Feeding the Larger Low-Birthweight Infant in a Resource-Poor Environment.

The high low birthweight prevalence in resource-poor countries (16.5%) places a burden on overstretched resources. Labor ward must have written guidelines to triage these infants for optimal nutritional support to the special care nursery (SCN; 1,500-1,800 g and <34 weeks) and postnatal ward (PW; >1,800 g and ≥ 34 weeks).

Probiotics Reduce Necrotizing Enterocolitis Severity in HIV-exposed Premature Infants.

Objective: To assess the effect of probiotics on the incidence of necrotizing enterocolitis (NEC) in premature infants born to human immunodeficiency virus (HIV)-positive and HIV-negative women.

Patients And Methods: HIV-exposed and HIV-unexposed premature infants were randomized to either the probiotic or the placebo group. The probiotic consisted of 1 × 10(9) colony-forming units, Lactobacillus rhamnosus GG and Bifidobacterium infantis per day.

Human milk oligosaccharides differ between HIV-infected and HIV-uninfected mothers and are related to necrotizing enterocolitis incidence in their preterm very-low-birth-weight infants.

The heavy burden of maternal HIV infection has resulted in a high prevalence of premature birth and associated necrotizing enterocolitis (NEC). Human milk oligosaccharides (HMOs) were recently associated with HIV infection and transmission through breastfeeding and were also shown to reduce NEC in an animal model, particularly the HMO disialyllacto-N-tetraose (DSLNT). The primary aim of this study was to verify differences in HMO composition between HIV-infected and HIV-uninfected women.

Is continuous positive airway pressure a feasible treatment modality for neonates with respiratory distress syndrome in a rural district hospital?

Objectives: To assess the feasibility of using nasal continuous positive airway pressure (nCPAP) in neonates with respiratory distress syndrome at district hospital level by assessing in-hospital survival rates and the impact on transfer rates.

Methods: A prospective database was kept from 2008 to record the outcomes of neonates with mild to moderate respiratory distress treated with nCPAP at a South African rural district hospital. Transfer rates were compared for the two years before and after introduction of neonatal nCPAP using additional retrospective data from the Perinatal Problem Identification Programme (PPIP) for comparison.

Meeting the challenge of providing neonatal nutritional care to very or extremely low birth weight infants in low-resource settings.

Most infant deaths (99%) occur in developing countries. The 14.9 million infants born prematurely (>11% of all live births) carry a particularly high mortality risk.

Bloodstream infections and antimicrobial resistance patterns in a South African neonatal intensive care unit.

Background: Bloodstream infections remain a leading cause of morbidity and mortality in neonatal intensive care units (NICU) worldwide. Commonly isolated NICU pathogens are increasingly resistant to standard antimicrobial treatment regimes.

Objectives: The primary aim of this study was to determine the burden of bloodstream infections (BSI) in an NICU in a low-to-middle-income country and to describe the spectrum of pathogens isolated together with their drug susceptibility patterns.

Probiotics, feeding tolerance, and growth: a comparison between HIV-exposed and unexposed very low birth weight infants.

Objective: The aim of this study was to compare the effect of administration of probiotics on feeding tolerance and growth outcomes of HIV-exposed (but uninfected) versus HIV non-exposed preterm infants. The null hypothesis of this study states that there will be no difference in the feeding tolerance and growth outcomes for both probiotic-exposed and unexposed premature very low birth weight infants.

Methods: A randomized, double-blind, placebo-controlled trial was conducted during the period from July 2011 to August 2012.

Effect of open-sandwich vs. adhesive restorative techniques on enamel and dentine demineralization: an in situ study.

Objectives: To assess in situ the effect of different restorative techniques used with fluoride-releasing materials on enamel and dentine demineralization in the presence of a cariogenic challenge.

Methods: Thirty human molars were prepared for 60 Class V cavities, with enamel and dentine margins. The teeth were divided into four groups (n=15): L1 - open sandwich technique with a conventional glass ionomer cement (GIC), L2 - open sandwich technique with a resin-modified GIC, A1 - total-etch bonding with a fluoride-containing adhesive, A2 - total-etch bonding with a nonfluoride-containing adhesive.

The outcome of ELBW infants treated with NCPAP and InSurE in a resource-limited institution.

Background And Objective: Nasal continuous positive airway pressure (NCPAP) plus intubation, surfactant, and extubation (InSurE) with the option of back-up ventilation for those infants for whom noninvasive ventilatory support failed resulted in a significant increase in survival in extremely low birth weight (ELBW) infants. The authors sought to determine the outcome of ELBW infants treated with NCPAP and InSurE in a neonatal high care ward with limited back-up ventilation.

Methods: Three hundred eighteen inborn infants with birth weight 500-1000 g and gestational age ≥25 weeks who were admitted to the neonatal high care ward were included in this observational study.

A case of congenital measles during the 2010 South African epidemic.

Congenital measles is a well recognised but uncommon transplacental infection in the post-vaccine era. A 4-day-old infant is described who presented with uncomplicated congenital measles during the 2010 South African measles outbreak. Clinicians working in regions affected by measles outbreaks should be mindful of waning vaccine-induced measles immunity where infections among pregnant women may result in a resurgence of congenital measles.

Effect of cigarette smoke and whiskey on the color stability of dental composites.

Purpose: To evaluate the effect of cigarette smoke and whiskey on the color stability of resin composites.

Methods: Disk-shaped specimens (8 mm x 1 mm) were prepared with five composites in two different shades (n=10). After light-curing, the specimens were stored in dark containers with artificial saliva at 37 degrees C for 24 hours.

Long-term outcome of surgically managed necrotizing enterocolitis in a developing country.

Unlabelled: Necrotizing enterocolitis (NEC) is a serious condition with a high morbidity and mortality commonly affecting premature babies. Data for the impact of the long-term disease burden in developing countries are limited although poor long-term outcome of surgically managed patients has been shown in terms of increased risk of neurodevelopmental delay, increased infectious disease burden and abnormal neurological outcomes in the developed world.

Purpose: To evaluate the long-term outcome of a pre-human immunodeficiency virus pandemic NEC cohort to characterize common risk factors and outcome in a developing world setting.

Microhardness of dentin underneath fluoride-releasing adhesive systems subjected to cariogenic challenge and fluoride therapy.

Objectives: The aim of this study was to evaluate the microhardness of dentin subjacent to the bonding interface of composite restorations using fluoride-releasing adhesive systems submitted to pH-cycling regimen associated or not to fluoride therapies.

Methods: Thirty human third molars were prepared with class V cavities with dentin cervical margins. The adhesive systems One-Up Bond F Plus (OU), Prime&Bond NT (NT), Clearfil Protect Bond (CF), Optibond Solo Plus (OP) and also the controls [-] Single Bond 2 (SB) and [+] Ketac Molar (KM) were used previously to composite resin restorations.

Effect of reservoirs on gingival inflammation after home dental bleaching.

Objective: To evaluate the influence of reservoirs on the gingival mucosa of patients submitted to at-home bleaching with 16% carbamide peroxide.

Method And Materials: Nineteen nonsmoking male patients, 18 to 25 years of age, were submitted to home bleaching with a 16% carbamide peroxide gel for 2 consecutive hours for 21 days. The custom-made mouth trays were made with a reservoir on only the left side and cut anatomically 1 mm beyond the gingival margin.

Kangaroo Mother Care--a review.

Kangaroo Mother Care is a simple and beneficial intervention for the care of low birth weight infants. Although initially conceived for use in developing countries with limited resources, its use has expanded worldwide as clinicians, administrators and parents become familiar with the psychological, physiological, clinical and cost benefits associated with the practice. A recently documented benefit has specific relevance to blood transfusion medicine.

Phototherapy and exchange transfusion for neonatal hyperbilirubinaemia: neonatal academic hospitals' consensus guidelines for South African hospitals and primary care facilities.

The purpose of this document is to address the current lack of consensus regarding the management of hyperbilirubinaemia in neonates in South Africa. If left untreated, severe neonatal hyperbilirubinaemia may cause kernicterus and ultimately death and the severity of neonatal jaundice is often underestimated clinically. However, if phototherapy is instituted timely and at the correct intensity an exchange transfusion can usually be avoided.

Kangaroo mother care in the nursery.

Kangaroo mother care is becoming an integral part of the care of low birth weight infants worldwide. It provides economic savings to families and health care facilities and many physiologic and psychobehavioral benefits to mothers and infants, the most important of which is the promotion of successful breastfeeding. The benefits of breastfeeding, of human milk over formula, and of feeding from the breast per se, are beyond dispute, and so KMC should be actively promoted.

Expectant management of early onset, severe pre-eclampsia: perinatal outcome.

Objective: To evaluate the perinatal outcome of expectant management of early onset, severe pre-eclampsia.

Design: Prospective case series extending over a five-year period.

Setting: Tertiary referral centre.

Infants of women with severe early pre-eclampsia: the effect of absent end-diastolic umbilical artery doppler flow velocities on neurodevelopmental outcome.

Umbilical artery Doppler flow velocity waveform studies were performed over a period of 4 y on 242 women with severe pre-eclampsia before 34 wk gestation. Sixty-eight (28%) had absent end-diastolic umbilical artery Doppler flow velocities. One hundred and ninety-three infants survived to hospital discharge and were followed at 6-monthly intervals until 48 mo of age.

Necrotizing enterocolitis in infants born to women with severe early preeclampsia and absent end-diastolic umbilical artery doppler flow velocity waveforms.

The aim of this study was to determine the prevalence of necrotizing enterocolitis (NEC) in infants born to a homogeneous group of women with severe preeclampsia before 34 weeks' gestation and who had absent end-diastolic umbilical artery Doppler flow (AEDF) or normal umbilical Doppler flow velocities (NUFV). A total of 242 infants were entered into the study. The mean birth weight was 1260.

The use of dexamethasone in women with preterm premature rupture of membranes--a multicentre, double-blind, placebo-controlled, randomised trial. Dexiprom Study Group.

Objective: To assess whether administration of dexamethasone in women with preterm premature rupture of membranes (PPROM) has an effect on the prevalence of maternal sepsis, neonatal respiratory distress syndrome (RDS), perinatal mortality and neonatal sepsis in a developing country.

Setting: Six public hospitals in South Africa that deal mainly with indigent women.

Method: A multicentre, double-blind, placebo-controlled, randomised trial was performed on women with PPROM and fetuses of 28-34 weeks' gestation or clinically estimated fetal weight between 1,000 and 2,000 g if the gestational age was unknown.