Katherine Vincent

Objective : Investigate associations between proactive vs. historical neonatal post-hemorrhagic hydrocephalus (PHH) surgical management and subsequent neurodevelopmental impairment (NDI). Study Design : Single-center retrospective, matched cohort of VLBW infants with PHH. Cases underwent earlier ventricular reservoir placement, serial imaging-guided cerebrospinal fluid withdrawal, reservoir weaning. Controls received historical management with later reservoir placement, symptom-driven cerebrospinal fluid withdrawal, earlier shunt conversion. Capute Cognitive Adaptive Test (CAT), Clinical Linguistic and Auditory Milestone Scale (CLAMS), Modified Peabody Developmental Motor Scale (PDMS-M)and Ages and Stages Questionnaires®, (ASQ) neurodevelopmental assessments during first two years compared between groups using Sign, McNemar-Bowker, Wilcoxon signed-rank and matched t-tests. Result : 48 subjects (24/group) included. NDI was common (67% Cases, 75% Controls). Composite NDI, individual NDI composite outcome components (CAT/CLAMS/PDMS-M), nor ASQ scores differed between groups. Conclusion : Proactive management was not associated with worse NDI, supporting its potential safety. Higher-powered studies with longer follow-up intervals are needed to assess potential developmental benefits.

Background Recurrent neonatal acute kidney injury (rAKI) may increase morbidity and mortality but remains understudied. We aimed to determine the incidence, risk factors, and clinical outcomes associated with rAKI in extremely low gestational age newborns (ELGANs), hypothesizing that rAKI would be associated with worse outcomes than no AKI or single AKI (sAKI). Methods We performed a secondary analysis (ALMOND study) of the multicenter Preterm Erythropoietin Neuroprotection (PENUT) Trial conducted from 2013–2016. AKI was diagnosed retrospectively using modified neonatal Kidney Disease: Improving Global Outcomes serum creatinine criteria. Outcomes included length of stay (LOS), bronchopulmonary dysplasia (BPD), mortality, and chronic kidney disease (CKD) and hypertension (HTN) at 2 years. Comparisons among no AKI, sAKI, and rAKI groups used multivariable generalized estimating equation regression and Cox proportional hazards models. Results Among 923 ELGANs, 211 (23%) developed rAKI. Risk factors included younger gestational age, lower birthweight, small for gestational age, lower Apgar scores, patent ductus arteriosus, severe sepsis, nephrotoxic medication exposure, hypotension, BPD, and necrotizing enterocolitis (all p < 0.05).

Background: Necrotizing enterocolitis (NEC) remains a highly morbid disease for preterm infants. The use of adjunct abdominal ultrasonography improves the evaluation of early or uncertain cases of NEC. No institutions have reported implementing a standardized adjunct abdominal ultrasound guideline and universally adopting adjunct abdominal ultrasound in routine neonatal practice for the evaluation of NEC. Objective: To determine if a standardized, adjunct abdominal ultrasound guideline for diagnosing NEC is feasible and beneficial for the routine detection of pathologic abdominal findings in NEC. Materials and methods: This retrospective study was conducted in an 82-bed level IV academic neonatal intensive care unit from February 2023-April 2024. Unit guidelines were updated in February 2023 to recommend the addition of an adjunct abdominal ultrasound to evaluate NEC universally at the time of initial evaluation. Imaging data was abstracted from a post-implementation observation period of 15 months. Implementation feasibility was assessed. Sonographic findings consistent with NEC were described after implementing standardized sonography protocols. Results: Adjunct abdominal ultrasound was performed in 22 of 23 cases (96%) of NEC following guideline implementation. Twenty ultrasounds (90%) had at least one finding suggestive of NEC, and 12 (55%) had multiple findings suggestive of NEC. Seven ultrasounds (32%) showed findings of NEC in cases with unremarkable initial abdominal radiographs. Two NEC cases had radiographic findings without abdominal ultrasound findings. The sensitivity of abdominal ultrasound for NEC was 0.91. In 59% of cases, abdominal ultrasound findings resulted in a higher modified Bell’s stage when compared to initial abdominal radiograph findings. Conclusion: Implementing a standardized adjunct abdominal ultrasound guideline to assist with the initial diagnostic evaluation of NEC is feasible and may aid in diagnosis of NEC. Graphical

Objective: To identify maternal and neonatal risk factors associated with progression to surgery or death after diagnosis of NEC. Study design: Forty-seven demographic and clinical factors were evaluated across 216 validated cases of NEC occurring between 2010–2020. Nutrition at NEC onset was evaluated in 149 cases. The binary outcome of surgical NEC (progressing to surgery or death) vs. medical NEC (resolved with antibiotic/bowel rest) was compared across variables. Results: Elevated CRP, rapidly decreasing platelet counts, inotropic medication, intubation, and positive blood cultures within 24 h of diagnosis were associated with progression to surgery/death. Infants with surgical NEC had higher abdominal circumferences at birth. Maternal milk intake and receipt of human milk fortifiers were associated with medical NEC, and infants receiving fortified, maternal milk showed the lowest progression to surgery/death. Conclusion: The index of suspicion should be heightened for surgical NEC when these risk factors are present.

Objective Determine recurrent neonatal acute kidney injury (rAKI) incidence, risk factors, and associated outcomes. Study design Single-center retrospective cohort of neonates admitted to the NICU 1/1/20-6/30/21. Comparisons were made between those with no AKI, single AKI episode (sAKI), and rAKI. Multivariable linear and logistic regression models were used to assess associations between rAKI and length of mechanical ventilation (LMV), length of hospitalization stay (LOS), mortality, and hypertension (HTN) at discharge. Results The incidence of AKI in the cohort of 869 infants was 19%: 705 (81%) no AKI, 100 (12%) sAKI, 64 (7%) rAKI. Both sAKI and rAKI were independently associated with longer LMV and LOS. sAKI was independently associated with almost 4x higher odds of mortality than rAKI. Conclusion In this single center cohort of neonates, sAKI independently predicts mortality, however rAKI is independently associated with increased LMV and LOS suggesting rAKI is clinically important and warrants further study.

Objective: Determine recurrent neonatal acute kidney injury (rAKI) incidence, risk factors, and associated outcomes. Study Design: Single-center retrospective cohort of neonates admitted to the NICU 1/1/20-6/30/21. Comparisons were made between those with no AKI, single episode AKI (sAKI), and rAKI. Multivariable linear and logistic regression models were used to assess associations between rAKI and length of mechanical ventilation (LMV), length of hospitalization stay (LOS), mortality, and hypertension (HTN) at discharge. Results: The incidence of AKI in the cohort of 869 infants was 19%: 705 (81%) no AKI, 100 (12%) sAKI, 64 (7%) rAKI. Both sAKI and rAKI were independently associated with longer LMV and LOS. sAKI was independently associated with almost 4x higher odds of mortality than rAKI. Conclusion: In this single center cohort of neonates, sAKI independently predicts mortality, however rAKI is independently associated with increased LMV and LOS suggesting rAKI is clinically important and warrants further study.

This study investigated whether delayed receipt of antibiotics in infants with necrotizing enterocolitis (NEC) is associated with disease severity. In this retrospective, single-center cohort study of infants diagnosed with NEC over 4 years, we compared the timing of antibiotic administration in infants (time order placed to time of receipt) in medical and surgical NEC. Cases were independently reviewed, then various clinical factors were compared. Of 46 suspected cases, 25 were confirmed by a panel of radiologists with good interrater reliability (ICC 0.657; p < 0.001). Delays in antibiotic receipt were 1.7× greater in surgical than medical NEC cases (p = 0.049). Every hour after order entry increased the adjusted odds of surgical NEC by 2.4 (1.08–5.23; p = 0.032). Delayed antibiotic receipt was more common in infants with surgical than medical NEC. Larger studies will be needed to investigate if optimizing antibiotic expediency could improve intestinal outcomes.