A Systematic Review

Morse, Shannon; Groër, Maureen; Shelton, Melissa M.; Maguire, David; Ashmeade, Terri

doi:10.1097/jpn.0000000000000135

Cited by 20 publications

(9 citation statements)

References 41 publications

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“…To determine overall illness severity, the Score for Neonatal Acute Physiology (SNAP) was calculated as described previously,31 based on 26 physiological measurements obtained within the first 48 hours of life. We chose the original SNAP instrument because it is the most comprehensive instrument and has been shown to be a reliable and significant predictor of neonatal mortality in preterm neonates, as compared with birth weight and Apgar scores as predictors alone 31–34. Health outcomes including enteral feeding tolerance, suspect or proven NEC, and late-onset infection were observed prospectively from weekly audits of the EMR until hospital discharge.…”

Section: Methodsmentioning

confidence: 99%

“…We chose the original SNAP instrument because it is the most comprehensive instrument and has been shown to be a reliable and significant predictor of neonatal mortality in preterm neonates, as compared with birth weight and Apgar scores as predictors alone. [31][32][33][34] Health outcomes including enteral feeding tolerance, suspect or proven NEC, and late-onset infection were observed prospectively from weekly audits of the EMR until hospital discharge. Any discrepancies in the EMR were clarified with the clinical management team.…”

Section: Clinical Outcomesmentioning

confidence: 99%

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Vagal Tone and Proinflammatory Cytokines Predict Feeding Intolerance and Necrotizing Enterocolitis Risk

Meister¹,

Gardner²,

Browning³

et al. 2021

Advances in Neonatal Care

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Background: Necrotizing enterocolitis (NEC) is the leading cause of death due to gastrointestinal disease in preterm neonates; yet, clinicians lack reliable and noninvasive predictive tools. Purpose: We aimed to test that diminished high-frequency heart rate variability (HF-HRV) and elevated levels of proinflammatory cytokines would have utility in NEC prediction. Methods: In this multisite prospective study, we enrolled 250 preterm (26-34 weeks' postmenstrual age [PMA]) neonates with physiological stability at 72 hours of life. HRV was measured noninvasively using electrocardiograhic data from standardized cardiorespiratory monitors at postnatal week 1 of life and weekly thereafter until 35 weeks' PMA or discharge; blood was collected for cytokines at postnatal weeks 1 and 3. NEC was diagnosed via Modified Bell's Staging Criteria. Results: HF-HRV was decreased at weeks 1 and 2 in neonates (47% females) who developed feeding intolerance or stage 2+ NEC. In addition, these neonates displayed elevated levels of IL-8 at week 1 and increased levels of IL-1β, IL-6, TNF-α, and IL-8 at week 3 of life. Low HF-HRV was associated with elevated IL-6 or IL-8 levels at weeks 1 and 3 of life. Logistic regression indicated that only HF-HRV was a significant predictor of feeding intolerance or NEC development. Implications for Practice and Research: HRV is a promising noninvasive modality for NEC risk detection. The association of low HF-HRV with elevated proinflammatory cytokines provides evidence for a putative role of the vagal cholinergic pathway in NEC pathogenesis. Future studies should focus on application of these techniques to test clinical therapeutics. Video Abstract available at https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=54.

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Section: Methodsmentioning

confidence: 99%

Section: Clinical Outcomesmentioning

confidence: 99%

Vagal Tone and Proinflammatory Cytokines Predict Feeding Intolerance and Necrotizing Enterocolitis Risk

Meister¹,

Gardner²,

Browning³

et al. 2021

Advances in Neonatal Care

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“…Clinicians with guidance from institutional protocols determined CRRT initiation, modality, prescription, vascular access, anticoagulation including venous thromboembolism prophylaxis (VTE), and termination. All patients received CVVHD with a starting prescribed clearance of 2000 ml/1.73m Illness severity is described by the Score for Neonatal Acute Physiology-II (SNAP-II) score which has been validated in critically ill neonates both at admission and sequentially to predict mortality risk due to physiologic instability [19]. SNAP-II score is a summative score out of 115 and based on mean arterial pressure, temperature, ratio of arterial oxygen partial pressure to fractional inspired oxygen, lowest pH, seizures, and urine output [19].…”

Section: Page 4/23mentioning

confidence: 99%

“…All patients received CVVHD with a starting prescribed clearance of 2000 ml/1.73m Illness severity is described by the Score for Neonatal Acute Physiology-II (SNAP-II) score which has been validated in critically ill neonates both at admission and sequentially to predict mortality risk due to physiologic instability [19]. SNAP-II score is a summative score out of 115 and based on mean arterial pressure, temperature, ratio of arterial oxygen partial pressure to fractional inspired oxygen, lowest pH, seizures, and urine output [19]. SNAP-II scores greater than 30 suggest a 3.5 times increased risk of mortality [19].…”

Section: Page 4/23mentioning

confidence: 99%

“…SNAP-II score is a summative score out of 115 and based on mean arterial pressure, temperature, ratio of arterial oxygen partial pressure to fractional inspired oxygen, lowest pH, seizures, and urine output [19]. SNAP-II scores greater than 30 suggest a 3.5 times increased risk of mortality [19]. Unlike many neonatal illness severity scores, SNAP-II score does not require data from the rst 24 hours of life, which is preferable given not all infants were born in-center.…”

Section: Page 4/23mentioning

confidence: 99%

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Clearance and Nutrition in Neonatal Continuous Renal Replacement Therapy (CRRT) Using the CARPEDIEM™ System

Vuong,

Vega,

Casey

et al. 2023

Preprint

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Background: Infants with end stage kidney disease (ESKD) demonstrate poor growth partly due to obligate fluid and protein restrictions. Delivery of liberalized nutrition on continuous renal replacement therapy (CRRT) is impacted by clinical instability, technical dialysis challenges, solute clearance, and nitrogen balance. We analyzed delivered nutrition and growth in infants receiving CRRT with the Cardio-Renal, Pediatric Dialysis Emergency Machine (CARPEDIEM™). Methods: Single center observational study of infants receiving CRRT with the CARPEDIEM™ between June 1 and December 31, 2021. We collected prospective circuit characteristics, delivered nutrition, anthropometric measurements, and illness severity Score for Neonatal Acute Physiology-II. As a surrogate to normalized protein catabolic rate in maintenance hemodialysis, we calculated normalized protein nitrogen appearance (nPNA) using the Randerson II continuous dialysis model. Descriptive statistics, Spearman correlation coefficient, Mann Whitney, Wilcoxon signed rank, Receiver-Operating Characteristic curves, and Kruskal-Wallis analysis were performed using SAS version 9.4. Results: Eight infants received 31.9 [22.0, 49.7] days of CRRT using mostly (90%) regional citrate anticoagulation. Delivered nutritional volume, protein, calories, enteral calories, nPNA, and nitrogen balance increased on CRRT. Using parenteral nutrition, 90 ml/kg/day should meet caloric and protein needs. Following initial weight loss of likely fluid overload, weight gain occurred after 14 days of CRRT. Despite adequate nutritional delivery, goal weight (z-score=0) and growth velocity were not achieved. Most (62.5%) survived and transitioned to peritoneal dialysis (PD). Conclusions: CARPEDIEM™ is a safe and efficacious bridge to PD in neonatal ESKD. Growth velocity of infants on CRRT appears delayed despite delivery of adequate calories and protein.

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Neonatal transport practices and effectiveness of the use of low‐cost interventions on outcomes of transported neonates in Sub‐Saharan Africa: A systematic review and narrative synthesis

Okai,

Fair,

Soltani

2024

Health Science Reports

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Background and AimsNeonatal deaths contribute significantly to under‐5 mortality worldwide with Sub‐Saharan Africa (SSA) alone accounting for 43% of global newborn deaths. Significant challenges in the region's health systems evidenced by huge disparities in health facility deliveries and poor planning for preterm births are major contributors to the high neonatal mortality. Many neonates in the region are delivered in suboptimal conditions and require transportation to facilities equipped for specialized care. This review describes neonatal transport across the subregion, focusing on low‐cost interventions employed.MethodsWe conducted a systematic review of studies on neonatal transport in SSA followed by a narrative synthesis. A search in the databases CINAHL, EMBASE, MEDLINE, Web of Science, African Index Medicus, and Google Scholar was performed from inception to March 2023. Two authors reviewed the full texts of relevant studies to determine eligibility for inclusion which was subsequently cross‐checked by a third reviewer using a random 30% overlay. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool.ResultsA total of 20 studies were included in this review involving 11,895 neonates from 10 countries. All studies evaluated the transfer of neonates into referral centers from the peripheries. Most neonates were transferred by public transport (n = 12), mostly in the arms of caregivers with little communication between referring facilities. Studies reporting on ambulance transfers reported pervasive inadequacies in both human resources and transport equipment. No study reported on the use of Kangaroo mother care (KMC) in the transfer process.ConclusionsThe neonatal transport system across the SSA region is poorly planned, poorly resourced, and executed with little communication between facilities. Using cost‐effective measures like KMC and improved training of community health workers may be key to improving the outcomes of transported neonates.

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A Systematic Review

Cited by 20 publications

References 41 publications

Vagal Tone and Proinflammatory Cytokines Predict Feeding Intolerance and Necrotizing Enterocolitis Risk

Vagal Tone and Proinflammatory Cytokines Predict Feeding Intolerance and Necrotizing Enterocolitis Risk

Clearance and Nutrition in Neonatal Continuous Renal Replacement Therapy (CRRT) Using the CARPEDIEM™ System

Neonatal transport practices and effectiveness of the use of low‐cost interventions on outcomes of transported neonates in Sub‐Saharan Africa: A systematic review and narrative synthesis

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