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Background: Respiratory distress syndrome is the most common cause of respiratory problems in preterm infants. Early nasal CPAP, combined with the INSURE method (INtubation-SURfactant- Extubation) as the primary respiratory support approach for preterm infants, has gained popularity over prophylactic surfactant with mechanical ventilation in recent years. Limited evidence exists to understand racial differences in resource usage among preterm infants. Objective: To investigate the trends, gender, and racial differences in the use of surfactant and assisted ventilation for > 6 hours among newborns in the United States. Methods: Using 2016-2020 population-based cohort data for all births from the Centers for Disease Control and Prevention's WONDER natality database, we calculated rates, examined trends, and investigated gender and racial differences for surfactant use and assisted ventilation. Contingency tables analyses and Chi-square calculations were performed to detect differences between the groups with statistical significance set at p<.05. Results: Among >18 million newborn births, overall rates of surfactant use and assisted ventilation for the study period were 4.8 and 15.6 per 1000 live births, respectively. While surfactant use remained similar (p=.99), assisted ventilation rates increased from 13.6 to 17.8 per 1000 live births (p <.0001) during the study period. Subgroup analysis among term infants (37-42 weeks) showed statistically significant increases in surfactant use (4.3 to 5.1 per 1000 live births; p<.0001) and assisted ventilation (26.2 to 38.3 per 1000 live births; p< .0001). Late preterm infants (34-36 weeks GA) had increasing assisted ventilation rates (44 to 59 per 1000 live births; OR: 1.35; p<.0001) and trend toward lower surfactant use (11 to 10/1000 live births; OR: 0.95; p=.010) during the study period. Male and Black infants had the highest utilization rates of surfactant and assisted ventilation. Conclusion: Assisted ventilation rates steadily increased across all gestational ages, while surfactant use remained stable during the study period. Racial and gender differences exist for surfactant use and assisted ventilation needs. Contemporary trends toward "gentle" approaches in early respiratory management and guidelines for surfactant administration might have contributed to the changes in utilization rates. Clinicians and stakeholders should consider such information when allocating assets to hospitals and planning regional perinatal programs. [ABSTRACT FROM AUTHOR]

The article focuses on the prevalence and implications of Glucose-6-phosphate dehydrogenase (G6PD) deficiency, the most common inherited enzymopathy worldwide, emphasizing its connection to prematurity and racial disparities in perinatal outcomes, particularly in African American infants, citing potential risks of hyperbilirubinemia, neurotoxicity, and various morbidities associated with G6PD deficiency in preterm infants.

Background: Hyperbilirubinemia is one of the most common diagnosis in newborn nurseries in United States. Universal pre-discharge bilirubin screening decreased the incidence of extreme hyperbilirubinemia and risk of kernicterus. Objectives: We sought to assess temporal population trends of hyperbilirubinemia, kernicterus and usage of phototherapy, intravenous immunoglobulin (IVIG), and exchange transfusion. Design/methods: Data from Healthcare Cost and Utilization Project (HCUP)-the Kids' Inpatient Database (KID) obtained for years 1997-2012. All neonatal discharges with ICD-9 codes for neonatal jaundice (774.2, 774.6), kernicterus (773.4, 774.7) and procedure codes for phototherapy (99.83), IVIG infusion (99.14), exchange transfusion (99.01) were extracted. We compared the trends of diagnosis of hyperbilirubinemia, kernicterus, use of phototherapy, IVIG, and exchange transfusion. Results: During the study period, the proportion of infants diagnosed with hyperbilirubinemia increased by 65% (9.4% vs. 15.5%; p<.001) in term infants and 34.5% (33.5% vs. 45%; p<.001) in preterm infants, respectively. Rate of kernicterus discharges significantly reduced from 7 to 1.9 per 100,000 newborns. Overall, the number of exchange transfusions has decreased by 67% during study period while phototherapy and IVIG use increased by 83% and 170%, respectively. Conclusions: In last two decades, there was a significant decrease in neonatal discharges with a history of exchange transfusion or with a diagnosis of kernicterus. However, there was a significant increase in number of neonates discharged home with a history of phototherapy during birth hospitalization and decreased number of exchange transfusions were observed during the study period. Incremental implementation of universal predischarge bilirubin screening and treatments based on 2004 AAP recommended risk-based strategies might have contributed to timely interventions in infants with significant hyperbilirubinemia. [ABSTRACT FROM AUTHOR]

Background and objectives Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency is frequent inherited enzymopathy that poses potentially preventable risk for extreme hyperbilirubinemia (EHB) which can, rarely, lead to acute bilirubin encephalopathy, childhood kernicterus and death. We aimed to estimate quality adjusted life years (QALY) lost due to G6PD deficiency associated with EHB and economic costs to best estimate value of universal pre-discharge screening. Methods We did a cost utility analysis for US birth cohort utilizing pre-discharge screening decision tree model to estimate population burden and EHB outcomes, based on literature search and expert opinions. Employing human capital approach, we measured health benefits in terms of QALYs and economic losses. QALYs and costs were discounted at 3%; one-way sensitivity analysis was used for decision variables. Results We determined for USA live births of 3.86 million in 2017, 1464 cases of EHB were estimated to be due to G6PD deficiency (CI 95%; range: 1270–1656) and contributed 2 deaths (CI 95%; range 1.3–3.2) and 14 (CI 95%; range: 9.1–21.5) cases of kernicterus. Over lifetime horizon, the model predicted undiscounted and discounted gains of 165 (102–252) life years; 241 (183–433) QALYs and 16 (9.9–24.5) life years; 89 (67.9–160.5) QALYs, respectively. Assuming 50% effectiveness, benefit cost ratios ranged from 0.19 to 3.42 for diverse operational settings. The cost to prevent a single case of kernicterus was $2.7 to 6.8 million per annum with cost per QALY gained at $35,946 to $89,159. Conclusion At incremental cost-effective threshold of $100,000/life year, pre-discharge screening would be expected to prove cost effective in preventing EHB related morbidities and mortality attributed to G6PD deficiency. [ABSTRACT FROM AUTHOR]

Background Dietary methyl donors (e.g. choline) support the activity of the phosphatidylethanolamine N -methyltransferase (PEMT) pathway, which generates phosphatidylcholine (PC) molecules enriched in DHA that are exported from the liver and made available to extrahepatic tissues. Objectives This study investigated the effect of prenatal choline supplementation on biomarkers of DHA status among pregnant participants consuming supplemental DHA. Methods Pregnant participants (n  = 30) were randomly assigned to receive supplemental choline intakes of 550 mg/d [500 mg/d d0 -choline + 50 mg/d deuterium-labeled choline (d9 -choline); intervention] or 25 mg/d (25 mg/d d9 -choline; control) from gestational week (GW) 12–16 until delivery. All participants received a daily 200-mg DHA supplement and consumed self-selected diets. Fasting blood samples were obtained at baseline, GW 20–24, and GW 28–32; maternal/cord blood was obtained at delivery. Mixed-effects linear models were used to assess the impact of prenatal choline supplementation on maternal and newborn DHA status. Results Choline supplementation (550 vs. 25 mg/d) did not achieve a statistically significant intervention × time interaction for RBC PC-DHA (P  = 0.11); a significant interaction was observed for plasma PC-DHA and RBC total DHA, with choline supplementation yielding higher levels (+32–38% and +8–11%, respectively) at GW 28–32 (P  < 0.05) and delivery (P  < 0.005). A main effect of choline supplementation on plasma total DHA was also observed (P  = 0.018); its interaction with time was not significant (P  = 0.068). Compared with controls, the intervention group exhibited higher (P  = 0.007; main effect) plasma enrichment of d3 -PC (d3 -PC/total PC). Moreover, the ratio of d3 -PC to d9 -PC was higher (+50–67%; P  < 0.001) in the choline intervention arm (vs. control) at GW 20–24, GW 28–32, and delivery. Conclusions Prenatal choline supplementation improves hepatic DHA export and biomarkers of DHA status by bolstering methyl group supply for PEMT activity among pregnant participants consuming supplemental DHA. This trial is registered at www.clinicaltrials.gov as NCT03194659. [ABSTRACT FROM AUTHOR]

Background: The hemodynamic impact of persistent patent ductus arteriosus (PDA) is associated with neonatal morbidities and mortality in preterm newborns. While there has been considerable debate about optimal management of PDA and its impact on clinical outcomes, there is widespread variation in practice, such as using different pharmacotherapies to achieve closure of hemodynamically significant PDA during the first week of life in very low birth weight infants. Aims: The objective was to estimate the efficacy of acetaminophen, ibuprofen, and indomethacin with regard to ductal closure and to compare the costs of these three commonly used medications to treat PDA in preterm infants. Methods: PubMed, Embase, and Cochrane Registry were searched for trials from the years 2010–2020. We identified 17 randomized clinical trials (RCTs) and 14 case series that enrolled preterm infants < 37 weeks gestational age for inclusion. Pooled estimates of closure rates for acetaminophen (n = 630), ibuprofen (n = 694), and indomethacin (n = 312) were analyzed using the weighted proportion ratio using a Mantel‑Haenszel random effects model. The chi-squared test of proportions was used to determine significance between groups. We accessed cost estimates of pharmacotherapy from the Lexi-Comp average wholesale price database and utilized a decision tree model to appraise cost benefits for the outcome measure of successful PDA closure. Results: The pooled proportional point estimates of closure rates from RCTs for acetaminophen, ibuprofen, and indomethacin were 70.1% (95% confidence interval [CI] 60–80), 63.4% (95% CI 52.8–74.1), and 71.5% (95% CI 62.3–80.7), respectively. There was no significant statistical difference in closure rates when RCTs and uncontrolled case series were combined. Pairwise comparisons showed both acetaminophen and indomethacin were each more effective in closing PDA than ibuprofen (acetaminophen vs indomethacin: p = 0.01; ibuprofen vs indomethacin: p = 0.02; acetaminophen vs indomethacin: p = 0.93). Comparing costs for successful closure of PDA, at the average wholesale price of different medications, suggested that treatment with acetaminophen costs significantly less, with a mean of $1487 (95% CI 1300–1737), compared to ibuprofen, with a mean of $2585 (95% CI 2214–3104), and indomethacin, with a mean of $2661 (95% CI 2358–3052), per course of treatment. Conclusions: Our meta-analysis suggests acetaminophen is non-inferior to both indomethacin and ibuprofen, and costs relatively less for successful PDA constriction in premature infants. Further clinical trials are warranted to compare acetaminophen's safety, along with short- and long-term effects, to help resolve the clinical conundrum of the necessity of early treatment in the management of PDA, and the optimal pharmacological course, if indicated. [ABSTRACT FROM AUTHOR]

Background: Hyperbilirubinemia is one of the most common diagnosis in newborn nurseries in United States. Universal pre-discharge bilirubin screening decreased the incidence of extreme hyperbilirubinemia and risk of kernicterus.Objectives: We sought to assess temporal population trends of hyperbilirubinemia, kernicterus and usage of phototherapy, intravenous immunoglobulin (IVIG), and exchange transfusion.Design/methods: Data from Healthcare Cost and Utilization Project (HCUP)-the Kids' Inpatient Database (KID) obtained for years 1997-2012. All neonatal discharges with ICD-9 codes for neonatal jaundice (774.2, 774.6), kernicterus (773.4, 774.7) and procedure codes for phototherapy (99.83), IVIG infusion (99.14), exchange transfusion (99.01) were extracted. We compared the trends of diagnosis of hyperbilirubinemia, kernicterus, use of phototherapy, IVIG, and exchange transfusion.Results: During the study period, the proportion of infants diagnosed with hyperbilirubinemia increased by 65% (9.4% vs. 15.5%; p<.001) in term infants and 34.5% (33.5% vs. 45%; p<.001) in preterm infants, respectively. Rate of kernicterus discharges significantly reduced from 7 to 1.9 per 100,000 newborns. Overall, the number of exchange transfusions has decreased by 67% during study period while phototherapy and IVIG use increased by 83% and 170%, respectively.Conclusions: In last two decades, there was a significant decrease in neonatal discharges with a history of exchange transfusion or with a diagnosis of kernicterus. However, there was a significant increase in number of neonates discharged home with a history of phototherapy during birth hospitalization and decreased number of exchange transfusions were observed during the study period. Incremental implementation of universal predischarge bilirubin screening and treatments based on 2004 AAP recommended risk-based strategies might have contributed to timely interventions in infants with significant hyperbilirubinemia. [ABSTRACT FROM AUTHOR]

Sildenafil citrate (SC), a drug for erectile dysfunction, is now emerging as a cardiopulmonary drug. Our study aimed to determine a novel role of sildenafil on cardioprotection through stimulating angiogenesis during ischaemia (I) reperfusion (R) at both capillary and arteriolar levels and to examine the role of vascular endothelial growth factor (VEGF) and angiopoietin-1 (Ang-1) in this mechanistic effect. Rats were divided into: control sham (CS), sildenafil sham (SS), control + IR (CIR) and sildenafil + IR (SIR). Rats were given 0.7 mg/kg, (i.v) of SC or saline 30 min. before occlusion of left anterior descending artery followed by reperfusion (R). Sildenafil treatment increased capillary and arteriolar density followed by increased blood flow (2-fold) compared to control. Treatment with sildenafil demonstrated increased VEGF and Ang-1 mRNA after early reperfusion. PCR data were validated by Western blot analysis. Significant reduction in infarct size, cardiomyocyte and endothelial apoptosis were observed in SC-treated rats. Increased phosphorylation of Akt, eNOS and expression of anti-apoptotic protein Bcl-2, and thioredoxin, hemeoxygenase-1 were observed in SC-treated rats. Echocardiography demonstrated increased fractional shortening and ejection fraction following 45 days of reperfusion in the treatment group. Stress testing with dobutamine infusion and echocardiogram revealed increased contractile reserve in the treatment group. Our study demonstrated for the first time a strong additional therapeutic potential of sildenafil by up-regulating VEGF and Ang-1 system, probably by stimulating a cascade of events leading to neovascularization and conferring myocardial protection in in vivo I/R rat model. [ABSTRACT FROM AUTHOR]

Background: HDR syndrome (also known as Barakat syndrome) is a rare genetic disorder due to deletions/mutations on specific regions of zinc-finger transcription factor (GATA3) gene.Case Characteristics: A male preterm infant presented with multiple dysmorphic features characterized by small for gestational age, hypognathia and facial abnormalities.Observation: Investigations revealed hypocalcemia and low parathyroid hormone levels and bilateral sensorineural deafness.Outcome: Chromosomal microarray analysis revealed a combination of deletion on chromosome 10p (10p15.3p14) with loss of GATA3 gene and duplication of chromosome 20p (20p13p12.3) as a result of unbalanced 10:20 translocation.Message: Detecting this syndrome at neonatal age is very important because it allows early intervention to minimize future clinical problems. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "The City Initiative for Newborn Health," by A. Fernandez and D. Osirin in the previous issue.