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Children
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Intensive Care for Critically Ill Neonates: Clinical Diagnosis and Treatment
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Special Issue "Intensive Care for Critically Ill Neonates: Clinical Diagnosis and Treatment"

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Neonatology".

Deadline for manuscript submissions: 1 May 2024 | Viewed by 2878

Special Issue Editor

Prof. Dr. Stefan Grosek

E-Mail Website
Guest Editor
1. Neonatology Section, Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Šlajmerjeva 3, 1000 Ljubljana, Slovenia
2. Department of Paediatrics, Faculty of Medicine, University of Ljubljana, Bohoričeva 20, 1000 Ljubljana, Slovenia
Interests: critically ill newborn infants and children; transportation medicine; medical and research ethics; adult, pediatric and neonatal intensive care medicine; palliative care medicine; philosophy; medical ethics

Special Issue Information

Dear Colleagues,

Critically ill neonates born prematurely and at term represent a major challenge for healthcare professionals. Critically ill neonates are infants with a broad spectrum of diseases and disorders that emerge pre-, peri- or postnatally, and who need life support treatment in the neonatal intensive care unit (NICU). The NICU is a place where initial and final diagnosis, many times with the involvement of an interdisciplinary team, is confirmed, and treatment is ongoing. Great advances and improvements in diagnostics and treatment with modern technical devices have allowed us to support and rescue many infants with neonatal disorders which would have not been imaginable years ago. Treatment options involving modern life support systems (mechanical ventilation, extracorporeal membrane oxygenation, blood purification techniques, and others), surgeries and the most advanced medicines are also available in the NICU. The treatment and prevention of pain, nosocomial infections and total parenteral nutrition is of great importance, too. Healthcare professional’s support of the families of the critically ill neonates is a prerequisite for the completeness of the care of critically ill neonates. Additionally, different ethical issues may arise during intensive treatment in the NICU.

Therefore, the aim of this Special Issue is to accept for publication your interesting research which may cover any aspects of the diagnostics and treatment options, as well as the outcomes and follow-up, of the critically ill neonates in the NICU.

Prof. Dr. Stefan Grosek
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • neonatal transport
  • SIRS
  • induced therapeutic hypothermia
  • ECMO
  • surfactant
  • congenital defects
  • total parenteral nutrition
  • inhaled nitric oxide
  • outcome
  • sedation and analgesia
  • ethics in NICU

Published Papers (5 papers)

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Editorial

Jump to: Research, Review

4 pages, 195 KiB  
Editorial
Special Issue: Intensive Care for Critically Ill Neonates: Clinical Diagnosis and Treatment
by
Stefan Grosek
Children 2023, 10(7), 1203; https://doi.org/10.3390/children10071203 - 11 Jul 2023
Viewed by 467
Abstract
Many physicians and researchers in the recent past have recognized the need to provide care and to study term and preterm infants when sufficient knowledge had not yet been attained, and to research how to approach and care for the most vulnerable children, [...] Read more.
Many physicians and researchers in the recent past have recognized the need to provide care and to study term and preterm infants when sufficient knowledge had not yet been attained, and to research how to approach and care for the most vulnerable children, i [...] Full article
(This article belongs to the Special Issue Intensive Care for Critically Ill Neonates: Clinical Diagnosis and Treatment)

Research

Jump to: Editorial, Review

12 pages, 265 KiB  
Article
Diagnostic Accuracy of Multiplex Polymerase Chain Reaction in Early Onset Neonatal Sepsis
by
Anja Stein
,
Daniel Soukup
,
Peter-Michael Rath
and
Ursula Felderhoff-Müser
Children 2023, 10(11), 1809; https://doi.org/10.3390/children10111809 - 14 Nov 2023
Viewed by 380
Abstract
Early onset neonatal sepsis is a significant contributor to neonatal morbidity and mortality. Although blood cultures remain the diagnostic gold standard, they detect pathogens in only a minority of suspected cases. This study compared the accuracy of blood cultures with a rapid multiplex [...] Read more.
Early onset neonatal sepsis is a significant contributor to neonatal morbidity and mortality. Although blood cultures remain the diagnostic gold standard, they detect pathogens in only a minority of suspected cases. This study compared the accuracy of blood cultures with a rapid multiplex PCR test. Newborns at risk of neonatal sepsis were prospectively screened as recommended per national guidelines. Evaluations included laboratory parameters (CrP, IL6, differential blood count), blood culture, and a molecular multiplex PCR test (ROCHE LightCycler SeptiFast®) identifying 20 common microbial agents. Blood samples were taken simultaneously from umbilical cord or venous sources on the first day of life. Of 229 infants included, 69% were born preterm. Blood culture and multiplex PCR sensitivity were 7.4% and 14.8%, respectively. Specificity, negative and positive predictive values between methods showed no significant variance, although multiplex PCR had more false positives due to contamination. The limited sensitivity of blood cultures for early onset neonatal sepsis is concerning. Despite quicker results, multiplex PCR does not enhance diagnostic accuracy or antibiotic therapy guidance, thus it cannot be recommended for this indication. Full article
(This article belongs to the Special Issue Intensive Care for Critically Ill Neonates: Clinical Diagnosis and Treatment)
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Graphical abstract

9 pages, 254 KiB  
Article
A Higher Amount of Nutritional Intake as a Possible Cause of Hyperglycemia in Extremely Premature Infants in Parenteral and Enteral Nutrition at the Tertiary Neonatal Intensive Care Unit
by
Iza Predanič Drobne
,
Lilijana Kornhauser Cerar
,
Vanja Erčulj
and
Štefan Grosek
Children 2023, 10(10), 1651; https://doi.org/10.3390/children10101651 - 04 Oct 2023
Viewed by 544
Abstract
Background: This study aimed to find an association between infants who had hyperglycemia and those who did not, those treated with insulin or not and several prenatal and postnatal variables or the suboptimal prescription of parenteral nutrition. Methods: We conducted a retrospective study, [...] Read more.
Background: This study aimed to find an association between infants who had hyperglycemia and those who did not, those treated with insulin or not and several prenatal and postnatal variables or the suboptimal prescription of parenteral nutrition. Methods: We conducted a retrospective study, which included extremely premature infants (<28 weeks of gestation) admitted to the tertiary NICU, University Medical Centre Ljubljana, between 1 January 2021 and 31 December 2021. Blood glucose measurements, insulin treatment, general characteristics, nutritional data and complications of prematurity were obtained retrospectively from hospital data. RESULTS: There were 21 infants included in the study who did not receive insulin and 17 who were treated with insulin. Infants receiving insulin were younger and lighter compared to the non-insulin treatment group (mean gestational age 178 vs. 188 days; median birth weight 680 g vs. 990 g). The younger insulin group of infants received the same daily number of total macronutrients per kg per day compared to the older non-insulin group, i.e., glucose, lipids and amino acids, as recommended for the gestational age and birth weight. After adjusting for gestational age, no significant association with complications of prematurity was found. Conclusions: The postulated explanation (with the prescription of a higher amount of macronutrients during the first seven days) for hyperglycemia and treatment with insulin in the less mature and lighter infants cannot be supported by the data given. Full article
(This article belongs to the Special Issue Intensive Care for Critically Ill Neonates: Clinical Diagnosis and Treatment)
11 pages, 560 KiB  
Article
Contingent Mother’s Voice Intervention Targeting Feeding in Hospitalized Infants with Critical Congenital Heart Defects
by
Caitlin P. Kjeldsen
,
Lelia Emery
,
Janet Simsic
,
Zhulin He
,
Ann R. Stark
,
Mary Lauren Neel
and
Nathalie L. Maitre
Children 2023, 10(10), 1642; https://doi.org/10.3390/children10101642 - 30 Sep 2023
Viewed by 580
Abstract
Infants with critical congenital heart defects (CCHD) are at high risk for feeding challenges and neurodevelopmental delays; however, few interventions promoting the neurodevelopmental progression of feeding have been studied with this population. Contingent mother’s voice has been successfully used as positive reinforcement for [...] Read more.
Infants with critical congenital heart defects (CCHD) are at high risk for feeding challenges and neurodevelopmental delays; however, few interventions promoting the neurodevelopmental progression of feeding have been studied with this population. Contingent mother’s voice has been successfully used as positive reinforcement for non-nutritive suck (NNS) in studies with preterm infants, leading to improved weight gain and more rapid cessation of tube feedings; however, this type of intervention has not been studied in infants with CCHD. This study aimed to determine whether an NNS-training protocol using the mother’s voice as positive reinforcement and validated in preterm infants could improve oral feeding outcomes in hospitalized infants with CCHD undergoing cardiac surgical procedures. Infants were randomized to receive the contingent mother’s voice intervention before or after cardiac surgery, with a control comparison group receiving passive exposure to the mother’s voice after surgery. There were no significant differences in discharge weight, PO intake, length of stay, time to full feeds, or feeding status at 1-month post-discharge between infants who received contingent mother’s voice compared to those who did not. There were significant differences in PO intake and time to full feeds following surgery based on infants’ pre-enrollment PO status and severity of illness. At 1-month post-discharge, parents of infants in the intervention group expressed a higher rate of positive feelings and fewer concerns regarding their infant’s feeding compared to parents of infants in the control group. While the current protocol of 5 sessions was not associated with improved feeding outcomes in infants with CCHD, it empowered parents to contribute to their infant’s care and demonstrated the feasibility of using the mother’s voice as positive reinforcement for infants with CCHD. Further study of timing, intensity, and duration of interventions leveraging the mother’s voice in this population is needed. ClinicalTrials.gov Identifier: NCT03035552. Full article
(This article belongs to the Special Issue Intensive Care for Critically Ill Neonates: Clinical Diagnosis and Treatment)
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Review

Jump to: Editorial, Research

12 pages, 791 KiB  
Review
Noninvasive Monitoring Strategies for Bronchopulmonary Dysplasia or Post-Prematurity Respiratory Disease: Current Challenges and Future Prospects
by
Tommaso Zini
,
Francesca Miselli
and
Alberto Berardi
Children 2023, 10(11), 1753; https://doi.org/10.3390/children10111753 - 29 Oct 2023
Viewed by 474
Abstract
Definitions of bronchopulmonary dysplasia (BPD) or post-prematurity respiratory disease (PPRD) aim to stratify the risk of mortality and morbidity, with an emphasis on long-term respiratory outcomes. There is no univocal classification of BPD due to its complex multifactorial nature and the substantial heterogeneity [...] Read more.
Definitions of bronchopulmonary dysplasia (BPD) or post-prematurity respiratory disease (PPRD) aim to stratify the risk of mortality and morbidity, with an emphasis on long-term respiratory outcomes. There is no univocal classification of BPD due to its complex multifactorial nature and the substantial heterogeneity of clinical presentation. Currently, there is no definitive treatment available for extremely premature very-low-birth-weight infants with BPD, and challenges in finding targeted preventive therapies persist. However, innovative stem cell-based postnatal therapies targeting BPD-free survival are emerging, which are likely to be offered in the first few days of life to high-risk premature infants. Hence, we need easy-to-use noninvasive tools for a standardized, precise, and reliable BPD assessment at a very early stage, to support clinical decision-making and to predict the response to treatment. In this non-systematic review, we present an overview of strategies for monitoring preterm infants with early and evolving BPD-PPRD, and we make some remarks on future prospects, with a focus on near-infrared spectroscopy (NIRS). Full article
(This article belongs to the Special Issue Intensive Care for Critically Ill Neonates: Clinical Diagnosis and Treatment)
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