Faculty Bibliography

OBJECTIVE:A standardized multifaceted approach to follow-up is crucial for monitoring neurodevelopment in neonates who undergo extracorporeal membrane oxygenation (ECMO). The Pittsburgh Index for Pre-ECMO Risk (PIPER+) score, which predicts the probability of hospital mortality, may help predict adverse neurodevelopmental outcomes. This study sought to assess the neurodevelopment of neonates who were treated with ECMO in our newly developed ECMO program, by analyzing Bayley Scales of Infant Development (BSID) scores obtained at the Neonatal Comprehensive Care Program (NCCP), our neurodevelopmental follow-up clinic, through two years of age. It also aimed to determine whether neurodevelopmental outcomes in our study population were correlated to PIPER+ score, magnetic resonance imaging (MRI), or video electroencephalography (vEEG) findings. STUDY DESIGN/METHODS:We conducted a retrospective chart review of neonatal patients placed on ECMO at our institution between March 2015 and June 2023 who had at least one follow-up visit at the NCCP clinic. The relationships between neurodevelopmental outcomes, quantified by the BSID score, PIPER + score, MRI results, and vEEG abnormalities were analyzed. RESULTS:A total of 18 patients met the inclusion criteria. There was a significant negative correlation (p<0.05) between PIPER+ and BSID scores at 12 months across all developmental domains analyzed. However, this correlation was no longer significant at 24 months. The odds of the combined outcome of mortality or neurodevelopmental impairment at two years of age increased by 17% for each 1% increase in the PIPER+ score. CONCLUSIONS:Higher PIPER+ scores were associated with higher mortality in our population; they also correlated with worse neurodevelopmental outcomes at 12 months, but not at 24 months. It is important and feasible to follow neonates who underwent ECMO using a neurodevelopmental follow-up clinic.

CONTEXT/BACKGROUND:Little is known about the prevalence of goal-concordant care (GCC) in the NICU and whether it can be measured from chart data. OBJECTIVES/OBJECTIVE:To determine if GCC can be evaluated using chart data, to identify factors associated with GCC, and to evaluate the impact of pediatric palliative care (PPC) consultation on GCC. METHODS:Retrospective review of infants who died in a level IV NICU over a 10-year period (2014-2024). A structured questionnaire was used to guide independent chart abstraction for GCC outcomes between two reviewers. Cohen's kappa was used to measure reviewer agreement. Mann-Whitney U and Chi-square or Fisher's exact tests were used to evaluate differences between infants with GCC vs. no GCC. Logistic regression was used to evaluate the impact of PPC on aspects of GCC. RESULTS:78% (99/127) of patients received GCC. Reviewer agreement for determining aspects of GCC was low, however, consensus was reached for all GCC outcomes. GCC was significantly associated with religious tradition, insurance status, limitations of resuscitation, mode of death, PPC consult, any family meeting or advance care planning discussion, and more social work visits. In logistic regression, PPC consultation was not a significant predictor of GCC after adjusting for religion, insurance, time since death, length of stay, and family meetings. CONCLUSION/CONCLUSIONS:Most infants received GCC, which was able to be determined from chart data. GCC was associated with several demographic and hospitalization factors such as PPC consultation and psychosocial supports. After adjusting for confounding, PPC was not a significant predictor of GCC.

PURPOSE/OBJECTIVE:The premature infant brain may be particularly vulnerable to anesthesia effects, but there is conflicting evidence on the association between anesthesia exposure and developmental outcomes. Twin studies can control for confounding factors. A twin cohort of premature twins provides internal control of difficulty to measure confounders and delivers added power to a study examining the effects of anesthesia on neurodevelopmental outcomes. METHODS:We conducted a retrospective cohort study of sets of premature twins and multiples born at an academic medical center, in which 1 member of the set was exposed to general anesthesia. The primary outcome was the composite scores using Bayley Scale of Infant and Toddler Development III performed at age 6 months to 18 months. Unpaired and paired analyses were performed with linear regression models, Wilcoxon signed rank test, and Mann-Whitney U test. RESULTS:We identified 81 children born at less than 32 weeks gestation within 39 sets of twins and 1 set of triplets for a total of 18 paired observations. All of the exposed infants had a single exposure to general anesthesia. There was no significant association between anesthesia exposure and a diagnosis of developmental delay (OR = 0.8; 95% confidence interval, 0.2-3.2; p = 0.99). Regression models demonstrated no association between anesthesia exposure and cognitive (96.67 vs 97.50; p = 0.74), language (98.33 vs 98.61; p = 0.94), or motor (96.25 vs 96.44; p = 0.91) composite Bayley scores. There was no association between duration of anesthesia and the 3 composite Bayley scores ( p = 0.33; p = 0.40; p = 0.74). CONCLUSION/CONCLUSIONS:Using a premature twin cohort with discordant exposure to anesthesia, our data did not demonstrate any association between anesthesia exposure and developmental delay in this vulnerable population of premature infants.

OBJECTIVES/OBJECTIVE:and fractional tissue oxygen extraction (FTOE) in stable preterm infants in the first week of life. METHODS:, splanchnic cerebral oxygen ratio (SCOR), FTOE, and regional intra-subject variability was calculated at each location at five different time intervals: 0-12 h, 12-24 h, 24-48 h, 48-72 h, and one week of life. RESULTS:=0.81). The FTOE increased in all three locations over time. Intra-subject variability was lowest in the cerebral region (1.3 % (±1.9)). CONCLUSIONS:in preterm infants.

OBJECTIVE:To screen for neurodevelopmental delays in a cohort of full-term infants born to mothers with SARS-CoV-2. STUDY DESIGN/METHODS:-3) at 16 to 18 months age. RESULTS:Of 51 subjects, twelve (24%) were below cutoff, and twenty-seven (53%) were either below or close to the cutoff in at least one developmental domain. Communication (29%), fine motor (31%), and problem-solving (24%) were the most affected domains. There were no differences in outcomes between infants born to asymptomatic and mildly symptomatic mothers. CONCLUSION/CONCLUSIONS:We observed increased risk of neurodevelopmental delays during screening of infants born at full-term to mothers with SARS-CoV-2 at 16 to 18 months age. These results highlight the urgent need for follow-up studies of infants born to mothers with SARS-CoV-2.

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.

OBJECTIVE: The 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: < 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: Inhaled 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:· Inhaled iloprost seems to have beneficial effects in improving oxygenation indices in PPHN.. · Inhaled iloprost is generally well tolerated in newborns with PPHN.. · There is a need for prospective RCTs to further ascertain the benefits of using inhaled iloprost..

OBJECTIVE: The 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: A 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 18 ± 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 18 ± 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: = 0.03, odds ratio [OR] = 0.8, 95% confidence interval [CI]: 0.6-0.97) when adjusted for birth weight and gestational age. CONCLUSION/CONCLUSIONS: Preterm 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:· Hypernatremia is a common electrolyte disturbance in preterm neonates.. · Hypernatremia may be associated with long-term neurodevelopmental outcomes in preterm infants.. · Hypernatremia is a potentially modifiable risk factor..

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.

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 (≤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 (p = 0.02). 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.