Journal of perinatology: official journal of the California Perinatal Association
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Publications in this journal
Article: Longitudinal neurodevelopmental and neuromotor outcome in congenital diaphragmatic hernia patients in the first 3 years of life.[show abstract] [hide abstract]
ABSTRACT: Objective:The objective of this study was to longitudinally evaluate the neurodevelopmental (ND) outcome in congenital diaphragmatic hernia (CDH) survivors during the first 3 years of life.Study Design:The study cohort consists of 47 CDH survivors that were enrolled in our prospective, follow-up program between July 2004 and September 2010, and underwent serial ND evaluations during the first 3 years of life. ND outcomes were evaluated using the Bayley Scales of Infant Development (BSID)-II or BSID-III. Persistent ND impairment was defined as a score that remained 79 for the cognitive, language and psychomotor domains at the most recent follow-up visit compared with the first assessment.Result:The median age at first and last evaluation was 8 (range, 5 to 15) and 29 (range, 23 to 36) months, respectively. During the follow-up, ND scores improved to average in 17%, remained average in 60%, remained delayed in 10%, improved from severely delayed to mildly delayed in 2% and deteriorated from average to delayed in 15%. Motor scores improved to average in 26%, remained average in 55%, remained delayed in 8% and improved from severely delayed to mildly delayed in 11%. Intrathoracic liver position (P=0.004), preterm delivery (P=0.03), supplemental O2 requirement at day of life 30 (P=0.007), age at discharge (P=0.03), periventricular leukomalacia (PVL; P=0.004) and initial neuromuscular hypotonicity (P=0.01) were associated with persistent motor delays. No relationship was found between patient's characteristics and the risk of persistent cognitive and language delays.Conclusion:(1) The majority of children with CDH are functioning in the average range by early preschool age, (2) most children who had early delays showed improvement in their ND outcome, (3) children showing delays in all the three domains were the least likely to show improvement and (4) CDH severity appears to be predictive of persistent psychomotor delays.Journal of Perinatology advance online publication, 9 May 2013; doi:10.1038/jp.2013.47.Journal of perinatology: official journal of the California Perinatal Association 05/2013;
Article: A randomized trial of platelet transfusions over 30 vs 120 minutes: is there an effect on post-transfusion platelet counts?[show abstract] [hide abstract]
ABSTRACT: Objective:To determine whether platelet infusion time affects platelet counts in thrombocytopenic newborns.Study Design:This was a prospective randomized control study of 43 platelet transfusions given to newborns. Transfusions were randomized to run over either 30 min or 2 h. Platelet counts taken 30 min and 6 h after transfusion were compared using parametric, nonparametric, Pearson's correlation and logistic regression.Result:Changes in platelet counts 30 min and 6 h after transfusion were not different between the groups. Weak but significant negative correlations existed between postmenstrual age and change in platelet count at 30 min (r=-0.33, P=0.04) and 6 h (r=-0.37, P=0.018) after transfusion. There were no differences between the mean blood pressures before and after transfusion in either group.Conclusion:Transfusion duration does not affect post-transfusion platelet counts in newborns. Babies of lower postmenstrual age (PMA) may have better responses to platelet transfusions. Finally, platelet transfusions over both durations are well tolerated in neonates.Journal of Perinatology advance online publication, 2 May 2013; doi:10.1038/jp.2013.46.Journal of perinatology: official journal of the California Perinatal Association 05/2013;
Article: Intestinal location of necrotizing enterocolitis among infants with congenital heart disease.[show abstract] [hide abstract]
ABSTRACT: Objective:To determine whether differences exist in the location of necrotizing enterocolitis (NEC) in infants with congenital heart disease (CHD) versus those without CHD.Study design:Retrospective cohort study utilizing 11 years of patient data. Inclusion criterion was surgical exploration for NEC. Presence or absence of CHD was determined. Surgical and/or pathology reports were reviewed to identify the location of NEC. Data were analyzed by t-tests and χ(2) analyses.Result:One hundred and sixty-seven patients met the inclusion criteria. CHD infants had a higher percentage of mortality. There was no difference in the location of NEC between non-CHD and CHD patients, with the predominant location being the small intestine in both. In addition, there was no difference in the location of NEC between preterm non-CHD patients and full-term CHD patients with the small intestine again being the primary site.Conclusion:Despite differences in gestational age between non-CHD and CHD patients, the location of NEC in these infants did not differ.Journal of Perinatology advance online publication, 2 May 2013; doi:10.1038/jp.2013.49.Journal of perinatology: official journal of the California Perinatal Association 05/2013;
Article: Electrical activity of the diaphragm (Edi) values and Edi catheter placement in non-ventilated preterm neonates.[show abstract] [hide abstract]
ABSTRACT: Objective:The electrical activity of the diaphragm (Edi) reflects neural respiratory drive. Edi peak correlates with inspiratory drive and Edi minimum (Edi min) correlates with the tonic activity of the diaphragm. Edi data in non-ventilated preterm neonates have not been determined.The primary aim of this study was to determine Edi values in non-ventilated preterm neonates throughout postnatal maturation and with various types of noninvasive respiratory support. The secondary aim was to evaluate the success or complications of placement of the Edi catheter in premature neonates.Study design:This was a prospective observational study of non-ventilated neonates <33 weeks gestation. Data were collected weekly using an Edi catheter placed in neonates on highflow nasal cannula (HFNC), nasal cannula (NC) or room air (RA). Clinical stability was determined by measuring heart rate (HR), respiratory rate (RR) and oxygen saturation (Sats). Success and adverse events of Edi catheter placement was monitored. Statistics were obtained by analysis of variance, P<0.05 was considered significant.Result:Seventeen neonates were enrolled at 26 to 33 weeks postmenstrual age and studied from 1 to 10 weeks in duration. Overall Edi peak was 10.8±3.7 mcV (range 3.7 to 18.7) and Edi min was 2.8±1.1 mcV (range 0.8 to 7.6). There was no difference in Edi peak and min over postmenstrual ages within or between neonates, and no difference between those neonates on HFNC, NC or RA. HR, RR and Sats were not different over postmenstrual age or between any groups. The Edi catheter was placed successfully in 100% of these neonates. There were no adverse events noted.Conclusion:In clinically stable neonates, the inspiratory drive (Edi peak) and tonic activity (Edi min) do not change with postnatal maturation or with the level of noninvasive respiratory support. The Edi catheter can be placed successfully in these premature neonates. These Edi data have the potential to guide ventilatory management of premature neonates.Journal of Perinatology advance online publication, 2 May 2013; doi:10.1038/jp.2013.45.Journal of perinatology: official journal of the California Perinatal Association 05/2013;
Article: Alveolar capillary dysplasia with misalignment of pulmonaryz veins: concordance between pathological and molecular diagnosis.[show abstract] [hide abstract]
ABSTRACT: We report the case of a newborn with alveolar capillary dysplasia with misalignment of pulmonary veins (ACD/MPV), a rare condition of unknown etiology presenting in the neonatal period with significant persistent pulmonary hypertension. The diagnosis was made by lung biopsy and confirmed at autopsy. Specific genetic analysis demonstrated defects in the FOXF1 gene. The diagnosis of ACD/MPV requires a high level of suspicion and is made by lung biopsy or necropsy examination by a pediatric pathologist with experience in this condition. The availability of genetic testing has led to increasing diagnosis of patients with this lethal disorder and can influence their management, specifically by indicating the need for lung biopsy in a critically ill newborn.Journal of perinatology: official journal of the California Perinatal Association 05/2013; 33(5):401-3.
Article: Awaiting evidence of neuroprotective effects of recombinant erythropoietin in very preterm infants.Journal of perinatology: official journal of the California Perinatal Association 05/2013; 33(5):411.
Article: Letter regarding 'Utilizing a line maintenance team to reduce central-line-associated bloodstream infections in a neonatal intensive care unit'.Journal of perinatology: official journal of the California Perinatal Association 05/2013; 33(5):410.
Journal of perinatology: official journal of the California Perinatal Association 05/2013; 33(5):407-9.
Article: Prenatal diagnosis of Potocki-Lupski syndrome in a fetus with hypoplastic left heart and aberrant right subclavian artery.[show abstract] [hide abstract]
ABSTRACT: Potocki-Lupski syndrome (PTLS) is a rare genetic disorder associated with neurodevelopmental delay and heart defects. We report the first case of prenatal diagnosis of PTLS in a fetus with hypoplastic left heart and aberrant right subclavian artery. Detection of a fetal heart defect should be followed by chromosomal and genetic studies in order to rule out fetal aneuploidy and/or associated genetic syndromes with significant implications for the treatment of children with PTLS.Journal of perinatology: official journal of the California Perinatal Association 05/2013; 33(5):394-6.
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ABSTRACT: We report a very rare case of isolated multiple pulmonary arterial calcification with severe bilateral peripheral pulmonary arterial stenosis diagnosed in utero. Despite treatment with bisphosphonate for 6 months, systolic right ventricular pressure increased persistently and surpassed left ventricular pressure. After successful bilateral pulmonary arterioplasty at 13 months of age, the patient showed decreased systolic right ventricular pressure with normal interventricular septal configuration. This is the first case report for an isolated pulmonary artery calcification without other arterial calcification proven by non-contrast computed tomography of a living patient.Journal of perinatology: official journal of the California Perinatal Association 05/2013; 33(5):397-400.
Article: Response to dr C dame.Journal of perinatology: official journal of the California Perinatal Association 05/2013; 33(5):412.
Article: Saving vs creating: perceptions of intensive care at different ages and the potential for injustice.Journal of perinatology: official journal of the California Perinatal Association 05/2013; 33(5):333-5.
Article: A neonate with Coombs-negative hemolytic jaundice with spherocytes but normal erythrocyte indices: a rare case of autosomal-recessive hereditary spherocytosis due to alpha-spectrin deficiency.[show abstract] [hide abstract]
ABSTRACT: The diagnosis of hereditary spherocytosis (HS) in a newborn infant is generally made on the basis of a positive family history, spherocytes on blood film and Coombs-negative hemolytic jaundice of variable severity with an elevated mean corpuscular hemoglobin concentration (MCHC) and a low mean corpuscular volume (MCV). In general, sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) quantification of erythrocyte membrane proteins is not needed to make the clinical diagnosis of HS. However, we observed that a neonate with no family history of HS, but with abundant spherocytosis on repeated blood films, Coombs-negative hemolytic jaundice and normal MCHC and MCV measurements, where SDS-PAGE revealed alpha-spectrin deficiency, a rare autosomal-recessive variety of HS that generally has a severe clinical phenotype.Journal of perinatology: official journal of the California Perinatal Association 05/2013; 33(5):404-6.
Article: Targeted neonatal echocardiography (TnECHO) service in a Canadian neonatal intensive care unit: a 4-year experience.[show abstract] [hide abstract]
ABSTRACT: Objective:To characterize the effect of a targeted neonatal echocardiography (TnECHO) program on decision making in a tertiary level unit.Study design:Retrospective cohort study of neonates, admitted between September 2007 and April 2011. Details of the TnECHO, and the clinical decisions within 6 h of the consultation were recorded.Result:A total of 199 infants underwent 512 echocardiograms with a median (interquartile range) of 2 (1 to 3) TnECHO studies per infant. The indications included assessment for patent ductus arteriosus (PDA; n=261, 51%), post-PDA ligation assessment (n=101, 19%), pulmonary hemodynamics (n=81, 16%), myocardial performance and systemic blood flow (n=52, 10%), and central venous catheter tip position (n=6, 1%). TnECHO consultation was followed by a change in clinical management in 212 cases (41%) and avoidance of a planned intervention in 112 cases (22%).Conclusion:TnECHO may be a useful tool to guide clinical decisions in the neonatal intensive care unit setting. Well-planned prospective studies are needed to assess the impact of TnECHO on outcomes.Journal of Perinatology advance online publication, 25 April 2013; doi:10.1038/jp.2013.42.Journal of perinatology: official journal of the California Perinatal Association 04/2013;
Article: Myocardial assessment using tissue doppler imaging in preterm very low-birth weight infants before and after red blood cell transfusion.[show abstract] [hide abstract]
ABSTRACT: Objective:To investigate myocardial velocities in anemic very low-birth weight (VLBW) preterm infants, pre and post red blood cells transfusion using tissue Doppler imaging echocardiography.Study design:Forty-eight VLBW preterm infants34 weeks and>2 weeks old were prospectively divided: Transfused symptomatic infants (Hematocrit (Hct)<0.30 (n=32)) and non transfused asymptomatic controls (control 1, Hct >0.30 (n=9) and control 2, Hct <0.30 (n=7)). Echocardiography was performed before and 3-5 days after transfusion in the transfused, and the controls were studied at similar intervals. Non parametric tests were used for statistical analysis.Result:Left ventricular (LV) systolic velocity increased (transfused (4.6±0.70 vs 6.0±0.65, P<0.01)) as did LV diastolic velocities (P<0.01) without significant difference over time in each control. The percentage change in LV velocity following transfusion correlated negatively (ρ=0.36) with pre transfusion Hct.Conclusion:There is a significant increase in myocardial performance following transfusion, which is related to the severity of the anemia.Journal of Perinatology advance online publication, 25 April 2013; doi:10.1038/jp.2013.39.Journal of perinatology: official journal of the California Perinatal Association 04/2013;
Article: Feasibility and efficacy of an intervention to reduce secondhand smoke exposure among infants discharged from a neonatal intensive care unit.[show abstract] [hide abstract]
ABSTRACT: Objective:To examine the feasibility and efficacy of a hospital-based, motivational intervention to reduce secondhand smoke exposure (SHSe) with mothers of infants in a neonatal intensive care unit (NICU).Study Design:One-hundred and forty-four mothers with infants (1500 g at birth or 12 h ventilation) in a NICU who reported a smoker in the household were randomized to two sessions of motivational interviewing (MI) conducted in the hospital, usual care (UC) or usual care-reduced measurement (UC-RM); follow-up occurred at 1- and 6-months post discharge.Result:For households that did not have a total smoking ban at baseline, 63.6% of those in the MI group instituted a ban by 1-month post discharge compared with 20% of the UC group, P<0.02. Six months post discharge, fewer smoking bans were noted in the UC-RM group relative to MI and UC, P<0.01.Conclusion:A need for SHSe interventions among NICU parents exists and initial evidence suggests MI can impact SHSe after discharge.Journal of Perinatology advance online publication, 25 April 2013; doi:10.1038/jp.2013.43.Journal of perinatology: official journal of the California Perinatal Association 04/2013;
Article: Observational study of cerebral hemodynamics during dopamine treatment in hypotensive ELBW infants on the first day of life.[show abstract] [hide abstract]
ABSTRACT: Objective:To evaluate cerebral hemodynamics during dopamine treatment in hypotensive (mean arterial blood pressure (MABP)<gestational age) extremely low birth weight (ELBW) infants.Study Design:Continuous monitoring of cerebral blood flow velocity (CBFv), MABP and PCO2 was performed in hypotensive ELBW infants on the first day of life, beginning with an ∼15-min baseline reading and continued during advancing dopamine infusion until MABP was optimized. Physiological variables and CBFv reactivity were compared before and after MABP was optimized.Result:Fifteen hypotensive ELBW infants (625±174 g; 24 (23 to 24.8) weeks) were studied. Mean CBFv increased from 10.9±3.7 to 15.7±5.7 cm s(-1) (P=0.001) simultaneously as MABP increased from 22.3±2.8 to 35.2±9.7 mm Hg (P<0.001). Mean CBFv reactivity (95% confidence interval (CI)) was 3.9 (1.6 to 6.2) %mm Hg(-1). Nine infants died and/or developed severe intraventricular hemorrhage (IVH).Conclusion:Mean CBFv increased pressure-passively as MABP was optimized by dopamine treatment in very sick hypotensive ELBW infants on the first day of life.Journal of Perinatology advance online publication, 25 April 2013; doi:10.1038/jp.2013.44.Journal of perinatology: official journal of the California Perinatal Association 04/2013;
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ABSTRACT: Objective:To investigate the impact of probiotic Bifidobacterium longum ssp. infantis on the fecal microbiota and plasma cytokines in neonates with congenital heart disease.Study design:Sixteen infants with congenital heart disease were randomly assigned to receive either B. infantis (4.2 × 10(9) colony-forming units two times daily) or placebo for 8 weeks. Stool specimens from enrolled infants and from six term infants without heart disease were analyzed for microbial composition. Plasma cytokines were analyzed weekly in the infants with heart disease.Results:Healthy control infants had increased total bacteria, total Bacteroidetes and total bifidobacteria compared to the infants with heart disease, but there were no significant differences between the placebo and probiotic groups. Plasma interleukin (IL)10, interferon (IFN)γ and IL1β levels were transiently higher in the probiotic group.Conclusion:Congenital heart disease in infants is associated with dysbiosis. Probiotic B. infantis did not significantly alter the fecal microbiota. Alterations in plasma cytokines were found to be inconsistent.Journal of Perinatology advance online publication, 18 April 2013; doi:10.1038/jp.2013.41.Journal of perinatology: official journal of the California Perinatal Association 04/2013;
Article: Iron supplementation in premature infants using the zinc protoporphyrin to heme ratio: short- and long-term outcomes.[show abstract] [hide abstract]
ABSTRACT: Objective:The objective of this study was to determine the effect of incrementally higher doses of iron on the zinc protoporphyrin to heme ratio (ZnPP/H) and serum ferritin, and developmental outcomes in premature infants at risk for iron deficiency.Study Design:Infants eligible for this prospective, randomized blinded trial were between 27 and 30 completed weeks of gestation, older than 1 week of age and tolerating 100 ml kg(-1) per day of enteral feedings. The control group was treated with 2.2 mg kg(-1) per day of ferrous sulfate and the treatment group was treated with 3 to 12 mg kg(-1) per day based on the ZnPP/H. Infants had follow-up with Bayley exams at 6 and 24 months corrected age. Statistical evaluation included Student's t-tests and Fisher's exact test.Result:Eighty-one infants were enrolled (40 control, 41 treatment). The average total iron dose for the control group was 2.2 mg kg(-1) per day and for the treatment group was 10.4 mg kg(-1) per day (P<0.05). The ZnPP/H was not different between the two groups. The ferritin at the end of the study was decreased in the control group but remained stable in the treatment group (control initial 202±109 ng ml(-1), final 168±141 ng ml(-1) (P<0.05); treatment initial 187±131 ng ml(-1), final 176±118 ng ml(-1)). At 24 months, infants with psychomotor development index <85 occurred in 25% of the subjects in the control group and in 7% of subjects in the treatment group in a post hoc analysis (odds ratio, 4.2; 95% confidence interval, 0.7 to 43, P=0.07).Conclusion:The ZnPP/H may not be a reliable marker of iron status when used in a short period of time during iron supplementation. Infants treated with a lower dose of ferrous sulfate had a decreasing serum ferritin and a trend toward increased motor delays at 24 months.Journal of Perinatology (2013) 0, 000-000. advance online publication, 18 April 2013; doi:10.1038/jp.2013.40.Journal of perinatology: official journal of the California Perinatal Association 04/2013;
Article: Neonatologists' perspectives of palliative and end-of-life care in neonatal intensive care units.[show abstract] [hide abstract]
ABSTRACT: Objective:Determine palliative and end-of-life care practices, barriers and beliefs among US neonatologists, and relationships between practice characteristics and palliative care delivery.Study design:A descriptive cross-sectional survey with ordinal measurements. The survey was sent to 1885 neonatologists.Results:There were 725 responses (38.5%) with 653 (34.6%) completing the survey. Of those, 58.0% (n=379) have palliative care teams and 72.0% (n=470) have staff support groups or bereavement services. Palliative care education was deemed important (n=623) and needed. Barriers include emotional difficulties, staff disagreements and difficulty forming palliative care teams. Palliative care teams or staff bereavement groups were significantly predictive of willingness to initiate palliative care and more positive views or experiences.Conclusion:Neonatologists believe that palliative care is important. Education and palliative care teams help provide quality care. Exploration of differing views of palliative care among team members is needed.Journal of Perinatology advance online publication, 11 April 2013; doi:10.1038/jp.2013.38.Journal of perinatology: official journal of the California Perinatal Association 04/2013;
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