bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improved perinatal and very low birth weight infant outcomes	following neonatal and perinatal regionalization in a rural setting
Authors: Hadeed Anthony J. , Neufeld Michael D. , Jackson J. Craig 
Published: December 2019

Objective: To evaluate the changes in outcome that occurred during implementation of a comprehensive outreach program to five level I newborn care facilities, by one level III neonatal intensive care unit in rural WA State. Study design: Standardized outreach educational programs were provided. Outcome measures were assessed by collecting monthly perinatal and postnatal data on 61,551 births. Three six-year periods were defined. Period I (1988–1994) was compared with period II (1994–2000) and period III (2000–2006). Results: Comparing the averages for the three periods, there was a statistically significant increase in maternal transports from level I hospitals, and significant decreases in early-onset sepsis, meconium aspiration syndrome, low Apgar scores, major congenital malformations, neonatal and perinatal mortality rates, very low birth weight (VLBW) infant mortality, chronic lung disease and duration of hospital stay (all p< 0.001). Conclusion: A successful regionalization of perinatal service in rural areas can be accomplished by establishing extensive outreach programs. This model can be utilized to improve perinatal, neonatal and VLBW infant outcomes.
Do beractant dosing intervals make a difference?
Authors: Attar Mohammad A. , Hieber Susan M. , Lieberman Kathleen E. , Donn Steven M. 
Published: December 2019

Introduction: Surfactant dosing in extremely premature infants is not based on rigorous human pharmacokinetic data. Beractant (Survanta®) is an animal-derived surfactant. The manufacturer's package insert suggests a dosing interval of "no sooner than 6 hours" after a preceding dose. Other animal-derived surfactant preparations are commonly dosed at 12 hour intervals. We evaluated Survanta use following a change in the re-treatment dosing interval from no less than 6 (Q6 h) to no less than 12 hours (Q12 h) in June 2007. Method: We used a retrospective comparison of two cohorts, Q6 h and Q12 h, born at <31 weeks' gestation or with birth weights < 1100 grams treated with Survanta for respiratory distress syndrome (RDS). Infants could receive up to 4 doses, if clinically indicated. Results: Infants in the Q12 group (n=77) and the Q6 group (n=140) had similar birth weight (mean ± SD; 1079 ± 351 vs. 1117 ± 326 g, p=0.44), birth in a tertiary center (inborn) (84% vs. 84%, p=1.0), prenatal treatment with steroids (88% vs 81%, p=0.17), Cesarean section delivery (78% vs. 73%, p=0.51), and singleton birth (64% vs. 62%, p=0.93). However, infants in the Q12 group had a slightly lower gestational age (mean ± SD; 27 ± 2 vs 28 ± 2 wk, p=0.014) and had a higher proportion of male infants (62% vs 48%, p=0.047.The Q12 group also had a higher but not statistically significant proportion of white infants (82% vs. 69%, p=0.053) than the Q6 group. Infants in the Q12 group received fewer surfactant doses per patient (mean ± SD; 1.91 ± 0.54 vs. 2.11 ± 0.63, p=0.018) and less frequently received more than two doses of surfactant (8% vs. 21%, p=0.012) compared to the Q6 group. The Q12 and the Q6 groups had similar rates of chronic lung disease (CLD) (23% vs. 18%, p=0.25), death (18% vs. 14%, p=0.44), duration of mechanical ventilation (mean ± SD; 21 ± 21 vs. 18 ± 25 days, p=0.477), and total hospital length of stay (mean ± SD; 58 ± 39 vs. 59 ± 33 days, p=0.94). Conclusions: Administering Survanta to premature infants at 12 hour intervals was associated with using less surfactant to treat RDS compared to dosing at 6 hour intervals and similar measured respiratory parameters, including duration of hospitalization and mechanical ventilation and rates of death and CLD. We speculate that using a longer Survanta dosing interval would also result in significant cost savings.
Amikacin-heparin lock for prevention of catheter-related	bloodstream infection in neonates with extended umbilical venous catheters use:	A randomized controlled trial
Authors: Seliem Wael , Abdel-Hady Hesham , El-Nady Ghada 
Published: December 2019

Objective: To ascertain the safety and the efficacy of amikacin-heparin lock technique in the prevention of catheter-related-bloodstream infection (CRBSI) in neonates with extended umbilical venous catheters (UVCs) use and to determine the applicability of keeping UVCs in situ for 14 days. Methods: A randomized controlled – blind trial was conducted on neonates who were expected to require UVC for at least 48 hours. Babies were randomized to have the catheter locked twice daily for 20 minutes either with heparinized normal saline (n=42) or heparinized saline containing amikacin 1.5 mg/mL (n=41). The blood glucose level was measured at the end of indwelling time and any episode of hypoglycemia was recorded. Doppler ultrasound was performed for the umbilical, portal and inferior vena cava veins. Surveillance cultures were taken from enrolled patients' skin to detect colonization by amikacin-resistant organisms. The UVCs were removed whenever their use was deemed unnecessary or at the 14th day after insertion. Results: There were 4 CRBSI episodes (definite, probable) in amikacin-heparin lock group and 12 episodes in the saline-heparin lock group [RR: 0.34; 95% CI: (0.02–0.65); p=0.01]. Density incidence of CRBSIs was 3.6 per 1000 catheter days in amikacin-heparin lock group and 18.4 per 1000 catheter days in saline-heparin lock group [RR: 0.19 CI: (0.08–0.67), p= 0.02]. No amikacin-resistant organisms were recovered from any of the cultures. Transient asymptomatic hypoglycemia occurred in 13 (15.6%) neonates at the end of catheter-lock period. No portal or inferior vena cava thrombosis was detected in any of our babies. Conclusions: Amikacin-heparin lock reduced the incidence of CRBSI in neonates with extended UVCs use, without promoting amikacin resistance.
Beckwith-Wiedemann Syndrome: Influence of the genetic pattern on	the clinical picture
Authors: Kalyanasundaram S. , Ibhanesebhor S.E. , Manjunatha C.M. , Mathews A.Z. 
Published: December 2019

Beckwith-Wiedemann Syndrome (BWS) is a condition associated with macroglossia, omphalocele, macrosomia and hypoglycemia, in addition to increased susceptibility to malignancies, especially Wilm's tumor and hepatoblastoma. Over the past few years, a clear pattern is emerging revealing a close link between the genetic pattern, clinical presentation and risk of developing malignancies. We report two cases of BWS seen recently in our neonatal unit to illustrate this aspect of the condition. Beckwith-Wiedemann Syndrome (BWS) is a condition associated with macroglossia, omphalocele, macrosomia and hypoglycemia, in addition to increased susceptibility to malignancies, especially Wilm's tumor and hepatoblastoma. This overgrowth-malformation syndrome has been linked to chromosome 11 p15, a region with many imprinted genes [1]. There has been a great deal of interest in the underlying genetic pattern in BWS especially since it has been shown to influence the clinical presentation as well as the risk of developing tumors (Wilm's tumor and Hepatoblastoma). We report two cases of BWS seen recently in our neonatal unit to illustrate the varied clinical presentation and underlying genetics of the condition. This is followed by a discussion focused on the various genetic patterns underlying the problem, and its possible influence on the clinical presentation.
Clinical profile of early postnatal body weight changes in	extremely low birth weight infants
Authors: Verma Rita Prasad , Shibli Syed , Fang Hai 
Published: December 2019

Background: Early postnatal weight changes are widely variable and unpredictable in the extremely low birth weight infants (ELBW, birth weight < 1000 g). As the fluid volume therapy is calculated based on the body weight these changes could potentially have implications in the hydration related morbidities in them. Early postnatal weight changes have not been systematically investigated in this population. Objectives: To determine the pattern and magnitude of weight changes early in life and its relationship with maturation and birth weight (BW) in ELBW infants. Methods: We studied the maximum weight loss (MWL), and the daily body weight changes from birth weight (DΔ bw) during the first 15 days of life. Prospectively entered infants' and maternal demographic and relevant clinical data were retrospectively extracted via computerized reports and chart reviews during a three-year study period. MWL and DΔ bw (calculated as % of birth weight and expressed as mean ± SD) were determined and correlated with gestational age (GA) and BW. Data were analyzed via Pearson's correlation co-efficient and the ordinary least square regression tests. Results: The mean ± standard deviation of GA and BW in 102 enrolled ELBW infants were 26.1 ± 2 weeks and 779.9 ± 157 g respectively. MWL in the entire cohort was 14.2 ± 5.4%. After initial loss the BW was regained on 14.5 ± 4.2 postnatal days of life. MWL varied widely within unit GA groups and was highest in infants born at 23 weeks. MWL correlated inversely with GA (r= − 0.3, p=0.007) but not with BW (r=0.17, p=0.09). DΔ bw varied widely and was highest on postnatal day 4. DΔ bw correlated negatively and significantly with GA during days 1–8 of life (p 0.05 to < 0.01) except for day 2 (p= 0.06). The slopes of regression coefficients for the two variables were also negative and highly significant during postnatal days 1–8 (p < 0.01) except for day 2 (p= 0.06). DΔ bw did not correlate with GA during 9–15 postnatal days and displayed a positive slope on day 15. Conclusions: MWL is related inversely to GA and has no relationship with BW in ELBW infant. DΔ bw is predictable by GA during the first but not the second postnatal week. The BW is regained on an average of 14 days of postnatal life.
The effect of listening to lullaby music on physiologic response	and weight gain of premature infants
Authors: Farhat Ahmadshah , Amiri Rana , Karbandi Sohaila , Esmaily Habibollah , Mohammadzadeh Ashraf 
Published: December 2019

Objectives: The environment plays a key role in survival and brain development for premature infants. Recent interest lends consideration to non pharmacological interventions as a beneficial alternative. This study seeks to investigate the effect of lullaby music on the physiological response and weight gain of premature infants in Mashhad, Iran. Method: In this study, 44 very low birth weight infants ⩽ 34 weeks of gestational age that were admitted to the Neonatal Intensive Care Unit (NICU) of Imamreza Hospital in Mashhad, Iran were enrolled. Infants were randomly assigned to one of two groups: the Music group and the Control group. Lullaby music was played through earphones for the Music group. This continued for 8 days at 20 minutes per day. The Control group received routine auditory stimulation. Neonates in the two groups were in stable condition and kept in their isolettes. Infants were monitored for 40 minutes; 10 minutes baseline, 20 minutes into the intervention and 10 minutes post intervention. Data measures were heart rate, respiration rate, oxygen saturation and body weight. Result: The two groups differed significantly in the respiratory rate (p= 0.01) and oxygen saturation (p= 0.001). There were no significant differences in the heart rate (p= 0.24) and weight gain (p= 0.093) between the two groups. Conclusion: Preterm infants respond to lullaby music as evidenced by the changes in their respiratory rates and oxygen saturations. Although this study did not demonstrate an improvement in weight gain, further studies are recommended to examine the effect of music on other growth and developmental aspects
The vulnerable very low birth weight infant: Late onset	bloodstream infections
Authors: Gibbs Kathleen A. , Kleinman Lawrence C. , Jenkins Stephen G. , Herold Betsy C. , Holzman Ian R. 
Published: December 2019

Objective: To review the epidemiology of late-onset bloodstream infections (LOBSI), evaluate risk factors associated with LOBSI and to compare our findings with the literature in light of new National Healthcare Safety Network (NHSN) birth weight categories. Design/methods: A retrospective case-controlled study of infants with LOBSI at ⩾ 72 hours of life admitted to the NICU between 2000 and 2005. Infection rates were determined for birth weight categories adopted by the NHSN. The exposures of cases and controls to established risk factors were compared. Antimicrobial susceptibility patterns were evaluated. Results: A total of 4061 neonates were studied. LOBSI occurred in 150 (3.7%) of infants. Out of these 150, 196 episodes of infection occurred with 210 isolated pathogens. Most cases of LOBSI were in the infants whose birth weight was < 1000 grams (ELBW). Sepsis was associated with increased mortality (23%) in very low birth weight infants (p< 0.05). Coagulase-negative staphylococci were responsible for most cases; LOBSI due to Candidal infections were less common but associated with high mortality rates (37%) in the ELBW infant. Rates of methicillin-resistant Staphylococcus aureus remained low. Infants who developed LOBSI had prolonged exposures to a number of established risk factors. In the logistic regression analysis, bacteremia was associated with use of parenteral nutrition (OR =5.9) and umbilical catherization (OR= 32). Conclusions: ELBW infants had the highest rates of LOBSI. There was a low overall incidence of LOBSI due to yeast. However, infections with a Candida species were more common in ELBW infants and were associated with a higher mortality.
Oxygen saturation monitoring in the Neonatal Intensive Care Unit	(NICU): Evaluation of a new alarm management
Authors: Brostowicz Heather M. , Rais-Bahrami K. 
Published: December 2019

Objective: Oxygen saturation (SpO $_{2}$ ) monitoring is an integral part of patient care in intensive care units. Unfortunately, the clinical application of this technology has been adversely affected by the unacceptably high rate of false alarms, which has resulted in desensitizing the clinicians to SpO $_{2}$ alarms The SatSeconds™ alarm management feature (Nellcor™) incorporates an integral alarm. The primary hypothesis is that there will be progressive reduction in percentage saturation using the SatSeconds™ alarm feature depending on the integral settings. Study design: 29 patients were monitored for 2 hours each with the study monitor. Upper and lower oxygen saturation alarm limits were determined individually and manually recorded and preset on the test oximeter for later analysis of alarm events. Test oximeter display values were not used for patient management. Audible alarms were silenced throughout the study. Results: Alarm events were recorded while the SatSeconds™ alarm management feature was set at various points. With application of the SatSeconds™ alarm management feature, there was an overall decrease in alarms to 40% with a setting of 50 SatSeconds™. Conclusion: Application of an integrated alarm system such as SatSeconds™ alarm management feature allows caregivers to respond to clinically relevant alarms.
Fungal CNS infection in a term neonate: Can a radiologist help	with diagnosis?
Authors: Rohilla Seema , Yadav Rohtas K. , Singh Jagjit , Gathwala Geeta , Dhaulakhandi Dhara B. 
Published: December 2019

Brain abscesses can be bacterial or fungal. It is usually difficult to distinguish between the two clinically as well as radiologically. However, careful scrutiny of the radiological images for subtle radiological signs and proper analysis of serial images can help in narrowing down the diagnosis and preventing delay in specific treatment. We report an infant who initially presented with a small parietal hemorrhage and subsequently evolved into multiple brain abscesses. Since fungi and not bacteria are preferentially known to invade blood vessels, the infant had a radiological diagnosis of fungal abscess in the brain. Although the cerebrespinal fluid did not grow any fungal micro-organism, the infant clinically improved after the administration of anti-fungal antibiotics. Blood and urine cultures later grew Candida albicans.
Evaluation of healthy full-term and late preterm infants	presenting with apnea in the newborn nursery: A comparison of neonatal apnea	and infantile acute life threatening event (ALTE)
Authors: Bozzetti Valentina , Tagliabue Paolo , Rhein Lawrence 
Published: December 2019

Objective: To describe common etiologies and diagnostic evaluations performed on term and late preterm neonates with neonatal apnea and to compare these etiologies and evaluations with those infants with infantile acute life threatening event (ALTE). Methods: Infants %isn't in document < 3 months of age and gestational age > 35 weeks, with diagnosis of apnea or ALTE were identified at Boston Children's Hospital from June 2000 to June 2009. Medical records were reviewed for diagnostic evaluations and discharge diagnoses. For analysis, neonates who presented with neonatal apnea within the first week of life and prior to discharge from the birth hospitalization were classified as the Inpatient Group and infants who presented with apnea post discharge were identified as the Outpatient Group. Infants with clear presenting etiologies were excluded from the study. Results: One hundred otherwise healthy subjects with diagnosis of apnea or ALTE in the study period were identified. Approximately one third were classified as the Inpatient Group. Diagnostic evaluations were highly variable, but testing for bacterial or viral sepsis was most commonly performed. In most cases, an etiology was not determined, and the diagnosis of "apnea of immaturity" was assigned. Other defined etiologic diagnoses included viral infection or pertussis, reflux/aspiration, laryngomalacia, and seizures. Conclusions: Diagnostic evaluation for apnea, in otherwise well-appearing full-term and late preterm infants, remains highly variable. Testing for infection, seizure, laryngomalacia and reflux may determine the majority of treatable etiologies. Guidelines for diagnostic evaluations and treatment strategies are clearly needed.
Plasticizer, Di(2-ethylhexyl)Phthalate (DEHP), exposure in	neonatal ECMO vs. near-miss ECMO patients
Authors: Eig Matthew , Rais-Bahrami K. , Soldin Steven J. , McCarter Robert , Mendu Damodara R. , Short Billie L. , Luban Naomi L. C. 
Published: December 2019

Objective: The plastic used in many medical devices is composed primarily of the plastic polyvinyl chloride (PVC). PVC is made flexible by treating it with chemical compounds called plasticizers. The most commonly used plasticizer is di(2-ethylhexyl) phthalate (DEHP). The general population is exposed daily to DEHP and one of its many metabolites, mono(2-ethylhexyl) phthalate (MEHP), primarily through food and aerosolization of environmental exposure. Exposure rises dramatically in premature or ill neonates, who are exposed to medical devices including enteral, blood and infusion bags, tubes and infusion devices. The rate of leaching of DEHP depends on many factors, including contact with lipophilic solutions and the amount of DEHP found in the product. Highly lipophilic substances readily extract plasticizers from PVC bags and tubes. Our objective was to determine the concentration of DEHP and MEHP in the urine of infants undergoing extracorporeal membrane oxygenation (ECMO) and near-miss ECMO to determine if ECMO results in increased concentrations of DEHP and MEHP in the urine. Study design: Using an in vivo prospective comparative study design, we evaluated 12 term or near-term neonates requiring ECMO. Our control population included 17 neonates with similar underlying diagnoses, referred to our NICU for ECMO but who ultimately responded to maximal medical therapy without ECMO. Two baseline urine samples were collected on admission to the NICU for DEHP and MEHP analysis on both the ECMO and near-miss populations. Daily urine samples were collected sequentially for five days in both populations. Urine samples were collected prior to discharge/transfer for both populations. Urinary DEHP and MEHP analysis was performed using tandem mass spectroscopy. Demographic data was collected for each patient. Results: We enrolled a total of twenty-nine patients in the study. All patients were transported to our NICU from outside birthing centers. Twelve neonates required ECMO support. The other seventeen patients responded to maximal medical therapy without ECMO. The mean DEHP for the ECMO group was 38.0 (95% CI=29.6, 47.5) compared to 33.0 (95% CI = 26.6, 40.1) in the near-miss group. The mean MEHP for the ECMO group was 29.8 (95% CI=22.4, 38.2) compared to 26.1 (95% CI=20.6, 32.3) for the near-miss group. Conclusion: Even though urinary levels of DEHP and MEHP were slightly higher in the ECMO group compared to the near-miss group, these differences were not statistically significant.
Thermal responses of the newborn pig: In vivo	comparison of two prototype hybrid systems to standard care neonatal warming
Authors: Lindemann Rolf , Hubert Terrence L. , Wu Jichuan , Agnew Catherine , Shaffer  , Wolfson Marla R. 
Published: December 2019

Objective: Underdeveloped thermoregulatory capability predisposes the preterm infant to metabolic instability. An ideal incubator environment should reduce thermal challenges of routine care. We compared the thermal responses of the newborn pig to clinical manipulations in 2 incubators and the impact of a heating blanket on these responses. Design: Anesthetized, paralyzed, and ventilated newborn pigs were randomized to pre-warmed Caleo® or Giraffe® Omnibed®, with or without a heating blanket, and subjected to warmup and a series of open door perturbations. The temperature variation, time constant, and change in skin temperature were calculated and analyzed by 2-factor analysis of variance. Results: There were no differences between the incubators during warm-up; incubator plus heating blanket decreased the time constant, independent of device. With the side access door open, the change in skin temperature was less in the Caleo®; the heating blanket attenuated the change in skin temperature in both devices. Conclusion: These data demonstrate device and clinical manipulation-dependent differences in the thermal responses of the newborn pig.
A score predicting late-onset sepsis in very low birthweight	infants
Authors: Höpfl Anja , Willeitner Andrea , Arenz Tina , Jeremias Irmela , Geiger Ralf , Küster Helmut 
Published: December 2019

Objective: To establish a score to predict late-onset sepsis in very low birth weight infants. Study Design: Two successive prospective multi center studies in very low birth weight infants were used: infants in the first served as calculation cohort, those in the second as validation cohort. Infants were divided into a sepsis group, a non-sepsis group, and an undetermined group by predefined criteria partially based on the sepsis definition by the Robert Koch institute. In the first study 39 parameters recorded daily were compared in the sepsis and the non-sepsis group between Day -3 and Day 0 of sepsis. The score was created combining those parameters with the highest area under the ROC curve. Results: A score was generated consisting of five clinical and laboratory categories: peripheral circulation, respiration, gastrointestinal tract, general laboratory findings and infection-specific laboratory findings. Sepsis was defined as pathological findings in at least 2 out of these 5 categories. This scoring system reached a sensitivity of 84.0% and a specificity of 91.7% (PPV 87.5% and NPV 89.2%) in discriminating the sepsis group from the non-sepsis group in the validation cohort. Conclusion: We created a score for early diagnosis of late-onset sepsis in very low birth weight infants. The score may be of value when comparing infants with sepsis in multi center studies.