Exhaled Volatile Organic Compounds for Early Prediction of Bronchopulmonary Dysplasia in Infants Born Preterm.

OBJECTIVE(S): To investigate the predictive performances of exhaled breath volatile organic compounds (VOCs) for development of bronchopulmonary dysplasia (BPD) in infants born preterm. METHODS: Exhaled breath was collected from infants born <30 weeks' gestation at days 3 and 7 of life. Ion fragments detected by gas chromatography-mass spectrometry analysis were used to derive and internally validate a VOC prediction model for moderate or severe BPD at 36 weeks of postmenstrual age. We tested the predictive performance of the National Institute of Child Health and Human Development (NICHD) clinical BPD prediction model with and without VOCs. RESULTS: Breath samples were collected from 117 infants (mean gestation 26.8 ± 1.5 weeks). Thirty-three percent of the infants developed moderate or severe BPD. The VOC model showed a c-statistic of 0.89 (95% CI 0.80-0.97) and 0.92 (95% CI 0.84-0.99) for the prediction of BPD at days 3 and 7, respectively. Adding the VOCs to the clinical prediction model in noninvasively supported infants resulted in significant improvement in discriminative power on both days (day 3: c-statistic 0.83 vs 0.92, P value .04; day 7: c-statistic 0.82 vs 0.94, P value .03). CONCLUSIONS: This study showed that VOC profiles in exhaled breath of preterm infants on noninvasive support in the first week of life differ between those developing and not developing BPD. Adding VOCs to a clinical prediction model significantly improved its discriminative performance.

Reducing post-extubation failure rates in very preterm infants: is BiPAP better than CPAP?

BACKGROUND AND AIM: Continuous positive airway pressure (CPAP) is currently used in neonates after mechanical ventilation though it may occasionally be associated with air leaks syndromes or it may fail to support the baby. The pressure difference offered by bilevel continuous positive distending pressure (BiPAP) respect to CPAP may be an advantage to the spontaneously breathing patient. In this study, we compared the efficacy of CPAP and BiPAP in the firstweek post-extubation in a series of very preterm infants. METHODS: Inborn neonates less than 30 weeks of gestational age who were intubated shortly after birth from January 2011 to December 2017 were enrolled in a retrospective study. The attending clinician assessed the patients for non-invasive respiratory support readiness and allocated them to CPAP (PEEP 4-6 cmH2O) or BiPAP (PEEP 4-5 cmH2O, rate 10-40; Thigh 0.7-1.2; upper-pressure level 8-10 cmH2O). Both techniques were compared for preventing extubation failure within 7 days from extubation as defined per local protocol (primary outcome). Secondary outcomes were: definitive failure of extubation, pneumothorax during non-invasive respiratory support, periventricular leukomalacia, bronchopulmonary dysplasia, sepsis, patent ductus arteriosus and retinopathy of prematurity at discharge. RESULTS: We enrolled 134 neonates; the CPAP group included 89 babies while 45 received BiPAP. Patients did not differ for their general characteristics (EG, antenatal steroids, incidence of SGA, maternal hypertension, surfactant replacement therapy). Short term extubation failure was significantly higher in the former group (23/89 in CPAP vs 5/45 in BiPAP; p = .005). No infant developed air leak syndrome. Secondary outcomes were comparable between groups. Multivariate analysis showed that on the whole population the extubation failure was correlated to the insurgence of late-onset sepsis. CONCLUSION: BiPAP safely reduced early extubation failure compared to CPAP in our cohort of very preterm neonates within 7 days from extubation.

An unusual aggressive presentation of late onset sepsis due to Staphylococcus aureus MRSA producing Panton-Valentine Leukocidin in preterm neonate.

We report an unusual and rare case of infection from methicillin resistant Staphylococcus aureus (MRSA) producing Panton-Valentine leukocidin in a preterm neonate in NICU. On day of life 8, a preterm baby boy suddenly developed arthritis, giant cutaneous abscesses and an osteomyelitic focus with pour clinical condition. This very aggressive presentation of infection from MRSA push us to test Panton-Valentine leukocidin resulted positive and to test contacts to discover the bearer of the germ. MRSA producing Panton-Valentine leukocidin is an unusual case of infection in preterm neonate that has not been reported elsewhere. A very aggressive sepsis in neonates from Staphilococcus aureus should evoke the need to test Panton-Valentine leukocidin to rapidly establish an appropriate treatment. We underline also the importance to test contacts to establish promptly a decontaminant therapy.

Thoracic Hypoplasia at Birth as Presenting Feature of Shwachman-Diamond Syndrome in Twins.

Shwachman-Diamond syndrome (SDS) is a rare autosomal recessive disorder of marrow failure syndrome and exocrine pancreatic dysfunction with an estimated incidence of 1/76,000. When present, characteristic skeletal abnormalities are strongly suggestive of SDS but most often they are seen during childhood and adolescence. We present a case of preterm twins with prenatal diagnosis of thoracic hypoplasia and a clinical evolution that lead to an early diagnosis of SDS. This report highlights the importance of a high index of suspicion for SDS in case of neonatal thoracic hypoplasia.

Respiratory management of ELGA infants in a region of Southern Italy.

The distribution of births in many regions of Southern Italy is scattered among a high number of level I centers, many of which still count less than 500 deliveries per year. Campania, the region around Naples, is no exception and this excessive fragmentation results in a high number of neonatal transports, many of which for respiratory distress. In the present paper, we review three different regional peculiarities relevant to the respiratory management of extremely low gestational age babies.

Immunoglobulins in neonatal sepsis: has the final word been said?

Systemic infection is a major cause of mortality and morbidity among premature neonates. In this fragile population, the immaturity of the innate immune response relates inversely to gestational age and is one of the determinants of susceptibility to infections. Antibiotic therapy, even when appropriately and timely instituted, may fail to prevent death or significant sequelae. The quest for additional strategies is still open; in this scenario, the supplementation with exogenous immunoglobulins represents an attractive additional strategy of defence. As current data are conflicting, we provide a critical appraisal with a focus on IgM enriched immunoglobulins preparations.