Neonatal respiratory distress syndrome: are risk factors the same in preterm and term infants?

Abstract
Objective: To analyze respiratory distress syndrome (RDS) incidence and risk factors at different gestational age.

Methods: We considered data from 321 327 infants born in Lombardy, a Northern Italian Region. We computed multivariate analysis to identify risk factors for RDS by dividing infants in early- and moderate-preterm, late-preterm and term infants.

Results: Low-birth weight is the main risk factor for RDS, with higher odds ratio in term births. The risk was higher in infants delivered by cesarean section and in male, for all gestational age. Pathological course of pregnancy resulted in increased risk only in late-preterm and term infants. Maternal age and multiple birth were not associated with increased risk in any group. Babies born at term after assisted conception were at higher risk of RDS.

Conclusion: Our analysis suggests as some risk factors do not influence RDS incidence in the same way at different gestational age.

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Evaluating the influence of ventilation and ventilation-compression synchronization on chest compression force and depth during simulated neonatal resuscitation

Abstract
Objectives: To investigate the influence of ventilation and ventilation-compression synchronization on compression force and sternal displacement during simulated neonatal cardiopulmonary resuscitation (NCPR) on an infant manikin.

Methods: Five Neonatal Resuscitation Program trained clinicians were recruited to perform simulated NCPR on an infant manikin using two-finger (TF) and two-thumb (TT) compression, with synchronous and asynchronous ventilation, as well as without ventilation. The sternal displacement and force were recorded and analyzed.

Results: Synchronous ventilation and compression yielded sternal displacements and forces in the range of 22.8–32.4?mm and 15.0–29.8 N, respectively, while asynchronous ventilation and compression produced depths and forces in the range of 21.2–32.4?mm and 14.0–28.8 N, respectively.

Conclusions: Ventilation exerts a significant influence on sternal displacement and force during simulated NCPR, regardless of the compression method used. Ventilation-compression synchronization, however, is only significant during TF compression with lower compression forces measured during synchronous ventilation than in asynchronous ventilation. This occurs for two reasons: (i) the strong influence of ventilation forces on the lower magnitude compression forces produced during TF compression relative to TT compression and (ii) in asynchronous ventilation, compression and ventilation may occur simultaneously, with inflation and deflation providing an opposing force to the applied compression force.

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Early, rapidly progressive enteral nutrition promotes growth of very low birth weight (VLBW) infants

Abstract
Aim: This study describes the effects of a quality improvement program to promote improved postnatal nutrition on the growth of very low birth weight (VLBW) infants.

Methods: Daily data regarding nutrition and growth were collected from the medical record of VLBW infants born during 1995–2010. The infants were grouped by year of birth in order to compare infants from before, during and after the policy change. Evaluation of growth included age in days at a return to birth weight and the proportion of infants with weight below the 10th percentile at discharge.

Results: The caloric and protein intake improved significantly. The age at a return to birth weight fell (p?<?0.01) from 14.6?±?5 d to 11?±?8 d after the change. The proportion of infants with a discharge weight below the 10th percentile for corrected age fell (p?<?0.01) from 72.1% to 42.1%. Data on enteral feeding showed that increased rate of enteral feeds (EF) was associated with better growth (p?<?0.001).

Conclusion: Increasing awareness led to increase in caloric and protein intake in VLBW infants. Aggressive EF was associated with more rapid weight gain. However, the provision of protein and calories during the first 2 weeks of life still falls short of the latest European Society of Pediatric Gastroenterology, Hepatology and Nutrition recommendations.

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Changes in lactate dehydrogenase are associated with central gray matter lesions in newborns with hypoxic-ischemic encephalopathy

Abstract
Purpose: Biomarkers may predict neurological prognosis in infants with hypoxic-ischemic encephalopathy (HIE). We evaluated the relationship between serum lactate dehydrogenase (LDH) and brain magnetic resonance imaging (MRI), which predicts neurodevelopmental outcomes, in order to assess whether LDH levels are similarly predictive.

Materials and methods: Medical records were reviewed for infants with HIE and LDH levels were assessed on the first (LDH1) and third (LDH3) days following birth. Receiver operating characteristic curves were obtained in relation to central gray matter hypoxic-ischemic lesions.

Results: Of 92 patients, 52 (56.5%) had hypoxic-ischemic lesions on brain MRI, and 21 of these infants (40.4%) had central gray matter lesions. LDH1 and LDH3 did not differ; however, the percentage change (?LDH%) was significantly higher in infants with central gray matter lesions (36.9% versus 6.6%, p?=?0.006). With cutoffs of 187 (IU/L, ?LDH) and 19.4 (%, ?LDH%), the sensitivity, specificity, positive predictive value and negative predictive value were 71.4, 69.0, 40.5 and 89.1%, respectively. The relative risk was 5.57 (p?=?0.001).

Conclusion: Changes in serum LDH may be a useful biomarker for predicting future neurodevelopmental prognosis in infants with HIE.

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Serum lactate levels and perfusion index: are these prognostic factors on mortality and morbidity in very low-birth weight infants?

Abstract
Aim: Early hemodynamic assessment of global parameters in critically ill newborns fails and requires mostly invasive measurements in neonatal intensive care unit. Clinical signs are frequently used for assessment of peripheral perfusion. Perfusion index (PI) is a new noninvasive numerical value of peripheral perfusion. Serum lactate levels and PI are the indicators that are important in determining prognosis of preterm infants. In this study, we aimed to investigate the relationship of serum lactate levels and PI with mortality and morbidity in very low-birth weight infants (VLBW).

Study design: This study was conducted between July 2014 and July 2015 in a Level III NICU. The study enrolled preterm infants with a gestational age?=?32 weeks, birth weight?=?1500?g. Serum lactate levels from blood gases and PI, SpO2 measurements were recorded at 1st, 12th and 24th hours by using a new generation pulse-oximeter. Morbidities and mortalities were documented.

Results: A total of 60 VLBW infants were enrolled the study. Mean birth weight and gestational age were 991?±?288?g and 27.5?±?2.5 w, respectively. Retinopathy of prematurity (ROP) was significantly higher in the patients with high lactate levels (>4?mg/dl) at 1st hour and low-PI levels (<0.5) at 12th hour of life (p?=?0.042, p?=?0.015), respectively. Bronchopulmonary displasia (BPD) was significantly higher in the patients with low PI (<?0.5) at 1st hour. Lactate and PI values were not significantly correlated with necrotizing enterocolitis, intraventricular hemorrhage, patent ductus arteriosus, sepsis and mortality.

Conclusion: High lactate levels (>?4?mg/dl) and low PI (<?0.5) could be used as early parameters for prediction of ROP and BPD. This data suggests that in VLBW infants lactate levels and PI parameters during the first 24?h will be effective in determining the prognosis of the disease. We believe that larger, randomized controlled clinical trials are likely to establish the true benefit.

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Total energy intake accounts for postnatal anthropometric growth in moderately/late preterm infants

Abstract
Objective: Moderately preterm (MP) (32–33 weeks) and late preterm (LP) (34–36 weeks) infants have higher risks of mortality and growth and developmental problems. We, herein present a new concept of nutritional assessment, total energy intake (TEI), which is the sum total of kilocalories administered in all nutrient forms.

Methods: Fifty-two preterm infants were classified as MP (n?=?12), LP/appropriate for gestational age (LP/AGA) (n?=?33), or LP/small for gestational age (LP/SGA) (n?=?7). All groups received nutrient therapy by the same protocol. The sum of the daily energy intake at 14 and 28 days after birth was determined.

Results: TEI was 2822.1?±?162.1?kcal/kg/28 days in the MP group, 3187.2?±?265.0?kcal/kg/28 days in the LP/AGA group and 3424.6?±?210.4?kcal/kg/28 days in the LP/SGA group. In all groups, TEI for 28 days was significantly correlated with body weight gain (r?=?0.465, p?=?0.006). TEI for 14 days after birth was inversely correlated with the body weight loss rate after birth (r?=?-0.491, p?=?0.0002).

Conclusion: TEI was well correlated with anthropometric changes after birth. TEI may be used to effectively assess preterm infants’ nutritional needs.

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Leminorella sepsis in very low birth weight neonate as cause of neonatal mortality

Abstract
Leminorella is a member of Enterobacteriaceae family and was known previously as Enteric Group 57. Based upon genetic differences using DNA hybridization, it has three taxa: Leminorella grimontii, Leminorella richardii, and Leminorella sp. strain 3. The third one is similar biochemically to the L. grimontii strains. The generic name has been derived on the name of a French microbiologist, Leon Le Minor. The biochemical properties includes being facultative anaerobes, growth on sheep blood, TSI, and MacConkey agar; hydrogen sulfide producer, l-arabinose fermenter, and tyrosine hydrolyzer; and are negative for d-mannose fermentation, urea, and lipase. They usually infect in adulthood and result in urinary tract infection, surgical site infection, bacteremia, peritonitis, respiratory tract infection, and soft tissue infection. We report the first case of L. grimontii sepsis in a very low birth weight neonate that died because of neonatal sepsis.

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