Role of umbilical cord C-peptide levels in early prediction of hypoglycemia in infants of diabetic mothers

The aim of this study was to evaluate the risk factors of hypoglycemia in IDM and its relation to maternal DM control in the last trimester. Furthermore, the relationship between UC C peptide and the risk of developing hypoglycemia was evaluated. The authors concluded, poor diabetes control, especially in the last trimester, is associated with neonatal hypoglycemia. Furthermore, increased UC C-peptide levels could be used as an early indicator for risk of developing neonatal hypoglycemia and a predictor for babies need neonatal admission. However, further studies with larger sample sizes are needed to determine the cost effectiveness of this relatively costly test before it can be used routinely in daily care practice.

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Bedside upper gastrointestinal series in the neonatal intensive care unit

In neonatal intensive care unit (NICU) patients with intubation status, fluoroscopic evaluation for the bowel is limited. This study evaluates the utility of bedside upper gastrointestinal (UGI) series with delayed radiographs (DR) for assessing duodenojejunal junction (DJJ) and small bowel passage in NICU patients with nonspecific bowel ultrasonography and contrast enema findings. The authors reviewed clinical and imaging data for bedside UGI with DR of NICU patients from 2014 to 2019. Five abdominal radiographs were obtained at fixed time intervals of immediately after, 1 min, 5 min, 1 h, and 2 h following the administration of 5 cc/kg isotonic water-soluble contrast agent via the nasogastric tube. They concluded bedside UGI with DR can evaluate intestinal malrotation using immediate and 1 min delay and small bowel passage using 1 and 2 h delay images in NICU patients with nonspecific ultrasonographic and contrast enema findings. The majority with delayed contrast passages can have bowel pathology. Because of a small number of patients in this study, further studies with more infants are needed.

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Histological chorioamnionitis is associated with an increased risk of wheezing in preterm children less than 34 gestational weeks

Chorioamnionitis is associated with various neonatal short- and long-term morbidities. The effect of chorioamnionitis on premature children’s outcomes remains controversial. The aim of this study was to investigate the relationship between histological chorioamnionitis (HCA) and physiological development, wheezing, and atopic diseases in preterm children. The authors found that HCA was associated with an increased risk of wheezing among preterm children less than 34 weeks. Moreover, HCA induced a significant change of serum metabolomic profile in preterm children. However, HCA was not linked to atopic diseases, abnormal blood pressure, or physical or neuro- development

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Full term focus: Bliss’ campaign to highlight #HiddenNeonatalJourney

At the end of 2020, Bliss surveyed over 500 parents of full term babies about their experience of neonatal care. Two points were clear from the answers we received: every neonatal journey is different, and parents of full term babies who need neonatal care need better support, whatever their journey looks like. As such, Bliss is raising awareness of these experiences with a campaign that highlights #HiddenNeonatalJourneys.

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Hand hygiene for the prevention of infections in neonates

A new Cochrane Systematic Review has found that there is no evidence to support the effectiveness of one hand hygiene intervention compared to another for preventing infection in newborns. None of the five included studies examined other important issues such as death and duration of hospital stay. There was not much difference in the undesirable effects of various hand hygiene interventions on the skin of caregivers. In conclusion, the authors are not sure of the hand hygiene intervention that is better for preventing infection in newborn babies. They assessed only a few studies that involved small numbers of nurses and babies. In addition, most of the studies assessed had high risk of bias. Larger studies with low risk of bias are needed so reliable conclusions can be reached.

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National Neonatal Audit Programme (NNAP) 2020 annual report on 2019 data

The National Neonatal Audit Programme (NNAP) is a national clinical audit run by the Royal College of Paediatrics and Child Health (RCPCH) on behalf of the NHS. It is commissioned by the Healthcare Quality Improvement Partnership (HQIP).

The NNAP aims to helps neonatal units improve care for babies and their families by identifying areas for quality improvement in relation to the delivery and outcomes of care.

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Association between cerebral oxygen saturation and brain injury in neonates receiving therapeutic hypothermia for neonatal encephalopathy

This retrospective cohort study aimed to assess the association of cerebral oxygen saturation (CrSO₂) collected by near infrared spectroscopy (NIRS) during therapeutic hypothermia (TH) and rewarming with evidence of brain injury on post-rewarming MRI.

The study included 49 infants, who received TH for mild to severe neonatal encephalopathy. Of those, 26 presented with brain injury assessed by a novel MRI grading system, whereas 23 had normal MRI scans.

The results showed that CrSO₂ increased significantly from the first to the second day of TH in infants with brain injury, whereas it remained stable in patients with normal MRI. Increasing mean CrSO₂ values during rewarming was associated with brain injury (aOR 1.14; 95% CI 1.00–1.28), specifically with gray matter (GM) injury (aOR 1.23; 95% CI 1.02–1.49). The area under the ROC curve showed an excellent discrimination for GM involvement.

The authors concluded that clinically applied NIRS during TH and rewarming can assist in identifying the risk for brain injury.

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Improving the quality of neonatal acute kidney injury care: neonatal-specific response to the 22nd Acute Disease Quality Initiative (ADQI) conference

With the adoption of standardized neonatal acute kidney injury (AKI) definitions over the past decade and the concomitant surge in research studies, the epidemiology of and risk factors for neonatal AKI have become much better understood. Thus, there is now a need to focus on strategies designed to improve AKI care processes with the goal of reducing the morbidity and mortality associated with neonatal AKI. The 22nd Acute Dialysis/Disease Quality Improvement (ADQI) report provides a framework for such quality improvement in adults at risk for AKI and its sequelae. While many of the concepts can be translated to neonates, there are a number of specific nuances which differ in neonatal AKI care. A group of experts in pediatric nephrology and neonatology came together to provide neonatal-specific responses to each of the 22nd ADQI consensus statements.

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