Noninvasive respiratory support via nasal cannula in premature infants: Is it really safe?

Büyüktiryaki M, Okur N, Kadioglu-Simsek G, Kanmaz HG, Canpolat FE. Noninvasive respiratory support via nasal cannula in premature infants: Is it really safe? Turk J Pediatr 2019; 61: 307-310. With this observational study we attempted to assess whether nasal cannulas originally used to administer high flow could be effectively used as an interface to provide ventilator generated noninvasive respiratory support. Preterm infants whose gestational ages between 26 < sup > 0/7 < /sup > and 29 < sup > 6/7 < /sup > weeks with respiratory instability who initially received noninvasive respiratory support with binasal prongs and then switched to nasal cannula with attending physician`s decision were included. Six infants (27%) needed intubation and mechanical ventilation while getting noninvasive support via nasal cannula, whereas this was not observed during noninvasive ventilation via short binasal prongs (p=0.02). Despite the nasal cannula being easy to use and well tolerated by the preterm infant, it is not as effective as the short binasal prong when it is used as an interface in a mechanical ventilator that provides noninvasive respiratory support other than its own equipment.

The effect of phototherapy on sister chromatid exchange with different light density in newborn hyperbilirubinemia.

AIM: Concerns of possible genotoxic effects of hyperbilirubinemia and phototherapy were raised from experimental and observational studies in neonates. The purpose of this study was to assess the effect of hyperbilirubinemia and phototherapy with three different methods on DNA damage by investigating sister chromatid exchange frequency. MATERIAL AND METHODS: Patients whose gestational ages were >37 weeks and bilirubin levels above phototherapy limits were enrolled into three groups and each group was planned to receive 25 babies. Group 1 received enhanced light-emitting diode phototherapy, group 2 had light-emitting diode phototherapy, and group 3 received conventional phototherapy. Infants with hyperbilirubinemia but did not require phototherapy comprised the control group, which was subdivided into two groups regarding bilirubin levels (10mg/dL). Blood samples were collected before and after phototherapy for sister chromatid exchange frequency and samples were examined by a biologist who was blinded to the study groups. RESULTS: The mean pre-treatment sister chromatid exchange frequency was 1.41±0.34/cell, post-treatment 2.65±0.68/cell, and 1.61±0.61/cell for the control group (p<0.05). A statistically significant increase in sister chromatid exchange frequency after phototherapy was observed in all three intervention groups (p values: 0.01, 0.01, and 0.008, respectively). When the treatment groups were compared with each other in terms of irradiance, no significant difference was found (p=0.08). CONCLUSIONS: Phototherapy causes an increase in the frequency of sister chromatid exchange regardless of the irradiance. Phototherapy could have some genotoxic adverse effects on chromosomes; however, further investigations are warranted to enlighten as to whether these effects are permanent or clinically important.

Does enteral protein intake affect renal glomerular and tubular functions in very low birth weight infants?

OBJECTIVES AND AIM: Very low birth weight infants require 3 - 4 g/kg/day protein intake to provide satisfactory postnata growth rates and neurodevelopmental outcomes. However, they have fewer functional nephrons, thereby increasing vulnerability for impaired renal functions. The aim of this study was to investigate the effect of different amounts of enteral protein intake during the fortification of human milk on renal glomerular and tubular functions. MATERIAL AND METHODS: Preterm infants were randomized into three groups in terms of their daily protein intake: standard fortification (3 g/kg/d), moderate fortification (3.3 g/kg/d), and aggressive fortification (3.6 g/kg/d). Serum urea, creatinine (Cr), Cystatin C (Cys-C) and urinary ß2 microglobulin (ß2M) levels were assessed and compared between groups. RESULTS: Serum urea, Cr, Cys-C and urinary ß2M levels were similar in all three groups, both on discharge and postnatal Day 14 (p > 0.05). Mean Cr and ß2M levels were significantly lower on discharge (p < 0.05), while Cys-C levels did not differ in time (p > 0.05). CONCLUSION: Enteral protein intake up to 3.6 g/kg/d did not alter the tubular and glomerular functions in very preterm infants. However, the long-term renal effects in these infants maintained on a high protein intake remain unknown and should be addressed in future studies.

Human milk fortification with differing amounts of fortifier and its association with growth and metabolic responses in preterm infants.

BACKGROUND: Fortification of human milk (HM) is a common clinical practice to adapt breast milk to the nutritional needs of very low birth weight (VLBW) infants. The optimal method for HM fortification remains to be determined, and a variety of protocols are currently used in neonatal intensive care units. OBJECTIVE: It is believed that standard fortification is insufficient to meet the needs of VLBW infants. Therefore, we designed a randomized prospective study that investigated the effects of varying levels of blind fortification on short-term growth and metabolic responses of preterm infants. METHODS: Eligible infants were randomized into 3 groups: standard fortification (SF), moderate fortification (MF), and aggressive fortification (AF). Short-term growth, feeding intolerance, and urea, calcium, phosphorus, and alkaline phosphatase levels were assessed. RESULTS: There were 26, 29, and 29 infants in the SF, MF, and AF groups, respectively. The baseline characteristics of the groups were similar. Daily weight gain and length at discharge did not differ among the groups; however, head circumference was significantly higher in the MF and AF groups compared with the SF group. Urea, calcium, phosphorus, and alkaline phosphatase levels were similar between the groups. CONCLUSION: We demonstrated that blind fortification of HM, even with higher amounts than recommended by manufacturers, did not cause any measured adverse effects on the metabolic response of preterm infants. Anthropometric measurements (except head circumference) were not different between the different dosages of fortification.