Maheshwari A, Singh R, Motta M. Coordinated Multispecialty Care: A Need for Critically Ill Newborn Infants. Newborn 2022; 1 (3):iv-v. DOI: 10.5005/newborn-1-3-iv.

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Chaudhary N, Jassar R, Singh R. Neonatal Anemia. Newborn 2022; 1 (3):263-270. DOI: 10.5005/jp-journals-11002-0027.

 

Abstract: Neonatal anemia is a public health problem of global concern and has significant associations with many short- and long-term morbidities. Many etiological factors ranging from perinatal physiologic transition, hematological maturation, illnesses, and iatrogenic reasons such as the phlebotomies necessary for laboratory evaluation may be involved, and there is a need for careful clinical decisions. In premature infants, the management of anemia also has to factor in the unique hematological transition seen during development, co-morbidities associated with preterm birth, the severity of illness severity, and all the iatrogenic factors. Untreated severe anemia is known to negatively impact long-term growth and neurodevelopment outcomes, making early diagnosis and treatment imperative. Additionally, there is a lack of consensus about the threshold and timing of packed red blood cell transfusions, and we need further consideration in view of various associated complications. Therefore, clinicians need to focus on preventable causes of anemia such as nutritional deficiencies, chronic illness, and excessive phlebotomy losses. In this article, we attempt to summarize the pathophysiology, etiologies, clinical management, and the opportunities in research in the field of neonatal anemia.

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Key scientific associations: public health problem, perinatal physiologic transition, hematological maturation, phlebotomy, preterm, premature, transfusion, nutritional deficiency, gestational age, chronological age, socioeconomic, iron deficiency, malnutrition, infections, World Health Organization, hemoglobin, trimester, low birth weights, adolescent, developing countries, iron dose, fetal hypoxia, placental insufficiency, iron stores, diabetic mothers, abruption, uterine rupture, feto-maternal hemorrhage, cord accidents, microcytic hypochromic, normocytic, normochromic, macrocytic, fetal hemoglobin, hereditary hemolytic, hematopoietic, phlebotomy, Need of Transfusion Trial (PINT), ETTNO trial, TOP trial, intestinal macrophages, cognition, acute kidney injury, AWAKEN (Assessment of Worldwide AKI Epidemiology in Neonates) database, hemoglobin, hematocrit, red blood cell count, mean corpuscular volume, mean corpuscular hemoglobin concentration, mean cell hemoglobin, RBC distribution width, RBC morphology, anisocytosis with spherocytes and other sickle cells, hereditary ovalocytes/elliptocytes, stomatocytes, echinocytes, acanthocytes, tear drops, dacryocytes, target cells, codocytes, iron supplementation, subgaleal, graft vs. host disease, transfusion related acute lung injury (TRALI), transfusion associated circulatory overload (TACO), Transfusion associated gut injury (TRAGI), National Heart, Lung and Brain Institute, WHEAT (WithHolding Enteral feeds Around packed red cell Transfusion) trial, Erythropoietin (EPO), darbopoetin, Cochrane Review, soluble transferrin receptor/ferritin index, hepcidin, Near-Infrared Spectroscopy.

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Tyagi M, Maheshwari A, Guaragni B, Motta M. Use of Fresh-frozen Plasma in Newborn Infants. Newborn 2022; 1 (3):271-277. DOI: 10.5005/jp-journals-11002-0039. Available in PubMed.

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Abstract: Nearly 10% of premature and critically ill infants receive fresh-frozen plasma (FFP) transfusions to reduce their high risk of bleeding. The authors have only limited data to identify relevant clinical predictors of bleeding and to evaluate the efficacy of FFP administration. There is still no consensus on the optimal use of FFP in infants who have abnormal coagulation parameters but are not having active bleeding. The aims of this review are to present current evidence derived from clinical studies focused on the use of FFP in neonatology and then use these data to propose best practice recommendations for the safety of neonates receiving FFP.

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Key scientific associations: preterm, whole-blood donor units, FFP, plasmapheresis, hemorrhages, premature, neonate, relative risk, coagulation tests, coagulopathy, disseminated intravascular coagulopathy, pro-coagulation factors, anticoagulants, tissue plasminogen activator inhibitor, clotting times, hemorrhagic complications, predictors of bleeding, prothrombin time, activated plasma thromboplastin time, whole-blood donor units, plasmapheresis, semi-permeable membranes, leukodepleted, non-hemolytic febrile reaction, alloimmunization, cytomegalovirus, fibrinogen, proteins C, protein S, antithrombin, factor VIII, von Willebrand factor, volume expanders, ABO-compatible, hepatitis A, parvovirus, methylene blue, phenothiazine, virucidal, prothrombin complex concentrates, hypothermia, necrotizing enterocolitis, vitamin K-dependent coagulation factors, hemorrhagic disease of the newborn, Classical HDN, Late HDN, gamma-carboxylation, vitamin K-dependent proteins, hyperfibrinolysis, microhemorrhages, Partial exchange transfusion; Network for the Advancement of Patient Blood Management, Hemostasis and Thrombosis.

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Singh S, Sharma A, Rahman MM, Kasniya G, Maheshwari A, Boppana SB. Congenital and Perinatal Varicella Infections. Newborn 2022; 1 (3):278-286. DOI: 10.5005/jp-journals-11002-0040. Available in Pubmed.

 

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Abstract: Varicella–zoster virus (VZV) is a human pathogen of the α-herpesvirus family. Some fetuses infected in utero around 8–20 weeks of pregnancy show signs of congenital varicella syndrome (CVS). Infants born to mothers who develop varicella within 5 days before and 2 days after delivery can experience severe disease with increased mortality. The best diagnostic modality is polymerase chain reaction (PCR), which can be done using vesicular swabs or scrapings, scabs from crusted lesions, tissue from biopsy samples, and cerebrospinal fluid. The prevention and management of varicella infections include vaccination, anti-VZV immunoglobulin, and specific antiviral drugs. In this article, we have reviewed the characteristics of VZV, clinical manifestations, management of perinatal infections, and short- and long-term prognosis.

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Key scientific associations: Varicella-zoster virus, chickenpox, icosahedral, capsid, envelope, congenital varicella syndrome, neonatal varicella, VZIG, Acyclovir, IVIG, Herpes zoster, vesicular rash, cicatrix, post exposure prophylaxis, limb abnormalities, vaccine, PCR, isolation, retrograde viral transport, open reading frame, ORF22, ORF21, ORF50, mosaic virus strain, transactivator gene, immediate-early protein 62, nucleocapsid core, ORF20, ORF23, ORF33, ORF38, ORF40, ORF41, ORF54, alpha-herpesvirus, intrauterine growth restriction, cicatricial, dermatome, cataracts, chorioretinitis, Horner syndrome, microphthalmos, nystagmus, localized bone hypoplasia, localized muscular hypoplasia, type I interferon, microphthalmia, anisocoria, hydroureter, acyclovir, valacyclovir, dermatome.

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Arif RH, Mahmoud LB, Ali AB, Abdelrahim A, Ilham OH, Wahid FN, Rahman MM, Panigrahy N, Panwar D, Kasniya G, Jha K, Maheshwari A. Gastroschisis: Anatomic Defects, Etiopathogenesis, Treatment, and Prognosis. Newborn 2022; 1 (3):287-296. DOI: 10.5005/jp-journals-11002-0041.

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Abstract: Gastroschisis is a congenital defect in the abdominal wall that is typically located to the right of the umbilicus. The intestines, and sometimes parts of the liver and the stomach, also protrude into the amniotic space. Unlike in omphaloceles, these visceral organs do not have a covering sac and are directly exposed to the amniotic fluid. The organs show variable degrees of inflammatory changes and scarring. In this review, we have summarized currently available information on the anatomical changes in the intestine directly exposed to the amniotic fluid, the etiopathogenesis, treatment, and prognosis.

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Key scientific associations: Congenital, abdominal wall defect, amniotic space, amniotic fluid, inflammation, laproschisis, neuromuscular, cardiac, pulmonary, renal, urological abnormalities, intestinal atresia, stenosis, perforation, volvulus, necrosis, dysmotility, neonatal intensive care unit, atresia, short bowel syndrome, illicit drugs, alcohol, body mass index, chronic hypertension, high educational attainment, non-Hispanic, embryonic somatopleural mesenchyme, gut herniation, mesenchyme, dorsolateral aortic branches, body folds, vitelline structures, umbilical ring, gut evisceration, teratogens.

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Singh S, Mane SS, Kasniya G, Cartaya S, Rahman MM, Maheshwari A, Motta M, Dudeja P. Enteroviral Infections in Infants. Newborn 2022; 1 (3):297-305. DOI: 10.5005/jp-journals-11002-0036. Available in Pubmed.

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Abstract: Enteroviruses (EVs) are major pathogens in young infants. These viruses were traditionally classified into the following four subgenera: polio, coxsackie A and B, and echoviruses. Now that poliomyelitis seems to be controlled in most parts of the world, coxsackie and echoviruses are gaining more attention because (i) the structural and pathophysiological similarities and (ii) the consequent possibilities in translational medicine. Enteroviruses are transmitted mainly by oral and fecal–oral routes; the clinical manifestations include a viral prodrome including fever, feeding intolerance, and lethargy, which may be followed by exanthema; aseptic meningitis and encephalitis; pleurodynia; myopericarditis; and multi-system organ failure. Laboratory diagnosis is largely based on reverse transcriptase–polymerase chain reaction, cell culture, and serology. Prevention and treatment can be achieved using vaccination, and administration of immunoglobulins and antiviral drugs. In this article, we have reviewed the properties of these viruses, their clinical manifestations, and currently available methods of detection, treatment, and prognosis.

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Key scientific associations: Preterm, premature, newborn, neonate, enteroviruses, Coxsackie virus, RNA, Picornavirus, VP1 capsid protein, exanthema, aseptic meningitis, encephalitis, pleurodynia, myocarditis, myopericarditis, RT PCR, cell culture and serology, vaccination, immunoglobulins, antiviral drugs, Pocapavir, pleconaril, hand washing, herpangina, Hand, foot, and mouth disease, coxsackievirus-adenovirus receptor (CAR), decay-accelerating factor (DAF), Acute haemorrhagic conjunctivitis, RNA genome, enterovirus A71 vaccines.

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Perez K, Valentine GC, Nangia S, Burrin DG, Maheshwari A, Abayneh M, Workneh R, Jerome M, Dinerstein NA, Salas A. Advancement of Enteral Feeding in Very-low-birth-weight Infants: Global Issues and Challenges. Newborn 2022; 1 (3):306-313. DOI: 10.5005/jp-journals-11002-0038.

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Abstract: In very-low-birth-weight (VLBW) infants, the initiation of enteral feedings is frequently delayed and the feeding volumes are advanced very slowly. Clinicians often express concerns about gut immaturity and consequent increased risk of feeding intolerance, spontaneous intestinal perforation (SIP), and necrotizing enterocolitis (NEC). Late initiation and ultra-cautious advancement of enteral feedings are seen all over the world, despite known associations with a prolonged need for central venous access and increased risk of sepsis, which is one of the leading causes of neonatal mortality. Promoting early establishment of full enteral feeding, particularly when maternal or donor milk is available, can improve neonatal outcomes, particularly the incidence of central-line-associated bacterial infections, the length of hospital stay, and survival. This review highlights current evidence for maximizing enteral feeding strategies for VLBW infants in various settings. Specifically, we will outline the physiologic evidence for early and continued enteral feedings in VLBW infants, discuss considerations for the initiation and advancement of enteral feedings, and highlight future areas of research focused on these issues. Consideration for the evidence from low- as well as high-resource settings is critical to inform optimal feeding strategies of VLBW infants globally.

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Key scientific associations: Preterm, premature, feeding intolerance, spontaneous intestinal perforation, necrotizing enterocolitis, sepsis, central-line associated bacterial infections, length of hospital stay, mortality, gut immaturity, dysmotility, cohorts, randomized clinical trials, parenteral nutrition, amniotic fluid, crypt-villus histoarchitecture, gastric acid output, bile synthesis, exocrine pancreatic function, splanchnic circulation, gut motility, peristaltic contractions, parasympathetic, sympathetic, neural elements, gut hormonal, mucosal IgA, adhesion molecules, enterocyte apoptosis, crypt cell proliferation, jejunal mass, mucosal atrophy, luminal bacteria, patent ductus arteriosus, prostaglandin inhibitors, systematic review, meta-analysis, post-NEC stricture, peristalsis, intestinal blood flow, intestinal barrier function, gut dysbiosis, gut microbiome, trophic feeding, umbilical artery, aorta, antenatal Doppler studies, in-hospital mortality, reversal of end-diastolic flow, SIFT trial, ENACT trial, FEED1 trial, fortifier, immunoglobulins, lactoferrin, lysozyme, oligosaccharides, white blood cells, antibodies, donor milk.

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Ethawi Y, Khalaf M, Nadhim H, Chedid F, Al Sayed Y, AlAzi R, Al Amad AM, Hannawi S, Hamouri M, Jawad M, Al Nemri A, Sharma A, Swaidat Y, Al Thawbti R. Neonatal Intensive Care Unit Care of Newborn Infants born to Mothers with Suspected or Confirmed COVID-19 Infection. Newborn 2022; 1 (3):314-319. DOI: 10.5005/jp-journals-11002-0042.

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Abstract: The virus severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), which was later termed Coronavirus disease-19 (COVID-19), was first identified as a cause of atypical respiratory diseases in the Hubei Province of Wuhan, China, December 2019, and was then officially declared a pandemic by the World Health Organization (WHO) on March 11, 2020. Severe acute respiratory syndrome coronavirus 2 contains a singlestranded, positive-sense ribonucleic acid (RNA) genome surrounded by an extracellular membrane containing a series of spike glycoproteins resembling a crown. In this article, we have reviewed the perinatal clinical implications of SARS-CoV-2 infections and their management in birthing and neonatal intensive care units (NICUs). Increasing evidence suggest that strict hospital protocols are needed, but we may not need to separate the mothers and their infants or discourage breastfeeding. We have included information from our infection-control protocols in our hospitals and from an extensive literature search in the databases PubMed, EMBASE, and Scopus. To avoid bias in the identification of studies, keywords were shortlisted a priori from anecdotal experience and PubMed’s Medical Subject Heading (MeSH) thesaurus.

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Key scientific associations: Wuhan, Hubei province, pneumonia, World Health Organization, COVID-19, SARS-CoV-2, beta-coronavirus, severe acute respiratory syndrome, SARS, bat-related coronaviruses, single-stranded ribonucleic acid virus, RNA, zoonotic, angiotensin-converting enzyme 2, ACE2, respiratory droplets, air-borne transmission, infectivity, viral load, RNA viruses, viral load, health care providers, close contacts, animal to human transmission, Center for Disease Control and Prevention of China, case fatality, lactate dehydrogenase, ferritin, C-reactive protein, erythrocyte sedimentation rate, D-dimer, ground glass appearance, ground-glass opacification, pleural thickening, pleural effusion, lymphadenopathy, myalgia, American College of Obstetricians and Gynecologists, Society of Maternal-Fetal Medicine, droplet transmission, social distancing, hospital visitation, expressed breast milk, pasteurization, self-isolation, CPAP, Bi-PAP, HFNC, NIPPV, HFOV, HFJV, surfactant, heat and moisture exchange, continuous renal replacement therapy, CRRT, extracorporeal membrane oxygenation.

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Manzar S, Bhat R, Asghar S, Riel–Romero R, Walyat N, Arevalo–Espejo O, Mhanna M. Hypoxic–Ischemic Encephalopathy: To Cool, or Not to Cool, That Is the Question. Newborn 2022; 1 (3):320-326. DOI: 10.5005/jp-journals-11002-0037.

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Abstract: An infant was born at 38 weeks’ gestation. The assigned Apgar scores were 2, 3, and 5 at 1, 5, and 10 minutes, respectively. The physical examination showed hypotonia, absent gag reflex, and poor response to pain. At 9 hours after birth, the infant was noted to have a subtle seizure and bradypnea. The infant was intubated and started on anticonvulsant therapy. A brain magnetic resonance imaging (MRI) and an electroencephalogram (EEG) were obtained. This report presents the clinical and diagnostic dilemma that is typically associated with decisions needed for treatment with therapeutic hypothermia.

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Key scientific associations: Newborn, infant, gestation, neonatal, Apgar, seizure, bradypnea, hypotonia, gag reflex, hypoxic-ischemic encephalopathy, therapeutic hypothermia, electroencephalogram, magnetic resonance imaging, reflexes, Sarnat and Sarnat scoring, cord prolapse, fetal heart rate decelerations, perinatal umbilical cord accidents, perinatal ischemic stroke, sinus venous thrombosis, subarachnoid, EEG background activity, isoelectric EEG, periodic EEG, transcranial doppler resistive index, hyperalertness, sympathetic overdrive, periodic delta activity, continuous delta activity, cytotoxic edema, burst suppression pattern, cortical restricted diffusion, thalamus, dorsal mesencephalon, left superior cerebellar artery, caudothalamic groove, occipital horns, anticonvulsants, interleukin-16, multicystic encephalomalacia.