Editorial

4 pages, 197 KiB

Open AccessEditorial

Special Issue: Advances in Healthcare for Neonates

by Arun Prasath and Vasantha H. S. Kumar

Children 2023, 10(6), 1048; https://doi.org/10.3390/children10061048 - 12 Jun 2023

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We are delighted to present an editorial for the Special Issue ‘Advances in Healthcare for Neonates’ [...] Full article

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Research

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12 pages, 860 KiB

Open AccessArticle

Do Spinal Needle Sizes Affect the Development of Traumatic CSF in Neonatal LP Procedures?

by Aysen Orman and Hilal Aydın

Children 2023, 10(3), 509; https://doi.org/10.3390/children10030509 - 04 Mar 2023

Cited by 2 | Viewed by 3011

Abstract

Lumbar puncture (LP) is widely employed to evaluate infectious, neurological and metabolic diseases in the newborn. Neonatal LP is a difficult procedure with 45–54% success rates. Although there are studies examining traumatic LP failure, studies on the effects of needle sizes are limited. [...] Read more.

Lumbar puncture (LP) is widely employed to evaluate infectious, neurological and metabolic diseases in the newborn. Neonatal LP is a difficult procedure with 45–54% success rates. Although there are studies examining traumatic LP failure, studies on the effects of needle sizes are limited. This study was intended to investigate the effect of needle sizes on LP traumatization. Term and premature babies who underwent LP in the neonatal intensive care unit between 30 November 2017 and 30 July 2019 were included in the study by retrospective file scanning. LP was performed by a pediatric or neonatal specialist using a 22 Gauge pen (G) or 25 G pen spinal needle in all cases, with all patients being placed in the lateral decubitus position. The primary outcome was to evaluate the effect of needle sizes used in LP on traumatization. The secondary outcome was to evaluate traumatization rates and complications. A statistically significant difference was determined in the rate of traumatized LP and desaturation development between needle sizes and CSF microscopic findings (p = 0.031, p = 0.005, and p = 0.006, respectively). The study data show that 25 G pen-tip spinal needles cause less traumatic LP in neonates than 22 G pen-tip spinal needles. Full article

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11 pages, 258 KiB

Open AccessArticle

Home Immunization with Palivizumab-A Randomized Pilot Study Describing Safety Aspects and Parents’ Preferences

by Christina Ebersjö, Eva Berggren Broström, Inger Kull and Anna Lindholm Olinder

Children 2023, 10(2), 198; https://doi.org/10.3390/children10020198 - 20 Jan 2023

Cited by 1 | Viewed by 1406

Abstract

Among prematurely born infants and newborns with chronic conditions, a respiratory syncytial virus (RSV) infection may cause (re-)admission and later respiratory complications. Therapeutic protection is possible with monthly injections of a specific monoclonal antibody, palivizumab, during RSV season. Standard care is giving up [...] Read more.

Among prematurely born infants and newborns with chronic conditions, a respiratory syncytial virus (RSV) infection may cause (re-)admission and later respiratory complications. Therapeutic protection is possible with monthly injections of a specific monoclonal antibody, palivizumab, during RSV season. Standard care is giving up to five injections in clinic-based settings. Immunization at home could be an alternative to standard care for vulnerable infants to reduce the number of revisits and associated risk of RSV infection. The aim of this randomized pilot trial was to evaluate safety aspects and explore parents’ preferences of home versus hospital immunization with palivizumab during one RSV season. Immediate adverse events (AEs) were observed and registered by a pediatric specialist nurse. Late-onset AEs were reported by parents. Parents’ perceptions were collected through a questionnaire and analyzed using content analysis. The study population consisted of 43 infants in 38 families. No immediate AEs occurred. Three late-onset AEs were reported in two infants in the intervention group. Three categories emerged in the content analysis: (1) protect and watch over the infant, (2) optimal health and well-being for the whole family, and (3) avoid suffering for the infant. The study results show that home immunization with palivizumab is feasible if safety aspects are considered and that parental involvement in the choice of place for immunization after a neonatal intensive care experience can be important. Full article

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13 pages, 570 KiB

Open AccessArticle

Should Perirectal Swab Culture Be Performed in Cases Admitted to the Neonatal Intensive Care Unit? Lessons Learned from the Neonatal Intensive Care Unit

by Aysen Orman, Yalcin Celik, Guliz Evik, Gulden Ersöz, Necdet Kuyucu and Berfin Ozgokce Ozmen

Children 2023, 10(2), 187; https://doi.org/10.3390/children10020187 - 19 Jan 2023

Cited by 3 | Viewed by 1636

Abstract

Serial perirectal swabs are used to identify colonization of multidrug-resistant bacteria and prevent spread. The purpose of this study was to determine colonization with carbapenem-resistant Enterobacterales (CRE) and vancomycin-resistant Enterococci (VRE). An additional purpose was to establish whether sepsis and epidemic associated with [...] Read more.

Serial perirectal swabs are used to identify colonization of multidrug-resistant bacteria and prevent spread. The purpose of this study was to determine colonization with carbapenem-resistant Enterobacterales (CRE) and vancomycin-resistant Enterococci (VRE). An additional purpose was to establish whether sepsis and epidemic associated with these factors were present in the neonatal intensive care unit (NICU), to which infants with hospital stays exceeding 48 h in an external healthcare center NICU were admitted. Perirectal swab samples were collected in the first 24 h by a trained infection nurse using sterile cotton swabs moistened with 0.9% NaCl from patients admitted to our unit after hospitalization exceeding 48 h in an external center. The primary outcome was positivity in perirectal swab cultures, and the secondary outcomes were whether this caused invasive infection and significant NICU outbreaks. A total of 125 newborns meeting the study criteria referred from external healthcare centers between January 2018 and January 2022 were enrolled. Analysis revealed that CRE constituted 27.2% of perirectal swab positivity and VRE 4.8%, and that one in every 4.4 infants included in the study exhibited perirectal swab positivity. The detection of colonization by these microorganisms, and including them within the scope of surveillance, is an important factor in the prevention of NICU epidemics. Full article

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8 pages, 245 KiB

Open AccessArticle

Lung Ultrasound Role in Diagnosis of Neonatal Respiratory Disorders: A Prospective Cross-Sectional Study

by Rania Ismail, Nehal M. El Raggal, Laila A. Hegazy, Hossam M. Sakr, Osama A. Eldafrawy and Yasmin A. Farid

Children 2023, 10(1), 173; https://doi.org/10.3390/children10010173 - 16 Jan 2023

Cited by 4 | Viewed by 2171

Abstract

Lung ultrasound (LUS) has become one of the most exciting applications in neonatal point-of-care ultrasound (POCUS), yet still lacks routine clinical use. This study assesses the utility of LUS for neonatal respiratory disorders (NRDs) diagnosis and follow-up compared to chest X-ray (CXR). A [...] Read more.

Lung ultrasound (LUS) has become one of the most exciting applications in neonatal point-of-care ultrasound (POCUS), yet still lacks routine clinical use. This study assesses the utility of LUS for neonatal respiratory disorders (NRDs) diagnosis and follow-up compared to chest X-ray (CXR). A prospective cross-sectional study was conducted on 100 neonates having NRDs with a gestational age ≥28 weeks, excluding those having multiple congenital anomalies, chromosomal aberrations, hydrops fetalis and/or heart failure. CXR and LUS were done on admission for diagnosis and were repeated after 7 days, or if needed earlier within the 7 days. The diagnosis of NRDs by CXR and LUS on admission and after 7 days was comparable (p > 0.05). LUS diagnosis sensitivity and specificity for respiratory distress syndrome, pneumonia, meconium aspiration syndrome, pneumothorax and pulmonary atelectasis were 94.7/100%, 97.5/95%, 92.3/100%, 90.9/98.9% and 100/97.8%, respectively. The total agreement between LUS and CXR was 98.5% with 95% CI (0.88 to 0.92). LUS and CXR had considerable agreement in the diagnosis of NRDs. Being a reliable bedside modality of diagnosis and safer than CXR, LUS may be considered an alternative method for the diagnosis of neonates with NRDs. Full article

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9 pages, 623 KiB

Open AccessArticle

An Algorithm for the Detection of General Movements of Preterm Infants Based on the Instantaneous Heart Rate

by Tomoki Maeda, Osamu Kobayashi, Eriko Eto, Masanori Inoue, Kazuhito Sekiguchi and Kenji Ihara

Children 2023, 10(1), 69; https://doi.org/10.3390/children10010069 - 29 Dec 2022

Cited by 2 | Viewed by 1256

Abstract

Video recording and editing of general movements (GMs) takes time. We devised an algorithm to automatically extract the period of GMs emergence to assist in the assessment of GMs. The algorithm consisted of δHR: subtracting the moving average heart rate (HR) for the [...] Read more.

Video recording and editing of general movements (GMs) takes time. We devised an algorithm to automatically extract the period of GMs emergence to assist in the assessment of GMs. The algorithm consisted of δHR: subtracting the moving average heart rate (HR) for the past 60 s from the average instantaneous HR; and %δHR: the percentage of the instantaneous HR to the moving average HR. Ten-second sections in which δHR was positive for three consecutive sections and contained at least one section with %δHR > 105% were extracted. Extracted periods are called automated extraction sections (AESs). We evaluated the concordance rate between AESs and GMs in three periods (gestational age 24–32, 33–34, and 35–36 weeks). The records of 84 very low birth weight infants were evaluated. Approximately 90% of AESs were accompanied by GMs at any period in both the supine and prone positions. The proportion of full-course (beginning to end) GMs among GMs in the AES was 80–85% in the supine position and 90% in the prone position in all periods. We could extract a sufficient number of assessable GMs with this algorithm, which is expected to be widely used for assisting in the assessment of GMs. Full article

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11 pages, 828 KiB

Open AccessArticle

Possibilities of Influencing Procedural Pain Associated with Premature Newborn Retinopathy Screening with Oral Clonidine

by Jiri Dusek, Eliska Simkova, Eva Fendrstatova, Radim J. Sram, Hana Kotouckova and Jan Voracek

Children 2022, 9(11), 1659; https://doi.org/10.3390/children9111659 - 29 Oct 2022

Cited by 1 | Viewed by 1539

Abstract

Background: The aim of our study was to compare the analgesic/sedative effects of various fundus-related procedural pain management strategies on the risk of retinopathy in premature infants. Method: This was a prospective comparative study involving a total of 94 neonates randomized to three [...] Read more.

Background: The aim of our study was to compare the analgesic/sedative effects of various fundus-related procedural pain management strategies on the risk of retinopathy in premature infants. Method: This was a prospective comparative study involving a total of 94 neonates randomized to three groups meeting the criteria for at-risk neonates. Ophthalmologic screening was performed to evaluate the outcome of three procedural pain management strategies. The intensity of pain over time during and after the screening examination was evaluated. At the same time, we also looked at the occurrence of vegetative symptoms and their influence by the chosen medication. Pain response was observed in all 94 neonates enrolled in the study. In group A, no pain treatment was given. Group B had a local anesthetic oxybuprocaine hydrochloride 0.4% introduced into both eyes immediately prior to the examination. Group C received oral clonidine. The study was conducted as a pilot project and aimed to clarify the problem so that a project with a higher proband representation could take place in the future. Consequently, we performed quantitative analysis of complete pain and vegetative functions, followed by a qualitative analysis of their internal components. Results: In our study, we identified the most considerable effects for all three groups, including NIPS (Neonatal Infant Pain Scale) responses immediately during and after the examination. The influence of vegetative functions is of a longer-term nature and increased values can be clearly demonstrated even six hours after the examination. Conclusion: The current results identify and quantify differences among all three methods of pain treatment on the level of single variables. Their internal structures, however, can be analysed only qualitatively because of the small size of the analysed sample. Full article

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10 pages, 1009 KiB

Open AccessArticle

Noninvasive Ventilation in Preterm Infants: Factors Influencing Weaning Decisions and the Role of the Silverman-Andersen Score

by Claudia Nussbaum, Maximilian Lengauer, Alexandra F. Puchwein-Schwepcke, Veronique B. N. Weiss, Benedikt Spielberger and Orsolya Genzel-Boroviczény

Children 2022, 9(9), 1292; https://doi.org/10.3390/children9091292 - 26 Aug 2022

Cited by 3 | Viewed by 3679

Abstract

The factors influencing weaning of preterm infants from noninvasive ventilation (NIV) are poorly defined and the weaning decisions are often driven by subjective judgement rather than objective measures. To standardize quantification of respiratory effort, the Silverman-Andersen Score (SAS) was included in our nursing [...] Read more.

The factors influencing weaning of preterm infants from noninvasive ventilation (NIV) are poorly defined and the weaning decisions are often driven by subjective judgement rather than objective measures. To standardize quantification of respiratory effort, the Silverman-Andersen Score (SAS) was included in our nursing routine. We investigated the factors that steer the weaning process and whether the inclusion of the SAS would lead to more stringent weaning. Following SAS implementation, we prospectively evaluated 33 neonates born ≤ 32 + 0 weeks gestational age. Age-, weight- and sex-matched infants born before routine SAS evaluation served as historic control. In 173 of 575 patient days, NIV was not weaned despite little respiratory distress (SAS ≤ 2), mainly due to bradycardias (60% of days without weaning), occurring alone (40%) or in combination with other factors such as apnea/desaturations. In addition, “soft factors” that are harder to grasp impact on weaning decisions, whereas the SAS overall played a minor role. Consequently, ventilation times did not differ between the groups. In conclusion, NIV weaning is influenced by various factors that override the absence of respiratory distress limiting the predictive value of the SAS. An awareness of the factors that influence weaning decisions is important as prolonged use of NIV has been associated with adverse outcome. Guidelines are necessary to standardize NIV weaning practice. Full article

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18 pages, 1361 KiB

Open AccessArticle

Early Physiotherapy Intervention Program for Preterm Infants and Parents: A Randomized, Single-Blind Clinical Trial

by Mirari Ochandorena-Acha, Marc Terradas-Monllor, Laura López Sala, Maria Engracia Cazorla Sánchez, Montserrat Fornaguera Marti, Isabel Muñoz Pérez, Thais Agut-Quijano, Martín Iriondo and Joan Carles Casas-Baroy

Children 2022, 9(6), 895; https://doi.org/10.3390/children9060895 - 15 Jun 2022

Cited by 6 | Viewed by 3665

Abstract

Background: The early developmental interventions might be designed with a preventative approach to improving the development of at-risk preterm infants. The present study aimed to evaluate the effectiveness of an early physiotherapy intervention on preterm infants’ motor and global development, and on parents’ [...] Read more.

Background: The early developmental interventions might be designed with a preventative approach to improving the development of at-risk preterm infants. The present study aimed to evaluate the effectiveness of an early physiotherapy intervention on preterm infants’ motor and global development, and on parents’ stress index. Methods: 48 infants were enrolled and randomized into two groups. Infants allocated to the intervention group received an early physiotherapy intervention, based on parental education sessions and tactile and kinesthetic stimulation during the NICU period, as well as a home-based activity program. The intervention commenced after 32 weeks post-menstrual age and ended at 2 months corrected age. Infants allocated to the control group received the usual care based on the NIDCAP-care. Results: No differences were found between groups on the Alberta Infant Motor Scale at 2- or 8-months corrected age. Infants in the intervention group showed more optimal fine motor, problem-solving, personal-social, and communication development at 1 month corrected age. Conclusions: The results showed no effect on the early physiotherapy intervention. Results might be related to the dose or intensity of the intervention, but also to the poor parental compliance. ClinicalTrials.gov NCT03313427. Full article

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Review

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15 pages, 1315 KiB

Open AccessEditor’s ChoiceReview

Cardiovascular Morbidities in Adults Born Preterm: Getting to the Heart of the Matter!

by Vasantha H. S. Kumar

Children 2022, 9(12), 1843; https://doi.org/10.3390/children9121843 - 28 Nov 2022

Cited by 9 | Viewed by 2337

Abstract

Advances in perinatal and neonatal care have led to improved survival of preterm infants into adulthood. However, the shift in focus to long-term health in adults born preterm requires a clear understanding of the impact of prematurity on developing organ systems and the [...] Read more.

Advances in perinatal and neonatal care have led to improved survival of preterm infants into adulthood. However, the shift in focus to long-term health in adults born preterm requires a clear understanding of the impact of prematurity on developing organ systems and the development of adult-oriented disease. A less well-recognized area of risk for surviving preterm infants is their cardiometabolic health. Epidemiologic evidence has linked preterm birth to the development of systemic hypertension, type 2 diabetes, metabolic syndrome, heart failure, and ischemic heart disease. Of more significant concern is that the risk of cardiometabolic disorders is higher in adults born preterm compared to full-term infants. The interconnected nature of the cardio-pulmonary system means worsening morbidity and mortality in adults born preterm. Addressing the problems of adults born preterm holistically would help promote cardiovascular health, wellness, and quality of life over their lifetime. Recognizing that adults born preterm are a unique subset of the population is a challenge in the current healthcare environment. Addressing issues relevant to adults born preterm in the clinically and research domain, using technology to characterize cardiopulmonary physiology and exercise tolerance, developing screening tools for early diagnosis and treatment, and robust follow-up of these infants with access to longitudinal data would improve both the quality and longevity of life in adults born preterm. Full article

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8 pages, 225 KiB

Open AccessCase Report

The Development of an Enhanced Recovery Protocol for Kasai Portoenterostomy

by Peggy Vogt, Renee Tolly, Matt Clifton, Tom Austin and Joelle Karlik

Children 2022, 9(11), 1675; https://doi.org/10.3390/children9111675 - 31 Oct 2022

Cited by 1 | Viewed by 1306

Abstract

Balancing post-operative adequate pain control, respiratory depression, and return of bowel function can be particularly challenging in infants receiving the Kasai procedure (hepatoportoenterostomy). We performed a retrospective chart review of all patients who underwent the Kasai procedure from a single surgeon at Children’s [...] Read more.

Balancing post-operative adequate pain control, respiratory depression, and return of bowel function can be particularly challenging in infants receiving the Kasai procedure (hepatoportoenterostomy). We performed a retrospective chart review of all patients who underwent the Kasai procedure from a single surgeon at Children’s Healthcare of Atlanta from 1 January 2018, to 1 September 2022. 12 patients received the Kasai procedure within the study period. Average weight was 4.47 kg and average age was 7.4 weeks. Most patients received multimodal pain management including dexmedetomidine and/or ketorolac along with intravenous opioids. A balance of colloid and crystalloids were used for all patients; 57% received blood products as well. All patients were extubated in the OR and transferred to the general surgical floor without complications. Return of bowel function occurred in all patients by POD2, and enteral feeds were started by POD3. One patient had a presumed opioid overdose while admitted requiring a rapid response and brief oxygen supplementation. Simultaneously optimizing pain control, respiratory safety, and bowel function is possible in infants receiving the Kasai procedure. Based on our experience and the current pediatric literature, we propose an enhanced recovery protocol to improve patient outcomes in this fragile population. Larger, prospective studies implementing an enhanced recovery protocol in the Kasai population are required for stronger evidence and recommendations. Full article

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9 pages, 7485 KiB

Open AccessCase Report

Cleft Palate and Aortic Dilatation as Clues for Loeys–Dietz Syndrome

by Pierluigi Zaza, Flavia Indrio, Annalisa Fracchiolla, Matteo Rinaldi, Giovanni Meliota, Alessia Salatto, Antonio Bonacaro and Gianfranco Maffei

Children 2022, 9(9), 1290; https://doi.org/10.3390/children9091290 - 26 Aug 2022

Cited by 1 | Viewed by 2346

Abstract

Loeys–Dietz syndrome (LDS) is a rare autosomal-dominant disorder of the connective tissue with some typical vascular findings, skeletal manifestations, craniofacial features, and cutaneous findings with a wide phenotypic spectrum. Six different genes are involved in LDS and the diagnosis is based on the [...] Read more.

Loeys–Dietz syndrome (LDS) is a rare autosomal-dominant disorder of the connective tissue with some typical vascular findings, skeletal manifestations, craniofacial features, and cutaneous findings with a wide phenotypic spectrum. Six different genes are involved in LDS and the diagnosis is based on the identification of a heterozygous pathogenic variant in TGFBR1, TGFBR2, SMAD3, TGFB2, TGFB3, or SMAD2 in children with suggestive findings. These genes distinguish LDS into six classes (LDS1–LDS6, respectively). Delay in diagnosis of Loeys–Dietz syndrome may be associated with an adverse prognosis due to a very high augmented risk of early complications such as aortic or vascular rupture. The present report describes a case of an early diagnosis of LDS in a neonate with cleft soft palate and aortic root dilatation. Full article

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