Urinary metabolomics (GC-MS) reveals that low and high birth weight infants share elevated inositol concentrations at birth

Abstract

Objective: Metabolomics is a new “omics” platform aimed at high-throughput identification, quantification and characterization of small-molecule metabolites. The metabolomics approach has been successfully applied to the classification different physiological states and identification of perturbed biochemical pathways. The purpose of the current investigation is the application of metabolomics to explore biological mechanisms which may lead to the onset of metabolic syndrome in adulthood.

Methods: We evaluated differences in metabolites in the urine collected within 12 h from 23 infants with IUGR (IntraUterine Growth Restriction), or LGA (Large for Gestational Age), compared to control infants (10 patients defined AGA: Appropriate for Gestational Age). Urinary metabolites were quantified by GC-MS and used to highlight similarities between the two metabolic diseases and identify metabolic markers for their predisposition. Quantified metabolites were analyzed using a multivariate statistics coupled with receiver operator characteristic curve (ROC) analysis of identified biomarkers.

Results: Urinary myo-inositol was the most important discriminant between LGA?+?IUGR and control infants, and displayed an area under the ROC curve?=?1.

Conclusion: We postulate that the increase in plasma and consequently urinary inositol may constitute a marker of altered glucose metabolism during fetal development in both IUGR and LGA newborns.     

Serum lactate levels and perfusion index: are these prognostic factors on mortality and morbidity in very low-birth weight infants?

Aim: Early hemodynamic assessment of global parameters in critically ill newborns fails and requires mostly invasive measurements in neonatal intensive care unit. Clinical signs are frequently used for assessment of peripheral perfusion. Perfusion index (PI) is a new noninvasive numerical value of peripheral perfusion. Serum lactate levels and PI are the indicators that are important in determining prognosis of preterm infants. In this study, we aimed to investigate the relationship of serum lactate levels and PI with mortality and morbidity in very low-birth weight infants (VLBW).

Study design: This study was conducted between July 2014 and July 2015 in a Level III NICU. The study enrolled preterm infants with a gestational age?≤?32 weeks, birth weight?≤?1500?g. Serum lactate levels from blood gases and PI, SpO2 measurements were recorded at 1st, 12th and 24th hours by using a new generation pulse-oximeter. Morbidities and mortalities were documented.

Results: A total of 60 VLBW infants were enrolled the study. Mean birth weight and gestational age were 991?±?288?g and 27.5?±?2.5 w, respectively. Retinopathy of prematurity (ROP) was significantly higher in the patients with high lactate levels (>4?mg/dl) at 1st hour and low-PI levels (<0.5) at 12th hour of life (p?=?0.042, p?=?0.015), respectively. Bronchopulmonary displasia (BPD) was significantly higher in the patients with low PI (Conclusion: High lactate levels (>?4?mg/dl) and low PI (相似文献   

A comparison of the effects of invasive mechanic ventilation/surfactant therapy and non-invasive nasal-continuous positive airway pressure in preterm newborns

Aims: This study compared the early-term outcomes of mechanical ventilation (MV)/surfactant treatment with nasal-continuous positive airway pressure (nCPAP) in preterm infants with respiratory distress syndrome (RDS).

Materials and methods: Data from newborns born between ≥24 and ≤32 weeks of gestation, hospitalized at our newborn intensive care unit, and diagnosed with RDS between January 2009 and February 2012 were analyzed.

Results: Of 193 newborns with RDS who were enrolled in the study, 113 were treated with nCPAP and 80 with MV at a level of 57.5% of nCPAP. Within the study group, 46.3% of the infants were female. The mean gestation of the continuous positive airway pressure (CPAP) group was 29.07?±?1.99 weeks; that of the MV group was 28.61?±?2.01 weeks. The birth weight was 1321.1?±?325.4?g and 1240.3?±?366.1?g; however, the difference between the two groups was not significant. MV was not required in 54.9% of the patients with nCPAP treatment. Bronchopulmonary dysplasia (BPD) developed in 20 (18.7%) patients in the nCPAP group and 18 (24.4%) patients in the MV group; the difference was not significant (p?=?.351). Between 2009 and 2012, nCPAP was used at a rate of 33.9, 70.8, 68.4, and 69%. The risk factors for developing BPD were low gestation week, duration of intubation, and proven sepsis (p?=?.0001, p?=?.004, and p?=?.011, respectively).

Conclusions: Early nCPAP treatment in preterm infants (≤32 weeks of gestation) decreases both the need for MV and the use of surfactant, but without a significant effect on BPD development. (No. 2016/324)     

Serum surfactant protein D as a marker for bronchopulmonary dysplasia

Background: Lung epithelial cells express surfactant protein D (SP-D), a calcium-dependent lectin that plays an important role in antibody-independent pulmonary host defense. Previous studies have shown that it is found in the peripheral circulation in patients with pulmonary disease, likely because of translocation into the blood when lung epithelial barriers are disrupted by inflammation or acute injury. In adults, serum SP-D levels are biomarkers for the progression and severity of chronic lung disease. In neonates, elevated SP-D levels in cord blood and on day 1 have been associated with prenatal risk factors and with an increased risk of respiratory distress syndrome and infections. It is not known whether serum SP-D during the first week of life is a marker for bronchopulmonary dysplasia (BPD), a form of chronic lung disease of prematurity that is associated with lung parenchymal maldevelopment and injury.

Objective: The goal of this study is to determine whether serum SP-D on days 3 and 7 of life are associated with the development of BPD in preterm infants.

Design/methods: Serum samples were obtained on postnatal days 3 and 7 from 106 preterm infants (500–2000?g birth weight, 23–32-week gestation). SP-D was quantified by Western blot. BPD was determined at 36 weeks PMA using NICHD criteria.

Results: The mean birth weight was 1145?±?347?g and gestational age 29.2?±?7.4 weeks. BPD was diagnosed in 7 and “BPD or death” in 16 infants. Days 3 and 7 values tracked significantly (r?=?0.648), and did not correlate with birth weight or gestational age. Contrary to expectations, serum SP-D was not associated with BPD. Significant gender differences were noted, with SP-D dropping from day 3 to day 7 in males, while increasing in females (p?Conclusion: Elevated serum SP-D does not appear to be a useful marker for BPD. Decreasing serum SP-D levels in males, as compared to females, during the first week of life are likely related to gender differences in lung maturation, consistent with the higher incidence of BPD in males.     

Surfactant treatment for neonatal respiratory disorders other than respiratory distress syndrome

Background: It is suggested that there may be expanded use of surfactant replacement for the neonatal diseases such as meconium aspiration syndrome (MAS), pneumonia and possibly bronchopulmonary dysplasia (BPD).

Objective: To evaluate the characteristics and short-term outcome of the neonates given exogenous surfactant because of the diseases other than respiratory disease syndrome (RDS).

Methods: This retrospective study included 35 neonates admitted to the neonatal intensive care unit from January 2012 to December 2012 for an expanded use of surfactant. Data related to gestational age, birth weight, gender and perinatal risk factors were obtained from the patients’ records. The short-term prognosis was also noted.

Results: The diagnosis was sepsis in 16 patients, eight MAS, seven transient tachypnea of the newborns (TTN) and four BPD. Mean gestational age was 35.6?±?4.5 weeks and mean birth weight was 2661?±?981?g. Of overall cases, 65% were boys and 35% girls. The mortality rate was 17%. Of six fatal cases, three was with BPD, two with sepsis and one with MAS.

Conclusion: We think that surfactant replacement may be life saver in the neonatal diseases other than RDS such as BPD, MAS and sepsis by rapidly improving oxygenation. Further investigation is necessary to validate the significance of expanded use of surfactant.     

Increased ADMA levels are associated with poor pulmonary outcome in preterm neonates

Background: Nitric oxide (NO), synthesized from the amino acid L-arginine by the action of NO synthases (NOS), is a pulmonary vasodilator. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of NOS. Preterm infants have higher plasma ADMA concentrations than term infants which could cause inhibition of NO synthesis and deterioration in pulmonary functions. We aimed to investigate the relationship between serum ADMA and L-arginine levels of preterm infants and respiratory distress syndrome (RDS), requirement of surfactant treatment, duration of mechanical ventilation, oxygen treatment, and development of bronchopulmonary dysplasia (BPD).

Methods: A prospective cohort study was conducted including 80 preterm infants born with gestational age (GA) ≤?32 weeks and birth weight (BW) ≤?1500?g. Blood samples were obtained from all infants immediately after birth, and at postnatal 28th day of age. The relationship of first-day serum ADMA and L-arginine levels and surfactant requirement, duration of mechanical ventilation, oxygen treatment was investigated. Serum ADMA and L-arginine levels at 1st and 28th days were compared at patients with and without BPD. The role of serum ADMA levels at postnatal 28th day of age to predict the requirement of oxygen at postmenstrual 36 weeks of age was also investigated.

Results: Eighty preterm infants (42 male, 38 female) were enrolled in the study. Mean BW and GA for the total cohort was 1144.81?±?220.44?g and 28.3?±?1.8 weeks, respectively. Sixty-one infants were diagnosed as RDS and 44 infants treated with surfactant. The first-day ADMA levels were significantly higher in infants with surfactant requirement (1.14?±?0.23 versus 0.86?±?0.37, p?p?>?0.05) but not significantly. Serum ADMA and L-arginine concentrations at first day were not different among infants with and without BPD (p?>?0.05). ADMA concentrations at 28th day was significantly higher in infants with BPD (1.00?±?0.25 versus 0.81?±?0.25, p?Conclus?on: Serum ADMA and L-arginine levels are related to pulmonary morbidities in newborn. The results of this study show that increased ADMA levels are associated with poor pulmonary outcomes in preterm infants.     

Absolute nucleated red blood cells counts do not predict the development of bronchopulmonary dysplasia

Objective: We tested the hypothesis that infants with bronchopulmonary dysplasia (BPD) have higher absolute nucleated red blood cells (aNRBCs) counts at birth than controls as a proxy measurement of exposure to intrauterine hypoxia.

Methods: We studied 39 preterm infants with BPD and compared them to 39 pair-matched controls without BPD. Criteria for exclusion in both groups included factors that may influence the aNRBCs at birth.

Results: In logistic regression, when pre-eclampsia, birthweight, gender, antenatal steroid therapy, 1-min Apgar scores, respiratory distress syndrome (RDS) (or surfactant use), intraventricular hemorrhage of grade 3 or more, nosocomial sepsis, patent ductus arteriosus, and aNRBC counts (or lymphocyte counts) were used as independent variables, and BPD as the dependent variable, only RDS (or its proxy measurement of surfactant use) and nosocomial sepsis remained included in the final analysis.

Conclusions: aNRBC counts and lymphocyte counts do not appear to be elevated in infants that develop BPD, as compared to pair-matched controls without BPD. We speculate that chronic intrauterine hypoxia does not appear to play a major role in the pathogenesis of BPD. In contrast, postnatal events such as RDS and nosocomial sepsis appear to play a determining role in the pathogenesis of BPD.     

Congenital and perinatal cytomegalovirus lung infection

Abstract

Background: Cytomegalovirus (CMV) pneumonitis may be severe, even lethal, following congenital infection or in premature infants with perinatal infection.

Objective: To review the epidemiological, pathogenetic, clinical and therapeutic features of prenatal and perinatal CMV lung diseases.

Methods: Evaluation of all published papers listed on PubMed describing CMV pneumonitis in infants.

Results: CMV is frequent and severe in immunosuppressed infants but infrequent in full-term neonates and occurs more frequently after perinatal than after congenital infection, particularly in premature infants. In premature infants, CMV infection is often protracted and causes a diffuse interstitial pneumonitis leading to fibrosis and bronchopulmonary dysplasia (BPD). Congenital CMV infection should also be considered in newborns with severe acute respiratory distress syndrome and refractory respiratory failure with progression to early chronic lung disease. The association between breast milk-transmitted CMV and development of cystic lung disease and Wilson–Mikity syndrome has also been reported. Data on the efficacy of antiviral therapy for infants with respiratory CMV diseases are lacking and only anecdotal case reports are available.

Conclusions: Persistent CMV infection appears to cause a diffuse necrotizing pneumonitis with fibrosis leading to BPD, in both immunocompromised or preterm infants and, less frequently in immunocompetent infants. The role of antiviral therapy remains to be elucidated.     

The role of carboxyhemoglobin measured with CO-oximetry in the detection of hemolysis in newborns with ABO alloimmunization

Objectives: To evaluate carboxyhemoglobin (COHb) values measured with a CO-oximeter (Roche-cobas b 221) in jaundiced newborns with or without hemolysis and healthy controls in order to assess whether COHb measurement determined with a CO-oximeter could be used as an indicator of hemolysis in newborns with ABO alloimmunization.

Methods: A total of 86 term newborn infants were prospectively studied. The study cohort consisted of three subgroups: 18 infants with ABO HDN, 21 infants with hyperbilirubinemia without hemolytic disease who required phototherapy, and 47 healthy controls. The COHb, bilirubin, and Hb levels were measured.

Results: The three subgroups did not differ significantly with respect to birth weight, gestational age, gender, Apgar score, or mode of delivery. The ABO HDN infants had significantly higher COHb values than the healthy controls (median 2.4% versus 1.3%, p?<?0.0005) and the group with hyperbilirubinemia without hemolytic disease (median 2.4% versus 1.3%, p?<?0.0005), although the infants with hyperbilirubinemia without hemolytic disease did not have significantly higher COHb values compared with the healthy controls. The cut-off value of 1.7% COHb had 72% sensitivity and 97% specificity for confirming hemolysis in ABO alloimmunization.

Conclusions: Our data show that COHb values determined with CO-oximeters are higher in newborns with hemolysis than in those without hemolysis. COHb measured with CO-oximeters could be used to confirm hemolysis in infants with ABO alloimmunization.     

The hospital outcomes compared between the early and late hypothermia-treated groups in neonates

Background and objective: The incidence of hypoxic ischemic encephalopathy (HIE) in developed countries is estimated to be 1.5 per 1000 live births. The primary aim of this study was to analyze whether earlier hypothermia (≤1?h) improves hospital outcomes in survivors who underwent therapeutic hypothermia (TH) when compared with late TH (>1?h).

Method: Forty-nine (70%) newborns received TH for 72?h, within 6?h of birth; the remaining 21 received standard care. We divided the TH-treated newborns into early and late groups; early cooling was considered when TH was started ≤1?h after birth; late cooling was considered when started >1?h.

Results: The early TH group consisted of 20 of 49 (41%) infants; the late TH group consisted of 29 (59%) infants. Apgar score at 1?min and the initial calcium level was significantly lower in the early (≤1?h) TH infants; there were significantly more inborns in the early TH group (p?=?0.008). Infants in the late TH group manifested more clinical seizures followed by more abnormal EEG findings, longer ventilator care and longer hospitalization (p?=?0.001). TH-related complications and mortality were not significantly different between the two groups.

Conclusions: Early TH (≤1?h) had lower Apgar score at 1?min and initial calcium level, but had decreased incidence of clinico-electrical seizures among HIE infants. Also, ventilator support and hospitalization period were longer in the late TH group.     

Vascular assessment of the right internal jugular vein in low birth weight newborns

Abstract

Objective: To determine the dimensions and depth of the right internal jugular vein (RIJV) in low birth weight newborns by ultrasound and assess the differences in weight and determine the relationship of the vein with the carotid artery.

Method: We performed a vascular assessment of the RIJV in 100 low birth weight newborns. The subjects were divided into three groups, low birth weight (LBW) newborns, <2500?g; very low birth weight (VLBW) newborns, <1500?g; and extremely low birth weight (ELBW) newborns <1000?g.

Results: Of the newborns, 39% had LBW, 33% had VLBW, and 28% had ELBW. The medians were gestational age 31 weeks, weight 1300?g, anteroposterior diameter of the RIJV 2.2?mm, and the distance from the skin–RIJV 3.6?mm. In LBW newborns, the median anteroposterior diameter of RIJV was 2.7?mm; in LBW newborns 2.2; in ELBW newborns 1.9 (p?<?0.001); the median distance from skin to RIJV for LBW newborns was 4.1?mm; for VLBW newborns, 3.6 and for ELBW newborns 2.9 (p?<?0.01); differences that were statistically significant.

Conclusions: In low birth weight newborns, the diameter and depth of the RIJV is directly proportional to the weight of the subjects studied.     

Early caffeine therapy for prevention of bronchopulmonary dysplasia in preterm infants

Abstract

Objective: To determine if an early commencement of caffeine is associated with improved survival without bronchopulmonary dysplasia (BPD) in preterm infants.

Methods: Retrospective data analysis from the Alere Neonatal Database for infants weighing ≤1250?g, and treated with caffeine within the first 10 days of life. The neonatal outcomes were compared between the infants who received early caffeine (0–2 days) with the infants who received delayed caffeine (3–10 days).

Results: A total of 2951 infants met the inclusion criteria (early caffeine 1986, late caffeine 965). The early use of caffeine was associated with reduction in BPD (OR 0.69, 95%?CI 0.58–0.82, p?<?0.001) and BPD or death (OR 0.77, 95%?CI 0.63–0.94, p?=?0.01). Other respiratory outcomes also improved with the early commencement of caffeine. The frequency of severe intraventricular hemorrhage and patent ductus arteriosus was lower and the length of hospitalization was shorter in infants receiving early caffeine therapy. However, early use of caffeine was associated with an increase in the risk of nectrotizing enterocolits (NEC) (OR 1.41, 95%?CI 1.04–1.91, p?=?0.027).

Conclusion: Early commencement of caffeine was associated with improvement in survival without BPD in preterm infants. The risk of NEC with early caffeine use requires further investigation.     

Prevalence and risk factors associated with the patency of ductus arteriosus in premature neonates: a prospective observational study from Iran

Background: Patent ductus arteriosus (PDA) is a common problem in the preterm infants. The frequency of PDA varies with the time of study, and the characteristics of the population included in the trial.

Aims and objective: To determine the prevalence and prenatal risk factor associated with PDA.

Methods and material: This prospective cross-sectional observational study was carried out on neonates who had gestational age below 37 weeks during the period of February 2014 to September 2014. Echocardiography was done at 4–7 days of postnatal age. The association between prenatal risk factors of the infants and the PDA was studied.

Results: From a total population of 200 enrolled infants 22.5% had PDA. The mean gestational age and birth weight were 32.1?±?2.65 (weeks) and 1741?±?622.85 (g), respectively. Maternal antepartum hemorrhage, respiratory distress syndrome (RDS), need for surfactant, birth weights, female gender, gestational age, Apgar scores at 1 and 5?min of the infants were found to be associated with the prevalence of PDA.

Conclusion: Several prenatal factors make preterm newborns susceptible to PDA. These risk factors should be identified as soon as possible for early commencement of PDA management.     

The association between glucose challenge test level and fetal nutritional status

Abstract

Objective: To examine the relationship between maternal glucose challenge test (GCT) levels and fetal nutritional status index (FNSI: a ratio of child’s birth weight (kg) over squared maternal height (m²).

Methods: A total of 2193 women from the Beichen district, Tianjin, China, who had 50?g GCT at gestational age 24–28 weeks, gave a full-term singleton birth between June 2011 and October 2012, and with both maternal height and birth weight measures are included in this report.

Results: Approximately 28.0% of women had a GCT?≥?7.8?mmol/L. The newborns of mothers with a GCT?≥?7.8?mmol/L had significantly higher level of FNSI ([kg/m²], boys: 1.336 versus 1.296, p?<?0.001; girls: 1.312 versus 1.268, p?<?0.0001). Logistic regression results, after adjustment for maternal age, residence, education, nationality, history of disease and reproduction, insurance and gestational age, indicated that every unit increase in FNSI was associated with approximately threefold higher odds (OR [95% CI]: 3.6 [1.5, 8.9]) of being in GCT?≥?7.8?mmol/L for women giving birth as boys and fivefold higher odds (5.9 [2.5, 14.1]) for giving birth as girls.

Conclusions: Women with a GCT?≥?7.8?mmol/L have babies with a higher FNSI, suggesting that these infants may be overnourished before birth and may increase cardiovascular risk in their future.     

早产儿支气管肺发育不良危险因素分析及防治措施

目的 分析早产儿支气管肺发育不良(BPD)的发生率和危险因素，探讨防治BPD的措施。方法 回顾性分析中山大学第一附属医院新生儿科1999年6月至2004年6月期间胎龄≤32周且出生体重≤2000g，存活时间>28d的早产儿72例，比较机械通气治疗中15例BPD(BPD组)和31例非BPD(对照组)患儿性别、胎龄、出生体重、生前使用糖皮质激素、生后使用肺表面活性物质、肺透明膜病、机械通气时间、呼吸支持条件、胃食管反流、动脉导管未闭、生后早期液体摄取量、反复肺部感染情况。结果早产儿BPD的总发生率为20.83%(15/72)，其中<1500g早产儿BPD的发生率为38.71%(12/31)；BPD组FiO2、PIP、PEEP和MAP与对照组差异无显著性意义(P>0.05)；多因素Logistic回归显示，胎龄<30周、体重<1250g、机械通气≥10d和反复肺部感染是发生BPD的独立危险因素(P<0.05)，而性别、生前使用糖皮质激素、生后使用肺表面活性物质、肺透明膜病、胃食管反流、动脉导管未闭、生后早期液体摄取量没有统计学意义(P>0.05)。结论 避免低体重早产、长时间机械通气和有效控制肺部感染是防治BPD的关键。 Abstract Objective To study the incidence,risk factors,prophylaxis and treatment for bronchopulmonary dysplasia (BPD) in premature.Methods From June 1999 to June 2004 seventy two prematures with gestational age less than 32 weeks,birth weight less than 2000 grams and surviving more than 28 days were enrolled in the study.Fifteen prematures with BPD were compared to thirty one prematures without BPD in terms of sex,gestational age,birth weight，usage of prenatal steroids,usage of postnatal surfactant,hyaline membrane disease,duration of mechanical ventilation,supportive conditions for ventilation,gastroesophageal reflux,patent ductus arteriosus,fluid intake in the first few days and recurrent pneumonia.Results The overall incidence of BPD in preterm newborns was 20.83%,and 38.71% in those infants weighting <1500g at birth；Fio2,PIP,PEEP and MAP were all not statistically significant between BPD group and control (P>0.05)；Multivariate logistic analysis revealed that gestational age less than 30 weeks,birth weight less than 1250 grams,prolonged mechanical ventilation (≥10days) and recurrent pneumonia were independent risk factors for BPD (P<0.05).Other factors including sex,usage of prenatal steroids,usage of postnatal surfactant,hyaline membrane disease,gastroesophageal reflux and excessive fluid intake in the first few days of life were not statistically significant (P>0.05).Conclusion Preventing small gestational age and low birth weight prematurity,shortening the duration of mechanical ventilation and controlling pneumonia were effective in preventing BPD. Key words Premature;Bronchopulmonary dysplasia;Risk factors     

Severe bronchopulmonary dysplasia – incidence and predictive factors in a prospective,multicenter study in very preterm infants with respiratory distress syndrome

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.     

Death or survival with major morbidity in VLBW infants born at Brazilian neonatal research network centers

Objective: To analyze unfavorable outcomes at hospital discharge of preterm infants born at Brazilian public university centers.

Methods: Prospective cohort of 2646 inborn infants with gestational age 23–33 weeks and birth weight 400–1499?g, without malformations, born at 20 centers in 2012–2013. Unfavorable outcome was defined as in-hospital death or survival at hospital discharge with ≥1 major morbidities: bronchopulmonary dysplasia (BPD) at 36 corrected weeks, intraventricular hemorrhage (IVH) grades 3–4, periventricular leukomalacia (PVL) or surgically treated retinopathy of prematurity (ROP).

Results: Among 2646 infants, 1390 (53%) either died or survived with major morbidities: 793 (30%) died; 497 (19%) had BPD; 358 (13%) had IVH 3–4 or PVL; and 84 (3%) had ROP. Logistic regression adjusted by center showed association of unfavorable outcome with: antenatal steroids (OR 0.70; 95%CI 0.55–0.88), C-section (0.72; 0.58–0.90), gestational age <30 (4.00; 3.16–5.07), being male (1.44; 1.19–1.75), small for gestational age (2.19; 1.72–2.78), 5th-min Apgar <7 (3.89; 2.88–5.26), temperature at NICU admission <36.0?°C (1.42; 1.15–1.76), respiratory distress syndrome (3.87; 2.99–5.01), proven late sepsis (1.33; 1.05–1.69), necrotizing enterocolitis (3.10; 2.09–4.60) and patent ductus arteriosus (1.69; 1.37–2.09).

Conclusions: More than half of the VLBW infants born at public university level 3 Brazilian hospitals either die or survive with major morbidities.     

Nebulized pentoxifylline for prevention of bronchopulmonary dysplasia in very low birth weight infants: A pilot clinical study

Objective.?To evaluate the effectiveness of nebulized pentoxifylline (PTXF) compared to intravenous dexamethasone (DX) or placebo (nebulized distilled water) for the prevention of bronchopulmonary dysplasia (BPD).

Methods.?One hundred and fifty very low birth weight infants were randomly assigned to three groups. Entry criteria were the need for oxygen administration on the fourth day of life, irrespective of whether ventilatory support was required. PTXF was administered with a nebulizer every 6 hours on three consecutive days (a single course) in a dose of 20 mg/kg when infants were breathing spontaneously or 10 mg/kg when they needed ventilatory support. DX was given every 12 hours on three consecutive days in a dose of 0.25 mg/kg. Nebulized distilled water was administered with the schedule of inhalation as in the PTXF group. When the need for ventilatory support or oxygen dependency persisted, the course of both drugs and placebo administration was repeated every seven days until the diagnosis of BPD was established.

Results.?Both PTXF and DX reduced the incidence of disease when compared with placebo. The respective data obtained for the PTXF-group versus the placebo group were as follows: difference in risk, 27%; OR: 0.32; CI: 0.11–0.94; p = 0.039; whereas the results for the DX-group versus the placebo group were: difference in risk, ? 23%; OR: 0.39; CI: 0.14–1.14; p = 0.07.

Conclusion.?Our data show that nebulized PTXF reduces the risk of BPD and may be a potential alternative to steroids in the prevention of this disease.     

Maternal hepatitis B surface antigen carrier status and its impact on neonatal outcomes: a cohort study of 21 947 singleton newborns in China

Objective: To explore the impact of maternal hepatitis B surface antigen (HBsAg) carrier status on neonatal outcomes.

Methods: A retrospective cohort study was conducted using data from medical records database of six hospitals in China. Information on maternal characteristics and selected neonatal outcomes was retrieved for all women who delivered singleton infants between 1 January 2009 and 31 December 2010.

Results: A total of 21 947 singleton newborns and their mothers were included. The prevalence of maternal HBsAg positivity was 4.2% (95% confidence interval (CI) 3.9–4.5%). Compared with infants born to HBsAg-negative women, infants born to HBsAg-positive mothers were more than twice more likely to have a malformation before (adjusted odds ratio (aOR) 2.23, 95% CI 1.15–4.30) and at birth (aOR 2.66, 95% CI 1.38–5.14), but were less likely to be macrosomia (aOR 0.67, 95% CI 0.47–0.96). No statistically significant association was found between maternal HBsAg positivity and preterm birth (aOR 1.20, 95% CI 0.95–1.51), low birth weight (aOR 1.24, 95% CI 0.91–1.69), and Apgar scores at 1?min (aOR 0.88, 95% CI 0.49–1.57) and 5?min (aOR 1.84, 95% CI 0.89–3.81).

Conclusion: Maternal HBsAg positivity may be associated with a higher risk of congenital malformation.     

Reference values of serum IgG and IgM levels in preterm and term newborns

Aim: Although, variations of normal immunoglobulin (Ig) levels in different gestational age and birth weight groups have been studied so far, data are still limited in newborns, especially in preterm infants. The aim of this study was to determine serum IgG and IgM levels in newborns in order to generate a reference standard for neonatal intensive care unit (NICU) and address the variations in preterm babies.

Methods: This study was conducted from June 2012 to June 2013 in a level III NICU. A total of 300 newborn infants hospitalized within first 72?h were included in the study. The quantification of serum IgG and IgM was performed by nephelometric method.

Results: Both serum IgG and IgM levels were increased in correlation with increased gestational age and birth weight.

Conclusion: The reference values of serum IgG and IgM levels should be further evaluated in larger series with the presented data in this article. In addition, preterm babies appear to have lower Ig levels thus carry the risk of relevant morbidity.