74 research outputs found
Experience of Remifentanil in Extremely Low-birth-weight Babies Undergoing Laparotomy
Premature babies experience pain and require adequate analgesia for any painful procedure. Fentanyl and morphine resulted in safe and effective anesthesia in the past; however, their pharmacokinetics may be impaired in preterm babies with multiorgan failure. Remifentanil, despite the absence of available pharmacokinetic data in preterm infants and few reports in newborns, demonstrated its advantages in children undergoing either major surgery or minor painful procedures and has been shown to be useful even in neonates, because its elimination is independent of organ function. We report two cases of babies born at 26 weeksâ and 27 weeksâ gestation, weighing 580g and 400g, respectively, undergoing laparotomy for necrotizing enterocolitis. Both received midazolam bolus and remifentanil infusion at high doses. This technique seems to be an advantageous alternative even in extremely low-birth-weight prematures. Furthermore, it becomes a technique of choice in these babies because the available ventilators are often not equipped with halogenated vaporizers. Particularly in intensive care, where there are no scavenger systems, it could allow to operate without moving out the preterm babies and avoiding stress and hypothermia
Different fetal-neonatal outcomes in siblings born to a mother with Graves-Basedow disease after total thyroidectomy: a case series
ABSTRACT:INTRODUCTION: We describe three different fetal or neonatal outcomes in
the offspring of a mother who had persistent circulating thyrotropin receptor
antibodies despite having undergone a total thyroidectomy several years before.
CASE PRESENTATION: The three different outcomes were an intrauterine death, a
mild and transient fetal and neonatal hyperthyroidism and a severe fetal and
neonatal hyperthyroidism that required specific therapy.
CONCLUSIONS: The three cases are interesting because of the different outcomes,
the absence of a direct correlation between thyrotropin receptor antibody levels
and clinical signs, and the persistence of thyrotropin receptor antibodies
several years after a total thyroidectomy
Convolutional neural network based on fluorescein angiography images for retinopathy of prematurity management
Purpose: The purpose of this study was to explore the use of fluorescein angiography (FA) images in a convolutional neural network (CNN) in the management of retinopathy of prematurity (ROP).Methods: The dataset involved a total of 835 FA images of 149 eyes (90 patients), where each eye was associated with a binary outcome (57 "untreated" eyes and 92 "treated"; 308 "untreated" images, 527 "treated"). The resolution of the images was 1600 and 1200 px in 20% of cases, whereas the remaining 80% had a resolution of 640 and 480 px. All the images were resized to 640 and 480 px before training and no other preprocessing was applied. A CNN with four convolutional layers was trained on 90% of the images (n = 752) randomly chosen. The accuracy of the prediction was assessed on the remaining 10% of images (n = 83). Keras version 2.2.0 for R with Tensorflow backend version 1.11.0 was used for the analysis.Results: The validation accuracy after 100 epochs was 0.88, whereas training accuracy was 0.97. The receiver operating characteristic (ROC) presented an area under the curve (AUC) of 0.91.Conclusions: Our study showed, we believe for the first time, the applicability of artificial intelligence (CNN) technology in the ROP management driven by FA. Further studies are needed to exploit different fields of applications of this technology.Translational Relevance: This algorithm is the basis for a system that could be applied to both ROP as well as experimental oxygen induced retinopathy
Feasibility of transferring intensive cared preterm infants from incubator to open crib at 1600 grams
Experience of Remifentanil in Extremely Low-birth-weight Babies Undergoing Laparotomy
Premature babies experience pain and require adequate analgesia for any painful procedure. Fentanyl and morphine resulted in safe and effective anesthesia in the past; however, their pharmacokinetics may be impaired in preterm babies with multiorgan failure. Remifentanil, despite the absence of available pharmacokinetic data in preterm infants and few reports in newborns, demonstrated its advantages in children undergoing either major surgery or minor painful procedures and has been shown to be useful even in neonates, because its elimination is independent of organ function. We report two cases of babies born at 26 weeksâ and 27 weeksâ gestation, weighing 580Â g and 400Â g, respectively, undergoing laparotomy for necrotizing enterocolitis. Both received midazolam bolus and remifentanil infusion at high doses. This technique seems to be an advantageous alternative even in extremely low-birth-weight prematures. Furthermore, it becomes a technique of choice in these babies because the available ventilators are often not equipped with halogenated vaporizers. Particularly in intensive care, where there are no scavenger systems, it could allow to operate without moving out the preterm babies and avoiding stress and hypothermia
Relationship between Maternal Parity, Basal Prolactin Levels and Neonatal Breast Milk Intake
Foetal haemoglobin, blood transfusion, and retinopathy of prematurity
Stutchfield et al. have recently demonstrated that low foetal
haemoglobin (HbF) levels predict retinopathy of prematurity
(ROP) . There is an increasing awareness that
red blood cell (RBC) transfusions are independent risk
factors for all prematurity-associated diseases (PAD).
Since adult haemoglobin (HbA) releases oxygen more
efficiently than HbF, autologous cord blood (CB) transfusion
has been attempted, with limited results due to the low
volume of CB collected. We have shown that allogeneic
CB RBC concentrates obtained from healthy full-term
babies can fulfil transfusion requirements of preterm neonates
(PNs) with gestational age 6430 weeks and/or birth
weight 641500 g, in their first 28 days of life. At first
transfusion episode, PNs received ABO-Rh(D) matched
CB-RBCs if available, or adult RBCs if CB units were not
available. At subsequent transfusions, the same regimen
was adopted, unless CB-RBCs were unavailable. Overall, 9
patients received CB-RBCs and 11 adult-RBCs; 6 patients
(3 in each group) died before ROP assessment. Table 1
illustrates ROP findings in 14 surviving patients. All PNs
receiving adult-RBCs developed ROP, while two of six
patients in the CB-RBC group did not. Stage 3 ROP was
observed in four heavily transfused extremely PNs: three of
them were transfused only or mainly with adult-RBCs
(patients 8,10 and 14, respectively; Table 1).
Transfusions contribute to the overwhelming oxidative
burden caused by infections, oxygen therapy and
inflammatory diseases in PNs. Unfortunately, to monitor in
these patients lipid peroxidation products or other biomarkers
of the oxidative stress, requires sophisticated
methodologies and exceeding volume of biologic samples.
Hence, these investigations are so far confined to the
research field. In this regard, the study of Stutchfield
et al. suggests that monitoring HbF levels in PNs might be a
feasible and reliable tool to figure out to what extent
transfusions might favour PAD developmen
Rotating-disc micro-solid phase extraction of F2-isoprostanes from maternal and cord plasma by using oxidized buckypaper as sorbent membrane
This paper describes the development of an original micro-solid phase extraction device and its evaluation for the isolation of F2-isoprostanes (F2-IsoPs) from cord and maternal plasma samples. The unit is very simple and consists in a rotating disc (1.8 cm diameter) of oxidized buckypaper (BP), enwrapped in a polypropylene mesh pouch. Even if the selected F2-IsoPs have logP and pKa values that make them suitable candidates for their sorption on BP, several parameters were optimized to maximize recoveries: time of adsorption and desorption; stirring speed; volume, pH and ionic strength of the sample; type, volume, and fractions of the elution solvent; oxidation grade of BP. Among all, the last one was crucial in affecting extraction yields because of the analyte interactions with polar functionalities, introduced by a preliminary oxidative acid treatment. The investigation established the optimal oxidation time and highlighted the pros and cons of the acid activation step. All extracts were analyzed by means of liquid chromatography-tandem mass spectrometry (LCâMS/MS). Validation was performed according to the main FDA guidelines for bioanalytical methods. Depending on the spike level and analyte, recoveries ranged between 30 and 120% with precision and accuracy values lower than 20%. Quantitative analysis was accomplished by matrix-matched calibration curves whose determination coefficients were higher than 0.95. Lower limit of quantitation (LLOQ) spanned the range 2.45â6.77 ÎŒg Lâ1. The validated method was applied to the analysis of eight pairs of mother/child plasma samples, revealing the presence of 8-iso-15-keto-PGF2α and 8-iso-PGE2 at a concentration of about 10 ÎŒg Lâ1 in most cord plasma samples of preterm newborns
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