Genetic and Biochemical Predictors of Neonatal Bronchopulmonary Dysplasia.

Bronchopulmonary dysplasia (BPD) is a common complication of prematurity with a multifactorial etiology, influenced by both genetic susceptibility and environmental factors on the immature lung. Fibroblast growth factor receptor-3 and -4 (FGFR-3 and FGFR-4) are abundantly expressed in both the epithelium and mesenchyme in the developing mammalian lung. FGFR-4 may play a role in developing BPD as it is associated with airway inflammation and remodeling; studies showed a link between BPD and a polymorphism in the FGFR-4 gene. The aim of this study was to study the significance of FGFR-4 in developing BPD and to investigate the correlation between its serum level and its genetic polymorphism in relation to development of BPD in preterms. This case-control study was performed on 80 preterm neonates (<32 weeks) divided into two groups: group I included 50 preterms with respiratory distress syndrome (RDS) who developed BPD and group II included 30 preterms with RDS only. The mean serum level of FGFR-4 was significantly lower in group I than in group II ( p -value < 0.05). There was no significant correlation between the serum levels of FGFR-4 and the degree of severity of BPD. Allele variation in the FGFR-4 gene was similar in both groups. The serum level of FGFR-4 was significantly lower in preterms with BPD, although the gene polymorphism was not significantly different in the studied groups.

Renal function in small for gestational age preterm infants.

OBJECTIVE: The objective of this study is to compare glomerular and tubular functions in small for gestational age (SGA) and appropriate for gestational age (AGA) preterm infants. STUDY DESIGN: A prospective controlled study was conducted on SGA and AGA infants with gestational ages between 320/7 and 366/7 weeks, who received gentamycin in the first 72 h of life. Glomerular and tubular functions were assessed on days 1 and 5. RESULTS: Fifty (25 SGA and 25 AGA) infants were included. On day of life 1, SGA group had higher serum sodium, serum urea, and urinary creatinine. On day 5, SGA infants had significant increase in serum creatinine (p = 0.04). Urinary NAG and FeNa were comparable among the two groups on days 1 and 5. CONCLUSIONS: Glomerular functions were compromised in SGA preterm infants. Tubular functions were comparable.

Does positioning affect tracheal aspiration of gastric content in ventilated infants?

OBJECTIVES: Gastroesophageal reflux and aspiration can occur in premature infants who are supported with mechanical ventilation. The relation between physical positioning and gastric aspiration in ventilated infants has not been studied. Pepsin measured in tracheal aspirate (TA) emerged as a specific marker for aspiration. The objective of our study was to assess pepsin in TA of ventilated infants at 2 different positions: supine and right lateral. METHODS: We conducted a randomized controlled trial on premature infants who were enterally fed and supported with mechanical ventilation. Patients were randomized into intervention and control groups. In the intervention group, infants were placed supine for 6 hours before a sample of TA was obtained. A second sample was collected 6 hours later while lying in the right lateral position. In the control group, the 2 samples of TA were obtained while infants remained in the supine position during the entire study time. Pepsin in TA was measured while blinded to the group assignment. RESULTS: A total of 34 patients were enrolled and randomized to intervention (n = 17) and control (n = 17) groups. Gestational age was 32.7 ± 2.7 weeks, and birth weight was 1617 ± 526 g; both groups had similar demographic and clinical characteristics. Pepsin concentration did not differ between groups at baseline. In the intervention group, pepsin concentration significantly declined from 13 ng/mL (interquartile range [IQR] 11.9-38.7) to 10 ng/mL (IQR 7-12; P < 0.001), whereas it did not change in the control group (P = 0.42). CONCLUSIONS: The right lateral positioning is associated with decreased TA pepsin. The implications of the present study on hospital practice and clinical outcomes need further investigations.

Pneumothorax in the neonatal intensive care unit in Cairo University Hospital.

Pneumothorax is more frequent in the neonatal period than at any other time in life and the incidence increases in neonates who have concurrent underlying lung disease or who require mechanical ventilation. This cross sectional study was performed in the inborn NICU in Cairo University Hospitals over one year from September 2010 to August 2011. All neonates admitted were included; their data were collected and observed for pneumothorax occurrence. A total of 59 neonates (9.1%) developed pneumothorax with highest incidence in ELBW and gestational ages less than 32 weeks. RDS and MAS were the most common coexisting lung pathologies. 89.83% of the cases with pneumothorax were on mechanical ventilation. Pneumothorax occurred on the right side in 64.4% of cases, on the left in 18.6% and bilateral in 16.95% of the cases. The mortality was higher (62.7%) in the neonates with pneumothorax than the mortality of the total admissions. The mortality was significantly higher with lower birth weights and gestational ages. Apgar score at one and five minutes and the associated medical diagnosis showed no significant differences between the neonates who died and those who survived.