Medical closure of patent ductus arteriosus does not reduce mortality and development of bronchopulmonary dysplasia in preterm infants

WOS: 000347553800011PubMed ID: 25657754Background: Although, patent ductus arteriosus (PDA) is associated with significant morbidity due to hemodynamic instability in preterm infants, the effect of ductus closure on mortality and morbidity is a controversial issue. The aim is to evaluate the efficacy of oral and intravenous (IV) ibuprofen treatment on ductal closure and effects on mortality and bronchoplumonary dysplasia. Materials and Methods: The medical records of 292 premature infants treated at Ege University Neonatal Intensive Care Unit were retrospectively evaluated. Patients were classified into 3 groups as; No PDA, hemodynamically insignificant PDA (hiPDA) and hemodynamically significant PDA (hsPDA) according to the presence and hemodynamical significance of PDA by echocardiography. hsPDA group was treated with IV or oral ibuprofen. Results: Patent ductus arteriosus was diagnosed by routine echocardiography in 145 patients, of whom 78 (53.7%) had hsPDA. All 65 infants with hiPDA had spontaneous PDA closure. Echocardiographic measurements were similar to those patients treated with oral or IV ibuprofen, as in the response rate to treatment without serious adverse effects. The presence of respiratory distress syndrome, surfactant therapy, late sepsis, bronchopulmonary dysplasia (BPD) and mortality rates were significantly higher in patients with hsPDA. However, with stepwise logistic regression; 5th min Apgar score (odds ratio [OR], 1.321, 95% confidence interval [CI], 1.063-1.641, P = 0.012) and gestational age (OR, 1.422, 95% CI, 1.212-1.662, P < 0.001) were the only significant variables associated with mortality. Gestational age (OR, 0.680, 95% CI, 0.531-0.871, P = 0.002) was the only significant variable associated with BPD shown with logistic regression. Conclusion: Ibuprofen treatment is effective for hsPDA closure with minimal side effects. HiPDA can close spontaneously; therefore treatment decision should be individualized. However, medical treatment of PDA does not reduce mortality and BPD

Contents of Breast Milk Obtained from Mothers of Preterm and Term Newborn Infants

WOS: 000219058200003Aim: We aimed to compare the macronutrient, antioxidant, insulin like growth factor 1 content of breast milk obtained from mothers of moderately premature and full-term infants. Materials and Methods: In this prospective study mature breast milk samples were collected and frozen from mothers of moderately premature (n=31, gestational age 32.16 +/- 2.42 weeks) and full term (n=14) infants who were admitted to the neonatal intensive care unit. Frozen milk samples were thawed and macroonutrients (triglycerides, glucose, cholesterol, protein), antioxidants (TEAC: Trolox equivalent antioxidant capacity, FRAP: ferric reducing ability of plasma, TOA: total antioxidant activity), TBARS (ThioBarbituric Acid Reactive Substances) and insulin like growth factor 1 (IGF-1) levels were analysed. Results: Macronutrient content, antioxidant properties, oxidative status and IGF-1 content of preterm and term breast milk were found similar. None of these parameters were related to necrotizing enterocolitis or achievement of total enteral feeds. Conclusion: The donor milk obtained from mothers of term infants may be safely used for the moderately preterm infants cared in NICUs since both groups have similar breast milk properties

Effects of Two Different Exogenous Surfactant Preparations on Serial Peripheral Perfusion Index and Tissue Carbon Monoxide Measurements in Preterm Infants with Severe Respiratory Distress Syndrome

Administration of an exogenous surfactant may affect both ventilatory and hemodynamic parameters in preterm infants with respiratory distress syndrome (RDS). Peripheral perfusion may be expected to be influenced, and serial perfusion index (PI) values may show this effect. Noninvasive transcutaneous carbon monoxide (TCO) monitoring may show RDS severity, oxidative and inflammatory stress, and response to surfactant treatment. Methods: This randomized controlled nonblinded study was performed in 30 preterm infants with RDS, treated with poractant alfa (n = 15) or beractant (n = 15); 18 preterm infants without RDS served as a control group. Oxygenation and hemodynamic parameters were recorded and compared through the first 6 hours of treatment. PI and TCO values were measured prior to (Tp), immediately after (T0), and at 5 minutes (T5), 30 minutes (T30), 60 minutes (T60), and 360 minutes (T360) after the bolus surfactant administration. The mean arterial pressure, oxygenation index, pH, and lactate levels were recorded simultaneously. Results: Both study groups had lower Tp PI and higher Tp TCO levels than controls. Both surfactant preparations improved the PI, TCO, mean arterial pressure, oxygenation index, pH, and lactate levels at the end point of T360. However, the median Tp PI value of 1.3 first decreased to 0.86 at T0 (P < 0.001), and then it increased to 0.99 at T5 (p < 0.001) and to 1.25 at T30 (p = 0.037). The median Tp TCO value of 3 decreased to 2, 1.5, 0, and 0 at T0, T5, T30, and T60, respectively (p < 0.001). PI more quickly recovered to Tp values (30 minutes vs. 60 minutes) and reached the control group values (30 minutes vs. 360 minutes) with beractant compared to that with poractant alfa. TCO recovered to Tp values in both groups at the same time (5 minutes vs. 5 minutes), but reached the control group values more quickly (5 minutes vs. 30 minutes) with poractant alfa than with beractant. Conclusion: Patients with RDS had poor perfusion, and PI improved with both surfactant preparations only following a short decline in the 1st minute. The expected improvement of PI occurred earlier in the beractant subgroup. TCO declined in both groups, showing lung improvement and decreased oxidative/inflammatory stress, and it was normalized earlier with poractant alfa

Single Versus Multiple Doses of Surfactant Treatment in Preterm Infants

Aim: Exogenous surfactant may be needed not only for Respiratory Distress syndrome (RDS) treatment; but also, in the management of other pulmonary diseases of infants. in this study, we aimed to investigate the impact of single versus multiple doses of surfactant therapy in pulmonary problems of preterm infants. Materials and Methods: in this study, preterm infants who needed surfactant treatment were retrospectively evaluated. Surfactant therapy for RDS were given as 200 mg/kg poractant or 100 mg/kg beractant and repeated with 100 mg/kg doses when needed later. Poractant or beractant (100 mg/kg) were given in the treatment of other pulmonary diseases. Results: Totally 64 preterm patients were recruited into this study. Patients in group 1 (43.8%) received a single dose of surfactant; whereas group 2 patients (56.2%) had more than one dose. Mean gestational age and birth weight of infants in group 2 were significantly lower than group 1 (p<0.05). Intrauterine growth restriction (IUGR) was more common in group 2 (p=0.041). Multiple doses of surfactant were needed for severe RDS, atelectasis, pulmonary hemorrhage and pneumonia. Duration of mechanical ventilation and hospitalization were longer in group 2 (p<0.05). Mortality rates were higher in group 2 (p=0.011). Conclusion: Preterm infants with earlier gestational age and lower birth weight; particularly with IUGR may need multiple doses of surfactant due to more severe respiratory problems regardless of antenatal steroid or maternal chorioamnionitis status. Duration of mechanical ventilation, hospitalization and also neonatal mortality remained higher due to disease severity in preterms who needed multiple doses of surfactant

Clinical and Molecular Spectrum of Tuberous Sclerosis Complex Patients: Identification of Three Novel Mutations

WOS:000618207400011Objective: Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous syndrome. TSC arises from mutations in either TSC1, at 9q34, or TSC2, at 16p13.3. Skin lesions, such as hypomelanotic macules, facial angiofibromas, shagreen patches, and ungual fibromas, are frequently seen in these patients. The present study aims to investigate clinical manifestations, molecular findings and phenotype-genotype correlations in 17 patients with TSC. Materials and Methods: TSC1 and TSC2 molecular analyses were performed on a next-generation sequencing platform (Illumina MiSeq). Variant interpretation was made in accordance with the American College of Medical Genetics 2015 recommendations. Results: Four patients carried a heterozygous mutation in TSC1, while the remaining seven carried mutations in TSC2. Three novel variants in TSC2 were defined. Sequencing failed to detect a mutation in six patients. in only one of these patients, multiplex ligation-dependent probe amplification (MLPA (R)) could be performed, and a large deletion in the TSC1 gene was detected. A wide spectrum of phenotypic features was noted throughout the study group. Dermatological findings were observed in almost all patients. Conclusion: in this study, in addition to the three novel mutations reported herein, the spectrum of TSC1 and TSC2 gene mutations and their phenotypes were reported