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Intranasal surfactant protein D as neuroprotective rescue in a neonatal rat model of periventricular leukomalacia

Abstract Background: Periventricular leukomalacia (PVL) is the leading cause of neurocognitive deficits in children with prematurity. We previously hypothesized that surfactant protein D (SPD) with its ability to bind toll-like receptors may have a possible ameliorating effect in PVL. Methods: Three groups were defined as: LPS-administered and postnatal intranasal saline administered group, LPS-administered and postnatal intranasal SPD-treated group, and control group. Twenty-eight offspring rats were reared with their dams until their sacrifice for histological evaluation on day 7. Results: A significant loss of brain weight occurred in the LPS group compared with controls. The postnatal intranasal SPD treatment significantly reduced the number of TUNEL-positive cells in the periventricular white matter as compared with the LPS-treated group. Compared with the control group, LPS injection in the rat brain significantly reduced the MBP-positive staining. Postnatal SPD treatment greatly prevented LPS-stimulated loss of MBP staining. Conclusions: Present study demonstrated a neuroprotective effect of SPD in a rat model of PVL. Our results offer future implications towards increasing our understanding about multifactorial mechanisms underlying periventricular leukomalacia and developing plausible therapeutic strategies in order to prevent neurocognitive deficits in preterm infants.

Early signs that predict later haemodynamically significant patent ductus arteriosus

OBJECTIVE Our aim was to determine the optimal cut-off values, sensitivity, specificity, and diagnostic power of 12 echocardiographic parameters on the second day of life to predict subsequent ductal patency. METHODS We evaluated preterm infants, born at ⩽32 weeks of gestation, starting on their second day of life, and they were evaluated every other day until ductal closure or until there were clinical signs of re-opening. We measured transductal diameter; pulmonary arterial diastolic flow; retrograde aortic diastolic flow; pulsatility index of the left pulmonary artery and descending aorta; left atrium and ventricle/aortic root ratio; left ventricular output; left ventricular flow velocity time integral; mitral early/late diastolic flow; and superior caval vein diameter and flow as well as performed receiver operating curve analysis. RESULTS Transductal diameter (>1.5 mm); pulmonary arterial diastolic flow (>25.6 cm/second); presence of retrograde aortic diastolic flow; ductal diameter by body weight (>1.07 mm/kg); left pulmonary arterial pulsatility index (⩽0.71); and left ventricle to aortic root ratio (>2.2) displayed high sensitivity and specificity (p0.9). Parameters with moderate sensitivity and specificity were as follows: left atrial to aortic root ratio; left ventricular output; left ventricular flow velocity time integral; and mitral early/late diastolic flow ratio (p0.05) had low diagnostic value. CONCLUSION Left pulmonary arterial pulsatility index, left ventricle/aortic root ratio, and ductal diameter by body weight are useful adjuncts offering a broader outlook for predicting ductal patency.

Surfactant protein D as a novel therapy for periventricular leukomalacia: is it the missing piece of the puzzle?

Activation of microglia with an inflammatory insult, which plays a central role in periventricular leukomalacia (PVL), results in premyelinating oligodendrocyte death via release of certain cytokines, reactive oxygen and nitrogen species. Toll-like receptor (TLR) 4 is necessary for lipopolysaccharide (LPS) induced oligodenrocyte injury in the CNS. Having an ability to bind TLR 2, 4, and LPS receptor CD14, surfactant protein D (spD) may be a promising agent to counteract the pathways associated with PVL. Supplementation of surfactant treatment with spD may be the key point in prevention of PVL by supression of inflammation and preventing damage to pre-OLs in a vulnerable premature brain operating through TLRs.

1610 Systemic Effects of Retinopathy of Prematurity Screening

Background and Aims Examination for retinopathy of prematurity (ROP) is one of the most painful procedures performed in neonatal intensive care units (NICU). In order to avoid severe visual impairment all infants below 1500 g and 32th gestational age should be screened. The aim of this study is to identify the systemic effects and complications of mydriatic eye drops and the physical manipulation of the globe. Methods The study sample included all preterm infants who were screened for ROP weighing up to 1500 g at birth and hospitalized in Adnan Menderes University NICU from January 2011 through December 2011. Hospital records were reviewed. Vital signs, apnea and seizure events, need for respiratory support, infection rates, amount of feedings, gastric residuals were investigated. Descriptive statistics and one way Anova test were applied. Results Seventy ROP examinations in 34 infants were included. Mean birth weight was 1157± 256(700–1945) g, mean gestational age was 28± 1.6(25–32) weeks. Median duration of mechanical support was 15.1± 12(0–50) days. Mean heart rate, respiratory rate and oxygen saturation were similar 24 hours before and after examination. There were no significant differences in apnea event and seizures. Gastric distention was seen in three babies, suspected necrotising enterocolitis in one infant. Conclusions There were no demostrable systemic effects associated with ROP examination although infants seemed to be somewhat tired. Low incidence of severe systemic side effects may be associated with fingertip pressure on lacrimal duct and reducing the amount of feedings just before and after the examination.