Early caffeine therapy on the prevention of severe hyperkalemia in preterm infants.

BACKGROUND: The aim of this study was to evaluate the effect of caffeine therapy in preventing severe hyperkalemia in preterm infants. METHODS: We performed a single-center, retrospective study of preterm infants of 25-29 weeks' gestation admitted in our neonatal intensive care unit from January 2019-August 2020. We divided the infants into two groups: the control group (January 2019-November 2019) and the early caffeine group (December 2019-August 2020). RESULTS: We identified 33 infants (early caffeine, 15; control, 18). Baseline potassium levels were 5.3 and 4.8 mEq/L, respectively (p = 0.274). Severe hyperkalemia (K > 6.5 mEq/L) was observed in 0 (0%) and 7 (39%) (p = 0.009), in the early caffeine group and control group. The linear mixed-effect model confirmed the correlation between caffeine therapy and time from birth for the prediction of potassium levels (p < 0.001). While the potassium levels increased from baseline potassium levels at birth by 0.869 mEq/L at 12 h of birth, 0.884 mEq/L at 18 h of birth, and 0.641 mEq/L at 24 h of birth in the control group, the potassium levels were similar to the baseline levels at 12, 18, and 24 h of life in the early caffeine group. Among the clinical features, only early caffeine therapy was negatively associated with the incidence of hyperkalemia within 72 h of life. CONCLUSION: Early caffeine therapy within a few hours of life effectively prevents the incidence of severe hyperkalemia within the first 72 h of life in preterm infants of 25-29 weeks' gestation. Prophylactic early caffeine therapy can, therefore, be considered in high-risk, preterm infants.

Extreme Prematurity and Pulmonary Outcomes Program in Saitama: Protocol for a Prospective Multicenter Cohort Study in Japan.

BACKGROUND: Because of the improvements in survival rates for preterm infants, not only the rates of bronchopulmonary dysplasia (BPD) but also those of long-term respiratory complications of premature birth are increasing, resulting in financial and health burdens in developed countries. Thus far, the risk factors of respiratory morbidities in extremely preterm infants remain unknown. Furthermore, the definition and the predictive ability of BPD for long-term respiratory outcomes are yet to be determined. OBJECTIVE: The objective of our study, Extreme Prematurity and Pulmonary Outcomes Program in Saitama, is to develop the diagnostic criteria for BPD and to determine the prognostic factors contributing to the long-term pulmonary outcomes manifesting in extremely preterm infants. METHODS: The Extreme Prematurity and Pulmonary Outcomes Program in Saitama is an observational prospective cohort study performed by a consortium of six neonatal intensive care units (NICUs) in Saitama, Japan. The subjects included in this study are infants (from each clinical center) with gestational ages 22 to 27 weeks. The target is 400 subjects. This study aims to determine the definition of BPD and other perinatal factors that accurately predict the long-term pulmonary outcomes in survivors of extreme prematurity. Moreover, the association between BPD and postprematurity respiratory disease will be investigated using generalized linear models. RESULTS: The protocol and consent forms were evaluated and approved on September 5, 2019, by the Ethics Committee of Saitama Medical Center, Saitama Medical University. Enrollment began on April 1, 2020. It is expected to end on March 31, 2023. The follow-up for 1 year corrected age is expected to continue through the middle of 2024. CONCLUSIONS: The Extreme Prematurity and Pulmonary Outcomes Program in Saitama incorporates aspects of neonatal care in secondary- and tertiary-level NICUs to develop existing research studies on the definition of BPD, objective biomarkers, and outcome measures of respiratory morbidity in extremely preterm infants beyond NICU hospitalization, thereby leading to a novel understanding of the nature and natural history of BPD and potential mechanistic and therapeutic targets in at-risk subjects. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/22948.

Perinatal factors affecting growth and development at age 3 years in extremely low birth weight infants born small for gestational age.

Factors affecting growth and development in extremely low birth weight infants (ELBWIs) born small for gestational age (SGA) have not been precisely elucidated. We performed a retrospective analysis of ELBWIs born SGA who were treated in the neonatal intensive care unit of Kawaguchi Municipal Medical Centre, Japan. A total 244 ELBWIs were born from 2003 to 2010, and 31 were born with weight and height below the 10th percentile for their gestational age. Among the 31 ELBWIs born SGA, we excluded 9 who died before they reached 3 yr of age or who had severe developmental retardation. A total of 16 patients (weight, 510-998 g; GA, 28w0d-32w5d) who were followed until age 3 yr were eligible for our study. At age 3 yr, 94% and 88% of ELBWIs were above the -2 standard deviation (SD) for height and weight, respectively. A history of mechanical ventilation was associated with height. The average score of the full developmental quotient (DQ) was 85, and 63% (10/16) of ELBWIs scored more than 85. Lower Apgar score (≤ 7) was a risk factor for lower DQ scores in motor development and full development. Our study revealed that most ELBWIs born SGA were more than -2 SD below the mean for height and body weight.

Perioperative management of severe congenital protein C deficiency.

: Perioperative care of congenital protein C deficiency has not been well established. Here, we describe a patient with congenital protein C deficiency who underwent laparoscopic fundoplication and gastrostomy at 2 years of age. Preoperatively, we stopped warfarin, administered fresh frozen plasma, and activated protein C. These procedures were performed without bleeding or clotting events, and at 3 days after the procedures, we restarted warfarin. Several episodes of abdominal hemorrhage and purpura fulminans occurred 2-4 weeks postoperatively, and the events were managed conservatively. We conclude that an invasive procedure can be performed in patients with protein C deficiency with appropriate supportive therapy, and postoperative observation for a sufficient length of time is essential to minimize the risk of complications.