Breast milk with unusual colour / Leche humana de color poco habitual

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Optimización de medidas para evitar el enfriamiento en la primera hora de vida de los prematuros menores de 35 semanas de gestación / Optimisation of measures to protect premature neonates of less than 35 weeks from the cold in the first hour of life

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Aspiració d'aigua dolça en un nadó nascut en una banyera / Aspiración de agua dulce en un neonato nacido en una bañera / Fresh water aspiration in a newborn after and underwater delivery

Introducció: els últims anys, el nombre de parts a l'aigua ha augmentat com a alternativa als parts medicalitzats, amb la idea que la immersió durant el part aporta diversos beneficis per a la mare i per al nadó. Cas clínic: es presenta el cas d'un nadó nascut en una banyera que desenvolupa insuficiència respiratòria greu i hipertensió pulmonar secundàries a l'aspiració d'aigua dolça. Comentaris: l'aspiració d'aigua és una de les complicacions a les quals s'exposen els nadons que neixen a l'aigua. El reflex de tancament de la glotis al medi aquàtic, que en condicions òptimes permet al nounat evitar l'aspiració, pot quedar abolit per l'anestèsia materna, en situacions d'asfíxia i d'hipotèrmia o hipertèrmia. S'han descrit casos de complicacions neonatals greus en relació amb l'expulsiu a l'aigua i, recentment, diverses societats de ginecologia i de pediatria han publicat la seva opinió respecte al part i l'expulsiu a l'aigua

Introducción. En los últimos años, el número de partos en el agua ha aumentado como alternativa a los partos medicalizados, con la idea de que la inmersión durante el parto aporta varios beneficios para la madre y el recién nacido. Caso clínico. Se presenta el caso de un neonato nacido en una bañera que desarrolla insuficiencia respiratoria severa e hipertensión pulmonar secundarias a la aspiración de agua dulce. Comentarios. La aspiración de agua es una de las complicaciones a las que se exponen los neonatos que nacen en el agua. El reflejo de cierre de la glotis en medio acuático, que en condiciones óptimas permite al recién nacido evitar la aspiración, puede quedar abolido por la anestesia materna, en situaciones de asfixia, de hipotermia o hipertermia. Se han descrito casos de complicaciones neonatales graves en relación al expulsivo en el agua y, recientemente, varias sociedades de ginecología y de pediatría han publicado su opinión respecto al parto y al expulsivo en el agua (AU)

Introduction. In recent years, underwater birth rates have increased as an alternative to medicalized births, due to the perception that water immersion during labor provides several benefits to both mother and baby. Clinical case. We report the case of a baby born in a bathtub who developed respiratory failure and pulmonary hypertension secondary to water aspiration. Comments. Water aspiration is one of the complications related to underwater delivery. In optimal situation the baby can prevent water aspiration with the glottis closure reflex. However, this reflex may be abolished by asphyxia, hypothermia, hyperthermia, and maternal anesthesia. There have been reports of severe neonatal complications in relation to underwater delivery, and several gynecology and pediatrics professional societies have recently published their statements about labor and delivery in water (AU)

Combination of vancomycin and rifampicin for the treatment of persistent coagulase-negative staphylococcal bacteremia in preterm neonates.

UNLABELLED: Coagulase-negative staphylococci are the most common cause of late-onset sepsis in premature neonates. The optimal approach in persistent coagulase-negative staphylococcal bacteremia, despite adequate treatment with glycopeptides, is not well established. A retrospective study was conducted on preterm neonates with persistent coagulase-negative staphylococcal bacteremia treated with the combination of vancomycin-rifampicin. Ten cases were included, with a median gestational age of 26 weeks (range 24 weeks + 3 days-31 weeks + 4 days, interquartile range 25 weeks + 3 days-29 weeks + 3 days) and a median birth weight of 715 g (range 555-2,030). The median age at the onset of infection was 9 days (range 5-37). The most frequent clinical presentation was apnea or increased ventilatory support. Bacteremia persisted for a median of 9 (range 6-19) days until rifampicin initiation. Bacteremia was resolved in all cases on vancomycin-rifampicin with no serious side effects. CONCLUSION: Our study provides data supporting the safety and efficacy of vancomycin-rifampicin combination for the treatment of persistent coagulase-negative staphylococcal bacteremia in preterm neonates.

Trends in survival among extremely-low-birth-weight infants (less than 1000 g) without significant bronchopulmonary dysplasia.

OBJECTIVE: The aim of this study was to analyze the evolution from 1997 to 2009 of survival without significant (moderate and severe) bronchopulmonary dysplasia (SWsBPD) in extremely-low-birth-weight (ELBW) infants and to determine the influence of changes in resuscitation, nutrition and mechanical ventilation on the survival rate. STUDY DESIGN: In this study, 415 premature infants with birth weights below 1000 g (ELBW) were divided into three chronological subgroups: 1997 to 2000 (n = 65), 2001 to 2005 (n = 178) and 2006 to 2009 (n = 172).Between 1997 and 2000, respiratory resuscitation in the delivery room was performed via a bag and mask (Ambu®, Ballerup, Sweden) with 40-50% oxygen. If this procedure was not effective, oral endotracheal intubation was always performed. Pulse oximetry was never used. Starting on January 1, 2001, a change in the delivery room respiratory policy was established for ELBW infants. Oxygenation and heart rate were monitored using a pulse oximeter (Nellcor®) attached to the newborn's right hand. If resuscitation was required, ventilation was performed using a face mask, and intermittent positive pressure was controlled via a ventilator (Babylog2, Drägger). In 2001, a policy of aggressive nutrition was also initiated with the early provision of parenteral amino acids. We used standardized parenteral nutrition to feed ELBW infants during the first 12-24 hours of life. Lipids were given on the first day. The glucose concentration administered was increased by 1 mg/kg/minute each day until levels reached 8 mg/kg/minute. Enteral nutrition was started with trophic feeding of milk. In 2006, volume guarantee treatment was instituted and administered together with synchronized intermittent mandatory ventilation (SIMV + VG). The complications of prematurity were treated similarly throughout the study period. Patent ductus arteriosus was only treated when hemodynamically significant. Surgical closure of the patent ductus arteriosus was performed when two courses of indomethacin or ibuprofen were not sufficient to close it.Mild BPD were defined by a supplemental oxygen requirement at 28 days of life and moderate BPD if breathing room air or a need for <30% oxygen at 36 weeks postmenstrual age or discharge from the NICU, whichever came first. Severe BPD was defined by a supplemental oxygen requirement at 28 days of life and a need for greater than or equal to 30% oxygen use and/or positive pressure support (IPPV or nCPAP) at 36 weeks postmenstrual age or discharge, whichever came first. Moderate and severe BPD have been considered together as "significant BPD". The goal of pulse oximetry was to maintain a hemoglobin saturation of between 88% and 93%. Patients were considered to not need oxygen supplementation when it could be permanently withdrawn. The distribution of the variables was not normal based on a Kolmogorov-Smirnov test (p < 0.05 in all cases). Therefore, quantitative variables were expressed as the median and interquartile range (IQR; 25th-75th percentile). Statistical analysis of the data was performed using nonparametric techniques (Kruskal-Wallis test and Mann-Whitney U test). A chi-square analysis was used to analyze qualitative variables. Potential confounding variables were those possibly related to BPD in survivors (p between 0.05 and 0.3 in univariate analysis). Logistic regression analysis was performed with variables related to BPD in survivors (p < 0.05) and potential confounding variables. The forward stepwise method adjusted for confounding factors was used to select the variables, and the enter method using selected variables was used to obtain the odds ratios. RESULTS AND CONCLUSION: There was an increase in the rate of SWsBPD (1997 to 2000: 58.5%; 2001 to 2005: 74.2%; and 2006 to 2009: 75.0%; p = 0.032). In survivors, the occurrence of significant BPD decreased after 2001 (9.5% vs. 2.3%; p = 0.013). The factors associated with improved SWsBPD were delivery by caesarean section, a reduced endotracheal intubation rate and a reduced duration of mechanical ventilation.While the mortality of ELBW infants has not changed since 2001, the frequency of SWsBPD has significantly increased (75.0%) in association with increased caesarean sections and reductions in the endotracheal intubation rate, as well as the duration of mechanical ventilation.

Serum soluble ICAM-1, VCAM-1, L-selectin, and P-selectin levels as markers of infection and their relation to clinical severity in neonatal sepsis.

Adhesion molecules may play a role in the evolution and severity of neonatal sepsis. The purposes of this study were to determine whether serum soluble intercellular adhesion molecule (ICAM)-1, vascular cell adhesion molecule (VCAM)-1, L-selectin, and P-selectin levels are useful tools in the diagnosis of proven sepsis in newborn infants, and whether their levels are related to the clinical severity of the disease. A cohort of 25 consecutive newborns meeting criteria for clinical sepsis, 10 hemoculture-negative (HC - ) and 15 hemoculture-positive (HC + ), were prospectively followed and compared with 12 healthy newborns (six /= 39 weeks). Serum soluble (s)ICAM-1, sVCAM-1, sL-selectin, and sP-selectin concentrations were measured at the time of the septic workup, then followed by up to three determinations in each newborn every third day. The Score for Neonatal Acute Physiology (SNAP)-II severity was assessed at the moment of highest clinical severity of the disease. At the beginning of sepsis, sICAM-1 levels increased in both groups, being higher in HC + sepsis than in HC - ; sVCAM-1 only increased slightly in HC + sepsis. Soluble ICAM-1 levels were independently related to group of sepsis, and not to days of life. The best initial sICAM-1 cutoff level for diagnosing HC + neonatal sepsis was 274 microg/L. The highest sICAM-1 levels were positively correlated with SNAP-II scores. Soluble L-selectin and sP-selectin did not change. Soluble ICAM-1 levels increased in HC - and HC + sepsis, but concentrations > 274 microg/L suggest HC + sepsis. These levels were related to the clinical severity of the disease. Soluble VCAM-1 levels increased only slightly in HC + sepsis. Soluble L-selectin and sP-selectin did not change.

Nonimmune hydrops fetalis due to congenital xerocytosis.

Hereditary xerocytosis is a rare hemolytic anemia in which erythrocytes are dehydrated due to a loss of potassium and water through their cell wall membrane. In adults, this condition leads to a mild-to-moderate hemolysis. We report a case of hydrops fetalis secondary to hereditary xerocytosis. Management with intrauterine erythrocyte and albumin transfusions resulted in a favorable postnatal course.

Energy intake, metabolic balance and growth in preterm infants fed formulas with different nonprotein energy supplements.

OBJECTIVE: To study metabolic and energy balances, growth and composition of increased body mass in healthy preterm infants fed control formula or control formula with three different nonprotein energy supplements. PATIENTS AND METHODS: Growing preterm infants (birth weight < 1,500 g and gestational age < 31 weeks) were fed standard preterm formula (control group) or the same formula enriched with three different nonprotein energy supplements. An energy supplement of 23 kcal/kg/day was achieved by adding medium-chain triglyceride and dextrinomaltose in three different caloric ratios: 33:66 in group A, 66:33 in group B, and 85:15 in group C. Energy balance was determined by open-circuit continuous (5-6 hours) measurements of energy expenditure, with simultaneous measurement of 24-hour urinary nitrogen excretion. Metabolic balance was determined by measurements of energy intake, energy oxidation, and energy output in urine and stool. The composition of body mass accretion was determined as the accretion of fat and protein in the total weight gain. RESULTS: The fat accretion (4.9, 5.9, 6.2, and 3.8 g/kg/day in groups A, B, C and D, respectively) correlated directly with fat intake. Infants receiving standard energy intake had a fat percentage of weight gain significantly lower (28%) than that of the high-energy intake groups (31%, 40%, and 38% in groups A, B, and C, respectively). This difference corresponded to the results obtained from skinfold thickness measurements. CONCLUSIONS: Excess nonprotein energy is stored as fat regardless of its source (fat or carbohydrate). High caloric and medium-chain triglyceride intake in otherwise healthy growing preterm infants does not promote nitrogen retention.