Neonatal Center Research Articles

23 Race Matters: Maternal Morbidity in the Military Health System

In the United States, Black women are 3-4 times more likely to die from childbirth, and have a twofold greater risk of maternal morbidity than their White counterparts. This disparity is theorized to be due to differences in access to health care and/or socioeconomic status. Military service members and their dependents are a diverse community and have equal access to healthcare and similar socioeconomic statuses. We hypothesize that universal access to health care, as seen in the military health care system, leads to similar rates of maternal morbidity regardless of race. We reviewed data from the Neonatal Perinatal Information Center special report from April 1 2018 through March 31 2019 on severe maternal morbidity by race in participating military treatment facilities (MTFs) that performed more than 1000 deliveries per year for our retrospective cohort study. Chi squared tests compared the percentages of cesarean deliveries, adult ICU admissions, and severe maternal morbidity between Black and White patients. There were a total of 23,728 deliveries with 15,305 encompassing self-identified Black and White women (23 vs. 77%). A total of 282 women experienced SMM with 38 adult ICU admissions and 190 postpartum hemorrhages. Black women were more likely to have a delivery via cesarean section (31.68% vs 23.58%, P value <0.0001), be admitted to an adult ICU (0.49% vs 0.18%, P value 0.0026), and experience overall SMM (2.66% vs 1.66%, P value 0.0001) compared to their White counterparts. Additionally, Black women were more likely to experience SMM when excluding blood transfusion (0.64% vs 0.32%, P value 0.0139). There was no significant difference between races in overall SMM among postpartum hemorrhage cases or when excluding blood transfusion. Equal access to care and socioeconomic status do not explain the healthcare disparities encountered by Black women having children in the United States. Further studies to assess causes such as systemic racism (including implicit and explicit medical biases) and physiologic factors are warranted.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Mortality and Morbidity in Premature Infants: An East and West Comparative Study.

Survival of preterm infants differs dramatically depending on birthplace. No previous studies have compared outcomes of preterm infants between low middle-income and high-income countries such as India and the United States. The purpose of this study is to evaluate differences in care practices, resources, mortality, and morbidities in preterm infants with birth weight 700 to 1,500 g between two major neonatal centers in these countries. This is a retrospective cohort study with de-identified data from Fernandez Hospital (FH) in Hyderabad, India, and Texas Children's Hospital (TCH) in Houston, TX, for infants born January 2016 to December 2018, and weighing 700 to 1,500 g at birth. The primary outcome was death before hospital discharge. Of 1,195 infants, 736 were admitted to FH and 459 were admitted to TCH. After controlling for differences in gestational age, small for gestational age, and antenatal corticosteroid use, TCH patients had lower mortality before hospital discharge (adjusted odds ratio [aOR] = 0.28, 95% confidence interval [CI]: 0.16-0.48, p < 0.001) and more bronchopulmonary dysplasia (BPD; aOR = 2.2, 95% CI: 1.51-3.21, p < 0.001). The composite outcome of death or BPD and death or any major morbidity (BPD or intraventricular hemorrhage grade II or more or periventricular leukomalacia grade II or more or retinopathy of prematurity requiring treatment) were not different. In this study, TCH infants had decreased odds of death before hospital discharge compared with FH but higher odds of BPD, which may be related to increased survival and differences in care practices. · Few studies compared outcomes of premature infants between different high-income countries.. · There are no studies comparing preterm infants between low middle-income and high-income countries such as India and the United States.. · This study evaluated detailed comparison of care practices and infrastructure of NICUs in India and United states..

COVID-19 in Neonates, A Case Series Study from Tertiary Neonatal Centers in Iran

Introduction: The Novel coronavirus, sars-cov-2, is responsible for the recent pandemic. Although it mostly affects adults, children of all ages, including neonates, can become ill with Covid-19, as well. The real prevalence rate of coronavirus disease 2019 (COVID-19) in children is unknown. However, the severity of symptoms in children and neonates is less than in adults. Regarding the new presentation of this disease, the current study has reported a case series of COVID-19 in neonates. Case Presentation: In this article, 10 neonates with COVID- 19 admitted to our neonatal intensive care units are reported. All reported neonates had general suspicious symptoms of COVID- 19 with positive results for SARS-CoV-2 assessed by polymerase chain reaction (PCR) from the nasopharynx area or nose of the patients. All neonates, except for two of them, were term neonates. One case had open-heart surgery for congenital heart disease (transposition of the great arteries (TGA)). The mean patients age was 7.8 days on admission. The most frequent symptom was fever. Severe respiratory symptoms were reported in two cases. Also, abnormal radiologic findings in the chest X-ray were detected in two cases. Regarding the lack of significant respiratory symptoms in most of the patients, the lung computed tomography (CT) scan was taken just from one neonate. Leukopenia (WBC &lt; 5000/mm3) was detected in one case, with no lymphopenia in all neonates. The positive C-reactive protein test was not found in all cases. No patient was treated by special anti-viral agents for COVID-19, and usual antibiotic treatment for neonatal sepsis was administered for all cases. All patients, except for one, survived with no significant sequela of the disease. Conclusions: This study demonstrated that clinical manifestations, as well as laboratory and radiologic findings of COVID-19, are milder in neonates than in the older ages. Hence, it can be argued that the prognosis of COVID-19 in the neonatal period is generally good.

Creation of a Neonatal Thrombosis Center and its Use to Successfully Treat Infants with Severe Thromboses

Creation of a Neonatal Thrombosis Center and its Use to Successfully Treat Infants with Severe Thromboses

Transfusion-associated necrotizing enterocolitis (NEC) in extremely preterm infants: experience of a tertiary neonatal center in UK

Objective To compare the characteristics and short-term outcomes in extremely preterm infants, who developed necrotizing enterocolitis (NEC) following a packed red blood cell transfusion (pRBC) within 48 h (TANEC), with those who developed NEC beyond 48 h (non-TANEC). Setting A single-center retrospective cohort study in a Tertiary neonatal intensive care unit in the UK over a 5-year period Patients and methods Extremely premature infants (23–27 weeks gestation) were selected. TANEC and non-TANEC incidence were calculated from the confirmed NEC group (defined as modified Bell’s stage II and beyond). The characteristics and short-term outcomes of infants with TANEC in the first 8 weeks of life were compared to infants with non-TANEC. Results and interpretation Incidence of confirmed NEC was 14% (28/207). On further subgroup analysis of the confirmed NEC cases, 46% (13/28) of infants were identified with TANEC and 54% (15/28) with non-TANEC. The incidence of TANEC did not correlate with the number of antecedent pRBC transfusions or the pre-transfusion median hemoglobin (Hb) levels. There were no significant differences in characteristics between the TANEC and non-TANEC groups. Infants within the TANEC group required more intensive neonatal care support, greater surgical intervention (p-value 0.043) with loss of gut integrity and an increase in number of TPN dependency days (p-value 0.014). Conclusions A significantly worse clinical course and short-term outcome was observed in the TANEC group when compared with the non-TANEC group.

Relationship between Apgar Scores and Morbidity and Mortality Outcomes in Preterm Infants: A Single-Centre Cohort Study

Introduction: Apgar scoring in modern practice has extended beyond the original described remit by Virginia Apgar, including prognostication. Prognostic value of Apgar scoring in preterm populations is unsupported by robust evidence. Objectives: We aimed to identify the association between mortality or a composite mortality/major morbidity outcome in preterm infants with 1-min, 5-min, and sum 1 + 5-min Apgar scores. Methods: Seven-year retrospective data was analysed on neonates born <32 weeks gestation in a regional neonatal centre. Co-primary outcomes were mortality and composite mortality/major morbidity. Adjusted odds ratios (aOR) were estimated using multivariable logistic regression analysis. Results: 394 infants were included in the analysis. In neonates born <28 weeks gestation, no significant association was found between Apgar scores and the co-primary outcomes. In neonates born ≥28 weeks, low 1-min (aOR 10.452 [1.273, 85.835] for scores 4–6, 22.173 [2.666, 184.438] for scores 0–3), 5-min (4.724 [1.616, 13.806] for scores 4–6, 11.178 [1.803, 69.299] for scores 0–3), and sum 1 + 5-min Apgar scores (12.447 [2.674, 57.941] for scores 4–6, 55.960 [8.333, 375.804] for scores 0–3) were associated with significantly increased aOR of mortality. Increased aOR of composite mortality/major morbidity were also seen in neonates with moderately low (4–6) Apgar scores (aOR 3.104 [1.522, 6.328] for 1 min, 2.804 [1.406, 5.594] for 5 min, and 3.232 [1.769, 5.905] for 1 + 5 min). Conclusions: Apgar scoring at 1 and 5 min has limited prognostic accuracy for extremely preterm infants but is prognostic in older infants. Sum Apgar scores, a measure of initial condition and response to resuscitation, may be a better predictor of mortality than individual scores.

Congenital right diaphragmatic defects: Our institutional experience

Background:The descriptive clinical study was conducted to analyse the clinical profile as well as the outcome of congenital right diaphragmatic defects among children including neonates in a tertiary care referral neonatal and paediatric centre in southern Karnataka, India.Materials and Methods:This retrospective and prospective observational clinical study was conducted from January 2005 to August 2019, over a period of 14.7 years in a tertiary care referral neonatal and paediatric centre. Clinical characteristics and risk factors of 33 children including neonates admitted and diagnosed with congenital right diaphragmatic defects were assessed both pre- and postoperatively. Neonates and children with acquired right diaphragmatic hernia defects and the left-sided diaphragmatic defects were not included in this clinical study.Results:For statistical as well as clinical analysis, 33 study subjects were grouped into four groups, depending on the pre-operative and intraoperative findings as well as on their final diagnosis. Group I comprised right congenital diaphragmatic hernia (RCDH) (n = 18), Group II comprised RCDH with sac (n = 6), the babies with diagnosis of right diaphragmatic eventration were included in Group III (n = 7), whereas babies with other right-sided diaphragmatic hernia defects diagnosis were included in Group IV (n = 2).Conclusion:Right-sided congenital diaphragmatic defects, though rare, do carry excellent survival if referred early and managed in a tertiary care neonatal and paediatric centre as that of left diaphragmatic defects.

Breast cancer and pregnancy: about 15 cases collected at the maternity center Monastir, Tunisia

Le but de cette étude était de décrire les caractéristiques cliniques, radiologiques, histologiques et thérapeutiques du cancer du sein diagnostiqué au cours de la grossesse. Nous avons effectué la revue de tous les cancers du sein diagnostiqués au cours de la grossesse dans le centre Maternité et de Néonatologie de Monastir -Tunisie, sur une période allant de 2004 à 2019. Nous avons ainsi colligé 15 cas. L'âge moyen des patientes était de 34 ans. La plupart des cancers du sein associés à la grossesse (CSAG) était diagnostiquée en post-partum. Le carcinome canalaire infiltrant était le type histologique majeur (93% de cas), un cas rare de carcinome sécrétoire a été observé. Le stade clinique était dominé par les formes T2 et T4. Les récepteurs hormonaux étaient négatifs dans 40% des cas, le récepteur HER2 était positif dans 26,6% des cas. Le traitement incluait la chirurgie, radiothérapie, chimiothérapie et palliative. La moyenne de survie est de 32,2 mois. Le cancer du sein associé à la grossesse est une entité rare. Son pronostic est globalement mauvais en raison de l'âge jeune de survenue et d´un diagnostic souvent tardif. La décision thérapeutique constitue une contrainte difficile, par nécessité, multidisciplinaire à laquelle participera la patiente. La thérapie ciblée reste le grand espoir des nouvelles thérapies.

A Cohort Study on Survival Predictors of Low Birth Weight Newborns

Introduction: Low Birth Weight (LBW) represent a vulnerable group of newborns associated with high risk of complications thus have a high mortality rate. There are many factors affecting the early survival of LBW neonates. There are limited studies providing the evidence on survival predictors in the newborns in western Indian region. Aim: To identify the various factors determining the survival of LBW newborns. Materials and Methods: This was a prospective cohort study conducted in the Neonatal Intensive Care Unit (NICU) of the Department of Paediatrics, Jay Kay Lon Mother and Child Hospital, a neonatal and paediatric tertiary care centre attached to Government Medical College, Kota, India over a period from January 2011 to December 2011. Three hundred and sixty two newborns, admitted to the neonatal intensive care unit with birth weight &lt;2500 gm within 24 hours of birth, were included in the study. Data were interpreted by using Statistical Package for Social Sciences (SPSS) Software for windows version 20.0. Those babies that were transferred and directly discharged to home were pooled as survivors and for the purpose of analysis were compared to babies that died during hospital stay. Associations between categorical variables and survival and death outcome were performed using the Chi-Square test. The p-value less than or equal to 0.05 was considered significant. Results: This study of total sample of 362 newborns, reported a survival rate of 76.52% (277) and a mortality of 23.48% (85). Single gestation birth had better survival (78.69%) than multiple births (64.91%) (p=0.024). The survival improved as the birth weight increased (p&lt;0.001). The survival in female was better (82.31%) as compared to males (72.56%) (p=0.032). The survival in Appropriate for Gestational Age (AGA) newborns was better (79.85%) than Small for Gestational Age (SGA) (67.68%) (p=0.0149). Neonates delivered to mothers who received antenatal steroids had a survival rate of 76.14% as compared to 68.13% in those who had not received steroids (p&lt;0.02). Main cause of mortality in the study group was Respiratory Distress Syndrome (RDS) (86.36%) followed by Birth Asphyxia (BA) (33.33%) and Necrotising Enterocolitis (NEC) (33.33%). Conclusion: The BA and RDS were the most common cause of neonatal mortality among various other complications related to prematurity and LBW. However, there are several factors that interplay and it is not possible to single out any particular factor influencing LBW survival. Reducing perinatal mortality requires a multidimensional approach with timely identification and appropriate management of the issues related to potential complications of prematurity as RDS, LBW and BA.

The use of severity assessment scales in evaluating the transportability of newborns: a cohort retrospective study

Introduction. Standardized assessment of the patient status and the decision on the possibility of transfer is an essential part of the neonatal transport service. However, there are no generally accepted tools for assessing severity and making decisions regarding newborn transfer. Objectives. To compare the capabilities of scales in relation to the decision about the non-transportability of newborns. Materials and Methods. The cohort study included data from 604 trips of the transport team of the neonatal resuscitation and consultation center. The assessment was carried out on the KSHONN, NTISS and TRIPS scales, the distribution of transportable and non-transportable patients was studied depending on the assessment for each scale. The calculation of the risk ratio of nontransportation was performed depending on the assessment on the scales. AUC ROC was calculated for all scales in relation to the decision of transport team about the patientʼs non-transportability. Results. The scores on the scales significantly differ between the subgroups of transportable and non-transportable newborns, p &lt; 0.0001. Significant differences in subgroup distribution were observed depending on the scores between transportable and nontransportable patients. When evaluated by KSHONN 6–8 points, the risk ratio of non-transportability was 61.36 [3.77–999.47]. For NTISS of 20–29 points, the risk ratio of non-transportability was 51.37 [3.18–829.11]. When evaluated by TRIPS 17–23 points, the risk ratio of non-transportability was 18.81 [1.09 — 327.26]. Conclusions. Scales have a high predictor value in relation to the decision of the transport team about the non-transportability of patients. Comparison of the subgroups by the proportion of non-transportable patients indicates that a score of more than 5 according to the KSHONN, more than 19 points on the NTISS scale and more than 16 points on the TRIPS scale are associated with a significant increase in the risk of non-transportability.

The Effect of Systemic Hydrocortisone Initiated 7 to 14 Days After Birth in Ventilated Preterm Infants on Mortality and Neurodevelopment at 2 Years’ Corrected Age: Follow-Up of a Double-Blind, Placebo-Controlled, Multicentre, Randomised Trial

Background: Our double-blind, placebo-controlled, randomised trial investigating systemic hydrocortisone in mechanically ventilated preterm infants (gestational age <30 weeks and/or birth weight <1250 grams) in the second week of life, reported no difference for the primary outcome death or bronchopulmonary dysplasia (BPD) at 36 weeks’ postmenstrual age. Here we report the results for death and neurodevelopmental impairment (NDI) at two years’ corrected age (CA). Methods: The infants were randomly assigned to a 22-day course of systemic hydrocortisone (cumulative dose 72∙5 mg/kg; n=182) or placebo (n=190) stratified by study centre and gestational age (<27, ≥27 weeks). Follow-up assessment was performed in the 16 neonatal trial centres at 2 years’ CA. Findings: Among 371 patients (mean gestational age 26 weeks) who completed the trial, 276 (74∙4%) survived till 2 years’ CA, and were assessed between April 18, 2014 and June, 27 2019; parents withdrew consent for one child treated with hydrocortisone. The composite outcome death or NDI was available in 356 (96∙0%) infants and occurred in 97 of 171 hydrocortisone treated infants (56∙7%), and in 116 of 185 infants (62∙7%) assigned to placebo (adjusted risk difference, -5∙2% [95% CI -15∙1 to 4∙6]; adjusted odds ratio, 0∙79 [95% CI 0∙51 to 1∙22], p=0∙28). Pre-specified subgroup analysis of infants <27 weeks gestation showed a significant reduction in death or NDI in the hydrocortisone group compared to the placebo group (54∙6% vs. 66∙2%; risk difference -11∙6% [95% CI -22∙4% to -0∙5%], p=0∙02 for interaction). Interpretation: The administration of hydrocortisone in the second week of life was not significantly associated with a difference in death or NDI in mechanically ventilated preterm infants. Future studies should confirm the observed increased intact survival in infants <27 weeks gestation treated with systemic hydrocortisone. Trial Registration: The SToP-BPD study was registered with The Netherlands Trial Register (NTR2768; registered on 17 February 2011) and the European Union Clinical Trials Register (EudraCT, 2010-023777-19; registered on 2 November 2010). Funding Statement: The Netherlands Organization for Health Research and Development ZonMW Priority Medicines for Children no. 11-32010-02. Declaration of Interests: Dr. van Kaam reports grants from The Netherlands Organization for Health Research and Development ZonMW during the conduct of the study. No other disclosures were reported. Ethics Approval Statement: The study-protocol was approved by the human research ethics committees at each participating centre. Written informed consent was obtained from both parents before randomisation.

Analysis of risk factors of perinatal pathology in newborns with congenital defects

Newborns with congenital defects usually have a burdened perinatal history, and their mothers' pregnancy proceeds against the background of severe complications and exacerbation of chronic pathology. In modern obstetrics, many indicative scales are used to determine the degree of risk of perinatal and maternal pathology, including a point assessment on the Coopland scale.The aim. Conduct a clinical and epidemiological analysis of perinatal and maternal risk factors according to the A. Coopland scale and analyze the frequency of perinatal pathology in newborns with congenital defects in the early neonatal period.Materials and methods. We retrospectively and selectively analyzed 88 birth histories of mothers of newborns with congenital malformations who received surgical treatment in the neonatal center and scored risk factors for perinatal and maternal pathology according to the A. Coopland scale.Results. It was revealed that mothers of newborns with congenital defects were included in the groups of high (3 - 6 points) and very high (7 or more) predicted risk of perinatal and maternal pathology. The high-risk group included 28 (32%) mothers, and 60 women (68%) - the very high-risk group of perinatal and maternal pathology.Conclusions. In women with more than 15 points on the A. Coopland scale 4.7 times more often children were born with intrauterine infection, gastrointestinal disorders, NEC and severe respiratory disorders in the early neonatal period compared with mothers who gave birth to newborns with the same gestational age and a group of low and high risk of perinatal and maternal pathology

Neurodevelopmental and Growth Outcomes of Extremely Preterm Infants with Short Bowel Syndrome

To determine if preterm infants with surgical necrotizing enterocolitis (sNEC) or spontaneous intestinal perforation (SIP) with short bowel syndrome (SBS) have worse neurodevelopmental and growth outcomes than those with sNEC/SIP without SBS, and those with no necrotizing enterocolitis, SIP, or SBS. We undertook a retrospective analysis of prospectively collected data from infants born between 22 and 26weeks of gestation in the National Institute of Child Health and Human Development Neonatal Research Network centers from January 1, 2008, to December 31, 2016. Survivors were assessed at 18-26months corrected age by standardized neurologic examination and Bayley Scales of Infant and Toddler Development, Third Edition. The primary outcome was moderate-severe neurodevelopmental impairment. Growth was assessed using World Health Organization z-score standards. Adjusted relative risks were estimated using modified Poisson regression models. Mortality was 32%, 45%, and 21% in the 3 groups, respectively. Eighty-nine percent of survivors were seen at 18-26months corrected age. Moderate-severe neurodevelopmental impairment was present in 77% of children with SBS compared with 62% with sNEC/SIP without SBS (adjusted relative risk, 1.22; 95% CI, 1.02-1.45; P=.03) and 44% with no necrotizing enterocolitis, SIP, or SBS (adjusted relative risk, 1.60; 95% CI, 1.37-1.88; P<.001). Children with SBS had lowcognitive, language, and motor scores than children with sNEC/SIP without SBS. At follow-up, length and head circumference z-scores remained more than 1 SD below the mean for children with SBS. Preterm infants with sNEC/SIP and SBS had increased risk of adverse neurodevelopmental outcomes at 18-26months corrected age and impaired growth compared with peers with sNEC/SIP without SBS or without any of these conditions.

Comparison of laparoscopic abdominal cerclage and transvaginal cerclage for the treatment of cervical insufficiency: a retrospective study

To compare the pregnancy outcome of patients with cervical insufficiency (CI) underwent prophylactic laparoscopic abdominal cervical cerclage (LAC) and transvaginal cervical cerclage (TVC). A retrospective trial was carried out in the Department of Gynecology, Qingdao Women and Children's Hospital, Shandong Province, China. A total of 217 women with cervical insufficiency underwent the prophylactic cerclage, and the surgical approach was decided by the patients or depended on doctors' advice. The primary outcome measure was the fetal outcome. Secondary outcome measures were delivery of an infant at ≥ 34th gestational weeks, newborn birth weight, neonatal intensive care center (NICU) occupancy, and postoperative complications. Nonparametric variables were analyzed with the Mann-Whitney (U) test, and categorical type outcomes were analyzed with the Chi-square test or the Fisher's exact test. A P value < 0.05 was considered significant. Data analysis was performed using SPSS Statistics Version 19. As of follow-up date, 154 eligible patients were included in this study, with 74 (48.1%) women in the LAC group and 80 (51.9%) in the TVC group. The total fetal survival rate in the two groups was 90.3% (139/154), of which the rate significantly higher in the LAC group compared to the TVC group (97.3% vs. 83.8%, P < 0.01). The delivery of an infant at ≥ 34th gestational weeks was significantly higher in the LAC group compared to the TVC group (94.6% vs. 71.3%, P < 0.01). Compared to the TVC group, the mean newborn birth weight was higher, and the NICU occupancy rate was less in the LAC group (3293.4 ± 542.8g vs. 2953.6 ± 704.4g, P = 0.002; 2.8% vs. 17.9%, P = 0.003). No fatal surgical complications occurred in both groups. In patients with cervical insufficiency, the history-indicated conception of prophylactic LAC appears to have a better pregnancy outcome than TVC.

Poor postnatal weight growth is a late finding after sepsis in very preterm infants

ObjectiveTo characterise the association between sepsis and postnatal weight growth when accounting for the degree of growth restriction present at birth.DesignRetrospective matched cohort study using data from the Postnatal Growth...

The effect of routine probiotics supplementation on preterm newborn health: a regression discontinuity analysis

Despite ongoing debate about the health impact of probiotics, rigorous evidence assessing the use of probiotics in routine preterm newborn care is lacking. We aimed to estimate the causal effect of routine probiotics supplementation on moderately preterm newborns' anthropometric development (weight-for-age and height-for-age z scores) and risk of late-onset sepsis. This study used a regression discontinuity analysis based on hospital guidelines that recommended routine probiotics supplementation for neonates born before 34 completed weeks of gestation. Data for this study came from electronic medical records of a level III neonatal care center in Germany and were collected between 2013 and 2019. Newborns born between 30 to 38 completed weeks of gestation without severe congenital defects were eligible for inclusion. Outcomes were weight-for-age and height-for-age z scores at discharge as well as late-onset sepsis. Study participants included 1734 preterm neonates. The results showed no significant intention-to-treat effect on weight-for-age (effect: -0.033 SD; 95% CI: -0.220, 0.155), length-for-age (-0.133 SD; 95% CI: -0.380, 0.114), or late-onset sepsis probability (-1.175 percentage points; 95% CI: -6.556, 4.205). There was no evidence for significant effects of probiotics for any of the study's endpoints on those complying with the hospital guidelines (local average treatment effect). Routine treatment of moderately preterm newborns with probiotics is unlikely to improve anthropometric outcomes. Complier-level analysis suggested that this finding was not simply driven by a lack of physician compliance with hospital guidelines but by an overall absence of large health effects from the treatment itself. Moreover, overall sepsis risk was low and did not change significantly as a result of probiotics supplementation. The findings of this study therefore do not support the routine use of probiotics for improving growth or preventing late-onset sepsis in moderately preterm neonates.

NICU Collaboration During the COVID-19 Worldwide Pandemic: A Memory of Gratitude.

NICU Collaboration During the COVID-19 Worldwide Pandemic: A Memory of Gratitude.

Withholding or withdrawing life-sustaining treatment in extremely low gestational age neonates

ObjectiveTo identify sociodemographic and clinical factors associated with withholding or withdrawing life-sustaining treatment (WWLST) for extremely low gestational age neonates.DesignObservational study of prospectively collected registry data from 19 National Institute...

Antiviral treatment in congenital HCMV infection: The six-year experience of a single neonatal center in Poland.

Antiviral treatment is recommended for symptomatic newborns with congenital cytomegalovirus infection (cCMV). To compare 2 treatment methods in neonates with cCMV - ganciclovir-based therapy (intravenous ganciclovir (GCV) or sequential GCV + valganciclovir (VGCV) therapy) with oral VGCV-based therapy - in Polish neonates. A total of 98 symptomatic infants with cCMV (positive HCMV DNA in urine ≤21st day of life) hospitalized in the neonatal intensive care unit (NICU) between 2012 and 2017 were enrolled. Clinical characteristics, the viral load in blood and urine, hematological and biochemical tests, neuroimaging results, and the length of hospitalization were compared between the study groups at baseline and at the 2nd hospitalization. In 2012, GCV was used in 57% of the cases, sequential therapy in 33% and VGCV in 10%. In 2017, VGCV monotherapy was used in 83% of the infants treated. Valganciclovir treatment allowed the length of hospitalization to be shortened over 2.5 times during the six-year observation period. Infants treated intravenously had lower birth weights and head circumferences, and more frequently presented splenomegaly, petechiae, thrombocytopenia, and hepatitis. The baseline viral load in the blood and urine were similar in both groups, but at follow-up visits 4-6 weeks later, a viral load about 70 times lower was observed in the blood of the VGCV-based group (1029 viral copies/mL compared to 72,188 viral copies/mL in the GCV-based group; p = 0.04). The prevalence of neutropenia was similar in both groups at the follow-up visits. Valganciclovir became the first line of antiviral therapy in cCMV in the study population. Compared to GCV-based therapy, VGCV monotherapy allowed shorter hospital stays and reduced the viral load in blood due to continuing treatment at home. Valganciclovir monotherapy did not provoke more side effects such as neutropenia. Intravenous GCV is still suitable for patients with severe disseminated disease, born prematurely, with low birth weights, or not tolerating enteral feeding. In those infants, the sequential therapy seems to be optimal.

Helicopter Neonatal Transport: First Golden Hour at Birth Is Useful Tool Guiding Activation of Appropriate Resources

ObjectiveA lack of consensus exists about the appropriate criteria to activate a helicopter during neonatal transport. The aim of the present study was to explore the possible guiding criteria to justify helicopter activation for neonatal transport (NETS). MethodsThis was a retrospective study of the Gaslini Genoa NETSs from February 1995 to December 2019. The flight and driving times and the reason for helicopter neonatal transport activation were obtained for every subject from the online NETS clinical database. Driving and flight data (mean and standard deviation [SD]) were compared using the Student t-test (P < .05). ResultsFive thousand eight hundred sixty-six transported newborn infants were identified. A significant difference emerged between the overall ground (mean = 99.2 minutes [SD = 15.7 minutes]) and overall helicopter transport times (mean = 27.8 minutes [SD = 11.9 minutes], P < .0001). Considering the “golden hour,” the chance to stabilize the patient within this time frame could have been possible for 4 of 5 neonatal care centers when using a helicopter. ConclusionOn the basis of our observations, we suggest including the golden hour as 1 of the guiding criteria justifying helicopter activation, especially if applied to the reason of transport and the quality of assistance the newborn will receive while waiting for the NETS team.