Investigation of the relationship between umbilical cord pH and intraventricular hemorrhage of infants delivered preterm

SUMMARY OBJECTIVE: We measured the level of pH gases in premature infants at birth, and examined the relationship between brain ultrasonography on the third and seventh day after birth. A case-control study conducted at the Neonatal Intensive Care Unit (NICU) of Shahid Akbar Abadi Hospital, Iran, during the years 2016-2017. METHODS: All premature infants who were admitted to NICU were enrolled in the current study. At birth, a blood gas sample was taken from the umbilical cord of the infants. On the third and seventh day after birth, an ultrasound of the brain of each neonate was performed by a radiologist. The umbilical cord was evaluated for blood gases in 72 neonates (mostly boys). RESULTS: Sixty-six newborns had normal sonography, and 16.7% (12 cases) had anomalies. A total of 75% of the 8 infants with intravenous bleeding were girls, which were significantly different from those in the non-hemodynamic group (62.5% male) (P 0.049). However, the type of delivery, mean weight, height, head circumference, the circumference of the chest, and Apgar score did not differ between the two groups. Mean pH, HCO3- and PCO2 in umbilical cord blood gas samples were not significantly different between the two groups with or without intraventricular hemorrhage (IVH). Although it was not related to gender and type of delivery in newborns CONCLUSION: Blood gases do not help in determining the occurrence of IVH in infants. Nevertheless, it is associated with immaturity and fetal age.

RESUMO OBJETIVOS: Medimos o nível de gases de pH em bebês prematuros, no nascimento dos neonatos, e examinamos a relação entre a ecografia cerebral no terceiro e no sétimo dia após o nascimento. Um estudo de casos e controles realizados na Unidade de Cuidados Intensivos Neonatais (UCIN) do Hospital Shahid Akbar Abadi durante os anos de 2016-2017, Irã. MÉTODOS: Todos os recém-nascidos prematuros que deram entrada na UCIN foram inscritos no estudo atual. Ao nascer, foi retirada uma amostra de gás em sangue, do sangue do cordão umbilical dos bebês. No terceiro e sétimo dia após o nascimento, um radiologista realizou uma ecografia do cérebro de cada neonato. O cordão umbilical foi avaliado para detectar gases no sangue em 72 neonatos (em sua maioria do sexo masculino). RESULTADOS: Sessenta e seis recém-nascidos tinham ecografia normal e 16.7% (12 casos) tinham anomalias. 75% das 8 crianças com hemorragia intravenosa eram meninas, que foram significativamente diferentes das do grupo não hemodinâmico (62.5% homens) (P.0.049). Contudo, o tipo de parto, o peso médio, a altura, o perímetro cefálico, a circunferência do tórax e a pontuação de Apgar não foram diferentes entre os grupos. O pH médio, HCO3 e PCO2 nas amostras de gás no sangue do cordão umbilical não foram significativamente diferentes entre dois grupos com ou sem hemorragia intraventricular (Hiv). Apesar de não estar relacionado com o gênero e o tipo de parto em recém-nascidos. Conclusão: os gases sanguíneos não ajudam a determinar o aparecimento de Hiv nos bebês. Contudo, está associado com a imaturidade e idade fetal.

Permissive Hyperglycemia in Extremely Low Birth Weight Infants

The aim of this study is to evaluate the outcomes of permissive hyperglycemia up to or = 300 mg/dL with insulin. Only 15% of patients were grouped as N, with 39% as P and 46% as T. Although P had lower birth weight, P had a similar daily calorie and glucose intake as well as urine output compared to N. There was no significant correlation between blood glucose level and urine output on day 7. Compared to N, P showed faster weight gain and similar mortality, morbidities, and long-term neurological outcomes. Permissive hyperglycemia up to < 300 mg/dL without insulin treatment during the first 14 days of life is not associated with osmotic diuresis or increased mortality or morbidities, suggesting that it is not detrimental in ELBWIs.

Relationship between Maternal Serum C-Reactive Protein, Funisitis and Early-Onset Neonatal Sepsis

The aim of this study was to determine whether maternal serum C-reactive protein (CRP) is of value in predicting funisitis and early-onset neonatal sepsis (EONS) in women with preterm labor or preterm premature rupture of membranes (PROM). This retrospective cohort study included 306 consecutive women with preterm labor or preterm PROM who delivered preterm singleton neonates (23-35 weeks gestation) within 72 hr of CRP measurement. The CRP level was measured with a highly sensitive immunoassay. The sensitivity, specificity, positive predictive value, and negative predictive value of an elevated serum CRP level (> or = 8 mg/L) were 74.1%, 67.5%, 32.8%, and 92.4% for funisitis, and 67.7%, 63.3%, 17.2%, and 94.6% for EONS, respectively. Logistic regression analysis demonstrated that elevated levels of serum CRP were significantly associated with funisitis and EONS, even after adjusting gestational age. The maternal serum CRP level obtained up to 72 hr before delivery is an independent predictor of funisitis and EONS in women with preterm labor or preterm PROM. A low serum CRP level (< 8 mg/L) has good negative predictive value in excluding funisitis and EONS, and may therefore be used as a non-invasive adjunct to clinical judgment to identify low-risk patients.

Níveis plasmáticos de cafeína no cordão umbilical e apneia da prematuridade / Serum levels of caffeine in umbilical cord and apnea of prematurity

OBJETIVO: Determinar a influência da presença de cafeína no sangue de cordão umbilical na ocorrência de apneia. MÉTODOS: Estudo de coorte prospectivo de recém-nascidos pré-termo com peso de nascimento menor que 2.000 g. Os critérios de exclusão foram: mães que receberam opioides; ventilação mecânica durante os primeiros 4 dias de vida; malformações cerebrais e cardíacas maiores; asfixia perinatal; hemorragia peri-intraventricular grave; exsanguineotransfusão antes do quarto dia de vida; e uso de metilxantina antes da extubação. Os recém-nascidos foram divididos em com e sem cafeína detectável no sangue de cordão umbilical, sendo acompanhados nos primeiros 4 dias para verificar ocorrência de apneia. RESULTADOS: Oitenta e sete recém-nascidos com e 40 sem cafeína detectável no sangue de cordão umbilical foram estudados. A mediana da concentração de cafeína dos 87 pacientes com cafeína detectável no sangue de cordão umbilical foi 2,3 µg/mL (0,2-9,4 µg/mL). Não houve associação entre ocorrência de apneia e presença de cafeína no sangue de cordão umbilical. Recém-nascidos com cafeína detectável no cordão umbilical tiveram tendência a apresentar apneia mais tardiamente (66,3±4,14 horas) do que aqueles com níveis indetectáveis (54,2±6,26 horas). CONCLUSÃO: A detecção de níveis de cafeína no sangue de cordão umbilical não diminuiu a ocorrência de apneia da prematuridade, mas teve um efeito limítrofe atrasando sua ocorrência, o que sugere que mesmo um nível baixo de cafeína no sangue de cordão umbilical pode retardar a ocorrência de apneia.

OBJECTIVE: To determine the influence of presence of caffeine in umbilical cord blood on apnea occurrence. METHODS: A prospective cohort study with preterm newborns with birth weight lower than 2,000 g was undertaken. Exclusion criteria were: mothers who received opioids; mechanical ventilation during the first 4 days of life; cerebral and major cardiac malformations; perinatal asphyxia; severe periintraventricular hemorrhage; exchange transfusion before the fourth day of life; and those who received methylxantine prior to extubation. Neonates were divided into detectable and undetectable caffeine in umbilical cord blood. Newborns were followed for the first 4 days for occurrence of apnea spells. RESULTS: Eighty-seven newborns with and 40 without detectable caffeine in umbilical cord blood were studied. Median caffeine concentration of the 87 patients with detectable caffeine in umbilical blood was 2.3 µg/mL (0.2-9.4 µg/mL). There was no association between occurrence of apnea spells and presence of caffeine in umbilical cord blood. Neonates with detectable caffeine in umbilical blood had borderline later apnea (66.3±4.14 hours) than those with undetectable levels (54.2±6.26 hours). CONCLUSION: Detected levels of caffeine in umbilical cord blood did not decrease occurrence of apnea of prematurity, but it had a borderline effect delaying its occurrence, suggesting that even a low level of caffeine in umbilical cord blood might delay occurrence of apnea spells.

Cortisol and 17-a-hydroxy-progesterone levels in infants with refractory hypotension born at 30 weeks of gestation or less

Refractory hypotension is frequent in very low-birth weight infants, whose hypothalamic-pituitary-adrenal axis has been suggested to be immature. The objective of the present study was to evaluate basal cortisol and 17-a-OH-progesterone in the first 36 h of life in preterm infants with and without refractory hypotension (mean arterial blood pressure below the lower limit for gestational age throughout the study despite aggressive volume expansion and use of vasopressors). Thirty-five infants with ú30 weeks of gestation and a birth weight ú1250 g, with no postnatal use of corticosteroid or death in the first 48 h were studied. Mean arterial pressure was measured every 4 h during the first 48 h. Cortisol and 17-a-OH-progesterone were determined at 12 and 36 h and patients were divided into refractory hypotensive (N = 15) and control (N = 20) groups. The groups were not different regarding type of delivery, use of prenatal corticosteroid, requirement of mechanical ventilation, use of vasopressor drugs, morphine, fentanyl, prophylactic indomethacin, and mean sample timing. Although refractory hypotensive newborns were more immature, were smaller, suffered more deaths after 48 h of life and had a higher SNAPPE-2 score, their cortisol and 17-a-OH-progesterone levels were not different from controls at 12 h and at 36 h. The increase of cortisol in newborns with refractory hypotension 36 h after birth was significantly higher than in controls. Despite the fact that refractory hypotensive very low-birth weight neonates were submitted to a very stressful condition, their cortisol and 17-a-OH-progesterone levels were similar to controls.

Criterios de transfusión (Shannon) para prematuros: Utilización y cumplimiento en la unidad de recién nacidos, Hospital de San José / Criteria of transfusion (Shannon) for premature babies: the use and compliance in the newborn unit, San José Hospital

Objetivo: describir la utilización y cumplimiento de los criterios de transfusión (TR) de Shannon en la unidad de recién nacidos (RN) del Hospital de San José. Método: estudio observacional descriptivo, retrospectivo, donde se incluyeron 67 RN prematuros que requirieron TR en el hospital de San José, entre junio 2004 y junio 2005. Se tomó como parámetro más importante la variable dependiente nivel de hematocrito (Ht). Resultados: el nivel de Ht más frecuente se ubicó en el grupo de 21 a 30%, los promedios de la edad gestacional al nacimiento y del peso promedio fueron 30.4 semanas y 1.305 g. Se cruzó la variable Ht con el resto que forman parte de los criterios de transfusión de Shannon, encontrándose que el único paciente con nivel de Ht menor de 20% no cumplió criterio, 36 entre 21 y 30% cumplieron con el 100% de los criterios establecidos y 19 entre 31-35%, se transfundieron cumpliendo los criterios. El grupo con nivel mayor de 35% no tenía criterios de transfusión. Ninguno de los pacientes transfundidos presentó complicaciones. Conclusión: el 83.58% de los prematuros que fueron transfundidos cumplieron los criterios establecidos (Shannon), mientras que un 16.42% no. Se planteó la pregunta: ¿Implementar los criterios de transfusión de Shannon como protocolo en la unidad de recién nacidos del Hospital de San José reduciría este porcentaje?

Vitamin A status in premature infants.

BACKGROUND: Premature infants are at risk of vitamin A deficiency due to inadequate transplacental transport, inadequate storage and increased tissue utilization. Previous studies reported a significant decrease in serum vitamin A levels in premature infants at birth compared to those of full term infants. OBJECTIVE: To determine serial changes of plasma vitamin A status during the first month of life in 19 healthy, very low birth weight premature infants. METHOD: Subjects were fed with premature infant formula and received multivitamin supplementation. Plasma vitamin A concentrations were measured at 7, 14, and 30 days of age. RESULTS: Plasma vitamin A levels at 7,14 and 30 days of age were 24.63 +/- 6.08, 30.97 +/- 5.26 and 30.68 +/- 7.14 microg/dl, respectively. Plasma vitamin A levels at age 7 days were significantly lower than those at 14 and 30 days of life (p < 0.001). Three infants out of 19 (16%) had low plasma vitamin A (<20 microg/dl) at 7 days. At 14 and 30 days of age, all infants had normal plasma vitamin A levels. CONCLUSION: The results suggested that healthy premature infants were prone to subclinical vitamin A deficiency during the first week of life which could be treated by adequate enteral feeding and routine multivitamin supplementation. A high dose of vitamin A supplementation was not necessary in healthy premature infants.

Cambios en los valores de hemoglobina y la reserva de Fe posterior a la transfusión durante la anemia del prematuro / Hemoglobin and iron stores after blood transfusion in infants with anemia of prematurity

Introducción. Se describen los cambios en los valores de hemoglobina (Hb) y reserva de hierro (Fe) en prematuros evaluados durante la anemia del prematuro, en relación a la transfusión de concentrado eritrocitario.Material y métodos. Se estudiaron neonatos con peso igual o menor de 1 500 g y edad gestacional de 32-34 semanas, divididos en grupo 1 (no transfundidos) y grupo 2 (transfundidos). Se determinaron los niveles de Hb y ferritina sérica (FS) en muestras de sangre venosa obtenidas al nacimiento y a las 11 semanas de edad.Resultados. Se incluyeron a 78 lactantes, 63 casos para el grupo 1 y 15 para el grupo 2. Entre ambos grupos, al nacimiento y 11 semanas, mostraron valores de Hb de 17.1 y 16.5 g/dL y FS de 273 y 212 µg/L. A las 11 semanas de vida, Hb de 11.1 y 11.3 g/dL (P no significativa) y de FS 138 vs 252 µg/L (P = 0.001). No hubo diferencia en los casos con deficiencia o sobrecarga de Fe. Entre las edades de corte la caída de Hb fue similar (6.0 y 5.2 g/dL), que representó 0.5 g/dL por semana y la FS disminuyó 134 µg/L y aumentó 40 µg/L para cada grupo.Conclusiones. Al final de la anemia del prematuro, la transfusión de eritrocitos aumenta la reserva corporal de Fe, aunque sin diferencia significativa en los valores de Hb en estos lactantes.

Usefulness of fractional excretion of sodium in critically Ill pre-term newborns

The purpose of this prospective study was to measure the fractional excretion of sodium (FENa) in critically ill pre-term newborns (PTNB) in order to determine its cut point in the diagnosis of acute renal failuyre (ARF). This study included 52 newborns and was conducted from May, 1994 to May, 1995. Patients were devided in two groups: patients without ARF in group A (n=47) and patients with ARF in group B (n=5). No statistically significant differences were found in bith weight, extrauterine life span, serum sodium levels, urine creatinine and urinary volumes between the two groups, but there was a difference in gestational age, urinary sodium concentration and serum creatinine levels. Sensitivity and specificity were determined, and the critical level of FENa was 4 percent or greater for ARF diagnosis. The average FENa value for Group A was 1.4 ñ 1.4 percent with a median of 0.92 percent. In Group B, average FENa was 6.9 ñ 2.9 percent with a median of 8.5 percent (p<0.001). We conclude that FENa ia a valuable tool for the assessment of renal function in critically-ill PTNB, in spite of all other factors present in this population that could modify its values

Symptomatic neonatal polycythemia: comparison of partial exchange transfusion with saline versus plasma.

A prospective study to evaluate efficacy and safety of partial exchange blood transfusion (PEBT) with normal saline or plasma was conducted in 30 symptomatic polycythemic newborns. Babies were randomly assigned to receive PEBT either with normal saline or plasma. Both groups were comparable in terms of birth weight, gestational age, preexchange hematocrit and viscosity. A significant fall in hematocrit and viscosity was noticed at 6 hours following PEBT which persisted even at 24 hours (P < 0.001). Hematocrit and viscosity were comparable in the two groups at 6 and 24 hours (p > 0.05 for both). Majority of babies became asymptomatic after 24 hours of PEBT, but one baby in the saline group remained polycythemic and symptomatic requiring repeat PEBT. No complications related to the procedure were encountered in the two groups. Partial exchange with normal saline was as effective and safe as plasma in symptomatic polycythemic newborns.

Prophylactic theophylline infusion for prevention of apnea of prematurity.

To assess if there was any advantage in the prophylactic use of theophylline to prevent apnea in preterms, we treated 56 preterms (Group A) < 34 weeks gestation with theophylline infusion and compared these with 25 age and weight matched preterms (Group B) who received no therapy. Aminophylline (25 mg/ml) was infused from admission in all neonates (group A) at rates ranging 0.2 to 0.38 mg/kg/h and blood levels estimated on an Abbots TDX analyser by Fluorescence Polarization Immunoassay, after 5 days infusion. All neonates (Groups A + B) were monitored on a Corometric 505 neonatal monitor. In Group A, 1/48 developed primary apnea while in Group B, 4-21 had primary apnea (p < 0.05). Serum theophylline ranged from 2.3 to 39.5 micrograms/ml with a mean of 12.7 micrograms/ml. The mean serum level of theophylline in 4 cases who exhibited clinical evidences of toxicity was 30.1 micrograms/ml. A statistically significant difference (p < 0.05) was noted in birth weight and serum level inspite of similar infusion rates of theophylline. A linear correlation r = 0.65 was noted between serum level and infusion rate. Multivariate regression analysis, between birth weight and gestational age to serum level, showed a linear correlationship only between birth weight and serum level (r = 0.45).

Evaluation of ceruloplasmin in neonatal septicemia.

Serial serum ceruloplasmin (Cp) levels were estimated in healthy and septicemic neonates, using single radial immunodiffusion. In 25 healthy neonates mean Cp levels were 19.82 mg/dl at birth, 18.20 mg/dl at 12-24 hours, 17.26 mg/dl at 14 +/- 4 days and 17.68 mg/dl at 28 +/- 4 days of life. For the entire neonatal period the mean Cp levels were computed to be 18.24 mg/dl. In 20 culture positive, septicemic neonates, mean Cp levels were 27 mg/dl at onset of disease, 28.65 mg/dl 12-24 hours later and 36.2 mg/dl after 7 +/- 3 days of start of illness (p less than 0.001 for all sampling intervals as compared to healthy group values in first month of life). The mean Cp levels were unaffected by gestational age in both groups. In the septicemic neonates, the mean Cp levels in dying neonates did not differ significantly from recovering neonates for all sampling intervals. It is concluded that estimation of serum Cp levels may help in diagnosis of neonatal septicemia, but it is not useful as an early diagnostic aid or for prognostication.

Icterometer: a useful screening tool for neonatal jaundice.

One hundred and sixty one jaundiced newborns were investigated for the usefulness of perspex icterometer as a screening tool for neonatal jaundice. Along with serum bilirubin estimation, icterometer score was simultaneously obtained in all the cases. The correlation between serum bilirubin and icterometer score was high (r = 0.99). The icterometer was useful in various subgroups. A high sensitivity, specificity, positive and negative predictive value was seen in all the groups. A possible role of icterometer in India for screening newborns with jaundice at peripheral level is highlighted.

Bacteremia y sepsis neonatal / Bacteremy and neonatal sepsis

Entre los meses de enero y diciembre de 1989 se investigó la incidencia de septicemia entre los recién nacidos con riesgo perinatal de sepsis neonatal temprana. El 11.1 (por ciento) de las admisiones a la Unidad del Hospital Militar Gorgas, en el Distrito de Ancón, ciudad de Panamá, presentó factores de riesgo perinatales de sepsis neonatal temprana. De ello, 14.1 (por ciento) presentaron hallazgos radiológicos consistentes con el diagnóstico de neumonía intrauterina y un 1.6 (por ciento) presentó infección urinaria; sin embrargo, sus cultivos de sangre fueron negativos. Solamente 1 de 64 recién nacidos tuvo hemocultivos positivos y lo fué por Estreptococo beta-hemolítico del grupo B. La incidencia de sepsis neonatal confirmada fué de 1.7/1000 nacidos vivos mientras que la sospecha de sepsis neonatal en el mismo período y población, por la presencia de factores de riesgo perinatales, fué 65 veces mayor

Cord blood lipid levels in low birth weight newborns.

Cord blood cholesterol, triglyceride and FFA levels were estimated in 73 newborns, subdivided into various gestation weight categories (FTAGA, PTAGA, FTSGA and PTSGA). Cholesterol levels were not influenced by birth weight and gestation. Prematurity and growth retardation caused a significant elevation in triglyceride values. FFA levels were not influenced by prematurity, but growth retardation produced a significant increase. Birth weight and gestational age should be taken into consideration before labelling the newborn as hyperlipidemic.