Parenteral nutrition-associated cholestasis and triglyceridemia in surgical term and near-term neonates: A pilot randomized controlled trial of two mixed intravenous lipid emulsions.

BACKGROUND: Cholestasis is a common complication in infants receiving prolonged parenteral nutrition (PN). We studied the effects of two intravenous lipid emulsions composed with either 30% soybean oil, 30% medium-chain triglycerides (MCT), 25% olive oil, and 15% fish oil (SMOF) or with 50% MCT and 50% soybean oil n-6 (MCT/SOY) on the incidence of cholestasis in surgical term and near-term neonates. METHODS: A single-center, double-blinded, randomized controlled trial compared the incidence of cholestasis using either SMOF or MCT/SOY in neonates born at gestational age ≥34 weeks undergoing major surgery. The primary outcome was the incidence of conjugated serum bilirubin >1 mg/dL. Other liver enzymes were assessed as secondary outcomes. A post-hoc analysis assessed serum triglycerides levels. Odds ratios were estimated by mixed-effects regression models. RESULTS: Enrollment was prematurely interrupted because the MCT/SOY became unavailable, thus 49 infants (SMOF 22, MCT/SOY 27) completed the study. The exposure (time on PN, cumulative dose of lipids) was similar in both groups. Similar cumulative incidence rates were found for elevated conjugated bilirubinemia and other liver enzymes. Hypertriglyceridemia >250 mg/dL (12/49) was more frequent in MCT/SOY (37.0%, 95% CI 21.53-55.77) than in SMOF (9.1%, 95% CI 2.53-27.81, p = 0.024). Triglyceridemia at the first assessment (median 8 postnatal days) was significantly higher with MCT/SOY than with SMOF (181 vs. 134 mg/dL, p = 0.006). Over the whole study period, mean triglyceride concentration was 36.5 mg/dL higher with MCT/SOY compared with SMOF (p = 0.013). CONCLUSION: Both emulsions had similar effects on the incidence of cholestasis and markers of liver integrity, but MCT/SOY induced higher serum triglyceride concentrations. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02633384.

Skin conductance indices discriminate nociceptive responses to acute stimuli from different heel prick procedures in infants.

AIM: To evaluate the ability of SC indexes in discriminating acute responses to different heel prick procedures. METHODS: Observational cohort study of a systematic, convenience sample of neonates with clinical indication of capillary blood sampling by heel prick, either for glycaemia or for blood gas analysis. The Neonatal Infant Pain Scale (NIPS) was used to confirm the painful nature of the stimuli. NIPS assessment and SC measurement (Med-Storm Pain Monitor(™)) were simultaneously performed by two independent observers before, during and after blood sampling. RESULTS: Sixty-eight heel prick procedures (46 for glycaemia and 22 for blood gas analysis) were applied to 16 infants. Both NIPS scores and SC peaks/s index were significantly higher during blood sampling than before or thereafter (Wilcoxon Signed Ranks, p < 0.001). There was no significant difference in NIPS score and SC peaks/s between the different heel prick procedures. Significantly higher SC area under low peaks index (Mann-Whitney, p = 0.001) and lower SC average rise time index (Mann-Whitney, p = 0.037) were registered when blood was drawn for blood gas analysis than for glycaemia, related to a sustained acute nociceptive response to a more prolonged stimulus. CONCLUSION: Using the conjunction of available SC indices, SC seems able to differentiate the nociceptive response to acute pain of different durations.

[Reference values for bone strength assessed by quantitative ultrasound early after birth in term and preterm neonates]. / Valores de referência de robustez óssea avaliados próximo ao nascimento por ultrassonografia quantitativa em recém-nascidos de termo e pré-termo.

AIM: To obtain reference values for bone strength assessed early after birth for term and preterm neonates in Portugal. METHODS: Speed of sound (SOS) (m/s) was measured using the quantitative ultrasound method in a systematic sample of appropriate-for-gestationalage term and preterm neonates, within the first two and five days after birth, respectively. Homogeneity of values between genders and between gestational age groups was assessed. RESULTS: A sample of 158 neonates was enrolled, 34 full-term and 124 preterm (26-41 weeks of gestation), birth weights of 595g-4195g, 84 males (53.2%) and 20 twins (10.8%). The mean of the SOS significantly increases with gestational age. Reference values of SOS for gestational age groups are provided as 10th, 25th, 50th, 75th and 90th centiles without gender distinction. CONCLUSION: Reference values for SOS early after birth are made available for term and preterm appropriate-for-gestational age neonates, reflecting the intrauterine bone status, a baseline for follow-up studies on bone strength in Portugal.