What makes twins arrive too early?

In this study Sarah Rae Easter, from Harvard Medical School, led a team of researchers looking into the links between a previous premature birth and an increased likelihood of twins arriving early into the world in a subsequent pregnancy. 653 women took part in the study. 294 had never had a baby before becoming pregnant with twins, 310 had had a normal pregnancy beforehand and 49 had had a premature birth beforehand. The study found that for women expecting twins, a history of premature birth increases the odds of the twins themselves arriving prematurely. Having a previous premature birth also increased the odds for one or both of the twins having health problems.

You can read the abstract of this article here.

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Incidences, risk factors and outcomes of neonatal thromboembolism

Abstract

Background: The incidences of thromboembolism (TE) in neonates were reported to be around 0.51 per 10,000 live births per year for overall TE and 24 per 10,000 NICU admissions per year. As the incidences of TE in children and adults are lower in Asian populations, the incidences, risk factors, and outcomes of neonatal TE may be different to those reports from other countries.

Objectives: To determine the incidences, risk factors, and outcomes of neonatal TE in a tertiary care hospital in Thailand.

Materials and methods: A retrospective study between the years 1998 and 2015.

Results: From a total of 2463 neonatal admissions, 28 patients were diagnosed with TE. The female/male ratio was 1:1.2. The breakdown of diagnoses of neonatal TE were arterial ischemic stroke (AIS; 36%), arterial TE (ATE; 29%), deep vein thrombosis (DVT; 14%), cerebral venous sinus thrombosis (CVST; 11%), renal vein thrombosis (RVT; 3%), and purpura fulminans (2%). Underlying diseases were identified 57.1% of patients. The most common thrombophilic risk factor was protein C (PC) deficiency (14.3%). The overall mortality rate was 14.3%.

Conclusion: The most common TE was AIS. PC deficiency was the most prevalent inherited risk factor, especially in neonates without precipitating factors.

To view the abstract click here.

 

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Risk factors associated with failure of extubation in very-low-birth-weight newborns

Abstract

Aim: To identify risk factors associated with the failure of extubation of mechanically ventilated very-low-birth-weight newborns.

Study design: Prospective observational study. Assessment of the occurrence of extubation failure in relation to demographic and ventilation parameters, the SpO2/FiO2 ratio, the spontaneous breathing test (SBT) and values of the Silverman–Andersen score (SAS). Extubation failure was defined as the need for reintubation for any reason within 72 h after extubation.

Results: Extubation failed in 14/50 (28%) patients. Tidal volume applied at the moment of extubation (p = 0.030), the values of the SpO2/FiO2 ratio (p = 0.006), SBT (p = 0.034) and SAS measured for 60 min after extubation and later (p = 0.010, p = 0.000001, p∼0.000, respectively) showed a significant association with reintubation.

Conclusions: Measured TV, SpO2/FiO2 ratio, SBT at the moment of extubation and values of SAS starting 1 h after extubation might be valuable parameters in identifying those VLBW newborns in the risk to fail extubation.

To view the abstract click here.

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Hearing-loss-associated gene detection in neonatal intensive care unit

Abstract

Objective: To investigate the frequency and mutation spectrum of hearing loss-associated gene mutation in Neonatal Intensive Care Unit (NICU).

Methods: Neonates (n=2305) admitted to NICU were enrolled in this study. Nine prominent hearing loss-associated genes, GJB2 (35 del G, 176 del 16,235 del C, 299 del AT), GJB3 (538 C > T), SLC26A4 (IVS7-2A > G, 2168 A > G) and mtDNA 12S rRNA(1555 A > G, 1494 C > T), were detected.

Result: There were 73 cases hearing-loss-associated gene mutation among 2305 cases, the mutation frequency was 3.1%, with 40 cases GJB2 (235del C) mutation (54.8%), 6 cases GJB2 (299 del AT) mutation (8.2%), 21 cases SLC26A4 (IVS 7-2 A > G) mutation (28.7%), 4 cases SLC26A4 (2168 A > G) mutation (5.5%), 2 cases of GJB2 (235del C) combined SLC26A4 (IVS 7-2 A > G, 2168 A > G) mutation (2.8%). Among 73 gene mutation cases, preterm neonates presented in 18 cases, accounting for 24.7% (18/73); hyperbilirubinemia in 13 cases, accounting for 17.8% (13/73); Torch Syndrome in 15 cases, with 12 cases CMV, 2 cases rubella, 1 case toxoplasm, respectively, totally accounting for 20.54% (15/73); neonatal pneumonia in 12 cases, accounting for 16.4% (12/73); birth asphyxia in 5 cases, accounting for 6.9% (5/73); sepsis in 5 cases, accounting for 6.9% (5/73); others in 5 cases, accounting for 6.8% (5/73) .

Conclusions: The frequency of hearing loss-associated gene mutation was higher in NICU.There were hearing loss-associated gene mutations in the NICU, suggesting this mutation may complicate with perinatal high-risk factors.

To view the abstract click here.

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Echocardiography may cause significant pain response in preterm infants

Abstract

Objective: The objective of this study is to evaluate if echocardiographic examination causes any pain response in term and preterm infants.

Methods: Term and preterm neonates who admitted to Neonatal Intensive Care Unit at Gazi University Hospital and Etlik Zubeyde Hanim Training and Research Hospital and were performed echocardiography for any reason were included into the study. Neonates were evaluated before, during and 10 minutes after the examination. Vital signs (heart rate, respiratory rate, blood pressure, transcutaneous oxygen saturation) were recorded. All subjects were also evaluated with Neonatal Infant Pain Scale during the examination.

Results: In this study, we evaluated 99 newborn infants. Five infants who received fentanyl treatment were excluded. The heart rate (p = 0.000), respiratory rate (p = 0.000), diastolic blood pressure (p = 0.001) and oxygen saturation (p = 0.000) during the examination were significantly different than the values before and 10 minutes after the examination. Infants whose gestational age ≤32 weeks (n:20) have significantly higher NIPS scores (mean ± SEM = 3.3 ± 0.4) than the infants whose gestational age is greater than 32 weeks (n:71) (mean ± SEM = 2.4 ± 0.2).

Conclusions: Echocardiographic examination which is known as noninvasive and painless causes significant pain in preterm infants.

To view the abstract click here.

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The correlation between frequency and duration of breastfeeding and the severity of neonatal hyperbilirubinemia

Abstract

Introduction: Inadequate intake of calorie or inadequate breastfeeding can cause neonatal hyperbilirubinemia. The present study was conducted to examine the correlation between frequency and duration of breastfeeding and the severity of neonatal hyperbilirubinemia among newborns admitted to Ghaem Hospital of Mashhad (Iran) due to neonatal hyperbilirubinemia.

Methodology: The present cross-sectional study was conducted on 634 newborns with idiopathic hyperbilirubinemia referred to either Emergency Department or Neonatal Clinic in Ghaem Hospital. The required data were collected through a researcher-made questionnaire covering information related to mothers and babies. The examined neonates were examined based on the frequency and duration of breastfeeding and the severity of hyperbilirubinemia. The collected data were analyzed using statistical tests of Shapiro–Wilk and Chi-squared (SPSS-19.5).

Results: According to the results, at bilirubin levels of 1–12 mg/dl, 12.1–16 mg/dl, 16.1–20 mg/dl and >20 mg/dl, the average frequencies of breastfeeding were respectively 10.66, 9.83, 9.19 and 7.50 times a day. The average serum bilirubin level in newborns with ≤7 times breastfeeding per day (19 mg/dl) was higher than newborns with >7 times breastfeeding per day (16 ml/dl). Additionally, by an increase in the frequency of breastfeeding, the percentage of weight loss decreased in the examined newborns. The results also showed that in newborns with bilirubin levels <20 mg/dl, the severity of hyperbilirubinemia reduced by increased defecation frequency and decreased percentage of weight loss.

Conclusion: The results of this study showed that increased frequency of breastfeeding, accelerated weight gain and increased defecation frequency reduce the severity of neonatal hyperbilirubinemia. Accordingly, breastfeeding education for mothers with an emphasis on increasing the frequency of breastfeeding is a helpful technique to reduce the severity of hyperbilirubinemia in newborns.

To view the abstract click here.

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Risk factors for tracheostomy requirement in extremely low birth weight infants

Abstract

Aim: To identify variables that affect the risk of tracheostomy in a population of extremely low birth weight (ELBW) infants.

Methods: A retrospective matched case–control study was conducted. ELBW infants with a tracheostomy were compared with controls without tracheostomy. Data collection included demographics, detailed information about each intubation and extubation attempt, the use of steroids and the presence of comorbidities. Statistical analyses include conditional logistic regression and Poisson regression for clustered observations.

Results: Twenty-eight ELBW infants with a tracheostomy were identified. Mean gestational age for both cases and controls was 25 weeks (22–29) and 67.9% were males. Tracheostomy was performed on average on day of life 118 (95%CI: 107–128) and weight at tracheostomy was 2877 g (95%CI: 2657–3098). In the final model, cumulative days with an endotracheal tube (ETT) and total number of intubation episodes were associated with a tracheostomy. For each additional day of intubation, odds of tracheostomy increased by 11% (OR = 1.11, 95%CI: 1.01, 1.23) and with each new intubation episode/failed extubation episode, odds of tracheostomy increased by 150% from the previous episode (OR = 2.5, 95%CI: 1.2, 5.2).

Conclusions: Greater cumulative exposure to ETT ventilation and number of intubations is associated with having a tracheostomy.

To view the abstract click here.

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