bluuebunny/crossref_metadata_2025 huggingface dataset:
Pregnancy and spontaneous delivery in a patient with primary myelofibrosis
Authors: Rehnitz J. , Hochhaus A. , Schaffelder R. , Erben P. , Sütterlin M.
Published: December 2019

Background: Primary myelofibrosis (PMF) is an incurable myeloproliferative disease that affects mainly elderly men and women. Very rarely, PMF may occur in fertile women. In case of an associated pregnancy the disease in itself and the necessary treatment may result in an increased risk for the mother and the fetus. Case: The patient, who was diagnosed with an infantile PMF at age 21, had hepatosplenomegaly since early childhood. She became pregnant at age 35 and had an unexpectedly uneventful pregnancy and spontaneous delivery at term. Conclusion: Despite of the risks reported in literature the interdisciplinary hematological and obstetrical care with close monitoring made a successful pregnancy possible. To our knowledge this is the first report of a successful gestation in a patient with infantile PMF. The uneventful course of this gestation is in contrast to the published risk of complications during pregnancy and delivery in patients with adult PMF.
Use of medical simulation in neonatal-perinatal fellowship training programs
Authors: Johnson L. , Mu T. , Sawyer T.
Published: December 2019

Objective: Simulation-based training is being increasingly used in undergraduate and graduate medical education. There are no prior studies on the use of simulation-based training in Neonatal-Perinatal Medicine (NPM) fellowship programs in the U.S. We conducted this study to evaluate the current use of simulation-based training in these programs. Subjects and methods: An 18 question survey was sent to all NPM fellowship Program Directors in the U.S. The survey contained questions regarding the use of simulation-based training, details on how the training was accomplished and perceived barriers to its use. Results: 62% (60/97) of the programs surveyed responded. Eighty-one percent of responding programs reporting using simulation. Of those, 86% used mannequin-based high-fidelity simulation. The most common uses for simulation training included: neonatal resuscitation skills (86%), procedural skills (71%), airway management (69%), crisis resource management/team training (69%), and professionalism (47%). Most programs are still developing their curriculums and there was a wide range in the amount of time spent on simulation training. Common barriers included time and cost of equipment. Conclusions: The majority of NPM fellowship programs we surveyed used simulation as part of their training and most did so with the use of high-fidelity mannequins. The proportion of programs using simulation for crisis team management and professionalism suggest that these types of training are important component of simulation-based training in addition to the traditional use for resuscitation skills. Further research is needed to determine if simulation-based training in NPM fellowship provides important benefits over traditional teaching methods.
Are serum markers of liver and muscle injury useful in neonatal hypoxic-ischemic encephalopathy?
Authors: Hayes B.C. , Doherty E. , Grehan A. , Madigan C. , McGarvey C. , Mulavany S. , Geary M. , Matthews T.G. , King M.D.
Published: December 2019

Aims: To determine the predictive value of lactate dehydrogenase (LDH), creatine phosphokinase (CPK), and transaminase concentrations in the first 96 hours after birth for grade of encephalopathy and neurodevelopmental outcome. Methods: Peak CPK, LDH and transaminase concentrations were collected in newborns with hypoxic ischaemic encephalopathy in the first 96 hours after birth. Receiver operating characteristic (ROC) curves were constructed and best cut off values were chosen. Children were assessed using a variety of standardised assessments. In children <42 months (n = 78) mean age at assessment was 26.2 months. In children ≥42 months (n = 68) mean age at assessment was 5 years 8 months. Results: The predictive value of LDH, AST, and ALT was of borderline significance (P = 0.046) when used to identify newborns with grade 3 encephalopathy. LDH (5000 U/L) was best for predicting abnormal outcome (sensitivity 50%, specificity 85%) followed by AST (100 U/L)(sensitivity 78%, specificity 59%). CPK was neither sensitive nor specific. LDH (5000 U/L) and AST (100 U/L) both showed a sensitivity of 36% and specificity 98% for the prediction of death or cerebral palsy. Conclusions: Wide interquartile ranges in LDH, CPK and transaminase concentrations in the first 96 hours after birth, limit their use as prognostic markers.
A randomized controlled trial on delayed cord clamping and iron status at 3–5 months in term neonates held at the level of maternal pelvis
Authors: Al-Tawil M.M. , Abdel-Aal M.R. , Kaddah M.A.
Published: December 2019

Background: Delayed umbilical cord clamping (DCC) for two to three minutes after birth, results in substantial transfusion of blood from the placenta to the newborn, thus likely to improve iron status within the first months of life. However, optimal infant position during DCC in relation to mother's pelvis has not yet been determined and this maneuver has been suggested to have substantial risk of neonatal jaundice and cardiopulmonary compromise. Objective: To study the effect of DCC with the infant held at the level of mother's pelvis, compared to early cord clamping on: a) iron status at 3–5 months of age (primary outcome), b) hemoglobin and iron status in immediate postnatal period, and c) potential hazards on neonatal outcome. Methods: This randomized controlled trial was conducted on mother-infant pairs born at term by normal vaginal delivery following uncomplicated low risk pregnancies. Neonates were randomized to early cord clamping, done immediately after birth (≤15 seconds) and DCC (3 minutes after birth), starting from the time of shoulder delivery, with the baby held at the level of mother's pelvis. Both groups were evaluated for hematological parameters mainly, transferrin saturation and serum ferritin at 24 hours and then at 3–5 months postnatally. Results: A total of 180 mother-infants pairs were included; with 90 subjects in each group. At 3–5 months old, infants with DCC had significantly higher serum ferritin (430 vs. 228 ug/L, p < 0.001). Although hemoglobin (Hb) concentration did not differ between groups, DCC group had fewer cases with diagnosed with low serum ferritin (p < 0.001). At 24 hours postnatally, infants with DCC had significantly higher Hb (19.6 vs. 16.8 g/dl, p < 0.001) and hematocrit values (55.8 vs. 51.4%, p < 0.001) compared to early cord clamping group. None of the cases, in either group had respiratory distress or polycythemia in the immediate postnatal period with no significant difference in mean serum bilirubin level on comparing both groups. Conclusion: with the baby held at the level of mother's pelvis, DCC resulted in increased ferritin concentrations and reduced the prevalence of iron deficiency at 3–5 months of age, without demonstrable adverse neonatal effects.
Fetal intestinal perforation and meconium peritonitis associated with maternal autoimmune hepatitis
Authors: Charlagorla P. , Sublett S. , Sy F. , Kessler E. , Gad A.
Published: December 2019

Autoimmune hepatitis (AIH) in pregnancy can affect both fetal and maternal outcomes. Little is known regarding the fetal outcomes of AIH in pregnancy. The major risks include spontaneous abortions, fetal mortality, perinatal mortality and prematurity. Two common drugs used in the management of AIH, azathioprine and prednisone, may also be associated with adverse fetal outcomes. We present the case of perinatal focal intestinal perforation with a meconium pseudocyst in a preterm infant of a mother with autoimmune hepatitis on azathioprine and methylprednisone.
Urinary ascites due to persistent urogenital sinus: A case report and review of literature
Authors: Loganathan P. , Kamaluddeen M. , Soraisham A.S.
Published: December 2019

BACKGROUND: Persistent urogenital sinus is one of the rare urogenital anomalies, which commonly presents as hydrometrocolpos. Fetal urinary ascites as a presentation of persistent urogenital sinus is extremely rare. CASE REPORT: We report on a preterm infant with antenatal diagnosis of hydrometrocolpos and massive urinary ascites secondary to urogenital sinus without any bladder or renal abnormalities. CONCLUSION: This case report emphasizes the importance of maintaining a high index of suspicion in the diagnosis of persistent urogenital sinus especially in infants presenting with urinary ascites along with hydrometrocolpos.
Antenatal hemorrhage of a cervical lymphatic malformation presenting as a draining neck mass: An unusual presentation
Authors: Haricharan R.N. , Nawaz M. , Bettolli M. , Ferretti E.
Published: December 2019

Lymphatic malformations in the neck can present as large fetal neck masses causing airway obstructions with potential perinatal demise and can pose a therapeutic challenge. We present a rare case of prenatally diagnosed large fetal neck mass with features of lymphatic malformation with intralesional hemorrhage of uncertain origin. Postnatal evaluation showed a complex cystic-solid lesion eroding through the skin with an open wound that made it clinically hard to differentiate from a teratoma. Given that malignancy could not be completely ruled out, surgery was favored. Final pathology showed a complex lymphatic malformation with intralesional hemorrhage, despite having no associated capillary, venous or arterial malformations.
Impact of umbilical catheterization on morbidity and mortality in extremely premature newborns
Authors: Oelberg David G. , Baker Ashlynn , Quast Deborah , Worley Leslie
Published: December 2019

OBJECTIVE: Investigate the benefit of umbilical catheterization upon survival and selected morbidities in extremely premature newborns (<28 weeks gestation). Outcomes of successfully catheterized extremely premature newborns are compared with others who cannot be successfully catheterized, and we hypothesize that umbilical catheterization promotes survival and reduces morbidities. STUDY DESIGN: Utilizing a retrospective, cohort study design, survival and outcomes of catheterized and non-catheterized newborns (n = 722) were compared by univariate and multiple logistic regression analyses. RESULTS: Of all newborns, 66.8% had both umbilical arterial catheter (UAC) and umbilical venous catheter (UVC) placements, 15.0% had only UAC, 13.7% had only UVC, and 4.6% had neither. Overall survival was 82.5%. Survivals with and without UAC were 82.5% and 82.6% (NS), but survival with UVC was 80.7% versus 90.1% without UVC (p = 0.012). Analysis of risk factors associated with death during umbilical catheterization reaffirmed that death remained significantly dependent upon UVC placement (OR = 35.7; 95% CI: 3.7–347.3, p = 0.002). CONCLUSION: Successful umbilical catheterization of extremely premature newborns does not provide benefit through promotion of survival or reduction of morbidities when compared to others who are not successfully catheterized at the umbilicus.
Plasma biomarkers and echocardiographic indices of left ventricular function in very low birth weight infants
Authors: Perugu S. , Rehan V.K. , Chow S.L. , Baylen B.
Published: December 2019

OBJECTIVE: Evaluate plasma markers of myocardial function and ischemia [B-type natriuretic peptide] (BNP) and cardiac troponin T (cTnT)] in relationship to echocardiographic indices of left ventricular (LV) function and severity of illness score (SNAPPE-II) in Very-Low-Birth-Weight-Infants (VLBWIs) prospectively. STUDY DESIGN: Serial echocardiography studies, clinical data, BNP and cTnT were obtained in thirty VLBWIs on postnatal days 1, 2, 3 and 7. RESULTS: BNP increased and cTnT decreased significantly day 1 through 3. BNP was significantly associated with patent ductus arteriosus (PDA), but did not correlate with LV function or cTnT and did not reflect use of inotropic medication. Cardiac troponin T increased with severity of illness, SNAPPE-II, score and was highest in babies receiving inotropic medication; Low cardiac output (CO) was common in the first seventy two hours and correlated negatively with cTnT (p < 0.01). A contractility index, the corrected LV mean velocity of circumferential fiber shortening, (mVcfc) was not related to cTnT. The LV mVcfc was inversely related to LV end systolic wall stress (p < 0.001) in all subgroups, and this index of contractility (mvcfc-ess) did not differ with large caliber PDA or use of inotropic medication. CONCLUSION: Cardiac troponin T exclusively rather than a combined biomarker approach may be useful in assessing myocardial injury. Cardiac output was low in sick VLBWIs with myocardial ischemia. Left ventricular contractile state was apparently preserved in significantly ill babies with elevated cTnT. Further research is needed to define the complex relationship between biomarkers and echocardiographic indices.
Variation and comparative effectiveness of patent ductus arteriosus pharmacotherapy in extremely low birth weight infants
Authors: ElHassan N.O. , Bird T.M. , King A.J. , Ambadwar P.B. , Jaquiss R.D.B. , Kaiser J.R. , Robbins J.M.
Published: December 2019

BACKGROUND: Patent ductus arteriosus (PDA) occurs in 70% of extremely low birth weight (ELBW, birth weight <1000 g) infants. Approximately 34% of ELBW infants with a PDA have spontaneous closure. Failure of the ductus arteriosus to close has been associated with multiple morbidities. OBJECTIVE: To examine variability over time and across hospitals in early therapeutic (2–7 day) use of indomethacin (INDO) vs ibuprofen (IBU) for PDA treatment in outborn ELBW infants and examine the outcomes and side effects of both pharmacological agents in this population. METHODS: Data were extracted from the Pediatric Health Information System. ELBW infants born between January 1, 2007 and December 31, 2010 and admitted on day of life 0 were eligible for inclusion. 732 infants had a PDA diagnosis and met inclusion criteria. We explored the variability in PDA pharmacotherapy over time and across hospitals. We compared outcomes of both agents for in-hospital mortality, need for surgical ligation, intraventricular hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia, periventricular leukomalacia, renal failure, and persistent pulmonary hypertension. Statistical methods included chi square and multivariable regression analysis. Instrumental variable analysis was used to control for selection bias and omitted variables. RESULTS: There was large variability in PDA pharmacotherapy over time and across hospitals. INDO use declined as IBU use grew from 12.8 to 38.9%. There was no difference in hospital or NICU characteristics between high and low IBU using NICUs. Renal failure was more common in infants receiving INDO compared to IBU. CONCLUSION: We noted large variability in PDA pharmacotherapy. Renal failure was more common with INDO use. Until further studies to compare the long-term effects of both drugs, our data support IBU as the preferred medication for PDA pharmacotherapy in ELBW infants.
Transporting neonates with hypoxic-ischemic encephalopathy utilizing active hypothermia
Authors: Weiss M.D. , Tang A. , Young L. , Irwin L. , Brophy C. , Larsen V. , Howard J. , Miller C. , Douglas-Escobar M.
Published: December 2019

OBJECTIVE: The objective of this report was to evaluate a servo-controlled active hypothermia device used during the transport of neonates with HIE. STUDY DESIGN: Retrospective review of all cases of therapeutic hypothermia, both passive and active, using a servo-controlled device in a single regional referral neonatal intensive care unit from 2009-2013 RESULTS: An ambulance (43%), fixed wing aircraft (25%), or helicopter (32%) transported 28 neonates with active hypothermia. The servo-controlled device captured core temperatures in all 28 neonates, resulting in 2,985 minutes of data. All neonates attained a core temperature between 33-34 °C by 33 minutes of the transport. Once the neonates attained a core temperature, the average temperature for the remainder of the transport was 33 ± 0.2 °C. The neonates maintained the core temperature regardless of the type of transport vehicle. CONCLUSION: Servo-controlled hypothermia enables rapid attainment of targeted temperatures and maintains the temperature throughout the transport process in both ground and air transport.
Optimal temperature for whole-body hypothermia in the newborn: An in vitro study using foreskin mitochondrial oxygen consumption
Authors: Al Zaabi A. , Rahmani A.Y. , Souid A.
Published: December 2019

OBJECTIVES: Whole-body hypothermia (to 33.5 ± 0.5°C) is a therapeutic modality that reduces risks of death and neurodevelopmental disability in neonates subjected to hypoxic-ischemic insults. This in vitro study was designed to determine changes in neonatal cellular metabolism with temperature. Its main aim was to compare the metabolic rate at ≤33°C with that at ≥35°C. STUDY DESIGN: Foreskin specimens were used as a source of neonatal tissue. Cellular respiration (mitochondrial O2 consumption) was used as a surrogate biomarker for the metabolic rate. Foreskin specimens from healthy newborns were collected immediately after circumcision and processed within one hour for measuring the rate of O2 consumption at various temperatures (±0.5°C). O2 consumption was determined as function of time from the phosphorescence decay of Pd (II) meso-tetra-(4-sulfonatophenyl)-tetrabenzoporphyrin. RESULTS: In a vial sealed from air and containing foreskin specimen in phosphate-buffered saline supplemented with 5 mM glucose, [O2] decreased linearly with time, confirming its zero-order kinetics. The rate of O2 consumption (μM O2.min−1), thus, was the negative of the slope of [O2] vs. time. Cyanide inhibited O2 consumption, confirming the oxidation occurred in the respiratory chain. Cellular respiration at ≤33°C (n = 25) significantly differed from that at ≥35°C (n = 24), p < 0.001. The rate (μM O2.min−1.mg−1) at 25°C was 0.034 ± 0.006 (n = 11, p = 0.044), at 33°C was 0.029 ± 0.008 (n = 14, reference temperature), at 35°C was 0.062 ± 0.020 (2-fold higher, n = 18, p < 0.001), and at 37°C was 0.061 ± 0.009 (2-fold higher, n = 6, p < 0.001). CONCLUSIONS: Neonatal foreskin cellular respiration is highly sensitive to critical temperatures (33°C vs. 35°C).
Association of packed red blood cell transfusion and necrotizing enterocolitis in very low birth weight infants
Authors: AlFaleh K. , Al-Jebreen A. , Baqays A. , Al-Hallali A. , Bedaiwi K. , Al-Balahi N. , AlGhamdi A. , AlKharfi T. , Alzahem A.
Published: December 2019

OBJECTIVE: To investigate the association of PRBC transfusion and the development of NEC in VLBW preterm infants at a tertiary care neonatal unit. METHODS: A retrospective case-control study was performed. All VLBW infants (gestational age ≤32 week and birth weight <1500 g) born between 1999 and 2013 were included. Cases and controls were divided into four groups: (1) Infants who received PRBC transfusion and developed NEC within 48 hours of transfusion; (2) Infants who received PRBC transfusion and did not develop NEC; (3) Infant who developed NEC and did not receive PRBC transfusion; and (4) Infants who neither developed NEC nor received PRBC transfusion. Our primary outcome was the association of PRBC transfusion with the development of severe NEC. RESULTS: One hundred fifty two VLBW infants were enrolled. The mean birth weight of enrolled infants was 1042 g and a mean gestational age of 28 weeks. The included four groups were not statistically different with regard to baseline important variables. Infants who had NEC and received PRBC transfusion (group 1) had higher incidence of sepsis and severe retinopathy of prematurity. Overall, Infants who received PRBC transfusion had a lower incidence of NEC (OR 0.39, 95% CI: 0.18,0.84, p = 0.02). CONCLUSION: We observed a lower association of PRBC transfusion and severe NEC in VLBW infants. Prospective, randomized well powered studies are needed to confirm our findings.
A comparison of supine and prone positioning on improves arterial oxygenation in premature neonates
Authors: Eghbalian F.
Published: December 2019

BACKGROUND: Respiratory distress syndrome (RDS) is one of the most important causes of mortality and morbidity in premature newborns. The aim of this study was to determine the effect of body position on oxygen saturation in hospitalized premature infants with RDS. METHODS: From June 2010 to December 2012, 69 premature infants with RDS were evaluated in an interventional analytic study. Patients had a mean gestational age (±SD) of 31.4 (±2.41) weeks (range: 28–35 weeks) with a mean birth weight (±SD) of 1446.6 (±218.90) grams (range: 850–2400 grams). Infants were studied both in supine and in prone positions. Oxygen saturation was monitored by trans-cutaneous pulse oximeter and oxygen saturation was continually monitored for 3 hours in each position and mean oxygen saturation was calculated at the end of each 3 hour period. All patients were premature, NPO, oxygen dependent and had RDS. The range of the postnatal age of the studied infants was 24–48 hr. RESULTS: Means (±SD) of oxygen saturation during 3 hours in prone and supine positions were 92.54% (±2.24%) and 91.78% (±2.35%), respectively (p = 0.001). Also means (±SD) of oxygen saturation at the end of each 3-hours period prone and supine positions were 91.30% (±2.42%) and 90.30% (±3.15%), respectively (p = 0.006). CONCLUSION: These findings suggest that, in premature infants with RDS, oxygen saturation was significantly higher in the prone compared with the supine posture.
Amplitude integrated EEG in very low birth weight infants exposed	to preterm infant massage
Authors: Massaro An N. , El-Dib Mohamed
Published: December 2019

Objective: To describe our experience with the use of aEEG as a measure of brain maturity in preterm neonates involved in a randomized controlled trial of infant massage.

Study design: This is a prospective observational study from a subset of patients who were recruited in a randomized controlled trial evaluating the effects of massage in very low birthweight (VLBW) infants. Infants included in this report had an aEEG recording at 34 weeks post-menstrual age (PMA). aEEG recordings were evaluated by an investigator who was blinded to subjects' clinical history and study group. Each infant was assigned scores for continuity, sleep wake cycling, amplitude of lower border, bandwidth span, and overall aEEG maturation. Differences in scores between intervention and control groups are described.

Results: Twenty-six VLBW infants had aEEG recordings at 34 weeks PMA; 13 who received massage and 13 in the control group. Twenty three percent of patients in the control group had a somewhat discontinuous aEEG, whereas all patients in the intervention group had a continuous aEEG. Overall maturation scores were delayed in 15% of massage group vs. 38% in control group. Both groups had similar sleep-wake cycle patterns.

Conclusion: aEEG may be a useful tool to evaluate interventions hypothesized to have neurobehavioral effects on preterm infants such as massage therapy. Further studies that evaluate aEEG maturation and other neurodevelopmental outcomes in neonates exposed to preterm infant massage are needed.
Terlipressin as rescue therapy for amine-resistant shock in	premature infants: A report on two cases
Authors: López-Suárez O. , Pérez-Muñuzuri A. , Crespo-Suárez P. , Fernández-Lorenzo J.R.
Published: December 2019

Terlipressin, a synthetic analogue of vasopressin, has been employed successfully against amine-resistant septic shock in both adults and children, including an 8-day-old infant. There have been no previous reports of its administration to premature infants. We report here on its compassionate use to treat two premature neonates with hypotensive shock that resisted volume replacement and amine therapy.
Tracheal agenesis with multiple congenital anomalies
Authors: Ali K. , Chandrasekaran M. , Mukherjee and S. , Sharief N.
Published: December 2019

Tracheal agenesis, though seemingly rare and fatal to date, has been reported with increasing frequency. It presents shortly after delivery as severe respiratory distress, absence of audible cry and impossible endotracheal intubation. Attempts to save these children have failed to permit survival although slight prolongation of life was achieved in some. We report a case of tracheal agenesis in a preterm infant associated with other organ malformations. The literature on tracheal agenesis is discussed.
Deviation of naso-gastric tube on frontal chest radiograph: A	marker of left atria enlargement in babies with ductus arteriosus
Authors: Sehgal Arvind , Kumbla Surekha , Jolley Damien , Ramsden Andrew
Published: December 2019

Background: Presence of a hemodynamically significant ductus arteriosus is common in preterm infants and left atria enlargement is used as a surrogate marker. Cardiothoracic ratio may not be a reliable indicator of left atria enlargement given its posterior location.

Aims: To assess the ability of angle of naso-gastric tube deviation to discriminate between babies with and without a hemodynamically significant ductus arteriosus.

Methodology and data analysis: Retrospective chart review and radiographic measurements of frontal chest radiographs for babies with hemodynamically significant ductus arteriosus that was proven by echocardiography (ECHO) (Group I) compared with individually matched babies with no hemodynamically significant ductus arteriosus matching on corrected gestation age. Unrotated frontal chest radiographs done within 72 hours of echo and gestational age matched frontal chest radiographs for Control (Group II) were assessed for measurements of angle of naso-gastric tube deviation and carinal angle by digital imaging technique.

Results: A total of 32 babies were enrolled in each group. Mean naso-gastric tube angle was significantly greater in babies from group I, with average difference 4.5° (95% CI 3° to 6°. Angle greater than 9° increased the odds of being a Group I baby (Odds ratio 25.9, 95% CI 3.4–198).

Conclusions: Measurement of naso-gastric tube angle deviation may be helpful in babies with hemodynamically significant ductus arteriosus and left heart volume overload.
Infant resuscitation outside the delivery room in	neonatal-perinatal and pediatric critical care fellowship programs: NRP or	PALS? Results of a national survey
Authors: Sawyer Taylor , Clark Aaron , Ridout Robert
Published: December 2019

Introduction: Infant cardiopulmonary resuscitation outside the delivery room can follow one of two national guidelines: Neonatal Resuscitation Program (NRP), or Pediatric Advanced Life Support (PALS). Important differences exist between NRP and PALS guidelines. There are no published recommendations concerning the chronologic age at which to change from NRP to PALS guidelines. This study was designed to investigate current resuscitative practices outside the delivery room for infants cared for in Neonatal-Perinatal (N-P) and Pediatric Critical Care (PCC) medicine fellowship programs with regard to the use of NRP or PALS guidelines.

Methods: Surveys were mailed to the program director of all one hundred fifty-eight ACGME accredited N-P and PCC medicine fellowship programs in the US. The survey included questions regarding the existence of written resuscitative policies for infants regarding the use of PALS versus NRP, provider certification requirements in NRP and PALS, resuscitation leadership, and the age after birth at which infants are resuscitated using PALS rather than NRP guidelines.

Results: Of the 158 programs surveyed, 98 responded (62%). Of those responding only one center (1%) reported having a written policy concerning the use of NRP versus PALS. Significant differences were seen in provider certification requirements in NRP and PALS. There were significant differences in the time to change from NRP to PALS guidelines between responding N-P programs and PCC fellowship programs. None of the responding PCC programs reported using NRP guidelines past two months of age, while 35% of N-P programs continued to resuscitate infants using NRP guidelines up to 1 year of life. Twenty seven percent of responding N-P programs reported using "NRP only" for infant resuscitation.

Conclusions: We found no consensus regarding the age at which infants are resuscitated with PALS rather than NRP in responding N-P and PCC fellowship programs. Our findings suggest that compared to infants cared for under the supervision of physicians in PCC medicine fellowship programs, infants cared for under the supervision of physicians in N-P medicine fellowship programs are much more likely to be resuscitated using NRP guidelines. While it is unclear if this variation in clinical practice has a significant effect on outcomes, this variation in practice makes it difficult to define the current standard of care for infant resuscitation in N-P and PCC fellowship programs and requires further investigation.
Clinical availability of neonatal blood culture results at 48	hours
Authors: d'Haens E.J. , Roell-Schorer E.A.M. , van Elzakker E.P.M. , de Beaufort A.J. , Sprij A.J.
Published: December 2019

Background/aim: To minimize the use of antibiotics in the neonatal unit, it is crucial to know the time needed for a blood culture to become positive. With the development of newer automated blood culture systems, the time needed to detect a positive culture is said to be reduced to 48 hours. The aim of this study was to determine the time at which neonatal blood culture results become clinically available to the attending neonatologist.

Design and methods: In an eighteen-months-period prospective study we collected 361 blood cultures from neonates admitted to our neonatal unit. Time to positivity (TTP) (the time between culture sampling and the moment the neonatologist received the results) was determined. Incubation time (time actually spent in the Bactec machine) was automatically registered.

Results: 72 out of 361 blood cultures were positive (20%). 93% (67/72) of the positive cultures had a TTP of less than 48 hours. One sample had a TTP of 50 and one of 53 hours. Three samples had an incubation time of more than 94 hours. A total of 99% (68/69) of the remaining cultures were positive within 30 hours of incubation.

Conclusion: This study demonstrated that 93% of blood cultures results are determined by 48 hours. Incubation time in the Bactec is consistent with reliable detection of pathogen microbes by 30 hours. If effort is made to improve logistics TTP can further be reduced to 30 hours resulting in further reduction of antibiotic usage in neonatal intensive care units.
The interindividual variability in metabolism of the analgesic	tramadol in neonates is independent of their disease state	characteristics
Authors: Allegaert Karel , van den Anker John N. , Verbesselt Rene , Rayyan Maissa , Debeer Anne , de Hoon Jan
Published: December 2019

Objective: To investigate the impact of disease characteristics on the interindividual variability of O- and N-demethylation of tramadol in neonates.

Methods: Tramadol (M), O-demethyl tramadol (M1), $N$-demethyl tramadol (M2), log M/M1 and log M/M2 were assessed in 24 hours urine collections during intravenous tramadol. Correlations with postnatal (PNA) and postmenstrual age (PMA), disease state characteristics [cardiopathy, (cardiac) surgery, small-for gestational age (SGA)] and CYP2D6 activity score were investigated.

Results: Collections were available in 67 neonates. The mean log M/M1 was 1.01 (SD 0.63). Inverse relationships between log M/M1 and PMA, PNA and CYP2D6 activity score were observed. Median log M/M1 in early life (< day 8) was higher compared to late neonatal life (day 8–28) (p < 0.01). In a multiple forward regression model, PMA and CYP2D6 activity score remained independent variables. The mean log M/M2 was 1.71 (SD 0.46). Inverse relationships between log M/M2 and PMA and PNA were observed. Median log M/M2 in early life was higher compared to late neonatal life (p < 0.01). In a multiple forward regression model, PMA and PNA remained independent variables.

Conclusions: Extensive interindividual variability in demethylation metabolic activity was observed. O-demethylation was in part explain by PMA and CYP2D6 activity score, N-demethylation by PMA and PNA while disease characteristics had no impact of demethylation activity.
Neonatal lead intoxication following maternal pica: A case report	and review of the literature
Authors: Vasquez Margarita M. , German Victor F. , Scott Anthony A. , Foulds D. Michael , Blanco Cynthia L.
Published: December 2019

Pica is a significant risk factor for lead exposure during pregnancy and may often go unrecognized. Lead exposure in the pregnant woman may be extremely toxic to the fetus due to unencumbered transport across the placenta. Long term neurological effects of in utero and neonatal lead exposure are largely unknown, and the efficacies of current therapies are controversial. We report a case of a pregnant woman with elevated blood lead levels secondary to pica that was not identified by a routine screening survey. Her full term baby girl had a blood lead level of 70.8 μg/dL. Neonatal therapy with double-volume exchange transfusion followed by a 3 day course of intravenous Edetate Calcium Disodium is described as well as the slow steady decline of her blood lead levels. Neurocognitive development to 18 months is also reported.
Portal venous gas as the first presenting radiological feature of	impending fulminant NEC in ELBW infants
Authors: Christodoulou Loucas , Mannan Khalid , Chow Peter , Godambe Sunit V.
Published: December 2019

Portal venous gas (PVG) is an ominous radiological sign in infants with necrotising enterocolitis (NEC). It usually presents as a sign of severe disease. We report two cases of extremely low birth weight (ELBW) infants who presented with PVG as an initial radiological finding of NEC, before evolvement of clinical features. Both progressed to fulminant NEC and required surgical intervention within a short span of the appearance of PVG. One baby died of fulminant NEC and the other survived. These cases highlight the fact that isolated PVG can be a primary radiological sign of impending fulminant NEC.
Effects of nasal continuous positive airway pressure on pulmonary	and systemic output in preterm infants
Authors: Di Bernardo Stefano , Sekarski Nicole , Tolsa Jean-François
Published: December 2019

Objective: Respiratory assistance with nasal continuous positive airway pressure (n-CPAP) is an effective treatment in premature newborns presenting respiratory distress. The aim of the study was to depict cardiac function, systemic (Qs) and pulmonary output (Qp) by echocardiography in stable premature infants requiring prolonged n-CPAP. Our hypothesis was that n-CPAP could reduce pulmonary blood flow.

Patients and methods: All premature infants < 32 weeks gestation, > 7 days-old, requiring n-CPAP without severe respiratory compromise nor need for additional oxygen were prospectively included. Every patient had a first echocardiography while on n-CPAP. N-CPAP was then discontinued for two hours and a second echocardiography was performed.

Results: 17 premature infants were included. Mean gestational age was 28 ± 2 weeks and mean weight 1.1 ± 0.3 kg. Following retrieval of n-CPAP we observed an increase in Qp of 53 ml/kg/min (95% CI 19–87 ml/kg/min), but no significant change in Qs. Consecutively a significant increase in Qp/Qs ratio of 16% was found (95% CI 7–29%).

Conclusions: Nasal continuous positive airway pressure has hemodynamic effects in preterm infants in stable pulmonary and cardiac conditions. It reduces pulmonary output without interference with systemic output.
Cystic abdominal malformations in the fetus and newborn
Authors: Krcho Peter , Janeski Bore , Dankovčík Róbert , Donn Steven M.
Published: December 2019

We report the case of a preterm newborn with a large cystic abdominal mass diagnosed prenatally, which caused respiratory impairment at birth. The mass was an ovarian cyst and was successfully excised on the second postnatal day. We review cystic abdominal masses in the fetus and newborn from diagnostic and therapeutic viewpoints.
Whole body hypothermia using a portable cooling unit in a neonatal	pig model: Implications for transport
Authors: Rabenstein Eric , Tyree Melissa , Dirnberger Daniel , DiGeronimo Robert
Published: December 2019

Background: Recent studies demonstrate a neuroprotective effect of therapeutic hypothermia following newborn hypoxic-ischemic encephalopathy; however, initiation of cooling must begin within 6 hours of birth. Evidence from animal models suggests that the earlier treatment is begun, the more efficacious hypothermia is in preventing brain injury. Unfortunately, timely initiation of therapy is often practically difficult to achieve for outborn neonates. Currently, there is no standardized methodology to safely initiate and regulate hypothermia during neonatal transport.

Methods: This study evaluated the effectiveness of the Electri-Cool II Cold Therapy Unit (Cincinnati Sub-Zero®) to induce and regulate mild whole body hypothermia (33.5°C) in a neonatal porcine model. Seven healthy neonatal piglets (2–3.5 kg) were initially allowed to passively cool from baseline in an open air isolette over 1 hour. Following this, animals were rewarmed to baseline (if necessary) and then actively cooled to 33.5°C using the Electri-Cool II. Once the target temperature was achieved, temperature was closely monitored using rectal and skin temperature probes over the next 1 hour.

Results: None of the study animals significantly lowered their temperature from baseline during the passive cooling period. By comparison, piglets actively cooled with the Electri-Cool II reached 33.5°C in a mean of 38 ± 19.7 minutes. Once at target temperature, hypothermia was maintained in the piglets with minimal average variation (0.3 ± 0.1°C) for the duration of the active study cooling period.

Conclusion: The Electri-Cool II is superior to passive cooling for inducing and maintaining mild whole body hypothermia in a neonatal piglet model. Further evaluation of this device to include its potential utility during transport of newborn infants is warranted.
Peripherally inserted central catheter inserted from the lower	extremity veins: Catheter tip placement
Authors: Hoang Viet , Sills Jack , Clifton-Koeppel Robin , Modanlou Houchang D.
Published: December 2019

The lower extremity veins are less utilized for the insertion of central catheter for prolonged venous access and the provision of total parenteral nutrition. We compared the complication rates for catheters inserted from the lower extremity veins in relation to their tip placement. During a 48-month period, 90 catheters inserted from the lower extremity veins were identified and their tip placement was documented. Catheter tips were placed in the upper portion of the inferior vena cava below the right atrium in 65, and just above or below the renal veins in 25. Data was analyzed for gestational age, birth weight, duration of catheters in place, duration of total parenteral nutrition, complications, necrotizing enterocolitis, serum direct bilirubin, liver enzyme, serum creatinine, length of hospitalization, and survival rate.

The median birth weight and gestational age, duration of catheter in place, duration of total parenteral nutrition infusion were similar between the two groups. Catheter related infections, occlusions, phlebitis, and leakage; necrotizing enterocolitis, intraventricular hemorrhage, serum direct bilirubin, liver enzyme and serum creatinine were also similar between the two groups.

We suggest that the lower extremity veins inserted catheters, with their tips at a lower position of the inferior vena cava may be as safe as those with their tips at the upper part of the inferior vena cava below the right atrium.
Multicenter investigation of prophylactic phenobarbital on	intraventricular hemorrhage in premature infants in China
Authors: Chen Hui-Jin , Wei Ke-Lun , Yao Yu-Jia , Yang Yu-Jia , Zhou Cong-Le , Fan Xiu-Fang , Gao Xi-Rong , Jiang Lian , Liu Xiao-Hong , Qian Ji-Hong , Wang Li , Wu Ben-Qing , Wu Gao-Qiang , Zhang Qing-Mei , Zhang Xiao-Lan , Zhou Xiao-Yu
Published: December 2019

Objective: The prophylactic use of phenobarbital for the prevention of intraventricular hemorrhage (IVH) in premature infants remains controversial. In order to objectively assess the effect of phenobarbital on IVH, nine large-scale hospitals participated in a nearly two year investigation of brain injuries in premature Infants in China.

Study Design: All premature infants with gestational age less than 34 weeks in three hospitals and less than 37 weeks in two other hospitals received intravenous phenobarbital (loading dose of 20 mg/kg) as early as possible before 6 hours of age. A maintenance dose of 5 mg/kg daily was given 24 hours after the loading dose and continued for 5 days. Premature infants in 4 other hospitals did not receive phenobarbital. All infants in nine hospitals were subjected to routine cranial ultrasound scanning within seven days after birth, and then repeated every 3∼7 days until discharge. The study period lasted from Jan. 2005 to Aug. 2006.
High altitude and microtia in Ecuadorian patients
Authors: González-Andrade Fabricio , López-Pulles Ramiro , Espín Víctor H. , Paz-y-Miño César
Published: December 2019

Objective: To examine the relationship between high altitude and microtia in Ecuador.

Methods: We evaluated the epidemiological issues of 1298 cases of microtia reported in Ecuador from 2001 to 2007. It used data arising from the Vital Statistics National Reports: Annual Survey of Admissions and Discharges in this 7 year period. The register is national and population based, run and funded by the government.

Results: It reported a total of 1298 cases of microtia out of 34654 cases of congenital malformations described in the registries. The overall prevalence was 2.38/10000 admissions/discharges calculated out of 5462263 admissions. An overall percentage (of 90.22%) were admitted before 19 years of age with the most prevalent group between 5 to 9 years of age (31.90%). There was progressive increase of cases every year; from 132 cases in 2001 to 304 in 2007. Total male cases in this study were 723 (55.70%) and female cases were 575 (44.30%). Tungurahua reported the highest prevalence of 18.31/10000 births, followed by Chimborazo, Azuay, Pichincha and Cotopaxi; all of them located over 2500 meters above sea level. It found that highest prevalence was 10.21 over 2700 meters above sea level followed by 8.28 over 2800 meters above sea level; with both having a cumulative prevalence of 8.81.

Conclusion: There is a higher prevalence of microtia in patients living above 2500 meters above sea level. This study was not able to establish a clear relationship between microtia and different ethnic groups.
Time limits for a failed response to inhaled nitric oxide in	newborn infants with persistent pulmonary hypertension: A retrospective	observational study
Authors: Salama Husam , Adlburaki Wissam , Ibrahim Amani Saeed , Lutfi Samawal , Magzoob Nawal
Published: December 2019

Background: The onset of response to inhaled nitric oxide (INO) vary in the literature. It is important to identify non responders from those who respond to the INO in order to formulate management plans.

Objective: To define a time limit for the acute effects of inhaled nitric oxide (INO) on systemic oxygenation beyond which the response to the inhaled therapy is unlikely to take place in sick newborn infants suffering from persistent pulmonary hypertension.

Methods: This study was a hospital-based retrospective chart review. All infants who received INO for the treatment of pulmonary hypertension with acute sever hypoxemic respiratory failure over a period of four years were analyzed using the oxygenation index (OI) as an indicator for starting the therapy and following the response for total period of gas exposure. The OI was measured before and every one to six hours after initiating the therapy. The starting time of the gas, timing of first response, course of responses, blood gases, calculated OI before, during, and after initiation of the gas were also recorded until INO was discontinued.

Results: Seventy-six infants were studied: 35 infants were born at 24 to 32 weeks gestation age, and 41 at 33 weeks gestation to full term. Mean duration time of exposure to INO was 53 hours in the preterm group and 84 hours in the near and full term group. The mean age at starting the therapy was 59 hours in the preterm group and 23 hours in the near and full term group. The degree of response to INO was as follows: 52.2% full response, 27.5% partial response, and 20.3% no response. The first two (2) hours contained the highest number of responders, 64%; while the response was 15% in the second two hours. No responders were recorded after eight hours of exposure.

Conclusion: Exposure to INO for eight (8) hours could be carefully considered as a time limit to determine the type of response to such gas and to help in making a decision of ``wean to discontinue'' in non-responders.
Anterior thoracic myelocystocele: Antenatal diagnosis
Authors: Rohilla Seema , Sen Jyotsna , Yadav Rohtas K. , Jain Sandeep , Dhaulakhandi Dhara B.
Published: December 2019

Anterior myelocystocele has not been reported previously. Our case showed anterior herniation of myelocystocele sac. This challenges the established hypothesis of Steinbock and Cochrane which holds partial neural-epidermal adhesion responsible for drawing the neural tissue outwards towards the skin. This cannot explain occurrence of anterior myelocystocele as there is no neural-epidermal adhesion anteriorly at any stage of embryogenesis. Myelocystoceles need to be differentiated from meningoceles as early as possible (preferably prenatally) due to different surgical treatments and possibility of fetal intervention.