Serafina Lacerenza

An evaluation of a new combined Spo2/PtcCO2 sensor in very low birth weight infants

BACKGROUND: Recently, a new sensor for combined assessment of pulse oximetry oxygen saturation (Spo2) and transcutaneous monitoring of carbon dioxide partial pressure (PtcCO2) has been introduced (TOSCA 500, Radiometer America Inc.). We designed this study to evaluate the usability and reliability of TOSCA in neonates with birth weight ≤1500 g (very low birth weight). METHODS: In a prospective study of 22 newborns, TOSCA was tested, positioning the sensor on the ear pinna with an adhesive attachment clip. Simultaneous monitoring with TOSCA, conventional pulse oximeter (HP; Datex Ohmeda 3740), and a transcutaneous device (TINA TCM3, Radiometer, Copenhagen) was performed for 60 min. PtcCO2 measurement from TOSCA (PtcCO2TOSCA) and TINA (PtcCO2) were compared with Pco2 from blood samples (PCO2EAB) at 1 and 60 min. During the monitoring period, values of PtcCO2TOSCA were compared with PtcCO2, and SatO2 values from TOSCA with those from a pulse oximeter. Corresponding data were compared using Bland–Altman analysis. RESULTS: Bias (precision) at 1 min and at 60 min between PCO2EAB and PtcCO2 values were 3.5 (12.4) mm Hg and 2.8 (10.2), respectively, whereas between PCO2EAB and PtcCO2TOSCA values were 18.3 (30.4) mm Hg and 1.8 (25) mm Hg. Bland–Altman analysis shows a better correspondence PtcCO2/PtcCO2TOSCA between 7 and 15 min. No significant differences were found between Spo2 and SpO2TOSCA. CONCLUSIONS: The TOSCA monitor is safe and easy to apply in very low birth weight newborns. The pulse oximeter measurements may be useful for titrating oxygen therapy. Pco2 measurement with TOSCA is most useful as a trend and independent confirmation of arterial Pco2 is required if an accurate value is needed.

Correlation analysis between echocardiographic flow pattern and N-terminal-pro-brain natriuretic peptide for early targeted treatment of patent ductus arteriosus

Abstract Objective: Echocardiographic flow patterns of patent ductus arteriosus (PDA) are useful to predict the development of hemodynamically significant ductus in premature infants. N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations seem to be useful to detect PDA. We investigated how NT-proBNP levels change on the basis of different flow patterns during the first day of life, and whether NT-proBNP might represent a reliable decision tool in PDA management. Methods: Neonates with gestational age <32 weeks were assessed prospectively, using paired Doppler-echocardiographic evaluation and NT-proBNP values, at T0 (6–24 h of life), and daily until ductal closure. Results: At T0, NT-proBNP concentrations of 41 neonates correlated to the kind of pattern (p = 0.018) with the highest values in neonates with pulsatile or growing patterns. A value <9854 pg/ml identified neonates with spontaneous closure (sensitivity 71.8%, specificity 100%). Overall, 32 infants needed treatment. Pre-treatment NT-proBNP values increased compared to those at T0, significantly in neonates with growing pattern at T0 (p = 0.001). After treatment, NT-proBNP concentrations decreased compared to pre-treatment values (p = 0.0024), more markedly in the responders than in the non-responders (p = 0.042). Conclusions: NT-proBNP concentrations at T0 show a good agreement with different flow patterns and represent a useful tool to identify neonates at risk of developing hemodynamically significant PDA.

Atypical manifestations of congenital parvovirus B19 infection

Parvovirus B19 infection in pregnancy is associated with fetal anemia, hydrops and fetal death. We report two unusual manifestations of vertical parvovirus B19 infection. The first patient developed hydrops as consequence of myocarditis with involvement of sino-atrial node. The other had pleural effusion reactive to the hepatic localization of the virus.

Use of a Combined SpO2/PtcCO2 Sensor in the Delivery Room

Arterial oxygen saturation (SaO2) and partial arterial pressure of carbon dioxide (PaCO2) are important respiratory parameters in critically ill neonates. A sensor combining a pulse oximeter with the Stow-Severinghaus electrode, required for the measurement of peripheral oxygen saturation (SpO2) and transcutaneous partial pressure of carbon dioxide (PtcCO2), respectively, has been recently used in neonatal clinical practice (TOSCA500ÒRadiometer). We evaluated TOSCA usability and reliability in the delivery room (DR), throughout three different periods, on term, late-preterm, and preterm neonates. During the first period (period A), 30 healthy term neonates were simultaneously monitored with both TOSCA and a MASIMO pulse oximeter. During the second period (period B), 10 healthy late-preterm neonates were monitored with both TOSCA and a transcutaneous device measuring PtcCO2 (TINAÒ TCM3, Radiometer). During the third period (period C), 15 preterm neonates were monitored with TOSCA and MASIMO after birth, during stabilization, and during transport to the neonatal intensive care unit (NICU). Blood gas analyses were performed to compare transcutaneous and blood gas values. TOSCA resulted easily and safely usable in the DR, allowing reliable noninvasive SaO2 estimation. Since PtcCO2 measurements with TOSCA required at least 10 min to be stable and reliable, this parameter was not useful during the early resuscitation immediately after birth. Moreover, PtcCO2 levels were less precise if compared to the conventional transcutaneous monitoring. However, PtcCO2 measurement by TOSCA was useful as trend-monitoring after stabilization and during transport to NICU.

Current evidence on the safety profile of NSAIDs for the treatment of PDA

Patent ductus arteriosus (PDA) complicates the clinical course of preterm infants. Nonsteroidal anti-inflammatory drugs, especially Indomethacin and Ibuprofen, have been widely used for both prevention and treatment of PDA. Short-term efficacy of Indomethacin or Ibuprofen is equivalent, while Ibuprofen results show a higher safety profile. Ibuprofen is associated with fewer clinical gastrointestinal and renal side effects with respect to Indomethacin even if subclinical potential effects are reported. When administered as prophylaxis, Ibuprofen has no effects on prevention of intraventricular haemorrhage unlike Indomethacin. Considering the potential adverse effects of both these drugs, a careful monitoring during and after the treatment period is highly recommended.

Exposure to Gastric Acid Inhibitors Increases the Risk of Infection in Preterm Very Low Birth Weight Infants but Concomitant Administration of Lactoferrin Counteracts This Effect

Objective To investigate whether exposure to inhibitors of gastric acidity, such as H2 blockers or proton pump inhibitors, can independently increase the risk of infections in very low birth weight (VLBW) preterm infants in the neonatal intensive care unit. Study design This is a secondary analysis of prospectively collected data from a multicenter, randomized controlled trial of bovine lactoferrin (BLF) supplementation (with or without the probiotic Lactobacillus rhamnosus GG) vs placebo in prevention of late‐onset sepsis (LOS) and necrotizing enterocolitis (NEC) in preterm infants. Inhibitors of gastric acidity were used at the recommended dosages/schedules based on the clinical judgment of attending physicians. The distribution of days of inhibitors of gastric acidity exposure between infants with and without LOS/NEC was assessed. The mutually adjusted effects of birth weight, gestational age, duration of inhibitors of gastric acidity treatment, and exposure to BLF were controlled through multivariable logistic regression. Interaction between inhibitors of gastric acidity and BLF was tested; the effects of any day of inhibitors of gastric acidity exposure were then computed for BLF‐treated vs ‐untreated infants. Results Two hundred thirty‐five of 743 infants underwent treatment with inhibitors of gastric acidity, and 86 LOS episodes occurred. After multivariate analysis, exposure to inhibitors of gastric acidity remained significantly and independently associated with LOS (OR, 1.03; 95% CI, 1.008‐1.067; P = .01); each day of inhibitors of gastric acidity exposure conferred an additional 3.7% odds of developing LOS. Risk was significant for Gram‐negative (P < .001) and fungal (P = .001) pathogens, but not for Gram‐positive pathogens (P = .97). On the test for interaction, 1 additional day of exposure to inhibitors of gastric acidity conferred an additional 7.7% risk for LOS (P = .003) in BLF‐untreated infants, compared with 1.2% (P = .58) in BLF‐treated infants. Conclusion Exposure to inhibitors of gastric acidity is significantly associated with the occurrence of LOS in preterm VLBW infants. Concomitant administration of BLF counteracts this selective disadvantage. Trial registration isrctn.org: ISRCTN53107700.

Peripheral Nerve Blockade and Neonatal Limb Ischemia Our Experience and Literature Review

Considering the high frequency of bleeding complications following fibrinolytic treatment in neonates, peripheral nerve blockade (PNB) has been proposed alone or in association with lower doses of tissue plasminogen activator, as a possible new therapeutic approach in the management of neonatal limb ischemia (LI) secondary to vasospasm and/or thrombosis. The present article provides a review of the current knowledge about the topic, in order to evaluate the efficacy and safety of this therapeutic approach. According to the few case reports documented in literature and to our experience, PNB could be considered as valid procedure for the treatment of LI, especially during neonatal period, when the risk of serious bleeding associated with fibrinolytic or anticoagulant therapy is higher. Peripheral nerve blockade resulted in a safe and effective procedure for the treatment of neonatal vascular spasm and thrombosis.

Hepatic hematoma in a neonate with a high level of alpha-fetoprotein

Hepatic hematomas in neonates are uncommon lesions. When they are large or subcapsular in location, they can rupture with clinical signs of hemoperitoneum. We report a case of subcapsular hepatic hematoma (SHH) associated with a high level of alpha-fetoprotein (AFP), for which diagnosis was made with conservative management, following up with the reduction in size at ultrasound examination and the reduction of the level of AFP.

Management of outbreaks in neonatal intensive care units

Outbreaks in neonatal intensive care units (NICUs) have disastrous consequences for neonates and raise enormous concerns in staff, altering usual practice patterns of the NICU. Our objective was to perform a systematic analysis for gaining insights into the control and prevention of NICUs outbreaks. Epidemiology, risk factors and outcomes are reviewed.

Vitamin D and fluoride: in order to prevent, not to cure

Abstract Vitamin D and fluoride are two typical examples of dietary supplements given to infants, children and adolescents. They allow to prevent specific diseases as rickets and dental caries, respectively, but questions have been suggested about adequate dosages and risk of excess. Neonates, particularly preterm, are a special risk class because of possible nutritional deficiency during hospitalization and post-discharge.