Eugene Cepeda

The effect of vitamin E prophylaxis on the incidence and severity of bronchopulmonary dysplasia

Forty-four infants (21 treated and 23 control subjects) ventilated for hyaline membrane disease were enrolled in a controlled trial of vitamin E (Roche E injectable) supplementation to assess the effects of the vitamin on the development of bronchopulmonary dysplasia. The two groups did not differ significantly in gestational age, birth weight, Apgar scores, the amount of oxygen received, the level of positive pressure applied per ventilator, or the time of exposure to oxygen and positive pressure. Peak pressures exceeding 40 cm H 2 O were uncommon (

Antenatal phenobarbital for the prevention of neonatal intracerebral hemorrhage

Forty-six pregnant women less than 35 weeks of gestation were enrolled in a prospective randomized controlled study evaluating the effects of antenatal phenobarbital on neonatal intracerebral hemorrhage. The women were randomly assigned to control (n = 22) or treatment (n = 24) groups; the treatment group received 500 mg of phenobarbital intravenously. The time interval between the dose of phenobarbital and delivery was 5.5 +/- 4.8 hours (mean +/- SD). The infants in the control group (n = 23) and those in the phenobarbital-treated group (n = 25) were comparable regarding birth weight, gestational age, and other obstetric and neonatal risk factors associated with intracerebral hemorrhage. The incidence of intracerebral hemorrhage was 56.5% (13 of 23 infants) in the control group and 32% (eight of 25 infants) in the phenobarbital-treated group (p = 0.08). Moderate or severe hemorrhage was diagnosed in six of 13 control infants and in none of the phenobarbital-treated infants (p less than 0.01). The mortality rate was significantly lower in the phenobarbital-treated group (two of 25 infants) than in the control group (eight of 23 infants; p less than 0.05). Our study suggests that antenatal phenobarbital administration results in a decrease in mortality and in the severity of intracerebral hemorrhage in the preterm neonate.

Red Cell Membrane Lipid Peroxidation and Hemolysis Secondary to Phototherapy

ABSTRACT. The exposure of red cells to phototherapy light in the presence of a sensitizer (bilirubin) resulted in oxidative injury to the red cell membrane as manifested by a significant increase in the concentration of the products of lipid peroxidation (TBA reactants and diene conjugation) in the membrane and hemolysis. To induce a photo‐oxidized membrane injury, the sensitizer (bilirubin) has to be membrane bound. Thus, by altering the availability of free bilirubin in the red cell suspension through changes in the molar concentration ratio of bilirubin to albumin, one is able to regulate the occurrence and extent of the oxidative red cell membrane injury. The clinical implications of these findings are discussed.

Neonatal facial coding system scores and spectral characteristics of infant crying during newborn circumcision

ObjectiveTo determine the relations between Neonatal Facial Coding System (NFCS) scores and measures of infant crying during newborn circumcision. MethodsVideo and audio recordings were made of infant facial activity and cry sounds, respectively, during the lysis phase of circumcisions of 44 healthy term males (<3 d of age). All infants received topical analgesia before circumcision. NFCS scores were determined by blinded assistant from video recordings of facial activity. Measures of infant crying were determined via spectrum analysis of audio recordings by a blinded, independent researcher. Pearson product-moment correlations were used to examine relationship between NFCS scores and measures of crying. Principal component factor analysis detected dimensions underlying related measures of crying. Factor scores from a factor analysis were used in stepwise linear regression to predict NFCS scores. ResultsHigher NFCS scores correlated with lower peak fundamental frequency of crying (P<0.01) and with higher amplitudes of crying at peak fundamental frequency and dominant frequency and in overall cry sample (P<0.01). The factor analysis showed 3 significant orthogonal dimensions underlying measures of crying: Power and Velocity (amplitude and rapidity), Pitch of Crying (frequency characteristics), and Infant Arousal (turbulence and intensity) accounting for 42.3%, 17.8%, and 14.6% of variance, respectively. A regression analysis showed all 3 factor scores accounted for significant and separate portions of variance (P<0.001). The best predictor of NFCS score was Power and Velocity (P<0.002), followed by Infant Arousal (P<0.002), and Pitch of Crying (P<0.007). DiscussionThese data provide some of the first known evidence linking specific measures of infant crying with an independent, validated measure of pain.

Randomized placebo-controlled trial of sucrose analgesia on neonatal skin blood flow and pain response during heel lance.

Objectives:To evaluate the effect of oral sucrose on skin blood flow (SBF; perfusion units; PU) measured by Laser Doppler Imager (LDI) in term newborns and pain response (Neonatal Infant Pain Scale score; NIPS score) during heel lance; (2) determine SBF changes during heel lance; and (3) the relationship between SBF and NIPS. Materials and Methods:Term infants ⩽7 days old (n=56) undergoing routine heel lance were randomized to pretreatment with 2.0 mL oral 24% sucrose (n=29) or sterile water (n=27) in a double-blinded, placebo-controlled trial. SBF was assessed by LDI scans and NIPS scores at 10 minutes before lance, immediately after lancing, and 5 minutes after blood extraction. Mean SBF and median NIPS scores were compared between groups using General Linear Model or Kruskal-Wallis. Regressions examined the relationship between SBF immediately after heel lance and NIPS score. Results:Mean SBF and median NIPS scores immediately after heel lance were lower in sucrose-treated infants (167.9±15.5 vs. 205.4±16.0 PU, P=0.09; NIPS 1 [interquartile range 0 to 4] vs. NIPS 3 [interquartile range 0 to 6], P=0.02), although no significant difference in mean SBF. During heel lance NIPS score was predictive of SBF. An increase of 1 in NIPS score was associated with 11 PU increase in SBF (R2=0.21; P=0.09) for sucrose, and 16 PU increase for placebo-treated infants (R2=0.20; P=0.014). Conclusions:Increased SBF assessed by LDI is a pain response among term neonates after routine heel lance, which was not completely attenuated by oral sucrose administration. Increased SBF is associated with NIPS scores. Sucrose analgesic efficacy evidenced by decreased NIPS scores for the sucrose group. Association of SBF with NIPS scores suggests that LDI is potentially useful for assessing newborn procedural pain.

Decreased Incidence of Intraventricular Hemorrhage in Infants of Opiate Dependent Mothers

ABSTRACT. The incidence of intraventricular hemorrhage (IVH) in infants born to opiate dependent mothers was compared to infants whose mothers denied the use of addicting substances. The two groups were comparable in birth weight, gestational age, 1 and 5 min Apgar scores, and sex distribution. The incidence of breech presentations, PROM, and type of anesthesia at delivery were similar. However, more infants in the control group were delivered by cesarean section. The incidence of IVH was 52% in the controls and 23% in the opiate infants (p<0.05). Neonatal risk factors such as use of ventilators, incidence of pneumothorax, administration of pressor and sedative drugs, acidosis, use of alkali therapy and volume expanders, fluid therapy in the first three days and transfers to other hospitals were the same.

Frequency of Otitis Media Based on Otoendoscopic Evaluation in Preterm Infants

Objective This study was conducted to determine the frequency of otitis media in preterm neonates using otoendoscopy and tympanometry. Study Design Prospective study. Setting Wayne State University, Hutzel Women’s Hospital Neonatal Intensive Care Unit. Subjects and Methods Eighty-six preterm infants were included (gestational age <36 weeks). Otoendoscopy and tympanometry were performed to detect the presence of otitis media. Kappa statistic and logistic regression were used for statistical analysis. Results Otoendoscopy was performed in 85 patients. The frequency of otoendoscopy-diagnosed otitis media was 72.9% (62/85). Tympanometry could be performed on 69.76% of the ears. There was 73.5% agreement between the findings of tympanometry and those of otoendoscopy. The association between the presence of otitis media and gestational age at birth was statistically significant. The lower the gestational age, the higher the frequency of otoendoscopy-diagnosed otitis media (P = .001). Conclusion Otoendoscopically diagnosed otitis media is frequent in preterm neonates. There was agreement between the results of tympanometry and those of otoendoscopy. The frequency of otitis media increased with lower gestational age.

943 GLUCOSE INTOLERANCE IN PREMATURE INFANTS WITH MASSIVE INTRACRANIAL HEMORRHAGE (ICH)

The hospital course of 60 premature infants with massive ICH were reviewed and compared to 60 controls matched for sex, birth weight, gestational age and date of birth. Intrapartum complications (p<.01), complicated delivery (p<.05), low Apgar score (p<.05) and hyaline membrane disease (p<.0005) were all seen more commonly in the ICH patients.37/60 patients with ICH had a recorded blood sugar ≥ 200 mg/dl while only 10/60 controls showed that level of hyperglycemia (X2= 21.9, p<.0001). Glucose infusion rates at the time of the highest recorded blood sugar correlated weakly with the highest recorded blood sugar in the control group (.06>r>.05) and not at all in the ICH group.The mean glucose infusion rate of the hyperglycemic (≥ 200 mg/dl) control patients (9.8 ± 1.2 mg/kg/min) was significantly higher than that of the normoglycemic controls (6.9 ± 1.0 mg/kg/min) (p<.05). The mean glucose infusion rate of the hyperglycemic ICH patients (7.6 ± 0.5 mg/kg/min) was not significantly different from that of the normoglycemic ICH patients (8.2 ± 1.9 mg/kg/min).Glucose intolerance was not related to the site of ICH found at autopsy.We conclude that sudden glucose intolerance in a premature infant may be a sign of massive intracranial hemorrhage.

Clinical utility of transcutaneous bilirubinometer (TcB) in very low birth weight (VLBW) infants.

Abstract Objective: This is a comprehensive study designed to evaluate the clinical usefulness of transcutaneous bilirubinometry (TcB) in very low birth weight (VLBW) newborns of African American (AA) descent. Methods: TcB was conducted at the anterior superior iliac spine (ASIS), temporal region and sternum within 2 h of total serum bilirubin (TSB) measurements in newborns born at ≤32 weeks’ gestation prospectively. Average (AVG) TcB levels were also calculated. The relationships between TSB and TcB levels were analyzed using non-parametric Spearman bivariate correlations, a Bland-Altman plot procedure and a decision tree (DT) analysis. Results: One hundred newborns and 555 TSB data points were available. Eighty-nine percent of the newborns were AA. A significant correlation (P<0.0001) was observed between TSB and TcB values obtained at the ASIS (r=0.73), sternum (0.73), temporal region (0.61) and AVG (0.77). The Bland-Altman plot revealed a good agreement between AVG TcB values and TSB values. A DT analysis indicated that AVG TcB was also found to be the most significant predictor of TSB values in both the no phototherapy (PT) and biliblanket subgroups. Conclusion: TcB can be used reliably in VLBW AA newborns in the absence of overhead PT. The use of TcB in monitoring jaundice in VLBW newborns would help decrease the number of blood draws and cost of care.

1519 ANTENATAL PHENOBARBITAL FOR PREVENTION OF NEONATAL IANTRAVENTRICULAR HEMORRHAGE

A prospective randomized controlled study was performed evaluating the effects of antenatal phenobarbital (PB) on neonatal intraventricular hemorrhage (IVH). Forty-six pregnant women in labor <35 wks gestation were assigned to control (n=22) or treatment groups (n=24); the treatment group received 500 mg PB by slow intravenous infusion prior to delivery. Echoencephalograms were performed on all infants. The time between dose of PB and delivery was 5.6 ± 4.6 hrs (all values mean ± SD). Maternal PB levels at delivery were 8.72 ± 2.01 μg/mL and cord serum PB levels were 8.85 ± 1.57 μg/mL. The infants in the control group and those in the PB treated group did not differ regarding delivery route, presentation, Apgar scores, ventilatory support, episodes of acidosis, hypoxemia, hypercarbia, hypotension and fluid therapy in the first 3 days. The results indicate a significant decrease in mortality and occurrence of moderate and severe IVH in the PB treated group as compared to the control group.