Systematic review and meta-analysis of optimal initial fraction of oxygen levels in the delivery room at ≤32 weeks
Abstract
Aim. The optimal initial fraction of oxygen (iFiO2) for resuscitating/stabilising premature infants is not known. We aimed to study currently available information and provide guidelines regarding the iFiO2 levels needed to resuscitate/stabilise premature infants of ≤32 weeks’ gestation.
Methods. Our systematic review and meta-analysis studied the effects of low and high iFiO2 during the resuscitation/stabilisation of 677 newborn babies ≤32 weeks’ gestation.
Results. Ten randomised studies were identified covering 321 infants receiving low (0,21–0,30) iFiO2 levels and 356 receiving high (0,60–1,0) levels. Relative risk for mortality was 0,62 (95% CI: 0,37–1,04, I2=0%, pheterogeneity=0,88) for low versus high iFiO2; for bronchopulmonary dysplasia, it was 1,11 (95% CI: 0,73–1,68, I2=46%, pheterogeneity=0,06); and for intraventricular haemorrhage, it was 0,90 (95% CI: 0,53–1,53, I2=9%, pheterogeneity=0,36).
Conclusion. These data show that reduced mortality approached significance when a low iFiO2 (0,21–0,30) was used for initial stabilisation, compared to a high iFiO2 (0,60–1,0).
There was no significant association for bronchopulmonary dysplasia or intraventricular haemorrhage when comparing low and high iFiO2. Based on present data, premature babies ≤32 weeks’ gestation in need of stabilisation in the delivery room should be given an iFiO2 of 0,21–0,30.
Acta Pеdiatrica. – 2014. – Vol. 103. – P. 744–751. doi:10.1111/apa.12656.
Measuring transcutaneous bilirubin: a comparative analysis of three devices on a multiracial population
Abstract
Background. Hyperbilirubinemia can lead to potentially irreversible bilirubin-induced neurotoxicity. Transcutaneous bilirubin (TcB) determination has become a valuable aid in non invasive screening of neonatal jaundice. The aim of this study is to compare the performance of three most widespread transcutaneous bilirubinometers on a multiracial population of term and late pre-term neonates.
Methods. Bilirubin concentration was determined using traditional photometric determination and transcutaneously with Bilicheck, BiliMed and JM-103, in random order. Total serum bilirubin (TSB) was determined over a wide concentration range (15,8–0,7 mg/dl) with a mean of 9,5 mg/dl. Related TcB values using Bilicheck (TcB-BC), BiliMed (TcB-BM), and JM-103 (TcB-JM) are reported in table 1.
Results. A multiracial population of 289 neonates was enrolled with a gestational age ranging from 35 to 41 weeks; birth weight ranging from 1800 to 4350 g; hours of life ranging from 4 to 424. In the total study population correlation analysis using Pearson coefficients showed good results for Bilicheck (r=0,86) and JM-103 (r=0,85) but poor for BiliMed (r=0,70). Similar results were found for the non-Caucasian neonates subgroup. Bilicheck and JM-103 had a greater area under the curve than BiliMed when TSB=14 mg/dl was chosen as a threshold value both for the total study population and the non-Caucasian subgroup.
Conclusions. Bilicheck and JM-103, but not BiliMed, are equally reliable screening tools for hyperbilirubinemia in our multiracial neonatal population.
Body composition in late preterm infants in the first 10 days of life and at full term
Abstract
Aim. To investigate changes in body weight, fat-free mass, fat mass and percentage of body fat during early life and at fullterm postconceptional age (PCA) in preterm infants born after 32 gestational weeks and before 37.
Methods. Twenty-nine late preterm infants underwent growth and body composition assessment by air displacement plethysmography (ADP) at the age of 4 days and at fullterm PCA. In 25 of these infants, body composition was assessed three times between days four and nine of life. The preterm infants were compared with 29 full-term infants, matched for gestational age, sex and body weight.
Results. There was a significant increase in birth weight and fat-free mass between days four and nine of life. Preterm infants had significantly more body fat 382±180 vs 287±160 g than full-term infants at full-term PCA. Preterm infants showed poor linear growth between birth and full-term PCA.
Conclusion. Weight gain after the initial postnatal weight loss consists of gain in fat-free mass. At full-term PCA, preterm infants were stunted. When compared with full-term new born infants matched for body weight and gestational age, preterm infants had more body fat and a higher percentage of body fat.
Effects of early inhaled nitric oxide therapy and vitamin a supplementation on the risk for bronchopulmonary dysplasia in premature newborns with respiratory failure
Abstract
Objective. To assess whether the combination of early inhaled nitric oxide (iNO) therapy and vitamin A supplemen¬tation lowers the incidence of bronchopulmonary dysplasia (BPD) in premature newborns with respiratory failure.
Study design. A total of 793 mechanically ventilated infants (birth weight 500–1250 g) were randomized (after stratification by birth weight) to receive placebo or iNO (5 ppm) for 21 days or until extubation (500–749, 750–999, or 1000–1250 g). A total of 398 newborns received iNO, and of these, 118 (30%) received vitamin A according to their enrollment center. We compared patients who received iNO + vitamin A with those who received iNO alone. The primary outcome was a composite of death or BPD at 36 weeks postconceptual age.
Results. BPD was reduced in infants who received iNO + vitamin A for the 750–999 g birth weight group compared with iNO alone (p=0,01). This group also showed a reduction in the combined outcome of BPD + death compared with iNO alone (p=0,01). The use of vitamin A did not change the risk for BPD in the placebo group. Overall, the use of vitamin A was low (229 of 793 patients, or 29%). Combined therapy improved Bayley Scales of Infant Development II Mental and Psychomotor Developmental Index scores at 1 year compared with infants treated solely with iNO for the 500–749 g birth weight group.
Conclusions. In this retrospective analysis of the nonrandomized use of vitamin A, combined iNO +vitamin A therapy in preterm infants with birth weight 750–999 g reduced the incidence of BPD and BPD + death and improved neurocognitive outcomes at 1 year in the 500–749 g birth weight group.
Синдром Вильсона-Микити: обзор литературы и клинические наблюдения
Abstract
Wilson–Mikity syndrome (WMS) is a chronic pulmonary disease of unknown etiology, manifesting in neonatal period and characterized by late development of oxygen-dependence. Authors present data about possible etiological factors of WMS, its pathogenesis, pathomorphology, its clinical, X-ray presentations and CT patterns of this rare pulmonary disease. Analysis of literature reports about 61 patients with WMS 1960 to 2008 permitted to establish dependence of WMS manifestation on patient’s age and degree of prematurity. Authors represent their own data about 11 patients with WMS, including high resolution computed tomography findings of 4 patients.
Modern principles of diagnostics and treatment of nonhemolytic hyperbilirubinemia at full-term and late prematurely born children in early neonatal period
Abstract
In recent years the early discharge of newborns is widely practices in the Russian Federation. That defined need of revision of approaches to diagnostics, treatment and forecasting of a menacing hyperbilirubinemia at nonhemolytic jaundice. Based on generalized data of literature and own experience the diagnostic algorithm at development of jaundice in full-term and late prematurely born children during the first days after the birth is presented in article. The main reasons for an indirect hyperbilirubinemia and the indication to carrying out phototherapy and operation of exchange blood transfusion are described.
Osteopenia (metabolic bone disease) in preterm infants: possibilities of diagnostics, treatment and prevention
Abstract
The review is devoted to modern possibilities of diagnosis, treatment and prevention of osteopenia (metabolic bone disease) in preterm infants. the reasons, pathogenesis and clinical symptoms of the disease are considered. Attention is paid to the development of electrolyte disorders (hypophosphatemia, hypercalcemia), at the initial stage of demineralization of the bones, which in severe cases can have serious consequences for the child. This review summarizes the existing diagnostic methods, approaches to treatment and prevention. The results of recent research, the controversial and unresolved issues are discussed. The problem of osteopenia in preterm infants currently requires attention and decision of many problems, starting with the development of effective diagnostic criteria, and ending organizational arrangements, including the registration of essential medicines in Russia.
Radiographic and endoscopic diagnostics and therapeutic approach to treatment of respiratory deseases of newborns
Abstract
Examination of 89 newborns with diseases of the respiratory organs complicated by respiratory distress has been conducted. At a comparative assessment of radiological and endoscopic changes it should be noted that almost all patients had radiological changes. The research results showed that in genesis of respiratory distresses and irreversible in consequence pathological changes in bronchopulmonary system the important place is taken by congenital deformities of larynx, trachea and bronchi, which timely endoscopic diagnostics defined further tactics of treatment and the disease prognosis.
Diagnostic and prognostic value of morphometric parameters of the umbilical cord and placenta
Abstract
Morphometric parameters of the umbilical cord and placenta are considered as a markers of fetal development disorders, and their early assessment allows to predict risk of adverse outcomes in children.
Aim of the study was to determine the diagnostic and prognostic value of the main morphometric parameters of the umbilical cord and placenta for fullterm newborns. The study enrolled 74 full-term newborns. Immediately after birth, we measured the length and diameter of the umbilical cord, and maximum diameter and mass of the placenta. Evaluation of acidbase status in cord blood were performed, as well as a complete blood count at age 1–2 days of life.
As a result of this work were determined the mean morphometric parameters of the umbilical cord and placenta, and demonstrated that they have diagnostic and prognostic value for the newborn.
They are influenced by a number of somatic and obstetrical factors, and anthropometric characteristics of the mother (mainly mothers growth). Umbilical cord diameter allows to predict the time of appearance of neonatal jaundice and time of the the development of the maximum weight loss, as well as the probability of occurrence of certain neurological abnormalities during the early neonatal period. The length of the umbilical cord, from other side, allows us to estimate the risk of neonatal jaundice, which is significantly reduced with increasing length of the umbilical cord, as well as a marker for a higher risk of fetal hypoxia. The diameter of the placenta can be considered as predictor of the hematocrit level in a newborn.
The new control algorithm oxygenation during intensive respiratory support in neonates – «Automatic regulation of oxygen by pulsoximetry»
Abstract
Regulation of oxygenation in infants at high risk has an important role in respiratory support in an intensive care unit and neonatal intensive care unit (NICU). We discuss the clinical significance of hypoxemia and hyperoxaemia in the short, medium and long term outcomes. We provided information about a new way of regulation of the oxygen status of newborns using a computer algorithm of automatic regulation of the oxygen concentration in the gas mixture during invasive respiratory support. The advantages and prospects of the clinical use of this algorithm in NICU for prevention of the fluctuations of the oxygen status and maintenance of adequate oxygenation at these patients. We presented our own experience in using this algorithm during invasive respiratory support in the NICU.