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Advances in Healthcare for Neonates Volume II

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A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Neonatology".

Deadline for manuscript submissions: closed (10 February 2024) | Viewed by 18945

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Prof. Dr. Vasanth Kumar

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Professor of Pediatrics, Jacob School of Medicine & Biomedical Sciences University at Buffalo, 1001 5th Floor Main Street Buffalo, NY 14203, USA
Interests: biomedical engineering; developmental lung biology; global health; lung inflammation and infection; bronchopulmonary dysplasia; brain injury; neonatal resuscitation
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Dear Colleagues,

Significant advances in neonatology with the discovery of surfactant, inhaled nitric oxide, ventilation management strategies, and the development of whole-body cooling have contributed to substantial improvements in survival and reduced morbidity in premature newborns. In addition, ongoing incremental changes in practices, such as gentle ventilation strategies, the importance of breastfeeding, neurodevelopment care, and quality assurance projects, have contributed to lower morbidity and improved quality of life in these fragile newborns. Therefore, this Special Issue, titled Advances in Healthcare for Neonates, will welcome articles in all fields of neonatal or perinatal medicine from across the globe, with a specific focus on the management and development of infants.

Prof. Dr. Vasanth Kumar
Guest Editor

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Keywords

morbidity and mortality
newborns
bronchopulmonary dysplasia
brain injury
growth
neurodevelopmental outcomes
clinical outcomes
quality assurance

Published Papers (12 papers)

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15 pages, 2227 KiB

Open AccessArticle

Trends in Amplitude-Integrated Electroencephalography in the Smallest Preterm Neonates

by Kristina Štuikienė, Elke Griesmaier, Ilona Aldakauskienė, Regina Vidmantė, Kastytis Šmigelskas and Rasa Tamelienė

Children 2024, 11(5), 566; https://doi.org/10.3390/children11050566 - 8 May 2024

Viewed by 366

Abstract

Background. Amplitude-integrated electroencephalography is increasingly used for the neuromonitoring of premature infants. However, it is still not clear how bioelectrical activity changes in the smallest gestational age newborns. The aim of our study was to evaluate the bioelectrical activity of amplitude-integrated electroencephalograms in premature newborns of different gestational age to assess how gestational age and postnatal age influence patterns of amplitude-integrated electroencephalograms and to test the hypothesis of whether the bioelectrical activity of the brain matures faster after the birth of premature newborns than in utero. Methods. We prospectively included infants born before 32 weeks of gestational age between June 2020 and July 2022. Serial recordings of amplitude-integrated electroencephalograms were performed at three time points of age (days 1–3, 13–15, and 27–29). Recordings were analyzed for background patterns, the onset and appearance of cyclicity, and lower amplitude border and bandwidth, which were used to derive a composite Burdjalov score. Results. In total, 140 premature neonates were included in the study, and 112 of them completed the study. The median gestational age of the newborns enrolled in the study was 29 (27–30) weeks, and the mean weight was 1206 (350) g. Burdjalov scores increased with increasing gestational age. Higher scores were observed in every dimension of the amplitude-integrated electroencephalograms for newborns of lower gestational age when compared to newborns of higher gestational age of the same postmenstrual age. There was a significant correlation between gestational age and parameters of amplitude-integrated electroencephalograms at all time points. Conclusions. A higher gestational age has a positive effect on the bioelectrical activity of amplitude-integrated electroencephalograms. Increasing postnatal age affected amplitude-integrated electroencephalograms more than gestational age. Our hypothesis that the bioelectrical activity of the brain matures faster for premature newborns after birth than in the womb was confirmed. Full article

(This article belongs to the Special Issue Advances in Healthcare for Neonates Volume II)

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10 pages, 275 KiB

Open AccessArticle

Effects of an Educational Intervention Program on Positional Cranial Deformity in Premature Infants

by Alexandra Mosca-Hayler, Daniela López-Schmidt, Romina Curotto-Noce, Jorge Cuevas-Aburto, Jaime Vásquez-Gómez, Samuel Durán-Agüero, Juana Borja González, Ximena Diaz-Martínez, Rafael Zapata-Lamana, María Antonia Parra-Rizo and Igor Cigarroa

Children 2024, 11(3), 302; https://doi.org/10.3390/children11030302 - 4 Mar 2024

Viewed by 978

Abstract

Positional cranial deformities are associated with prematurity evolving during the first 2 years of life due to the malleable characteristics of the skull, the first year being the main/primary therapeutic window for intervention. The objectives were (a) to describe health characteristics, peri- and postnatal pathologies, and positional cranial deformities in infants enrolled in an early intervention program and (b) to analyze the effects of a parent education-based intervention program on positional cranial deformity in premature infants. A quantitative, analytical, longitudinal study was conducted. It included 103 premature infants enrolled in an early intervention program (EIP) during the year 2017, all under 4 months of corrected age, to whom a parent education-based intervention program was applied. Cranial circumference, cranial width, diagonals, and anteroposterior diameter were measured, and the cranial asymmetry index (CAI) and cephalic index (CI) were calculated at baseline and during two subsequent evaluations separated by a 3-month period. The main results showed that 75.7% of the infants belonged to a very premature gestational age category, and 57.3% had an adequate weight for gestational age. The most frequent pathologies were premature jaundice, premature anemia, and hyaline membrane disease. The most frequent positional cranial deformity was plagiocephaly. The parent education-based intervention program resulted in (1) a significant decrease in the CAI and a significant increase in the IC, (2) plagiocephalies: an increase in the mild category and a decrease in the moderate + severe categories, (3) brachycephalies: a decrease in the absence category and an increase in the moderate + severe category, and (4) dolichocephalies: an increase in the absence category and a decrease in the mild category. In conclusion, the recommended first line of intervention was not enough for this population, and future studies should support the development of national clinical guidelines, where education is complemented with other therapeutic measures. Full article

(This article belongs to the Special Issue Advances in Healthcare for Neonates Volume II)

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13 pages, 467 KiB

Open AccessArticle

Diagnostic Utility of Interleukin-6 in Early-Onset Sepsis among Term Newborns: Impact of Maternal Risk Factors and CRP Evaluation

by Maria Schleier, Julia Lubig, Sven Kehl, Steven Hébert, Joachim Woelfle, Adriana van der Donk, Alisa Bär, Heiko Reutter, Tobias Hepp and Patrick Morhart

Children 2024, 11(1), 53; https://doi.org/10.3390/children11010053 - 30 Dec 2023

Cited by 1 | Viewed by 967

Abstract

(1) Background: Interleukin-6 (IL-6) levels act as an early infection marker preceding C-reactive protein (CRP) elevation. This study seeks to analyze IL-6 behavior in suspected early-onset sepsis (EOS) cases among term newborns, comparing it to that of CRP and evaluating IL-6’s diagnostic utility. We also aim to assess the impact of maternal risk factors on EOS in term newborns, quantifying their influence for informed decision making. (2) Methods: The retrospective data analysis included 533 term newborns who were admitted to our hospital because of suspected EOS. IL-6, CRP, and the impact of maternal risk factors were analyzed in the context of EOS using binomial test, Chi-squared test, logistic and linear regression. (3) Results: In the cases of EOS, both IL-6 and CRP were elevated. The increase in CRP can be predicted by the initial increase in IL-6 levels. Among the assessed risk factors, intrapartum maternal fever (adjusted odds ratio 18.1; 95% CI (1.7–4.1)) was identified as the only risk factor significantly associated with EOS. (4) Conclusions: Employing IL-6 as an early infection marker enhanced EOS diagnostic precision due to its detectable early rise. However, caution is required, as elevations in IL-6 and CRP levels do not exclusively indicate EOS. Increased CRP levels in healthy newborns with maternal risk factors may be attributed to dynamics of vaginal labor. Full article

(This article belongs to the Special Issue Advances in Healthcare for Neonates Volume II)

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10 pages, 512 KiB

Open AccessArticle

Exclusive Breastfeeding in Health Personnel: Incidence and Barriers

by Tongta Nanthakomon, Sonthaya Nukaw and Sudatip Kositamongkol

Children 2023, 10(8), 1424; https://doi.org/10.3390/children10081424 - 21 Aug 2023

Viewed by 1018

Abstract

Exclusive breastfeeding for 6 months (EBF) in healthcare personnel is challenging due to work schedules, high workloads, or separation issues. This study aimed to evaluate the incidence and factors related to EBF in our hospital personnel. Material and Methods: This was a cross-sectional study. Female employees who took maternity leave within 2 years were approached. A questionnaire regarding factors associated with EBF was sent to participants. Factors associated with EBF were analyzed using logistic regression analysis. Results: There were 110 mothers enrolled. The mean maternal age was 32.5 ± 4.21 years, 66.36% came from the nursing department, the infant’s age was 6–24 months, and 46.4% of mothers had previous breastfeeding experience. Our EBF for 6 months rate was 63.6%. Breastfeeding attitude (OR = 1.12, 95%CI 1.08–1.38), perception of breastfeeding obstacle (OR = 1.45, 95%CI 1.26–1.66), breastfeeding behavior (OR = 1.17, 95%CI 1.08–1.26), and support from health system (OR = 1.09, 95%CI 1.01–1.19) were significantly associated with EBF. From multiple logistic regression models, perception of breastfeeding obstacles (aOR 1.55, 95%CI 1.27–1.90), breastfeeding behavior (aOR 1.12, 95%CI 1.01–1.24), and support from health care system (aOR 0.84, 95%CI 0.72–0.97) remain the significant factors associated with successful EBF. Conclusion: Successful EBF was prevalent in mothers who had good attitudes to breastfeeding, perceived low levels of obstacles, and had support from the health care system. Full article

(This article belongs to the Special Issue Advances in Healthcare for Neonates Volume II)

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10 pages, 1277 KiB

Open AccessArticle

Iatrogenic Esophageal Perforation in Premature Infants: A Multicenter Retrospective Study from Poland

by Aleksandra Mikołajczak, Katarzyna Kufel, Joanna Żytyńska-Daniluk, Magdalena Rutkowska and Renata Bokiniec

Children 2023, 10(8), 1399; https://doi.org/10.3390/children10081399 - 16 Aug 2023

Viewed by 1031

Abstract

Greater awareness of possible iatrogenic esophageal perforation (EP) is needed. Though rare, EP is a legitimate health risk as it may lead to long-term morbidities. This study presents and discusses iatrogenic EP in a subset of preterm infants. Using radiographic images, we study and describe the consequences of the orogastric/nasogastric tube position (in radiographic images). We analyze the possible influence of histological chorioamnionitis on the development of esophageal perforation. This retrospective study examines the hospital records of 1149 preterm infants, 2009–2016, with very low birth weight (VLBW) and iatrogenic EP, comparing mortalities and morbidities between the two groups of preterm infants who had birth weights (BWs) of less than 750 g and were less than 27 weeks gestation age at birth: one group with iatrogenic esophageal perforation (EP group) and one group without perforation (non-EP group—the control group). Histopathological chorioamnionitis of the placenta showed no statistically significant differences between the groups. The only statistically significant difference was in the air leaks (p = 0.01). Three types of nasogastric tube (NGT) X-ray location were identified, depending on the place of the perforation: (1) high position below the carina mimicking esophageal atresia; (2) low, intra-abdominal; (3) NGT right pleura-directed. We also highlight the particular symptoms that may be indicative of EP due to a displacement of the nasogastric tube. Full article

(This article belongs to the Special Issue Advances in Healthcare for Neonates Volume II)

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14 pages, 2963 KiB

Open AccessArticle

The Effect of Incubator Cover on Newborn Vital Signs: The Design of Repeated Measurements in Two Separate Groups with No Control Group

by Kenan Çetin and Behice Ekici

Children 2023, 10(7), 1224; https://doi.org/10.3390/children10071224 - 14 Jul 2023

Cited by 1 | Viewed by 1150

Abstract

(1) Background: During their stays in neonatal intensive care units (NICU), newborns are exposed to many stimuli that disrupt their physiological indicators. The aim of this study was to investigate the impact of the light–dark cycle created with and without an incubator cover on the vital signs of term and preterm newborns. (2) Methods: A repeated measures design was used in the study utilizing two separate groups, without a control group. The study included 91 neonates hospitalized in a NICU (44 term and 47 preterm). With and without an incubator cover, the newborns’ vital signs (heart rate (HR), respiratory rate (RR), oxygen saturation (SpO₂), and body temperature (BT)) were measured. Three separate measurements were taken. (3) Results: The mean age of the newborns was 37.0 weeks. There was no significant difference between the HR and RR medians of the term and preterms in the incubator undraped and clad measurements (p > 0.05). At the first measurement, the SpO₂ medians of the incubator-covered term and preterms were significantly higher than those of the incubator-covered term and preterms (p = 0.001). (4) Conclusions: The vital signs of the neonates demonstrated variable responses in the measurements when their incubators were covered vs. when they were not covered. However, more research on the effect of the light-dark cycle on their vital signs is required. Full article

(This article belongs to the Special Issue Advances in Healthcare for Neonates Volume II)

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12 pages, 921 KiB

Open AccessArticle

The Effect of Maternal SARS-CoV-2 Infection on Neonatal Outcome

by Melinda Matyas, Madalina Valeanu, Monica Hasmasanu, Bianca Voina, Adelina Tutu and Gabriela C. Zaharie

Children 2023, 10(5), 771; https://doi.org/10.3390/children10050771 - 25 Apr 2023

Cited by 3 | Viewed by 1170

Abstract

(1) Background: Neonates born to SARS-CoV-2 positive mothers are at risk of infection, as well as adverse outcomes due to the infection. The aim of our study was to analyze the impact of maternal SARS-CoV-2 infection on neonatal outcome. (2) Methods: We conducted a prospective, longitudinal study. We collected data on maternal symptomatology upon admission and their correlation with the development of the infant. Through a questionnaire we analyzed the impact on breastfeeding of the separation of the mother from the newborn, as well as the maternal psycho-emotional effect. (3) Results: Ninety infants were enrolled in the study, from one twin pregnancy and the rest singleton pregnancies. Out of the 89 mothers, 34 showed symptoms. Neonates from mothers with anosmia and ageusia had a higher value of WBC and lymphocytes (p = 0.06 and p = 0.04). Breastfeeding was started in 57.3% of mothers after their discharge from hospital and only 41.6% of the whole study group continued at the follow-up visit. Mothers who described a negative experience during hospitalization associated a 2.42 times higher risk of not continuing breastfeeding. (4) Conclusion: None of the infants enrolled in the study had SARS-CoV-2 infection either at birth or within the first two months of life. Breastfeeding was started with more than half newborns after discharge from hospital. The negative experience generated by the separation from their babies influenced breastfeeding. Full article

(This article belongs to the Special Issue Advances in Healthcare for Neonates Volume II)

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10 pages, 1137 KiB

Open AccessArticle

Postnatal Outcomes of Fetuses with Prenatal Diagnosis of 6–9.9 mm Pyelectasis

by Sivan Farladansky-Gershnabel, Hadar Gluska, Segev Meyer, Maya Sharon-Weiner, Hanoch Schreiber, Shmuel Arnon and Ofer Markovitch

Children 2023, 10(2), 407; https://doi.org/10.3390/children10020407 - 19 Feb 2023

Cited by 2 | Viewed by 4576

Abstract

Pyelectasis, also known as renal pelvic dilatation or hydronephrosis, is frequently found on fetal ultrasound. This study correlated prenatally-detected, moderate pyelectasis with postnatal outcomes. This retrospective, observational study was conducted at a tertiary medical center in Israel. The study group consisted of 54 fetuses with prenatal diagnosis of pyelectasis on ultrasound scan during the second trimester, defined as anteroposterior renal pelvic diameter (APRPD) 6–9.9 mm. Long-term postnatal outcomes and renal-related sequelae were obtained using medical records and telephone-based questionnaires. The control group included 98 cases with APRPD < 6 mm. Results indicate that fetal pyelectasis 6–9.9 mm was more frequent among males (68.5%) than females (51%, p = 0.034). We did not find significant correlations between 6–9.9 mm pyelectasis and other anomalies or chromosomal/genetic disorders. Pyelectasis resolved during the pregnancy in 15/54 (27.8%) cases. There was no change in 17/54 (31.5%) and 22/54 (40.7%) progressed to hydronephrosis Among the study group, 25/54 (46.3%) were diagnosed with neonatal hydronephrosis. There were more cases of renal reflux or renal obstruction in the study group compared to the control group 8/54 (14.8%) vs. 1/98 (1.0%), respectively; p = 0.002. In conclusion, most cases of 6–9.9 mm pyelectasis remained stable or resolved spontaneously during pregnancy. There was a higher rate of postnatal renal reflux and renal obstruction in this group; however, most did not require surgical intervention. Full article

(This article belongs to the Special Issue Advances in Healthcare for Neonates Volume II)

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11 pages, 275 KiB

Open AccessArticle

The Effect of External Cephalic Version on Fetal Circulation: A Prospective Cohort Study

by Offra Engel, Shmuel Arnon, Gil Shechter Maor, Hanoch Schreiber, Ettie Piura and Ofer Markovitch

Children 2023, 10(2), 354; https://doi.org/10.3390/children10020354 - 10 Feb 2023

Cited by 1 | Viewed by 1448

Abstract

External cephalic version (ECV) is a cost-effective and safe treatment option for breech presentation at term. Following ECV, fetal well-being is assessed via a non-stress test (NST). An alternative option to identify signs of fetal compromise is via the Doppler indices of the umbilical artery (UA), middle cerebral artery (MCA) and ductus venosus (DV). Inclusion criteria were an uncomplicated pregnancy with breech presentation at term. Doppler velocimetry of the UA, MCA and DV were performed up to 1 h before and up to 2 h after ECV. The study included 56 patients who underwent elective ECV with a success rate of 75%. After ECV, the UA S/D ratio, UA pulsatility index (PI) and UA resistance index (RI) were increased compared to before the ECV (p = 0.021, p = 0.042, and p = 0.022, respectively). There were no differences in the Doppler MCA and DV before or after ECV. All patients were discharged after the procedure. ECV is associated with changes in the UA Doppler indices that might reflect interference in placental perfusion. These changes are probably short-term and have no detrimental effects on the outcomes of uncomplicated pregnancies. ECV is safe; yet it is a stimulus or stress that can affect placental circulation. Therefore, careful case selection for ECV is important. Full article

(This article belongs to the Special Issue Advances in Healthcare for Neonates Volume II)

11 pages, 690 KiB

Open AccessArticle

Cleft Lip and/or Cleft Palate: Prenatal Accuracy, Postnatal Course, and Long-Term Outcomes

by Sivan Farladansky-Gershnabel, Hadar Gluska, Nufar Halevi, Neta Kotser, Maya Sharon-Weiner, Hanoch Schreiber, Rivka Sukenik-Halevi, Yaniv Ebner, Shmuel Arnon and Ofer Markovitch

Children 2022, 9(12), 1880; https://doi.org/10.3390/children9121880 - 30 Nov 2022

Cited by 3 | Viewed by 1634

Abstract

Orofacial clefts include cleft lip (CL) and cleft palate (CP). This retrospective study assessed the efficacy of prenatal sonographic diagnosis of isolated and non-isolated cases of CL/CP and the postnatal outcomes of these children. Data regarding patients diagnosed and treated in the tertiary orofacial clinic from 2000 to 2020 were retrieved from electronic medical records and telephone-based questionnaires. Isolated CL was found in 7 cases (7.2%), isolated CP in 51 (53%), and combined CL/CP in 38 (39.5%), and 22 cases (23%) were associated with other anomalies. Among 96 cases, 39 (40.6%) were diagnosed prenatally. Isolated CL was diagnosed in 5/7 (71.5%), combined clefts in 29/38 (76.3%), and CP in 7/51 (13.8%). Prenatal chromosomal analysis performed in 32/39 (82%) cases was normal for all. The rate of surgical intervention in the first year of life was 36/38 (94.7%) for combined clefts, 5/7 (71.4%) for CL, and 20/51 (39%) for isolated CP. Most children had speech therapy (23/38 (60.5%), 3/7 (42.8%), and 41/51 (80.3%), respectively) and psychotherapy (6/38 (15.7%), 3/7 (42.8%) and, 15/51 (29.4%), respectively). The accuracy rate of sonographic prenatal diagnosis is low. Our results emphasize the suggested work-up of fetuses with CL and/or CP and improvements to parental counseling, as well as their understanding and compliance regarding post-natal therapeutic plans. Full article

(This article belongs to the Special Issue Advances in Healthcare for Neonates Volume II)

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7 pages, 536 KiB

Open AccessCommunication

Regional Splanchnic Oxygenation during Continuous versus Bolus Feeding among Stable Preterm Infants

by Gisela Laura Sirota, Ita Litmanovitz, Carmel Vider, Shmuel Arnon, Shiran Sara Moore, Eynit Grinblatt, Orly Levkovitz and Sofia Bauer Rusek

Children 2022, 9(5), 691; https://doi.org/10.3390/children9050691 - 9 May 2022

Cited by 2 | Viewed by 1690

Abstract

Introduction: There is no agreement regarding the best method for tube-feeding preterm infants. Few studies, to date, have evaluated the influence of different methods of enteral feeding on intestinal oxygenation. The use of near-infrared spectroscopy (NIRS) has permitted the noninvasive measurement of splanchnic regional oxygenation (rSO₂S) in different clinical conditions. The aim of this prospective, single-center study was to compare rSO₂S during continuous versus bolus feeding among stable preterm infants. Methods: Twenty-one preterm infants, less than 32 weeks gestation and appropriate for gestational age, were enrolled. All infants were clinically stable and on full tube feedings. Each infant received a bolus feeding initially (20 min duration), and after 3 h, a continuous feeding (5 h duration). Infants were evaluated 30 min before and 30 min after the bolus and continuous feedings. The regional splanchnic saturation (rSO₂S) was measured using near-infrared spectroscopy (NIRS) technology and systemic saturation was measured with pulse oximetry. From these measurements, we calculated the splanchnic fractional oxygen extraction ratio (FOES) for each of the four intervals. Results: rSO₂S decreased after continuous vs. bolus feeding (p = 0.025), while there was a trend toward decreased SaO₂ after bolus feeding (p = 0.055). The FOES, which reflects intestinal oxygen extraction, was not affected by the feeding mode (p = 0.129). Discussion/Conclusion: Continuous vs. bolus feeding decreases rSO₂S but does not affect oxygen extraction by intestinal tissue; after bolus feeding there was a trend towards decreased systemic saturation. Full article

(This article belongs to the Special Issue Advances in Healthcare for Neonates Volume II)

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Review

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21 pages, 357 KiB

Open AccessReview

“Light” on Phototherapy—Complications and Strategies for Shortening Its Duration, A Review of the Literature

by Irit Shoris, Ayala Gover, Arina Toropine, Adir Iofe, Rasha Zoabi-Safadi, Svetlana Tsuprun and Arieh Riskin

Children 2023, 10(10), 1699; https://doi.org/10.3390/children10101699 - 17 Oct 2023

Cited by 1 | Viewed by 2026

Abstract

Neonatal hyperbilirubinemia is an extremely common metabolic complication of the neonatal period which may be associated with bilirubin encephalopathy and even death. Adverse neurological consequences are preventable if a timely diagnosis and treatment are provided. Phototherapy is usually the preferred option to decrease hyperbilirubinemia. Although considered to be safe, evidence in recent years has shown that this treatment may not be free of side effects and short- and long-term unfavorable outcomes. These are usually mild or rare, but should be decreased or avoided if possible. Many useful complementary measures and treatments have been described that could shorten the duration of exposure to phototherapy. However, there is no current unequivocal recommendation to use any of the methods presented in this review. Our review aims to depict the wide range of possible complementary treatments to phototherapy, and to provide the scientific and clinical evidence available regarding their usefulness. It is essential that, while utilizing the full potential of phototherapy to treat hyperbilirubinemia, caregivers are aware of its side effects and possible inherent dangers, and seek ways to minimize the exposure to phototherapy to what is really needed for the newborn. Further studies are needed to clarify the preferred complementary treatments that could reduce the duration of exposure to phototherapy without impairing its effectiveness. Full article

(This article belongs to the Special Issue Advances in Healthcare for Neonates Volume II)

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