211 G to A Variation of UDP-Glucuronosyl Transferase 1A1 Gene and Neonatal Breastfeeding Jaundice

http://journals.lww.com/pedresearch/Abstract/2011/02000/211_G_to_A_Variation_of_UDP_Glucuronosyl.14.aspx

The uridine diphosphate glucuronosyl transferase 1A1 (UGT1A1) gene polymorphism was shown to contribute to the development of neonatal hyperbilirubinemia. We hypothesize that the variation of UGT1A1 gene may contribute to neonatal breastfeeding jaundice. We prospectively enrolled 688 near-term and term infants who were exclusively breastfed (BF group) or were supplemented by infant formula partially (SF group) before onset of hyperbilirubinemia.

Neonates with nucleotide 211 GA or AA variation in UGT1A1 genotypes had higher peak serum bilirubin levels and higher incidence of hyperbilirubinemia than WTs (GG). This phenomenon was only seen in BF group but not in SF group when subset analysis was performed. This suggests that neonates who carry the nucleotide 211 GA or AA variation within coding region in UGT1A1 gene are more susceptible to develop early-onset neonatal breastfeeding jaundice.

Milking Compared With Delayed Cord Clamping to Increase Placental Transfusion in Preterm Neonates: A Randomized Controlled Trial

http://journals.lww.com/greenjournal/Fulltext/2011/02000/Milking_Compared_With_Delayed_Cord_Clamping_to.2.aspx
Methods: All delivered before 33 completed weeks of gestation. In this single-center trial, women were randomized to either standard treatment (clamping the cord for 30 seconds after delivery) or repeated (four times) milking of the cord toward the neonate.
Results: Mean birth weight was 1,263±428 g in the clamping group and 1,235±468 g in the milking group, with mean gestational age of 29.2±2.3 weeks and 29.5±2.7 weeks, respectively. Mean hemoglobin values for each group at 1 hour after birth were 17.3 g/L for clamping and 17.5 g/L for milking (P=.71).
median number of transfusions within the first 42 days of life (median [range]: clamping group 0 [0–7]; milking group 0 [0–20]; P=.76).
My Point: We need to assess how much time was spent in milking and if associated chorioamniobnitis is an issue and if IVH incidence is different.

Oseltamivir-NICU experience

http://www.nature.com/jp/journal/vaop/ncurrent/full/jp2010159a.html
About 11 infants were treated for H1N1 and 21 were prophylaxed with Oseltamivir.
Age ranged from 2 days to 11.4 months (mean, 2.1 months). Corrected gestational age and weight at initiation of oseltamivir ranged from 32 to 86 weeks (mean, 41 weeks) and 775 to 8635 g (mean, 3074 g), respectively.

Conclusion:

Oseltamivir appears to be well tolerated in preterm and term neonates and infants with complex underlying conditions. More studies are needed to determine optimal dosing for treatment and prophylaxis in this vulnerable age group.

Levetiracetam in Neonatal Seizures

http://jcn.sagepub.com/content/early/2011/01/06/0883073810384263.abstract
Published as a retrospective study from CHOP, Philadelphia in Journal of Child Neurology. Twenty three neonates were given levetiracetam in a dosage of 16mg/kg +/- 6mg/kg.
Levetiracetam was associated with a greater than 50% seizure reduction in 35% (8 of 23), including seizure termination in 7. Further study is warranted to determine optimal levetiracetam dosing in neonates and to compare efficacy with other antiseizure medications.

RBC Transfusions & Severe IVH!

http://onlinelibrary.wiley.com/doi/10.1111/j.1537-2995.2010.02980.x/abstract

RESULTS: Fifty-four cases were matched (1:2) with controls. No differences were found between cases and controls in initial pH, sepsis, ventilation, coagulation studies, or proportion with severe thrombocytopenia. However, during the period when the head ultrasound was normal, cases were more likely to have had a red blood cell (RBC) transfusion (p <>

CONCLUSION: These findings suggest a new hypothesis. Namely, RBC transfusions given before the development of an IVH are an independent risk factor for developing a severe IVH.

Point: One more reason to be mindful of what we do in the first week of life. This study does not mean that we have proved transfusions lead to IVH. But, it makes us pause and ponder of what we do so routinely.

Early Opioid Infusion and Neonatal Outcomes in Preterm Neonates ≤28 Weeks' Gestation

https://www.thieme-connect.com/ejournals/abstract/ajp/doi/10.1055/s-0030-1270112
A retrospective analysis of preterm infants ≤28 weeks' gestational age (GA) admitted to neonatal intensive care units in the Canadian Neonatal Network was conducted comparing infants on the basis of receipt of opioid infusion during day 1 and day 3 after birth.
A total 362 infants received opioid infusion on day 1 and day 3, whereas 4419 infants did not receive opioid infusion.

Neonates who received opioid infusion had higher risk for mortality (adjusted odds ratio [AOR] 1.57, 95% confidence interval [CI] 1.13, 2.18), severe neurological injury (AOR 1.63, 95% CI 1.30, 2.04), severe retinopathy of prematurity (AOR 1. 39, 95% CI 1.08, 1.79), and bronchopulmonary dysplasia (AOR 1.36, 95% CI 1.03, 1.79). Early exposure to opioid infusion in the first 3 days was associated with higher risk of adverse outcomes in extremely preterm infants.
POINT: Narcotics are known to produce apoptosis of neurons in animal models. So, ask yourself-do we need to give it today and if so, why? Everything we d, can affect the outcomes, so be judicious!

BP recording dock for Iphone/Ipad

http://www.ihealth99.com/video1
This is cool neat device, with which you can not only record the BP but share it with your doctors or well wishers. I believe it costs about $99.