Early aggressive parenteral nutrition induced high insulin-like growth factor 1 [IGF-1] and insulin-like growth factor binding protein 3 [IGFBP3] levels can prevent risk of retinopathy of prematurity

To evaluate early aggressive vs. conservative nutrition and its effect on Retinopathy of Prematurity [ROP] in <32 weeks of gestation neonates. A prospective, randomized, clinical study was conducted in NICU with a total of 75 preterm infants. In the intervention group, infants received early aggressive nutrition immediately after birth, in the control group infants were started on conventional parenteral nutrition [PN]. Blood samples were obtained for Insulin-like growth factor 1 [IGF-1] and insulin-like growth factor binding protein 3 [IGFBP3] levels before commencement of PN on the first postnatal day, and from week 1 to 6 every week. All the infants were examined for ROP. Infants in the early aggressive group had a reduction in the risk of ROP of 5% [2 from 40]; the number of infants needed treatment averaged 3.7 [2.7 to 5.2]. A total of 11 neonates in the conventional group were detected having ROP [P<0.05]. Overall, IGF-I levels were higher in the aggressive PN [APN] vs the conventional PN [CPN]. ROP development was higher in the CPN compared to the APN. IGF-1levels were lower in ROP developers compared with non-ROP in the APN group. There was no difference in IGF-I levels in ROP developers versus non-ROP in the CPN group. IGF-1 levels were lower in the CPN group compared with the APN group in the third week in ROP developers. There was a correlation between ROP and IGF-1 levels. Through ROC analysis, IGF-1 was demonstrated as being a sensitive marker for ROP. IGF-1 levels were higher in the APN group versus the CPN group. This may indicate that IGF-1 levels simply being higher is not enough; rather, that being higher above a cutoff value may prevent ROP

Short-term outcomes of very low birth weight infants born at a tertiary care hospital, Istanbul, Turkey

To evaluate mortality and short-term outcomes in very low birth weight infants admitted to the tertiary neonatal intensive care unit, Istanbul, Turkey. Study data were recorded prospectively from January 1, 2010, to December 31, 2010. The clinical findings in neonates with birth weights <1000g were compared with infants with birth weights of between 1000g and 1499g. In the present study, survival rates were 40% and 86.2% for infants weighing <1000g and 1000g to 1499g, respectively. There was no difference between males and females with respect to mortality [P>0.05]. The mean [ +/- standard deviation] birth weight was 985.6 +/- 150.15 g and mean gestational age was 27.5 +/- 2.04 weeks. The antenatal steroid rate was 37.2%, and the Cesarean section rate was 73%. Respiratory distress syndrome was diagnosed in 89% of the infants, with a 69% surfactant administration rate. Severe intracranial hemorrhage [IVH] [grade >II] was 14%. Grade 4 periventricular leukomalacia was 10%. Twelve [24%] infants had evidence of bronchopulmonary dysplasia [BPD]. Retinopathy of prematurity [stage >II] was 4%. The correlation between ROP rate and need for ventilation therapy was present [r=0.52]. Proven necrotizing enterocolitis [stage >2] was not observed. Patent ductus arteriosus [PDA] was diagnosed in 67% of the neonates. BPD, IVH, and PDA were statistically higher in neonates with a birth weight <1000g. Survival rate of VLBW infants increased with increasing BW. Sex was not a risk factor for mortality. The need for ventilatory therapy may be an important risk factor for ROP in infants <1500g