Effectiveness and Safety of Intravenous Iloprost for Severe Persistent Pulmonary Hypertension of the Newborn.

Objective: The aims of this study were to determine the effectiveness (oxygenation), safety (hemodynamic status) and short term outcomes of intravenous iloprost (IVI) administration as a rescue therapy in severe persistent pulmonary hypertension of the newborn (PPHN). Design: Retrospective medical records review. Setting: Tertiary neonatal intensive care unit at Songklanagarind Hospital, Songkhla Province, Hat Yai, Thailand. Participants: Newborns who received IVI as an adjunctive therapy for treatment of severe PPHN, as defined by an oxygen index (OI) of >20 and without response to conventional therapies. Main Outcome Measures: The change of OI and alveolar-arterial oxygen difference before and after commencement of IVI. Results: 33 neonates with severe PPHN at a median gestation of 39 weeks and a baseline OI of 40 (range, 21-101) received IVI. The median OI and alveolar-arterial oxygen difference had a statistically significant decrease after 2 hours of treatment and continued to decline thereafter (P<0.05). All infants received one or more inotropic medications and volume expanders to provide blood pressure support with no statistically significant difference of blood pressure and heart rate before and after IVI treatment. The mortality rate was 15.2%, all of them had initially severe hypoxemia with a median OI of 53.6. Conclusions: IVI may be effective in improving oxygenation and should be considered as a rescue therapy for infants with severe PPHN, especially in a limited resource environment with no inhaled nitric oxide available. Systemic hypotension may be a cause for concern.

Effect of fortification on the osmolality of human milk.

BACKGROUND: Human milk is nutritionally better than formula milk for preterm infants. However, unfortified human milk may fail to meet the theoretical requirements of very low birth weight (VLBW). Human milk fortifier (HMF) increases the nutritional content of human milk. However, the important factor of concern in feeding VLBW is the osmolality, the higher the osmolality, the greater the risk of necrotizing entero colitis (NEC). Therefore, high osmolality in fortified human milk should be considered for this condition. OBJECTIVE: To evaluate the effect of fortification on the osmolality of human milk. MATERIAL AND METHOD: Twenty samples of human milk were collected from mothers of gestational age less than 32 weeks, at about 1 week postpartum in Songklanagarind Hospital. The osmolality of each sample was determined at baseline and after supplementation with HMF at 10 minutes, 1, 2, 4, and 6 hours at room temperature and 24 hours at 4 degrees C in a refrigerator. RESULTS: The mean osmolalities (SD) of human milk and HMF dissolved in sterile water were 285.3 (3.3) mOsm/kg H2O and 64.6 (0.7) mOsm/kg H2O, respectively. Thus, the expected osmolality of human milk after supplementation with HMF was 349 mOsm/kg H2O. Mean measured osmolalities (SD) of human milk after supplementation with HMF at 10 minutes, and 1, 2, 4, 6 and 24 hours was 394.7 (2.9), 399.5 (2.8), 402.1 (2.2), 401.0 (2.7), 401.3 (2.3) and 401.2 (3.1) mOsm/kg H2O, respectively. The mean osmolality at 10 minutes, 1, 2, 4, 6 and 24 hours were significantly higher than human milk (p < 0.001) and the mean osmolality at 10_minutes was significantly higher than expected osmolality (p < 0.001). There were no significant differences among groups of osmolality after supplementation with HMF at 10 minutes, 1, 2, 4, 6, and 24 hours (p > 0.05). CONCLUSION: The supplementation of human milk with HMF induced an increase in osmolality after mixing. The osmolality, after mixing with HMF which was about 400 mOsm/kg H2O, creates a greater risk of NEC. Therefore, HMF milk should be considered for feeding in only high risk preterm neonates.

Time to positivity of blood culture in newborn infants.

The purpose of this study was to evaluate the minimum incubation time required to detect positive blood cultures from newborn infants with sepsis. Data were collected retrospectively on seventy-five positive blood cultures from newborn infants in the neonatal intensive care unit of Songklanagarind Hospital. The BacT/Alert Microbial Detection System had been used to culture the samples. Data were obtained retrospectively from the patients' medical records for positive blood cultures. A computer algorithm in the automated blood culture system determined the time to positivity, which was then evaluated for clinically important definite bacterial pathogens, possible bacterial pathogens, fungi and contaminants. Definite bacterial pathogens accounted for 46% (34/74) of the positive blood culture results, possible bacterial pathogens accounted for 39% (29/74), fungi for 7% (5/74) and contaminants for 8% (6/74). The cultures were positive at 24, 36 and 48 hours of incubation in 70.2%, 91.8% and 95.9% respectively. At 36 hours of incubation, the sensitivity, specificity and negative predictive value were 70.3%, 100% and 93.3%, respectively. All cultures growing clinically significant definite bacterial pathogens were positive by 36 hours of incubations, 88% by 24 hours. The cultures had 100% sensitivity, specificity and negative predictive value at 36 hours of incubation. If definite and possible bacterial pathogens were considered, the time to positivity was 71% at 24 hours, 95% at 36 hours and 97% at 48 hours, respectively. The sensitivity, specificity and negative predictive values were 70.3%, 100%, and 93.3%, respectively. Of cultures growing fungi, 80% were positive by 36 hours and all by 48 hours.

A novel nonsense mutation, E150X, in the SOX9 gene underlying campomelic dysplasia

Campomelic dysplasia (CD) is an autosomal dominant skeletal malformation syndrome with features including bowed lower limbs with pretibial skin dimpling, hypoplastic scapulae and pelvic bones, and 11 pairs of ribs. Mutations in the SOX9 gene have been identified to cause CD. The gene encodes a transcription factor containing a dimerization, a high mobility group, and a C-terminal transactivation (TA) domain. Up to now, 35 SOX9 mutations have been published. In the present study, we describe a Thai girl with clinically and radiologically typical CD. Direct sequencing analysis of the PCR products for the entire coding region of SOX9 revealed that she was heterozygous for a novel 448G > T in exon 2 of SOX9. The DNA change was expected to result in E150X and loss of the entire TA domain. This result further supports that SOX9 is the only gene, discovered to date, responsible for CD across different populations and that the TA domain is important to the function of the normal SOX9.

Accuracy of transcutaneous bilirubinometer estimates using BiliCheck in Thai neonates.

BACKGROUND: Neonatal jaundice is the most frequently encountered diagnostic and therapeutic problem in the newborn. In the jaundiced infant, it is thought that the binding capacity of plasma albumin is exceeded, which allows free bilirubin to diffuse into and accumulate within extravascular tissues, such as the central nervous system. Affected newborns may develop kernicterus. The standard method of serum bilirubin measurement requires blood specimen taken by heel prick or venepunetue which involves pain of the newborn and is time consuming. A non invasive, transcutaneous measurement of bilirubin concentration is developed to be an alternative method as a reliable for the screening method to detect hyperbilirubinemia OBJECTIVE: To compare the estimates of serum bilirubin using a recently introduced device called a BiliCheck and its transcutaneous bilirubinometer index with the standard direct spectrophotometric measurement of serum bilirubin. DESIGN: Prospective descriptive study. MATERIAL AND METHOD: Estimates of serum bilirubin, as measured using the BiliCheck, were compared with serum bilirubin concentration measured by direct spectrophotometry in neonates at Songklanagarind Hospital. Transcutaneous bilirubinometer readings were taken on the forehead. RESULTS: Eighty-two newborns were enrolled in the present study. The means and standard deviations of serum bilirubin concentration and transcutaneous bilirubinometer index were 11.96 +/- 2.98 and 11.61 +/- 2.93 mg/dl, respectively. There was no statistically significant difference (p = 0.44, paired t-test). The correlation coefficient between total serum bilirubin and BiliCheck index was 0.95 with the linear regression equation of Y= 0.99x + 0.4. CONCLUSION: Serum bilirubin can be accurately measured by the transcutaneous bilirubinometer index in full term newborn infants prior to any intervention modalities.

Perinatal dengue infection: a case report and review of literature.

A case of vertical transmission of dengue infection in the perinatal period is reported. The mother, a term pregnancy, had acute dengue the day before admission. The infant was born at term and developed fever on the fifth day of life which lasted for 5 days. No bleeding or plasma leakage was detected during the course of fever in infant or mother. A liver function test showed elevated SGOT and SGPT in the infant. The infant developed a convalescent rash on day 5 of the fever. The diagnosis of secondary dengue hemorrhagic fever in the mother was confirmed by serology and primary dengue infection in the infant was confirmed by serology and serotyped as dengue type 2 by PCR. The clinical course and management of mothers and infants with perinatal dengue infection are reviewed.