Are We Enhancing Recovery After Neonatal Surgery? Assessment of Enhanced Recovery After Surgery Principles for Ostomy Takedown.

Introduction: Enhanced Recovery After Surgery (ERAS) guidelines in adults have demonstrated reduced complications, length of stay, and cost. However, neonatal ERAS studies are limited and translation of adult ERAS guidelines to neonates is challenging. Furthermore, the knowledge, perception, and practice of neonatal ERAS guidelines is largely unknown.

Attitudes on Artificial Intelligence use in Pediatric Care From Parents of Hospitalized Children.

Introduction: Artificial intelligence (AI) may benefit pediatric healthcare, but it also raises ethical and pragmatic questions. Parental support is important for the advancement of AI in pediatric medicine. However, there is little literature describing parental attitudes toward AI in pediatric healthcare, and existing studies do not represent parents of hospitalized children well.

Effect of reduced versus usual lipid emulsion dosing on bilirubin neurotoxicity and neurodevelopmental impairment in extremely preterm infants: study protocol for a randomized controlled trial.

Background: Bilirubin neurotoxicity (BN) occurs in premature infants at lower total serum bilirubin levels than term infants and causes neurodevelopmental impairment. Usual dose lipid infusions in preterm infants may increase free fatty acids sufficiently to cause bilirubin displacement from albumin, increasing passage of unbound bilirubin (UB) into the brain leading to BN and neurodevelopmental impairment not reliably identifiable in infancy. These risks may be influenced by whether cycled or continuous phototherapy is used to control bilirubin levels.

The Effect of Severe Intraventricular Hemorrhage on the Biorhythms of Feeding in Premature Infants.

Suck-swallow rhythmicity and the integration of breathing into infant feeding are developmentally regulated. Neurological injury and breathing abnormalities can both impact feeding in preterm infants. To determine the effects of neurologic injury independent of effects of disordered breathing on feeding biorhythms in premature infants.

Variation in opioid utilization among neonates with gastroschisis.

Purpose: Repetitive painful stimuli and early exposure to opioids places neonates at risk for neurocognitive delays. We aimed to understand opioid utilization for neonates with gastroschisis.

Methods: We performed a retrospective review of infants with gastroschisis at a tertiary children's hospital (2017-2019).

Sirolimus for Kaposiform Hemangioendothelioma and Kasabach-Merritt Phenomenon in a Neonate.

We present a case of a neonate born with kaposiform hemangioendothelioma (KHE), complicated by Kasabach-Merritt phenomenon (KMP) and other serious conditions, who was successfully treated with sirolimus. In addition to complications from thrombocytopenia and fluid overload, during the course of therapy, our patient experienced supratherapeutic drug levels at the commonly accepted starting dose of sirolimus. Patients with KHE and KMP should be closely monitored for potential complications of both the initial disease and unexpected side effects of treatments.

Effects of Bronchopulmonary Dysplasia on Swallow:Breath Interaction and Phase of Respiration with Swallow During Non-nutritive Suck.

Objectives: The objective of this study is to describe swallow:breath interaction (SwBr) and phase of respiration incident to swallow (POR) during non-nutritive suck in infants with bronchopulmonary dysplasia and determine if speech-language intervention can modify the characteristics of non-nutritive suck in these infants.

Methods: Logistic regression models were used to describe SwBr and POR in 16 low-risk preterm (LRP) infants and 43 infants with bronchopulmonary dysplasia. Infants with bronchopulmonary dysplasia were randomized to receive individualized intervention from a speech-language pathologist (BPDwithTX) or standard care (BPDnoTX).

Swallow-Breath Interaction and Phase of Respiration with Swallow during Non-Nutritive Suck in Infants Affected by Neonatal Abstinence Syndrome.

Background: The development of suck-swallow-breath rhythms during non-nutritive suck (NNS) may be an indicator of neurologic integrity. We have described swallow-breath (SwBr) interaction and phase of respiration (POR) with swallow during NNS in low-risk preterm (LRP) infants. NNS in infants with neonatal abstinence syndrome (NAS) has not been described with our method.

Autonomic nervous system function following prenatal opiate exposure.

In utero exposure to opiates may affect autonomic functioning of the fetus and newborn. We investigated heart rate variability (HRV) as a measure of autonomic stability in prenatal opiate-exposed neonates (n = 14) and in control term infants (n = 10). Electrocardiographic data during both non-nutritive and nutritive sucking were evaluated for RR intervals, heart rate (HR), standard deviation of the consecutive RR intervals (SDRR), standard deviation of the differences of consecutive RR intervals (SDDRR), and the power spectral densities in low and high frequency bands.

Fetal-maternal hemorrhage: a case and literature review.

Nearly all pregnancies include an insignificant hemorrhage of fetal blood into the maternal circulation. In some cases, the hemorrhage is large enough to compromise the fetus, resulting in fetal demise, stillbirth, or delivery of a severely anemic infant. Unfortunately, the symptoms of a significant fetal-maternal hemorrhage can be subtle, nonspecific, and difficult to identify at the time of the event.

Swallow-breath interaction and phase of respiration with swallow during nonnutritive suck among low-risk preterm infants.

This study describes swallow-breath interaction and phase of respiration with swallow during nonnutritive suck (NNS) in low-risk preterm infants. Suckle and swallow, thoracic motion, and airflow were measured in 16 infants during NNS. Logistic regression models were used to describe swallow-breath interaction and phase of respiration with swallow.

Adrenal hemorrhage in a newborn.

Sometimes in the course of care in a neonatal intensive care unit, there may be a rush to intervene in cases where limited intervention is actually the correct course. One such example is that of neonatal adrenal hemorrhage. We present the case of a male term neonate with shock, metabolic acidosis, distended abdomen, and falling hematocrit.

Variability of swallow-associated sounds in adults and infants.

We previously used cervical auscultation (CA) to describe the stability of swallow-associated sounds of infant feeding. To date, no similar studies have been performed in adults. The objectives of this study were to identify the initial discrete sounds (IDS) of adult swallows and compare the stability of IDS signals in infants to that of adults.

Neonatal abstinence syndrome and cerebral infarction following maternal codeine use during pregnancy.

Neonatal withdrawal from maternal drugs and medications is common in some NICUs. Codeine-containing cough preparations given to pregnant mothers have been identified as a cause of neonatal abstinence syndrome. However, many women do not consider prescription cough syrups when asked about drug use.

Nonphysician clinicians in the neonatal intensive care unit: meeting the needs of our smallest patients.

Regional variations in the distribution of neonatal physicians and dependence on housestaff with restricted work hours have created workforce shortages in many NICUs. Although neonatal nurse practitioners assist in the delivery of high-quality care, availability of these providers may be inadequate in certain regions. Physician assistants represent a historically underutilized resource to resolve neonatology's workforce issues.

Brain-type natriuretic peptide in the diagnosis and management of persistent pulmonary hypertension of the newborn.

Objective: The diagnosis of persistent pulmonary hypertension (PPHN) can often be difficult to make, especially in a clinical setting in which pediatric echocardiography is not readily available. A noninvasive test that could differentiate PPHN from other cardiorespiratory disease would be very useful in the early management of the disease, because it would allow rapid identification of those infants at greatest risk of requiring the services of a level 3 nursery. Brain-type natriuretic peptide (BNP) is an endogenous peptide hormone secreted by the cardiac ventricles in response to increased wall stress and related ventricular filling pressures.

Pharmacology of drugs of abuse.

The pharmacology of most addictive substances is being studied extensively, not just for their acute effects but also the mechanisms that lead to drug seeking and addiction. The understanding of how these drugs alter their effects at the molecular level with continuing use gives promise toward investigation of novel substances that may be used for treatment. Genetic predisposition and gender differences are also some of the areas where more research is needed.

Cervical accelerometry in preterm infants with and without bronchopulmonary dysplasia.

Cervical accelerometry with digital signal processing (DSP) can identify signals that are consistently associated with swallowing during feeding of infants. It is shown that these signals, called initial discrete sounds (IDSs), become more uniform with advancing postmenstrual age (PMA) in healthy preterm infants. The objectives of this study were to determine if cervical accelerometry and DSP at a higher sample rate than previously used (22 kHz versus 16 kHz), in conjunction with a DSP software package that allows manipulation of the sound files, would improve the accuracy of the previously developed variance index (VI) method of analyzing accelerometric information.

Integration of suck and swallow rhythms during feeding in preterm infants with and without bronchopulmonary dysplasia.

The aim of this study was to define quantitative measures for assessing the integration and maturation of suck and swallow rhythms in preterm infants as they relate to each other. Fourteen preterm infants (eight males, six females; gestational age range 26 to 32 weeks) with bronchopulmonary dysplasia (BPD) and an age-matched cohort of 20 infants (10 males, 10 females; gestational age range 26 to 33 weeks) without BPD were studied weekly from time of initiation of oral feeding using simultaneous recordings of nipple and pharyngeal pressure. The integration of suck and swallow rhythms was quantified by using the coefficient of variation (COV) of the suck-swallow dyad interval.