M F Reali

The role of blood transfusions and iron intake on retinopathy of prematurity

BACKGROUND The role of blood transfusions and iron intake in the pathogenesis or retinopathy of prematurity (ROP) is controversial. AIM To evaluate the influence of packed red cell (PRC) transfusions and iron intake on ROP incidence. STUDY DESIGN Prospective observational study. SUBJECTS Forty-five preterm infants with birthweight <1250 g were studied. After ophthalmological study, they were divided into group A (n=24) that included newborns without ROP, and group B (n=21) that included newborns with ROP. RESULTS Logistic regression analysis demonstrated that gestational age (OR 0.61; 95% C.I. 0.41-0.90), transfusion volume during the first week (OR 1.16; 95% C.I. 1.03-1.3) and during the first 2 months of life (OR 2.93; 95% C.I. 1.52-5.62), and iron intake during the first week of life (OR 1.15; C.I. 1.01-1.32) and during the first 2 months of life (OR 2.93; 95% C.I. 1.52-5.62) were associated with the development of ROP. CONCLUSION Our study showed that gestational age, blood transfusion volume and iron load by transfusions are associated with the risk of occurrence of ROP in infants with a birthweight of less than 1250 g.

Acute neonatal respiratory distress in Italy: a one-year prospective study

A prospective multicentre 12‐month survey of neonatal respiratory disorders in 63 537 Italian infants was performed to evaluate the incidence of acute neonatal respiratory disorders and of the main related complications. A total of 1427 developed respiratory disorders (2.2%), 208 of whom died (14.6%). The incidence of respiratory distress syndrome was 1.16%, with a case fatality rate (CFR) of 24%; that of transient tachypnoea was 0.93%, with a CFR of 1.3%. The rates of meconium aspiration syndrome, persistent pulmonary hypertension and pneumonia were 0.06%, 0.02% and 0.07%, with CFRs of 10.3%, 38.5% and 21.7%, respectively. The occurrences of the main complications in affected newborns were: bronchopulmonary dysplasia 5.6%, necrotizing enterocolitis 1.7%, patent ductus arteriosus 9.8%, 3o and 4o grade intraventricular haemorrhage 6.8% and air leak 4.9%. It was concluded that the incidence of acute neonatal respiratory disorders and the main related complications was lower than that reported two decades ago and that the CFR of acute neonatal respiratory disorders had increased. These results may be the consequences of (i) progress in the management of high‐risk pregnancies, (ii) an increased number of viable infants with extremely low birth weight and (iii) diffusion of antenatal treatment with corticosteroids which, in this series, seemed to reduce the morbidity but not the mortality in the high‐risk infants.

Prophylaxis of patent ductus arteriosus with ibuprofen in preterm infants

The aim of our study was to evaluate whether the prophylactic use of ibuprofen would reduce the incidence of significant patent ductus arteriosus (PDA) and to confirm the effectiveness of ibuprofen as rescue treatment in closing PDA. Eighty preterm infants with gestational age less than 34 wk with infant respiratory distress syndrome (iRDS) were randomized to receive intravenous ibuprofen lysine (10 mg/kg, followed by 5 mg/kg after 24 and 48 h) either within 24 h of life (group A) or after echocardiographic diagnosis of PDA (group B). To evaluate the severity of RDS in each patient, we calculated the initial and highest values of Oxygenation Index (O.I. =mean airway pressure × FiO2 × 100 / PaO2) and Ventilatory Index (V.I. = O.I. × mechanical respiratory rate). Other studied variables were ventilatory support, renal function, biochemical and haematological profiles, frequency of bronchopulmonary dysplasia (BPD), intraventricular haemorrhage (IVH), necrotizing enterocolitis (NEC) and retinopathy of prematurity (ROP). On the 3rd day of life, 8% (3/40) of patients of group A and 53% of patients (21/40) of group B (p < 0.0001) developed a significant PDA. Between patients of group B who presented PDA at 3 d of life 90% (19/21) had a closure of ductus arteriosus after ibuprofen treatment. Initial and highest values of O.I. and V.I. were similar in both groups A and B. No significant differences between the groups were observed in regard to respiratory support, renal function and frequency of BPD, IVH, NEC and ROP. Ibuprofen was not associated with adverse effects.

Brain Hemodynamic Changes in Preterm Infants after Maintenance Dose Caffeine and Aminophylline Treatment

Objective: To investigate the acute effects of low-dose caffeine and aminophylline on cerebral blood flow in preterm infants, using both near-infrared spectroscopy (NIRS) and cerebral Doppler ultrasonography. Methods: Preterm infants with a gestational age of <32 weeks and birth weight of <1,500 g were randomized to receive either caffeine or aminophylline treatment for apnea of prematurity. The study period went from 30 min before to 60 min after the administration of the maintenance dose of pure caffeine (2.5 mg/kg once a day) or aminophylline (1.25 mg/kg twice a day). NIRS was used to measure changes in oxygenated hemoglobin (O2Hb), deoxygenated hemoglobin (HHb), oxidized-reduced cytochrome aa3 (CtOx), and mean cerebral oxygen saturation (SmO2 = O2Hb/total Hb). Changes in cerebral blood volume (ΔCBV) after caffeine or aminophylline administration were calculated. Cerebral blood flow velocity (CBV) in the pericallosal artery was evaluated by cerebral Doppler ultrasounds. Results: Data collected by NIRS and cerebral Doppler ultrasounds did not show significant differences before and after caffeine treatment. We observed a significant increase in O2Hb and HHb concentration and in CBV at 30 min after the infusion of aminophylline, which tended to return to baseline at the end of the study period. Conclusion: Caffeine does not significantly affect brain hemodynamics, while aminophylline induces a significant transient increase in O2Hb and HHb concentration and CBV.

Liquid ventilation in an infant with persistent interstitial pulmonary emphysema

Abstract We present the case of a full term infant affected by diffuse persistent interstitial pulmonary emphysema (PIPE), who was treated with partial liquid ventilation (PLV) after the failure of conventional management. PIPE is a lethal chronic lung disease of unclear pathogenesis. Clinical history, radiological and histological findings confirmed the diagnosis in our patient. PLV applied for 48 hours resulted in a significant improvement in the infants respiratory function and was not associated with adverse effects. We concluded that PLV could be effective in prolonging the survival of infants with PIPE; its application represents an effective form of respiratory support in infants with chronic lung disease.

Short‐term outcome of newborn infants born by a modified procedure of cesarean section A prospective randomized study

In recent years Stark and colleagues (1, 2) proposed the application to the cesarean section of a number of new surgical techniques adopted from various sources: the differences with respect to the traditional procedures were the Joel-Cohen methods for opening the abdomen, suturing the uterus in one layer, and non-closure of the visceral and parietal peritoneal layers. They demonstrated that this cesarean section procedure is safe, fast and has a low risk of postoperative complications in the mothers (2) and therefore this technique has been adopted in many centers. Nevertheless, the possible consequences of these changes on the short-term outcome of the newborn have never been evaluated. Cesarean section and maternal anesthesia are risk factors for the respiratory distress syndrome, transient tachypnea and respiratory depression in the newborn infants (3) and, therefore, we wanted to evaluate if a cesarean section technique presumably faster than the traditional procedure could improve the short-term outcome of the newborns.

Does early closure of PDA with ibuprofen reduce the severity of RDS in premature infants? † 1736

Does early closure of PDA with ibuprofen reduce the severity of RDS in premature infants? † 1736

Birth weight of Chinese babies born in Italy.

Fok et al 1 note that the birth weight (BW) of the Chinese neonates they studied is lower than that of babies born in some western countries and state that a genuine genetic predisposition exists leading to the smaller size of Chinese infants. In Tuscany, an Italian region with 3.4 million inhabitants, about 0.5% of the population are immigrants from the People’s Republic of China. Since the early 1990s, Chinese immigrants in Tuscany …