Maheshwari A, Lui K, Motta M. Need for larger cohorts and standardized tools to study diseases in newborn infants. Newborn 2023; 2(3):iv-vii. DOI: 10.5005/newborn-2-3-iv.

----------------------------------------------------------------------------------------------------------------------------------------------------

Totapally BR, Hussain N, Raju VN. Neonates with an Extremely Prolonged Length of Stay: An Analysis of Kids Inpatient Database. Newborn 2023; 2(3):179–184. DOI: 10.5005/jp-journals-11002-0067.

 

Abstract:

Background: With scientific and technological advances in intensive care there is increasing survival of neonates with complex medical problems who have an extremely prolonged length of stay (EPLOS) of ≥ 180 days in the hospital. Little is known about the antecedents and characteristics of this group of neonates.

Aim: To characterize the risk factors associated with EPLOS in neonates.

Methods: Retrospective study of neonates from the national hospital discharge database for Children, Kids Inpatient Database 2012 (KIDS-2012), maintained by the Healthcare Cost and Utilization Project (HCUP) using data from 4,170 hospitals in 44 states in the US. All neonates with complicated births who were discharged from the hospital other than from normal newborn nursey during the year 2012 were included. Newborns with uncomplicated hospital stays who were discharged from the normal newborn nursery were excluded. Diagnoses and procedures were retrieved using ICD-9 and CPT codes. Descriptive analyses were done to identify incidence and prevalence. Comparisons were made of neonates with EPLOS (LOS ≥180 days) and Non-EPLOS (LOS ≤179 days) using univariate and multivariate analyses.

Results: A total of 1,314,066 neonates with complicated births discharged from US hospitals in 2012 were included in the analysis. The incidence of EPLOS was 6.2/10,000 (n = 812). On univariate analyses, neonates with EPLOS were more likely to have the following risk factors: Black race, Medicaid insurance, ZIP codes associated with lower median incomes, and born in South and Mid-West regions of the US. Most were neonates who had a surgical procedure done, especially tracheostomy and gastrostomy being the most common procedures.

Conclusions: The occurrence of EPLOS is relatively uncommon among hospitalized neonates. The clinical and demographic characteristics of this subset of complicated neonates are distinct and can be anticipated using prediction models. Prediction models for EPLOS may be important for public policy issues and the proper allocation of health care resources.

​

Key scientific associations: Neonate, newborn, infant, Reporting, cranial ultrasound abnormalities, retrospective, single-centre study, intraventricular haemorrhage, cystic periventricular leukomalacia, parenchymal or cerebellar haemorrhage, cerebral palsy, developmental delay, white matter injury, ventriculomegaly, hydrocephalus, brain atrophy, term equivalent age, outpatient neurodevelopmental assessments, early neurodevelopment clinic assessment, cerebellar haemorrhage, general movements assessment, fidgety age, Hammersmith Infant Neurological Examination, prediction, sensitivity, specificity, MRI scoring systems, corpus callosum thinning, delayed folding of the cortex, periventricular haemorrhagic infarction, receiver-operator characteristic, diagnostic test accuracy.

​

-----------------------------------------------------------------------------------------------------------------------------------------------------------------

Alam MZ, Tareq MR, Shapna DS, Maheshwari A, Sohel MH, Rehnuma N, Hamid K, Majumder MMI. Epidemiological Study of Congenital Anomalies and Risk Factors in Newborn Infants at a Tertiary Care Hospital in Bangladesh. Newborn 2023; 2(3):185–190. DOI: 10.5005/jp-journals-11002-0071.

​

Abstract:

Background: Congenital anomalies are defects that are apparent at birth and are either structural or functional, including metabolic diseases. These flaws originate before birth as a result of flawed embryogenesis or inherent flaws in the development process. It is a significant contributor to neonatal and stillbirth mortality. Congenital anomaly prevalence varies across the world, which may be due to various etiological variables in various geographical areas.

Objectives: To investigate the epidemiological profile of the prevalence of various congenital abnormalities in newborn infants

Materials & methods: This cross-sectional observational study was conducted in Central Medical College Hospital, Cumilla, Bangladesh. Total sample size was 100. The study subject comprised newborn babies with congenital anomalies attended in hospital. Clinical examination and relevant investigation were done meticulously. Data were collected from the patient’s guardian after taking informed written consent. Microsoft Excel and the computer application SPSS were used to examine the data. Qualitative data are reported as frequency and percentage, whereas quantitative data are given as mean and standard deviation. Student t-tests and chi-square tests were used to conduct statistically fictitious tests. Comparisons were made using tabulation and graphic displays such tables and bar diagrams.

Results: Out of 100 cases, 69.0% patients were male and 31.0% were female. Male – female ratio was 2.2:1. The pattern of congenital abnormalities is described as follows: the central nervous system is afflicted the most frequently (30.0%), followed by the musculoskeletal system (24.0%), gastrointestinal system (GIT) (24.0%), cardiovascular system (CVS) (13.0%), and genitourinary system (9.0%) of total anomalies. On evaluation of maternal history & risk factors, 38.0% of cases had history of exposed to antenatal radiation, 35.0% of women noticed that exposure to pesticides, maternal diabetes was in 22 cases and maternal hypertensive disorder in 18 cases.

Conclusion: Present study concluded that maternal history of exposed to antenatal radiation, exposure to pesticides, maternal diabetes etc., were important predisposing factor for congenital anomaly. In this study most common congenital anomalies are central nervous system and musculoskeletal defects. Prevention of risk factors and regular ANC can lower the burden of congenital anomalies.

​

Key scientific associations: congenital anomalies, embryonic development, fetal development, radiation, pesticides, birth-defect registries, single-gene disorders, chromosomal abnormalities, multifactorial transmission, external teratogens, micronutrients, Rubella, cytomegalovirus, iodine deficiency, folic acid deficiency, environmental contaminants, radiation, Global Burden of Disease study, cleft palate, cleft lip, talipes, ventricular septal defect, patent ductus arteriosus, tetralogy of Fallot, congenital diaphragmatic hernia, anencephaly, tracheo-esophageal fistula, polydactyly, meningomyelocele, hydrocephalus, hypospadias, inguinal hernia, imperforate anus, syndactyly, duodenal atresia, undescended testis, atrial septal defect, spina Bifida, ambiguous genitalia, ICD-9, ICD-10.

​

-----------------------------------------------------------------------------------------------------------------------------------------------------------------

Garg PM, Pittman I, Yi J, Weis VG, Rodriguez RJ, Ladd MR, Rauh JL, McDonald AG, Welch C, Premkumar MH, Garg PP, Maheshwari A. Clinical Correlates of Cholestasis in Preterm Infants with Surgical Necrotizing Enterocolitis. Newborn 2023; 2(3):191-197. DOI: 10.5005/jp-journals-11002-0069. 

​

Abstract:

Background: We sought to investigate the clinical determinants and outcomes of cholestasis in preterm infants with surgical necrotizing enterocolitis (sNEC).

Methods: Retrospective comparison of clinical information in preterm infants who developed cholestasis vs. those who did not.

Results: Sixty-two (62/91, 68.1%) infants with NEC developed cholestasis at any time following the onset of illness. Cholestasis was seen more frequently in those who had received ionotropic support at 24 hours following sNEC diagnosis (87.1% vs. 58.6%; p=0.002), had higher mean C -reactive protein levels 2 weeks after NEC diagnosis (p = 0.009), had blood culture-positive sepsis [25 (40.3%) vs. 4 (13.8%); p = 0.011], received parenteral nutrition (PN) for longer durations (108.4 ± 56.63 days vs. 97.56 ± 56.05 days; p = 0.007), had higher weight-for-length z scores at 36 weeks’ post menstrual age [-1.0 (-1.73, -0.12) vs. -1.32 ( -1.76, -0.76); p = 0.025], had a longer length of hospital stay (153.7 ± 77.57 days vs. 112.51 ± 85.22 days; p = 0.024), had intestinal failure more often (61% vs 25.0%, p = 0.003), had more surgical complications (50% vs 27.6%; p = 0.044), and had >1 complication (21% vs 3.4%; p = 0.031). Using linear regression, the number of days after surgery when feeds could be started [OR 15.4; confidence interval (CI) 3.71, 27.13; p=0.009] and the postoperative ileus duration (OR 11.9, CI 1.1, 22.8; p=0.03) were independently associated with direct bilirubin between 2-5 mg/dL (mild-moderate cholestasis) at 2 months of age. The duration of PN was independently associated with direct bilirubin >5 mg/dL 9 (severe cholestasis) at 2 months of age in these patients.

Conclusion: Cholestasis was seen in 68% of infants following surgical NEC. The most likely contributive factors are intestinal failure and subsequent PN dependence for longer periods. Our data suggest that identification and prevention of risk factors such as sepsis and surgical complications and early feeds following NEC surgery may improve outcomes.

​

Key scientific associations: Preterm, neonate, necrotizing enterocolitis, cholestasis, intestinal failure, ileo-cecal valve, parenteral nutrition, logistic regression, portal venous gas, pneumatosis, pneumoperitoneum, Bell's criteria, stricture, fistula, wound dehiscence, surgical site infection, adhesions, perforations, anthropometric, weight-for-length, z-scores, Fenton growth, term-equivalent age, logistic regression, soybean oil-medium chain triglycerides-olive oil-fish oil, Intralipids, fish oil-containing lipid emulsion, farnesoid X, liver X receptors.

​

-------------------------------------------------------------------------------------------------------------------------------------------------------------

Bagga N, Panigrahi N, Germain A, Namazova I, Rahman MM, Saugstad OD, Maheshwari A. Extrauterine Growth Restriction: Need for an Accurate Definition. Newborn 2023; 2(3):198–202. DOI: 10.5005/jp-journals-11002-0072. 

​

Abstract: Neonates show considerable variation in growth that can be recognized through serial measurements of basic variables such as weight, length, and head circumference. If possible, measurement of subcutaneous and total body fat mass can also be useful. These biometric measurements at birth may be influenced by demographics, maternal and paternal anthropometrics, maternal metabolism, pre-conceptional nutritional status, and placental health. Subsequent growth may depend on optimal feeding, total caloric intake, total metabolic activity, genetic make-up, postnatal morbidities, medications, and environmental conditions. For premature infants, these factors become even more important; poor in-utero growth can be an important reason for spontaneous or induced preterm delivery. Later, many infants who have had intra-uterine growth restriction (IUGR) and are born small for gestation (SGA) continue to show suboptimal growth below the 10th centile, a condition which has been defined as extra-uterine growth failure (EUGR) or postnatal growth failure (PNGR). More importantly, a subset of these growth-restricted infants may also be at high risk of abnormal neurodevelopmental outcomes. We need well-defined criteria to recognize EUGR/PNGR, so that correctional steps can be instituted in a timely fashion.

​

Key scientific associations: newborn, neonate, infant growth, body fat mass, demographic factors, maternal and paternal anthropometrics, growth charts, maternal metabolism, pre-conceptional nutritional status, placental health, infant feeding, total caloric intake, total metabolic activity, genetic make-up, postnatal morbidities, medications, intra-uterine growth restriction, small for gestation, neurodevelopmental outcomes, corrected gestational age, extra-uterine growth restriction, postnatal growth restriction, failure to thrive, postnatal malnutrition, Z-scores, postnatal growth, delta-Z, Cohort of Indonesian PreTerm infants for long-term Outcomes (CIPTO) study, term corrected age, neonatal morbidities, Fenton growth chart, Intergrowth 21st charts, weight gain, linear growth velocity.

​

------------------------------------------------------------------------------------------------------------------------------------------------------

Chetan C, Garegrat R, Hazarika J, Maheshwari A, Suryawanshi P. Point-of-care Ultrasound to Diagnose and Monitor the Course of Necrotizing Enterocolitis. Newborn 2023; 2(3):203–213. DOI: 10.5005/jp-journals-11002-0070.

​

Abstract: Context: Neonatal gut ultrasound is an emerging clinical tool for quick diagnosis and prognosis in various abdominal pathologies. In this review, we summarise normal gut ultrasound findings and concentrate on the specifications of diagnosing necrotising enterocolitis. Evidence: A comprehensive literature search was conducted across numerous sources with relevant keywords along with the specified age group of 0-28 days of life. Findings: This review describes the normal gut ultrasound picture with basic technicalities needed to master the art of point-of-care abdominal ultrasound. This modality is gaining importance due to its accuracy, applicability, safety and affordability. Key findings include altered bowel perfusion, decreased peristalsis, and bowel wall thickening with better precision compared to abdominal x-ray. Many metanalysis and narrative reviews have already demonstrated its usefulness. The high specificity and positive predictive value could make this tool a guide for early identification and prompt surgical intervention in the dreaded diagnosis of necrotizing enterocolitis. Conclusion: Emerging evidence and expertise in the field of abdominal ultrasound will make it a valuable tool for early diagnosis and prognosis of necrotizing enterocolitis.

​

Key scientific associations: Point-of-Care abdominal ultrasound, necrotizing enterocolitis, gut signature, portal venous gas, pneumatosis intestinalis, pneumoperitoneum, gut wall perfusion, gut wall thickness, abdominal x-ray, Higher frequency linear probes, Lower-frequency curvilinear probes, quadrants, echotexture, Doppler gain, artifacts, muscularis mucosae, hypoechoic, hyperechoic, serosa, worm-like motion, spectral doppler, portal venous gas, zebra pattern, Y-shaped patterns, ring-shaped patterns.

​

--------------------------------------------------------------------------------------------------------------------------------------------------------

Hiranandani M, Kaur I, Grover S. Umbilical Cord Blood Gases: Sampling, Evaluation, and Application for Clinicians. Newborn 2023; 2(3):214–221. DOI: 10.5005/jp-journals-11002-0074.  

​

Abstract: Predicting the severity of birth asphyxia-related brain injury in newborn infants is a difficult task. Cord blood gases can be useful indices in the assessment the impact of peripartum events; these tests are particularly important because despite all the progress in fetal monitoring, the time gap between onset of fetal heart rate (FHR) abnormalities and birth asphyxia-related brain injury has remained difficult to predict. In this article, we have focused on cord blood gas values in understanding the degree of compromise. These data can help determine the timing of fetal compromise prior to labour, and whether these precipitating event were acute or prolonged. When combined with some adverse clinical markers, the accuracy of low cord pH in predicting neonatal mortality and morbidity can be even higher. Low cord pH or eucapnic neonatal pH can also help in the surveillance of at-risk infants and in timely institution of neuroprotective therapies. We present a detailed review on the evaluation and interpretation of cord blood gas values..

​

Key scientific associations: Cord Blood Gas, birth asphyxia, peripartum events, brain injury, surveillance, placenta, umbilical arteries, umbilical venous blood, carbonic acid, organic acids, arterio-venous difference, ‘20, 30, 40, 50 rule’, oxygen-carrying capacity, regional anaesthesia, maternal positioning, nuchal cord, stillbirth, cerebral palsy, respiratory acidosis, hypercapnia, hypoxic-ischemic encephalopathy, neonatal encephalopathy, rectal temperature, base deficit, eucapnic pH, pH qu 40, Universal cord blood gas analysis.

-----------------------------------------------------------------------------------------------------------------------------------------------------------------

Singh S, Maheshwari A, Namazova I, Benjamin JT, Wang Y. Respiratory Syncytial Virus Infections in Neonates: A Persisting Problem. Newborn 2023; 2(3):222–234. DOI: 10.5005/jp-journals-11002-0073.

​

Abstract: Respiratory Syncytial Virus (RSV) is the most common cause of lower respiratory tract infections in young infants. It is an enveloped, sin¬gle-stranded, nonsegmented, negative-strand RNA vi¬rus, a member of the family Pneumoviridae. Globally, RSV is responsible for 2.3 percent of deaths among neonates 0 to 27 days of age. Respiratory syncytial virus infection is most common in children aged below 24 months. Neonates present with cough and fever. RSV-associated wheezing is seen in 20 percent infants during the first year of life of which 2 to 3 percent require hospitalization. Reverse transcriptase polymerase chain reaction (RT-PCR) gives fast results and has higher sen¬sitivity compared with culture and rapid antigen tests and are not affected by passively administered antibody to RSV. Therapy for RSV infection of the lower respiratory tract is mainly supportive, and preventive measures like good hygiene and isolation are the mainstay of management. Standard precautions, hand hygiene, breastfeeding and contact isolation should be followed for RSV infected newborns. Recent AAP guidelines do not recommend pavilizumab prophylaxis for preterm infants born at 29–35 weeks without chronic lung disease, haemodynamically significant congenital heart disease and coexisting conditions. RSV can lead to long-term sequelae such as wheezing and asthma, associated with increased health care costs and reduced quality of life.

​

Key scientific associations: Perinatal RSV infection, neonate, newborn, vertical transmission, lower respiratory tract infection (LRTI), bronchiolitis, pregnant women, Risk Scoring Tool (RST), Rapid antigen diagnostic tests (RADT), Pneumoviridae, Palivizumab, Ribavirin, RSV-IVIG, Nirsevimab, nerve growth factor (NGF)/TrkA receptor axis, Arexvy.

​

----------------------------------------------------------------------------------------------------------------------------------------------------------------

Roff M, Slifirski O, Grooby E, Marzbanrad F, Malhotra A. ​Digital Stethoscope Use in Neonates: A Systematic Review. Newborn 2023; 2(3):235-243. DOI: 10.5005/jp-journals-11002-0068.

​

Abstract:

Aim: To assess the evidence for use of digital stethoscopes in neonates and evaluate whether they are effective, appropriate, and advantageous for neonatal auscultation.

Methods: A systematic review and narrative synthesis of studies published between January 1, 1990, and May 29, 2023, were conducted following searches of MEDLINE, Embase, PubMed, Scopus, and Google Scholar databases, as well as trial registries.

Results: Of 3852 records identified, a total of 41 papers were eligible and included for the narrative synthesis. 13 records were non-full text articles, either in the form of journal letters or conference abstracts and these were included separately for completion purposes but may be unreliable. 28 papers were full text articles and were included for full qualitative analysis. Digital stethoscopes have been studied in neonatology across various clinical areas, including Artificial Intelligence for sound quality assessment and chest sound separation (n=5), cardiovascular sounds (n=11), respiratory sounds (n=4), bowel sounds (n=4), swallowing sounds (n=2), and telemedicine (n=2). This paper discusses the potential utility of digital stethoscope technology for the interpretation of neonatal sounds for both humans and Artificial Intelligence. Limitations of current devices are also assessed.

Conclusion: The utilisation of digital stethoscopes in neonatology is an emerging field with a wide range of potential applications, which has the capacity to advance neonatal auscultation. Artificial Intelligence and digital stethoscope technology offer novel objective avenues for automatic pathological sound detection. Further, digital stethoscopes may improve our scientific understanding of normal neonatal physiology and can be employed in telemedicine to facilitate remote medical access. Digital stethoscopes can also provide phonocardiograms, enabling enhanced interpretation of neonatal cardiac sounds. However, current digital stethoscopes necessitate refinement as they consistently produce low-quality sounds when used on neonates.

​

Key scientific associations: Neonate, newborn, infant, MEDLINE, Embase, PubMed, Scopus, Google Scholar, trial registries

artificial Intelligence, telemedicine, digital stethoscope, clinical trial registries, Boolean operators, synonyms, truncations, Covidence Systematic Review Software, meta-analyses, Temporal correlogram, Piezoelectric sensor, NICU robotic telemedicine, Non-Negative Matrix Co-Factorisation, Non-Negative Matrix Factorisation, Single-Channel Blind Source Separation, Hidden Semi-Markov and Convolutional Neural Network models.

.

​