Nasal high frequency percussive ventilation versus nasal continuous positive airway pressure in transient tachypnea of the newborn: A pilot randomized

Methods

A prospective, unmasked, randomized, controlled clinical trial was conducted in 46 eligible newborn infants who were hospitalized for TTN in the University Hospital of Bordeaux (France) between 2007 and 2009.

Results

In the NHFPV group the duration of TTN was half the time of NCPAP group (105 min ± 20 and 377 min ± 150, respectively; P  < 0.0001). There was a significant decrease in duration of oxygen supplementation in the NHFPV group (6.3 min ± 3.3) compared to the NCPAP group (19.1 min ± 8.1; P < 0.001), and a significant decrease in level of oxygen supplementation [(FiO₂—0.21)/time of O₂ therapy] in the NHFPV group (0.29 min⁻¹ ± 0.16) compared to the NCPAP group (0.46 min⁻¹ ± 0.50; P < 0.001). There was no complication and NHFPV was as well tolerated as NCPAP.

My Word: The results are statistically significant but not clinically relevant 6.3 minutes vs 19 minutes! Not for prime time yet.

Maternal C-reactive protein levels in pregnancy are associated with wheezing and lower respiratory tract infections in the offspring

http://www.ajog.org/article/PIIS0002937810011117/abstract?rss=yes
Children in the highest tertile of maternal CRP levels had a higher risk of experiencing recurrent wheezing (adjusted odds ratio, 2.87; 95% confidence interval, 1.23–6.71) and being diagnosed with recurrent LRTIs (odds ratio, 2.37; 95% confidence interval, 1.01–5.55), as compared with children in the lowest tertile. The rs1205 polymorphism influenced maternal serum CRP levels but not the risk of the offspring outcomes.

Conclusion:

Higher CRP levels in pregnancy are associated with wheezing and LRTIs in offspring. However, genetic variation in CRP influencing maternal levels is not related to these phenotypes.

Early intravenous immunoglobin (two-dose regimen) in the management of severe Rh hemolytic disease of newborn—a prospective randomized controlled tria

http://www.springerlink.com/content/t6p22706q04m4100/
The study included 90 full-term neonates with Rh incompatibility unmodified by antenatal treatment and not eligible for early ET and which were randomly assigned into one of three groups: group (I), treated by conventional method; groups IIa and IIb received IVIG once at 12 h postnatal age if PT was indicated, in a dose of 0.5 and 1 g/kg, respectively.

Analysis revealed 11 neonates (22%) in the conventional group and 2 (5%) in the intervention group who administered low-dose IVIG at 12 h, while none in group IIb required exchange transfusion (p = 0.03). Mean bilirubin levels were significantly lower during the first 96 h in the intervention group compared to the conventional group (p < 0.0001). Shorter duration of phototherapy (52.8 ± 12.39 h) and hospital stay (3.25 ± 0.71 days) in the IVIG group compared to conventional group (84 ± 12.12 h and 4.72 ±0.78 days, p < 0.0001, respectively) were observed.

Persistent non-visualisation of the fetal stomach: diagnostic and prognostic implications

http://fn.bmj.com/content/95/6/F439.abstract
Conclusions Persistent non-visualisation of the fetal stomach in the antenatal period was associated with a wide range of underlying diagnoses. In many cases, prognosis was poor. Only 37% of pregnancies resulted in liveborn infants surviving more than 6 months. The incidence of an abnormal karyotype was 29%. Diagnosis and outcome was normal in only 9.2% of cases. We propose an algorithm for the management of persistent non-visualisation of the fetal stomach on antenatal ultrasound.

Preterm Transport-Higher IVH?

http://fn.bmj.com/content/95/6/F403.abstract

Results A total of 67 596 VLBW infants were included in the study. Overall incidence of IVH in the sample was 14.7%; the transport group had more IVH compared to inborn group (27.4% vs 13.42%): adjusted OR 1.75 (95% CI 1.64 to 1.86; p<0.001). p="0.001).">

Conclusion Inter-hospital transport of VLBW Infants is correlated with increased incidence and severity of IVH. This correlation has remained constant over the recent years.

My Word: May be maternal transports are safer??

PDA Ligation-Cereboxygenation

http://fn.bmj.com/content/95/6/F429.abstract

Objective To investigate the impact of surgical closure of PDA on rScO₂ and cerebral fractional tissue oxygen extraction (cFTOE), measured by near-infrared spectroscopy, and on amplitude-integrated electro-encephalography (aEEG) measured brain activity.

Design/methods In 20 preterm infants (gestational age 24.7–30.4 weeks; birth weight 630–1540 g), blood pressure, arterial saturation, rScO₂, cFTOE and aEEG were monitored before, during and up to 24 h after surgery.

Conclusion Ductal ligation poses a risk for a further decrease in already compromised cerebral oxygenation in preterm infants.

My Word: this does not mean that PDA ligation has long term implications.

Parenteral but Not Enteral Omega-3 Fatty Acids (Omegaven) Modulate Intestinal Regrowth After Massive Small Bowel Resection in Rats

http://pen.sagepub.com/content/34/5/503.abstract
Conclusions: Parenteral but not enteral Omegaven augments and accelerates structural bowel adaptation in a rat model of SBS. Increased cell proliferation and decreased apoptosis reflect increased cell turnover in Omegaven-treated animals.
This study has some good clinical value and more and more studies are suggesting that omega-3 fatty acids fish oil has lot of clinical benefit especially with prolonged TPN and following bowel resection.

Parenteral Fish Oil as Monotherapy Improves Lipid Profiles in Children With Parenteral Nutrition–Associated Liver Disease

http://pen.sagepub.com/content/34/5/477.abstract
The authors examined the lipid profiles of a unique cohort of 10 children who were exclusively administered a fish oil–based lipid emulsion while on PN for a median duration of 14 weeks.
Results: After 14 weeks of fish oil monotherapy, children had a 24% increase in high-density lipoprotein. Compared to baseline, serum low-density lipoprotein, very low-density lipoprotein, total cholesterol, and triglyceride levels all significantly decreased. Eight children had their bilirubin improved with a decreased direct bilirubin from 6.9 mg/dL (range, 4.4-10.7) at baseline to 2.3 mg/dL (range, 1.3-4.0) after 14 weeks, and a decrease in total bilirubin from 8.7 mg/dL (range, 5.5-13.7) to 3.8 mg/dL (range, 2.2-6.5).
Conclusion: A fish oil–based lipid emulsion used as monotherapy in children who exclusively depended on PN for survival was associated with significant improvement in all major lipid panels as well as improvement of hyperbilirubinemia. Parenteral fish oil may be the preferred lipid source in children with dyslipidemia.

Bile Acids are Early Markers of TPN Associated Cholestasis!

www.jpen.sagepub.com september 2010 issue.
The study group included 22 term and preterm newborns (group T1) who had received at least 75% of the required energy via parenteral nutrition for 3–15 days. Analyses of conjugated BAs were performed using the high-performance liquid chromatography–mass spectrometry (HPLC-MS) method. The authors’ results suggest that there is an early increase in glycine- and taurine-conjugated BAs in the plasma of newborns receiving PN for 3–15 days compared with healthy controls (CN, n = 15) and patients before PN (T0, n = 9). More specifically, patients receiving PN had significantly increased levels of glycocholic acid, taurocholic acid, and combined taurochenodeoxycholic + taurodeoxycholic + tauroursodeoxycholic acids.

Bile acids correlate quite well with histological liver damage than bilirubin and hence early recognition and modification of TPN or cycling of TPN or use of omega-3 fatty acid fish oil emulsion may prevent severe form of cholestasis-Nadia Ovchinsky commented on the study.

Impact of Fetal Growth Restriction on Mortality and Morbidity in a Very Preterm Birth Cohort

http://www.jpeds.com/article/S0022-3476%2810%2900398-7/abstract
he study included singletons and twins alive at onset of labor between 24 and 31 weeks of gestation without congenital anomalies from the Models of Organising Access to Intensive Care for very preterm births very preterm cohort in 10 European regions in 2003 (n = 4525).
The mortality rate was higher for infants with birthweights <25th percentile when compared with the 50th to 74th percentile (adjusted odds ratio, 3.98 [95% CI, 2.79-5.67] for <10th; adjusted odds ratio, 2.15 [95% CI, 1.54-3.00] for 10th-24th). BPD declined continuously with increasing birthweight. There was no association for periventricular leukomalacia or intraventricular hemorrhage.

Conclusions

A 25th percentile cutoff point was a means of identifying infants at higher risk of death and a continuous measure better described risks of BPD. Lower birthweights were associated with poor outcomes regardless of pregnancy complications.

Inter-Alpha Inhibitor Protein Level in Neonates Predicts Necrotizing Enterocolitis

http://www.jpeds.com/article/S0022-3476%2810%2900394-X/abstract
This was a prospective observational study of neonates in the neonatal intensive care unit.

Results

Seventeen neonates had confirmed NEC, and 34 neonates had nonspecific abdominal disorders that improved rapidly. Gestational age, postnatal age, weight, sex, maternal obstetric variables, rupture of membranes, and mode of delivery did not differ between the two groups. Mean IaIp level was significantly lower in the NEC group compared with the control group (137 ± 38 mg/L; 95% confidence interval [CI], 118-157 mg/L vs 258 ± 53 mg/L; 95% CI, 238-277 mg/L; P <.0001).

Conclusions

The finding of significantly lower IaIp levels in neonates with NEC suggests that IaIp might be a useful, sensitive biomarker, allowing initiation of appropriate therapy
Looks promising.

Does abdominal sonography provide additional information over abdominal plain radiography for diagnosis of necrotizing enterocolitis in neonates?

http://www.springerlink.com/content/u0522u5774g223l1/

Results

Patients were classified into two groups; group I with suspected NEC (stage I) (n = 54) and group II with definite NEC (stage ≥II) (n = 39). Pneumatosis intestinalis (PI) (n = 29), free air (n = 9), and portal venous gas (PVG) (n = 1) were observed in group II on plain radiography. In the same group, echoic free fluid (EFF) (n = 9), PVG (n = 6), PI (n = 5), and focal fluid collection (n = 3) were the most prominent sonographic findings. In patients with intestinal perforation, whereas EFF and bowel wall thinning were observed on AUS, free air was not detected on plain radiography as a sign of intestinal perforation.

Conclusion Our results suggest AUS to be superior to plain radiography on early detection of intestinal perforation by demonstrating PVG and EFF collection. Therefore, it may be life-saving by directing the surgeon to perform surgical intervention in the case of clinical deterioration in the course of NEC.