Young infants with bronchiolitis at low risk of respiratory deterioration in an urban, academic emergency department: prospective cohort study protocol.

Introduction: Bronchiolitis, a viral lower respiratory tract infection, is the leading cause of hospitalisation for infants, with healthcare utilisation highest among young infants (aged ≤90 days). Clinical models to predict respiratory deterioration in infants with bronchiolitis have been developed for a broad age group that includes children up to 2 years old, not focusing specifically on young infants. These models have also been limited by exclusion of viral aetiology and by use of vital signs measured at a single time point during clinical evaluation, overlooking the variable and dynamic course of bronchiolitis.

Neighborhood deprivation and association with 18-month neurodevelopmental impairment of preterm infants born in a dense urban setting.

Background: Neighborhood adversity's impact on 18-month neurodevelopmental impairment (NDI) is not well-described. The aim of our study was to determine whether area deprivation index (ADI), a measure of neighborhood socioeconomic disadvantage, at birth is associated with 18-month NDI of preterm infants born in dense urban setting.

Methods: A retrospective case-cohort study was performed in infants born at 23-32 weeks gestational age (GA) with birth weight (BW) ≤1250 g between 2013 and 2017 and evaluated for NDI at 18-month corrected age (CA).

Differences Between Preterm and Full-Term Infants in Electroencephalogram Power Spectral Density Slope.

A growing body of literature suggests that power spectral density (PSD) slope, measured using electroencephalography (EEG), might reflect synaptic activity and be a useful marker of early brain development. The objective of this article is to identify differences between preterm and full-term infants in PSD slope in active and quiet sleep. This is a secondary analysis of two studies, including premature (N = 33) (30 0/7 and 36 0/7 weeks' gestation) and full-term infants (N = 22).

Safety and Tolerability of Continuous Inhaled Iloprost Therapy for Severe Pulmonary Hypertension in Neonates and Infants.

This is a single-center retrospective study to assess the safety and tolerability of continuous inhaled iloprost use as rescue therapy for refractory pulmonary hypertension (PH) in critically ill neonates and infants. A retrospective chart review was performed on 58 infants and data were collected at baseline, 1, 6, 12, 24, 48 and 72 h of iloprost initiation. Primary outcomes were change in heart rate (HR), fraction of inspired oxygen (FiO), mean airway pressures (MAP), blood pressure (BP) and oxygenation index (OI).

Impact of active surveillance and decolonization strategies for methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit.

Objective: To assess the impact of active surveillance and decolonization strategies on methicillin-resistant Staphylococcus aureus (MRSA) infection rates in a NICU.

Study Design: MRSA infection rates were compared before (2014-2016) and during (2017-2022) an active surveillance program. Eligible infants were decolonized with chlorohexidine gluconate (CHG) bathing and/or topical mupirocin.

Association between intermittent hypoxemia and neurodevelopmental outcomes in extremely premature infants: A single-center experience.

Objective: To describe the association between intermittent hypoxemic events (IHEs) and severe neurodevelopmental impairment (SNDI) or death in extremely premature infants.

Study Design: Retrospective study of extremely premature infants 23-27 weeks gestational age (GA) and birthweight (BW) ≤1250 grams (g) admitted to a level IV neonatal intensive care unit (NICU) from 2013 to 2017. IHEs, defined as events with SpO ≤ 80 % lasting 10 s to 5 min, were algorithmically identified using data extracted from bedside monitors at 2 s intervals (0.

Prevalence and Clinical Significance of Commonly Diagnosed Genetic Disorders in Preterm Infants.

Background And Objectives: Preterm infants (<34 weeks' gestation) experience high rates of morbidity and mortality before hospital discharge. Genetic disorders substantially contribute to morbidity and mortality in related populations. The prevalence and clinical impact of genetic disorders is unknown in this population.

The Contribution of Commonly Diagnosed Genetic Disorders to Small for Gestational Age Birth and Subsequent Morbidity and Mortality in Preterm Infants.

Objective: Preterm infants born small, vs. appropriate for gestational age (SGA, AGA) are at greater risk for morbidity and mortality. The contribution of genetic disorders to preterm SGA birth, morbidity, and mortality is unknown.

Neighborhood Deprivation and Association With Neonatal Intensive Care Unit Mortality and Morbidity for Extremely Premature Infants.

Importance: Socioeconomic status affects pregnancy and neurodevelopment, but its association with hospital outcomes among premature infants is unknown. The Area Deprivation Index (ADI) is a validated measure of neighborhood disadvantage that uses US Census Bureau data on income, educational level, employment, and housing quality.

Objective: To determine whether ADI is associated with neonatal intensive care unit (NICU) mortality and morbidity in extremely premature infants.

A physiological approach to applying CPAP in the preterm infant.

Nasal continuous positive airway pressure (CPAP) is increasingly used for respiratory support in preterm infants with respiratory distress syndrome at birth and after extubation from mechanical ventilation. Controversies with CPAP use still exists due to non-uniformity of devices and interfaces used, equivalence of testing conditions for different CPAP systems, differences in study designs, and short study periods that may be insufficient to detect important and relevant clinical outcomes. Compared with ventilator-derived constant-pressure flow-opposition CPAP, variable fluidic flow-opposition CPAP systems may be advantageous and offer some clinical benefits.

Cardiorespiratory signature of neonatal sepsis: development and validation of prediction models in 3 NICUs.

Background: Heart rate characteristics aid early detection of late-onset sepsis (LOS), but respiratory data contain additional signatures of illness due to infection. Predictive models using cardiorespiratory data may improve early sepsis detection. We hypothesized that heart rate (HR) and oxygenation (SpO) data contain signatures that improve sepsis risk prediction over HR or demographics alone.

Noninvasive Monitoring to Demonstrate Postoperative Differences in Regional Hemodynamics in Newborn Infants With d-Transposition of the Great Arteries and Hypoplastic Left Heart Syndrome.

Background: The adequacy of tissue O delivery in infants receiving intensive care is difficult to measure directly. Regional O (rSO) and fractional tissue O extraction (FTOE), the ratio of O consumption to O delivery, obtained from newer noninvasive tools, such as near-infrared spectroscopy (INVOS) and microvascular tissue oximetry (T-Stat) can provide important information on the adequacy of tissue oxygenation and aid in managing critically ill infants.

Methods: We prospectively evaluated differences in rSO and FTOE in 26 infants with hypoplastic left heart syndrome (HLHS) (n = 12) or d-transposition of the great arteries (d-TGA) (n = 14).

The Prevalence and Clinical Significance of Congenital Anomalies of the Kidney and Urinary Tract in Preterm Infants.

Importance: The prevalence and importance of congenital anomalies of the kidney and urinary tract (CAKUT) in preterm infants is unknown.

Objective: To determine the prevalence of CAKUT in preterm infants and association with in-hospital morbidity and mortality.

Design, Setting, And Participants: This cohort study included infants cared for in neonatal intensive care units managed by a large US network of hospitals and doctors.

High-Frequency Positive Pressure Ventilation as Primary Rescue Strategy for Patients with Congenital Diaphragmatic Hernia: A Comparison to High-Frequency Oscillatory Ventilation.

Objective: The aim of this article was to evaluate high-frequency positive pressure ventilation (HFPPV) compared with high-frequency oscillatory ventilation (HFOV) as a rescue ventilation strategy for patients with congenital diaphragmatic hernia (CDH). HFPPV is a pressure-controlled conventional ventilation method utilizing high respiratory rate and low positive end-expiratory pressure.

Study Design: Seventy-seven patients diagnosed with CDH from January 2005 to September 2019 who were treated with stepwise progression from HFPPV to HFOV versus only HFOV were included.

Antibiotic spectrum index: A new tool comparing antibiotic use in three NICUs.

Background: Antibiotics are widely used in very low-birth-weight infants (VLBW, <1500 g), and excess exposure, particularly to broad-spectrum antibiotics, is associated with significant morbidity. An antibiotic spectrum index (ASI) quantifies antibiotic exposure by relative antimicrobial activity, adding information to exposure measured by days of therapy (DOT). We compared ASI and DOT across multiple centers to evaluate differences in antibiotic exposures.

Ocular Blood Flow in Preterm Neonates: A Preliminary Report.

Purpose: Retinopathy of prematurity (ROP) is a vision-threatening complication occurring in pre-term neonates. The standard of care entails regular monitoring by dilated ophthalmoscopy examinations, which entail stress and potential morbidity. In this pilot study, we used plane-wave ultrasound (PWUS) to image, measure, and assess the association of blood-flow velocities in the retrobulbar vessels with ROP stages ranging from stage 0 (immature vessels without ROP) to stage 3.

Vital sign metrics of VLBW infants in three NICUs: implications for predictive algorithms.

Background: Continuous heart rate (HR) and oxygenation (SpO) metrics can be useful for predicting adverse events in very low birth weight (VLBW) infants. To optimize the utility of these tools, inter-site variability must be taken into account.

Methods: For VLBW infants at three neonatal intensive care units (NICUs), we analyzed the mean, standard deviation, skewness, kurtosis, and cross-correlation of electrocardiogram HR, pulse oximeter pulse rate, and SpO.

Revisiting the definition of bronchopulmonary dysplasia in premature infants at a single center quaternary neonatal intensive care unit.

Objective: To compare the incidence of bronchopulmonary dysplasia (BPD) based on the 1988 Vermont Oxford Network (VON) criteria, National Institutes of Health (NIH) 2001 definition, and NIH 2018 definition.

Methods: BPD incidence by each definition was compared in premature infants born at a single center between 2016 and 2018. Comorbidities were compared between those with and without BPD according to the newest definition.

Infection prevention and control for labor and delivery, well baby nurseries, and neonatal intensive care units.

During the early months of the COVID-19 pandemic, infection prevention and control (IP&C) for women in labor and mothers and newborns during delivery and receiving post-partum care was quite challenging for staff, patients, and support persons due to a relative lack of evidence-based practices, high rates of community transmission, and shortages of personal protective equipment (PPE). We present our IP&C policies and procedures for the obstetrical population developed from mid-March to mid-May 2020 when New York City served as the epicenter of the pandemic in the U.S.

Comparing liver and lower abdomen near-infrared spectroscopy in preterm infants.

Background: Near-infrared spectroscopy (NIRS) is being increasingly used to investigate regional oxygenation (rSO) and perfusion in areas such as the abdomen in preterm infants prone to feeding intolerance. Lower abdominal rSO values are extremely variable, high sensitivity and currently low specificity tools. The liver, a solid organ, could provide a more reliable site for splanchnic oxygenation and perfusion monitoring.

Care of the COVID-19 exposed complex newborn infant.

As we confront COVID-19, the global public health emergency of our times, new knowledge is emerging that, combined with information from prior epidemics, can provide insights on how to manage this threat in specific patient populations. Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS), both caused by coronaviruses, caused serious respiratory illness in pregnant women that resulted in adverse perinatal outcomes. Thus far, COVID-19 appears to follow a mild course in the vast majority of pregnant women.