Evaluation of neurological behaviour in late-preterm newborn infants using the Hammersmith Neonatal Neurological Examination.

AIM: We hypothesise that clinically well late-preterm infants (LPI) (34+0 -36+6 weeks) are neurologically more immature than their term counterparts, and this immaturity persists even when these infants reach term-corrected age (TCA). The primary aim of our study was to characterise and contrast the neurodevelopmental profile of well LPI with full-term infants (FTI) (39+0 -41+6 weeks) using the Hammersmith Neonatal Neurological Examination (HNNE). Our secondary aim was to obtain local reference ranges for the 34 items in the HNNE in an Asian-dominant population. METHODS: LPI were assessed at two time points: 12-72 h of life and at TCA of 39+0 -41+6 weeks, while FTI were assessed at 12-72 h of life using the HNNE. Each of the 34 items on the HNNE was assigned an optimality score (OS) of 0, 0.5 or 1, totalling up to 34. A quantitative comparison of the neurobehavioral patterns was made using two-sample t-tests. RESULTS: A total of 212 infants (79 LPI and 133 FTI) were recruited. Mean OSs for LPI and FTI at birth were (25.11 ± 3.36)/34 and (31.19 ± 1.50)/34, respectively, with a mean difference of 6.08 (P value <0.0001). The mean OS for LPI on reaching TCA was (28.91 ± 2.30)/34, with a mean difference of 2.28 (P value <0.0001). Reference OSs for the 34 items on the HNNE were also obtained. CONCLUSION: LPI are more immature than their term counterparts even on reaching TCA, with discrepancies most apparent in 'tone' and 'movement'. We provide reference OSs of 34 items in the HNNE for infants in an Asian-dominant population.

Principles of Clinical Management of Patent Ductus Arteriosus in Extremely Preterm Neonates.

The clinical management of a patent ductus arteriosus (PDA) in preterm newborns is a controversial topic, and despite nearly three decades of research, varying opinions remain. This dilemma stems from uncertain causal linkage between PDA and neonatal comorbidities, as well as the lack of clear evidence showing that benefits of treatment outweigh risks. There has been a general shift in the management of PDA in preterm newborns from early and aggressive closure to a more conservative approach of watchful waiting and spontaneous closure. However, a firm recommendation cannot be made due to a lack of randomized controlled trials validating either treatment strategies. Although cyclooxygenase inhibitors, namely indomethacin and ibuprofen, are approved pharmacological treatments for PDA, there is a need to explore alternative medical therapies in view of lack of clinical response in many newborns and concerns over adverse effects. One such recent interest is the use of acetaminophen as a pharmacological agent. This present review tries to address the questions at hand, integrate the current evidence, highlight the principles of PDA management in preterm newborns, and suggest areas for possible future research.

Successful percutaneous ablation of ventricular tachycardia in congenitally corrected transposition of the great arteries, a case report.

Ventricular tachycardia (VT) is rarely recognized in patients with congenitally corrected transposition of the great arteries (CCTGA). We describe a 48-year-old woman with CCTGA, systemic atrioventricular valve replacement for Ebsteinoid malformation of the valve, ventricular dysfunction and ventricular tachycardia related to the previous surgical scar. The patient had successful non-contact mapping and radiofrequency ablation of the offending tachycardia substrate.