Serena Antonia Rubortone

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.

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.

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.

Hypoglycemia and hyperglycemia in extremely low-birth-weight infants.

Materials and methods All inborn ELBW neonates admitted to our NICU during a 5-year period were eligible for this retrospective analysis. Exclusion criteria were: birth weight (BW) 240 mg/dL in a single determination or >180 mg/dL in two determinations at 2-hour intervals. Continuous intravenous insulin infusion was started after an ineffective glucose restriction.

Double Tracheoesophageal Fistula and Azygos Lobe

Figure 1 Chest computed tomography image showing the azygos fissure (AF) outlining the azygos lobe (AL). On Day 3 of life, a term female neonate, whose mother had gone through normal pregnancy and delivery, developed dyspnea and cyanosis during feeding. Chest X-ray demonstrated infiltration in the right upper lobe. Aspiration pneumonia was diagnosed, then antibiotic therapy was initiated, and enteral feeding was discontinued. After the feeding bottle was reintroduced, regurgitation, cyanosis, and coughing reappeared. Esophageal pH monitoring excluded gastroesophageal reflux and video-fluorographic swallowing study revealed no motor alterations. However, after recurrent episodes of aspiration pneumonia, a computed tomography (CT) scan was performed. CT revealed several right lung pulmonary opacities and a distinguished azygos lobe (Figure 1). To rule out the possibility of tracheal abnormality, a flexible bronchoscopy was performed and no pathology was found. Subsequent rigid bronchoscopy (Karl Storz, Tuttlingen, Germany; Ø 3.0) with a Hopkins Forward-Oblique Telescope 30 and positive pressure ventilation under general anesthesia detected two isolated H-type tracheoesophageal fistulas (TEFs) in the cervical trachea (Figure 2).

The transition of late preterm

Background The transition from the intrato the extra-uterine life is characterized by major physiological changes in respiratory and hemodynamic functions [1]; moreover, the intrauterine thermostability has to been replaced by the neonatal termoregulation [2]. Many of the antepartum and intrapartum risk factors associated with the need of resuscitation may be present in late-preterm neonates (34-36 weeks) [3]. It is also reported a double risk of Caesarean Section (CS) in case of late-preterm compared to term deliveries [4]. Our objective was to evaluate the transition period in late-preterm infants in particular considering the need for resuscitation and the incidence of hypothermia.

An interlabial mass

A 3000 g female neonate was born at 40 weeks gestation by emergency caesarean. Antenatal sonography identified a left duplex kidney. At birth she showed an interlabial mass (figure 1) which was round, pale pink, 3 cm in diameter, and with a smooth surface. Vaginal introitus was overlapped by the …