N L Brodsky

A Prospective Observational Pilot Study of Synchronized Nasal Intermittent Positive Pressure Ventilation (SNIPPV) as a Primary Mode of Ventilation in Infants ≥ 28 Weeks with Respiratory Distress Syndrome (RDS)

OBJECTIVE: To compare the outcome of infants with respiratory distress syndrome (RDS) in the neonatal intensive care unit (NICU) who were extubated to synchronized nasal intermittent positive pressure ventilation (SNIPPV) or continued on conventional ventilation (CV), immediately postsurfactant.STUDY DESIGN: Prospective observational study of postsurfactant ventilatory management of consecutive infants (born between 10/99 and 12/02) of 28 to 34 weeks gestation. Extubation to SNIPPV was at the attending neonatologists discretion. Babies in the CV group remained intubated, postsurfactant.RESULTS: There were no significant differences in the maternal demographics, antenatal steroid use, mode of delivery, birth weight (BW), gestational age (GA), gender, Apgar at 5 minutes, age at surfactant instillation, or oxygenation index (OI) prior to surfactant administration, between infants continued on CV (n=35) and those extubated to SNIPPV (n=24). The total duration of endotracheal intubation (mean±SEM; CV versus SNIPPV; 2.4±0.4 versus 0.3±0.0 days, p=0.001) and duration of supplemental oxygen exposure (15±3.2 versus 8.2±3.3 days, p=0.04) were significantly shorter in the SNIPPV group. Furthermore, the duration of parenteral nutrition (12.1±1.6 versus 8.4±0.8 days, p=0.02) and length of stay (37.5±3.0 versus 29.1±3.3 days, p=0.04) were also significantly shorter in the SNIPPV group. There were no differences between the two groups in blood gas or OI values postsurfactant (up to 48 hours). There was no statistical difference in the incidence of intraventricular hemorrhage grade I (three (9%) in the CV group and two infants (8%) in the SNIPPV group). No infant died in either group or had patent ductus arteriosus, air leaks, necrotizing enterocolitis, periventricular leukomalacia, retinopathy of prematurity or bronchopulmonary dysplasia.CONCLUSIONS: Infants of 28 to 34 weeks GA with RDS requiring surfactant with early extubation to SNIPPV had a shorter duration of intubation, and decreased need for oxygen as compared to CV. There was also a significant decrease in the duration of parenteral nutrition and hospitalization. SNIPPV is a safe and effective primary mode of ventilation in larger premature infants.

Neutral oligosaccharide content of preterm human milk.

Human milk oligosaccharides are known to play a role in protection against certain infectious diseases. Previous reports indicate that the content of human milk oligosaccharides varies widely among individuals at term but such information on preterm milk is lacking. After removal of the fat, protein and most of the lactose from non-pooled human milk samples, a total neutral oligosaccharide fraction was isolated by ion-exchange chromatography followed by gel filtration. A Dionex high-performance anion-exchange chromatography system equipped with a pulsed electrometric detector was then employed to measure the levels of ten neutral oligosaccharides in the individual milk samples. Twenty-three milk samples from thirteen mothers who delivered at a mean gestational age of 29.5 (SD 3.1) weeks were collected between days 0 and 33 of lactation, and compared with three samples of term milk from two mothers. The ranges of the total and individual levels of the ten neutral oligosaccharides in preterm milk were similar to those in term milk. Further, as previously described in term milk, preterm milk exhibited a quantitative individual variation. This variation was independent of the gestational age, day of lactation, and postconceptional age. In conclusion, levels of ten neutral oligosaccharides did not differ between preterm and term human milk.

Improved Outcome of Extremely Low Birth Weight Infants with Tegaderm ® Application to Skin

OBJECTIVE:Significant fluid and electrolyte disturbances occur in extremely low birth weight (ELBW) infants in the first few days of life. We investigated the effect of semipermeable polyurethane membrane (Tegaderm®) applied to the skin shortly after birth on fluid and electrolyte status and the clinical outcome in these infants.STUDY DESIGN:We reviewed charts of ELBW infants (BW<1.0u2009kg) born during 24 months prior to Tegaderm® application and 19 months after starting Tegaderm®. Data were collected daily from the first week of life and additional clinical morbidities were compared.RESULTS:A total of 39 infants from pre-Tegaderm® period (NOTEG) (mean±SD, BW 756±158u2009g, GA 26.1±1.9 weeks) were compared to 30 infants with extensive Tegaderm® application to chest, abdomen and extremities (TEG) (BW 802±160u2009g, GA 26.3±1.8 weeks). The groups were similar in maternal demographics as well as postnatal surfactant use. Throughout the first week of life, serum Na levels, daily fluid intake and daily weight loss were significantly higher in the NOTEG infants (all P≤0.04) while BUN/Serum creatinine levels were similar. Hypernatremia (Na>150u2009mEq/l) developed in 51% of NOTEG infants compared to 17% of TEG (P=0.0005) and daily fluid intake ≥170u2009ml/kg/day was required in 54 vs 13% (P=0.0008), respectively. The mean time to regain BW was significantly longer in NOTEG vs TEG infants, 20.7±7.4 vs 15.8±6.3 days, respectively (P<0.02). There were no statistical significant differences among the groups in incidence of IVH, NEC, PDA or nosocomial sepsis; however, respiratory outcome was better in TEG infants. They had significantly less BPD (58% in NOTEG vs 22% TEG (P=0.01)) and fewer infants in the TEG group required supplemental oxygen at discharge (58% vs 22% (P=0.01)). Survival was significantly higher in TEG 90% vs 64% in NOTEG infants (P=0.02).CONCLUSIONS:Semipermeable polyurethane membrane application to skin of ELBW infants shortly after birth decreased postnatal fluid and electrolyte disturbances and significantly improved their outcome by reducing severity of lung disease and decreasing mortality.

Caregiver Interaction Behavior with Prenatally Cocaine-Exposed and Nonexposed Preschoolers.

This study examined the quality of caregiver-child interaction as measured by the Parent/ Caregiver Involvement Scale (PCIS), with a sample of 41 preschoolers who were prenatally exposed to cocaine and 39 nonexposed preschoolers. Within the cocaine group, 19 children were in the care of relatives or foster caregivers and 22 were in the care of their biological mothers. Results suggest that mothers of nonexposed children were significantly more emotionally and developmentally appropriate than caregivers of prenatally cocaine-exposed children, and no significant differences in interaction behavior were found between biological mothers and foster caregivers of prenatally cocaine-exposed children. The importance of conceptualizing this population of children within the context of their environment is stressed.

INNER CITY CHILDREN WITH IN UTERO COCAINE EXPOSURE (COC) DO NOT DIFFER FROM CONTROLS (CON) ON WECHSLER PRESCHOOL AND PRIMARY SCALE OF INTELLIGENCE-REVISED (WPPSI-R). ▴ 1592

In utero cocaine exposure is a risk factor for adverse neurodevelopmental outcome. AIM: To determine whether COC and CON differ in intelligence scores at age 4 yr. STUDY DESIGN: As part of a prospective, long-term study in which we are following COC and CON of similar low socioeconomic status, individuals masked to child group status administered the WPPSI-R to children aged 48 mo. Because multiple factors may influence intelligence, the effect of primary caretaker(biologic or foster), home environment [Home Observation for Measurement of the Environment (HOME)], and social support [Social Support Scale (SSS) and Inventory of Social Support (ISS)] were also assessed.RESULTS. COC (n=55) and CON (n=51) were similar in natal status, gender, scores on Bayley Scales, and age at testing (both 48.8 mo.)(all p>0.05). COC and CON did not differ in mean Performance, Verbal, and Full Scale IQ scores (p≥0.14). However, with the exception of CON Performance IQ, all mean IQ scores were >1 S.D. below the test mean of 100(Figure). On the HOME, COC was lower in language, learning, and academic stimulation, and total score (all p<0.05). COC also differed from CON on 4 of 12 SSS items and 2 of 18 ISS items (all p<0.018). By regression analysis, Performance, Verbal, and Full Scale IQ scores were associated with total HOME score (p≤0.01), but not with COC or CON status, primary caretaker, SSS or ISS. CONCLUSION: Inner city children, COC and CON, perform poorly on intelligence testing at age 4 yrs. The home environment, while worse in COC than CON, influenced IQ scores of both. Given the young age of these children, and the significant effect of the home, measures to change poor WPPSI-R outcome must be targeted, powerful, and early. (Funded by NIDA DA-04965.)

A COMPARISON OF CAREGIVER INTERACTION WITH PRESCHOOLERS WITH IN UTERO COCAINE EXPOSURE (COC) AND CONTROLS (CON). |[dagger]| 94

Because of their prenatal drug exposure, COC are considered at risk for adverse neurodevelopmental outcome. As COC grow older, however, it is increasingly important to include analysis of post-natal factors, such as primary caregiver (PC), in assessments of outcome. AIM: To determine whether COC-PC and CON-PC interact differently with their children. STUDY DESIGN: Children 3½ to 4½ yrs. old followed in a prospective study of COC and CON of similar low SES were videotaped for 20 minutes of free play with their PC. Caregivers interaction (using a scale of 1-5) was measured with the Parent/Caregiver Involvement Scale, in terms of amount, emotional quality, and developmental appropriateness of PC; an overall impression score was also given. The off-site coder was masked to PC group status. The resultant 38 items and 4 summary scores were compared. RESULTS: Forty-one COC-PC[22 biologic mothers (BIO) and 19 foster mothers] and 37 CON-PC (all BIO mothers) participated. COC-PC (BIO and foster) had lower scores than CON-PC on 20/38 items (data not shown) and on the Summary Quality and Appropriateness scores. COC-PC (BIO only) had a lower Summary Impression score than CON-PC.CONCLUSION: CON-PC were more emotionally and developmentally appropriate in their interactions with their children than COC-PC. COC-PC, BIO and foster, did not differ from each other, with each providing less positive interactions than CON-PC. Studies are in progress to determine if PC interaction impacts on developmental outcome. (Funded by NIDA.) Table

ASSESSMENT OF LANGUAGE IN CHILDREN WITH IN UTERO COCAINE EXPOSURE(COC) AND CONTROLS (CON): A PROSPECTIVE, MASKED EVALUATION. † 1591

ASSESSMENT OF LANGUAGE IN CHILDREN WITH IN UTERO COCAINE EXPOSURE(COC) AND CONTROLS (CON): A PROSPECTIVE, MASKED EVALUATION. † 1591