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Noteworthy Professional News

Noteworthy Professional News

Allen, Kimberly PhD, RN; Smith, Heather E. PhD, RN, NNP-BC, CNS

Section Editor(s): Newnam, Katherine PhD, RN, NNP-BC, CPNP, IBCLE; Section Editors; Smith, Heather E. PhD, RN, NNP-BC, CNS; Section Editors

Author Information
doi: 10.1097/ANC.0000000000000437
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FIRST NEONATAL MRI DEVICE CLEARED BY FDA

The first neonatal magnetic resonance imaging (MRI) device designed to scan the head and brain of a neonate has received clearance from the US Food and Drug Administration. The MRI machine uses strong magnetic fields and radio waves to generate the images needed to view the head and the brain. The images are produced when protons in fat and water molecules line up in the body, producing scans that are useful in the diagnosis of many neurological diseases.1Embrace Neonatal MRI System was designed for infants with a head circumference of up to 38 cm and weight of 1 to 4.5 kg; the machine was designed in such a way to allow a temperature-controlled incubator to be placed directly into the machine, limiting temperature fluctuations. If the infant does exhibit signs of distress, removal of the infant from the machine takes only approximately 30 seconds. The Embrace Neonatal MRI System is contraindicated for patients weighing more than 4.5 kg, those with a head circumference of more than 38 cm, and infants with metallic or electronically active implants. The MRI system can be placed directly in the neonatal intensive care unit because the machine does not require a safety zone.2

NEW BREAST PUMP KIT CLEANING INSTRUCTIONS

New guidelines for how to keep breast pump kits clean have been released following the tragic death of an infant who was 29 weeks old.3,4 The infant developed sepsis at the age of 21 days of life demonstrating positive Cronobacter sakazakii in both her blood and her cerebrospinal fluid. Despite aggressive treatment, the infant developed global developmental delay and required a ventriculoperitoneal shunt and a gastrostomy feeding tube. After extensive investigation, one of the potential contributing factors to the sepsis was the breast pump kit that became contaminated with C sakazakii. Without adequate cleaning or sanitation, the infant was exposed to the deadly bacterial infection. Thus, the Centers for Disease Control and Prevention has introduced new guidelines for parents to facilitate more hygienic expression and handling of human milk.4 Before using the breast pump kit, always wash hands with soap and water. Then assemble and inspect the kit to ensure that no mold or dirt is directly visible in the tubing. Finally, clean pump dial, power switch, and countertop with disinfectant wipes. After using the breast pump, store the milk safely, clean the pumping area, take apart the breast pump, rinse the pump parts, and clean the pump parts either in the dishwasher or by hand. Finally, after cleaning for extra protection, sanitize the pump parts, washbasin, and bottlebrush at least once daily after they have been cleaned. Ensure that items are stored in a clean dry area until needed.3

HIGH PERIPHERAL SEROTONIN IN INFANTS WITH SUDDEN INFANT DEATH SYNDROME MAY BE A PERIPHERAL BIOMARKER

The incidence of sudden infant death syndrome (SIDS) even after the national Back to Sleep campaign continues to remain at 0.4 per 1000 live births, which is the leading cause of postneonatal infant mortality.5 SIDS is defined as an infant who dies suddenly without explanation despite a complete autopsy, an examination of the death scene, and a review of the clinical history.6 Infants with SIDS appear to have what is called the triple risk hypothesis: underlying vulnerability (poverty, prematurity, gender, race); critical developmental period (infancy); and an outside stressor that precipitates sudden death (asphyxia due to prone sleeping).7–10 The infants with SIDS appear to have respiratory and cardiac abnormalities within the brainstem, combined with the environmental stressors (sleeping position, temperature, exposure to tobacco smoke, sleep state) and a “terminal cascade of hypoxia, bradycardia, apnea, and death,” thus the infants suffer irreversible injury and death occurs.10(p778),11 A new study sought to determine whether peripheral serum serotonin (5-hydroxytryptamine [5-HT]) levels are altered in SIDS cases compared with deceased infants with known causes, since no known peripheral biomarkers exist for SIDS.12 Sixty-one SIDS cases were identified and 15 control infants were also recruited following a thorough investigation using the postulated triple risk hypothesis. Postmortem results indicated that the serum 5-HT levels for SIDS cases was 177.2 + 15.1 with control infants having 5-HT levels of 91.1 ng/mL + 30.6 ng/ml, which was statistically significant difference. Results confirm that increased serum 5-HT levels in SIDS infants were present when compared with other infants who died within the first year of life. The high levels of serum 5-HT may serve as a potential biomarker for infants.12 Potential use for this may allow for differentiation of different types of neonatal death, allowing for correct diagnosis.

References

1. Food and Drug Administration. FDA Clears First Neonatal Magnetic Resonance Imaging Device. Silver Spring, MD: US Food and Drug Administration; 2017.
2. EmbraceTM Neonatal MRI System—the first magnetic resonance imaging (MRI) device specifically for neonatal brain and head imaging in neonatal intensive care units (NICU). https://www.aspectimaging.com/embrace-neonatal-mri-system. Published 2017. Accessed July 28, 2017.
3. Centers for Disease Control and Prevention. How to Keep Your Breast Pump Kit Clean. Atlanta, GA: Centers for Disease Control and Prevention; 2017.
4. Bowen A, Wiesenfeld H, Kloesz J, et al. Notes from the Field: Cronobacter sakazakii infection associated with feeding extrinsically contaminated expressed human milk to a premature infant—Pennsylvania, 2016. MMWR Morb Mortal Wkly Rep. 2017;66(28):761–762.
5. Matthews TJ, MacDorman MF. Infant mortality statistics from the 2010 period linked birth/infant death data set. Natl Vital Stat Rep. 2013;62:1–26.
6. Willinger M, James LS, Catz C. Defining the sudden infant death syndrome (SIDS): deliberations of an expert panel convened by the National Institute of Child Health and Human Development. Pediatr Pathol. 1991;11:677–684.
7. Task Force on Sudden Infant Death Syndrome; Moon RY. SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment. Pediatrics. 2011;128:1030–1039.
8. Kinney HC, Richerson GB, Dymecki SM, Darnall RA, Nattie EE. The brainstem and serotonin in the sudden infant death syndrome. Annu Rev Pathol. 2009;4:517–550.
9. Goldwater PN. A perspective on SIDS pathogenesis. The hypotheses: plausibility and evidence. BMC Med. 2011;9:64.
10. Adams SM, Ward CE, Garcia KL. Sudden infant death syndrome. Am Fam Phys. 2015;91:778–783.
11. Guntheroth WG, Spiers PS. The triple risk hypotheses in sudden infant death syndrome. Pediatrics. 2002;110:e64.
12. Haynes RL, Frelinger AL III, Giles EK, et al. High serum serotonin in sudden infant death syndrome. Proc Natl Acad Sci U S A. 2017;114:7695–7700.
© 2017 by the National Association of Neonatal Nurses.