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BackgroundHypertensive disorders of pregnancy (HDP) are a major cause of small for gestational age (SGA). Preterm SGA infants have higher rates of adverse outcomes than appropriate for gestational age infants. However, the outcomes are not well established in the setting of HDP.MethodsRetrospective population-based study using the Canadian Neonatal Network database from January 1, 2010 to December 31, 2016 of SGA infants <33 weeks gestation. Using multivariable models, we determined the adjusted odds ratios (AORs) with 95% confidence intervals (CI) for mortality, bronchopulmonary dysplasia (BPD), severe intraventricular hemorrhage (IVH), severe retinopathy of prematurity, necrotizing enterocolitis, late-onset sepsis, and patent ductus arteriosus (PDA) in infants of HDP mothers and compared them to infants of non-HDP mothers.ResultsOf the 2081 eligible SGA infants, 1317 (63%) were born to HDP mothers and had lower odds of mortality (AOR 0.57, 95% CI 0.39–0.83) and BPD (AOR 0.69, 95% CI 0.53–0.90). Sub-group analysis demonstrated decreased mortality in 26–28 and 29–32 weeks gestation groups, decreased BPD in 29–32 weeks gestation group, and decreased PDA in <26 weeks gestation group.ConclusionPreterm SGA infants of HDP mothers have lower odds of mortality and BPD compared to infants of non-HDP mothers.

ObjectiveThe objective of this study is to assess the impact of maternal age on neurodevelopmental (ND) outcomes of infants < 29 weeks gestational age (GA) at 18–24 months.Study designA retrospective cohort study of preterm infants < 29 weeks GA admitted to Canadian tertiary NICUs was performed. The primary outcome was a composite of death or ND impairment (NDI)/significant NDI (sNDI) at 18–24 months. Association between maternal age and outcome was assessed across maternal age groups (15–19, 20–34, 35–39 and ≥40 years) using logistic regression after adjusting for confounders.ResultsOf 3691 eligible infants, 2652 with complete data were included in the analysis. Significant differences in maternal characteristics existed across age groups. The only difference in neonatal characteristics was the incidence of bronchopulmonary dysplasia (p < 0.01). There was no association between maternal age and death or NDI/sNDI after controlling for confounders.ConclusionMaternal age is not associated with differences in NDI/sNDI rates among Canadian preterm infants < 29 weeks GA.

ObjectiveTo compare the characteristics and outcomes of neonates with mild hypoxic-ischemic encephalopathy (HIE) who received hypothermia versus standard care.Study designWe conducted a retrospective cohort study of neonates ≥35 weeks’ gestation and ≥1800 g admitted with a diagnosis of Sarnat stage 1 encephalopathy. We evaluated length of hospital stay, duration of ventilation, evidence of brain injury on MRI, and neonatal morbidities.ResultsOf 1089 eligible neonates, 393 (36%) received hypothermia and 595 (55%) had neuroimaging. The hypothermia group was more likely to be outborn, born via C-section, had lower Apgar scores, and required extensive resuscitation. They had longer durations of stay (9 vs. 6 days, P < 0.001), respiratory support (3 vs. 2 days, P < 0.001), but lower odds of brain injury on MRI (adjusted odds ratio 0.33, 95% CI: 0.22–0.52) compared with standard care group.ConclusionDespite prolongation of hospital stay, hypothermia may be potentially beneficial in neonates with mild HIE; however, selection bias cannot be ruled out.

ObjectiveTo assess the association between time of birth and mortality among preterm infants.Study designPopulation-based study of infants born 22–36 weeks gestation (GA) in Canada from 2010 to 2015 (n = 173 789). Multivariable logistic regression models assessed associations between timing of birth and mortality.ResultAmong infants 22–27 weeks GA, evening birth was associated with higher mortality than daytime birth (adjusted odds ratio [AOR] 1.14, 95% CI 1.01–1.29). Among infants 28–32 weeks GA and 33–36 weeks GA, night birth was associated with lower mortality than daytime birth (AOR 0.75, 95% CI 0.59–0.95; AOR 0.78, 95% CI 0.62–0.99, respectively). Sensitivity analysis excluding infants with major congenital anomaly revealed that associations between hour of birth and mortality among infants born 28–32 and 33–36 weeks GA decreased or were not statistically significant.ConclusionHigher mortality among extremely preterm infants during off-peak hours may suggest variations in available resources based on time of day.

Objective: Near-infrared spectroscopy (NIRS) measures cerebral oxygenation and could measure the risk of hypoxia or hyperoxia in infants with bronchopulmonary dysplasia (BPD). We lack normalized data for NIRS values in neonates. We sought normative values of NIRS and proposed that NIRS could better identify a safe oxygen flow rate compared to pulse oximetry (POX).Methods: This prospective cohort study compared POX and NIRS values in healthy infants in room air (n = 22) with BPD infants (n = 10) on oxygen (0.03, 0.06, 0.12 L/min).Results: In healthy infants, the average POX value was 97.8%, and NIRS was 78.24%. Time (% time) with hypoxia was similarly low using either POX or NIRS (3.5% and 1.4%). On oxygen, % time with hypoxemia was similarly low with both POX or NIRS (0.03 lpm: 2.35% POX and 0.01% NIRS; 0.06 lpm: 1.43% POX and 0.6% NIRS; 0.12 lpm: 1.46% POX and 0.2% NIRS). In contrast, the potential hyperoxia %time was higher using POX compared to NIRS (96.5% vs 47.9%) in room air healthy infants. Similarly, hyperoxia %time was more common with POX compared to NIRS, but there was no difference with increasing oxygen flow rates (0.03 lpm, 82.13% POX and 41.5% NIRS; 0.06 lpm: 92.49% POX and 34.4% NIRS; 0.12 lpm: 87.00% POX and 34.8% NIRS).Conclusion: We did not see a dose response correlation between oxygen flow rate and time spent in the hyperoxemic range across different flow rates by POX or cerebral NIRS. We did not see a benefit of NIRS in setting home oxygen flow rates.

The recent clinical experience with hemolytic disease of the newborn and its post-icteric sequelae is limited among high-income countries because of nearly over four decades of effective prevention care. In this case, we will discuss the sequelae of a baby born with hemolytic disease of the newborn to an Rh negative mother with no prenatal care from remote northern Saskatchewan. Inspissated bile syndrome is a rare but serious complication of hemolytic disease of the newborn. The concentration of hemolytic products parallels with serum color changes.

ObjectiveTo evaluate outcomes of preterm infants <26 weeks gestational age (GA) following postdelivery extensive cardiopulmonary resuscitation (ECPR) compared with airway and breathing support (ABS).Study designRetrospective review of Canadian Neonatal Network data during January 2010 to December 2016. The primary outcome was death or severe morbidity (intraventricular hemorrhage ≥grade 3 or periventricular leucomalacia, retinopathy of prematurity ≥stage 3, bronchopulmonary dysplasia, or necrotizing enterocolitis).ResultAmong 3633 infants analyzed, 433 (11.9%) received ECPR. In multivariable analysis, death or severe morbidity was higher in the ECPR versus ABS group [adjusted odds ratio 2.26 (95% confidence interval 1.49, 3.43)]. The majority of the difference was due to increased mortality, which occurred mostly during the first week of life.ConclusionThese data from a recent cohort of infants near the limits of viability may be useful for prognostication for health care providers and counseling of parents.

Retinopathy of Prematurity (ROP) is a vascular proliferative disorder of preterm infants, with increased disease severity and incidence occurring with lower gestational age and birth weight. An alternate approach to ROP screening with wide-field digital retinal imaging helps with the early detection of ROP, especially during the pandemic.