Neonatal Organ and Tissue Donation for Research: Options Following Death by Natural Causes.

The donation of organs and tissues from neonates (birth to 28 days) for transplantation has been a relatively infrequent occurrence. Less common has been the use of neonatal organs and tissues for research. Specific ethical and legal questions beg for rational and transparent guidelines with which to evaluate referrals of potential donors. Donation of organs and tissues from a neonate can play a key role in the care and support provided to families by health care professionals around the time of a neonate's death. We report on the recovery of neonatal organs and tissues for research. A working group made up of bioethicists, neonatologists, lawyers, obstetric practioners as well as organ procurement and tissue banking professionals evaluated legal, ethical and medical issues. Neonatal donor family members were also consulted. Our primary goals were (a) to ensure that referrals were made in compliance with all applicable federal and state laws, regulations and institutional protocols, and (b) to follow acceptable ethical standards. Algorithms and policies designed to assist in the evaluation of potential neonatal donors were developed. Neonatal donation is proving increasingly valuable for research into areas including diabetes, pulmonary, gastrointestinal, genitourinary and neurological development, rheumatoid arthritis, autism, childhood psychiatric and neurologic disorders, treatment of MRSA infection and pediatric emergency resuscitation. The development of policies and procedures will assist medical professionals who wish to offer the option of donation to family members anticipating the death of a neonate.

A Rare Association of Non-Compaction of the Ventricular Myocardium, and Non-Immune Hydrops Fetalis.

Hydrops fetalis is a rare manifestation of severe congestive heart failure in a fetus, resulting in pathological fluid accumulation in fetal soft tissues and/or serous cavities. Non-compaction of the ventricular myocardium, frequently referred to as the left ventricular non-compaction (LVNC), is a very rare congenital cardiomyopathy. For LVNC, echocardiography is the diagnostic modality of choice. Various diagnostic criteria exist based on either echocardiography or MRI. Currently, nonimmune hydrops fetalis (NIHF) comprise almost 90% of all hydrops fetalis cases. Among cardiovascular conditions that contribute to NIHF (20%), structural malformations (especially hypoplastic left heart, endocardial cushion defect) and arrhythmias are the most frequent etiological factors. We describe an extremely preterm neonate who presented with features of non-Immune hydrops fetalis (NIHF) associated with LVNC and profound refractory systemic hypotension.

Late preterm infant - Nature's unfinished master piece.

Late preterm infants (LPI) are preterm infants born at a gestational age between 34 and 0/7 weeks to 36 6/7 weeks. Because of their physiologic and metabolic immaturities, they are at increased risk for a spectrum of morbidities and mortality when compared to the term infants. LPI are "great pretenders and masqueraders", as they pretend to be and masquerading as term infants. Because of their size, frequently they are treated as term infants with potential for bad consequences. In this review, the incidence and high risk factors for late preterm deliveries, early morbidities, late complications and management are described. Computerized data bases such as PubMed, OVID and Embase were searched between January 2005 and March 2012, by using the search terms, Late Preterm Infants and Near Term Infants. From this detailed search available, evidence based guidelines were incorporated in the care of these LPI.

Azithromycin for Eradication of Ureaplasma and Prevention of Bronchopulmonary Dysplasia in Preterm Neonates in the Neonatal Intensive Care Unit.

Azithromycin has been explored as a treatment option for eradication of Ureaplasma and prevention of bronchopulmonary dysplasia (BPD) in preterm neonates. However, there is debate about the need for eradication of Ureaplasma and whether azithromycin is safe and efficacious for this indication. This literature review provides an overview of the evidence for use of azithromycin for eradication of Ureaplasma and prevention of BPD, including dosing and duration of azithromycin used in these studies. The literature search included articles published in the English language in Medline and PubMed from 1946 to January 2022. Relevant citations within identified articles were also reviewed. A total of 9 studies representing 388 neonates were included. The percentage of neonates that tested positive for Ureaplasma in these studies ranged from 18.6% to 57.1%. Azithromycin was initiated at <3 days of life in 8 studies (88.9%). Dosing was variable and ranged from 5 to 20 mg/kg/dose administered once daily, and the duration of treatment ranged from 1 to 35 days. Most studies used intravenous azithromycin. Overall, azithromycin was more efficacious than placebo at Ureaplasma eradication; however, most of these studies did not find a difference in the incidence of BPD between patients receiving azithromycin versus placebo. No adverse effects, specifically pyloric stenosis or QT interval prolongation, were noted in these studies.

Update on group B streptococcal infections: perinatal and neonatal periods.

Group B Streptococcus (GBS), one of the beta-Hemolytic streptococci, remains a leading cause of neonatal sepsis in the United States. The first consensus guidelines for the prevention of neonatal GBS disease were published in 1996, recommending intrapartum antibiotic prophylaxis on the basis of screening-based or risk-based strategies. Since then, there has been a 70% decrease in the rate of early-onset GBS disease. On the basis of evidence-validating superiority of this screening-based strategy, new national guidelines were released in 2002. Data from the Centers for Disease Control and Prevention in 2005 showed a continued decrease in the annual incidence of early-onset GBS infection. The screening-based strategy involves universal screening of all pregnant women at 35 to 37 weeks' gestation for vaginal and rectal GBS colonization and recommends intrapartum antibiotic prophylaxis for all GBS carriers (unless delivered by planned cesarean section before the onset of labor in a woman with intact membranes) with penicillin-G (or ampicillin). For mothers with severe penicillin allergy, clindamycin or erythromycin is recommended, when GBS' sensitivity is known; otherwise, vancomycin is recommended. Cefazolin is recommended for individuals with mild penicillin allergy. Severe anaphylactic reactions to penicillin were extremely rare. Emergence of antibiotic resistance to penicillin is still a theoretical possibility. This article provides a detailed account of recommendations for screening, diagnosing, and treating GBS disease in newborns.

Medical Surveillance and Child Maltreatment Incidence Reporting among NICU Graduates.

Objective of this study is to identify background infant and maternal characteristics that predict child maltreatment (CM) incidence reporting among Neonatal Intensive Care Unit (NICU) graduates by health care providers versus community sentinels with the goal of identifying ways to improve CM risk surveillance. Demographic, medical data including diagnoses and caregiving needs at discharge for infants treated in a NICU during 2005 to 2008 were obtained from the neonatology databases. CM outcome data was obtained from child welfare databases. Latent class analysis procedures were used to identify observable infant and maternal characteristics that define unobserved groups (latent classes) that predict NICU graduates CM incidence reporting among health care providers versus community sentinels. Medical surveillance (reports made by health care providers) accounted for only 37% of the CM reports made to child welfare. Infant health was more predictive of medical surveillance than maternal characteristics suggesting that health providers may assess risk differently than community sentinels. Based on a simple, two latent class model, the latent class with high infant health indicator membership probabilities was a better predictor of health care provider related reports than the class with lower membership probabilities (odds ratio = 2.72; 95% confidence interval [1.76, 4.20]). Health care providers may be keyed more to an infant's medical frailty than to caregiver (maternal) contextual characteristics and thus may miss an opportunity to identify and intervene to prevent CM among children with medical problems. Findings raise the question of whether increased attention to contextual factors can aid or increase early identification of infants at risk of child maltreatment in NICU settings.

Risk for Child Maltreatment Among Infants Discharged From a Neonatal Intensive Care Unit: A Sibling Comparison.

Studies suggest that neonatal illness may cause increased risk for child maltreatment (CM), but these findings may be biased by observed and unobserved confounding factors (social, family, and maternal characteristics) including increased surveillance by health care providers. This study expands on previous research by examining and controlling for these potential study biases and confounders using a sibling discordance retrospective cohort study design. Infants born in a Level IV neonatal intensive care unit (NICU) were matched with non-NICU born sibling controls. Cox proportional hazard models with shared frailty terms were used to account for clustering and heterogeneity in CM survival time (time to CM event). Potentially key covariates were selected using the directed acyclic graph approach, and surveillance reports were identified and systematically included or excluded from analyses. Managing these sources of bias reduced but did not eliminate the association between neonatal illness and CM report risk. Risk was especially high during the first year of the NICU infant's life and among families with multiple well-known CM risk factors.

Special care needs and risk for child maltreatment reports among babies that graduated from the Neonatal Intensive Care.

Newborns discharged from intensive care are at elevated risk for child welfare reports, especially for child neglect. This study investigates the role of caregiving burden as a risk predictor among the NICU graduate population. Discharge data were captured for 2,463 infants graduating from a Neonatal Intensive Care Unit (NICU) during 2005-2008, then linked to child welfare reports at a median 3.2 year follow-up. Survival analyses were used to examine child welfare report outcomes conditional on caregiving burden and its moderating relationships with other family risk factors. Caregiving burden was associated primarily with an increased risk of child welfare reporting during the first few months to first year of life, after which risk was similar to NICU graduates without caregiving burden. Caregiving burden effects were potentiated by having three or more siblings in the family. A history of prior child welfare reports predicted very high risk, regardless of caregiving burden. Young maternal age increased risk. The findings suggest that the immediate months after NICU discharge may be an important window of child neglect prevention opportunity among newborns with special caregiving needs. This may be a key time to provide caregiver support and monitoring, particularly when caregivers have multiple children.

Relationship of caffeine dosing with serum alkaline phosphatase levels in extremely low-birth-weight infants.

OBJECTIVE: To determine whether patients receiving higher doses of caffeine have increased alkaline phosphatase (ALP) levels, as a biomarker for osteopenia. METHODS: This descriptive, retrospective study included 152 extremely low-birth-weight infants (ie, <1 kg) admitted from January 1, 2007, to September 30, 2009, who received caffeine for >2 weeks. Patients were divided into a low-dose (<7.5 mg/kg/day) and high-dose (≥7.5 mg/kg/day) group based on maximum caffeine dose received. The primary objective was to compare peak ALP levels between groups. Secondary objectives included a comparison of caffeine regimens and risk factors for osteopenia between groups and identification of factors significantly related to increase in ALP. Between-group analysis was performed using the chi-squared or Fisher exact test and Wilcoxon Mann-Whitney median test or t-tests where appropriate. A linear regression model was used, with peak ALP as the dependent variable. RESULTS: A majority of the patients (n=122) were included in the high-dose caffeine group. No significant difference in maximum ALP level between groups (median, 599.5, versus 602.5 units/L, p=0.72). Gestational age and birth weight were inversely related to ALP, whereas parenteral nutrition duration was directly related. No significant relationship between caffeine dose and ALP was identified. CONCLUSIONS: In this preliminary study, using ALP as a biochemical marker for bone turnover, there does not appear to be a dose-related effect between ALP and caffeine dose.