The effect of inhaled nitric oxide treatment on biomarkers of oxidative/nitrosative damage to proteins and DNA/RNA.

Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator that is used as a treatment for persistent pulmonary hypertension in neonates (PPHN) with hypoxic respiratory failure. The generation of reactive oxygen and nitrogen species might induce oxidative/nitrosative damage to multiple organs. There is an increasing scientific and clinical interest in the determination of specific biomarkers to measure the degree of oxidative/nitrosative stress in non-invasively collected biofluids.

Effects of Sepsis on Immune Response, Microbiome and Oxidative Metabolism in Preterm Infants.

This is a narrative review about the mechanisms involved in bacterial sepsis in preterm infants, which is an illness with a high incidence, morbidity, and mortality. The role of the innate immune response and its relationship with oxidative stress in the pathogenesis are described as well as their potential implementation as early biomarkers. Moreover, we address the impact that all the mechanisms triggered by sepsis have on the dysbiosis and the changes on neonatal microbiota.

Survey of transfusion practices in preterm infants in Europe.

Background: Preterm infants commonly receive red blood cell (RBC), platelet and fresh frozen plasma (FFP) transfusions. The aim of this Neonatal Transfusion Network survey was to describe current transfusion practices in Europe and to compare our findings to three recent randomised controlled trials to understand how clinical practice relates to the trial data.

Methods: From October to December 2020, we performed an online survey among 597 neonatal intensive care units (NICUs) caring for infants with a gestational age (GA) of <32 weeks in 18 European countries.

Early molecular markers of ventilator-associated pneumonia in bronchoalveolar lavage in preterm infants.

Introduction: Ventilator-associated pneumonia (VAP) constitutes a serious nosocomial infection. Our aim was to evaluate the reliability of cytokines and oxidative stress/inflammation biomarkers in bronchoalveolar lavage fluid (BALF) and tracheal aspirates (TA) as early biomarkers of VAP in preterm infants.

Methods: Two cohorts were enrolled, one to select candidates and the other for validation.

Five-country manikin study found that neonatologists preferred using the LISAcath rather than the Angiocath for less invasive surfactant administration.

Aim: Less invasive surfactant administration (LISA) has been shown to decrease the risk of death and bronchopulmonary dysplasia in preterm neonates. The LISAcath is the first catheter to be specifically developed for LISA, and we compared the clinical impressions of neonatologists using the LISAcath and the commonly used Angiocath in a simulated setting.

Methods: This was a multinational, multicentre study, conducted in October 2016, which involved 39 neonatologists who were recruited by employees of the sponsor from large, well-recognised neonatal intensive care units across Europe.

Oxygen needs during resuscitation and surfactant to achieve stabilisation were independent risks factors for pulmonary interstitial emphysema in preterm infants.

Aim: Pulmonary interstitial emphysema is a severe complication of mechanical ventilation in preterm infants that leads to air leakage and, or, chronic lung disease. We determined the associated risk factors.

Methods: This was a retrospective case-control study from 2005 to 2014 at a regional referral centre in Valencia, Spain.

Abdominal Near-Infrared Spectroscopy Detects Low Mesenteric Perfusion Early in Preterm Infants with Hemodynamic Significant Ductus Arteriosus.

Background: The therapeutic decision to close patent ductus arteriosus in preterm infants entails great uncertainty. Near-infrared spectroscopy is a noninvasive bedside technique used to monitor mixed regional oxygen saturation. We hypothesized that near-infrared spectroscopy could identify preterm infants at risk of mesenteric hypoperfusion associated with hemodynamically significant ductus arteriosus.

Survival and Neurodevelopmental Outcomes of Preterms Resuscitated With Different Oxygen Fractions.

Background And Objectives: Stabilization of preterm infants after birth frequently requires oxygen supplementation. At present the optimal initial oxygen inspiratory fraction (Fio) for preterm stabilization after birth is still under debate. We aimed to compare neurodevelopmental outcomes of extremely preterm infants at 24 months corrected age randomly assigned to be stabilized after birth with an initial Fio of 0.

Accuracy of PaO2 /FiO2 calculated from SpO2 for severity assessment in ED patients with pneumonia.

Background And Objective: Assessment of oxygenation in patients with community-acquired pneumonia is critical for treatment. The accuracy of percutaneous oxygen saturation (SpO2 ) determined by pulse oximetry is uncertain, and it has limited value in patients receiving supplemental oxygen. We hypothesized that calculation of partial arterial oxygen concentration/inspired oxygen faction (PaO2 /FiO2 ) from SpO2 by the Ellis or Rice equations might adequately correlate with PaO2 /FiO2 measured by arterial blood gases.

Neonatal assessment in the delivery room--Trial to Evaluate a Specified Type of Apgar (TEST-Apgar).

Background: Since an objective description is essential to determine infant's postnatal condition and efficacy of interventions, two scores were suggested in the past but weren't tested yet: The Specified-Apgar uses the 5 items of the conventional Apgar score; however describes the condition regardless of gestational age (GA) or resuscitative interventions. The Expanded-Apgar measures interventions needed to achieve this condition. We hypothesized that the combination of both (Combined-Apgar) describes postnatal condition of preterm infants better than either of the scores alone.

Urinary Lipid Peroxidation Byproducts: Are They Relevant for Predicting Neonatal Morbidity in Preterm Infants?

Preterm infants have an immature antioxidant system; however, they frequently require supplemental oxygen. Oxygen-free radicals cause both pulmonary and systemic inflammation, and they are associated with increased morbidity and mortality. Consequently, screening of metabolite profiles representing the amount of lipid peroxidation is considered of great relevance for the evaluation of in vivo oxidative stress and derived inflammation and damage.

Administration of surfactant using less invasive techniques as a part of a non-aggressive paradigm towards preterm infants.

Traditional treatment of respiratory distress syndrome in preterm infants consisted of early intubation, mechanical ventilation and intra-tracheal administration of exogenous surfactant. Recently, non-invasive ventilation, which has shown some advantages in short- and long-term outcomes, has gained popularity for the initial management of respiratory insufficiency in preterm infants. However, non-invasive ventilation from the outset poses difficulties in relation to administration of exogenous surfactant.

Does prolonged onset of symptoms have a prognostic significance in community-acquired pneumonia?

Background And Objective: Severity assessment is made at the time of the initial clinical presentation in patients with community-acquired pneumonia (CAP). It is unclear how the gap between time of presentation and duration of symptoms onset may impact clinical outcomes. Here we evaluate the association of prolonged onset of symptoms (POS) and the impact on clinical outcomes among hospitalized patients with CAP.

Systematic review and meta-analysis of optimal initial fraction of oxygen levels in the delivery room at ≤32 weeks.

Aim: The optimal initial fraction of oxygen (iFiO2 ) for resuscitating/stabilising premature infants is not known. We aimed to study currently available information and provide guidelines regarding the iFiO2 levels needed to resuscitate/stabilise premature infants of ≤32 weeks' gestation.

Methods: Our systematic review and meta-analysis studied the effects of low and high iFiO2 during the resuscitation/stabilisation of 677 newborn babies ≤32 weeks' gestation.

Minimally invasive surfactant therapy with a gastric tube is as effective as the intubation, surfactant, and extubation technique in preterm babies.

Aim: Preterm infants requiring surfactant replacement have been treated using the INSURE technique, which requires sedation and comprises tracheal intubation, surfactant instillation and extubation. However, minimally invasive surfactant therapy (MIST) does not require sedation, minimises airway injury and avoids placing positive pressure ventilation on an immature lung. This study compared the feasibility of the two techniques and the outcomes in preterm babies with respiratory distress syndrome (RDS).

Cervical IL-6 and pIGFBP-1 and the prediction of neonatal outcome in symptomatic preterm labour.

Objective: To evaluate the use of cervical Interleukin 6 (IL-6) and phosphorylated Insulin Growth Binding Protein 1 (pIGFBP1) in the prediction of adverse neonatal outcome.

Methods: Prospective observational study including women between 24 and 34 weeks of gestation. One hundred and twelve cervical samples for IL-6 and pIFBP1 were taken.

[Factors associated with early weaning in a Spanish region].

Introduction: Breastfeeding has undoubtedly great benefits. Previous studies have foundan early dropout. Only a few studies have investigated related factors.

Oxygen in the delivery room.

Immediately after birth the newly born infant aerates the lungs, diminishes pulmonary vascular resistance, and initiates gas exchange. However, under certain circumstances this process will not be adequately accomplished. Asphyxia is characterized by periods of hypoxia and ischemia leading frequently to hypoxic ischemic encephalopathy.

Oxygen saturation after birth in preterm infants treated with continuous positive airway pressure and air: assessment of gender differences and comparison with a published nomogram.

Aims: The goal of the study was to compare preductal SpO2 in the first 10 min after birth in preterm infants treated with non-invasive continuous positive airway pressure (CPAP) and air with a published nomogram of preductal SpO2 in preterm infants who received no medical intervention, and to examine gender differences.

Design: Prospective observational study.

Patients And Methods: We enrolled infants of ≤32 weeks gestation who were spontaneously breathing with heart rate >100 bpm, and treated with face mask CPAP and air during postnatal stabilisation.

Ventilator-associated pneumonia in newborn infants diagnosed with an invasive bronchoalveolar lavage technique: a prospective observational study.

Objectives: To establish the incidence, etiology, risk factors, and outcomes associated with ventilator-associated pneumonia using an invasive sampling technique to avoid contamination.

Patients: Eligible patients were intubated neonates treated with mechanical ventilation who followed the criteria of the Centers for Disease Control and Prevention/National Nosocomial Infection Surveillance. Bronchoalveolar lavage samples were collected using a blind-protected catheter to avoid contamination of upper respiratory microorganisms.

Oxygen saturation targets for preterm infants in the delivery room.

Fetal life evolves in a low oxygen milieu as compared to the extra-uterine. In the fetal to neonatal transition rapid changes in the oxygen content of the newly born infant occur within a brief period of time. Delivery room care givers should be aware of the slow transition regarding oxygenation, and supply oxygen as needed trying to avoid damage caused by hyper-and-hypoxia.

The use and misuse of oxygen during the neonatal period.

This article describes aerobic metabolism, oxygen free radicals, antioxidant defenses, oxidative stress, inflammatory response and redox signaling, the fetal to neonatal transition, arterial oxygen saturation, oxygen administration in the delivery room, oxygen during neonatal care in the NICU, evolving oxygen needs in the first few weeks of life, and complications that can occur when infants go home from the hospital on oxygen.

[Relation between packed red blood cell transfusion and severity of necrotizing enterocolitis in premature infants].

Objective: It has been proposed recently that red blood cell transfusions (RBCT) might increase severity in infants with necrotizing enterocolitis (NEC). We intend to study if patients who have received red blood transfusions before the onset of NEC develop more severe forms of this entity.

Methods: A retrospective study was carried out including prematures with NEC.