Milena Bray

Comparative evaluation of the effects of indomethacin and ibuprofen on cerebral perfusion and oxygenation in preterm infants with patent ductus arteriosus

OBJECTIVE To compare the effects on cerebral perfusion and oxygenation of intravenous ibuprofen and indomethacin as treatment for patent ductus arteriosus in preterm infants. STUDY DESIGN Sixteen infants receiving mechanical ventilation (< 31 weeks gestation) with patent ductus arteriosus received either 0.2 mg/kg indomethacin (n = 8) or 10 mg/kg ibuprofen (n = 8) infused over 1 minute. Near-infrared spectroscopy was used to measure changes in cerebral blood volume and in oxidized cytochrome oxidase concentration. Cerebral blood flow velocity in the pericallosal artery was measured using Doppler ultrasonography. RESULTS Indomethacin caused a significant reduction of CBV (maximal changes in cerebral blood volume: -320 +/- 171 microL/100 gm) and, in four of eight patients, a fall in oxidized cytochrome oxidase concentration (maximal change in oxidized cytochrome oxidase concentration in the eight patients: -0.68 +/- 0.98 mumol/L, NS). Cerebral blood flow velocity fell significantly. Ibuprofen caused no significant reduction of cerebral blood volume, oxidized cytochrome oxidase concentration, or cerebral blood flow velocity, whereas a significant increase of cerebral blood volume (+207 +/- 200 microL/100 gm) was observed after 60 minutes. Ductus closure was seen in six of eight infants after the first dose of indomethacin and in five of eight infants after the first dose of ibuprofen. The therapeutic cycle involved administration of a second and third dose, provided no side effects occurred. Treatment was effective in all infants. CONCLUSION Compared with indomethacin, treatment with ibuprofen does not significantly reduce cerebral perfusion and oxygen availability; the observed increase in cerebral blood volume requires further investigation.

Closed versus Open Endotracheal Suctioning in Preterm Infants: Effects on Cerebral Oxygenation and Blood Volume

The aim of our study was to compare, using near-infrared spectroscopy (NIRS), the effects on cerebral intracellular oxygenation and cerebral blood volume (CBV) of closed endotracheal suctioning (CS), which permits continuous ventilation of the patient, with open endotracheal suctioning (OS), which requires disconnection from the ventilator. Eleven preterm infants were studied. Each patient underwent one CS, followed, after 60 min, by one OS, or vice versa, three times during the same day. Modifications in CBV and oxidized cytochrome oxidase (CytO2) were continuously detected by NIRS; arterial oxygen saturation (SaO2) heart rate (HR), transcutaneous carbon dioxide tension and mean arterial blood pressure were simultaneously recorded. Significant reductions in HR and SaO2 were observed following OS; the magnitude and duration of these negative effects of suctioning were significantly reduced with CS. In addition, the decrease in CBV was more pronounced than following CS. No changes in CytO2 concentration were seen.

Epileptic seizures, epilepsy and epileptic syndromes in newborns: a nosological approach to 94 new cases by the 2001 proposed diagnostic scheme for people with epileptic seizures and with epilepsy.

PURPOSE To assess the advantages of the 2001 ILAE proposed diagnostic scheme for classification of newborns with epileptic seizures over the 1989 ILAE classification. METHOD Clinical features, seizure semiology and duration, neurological evaluation, ictal and interictal EEG, brain imaging and outcome at the end of the neonatal period (44 weeks post-conceptional age) of 94 newborns with EEG confirmed seizures were analyzed. The 2001 ILAE classification was applied where possible. RESULTS Twenty patients died before the end of the neonatal period. In the remaining patients, applying axis 3, we classified 54 newborns as having epileptic seizures that do not require a diagnosis of epilepsy; 14 as symptomatic partial epilepsy; 5 within the neonatal epileptic syndromes and one as benign neonatal seizures (NS). Axis 4 in all newborns provided a valuable tool in order to better define the individual patient. CONCLUSIONS Compared to the 1989 ILAE classification, which allowed a syndromic diagnosis in only 6/94 patients, the remaining being classified as Epilepsies and Syndromes undetermined whether focal or generalized, the 2001 ILAE diagnostic scheme, applied at the end of the neonatal period, offers a variety of approaches to classification, allowing an early distinction between epilepsy and single or isolated clusters of seizures, with therapeutic and prognostic implications.

Blood Withdrawal and Infusion via Umbilical Catheters: Effect on Cerebral Perfusion and Influence of Ibuprofen

Withdrawal and infusion of blood via umbilical catheters can affect cerebral blood flow in preterm infants. We compared the effects on cerebral perfusion of 3 ml/kg blood withdrawal and infusion via umbilical arterial (UAC) and venous (UVC) catheters in 16 infants ≤32 weeks gestation, age <24 h, on mechanical ventilation. Near infrared spectroscopy was used to monitor changes in cerebral oxy- and deoxyhemoglobin, total cerebral hemoglobin (an index of cerebral blood volume; CBV) and HbD (an index of cerebral intravascular oxygenation). In 10 infants the study was repeated 1 h after intravenous administration of 10 mg/kg ibuprofen as prophylaxis against PDA. Withdrawal and infusion via the UVC caused significant MABP and concordant HbD and CBV changes. Smaller modifications were seen following blood withdrawal and infusion via the UAC. Ibuprofen attenuated cerebral hemodynamic changes associated with withdrawal, but not infusion, from UAC and UVC.

Comparison of The Effects of Ibuprofen and Indomethacin on PDA Closure and Cerebral Perfusion and Oxygenation. † 977

Introduction Closure of patent ductus arteriosus (PDA) with indomethacin (INDO) in preterm infants is associated with cerebral vasoconstriction leading to a reduction of cerebral perfusion and oxygenation. We have evaluated the efficacy of ibuprofen (IBU) in PDA treatment and compared, using near-infrared spectroscopy (NIRS), the effects of the two drugs on cerebral blood volume (CBV) and oxidized cytochrome oxidase concentration [cytO2].

COMPARISON OF THE EFFECTS OF INDOMETHACIN (INDO) AND IBUPROFEN (IBU) ON CEREBRAL PERFUSION AND OXYGENATION IN PRETERM INFANTS. † 1371

COMPARISON OF THE EFFECTS OF INDOMETHACIN (INDO) AND IBUPROFEN (IBU) ON CEREBRAL PERFUSION AND OXYGENATION IN PRETERM INFANTS. † 1371

Cerebral Vasoreactivity to Arterial Carbon Dioxide Tension in Premature Infants: Effect of Ibuprofen

Cerebral Vasoreactivity to Arterial Carbon Dioxide Tension in Premature Infants: Effect of Ibuprofen

Role Of Tumor Necrosis Factor (Tnf) And Interleukin-6 (Il-6) In The Early Diagnosis Of Neonatal Infections 1459

Role Of Tumor Necrosis Factor (Tnf) And Interleukin-6 (Il-6) In The Early Diagnosis Of Neonatal Infections 1459

Prophylactic Closure Of Pda With Ibuprofen Reduces Pulmonary Myeloperoxidase(Mpo) In Preterm Infants. † 985

Prophylactic Closure Of Pda With Ibuprofen Reduces Pulmonary Myeloperoxidase(Mpo) In Preterm Infants. † 985

Effects On Cerebral Perfusion Of Blood Withdrawal And Infusion Through The Umbelical Arterial (UAC) And Venous Catheters (UVC) In Preterm Infants|[dagger]| 1079

Objectives. To compare, using cerebral near-infrared spectroscopy (NIRS), the effects of blood withdrawal (W) and infusion (I) via, respectively, UAC with tip in the thoracic aorta and UVC. Method Twelve infants of 30 weeks (25-33) gestational age, 1175 g (760-1690) birth weight, mechanically ventilated for RDS were studied at 19 hours (2-25) postnatal age. The protocol involved W, through UAC of 3 ml/kg blood in 30 seconds, followed by I at the same rate, after recovery of the NIRS trace. The procedure was repeated 3 times for UAC and 3 times for UVC. NIRS (NIRO 500, Hamamatsu Photonics), a technique based on the differential absorption of NIR light by hemoglobin and cytochrome aa3 (CytO2), depending on their oxidation state, was used to assess changes in cerebral blood volume (DCBV), calculated from total hemoglobin, oxy- (DHbO2), deoxy-(DHb) hemoglobin and CytO2, time of max variation and recovery (from start of W and I). Vital parameters, including mean arterial blood pressure (MABP) were continuously measured. Results No significant change in Hb or CytO2, heart rate, pCO2 or pO2 was seen. Concordant changes in HbO2 and CBV indicate modifications of cerebral blood flow. MABP increased significantly during I-UVC and decreased during W-UVC. A positive correlation between MABP and CBV changes during W-UVC(r2 =0.41, p = 0.036) was observed. Conclusion Blood withdrawal and infusion via UVC cause significant MABP changes and related CBV oscillation which could potentially precipitate germinal matrix hemorrhage in preterm infants; utilizing the UAC this effect may be reduced or altogether avoided. Table