Neurodevelopmental follow-up at five years corrected age of extremely low birth weight infants after postnatal replacement of 17β-estradiol and progesterone.

Context: Extremely low birth weight (ELBW) infants are prone to impaired neurodevelopment.

Objective: The aim was to determine long-term neurodevelopmental outcome in ELBW infants after postnatal 17β-estradiol (E2) and progesterone (P) replacement.

Design: At 5-yr corrected age, ELBW infants were assessed for standardized cognitive and neurological outcome after postnatal randomized E2 and P replacement or placebo administration.

Critical systematic review of the level of evidence for routine use of probiotics for reduction of mortality and prevention of necrotizing enterocolitis and sepsis in preterm infants.

Background & Aims: Probiotics have been suggested to prevent severe necrotizing enterocolitis (NEC) and decrease mortality in preterm infants. The aim of this paper was to systematically analyze the level of evidence (LoE) of published controlled randomized trials (RCTs) on probiotics in preterm infants.

Methods: Literature searches were made up to November 2010.

Results of extremely-low-birth-weight infants randomized to receive extra enteral calcium supply.

Background And Objective: Bone mineral deficiency continues to occur in extremely-low-birth-weight (ELBW) infants despite formulas enriched in calcium (Ca) and phosphorus (P). This study tested whether extra enteral Ca supplementation increases bone mineral content (BMC) and prevents dolichocephalic head flattening and myopia in ELBW infants.

Study Design: Infants 401 to 1000 birth weight receiving enteral feeds were randomized to receive feeds supplemented with Ca-gluconate powder or pure standard feeds.

Gender-related effects of prenatal administration of estrogen and progesterone receptor antagonists on VEGF and surfactant-proteins and on alveolarisation in the developing piglet lung.

Background: Vascular endothelial growth factor (VEGF) is essential for embryonic lung development and has been shown to be regulated by estradiol (E2) and progesterone (P).

Aim: To investigate the effects of prenatal E2 and P withdrawal by specific receptor antagonists on the mRNA expression of VEGF, surfactant proteins (SP-B and SP-C) and on alveolarisation in lung tissue of male and female pig fetuses.

Methods: Fetuses from 10 sows were randomized to receive either both an intramuscular injection of the E2 receptor blocker ICI 182.

Intrauterine, early neonatal, and postdischarge growth and neurodevelopmental outcome at 5.4 years in extremely preterm infants after intensive neonatal nutritional support.

Objective: Extremely preterm infants are at risk for poor growth and impaired neurodevelopment. The objective of this study was to determine whether intrauterine, early neonatal, or postdischarge growth is associated with neurocognitive and motor-developmental outcome in extremely preterm infants.

Methods: Surviving children who were born between July 1996 and June 1999 at <30 weeks' gestation and with a birth weight <1500 g were evaluated at the age of school entry by application of (1) a standardized neurologic evaluation, (2) the Kaufmann Assessment Battery for Children, and (3) the Gross Motor Function Classification Scale.

Oxygenation and ventilation in spontaneously breathing very preterm infants with nasopharyngeal CPAP in the delivery room.

Aim: To provide data on ventilation, oxygenation and acid-base state from birth to 48 h in very preterm infants treated with lung recruitment manoeuvre and nasopharyngeal continuous positive airway pressure in the delivery room.

Methods: Subjects of this prospective observational cohort study were 48 of 61 infants enrolled in a randomised controlled trial to test two lung recruitment manoeuvres after birth. The infants had received an arterial line in the delivery room.

Amiloride-sensitive nasal potential difference is not changed by estradiol and progesterone replacement but relates to BPD or death in a randomized trial on preterm infants.

Postnatal replacement of placental estradiol (E2) and progesterone (P) in preterm infants may improve lung function, possibly mediated through enhanced epithelial Na(+) transport and alveolar fluid clearance. Preterm infants of <29 wk gestational age and <1000 g birth weight requiring mechanical ventilation within 12 h of birth were randomized to receive either 2.5 mg/kg E2 and 22.

Glutamate in current paediatric amino acid solutions is not toxic.

Aim: To discuss the viewpoint article "How much glutamate is toxic in paediatric parenteral nutrition?" Acta Paediatr 2005;94;16-9.

Conclusion: There is no doubt that glutamate used at high bolus doses in animal experiments would permanently damage brain cells. However, these effects should not be extrapolated to the condition of parenteral nutrition of newborn infants when much smaller amounts of glutamate are infused constantly during 24 h.

Decreased accuracy of pulse oximetry measurements during low perfusion caused by sepsis: Is the perfusion index of any value?

Objective: To evaluate the effects of deteriorating perfusion caused by sepsis on the accuracy of pulse oximetry measurements using two more recently available techniques (Nellcor N-395 and Masimo Radical) and to evaluate the perfusion index as a marker of impaired peripheral perfusion to indicate that accuracy of pulse oximetry readings may be affected.

Design And Setting: Interventional cohort study in a university animal research facility.

Subjects: Thirty-seven adult anesthetized, ventilated rabbits.

Prebiotic oligosaccharides reduce stool viscosity and accelerate gastrointestinal transport in preterm infants.

Aim: To investigate whether a mixture of prebiotic non-digestible oligosaccharides (GosFos; referring to galacto- and fructo-oligosaccharides) would improve feeding tolerance in preterm infants on full enteral formula feeding. We hypothesized that GosFos would: (1) reduce stool viscosity and (2) accelerate gastrointestinal transport.

Methods: In a placebo-controlled double-blind trial 20 preterm infants on full enteral nutrition (gestational age 27 (24-31) weeks, postnatal age 42 (11-84) days, and weight at study entry 1570 (1080-2300) g were randomly allocated to have their feedings supplemented with either GosFos (1 g/100 mL) or placebo for 14 days.

Prenatal estrogen and progesterone deprivation impairs alveolar formation and fluid clearance in newborn piglets.

Exposure to high levels of estradiol (E2) and progesterone (P) derived from the fetoplacentomaternal unit during the last trimester of pregnancy may play a crucial role in prenatal lung development and immediate postnatal alveolar fluid clearance (AFC). To measure prenatal alveolar formation and postnatal amiloride-sensitive AFC after pharmacological deprivation of E2 and P in utero, fetuses from five sows received an intramuscular depot injection of the E2 receptor blocker ICI 182.780 (ICI) and the P receptor blocker RTI 3021-022 (RTI) and fetuses of five other sows received a placebo injection (control group) during a laparotomy at 90 d of gestation (term gestation, 115 d).

Survival and major neonatal complications in infants born between 22 0/7 and 24 6/7 weeks of gestation (1999-2003).

Objective: This study was undertaken to compare survival and morbidity until discharge in infants born after 22-23 versus 24 weeks' gestational age (GA).

Study Design: Cohort study of all infants 25 weeks or less, born in 3 tertiary perinatal centers (1999-2003).

Results: Of a total of 336 infants, 133 (40%) died before or immediately after birth without the provision of life support, 203 (60%) received active neonatal treatment.

Volume-controlled intermittent mandatory ventilation in preterm infants with hypoxemic episodes.

Objective: To test the hypothesis in ventilated very low birth weight infants with frequent hypoxemic episodes that volume-controlled synchronized intermittent mandatory ventilation (SIMV) vs. pressure-controlled SIMV reduces by at least 20% the time with hypoxemia (defined as SpO(2)<80%).

Design: Randomized cross-over design.

The influence of prematurity, maternal anxiety, and infants' neurobiological risk on mother-infant interactions.

In this study, we investigated how the birth of a very low birth weight preterm (VLBW) infant influences the mother-infant interaction at 3 months. We also focused on the impact of the infant's neurobiological risk and maternal anxiety, and their interaction. The comparison of the VLBW preterm sample (n = 79) with an external full-term sample (n = 35) showed mother-infant interactions of the families with the preterm infant to be more vocally responsive during the interaction, but less facially responsive during the interaction.

Sustained pressure-controlled inflation or intermittent mandatory ventilation in preterm infants in the delivery room? A randomized, controlled trial on initial respiratory support via nasopharyngeal tube.

Aim: To prove the hypothesis that sustained pressure-controlled inflation compared to intermittent mandatory ventilation for lung recruitment via nasopharyngeal tube after delivery is more effective in reducing the rate of endotracheal intubation and mechanical ventilation in very preterm infants.

Methods: The study was designed as a randomized, controlled trial. The setting was the delivery room and neonatal intensive care unit of a university hospital in Germany.

Measurement of interleukin 8 in combination with C-reactive protein reduced unnecessary antibiotic therapy in newborn infants: a multicenter, randomized, controlled trial.

Objective: Neonatal bacterial infections carry a high mortality when diagnosed late. Early diagnosis is difficult because initial clinical signs are nonspecific. Consequently, physicians frequently prescribe antibiotic treatment to newborn infants for fear of missing a life-threatening infection.

Accuracy of pulse oximetry readings in an animal model of low perfusion caused by emerging pneumonia and sepsis.

Objective: To test the effects of low perfusion caused by emerging sepsis on the performance of two new pulse oximetry techniques: Masimo SET in comparison with Nellcor Oxismart XL.

Design: Cohort study with random allocation of two pulse oximetry devices to two sensor sites. SETTING.

Hydrolyzed protein accelerates feeding advancement in very low birth weight infants.

Background: Feeding intolerance is common in very low birth weight (VLBW; <1500 g) infants. Hydrolyzed protein preterm infant formula (HPF) has been shown to accelerate the gastrointestinal transit of formula. The aim of this study was to investigate whether HPF improves early feeding tolerance compared with standard preterm infant formula (SPF).

Pulse oximetry during low perfusion caused by emerging pneumonia and sepsis in rabbits.

Objective: This study tested the effects of low perfusion caused by emerging sepsis on the reliability of a new pulse oximetry technology (Masimo SET; IVY 405T) compared with a standard pulse oximeter (Nellcor N-200).

Design: Randomized trial.

Setting: University animal research facility.