Late preterm births (34 + 0–36 + 6 gestational weeks) comprise 75

Congenital complete atrioventricular block is a rare cardiac conduction disorder where atrial impulses fail to conduct to the ventricles, resulting in asynchronous atrial and ventricular activation. This asynchrony often leads to severe bradycardia, frequently necessitating cardiac pacing, and is associated with significant morbidity and mortality both in utero and postnatally. We present a case of a preterm twin born at 34 weeks of gestation, with a birth weight of 1.5 kg, diagnosed with congenital complete atrioventricular block during pregnancy. Following birth, due to severe bradycardia of 40 bpm, the infant was initially managed with continuous isoproterenol infusion. Oral salbutamol was subsequently introduced, allowing for a gradual tapering off isoproterenol. The side effect of increased heart rate associated with salbutamol allowed the infant to maintain a heart rate above 70 bpm. Over the first 4 months of life, the infant demonstrated normal growth and development, reaching a weight of 4 kg. At 4 months, after experiencing feeding difficulties, a pacemaker was implanted. This therapeutic strategy allowed for the postponement of pacemaker implantation through noninvasive management with oral salbutamol, reducing the risks of prolonged central line use and repeated pacemaker implantation.

Esophageal lung is a rare congenital malformation. We present a full-term infant with an esophageal lung presenting as a white lung, dysmorphic features, and VACTER association. Right pneumonectomy was successfully performed. This is the first report of esophageal lung associated with the VACTER group of anomalies combined with dysmorphic features.

BACKGROUND AND OBJECTIVES Late-onset sepsis is associated with significant morbidity and mortality among very low birth weight (VLBW) infants. Our objective was to determine risk factors associated with late-onset sepsis and to present temporal trends in overall and pathogen-specific rates. METHODS Population-based study by the Israel Neonatal Network on VLBW infants (≤1500 g) born between 1995 and 2019. Late-onset sepsis required clinical symptoms and microbiologic confirmation. Bivariate and multivariable analyses were performed to identify risk factors. The study period was divided into 4 epochs. Overall and pathogen-specific late-onset sepsis rates for each epoch were compared. RESULTS The study population comprised 31 612 VLBW infants, of whom 7423 (23.5%) had late-onset sepsis. An increased adjusted risk of late-onset sepsis was associated with gestational age <27 w (odds ratio [OR] 8.90, 95% confidence interval [CI] 7.85-10.09) and delivery room resuscitation (OR 1.43, 95% CI 1.34-1.52) and a decreased adjusted risk among infants born between 2013 and 2019 (OR 0.32, 95% CI 0.29-0.35). Late-onset sepsis rates declined from 29.5% in 1995 to 2000 to 13.0% in 2013 to 2019. Gram-negative and fungal rates decreased in all epochs, whereas gram-positive rates decreased only in the last epoch. The adjusted hazard ratios (95% CI) decreased in the 2013 to 2019 versus 1995 to 2000 epochs and were: all late-onset sepsis, 0.40 (0.37-0.43); gram-positive, 0.47 (0.37-0.59); gram- negative, 0.54 (0.48-0.61); fungal, 0.17 (0.12-0.22). CONCLUSIONS The strongest risk factor for late-onset sepsis was gestational age <27 w. Over a 25-year period, the pathogen-specific rates of late-onset sepsis among VLBW infants decreased approximately twofold for gram-positive and gram-negative bacterial infections and sixfold for fungal infections.

To evaluate the effectiveness of a novel protocol, adopted in our institution, as a quality improvement project for congenital diaphragmatic hernia (CDH). A maximal lung protection (MLP) protocol was implemented in 2019. This strategy included immediate use of high-frequency oscillatory ventilation (HFOV) after birth, during the stay at the Neonatal Intensive Care Unit (NICU), and during surgical repair. HFOV strategy included low distending pressures and higher frequencies (15 Hz) with subsequent lower tidal volumes. Surgical repair was performed early, within 24 h of birth, if possible. A retrospective study of all inborn neonates prenatally diagnosed with CDH and without major associated anomalies was performed at the NICU of Schneider Children’s Medical Center of Israel between 2009 and 2022. Survival rates and pulmonary outcomes of neonates managed with MLP were compared to the historical standard care cohort. Thirty-three neonates were managed with the MLP protocol vs. 39 neonates that were not. Major adverse outcomes decreased including death rate from 46 to 18

Objective We aimed to determine the independent effect of maternal antepartum hemorrhage (APH) on mortality and major neonatal morbidities among very low birth weight (VLBW), very preterm infants. Study Design A population-based cohort study of VLBW singleton infants born at 24 to 31 weeks of gestation between 1995 and 2016 was performed. Infants born with the following pregnancy associated complications were excluded: maternal hypertensive disorders, prolonged rupture of membranes, amnionitis, maternal diabetes, and small for gestational age. APH included hemorrhage due to either placenta previa or placental abruption. Univariate and multivariable logistic regression analyses were performed to assess the effect of maternal APH on mortality and major neonatal morbidities. Results The initial cohort included 33,627 VLBW infants. Following exclusions, the final study population comprised 6,235 infants of whom 2,006 (32.2%) were born following APH and 4,229 (67.8%) without APH. In the APH versus no APH group, there were higher rates of extreme prematurity (24-27 weeks of gestation; 51.6% vs. 45.3%, p < 0.0001), mortality (20.2 vs. 18.5%, p = 0.011), bronchopulmonary dysplasia (BPD, 16.1 vs. 13.0%, p = 0.004) and death or adverse neurologic outcome (37.4 vs. 34.5%, p = 0.03). In the multivariable analyses, APH was associated with significantly increased odds ratio (OR) for BPD in the extremely preterm infants (OR: 1.31, 95% confidence interval: 1.05-1.65). The OR's for mortality, adverse neurological outcomes, and death or adverse neurological outcome were not significantly increased in the APH group. Conclusion Among singleton, very preterm VLBW infants, maternal APH was associated with increased odds for BPD only in extremely premature infants, but was not associated with excess mortality or adverse neonatal neurological outcomes.

Objectives: Neonatal late-onset sepsis work-up is a frequent occurrence in every neonatal department. Blood cultures are the diagnostic gold standard, however, a negative culture prior to 48–72 h is often considered insufficient to exclude sepsis. We aimed to develop a decision tree which would enable exclusion of late-onset sepsis within 24 h using clinical and laboratory variables.Study Design: Infants evaluated for late-onset sepsis during the years 2016–2019, without major malformations, in a tertiary neonatal center were eligible for inclusion. Blood cultures and clinical and laboratory data were extracted at 0 and 24 h after sepsis work-up. Infants with bacteriologically confirmed late-onset sepsis were compared to matched control infants. Univariate logistic regression identified potential risk factors. A decision tree based on Chi-square automatic interaction detection methodology was developed and validated.Results: The study cohort was divided to a development cohort (105 patients) and a validation cohort (60 patients). At 24 h after initial evaluation, the best variables to identify sepsis were C-reactive protein > 0.75 mg/dl, neutrophil-to-lymphocyte ratio > 1.5 and sick-appearance at 24 h. Use of these 3 variables together with blood culture status at 24 h, enabled identification of all infants that eventually developed sepsis through the decision tree model. Our decision tree has an area under the receiver operating characteristic curve of 0.94 (95% CI: 0.90–0.98).Conclusions: In non-sick appearing infants with a negative blood culture at 24 h and normal laboratory values, sepsis is highly unlikely and discontinuing antibiotics after 24 h is a viable option.

Objective: Very low birth weight (VLBW), defined as less than 1500 gr, is an established risk factor for kidney disease in adulthood. To assess that, we examined whether VLBW manifests signs of renal dysfunction at as early as age 10 years, as reflected by elevated blood pressure, proteinuria and reduced glomerular filtration rate (GFR). Methods: 103 children aged 10-13 years and born with VLBW underwent consecutive blood pressure measurements, spot urine analysis, and weight and height measurements. Prevalence rates of hypertension, pre-hypertension and proteinuria were calculated. Characteristics were compared between children with normal and abnormal renal function, to identify risk factors for renal dysfunction. Results: The prevalence of systolic hypertension was 15.8% (95% CI 8.69% - 22.91%) of systolic pre-hypertension 6.9% (95% CI1.96% - 11.84%), and of proteinuria 15.7% (95% CI 8.64% - 22.76%) of the study population. Hypertension was associated with a significantly diminished mean birth weight compared to the remainder of the cohort (939.3gr vs 1111gr, P=0.024). Proteinuria and microalbuminuria were associated with lower mean current body weights: 27.2kg vs 36.7kg P=0.015 and 31.3 kg vs 36.8kg; P=0.023; and with increased mean estimated GFR (126.1 vs 108.3 mL/min per 1.73 m2; P = 0.0059). Conclusions: In a cohort of children aged 10-13 years, who were born preterm with VLBW, disturbed kidney function presented in considerably higher proportions than in general populations of this age. The findings merit considering initiation of routine screening during early adolescence, for hypertension, proteinuria and GFR in this risk group.

BACKGROUND:Monitoring infant growth is essential for evaluation of development and is an important indicator of health and illness. Length is an essential indicator of infant growth, however, length measurement methods suffer from limitations which restrict their use.OBJECTIVE:To improve infant length measurement by development of a novel, accurate, precise and practical measurement technique.METHODS:A new system based on stereoscopic vision was developed. The system is comprised of two digital still cameras combined with software that calculates the infant's length from two simultaneously taken pictures. Length measurements of 54 healthy newborns were performed using a standard length board and the stereoscopic system. The two measurement methods were compared.RESULTS:Mean infant length was 473.1 (SD=29.1) mm versus 473.3 (SD=29.3) mm by length board and by the stereoscopic system, respectively. The mean difference between measurements was 0.2 (SD=2.5) mm and the mean of the absolute values of differences was 2.0 (SD=1.4) mm. Bland-Altman analysis showed good agreement between the two measurement methods. Precision of the new technique was demonstrated by a technical error of measurement of 2.57 mm.CONCLUSIONS:The stereoscopic system is accurate, reliable, easy to use, and involves less handling and discomfort to the newborns. It has the potential to measure premature infants or sick neonates through incubators.

We aimed to evaluate pregnancy outcome in parturients > 34 weeks of gestation diagnosed with isolated polyhydoramnios (AFI > 25cm). A retrospective cohort study of singleton pregnancies with no gestational or pre-gestational diabetes, or structural or chromosomal anomalies. Overall, 631 women with polyhydramnios were compared with 32900 women with normal amniotic fluid volume. Our main findings were (p<0.001 unless stated otherwise):1)Parturients in the study group were less likely to be primiparous (26 vs. 32%, p=.001) or to deliver at 34-36 weeks (2.7 vs. 4.7%, p=.02), and more likely to undergo cesarean delivery (25.4 vs. 16.7%), mainly due to emergency cesarean delivery (73.1 vs. 62.1%, p=.005) (Table). They were also more likely to undergo induction of labor (6.8 vs. 4.4%), more likely to require intervention because of nonreassuring fetal heart rate (NRFHR) (4.8 vs 3.0%, p=.01) and less likely to have a successful VBAC (69.7 vs. 91.5%).2)Neonates in the study group had higher mean birth weight and birth weight percentile (3520±444 vs. 3235±447 grams and 72±23 vs. 56±26%, respectively), were at 3-fold risk for macrosomia (12 vs. 4.3%) and 5-fold risk for shoulder dystocia (1 vs. 0.2%). Rates of asphyxia (2.5 vs. 1.4%, p=.02), hypoglycemia (1.9 vs. 1.0%, p=.03) and RDS (0.3 vs. 0.04%, p=.002) were higher as well as the composite outcome rate (15.7 vs. 11.6%, p=.001)(Table).3)After multivariate regression analysis, isolated polyhydramnios was still significantly associated with cesarean delivery (OR 2.2, 95% CI 1.8-2.8), NRFHR requiring intervention (OR 2.0, 95% CI 1.4-3.0, p=.001) and RDS (OR 8.4, 95% CI 1.6-44.5, p=.01).4)No significant differences were observed regarding fetal death, prolapsed umbilical cord or placental abruption rates, PPH, NICU admissions, jaundice, HIE, IVH or seizures. Isolated polyhydroamnios after 34 weeks of gestation is associated with adverse obstetrical and neonatal outcomes.Tabled 1Obstetrical and neonatal outcomeComposite: 5 minutes Apgar<7; placental abruption; prolapsed umbilical cord; chorioamnionitis; shoulder dystocia; NICU admission; seizures; HIE, IVH, acidosis, TTN, NEC; Sepsis; cardiorespiratory distress or mechanical ventilation; cephlahematoma; subgalleal, subarachnoid or subdural hemorrhage; TOLAC - Trial of labor after cesarean delivery, VBAC - Vaginal birth after cesarean delivery; RDS - Respiratory distress syndrome.€Data are presented as mean±SD; ∗Percentage out of total cesarean deliveries; ∗∗Percentage out of parturients with previous cesarean delivery; ∗∗∗Percentage out of TOLAC. Open table in a new tab

OBJECTIVE:We sought to assess the independent effect of perinatal factors on the risk for bronchopulmonary dysplasia (BPD) in very-low-birthweight infants.STUDY DESIGN:This was a population-based observational study. Data were prospectively collected by the Israel Neonatal Network. Multivariable analyses identified independent risk factors for BPD.RESULTS:Of 12,139 infants surviving to a postmenstrual age of 36 weeks, 1663 (13.7%) developed BPD. BPD was independently associated with young maternal age (odds ratio [OR], 1.53), maternal hypertensive disorders (OR, 1.28), antepartum hemorrhage (OR, 1.26), male gender (OR, 1.41), non-Jewish ethnicity (OR, 1.23), birth defects (OR, 1.94), small for gestational age (GA) (OR, 2.65), and delivery room resuscitation (OR, 1.86). Stratified analysis by GA groups showed that postdelivery resuscitation had a more pronounced effect with increasing maturity.CONCLUSION:Perinatal factors and pregnancy complications were independently associated with development of BPD in very-low-birthweight infants. Most risk factors identified were consistent within GA groups.

Background & aims: The risk of childhood obesity, an increasingly prevalent problem worldwide, might be predictable by early body mass index measurements. This study sought to develop body mass index and weight-for-length ratio references for infants born at 33-42 weeks gestation and to validate these data against the growth curves of the World Health Organization Multicenter Growth Reference Study.Methods: Data were collected from the Neonatal Registry of Rabin Medical Center for all healthy singleton babies born live at 33-42 weeks gestation. Crude and smoothed reference tables and graphs for body mass index and weight-for-length ratio by gestational age were created for males and females, separately.Results: Birth weight, length, and body mass index percentiles for full-term neonates were similar to the World Health Organization study, reinforcing the generalizability of our reference charts for infants born at 33-42 weeks. Cutoff values for small for date (<5th, <10th percentile) and large for date (>85th, >95th percentile) infants differed across gestational ages in both pre-term and full-term infants.Conclusions: As body proportionality indexes provide an assessment of body mass and fatness relative to length, we suggest that BMI and Wt/L ratio percentiles be added to weight and length growth curves as a routine intrauterine growth assessment at birth. (C) 2011 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

BACKGROUND Many centers in Israel still use pre-1970 reference data for neonatal weight, length and head circumference. A recently published population-based reference overestimated the weight of premature infants. OBJECTIVE To develop a national reference for birth weight, birth length and head circumference by gestational age for singleton infants in Israel. METHODS Data were collected on all singleton live births documented in the neonatal registry of Rabin Medical Center from 1991 to 2005 (n=82,066). Gestational age estimation was based on the last menstrual period until 1977 and early fetal ultrasound thereafter. Neonates with an implausible birth weight for gestational age (identified by the rule of median +/- 5 standard deviations or expert clinical opinion) were excluded. Reference tables for fetal growth by gestational age were created for males and females separately. RESULTS The growth references developed differed markedly from the Usher curves currently used in our department. Compared to the recently published population-based birth weight reference, our data were free of the problem of differential misclassification of birth weight for gestational age for the premature infants and very similar for the other gestational age groups. This finding reinforced the validity of our measurements of birth weight, as well as of birth length and head circumference. CONCLUSIONS Use of our new (birth length and head circumference) and improved (birth weight) gender-specific hospital-based reference for fetal growth may help to define normal and abnormal growth in the neonatal population of Israel and thereby improve neonatal care and public health comparisons.

We present a case of recurrent hypothermia in concordant monozygotic twins born to a mirtazapine treated mother. The twins were born at 35 weeks gestation at birth weights of 2426 g and 2355 g. Both twins presented with recurrent hypothermia continuing until day 10 of life. Possible etiologies of hypothermia were excluded. The degree of prematurity and the weight of the twins were not consistent with prolonged thermal instability. The twins' mother was treated with mirtazapine during the entire pregnancy. Due to its serotonin and alpha 2 receptors antagonism mirtazapine is known to influence thermoregulation in adult humans and other mammals. We suggest that maternal mirtazapine treatment during pregnancy was associated with recurrent hypothermia in both identical twins.