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

cost analysis of preterm infants from a NICU of a state hospital in Istanbul

The objective of this study was assessment of hospital costs of 211 preterm babies admitted to NICU in a 12-month period. Preterm babies with gestational age 28-37 GW hospitalized in Dr. L. Kirdar Kartal Research and Training Hospital NICU between November 1st, 2006 to October 31st, 2007 were included in this retrospective study. The financial records of the babies were plotted and investigational, interventional, consumable costs, drugs and ancillary costs were determined. The average daily cost of a preterm has been determined. Group I and II consisted of babies with gestational ages 37-33 GW and 32-28 GWs respectively. The length of stay, ventilation duration and costs of each group were compared. The mean birth weight was 1689 +/- 497 gr. The mean length of hospital stay was 13.6 +/- 13.4 days. Hundred and four [49.5%] patients were found to be ventilated. The median ventilation day was 3 days. We found a statistically significant relation between length of hospital stay, ventilation duration, presence of interventions, RDS, sepsis and hospital costs. The mean total hospitalization cost and the daily cost of a preterm was determined as [dollar sign] 4187 and [dollar sign] 303 respectively. The highest intensive care costs of preterm neonates were found to be paid for interventional procedures, followed by NICU personnel salary and ancillary costs. Between two groups statistically significant difference was found for length of stay, duration of ventilation, interventional and consumable costs [P=0.014, P=0.019, P=0.001, P=0.03 respectively]. Strategies for prevention of prematurity and early weaning from mechanical ventilation may shorten length of hospital stay leading to decreased NICU costs

Increasing low birth weight rates: deliveries in a tertiary hospital in Istanbul

Prevalence of low birth weight deliveries may vary across different environments. The necessity of determination of regional data prompted this study. Information of all deliveries from January 2004 to December 2008 was obtained from delivery registry records retrospectively. Initial data including birth weight, vital status, sex, maternal age and mode of delivery were recorded using medical files. The frequency of low birth weight, very low birth weight, extremely low birth weight and stillbirth deliveries were determined. Among 19,533 total births, there were 450 [23.04 per 1000] stillbirths. Low birth weight rate was 10.61%. A significant increase in yearly distribution of low birth weight deliveries was observed [P<0.001]. Very low birth weight and extremely low birth weight delivery rates were 3.14% and 1.58% respectively. Among 2073 low birth weight infants, 333 [16.06%] were stillbirths. The stillbirth delivery rate and the birth of a female infant among low birth weight deliveries were significantly higher than infants with birth weight >/-2500g [P<0.001, OR=28.37], [P<0.001] retrospectively. There was no statistical difference between low birth weight and maternal age. The rate of cesarean section among low birth weight infants was 49.4%. High low birth weight and stillbirth rates, as well as the increase in low birth weight deliveries over the past five years in this study are striking. For reduction of increased low birth weight rates, appropriate intervention methods should be initiated

effect of maternal anemia on anthropometric measurements of newborns

To evaluate the relation between maternal prenatal hemoglobin concentration and neonatal anthropometric measurements. All pregnant women who gave birth at the Obstetrics Department of Dr. LK Kartal Training and Research Hospital, Istanbul, Turkey, from January 1, 2005 to December 31, 2006, and their newborns were included in this prospective, cross-sectional study. The newborns' weight, height, head, and chest circumference were recorded. Mothers with hemoglobin concentration less than 11g/dl were evaluated as anemic. The anemic mothers were then grouped into 3 categories according to the corresponding hemoglobin concentration: mild [10.9-9.0g/dl], moderate [8.9-7.0 g/dl], and severe anemic [less than 7 g/dl]. The anthropometric measurements of newborns from non-anemic and anemic mother groups were compared. Of the 3688 pregnant women, 1588 [43%] were found to be anemic. Among the anemic mothers, 1245 had mild [78.5%], 311 had moderate [19.5%], and 32 [2%] had severe anemia. The anthropometric measurements [height, weight, head and chest circumference] of newborns of anemic and non-anemic mother groups showed a statistically significant difference [p=0.036, p=0.044, p=0.013, and p=0.0002]. There was a statistically significant difference in height, weight, and chest circumference of newborns of severe anemic and mild anemic mothers [p=0.017, p=0.008 and p=0.02]. The height [1.1 cm], weight [260 g], head [0.42 cm], and chest [1 cm] circumference of neonates in the severe anemic group is less than the mild anemic group. Anemia during pregnancy affect the anthropometric measurements of a newborn. Severe anemia had significant negative effect on neonatal anthropometric measurements