Reducing the incidence of chronic lung disease in very premature infants with aminophylline

The objective of this study is to assess the safety and preventative effects of aminophylline on the incidence of chronic lung disease [CLD] in very premature infants. This was a long follow-up randomized clinical trial. The prophylactic effect of aminophylline on the incidence of CLD was investigated in very premature infants. The study group received aminophylline for the 1[st] 10 days of life and control infants received no aminophylline during the 1st 10 days of life. Fifty-two infants participated [26 aminophylline, 26 controls]. Premature infants on aminophylline had clearly shorter oxygen dependency time than those in the control group. Median time of oxygen dependency was 3 [0-9.5] days and 14 [3-40.5] days in group A and C, respectively [P: 0.001]. Incidence of CLD was significantly different between the two groups. Only two infants [8.7%] on aminophylline developed CLD, when compared to 11 infants [44.0%], who did not receive aminophylline [P: 0.006]. No side-effects were reported in the neonates [P: 1]. This study supports the preventative effects of aminophylline on the incidence of CLD in very premature infants. In other words, the more premature the infants, the greater will be the preventative effect of aminophylline on the incidence of CLD

Initial treatment of respiratory distress syndrome with nasal intermittent mandatory ventilation versus nasal continuous positive airway pressure: a randomized controlled trial

Neonatal respiratory distress syndrome [RDS] in premature infants who survived and its complications are a common problem. Due to high morbidity and mechanical ventilation [MV] nowadays researchers in interested minimizing MV. To determine, in very low birth weight [BW] preterm neonates with RDS, if initial treatment with nasal intermittent mandatory ventilation [early NIMV] compared with early nasal continuous positive airway pressure [early NCPAP] obtains more favorable outcomes in terms of the duration of treatment, and the need for endotracheal tube ventilation. In this single-center randomized control trial study, infants [BW 30%. Primary outcomes were failure of noninvasive respiratory support, that is, the need for MV in the first 48 h of life and for the duration of noninvasive respiratory support in each group. 98 infants were enrolled [44 in the NIMV and 54 in the NCPAP group]. The Preventive power of MV of NIMV usage [95.5%] was not lower than the NCPAP [98.1%] strength [hazard ratio: 0.21 [95% confidence interval: 0.02-2.66]; P: 0.23]. The duration of noninvasive respiratory support in the NIMV group was significantly shorter than NCPAP [the median [range] was 24 [18.00-48.00] h versus 48.00 [22.00-120.00] h in NIMV versus NCPAP groups; P < 0.001]. Similarly, the duration of dependency on oxygen was less, for NIMV [the median [range] was 96.00 [41.00-504.00] h versus144.00 [70.00-1130.00] h in NIMV versus NCPAP groups; P: 0.009]. Interestingly, time to full enteral feeds and length of hospital stay were more favorable in the NIMV versus the NCPAP group

Suprapubic bladder aspiration or urethral catheterization: which is more painful in uncircumcised male newborns?

The aim was to compare the intensity of pain caused by Suprapubic aspiration [SPA] and urethral Catheterization for urine sampling in premature infants. A prospective randomized controlled design with 80 premature infants in Alzahra University Hospital, Isfahan, Iran was conducted. Premature newborns who needed urine samples for microbiologic analysis were randomly assigned into two groups: SPA group and urethral Catheterization group. Newborn faces and upper parts of the body were videotaped during the study and the pain was assessed during urine collection using Premature Infant Pain Profile [PIPP] score. Furthermore, crying time compared between groups. The mean crying time was significantly higher in SPA than urethral Catheterization group [77 vs. 34.4 s] [P < 0.001]. The PIPP score was significantly lower in urethral Catheterization group [13.4] than SPA group [11.5] P < 0.001. The success rate of SPA was 53% compared with 71% success rate of urethral Catheterization. SPA is more painful than urethral Catheterization in premature male infants as assessed by PIPP score and is more likely leads to procedure failure

Diagnostic usefulness of transcutaneous bilirubinometry in very preterm newborns

This study was performed to find out whether transcutaneous bilirubinometry could be a valid screening method for hyperbilirubinemia in preterm infants, especially for those who needed mechanical ventilation. We evaluated 63 preterm Iranian newborns who were managed in the neonatal intensive care unit of Shahid Beheshti University Hospital, Isfahan, Iran from April 2009 to April 2010. Transcutaneous bilirubin [TCB] measurements were obtained using BiliCheck [Trade mark sign] shortly before or 10 minutes after taking blood for determination of the plasma bilirubin level in premature newborns, who did not receive phototherapy. We assessed the correlation between the transcutaneous bilirubin and plasma bilirubin level by linear regression analysis. We also analyzed the gestational age, birth weight, postnatal age, sex, and hematocrit, for determination of their effect on transcutaneous bilirubin accuracy. The overall bilirubin concentration ranged from 5.4 to 17 mg/dL and from 4.8 to 17.3 mg/dl for total serum bilirubin [TSB] and transcutaneous bilirubin, respectively. The mean values obtained by transcutaneous bilirubinometry were slightly higher than the total TSB values. The correlation coefficient between TSB and TCB was r=0.82, P<0.001, and this was not influenced by gestational age, postnatal age or hematocrit, which were previously considered to be important. The correlation coefficient between TSB and TCB in mechanically ventilated preterm infants was r=0.75, P<0.001. Plasma bilirubin level can be accurately measured by BiliChec[Trade mark sign] in premature newborns, even in newborns who need mechanical ventilation

Effect of massage on weight gain in premature infants

After the introduction of surfactant, the survival rate of preterm neonates has increased significantly. This issue attracted much attention towards this fragile population. Many studies have demonstrated that massage plays a role in the weight gain of preterm infants. This study compares the effect of massage therapy on infants who were massaged by a nurse or their mother with those who did not receive massage therapy at all. This randomized clinical trial was conducted on three groups. [1] The infants who only received routine care and no massage, [2] Those who received massage by an expert nurse and [3] Those who received massage by their mothers. We recorded daily weight gain, the length of hospital stay and fluid intake of infants. Kruskal Wallis test and SPSS software were used for statistical analysis. The gestational age of infants ranged between 28 to 34 weeks. At the end of the fifth day the group massaged by a nurse had significantly more weight gain compared to the other two groups [6.5+1.5 in the nurse group, 4.6 + 1 in the mother group and 3.7 + 1.5 in the control group, p-value = 0.001]. Those who were massaged by their mothers also gained weight significantly more than the control group [P =0.05]. There was no significant difference in the length of hospital stay among the understudy groups. Our study showed that the five-day massage therapy is a safe technique mothers can perform for stable preterm infants to facilitate weight gain in neonate

Effects of high dose orally administered paracetamol for heel prick pain in premature infants

To evaluate whether high dose paracetamol [40mg/kg orally] relieves pain in premature infants. This study was a randomized controlled trial analyzing the effect of high dose oral paracetamol on pain response due to heel prick in 72 premature infants treated in the neonatal intensive care unit of Alzahra University Hospital, Isfahan, Iran during the period of April 2007 to August 2007. Ninety minutes before the heel prick, neonates received paracetamol orally in a dose of 40 mg/kg [Group 1] or an equal volume of placebo [Group 2]. We assessed the pain using the premature infant pain profile [PIPP] score. Infants in the paracetamol and placebo groups had similar gestational ages [mean +/- SD: 31.7 +/- 1.7 versus 32.6 +/- 1.5] and birth weights [mean +/- SD: 1530 +/- 292 versus 1739 +/- 369]. The mean +/- SD PIPP scores in Group 1 was 11.1 +/- 3.8 and in Group 2 was 9.7 +/- 4.2, [p=0.15]. Single high dose paracetamol does not appear to provide adequate analgesia for the acute pain caused by heel prick in premature neonates

Intraventricular hemorrhage in very low birth weight infants. associated risk factors in Isfahan, Iran

Prematurely born infants with intraventricular hemorrhage [IVH] suffer significant morbidity and mortality, particularly those infants with high-grade hemorrhage. Previous studies have proposed a number of risk factors for IVH; however, lack of adequate matching for gestational age and birth weight may have confounded the results. The purpose of this study was to identify variables that affect the risk of IVH. We identified 31 preterm infants with gestational age <32 weeks and birth weight < 1500 g, with IVH, from November 2003 to January 2005 at Alzahra University Hospital, Isfahan, Iran. A control group of 90 infants, matched for gestational age and birth weight was selected. Maternal factors, labor and delivery characteristics and neonatal parameters were colleted in both groups. Results of cranial ultrasound examinations were also collected. The significant risk factors for IVH were found to be: patent ductus arteriosus [PDA] [4 [13.3%]versus 3 [3.3%] [P=0.01]], longer duration of assisted ventilation [2.8 +/- 5.8 days versus 0.5 +/- 2.1 days [p=0.002]], higher number of endotracheal suctioning [9.7 +/- 18.4 versus 3.06 +/- 13.7 [P=0.004]], surfactant use, [7 [22.6%] versus 3 [3.4%] [p=0.003]], positive pressure ventilation at birth [[12 [38.7%] versus 12 [13.3%], [p=0.004]] and low Apgar score at 1 and 5 minutes. Whereas antenatal steroid treatments and cesarean section have a protective effect on the occurrence of IVH. Our data emphasize the importance of obstetric and perinatal care to improve outcomes of premature infants

Comparison of oral ibuprofen and indomethacin therapy for patent ductus arteriosus in preterm infants / 中国当代儿科杂志

<p><b>OBJECTIVE</b>Intravenous indomethacin is the conventional treatment for patent ductus arteriosus (PDA) in preterm infants; however its use is associated with various side effects such as oliguria, gastrointestinal bleeding and reduction of cerebral perfusion. Intravenous ibuprofen has recently been used to treat PDA in preterm infants without reducing cerebral blood flow or affecting intestinal or renal hemodynamics. Intravenous forms of indomethacin and ibuprofen are not available in Iran. This study aimed to examine and compare the efficacy and safety of oral ibuprofen and oral indomethacin for the treatment of PDA in preterm infants.</p><p><b>METHODS</b>Thirty-six infants (gestational age less than 34 weeks) who had echocardiographically confirmed PDA were enrolled in this study. The patients were randomly administered with three oral doses of either indomethacin (0.2 mg/kg, at an interval of 24 hrs) or ibuprofen (a first dose of 10 mg/kg, followed at an interval of 24 hrs by two doses of 5 mg/kg each) (n=18 each group). The rate of ductal closure, side effects, complications, and the infants' clinical course were recorded.</p><p><b>RESULTS</b>The ductus was closed in all of 18 patients (100%) in the ibuprofen group and in 15 (83.3%) patients in the indomethacin group (P > 0.05). There were no significant differences in the levels of serum blood urea nitrogen and creatinine between the two groups before and after treatment. Necrotizing enterocolitis (NEC) occurred in 3 patients in the indomethacin group and none in the ibuprofen group (P < 0.05). The survival rate at 1 month after treatment was 94% (17/18) in both groups. One infant in the ibuprofen group died from sepsis and one in the indomethacin group died as a result of NEC.</p><p><b>CONCLUSIONS</b>Oral ibuprofen is as effective as oral indomethacin for the treatment of PDA in preterm infants. Oral ibuprofen therapy is associated with a lower incidence of NEC.</p>

Oral hypertonic glucose, for analgesia in the premature newborns

A number of studies have shown that orally administered sweet tasting solutions reduce signs of pain during painful procedures in the term newborns. The aim of the present study was to compare the pain reducing effect of orally administered glucose with that of placebo during venipuncture in preterm infants. A Randomized. double-blind, placebo controlled trial was carried out at the neonatal intensive care unit at the Alzahra Hospital Isfahan-Iran from June to September 2005. Thirty six preterm newborns [gestational age 28-34 weeks: postnatal age [1-14 days] undergoing venipuncture for clinical purposes, were enrolled in the study. Each infant was assessed two times receiving 1 ml 30% glucose or 1 ml sterile water by mouth, 2 minutes before venipuncture. The behavioral pain reactions were scored with the Premature Infant Pain Profile and duration of crying and heart rate were measured. The PIPP scores were significantly lower in the glucose group compared with the placebo group [8.94 +/- 3.013 VS 11.44 +/- 3.42 respectively. P<0.001]. The duration of crying in the first 3 minutes was significantly lower in 30% glucose compared with placebo group [24.1 +/- 18.48 VS 39.6 +/- 26.8 respectively, P=0.002]. We found that 30% glucose may be a useful and sate analgesic for minor procedures in preterm newborns

Recombinant human erythropoietin and blood transfusion in low-birth weight preterm infants under restrictive transfusion guidelines

To compare the number and volume of red blood cell transfusions [RBCTs] in very low birth weight infants under restrictive red blood cell transfusion guidelines with and without erythropoietin administration. In a controlled clinical trial conducted at the neonatal intensive care unit of Alzahra Hospital, Isfahan, Iran, between April 2002 to April 2004, 60 premature infants with gestational age up to 34 weeks, birth weight up to 1500 g, and postnatal age between 8 and 14 days were included. The newborns were randomized into 2 groups: Group 1 received 3 doses of 400 IU/kg erythropoietin per week for 6 weeks, and Group 2 received no treatment aside from their conventional medications. The 2 groups did not differ significantly with respect to their mean gestational age, birth weight and hematocrit at the study entry. Fewer transfusions were administered to those receiving erythropoietin [26.7% versus 50%, p=0.03], but there was no statistically significant difference between groups with respect to volume of transfusion. Compared with the placebo group, the infants receiving erythropoietin had a higher mean hematocrit [34% +/- 4.3 versus 29% +/- 5.9, p<0.001] and absolute reticulocyte count [57 +/- 19 versus 10 +/- 4.8 x 106, p<0.001] at the end of the study. We found no significant difference in the incidence of thrombocytopenia and leukopenia between the 2 groups. We conclude that when the restrictive RBCT guidelines were followed, treatment with erythropoietin can be useful in reduction of the number of RBCTs