Improving feeding skills and transition to breastfeeding in early preterm infants: a randomized controlled trial of oromotor intervention

IntroductionOromotor therapy exercises used for preterm infants in the NICU might promote oral-motor skills and shorten discharge day. This study investigates the impact of an oral-motor therapy program on the successful transition to breastfeeding (BF) and the enhancement of feeding skills in preterm infants below 30 weeks of gestational age who experience feeding intolerance.MethodsThe intervention group received oral-motor therapy programme for one month, while the control group did not. The feeding skills were evaluated by Early Feeding Skills Assessment Tool (EFS) and Preterm Oral Feeding Readiness Scales (POFRAS).ResultsThere was a significant difference in EFS and POFRAS scores, transition to bottle feeding at discharge and transition to BF after discharge between babies given oral-motor therapy programme and controls (p < 0.05). While the transition time to full enteral feeds did not vary significantly between the groups, noteworthy outcomes were observed in the intervention group, including differences in feeding type at discharge, the nature of feeds at discharge, and the success of transitioning to breastfeeding after discharge.DiscussionWe conclude that the oromotor therapy exercises in NICU improves the quality of sucking, contributes to better oromotor skills and promotes transition to enteral feeding and BF in preterm babies. Clinical Trial RegistrationClinicalTrials.gov, identifier (NCT05845684)

Assessment of Endotracheal Tube Position After Oral Intubation in Neonates

Aim: Endotracheal intubation is a common procedure in the delivery room and neonatal intensive care unit. We aimed to determine the accuracy of this method of endotracheal tube (ETT) placement in our neonatal cohort. Materials and Methods: Data on infants requiring oral intubation were reviewed retrospectively. The initial ETT depth of insertion had been calculated using the Tochen 7-8-9 rule. The initial depth was compared to the mid-tracheal region. The differences between the initial and ideal depth was calculated and divided by the mid-tracheal distance. Infants were grouped according to their weights as = 3001g. Results: We evaluated ETT placement in 160 neonates. The mean gestational age was 32.2 +/- 4.4 weeks (23 to 41 weeks) and the mean weight was 1989 +/- 829 g (560 to 3800 g). The mean range of the difference between the initial depth and ideal depth divided by mid-tracheal distance was 0.39 +/- 0.04, 0.35 +/- 0.04, 0.46 +/- 0.05, and 0.23 +/- 0.04 in infants weighing = 3001 g respectively (p=0.025). The differences between the 2001-3000 g group and the 1001-2000, also the 2001-3000 g group and the >= 3001 g group were statistically significant (p<0.05). Conclusion: The 7-8-9 rule should be used to assess ETT length in neonates, especially in those weighing more than 3 kg. As this rule has low accuracy for extremely low birth weight neonates, its reliability may not be high for neonates weighing less than 3 kg in weight

Perfusion Index and Pleth Variability Index in the First Hour of Life According to Mode of Delivery

Perfusion index (PI) is a relative assessment of the pulse strength at the monitoring site. The plethysmographic variability index (PVI, pleth variability index) is a noninvasive and continuous measure of the dynamic change in PI that occurs during respiratory cycles. In this study PI and PVI changes were compared in babies born with cesarean section (C/S) or spontaneous vaginal delivery (SVD); 125 healthy term infants were monitored with pulse oxymeter after first ten minutes of life. Data were recorded from this monitor on a personal computer and analyzed by generalized estimating equations (GEE) method. Pulse rate was lower in babies born via SVD. Perfusion index were higher in C/S group. Pleth variability index were higher in C/S group. Higher pulse rate, PI and PVI values in babies born via C/S may be indicative of more significant hemodynamic changes in these infants during early transitional period after birth.WoSScopu

An Autopsy Case Report: Prune Belly Syndrome with Overlapping Presentation of Partial Urorectal Septum Malformation Sequence

Prune belly syndrome (PBS) is characterized by a classical triad of congenitally absent abdominal muscles, bilateral cryptorchidism, and a malformed urinary tract. Urorectal septum malformation sequence (URSM) is identified with the absence of urogenital and anal openings. This case report describes a 15-week-old female fetus with megacystis, ascites and oligohydramnios in a 19-year-old nulliparous woman. The patient underwent preterm labor at the 33rd gestational week and delivered a female newborn weighing 2250 grams who died three days later due to progressive respiratory insufficiency. To the best of our knowledge, this is the third case of an overlap between PBS and URSM in literature. Such an overlap refers to the existence of left renal agenesis, right renal cystic dysplasia, bilateral club foot and lumbar scoliosis as well as the absence of abdominal wall muscles, internal genital organs, urethral, vaginal and anal openings. This case report aims to remind the obstetricians about the concurrent occurrence of PBS with URSM and its poor prognosis

Demographic and Clinic Characteristics and Risk Factors of Molluscum Contagiosum in Children

Objective: To address the gap in evidence related to molluscum contagiosum in children by focusing on demographic and clinical features as well as risk factors. Method: The multicentre, prospective, clinical study was conducted at four hospitals in Ankara and Tokat cities of Turkey from August 1, 2014, to August 5, 2019, and comprised patients aged 18 years diagnosed with molluscum contagiosum. Data about demographics, day nursery and preschool attendance, the seasons when the disease occurred, any use of Turkish baths and swimming pools, history of personal/familial atopy, coexistence of diseases, disease duration, courses, number of lesions and anatomic localisation. Data was analysed using SPSS 19. Results: Of the 286 patients, 130(45.5%) were girls and 156(54.5%) were boys. The overall mean age was 5.94±3.95 years. The median duration of the disease was 5 weeks (interquartile range: 3.00-12.00 weeks). There was a significant number of cases with family history 18(48.6%) in the 0-3 age group (p=0.027). History of personal atopy was significantly high in the winter season (p20 lesions had used swimming pools significantly more frequently than the rest (p=0.042). The trunk was the most commonly involved region 162(56.6%). Conclusion: Providing prospective data about demographics, clinical characteristics and risk factors of molluscum contagiosum in children will lead to appropriate preventive and therapeutic measures. Key Words: Children, Molluscum contagiosum, Epidemiology

Lead and Mercury Levels in Preterm Infants Before and After Blood Transfusions.

Very low birth weight (VLBW) infants usually receive packed red blood cell unit (pRBC) transfusions. Heavy metal transfer via pRBCs is not widely discussed before. This study aimed to determine pre-/post-transfusion erythrocyte lead and mercury levels in infants and to correlate these levels to heavy metal concentrations in pRBCs. VLBW infants (n = 80), needing pRBC transfusion for the first time, were enrolled. Erythrocyte heavy metal levels were determined in pre-/post-transfusion blood samples and also in pRBC units. Mean lead and mercury levels in the pRBCs were found to be 16.3 ± 10.8 and 3.75 ± 3.23 μg/L, respectively. Of the infants, 69.7% received lead above reference dose. Erythrocyte lead levels increased significantly after transfusions (10.6 ± 10.3 vs. 13 ± 8.5, p  0.05). There was a significant correlation between mean difference of mercury levels after transfusion and amount of mercury delivered by pRBCs (r = 0.28). Infants can be subject to high levels of lead and mercury through pRBC transfusions

Etiology And Outcome Of Hydrops Fetalis: Report Of 62 Cases

Aim: We aimed to define the etiologic and prognostic factors in live-born infants with hydrops fetalis (HF) in our tertiary neonatal intensive care unit over a 10-year period. Methods: Medical records of newborn infants with HF during 2002-2011 were reviewed retrospectively. Demographic data, prenatal interventions, clinical and laboratory findings, outcomes, and the results of postmortem examinations were analyzed. Results: During the study period, 62 newborn infants with HF were identified from 16,200 live-born deliveries and the incidence of HF was 3.8/1000 live births in our hospital. Twenty-eight infants (45.2%) had immune HF, whereas 34 (54.8%) had nonimmune HF. An etiologic factor could be identified in 24 (70.5%) infants with nonimmune HF. Lymphatic dysplasias comprised the majority (23.5%) of the infants with nonimmune HF. Mortality rate was 50%. The presence of two or more serous cavity effusions and gestational age were independently associated with the risk of mortality. Conclusion: Despite the improvements in neonatal care, mortality rate in infants with HF is still high. Gestational age and the extent of serous cavity determine the risk of mortality. Timely and advanced prenatal or postnatal new therapeutic strategies may alter this fatal outcome in appropriate patients. Copyright (C) 2013, Taiwan Pediatric Association. Published by Elsevier Taiwan LLC. All rights reserved.WoSScopu

A rare large mutation involving two exons of the SP-B gene in an infant with severe respiratory distress

Hereditary surfactant protein-B (SP-B) deficiency is a rare autosomal recessive disease of newborn infants causing severe respiratory failure and death within the first year of life. The most common cause of SP-B deficiency is a frameshift mutation in exon 4 (121ins2) in the gene encoding SP-B. We report a term infant with unremitting respiratory distress who was unresponsive to all treatment modalities. The parents were consanguineous and a term sibling of the infant had died due to respiratory failure without a certain diagnosis. In the first step of the diagnostic work-up, common genetic mutations for SP-B, surfactant protein C and ATP-binding cassette s3 were absent, however sequencing of SP-B gene revealed a large homozygous genomic deletion covering exon 8 and 9. In this case report, we aimed to emphasize further genetic evaluation in all cases suggestive of surfactant dysfunction, even if common mutations are absent

Lead and Mercury Levels in Preterm Infants Before and After Blood Transfusions

Very low birth weight (VLBW) infants usually receive packed red blood cell unit (pRBC) transfusions. Heavy metal transfer via pRBCs is not widely discussed before. This study aimed to determine pre-/post-transfusion erythrocyte lead and mercury levels in infants and to correlate these levels to heavy metal concentrations in pRBCs. VLBW infants (n=80), needing pRBC transfusion for the first time, were enrolled. Erythrocyte heavy metal levels were determined in pre-/post-transfusion blood samples and also in pRBC units. Mean lead and mercury levels in the pRBCs were found to be 16.3 +/- 10.8 and 3.75 +/- 3.23g/L, respectively. Of the infants, 69.7\% received lead above reference dose. Erythrocyte lead levels increased significantly after transfusions (10.6 +/- 10.3 vs. 13 +/- 8.5, p<0.05) with significant correlated to amount of lead within pRBCs (r=0.28). Mean pre-/post-transfusion erythrocyte mercury levels were 3.28 +/- 3.08 and 3.5 +/- 2.83g/L, respectively (p>0.05). There was a significant correlation between mean difference of mercury levels after transfusion and amount of mercury delivered by pRBCs (r=0.28). Infants can be subject to high levels of lead and mercury through pRBC transfusions