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Abdominal distension is a common clinical presentation in neonates admitted to neonatal intensive care units (NICUs), especially preterm infants. The underlying causes are multiple and range from simple transient etiologies to life-threatening events with significant morbidities. Neonatal sepsis is the most common diagnosis encountered; however, other differential diagnoses should be thought. Premature neonates are particularly susceptible to abdominal distension because of gut immaturity, relative immune deficiency and frequent exposure to invasive procedures. Herein, we report a preterm infant who developed abdominal distension and hepatomegaly on day 4 of life. This was associated with progressively rising C-reactive protein (CRP) levels and normal abdominal X-ray. Bed side abdominal ultrasonography revealed the diagnosis.

Neonatal lupus erythematosus (NLE) is a rare autoimmune- mediated spectrum of disorders occurring in 1/20,000 live births and causing fetal tissue damage due to trans placental passage of anti-Sjögren’s-syndrome-related antigens A and B (anti Ro/SSA and anti La/SSB immunoglobulin G). Approximately 60% of the mothers are asymptomatic on diagnosis of NLE, while the remaining may have SLE, Sjögren syndrome, or other autoimmune disorders. Clinical presentation of NLE varies from dermatologic, cardiac, hepatic, splenic, hematologic, or neurogenic abnormalities. All except cardiac manifestations are reversible and benign. We report a case of NLE in a late preterm infant presenting with multi-organ involvement and congenital complete heart block. The mother was completely asymptomatic but had a significantly high anti-Ro/SSA antibody level. Antenatal fetal echocardiography revealed a structurally normal heart with significant bradycardia and complete heart block. After birth, the infant had multi-organ involvement and persistent bradycardia ranging from 45 to 65bpm with respiratory distress secondary to cardiac decompensation. A permanent epicardial pacemaker was implanted at the age of 2weeks with gradual improvement of respiratory and cardiac functions. Upon follow-up, the infant was thriving well and gaining weight with a stable general condition and reasonable pacemaker function at a rate of 100bpm.

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Umbilical venous catheters (UVCs) are routinely inserted in preterm infants for total parenteral nutrition, medications, and blood sampling. The unique course of the umbilical vein, and the associated hemodynamic instability during sampling or infusion via UVCs place preterm infants at a higher risk of intraventricular hemorrhage (IVH). Alternative central line placement would theoretically avoid the swinging of cerebral blood flow and reduce chances of IVH development.PURPOSE To examine whether the rates of severe IVH or death vary among preterm infants receiving UVCs compared to peripherally inserted central catheters (PICCs).METHODS This randomized, controlled unmasked trial was conducted at the neonatal intensive care unit of Dubai Hospital between January 2018 and December 2021. A total of 280 preterm infants (born at 23-30 weeks gestation) were randomly assigned after birth to either the UVC placement group or the PICC group. MAIN OUTCOMES AND MEASURES The primary outcome was a composite of severe IVH or death among preterm infants less than 30 weeks gestation with UVC vs PICC. The secondary outcomes were the incidence of neonatal sepsis, necrotizing enterocolitis, any grade of IVH, and feeding intolerance.RESULTS Among the 223 preterm infants randomized (median gestational age, 27 weeks [interquartile range, 26-29]; male: UVC group, 59 [49%]; PICC group, 63 [61%]), 120 (53%) were randomized to the UVC group and 103 infants (47%) were randomized to the PICC group. Severe IVH occurred in 16 infants (13.3%) in the UVC group and 11(10.7%) in the PICC group (risk difference [RD], 2.6% [95% CI, -5.9 to 11.1]; P = 0.55). The incidence of death before 28 days of life did not differ significantly between groups (10 [8.3%] in UVC vs 6 [5.8%] in PICC; RD, 2.5% [95% CI, −4.1% to 9.1%]; P = 0.47). Sixteen percent (20/120) of the UVC group died or developed severe IVH compared with 13% (14/103) of the PICC group (risk difference, 1.7% [95% CI, −7.3% to 10.9%]; P = 0.57). Logistic regression analysis showed that gestational age rather than birth weight and early inotropic support were significant risk factors for severe IVH occurrence in preterm infants [OR= 0.75, (95% CI, 0.58-0.99); p=0.042], and [OR= 3.15, (95% CI, 1.18-8.38); p=0.022]. The incidence of necrotizing enterocolitis was significantly higher in the UVC group infants than in the PICC group infants (7.5% vs. 2%); p = 0.04.CONCLUSION This study found that the incidence of severe IVH or death did not differ significantly among preterm infants <30 weeks gestation subjected to UVC or PICC placement. Gestational age rather than birth weight and early inotropic support were significant risk factors for the development of severe IVH. Umbilical venous catheter is an additional risk factor for the development of NEC, but further research is required to validate this finding.TRIAL REGISTRATION ANZCTR Identifier: ACTRN12617001049369.

Background: Nutritional management of preterm infants represents a significant challenge for most practitioners caring for sick and/or premature babies. Despite aggressive parenteral and enteral alimentation, a considerable number of preterm infants continue to fall far short of expected growth trajectories that match infants of similar gestation in-utero. Postnatal growth failure may be associated with future neurodevelopmental and cognitive impairments. Objective: The aim of the research is to investigate the incidence of postnatal growth restriction (PNGR) and characteristics of nutritional practices and growth parameters in a cohort of preterm infants born <32 weeks’ gestational age (GA) in a single neonatal intensive care unit (NICU). Methodology: This prospective study included 130 preterm infants born <32 weeks’ GA and admitted to the NICU between February 2018 and January 2020. The infants were divided into two groups: A (GA 23–26+6 weeks [n=50]) and B (27–31+6 weeks [n=80]). The association between PNGR and predicting risk factors was evaluated using logistic regression models. Results: PNGR was found in 62 (47%) infants at 28 days of life and increased to 73% of infants at 36 weeks’ postmenstrual age. Low birth weight and GA were independent factors predicting growth failure. PNGR was significantly correlated with birth weight (p < 0.01), length (p < 0.002), and GA (p < 0.03) at birth; however, HC was not a predictor of PNGR at 28 days. At 36 weeks’ PMA or discharge, PNGR was more pronounced in length, with a mean Z-score of -3.0, followed by weight, with a mean Z-score of -2.1, and an HC Z-score of -1.4. Conclusion : PNGR was significantly high in preterm infants <32 weeks’ gestation. A significant nutritional gap still exists between the recommended and actual caloric and protein supplementation, especially in the first few days after birth. Delayed optimization of caloric intake may be insufficient to promote growth trajectories, especially in preterm infants with significant morbidities.

BACKGROUND: Umbilical venous catheters (UVCs) or peripherally inserted central catheters (PICCs) are routinely inserted in preterm infants for total parenteral nutrition and medications. We aimed to examine whether the rates of severe intraventricular hemorrhage (IVH) or death vary among preterm infants receiving UVCs compared to PICCs. METHODS: This randomized controlled trial included preterm infants <  30 weeks gestation assigned after birth to either UVC placement group or PICC group. RESULTS: A total of 233 preterm infants (117 infants in UVC group, 116 infants in PICC group) were randomized and collected data was available for intention-to-treat analysis. There were no differences in baseline population characteristics. Severe IVH occurred in 16 infants (13.6%) in the UVC group and 11(9.5%) in the PICC group (risk difference [RD], 4.1% [5% CI, –4 to 12.3]; P = 0.42). The incidence of death before 28 days of life did not differ significantly between groups (10 [8.5% ] in UVC vs 6 [5.1%] in PICC; RD, 3.4% [95% CI, –3.0 to 9.84]; P = 0.44). Seventeen percent (20/117) of the UVC group died or developed severe IVH compared with 12% (14/116) of the PICC group (risk difference, 5% [95% CI, –4.01 –14.06]; P = 0.36). The incidence of necrotizing enterocolitis (NEC) was significantly higher in the UVC group infants than in the PICC group infants (7.7% vs. 1.7%); p = 0.03. CONCLUSIONS: The incidence of severe IVH or death did not differ significantly among preterm m infants <  30 weeks gestation subjected to UVC or PICC placement. Early inotropic support was a significant risk factor for the development of severe IVH. UVC maybe an additional risk factor for the development of NEC, but further research is required to validate this finding.