http://link.springer.com/article/10.1007%2Fs00467-015-3080-z
Background
Prenatal ultrasonography has greatly enhanced detection of congenital genitourinary abnormalities. However, although persistent prenatal hydronephrosis (PPH) is typically imaged and followed postnatally, it remains unclear if prenatal hydronephrosis that resolves in utero (RPH) should be similarly managed. We determined postnatal abnormalities associated with RPH and compared these to those associated with PPH.
Methods
We performed a retrospective review of all consecutive patients evaluated for prenatal hydronephrosis over 24 months. Patients were followed prenatally with serial ultrasounds and postnatally with ultrasonography and a voiding cystourethrogram.
Results
Of the consecutive 165 patients enrolled in the study, 72 had RPH. The average prenatal anterior–posterior renal pelvis length was significantly longer in patients with PPH (5.5 mm) than in those with RPH (4.9 mm) (p = 0.01). Recurrent postnatal hydronephrosis occurred in 44 % of patients with RPH, with eventual resolution in 34 % of those affected. In comparison, 29 % of PPH cases resolved postnatally. Mean time to resolution was statistically shorter for PPH (116 days) than for RPH (175 days) (p = 0.01). Seven PPH patients required surgery, while no RPH patients needed intervention (difference was statistically significant).
Conclusions
A significant number of RPH children had postnatal hydronephrosis. Despite a slower resolution time, no children with RPH required intervention. Although RPH may recur postnatally, the significantly lower chance of intervention being required suggests that these children may not require postnatal imaging.
Tuesday, August 25, 2015
Friday, July 31, 2015
Metanalysis of Probiotics Advantage in Reducing NEC in VLBW Infants
Yet another confirmation of utility of probiotics in VLBW infants
http://www.jpedsurg.org/article/S0022-3468(15)00362-0/abstract?rss=yes
Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in preterm infants, affecting ~6–7% of very-low-birth-weight (VLBW) infants. Early intervention and aggressive treatment has improved clinical outcomes, but considerable morbidity continues to accrue to NEC survivors. This meta-analysis examines the impact of probiotics on the incidence of NEC and complications among VLBW infants.
Methods
A comprehensive literature search for all published randomized control trials (RCTs) assessing the use of probiotics to prevent NEC in VLBW infants was conducted using PubMed, Cochrane Central Registry of Controlled Trials, and Google Scholar (1966–2014). The incidences of NEC, sepsis, overall mortality, and time to reach full enteral feeds were analyzed.
Results
20 RCTs involving 5982 preterm VLBW infants were analyzed. Risk of NEC was reduced by 49.1% (RR = 0.509; 95% CI, 0.385–0.672; p < 0.001), and overall mortality by 26.9% among infants receiving probiotics (RR = 0.731; 95% CI, 0.577–0.926; p = 0.009). An 8.1% reduction in sepsis was also observed in infants receiving probiotics (RR = 0.919; 95% CI, 0.823–1.027; p = 0.137). Time to reach full enteral feeds was reduced by 1.2 days among infants receiving probiotics (MD: −1.217; 95% CI, −2.151 to −0.283; p = 0.011).
Conclusion
The use of probiotic supplementation in preterm VLBW infants is associated with a significant reduction in the risk of NEC and overall mortality. Additional studies are required to determine the optimal genus, species, and dose of probiotic.
http://www.jpedsurg.org/article/S0022-3468(15)00362-0/abstract?rss=yes
Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in preterm infants, affecting ~6–7% of very-low-birth-weight (VLBW) infants. Early intervention and aggressive treatment has improved clinical outcomes, but considerable morbidity continues to accrue to NEC survivors. This meta-analysis examines the impact of probiotics on the incidence of NEC and complications among VLBW infants.
Methods
A comprehensive literature search for all published randomized control trials (RCTs) assessing the use of probiotics to prevent NEC in VLBW infants was conducted using PubMed, Cochrane Central Registry of Controlled Trials, and Google Scholar (1966–2014). The incidences of NEC, sepsis, overall mortality, and time to reach full enteral feeds were analyzed.
Results
20 RCTs involving 5982 preterm VLBW infants were analyzed. Risk of NEC was reduced by 49.1% (RR = 0.509; 95% CI, 0.385–0.672; p < 0.001), and overall mortality by 26.9% among infants receiving probiotics (RR = 0.731; 95% CI, 0.577–0.926; p = 0.009). An 8.1% reduction in sepsis was also observed in infants receiving probiotics (RR = 0.919; 95% CI, 0.823–1.027; p = 0.137). Time to reach full enteral feeds was reduced by 1.2 days among infants receiving probiotics (MD: −1.217; 95% CI, −2.151 to −0.283; p = 0.011).
Conclusion
The use of probiotic supplementation in preterm VLBW infants is associated with a significant reduction in the risk of NEC and overall mortality. Additional studies are required to determine the optimal genus, species, and dose of probiotic.
Wednesday, July 22, 2015
Evaluating Persistent Hypoglycemia-Recommendations
http://www.jpeds.com/article/S0022-3476(15)00358-3/fulltext
For infants and younger children who are unable to reliably communicate symptoms, suggestted evaluation and management only of those whose Plasma Glucose concentrations are documented by laboratory quality assays to be below the normal threshold for neurogenic responses (<60 mg/dL [3.3 mmol/L]). GRADE 2+++0. Free fatty acids cannot be used by brain as fuel, whereas, Beta Hydroxy Buteric Acid (BOHB)and lactate can be used by the brain. When glucose level is <60mg/dl, measure lactate, FFA, BOHB, and HCO3 Insulin, cpeptide, GH (growth hormone)cortisol, acyl carnitine, and free carnitine may need to be measured.
HyperInhyperinsulinemic states--LOW BOHB, and FFA will be seen, and HCO3 will be normal.
In Fatty Acid Oxidation defects--- LOW BOHB, but INCREASED FFA, with normal HCO3 will be seen.
In Gluconeogenesis defects: LOW HOCO3, and INcreased Lactate is noted.
In GH, or Cortisol deficiency-Low HCO3, and Increased BOHB.
An exaggerated glycemic response (>30 mg/dL [>1.7 mmol/L]) is nearly pathognomonic of hyperinsulinism.
Because plasma insulin concentration is sometimes not above the lower limit of detection,
it is important to include the following tests when assessing the possibility of hypoglycemia due to hyperinsulinism: plasma BOHB and FFA (both inappropriately low; BOHB <1.5 mmol/L [<15 mg/dL] and FFA <1.0-1.5 mmol/L [<28-42 mg/dL]), and an increased glycemic response to glucagon. For neonates with a suspected congenital hypoglycemia disorder and older infants and children with a confirmed hypoglycemia disorder, recommend that the goal of treatment be to maintain a PG concentration >70 mg/dL.
For high-risk neonates without a suspected congenital hypoglycemia disorder, we suggest the goal of treatment be to maintain a PG concentration >50 mg/dL (>2.8 mmol/L) for those aged <48 hours and >60 mg/dL (>3.3 mmol/L) for those aged >48 hours.
For infants and younger children who are unable to reliably communicate symptoms, suggestted evaluation and management only of those whose Plasma Glucose concentrations are documented by laboratory quality assays to be below the normal threshold for neurogenic responses (<60 mg/dL [3.3 mmol/L]). GRADE 2+++0. Free fatty acids cannot be used by brain as fuel, whereas, Beta Hydroxy Buteric Acid (BOHB)and lactate can be used by the brain. When glucose level is <60mg/dl, measure lactate, FFA, BOHB, and HCO3 Insulin, cpeptide, GH (growth hormone)cortisol, acyl carnitine, and free carnitine may need to be measured.
HyperInhyperinsulinemic states--LOW BOHB, and FFA will be seen, and HCO3 will be normal.
In Fatty Acid Oxidation defects--- LOW BOHB, but INCREASED FFA, with normal HCO3 will be seen.
In Gluconeogenesis defects: LOW HOCO3, and INcreased Lactate is noted.
In GH, or Cortisol deficiency-Low HCO3, and Increased BOHB.
An exaggerated glycemic response (>30 mg/dL [>1.7 mmol/L]) is nearly pathognomonic of hyperinsulinism.
Because plasma insulin concentration is sometimes not above the lower limit of detection,
it is important to include the following tests when assessing the possibility of hypoglycemia due to hyperinsulinism: plasma BOHB and FFA (both inappropriately low; BOHB <1.5 mmol/L [<15 mg/dL] and FFA <1.0-1.5 mmol/L [<28-42 mg/dL]), and an increased glycemic response to glucagon. For neonates with a suspected congenital hypoglycemia disorder and older infants and children with a confirmed hypoglycemia disorder, recommend that the goal of treatment be to maintain a PG concentration >70 mg/dL.
For high-risk neonates without a suspected congenital hypoglycemia disorder, we suggest the goal of treatment be to maintain a PG concentration >50 mg/dL (>2.8 mmol/L) for those aged <48 hours and >60 mg/dL (>3.3 mmol/L) for those aged >48 hours.
Automating inspired oxygen to targeted SpO2 in preterm infants
Automated control of inspired oxygen in ventilated preterm infants: crossover physiological study
Mithilesh Lal1, Win Tin1,and Sunil Sinha
Aim
To evaluate the efficacy of automated control of the fraction of inspired oxygen (FiO2) in comparison to manual FiO2 control in maintaining target pulse oxygen saturation (SpO2) range.
Methods
Crossover physiologic study involving preterm infants requiring mechanical ventilation and supplemental oxygen. Each infant was studied for 2 consecutive 12-hour in a random sequence. Outcome measures included the proportion of time with SpO2 within and outside the target range of 90-95%, extreme hypoxaemia (<80%) and hyperoxaemia (≥98%).
Results
Complete dataset was available in 27 infants. The percentage of time (median, IQR) within the target range was higher during automated control 72.8 (58.8-82.6) compared to manual control 59.6 (49.3-73.3), p=0.031. Corresponding reduction in percent time below the target range was 18.1 (12.7-23.6) versus 25.9 (17.8-30.7), p=0.028, and above the target range 4.8 (3-16) versus 10.1 (6.4-22.5), p=0.026. Median (IQR) percent time spent with severe hypoxaemia (SpO2<80%) and severe hyperoxaemia (SpO2≥98%) were 1.3 (0.1-2.9) versus 3.2 (1.4-6.1), p= 0.022 and 0.08 (0.05-0.36) versus 1.7 (0.7-6.8), p=0.001 respectively. Median number of manual adjustments of FiO2 per 12-hour was 0 and 63 respectively.
Conclusion
Automated control of FiO2 significantly improved compliance of oxygen saturation targeting and significantly reduced exposure to hypoxaemia as well as hyperoxaemia.
Sunday, July 5, 2015
Strategies in PPROM in Preterm Infants
There is usually pulmonary hypoplasia with relatively normal compliance.
Strategy: Use low PEEP, as high PEEP can interfere with venous return, and cardiac output.
There is usually pulmonary vasoconstriction, and hypertension.
Strategy: Keep PaO2 above 50mm Hg.
Frequent Echocardiograms to evaluate shunting across PDA.
Use iNO as needed.
Ventricular dysfunction, and or systemic hypotension.
Strategy: May use volume and or inotropics (dobutamine if LV dysfunction, and dopamine if systemic hypotension)
Use inotropes if there is LV systolic dysfunction with or without left atrial dialatation before using iNO to avoid pulmonary edema.
Source: Journal of Pediatrics, 2015, Dr. de Waal, and Dr. Kluckow.
Tuesday, May 12, 2015
ESPGHAN: Irish scientists have identified a novel milk-derived component that may help resolve cow’s milk protein allergy
http://www.merckmedicus.com/conference-reports/10/ESPGHAN-Irish-scientists-have-identified-a-novel-milk-derived-component-that-may-help-resolve-cow-s-milk-protein-allergy?
presented at the Annual Meeting of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition
Irish scientists have identified a novel milk-derived component that can specifically suppress secretion of IL-4 by differentiated Th2 cells. The presence of such a component in hypoallergenic infant formula may act to suppress the over-activated Th2 response associated with allergy and find usefulness in enhancing resolution of cow’s milk protein allergy. Researchers at the Immunomodulation Group, Dublin City University, and colleagues presented their paper at ESPGHAN, held in May in Amsterdam.
In Europe, 20% to 30% of infants are diagnosed with an atopic disease. The majority of first atopic responses are directed towards food proteins that are observed during the first months of life, such as cows milk protein. Cows milk protein allergy (CMPA) affects 2.2% to 7.5% of infants worldwide and is a growing public health problem in Western Europe and the USA. Existing hypoallergenic formula solutions adopt avoidance strategies such as the extensive hydrolysis of whey or casein proteins (using proteolytic bacteria or enzymes). However, allergic responses are associated with a dominant T helper type 2 (Th2) response, which plays a key role in triggering IgE production by B cells. The aim of the Irish study was to assess whether novel milk-derived component can suppress Th2 responses which may enhance resolution of CMPA and lower the risk of developing a further allergy.
Murine spleenocytes were isolated from the spleens of 8-14 week old BALB/c mice and purified for CD4+ T-cells using magnetic negative isolation. After extensive cell activation and differention, The novel milk-derived component was added during T helper cell differentiation. Th1 and Th2 subsets were confirmed using ELISA analysis of cytokine production after 3 days. The novel milk-derived component specifically suppressed the secretion of IL-4 from differentiated Th2 cells in a dose dependent manner. A regenerated form of the novel milk-derived component also had the same effect. Interestingly, the novel component had no effect on Th1 cells and the level of secretion of IFNγ was not affected by the presence of the component. This suggests that the component specifically suppresses Th2 responses.
presented at the Annual Meeting of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition
Irish scientists have identified a novel milk-derived component that can specifically suppress secretion of IL-4 by differentiated Th2 cells. The presence of such a component in hypoallergenic infant formula may act to suppress the over-activated Th2 response associated with allergy and find usefulness in enhancing resolution of cow’s milk protein allergy. Researchers at the Immunomodulation Group, Dublin City University, and colleagues presented their paper at ESPGHAN, held in May in Amsterdam.
In Europe, 20% to 30% of infants are diagnosed with an atopic disease. The majority of first atopic responses are directed towards food proteins that are observed during the first months of life, such as cows milk protein. Cows milk protein allergy (CMPA) affects 2.2% to 7.5% of infants worldwide and is a growing public health problem in Western Europe and the USA. Existing hypoallergenic formula solutions adopt avoidance strategies such as the extensive hydrolysis of whey or casein proteins (using proteolytic bacteria or enzymes). However, allergic responses are associated with a dominant T helper type 2 (Th2) response, which plays a key role in triggering IgE production by B cells. The aim of the Irish study was to assess whether novel milk-derived component can suppress Th2 responses which may enhance resolution of CMPA and lower the risk of developing a further allergy.
Murine spleenocytes were isolated from the spleens of 8-14 week old BALB/c mice and purified for CD4+ T-cells using magnetic negative isolation. After extensive cell activation and differention, The novel milk-derived component was added during T helper cell differentiation. Th1 and Th2 subsets were confirmed using ELISA analysis of cytokine production after 3 days. The novel milk-derived component specifically suppressed the secretion of IL-4 from differentiated Th2 cells in a dose dependent manner. A regenerated form of the novel milk-derived component also had the same effect. Interestingly, the novel component had no effect on Th1 cells and the level of secretion of IFNγ was not affected by the presence of the component. This suggests that the component specifically suppresses Th2 responses.
Sunday, May 10, 2015
Oh Mother!
Oh mother of mine
How can I describe you in a line
For you are so divine
And makes us feel always on cloud nine
Whenever our lethargy makes you whine
For you made us so with your intoxicating love wine
With your affection you entwine
With devotion that you combine
Our character you refine
You seek pleasure when we shine
We are always blessed in mother’s shrine
Pradeep Alur.
Monday, April 6, 2015
Brain imaging in cooled encephalopatic neonates does not differ between four and 11 days after birth
http://onlinelibrary.wiley.com/doi/10.1111/apa.13016/abstract;jsessionid=2C705A58BFCBA24FA7668F6E33B7183C.f02t02
Aim
The optimal timing of magnetic resonance imaging (MRI) in encephalopathic infants treated with hypothermia is unknown and this study examined whether early scans differed from later scans.
Methods
We assessed paired MRI scans carried out on 41 cooled encephalopathic infants at a median of four and 11 days using two scoring systems: the Rutherford injury scores for the basal ganglia and thalami (BGT), white matter and the posterior limb of the internal capsule and the Bonifacio injury scores for the BGT and watershed area.
Results
Both systems produced consistent injury severity scores in 37/41 infants on both days, with Rutherford scores predicting poor outcome in six early scans and seven later scans (Kappa 0.91) and Bonifacio doing the same in seven and nine scans (Kappa 0.85). A white matter/watershed score of two or a BGT score of one indicated severe changes by day 11 in three infants but lower scores did not.
Conclusion
MRI scans indicated that the Rutherford and Bonifacio systems produced similar scores in 37/41 cooled encephalopathic infants at a median of four and 11 days. Infants with an early white matter/watershed scores of two or a BGT score of one may worsen and should be rescanned.
Aim
The optimal timing of magnetic resonance imaging (MRI) in encephalopathic infants treated with hypothermia is unknown and this study examined whether early scans differed from later scans.
Methods
We assessed paired MRI scans carried out on 41 cooled encephalopathic infants at a median of four and 11 days using two scoring systems: the Rutherford injury scores for the basal ganglia and thalami (BGT), white matter and the posterior limb of the internal capsule and the Bonifacio injury scores for the BGT and watershed area.
Results
Both systems produced consistent injury severity scores in 37/41 infants on both days, with Rutherford scores predicting poor outcome in six early scans and seven later scans (Kappa 0.91) and Bonifacio doing the same in seven and nine scans (Kappa 0.85). A white matter/watershed score of two or a BGT score of one indicated severe changes by day 11 in three infants but lower scores did not.
Conclusion
MRI scans indicated that the Rutherford and Bonifacio systems produced similar scores in 37/41 cooled encephalopathic infants at a median of four and 11 days. Infants with an early white matter/watershed scores of two or a BGT score of one may worsen and should be rescanned.
Thursday, March 12, 2015
Picc Lines in Lower Limbs-Do They Increase Thrombotic Risk?
http://www.jpedsurg.org/article/S0022-3468(15)00123-2/abstract?rss=yes
Background
PICC lines are now used routinely to provide central access for neonatal intensive care unit (NICU) patients. Neonates are known to be at risk for venous thromboembolism (VTE) related to central catheters. No literature exists about VTE PICC-related morbidity in the NICU abdominal surgery subgroup.
Methods
With REB approval, a retrospective review of a NICU database of PICC insertions performed at a tertiary children's hospital was conducted (January 2010–June 2013). Information about PICCs and complications was recorded. For patients with a major thrombotic complication, charts were reviewed. A major thrombotic complication was defined as a thrombosis which required medical and/or surgical intervention.
Results
692 PICCs were inserted (485 in the upper extremity, 142 in the lower extremity, and 65 in the scalp). Seventy-four patients had significant intraabdominal pathology, and 5 had a major thrombotic complication. All patients with a major thrombotic complication had a lower extremity PICC which was at or below L1 (L1-S1) running parenteral nutrition.
Conclusions
In the current study, only neonates with abdominal pathology and a lower extremity insertion site suffered major thrombotic complications from PICC lines. Given all patients' PICC tips were below the recommended location, more rigorous surveillance (with repositioning if required) may avoid these complications for future patients.
Monday, January 12, 2015
Wednesday, January 7, 2015
http://www.engadget.com/2015/01/07/babybe-brings-premature-children-closer-to-their-mothers/
BabyBe is using Intel's connected device platform Edison to actually better the lives of people, specifically premature babies and their mothers.
The most important component is the "Cradle" a pad embedded with air bladders and heating elements, sheathed in a medically-safe polyurethane.
It's soft and a little odd feeling. It's supposed to mimic the density and texture of human skin, but kind of ends up falling into uncanny valley territory. The air-sacks inside mimic the heartbeat and chest movement of the mother, who can't hold her fragile premature child.
Tuesday, January 6, 2015
Fish Oil For Parenteral Nutrition Associated Cholestasis.
http://jn.nutrition.org/content/early/2014/12/17/jn.114.204974.abstract
Parenteral Fish Oil–Containing Lipid Emulsions May Reverse Parenteral Nutrition–Associated Cholestasis in Neonates: A Systematic Review and Meta-Analysis
Hye Won Park3, Na Mi Lee5, Ji Hee Kim6,Kyo Sun Kim3, and Soo-Nyung Kim4,*
Abstract
Background: Growing evidence indicates that fish oil–containing lipid emulsions have a beneficial effect on parenteral nutrition–associated cholestasis (PNAC) in adults; however, data are limited in neonates to confirm the effect of fish oil on PNAC.
Objective: We conducted a meta-analysis of studies that addressed the effect of fish oil–containing lipid emulsions on reversing and preventing PNAC.
Methods: We searched MEDLINE, the EMBASE database, and the Cochrane Library for this systematic review and meta-analysis. The methodologic assessment of studies was performed with Jadad scale and the Newcastle-Ottawa Scale. Comprehensive Met-Analysis version 2.0 was used for the statistical analysis. We performed a meta-analysis with the primary outcomes of reversal of PNAC and the occurrence of PNAC in newborn infants, including preterm infants, after parenteral administration of fish oil–containing lipid emulsions.
Results: Of the 36 studies identified, 7 fulfilled the inclusion criteria and were used in this meta-analysis, including 3 studies with 93 participants in which reversal of PNAC was an outcome and 4 studies with 1012 participants on preventing PNAC. The use of fish oil–containing lipid emulsions was more likely to reverse PNAC (OR: 6.14; 95% CI: 2.27, 16.6; P < 0.01), but the use of fish oil–containing lipid emulsions did not have a significant effect on the development of PNAC (OR: 0.56; 95% CI: 0.28, 1.10; P = 0.09) compared with soybean-based or olive oil–based lipid emulsions.
Conclusions: The pooled data suggest that the use of fish oil–containing lipid emulsions is effective for reversing PNAC but cannot prevent PNAC in neonates who require prolonged parenteral nutritional support.
Parenteral Fish Oil–Containing Lipid Emulsions May Reverse Parenteral Nutrition–Associated Cholestasis in Neonates: A Systematic Review and Meta-Analysis
Hye Won Park3, Na Mi Lee5, Ji Hee Kim6,Kyo Sun Kim3, and Soo-Nyung Kim4,*
Abstract
Background: Growing evidence indicates that fish oil–containing lipid emulsions have a beneficial effect on parenteral nutrition–associated cholestasis (PNAC) in adults; however, data are limited in neonates to confirm the effect of fish oil on PNAC.
Objective: We conducted a meta-analysis of studies that addressed the effect of fish oil–containing lipid emulsions on reversing and preventing PNAC.
Methods: We searched MEDLINE, the EMBASE database, and the Cochrane Library for this systematic review and meta-analysis. The methodologic assessment of studies was performed with Jadad scale and the Newcastle-Ottawa Scale. Comprehensive Met-Analysis version 2.0 was used for the statistical analysis. We performed a meta-analysis with the primary outcomes of reversal of PNAC and the occurrence of PNAC in newborn infants, including preterm infants, after parenteral administration of fish oil–containing lipid emulsions.
Results: Of the 36 studies identified, 7 fulfilled the inclusion criteria and were used in this meta-analysis, including 3 studies with 93 participants in which reversal of PNAC was an outcome and 4 studies with 1012 participants on preventing PNAC. The use of fish oil–containing lipid emulsions was more likely to reverse PNAC (OR: 6.14; 95% CI: 2.27, 16.6; P < 0.01), but the use of fish oil–containing lipid emulsions did not have a significant effect on the development of PNAC (OR: 0.56; 95% CI: 0.28, 1.10; P = 0.09) compared with soybean-based or olive oil–based lipid emulsions.
Conclusions: The pooled data suggest that the use of fish oil–containing lipid emulsions is effective for reversing PNAC but cannot prevent PNAC in neonates who require prolonged parenteral nutritional support.
Thursday, January 1, 2015
A Happy New Year
We wish you in this great New Year
That you will live without Fear
With your near and dear.
And that you
Will have a lot to Cheer
Holding your root Beer
And may this year steer
Your career to a high Gear
And free you from eerie Peer
Who
Appear to be a pain in your Rear
May for your spouse Dear
You develop a patient Ear
And
May for your child you become a sincere financier
So
They could explore many a new Frontier
And thus
Your fame spread around the Sphere
And your
Name be known for a light Year.
Pradeep Dear.
Sunday, December 21, 2014
Correlation Between Serum Caffeine Levels And Outcomes in Preterm Infants.
http://www.nature.com/jp/journal/vaop/ncurrent/full/jp2014226a.html
Serum caffeine concentrations and short-term outcomes in premature infants of 29 weeks of gestation
P Alur, V Bollampalli, T Bell, N Hussain and J Liss
Abstract
Objective:
Caffeine is effective in the treatment of apnea of prematurity but it is not well known if the therapeutic concentration of the drug has an impact on other neonatal outcomes such as chronic lung disease (CLD). The aim of this study was to determine if there is an association between caffeine concentrations and the incidence of CLD in premature infants of 29 weeks of gestation.
Study design:
A retrospective chart review of all the infants born 29 weeks of gestation from 2007 to 2011, who survived until discharge or 36 weeks postmenstrual age, was conducted. Caffeine concentrations were obtained weekly on infants getting the drug. Average caffeine concentrations (ACCs) were determined for the duration of caffeine therapy and correlated with CLD, length of stay (LOS), oxygen at discharge (OD), duration of ventilation (DV) and total charges for hospitalization for each patient.
Results:
Of the 222 eligible infants, 198 met the inclusion criteria. ACC for infants without CLD was 17.0±3.8 μg ml−1 compared with infants with CLD 14.3±6.1 μg ml−1 (P<0.001). Infants receiving high ACC (>14.5 μg ml−1) had lower incidence of patent ductus arteriosus, lesser number of days on ventilator and oxygen, lesser need for diuretics, lower incidence of CLD, were more likely to go home without supplemental OD and had lower LOS and lower total hospital charges (all differences were significant P<0.05) Multiple logistic regression modeling after adjusting for confounding variables indicated that higher caffeine concentrations were significantly associated with decrease in CLD. Receiver operating curve analysis confirmed a significant predictive ability of caffeine concentration for CLD with a cutoff concentration of 14.5 μg ml−1 (sensitivity of 42.6 and specificity of 86.8). The AUC (area under the curve) for the prediction of CLD was 0.632 (95% confidence interval 0.56–0.69, P=0.009). Conclusions:
Caffeine concentrations >14.5 μg ml−1 were strongly correlated with reduced CLD in infants born at 29 weeks of gestation. Higher caffeine concentrations were associated with decreased total hospital charges, DV, OD and LOS. Additional randomized trials are needed to confirm these findings, to identify ideal serum concentrations and determine possible long-term neurologic benefits.
Serum caffeine concentrations and short-term outcomes in premature infants of 29 weeks of gestation
P Alur, V Bollampalli, T Bell, N Hussain and J Liss
Abstract
Objective:
Caffeine is effective in the treatment of apnea of prematurity but it is not well known if the therapeutic concentration of the drug has an impact on other neonatal outcomes such as chronic lung disease (CLD). The aim of this study was to determine if there is an association between caffeine concentrations and the incidence of CLD in premature infants of 29 weeks of gestation.
Study design:
A retrospective chart review of all the infants born 29 weeks of gestation from 2007 to 2011, who survived until discharge or 36 weeks postmenstrual age, was conducted. Caffeine concentrations were obtained weekly on infants getting the drug. Average caffeine concentrations (ACCs) were determined for the duration of caffeine therapy and correlated with CLD, length of stay (LOS), oxygen at discharge (OD), duration of ventilation (DV) and total charges for hospitalization for each patient.
Results:
Of the 222 eligible infants, 198 met the inclusion criteria. ACC for infants without CLD was 17.0±3.8 μg ml−1 compared with infants with CLD 14.3±6.1 μg ml−1 (P<0.001). Infants receiving high ACC (>14.5 μg ml−1) had lower incidence of patent ductus arteriosus, lesser number of days on ventilator and oxygen, lesser need for diuretics, lower incidence of CLD, were more likely to go home without supplemental OD and had lower LOS and lower total hospital charges (all differences were significant P<0.05) Multiple logistic regression modeling after adjusting for confounding variables indicated that higher caffeine concentrations were significantly associated with decrease in CLD. Receiver operating curve analysis confirmed a significant predictive ability of caffeine concentration for CLD with a cutoff concentration of 14.5 μg ml−1 (sensitivity of 42.6 and specificity of 86.8). The AUC (area under the curve) for the prediction of CLD was 0.632 (95% confidence interval 0.56–0.69, P=0.009). Conclusions:
Caffeine concentrations >14.5 μg ml−1 were strongly correlated with reduced CLD in infants born at 29 weeks of gestation. Higher caffeine concentrations were associated with decreased total hospital charges, DV, OD and LOS. Additional randomized trials are needed to confirm these findings, to identify ideal serum concentrations and determine possible long-term neurologic benefits.
Thursday, December 4, 2014
Umbilical Cord Milking-Evidence in Preterm Infants
http://archpedi.jamanetwork.com/article.aspx?articleID=1919654#Abstract
JAMA Pediatr. 2014 Nov 3. doi: 10.1001/jamapediatrics.2014.1906. [Epub ahead of print]
Efficacy and Safety of Umbilical Cord Milking at Birth: A Systematic Review and Meta-analysis.
Al-Wassia H1, Shah PS2.
Author information
1Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia.
2Department of Pediatrics, Mt Sinai Hospital, Toronto, Ontario, Canada3Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Abstract
Importance:
Umbilical cord milking (UCM) is suggested to improve neonatal outcomes.
Objectives:
To perform a systematic review and meta-analysis of the efficacy and safety of UCM in full-term and preterm neonates.
Data Sources:
A systematic search of MEDLINE, EMBASE, CINAHL, the Cochrane Database of Clinical Trials, the clinicaltrails.gov database, and the reference list of retrieved articles from 1940 to 2014.
Study Selection:
Randomized clinical trials comparing UCM with other strategies of handling the umbilical cord at birth in full-term and preterm infants. Seven of the 18 initially identified studies were selected.
Data Extraction and Synthesis:
Two reviewers independently extracted data and assessed the risk for bias in included trials using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions.
Main Outcomes and Measures:
Neonatal mortality before discharge from the hospital.
Results:
We included 7 randomized clinical trials involving 501 infants. Infants with a gestational age of less than 33 weeks allocated to UCM compared with control conditions showed no difference in the risk for mortality (risk ratio [RR], 0.75 [95% CI, 0.35 to 1.64]; risk difference [RD], -0.02 [95% CI, -0.09 to 0.04]), hypotension requiring volume expanders (RR, 0.71 [95% CI, 0.41 to 1.25]; RD, -0.09 [95% CI, -0.22 to 0.05]), or inotrope support (RR, 0.77 [95% CI, 0.51 to 1.17]; RD, -0.10 [95% CI, -0.25 to 0.05]). Higher initial levels of hemoglobin (mean difference, 2.0 [95% CI, 1.3-2.7] g/dL) and hematocrit (mean difference, 4.5% [95% CI, 1.5%-7.4%]) were identified in the UCM groups.
We found a reduced risk for oxygen requirement at 36 weeks (RR, 0.42 [95% CI, 0.21 to 0.83]; RD, -0.14 [95% CI, -0.25 to -0.04]) and for intraventricular hemorrhage of all grades (RR, 0.62 [95% CI, 0.41 to 0.93]; RD, -0.12 [95% CI, -0.22 to -0.02]) in infants assigned to UCM. Among infants with a gestational age of at least 33 weeks, UCM was associated with higher hemoglobin levels in the first 48 hours in 224 infants (mean difference, 1.2 [95% CI, 0.8-1.5] g/dL) and at 6 weeks of life in 170 infants (mean difference, 1.1 [95% CI, 0.7-1.5] g/dL).
Conclusions and Relevance:
Umbilical cord milking was associated with some benefits and no adverse effects in the immediate postnatal period in preterm infants gestational age, <33 nbsp="" p="" weeks.="">
JAMA Pediatr. 2014 Nov 3. doi: 10.1001/jamapediatrics.2014.1906. [Epub ahead of print]
Efficacy and Safety of Umbilical Cord Milking at Birth: A Systematic Review and Meta-analysis.
Al-Wassia H1, Shah PS2.
Author information
1Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia.
2Department of Pediatrics, Mt Sinai Hospital, Toronto, Ontario, Canada3Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Abstract
Importance:
Umbilical cord milking (UCM) is suggested to improve neonatal outcomes.
Objectives:
To perform a systematic review and meta-analysis of the efficacy and safety of UCM in full-term and preterm neonates.
Data Sources:
A systematic search of MEDLINE, EMBASE, CINAHL, the Cochrane Database of Clinical Trials, the clinicaltrails.gov database, and the reference list of retrieved articles from 1940 to 2014.
Study Selection:
Randomized clinical trials comparing UCM with other strategies of handling the umbilical cord at birth in full-term and preterm infants. Seven of the 18 initially identified studies were selected.
Data Extraction and Synthesis:
Two reviewers independently extracted data and assessed the risk for bias in included trials using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions.
Main Outcomes and Measures:
Neonatal mortality before discharge from the hospital.
Results:
We included 7 randomized clinical trials involving 501 infants. Infants with a gestational age of less than 33 weeks allocated to UCM compared with control conditions showed no difference in the risk for mortality (risk ratio [RR], 0.75 [95% CI, 0.35 to 1.64]; risk difference [RD], -0.02 [95% CI, -0.09 to 0.04]), hypotension requiring volume expanders (RR, 0.71 [95% CI, 0.41 to 1.25]; RD, -0.09 [95% CI, -0.22 to 0.05]), or inotrope support (RR, 0.77 [95% CI, 0.51 to 1.17]; RD, -0.10 [95% CI, -0.25 to 0.05]). Higher initial levels of hemoglobin (mean difference, 2.0 [95% CI, 1.3-2.7] g/dL) and hematocrit (mean difference, 4.5% [95% CI, 1.5%-7.4%]) were identified in the UCM groups.
We found a reduced risk for oxygen requirement at 36 weeks (RR, 0.42 [95% CI, 0.21 to 0.83]; RD, -0.14 [95% CI, -0.25 to -0.04]) and for intraventricular hemorrhage of all grades (RR, 0.62 [95% CI, 0.41 to 0.93]; RD, -0.12 [95% CI, -0.22 to -0.02]) in infants assigned to UCM. Among infants with a gestational age of at least 33 weeks, UCM was associated with higher hemoglobin levels in the first 48 hours in 224 infants (mean difference, 1.2 [95% CI, 0.8-1.5] g/dL) and at 6 weeks of life in 170 infants (mean difference, 1.1 [95% CI, 0.7-1.5] g/dL).
Conclusions and Relevance:
Umbilical cord milking was associated with some benefits and no adverse effects in the immediate postnatal period in preterm infants gestational age, <33 nbsp="" p="" weeks.="">
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