There is growing evidence that supports the benefits of early use of caffeine in preterm neonates with RDS; however, no formal recommendations specifying the exact timing of therapy initiation have ...been provided.
We compared neonatal outcomes in infants receiving early (initial dose on the 1st day of life) and late (initial dose on day 2+ of life) caffeine therapy.
Using data from a prospective, cohort study, we identified 986 infants ≤32 weeks' gestation with RDS and assessed the timing of caffeine therapy initiation, need for ventilatory support, mortality and incidence of typical complications of prematurity. To adjust for baseline severity, the early and late caffeine groups were propensity score (PS) matched to 286 infants (1:1). Clinical outcomes were compared between the PS-matched groups.
Early treatment with caffeine citrate was associated with a significantly reduced need for invasive ventilation (71.3% vs 83.2%; P = 0.0165) and total duration of mechanical ventilation (mean 5 ± 11.1 days vs 10.8 ± 14.6 days; P = 0.0000) and significantly lower odds of intraventricular hemorrhage (IVH) (OR 0.4827; 95% CI 0.2999-0.7787) and patent ductus arteriosus (PDA) (OR 0.5686; 95% CI 0.3395-0.9523). The incidence of bronchopulmonary dysplasia (BPD) (36.4% vs 45.8%) and rates of moderate and severe BPD were not significantly different between the two groups. The mortality rates were comparable between the two groups (8.6% vs 8.5%, P = ns).
Early caffeine initiation was associated with a decreased need for invasive ventilatory support and lower incidence of IVH and PDA.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Introduction: There are limited data available regarding the fraction of inspired oxygen (FiO 2 ) predictive of the failure of continuous positive airway pressure (CPAP) in preterm infants with ...respiratory distress syndrome (RDS). Therefore, we investigated factors predictive of CPAP failure in the first 72 h of life, with special attention to the prognostic role of FiO 2 . Methods: This multicenter, prospective study enrolled infants <30 weeks gestation in whom CPAP was initiated within the first 15 min after birth. In the univariate and multivariate logistic regression models, demographic, perinatal, and respiratory parameters were analyzed. The FiO 2 threshold was determined with ROC curve analysis. Results: Of 389 recruited newborns, CPAP failure occurred in 108 infants (27.8%). In the univariate model, each gestational week reduced the odds of CPAP failure by 19%, and each 100 g of birth weight reduced the odds by 16% (both p < 0.05). The risk was increased by 4.2 and 7.5% for each 0.01 increase in FiO 2 in the first and second hours of life, respectively. In the final multivariate model, birth weight and FiO 2 in the second hour of life were the predictive measures. The prognostic threshold was FiO 2 = 0.29 in the second hour of life (AUC 0.7; p < 0.0001), with a sensitivity of 73% and a specificity of 57%. CPAP failure implied a more than 20-fold higher risk of death and pneumothorax and a 2- to 5-fold higher risk of typical complications of prematurity, including bronchopulmonary dysplasia and severe intraventricular hemorrhage. Conclusion: FiO 2 in the second hour of life is a significantpredictor of CPAP failure. The threshold of 0.29 best discriminates the CPAP outcome. Nonresponders to CPAP have a remarkably higher incidence of complications and a higher mortality rate.
Aim
To explore the appropriateness of applying a detailed assessment of general movements and characterize the relationship between global and detailed assessment.
Method
The analysis was based on ...783 video recordings of 233 infants (154 males, 79 females) who had been videoed from 27 to 45 weeks postmenstrual age. Apart from assessing the global general movement categories (normal, poor repertoire, cramped‐synchronized, or chaotic general movements), we scored the amplitude, speed, spatial range, proximal and distal rotations, onset and offset, tremulous and cramped components of the upper and lower extremities. Applying the optimality concept, the maximum general movement optimality score of 42 indicates the optimal performance.
Results
General movement optimality scores (GMOS) differentiated between normal general movements (median 39 25–75th centile 37–41), poor repertoire general movements (median 25 22–29), and cramped‐synchronized general movements (median 12 10–14; p<0.01). The optimality score for chaotic general movements (mainly occurring at late preterm age) was similar to those for cramped‐synchronized general movements (median 14 12–17). Short‐lasting tremulous movements occurred from very preterm age (<32wks) to post‐term age across all general movement categories, including normal general movements. The detailed score at post‐term age was slightly lower compared to the scores at preterm and term age for both normal (p=0.02) and poor repertoire general movements (p<0.01).
Interpretation
Further research might demonstrate that the GMOS provides a solid base for the prediction of improvement versus deterioration within an individual general movement trajectory.
What this paper adds
General movement optimality score (GMOS) differentiates between normal, poor repertoire, and cramped‐sychronized general movements.
Short‐lasting tremulous movements occurred from very preterm age to post‐term age.
This was the case across all categories including normal general movements.
GMOS post‐term was lower compared to the scores at preterm/term age.
This held true for both normal and poor repertoire general movements.
This article is commented on by Crowle on pages 323–324 of this issue.
Background: Severe bronchopulmonary dysplasia (BPD) remains a major complication of prematurity and can have significant impact on long-term pulmonary sequelae and adverse neurodevelopmental ...outcomes.
Objective: To assess the incidence and evaluate the predictive factors for severe BPD in very preterm infants with respiratory distress syndrome.
Methods: Of the 846 premature infants born at ≤32-week gestation who developed respiratory distress syndrome (RDS), 707 infants with known oxygen dependency at 36 weeks gestational age were included in the analysis of BPD incidence. With univariate and multiple logistic regression models we evaluated the risk factors for the development of severe BPD and calculated odds ratios (ORs).
Results: The overall incidence of BPD was 45.2%. Severe BPD accounted for 6%, with morbidity pertaining mainly to infants <29-week gestation (incidence 10%). The risk factors for severe BPD included male gender (OR 3.02 95%CI 1.30-7.46), intubation in the delivery room (OR 2.57, 95%CI 1.00-7.18), and invasive ventilation >7 days (OR 7.05, 95%CI 2.63-22.4). The protective factors were early continuous positive airway pressure (CPAP) in the univariate analysis and receiving surfactant <15 min after birth in the multivariate model.
Conclusions: Mechanical ventilation >7 days is the most prevalent risk factor for severe BPD. CPAP initiated in the delivery room and early surfactant are key preventive measures.
The optimal vitamin D intake for nursing women is controversial. Deterioration, at least in bone mass, is reported during lactation. This study evaluated whether vitamin D supplementation during ...lactation enhances the maternal and infant's vitamin D status, bone mass and body composition.
After term delivery, 174 healthy mothers were randomized to receive 1200 IU/d (800 IU/d+400 IU/d from multivitamins) or 400 IU/d (placebo+400 IU/d from multivitamins) of cholecalciferol for 6 months while breastfeeding. All infants received 400 IU/d of cholecalciferol. Serum 25-hydroxyvitamin D 25(OH)D, iPTH, calcium, urinary calcium, and densitometry were performed in mother-offspring pairs after delivery, and at 3 and 6 months later.
A total of 137 (79%) (n = 70; 1200 IU/d, n = 67; 400 IU/d) completed the study. 25(OH)D was similar in both groups at baseline (13.7 ng/ml vs. 16.1 ng/ml; P = 0.09) and at 3 months (25.7 ng/ml vs. 24.5 ng/ml; P = 0.09), but appeared higher in the 1200 IU/d group at 6 months of supplementation (25.6 ng/ml vs. 23.1 ng/ml; P = 0.009). The prevalence of 25(OH)D <20 ng/ml was comparable between groups at baseline (71% vs. 64%, P = 0.36) but lower in the 1200 IU/d group after 3 months (9% vs. 25%, P = 0.009) and 6 months (14% vs. 30%, P = 0.03). Maternal and infants' iPTH, calciuria, bone mass and body composition as well as infants' 25(OH)D levels were not significantly different between groups during the study. Significant negative correlations were noted between maternal 25(OH)D and fat mass (R = -0.49, P = 0.00001), android fat mass (R = -0.53, P = 0.00001), and gynoid fat mass (R = -0.43, P = 0.00001) after 6 months of supplementation.
Vitamin D supplementation at a dose of 400 IU/d was not sufficient to maintain 25(OH)D >20 ng/ml in nursing women, while 1200 IU/d appeared more effective, but had no effect on breastfed offspring vitamin D status, or changes in the bone mass and the body composition observed in both during breastfeeding.
ClinicalTrials.gov NCT01506557.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The peripartum period and delivery are considered critical for maintaining a balance between the production of free oxygen radicals and functional incompetence of the antioxidant system of a foetus ...and a neonate.
The aim of the study was to evaluate the oxidoreductive state of mothers and their newborns immediately after delivery and in the first few days after birth.
Eighty-five mothers and their healthy, term newborns were included into the prospective study. Total antioxidant capacity (TAC) and thiobarbituric acid reactive substances (TBARS) in maternal placenta and milk, as well as blood and urine of the neonates on the first and third day after birth, were examined.
Elevated levels of TBARS were found in maternal placenta and neonatal blood on the third day after birth, but low concentrations were observed in maternal milk. On the contrary, total antioxidant status (TAS) showed a declining tendency in neonatal blood and an increasing tendency in breast milk. Markers of oxidative stress and antioxidant capacity were independent of the mode of delivery.
Values of oxidative stress markers in mothers and newborns immediately after birth were elevated and increased further during the first few days of neonatal life. Breast milk was the only nutritional substance with high antioxidant activity. At the same time, TBARS levels in breast milk decreased, which might indicate its protective role in reducing oxidative stress in newborns.
Abstract Purpose We hypothesised that abnormal genital tract colonisation leading to an in utero inflammation/infection process, contributes to the risk of respiratory distress syndrome (RDS), patent ...ductus arteriosus (PDA), intra ventricular haemorrhage (IVH), bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP) and necrotizing enterocolitis (NEC) in preterm infants. Methods 396 placentas and umbilical cords of neonates born at 22–32 weeks of gestation were evaluated. Genital tract and amniotic fluid swabs were cultured for aerobic and anaerobic bacteria. Results Chorioamnionitis significantly increases the risk for RDS (OR 1.74, 95% CI 1.14–2.65), NEC (OR 3.22, 95% CI 1.36–3.28) and ROP > 2 (OR 2.12, 95% CI 1.33–3.36). But the risk for IVH, PDA and BPD did not differ between the groups. Klebsiella pneumoniae (OR 5.33, 95% CI 1.06–26.79), Staphylococcus sp. (OR 18.39, 95% CI 2.32–145.2) and Enterococcus faecalis (OR 10.7, 95% CI 1.27–89.9) showed a significant relationship with intrauterine inflammation processes. E. faecalis increased the risk for NEC (OR 6.13, 95% CI 1.059–37.6). We did not note a link between ROP and genital tract colonisation. Interestingly PDA seems to be triggered by the presence of Pseudomonas aeruginosa (OR 2.38 95% CI 1.83–3.82). Conclusion Our results show a link between K. pneumoniae , Staphylococcus sp., E. faecalis and intrauterine infection. E. faecalis increases the risk for NEC, and suggests a direct link between gram + bacteria, chorioamnionitis and NEC.
The pivotal role of vitamin D (vit D) in skeletal health is well known. Neonatal vit D storage at birth is dependent on maternal levels, and newborns receive 50-70% of their mother's ...25-hydroxyvitamin D 25(OH)D. Deficiency of vit D can lead to prematurity bone disease, with an incidence of up to 55% in infants weighing < 1000 g. The aim of this study is to assess the effectiveness of monitored supplementation of vit D in a population of preterm infants.
Preterm infants born at 24-32 weeks of gestation will be recruited within the first 7 days of life. Depending on the type of feeding, and after reaching partial enteral feeding or at 7 days of life, vit D supplementation will consist of 500 IU and an additional 150-300 IU/kg included in human milk fortifiers (if fed exclusively with breast milk) or 190 IU/kg in milk formulas. Subjects will be randomised to either monitored (with an option of dose modification based on 25(OH)D levels as per protocol) or standard therapy up to 52 weeks of post-conceptional age (PCA). The primary outcome measure will be the number of neonates with deficiency or excess levels of 25(OH)D at 40 ±2 weeks of PCA. Additional 25(OH)D levels will be measured at birth, at 4 and 8 weeks of age, and/or at 35 and 52 ±2 weeks of PCA. Secondary objectives will include the incidence of osteopenia, nephrocalcinosis and nephrolithiasis. Serum parameters of calcium phosphorus metabolism will also be measured.
Despite multiple years of research and numerous publications, there is still a lack of consensus in regard to how much vit D infants should receive and how long they should receive it. Because 80% of calcium and phosphorus placental transfer occurs between 24 and 40 weeks of gestation, preterm infants are especially prone to adverse effects of vit D insufficiency. However, both inadequate and excessive amounts of vit D may be unsafe and lead to serious health issues. The results of our study may shed new light on these concerns and contribute to optimising vit D supplementation.
ClinicalTrials.gov, NCT03087149 . Registered on 15 March 2017.
Over 85% of osteogenesis imperfecta (OI) cases associates to mutations in procollagen type I genes (COL1A1 or COL1A2), however, no hot spots were linked to particular clinical phenotypes. The 8 ...patients whom were clinically diagnosed with OI are from Polish population with no ethnic background indicated. Six unpublished mutations were detected in eight patients diagnosed with OI. Genotypes for polymorphisms (Sp1 - rs1800012 and PvuII - rs412777), linked to bone formation and metabolism were also determined. In COL1A1 gene the mutations were found in exons 2, 22, 50 and in introns 13 and 51. In COL1A2 one mutation was identified in exon 22. Mutations of deletion type in COL1A1 that resulted in OI type I an effect neither on collagen type I secretion nor its intracellular accumulation were detected. Also, a single base substitution in I13 (c.904-9 G>T) was associated with OI type I. The OI type III was associated with single base change in I51 of COL1A1, possibly causing an exon skipping. Also, a missense mutation in COL1A2 changing Gly®Cys in the central part of triple helical domain of the collagen type I molecule caused OI type III. It affected secretion of heterotrimeric form of procollagen type I. However, no intracellular accumulation of procollagen chains could be detected. Mutation in COL1A2 affected its incorporation to procollagen type I. The results shall help in genetic counseling of OI patients and provide rational support in making by them and their families conscious, life important decisions.
Abstract Background and Aim Intestinal flora of preterms, dominantly presents with decreased amounts of physiological microbiota. This double blinded randomized control trial compared the stool of ...bottle fed preterms, randomized to receive lactobacillus rhamnosus GG (LGG) 6x109or placebo with formula feeding. Study design 46 enterally fed preterms were randomized to receive probiotics or placebo within 0–3 days after birth. All personnel were blinded to treatment assignment. Faecal sampling was preformed at day 7, 21, 42. Presence of LGG colonization, somatic growth and length of hospital stay were recorded. Results 60 patients were initially identified and enrolled but after exclusion criteria were applied, 21 babies were analyzed in the probiotic group and 26 in the placebo group. The number of lactobacillus were significantly higher (p = 0.014) on day 7, and 21 (p = 0.024) in the study group, and so was the number of enterobacteriaceae on all study days (p = 0.004, p = 0.000, p = 0.000), and Enterococcus sp on day 21 (p = 0.000). The amount of samples positive for staphylococci was significantly higher in the study group, on days 7 and 42 (p = 0.001 and 0.011). We did not show a significant difference in weight gain upon discharge between the groups p = 0.567, 95% CI (− 168; 305) or mean of hospital stay p = 0.421 95% CI (− 13.43;5.71). Conclusions A preterm infant formula with an addition of probiotics leads to a rapid growth of LGG in the gut of bottle fed infants, but does not decrease the amount of pathogenic organisms, nor increase weight gain during enteral feeding, or decrease length of hospital stay.
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