Cerebral Oximetry Monitoring in Extremely Preterm Infants

BACKGROUND

The use of cerebral oximetry monitoring in the care of extremely preterm infants is increasing. However, evidence that its use improves clinical outcomes is lacking.

METHODS

In this randomized, phase 3 trial conducted at 70 sites in 17 countries, we assigned extremely preterm infants (gestational age, <28 weeks), within 6 hours after birth, to receive treatment guided by cerebral oximetry monitoring for the first 72 hours after birth or to receive usual care. The primary outcome was a composite of death or severe brain injury on cerebral ultrasonography at 36 weeks' postmenstrual age. Serious adverse events that were assessed were death, severe brain injury, bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, and late-onset sepsis.

RESULTS

A total of 1601 infants underwent randomization and 1579 (98.6%) were evaluated for the primary outcome. At 36 weeks' postmenstrual age, death or severe brain injury had occurred in 272 of 772 infants (35.2%) in the cerebral oximetry group, as compared with 274 of 807 infants (34.0%) in the usual-care group (relative risk with cerebral oximetry, 1.03; 95% confidence interval, 0.90 to 1.18; P = 0.64). The incidence of serious adverse events did not differ between the two groups.

CONCLUSIONS

In extremely preterm infants, treatment guided by cerebral oximetry monitoring for the first 72 hours after birth was not associated with a lower incidence of death or severe brain injury at 36 weeks' postmenstrual age than usual care. (Funded by the Elsass Foundation and others; SafeBoosC-III ClinicalTrials.gov number, NCT03770741.).

Cell death in Tetrahymena thermophila: new observations on culture conditions

We previously suggested that the cell fate of the protozoan ciliate, Tetrahymena thermophila, effectively relates to a quorum-sensing mechanism where cell-released factors support cell survival and proliferation. The cells have to be present above a critical initial density in a chemically defined nutrient medium in order to release a sufficient level of these factors to allow a new colony to flourish. At a relatively high rate of metabolism and/or macromolecular synthesis and below this critical density, cells began to die abruptly within 30 min of inoculation, and this death took the form of an explosive disintegration lasting less than 50 milliseconds. The cells died at any location in the culture, and the frequency of cell death was always lower in well-filled vials than those with medium/air interface. Cell death was inhibited by the addition of Actinomycin D or through modifications of the culture conditions either by reducing the oxygen tension or by decreasing the temperature of the growth medium. In addition, plastic caps in well-filled vials release substances, which promote cell survival. The fate of low-density cultures is related to certain 'physical' conditions, in addition to the availability of oxygen within closed culture systems.

Mechanisms controlling death, survival and proliferation in a model unicellular eukaryote Tetrahymena thermophila

Below a critical cell density of 750 cells ml(-1), and in a manner familiar throughout much of cell culture technology, Tetrahymena thermophila die within a few hours despite being supported by a nutritionally complete synthetic medium, SSM, in which a supracritical inoculum (1000 cells ml(-1)) nevertheless proliferates and quickly reaches 1 x 10(6) cells ml(-1). The kinetics of cell death, and the conditions required to keep cells alive at and below the critical density have now been more fully investigated. Interestingly, cell death follows first order kinetics, with a half-life of less than two hours at 250 cells ml(-1). Survival can be extended by an order of magnitude, however, when protein synthesis is reduced by inoculation of cells at this density in: (a)Tris/HCI-buffer;(b) SSM deficient in an essential amino acid (arginine or phenylalanine); or, (c) SSM containing cycloheximide. In the presence of actinomycin D, the critical density required for proliferation can be lowered to 100 cells ml(-1). These results are discussed in relation to the capacity of Tetrahymenaio produce and release signal molecules (loosely referred to as growth factors), which need to be present above a certain threshold level before proliferation occurs. The evidence for the demise of cells at low density being active - in terms of requirement for, or dependency on, new transcriptional and translational processes - is discussed, along with more general implications of the findings for the control of cell death in populations of 'free-living' unicellular organisms in culture compared with their normal habitats.