Randomized trial of exclusive human milk versus preterm formula diets in extremely premature infants.

Objective: To compare the duration of parenteral nutrition, growth, and morbidity in extremely premature infants fed exclusive diets of either bovine milk-based preterm formula (BOV) or donor human milk and human milk-based human milk fortifier (HUM), in a randomized trial of formula vs human milk.

Study Design: Multicenter randomized controlled trial. The authors studied extremely preterm infants whose mothers did not provide their milk.

Do red cell transfusions increase the risk of necrotizing enterocolitis in premature infants?

Objective: To test the hypothesis that red blood cell (RBC) transfusions increase the risk of necrotizing enterocolitis (NEC) in premature infants, we investigated whether the risk of "transfusion-associated" NEC is higher in infants with lower hematocrits and advanced postnatal age.

Study Design: Retrospective comparison of NEC patients and control patients born at < 34 weeks gestation.

Results: The frequency of RBC transfusions was similar in NEC patients (47/93, 51%) and control patients (52/91, 58%).

An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products.

Objective: To evaluate the health benefits of an exclusively human milk-based diet compared with a diet of both human milk and bovine milk-based products in extremely premature infants.

Study Design: Infants fed their own mothers' milk were randomized to 1 of 3 study groups. Groups HM100 and HM40 received pasteurized donor human milk-based human milk fortifier when the enteral intake was 100 and 40 mL/kg/d, respectively, and both groups received pasteurized donor human milk if no mother's milk was available.

Treatment-by-gender effect when aiming to avoid hyperoxia in preterm infants in the NICU.

Objective: To examine gender-specific differences in response to the O(2) saturation (SpO(2)) targets aimed at avoiding hyperoxia in very low birth weight infants (VLBW).

Methods: Analysis of a prospectively collected database of all infants View Article and Find Full Text PDF

Hypoxic respiratory failure in the late preterm infant.

Hypoxic respiratory failure in late preterm infants has received increased attention in the last decade, and while the incidence is low, it accounts for a significant number of admissions to neonatal ICUs because of the large number of late preterm births in the United States and worldwide. Causes of respiratory distress include transient tachypnea of the newborn, surfactant deficiency, pneumonia, and pulmonary hypertension. The physiologic mechanisms underlying delayed transition caused by surfactant deficiency and poor fetal lung fluid absorption have been reviewed recently elsewhere.

Respiratory transition in infants delivered by cesarean section.

One of the biggest challenges a newborn faces after birth is the task of making a smooth transition to air breathing. This task is complicated by the fact that fetal lungs are full of fluid which must be cleared rapidly to allow for gas exchange. Respiratory morbidity as a result of failure to clear fetal lung fluid is not uncommon, and can be particularly problematic in some infants delivered by elective cesarean delivery (ECS).

Treatment evolution in high-risk congenital diaphragmatic hernia: ten years' experience with diaphragmatic agenesis.

Objective: The objective of this study was to evaluate the impact of newer therapies on the highest risk patients with congenital diaphragmatic hernia (CDH), those with agenesis of the diaphragm.

Summary Background Data: CDH remains a significant cause of neonatal mortality. Many novel therapeutic interventions have been used in these infants.

Clinical performance of an in-line, ex vivo point-of-care monitor: a multicenter study.

Background: The management of critically ill infants and neonates includes frequent determination of arterial blood gas, electrolyte, and hematocrit values. An objective of attached point-of-care patient monitoring is to provide clinically relevant data without the adverse consequences associated with serial phlebotomy.

Methods: We prospectively determined the mean difference (and SD of the difference) from laboratory methods of an in-line, ex vivo monitor, the VIA LVM Blood Gas and Chemistry Monitoring System (VIA LVM Monitor; Metracor Technologies, Inc.

Safety of withdrawing inhaled nitric oxide therapy in persistent pulmonary hypertension of the newborn.

Objective: Because of case reports describing hypoxemia on withdrawal of inhaled nitric oxide (I-NO), we prospectively examined this safety issue in newborns with persistent pulmonary hypertension who were classified as treatment successes or failures during a course of I-NO therapy.

Methods: Randomized, placebo-controlled, double-masked, dose-response clinical trial at 25 tertiary centers from April 1994 to June 1996. Change in oxygenation and outcome (death and/or extracorporeal membrane oxygenation) during or immediately after withdrawing I-NO were the principal endpoints.

Congenital diaphragmatic hernia survival and use of extracorporeal life support at selected level III nurseries with multimodality support.

Background: Congenital diaphragmatic hernia (CDH) has been cited to have a mortality rate of 50%. There have been multiple studies at individual institutions demonstrating potential benefits from various strategies including extracorporeal life support (ECLS), delayed repair, and lower levels of ventilator support. There has been no multicenter survey of institutions offering these modalities to describe the current use of ECLS and survival of these infants.

Inhaled nitric oxide for the early treatment of persistent pulmonary hypertension of the term newborn: a randomized, double-masked, placebo-controlled, dose-response, multicenter study. The I-NO/PPHN Study Group.

Objectives: To assess the dose-related effects of inhaled nitric oxide (I-NO) as a specific adjunct to early conventional therapy for term infants with persistent pulmonary hypertension (PPHN), with regard to neonatal outcome, oxygenation, and safety.

Methods: Randomized, placebo-controlled, double-masked, dose-response, clinical trial at 25 tertiary centers from April 1994 to June 1996. The primary endpoint was the PPHN Major Sequelae Index ([MSI], including the incidence of death, extracorporeal membrane oxygenation (ECMO), neurologic injury, or bronchopulmonary dysplasia [BPD]).

A comparison of venovenous and venoarterial extracorporeal membrane oxygenation in the treatment of neonatal respiratory failure.

Objective: To compare the efficacy of venovenous to venoarterial bypass in an unselected cohort of infants with refractory cardiorespiratory failure.

Design: Retrospective cohort analysis.

Setting: Two tertiary hospitals capable of providing extracorporeal life support for neonates with acute respiratory failure.

Predictors of early childhood outcome in candidates for extracorporeal membrane oxygenation.

Objective: To examine the effect of neonatal risk factors and treatment strategy on pulmonary, growth, and neurodevelopmental outcome of candidates for extracorporeal membrane oxygenation (ECMO).

Design: We prospectively assessed growth and neurodevelopmental outcome in a cohort of 190 neonates who had severe respiratory failure, no major congenital anomalies, and met institutional criteria for the use of ECMO. The relationships among perinatal risk factors, neonatal outcome, postnatal growth, and neurodevelopmental outcome were studied by univariate and multivariate analyses.

Extracorporeal membrane oxygenation in the neonate with congenital renal disease and pulmonary hypoplasia.

Extracorporeal membrane oxygenation (ECMO) is an effective treatment modality for the newborn with refractory hypoxemia. Oligohydramnios can be associated with congenital renal disease (CRD) and can result in respiratory insufficiency from pulmonary hypoplasia, delayed lung maturation, and persistent pulmonary hypertension of the newborn. In this retrospective study, the authors reviewed the outcome of four children with CRD who required ECMO in the neonatal period.

Common pulmonary vein atresia: the role of extracorporeal membrane oxygenation.

Common pulmonary vein atresia is a rare form of cyanotic congenital heart disease in which the pulmonary veins join to form a blind confluence that does not communicate with the heart or the major systemic veins. Twenty-one cases have been reported since the lesion was first described in 1962; only two patients with this lesion have survived. Over a 4-year period, common pulmonary vein atresia was diagnosed in five newborns referred to the San Diego Regional Extracorporeal Membrane Oxygenation Program.

Use of umbilical vessels for neonatal ECMO cannulation: possibilities and precautions.

Extracorporeal membrane oxygenation (ECMO) is being employed with increasing frequency for the treatment of neonates with severe cardiac or respiratory failure. The risks related both to carotid artery and jugular vein ligation continue to cause concern. Use of umbilical vessels for vascular access in ECMO could eliminate many of these risks.

Massive hemoperitoneum following suprapubic bladder aspiration.

Hemoperitoneum in the newborn is usually a result of visceral injury from birth trauma. This report describes an as yet unreported complication of massive hemoperitoneum following suprapubic bladder aspiration.

Patent ductus arteriosus in neonates with severe respiratory disease.

Daily aortic contrast echo studies were carried out in 200 neonates with severe respiratory disease to determine the natural history of the ductus arteriosus during the first days of life and the effect of patency on subsequent morbidity and mortality. Decisions related to surgical or pharmacologic closure of a PDA were not based on the results of the contrast echo studies. The risk that intervention would be required was greater in infants weighing less than 1500 gm (P less than 0.

Preclinical abnormal segmental cardiac manifestations of thalassemia major in children on transfusion-chelation therapy: echographic alterations of left ventricular posterior wall contraction and relaxation patterns.

The purpose of this study was to evaluate young asymptomatic patients with thalassemia major by utilizing an echocardiographic technique which traces an expanded image of the left ventricular posterior wall (LVPW). This technique separates global cardiac function from segmental changes in LV free wall thickness during systole and diastole. The study population consisted of 13 patients aged 2 to 15 years with classical homozygous beta-thalassemia.

Utility of M-mode echocardiography for early identification of infants with persistent pulmonary hypertension of the newborn.

The clinical syndrome of persistent pulmonary hypertension of the newborn (PPHN) still carries high mortality in spite of improved neonatal care. The purpose of this prospective study was to assess the utility of M-mode echocardiography for the early identification of infants with PPHN prior to clinical deterioration. Echocardiograms of 51 infants who needed fractional inspiratory oxygen (FIO2) greater than or equal to 0.

Specificity and accuracy of echocardiographic and clinical criteria for diagnosis of patent ductus arteriosus in fluid-restricted infants.

We assessed the utility of M-mode echocardiographic and clinical criteria for diagnosis of left-to-righ shunting PDA in fluid-restricted newborn infants. The presence of a left-to-right shunting PDA was established in 56 infants by 103 aortic contrast echo injections. The studies were graded negative (pattern 0) if only the transverse aortic arch opacified; positive (pattern I) if both the transverse aortic arch and right pulmonary artery opacified; and very positive (pattern II) if only the right pulmonary artery opacified.