Early onset neonatal thrombocytopenia is associated with severe intraventricular hemorrhage in very preterm infants: A retrospective cohort study.

BACKGROUND: The role of platelet function in the development of intraventricular hemorrhage is still a subject of debate. In this study, we aimed to determine whether there is an association between platelet indices in the first week of life and severity of intraventricular hemorrhage in very preterm infants. MATERIALS AND METHODS: Preterm infants born < 30 weeks of gestation in our hospital were retrospectively evaluated. Platelet parameters, including platelet counts, mean platelet volume, platelet distribution width, and platelet mass were retrieved at two different time points: the initial value on the first day of life and the value closest to the end of the first week of life. The infants were categorized according to the findings of cranial ultrasonography as; no intraventricular hemorrhage, mild or severe intraventricular hemorrhage. RESULTS: Totally, 1051 infants were evaluated. The mean gestational age and birth weight for the entire cohort were 27.9±1.6 weeks and 1058±247 g, respectively. Infants in the severe intraventricular hemorrhage group had significantly lower gestational age (p < 0.001) and birthweight (p < 0.001) compared to other two groups. Furthermore, there were significant differences in platelet count and platelet mass between the groups at two time intervals. However, logistic regression analysis revealed that only platelet count of < 100×109/L on the first postnatal day was independently associated with the severity of intraventricular hemorrhage. CONCLUSION: There is an association between platelet count of < 100×109/L on the first postnatal day and severe intraventricular hemorrhage in very preterm infants.

Comparison of three different noninvasive ventilation strategies as initial respiratory support in very low birth weight infants with respiratory distress syndrome: A retrospective study.

BACKGROUND: There is inadequate evidence regarding which noninvasive ventilation (NIV) is superior for initial respiratory support of preterm infants with respiratory distress syndrome. OBJECTIVES: To compare the failure of noninvasive ventilation (NIV) and neonatal outcomes between nasal continuous positive airway pressure (NCPAP), bi-level positive airway pressure (BiPAP), and nasal intermittent positive pressure ventilation (NIPPV) as the initial respiratory support with less invasive surfactant administration (LISA) in very low birth weight (VLBW) infants. METHODS: Medical records of 419 VLBW infants born at 26-30weeks' gestation who did not require intubation in the delivery room and were initially supported with either NCPAP (n=221), BiPAP (n=101), or NIPPV (n=97) were retrospectively reviewed. The LISA approach was preferred in cases of surfactant requirement. The primary outcome was the failure of NIV within the first 72h of life. Failure of NIV was defined as the persistence or recurrence of one or more of the following: hypoxemia, respiratory acidosis, more than one episode of apnea requiring bag and mask ventilation or more than six episodes of apnea requiring stimulation over a 6-h period. Data were analyzed using univariate and multivariate logistic regression analysis. RESULTS: Failure of NIV within the first 72h of life was significantly higher in the NCPAP group (29.4%) compared with the BiPAP (12.9%) or NIPPV (12.4%) group (P<0.001). However, the BiPAP and NIPPV groups were not different in terms of NIV failure (P=0.91). Multivariable logistic regression analysis showed that antenatal steroid administration (OR: 0.49, 95% CI: 0.27-0.90; P=0.02) and gestational age˂28weeks (OR: 2.03, 95% CI: 1.18-3.49; P=0.01) were independent factors that influence failure of NIV within the first 72h of life. CONCLUSION: Compared with NCPAP, the use of NIPPV/BiPAP strategies for initial respiratory support can reduce the need for invasive ventilation in infants born at 26-30weeks' gestation.

Fryns anophthalmia-plus syndrome: two rare cases.

Fryns anophthalmia-plus syndrome is a rare syndrome with clinical diversity primarily including anophthalmia/microphthalmia, facial clefts, cleft lip/palate, ear and nasal deformities. Here we present two different cases of APS with anopthalmia/microphthalmia, cleft palate, low set ears, ventriculomegaly and one of which had intestinal non-fixation anomaly not described in the literature before.

CD31 and Factor VIII in angiogenesis of normal and pre-eclamptic human placentas.

We aimed to evaluate normal and pre-eclamptic placental vasculature by using CD31 and Factor VIII. We evaluated placentas of 37 pre-eclamptic women by using immunohistochemical staining with CD31 and Factor VIII antibodies. Individual microvessels in the placental tissues were counted at × 100 and × 400 magnification. Microvessel counts were lower in placentas of pre-eclamptic patients compared with healthy controls after staining with CD31 (26.5 ± 5.7 vs 103.9 ± 8.2, p < 0.001) and Factor VIII (24.8 ± 6.7 vs 98.7 ± 10.3, p < 0.001). Balance between proangiogenic and antiangiogenic factors seems to be shifted in favour of anti-angiogenic factors in pre-eclampsia.

Oral probiotics: Lactobacillus sporogenes for prevention of necrotizing enterocolitis in very low-birth weight infants: a randomized, controlled trial.

BACKGROUND/OBJECTIVE: The identification of probiotic species involved in gut homeostasis and their potential therapeutic benefits have led to an interest in their use for preventing necrotizing enterocolitis (NEC). Although bifidobacterium and lactobacilli sp. have been used to reduce the incidence of NEC in clinical trials. Lactobacillus sporogenes has not been used in the prevention of NEC in very low-birth weight infants yet. The objective of this study was to evaluate the efficacy of orally administered L sporogenes in reducing the incidence and severity of NEC in very low-birth weight (VLBW) infants. SUBJECTS/METHODS: A prospective, blinded, randomized controlled trial was conducted in preterm infants with a gestational age of <33 weeks or birth weight of <1500 g. VLBW infants who survived to start enteral feeding were randomized into two groups The infants in the study group were given L. sporogenes with a dose of 350,000,000 c.f.u. added to breast milk or formula, once a day, starting with the first feed until discharged. The infants in the control group were fed without L. sporogenes supplementation. The primary outcome measurement was death or NEC (Bell's stage ≥2). RESULTS: A total of 221 infants were studied: 110 in the study group and 111 in the control group. There was no significant difference in the incidence of death or NEC between the groups. Feeding intolerance was significantly lower in the probiotics group than in the control group (44.5% (n: 49) vs 63.1% (n: 70), respectively; P=0.006). CONCLUSIONS: L. sporogenes supplementation at the dose of 350,000,000 c.f.u/day is not effective in reducing the incidence of death or NEC in VLBW infants, however, it could improve the feeding tolerance.

Respiratory syncytial virus outbreak defined by rapid screening in a neonatal intensive care unit.

Palivizumab is currently licensed for the prevention of respiratory syncytial virus (RSV) lower respiratory tract disease in infants and children with chronic lung disease, with a history of preterm birth, or with haemodynamically significant congenital heart disease, but its routine use during outbreaks in neonatal intensive care units (NICUs) is not currently recommended. Here we report an outbreak in a NICU detected during a screening trial for RSV infection using a rapid antigen test (Respi-Strip((R))). Eleven preterm infants in our NICU tested positive for RSV during January 2009. Subsequent testing of the remaining infants in the NICU revealed two additional asymptomatic cases. In addition to precautions against cross-infection, palivizumab prophylaxis was administered to the remaining 37 premature infants. Two days after treatment, RSV was detected in two additional infants who had become symptomatic. To our knowledge this is the largest RSV outbreak in a NICU to be identified at an early stage by rapid testing and effectively controlled by infection control measures and palivizumab prophylaxis.

Oxidative stress and its determinants in the airways of children with asthma.

BACKGROUND: There is ample evidence for the existence of a systemic oxidative stress in childhood asthma but relatively little information on the oxidant stress in the airways. OBJECTIVE: To determine the extent of oxidant/antioxidant imbalance and describe its determinants in the airways of asthmatic children including asthma severity and the genotype of the antioxidant enzymes. METHODS: One hundred and ten children with mild asthma, 30 children with moderate asthma and 191 healthy controls were included in the study. Exhaled breath condensate (EBC) was collected from all children with EcoScreen. Levels of malondialdehyde were measured as the indicator of oxidative stress, and of reduced glutathione as the indicator of antioxidant defense. Children were genotyped for the presence of null variants of glutathione S transferase (GST) T1 and GSTM1, and ile105val variant of GSTP1. Risk factors were analyzed with multivariate logistic regression. RESULTS: EBC contained significantly higher levels of malondialdehyde and lower levels of reduced glutathione in asthmatic children compared with healthy controls (P < 0.001 for each), whereas there was no difference between mild and moderate asthmatics. Multivariate logistic regression identified asthma as the only independent factor contributing to oxidative stress. Genotypes of the antioxidant enzymes had no effect on the oxidative burden. CONCLUSIONS: Asthma is associated with an extremely powerful oxidative stress not only in the systemic circulation but also in the airways.

The effect of regular versus on-demand desloratadine treatment in children with allergic rhinitis.

OBJECTIVE: Desloratadine is a potent antihistamine. Whether regular or on-demand use of desloratadine influences its therapeutic efficacy in allergic rhinitis is unknown. The aim of the study was to compare the clinical efficacy and the anti-inflammatory activity of regularly administered desloratadine to its on-demand use in children with allergic rhinitis due to pollen allergy. METHODS: Thirty-seven patients with allergic rhinitis with or without mild intermittent asthma were enrolled in a prospective parallel group study. Patients were treated with desloratadine regularly or on-demand during pollen season. Rescue medications and symptom scores were recorded on a diary card. Nasal flow rate and inflammatory markers were recorded, and methacholine (Mch) challenge test was administered before and within the pollen season. RESULTS: Though symptoms were lower in the evening than in the morning (p<0.001), there was no difference between the two groups. There was no difference between the groups with respect to medication score except that the salbutamol use was lower in the regular treatment group during the fourth week (p=0.032) in the pollen season. Nasal flow rate and inflammatory markers failed to show any difference between the groups. A significant reduction in PC20 values (provocative concentration of Mch causing a 20% fall in FEV(1)) was observed in regular (p=0.016) and on-demand (p=0.005) treatment groups compared to the pre-season measurements. The number of children with a PC20 below 8 mg/ml increased significantly in the on-demand group. CONCLUSION: Our study demonstrates that on-demand use of desloratadine during the pollen season is clinically as effective as regular treatment. However, regular treatment may provide better control of lower airway symptoms and airway reactivity.

Comparison of two methods for exhaled breath condensate collection.

BACKGROUND: Exhaled breath condensate (EBC) is a noninvasive method to obtain samples from fluids lining the respiratory surfaces. Even though various methods and devices are now available, the relative efficiency of these methods for recovering airway mediators and characterizing EBC has not been established. AIM: To compare the volume, pH, lipid mediator, and protein concentrations in EBCs collected by two commonly used commercially available devices, RTube and ECoScreen. METHODS: Exhaled breath condensates were obtained consecutively using the RTube and ECoScreen methods from 30 healthy, nonallergic adults. Samples were immediately placed on dry ice after collection. pH was measured after argon deaeration. Cysteinyl leukotrienes (cys-LTs) were measured as a representative lipid mediator and eotaxin as the protein mediator by using enzyme-linked immunosorbent assay. RESULTS: The mean volume of samples obtained with ECoScreen (1880 +/- 116 microl) was significantly higher than that obtained with RTube (1405 +/- 82 microl) (P < 0.001). Concentrations of both cys-LTs [205.4 pg/ml (65.5-472.3) with ECoScreen vs 21.6 (11.87-152.2) with RTube, P < 0.001] and eotaxin [17.0 pg/ml (11.4-22.4) with ECoScreen vs 11.7 (10.5-13.5) with RTube, P = 0.01] were significantly higher in samples collected with ECoScreen than with RTube. There was no significant difference between the pH measurements. CONCLUSION: Compared with RTube, collection of exhaled breath by ECoScreen allows larger volumes to be collected and detects protein and lipid mediators with greater sensitivity. These differences in mediator recovery may be due to the differences in the collection temperature.