Lung Ultrasound Role in Diagnosis of Neonatal Respiratory Disorders: A Prospective Cross-Sectional Study.

Lung ultrasound (LUS) has become one of the most exciting applications in neonatal point-of-care ultrasound (POCUS), yet still lacks routine clinical use. This study assesses the utility of LUS for neonatal respiratory disorders (NRDs) diagnosis and follow-up compared to chest X-ray (CXR). A prospective cross-sectional study was conducted on 100 neonates having NRDs with a gestational age ≥28 weeks, excluding those having multiple congenital anomalies, chromosomal aberrations, hydrops fetalis and/or heart failure. CXR and LUS were done on admission for diagnosis and were repeated after 7 days, or if needed earlier within the 7 days. The diagnosis of NRDs by CXR and LUS on admission and after 7 days was comparable (p > 0.05). LUS diagnosis sensitivity and specificity for respiratory distress syndrome, pneumonia, meconium aspiration syndrome, pneumothorax and pulmonary atelectasis were 94.7/100%, 97.5/95%, 92.3/100%, 90.9/98.9% and 100/97.8%, respectively. The total agreement between LUS and CXR was 98.5% with 95% CI (0.88 to 0.92). LUS and CXR had considerable agreement in the diagnosis of NRDs. Being a reliable bedside modality of diagnosis and safer than CXR, LUS may be considered an alternative method for the diagnosis of neonates with NRDs.

Cerebral blood flow and serum neuron-specific enolase in early-onset neonatal sepsis.

BACKGROUND AND OBJECTIVES: Sepsis leads to systemic inflammatory response with cerebral blood flow (CBF) alteration and blood-brain barrier disruption that contribute to sepsis-associated encephalopathy (SAE). We aimed to evaluate cord blood neuron-specific enolase (cNSE) and CBF in early-onset neonatal sepsis (EONS) as predictors of SAE and to define short-term neurodevelopmental outcomes among survivors. METHODS: cNSE was measured in 200 neonates with antenatal risk factors for EONS, stratified into two groups: sepsis (n = 96) and no-sepsis (n = 104). Trans-cranial Doppler of peak systolic velocities (PSV), end diastolic velocities (EDV) and resistive indices (RI) of anterior (ACA) and middle (MCA) cerebral arteries recorded on day 1 postnatal. Griffiths mental developmental scale (GMDS) was assessed at 6 months. RESULTS: Increased cNSE, PSV, EDV, and decreased RI of both ACA and MCA were found in sepsis group compared to no-sepsis group (p < 0.001 for all). Patients with SAE (n = 34) had higher NSE, PSV, and EDV as well as lower RI of ACA and MCA compared to those without (p < 0.01 for all). SAE neonates had lower GMDS than those without. ACA RI of ≤0.61 was the best predictor of SAE. CONCLUSION: High CBF and cNSE could be useful markers for prediction of SAE. SAE impairs neurodevelopmental scales at 6 months.

Circulating Levels of Vascular Endothelial Growth Factor and Basic Fibroblastic Growth Factor in Infantile Hemangioma Versus Vascular Malformations.

Few preliminary reports studied the utility of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) for differentiation between infantile hemangiomas (IHs) and vascular malformations. The aim of this study was to investigate the role of serum VEGF and bFGF levels in differentiating IHs from vascular malformations and identifying the stage and clinical course of IHs. Serum levels of VEGF and bFGF were assessed in 60 infants and children with various cutaneous vascular anomalies defined in 3 groups: proliferating IHs (n = 25), involuting IHs (n = 23), and vascular malformations (n = 12), in comparison with their levels in 40 healthy matched control. Serum levels of VEGF and bFGF were significantly elevated in all groups as compared to control ( P < .001, respectively). Both proliferating and involuting IHs had comparable levels of both markers ( P > .05, respectively) that were significantly higher in comparison with vascular malformations ( P < .05, respectively). Significantly lower VEGF levels were found in IHs that had regressed spontaneously (n = 11) compared to those regressed by treatment (n = 37), ( P < .05); meanwhile, bFGF showed no significant difference between both groups ( P > .05). Using receiver operating characteristic curves, a combined use of VGEF and bFGF yielded a sensitivity of 85.42% and a specificity of 100% for differentiating IHs from vascular malformations. Serum VEGF and/or bFGF levels are increased in cutaneous vascular anomalies and can differentiate IHs from vascular malformations. None of these markers could help in identifying the stage of IHs. Low VEGF is associated with spontaneous regression of IHs.

Neonatal nursery noise: practice-based learning and improvement.

OBJECTIVES: To study the impact of interrupted loud noise in Neonatal Intensive Care Unit (NICU) on neonatal physiologic parameters, and apply methods to alleviate noise sources through teaching NICU's staff. METHODS: Noise level measured at different day times and during different noisy events in the NICU. Changes in the heart rate, respiratory rate and oxygen saturation were recorded just before and immediately after providing noisy events for 36 preterm and 26 full-term neonates. Focused training, guided by sound-level-meter, was provided to the NICU's staff to minimize noise. RESULTS: The highest mean baseline noise level, 60.5 decibel (dB), was recorded in the NICU critical care area at 12:00 am. The lowest level, 55.2 dB was recorded at 10:00 pm. Noise level inside the incubators was significantly lower than outside, p < 0.001. Noisy events resulted in a significant increase in heart and respiratory rates in preterm neonates as compared to full-terms, p < 0.05. CONCLUSION: Noise in our NICU exceeded the international permissible levels. Noisy events are numerous, which altered the neonates' physiologic stability especially preterm infants. Staff education is mandatory in ameliorating noise pollution with its deleterious effects on neonatal physiologic homeostasis.