Comparison of INTERGROWTH-21 and Fenton growth standards to assess size at birth and extrauterine growth in very preterm infants

Aim: This study aimed to compare the recently published prescriptive INTERGROWTH-21st standards with commonly used intrauterine based Fenton growth standards in terms of birth size classification and extrauterine growth restriction (EUGR) incidence in a sample of very preterm infants.Methods: The anthropometric measures of preterm infants born before 32weeks of gestation at the Dokuz Eylul University Hospital during the period from January 2012 to February 2016 were obtained at birth, at the 36th gestational weeks or at the time of discharge. Birth and growth data were presented as percentiles according to the two reference standards.Results: A total of 248 infants with mean gestational age of 29.12.1weeks were included. The small for gestational age (SGA) rate was significantly higher (12 versus 15%, p=.004) and the EUGR rate was significantly lower (40.2 versus 31.5%, p<.001) with the INTERGROWTH-21st charts compared with the Fentons'. Twenty-four per cent of the infants who were accepted as SGA according to the INTERGROWTH-21st standards were appropriate for gestational age (AGA) according to the Fenton preterm growth charts. However, these newly identified SGA infants according to the Intergrowth-21st standards did not have increased risks of early morbidities. Furthermore, 77% of the cases who had EUGR due to the Fenton standards were categorized as EUGR when evaluated using the INTERGROWTH-21st standards.Conclusions: Results indicated that almost one out of every five cases assessed as EUGR according to Fenton standards was within the normal interval according to Intergrowth standards. On the contrary, one out of every four cases assessed as SGA according to the INTERGROWTH-21st standards was within the normal interval according to Fentons'. These differences observed with INTERGROWTH-21st standards may affect in-hospital and postdischarge nutrition plan of these vulnerable infants. However, new standards are needed to be evaluated against currently used ones before they are implemented and further studies should be conducted to evaluate the functional impact of these differences on long-term outcomes including neurologic and cardio-metabolic morbidities

A prospective cohort study on the prediction of fetal distress and neonatal status with arterial and venous Doppler measurements in appropriately grown term fetuses

To assess the predictive power of the cerebro-placental ratio (CPR) and the venous-arterial index (VAI) for the development of intrapartum fetal distress (FD) and neonatal intensive care unit (NICU) admission

Comparison of the Stability of Sandblasted, Large-Grit, and Acid-Etched Treated Mini-Screws With Two Different Surface Roughness Values: A Histomorphometric Study

Purpose: To evaluate the effects of 2 different surface roughness values produced by sandblasted, large-grit, and acid-etched treatments at different loading conditions on the stability of mini-screws

The The role of diffusion weighted imaging in magnetic resonance to evaluate breast masses

Aim: To investigate the role of diffusion weighted magnetic resonance imaging (MRI) in differentiation of benign and malignant breast lesions using apparent diffusion coefficient (ADC) values preoperatively. Methods: A total of 30 women between the ages of 14-75 years (mean, 47, 6 years) with 30 histopathologically verified breast lesions were investigated in this study. The patients were examined by a 1, 5 T MRI device using bilateral phased array breast coil. Spin echo planar diffusion imaging was used to scan patients. Images were obtained by b values 0 and 500 seconds/mm². Mean ADC values of the benign and malignant lesions were measured and calculated. The comparison between the histopathological diagnoses and the mean ADCs were performed by Mann Whitney U test. Results: The diagnosis of 30 patients with 30 breast lesions were as follows; malign lesions (n=13), benign lesions (n=17). The ADC values were as follows (in units of 10-3mm² /sec): benign breast lesions (range: 1, 09-1, 98, mean: 1, 45) and malignant breast lesions (range: 0, 59-1, 08, mean: 0, 76). The mean ADC obtained from malignant breast lesions was statistically different from that observed in benign solid lesions (p&lt;0, 01). Conclusion: Diffusion imaging can be used in differentiation of malign and benign breast lesions

Is Nasal Septum-Tragus Length Measurement Appropriate for Endotracheal Tube Intubation Depth in Neonates? A Randomized Controlled Study

Objective Endotracheal intubation is a frequent procedure performed in neonates with respiratory distress. Clinicians use different methods to estimate the intubation insertion depth, but, unfortunately, the improper insertion results are very high. In this study, we aimed to compare the two different methods (Tochen's formula=weight in kilograms+6cm; and nasal septum-tragus length [NTL]+1cm) used to determine the endotracheal tube (ETT) insertion depth. Study Design Infants who had intubation indications were enrolled in this study. The intubation tube was fixed using the Tochen formula (Tochen group) or the NTL+1cm formula (NTL group). After intubation, the chest radiograph was evaluated (above T1, proper place, and below T2). Results A total of 167 infants (22-42 weeks of gestational age) were included in the study. The proper tube placement rate in both groups was similar (32.4 vs. 30.4% for infants34 weeks of gestational age and 56.8 vs. 45.0% in infants>34 weeks of gestational age). The ETT was frequently placed below T2 at a higher rate in infants with a gestational age of 34 weeks, especially in the NTL group (46% in the Tochen group and 60.7% in the NTL group). Conclusion The NTL+1cm formula led to a higher rate of ETT placement below T2, especially in infants with a birth weight of 1,500g. Therefore, more studies are needed to determine the optimal ETT insertion depth

Comparison of INTERGROWTH-21 and Fenton growth standards to assess size at birth and extrauterine growth in very preterm infants

Aim: This study aimed to compare the recently published prescriptive INTERGROWTH-21st standards with commonly used intrauterine based Fenton growth standards in terms of birth size classification and extrauterine growth restriction (EUGR) incidence in a sample of very preterm infants.Methods: The anthropometric measures of preterm infants born before 32weeks of gestation at the Dokuz Eylul University Hospital during the period from January 2012 to February 2016 were obtained at birth, at the 36th gestational weeks or at the time of discharge. Birth and growth data were presented as percentiles according to the two reference standards.Results: A total of 248 infants with mean gestational age of 29.12.1weeks were included. The small for gestational age (SGA) rate was significantly higher (12 versus 15%, p=.004) and the EUGR rate was significantly lower (40.2 versus 31.5%, p<.001) with the INTERGROWTH-21st charts compared with the Fentons'. Twenty-four per cent of the infants who were accepted as SGA according to the INTERGROWTH-21st standards were appropriate for gestational age (AGA) according to the Fenton preterm growth charts. However, these newly identified SGA infants according to the Intergrowth-21st standards did not have increased risks of early morbidities. Furthermore, 77% of the cases who had EUGR due to the Fenton standards were categorized as EUGR when evaluated using the INTERGROWTH-21st standards.Conclusions: Results indicated that almost one out of every five cases assessed as EUGR according to Fenton standards was within the normal interval according to Intergrowth standards. On the contrary, one out of every four cases assessed as SGA according to the INTERGROWTH-21st standards was within the normal interval according to Fentons'. These differences observed with INTERGROWTH-21st standards may affect in-hospital and postdischarge nutrition plan of these vulnerable infants. However, new standards are needed to be evaluated against currently used ones before they are implemented and further studies should be conducted to evaluate the functional impact of these differences on long-term outcomes including neurologic and cardio-metabolic morbidities

Prophylactic Fucose can Alleviate Lipopolysaccharide-Induced Cholestatic Liver Injury in Neonatal Rats

Objectives Cholestasis is a common disease of the liver in premature infants and no specific preventive treatment is currently available. Fucose, one of the monosaccharide building blocks of human milk oligosaccharides, may prevent cholestatic hepatic injury by various mechanisms. The aim of this study was to investigate the protective effect of fucose treatment after endotoxin-induced cholestasis in a rat model. Methods Wistar rat pups were divided into four groups as: group I, control group; group II, fucose-supplemented group; group III, lipopolysaccharide (LPS)-administered group, and group IV, LPS-exposed and fucose-supplemented group. Fucose was given 100 mg/kg i.p. every other day between PN5-17. LPS was administered on PN19 to establish endotoxin-induced cholestasis model. On PN21, animals were sacrificed to evaluate liver cell damage and apoptosis. Results Fucose supplementation significantly improved the biochemical parameters that deteriorated in LPS-administered group, significantly increased the expression of bile salt export pump, reduced the number of apoptotic cell death, and greatly prevented LPS-induced cholestatic hepatic injury. Conclusion Given our results, fucose may be useful in reducing hepatic injury and might possess clinical relevance for the preventive treatment of inflammation-induced cholestatic injury in newborns

Is European Medicines Agency (EMA) sepsis criteria accurate for neonatal sepsis diagnosis or do we need new criteria?

BackgroundCurrently, there is a lack of clear definition for neonatal sepsis. The Pediatric Committee of the European Medicines Agency (EMA) developed consensus criteria to ensure a standardization for neonatal sepsis definition. However, there is no evidence supporting the accuracy of the EMA sepsis criteria in neonatal sepsis diagnosis. The main objective of this study was to evaluate the diagnostic accuracy of EMA sepsis criteria for proven neonatal sepsis.MethodsA multicenter prospective cohort study was conducted from October 2015 to November 2018. Infants with a gestational age over 34th weeks, diagnosed with clinical sepsis and received antibiotics according to the EMA criteria or experienced neonatologists' opinion were included. Blood culture or multiplex real time-PCR or 16S-rRNA positive infants were accepted as "proven sepsis". The predictive performance of EMA criteria for proven sepsis was evaluated by sensitivity, specificity, accuracy, and area under the curve measures of receiver operator characteristic curves. Data-mining methods were used for further analysis.ResultsAmong the 245 included infants, the EMA criteria were positive in 97 infants (39.6%), while proven sepsis was diagnosed in 113 infants (46.1%). The sensitivity, specificity, and accuracy of the EMA criteria for proven sepsis were 44.2% (95%CI: 34.9-53.9), 64.4% (95%CI: 55.6-72.5), 55.1% (95%CI: 46.6-59.4) respectively. None of the clinical and laboratory parameters had sufficient performance individually in terms of sensitivity, specificity and accuracy measures. The diagnostic performance was similar when different clinical findings were added to the EMA sepsis criteria or assessment of the score was interpreted in different ways.ConclusionsResults highlighted that clinician opinion and standard laboratory tests are limited in the neonatal sepsis diagnosis. The EMA criteria also did not efficiently meet the diagnostic accuracy measures for neonatal sepsis. A predictive sepsis definition and rapid bedside point-of care tests are urgently needed