Irena Ulanovsky

Oral propranolol versus placebo for retinopathy of prematurity: a pilot, randomised, double-blind prospective study

Retinopathy of prematurity (ROP) can progress to neovascularisation (NV) and retinal detachment. Laser photocoagulation1 or intravitreal bevacizumab (Avastin)2 are the current interventions for severe ROP. Vascular endothelial growth factor (VEGF) plays a key role in ROP pathogenesis, being downregulated and upregulated in vaso-obliterative and vaso-proliferative phases of ROP, respectively. ROP and infantile haemangiomas share the same VEGF-mediated pathogenesis. Propranolol downregulates VEGF expression, and thus, mitigates progression of infantile haemangiomas3 and NV in oxygen-induced retinopathy in animals.4 We examined the safety and feasibility of propranolol for ROP. Twenty premature infants with ROP, born between 1 May 2010 and 31 July 2012 at 24–28 weeks’ gestation and birth weight <1500 g, were randomised either to oral propranolol (propranolol+sucrose 5%; n=10) or placebo (sucrose 5%; n=10) (figure 1). Inclusion criterion: evidence for ROP with any of the following: (a) stage 1 (zone I); (b) stage 2 or …

Experience with oral betamethasone in extremely low birthweight infants with bronchopulmonary dysplasia.

Postnatal dexamethasone (DEXA) for bronchopulmonary dysplasia (BPD) during the first week of life increases the risk of cerebral palsy.1 DEXA use beyond the first week of life also raises concerns as to neurodevelopmental outcome.2 Thus, a safe and efficacious alternative corticosteroid preparation is needed. We highlight the issue of postnatal steroid use in preterm infants, a rather important unresolved dilemma for the clinician. Starting January 2002, we replaced DEXA by oral betamethasone (BETA) for BPD. We report our experience regarding efficacy and safety of BETA in extremely low birthweight (ELBW) infants with BPD. During the study period, 291 ELBW infants 30% FiO …

Triplet pregnancies – a three-decade perspective: do we fare better?

OBJECTIVES To evaluate the impact of advances in perinatal and neonatal care in the past three decades on the outcome of triplet pregnancies. STUDY DESIGN We compared the outcome of 29 sets of triplets born in our medical center during 1978-1987 with 34 sets of triplets born in the same medical center during 2001-2011. Data were extracted from maternal and neonatal medical records. RESULTS There were no significant differences in mortality or morbidity in any of the studied outcome measures between the two epochs. Of the 34 women with triplet pregnancies in the present cohort only 28 (82%) took all three born babies home, not different from the 86% found in the early cohort. The overall take-home baby rate was 93% (95/102) in the present cohort, not different than the 86% (74/86) in the early cohort. CONCLUSIONS Despite technological advances in perinatal and neonatal care, there was no significant improvement in the outcome of triplet pregnancies during the past three decades.

Standards of admission capillary blood glucose levels in cesarean born neonates

BackgroundNeonatal hypoglycemia (NH) and cutoffs remain undefined. Our center screens all cesarean-delivered (CD) neonates for NH. We sought to define standards of admission capillary blood glucose levels (ACBGLs) in CD neonates who were at the lowest risk for hypoglycemia.MethodsOf 4947 neonates, 519 met all 14 inclusion criteria. These highly-selected neonates were apparently the healthiest, least-stressed, earliest to be admitted to nursery and at lowest-risk for hypoglycemia. For each CD, cord blood gases and glucose were determined and each infant was screened for blood glucose at nursery admission.ResultsSampling age was 41.6±15.3 minutes, a mean ACBGL of 52.3±10.7 mg/dL, and percentiles as follows: 1st percentile, 29.2; 3rd, 33.6; 5th, 35.0; 10th, 39.0; 25th, 46.0; 50th, 51.0; 75th, 58.0; 90th, 67.0; 95th, 71.0; 97th, 73.0, and 99th, 84.4. ACBGL rose significantly with increasing gestational age (P=0.004), increasing cord blood glucose (P<0.001), decreasing cord blood pH (P<0.001) and decreasing sampling age (P=0.027).ConclusionsSetting uniform ACBGL cutoffs for NH definition is unachievable due to the enormous heterogeneity among newborns. Hence, we provide group-based ACBGL standards in CD neonates. We propose setting ACBGL cutoffs for use in CD neonates: 1) hypoglycemia: ACBGL <5th percentile (<35 mg/dL); and 2) interventional hypoglycemia: ACBGL <1st percentile (<30 mg/dL).

Hypothyroxinemia and Risk for Transient Tachypnea of Newborn

Transient tachypnea of newborn is associated with hypothyroxinemia in animals via decreased stimulation of beta-adrenergic receptors and Na-K-ATPase activity. In 26 549 term neonates, serum total thyroxine <14 ug/dL, male sex, and elective cesarean delivery were significantly associated with greater risk for transient tachypnea of newborn.

Performing red reflex eye examinations increases the rate of neonatal conjunctivitis.

Red reflex eye examinations often require opening the eyelids, risking infection. We evaluated links between this procedure and neonatal conjunctivitis.

Are some clinicians missing a trick when it comes to gender at birth? (Discussion and Diagnosis)

DISCUSSION A quick glance at the infant’s genitalia at birth would immediately raise the possibility of a female newborn infant with virilisation due to congenital adrenal hyperplasia. However, the laboratory and imaging workup ruled out congenital adrenal hyperplasia as the serum levels of glucose (68 mg/dL), sodium (144 mEq/L) and potassium (5.4 mEq/L) were all normal. The ACTH test (0.125 mg) was normal, with the following baseline and 60-minute serum hormonal levels, respectively: cortisol (28 ? 1286 nmol/L), 17-OH progesterone (0.5 ? 2.3 nmol/L) and 11deoxycortisol (3.0 ? 11.5 nmol/L). Testosterone level was normal (0.8 nmol/L). Ultrasonography showed a normal uterus and normal-size adrenal glands. The enlargement of the clitoris and labia major gradually decreased during the first week of life (Fig. 2A). Follow-up at 3 weeks (Fig. 2B) and 3 months of age (Fig. 2C) showed an infant that was growing and developing normally and no longer had an enlarged clitoris or labia. Her external genitalia looked normal. During breech presentation, the presenting part of the foetus can become swollen or even injured (1–4). For example, Carceller et al. (1) described two female neonates with haematoma and bleeding of the external genitalia after vaginal delivery with breech presentation. Tiwary et al. (2) showed that 19 of 134 (14.2%) males born vaginally with breech presentation had injury to their buttocks, scrotum or testis. Furthermore, follow-up showed that 10 infants (6.5%) were found to have damage to their testis when they were palpated. Of these 10 infants, only three had normal testis at 4 years of age. Negrine et al. (3) described an infant with scrotal rupture following vaginal breech delivery. In addition, Finan et al. (4) described a

Are some clinicians missing a trick when it comes to gender at birth? (Case Presentation)

CASE PRESENTATION A 3520 g, infant born at 39 weeks of a primipara mother was delivered by caesarean section, due to breech presentation and significant uterine contractions. The parents were healthy nonconsanguineous Moslem Arabs, a 24-yearold mother and 28-year-old father. Examination at birth revealed significant clitoromegaly and enlargement of the labia major (Fig. 1), consistent with ambiguous-looking genitalia. Otherwise, the physical examination was normal. The labia minor were not fused, the urethral and vaginal openings were normal for a female infant, and no skin hyperpigmentation was noticed. Serum levels of glucose, sodium and potassium were obtained. An adrenocorticotropic hormone (ACTH) test was performed, including baseline and 60-minute serum hormonal levels, together with tests for cortisol, 17-OH progesterone and 11-deoxycortisol. Serum testosterone level was also obtained. Abdominal ultrasonography was performed to determine the size of the adrenal glands and the presence of internal genital organs.