Neonatology Practice Research Articles

Meaning and Clinical Interest of Minor Malformations and Normal Variants in Neonatology.

Congenital malformations can be found in all organ systems of a newborn. Almost two-thirds of congenital malformations have an unknown cause. There are minor (mM) and major (MM) congenital malformations. Searching for minor malformations has its vital place in everyday neonatology practice. Minor malformations are defined as physical variants that have no medical consequences and are mostly located on the face and distal parts of the extremities and are easily noticed. Minor malformations occur in approximately 15% of newborns. Minor congenital malformations are of great importance because they can be an indicator of the existence of major congenital malformations and syndromes. In a one-year retrospective study that analyzed the occurrence of 38 minor malformations through the year 2023 at the University Clinical Hospital of Mostar, there was an incidence of 10.59% of minor malformations. The most frequently recorded minor malformation was deep a sacral dimple at 44.72%, then poorly modeled ears at 15.08%, and moderate rectal diastasis at 14.58%. Three or more minor congenital malformations indicate one or more major congenital malformations. Major congenital malformations are severe structural defects of tissues and organs that endanger life, create serious functional disturbances and hinder the development of the child. In our country, there is currently a recorded incidence of 8.04%. The search for minor malformations in the newborn period is of great importance to children and the whole family, and the search must not be neglected.

A "Gold Standard" Test for Diagnosing and Quantifying Hemolysis in Neonates and Infants.

Identifying "gold standard" diagnostic tests can promote evidence-based neonatology practice. Hemolysis is a pathological shortening of the erythrocyte lifespan, differing from erythrocyte senescence in responsible mechanisms and clinical implications. Diagnosing hemolysis goes beyond a binary (yes vs. no) determination. It is characterized according to magnitude, and as acute vs. chronic, and genetically based vs. not. For neonates with significant hyperbilirubinemia or anemia, detecting hemolysis and quantifying its magnitude provides diagnostic clarity. The 2022 American Academy of Pediatrics (AAP) Clinical Practice Guideline on management of hyperbilirubinemia in the newborn states that hemolysis is a risk factor for developing significant hyperbilirubinemia and neurotoxicity. The guideline recommends identifying hemolysis from any cause, but specific guidance is not provided. A spectrum of laboratory tests has been endorsed as diagnostic methods for hemolysis. Herein we examine these laboratory tests and recommend one as the "gold standard" for diagnosing and quantifying hemolysis in neonates and infants.

Impact of postnatal nutrition on neurodevelopmental outcome in rat model of intrauterine growth restriction.

There are limited data on nutritional management of infants with intrauterine growth restriction (IUGR). Postnatal protein supplementation for promoting growth is a common clinical practice in neonatology. The present study aims to investigate the consequences of protein supplementation on long-term growth, brain and body weight, brain histology and behavioral outcome in a rat model of IUGR. Twenty-four IUGR-formed rat puppies and 12 healthy puppies were included in the study. IUGR model was established by low (10%) protein diet throughout pregnancy together with intraperitoneal injection of lipopolysaccharide (LPS). Pups were started to be fed with either standard protein (SP), or high protein (HP) diet until postnatal day (PN) 35. Puppies in the control group were given SP diet for 35 days. Six pups from each group were sacrificed at PN7, remaining six were evaluated by Morris water maze test between PN 30 to 35 days and then sacrificed at PN35. Histologic evaluation of brain tissue was performed at PN7 and PN35. IUGR group displayed lower body and brain weights at PN7 when compared with control. At PN35, SP group achieved similar brain/body weight ratios with control, whereas HP group displayed lowest brain/body weight ratio. The number of TUNEL positive cells was significantly higher and myelin basic protein and oligodendrocyte marker O4 immunoreactivity were significantly lower in HP group when compared with SP at PN35. Neuronal density in prefrontal cortex and hippocampus at PN7 were similar among SP and HP groups, but significantly lower in HP group when compared with SP at PN35. SP group displayed better results in the Morris water maze test when compared with HP group. Although postnatal HP support is associated with increase in body weight at PN35, it did not result in better brain/body weight ratios in the rat model of IUGR. In IUGR rats, HP diet was associated with increased apoptosis in brain tissue with lower neuronal density and decreased myelination when compared to SP. Furthermore, better neurodevelopmental scores were achieved by SP diet rather than HP support in IUGR.

Identifying the essential knowledge and skills for Neonatal-Perinatal Medicine: a systematic analysis of practice.

The knowledge and skills expected for board certification in Neonatal-Perinatal Medicine (NPM) should reflect the clinical practice of neonatology. First, a 14-member panel of practicing neonatologists, convened by the American Board of Pediatrics (ABP), drafted a practice analysis document which identified the practice domains, tasks, knowledge, and skills deemed essential for clinical practice. NPM fellowship program directors provided feedback via online survey resulting in revisions to the document. During the second phase of the project, the panel organized testable knowledge areas into content domains and subdomains to update the existing ABP NPM content outline. All ABP board-certified neonatologists were asked to review via online survey, and results were used to guide final revisions to the content outline. The NPM practice analysis document and the updated NPM content outline should serve as helpful resources for educators, trainees, and practicing neonatologists.

TO DETERMINE KNOWLEDGE, ATTITUDE AND PRACTICE OF KANGAROO MOTHER CARE(KMC) IN POSTNATAL MOTHERS IN A NEONATAL CARE UNIT OF A TERTIARY CARE TEACHING HOSPITAL- A CROSS SECTIONAL STUDY.

TO DETERMINE KNOWLEDGE, ATTITUDE AND PRACTICE OF KANGAROO MOTHER CARE(KMC) IN POSTNATAL MOTHERS IN A NEONATAL CARE UNIT OF A TERTIARY CARE TEACHING HOSPITAL- A CROSS SECTIONAL STUDY. Original Research Paper Dr Mugdha Todkar Senior Resident, Dept Of Paediatrics, Postgraduate Institute , Yashwantrao Chavan Memorial Hospital, Pimpri, Pune-18 Background;Kangaroo Mother Care (KMC) is identied by WHO as a biologically sound method of care for all new-borns, particularly for low birth weight infants as a part of their strategy to decrease the morbidity and mortality of premature infants. This study was planned to understand the knowledge, attitude, and practice of KMC among the mothers . Aim: To determine knowledge, attitude and practice of kangaroo mother care (KMC) among postnatal mothers in neonatal care unit of a tertiary care teaching hospital. Materials and Methods: A cross- sectional study by administering an open-ended questionnaire was used in an interview of mothers providing KMC at a tertiary care center. The mothers' response to these questions was marked according to a predetermined scoring system. Results: At recruitment (91.2%) mothers did not know about KMC. 86% of mothers could follow the verbal instructions and found it easy in rst sitting. 100 % of them felt closeness to the babies and their babies slept well too. 91.8% of mothers thought that KMC is benecial for their babies. 84.8% perceived increased in breast milk production and 89.9% felt that the babies cried less after KMC.At discharge 100% were willing to continue KMC at home. 98.7% of the mothers were happy with the support they received from the doctors and nurses for same.Conclusion:These results support earlier ndings of the benecial effects of KMC on mortality and growth. Use of this technique would humanize the practice of neonatology, promote breastfeeding, and shorten the neonatal hospital stay without compromising survival, growth, or development.

Neonatal & Paediatric Point Of Care Ultrasound (Pocus): A Novel Standard Practice

An ever expanding branch of applications have been developed for ultrasound, including its goal directed use at the bedside, often called point-of-care ultrasound (POCUS). ). Although neonatologist-performed functional echocardiography has been at the frontline of the worldwide growth of POCUS, a rapidly growing body of evidence has also demonstrated the importance of non-cardiac applications, including guidance of placement of central catheterisation and lumbar puncture, endotracheal tube localisation as well as rapid estimation of the brain, lungs, bladder and bowel. Ultrasonography has become a pivotal adjunct to the care of neonates in the neonatal intensive care unit (NICU); but a full appreciation for its diagnostic capabilities in the NICU is lacking.(2) Ultrasonography (USG) is no longer the exclusive domain of radiologists and cardiologists. With appropriate training, clinician performed ultrasound (CPU) is now practised widely in obstetrics, emergency medicine and adult intensive care .In many developed countries,it is standard practice in neonatology. (3) In this review, we will discuss neonatal & pediatric point of care ultrasound (POCUS) as a novel standard practice & its clinical application for assessment of the head, heart, lung, gut, bladder, for vascular line localization & for endotracheal tube placement. As new applications and adoption of point-of-care ultrasound continues to gain acceptance in paediatric and neonatal medicine throughout the world, a rapidly growing body of evidence suggests that the result will be faster, safer and more successful diagnosis and treatment of our patients.

Церебральна ауторегуляція та цереброваскулярні ураження у передчасно народжених дітей: сучасні погляди на патогенез, діагностику і превентивні стратегії

Представлений огляд наукових джерел спрямований на висвітлення досягнень у розумінні особливостей ауторегуляції церебральної перфузії у передчасно народжених дітей, встановлення значення сучасних методів її моніторингу та визначення загальних підходів до профілактики цереброваскулярних порушень. У статті розглянуто історію дослідження реактивності церебральних судин, висвітлено функцію внутрішнього нейропротективного фізіологічного феномену — церебральної ауторегуляції відповідно до новітніх міжнародних досліджень. Проведений огляд комплексу інтегрованих механізмів церебральної ауторегуляції. Наведені результати досліджень ролі міогенних, нейрогенних і метаболічних механізмів у здійсненні церебральної ауторегуляції, а також можливий генез їх розладів у передчасно народжених дітей. Відповідно до наведених у дослідженнях даних незрілість ауторегуляційних механізмів, анатомічні особливості мозкової тканини, численні внутрішні та зовнішні фактори, що впливають на цереброваскулярні структури, обумовлюють високий ризик уражень центральної нервової системи у передчасно народжених дітей. Зусилля дослідників спрямовані на розвиток неінвазивних діагностичних технологій, які можуть допомогти тривалий час проводити моніторинг церебральної оксигенації, сприяти своєчасній корекції терапевтичних підходів. Параінфрачервона спектроскопія є відносно новим у інтенсивній неонатології методом, який вже довів свою безпечність та ефективність при прийнятті тактичних рішень під час виходжування передчасно народжених дітей. У огляді наведено отримані дослідниками референтні значення для передчасно народжених дітей різного гестаційного віку, які можна використовувати у практиці інтенсивної неонатології для оптимізації інфузійної терапії та респіраторної підтримки немовлят на доклінічному етапі розвитку цереброваскулярних уражень. У статті розглянуто питання щодо діагностики гіпотензії у недоношених новонароджених, окремі фармакологічні підходи до профілактики та лікування порушень церебрального кровообігу.

NeoCheck: a prescription-screening tool to optimise pharmacotherapy for hospitalised neonates.

To develop a screening tool to optimise neonatal drug prescription, which is often based on low-quality evidence. Neonatal pharmacotherapy recommendations were identified by literature review and synthesised into NeoCheck tool statements. In a two-round modified Delphi process, experts from Swiss neonatal intensive care units (NICUs) rated their agreement with individual statements using a five-point Likert scale (5 = totally agree). Statements with >65% scores ≥4 in round 1 and >75% scores ≥4 in round 2 were selected. We identified 1375 clinical guidelines via literature review. After synthesis, 158 statements were submitted to 23 experts (1 clinical pharmacist, 22 neonatologists; 65% with >10 years neonatology practice) from 10 Swiss NICUs. Nineteen items did not reach the agreement threshold and were eliminated in the second Delphi round. The final NeoCheck tool comprises 141 statements in 11 medical domains concerning 49 neonatal diseases. Most (79%) statements concern all neonates, 13% concern preterm (<37 weeks gestational age) infants and 3% concern very preterm (<32 weeks gestational age) infants CONCLUSIONS: NeoCheck is the first prescription-screening tool developed to optimise neonatal pharmacotherapy. In a future prospective study, its effect on NICU prescription optimisation and the quality of care will be assessed.

Questionnaires for the Assessment of Bonding During Pregnancy and after Birth (Part 3 of a series on psychological assessment during the peripartum period)

Bonding of (expectant) parents with their child is of great importance for the psychological well-being of both the parents and the child. This is especially true if parents suffer from mental health problems like depression. Furthermore, attachment experiences during early childhood can affect both the child's mental health as well as later relationships. However, typical assessment methods like the Strange Situation Test are not very suitable in clinical practice in neonatology and obstetrics, especially since the focus here is primarily on the child's attachment behavior. In addition, bonding with the unborn child cannot be assessed in this way. Therefore, questionnaires represent a more feasible method for the assessment of parental bonding. Instruments have been developed for the time during pregnancy and after birth, but most of them were developed for women. Also, there is a need for further methodological development of these questionnaires. Cut-offs and norm values are highly relevant for clinical practice, but still need to be established in some cases. Assessment of parental bonding using questionnaires can potentially be beneficial and will most likely help to initiate timely supportive interventions.

ГЛЮКОЗАМИНИЛМУРАМИЛДИПЕПТИД: ОБЗОР ПО ИСПОЛЬЗОВАНИЮ И ОЦЕНКЕ ЭФФЕКТИВНОСТИ В ПЕДИАТРИЧЕСКОЙ ПРАКТИКЕ

A review of the accumulated data on the use of glucosaminylmuramyldipeptide (GMDP, Likopid drug) and the assessment of its effectiveness in children are presented. Objective of the research: to systematize the results of clinical trials of the efficacy and safety of GMDP therapy in neonatology and pediatrics. Materials and methods. Publications were searched for in Pubmed/MEDLINE, ScienceDirect, Cochrane, Elibrary.ru, registers of clinical trials and in open sources on the Internet. The authors assessed the level of evidence for reliability and the methodological quality of the studies. Results. The screening resulted in selection of 38 clinical trials with satisfactory methodological quality and a total of 2,692 0-18 year old patients. The effectiveness of use of GMDP (Likopid) as part of complex therapy for infectious diseases of the respiratory tract (2A), allergy-related diseases (2A), herpesvirus infection (3B), dysbiosis/dysbacteriosis (3B), and newborn respiratory distress syndrome (2B) has been demonstrated. The safety assessment is given in 7 studies, of which 5 confirmed absence of any adverse events. Scope of application. The results of the review enable practitioners to prescribe GMDP (Likopid) based on the levels of evidence. The existence of evidence base for the use of GMDP in newborns allows us to raise the question of restoring appropriate indications in the Instructions for Medical Use. Conclusions. For a number of nosologies, further studies of modern design, based on the principles of evidence-based medicine, are required to assess the efficacy and safety of GMDP for good clinical practice in neonatology and pediatrics.

Conventional revolution: the ethical implications of the natural progress of neonatal intensive care to artificial wombs

Research teams have used extra-uterine systems (Biobags) to support premature fetal lambs and to bring them to maturation in a way not previously possible. The researchers have called attention to...

Neonatal Intubation: Past, Present, and Future.

* Abbreviations: NEAR4NEOS: : National Emergency Airway Registry for Neonates 3D-CT: : 3-dimensional computed tomography Neonatal intubation is a lifesaving skill that has been performed by clinicians for over 200 years. Throughout history, the techniques used for neonatal intubation have improved and will continue to advance in the future. Although the incidence of neonatal intubation has decreased over time, the focus on neonatal intubation safety has increased. Current and future efforts to improve neonatal intubation success and safety are critical to improving neonatal outcomes. After completing this article, readers should be able to: 1. Summarize the history of neonatal intubation. 2. Recognize trends in the incidence of neonatal intubation. 3. Describe current and future efforts to improve neonatal intubation safety. Neonatal intubation is a lifesaving procedure. Neonatal intubation has been an essential skill in the practice of neonatology since the subspecialty was founded in the 1970s; however, the origins of neonatal intubation date back over 200 years. (1)(2)(3) Multiple advances have taken place in the practice of neonatal intubation since it was first described. Continued advances will undoubtedly take place in the future. Although the incidence of neonatal intubation has decreased over time, intubation remains a critical skill for neonatal clinicians. Current and future efforts focused on improving neonatal intubation safety are critical to improving neonatal outcomes. In this review, we examine the past, present, and future of neonatal intubation. ### The First Intubation Techniques The earliest accounts of neonatal resuscitation date back to the mid-1700s when Benjamin Pugh used a small tube made of coiled wire and covered in leather to ventilate the lungs of asphyxiated newborns. (2)(4) The Copenhagen obstetrician Paul Scheel published the first detailed description of neonatal tracheal intubation in 1798:“Having cleaned the throat, we come to the trachea itself. I believe it is best evacuated with a syringe attached to a long flexible tube, the diameter of which fits in the …

Particular paraclinical indices in newborn sepsis patients whose parents constantly lived in different environmental conditions

Xenobiotics can have a variety of effects on the human body, and especially on the course of intrauterine development. Numerous researchers point out that it is the nature of the environment that can negatively affect the course of certain diseases in both children and adults. Neonatal sepsis is one of the most serious diseases in neonatology practice. And, in our opinion, the topic of the influence of adverse environmental factors on the features of sepsis in newborns depending on the ecological situation of their parents' habitats is unclarified.The research aims at the particular paraclinical indices in children with neonatal sepsis whose parents constantly lived in different environmental conditions.Material and methods. To study the aim, a comprehensive survey of 260 newborns who suffered from neonatal sepsis in 2016-2018 was conducted. The groups have been formed based on the complex evaluation of the prolonged influence of the anthropogenic pollution of air, water and soil on the body of parents of newborns in the parts of the region. The ecological risk coefficient (ERC) has been proposed concerning the environmental situation in the regional centers. Thus, the first clinical group (the main group) included neonatal sepsis patients whose parents permanently lived in parts with an ERC of 2.0 or more and with unfavorable environmental characteristics of the regional center. The second group (comparison) was formed by newborns with sepsis, whose parents permanently lived in areas with a low risk of adverse effects of these environmental factors on their body (ERC<2.0).Results and discussion. The content of interleukins-6, -8.-10, C-reactive protein, presepsin and procalcitonin in the blood serum of patients with neonatal sepsis showed the activity of the systemic inflammatory response of the body to an infectious agent. It should be noted that high serum levels of interleukin-10, which has an anti-inflammatory effect, was more often registered in patients of the I clinical group. Thus, the blood content of this interleukin 35.0 pg/ml occurred in the newborn of the main group in 23.7% of cases, and in children of the comparison group – in 18.1% of observations. Along with a clearer identification of high levels of anti-inflammatory interleukin-10 inpatients of the I group, a significant decrease in serum concentrations of immunoglobulins of classes A, G, M was observed in these newborns.Conclusions. The decrease in the level of the above serum immunoglobulins is probably due to the immunosuppressive effect of xenobiotics on the fetus, whose mother was under the conditions of long-term action of xenobiotics. This, in turn, reduces the resistance of the newborn body to infection and contributes to a more severe course of the infectious process. Probably, the more severe manifestations of neonatal sepsis in newborns of the I clinical group are partly due to a combination of decreased immunoglobulin synthesis and increased interleukin-10 production.

Thermal imaging applications in neonatal care: a scoping review

BackgroundIn neonatal care, assessment of the temperature of the neonate is essential to confirm on-going health, and as an early signal of potential pathology. However, some methods of temperature assessment involve disturbing the baby, disrupting essential sleep patterns, and interrupting maternal/infant interaction. Thermal imaging is a completely non-invasive and non-contact method of assessing emitted temperature, but it is not a standard method for neonatal thermal monitoring. To examine the potential utility of using thermal imaging in neonatal care, we conducted a comprehensive systematic scoping review of thermal imaging applications in this context.MethodsWe searched EMBASE, MEDLINE and MIDIRS.ResultsFrom 442 hits, 21 met the inclusion criteria and were included in the review. A significant number (n = 9) were published in the last 8 years. All the studies were observational studies, with 20 out of 21 undertaken in North America or Europe. Most of them had small cohorts (range 4–29 participants). The findings were analysed narratively, to establish the issues identified in the included studies. Five broad themes emerged for future examination. These were: general thermal physiology; heat loss and respiratory monitoring; identification of internal pathologies, including necrotising enterocolitis; other uses of thermal imaging; and technical concerns. The findings suggest that thermal imaging is a reliable and non-invasive method for continuous monitoring of the emitted temperature of the neonates, with potential for contributing to the assurance of wellbeing, and to the diagnosis of pathologies, including internal abnormalities. However, the introduction of thermal imaging into everyday neonatology practice has several methodological challenges, including environmental parameters, especially when infants are placed in incubators or open radiant warmers.ConclusionIn conclusion, although the first attempt at using thermal imaging in neonatal care started in the early-1970s, with promising results, and subsequent small cohort studies have recently reinforced this potential, there have not been any large prospective studies in this area that examine both the benefits and the barriers to its use in practice.

Translating family systems care into neonatology practice: A mixed method study of practitioners’ attitudes, practice skills and implementation experience

BackgroundFamily-centered care interventions are a recommended part of high-quality neonatal intensive care. Evidence suggests that engaging and supporting families improves parental and infant health outcomes. Enabling practitioners to work with families in a relational, strength-oriented way is thus vital to ensure quality care. However, implementing family-centered care remains a challenge, and its uptake is often slow and inconsistent. ObjectivesTo examine the impact of family systems care implementation activities on neonatal nurses’ and physicians’ attitudes and skills in working with families, and to explore their implementation experience. DesignMixed method design. Setting and participantsTwo neonatal intensive and one intermediate care unit in a Swiss, university-affiliated hospital. A total of 65 practitioners participated in the pre-post study, and 17 in focus group interviews. MethodsQuantitative data was obtained before, mid-, and post-implementation through an online questionnaire. Attitudes were measured with the Families’ Importance in Nursing Care – Nurses’ Attitudes Scale. Skills and reciprocity in working with families was assessed with the Family Nursing Practice Scale. Four focus group interviews were conducted post-implementation. Data analysis included descriptive statistics, group comparison, and qualitative content analysis. ResultsA statistically significant increase in practice skills and reciprocity, but not in attitudes was found mid- and post-implementation. Practitioners reported new ways of working with families, which included enhanced awareness of the extended family, intentional relationship-building, augmented family involvement, and systemic interventions, such as therapeutic listening. They experienced implementation as a wheel that moved forward or stood still, depending on the challenges faced and the predominance of enabling versus limiting organizational factors. Practitioners felt not only challenged regarding the meaning of being-acting in family-centered ways, but also in delivering family systems care consistently and collaboratively. While practitioners experienced the educational workshop as helpful, they felt left alone during consolidation. ConclusionsFindings demonstrate that the inter-professional implementation of family systems care is highly relevant for practitioners’ clinical practice. Implementation strategies yielded an increase in practice skills/reciprocity and new ways of working with families, but no quantifiable impact on attitudes. Adoption fluctuated and was ongoing, hindered by organizational constraints and lack of consolidation support. Nonetheless, practitioners gave numerous examples of family-centered practices. A combination of implementation strategies offered over time and supported by organizational structures are the most likely means to enable teams to work in partnership with families, and to promote infant and family well-being in neonatal care.

A prospective study on feasibility, acceptability and outcome of kangaroo mother care in low birth weight babies

Background: Low Birth Weight (LBW) continues as an important social health problem. About 20 million LBW babies are born each year worldwide. In India 8 million (40%) LBW babies are born each year. LBW preterm babies are associated with high neonatal/infant mortality and morbidity. Kangaroo Mother Care is an alternative approach for providing thermal care and improving survival of LBW infants which is effective and affordable. The present study was undertaken to study feasibility, acceptability and outcome of KMC in LBW babies. Aims and Objectives: To study feasibility, acceptability and outcome of KMC in LBW babies with an objective to determine the effect of kangaroo mother care on vital parameters like temperature, respiratory rate, heart rate and oxygen saturation; and to denote the establishment of breastfeeding and weight gain in LBW babies and their duration of hospital stay. Methodology: A hospital based prospective observational study conducted over a period of one year from September 2017 to August 2018, at SNCU, SVRRGGH, Tirupati. The study subjects are 210 babies. Results: In the present study, it was observed that there was a significant increase in axillary temperature, decrease in respiratory rate, decrease in heart rate and increase in oxygen saturation observed after KMC which were physiologically favorable. Higher proportion of neonates achieved transition from expressed breast milk consumption to direct breastfeeding during hospital stay. The study showed significant mean weight gain of 20.2 g/day during hospital KMC. Neonates were discharged early as they met our discharge criteria with mean age being 14.3 days. The maternal acceptance of KMC was good. All the mothers providing KMC were satisfied with the training and care. During follow up, it was observed that neonates were all exclusively breastfed; and the velocity of weight gain was satisfactory (153.6 g/week). The response of the family and/or the father was supportive and encouraging. Conclusion: The present study concluded that practice of KMC promotes breastfeeding, shorten hospital stay without compromising survival, growth and development; and would humanize the practice of neonatology. It is superior alternative to conventional method of care in institutions with limited resources. It is definitely feasible, acceptable to mothers at tertiary care hospital and can be continued at home in the Indian setup.

Neonatal seizures and neonatal epilepsy: Urgent need for training programs

Neonatal seizures (NS), even short lived, may signify serious underlying problem that occur in immature brain. It may lead to horrible long term adulthood comorbid neurological, behavioral and psychiatric disorders. Experimentally, even single episode of neonatal seizures permanently affects cognition and memory.Neonatal Seizures are considered as a neurological emergency requiring urgent intervention especially in case with potentially treatable etiologies. The prevalence of NS is about 1.5% and overall incidence about 0.3% live births. The incidence is so higher in pre-term infants (57–132 per 1000 live births). About 80% of NS occur in the 1st week of life. From literature, 7:16% of neonates with NS may be died (higher for preterm infants). Among survivors; adverse neurodevelopmental sequelae will take place in 27-55% including cerebral palsy, developmental delay, and postneonatal epilepsy.Neonatal neurology is an emergent sub-specialty area concerning neurologic problems present in the neonatal period. A neurologist with expertise in neonates is becoming more needed. Few neonatologists are interested in neonatal neurology; they considered it as a subject of ambiguity and mystery.Dealing with NS is challenging, especially, for neurologists who aren’t involved in neonatology practice. This may due to dissimilarities and special characteristics of neonates when compared with those of older age groups. In NS; various etiologies should be considered notably hypoxic ischemic encephalopathy, neonatal stroke, kernicterus, traumatic brain injury and metabolic causes. Most NS are subclinical occurring without overt clinical correlate and having the same prognosis as electroclinical seizures. Clinical seizure types in neonates are focal-clonic, focal-tonic, some types of myoclonic, and epileptic spasms. In addition to clinical skills, video EEG monitoring can be used to exclude seizure mimickers including non-seizure behaviors and non-epileptic paroxysmal events as benign neonatal sleep myoclonus, benign non epileptic myoclonus of early infancy (benign non-epileptic infantile spasms) and hyperekplexia. Diagnostic procedures for NS including; biochemical laboratory workup, striking electrophysiological and neuroradiological findings; all have different implication and values in neonates, and lastly; special considerations regarding potentially toxic anti-epileptic medications and other therapeutic modalities should be taken when used in little infants with immature brain, liver and kidneys.Although, most NS are mainly acute, symptomatic and reactive to a specific distinguishable cause, rare distinct early neonatal epilepsy syndromes may occur. Benign familial neonatal epilepsy, early myoclonic encephalopathy, and early infantile epileptic encephalopathy are well known neonatal epileptic syndromes. Understanding genetic heritages for these syndromes are being increasingly acknowledged [7]. Urgent need to understand possible underestimated underlying treatable neurometabolic issues is a matter of necessity in dealing with refractory neonatal epileptic syndromes.So, NS and neonatal epilepsy syndromes may represent a neglected area in medical practice among non- neonatologist primary care providers and adult neurologists in one side and neonatologists not interested in neonatal neurology in the other side. Bridges can cross over barriers and physicians can gain much benefit from comprehensive neonatal neurology training programs.

Medicinal Uses of Hematopoietic Growth Factors in Neonatal Medicine.

This review focuses on certain hematopoietic growth factors that are used as medications in clinical neonatology. It is important to note at the chapter onset that although all of the pharmacological agents mentioned in this review have been approved by the US Food and Drug administration for use in humans, none have been granted a specific FDA indication for neonates. Thus, in a sense, all of the agents mentioned in this chapter could be considered experimental, when used in neonates. However, a great many of the pharmacological agents utilized routinely in neonatology practice do not have a specific FDA indication for this population of patients. Consequently, many of the agents reviewed in this chapter are considered by some practitioners to be nonexperimental and are used when they judge such use to be "best practice" for the disorders under treatment.The medicinal uses of the agents in this chapter vary considerably, between geographic locations, and sometimes even within an institutions. "Consistent approaches" aimed at using these agents in uniform ways in the practice of neonatology are encouraged. Indeed some healthcare systems, and some individual NICUs, have developed written guidelines for using these agents within the practice group. Some such guidelines are provided in this review. It should be noted that these guidelines, or "consistent approaches," must be viewed as dynamic and changing, requiring adjustment and refinement as additional evidence accrues.

Pediatrics in the Maternity Unit at the Teaching Hospital Gabriel Touré of Mali: Results of a Year of Activities

Introduction : Pediatrics in maternity unit is a particular mode of practice of neonatology, which cannot be reduced to the simple transposition, in an obstetric environment, of neonatal practice performed in a pediatric environment, let alone in a neonatal resuscitation environment. Methodology : It was a retrospective study over 12 months from January 1 st to December 31 st , 2018. Data were collected from birth records, newborn resuscitation and newborn follow - up registers. The variables studied were the indication of the call for a pediatrician, the delivery route, the pediatrician's actions according to the ILCOR's recommendations, the reason for transfer to the neonatology and the fate of newborns. Results : Over the year, 3168 deliveries were made, of which 38.16% (n = 1209) by caesarean section. The pediatrician was asked for 590 deliveries that led to the management of 641 newborns. The main reason for the calls was cesarean delivery (81.4%). The main indications for Caesarean section were severe pre - eclampsia (24.1%), eclamptic crisis (21%) and scarred uterus (16.4%). For the maj ority of newborns, or 63.6% (n = 408), the management stopped at phase A of ILCOR. It continued to phase B and C in 21.5% (n = 151) and 8.4% (n = 54), respectively. Resuscitation failure was observed in 10 newborns (1.6%). In 47.1% of cases (n = 302), neonates were transferred to the neonatal department. The main reasons for transfer were preterm birth (66.2%), perinatal anoxia (15%) and respiratory distress (4.6%). In neonatology, the mortality rate was 14% (n = 42) Conclusion: The pediatric activity in the maternity unit has permitted the management of a large number of newborns from birth at Gabriel Touré Teaching Hospital. Its regular evaluation will improve it and ensure better survival of newborns

Leave against medical advice from SNCU of a teaching hospital in Garhwal, Uttarakhand, India

Background: Patients who leave against medical advice (LAMA) is a universal problem. Neonates being unable to decide for their own, are dependent on parents for all decisions for their treatment. LAMA is a sensitive issue in neonatology practice with ethical and medico legal ramifications. This study was done to evaluate the factors associated with the decision of LAMA by care givers in our special newborn care unit (SNCU).Methods: This is a retrospective hospital based observational study and was conducted in SNCU of HNB Base Teaching Hospital, Srinagar, Garhwal. Data pertaining to LAMA between 1st August 2017 and 31st July 2018 was retrieved. Information obtained included place of birth, gestational age, weight, diagnoses, duration of hospital stay and reasons for LAMA. Data were entered into a Microsoft Excel Spread Sheet and analyzed using software. Graph Pad Prism v 7.04. Chi-Square test was used to test for significant difference among various groups.Results: Out of 689 neonates admitted in SNCU during the study period, 167 (24.24%) took LAMA. Male to female ratio of 1:1.1. 102 (61%) were inborn and 65 (39%) were out born. Term babies constituted 62.87%. 78.44% neonates were discharged within 7 days of admission. 58 (34.73%) neonates had sepsis and 30 (17.96%) had birth asphyxia. The commonest reason in 25.15% for taking LAMA was to take the neonate to better equipped facility followed by false perception that the baby is well enough to be discharged.Conclusions: Multiple factors contribute for getting a neonate discharged against medical advice. Improvement of infrastructure, training of health care staff for proper counselling, sensitivity and empathy towards neonate and the care givers can decrease the rate of LAMA.