Comparative evaluation of the effects of indomethacin and ibuprofen on cerebral perfusion and oxygenation in preterm infants with patent ductus arteriosus.

OBJECTIVE: To compare the effects on cerebral perfusion and oxygenation of intravenous ibuprofen and indomethacin as treatment for patent ductus arteriosus in preterm infants. STUDY DESIGN: Sixteen infants receiving mechanical ventilation (< 31 weeks gestation) with patent ductus arteriosus received either 0.2 mg/kg indomethacin (n = 8) or 10 mg/kg ibuprofen (n = 8) infused over 1 minute. Near-infrared spectroscopy was used to measure changes in cerebral blood volume and in oxidized cytochrome oxidase concentration. Cerebral blood flow velocity in the pericallosal artery was measured using Doppler ultrasonography. RESULTS: Indomethacin caused a significant reduction of CBV (maximal changes in cerebral blood volume: -320 +/- 171 microL/100 gm) and, in four of eight patients, a fall in oxidized cytochrome oxidase concentration (maximal change in oxidized cytochrome oxidase concentration in the eight patients: -0.68 +/- 0.98 mumol/L, NS). Cerebral blood flow velocity fell significantly. Ibuprofen caused no significant reduction of cerebral blood volume, oxidized cytochrome oxidase concentration, or cerebral blood flow velocity, whereas a significant increase of cerebral blood volume (+207 +/- 200 microL/100 gm) was observed after 60 minutes. Ductus closure was seen in six of eight infants after the first dose of indomethacin and in five of eight infants after the first dose of ibuprofen. The therapeutic cycle involved administration of a second and third dose, provided no side effects occurred. Treatment was effective in all infants. CONCLUSION: Compared with indomethacin, treatment with ibuprofen does not significantly reduce cerebral perfusion and oxygen availability; the observed increase in cerebral blood volume requires further investigation.

Closed versus open endotracheal suctioning in preterm infants: effects on cerebral oxygenation and blood volume.

The aim of our study was to compare, using near-infrared spectroscopy (NIRS), the effects on cerebral intracellular oxygenation and cerebral blood volume (CBV) of closed endotracheal suctioning (CS), which permits continuous ventilation of the patient, with open endotracheal suctioning (OS), which requires disconnection from the ventilator. Eleven preterm infants were studied. Each patient underwent one CS, followed, after 60 min, by one OS, or vice versa, three times during the same day. Modifications in CBV and oxidized cytochrome oxidase (CytO2) were continuously detected by NIRS; arterial oxygen saturation (SaO2) heart rate (HR), transcutaneous carbon dioxide tension and mean arterial blood pressure were simultaneously recorded. Significant reductions in HR and SaO2 were observed following OS; the magnitude and duration of these negative effects of suctioning were significantly reduced with CS. In addition, the decrease in CBV was more pronounced than following CS. No changes in CytO2 concentration were seen.

Prevalence of dementia in an elderly rural population: effects of age, sex, and education.

OBJECTIVES: To estimate the prevalence of dementia in an elderly rural population and to determine the effects of age, sex, and education. METHODS: To obtain prevalence estimates of both cognitive impairment and dementia a door to door two phase population survey was carried out in three rural villages in central Italy. Of 1147 inhabitants older than 64, 968 (84.4%) completed the protocol. RESULTS: The prevalence rates (cases per 100 population over 64) were 8.0 for dementia and 27.3 for cognitive impairment. The prevalence rate for dementia did not differ between men and women (7.9 v 8.2), but increased with age (from 1.1 at age 65-69 to 34.8 at age 90-96). Subjects with less than three years of schooling had a significantly higher prevalence of dementia (14.6; 95% confidence interval (95% CI) 10.2-19.1) than subjects with three or more years of schooling (5.9; 95% CI 4.2-7.7). At the multivariate logistic analysis, the risk related with a low level of education was still present after adjustment for age and sex (OR = 2.0; 95% CI 1.2-3.3). Alzheimer's disease was diagnosed in 64% of the 78 demented patients, vascular dementia in 27%, and other dementing diseases in 9%. CONCLUSIONS: In both Alzheimer and vascular dementia subtypes, the prevalence rates did not differ between men and women, but increased with age and were higher in subjects with a low level of education.

Bronchopleural fistula: successful selective bronchial occlusion with a Fogarty's catheter in a preterm infant.

A preterm infant (26 weeks' gestation) mechanically ventilated for respiratory distress syndrome developed severe interstitial emphysema of the right lung with a bronchopleural fistula, pneumothorax and mediastinal shift. Selective occlusion of the right main bronchus with a Fogarty's catheter produced rapid improvement in the clinical condition and radiological features. Occlusion of the main bronchus in a newborn with a bronchopleural fistula and pulmonary interstitial emphysema is an easily performed manoeuvre that can be life-saving.

[Congenital cytomegalovirus infections in a neonatal pathology unit]. / Infezioni congenite da cytomegalovirus in una unita' di patologia neonatale.

In order to evaluate the incidence of congenital CMV infections we checked 200 babies in the special care baby unit of an obstetric clinic in Milan. In the same period 3779 babies were born in that clinic. Congenital CMV infection was diagnosed by virus isolation from urine specimens collected in the first week of life in two babies. One of them was asymptomatic, the other had the classical CID. Virological confirmation of a further CID observed in an infant hospitalized at that time in the unit was obtained. Different serological methods of congenital infections diagnosis, specific IgM, total IgM and IgA, rheumatoid factor determinations, were employed. Only the CMV-IgM ELA method didn't give false positive reactions and picked up 2 congenitally infected babies out of 3. From our data, we infer that the incidence of congenital CMV infection in the general milanese population might lie between 0.5-1% of live births. The level of seropositivity for CMV antibodies in the same population, as judged from the complement fixing antibodies determinations in the group of the mothers, was 87%.

[Rotavirus infections in a neonatal pathology unit]. / Le infezioni da rotavirus in una unità di patologia neonatale.

From February to June 1981, 38 newborn babies admitted to a special care unit were examined to determine the incidence of rotavirus infections. Fecal specimens were collected from all babies on the fifth day after birth and thereafter weekly. The stool samples were examined with an immunoenzymatic test. Serum was collected from the newborn babies and from their mothers three days after delivery. Thereafter more serum was collected from the babies at intervals. Serum was also collected from the hospital staff. Rotavirus was detected in one or more of the stool samples taken from 20 (53%) of the 38 newborn babies. Of these 20, 11 (55%) were already positive in the first specimen. Three babies still had rotavirus in their faeces after four weeks. No relation was noted between the admission to one or the other of the two wards in the unit and the presence of rotavirus in their stools. Complement fixing antibody (CFA) titers in the babies were not different from those in the mothers. A decline of antibody levels was observed in all the babies whether they were rotavirus positive or negative. Only three of the babies without CFA in the first serum sample had a significant increase of the titer while rotavirus was not found in their stools. The CFA titer geometric mean was significantly higher for babies who were found to have rotavirus from the first stool sample than for those whose subsequent samples were found to be positive. Moreover, the CFA titer geometric mean for the hospital staff was significantly higher than that of the mothers. Mild gastrointestinal symptoms were observed in 70% of the newborn babies having rotavirus in their stool and in 39% of those without rotavirus. However, this difference did not prove to be significant.