Measurement of carnitine in preterm neonates suffering respiratory distress syndrome and the effect of its supplement

Background: Respiratory distress syndrome [RDS] is among the most common diseases of preterm infants. RDS is caused by a decreased production or secretion of pulmonary surfactant. Numerous causes of RDS have been identified, and the factors suspected to be involved in the pathogenesis of RDS are numerous, Carnitine is essential for the fetus and is provided via placental transport. As the gestational age increases, fetal tissues store increasing amounts of carnitine, therefore, preterm infants require exogenous carnitine supplementation for carnitine homeostasis. Treatment with carnitine has shown benefit in the respiratory status of ventilator- dependent adults, as well as stabilization of respiratory parameters and increased physical performance in adult patients with chronic respiratory insufficiency

Objective: The present study was designed to measure the level of free carnitine in preterm neonates with RDS and to evaluate the efficacy of L-carnitine therapy on those neonates

Patients and Methods: Forty preterm infants, including 14 females and 26 males. Study group were divided in to 2 groups, group A: received L-carnitin in a dose of 30 mg/kg/ day for 7 days and group B: did not receive supplementation

Results: our results show non statistically significant difference between group A [with Carnitine supplementation] and group B [no supplementation] at day 1. There was statistically significant higher serum carnitine level in group A compared to group B at day 7 [after supplementation]. Seven neonates [35%] in group A, and 13 [65%] in group B, needed surfactant administration and MV after 24 hours from admission and this difference was statistically significant. Dose of surfactant was statistically significant lower in group A compared to group B [P=0.001] and duration of mechanical ventilation was statistically significant lower in group A compared to group B [p=0.03]

Conclusion: L-carnitine is more deficient in preterm with RDS than preterm without RDS and its supplementation can reduce the need and duration of MV and/ or need and dose of surfactant

Plasma antioxidant status in preterm infants in health and disease and its relation to vitamin C concentration at birth

Concentrations of circulating antioxidants may be important in the etiology of disease in preterm infants. We aimed at measuring vitamin C. ceruloplasmin and ability of plasma to prevent lipid peroxidation at birth and observing the variation of these measures with gestational age. We also examined the relation between plasma antioxidant activity in diseased preterm infants and their mortality. 30 diseased preterm infants requiring intensive care, 20 healthy preterm and 15 healthy full term infants were enrolled in the study. The antioxidant activity of plasma [ul plasma required to inhibit lipid peroxidation], plasma vitamin C and ceruloplasmin were measured. Diseased preterm infants showed significantly higher vitamin C, and significantly lower ceruloplasmin and antioxidant activity of plasma than healthy preterm and full term infants. In the preterm infants, there was a strong negative correlation between plasma antioxidant activity and vitamin C. Diseased preterm infants who died showed significanrly lower plasma antioxidant activity than those who survived

Use of simple anthropometric measurements to predict newborn infants at risk for early postnatal morbidity

The value of anthropometric measurements in the identification of infants at risk for early postnatal morbidity was assessed in 135 low birth weight infants. Weight, mid arm circumference [MAC], head circumference, length and gestational age were measured within 24 hours of birth. MAC/head circumference ratio and pondral index were calculated. Detailed gestational medical history was obtained from the mothers. All studied babies were examined and closely observed for the first 72 hours after delivery for detection of any medical problem requiring medical intervention. Early postnatal morbidity observed in 75.5% of low birth weight infants, respiratory distress [66.7%] infection [26.7%], seizures [8.9%], anemia [4.4%] and bleeding per rectum [0.7%]. MAC correlated best of all variables with birth weight [r=0.715], a value of <9.5 cm had a 88.6% sensitivity and a 60% specificity in prediction of low birth weight, MAC cutoff value of <9.5% and MAC/HC ratio <0.3 were also the best of all variables in prediction of early postnatal morbidity with 91.2% sensitivity and 63.6% specificity. It was recommended that in the developing countries, the use of MAC in estimation of LBW. Moreover, the calculated cutoff value for MAC may serve as reliable indicator of LBW at risk for early postnatal morbidity