Atypical histological presentation of bone regeneration after insertion of cryoprotected allogeneic bone graft.

BACKGROUND: To evaluate bone regenerative capacity of cryoprotected corticocancellous allogeneic bone graft performed in type II and III post-extraction sockets for ridge preservation after twelve weeks in-vivo. MATERIAL AND METHODS: Twenty-seven type II or III bony-walled extraction sockets (mandible and maxilla) were selected for this study. Following atraumatic tooth-extraction a cryoprotected corticocancellous allogeneic bone graft material and a resorbable porcine-derived collagen membrane were used for ridge preservation. During re-entry surgery at approximately 12 weeks, bone core biopsies were obtained using a 3.2 mm trephine drill and samples were histologically processed and subjected to qualitative and quantitative histomorphometric analysis. Quantitative data was analyzed using a general linear mixed model with results presented as mean values with the corresponding 95% confidence interval values. RESULTS: Healing without incident and ridge preservation allowed for the placement of dental implants after 12 weeks in 25 out of the 27 treated socket sites. Analyses yielded an average of ~21.0±7% of old/native bone, ~17±5.5% of newly regenerated bone (total of ~38±12.8% for all bone), 0.23±0.14% of new bone presenting with nucleating sites within the matrix, ~52±5.12% of soft tissue, and 3.6±2.09% of damaged bone. The average regenerated bone was statistically analogous to that of old/native bone (p=0.355). Furthermore, an atypical histological pattern of bone regeneration was observed, with newly formed bone exhibiting "infiltration-like" behavior and with new bone nucleating sites observed within the demineralized bone matrix. CONCLUSIONS: Cryoprotected corticocancellous allogeneic bone-graft demonstrated osteoconductive, osteoinductive, and osteogenic properties, yielding unique healing patterns which does warrant further investigation.

How much does a minimum weight at discharge delay discharge from the neonatal intensive care unit?

BACKGROUND: Current American Academy of Pediatrics guidelines recommend discharge at physiologic maturity regardless of weight; however, our institution's neonatal ICU policy requires a minimum weight of 1800 g for discharge even when infant is physiologically mature. So, we wanted to determine if discharge at physiologic maturity (PM), based on national guidelines, would decrease hospital days (HD). METHODS: We reviewed 129 infants with birthweight 1300g- 1800 g. Data were analyzed by paired t-test/ Wilcoxon-rank-sum test. RESULTS: Age at discharge vs. age at PM was 0.55d per infant higher (P-value 0.033) resulting in 71 total HD. For SGA babies, this difference was 1.47d vs 0.19d in non-SGA babies (P- value 0.0243) and this difference was an average of 2.63d (P-value < 0.001) for those who reached PM < 1800 g, contributing to 50 of 71 HD potentially saved. CONCLUSION: There was a 0.55-2.6-day difference between age at discharge and age at PM, greater in SGA infants and infants who reached PM prior to 1800 g. There might be an opportunity to send infants home earlier to their families if there is no minimum weight required.

Safety of immediate skin-to-skin contact after vaginal birth in vigorous late preterm neonates - A pilot study.

BACKGROUND: To evaluate the safety of immediate skin-to-skin contact (SSC) in vigorous late preterm neonates, where observation under radiant warmer is standard of care, in a prospective, randomized, controlled, and equivalence pilot study. METHODS: Singletons born vaginally at 35-36 6/7 weeks gestation were randomized to initiate immediate SSC or standard of care with continuous pulse oximeter monitoring for the first hour of life. RESULTS: Forty-seven dyads were randomized to SSC (n = 21) or radiant warmer (n = 26). Vitals were recorded at designated time intervals to assess tolerance of postnatal transitioning. We found no significant difference in the number of SSC interruptions, pulse oximeter readings, initial glucose level, and rates of hypoglycemia, hypothermia, or NICU admission between the two groups. CONCLUSIONS: Vigorous late preterm neonates transitioned to immediate SSC without additional risks compared to control counterparts. Large, multicenter, and randomized-control studies need to be conducted to establish standardized guidelines for this practice.

Safety and efficacy of delayed umbilical cord clamping in multiple and singleton premature infants - A quality improvement study.

OBJECTIVES: To evaluate the safety and efficacy of a quality improvement (QI) program of delayed umbilical cord clamping (DCC) in multiple and singleton preterm infants born at our center. METHODS: After DCC protocol implementation, compliance and success rate were assessed. Clinical outcomes of selected 150 preterm infants <34 weeks gestation born in 2014 after protocol implementation (Epoch II) were compared to those of preterm infants born in 2013 before protocol implementation (Epoch I). RESULTS: Overall protocol compliance rate was 92% (246/267). DCC was successfully performed in 77% (205/267) after protocol implementation. There were higher multiple births in Epoch II compared to Epoch I (27.3 vs. 15.3% , p <  0.01). At birth, infants in Epoch II had significantly decreased need for intubation in delivery room (23.3 vs. 39.3% , p <  0.01), had higher hematocrit (46.4±7.3 vs. 44.0±7.1% , p <  0.01) and less metabolic acidosis (base excess -4.1±2.7 vs. -5.3±4.2 mmol/L, p <  0.01) compared to those born in Epoch I. During hospital stay, fewer infants in Epoch II received rescue surfactant therapy (45.3 vs. 56.7% , p = 0.05), medical treatment for PDA (6.7 vs. 16.6% , p = 0.04%) and red blood cell transfusions (20.7 VS. 32.0% , p <  0.01) compared to Epoch I. CONCLUSIONS: Protocol-guided practice of DCC for 30 seconds can be safely performed in multiple and singleton preterm infants. In addition to higher initial hematocrit, infants in our QI project had lower need for delivery room resuscitation and less metabolic acidosis at birth. We also observed decreased need for rescue surfactant therapy, medical treatment for PDA and red blood cell transfusions after DCC protocol implementation.

Experience with a gonadotrophin-releasing hormone agonist prior to myomectomy--comparison of twice- vs thrice-monthly doses and a control group.

The aim of this randomised prospective study was to investigate the impact of preoperative gonadotrophin-releasing hormone agonist (GnRHa) compared with a control group with myomectomy. A total of 36 women (n = 36, group 1) with fibroids were randomised to receive either two monthly doses (n = 18/36, group 1a) or three monthly doses of goserelin (n = 18/36, group 1b) prior to myomectomy. The 32 women who received no treatment (group 2) comprised the controls. All patients had similar demographic features. There were no significant differences among the three groups with respect to: (1) mean intraoperative blood loss; (2) preoperative and postoperative blood transfusion or (3) length of hospital stay. The only advantage of administering GnRHa prior to myomectomy for symptomatic fibroids in our population was a higher haemoglobin level prior to surgery among the women who received three doses of the drug.

Pregnancy outcome among women universally screened for gestational diabetes mellitus with a lime-flavoured drink.

We performed a prospective study involving 400 consecutive pregnant patients to determine whether the administration of a lime-flavoured glucose drink followed by a blood test 1 h later was a better method of screening for gestational diabetes (GDM) than the use of selective screening based on risk factors (maternal age over 30 years, East Indian ancestry and obesity). Complete data were available for 388 women, 76 were screen positive (1 h blood glucose ≥ 140 mg/dl) and GDM was diagnosed in 42 (using a 75 g oral glucose tolerance test) giving a positive predictive value of 55%. Selective screening applied to the same population would have identified only 34 cases, eight fewer with GDM. In this population, the use of the lime-flavoured glucose drink detected approximately 25% more cases of GDM than selective screening based on risk factors. Caesarean sections were performed in 18 (42.8%) of women with gestational diabetes. None of the four perinatal deaths was observed among the women with gestational diabetes.

Neonatal-perinatal risk factors for the development of persistent pulmonary hypertension of the newborn in preterm newborns.

There is a long-held belief that preterm newborns lack sufficient arteriolar musculature to maintain a prolonged elevated pulmonary vascular resistance (PVR) after birth. Net ductal flow is thought to be minimal, with the developing pulmonary circulation incapable of significant vasoconstriction. We identified retrospectively 15 premature newborns over a 10-year period weighing < or = 1500 g and with a gestational age of < or = 30 weeks with documented persistent pulmonary hypertension of the newborn (PPHN) in the first 24 hours after birth. We matched 36 newborns of similar weight and gestation with no clinical evidence of shunting. The control group weaned to an FiO2 < or = 0.50 by 12 hours after birth. Despite similar gestational ages, the PPHN group (n = 15) had significantly higher birth weights than the control group (n = 36). The duration of ruptured membranes, maternal tobacco use, and use of antenatal steroids were significantly higher in the PPHN group. We speculate that these three factors might act in a synergistic relationship with which to accelerate pulmonary vascular smooth muscle development in premature newborns.

Effect of polyclonal anti-TNFalpha antibody on endotoxic shock in suckling rats.

The aim of this study was to evaluate the effect of anti-tumor necrosis factor alpha (TNFalpha) antibodies on the TNFalpha gene expression in a neonatal septic shock model. Ten-day-old Sprague-Dawley rats were divided into four groups and given intraperitoneal (ip) injection as follows: group 1: 0.1 ml saline; group 2: 0.1 mg/kg Salmonella enteritidis lipopolysaccharide (LPS); group 3: 1 mg/kg of anti-TNFalpha antibodies (Ab); group 4: 0.1 mg/kg of LPS and 1 mg/kg of Ab. We found that in group 2, LPS induced shock, demonstrating hypoglycemia and lactacidemia (p < 0. 05) and death (81.8%). Ab decreased the mortality significantly (35%) and attenuated the hypoglycemia (35 +/- 8 mg/dl in group 2 vs. 53 +/- 3 mg/dl in group 4) and lactacidemia (5.40 +/- 0.63 vs. 2.35 +/- 0.45 mmol) at 8 h in group 4 when compared to group 2. Northern blot demonstrated a significant decrease in TNFalpha mRNA expression in group 4 as compared to group 2, at 2 h after LPS injection. We conclude that the beneficial effects of anti-TNFalpha antibodies on LPS-induced shock may be due to decreased TNFalpha gene expression.