Browsing by Subject "neonate"
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Item Circumcision bleeding complications: neonatal intensive care infants compared to those in the normal newborn nursery(Taylor & Francis, 2017) Litwiller, Abigail R.; Haas, David M.; Obstetrics and Gynecology, School of MedicinePurpose: To determine if a significant difference exists in the bleeding complications following circumcision in neonates admitted to neonatal intensive care unit (NICU) versus the normal newborn nursery (NNN). Materials and methods: Observational cohort study of 260 infants undergoing circumcision with Gomco clamp. Vitamin K was given to neonates at delivery. Demographic data, procedural characteristics, bleeding complications, and interventions were recorded. The bleeding rates of the two groups were compared using chi square. Results: NICU neonates experienced increased bleeding complications versus NNN neonates (22% vs. 9.6%, p = .029). No differences were found regarding gestational age at delivery, age at circumcision, and birth weight. Neonates with circumcision performed at ≥5 days of life experienced increased rates of bleeding complications versus those performed at ≤4 days (28% vs. 10.3%, p = .023). All neonates with circumcision performed ≥5 days of life were initially admitted to the NICU. Conclusion: NICU neonates had increased rate of bleeding complications following circumcision when compared to the NNN neonates. There was an increased rate of bleeding complications in neonates who undergo circumcision at ≥5 days of life. Further research may help to determine if redosing of vitamin K or variations in the circumcision procedure are necessary for circumcision at >4 days of life.Item Congenital leukemia presenting as fever in a neonate(Elsevier, 2015-06) Beard, Bethany; Turner, Joseph; Department of Emergency Medicine, IU School of MedicineBackground Emergency department workup of pediatric fever typically focuses on ruling out serious bacterial infection, but other disease processes can cause fever. Congenital leukemia is a rare but important cause of fever in neonates. We review the presentation, pathophysiology, and potential complications of congenital leukemia presenting to the emergency department as pediatric fever. Case Report We report a case of a 4-week-old infant brought to the emergency department for fever and “not acting normally.” Complete blood count demonstrated hyperleukocytosis. Subsequent bone marrow biopsy and flow cytometry confirmed the diagnosis of congenital leukemia. The extreme elevation of the patient's white blood cell count put her at high risk for complications, necessitating aggressive treatment, close monitoring, and appropriate consultation for comprehensive care. Why Should an Emergency Physician Be Aware of This Congenital leukemia is a rare but serious cause of neonatal fever. While the workup for fever without a source in young pediatric patients primarily focuses on ruling out serious bacterial illness, emergency physicians must be familiar with other potentially life-threatening causes of this complaint.Item Neonatal Acute Kidney Injury: A Case Based Approach(Springer, 2021-11) Starr, Michelle C.; Menon, Shina; Pediatrics, School of MedicineNeonatal acute kidney injury (AKI) is increasingly recognized as a common complication in critically ill neonates. Over the last 5–10 years, there have been significant advancements which have improved our understanding and ability to care for neonates with kidney disease. A variety of factors contribute to an increased risk of AKI in neonates, including decreased nephron mass and immature tubular function. Multiple factors complicate the diagnosis of AKI including low glomerular filtration rate at birth and challenges with serum creatinine as a marker of kidney function in newborns. AKI in neonates is often multifactorial, but the cause can be identified with careful diagnostic evaluation. The best approach to treatment in such patients may include diuretic therapies or kidney support therapy. Data for long-term outcomes are limited but suggest an increased risk of chronic kidney disease (CKD) and hypertension in these infants. We use a case-based approach throughout this review to illustrate these concepts and highlight important evidence gaps in the diagnosis and management of neonatal AKI.Item Obstructive choledocholithiasis requiring intervention in a three week old neonate: A case report and review of the literature(Elsevier, 2016-01) Peters, Lindsay E.; Ladd, Alan P.; Markel, Troy A.; Department of Surgery, IU School of MedicineThe discovery of cholelithiasis in neonates is often incidental, however obstructing common bile duct stones are rare. Herein we report the case of a 3 week old neonate who presented with obstructive choledocholithiasis. The patient was treated conservatively with antibiotics and ursodeoxycholic acid but did not improve. He was therefore taken to surgery for cholecystectomy and stone extraction. The operation was successful and his transaminases and bilirubin levels declined. Trials of conservative management can be attempted in asymptomatic infants with choledocholithiasis. However, failure of the stone to pass or ongoing signs of cholecystitis should be met with operative intervention to remove the obstruction.Item Ventilation Strategies during Extracorporeal Membrane Oxygenation for Neonatal Respiratory Failure: Current Approaches among Level IV Neonatal ICUs(Wolters Kluwer, 2022-11) Ibrahim, John; Mahmood, Burhan; DiGeronimo, Robert; Rintoul, Natalie E.; Hamrick, Shannon E.; Chapman, Rachel; Keene, Sarah; Seabrook, Ruth B.; Billimoria, Zeenia; Rao, Rakesh; Daniel, John; Cleary, John; Sullivan, Kevin; Gray, Brian; Weems, Mark; Dirnberger, Daniel R.; Surgery, School of MedicineOBJECTIVES: To describe ventilation strategies used during extracorporeal membrane oxygenation (ECMO) for neonatal respiratory failure among level IV neonatal ICUs (NICUs). DESIGN: Cross-sectional electronic survey. SETTING: Email-based Research Electronic Data Capture survey. PATIENTS: Neonates undergoing ECMO for respiratory failure at level IV NICUs. INTERVENTIONS: A 40-question survey was sent to site sponsors of regional referral neonatal ECMO centers participating in the Children’s Hospitals Neonatal Consortium. Reminder emails were sent at 2- and 4-week intervals. MEASUREMENTS AND MAIN RESULTS: Twenty ECMO centers responded to the survey. Most primarily use venoarterial ECMO (65%); this percentage is higher (90%) for congenital diaphragmatic hernia. Sixty-five percent reported following protocol-based guidelines, with neonatologists primarily responsible for ventilator management (80%). The primary mode of ventilation was pressure control (90%), with synchronized intermittent mechanical ventilation (SIMV) comprising 80%. Common settings included peak inspiratory pressure (PIP) of 16–20 cm H2O (55%), positive end-expiratory pressure (PEEP) of 9–10 cm H2O (40%), I-time 0.5 seconds (55%), rate of 10–15 (60%), and Fio2 22–30% (65%). A minority of sites use high-frequency ventilation (HFV) as the primary mode (5%). During ECMO, 55% of sites target some degree of lung aeration to avoid complete atelectasis. Fifty-five percent discontinue inhaled nitric oxide (iNO) during ECMO, while 60% use iNO when trialing off ECMO. Nonventilator practices to facilitate decannulation include bronchoscopy (50%), exogenous surfactant (25%), and noninhaled pulmonary vasodilators (50%). Common ventilator thresholds for decannulation include PEEP of 6–7 (45%), PIP of 21–25 (55%), and tidal volume 5–5.9 mL/kg (50%). CONCLUSIONS: The majority of level IV NICUs follow internal protocols for ventilator management during neonatal respiratory ECMO, and neonatologists primarily direct management in the NICU. While most centers use pressure-controlled SIMV, there is considerable variability in the range of settings used, with few centers using HFV primarily. Future studies should focus on identifying respiratory management practices that improve outcomes for neonatal ECMO patients.