Minimal invasive surfactant therapy in preterm infants with respiratory distress syndrome: a single center experience.

BACKGROUND: Minimal invasive surfactant therapy (MIST) includes the tracheal instillation of surfactant via a thin catheter for the treatment of preterm infants with respiratory distress syndrome (RDS). We aimed to evaluate the impact of MIST compared to intubation, surfactant, extubation (INSURE) technique on respiratory outcomes. METHODS: A prospectively recruited cohort of preterm infants ≤32 weeks with RDS was compared against a historical cohort of infants treated with INSURE. The primary outcome was the need for mechanical ventilation within 72 hours of age and secondary outcomes the overall need and duration of mechanical ventilation, the development of bronchopulmonary dysplasia, common morbidities, and survival. RESULTS: Thirty-six infants treated with MIST of 29.1±2.2 weeks' gestation and 1219±238 grams' birthweight compared against 37 infants of 28.8±2.3 weeks' gestation and 1195±336 grams' birthweight treated with INSURE. A lower proportion of infants treated with MIST required mechanical ventilation within 72 hours of age compared to those treated with INSURE (11% compared 32%, p=0.042). However, no significant differences were noted regarding the overall intubation incidence, bronchopulmonary dysplasia, other morbidities, or survival. CONCLUSIONS: In spontaneously breathing infants ≤32 weeks with RDS, the MIST technique was associated with a lower need for intubation within 72 hours of age, but otherwise with no significant differences regarding BPD or other neonatal morbidities.

The association of the cerebral oxygenation during neonatal sepsis with the Bayley-III Scale of Infant and Toddler Development index scores at 18-24 months of age.

BACKGROUND: Neonatal sepsis has been associated with poor neurodevelopmental outcome, however the evidence regarding the exact mechanism of the inflammation to the developing neonatal brain are inconclusive. AIMS: To investigate association between cerebral oxygenation during neonatal sepsis and neurodevelopmental outcome. STUDY DESIGN: Follow-up assessment of a previously described prospective case-control study. SUBJECTS: A cohort of late preterm (34-37 weeks' gestation) and preterm (<34 weeks' gestation) infants with sepsis and healthy controls, evaluated at 18-24 months of corrected gestational age with Bayley-III Scales for Infant and Toddler Development (BSID-III). OUTCOME MEASURES: To evaluate the association between cerebral tissue oxygenation index (cTOI) and fractional tissue oxygen extraction (FTOE), measured with near-infrared spectroscopy, during sepsis and the composite cognitive and motor index scores. RESULTS: Thirty-one infants with blood culture confirmed neonatal sepsis and thirty-five controls were recruited. The cerebral oxygenation was significantly lower in septic neonates, compared to controls (61 ±â€¯7 compared to 72 ±â€¯5; p < 0.001). Infants with sepsis had significantly lower cognitive and motor index scores and higher proportion of suboptimal cognitive (16% compared to 3%, p = 0.045) and motor (16% compared to none, p = 0.008) index score. The low mean cTOI and FTOE noted in septic infants were significantly associated with worse cognitive and motor composite index scores. CONCLUSIONS: Infants with lower cerebral oxygenation during neonatal sepsis are at increased risk of worse cognitive and motor scores in the neurodevelopmental assessment.

Visual function in preterm infants without major retinopathy of prematurity or neurological complications.

OBJECTIVE: Early exposure of preterm infants to visual stimulation could affect the process of visual maturation. The aim of this study was to assess the impact of prematurity on visual function at 15 months post-term. SUBJECTS AND METHODS: Visual function was assessed in 102 preterm (PTI) and 50 full-term infants (FTI) without major cerebral pathology or retinopathy of prematurity (ROP) of grade 2 to 5, at 15 months' corrected age. The visual acuity, refractive status, contrast sensitivity, strabismus, fundus, and neurodevelopment were examined. RESULTS: Impairments of individual visual functions were 2 to 10 times more common in PTI than FTI. However, the difference was significant only for refractive errors (p = 0.007, odds ratio [OR] = 10.5). The incidence of visual deficits was higher in PTI with gestational age less than 32 weeks compared with PTI with higher gestational age (OR = 1.3 to 2.0), but not significantly. Of the PTI, 4.9%, 2.9%, and 10.8% had mild abnormalities on ultrasound scans, neuromotor, and developmental examination, respectively, which were not associated with increased incidence of visual deficits. CONCLUSION: Premature exposure to visual stimulation does not induce visual maturation but it is associated with impairment of certain aspects of visual function even in the absence of major ROP or neurodevelopmental deficits.

Diagnostic utility of elevated serum soluble triggering receptor expressed on myeloid cells (sTREM)-1 in infected neonates.

OBJECTIVE: To assess the value of serum levels of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) for early diagnosis of late-onset sepsis (LOS) in neonates, compared with interleukin-6 (IL-6). DESIGN AND SETTING: Prospective, observational study in a single, level III neonatal intensive care unit of a university hospital. PATIENTS: Fifty-two preterm and term neonates evaluated for suspected LOS were studied. Neonates were classified into two groups: infected [confirmed sepsis (n = 22) and possible sepsis (n = 9)] and noninfected neonates (n = 21). MEASUREMENTS AND RESULTS: Serum sTREM-1 and IL-6 were measured (enzyme-linked immunosorbent assays) when signs suggestive of sepsis emerged. Infected neonates had significantly higher sTREM-1 (p = 0.004) and IL-6 (p < 0.0001) than noninfected neonates. Receiver operating characteristic (ROC) curve analysis resulted in significant areas under the curve (AUC) for both sTREM-1 (AUC = 0.733, p = 0.005) and IL-6 (AUC = 0.892, p = 0.001) for identification of infected neonates, with the difference between the two AUC not being significant. Further analysis documented acceptable diagnostic performance of sTREM-1 and IL-6, which was not improved, however, when the two markers were combined. CONCLUSIONS: Serum sTREM-1 increases in infected neonates. Diagnostic accuracy of sTREM-1 either alone or in combination with IL-6 is not better than that of IL-6.

Antenatal betamethasone does not influence lymphocyte apoptosis in preterm neonates.

Despite the widespread use of antenatal glucocorticosteroids (GCs), the possibility of adverse effects on the immune response in preterm neonates remains a major concern. GCs stimulate lymphocyte apoptosis, resulting in lymphopenia and functional disorders, which have been associated with sepsis-related death in critically ill neonates. We sought to assess the effect of antenatal betamethasone (BM) on lymphocyte apoptosis in preterm neonates. Fifty preterm neonates exposed to antenatal BM and 50 controls were studied prospectively. Lymphocyte apoptosis was assessed using the annexin-V/propidium iodide (PI) assay, analysis of cell cycle after staining with PI, and intracellular caspase-3 activity. The two groups did not differ significantly as regards absolute lymphocyte counts and the percentage of lymphocytes being annexin-V (+)/PI (-) (early apoptotic) or lymphocytes in the subG1 peak after staining with PI and those with intracellular caspase-3 activation. The lymphocyte number and apoptosis were not associated with the time elapsed between antenatal BM administration and delivery. A single course of antenatal BM does not influence apoptosis of neonatal lymphocytes. This is of significant importance with respect to the preservation of lymphocyte-associated immune response in preterm neonates.