Correlation of Plethysmograph Variability Index with Inferior Vena Cava Index in Spontaneously Breathing Neonates - A Cross Sectional Study.

Inferior vena cava (IVC) indices are commonly used to assess the need for fluid bolus during shock. It needs expertise and is difficult to do during surgical procedures. Plethysmograph variability index (PVI) is a simpler non-invasive tool used to measure fluid responsiveness in adults. However, the data on PVI in neonates is limited. This cross-sectional observational study was done at a tertiary level NICU to correlate PVI and IVC among spontaneously breathing neonates. The PVI was documented using the Masimo Radical 7 pulse oximeter. The IVC collapsibility index (IVC CI) was determined by bedside ultrasound. The Spearman correlation coefficient was analyzed. The PVI showed strong positive correlation with IVC CI (rho = 0.64, 95% CI: 0.474-0.762) (p <0.001). Thus, PVI can be a useful tool for hemodynamic monitoring of neonates. However, further studies are needed before applying it to clinical use.

Plethysmograph Variability Index Values in Healthy Neonates - An Observational Pilot Study.

OBJECTIVES: To establish normative data of plethysmograph variability index (PVI), a simple non-invasive tool to measure fluid responsiveness, in neonates. METHODS: All healthy term and late preterm neonates were enrolled. PVI was recorded by pulse-oximeter on first three days of life along with other vital parameters. Data was analysed using SPSS software. RESULTS: The median PVI value was noted to be 21 with a wide range. The distribution of PVI did not differ according to day of life/ gestational age/ gender/ weight for gestational age. It did not significantly correlate with heart rate, gestational age or birth weight. A weak positive correlation was noted between PVI and PI (Rho = 0.157, p <0.001). CONCLUSIONS: PVI normative data in neonates has been presented. Serial trend of PVI values is more useful than a single value in making clinical decisions.

Retinopathy of prematurity and neurodevelopmental outcomes in preterm infants: A systematic review and meta-analysis.

Background: Retinopathy of prematurity (ROP) and abnormal brain development share similar risk factors and mechanisms. There has been contrasting evidence on the association of ROP with adverse neurodevelopmental outcomes. Objective: We analysed the association between ROP at levels of severity and treatment with all neurodevelopmental outcomes until adolescence. Data source: We followed PRISMA guidelines and searched Medline and Embase between 1 August 1990 and 31 March 2022. Study selection and participants: Randomised or quasi-randomised clinical trials and observational studies on preterm infants (<37 weeks) with ROP [type 1 or severe ROP, type 2 or milder ROP, laser or anti-vascular endothelial growth factor (VEGF) treated] were included. Data extraction and synthesis: We included studies on ROP and any neurocognitive or neuropsychiatric outcomes. Outcomes: The primary outcomes were as follows: cognitive composite scores evaluated between the ages of 18 and 48 months by the Bayley Scales of Infant and Toddler Development (BSID) or equivalent; neurodevelopmental impairment (NDI; moderate to severe NDI or severe NDI), cerebral palsy, cognitive impairment; and neuropsychiatric or behavioural problems. The secondary outcomes were as follows: motor and language composite scores evaluated between the ages of 18 and 48 months by BSID or equivalent; motor/language impairment; and moderate/severe NDI as defined by the authors. Results: In preterm infants, "any ROP" was associated with an increased risk of cognitive impairment or intellectual disability [n = 83,506; odds ratio (OR): 2.56; 95% CI: 1.40-4.69; p = 0.002], cerebral palsy (n = 3,706; OR: 2.26; 95% CI: 1.72-2.96; p < 0.001), behavioural problems (n = 81,439; OR: 2.45; 95% CI: 1.03-5.83; p = 0.04), or NDI as defined by authors (n = 1,930; OR: 3.83; 95% CI: 1.61-9.12; p = 0.002). Type 1 or severe ROP increased the risk of cerebral palsy (OR: 2.19; 95% CI: 1.23-3.88; p = 0.07), cognitive impairment or intellectual disability (n = 5,167; OR: 3.56; 95% CI: 2.6-4.86; p < 0.001), and behavioural problems (n = 5,500; OR: 2.76; 95% CI: 2.11-3.60; p < 0.001) more than type 2 ROP at 18-24 months. Infants treated with anti-VEGF had higher odds of moderate cognitive impairment than the laser surgery group if adjusted data (gestational age, sex severe intraventricular haemorrhage, bronchopulmonary dysplasia, sepsis, surgical necrotising enterocolitis, and maternal education) were analysed [adjusted OR (aOR): 1.93; 95% CI: 1.23-3.03; p = 0.04], but not for cerebral palsy (aOR: 1.29; 95% CI: 0.65-2.56; p = 0.45). All outcomes were adjudged with a "very low" certainty of evidence. Conclusion and relevance: Infants with "any ROP" had higher risks of cognitive impairment or intellectual disability, cerebral palsy, and behavioural problems. Anti-VEGF treatment increased the risk of moderate cognitive impairment. These results support the association of ROP and anti-VEGF treatment with adverse neurodevelopmental outcomes. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42022326009.

A study comparing short-term outcome in preterm infants of ≤30 weeks gestation between a tertiary neonatal care unit in Bangalore, India and one in London, UK.

BACKGROUND: Large numbers of preterm infants are born in middle-income countries and neonatal care is improving in these countries. Few studies have compared clinical outcome in preterm infants in a tertiary neonatal unit in a middle-income country with one in a high-income country. OBJECTIVE: To compare the short-term outcome in preterm infants of ≤30 weeks gestation admitted to a tertiary neonatal unit in Bengaluru, India and in London, UK. METHODS: This was a retrospective observational study using anonymised data from electronic patient records. Preterm infants born at ≤30 weeks gestation admitted to neonatal units in Bengaluru (n = 294) and London (n = 740) over a 5-year period (January 2011 to December 2015) were compared. RESULTS: Fewer mothers in the Bengaluru centre received antenatal steroids (37% vs 73%, p < 0.001). The incidence of retinopathy of prematurity requiring treatment (12.9% vs 7.7%, NS), treated patent ductus arteriosus (32.3% vs 10.7%, NS) and blood culture-positive sepsis (32.4% vs 1.7%, p < 0.001) was higher in infants in the Indian centre. Overall survival was 83% vs 87.2% (NS) in the Bengaluru and the London cohorts, respectively. Survival of infants born at ≤28 weeks gestation was lower in Bengaluru than in London [24 weeks: 33.0% vs 79.3% (NS); 25 weeks: 50.0% vs 78.9%, p = 0.02; 26 weeks: 45.2% vs 86.5%, p < 0.01; 27 weeks: 79.3% vs 91.3% (NS); 28 weeks 82.5% vs 94.1%, p = 0.03]. CONCLUSION: The survival of infants ≤28 weeks gestation was significantly lower in the Bengaluru centre. Increasing the provision of antenatal corticosteroids may improve the outcome in these infants. ABBREVIATIONS: BPD: bronchopulmonary dysplasia; CPAP: continuous positive airway pressure; EPR: electronic patient records; HIC: high-income countries; HDU: high dependency unit; hsPDA: haemodynamically significant patent ductus arteriosus; IVH: intraventricular haemorrhage; ITU: Intensive Care Unit, IUGR: intrauterine growth restriction; LAMA: leaving against medical advice; LMIC: low- and middle-income countries; NICU: neonatal intensive care unit; NNFI: National Neonatal Forum of India; NS: not significant; NTS: neonatal transfer service; NNAP: National Neonatal Audit Programme; NHM: National Health Mission; NMR: neonatal mortality rate; NEC: necrotising enterocolitis; NS: not significant; PDA: patent ductus arteriosus; ROP: retinopathy of prematurity; SCBU: special care baby unit; VLBW: very low birthweight; WHO: World Health Organization.

Efficacious Continuous Monitoring of Infants Using Wireless Remote Monitoring Technology.

OBJECTIVE: To compare postductal heart rate and saturation (SpO2) measurements from the wireless PO device obtained by iVital+ against measurements by the standard Masimo (SET technology) monitor in the monitoring of neonates. METHODS: Pulse oximetry reading of newborns were assessed in terms of heart rate and saturations with two PO simultaneously attached to postductal site and data comparison was done. RESULTS: Out of the 1000 cumulative recordings, the mean difference between HR obtained from both PO was 0.415 and level of agreement was 2.3 beats per minute. For SpO2 mean difference between devices was 1.21 and level of agreement was 1.5%. There was very little difference between SpO2 measurements when the Masimo SpO2 was ≥ 70%. CONCLUSION: As this pulse oximeter is small, portable and accuracy is as comparable to Masimo, this provides a good solution for efficaciously monitoring neonates. It can also be used in the monitoring of children with suspected or affected with COVID-19 in hospital and ICU settings as also in the quarantine facilities. This reduces the need for constant presence of medical and nursing personnel.

Oral Paracetamol for Closure of Patent Ductus Arteriosus in Selected Preterm Neonates.

We prospectively studied the effect of oral paracetamol in closing hemodynamically significant Patent ductus arteriosus in preterm infants (gestational age <32 weeks) where Ibuprofen was contraindicated. 29 of 40 neonates (72.5%) showed successful response while 11 (29.5%) failed to show any response. No major complications were seen.

Alveolar Capillary Dysplasia as a Cause of Persistent Pulmonary Hypertension.

BACKGROUND: Persistent pulmonary hypertension (PPHN) in a term or late preterm has varied etiology. CASE CHARACTERISTICS: A late preterm neonate operated for esophageal atresia with tracheo-esophageal fistula was complicated by severe pulmonary hypertension and unable to be weaned off from respiratory support. OUTCOME: The neonate expired by 15 weeks of life; diagnosis was made on postmortem lung biopsy. MESSAGE: Alveolarcapillary dysplasia should be considered in a neonate with idiopathic refractory PPHN, if associated with anomalies.

Perinatal neuroblastoma: a hidden bullet in the chest.

A neonate with antenatally diagnosed intrathoracic mass by ultrasound scan was delivered uneventfully at 35 weeks gestation by caesarean section due to pre-eclampsia and fluctuating hypertension in the mother. The intrathoracic mass was echogenic and the diagnosis was inconclusive. At 12 h of life the baby deteriorated acutely, in terms of increased oxygen requirement, ventilatory care, heart rate fluctuation, hypotension requiring inotropic support and died despite intensive care support. The parents were counselled that an autopsy would be invaluable in providing a diagnosis given the antenatal finding of an intrathoracic mass. The final diagnosis of neuroblastoma was performed at postmortem.