To compare seizure burden between newborn infants treated with therapeutic hypothermia (TH) and those that were not and to compare the need for antiseizure medications (ASM) in a cohort of infants ...who were diagnosed with neonatal hypoxic-ischemic encephalopathy (HIE).
This was a retrospective cohort study on infants born after 35 weeks' gestation, diagnosed with moderate to severe HIE, monitored with amplitude-integrated electroencephalography (aEEG) and eligible for TH. Infants born before the implementation of TH in 2008 were compared with infants born thereafter who received TH. Seizure burden was assessed from aEEG as total time in minutes of seizures activity per hour of recording. Other clinical and demographic data were retrieved from a prospective local database of infants with HIE.
Overall, 149 of 207 infants were included in the study: 112 exposed to TH and 37 not exposed. Cooled infants had a lower seizure burden overall (0.4 vs 2.3 min/h, P < 0.001) and were also less likely to be treated with ASM (74% vs 100%, P < 0.001). In multivariable regression models, not exposed to TH, having a depressed aEEG background, and having higher Apgar scores were associated with higher seizure burden (incidence rate ratio: 4.78 for noncooled infants, P < 0.001); also, not exposed to TH was associated with a higher likelihood of multidrug ASM (odds ratio: 4.83, P < 0.001).
TH in infants with moderate to severe HIE is associated with significant reduction of seizure burden and ASM therapy.
The interactions between premature birth and the caregiving environment on infants' cognitive and social functioning were examined. Participants were 150 infants (83 preterm, 67 full-term) and their ...parents. When infants were 6 months old, parents reported on their levels of emotional distress, and triadic family interactions were filmed and coded. At 12 months of age, the infants' cognitive and social functioning was assessed. Prematurity moderated the effects of maternal (but not paternal) emotional distress and triadic interactions on infants' cognitive and social outcomes. Whereas for cognitive functioning the interactions were consistent with a diathesis–stress approach, for social functioning the interactions were consistent with a differential susceptibility approach. The differential effects of the caregiving environment between groups and outcomes are discussed.
Abstract This case report describes a twin fetus diagnosed in the third trimester with an enlarging abdominal mass that was confirmed on fetal magnetic resonance imaging (MRI) to be a hepatic ...mesenchymal hamartoma (HMH) without involvement of the placenta. Serial ultrasonography demonstrated progressive enlargement of the mass and infant was delivered at 33 + 6 weeks gestational age following maternal complications. On the fifth day, at laparotomy, a huge mass connected to the lower portion of the liver was completely resected. Microscopic evaluation confirmed a hepatic mesenchymal hamartoma. Postoperative recovery was uneventful and the infant was discharged at 4 weeks. The antenatal diagnosis of the hepatic mesenchymal hamartoma by fetal MRI and subsequent follow-up by serial ultrasonography emphasizes the importance of combining these 2 modalities for optimal management of the pregnancy to allow a favorable outcome.
To evaluate the effect of implementation of the Kaiser Permanente (KP) early onset sepsis (EOS) calculator in infants born at 34 week’s gestation or more on antibiotic utilization and length of ...hospitalization. A single center, retrospective cohort study included all neonates born in Soroka Medical Center at 34 weeks gestation or more between January 1
st
, 2015, and January 1
st
, 2019, with a predefined maternal risk factor for EOS. Two cohorts of neonates were compared during two time periods, before and after the implementation of the KP calculator. Multivariable logistic and linear regressions were performed to assess the effect of the KP calculator on antibiotic treatment and length of hospitalization. Also, an interrupted time series (ITS) analysis was used to assess the time trends of the two periods. The study included 3858 neonates in the pre-implementation period and 3081 neonates in the post-implementation cohort. The use of the calculator resulted in a significant reduction (46%) in antibiotics treatment for suspected EOS (5.1 vs. 9.4%, P < 0.001). The ITS analysis demonstrated a sharp decline in the slope of antibiotic treatment in the post intervention period: (b = -0.14, p-value = 0.08). The length of hospitalization was significantly reduced in the post-implementation cohort from 62 to 60 h (p-value < 0.001) with no clinical significance. The incidence of EOS was similar in both groups.
Conclusion
: A significant reduction in antibiotic treatment was demonstrated after the implementation of the KP calculator without an increase incidence of EOS. The calculator is a powerful accessory decision-making tool that can be used safely in combination with, but not replacing, thorough clinical assessment.
What is Known:
• The EOS calculator is a useful tool that leads to a significant reduction in preemptive antibiotic utilization.
What is New:
• The EOS calculator is sensitive when applied to the whole-nursery.
• The calculator is useful in different populations, also when women are not routinely screened for GBS.
Infant exposure to macrolide antibiotics is a risk factor for infantile hypertrophic pyloric stenosis (IHPS). The aim of the study was to establish whether perinatal exposure to non-macrolide ...antibiotics was a risk factor for IHPS.
A retrospective matched case-control study was performed using a database including all children born at Soroka University Medical Centre between 2006 and 2018. Cases and controls were compared using Student T-test and multiple logistic regression.
Of 189 461 children in the database, 63 infants were diagnosed with IHPS and underwent pyloromyotomy. There was no association between non-macrolide antibiotic exposure and IHPS. Maternal diabetes (DM) had an adjusted odds ratio for infants developing IHPS of 4.53 (p = 0.004).
The lack of association between exposure to non-macrolide antibiotics and IHPS suggests a quality unique to macrolides. An association between DM and IHPS may suggest elevated levels of IGF-1 have a role.
This study investigated predictors of early infant social development and the role of social support as a resilience factor among Arab‐Bedouin families. We propose a mediation model in which social ...support will be related to maternal postpartum emotional distress (PPED), which in turn will be related to infant social responsiveness. One hundred five Arab‐Bedouin mothers (age range = 17–44 years) and their preterm (n = 48) and full‐term (n = 57) infants were recruited shortly after birth and were followed up at age 12 months. Findings demonstrate that, among the preterm group, higher levels of social support predicted lower levels of maternal PPED, and this, in turn, predicted higher levels of infant social responsiveness.
Mothers of preterm infants are at higher risk for postpartum emotional distress (PPED). In this study, we investigated PPED among Bedouin mothers, an ethnic minority group living in Israel. Our aim ...was to understand how maternal acculturation style and birth order were related to mothers’ PPED following a premature birth. Three hundred twenty-one Bedouin mothers and their babies (preterm: n = 66; full-term: n = 255) participated in the study. Data were collected in the maternity ward and the NICU (Neonatal Intensive Care Unit) of a large general hospital in Southern Israel providing medical care to all populations in the southern region. Mothers completed questionnaires on maternal postpartum depression and anxiety. Additionally, maternal acculturation style was assessed using the acculturation questionnaire and information on child birth order. Mothers of preterm infants indicated having more symptoms of PPED than mothers of full-term infants. Additionally, both maternal acculturation style as well as birth order (i.e., whether the preterm was first- or later-born) were found to act as moderators in the link between prematurity and PPED. Specifically, we found that among the preterm group, low levels of Westernized acculturation style and the birth of a preterm infant who was later-born predicted higher levels of PPED. Our findings indicate that ethnicity, acculturation, and birth order are important variables that need to be considered when studying PPED and premature birth. Results highlight the fact that mothers from an ethnic minority group who have had a premature birth are at higher risk for experiencing PPED. However, individual differences emerged when examining maternal acculturation style and birth order. Culturally—informed clinical implications are proposed.
This study aimed to test a serial mediation model proposing that prematurity would be related to changes in maternal emotional distress, which in turn would be related to the mother–child (M-C) ...interaction, which would ultimately be related to infant social withdrawal. Bedouin mothers and their preterm (n = 48) and full-term (n = 57) infants participated in this study. Mothers’ mean age was 27.67 years. In addition, 39.4% of the mothers were primiparas and 60.6% were multiparas. Infants and their mothers were recruited shortly after birth (T1) in the maternity ward or Neonatal Intensive Care Unit (NICU) at Soroka Medical Center and were followed up at ages 6 months (T2) and 12 months (T3). Findings indicated that HIGHER levels of maternal emotional distress during the second half of the first year postpartum and LOWER levels of mother–child interaction, were associated with HIGHER levels of infant social withdrawal at T3. Furthermore, the overall indirect effect suggested that HIGHER levels of maternal nonhostility was a main variable mediating the link between prematurity and LOW levels of infant social withdrawal. Our findings provide evidence that changes in maternal emotional distress during the first year are related to lower infant social withdrawal. Moreover, mothers of premature infants showed higher levels of nonhostility when interacting with their premature infants. These findings highlight the importance of gaining a better understanding of maternal behaviors. Specifically, our study provides important information for researchers and clinicians on a possible mechanism leading to early socioemotional difficulties of premature infants.
Research highlights ► Experienced clinicians can detect seizures using amplitude integrated EEG (aEEG) with high specificity. ► Early aEEG recording in high risk infants can help in the diagnosis and ...treatment of neonatal seizures. ► Conventional EEG is needed for characterization of seizures, detection of artefacts and diagnosis of seizures hidden to aEEG.
Aim: To determine in a cohort of very‐low‐birthweight (VLBW) infants the incidence of postnatal growth failure and the influence of intrauterine growth and neonatal morbidities on the risk for severe ...postnatal growth failure (PNGF). Methods: The study was based on analysis of data from the Israel Neonatal Network database on VLBW infants born between 1995 and 2001. Z‐score was determined for weight at birth and discharge, and severe PNGF was defined as a decline in z‐score of greater than 2. Univariate analysis and multi‐linear regression determined the effect of fetal growth and neonatal morbidities on the risk for severe PNGF. Results: Severe PNGF occurred in 10.6% of the cohort. The mean±SD birthweight (BW) z‐score was −0.59±0.74, decreasing to −1.67±0.77 at discharge. The incidence of severe PNGF increased significantly with decreasing BW and gestational age. Each 1‐unit increase in z‐score BW was associated with a 2.37‐fold increased risk for severe PNGF. Severe respiratory distress syndrome, patent ductus arteriosus, sepsis, necrotizing enterocolitis, and bronchopulmonary dysplasia were associated with severe PNGF.
Conclusion: Severe PNGF among VLBW infants was markedly influenced by intrauterine growth as well as major morbidities. In the assessment of postnatal growth among VLBW infants, growth status at birth should be considered.
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