Hypoxemia associated with lumbar puncture in neonates

Objectives: The objectives of the study were to study the effect of different stages of lumber puncture (LP) procedure on oxygen saturation (SpO2) in newborn baby. Materials and Methods: It was a 1-year, prospective observational study conducted in a tertiary care hospital. Forty neonates were included who fulfilled the inclusion criteria. SpO2 was measured during the different stages of LP in the recruited newborns and comparison was done between SpO2 changes in LP duration of <5 min and more than 5 min groups and the effect on SpO2 in preterm and term babies during LP. Results: Mean SpO2 during baseline, flexion, needle insertion, immediate repositioning, and 5 min after procedure were 94.5, 91.82, 88.92, 94.7, and 95.38, respectively. When compare to baseline, drop in SpO2 was found during flexion and needle insertion with p = 0.0025 and <0.0001, respectively. While comparing Mean SpO2 during different phases between duration of LP >5 min versus <5 min group, the saturation was less during flexion positioning with maximum fall at the time of needle insertion in LP duration >5 min. The regain of saturation during repositioning was more in LP <5 min versus duration >5 min group. Comparing between LP duration >5 min versus <5 min group, fall in SpO2 from baseline (5 min before LP procedure) was more in LP duration >5 min group during flexion and needle insertion phase. Hypoxemia is more in preterm than term neonates during flexion and during needle insertion, supine repositioning. Furthermore, hypoxia recovered after 5 min of supine repositioning more in term infants. Conclusions: Significant hypoxia was associated in newborn in flexion and needle insertion phase of lumbar puncture, especially in preterm newborns and those with prolonged duration of procedure.

Newborn skin maturity models for gestational age prediction

A multicenter clinical trial evaluated the accuracy of a novel device to detect preterm newborns. A portable multiband reflectance photometric device assessed 781 newborns’ skin maturity and used machine learning models to predict reference gestational age, adjusting it to birth weight and antenatal corticosteroid therapy exposure. The day difference between the reference and the test had a median of -1.4 (IQR: -2.1). Using established methods such as comparator ultrasound and last menstrual period (LMP), the medians were 0 (IQR: 4) and 0.01 (IQR: 4), respectively. For prematurity discrimination, the area under the receiver operating characteristic curve (AUROC) was 0.986 (95% CI: 0.977 to 0.994). In newborns with absent or unreliable LMP, the intent-to-discriminate analysis showed that the test generated correct classifications 95.8% of the time. The assessment of the newborn's skin maturity adjusted by learning models promises accurate pregnancy dating at birth without the use of antenatal ultrasound reference.

Effects of Late Surfactant Treatment Delivered After a Recruitment Maneuver on Respiratory Outcomes in Extremely Low Gestational Age Newborns: A Randomized Controlled Pilot Trial – LATE-REC-SURF Trial.

Background Mechanical ventilation is still needed in most preterm newborns, even in the non-invasive ventilation era. Ventilator-induced lung injury is one of the known pathogenetic factors of bronchopulmonary dysplasia (BPD) in preterm newborns. Lung injury has several patterns including surfactant dysfunction. Some recent trials have showed that a late surfactant administration can improve respiratory outcome in preterm babies still on invasive ventilation after the first week of life. Unfortunately, these results are still not conclusive. Moreover, giving surfactant after a recruitment manoeuvre in High Frequency Oscillatory Ventilation (HFOV) was shown to be safe and to reduce mortality in extremely preterm infants in a recent RCT. Our aim is to test the hypothesis that endotracheal administration of poractant-alfa preceded by a recruitment manoeuvre in HFOV in preterm infants still requiring mechanical ventilation at 7-10 days of life could facilitate extubation. Methods/Design: This will be an unblinded monocentric pilot trial that will be conducted in a III level Neonatal Intensive Care Unit at Fondazione Policlinico Agostino Gemelli IRCCS in Rome - Italy. Preterm newborns with a gestational age < 28 weeks still requiring invasive mechanical ventilation at 7-10 days of life with a fraction of inspired oxygen (FiO2) of more than 0.30 and/or an oxygenation index of 8 or more for at least 6 hours will be eligible for the study. Patients will be randomly assigned to intervention or to standard care. Intervention group infants will receive up to 4 doses of Poractant-alfa every 12 hours, each dose preceded by a recruitment manoeuvre in HFOV, until extubation. Primary endpoint will be the first successful extubation. Discussion Surfactant therapy is nowadays recommended in case of RDS in the first days of life but little is known about its effects in ventilator-dependant preterm newborns. Late administration of surfactant could help healing the lung of preterm babies in which RDS is evolving in a chronic pulmonary insufficiency of prematurity. The findings of this pilot trial will permit evaluation of the study design for a full-scale RCT. Trial registration: Clinicaltrials.gov – ID NCT04825197. Registered 12 April 2021, https://clinicaltrials.gov/ct2/home

Neurological, cognitive and learning evaluation of students who were born preterm

ABSTRACT Objective: To evaluate the cognitive and academic profile of preterm newborns at school age and to determine the factors related to prematurity and sociodemographic profile that influence these results. Methods: Patients aged 6-14 years old that were assisted in the preterm follow-up clinic were recruited. The cognitive, academic, and neurological capacities were accessed through a detailed evaluation with a child neurologist, a neuropsychologist and a psychopedagogue. Neonatal data were collected from patient records. Results: 97 children were included and 14 were excluded from the study, resulting in 83 children. Gestational age (GA) was 30±3 weeks and weight at birth was 1138g (605 to 4185g). Poor performance was shown in 38.4% for writing, 57.5% for reading and 42.5% for mathematics. The mean total intelligence quotient (IQ) was 96±14.9 points, and 10.9% were considered altered. Children with unstructured families presented 78.3% of failure in reading tests (p=0.029). The multivariate analysis showed association between GA at birth and classic mini-mental score (p=0.043), total IQ (p=0.047), perceptual organization IQ (p=0.035), and processing speed IQ (p=0.036). There was also association between weight at birth and the classic (p=0.004) and adapted (p=0.007) mini-mental scores; invasive mechanic ventilation duration and classic mini-mental (p=0.049); and lower maternal age and processing speed IQ (p=0.033). Conclusions: Preterm infants at school age had high frequency of failure in cognitive and academic evaluation tests. Learning difficulties are high among them. Multiple neonatal variables are related with altered cognitive and students development.

Newborn skin maturity models for gestational age prediction

A multicenter clinical trial evaluated the accuracy of a novel device to detect preterm newborns. A portable multiband reflectance photometric device assessed 781 newborns’ skin maturity and used machine learning models to predict reference gestational age, adjusting it to birth weight and antenatal corticosteroid therapy exposition. The day difference between the reference and the test had a median of -1.4 (IQR: -2.1). Using established methods such as comparator ultrasound and last menstrual period (LMP), the medians were 0 (IQR: 4) and 0.01 (IQR: 4), respectively. For prematurity discrimination, the area under the receiver operating characteristic curve (AUROC) was 0.986 (95% CI: 0.977 to 0.994). In newborns with absent or unreliable LMP, the intent-to-discriminate analysis showed that the test generated correct classifications 95.8% of the time. The assessment of the newborn's skin maturity adjusted by learning models promises accurate pregnancy dating at birth without the use of antenatal ultrasound reference.

Overview on Fluid, Electrolyte and Nutrition Management of the Newborn and Pre-term Newborns

Often in extremely preterm newborns in the early postnatal daysproblems in fluid and electrolyte balance occur Due to excessive insensible water loss and renal immaturity. The dietary care of newborn newborns is challenged by the demands of growth and organ development. The stress of a serious disease makes it much more difficult to get enough nourishment. Newborns andespecially premature newborns must be assessed thoroughly for fluid and electrolytes balance. Calculating the fluid and electrolyte demand for sustaining metabolic activities, replacing losses (evaporative, third space, external), and considering pre-existing fluid imbalance are all part of effective fluid and electrolyte management. When a neonate's size or condition prevents them from receiving enteral nutrition, parenteral nutrition can help them grow and thrive. Although eating through the gastrointestinal tract is the recommended method of nutritional management, some situations necessitate the use of PN as an adjuvant or sole treatment. In this article we discuss fluid electrolytes and Nutritional management using parenteral nutrition.

Extrauterine Growth Restriction in Preterm Infants: How to Achieve Optimal Catch-Up Growth During Hospitalization?

Extrauterine growth restriction (EUGR), a serious risk that potentially impairs the growth of preterm infants after birth and during childhood, triggers a thought of how to achieve optimal catch-up growth during hospitalization.We aimed to access the incidence of optimal catch-up growth in small-for-gestational-age (SGA), appropriate-for-gestational age (AGA) and large-for-gestational-age (LGA) infants, and identify the factors for optimal catch-up growth in preterm infants during hospitalization. Premature infants admitted to Shanghai Children’s Medical Center within 24 hours after birth from January 1,2016 to December 31, 2018 were enrolled. Prenatal, neonatal etiological, and nutrition data were collected and analyzed to identify factors associated with optimal catch-up growth during hospitalization. 105 (9.9%) of 1065 preterm newborns achieved predischarge optimal catch-up growth, including 27 (17.2%) of 157 SGA, 74 (8.5%) of 868 AGA, and 4 (10.0%) of 40 LGA infants. Logistic regression analysis indicated SGA, avoiding BPD and less days to regain birth weight as the contributing factors of optimal catch-up growth during hospitalization.Conclusion: SGA infants showed greater potential in predischarge optimal catch-up growth. Early abundant nutrition and avoiding BPD are essential for achieving optimal catch-up growth during hospitalization.