Impact of Optimized Breastfeeding on the Costs of Necrotizing Enterocolitis in Extremely Low Birthweight Infants

To estimate risk of NEC for ELBW infants as a function of preterm formula and maternal milk (MM) intake and calculate the impact of suboptimal feeding on NEC incidence and costs

Primary Immunization of Premature Infants with Gestational Age <35 Weeks: Cardiorespiratory Complications and C-Reactive Protein Responses Associated with Administration of Single and Multiple Separate Vaccines Simultaneously

To determine the incidence of cardiorespiratory events and abnormal C-reactive protein (CRP) level associated with administration of a single vaccine or multiple separate vaccines simultaneously. Prospective observational study on 239 preterm infants at ≥2 months of age in the neonatal intensive care unit (NICU). Each infant received either a single vaccine or multiple vaccines on one day. CRP levels and cardiorespiratory manifestations were monitored for 3 days following immunization. Abnormal elevation of CRP level occurred in 85% of infants administered multiple vaccines and up to 70% of those given a single vaccine. Overall, 16% of infants had vaccine-associated cardiorespiratory events within 48 hours postimmunization. In logistic regression analysis, abnormal CRP values were associated with multiple vaccines (OR, 15.77; 95% CI 5.10-48.77) and severe intraventricular hemorrhage (IVH) (OR, 2.28; 95% CI 1.02-5.13). Cardiorespiratory events were associated marginally with receipt of multiple injections (OR, 3.62; 95% CI 0.99-13.25) and significantly with gastroesophageal reflux (GER) (OR, 4.76; 95% CI 1.22-18.52). CRP level is expected to be elevated in the 48 hours following immunization. In a minority of infants immunized, cardiorespiratory events were associated with presumed need for intervention. Underlying medical conditions and possibly multiple injections are associated with cardiorespiratory events. Precautionary monitoring following immunizations is warranted

Adjusting for bias in C-reactive protein levels when using a vitros slide method in infants

Low total serum protein levels may cause a positive bias on C-reactive protein (CRP) detected by the Vitros 250 Chemistry System (Ortho-Clinical Diagnostics, Inc., Johnson & Johnson Co., Raritan, NJ). Low total serum protein levels are observed in some infants. Our objective was to define a cutoff value for normal levels of CRP measured on the Vitros System that is comparable to the cutoff value of 1.0 mg/dL measured by rate nephelometry on a Beckman Array System (Beckman Instruments Inc., Fullerton, CA). CRP was prospectively measured on the same serum sample on Vitros and Beckman systems. Using a result of ≥1.0 as the "gold standard" definition of an abnormal CRP, measures of association were calculated. CRP was measured in 981 blood samples that were collected from 361 infants. A cutoff CRP level using the Vitros system at 1.5 mg/dL had the highest sensitivity and negative predictive value comparable to 1.0 mg/dL measured by nephelometry. By regression analysis, each increase by 1 mg/dL by nephelometry caused an increase by 1.5 mg/dL on the Vitros system (R(2) = 0.94; p < 0.001; slope = 0.66; 95% confidence intervals, 0.65, 0.67). In infants, when measuring CRP levels by Vitros CRP slide system, a normal reference level of 1.5 mg/dL instead of 1 mg/dL should be used

The effect of cesarean section on intraventricular hemorrhage in the preterm infant

Objective: The null hypothesis is that active labor is a more important factor with regard to both timing and progression of periventricular-intraventricular hemorrhage than is route of delivery. Infants delivered by cesarean section after entering the active phase of labor will behave in a manner similar to that of previously studied infants delivered vaginally as to when periventricular-intraventricular hemorrhage occurs and frequency of progression. Study Design: The 106 infants of 85 women delivered by cesarean section were the subjects of this study. Forty-six infants were in the no-labor group, 33 in the latent-phase labor group, and 27 in the active-phase labor group. Head ultrasonographic examinations were performed at delivery, at 1, 6, 12, and 24 hours, and then daily for the first 7 days of life. Continuous variables were compared by one-way analysis of variance among those infants with no hemorrhage or with periventricular-intraventricular hemorrhage. Categoric variables were compared by χ2 analysis and Fisher's exact test when appropriate. A p value of <0.05 was considered significant. Results: There was no difference in the frequency of early hemorrhage (≤1 hour of age), late hemorrhage (>1 hour of age), or overall periventricular-intraventricular hemorrhage in the infants not in labor, in latent-phase labor, or in active-phase labor at the time of cesarean section. However, the frequency of grade 3 or 4 hemorrhage and the progression of hemorrhage were significantly higher in the infants whose mothers had an active phase of labor compared with infants whose mothers had no labor or did not progress beyond the latent phase. Infants who had early periventricular-intraventricular hemorrhage (<1 hour of age) also had a higher frequency of progression of hemorrhage. Conclusions: Cesarean section before the active phase of labor does not change the overall frequency of hemorrhage but results in a lower frequency of progression to grade 3 or 4 hemorrhage. We do not feel that these data support performing more cesarean sections for preterm delivery as a method of preventing progression of periventricular-intraventricular hemorrhage in the preterm infant

A Controlled Trial of Intravenous Immune Globulin to Reduce Nosocomial Infections in Very-Low-Birth-Weight Infants

Although survival rates for very-low-birth-weight infants ( ≤ 1.5 kg) continue to increase, 1 nosocomial infections remain a major cause of morbidity and mortality. Prolonged hospitalization with exposure to resistant organisms and multiple invasive procedures, in the presence of immunologic immaturity, 2 renders these infants vulnerable to hospital-acquired infections 3 . Profound hypogammaglobulinemia may result from low levels of IgG at birth (IgG is largely acquired transplacentally in the latter half of the third trimester), degradation of maternally acquired IgG, and delayed production of IgG after birth 4 . The use of pooled IgG has been suggested as a possible means of reducing this . . 

Mean arterial blood pressure changes in premature infants and those at risk for intraventricular hemorrhage

Bedside microcomputer-derived, minute-to-minute mean arterial pressure (MAP) values during the first 48 hours of life were studied in 100 preterm babies with birth weight ≤1500 gm. In those babies (n=72) with no periventricular-intraventricular hemorrhage (PV-IVH) or with grade 1 PV-IVH, the MAP values increased during the study period, with minute-to-minute variation and interval undulation. The MAP values in those with birth weight>1000 gm were higher than in those of lower birth weight. Infants in whom grades 2 to 4 PV-IVH developed (n=28) had consistently lower MAP values during the study period. Minute-to-minute variability, expressed as the average of the coefficients of variation at 15-minute intervals, did not differ between birth weight groups, nor did they differ between the PV-IVH group and their matched control subjects. However, those with PV-IVH spent a greater percentage of time, with a coefficient of variation≥13% or <3%, than their matched control subjects spent (p<0.005). This study provides reference data for MAP changes in premature babies. The observed MAP changes in those with PV-IVH lend support to a significant role for MAP alterations in the pathogenesis of PV-IVH

Indomethacin reduces the risks of severe intraventricular hemorrhage

A prospective, random selection, double-blind clinical trial was carried out to determine the efficacy of indomethacin in preventing periventricular-intraventricular hemorrhage (PV-IVH). Babies who were born in our institution, had birth weights ≤1500 gm, and had no PV-IVH or grade 1 PV-IVH were given either placebo (n=70) or indomethacin (n=71), 0.2 mg/kg intravenously at 6 hours of age and 0.1 mg/kg at 18 and 30 hours. Two major outcomes were determined: the development of grades 2 to 4 PV-IVH and the development of severe PV-IVH (i.e., hemorrhages with blood filling >50% of the ventricles and in some cases with associated parenchymal echodensities). Grades 2 to 4 PV-IVH occurred in 16 (23%) of the indomethacin group and 27 (39%) of the placebo group ( p<0.03). The incidence of severe PV-IVH was 3% in the indomethacin-treated babies and 14% in the control group ( p<0.02). The influence of other perinatal factors on the incidence of grades 2 to 4 or severe PV-IVH was determined by stepwise logistic regression. Placebo use, early grade 1 PV-IVH, lower birth weight, and higher fraction of inspired oxygen at 6 hours of life were associated with higher estimated odds of the development of grades 2 to 4 PV-IVH. Placebo use, male gender, lower 5-minute Apgar score, and a large base deficit were predictive of severe PV-IVH. Estimated odds ratios of severe PV-IVH with placebo use and male gender were 11.251 and 91, respectively. Thus indomethacin prophylaxis reduced the relative risk of grades 2 to 4 PV-IVH and severe PV-IVH, but other perinatal variables contributed significantly to the overall risk of PV-IVH