Antenatal corticosteroid administration is associated with lower risk of severe ROP in preterm twin infants

INTRODUCTION

Robust evidence revealed the impact of antenatal corticosteroid (ACS) administration on lower mortality and short-term neonatal outcomes in singleton preterm infants. We aimed to investigate the impact of ACS therapy on morbidity and mortality in preterm twin infants.

METHODS

We conducted this retrospective single-center study from to the records of twin babies of 24-30 weeks of gestation admitted to the neonatal intensive care unit. The study population was grouped based on the exposure to ACS 1-7 days before birth as received or not. Groups were compared regarding in-hospital mortality and neonatal outcomes.

RESULTS

Data from 160 twin infants were analyzed. Of those, 102 (64 %) were administered ACS. The median (IQR) gestational age and birth weight of the whole cohort were 28 (27-29) weeks and 1060 (900-1240) g, respectively. ACS administration was associated with a significant decline in respiratory distress syndrome (RDS), requirement ≥2 doses of surfactant, severe intraventricular hemorrhage (IVH), early-onset sepsis (EOS), and retinopathy of prematurity (ROP) requiring treatment (p < 0.05). Logistic regression analysis revealed that gestational age (OR 0.29 95 % CI 0.14-0.62; p = 0.001), ACS administration (OR 0.14 95 % CI 0.03-0.85; p = 0.032), and time to achieve full enteral feeding (OR 1.16 95 % CI 1.03-1.31; p = 0.019) were independently associated with the risk of severe ROP.

CONCLUSION

The reduction in the risk of severe ROP besides RDS, severe IVH, and EOS among preterm twins who received ACS was remarkable in our study similar to the trials conducted in preterm singletons. However, large-scale prospective observational studies are required to reveal the efficacy of ACS in preterm twins.

Evaluation of cerebral autoregulation of oxygen by NIRS method during postnatal transition period in term and late preterm newborns without resuscitation requirement

BACKGROUND

Pulse oximetry is commonly used to monitor arterial oxygen saturation and heart rate during the transition period and reference intervals have been determined. However, the effect of the change in arterial oxygen saturation on tissue oxygenation does not seem to be the same. So, a non-invasive method for monitoring cerebral or regional tissue oxygenation will be potentially useful for vulnerable infants. This study aims to evaluate the effectiveness of cerebral autoregulation in the first 10 min after delivery in term and late preterm newborns without resuscitation requirement.

METHODS

Cerebral tissue oxygen saturation was measured in the first 10 min after birth with near-infrared spectroscopy (NIRS) from the left forehead. Peripheral oxygen saturation was measured with pulse oximetry from the right hand and cerebral fractional tissue oxygen extraction was calculated.

RESULTS

Nineteen late preterms and 20 term infants were included in the study. There was no statistically significant difference between median cerebral tissue oxygen saturation and cerebral fractional tissue oxygen extraction values of late preterm and term infants (p < 0.001). There was a strong inverse relationship between cerebral tissue oxygen saturation and cerebral fractional tissue oxygen extraction (p < 0.001).

CONCLUSIONS

In late preterm infants similar to term infants, arterial oxygen saturation and cerebral tissue oxygen saturation increased with time, but inverse reduction of cerebral fractional tissue oxygen extraction showed the presence of an active autoregulation in the brain. This can be interpreted as the ability of the brain to protect itself from hypoxia by regulating oxygen uptake during normal fetal-neonatal transition process. A larger scale multi-center randomized control trial is now needed to further inform practice.

Comparison of different growth curves in the assessment of extrauterine growth restriction in very low birth weight preterm infants

BACKGROUND

Preterm infants are at risk of extrauterine growth restriction (EUGR) and associated complications in the long term. Growth curves are important in assessing postnatal growth in these infants. The aim of this study was to determine the prevalence of EUGR in preterm infants and the factors associated with EUGR using two different growth curves.

METHODS

We retrospectively evaluated 596 preterm infants with birth weight ≤1500 g. Small for gestational age (SGA) was defined as birth weight <10th percentile for gestational age. EUGR was defined as discharge weight z score <-2. All z scores were determined using both the Fenton 2013 and Intergrowth-21st (IG-21) growth curves.

RESULTS

The infants' median gestational age was 28 weeks (27-29) and median birth weight was 1080 g (900-1243). The prevalence of SGA was 9.2% with IG-21 curves and 5% with Fenton curves (p < 0.001). The median discharge weight was 2060 g (1860-2363). The prevalence of EUGR was significantly higher with the Fenton curves than with the IG-21 curves (38% vs. 31.7%, p < 0.001). The mean discharge weight z score was -1.82±1.29 with Fenton and -1.44±1.49 with IG-21 curves. In multivariate analysis, significant risk factors for EUGR according to the Fenton curves were SGA (odds ratio [OR]: 19.15, 95% confidence interval [CI]: 4.4-82.59), respiratory distress syndrome (RDS) (OR 1.64, 95% CI 1.12-2.4), late neonatal sepsis (LNS) (OR: 2.27, 95% CI: 1.5-3.44), and >16 days to full enteral feeding (OR: 1.8, 95% CI: 1.22-2.68). Similarly, independent risk factors for EUGR according to the IG-21 curve were SGA (OR: 16.3, 95% CI: 7.23-36.9), RDS (OR: 1.81, 95% CI: 1.16-2.83), LNS (OR: 2.29, 95% CI: 1.43-3.68), and >16 days to full enteral feeding (OR: 2.11, 95% CI: 1.38-3.23).

CONCLUSION

The growth curves used for diagnosis may lead to differences in EUGR rates in intensive care units and the factors identified as associated with EUGR. At-risk infants should be evaluated for EUGR and their weight and nutritional support should be monitored carefully. Comparisons of long-term outcomes are needed to assess the suitability of growth curves used for EUGR follow-up.

Platelet mass index in very preterm infants: can it be used as a parameter for neonatal morbidities?

OBJECTIVE

Platelet mass index (PMI) is related to the platelet functionality. The aim of this study was to evaluate the correlation between PMI and the occurrence of various inflammation-related morbidities of prematurity, such as bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH) and sepsis in very low-birth weight (VLBW) infants.

METHODS

This retrospective analysis of VLBW infants admitted to a level 3 neonatal intensive care unit from October 2012 and 2014, n = 330. Platelet mass was calculated and recorded on the day of birth and between 3 and 7 days (second measure) for each patient. Statistical analysis included analysis of paired samples t test and independent samples t test.

RESULT

Among VLBW neonates, PMI values were lower in infants with ROP (p = 0.016), BPD (p = 0.002), IVH (p = 0.018) and NEC (p = 0.011) when compared with the control group in the second measurement.

CONCLUSIONS

In this study, we found that premature infants with BPD, NEC, ROP, IVH and sepsis had lower PMI levels in early postnatal life than infants without these diseases. This might be associated with the inflammatory process.

Expression characteristics of ARF1 and SAR1 during development and the de-etiolation process

ARF1 (ADP-ribosylation factor 1) and SAR1 (secretion-associated RAS super family) are involved in the formation and budding of vesicles throughout plant endomembrane systems. The molecular mechanisms of this transport have been studied extensively in mammalian and yeast cells. However, very little is known about the mechanisms of coat protein complex (COP) formation and recruitment of COP-vesicle cargoes in plants. To provide insights into vesicular trafficking in Pisum sativum L., we investigated mRNA and protein expression patterns of ARF1 and SAR1 in roots and shoots at early growth stages and in the de-etiolation process. We showed that ARF1 was concentrated mostly in the crude Golgi fractions, and SAR1 was concentrated predominantly in the crude ER fractions of de-etiolated shoots. ARF1 and SAR1 proteins were several times more abundant in shoots relative to roots. In total protein homogenates, the expression level of SAR1 and ARF1 was higher in shoots of dark-grown pea plants than light-grown plants. In contrast, ARF1 was higher in roots of light-grown pea relative to roots of dark-grown pea. With ageing, the ARF1 mRNA in roots was reduced, while SAR1 expression increased. Unlike ARF1 transcripts, ARF1 protein levels did not fluctuate significantly in root and shoot tissue during early development. The relative abundance of SAR1 protein in root tissues may suggest a high level of vesicular transport from the ER to the Golgi. Experimental results suggested that white light probably affects the regulation of ARF1 and SAR1 protein levels. On the other hand, short-term white light affects SAR1 but not ARF1.