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Kimble LL, Perry D, Bach KP. Curds in the way: A milk curd obstruction review and normal sonographic bowel appearances using a novel scoring system in neonates on fortified breast milk feeds. J Med Imaging Radiat Oncol 2024. [PMID: 38185883 DOI: 10.1111/1754-9485.13617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/17/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Fortified expressed breast milk (FEBM) is a standard of care for premature and low birth weight neonates, but comes with an elevated risk of a rare but re-emergent pathology called milk curd obstruction (MCO). Little is known about normal sonographic appearances of bowel contents in this feeding setting, making the recognition of abnormalities difficult. Thus, we aimed to describe appearances that may be considered typical pre- and post-fortifier inclusion. METHODS Ten neonates of <32 weeks' gestation or a birth weight of <1,800 g recruited from Auckland City Hospital Neonatal Intensive Care between 1/5/2019 and 10/9/2019 received bowel ultrasounds within 24 h before and 10-14 days after starting FEBM. Bowel contents in six abdominal regions were assigned scores of 1-6 based on increasing solidification. RESULTS Lower gestational age was correlated with more solid contents on the pre-fortifier ultrasound (P = 0.02). Fortifier was significantly associated with increasing solidity, particularly in the left abdomen (P < 0.001). The left lower quadrant and rectum accounted for much of this change (P = 0.012 and P = 0.002). One subject who subsequently developed a clinical picture consistent with early MCO had uniquely demonstrated non-rectal solid contents (score 6). The interobserver kappa score for two assessors was 0.91 (95% CI 0.94-0.99) on still images. CONCLUSION This small cohort demonstrated increasing bowel content solidification after breast milk fortification using a novel ultrasound scoring system with good interobserver agreement. Non-rectal solid contents (score 6) appeared atypical. Ultrasound shows promise for its non-irradiating diagnostic utility in the setting of early milk curd disease evaluation of the premature neonate.
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Affiliation(s)
- Lara L Kimble
- Department of Paediatric Radiology, Starship Hospital, Auckland, New Zealand
| | - David Perry
- Department of Paediatric Radiology, Starship Hospital, Auckland, New Zealand
| | - Katinka P Bach
- Newborn Intensive Care Unit, Starship Hospital, Auckland, New Zealand
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Akkoca Z, Yavuz B, Koçak Sezgin A, Bildirici Y. The effect of the swaddling method on stress levels in newborns administered nasal CPAP. BMC Pediatr 2023; 23:629. [PMID: 38087248 PMCID: PMC10714443 DOI: 10.1186/s12887-023-04457-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 12/02/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND This study aims to investigate the effects of the swaddling method on the stress levels in newborns receiving nasal continuous positive airway pressure (nCPAP). METHODS The study was conducted between 1 June 2022 and 1 October 2022 with 40 newborns who underwent nCPAP in the second-level Neonatal Intensive Care Unit (NICU) of a city hospital in the Central Anatolia Region of Turkey. Data were collected using a descriptive form, including the characteristics of newborns, a patient follow-up chart, and the Newborn Stress Scale (NSS). The descriptive form, the patient follow-up chart, and the NSS were completed by the researcher 30 min after the nCPAP was started and the first saliva sample was taken. The patient follow-up chart and NSS were completed 30 min after applying the swaddling method and the second saliva sample was collected. The data were analyzed using IBM SPSS Statistics 25.0 package software and presented with number, percentage, mean, standard deviation, min-max, and t-test. RESULTS The study found that the mean score of the NSS after the intervention (3.52 ± 2.57) was lower than that before the intervention (10.02 ± 2.05) (p < 0.05). The mean saliva cortisol levels of the newborns after the intervention (4.99 ± 1.89) were lower than before the intervention (5.51 ± 1.65) (p < 0.05). The mean heart (135.50 ± 14.15) and respiratory rates (68.07 ± 10.16) of the newborns after the intervention were lower than those before the intervention (140.82 ± 18.11; 72.95 ± 9.06, respectively) (p < 0.05). There was no difference between the mean oxygen saturation of newborns before and after the intervention (p > 0.05). CONCLUSIONS The study showed that the swaddling method played a role in reducing the stress levels in newborns who underwent nCPAP. It is recommended that randomized controlled trials examining the effect of swaddling on the stress levels of newborns who underwent nCPAP be conducted.
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Affiliation(s)
- Zehra Akkoca
- Neonatal Intensive Care Unit, Eskisehir City Hospital, Neonatal Nurse, Eskisehir, Turkey
| | - Betul Yavuz
- Faculty of Health Sciences, Department of Pediatric Nursing, Kütahya Health Sciences University, Kutahya, Turkey.
| | - Ayşe Koçak Sezgin
- Faculty of Medicine, Basic Medical Science, Medical Biochemistry Department Kutahya, Kütahya Health Sciences University, Kutahya, Turkey
| | - Yaşar Bildirici
- Department of Pediatrics Eskisehir, University of Health Sciences, Eskisehir City Hospital, Eskisehir, Turkey
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Priyadarshi A, Tracy M, Kothari P, Sitaula C, Hinder M, Marzbanrad F, Morakeas S, Trivedi A, Badawi N, Rogerson S. Comparison of simultaneous auscultation and ultrasound for clinical assessment of bowel peristalsis in neonates. Front Pediatr 2023; 11:1173332. [PMID: 37794960 PMCID: PMC10546054 DOI: 10.3389/fped.2023.1173332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/31/2023] [Indexed: 10/06/2023] Open
Abstract
Introduction Assessment of bowel health in ill preterm infants is essential to prevent and diagnose early potentially life-threatening intestinal conditions such as necrotizing enterocolitis. Auscultation of bowel sounds helps assess peristalsis and is an essential component of this assessment. Aim We aim to compare conventional bowel sound auscultation using acoustic recordings from an electronic stethoscope to real-time bowel motility visualized on point-of-care bowel ultrasound (US) in neonates with no known bowel disease. Methods This is a prospective observational cohort study in neonates on full enteral feeds with no known bowel disease. A 3M™ Littmann® Model 3200 electronic stethoscope was used to obtain a continuous 60-s recording of bowel sounds at a set region over the abdomen, with a concurrent recording of US using a 12l high-frequency Linear probe. The bowel sounds heard by the first investigator using the stethoscope were contemporaneously transferred for a computerized assessment of their electronic waveforms. The second investigator, blinded to the auscultation findings, obtained bowel US images using a 12l Linear US probe. All recordings were analyzed for bowel peristalsis (duration in seconds) by each of the two methods. Results We recruited 30 neonates (gestational age range 27-43 weeks) on full enteral feeds with no known bowel disease. The detection of bowel peristalsis (duration in seconds) by both methods (acoustic and US) was reported as a percentage of the total recording time for each participant. Comparing the time segments of bowel sound detection by digital stethoscope recording to that of the visual detection of bowel movements in US revealed a median time of peristalsis with US of 58%, compared to 88.3% with acoustic assessment (p < 0.002). The median regression difference was 26.7% [95% confidence interval (CI) 5%-48%], demonstrating no correlation between the two methods. Conclusion Our study demonstrates disconcordance between the detection of bowel sounds by auscultation and the detection of bowel motility in real time using US in neonates on full enteral feeds and with no known bowel disease. Better innovative methods using artificial intelligence to characterize bowel sounds, integrating acoustic mapping with sonographic detection of bowel peristalsis, will allow us to develop continuous neonatal bowel sound monitoring devices.
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Affiliation(s)
- Archana Priyadarshi
- Department of Neonatology, Westmead Hospital Neonatal Intensive Care Unit, Sydney, NSW, Australia
- Grace Neonatal Intensive Care Unit, The Children’s Hospital Westmead, Sydney, NSW, Australia
| | - Mark Tracy
- Department of Neonatology, Westmead Hospital Neonatal Intensive Care Unit, Sydney, NSW, Australia
| | - Pankhuri Kothari
- Department of Neonatology, Westmead Hospital Neonatal Intensive Care Unit, Sydney, NSW, Australia
| | - Chiranjibi Sitaula
- Department of Electrical & Computer Systems Engineering, Monash University, Clayton, VIC, Australia
| | - Murray Hinder
- Grace Neonatal Intensive Care Unit, The Children’s Hospital Westmead, Sydney, NSW, Australia
| | - Faezeh Marzbanrad
- Department of Electrical & Computer Systems Engineering, Monash University, Clayton, VIC, Australia
| | - Stephanie Morakeas
- Department of Neonatology, Westmead Hospital Neonatal Intensive Care Unit, Sydney, NSW, Australia
| | - Amit Trivedi
- Grace Neonatal Intensive Care Unit, The Children’s Hospital Westmead, Sydney, NSW, Australia
| | - Nadia Badawi
- Grace Neonatal Intensive Care Unit, The Children’s Hospital Westmead, Sydney, NSW, Australia
| | - Sheryl Rogerson
- Department of Neonatal Intensive Care Unit, The Royal Women’s Hospital, Melbourne, VIC, Australia
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Chetan C, Garegrat R, Hazarika J, Maheshwari A, Suryawanshi P. Point-of-care Ultrasound to Diagnose and Monitor the Course of Necrotizing Enterocolitis. NEWBORN (CLARKSVILLE, MD.) 2023; 2:203-213. [PMID: 37974931 PMCID: PMC10653205 DOI: 10.5005/jp-journals-11002-0070] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Context Neonatal gut ultrasound (US) is an emerging clinical tool for quick diagnosis and prognosis in various abdominal pathologies. In this review, we summarize normal gut US findings and concentrate on the specifications of diagnosing necrotizing enterocolitis. Evidence A comprehensive literature search was conducted across numerous sources with relevant keywords along with the specified age group of 0-28 days of life. Findings This review describes the normal gut US picture with the basic technicalities needed to master the art of point-of-care (POC) abdominal US. This modality is gaining importance due to its accuracy, applicability, safety, and affordability. Key findings include altered bowel perfusion, decreased peristalsis, and bowel wall thickening with better precision compared to abdominal X-ray (AXR). Many meta-analyses and narrative reviews have already demonstrated their usefulness. The high specificity and positive predictive value could make this tool a guide for early identification and prompt surgical intervention in the dreaded diagnosis of necrotizing enterocolitis. Conclusion Emerging evidence and expertise in the field of abdominal US will make it a valuable tool for early diagnosis and prognosis of necrotizing enterocolitis.
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Affiliation(s)
- Chinmay Chetan
- Department of Neonatology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Reema Garegrat
- Department of Neonatology, Gupta Neonatal Hospital, Hisar, Haryana, India
| | - Jayanta Hazarika
- Department of Pediatrics and Neonatology, Mercy Hospital, Nagaon, Assam, India
| | - Akhil Maheshwari
- Department of Pediatrics, Louisville State University, Shreveport, Louisville
- Global Newborn Society (https://www.globalnewbornsociety.org/)
| | - Pradeep Suryawanshi
- Global Newborn Society (https://www.globalnewbornsociety.org/)
- Department of Neonatology, Bharati Vidyapeeth University Medical College, Pune, Maharashtra, India
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Priyadarshi A, Rogerson S, Cruzado R, Crow A, Hinder M, Popat H, Soundappan SSV, Badawi N, Tracy M. Neonatologist-performed point-of-care abdominal ultrasound: What have we learned so far? Front Pediatr 2023; 11:1173311. [PMID: 37187587 PMCID: PMC10175674 DOI: 10.3389/fped.2023.1173311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/31/2023] [Indexed: 05/17/2023] Open
Abstract
This review describes the sonographic appearances of the neonatal bowel in Necrotising enterocolitis. It compares these findings to those seen in midgut-Volvulus, obstructive intestinal conditions such as milk-curd obstruction, and slow gut motility in preterm infants on continuous positive airway pressure (CPAP)-CPAP belly syndrome. Point-of-care bowel ultrasound is also helpful in ruling out severe and active intestinal conditions, reassuring clinicians when the diagnosis is unclear in a non-specific clinical presentation where NEC cannot be excluded. As NEC is a severe disease, it is often over-diagnosed, mainly due to a lack of reliable biomarkers and clinical presentation similar to sepsis in neonates. Thus, the assessment of the bowel in real-time would allow clinicians to determine the timing of re-initiation of feeds and would also be reassuring based on specific typical bowel characteristics visualised on the ultrasound.
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Affiliation(s)
- Archana Priyadarshi
- Westmead Hospital Neonatal Intensive Care Unit, Sydney, NSW, Australia
- Grace Centre for Newborn Intensive Care at The Children`s Hospital Westmead, Sydney, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
- Correspondence: Archana Priyadarshi
| | - Sheryl Rogerson
- The Royal Women's Hospital Neonatal Intensive Care Unit, Melbourne, VIC, Australia
| | - Rommel Cruzado
- Department of Radiology, The Children's Hospital Westmead, NSW, Australia
| | - Amanda Crow
- Department of Radiology, The Children's Hospital Westmead, NSW, Australia
| | - Murray Hinder
- Westmead Hospital Neonatal Intensive Care Unit, Sydney, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
| | - Himanshu Popat
- Grace Centre for Newborn Intensive Care at The Children`s Hospital Westmead, Sydney, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
| | - Soundappan S. V. Soundappan
- The University of Sydney, Sydney, NSW, Australia
- Department of Surgery, The Children's Hospital Westmead, NSW, Australia
| | - Nadia Badawi
- Grace Centre for Newborn Intensive Care at The Children`s Hospital Westmead, Sydney, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
| | - Mark Tracy
- Westmead Hospital Neonatal Intensive Care Unit, Sydney, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
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McGill VE. Neonatal abdominal support to address CPAP belly: Two cases report and literature review. J Neonatal Perinatal Med 2022; 15:831-836. [PMID: 36031911 DOI: 10.3233/npm-221047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Gaseous distension of the abdomen from the use of continuous positive airway pressure (CPAP) in the preterm population is of increasing concern for its unintended consequences. Methods to treat and prevent CPAP belly deserve further investigation. An intervention to provide abdominal support to address CPAP belly is presented in these case studies.
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Affiliation(s)
- V E McGill
- Department of Pediatric Therapy, Providence Alaska Children's Hospital, Anchorage, AK, USA
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