Association between admission temperature and mortality and major morbidity in very low birth weight neonates - single center prospective observational study.

BACKGROUND AND OBJECTIVE: Hypothermia is a common problem especially in preterm neonates and has been associated with increased neonatal mortality and morbidities. The objective of our study was to look into the distribution of admission temperature among VLBW neonates getting admitted to the NICU, association of admission temperatures to selected neonatal morbidities/mortality, and to evaluate for modifiable factors contributing to hypothermia. METHODS: Infants with birth weight between 500 and 1499 g and gestation ≥ 25 weeks without major congenital malformations delivered between October 2017 and March 2020 who were admitted directly from the delivery room to the NICU were included in the study. Data were collected prospectively on perinatal/birth characteristics to look for their association with admission hypothermia, and to look into the association of admission temperature with selected neonatal morbidities/mortality. RESULTS: There were a total of 538 neonates with the mean birth weight of 1206 ± 271 g included in the study. Mean admission temperature was 35.8 ± 1.3 °C. Low delivery room temperature was the most important contributor to admission hypothermia. Also, 3.3% of neonates were hyperthermic at admission to NICU, all of them having been delivered to mothers with intrapartum pyrexia. On adjusted analysis, we found that low admission temperature significantly increased therisk of adverse composite neonatal outcomes with admission temperature < 34.5 °C having 42% increased risk of the adverse outcome when compared to normothermic neonates. CONCLUSION: Admission hypothermia remains a common problem in preterm neonates which is significantly associated with adverse neonatal outcome.

Comparison of delivered distending pressures in the oropharynx in preterm infant on bubble CPAP and on three different nasal interfaces.

OBJECTIVE: To compare the level of continuous positive airway pressure (CPAP) delivered by three different CPAP delivery interfaces (RAM cannula system, Hudson prongs, and nasal mask) in preterm neonates with respiratory distress. METHODS: Preterm neonates with gestation between 28 weeks and 34 weeks and birth weight more than or equal to 1000 g and requiring nasal CPAP for respiratory distress were eligible for the study. During the study period, consecutive infants requiring CPAP were started on Hudson prongs or RAM cannula or nasal mask in that order. We measured the mean oropharyngeal pressure, which approximates the applied CPAP level. Oropharyngeal pressures in the recruited neonates were measured between 24 and 48 hours of postnatal age, when stable and in sleep or quiet awake state. Comparison of the delivered oropharyngeal pressures when on three different nasal interfaces at the same set flow rate and at set CPAP of 5 cm or 6 cm of H2 O was the primary outcome. RESULTS: Data was analyzed from 30 neonates in each group. We found that measured oropharyngeal pressures were less than set CPAP level in all three studied interfaces. Maximum drop in oropharyngeal pressure was observed with use of RAM cannula with measured oropharyngeal pressures being 1.1 and 1.2 cm H2 O less than set CPAP of 5 and 6 cm H2 O respectively. Pharyngeal pressure best correlated to set CPAP level with the use of nasal mask. CONCLUSION: None of the nasal interfaces delivered oropharyngeal pressure equivalent to the set CPAP. However, nasal mask delivered oropharyngeal pressure best matched to the set CPAP.

Anti-M antibodies as a cause of intrauterine fetal death and neonatal hyperbilirubinaemia.

A preterm male infant (35 weeks), appropriate for gestational age with birth weight of 2.20 kg was born to a 28-year G2 P0 mother. The mother's blood group was A positive and the father's was B positive. Her first pregnancy was an intrauterine fetal death due to immune hydrops. The mother's blood was positive for indirect Coomb's test with 1:32 dilution and anti-M antibodies. This pregnancy was induced at 35 weeks of gestation. Investigations from the cord blood revealed A positive blood group, positive direct Coomb's test, haematocrit of 41.4%, cord reticulocyte count of 5.3% and total serum bilirubin (TSB) of 2.7 mg/dL. Phototherapy was started at 27 h of life for visible jaundice. In view of progressive pallor and a sudden rise of bilirubin, the infant was subjected to exchange transfusion on day 5 of life. The transfusion was given with O negative and anti-M antibodies negative donor blood. Total serum bilirubin (TSB) prior to exchange transfusion was 28 mg/dL and packed cell volume (PCV) was 21%. Phototherapy was continued for a total duration of 8 days.

Cat eye syndrome.

A full-term female baby, a product of non-consanguineous marriage, was born at 37 weeks of gestation with a birth weight of 2.08 kg. Antenatal scan at 31 weeks revealed complex congenital heart disease with a hypoplastic right ventricle, pulmonary atresia and an intact septum. Immediately after birth, the infant was shifted to the nursery and was started on intravenous fluids and infusion prostaglandin E1 (Alprostidil). On examination, she had microcephaly, periorbital puffiness, a long philtrum, a broad nasal bridge and retrognathia, up slanting palpebral fissures, widely spaced nipples, a sacral dimple and right upper limb postaxial polydactyly. Postnatal echocardiography confirmed a large ostium secundum atrial septal defect with left to right shunt, right ventricle hypoplasia, pulmonary atresia with an intact septum and a large vertical patent ductus arteriosus. Ophthalmological examination showed a bilateral chorioretinal coloboma sparing disc and fovea. Karyotyping showed an extra small marker chromosome suggestive of the Cat eye syndrome.