Science topic

Neonatology - Science topic

A subspecialty of Pediatrics concerned with the newborn infant.
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I want to analyze X condition, for example, hypotension in neonatology and its association with mortality. There is no current definition of what hypotension is.
When doing a systematic review, and I want to analyze the association between hypotension and mortality, but I have to include different hypotension definitions.
Imagine that I divide all studies into two groups: One group with studies that used definition X, and another group with studies that used definition Y.
If both X and Y show association with mortality, with low heterogeneity (between subgroup), can I infer that the definition of hypotension per se is not important? What if there was a high heterogeneity, can I infer that I cannot exclude that the definition of hypotension is not important and it actually may influence mortality?
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Hi,
Heterogeneity is common in meta-analysis.
Reasons for heterogeneity, other than clinical differences, could include methodological issues such as problems with randomization, early termination of trials, use of absolute rather than relative measures of risk, and publication bias.
So, the definition of the clinical problem is important before taking up the analysis. You can do two different analyses and compare.
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I would like to examine burnout among neonatologists and nurses on neonatology. A would need free form of inventory. Any ideas?
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oldenburg burnout inventory maybe
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A number of families of children with a particular genetic syndrome report that their babies were full-term but they were told that they had to be approximately 6 weeks early based on underdevelopment of plantar creases, ears, nipples etc. is this possible, unusual, or simply a mistake?
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I have also seen this type of newborn. But most of the cases the LMP date was wrong. But I do agree with Robert Simon.
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Hi All, my dissertation is about filicide... im researching the factors that are behind/contribute towards this from a biopsychosocial perspective... thankyou
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Dear Bethany, 
Here I send you some papers we wrote about maternal blues and postpartum depression.
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Is there a standardization of Hindi version of Pediatric Symptom Checklist?
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Dear Vankar
please check pdf  it helps you
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The placenta is organized as fetal and maternal compartments in broad perspective. However, it is a very complicated organ where fetal and maternal bloods touch together through villous trees to exchange oxygen and nutrients. I would like to hear your ideas and experiences on what the criteria for distinguishing fetal and maternal compartments were applied in either your MR imaging studies of the placenta or histological studies of the placenta. Thank you sincerely for your opinions in advance.
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does it affects maternal condition by any means, rather than its established effect on fetus
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are there any studies prove that Padmesh?
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99% of people with Down Syndrome say they are happy with their lives. Parents of children with Down Syndrome say they derive such joy from their children. Where is their defense to live?
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I think the  parents have  rights to decide prolong or not this pregnancy
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1-what do you think are the most appropriate quanti and quali study designs/methodologies to investigate the relation between caffeine exposure during pregnancy and births before 37-41 weeks of gestation ?
2-what are the ethical considerations to be taken into account during this study ?
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See our article in the European Journal of Public Health, Vol. 23, No. 3, 480–485
doi:10.1093/eurpub/cks089
Risk factors of preterm birth and low birth weight babies among Roma and non-Roma mothers: a population-based study.
In the multivariable logistic regression model (non concerning ethnic differences) the effect on PTB of non-daily versus daily consumption of caffein was: OR=0.97 95%CI=0.84–1.26 p=0.899.
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How soon can the baby be breastfed after her mother is injected quinolones? Is the time interval  from quinolones injection to breastfeding  associated with the T1/2 of quinolones?
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Little amount of quinolones , injection or oral may be expressed in the breast milk after administration. The amount is negligible and may not be harmful to the baby. This is an interesting area and if you are a researcher, then a study can be conducted on different types of quinolones, blood level in the lactating mother and level in the breast milk.  
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Extensive stroke in MRI. First hours of life. Hemiparesis in the left hemibody. 
Anti-beta-2-glycoprotein-I in elevated titers in three occasions;
Low C3 and C4.
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Although I didn't see a case of antiphospholipid syndrome presented with stroke in the neonatal period, I  know a case of antiphospholipid syndrome presented with neonatal aortic thrombosis that mimicing aortic coartation in  the neonatal period.  
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Sidenafil is a very good drug in the management of PPHN in my experience. I have used in some cases of PPHN and the results were really good, but some studies show no beneficial effects and some show equivocal results. At present there are no guidelines for use of sildenafil in management of PPHN. What is your experiences?
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As we have not iNO in our NICU ,our PPHN patients would  have benefits from using the full dose of sildenafil (2 mg/kg/dose ,QID) with simple mechanical ventilation.
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Oral sucrose seems to be not sufficient; more integrated strategies like sensorial saturation or breastfeeding or a combination of oral sucrose and facilitated tucking seem more effective than oral sucrose alone
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actually sucrose solution has been shown to be effective by evidence based observations  
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I am seeking a validated tool which can be applied to the Caribbean.
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That is a good point, Genevieve. I hope the tools to measure that have been offered in this topic have been helpful to you, Sydonnie.
If Maria wishes to start a new thread, I have some further references to offer about best practice.
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For assessing the quality of neurodevelopmental care in the NICUs,what tool is preferred?
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The Bayley is beneficial for assessing outcome after NICU discharge.  However, the assessment of short term outcome is possible prior to NICU discharge.  I prefer the NICU Network Neurobehavioral Scale for a comprehensive measure of outcome prior to discharage.  It gives 13 summary scores of function: habituation, orientation, arousal, tolerance of handling, self regulation, asymmetry, sub-optimal reflexes, hypertonia, hypotonia, excitability, lethargy, stress, and quality of movement.  However, this tool requires that the infant can tolerate multiple position changes over approximately 20 minutes.  It also requires a certified examiner.  The Dubowitz is a 34 item tool that can be administered in approximately 10 minutes.  The Premie Neuro is appropriate for infants between 23-37 PMA, and an abbreviated from can be used for infants who are still intubated.  If attempting to discriminate CP, Prechtl's General Movement assessment may be a good choice.  If assessing feeding, the Neontal Oral Motor Asessment.  There are other tools that are used in the NICU, including  the NAPI, APIB, TIMP,  
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Maternal diagnosis of VZV was based on clinical symptoms and signs, positive specific IgM and IgG and positive PCR for VZV on samples from cutaneous lesions.
The newborn, was born at 37+5 weeks and IgG and IgM for VZV were tested two times in different laboratories.
No evidence of immunodeficency in mother and child.
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Hi
dear doctor
Your answer is yes!
1. After 8 wk or more of gestation mother with evidence of immunity against varicella will transfer maternal IgG Ab to their fetus, thus their newborn infants already have positive Anti-varicella Ab that reflect passively-acquired maternal Ab (The IgG of the newborn is solely of maternal origin)
2. On the other hand, maternal Ab titers are affected  by her nutritional and immune
status,
3.In rare circumstances, mother may have low or absent levels of circulating IgG antibody. In these cases, the mother cannot transfer protection to her infant
4. You should check IG profile of mother in addition to serum IgG/IgM level of both infant and her mother simultaneously
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For my bachelor's description I need to know what the effect is on stem cells of delayed cord clamping after birth.
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There is no RCT to answer the impact on health   to a different amount of stem cells caused by the timing of cord clamping. It is a very difficult study to do.
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To facilitate a consensus towards European guidelines for the management of pregnant women in labor and during pregnancy for the prevention of GBS perinatal disease, a conference was organized in 2013 with a group of experts in neonatology, gynecology-obstetrics and clinical microbiology coming from European representative countries. The group reviewed available data, identified areas where results were suboptimal, where revised procedures and new technologies could improve current practices for prevention of perinatal GBS disease. The key decision issued after the conference is to recommend intrapartum antimicrobial prophylaxis based on a universal intrapartum GBS screening strategy using a rapid real time testing.  Di Renzo GC, Melin P, Berardi A, Blennow M, Carbonell-Estrany X, Donzelli GP, Hakansson S, Hod M, Hughes R, Kurtzer M, Poyart C, Shinwell E, Stray-Pedersen B, Wielgos M, El Helali N. Intrapartum GBS screening and antibiotic prophylaxis: a European consensus conference. J Matern Fetal Neonatal Med. 2014 Aug 27:1-17. [Epub ahead of print].  
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This sounds as a reasonable approach. However, I would be careful with straightforward paneuropean recommendation for implementation until you are sure that GBS is present everywhere.
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The association of necrotizing enterocolitis (NEC) and blood transfusion is suggested by several case series and observational studies. The few RCTs dealt with this matter so far have not confirmed such association. Nonetheless, many colleagues like to err on the conservative side, i.e. to stop feeding altogether upon blood transfusion. Do you support this approach in your practice?
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OUR INCIDENCE OF NEC VERY LOW, AND OVER MANY YEARS OF EXPERIENCE I HAVE SEEN FEW CASES OF PRETERM INFANTS DEVELOPED NEC AFTER BLOOD TRANSFUSION AND THEY WERE ON FEEDS.
WE DON'T HAVE GUIDLINE TO STOP FEEDING DURING TRANSFUSION, BUT MY PRACITCE NOT TO FEED AT LEAST DURING TRANSFUSION AND MAY FEW HOURS AFTER. (THIS PERSONAL PRACTICE WITHOUT CLEAR EVIDENCE YET WHAT TO DO!) 
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An indirect evaluation of infants' acute pain can be given by using complicated pain scales, that use simultaneously several parameters. These scales have been criticised for their complexity but also for the scarce need of scoring pain during acute pain. In fact, pain scoring is useful during cronical pain, but in the case of acute pain such as during injections, tracheal aspirations, heel-pricks and so on, it has scarce utility. I argue that all these scales decontextualize pain, i.e. they  assess pain without any reference to the type of painful stimulation. I believe that it is sufficient to be aware of the risk of provoking pain with reference to the type of stymulus and to the part of the body (and its state) where it is apllied to, of course, avoid it. Do you want to be sure you are provoking pain? First, consider if you are touching an area with nociceptors; second, see if this provokes a sudden reaction: this is the clear signal of pain with no need of scales: there's no need for scoring pain after provoking it, because any pain provoked to a baby is always a failure. 
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I'm sure that chronic-pain scales are useful to score pain in order to modulate analgesics. While acute-pain scales have scarce utility. Thus, I suggest not to score acute pain but just to detect it (pain we provoke - at any score level - is always a failure). Detecting pain is easy: you just have to know if you are activating parts of the body with nociceptors and then to assess if a sudden reaction (crying or increase in heart rate) appears.
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Adaptation is necessary for tests in different cultures. In neonatal period for assessment of behavioral state, is it necessary?
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Thank you
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In different countries neurodevelopmental care in the NICUs definitions are different. What do you think about this?
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I consider several things to be part of developmental care...skin-to-skin, clustered care, proper positioning and containment, light and noise modifications, cue-based care and feeding, and family focused care.
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Neonatal pain is recognized to alter stress hormone levels and in turn influences neural development.
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We use the modified NIPS that add HR and O2 saturation as physiologic markers of pain. I am attaching the scale for you.
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Time table and screening methods on developmental follow-ups in at risk infants vary in different countries. Some NICUs use objective screeners and others subjective tools. Is the ASQ appropriate for high risk follow-ups?
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I wrote ASQ-SE but meant ASQ in general without forgetting to include the Social-emotional module. In addition, I meant also add that the Bayley Scales for observation are the most important measure we use once the infant is old enough.
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Probably there are not guidelines for this topic universally admitted.
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Please find below a study that might be helpful
Pediatr Res. 1995 Sep;38(3):332-5.
Sucrose reduces pain reaction to heel lancing in preterm infants: a placebo-controlled, randomized and masked study.
Bucher HU, Moser T, von Siebenthal K, Keel M, Wolf M, Duc G.
Author information
Abstract
In term infants sucrose given by mouth has been reported to reduce duration of crying after a heel prick. This study was designed primarily to investigate the effect of sucrose administered orally immediately before heel lancing on the nociceptive reaction in preterm infants as assessed by change in heart rate and duration of crying. A secondary objective was to document changes in cerebral blood volume during acute pain. We used a randomized, masked, placebo-controlled, crossover trial in a neonatal intermediate care unit in a level 3 perinatal center. The patients studied were 16 preterm infants; birth weight, 900-1900 g; gestational wk, 27-34; corrected postmenstrual age at time of investigation, 33-36 wk. Each infant was assessed twice receiving 2 mL of sucrose 50% or 2 mL of distilled water in random order immediately before heel lance. Heart rate, thoracic movements, and transcutaneous blood gases were monitored continuously. Crying during the procedure was documented by a video-camera. A change in cerebral blood volume was assessed by near-infrared spectroscopy. We found the heart increased by a mean of 35 beats/min (bpm) after sucrose and 51 bpm after placebo (median difference 16 bpm, interquartile range 1-30 bpm, p = 0.005). Infants cried 67% of time after sucrose and 88% after placebo (median difference 10%, interquartile range 3-33%, p = 0.002). Cerebral blood volume decreased in 5 of 14 infants after sucrose and in 6 of 14 infants after placebo (difference not significant).
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Because phenobarbitone seems to help in cardiovascular stabilization and cerebral protection by decreasing oxygen demand.
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I totally agree with johan. there is no need of prophylactic phenobarbitone therapy becoz most of the cases of HIE stage 1 recovers with supportive treatment and they never developed Seizures.
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There have been multiple experiments and analyses performed to identify and tackle preterm labor, but what are the most effective ones?
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Maybe you can find some information in this article:
"A Blood Test to Predict Preterm Birth: Don't Mess with Maternal-Fetal Stress"
Norwitz, ER
Journal Of Clinical Endocrinology & Metabolism, 2009, Vol.94(6), pp.1886-1889
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It is our clinical routine to suction the nose and mouth of the ventilated neonate after endotracheal suctioning. No evidence is available. Is it of additional value or need or just a routine?
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Frequent suction of nose and mouth is necessary because if we don't remove than secretions comes out from the angle of mouth and can soak the ET dressing. Thus there may be increased chances of displacement of endotracheal tube as well as chances of infections are more. But oronasal suction should be gentle and not very frequent because frequent suction of nose and mouth may traumatize the fragile mucosa in premature infants.
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In our unit (a tertiary care, referral center) a review over a 2 year period revealed the incidence of UVC extravasation to be 4.2%. The most common mode of diagnosis was ultrasound of abdomen with the following features.
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I am surprised with your results.! Which persons (nurses, interns, paeditricians or neonatologists) in your NICU staff are responsible for setting UVC? Do you have a control group (infants without UVC)?
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Experiences vary, but I for one- have seen the miraculous effect of kangaroo mother care in babies who have been admitted to our NICUs and nurseries - not just pre-terms, but also those recovering from serious illnesses. There is a definite improvement in weight gain, immunity, respiratory effort and various other parameters. Do narrate your experiences and wonders you have observed with this simple but effective technique. Do you use it only in pre-terms? Or do you advise it for all babies?
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hi Suresh, you can also that I practice infant massage as mode of helping babies gain weight rapidly as this works well. Mothers can be advise to do this in Kangoroo care. Best wihes and hope to hear from you again.
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What are different methods (clinical / pathological / radiological etc.) to diagnose and confirm Umbilical venous catheter (UVC) extravasation injuries?
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Sonography is the most useful tool per my own experience. Clinical sign is deceiving and we experienced large subcapsular liver hematoma due to UVL without remarkable clinical sign. We probably will obtain pathological evidence after the patient is dead (too late).
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I am currently reviewing data of umbilical venous catheter related extravastion injuries in our unit. The retrospective analysis lead to identifying large number of cases. Put together, it could easily become one of the largest published cohort of UVC extravasation injuries, till date. But still the total number of cases will be in single digit. We are specifically looking to study the possible associated factors, clinical manifestations, complications and outcome. More like a descriptive study. I wanted to have your opinion regarding what would be the best category of paper under which such research could be published?
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It would depend upon the available evidence in the literature and what you wish to study. I think it could be a Case Series providing information about the possible associated factors, clinical manifestations, complications and outcome. Alternatively, you could study the associated factors using a case-control study design. This might help answer a question why some develop this complication while the others do not!
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There are some reports and a few clinical studies that illustrate a potential positive effect of music therapy on well-being, energy consumption and other short term parameters in premature neonates. Do colleagues in this network have own experience in active music , i.e. with live music (not passive music e.g. from CD)? Which kind of music, instruments or sounds has been used? Is anyone aware of studies that show a long term effect on neurodevelopmental outcome? For instance, could there be any data that might illustrate an effect on the incidence and severity of attention disorders in low birth weight children? And how about the mothers?
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As in many other areas there are no really good data on the effect of "music therapy" on preterm infants and certainly this term does not mean a real music band playing in front of the incubatrors.... The basic idea behind real music therapy (and not music just coming from the mp3 player), however, is that it may be a good way of nonverbal communication between caregivers and the preterm infant which may be good for mood and brain (of both sides). I recently heard a quite interesting talk by a music therapists, Friederike Haslbeck, who now teaches in Zurich/CH. You will find some citations in google, e.g.: http://www.haslbecks.info/page0/page8/files/MTT5_4_Haslbeck.pdf, which also presents some video material.
In any way, it may be diffiult to proof benefits fom such interventions.
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any published studies involving NAVA
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Hi Tim
I published case report on use of NAVA in Congenital Diaphragmatic hernia, my two more publications in pipeline and soon will be published