Pediatrics: Updates in Neonatology

A newborn infant under the age of 28 days is known as a neonate. The study of these infants is known as neonatology. There is a high risk of death associated with neonates as they do not have a well-established immune system and depend on their mothers for all their vital nutrients. 

There are constant developments in neonatology. A good doctor must know these updates, as they are quite handy when dealing with patients in the hospital setting.

Antenatal Corticosteroids

Let us read about the Antenatal Corticosteroids. A preterm baby is a baby born before the 37th week of pregnancy. When a pre-term baby is born, the most important problem that occurs with them is the inability to breathe due to immature lungs. Thus, Antenatal steroids are recommended for any pregnant woman expected to deliver between 24- 34 weeks of gestation. They decrease neonatal mortality and intraventricular hemorrhage.

A single repeat course of antenatal steroids may be given if the last dose was received ≥ 14 days ago. It is Even If the completion of an entire course of antenatal steroids is unlikely, a single dose of antenatal steroids decreases neonatal mortality and morbidity.

Antenatal MgSO4

Antenatal MgSO4 is also Indicated for pregnant women ≤ 32 weeks of gestation with imminent preterm birth. Magnesium sulfate reduces the risk of Cerebral Palsy in preterm babies and decreases gross motor dysfunction. It acts as a Neuroprotective agent which acts by Inhibiting Ca influx into cells.

Delivery Room CPAP

After the delivery of a preterm baby, Delivery Room CPAP should be given for Preterms < 32 Weeks Gestation as compared to intubation and surfactant administration. This has shown a decreased risk of bronchopulmonary dysplasia or chronic lung disease at 36 weeks of age. This Decreased the risk of mechanical ventilation and surfactant. There are specific techniques used for Surfactant Administration. First, we Intubate, then Surfactant, and then we extubate the patient. This is a type of Less invasive surfactant administration.

Neonatal Seizures

A new update, as per the ILAE Classification of Neonatal Seizures, defines Neonatal seizures only as electroclinical or electrical events. Therefore, all Clinical events without EEG correlation are known as Non-seizure episodes. In most cases of acute symptomatic seizures,10-15% occur as a manifestation of an underlying epilepsy syndrome. The most common cause of neonatal seizures is hypoxic-ischemic encephalopathy (HIE), secondary to

perinatal asphyxia. Neonatal seizures occur most commonly at 12-24 hrs of life. Seizures occurring in otherwise well-term neonates on day 2 or 3 of life give a suspicion of Subarachnoid hemorrhage.

You must have heard in your hospital’s obstetrics & gynecology and pediatric department about the term mecinium aspirate. Meconium is the first stool the baby passes. Usually, the baby passes stools within the first few hrs to days, but sometimes this time duration is shortened, and the baby passes meconium while still in the mother’s mom in late pregnancy. The main pathophysiology of Meconium Aspiration Syndrome is the Term neonate when under fetal stress due to hypoxia or acidosis, there is a vagal response generated which increases gut peristalsis

and causes anal sphincter relaxation, due to which the baby passes the meconium in utero.

In a Preterm, The risk of meconium aspiration is respiratory distress. Meconium-stained liquor(MSL) can be due to fetal diarrhea due to sepsis by listeria.

Here we can see Airway obstruction, which could be Partial(in the case of Emphysema) or Complete(in the case of Atelectasis)

Meconium is toxic for type II pneumocytes, and thus, it causes Surfactant inactivation. This causes Cytokine release and complement activation.

Also Read: Intestinal Obstruction: Intussusception, Hirschsprung Disease

Management of a Baby Born to an HIV-Positive Mother

Some new guidelines for a baby born to an HIV Positive mother are that If the mother is already on Anti Retroviral therapy (ART), then daily nevirapine prophylaxis is given starting at birth until the 6th week.

For high-risk neonates, two drugs (zidovudine + nevirapine) are given for the first 6 weeks if the baby is not breastfed and for 12 weeks if the baby is breastfed.

Diagnosis and prophylaxis of HIV in infants:

NAT (nucleic acid amplification testing) at birth or within 2 days of birth and nevirapine ±

Zidovudine is started.

Cotrimoxazole prophylaxis should be started for the babies, and it needs to be continued if HIV

comes positive or unless HIV infection is completely ruled out.

Also Read: Acute Kidney Injury in Pediatrics

Umbilical Cord Blood Banking 

It is the Process by which umbilical and placental blood are salvaged at birth and stored by cryopreservation for future use in umbilical cord blood banks. The main Indication for UCB transplant is for first-degree relatives with disorders like Thalassemia.

There are many advantages of umbilical cord blood banking 

• Ease of procurement
• There is No harm to neonate
• Low immunogenicity
• Decreased risk of Graft versus Host Disease

Packet red blood cell (PRBC) Transfusion in Neonates

The next update in neonatology pertains to the transfusion in neonates. It is done in cases of Severe pulmonary disease/ severe cardiac disease/ major surgery when the Hb < 10 g/dl

For a Moderate pulmonary disease, the threshold of Hb is < 8 g/dl.

In cases of Symptomatic anemia which has symptoms of Tachycardia, increased FiO2, increased lactate levels, and inadequate weight gain) the Hb must be < 7 g/dl to initiate transfusion.

Nasal Cannula Size:

Last but not the least. A component of ventilation is the nasal cannula. To make sure there is a sufficient flow maintained, a High-Flow Nasal Cannula (HFNC) with < 50% of the nasal aperture is used.

While CPAP, a more snuggly fitting cannula, is used.

These were all the main updates for neonatology.

Also Read: Bed Wetting: Causes, Symptoms, Risk Factors, Diagnosis, Treatment and Complications

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