Healthy Term Newborns Research Articles

Combined Laparoscopic-Hysteroscopic Isthmoplasty Using the Rendez-vous Technique Guided Step by Step

To demonstrate the surgical technique of Rendez-vous isthmoplasty for the treatment of symptomatic cesarean scar defect. In this video, the authors show the complete procedure in a step-by-step manner to standardize and facilitate the comprehension and performance of the procedure in a simple and safe way. Step-by-step video demonstration of the surgical technique. Private hospital in Curitiba, Paraná, Brazil. The patient is a 36-year-old woman without any comorbidities, G3 C3, and with radiologic transvaginal ultrasound diagnosis of isthmocele grade 3 (over 25 mm) identified in the superior third of the cervical canal. The main steps of combined laparoscopic-hysteroscopic isthmoplasty using the Rendez-vous technique are described in detail. A combined laparoscopic-hysteroscopic approach was performed. Under general anesthesia, the patient was placed in 0° supine decubitus, with her arms alongside her body. Operative setup included 15 mm Hg pneumoperitoneum, created using the closed Veress technique, and 4 trocars: a 10-mm trocar at the umbilicus for a 0° laparoscope, a 5-mm trocar in the right iliac fossa, a 5-mm trocar in the left iliac fossa, and a 5-mm trocar in the suprapubic area. The procedure begins after a systematic exploration of the pelvic and abdominal cavities. Step 1: Identification of key anatomic landmarks and exposure of the operation field. Step 2: By carrying out blunt and sharp dissection with cold scissors or a harmonic scalpel, the visceral peritoneal layer over the isthmus area is opened, a vesicouterine space is developed, and the bladder is pushed down at least 2 cm from the lower edge of the isthmocele. Step 3: Final Phrase: By hysteroscopic exploration of the cervical canal using the vaginoscopic approach, identification and delimitation of the isthmocele its performed by recognizing the diverticular mucosal hyperplasia, and then the hysteroscopic light is pointed directly toward the cephalic limit of the scar defect. Step 4: Laparoscopic lights are decreased in intensity and the "Halloween sign" is identified (hysteroscopic transillumination). The light of the hysteroscope is pointed to the top of the cesarean scar defect allowing the laparoscopist to identify the upper and lower edges of the scar. Step 5: Laparoscopic resection of all scar tissue, excision of all the edges of the pseudo cavity. Step 6: Adequate intracorporeal suturing technique, with a 2-layer myometrial repair using intracorporeal running and interrupted stitches of polydioxanone 2-0, is done, while ensuring preservation of the cavity by not including the endometrial tissue in the myometrial suture [1-3]. Step 7: Installation of the methylene blue dye to locate any leakage. The surgery ended without any intraoperative complications and within 60 minutes. The patient was discharged on the first day postoperatively and became pregnant 6 months after surgery, with a final C-section delivery of a healthy term newborn at 39-weeks gestational age. Combined Rendez-vous isthmoplasty is feasible, safe, and effective in experienced hands, giving the surgeon a comprehensive evaluation of the anatomy of the isthmocele, and increasing the odds of a complete resection and restoration of the anatomy [4-7]. In this patient, the procedure was uneventful, without any intra- or postoperative complications, and the symptoms were completely controlled.

Feasibility and ethical issues: experiences and concerns of healthcare workers regarding a new RSV prophylaxis programme in Nunavik, Quebec

ABSTRACT Background: The respiratory syncytial virus (RSV) is a major cause of hospitalisation in young Inuit children. Prophylaxis with palivizumab is routinely recommended for premature infants and those with severe pulmonary or cardiac diseases. In the fall 2016, the Quebec Ministry of Health expanded the criteria to include healthy full-term (HFT) newborns from Nunavik based on their high RSV hospitalisation rates. Objectives: The aim of this study was to describe the impact of this programme on Nunavik health services during the first RSV season after its implementation (2016–2017) by studying challenges, concerns and needs of healthcare workers (HCWs). Methods: An ethnographic approach was used. Semi-structured interviews focusing on HCWs experiences, and opinions to improve the new programme were conducted with 20 HCWs involved in its implementation. Results: Main reported challenges and concerns were: additional work(over)load, lack of information and evidence about the need and efficacy of palivizumab in HFT newborns, communication issues between stakeholders, and ethical issues regarding the Inuit population. Conclusion: The study revealed significant feasibility and acceptability issues. The programme was highly resource consuming. To address HCWs’ concerns, evidence-based data regarding palivizumab effectiveness in HFT infants, as well as consultation and involvement of Inuit population are warranted.

Evaluation of the cord blood albumin for the early prediction of neonatal jaundice

Background and Aim: Neonatal Hyperbilirubinemia (NH) is the most common cause for readmission during the early neonatal period. There are reports of bilirubin induced brain damage occurred in healthy term infants even without haemolysis and the sequalae could be serious. Aim of the study was to predict the development of Neonatal Hyperbilirubinemia at birth using Cord Serum Albumin as a risk indicator.Material and Methods: Observation study was performed on 348 healthy term new-borns. Cord blood was collected from the healthy term new-borns delivered either vaginally or caesarean section for cord serum albumin level measurements. Total serum bilirubin and direct serum bilirubin were measured during 72-96 hours of life with serum sampling of peripheral venous blood. Newburn was assessed clinically daily for Neonatal Hyperbilirubinemia or for any other complication during the study period. Results: Study cohort is grouped into Group1, Group2 and Group 3 based on Cord Serum Albumin level 2.8g/dl, 2.9-3.3g/dl and 3.4g/dl, respectively. In these groups, new-borns with total serum bilirubin level 17mg/dl after 72 hours are taken as Neonatal Hyperbilirubinemia, requiring interventions like phototherapy or exchange transfusion. Conclusion: There is a correlation between Cord serum albumin level and neonatal hyperbilirubinemia in healthy term new-borns. Cord serum albumin level of 2.8 g/dl can predict the development of neonatal hyperbilirubinemia.

Neurodevelopmental outcome at 6 months of age in full-term healthy newborns with neonatal hyperbilirubinemia

Background: Neonatal hyperbilirubinemia (NNH) is an important cause of preventable brain damage among infants. Neurodevelopmental assessment and Brainstem-Evoked Response Audiometry (BERA) may help in the early identification and management of neurodevelopmental sequelae. Objectives: The objectives of this study were to find the association between neonatal peak serum bilirubin levels and the neurodevelopmental outcomes at 6 months in term infants with NNH and to assess the changes in BERA of these neonates. Methodology: A prospective cohort study was conducted in the Department of Pediatrics, Gandhi Medical College, Bhopal. All healthy, full-term, appropriate-for-date neonates, admitted from December 2014 to June 2015 with hyperbilirubinemia and serum bilirubin >12 mg/dL, were included in the study and were followed up till 6 months of age. The neurodevelopmental assessment was done using the Denver Developmental Screening Test II and BERA was done at an average age of 69 ± 6 days. Results: A total of 77 newborns were enrolled, and 73 completed the study. Of these 77 neonates, 40 (51.65%) had abnormal BERA results, whereas 3 (3.9%) had neurodevelopmental abnormalities. BERA and neurodevelopmental abnormalities were associated with a mean serum bilirubin of 22.58 mg/dL and 31.33 mg/dL, respectively. The cutoff value of serum bilirubin was 16.3 mg/dL and 23.8 mg/dL, respectively, to detect BERA and neurodevelopmental abnormalities, respectively. All patients (11) who received exchange transfusion had BERA abnormalities, and 3/11 (27.3%) had neurodevelopmental abnormalities. The association of ABO incompatibility was significant (P

Long-term Effects of Indirect Hyperbilirubinemia on Auditory and Neurological Functions in Term Newborns.

Objective:The aim of this study was to investigate the long-term effects of hyperbilirubinemia on neurological and hearing function in otherwise healthy term newborns with neonatal indirect hyperbilirubinemia.Method:This study was performed prospectively in 41 term newborns hospitalized for indirect hyperbilirubinemia. Patients with no signs of hemolysis were categorized in 3 groups based on stabil levels as sTB <20 mg/dl, 20-24.9 mg/dl, and =>25 mg/dl. Patients with total bilirubin level =>20 mg/dl and hemolytic disease were classified as the fourth group. The relationship between maximum sTB level, duration of exposure to sTB levels >20 mg/dl and etiology of jaundice with neurological and auditory functions was investigated. Detailed neurological examination, Denver II developmental screening test and hearing tests (otoacoustic emissions, OAE and auditory brainstem responses, ABR) were performed to all patients between 18-24 months of age.Results:Neurodevelopmental disorder was found in 5 (12.2%) patients. Hemolytic disease was detected in two of these patients. Hearing loss was found in 4 (9.8%) of the patients. Two of these patients had auditory neuropathy spectrum disorder and the other two had cochlear hearing loss. The sTB levels of all these patients were above 25 mg/dl. No neurological disorder or hearing loss was found in the patients who had stabil of <25 mg/dl. Exposure time to sTB levels above 20 mg/dl was significantly longer in patients with neurological dysfunction and pathologic ABR results (p:0.007, p:0.007; p<0.05).Conclusion:This study demonstrates that kernicterus may develop in term newborns with severe hyperbilirubinemia (sTB>25 mg/dl) without any finding of significant hemolysis. Not only the bilirubin level but also the duration of exposure to high bilirubin levels may be effective in the development of bilirubin neurotoxicity. The high rate of hearing loss in our patients emphasizes the importance of screening for infants with severe hyperbilirubinemia using comprehensive auditory evaluation for early diagnosis of possible hearing loss.

Report of a series of healthy term newborns from convalescent mothers with COVID-19.

Background:The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly transmittable virus associated with a significantly increased risk of complications among the infected population. Few data are available for the outcome of pregnancy complicated by serious respiratory disease due to SARS-CoV-2 infection.Aim:We herein report a series of four neonates whose mothers had recovered from new coronavirus 2019 disease (COVID-19) diagnosed in the third trimester of pregnancy.Methods:pregnant women with documented COVID-19 infection during their pregnancy, who gave birth in Parma Hospital, University of Parma, Italy, in March and April 2020, during the peak of incidence of COVID-19 in Italy. Clinical records and laboratory tests were retrospectively reviewed.Results:All neonates were delivered at term in good conditions without congenital COVID-19 infection.Conclusions:Findings from our series of cases indicated that adverse effects on foetuses from pregnancies complicated by COVID-19 infection in late pregnancy are unlikely.

The role of thrombophilia genes in the clinical implementation of arterial and venous thrombosis in newborns

The article considers the analysis results of the occurrence frequency of genotypes and alleles of plasma, platelet and fibrinolytic hemostasis in full-term newborns with arterial and venous thrombosis of various localization. Gene polymorphisms were studied by real-time PCR in human DNA samples obtained from buccal epithelium and venous blood lymphocytes. The control group was a group of healthy full-term newborns from families without a thrombophilic history. Predictors of arterial and venous thrombosis in children are such as polymorphism of the plasminogen activator inhibitor gene PAI-1-675 4G/4G (OR=5,6 [2,3-13,8]), combinations of polymorphisms PAI-1-675 4G/4G + factor VII G10976A G/G (OR=5,8 [1,7-19,1]), combinations of polymorphisms PAI-1 -675 4G/4G + factor VII G10976A G/G + factor XIII Val34Leu G/G (% AR=61), fibrinogen FGB -455 G/A (OR=3,75 [1,4-9,4]) and integrin alpha 2 ITGA2 807 T/T (OR=15,56 [1,9-126,7]). Thus, the study of polymorphisms of the plasminogen activator inhibitor, fibrinogen, integrin alpha 2 can serve as one of the criteria for identifying a high-risk group for the development of arterial and venous thrombosis in newborns and should be taken into account when evaluating individual thrombophilia risk.

Reliability of transcutaneous bilirubin estimation during phototherapy in term infants: A hospital-based observational study

Background:Blood sampling method is the most common but invasive method for bilirubin estimation. Transcutaneous bilirubin (TCB) estimation, on the other hand is non-invasive. Objectives: The aim was to compare neonatal bilirubin estimation by serum bilirubin and transcutaneous bilirubinometer methods both pre- and during phototherapy and establish the precision of transcutaneous bilirubinometer. Materials and Methods: This prospective hospital-based observational study was conducted on 350 term neonates over a period of 2 years. Bilirubin was estimated in all newborn by both serum bilirubin and transcutaneous method, at the time of admission in nursery (prephototherapy), at 6 h after phototherapy (while neonates were still under phototherapy treatment), and at withholding phototherapy, and a photo opaque patch of 2.5 cm was used to cover the area on midforehead and transcutaneous bilirubin was estimated from this area after removing it during phototherapy. All data were tabulated and analyzed by relevant statistical tests. Results: A total of 350 term healthy newborns with mean gestational age of 38 ± 2 weeks and mean birth weight of 2.97 ± 0.9 kg were studied. Correlation analysis revealed a significant correlation between total serum bilirubin and transcutaneous method (TCB) measurements of bilirubin. When these methods were compared at pre-phototherapy, at 6 hours after phototherapy and before withholding phototherapy, correlation coefficient(r) of 0.9571, 0.7988, and 0.9206 were seen respectively. The precision levels of transcutaneous bilirubinometer (BiliCheck™) were good because plotting of Bland–Altman graphs showed maximum (>97%) data within agreement limits at all stages of phototherapy. Conclusion: Our study revealed good correlation and precision of transcutaneous bilirubinometer both before and during phototherapy. Thus, it supports the previous studies which justify the use of transcutaneous bilirubinometer in assessing newborn jaundice during phototherapy.

Newborn metabolomic profile mirrors that of mother in pregnancy

BackgroundPregnancy is characterized by multiple metabolic processes to allow proper foetal development and ensure adequate stores. Little is known about the interactions between maternal and foetal metabolism during the last phase of pregnancy. Metabolomic offers potential to discover changes in maternal metabolism in pregnancy and their relation to the newborn metabolic status. ObjectiveIn this study we tested the hypothesis that metabolomic status in newborns at birth depends upon the metabolomic profile of their mothers in the last phase of pregnancy. Study designUrine samples were collected from 36 pregnant women three weeks before delivery and from 21 healthy term newborns within 48 h after birth. Urines were analysed using proton nuclear magnetic resonance (1H NMR) spectroscopy and NMR urine spectra were evaluated through Principal Components Analysis. ResultsThe first component of the PCA analysis showed two distinct metabolic groups: pregnant women and newborns. A significant correlation was found between urine metabolic profiles of newborns and those of their mothers. ConclusionUrine metabolomic profiles of newborns at birth mirrors that of their mothers in the last phase of pregnancy. The metabolomic approach appears to be crucial to understand the maternal effects on foetal programming and infant outcomes.

Effect of delayed cord clamping on cerebral tissue oxygen saturation in newborns

Objective To investigate the influence of different delayed cord clamping(DCC) time on cerebral tissue oxygen saturation in normal newborns after birth and to explore the causes. Methods From November 2018 to February 2019, 164 healthy full term newborns were delivered in the Department of Obstetrics, Binhu Hospital, the Southern District of the Third Affiliated Hospital of Anhui Medical University.The newborns were divided into early cord clamping (ECC) group, DCC groups for 1 minute, 2 minutes and 3 minutes according to the different cord clamping time, and the changes of cerebral tissue oxygen saturation index (cTOI) and cerebral tissue hemoglobin index(cTHI) were monitored by near infrared spectroscopy (NIRS) for 15 minutes after birth. Results After birth, cTOI increased gradually but cTHI was basically stable.The cTOI in DCC group was higher than ECC group, but there was no difference between group 3 and group 4.In ECC group, the cTOI tended to be stable about 6 minutes after birth, and the stable range was 55%-59%.In DCC group, group 2 tended to be stable about 8 minutes after birth, and the stable range was 59%-64%.Group 3 and group 4 tended to be stable about 10 minutes after birth, the stable range was 64%-69%.There was no difference in cTHI among the groups. Conclusions Delayed cord clamping can increase cerebral oxygenation in newborns.The cause may not be due to the direct increase in cerebral blood flow, but the increase in brain oxygen content, and the optimal duration of DCC is 2 minutes. Key words: Delayed cord clamping; Cerebral tissue oxygen saturation; Cerebral tissue hemoglobin; Near infrared spectroscopy; Infant, newborn

Association of Low Umbilical Cord pH and Hypoglycemia in Healthy Term Newborns: Should it Be a Part of Postnatal Screening?

Hypoglycemia may lead to neurological impairment; therefore, high-risk newborns are screened postnatally. However, hypoglycemia monitoring protocols often do not include cord blood acidosis as a risk factor. The study aimed to find an association between asymptomatic cord blood acidosis and hypoglycemia. All healthy term infants born at McMaster Children Hospital, Hamilton, Canada, between October 2013 and September 2014, who had umbilical cord blood pH <7.0 or base excess <12 mmol/L were studied. Infants with evidence of hypoxic-ischemic encephalopathy, birth weights outside of 10th to 95th percentiles for gestation, mothers with preeclampsia, diabetes or taking a -blockers at the time of the birth were excluded. Hypoglycemia was defined as blood glucose <2.6 mmol/L in the first two hours of life. One hundred sixtysix infants met the cord blood gas criteria, but only 16 had hypoglycemia. Although infants with mild perinatal depression are at risk for hypoglycemia, a significant association could not be proved.

Week-by-week changes in sleep EEG in healthy full-term newborns.

To extract independent EEG broad bands using principal component analysis (PCA) and describe week-by-week EEG changes in quiet sleep (QS) and active sleep (AS) during the first 5 weeks of postnatal life in healthy, full-term newborns. Polysomnography of spontaneous sleep was recorded in 60 newborns in 5 groups at 41, 42, 43, 44, and 45 weeks (n = 12 each) postconceptional age (POST-C). QS and AS stages were identified. Absolute power (AP) for 1 Hz bins between 1 and 30 Hz was subjected to PCA to extract independent broad bands. PCA rendered three independent broad bands distinct from conventional bands. They explained 82.8% of variance: 2-10 Hz, 10-16 Hz, and 17-30 Hz. ANOVAs (group × age × derivations) showed significant higher power at 2-10 Hz with greater age, higher power in QS than AS in all three bands, and significantly higher AP in the left central region, and in the right occipital and temporal areas, in both sleep stages. A different method of analyzing sleep EEG generated new information on brain maturation. The Sigma frequencies identified suggest that sleep spindle maturation begins by at least 41 weeks of POST-C age. Interhemispheric asymmetries during sleep suggest earlier development of the central left region and the right occipital and temporal areas.

Breastfeeding Difficulties and Risk for Early Breastfeeding Cessation.

Although breast milk is the normative feeding for infants, breastfeeding rates are lower than recommended. We investigated breastfeeding difficulties experienced by mothers in the first months after delivery and their association with early breastfeeding discontinuation. We conducted a prospective observational study. Mothers breastfeeding singleton healthy term newborns at hospital discharge were enrolled and, at three months post-delivery, were administered a questionnaire on their breastfeeding experience. Association among neonatal/maternal characteristics, breastfeeding difficulties and support after hospital discharge, and type of feeding at three months was assessed using multivariate binary logistic regression analysis. We enrolled 792 mothers, 552 completed the study. Around 70.3% of mothers experienced breastfeeding difficulties, reporting cracked nipples, perception of insufficient amount of milk, pain, and fatigue. Difficulties occurred mostly within the first month. Half of mothers with breastfeeding issues felt well-supported by health professionals. Maternal perception of not having a sufficient amount of milk, infant’s failure to thrive, mastitis, and the return to work were associated with a higher risk of non-exclusive breastfeeding at three months whereas vaginal delivery and breastfeeding support after hospital discharge were associated with a decreased risk. These results underline the importance of continued, tailored professional breastfeeding support.

Cardiac Troponin T in Healthy Full-Term Infants

In this prospective cohort study of healthy full-term infants, we hypothesized that high-sensitivity cardiac troponin T (hs-cTnT) would be elevated in cord blood, compared with adult reference values, and that it would further increase over the first days of age. Cardiac troponin T has been shown to be significantly increased in healthy full-term newborns compared with adult reference values, but there is no established reference range. Most studies of cTnT in newborns have been performed before the introduction of high-sensitivity cTnT (hs-cTnT) assay. We conducted a study including 158 full-term newborns, at Stockholm South General Hospital. High-sensitivity cTnT was analyzed in umbilical cord blood and at 2–5 days of age. Median hs-cTnT (interquartile range) in cord blood was 34(26–44) ng/L; 99th percentile 88 ng/L. Median hs-cTnT at 2–5 days of age was 92(54–158) ng/L; 99th percentile 664 ng/L. We conclude that hs-cTnT is elevated in cord blood in healthy, full-term newborn infants compared with adult reference values, and that it increases significantly during the first days of life. Our findings further underline the need of caution when using hs-cTnT as a measurement of cardiac impact in newborns.

Differences in omentin-1 levels in term newborns according to birth weight

BackgroundAdipokines are produced by adipose tissue and are involved in metabolic processes. Omentin-1 is an adipokine that has been shown in vitro to possibly be involved in insulin sensitivity modulation. The prenatal stage is a crucial period for development of metabolic diseases in the long term, therefore, small (SGA) and large (LGA) for gestational age newborns have an increased risk of type 2 diabetes and metabolic syndrome later in life. AimsTo evaluate the differences in omentin-1 concentrations in umbilical cord blood from healthy term newborns according to birth weight and explore the association between omentin-1 and anthropometry, glucose, insulin and insulin sensitivity. Study designThis was a secondary analysis of stored umbilical cord blood of term newborns. SubjectsNewborns classified according to birth weight as SGA (n = 30), adequate for gestational age (AGA) (n = 12) and LGA (n = 34). Outcome measuresAn analysis of omentin-1, glucose and insulin were performed. ResultsDifferences were found in serum omentin-1 levels (ng/mL) between SGA 328.17 ± 108.04, AGA 253.05 ± 98.25 and LGA 250.91 ± 100.48 (p = 0.009). In the linear regression analysis, the independent variables HOMA-IR, QUICK-I and FGIR were predictors of serum omentin-1 levels (r = 0.175, p = 0.003). ConclusionsOmentin-1 cord blood levels have a differentiated behavior according to weight for gestational age with LGA newborns having lower levels and SGA newborns higher levels. HOMA-IR, QUICK-I and FGIR weakly predicted omentin-1 in cord blood, suggesting that omentin-1 possibly has an implication in insulin sensitivity since birth.

Effects of pharyngeal suction on the arterial oxygen saturation and heart rate in healthy newborns delivered by elective cesarean section.

To evaluate the effect of oro-and naso- pharyngeal suction (ONPS) on the SpO2 and heart rate (HR) in healthy term newborns delivered by cesarean section, at the first minutes after birth. We conducted a prospective randomized trial. Newborns were randomized to ONPS and No-ONSP groups. Continuous readings of SpO2 and HR were performed during the first 10 minutes, and subsequently at 15, 30 and 60 minutes after birth. A total of 84 newborns were evaluated; 42 in ONPS group and 42 in No-ONPS group, with mean gestational age and birth weight±SD of 38.4 weeks and 3533±403 g in the ONPS group and 38.0 weeks and 3575±568 g in the No-ONPS group. The mean SpO2±SD at the first minute of life in the former group was 52.6±7.6% vs 56.1±10.8% on the latter; with no significant difference (p = 0.28). The mean HR±SD at first minute of life was 137±25 in the No-ONPS and 148±13 in the ONPS group (p = 0.02), but no difference was found in the subsequent minutes. Not performing ONPS in newborns delivered by cesarean section does not affect SpO2 and HR in the first postpartum hour.

Are Cord Blood Bilirubin Values Trustable to Predict the Forthcoming Significant Hyperbilirubinemia Requiring Treatment in Healthy Term Newborns?

Background: Jaundice is a clinical condition that is often observed in pediatric practice and constitutes one of the major issues within the neonatal period. As severe jaundice causes neurotoxicity(kernicterus), the diagnosis and treatment of severe hyperbilirubinemia is very important. Early prediction will help in early discharge and will prevent hospitalization of babies and mothers. On the other hand, predicting outcome in high risk neonates for subsequent hyperbilirubinemia is required.Objectives: This study investigates the predictive value of umbilical cord serum bilirubin (UCSB) for subsequent hyperbilirubinemia which is a required treatment in healthy term newborns.Methods: In this prospective study, 238 healthy term newborns were inducted into the study. Soon after delivery, the cord blood was sent for serum bilirubin analysis. Newborns were followed up by TCB (transcutaneous bilirubinometry) until the third day post birth and those who showed significantly high TCB values, according to the hour-specific normogram, received the appropriate intervention and treatment. The data were analyzed using t-Test, ROC (receiver operating characteristic) curve, and chi-square tests.Results: Of 238 newborns, 27 (11.4%) cases developed hyperbilirubinemia (bilirubin >= 15 mg/dL), which required phototherapy. There were no significant differences between the cases who did and who did not develop hyperbilirubinemia (bilirubin = 2.25 mg/dl had high sensitivity (92.6%), good positive and negative predictive value (66% and 69% respectively).Conclusions: UCSB level >= 2.25 mg/dL can be a useful predictor of hyperbilirubinemia in healthy term newborns on the third day. Therefore, infants with UCSB level >= 2.25 mg/dL should be followed up strictly either in a hospital or in an outpatient department on the third day, whereas neonates with cord bilirubin level < 2.25 mg/dL are probably safe for early discharge.

Arterial oxygen saturation and heart rate in term newborn in the first hour after birth.

The pulse oximeter has been useful in the cardiorespiratory evaluation of the newborn. To assess arterial oxygen saturation (SpO2) and heart rate (HR) in newborns in the first 60 minutes after birth. Prospective observational study in healthy term newborns, delivered vaginally or by cesarean section, with maternal bonding, carried out at sea level. A continuous post- ductal SpO2 and HR record were obtained from minute 1 to 10 after birth, and then at 15, 30 and 60 minutes. The SpO2 and HR were measured with a Nellcor pulse oximeter. The software Stata v.14 was used for the statistical analysis. 324 healthy term newborns that met the inclusion criteria were included, of which 160 born vaginally and 164 by cesarean section. The SpO2 increased progres sively from minute 1 (58.7%) to minute 10 (94.5%). Newborns delivered vaginally had a significantly higher SpO2 until minute 10 after birth than those born by cesarean section (p < 0.001). In newborns delivered vaginally, HR was significantly higher in the first two minutes after birth, and then from minute 10 to 60 (p < 0.003). There were no differences by gender in SpO2 and HR. In term newborns, the SpO2 increases progressively, being higher in the first 10 minutes in those born vaginally. In newborns delivered vaginally, a higher HR was also observed in the first and last minutes evaluated.

Role of pulse oximetry in detecting critical congenital heart disease among newborns delivered at a high altitude setting in Ethiopia.

BackgroundCongenital heart disease is one of the most common birth defects. It is not detected in some newborns until after their hospital discharge. Pulse oximetry (SpO2) screening for critical congenital heart disease (CCHD) is practiced in some settings, mainly based on evidence derived from studies done in lowland areas. This study aimed to assess the role of SpO2 screening performed before discharge in detecting CCHD in our setting (Addis Ababa) which is located at high altitude.MethodsOxygen saturation of 941 apparently healthy term newborns in the nursery unit of St Paul’s Hospital Millennium Medical College located in Addis Ababa, was measured before discharge during the period from January 2018 to July 2018. SpO2 reading ≥95% was taken as a negative screening result. Positive SPO2 was defined as SpO2 <90% in any extremity, or a persistent SpO2 of 90%–94% in both right arm and lower extremity sites on three measurements or a persistent right arm to lower extremity SpO2 difference of >3%. Subsequent confirmatory echocardiography examination was done for those who tested positive during the SpO2 screening test. Data were analyzed using Statistical Package for Social Sciences version 20.0.ResultsA total of 56/941 (6.0%) newborns tested positive during the screening test. Of those 56 cases, subsequent echocardiography examination detected persistent pulmonary hypertension of the newborn (PPHN) in ten (17.9%) cases (subsequently two of them were found to have sepsis), patent ductus arteriosus in eleven (19.6%) cases, and atrial septal defect in two (3.6%) cases. No case of CCHD was detected among the screened newborns.ConclusionSpO2 screening detected non-cardiac causes of hypoxemic illnesses (sepsis and PPHN) which otherwise would have been missed. However, we recommend a larger sample size study to assess the efficacy of SpO2 screening in detecting CCHD in our setting.

Hematocrit: another important factor in systemic neonatal cardiovascular adaptation

Background: Global cardiovascular adaptation of normal healthy term newborns is rarely studied from a multiorgan and hematological point of view.Aims: To evaluate comprehensive neonatal cardiovascular adaptation during the first days of life with echocardiography and renal-cerebral echo color-Doppler and to correlate it with hematocrit (Ht) changes.Study design: A prospective observational study was conducted on 35 healthy term neonates with a mean ± SD gestational age and birth weight of 39.5 ± 1.1 weeks and 3,400 ± 330 g, respectively. All infants underwent serial echocardiograms at 15 ± 4 hours (day 1) and 72 ± 4 hours (day 3) of age. At the same time, cerebral and renal Doppler parameters were acquired and Ht was sampled.Results: The weight and Ht declined by 220 g (189-251) and 8.1% (6.7-9.5), respectively. Systolic and diastolic diameters of the right ventricle and diastolic left ventricle posterior wall thickness showed a reduction, while the diastolic diameter of the left ventricle showed a small increase. The Doppler cardiac evaluation showed an increase in the mitral E/A ratio and pulmonary acceleration time, a reduction of late transmitral flow peak velocity, aortic peak systolic velocity (PSV), aortic peak systolic pressure gradient, aortic velocity-time integral, aortic mean pressure gradient and pulmonary mean acceleration. We also found a reduction of cerebral resistance parameters and an increase in PSV, end-diastolic velocity, and time-averaged velocity. Other measured parameters remained unchanged.Conclusion: Systemic cardiovascular evaluation about changes in Ht is an essential approach to study newborns, especially during the first days of life when Ht shows a significant decrease. Knowledge of the laws of physics related to the effect of Ht changes on vascular parameters is another important factor in understanding the pathophysiology of neonatal disease states. Further studies are useful to help physicians make evidence-based decisions in the management of newborns in Neonatal Intensive Care Units (NICUs).