Effects of Sustained Lung Inflation, a lung recruitment maneuver in primary acute respiratory distress syndrome, in respiratory and cerebral outcomes in preterm infants.

BACKGROUND: Sustained Lung Inflation (SLI) is a maneuver of lung recruitment in preterm newborns at birth that can facilitate the achieving of larger inflation volumes, leading to the clearance of lung fluid and formation of functional residual capacity (FRC). AIM: To investigate if Sustained Lung Inflation (SLI) reduces the need of invasive procedures and iatrogenic risks. STUDY DESIGN: 78 newborns (gestational age≤34 weeks, weighing≤2000 g) who didn't breathe adequately at birth and needed to receive SLI in addition to other resuscitation maneuvers (2010 guidelines). SUBJECTS: 78 preterm infants born one after the other in our department of Neonatology of Catania University from 2010 to 2012. OUTCOME MEASURES: The need of intubation and surfactant, the ventilation required, radiological signs, the incidence of intraventricular hemorrhage (IVH), periventricular leukomalacia, retinopathy in prematurity from III to IV plus grades, bronchopulmonary dysplasia, patent ductus arteriosus, pneumothorax and necrotizing enterocolitis. RESULTS: In the SLI group infants needed less intubation in the delivery room (6% vs 21%; p<0.01), less invasive mechanical ventilation (14% vs 55%; p≤0.001) and shorter duration of ventilation (9.1 days vs 13.8 days; p≤0.001). There wasn't any difference for nasal continuous positive airway pressure (82% vs 77%; p=0.43); but there was less surfactant administration (54% vs 85%; p≤0.001) and more infants received INSURE (40% vs 29%; p=0.17). We didn't found any differences in the outcomes, except for more mild intraventricular hemorrhage in the SLI group (23% vs 14%; p=0.15; OR=1.83). CONCLUSION: SLI is easier to perform even with a single operator, it reduces the necessity of more complicated maneuvers and surfactant without statistically evident adverse effects.

beta-Endorphin concentration in colostrums of Burkinabe and Sicilian women.

OBJECTIVE: Endorphins (EPs) present in human colostrum may be relevant for immediate postnatal fetal adaptation because this compound is involved in stress response and adaptation mechanisms. Endorphin levels in human colostrum are two-fold greater than corresponding maternal plasma levels; however, the high endorphin levels in human milk decrease as lactation continues. The aim of this study was to determine the beta-EP concentration in colostrums of women residing in Burkina Faso and Sicily. In addition, we investigated the source of potential differences in beta-EP levels between these populations, especially ethnic sources of these deviations. METHODS: The concentration of beta-EP was determined in the colostrum from the first 3 d subsequent to delivery by an enzyme immunoassay as immunoreactive material (IRM). RESULTS: The production of beta-EP in the colostrum was significantly higher in Burkinabe mothers (0.83 +/- 0.04 ng/mL) than in Sicilian mothers (0.31 +/- 0.02 ng/mL) at 24 h after delivery. Colostrum levels of beta-EP declined progressively during the first 3 d after delivery in both populations (0.64 +/- 0.1 and 0.28 +/- 0.015 ng/mL, respectively, at 72 h). The level of beta-EP-IRM correlated significantly with pain and psychological involvement during and after delivery. In addition, the correlation between beta-EP-IRM and length of stage II of labor was significant (P < 0.0001) in the colostrums of Sicilian mothers who received ergot derivatives, episiorrhaphy, and child birth preparation. The correlation between beta-EP-IRM and length of stage II was less significant (P < 0.001) in the colostrums of Burkinabe mothers who received neither ergot derivatives nor child birth preparation. CONCLUSION: During the first 3 d after labor the beta-EP-IRM concentration in the colostrums of Burkinabe mothers differs from that of Sicilians. In addition, because Burkinabe women produce a larger volume of colostrum, their newborns receive, during the first days of life, a larger absolute amount of beta-EP-IRM, likely resulting in better postnatal fetal adaptation.

[Normal urine levels of the aminoterminal telopeptide of type I collagen (NTx) in premature newborns in the first week of life]. / Livelli normali urinari del telopeptide aminoterminale del collagene di tipo I (NTx) nei neonati prematuri durante la prima settimana di vita.

Urinary excretion of type I collagen cross-linked aminoterminal telopeptide (NTx) is a specific index of bone resorption. The Authors have studied urinary NTx concentrations in 60 urine samples of preterm infants, from 32 to 36 weeks of gestation, to evaluate the trend of the bone marker in the first week of life. Urine samples were collected at 1, 3 and 7 days of life. NTx was measured by ELISA (OSTEOMARK) and the values expressed in nmol Bone Collagen Equivalent (BCE)/mmol u-creatinine and the mean values (+/- 1 SD) were compared by ANOVA. NTx levels showed a progressive increase from 1 to 7 days of life in every group (P = 0.002 at 32, 0.040 at 33, 0.019 at 34, 0.010 at 35 and 0.000 at 36 weeks of gestation). Moreover, by comparing the mean values in every day (1st, 3rd and 7th) in the whole period under investigation, significant variations were noticed at 1 and 7 days (P = 0.045 and P = 0.021) and highly significant variation on the 3r day (P =0.000). We found a inverse relationship between gestational age and NTx concentrations, with significantly higher values in preterm infants of 32-34 weeks compared to those found in the following weeks of life and to those of full term infants. Preterm infants have a higher bone turnover rate that seems to be responsible of the major risk of osteopenia. In conclusion, the trend of NTx at different gestational ages reflects the peculiar balance of mineral metabolism. The unexpected interruption of nutritional supply and of mineral triggers the turbulent combination of processes of bone formation and especially of bone resorption, that becomes more evident as more premature is the delivery.