Low Birth Weight Premature Neonates Research Articles

Basement Membrane Biomarkers in Very Low Birth Weight Premature Infants

Basement membranes, critical for vital organs like the lungs, consist of two interwoven homopolymers, one assembled by type IV collagens and one by laminins. We hypothesized their serum antigens C-IV and P1, respectively, to be global measures for the maturity of these organs. In 39 very low birth weight premature neonates (means: gestational age, 25.8 weeks; birth weight, 779 g) requiring intensive care, we analyzed these biomarkers during the first two months post partum. Median C-IV and P1 exceeded adult levels by one order of magnitude. The individuals with the lowest first week C-IV values (mean: 667 ng/ml) required significantly longer neonatal intensive care unit stays than those with the highest values (mean: 2,467 ng/ml), on average 109 vs. 80 days (p = 0.008) irrespective of gestational age. Patients diagnosed with bronchopulmonary dysplasia (BPD) at 36 weeks postconceptional age, already in their first week of life displayed C-IV levels lower than in controls, suggesting a defect in pulmonary basement membrane remodeling. This is the first identification by a matrix biomarker of a BPD-antecedent state.

Absceso hepático piógeno: complicación del cateterismo venoso umbilical en un paciente prematuro

Hepatic abscess in the neonatal period is a rare but serious disorder. We report the clinical and radiological course of a solitary pyogenic liver abscess in a very low birth weight premature neonate, probably caused by a complication of umbilical venous catheterization. The patient recovered uneventfully following percutaneous drainage using ultrasound guidance and antibiotic therapy. We also review the clinical features, diagnosis and management of this condition.

Cardiorespiratory stability of very low birth weight premature neonates following postoperative administration of morphine

Abstract The cardiac and respiratory status of mechanically ventilated premature neonates, who received intraoperative fentanyl during thoracotomy for ligation of a patent ductus arteriosus ( n =24), were evaluated before and after administration of the first postoperative dose of morphine. The neonates were 26.1 ± 2.1 (mean ± SD) weeks gestational age and 13.8 ± 8.1 (mean ± SD) days of age at the time of surgery. Changes in heart rate, arterial blood pressure, respiratory rate and oxygen saturation were measured preoperatively and immediately before and 20 and 60 minutes after parenteral administration of the morphine dose. Heart rate values increased (mean increase 6%; p=0.02) and respiratory rate values decreased (mean decrease 23%; p=0.01) postoperatively. There were no significant differences in heart rate, respiratory rate, blood pressure and oxygen saturation following administration of morphine. Mean arterial blood pressure decreased following the administration of morphine in a few neonates already being treated for hypotension. However, given the severity of illness of these neonates during the immediate postoperative period, it is difficult to directly attribute clinically significant hypotension to morphine administration alone. The findings from this study suggest that fears of morphine-induced bradycardia and hypotension in normovolaemic critically ill premature neonates during the immediate postoperative period are not warranted and should not be used as reasons for withholding opioid analgesia from these neonates. Use of a continuous infusion of morphine or fentanyl may be more appropriate methods of postoperative analgesia for hypotensive neonates or those at risk for hypotension.

Clinical significance of fungi isolated from cerebrospinal fluid in children.

We reviewed the isolation of fungi from cerebrospinal fluid (CSF) cultures at Texas Children's Hospital during the past 6 years to evaluate the significance of a positive culture and to identify potential risk factors. Thirty-seven fungal isolates were recovered from 23 patients representing 2% of all 1498 positive CSF cultures for the study period. Candida species accounted for 94.5% of all fungal isolates. Nine of the 23 patients were newborns and 8 of these were very low birth weight premature neonates. C. albicans was recovered from the CSF of all newborns. Eleven patients were children 4 months to 14 years old. Three patients had positive cultures of CSF obtained on postmortem examination. Leading potential risk factors for positive CSF cultures from neonates included antimicrobial therapy, prematurity, very low birth weight, umbilical catheterization, total parenteral nutrition, intubation and respiratory distress syndrome. For children beyond the newborn period, potential risk factors were antimicrobial therapy for concurrent bacterial infection, chronic systemic or central nervous system disease and central venous cathterization. Disseminated fungal infection was documented in 40% of all patients with positive CSF cultures. Fungi recovered from 7 (35%) of 20 live patients were considered contaminants. We conclude that true fungal meningitis in children is accompanied by multiple positive cultures from CSF or CSF and a second site. A single positive CSF culture for fungi should be considered significant when both CSF findings compatible with meningitis and associated risk factors are present. The isolation of fungi from a single CSF culture can be considered insignificant when CSF findings are within normal limits despite the presence of potential risk factors or vice versa.(ABSTRACT TRUNCATED AT 250 WORDS)

Sodium restriction versus daily maintenance replacement in very low birth weight premature neonates: A randomized, blind therapeutic trial

To test the hypothesis that restriction of sodium intake during the first 3 to 5 days of life will prevent the occurrence of hypernatremia and the need for administration of large fluid volumes, we prospectively and randomly assigned 17 babies (mean +/- SD: 850 +/- 120 gm; 27 +/- 1 weeks of gestation) to receive in blind fashion either daily maintenance sodium or salt restriction with physician-prescribed parenteral fluid intake. Maintenance-group infants received 3 to 4 mEq of sodium per kilogram per day; restricted infants received no sodium supplement other than with such treatments as transfusion. Sodium balance studies conducted for 5 days demonstrated that maintenance salt intake resulted in a daily sodium balance near zero, whereas sodium-restricted infants continued to excrete urinary sodium at a high rate, which promoted a more negative balance (average daily sodium balance -0.30 +/- 1.78 SD in maintenance group vs -3.71 +/- 1.47 mEq/kg per day in restriction group; p less than 0.001). Care givers tended to prescribe daily increases in parenteral fluids for the salt-supplemented infants, perhaps because serum sodium concentrations were elevated in these infants after the first day of the study (p less than 0.001). Hypernatremia developed in two sodium-supplemented infants (greater than 150 mEq/L), and hyponatremia developed in two sodium-restricted infants (less than 130 mEq/L); however, the restricted infants were more likely to have normal serum osmolality (p less than 0.05). Both groups of infants produced urine that was neither concentrated nor dilute, with a high fractional excretion of sodium; renal failure was not observed. The mortality rate was not affected, but the incidence of bronchopulmonary dysplasia was significantly less in the sodium-restricted babies (p less than 0.02). We conclude that in tiny premature infants, a fluid regimen that restricts sodium may simplify parenteral fluid therapy targeted to prevent hypernatremia and excessive administration of parenteral fluids.

Ligation of patent ductus arteriosus in very low birthweight premature neonates.

The results of ligation of a patent ductus arteriosus in 30 premature neonates with a very low birth weight were analysed. The mean gestational age at birth was 27 weeks and the mean weight 811 g. Attempted closure of the ductus with indomethacin in 19 infants failed, though there was temporary closure in nine. Congestive heart failure was present in 29 and respiratory distress in 22 patients. Endotracheal intubation with assisted ventilation was necessary in all cases. The mean age at operation was 13.5 days and ductal ligation was performed in the intensive care unit under local anaesthesia supplemented with pancuronium and pethidine. There were no intraoperative deaths, but five infants died in hospital. There were seven late deaths. Eighteen survivors have been followed for a mean of 26.5 months. Early ligation of a patent ductus arteriosus in premature infants with a very low birth weight improved the cardiorespiratory state. Long term follow up showed good clinical progress in two thirds of the surviving group.