Is Early Preventive Caffeine Safe and Effective in Premature Neonates? A Clinical Trial.

Background: Advantages of caffeine for the treatment of apnea of prematurity (AOP) have prompted clinicians to use it as a preventive drug even before the occurrence of apnea. Objective: To compare the effect of early preventive caffeine therapy with routine late preventive caffeine on the occurrence rate of apnea of prematurity, bronchopulmonary dysplasia (BPD) and related radiographic changes, necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), and patent ductus arteriosus (PDA), the need for mechanical ventilation, the length of mechanical ventilation, and the length of hospitalization. Materials and Methods: In this open randomized clinical trial study, 90 preterm neonates with the gestational age of 25-35 weeks were divided into 2 groups: group A received caffeine during the first two days of life (early preventive caffeine), while group B received caffeine during the third to the tenth day of life (late preventive caffeine). The occurrence rate of AOP and other outcomes were the primary outcomes. The adverse effects of caffeine in each group were the secondary outcomes. Results: The total occurrence rate of AOP was significantly higher (32.6%) in the late group versus (6.8%) in the early group (p = 0.002). The total occurrence rate of BPD was also significantly higher (37%) in the late group versus (18.2%) in the early group (p = 0.047). On the other hand, we found a lower need for mechanical ventilation, shorter length of mechanical ventilation, shorter length of hospitalization, and a lower occurrence rate of PDA, NEC, and IVH in the early group that was not significant. No adverse effect of caffeine was observed in each group. Conclusions: Early preventive caffeine administration was associated with a significantly lower occurrence rate of AOP, BPD, and BPD radiologic changes. As other outcomes occurred lesser in the early group that were not significant, future studies with more participants are recommended. This study has been registered at the Iranian Registry of Clinical Trials (IRCT20160827029535N8).

Positive effects of low intensity recorded maternal voice on physiologic reactions in premature infants.

OBJECTIVE: To evaluate the effect of low intensity recorded maternal voice on the physiologic reactions of healthy premature infants in the neonatal intensive care unit (NICU). METHODS: Physiologic responses of 20 healthy preterm infants in the NICU of Shariati Hospital, Tehran, were obtained during a 15min intervention including three 5min periods (no-sound control, audio recorded playback of mother's voice, no-sound post-voice). The intervention was presented three times a day for three consecutive days. During each intervention, oxygen saturation (%, OSPR), heart rate (HR), and respiratory rate (RR) were recorded at 1min intervals over the 15min and then averaged over each 5min period, resulting in 3 averages for each variable for each intervention. RESULTS: Repeated Measures Analysis of Variance were employed to examine each variable separately. Over the three days, comparison of oxygen saturation over each of the three periods (before, during voice, after) revealed an increase in oxygen saturation during the voice period, compared to the pre-voice period, which persisted over the post-voice period; there were no differences between the voice and post-voice periods. Analyses of the HR and RR data showed a decrease in both variables during the voice period compared to the pre-voice period which persisted over the post-voice period. Again, there were no differences between the voice and post-voice periods. CONCLUSION: Exposure to low intensity recorded maternal voice has positive effects on the preterm infants 'physiologic responses.

Is early breast milk fortification more effective in preterm infants?: a clinical trial.

OBJECTIVE: Breast feeding alone does not provide adequate nutrition for growth in preterm infants; therefore, fortifiers are added when over 70-80 cc/kg/day of breast milk is tolerated. As there are few studies comparing early and late breast milk fortification, the following study was conducted. STUDY DESIGN: This double-blind clinical trial was performed on 80 preterm infants (gestational age of 28-34 weeks, birth weight <2 kg). The newborns were randomly divided into two groups to receive either early or late fortification. The primary and secondary outcomes were the difference in growth indices and complications (including feeding intolerance, necrotizing enterocolitis (NEC), and septicemia) between the two groups, respectively. RESULTS: Both groups showed increases in growth indices; however, there was no statistically significant difference in increments of growth indices and complications between the two groups. CONCLUSION: Our findings suggest that early fortification from the first feeding in neonates with exclusive breast feeding did not improve growth in the first 4 weeks in preterm neonates in comparison with late fortification; so early fortification may not be cost effective.

Severe neonatal hyperbilirubinemia leading to exchange transfusion.

BACKGROUND: Severe neonatal hyperbilirubinemia is associated with significant morbidity and mortality. This study was conducted to investigate the causes of severe hyperbilirubinemia leading to Exchange Transfusion (ET) from March 2009 to March 2011 in Bahrami children hospital, Tehran, Iran in order to establish guidelines to prevent profound jaundice & ET. METHODS: 94 neonates underwent ET for severe hyperbilirubinemia data for demographic data, and onset of jaundice, history of severe hyperbilirubinemia in siblings, blood group of both mother and neonate, G6PD activity, hemoglobin, hematocrite, reticulocyte count, peripheral blood smear, total and direct bilirubin before and after ET, direct and indirect Coombs, times of transfusion and the cause of hyperbilirubinemia were all recorded for analysis. RESULTS: Ninety four neonates (56.4% boys and 43.6% girls) underwent ET with a mean birth weight of 1950±40 g and a mean gestational age of 35.2±1.4 weeks. Premature labor, breastfeeding jaundice, ABO incompatibility and G6PDD with the frequency of 59(63%), 33(35%), 25(24/5%) and 12(12.8%) were of major causes of ET. CONCLUSIONS: Predisposing factors for severe hyperbilirubinemia in this study were premature labor, breastfeeding jaundice, ABO incompatibility and G6PDD. The authors recommend prevention of premature labor, reevaluation of successful breastfeeding education for mothers and screening infants for blood group and G6PD In the first of life. Arranging earlier and continuous visits in neonates with these risk factors during the first four days of life is also recommended.

Prophylactic effect of low dose vitamin D in osteopenia of prematurity: a clinical trial study.

Osteopenia of prematurity (OOP) is a preventable disease. Improved survival of premature newborns is associated with an increased incidence of OOP. The purpose of this study was to compare the prophylactic effects of two low doses of vitamin D (200 and 400 IU/Day) on the clinical, biochemical and radiological indices of the rickets of prematurity. In a randomized clinical trial, 60 preterm newborns with birth weight < 2000 g & gestational age < 37 weeks were randomly divided in two groups. Thirty newborns received 200 IU/d of vitamin D in group one and 30 ones received 400 IU/day of vitamin D in group two. On the 6th to 8th weeks of life, serum calcium, phosphate, alkaline phosphates, and 25-hydroxy vitamin D concentrations were measured and x- ray of left wrist and physical examination were performed. Both groups had no difference in biochemical, radiological or clinical presentation of rickets. Current study indicated that low dose vitamin D (200 IU/Day) is enough for prevention of OOP.

Transcutaneous bilirubin measurement in preterm neonates.

Hyperbilirubinemia is a common problem during neonatal period especially in preterm neonates. Transcutaneous bilirubin measurement (TcB) by special devices had been documented as an effective tool for predicting neonatal jaundice in full term neonate, but for preterm infants the present evidences are controversial. We carried out a prospective study in Shariati Hospital NICU. 126 paired TcB/total serum bilirubin (TSB) measurements were obtained. TcB (on forehead and sternum) were measured using JH2-1A device for every admitted preterm infant who clinically showed jaundice and TSB measurements was obtained within 30 min of TcB. 58 (46%) were male and 68 (54%) were female. The mean gestational age was 31 week and mean birth weight was 1728 ± 60 g. 30 percent of neonates were ill. The mean value obtained by TBS was 8.8 mg/dl and for frontal TcB was 8.2mg/dl and for sternal TcB was 7.4mg/dl. There were good correlation between TBS and TcB and the maximum correlation were seen in 33-37 weeks of gestation and birth weight more than 2500 g with forehead TcB measurement. Healthy preterm infants had significant correlation of TSB and TcB (r=0.56, P<0.001) and ill preterm neonate had r =0.82, P<0.001. The correlation between TBS and TcB with and without phototherapy was r=0.66, P=0.000 and r=0.69, P=0.000 respectively. Although TcB measurement may underestimate TBS but there is significant correlation between TcB and TBS in preterm cases even in ill neonate or who receiving phototherapy. This method can be used for determination of bilirbin level in preterm neonate and reduces the number of blood sampling.

Relationship between birth weight and time of first deciduous tooth eruption in 143 consecutively born infants.

BACKGROUND: Deciduous teeth play an important role in the proper alignment, spacing and occlusion of permanent teeth. The calcification of deciduous teeth begins during the fourth prenatal month, and calcification of all deciduous teeth begin by the end of the sixth prenatal month. The eruption date varies and is genetically influenced. Delayed eruption of deciduous teeth, especially the first teeth, causes nutritional problems for the infants. It also results in parental concerns. In this study, we compared the timing of eruption of the first deciduous teeth in infants in relation to their birth weight. METHODS: A total of 143 infants born at Shariati Hospital in Tehran from December 2004 to December 2005 were included in the study. Data on sex, birth weight, gestational age, and time of first tooth eruption were collected. RESULTS: The mean birth weight was 3220 +/- 420 g with 5.5% of infants weighing less than 2500 g, and 19.9% weighing more than 3500 g. Patients were monitored weekly from the third month of age until the time of first tooth eruption. The mean age of first tooth eruption was 7.68 +/- 1.84 months. CONCLUSION: There was a negative linear correlation between the time of first deciduous tooth eruption and birth weight, suggesting that delayed tooth eruption may be related to lower birth weight.

Incidence of intraventricular hemorrhage and post hemorrhagic hydrocephalus in preterm infants.

Germinal matrix-intraventricular hemorrhage (IVH) is the most common variety of neonatal intracranial hemorrhage and is characteristics of the premature infant. The importance of the lesion relates not only to its high incidence but to their attendant complications (IC: hydrocephalus). Brain sonography is the procedure of choice in diagnosis of germinal matrix- intraventricular hemorrhage and hydrocephalus. In this study we have used brain sonography for detection of intraventricular hemorrhage and post hemorrhagic hydrocephalus and their incidences. The studied population was consisted of premature neonate (birth weight equal or less than 1500 g and gestational age equal or less than 37 weeks) who admitted in Mofid Hospital NICU (Tehran, Iran) during a one year period. For all neonate (including criteria) brain sonography in first week of life was done and in presence of IVH, serial Brain sonography was done weekly for detection of hydrocephalus. A total of 57 neonate entered the study. Intraventricular-germinal matrix hemorrhage was seen in 64.4% (35 patients). Forty percent of patients with intraventricular-germinal matrix hemorrhage had grade I, 11% grade II, 25.7% grade III, 2.8% grade VI. Hydrocephalus was detected in 20 percent of patients who had intraventricular-germinal matrix hemorrhage. That incidence of IVH in our study in comparison with other area and situation is higher. Hydrocephaly had direct relation with severity of IVH. This shows that with control of risk factor of IVH, we can control Post hemorrhagic hydrocephalus.