A global need for affordable neonatal jaundice technologies

Globally, health care providers worldwide recognize that severe neonatal jaundice is a "silent" cause of significant neonatal morbidity and mortality. Untreated neonatal jaundice can lead to death in the neonatal period and to kernicterus, a major cause of neurologic disability (choreo-athetoid cerebral palsy, deafness, language difficulty) in children who survive this largely preventable neonatal tragedy. Appropriate technologies are urgently needed. These include tools to promote and enhance visual assessment of the degree of jaundice, such as simpler transcutaneous bilirubin measurements and readily available serum bilirubin measurements that could be incorporated into routine treatment and follow-up. Widespread screening for glucose-6-phoshate dehydrogenase deficiency is needed because this is often a major cause of neonatal jaundice and kernicterus worldwide. Recognition and treatment of Rh hemolytic disease, another known preventable cause of kernicterus, is critical. In addition, effective phototherapy is crucial if we are to make kernicterus a "never-event." Finally it is essential that we conduct appropriate population-based studies to accurately elucidate the magnitude of the problem. However, knowledge alone is not sufficient. If we are to implement these and other programs and technologies to relegate severe neonatal jaundice and its sequelae to the history books, screening and interventions must be low cost and technologically appropriate for low and middle income nations.     

Transcutaneous Bilirubin Levels and Risk of Significant Hyperbilirubinemia in Early-Term and Term Newborns

ObjectiveTo compare the course of the transcutaneous bilirubin (TcB) values of early-term newborns with those of term newborns in the first month of life and to investigate whether early-term newborns have an increased risk of significant hyperbilirubinemia requiring treatment.DesignA prospective, controlled cohort analysis.SettingA tertiary level mother–child birth and health care center.ParticipantsFour hundred early-term (37 0/7 to 38 6/7 weeks) and 320 term (39 0/7 to 41 6/7 weeks) newborns born during a 27-month period.MethodsA total of six TcB measurements in a longitudinal manner were made in early-term and term newborns: the first two at 6 and 48 hours after birth and the next four on routine examination days (Days 4, 7, 15, and 30). Demographic characteristics, values of daily TcB measurements, number of newborns with significant hyperbilirubinemia, and risk of jaundice requiring treatment were compared between the two groups.ResultsAll six TcB values were significantly greater in the early-term group than in the term group (p < .001 for each). Early-term newborns had a statistically significant increased risk of jaundice requiring treatment compared to term newborns (risk ratio = 1.91; 95% confidence interval [1.23–2.96]; p = .0046). Results of the repeated-measures analysis of variance and post hoc adjusted multiple comparison analysis showed that TcB levels increased to and peaked at 96 hours after birth and then gradually decreased to baseline (first measurement) levels at 30 days after birth in each group.ConclusionsEarly-term newborns should not be treated as full-term newborns because they have significantly higher TcB levels. These newborns should be closely monitored for pathologic jaundice because they have increased risk for significant hyperbilirubinemia requiring phototherapy.     

The influence of zinc sulfate on neonatal jaundice: a systematic review and meta-analysis

Introduction: Zinc sulfate may be a promising approach to treat neonatal jaundice. However, the results remain controversial. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of zinc sulfate on hyperbilirubinemia among neonates.

Methods: PubMed, EMbase, Web of science, EBSCO, Cochrane library databases, Ovid, BMJ database, and CINAHL were systematically searched. Randomized controlled trials (RCTs) assessing the effect of zinc sulfate versus placebo on the prevention of jaundice in neonates were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcomes were total serum bilirubin (TSB) on three days and seven days, the incidence of hyperbilirubinemia. Meta-analysis was performed using random- or fixed-effect models.

Results: Five RCTs involving 645 patients were included in the meta-analysis. Overall, compared with placebo, zinc sulfate supplementation failed to significantly reduce TSB on three days (mean difference (MD)?=?0.09?mg/dL; 95% confidence interval (CI)?=??0.49 to 0.67; p?=?.77), TSB on seven days (MD?=??0.37?mg/dL; 95% CI?=??98 to 0.25; p?=?.25) as well as the incidence of hyperbilirubinemia (OR?=?1.14; 95% CI?=?0.74 to 1.76; p?=?.56). Zinc sulfate showed no influence on phototherapy requirement (OR?=?0.90; 95% CI?=?0.41 to 1.98; p?=?.79), but resulted in significantly decreased duration of phototherapy (MD?=??16.69?h; 95% CI?=??25.09 to ?8.3?h; p?Conclusions: Zinc sulfate could not reduce the TSB on three days and seven days, the incidence of hyperbilirubinemia and phototherapy requirement, but lead to significantly decreased duration of phototherapy.     

Effect of unconjugated hyperbilirubinemia on neonatal autonomic functions: evaluation by heart rate variability

Background: Serum bilirubin levels beyond the physiological limits, may lead to alterations in autonomic regulation in a newborn infant. Heart rate variability (HRV), is a noninvasive and quantitative marker of the activity of the autonomic nervous system (ANS). To date, few studies have demonstrated the undesirable effects of severe unconjugated hyperbilirubinemia (UHB) on autonomic functions, and only one study has used HRV as a marker of the autonomic activity. However, the relationship between altered cardiac autonomic functions and UHB by using the HRV derived from 24-hour Holter electrocardiography (ECG) recording has not been investigated previously.

Objective: We aimed to assess whether a relationship exists between severe UHB and cardiac autonomic dysfunction by evaluating HRV via 24-hour Holter ECG recording.

Methods: This single-center, prospective, case-control study was conducted on 50 full-term newborn infants with severe UHB requiring phototherapy and 50 healthy infants as controls. HRV assessment was performed by using 24-hour Holter ECG recording.

Results: There was no significant difference in terms of mean average heart rate, mean maximum heart rate and mean RR duration between the groups. However, mean minimum heart rate was significantly lower in the study group. When 24-hour time and frequency domain parameters were compared, time and frequency domain parameters rMSDD as well as high frequency (HF), which represent parasymphathetic activity, were significantly higher in the study group. Furthermore, low frequency to high frequency (LF/HF) ratio, that serves as an indicator of sympathovagal balance, was significantly lower in the study group.

Conclusion: Severe UHB may cause cardiac autonomic dysfunction in favor of parasympathetic predominance in jaundiced neonates.     

Accuracy of transcutaneous bilirubinometry in the preterm infants: a comprehensive meta-analysis

Background: Transcutaneous bilirubin (TcB) measurement is widely used in term babies. But its effectiveness till debated in preterm infants. So, our objective was to pool data to see the accuracy of transcutaneous bilirubinometry in preterm infants.

Method: MEDLINE, Embase, Cochrane Library database were searched from 2000 to July 2017. The included studies had compared TcB with total serum bilirubin (TSB) in preterm infants before phototherapy and data were presented as correlation coefficients. Data were extracted by two reviewers and checked for accuracy by the third reviewer. The risk bias assessments were done by an assessment quality assessment of diagnostic accuracy studies tool. Pooled correlation coefficient assed after Fisher’s z transformation and then converted to r.

Results: We included 28 studies; all those studies reported results as correlation coefficients. In combination of both sternal and forehead site measurement, our pooled estimates of r?=?0.82 (95% CI: 0.78–0.85) in random effect and r?=?0.803 (95% CI: 0.78–0.81) in fixed effect model. For separate sites of measurement of TcB pooled r for forehead and sternum were comparable, r?=?0.82 (95% CI: 0.78–0.85), and pooled correlation coefficient for the two devices JM103 and Bilicheck the estimated pooled r were also comparable (Pooled r?=?0.83).

Conclusion: Our study found that TcB measurement is well related with TSB values and can represent a reliable method for evaluating preterm infants with possible hyperbilirubinemia. Our findings support the use of investigated devices at both forehead and sternum sites in preterm infants.     

The influence of massage on neonatal hyperbilirubinemia: a meta-analysis of randomized controlled trials

Introduction: The efficacy of massage to treat neonatal hyperbilirubinemia remains controversial. We conducted a systematic review and meta-analysis to explore the influence of massage on the neonatal hyperbilirubinemia.

Methods: We search PubMed, Embase, Web of science, EBSCO, and Cochrane Library databases through November 2017 for randomized controlled trials (RCTs) assessing the effect of massage on neonatal hyperbilirubinemia. This meta-analysis is performed using the random-effect model.

Results: Six RCTs involving 357 patients are included in the meta-analysis. Overall, compared with the control group in neonatal hyperbilirubinemia, massage therapy is associated with substantially reduced serum bilirubin level within 4?d (mean difference (MD)?=??2.31; 95% CI?=??2.92 to ?1.70; p?p?p?=?.23), transcutaneous bilirubin level on 2?d (MD?=??0.17; 95% CI?=??1.34 to 1.00; p?=?.77), frequency of defecation daily on 2?d (MD?=?0.57; 95% CI?=??0.03 to 1.16; p?=?.06), and frequency of defecation daily within 4?d (MD?=?0.83; 95% CI?=??0.11 to 1.76; p?=?.08).

Conclusions: Massage therapy can significantly reduce serum bilirubin level and transcutaneous bilirubin level within 4?d, but demonstrates no influence on serum bilirubin level and transcutaneous bilirubin level on 2?d, frequency of defecation daily on 2 and 4?d for neonatal hyperbilirubinemia.     

Role of massage therapy on reduction of neonatal hyperbilirubinemia in term and preterm neonates: a review of clinical trials

Background: Neonatal hyperbilirubinemia (NNH) is one of the leading causes of admissions in nursery throughout the world. It affects approximately 2.4–15% of neonates during the first 2 weeks of life.

Aims: To evaluate the role of massage therapy for reduction of NNH in both term and preterm neonates.

Method: The literature search was done for various randomized control trials (RCTs) by searching the Cochrane Library, PubMed, and EMBASE.

Results: This review included total of 10 RCTs (two in preterm neonates and eight in term neonates) that fulfilled inclusion criteria. In most of the trials, Field massage was given. Six out of eight trials reported reduction in bilirubin levels in term neonates. However, only one trial (out of two) reported significant reduction in bilirubin levels in preterm neonates. Both trials in preterm neonates and most of the trials in term neonates (five trials) reported increased stool frequencies.

Conclusion: Role of massage therapy in the management of NNH is supported by the current evidence. However, due to limitations of the trials, current evidences are not sufficient to use massage therapy for the management of NNH in routine practice.     

The implementation of neonatal peritoneal dialysis in a clinical setting

Objective: To investigate etiology, outcome and complications related to neonatal peritoneal dialysis (PD). Methods: Neonates treated with PD in our neonatal intensive care unit during 2007–2010 were analyzed retrospectively. Results: Among 4036 hospitalized neonates; 20 neonates (0.5%) who underwent 21 cycles of PD [7 preterm, 13 term; 13 female, 7 male] were included. The mean birth weight was 2930.2 ± 720.6 g (1120–4570), mean gestational age was 37.5 ± 3.5 weeks (27–41). The etiologic disorders included inborn errors of metabolism (propionic acidemia, methylmalonic acidemia, citrullinemia, glutaric aciduria type2, maple syrup urine disease, 10), or acute renal failure secondary to perinatal asphyxia (4), sepsis (2), prematurity (2), hypoplastic left heart syndrome (1), kernicterus (1). The complications included peritonitis (2), early leakage (4), hemorrhage (1), catheter removal (3) and occlusion (2). The mortality rate was 50%. The gestational ages and birth weights of surviving neonates were higher (p < 0.05). Among surviving neonates, chronic renal failure (1), severe (4) and moderate neuromotor impairment (2) developed within 4–43 months. Conclusion: PD, although invasive, is an effective therapy in neonates. The complexity and invasiveness of the procedure is probably responsible for high rate of complications and mortality. If appropriate catheter selection and technique in the placement should be done, PD might improve outcome.     

Maternal and neonatal profile of late-preterm survivors in a poorly resourced country

Objective.?To determine maternal indicators and adverse perinatal outcomes among late-preterm infants during birth hospitalization in a low-income country.

Methods.?Cross-sectional study of late-preterm and term survivors in a tertiary maternity hospital in southwest Nigeria using multivariable logistic regression analysis and population attributable risk (PAR) percentage. Adjusted odds ratios (OR) and 95% confidence intervals (CI) of significant factors are stated.

Results.?Of 4176 infants enrolled, 731 (17.5%) were late preterm and 3445 (82.5%) were full-term. Late-preterm delivery was independently associated with mothers who were unmarried (OR: 1.71, CI: 1.06–2.75), lacked formal education (OR: 1.75, CI: 1.06–2.89), human immunodeficiency virus positive (OR: 1.61, CI: 1.17–2.20), with hypertensive disorders (OR: 3.07, CI: 2.32–4.08), antepartum hemorrhage (OR: 3.66, CI: 1.97–6.84), and were unlikely to have induced labor (OR: 0.010, CI: 0.01–0.69). Hypertensive disorders and antepartum hemorrhage had a combined PAR of 48.4%. Infants born late preterm were more likely to have low 5-min Apgar scores (OR: 1.70, CI: 1.01–2.83), sepsis (OR: 1.62, CI: 1.05–2.50), hyperbilirubinemia (OR: 1.56, CI: 1.05–2.33), admission into special care baby unit (OR: 1.85, CI: 1.38–2.48), and nonexclusive breast-feeding (OR: 1.49, CI: 1.49, CI: 1.18–1.89).

Conclusions.?These findings suggest that late-preterm infants in low-resource settings are at risk of severe morbidity and suboptimal feeding. Education and close monitoring of high-risk mothers are warranted to prevent avoidable late-preterm delivery and facilitate the proactive management of unavoidable late-preterm births.     

Distribution of congenital anomalies in a neonatal intensive care unit in Turkey

Abstract

Background: Congenital anomalies are one of the important reasons of mortality and morbidity in newborns. The aim of this study is to determine the incidence, distribution and the mortality of the congenital anomalies in a single neonatal intensive care unit (NICU) from Turkey.

Method: A retrospective analysis was performed between 2005 and 2012 in NICU using a computerized database. Variables including the type of anomaly, antenatal and postnatal history, gestational age, birth weight, consanguinity and other demographic, clinical and related laboratory variables were extracted from the computerized database using ICD-10 codes. Congenital anomalies were classified according to involved organ systems and also classified as single and multiple anomalies.

Results: A total of 1024 newborns with congenital anomaly (CA) (13.7%) were identified among the 7450 hospitalized newborns in NICU. The most affected system was the cardiovascular system (68.8%). Most of the anomalies (67.1%) were single anomalies. Of all, 59.4% had single major, 7.7% had single minor, 9% had single major plus single minor, 18.4% had multiple major and 2% had multiple minor anomalies. On the other hand, 96.3, 1.9, 0.1 and 1.7% of the newborns had malformation, deformation, disruption and dysplasia, respectively. Chromosomal analysis was only performed 24.8% of the newborns with CA and among them, 65.3% of these were in normal limits. The most frequently detected chromosomal abnormality was trisomy 21. Overall, mortality rate was 15.5% among the newborns with CA.

Conclusion: In conclusion, the most common and mortal CA was cardio-vascular malformations in our hospital. The overall prevalence of cardio-vascular malformations among the newborn was higher than previously reported studies in Turkey. Further, studies with larger sample size are needed to determine CA in Turkey.     

Effects of Gly71Arg mutation in UGT1A1 gene on neonatal hyperbilirubinemia: a systematic review and meta-analysis

Objective: The associations between Gly71Arg polymorphism in the coding region of uridine diphosphate glucuronosyl transferase 1A1 (UGT1A1) gene and the risk of neonatal hyperbilirubinemia remained controversial. Therefore, a meta-analysis of observational studies has been conducted to assess the relationship between UGT1A1 gene polymorphism of Gly71Arg and neonatal hyperbilirubinemia susceptibility.

Methods: An electronic literature search from online databases, such as PubMed, Embase, Cochrane, and Scopus was conducted to identify eligible studies. The effect summary odds ratio (OR) with 95% confidence interval (CI) was used to estimate the strength of association in the fixed or random effects model, based on the absence or presence of heterogeneity.

Results: A total of 32 eligible studies involving 2634 cases of neonatal hyperbilirubinemia and 4996 controls were enrolled in this meta-analysis. The combined results showed that UGT1A1 Gly71Arg polymorphism was associated with an increased risk of neonatal hyperbilirubinemia in all genetic models (homozygote model: OR?=?6.12, 95% CI?=?4.42–8.46; heterozygote model: OR?=?2.06, 95% CI?=?1.82–2.33; dominant model: OR?=?2.44, 95% CI?=?2.03–2.93; recessive model: OR?=?4.79, 95% CI?=?3.48–6.59, and allelic model: OR?=?2.37, 95% CI?=?1.98–2.82). Subgroup analysis by ethnicity strongly validated this correlation in Asians but slightly in Caucasian population.

Conclusions: This meta-analysis confirms that UGT1A1 Gly71Arg polymorphism significantly increases the risk of neonatal hyperbilirubinemia in Asian population, but results from the Caucasians were conflicting and further well-designed epidemiological studies are, therefore, required to more adequately assess this correlation.     

Role of oral zinc supplementation for reduction of neonatal hyperbilirubinemia: a systematic review of current evidence

Background: Neonatal hyperbilirubinemia is frequently seen condition in the NICU. Oral zinc has been tried for the prevention of hyperbilirubinemia.

Aims: To evaluate the role of oral zinc supplementation for reduction of neonatal hyperbilirubinemia in term and preterm infants.

Method: The literature search was done for various randomized control trial (RCT) by searching the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, Web of Science, Scopus, Index Copernicus, African Index Medicus (AIM), Thomson Reuters (ESCI), Chemical Abstracts Service (CAS) and other data base.

Results: This review included six RCT that fulfilled inclusion criteria. One study evaluated the role of zinc in very low birth weight (VLBW) infants and remaining enrolled neonates ≥35 weeks of gestation. The dose of zinc varied from 5 to 20?mg/day and duration from 5–7 days. All the studies used zinc sulfate, only one study used zinc gluconate. The total neonates enrolled in these different RCT are 749.

Conclusion: Role of zinc in the prevention of neonatal hyperbilirubinemia is not supported by the current evidence. Only one study was able to show reduction in the mean TSB level and requirement of phototherapy with zinc, and the remaining studies did not report any positive effect. None of the studies showed any effect on the duration of phototherapy, incidence of phototherapy, age of starting of phototherapy and any serious adverse effect     

The prevalence and pattern of pharmaceutical and excipient exposure in a neonatal unit in Slovenia

Objective: Because of the restraints on conducting studies on pharmaceutical use in sick newborns, many drugs are used off-label in this population. Moreover, industrially manufactured pharmaceuticals may contain different excipients, which may be either untested or not licensed for use in neonates. The aim of our study was to determine the prevalence and pattern of pharmaceutical and excipient exposure in newborns hospitalized at the Department of Neonatology, Ljubljana, Slovenia.

Methods: A longitudinal prospective cross-sectional study was performed during a one-month period and included all hospitalized neonates. Route of administration, site of action, type of manufacture, licensing status, type and concentrations of excipients for all pharmaceuticals given to the neonates were determined.

Results: Twenty seven different pharmaceutical preparations were prescribed to a total of 48 hospitalized newborns. In most cases, newborns were prescribed various pharmaceuticals that were not approved for use in this population. Newborns were exposed to 60 different excipients in industrially manufactured pharmaceutical preparations. More than half of the received pharmaceuticals contained potentially harmful and harmful excipients.

Conclusions: Two-thirds of pharmaceutical preparations for neonates were used off-label. Newborns receive more auxiliary substances, which may be unsuitable for this age group and may even be toxic to them, via industrially manufactured pharmaceuticals.     

Intranasal surfactant protein D as neuroprotective rescue in a neonatal rat model of periventricular leukomalacia

Background: Periventricular leukomalacia (PVL) is the leading cause of neurocognitive deficits in children with prematurity. We previously hypothesized that surfactant protein D (SPD) with its ability to bind toll-like receptors may have a possible ameliorating effect in PVL.

Methods: Three groups were defined as: LPS-administered and postnatal intranasal saline administered group, LPS-administered and postnatal intranasal SPD-treated group, and control group. Twenty-eight offspring rats were reared with their dams until their sacrifice for histological evaluation on day 7.

Results: A significant loss of brain weight occurred in the LPS group compared with controls. The postnatal intranasal SPD treatment significantly reduced the number of TUNEL-positive cells in the periventricular white matter as compared with the LPS-treated group. Compared with the control group, LPS injection in the rat brain significantly reduced the MBP-positive staining. Postnatal SPD treatment greatly prevented LPS-stimulated loss of MBP staining.

Conclusions: Present study demonstrated a neuroprotective effect of SPD in a rat model of PVL. Our results offer future implications towards increasing our understanding about multifactorial mechanisms underlying periventricular leukomalacia and developing plausible therapeutic strategies in order to prevent neurocognitive deficits in preterm infants.     

Prevention of central venous catheter-related infection in the neonatal unit: a literature review

Central venous catheter infections are the leading cause of healthcare-associated bloodstream infections and contribute significantly to mortality and morbidity in neonatal intensive care units. Moreover, infection poses significant economic consequence which increased hospital costs and increased length of hospital stay. Prevention strategies are detailed in guidelines published by the Centers for Disease Control and Prevention (CDC) in the United States; nevertheless, recent surveys in neonatal units in the United States, and Australia and New Zealand demonstrate these are not always followed. This review discusses the numerous evidence-based strategies to prevent catheter infections including hand hygiene, maximal sterile barriers during insertion, skin disinfection, selection of insertion site, dressings, aseptic non-touch technique, disinfection of catheter hubs/ports, administration set management, prompt removal of catheter, antibiotic locks, systemic antibiotic prophylaxis and chlorhexidine bathing. Furthermore, it will describe different strategies that can be implemented into clinical practice to reduce infection rates. These include the use of care bundles including checklists, education and the use of CVC teams.     

新生儿脐动脉血气正常参考值及其生物学影响因素的多中心临床研究

目的 研究多种生物学因素对新生儿脐动脉血气的影响,建立正常新生儿脐动脉血气的正常参考值范围. 方法 2008年3月至2009年9月,连续纳入国内6家协作医院分娩的1 min Apgar评分≥8分且无畸形的新生儿为研究对象,采用规范化的采集脐带和脐动脉血的方法及统一的血气分析仪检测脐动脉血pH、PO2、PCO2和碱剩余(base excess,BE).采用方差分析(LSD两两检验)和两独立样本t检验比较不同产次、胎别、性别、胎龄、出生体重、出生体重与胎龄的关系、分娩方式等生物学因素对新生儿脐动脉血气的影响.在此基础上,建立排除生物学影响因素后的正常新生儿的脐动脉血气值. 结果 研究期间6家协作医院共分娩活产婴儿20605例,符合纳入标准者20191例.除性别外,其余生物学因素对脐动脉血气均有影响.第1产新生儿脐动脉血pH(7.19±0.10)和BE值[(-7.75±3.03)mmol/L]较其他产次组低,第2产新生儿BE值[(-7.60±3.02) mmol/L]又分别较第3、4及以上产次组低.单胎儿组的PO2[(3.16±1.24) kPa]高于,而PCO2[(7.01±1.65) kPa]和BE[(-7.65±3.11)mmol/L]低于双胎儿组[分别为(2.91±1.21) kPa、(7.18±1.43) kPa和( 6.84±3.26) mmol/L](t=3.612、2.092和2.930,P均＜0.05).不同胎龄组中pH、BE和PO2随着胎龄的增加而降低,而PCO2随着胎龄的增加而升高.低出生体重儿pH、BE较正常体重儿和巨大儿高.小于胎龄儿的pH、BE、PO2低于而PCO2高于适于胎龄儿和大于胎龄儿.剖宫产组与自然分娩组、臀位和产钳助产组相比,其pH、PO2和BE稍高,而PCO2稍低;产钳助产组与自然分娩组相比,其PO2和BE较低而PCO2较高,差异均有统计学意义(P均＜0.05).排除有影响的生物学因素后,10645例单胎、足月、自然分娩、正常出生体重、适于胎龄、1 minApgar评分≥8分且无畸形的正常新生儿的脐动脉血气参考值范围((x)±1.96s)如下:pH为7.20±0.20,PO2为(3.15±1.23) kPa,PCO2为(7.02±1.62) kPa,BE为(-7.64±6.36)mmol/L.结论 多种生物学因素对新生儿脐动脉血气有影响,建立正常新生儿脐动脉血气参考值范围应排除这些影响因素;临床上应用脐动脉血pH和BE阈值作为评估窒息的综合指标之一时,适当考虑生物学因素的影响,可能有助于改进评估的准确性.     

Lutein administration to pregnant women with gestational diabetes mellitus is associated to a decrease of oxidative stress in newborns

Abstract

Oxidative stress (OS) is defined as an imbalance between pro- and antioxidant factors that can lead to cellular and tissue damage. Under condition of gestational diabetes, OS is exacerbated and can cause vascular dysfunction in the placenta, leading to fetal and perinatal complications. We investigated the oxidative status of diabetic pregnant women and of their babies. A group of those diabetic women received lutein, and another group did not receive anything. In order to verify a possible antioxidant function of lutein, we compared the OS values of the two groups. OS appeared lower in treated gravidas than in untreated ones; however, there was not a statistically significant difference between the two groups. As far as newborns are concerned, there was a significant difference of OS values between babies born to mothers treated with lutein and newborns to mothers untreated at 2?h of life. However, at 48?h, there was not a significant difference between the two groups. In conclusion, lutein administration during pregnancy significantly reduced neonatal OS at birth. Further studies are necessary to evaluate the effects of combined administration to mother and infants.     

An abrupt increment in the respiratory rate is a sign of neonatal pneumothorax

Objective: The objective of the present study was to investigate the early clinical signs of neonatal pneumothorax.

Methods: A case-control study at a level III referral center from 2006 to 2012 was conducted. For each neonate with pneumothorax (Group I), one control subject (Group II) was identified by selecting an infant born within the same week with a gestational age of?±?7 days and with a birth weight within 10% of the index case. The primary outcome was to investigate the clinical findings preceding the onset of pneumothorax. Secondary outcome was to assess the risk factors.

Results: Of the 1375 infants admitted, 39 had a pneumothorax. Patients with pneumothorax showed significantly increased respiratory rates preceding the definitive diagnosis when compared with control patients (median: 16 (0–58) versus 4 (0–10); p?<?0.001). An increase in the respiratory rate was found to be a significant clinical parameter preceding the diagnosis of pneumothorax (odds ratio (OR): 1.47, 95% confidence interval (CI): 1.12–2.14, p?<?0.001; R²?=?0.80). Sensitivity and specificity of this sign were found to be 77 and 90%, respectively.

Conclusion: An abrupt increase in the respiratory rate would be used as a reliable parameter to help determine an impending pneumothorax in neonates.