Supplemented vs. unsupplemented human milk on bone mineralization in very low birth weight preterm infants: a randomized clinical trial.

UNLABELLED: Very low birth weight preterm newborns weighing less than 1500 g were randomized to receive human milk supplemented with FM 85® or not. They have similar bone mineral content (BMC) at baseline, but, at the end of study, BMC was increasingly higher in the FM 85® group. INTRODUCTION: The purpose of this study is to evaluate the effectiveness of a human milk supplement (FM 85®; Nestlé, Vevey, Switzerland) developed for the purpose of improving nutrition, including bone mineralization, in very low birth weight preterm newborns. METHODS: Preterm infants weighing less than 1500 g at birth admitted to the neonatal intensive care unit of a university hospital were studied. During hospitalization, they were fed at least 50 % of human milk. Newborns with ≥20 days of age were randomly assigned to the intervention group (n = 19) to receive human milk supplemented with FM 85® or to a control group (n = 19) to receive human milk only. Anthropometric measurements, whole-body bone densitometry (DXA), and biochemical tests were performed at study entry and at the end of the study (shortly before discharge when the infant had reached 2000 g). RESULTS: There were no start- or end-of-study differences between the two groups, except for daily increase in length (p = 0.010). At baseline, both groups had similar BMC: 5.49 ± 3.65 vs. 4.34 ± 2.98 g (p = 0.39) for the intervention and control group, respectively. However, at the end of the study, BMC was higher in the intervention group: 10.3 ± 4.71 vs. 6.19 ± 3.23 g (p = 0.003). The mean increase in BMC during the observation period was 4.90 ± 4.46 g for the intervention group and 1.86 ± 3.17 g for the control group (p = 0.020). Serum alkaline phosphatase levels were higher in the control group (720 ± 465 vs. 391 ± 177 IU/L; p = 0.007). CONCLUSIONS: Our data suggest that supplementation of human milk with FM 85® leads to improved bone mineralization in very low birth weight preterm newborns.

Computerized image analysis of bubbles in gastric aspirate for prediction of respiratory distress syndrome.

UNLABELLED: Gastric aspirates were obtained from 80 newborn babies (gestational age 24-34 wk). Fifteen of these babies developed respiratory distress syndrome (RDS). Bubbles were generated in the samples by vigorous suctioning and the number and size distribution of the bubbles were determined in random fields by computer-aided image analysis. Sensitivity and specificity for prediction of RDS were 87% and 78% for average diameter of bubbles (cut-off points >45 microm) and similar for the proportion and total number of microbubbles (diameter <20 microm). CONCLUSION: Computerized image analysis of bubbles in gastric aspirate can be used for non-biased prediction of RDS in newborn babies.

[Periodontal disease in pregnancy and low birth weight] / Doença periodontal na gravidez e baixo peso ao nascer.

OBJECTIVE: Recently, it has been suggested that periodontal disease during pregnancy could have a causal relationship with low weight at birth. Our objective was to evaluate the influence of periodontal disease during pregnancy on the birth weight of newborn infants. METHODS: Mothers who gave birth to low-birth-weight infants were randomly selected (Group 1 - G1; n=13). Immediately after inclusion of each mother in group 1, the mother of the next term newborn with birth weight of > 2,500 g (Group 2 - G2; n=13) was included as control. Mothers were examined by a periodontist who was not informed of the group the child belonged to. A probe was used to measure attachment loss of the alveolar bone. The extension index (EI) and severity index (SI) of the periodontal disease were determined. RESULTS: Both groups of mothers were similar in terms of maternal age, parity, color of skin, height, nutrition, smoking, drinking, socioeconomic status, prenatal examinations, premature rupture of membranes, chorioamnionitis, bacteriuria, placenta previa, abruptio placentae, previous hypertensive disease, preeclampsia, and heart disease. The characteristics of the newborns were: birth weight - G1 = 1,804 -/+ 675 g x G2 = 3,030 -/+ 516 g; gestational age - G1 = 33 -/+ 5 weeks x G2 = 39 -/+ 2 weeks; length of stay in the neonatal intensive care unit (NICU) - G1 = 128 days x G2 = 0 days. Average EI: G1 = 89.788 -/+ 18.355 x G2 = 72.420 -/+ 20.717; p=0.033. Average SI: G1 = 1.377 -/+ 0.626 x G2 = 0.754 -/+ 0.413 (OR=18.3; CI95%: 2.5-133.3; p = 0.006). After adjustment for risk factors for low birth weight, such as smoking, maternal height, bacteriuria, and previous hypertension, the odds ratio for SI dropped to 7.2 (CI95% = 0.4-125.4; P = 0.176). CONCLUSION: The multivariate analysis indicated a marked association between periodontal disease measured by SI score and low birth weight. Our data suggested that periodontal disease during pregnancy may be a risk factor for low weight at birth.

[Short-term effects of prone positioning on the oxygenation of pediatric patients submitted to mechanical ventilation] / Efeito a curto prazo da posição prona na oxigenação de crianças em ventilação mecânica.

OBJECTIVE: To analyze the short-term effects of prone positioning on the oxygenation of mechanically-ventilated children suffering from severe hypoxemia. MATERIALS AND METHODS: A prospective, nonrandomized trial (each patient as his/her own control) was conducted between July 1998 and July 1999. Mechanically-ventilated children with peak inspiratory pressure greater than or equal to 30 cm H(2)O, FiO(2) greater than or equal to 0.5, and PaO(2)/FiO(2) ratio less than or equal to 200 were included in the study. Each patient was kept in the prone position for two hours, returning to the supine position after this period. Oxygenation was assessed by means of PaO(2)/FiO(2) in the supine position (one hour before prone positioning), one hour after prone positioning, and one hour after returning to the supine position. Patients who presented an increase of at least 20 in PaO(2)/FiO(2) were considered responsive. The results were compared by Student t-test, Friedman test, chi-square test, Fishers exact test, and confidence interval. RESULTS: Eighteen children (10 males), whose mean age was 11.5 -/+11.5 months, with initial PaO(2)/FiO(2) of 96.06 -/+ 41.78, participated in the study. After one hour in the prone position, 27.7% of the patients (5/18) improved their PaO(2)/FiO(2) ratio (P=0.045). Six of these patients presented reduced lung compliance (four of them had acute respiratory distress syndrome); and twelve patients showed increased airway resistance (six of them presented bronchiolitis). No significant difference was observed between these two groups (reduced lung compliance x increased airway resistance) in terms of age, sex, duration of ventilation prior to change in position, peak inspiratory pressure, FiO(2), severity of hypoxemia, and outcome. CONCLUSION: Prone positioning during mechanical ventilation of children with severe hypoxemia may improve the PaO(2)/FiO(2) ratio in the first hour.

[Seizures in the neonatal period] / Convulsões no período neonatal.

OBJECTIVE: To characterize and differentiate neonatal seizures from those that occur at different ages, based on a critical assessment of the available literature and also on the authors clinical experience. SOURCES: Literature review, including up-to-date and classical studies that helped us to better understand clinical, neurophysiological and physiopathological aspects related to seizures in the newborn. SUMMARY OF THE FINDINGS: The authors present clinical and electroencephalographic characteristics of neonatal seizures, discuss their classification, treatment and prognosis. CONCLUSIONS: Neonatal seizures have a distinct clinical pattern, which justifies the necessity of an appropriate classification. The etiology is predominantly symptomatic and multifactorial; the treatment should follow a routine protocol, and the prognosis seems to be closely related to etiology.

Surfactant replacement therapy: a multicentric trial comparing two dosage approaches.

In this study the results of two different initial doses (Group A: 200 mg/kg--82 patients; Group B: 100 mg/kg--83 patients) of a porcine surfactant were compared in the treatment of neonatal respiratory distress syndrome. Main entry criteria were: birth weight between 700 and 2,000 grams, need of mechanical ventilation, FiO2 > or = 0.60 to obtain a PaO2 between 50 and 80 mmHg (PaO2/FiO2 < or = 133.3 mmHg) and less than 15 hours of postnatal age. Two further 100 mg/kg doses could be given in both groups at 12 hours interval if FiO2 was > 0.40. Birth weight (Group A: 1,231 +/- 281 g. and Group B: 1,324 +/- 355 g.), gestational age (Group A: 29.9 +/- 2.7 wk. and Group B: 30.6 +/- 2.6 wk.) and Apgar scores were similar in the two groups. Group A had a significantly higher mean PaO2/FiO2 ratio (p < 0.05) after 12 hours--178 (40-506) vs 133 (17-243) mmHg, before receiving a 2nd dose, after 24 hours--180 (17-431) vs 152 (39-360), and in the 3rd day--177 (40-333) vs 124 (24-249) and needed a lower FiO2 (p < 0.05) after 36 hours (0.47 +/- 0.20 vs 0.53 +/- 0.23) and on the 3rd day (0.51 +/- 0.23 vs 0.61 +/- 0.24). The mean peak inspiratory pressure was lower in Group A at 36 hours (17.5 +/- 4.5 vs 20.6 +/- 6.8) after the initial dose (p < 0.05). The time of exposure to high oxygen concentrations (FiO2 > or = 0.40) was lower in Group A--85 (3-643) vs 131 (3-672) hours; p < 0.05). Total amount of phospholipids given per patient was meanly 224 mg in Group A and 144 mg in Group B. Mortality was lower in group A but without significant difference (Group A: 17/82; Group B: 26/83). The analysis of the subgroup of babies with less than 1,500 gr. at birth showed a statistically significant difference in mortality (Group A: 15/70; Group B: 24/56; p < 0.02).

[Surfactant replacement therapy: a multicentric trial comparing two dosage approaches]. / Tratamento com surfactante pulmonar exógeno: um estudo multicêntrico comparativo entre duas diferentes doses iniciais.

This is an interim analysis of a multicentric trial that took place in 7 Neonatal Units to compare two initial doses of exigenous pulmonary surfactant (100 mg/kg and 200 mg/kg of phospholipids)by using a porcine surfactant for the treatment of very severe Hyaline Membrane Disease. The initial higher dose produced better oxigenation of arterial blood, reducing the time in high oxygen concentrations,while retreatments were necessary in less than half of the infants receiving 200 mg/kg as initial dose. The protocol of this study allowed the administration of additional doses only when FiO(2) was equal or greater than 0.40 instead of > 0.21, as in a large study recently published, where the same initial doses were given. This resulted in more than 40% reduction in the amount of surfactant administered,with apparently similar clinical outcome.

Fatores maternos associados ao lactocrito de leite humano. / Maternal factors associated with the crematocrit of human milk

O lactocrito (ou crematocrito) traduz a porcentagem de creme do leite humano: e um micrometodo que mede suas calorias com facilidade, sensibilidade e fidelidade. E de execucao rapida e demanda baixo custo. Pode ser utilizado na pratica clinica, em pesquisa e em estudos epidemiologicos. O leite estudado proveio de maes indias e nao-indias do Amazonas (regiao do Alto Solimoes). Foram analisados nas maes os seguintes fatores: idade, cor, paridade, historia de tabagismo, dias pos-parto, hora da coleta, tipo de alimentacao fornecida ao lactente, quantidade coletada e tempo entre o fim da ultima mamada e o inicio da coleta do leite para exame. Foram coletadas 77 amostras de leite pelas maes. Pode-se constatar que diferencas estatisticamente significativas ocorreram nos seguintes fatores: numero de dias pos-parto, hora de coleta e quantidade coletada