Amuchou Soraisham

Incidence and Timing of Presentation of Necrotizing Enterocolitis in Preterm Infants

OBJECTIVES: To examine the variation in the incidence and to identify the timing of the presentation of necrotizing enterocolitis (NEC) in a cohort of preterm infants within the Canadian Neonatal Network (CNN). METHODS: This was a population-based cohort of 16 669 infants with gestational age (GA) <33 weeks, admitted to 25 NICUs participating in the CNN between January 1, 2003, and December 31, 2008. Variations in NEC incidence among the participating NICUs for the study period were examined. We categorized early-onset NEC as occurring at <14 days of age and late-onset NEC occurring at ≥14 days. Multivariate logistic regression analysis was performed to identify risk factors for early-onset NEC. RESULTS: The overall incidence of NEC was 5.1%, with significant variation in the risk adjusted incidence among the participating NICUs in the CNN. Early-onset NEC occurred at a mean of 7 days compared with 32 days for late-onset NEC. Early-onset NEC infants had lower incidence of respiratory distress syndrome, patent ductus treated with indomethacin, less use of postnatal steroids, and shorter duration of ventilation days. Multivariate logistic regression analysis identified that greater GA and vaginal delivery were associated with increased risk of early-onset NEC. CONCLUSIONS: Among infants <33 weeks’ gestation, NEC appears to present at mean age of 7 days in more mature infants, whereas onset of NEC is delayed to 32 days of age in smaller, lower GA infants. Further studies are required to understand the etiology of this disease process.

Does necrotising enterocolitis impact the neurodevelopmental and growth outcomes in preterm infants with birthweight ≤1250 g?

Aim:  To compare the long‐term growth and neurodevelopmental outcomes at 36 months adjusted age in preterm infants (birthweight (BW) ≤ 1250 g) with necrotising enterocolitis (NEC) with BW‐matched controls.

Association Between Antenatal Corticosteroid Administration-to-Birth Interval and Outcomes of Preterm Neonates.

OBJECTIVE: To assess the association between antenatal corticosteroid administration-to-birth interval and outcomes. METHODS: In this retrospective cohort study, data on singleton neonates born between 24 0/7 and 33 6/7 weeks of gestation and admitted to tertiary neonatal units in Canada during 2010–2012 were obtained from the Canadian Neonatal Network. Neonatal outcomes were compared among four groups based on the interval between antenatal corticosteroid administration and birth: no antenatal corticosteroids, partial antenatal corticosteroids (less than 24 hours before birth), antenatal corticosteroids 1–7 days before birth, and antenatal corticosteroids greater than 7 days before birth. Composite outcome was defined as any of neonatal mortality, bronchopulmonary dysplasia, grade 3–4 intraventricular hemorrhage, periventricular leukomalacia, or stage 3 or higher retinopathy. RESULTS: Of 6,870 eligible neonates, 1,378 (20%) received no antenatal corticosteroids; 1,473 (21%) received partial antenatal corticosteroids; 2,721 (40%) received antenatal corticosteroids 1–7 days before birth; and 1,298 (19%) received antenatal corticosteroids greater than 7 days before birth. The odds of the composite adverse outcome were significantly higher in all groups compared with neonates who received antenatal corticosteroids 1–7 days before birth (no antenatal corticosteroids: adjusted odds ratio [OR] 2.12, 95% confidence interval [CI] 1.69–2.65; partial antenatal corticosteroids: adjusted OR 1.48, 95% CI 1.22–1.80; and antenatal corticosteroids at greater than 7 days: adjusted OR 1.46, 95% CI 1.20–1.77). Similar findings were observed with respect to neonatal mortality (no antenatal corticosteroids: adjusted OR 2.56, 95% CI 1.83–3.59; partial antenatal corticosteroids: adjusted OR 1.59, 95% CI 1.16–2.18; and antenatal corticosteroids at greater than 7 days: adjusted OR 1.40, 95% CI 1.00–1.97). CONCLUSION: Antenatal corticosteroids had maximum benefit when given between 1 and 7 days before birth. LEVEL OF EVIDENCE: II

Outcomes of preterm infants following the introduction of room air resuscitation

BACKGROUND After 2006 most neonatal intensive care units (NICUs) in Canada stopped initiating newborn resuscitation with 100% oxygen. METHODS In this retrospective cohort study, we compared neonatal outcomes in infants born at ≤ 27 weeks gestation that received <100% oxygen (OXtitrate group, typically 21-40% oxygen) during delivery room resuscitation to infants that received 100% oxygen (OX100 group). RESULTS Data from 17 NICUs included 2326 infants, 1244 in the OXtitrate group and 1082 in the OX100 group. The adjusted odds ratio (AOR) for the primary outcome of severe neurologic injury or death was higher in the OXtitrate group compared with the OX100 group (AOR 1.36; 95% CI 1.11, 1.66). A similar increase was also noted when comparing infants initially resuscitated with room air to the OX100 group (AOR 1.33; 95% CI 1.04, 1.69). Infants in the OXtitrate group were less likely to have received either medical or surgical treatment for a patent ductus arteriosus (AOR 0.53; 95% CI 0.37, 0.74). CONCLUSIONS In Canadian NICUs, we observed a higher risk of severe neurologic injury or death among preterm infants of ≤ 27 weeks gestation following a change in practice to initiating resuscitation with either room air or an intermediate oxygen concentration.

Postoperative urinary incontinence after total abdominal hysterectomy or supracervical hysterectomy: a metaanalysis.

OBJECTIVE A metaanalysis of randomized trials was conducted to evaluate if the type of hysterectomy, total abdominal hysterectomy or supracervical hysterectomy, has an impact on the development of urinary incontinence. STUDY DESIGN We searched MEDLINE, EMBASE, CINAHL, Biological Abstract, and the Cochrane Library up to February 2007; abstracts at major meetings and bibliographies of retrieved articles were scanned. A fixed effect model was used to calculate summary relative risk estimates and 95% confidence intervals (CIs). RESULTS Analysis showed no statistical difference in the risk of developing stress or urge urinary incontinence in women who underwent supracervical hysterectomy compared with women who underwent total abdominal hysterectomy (relative risk, 1.3; 95% CI, 0.94-1.78; P = 0.16 and relative risk, 1.37; 95% CI, 0.77-2.46; P = .25). CONCLUSION There is no statistical evidence of a different risk for developing either stress or urge urinary incontinence after a supracervical hysterectomy or a total hysterectomy.

Probiotics and prebiotics: role in prevention of nosocomial sepsis in preterm infants.

Nosocomial sepsis is associated with increased mortality and morbidity including neurodevelopmental impairment and prolonged hospital stay. Prevention of sepsis especially in the preterm infants in the neonatal intensive care unit remains a major challenge. The gastrointestinal tract is an important source of potential pathogens causing nosocomial sepsis as the immature intestinal epithelium can permit translocation of bacteria and yeast. The intestinal tract and its microflora play an important role in the immunity. Altering the gut microflora has been extensively studied for immunomodulation in preterm infants. Probiotics are live microorganisms which when administered in adequate amounts confer a health benefit on the host. Probiotics have been used for prevention and treatment of various medical conditions in children and adults. Studies on probiotics in premature infants have focused on normalizing intestinal flora, improvement in feeding intolerance, prevention of necrotizing enterocolitis and sepsis. In this paper, we discuss the intestinal bacterial colonization pattern; the rational for probiotics and prebiotic therapy with special focus on the prevention of nosocomial sepsis in preterm infants.

Effect of single loading dose of intravenous caffeine infusion on superior mesenteric artery blood flow velocities in preterm infants.

Aim:  To evaluate the effects of a single loading dose of caffeine base (10 mg/kg) on superior mesenteric artery (SMA) blood flow velocities (BFV).

Neurodevelopmental outcomes of premature infants treated with l-arginine for prevention of necrotising enterocolitis

Aim:  This study aimed to compare the long‐term neurodevelopmental outcomes at 36 months adjusted age in preterm infants (birth weight ≤ 1250 gm) who received supplementation with l‐arginine during the first 28 days of life with controls.

Rates of Intracardiac Umbilical Venous Catheter Placement in Neonates

To review umbilical venous catheter (UVC) placement in neonates who underwent targeted neonatal echocardiography (TNE) and to correlate catheter tip placement on TNE and anteroposterior thoracoabdominal radiography.

Utility of Targeted Neonatal Echocardiography in the Management of Neonatal Illness

To describe the impact of targeted neonatal echocardiography on management of neonatal illness in a tertiary perinatal center neonatal intensive care unit (NICU).