Maximizing Calcium and Phosphate Content in Neonatal Parenteral Nutrition Solutions Using Organic Calcium and Phosphate Salts

http://pen.sagepub.com/content/34/5/542.abstract.
Journal of Parenteral and Enteral Nutrition

Background: The provision of high amounts of calcium and phosphate in parenteral nutrition (PN) solution for neonates is important for bone mass accretion. Because of the risk of calcium phosphate precipitation, a well-documented incompatibility for inorganic salts, the concentrations of these electrolytes in PN are generally limited to 5 mmol/L. The aim of this study was to assess the risk of precipitation of calcium phosphate when organic calcium and phosphate salts are used instead of inorganic salts. Methods: Precipitation curves were determined for inorganic and organic calcium and phosphate salts in a PN solution favorable to precipitation (low concentration of amino acids and glucose) using visual inspection and particle counts. Results: The use of organic phosphate salt was associated with a decreased risk of precipitation of calcium phosphate. No precipitation occurred up to a concentration of 50 mmol/L of calcium and phosphate. In contrast, organic calcium salt only slightly decreased the risk of precipitation. Conclusion: Up to 50 mmol/L of organic calcium and phosphate salts can be safely mixed in PN, even in unstable conditions, making it possible to follow the current European recommendations for requirements in neonates.

Role of Polymorphic Variants as Genetic Modulators of Infection in Neonatal Sepsis

Pediatric Research:

October 2010 - Volume 68 - Issue 4 - pp 323-329

doi: 10.1203/PDR.0b013e3181e6a068.
This study is a retrospective, case control study involving 535 preterm infants examining the roles of sequence polymorphisms in genes that mediate host immune responses to bacterial infection in newborn infants. A total of 49 single nucleotide polymorphisms (SNPs) in 19 candidate genes including inflammatory cytokines (IL6, IL10, IL1B, and TNF), cytokine receptors (IL1RN), toll-like receptors (TLR2, TLR4, and TLR5), and cell surface receptors (CD14) were genotyped.

Allelic variants in PLA2G2A and TLR2 were associated with Gram-positive infections, whereas IL10 was associated with Gram-negative infections (p <>PLA2G2A, TLR2, TLR5, and IL10 may moderate the predisposition to sepsis in preterm infants.

Intracardiac echogenic focus and fetal outcome

http://onlinelibrary.wiley.com/doi/10.1002/jcu.20741/abstract;jsessionid=06AFD85D417B9CD25216DF49E386CEA3.d01t01
Of 762 fetuses evaluated by US, 48 (6.3%) were found to have an ICEF.

Conclusion The prevalence of ICEF was 6.3%. Of 31 fetuses with an isolated ICEF, outcomes of 28 fetuses are known and all neonates were reported to be normal at birth. Thus we infer that the presence of an isolated ICEF has no adverse effect on outcome of the neonate. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound, 2010

Protein C Concentrate As Adjuvant Treatment in Neonates With Sepsis-Induced Coagulopathy: A Pilot Study

http://journals.lww.com/shockjournal/Abstract/2010/10000/Protein_C_Concentrate_As_Adjuvant_Treatment_in.4.aspx

After 24 h of treatment, PC activity levels increased from an average of 19% to 57%, and they were within normal limits before the last PCConc bolus. During the treatment period, a shortening of PT (P = 0.04) and activated partial thromboplastin time (P = 0.02), and an increase in antithrombin levels (P <>P = 0.005) and NTISS values (P = 0.003). No adverse events were observed. This pilot study shows that in neonatal severe sepsis, normalization of PC levels is safe and probably effective in modulating the inflammatory response and in controlling coagulopathy. However, for the potential beneficial effects of PCConc administration on morbidity and mortality, a placebo-controlled, double-blind study is required.

Just a preliminary study.

Octreotide in Chylothorax Rx

Abstract

Chylothorax is a well-recognized complication after neonatal cardiothoracic surgery. Management strategies include cessation of enteral feedings, repeated aspiration, chest drainage, and total parenteral nutrition. Somatostatin and its analogue, octreotide, have been used with promising results. The authors present three cases of neonatal postoperative chylothorax in which octreotide was used. After literature review, we can say that octreotide is relatively safe, and may reduce clinical course and complications associated with neonatal postoperative chylothorax. One should be aware of possible association between octreotide and necrotizing enterocolitis. Prospective controlled trials supporting octreotide use are lacking.
http://www.springerlink.com/content/dk0155j31v6l13p2/

Pediatric Surgery International

DOI: 10.1007/s00383-010-2730-2

Atelectasis Rx-3% saline vs rh DNase

http://onlinelibrary.wiley.com/doi/10.1111/j.1442-200X.2010.03245.x/abstract;jsessionid=7692CED7DAA6EDC0A861A33BBDC4D05E.d02t01

Objective: To compare and evaluate the efficacy of nebulized 3% hypertonic saline (HS) and recombinant human Dnase (rhDNase) treatment for resolution of persistent atelectasis in newborns.

Study Design: Forty newborns (38 preterms) who did not respond to conventional treatment enrolled to receive either nebulized 3% HS solution (n = 20) or rhDNase (n = 20) between September 2007 and March 2008. Clinical parameters, oxygen saturation and radiological response (chest X-ray scoring) were analyzed before and after administration of 3% HS or rhDNase.

Resolution time of atelectasis did not differ between two groups after whole treatment but the percentage of atelectasis resolution after 3 days treatment were 90% (18/20) in the 3%HS group and 70% (14/20) in the rhDNase group. The patients in the 3% HS group improved better also in clinical parameters in comparison to the rhDNase treatment. The difference of oxygen saturation before and after the treatment was 4.6 ± 0.8 in 3% HS group as in comparison to 2.6 ± 0.1 in the rhDNase group (p <>

Interesting findings!

Intratracheal catheter suction removes the same volume of meconium

Early Human Development
Volume 86, Issue 8, August 2010, Pages 499-502
Intratracheal catheter suction removes the same volume of meconium with less impact on desaturation compared with meconium aspirator in meconium aspiration syndrome.

Methods

MAS was induced in ventilated rabbits using 3.5 ml/kg of 20% human meconium. Tracheal suction with either catheter suction (CS) or meconium aspirator (MA) was performed after meconium instillation. Percentage of meconium collection rate, PaO₂ trends for 2 h after tracheal suction, and acute-phase SpO₂ trends were compared between CS and the other three groups, the tube was withdrawn while meconium was aspirated with an MA, then the trachea was reintubated 5, 10 or 15 s after suctioning of meconium.

Results

Percentage of meconium collection rate and PaO₂ showed no significant differences between groups. The MA group taking 15 s for reintubation after meconium suctioning, showed a significantly lower acute-phase SpO₂ than the CS group (P <>2 to return to ≥ 90% was also longer in the MA group taking 15 s for reintubation than in the CS group (P <>