Vitamin D status in very low birth weight infants and response to vitamin D intake during their NICU stays: a prospective cohort study.

OBJECTIVE: To evaluate vitamin D status in very low birth weight (VLBW) infants and response to vitamin D intake. STUDY DESIGN: In this prospective cohort study of VLBW infants, 25-hydroxyvitamin D [25(OH)D] was measured regularly starting at birth. Daily vitamin D intake was estimated from parenteral and enteral sources. RESULTS: Of the included 83 infants born between November 2016 and March 2018, 44 (53%) had 25(OH)D < 30 ng/mL at birth but achieved vitamin D sufficiency (VDS) by 3 weeks while receiving 120-400 IU/day. Twenty-three (27.7%) infants had at least one 25(OH)D level >100 ng/mL during the study period. Infants whose intake was > 600 IU/day had higher prevalence of vitamin D excess (VDE). CONCLUSION: In our study, low 25(OH)D was common in VLBW infants at birth. Vitamin D intake of 120-260 IU/day from parenteral and 200-400 IU/day from enteral route was appropriate for VLBW infants to achieve VDS. Doses > 600 IU/day increased risk of VDE.

Randomized Trial to Compare Renal Function and Ductal Response between Indomethacin and Ibuprofen Treatment in Extremely Low Birth Weight Infants.

BACKGROUND: A head to head comparison study on renal function and ductal response between indomethacin and ibuprofen has rarely been conducted in extremely low birth weight (ELBW) infants. OBJECTIVES: The aim was to compare renal function and ductal response between indomethacin and ibuprofen in ELBW infants. METHODS: We performed a double-blind randomized control trial to compare renal function and ductal response between indomethacin (0.2, 0.1, and 0.1 mg/kg i.v. every 24 h for 3 doses) and ibuprofen lysine (10, 5, and 5 mg/kg i.v. every 24 h for 3 doses) in ELBW infants with significant hemodynamic patent ductus arteriosus (cardiovascular dysfunction score >3 and LA/AO ratio ≥1.3). RESULTS: A total of 144 infants were enrolled: 73 received indomethacin and 71 received ibuprofen lysine. Significant decreases in urine output were seen in 30 infants (41%) in the indomethacin group and 15 (21%) in the ibuprofen group (p = 0.02). The indomethacin group was associated with a significantly higher chance of persistent ductal response than the ibuprofen group (66 vs. 49%, p = 0.046), but with a lower glomerular filtration rate on day 1, higher serum creatinine on days 1, 2, and 7, and lower urinary prostaglandin on days 2-7. Both groups were comparable in mortality and in bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, and retinopathy of prematurity morbidity. CONCLUSIONS: With the current dosage, ibuprofen had fewer renal side effects but was associated with a lower rate of persistent ductal closure in ELBW infants. The precise role of prostaglandin on renal tubular function in ELBW infants remains to be further investigated.

Neonatal volkmann ischemic contracture: case report and review of literature.

Background Neonatal Volkmann ischemic contracture in newborns is a devastating condition with lifelong consequences. Case Report We report a neonate born with necrotic skin lesions and bullae on right dorsal thenar aspect of hand, who subsequently developed compartment syndrome requiring fasciotomy. Review and Conclusion Necrotic skin lesions with/without swelling, bullae are invariably present at birth in these patients and should be recognized as a sentinel finding of underlying tissue ischemia/compartment syndrome. Early recognition and prompt surgical intervention can be limb saving. A range of radiologic abnormalities and contractures were noted in upto 84% of such patients followed long term. Hence, we recommend close follow-up until occurrence of epiphyseal fusion in these patients.

Intergenerational birth weights among the direct female descendants of US-born and Mexican-born Mexican-American women in Illinois: an exploratory study.

OBJECTIVE: To explore the intergenerational birth-weight patterns of the direct female descendants of Mexican-American women. DESIGN: This is a population-based study. METHODS: Stratified analyses were performed on a transgenerational dataset of 1956-1975 and 1989-1991 Illinois computerized vital records of Mexican-American infants. RESULTS: Among the descendants of generation 1 US-born Mexican-American women (n=1,940), generation 3 females had a birth weight equivalent to that of their generation 2 mothers, (3294 g vs 3283 g); generation 3 infants with unmarried mothers had a birth weight 121 g less than that of generation 2 infants born to unmarried mothers (3163 g vs 3284 g, P<.01); and generation 3 female infants born to teenaged women had a birth weight 70 g less than that of their generation 2 mothers who were born to teenaged women (3178 g vs 3248 g, P<.01). Among the descendants of generation 1 Mexican-born women (n=1,017), generation 3 females had a birth weight equivalent to that of their generation 2 mothers (3335 g vs 3363 g); generation 3 infants with teenaged mothers had a birth weight 108 g less than that of generation 2 infants with teenaged mothers (3264 g vs 3372 g, P<.01). CONCLUSIONS: An intergenerational rise in birth weight does not occur among the direct female descendants of Mexican-American women.

Palivizumab use in very premature infants in the neonatal intensive care unit.

OBJECTIVE: The purpose of this study was to determine the ability of young hospitalized premature (born < or =30 weeks' gestational age) infants to achieve serum levels of palivizumab that are protective against RSV infection. METHODS: Palivizumab, 15 mg/kg per dose intramuscularly, was administered every 28 days to stable premature infants who were hospitalized in the neonatal intensive care unit starting at 1 month of postnatal life. Palivizumab concentrations were assayed in serum samples that were drawn from infants who remained in the hospital at 14 days (midpoint concentration) and at 28 days (trough concentration) after each dose was administered. RESULTS: The gestational age of the 24 infants who were enrolled was 27.5 +/- 1.8 weeks (mean +/- standard deviation), and birth weight was 928 +/- 159 g. Midpoint palivizumab concentrations in the 24 infants after the first dose were 45.6 +/- 13.0 microg/mL; 71% (17 of 24) of the infants maintained optimal palivizumab concentrations (> or =40 microg/mL). The concentrations dropped subsequently; trough concentrations just before the second dose were 32.2 +/- 10.5 microg/mL, and only 23% (5 of 22) of the infants had concentrations in the optimal range. Sixteen infants were given 2 doses and 6 were given three doses of palivizumab while in the neonatal intensive care unit. Midpoint concentrations after the second dose were significantly higher than those after the first dose. Likewise, trough concentrations before the third dose were 51.9 +/- 7.8 microg/mL and higher than those before the second dose; the concentrations were >40 microg/ml in all 6 infants tested. CONCLUSIONS: Very premature infants had sustained optimal protective serum concentrations only after the second dose of palivizumab; 77% of infants tested had trough concentrations <40 microg/mL before the second dose. Additional studies are needed to establish the optimal timing of the initial dose and optimal dosing interval of palivizumab in this most vulnerable population.

Differing intergenerational birth weights among the descendants of US-born and foreign-born Whites and African Americans in Illinois.

The authors analyzed Illinois vital records to determine the intergenerational birth weight patterns among the descendants of US-born and foreign-born White and African-American women. Among the descendants of the generation 1 US-born White women (n = 91,061), generation 3 females had a birth weight 65 g more than that of their generation 2 mothers (p < 0.0001); generation 3 infants had a 10% lower moderately low birth weight (1,500-2,499 g) rate than did their generation 2 mothers: 5.0% versus 5.5% percent, respectively (relative risk = 0.9, 95% confidence interval: 0.9, 0.9). Among the descendants of generation 1 European-born White women (n = 3,339), generation 3 females had a birth weight 45 g more than that of their generation 2 mothers (p < 0.0001). Among the descendants of generation 1 US-born African-American women (n = 31,699), generation 3 females had a birth weight 17 g more than that of their generation 2 mothers (p < 0.001). Among the descendants of generation 1 African/Caribbean-born women (n = 104), generation 3 females had a birth weight 57 g less than that of their generation 2 mothers; generation 3 females had a 40% greater moderately low birth weight rate than did their generation 2 mothers: 9.6% percent versus 6.7% percent (relative risk = 1.4, 95% confidence interval: 0.6, 3.6). Maternal age and marital status did not account for the birth weight trends. The authors conclude that the expected intergenerational rise in birth weight does not occur among the direct female descendants of foreign-born African-American women.