Near-infrared spectroscopy in the medical management of infants
Bailey, Sean M; Prakash, Shrawani Soorneela; Verma, Sourabh; Desai, Purnahamsi; Kazmi, Sadaf; Mally, Pradeep V
Near-infrared spectroscopy (NIRS) is a technology that is easy to use and can provide helpful information about organ oxygenation and perfusion by measuring regional tissue oxygen saturation (rSO2) with near-infrared light. The sensors can be placed in different anatomical locations to monitor rSO2 levels in several organs. While NIRS is not without limitations, this equipment is now becoming increasingly integrated into modern healthcare practice with the goal of achieving better outcomes for patients. It can be particularly applicable in the monitoring of pediatric patients because of their size, and especially so in infant patients. Infants are ideal for NIRS monitoring as nearly all of their vital organs lie near the skin surface which near-infrared light penetrates through. In addition, infants are a difficult population to evaluate with traditional invasive monitoring techniques that normally rely on the use of larger catheters and maintaining vascular access. Pediatric clinicians can observe rSO2 values in order to gain insight about tissue perfusion, oxygenation, and the metabolic status of their patients. In this way, NIRS can be used in a non-invasive manner to either continuously or periodically check rSO2. Because of these attributes and capabilities, NIRS can be used in various pediatric inpatient settings and on a variety of patients who require monitoring. The primary objective of this review is to provide pediatric clinicians with a general understanding of how NIRS works, to discuss how it currently is being studied and employed, and how NIRS could be increasingly used in the near future, all with a focus on infant management.
Effects of Inhaled Iloprost for the Management of Persistent Pulmonary Hypertension of the Newborn
Verma, Sourabh; Lumba, Rishi; Kazmi, Sadaf H; Vaz, Michelle J; Prakash, Shrawani Soorneela; Bailey, Sean M; Mally, Pradeep V; Randis, Tara M
OBJECTIVE:â€ƒThe study aimed to evaluate the effects of inhaled iloprost on oxygenation indices in neonates with persistent pulmonary hypertension of the newborn (PPHN). STUDY DESIGN/METHODS:) were recorded. RESULTS:â€‰<â€‰0.05), with no significant change in required mean airway pressure over that same period. There was no change in vasopressor use or clinically significant worsening of platelets count, liver, and kidney functions after initiating iloprost. CONCLUSION/CONCLUSIONS:â€ƒInhaled iloprost is well tolerated and seems to have beneficial effects in improving oxygenation indices in neonates with PPHN who do not respond to iNO. There is a need of well-designed prospective trials to further ascertain the benefits of using inhaled iloprost as an adjunct treatment in neonates with PPHN who do not respond to iNO alone. KEY POINTS/CONCLUSIONS:Â· Inhaled iloprost seems to have beneficial effects in improving oxygenation indices in PPHN.. Â· Inhaled iloprost is generally well tolerated in newborns with PPHN.. Â· There is a need for prospective RCTs to further ascertain the benefits of using inhaled iloprost..
The Impact of Hypernatremia in Preterm Infants on Neurodevelopmental Outcome at 18 Months of Corrected Age
Howell, Heather B; Lin, Matthew; Zaccario, Michele; Kazmi, Sadaf; Sklamberg, Felice; Santaniello, Nicholas; Wachtel, Elena
OBJECTIVE:â€ƒThe study objective was to assess the correlation between hypernatremia during the first week of life and neurodevelopmental outcomes at 18 months of corrected age in premature infants. STUDY DESIGN/METHODS:â€ƒA retrospective observational study of preterm infants born at less than 32 weeks of gestation who had a neurodevelopmental assessment with the Bayley scales of infant and toddler development III at 18â€‰Â±â€‰6 months of corrected age. Serum sodium levels from birth through 7 days of life were collected. The study cohort was divided into two groups: infants with a peak serum sodium of >145 mmol/L (hypernatremia group) and infants with a peak serum sodium level of <145 mmol/L (no hypernatremia group). Prenatal, intrapartum, and postnatal hospital course and neurodevelopmental data at 18â€‰Â±â€‰6 months were collected. Logistic regression analysis was used to assess the correlation between neonatal hypernatremia and neurodevelopment with adjustment for selected population characteristics. RESULTS:â€‰=â€‰0.03, odds ratio [OR]â€‰=â€‰0.8, 95% confidence interval [CI]: 0.6-0.97) when adjusted for birth weight and gestational age. CONCLUSION/CONCLUSIONS:â€ƒPreterm infants born at less than 32 weeks of gestation with hypernatremia in the first week of life have lower fine motor scores at 18 months of corrected age. KEY POINTS/CONCLUSIONS:Â· Hypernatremia is a common electrolyte disturbance in preterm neonates.. Â· Hypernatremia may be associated with long-term neurodevelopmental outcomes in preterm infants.. Â· Hypernatremia is a potentially modifiable risk factor..
The impact of donor breast milk on metabolic bone disease, postnatal growth and neurodevelopmental outcomes at 18 months corrected age
Kazmi, Sadaf H; Berman, Sarah; Caprio, Martha; Wachtel, Elena V
BACKGROUND:Preterm infants are at high risk for metabolic bone disease (MBD). Analysis of donor breast milk (DBM) shows lower levels of macronutrients compared to mother's own milk (MOM). The purpose of this study was to investigate the prevalence of MBD, rate of postnatal growth, and long-term neurodevelopmental (ND) outcomes in infants fed predominantly MOM vs. DBM. METHODS:Retrospective observational study of infants born < 1500g and < 32 weeks at NYU Langone Health or Bellevue Hospital from January 2014 to January 2018. Infants were divided into two groups, those who received > 70% of feeds with either MOM or DBM by 34 weeks CA. MBD was assessed using alkaline phosphatase (AlkPO4) levels and x-ray findings. Data was also collected on growth, feeding tolerance, and long-term ND outcomes. RESULTS:210 infants were included: 156 in MOM and 54 in DBM group. The DBM group had higher AlkPO4 levels compared to the MOM group for the first 3 weeks of life (p < 0.01). Growth was similar between the groups and both groups demonstrated catch-up growth after discharge. No difference was seen in feeding intolerance, incidence of NEC, or sepsis. The DBM group had lower cognitive (OR 0.93 [0.88-0.98], p < 0.01) and language (OR 0.95 [0.90-0.99], p < 0.01) scores at 18-month CA. CONCLUSIONS:Infants fed predominantly DBM had elevated AlkPO4 levels suggestive of MBD, but did not develop significant osteopenia. Despite appropriate growth and comparable short-term outcomes, infants fed DBM had lower cognitive and language scores at 18-month CA. This article is protected by copyright. All rights reserved.
The value of routine laboratory screening in the neonatal intensive care unit
Kazmi, S H; Caprio, M; Boolchandani, H; Mally, P; Bailey, S; Desai, P
BACKGROUND:Healthcare spending is expected to grow faster than the economy over the next decade, and the cost of prematurity increases annually. The aim of this study was to investigate the frequency of intervention after routine laboratory testing in preterm infants. METHODS:This was a retrospective study of preterm infants (â‰¤34 weeks) admitted to the NYU Langone Health NICU from June 2013 to December 2014. Data collected included demographics, results of laboratory tests, and resulting interventions. Intervention after a hemogram was defined as a blood transfusion. Intervention after a hepatic panel was defined as initiation or termination of ursodiol or change in dose of vitamin D. Subjects were stratified into 3 groups based on gestation (<28 weeks, 28-31 6/7 weeks, 32-34 weeks). Chi-square analysis was used to compare the frequency of intervention between the groups. RESULTS:A total of 135 subjects were included in the study. The frequency of intervention after a hemogram was 8.4% in infants <28 weeks, 4.6% in infants 28-31 6/7 weeks, and 0% in infants 32-34 weeks; this difference was found to be statistically significant (pâ€Š=â€Š0.02). The frequency of intervention after a hepatic panel was 4.2% in infants <28 weeks, 5.7% in infants 28-31 6/7 weeks, and 0% in infants 32-34 weeks, which was not found to be a statistically significant different. CONCLUSION/CONCLUSIONS:No interventions were undertaken post-routine laboratory testing in any infant 32-34 weeks and routine testing in this population may be unnecessary. Further studies are needed to elucidate if routine testing affects neonatal outcomes.
Neurodevelopmental outcomes of children with congenital heart disease: A review
Howell, Heather B; Zaccario, Michele; Kazmi, Sadaf H; Desai, Purnahamsi; Sklamberg, Felice E; Mally, Pradeep
Congenital heart defects are the most common birth anomaly affecting approximately 1% of births. With improved survival in this population, there is enhanced ability to assess long-term morbidities including neurodevelopment. There is a wide range of congenital heart defects, from those with minimal physiologic consequence that do not require medical or surgical intervention, to complex structural anomalies requiring highly specialized medical management and intricate surgical repair or palliation. The impact of congenital heart disease on neurodevelopment is multifactorial. Susceptibility for adverse neurodevelopment increases with advancing severity of the defect with initial risk factors originating during gestation. Complex structural heart anomalies may pre-dispose the fetus to abnormal circulatory patterns in utero that ultimately impact delivery of oxygen rich blood to the fetal brain. Thus, the brain of a neonate born with complex congenital heart disease may be particularly vulnerable from the outset. That vulnerability is compounded during the newborn period and through childhood, as this population endures a myriad of medical and surgical interventions. For each individual patient, these factors are likely cumulative and synergistic with progression from fetal life through childhood. This review discusses the spectrum of risk factors that may impact neurodevelopment in children with congenital heart disease, describes current recommendations and practices for neurodevelopmental follow-up of children with congenital heart disease and reviews important neurodevelopmental trends in this high risk population.
The Effect of Complete Blood Count Timing on Lumbar Puncture Rates in Asymptomatic Infants Born to Mothers with Chorioamnionitis
Kazmi, Sadaf H; Bailey, Sean M; Mally, Pradeep V; Verma, Sourabh; Borkowsky, William; Howell, Heather B
Background Maternal chorioamnionitis is a risk factor for sepsisÂ but, often, these infants are asymptomatic at birth. Different markers for infections, such as the immature to total (I/T) white blood cell (WBC) ratio, are used to help determine which infants require lumbar punctures (LPs), in addition to blood cultures and antibiotics. The timing of when the complete blood count (CBC) is obtained may have some effect on the length of antibiotic treatment. Aims The purpose of this proof-of-concept study was to assess if obtaining a CBC at greater thanÂ four hours of life as compared to less thanÂ four hours of life has an impact on the incidence of LPs performed in asymptomatic, full-term infants undergoing evaluation for sepsis secondary to maternal chorioamnionitis. Methods We performed a retrospective study of full-term, asymptomatic infants admitted for sepsis evaluation secondary to maternal chorioamnionitis. Subjects were grouped based upon the timing of their initial CBC (early = <Â four hours of life or late = >Â four hours of life). The incidence of LPs, duration of antibiotic treatment, and length of hospitalization wereÂ compared between the groups. Results A total of 230Â subjects were included in the study (early group = 124, late group = 106). Subjects in the late group underwent significantly fewer LPs than subjects in the early group, 5.7% vs. 22.6% (p<0.001). There was no difference in length of treatment or hospitalization. Conclusions Asymptomatic full-term infants undergoing evaluation for sepsis secondary to maternal chorioamnionitis are less likely to undergo an LP if their initial CBC is obtained at greater thanÂ four hours of life.