Mohamed El-Dib

Red blood cell transfusion, feeding and necrotizing enterocolitis in preterm infants.

Objective:Preliminary studies suggested an association between red blood cell (RBC) transfusion and necrotizing enterocolitis (NEC) in premature neonates. An advantageous effect of withholding feeds during transfusion has never been studied. We aimed, first, to determine whether preterm infants who developed NEC were more likely to be transfused in the 48 to 72 h before the diagnosis of NEC; second, to test if a strict policy of withholding feeds during transfusion would decrease the incidence of transfusion-associated NEC.Study Design:The study was conducted in two phases. Phase 1: a retrospective case–control study of premature low-birth weight (<32 weeks and <2500 g) infants who developed NEC over a 6-year period. Phase 2: a comparison study of the incidence of NEC during the 18-months preceding, and the 18 months following the change of practice to withholding feeds during RBC transfusion.Result:In the case–control study (25 infants with NEC and 25 controls), more infants in the NEC group received transfusions in the 48 and 72 h preceding diagnosis (56 vs 20% within 48 h, P=0.019; and 64 vs 24% within 72 h, P=0.01). The total number of transfusions and age of RBCs were not different between the two groups. Implementing the policy of withholding feeds during transfusion was associated with a decrease in the incidence of NEC from 5.3 to 1.3% (P=0.047).Conclusion:Infants who developed NEC frequently received RBC transfusions in the 48 and 72 h preceding presentation of NEC. A strict policy of withholding feeds during transfusion may have a protective effect from NEC.

Factors associated with adverse neurodevelopmental outcomes in infants with congenital heart disease

OBJECTIVE To review reported neurodevelopmental outcome data for patients with congenital heart disease, identify risk factors for adverse neurodevelopmental sequelae and summarize potential neuromonitoring strategies that have been described. METHODS A Medline search was performed utilizing combinations of the keywords congenital heart, cardiac, neurologic, neurodevelopment, neuromonitoring, quality of life, and outcome. All prospective and longitudinal follow-up studies of patients with congenital heart disease were included. Additionally, studies that examined neuroimaging, neuromonitoring, and clinical factors in relation to outcome were examined. Case reports and editorials were excluded. Additional references were retrieved from selected articles if the abstract described an evaluation of neurodevelopmental outcomes and/or predictors of outcome in patients with congenital heart disease. RESULTS Overall, patients with CHD have increased rates of neurodevelopmental impairments, although intelligence appears to be in the normal range. Preoperative risk stratification, intraoperative techniques, postoperative care, and neuromonitoring strategies may all contribute to ultimate long-term neurodevelopmental outcomes in patients with CHD postsurgical repair. CONCLUSIONS As advances in the medical and surgical management improves survival in patients with CHD, increasing knowledge about neurodevelopmental outcomes and the factors that affect them will provide for strategies to optimize long-term outcome in this high-risk population.

Melatonin use for neuroprotection in perinatal asphyxia: a randomized controlled pilot study

Objective:Melatonin has been shown to be neuroprotective in animal models. The objective of this study is to examine the effect of melatonin on clinical, biochemical, neurophysiological and radiological outcomes of neonates with hypoxic–ischemic encephalopathy (HIE).Study Design:We conducted a prospective trial on 45 newborns, 30 with HIE and 15 healthy controls. HIE infants were randomized into: hypothermia group (N=15; received 72-h whole-body cooling) and melatonin/hypothermia group (N=15; received hypothermia and five daily enteral doses of melatonin 10 mg kg−1). Serum melatonin, plasma superoxide dismutase (SOD) and serum nitric oxide (NO) were measured at enrollment for all infants (N=45) and at 5 days for the HIE groups (N=30). In addition to electroencephalography (EEG) at enrollment, all surviving HIE infants were studied with brain magnetic resonance imaging (MRI) and repeated EEG at 2 weeks of life. Neurologic evaluations and Denver Developmental Screening Test II were performed at 6 months.Result:Compared with healthy neonates, the two HIE groups had increased melatonin, SOD and NO. At enrollment, the two HIE groups did not differ in clinical, laboratory or EEG findings. At 5 days, the melatonin/hypothermia group had greater increase in melatonin (P<0.001) and decline in NO (P<0.001), but less decline in SOD (P=0.004). The melatonin/hypothermia group had fewer seizures on follow-up EEG and less white matter abnormalities on MRI. At 6 months, the melatonin/hypothermia group had improved survival without neurological or developmental abnormalities (P<0.001).Conclusion:Early administration of melatonin to asphyxiated term neonates is feasible and may ameliorate brain injury.

Neuroimaging and neurodevelopmental outcome of premature infants.

Preterm birth is associated with variable degrees of brain injury and adverse neurodevelopmental outcomes. Neuroimaging has been investigated as a predictor of outcome in this population. Head ultrasound allows for rapid bedside evaluation of the neonatal brain for early intraventricular hemorrhage surveillance and later detection of periventricular leukomalacia. Computed tomography can provide excellent views for bones, hemorrhage, extra-axial space, and the ventricles but is rarely used for prognostic purposes. Magnetic resonance imaging allows for high-resolution images of brain structures, differentiation of white and gray matter, visualization of the brain stem and posterior fossa, and getting additional physiological information with specialized sequences. Though controversial, the use of magnetic resonance imaging, at term equivalent, as a predictor of later outcome in preterm infants has been increasing and has been advocated by some as a standard practice. In this article, we review and contrast the use of these various imaging modalities in predicting neurodevelopmental outcome of premature infants.

Soccer video summarization using enhanced logo detection

We propose an automatic soccer video summarization engine which relies on an improved algorithm for the detection of replay shots which delineate interesting events. Video shots are first detected using dominant color and histogram intersection methods. Replay shots are detected using an improved technique, then processed through a set of mid-level descriptors (goal-mouth and score board with other cinematic features) and finally fed into a rule-based classifier. The proposed summarization has been experimentally tested on 6 hours from 10 videos in total. The proposed logo-based replay detection technique achieves 100% recall with 96.3% precision. Interesting events such as goals are detected with 100% recall and 100% precision, attacks with 91.7% recall and 86.7% precision) and other events such as (fouls, free kicks etc) with 90.8% recall and 95% precision.

aEEG evolution during therapeutic hypothermia and prediction of NICU outcome in encephalopathic neonates.

Background: Initial aEEG background pattern has been used as a predictor of neurological outcome after asphyxia and has been used as inclusion criterion for trials evaluating efficacy of therapeutic hypothermia in encephalopathic newborns. The utility of continuous aEEG monitoring during hypothermia has not been well described. Objectives: (1) To describe the evolution of aEEG during therapeutic hypothermia in newborns with encephalopathy, and (2) to evaluate the utility of continuous aEEG monitoring during therapeutic hypothermia. Methods: This is a retrospective review of continuous aEEG data from encephalopathic newborns treated with whole-body hypothermia. aEEG segments were scored for background and sleep-wake cycling (SWC). Sensitivity and specificity calculations and logistic regression analyses were performed to evaluate the ability of aEEG to predict death or severe MRI abnormality/significant neurological deficit at discharge. Results: aEEG data from 75 encephalopathic newborns were reviewed. Abnormal aEEG background was predictive of adverse outcome with increasing positive predictive value over the course of hypothermia. Few patients (5%) had early SWC, but 58% developed SWC by rewarming and all had favorable outcome. Conclusions: Persisting aEEG background abnormality beyond 48 h of life and lack of SWC over the course of hypothermia is predictive of adverse NICU outcome in encephalopathic newborns.

Neurodevelopmental assessment of the newborn: An opportunity for prediction of outcome

Over the decades, the evolution of neonatology has been a continuum. After intense focus on cardiac and respiratory support, now more time, effort and research are concerned about brain development of the term and preterm infants. There is no single standardized neurodevelopmental assessment tool that can be advocated for infants in the neonatal intensive care unit. The tools that are currently available vary in their physiological bases, pre requisite training and expertise, time allotted to perform and score, and clinical utility and validity. In this communication, we describe the neurobehavioral and sensory capabilities of the neonate. We then compare the commonly used neurobehavioral examinations with an emphasis on premature infants. We envision this effort as an essential step before the development of a universal and comprehensive assessment tool.

Neurobehavioral assessment as a predictor of neurodevelopmental outcome in preterm infants

Objective:Preterm infants are at risk for neurodevelopmental impairment. The Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS) is a standardized assessment for the neurobehavioral integrity of the newborn. The use of NNNS as a prognostic tool is still emerging. We hypothesized that the NNNS examination performed at term equivalent can detect neurobehavioral alterations in very low birth weight infants and can help in predicting their neurodevelopmental outcome at 18 months corrected age (CA).Study Design:This is a prospective study that included preterm infants with birth weight <1500 g and gestational age ⩽34 weeks. They were evaluated with NNNS at term-equivalent and 12 summary scores were assigned. Infants who had 2 or more NNNS summary scores that were 2 s.d. beyond the mean of the study group were categorized as having abnormal NNNS. Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI) of Bayley Scales of Infant Development (BSID-II) were determined at 18 months CA. Multiple linear regression models were used to examine the predictivity of the NNNS summary scores for both MDI and PDI.Result:A total of 41 infants were evaluated at term and at 18 months CA. The average MDI was 78±15 and the average PDI was 80±14. Significant neurodevelopmental delay was observed in 50% and 31% of infants with abnormal and normal NNNS, respectively. Using multiple linear regression, NNNS was predictive for both MDI (P=0.011, adjusted R 2=0.295) and PDI (P=0.002, adjusted R 2=0.441). Lower MDI was associated with less regulation and more nonoptimal reflexes, whereas lower PDI was associated with less regulation, more nonoptimal reflexes, hypertonicity and handling.Conclusion:NNNS at term-equivalent age can detect neurobehavioral alterations in very low birth weight infants. Individual summary scores showed significant correlation with both the MDI and PDI at 18 months CA.

Early amplitude integrated electroencephalography and outcome of very low birth weight infants

Objective:  Amplitude integrated electroencephalography (aEEG) has been used in neonates in various clinical and research applications. We hypothesized that an abnormal aEEG score could be used as a predictor of short‐term adverse outcome.

Renal function is impaired in small for gestational age premature infants

Objectives: Small for gestational age (SGA) premature infants are at increased risk for complications. We aimed to evaluate if SGA infants are at higher risk for presenting renal insufficiency in the newborn period compared to appropriate for gestational age (AGA) premature infants. Methods: We conducted a retrospective case-control study of infants ≤ 34 weeks gestation. Markers of renal function based upon the Acute Kidney Injury Network were compared between both groups. Results: Twenty SGA infants were compared to twenty AGA infants matching in sex and gestational age. SGA infants had higher serum creatinine on day of life (DOL) 1 (p = 0.014) and DOL 3 (p = 0.05) and a higher overall maximum creatinine concentration (p = 0.013). They were also more likely to have an increase in serum creatinine more than 0.3 mg/dL in a 48-h period (OR: 7.8, p = 0.008) and increase in serum creatinine more than 50% in a 48-h period (OR: 12.4, p = 0.002). Urine output (mL/kg/h) was significantly less in the SGA group on DOL 3 (p = 0.002) and DOL 7 (p = 0.017). Conclusions: SGA infants are at increased risk for renal insufficiency during the neonatal period, thereby implying the need for special considerations in their fluid and medication management.