Search

Background and Objectives: Anemia is a common morbidity seen in neonates, having an impact on cerebral circulation. Commonly, severe anemia is managed with red blood cell transfusion. This study was done to determine the cerebral hemodynamic change occurring in neonates before and after packed red blood cell transfusion. Methods: Neonates who had undergone blood transfusions were prospectively studied using cerebral Doppler ultrasonography. Cerebral blood flow (CBF) velocity of the middle cerebral artery was calculated before and after PRBC transfusion. Results: Twenty neonates of median gestational age 34 weeks (interquartile range: 24-40 weeks) with a mean birth weight of 1670 g were enrolled. Pre and post transfusion mean resistive index (RI) were 0.7 and 0.67, respectively, with confidence interval (-0.04-0.09) (P = 0.40). There was a decrease in peak systolic velocity and an increase in end diastolic velocity, though not statistically significant. Conclusion: The study concluded that there was no statistically significant difference in the CBF velocities, including RI pre and post PRBC transfusion. [ABSTRACT FROM AUTHOR]

Large numbers of preterm infants are born in middle-income countries and neonatal care is improving in these countries. Few studies have compared clinical outcome in preterm infants in a tertiary neonatal unit in a middle-income country with one in a high-income country. To compare the short-term outcome in preterm infants of ≤30 weeks gestation admitted to a tertiary neonatal unit in Bengaluru, India and in London, UK. This was a retrospective observational study using anonymised data from electronic patient records. Preterm infants born at ≤30 weeks gestation admitted to neonatal units in Bengaluru (n = 294) and London (n = 740) over a 5-year period (January 2011 to December 2015) were compared. Fewer mothers in the Bengaluru centre received antenatal steroids (37% vs 73%, p < 0.001). The incidence of retinopathy of prematurity requiring treatment (12.9% vs 7.7%, NS), treated patent ductus arteriosus (32.3% vs 10.7%, NS) and blood culture-positive sepsis (32.4% vs 1.7%, p < 0.001) was higher in infants in the Indian centre. Overall survival was 83% vs 87.2% (NS) in the Bengaluru and the London cohorts, respectively. Survival of infants born at ≤28 weeks gestation was lower in Bengaluru than in London [24 weeks: 33.0% vs 79.3% (NS); 25 weeks: 50.0% vs 78.9%, p = 0.02; 26 weeks: 45.2% vs 86.5%, p < 0.01; 27 weeks: 79.3% vs 91.3% (NS); 28 weeks 82.5% vs 94.1%, p = 0.03]. The survival of infants ≤28 weeks gestation was significantly lower in the Bengaluru centre. Increasing the provision of antenatal corticosteroids may improve the outcome in these infants. BPD: bronchopulmonary dysplasia; CPAP: continuous positive airway pressure; EPR: electronic patient records; HIC: high-income countries; HDU: high dependency unit; hsPDA: haemodynamically significant patent ductus arteriosus; IVH: intraventricular haemorrhage; ITU: Intensive Care Unit, IUGR: intrauterine growth restriction; LAMA: leaving against medical advice; LMIC: low- and middle-income countries; NICU: neonatal intensive care unit; NNFI: National Neonatal Forum of India; NS: not significant; NTS: neonatal transfer service; NNAP: National Neonatal Audit Programme; NHM: National Health Mission; NMR: neonatal mortality rate; NEC: necrotising enterocolitis; NS: not significant; PDA: patent ductus arteriosus; ROP: retinopathy of prematurity; SCBU: special care baby unit; VLBW: very low birthweight; WHO: World Health Organization [ABSTRACT FROM AUTHOR]

Background: Retinopathy of prematurity (ROP) and abnormal brain development share similar risk factors and mechanisms. There has been contrasting evidence on the association of ROP with adverse neurodevelopmental outcomes., Objective: We analysed the association between ROP at levels of severity and treatment with all neurodevelopmental outcomes until adolescence., Data Source: We followed PRISMA guidelines and searched Medline and Embase between 1 August 1990 and 31 March 2022., Study Selection and Participants: Randomised or quasi-randomised clinical trials and observational studies on preterm infants (<37 weeks) with ROP [type 1 or severe ROP, type 2 or milder ROP, laser or anti-vascular endothelial growth factor (VEGF) treated] were included., Data Extraction and Synthesis: We included studies on ROP and any neurocognitive or neuropsychiatric outcomes., Outcomes: The primary outcomes were as follows: cognitive composite scores evaluated between the ages of 18 and 48 months by the Bayley Scales of Infant and Toddler Development (BSID) or equivalent; neurodevelopmental impairment (NDI; moderate to severe NDI or severe NDI), cerebral palsy, cognitive impairment; and neuropsychiatric or behavioural problems. The secondary outcomes were as follows: motor and language composite scores evaluated between the ages of 18 and 48 months by BSID or equivalent; motor/language impairment; and moderate/severe NDI as defined by the authors., Results: In preterm infants, "any ROP" was associated with an increased risk of cognitive impairment or intellectual disability [ n  = 83,506; odds ratio (OR): 2.56; 95% CI: 1.40-4.69; p  = 0.002], cerebral palsy ( n  = 3,706; OR: 2.26; 95% CI: 1.72-2.96; p  < 0.001), behavioural problems ( n  = 81,439; OR: 2.45; 95% CI: 1.03-5.83; p  = 0.04), or NDI as defined by authors ( n  = 1,930; OR: 3.83; 95% CI: 1.61-9.12; p  = 0.002). Type 1 or severe ROP increased the risk of cerebral palsy (OR: 2.19; 95% CI: 1.23-3.88; p  = 0.07), cognitive impairment or intellectual disability ( n  = 5,167; OR: 3.56; 95% CI: 2.6-4.86; p  < 0.001), and behavioural problems ( n  = 5,500; OR: 2.76; 95% CI: 2.11-3.60; p  < 0.001) more than type 2 ROP at 18-24 months. Infants treated with anti-VEGF had higher odds of moderate cognitive impairment than the laser surgery group if adjusted data (gestational age, sex severe intraventricular haemorrhage, bronchopulmonary dysplasia, sepsis, surgical necrotising enterocolitis, and maternal education) were analysed [adjusted OR (aOR): 1.93; 95% CI: 1.23-3.03; p  = 0.04], but not for cerebral palsy (aOR: 1.29; 95% CI: 0.65-2.56; p  = 0.45). All outcomes were adjudged with a "very low" certainty of evidence., Conclusion and Relevance: Infants with "any ROP" had higher risks of cognitive impairment or intellectual disability, cerebral palsy, and behavioural problems. Anti-VEGF treatment increased the risk of moderate cognitive impairment. These results support the association of ROP and anti-VEGF treatment with adverse neurodevelopmental outcomes., Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42022326009., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Diggikar, Gurumoorthy, Trif, Mudura, Nagesh, Galis, Vinekar and Kramer.)

We prospectively studied the effect of oral paracetamol in closing hemodynamically significant Patent ductus arteriosus in preterm infants (gestational age <32 weeks) where Ibuprofen was contraindicated. 29 of 40 neonates (72.5%) showed successful response while 11 (29.5%) failed to show any response. No major complications were seen.

Background: Persistent pulmonary hypertension (PPHN) in a term or late preterm has varied etiology., Case Characteristics: A late preterm neonate operated for esophageal atresia with tracheo-esophageal fistula was complicated by severe pulmonary hypertension and unable to be weaned off from respiratory support., Outcome: The neonate expired by 15 weeks of life; diagnosis was made on postmortem lung biopsy., Message: Alveolarcapillary dysplasia should be considered in a neonate with idiopathic refractory PPHN, if associated with anomalies.