously immunised and naïve participants. Secondary outcomes will include investigating the persistence of antibody protection in previously immunised participants at the beginning of the study, describing the characteristics of the memory B-cell responses in previously immunised participants, and measuring reactogenicity in all participants following 4CMenB doses.DiscussionThis study aims to describe whether or not a single booster dose of 4CMenB given to those who have received an infant course of 4CMenB induces a recall immune response, while concurrently describing immune responses in naïve children of the same age. If an anamnestic response is proven, a single dose adolescent booster could be envisaged as an addition to the current UK vaccination schedule.Trial registrationEudraCT, 2017–004732-11. ISRCTN, ISRCTN16774163. Registered on 10 May 2018 (retrospectively registered).

Using Spline Models to Analyze Event-Based Changes in Eye Tracking Data

ABSTRACTEye tracking is widely used in developmental research to measure infants’ looking behavior before, during, or after particular events and can provide a measure of real-time processing. However, the dynamic time course of infants’ looking behaviors is rarely analyzed. Instead, eye tracking data is often averaged within a large window or is restricted to certain predictive or reactive looks before or after an event, which could conceal interesting looking patterns. In this article, we discuss an alternative approach using spline models – an approachable and informative method for analyzing how the trajectory of infants’ looking behaviors changes at discrete time points. We illustrate the benefits of spline models by demonstrating how to prepare, estimate, and interpret the results of a spline model in R and SAS, and we compare the results with an analysis of averaged looking times within a time window. We show that spline models can reveal patterns in the trajectory of participants’ looking that can be obscured by averaged looking times. Finally, we use a sensitivity analysis to show that spline models are reliable with small samples typical of developmental studies. Spline models can be useful to developmental researchers for analyzing the time course of event-based changes in eye tracking data.

A rare cause of scalp swelling in infancy: delayed subaponeurotic fluid collections in five cases

Subaponeurotic (subgaleal) fluid collection (DSFC) is a rare clinical entity of unknown etiology. We aimed to present our series of infants who were diagnosed with DSCF at Ankara University Children's Hospital. We retrospectively reviewed clinical findings, imaging studies, laboratory tests, management, and clinical courses of infants diagnosed with DSCF between June 2014 and June 2018. Five infants (4 males, 1 female), aged 5-14weeks, were identified during the study period. All deliveries were non-progressive (3 normal deliveries, 2 cesarean sections) while instrumentation (vacuum extraction or forceps) was used in 2. History of recent trauma, concern for child abuse, and family or personal history of coagulopathy were negative for all patients. Conservative management with the spontaneous resolution was observed in 2 to 12weeks in all infants. Although rare, DSFC should always be kept in mind in the differential diagnosis of scalp swelling in young infants. The diagnosis is primarily clinical, and current treatment is conservative.

Nutritional Management of Gastroesophageal Reflux Among Infants in the Philippines: Insights From Real-World Evidence

Background: The objective of the study was to describe the clinical course of infants with pediatrician-diagnosed gastroesophageal regurgitation (GER), after changing to an infant anti-regurgitation formula. Methods: Information on frequency and volume of regurgitation, and disease progression were collected from mothers of 0- to 12-month-old Filipino infants with GER at baseline and 1 month after a pediatrician prescribed-formula containing carob bean gum, galacto-oligosaccharides and partially hydrolyzed whey protein for 14 days. Results: Eighty-nine infants aged <= 6 months and 40 aged 7 - 12 months old were enrolled. The most frequently reported amount of baseline regurgitation was half of the total feed (29 (33%) younger infants and 17 (43%) older infants). Baseline regurgitation frequency ranged from 1 - 3 times/day (45 (51%) and 21 (52%)) to 4 - 6 times/day (33 (37%) and 14 (35%)) and 7 - 9 times/day (11 (12%) and five (13%)). Regurgitation after 1-day consumption was resolved in 16 (18%) and 8 (20%) and in 57 (64%) and 31 (78%) younger and older infants at 14 days. Forty-one (32%) infants still had regurgitation episodes after a 14-day trial with decreased frequency and volume; three (7%) infants did not show any improvement, while one (1%) infant had increased amount of regurgitation. No medicine was given to study participants. Parent-reported sleep disturbance decreased in three (37%) younger infants and 25 (63%) older infants. Conclusion: Nutrition intervention has effectively improved symptom and quality of life among infants with GER within 14 days. Information on underlying conditions among those with unresolved symptoms are needed. Int J Clin Pediatr. 2019;8(1):1-7 doi: https://doi.org/10.14740/ijcp338

How Respiratory Syncytial Virus Genotypes Influence the Clinical Course in Infants Hospitalized for Bronchiolitis.

We aimed to study respiratory syncytial virus (RSV) genotype distribution, clinical presentation, and disease severity in infants with bronchiolitis from RSV subtypes and new RSV genotypes. We prospectively enrolled previously healthy term infants less than 1 year old hospitalized for bronchiolitis in an Italian university hospital over 12 epidemic seasons. In 312 nasopharyngeal washings positive for RSV, we sequenced the viral genotype and analyzed this according to patient data. Strain-specific RSV loads were quantified for 273 specimens. From 2005-2006 to 2011-2012, the RSV-A genotype NA1 predominated, and was replaced in 2012 by the novel ON1. All infants infected with RSV subtype B were genotype BA. Stratifying data according to genotypes NA1, ON1, and BA showed that NA1-infected infants were the youngest and had the most severe clinical course. Conversely, BA-infected infants had less severe symptoms and more frequently had eosinophilia and a family history of asthma. Infants with the ON1 genotype had a milder clinical course than those with NA1 and more risk factors for asthma, despite having the highest viral loads. The disease course in infants hospitalized for acute RSV bronchiolitis may depend on the RSV genotype.

Inability of infants to push up in the prone position and subsequent development.

During routine health screening, some infants cannot maintain the prone position with extended arm support at 6months. Little is known, however, about the development of full-term infants with this developmental deviation. We investigated the developmental course of infants with this characteristic. We enrolled 2,020 full-term infants who had been recruited at a regional center for the Japan Environment and Children's Study. Their development was measured using the Ages and Stages Questionnaire, third edition, at 0.5, 1, 1.5, 2, 2.5, and 3years. The children were grouped according to their ability to stay prone on extended arms at 6months, and their development was compared. A total of 1,625 infants could stay prone on extended arms and 179 could not. We excluded 212 infants who could stay prone on extended arms only sometimes, and four who did not have a questionnaire response. In the gross motor domain, significant difference in questionnaire scores was observed between the "could" and "could-not" groups at 6months (Hedges' g, 1.83) and persisted until 3years (Hedges' g, 0.33). Significant differences were also observed in the communication, fine motor, problem solving, and personal-social domains at 6months (Hedges' g, 0.20-0.58) and persisted until 1, 2, 2, and 1.5years, respectively (Hedges' g, 0.21-0.25). Infants who cannot maintain the prone position on extended arms lag behind those who can, although the effect sizes become relatively small after 1.5years of age. Early intervention may be considered if delay is problematic or persistent.

Delayed resolution of retinopathy of prematurity

We investigated the clinical course of infants with unresolved retinopathy of prematurity (ROP) at 50 weeks corrected gestational age (CGA). We compared clinical characteristics between infants whose ROP resolved before 50 weeks CGA and those with a delayed resolution of ROP.

Different novelties revealed by infants\u2019 pupillary responses

To account for infants’ perceptual and cognitive development, the constructivist model proposes that learning a new object depends on the capability of processing simpler lower-level units, and then integrating these units into more complex higher-level units based on their relationships, such as regular co-occurrence. Here, we demonstrate that the process of associating visual and auditory attributes to build a new multisensory object representation is not only observed in the course of development, but also in the course of infants’ in-the-moment information processing. After a brief familiarization session of learning two pairs of novel audiovisual stimuli, 15-month-old infants showed two components in pupil dilations over time: A rapid dilation was observed when processing perceptually novel compared to familiar stimuli, and a slower dilation was observed when processing novel combinations of familiar stimuli. However, in 10-month-old infants, only the effect elicited by novel stimuli was observed. Our results therefore demonstrate that detecting perceptual novelty occurred earlier than detecting association novelty in infants’ information processing. These results support the view that infants perceive newly-learned objects by processing their constituent attributes and then integrating these components, as suggested by the constructivist model.

Palivizumab use in infants with Down syndrome-report from the German Synagis™ Registry 2009-2016.

Data from 249 children with DS receiving palivizumab prophylaxis in seven consecutive RSV seasons (2009-2016) in Germany reveal important differences between patients with and without DS concerning the main indication for palivizumab use and additional risk factors. Bearing in mind the limitations of an uncontrolled postmarketing observational study, the results confirm the field effectiveness of palivizumab prophylaxis in this special population. What is Known: • Recent studies describe the Down syndrome as independent risk factor for a complicated clinical course in infants with RSV infection. What is New: • Compared with other infants receiving palivizumab prophylaxis, patients with Down syndrome significantly more often had congenital heart disease, siblings in kindergarten or school, treatment with oxygen at home, immunodeficiency, and neuromuscular impairment. • In infants with palivizumab prophylaxis breakthrough, RSV-related hospitalization rates were not significantly higher in those with Down syndrome.

Clinical course of infants with congenital heart disease who developed thyroid dysfunction within 100 days.

PurposeWe investigated the clinical course of infants with congenital heart disease (CHD) who experienced thyroid dysfunction within 100 days of birth.MethodsWe performed retrospective medical reviews of 54 CHD patients (24 male patients) who underwent a thyroid function test (TFT) between January 2007 and July 2016. Data were collected on birth history, diagnosis of CHD, underlying chromosomal or genetic abnormalities, medication history, surgery, ventilator care, and exposure to iodine contrast media (ICM). Results of neonatal screening tests (NSTs) and TFTs were reviewed.ResultsA total of 36 patients (29 transient, 7 permanent) showed thyroid dysfunction. Among the seven patients with permanent hypothyroidism, three had an underlying syndrome, three showed abnormal NST results, and one was admitted to the intensive care unit for macroglossia and feeding cyanosis. We found that infants with transient thyroid dysfunction had a lower birth weight and were more commonly exposed to thyroid disrupting medication and/or ICM. However, these risk factors were not significant. A total of 8 patients with a history of ICM exposure showed thyroid dysfunction. Excluding 3 patients with elevated thyroid stimulating hormone before ICM exposure, 5 patients recovered from transient thyroid dysfunction.ConclusionsWe observed thyroid dysfunction in two-thirds of CHD infants (53.7% transient, 13.0% permanent) who had risk factors and received TFT screening within 100 days, despite normal NSTs. Further studies with larger sample sizes are required to revise the criteria for TFT screening in CHD infants.

Clinical course in infants diagnosed with transient tachypnea of newborn: A clinical trial assessing the role of conservative versus conventional management

BackgroundTransient tachypnea of the newborn (TTN) is a respiratory disorder secondary to inadequate or delayed clearance of lung fluids. Early symptoms of the disease are indistinguishable from neonatal respiratory distress syndrome, pneumonia, and persistent pulmonary hypertension. Therefore, these newborns, in addition to receiving conservative management, receive antibiotics until blood cultures provide definite results. In this study, we assessed the clinical course of neonates diagnosed with TTN who received conventional versus conservative management. MethodsOne hundred and thirty neonates diagnosed as having TTN were randomly enrolled in two study groups. While patients belonging to one group received conservative management, those from the other group were treated with conventional medical therapy. ResultsMean duration of hospitalization was 7 ± 0.2 in the conventional and 5 ± 1.5 in the conservative group. Duration of antibiotic therapy was 6.7 ± 2.47 days in the conventional group. ConclusionNewborns diagnosed with TTN without prenatal risk factors and a negative C reactive protein test do not need to be administered antibiotics and hospitalized until confirmatory blood culture results are obtained.

How to assess hemodynamic status in very preterm newborns in the first week of life?

Assessing hemodynamic status in preterm newborns is an essential task, as many studies have shown increased morbidity when hemodynamic parameters are abnormal. Although oscillometric monitoring of arterial blood pressure (BP) is widely used due to its simplicity and lack of side effects, these values are not always correlated with microcirculation and oxygen delivery. This review focuses on different tools for the assessment of hemodynamic status in preterm newborns. These include the measurement of clinical (BP, capillary refill time and urinary output (UO)) or biological parameters (lactate analysis), functional echocardiography, and near-infrared spectroscopy (NIRS). We describe the concepts and techniques involved in these tools in detail, and examine the interest and limitations of each type of assessment. This review highlights the complementarities between the different parameters used to assess hemodynamic status in preterm newborns during the first week of life. The analysis of arterial BP measured by oscillometric monitoring must take into account other clinical data, in particular capillary refill time and UO, and biological data such as lactate levels. Echocardiography improves noninvasive hemodynamic management in newborns but requires specific training. In contrast, NIRS may be useful in monitoring the clinical course of infants at risk of, or presenting with, hypotension. It holds the potential for early and noninvasive identification of silent hypoperfusion in critically ill preterm infants. However, more data are needed to confirm the usefulness of this promising tool in significantly changing the outcome of these infants.

Disparities in Postnatal Treatment of Congenital Renal Anomalies [31L

INTRODUCTION: Congenital renal anomalies (CRAs), including dysplastic kidneys, lower urinary tract obstruction, and infantile recessive polycystic kidney disease, are often identifiable on antenatal ultrasound and generally confer a poor prognosis for the affected fetus. We sought to evaluate social determinants influencing the postnatal course of infants with CRAs. METHODS: 900 infants with CRAs who developed end-stage renal disease (ESRD) in the first 6 months of life between 1995-2012 were identified in the United States Renal Data System. This information was then linked to the Social Security Master Death File and the United Network for Organ Sharing. Cox proportional hazards models were used to examine associations between race, insurance, and 1) survival and 2) receipt of a kidney transplant. RESULTS: Survival: Black infants with CRAs who developed ESRD in the first 6 months of life had a 1.34-fold higher hazard of death compared to white infants, even after adjusting for insurance type (p=0.02). Private insurance was associated with a non-significant 0.84-fold lower hazard of death. Receipt of a Kidney Transplant: Black and Hispanic infants had 0.59 and 0.79-fold lower rate of transplant compared to white infants, respectively (p &lt; 0.02), even after adjusting for insurance type. Patients with private insurance had a 1.3-fold higher rate of transplant compared to those with public or no insurance (p &lt; 0.001). CONCLUSION: Significant racial disparities exist in the outcomes of CRAs. More research is warranted to discern what patient-level factors are contributory. Outcomes of CRAs by insurance status also suggest a role of system-based factors in postnatal mortality.

In-hospital outcomes of premature infants with severe bronchopulmonary dysplasia.

ObjectiveTo characterize in-hospital outcomes of premature infants diagnosed with severe bronchopulmonary dysplasia.Study DesignRetrospective cohort study including premature infants with severe bronchopulmonary dysplasia discharged from 348 Pediatrix Medical Group neonatal intensive care units from 1997–2015.ResultThere were 10,752 infants with severe bronchopulmonary dysplasia, and 549/10,752 (5%) died prior to discharge. Infants who died were more likely to be male, small for gestational age, have received more medical interventions, and more frequently diagnosed with surgical necrotizing enterocolitis, culture-proven sepsis, and pulmonary hypertension following 36 weeks postmenstrual age compared to survivors. Approximately 70% of infants with severe bronchopulmonary dysplasia were discharged by 44 weeks postmenstrual age, and 86% were discharged by 48 weeks postmenstrual age.ConclusionA majority of infants diagnosed with severe bronchopulmonary dysplasia were discharged home by 44 weeks postmenstrual age. These results may inform discussions with families regarding the expected hospital course of infants diagnosed with severe bronchopulmonary dysplasia.