Bernd Beedgen

Effectiveness and side effects of an escalating, stepwise approach to indomethacin treatment for symptomatic patent ductus arteriosus in premature infants below 33 weeks of gestation.

Objective. Symptomatic patent ductus arteriosus (sPDA) is a common problem in premature infants and can be treated effectively with intravenous indomethacin, leading to permanent ductal closure in 70% to 80% of infants. Infants who do not respond to pharmacologic closure of the duct ultimately have to undergo surgical or interventional closure of the PDA. Optimizing the pharmacologic treatment could offer an interesting approach to reduce the number of infants who need surgical closure of the duct. Methods. We conducted a retrospective analysis in infants who were <33 weeks’ gestation, had sPDA, and were treated with high-dose intravenous indomethacin. From 1993 to 2002, 129 infants with sPDA received indomethacin after diagnosis of sPDA was confirmed by echocardiography. Treatment was started in all infants with intravenous indomethacin (0.2 mg/kg given 5 times at 0 hours, 12 hours, 24 hours, 48 hours, and 72 hours). When the ductus was still open at 36 hours, indomethacin every 12 hours was continued and single doses increased up to 1 mg/kg until ductal closure was achieved. Results. In 68 (53%) of 129 infants who were treated with indomethacin, ductal closure occurred during intermediate-dose indomethacin therapy (up to 1.5 mg/kg total dose). In the 61 initial nonresponders, the continuation of indomethacin led to ductal closure in 59 infants. When infants who were treated with an intermediate dose were compared with the initial nonresponders, no differences in the incidences of renal or electrolyte abnormalities, gastrointestinal bleeding, intraventricular hemorrhage, or periventricular leukomalacia were found. Conclusions. High-dose indomethacin after intermediate-dose therapy resulted in an overall closure rate of 98.5% (127 of 129). Although single indomethacin doses of up to 1 mg/kg were given, high-dose indomethacin was safe.

Effects of a divided high loading dose of caffeine on circulatory variables in preterm infants

Background: A single high loading dose of 25 mg/kg caffeine has been shown to be effective for the prevention of apnoea, but may result in considerable reductions in blood flow velocity (BFV) in cerebral and intestinal arteries. Objective: To assess the effects of two loading doses of 12.5 mg/kg caffeine given four hours apart on BFV in cerebral and intestinal arteries, left ventricular output (LVO), and plasma caffeine concentrations in preterm infants. Design: Sixteen preterm neonates of <34 weeks gestation were investigated one hour after the first oral dose and one, two, and 20 hours after the second dose by Doppler sonography. Results: The mean (SD) plasma caffeine concentrations were 31 (7) and 29 (7) mg/l at two and 20 hours respectively after the second dose. One hour after the first dose, none of the circulatory variables had changed significantly. One hour after the second caffeine dose, mean BFV in the internal carotid artery and anterior cerebral artery showed significant reductions of 17% and 19% (p  =  0.01 and p  =  0.003 respectively). BFV in the coeliac artery and superior mesenteric artery, LVO, Pco2, and respiratory rate had not changed significantly. Total vascular resistance, calculated as the ratio of mean blood pressure to LVO, had increased significantly one and two hours after the second dose (p  =  0.049 and p  =  0.023 respectively). Conclusion: A divided high loading dose of 25 mg/kg caffeine given four hours apart had decreased BFV in cerebral arteries after the second dose, whereas BFV in intestinal arteries and LVO were not affected.

Intracerebellar hemorrhage in premature infants: sonographic detection and outcome.

Abstract Aims: Intracerebellar hemorrhage is a rarely confirmed diagnosis in preterm infants in comparison to peri-/intraventricular hemorrhage. This study evaluates the incidence of intracerebellar hemorrhage and neurological outcome in preterm infants. Methods: 260 infants with gestational age of 22–32 weeks were studied prospectively by cranial ultrasound. Neurodevelopmental outcome was examined in the first three years of life. Results: 15 infants had intracranial hemorrhage grade II-IV (10 intraventricular, 6 intracerebellar hemorrhage). Neurodevelopmental follow-up showed that one infant with intracerebellar hemorrhage is severely handicapped, two have moderate and two mild impairments and one has no sequelae. Conclusion: Cerebellar hemorrhage is not rare if ultrasound examination is specifically focused on cerebellar lesions.

Energy expenditure in neonates with Down syndrome.

Resting energy expenditure was measured in term neonates with Down syndrome during the first week of life and compared with healthy neonates. Infants with Down syndrome expended 14% fewer calories than did healthy infants of the same age.

Six Day Antimicrobial Therapy for Early-onset Group B Streptococcal Infection in Near-term and Term Neonates

Antibiotics for the treatment of group B streptococcal (GBS) infection are usually given for 7–10 d. The aim of this prospective investigation was to study whether antibiotic treatment for 6 d is sufficient to treat early-onset GBS infection in term and near-term neonates. During a 2 y period 67 neonates of GBS-positive mothers developed GBS infection and were admitted to the neonatal intensive care unit. All neonates showed clinical signs of infection, C-reactive protein levels >20 mg/l and/or elevated immature to total neutrophil ratio >0.25. Two groups were differentiated: 10 neonates with proven sepsis with GBS-positive blood cultures (15%) and 57 neonates with presumed GBS infection with negative blood cultures but with GBS-positive surface swab cultures of ear (68%), nasopharyngeal (21%) or gastric aspirate (16%). All patients were GBS positive in 1 or more cultures. Antimicrobial therapy with ampicillin and cefotaxime was discontinued after 6 d. At that time all neonates were asymptomatic and laboratory results were normal. No relapse or death within 4 weeks after therapy was detected. In conclusion, antibiotic therapy for 6 d was sufficient to treat 10 neonates with proven and 57 neonates with presumed early-onset GBS infection. Owing to the small sample size, further studies are needed to show significant differences to longer therapy regimens.

EFFECTS OF BLOOD VOLUME AND SERUM INFUSION ON BLOOD PRESSURE IN NEONATES (VLBWI) TWO HOURS AFTER BIRTH

EFFECTS OF BLOOD VOLUME AND SERUM INFUSION ON BLOOD PRESSURE IN NEONATES (VLBWI) TWO HOURS AFTER BIRTH

Salivary Cortisol Levels in Very Low Birth Weight Infants with Bronchopulmonary Dysplasia Treated with Dexamethasone and Nebulized Budesonide 20

The administration of systemic and nebulized corticosteroids to VLBW infants is beneficial in the treatment of bronchopulmonary dysplasia (BPD). Side effects and complications are frequent and sometimes serious. The aim of the study was to investigate the effect of systemic dexamethasone and nebulized budesonide on adrenal function in infants with BPD using salivary samples. Methods: We measured salivary cortisol levels by RIA in saliva in four groups: (1) ten full-term neonates; (2) ten healthy preterm infants (GA 28-31 wks); (3) ten infants with BPD after 16 days of systemic dexamethasone treatment (24-28 wks); and (4) 10 infants with BPD after 5 days of nebulized budesonide (26-35 wks). Saliva samples were collected in each infant on three consecutive days at 8.00, 12.00, 18.00, 24.00 hours. Results: Our results show suppression of the adrenal function in infants treated with systemic dexamethasone and less pronounced with nebulized budesonide. The results are mean ± SEM (ng/ml).Table