Preterm Research Articles

Effectiveness of Chest Physiotherapy in Broncho Pulmonary Clearance in Respiratory Distress Neonates

Purpose: Globally, the mortality rate of respiratory distress has been quite high due to unability to maintain oxygenation and overcome abnormal work of breathing. Chest Physical therapy, apart from providing advantageous outcomes to the adults, chest physical therapy is pivotal for newborns too but differs in terms of physiology and anatomy. Various chest physiotherapy techniques including percussions, vibrations, and compressions are quite effective in reducing mortality rate in neonates.Many studies has been conducted worldwidely, but still there has been limited data in Pakistan about the effect of bronchopulmonary clearance in neonatal intensive care unit, so this study was conducted to find the effectiveness of chest physiotherapy in neonatal intensive care unit
 Materials and Methods: This was the non-randomized controlled trial study conducted in tertiary care hospital of karachi , Pakistan. Total 40 samples collected through convenient based sampling were included in this study . The inclusion criteria including gestational age more than 37 weeks with atelactasis, mucous plugging, airway compromised, intubated or extubated, hospital admission, and chest complications where as exclusion criteria included cardiopulmonary instability, post surgery, pre term, intra ventricular hemmorage, fits or epilepsy, failure to thrive, and on consistent feed. Bronchopulmonary Clearance techniques such as Percussions , Compressions, and Vibrations along with suctioning and postural drainage were performed routinely twice daily session one in morning and one in evening was performed for total 14 days which means total 28 sessions of chest physiotherapy was implemented and chest xray, sp02, Heart rate, and respiratory rate was measured pre and post the sessions.
 Findings: The mean age of the participants were 37.050±5.57, out of which 20(52.5%) were females and 19(47.5%) were males. Result showed that post chest xray after chest physiotherapy was .2500±.49355 and post session spo2 was 2. .075 ± 4.56513. The chest physiotherapy was statistically significant in mucociliary clearance, lung expansion, preventing atelectasis, airway clearance, and other chest complications (0.008).
 Implications to Theory, Practice and Policy: Limitations of this study were that small sample size was taken, and data was collected from one tertiary care hospital of Karachi so it doesn’t showed generalization. Further studies in terms of large sample size are required for validity and reliability of this research.

Attachment and mother-infant interactions in dyads with infants born full-term, moderate-to-late preterm, and very-to-extreme preterm

BackgroundThe impact of prematurity status on attachment quality remains indeterminate. Some studies found no differences between infants born preterm (PT) and infants born full-term (FT), while other investigations present opposite results. AimsWe aim to contribute to this body of research by studying mother-infant interactive behaviors and quality of attachment in 3 independent samples: Full-Term (FT), Moderate-to-Late Preterm (MLPT) and Very-to-Extreme Preterm (VEPT). Study designThis is a longitudinal laboratory study conducted from 3 to 12 months of age (corrected-age in the case of infants born PT). SubjectsThe participants are 213 Portuguese infants (FT = 105; MLPT = 52; VEPT = 56) and their mothers. Outcome measuresMother-infant interactive behavior was observed in free-play at 3 and 9 months (corrected-age). Infant attachment was observed in Strange Situation at 12 months. ResultsSecure attachment is more prevalent in infants born FT, and ambivalent attachment is more prevalent in infants born VEPT. Infants with a secure attachment have higher gestational age and weight at birth. Infant and maternal interactive behavior quality is associated with attachment patterns and varies according to infant prematurity status. Last, the results indicate changes in maternal sensitivity and infant difficult behavior from 3 to 9 months of infant's age. ConclusionsOur findings indicate that prematurity status impacts attachment quality. Changes in maternal and infant behavior from 3 to 9 months suggest a period of rapid non-linear development, supporting a transactional multilayered approach to the study of mother-infant relationship.

Composition of Microbiota in Transient and Mature Human Milk: Significant Changes in Large for Gestational Age Group.

The composition of the human milk (HM) microbiota and, consequently, the microorganisms that are passed on to the infant through breastfeeding, can be influenced by various factors such as the mother's health and diet, gestational age, delivery mode, lactation stage, method of infant feeding, and geographical location. The aim of the Human Milk-Gest Study was to compare the microbiota of transient (postpartum 7-15 days) and mature HM (postpartum 45-90 days) of 44 mothers, and to investigate any potential changes associated with preterm birth, mode of delivery, and birth weight in relation to gestational age. The data were classified into five study groups: normal spontaneous delivery-term (NS-T) newborns, cesarean delivery-term (CS-T) newborns, preterm (PT) newborns (with a gestational age of less than 37 weeks), small for gestational age (SGA) newborns, and large for gestational age (LGA) newborns. An analysis of differential abundance was conducted using ANCOM-BC to compare the microbial genera between transient and mature HM samples as well as between other study groups. A significant difference was detected between HM samples at different sampling times and between the study groups (p < 0.01). In transient HM samples, Ralstonia, Burkholderiaceae_uc, and Pelomonas were significantly dominant in the LGA group compared to the NS-T, CS-T, PT, and SGA groups. In mature HM samples, Burkholderiaceae_uc, Ralstonia, Pelomonas, and Klebsiella were significantly dominant in the LGA group compared to the NS-T, CS-T, and PT groups, while Ralstonia, Burkholderiaceae_uc, and Pelomonas were significantly dominant in the LGA group compared to the SGA group. Differences were also detected between the transient and mature HM samples in the CS-T, PT, SGA, and LGA groups, but no differences occurred in the NS-T groups. In conclusion, we showed that Ralstonia, Burkholderiaceae_uc, and Pelomonas were significantly dominant in the LGA group in transient HM and continued in mature HM. The body mass index (BMI) of the mothers in the LGA group was not >30 at conception, however, the maternal BMI at birth and maternal weight gain during pregnancy were higher than in the other groups. The nutritional composition of HM is specifically designed to meet infant nutritional requirements during early life. Evaluating the effects of HM microbiota on infant microbiota composition and short- and long-term health effects in larger studies would be useful.

Frequency of Peripheral IV Catheter in Neonates with Prolong Stay in Emergency of Low-Income Country

BACKGROUND Peripheral intra venous catheter-the usual route for administrating iv antibiotics, nutrition, and other medications. It is secured by splints and adhesive dressings to the skin. However, prolong stay in the ED, and other factors result in frequent IV cannulation which increases the risk of infection and is always a painful procedure. Multiple dressings used to secure the cannula may also result in skin injury and further increase risk for infection. OBJECTIVE The present study aims to establish a relationship between length of stay of neonates and the number of peripheral IV catheter lines placed. MATERIAL AND METHOD This is a retrospective chart review of neonates admitted through the emergency room of a public sector hospital supported by Child life foundation, their length of stay, and the number of IV catheters used during their stay with the help of EMR data from doctors, staff, and pharmacists for each patient. RESULTS 1641 neonates admitted in ED between JAN-JUN 2023. 827(50.3%) neonates stayed in ED for less than 12 hours, with 1.7 average IV cannulations per neonate. 463(28.2%) neonates with length of stay between 12–24 hours had 2.08 IV cannulations per neonate. 239(14.56%) neonates stayed for 24–48 hours, with 2.3 IV cannulations per neonate. 78 (4.75%) neonates with length of stay between 48–72 had 2.76 IV cannulations per neonate. 34(2.07%) neonates stayed for more than 72hrs, with 3.17 IV cannulations per neonate. We established that as the need for IV medication and nutrition prolongs, so does the frequency of IV cannulations at new sites. The neonates were discharged on IV medication for a further 3–6 days, hence further increasing the need and number of peripheral IV cannulations per neonate. The frequency of change in cannulations is more in pre term as compared to term babies. CONCLUSION Increase length of stay is directly related to increase frequency of change in IV cannulation. Umbilical vein and peripherally inserted central catheter (PICC) can be utilized for IV antibiotics, nutrition, and other medications in ED. This will help in decreasing the risk of infection and painful stimulus to the neonates.

Visual scanning of social stimuli in preterm and autism spectrum disorder children.

To evaluate the pattern of eye-gaze of preterm (PT), autism spectrum disorder (ASD) and neurotypical (Ty) children. A cross-sectional study with eight preterm (born with ≤2000 g weight), nine ASD and five Ty male children, between six and nine years old, was performed. The eye gaze was evaluated presenting a board with a couple in social interaction, and a video with four children playing with blocks, projected in a screen computer, successively, evaluating the time that the children looked at each stimulus. Although all the groups focus on the central social figure with no significant differences, ASD presented significant differences in time fixation of the objects (p=0.021), while premature children fixated more time in the central social interaction than in the whole scene than typical children. Although this study found noteworthy differences in the eye-gaze patterns among the three groups, additional research with a more extensive participant pool is necessary to validate these preliminary results.

CHARACTERIZATION OF NEONATAL THROMBOCYTOPENIA AT TEACHING HOSPITAL OF RAHIM YAR KHAN

Objective: To determine the prevalence and characterization of thrombocytopenia in neonates and the pattern of illnesses in these thrombocytopenic neonates. Material and Methods: A cross sectional study was conducted on 400 neonates in Pathology and Pediatric departments of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, from November 2022 to July 2023. Analysis of data was done by using SPSS 23. Results: Out of 400 studied neonates, males made up 238 (59.5%), while females were 162 (40.5%). Thrombocytopenic neonates were 76(19%) while 324(81%) neonates had normal platelet count. Out of the 76 thrombocytopenic neonates, 42(10.5%) neonates had mild thrombocytopenia, 25(6.25%) had moderate thrombocytopenia and 9 (2.25%) had severe thrombocytopenia. Degree of thrombocytopenia revealed that 46 (11.5%) of neonates had thrombocytopenia in late onset phase while 30 (7.5%) had early onset thrombocytopenia. Correlation of thrombocytopenia with several disorders displayed that neonatal sepsis and anemia were significantly linked with thrombocytopenia, followed by birth asphyxia, neonatal birth in preterm and full-term neonates, low birth weight and Neonatal jaundice, furthermore, the p-value for bleeding in neonates allied with thrombocytopenia was found significant with value of 0.03. Conclusion: The current study discovered that mild thrombocytopenia among neonates is frequent followed by moderate and severe. Thrombocytopenia has strong correlation with neonatal sepsis, anemia, birth asphyxia, neonatal birth (pre term, full term) and bleeding. Severe thrombocytopenia can be used as a prognostic indicator in sick neonates. Hence thrombocytopenia is a frequent challenge for neonatologists to cope the serious consequences of neonatal health. Keywords: Neonatal thrombocytopenia, Platelet, Low birth weight neonates, Sepsis, Asphyxia.

Exchange Transfusion in Neonatal Hyperbilirubinemia: Experience of A Tertiary Care Hospital in Dhaka

Background: Hyperbilirubinaemia is a benign condition in newborn babies in some infants may become severe, progressing to kernicterus with substantial risk of neonatal mortality and long-term neurodevelopmental impairments. Among many treatment options exchange transfusion (ET) is the standard method for treatment of severe hyperbilirubinemia.&#x0D; Objectives: To investigate the frequency of primary risk factors for neonatal hyperbilirubinemia leading to ET, to evaluate the complications and immediate outcome of ET.&#x0D; Methods: This was an observational cross sectional study conducted in Dr. MR Khan Shishu Hospital and ICH, Dhaka. Frequency of primary risk factors for severe neonatal hyperbilirubinemia leading to ET, characteristics of babies undergoing ET, complications and immediate outcome of ET were analyzed among the neonates admitted between January 2017 to February 2021.&#x0D; Results: Among 61 neonates 49.18% were male and 50.82% were female, 65.57% of neonates were term and 34.43% pre term. The mean gestational age was 37.00 ± 1.50 weeks and mean birth weight was 2619±50gm. The leading causes of jaundice requiring ET were sepsis 31.17%, ABO incompatibility 24.59%, Rh incompatibility 14.75%, PT LBW with sepsis 14.75%, Infant of diabetic mother (IDM) 6.55%, PT LBW 6.55%, and neonatal sepsis with Down syndrome with congenital hypothyroidism 1.63%. Twenty (32.79%) neonates presented with signs of Kernicterus. Seven neonates (35%) presented with lethargy/poor feeding or hypotonic posture, 4(20%) patients had opisthotonus posture/hypertonia, and 9(45%) had convulsion. Nineteen (31.14%) neonates had complications related to ET. The most frequent complication was bradycardia (16.34%), then Catheter block (9.83%), apnaea (6.55%), cardiac arrest (6.55%), hypothermia (4.92%), NEC after ET (1.64%). Immediate outcome was good in 72.13% patients with smooth recovery, 14.75% had neurological deficit and 1.64% died. Among 20 neonates who presented with signs of Kernicterus 35% patients discharged with good recovery, 45% had neurological deficit.&#x0D; Conclusion: The common causes of exchange transfusion in neonatal jaundice were sepsis, ABO incompatibility, PT LBW, and infants of diabetic mothers. Overall outcome was good few developed neurological deficit.&#x0D; DS (Child) H J 2022; 38(2): 89-95

The possible role of artificial intelligence in deciding postnatal steroid management in extremely premature ventilated infants.

Clinical decision support (CDS) has shown a positive effect on physicians. There is variability among physicians about using postnatal steroids (PNS) in preterm (PT) infants. It is, therefore, essential to develop tools supporting the decision to use PNS in PT infants. We propose a model using online tools such as CDS in deciding to use PNS in PT infants. We combined the online bronchopulmonary dysplasia (BPD) estimator and extubation success calculator tools to be used as a simple bedside tool assisting decisions about using PNS in ventilated PT infants.

Heart Rate and Heart Rate Variability in Healthy Preterm-Born Young Adults and Association with Vitamin D: A Wearable Device Assessment.

Prematurity has been associated with impaired parasympathetic cardiac regulation later in life. Changes in heart rate (HR) and heart rate variability (HRV) may indicate a risk for future cardiac dysfunction. The putative role of Vitamin D on cardiac autonomic function in individuals born preterm (PT) remains unknown. This study involves monitoring autonomic cardiac regulation and Vitamin D concentrations in 30 PT and 16 full-term (FT) young adults in a free-living context. The PT subjects were born between 1994 and 1997 at Oulu University Hospital. The inclusion criteria were (1) being born ≤ 32 gestation weeks or (2) being born < 34 gestation weeks with a birth weight under 1500 g. Participants wore an Oura ring sleep tracer, a smart ring device, for 2 weeks to monitor cardiac autonomic function. Parameters related to autonomic cardiac regulation, lowest nighttime resting HR, and the root mean square of successive differences (RMSSD) to describe HRV were collected. PT males exhibited a tendency toward lower RMSSD (71.8 ± 22.6) compared to FT males (95.63 ± 29.0; p = 0.10). Female participants had a similar mean RMSSD in the FT and PT groups at 72.04 ± 33.2 and 74.0 ± 35.0, respectively. Serum 25-hydroxyvitamin D concentration did not correlate with cardiac autonomic function parameters. When assessing the lowest resting nighttime HRs and HRVs in a long-term, real-world context, healthy female PT young adults performed similarly to their FT peers. In contrast, the present study's results suggest that male PT young adults exhibit impaired autonomic cardiac function, potentially putting them at risk for cardiovascular disease later in adulthood.

Bilirubin metabolism &amp; pathophysiology of neonatal jaundice

Jaundice is a visible yellowish color change in skin and sclera, secondary to elevated serum bilirubin which accumulates in the skin. Visibility of jaundice depends upon the age of the patient, color/complexion of the skin and level of bilirubin in blood. It is more easily visible in fair complexioned and new born (particularly, pre term) babies. In the new born, jaundice is visible during the 1 week of life in 60% of full term and 80% preterm infants.

Language outcomes at 18-24 months of preterm infants from US Spanish- and English-speaking homes.

To evaluate the association of Spanish compared to English primary household language on preterm (PT) infants' language outcomes in the United States and to examine associations with socio-economic factors. This was a retrospective cohort of PT infants born <32 weeks gestation from Spanish-speaking (n = 95) and English-speaking homes (n = 1030) born 2005-2019. Language (primary outcome) and cognitive and motor skills (secondary outcomes) were measured using the BSID-III at 18-24 months corrected age. Group differences were evaluated using bivariate comparisons and logistic regression analyses. Mothers reporting Spanish-speaking homes had higher rates of public insurance and lower educational achievement. Group newborn characteristics were similar. Preterm infants from Spanish-speaking homes had significantly lower BSID-III language composite, cognitive composite, receptive and expressive scores compared to infants from English-speaking homes. Logistic regression modelling identified independent negative effects of Spanish-speaking household OR 3.26 (CI 1.89-5.62) and public insurance OR 2.31 (CI 1.71-3.12) with a protective benefit derived from breast milk OR 0.68 (CI 0.50-0.92) when adjusting for medical morbidities, socio-economic factors and gestational age. Public health policies and interventions in the United States should target language and cognitive outcomes of PT infants from Spanish-speaking homes.

Minipuberty in Male Full-term Neonates Appropriate and Small for Gestational Age and in Preterm Babies: Data from a Single Centre

The postnatal activation of the hypothalamic-pituitary-gonadal (HPG) axis is usually known as “minipuberty”. There are still open questions about its biological function and significance depending on sex, gestational age (GA) and birth weight (BW) with few available longitudinal data. A single-centre, longitudinal study to quantify urinary follicle stimulating hormone (uFSH), luteinizing hormone (uLH) and testosterone (uTs) in male neonates. Neonates were enrolled and stratified into three subgroups: full-term boys appropriate for GA (FT AGA); FT boys with BW ≤3rd centile [FT small for gestational age (SGA)]; and preterm (PT) boys ≤33 weeks of GA. Urinary hormones were correlated to simultaneous auxological parameters, linear growth and external genitalia at scheduled time-points. Forty-six boys were recruited, with subgroup sizes FT AGA n=23, FT SGA n=11 and PT n=12. PT boys display a pulsatile pattern of urinary gonadotropins (uGns) with higher levels of uLH and a gradual increase of uTs. Testicular descent started from 29-32 weeks with the peak of uTs. During the first 12-months post-term age (PTA), FT AGA boys displayed a better linear growth (p<0.05). PT showed higher uGns levels until 3-months PTA. PT babies had higher uLH levels than FT AGA, with a peak at 7 and 30 days, during the first 90 days of life (p<0.001) and higher uTs levels. Correlation analysis between penile growth of all neonates and uTs was significant (p=0.04) but not within subgroups. This study investigated postnatal HPG axis activation in term and PT infants. Minipuberty may involve an early window of opportunity to evaluate the functionality of the HPG axis. Further studies with a long-term follow-up are needed with a special focus on possible consequences of GA and BW.

Prevalence and risk of stillbirth according to biologic vulnerability phenotypes in the municipality of São Paulo, Brazil: A population-based cohort study.

To estimate the prevalence and risk of stillbirths by biologic vulnerability phenotypes in a cohort of pregnant women in the municipality of São Paulo, Brazil, 2017-2019. Retrospective population-based cohort study. Fetuses were assessed as small for gestational age (SGA), large for gestational age (LGA), adequate for gestational age (AGA), preterm (PT) as less than 37 weeks of gestation, non-PT (NPT) as 37 weeks of gestation or more, low birth weight (LBW) as less than 2500 g, and non-LBW (NLBW) as 2500 g or more. Relative risks (RR) with robust variance were estimated using Poisson regression. In all 442 782 pregnancies, including 2321 (0.5%) stillbirths, were included. About 85% (n = 1983) of stillbirths had at least one characteristic of vulnerability, compared with 21% (n = 92524) of live births. Fetuses with all three markers of vulnerability had the highest adjusted RR of stillbirth-SGA + LBW + PT (RR 155.00; 95% confidence interval [CI] 136.29-176.30) and LGA + LBW + PT (RR 262.04; 95% CI 206.10-333.16) when compared with AGA + NLBW + NPT. Our findings show that the simultaneous presence of prematurity, low birth weight, and abnormal intrauterine growth presented a higher risk of stillbirths. To accelerate progress towards reducing preventable stillbirths, one must identify the circumstances of greatest biologic vulnerability.

Hydrogen sulfide inhibits the rupture of fetal membranes throngh anti-aging pathways

IntroductionTo investigate the relationship between hydrogen sulfide(H2S) and the senescence level of the fetal membranes, and to elucidate how H2S affects the integrity of the fetal membranes. MethodsThe H2S and the senescence levels of fetal membranes, and the expressions of H2S synthase CBS and CSE were detected in the preterm (PT) group and the preterm premature ruptured membranes (pPROM) group. The effects of H2S donors and knockdown of CBS on the senescence level of amniotic epithelial cells, and the expression level of matrix metalloproteinases (MMPs) and epithelial-mesenchymal translation (EMT) were observed. ResultsThe level of H2S in the fetal membranes in the pPROM group is significantly lower than that in the PT group matched for gestational age. The level of H2S is negatively correlated with the senescence level of fetal membranes. Treatment with H2S donors reduced cell senescence and MMPs expression, but did not affect EMT. CBS siRNA transfection accelerated the senescence of amniotic epithelial cells, and promoted the expression of MMPs and EMT occurrence, but l-cysteine could reverse these effects. DiscussionOur study suggests that H2S, through its anti-aging effect, can influence the expression of MMPs and EMT, thereby contributing to the maintenance of fetal membrane integrity.

Effect of non-traumatic first trimester per vaginal bleeding on maternal and fetal outcomes in Indian tertiary care teaching hospital

Background: Aim of study was to assess the maternal and perinatal outcomes in first trimester vaginal bleeding. Methods: This prospective observational study was done on 112 patients with first trimester vaginal bleeding at a tertiary care teaching hospital in South India over a period of two years. All the patients who satisfied the inclusion and exclusion criteria were evaluated for the outcomes like hypertensive disorders, post partum and anter partum haemorrhage, rupture of menbranes, anemia, gestational diabetes, pre term delivery, low birth weight, small for gestational age, NICU admissions, intra-uterine growth restriction and mode of delivery. Results: Maximum patients with bleeding per vagina in first trimester belonged to 26-30 years age group out of which majority had spotting. No specific significance was found to be associated between gravida score and bleeding or bleeding types. Out of 75 patients who continued pregnancy, 57 (76.0%) patients had one or the other complication in pregnancy which was significant (p&lt;0.05). Regarding fetal outcomes, 19 had preterm delivery, 10 were LBW while 4 were SGA, 26 required NICU admissions and 8 had IUGR. 48 patients had recurrent bleeding PV which showed no significant correlation with abortion or APH. Conclusions: Study shows that per vaginal bleeding in first trimester may lead to maternal and foetal complications. We recommend training pregnant women regarding those complications and their prevention.

Growth and neurodevelopmental outcomes of preterm and low birth weight infants in rural Kenya: a cross-sectional study

ObjectiveData on long-term outcomes of preterm (PT) and low birth weight (LBW) infants in countries with high rates of neonatal mortality and childhood stunting are limited, especially from community settings....

Higher Availability of Long-Chain Monounsaturated Fatty Acids in Preterm than in Full-Term Human Milk.

While the role of n-3 and n-6 long-chain polyunsaturated fatty acids (LCPUFAs) in the maturation of the infantile nervous system is extensively studied and relatively well-characterized, data on the potential developmental importance of the n-9 long-chain monounsaturated fatty acid (LCMUFA), nervonic acid (NA, C24:1n-9) are scarce and ambiguous. Therefore, the aim of the present study was to reanalyze our available data on the contribution of NA and its LCMUFA precursors, gondoic acid (C20:1n-9) and erucic acid (EA, C22:1n-9) to the fatty acid composition of human milk (HM) during the first month of lactation in mothers of both preterm (PT) and full-term (FT) infants. HM samples were obtained daily during the first week of lactation, and then on the 14th, 21st, and 28th days. Values of the LCMUFAs, C20:1n-9, EA, and NA were significantly higher in colostrum than in transient and mature HM. Consequently, there were highly significant inverse associations between LCMUFA values and the duration of lactation. Moreover, C20:1n-9, EA, and NA values were monotonously, considerably, and at many timepoints significantly higher in PT than in FT HM samples. By the 28th day of lactation, summarized LCMUFA values in PT HM samples declined to the level measured in FT HM samples on the first day of lactation; however, EA and NA values were still significantly higher in PT than in FT HM on the 28th day. Significantly higher availability of LCMUFAs in PT than in FT HM underpins the potential biological role of this hitherto somewhat neglected group of fatty acids.

Characteristics and outcomes of neonatal opioid withdrawal syndrome in preterm infants: a retrospective cohort study in the current era.

Compare Neonatal Opioid Withdrawal Syndrome (NOWS) in preterm and term infants. Single center, retrospective chart review of all in-utero opioid exposed infants born between 2014 and 2019. Withdrawal symptoms were assessed using Modified Finnegan Assessment Tool. Thirteen preterm (PT), 72 late preterm (LPT), and 178 term infants were included. Preterm and LPT compared to term infants had lower peak Finnegan scores (9/9 vs. 12) and received less pharmacologic treatment (23.1/44.4 vs. 66.3%). Similar onset, peak symptoms, and treatment duration was observed in LPT and term infants. Preterm and LPT infants have lower Finnegan scores and require less pharmacologic therapy for NOWS. It is unclear if this is because our current assessment tool does not capture their symptoms or if they truly have less withdrawal. Onset of NOWS is similar in LPT and term infant, thus LPT infants do not require prolonged hospital monitoring for NOWS.

Does Gender Affect Levels of Hyperbilirubinemia in Term Neonates

Introduction: Hyperbilirubinemia is a common &amp; in most1cases, benign problem in1first month of1life which is often1physiologic &amp; intervention is not1usually1necessary. In the first week of life, about 60.0% of term &amp; 80.0% of preterm infants have jaundice. Jaundice could lead to major side effects like kernicterus and permanent impairment.1One of the most frequent disorders requiring medical1attention in babies is neonatal jaundice. It has high levels of unconjugated1bilirubin, which can occasionally lead to kernicterus. Objective: To determine frequency of hyperbilirubinemia among neonates who present with physiological jaundice and compare the mean levels of hyperbilirubinemia among genders. Methodology: A total of 368 consecutive neonates were included. This cross-sectional study1was conducted at Department of Paediatric Medicine, NICH Karachi during June 2020 to December 2020. All pre-term or term neonates of either gender with physiological jaundice, and get admitted to pediatric medicine department were included in this study. While Neonates who did not survive first 48 hours of life, neonates who were not exclusively breast fed as determined by History were excluded from study. Blood samples1were taken from the patients and concentrations of serum total bilirubin, In the centrifuged venous samples, direct &amp; indirect1bilirubin concentrations were determined. Serum total,1direct&amp; indirect bilirubin was recorded for each patient. Data was analyzed using IBM. SPSS 22 on computer. Results: Mean ±SD age of neonates was 10.6±4.2 days. In distribution of gender, 214 (58.2%) were male while 154 (41.8%) were female. Mean ±SD of birth weight was 3.4±1.8 kg. Mean ±SD of birth weight was 3.4±1.8 kg with min to max 1.5 – 4.5 kg. majority 203 (55.2%) of neonates had birth weight was 1.5 – 3.0 kg. pre term delivery was done in 195 (53%) neonates while 173 (46.7%) were documented in term neonates. Hyperbilirubinemia was found in 156 (42.4%) patients. Mean levels of hyperbilirubinemia in male v/s female was noted as (12.3±3.8) and (11.5±3.4) respectively and P value found to be significant i.e. (P=0.038). Proportion of hyperbilirubinemia was significantly high 92 (52.9%) in neonates with age &gt; 9 days (p=0.00). Advanced maternal age (&gt;30 years) was also significantly associated with hyperbilirubinemia 88 (50.9%), (p=0.002; OR=1.9). C-section was significantly associated with hyperbilirubinemia 99 (49.3%), (p=0.003). Practical Implication: This study aims to provide an answer to the question of whether gender affects the level of hyperbilirubinemia in neonates. The rationale behind this is that because both preterm and term neonates are affected by this condition, if it is determined that one gender is more affected and experiences higher levels of bilirubinemia, neonates of that specific gender can be closely monitored and followed up in the future. Conclusion: It is to be concluded that hyperbilirubinemia is a frequent finding among neonates who present with physiological jaundice. Therefore, to correctly diagnose and treat the disease, both parents and professionals should take precautions. Keywords: 1Hyperbilirubinemia, Neonates, Jaundice, Risk Factors, Etiology, Hemolysis

Does Gender Affect Levels of Hyperbilirubinemia in Term Neonates

Introduction: Hyperbilirubinemia is a common &amp; in most1cases, benign problem in1first month of1life which is often1physiologic &amp; intervention is not1usually1necessary. In the first week of life, about 60.0% of term &amp; 80.0% of preterm infants have jaundice. Jaundice could lead to major side effects like kernicterus and permanent impairment.1One of the most frequent disorders requiring medical1attention in babies is neonatal jaundice. It has high levels of unconjugated1bilirubin, which can occasionally lead to kernicterus. Objective: To determine frequency of hyperbilirubinemia among neonates who present with physiological jaundice and compare the mean levels of hyperbilirubinemia among genders. Methodology: A total of 368 consecutive neonates were included. This cross-sectional study1was conducted at Department of Paediatric Medicine, NICH Karachi during June 2020 to December 2020. All pre-term or term neonates of either gender with physiological jaundice, and get admitted to pediatric medicine department were included in this study. While Neonates who did not survive first 48 hours of life, neonates who were not exclusively breast fed as determined by History were excluded from study. Blood samples1were taken from the patients and concentrations of serum total bilirubin, In the centrifuged venous samples, direct &amp; indirect1bilirubin concentrations were determined. Serum total,1direct&amp; indirect bilirubin was recorded for each patient. Data was analyzed using IBM. SPSS 22 on computer. Results: Mean ±SD age of neonates was 10.6±4.2 days. In distribution of gender, 214 (58.2%) were male while 154 (41.8%) were female. Mean ±SD of birth weight was 3.4±1.8 kg. Mean ±SD of birth weight was 3.4±1.8 kg with min to max 1.5 – 4.5 kg. majority 203 (55.2%) of neonates had birth weight was 1.5 – 3.0 kg. pre term delivery was done in 195 (53%) neonates while 173 (46.7%) were documented in term neonates. Hyperbilirubinemia was found in 156 (42.4%) patients. Mean levels of hyperbilirubinemia in male v/s female was noted as (12.3±3.8) and (11.5±3.4) respectively and P value found to be significant i.e. (P=0.038). Proportion of hyperbilirubinemia was significantly high 92 (52.9%) in neonates with age &gt; 9 days (p=0.00). Advanced maternal age (&gt;30 years) was also significantly associated with hyperbilirubinemia 88 (50.9%), (p=0.002; OR=1.9). C-section was significantly associated with hyperbilirubinemia 99 (49.3%), (p=0.003). Practical Implication: This study aims to provide an answer to the question of whether gender affects the level of hyperbilirubinemia in neonates. The rationale behind this is that because both preterm and term neonates are affected by this condition, if it is determined that one gender is more affected and experiences higher levels of bilirubinemia, neonates of that specific gender can be closely monitored and followed up in the future. Conclusion: It is to be concluded that hyperbilirubinemia is a frequent finding among neonates who present with physiological jaundice. Therefore, to correctly diagnose and treat the disease, both parents and professionals should take precautions. Keywords: 1Hyperbilirubinemia, Neonates, Jaundice, Risk Factors, Etiology, Hemolysis