Pain treatment in neonates : a Polish multicentre survey conducted in 2014

Introduction: Preventing pain before and during medical procedures is a basic human right, regardless of age. Painful invasive procedures are frequently performed on infants admitted to neonatal units. Aim of the study: The aim of this study was to describe current neonatal pain management in Polish neonatal units according to the opinions of physicians. Material and methods: A survey of 100 Polish neonatal units was performed. Physicians were asked to complete a researcher-developed questionnaire. The survey comprised 40 questions. The frequency of use of selected pain medicines and pain treatment according to guidelines was assessed using Likert-scale questions.Results: Seventy-six units agreed to participate in the study. Data were available from 235 physicians. Most neonatal units did not have guidelines for the treatment of pain in newborns. There was no significant correlation between theoretical knowledge and pain treatment in accordance with the guidelines (r = -0.04, p = 0.6). Pain treatment before selected procedures seems to be insufficient. The study revealed the frequent use of paracetamol before painful procedures. Before central line insertion 42% of physicians from level III units very often or often administered paracetamol. About 40% of physicians used paracetamol before chest tube insertion. Phenobarbital intravenous/per os/per rectum was the most frequently used drug (76% of respondents from level III NICU). Almost 60% of physicians did not use written guidelines for pain management, but they followed their experience. Conclusions: Despite changes in the approach to pain management in neonates and the widespread availability of recommendations, pain treatment in Polish neonatal units is still insufficient. There is a need for the education of health professionals on neonatal pain management. This study suggests that Polish neonatal units need national guidelines for pain management

Blood pressure profile in the 7th and 11th year of life in children born prematurely

BACKGROUND: Several research trials have analyzed the impact of prematurity on the prevalence of hypertension (HT). However, prospective long-term studies are lacking. OBJECTIVES: The aim of this study was to evaluate the prevalence of HT at the age of 7 and 11 years in a regional cohort of preterm infants with a birth weight of ≤ 1000 g. PATIENTS AND METHODS: This study included 67 children with a birth weight of ≤ 1000 g who were born in Malopolska between September 2002 and August 2004. The control group consisted of 38 children born at term, matched for age. Each child underwent 24-h ambulatory blood pressure measurement (ABPM) twice, once at the age of 7 and again at 11 years. The presence of HT was estimated according to the mean arterial pressure (MAP) and a number of individual measurements. RESULTS: At aged 7 years, preterm infants had a significantly higher incidence of HT, defined on the basis of MAP (15% vs. 0%; P < 0.02) and on the percent of individual measurements (56% vs. 33%, P < 0.036). After taking into account the group of patients who received anti-HT treatment after the first part of the study, the incidence of HT at the age of 11 years based on MAP was 19% vs. 10%. Based on the individual measurements, it was 36.5% in the preterm infants vs. 24% in the control group. The differences were not statistically significant. At both time points, the preterm group had a higher mean heart rate (HR) than the control group. CONCLUSIONS: Children born prematurely are predisposed to HT in later life, in addition to the persistence of an increased HR

Thrombomodulin as a new marker of endothelial dysfunction in chronic kidney disease in children

Endothelial dysfunction (ED) and oxidative stress are potential new pathomechanisms of cardiovascular diseases in patients with chronic kidney disease (CKD). The aim of the study was to assess the association between endothelial dysfunction, oxidative stress biomarkers, and cardiovascular risk factors in children with CKD. Serum oxidized LDL (oxLDL), protein carbonyl group, urea, creatinine, cystatin C, thrombomodulin, asymmetric dimethylarginine (ADMA), von Willebrand factor, brain natriuretic peptide (BNP), lipids, high sensitivity C-reactive protein, intercellular adhesion molecule-1 levels, and albuminuria were measured. Anthropometric, ambulatory blood pressure (BP) measurements and echocardiography were performed. The studied group consisted of 59 patients aged 0.7–18.6 (mean 11.1) years with stages 1 to 5 CKD. Thrombomodulin strongly correlated with creatinine (R=0.666; p<0.001), cystatin C (R=0.738; p<0.001), BNP (R=0.406; p=0.001), ADMA (R=0.353; p=0.01), oxLDL (R=0.340; p=0.009), 24-hour systolic (R=0.345; p=0.011) and mean (R=0.315; p<0.05) BP values, and left ventricular mass index (LVMI, R=0.293; p=0.024) and negatively with estimated glomerular filtration rate (R=−0.716; p<0.001). In children with CKD, TM strongly depended on kidney function parameters, oxLDL levels, and 24-hour systolic and mean BP values. Thrombomodulin seems to be a valuable marker of ED in CKD patients, correlating with CKD stage as well as oxidative stress, BP values, and LVMI

Longitudinal assessment of renal size and function in extremely low birth weight children at 7 and 11 years of age

BACKGROUND: There are a lack of studies describing a longitudinal association between preterm delivery and renal complications later in life. We assessed renal size and function in preterm infants born with extremely low birth weight (ELBW) during 4 years of follow-up, comparing these parameters to age-matched children born full term (term controls). METHODS: The results of selected renal laboratory tests [levels of cystatin C, creatinine, blood urea nitrogen (BUN)] and of renal ultrasound evaluations were compared between the ELBW group and the term control group at age 7 and 11 years. RESULTS: The study population consisted of 64 children born with ELBW (ELBW children) who had been recruited at birth and 36 children born at term (term children) who took part in both follow-up assessments. Renal ultrasound examination revealed a significantly smaller renal volume in the 7- and 11-year-old ELBW children compared to the term controls [right kidney volume: 50.8 vs. 61.2 ml/m(2), respectively, at 7 years (p <0.01) and 51.4 vs. 58.2 ml/m(2), respectively, at 11 years (p <0.01); left kidney volume: 51.4 vs. 60.3 ml/m(2), respectively, at 7 years (p <0.01) and 55.2 vs. 60.7 ml/m(2), respectively, at 11 years (p = 0.02)]. Renal function in ELBW children was also affected. Serum cystatin C levels were significantly higher in ELBW children than in the controls at 7 years of age, and this difference remained statistically significant at 11 years of age [0.63 vs. 0.59 mg/l, respectively, at 7 years (p = 0.02) and 0.72 vs. 0.61 mg/l, respectively, at 11 years (p = 0.01)]. Six ELBW children also had elevated cystatin C levels (0.97–1.11 mg/l) at 11 years of age. Cystatin C levels were within normal range in the ELBW children at age 7 years and in term children in both follow-up studies. BUN levels were higher in ELBW children at the age of 11 years (4.49 vs. 4.15 mmol/l; p = 0.028). CONCLUSION: Continued follow-up of these patients will reveal whether the observed worsening in renal function will persist into adulthood

Small for gestational age is an independent risk factor for N neurodevelopmental impairment

Background: There is a deficit of publications regarding the impact of small for gestational age (SGA) on later neurodevelopment of premature infants and existing results are conflicting. Objectives: The aim of the present study was multifaceted neurodevelopmental assessment of children born prematurely, with particular assessment of SGA as an independent risk factor for impairment in prematurely born children. Methods: Eighty-nine children born with very low birth weight were evaluated at the age of 50 months. Anthropometric measurements and several psychomotor tests (WeeFIM-Functional Independence Measure scale, Leiter Test-Non-Verbal Psychometric Evaluation, DTVP-2-Developmental test of Visual Perception, CAST-Childhood Autism Spectrum test, EAS-C-temperament questionnaire and TSD-children vocabulary test) were performed in each child. Results: SGA appears to be a risk factor for low self-reliance (mean WeeFIM score 89 ± 20 points vs 99 ± 15; P = 0.034), decreased non-verbal intelligence (Leiter score 87±18 points vs 100±18 points; P = 0.022) and low visual perception (Frostig test 81±17 points vs 93±17 points; P = 0.035). Moreover, the incidence of autism spectrum disorders was significantly higher in the SGA group (21% vs 2.8%; P = 0.029). There were no differences in frequency of cerebral palsy diagnosis, vocabulary test results and temper tests scores between SGA and AGA groups. Conclusions: Birth weight small for gestational age seems to be an additional, independent risk factor of neurodevelopmental delay in prematurely born childre

Development and maturation of the immune system in preterm neonates : results from a whole genome expression study

To expand the knowledge about the consecutive expression of genes involved in the immune system development in preterm neonates and to verify if the environment changes the gene expression after birth we conducted a prospective study that included three cohorts: (A) extremely (gestational age (GA): 23–26 weeks; n=41), (B) very (GA: 27–29 weeks; n=39), and (C) moderately preterm infants (GA: 30–32 weeks; n=33). Blood samples were drawn from the study participants on the 5th and 28th day of life (DOL). The mRNA samples were evaluated for gene expression with the use of GeneChip Human Gene 1.0ST microarrays. Differential expression analysis revealed small subsets of genes that presented positive or negative monotone trends in both the 5th (138 genes) and 28th DOL (308 genes) in the three subgroups of patients. Based on pathway enrichment analysis, we found that most of the pathways that revealed a positive monotone trend were involved in host immunity. The most significantly GA dependent pathways were T-cell receptor signaling pathway and intestinal immune network for IgA production. Overall 4431 genes were differentially expressed between the 5th and 28th DOL. Despite differences in gestational age, patients with the same postconceptional age have a very similar expression of genes