Short-term Outcomes Of Infants Research Articles

Neonatal and short-term outcome after late vertical transmission in congenital CMV-infected fetuses following primary first-trimester maternal seroconversion

ObjectiveTo document the course of neonatal and short-term outcomes in pregnancies after first trimester CMV (cytomegalovirus) seroconversion and negative amniotic fluid (AF) CMV PCR.MethodsWe included 375 patients with a first-trimester...

Prevalence of Pulmonary Hypertension During Therapeutic Hypothermia for Hypoxic Ischemic Encephalopathy and Evaluation of Short-Term Outcomes.

Infants with perinatal asphyxia and moderate-to-severe hypoxic ischemic encephalopathy (HIE) are currently treated with therapeutic hypothermia (TH) as part of a brain protective strategy. However, perinatal asphyxia is a risk factor for development of persistent pulmonary hypertension (PPHN). As such, the aim of this study was to quantify the risk of PPHN in infants undergoing TH and assess short-term outcomes in infants developing PPHN. All N = 59 infants undergoing TH for moderate-to-severe HIE over a period of 3 years (January 2020-December 2022) at a single center were included. PPHN was diagnosed in N = 10 (17%), with this deemed to have been exacerbated by TH in n = 6 (10%). Only 50% (5/10) with PPHN required inhaled nitric oxide, and none of the infants received extracorporeal membrane oxygenation. PPHN was not found to be significantly associated with short-term outcomes, including the extent of HIE on brain magnetic resonance imagings, in-hospital mortality or requirement for nasogastric feeding at discharge. In conclusion, TH appears to be a safe and effective treatment for moderate-to-severe HIE with or without PPHN.

Risk factors for infection and outcomes in infants with neonatal encephalopathy: a cohort study.

To determine the association between early infection risk factors and short-term outcomes in infants with neonatal encephalopathy following perinatal asphyxia (NE). A retrospective population-based cohort study utilizing the National Neonatal Research Database that included infants with NE admitted to neonatal units in England and Wales, Jan 2008-Feb 2018. one or more of rupture of membranes >18 h, maternal group B streptococcus colonization, chorioamnionitis, maternal pyrexia or antepartum antibiotics. death or nasogastric feeds/nil by mouth (NG/NBM) at discharge. organ dysfunction; length of stay; intraventricular hemorrhage; antiseizure medications use. 998 (13.7%) out of 7265 NE infants had exposure to early infection risk factors. Primary outcome (20.3% vs. 23.1%, OR 0.87 (95% CI 0.71-1.08), p = 0.22), death (12.8% vs. 14.0%, p = 0.32) and NG/NBM (17.4% vs. 19.9%. p = 0.07) did not differ between the exposed and unexposed group. Time to full sucking feeds (OR 0.81 (0.69-0.95)), duration (OR 0.82 (0.71-0.95)) and the number of antiseizure medications (OR 0.84 (0.72-0.98)) were lower in exposed than unexposed infants after adjusting for confounders. Therapeutic hypothermia did not alter the results. Infants with NE exposed to risk factors for early-onset infection did not have worse short-term adverse outcomes. Risk factors for early-onset neonatal infection, including rupture of membranes >18 h, maternal group B streptococcus colonization, chorioamnionitis, maternal pyrexia or antepartum antibiotics, were not associated with death or short-term morbidity after cooling for NE. Despite exposure to risk factors for early-onset neonatal infection, infants with NE reached oral feeds earlier and needed fewer anti-seizure medications for a shorter duration than infants with NE but without such risk factors. This study supports current provision of therapeutic hypothermia for infants with NE and any risk factors for early-onset neonatal infection.

Impact of a family-centered clinical care program on short term outcomes of very low birth weight infants.

We evaluated the effects of a family-centered clinical care pathway and case management program on short term clinical outcome in a cohort of very low birth weight (VLBW) infants. The program, named NeoPAss, was developed at the Department of Neonatology Children´s hospital Passau in 2013. Short term outcomes of infants were compared to matched controls from the Bavarian neonatology surveillance database before (n=111; 2008-2012) and after implementation (n=170; 2014-2017). After implementation the rate of late-onset sepsis was significantly lower (2.5% vs. 10.7%, p=0.005) and the length of stay was significantly shorter (VLBW 28 to 31 weeks' gestational age (GA) 47.5 vs 53.1 days, p=0.047; <28 weeks' GA 79.4 vs. 91.9 days, p=0.007) in the intervention group compared to controls. Infants were discharged with significantly lower weight (mean 2,351g vs 2,539g, p=0.013). There was no statistical significant difference in the rate of intraventricular hemorrhage (3.7% vs. 8.2%), necrotizing enterocolitis (0.6% vs. 1.9%) and bronchopulmonary dysplasia (0% vs. 6.9%). Our data confirms that of other studies, demonstrating a beneficial effect of family-centered care programs and provides evidence that structured parental involvement is not associated with increased risk of infection in a VLBW cohort.

Short-term outcomes of infants with hyperbilirubinemia-associated auditory neuropathy spectrum disorder in neonatal intensive care unit

Hyperbilirubinemia is a high-risk factor for auditory neuropathy spectrum disorder (ANSD) as well as hearing loss in general. This study described the outcomes of hyperbilirubinemia-associated ANSD infants diagnosed in hearing screening in the neonatal intensive care unit (NICU).A total of 578 children with hyperbilirubinemia admitted to the NICU between October 2020 and October 2021 were included in this study. The distortion product otoacoustic emission (DPOAE) and automatic auditory brainstem response (AABR) were combined for hearing screening, and those who failed the DPOAE or/and AABR underwent an auditory brainstem response (ABR) test. Infants with ANSD were followed up for 12 months.Forty infants (40/578, 6.9%) failed the DPOAE or/and AABR tests, of which, 13 (13/578, 2.2%) were diagnosed as ANSD, and 27 (27/578, 4.7%) were diagnosed as having sensorineural hearing loss (SNHL). Of the 13 ANSD infants followed up for 12 months, 7 recovered, 3 improved, 3 did not recover, and 1 was lost, equating to improved or recovered hearing in 75% (9/12) of ANSD infants at 12 months of age. Moreover, the maximum bilirubin in recovered or improved ANSD infants was 408.6 ± 129.0 μmol/L, while the maximum bilirubin in unrecovered ANSD infants was 749.3 ± 323.0 μmol/L. Furthermore, poorly differentiated and absent ABR waveforms were observed in 6 and 14 ears at 1 month, 2 ears were lost, 6 (6/6, 100.0%) and 6 (6/12, 50.0%) ears were recovered or improved at 12 months of age.s: The incidence of hyperbilirubinemia associated-ANSD was 2.2% of infants screened in the NICU. ANSD caused by hyperbilirubinemia may be transient, with most infants improving or recovering hearing by 12 months of age. Infants with poorly differentiated ABR waveforms and low bilirubin concentration are more likely to recover and hearing aids are not recommended in hyperbilirubinemia-associated ANSD below 12 months of age.

Safety and Short-Term Outcomes for Infants < 2.5kg Undergoing PDA Device Closure: A C3PO Registry Study.

To evaluate short-term procedural outcomes and safety for infants < 2.5kg who underwent catheterization with intended patent ductus arteriosus (PDA) device closure in a multi-center registry, as performance of this procedure becomes widespread. A multi-center retrospective review was performed using data from the Congenital Cardiac Catheterization Project on Outcomes (C3PO) registry. Data were collected for all intended cases of PDA closure in infants < 2.5kg from April 2019 to December 2020 at 13 participating sites. Successful device closure was defined as device placement at the conclusion of the catheterization. Procedural outcomes and adverse events (AE) were described, and associations between patient characteristics, procedural outcomes and AEs were analyzed. During the study period, 300 cases were performed with a median weight of 1.0kg (range 0.7-2.4). Successful device closure was achieved in 98.7% of cases with a 1.7% incidence of level 4/5 AEs, including one periprocedural mortality. Neither failed device placement nor adverse events were significantly associated with patient age, weight or institutional volume. Higher incidence of adverse events associated with patients who had non-cardiac problems (p = 0.017) and cases with multiple devices attempted (p = 0.064). Transcatheter PDA closure in small infants can be performed with excellent short-term outcomes and safety across institutions with variable case volume.

Hospital Outcomes for Neonates Exposed to Methamphetamine Prenatally

Objective: Methamphetamine use remains a problem, with a reported prevalence of 14 to 57 million of all 15-64-year-olds in the United States. However, there is limited knowledge about neonatal outcomes following in-utero exposure to methamphetamine. This study describes the short-term outcomes of infants born with confirmed methamphetamine exposure.&#x0D; Study Design: A retrospective chart review was conducted, and a total of 51 neonates were found to have positive drug screens.&#x0D; Result: Neonatal subjects had an average gestational age of 38 weeks and an average birth weight of 3.142 kg. Twenty-six neonates (50.98%) were admitted to the NICU with an average stay of 11.12 days. Maternal subjects were primarily Caucasian, had not obtained a high school diploma, frequently used tobacco, and had public insurance.&#x0D; Conclusion: Many of our findings were similar to the 2014 Infant Development, Environment, and Lifestyle Study (IDEAL). A large percentage of our patient population required NICU admission. However, the infants were of average size and gestational age.

Syphilis in pregnancy and infant outcomes in Manitoba.

Infectious syphilis has been increasing in incidence in Manitoba since 2012, especially in heterosexual women of childbearing age resulting in an increasing number of infants with in utero exposure and who are at risk for congenital syphilis (CS). We aimed to evaluate the impact of syphilis in pregnancy on infants and to describe our experience with CS. This retrospective 2012 to 2018 cohort study reviewed women with syphilis in pregnancy and short-term infant outcomes. We grouped mother-infant pairs into high risk and low risk for CS and compared their management and outcomes. We also describe our cases of confirmed and possible CS. Seventy-nine mothers and 80 infants met inclusion criteria. Thirty mother-infant pairs were classified as high risk for CS. Nine of their infants were diagnosed with confirmed CS and four with possible CS. All confirmed CS cases were asymptomatic at birth but two were not recognized to have CS until they later presented with symptoms. One of these infants had negative serologies (treponemal and non-treponemal) at birth, but at 3 months old had reactive serologies. Two months of age was the earliest clearance of maternal treponemal antibodies amongst low-risk infants compared to 6 months in high-risk infants. Most infants who did not have confirmed CS had non-reactive non-treponemal tests by 6 months old. Our study shows that symptoms and paired maternal-infant non-treponemal titres at birth are not sensitive for diagnosing CS. Serologies can be falsely negative with recent infection. Regardless of investigations or clinical findings, 10 days of intravenous penicillin G should be considered for all high-risk infants.

Neonates with mild hypoxic–ischaemic encephalopathy receiving supportive care versus therapeutic hypothermia in California

ObjectiveThe use of therapeutic hypothermia (TH) for mild hypoxic–ischaemic encephalopathy (HIE) remains controversial and inconsistent. We analysed trends in TH and maternal and infant characteristics associated with short-term outcomes of...

Short\u2010term outcomes in infants with mild neonatal encephalopathy: a retrospective, observational study

BackgroundNeonatal encephalopathy due to acute perinatal asphyxia is a major cause of perinatal brain damage. Moderate to severe neonatal encephalopathy is associated with high mortality and morbidity rates. However, the neurodevelopmental outcomes in neonates with mild neonatal encephalopathy are unclear. The primary aim of this single-center observational study was to assess the short-term outcomes in term neonates with mild neonatal encephalopathy due to perinatal asphyxia. A secondary aim was to identify predictors of poor prognosis by identifying the characteristics of these infants according to their short-term outcomes.MethodsWe retrospectively investigated all infants with perinatal asphyxia at Tokyo Metropolitan Children’s Medical Center from January 2014 to December 2019. An abnormal short-term outcome was defined as any one of the following: seizures or abnormal electroencephalography, abnormal brain magnetic resonance imaging obtained within the first 4 weeks of life, and abnormal neurological examination findings at discharge.ResultsIn total, 110 term infants with perinatal asphyxia during the study period were screened and 61 were diagnosed with mild neonatal encephalopathy. Eleven (18 %) of these infants had an abnormal short-term outcome. The median Thompson score at admission was significantly higher in infants with abnormal short-term outcomes than in those with normal short-term outcomes (5 [interquartile range, 4-5.5] vs. 2 [interquartile range, 1–3], p < 0.01). Receiver operating characteristic curve analysis showed that a cutoff value of 4 had high sensitivity and specificity (90.9 and 83.0 %, respectively) for prediction of an abnormal short-term outcome.Conclusions18 % of infants with mild encephalopathy had an abnormal short-term outcome, such as abnormal brain magnetic resonance imaging findings. The Thompson score at admission may be a useful predictor of an abnormal short-term outcome in infants with mild neonatal encephalopathy.

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

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

Short Term Outcome of Children with Antenatally Diagnosed Heart Disease: A Retrospective Single Centre Study

Introduction: The aim of foetal echocardiography is to improve the outcome of foetuses with congenital heart diseases. Impact of foetal echocardiography on the foetuses with antenatally diagnosed heart disease is less studied in public sector hospitals in India. Aim: To evaluate the short term outcome of infants born with antenatally diagnosed heart disease. Materials and Methods: This was a retrospective observational study conducted from April 2016 to June 2019 in a tertiary care public hospital in Northern India. Data was tabulated as mean, frequency and percentages, analysis were done in Microsoft excel 2013. Study included total of 1013 patients who underwent foetal echocardiography during the study period. Results: Heart disease was found in 59 patients after excluding five cases of ductal constriction. Referral for foetal echocardiography was frequently late. Among the group with abnormal foetal echocardiography, the mean gestational age at the time of diagnosis was 28.4 weeks. Follow-up data was available for 45 patients. A 24.4% (11/45) of those diagnosed with heart disease did not survive till term. 50% (17/34) of those born died before three months of age. Only two neonates underwent surgery before three months of age. Overall, 62.2% did not survive beyond three months of age. Conclusion: It was found that referrals for foetal echocardiography in setting were frequently late. Despite antenatal diagnosis the outcome for foetuses with heart disease was less than optimal. This reflects both the complexity of heart disease as well as lack of paediatric cardiac care to young infants in the setting. Access to high quality cardiac care for infants and neonates are essential for foetal echocardiography to have a meaningful impact on foetuses with heart disease.

Epilepsy-Related Outcomes in Children With Neonatal Cerebellar Injury.

Acute brain injury is a frequent perinatal neurologic complication that can involve the cerebellum. Although short-term outcomes of infants with neonatal cerebellar injury are well described, neurologic sequelae in older children are underreported. Here, we describe epilepsy-related outcomes in young children who suffered from neonatal cerebellar injuries. In-house automated software identified patients with neonatal brain injuries who were evaluated at our institution both as neonates (≤28 days) and as children (≥1 year). Neonatal hospital course, neuroimaging, and outcomes related to epilepsy were reviewed from the medical record. Patients were stratified into 2 groups based on neonatal brain injuries: those with cerebellar injury and those without cerebellar involvement. Of the 282 neonates followed through childhood over the decade-long study period, 33 (12%) experienced neonatal brain injury. All 33 cases involved supratentorial injury, and 5 (15%) also included cerebellar injury. The development of epilepsy was significantly less likely in the group with cerebellar involvement (40%) compared to that with cerebellar sparing (82%; P = 0.043). In some cases, children with cerebellum-sparing injuries required admission for seizure control and developed drug-resistant epilepsy as well as status epilepticus. These outcomes occurred less frequently in the group with cerebellar involvement. Epilepsy-related sequelae may occur less frequently when the cerebellum is involved in neonatal brain injury. Larger prospective studies are needed to clarify how cerebellocortical networks impact functional brain connectivity and epilepsy longitudinally.

Steroids for All

Background: Due to difficulties estimating the risk of preterm labor, many women diagnosed with threatened preterm delivery and given antenatal corticosteroids to improve neonatal outcomes do not deliver until term. Our objective was to compare the short-term outcomes of infants born at term to women who received betamethasone (BMZ) for threatened preterm labor to infants who were not exposed to BMZ in utero. &#x0D; &#x0D; Methods: We performed a retrospective cohort study of infants born at or after 37 weeks’ gestational age (GA) to mothers diagnosed with threatened preterm labor during pregnancy. Controlling for covariates, the primary neonatal outcomes of interest, including transient tachypnea of the newborn (TTN), neonatal intensive care unit (NICU) admission, and birthweight, were evaluated for their association with BMZ exposure. &#x0D; &#x0D; Results: Of 5330 women, 1459 (27.5%) women received BMZ at a mean GA of 32.2±3.3 weeks. The mean age of women was 27±5.9 years-old and the mean GA at delivery was 38.9±1.1 weeks. Women receiving BMZ had higher rates of maternal comorbidities (P&lt;0.001 for diabetes, asthma, and hypertensive disorder) and were more likely to self-identify as white (P=0.022). BMZ-exposed neonates had lower birth weights and increased rates of oxygen usage, TTN, hyperbilirubinemia, hypoglycemia, and NICU admission rates (all P-values &lt;0.05). &#x0D; Controlling for maternal characteristics and GA at delivery, BMZ exposure was not significantly associated with diagnosis of TTN [OR 1.09 (95% CI 0.80-1.50)], though it was associated with more NICU admissions [1.49 (1.19-1.86)] and lower birthweight by 91.5 (-122.3 to -60.6) grams. &#x0D; &#x0D; Conclusions: Compared to women evaluated for preterm labor that did not receive BMZ, women receiving BMZ had infants with higher rates of NICU admission and lower birthweights, though the rate of TTN diagnosis was similar between the two groups. While the benefits of BMZ to infants born preterm are clear, there may be negative impacts for infants delivered at term.

Short-Term Outcomes of Infants and Children Receiving Selexipag for Pulmonary Hypertension

Selexipag is a long acting, immediate release, prostacyclin IP receptor agonist used to treat pulmonary hypertension (PH). Little is known about its use in infants and children. Our study reports short-term outcomes in pediatric patients receiving selexipag. We reviewed pediatric PH patients who received selexipag at our hospital. Previously published dosing/titration recommendations from our group were followed. Nine children (3 infants, 1 toddler, & 5 adolescents) received selexipag since Feb. 2018. Median age and weight at initiation were 10 years (97 days to 18.6 years) and 34 kg (3.4-162 kg). The 4 youngest subjects were transitioned from intravenous treprostinil to selexipag and 5 subjects initiated de novo. Transitions from treprostinil were uneventful, with one infant requiring slower titration due to asymptomatic hypotension. Three adolescents required selexipag dose reduction, with two unable to achieve target dose. Median duration of therapy was 322 days (54-600 days) with five subjects remaining on selexipag. Two subjects remain on PH therapy after discontinuation of selexipag. One subject's follow up catheterization showed elevated pulmonary vascular resistance after discontinuing selexipag, thus it was re-initiated. A subject with worsening PH required transition to subcutaneous treprostinil while undergoing lung transplant evaluation. Children with a variety of other disease processes have received selexipag, including one with single ventricle anatomy status post BT shunt, one awaiting heart transplant with ventricular assist device support, and one status post heart transplant receiving treprostinil. There were no deaths and side effects mirror those seen in adults [Figure]. Administration of selexipag in infants and children appears safe, and is a viable alternative to other forms of prostacyclin administration in stable patients. Selexipag may also have a role as tertiary adjunct therapy for those who do not improve on dual oral therapy.

Short-term outcomes of infants with an extremely low birth weight in a resource-limited neonatal intensive care unit, Grey’s Hospital, KwaZulu-Natal

Background. Neonates with an extremely low birth weight (ELBW) constitute a small proportion of live births. However, there is limited information about the outcome of this specific group in developing countries, including South Africa (SA). Objective. To determine the outcome to discharge of ELBW neonates admitted to a resource-limited neonatal intensive care unit (NICU). Methods. A retrospective chart review was conducted of neonates admitted to the NICU at Grey’s Hospital between 1 July 2011 and 30 June 2014. All neonates with a birth weight of 900 g had better outcomes but without statistical significance. There were no statistically significant associations between outcome and any maternal variables. Nasal continuous positive airway pressure ventilation was associated with higher survival, but without statistical significance. Conclusion. The survival rate of ELBW neonates in this study is comparable to what has been reported in other developing countries, but higher than for other NICUs in SA with similar resource limitations. More studies are required to determine factors that may influence the survival rate of the ELBW neonates.

Implementation of Neonatal Neurocritical Care Program Improved Short-Term Outcomes in Neonates With Moderate-to-Severe Hypoxic Ischemic Encephalopathy

BackgroundDespite the introduction of therapeutic hypothermia, infants with moderate-to-severe hypoxic-ischemic encephalopathy remain at risk of mortality and morbidity. A dedicated service with standardized management protocols and improved communication may help improve care. We aimed to evaluate the impact of a dedicated neonatal neurocritical care service on short-term outcomes in infants with hypoxic-ischemic encephalopathy. MethodsWe performed a retrospective cohort study (July 2008 to December 2017) on term and near-term infants admitted to two tertiary neonatal intensive care units with moderate-to-severe hypoxic-ischemic encephalopathy, before and after neonatal neurocritical care service implementation. The primary outcome was brain magnetic resonance imaging findings consistent with those of hypoxic-ischemic encephalopathy. Secondary outcomes included the cooling initiation rate, hospital stay duration, antiseizure medication use, and inotrope use. Regression analysis and interrupted time series analysis were performed after adjusting for confounding factors. ResultsIn total, 216 infants with moderate-to-severe hypoxic-ischemic encephalopathy were analyzed—109 before and 107 after neonatal neurocritical care implementation. After adjusting for confounding factors, there was a significant reduction in primary outcomes (adjusted odds ratio: 0.3, confidence interval: 0.15 to 0.57, P < 0.001) after neonatal neurocritical care implementation. Average hospital stay duration reduced by 5.2 days per infant (P = 0.03), identification of eligible infants for cooling improved (P < 0.001), antiseizure medication use reduced (P = 0.001), and early inotropes use reduced (P = 0.04). ConclusionImplementation of a neonatal neurocritical care service associated with decreased brain injury shortened the hospital stay duration and improved the care of infants with moderate-to-severe hypoxic-ischemic encephalopathy.

Monitoring cerebral oxygenation of preterm infants using a neonatal specific sensor.

Cerebral oxygenation (rcSO2) monitoring in preterm infants may identify periods of cerebral hypoxia or hyperoxia. We hypothesised that there was a relationship between rcSO2 values and short term outcome in infants of GA < 32weeks. RcSO2 values were recorded for the first 48 h of life using an INVOS monitor with a neonatal sensor. The association between cranial ultrasound scan measured brain injury and rcSO2 was assessed. 120 infants were included. Sixty-nine percent (83) of infants had a normal outcome (no IVH, no PVL, and survival at 1 month); less than one-quarter, 22% (26), had low grade IVH 1 or 2 (moderate outcome); and 9% (11) of infants had a severe outcome (IVH ≥ 3, PVL or died before 1 month age). rcSO2 values were lower for infants GA < 28weeks when compared with those GA 28-32, p < 0.001. There was no difference in absolute rcSO2 values between the three outcome groups but a greater degree of cerebral hypoxia was associated with preterm infants who had low grade 1 or 2 IVH. Infants of GA < 28 weeks have lower cerebral oxygenation in the first 2 days of life. A greater degree of hypoxia was seen in infants with grade 1 or 2 haemorrhage. Normative ranges need to be gestation specific.

Surgical Interventions in Infants Born Preterm with Congenital Heart Defects: An Analysis of the Kids' Inpatient Database

To evaluate short-term outcomes in infants born preterm with congenital heart defects (CHDs) and the factors associated with surgery, survival, and length of hospitalization in this population. We analyzed data from infants born preterm (gestational age <37 weeks) enrolled in the multicenter Kids' Inpatient Database of the Healthcare Cost and Utilization Project who were admitted to the hospital within 30 days after birth. Infants with atrial septal defects were excluded. Of 1 429 762 enrolled infants born preterm, 27 434 (2.0%) with CHDs were included. Overall survival to discharge was 90.5%; 74.0% among infants with critical CHDs and 45.7% among infants with hypoplastic left heart syndrome. Cardiac surgeries were performed in 12.2% of all infants born preterm. Rates of surgical intervention for infants with critical CHDs were lower for very low birth weight (≤1.5 kg) vs larger infants >1.5 kg (27% vs 44%), and only 6.3% of infants born with very low birth weight underwent surgeries in Risk-adjustment for Congenital Heart Surgery categories 4 or greater. Greater birth weight, left-sided lesions, care at children's hospitals, and absence of trisomies were associated with a greater likelihood of surgery. Birth weight <2 kg, nonwhite race, trisomy syndromes, prematurity-related morbidities, and Risk-adjustment for Congenital Heart Surgery category 4 or greater were independent predictors of mortality. Birth weight <2 kg, Risk-adjustment for Congenital Heart Surgery category, morbidities, and sidedness of lesion predicted length of stay. The high survival rates of infants born preterm with CHDs suggests that a cautiously optimistic approach to surgery may be warranted in all but the most immature infants with the greatest-risk conditions.

Role of magnesium sulphate in management and prevention of short term complications of birth asphyxia

Objective: To assess the efficacy of intravenous (IV) magnesium sulphate in treating birth asphyxia and improving short term neurological outcome. Method: A prospective study was conducted in Onake Obavva Women and Children Hospital from February 2015 to March 2016. A sample size of 100 term neonates (50 study group and 50 control group) with perinatal asphyxia were included in the study. Congenitally malformed babies and babies born to mothers who received general anaesthesia, magnesium sulphate and drugs likely to depress the baby were excluded from study. Routine protocol for asphyxiated babies in the neonatal intensive care unit (NICU) was followed in all 100 neonates. In addition, babies in the study group were given IV magnesium sulphate 250 mg/kg/dose within 6 hours of birth, after 24 hours of birth and at 48 hours of birth. During their stay in the NICU all 100 neonates were neurologically assessed. Results: Each group comprised 50 neonates. Seizure control with a single anticonvulsant was significantly greater in the study group compared with the control group (p Conclusions: Postnatal IV magnesium sulphate infusion is effective in improving short term outcomes for infants with perinatal asphyxia when it is given early (within 6 hours). (Keywords: Perinatal asphyxia, neonates, magnesium sulphate, anticonvulsant, hypoxic ischaemic encephalopathy) Sri Lanka Journal of Child Health , 2017; 46 (2): 148-151