scholarly journals Refeeding Syndrome in the Neonatal Intensive Care Unit

2021 ◽  
Vol 26 (8) ◽  
pp. 771-782
Author(s):  
Caitlyn V. Bradford ◽  
M. Petrea Cober ◽  
Jamie L. Miller
Keyword(s):  
Gestational Age ◽  
Neonatal Intensive Care ◽  
English Language ◽  
Molar Ratio ◽  
Patient Specific ◽  
Refeeding Syndrome ◽  
Amino Acid Intake ◽  
American Society ◽  
The Impact ◽  
Neonatal Population

Refeeding syndrome (RS) has not been well defined in the neonatal population, although hypophosphatemia is identified as the most common manifestation. The American Society for Parenteral and Enteral Nutrition recently provided recommendations for the prevention and management of RS in children and adults; however, specific neonatal recommendations were not provided. In an effort to provide an overview of the incidence of RS or hypophosphatemia in the neonatal population and the impact of patient-specific and nutrition factors, a review of the literature was conducted. The literature search included articles published in the English language in Medline, PubMed, and EPub between 1946 and December 2020. Relevant citations within identified articles were also reviewed. Sixteen studies representing 3688 neonates were included. There was variation in the incidence of hypophosphatemia (20%–90%), hypokalemia (8.8%–66.7%), and hypomagnesemia (1%–8.3%) between studies. There was significant variability in definitions of hypophosphatemia, patient populations (e.g., gestational age, small for gestational age status, intrauterine growth restriction), and initial nutrition between studies (i.e., initial amino acid intake, calcium and phosphate ratio), proving it difficult to identify the overall incidence of neonatal RS. Clinical outcomes associated with hypophosphatemia identified in the studies included increased duration of mechanical ventilation, development of bronchopulmonary dysplasia, and increased mortality. Vigilant monitoring of serum phosphate, potassium, and magnesium is required in the first week of life. In addition, early addition of phosphate in a 1:1 molar ratio with calcium is recommended in the first week of life for patients who are at greatest risk for RS.

scholarly journals Accuracy of Pulse Oximetry in the Presence of Fetal Hemoglobin—A Systematic Review

Children ◽  
2021 ◽  
Vol 8 (5) ◽  
pp. 361
Author(s):  
Ena Pritišanac ◽  
Berndt Urlesberger ◽  
Bernhard Schwaberger ◽  
Gerhard Pichler
Keyword(s):  
Pulse Oximetry ◽  
Neonatal Intensive Care ◽  
English Language ◽  
Arterial Oxygen Saturation ◽  
Fetal Hemoglobin ◽  
Arterial Oxygen ◽  
Cochrane Library ◽  
Preterm Neonates ◽  
Neonatal Blood ◽  
The Impact

Continuous monitoring of arterial oxygen saturation by pulse oximetry (SpO2) is the main method to guide respiratory and oxygen support in neonates during postnatal stabilization and after admission to neonatal intensive care unit. The accuracy of these devices is therefore crucial. The presence of fetal hemoglobin (HbF) in neonatal blood might affect SpO2 readings. We performed a systematic qualitative review to investigate the impact of HbF on SpO2 accuracy in neonates. PubMed/Medline, Embase, Cumulative Index to Nursing & Allied Health database (CINAHL) and Cochrane library databases were searched from inception to January 2021 for human studies in the English language, which compared arterial oxygen saturations (SaO2) from neonatal blood with SpO2 readings and included HbF measurements in their reports. Ten observational studies were included. Eight studies reported SpO2-SaO2 bias that ranged from −3.6%, standard deviation (SD) 2.3%, to +4.2% (SD 2.4). However, it remains unclear to what extent this depends on HbF. Five studies showed that an increase in HbF changes the relation of partial oxygen pressure (paO2) to SpO2, which is physiologically explained by the leftward shift in oxygen dissociation curve. It is important to be aware of this shift when treating a neonate, especially for the lower SpO2 limits in preterm neonates to avoid undetected hypoxia.

scholarly journals Birth-weight centiles and the risk of serious adverse neonatal outcomes at term

2018 ◽  
Vol 46 (9) ◽  
pp. 1048-1056 ◽  
Author(s):  
Joanna Yu ◽  
Christopher Flatley ◽  
Ristan M. Greer ◽  
Sailesh Kumar
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Neonatal Outcomes ◽  
Predicted Probability ◽  
Exposure Variable ◽  
Adverse Neonatal Outcomes ◽  
Gestational Age At Birth ◽  
The Impact ◽  
Age At Birth

Abstract Background: Birth-weight is an important determinant of perinatal outcome with low birth-weight being a particular risk factor for adverse consequences. Aim: To investigate the impact of neonatal sex, mode of birth and gestational age at birth according to birth-weight centile on serious adverse neonatal outcomes in singleton term pregnancies. Materials and methods: This was a retrospective cohort study of singleton term births at the Mater Mother’s Hospital, Brisbane, Australia. Serious adverse neonatal outcome was defined as a composite of severe acidosis at birth (pH ≤7.0 and/or lactate ≥6 mmol/L and/or base excess ≤−12 mmol/L), Apgar <3 at 5 min, neonatal intensive-care unit admission and antepartum or neonatal death. The main exposure variable was birth-weight centile. Results: Of the 69,210 babies in our study, the overall proportion of serious adverse neonatal outcomes was 9.1% (6327/69,210). Overall, neonates in the <3rd birth-weight centile category had the highest adjusted odds ratio (OR) for serious adverse neonatal outcomes [OR 3.53, 95% confidence interval (CI) 3.06–4.07], whilst those in the ≥97th centile group also had elevated odds (OR 1.51, 95% CI 1.30–1.75). Regardless of birth modality, smaller babies in the <3rd centile group had the highest adjusted OR and predicted probability for serious adverse neonatal outcomes. When stratified by sex, male babies consistently demonstrated a higher predicted probability of serious adverse neonatal outcomes across all birth-weight centiles. The adjusted odds, when stratified by gestational age at birth, were the highest from 37+0 to 38+6 weeks in the <3rd centile group (OR 5.97, 95% CI 4.60–7.75). Conclusions: Low and high birth-weights are risk factors for serious adverse neonatal outcomes. The adjusted OR appears to be greatest for babies in the <3rd birth-weight centile group, although an elevated risk was also found in babies within the ≥97th centile category.

Babies at Double Hazard: Early Development of Infants at Biologic and Social Risk

PEDIATRICS ◽  
1982 ◽  
Vol 70 (5) ◽  
pp. 670-676 ◽  
Author(s):  
Sibylle K. Escalona
Keyword(s):  
Social Class ◽  
Cognitive Development ◽  
Brain Damage ◽  
Psychosocial Development ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Cognitive Status ◽  
Full Term ◽  
Social Risk ◽  
The Impact

From the population of a neonatal intensive care unit, 114 infants and their families were followed from birth to age 3½ years. Infants showing massive brain damage at birth and/or severe mental retardation at 7 months of age were excluded from this analysis. The remainder were predominantly poor and nonwhite. The group showed normal cognitive development through age 15 months. By 28 months of age and thereafter, a severe decline in cognitive status proved to be associated with social class. In addition, serious behavioral maladjustment led to improverished cognitive development. The incidence of maladjustment was unrelated to social class. The impact of maladjustment on test scores was significant in all classes, but greater for the higher rather than the lower socioeconomic social groups. Neither neurologic pathology (excepting severe brain damage) nor gestational age (small for gestational age [SGA] vs appropriate for gestational age [AGA]) had a significant effect on IQ scores at 3½ years of age. It is suggested that environmental deficits and stresses impair early cognitive and psychosocial development for both full-term and premature infants, but that the latter group is more vulnerable to environmental insufficiencies than are full-term babies.

scholarly journals The impact of level of neonatal care provision on outcomes for preterm babies born between 27 and 31 weeks of gestation, or with a birth weight between 1000 and 1500 g: a review of the literature

2020 ◽  
Vol 4 (1) ◽  
pp. e000583
Author(s):  
Abdul Qader Tahir Ismail ◽  
Elaine M Boyle ◽  
Thillagavathie Pillay
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Large Scale ◽  
Meta Analysis ◽  
Significant Heterogeneity ◽  
Place Of Birth ◽  
Preterm Babies ◽  
Assess Quality ◽  
The Impact

ObjectiveThere is evidence that birth and care in a maternity service associated with a neonatal intensive care unit (NICU) is associated with improved survival in preterm babies born at <27 weeks of gestation. We conducted a systematic review to address whether similar gains manifested in babies born between 27+0 and 31+6 weeks (hereafter 27 and 31 weeks) of gestation, or in those with a birth weight between 1000 and 1500 g.MethodsWe searched Embase, Medline and CINAHL databases for studies comparing outcomes for babies born between 27 and 31 weeks or between 1000 and 1500 g birth weight, based on designation of the neonatal unit where the baby was born or subsequently cared for (NICU vs non-NICU setting). A modified QUIPS (QUality In Prognostic Studies) tool was used to assess quality.ResultsNine studies compared outcomes for babies born between 27 and 31 weeks of gestation and 11 studies compared outcomes for babies born between 1000 and 1500 g birth weight. Heterogeneity in comparator groups, birth locations, gestational age ranges, timescale for mortality reporting, and description of morbidities facilitated a narrative review as opposed to a meta-analysis.ConclusionDue to paucity of evidence, significant heterogeneity and potential for bias, we were not able to answer our question—does place of birth or care affect outcomes for babies born between 27 and 31 weeks? This supports the need for large-scale research to investigate place of birth and care for babies born in this gestational age range.

scholarly journals Restricted Palivizumab Recommendations and the Impact on RSV Hospitalizations among Infants Born at > 29 Weeks of Gestational Age: An Italian Multicenter Study

2019 ◽  
Vol 36 (S 02) ◽  
pp. S77-S82
Author(s):  
Elena Priante ◽  
Elena Tavella ◽  
Elisa Girardi ◽  
Maria Angela Militello ◽  
Veronica Mardegan ◽  
...  
Keyword(s):  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Hospital Admissions ◽  
Respiratory Infections ◽  
Cost Benefit ◽  
Respiratory Viruses ◽  
Before And After ◽  
Cost Benefit Ratio ◽  
Syncytial Virus ◽  
The Impact

Objective Premature infants have the highest risk of being hospitalized with respiratory syncytial virus (RSV) infections. Palivizumab is the only licensed agent for RSVhospitalization (RSVH) prophylaxis in infants born at < 35 weeks of gestational age (wGA). In 2016, the Italian Drug Agency (Agenzia Italiana del Farmaco [AIFA]) has restricted the eligibility for reimbursement to infants at high risk of RSVH, ruling out palivizumab administration for infants born at > 29 wGA. The aim of the present study was to compare the incidence of RSVH in two consecutive epidemic seasons (2015–2016 vs. 2016–2017), that is, before and after the new AIFA recommendations on palivizumab eligibility. Study Design This was a noninterventional retrospective cohort study conducted at three neonatal intensive care units (NICUs) in northern Italy. Infants born at 29 and 35 wGA between March 15, 2015 and March 14, 2017 were enrolled for this study. Electronic medical charts were reviewed and parents were interviewed by telephone. Data were collected on neonatal course during NICU stay, palivizumab administration, and hospitalizations related to respiratory infections during the 1st year of life, comparing the infants born in season 1 with season 2. Results Of 632 eligible infants, data were available for 536 (262 in season 1 and 274 in season 2). Overall, RSVH occurred 1.9 and 5.1% in infants in seasons 1 and 2, respectively (odds ratio [OR] = 2.77; 95% confidence interval [CI]: 0.98–7.8, p = 0.045). When the analysis was limited to patients not exposed to palivizumab, RSVHs were recorded for 1.8 and 5.9% infants in seasons 1 and 2, respectively (OR = 3.42; 95% CI: 0.96–12.20, p = 0.045). It is noteworthy that the incidence of hospital admissions for respiratory viruses other than RSV did not differ between the two seasons. Conclusion Restricting eligibility for palivizumab reimbursement led to a significant increase in RSVH but had no impact on hospitalizations for other respiratory viruses. Future decisions on palivizumab prescription and coverage rules should be driven by a careful assessment of the cost-benefit ratio.

scholarly journals In Silico Mathematical Modelling for Glioblastoma: A Critical Review and a Patient-Specific Case

2021 ◽  
Vol 10 (10) ◽  
pp. 2169
Author(s):  
Jacopo Falco ◽  
Abramo Agosti ◽  
Ignazio G. Vetrano ◽  
Alberto Bizzi ◽  
Francesco Restelli ◽  
...  
Keyword(s):  
Mathematical Modelling ◽  
Mathematical Models ◽  
Critical Review ◽  
English Language ◽  
Theoretical Models ◽  
Patient Specific ◽  
Tumor Control ◽  
Tumor Evolution ◽  
Radiological Data ◽  
The Impact

Glioblastoma extensively infiltrates the brain; despite surgery and aggressive therapies, the prognosis is poor. A multidisciplinary approach combining mathematical, clinical and radiological data has the potential to foster our understanding of glioblastoma evolution in every single patient, with the aim of tailoring therapeutic weapons. In particular, the ultimate goal of biomathematics for cancer is the identification of the most suitable theoretical models and simulation tools, both to describe the biological complexity of carcinogenesis and to predict tumor evolution. In this report, we describe the results of a critical review about different mathematical models in neuro-oncology with their clinical implications. A comprehensive literature search and review for English-language articles concerning mathematical modelling in glioblastoma has been conducted. The review explored the different proposed models, classifying them and indicating the significative advances of each one. Furthermore, we present a specific case of a glioblastoma patient in which our recently proposed innovative mechanical model has been applied. The results of the mathematical models have the potential to provide a relevant benefit for clinicians and, more importantly, they might drive progress towards improving tumor control and patient’s prognosis. Further prospective comparative trials, however, are still necessary to prove the impact of mathematical neuro-oncology in clinical practice.

scholarly journals ASSOCIATION OF THE IMPACT OF POSTNATAL NUTRITION ON THE GROWTH OF PRETERM INFANTS <34 WEEKS GESTATIONAL AGE FROM BIRTH TO DISCHARGE

2020 ◽  
pp. 63-67
Author(s):  
JITENDRA SINGH FAUJDAR ◽  
KALPANA SINGH ◽  
RAJVEER SINGH YADAV ◽  
JITENDRA KUMAR GUPTA ◽  
MUNISH KAKKAR ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Nutritional Supplement ◽  
Preterm Neonates ◽  
Preterm Baby ◽  
Medical College ◽  
Gandhi Medical College ◽  
The Impact

Objectives: The objectives of the study were to measure the actual daily amount of each nutrient (protein, glucose, and fat) energy and fluid as per current ESPGHAN guidelines for preterm infants and to analyze the role of nutrients at different gestational age on growth and weight of preterm infants. Material and Methods: An observational and prospective cohort study was conducted from January 1, 2018, to December 31, 2018. This study included all preterm infants born <34 weeks gestational age admitted in the neonatal intensive care unit during this period at Mahatma Gandhi Medical College and Hospital. A total of 120 preterm neonates were studied. Results: There were mean weight, length, and head circumference continues to rise till the study end. Mean energy at birth was also continues to rise till the end. Conclusion: In the study, proper nutritional supplement as per ESPHAGEN guidelines was used for the development of preterm infant. The study showed that there were statistically significant results with anthropometry parameters with preterm baby growth in all domains.

scholarly journals Small for Gestational Age in Late Preterm Deliveries - The Impact of Antenatal Corticosteroids on Perinatal Outcome

2021 ◽  
Author(s):  
KEREN ZLOTO ◽  
Eyal Krispin ◽  
Anat Shmueli ◽  
Eran Hadar ◽  
Lina Salman
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Neonatal Intensive Care ◽  
Medical Center ◽  
Multivariate Regression Analysis ◽  
Late Preterm ◽  
Intrauterine Fetal Death ◽  
Antenatal Corticosteroids ◽  
The Impact

Abstract Purpose The aim of this study is to evaluate the impact of antenatal corticosteroids (ACS) on late preterm small for gestational age neonates. Methods A retrospective cohort study of all women, carrying a singleton gestation, who had late preterm delivery (34 + 0–36 + 6, gestational weeks) of small for gestational age neonates, in a single, tertiary, university-affiliated medical center (July 2012- December 2017). Exclusion criteria included: birth weight above the 10th percentile, termination of pregnancy and intrauterine fetal death. Outcomes were compared between those who were treated with ACS prior to delivery and those who did not receive ACS. The primary outcome was neonatal composite outcome which included: neonatal intensive care unit admission, respiratory distress syndrome, mechanical ventilation and transient tachypnea of the newborn. Results Overall, 228 women met inclusion criteria.102 (44.7%) received ACS and 126 did not (55.3%). Birth weight among non-ACS group was significantly higher (1880.38 ± 171.54 vs 1774.84 ± 229.15 grams p < 0.001). Rates of NICU and Jaundice requiring phototherapy were higher among the ACS group (53.92% vs 31.74%, p = 0.01 and 12.74% vs 5.55%, p = 0.05, respectively). Composite neonatal outcome was significantly higher among the ACS group (53.92% vs 32.53%, OR 2.42, CI 1.41–4.15, p = 0.01). After adjustment for potential confounders, using multivariate regression analysis this association remained significant (OR 2.38, 95% CI 1.39–4.10, p = 0.002). Conclusion Our findings suggest that ACS delivered during pregnancy did not improve respiratory adverse outcome for SGA neonates born in late preterm. ACS in this specific cohort might be associated with worse outcome than those not treated with ACS.

scholarly journals Peripherally Inserted Central Catheters: Evaluation of Diluted Lipid Emulsion as Lubricant for Improved Guidewire Removal in a Neonatal Population.

2021 ◽  
Author(s):  
Matheus F.P.T. van Rens ◽  
Ratheesh Paramban ◽  
Airene L.V. Francia ◽  
Kalpana Singh ◽  
Prem Chandra ◽  
...  
Keyword(s):  
Intensive Care ◽  
Vascular Access ◽  
Neonatal Intensive Care ◽  
Supportive Therapy ◽  
Research Centre ◽  
Control Group ◽  
Peripherally Inserted Central Catheters ◽  
The Impact ◽  
Central Catheters ◽  
Neonatal Population

Abstract Background: Medical management of neonates is often predicated upon safe and reliable vascular access which may be related to physiological monitoring, medical treatment, supportive therapy and diagnostic or procedural purposes. For this, peripherally inserted central catheters (PICCs) are deemed safe to provide vascular access and infusion related therapy in the neonatal intensive care setting. Purpose: PICCs are associated with a reduced incidence of complications compared to short peripheral catheters. Despite a reduced complication rate, the impact for the patient has to be considered severe. Difficult PICC guidewire removal during the insertion procedure is known to cause catheter damage, resulting in leakage or breakage of the catheter itself. The aim of this study was to assess and compare the incidence of therapy failure related to the use of preflush fluids (normal saline (NSS) versus diluted lipid solution(DLS)) used before PICC guidewire removal. Method and Setting: This was a retrospective observational study and performed on the Neonatal Intensive Care Unit (NICU) of the Women’s Wellness and Research Centre, Hamad Medical Corporation, Qatar. The single site study included 507 neonates who required intravenous therapy. Results: The results show that the use of a diluted lipid preflush resulted in significantly less therapy failures, compared with the control group. This remains significant after adjusting for day of insertion, gestational age, birth weight and catheter type.Conclusion: DLS preflush demonstrated a benefit over the use of a NSS preflush to enhance PICC guidewire removal in patients admitted to the NICU. The risk for the development of maintenance-related complications leading to premature removal of the device, decreased significantly if the preflush DLS was used. During the study period no known complications related to the used lipid solution were identified. Implications for Practice and Research: This study is the first of its kind ever published in international literature and supports the enhancement of guidewire removal by using a diluted lipid preflush. When the requirement for vascular access is most pertinent, using a diluted lipid preflush is a safe and effective method to remove the guidewire in order to facilitate long-term vascular access amongst the neonatal population.

Sign in / Sign up

Export Citation Format

Share Document