Bronchopulmonary dysplasia (BPD) represents a severe sequela in neonates born very prematurely. The provision of adequate nutritional support in this high-risk population is challenging. The ...development of the lungs and physical growth are closely linked together in infants with BPD. Growth deficiency has been associated with pulmonary dysfunction, whereas improvement in respiratory status results in growth acceleration. Currently, there is not enough data regarding optimal nutritional strategies in this population. Nutrition in these infants should provide sufficient calories and nutrients to establish growth, avoid growth retardation and assist alveolarization of the lungs. Meticulous follow-up is mandatory during and after discharge from the Neonatal Intensive care Unit (NICU) to minimize growth retardation and improve lung function. Despite the significant literature supporting the contribution of growth and nutrition in the avoidance of BPD, there is limited research regarding interventions and management of infants with established BPD. Our aim was to review clinical strategies applied in everyday clinical practice and identify debates on the nutritional approach of newborns with BPD. Well-organized interventions and clinical trials regarding the somatic development and nutrition of infants with BPD are warranted.
Introduction: Congenital heart disease is one of the most of the groups of congenital anomalies with an incidence of about 1 per 100 live births. Almost one-third of these infants require some type ...of intervention, usually in the first year of life and increasingly often in the neonatal period. Innovative reparative and palliative surgical procedures and advanced medical support in the Neonatal Intensive Care Unit have significantly reduced the mortality related to congenital heart disease. Achieving survival is not the only target of clinicians for these patients. Appropriate growth, development, and improved quality of life are also very important. Growth failure is a very common problem of these children and nutritional support and management are a challenge for health care providers. Early intervention and identification of at-risk patients have the potential to decrease morbidity and mortality related to malnutrition.
Aim/methods: The purpose of this article is to analyze the existing evidence and common concerns about perioperative and postdischarge nutritional management of neonates with congenital heart disease based on the special issues or complications that may arise. Furthermore, we reviewed the recent literature about current practices and proposed policies that could prevent malnutrition and improve the outcomes of neonates with congenital heart disease.
Results/conclusion: A standardized institutional protocol and clear guidelines referring to feeding initiation, prompt estimation of caloric needs and provision of adequate and appropriate nutrient intake is likely to benefit these patients. Clear definitions for the nutritional approach in the setting of medical complications and close assessment of growth by pediatricians and specialized nutritionists are crucial for the long-term outlook and quality of life of these infants.
Purpose
We aimed to assess diaphragmatic function in term and preterm infants with and without history of bronchopulmonary dysplasia (BPD), before and after the application of inspiratory flow ...resistive loading.
Methods
Forty infants of a median (range) gestational age of 34 (25–40) weeks were studied. BPD was defined as supplemental oxygen requirement for >28 days of life. Seventeen infants were term, 17 preterm without history of BPD, and six preterm with a history of BPD. The diaphragmatic pressure–time index (PTIdi) was calculated as the mean to maximum trans‐diaphragmatic pressure ratio times the inspiratory duty cycle. The PTIdi was calculated before and after the application of an inspiratory‐flow resistance for 120 s. Airflow was measured by a pneumotachograph and the transdiaphragmatic pressure by a dual pressure catheter.
Results
The median (interquartile range IQR) pre‐resistance PTIdi was higher in preterm infants without BPD (0.064 0.050–0.077) compared with term infants (0.052 0.044–0.062, p = .029) and was higher in preterm infants with BPD (0.119 0.086–0.132) compared with a subgroup of preterm infants without BPD (0.062 0.056–0.072, p = .004). The median (IQR) postresistance PTIdi was higher in preterm infants without BPD (0.101 0.084–0.132) compared with term infants (0.067 0.055–0.083, p < .001) and was higher in preterm infants with BPD 0.201(0.172‐0.272) compared with the preterm subgroup without BPD (0.091 0.081–0.108,p = .004). The median (IQR) percentage change of the PTIdi after the application of the resistance was higher in preterm infants without BPD (65 51–92 %) compared with term infants (34 20–39 %, p < .001).
Conclusions
Preterm infants, especially those recovering from BPD, are at increased risk of diaphragmatic muscle fatigue under conditions of increased inspiratory loading.
We aimed to assess the determinants of diaphragmatic function in term and preterm infants. 149 infants (56 term; 93 preterm, of whom 14 were diagnosed with bronchopulmonary dysplasia—BPD) were ...studied before discharge. Diaphragmatic function was assessed by measurement of the maximum transdiaphragmatic pressure (Pdimax)—a measure of diaphragmatic strength, and the pressure–time index of the diaphragm (PTIdi)—a measure of the load-to-capacity ratio of the diaphragm. The Pdimax was higher in term than preterm infants without BPD (90.1 ± 16.3 vs 81.1 ± 11.8 cmH
2
O; P = 0.001). Term-born infants also had lower PTIdi compared to preterms without BPD (0.052 ± 0.014 vs 0.060 ± 0.017; P = 0.006). In term and preterm infants without BPD, GA was the most significant predictor of Pdimax and PTIdi, independently of the duration of mechanical ventilation and oxygen support. In infants with GA < 32 weeks (n = 30), the Pdimax was higher in infants without BPD compared to those with BPD (76.1 ± 11.1 vs 65.2 ± 11.9 cmH
2
O; P = 0.015). Preterms without BPD also had lower PTIdi compared to those with BPD (0.069 ± 0.016 vs 0.109 ± 0.017; P < 0.001). In this subgroup, GA was the only significant independent determinant of Pdimax, while BPD and the GA were significant determinants of the PTIdi.
Conclusions
: Preterm infants present lower diaphragmatic strength and impaired ability to sustain the generated force over time, which renders them prone to diaphragmatic fatigue. In very preterm infants, BPD may further aggravate diaphragmatic function.
What is Known:
• The diaphragm of preterm infants has limited capacity to undertake the work of breathing effectively.
• The maximum transdiaphragmatic pressure (a measure of diaphragmatic strength) and the pressure–time index of the diaphragm (a measure of the load-to-capacity ratio of the muscle) have not been extensively assessed in small infants.
What is New:
• Preterm infants have lower diaphragmatic strength and impaired ability to sustain the generated force over time, which renders them prone to diaphragmatic fatigue.
• In very preterm infants, bronchopulmonary dysplasia may further impair diaphragmatic function.
•We design and implement two adaptations of the simulated annealing meta-heuristic for use in Bag-of-Tasks scheduling in multiple clouds and with multiple scheduling criteria.•We implement and study ...a multi-cloud model with heterogeneous characteristics both in terms of cost, performance and size.•Performance and cost analysis results of the model demonstrate the benefits of the use of simulated annealing in the scheduling of heterogeneous multi-cloud models.
Cloud computing has spurred the creation of a multitude of services that use the cloud to deliver their products on-demand. Behind it, stand multiple “Cloud Providers” that in the past few years have created data-centers, spread around the world, creating a mesh of distributed resources that can meet high availability and quality of service requirements. The growing number of cloud clients demand reliability, performance and better cost-to-performance ratios. Recently, scientific research has focused on the optimization of interlinked cloud systems, an aim which requires strategies for allocation of resources and distribution of computing tasks between them, while also considering their cost along with any factors that may differentiate them. In this study, we have evaluated the use of simulated annealing and thermodynamic simulated annealing in the scheduling of a dynamic multi-cloud system with virtual machines of heterogeneous performance serving Bag-of-Tasks applications. The scheduling heuristics applied, consider multiple criteria when scheduling said applications and try to optimize both for performance and cost, while also taking into account the heterogeneity of the virtual machines. Simulation results indicate that the use of these heuristics can have a significant impact in performance while maintaining a good cost-performance trade-off.
To explore the effect of early-onset preeclampsia on the blood pressure of offspring during the first month of life.
This prospective case-control study included 106 neonates of mothers with ...early-onset preeclampsia (developing at <34 weeks of gestation) and 106 infants of normotensive mothers, matched 1-to-1 for sex and gestational age. Serial blood pressure measurements were obtained on admission, daily for the first postnatal week, and then weekly up to the fourth week of life.
There were no differences in blood pressure values on admission and the first day of life between cases and controls. Conversely, infants exposed to preeclampsia had significantly higher systolic (SBP), diastolic (DBP), and mean blood pressure (MBP) on the subsequent days up to the fourth postnatal week (P <.001-.033). Multiple regression analyses with adjustment for sex, gestational age, antenatal corticosteroid use, and maternal antihypertensive medication use confirmed the foregoing findings (P <.001-.048). Repeated-measures ANOVA also identified preeclampsia as a significant determinant of trends in SBP, DBP, and MBP during the first month of life (F = 16.2, P < .001; F = 16.4, P < .001; and F = 17.7, P < .001, respectively).
Infants of mothers with early-onset preeclampsia have elevated blood pressure values throughout the neonatal period compared with infants born to normotensive mothers.
Respiratory syncytial virus is the most common pathogen causing lower respiratory tract infection in infants. In recent years, the importance of extrapulmonary complications and longterm sequelae ...including those involving the cardiovascular system has become apparent. We report on a 10 month old infant with respiratory syncytial virus bronchiolitis, the acute phase of which was complicated by irreversible complete heart block, which was managed conservatively.
Aortic intima-media thickness (aIMT) and its ratio to aortic diameter (aIMT/AoD) were measured on the second and fifth postnatal day in 39 neonates exposed to early-onset preeclampsia and 39 ...controls. Both aIMT and aIMT/AoD were higher in neonates exposed to preeclampsia (P < 0.001 for all comparisons).
•Early-onset preeclampsia is associated with structural aortic changes at birth.•Exposed newborns have increased aortic intima-media thickness (aIMT).•aIMT remains increased after correction for the diameter of the vessel.•These changes are consistent up to the fifth day of life.
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