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.

RBC Transfusions-NEC?

http://www.jpeds.com/article/S0022-3476%2810%2900482-8/abstract

Results

The frequency of RBC transfusions was similar in NEC patients (47/93, 51%) and control patients (52/91, 58%). Late-onset NEC (>4 weeks of age) was more frequently associated with a history of transfusion(s) than early-onset NEC (adjusted OR, 6.7; 95% CI, 1.5 to 31.2; P = .02). Compared with nontransfused patients, RBC-transfused patients were born at earlier gestational ages, had greater intensive care needs (including at the time of onset of NEC), and longer hospital stay. A history of RBC transfusions within 48-hours before NEC onset was noted in 38% of patients, most of whom were extremely low birth weight infants.

Conclusions

In most patients, RBC transfusions were temporally unrelated to NEC and may be merely a marker of overall severity of illness. However, the relationship between RBC transfusions and NEC requires further evaluation in extremely low birth weight infants using a prospective cohort design.

My Word: Few recent studies did not show any correlation between transfusions and NEC. But,

my hypothesis is that: older the blood and lower the hct,

higher the chances for NEC or hematoschezia. Older blood may accumulate oxygen radicals secondary to hemolysis and cause vasoconstriction and ischemia.

Efficacy of Bifidobacterium breve and Lactobacillus casei oral supplementation on necrotizing enterocolitis in very-low-birth-weight preterm infants:a

http://www.ajcn.org/content/early/2010/10/27/ajcn.2010.29799.abstract
a double-blind, randomized, controlled trial
Design: A double-blind, randomized, controlled clinical trial was conducted in 231 preterm infants weighing from 750 to 1499 g at birth. The intervention group was composed of 119 infants who received human milk with probiotic supplementation (B. breve and L. casei) and a control group of 112 infants who received human milk containing no probiotics. The primary outcome was the occurrence of NEC stage ≥2 as defined by Bell's modified criteria.

Results: Four confirmed cases of NEC stage ≥2 by Bell's criterion occurred only in the control group.

Though the follow up is not mentioned in this article, they compared probiotic group with those receiving breast milk alone rather than with formula. That makes it interesting!

If Medical Degree was obtained online solely.

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??