Pracha Nuntnarumit

Vertical Dengue Infection Case Reports and Review

Two vertical dengue infection cases are presented, and 15 others are reviewed. Twelve mothers had fever 0–9 (median, 2) days antepartum. The fevers of 17 neonates occurred at 1–11 (median, 4) days of life and lasted for 1–5 (median, 3) days. Neonatal thrombocytopenia was detected at 1–11 (median, 6) days of life and lasted for 3–18 (median, 6) days; the lowest platelet counts were 5–75 × 103 (median, 19 × 103)/mm3. One neonate died.

A Randomized Controlled Trial of 1% Aqueous Chlorhexidine Gluconate Compared with 10% Povidone-Iodine for Topical Antiseptic in Neonates: Effects on Blood Culture Contamination Rates

We conducted a randomized controlled trial in neonates with birth weight greater than or equal to 1,500 g that compared 1% aqueous chlorhexidine gluconate (CHG) with 10% povidone-iodine (PI) as a topical antiseptic. We found 1% CHG to be more effective than 1% PI in reducing blood culture contamination rates, and no contact dermatitis was observed.

N-terminal probrain natriuretic peptide and patent ductus arteriosus in preterm infants

Objective:To determine whether plasma N-terminal probrain natriuretic peptide (NT-proBNP) in premature infants could identify hemodynamically significant patent ductus arteriosus (HsPDA) and to determine the correlation between serial plasma NT-proBNP and echocardiographic assessment of ductal shunting.Study Design:An observational study involving 35 preterm infants who underwent echocardiographic assessment for PDA on day 2, 4 and 7 of life with simultaneous blood sampling for determination of NT-proBNP concentrations. HsPDA was diagnosed by left-to-right ductal shunt on color Doppler, measuring diameter >1.5 mm on two-dimensional echocardiography plus ⩾2 clinical features of PDA.Result:Plasma NT-proNBP levels on day 2 in the HsPDA group (n=12) were significantly higher than in non-HsPDA group (n=23) with a median of 16 353 pg ml−1 (interquartile range (IQR), 12 360–33 459; range, 10 316–104 998) vs 3914 pg ml−1 (IQR, 2601–5782; range, 1535–19 516) (P<0.001), respectively. Eight infants (67%) in the HsPDA group responded to an initial course of indomethacin or ibuprofen and their NT-proBNP levels significantly decreased within 48 h after treatment compared with non-responders (P=0.007). NT-proBNP concentrations were significantly correlated with left atrial to aortic root ratio. A cut-off NT-proBNP on day 2 of 10 180 pg ml−1 offered the best predictive values for HsPDA with a sensitivity of 100% and a specificity of 91%.Conclusion:Plasma NT-proBNP on day 2 was found as a sensitive marker for predicting HsPDA in preterm infants. Successful closure of PDA was also correspondent with the decline in plasma NT-proBNP.

Neonatal Tuberculosis Associated With Shock, Disseminated Intravascular Coagulation, Hemophagocytic Syndrome, and Hypercalcemia: A Case Report

We report on a female infant with disseminated tuberculosis who presented with clinical sepsis and disseminated intravascular coagulation starting at 14 days of age. Parenteral ofloxacin combined with streptomycin were used because the enteral route was not possible and intravenous isoniazid and rifampicin were not available. Rare complications including infection-associated hemophagocytic syndrome, hypercalcemia, and adrenal insufficiency were detected and successfully managed.

Perfusion Index as a Diagnostic Tool for Patent Ductus Arteriosus in Preterm Infants

Background: Perfusion index (PI) could reflect peripheral flow. Preterm infants with hemodynamically significant patent ductus arteriosus (hsPDA) will have left-to-right shunt across PDA causing less blood flow to the lower legs. Objective: To evaluate pre- and postductal PI differences (ΔPI) in hsPDA. Methods: Preterm infants with gestational age <34 weeks were assessed for ΔPI on days 1, 3, and 7 of life with simultaneous echocardiography. Based on echocardiography, each infant was categorized into hsPDA, non-hsPDA, and no PDA. Results: Thirty infants (16 males), median age 31 weeks (interquartile range, IQR, 29-32) and weight 1,490 g (IQR 1,100-1,670) were enrolled. On days 1 and 3 of life, the ΔPI of infants with hsPDA (1.57%, IQR 0.28-2.32, n = 14, and 1.32%, IQR 0.28-1.83, n = 10) were significantly higher than those without hsPDA (0.14%, IQR -0.03 to 0.30, n = 16, and 0.08%, IQR -0.07 to 0.26, n = 20), p = 0.009 and 0.005, respectively. At all time points (days 1, 3, and 7 of life, n = 84), ΔPI >1.05% had sensitivity, specificity, positive predictive value, and negative predictive value of 66.7, 100, 100, and 86.4%, respectively, to detect hsPDA. Conclusion: The pre- and postductal PI differences were significantly related to the hemodynamic changes of PDA and might be useful to detect hemodynamically significant PDA.

N-terminal-pro-brain natriuretic peptide: a guide for early targeted indomethacin therapy for patent ductus arteriosus in preterm Infants

Aim:  To determine whether N‐terminal‐pro‐brain natriuretic peptide (NT‐proBNP) level could be an effective guide for early targeted indomethacin therapy for patent ductus arteriosus (PDA) in preterm infants.

Clinical performance of the new glucometer in the nursery and neonatal intensive care unit

Background:  Performance of point‐of‐care (POC) glucometers in newborns have been unsatisfactory in low glucose concentration range and the effects of different hematocrit levels on glucose measurements have also demonstrated in currently used POC glucometers.

Heated Humidified High-Flow Nasal Cannula for Weaning from Continuous Positive Airway Pressure in Preterm Infants: A Randomized Controlled Trial

Background: Heated humidified high-flow nasal cannula (HHHFNC) therapy has been widely used in preterm infants. However, evidence to support its use as a continuous positive airway pressure (CPAP) weaning method is still controversial. Objectives: We aimed to compare time to wean directly off CPAP vs. weaning by using HHHFNC. Methods: Infants with a gestational age (GA) of <32 weeks who met the predefined criteria for weaning off CPAP, i.e. with a CPAP of ≤6 cm H2O and a fraction of inspired oxygen (FiO2) of ≤0.3 for at least 24 h, were randomly assigned to wean by using HHHFNC or wean directly from CPAP. In the HHHFNC group, flow rate was reduced by 1 liter/min every 24 h to 2-3 liters/min depending on body weight (i.e. < or ≥1,000 g), and then HHHFNC was discontinued. In the CPAP group, pressure was reduced by 1 cm H2O every 24 h until stable on CPAP 4 cm H2O and then discontinued. The primary outcome was the time it took to wean off the use of the CPAP or HHHFNC devices. Results: One-hundred and one infants were enrolled, 51 in the HHHFNC and 50 in the CPAP group. Both groups had similar demographics and respiratory conditions before enrollment. There was no difference in time to successfully wean between the 2 groups [median (IQR): 11 (4-21) days in the HHHFNC group vs. 11 (4-29) days in the CPAP group; p = 0.12]. There were no differences in morbidities or related complications. Infants in the HHHFNC group had significantly less nasal trauma (20 vs. 42%; p = 0.01). Conclusions: In our study, the time to wean off CPAP using HHHFNC was not different from when weaning directly from CPAP.

Randomised controlled trial of sustained lung inflation for resuscitation of preterm infants in the delivery room

AIM To compare the effects of sustained lung inflation (SLI) vs. standard resuscitation on physiologic responses of preterm infants during resuscitation. METHODS Preterm infants (25-32 weeks gestational age) requiring positive-pressure ventilation or continuous positive airway pressure were randomly assigned to either the SLI group (SLI at 25cmH2O for 15s) or Non-SLI group (standard resuscitation alone). The heart rate (HR), oxygen saturation (SpO2), oxygen requirement, and intubation rate in the delivery room were evaluated. RESULTS Eighty-one infants were enrolled (SLI group, 43; Non-SLI group, 38). The use of SLI effectively reduced the oxygen requirement. The mean fraction of inspired oxygen 10min after birth was 0.28 (95% CI, 0.26-0.30) in the SLI group and 0.47 (95% CI, 0.43-0.52) in the Non-SLI group (p<0.001). During the first 5min, infants in the SLI group trended towards a higher HR and SpO2 than those in the Non-SLI group. The intubation rate in the delivery room was not different between the two groups; however, among infants ≤28 weeks gestational age, the intubation rate was lower in the SLI than Non-SLI group (5 of 17 [29%] vs. 10 of 16 [63%], respectively; p=0.05). The duration of respiratory support, survival without bronchopulmonary dysplasia, and the occurrence of pneumothorax were not different between the groups. CONCLUSION SLI in infants who require respiratory support appears to be effective in facilitating postnatal transition as determined by HR and SpO2 responses, resulting in less oxygen supplementation. Further studies are needed to confirm the benefits of SLI.

Incidences, risk factors and outcomes of neonatal thromboembolism

Abstract Background: The incidences of thromboembolism (TE) in neonates were reported to be around 0.51 per 10,000 live births per year for overall TE and 24 per 10,000 NICU admissions per year. As the incidences of TE in children and adults are lower in Asian populations, the incidences, risk factors, and outcomes of neonatal TE may be different to those reports from other countries. Objectives: To determine the incidences, risk factors, and outcomes of neonatal TE in a tertiary care hospital in Thailand. Materials and methods: A retrospective study between the years 1998 and 2015. Results: From a total of 2463 neonatal admissions, 28 patients were diagnosed with TE. The female/male ratio was 1:1.2. The breakdown of diagnoses of neonatal TE were arterial ischemic stroke (AIS; 36%), arterial TE (ATE; 29%), deep vein thrombosis (DVT; 14%), cerebral venous sinus thrombosis (CVST; 11%), renal vein thrombosis (RVT; 3%), and purpura fulminans (2%). Underlying diseases were identified 57.1% of patients. The most common thrombophilic risk factor was protein C (PC) deficiency (14.3%). The overall mortality rate was 14.3%. Conclusion: The most common TE was AIS. PC deficiency was the most prevalent inherited risk factor, especially in neonates without precipitating factors.