Respiratory disorders and hospitalization rates during the second RSV season in preterm infants who received palivizumab prophylaxis during their first RSV season.

This prospective study evaluated the frequency and severity of respiratory symptoms during the second respiratory syncytial virus (RSV) season in an italian cohort of preterm infants (< or = 35 weeks) who had received palivizumab prophylaxis in their first year of life (October 2004-April 2005) and who had not previously been hospitalized for RSV-induced lower respiratory tract infection (LRTI). infants were evaluated at enrolment (May-September 2005), in October/November 2005 and in April 2006. The occurrence of any respiratory episode, the rate of hospitalization for respiratory-related LRTI, total length of stay in hospital, physician-documented recurrent wheezing (>or = 3 physician-documented episodes of wheezing) and use of airway medication/antibiotics were recorded during follow-up. All infants had prior palivizumab prophylaxis during their first RSV season. In the total evaluable population (n=260), 32.3% of infants experienced at least one respiratory episode, 3.8% required short hospitalization because of LRTI, 8.5% had physician-documented recurrent wheezing, and 48.8% required airway medications/antibiotics during follow-up. in this study the rate of airway morbidity, hospitalization and physician-documented recurrent wheezing during the second RSV season was low among preterm infants who had received prior palivizumab prophylaxis.

Status epilepticus and neurodevelopmental outcome at 2 years of age in an extremely low birth weight infant.

Neonatal status epilepticus (SE) is very rare and, to date, very little information exists on SE in preterm infants. Here, we report recurrent SE as a result of hypoxic-ischemic encephalopathy in an extremely low birth weight (ELBW) infant, who had favorable neurodevelopment at a corrected age of 2 years. This clinical observation seems to indicate that recurrent SE does not exclude normal long-term neurodevelopment, even in ELBW infants.

Scintigraphic evaluation of gastroesophageal reflux in newborns.

OBJECTIVES: This study was carried out to verify whether during neonatal stage gastroesophageal scintigraphy, may be useful not only to diagnose gastroesophageal reflux (GER), but also to detect pulmonary aspiration, at times responsible for respiratory symptoms frequently associated with GER. PATIENTS AND METHODS: Gastroesophageal scintigraphy was performed on 50 newborns admitted to NICU of Brindisi in the last two years who presented symptoms as cyanosis, apnoea, bradycardia, laringeal stridor, wheezing, not related to respiratory or cardiac problems, but suspected to be clinical suggestive symptoms of "pathological" GER. After administration of 99mTC mixed with the usual meal formula, we obtained a recording period of 60-90 minutes and a later recording at 4 and 24 hours to document radioactive material in lungs. RESULTS: Scintigraphy showed GER in 40/50 cases and despite frequent observation of respiratory symptoms (39/40 cases) in these newborns never radiation in pulmonary fields. CONCLUSIONS: Our results could indicate that scintigraphy, noninvasive and low in radiation, may be considered effective and reliable to diagnose GER in newborns. The absence of radiation in pulmonary fields could indicate that respiratory symptoms frequently associated with GER could depend on involuntary mechanism of vagal type and not on pulmonary aspiration.

Prenatal pseudocysts of the germinal matrix in preterm infants.

Sonographic characteristics of germinal-matrix (PGM) pseudocysts of prenatal origin detected on cranial ultrasound in preterm newborns were correlated with their outcomes. PGM cysts were classified as typical or atypical, according to their location. Typical PGM cysts were present at the head of the caudate nucleus or slightly medially, adjacent to the foramen of Monro. Cysts were defined as atypical when they were located subependymally elsewhere. Only one infant of 16 with a typical PGM cyst presented with psychomotor retardation. His cerebral scan also showed subependymal calcifications due to cytomegalovirus infection. Three babies had cysts in the frontal periventricular zones (atypical PGM cyst). They had negative cranial MRI (12-15 months of age) and normal neurological follow-up (24 months). In conclusion, isolated prenatal PGM cysts in preterm infants correlate with a normal outcome.

Hemodynamic effects of intravenous morphine infusion in ventilated preterm babies.

BACKGROUND: the importance of sedation and analgesia of newborn babies in intensive care is only now receiving recognition in many neonatal units. OBJECTIVE: to evaluate the hemodynamic effects of morphine on Cerebral Blood Flow velocities (CBFv), Cardiac Output (CO), Stroke Volume (SV), Mean Arterial Blood Pressure (MABP) and Heart Rate (HR) in ventilated preterm infants, before and during the infusion of a loading dose. DESIGN: prospective, open, non-randomized, before-after intervention study with hemodynamic measurements made by Doppler ultrasound. SETTING: neonatal Intensive Care Unit, Tertiary Care Center. PATIENTS: sequential sample of 30 ventilated preterm newborns (gestational age (GA) 29 +/- 2 wks, range 27-31, birth weight (BW) 1240 +/- 440 g, range 800-1680). INTERVENTION: each subject received an intravenous loading dose of morphine (100 mcg/Kg/h) for 2 h, followed by a continuous infusion of 25 mcg/kg/h. MEASUREMENTS: the following Doppler parameters of the anterior cerebral artery were estimated: Peak systolic flow velocity (Vs), end-diastolic flow velocity (Vd), mean flow velocity (Vm) and Pourcelot' Resistance Index (RI). Measurements of CBFv, CO and SV (by Doppler ultrasound), MABP and HR were made 30 min before (baseline values) and at 15 (M15), 30 (M30), 60 (M60) and 120 min (M120), during the morphine loading infusion. Statistical evaluation analysis of variance, significance was calculated by Student-Newman-Kenfeld test. RESULTS: there were no statistically significant changes in the cerebral and cardiac Doppler parameters before or during the 120 min of morphine loading infusion. There was a non-significant fall in MABP (MABP: Baseline value = 44 +/- 6 mmHg, M120 = 42 +/- 4 mmHg; reduction = 4%) and HR (HR = Baseline value = 148 +/- 12 beats/min., M120 = 140 +/- 16 beats/min.; reduction = 5%). CONCLUSIONS: a loading dose of morphine over 2 h did not have any significant effect on MABP or cerebral and cardiac hemodynamics. No adverse effects were noted that could be attributed to morphine therapy.

[Effects of recombinant human erythropoietin in the treatment of anemia of prematurity]. / Effetti della eritropoietina umana ricombinante nel trattamento dell'anemia del pretermine.

13 premature babies (gestational age 31.1 +/- 0.9 weeks and birth weight 1586 +/- 261 g) were randomly assigned to receive recombinant human erythropoietin (200 U/kg i.v. three times a week during 4 weeks) or no (13 babies) as soon as haematocrit decrease < 30% between second and seventh week (TO). The two groups had similar gestational age, birth weight, Apgar score 1' and 5', O2-therapy, IPPV and volume of packed erythrocytes transfused before TO. Treatment was started at 30 +/- 0.5 days (range 21-42). At TO all subjects had not cardiopulmonary compromission, sepsis, O2-dependence, GMH-IVH > or = 2 degree grade and received iron and Vit. E by i.m. Result were evaluated through determination of hemoglobin, haematocrit, reticulocytes and volume of packed erythrocytes before and on days 7, 14, 21 and 28 of therapy. After rHuEPO the number of reticulocytes increased on days 21 and 28 of therapy (on day 21: 92.4 +/- 34.2 x 1000/L vs. 71.8 +/- 21.0, p < 0.10; on day 28: 116.2 +/- 42.9 vs. 83.8 +/- 23.2, p < 0.05); otherwise the number of transfusion (0.2 +/- 0.4 vs. 1.0 +/- 1.2, p < 0.10) and volume of packed erythrocytes (3.0 +/- 6.3 ml/kg vs. 14.9 +/- 15.9, p < 0.05) were reduced. Serum erythropoietin levels did not change during treatment, probably because, reducing the lowering of hemoglobin, hypoxic stimulus to increase of erythropoietin was suppressed.