Short- and long-term effects of individualized enteral protein supplementation in preterm newborns.

The aim of this retrospective study was to assess the need for additional enteral protein supplementation in preterm newborns with gestational age (GA) ≤32 weeks after full enteral feeds with either fortified breast milk (FBM) or preterm formula (PF) were reached, and to determine the effects of additional protein on physical and neurological development. After the standard early total parenteral nutrition (TPN) and reaching full enteral nutrition with 150-160 ml/kg/day, preterms were assessed for the requirement of additional protein based on serum blood urea nitrogen (BUN)/prealbumin levels. Additional enteral protein was given for BUN <5 mg/dl and/or prealbumin ≤8 mg/dl with weekly assessments as per Neonatal Intensive Care Unit (NICU) protocol. Growth in the NICU and neurodevelopmental outcome at 18 months' corrected age (CA) were determined. There were 32 newborns in the non-supplemented group (Group 1) and 33 newborns in the supplemented group (Group 2). All newborns in Group 2 were on FBM. Weight gain and head growth were better and Bayley scores at 18 months' CA were higher in Group 2. Standard preterm nutrition with FBM may not be sufficient for preterms, and additional enteral protein supplementation may improve the physical growth rate in the NICU and result in better neurodevelopmental outcome at 18 months' CA.

Partial exchange transfusion results in increased cerebral oxygenation and faster peripheral microcirculation in newborns with polycythemia.

AIM: The aim of this study was to assess cerebral and peripheral oxygenation, by using near infrared spectroscopy (NIRS) and microcirculation by using side stream dark field (SDF) imaging in newborns with polycythemia before and after partial exchange transfusion (PET) therapy to investigate treatment effect on tissue oxygenation and microcirculation. METHODS: Polycythemic newborns with venous haematocrit (Htc) >70% or ≥65% with symptoms were included. NIRS measurements for cerebral and peripheral oxygenation and SDF recordings for microcirculatory flow assessment were obtained before and after PET. Fractional tissue oxygen extraction (FTOE) was calculated based on tissue oxygenation index and oxygen saturation. Wilcoxon test was used for statistical analysis. RESULTS: Fifteen newborns were included. Cerebral tissue oxygenation index, microvascular flow index and % of vessels with hyperdynamic flow increased after PET; median (range): 61.27 (51.36-61.87) versus 64.54 (54.1-74.38), 2.74 (2.46-3) versus 3.22 (2.64-3.75) and 0 (0-2.8) versus 3 (0-99.3), respectively. Whereas cerebral fractional tissue oxygen extraction (CFTOE), % of vessels with sluggish flow decreased after treatment; 0.36 (0.22-0.44) versus 0.31 (0.17-0.46), 1.4 (0-69) versus 0 (0-0.9), respectively. Peripheral oxygenation was unchanged. CONCLUSION: Partial exchange transfusion improves microcirculation in polycythemic newborns. Cerebral oxygenation increases and cFTOE decreases suggesting increased blood flow. Microvascular flow increases possibly representing reactive hyperperfusion after hemodilution. Whether these effects are beneficial require further research.

Evaluation of bone turnover in epileptic children using oxcarbazepine.

This study evaluated the effects of oxcarbazepine monotherapy on bone turnover in prepubertal and pubertal children. Thirty-four newly diagnosed pediatric patients with normal bone mineral density, serum biochemical markers of bone formation, and hormonal markers participated. Levels of 25-hydroxyvitamin D were significantly decreased after therapy compared with baseline values. Levels of gamma-glutamyl transferase, phosphorus, alkaline phosphatase, osteocalcin, parathyroid hormone, and calcitonin had increased. However, only changes in osteocalcin and gamma-glutamyl transferase levels were statistically significant compared with baseline values. Drug-induced osteopenia was evident in 3 patients with z scores of bone-mineral density less than -2.0, whereas these patients had z scores of less than -1.5 before treatment. Although 18 months of oxcarbazepine treatment exerted slightly adverse effects on bone metabolism, the effect seems insignificant in children with normal bone-mineral density. Although alterations in bone metabolism do not always suffice to explain the decrease in bone-mineral metabolism, we think that patients with osteopenia before the initiation of oxcarbazepine therapy should be followed carefully, especially in long-term treatment.

Impact of phototherapy on vasoactive mediators: NO and VEGF in the newborn.

AIM: The objective of this study was to evaluate the effects of close and remote phototherapy on serum nitric oxide (NO) and vascular endothelial growth factor (VEGF) levels as well as on body temperature heart rate and blood pressure in neonates of different gestational ages. PATIENTS AND METHOD: Term (gestational age > or = 37 weeks) and preterm neonates (GA < 37 weeks) with hyperbilirubinemia requiring phototherapy were included in the study. All patients except for the ones in incubators were randomized to receive either close phototherapy (15 cm above the patient) or remote phototherapy (30-45 cm above patient). Body temperature, heart rate and blood pressure were measured before treatment, six hours into treatment and one hour after cessation of treatment. Blood samples for NO and VEGF measurements were also taken at the same times. RESULTS: Sixty-one term newborns and 37 preterm newborns were included in the study. Patients were distributed into four groups according to the dose of treatment together with gestational age, i.e. term close and remote photoherapy groups (n = 29, n = 32, respectively), preterm close and remote photoherapy groups (n=10, n=27, respectively). Body temperature increased significantly with phototherapy in all groups but was not at hyperthermia level. Heart rate increased in all groups except for term newborns in the remote phototherapy group and blood pressure decreased in term infants but was unchanged in preterms. None of these changes were at the level of tachycardia or hypotension for a newborn. Phototherapy did not result in elevation of NO or VEGF levels. CONCLUSION: This study showed that in our group of patients close or remote phototherapy caused some body temperature, heart rate and blood pressure changes that were not clinically significant and did not result in increased levels of NO or VEGF, which are well known vasodilator mediators.

Nitric oxide production in newborns under phototherapy.

Nitrogen monoxide (NO) is a potent endogenous vasodilator and is involved in cytotoxicity, neurotransmission, and immunological defense mechanisms. Phototherapy has long been known to change the distribution of blood flow throughout the body in newborn infants. The objective of this study was to investigate the effect of phototherapy on NO production in otherwise healthy newborns. Urinary NO levels were measured before and 6 h after phototherapy by a chemiluminescence method using Sievers NOA. Ten newborns (gestational age, 36.4 +/- 3.9 weeks; birth weight, 2863 +/- 677.44 g; postnatal age, 5.1 +/- 2.72 days) were started on phototherapy according to AAP guidelines and urine for NO measurement was collected prior to therapy and 6 h after the commencement of treatment. Urinary NO levels measured during phototherapy were significantly higher (108.8+/-50.69 micromol/mmol creatinine) than the levels measured before phototherapy (73.13+/-34.15 micromol/mmol creatinine; P < 0.05). These results suggest that newborns receiving phototherapy might have increased NO production, which might result in hemodynamic changes. However, further studies on the effects of phototherapy on NO and photorelaxation are needed before reaching firm conclusions.