hemodynamic-precision-neonatal-intensive-care-unit-using-targeted

Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography

Targeted neonatal echocardiography (TnECHO) refers to the use of comprehensive echocardiographic evaluation and physiologic data to obtain accurate, ...

University of Oklahoma Health Sciences Center

Automated complete blood counts (CBCs) provide imprecise measures of neonatal neutrophil composition due to the presence of nucleated red cells, which masquerade as white cells. Manual differentials (MDs) must be performed but can be flawed due to technician inexperience or limited cell counts. Our study evaluated whether flow cytometry could more accurately determine neutrophil composition in term newborns compared with adult controls.

Is the Use of Complete Blood Counts with Manual Differentials an Antiquated Method of Determining Neutrophil Composition in Newborns?

At birth neonatal neutrophil composition differs from that of adults due to a higher number of circulating immature forms. To date only a single study has evaluated neutrophil performance based on cell maturity. For this study, we examined functional differences in chemotaxis and phagocytosis between neonatal and adult neutrophils based on cell development and labor exposure.

Alterations in neonatal neutrophil function attributable to increased immature forms.

Inhaled nitric oxide (iNO) use in premature newborns remains controversial among clinicians. In 2014, the American Academy of Pediatrics, Committee on Fetus and Newborn released a statement that the available data do not support routine iNO use in pre-term newborns. Despite the absence of significant benefits, 2016 California data showed that clinicians continue to utilize iNO in pre-term infants. With studies as recent as January 2017, the Cochrane review confirmed no major advantages of iNO in pre-term newborns. Still, it recognized that a subset of pre-term infants with pulmonary hypertension (PHTN) had not been separately investigated. Furthermore, recent non-randomized controlled trials have suggested that iNO may benefit specific subgroups of pre-term newborns, especially those with PHTN, prolonged rupture of membranes, and antenatal steroid exposure. Those pre-term infants who showed a clinical response to iNO had increased survival without disability. These findings underscore the need for future studies in pre-term newborns with hypoxemic respiratory failure and PHTN. This review will discuss the rationale for using iNO, controversies regarding the diagnosis of PHTN, and additional novel approaches of iNO treatment in perinatal asphyxia and neonatal resuscitation in the pre-term population < 34 weeks gestation.

The Controversy Persists: Is There a Qualification Criterion to Utilize Inhaled Nitric Oxide in Pre-term Newborns?

Neonates with congenital heart disease (CHD) are at an increased risk of developing necrotizing enterocolitis (NEC), an acute inflammatory intestinal injury most commonly associated with preterm infants. The rarity of this complex disease, termed cardiac NEC, has resulted in a dearth of information on its pathophysiology. However, a higher incidence in term infants, effects on more distal regions of the intestine, and potentially a differential immune response may distinguish cardiac NEC as a distinct condition from the more common preterm, classical NEC. In this review, risk factors, differentiated from those of classical NEC, are discussed according to their potential contribution to the disease process, and a general pathogenesis is postulated for cardiac NEC. Additionally, biomarkers specific to cardiac NEC, clinical outcomes, and strategies for achieving enteral feeds are discussed. Working towards an understanding of the mechanisms underlying cardiac NEC may aid in future diagnosis of the condition and provide potential therapeutic targets.

Clinical Characteristics and Potential Pathogenesis of Cardiac Necrotizing Enterocolitis in Neonates with Congenital Heart Disease: A Narrative Review.

Article	Year
Is the Use of Complete Blood Counts with Manual Differentials an Antiquated Method of Determining Neutrophil Composition in Newborns? Annals of clinical and laboratory science\| PubMed ID: 26275691	2015
Alterations in neonatal neutrophil function attributable to increased immature forms. Early human development\| PubMed ID: 27428466	2016
The Controversy Persists: Is There a Qualification Criterion to Utilize Inhaled Nitric Oxide in Pre-term Newborns? Frontiers in pediatrics\| PubMed ID: 33869113	2021
Clinical Characteristics and Potential Pathogenesis of Cardiac Necrotizing Enterocolitis in Neonates with Congenital Heart Disease: A Narrative Review. Journal of clinical medicine\| PubMed ID: 35887751	2022

Marjorie Makoni

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