Premature Neonate Research Articles

Pneumococcal Septicemia: A Neonatal Case Report

Pneumococcus or Streptococcus pneumoniae is a rare cause of neonatal sepsis, associated with significant morbidity and a very high mortality rate. The infection is generally acquired during pregnancy, from colonization of the maternal genital tract. Most affected newborns present with early symptoms, usually within 48 hours of birth, which is similar to other causes of neonatal sepsis. We report the case of a premature female neonate with fatal, early pneumococcal sepsis that appeared at D1 of life, with an unfavorable course that initially led to intubation and death after 24 hours of hospitalization.

Neonatal cardiorespiratory failure caused by splenic hemorrhages: a case report on a fatal and a rescued case

Two cases of neonatal splenic hemorrhage with acute cardiorespiratory failure are described in this report. The first case involves a full-term neonate who was found unresponsive without any witnesses and could not be successfully resuscitated. A postmortem diagnosis revealed a splenic hemorrhage. Second case is an extremely premature neonate who experienced a witnessed cardiovascular collapse on the 14th day of life. Rapid cardiovascular support was administered, resulting in a positive outcome. While splenic hemorrhage is commonly associated with traumatic events, these cases highlight the need of considering spontaneous splenic hemorrhages as a potential cause of acute neonatal compromise, even in the absence of birth-related trauma (e.g., asphyxia, prolonged labor, clavicle fractures, brachial plexus injuries). This report emphasizes the importance of including splenic hemorrhage timely in the differential diagnosis of neonatal cardiorespiratory instability, especially in the absence of more common diagnoses, and discusses the challenges associated with its recognition and treatment.

Diseño de protocolo para neonatos prematuros con alteraciones de succión nutricia internados en la UCIN

The premature neonate is a fragile being because it is born with a gestational age of less than 37 weeks and is not prepared for independent survival; therefore, the present research aims to propose a protocol in premature newborn patients with alterations in the sucking-breathing-swallowing triad hospitalized in the neonatal intensive care unit of the Hospital del niño Dr. Ovidio Aliaga Uría in the city of La Paz. Methodologically, the research was of a socio-critical paradigm, with a quali-quantitative approach, experimental level and non-experimental cross-sectional design, in a sample of convenience selection made up of 45 babies with nutritional sucking disorders treated in the sanatorium under study, whose instruments used were the observation of infants and interviews to specialists treating these children. The results showed that the proposal is a highly effective instrument in time and application for patients with this pathology.

Short-term effectiveness of music therapy songwriting for mental health outcomes of at-risk parents in the NICU: a study protocol of an international multicenter mixed-methods trial.

Preterm birth contributes to adverse mental health outcomes of parents dealing with a premature neonate. The main objective of this study is to determine whether music therapy (MT) songwriting during the infants' stay in the neonatal intensive care unit (NICU) is superior to standard care in reducing the risk of postpartum depression in high-risk parents of preterm children throughout the hospital treatment. The secondary objectives include assessment of effectiveness of MT in other aspects of mental health (anxiety level, perceived stress, mental wellbeing, coping, resilience). Furthermore, this trial will evaluate the medical and social factors that may be associated with the effects of MT songwriting. The study design is a sequential mixed method study with a dominant status QUAN to qual. The quantitative trial was designed as a parallel, multicenter, pragmatic, randomized controlled trial. The qualitative study is a descriptive phenomenological study that seeks to understand the lived experiences of participants exposed to songwriting. Participants are parents of premature infants hospitalized in NICU (106 families) in 5 hospitals, in Colombia and Poland. Intervention: 3 MT songwriting sessions per week across 3 weeks. Primary outcome: the risk of postnatal depression; secondary outcomes: anxiety level, mental wellbeing, resilience, stress, coping. The results will be analyzed quantitatively and qualitatively. This study will provide a report on the effectiveness of MT songwriting on mental health in at-risk parents of preterm infants.

Obstructive Bilateral Renal Fungal Bezoars in an Extremely Premature Neonate Treated With Antifungals and Urokinase Irrigation: A Case Report and Review of the Literature.

An ex-27-week gestation female infant developed bilateral forearm nodules at 4 weeks of life during treatment for methicillin-sensitive Staphylococcus aureus bacteremia. A pure growth of Candida albicans was isolated on culture of both sterile aspiration of the forearm abscess and urine without evidence of methicillin-sensitive Staphylococcus aureus. The patient went on to develop bilateral obstructive renal fungal bezoars at 11 weeks of life. Bilateral nephrostomies were required to alleviate obstruction with the addition of local irrigation with amphotericin B deoxycholate. Two weeks later, urokinase via the nephrostomy tubes was added due to an unchanged appearance on ultrasound (US) and ongoing candiduria. A significant reduction in the size of bezoars was seen on US after 3 days. Sterilization of urine culture was achieved 7 weeks into treatment, and resolution of bezoars on US was seen 9 weeks after treatment began. No adverse events occurred from the use of local urokinase. Urokinase irrigation via nephrostomy is an effective and safe adjunctive treatment in refractory obstructive renal candidiasis in neonates.

Lobar Emphysema Successfully Operated in an Extreme Premature Neonate

Background: Lobar emphysema in a newborn may be due to a rare congenital developmental anomaly of the lung, termed congenital lobar emphysema (CLE) or may develop secondary to lung damage, especially with positive airway pressures in premature newborns, known as acquired lobar emphysema (LE). They may have overlapping clinical and radiological features. However, surgical lobectomy is required whenever there is significant respiratory compromise. Reports of surgery in LE in extreme preterms are sparse. Clinical Description: A female newborn with gestational age of 28 weeks, weight of 1.180 kg, presented with respiratory distress after birth, initially treated as hyaline membrane disease. With worsening respiratory distress on positive airway pressures, repeat chest X-ray and computed tomography (CT) chest on day 15 of life, suggested possible LE on the left side with the tracheo-mediastinal shift to the right. Management and Outcome: Left thoracotomy and left upper lobectomy was done, following which, there was rapid improvement in respiratory distress, the newborn being extubated after 6 hours, and weaned off oxygen over the next 3 days. The baby was discharged after 8 weeks and at the last follow-up of 3 years of age, the child was growing well with no complications. Conclusion: Preterm neonates with initial radiological features of hyaline membrane disease, requiring prolonged respiratory support, may be harboring other underlying lung anomalies, which are identified by CT chest. Lobar emphysema with tracheo-mediastinal shift warrants prompt surgery, which is feasible and successful, even in a low birth-weight premature infant.

A case of early neonatal sepsis caused by <i>Streptococcus pneumoniae</i>

The article presents a case of early neonatal sepsis in a premature neonate caused by Streptococcus pneumoniae with the development of purulent meningitis, describes the diagnostic possibilities and features of treatment, as well as the outcome of this condition in the child. In the presented case the rapid increase of symptoms of meningo-encephalitis, slow sanation of liquor, despite the adequacy of the conducted therapy, attracts attention.

Assessing Agreement of Clinical Estimation of Vertical Optic Disc Cupping against Retcam Assessment in the Premature Neonate and Prospective Observation for Changes

Aim: To assess agreement between binocular assessment of optic disc cupping and objective evaluation with RetCam imaging in premature infants. To look for difference in changes observed in disc cupping between different birthweight groups and effect of retinopathy of prematurity, intraventricular hemorrhage and sepsis. Methods: A cohort of premature infants were examined prospectively. At Timepoint I (31 – 36 weeks), the vertical optic disc cupping(vCDR) was assessed clinically through a 28D lens. Two RetCam fundus images centred on the optic discs were taken. A blinded assessor measured the vCDR and the average was calculated. This was repeated at Timepoint 2(37– 40 weeks). Exclusion criteria included IOP >21mmHg, abnormality in cornea, enlarged cornea size (>10.0mm) and abnormal eye. Consistency between the 2 methods was assessed with intraclass correlation coefficient (ICC). Bland-Altmann plots were used for agreement analysis. Results: In total, 126 eyes (n= 63 infants) were examined, 504 images captured and assessed. The average vCDR by clinician was 0.30(SD:0.1) and by RetCam 0.32(SD:0.1). The ICC showed moderate correlation however, Bland-Altman plot showed a wide 95% limits of agreement (-0.24, 0.26). Paired t-test did not show significant change in vCDR between the time-points for infants in different birthweight groups but trend of change were identical for both methods. Retinopathy of prematurity, intraventricular hemorrhage and sepsis were not associated with changes in cupping in this cohort. Conclusion: Optic disc cupping with clinical estimation is not interchangeable with RetCam values but showed identical trend of change. Mean optic disc vertical cupping in this population was 0.3 at term.

Staged biventricular repair in a premature neonate with critical aortic stenosis, severe mitral regurgitation, and fetal hydrops: a case report

BackgroundThe surgical management of critical aortic stenosis, mitral regurgitation, and left ventricular dysfunction is a significant clinical challenge. Whether left ventricular function will recover to support systemic circulation after the relief of aortic stenosis is a concern. In this setting, surgical or balloon aortic valvotomy combined with bilateral pulmonary artery banding and atrial septectomy may allow time for left ventricular adaptation, while the systemic circulation is supported by the right ventricle through the ductus arteriosus. We describe the case of a premature neonate with critical aortic stenosis, severe mitral regurgitation, and fetal hydrops who successfully underwent staged biventricular repair after bilateral pulmonary artery banding, atrial septectomy, balloon aortic valvuloplasty, and stent implantation for ductus arteriosus.Case presentationA 29-year-old female was referred to our hospital at 25 weeks of gestation with fetal echocardiography findings of critical aortic stenosis, severely impaired left ventricular function, severe mitral regurgitation, and restrictive foramen ovale. At 33 weeks of gestational age, the baby was born via cesarean delivery. Prostaglandin E1 infusion was immediately initiated, and the neonate underwent emergecy bilateral pulmonary artery banding and atrial septectomy. On the second day, a balloon aortic valvuloplasty was performed. The neonate underwent stent implantation to open the ductus arteriosus and multiple-balloon aortic valvuloplasty. At 4 months of age, he underwent biventricular repair consisting of surgical aortic valvuloplasty, atrial septal defect closure, bilateral pulmonary artery debanding, and ductus arteriosus ligation. At 1 year of age, he underwent the Ross –Konno procedure. Six years after the operation, the patient’s general condition was stable, and the patient is doing well.ConclusionsStaged biventricular repair was successfully achieved in a premature neonate with fetal hydrops and critical aortic stenosis associated with severe mitral valve regurgitation and left ventricular dysfunction.

Transumbilical Arterial Access for Embolization of a Hepatic Vascular Tumor in a Critically Ill Premature Neonate

AbstractCatheter-based interventions are relatively rare in the neonate population but serve as an invaluable tool in managing many pathologies. Here we present a case report of a neonate with a vascular hepatic tumor managed by embolization via transumbilical access. In neonates, the small size of the common femoral artery makes cannulation difficult and is thought to increase the risk of catheter-associated thrombosis and ischemia. Often, these patients reside in the neonatal intensive care unit (NICU) and already have an umbilical artery catheter (UAC) in place, which can be used as an effective alternative route of vascular access to carry out life-saving interventions.

Nursing knowledge and care in the neurodevelopment of the premature neonate

Nursing knowledge and care in the neurodevelopment of the premature neonate

Creating a flow restrictor in ductal stenting: a novel technique.

Ductal stenting has transformed the care of neonates with ductal-dependent critical CHD, especially in low-income countries. In small infants, a 3.5- or 4-mm stent may lead to too much pulmonary blood flow resulting in pulmonary oedema. We herein presented a novel technique to restrict ductal stent flow in a premature neonate with pulmonary atresia and intact ventricular septum following radiofrequency perforation of the pulmonary valve.

Curds in the way: A milk curd obstruction review and normal sonographic bowel appearances using a novel scoring system in neonates on fortified breast milk feeds.

Fortified expressed breast milk (FEBM) is a standard of care for premature and low birth weight neonates, but comes with an elevated risk of a rare but re-emergent pathology called milk curd obstruction (MCO). Little is known about normal sonographic appearances of bowel contents in this feeding setting, making the recognition of abnormalities difficult. Thus, we aimed to describe appearances that may be considered typical pre- and post-fortifier inclusion. Ten neonates of <32 weeks' gestation or a birth weight of <1,800 g recruited from Auckland City Hospital Neonatal Intensive Care between 1/5/2019 and 10/9/2019 received bowel ultrasounds within 24 h before and 10-14 days after starting FEBM. Bowel contents in six abdominal regions were assigned scores of 1-6 based on increasing solidification. Lower gestational age was correlated with more solid contents on the pre-fortifier ultrasound (P = 0.02). Fortifier was significantly associated with increasing solidity, particularly in the left abdomen (P < 0.001). The left lower quadrant and rectum accounted for much of this change (P = 0.012 and P = 0.002). One subject who subsequently developed a clinical picture consistent with early MCO had uniquely demonstrated non-rectal solid contents (score 6). The interobserver kappa score for two assessors was 0.91 (95% CI 0.94-0.99) on still images. This small cohort demonstrated increasing bowel content solidification after breast milk fortification using a novel ultrasound scoring system with good interobserver agreement. Non-rectal solid contents (score 6) appeared atypical. Ultrasound shows promise for its non-irradiating diagnostic utility in the setting of early milk curd disease evaluation of the premature neonate.

Maternal and neonatal outcomes according to the timing of diagnosis of hyperglycaemia in pregnancy: a nationwide cross-sectional study of 695,912 deliveries in France in 2018.

We aimed to assess maternal-fetal outcomes according to various subtypes of hyperglycaemia in pregnancy. We used data from the French National Health Data System (Système National des Données de Santé), which links individual data from the hospital discharge database and the French National Health Insurance information system. We included all deliveries after 22 gestational weeks (GW) in women without pre-existing diabetes recorded in 2018. Women with hyperglycaemia were classified as having overt diabetes in pregnancy or gestational diabetes mellitus (GDM), then categorised into three subgroups according to their gestational age at the time of GDM diagnosis: before 22 GW (GDM<22); between 22 and 30 GW (GDM22-30); and after 30 GW (GDM>30). Adjusted prevalence ratios (95% CI) for the outcomes were estimated after adjusting for maternal age, gestational age and socioeconomic status. Due to the multiple tests, we considered an association to be statistically significant according to the Holm-Bonferroni procedure. To take into account the potential immortal time bias, we performed analyses on deliveries at ≥31 GW and deliveries at ≥37 GW. The study population of 695,912 women who gave birth in 2018 included 84,705 women (12.2%) with hyperglycaemia in pregnancy: overt diabetes in pregnancy, 0.4%; GDM<22, 36.8%; GDM22-30, 52.4%; and GDM>30, 10.4%. The following outcomes were statistically significant after Holm-Bonferroni adjustment for deliveries at ≥31 GW using GDM22-30 as the reference. Caesarean sections (1.54 [1.39, 1.72]), large-for-gestational-age (LGA) infants (2.00 [1.72, 2.32]), Erb's palsy or clavicle fracture (6.38 [2.42, 16.8]), preterm birth (1.84 [1.41, 2.40]) and neonatal hypoglycaemia (1.98 [1.39, 2.83]) were more frequent in women with overt diabetes. Similarly, LGA infants (1.10 [1.06, 1.14]) and Erb's palsy or clavicle fracture (1.55 [1.22, 1.99]) were more frequent in GDM<22. LGA infants (1.44 [1.37, 1.52]) were more frequent in GDM>30. Finally, women without hyperglycaemia in pregnancy were less likely to have preeclampsia or eclampsia (0.74 [0.69, 0.79]), Caesarean section (0.80 [0.79, 0.82]), pregnancy and postpartum haemorrhage (0.93 [0.89, 0.96]), LGA neonate (0.67 [0.65, 0.69]), premature neonate (0.80 [0.77, 0.83]) and neonate with neonatal hypoglycaemia (0.73 [0.66, 0.82]). Overall, the results were similar for deliveries at ≥37 GW. Although the estimation of the adjusted prevalence ratio of perinatal death was five times higher (5.06 [1.87, 13.7]) for women with overt diabetes, this result was non-significant after Holm-Bonferroni adjustment. Compared with GDM22-30, overt diabetes, GDM<22 and, to a lesser extent, GDM>30 were associated with poorer maternal-fetal outcomes.

A rare case of congenital central hypoventilation syndrome in a premature neonate with multiple coexisting morbidities: A comprehensive clinical analysis

A rare case of congenital central hypoventilation syndrome in a premature neonate with multiple coexisting morbidities: A comprehensive clinical analysis

Necrotizing Enterocolitis in a 10-day-old premature male neonate with surgical resolution. Case Report

Necrotizing Enterocolitis in a 10-day-old premature male neonate with surgical resolution. Case Report

The Role of Erythropoietin in Preventing Anemia in the Premature Neonate.

Recombinant human erythropoietin (rhEPO) treatment is an alternative to red blood cell (RBC) transfusions in neonates presenting anemia of prematurity (AOP). This study assesses the impact of early rhEPO administration on AOP (any stage) incidence, as well as the incidence of individual AOP stages and RBC transfusions. Out of 108 preterm neonates, 49 were administered rhEPO and compared to the remaining group using univariate and multivariate analyses. Univariately, gestational age (GA), birth weight (BW), hemoglobin (Hb), hematocrit (HCT), RBC levels, and iron administration were significantly associated with AOP (p < 0.05 each); however, only the latter remained significant following multivariate analysis (AOR: 2.75, 95% CI, 1.06-7.11). Multinomial analysis revealed rhEPO treatment was associated with a near three-fold reduction in moderate AOP incidence (OR: 0.36, 95% CI, 0.15-0.89). Furthermore, ANCOVA revealed positive correlations between rhEPO administration and 21-day Hb (p < 0.01), HCT (p < 0.05), and EPO (p < 0.001) levels. The results confirm previously reported benefits of rhEPO treatment, such as reduced moderate AOP incidence and increased Hb, HCT, and serum EPO levels.

Section 1 - Care of the Premature and Critically-Ill Neonate

Section 1 - Care of the Premature and Critically-Ill Neonate

When should a premature neonate (24-35 weeks) be discharged? five-year experience from a single-center neonatal intensive care unit in Türkiye.

The survival rate among preterm infants has improved, and hospital stays have been prolonged, consistent with positive developments in perinatal and neonatal care. The aim of this study was to provide evidence-based information for healthcare professionals concerning the ideal time for discharge by evaluating the reasons for prolonged hospital stays. Six hundred eighty-one premature babies born at 24-35 weeks at the Mersin University Medical Faculty Hospital between January 2016 and May 2020 and admitted to the neonatal intensive care unit were included in the study following a retrospective file examination. Date of birth (gestational age) and discharge week (duration of hospital stay) calculated from the date of final discharge were recorded. Based on the literature, the ideal discharge time was determined to be 40 weeks according to postmenstrual age (week of birth + length of hospital stay). The primary variable was whether the infants were discharged before the ideal discharge week. The secondary variable was the effect of the presence of comorbidity on the length of hospital stay and ideal discharge time. The mean hospital stay of preterm neonate born at 250-7-260-7, 270-7-280-7 and 290-7-300-7 weeks was significantly shorter in the absence of comorbidity than in the presence of comorbidity (p = 0.001, 0.004, and 0.008, respectively). More than half (53.5%) were discharged before the expected date of birth as gestational weeks increased, despite the prolonged length of stay in the presence of comorbidity. Health professionals can inform families that, in the absence of comorbidity, discharge is possible at an average of 36 weeks for 250-7-280-7-week gestational ages, and at an average of 34 weeks for 290-7-320-7-week gestational ages.

The Urinary Concentrations of Neutrophil Gelatinase-Associated Lipocalin, Cystatin C and Osteopontin in the Healthy Term and Stable Preterm Neonates: A Pilot Study.

In neonates, the assessment of kidney function with serum creatinine is limited; therefore, more effective biomarkers are needed. The study aimed at analyzing the concentrations of renal biomarkers (osteopontin, cystatin C, and NGAL) in neonates. The study included 80 term and 20 preterm neonates aged 28-33 weeks of gestation. Biomarkers were measured in urine. Term neonates' urine was collected on the 1st day of life. Preterm neonates' urine was collected on the 1st, 8th, 15th, 22nd day of life. Biomarkers' concentrations were normalized to urinary creatinine (cr.) and presented as urinary biomarker/cr. ratios. Median values of biomarker/creatine ratios in term and preterm neonates were the following: cystatin C/cr.: 7.26 and 439.49; osteopontin/cr.: 135.86 and 1633.37; NGAL/cr. in girls: 212.14 and 256.93; and NGAL/cr. in boys 27.123 and 65.29 ng/mg cr. In preterm neonates the cystatin C/cr. ratio was higher on the 1st than on the 8th day. The osteopontin/cr. ratio did not differ between the days. The NGAL/cr. ratio in girls was higher on the 8th than on the 22nd day, and in boys, the lowest was on the 22nd day. Prematurity in stable, Caucasian neonates might cause higher osteopontin and cystatin C excretion, but not NGAL. The excretion of NGAL and cystatin C, but not osteopontin, may change during first weeks of premature neonate's life.