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.
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.
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.
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.
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/
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 <>
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 <>
Among 1804 pregnancies exposed to acyclovir, valacyclovir,or famciclovir in the first trimester, 40 infants (2.2%) werediagnosed with a major birth defect compared with 19 920(2.4%) among the unexposed (adjusted POR, 0.89; 95% confidenceinterval [CI], 0.65-1.22). It seems quite safe.
Recommendation: Voiding cystourethrogram is recommended for children with high-grade (Society of Fetal Urology grade 3 and 4) hydronephrosis, hydroureter or an abnormal bladder on ultrasound (late term prenatal or postnatal), or who develop a urinary tract infection on observation. Option: An observational approach without screening for VUR, with prompt treatment of any urinary tract infection, may be taken for children with prenatally detected hydronephrosis (SFU grade 1 or 2), given the unproven value of identifying and treating VUR. It is also considered an option to perform a voiding cystourethrogram in these patients to screen for VUR. http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/main-reports/vur2010/ScreenNeonateinfantWithPrenatalHydronephrosis.pdf (for complete article). Summary:In screened populations with prenatal hydronephrosis the prevalence of vesicoureteral reflux is 16.2%. Reflux in the contralateral nondilated kidney accounted for a mean of 25.2% of detected cases for a mean prevalence of 4.1%. In patients with a normal postnatal renal ultrasound the prevalence of reflux is 17%. The prenatal anteroposterior renal pelvic diameter was not predictive of reflux prevalence.
https://www.thieme-connect.com/ejournals/abstract/ajp/doi/10.1055/s-0030-1263298 In view of our experience and the review of the literature, we suggest that unilateral intubation is an efficient and relatively safe therapy in cases of neonatal air leak syndrome. It is also suggested that appropriate treatment duration should be at least 48 hours. Amer J Perinatol : DOI: 10.1055/s-0030-1263298
http://www3.interscience.wiley.com/journal/123531601/abstract?CRETRY=1&SRETRY=0 401 newborns were prospectively followed and clinical signs and CRP values were recorded and blood culture results were compared. Conclusion: In this selected population of infants with suspected sepsis, apnoea and hypotension are independently predictive of a confirmed diagnosis, while bradycardia is more predictive among preterm infants and tachypnea among term infants. Apnea, hypotension and CRP were independently predictive of positive blood culture.
The Lancet, Early Online Publication, 22 July 2010
doi:10.1016/S0140-6736(10)60664-2 Methods: 800 preterm infants with a gestational age at birth of between 24 weeks and 28 weeks plus 6 days (inclusive), weighing at least 500 g, requiring surfactant or continuous positive airway pressure for respiratory distress syndrome within 24 h of birth were randomly assigned in a one-to-one ratio to inhaled nitric oxide (5 parts per million) or placebo gas (nitrogen gas) for a minimum of 7 days and a maximum of 21 days in a double-blind study
Interpretation:Early use of low-dose inhaled nitric oxide in very premature babies did not improve survival without bronchopulmonary dysplasia or brain injury, suggesting that such a preventive treatment strategy is unsuccessful.
Reese J et al. – Exposure of premature infants to unintended vasodilatory stimuli may be one of the risk factors for PDA that is underrecognized. In this article, authors summarize the clinical factors that are associated with PDA and review commonly used neonatal drugs for their vasodilatory properties. Data demonstrating relaxation of the ductus arteriosus by gentamicin and other aminoglycoside antibiotics, by cimetidine and other H2 receptor antagonists, and by heparin are provided as examples of neonatal therapies that have unanticipated effects that may promote PDA.
I need to check the original articles to check the how significant this is!
Whew! We all settled down and drove calmly to our next fortuity-the mini boat tour. These are small air filled 13’ boats and only 4 people can ride at any time. I had seen the pictures on the web; it was very exciting and a new kind of sport. I saw people riding them in calm back waters of the ocean. Fun filled activity I thought and booked the tour in advance paid the charges in full. I wanted this to be a pleasant surprise for my family.
It was blistering hot and the ride in the ocean should cool us down, I thought. There were five groups of fun seeking fanatics. The main leader gave us inspiring speech praising us for selecting this one and only kind of ADVENTURE. Yes, he stressed- it is an adventure as we would go in the real ocean to two different islands for snorkeling. You got it right, real turbulent ocean and not the calm back waters, as I originally envisioned. Besides, this surly surprise, I noticed that there were only two leaders and we were 5 groups. As I was trying to comprehend the impending calamity, the leader’s announcement enhanced my bemusement. He declared that I am the captain of my boat and will be driving my family in to the ocean. I thought I would be a rider and not a driver myself! Money was non refundable besides my prestige was at stake, if I backed out. It was a blissful blithe for my kids and astounding astonishment for me. One man’s pleasure is other man’s pressure.
The other groups were elated and my fears were unabated! The leader zoomed past us in to the open seas and I followed. Oh Shoots! I don’t know swimming-the harsh truth dawned upon me in the middle of the sojourn. I am a driver but, will I be a survivor? As we proceeded, it was titillation for others and trepidation for me. As time went by, I got used to the waves, the distress regressed, and I wore a smile after a while. We snorkeled and it was phenomenal. We ventured out to the second island. Just then a storm system was approaching us very fast. The leader declared that if we stopped at the second island, we could be struck for the whole night and hence, we should rush back to the main land.
The ocean became choppy because of the storm. If I went slowly, I could be caught in the middle of the ferocious winds and may make it to the obituary column. I had no choice, my family lives were in my hands. I used the full throttle, the waves were humongous, and the boat was whammed from all directions by the rough sea. As the boat was thrashed, my back was bashed. Should I have worn a diaper, a thought just flashed! Boat was repeatedly tossed in to the air and would come down with a huge thud. The impact was so enormous it broke my daughter’s seat. We were falling from a height of at least 6-10feet constantly and consistently and my back took the brunt of the impact.
We reached the land finally. I could barely walk and the pain was intolerable. The medications I had gave little relief and a unanimous decision was made to send me to get a massage at the Chakra spa of the resort. The spa receptionist added perplexity to my predicament. Do you need a male or a female therapist? I never faced such a tough question in my life. It was a double edged sword. A dialogue specially scripted for me, I pondered. If I say, man, would they think that I am a homosexual and if I answered female, do they think I have a passion for perversion? Why should my life be a perplexing byzantine enigma? I wanted to pull my hair. That was a more difficult task to perform than answering her contentious and controversy generating question! I cleared my throat but, what should I say?
I wish Radha was by my side and she would have saved me from this quandary. I asked who is more experienced. I thought, I had found a great solution to the problem. However, the receptionist was very diplomatic and did not divulge the truth to make things more intricate and prolong my torture. But, I had a reprieve, when she said, which time you want. I picked 10am for the massage. It was open and I took it. I was curious, who was the therapist. It was a woman. Well, like a loyal husband, I conveyed the same to Radha. She was not amused that another woman was going to touch my body.
She started her prayers on the beach.
I went the next day to the Chakra spa. I was seated in a small but beautifully decorated room. “Good morning sir, please meet your massage therapist”, a pleasant voice greeted me and shut the door locked. I shyly turned my head and looked at her. What! Is this chakra or Vishnu Chakra! (a deadly weapon in Indian mythology). Am I punished? Did Radha talk to the receptionist and arrange this? I was like a rat beside a great cat. Her hair style was like a Sumo wrestler. I may be puny but not loony! I was expecting suma maina (delicate, soft) maalish not SUMO mardhana (violent bashing). I stood like a lamb (bakra) before the sacrifice (Chakra pe Bakra!) and there was not even a window to escape! It was a non-refundable commitment or was it atonement! It seemed that she was specially hired for me and was flown from Japan. Can I have a No-Touch Technique massage? I begged. Radha’s prayers were answered!
At last the trip was finalized, yet I was skeptical about the itinerary. Is this island, worthy of 5 days of our vacation? Do I need to book for excursions to other islands? Will I be able to provide memorable vacation for my family? My mind was rattled with emotional commotion. All my apprehensions seemed to have dissipated by the heat of this beautiful tropical island.
The resort was beautiful and apotheosis (ideal example) of perfect requiescence (A state of quiescence; rest; repose). The lobby was large and the commanding view of the vast Atlantic Ocean was magnetically enticing. Soft and soothing breeze was seducing us to the beach on the resort. “Do you want us to use the credit card on record?”the affable voice of the receptionist brought me back to the mollifying lounge. We checked in to the room, which was oceanfront. It set the pace for rest of our vacation.“It is beautiful daddy!”, said my eldest one, leaning on my shoulder. As I was priding myself, I felt someone was pinching me repeatedly! I thought it was Radha. She was engrossed in enjoying the enthralling views of Atlantic. Whereas, mindless mosquitoes were mercilessly marauding my blood. I was prepared. I immediately wore the medicated mosquito repellant band. They were amused and began to focus around the band instead of rest of the body.I was very soon thrashing myself and ended up with bumps and bruises.
Radha realized that the enchanting beauty should be shared with me. She turned around and was flabbergasted. How could I get so many hickies? She thought. She looked around ferociously for the perpetrator and I pointed her to the beguiling band. It is an arthropod allurer specially sold at CVS. The bewitching beauty of the resort and island made the mosquito menace a miniscule issue.
We explored the island with Lety. She showed us some historic places and beautiful beaches in her huge minivan. Roads were perhaps built for one person to walk, but Lety managed to navigate her truck size minivan with impeccable dexterity. Other faster alternative would have been-training under Tarzan, jumping from tree to tree. We immensely enjoyed the serene atmosphere on the island and decided to explore the main island in 36 hours. We flew in a small 6 seater plane. We were seated by weight and no one dared to sneeze or cough after the flight took off, lest it might disturb the delicate balance in midair. No one took chances! Ride was comfortable. It flew low over the ocean giving us a panoramic view of the turquoise waters, but I found everyone was focused upon finding the life jackets beneath their seats. Before they could retrieve, they had a reprieve as the plane glided on to the runway.
Renting a car was no brainer but for driving, we needed a trainer. All the signs were non-English. You do not know if the sign says east or west as they are spelled so similarly. If you are a fresher, use the right lane but, if you are a thinker-then left lane (lost in thoughts and oblivious to the minimum speed limits). But, if you want to pass, you may use the shoulder. Yes, it is complex in a simple way! We were told not to use the express lane at the toll as it is meant for ez-pass holders. So, we comfortably avoided that lane, but ended up in cash only lane. To make it simply complicated it was the lane for exact change. I threw a quarter and it wanted more, how much more? I had no clue. I found one more quarter and threw it in to the receptacle. It was not satisfied. I had no more change, I threw a dollar note, it gulped it down but did not register any transaction. Drivers behind me became restless and started honking. I was flustered and everyone in the car exhorted me to throw one more dollar note. I did, but to no avail. The honking increased to a ferocious level. I was nervous and I could not go back as cars were blocking me and no savior in sight. I was frantic and decided to something and started to remove my socks and shoes to throw them in to the money mongering monster. Fortunately, my kids found some dimes and nickels and that seemed to have satisfied the fastidious appetite for change. The gate opened, the honking dampened, seat belt fastened, anxiety lessened and speed heightened. I was saved of losing my garments. Wow! Study before your sojourn and verify (signs) before you venture in a foreign place. Phew! to be continued.....
