Term intra-partum asphyxia: An analysis of acute non-specific supportive criteria and non-CNS organ injury

ObjectiveThe purpose of this study was to describe the frequencies and relationships of non-specific non-essential diagnostic criteria and non-CNS organ system injury in term intra-partum asphyxia.MethodsAll children with term intra-partum asphyxia encountered in a single pediatric neurology practice with at least two years follow-up and an abnormal neurologic outcome were identified.ResultsA total of 40 children (28 males, 12 females) were identified. Twenty-four had moderate NE and sixteen severe NE. The mean number of non-specific non-essential diagnostic criteria (out of a possible 7) was 4.75 ± 1.39 SD. Sixty percent had five or more criteria and all criteria were present in only 10% of newborns. The mean number of non-CNS organ systems affected was 2.88 ± 1.96 SD (out of a possible 6). Ten percent of our sample showed no evident non-CNS organ injury acutely.ConclusionMost asphyxiated neonates failed to consistently satisfy all elements of present consensus statements.     

Negative influence of maternal smoking during pregnancy on infant outcomes

BackgroundAccording to the INPES 2014 health barometer, the prevalence of smoking in pregnant women in France is the highest in Europe : 17.8% of expectant mothers who smoke continue to do so during pregnancy. Several epidemiological studies have confirmed multiple risks for tobacco-exposed infants (low birth weight; digestive, respiratory, neurological, and psychological disorders; obesity; type 1 diabetes).PurposeThis study compared a cohort of infants exposed to tobacco in utero (T + ) with those unexposed (T−). Birth weight, diet, presence of colic (ROME III criteria) and regurgitations (Vandenplas scale) were specifically analyzed.MethodsThis observational, cross-sectional, and multicenter survey was conducted in France by pediatricians and general practitioners from September 2016 to February 2017. Infants with a chronic pathology and those with parents under 18 years of age were excluded. The data were collected by the physician and by the mother through a self-administered questionnaire.ResultsA total of 452 physicians recruited 759 T+ and 741 T- infants in the study. The mean birth weight of T+ infants was significantly lower (3.1 ± 0.5 kg [WHO z-score -0.476 ± 1.081]) than that of T− infants (3.3 ± 0.5 kg [0.033 ± 0.965]; P < 0.001). At the time of leaving the maternity facility, 47.7% of T+ infants were breastfed by their mother compared with 70.1% of T− infants. The median reported duration of breastfeeding was 1 month vs. 2 months for T+ and T− infants, respectively. Colic was significantly more common in T+ than in T− infants: 25.6% vs. 12.3% according to the ROME III criteria, and 45.7% vs. 29.7% according to the doctor's opinion (P < 0.001 for both). In the T+ group, cases of regurgitation (63.6% vs. 56.5%; P = 0.005), respiratory disorder (6.3% vs. 2.4%, P < 0.001), and bronchiolitis (6.5% vs. 3.0%; P = 0.001) were also more frequent.ConclusionThis study confirms that maternal smoking during pregnancy is associated with health risks; exposed infants had significantly more digestive/respiratory symptoms and lower birth weight than unexposed infants. Preventive and educational actions need to be further strengthened in the face of this public health problem.     

Association of late-onset neonatal sepsis with late neurodevelopment in the first two years of life of preterm infants with very low birth weight

Objectiveto establish the influence of late-onset sepsis on neurodevelopment of preterm infants with very low birth weight (VLBW), according to the etiologic agent.Methodthis was a cohort of newborns with birth weight < 1,500 g and gestational age less than 32 weeks, admitted to the institutional intensive care unit (ICU) with up to 48 hours of life, and followed-up at the outpatient follow-up clinic for preterm infants with VLBW until 2 years of corrected age. Exclusion criteria: death within the first 72 hours of life, congenital malformations and genetic syndromes, children with congenital infection by the human immunodeficiency virus (HIV), congenital infection (STORCH), presence of early-onset sepsis and cases with more than one pathogen growth in blood cultures. Septic and non-septic infants were compared regarding neonatal outcomes and mortality. Neurodevelopment was assessed using the Bayley Scale (BSDI-II) at 18 to 24 months of corrected age.Results411 preterm infants with VLBW were eligible; the mean gestational age was 29 ± 2.2 weeks and mean birth weight was 1,041 ± 281grams. Late-onset sepsis occurred in 94 preterm infants with VLBW (22.8%). VLBW infants with Gram-positive infection showed motor deficit when compared to the non-septic group, 68.8% vs. 29.3%, respectively (OR 6; 1.6-21.8, p = 0.006); the cognitive development was similar between the groups. The overall mortality rate from infection was 26.7%; considering the pathogens, the rates were 18.7% for coagulase-negative Staphylococcus, 21.8% for Gram-positive bacteria, and 50% for Gram-negative bacteria and fungi.Conclusionneonatal sepsis has a significant influence on late neurodevelopment at 2 years of corrected age in preterm infants with VLBW, and Gram-positive infections are associated with motor deficit.     

Comparison of three different noninvasive ventilation strategies as initial respiratory support in very low birth weight infants with respiratory distress syndrome: A retrospective study

BackgroundThere is inadequate evidence regarding which noninvasive ventilation (NIV) is superior for initial respiratory support of preterm infants with respiratory distress syndrome.ObjectivesTo compare the failure of noninvasive ventilation (NIV) and neonatal outcomes between nasal continuous positive airway pressure (NCPAP), bi-level positive airway pressure (BiPAP), and nasal intermittent positive pressure ventilation (NIPPV) as the initial respiratory support with less invasive surfactant administration (LISA) in very low birth weight (VLBW) infants.MethodsMedical records of 419 VLBW infants born at 26–30 weeks’ gestation who did not require intubation in the delivery room and were initially supported with either NCPAP (n = 221), BiPAP (n = 101), or NIPPV (n = 97) were retrospectively reviewed. The LISA approach was preferred in cases of surfactant requirement. The primary outcome was the failure of NIV within the first 72 h of life. Failure of NIV was defined as the persistence or recurrence of one or more of the following: hypoxemia, respiratory acidosis, more than one episode of apnea requiring bag and mask ventilation or more than six episodes of apnea requiring stimulation over a 6-h period. Data were analyzed using univariate and multivariate logistic regression analysis.ResultsFailure of NIV within the first 72 h of life was significantly higher in the NCPAP group (29.4%) compared with the BiPAP (12.9%) or NIPPV (12.4%) group (P < 0.001). However, the BiPAP and NIPPV groups were not different in terms of NIV failure (P = 0.91). Multivariable logistic regression analysis showed that antenatal steroid administration (OR: 0.49, 95% CI: 0.27–0.90; P = 0.02) and gestational age ˂ 28 weeks (OR: 2.03, 95% CI: 1.18–3.49; P = 0.01) were independent factors that influence failure of NIV within the first 72 h of life.ConclusionCompared with NCPAP, the use of NIPPV/BiPAP strategies for initial respiratory support can reduce the need for invasive ventilation in infants born at 26–30 weeks’ gestation.     

Prevalence of metabolic syndrome-like in the follow-up of very low birth weight preterm infants and associated factors

ObjectiveTo assess the prevalence of metabolic syndrome-like symptoms in a population of preterm infants with very low birth weight (<1500 g) at 2 years of corrected age and identify the occurrence of associated risk factors.MethodsCross-sectional study during a five-year period, including preterm infants born with very low birth weight evaluated at 2 years of corrected age. Metabolic syndrome-like symptoms was defined by the presence of three or more of these criteria: abdominal circumference ≥ 90th percentile, fasting blood glucose ≥ 100 mg/dL, triglycerides ≥ 110 mg/dL, HDL cholesterol ≤ 40 mg/dL, and blood pressure ≥ 90th percentile.ResultsA total of 214 preterm infants with birth weight < 1500 g were evaluated. The prevalence of metabolic syndrome-like symptoms at 2 years of corrected age was 15.1%. Arterial hypertension was present in 57.5%, HDL ≤ 40 mg/dL in 29.2%, hypertriglyceridemia in 22.6%, and abdominal circumference above the 90th percentile in 18.8%. Only 3.7% had hyperglycemia. The presence of periventricular leukomalacia was an independent risk factor for arterial hypertension at this age (OR 2.34, 95% CI: 0.079–0.69, p = 0.008). Overweight and obesity at 2 years of corrected age were independently associated with metabolic syndrome-like symptoms (OR 2.75, 95% CI: 1.19–6.36, p = 0.018).ConclusionMetabolic syndrome-like symptoms can be observed in very low birth weight preterm infants as early as 2 years of corrected age. Overweight and early-onset obesity are significant risk factors for metabolic syndrome-like symptoms, which deserves appropriate intervention for this high-risk population.     

A light/dark cycle in the NICU accelerates body weight gain and shortens time to discharge in preterm infants

BackgroundBright constant light levels in the NICU may have negative effects on the growth and development of preterm infantsObjectiveThe aim of this study is to evaluate the benefits of an alternating light/dark cycle in the NICU on weight gain and early discharge from the therapy in premature infants.Patients and methodsA randomized interventional study was designed comparing infants in the NICU of Hospital Juarez de México, exposed from birth either to an LD environment (LD, n = 19) or to the traditional continuous light (LL, n = 19). The LD condition was achieved by placing individual removable helmets over the infant's heads. Body weight gain was analyzed, as the main indicator of stability and the main criteria for discharge in preterm infants born at 31.73 ± 0.31 week gestational age.ResultsInfants maintained in an LD cycle gained weight faster than infants in LL and therefore attained a shorter hospital stay, (34.37 ± 3.12 vs 51.11 ± 5.29 days; P > 0.01). Also, LD infants exhibited improved oxygen saturation and developed a daily melatonin rhythm.ConclusionsThese findings provide a convenient alternative for establishing an LD environment for preterm healthy newborns in the NICU and confirm the beneficial effects of an alternating LD cycle for growth and weight gain and for earlier discharge time. Here we provide an easy and practical alternative to implement light/dark conditions in the NICU.     

Consensus international sur le dépistage,le diagnostic et le traitement des adolescents avec un trouble du déficit de l’attention avec ou sans hyperactivité en cas de comorbidité avec des troubles de l’usage de substances

BackgroundChildhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for substance misuse and substance use disorder (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment and is associated with poor treatment outcomes. Research on the effect of treatment of childhood ADHD on the prevention of adolescent SUD is inconclusive, and studies on the diagnosis and treatment of adolescents with ADHD and SUD are scarce. Thus, the available evidence is generally not sufficient to justify robust treatment recommendations.ObjectiveThe aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience.MethodA modified Delphi study to reach consensus based upon the combination of scientific data and clinical experience with a multidisciplinary group of 55 experts from 17 countries. The experts were asked to rate a set of statements on the effect of treatment of childhood ADHD on adolescent SUD and on the screening, diagnosis, and treatment of adolescents with comorbid ADHD and SUD.ResultsAfter 3 iterative rounds of rating and adapting 37 statements, consensus was reached on 36 of these statements representing 6 domains: general (n = 4), risk of developing SUD (n = 3), screening and diagnosis (n = 7), psychosocial treatment (n = 5), pharmacological treatment (n = 11), and complementary treatments (n = 7). Routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings. Long-acting stimulants are recommended as the firstline treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should preferably be embedded in psychosocial treatment. The only remaining no-consensus statement concerned the requirement of abstinence before starting pharmacological treatment in adolescents with ADHD and concurrent SUD. In contrast to the majority, some experts required full abstinence before starting any pharmacological treatment, some were against the use of stimulants in the treatment of these patients (independent of abstinence), while some were against the alternative use of bupropion.ConclusionThis international consensus statement can be used by clinicians and patients together in a shared decision-making process to select the best interventions and to reach optimal outcomes in adolescent patients with concurrent ADHD and SUD.     

Factores de riesgo para el desarrollo de hiponatremia precoz en el prematuro. Revisión de nuestra práctica en administración de sodio en los primeros días de vida

IntroductionA retrospective study was conducted in the Neonatal Intensive Care Unit of a tertiary hospital to determine the incidence of early hyponatraemia (first 48 hours of life) in preterm infants. Risk and protection factors in this condition were also examined as a starting point for a change in the medical action when prescribing intravenous fluids.Material and methodsThe study included a sample of 256 premature babies (gestational age: 23⁵-36⁶) admitted to the Neonatal Intensive Care Unit of a tertiary hospital between January 2016 and June 2018. The number of patients receiving intravenous sodium in different intervals during the first 48 hours of life was determined, as well as the number of those with hyponatraemia of any type (<135mmol / l), and moderate-severe (<130mmol / l). An analysis was made of the relationship between early hyponatraemia and weight / gestational age, antenatal steroids exposure, respiratory pathology, early sepsis, and perinatal asphyxia.ResultsHyponatraemia occurred in 81 patients, 31.64% of the total (up to 50% in < 30 weeks of gestational age), and was moderate-severe (<130mmol / l) in 17.3% of the cases. The period of time with the most cases of hyponatraemia was in the first 12 hours of life (22.64%). Weight (P = .034), gestational age (P < .001) and respiratory disease (P < .001) were found to be risk factors and, in a multivariate analysis, the latter was independently related to early hyponatremia (P < .01, OR = 5.24, 95% CI: 2.79-9.84). Antenatal betamethasone exposure did not show to be a protection factor.ConclusionAccording to the results of this study, it is considered an advantage to provide sodium in the intravenous fluids prescribed during the first days of life, particularly in preterm infants of lower gestational age and with respiratory disease involvement.     

Impacts des facteurs maternels sur l’allaitement maternel en réanimation néonatale

ObjectiveAdmission at birth to a Neonatal Intensive Care Unit (NICU) complicates breastfeeding especially for preterm babies despite hospital staff trained to encourage breastfeeding. The aim of this study was to find factors related to the mother, the pregnancy or the neonate influencing breastfeeding rate on a NICU.Patients and methodsThis was a retrospective study including neonatal admissions to the NICU at Antoine-Béclère University Hospital from 1st May 2009 to 30th April 2010. Data was collected from medical notes. The breastfeeding rate (at initiation and at discharge) was analysed with regards to maternal age, method of procreation, type of pregnancy (single or multiple), parity, mode of delivery (vaginal delivery or C-section), birthweight, gestational age and intra-uterine growth restriction (IUGR).ResultsThe study was based on 460 neonates having complete documentation. The average maternal age was 32 years. Premature infants represented 74.8% of the population (median gestational age = 34 weeks) of which 57% were less than 33 weeks (42.6% of all infants, n = 196). The median birthweight was 1900 g with 17.6% of IUGR infants. Breastfeeding rate at initiation was 58.7 and 43.9% at discharge (mean admission days: 17.1 [0–180], median = 8 days). For infants born of multiple pregnancies (24.3% of the population) 51.6% were born of medically assisted pregnancies (MAP) and 17.6% of spontaneous pregnancies. Breastfeeding rate among these infants was 57.1% at initiation and 45.5% at discharge. It was higher in infants born of MAP at initiation (70.3% versus 55.8% for spontaneous pregnancies, P < 0.05) and at discharge (49.5% versus 42.5% for spontaneous pregnancies). For these infants, average maternal age was higher for breastfed infants (33.9 versus 32.1 years for the formula-fed, P < 0.05). Breastfeeding rate in infants born to primipares was higher at initiation (64.9% versus 53.6% for multipares, P < 0.05) and at discharge (48.5% versus 40.8% for multipares, P < 0.05). The rate of infants breastfed was influenced neither by maternal age alone (31.8 ± 5.6 versus 31.4 ± 5.7 years for formula-fed), nor by type of delivery (56.7% for infants born by C-section versus 62.5% for infants born by vaginal delivery), nor gestational age (33.2 ± 4.3 weeks for breastfed, versus 33.4 ± 4.2 weeks for formula-fed infants), nor birthweight (2060 ± 978 g for breastfed versus 2055 ± 909 g for formula-fed infants), nor IUGR (58% versus 58.8% for eutrophes).DiscussionOur maternal population was different as 16.7% of deliveries were accounted for by MAP, superior to the French average (< 10%). We describe for the first time MAP as a positive influencing factor on breastfeeding rates in newborns admitted to a NICU. A better breastfeeding information policy during pregnancy, higher maternal age and increased multiple pregnancies would explain a higher breastfeeding rate among the women who had MAP. An impact of increasing maternal age was found on the rate of breastfed infants born of MAP. Primiparity was also a contributing factor for breastfeeding. Professional formation for all hospital staff concerned would be essential to give out clear and consistent information to families and to encourage support and intimacy throughout hospitalisation as well as at discharge.     

Point-of-care lung ultrasound in children with bronchiolitis in a pediatric emergency department

ObjectivesThis study assessed the association between findings of lung ultrasound (LUS) performed in the pediatric emergency department (PED) on infants with bronchiolitis and need for respiratory support.MethodsAn observational study was carried out in the PED during the epidemic seasons in two consecutive years. Infants diagnosed with bronchiolitis who fulfilled the inclusion criteria were evaluated. A group of six pediatricians performed LUS and classified lung findings into four groups: normal pattern (A), moderate interstitial pattern (B1), severe interstitial pattern (B2), and isolated consolidation (C). The relationship between LUS findings and need for respiratory support was explored. An expert sonographer, blinded to the results, reviewed the ultrasound studies to determine the interobserver reliability.ResultsA total of 200 infants were included (mean age 5.7 months ± 4.4 SD); 65 (32.5%) obtained moderate clinical scores, while 23 (11.5%) needed respiratory support at admission and 34 (17.0%) at 48 h. The ultrasound findings in the PED were the following: A = 89 (44.5%), B1 = 55 (27.5%), B2 = 34 (17%), and C = 22 (11%). Age less than 6 weeks and moderate bronchiolitis were correlated with abnormal LUS (P < 0.005). The severity of interstitial ultrasound pattern has some correlation with an increased need for respiratory support. The interobserver concordance was high (0.95, confidence interval: 0.92–0.98).ConclusionLUS is a feasible tool that may help to confirm the clinical impression and assess the need for respiratory support in children with bronchiolitis, but further multicenter studies are needed.     

Rapid diagnosis of respiratory distress syndrome by oral aspirate in premature newborns

ObjectiveThe stable microbubble test on gastric aspirate and on amniotic fluid has been used for the diagnosis of respiratory distress syndrome in the newborn. However, no study has performed this test on oral aspirates from premature infants. The objective of this study was to evaluate the performance of the stable microbubble test on oral aspirates from preterm newborns to predict respiratory distress syndrome.MethodThis study included infants with gestational age <34 weeks. Oral fluids were obtained immediately after birth and gastric fluids were collected within the first 30 minutes of life. The samples were frozen and tested within 72 hours.ResultsThe sample was composed of paired aspirates from 64 newborns, who were divided into two groups: respiratory distress syndrome group (n = 21) and control group (n = 43). The median (interquartile range) of the stable microbubble count in the oral samples of infants with respiratory distress syndrome was significantly lower than that of infants who did not develop respiratory symptoms: respiratory distress syndrome group = 12 (8–22) stable microbubbles/mm²; control group = 100 (48–230) microbubbles/mm² (p < 0.001). The correlation between microbubble count in gastric and oral aspirates was 0.90 (95% confidence interval = 0.85–0.95; p < 0.001). Considering a cut-off point of 25 microbubbles/mm², the sensitivity and the specificity of the stable microbubble test were 81.4% and 85.7%, respectively.ConclusionThe study suggests that the stable microbubble test performed on oral aspirate is a reliable alternative to that performed on gastric fluid for the prediction of respiratory distress syndrome in the newborn.     

Challenges in choosing the appropriate guidelines for use in children and adolescents with hypertension

BackgroundThis study was designed to observe the effect of antihypertensive treatment on blood pressure (BP) and target organ damage in patients followed up according to the American Academy of Pediatrics Hypertension Guidelines (AAPG). The results were also assessed in comparison with the definitions and target organ damage according to the European Society of Hypertension Guidelines 2016 (ESHG).Materials and methodsA total of 44 (34 male) out of 140 patients were enrolled in the study and the mean age was 14 ± 3.19 years. The follow-up period was at least 12 months. All patients underwent the following assessments: anthropometrical measurements of body mass index (BMI), left ventricular mass index (LVMI), and biochemical parameters according to the relevant guidelines. The pre-treatment and post-treatment datasets collected were compared.ResultsThe frequency of symptomatic patients decreased from 88% to 30%. After treatment, 29.4% (n = 13) of patients still had elevated and stage 1 hypertension (HT) according to the AAPG. These patients were older and had higher BMI z-scores, LVMI z-scores, mean BP indices, and also had longer symptom duration than normotensive patients (P < 0.001). When patients were assessed according to the ESHG, 34.1% (n = 15) of patients had high–normal stage 1 and stage 2 HT. While 53.3% (n = 8) of the patients aged 13–15 years were classified as having high–normal stage 1 and stage 2 HT according to the ESHG, 33.3% (n = 5) were classified as having elevated BP and stage 1 HT according to the AAPG. Additionally, 36.4% (n = 4) of the patients aged ≥ 16 years were classified as having high–normal and stage 1 HT according to the ESHG, whereas 45.5% (n = 5) were classified as having elevated BP and stage 1 HT according to the AAPG.ConclusionTo control HT in children with higher BMI z-scores, higher LVMI z-scores, and higher BP indices, an earlier and more intensive approach is needed. Considering that the duration of exposure to HT may also affect the LVMI, adjusting age and gender or decreasing the current thresholds for LVMI may lead to an earlier diagnosis for more patients. According to the present classifications, the ESHG covers more children aged between 13 and 15 years in contrast to the AAPG, which covers more patients aged ≥ 16 years. However, further studies are needed to confirm these results.     

Aspectos perinatales,crecimiento y tipo de lactancia de los nacidos pequeños para su edad gestacional

IntroductionBeing born small for gestational age (SGA) has short and long term risks. The aim of this study was to describe perinatal and socio-cultural characteristics, and the pattern of growth and diet of SGA infants during their first 6 months of life.Materials and methodsAnthropometry and diet were evaluated during six months in a representative sample of 1596 newborns the population of Aragon (Spain).ResultsMothers of SGA (N = 94) infants gained less weight during pregnancy (10.5 ± 5.8 vs 12.0 ± 5.07 kg, P= .012), gestational age at birth was lower (37.84 ± 1.7 vs 39.06 ± 1.6 weeks, P < .001), and the probability of cesarean delivery was higher (37.2% vs 20.5%, P = .001). The height of the mother was lower in the SGA group (1.61 ± 0.58 vs 1.63 ± 0.06 metres, P = .004), but their body mass index was similar. No differences were found between groups in social or cultural aspects. Mothers of SGA infants smoked more during pregnancy (32.3% vs 18.5%, P = .003) (RR = 1.92; 95% CI; 1.31 to 3.02). Infants born SGA remained smaller during the first 6 months of life, and the monthly weight gain was similar to the rest. In the SGA group, the prevalence of breastfeeding was lower at 4 months of age (54.9% vs 68.2%, RR  =  0.58, 95% CI; 0.38 to 0.89).ConclusionsInfants born SGA are more likely to converge a number of characteristics that must be considered together because they may lead to health risks. SGA do not show a rapid recovery pattern of postnatal growth, and their smaller size persists at six months.     

Association between hypothermia in the first day of life and survival in the preterm infant

ObjectiveHypothermia is associated with elevated mortality in the preterm infant. The preterm infant's thermoregulatory capacity is limited, and the thermal environment in an incubator is often perturbed by nursing procedures. We evaluated the incidence of a postnatal low body temperature and hypothermia in preterm infants and its association with mortality.MethodsWe measured the lowest body temperature during the first 24 h of life (T_{Body Nadir 24h}) and hypothermia (T_{Body Nadir 24h} < 36.0 °C) in preterm infants (gestational age: 23⁰–31⁶ weeks) in a neonatal intensive care unit. Prenatal and neonatal characteristics associated with mortality were identified in univariate and multivariable analyses.ResultsA total of 102 preterm infants were included, with a mean gestational age at birth of 28.4 ± 2.3 weeks. The incidence of hypothermia during the first 24 h was 53%. A Cox multivariate regression model indicated that T_{Body Nadir 24h} (hazard ratio (HR) [95% confidence interval]: 0.57 [0.36–0.90]; P = 0.017), gestational age (0.62 [0.50–0.76]; P < 0.001), and amine use (4.55 [2.01–10.28]; P = 0.001) were significantly associated with mortality. When considering a threshold for T_{Body Nadir 24h}, a value of 35.0 °C had the highest HR (3.30 [1.42–7.68]; P < 0.01).ConclusionIn preterm infants, the incidence of hypothermia during the first 24 h of life was 53%. T_{Body Nadir 24h} had an influence on mortality, independently of other factors (notably birth weight and amine use). Within the framework of a quality improvement strategy, the implementation of a thermoregulation bundle is required to prevent hypothermia and decrease mortality in preterm infants.     

Valor pronóstico de la espectroscopia cercana al infrarrojo en la encefalopatía hipóxico-isquémica

IntroductionDespite treatment with hypothermia, 40% of newborns with hypoxic-ischaemic encephalopathy die or suffer moderate to severe disability. Near-infrared spectroscopy (NIRS) could be a useful, non-invasive tool to establish the prognosis.ObjectivesTo evaluate the prognostic value of NIRS in predicting neurodevelopmental outcomes at 18 to 36 months in newborns with hypoxic-ischaemic encephalopathy, and to establish the time points and cut-off values of regional cerebral oxygen saturation that exhibit the strongest correlation to these outcomes.Patients and methodsThe study included all term newborns with hypoxic-ischaemic encephalopathy managed with hypothermia and NIRS between 2013 and 2016. We established 3 outcome categories: normal neurodevelopment, moderate disability and severe disability.ResultsThe sample comprised 28 newborns (median gestational age, 39 weeks; median birth weight, 3195 g). The median regional cerebral oxygen saturation increased from 65% to 85% at 48 hours post birth. Neurodevelopmental outcomes were normal in 28.6%, while 35.7% developed moderate disability and 35.7% severe disability; 3 patients died. We found a statistically significant difference between groups at 48 hours (P = .005) and after hypothermia (P = .03), with higher values in patients with disability. When we compared patients in the severe disability group with the other groups, we found a statistically significant area under the ROC curve at 48 hours of 0.872 (P = .001) applying a regional cerebral oxygen saturation cutoff of 83.5%. After hypothermia, regional cerebral oxygen saturation values below 66.0% (AUC, 0.794; P = .017) predicted normal development, while values above 82% (AUC, 0.881; P = .001) predicted severe disability.ConclusionsNIRS seems to be a valuable tool to predict neurodevelopmental outcomes in patients with hypoxic-ischaemic encephalopathy, even after hypothermia, with higher cerebral oxygen saturation values in patients with disability.     

La punción suprapúbica guiada por ecografía aumenta el rendimiento de la técnica en menores de 4 meses

IntroductionSuprapubic bladder aspiration (SBA) is a widely accepted technique used to collect uncontaminated urine samples from infants with suspected urinary tract infection (UTI). Ultrasound-based guidance improves the success rates. The standard measurements for a successful procedure, however, have been scarcely evaluated.ObjectiveTo assess the efficacy of ultrasound-guided SBA versus blind SBA, and to establish the bladder measurements associated with optimal results.Patients and methodUltrasound-guided SBA was performed in 50 infants ≤ 4 months of age with suspected UTI, and the anteroposterior (APD) and transverse diameter of the bladder were determined using ultrasound equipment (Esaote MyLab^® 25 Gold, and Hewlett Packard Sonos^® 5500) with a 3.5 MHz convex probe. The success rates and the total volumes of collected urine were compared to a control group of 50 patients of similar age and clinical characteristics, to whom conventional blind SBA was performed.ResultsThe rate of successful ultrasound-guided SBA was 92.3% compared to 30.8% in the blind SBA group (P < .05). The collected urine volumes were 7.65 ± 1.85 ml and 6.1 ± 2.13 ml, respectively (P < .001). An APD ≥ 2 cm was associated with an optimal performance of the technique (97.8% success). No major complications were observed in either group.ConclusionsUltrasound-guided SBA is significantly more successful than blind SBA in infants less than 4 months of age, with an APD ≥ 2 cm being optimal for conducting the procedure.     

El peso para la longitud en pretérminos tardíos evaluados con impedancia bioélectrica se asocia a variables antropométricas

IntroductionThe fat mass is greater in late preterm than full term infants at 1 month post birth, which may be an additional risk factor for metabolic syndrome in adulthood.ObjectivesTo evaluate body composition (BC) in late preterm infants using bioelectrical impedance analysis to determine which anthropometric parameters are associated with BC. Our hypothesis was that weight-for-length is associated with the length-normalized fat mass index (FMI) at 1 year of life.Materials and methodsWe carried out a prospective cohort study in 2 groups: late preterm infants and full term infants. We obtained BC data by bioelectrical impedance analysis. We calculated the fat mass, FMI, fat-free mass (FFM) and length-normalized FFM index at 1, 6 and 12 months of life. After, we assessed the association of the FMI with anthropometric parameters using multiple linear regression analysis.ResultsThe study included 97 late preterm and 47 full term infants, although at 12 months of life, the BC assessment was performed on 66 and 33 infants, respectively. Late preterm infants, compared to full term infants, had a higher FFM at 1 month (4013 g vs. 3524 g), a higher weight velocity at 6 months (5480 g vs. 4604 g) and a lower FFM (7232 g vs. 7813 g) and FFM index (12.55 vs. 13.26) at 12 months of life. The multivariate regression analysis showed that the weight-for-length z-core at 12 months was positively associated with the FMI at 12 months in all infants.ConclusionThe weight-for-length z-score at 12 months is strongly associated with the FMI at 1 year of life. Further studies are needed to investigate whether an increment in this anthropometric parameter may modulate the risk of chronic diseases.     

Family history of atopy in infants with cow's milk protein allergy: A French population-based study

ObjectivesThis French multicenter, cross-sectional, observational study aimed to describe the family history of atopy in infants with cow's milk protein allergy (CMPA), and the related diagnostic approaches used by specialists in a real-life ambulatory setting.Patients and methodsIn total, 1674 infants with suspected CMPA [median age 4.5 months (range: 0.1–18.0), males 54%] were enrolled in the study by 466 private physicians (pediatricians: 97%). Family history of atopy was defined as a known history of atopy in at least one first- (father, mother, and/or sibling) and/or second-degree relative (grandparents, uncles, and aunts), as reported by parents to physicians.ResultsAtopy in a first-degree relative was more common among infants with documented or high probability of CMPA (in 84% and 80% of cases, respectively, vs. the other subgroups, P = 0.005). Most infants experienced digestive (92%) and skin (61%) symptoms suggestive of CMPA. Delayed reactions were reported in 64% of infants. According to a post-classification based on the results of previous diagnostic tests and procedures, 1133 infants (68%) had highly probable (52%) or documented CMPA (16%). In these infants, a history of atopy was reported in first- and/or second-degree relative(s) in 86% of cases (81% in first-degree relatives). Whatever the family history of atopy, the characteristics of the infants were similar, except for fewer pets in the case of negative family atopy (14% vs. 25%, P < 0.001). Atopy in a parent was more frequent in infants who presented with the first signs suggestive of CMPA within the first 6 months of life vs. those with later first symptoms (75% vs. 65%, P = 0.063).ConclusionThis French study confirms the high rate of family history of atopy in first-degree relatives of infants with probable or documented CMPA.     

Adverse events related to ibuprofen treatment for patent ductus arteriosus in premature neonates

ObjectiveOur study aimed to review adverse drug reactions (ADRs) associated with ibuprofen treatment of patent ductus arteriosus (PDA) in premature neonates.MethodWe retrospectively evaluated electronic patient records from neonates treated with ibuprofen for PDA during 5 years in a French neonatal intensive care unit. Full chart review and targeted triggers were used to detect ADRs. The causality between suspected ADRs and medication was evaluated using the WHO causality assessment method by pharmacovigilance experts. Categorical variables were compared using chi-square tests or Fisher's test. Quantitative variables were compared using the Student t test. We explored the risk factors associated with ADR using univariate model analysis.ResultOf 227 infants with a mean gestational age (GA) of 27 weeks (24–33), 12 (5%) developed intestinal perforation and seven, necrotizing enterocolitis (3%). The perforation occurred less frequently in infants older than 27 weeks GA (OR = 0.14; 95% CI = 0.03–0.66, P = 0.01). Other observed ADRs were acute renal failure (25 infants, 11%) and thrombocytopenia (five infants, 2%).ConclusionGastrointestinal complications observed in infants treated with ibuprofen for PDA including gastrointestinal perforations occur in less mature infants. Active chart review of the patient's medical file with a trigger tool should be evaluated for routine ADR monitoring.