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Children
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Advances in NICU Health Care
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Advances in NICU Health Care

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

Deadline for manuscript submissions: closed (10 April 2024) | Viewed by 15344

Special Issue Editor

Dr. Boris Filipović-Grčić

E-Mail Website
Guest Editor
Department of Pediatrics, Clinical Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
Interests: neonatal intensive care; organization of neonatal care; preterm newborns; persistent pulmonary hypertension; newborn sepsis; education in delivery room management

Special Issue Information

Dear Colleagues,

Only in neonatology have advances over the years made such tremendous steps forward, saving a huge number of people. We know that approximately 5–10% of newborns will require support upon delivery and later on. The same number of newborns will be treated for some time in the Neonatal Intensive Care Unit—NICU. Since the first NICUs emerged in USA in the 1960s, our abilities to treat extremely preterm newborns or those with complicated illnesses, such as hypoxic-ischemic encephalopathy, organ failure, or congenital anomalies, are still growing. Many conditions became rare due to preventive measures (e.g., Rh isoimmunization), but our methodology and the appearance of a new modalities (such as iNO) reduced mortality, morbidity, and long-term consequences in large number of sick newborns. As well as new methods, changes in daily practice, including minimal manipulation and nurturing, family centered care, the discovery of breast milk benefits, the reduction of blood sampling, and others, also gave us the opportunity to offer substantially improved chances for intact survival in the most venerable group of people.

We are inviting review articles, original research, and case reports from across the world which will provide more information on all clinical, organizational, or scientific progress which were made in neonatology. The authors can contact the editor directly at [email protected] with any further questions.

Dr. Boris Filipović-Grčić
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • newborn
  • Neonatal Intensive Care Unit
  • neuroprotective strategies in newborn
  • stabilization and resuscitation in delivery room
  • obstetrical prevention of newborn conditions
  • neurodevelopmental care in NICU
  • outcomes of the NICU treatment

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Published Papers (8 papers)

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Research

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11 pages, 2575 KiB  
Article
Impact of Nutritional Status on Total Brain Tissue Volumes in Preterm Infants
by Cyndi Valdes, Parvathi Nataraj, Katherine Kisilewicz, Ashley Simenson, Gabriela Leon, Dahyun Kang, Dai Nguyen, Livia Sura, Nikolay Bliznyuk and Michael Weiss
Children 2024, 11(1), 121; https://doi.org/10.3390/children11010121 - 18 Jan 2024
Cited by 1 | Viewed by 1803
Abstract
Preterm infants bypass the crucial in utero period of brain development and are at increased risk of malnutrition. We aimed to determine if their nutritional status is associated with brain tissue volumes at term equivalent age (TEA), applying recently published malnutrition guidelines for [...] Read more.
Preterm infants bypass the crucial in utero period of brain development and are at increased risk of malnutrition. We aimed to determine if their nutritional status is associated with brain tissue volumes at term equivalent age (TEA), applying recently published malnutrition guidelines for preterm infants. We performed a single center retrospective chart review of 198 infants < 30 weeks’ gestation between 2018 and 2021. We primarily analyzed the relationship between the manually obtained neonatal MR-based brain tissue volumes with the maximum weight and length z-score. Significant positive linear associations between brain tissue volumes at TEA and weight and length z-scores were found (p < 0.05). Recommended nutrient intake for preterm infants is not routinely achieved despite efforts to optimize nutrition. Neonatal MR-based brain tissue volumes of preterm infants could serve as objective, quantitative and reproducible surrogate parameters of early brain development. Nutrition is a modifiable factor affecting neurodevelopment and these results could perhaps be used as reference data for future timely nutritional interventions to promote optimal brain volume. Full article
(This article belongs to the Special Issue Advances in NICU Health Care)
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11 pages, 534 KiB  
Article
Comprehensive Analysis of Risk Factors for Bronchopulmonary Dysplasia in Preterm Infants in Taiwan: A Four-Year Study
by Lin-Yi Huang, Ting-I Lin, Chyi-Her Lin, San-Nan Yang, Wan-Ju Chen, Chien-Yi Wu, Hsien-Kuan Liu, Pei-Ling Wu, Jau-Ling Suen, Jung-Sheng Chen and Yung-Ning Yang
Children 2023, 10(11), 1822; https://doi.org/10.3390/children10111822 - 17 Nov 2023
Cited by 1 | Viewed by 1337
Abstract
Bronchopulmonary dysplasia (BPD) is a major respiratory condition mainly affecting premature infants. Although its occurrence is global, risk factors may differ regionally. This study, involving 3111 infants with birth weight ≤ 1500 gm or gestational age (GA) < 30 weeks, aimed to identify [...] Read more.
Bronchopulmonary dysplasia (BPD) is a major respiratory condition mainly affecting premature infants. Although its occurrence is global, risk factors may differ regionally. This study, involving 3111 infants with birth weight ≤ 1500 gm or gestational age (GA) < 30 weeks, aimed to identify risk factors for BPD and BPD/mortality in Taiwan using data from the Taiwan Neonatal Network. The BPD criteria were based on the National Institute of Child Health and Human Development standards. Average GA was 27.5 weeks, with 23.7% classified as small for GA (SGA). Multivariate analysis highlighted low GA, low birth weight, and other perinatal factors as significant risk indicators for BPD. For moderate-to-severe BPD, additional risk factors included male gender and SGA, endotracheal intubation (ETT) or cardiopulmonary cerebral resuscitation (CPCR) in initial resuscitation. In the moderate-to-severe BPD/death group, SGA and ETT or CPCR in initial resuscitation remained the only additional risk factors. The study pinpoints male gender, SGA and ETT or CPCR as key risk factors for moderate-to-severe BPD/death in low-birth-weight infants in Taiwan, offering a basis for focused interventions and further research. Full article
(This article belongs to the Special Issue Advances in NICU Health Care)
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14 pages, 1745 KiB  
Article
Trends in Neonatal Mortality at Princess Marie Louise Children’s Hospital, Accra, and the Newborn Strategic Plan: Implications for Reducing Mortality in Hospital and the Community
by Edem M. A. Tette, Edmund T. Nartey, Mame Yaa Nyarko, Abena K. Aduful and Margaret L. Neizer
Children 2023, 10(11), 1755; https://doi.org/10.3390/children10111755 - 29 Oct 2023
Cited by 1 | Viewed by 1892
Abstract
Background: In low and middle-income countries, close to half of the mortality in children under the age of five years occurs in neonates. Objectives: We examined the trend, medical conditions and factors associated with newborn deaths at the Princess Marie Louise Children’s Hospital [...] Read more.
Background: In low and middle-income countries, close to half of the mortality in children under the age of five years occurs in neonates. Objectives: We examined the trend, medical conditions and factors associated with newborn deaths at the Princess Marie Louise Children’s Hospital (PML), Accra, from 2014 to 2017 (4 years). Methods: The study was a cross-sectional study. Data on age, sex, date of admission, date of discharge, cause of death and place of residence of these babies were obtained from the records department. This was transferred into an Access database and analyzed. Components of the Newborn Strategic Plan implemented at the hospital were described. Results: Neonatal sepsis, pneumonia and kernicterus were the major causes of death. Admissions increased and 5.4% of the neonates died, declining from 6.5% in 2014 to 4.2% in 2017 due to deliberate actions to reduce neonatal death. The highest mortality occurred in babies residing in an area more than 1 hour’s drive away from the hospital. Conclusion: Implementing the Newborn Strategic Plan was associated with a drop in mortality. A preponderance of community-acquired infections was observed. Thus, locality-specific interventions targeted at known determinants and implementing the newborn strategic plan are essential for reducing neonatal mortality. Full article
(This article belongs to the Special Issue Advances in NICU Health Care)
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13 pages, 1319 KiB  
Article
Application of Next-Generation Sequencing to Enterobacter Hormaechei Subspecies Analysis during a Neonatal Intensive Care Unit Outbreak
by Patrick Morhart, Roman G. Gerlach, Caroline Kunz, Jürgen Held, Giuseppe Valenza, Joachim Wölfle, Heiko Reutter, Gregor J. Hanslik and Fabian B. Fahlbusch
Children 2023, 10(10), 1696; https://doi.org/10.3390/children10101696 - 16 Oct 2023
Cited by 4 | Viewed by 1791
Abstract
Introduction: The Enterobacter cloacae complex (ECC) species are potential neonatal pathogens, and ECC strains are among the most commonly encountered Enterobacter spp. associated with nosocomial bloodstream infections. Outbreaks caused by ECC can lead to significant morbidity and mortality in susceptible neonates. At the [...] Read more.
Introduction: The Enterobacter cloacae complex (ECC) species are potential neonatal pathogens, and ECC strains are among the most commonly encountered Enterobacter spp. associated with nosocomial bloodstream infections. Outbreaks caused by ECC can lead to significant morbidity and mortality in susceptible neonates. At the molecular level, ECC exhibits genomic heterogeneity, with six closely related species and subspecies. Genetic variability poses a challenge in accurately identifying outbreaks by determining the clonality of ECC isolates. This difficulty is further compounded by the limitations of the commonly used molecular typing methods, such as pulsed field gel electrophoresis, which do not provide reliable accuracy in distinguishing between ECC strains and can lead to incorrect conclusions. Next-generation sequencing (NGS) offers superior resolution in determining strain relatedness. Therefore, we investigated the clinical pertinence of incorporating NGS into existing bundle measures to enhance patient management during an outbreak of ECC in a level-3 neonatal intensive care unit (NICU) in Germany. Methods: As the standard of care, all neonates on the NICU received weekly microbiological swabs (nasopharyngeal and rectal) and analysis of endotracheal secretion, where feasible. During the 2.5-month outbreak, colonisation with ECC was detected in n = 10 neonates. The phylogenetic relationship and potential antimicrobial resistance genes as well as mobile genetic elements were identified via bacterial whole-genome sequencing (WGS) using Illumina MiSeq followed by in silico data analysis. Results: Although all ECC isolates exhibited almost identical antimicrobial susceptibility patterns, the WGS data revealed the involvement of four different ECC clones. The isolates could be characterised as Enterobacter hormaechei subspecies steigerwaltii (n = 6, clonal), subsp. hoffmannii (n = 3, two clones) and subsp. oharae (n = 1). Despite the collection of environmental samples, no source of this diffuse outbreak could be identified. A new standardised operating procedure was implemented to enhance the management of neonates colonised with MRGN. This collaborative approach involved both parents and medical professionals and successfully prevented further transmission of ECC. Conclusions: Initially, it was believed that the NICU outbreak was caused by a single ECC clone due to the similarity in antibiotic resistance. However, our findings show that antibiotic susceptibility patterns can be misleading in investigating outbreaks of multi-drug-resistant ECC. In contrast, bacterial WGS accurately identified ECC at the clonal level, which significantly helped to delineate the nature of the observed outbreak. Full article
(This article belongs to the Special Issue Advances in NICU Health Care)
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Review

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30 pages, 674 KiB  
Review
Amenable Mortality in Children under 5: An Indicator for Identifying Inequalities in Healthcare Delivery: A Review
by Eduardo Navarro-Jimenez, Pedro Saturno-Hernández, Marta Jaramillo-Mejía and Vicente Javier Clemente-Suárez
Children 2024, 11(7), 764; https://doi.org/10.3390/children11070764 - 24 Jun 2024
Viewed by 1583
Abstract
Universal health coverage has been proposed as a strategy to improve health in low- and middle-income countries, but this depends on a good provision of health services. Under-5 mortality (U5M) reflects the quality of health services, and its reduction has been a milestone [...] Read more.
Universal health coverage has been proposed as a strategy to improve health in low- and middle-income countries, but this depends on a good provision of health services. Under-5 mortality (U5M) reflects the quality of health services, and its reduction has been a milestone in modern society, reducing global mortality rates by more than two-thirds between 1990 and 2020. However, despite these impressive achievements, they are still insufficient, and most deaths in children under 5 can be prevented with the provision of timely and high-quality health services. The aim of this paper is to conduct a literature review on amenable (treatable) mortality in children under 5. This indicator is based on the concept that deaths from certain causes should not occur in the presence of timely and effective medical care. A systematic and exhaustive review of available literature on amenable mortality in children under 5 was conducted using MEDLINE/PubMed, Cochrane CENTRAL, OVID medline, Scielo, Epistemonikos, ScienceDirect, and Google Scholar in both English and Spanish. Both primary sources, such as scientific articles, and secondary sources, such as bibliographic indices, websites, and databases, were used. Results: The main cause of amenable mortality in children under 5 was respiratory disease, and the highest proportion of deaths occurred in the perinatal period. Approximately 65% of avoidable deaths in children under 5 were due to amenable mortality, that is, due to insufficient quality in the provision of health services. Most deaths in all countries and around the world are preventable, primarily through effective and timely access to healthcare (amenable mortality) and the management of public health programs focused on mothers and children (preventable mortality). Full article
(This article belongs to the Special Issue Advances in NICU Health Care)
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Other

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10 pages, 714 KiB  
Perspective
Music Therapy in the Neonatal Intensive Care Unit: A Center’s Experience with Program Development, Implementation, and Preliminary Outcomes
by Carmina Erdei, Kim Schlesinger, Meredith R. Pizzi and Terrie E. Inder
Children 2024, 11(5), 533; https://doi.org/10.3390/children11050533 - 29 Apr 2024
Viewed by 2716
Abstract
Background: The role of music in the NICU continues to evolve, with recent studies documenting the positive impact of music therapy for hospitalized infants and families. With many potential benefits and no substantial adverse effects reported to date in medically stable infants, we [...] Read more.
Background: The role of music in the NICU continues to evolve, with recent studies documenting the positive impact of music therapy for hospitalized infants and families. With many potential benefits and no substantial adverse effects reported to date in medically stable infants, we aimed to create a clinical guideline to integrate this therapy into the NICU operations. Methods: we launched and implemented a pilot music therapy clinical program within a subunit of a level-III NICU, building upon available evidence. Results: In this report, we describe our experience with initial program development and early outcomes in terms of population served, frequency of music therapy, and therapeutic modalities employed to implement service delivery. Conclusion: we highlight the importance of establishing practices that are aligned with currently available data and recommendations, in order to facilitate delivery of a safe, evidence-based, meaningful therapeutic experience with monitoring of preliminary effects of the therapy on all those involved in the experience. Full article
(This article belongs to the Special Issue Advances in NICU Health Care)
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8 pages, 1979 KiB  
Case Report
Neonatal Enterovirus-Associated Myocarditis in Dizygotic Twins: Myocardial Longitudinal Strain Pattern Analysis
by Stefania Giampetruzzi, Domenico Sirico, Nicoletta Mainini, Marta Meneghelli, Enrico Valerio, Sabrina Salvadori and Giovanni Di Salvo
Children 2024, 11(5), 506; https://doi.org/10.3390/children11050506 - 24 Apr 2024
Viewed by 1689
Abstract
Enteroviruses (EVs) are the most common causes of viral myocarditis in neonates. Neonatal enterovirus myocarditis manifestations range from nonspecific febrile illness to congestive heart failure and cardiogenic shock with high risk of in-hospital mortality and long-term cardiac sequelae. Early recognition is essential to [...] Read more.
Enteroviruses (EVs) are the most common causes of viral myocarditis in neonates. Neonatal enterovirus myocarditis manifestations range from nonspecific febrile illness to congestive heart failure and cardiogenic shock with high risk of in-hospital mortality and long-term cardiac sequelae. Early recognition is essential to undertake appropriate therapy and predict outcomes. Echocardiography and echo-derived left ventricular strain measures seem promising for these purposes. We herein report two cases of neonatal enterovirus-associated myocarditis in dichorionic diamniotic twins, with different presentation, clinical course, and intensity of treatments. Full article
(This article belongs to the Special Issue Advances in NICU Health Care)
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8 pages, 818 KiB  
Brief Report
Blood Glucose, Lactate and Platelet Count in Infants with Spontaneous Intestinal Perforation versus Necrotizing Enterocolitis—A Pilot Study
by Jacky Herzlich, Dror Mandel, Ronella Marom, Rafael Mendelsohn, Audelia Eshel Fuhrer and Laurence Mangel
Children 2023, 10(6), 1028; https://doi.org/10.3390/children10061028 - 8 Jun 2023
Viewed by 1469
Abstract
The incidence of spontaneous intestinal perforation (SIP) increases up to 10% with decreasing gestational age (GA). We aimed to explore early biomarkers for predicting SIP in preterm infants. In this case–control study, neonates born at ≤34 weeks GA diagnosed with SIP were compared [...] Read more.
The incidence of spontaneous intestinal perforation (SIP) increases up to 10% with decreasing gestational age (GA). We aimed to explore early biomarkers for predicting SIP in preterm infants. In this case–control study, neonates born at ≤34 weeks GA diagnosed with SIP were compared with GA and/or birth-weight-matched neonates diagnosed with necrotizing enterocolitis (NEC). Laboratory markers assessed prior and adjacent to the day of SIP or NEC diagnosis were evaluated. The cohort included 16 SIP and 16 matched NEC infants. Hyperlactatemia was less frequent in SIP than in NEC infants (12% vs. 50%, p = 0.02). The platelets count was lower in SIP than in NEC infants (p < 0.001). Glucose levels strongly correlated with lactate levels (p = 0.01) only in the NEC group. The odds of being diagnosed with SIP decreased as lactate levels increased (OR = 0.607, 95% CI: 0.377–0.978, p = 0.04). Our results suggest that a combination of laboratory markers, namely glucose and lactate, could help differentiate SIP from NEC at early stages so that, in the presence of an elevated blood glucose, an increase in blood lactate was associated with a decrease in the odds of being diagnosed with SIP. Full article
(This article belongs to the Special Issue Advances in NICU Health Care)
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