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BACKGROUND: Before the advent of antenatal steroids, early non-invasive respiratory support (NIV), and intratracheal surfactant, antenatal terbutaline was also used to improve lung compliance and reduce the incidence of respiratory distress syndrome (RDS). OBJECTIVES: The objective of this paper was to study the association between antenatal terbutaline and endotracheal intubation (ET) within the first 24 hours of life, RDS, bronchopulmonary dysplasia (BPD), and intraventricular hemorrhage (IVH) in infants with the gestational age (GA) of <32 weeks, and to study the association between antenatal terbutaline, and ET or NIV within the first 24 hours of life, and RDS in infants with the GA of 32 to 36 weeks. METHOD: This was a retrospective medical record review of preterm infants delivered at a single tertiary care center from October 2016 to December 2020. Multivariable logistic regression was used to explore the association between antenatal terbutaline and neonatal respiratory support. RESULT: 1,794 infants were included, 234 (13.0%) had the GA of <32 weeks and 1,560 (86.9%) had the GA of 32 to 36 weeks. Antenatal terbutaline, corticosteroid, or both agents were administered in 561 (31.3%), 1,461 (81.4%), and 555 (30.9%), respectively. Antenatal terbutaline was significantly associated with a reduction in ET (adjusted odds ratio [aOR] = 0.40, 95% confident interval [CI] 0.19-0.82, p = 0.012) in infants with the GA of <32 weeks, but not in infants with the GA of 32-36 weeks. Antenatal terbutaline was not associated with RDS or BPD but was significantly associated with a reduction in grade III-IV IVH (aOR 0.11, CI 0.01-0.98; p = 0.048), in infants with the GA of <32 weeks. CONCLUSION: In a state-of-the-art neonatal care setting, antenatal terbutaline was associated with a reduction in ET during the first 24 hours in infants with the GA of <32 weeks. The use of antenatal terbutaline to improve acute neonatal respiratory outcomes merits reconsideration. KEY POINTS: · The neonatal respiratory benefits of antenatal terbutaline in the era of antenatal corticosteroids were uncertain.. · Terbutaline is associated with a reduction in endotracheal intubation in a modern care setting.. · The role of terbutaline, and potentially other betamimetics, to improve neonatal respiratory outcomes merits reconsideration..
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BACKGROUND: Umbilical cord blood gas values are better indicators of perinatal asphyxia than Apgar scores. Many studies have reported normal ranges of umbilical cord blood gases, which vary greatly due to many factors. This study aimed to establish the reference values of umbilical cord blood gases of normal cesarean newborns in a university hospital setting. MATERIAL AND METHOD: Blood samples from the umbilical artery and vein were collected from 160 newborns delivered by elective cesarean section. The indications for caesarean section were not due to fetal distress, intrauterine growth retardation, or non-reassuring fetal heart rate. The blood samples were collected immediately after birth in the operating room and then sent for blood-gas analysis. The blood-gas values were statistically analyzed and reported. RESULTS: The cord blood collected from 160 newborns was analyzed in this study. Seventy-eight percent (115) of the parturients were hypotensive before delivery. All Apgar scores at one and five minutes after delivery were at least 7. The calculated reference range of the umbilical arterial pH was 7.18-7.42, of pO2was 6.43-29.43 mmHg, of pCO2was 33.44-66.56 mmHg, and of HCO3was 15.60-30.70 mEq/L. The reference range obtained for the umbilical venous pH was 7.28-7.44,for pO2was 13.97-37.13 mmHg, for pCO2was 30.70-57.0 mmHg, and for HCO3was 18.50-29.90 mEq/L. CONCLUSION: The study determined normal reference values as a result of umbilical cord blood gas analyses.
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Cesárea , Sangre Fetal/química , Adulto , Puntaje de Apgar , Análisis de los Gases de la Sangre , Procedimientos Quirúrgicos Electivos , Femenino , Humanos , Concentración de Iones de Hidrógeno , Recién Nacido , Embarazo , Valores de ReferenciaRESUMEN
PURPOSE: To develop prediction models for severe retinopathy of prematurity (ROP) based on risk factors in preterm Thai infants to reduce unnecessary eye examinations in low-risk infants. METHODS: This retrospective cohort study included preterm infants screened for ROP in a tertiary hospital in Bangkok, Thailand, between September 2009 and December 2020. A predictive score model and a risk factor-based algorithm were developed based on the risk factors identified by a multivariate logistic regression analysis. Validity scores, and corresponding 95% confidence intervals (CIs), were reported. RESULTS: The mean gestational age and birth weight (standard deviation) of 845 enrolled infants were 30.3 (2.6) weeks and 1264.9 (398.1) g, respectively. The prevalence of ROP was 26.2%. Independent risk factors across models included gestational age, birth weight, no antenatal steroid use, postnatal steroid use, duration of oxygen supplementation, and weight gain during the first 4 weeks of life. The predictive score had a sensitivity (95% CI) of 92.2% (83.0, 96.6), negative predictive value (NPV) of 99.2% (98.1, 99.6), and negative likelihood ratio (NLR) of 0.1. The risk factor-based algorithm revealed a sensitivity of 100% (94, 100), NPV of 100% (99, 100), and NLR of 0. Similar validity was observed when "any oxygen supplementation" replaced "duration of oxygen supplementation." Predictive score, unmodified, and modified algorithms reduced eye examinations by 71%, 43%, and 16%, respectively. CONCLUSIONS: Our risk factor-based algorithm offered an efficient approach to reducing unnecessary eye examinations while maintaining the safety of infants at risk of severe ROP. Prospective validation of the model is required.
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Edad Gestacional , Recien Nacido Prematuro , Retinopatía de la Prematuridad , Humanos , Retinopatía de la Prematuridad/diagnóstico , Retinopatía de la Prematuridad/epidemiología , Estudios Retrospectivos , Recién Nacido , Factores de Riesgo , Masculino , Tailandia/epidemiología , Femenino , Peso al Nacer , Medición de Riesgo/métodos , Algoritmos , Prevalencia , Tamizaje Neonatal/métodos , Valor Predictivo de las Pruebas , Pueblos del Sudeste AsiáticoRESUMEN
Objectives: The management of patent ductus arteriosus (PDA) is a critical concern in premature infants, and different hospitals may have varying treatment policies, fluid management strategies, and incubator humidity. The Asian Neonatal Network Collaboration (AsianNeo) collected data on prematurity care details from hospitals across Asian countries. The aim of this study was to provide a survey of the current practices in the management of PDA in premature infants in Asian countries. Methods: AsianNeo performed a cross-sectional international questionnaire survey in 2022 to assess the human and physical resources of hospitals and clinical management of very preterm infants. The survey covered various aspects of hospitals resources and clinical management, and data were collected from 337 hospitals across Asia. The data collected were used to compare hospitals resources and clinical management of preterm infants between areas and economic status. Results: The policy of PDA management for preterm infants varied across Asian countries in AsianNeo. Hospitals in Northeast Asia were more likely to perform PDA ligation (p < 0.001) than hospitals in Southeast Asia. Hospitals in Northeast Asia had stricter fluid restrictions in the first 24â h after birth for infants born at <29 weeks gestation (p < 0.001) and on day 14 after birth for infants born at <29 weeks gestation (p < 0.001) compared to hospitals in Southeast Asia. Hospitals in Northeast Asia also had a more humidified environment for infants born between 24 weeks gestation and 25 weeks gestation in the first 72â h after birth (p < 0.001). A logistic regression model predicted that hospitals were more likely to perform PDA ligation for PDA when the hospitals had a stricter fluid planning on day 14 after birth [Odds ratio (OR) of 1.70, p = 0.048], more incubator humidity settings (<80% vs. 80%-89%, OR of 3.35, p = 0.012 and <80% vs. 90%-100%, OR of 5.31, p < 0.001). Conclusions: In advanced economies and Northeast Asia, neonatologists tend to adopt a more conservative approach towards fluid management, maintain higher incubator humidity settings and inclined to perform surgical ligation for PDA.
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The study was performed to evaluate the accuracy of the StatStrip (SS) and SureStep Flexx (SF) glucose meters compared to plasma glucose in infants at risk for neonatal hypoglycemia and to determine the effect of bilirubin and hematocrit on the results. A prospective cross-sectional study was conducted on 172 venous blood glucose samples from infants who had initial low point-of-care (POC) glucose tests measured simultaneously by SS and SF. Plasma glucose levels were compared to both POC instruments, and the effect of bilirubin and hematocrit levels on mean glucose differences were analysed. Mean (SD) plasma glucose was 2.12 (0.45) mmol/L; (range, 1.11-3.06 mmol/L). Mean (1.96SD) glucose differences of the SS versus SF were 0.21 (0.70) mmol/L and -0.04 (0.78) mmol/L, respectively. SS sensitivity was 94.7 % with an 86.1 % negative predictive value (NPV) at 2.8 mmol/L, while the SF had a 100 % sensitivity and NPV at the same cut-off level. No correlations were identified between mean glucose differences and either hematocrit or bilirubin levels in both glucose meters. Both the SS and SF glucose meters have limited use when compared to plasma glucose. Hence, they can only be employed as screening tools in at-risk neonates with an appropriate, predetermined cut-off level. Hematocrit and bilirubin levels did not affect the accuracy of both devices.
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Análisis Químico de la Sangre/instrumentación , Glucemia/análisis , Hipoglucemia/diagnóstico , Sistemas de Atención de Punto , Biomarcadores/análisis , Biomarcadores/metabolismo , Glucemia/metabolismo , Estudios Transversales , Femenino , Humanos , Hipoglucemia/sangre , Recién Nacido , Masculino , Valor Predictivo de las Pruebas , Estudios Prospectivos , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: Human hindmilk contains higher concentrations of fat than foremilk and is more desirable for growth in preterm infants who can tolerate limited volumes of breastmilk. There is currently no clear demarcation between foremilk and hindmilk. This study characterized the change in breastmilk's fat content from the start to end of milk flow and defined this demarcation. METHODS: Mothers of infants born at ≤ 32 weeks gestational age and ≥ 14 days after childbirth in a University hospital in Bangkok, Thailand between July, 2011, and April, 2012 were included in this cross-sectional study. Breastmilk samples were sequentially collected from the start to end of milk flow in 5-mL aliquots using breast pumps. The fat content of each aliquot from each breast was determined through creamatocrit. The average creamatocrit of foremilk and hindmilk were compared in predefined foremilk to hindmilk ratios of 20:80, 25:75, 33:67, and 50:50. Creamatocrit of the first and last aliquots were compared for mothers who expressed low- (≤ 25-mL per breast) and high-volumes (> 25-mL per breast) of breastmilk. RESULTS: Of the 25 mothers enrolled, one was excluded due to unsuccessful creamatocrit measurement. The last aliquot of breastmilk had a significantly higher creamatocrit than the first from the same breast (median [interquartile range] of 12.7% [8.9%, 15.3%] vs. 5.6% [4.3%, 7.7%]; test statistic 1128, p < 0.001). Mean creamatocrit in hindmilk portions (9.23%, 9.35%, 9.81%, and 10.62%, respectively) was significantly higher than foremilk portions (6.28%, 6.33%, 6.72%, and 7.17%, respectively) at all predefined ratios. Creamatocrit increased by 1% for every 10% incremental increase in expressed breastmilk volume until the breast was emptied. Low-volume mothers had a significantly higher creamatocrit in the first aliquot compared with high-volume mothers (U = 437, p = 0.002). No significant difference in breastmilk volume was observed between mothers with and without breastfeeding experience. CONCLUSIONS: Fat content in breastmilk increased on an incremental basis. More fluid definitions of foremilk and hindmilk should be adopted. Mothers should prepare their breastmilk into aliquots based on the required feeding volume of their infant. Hindmilk aliquots can be prioritized over foremilk aliquots to ensure infants obtain optimal caloric intake.
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Lactancia Materna , Recien Nacido Prematuro , Lactante , Femenino , Embarazo , Recién Nacido , Humanos , Estudios Transversales , Tailandia , Leche HumanaRESUMEN
OBJECTIVES: To determine the incidence of hyperferritinemia in VLBW infants, and its association with neonatal morbidity. STUDY DESIGN: Prospective cohort study in a tertiary-level hospital in Bangkok, from March 2022 to January 2023. Serum ferritin (SF) was measured in VLBW infants at one month and repeated monthly for those with hyperferritinemia (SF > 300 ng/mL). RESULTS: Gestational age and birth weight were 29.7 ± 2.4 weeks (mean ± SD) and 1100 g (IQR, 830, 1340). Hyperferritinemia was identified in 30.1% (95% CI, 20.8-41.4). After adjustment, only packed red cell transfusion >15 mL/kg was associated with hyperferritinemia (RR 3.1; 95% CI, 1.5-6.4). All elevated SF levels returned to normal within four months. Hyperferritinemia was associated with severe bronchopulmonary dysplasia (RR 2.3, 95% CI, 1.0-5.4) and retinopathy of prematurity (RR 3.5, 95% CI, 1.4-8.6). CONCLUSION: Hyperferritinemia is common among our VLBW infants, particularly after transfusion, and is associated with severe BPD and ROP.
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PURPOSE: To validate Postnatal Growth and Retinopathy of Prematurity (G-ROP) criteria for Thai infants. STUDY DESIGN: A retrospective review of infants receiving ROP screening during 2009-2020. METHODS: Baseline characteristics, clinical progression and final ROP outcomes were collected. G-ROP was applied to infants who met at least one of the following 6 criteria: birth weight (BW) below 1051 g, gestational age (GA) under 28 weeks, weight gain (WG) less than 120 g during postnatal day 10-19, WG less than 180 g during day 20-29, WG less than 170 g during day 30-39 and hydrocephalus. RESULTS: A total of 684 infants (boys, 53.4%) were included. Median (IQR) BW was 1200 (960-1470) grams and median GA was 30 (28-32) weeks. Prevalence of ROP was 26.6%, with 28 (4.1%) having type 1, 19 (2.8%) type 2 and, 135 (19.7%) having other ROP. Treatment was performed in 26 infants (3.8%). Sensitivity of G-ROP to include type 1, 2 or treatment-requiring ROP cases was 100% with 36.9% specificity, excluding 235 (34.4%) cases of unnecessary screening. To adjust for our setting of initial eye examination at 4 weeks' postnatal date, the last 2 criteria of G-ROP were replaced by the occurrence of grade 3 or 4 intraventricular hemorrhage (IVH). This modified G-ROP criteria yielded 100% sensitivity, 42.5% specificity and excluded 271 (39.6%) cases of unnecessary screening. CONCLUSION: G-ROP criteria can be applied to our hospital setting. Occurrence of IVH grade 3 or 4 was proposed as an alternative in modified G-ROP criteria.
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Desarrollo Infantil , Tamizaje Masivo , Retinopatía de la Prematuridad , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Peso al Nacer , Hemorragia Cerebral Intraventricular , Edad Gestacional , Crecimiento , Hidrocefalia , Recien Nacido Extremadamente Prematuro/crecimiento & desarrollo , Recien Nacido Prematuro , Recién Nacido de muy Bajo Peso/crecimiento & desarrollo , Tamizaje Masivo/métodos , Retinopatía de la Prematuridad/diagnóstico , Estudios Retrospectivos , Factores de Riesgo , Pueblos del Sudeste Asiático , Tailandia , Aumento de Peso , Selección de PacienteRESUMEN
Advances in perinatal care have led to the increased survival of preterm infants with subsequent neonatal morbidities, such as retinopathy of prematurity (ROP). This study aims to compare the differences of neonatal healthcare systems, resources, and clinical practice concerning ROP in Asia with review of current literature. An on-line survey at the institutional level was sent to the directors of 336 neonatal intensive care units (NICU) in 8 collaborating national neonatal networks through the Asian Neonatal Network Collaboration (AsianNeo). ROP screening was performed in infants born at < 34 weeks in Indonesia and Japan. In South Korea, Malaysia, and Taiwan, most screened for ROP in infants born at < 32 weeks. In all networks, majority of NICUs conducted ROP screening to infants with birth weight < 1500 g. In most NICU's in-hospital ophthalmologists performed indirect ophthalmoscopy and some were supplemented with digital imaging. Both laser photocoagulation and anti-vascular endothelial growth factor injection are performed for treatment and, vitreous surgeries are conducted less frequently in all countries. Despite limited information collected by the survey, this first study to compare ROP practices implemented in eight Asian countries through AsianNeo will enable an understanding of the differences and facilitate quality improvement by sharing better practices.
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Retinopatía de la Prematuridad , Recién Nacido , Lactante , Femenino , Embarazo , Humanos , Retinopatía de la Prematuridad/diagnóstico , Retinopatía de la Prematuridad/epidemiología , Recien Nacido Prematuro , Asia/epidemiología , Japón , Taiwán , Recién Nacido de muy Bajo PesoRESUMEN
OBJECTIVE: To compare the effectiveness and safety of two instillation methods of combined 0.75% tropicamide and 2.5% phenylephrine at 0, 5 minutes (min) with the same combined regimen at 0,30 minutes in preterm infants. MATERIAL AND METHOD: A prospective, cross-over, randomized controlled trial was performed to compare 0, 5-min instillation (Method A) of combined 0.75% tropicamide and 2.5% phenylephrine with 0, 30-min instillation (Method B) of the same regimen. Forty-two preterm infants scheduled for screening retinopathy of prematurity (ROP) were randomly assigned to two groups. Group 1 was defined as preterms applied by Method A at first examination then by Method B 1-4 weeks apart whereas vice versa in Group 2. Pupil size, heart rate (HR), systolic and diastolic blood pressure (SBP, DBP) were recorded before and after eye-drop instillation. RESULTS: Mean time to 7-mm pupil size was no statistically significant difference between the two methods (Method A 46.47 min, Method B 46.58 min; p = 0.894). Method B has mean longer time to maintain 7-mm pupil size than Method A (Method A 67.67 min, Method B 75.33 min); but not statistically significant different (p = 0.323). HR, SBP and DBP were not significant change between the two methods. CONCLUSION: Both instillation methods produced consistently sufficient mydriasis and safety for evaluation peripheral fundus. Method B has slight longer mydriatic effect than Method A; thus giving more time to evaluate infant's eye for ophthalmologists.
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Midriáticos/administración & dosificación , Fenilefrina/administración & dosificación , Pupila/efectos de los fármacos , Retinopatía de la Prematuridad/diagnóstico , Tropicamida/administración & dosificación , Estudios Cruzados , Quimioterapia Combinada , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , Instilación de Medicamentos , Masculino , Tamizaje NeonatalRESUMEN
BACKGROUND: Neonatal hyperbilirubinemia is very common. Phototherapy has been used for decades to prevent severe hyperbilirubinemia, which can cause kernicterus. OBJECTIVE: To compare the effectiveness of two phototherapy devices in reducing plasma bilirubin and duration of phototherapy in non-severe hyperbilirubinemia. MATERIAL AND METHOD: This was an open-label randomized controlled trial. Forty healthy infants aged between 1 and 5 days with non-severe hyperbilirubinemia, but to the level requiring phototherapy, were recruited. The phototherapy unit used in the "blue-light" group was the Siriraj Phototherapy Lamp with 6 special blue fluorescent tubes. The phototherapy unit used in the "light-emitting diodes (LEDs)" group was the Bilitron 3006 with 5 super LEDs. RESULTS: Twenty infants were included in each group. Demographic data and baseline clinical characteristics of infants in both groups were comparable. Median rate (25%, 75%tile) ofplasma bilirubin decreasing during phototherapy in the "blue light" was significantly higher than in the "LEDs" group [0.16 (0.09, 0.25) and 0.10 (0.02, 0.17) mg/dL/hour, respectively; p = 0.03]. Duration of phototherapy in "blue light" group was shorter than in "LEDs" group but was not statistically significant. CONCLUSION: A locally invented phototherapy device with special blue fluorescent tubes can be more effective than the more expensive commercial super LEDs phototherapy device in decreasing plasma bilirubin.
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Hiperbilirrubinemia Neonatal/terapia , Fototerapia/métodos , Femenino , Humanos , Recién Nacido , MasculinoRESUMEN
BACKGROUND: Plugged milk duct during lactation is a common problem in breastfeeding. Traditional breast massage (TBM) has been performed in Thailand with reasonable outcomes, but several follow-up sessions are often required. A new massage technique, the integrated breast massage (IBM), was subsequently developed. This study aimed to compare resolution time, reduction in mass size, and pain score after breast massage between the IBM and TBM techniques. METHODS: This randomized controlled trial was conducted at the Lactation Clinic of the Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand during February 2019-July 2020. Women presenting with acute plugged milk duct were enrolled and randomly allocated to the IBM or TBM/control groups. Mass size in square centimeters (cm2) was calculated by multiplying the perpendicular axes of the mass. Pain score was self-scored by participants using a numerical rating scale. Median time (95% confidence interval [CI]) to resolution of plugged milk duct was derived using Kaplan-Meier survival analysis. Intention-to-treat analysis was performed. RESULTS: Eighty-four women (42 per group) were included. All enrolled study participants completed the study and were included in the final analysis. Twenty-six (61.9%) and 25 (59.5%) participants from IBM and TBM, respectively, had mass diameter > 5 cm. The median (interquartile range [IQR]) mass size was 30 (20-48) and 20 (12-14) cm2 in IBM and TBM (p = 0.05), respectively. The median (95% CI) time to resolution of plugged duct was 0 (not available) and 1 (0.47-1.53) day in IBM and TBM, respectively (p < 0.01). After the first breast massage, the median (IQR) size of mass reduction was 30 (20-48) and 10 (10-26) cm2 in IBM and TBM, respectively (p = 0.01). The median (IQR) reduction in pain score was 8 (7-8) and 6 (4-7) in IBM and TBM, respectively (p = 0.01). No participants developed skin bruising or hematoma after breast massage. CONCLUSIONS: The IBM technique resolved plugged milk duct significantly faster, with significantly less pain, and with significantly greater reduction in mass size after the first massage compared to TBM. TRIAL REGISTRATION: Retrospectively registered in the Thai Clinical Trials Registry on 25 September 2019 ( TCTR20190925001 ).
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Lactancia , Glándulas Mamarias Humanas , Masaje , Lactancia Materna , Femenino , Humanos , Glándulas Mamarias Humanas/fisiopatología , Dolor/etiología , Manejo del Dolor , TailandiaRESUMEN
BACKGROUND: The World Health Organization (WHO) recommendations on infant feeding in the context of COVID-19 uphold standing recommendations for breastfeeding, non-separation, and skin-to-skin contact, including the use of donor human milk when mother's own milk is not available. INSUFFICIENT GUIDANCE ON THE USE OF DONOR HUMAN MILK AND THE ROLE OF HUMAN MILK BANKS IN THE PANDEMIC RESPONSE: COVID-19 clinical management guidelines in seven countries in Southeast Asia are not aligned with WHO recommendations despite the lack of evidence of transmission through either breastmilk or breastfeeding. The use of safe donor human milk accessed through human milk banks is also insufficiently recommended, even in countries with an existing human milk bank, leading to a gap in evidence-based management of COVID-19. This highlights long-standing challenges as well as opportunities in the safe, equitable, and resilient implementation of human milk banks in the region. CONCLUSIONS: This statement reflects the expert opinion of the Regional Human Milk Bank Network for Southeast Asia and Beyond on the need to revisit national guidelines based on the best evidence for breastfeeding during the COVID-19 pandemic, to incorporate human milk bank services in national obstetric and newborn care guidelines for COVID-19 where possible, and to ensure that operations of human milk banks are adapted to meet the needs of the current pandemic and to sustain donor human milk supply in the long-term. The Network also recommends sustained engagement with the global human milk bank community.
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Lactancia Materna , COVID-19/prevención & control , Guías como Asunto , Bancos de Leche Humana/organización & administración , Bancos de Leche Humana/normas , Leche Humana , Asia Sudoriental/epidemiología , Humanos , Organización Mundial de la SaludRESUMEN
BACKGROUND: Hyperbilirubinaemia is a common cause of hospital admission of newborn infants; however, maternal visual assessment of jaundice may reduce unnecessary hospital visits. AIMS: To investigate the validity of maternal visual assessment of neonatal jaundice to identify infants with hyperbilirubinaemia requiring phototherapy or who have significant hyperbilirubinaemia ≥239.4 µmol/L (14 mg/dL). METHODS: A prospective study of the diagnostic accuracy of maternal visual assessment of jaundice was conducted at a university hospital in Bangkok. Mothers were trained to assess for neonatal jaundice using their infant's palms as a skin colour reference. Trained mothers who were blinded to transcutaneous bilirubin or serum bilirubin values assessed their infants and reported 'jaundice' or 'no jaundice', and determined jaundice severity using dermal icterus zones. Sensitivity and negative predictive values were used to assess the validity of visual assessment for neonatal jaundice. RESULTS: In 180 mothers, the median (min/max) transcutaneous or serum bilirubin value in their infants was 177.8 µmol/L (119.7-309.5). The sensitivity and negative predictive values (95% CI) of maternal assessment for detecting hyperbilirubinaemia requiring phototherapy were 91.7% (73.0-99.0) and 96.6% (87.9-99.1), respectively, and for identifying significant hyperbilirubinaemia were 92.9% (76.5-99.1) and 96.6% (87.9-99.1), respectively. The accuracy of maternal report of dermal zones for serum bilirubin levels was only 44.5%. In 56 infants who received a second jaundice assessment, the sensitivity of maternal assessment for detecting increased transcutaneous or serum bilirubin was 93.9% (83.1-98.7). CONCLUSION: Teaching mothers to visually assess their infants for neonatal jaundice was demonstrated to be feasible. ABBREVIATIONS: CI, confidence interval; MB, microbilirubin; min/max, minimum/maximum; NPV, negative predictive value; OPD, outpatient department; PPV, positive predictive value; SD, standard deviation; TcB, transcutaneous bilirubin.
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Ictericia Neonatal/diagnóstico , Adulto , Bilirrubina/sangre , Femenino , Humanos , Recién Nacido , Ictericia Neonatal/sangre , Ictericia Neonatal/terapia , Masculino , Fototerapia , Guías de Práctica Clínica como Asunto , Estudios ProspectivosRESUMEN
Background: The nutritional content of preterm human milk (HM) can be increased by adding human milk fortifier (HMF). Premature formula (PF) has been used as an alternative to HMF due to the high cost of HMF in some countries. However, the osmolality of HM after fortification remains a matter of concern. Aim: To evaluate the osmolality of fortified preterm HM. Methods: This was a cross-sectional study. HM was collected from 28 mothers of infants with a gestational age of <32 weeks or birthweight <1500 g. Expressed HM was divided into (i) pure HM; (ii) HM+PF to 24 kcal/oz; (iii) HM+PF to 28 kcal/oz; and (iv) HM+HMF to 24 kcal/oz + protein powder 0.5 g/100 ml. Results: Twenty-eight samples of preterm HM were analysed. The mean (SD) osmolality of baseline HM was 297.6 (9.7) mOsm/kg. Mean osmolality of preterm HM after fortification with PF to 24 and 28 kcal/oz was 357.2 (11.1) and 419.9 (18.8) mOsm/kg, respectively. The mean osmolality after fortification with HMF plus protein powder was 464.1 (18.8) mOsm/kg. Repeated-measures ANOVA was used to compare osmolality between pure HM and HM fortified with different fortifiers. All pairwise comparisons by the Bonferroni method were statistically significant (p < 0.001). Conclusions: The osmolality of preterm HM fortified with PF up to 28 kcal/oz does not exceed the American Academy of Paediatrics recommendation of 450 mOsm/kg. The addition of extra protein to preterm HM fortified with commercial HMF must be cautiously considered due to the risk of excessively high osmolality.
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Suplementos Dietéticos , Alimentos Fortificados , Leche Humana/química , Concentración Osmolar , Adulto , Estudios Transversales , Femenino , Humanos , Recién Nacido , MasculinoRESUMEN
The high prevalence of smoking in Southeast Asia (SEA) means pregnant women face exposure to tobacco smoke that may affect the health of their fetus. This study determined fetal exposure to tobacco smoke by meconium analysis for cotinine in 3 locations in SEA: Bulacan Province, Philippines (N=316), Bangkok, Thailand (N=106) and Singapore City (N=61). Maternal exposure to tobacco smoke was 71.1% (1.3% active; 69.8% passive) in Bulacan, 57.5% (0.9% active; 58.6% passive) in Bangkok and 54.1% (11.5% active; 42.0% passive) in Singapore. Fetal exposure to tobacco smoke (by meconium analysis) was 1.3% (Bulacan), 4.7% (Bangkok) and 13.1% (Singapore); however, a large proportion of infants who tested positive for cotinine (65%) were born to mothers who gave no history of either active or passive exposure to environmental tobacco smoke. Fetal exposure to tobacco smoke is a major health problem.
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Cotinina/análisis , Feto/química , Intercambio Materno-Fetal , Meconio/química , Contaminación por Humo de Tabaco , Adulto , Femenino , Humanos , Recién Nacido , Nicotina/metabolismo , Filipinas/epidemiología , Embarazo , Prevalencia , Análisis de Regresión , Singapur/epidemiología , Fumar/epidemiología , Estadísticas no Paramétricas , Tailandia/epidemiologíaRESUMEN
Neonatal infection due to Cryptococcus neoformans is extremely rare. We report a case of a 21-day-old neonate diagnosed with cryptococcal septicemia who was successfully treated with amphotericin B. He was born to a human immunodeficiency virus (HIV) seronegative mother. This report alerts general pediatricians and neonatologists to consider Cryptococcus neoformans infection as a possible cause of sepsis in newborn infants.
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Anfotericina B/administración & dosificación , Antifúngicos/administración & dosificación , Criptococosis/diagnóstico , Criptococosis/tratamiento farmacológico , Sepsis/tratamiento farmacológico , Sepsis/microbiología , Criptococosis/inmunología , Criptococosis/microbiología , Cryptococcus neoformans/aislamiento & purificación , Humanos , Inmunocompetencia , Recién Nacido , Masculino , Sepsis/inmunologíaRESUMEN
Magnetic resonance imaging (MRI), as an adjunct to ultrasonography, has become a promising tool in prenatal diagnosis and therapy. In this report, the authors described a case of giant solid mass arising in the fetal neck region diagnosed by prenatal sonographic examination at the gestational age of 33 weeks'. MRI was used to confirm the diagnosis, and to assist fetal airway assessment. Due to the concern of fetal airway compromise, the ex utero intrapartum treatment (EXIT) was strategically planned with help from specialists in the according fields. This allowed the authors to secure the fetal airway before fetomaternal circulation was disconnected. It was performed successfully through Cesarean section at the time of birth. Histopathology revealed infantile myofibroma, which is a rare form of such a tumor arising on the fetal head and neck region diagnosed prenatally.
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Enfermedades Fetales/diagnóstico , Miofibroma/diagnóstico , Cuello/patología , Cesárea , Femenino , Enfermedades Fetales/diagnóstico por imagen , Enfermedades Fetales/cirugía , Humanos , Recién Nacido , Imagen por Resonancia Magnética , Miofibroma/diagnóstico por imagen , Miofibroma/cirugía , Cuello/cirugía , Embarazo , Tercer Trimestre del Embarazo , Diagnóstico Prenatal , Ultrasonografía PrenatalRESUMEN
BACKGROUND: Pneumothorax is one of the air leak syndrome and is more common in the newborn period than in any other childhood periods. It can be divided into spontaneous pneumothorax and secondary pneumothorax from underlying lung pathology or assisted ventilation. Pneumothorax results in longer hospital stays and even deaths in some cases. To date, there are few studies that focus on identifying risk factors of pneumothorax. We conducted this study to ascertain risk factors for pneumothorax, in order to create a guideline to prevent this condition. MATERIAL AND METHOD: This is a retrospective case-control study. CASEs were infants with the diagnosis of pneumothorax (P25.1 Pneumothorax originating in the perinatal period) between January 2001 and December 2004. Controls were those whose birth times followed in the immediate chronology to the cases. CASE: control ratio was 1:2. Univariate analysis was used to compare the two groups. Odds ratio and 95% confidence interval were used to identify possible risk factors. Statistical significance was considered as p < 0.05. RESULTS: There are 44 cases and 88 controls. Risk factors are shown as Odds ratio and 95% confidence interval. Infant factors associated with higher risk of pneumothorax are male (2.6; 1.2, 5.6), low birth weight (19.3; 2.3, 160.2), vacuum extraction (20.9; 1.1, 403.4), meconium-stained amniotic fluid (4.5; 1.8, 11.0), low 1-minute Apgar score (78.3; 4.5, 1357.8), and the administration of bag and mask positive-pressure ventilation (29.0; 3.6, 233.5). Maternal factor associated with higher risk of pneumothorax is poor antenatal care (3.5; 1.04, 11.9). CONCLUSION: All pregnant women should be encouraged to have good antenatal care. Mother who has complication(s) during pregnancy and delivery should receive special care to prevent perinatal depression. For mothers with meconium-stained amniotic fluid, close fetal monitoring and tracheal suction for meconium after delivery should be appropriately considered to prevent meconium aspiration. Finally, neonatal resuscitation, when needed, should be done very carefully by following the American Heart Association and the American Academy of Pediatrics guidelines, especially for bag and mask positive-pressure ventilation.
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Neumotórax/congénito , Neumotórax/epidemiología , Estudios de Casos y Controles , Parto Obstétrico , Femenino , Humanos , Recién Nacido , Tiempo de Internación , Masculino , Oportunidad Relativa , Embarazo , Complicaciones del Embarazo/epidemiología , Factores de RiesgoRESUMEN
OBJECTIVES: To determine the prevalence and significant risk factors for pathologic hearing screening test results in high-risk neonates and the feasibility of implementing hearing screening program using automated otoacoustic emission (OAE)/ auditory brain stem response (ABR) device performed by trained nursing staffs. STUDY DESIGN: Single-center prospective, descriptive study. MATERIAL AND METHOD: All neonates admitted to the Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, who met the high-risk criteria according to Joint Committee of Infant Hearing 1994, American Academy of Pediatrics, were screened with one-step protocol using an automated OAE/ABR device (AccuScreen, GN Otometrics, Denmark). Infants who failed 2 consecutive OAE tests were reconfirmed by ABR prior to discharge. Descriptive analysis was used for the prevalence of pathologic hearing test results, age at screening, duration of procedure, number of risk factors per infant. Univariate analysis using Chi-square test and multiple logistic regression analysis were used for identification of significant risk factors. RESULTS: Five hundred and seven infants were identified to be at-risk in an 18-month study period. The prevalence of pathologic hearing screening test was 6.7% with unilateral and bilateral pathologic results in 13 and 21 infants (2.6% and 4.1%). Only craniofacial anomalies and mechanical ventilation > 5 days were shown to be independent significant risk factors (42-fold and 4-fold increased risk). Median age at screening test performed was 19 days (range 1-149 days) and almost all infants (97.3%) were screened within 3-month postnatal age. The mean time for hearing screening procedure was 10.7 +/- 8.0 minutes (range 2-60 minutes), 98.1% of procedure was accomplished within 30 minutes. CONCLUSION: Hearing screening using automated OAE/ABR devices in high-risk neonates revealed approximately 7% of pathologic results with almost two-thirds having bilateral affected. The significant independent risk factors in this study population were craniofacial anomalies and mechnical ventilation > 5 days. The protocol of having trained nursing staffs to perform the screening yielded good results, i.e., the coverage of screened infants within 3 months of age (97%), feasible duration of procedure.