Does ibuprofen treatment in patent ductus arteriosus alter oxygen free radicals in premature infants?

Introduction Ibuprofen is used widely to close patent ductus arteriosus in preterm infants. The anti-inflammatory activity of ibuprofen may also be partly due to its ability to scavenge reactive oxygen species and reactive nitrogen species. We evaluated the interaction between oxidative status and the medical treatment of patent ductus arteriosus with two forms of ibuprofen. Materials and methods This study enrolled newborns of gestational age ⩽32 weeks, birth weight ⩽1500 g, and postnatal age 48-96 hours, who received either intravenous or oral ibuprofen to treat patent ductus arteriosus. Venous blood was sampled before ibuprofen treatment from each patient to determine antioxidant and oxidant concentrations. Secondary samples were collected 24 hours after the end of the treatment. Total oxidant status and total antioxidant capacity were measured using Erel's method. RESULTS: This prospective randomised study enrolled 102 preterm infants with patent ductus arteriosus. The patent ductus arteriosus closure rate was significantly higher in the oral ibuprofen group (84.6 versus 62%) after the first course of treatment (p=0.011). No significant difference was found between the pre- and post-treatment total oxidant status and total antioxidant capacity in the groups. Discussion Ibuprofen treatment does not change the total oxidant status or total antioxidant capacity. We believe that the effect of ibuprofen treatment in inducing ischaemia overcomes the scavenging effect of ibuprofen.

The propre-save study: effects of probiotics and prebiotics alone or combined on necrotizing enterocolitis in very low birth weight infants.

OBJECTIVE: To test the efficacy of probiotic and prebiotic, alone or combined (synbiotic), on the prevention of necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants. STUDY DESIGN: A prospective, randomized, controlled trial was conducted at 5 neonatal intensive care units in Turkey. VLBW infants (n = 400) were assigned to a control group and 3 study groups that were given probiotic (Bifidobacterium lactis), prebiotic (inulin), or synbiotic (Bifidobacterium lactis plus inulin) added to breastmilk or formula for a maximum of 8 weeks before discharge or death. The primary outcome was NEC (Bell stage ≥2). RESULTS: The rate of NEC was lower in probiotic (2.0%) and synbiotic (4.0%) groups compared with prebiotic (12.0%) and placebo (18.0%) groups (P < .001). The times to reach full enteral feeding were faster (P < .001), the rates of clinical nosocomial sepsis were lower (P = .004), stays in the neonatal intensive care unit were shorter, (P = .002), and mortality rates were lower (P = .003) for infants receiving probiotics, prebiotics, or synbiotic than controls. The use of antenatal steroid (OR 0.5, 95% CI 0.3-0.9) and postnatal probiotic (alone or in synbiotic) (OR 0.5, 95% CI 0.2-0.8) decreased the risk of NEC, and maternal antibiotic exposure increased this risk (OR 1.9, 95% CI 1.1-3.6). CONCLUSIONS: In VLBW infants, probiotic (Bifidobacterium lactis) and synbiotic (Bifidobacterium lactis plus inulin) but not prebiotic (inulin) alone decrease NEC.

Comparison of two natural surfactants for pulmonary hemorrhage in very low-birth-weight infants: a randomized controlled trial.

OBJECTIVE: To compare the efficacy of two natural surfactants for pulmonary hemorrhage in very low-birth-weight (VLBW) infants. STUDY DESIGN: A prospective randomized controlled trial was conducted on 42 infants who were divided into two groups, poractant alfa (n = 21) and beractant (n = 21). RESULTS: In both the groups, the mean standard deviation (SD) birth-weight and gestational age were similar (p = 0.33 and 0.89, respectively). Although, the mean oxygenation index (OI) increased after pulmonary hemorrhage compared with baseline value and decreased after surfactant in both groups, variations in OI were more prominent in poractant alfa group (before hemorrhage: 11.9, after hemorrhage: 22.7, 1 hour of surfactant: 14.6, 8th hour of surfactant: 7.8, 24th hour of surfactant: 8.5, p = 0.007 vs. before pulmonary hemorrhage:11.1, after pulmonary hemorrhage: 17.9, 1 hour of surfactant: 12.8, 8th hour of surfactant: 12.8, 24th hour of surfactant: 9.7, p = 0.02). There was no significant difference between the groups for OI values at all time points (p > 0.05). The rates of bronchopulmonary dysplasia (BPD) and mortality related to pulmonary hemorrhage were similar in both the groups. CONCLUSION: Both natural surfactants improved oxygenation when administered for pulmonary hemorrhage in VLBW infants. The type of surfactant seems to have no effect on BPD and mortality rates in these patients.

Partial trisomy 1q41-qter and partial trisomy 9pter-9q21.32 in a newborn infant: an array CGH analysis and review.

We report on a girl who presented with distinctive abducted hip and hyperextended knee. Cytogenetic analysis detected an extra derivative chromosome resulting from a balanced translocation in the mother and 3:1 segregation. Using array comparative genomic hybridization (CGH) in combination with conventional high resolution GTG banding, we designate the karyotype as 47, XX, +der(9)t(1;9)(q41;q21.32)mat, indicating tertiary trisomy of chromosome segments 1q41-qter and 9pter-9q21.32. A review and genotype-phenotype correlation suggested that the patient represented most of the manifestations of duplication of chromosome arms 1q and 9p. To our knowledge, a similar case has so far not been reported.

A Multicentered Study on Epidemiologic and Clinical Characteristics of 37 Neonates With Community-acquired COVID-19.

BACKGROUND: Coronavirus disease 2019 (COVID-19) primarily affects adults and spares children, whereas very little is known about neonates. We tried to define the clinical characteristics, risk factors, laboratory, and imagining results of neonates with community-acquired COVID-19. METHODS: This prospective multicentered cohort study included 24 neonatal intensive care units around Turkey, wherein outpatient neonates with COVID-19 were registered in an online national database. Full-term and premature neonates diagnosed with COVID-19 were included in the study, whether hospitalized or followed up as ambulatory patients. Neonates without severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) via reverse transcriptase-polymerase chain reaction testing or whose mothers had been diagnosed with COVID-19 during pregnancy were excluded. RESULTS: Thirty-seven symptomatic neonates were included. The most frequent findings were fever, hypoxemia, and cough (49%, 41%, 27%, respectively). Oxygen administration (41%) and noninvasive ventilation (16%) were frequently required; however, mechanical ventilation (3%) was rarely needed. Median hospitalization was 11 days (1-35 days). One patient with Down syndrome and congenital cardiovascular disorders died in the study period. C-reactive protein (CRP) and prothrombin time (PT) levels were found to be higher in patients who needed supplemental oxygen (0.9 [0.1-8.6] vs. 5.8 [0.3-69.2] p = 0.002, 11.9 [10.1-17.2] vs. 15.2 [11.7-18.0] p = 0.01, respectively) or who were severe/critical (1.0 [0.01-8.6] vs. 4.5 [0.1-69.2] p = 0.01, 11.7 [10.1-13.9] vs. 15.0 [11.7-18.0] p = 0.001, respectively). CONCLUSIONS: Symptomatic neonates with COVID-19 had high rates of respiratory support requirements. High CRP levels or a greater PT should alert the physician to more severe disease.

Effect of Hyperbilirubinemia on Medial Olivocochlear System in Newborns.

OBJECTIVES: To evaluate medial olivocochlear efferent system of babies with hyperbilirubinemia with normal auditory brain stem responses. MATERIALS AND METHODS: This was a prospective study in a tertiary referral hospital. The study involved 40 hyperbilirubinemic and 44 healthy newborns. Cochlear and auditory activity of participants was evaluated by transient otoacoustic emissions (TOAEs) and brainstem auditory evoked response components (BAER). Medial olivocochlear (MOC) reflex was evoked with contralateral acoustic stimulation and recorded with TOAEs. RESULTS: A comparison of the MOC reflex activity between two groups with Mann Whitney U test revealed that MOC reflex activity were significantly decreased in the hyberbilirubinemic group for both ears (p<.05). This difference was significant for all frequencies in both ears. There was no significant relation between total serum bilirubin level and MOC reflex activity. CONCLUSION: Hyperbilirubinemic newborns had decreased MOC reflex activity. This may be indicative of future problems in speech discrimination and effective hearing in noisy background. Additional long cohort studies are needed to evaluate the clinical importance of MOC reflex measurements in this group. MOC reflex measurement has the potential to form part of the audiologic evaluation of newborns with hyperbilirubinemia in the future.

Early neonatal outcomes of volume guaranteed ventilation in preterm infants with respiratory distress syndrome.

BACKGROUND: Volume guaranteed (VG) synchronized intermittent mandatory ventilation (SIMV) is a novel mode of SIMV that provides automatic adjustment of the peak inspiratory pressure for ensuring a minimum set tidal volume and there are limited data about the effects of VG ventilation on short term neonatal outcomes in preterm infants with respiratory distress syndrome (RDS). OBJECTIVE: The main objective of this study was to evaluate the effect of VG ventilation on duration of ventilation and total supplemental oxygen. We also aimed to compare the early neonatal outcomes of VG ventilation versus conventional SIMV on short-term outcomes in preterm babies with RDS who were given surfactant. METHODS: In this randomized controlled study, preterm infants who were admitted with RDS and given surfactant were divided into 2 groups: group 1 included infants ventilated on conventional SIMV (n = 30) and group 2 included infants ventilated on VG ventilation (n = 42). Neonatal morbidities such as air leak, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC) and duration of mechanical ventilation and total oxygen supplementation were all recorded. RESULTS: There were no significant differences between two groups in terms of demographic features. Infants ventilated with VG mode had significantly shorter duration of ventilation and need of total supplemental oxygen. The incidences of oxygen related short term complications including BPD, ROP, and IVH were also significantly lower in these infants compared with those ventilated with conventional SIMV. No significant differences were found between two groups with respect to NEC and air leak. CONCLUSION: In conclusion, VG ventilation in combination with surfactant treatment significantly reduced both duration of mechanical ventilation and early neonatal oxygen related morbidities including BPD, ROP and IVH in preterm infants with RDS. This data favors the use of VG ventilation in respiratory support of premature infants.

Clarithromycin treatment in preterm infants: a pilot study for prevention of feeding intolerance.

OBJECTIVE: To compare the effectiveness of oral clarithromycin versus placebo treatment in preventing feeding intolerance in very low birth weight (VLBW) infants. STUDY DESIGN: A prospective, randomised controlled trial in which two groups of preterm infants (birth weight <1500 g) were randomised to clarithromycin (7.5 mg/kg/dose every 12 h) or placebo treatment. During the period, 38 infants, whose parents accepted participation, were enrolled in the study. Feeding intolerance and time to achieve full enteral feeding were considered as primary outcome measures. RESULTS: Feeding intolerance was significantly longer in placebo than clarithromycin (p = 0.031). Time to achieve full feeding after beginning the treatment was equal among the groups. CONCLUSION: This is the first randomised controlled study of clarithromycin and placebo treatment that compares the improvement of feeding intolerance in VLBW infants. Our findings indicate a dramatic improvement in feeding intolerance after oral clarithromycin treatment. But according to our results, clarithromycin-treated infants were not able to attain full enteral feeding more quickly than placebo. This may be due to prophylactic usage of clarithromycin. Significant differences might have resulted if only infants who had feeding intolerance were recruited.

Possible association of medications during pregnancy with low estriol level of the triple antenatal screening test.

OBJECTIVE: Our purpose was to reach the reasons of isolated low levels of maternal serum unconjugated estriol (uE3) levels (≤ 0.3 multiples of the median (MoM)) in the triple-marker screen with special emphasis on maternal diseases and medications used for them. METHODS: Single center retrospective cross-sectional analysis. Of 13,367 non-smoking women with identified singleton pregnancies screened for triple test, during 3-year period (2007-2009), a group of women with isolated low serum uE3 levels (≤ 0.3 MoM) (n = 14) were selected as the study group. RESULTS: Of these 14 women, no one gave birth with ichthyosis. Five patients had, isolated very low uE3 levels (<0.01 MoM). Of these women, one had umbilical cord knot, one was on corticosteroid and three were on propylthiouracil treatment. So, there was history of maternal drug intake in 28.5% of cases with isolated low uE3 (≤ 0.3 MoM). This rate increases to 80% in cases with very low uE3 levels (<0.01 MoM). CONCLUSIONS: Maternal diseases and medications used during pregnancy can affect fetus and antenatal screening test results. This is important during counseling of patients and to perform the appropriate antenatal and postnatal evaluation of the mother and fetus with multidisciplinary approach.

Serum fructosamine and retinopathy of prematurity.

OBJECTIVE: To determine whether serum fructosamine which is a good marker for detecting hyperglycemia during the previous 2 to 3 wk in infants could predict the development of retinopathy of prematurity in very low birth weight infants. METHODS: One hundred sixty seven premature infants who had a birth weight of < 1500 g and a gestational age of less than 32 wk were investigated in the present study. Blood glucose was measured at the bedside and infants were recorded as hyperglycemic if their mean blood glucose levels were higher than 150 mg/dL. Serum corrected fructosamine level was obtained from the cord blood at birth and after the first month of life. The infants' eyes were examined by ophthalmologists to detect retinopathy of prematurity at the gestational age of 32 wk or at four wk after birth, whichever came first. RESULTS: Corrected fructosamine was 319.6 ± 59.6 and 272.8 ± 50.6 mmol/l for group 1 on 1(st) and 30(th) day respectively; 320 ± 61.7 and 268.2 ± 47.3 mmol/l for groups 2 + 3 on 1(st) and 30(th) day respectively which did not differ between groups (p = 0.766 and p = 0.665), whereas duration of hyperglycemia was 1.69 ± 1.1 day in group 1 compared with 3.05 ± 2.4 day in groups 2 + 3 which was significantly different (p = 0.019). The multivariate regression analysis indicated that the duration of hyperglycemia in days was significantly correlated with the development of retinopathy of prematurity (OR 3.26; 95% CI 1.09-9.80; p = 0.035). CONCLUSIONS: Although the duration of hyperglycemia may contribute to the development of retinopathy of prematurity, serum corrected fructosamine does not have a good predictive value in developing retinopathy of prematurity in very-low-birth-weight (VLBW) infants.

Profile of children with migraine.

OBJECTIVE: To assess the clinical characteristics of patients with migraine. METHODS: The medical records of 76 patients diagnosed with migraine were reviewed using the ICHD-II 2004 diagnosis criteria. The patients were classified into three age groups: 3-6 yr olds (group I), 7-12 yr olds (group II), and 13-17 yr olds (group III). RESULTS: Migraine was the most common cause of headache in the patients of present pediatric neurology outpatient clinic (57.1%, 76/133). The mean age of patients was 11.08 ± 3.27 (3.25-17) yrs. The number of girls as the age increased (groups II and III). The mean headache attacks rate was 2.5 ± 1.5 per wk, which resulted in worsening of school performance (n = 26, 34.2%). In the majority of patients (n = 54, 71.1%), there was a family history of migraine or headache in the close relatives. Prophylaxis was found effective for all given medications (flunarizine: 46/54, propranolol: 19/21, topiramate: 10/10, sodium valproate: 1/1). CONCLUSIONS: These findings indicate that: (a) migraine is the most frequent cause of headache in pediatric patients, (b) it has negative effects on school performance and daily activities, (c) the family history is important for making the diagnosis and (d) prophylaxis is significantly effective.

Profile of Children with Migraine.

Objective To assess the clinical characteristics of patients with migraine. Methods The medical records of 76 patients diagnosed with migraine were reviewed using the ICHD–II 2004 diagnosis criteria. The patients were classified into three age groups: 3–6 yr olds (group I), 7–12 yr olds (group II), and 13–17 yr olds (group III). Results Migraine was the most common cause of headache in the patients of present pediatric neurology outpatient clinic (57.1%, 76/133). The mean age of patients was 11.08±3.27 (3.25–17) yrs. The number of girls as the age increased (groups II and III). The mean headache attacks rate was 2.5±1.5 per wk, which resulted in worsening of school performance (n=26, 34.2%). In the majority of patients (n= 54, 71.1%), there was a family history of migraine or headache in the close relatives. Prophylaxis was found effective for all given medications (flunarizine: 46/54, propranolol: 19/21, topiramate: 10/10, sodium valproate: 1/1). Conclusions These findings indicate that: (a) migraine is the most frequent cause of headache in pediatric patients, (b) it has negative effects on school performance and daily activities, (c) the family history is important for making the diagnosis and (d) prophylaxis is significantly effective.