Effects of hypertensive disorders of pregnancy on the complications in very low birth weight neonates.

OBJECTIVE: This study was designed to investigate the effects of hypertensive disorders of pregnancy (HDP) on the complications in very low birth weight (VLBW) neonates. METHODS: We retrospectively included VLBW neonates (<37 weeks) who were delivered by HDP pregnant women with a body weight of < 1,500 g (HDP group) hospitalized in our hospital between January 2016 and July 2021. Gestational age matched VLBW neonates delivered by pregnant women with a normal blood pressure, with a proportion of 1:1 to the HDP group in number, served as normal control. RESULTS: Then we compared the peripartum data and major complications between HDP group and control. The body weight, prelabor rupture of membrane (PROM), maternal age, cesarean section rate, fetal distress, small for gestational age (SGA), mechanical ventilation, RDS, necrotizing enterocolitis (NEC) (≥2 stage), Apgar score at 1 min, and mortality in HDP group showed statistical differences compared with those of the control (all p < 0.05). To compare the major complications among HDP subgroups, we classified the VLBW neonates of the HDP group into three subgroups including gestational hypertension group (n = 72), pre-eclampsia (PE) group (n = 222), and eclampsia group (n = 14), which showed significant differences in the fetal distress, Apgar score at 1 min, SGA, ventilation, RDS and NEC (≥2 stage) among these subgroups (all p < 0.05). Multivariate regression analysis showed that eclampsia and PE were the independent risk factors for SGA and NEC, respectively. CONCLUSION: HDP was associated with increased incidence of neonatal asphyxia, fatal distress, SGA, mechanical ventilation, RDS, NEC and mortality. Besides, eclampsia and PE were independent risk factors for SGA and NEC.

Infección congénita por citomegalovirus en neonatos muy bajo peso / Congenital cytomegalovirus infection in very low birth weight neonates

Introducción: La infección congénita por el citomegalovirus en neonatos menores de 1500 gramos puede ser causa de morbilidad, mortalidad y discapacidad. Objetivo: Describir el comportamiento de la infección congénita por citomegalovirus en un servicio de neonatología. Métodos: Se realizó un estudio descriptivo y transversal con 61 neonatos. Se les realizó detección de citomegalovirus en la primera semana de vida en suero y orina, mediante reacción en cadena de la polimerasa, para determinar infección congénita. Se evaluaron variables perinatales en todos los neonatos, así como elementos clínicos y resultados de exámenes complementarios en los infectados. Resultados: La incidencia de infección congénita fue de un 10 por ciento (6/61). El 5 por ciento de los estudios fueron positivos (6/122). Ninguna muestra de orina resultó positiva (0/61) y en el 10 por ciento de las muestras de suero (6/61) se detectó el genoma del virus. Se encontró asociación entre valoración nutricional al nacer e infección por citomegalovirus (p< 0,05). El 83 por ciento de los neonatos infectados presentaron algún signo clínico y el síndrome de dificultad respiratoria fue el más frecuente (67 por ciento). En todos los neonatos con infección congénita el ultrasonido cerebral fue normal y en el 33 por ciento se detectó retinopatía de la prematuridad en el fondo de ojo. Conclusiones: La incidencia de infección congénita por citomegalovirus es alta en este grupo de riesgo. Los signos clínicos encontrados y los resultados del fondo de ojo en neonatos con infección congénita se relacionaron con la prematuridad y la valoración nutricional de hipotrófico se asoció con esta infección(AU)

Introduction: Congenital cytomegalovirus infection in neonates weighing less than 1500 grams can be a cause of morbidity, mortality, and disability. Objective: To describe the behavior of congenital cytomegalovirus infection in a neonatal service. Methods: A descriptive and cross-sectional study was conducted with 61 neonates. Cytomegalovirus was detected in the first week of life in serum and urine, by polymerase chain reaction, to determine congenital infection. Perinatal variables were evaluated in all neonates, as well as clinical elements and results of complementary examinations in infected infants. Results: The incidence of congenital infection was 10 percent (6/61). 5 percent of the studies were positive (6/122). No urine samples were positive (0/61) and the virus genome was detected in 10 percent of serum samples (6/61). An association was found between nutritional assessment at birth and cytomegalovirus infection (p < 0.05). A total of 83 percent of infected neonates had some clinical sign, with respiratory distress syndrome being the most common (67 percent). In all neonates with congenital infection, brain ultrasound was normal, and retinopathy of prematurity was detected in 33 percent of patients with fundus retinopathy. Conclusions: The incidence of congenital cytomegalovirus infection is high in this risk group. The clinical signs found and the results of the fundus in neonates with congenital infection were related to prematurity and the nutritional assessment of hypotrophic was associated with this infection(AU)

Calcium and Phosphorus: All You Need to Know but Were Afraid to Ask.

Inadequate intake of calcium and phosphorus during the perinatal period can result in metabolic bone disease (MBD), characterized by decreased bone mass, altered bone mineralization, and increased risk for fractures. Preterm neonates have higher risk of developing MBD. Treating MBD involves ensuring adequate calcium and phosphorus intake, early fortification, and vitamin D supplementation. Health care providers should closely monitor nutrient intake, postnatal growth, and screening of preterm neonates at risk for MBD. This review summarizes the critical roles of calcium and phosphorus in regulating bone physiology, how they regulate bone formation and resorption, and their influence on overall bone health.

Successful application of continuous renal replacement therapy in a very low birth weight neonate with acute kidney injury.

Diagnosis and treatment process during hospitalization.

Transcatheter retrieval of embolised fractured peripherally inserted central catheter: a nightmare in very low birth weight preterm neonate.

Peripherally inserted central catheters are commonly used for intravascular access in low birth weight neonates. Here, we describe a case of transcatheter retrieval of an embolised peripherally inserted central catheter line in the right ventricle extending to the left pulmonary artery in a preterm very low birth weight baby. To the best of our knowledge, this is the first case where transcatheter retrieval of embolised peripherally inserted central catheter line has been done from the left pulmonary artery in such a very low birth weight preterm neonate. Although retrieval of foreign body is common in adults and older children, very few case reports have documented successful retrieval of embolised peripherally inserted central catheter line in very low birth weight neonates using interventional techniques. Most of the cases in literature reported retrieval of an indwelling umbilical venous catheter rather than a peripherally inserted central catheter line as in our case. Also, none of these cases had the embolised fragment retrieved from the left pulmonary artery. This approach was technically very challenging as we were taking care of a 5-day old preterm neonate born at 32 weeks of gestation having very low birth weight (1100 g) with features of clinical sepsis, coagulopathy, and embolised catheter fragment extending from right ventricle to left pulmonary artery. The procedure was uneventful without any complication and the catheter was retrieved successfully.

The Effect of Low-Grade Intraventricular Hemorrhage on the Neurodevelopment of Very Low Birth Weight Infants.

Objective: Intraventricular hemorrhage (IVH) is a significant concern for premature very low birth weight (VLBW) neonates worldwide. Recently, the popular theory of the benign nature of low-grade IVH has been argued with uncertain outcomes. This study aimed to assess the effect of low-grade IVH on the neurodevelopment of VLBW neonates. Materials & Methods: This six-month follow-up cohort study was conducted on VLBW neonates with and without grade I-II IVH diagnosed through brain ultrasonography. Participants were neurologically examined at birth and within six months. Neurodevelopment was assessed using the Bayley-III questionnaire, which includes evaluating cognition, receptive language, expressive language, fine motor, and gross motor performance. Results: A total of 100 VLBW neonates were recruited, including 40 cases with grade I-II IVH diagnosed through brain ultrasonography and 60 controls. Cases and controls were similar in terms of gestational age, body birth weight, hospitalization duration, gender distribution, and age at Bayley-III evaluation (P>0.05). The neurological assessments at birth showed no significant difference between the two groups (P=0.20), while controls showed significantly better results at the sixth month of age (P =0.004). Concerning different neurodevelopmental indices, after adjusting for demographic characteristics and respiratory-related variables at the time of Bayley-III evaluation, controls presented a higher performance in cognition and gross motor aspects compared to cases (P= 0.04 and 0.03, respectively). Conclusions: The low-grade IVH affected the sixth-month neurological examination and gross motor performance of the VLBW newborns. Notably, cognition and gross motor were the two affected subscales in the presence of low-grade IVH, independent of demographic factors.

Papiliotrema laurentii fungemia in a premature, very low-birth-weight neonate in Kuwait successfully treated with liposomal amphotericin B.

Papiliotrema laurentii (formerly Cryptococcus laurentii) and Papiliotrema albidus (formerly Cryptococcus albidus) are yeast-like environmental fungi which are largely considered as non-pathogenic to humans. However, invasive infections caused by P. laurentii have recently been reported in some patients with an impaired immune system. Here, we describe the first case of P. laurentii fungemia in a premature, very low-birth-weight neonate in Kuwait and the Middle East. Repeated bloodstream isolates were obtained and were tentatively identified as P. laurentii by Vitek 2 yeast identification system. The identification of the yeast isolates as P. laurentii was confirmed by PCR-sequencing of ribosomal DNA (rDNA). Antifungal susceptibility testing data showed that the isolates were susceptible to amphotericin B, fluconazole and voriconazole but appeared resistant to caspofungin. The baby was successfully treated with liposomal amphotericin B.

Impacto dos fatores perinatais nos déficits de crescimento de prematuros / Impact of perinatal factors on growth deficits of preterm infants

OBJETIVO: Analisar fatores perinatais associados a déficit de crescimento em prematuros com 1 ano de idade corrigida. MÉTODOS: Estudo de coorte de prematuros com peso ao nascer < 2.000 g. Calcularam-se os percentis e escores Z de peso (P/I), comprimento (C/I) e perímetro cefálico (PC/I) com 1 ano de idade corrigida, utilizando a curva do Centers for Disease Control and Prevention. RESULTADOS: Entre 303 prematuros, as frequências de medidas abaixo do percentil 10 (P10) e de -2 escores Z foram, respectivamente, 43,2 por cento e 24,4 por cento de P/I, 22,1 por cento e 8,6 por cento de C/I e 15,8 por cento e 4,6 por cento de PC/I. A análise de regressão logística mostrou que fatores associados à maior chance de P/I < P10 foram reanimação ao nascimento (1,8 vez) e pequeno para a idade gestacional (3,0 vezes). Nas crianças classificadas como pequenas na idade pós-conceptual de termo, a chance de P/I < P10 foi 4,0 vezes maior naquelas com peso ao nascer entre 1.000 g e 1.499 g e 3,5 vezes maior naquelas > 1.500 g. A chance de C/I < P10 aumentou com a diminuição do comprimento ao nascer, mas não associou ao peso ao nascer. A chance de PC/I < P10 foi 2,5 vezes maior nas crianças pequenas para a idade gestacional. Nas crianças com peso < 1.000 g, a chance de PC/I < P10 foi 4,4 vezes maior quando comparadas àquelas entre 1.000 g e 1.499 g e 5,3 vezes maior quando comparadas àquelas > 1.500 g. CONCLUSÃO: Com 1 ano de idade corrigida, prematuros nascidos com peso < 2.000 g apresentaram frequências elevadas de déficits de crescimento, e os fatores associados variaram com o déficit analisado, destacando-se a restrição de crescimento intrauterino e pós-natal.

OBJECTIVE: To review perinatal factors associated with a growth deficit in preterm infants at a corrected age of one year. METHODS: Cohort study of preterm infants with a birth weight < 2,000 g. Percentiles and Z scores of body weight (W/A), length (L/A) and head circumference (HC/A) at one year of corrected age were calculated by using the Centers for Disease Control and Prevention curves. RESULTS: Among 303 preterm infants, the frequencies of measures below the 10th percentile (P10) and Z scores -2 were 43.2 percent and 24.4 percent for W/A, 22.1 percent and 8.6 percent for L/A and 15.8 percent and 4.6 percent for HC/A, respectively. Logistic regression analyses showed factors associated with higher odds for W/A < P10 were resuscitation at birth (1.8 times) and small for gestational age infants (3.0 times). In infants rated as small at full-term postconceptual age, the odds for W/A < P10 were 4.0 times as high in those with a birth weight between 1,000 and 1,499 g and 3.5 times as high in those > 1,500 g. As birth length was reduced, the odds for L/A < P10 increased, but this was not associated with birth weight. The odds for HC/A < P10 were 2.5 times as high in small for gestational age infants. In infants with a body weight < 1,000 g, the odds for HC/A < P10 were 4.4 times higher, compared with those between 1,000 g and 1,499 g and 5.3 times higher if compared with those > 1,500 g. CONCLUSION: At a corrected age of one year, preterm infants with a birth weight < 2,000 g were found with high growth deficits frequencies, and associated factors were variable, depending on the analyzed deficit, with intrauterine and postnatal growth restriction being outstanding predictors.