Risk factors and neonatal outcomes of pulmonary air leak syndrome in extremely preterm infants: A nationwide descriptive cohort study.

Most extremely preterm infants (EPIs), who were born before 28 weeks of gestation, with pulmonary air leak syndrome (ALS) are symptomatic, often severe, and require drainage. EPIs with severe air leak syndrome (sALS) that require tube drainage or needle aspiration are at high risk of morbidities and mortality. This study aimed to investigate perinatal characteristics, morbidities, and mortality in EPIs with sALS, and to estimate the risk of mortality according to gestational age (GA). A prospective cohort study conducted from 2013 to 2020 compiled the Korean Neonatal Network database to evaluate the incidence, perinatal characteristics, and outcomes of sALS in EPIs born before 28 weeks of gestation. Among 5666 EPIs, the incidence of sALS was 9.4% and inversely related to GA. From this cohort, we compared 532 EPIs with sALS to 1064 EPIs without sALS as controls, matching the subjects by GA and birth weight. Preterm premature rupture of membranes, oligohydramnios, resuscitation after birth, low Apgar scores, repeated surfactant administration, persistent pulmonary hypertension of the newborn, and pulmonary hemorrhage were associated with the development of pneumothorax. The sALS group required a higher fraction of inspired oxygen and more invasive respiratory support at both 28 days of life and 36 weeks of postmenstrual age. The sALS group had a higher incidence of bronchopulmonary dysplasia and major brain injury. The mortality rate was higher in the sALS group than in the control group (55.3% vs 32.5%, P < .001), and the ALS group had a 1.7 times risk of mortality than the control group. More attention should be paid to sALS in EPIs because the frequency of sALS increased as GA decreased, and the risk of mortality was more significant at lower GA.

Can red cell distribution width in very low birth weight infants predict bronchopulmonary dysplasia?

ABSTRACT: Red cell distribution width (RDW) is a useful marker for assessing the severity and prognosis of various diseases in adults. However, whether it is applicable to children, especially in newborns, has not been determined.This study aimed to investigate the RDW values of preterm infants and evaluate whether RDW values in the early days of life can predict bronchopulmonary dysplasia (BPD) development.One hundred and eight infants born at <30 weeks of gestation with a birth weight of <1500 g participated in this retrospective study. RDW values measured at birth, 7 days (D7), and 28 days (D28) after birth were reviewed. The changes in RDW values in the first month of life were analyzed, and we evaluated the relationship between RDW and BPD.The mean RDW values at birth, D7, D28 and the change from birth to D7 were 16.2 ±â€Š0.1%, 17.5 ±â€Š0.2%, 17.6 ±â€Š0.2% and 1.3 ±â€Š1.8%, respectively. RDW at birth was lower in the infants born at <28 weeks' gestational age than in those born at ≥28 weeks' gestational age (15.7 ±â€Š0.3 vs 16.4 ±â€Š0.2, P = .024). RDW values of both groups increased during the first week after birth and did not differ significantly at D7. The levels remained similar at 1 month of age. RDW at birth, D7, and D28 and the changes in RDW from birth to D7 were not correlated with the development of BPD independent of its severity.The usefulness of RDW as a predictor of BPD development remains questionable and requires further study.

Dynamic Changes of Fecal Calprotectin and Related Clinical Factors in Neonates.

Objective: Fecal calprotectin (FC) has been widely used for a clinical marker of intestinal inflammation in children and adults. However, the clinical usefulness has not been determined in neonates. The purpose of this study was to investigate the change of FC and associated clinical factors in neonates. Methods and Materials: In total, 146 neonates among 472 admissions to our NICU between 2018 and 2019 were included, and 242 stool samples were collected. FC was measured in the first, second, and third-fourth week after birth, respectively, using commercial ELISA. The clinical characteristics were reviewed from medical records. Statistical analyses were performed to analyze associated factors regarding on changes of fecal calprotectin. Results: A wide range from 5.5 to 6,000 mg/kg of FC was observed in neonates. FCs during neonatal period were not correlated with the gestational age at birth or birth weight. The meconial calprotectin was higher than FCs after 2 weeks of age (n = 134, 418.06 vs. 243.12 in the second week and 259.58 in the third week after birth). Meconial calprotectin was associated with birth weight and meconium stained amniotic fluid. FC during the neonatal period decreased with postnatal week (-464.93 ± 158.02 at third-fourth week after birth compared with the 1st week, P = 0.004) and breast milk (-337.27 ± 150.51 compared with formula milk, P = 0.026). Conclusion: Fecal calprotectin tended to decrease with postnatal week during the neonatal period, and breast milk could affect more decrease of FC.

Plasma B-type natriuretic peptide cannot predict treatment response to ibuprofen in preterm infants with patent ductus arteriosus.

Plasma B-type natriuretic peptide (BNP) is a useful marker for diagnosis of hemodynamically significant PDA (hsPDA) and serial BNP measurement is also valuable for monitoring treatment response. This retrospective study was performed to evaluate whether plasma BNP level can predict treatment response to ibuprofen in preterm infants born at <30 weeks of gestation with hsPDA. Plasma BNP was measured before (baseline) and 12 to 24 h after (post-treatment) completion of the first (IBU1) and second (IBU2) course of ibuprofen. We compared the BNP levels of responders (closed or insignificant PDA) with those of non-responders (hsPDA requiring further pharmacologic or surgical closure) to each course of ibuprofen. The treatment response rates for IBU1 (n = 92) and IBU2 (n = 19) were 74% and 26%, respectively. In IBU1, non-responders had lower gestational age and birth weight than responders (both, P = 0.004), while in IBU2, non-responders had lower birth weight (P = 0.014) and platelet counts (P = 0.005) than responders; however, baseline BNP levels did not differ significantly between responders and non-responders in either IBU1 (median 1,434 vs. 1,750 pg/mL) or IBU2 (415 vs. 596 pg/mL). Post-treatment BNP was a useful marker for monitoring treatment efficacy of IBU1 and IBU2 for hsPDA with a cut-off value of 331 pg/mL (P < 0.001) and 423 pg/mL(P < 0.010), respectively. We did not identify a cut-off baseline BNP level that could predict treatment response to ibuprofen in preterm infants with hsPDA.

Transthoracic catheter drainage for large symptomatic congenital pulmonary airway malformation.

BACKGROUND: Surgical resection of large symptomatic congenital pulmonary airway malformation (CPAM) in newborns has high risks of mortality and postoperative morbidity. This study aimed to report the clinical outcomes of newborns who underwent percutaneous transthoracic catheter drainage (PTCD) of large symptomatic CPAM before surgical resection. METHODS: This was a retrospective, descriptive study based on review of the medical records of newborn infants who required surgical resection of large symptomatic CPAM at a single tertiary hospital from 2001 to 2017. The clinical outcomes were compared between patients who underwent surgical resection following PTCD (PTCD group) and those who underwent surgical resection alone (non-PTCD group). RESULTS: A total of 17 newborns were included. PTCD was performed in seven cases; the median age at the time of the initial PTCD was 4 days (range, 0-20 days). Following PTCD in all cases, chest radiograph demonstrated a dramatic reduction in the sizes of the cysts and improvement of mediastinal shift and the Alveolar-arterial oxygen difference decreased. The median duration between initial PTCD and surgery was 4 days (range, 2-33 days). PTCD-related complications included pneumothorax (n = 2), catheter displacement (n = 1), and failure to drain (n = 1). Compared with the non-PTCD group (6 of 10), the PTCD group had a tendency toward lower rates of postoperative complications (1 of 7). CONCLUSION: PTCD can be an effective interim management for symptomatic newborn infants who require emergency surgical resection of large CPAM.

Early sodium and fluid intake and severe intraventricular hemorrhage in extremely low birth weight infants.

Hypernatremic dehydration is an important cause of intracranial hemorrhage. A possible association of intraventricular hemorrhage (IVH) with hypernatremia and/or high sodium intake has been suggested in preterm infants. To investigate the associations of early fluid and sodium intake or serum sodium concentrations with severe intraventricular hemorrhage (IVH) in extremely low birth weight (ELBW) infants, we reviewed the medical records of 169 inborn ELBW infants. Daily fluid and sodium intake, urine output, weight loss and serum sodium concentration during the first 4 days of life were obtained. Patients were divided into the severe IVH (grade 3/4) and the control (no or grade 1/2 IVH) group. The maximum serum sodium concentration and the incidence of hypernatremia did not differ between the two groups. Related to the fluid balance and sodium intake, the risk for severe IVH was strongly associated with total fluid and sodium intake during the initial four days of life. With respect to the fluids other than transfusion, severe IVH can be discriminated only by sodium intake but not by fluid intake. Large randomized controlled trials are required to clarify the causal relationship between the early sodium intake and severe IVH in ELBW infants.

Nerve and behavioral responses of mice to various umami substances.

Food contains various taste substances. Among them, umami substances play an important role with regard to the perception of the taste of food, but, few studies have examined the taste characteristics of representative umami substances other than monosodium L-glutamate (MSG). By conducting mouse behavioral studies (the 48-h 2-bottle preference test and the conditioned taste aversion test) and assessing gustatory nerve responses, we investigated the taste characteristics of unique umami substances, including sodium succinate, L-theanine, betaine, and the enantiomer of MSG, D-MSG. Furthermore, we examined the synergy of umami with inosine 5'-monophoshate (IMP). In the case of the mice, sodium succinate had an umami taste and showed strong synergy with IMP. L-theanine showed synergy with IMP but did not have an umami taste without IMP. In contrast, betaine did not have an umami taste or synergy with IMP. D-MSG might have weak synergy with IMP.

Determination of oceanic carbon dioxide using a carbonate-selective electrode.

Potentiometric properties of the PVC membrane-based electrodes prepared with molecular tweezer-type neutral carriers, 3,12-bis(TFAB)CA and deoxy-3,12-bis(TFAB)CA, and trifluoroacetyl-p-decylbenzene (TFADB) were measured in buffered electrolytes (0.1 M Tris-H2SO4, pH 8.6 and 8.0) and artificial seawater. It was observed that the deoxy-3,12-bis(TFAB)CA-based electrode provides greatly enhanced carbonate selectivity over chloride (log K(CO3(2-), Cl-)POT approximately -6) and other minor anions present in seawater. Thus, we explored the possibility of applying this new carbonate-selective electrode for direct determination of oceanic carbon dioxide. The total carbon dioxide (TCO2) level in surface Yellow Sea water was determined with the deoxy-3,12-bis(TFAB)CA-based electrode, Severinghaus-type CO2 gas sensor, and the traditional potentiometric titration methods. The results showed that the carbonate-selective electrode provides accurate oceanic TCO2 determination comparable to that obtainable with the other two methods. The analytical procedure based on a carbonate-selective electrode is clearly advantageous over other conventional methods: it does not require any sample pretreatment and extra reagents other than the standard calibration solutions, while providing the measured results directly and immediately.