Kireä kielijänne ja hämmentävä huulijänne - pitääkö hoitaa?

VertaisarvioituImetyksen parantamiseksi tehtävät vauvan kielijänteen leikkaukset ovat yleistyneet useissa maissa, viime aikoina myös ylähuulijänteen leikkaukset. Asiasta käydään vilkasta keskustelua sosiaalisessa mediassa. Kireyden arviointiin ei ole olemassa hyvää kliinistä luokittelua. Toimenpidekäytännöt vaihtelevat alueittain. Tutkimusnäytön perusteella kielijänne kannattaa katkaista, jos jänne rajoittaa kielen liikkeitä. Ylähuulijänteen vaikutuksesta imemiseen ei ole näyttöä.Peer reviewe

Pulmonary nitric oxide in preterm and term infants with respiratory failure

Abstract The aim of the study was to evaluate pulmonary endogenous and inhaled nitric oxide (NO) in neonates with severe respiratory failure. Infant autopsy documents were reviewed for fulminant early-onset bacterial pneumonia. 12 infants with the onset at < 72 h of age and three control groups were identified. Immunohistochemistry revealed that 11 of the infants with early-onset pneumonia (92%) had no or faint inducible nitric oxide synthase (NOS2) staining in their alveolar macrophages (AM). All control infants, regardless of their postnatal age, had NOS2-positive AM. The marker of NO-toxicity, nitrotyrosine, was low in all specimens. To confirm this finding, airway specimens of 21 newborns requiring mechanical ventilation were examined. Seven of them had fulminant early-onset pneumonia with maternal ascending intra-uterine infection (IUI). The controls had no infection at birth despite IUI or neither infection nor IUI. In early-onset pneumonia, NOS2 and nitrotyrosine immunoreactivity were low at birth and increased during the recovery phase (p < 0.05). Analyses of interleukin-1 and surfactant protein A showed the same pattern of age-dependent change. Of the autopsied infants, 12 had received inhaled NO (iNO) before death. Each case was paired with a matched control. Additional five infants without respiratory failure prior to death were also studied. The iNO-treated ones tended to have more intensive NOS2 staining in the bronchiolar epithelium and adjacent tissue than the controls. No differences in other NOS isoforms or nitrotyrosine were detected. A novel method for exhaled NO measurements of intubated infants was developed. Six preterm and six term newborns were prospectively recruited for expired and nasal NO measurements. During the first week of life, the preterm infants showed a different pattern of exhaled NO excretion compared to the term infants. For the pilot intervention study on very early iNO, the eligible patients had a birth weight < 1500 g and progressive, therapy-resistant respiratory failure before five hours of age. Five infants received iNO, showed immediately improved oxygenation and survived without deleterious side effects. Deficient production of NO in small premature infants is associated with severe infection and respiratory failure. Very early iNO therapy may be exceptionally effective in a select group of infants, and did not appear to cause oxidation lung injury

Kosketuksen vaikutus pikkukeskosen stressiin – Integroitu kirjallisuuskatsaus

Integroidun kirjallisuuskatsauksen tarkoituksena oli kuvata kosketuksen vaikutuksia pikkukeskosen stressiin. Tiedonhaku suoritettiin Academic Search Ultimate (EBSCO)-, Pubmed-, Scopus-, Cinahl (EBSCO)-, ProQuest-, ARTO-, Journal.fi- ja Oulu-Finna-tietokannoista. Lisäksi sitä täydennettiin manuaalisella tiedonhaulla vuosilta 2000–2020 valittujen tutkimusten lähdeluetteloista. Tutkimusaineistoksi valikoitui laadunarvioinnin jälkeen 14 tutkimusta, jotka analysoitiin aineistolähtöisellä sisällönanalyysimenetelmällä. Kosketusstimulaatio ei ollut pikkukeskoselle vahingollinen tai stressiä aiheuttava menetelmä. Kosketus vaikutti myönteisesti pikkukeskosen stressihormonitasoon, uneen, käyttäytymiseen ja muihin fysiologisiin muutoksiin. Se oli myös varteenotettava ei-farmakologinen kivunhallintamenetelmä. Tutkimustulokset vahvistivat tietoa, että vakaavointisen pikkukeskosen koskettaminen on tärkeää. Saatuja tuloksia voidaan hyödyntää kehitettäessä keskosten hoitotyötä ja käytössä olevia hoito-ohjeita tukemaan entistä paremmin pikkukeskosen yksilöllistä kasvua ja kehitystä

Miten hoidamme vastasyntyneen kipua?

Tiivistelmä Sikiön kipujärjestelmä kehittyy 20 raskausviikkoon mennessä, joten jo pienimmät ja epäkypsimmät keskoset aistivat kipua. Hoitamaton kipu heikentää älyllisten ja liikunnallisten taitojen kehittymistä. Kivun hoidossa oleellista on sitä aiheuttavan syyn tunnistaminen ja sen poistaminen. Kivun voimakkuuden arvioimisessa käytetään menetelmiä, joilla vastasyntyneen käyttäytymistä ja fysiologisia vasteita tarkkailemalla saadaan arvio kivun vaikeudesta ja pystytään reagoimaan siihen tarvittavalla tavalla välttäen ylihoitoa. Lääkkeettömät keinot ovat hoidon perusta. Niitä tehostetaan tarvittaessa miedoilla kipulääkkeillä, erityisesti parasetamolilla. Tulehduskipulääkkeet eivät sovi vastasyntyneen kivunhoitoon. Voimakkaammassa ja toimenpidekivussa opioidit, morfiini ja fentanyyli ovat vaihtoehtoja. Deksmedetomidiini on uusi kipua hoitava ja rauhoittava lääke vastasyntyneiden hoidossa. Seuraava tavoite on korkeatasoinen, näyttöön perustuva vastasyntyneiden kivunhoitosuositus

Trial of paracetamol for premature newborns:five-year follow-up

Abstract Introduction: Paracetamol is a commonly used pain medication for the very-high risk neonates and it is increasingly being used for patent ductus arteriosus treatment in preterm infants. However, randomized trial data on long-term consequences are not yet available, but there is some evidence of serious adverse effects on children exposed to paracetamol during pregnancy. Patients and methods:A five-year follow-up study of a placebo-controlled paracetamol trial on very preterm infants (PreParaS) was conducted (n = 48). Using a web-based parental questionnaire, parents answered questions about their children’s cardiac and respiratory symptoms, allergies, neurodevelopment, infections, medications and hospitalizations. Results:Most parents reported that their child had normal development (paracetamol 79% vs. placebo 65%). Physician-diagnosed asthma or allergy (paracetamol 10.5% vs. placebo 25.0%), or hospitalization due to respiratory symptoms (0 vs. 15%) were uncommon and neurological or neuro-psychiatric symptoms were rare. Conclusions:Current follow-up results on paracetamol-exposed very preterm infants may not be alarming suggesting that paracetamol administration shortly after birth is not associated with common adverse consequences

Paracetamol preceding very preterm birth:is it safe?

Abstract Introduction: The use of paracetamol for pain relief in pregnancy is common. However, the influence of paracetamol on the perinatal adaptation of high-risk infants has not been studied. These data are important for safety, since another inhibitor of prostaglandin synthesis is harmful to infants born very preterm and increases serious morbidity. We studied whether the use of paracetamol had an adverse influence on neonatal adaptation and the outcomes of infants during the first hospitalization. Material and Methods: We studied the patient records of high-risk mothers and their infants born before 32 weeks of gestation for multiple variables over a period of 84 months in Oulu University Hospital, a regional tertiary care hospital caring for high-risk deliveries and providing neonatal intensive care. In a matched cohort setting, the exposition was defined as paracetamol use <24 h before childbirth. The controls had consumed no paracetamol up to 1 week before delivery. Infants with major anomalies were excluded. The primary outcome was defined as the need for early interventional treatments for the preterm infants. Outcomes during the first hospitalization were also studied. Results: Altogether, 170 fetuses from 149 mothers were exposed to paracetamol during the study period. The control population, delivering during the same period, consisted of 118 non-exposed fetuses from 104 mothers. Among them, the mothers were pairwise matched according to their medications, amniotic fluid leakage time, clinical infections, and delivery mode. After matching, 72 mothers/group remained, resulting in 88 paracetamol-exposed infants and 85 controls. No perinatal adverse reactions were detected. There were no differences in either circulatory support during the first postnatal day or in the risk for major diseases during the first hospitalization. Paracetamol-exposed infants needed fewer acute delivery room therapies (51.1% vs 65.9%, mean difference −14.89; 95% confidence interval −0.29 to −0.003). Maternal total paracetamol dose in the 1 week before delivery correlated positively with Apgar scores. Conclusions: Antenatal paracetamol given within 24 h before birth had no adverse effects on extremely or very preterm infants. The long-term safety of paracetamol and the potential acute benefits for preterm infants during perinatal transition remain to be proven in larger, prospective settings

Inflammatory biomarkers in very preterm infants during early intravenous paracetamol administration

Abstract Background: Paracetamol promotes early closure of patent ductus arteriosus (PDA), and it may affect inflammation after preterm birth. Objective: The aim of this study was to evaluate the association between paracetamol treatment and serum inflammatory biomarkers in very preterm infants with respiratory distress. Study design: The infants were randomly assigned to intravenous paracetamol or placebo during the first 4 days of life, and others received a lower dose of paracetamol unblinded. Serum samples were used for the analysis of 10 cytokines, C-reactive protein (CRP) and malondialdehyde (MDA). The impact of paracetamol on the biomarkers was evaluated, based on the levels during the early (<60 h) and the later (60–120 h) postnatal age. Results: Altogether, 296 serum samples from 31 paracetamol and 25 placebo group infants were analysed. Paracetamol had no effect on cytokine levels during the first 60 h when most induced PDA contractions took place. Later paracetamol treatment was associated with lower serum levels of several cytokines, including interleukin (IL-) 10, interferon gamma-induced protein (IP-) 10, and monocyte chemoattractant protein-1. CRP levels were lower in the paracetamol group during the early treatment. Amongst the infants who had severe morbidities, MDA was higher (p = .045), regardless of paracetamol treatment. Conclusion: No significant differences in the cytokine levels were evident between the treatment and placebo groups. However, during early treatment, CRP levels were lower in the paracetamol group. To clarify whether this was due to a decrease in cardiopulmonary distress, or a distinct anti-inflammatory effect, requires further studies

Prophylactic Intravenous Acetaminophen in Extremely Premature Infants : Minimum Effective Dose Research by Bayesian Approach

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