Does tight glycaemic control with insulin therapy in the early neonatal period improve long-term outcomes?

Abstract Objective This article aims to describe the frequency and characteristics of anticonvulsant medication treatments initiated in the neonatal period. Study Design We analyzed a cohort of neonates with a seizure diagnosis who were discharged from institutions in the Pediatric Health Information System between 2007 and 2016. Adjusted risk ratios and 95% confidence intervals for characteristics associated with neonatal (≤ 28 days postnatal) anticonvulsant initiation were calculated via modified Poisson regression. Results A total of 6,245 infants from 47 institutions were included. There was a decrease in both phenobarbital initiation within the neonatal period (96.9 to 91.3%, p = 0.015) and continuation at discharge (90.6 to 68.6%, p <0.001). Levetiracetam (7.9 to 39.6%, p < 0.001) initiation within the neonatal period and continuation at discharge (9.4 to 49.8%, p < 0.001) increased. Neonates born at ≥ 37 weeks' gestation and those diagnosed with intraventricular hemorrhage, ischemic/thrombotic stroke, other hemorrhagic stroke, and hypoxic ischemic encephalopathy (HIE) had a higher probability of anticonvulsant administration. The most prevalent diagnosis was HIE (n = 2,223, 44.4%). Conclusion Phenobarbital remains the most widely used neonatal seizure treatment. Levetiracetam is increasingly used as a second line therapy. Increasing levetiracetam use indicates a need for additional study to determine its effectiveness in reducing seizure burden and improving long-term outcomes.

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The repercussions of reduced energy and protein intake during the early neonatal period of very-low-birth-weight infants on their lung function during childhood

10.22541/au.160849874.46521425/v1 ◽

2020 ◽

Author(s):

José Uberos Fernández ◽

YOLANDA Gónzalez Jimenez ◽

Ana Campos-Martínez ◽

María Tejerizo-Hidalgo ◽

Elizabeth Fernández-Marín ◽

...

Keyword(s):

Birth Weight ◽

Lung Function ◽

Low Birth Weight ◽

Very Low Birth Weight ◽

Neonatal Period ◽

Low Birth Weight Infants ◽

Early Neonatal Period ◽

Protein Energy ◽

Z Scores

Background Prematurity and bronchopulmonary dysplasia can modify lung function in children and adults. Postnatal nutrition and rapid growth catch-up may influence the long-term development of lung function. Methods This prospective observational study was based on a cohort of 334 very-low-birth-weight (VLBW) neonates, born between 1 January 2008 and 12 December 2015. Patients with severe neurological damage, death or incomplete data record were excluded. When these infants reached a mean age of 7.7 years, a spirometry evaluation was performed, to determine FEV1, FEF25-75%, FVC and the FEV1/FVC ratio. The relation between these parameters and nutritional intake in the early neonatal period was determined by regression analysis. Results In total, 40 spirometry tests were performed. The results obtained, after adjusting for age and sex by Z-scores for the spirometry variables, showed that the schoolchildren who had been VLBW recorded significantly lower spirometry results (FVC, FEV1, FEF25-75%) than the reference values. Furthermore, there was a significant association between the FEV1/FVC ratio and the intake of macronutrients and energy in the first week of life. It is hypothesised that increasing energy intake and achieving a higher protein/energy ratio in the first week of life would improve the FEV1/FVC ratio by the time these VLBW infants reach school age. Conclusions Active nutritional management in the early neonatal period is associated with improved lung function, as reflected by the spirometry findings obtained.

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Perinatal outcomes of newborns born from young mothers with epidural analgesia

Rossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics) ◽

10.21508/1027-4065-2021-66-3-118-124 ◽

2021 ◽

Vol 66 (3) ◽

pp. 118-124

Author(s):

R. T. Shakirov ◽

S. V. Kinzhalova ◽

R. A. Makarov ◽

S. V. Bychkova ◽

N. V. Putilova ◽

...

Keyword(s):

Epidural Analgesia ◽

Cord Blood ◽

Young Women ◽

Neonatal Period ◽

Young Mothers ◽

Acid Base ◽

Term Infants ◽

Early Neonatal Period ◽

Arterial Blood

Objective. To evaluate the features of the course of the early neonatal period of newborns born from young women under conditions of epidural analgesia.Material and methods. The authors conducted a prospective, comparative, randomized, longitudinal, monocenter study. Patients of Group 1 (n=25) were anesthetized with a narcotic analgesic (2% Тrimeperedine 1,0 ml intramuscularly). Patients of Group 2 (n=30) received long-term epidural analgesia (EA) with 0,2% Ropivacaine (10,0 ml/hour). All patients delivered full-term infants. The course of labor, clinical and laboratory characteristics of newborns in the early neonatal period were evaluated.Results. There were no significant differences in the duration of labor, volume of blood loss, and other characteristics between the groups. There were no clinical differences between the groups of newborns. We did not find a negative effect of epidural analgesia on the Apgar score at the 1st (p=0,166) and 5th (p=0,217) minutes of life and the neuropsychiatric status of the newborn (p=0,322). At the same time, in the group of long-term epidural analgesia, there was a tendency to a higher incidence of moderate and mild asphyxia (19,2% versus 9,5%; p=0,436). When comparing the acid-base state of umbilical cord arterial blood, significant differences were found in the following indicators: lower pH (p=0,042) and pO2 level (p=0,007) and higher pCO2 level (p=0,031) in arterial cord blood.Conclusion. Epidural analgesia during labor in young women is accompanied by a lower level of pH and pO2 and a higher level of pCO2 in the arterial cord blood as compared to a Group of Тrimeperedine, which indicates a more pronounced shift in the acid-base state of the fetal blood. When analyzing neurological outcomes in newborns, there were no statistically significant differences. However, further follow-up is required for children born from young mothers who have received long-term epidural analgesia in labor.

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The evaluation and management of neonatal brachial plexus palsy

Paediatrics & Child Health ◽

10.1093/pch/pxab083 ◽

2021 ◽

Vol 26 (8) ◽

pp. 493-497

Author(s):

Vibhuti Shah ◽

Christopher J Coroneos ◽

Eugene Ng

Keyword(s):

Brachial Plexus ◽

Neonatal Period ◽

Position Statement ◽

Brachial Plexus Palsy ◽

Long Term Outcomes ◽

Early Referral ◽

Neonatal Brachial Plexus Palsy ◽

Active Range Of Motion ◽

Specialized Team

Abstract Neonatal brachial plexus palsy presents at birth and can be a debilitating condition with long-term consequences. Presentation at birth depends on the extent of nerve injury, and can vary from transient weakness to global paresis, with active range of motion affected. Serial clinical examination after birth and during the neonatal period (first month of life) is crucial to assess recovery and predicts long-term outcomes. This position statement guides the evaluation of neonates for risk factors at birth, early referral to a multidisciplinary specialized team, and ongoing communication between community providers and specialists to optimize childhood outcomes.

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Pulmonary hypertension and myocardial function in infants and children with Down syndrome

Archives of Disease in Childhood ◽

10.1136/archdischild-2019-318178 ◽

2020 ◽

Vol 105 (11) ◽

pp. 1031-1034

Author(s):

Aisling Mary Smith ◽

Philip T Levy ◽

Orla Franklin ◽

Eleanor Molloy ◽

Afif EL-Khuffash

Keyword(s):

Pulmonary Hypertension ◽

Down Syndrome ◽

Neonatal Period ◽

Myocardial Performance ◽

Early Neonatal Period ◽

At Risk Children ◽

Increased Risk ◽

Infancy And Childhood ◽

Pulmonary Arterial

Down Syndrome (DS) is the most common chromosomal abnormality of live born babies. Individuals with DS are at increased risk of cardiopulmonary morbidities in the early neonatal period, infancy and childhood that manifest with elevated pulmonary arterial pressures and altered myocardial performance. Pulmonary hypertension (PH) during the early neonatal period remains under-recognised in this population. PH may occur with or without a congenital heart defect in children with DS and is more common than in the general population. Early detection and continued screening of PH throughout infancy and childhood for these at-risk children is crucial for prompt intervention and potential prevention of long-term sequelae on cardiac function. This review summarises the main physiological concepts behind the mechanisms of PH in children with DS and provides a summary of the current available literature on PH and its impact on myocardial performance.

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