Tip 33b: congenital CMV

>90% infants with infection are asymptomatic but can still develop sensorineural hearing loss.

Other symptoms/signs are: IUGR, microcephaly,  thrombocytopenia, jaundice, hepatitis, pneumonitis, periventricular calcification, chorioretinitis and cataracts.

Reference: Rennie & Roberton’s Textbook of Neonatology, 5th Ed, 2005. London: Churchill.

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Tip 33a: congenital cytomegalovirus (CMV)

In the UK, 50% women in antenatal clinics are seropositive for CMV.

Incidence of congenital CMV infection is ~3 in 1,000 live births. Placental transmission rates are ~40% during primary infection and 1% for reactivated infection.

The earlier the gestation at transmission, the worse the prognosis.

Reference: Rennie & Roberton’s Textbook of Neonatology, 5th Ed, 2005. London: Churchill.

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Tip 32: specialist preterm milks 2

Nutriprem 2 and SMA Gold Prem 2 contains slightly less Kcal, protein, Ca, PO4 & iron than Nutriprem 1 and SMA Gold Prem 1. Babies on this milk still require vitamin supplementation but not iron. It is generally introduced to formula fed preterm infants >37/40 CGA and >2kg and continues until they are thriving (1-6 months’ CGA).

Reference: Larmour, K., Shaw, V., 2016. Enteral nutrition for the preterm infant, version 2.0. Great Ormond Street Hospital for Children NHS Trust: London.

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Tip 31: delayed cord clamping

Delayed cord clamping (>1 min) in healthy term infants leads to higher birthweight, early haemoglobin concentration and increased iron reserves up to six months after birth. However, there is also an increased risk of jaundice requiring phototherapy.

Reference:  McDonald SJ, Middleton P, Dowswell T, Morris PS. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD004074. 

Review trials included 3139 infants.

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Tip 30: specialist preterm milks

Nutriprem 1 contains slightly more kcal than breast-milk, about twice as much protein, Ca, PO4 and iron, but about the same about of fat.

As a rough guide, full requirements of Nutriprem 1 are about 150ml/kg/day and of expressed breast-milk (EBM) are about 180ml/kg/day.

External link: GOS guideline –  enteral nutrition for the preterm infant

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Tip 29: NEC surgery

The main indications for surgery in NEC are: failure to respond to medical management, formation of a mass, perforation.

Reference: Rees, C.M., Hall, N.J., Eaton, S., et al. 2005. Surgical strategies for necrotising enterocolitis: a survey of practice in the United Kingdom. Arch Dis Child; 90: F152 – F155.

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Tip 28: NEC stages

The modified Bell’s stages for NEC are:

1 (suspected) – general features of sepsis, mild abdo distension, increased NG asp, AXR: normal/mild ileus.

2a (confirmed) – prominent abdo distension, bloody stools, mild abdo tenderness, AXR: thickened bowel wall, focal pneumatosis.

2b (confirmed severe) – thrombocytopenia, mild met acidosis, palpable abdo loops, tenderness, AXR: widespread pneumatosis, ascites or portal gas.

3a (advanced) – septic shock incl. DIC, peritonitis.

3b (advanced plus perforation) – AXR: pneumoperitoneum.

References:

Bell, M. J., Ternberg, J.L., Feigin R.D., et al., 1978. Neonatal necrotizing enterocolitis: therapeutic decisions based upon clinical staging. Ann Surg., 187: 1 – 7.

Kliegman, R.M., Walsh, M.C, 1987. Neonatal necrotizing enterocolitis: pathogenesis, classification, and spectrum of disease. Curr Probl Pediatr; 17(4): 243–288.

Rennie & Roberton’s Textbook of Neonatology, 5th Ed, 2005. London: Churchill.

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