Background - Early prediction of Hemodynamically significant Patent ductus arteriosus (HsPDA) in preterm with perfusion index (PI) by pulse oximeter will help manage PDA in centers where echocardiography is not feasible hence reducing morbidity.
Objective – To assess the value of PI and arrive at the ideal cut-off value of delta PI (DPI) (pre and postductal difference in PI) in identifying echocardiogram confirmed HsPDA and to identify the independent influence of HsPDA on DPI.
Methods – Prospective observational study conducted in 156 preterm newborns of <37 weeks in the NICU of Mehta multispecialty hospitals India Pvt. Ltd, Chennai, from August 2019 to March 2020 after ethics approval and informed consent. 156 preterm babies were classified into noPDA, HsPDA and Non-Hs PDA based on echocardiogram findings and compared with DPI value on Day 1 to 3 of life. Receiver operating characteristic (ROC) curve was constructed for DPI to establish cut-offs for diagnosing HsPDA. A p value <0.05 is considered for statistical significance.
Results - There was a significant lower PI in both preductal and post ductal limbs with HsPDA compared to other groups. A DPI Cut-off of 0.75 on day 2 of life has a sensitivity of 75%, specificity of 100% and positive predictive value (PPV) of 100% and a negative predictive value of 89%.
Conclusion - PI is a simple non-invasive bed side tool predict the presence of a HsPDA in preterm newborns and DPI of >0.75 indicates for the presence of HsPDA.

Background:

Hypoxic-ischaemic encephalopathy(HIE) carries significant risk of brain injury and adverse neurodevelopmental outcome.

Objective:

To investigate the ability of currently available bedside monitoring techniques to predict short-term and long-term outcome in infants with HIE.

Methods:

Prospective observational study, tertiary NICU, Ireland. Infants with all grades of HIE had continuous electroencephalography(EEG), non-invasive cardiac output monitoring(NICOM) and near-infrared spectroscopy(NIRS) commenced after birth. One-hour epochs of time-synchronised data were selected at 6 and 12-hours.

Abnormal short-term outcome: Abnormal MRI and/or death in the first week after birth.

Abnormal long-term outcome: A score of <1SD below the mean in any of the developmental domains of the Bayley’s Developmental Assessment at 2 years and/or death of the infant.

Results:

Fifty-seven infants with HIE were included(27mild, 24moderate, 6severe). Three infants died in the first week and neurodevelopmental outcome was available in 42 infants. At 6-hours, EEG relative spectral power and spectral difference at the higher frequency bands were significantly associated with abnormal long-term outcome: AUC 0.83, 95%CI 0.66-0.99 and AUC 0.78, 95%CI 0.55-1.00 respectively(Table 1). At 12-hours, EEG spectral power significantly predicted abnormal short-term outcome(AUC 0.68, 95%CI 0.53-0.84). EEG spectral power and cerebral oxygenation(cSO2) significantly predicted long-term outcome:AUC 0.75, 95%CI 0.57-0.93 and AUC 0.73, 95%CI 0.55-0.90 respectively. Combining different modalities did not improve prediction. NICOM measurements were not helpful in identifying infants with abnormal outcome.

Conclusion:

EEG remains the best individual predictor of outcome in infants with HIE. Quantitative EEG features at 6- and 12-hours successively predicted both short- and long-term outcome in infants with HIE.

Background: Continuous improvements in neonatal intensive care are associated with improvements in the survival of extremely preterm infants (EP).
Objective: To assess the impact of infrastructural changes and modern protocols for neonatal care performed in 2014 on the survival rate of EP.
Methods: All surviving EP (≤28 weeks of gestation) cared for in our tertiary neonatal intensive care unit between January, 1 2010 and December, 31 2020 were included. Perinatal, maternal and neonatal data related to neonatal care, treatment, and short term outcome were prospectively collected in our unit's database. The data of EP born in 2010-2014 were compared to those delivered in 2015-2020. Statistical analysis was performed using IBM SPSS Statistics 23.0, p<0.05 being considered statistically significant.
Results: 277 EP were included. EP born during the second study period had significantly lower gestational age (26.6±1.3 vs 27.1±1.3 weeks), birthweight (927.5±192.7 vs. 1001.9±173.8 g), increased rates of prenatal corticosteroid prophylaxis, lower rates of mechanical ventilation, shorter duration of parenteral nutrition, shorter time to regain birth weight, shorter duration of prophylactic antibiotic therapy and a reduced number of blood transfusions (despite lower hemoglobin levels at birth; p<0.05), but an increased rate of bronchopulmonary dysplasia (p=0.051) and metabolic bone disease of prematurity.
Conclusion: Modern infrastructure and implementation of new care and treatment protocols were associated with improvements in the survival of EP. More efforts are needed to improve the outcomes of this vulnerable population.