Low Birth Weight Preterm Newborns Research Articles

Multimodal Sensory Stimulation among Very Low Birth Weight Preterm Newborns: A Quasi-experimental Study at a Tertiary Care Hospital in Agartala, Tripura, India

Introduction: There is a continuous search for an effective intervention to help preterm low birth weight neonates overcome their poor growth and developmental outcomes. Most researchers have examined the effect of Oromotor Stimulation (OMS) on feeding performance. Studies exploring Multimodal Sensory Stimulation (MSS) on various outcome parameters are sparse and reveal inconsistent results. Aim: To analyse the effectiveness of MSS in improving weight gain, length of hospitalisation, and feeding performance in preterm Very Low Birth Weight (VLBW) neonates. Materials and Methods: This quasi-experimental study was conducted between June 2021 and December 2022 in the Paediatrics Department of Agartala Government Medical College, Agartala, Tripura, India. A total of 104 hospitalised neonates with gestational age from 28 to less than 37 weeks and birth weight from 1000 to less than 1500 grams (VLBW) were included in the study. All neonates received standard care and Kangaroo Mother Care (KMC). On the advice of some faculties, several of them also received MSS. All neonates were divided into two groups: those who received MSS and those who did not, and they were monitored until discharge. Mean hospitalisation length, weight gain, and transition time were derived and statistically analysed using Chi-square and Mann-Whitney U tests. Results: In the present study, the mean gestational age was 32.04±1.75 and 32.679±1.19 weeks, and the M:F ratio was 1.43:1 and 1.30:1 in the MSS-given and MSS-not given groups, respectively. Mean weight gain was significantly higher in the MSS-given group (97.00±123.09 g versus- 23.42±43.96 g). Mean hospitalisation length was longer in the MSS-given group, but transition time did not differ significantly across the groups. Conclusion: Multimodal sensory stimulation is effective in promoting weight gain in preterm VLBW neonates.

IoT Based Continuous Positive Airway Pressure for Sleep Apnea and Unhealthy Snoring Patient

The non-invasive mechanical breathing technique known as Continuous Positive Airway Pressure (CPAP) is frequently employed in neonatology. The survival of very low birth weight preterm newborns may be impacted by the use of new therapeutic and technological advancements. The exorbitant cost of this device and its multiple add-on features, like Apnea Hypopnea Index (AHI) and flow limiting, among others, present a challenge. As a proof of concept for use in a Neonatal Intensive Care Unit (NICU), the design and fabrication of a CPAP device are the focus of this study. Methods: Electro-pneumatic circuits and signal conditioning boards of sensors have been installed in order to design the experimental CPAP device with sensory instrumentation for supplying data to a micro-controlled system and achieve optimized CPAP performance with minimal energy consumption.The Cloud Platform would store the received data.At a proof of concept level, the same might likewise be used to Sleep Apnea Subject(s). Keywords: Continuous Positive Airway Pressure (CPAP), Sleep Apnea, Neonatal, Respiratory Distress Syndrome (RDS), Premature baby, Transpiration medical device, Internet of Things.

IMPLEMENTATION OF PRETERM INFANT ORAL MOTOR STIMULATION INTERVENTION (PIOMI) ON VERY LOW BIRTH WEIGHT PRETERM BABY

Background: Very low birth weight is a condition of babies with a birth weight of less than 1500 grams. Premature or preterm babies are prone to nutrition deficiencies due to inadequate suction reflexes and inability of the digestive tract to absorb nutrients. Preterm Infant Oral Motor Intervention as known as PIOMI is an intervention used to stimulate the sucking reflex. The PIOMI intervention was carried out by massaging and stimulating the oral cavity, cheeks, and tongue before feeding once a day.
 Objectives: This study aims to analyze the effect of administration of the PIOMI intervention on weight gain, increased intake and increasing LATCH on, Audible of swallowing, Type of nipple, Comfort level, Hold positioning as known as LATCH score.
 Methods: This case study type experimental research design with nursing care approach. The population of this study consisted of very low birth preterm (<1200 grams) newborns. The study sample included 1 single case of very low birth weight preterm newborns, resulting from the strength analysis, who were treated in high risk neonatal unit university hospital. Data were collected using the Preterm Infant Chart Form and LATCH Breastfeeding Scale. PIOMI intervention was conducted for 7 consecutive days. Nutritional status evaluated each day and the sucking successes were evaluated at day 1 and day 7.
 Results: The results indicated that after the intervention for 7 consecutive days the weight and diet increased. There was also an increase in the LATCH score before treatment until prior to discharge from the hospital (7-9).
 Conclusion: Administration of PIOMI is expected to prevent delays in oral feeding, increasing LATCH score and overcome nutritional deficiencies in low birth weight infants.

Analysis of microsamples by miniaturized magnetic-based pipette tip microextraction: determination of free cortisol in serum and urine from very low birth weight preterm newborns.

Miniaturized magnetic-based pipette tip microextraction is presented as a sample preparation approach for microsamples. It involves quick dispersion of a diminutive amount of a magnetic sorbent material in a low-volume sample (10 μL) to entrap the target analytes. Next, the dispersion is aspirated using a (semi)automatic pipette through a pipette tip with a small cubic neodymium magnet inside, which retrieves the magnetic sorbent containing the analytes. After discarding the rest of the sample, the sorbent is properly rinsed by aspirating/dispensing deionized water, and then, the analytes are eluted by aspirating/dispensing an appropriate solvent. This approach was employed for the determination of free cortisol in serum and urine from very low birth weight preterm newborns, a vulnerable patient group who present low availability for sampling biological fluids. A magnetic immunosorbent made of a cortisol antibody was employed for the selective extraction, followed by liquid chromatography-tandem mass spectrometry. Good analytical features were obtained, such as limits of detection and quantification of 0.08 and 0.27 ng mL-1, respectively, linearity up to 50 ng mL-1 (R2 > 0.999), RSD values under 15% and relative recoveries between 91 and 111%. The cross-reactivity with other glucocorticoids (i.e., cortisone and prednisolone) was evaluated to show the selectivity of the extraction. Finally, the method applicability was demonstrated towards the determination of free cortisol in the serum and urine samples from low birth weight preterm newborns.

Kidney Replacement Therapy in Low Birth Weight Preterm Newborns

Managing newborns with kidney failure is a complex undertaking; even under ideal circumstances, dialysis is technically challenging and available therapies are designed for adults. These issues are exacerbated in smaller newborns, and intervention has traditionally not been offered in those below a certain weight threshold. Ethical concerns abound and patients deemed too small for dialysis are typically transitioned to comfort or palliative care. However, many of these neonates are otherwise healthy and would be considered survivable if kidney replacement therapy were available. To challenge the existing paradigm, we present 7 preterm, low birth weight neonates with end-stage kidney disease who were successfully managed using an innovative approach to kidney replacement therapy. These newborns had a median gestational age of 32 weeks (interquartile range [IQR], 32-35) and a median birth weight of 1.58 kg (IQR, 1.41-2.01). Kidney replacement therapy was initiated at a median age of 16 days (IQR, 1.5-40) and a weight of 1.85 kg (IQR, 1.57-2.1). Five of the 7 newborns (71%) survived to hospital discharge. Kidney replacement therapy was provided using 3F and 4F single lumen catheters and a modified ultrafiltration device. Patients experienced excellent metabolic control, and fluid homeostasis was achieved in the first week of life. Furthermore, survivors experienced physiologic weight gain and linear growth throughout their hospitalization. These findings, although preliminary, are encouraging for our smallest patients with kidney failure and suggest that survivability thresholds should be reexamined. At a minimum, neonatologists should be aware that novel approaches exist and may be considered for these challenging patients.

Prevalence and Risk Factors Associated With Elevated Thyroid Stimulating Hormone in Late Preterm Newborns With Low Birthweight: A Cross-Sectional Study

Introduction: Congenital hypothyroidism (CH) is seen more often in preterm and low birthweight infants. However, very few studies exist that explore the epidemiology and risk factors associated with CH, especially from the Indian subcontinent. Methods: A cross-sectional screening study was carried out on 240 low birthweight (<2.5 kg) and late preterm (34-36.6 weeks) newborns not requiring ventilator support over a period of 18 months. A total of 0.5 mL of venous sample was obtained on day 4 of life for analyzing thyroid stimulating hormone (TSH), tetraiodothyronine (T4), as well as tetraiodothyronine (T3) levels by an architect plus Chemiluminescence microparticle immunosorbent assay. Neonates with TSH values of more than 20 mIU/L were categorized as having elevated TSH. Results: Elevated TSH was seen in 10 (4.2%) neonates. The presence of maternal anemia ( P = .011), gestational diabetes mellitus (GDM) ( P < .001), and maternal hypothyroidism ( P < .01) was found to be significantly linked to elevated TSH levels. Other maternal comorbidities, gestational age, birthweight, as well as the nature of birth bore no significant relation with CH. Discussion: Elevated TSH was found to be common in late preterm and low birthweight newborns. Neonates of mothers suffering from hypothyroidism, advanced maternal age, GDM, and maternal anemia should be serially evaluated for thyroid abnormalities as they possess a significantly higher risk of having elevated TSH levels.

Oropharyngeal colostrum immunotherapy and nutrition in preterm newborns: meta-analysis.

ABSTRACTOBJECTIVE To investigated the effect of oropharyngeal colostrum immunotherapy in reducing the time required for very low birth weight preterm newborns (VLBW-PTNB: < 1,500g and < 37 weeks) to achieve full enteral nutrition.METHODS Literature search was conducted using four databases, including gray literature, with additional manual search of the references of selected articles. Eligibility criteria consisted of randomized clinical trials, without restriction regarding the date or language of the publication. Two independent reviewers performed the article selection and data extraction. The random-effects meta-analysis used a non-standard technique to assess the mean difference in days to achieve full enteral nutrition, carried out by the Stata 15 statistic program.RESULTS The systematic review comprised 10 studies, and five were selected for meta-analysis, with a population of 764 VLBW-PTNB and gestational age of birth between 25 and 32 weeks. The studies were conducted between 2011 and 2018 in North America, Asia and Africa, with only one conducted in South America. Altogether, they reported the number of days it took 708 VLBW-PTNB to achieve full enteral nutrition, with newborns treated with immunotherapy showing a shorter time in only three studies. Meta-analysis showed a mean difference of -4.26 days, (95% CI -7.44; -1.08d), with high heterogeneity (I2 = 83.1%).CONCLUSION The use of oropharyngeal colostrum immunotherapy can reduce the time for VLBW-PTNB to achieve full nutrition when compared to those who used a placebo or received routine care.

Urine NMR Metabolomics Profile of Preterm Infants With Necrotizing Enterocolitis Over the First Two Months of Life: A Pilot Longitudinal Case-Control Study.

Objective: To investigate changes in the urine metabolome of very low birth weight preterm newborns with necrotizing enterocolitis (NEC) and feed intolerance, we conducted a longitudinal study over the first 2 months of life. The metabolome of NEC newborns was compared with two control groups that did not develop NEC: the first one included preterm babies with feed intolerance, while the second one preterm babies with good feed tolerance. Methods: Newborns developing NEC within the 3 weeks of life were identified as early onset NEC, while the remaining as late onset NEC. Case-control matching was done according to the gestational age (±1 week), birth weight (± 200 g), and postnatal age. A total of 96 urine samples were collected and analyzed. In newborns with NEC, samples were collected before, during and after the diagnosis over the first 2 months of life, while in controls samples were collected as close as possible to the postnatal age of newborns with NEC. Proton nuclear magnetic resonance (1H NMR) spectroscopy was used for metabolomic analysis. Data were analyzed by univariate and multivariate statistical analysis. Results: In all the preterm newborns, urine levels of betaine, glycine, succinate, and citrate positively correlated with postnatal age. Suberate and lactate correlated with postnatal age in preterms with NEC and in controls with food intolerance, while N,N-dimethylglycine (N,N-DMG) correlated only in controls with good digestive tolerance. Preterm controls with feed intolerance showed a progressive significant decrease of N-methylnicotinamide and carnitine. Lactate, betaine, myo-inositol, urea, creatinine, and N,N-dimethylglycine discriminated late-onset NEC from controls with good feed tolerance. Conclusion: Our findings are discussed in terms of contributions from nutritional and clinical managements of patients and gut microbiota.

Severe sepsis and retinopathy of prematurity in very low birth weight preterm newborns in a third-level healthcare center in Lima, Peru between 2008 and 2018: A case-control study

Retinopathy of prematurity is the leading worldwide cause of visual impairment. There is little available data on its epidemiology and related factors and consequences in developing countries such as Peru. Due to this lack of information, we decided to do this study. To evaluate factors related to the development of retinopathy of prematurity in very low birth weight newborn patients. We did a case-control (paired 1:1) study of patients admitted to the Neonatal Intensive Care Unit of the Hospital Cayetano Heredia between 2008 and 2018 who had a complete record in the Neocosur network database (N = 293). The case was defined as a preterm newborn patient with a birth weight lower than 1500 grams who developed any type or stage of retinopathy of prematurity; control was defined as a patient with similar characteristics without retinopathy. Univariate and bivariate analysis (using logistic regression model) was performed to obtain the odds ratio with a 95% confidence interval. Data were obtained from 57 cases and 57 controls admitted to the Neonatal Intensive Care Unit at Hospital Cayetano Heredia. Late-onset sepsis was the main factor associated with retinopathy of prematurity (odds ratio 4.39; 95% confidence interval 1.23 to 15.76, p = 0.02). Additionally, we performed a bivariate and multivariate analysis that showed that exposure to supplementary oxygen at 36 weeks of postmenstrual age and retinopathy of prematurity were not significantly associated (8.47; 0.51 to 141.17, p = 0.14). Patients with late-onset sepsis have a 4.39 times higher odds of developing retinopathy of prematurity. Prospective studies are needed with larger sample sizes.

Oral melatonin as a new tool for neuroprotection in preterm newborns: study protocol for a randomized controlled trial

BackgroundPrevention of neurodevelopmental impairment due to preterm birth is a major health challenge. Despite advanced obstetric and neonatal care, to date there are few neuroprotective molecules available. Melatonin has been shown to have anti-oxidant/anti-inflammatory effects and to reduce brain damage, mainly after hypoxic ischemic encephalopathy. The planned study will be the first aiming to evaluate the capacity of melatonin to mitigate brain impairment due to premature birth.MethodIn our planned prospective, multicenter, double-blind, randomized vs placebo study, we will recruit, within 96 h of birth, 60 preterm newborns with a gestational age ≤ 29 weeks + 6 days; these infants will be randomly allocated to oral melatonin, 3 mg/kg/day, or placebo for 15 days. After the administration period, we will measure plasma levels of malondialdehyde, a lipid peroxidation product considered an early biological marker of melatonin treatment efficacy (primary outcome). At term-equivalent age, we will evaluate neurological status (through cerebral ultrasound, cerebral magnetic resonance imaging, vision and hearing evaluations, clinical neurological assessment, and screening for retinopathy of prematurity) as well as the incidence of bronchodysplasia and sepsis. We will also monitor neurodevelopmental outcome during the first 24 months of corrected age (using the modified Fagan Test of Infant Intelligence at 4–6 months and standardized neurological and developmental assessments at 24 months).DiscussionPreterm birth survivors often present long-term neurodevelopmental sequelae, such as motor, learning, social-behavioral, and communication problems. We aim to assess the role of melatonin as a neuroprotectant during the first weeks of extrauterine life, when preterm infants are unable to produce it spontaneously. This approach is based on the supposition that its anti-oxidant mechanism could be useful in preventing neurodevelopmental impairment. Considering the short- and long-term morbidities related to preterm birth, and the financial and social costs of the care of preterm infants, both at birth and over time, we suggest that melatonin administration could lead to considerable saving of resources. This would be the first study addressing the role of melatonin in very low birth weight preterm newborns, and it could provide a basis for further studies on melatonin as a neuroprotection strategy in this vulnerable population.Trial registrationClinicalTrials.gov NCT04235673. Prospectively registered on 22 January 2020.

Colostrum oropharyngeal immunotherapy for very low birth weight preterm infants: protocol of an intervention study

BackgroundThe oropharyngeal colostrum administration protocol to treat premature newborns is a possible and plausible strategy in neonatal health services, since the immunoprotective components of colostrum can be absorbed by the lymphoid tissues of the oropharynx. In this context, this study aims to describe the implementation of oropharyngeal colostrum immunotherapy in very low birth weight preterm newborns in a neonatal unit, as well as to test an algorithm in a public hospital.MethodsThe protocol is applied in a non-randomized, superiority clinical trial with historical control. In the treatment group, 0.2 mL of raw colostrum is dripped into the right and left oropharyngeal mucosa, totaling 8 administrations every 24 h until the 7th complete day of life interruptedly. The control group consists of very low birth weight preterm newborns born in the same hospital in previous years (historical control). The clinical progression of 60 newborns until hospital discharge is recorded on standardized forms. A total of 350 participants are estimated to complete the survey in 4 years. The occurrence of continuous outcomes between the groups are compared through the paired t-test or Wilcoxon’s two-sample test. The chi-square test or Fisher’s exact test, and survival analysis are used for binary outcomes. The nutritional status is assessed through Intergrowth-21st growth curves for preterm newborns.DiscussionThe flows of the protocol’s actions is sorted by an algorithm, compatible with the Brazilian reality of a public hospital. This measure facilitates and systematizes clinical care, organizes the team’s work process, speeds up the intervention steps, standardizes decision-making and unifies the quality of care, besides showing the feasibility of oropharyngeal colostrum immunotherapy.Trial registrationReBEC, U1111–1222-0598, Registered 09 October 2018, http://www.ensaiosclinicos.gov.br/rg/RBR-2cyp7c/.

Standardised parenteral nutrition in low birth weight preterm newborns: a case report.

The aim of this study is to evaluate the possibility of increasing the use of standardised parenteral nutrition (PN) as a replacement of individualized parenteral nutrition in the neonatal intensive care unit (NICU). The standardisation of the PN formulations has the potential to improve nutrient intakes, quality control, cost effectiveness and reduce prescription errors. In our hospital the individualized PN solutions are made by Chemists for premature babies born during the working days. We have been using standardised PN formulations for about two years for the preterm infants born during the weekend. The use of SPN is currently limited to the weekend, until our Chemists can prepare the IPN.In this study we describe the case of a sick low birth weight baby for whom we used for the first time the bags of a standardised PN "ready to use" since the sixth day of life for thirteen consecutive days. The baby was not a very low birth weight, but he needed parenteral nutrition because he was relatively unstable and he had a poor feeding tolerance. As result of the study, the baby growth was regular and the SPN were well tolerated. No adverse effects were reported.

SAT-453 Delayed TSH Elevation in Small for Gestational Age Infants: A Need for Second Screening?

The incidence of CH with a delayed TSH elevation was higher in ELBW and VLBW infants compared with infants weighing ≥1500 grams. Second screening should be considered in preterm neonates, low birth weight (LBW) and very low-birth weight (VLBW) neonates, ill and preterm newborns admitted to NICU, specimen collection within the first 24 hours of life, and multiple births (particularly same-sex twins). Purpose of this study was to determine incidence of delayed TSH elevation with or without congenital hypothyroidism in SGA infants and to Investigate necessity for second screening. Retrospective analysis was performed. 66 SGA newborns with 34-40 weeks’ gestation born at Keimyung University Dongsan Medical Center from 2015 to 2018 were enrolled. Primary screening was performed 48 hours - 7 days after birth. Second screening including venous TSH and venous free T4 at postnatal 8-40 days. Exclusion criteria were infants with congenital hypothyroidism at primary screening (NBS), descendants of mothers with immune thyroid disease, congenital malformations, renal, hepatic, and metabolic diseases, history of steroid or dopamine usage. Initial NBS were collected onto pre-printed filter at the age of 2-7 days by heel prick. (normal TSH < 10 mIU/L). Second sample was obtained at the age of 8-49 days by venous sampling (normal TSH < 5 mIU/L). TSH and free T4 were measured on venous samples with Cobas 8000 e801 (electrochemiluminescence, Roche, Diagnostics, Basel, Switzerland) using standard methods.Incidence of delayed TSH elevation was 27% (18/66). Of them number of transient hyperthyrotropinemia was 13. Mean TSH at initial elevation was 7.56 mIU/L and median age at initial TSH elevation was 18.6 days. Median age at resolution of TSH elevation was 41.5 days. Number of hypothyroidism undergoing l-thyroxine medication was 5. Mean TSH at initial elevation was 22.1 mIU/L. Median age at initial TSH elevation was 14 days. Mean peak TSH was 23.4 mIU/L.The presence of delayed TSH elevation was not related to very low birth weight. SGA infants might be at a risk of delayed TSH elevation. Considering 2nd screening test within 1 month. Further study with more SGA infants are needed. Limitation of this study was relative small number of patients and iodine status was not considered

Витамин D, маловесные, рожденные раньше срока и доношенные новорожденные дети: время изменить парадигму

This article discusses negative effects of vitamin D deficiency on low birthweight preterm and full-term newborns. Results of the studies on vitamin D provision to pregnant women and their newborn children are addressed. Vitamin D deficiency is highly prevalent in pregnant women and newborns. It was demonstrated that inadequate antenatal provision of a fetus with vitamin D may result in congenital rickets and neonatal seizures due to hypocalcemia in newborns and also accounts for increased rates of necrotic enterocolitis, bronchopulmonary dys-plasia, and impaired growth and development as well as higher risk of lower respiratory tract infections (i.e., bronchiolitis, pneumonia) during the first year of a child’s life. In addition, it was shown that persistent vitamin D deficiency in future years may be associated with recurrent respiratory infections, allergic (e.g., atopic dermatitis, asthma, etc.), autoimmune, endocrine, and psycho-neurological disorders. Preventive and therapeutic strategies for vitamin D deficiency in low birthweight preterm and full-term newborns since neonatal period are discussed.Keywords: vitamin D, vitamin D deficiency, calcidiol, low birthweight newborn, preterm newborn, full-term newborn.For citation: Zakharova I.N., Mal’tsev S.V., Zubkov V.V. et al. Vitamin D, low birthweight preterm and full-term newborns: time for a paradigm shift. Russian Journal of Woman and Child Health. 2020;3(2):142–148. DOI: 10.32364/2618-8430-2020-3-2-142-148.

Impact of Kangaroo Mother Care on Outcome of Very Low Birthweight Preterm Newborns in a Tertiary Hospital in Abakaliki, Nigeria

&#x0D; &#x0D; &#x0D; &#x0D; Introduction: KMC was developed for care of preterm and low birth weight babies due to shortage of staff and inadequate incubator care enabling early discharge from the hospital for close follow-up at home. It is essential in resource-limited countries where there is epileptic power supply. Therefore, strengthening the evidence for KMC becomes imperative in these resource-limited and adverse cultural regions.&#x0D; Methods: The KMC register of the Newborn Special Care Baby Unit of a tertiary hospital was used to analyse records from January 2016 to February 2018. A total of 55 preterm babies enrolled into KMC were studied. The age and parity of the mother, sex, birth weight, admission and discharge temperatures and weights, duration of KMC per day was retrieved from the KMC register.&#x0D; Results: The mothers’ ages ranged from 18 to 40 years (mean 28.6 ± 6.2 years) with 34% being inexperienced first-time mothers and 10% grand multipara. The birth weights of the babies ranged from 0.9 kg to 2.5 kg. Primiparous women were more likely to do KMC for longer durations. A linear regression model showed that the duration of KMC was related to parity. (R2 = 0.12, p = 0.02). On average there was significant weight gain on discharge with a paired t-test (t = 5.881, df = 44) comparing the discharge and commencement weights showing a mean difference of 0.123 kg (CI 0.081 kg, 0.165 kg, p &lt; 0.001).&#x0D; Conclusions: KMC impacts positively on all parameters of the extremely LBW and premature babies and the duration of KMC is positively associated with better outcome.&#x0D; &#x0D; &#x0D; &#x0D;

Procoagulant imbalance in preterm neonates detected by thrombin generation procedures

Preterm newborns are considered at risk of acquired coagulopathy and are often prophylactically infused with fresh frozen plasma (FFP) even in the absence of bleeding. To assess the coagulation asset of preterm neonates and the biological plausibility of such infusions, we investigated at birth 87 very low birth weight (≤1500 g) preterm (gestational age <35 weeks) newborns and 64 full-term newborns. Preterm neonates were also investigated at different time-points up to 30 days after birth. Plasma from preterm and full-term neonates were subjected to the measurement of prothrombin and activated partial thromboplastin time (PT, APTT), pro- and anticoagulant factors as well as to thrombin-generation procedures both with and without thrombomodulin. PT and APTT of preterm newborns were longer than those of full-term neonates [PT: 15.9 s (11.7–51.2)-vs-13.8 (11.0–25.4), p < 0.001. APTT: 59.0 (37.8–97.5)-vs- 47.3 (28.1–71.9), p < 0.001] and tended to shortening after 30 days from birth. Thrombin-generation defined as endogenous thrombin potential (ETP) was increased in preterm as compared to full-term neonates at birth [1322 nM·min (474–2384)-vs-1006 (697–1612), p < 0.001] and did not change appreciably over time up to 30 days from birth. In conclusion, plasma from preterm neonates displays a procoagulant imbalance at birth as shown by increasing ETP, despite the prolongation of PT and APTT. The results define preterm newborns as having hyper- rather than hypo-coagulability and argue against the infusion of FFP when given prophylactically and/or based solely on prolongation of PT or APTT.

Neurodevelopmental Outcome in Very Low Birth Weight Preterm Newborns: The Role of Neonatal Sepsis

Neurodevelopmental Outcome in Very Low Birth Weight Preterm Newborns: The Role of Neonatal Sepsis

Does type of feeding affect body composition in very low birth weight infants? – A prospective cohort study

BackgroundThe aim of the study was to analyse body composition of preterm infants fed with either breast milk or formula compared to a control group of full-term newborns. MethodsFifty-three newborns were enrolled: a group of 34 very low birth weight (VLBW) preterm newborns subdivided into a formula-fed (n = 23; group A) and breast milk-fed (n = 11; group B) group, and a control group of 19 full-term infants (group C). Their body composition was assessed by a bioelectrical impedance analysis (BIA) either at the estimated time of birth in the VLBW group or during the 1st week of life in the full-term group. ResultsThere was no difference in body weight or length between any of the three studied groups. However, we discovered that fat free mass (% FFM) was lower (83.5% vs. 85.5%; p < 0.01), while fat mass (% FM) was higher (16.4% vs.14.5%; p < 0.01) in group A compared to full-term newborns. There were no such differences in FFM (84.3% vs. 85.5%; p = 0.13) or FM (15.7% vs. 14.5%; p = 0.13) between group B and control. ConclusionTo sum up, the VLBW infants fed with breast milk shared similar body composition with the full-term infants, while the formula-fed VLBW developed higher amounts of adipose tissue and lower amounts of fat-free mass. This is the first study to expose differences in fat tissue content attributed to type of provided nutrition, which has become significant as early as estimated time of birth despite the comparable weight.

Effects of hammock positioning in behavioral status, vital signs, and pain in preterms: a case series study

BackgroundThe hammock positioning within the incubators simulates the intrauterine environment, however, there is little evidence of its benefits and possible risks. ObjectivesThe aim of this study was to assess the effects of hammock positioning on behavioral status, vital signs, and pain in very low birth weight preterm newborns. MethodsThis is a quasi-experimental/case series study in which premature infants (<1500g) were positioned in supine for one hour in a hammock. The preterm newborns were assessed 10min before, during (2, 20, 40, and 60min), and 10min after hammock positioning with the Brazelton Neonatal Behavioral Assessment Scale, vital signs and pain by the Neonatal Facial Coding System. Results28 preterm infants between 28 and 36 weeks of gestational age were evaluated. Regarding the behavioral state, the preterm newborns progressively evolved to light or deep sleep during hammock positioning. There was a statistically significant reduction of the heart and respiratory rate from 2 to 60th minute in a hammock, which was maintained after the positioning. The oxygen saturation remained within normal values. No changes in pain scores were observed. ConclusionThe hammock positioning can be considered a safe method of positioning that can be used to reduce the stress levels in very low birth weight preterm newborns. We did not observe worsening in either pain or vital signs.

Posição canguru em recém-nascidos pré-termo de muito baixo peso: estudo descritivo

Descrever o número de períodos em que recém-nascidos pré-termo de muito baixo peso estiveram em posição canguru durante internação na unidade neonatal e buscar relações entre variáveis maternas e neonatais com a realização da posição canguru. Estudo descritivo retrospectivo com todos os recém-nascidos pré-termo admitidos em 2012, com peso de nascimento igual ou inferior a 1500g e idade gestacional menor que 31 semanas, classificados como pacientes de maior risco clínico, segundo o Clinical Risk Index for Babies. Foram investigados 38 sujeitos, cujo período de hospitalização variou entre 18 a 136 dias. O início da posição canguru ocorreu em média aos 30,8 dias de vida pós-natal (DP=18,5) e a quantidade de períodos em que estiveram em posição canguru foi em média 10,7 vezes. A ocorrência da posição canguru foi menos frequente que as oportunidades advindas da presença materna e esteve relacionado ao maior oferecimento de leite em livre demanda.