Effects of red cell transfusion on cardiac output and perfusion index in preterm infants.

OBJECTIVE/AIM: The present investigation was designed to study the effect of blood transfusion on cardiac output and perfusion index. The aim was to demonstrate a relationship between hematocrit, lactate, cardiac output and perfusion index in anemic preterm infants and to investigate significant changes in these parameters induced by RBC transfusion. METHODS: Anemic infants who were under 35 weeks of gestational age (GA) and were in a stable clinical condition without respiratory or cardiac problems, signs of sepsis, or renal disease at the time of investigation were enrolled in the study. Enrolled infants received 15 ml/kg pure red blood cells over 4 h. Hematocrit and lactate levels were studied before and after transfusion. Cardiac output was measured by an ultrasound device (USCOM 1A) and perfusion index was monitored by pulse oximeter (MasimoRad7). RESULTS: Cardiac output decreased by 9% (p < 0.05), due to decrease in heart rate by 10% (p < 0.05) and stroke volume significantly by 5% (p < 0.05) both in left and right sided cardiac measurements. Perfusion index significantly increased and lactate levels significantly decreased after transfusion (p < 0.05). Htc was inversely correlated with lactate levels, HR, CI and CO (r = -0.33, p = 0.01; r = -0.53, p = 0; r = -0.37, p = 0.004, r = -0.28, p = 0.03). PI was not significantly correlated with Htc levels before and after transfusion (r = 0.07, p = 0.7 and r = 0.007, p =0.97). CONCLUSION: Our data support that heart rate, CO and CI and lactate levels increased as a response to anemia in preterm infants and RBC transfusion improved perfusion index suggesting better tissue oxygenation.

Surfactant administration via thin catheter during spontaneous breathing: randomized controlled trial.

BACKGROUND: The primary aim of this randomized study was to describe the feasibility of early administration of surfactant via a thin catheter during spontaneous breathing (Take Care) and compare early mechanical ventilation (MV) requirement with the InSurE (Intubate, Surfactant, Extubate) procedure. METHODS: Preterm infants, who were <32 weeks and stabilized with nasal continuous positive airway pressure (nCPAP) in the delivery room, were randomized to receive early surfactant treatment either by the Take Care or InSurE technique. Tracheal instillation of 100 mg/kg poractant α via 5-F catheter during spontaneous breathing under nCPAP was performed in the intervention group. In the InSurE procedure, infants were intubated, received positive pressure ventilation for 30 seconds after surfactant instillation, and placed on nCPAP immediately. RESULTS: One hundred infants in each group were analyzed. The MV requirement in the first 72 hours of life was significantly lower in the Take Care group when compared with the InSurE group (30% vs 45%, P = .02, odds ratio -0.52, 95% confidence interval -0.94 to -0.29). Mean duration of both nCPAP and MV were significantly shorter in the Take Care group (P values .006 and .002, respectively). Bronchopulmonary dysplasia rate was significantly lower among the infants treated with the Take Care technique (relative risk -0.27, 95% confidence interval -0.1 to -0.72) CONCLUSIONS: The Take Care technique is feasible for the treatment of respiratory distress syndrome in infants with very low birth weight. It significantly reduces both the need and duration of MV, and thus the bronchopulmonary dysplasia rate in preterm infants.

The impact of the new Turkish regulation, imposing single embryo transfer after assisted reproduction technology, on neonatal intensive care unit utilization: a single center experience.

OBJECTIVES AND AIM: IVF has become an efficient and widely used treatment for infertile couples, however, it is responsible for an increasing number of multifetal pregnancies and adverse neonatal outcomes. This study aimed to assess a health service utilization in one neonatal intensive care unit (NICU), as a response to the 2010 Turkish reproductive regulation requiring single embryo transfer (SET). METHODS: All assisted reproductive technology (ART) pregnancies delivered at Zekai Tahir Burak Maternity Teaching Hospital between February 2010 and October 2011 were included in this study. Subjects were divided into two groups: Group 1 consisted of infants conceived before the ART regulation, and born between February 2010 and October 2010, and Group 2 consisted of infants conceived after the ART regulation, and born between November 2010 and October 2011. RESULTS: Upon comparing the study groups, we observed a significant decrease in the incidence of multiple births in Group 2. The mean gestational age and mean birthweight were significantly higher in Group 2. The rates of prematurity and low birthweight, very low birthweight and extremely low birthweight infants were significantly lower in Group 2. Similarly, the rates of NICU admission, respiratory distress syndrome, necrotizing enterocolitis anemia and pneumonia/sepsis, and the need for respiratory support (mechanical ventilation and nasal continuous positive airway pressure) were significantly lower in Group 2. CONCLUSIONS: According to our data, NICU utilization was reduced and the early post-natal outcomes of the babies were improved after the new Turkish regulation on ART imposing SET. However, multicenter studies are needed to generalize our results to the whole country.

Off-label and unlicensed drug use in neonatal intensive care units in Turkey: the old-inn study.

BACKGROUND: Recently several developed countries have improved the safety and efficacy of drugs used in infants and pediatric patients. Most drugs administered to adults have licensed approvals outlining indications, doses, and the recommended route of administration. However, many drugs that are given to children are unlicensed or used off-label. OBJECTIVES: To assess the extent and nature of unregistered and off-label drug use in neonatal intensive care units (NICUs) in Turkey, and to explore awareness and views of the general public on the unlicensed use of medicine in preterm and term infants in developing countries. STUDY DESIGN: A prospective observational study of a dynamic cohort of 464 neonates from 17 NICUs in Turkey. All medications administered to neonates who were hospitalized and admitted to the NICU over a 24-h period were recorded. The prescriptions were analyzed to determine whether the medicines were used in a licensed or unlicensed manner. RESULTS: In total, 1,315 prescriptions comprising 93 different medicines were written. We found that 62.3% of the drugs prescribed to the neonates over the 24-h period were unlicensed or off-labeled. CONCLUSIONS: The present study indicates that unlicensed and off-label medicines are frequently used in preterm and term infants in Turkish NICUs. This finding is consistent and reported in other countries. We believe that the needs of the neonatal population must be a priority and access to safe and appropriate medicines requires urgent attention.

Placental transmission of novel pandemic influenza a virus.

The effects of maternal influenza on the fetus are not well understood. Viremia is believed to occur infrequently and thus vertical transmission appears to be rare. Highly pathogenic strains of influenza virus, such as avian influenza A (H5N1), are more likely to be transmitted across the placenta. Placental tissues of seven women with confirmed H1N1 infection were examined molecularly with RT-PCR and microscopically to investigate whether H1N1 virus vertically transmitted. We found no evidence for placental transmission of H1N1 virus in this study. In the absence of vertical transmission, adverse effects like neonatal seizures, encephalopathy, cerebral palsy, and even neonatal death can still occur. Since a significant knowledge gap exists for the effects of this novel virus on the fetus, further studies will be beneficial.

Dealing with pandemic influenza A during postpartum and early neonatal period in a busy family-centered neonatal intensive care unit.

Although most infections with the current pandemic H1N1 virus have been self-limited, the risk of influenza complications is higher in some subpopulations. Pregnant women had an increased risk of influenza complications in two past epidemics (1918-1919 and 1957-1958). Since neonates do not have a well-developed immune system, they are also vulnerable to viral infections and its complications. This article reports the interventions and health care planning strategies for pandemic influenza A, and its seasonal results in a tertiary perinatal care center with annually 20,000 deliveries.