Joghee S, Kamaluddeen M, Soraisham A. Low-lying Umbilical Venous Catheters are not Always Associated with Increased Complications. Newborn 2022; 1 (1):1-6. DOI: 10.5005/jp-journals-11002-0004.

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Abstract: 

Background: Low-lying umbilical venous catheter (UVC) is often used for clinical care in case of failure to place in an ideal position. However, little is known about the association between catheter tip position and UVC related complications in neonates. Objectives: To examine the association between UVC tip position and related complications in neonates. Our secondary objective was to evaluate the association between timing of UVC insertion and complication rates. 

Methods: We performed retrospective cohort study of all neonates who had UVC in a tertiary NICU between January 2016 and December 2018. Neonates with major congenital or chromosomal anomalies, hydrops fetalis and prenatally diagnosed cardiac arrhythmias or pericardial effusion were excluded. The primary outcome was presence of UVC related complications resulting in early removal of catheters. We compared the complication rates based on the position of the UVC on thoraco-abdominal radiograph (TAR) at the time of insertion. UVC position was defined as optimum if its tip on TAR was between T8-10 vertebrae, low if the tip was below T10 and high if above T8. We also examined the association between age at UVC insertion (i.e. early (<12 hours) versus late (≥12 hours) and success rate and the type of complications. 

Results: Of the 919 eligible infants, UVC tip was at optimal position in 433 (47%), low position in 415 (45%) and high position in 71 (8%) neonates. UVC was inserted within 12 hours in 665 (72.3%) infants. The overall complication rate was 54/919 (5.9%). The complication rate was lowest in optimum position (20/433 (4.5%), followed by low-lying position (27/415 (6.5%) and highest among high position UVC (7/71 (9.8%). Multivariate logistic regression analysis after controlling for gestational age and duration of catheter showed that the total UVC related complications was not significantly different between low-lying UVC (aOR 1.16; 95% CI 0.62, 2.17) compared to optimum position. However, high UVC position was associated with increased risk of cardiac complications (aOR 6.09, 95% CI 2.03 -18.28) compared to optimum position group. There was no significant difference in UVC related complications between early and late insertion of UVC (6.3 % versus 4.7%, p =0.34). 

Conclusions: Compared to optimal UVC position, high position UVC is associated with increase in risk of cardiac complications. Complication rates were not different between early insertion and late insertion of UVC.

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Key scientific associations: Newborn, neonate, preterm, neonatal intensive care unit, very low birth weight infants, malposition, arrhythmias, pericardial effusion, cardiac tamponade, hepatic complications, liver hematoma, thrombosis, abscess, ascites, catheter occlusion, catheter breakage, migration of fragmented catheter, UVC position, thoraco-abdominal radiograph, supraventricular tachycardia, Coagulase Negative Staphylococcus, Escherichia coli, Enterococcus fecalis, Pseudomonas, hemidiaphragm.

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Viswanathan S, McNelis KM, Maheshwari A, Aja'Nini Z, Merlino S, Culver M, Collin M, Calhoun D, Grow-Wargo S. Accretion Rates of Fat and Fat-free Mass in Infants at 30–45 weeks’ Postmenstrual Age. Newborn 2022; 1 (1):7-13. DOI: 10.5005/jp-journals-11002-0018.

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Abstract: 

Background: Body composition assessment using noninvasive air displacement plethysmography (ADP) can help determine the quality of postnatal growth in infants. The accretion rates of fat mass (FM) and fat-free mass (FFM), both are known to change in various clinicopathological situations in a discordant fashion, can also help evaluate the short-term impacts of nutritional interventions on body composition. 

Objectives: To determine the FM and FFM accretion rates from 30 to 45 weeks’ postmenstrual age (PMA) and whether these rates are different between male and female infants. 

Methods: We used previously published normative data with median FM and FFM values for infants at 30-45 weeks’ PMA (Norris et al, 2019). Weekly gains in FM and FFM in g/week and g/kg/week were calculated using early 1-point and average 2-point methods. 

Results: FM and FFM accretion rates calculated by the early 1-point method were higher than the average 2-point method. Male and female infants had similar FM and FFM accretion rates. Constant accretion rates of FM and FFM were not aligned with individual weekly accretion rates, which showed a 2-4-fold change. A composite index (FFM/FM accretion rate ratio), which we named the ‘body composition accretion ratio’ (BCAR), was more sensitive than the individual weekly accretion rates and showed a 9-fold change during the study period. 

Conclusions: Weekly FM and FFM accretion rates can help assess quality of postnatal growth in young infants, but BCAR can be a more useful, sensitive index for early identification of body composition changes, and may possibly guide nutritional interventions. 

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Key scientific associations: Newborn, neonate, preterm, neonatal intensive care unit, very low birth weight infants, non-invasive air displacement plethysmography, postnatal growth, body composition accretion ratio, early body composition, air displacement plethysmography, Norris body composition charts, lambda-mu-sigma method, exponential model, extracellular fluid, body fat..

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Garg PM, Paschal JL, Lett K, Middleton C, Varshney N, Maheshwari A. Intestinal Resection is More Likely to be Effective in Necrotizing Enterocolitis Extending to Colon than in Disease Limited to the Small Intestine. Newborn 2022; 1 (1): 14-26. DOI: 10.5005/jp-journals-11002-0024. Available in PubMed.  

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Abstract:

Background: The prognosis in surgical necrotizing enterocolitis (NEC) has focused on the total length of the resected bowel; the relative impact of small intestinal vs. colonic resection is not well studied. 

Objective: We hypothesized that intestinal resections may reduce mortality and length of hospital stay (LOS) more likely in infants who have NEC extending into the colon than in those with disease limited to the small intestine. We also investigated the relationship between gestational maturation and NEC-related mortality.

Methods: Retrospective study of 153 patients compared demographic, clinical, and histopathological information in infants who had NEC limited to the small intestine vs. disease with colonic involvement. 

Results: Our 153 infants had a mean (± standard deviation) gestational age of 27.4±3.4 weeks and a birth weight of 987±505 g. NEC was limited to the small intestine in 103 (67.3%) infants and extended into the colon in 50 (32.7%). Infants with small intestinal NEC needed shorter bowel resections of 28±31.9 cm than 42.2±40.7 cm in those with colonic involvement (p=0.02). The LOS was longer in NEC limited to the small intestine than in disease with colonic lesions (96±88.1 vs 69.7±19.1 days; p<0.05).In small intestinal NEC, mortality decreased to <50% beyond a gestational age (GA) >37 weeks. In contrast, infants with NEC that involved the colon had mortality <50% mortality beyond 27.3 weeks’ GA (p=0.008). 

Conclusions: Bowel resections may be more likely associated with shorter LOS in surgical NEC that involves both the small bowel and colon, even when longer segments of the gastrointestinal tract are removed, than in disease limited to the small intestine.

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Key scientific associations: newborn, neonate, premature, surgical necrotizing enterocolitis, mortality, length of hospital stay, NEC-related mortality, bowel resections, gestational age, inflammatory bowel necrosis, birth weight, pathogenesis of NEC, pneumatosis intestinalis, intramural cysts, coagulative necrosis, cholestasis, short bowel syndrome, bacterial translocation, pregnancy-induced hypertension, chorioamnionitis, antenatal steroids, patent ductus arteriosus, Shapiro-Wilk, Kolmogorov-Smirnov test, thrombocytopenia, anemia, metabolic acidosis, Kaplan-Meier curves, sucrose-isomaltase, aminopeptidase, alkaline peptidase, glucagon, somatostatin, pancreatic polypeptide, alanine, and methionine, apolipoproteins, Paneth cells.

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Gowda SH, King A, Vogel AM, Coleman RD, Chartan CA, Garcia-Prats JA, Fernandes CJ. Real-time Echocardiography-guided Weaning of Veno-arterial Extracorporeal Membrane Oxygenation in Neonates. Newborn 2022; 1 (1): 27-31. DOI: 10.5005/jp-journals-11002-0006.  

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Abstract:

Objective: The objective of the study is to evaluate the utility of real-time echocardiography (RTE) to provide objective hemodynamic guidance during decannulation of neonates from extracorporeal membrane oxygenation (ECMO). Design: Retrospective case series. Patients: Neonates with respiratory and circulatory failure who underwent venoarterial ECMO (VA-ECMO). Interventions: Use of RTE to assess cardiac function, pulmonary hypertension (PH), and readiness for decannulation from ECMO. Outcome measures: Data abstracted included clinical parameters, RTE data, and management decisions during weaning from VA-ECMO.

Results: We used RTE during weaning in 12 of 33 patients between 2016 and 2019. Findings prompted inotrope titration in 10 (83%) patients and volume resuscitation in 10 patients. PH was present in 12 (100%) patients and prompted initiation of prostaglandin infusion (in 3 (25%) patients. Ten of 12 patients were successfully weaned off; in 2, RTE was instrumental in halting decannulation.

Conclusions: RTE may serve as a valuable tool in clinical decision-making while weaning neonates from VA-ECMO and providing data to choose appropriate support for successful decannulation.

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Key scientific associations: newborn, neonate, meconium aspiration syndrome, extracorporeal life support (ELSO), inhaled nitric oxide, congenital diaphragmatic hernia, pulmonary hypoplasia, pulmonary hypertension, hydrops, hypoxemic respiratory failure, pulmonary vascular resistance, ventricular interaction during ECMO, ventricular function during ECMO, ductal patency during ECMO, shunt directionality during ECMO, volume status during ECMO, decannulation from ECMO, intravascular volume status during ECMO, atrio-ventricular valves, left ventricle fractional shortening¸ tricuspid regurgitation, septal configuration, pulmonary valve regurgitant velocity, inotropic therapy,  pulmonary vasodilator therapy, alveolar capillary dysplasia, pulmonary hypoplasia, bilateral renal agenesis, epinephrine, dopamine, vasopressin, milrinone, PGE, iNO, RV index of myocardial performance, tricuspid annular plane systolic excursion, fractional area change, Doppler tissue imaging-derived tricuspid lateral annular systolic velocity, three-dimensional RVEF, RV longitudinal strain/strain rate by speckle-tracking echocardiography, biventricular function, septal configuration, ventricular interaction, intracardiac volume, lusitropic, asymmetric septal hypertrophy.

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Managlia E, Yan X, De Plaen IG. Intestinal Epithelial Barrier Function and Necrotizing Enterocolitis. Newborn 2022; 1 (1): 32-43. DOI: 10.5005/jp-journals-11002-0003. Available in PubMed.  

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Abstract: Necrotizing enterocolitis (NEC) is a major cause of morbidity and mortality in premature infants. NEC is characterized by intestinal tissue inflammation and necrosis. The intestinal barrier is altered in NEC, which potentially contributes to its pathogenesis by promoting intestinal bacterial translocation and stimulating the inflammatory response. In premature infants, many components of the intestinal barrier are immature. This article reviews the different components of the intestinal barrier and how their immaturity contributes to intestinal barrier dysfunction and NEC.

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Key scientific associations: Neonate, newborn, immune system, mucosal barrier, intestinal permeability, infant formula, gelatinous, mucus layer, Paneth cells, enteric nervous system, mucin, O-glycosylated, glycan, Muc2, MUC5AC, MUC5B, MUC6, MUC7, membane-bound mucins, MUC1, MUC3, MUC4, MUC12, MUC13, MUC16, and MUC17, mucins with a transmembrane domain, apical cell surface sensing, alpha-defensins, cathelicidins, lysosyme, secreted phospholipase A2, alpha-defensins, cryptdins, matrilysin, prostanoids, cathelicidins, beta-defensin, intestinal alkaline phosphatase, lipid-A, occludin, ZO-1, trefoil Factor 3, colostrum, lactoferrin, desmosome, desmoglein-2, adherens junction, occludin, claudins, myosin light chain, myosin light chain kinase, α-catenin, beta-catenin, transcytosis, M (microfold)-cells, enteroendocrine cells, connexin43, dendritic cells, macrophages, CCL20, CCL2, IL-13, NF-κB, hepatocyte growth factor, epithelial Growth Factor, transforming-growth Factor-beta, erythropoietin.

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Mezu-Ndubuisi OJ, Maheshwari A. Role of the Endothelium in Neonatal Diseases. Newborn 2022; 1 (1): 44-57. DOI: 10.5005/jp-journals-11002-0025. Available in PubMed. 

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Abstract: In the fetus and the neonate, endothelial cells are critically involved in all physiologic and pathologic processes in nearly every organ. Although the endothelium is one of the most frequently encountered cell types in the body, the tight adherence to the blood vessel wall has made it difficult to study the structural and functional diversity of these cells. In this article, we have reviewed the origin of endothelial cells and explored the heterogeneity of these cells in terms of structure, function, developmental changes, and their role in inflammatory and infectious diseases. We have also attempted to evaluate the untapped therapeutic potentials of endothelial cells in neonatal disease. This article combines peer-reviewed evidence from our own studies with results of an extensive literature search in the databases PubMed, EMBASE, and Scopus.

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Key scientific associations: Neonate, newborn, mesenchymal stem cells, colony-forming units of fibroblasts, hemangioblast, hematopoietic stem cells, erythro-myeloid progenitors, hemogenic endothelium, endothelial progenitor cells, Hoxa, wnt, notch, endothelium, angiogenesis, vasculogenesis, vascular labyrinth, bone morphogenetic protein 4, vascular endothelial growth factor, transforming growth factor-β, bone morphogenetic protein, intercellular adhesion molecule 1, vascular cell adhesion molecule 1, angiogenesis, vasculogenesis, CD31, CD34, CD38, CD41, CD43, CD44, CD45, CD45RA, CD54, CD62E, CD73, CD90, CD99, CD105, CD117, CD144, KDR, Ter-119, bone marrow endothelial progenitor cells, von Willebrand factor, factor VIII, intercellular adhesion molecule-1, E-selectin, VCAM-1, VEGFR1,VEGFR2, VEGFR3, vWF, E-cadherin, VE-cadherin, ICAM-1, mitochondrial transfer, ephrinB2, ephrinB4, lymphatic endothelial cells, prox-1, endothelial cell-translating ribosome affinity, Tek, Cdh5, Nos3, Eng, Robo4, circulating endothelial progenitors, brain endothelium, DLL4, Ang-1, Ang-2, Ang-4, Tie2, FOXO1, JAM-A, JAM-B, PECAM1, single-chain type-1 glycoprotein, VEGFA165a, angiogenic receptors, dimethyloxalylglycine, L-arginine, tetrahydrobiopterin, avastin, ranibizumab, relaxin, sTREM-1, resveratrol, trans-3,4′,5-trihydroxystilbene.

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Singh R, Vaidya R, Ashwath R, Maheshwari A. Patent Ductus Arteriosus: A Diagnostic and Treatment Dilemma. Newborn 2022; 1 (1):58-66. DOI: 10.5005/jp-journals-11002-0023.  

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Abstract: Ductus arteriosus is a critically important vascular structure that functions as an extracardiac shunt in fetal life between the pulmonary and systemic circulations for optimal utilization of the placenta as a gas exchange organ and fetal well-being. While morbidities and mortality are well known to be associated with persistence of patent ductus arteriosus (PDA) in postnatal life, the treatment options have concerns for adverse outcomes. Additionally, high spontaneous closure rates, lack of clear definition of hemodynamically significant PDA (hs-PDA), ideal diagnostic tools, conflicting evidence regarding timing of treatment, and lack of clear benefits of PDA treatment from randomized trial in reducing adverse outcomes continue to pose challenges for clinicians managing preterm infants with PDA. This review focuses on the pathophysiology, current diagnostic and management practices, as well as the potential of utilizing unique diagnostic tools to support precision medicine for preterm infants with hs-PDA.

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Key scientific associations: Ductus arteriosus, neonate, patent ductus arteriosus, prematurity, in utero shunts, fetal oxygen tension, PDA size, left atrium-to-aorta (LA/Ao) ratio, left ventricular size, LV output, cerebral Doppler, near infra-red spectroscopy, Scoring preterm Infants for PDA clinically without Echocardiographic evaluation (SIMPLE) score, PDA severity score (PDAsc), brain natriuretic peptide, serum/urinary N-terminal pro-brain natriuretic peptide (NTproBNP), IL-6, IL-8, IL-10, IL-12, growth differentiation factor-15, monocyte chemotactic protein-1, erythropoietin, descending aortic diastolic flow reversal, increased LV output, isovolumic relaxation time, PDA diamete, pulmonary vein D wave, LA:Ao ratio, mitral E wave, E/A ratio, isovolumic relaxation time, real time 3D dimensional echocardiography, cardiac magnetic resonance imaging, spatial resolution and 3-dimensional multiplanar reconstruction, left ventricular outflow, near infrared spectroscopy, Csat and/or Rsat, fraction tissue oxygenation extraction, cyclooxygenase inhibitors, gastrointestinal bleeding, gastrointestinal perforation, platelet aggregation, hyperbilirubinemia, renal failure, thrombocytopenia, hyponatremia, pneumothorax, hypothermia, intra-operative bleeding, phrenic nerve palsy, wound infection, vocal cord palsy, thoracic scoliosis.

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Bagga N, Panigrahay N, Maheshwari A. Extra-uterine Growth Restriction in Preterm Infants. Newborn 2022; 1 (1): 67-73. DOI: 10.5005/jp-journals-11002-0019. 

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Abstract: Extra-uterine growth restriction (EUGR) is frequently seen in premature and critically ill infants. Even though advancements in neonatal intensive care have improved the survival of these high-risk infants, many new questions have emerged about the relationship between postnatal growth and neurodevelopmental outcome of these infants. EUGR has traditionally been ascribed to caloric restriction during postnatal periods of critical illness. Nutritional compromise, particularly during the first few weeks of life, may affect the overall growth and could also cause long-term neurodevelopmental impairment. The accidental and premature interruptions of pregnancy could also alter the normal mobilization and utilization of major nutrients from the ways that would have otherwise occurred during the last trimester of pregnancy, which is normally a period of maximal in utero growth. In this article, we review our current understanding of defining EUGR, various risk factors for EUGR, its pathophysiology, and possible ways with which our current healthcare protocols could prevent EUGR.

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Key scientific associations: Development, growth restriction, IUGR, premature, skeletal, newborn, neonate, neurodevelopmental impairment, in utero growth, Z scores, weight-for-age Z scores, Weight gain velocity, Length-for-age Z scores, length gain velocity, extra-uterine head growth restriction, donor human milk, epigenetic, imprinting center 1, hypermethylation, DNA methylation, metabolome, branched-chain amino acid, glycerophospholipids, sphingolipids, Kangaroo Mother Care, non-nutritive sucking.

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Thattaliyath B, Porayette P, Ashwath R. Advanced Cardiac Imaging in Neonatology. Newborn 2022; 1 (1): 74-80. DOI: 10.5005/jp-journals-11002-0020.

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Abstract: Imaging of congenital heart disease (CHD) starts in the intrauterine period by fetal echocardiography. The anatomy and physiology are confirmed postnatally by transthoracic echocardiogram. However, complex CHDs require further imaging to delineate anatomy for further management and surgical intervention. Cardiac magnetic resonance imaging (MRI) and cardiac chest tomography (CT) complement the role of transthoracic echocardiogram in delineating further details of anatomy and physiology in the neonatal period. This review covers the basic sequences and terminologies used in cardiac MRI and cardiac CT. A brief description of the indications and the ideal modality of imaging is described, including the limitations of each modality of imaging.

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Key scientific associations: Cardiac, contrast, CT, imaging, indications, MRI, neonate, radiation, TnEcho, M-mode echocardiography, congenital heart disease, intracardiac, portable ultrasonography, targeted neonatal echocardiography, computed tomography, nuclear MR, fetal cardiovascular MR, Black Blood Spin Echo, balanced steady state free precision, phase-encoded flow imaging, 3D gadolinium-enhanced MR angiography, first-pass perfusion imaging, late gadolinium enhancement imaging, ALARA, high-pitched helical scanning and iterative reconstruction, multidetector-row CT, submillisevert, dual-source helical CT, FLASH imaging, etrospective EKG gated imaging, multiplanar reconstruction.

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Valentine GC, Juul SE. The Potential Role of Maternal Periodontitis on Preterm Birth and Adverse Neonatal Neurologic Outcomes. Newborn 2022; 1 (1): 81-90. DOI: 10.5005/jp-journals-11002-0008.

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Abstract: Periodontitis is an often overlooked but important risk factor for both preterm birth and adverse neonatal outcomes. With preterm birth being the leading cause of mortality for all children under the age of 5, any potentially modifiable risk factor associated with preterm birth must be fully evaluated. Periodontal disease is due to bacterial infection of the gingivae with resulting localized and systemic inflammation that can have profound effects in both nonpregnant and pregnant individuals. In pregnancy, several studies have demonstrated an association between periodontitis and preterm birth. Furthermore, extensive evidence demonstrates that fetal exposure to systemic inflammation during gestation predisposes to brain injury and neurodevelopmental delay. Thus, periodontitis and the resulting inflammatory cascade not only affect the pregnant individual but also have significant lifelong consequences on the development and well-being of future offspring. In this review, we will first discuss the epidemiology, prevalence, and pathophysiology of periodontitis. We will then explore the medical literature evaluating the association between periodontitis and preterm birth prior to delving into the potential for neurodevelopmental delay and brain injury among offspring. Finally, we will conclude by discussing future directions and unanswered questions related to periodontitis and its relationship with preterm birth and adverse neonatal outcomes.

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Key scientific associations: Inflammation, neurologic impairment, periodontitis, preterm birth, dental caries, dental plaque, biofilm, Gram-positive, facultative bacteria, Streptococcus, Actinomyces, Gram-negative, anaerobic bacteria, Fusobacterium, gingivitis, lymphocyte differentiation, receptor activator of nuclear factor-kB (RANK), gingivitis, estrogen receptors, progesterone receptors, periodontal ligament, Bacteroides intermedius, Porphyromonas gingivalis, Prevotella intermedia, Campylobacter rectus, pro-inflammatory cytokine production, uterine myometrial contractions, Prevotella tannerae, nonpathogenic Neisseria species, Bergeyella, Fusobacterium, Escherichiae coli, Lactobacillus species, Ureaplasma species, Streptococcus agalactiae, Porphyromonas gingivalis, fetal neural injury, microglial proliferation, hippocampal subgranular zone, serotonin, synaptogenesis.

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Nguyen T, Jordan BK. Let's Talk about Dex: When do the Benefits of Dexamethasone for Prevention of Bronchopulmonary Dysplasia Outweigh the Risks? Newborn 2022; 1 (1): 91-96. DOI: 10.5005/jp-journals-11002-0009. Available in PubMed.

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Abstract: Bronchopulmonary dysplasia (BPD) is a common complication of prematurity and carries increased respiratory morbidity into childhood and adulthood. Systemic administration of dexamethasone during the preterm period has been shown to decrease the incidence of BPD in this population. However, enthusiasm about its use has been tempered by early evidence that suggested potential adverse neurodevelopmental outcomes. More recent studies suggest that the timing, dosing, and duration of therapy may have a significant impact on the safety and efficacy of dexamethasone administration and that side effects and harms may be minimized if its use is appropriately targeted. Focusing on the American Academy of Pediatrics (AAP) statement on dexamethasone, this review seeks to examine recent clinical trials to present the current state of knowledge regarding the systemic dexamethasone administration to prevent BPD in extremely premature infants and how dose, duration, and timing might impact its safety and efficacy in this vulnerable population.

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Key scientific associations: Bronchopulmonary dysplasia, corticosteroids, dexamethasone, prematurity, caffeine, vitamin A, neurodevelopmental outcomes, cerebral palsy, necrotizing enterocolitis, spontaneous intestinal perforation, DART trial, successful extubation rates, cumulative dexamethasone dosing regimen, Individualized Education Program, neurodevelopmental impairment, intraventricular hemorrhage, periventricular leukomalacia.

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Christensen RD, Bahr TM, Ward DM. Iron Deficiency in Newborn Infants: Global Rewards for Recognizing and Treating This Silent Malady. Newborn 2022; 1 (1): 97-103. DOI: 10.5005/jp-journals-11002-0021. Available in PubMed.  

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Abstract: Iron deficiency can exist at birth. Even if iron is sufficient at birth, deficiency can develop during the neonatal period, or during infancy, or during childhood. Iron deficiency can exist despite a normal hematocrit and a normal blood hemoglobin concentration, because anemia is a very late manifestation of iron deficiency. It is likely that adverse neurodevelopmental consequences occur during perinatal biochemical iron deficiency, despite a normal hematocrit and hemoglobin. Consequently, measuring those parameters is a very insensitive method for perinatal iron deficiency screening. This review focuses on potentially better practices for diagnosing perinatal iron deficiency, including recent advances in understanding the pathogenesis of this condition, and also on practical means of treatment, and on global rewards of so doing.

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Key scientific associations: Anemia, erythropoiesis, erythroferrone, diagnosis, hepcidin, iron, treatment, neurodevelopmental consequences, perinatal biochemical iron deficiency, erythrocyte microcytosis, hypochromia, iron endowment, ferritin, hemosiderin, heme-containing molecules, hemoglobin, myoglobin, transferrin, iron-containing enzymes, iron-containing cofactors, erythropoietin, ferroportin, syncytiotrophoblasts, erythropoiesis, mitochondrial respiration, nucleic acid replication, immune function, iron-deficient neurodevelopmental damage, serum iron, transferrin, transferrin saturation, serum ferritin, soluble transferrin receptor, zinc protoporphyrin-to-heme ratio, Micro-R and HYPO-He, reticulocyte hemoglobin content.

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Dietrich LJ, Blanco C. Oral Feeding of Preterm Infants in the NICU: Interventions and Outcomes. Newborn 2022; 1 (1): 104-108. DOI: 10.5005/jp-journals-11002-0010.

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Abstract: Preterm infants spend much of their time in the neonatal intensive care unit (NICU) learning to orally feed. Attempts to support the preterm infant in acquiring oral skills have evolved greatly over the past decades, including the increasing involvement of speech, physical, and occupational therapists. Interventions have included modified positioning, specialized nipples, external pacing, sensorimotor exercises, oral motor skills programs, and cue-based feeding programs. While many infants seem to have benefited from these methods, a subset of babies continues to require supplemental feeding methods via nasogastric or gastrostomy tube. In particular, infants with aerodigestive complications are at high risk for needing supplemental feeding methods. Additionally, the neurodevelopmental implications of having significant feeding difficulties early on is not fully known. Studies have brought about concerns that children with early oral feeding difficulties may be at risk for the presence of neurodevelopmental delays and continued feeding issues later in childhood. Further research is needed to better understand which infants will struggle with oral feeding, as well as identify appropriate therapeutic options and optimal time periods of implementation.

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Key scientific associations: Feeding disorder, gastrostomy tube, nasogastric feeding, neurodevelopment, oral feeding, preterm, aerodigestive complications, nasogastric, gastrostomy, non-nutritive suck, poor tongue movement, sphincter closure, epiglottic closure, esophageal muscle peristalsis, breathing patterns, coughing, choking, gagging, laryngeal penetration, aspiration, modified positioning, side-lying position, swaddling, pacing, oral motor muscles, suck-swallow- respiration coordination, premature infant oral motor intervention (PIOMI), Beckman’s Oral Motor Intervention, NIDCAP (Newborn Individualized Developmental Care and Assessment Program), cue-based feeding, infant-driven feeding, gastric tube dependence.

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