Newborn from mother with diabetes mellitus - short term prognostic

Facultatea de Medicină, Universitatea Lucian Blaga, Sibiu, Clinica Neonatologie, Spitalul Clinic Judeţean de Urgenţă, Sibiu, RomâniaIntroduction: Diabetes mellitus has an increased incidence in the latest years, frequently complicating pregnancy course and the short and long term neonatal outcome. Aim: Evaluation of the short-term prognosis of the infant of the diabetic mother (IDM) and of the impact of hypoglycemia on the neonatal outcome. Material and methods: Epidemiological, clinical data, and laboratory investigations of the IDMs admitted to Neonatology Dept. of the Clinical County Emergency Hospital Sibiu between January 1, 2015, and December 31, 2017, were retrospectively analyzed. Comparisons were performed between IDMs with and without hypoglycemia. Statistical analysis was done using SPSS for Windows, p being considered statistically significant if <0,05. Results: The study group comprised 108 IDMs, 13 born in 2015, 43 in 2016, and 52 in 2017 (significant increase of the prevalence, p=0.030), weighing between 760 and 5450 g, and with gestational ages (GA) between (VG) 24-42 weeks. 13 infants were classified as small for GA (12%), 52 were large for GA (48%), 27 infants were prematurely delivered, 8 infants being delivered from twin pregnancies. 78 IDMs (72.2%) were delivered by cesarean section. Neonatal respiratory distress was diagnosed in 20 cases (18.5%) and maternal-fetal infections were found in 15 cases. 20 IDMs needed admission in the neonatal intensive care unit, 2 infants died. Early neonatal hypoglycemia was identified in 24 cases (22.2%), with mean blood sugar values of 31.9±6.4 mg/dL, and correction of hypoglycemia in 5.3±6.4 hours. Hypoglycemia was observed mainly after pregestational diabetes, insulin-dependent diabetes, in infants delivered by cesarean section, small for GA, and with respiratory distress (p>0.05). Intense jaundice, needing phototherapy, was seen significantly more often in IDMs with hypoglycemia (p<0.001; OR 3.44[1.66-7.14]). Early neonatal hypoglycemia significantly increased the admission rate in the neonatal intensive care unit. Conclusions: Infants of diabetic mothers continue to present an increased rate of postnatal complications, many of them with possible impact on neurodevelopment.Introducere: Diabetul zaharat are o incidenţă în creştere în ultimii ani complicând frecvent evoluţia sarcinii şi prognosticul neonatal pe termen scurt şi lung. Scop: Evaluarea prognosticului pe termen scurt al nou-născutului din mamă cu diabet zaharat şi a impactului hipoglicemiei asupra prognosticului neonatal. Material şi metodă: Au fost analizate retrospectiv datele epidemiologice, clinice şi investigaţiile paraclinice ale nou-născuţilor din mamă cu diabet îngrijiţi în Clinica Neonatologie a Spitalului Clinic Judeţean de Urgenţă Sibiu între 1 ianuarie 2015-31 decembrie 2017. Au fost efectuate comparaţii între nou-născuţii din mamă cu diabet cu şi fără hipoglicemie. Analiza statistică a fost efectuată cu ajutorul programului SPSS for Windows 10.0, p fiind statistic semnificativ la valori <0,05. Rezultate: În lotul de studiu au fost incluşi 108 nou-născuţi din mame cu diabet, 13 născuţi în 2015, 43 în 2016 şi 52 în 2017 (creştere semnificativă a prevalenţei, p=0.030), cu greutăţi între 760 şi 5450 g şi vârste de gestaţie (VG) de 24-42 săptămâni. 13 nou-născuţi au fost clasifi caţi drept mici pentru VG (12%), 52 au avut greutate mare pentru VG (48%), 27 au fost prematuri, 8 au provenit din sarcini gemelare (7,4%). 78 copii (72,2%) s-au născut prin operaţie cezariană. Detresa respiratorie neonatală a fost semnalată în 20 de cazuri (18,5%) iar infecţii materno-fetale în 15 cazuri. 20 de nou-născuţi au avut nevoie de îngrijiri în terapia intensivă neonatală, 2 au decedat. Hipoglicemia a fost semnalată precoce în 24 de cazuri (22,2%), valorile glicemiei fi ind de 31,9±6,4 mg/dL, hipoglicemia fiind corectată în 5,3±6,4 ore. Hipoglicemia a fost observată mai des la nou-născuţii din mame cu diabet pregestaţional sau insulinodependent, la cei extraşi prin operaţie cezariană, mici pentru VG sau cu suferinţă respiratorie (p>0,05). Icterul intens, necesitând fototerapie s-a atestat semnificativ mai des la nou-născuţii cu hipoglicemie (p<0,001; OR 3,44[1,66-7,14]). Prezenţa precoce a hipoglicemiei a crescut semnificativ rata de internare în terapia intensivă neonatală. Concluzii: Nou-născuţii din mamă cu diabet continuă să prezinte o incidenţă crescută a complicaţiilor postnatale, multe cu posibil impact asupra dezvoltării, mai ales a celei neurologice

Auxological correlation between the maternal obesity, excessive weight gain during pregnancy, macrosomia, feeding practices and infant obesity

UMF “Iuliu Haţieganu” Cluj, UMF “Gr. T. Popa” Iaşi, UMF “Carol Davila” Bucureşti, Fac. Medicină Oradea, UMF Târgu Mureș, SJU SibiuThe infant and adult obesity is becoming a real public health concern in Romania too. The mother's obesity and excessive weight gain during pregnancy are proven risk factors for the obesity of the child in the future. The protective role of breastfeeding against obesity is already demonstrated. The most important issue is whether the choice of a milk formula with the right protein composition could also protect or not the newborn from becoming future obese infants and children.Obezitatea copilului şi adultului are rate îngrijorătoare şi în Romania. Obezitatea mamei şi creşterea excesivă în greutate a gravidei constituie factori de risc pentru macrosomie şi pentru obezitatea ulterioară a copilului. Rolul protector al laptelui de mamă în prevenţia obezităţii infantile este deja demonstrat. Se pune întrebarea dacă alegerea unei formule de lapte cu conţinut adecvat de proteine protejează sau nu nou-născuţii care au deja greutate mare la naştere, pentru dezvoltarea obezităţii în perioada de sugar si copil mic

Intubation-Surfactant: Extubation on Continuous Positive Pressure Ventilation. Who Are the Best Candidates?

Introduction: Respiratory distress syndrome (RDS) continues to be the leading cause of illness and death in preterm infants. Studies indicate that INSURE strategy (INtubate-SURfactant administration and Extubate to nasal continuous positive airway pressure [nCPAP]) is better than mechanical ventilation (MV) with rescue surfactant, for the management of respiratory distress syndrome (RDS) in very low birth weight (VLBW) neonates, as it has a synergistic effect on alveolar stability

Updated Clinical Practice Guidelines in Resuscitation and the Management of Respiratory Distress Syndrome in Extremely Preterm Infants during Two Epochs in Romania: Impact on Outcomes

Background: Adequate perinatal management is essential in caring for extremely preterm (EP) infants. We aimed to evaluate and compare the impact of different protocols on short-term outcomes. Methods: A retrospective study was conducted on EP infants in a Romanian perinatal tertiary center during 2008–2012 and 2018–2022. Results: Data on 270 EP infants (121 in period I, 149 in period II) were analyzed collectively and stratified into two subgroups by gestational age. Initial FiO2 administration (100% vs. 40%% p p p p p = 0.045) in the 26–28 weeks subgroup. Despite improvements, there were no significant differences in the frequencies of NEC, sepsis, PVL, ROP, or PDA. Conclusions: Implementing evidence-based clinical guidelines can improve short-term outcomes

The Early Hematological Profile and Its Variations: A Useful Tool in the Prediction of Intraventricular Hemorrhage in Extremely Preterm Infants

Background and Objectives: The purpose of this study to investigate if the early variations in the hematological profile could be a useful tool in the prediction and evaluation of intraventricular hemorrhage. Materials and Methods: It is a retrospective study conducted between 1 January 2017 and 31 December 2022, in a tertiary academic center. In-born infants ≤ 28 weeks of gestation (n = 134) were enrolled. The study group of infants with all grades of IVH was further divided into mild IVH subgroups (grades 1 and 2) and severe IVH subgroups (grades 3 and 4); the control group included infants without IVH. Results: The prevalence of IVH was 35.8% (n = 48 of 134 infants—study group). We identified significantly lower median values of HGB (p = 0.0312) and HCT (p = 0.0172) in all grades of the IVH group at birth as compared with control, followed by a significantly higher drop in MCV (p = 0.0146) and MCH (p = 0.0002) in the fourth day of life. Conclusions: Extremely preterm infants with IVH may have lower HTC and HGB values at birth, together with a decrease in MCH and MCHC and increase in MPV. The predictive model based on logistic regression analysis could predict the probability of the occurrence of IVH according to their values

Persistent Ductus Arteriosus in Critically Ill Preterm Infants

Introduction: Persistent ductus arteriosus (PDA) is found with increased incidence in preterm infants, significantly affecting neonatal morbidity and mortality rates

Nasal High-Frequency Oscillatory Ventilation Use in Romanian Neonatal Intensive Care Units—The Results of a Recent Survey

Background: Nasal high-frequency oscillatory ventilation (nHFOV) has emerged as an effective initial and rescue noninvasive respiratory support mode for preterm infants with respiratory distress syndrome (RDS); however, little is known about nHFOV use in Romanian neonatal intensive care units (NICUs). Objectives: We aimed to identify the usage extent and clinical application of nHFOV in Romania. Methods: A structured web-based questionnaire was designed to find the rate of nHFOV use and knowledge of this new method of noninvasive respiratory support in Romanian level III NICUs. Using multiple-choice, open-ended, and yes/no questions, we collected information on the NICU’s size, noninvasive respiratory support modes used, nHFOV use, indications, settings, nasal interfaces, secondary effects, and equipment used. Descriptive statistics and comparisons were performed using IBM SPSS Statistics 26.0. Results: A total of 21/23 (91.3%) leaders from level III NICUs (median [IQR] number of beds of 10 [10–17.5]) responded to the survey. The most frequently used noninvasive ventilation modes were CPAP mode on mechanical ventilators (76.2%), followed by NIPPV (76.2%); heated, humidified high-flow nasal cannula (HHHFNC) (61.9%); and nHFOV (11/21 units; 52.4%). A total of 5/11 units reported frequent nHFOV use (in two or more newborns/month) in both term and preterm infants. The main indications reported for nHFOV use were CPAP failure (90.9%), hypercapnia (81.8%), and bronchopulmonary dysplasia (72.7%). Face/nasal masks and short binasal prongs are the most commonly used nasal interfaces (90.9% and 72.7%, respectively). Air leaks at the interface level (90.9%), thick secretions (81.8%), and airway obstruction (63.6%) were the most frequently mentioned adverse effects of nHFOV. Only three of the NICUs had a written protocol for nHFOV use. Most units not yet using nHFOV cited lack of equipment, experience, training, or insufficient information and evidence for the clinical use and outcome of nHFOV use in neonates as the main reasons for not implementing this noninvasive respiratory mode. Conclusions: Our survey showed that nHFOV is already used in more than half of the Romanian level III NICUs to support term and preterm infants with respiratory distress despite a lack of consensus regarding indications and settings during nHFOV

Impact of Early Surfactant Administration on Ductus Arteriosus Assessed at 24 h in Preterm Neonates Less than 32 Weeks of Gestational Age

Background and Objectives: The purpose of this study was to investigate whether early surfactant administration affects the status of ductus arteriosus (DA) in preterm infants ≤ 32 weeks of gestational age (GA) within 24 h of birth. Materials and Methods: It is a prospective study conducted from 1 March 2022 to 31 December 2023 in a tertiary academic center. In-born infants ≤ 32 weeks of gestation (n = 88) were enrolled. The study group was further divided into surfactant (n = 44) and non-surfactant (n = 44) subgroups. Results: A total of 76% of the preterm infants who received surfactant therapy (RRR = 0.839) recorded an increase in Kindler score at 24 h of life (1 − RR = 1 − 0.24 = 76%). Surfactant administration was significantly associated with decreased pre-ductal diastolic pressure (29.9 mmHg vs. 34.8 mmHg, p = 0.0231), post-ductal diastolic pressure (28.7 mmHg vs. 32.2 mmHg, p = 0.0178), pre-ductal MAP (41.6 mmHg vs. 46.5 mmHg, p = 0.0210), and post-ductal MAP (41.0 mmHg vs. 45.3 mmHg, p = 0.0336). There were no significant changes in ductus arteriosus parameters at 24 h of life. Conclusions: Early surfactant administration does not affect the status of ductus arteriosus in preterm infants ≤ 32 weeks of gestational age at 24 h of life

A Decision-Tree Approach to Assist in Forecasting the Outcomes of the Neonatal Brain Injury

Neonatal brain injury or neonatal encephalopathy (NE) is a significant morbidity and mortality factor in preterm and full-term newborns. NE has an incidence in the range of 2.5 to 3.5 per 1000 live births carrying a considerable burden for neurological outcomes such as epilepsy, cerebral palsy, cognitive impairments, and hydrocephaly. Many scoring systems based on different risk factor combinations in regression models have been proposed to predict abnormal outcomes. Birthweight, gestational age, Apgar scores, pH, ultrasound and MRI biomarkers, seizures onset, EEG pattern, and seizure duration were the most referred predictors in the literature. Our study proposes a decision-tree approach based on clinical risk factors for abnormal outcomes in newborns with the neurological syndrome to assist in neonatal encephalopathy prognosis as a complementary tool to the acknowledged scoring systems. We retrospectively studied 188 newborns with associated encephalopathy and seizures in the perinatal period. Etiology and abnormal outcomes were assessed through correlations with the risk factors. We computed mean, median, odds ratios values for birth weight, gestational age, 1-min Apgar Score, 5-min Apgar score, seizures onset, and seizures duration monitoring, applying standard statistical methods first. Subsequently, CART (classification and regression trees) and cluster analysis were employed, further adjusting the medians. Out of 188 cases, 84 were associated to abnormal outcomes. The hierarchy on etiology frequencies was dominated by cerebrovascular impairments, metabolic anomalies, and infections. Both preterms and full-terms at risk were bundled in specific categories defined as high-risk 75–100%, intermediate risk 52.9%, and low risk 0–25% after CART algorithm implementation. Cluster analysis illustrated the median values, profiling at a glance the preterm model in high-risk groups and a full-term model in the inter-mediate-risk category. Our study illustrates that, in addition to standard statistics methodologies, decision-tree approaches could provide a first-step tool for the prognosis of the abnormal outcome in newborns with encephalopathy