Function In Preterm Neonates Research Articles

Sepsis-induced coagulopathy in preterm neonates with Gram-positive sepsis presents with hypercoagulation and reduced platelet activation compared with healthy preterm neonates

BackgroundNeonatal sepsis is frequently accompanied by coagulopathy and thrombocytopenia attributed to the cross-link between inflammation and coagulation. However, sepsis-induced coagulopathy and platelet function in septic preterm neonates remain to be elucidated. In addition, there is no robust evidence for a causal relationship between thrombocytopenia and bleeding in preterm neonates with sepsis. ObjectiveThis single-center prospective cohort study aimed to assess sepsis-induced coagulopathy and platelet function in preterm neonates during sepsis. MethodsWe included 25 preterm neonates with Gram-positive sepsis born at gestational age 24 + 1 to 34 + 3 and studied in comparison to 30 healthy counterparts. Coagulation was assessed using conventional coagulation tests (CCTs) and rotational thromboelastometry (ROTEM). Platelet function was evaluated by flow cytometry. The study was conducted at 3-time points, at 1st, at 2nd to 3rd, and at 5th to 7th day of sepsis, respectively. ResultsCompared with healthy controls, neonates with Gram-positive sepsis present in ROTEM a hypercoagulable state; a higher maximum clot firmness (MCF) and higher amplitudes of intrinsic rotational thromboelastometry (INTEM) (INTEM MCF: median, 71; P .004 and INTEM A10: median, 67; P .005, respectively), extrinsic rotational thromboelastometry (EXTEM) (EXTEM MCF: median, 70; P .02 and EXTEM A10: median, 67; P .02, respectively), and rotational thromboelastometry assay for fibrin formation (FIBTEM) (FIBTEM MCF: median, 25; P < .001 and FIBTEM A10: median, 23; P .002, respectively). Conversely, CCTs exhibited hypocoagulation. Thrombocytopenia in preterm neonates with Gram-positive sepsis is not associated with an increased bleeding risk. In Gram-positive sepsis, platelets display increased glycoprotein (GP) surface receptors' expression (GPIb: median, 2.8; P .03, GPIIb: median, 3.1; P .004, and GPIIIa: median, 3.9; P .008, respectively) and reduced activation (P-selectin: median, 1; P < .001). A higher expression of platelets GP and improved degranulation capacity were recorded in patients in higher gestational age groups of >32 weeks of gestation. Platelet GPIb expression is age-dependent in healthy neonates. ConclusionNeonatal Gram-positive sepsis is characterized by a progressive hypercoagulation along with increased GP expression, reduced platelet activation, and thrombocytopenia without bleeding. Platelet GP expression and degranulation capacity are age-dependent among neonates with sepsis. Platelet GP expression is age-dependent among healthy counterparts.

Expression of TRPM6 and TRPM7 in the preterm piglet heart.

Preterm infants are at increased risk of death and disability, and cardiovascular instability after birth is a contributing factor. Immaturity of calcium handling in the preterm heart may limit myocardial contractility and cardiac output. Two transmembrane cation channels, TRPM6 and TRPM7, may regulate intracellular cardiac calcium in the neonatal period. The aim of this study was to determine TRPM6 and TRPM7 mRNA expression in piglet hearts in late gestation, and the effects of sex, maternal glucocorticoids, and the transition to extrauterine life. Left and right ventricular tissue was collected at a range of gestational ages from cesarean delivered piglets at birth and at 6 h old. Additional groups included piglets exposed to maternal glucocorticoid treatment and spontaneously born term piglets at 12–24 h old. TRPM6 and TRPM7 mRNA expression was measured using RT-qPCR. Males had significantly lower TRPM7 expression in the left ventricle across all gestational ages compared to females. At term, both ventricles had higher TRPM7 expression at 6 h old than at birth. In preterm piglets, TRPM7 expression only increased postnatally in the right ventricle following maternal glucocorticoid exposure. At 12–24 h old, TRPM7 expression in both ventricles was lower than levels in 6 h old term Caesar piglets (113 days). Male preterm piglets may have immature myocardial Ca2+ handling and this could contribute to their poorer outcomes. Increased TRPM7 expression is the mature response to birth that is missing in preterm neonates. TRPM7 could serve as a novel target to improve cardiac function in preterm neonates.

Reduced platelet function in preterm neonates compared with term neonates

BackgroundA reduced platelet function might contribute to the longer bleeding time seen in preterm neonates. However, the previously used platelet function testing in neonates is limited due to methodological limitations, mainly caused by difficulties in obtaining adequate blood volume. Therefore, the platelet function in preterm neonates is sparsely investigated. The aim of this study was to compare platelet function in preterm neonates at birth and at expected term age with platelet function in term neonates at birth. MethodsWe included 43 preterm neonates born at gestational age (GA) 28 + 0 to 34 + 0 and 21 term neonates born at GA 38 + 0 to 41 + 0. Within the first 24 hours of life, 1–1.5 mL peripheral blood was obtained and for preterm neonates, resampling was performed at expected term age (GA 38 + 0 to 41 + 0). Platelet function testing included impedance aggregometry and platelet activation measured by flow cytometry. In addition, platelet count was determined. ResultsPlatelet count and platelet activation were reduced in preterm neonates compared with term neonates at birth, but we found no difference in impedance aggregometry at birth. At expected term age, platelet count and aggregation exceeded term levels, but platelet activation remained impaired in the preterm. ConclusionPreterm neonatal function is decreased at birth and does not seem to reach term levels during the first 4 to 13 weeks of life.

Pilot Study to Evaluate the Impact of NAVA Compared to SIMV on Cardiac Function in Preterm Neonates

Pilot Study to Evaluate the Impact of NAVA Compared to SIMV on Cardiac Function in Preterm Neonates

Protocol for a scoping review of neonatal emollient therapy and massage practices throughout sub-Saharan Africa

Background: Serious infections and other complications from very low birth weight and prematurity are the leading causes of death for neonates worldwide. Infections partly result from the compromised skin barrier function in preterm neonates. Optimal skin care practices for neonates, especially in settings with limited access to adequate hygienic conditions, hold potential to reduce infection and avoid these preventable preterm neonatal deaths. The purpose of this protocol is to support a scoping review of neonatal skin care, emollient therapy and massage practices throughout sub-Saharan Africa. Protocol: The proposed review will follow a methodological framework consisting of the following five steps: (i) identifying the research question, (ii) identifying relevant studies, (iii) selection of eligible studies, (iv) charting the data, and (v) collating and summarizing the results. In addition, we will reflect on the implications of the findings for the feasibility and design of randomized controlled trials to examine the impact of emollient therapy on survival, growth, infection and neurodevelopment of very low birth weight infants in sub-Saharan Africa. We will search domestic and international databases for literature published in English between January 1, 2000, and July 12, 2021. Articles will be chosen based on standardized inclusion criteria. The primary criteria for inclusion will be a report on skin care practices administered to neonates in Africa. Conclusions: Documentation of common neonatal skin care practices throughout Africa has the potential to highlight opportunities for skin care intervention and future research on neonatal skin care practices in sub-Saharan Africa, and support the development of future emollient intervention trials for preterm and low birthweight neonates in low- and middle-income countries.

Protocol for a scoping review of neonatal emollient therapy and massage practices throughout sub-Saharan Africa.

Background: Serious infections and other complications from very low birth weight and prematurity are the leading causes of death for neonates worldwide. Infections partly result from the compromised skin barrier function in preterm neonates. Optimal skin care practices for neonates, especially in settings with limited access to adequate hygienic conditions, hold potential to reduce infection and avoid these preventable preterm neonatal deaths. The purpose of this protocol is to support a scoping review of neonatal skin care, emollient therapy and massage practices throughout sub-Saharan Africa. Protocol: The proposed review will follow a methodological framework consisting of the following five steps: (i) identifying the research question, (ii) identifying relevant studies, (iii) selection of eligible studies, (iv) charting the data, and (v) collating and summarizing the results. In addition, we will reflect on the implications of the findings for the feasibility and design of randomized controlled trials to examine the impact of emollient therapy on survival, growth, infection and neurodevelopment of very low birth weight infants in sub-Saharan Africa. We will search domestic and international databases for literature published in English between January 1, 2000, and July 12, 2021. Articles will be chosen based on standardized inclusion criteria. The primary criteria for inclusion will be a report on skin care practices administered to neonates in Africa. Conclusions: Documentation of common neonatal skin care practices throughout Africa has the potential to highlight opportunities for skin care intervention and future research on neonatal skin care practices in sub-Saharan Africa, and support the development of future emollient intervention trials for preterm and low birthweight neonates in low- and middle-income countries.

Biomarkers of renal function in preterm neonates at 72 h and 3 weeks of life

ObjectiveSerum levels of creatinine in neonates are quite variable and suffer interference from the immature kidney and maternal creatinine concentration. The aim of this study was to measure novel biomarkers of glomerular and tubular function in healthy preterm neonates at 72h and 3 weeks of life. MethodsUrine samples were collected in 40 preterm neonates with 28–34 incomplete weeks of gestational age. None of the participants had comorbidities, malformations and infections. The samples were collected at 72h of life and at 3 weeks after birth. Measurements of Calbindin, Collagen IV, FABP1, αGST, IP-10, KIM-1, Osteoactivin, Renin, TFF-3, TIMP-1, α-1-Microglobulin, Albumin, Clusterin, Cystatin C, EGF, Lipocalin-2/NGAL and Osteopontin were performed using panels 1 and 2 of multiplex kits of kidney injury. Data were analyzed using the software GraphPad Prism version 6.0. ResultsThe preterm neonates included 55% of males with gestational age of 30±1 weeks. The most frequent maternal condition associated with preterm birth was preeclampsia (80%). Molecules related to glomerular function showed a significant increase in the concentrations obtained at 3 weeks of life compared to 72h of life. Markers related to tubular injury (KIM-1 and NGAL) also showed an increase. On the other hand, cystatin C did not change. ConclusionThe elevation of molecules related to glomerular function indicates an increase of glomerular filtration rate from 72h up until 3 weeks of life, which was not clearly detected with the measurement of cystatin C.

Renal Function Profiles in Preterm Neonates With Birth Asphyxia Within the First 24 H of Life.

The characteristics of early renal function in preterm neonates of different gestational ages (GAs) with birth asphyxia (BA) remain unclear. Kidneys are sensitive to oxygen deprivation, and renal insufficiency may occur within 24 h of BA. We aimed to elucidate the renal function profiles within the first 24 h after the development of BA among vulnerable preterm neonates of different GAs. The medical records of 128 preterm neonates born to mothers with normal renal function were retrospectively analyzed. Data regarding the serum creatinine (SCr) and urea nitrogen (BUN) levels in venous blood, estimated creatinine clearance (eCCI) within the first hours after birth, and urinary output (UOP) in the first 24 h after birth were compared between the preterm with BA population and GA-matched population without BA (n = 64 and n = 64, respectively). Significantly higher SCr levels and lower eCCI were observed in mid-late preterm neonates with BA than in preterm neonates without BA (84.05 versus [vs.] 64.20 μmol/L, z = 4.41, p < 0.001; 15.02 vs. 21.30 mL/min/1.73 m2, z = 3.57, p < 0.001, respectively). Very preterm neonates showed a higher UOP (2.01 vs. 1.66 mL/kg/h, z = 2.01, p = 0.045) after the development of BA than before. In preterm neonates with BA, the incidence of SCr > 133 μmol/L, CCI < 16 mL/min/1.73 m2 and UOP < 1.0 ml/kg/h, was 10.94%, 62.50%, and 20.31%, respectively. Within 24 h after birth, BA was associated with eCCI < 16 mL/min/1.73 m2 (p = 0.016, odds ratio = 2.83, 95% confidence interval: 1.210–6.613) in preterm neonates. Different renal function profiles were observed in preterm neonates of different GAs within the first 24 h of life after the development of BA. Candidate therapies based on different renal function statuses will bring these vulnerable patient populations of different GAs closer to receiving precision medicine.

EGFR values and selected renal urine biomarkers in preterm neonates with uncomplicated clinical course.

Diagnosing acute kidney injury (AKI) in preterm newborns, who are particularly susceptible to renal damage, is a serious challenge as there is no definite consensus about the diagnostic criteria. The objective of this study was to measure the values for selected urinary biomarkers and estimated glomerular filtration rate (eGFR) among a population of preterm infants with uncomplicated clinical course as well as to determine whether these markers depend on birth weight (BW), gestational age (GA), postnatal age (PNA), or gender. The prospective study was carried out in neonatal intensive care unit (NICU). The evaluation included 57 children that were divided into 3 categories according to BW: low birth weight (LBW) - 1501-2500 g (22 infants); very low birth weight (VLBW) - 1000-1500 g (25 infants); and extremely low birth weight (ELBW) - 750-999 g (10 infants). Urine samples were collected daily between the 4th and 28th day of life for measurements of creatinine (Cr), neutrophil gelatinase-associated lipocalin (NGAL), osteopontin (OPN), and human kidney injury molecule 1 (hKIM1). The values of the 3 urine tubular biomarkers, serum creatinine and eGFR were taken in substantially healthy preterm infants with normal kidney function at 4 time intervals during the neonatal period. Their correlations were determined and a multivariable regression analysis was carried out with respect to BW, GA, PNA, and gender. Trends of the studied markers in terms of PNA and BW were also assessed with the Jonckheere-Terpstra test. Glomerular and tubular function in preterm neonates during the 1st month of life is significantly influenced by BW, GA, PNA, and gender.

Effect of Deferred Cord Clamping on Respiratory Function in Neonates

Background: the optimal timing of clamping of the umbilical cord after birth have been a subject of controversy and debate, However, there is insufficient evidence to date to support a recommendation as regards the impact of DCC on respiratory function in preterm neonates to delay cord clamping. Aim of the work: this study aimed to evaluate the effect of deferred cord clamping on respiratory function in preterm neonates born vaginal. Methods: The study was randomized controlled trial, including 100 Pregnant women (age 20-35 years old) had spontaneous preterm birth vaginal from 34-36+6 weeks, 50 subjected to ECC and 50 subjected to DCC. Results: neonates in the two-randomization group differed significantly in requirement of O2 and ventilatory support, and neonates in the ECC group had a mean that was higher than neonates in the DCC group in both CPAP and nasal O2 (ECC 6 (12.0%) vs. DCC 1 (2.0%) – ECC 27 (54.0%) vs. DCC 18 (36.0%) in CPAP and O2 requirement respectively. Apgar scores at 1 and 5 min were significantly different in the two groups, and in general higher in DCC than ECC, reflecting better respiratory symptoms in group DCC. Conclusion: the existing literature on delayed cord clamping has consistently demonstrated benefit especially for preterm neonates in facilitating placental transfusion. Improved physiologic stability in transition (blood pressure), better respiratory outcome, reduced need for transfusion is valuable improvements in outcome.

Impact of intrauterine growth restriction on kidney growth and function in preterm neonates

Impact of intrauterine growth restriction on kidney growth and function in preterm neonates

Abstract 14760: Right Ventricular Function in Preterm Neonates: Reference Values for Longitudinal Strain by Two-dimensional Speckle Tracking Echocardiography From Birth to One Year of Life

Introduction: Right ventricle (RV) systolic function is an important determinant of cardiopulmonary outcomes in premature infants. Two-dimensional speckle tracking echocardiography (2DSTE) derived myocardial strain is a reliable measure of RV systolic function in premature infants, but lacks reference values for clinical application in premature infants. We aimed to determine the maturational (age- and weight- related) changes in RV strain to establish reference values in preterm infants from birth to one year corrected age (CA). Methods: RV peak global longitudinal strain (pGLS) and RV free wall longitudinal strain (FWLS) were measured in a prospective longitudinal study in 115 preterm infants (&lt; 29 weeks at birth) at 24 and 72 hours of age (HOA), 32 and 36 weeks postmenstrual age (PMA), and one year (CA) by 2DTSE (GE EchoPac) from a RV-focus apical 4-chamber view using a validated protocol. Premature infants that developed chronic lung disease or had a hemodynamically significant PDA were excluded (n=65) from analysis for the reference values. Results: RV pGLS ranged from -16% at birth to -26% by one year CA and RV FWLS ranged from -18% at birth to -27% to one year CA in healthy preterm infants. RV pGLS and FWLS strain correlated with increasing weight (r=0.87, p &lt; 0.001), PMA in weeks (r=0.85, p &lt; 0.001; r=0.83, p &lt; 0.001), but were independent of gestational age at birth (r=0.4, p=0.38; r=0.3, p=0.5). RV strain was significantly lower in preterm infants with bronchopulmonary dysplasia (p=0.004) at 32 and 36 weeks PMA, and one year CA (Figure). RV strain was independent of gender or need for mechanical ventilation. Conclusions: This study establishes reference values of RV global and free wall longitudinal strain and tracks their postnatal maturational changes in preterm infants. These measures increase from birth to one year CA and are linearly associated with increasing weight reflecting the postnatal cardiac growth as a contributor to the maturation of RV function.

Benefits of probiotics on enteral nutrition in preterm neonates: a systematic review

The optimization of enteral nutrition is a priority in preterm neonates worldwide. Probiotics are known to improve gut maturity and function in preterm neonates. To our knowledge, previous systematic reviews have not adequately assessed the effects of probiotic supplementation on enteral nutrition in preterm neonates. We assessed the evidence on effects of probiotics on enteral nutrition in preterm neonates. A systematic review of randomized controlled trials (RCTs) of probiotic supplementation in preterm (gestation <37 wk) or low-birth-weight (birth weight <2500 g) neonates was conducted. With the use of the Cochrane Neonatal Review Group strategy, we searched the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, and Cumulative Index of Nursing and Allied Health Literature databases and proceedings of Pediatric Academic Society meetings in April 2014. A total of 25 RCTs (n = 5895) were included in the review. A meta-analysis (random-effects model) of data from 19 of 25 trials (n = 4527) estimated that the time to full enteral feeds was shorter in the probiotic group (mean difference: -1.54 d; 95% CI: -2.75, -0.32 d; P < 0.00001, I(2) = 93%). Other benefits included fewer episodes of feed intolerance, better weight gain and growth velocity, decreased transition time from orogastric to breast feeds, and increased postprandial mesenteric flow. There were no adverse effects of probiotic supplementation. Probiotics reduced the time to full enteral feeds in preterm neonates. Additional research is necessary to assess the optimal dose, duration, and probiotic strain or strains used specifically for facilitating enteral nutrition in this population.

Diastolic ventricular function improves during the first 48-hours-of-life in infants weighting

Few studies have focused on cardiac ventricular diastolic function in preterm neonates in the immediate post-natal period. This study evaluated Doppler-derived parameters of diastolic ventricular function in infants with birth weights of <1250 g during the transitional period. This was a prospective observational study conducted in the Coombe Women and Infants University Hospital in Dublin, Ireland. Flow patterns on the mitral and tricuspid valve, isovolumic relaxation time (IVRT), left and right ventricular output and superior vena cava flow were measured in 22 infants with a birth weight of below 1250 g at six, 12, 24 and 48 h of age. Early filling peak velocity of the left and right ventricle increased significantly from 30.3 to 39.5 cm/sec and 26.6 to 32.1 cm/sec, respectively. IVRT of the right ventricle decreased from 70 to 57 ms, and there was a nonsignificant decrease in IVRT of the left ventricle from 61.6 to 54 ms over the first 48 h. We have demonstrated that parameters of diastolic ventricular function change significantly over the first 48 h of life in preterm infants <1250 g and that these changes may represent early diastolic dysfunction during the transitional period.

Reference intervals of serum cystatin C for determining cystatin C-based glomerular filtration rates in preterm neonates

Objective: The aim of this study is to determine the reference values of serum Cystatin C (CysC) and CysC-based estimated glomerular filtration rate (GFR) on the 3rd and 30th day of life in comparison with serum creatinine (Cr) and Cr-based estimated GFR.Methods: This prospective study was performed on 52 preterm neonates whose gestational ages were between 28 and 34 weeks. Preterm neonates were divided into three groups according to the gestational age as follows: gestational week of 28–29 (group 1), gestational week of 30–32 (group 2) and gestational week of 33–34 (group 3). Blood samples were obtained on the 3rd and the 30th days of life. CysC was determined by particle-enhanced nephelometric immunoassay.Results: The group 1 preterm neonates have higher CysC values (1.34 ± 0.1 mg/L) on the 3rd day of life than the group 2 (1.28 ± 0.2 mg/L) and the group 3 (1.24 ± 0.2 mg/L) but the differences were not significant (p > 0.05, for each). CysC values were independent of gestational age, birth weight and gender (p > 0.05, for each). No correlation was found between CysC and Cr on the 3rd day of life (p > 0.05).Conclusions: CysC is regarded as an alternative for assessing the renal function in preterm neonates.

In Utero Exposure to Smoking and Peripheral Chemoreceptor Function in Preterm Neonates

We aimed to assess the involvement of peripheral chemoreceptor tonic activity in the ventilatory pattern during sleep in preterm neonates exposed in utero to maternal smoking. Peripheral chemoreceptor activity was measured at thermoneutrality in neonates (postmenstrual age: 36.1 +/- 1.2 weeks) born to nonsmoking (n = 21) or smoking (n = 16) mothers by performing a 30-second hyperoxic test during active and quiet sleep. Blood oxygen saturation, baseline ventilatory parameters, and central apnea were monitored. Prenatal smoking exposure did not modify baseline ventilation. It was interesting to note that prenatal smoking exposure decreased the peripheral chemoreceptor tonic activity during active sleep and increased the response time during quiet sleep. These changes could explain the increase in the time spent in apnea (both with and without blood oxygen desaturation) and in the mean duration of apneic episodes with desaturation found in neonates exposed to smoking in utero. The involvement of a change in the chemoreceptor function is supported by the fact that the peripheral chemoreceptor tonic activity was negatively correlated with the mean duration of apneic episodes with desaturation in the control group only. To our knowledge, this is the first study to reveal that prenatal smoking exposure does not directly modify baseline ventilatory parameters in the neonate but has a negative impact on peripheral chemoreceptor tonic activity. These alterations may increase the risk of sleep respiratory disorders, especially via apnea with desaturation.

Low T Cell Function in Preterm Neonates (PN) as Analyzed by Cylex ImmuKnow Assay (ICF) May be Responsible for a Higher Rate of Infection (134.47)

Abstract Background: Cell mediated immunity is a critical defense mechanism against various pathogens. Lymphocyte number and function, and their links to risk for infection in neonates are not well understood. ICF measures immune function by assessing ATP levels in mitogen stimulated CD4+ cells. We investigate CD4+ cell function in neonates and the implication for infections. Methods: Heparinized cord blood from 30 term neonates (TN) and 3 PN (25-28 weeks) were submitted for ICF. Results: ATP levels were significantly lower in PN than TN (221 + 49 vs. 588 + 293 ng/ml, p&amp;lt;0.02). All 3 PN were exposed to maternal chorioamnionitis and treated postnatally for clinical sepsis, while none of the TN showed evidence of infection. In TN, the 18 vaginally delivered (VD) had significantly higher ATP levels than 12 born by cesarean (CS) (731±255 vs. 373±206 ng/ml, p&amp;lt;0.001). Of the 12 TN born by CS, 3 were exposed to labor and 9 were not, and showed similar ATP levels (277±110 vs. 405±225 ng/ml, NS). All 3 PN (1 CS) exposed to labor had low ATP levels. Conclusions: 1) CD4+ cell function is significantly lower in PN than TN, 2) VD in TN, but not CS w/ or w/o labor, increases ATP levels, suggesting that delivery via the birth canal is stressful for the TN and stimulates immune response, 3) ATP levels are not elevated in PN despite VD, suggesting that immune response in PN is poor, and may be partly responsible for a higher rate for infection in this patient population. Research Sponsors: Dept. of Pediatrics &amp; Transplant/Immunology Lab, Cedars-Sinai Medical Center, Los Angeles, CA

Determination of reference values for plasma cystatin C and comparison with creatinine in premature infants

Cystatin C (CysC) is a low-molecular-mass protein (13,343 dalton, 120 amino acids) belonging to the cystatin superfamily of reversible inhibitors of cysteine proteases. CysC appears to be eliminated from the circulation almost exclusively by glomerular filtration, which makes it a promising endogenous marker of renal function. CysC has been demonstrated to reflect glomerular filtration rate better than other low-molecular-weight proteins, including creatinine (Cr). We established reference values for serum CysC and compared them with Cr in 108 preterm infants by particle-enhanced nephelometric immunoassay. On the first day, serum CysC values ranged from 1.25 to 2.84 mg/L, significantly decreasing after 3 days of life. Cr levels determined simultaneously on the first day ranged from 0.05 to 1.12 mg/dl and were also significantly different from day 3 levels. Both CysC and Cr levels were independent of gender, birth weight, hemoglobin levels, and hydration state. Cr correlated negatively with gestational age (r = -0.25, p = 0.009), but not CysC. A significant correlation was found between CysC and Cr on day 1 (r = 0.21, p = 0.031), but no correlation was found according to day 3 blood samples (r = 0.19, p = 0.053). CysC is regarded as an alternative for assessing renal function in preterm neonates, but its advantages over Cr are not yet proven.

Parenteral nutrition

Nutritional insufficiency, leading to early growth deficits has long-lasting effects, including short stature and poor neurodevelopmental outcomes. Early enteral feeding is commonly limited by immaturity of gastrointestinal motor function in preterm neonates. To ensure that a stressed premature infant receives an adequate but not excessive amount of glucose, the amount of carbohydrate delivered in the form of dextrose is commonly initiated at the endogenous hepatic glucose production and utilization rate of 4 to 6 mg/kg/min; and 8 to 10 mg/kg/min in ELBW infants. The early provision of protein is critical to attain positive nitrogen balance and accretion as premature babies lose approximately 1% of their protein stores daily. Aminoacid can be used at concentrations of 3-3.5 g/kg/day and lipid at 3.5-4 g/kg/day as long as the fat intake remains less than 60% of nonprotein calories. Sodium, potassium, chloride, calcium, magnesium and phosphorus need to be provided in PN solution as per their daily needs. Hospital-acquired infection (HAI) is a major complication of PN. All efforts should be made to avoid it.

AGE-RELATED SERIAL PLASMA CITRULLINE LEVELS IN PRETERM NEONATES

INTRODUCTION: Citrulline is a nonessential amino acid that is synthesized almost exclusively in the small intestine. In adults and children with short-bowel syndrome, citrulline has served as a reliable index of the remaining small intestine length. Citrulline is also a precursor of arginine, the role of which is crucial for neonatal metabolism and growth. OBJECTIVE: We sought to determine serial plasma citrulline levels of preterm neonates to assess levels in accordance with age and intestinal maturation, which may serve as a baseline in the event of intestinal abnormalities such as necrotizing enterocolitis (a devastating complication in this age group). METHODS: We measured serial plasma citrulline levels in 18 clinically stable neonates (gestational age: ≤32 weeks; birth weight: 1000–1750 g) on days 2, 7, 14, 21, and 28. Quantitative analysis of plasma citrulline levels was performed by ion-exchange chromatography with postcolumn derivatization. RESULTS: In the study population, mean plasma citrulline levels showed a statistically significant increase from 19 ± 4 μmol/L on day 2 and 20 ± 4 μmol/L on day 7 to 23 ± 4 μmol/L on day 14, 29 ± 5 μmol/L on day 21, and 31 ± 5 μmol/L on day 28 (P &amp;lt; .01). The route of feeding did not seem to have an affect on plasma levels of citrulline (similar values were obtained from neonates who were fed enterally and parenterally on day 7). CONCLUSIONS: Citrulline levels in normal preterm neonates seem to be age-related and may serve as reference values, which facilitates the evaluation of compromised intestinal function in preterm neonates with severe gastrointestinal problems.