Rolland Kohan

Late-onset infections of infants in neonatal units

Objective: To examine regional variations in the incidence of late‐onset neonatal infections in Australian and New Zealand neonatal units.

Morphine increases synchronous ventilation in preterm infants.

Objectives: To examine the short‐term cardiorespiratory effects of intravenous morphine infusion in ventilated preterm infants.

Use of nicotine patches in breast‐feeding mothers: Transfer of nicotine and cotinine into human milk

Our objective was to assess the extent of exposure to nicotine and cotinine in breast‐fed infants during maternal smoking and later during maternal use of the nicotine transdermal patch to achieve smoking cessation.

C-reactive protein as a diagnostic tool of sepsis in very immature babies

Abstract Three hundred and nine septic screens were performed on 123 consecutively admitted infants of <30 weeks gestation. As part of the septic screen, serial quantitative measurements of C‐reactive protein (CRP) were performed daily until discontinuation of antibiotic therapy. Complete blood counts were performed daily for the first 2 days of each septic episode.

The Amount of Fluvoxamine in Milk Is Unlikely to Be a Cause of Adverse Effects in Breastfed Infants

The aim of this study was to characterize milk/plasma (M/P) ratio, as well as relative infant dose and well-being, in 2 breastfeeding women taking fluvoxamine. The women (37 and 34 years old) and their infants (26 and 0.75 months old) were studied over a 24-hour dose interval at steady state. Fluvoxamine concentrations were measured by high-performance liquid chromatography. Infant exposure was measured as concentration in milk multiplied by an estimated milk production of 0.15 L/kg/d and normalized to the weight-adjusted maternal dose. M/P values of 1.34 and 1.21 were calculated for subjects 1 and 2, respectively, and relative infant doses were estimated to be 1.38% and 0.8%, respectively. No adverse effects in the infants were detected by the mother or on clinical examination, and fluvoxamine was not detected in the infants’ plasma (limit of detection 2 µ g/L). These limited data support the prescription of fluvoxamine to breastfeeding mothers after a careful, individual risk/benefit analysis is undertaken.

Postnatal Lung Function after Prenatal Steroid Treatment in Sheep: Effect of Gender

The effect of fetal gender on postnatal lung function and response to prenatal steroid exposure were examined retrospectively in a group of 115 preterm lambs. Fetuses received a single intramuscular injection of 0.5 mg/kg betamethasone alone or in conjunction with l-thyroxine 48 h before delivery at 128-d gestational age. Control animals received an equivalent volume of saline. After delivery, respiratory mechanics and blood gas parameters were recorded for 40 min. Deflation pressure volume curves were constructed in excised lungs. Right upper lobes from a randomly selected subgroup of control animals were examined morphometrically. Control (saline-treated) females were able to be ventilated at lower ventilatory pressures with equivalent tidal volumes and more efficient gas exchange. There were no gender differences in compliance, conductance, or excised lung volumes for saline-treated animals. More efficient gas exchange in females could not be explained by thinner alveolar septa or greater alveolar surface area. After hormone treatment, both males and females exhibited significant improvements in respiratory mechanics, gas exchange, and an increase in alveolar surfactant concentration. However, females exhibited a significantly greater improvement than males for compliance, conductance, excised lung volume, and arterial oxygen partial pressure. These data provide a comprehensive description of gender differences in postnatal lung function and response to steroid treatment in preterm animals, and support clinical findings of sexual dimorphism.

Gabapentin and Breastfeeding: A Case Report

The aim of this study was to describe the milk-plasma ratio and relative infant dose of gabapentin in a breastfeeding mother and to determine the well-being of her exposed infant. The mother-infant pair was studied over a 24-hour dose interval at steady state. Gabapentin concentrations were quantified by high-performance liquid chromatography. Infant exposure was calculated as concentration in milk multiplied by an estimated milk production of 0.15 L/kg/d and normalized to the weight-adjusted maternal dose. The milk-plasma ratio was 0.86; the relative infant dose was 2.34%. The absolute infant dose was approximately 3% of the children’s dose for gabapentin, and the infant plasma level of 0.4 mg/L was approximately 6% of the maternal plasma drug concentration. No adverse effects attributable to gabapentin were noted in the infant. In combination with a previously published report, these limited data support the prescription of gabapentin to a breastfeeding mother after a careful individual risk-benefit analysis.

Benefits of introducing universal umbilical cord blood gas and lactate analysis into an obstetric unit

Background:  Current evidence suggests that umbilical arterial pH analysis provides the most sensitive reflection of birth asphyxia. However, there’s debate whether umbilical cord blood gas analysis (UC‐BGA) should be conducted on some or all deliveries.

Accurate prediction of hypoxic-ischaemic encephalopathy at delivery: a cohort study

Objective: Hypoxic-ischaemic encephalopathy (HIE) is a major acute neurologic manifestation of perinatal asphyxia associated with significant mortality and morbidity. The study aimed to develop a simple, accurate method of predicting HIE at delivery. Methods: Between January 2003 and December 2009, all HIE cases were identified from the 38,404 deliveries at a single tertiary centre. Receiver operating curve (ROC) analysis and multivariate logistic regression assessed the ability of clinical and biochemical assessments to predict HIE. Results: Sixty neonates met the HIE criteria: 39 were moderate-severe HIE. Univariate analyses identified clinical neonatal markers (Apgar scores and neonatal resuscitation level) to be better HIE predictors than biochemical markers (umbilical artery pH, base excess and lactate values). Multivariable models using two to four predictors had areas under ROC curves up to 0.98, sensitivities up to 93% and specificities up to 99%. For moderate-severe HIE, the most effective predictor was neonatal resuscitation level and arterial lactate (ROC 0.98, sensitivity 85%, specificity 99%). Conclusion: The combination of umbilical arterial lactate and neonatal resuscitation level provides a rapid and accurate method of predicting moderate-severe HIE that can identify neonates at birth that may benefit from tertiary care and neuroprotective therapies.

Ureaplasma urealyticum in a neonatal intensive care population

The incidence of Ureaplasma colonization at birth and its effect on the development of chronic lung disease (CLD) and on mortality was studied in a neonatal intensive care population. Ureaplasma colonization was associated with a birthweight < 1000 g (odds ratio [OR] 3.45 confidence intervals [CI] 2.13‐5.60) and a gestational age < 30 weeks (OR 2.54 CI 1.71–3.79). In a case‐controlled study of 112 infants, significant associations with Ureaplasma colonization were maternal pyrexia in labour (n= 38 vs 21; P= 0.015), the requirement for antibiotics in labour (n= 39 vs 16; P= 0.0005) and vaginal delivery (n= 78 vs 58; P= 0.009). Risk factors associated with the development of CLD were birthweight < 1000 g (OR 3.77 CI 2.53–5.62) and delivery by Caesarean section (OR 1.65 CI 1.11–2.43). Within the group delivered by Caesarean section. Ureaplasma colonization was also associated with an increased risk of CLD (OR 1.97 CI 1.08–3.62). Ureaplasma colonization of infants at birth is associated with factors suggestive of maternal chorioamnionitis as well as preterm birth and low birthweight. In infants delivered by Caesarean section, Ureaplasma colonization is associated with an increased risk of chronic lung disease.