Differential effects of ibuprofen and indomethacin on cerebral oxygen kinetics in the very preterm baby.

Background: Ibuprofen is preferred to indomethacin for treatment of a significant patent ductus arteriosus (PDA) in preterm babies despite indomethacin being associated with a lower risk of intraventricular haemorrhage. This difference is thought to relate to the discrepant effects of each medication on cerebral oxygen kinetics yet the effect of ibuprofen on cerebral perfusion is uncertain. Methods: Forty-eight babies < 30 weeks with a significant PDA, defined by echocardiography, were randomly assigned to either indomethacin or ibuprofen (n = 24 per group) and stratified by gestation and chronologic age. Cerebral blood flow [total internal carotid blood flow (TICF)] and oxygen physiology [oxygen delivery (modCerbDO2) and consumption (modCerbVO2)] were measured using cranial Doppler ultrasound and near-infrared spectroscopy, and cerebral oxygen extraction (cFTOE) calculated, immediately before and following administration. Temporal and treatment related changes were analysed. Results: A fixed effect of time was seen for TICF (p = 0.03) and therefore modCerbDO2 (p = 0.046) and cFTOE (p = 0.04) for indomethacin alone. In the indomethacin group, TICF and modCerbDO2 fell from baseline to 5 and 30 min respectively (TICF p < 0.01, cDO2 p = 0.01) before increasing from 5 min to 24 h (p < 0.01) and 30 min and 24 h (p < 0.01) timepoints. cFTOE peaked at 30 min (p = 0.02) returning to baseline at 24 h. There was a parallel increase in arterial lactate. Conclusion: Indomethacin significantly reduces cerebral blood flow soon after administration, resulting in a parallel increase in oxygen extraction and arterial lactate. This implies that the balance of oxygen kinetics at the time of treatment may be critical in very preterm babies with significant PDA.

Determining the venous oxygen reservoir: A novel, hypothetical approach to titration of supplemental oxygen in preterm newborns.

While normal oxygen saturation is commonly thought to be a marker of normal oxygenation, cutaneous saturation does not account for the sufficiency of oxygen within each cell or that of the system overall. Rather, cutaneous oximetry simply defines the saturation of haemoglobin (Hb) with oxygen in a pulsatile vessel. Assessment of sufficiency is best determined by measurement of the amount of oxygen left over following aerobic respiration. This left over oxygen is 'stored' on Hb in the venous compartment and can be calculated as the venous oxygen content. We hypothesize that the development of a venous oxygen content or saturation reference range in a group of well, uninjured very preterm newborns and subsequent application, in a randomised trial, with a structural, functional and molecular outcome will resolve the method for assessment of oxygen sufficiency in preterms by demonstrating both clinical safety and effectiveness. This method could be subsequently used for titration of supplemental oxygen.

[Comparative field study of litter moisture and footpad alterations during the rearing period of fattening turkeys]. / Vergleichende Feldstudie zur Einstreu- feuchtigkeit und zur Fussballengesundheit während der Aufzucht von Mastputen.

In the course of a nationwide performed field study from 2010 to 2012, the footpad health of conventionally kept fattening turkeys and their rearing conditions were studied and compared to results from litter moisture measurements. In each case two rearing periods from 24 rearing farms were chosen and visited 3 to 5 days after delivery of the poults (examination 1) and again during the days 22 to 35 (examination 2). In the course of each flock inspection 60 randomly chosen turkeys were examined by adspection and palpation. Litter samples from drinking, feeding and resting areas were taken using the Darr procedure to measure moisture. Data regarding rearing conditions was collected from the farmer using standardized questionnaires. The litter moisture was 10% (6-20%) before the birds' entered the barn. At the time of examination 1 litter moisture of 43% (14-67%) in the drinking zone, 28% (12-66%) in the feeding zone, and 13% (8-31%) in the resting area were measured. At the time of examination 2 the litter moisture measurements showed 51% (32-72%) in the drinking zone, 27% (13-56% in the feeding zone and 28% (16-53%) in the resting area. At the time of examination 127.3% of the poults had footpad alterations, during examination 2 that number increased to 63.3% with 12.1% showing epithelial necrosis. The young turkeys on the three most commonly used litter substrates showed the following results at the time of examination 2: when held on straw pellets 58%, on wood shavings 29%, and on straw 17% showed unaltered footpads. Regarding the housing conditions the examinations showed specifically differences in stocking rate, drinking system and litter management.

Neonatal exchange transfusions in the 21st century: a single hospital study.

AIM: In the 21st century, neonatal exchange transfusions (ETs) are uncommon procedures usually performed in tertiary neonatal units. As junior clinical staff now lack familiarity with the procedure, it is important to maintain awareness of its complications in order to manage clinical risks and counsel parents appropriately. The study aims to analyse the ET rate, its indications and its associated complications, in a single tertiary centre in the 21st century. METHODS: This is a retrospective cohort study of all infants receiving ET from 1 January 2001 to 31 December 2010 at the Royal Women's Hospital, Melbourne. RESULTS: Sixty-four ETs were performed in 51 infants, an average of 6.4 ETs per year. Forty-nine (96%) infants were exchanged for hyperbilirubinaemia and two (4%) for anaemia. Thirty-six (71%) infants had Rhesus haemolytic disease of the newborn and six (12%) had ABO incompatibility. Six infants were intubated and mechanically ventilated after ET; these infants were significantly more acidotic during the ET than those who were never on respiratory support (mean pH 7.153 and 7.309 respectively, mean difference -0.156, 95% CI -0.196 to -0.116, t = 7.85, P < 0.001). Overall mortality was 8% (n = 4). CONCLUSIONS: Our current ET rate is very low compared with historical data. It is difficult to ascribe mortality and morbidity directly to ET as the procedure is now often performed on smaller, sicker or more premature infants whose risks of mortality and morbidity are high regardless of ET. Prospective multi-centre studies are needed to provide adequate data to analyse complications in greater detail.

[Effects of the housing climate on the foot pad health of fattening turkeys of British United Turkeys 6 origin during the early rearing phase]. / Auswirkungen des Stallklimas auf die Fussballengesundheit von Mastputen der Herkunft B.U.T. 6 in der Aufzuchtphase.

The climate in the stables during the turkeys' first weeks of life is a crucial factor for a successful rearing and the following fattening period. The present study has examined the influence of climate parameters on the foot pad health status of 2681 fattened turkeys from twelve farms during the early rearing phase. In addition to wide-ranging collections of data concerning livestock husbandry and management an examination of the foot pads of 60 animals has been carried out respectively on day 3-5, as well as on day 22-35, shortly before relocation into another stable. For assessing the foot pads a scheme of five categories has been used (ranging from category 0 = no alteration to category 4 = deep lesion). Solely beak trimmed turkeys of the British United Turkeys (BUT) 6 strain, male and female, were examined. In twelve farms air temperature and humidity have been recorded continuously, ammonia and dust concentration were registered on each day of the examination. When assessing the foot pads, the first alterations could already be noted at the age of 3-5 days. On the second period of exzmination 55.6% of the turkeys showed category 2 or category 3. Examinations of the climate parameters showed strong differences concerning temperature, humidity and ammonia concentration among all farms. Using the Fisher's Exact Test, significant dependency of foot pad health on starting temperature (p < 0.001), on temperature measured one week before the second examination (p = 0.004), on humidity (p < 0.001), and on air ammonia concentration (p < 0.001) could be indicated.

Impact of Selected Factors on the Occurrence of Contact Dermatitis in Turkeys on Commercial Farms in Germany.

In a long term research project in Germany the influence of husbandry on the health of fattening turkeys (Study 1) as well as the influence of practiced rearing conditions on the health of turkey poults (Study 2) was examined in 24 farms and at the meat processing plant. In all examined rearing farms, litter samples for the determination of litter moisture were taken. This paper summarizes the results obtained by our working group from 2007 until 2012. The results elucidate the universal problem of foot pad dermatitis (FPD). Nearly 100% of the observed turkeys showed a clinically apparent FPD at the meat processing plant. Furthermore, skin lesions of the breast, especially breast buttons were diagnosed, particularly at the slaughterhouse. FPD was detected in the first week of the rearing phase. Prevalence and degree showed a progressive development up to the age of 22-35 days, whereas 63.3% of the poults had foot pad alterations. As even mild alterations in the foot pad condition can be indicators for suboptimal design of the rearing environment, especially high litter moisture, it is important to focus on the early rearing phase.