Neonatal Examination Research Articles

Prediction of neuromotor outcome in infants born preterm at 11 years of age using volumetric neonatal magnetic resonance imaging and neurological examinations.

To study the prognostic value of volumetric brain magnetic resonance imaging (MRI) at term equivalent age (TEA) and neurological examinations at TEA and at 2 years of corrected age for long-term neuromotor outcome in infants born very preterm. A total of 98 infants born very preterm were included. Structural and volumetric brain MRI and the Dubowitz neurologic examination were done at TEA. The Hammersmith Infant Neurological Examination (HINE) was performed at 2 years of corrected age. The Touwen examination was used for the assessment of minor neurological dysfunction (MND) at the age of 11 years. Of all children (median birthweight 1083g [quartiles 820, 1300]; gestational age 28 5/7wks [26 4/7, 30 2/7]), 41 had simple MND, 11 had complex MND (cMND), and eight had cerebral palsy (CP). The negative and positive predictive value of structural brain MRI for cMND or CP was 88% and 50% respectively. Reduced volumes of total brain tissue, frontal lobes, basal ganglia and thalami, and cerebellum associated with cMND or CP. The results of the Dubowitz neurologic examination and the HINE correlated with the Touwen examination. Structural and volumetric MRI at TEA and structured neurological examinations predict long-term neuromotor outcome in infants born preterm.

Urine examination for early diagnosis of neonatal multiple organ injury

Neonatal visceral injury have high clinical incidence and it is hard to make clinical diagnosis early by routine inspection.In recent years, researches have shown that neonatal multiple organs damage can be diagnosed early by analyzing some special components in urine.Besides, urine analysis is a noninvasive examination method and it is suitable for clinical promotion.This paper enumerates the application of neonatal urine examination in the early diagnosis of kidney damage, bronchial pulmonary displasia, patent ductus arteriosus, hypoxic ischemic encephalopathy and metabolic disease. Key words: Neonates; Urine analysis; Organ injury

Delayed diagnosis of anorectal malformations (ARM): causes and consequences in a resource-constrained environment.

Delay in diagnosis or referral of patients with an anorectal malformation (ARM) is associated with significant morbidity and mortality. We describe the frequency and consequences of delay in recognition or referral of patients with ARM. Our study aims to determine whether the source healthcare facility affects the timing of diagnosis and to identify modifiable factors that may expedite diagnosis and referral. Retrospective study of patients referred to a pediatric surgical service with a newly diagnosed ARM between July 2002 and December 2010. Data retrieved included patient demographics, perinatal history, time of diagnosis, clinical findings, management, and morbidity and mortality. Delay was defined as diagnosis after 24 h of birth or transfer to the tertiary referral centre more than 24 h after diagnosis. 273 patients (186 males, 87 females) were referred during the study period. Delays were seen in 158 (57.9%) patients with morbidity in 58 (36.7%, p < 0.001) and mortality in 9 (5.7%, p = 0.008). Delay was more frequent amongst babies born in community health centres (CHCs) than in hospitals (90.5 vs. 55.1%, p = 0.002). The median age at diagnosis was 3 days (range 2 days to 5 years). There is a need for staff education, particularly in CHCs, concerning routine neonatal examination and normal perineal anatomy. Girls, in whom a decompressive fistula is often present, are at particular risk of diagnostic delay. Delay causes increased morbidity and mortality.

Idiopathic Recurrent Polyhydramnios: A Rare Case Report

Polyhydramnios occurs in 1-2% of pregnancies and may be idiopathic in more than half of the cases. The diagnosis of idiopathic polyhydramnios can be made only in the absence of maternal diabetes, fetal anomalies, aneuploidies, multiple gestation, Rh incompatibility, placental tumours and non-immune hydrops. Rarely, idiopathic polyhydramnios may be recurrent in future pregnancies and sometimes neonatal examination may reveal cause of polyhydramnios. Preterm delivery and associated fetal anomalies are the main concerns with recurrent polyhydramnios. Very few cases of recurrent idiopathic polyhydramnios have been reported in literature with a maximum number of four pregnancies being affected consecutively. We report here a case of idiopathic polyhydramnios which recurred consecutively in three pregnancies with a good neonatal outcome.

Staphylococcal scalded skin syndrome in a neonate following prolong labor

Staphylococcal scalded skin syndrome (SSSS) encompasses a spectrum of superficial blistering skin disorders caused by the exfoliative toxins (ETs) of some strains of Staphylococcus aureus. In this case report, we present a case of SSSS in an 8-day-old neonate. Furthermore, we tried to highlight the importance of early diagnosis by history and physical examination and isolation of the infected neonates because of the risk of spread of infection to other neonates in the Neonatal Intensive Care Unit.

Epidemiology of the neural tube defects in Kashmir Valley.

Background:Neural tube defects (NTDs) are the most common congenital malformations affecting the brain and spinal cord and have a multifactorial etiology. Genetic and environmental factors have been found to cause these defects, both individually and in combination.Methods:A 2-year hospital-based prospective study was carried out from November 2013 to October 2015 to determine the incidence, types, demographics, risk factors, and other associated anamolies relevant to NTDs in Kashmir Valley. A detailed history of the mother was taken along with detailed clinical examination of neonate including measurement of head circumference and checking the status of fontanella, whether lax/full/bulging/or tense, type of NTD. Investigations that were done included were X-ray skull: Anterior-posterior (AP) and lateral, X-ray spine: AP and lateral, ultrasonography abdomen, magnetic resonance imaging: Spine and brain.Results:The total number of babies with NTD's was 125 with an overall incidence of 0.503. Kupwara district was having the highest incidence (1.047) and Srinagar district the lowest incidence of NTD's (0.197). Majority of NTD's (116 cases, 92.8%) were found in the rural areas. Among the different types of NTD's, spina bifida had an incidence of 0.342 (85 cases, 68%) and anencephaly had an incidence of 0.113 (28 cases, 22.4%). There was a slight preponderance of females over males with NTD's. There were 70 females (56%) and 55 males (44%), respectively, with a male: female ratio of 0.8:1Conclusions:The incidence rates of NTDs is very high for Kashmir Valley. Geographical distribution of NTDs at this place confirms a relationship between the socioeconomic status, educational status, maternal too young or advanced age, and environmental factors for the development of a NTD. The results of this study point to the importance establishing a health policy to prevent NTD in Kashmir Valley.

Innocent versus pathologic murmurs: A challenge of neonatal examination

Objective: Auscultation is one of the most important procedures in routine examination of neonates for congenital heart disease (CHD). Differentiating between innocent and pathologic murmurs during auscultation is very hard and usually unfeasible. The aim of this study was to assess the ability of clinical examination in comparison to echocardiographic examination to differentiate innocent from pathological murmurs and also to define the prevalence of heart murmurs in neonates. Materials and Methods: In the current cross-sectional study, 7113 neonates were examined in a period of 1 year by two neonatologists. If heart murmurs or unnatural sounds were auscultated during the examination, the observations were categorized as probably pathologic or probably innocent and the neonates were then referred to a pediatric cardiologist for echocardiography. Results: Prevalence of heart murmurs was found to be 19.26 for every thousand live births. According to the clinical examinations, 55% of murmurs were categorized as innocent and 45% as pathologic. Echocardiographic results revealed that in fact 50.8% of cases were either normal or had physiological defects and 49.2% were pathologic. Sensitivity, specificity, positive predictive value, and negative predictive value of clinical examination in differentiating between innocent and pathologic murmurs were found to be 79.7%, 88.5%, 87%, and 81.8%, respectively, and the false-positive and false-negative rates were found to be 11.5% and 20.3%, respectively. Conclusion: Although these numbers show that clinical examination is adequate for differentiating between innocent murmurs and CHD, however the false-positive and false-negative rates in clinical examination, stress that echocardiography must be performed for a better CHD diagnosis.

Epidemiology of the neural tube defects in Kashmir Valley.

Introduction/Background:Neural tube defects (NTD) are the most common congenital malformations affecting the brain and spinal cord and have a multifactorial etiology. Genetic and environmental factors have been found to cause these defects, both individually and in combination.Aims and Objectives:The aim of this study was to determine the incidence, types, demographics, risk factors, and other associated anomalies relevant to NTDs in Kashmir Valley.Materials and Methods:A 2-year hospital-based prospective study was carried out from November 2013 to October 2015. A detailed history of the mother was taken along with detailed clinical examination of neonate including measurement of head circumference and checking the status of fontanella, whether - lax/full/bulging/or tense, type of NTD. Investigations that were done included were X-ray skull: Anteroposterior (AP) and lateral, X-ray spine: AP and lateral, ultrasonography abdomen, magnetic resonance imaging: Spine and brain.Results:The total number of babies with NTD's was 125 with an overall incidence of 0.503. District Kupwara was having the highest incidence (1.047) and district Srinagar the lowest incidence of NTD's (0.197). The majority of NTD's (116 cases, 92.8%) were found in the rural areas. Among the different types of NTD's, spina bifida had an incidence of 0.342 (85 cases, 68%), and anencephaly had an incidence of 0.113 (28 cases, 22.4%). There was a slight preponderance of females over males with NTD's. There were70 females (56%) and 55 males (44%) respectively with a male:female ratio of 0.8:1.Conclusions:The incidence rates of NTDs are very high for Kashmir Valley. Geographical distribution of NTDs at this place confirms a relationship between the socioeconomic status, educational status, maternal age and environmental factors for the development of an NTD. The results of this study point to the importance establishing a health policy to prevent NTDs in Kashmir Valley.

Neonatal Seizures: A Review of Outcomes and Outcome Predictors.

The majority of neonatal seizures are of acute symptomatic origin, and their occurrence is associated with higher mortality and morbidity compared with the general population, even if there is conflicting evidence of a detrimental effect per se. Etiology is considered the main determinant of outcome, but other factors, including gestational age, brain damage severity, neonatal neurological examination, and electroencephalographically (EEG) interictal and ictal characteristics are also related to neurodevelopmental outcome or death. Therefore, accuracy in early prognostication since the neonatal period can be improved by conveniently integrating different clinical and instrumental findings.The aim of this review is first to review the outcome of newborns with seizures (mortality, epilepsy, cerebral palsy, and intellectual disability), second to review the risk factors for adverse outcome after seizures in the newborn period, considering clinical, EEG/amplitude-integrated EEG, and neuroimaging findings associated with adverse outcome and lack of response to treatment, and finally to review published scoring systems for predicting neurologic outcome after neonatal seizures.

Impact of pulse oximetry screening on the detection of duct dependent Congenital Heart Diseases (CHD)

Background Cardio vascular malformations are the commonest type of congenital malformations, but most are not detected by routine neonatal examination. Approximately 1-1.8 babies per 1000 live births have a duct dependent circulation, with a persistent ductus arteriosus being necessary for survival. These babies are at particular risk due to the trend towards early discharge from postnatal wards. Critical congenital heart defect (CCHD) is life threatening and requires intervention in infancy. However, CCHD is not always detected prenatally or upon examination in the post natal wards. As a result, some infants with CCHD are discharged from the postnatal wards to home, where they quickly decompensate. Methods Prospective study was done over ten weeks duration in the postnatal wards in Teaching Hospital Peradeniya. The preductal and postductal oxygen saturation (SpO2) of 1450 clinically healthy term newborns was measured by using pulse oximeter before they were discharged from the wards by a medical officer. Results Out of 1450 babies, the screening was positive in seven babies. The 2D Echocardiogram was done by a Consultant Paediatric Cardiologist. All seven of them confirmed to be suffered from a CHD. Among them, there was one Critical CHD which needed immediate surgical intervention and six other CHDs where four of them needed medical management for Persistent Pulmonary Hypertension as well. The sensitivity and the specificity of this screening test was 100%. Conclusion As the using of pulse oximetry is a low cost, painless and non-invasive procedure which can be done within minutes it is an effective method that can be used in our set up to screen duct dependent CHDs.

Neonatal neurological examination in well newborn term Ugandan infants

BackgroundNewborn neurological examinations have mostly been developed in high-resource settings with cohorts comprising predominantly white Caucasian infants. No comparison has been made with different populations. AimsTo (i) establish the range of neurological findings in apparently well newborn term Ugandan infants, (ii) compare these findings to published data for equivalent term UK infants and (iii) correlate the neurological findings with perinatal characteristics and cranial ultrasound (cUS) imaging. MethodsLow-risk term Ugandan infants were recruited from the postnatal ward at Mulago Hospital, Kampala, Uganda. Neurological examination (1) and cUS were performed. The raw data and neurological optimality scores were compared to published data from UK infants (1). Gestational age, postnatal age, sex, maternal parity and HIV status, mode of delivery, birth weight and head circumference were correlated with raw scores. ResultsUgandan infants showed significantly stronger palmar grasp, better auditory and visual orientation, less irritability and less need for consoling but had poorer tone, poorer quality of spontaneous movements and more abnormal signs than UK infants. No correlation was found between raw scores and cUS findings, gestational age, sex, birth weight and head circumference. Significantly fewer Ugandan infants had optimal scores based on the UK data. ConclusionThe neurological status of low-risk hospital-born term Ugandan infants differs from that of low-risk UK infants. The study findings have implications for assessing normality in Ugandan infants and raise concerns about the use of this UK “optimality” score in other research settings. Further work is needed to understand fully the reasons for the differences.

PPREMO: a prospective cohort study of preterm infant brain structure and function to predict neurodevelopmental outcome.

BackgroundMore than 50 percent of all infants born very preterm will experience significant motor and cognitive impairment. Provision of early intervention is dependent upon accurate, early identification of infants at risk of adverse outcomes. Magnetic resonance imaging at term equivalent age combined with General Movements assessment at 12 weeks corrected age is currently the most accurate method for early prediction of cerebral palsy at 12 months corrected age. To date no studies have compared the use of earlier magnetic resonance imaging combined with neuromotor and neurobehavioural assessments (at 30 weeks postmenstrual age) to predict later motor and neurodevelopmental outcomes including cerebral palsy (at 12–24 months corrected age). This study aims to investigate i) the relationship between earlier brain imaging and neuromotor/neurobehavioural assessments at 30 and 40 weeks postmenstrual age, and ii) their ability to predict motor and neurodevelopmental outcomes at 3 and 12 months corrected age.Methods/designThis prospective cohort study will recruit 80 preterm infants born ≤30 week’s gestation and a reference group of 20 healthy term born infants from the Royal Brisbane & Women’s Hospital in Brisbane, Australia. Infants will undergo brain magnetic resonance imaging at approximately 30 and 40 weeks postmenstrual age to develop our understanding of very early brain structure at 30 weeks and maturation that occurs between 30 and 40 weeks postmenstrual age. A combination of neurological (Hammersmith Neonatal Neurologic Examination), neuromotor (General Movements, Test of Infant Motor Performance), neurobehavioural (NICU Network Neurobehavioural Scale, Premie-Neuro) and visual assessments will be performed at 30 and 40 weeks postmenstrual age to improve our understanding of the relationship between brain structure and function. These data will be compared to motor assessments at 12 weeks corrected age and motor and neurodevelopmental outcomes at 12 months corrected age (neurological assessment by paediatrician, Bayley scales of Infant and Toddler Development, Alberta Infant Motor Scale, Neurosensory Motor Developmental Assessment) to differentiate atypical development (including cerebral palsy and/or motor delay).DiscussionEarlier identification of those very preterm infants at risk of adverse neurodevelopmental and motor outcomes provides an additional period for intervention to optimise outcomes.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12613000280707. Registered 8 March 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-015-0439-z) contains supplementary material, which is available to authorized users.

O.31 - The effect of collimation on the radiation dose received by neonates

Introduction: The rate of preterm births has increased since 1990. Preterm birth leads to less development time for the baby, leading to medical problems. These premature babies need special care and multiple radiographic examinations. Babies are still developing and possess many rapidly dividing cells, making them more susceptible to low levels of ionizing radiation. The dose received is influenced by a few controllable parameters. A difficult to control parameter that influences dose is the collimation used. Diagnostic X-ray examinations of neonates usually include the chest, abdomen or a combined image of both called a baby-gram. The aim was to determine the effect of collimation on the amount of unnecessary radiation dose received by neonates.

The influence of the obstetrical condition on canine neonatal pulmonary functional competence.

To compare the influence of the obstetrical condition on neonatal respiratory performance, to estimate surfactant synthesis through lecithin and sphingomyelin ratio (L/S) in amniotic fluid of pregnant bitches and correlate the L/S with the respiratory condition during the first hour of life. Prospective randomized study. University veterinary teaching hospital and private referral centers. In accordance to the condition at birth, puppies from 25 healthy bitches aged 2-6 years were allocated into: Eutocia Group--EUT (n = 19 neonates and 14 bitches); Dystocia Group--DYS (n = 8 neonates and 5 bitches) and Elective Cesarean Section Group--CS (n = 12 neonates and 11 bitches). Amniotic fluid was drawn from amniotic sac and lecithin (L) and sphingomyelin (S) were measured by high performance liquid chromatography to obtain the L/S ratio. Neonatal physical examination was performed at 1, 5, and 60 minutes after delivery, and included the assessment of respiratory rate (RR) and respiration effort (RE). CS group had significantly lower amniotic L/S ratio when compared to EUT and DYS. There were no significant differences between vaginal groups (EUT versus DYS) in respect to L/S ratios. RE of eutocic neonates improved promptly, while RE of DYS and CS groups improved only 1 hour following birth. Moreover, amniotic L/S ratio positively correlated with RR after 60 minutes. We identified a possible influence of the delivery method on the final surfactant maturation process. Thus, neonates born by elective CS prior to the onset of expulsive uterine contractions should have their respiratory parameters carefully monitored. Additionally, we propose that assessment of respiratory parameters 1 hour following birth can serve as a practical means to indirectly estimate pulmonary maturation (ie, surfactant synthesis) in puppies.

Maternal use of methadone and risk of sudden neonatal death.

To identify and describe infant deaths presenting suddenly and unexpectedly in whom there was a history of maternal methadone consumption or misuse of drugs during pregnancy. Retrospective review of neonatal postmortem examinations between 2004 and 2011. A total of 138 autopsies were performed in infants up to 28days. Thirty-two cases (23%) presented suddenly and unexpectedly. In 12 of 32 (37.5%), in whom the cause ofdeath remained unexplained after a thorough postmortem, there was a history of methadone use and/or other drugs of abuse during pregnancy. Their mean age at death was 11days (range 1-28days). Multiple risk factors for sudden infant death syndrome were present in these 12 cases: smoking (10), prematurity (7), and inappropriate sleeping place (8). Five mothers were positive for hepatitis C. The history was inconsistent with the findings in only one case. An unexpectedly high proportion of infants dying suddenly and unexpectedly in the first month had a history of maternal substance misuse. All had multiple risk factors, for sudden infant death syndrome many avoidable. We would stress the need to emphasise the 'Safe Sleep' message with these families at every contact with health professionals.

A collective review of cases with cryptorchidism managed in a teaching hospital in Sudan

Background: Cryptorchidism is one of the most common urogenital abnormalities in male children. Delayed diagnosis and treatment of cryptorchidism lead to complications such as infertility, malignancy and testis torsion.Objective: To determine the cause of delayed presentation, complications recorded, the surgical treatment offered in a developing country.Methods:A retrospective review of patients’ records from December 2012 to December 2014 was carried out. Sixty one patients presented to the University Charity Teaching Hospital during this period.Results: Sixty one patients were included in the study. Age ranged from 1-75 years with mean at surgery is 11 years. Twenty seven patients (44%) presented after 24 months, 3 (4.9%) less than 12 months, and 23 (37.3%) less than 1 month. Age at operation, 7 (13%) were £ 2years, 15 (28%) were 2-5years, 39 (59%) were &gt; 5 years.Fifty four (88.5%) patients have undergone orchidopexy, 3(4.9%) orchidectomies, 1 (1.6%) biopsy, 1 (1.6%) exploratory laparotomy, and in 2 (3.3%) cases operation wasn’t done.Conclusion:Late presentation observed in this study is alarming and action should be taken by spreading awareness in the community and ensuring adequate neonatal and children examination in order to avoid the complications.

The concurrent validity of assessment of general movements with traditional neonatal neurobehavioral examination in preterm period

The concurrent validity of assessment of general movements with traditional neonatal neurobehavioral examination in preterm period

Clinical significance of cardiac murmurs among neonates in non-university units of a tertiary care maternity hospital, Colombo, Sri Lanka

Introduction: The complete routine neonatal examination before discharge of the newborn baby is the simplest and earliest way to identify possible heart lesions. Objective: The aim of this study was to ascertain the clinical significance of precordial murmurs heard on routine neonatal examination Design: Descriptive, cross sectional study design was applied at routine neonatal examination before discharge of the neonate Method: All consecutive 4,804 live born neonates (excluding those dying before neonatal evaluation) at non-university units of the De Soysa Hospital for Women (DSHW) during a ten month period from 15.05.2013 were screened within 24 hours of birth for precordial murmurs and those with audible murmurs were then referred for echocardiography Results: Prevalence of murmurs and CHD at routine neonatal examination was 16 per 1,000 live births and 15 per 1,000 live births respectively. The most common lesions found in echocardiographic evaluation were atrial septal defect (62%), patent ductus arteriosus (26%), ventricular septal defect (19%) and cyanotic heart with multiple lesions (12%). Conclusions: At routine neonatal examination, prevalence of murmurs was 1.6% and the prevalence of CHD was 15 per 1,000 live births. If a murmur was heard, there was a 96% chance that the neonate could have CHD. Sri Lanka Journal of Child Health , 2015; 44 (1): 24-30 DOI: http://dx.doi.org/10.4038/sljch.v44i1.7959

Motor behaviour of human foetuses during the second trimester of gestation: A longitudinal ultrasound study

Abstract Introduction The aim of this research is to contribute to the knowledge of the normal spontaneous motor behaviour of the human foetus during the second trimester of pregnancy. This study focuses on five patterns of spontaneous foetal movement: startle (S), axo-rhizomelic rhythmia (ARR), axial stretching (AS), general movement (GM), and diaphragmatic contraction (DC). Methods A cohort of 13 subjects was followed up using 2D obstetrical ultrasound images at 12, 16, 20, and 24 weeks of gestation. As inclusion criteria, neonatal neurological examination and general movements after eutocic delivery at term were normal in all of the subjects, and their neuromotor and cognitive developments until the end of pre-school age were also normal. Results All these five motor patterns are present at the beginning of the 2nd gestational trimester, but their quantitative and qualitative traits are diverse according to gestational ages. The phasic, isolated or rhythmically repeated movements, S and ARR, are prominent at 12 and 16 weeks of gestation, and then their presence gradually diminishes. By contrast, tonic and complex AS and GM movements increase their presence and quality at 20 and 24 weeks. RAR constitute a particular periodic motor pattern not described in previous literature. Moreover, the incidence of DC is progressive throughout the trimester, in clusters of 2–6 arrhythmic and irregular beats. Foetal heart rate increases during foetal motor active periods. Conclusions All five normal behavioural patterns observed in the ultrasounds reflect the progressive tuning of motor generators in human nervous system during mid-pregnancy.

LC-MS-based metabolomics identification of novel biomarkers of chorioamnionitis and its associated perinatal neurological damage.

Chorioamnionitis is a complication of pregnancy associated with significant maternal and perinatal long-term adverse outcomes. We apply high-throughput amniotic fluid (AF) metabolomics analysis for better understanding the pathophysiological mechanism of chorioamnionitis and its associated perinatal neurological injury and to provide meaningful information about new potential biomarkers. AF samples (n = 40) were collected from women at risk of chorioamnionits. Detailed clinical information on each pregnancy was obtained from obstetrical and neonatal medical examination. Liquid chromatography (LC)/mass spectrometry (MS) followed by data alignment and filtration as well as univariate and multivariate statistical analysis was performed. Statistically significant differences were found in 60 masses in positive and 115 in negative ionization mode obtained with LC/quadrupole time-of-flight MS (LC-QTOF-MS) between women with and without chorioamnionitis. Identified compounds were mainly related to glycerophospholipids and sphingolipids metabolism. From them, LPE(16:0)/LPE(P-16:0) and especially lactosylceramides emerged as the best biomarker candidates. Sulfocholic acid, trioxocholenoic acids, and LPC(18:2) were particularly increased in women with chorioamnionitis whose newborns developed perinatal brain damage. Therefore, we propose LPE(16:0)/LPE(P-16:0) and lactosylceramides as biomarkers for chorioamnionitis as well as LPC(18:2), trioxocholenoic acid, and sulfocholic acid for its associated perinatal brain damage. Metabolomics fingerprinting of AF enables the prediction of pregnancy-related disorders and the development of new diagnostics strategies.