Ultrasonographic measurements of the inferior vena cava diameter in newborns: is it a useful tool for choosing an umbilical venous catheter?

Objectives: The primary outcomes of this study were to evaluate the diameters of the inferior vena cava (IVC) in a cohort of newborns and the correlation between newborn weight and IVC diameter. The secondary outcome was to evaluate the concordance between the measurements performed by the two investigators. Methods: Two blind examiners performed an ultrasonographic (US) evaluation of the IVC diameter in neonates with a weight ranging from 2 to 4 kg. The exclusion criteria included hemodynamic instability, known vascular malformations, and major congenital malformations. Results: A total of 143 neonates were enrolled between June 2019 and January 2021. All the US examinations were performed in the first 3 days of life. After dividing the patients into two groups according to their weight at the time of examination (2.0-2.99 kg and 3.0-4.0 kg), the median IVC diameters measured by examiner 1 were 3.1 mm (interquartile range 2.8-3.4) and 3.4 mm (interquartile range 2.9-3.8) (p = 0.003) for the two groups, respectively. The median IVC diameters measured by examiner 2 were 3.1 mm (interquartile range 2.6-3.3) and 3.3 mm (interquartile range 2.8-3.8) (p = 0.004) for the two groups, respectively. The intraclass correlation coefficient was 0.93 (95% CI: 0.90-0.95). Conclusion: The IVC diameter values varied widely from 1.2 to 5.2 mm in newborns weighing 2-4 kg, and a low correlation between newborn weight and IVC diameter was found, so measuring IVC diameter may be a recommended step prior to inserting a umbilical venous catheter (UVC). The concordance between operators was good. We contemplated that the IVC diameter could be a potentially useful tool to identify the most appropriate UVC, thus reducing the risk of catheter-related thrombosis.

Preterm Newborn Adaptive Responses to Daily Nursing during Neonatal Intensive Care Unit Stay, Associate with Neurodevelopment, 2 Years Later.

OBJECTIVE: This study aimed to evaluate if adaptive responses of very preterm newborns to neonatal intensive care unit (NICU) daily nursing, specifically bathing and weighing procedures are associated with their neurodevelopment after 2 years. STUDY DESIGN: Twenty-six very preterm newborns, with a gestational age <32 weeks, were enrolled. Infants' adaptive responses to daily nursing were evaluated, at 30 to 32 to 35 postmenstrual age (PMA) weeks by an observational sheet. Neurodevelopment was assessed at 24 months of corrected age by the Bayley Scales of Infant and Toddler Development, third edition. Autonomic, motor, and self-regulatory responses to NICU nursing were analyzed by Spearman's correlation coefficient and multivariate linear regression with Bayley's cognitive, language, and motor scales. RESULTS: Significant (p < 0.05) positive correlations of self-regulatory and autonomic responses to nursing with all Bayley's scales were found at 30- and 32-week PMA. At 35-week PMA, only self-regulatory responses had significant positive correlations with all Bayley's scales. When adjusted for birth weight and sex, the significant associations were confirmed only at 30- and 32-week PMA. CONCLUSION: Very preterm newborn adaptive responses to NICU daily nursing reveal to be positively related to forthcoming neurodevelopment 2 years later, as early as the 30-week PMA. Helping preterm babies to adapt to daily NICU nursing may promote their future neurobehavior. KEY POINTS: · Preterm adaptation to nursing was studied.. · Adaptation positively relates to neurodevelopment.. · Such relation is detected since 30-week PMA..

The role of weighing-bathing sequence and postmenstrual age in eliciting adaptive/maladaptive responses in very low birth weight preterm infants.

PURPOSE: In the neonatal intensive care unit, preterm infants are exposed to several stressful stimuli. Inappropriate stimulation led to high risk for short- and long-term neurocognitive disabilities. This study aimed to evaluate whether the sequence of execution of weighing/bathing nursing procedures and postmenstrual age (PMA) have any effect on preterm infants' stress responses. DESIGN AND METHODS: Prospective cross-sectional study on a sample of 21 preterm infants. Responses to the procedures were assessed using an observational sheet based on Als's Synactive Theory of Development. Autonomic and motor responses were scored according to five-point Likert scales. The order of execution of weighing/bathing nursing procedures and PMA were documented. Effects of weighing/bathing execution sequence and PMA on autonomic and motor response scores were analyzed by linear multiple regression analysis. RESULTS: The sequence of execution had a significant effect on the autonomic score during weighing (p = .035), evidencing more stress when weighing was executed first. A higher level of stress response on the autonomic score during both weighing (p = .015) and bathing (p = .018) procedure was independently associated with a lower infant PMA. CONCLUSIONS AND PRACTICE IMPLICATIONS: The real-time recognition of adaptive/maladaptive responses allows nurses to personalize their approach to preterm infants, taking into account PMA and adjusting the appropriate sequence of execution of weighing/bathing nursing procedures.

TAS2R38 bitter taste genotype is associated with complementary feeding behavior in infants.

BACKGROUND: Genetically mediated sensitivity to bitter taste has been associated with food preferences and eating behavior in adults and children. The aim of this study was to assess the association between TAS2R38 bitter taste genotype and the first complementary food acceptance in infants.Parents of healthy, breastfed, term-born infants were instructed, at discharge from the nursery, to feed their baby with a first complementary meal of 150 mL at 4 to 6 months of age. They recorded the day when the child ate the whole meal in a questionnaire. Additional data included food composition, breastfeeding duration, feeding practices, and growth at 6 months. Infants' TAS2R38 genotypes were determined at birth, and infants were classified as "bitter-insensitive" (genotype AVI/AVI) and "bitter-sensitive" (genotypes AVI/PAV or PAV/PAV). RESULTS: One hundred seventy-six infants and their mothers were enrolled; completed data were available for 131/176 (74.4%) infants (gestational age 39.3 ± 1.1 weeks, birth weight 3390 ± 430 g). Bitter-insensitive were 45/131 (34.3%), and bitter-sensitive were 86/131 (65.6%). Thirty-one percent of bitter-insensitive infants consumed the whole complementary meal at first attempt, versus 13% of bitter-sensitive ones (p = 0.006). This difference was significant independently of confounding variables such as sex, breastfeeding, or foods used in the meal. Growth at 6 months did not differ between the two groups. CONCLUSIONS: Differences in TAS2R38 bitter taste gene were associated with acceptance of the first complementary food in infants, suggesting a possible involvement in eating behavior at weaning.

Unusual left atrial appendage thrombus in a neonate with normal heart after sustained supraventricular tachycardia.

Left atrial appendage thrombi in neonates are uncommon. We describe a neonate with a large thrombus in the left atrial appendage detected by echocardiography after a paroxystic sustained supraventricular tachycardia associated with intermittent Wolff-Parkinson-White syndrome. Mechanisms and therapy of atrial thrombosis in neonates are briefly discussed.

Generalized arterial calcification of infancy: two siblings with prolonged survival.

In generalized arterial calcification of infancy (OMIM no. 208000), calcification of the media and proliferation of the intima lead to arterial stenoses. Most affected patients present with untreatable arterial hypertension and die within the first months of life. The disease has recently been linked to mutations in ENPP1. We report two siblings with prolonged survival, both of whom carry the compound heterozygous ENPP1 mutations c.913C>A and c.1164+2T>A. In both siblings, spontaneous regression of arterial calcifications occurred, and antihypertensive treatment could be tapered off gradually. In some patients, the natural course of GACI may be more favourable than previously assumed.