Palliative balloon dilation of native coarctation of the aorta in a preterm infant

The role of balloon dilation for native coarctation in neonates is controversial, due to the relatively high recurrence rate. Balloon dilation may however provide adequate palliation in preterm infants, by relieving symptoms and allowing somatic growth until definitive surgical repair can be performed. We report successful balloon angioplasty, on 2 occasions, in a preterm neonate with coarctation of the aorta and associated left ventricular cardiomyopathy.peer-reviewe

Long-term continuous monitoring of the preterm brain with diffuse optical tomography and electroencephalography: A technical note on cap manufacturing

open12noDiffuse optical tomography (DOT) has recently proved useful for detecting whole-brain oxygenation changes in preterm and term newborns' brains. The data recording phase in prior explorations was limited up to a maximum of a couple of hours, a time dictated by the need to minimize skin damage caused by the protracted contact with optode holders and interference with concomitant clinical/nursing procedures. In an attempt to extend the data recording phase, we developed a new custom-made cap for multimodal DOT and electroencephalography acquisitions for the neonatal population. The cap was tested on a preterm neonate (28 weeks gestation) for a 7-day continuous monitoring period. The cap was well tolerated by the neonate, who did not suffer any evident discomfort and/or skin damage. Montage and data acquisition using our cap was operated by an attending nurse with no difficulty. DOT data quality was remarkable, with an average of 92% of reliable channels, characterized by the clear presence of the heartbeat in most of them.openopenAlfonso Galderisi; Sabrina Brigadoi; Simone Cutini; Sara Basso Moro; Elisabetta Lolli; Federica Meconi; Silvia Benavides-Varela; Eugenio Baraldi; Piero Amodio; Claudio Cobelli; Daniele Trevisanuto; Roberto Dell'AcquaGalderisi, Alfonso; Brigadoi, Sabrina; Cutini, Simone; BASSO MORO, Sara; Lolli, Elisabetta; Meconi, Federica; Silvia, Benavides-Varela; Baraldi, Eugenio; Amodio, Piero; Cobelli, Claudio; Trevisanuto, Daniele; Dell'Acqua, Robert

Interactions of the Gasotransmitters Contribute to Microvascular Tone (Dys)regulation in the Preterm Neonate

Background & Aims Hydrogen sulphide (H2S), nitric oxide (NO), and carbon monoxide (CO) are involved in transitional microvascular tone dysregulation in the preterm infant; however there is conflicting evidence on the interaction of these gasotransmitters, and their overall contribution to the microcirculation in newborns is not known. The aim of this study was to measure the levels of all 3 gasotransmitters, characterise their interrelationships and elucidate their combined effects on microvascular blood flow. Methods 90 preterm neonates were studied at 24h postnatal age. Microvascular studies were performed by laser Doppler. Arterial COHb levels (a measure of CO) were determined through co-oximetry. NO was measured as nitrate and nitrite in urine. H2S was measured as thiosulphate by liquid chromatography. Relationships between levels of the gasotransmitters and microvascular blood flow were assessed through partial correlation controlling for the influence of gestational age. Structural equation modelling was used to examine the combination of these effects on microvascular blood flow and derive a theoretical model of their interactions. Results No relationship was observed between NO and CO (p = 0.18, r = 0.18). A positive relationship between NO and H2S (p = 0.008, r = 0.28) and an inverse relationship between CO and H2S (p = 0.01, r = -0.33) exists. Structural equation modelling was used to examine the combination of these effects on microvascular blood flow. The model with the best fit is presented. Conclusions The relationships between NO and H2S, and CO and H2S may be of importance in the preterm newborn, particularly as NO levels in males are associated with higher H2S levels and higher microvascular blood flow and CO in females appears to convey protection against vascular dysregulation. Here we present a theoretical model of these interactions and their overall effects on microvascular flow in the preterm newborn, upon which future mechanistic studies may be based.The authors would like to acknowledge the parents of the neonates enrolled in the 2CANS study for their participation, the staff of the Kaleidoscope Neonatal Intensive Care Unit at the John Hunter Children’s Hospital, and Kimberly-Clark Australia for providing the diapers used in this stud

Placental Transfusion for Asphyxiated Infants.

The current recommendation for umbilical cord management of non-vigorous infants (limp, pale, and not breathing) who need resuscitation at birth is to immediately clamp the umbilical cord. This recommendation is due in part to insufficient evidence for delayed cord clamping (DCC) or umbilical cord milking (UCM). These methods may provide a neuroprotective mechanism that also facilitates cardiovascular transition for non-vigorous infants at birth

Total parenteral nutrition and carnitine supplementation practices in preterm neonates - results of a national survey

Thesis (M.A.)--Boston UniversityBackground: The goal of postnatal total parenteral nutrition (TPN) in premature neonates (PT) is to mimic the intrauterine environment of the fetus. Micronutrients are essential for optimal development. Although carnitine is present in human breast milk and is supplemented in infant formula, very preterm infants primarily receive parenteral nutrition, often devoid of carnitine, shortly after birth. Carnitine plays a critical role in cellular and mitochondrial metabolism. Preterm infants are deficient in carnitine as it is transferred from the placenta to the fetus during late pregnancy. Previously, our group surveyed US neonatologists in 2001 regarding carnitine supplementation practices and found that the majority were not fully familiar with the implications of carnitine deficiency and only 28% of preterm neonates on TPN were receiving carnitine. Since this study, recent research has emphasized the impact of carnitine on early weight gain and its neuroprotective effects. Objective: To determine current TPN carnitine supplementation practices in fasting preterm neonates (< 32 wks and < 1,500g) by conducting a national survey of board- certified neonatologists. [TRUNCATED

Fetal and early neonatal interleukin-6 response

In 1998, a systemic fetal cytokine response, defined as a plasma interleukin-6 (IL-6) value above 11 pg/mL, was reported to be a major independent risk factor for the subsequent development of neonatal morbid events even after adjustments for gestational age and other confounders. Since then, the body of literature investigating the use of blood concentrations of IL-6 as a hallmark of the fetal inflammatory response syndrome (FIRS), a diagnostic marker of early-onset neonatal sepsis (EONS) and a risk predictor of white matter injury (WMI), has grown rapidly. In this article, we critically review: IL-6 biological functions; current evidence on the association between IL-6, preterm birth, FIRS and EONS; IL-6 reference intervals and dynamics in the early neonatal period; IL-6 response during the immediate postnatal period and perinatal confounders; accuracy and completeness of IL-6 diagnostic studies for EONS (according to the Standards for Reporting of Diagnostic Accuracy statement); and recent breakthroughs in the association between fetal blood IL-6, EONS, and WMI

A multidisciplinary approach to the implementation of non-pharmacological strategies to manage infant pain

Hills E., Rosenberg J., Banfield N., Harding C. A multidisciplinary approach to the implementation of non-pharmacological strategies to manage infant pain. Infant 2020; 16(2): 78-81. 1. Newborn infants are capable of experiencing pain. 2. Infants requiring specialist hospital care are likely to experience painful medical procedures. 3. Unmanaged pain has a long-lasting impact on an infant’s behaviour and physiological status

The rate of the prevalence of high-risk pregnancies and the results on pregnant mothers and the effect on parameters after the birth

Pregnancy causes large physiologic changes in most body systems and these changes may lead to ease or harden examining some events. The purpose of this study is to define the rate of risk in pregnant women and the results in mother and fetus and also to define the risk rate of pregnancy in pregnant women and its effect on parameters after birth in patients of Educational and Medical center of Gorgan, Dezyani. This case - control study was performed in Educational and Medical Center Dezyany, of Golestan University of Medical Sciences in 1390. In this study, 1266 pregnant women were enrolled of which 804 cases (63.5%) according to the criteria for scoring in the questionnaire with a score greater than or equal to 7 were considered as high risk pregnancies (case group), 462 patients (36.5%) were considered as low-risk pregnancies (control group). Parameters after the birth and pregnancy results such as delivery type, infant difficulties, mother health after labor were compared and analyzed by T-test and ANOVA in both groups. About the history of infertility almost 80% of the people who had a 2-year history of infertility were in high-risk group and the difference was significant. (P = 0.02) About the history of abortion also almost 90% of the people who had a 2-year history of abortion were in highrisk group and the difference was significant. (P<0.05) Post-term infant was found in 77 cases that were entirely in high-risk group. This difference was statistically significant (P<0.05). According to results and comparing them to other studies we can conclude that pregnant mothers who have pregnancy difficulties history such as history of abortion or infertility, visits during pregnancy should be paid attention and warn them about the risk of not being visited and timely pursuits

Neonatal Cortical Auditory Evoked Potentials Are Affected by Clinical Conditions Occurring in Early Prematurity

Purpose: Cortical auditory evoked potentials may serve as an early indicator of developmental problems in the auditory cortex. The aim of the study was to determine the effect on neonatal cortical auditory processing of clinical conditions occurring in early prematurity. Methods: Sixty-seven preterm infants born at 29 weeks mean gestational age (range, 23\u201334 weeks) were recorded at a mean postconception age of 35 weeks, before discharge from the third level neonatal intensive care unit. The average of 330 responses to standard 1000 Hz pure tones delivered in an oddball paradigm was recorded at frontal location. Data of 45 of 67 recruited premature infants were available for analysis. Mean amplitudes calculated from the data points of 30 milliseconds centered on P1 and N2 peaks in the waveforms of each subject were measured. The effect of perinatal clinical factors on cortical auditory evoked responses was evaluated. Results: The amplitude of P1 component was significantly lower in infants with bronco-pulmonary dysplasia (P \ubc 0.004) and retinopathy of prematurity (P \ubc 0.03). The multivariate analysis, done to evaluate the relative weight of gestational age and bronco-pulmonary dysplasia and/or retinopathy of prematurity on cortical auditory evoked potentials components, showed an effect of clinical factors on P1 (P \ubc 0.005) and of gestational age on N2 (P \ubc 0.02). Conclusions: Cortical auditory processing seems to be influenced by clinical conditions complicating extremely preterm birth