Influence of nose and mouth leaks on peripheral oxygen saturation during continuous positive airway pressure in neonates

Background

Nose and mouth leaks impair effective pressure transmission during neonatal continuous positive airway pressure (CPAP), but little is known about how these leaks affect physiological parameters. This study investigated the influence of nose leaks and spontaneous mouth opening on peripheral oxygen saturation (SpO₂) and respiratory rate (RR) using nasopharyngeal CPAP.

Methods

In 32 neonates with a gestational age of 30 (24–38) weeks and a birth weight of 1435 (710–2730) g, SpO₂ and RR measurements were taken with and without occlusion of the contralateral nostril in a randomized cross-over trial in 1-minute intervals over a 10-minute period during each condition. Mouth opening and newborn activity were documented.

Results

SpO₂ with open nostril was comparable to that with occluded nostril [93 (78.5–99.5)% vs. 94 (80–100)%, P=0.20]. RR decreased from 51 (26–82)/min to 48 (32–85)/min (P=0.027). In infants with an SpO₂≤93% during open nostril (n=17), SpO₂ increased after nostril occlusion [91 (80–96)% vs. 89.5 (78.5–93)%, P=0.036]. The mouth was open in 78.5% of measurements with open nostril, and in 87.4% of measurements after nostril occlusion (P=0.005). No significant influence of mouth opening or closure on SpO₂ or RR was detected.

Conclusions

In neonates on unilateral nasopharyngeal CPAP with an SpO₂ ≤93%, occlusion of the contralateral nostril significantly increased SpO₂ and reduced RR. The beneficial physiological effects further support using binasal prongs to minimize nose leaks in this population. Future studies should investigate the beneficial effects of reducing mouth leaks when applying CPAP to these infants.     

Kangaroo Mother Care in Reducing Pain in Preterm Neonates on Heel Prick

Objectives

To determine the effect of Kangaroo Mother Care (KMC) of small duration of 15 min in decreasing pain in preterm neonates between 32–36 wk 6 d on heel prick by a 26 gauge needle.

Methods

Randomized controlled double masked crossover trial involving 50 neonates, between 32 wk and 36 wk 6 d gestation and weighing less than 2500 g, within 10 d of birth, vitally stable, breathing without assistance or on Continuous positive airway pressure (CPAP), without any clinically evident neurological signs, not having received analgesics/sedatives within last 24 h and not fed within last 30 min and requiring heel pricking were eligible. Outcome measured was the Premature Infant Pain Profile (PIPP). Analysis was done using independent sample t test, with Bonferroni correction applied for comparing individual components of PIPP score.

Results

The heart rate, behaviour and facial scores were statistically significant and lower in KMC group. But there was no statistically significant difference in oxygen saturation (SpO₂₎. The difference(4.85) in PIPP score was clinically and statistically significant (p?<?0.0001).

Conclusions

The findings suggest that short duration KMC (15 min) has stress reducing benefits. Preterm neonates above 32 wk gestational age can benefit from KMC to decrease pain from heel prick procedure.     

Expressed breast milk vs 25% Dextrose in procedural pain in neonates: A double blind randomized controlled trial

Objective

To compare the effect of expressed breast milk (EBM), 25% dextrose (25 D) and sterile water (SW) on procedural pain in neonates as assessed by the premature infant pain profile (PIPP), changes in heart rate (HR), oxygen saturation (SpO₂) and duration of crying.

Design

Prospective, double blind, randomized controlled trial.

Setting

Postnatal ward of a tertiary-care hospital.

Participants

210 babies who required venipuncture for blood sampling and who were on oral feeds were recruited into the study after parental informed consent.

Methods

The enrolled babies were randomized into intervention groups (EBM, 25% dextrose) and control group (sterile water). Two ml of test solution was given to baby by paladay (a traditional cup with a spout) 2 min before venipuncture. The face and crying of baby were video graphed by an independent, blinded observer. The facial response to pain (brow bulge, eye squeeze, nasolabial furrow) was analysed from the video. Maximum HR and minimum SpO₂ were recorded during, and 1, 3 and 5 min after venipuncture by another blinded observer.

Outcome variable

PIPP score, HR, SpO₂ and crying time at 0/1/3/5 min after sampling.

Results

160 babies were considered for final analysis with 50 in 25 D, 62 in EBM and 48 in SW group. The mean PIPP score in the 3 groups were 5.22, 6.84 and 11.22 at 0–30 sec after venipuncture; 4.52, 6.34, and 10.88 at 1–1 ½ min; 3.96, 6.15 and 9.35 at 3–3 ½ min; and 3.12, 4.68 and 7.83 at 5–5 ½ min; respectively (P< 0.001). The median crying time was 10,37.5 and 162 seconds in 25 D, EBM and SW groups, respectively (P< 0.001).

Conclusions

EBM significantly reduces procedural pain in neonates though to a lesser extent as compared to 25% dextrose.     

Enteral vitamin A for reducing severity of bronchopulmonary dysplasia in extremely preterm infants: a randomised controlled trial

Background

Intramuscular vitamin A supplementation decreases the risk of bronchopulmonary dysplasia (BPD) in very-low-birth-weight preterm infants without significant adverse effects. However, intramuscular vitamin A supplementation is not widely accepted because of the discomfort and risk of trauma associated with repeated injections. Enteral vitamin A supplementation has not been studied adequately in the clinical trials. Enterally administered water-soluble vitamin A is absorbed better than the fat-soluble form. We hypothesised that enteral administration of a water-soluble vitamin A preparation will decrease severity of BPD compared with a control group receiving placebo.

Methods

We plan a double-blind randomised placebo-controlled trial at a tertiary neonatal-perinatal intensive care unit. Eligibility criteria include infants born at less than 28 weeks’ gestational age and less than 72 h of life. Infants with major congenital gastrointestinal or respiratory tract abnormalities will be excluded. After parental consent, infants will be randomized to receive either enteral water-soluble vitamin A (5000 IU once a day) or placebo. The intervention will be started within 24 h of introduction of feeds and continued until 34 weeks’ post-menstrual age (PMA).The primary outcome is severity of BPD at 36 weeks’ PMA. Severity of BPD will be assessed objectively from the right-shift of the peripheral oxyhaemoglobin saturation versus partial pressure of inspired oxygen (SpO₂-PiO₂) curve. We require 188 infants for 80% power and 5% significance level based on an expected 20% decrease in the right shift of the SpO₂-PiO₂ curve in the vitamin A group (primary outcome) compared with control group at 36 weeks’ PMA, and a 20% attrition rate.Secondary outcomes will be plasma and salivary concentrations of vitamin A on day 28 of the trial (first 30 infants), lung and diaphragm function, clinical outcomes at 36 week’ PMA or before discharge/death, and safety of vitamin A.

Discussion

BPD poses a significant economic burden on the health-care system. If our study shows that enteral supplementation of water-soluble vitamin A is safe and effective for decreasing the severity of BPD, it will provide the opportunity to further evaluate a simple, globally acceptable preventive therapy for BPD.

Trial registration

ANZCTR; ACTRN12616000408482 (30th March 2016).

     

Comparison of salivary cortisol, heart rate, and oxygen saturation between early skin-to-skin contact with different initiation and duration times in healthy, full-term infants

Background

There are few studies that compare the physiological and biological efficacies between different early skin-to-skin contacts (SSC) post birth.

Aim

To investigate physiologically and biochemically how early SSC with different initiation and duration time influence the stress post birth for full-term infants.

Study design

Non-experimental study.

Subjects

Study I; Thirty-two infants who began SSC 5 min or less [birth SSC, mean initiation time (standard deviation): 1.6 (1.1) min] after birth and 36 infants who did so more than 5 min [very early SSC, 26.3 (5.0) min] in heart rate (HR) and oxygen saturation (SpO₂) analysis. Study II; Eighteen infants who underwent SSC for 60 min or less [mean initiation time: 7.5 (12.2) min] and 61 infants who did so for more than 60 min [15.3 (12.5) min] in salivary cortisol analysis.

Outcome measures

HR and SpO₂ measured for 30 min post birth. Salivary cortisol concentration measured at 1 min, 60 min, and 120 min post birth.

Results

Birth SSC group reached HR stability of 120-160 bpm significantly faster than very early SSC group by Kaplan-Meier analysis (P = 0.001 by log-rank test). As for SpO₂ stability of 92% and 96%, no significantly between-group difference was found. Salivary cortisol levels were significantly lower between 60 and 120 min after birth in SSC group, continuing for more than 60 min compared with SSC group for 60 min or less after adjustment for salivary cortisol level at 1 min besides the infant stress factors (P = 0.046).

Conclusions

Earlier SSC beginning within 5 min post birth and longer SSC continuing for more than 60 min within 120 min post birth are beneficial for stability of cardiopulmonary dynamics and the reduction of infant stress during the early period post birth.     

Target Oxygen Saturation Among Preterm Neonates on Supplemental Oxygen Therapy: A Quality Improvement Study

Objective

To avoid excessive oxygen exposure and achieve target oxygen saturation (SpO₂) within intended range of 88%–95% among preterm neonates on oxygen therapy.

Methods

20 preterm neonates receiving supplemental oxygen in the first week of life were enrolled. The percentage of time per epoch (a consecutive time interval of 10 hours/day) spent by them within the target SpO₂ range was measured in phase 1 followed by implementation of a unit policy on oxygen administration and targeting in phase 2. In phase 3, oxygen saturation histograms constructed from pulse-oximeter data were used as daily feedback to nurses and compliance with oxygen-targeting was measured again.

Results

48 epochs in phase 1 and 69 in phase 3 were analyzed. The mean (SD) percent time spent within target SpO₂ range increased from 65.9% (21.4) to 76.5% (12.6) (P=0.001).

Conclusion

Effective implementation of oxygen targeting policy and feedback using oxygen saturation histograms may improve compliance with oxygen targeting.

     

Stress and ano-colorectal surgery in newborn/infant: role of anesthesia

Purpose

The best anesthesia for newborns/infants necessitating colorectal surgery remains questionable. Endovenous and locoregional anesthesiological approaches were compared to determine the influence on stress response.

Methods

Patients with anorectal malformations or Hirschsprung’s disease were randomized to inhalatory/epidural anesthesia (IPA) or inhalatory/endovenous anesthesia (IEA). Heart rate, blood pressure, oxygen saturation, serum concentrations of dehydroepiandrosterone, cortisol, and glucose were recorded 24 h before operation (T0), after tracheal intubation (T1), 120 min after skin incision (T2), 60 min (T3) and 24 h after operation (T4).

Results

Seventeen patients were enrolled in the study, 8 receiving IPA, and 9 IEA. Heart rate, blood pressure, oxygen saturation remained stable and normal, without statistical differences between the two groups, during the study period. Similar cortisol and glucose levels showed no statistical differences between groups. Dehydroepiandrosterone values were significantly higher in IEA during anesthesia (T1–T3) compared with IPA (T1: 494.0 vs. 266.5, p < 0.05; T2: 444.0 vs. 201.0, p < 0.05; T3: 385.0 vs. 305.0, p < 0.05).

Conclusion

This study suggests that epidural and endovenous anesthesia are both effective in intra- and postoperative period. This preliminary report suggests that IPA is more efficient compared to IEA in controlling stress reaction related to surgery. Further larger studies are needed to confirm these findings.     

Very early postnatal changes in splanchnic circulation in term infants

Background

Reversed blood flow has been reported in the superior mesenteric artery (SMA) in 92% of healthy term newborns at 2 h of age. By 24 h after birth the end-diastolic velocity became positive in all of the infants.

Objective

To characterize hemodynamic changes in the coeliac artery and superior mesenteric artery in healthy term newborns during the first 6 h after birth and to specify the time interval when the negative values of end-diastolic velocity in the superior mesenteric artery become positive.

Materials and methods

Our study included 30 healthy term newborns. The blood flow velocity was assessed by Doppler ultrasonography at 2 h, 4 h and 6 h after birth.

Results

The end-diastolic velocity in the superior mesenteric artery changed from negative values at the age of 2 h (?0.9 cm/s, range ?13.2 to 0.0) to positive (7.08 cm/s, range 6.3 to 13.5, P?<?0.001) at 6 h after birth. In the coeliac artery, the end-diastolic velocity increased during this period, but negative values were not observed (11.8 cm/s, range 9.3 to 13.9 at 2 h and 18.03 cm/s, range 14.2 to 27.6 at 6 h).

Conclusion

Important changes occur in splanchnic circulation during the first 6 h after birth. The rise in end-diastolic velocity in the superior mesenteric artery from negative to positive values in 83% of healthy term newborns is the most important change.     

Intracranial haemorrhage: an incidental finding at magnetic resonance imaging in a cohort of late preterm and term infants

Background

Intracranial haemorrhage (ICH) in term newborns has been increasingly recognised but the occurrence in late preterm infants and the clinical presentation are still unclear.

Objective

To investigate the appearance of intracranial haemorrhage at MRI in a cohort of infants born at 34 weeks’ gestation or more and to correlate MRI findings with neonatal symptoms.

Materials and methods

We retrospectively reviewed neonatal brain MRI scans performed during a 3-year period. We included neonates ≥34 weeks’ gestation with intracranial haemorrhage and compared findings with those in babies without intracranial haemorrhage. Babies were classified into three groups according to haemorrhage location: (1) infratentorial, (2) infra- and supratentorial, (3) infra- and supratentorial + parenchymal involvement.

Results

Intracranial haemorrhage was observed in 36/240 babies (15%). All of these 36 had subdural haemorrhage. Sixteen babies were included in group 1; 16 in group 2; 4 in group 3. All infants in groups 1 and 2 were asymptomatic except one who was affected by intraventricular haemorrhage grade 3. Among the infants in group 3, who had intracranial haemorrhage with parenchymal involvement, three of the four (75%) presented with acute neurological symptoms. Uncomplicated spontaneous vaginal delivery was reported in 20/36 neonates (56%), vacuum extraction in 4 (11%) and caesarean section in 12 (33%). Babies with intracranial haemorrhage had significantly higher gestational age (38?±?2 weeks vs. 37?±?2 weeks) and birth weight (3,097?±?485 g vs. 2,803 ± 741 g) compared to babies without intracranial haemorrhage and were more likely to be delivered vaginally than by caesarian section.

Conclusion

Mild intracranial haemorrhage (groups 1 and 2) is relatively common in late preterm and term infants, although it mostly represents an incidental finding in clinically asymptomatic babies; early neurological symptoms appear to be related to parenchymal involvement.     

Effect of Multisensory Stimulation on Neuromotor Development in Preterm Infants

Objective

To investigate the effect of Auditory, Tactile, Visual and Vestibular stimulus (ATVV) on neuromotor development in preterm infants.

Methods

Fifty preterm infants born at 28–36 wk with a birth weight ranging from 1,000–2,000 g were recruited for the study. They were block randomized into a control group (n?=?25) and study group (n?=?25). New Ballard score was used for the baseline measurement of neuromaturity in both groups. In neonatal intensive care unit (NICU), the study group received multisensory stimulation for 12 min per session, 5 sessions per wk along with routine NICU care either from 33 wk corrected gestational age for infants born at 28–32 wk or from 48 h of birth for infants born at 33–36 wk until discharge from the hospital. The control group received the routine NICU care. At term age the preterm infants were assessed using Infant Neurological International Battery (INFANIB) and the groups were compared using independent t test.

Results

The multisensory stimulated infants showed higher neuromotor score (p?=?0.001) compared to the control group. The french angle components of INFANIB including heel to ear (p?=?0.016) and popliteal angle (p?=?0.001) were statistically significant between the groups.

Conclusions

Multisensory stimulation appears to have a beneficial effect on the tonal maturation in preterm infants. However, further studies are warranted to investigate the long-term effects of multisensory stimulation on neurodevelopmental outcome in preterm infants.     

Body growth and brain development in premature babies: an MRI study

Background

Prematurity and intrauterine growth restriction are associated with neurodevelopmental disabilities.

Objective

To assess the relationship between growth status and regional brain volume (rBV) and white matter microstructure in premature babies at around term-equivalent age.

Materials and methods

Premature infants (n=?27) of gestational age (GA): 29.8?±?2.1 weeks, with normal brain MRI scans were studied at corrected age: 41.2?±?1.4 weeks. The infants were divided into three groups: 1) appropriate for GA at birth and at the time of MRI (AGA), 2) small for GA at birth with catch-up growth at the time of MRI (SGA_a) and 3) small for GA at birth with failure of catch-up growth at the time of MRI (SGA_b). The T1-weighted images were segmented into 90 rBVs using the SPM8/IBASPM and differences among groups were assessed. Fractional anisotropy (FA) was measured bilaterally in 15 fiber tracts and its relationship to GA and somatometric measurements was explored.

Results

Lower rBV was observed in SGA_b in superior and anterior brain areas. A positive correlation was demonstrated between FA and head circumference and body weight. Body weight was the only significant predictor for FA (P<?0.05).

Conclusion

In premature babies, catch-up growth is associated with regional brain volume catch-up at around term-equivalent age, starting from the brain areas maturing first. Body weight seems to be a strong predictor associated with WM microstructure in brain areas related to attention, language, cognition, memory and executing functioning.     

Diffusion tensor imaging in extremely low birth weight infants managed with hypercapnic vs. normocapnic ventilation

Background

Permissive hypercapnia is a ventilatory strategy used to prevent lung injury in ventilated extremely low birth weight (ELBW, birth weight ≤1,000 g) infants. However, there is retrospective evidence showing that high CO₂ is associated with brain injury.

Objective

The objective of this study was to compare brain white matter development at term-equivalent age in ELBW infants randomized to hypercapnic vs. normocapnic ventilation during the first week of life and in healthy non-ventilated term newborns.

Materials and methods

Twenty-two ELBW infants from a randomized controlled trial were included in this study; 11 received hypercapnic (transcutaneous PCO₂ [tcPCO₂] 50–60 mmHg) ventilation and 11 normocapnic (tcPCO₂ 35–45 mmHg) ventilation during the first week of life while still intubated. In addition, ten term healthy newborns served as controls. Magnetic resonance imaging (MRI) with diffusion tensor imaging (DTI) was performed at term-equivalent age for the ELBW infants and at approximately 2 weeks of age for the control infants. White matter injury on conventional MRI was graded in the ELBW and control infants using a scoring system adopted from literature. Tract-based spatial statistics (TBSS) was used to evaluate for differences in DTI measured fractional anisotropy (FA, spatially normalized to a customized template) among the ELBW and term control infants.

Results

Conventional MRI white matter scores were not different (7.3?±?1.7 vs. 6.9?±?1.4, P?=?0.65) between the hypercapnic and normocapnic ELBW infants. TBSS analysis did not show significant differences (P?<?0.05, corrected) between the two ELBW infant groups, although before multiple comparisons correction, hypercapnic infants had many regions with lower FA and no regions with higher FA (P?<?0.05, uncorrected) compared to normocapnic infants. When compared to the control infants, normocapnic ELBW infants had a few small regions with significantly lower FA, while hypercapnic ELBW infants had more widespread regions with significantly lower FA (P?<?0.05, fully corrected for multiple comparisons).

Conclusions

Normocapnic ventilation vs. permissive hypercapnia may be associated with improved white matter development at term-equivalent age in ELBW infants. This effect, however, was small and was not apparent on conventional MRI. Further research is needed using larger sample sizes to assess if permissive hypercapnic ventilation in ELBW infants is associated with worse white matter development.     

Effect of polymyxin B-immobilized fiber hemoperfusion on respiratory impairment, hepatocellular dysfunction, and leucopenia in a neonatal sepsis model

Purpose

Sepsis and septic shock remain a major source of morbidity and mortality in neonates despite advances in antimicrobials and aggressive supportive care. Our aim was to study the effects of polymyxin-B direct hemoperfusion (PMX-DHP) therapy on sepsis-induced respiratory impairment, liver dysfunction and leucopenia in a neonatal cecal ligation and perforation (CLP) model.

Methods

Fourteen anesthetized and mechanically ventilated 3-day-old piglets underwent CLP and an arteriovenous extracorporeal circuit from 3 h until 6 h post-CLP, with a PMX column in the PMX-DHP treated group (7 piglets). Changes in oxygen saturation, PCO₂, base excess, white blood cell (WBC) count, platelet count, hematocrit (Hct%), serum glutamate pyruvate transaminase (SGPT), and serum glutamic oxaloacetic transaminase were measured before CLP and at 1, 3 and 6 h after.

Results

At 6 h, the PMX-DHP group showed lower Hct%, and SGPT in comparison to the control group, but higher oxygen saturation and WBC count. No effects on the platelet count were found. The survival times of the PMX-DHP group were longer than in control.

Conclusion

PMX-DHP therapy limited the respiratory impairment, liver dysfunction and leucopenia in a neonatal septic model, which resulted in an improvement of survival time.     

Clinical predictors of hypoxemia in Indian children with acute respiratory tract infection presenting to pediatric emergency department

Background

In developing countries, facilities for measuring arterial oxygen saturation are not available in most settings, which make it difficult for health providers to detect hypoxemia in children with acute respiratory tract infection (ARI). Most health providers rely on symptoms and signs to identify hypoxemia and start oxygen therapy. Therefore, this study was conducted to determine the clinical predictors of hypoxemia in children with ARI.

Methods

It was a cross-sectional study carried out at the Pediatric Emergency Department of GSVM Medical College, Kanpur, India in children in the age group between 2 months and 5 years, presenting with ARI. All children with ARI attending the pediatric emergency department from April 2007 to September 2008 were included in the study. Clinical signs and symptoms including fever, cough, nasal flaring, inability to feed/drink, cyanosis, chest wall retraction, wheezing, grunting, tachypnea and crepitations were noted and oxygen saturation (SpO₂) was measured. Hypoxemia was defined as SpO₂ <90%.

Results

Of the 261 children included in the study, 62 (23.8%) had hypoxemia. Chest wall retraction (sensitivity=90%), crepitations (sensitivity=87%), nasal flaring (sensitivity=84%), tachypnea (sensitivity=81%) and inability to feed (sensitivity=81%) were observed to be the most sensitive indicators of hypoxemia while the best predictors were cyanosis [positive predictive value (PPV)=88%] and nasal flaring (PPV=53%).

Conclusions

Chest wall retraction was found to be the most sensitive indicator, and cyanosis was the most specific indicator for hypoxemia. Of all the clinical signs and symptoms of hypoxemia, none had all the attributes of being a good predictor. A new hypoxemia score has been designed using a combination of clinical signs and symptoms to predict the need for supplemental oxygen therapy.     

Vorhersage motorischer Entwicklung Frühgeborener

Background

Early prognosis regarding the neurodevelopmental outcome of preterm infants remains challenging.

Methods

Ninety-six very low birth weight (VLBW) infants were examined for their postural reactions according to the criteria of Vojta. The predictive value with regard to motor outcome and development of cerebral palsy at a corrected age of 20 months was calculated.

Results

The positive predictive value regarding motor outcome reached a maximum of 0.2. The negative predictive value with regard to the development of cerebral palsy was fairly high (0.9 at term and 1.0 at a corrected age of 3 months). However, the rate of false positive results was 0.89.

Conclusions

In the first months, use of the postural reactions according to Vojta is not helpful for assessing motor outcome in VLBW infants.     

Serum Fructosamine and Retinopathy of Prematurity

Objective

To determine whether serum fructosamine which is a good marker for detecting hyperglycemia during the previous 2 to 3 wk in infants could predict the development of retinopathy of prematurity in very low birth weight infants.

Methods

One hundred sixty seven premature infants who had a birth weight of <1500 g and a gestational age of less than 32 wk were investigated in the present study. Blood glucose was measured at the bedside and infants were recorded as hyperglycemic if their mean blood glucose levels were higher than 150 mg/dL. Serum corrected fructosamine level was obtained from the cord blood at birth and after the first month of life. The infants’ eyes were examined by ophthalmologists to detect retinopathy of prematurity at the gestational age of 32 wk or at four wk after birth, whichever came first.

Results

Corrected fructosamine was 319.6?±?59.6 and 272.8?±?50.6 mmol/l for group1 on 1^st and 30^th day respectively; 320?±?61.7 and 268.2?±?47.3 mmol/l for groups 2?+?3 on 1^st and 30^th day respectively which did not differ between groups (p?=?0.766 and p?=?0.665), whereas duration of hyperglycemia was 1.69?±?1.1 day in group 1 compared with 3.05?±?2.4 day in groups 2?+?3 which was significantly different (p?=?0.019). The multivariate regression analysis indicated that the duration of hyperglycemia in days was significantly correlated with the development of retinopathy of prematurity (OR 3.26; 95% CI 1.09–9.80; p?=?0.035).

Conclusions

Although the duration of hyperglycemia may contribute to the development of retinopathy of prematurity, serum corrected fructosamine does not have a good predictive value in developing retinopathy of prematurity in very-low-birth-weight (VLBW) infants.     

Role of Sucrose in Reducing Painful Response to Orogastric Tube Insertion in Preterm Neonates

Objectives

To study whether orogastric tube (OGT) insertion elicits a painful response in preterm neonates, and the role of oral sucrose in reducing this pain.

Methods

This double blinded, randomized control trial was conducted in the neonatal intensive care units of Kalawati Saran Children's Hospital. Clinically stable preterms within the first 7 postnatal days, who had not received painful stimulus 30 min prior to intervention, and who required routine OGT insertion were included. Lingual 24 % sucrose or distilled water (1 ml) was administered 2 min before OGT insertion. The primary outcome was painful response assessed by Premature Infant Pain Profile scale (PIPP), while the secondary outcomes were heart rate and SpO₂ changes. The trial is registered with ClinicalTrials.gov (Registration number: NCT 00949104)

Results

Sixty preterms were randomized in each group. Final analysis was carried out on 52 subjects in the placebo group and 53 in the sucrose group. The mean intra-procedure PIPP scores were significantly higher than the mean pre-procedure PIPP scores, in the gestational age groups of more than 34 wk, and 32 wk to 33 wk, 6 d, in both the placebo (7.25 vs. 3, and 8.14 vs. 3.14, respectively) and sucrose arm (8.06 vs. 3.21, and 7.18 vs. 4.18, respectively). The mean PIPP scores assessed at 30 s post procedure in the sucrose group were significantly lower than the placebo group (4.32 vs. 5.6, p?=?0.014). No significant adverse events were seen.

Conclusions

OGT insertion causes pain in preterms and single dose lingual 24 % sucrose may alleviate this pain.     

Nichtinvasive nasale Maskenbeatmung bei akuter Pneumonie bei einem Patienten mit McCune-Albright-Syndrom

Background.

No bibliographical references exist in non-invasive nasal mask ventilation because of acute pneumonia in McCune-Albright syndrome till now.

Case report.

Emergency hospitalisation of a 16-year-old boy due to an acute pneumonia with acute respiratory failure (pH 7,27, pCO₂ 8,96 kPa, SpO₂ 92% despite 6 l/min O₂-supplement). History: McCune-Albright syndrome already in the 3rd life month diagnosed. In the course of a disease multiple bone fractures of all extremities. During the last years recurrent respiratory infections. Since some month frontal headache in the morning. X-ray-thorax: pneumonia of the left lower lobe. Sputum-microbiology: Streptococcus pneumoniae. Spirometry: most severe restrictive ventilatory disorder also after pneumonia went down (inspiratory vital capacity 200 ml, about 10% of rated value). Pulsoximetry: recurrent short O₂-desaturation in the morning till 60% despite 3 l O₂-supplementation. Course and therapy: well tolerated non-invasive nasal mask ventilation in controlled mode with stop of the frontal headache. Initial ventilation with a duration of 24 h/d, later only at night and at afternoon nap with 0,5 l O₂/min. During mask ventilation, antibiotical therapy and physiotherapy normalisation of the blood gas value, O₂-saturation (measured by pulsoximetry), inflammatory parameters and slightly risen inspiratory vital capacity up to 370 ml.

Discussion.

In patients with acute respiratory failure due to restrictive ventilatory disorder because of weakness of "breath-pump" the possibility of non-invasive mask ventilation should be considered, to avoid Intubation on intensive care units and tracheotomy.     

Does Mesenchymal Stem Cell Population in Umbilical Cord Blood Vary at Different Gestational Periods?

Objective

To identify and quantitatively determine Mesenchymal stem cells (MSCs) in the umbilical cord blood (UCB) of neonates born at different gestational periods.

Methods

UCB was collected at birth in neonates of three different gestational groups. The mononuclear cells (MNCs) were phenotypically analyzed by flow cytometer.

Results

The yield of total MNCs did not differ much with gestation; the average values were 22.6?±?6.48?×?106 cells/ml. The MSCs were significantly higher in the lower gestation group. These were 0.0219?±?0.012 %, 0.0044?±?0.003 % and 0.0022?±?0.003 % in 28 to 31 wk, 32 to 35 wk and >36 wk, respectively (P?=?0.00). There was a significant inverse correlation between the gestational age and the presence of MSCs with a correlation co-efficient of ?0.54 (P?=?0.0001).

Conclusions

The MSCs population was significantly higher in infants born at lesser gestation than those born at term gestation.     

Radiologic differences in white matter maturation between preterm and full-term infants: TBSS study

Background

Widespread white matter (WM) pathology in preterm children has been proposed.

Objective

The purpose of this study was to investigate maturational differences of WM between preterm infants with thinning of the corpus callosum and full-term infants.

Materials and methods

A total of 18 preterm children and 18 full-term children were divided into three subgroups according to the corrected age at the time of diffusion tensor imaging scanning. Tract-based spatial statistics was used for assessing differences in fractional anisotropy (FA) between preterm and full-term children, and between each age-related subgroup in preterm and in full-term children.

Results

In the preterm group, FA values of overall WM showed an increase with age. This trend indicates that WM maturation is a gradual occurrence during a child’s first 2 years. In the full-term group, most WM structures had reached maturation at around 1 year of age; however, centrum semiovale level showed sustained maturation during the first 2 years.

Conclusion

Results of our study demonstrate radiologic maturational differences of WM and provide evidence of the need for therapeutic intervention within 2 years of birth to prevent specific functional impairment and to improve clinical outcome in preterm children.