Nasal intermittent mandatory ventilation versus nasal continuous positive airway pressure for transient tachypnea of newborn: a randomized,prospective study

Abstract

Objective: To evaluate the efficacy of nasal intermittent mandatory ventilation (NIMV) in reducing the duration of respiratory distress compared with nasal continuous positive airway pressure (NCPAP) in transient tachypnea of the newborn (TTN).

Patient and methods: ?n this randomized-prospective study, 40 infants with a gestational age ≥37 weeks and birth weight ≥2000?g with TTN were randomized to either nonsynchronized NIMV (n?=?20) or NCPAP (n?=?20). The primary end point was the reduction of the duration of respiratory distress. Secondary end points were the duration and level of oxygen supplementation, the incidence of complications such as pneumothorax, pneumonia and respiratory failure requiring entubation.

Results: There were no significant difference in the duration of respiratory support (28.0?±?19.2?h versus 32.2?±?23.3?h, p?=?0.231), O₂ therapy (31.2?±?15.6?h versus 29.0?±?19.3?h, p?=?0.187), duration of TTN (67.6?±?36.5?h versus 63.3?±?39.1?h, p?=?0.480) and hospitalization (6.2?±?2.6?d versus 5.4?±?2.0?d, p?=?0.330) between the groups. The rate of complications were not significantly different between the groups.

Conclusion: Our study indicates that NIMV is well tolerated and as effective as NCPAP in the treatment of TTN.     

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)     

Adenosine deaminase levels in premature infants with respiratory distress syndrome and bronchopulmonary dysplasia

Adenosine is produced in the inflammed and damaged lung where it plays roles in the regulation of inflammation and tissue remodeling. Adenosine deaminase (ADA) is an enzyme responsible for the degradation of adenosine. Our aim was to compare the levels of ADA between infants with and without respiratory distress syndrome (RDS) and to determine the relationship between plasma ADA levels and bronchopulmonary dysplasia (BPD). One-hundred and twenty-five premature infants who were admitted to our neonatal intensive care unit were included in the study. Eighty-one of these infants with RDS were study group and the other 44 infants without RDS served as controls. Blood collection was made in the first day of life at the end of 24th-h and was used for laboratory testing. In the RDS group, mean ADA level was 25.5 (±4.5) U/l, and in controls it was 26.3 (±5.7) U/l. There was no statistically significant difference (p?=?0.326) in these groups although there was a statistically difference of ADA levels between BPD (34.5?±?5.2 U/l) and non-BPD (24.6?±?4.1) patients (p?=?0.001). There was also a positive relationship between ADA levels and severity of BPD (r?=?+?0.845, p?=?0.01). Perinatal inflammation is the key mechanism of BPD. ADA level in early postnatal life is elevated in infants with BPD and may be related with perinatal inflammation.     

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.     

The use of continuous positive airway pressure in preterm babies with respiratory distress syndrome: a report from Baghdad,Iraq

Abstract

Objectives: To study maternal and neonatal risk factors related to outcome of preterm babies with respiratory distress syndrome (RDS) on Continuous Positive Airway Pressure (CPAP) in a tertiary Iraqi NICU.

Methods: A prospective case study carried out from January 5, 2011 to January 5, 2012, on 70 preterm neonates with RDS who were started on CPAP. Maternal and infant variables of preterm babies with successful or failed CPAP therapy were compared.

Results: Seventy neonates, 44 (63%) males and 26 (37%) females were included. Mean (SD) gestation was 32.8 (2.8) weeks and mean (SD) birth weight was 1860 (656) g. Thirty-seven (52.9%) babies failed CPAP, of them 29 (78.3%) were started on mechanical ventilation. The variables associated with failure of CPAP were: Birth weight ≤1500?g, gestational age ≤30 weeks, white out on the chest X-ray, FiO₂ ≥50% at 20?min of CPAP, PEEP ≥5.5?cm H₂O. Mortality rates were 94.6% in CPAP failures versus 5.4% in CPAP successes (p?=?0.001). In infants surviving till discharge, duration of hospital stay was longer in babies who were CPAP successes (9.6?±?3.7 versus 3.0?±?2.7 days, p?=?0.001).

Conclusions: Gestational age, birth weight, whiteout chest X-ray, and FiO₂ are important predictive values for success of CPAP therapy. A larger prospective multicenter controlled trial is needed to determine the benefits and risks of CPAP and predictors of its failure in our setting. Our results may be useful for others practicing in similar settings as us.     

Comparison of three non-invasive ventilation strategies (NSIPPV/BiPAP/NCPAP) for RDS in VLBW infants

Background: Non-invasive ventilation (NIV) significantly changed the management of respiratory distress syndrome (RDS) in preterm infants. Further perspectives for neonatologists regard the assessment of different NIV strategies in terms of availability, effectiveness, and failure.

Objective: The aim of the present study is to evaluate the effectiveness of three different NIV strategies: nasal continuous positive airway pressure (N-CPAP), nasal synchronized intermittent positive pressure ventilation (N-SIPPV), and nasal bilevel-CPAP (BiPAP), as first intention treatment for RDS in very low birth-weight infants (VLBW).

Methods: A multicenter retrospective study was conducted in three neonatal intensive care unit (NICUs) that enrolled 191 VLBW infants complicated by RDS, who received, as first intention treatment for RDS, three different NIV approaches (N-CPAP: n?=?66; N-SIPPV: n?=?62, BiPAP: n?=?63). We evaluated the performance of different NIV strategies by primary (failure within the first 5 d of life) and some selected secondary end-points.

Results: The incidence of NIV failure was significantly higher in the N-CPAP group (22/66) versus N-SIPPV/BiPAP groups (11/62; 11/63) (p?Conclusions: The present study shows that first intention N-SIPPV/BiPAP, as NIV support, augment the beneficial effects of N-CPAP contributing to a reduced risk of failure in VLBW infants complicated by RDS. Data open up to further RCTs on a wider population to evaluate NIV effectiveness on long-term outcomes.     

Neonatal respiratory morbidity in late-preterm births in pregnancies with and without gestational diabetes mellitus

Objective: To evaluate neonatal respiratory morbidity in infants born late-preterm to mothers with or without gestational diabetes mellitus (GDM).

Methods: Analysis of a population-based cohort of all live-born singletons, born at 34 0/7 to 36 6/7 weeks to mothers with and without GDM, focusing on transient tachypnea of the newborn (TTN) and respiratory distress syndrome (RDS).

Results: The study group comprised 363 (4.7%) singletons born to mothers with GDM and the controls were 7400 born to mothers without GDM. Mothers with GDM were older (31.4?±?5.1 versus 29.5?±?5.1 years, p?p?Conclusion: GDM, per se, is not a major contributor to RDS in late pre-term infants. Rather, the combination of prematurity and cesarean birth act independently to increase the risk of respiratory morbidity.     

Early versus late inguinal hernia repair in extremely low-birthweight infants

Objective: Compare outcomes of extremely low-birthweight (ELBW) infants following early (before discharge) versus late (after discharge) inguinal hernia (IH) repair.

Study design: In a retrospective study of ELBW infants with IH, data were abstracted for clinical characteristics, IH and related outcomes.

Result: Of the 39/252 (15.4%) ELBW infants who developed IH, those with early (59%) versus late (41%) repair were comparable in birth weight (753?±?158 versus 744?±?131?g, p?=?0.84), gestation age (26?±?2 versus 26.2?±?2 weeks, p?=?0.92), with comparable rate of broncopulmonary dysplasia (87% versus 75%, p?=?0.41), but early repair group had prolonged respiratory support (60.6?±?28.6 versus 39?±?30 days, p?=?0.032). Both groups had comparable diagnosis to repair interval (51.2?±?29.2 versus 60.5?±?30.6 days, p?=?0.38) and early repair group has earlier corrected gestation (41.6?±?3.9 versus 45.4?±?4.6 weeks, p?Conclusions: We did not find significant differences in outcomes of IH in early and late repair groups of ELBW infants.     

Heliox non-invasive ventilation for preventing extubation failure in preterm infants

Objectives: Our aim was to assess whether non-invasive ventilation with heliox may decrease the incidence of extubation failure in preterm infants with RDS.

Methods: Infants <29 weeks of gestation were treated immediately after extubation with heliox combined with nasal continuous airway pressure (Hx-NCPAP) or bilevel NCPAP (Hx-BiPAP) for 24?h, while infants in the control groups were treated with conventional NCPAP or BiPAP. The primary endpoint was the comparison of the extubation failure rate in the two groups, where failure was defined as the need for MV during the 24?h following extubation.

Results: Eighteen infants were assigned to the heliox group and 18 to the control group. The extubation failure rate was similar (p = 0.249) in the heliox (n = 6; 33%) and in the control group (n = 9; 50%), but required mean airway pressure (MAP: 4.0+1.0 vs. 4.8+1.2?cm H₂O; p = 0.037) and PaCO₂ (39+8 mmHg vs. 52+7 mmHg; p < 0.001) at 24?h of treatment were lower in the heliox group.

Conclusions: Non-invasive ventilation with heliox was not effective in decreasing extubation failure in preterm infants with RDS, but did improve their respiratory function. Our findings might support the planning of large randomized controlled studies to evaluate the effectiveness of heliox non-invasive ventilation for decreasing extubation failure in premature infants.     

Risk factor profile of massive pulmonary haemorrhage in neonates: the impact on survival studied in a tertiary care centre

Objective: Pulmonary haemorrhage (PH) in neonates is a fatal event leading to hazardous complications and even death. The aim of this study was to elucidate influential factors of the ultimate disease course that affect death or survival.

Methods: Infants treated for PH in our institution from March 2009 to December 2013 were retrospectively reviewed. Infants transferred from other hospitals were excluded. Infants were grouped into two categories, deceased or survived at neonatal intensive care unit discharge. Information regarding perinatal history, initial management and laboratory results were obtained and analysed for each group.

Results: Seventy infants fulfilled the inclusion criteria, 41 infants in the deceased group and 29 infants in the survived group. Overall, the infants in the deceased group displayed lower gestational age (27 and 1/7?±?3.610 versus 29 and 3/7?±?3.530 weeks, p?=?0.009) and lower one-minute (2.342?±?1.493 versus 4.035?±?2.079, p?<?0.001) and five-minute Apgar scores (2.342?±?1.493 versus 4.035?±?2.079, p?<?0.001) and required aggressive resuscitation (p?=?0.003) and a greater number of inotropes (2.195?±?1.346 versus 1.069?±?0.704, p?<?0.001). Deceased infants were administered increased amounts of fluid during the first 24?h after birth (117.783?±?32.325 versus 99.379?±?17.728?mL/kg, p?=?0.004). A relatively short prothrombin time impacted survival (p?=?0.01), whereas platelet count was the only factor that significantly affected the time length from the onset of PH to death (p?=?0.01).

Conclusion: Infants with a lower gestational age in a compromised state are prone to die once PH develops. The initial management of fluid intake not to exceed the adequate limit is especially important in order to prevent PH-related deaths when correcting hypoalbuminemia and coagulopathy.     

N-SIPPV versus bi-level N-CPAP for early treatment of respiratory distress syndrome in preterm infants

Abstract

Objective: Non-invasive ventilation (NIV) for RDS in extremely/very low birth-weight infants represents the new challenge for neonatologists. In this regard, data comparing the effectiveness of Bi-Level-NCPAP (BiPAP) versus nasal synchronized intermittent positive pressure ventilation (NSIPPV) as primary mode of treatment for RDS are lacking.

Study design: We conducted a retrospective study from December 2007 to December 2010 in seventy-eight infants, who received NIV (N-SIPPV: 33; BiPAP: 45). The primary outcomes were the length and failure of NIV. Secondary outcomes were adverse short-long term pulmonary outcomes, multiple doses of surfactant and others.

Results: There were no significant differences (p?>?0.05) between the two different NIV modes.

Conclusion: The present findings suggest that N-SIPPV and BiPAP gives similar results in the RDS treatment. We did not find a benefit of one over the other ventilation mode and both could be constitute a valid option to conventional mechanical ventilation. The theoretical benefits of these two different methods of NIV are tidal volume enhancement, improvements of the functional residual capacity and of the mean airway pressure and reducing apnea episodes. Further randomized studies to assess the advantages and the efficacy of different methods of NIV for the treatment of the RDS are needed.     

Vaginal alpha-lipoic acid shows an anti-inflammatory effect on the cervix,preventing its shortening after primary tocolysis. A pilot,randomized, placebo-controlled study

Introduction: Inflammation might be an important underlying cause of preterm birth. Our aim is to explore whether vaginal administration α-lipoic acid reduces cervical inflammation and shortening after primary tocolysis.

Materials and methods: Singleton pregnancies between 24–30 weeks remaining undelivered after hospitalization for preterm labor were randomly allocated to placebo (20 women, 15 analyzed) or vaginal ALA 400?mg (active ingredient 10?mg) daily (20 women, 17 analyzed) for 30 days. A cervical swab to quantify pro-inflammatory (IL1, IL2, IL6, IL8, TNFα) and anti-inflammatory (IL4, IL10) cytokines as well as transvaginal ultrasound cervical length measurement (CL) were performed before and after treatment.

Results: The % changes of pro-inflammatory cytokines do not differ between treatment groups, while IL4 significantly increases by vaginal ALA in comparison to placebo (118.0?±?364.3% versus 29.9?±?103.5%, p?=?0.012). Combined anti-inflammatory cytokines show same trend (292.5?±?208.5% versus 64.5?±?107.4, p?=?0.03). CL remains similar in vaginal ALA group (from 23.1?±?6.6 to 20.80?±?7.9?mm), while it significantly decreased in placebo group (from 20.4?±?6.5 to 13.8?±?7.5?mm, p?p?=?0.003 versus vaginal ALA).

Conclusion: Vaginal ALA significantly stimulates anti-inflammatory ILs in the cervix of undelivered women after a preterm labor episode. This effect is associated with a stabilization of the CL.     

Effect of early administration of probiotics on gut microflora and feeding in pre-term infants: a randomized controlled trial

Background: This study aimed to evaluate the effect of early probiotic administration on gut microflora and influence on feeding in pre-term infants.

Methods: A double-blind, randomized, controlled clinical study was conducted to assess the effect of probiotics [live, combined lactobacillus and bifidobacterium (LCB)] supplementation in pre-term infants. Sixty hospitalized pre-term babies were randomly assigned to two groups: a probiotics-supplemented group and the control group. The primary endpoint was measurement of lactobacillus and bifidobacterium in the gut. The secondary outcome was the rate of feeding intolerance.

Results: In the first weekend, the quantity of gut lactobacillus and bifidobacterium was significantly higher in the probiotics-supplemented group than in the control group [7.84?±?0.35 versus 6.39?±?0.53 (log copy number/g wet fecal weight), p?=?0.013; 8.52?±?0.23 versus 7.01?±?0.48, p?=?0.024, respectively]. In the second weekend, the amount of gut lactobacillus and bifidobacterium in the probiotics-supplemented group remained significantly higher (8.62?±?0.28 versus 7.34?±?0.59, p?=?0.036 and 9.45?±?0.64 versus 7.85?±?0.43, p?=?0.007, respectively). Fewer patients in the probiotics-supplemented group developed a feeding intolerance (13.3% versus 46.7%, p?=?0.013).

Conclusions: Probiotic supplementation in the hospitalized pre-term infants in the first 2 weeks of life resulted in higher amounts of lactobacillus and bifidobacterium in the gut and a concomitant lower rate of feeding intolerance.     

Early neonatal outcomes of volume guaranteed ventilation in preterm infants with respiratory distress syndrome

Background: Volume guaranteed (VG) synchronized intermittent mandatory ventilation (SIMV) is a novel mode of SIMV that provides automatic adjustment of the peak inspiratory pressure for ensuring a minimum set tidal volume and there are limited data about the effects of VG ventilation on short term neonatal outcomes in preterm infants with respiratory distress syndrome (RDS). Objective: The main objective of this study was to evaluate the effect of VG ventilation on duration of ventilation and total supplemental oxygen. We also aimed to compare the early neonatal outcomes of VG ventilation versus conventional SIMV on short-term outcomes in preterm babies with RDS who were given surfactant. Methods: In this randomized controlled study, preterm infants who were admitted with RDS and given surfactant were divided into 2 groups: group 1 included infants ventilated on conventional SIMV (n = 30) and group 2 included infants ventilated on VG ventilation (n = 42). Neonatal morbidities such as air leak, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC) and duration of mechanical ventilation and total oxygen supplementation were all recorded. Results: There were no significant differences between two groups in terms of demographic features. Infants ventilated with VG mode had significantly shorter duration of ventilation and need of total supplemental oxygen. The incidences of oxygen related short term complications including BPD, ROP, and IVH were also significantly lower in these infants compared with those ventilated with conventional SIMV. No significant differences were found between two groups with respect to NEC and air leak. Conclusion: In conclusion, VG ventilation in combination with surfactant treatment significantly reduced both duration of mechanical ventilation and early neonatal oxygen related morbidities including BPD, ROP and IVH in preterm infants with RDS. This data favors the use of VG ventilation in respiratory support of premature infants.     

Nasal intermittent positive pressure ventilation with or without very early surfactant therapy for the primary treatment of respiratory distress syndrome

Aim: Current evidence suggests that nasal intermittent positive pressure ventilation (NIPPV) as a primary treatment for RDS reduces the duration of invasive mechanical ventilation (MV) comparing with nasal continuous airway pressure (NCPAP). We aimed to evaluate whether very early surfactant treatment decreases the need for MV when used in premature infants treated with early NIPPV soon after birth.

Methods: The inclusion criteria of this prospective cohort study were a gestational age of 24–31^6/7 weeks and supplemental oxygen with the evidence of labored breathing within 60?min. Infants were stabilized on NCPAP and then continued with NIPPV, following early surfactant treatment, or were only put on NIPPV. Thirty infants in the NIPPV group and 29 infants in the NIPPV?+?SURFACTANT group met the inclusion criteria. Primary end-point was the need of MV in the first 72?h of life according to the predefined criteria.

Results: The failure rate was significantly lower in the NIPPV?+?SURFACTANT group compared with the NIPPV group (37.9% and 66.7% respectively, p?<?0.05). All other results, including bronchopulmonary dysplasia and death, were similar between the groups.

Conclusion: NIPPV failure was significantly lower when combined with surfactant treatment, which indicates the critical role of early surfactant treatment in reducing the need for invasive ventilation.     

Prebiotics for the management of hyperbilirubinemia in preterm neonates

Objective: We evaluated if prebiotics have benefits for the management of hyperbilirubinemia in preterm neonates.

Methods: Preterm neonates were entered into the study when enteral feeding volume met 30?mL/kg/day. They randomly received a mixture of short-chain galacto-oligosacarids/long-chain fructo-oligosacarids or distilled water (placebo) for 1 week. Total serum bilirubin level was measured by transcutaneous bilirubinometry. Stool frequency and meeting full enteral feeding during the study period were considered as secondary outcomes.

Results: Twenty-five neonates in each group completed the trial. Bilirubin level was decreased with the prebiotic (?1.3?± 1.8?mg/dL, p?=?0.004), but not placebo (?0.1?±?3.3?mg/dL, p?=?0.416). Peak bilirubin level was lower with the prebiotic than placebo (8.3?±?1.7 versus 10.1?±?2.2?mg/dL, p?=?0.003). Stool frequency was increased with the prebiotic (0.7?±?1.9 defecation/day, p?=?0.014), but not with placebo (0.6?± 1.5 defecation/day, p?=?0.133). Average stool frequency (2.4?± 0.4 versus 1.9?±?0.5 defecation/day, p?=?0.003) and frequently of meeting full enteral feeding (60% versus 16%, p?=?0.002) were higher with the prebiotic than placebo.

Conclusions: Prebiotic oligosaccharides increase stool frequency, improve feeding tolerance and reduce bilirubin level in preterm neonates and therefore can be efficacious for the management of neonatal hyperbilirubinemia.     

Echocardiography may cause significant pain response in preterm infants

Objective: The objective of this study is to evaluate if echocardiographic examination causes any pain response in term and preterm infants.

Methods: Term and preterm neonates who admitted to Neonatal Intensive Care Unit at Gazi University Hospital and Etlik Zubeyde Hanim Training and Research Hospital and were performed echocardiography for any reason were included into the study. Neonates were evaluated before, during and 10?minutes after the examination. Vital signs (heart rate, respiratory rate, blood pressure, transcutaneous oxygen saturation) were recorded. All subjects were also evaluated with Neonatal Infant Pain Scale during the examination.

Results: In this study, we evaluated 99 newborn infants. Five infants who received fentanyl treatment were excluded. The heart rate (p?=?0.000), respiratory rate (p?=?0.000), diastolic blood pressure (p?=?0.001) and oxygen saturation (p?=?0.000) during the examination were significantly different than the values before and 10?minutes after the examination. Infants whose gestational age ≤32 weeks (n:20) have significantly higher NIPS scores (mean?±?SEM?=?3.3?±?0.4) than the infants whose gestational age is greater than 32 weeks (n:71) (mean?±?SEM?=?2.4?±?0.2).

Conclusions: Echocardiographic examination which is known as noninvasive and painless causes significant pain in preterm infants.     

Low-birth-weight,but not catch-up growth,correlates with insulin resistance and resistin level in SGA infants at 12 months

Objective: To investigate the insulin resistance status in SGA infants at 12 months and its relationship with auxological and metabolic parameters.

Methods: One group of 45 SGA and one of 50 appropriate for gestational age infants were followed from birth to the end of the first year of life. At 12 months, skinfold thickness, waist circumference, and blood levels of glucose, insulin, adiponectin, leptin, resistin, visfatin, retinol-binding protein 4, IGFs, lipids profile were determined, and the HOMA-IR index was calculated.

Results: The SGAs had increased insulin (5.2?±?2.7 versus 2.9?±?2.4 μIU/ml, p?=?0.012) and HOMA-IR (1.09?±?0.9 versus 0.59?±?0.55, p?=?0.016). In multiple regression, insulin resistance indices were independently correlated with low-birth-weight (β?=??2.92, p?=?0.015 for insulin, β?=??2.98, p?=?0.011 for HOMA-IR) but not with catch-up growth in either height or weight or any other metabolic parameter. Resistin was higher in the SGAs (5.1?±?2.1 versus 3.9?±?2.1?ng/ml, p?=?0.03) and independently correlated with low-birth-weight but not insulin resistance. Resistin was negatively correlated with total cholesterol (R?=??0.33, p?=?0.007) and positively with lipoprotein(a) (R?=?0.49, p?=?0.001).

Conclusion: Low-birth-weight, but not catch-up growth or adiposity tissue hormones, was correlated with insulin resistance at 12 months in non-obese SGA infants. The higher resistin in SGA infants and its correlation with total cholesterol and lipoprotein(a) need further clarification.     

Total energy intake accounts for postnatal anthropometric growth in moderately/late preterm infants

Objective: Moderately preterm (MP) (32–33 weeks) and late preterm (LP) (34–36 weeks) infants have higher risks of mortality and growth and developmental problems. We, herein present a new concept of nutritional assessment, total energy intake (TEI), which is the sum total of kilocalories administered in all nutrient forms.

Methods: Fifty-two preterm infants were classified as MP (n?=?12), LP/appropriate for gestational age (LP/AGA) (n?=?33), or LP/small for gestational age (LP/SGA) (n?=?7). All groups received nutrient therapy by the same protocol. The sum of the daily energy intake at 14 and 28 days after birth was determined.

Results: TEI was 2822.1?±?162.1?kcal/kg/28 days in the MP group, 3187.2?±?265.0?kcal/kg/28 days in the LP/AGA group and 3424.6?±?210.4?kcal/kg/28 days in the LP/SGA group. In all groups, TEI for 28 days was significantly correlated with body weight gain (r?=?0.465, p?=?0.006). TEI for 14 days after birth was inversely correlated with the body weight loss rate after birth (r?=??0.491, p?=?0.0002).

Conclusion: TEI was well correlated with anthropometric changes after birth. TEI may be used to effectively assess preterm infants’ nutritional needs.     

Fetal fibronectin,cervical length,and the risk of preterm birth in patients with an ultrasound or physical exam indicated cervical cerclage

Objective: The objective of this study is to estimate the risk of preterm birth in patients with an ultrasound or physical exam indicated cervical cerclage based on the results of fetal fibronectin (fFN) and cervical length (CL) screening.

Methods: Retrospective cohort of patients with a singleton pregnancy and an ultrasound or physical exam indicated Shirodkar cerclage placed by one maternal–fetal medicine practice from November 2005 to January 2015. Patients routinely underwent serial CL and fFN testing from 22 to 32 weeks. Based on ROC curve analysis, a short CL was defined as?≤15?mm. All fFN and CL results included are from after the cerclage placement.

Results: One hundred and four patients were included. Seventy eight (75%) patients had an ultrasound-indicated cerclage and 26 (25%) patients had a physical exam-indicated cerclage. A positive fFN was associate with preterm birth?<32 weeks (15.6% versus 4.2%, p?=?0.043), <35 weeks (37.5% versus 11.1%, p?=?0.002), <37 weeks (65.6% versus 20.8%, p?<?0.001), and earlier gestational ages at delivery (35.2?±?3.9 versus 37.4?±?2.9, p?=?0.001). A short CL was also associated with preterm birth?<35 weeks (50.0% versus 11.9%, p?<?0.01), preterm birth?<37 weeks (55.0% versus 29.8%, p?=?0.033), and earlier gestational ages at delivery (34.8?±?4.1 versus 37.2?±?3.0, p?=?0.004). The risk of preterm birth?<32, <35, and?<37 weeks increased significantly with the number of abnormal markers.

Conclusion: In patients with an ultrasound or physical exam indicated cerclage, a positive fFN and a short CL are both associated with preterm birth. The risk of preterm birth increases with the number of abnormal biomarkers.