Clinically determining appropriate respiratory support from the point of delivery to the NICU is difficult and inadvertent overventilation may be common. The aim of the study was to determine whether delivery room managements done by skilled team will produce ‘normocarbic’ blood gas values in <29 weeks’ preterm infants.
Method
A prospective cohort study was designed and infants born before 29 weeks’ from January 2009 to December 2011 were enrolled. All infants received 100 mg/kg prophylactic surfactant in delivery room. During resuscitation, stabilization, surfactant administration and transport infants were ventilated with a T-piece resuscitator. If respiratory drive was present, infants were extubated to nasal CPAP through short binasal prong. FiO2 was adjusted to achive SaO2 of 88–92% which was monitored by pulse oxymeter. Carbon dioxide (CO2) levels on admission and early NICU hours (0–6 hours) were evaluated.
Results
Fifty nine infants were included with a mean gestation age of 26.2±1.7 (23–28.6) weeks and a birth weight of 857±237 (400–1470). The mean pCO2 levels of the first blood gas analysis was 45.3±9.8 (range 30.4–71.2). Four (6.8%) infants had hypocarbia (pCO2 < 35 mmHg).
Conclusion
To prevent both hyperoxia and hypocarbia from the point of delivery to the NICU is a challenge. More caution is required to prevent hypocarbia and hyperoxia.
Cok Dusuk Dogum Agirlikli Premature Yenidoganlarin Anemisinde Otolog Kordon Kani Transfuzyonunun Etkinliginin ve Guvenilirliginin ArastirilmasiSon yillarda, otolog kordon kani CDDA'li prematurelerde eritrosit transfuzyonu icin alternatif bir metod olarak kabul edilmektedir. Ancak kordon kani ve eriskin bagisci kandan hazirlanan eritrosit suspansiyonlarinin CDDA'li prematurelerde in-vivo etkinlik ve guvenilirligini karsilastiran cok az sayida arastirma bulunmaktadir. Ulkemizde ise bu konuda yapilmis baska bir calisma bildirilmemistir. Ulkemiz kosullarinda otolog kordon kani ve eriskin bagisci kandan hazirlanan eritrosit suspansiyonlarinin CDDA'li prematurelerde in-vivo etkinlik ve guvenilirliginin karsilastirilmasi bu calismanin temel amacidir.Calismamiz 01.03.2008-01.09.2009 tarihleri arasinda prospektif randomize kor kontrollu olarak yurutulmustur. Calismaya hastanemizde dogan 32 hafta alti ve/veya 1500 gr alti 39 CDDA'li premature bebek alinmistir. Deneklerden dogum sirasinda kordon kani elde edilmis, her denek icin kan merkezinde otolog kandan, es zamanli tek uygun vericiden allojeneik eritrosit suspansiyon paketleri hazirlanmis, bebekler adina etiketlenerek saklamaya alinmistir. Yenidogan servis transfuzyon protokolune gore transfuzyon endikasyonu konan bebekler kan merkezinde otolog veya allojeneik kan almak uzere randomize edilmis, otolog transfuzyon grubuna secilenler otolog eritrosit kaynaklari tukendiginde allojeneik transfuzyon almislar, transfuzyon turleri taburculuk sirasinda ogrenilerek kaydedilmistir.Otolog veya allojeneik transfuzyon almak uzere randomize edilen 2 gruptaki deneklerin; 14, 28, 35. gunlerde hemoglobin degerleri, > 35. gunden sonra ortalama hemoglobin degerleri, transfuzyon sayilari, transfuzyon ve flebotomi hacimleri, klinik sepsis suphesi ile postkonsepsiyonel 36 ve 40. haftalarda hemoglobin retikulosit ve EPO duzeyleri degerlendirilmis ve tum transfuzyonlar olasi komplikasyonlar acisindan izlenmistir.Calismaya alinan 39 bebekten, dogum agirligi ve haftasi daha buyuk olan 8 bebegin transfuzyon gereksinimi olmamistir. Bu hastalarda RDS, klinik sepsis suphesi gibi sorunlarin daha az goruldugu, flebotomi hacimleri ve yatis surelerinin de transfuzyon alan hastalara gore daha az oldugu dikkat cekmistir.Calisma sonunda otolog kordon kaninin CDDA'li prematurelerde eriskin bagisci kandan hazirlanan eritrosit suspansiyonlari ile ayni guvenilirlige ve etkinlige sahip oldugu gozlenmistir. Ayrica otolog kordon kaninin immunolojik ve mikrobiyolojik olarak allojeneik transfuzyonlara gore daha ustun oldugu gercegi de goz onune alinarak CDDA'li prematurelerde eritrosit transfuzyonu icin alternatif bir metod olabilecegi dusunulmustur. Ancak bu bebeklerde prematuriteye eslik eden sorunlar nedeni ile flebotomi hacimlerinin fazla oldugu, kordon kaninin yapilan tum transfuzyonlari karsilayamadigi, izlemde allojeneik transfuzyonlara gereksinim oldugu gozlenmistir. Bu nedenle CDDA'li prematurelerde, laboratuvar tetkiklerinin dikkatle planlanip flebotomi hacmi ve klinik sepsis suphesinin azaltilmasi, daha kisitlayici transfuzyon kriterlerine uyulmasi durumunda otolog kaynagin yeterliligi artacak ve daha yararli olacaktir. AbstractEvalution of the Efficacy and Safety of Autologous Cord Blood Transfusions in Very Low-birth-weight Premature NewbornsIn recent years, cord blood is accepted as an alternative method for red cell transfusions in low-birth-weight premature newborns. However there is very little knowledge on the comparison of in-vivo efficacy and safety of red cell concentrates drived from cord blood and banked adult blood in very low-birth-weight premature newborns. In this study our purpose was to compare the in-vivo efficacy and safety of red cell concentrates drived from cord blood and banked adult blood in very low-birth-weight premature newborns.This prospective, randomized, blind-controlled study was conducted between 01.03.2008-01.09.2009. Thirty-nine premature neonates were included in this study. They were born at a gestational age less than 32 weeks and/or with a birth weight less than 1500 g. Red cell concentrate bags were prepared from the cord blood and a single proper adult donor concurrently for every case in the blood bank. All red cell concentrates were labelled and stored in blood bank for every premature newborn. According to our transfusion guidelines, premature infants requiring red blood cell transfusion were randomly assigned to an autologous or allogeneic product in the blood bank. In the autologous group; if an autologous source had been totally consumed, allogeneik product was sent for transfusion by the blood bank. When patients were discharged, transfusion types were resumed.Two randomized groups were compared on the 14, 28, 35. days and > 35 days with respect to hemoglobin levels, transfusion numbers, transfusion and phlebotomy volumes. In addition, all cases in two groups were assessed according to hemoglobin and erythropoietin levels, reticulocyte counts in the postnatal 36. and 40. weeks. All transfusions were monitored for complications.In this clinical trial, 39 premature infants were analyzed among which 8 cases did not receive any transfusions during their stay in the hospital. This group of patients had a higher birth weight and gestastional week than the patients who were transfuzed. In this group, RDS and clinical sepsis doubt were lesser as well as the phlebotomy losses. They had a shorter hospital stays during the study period.Autologous cord blood had the same efficacy and safety with red cell concentrates derived from banked adult blood in our study group. Theoretically autologous cord blood transfusions are immunologically and microbiologically safer than allogeneic transfusions. However very low-birth-weight premature newborns who are critically ill, have high phlebotomy losses and auotologous cord blood can not cover all transfusion needs. Careful monitorization of phlebotomies for laboratory testing, decreasing clinical sepsis doubt and phlebotomy losses, implementing more restrictive transfusion guidelines may increase the efficacy of autologous cord blood.
The aim of this study was to investigate the effect of high energy formula to the short term growth of infants who could not reach the postnatal growth target.
Methods
The infants with postnatal growth problem who were followed in an outpatient unit of a tertiary neonatal intensive care unit between September 2012 and September 2013 were included. Demographical, clinical, feeding and growth patterns were investigated retrospectively and weight, height and head circumference at the 1st, 2nd and 3rd months were compared after adding high energy formula (Similac High Energy, Abboutt Laboraties BV, Zwolle, Holland) to nutrition.
Results
6 infants with congenital heart disease, 1 infant with perinatal asphyxia, 1 infant with chilotorax and 6 preterm infants were included. The median of birth weight and gestational age of these infants were 2595 (750–3110) gr and 35.4 (28–40) weeks respectively. The difference of 1st, 2nd and 3rd month weight, height and head circumference z-score were found statistically significant between daily calorie of 102.1 ± 32.1 kc/kg/day before starting high energy formula and 106.1 ± 20.8 kc/kg/day with high energy formula (Table 1).
Conclusion
This pilot study showed that growth parameters could be improved by adding high energy formula to nutrition in preterm infants with serious growth problem and term infants with an illness.
Parathyroid hormone (PTH) is the major calciotropic hormone in the body. PTH secretion is increased by hypocalcaemia, through interaction of ionized calcium with calcium sensing receptors (CASR) (8). Neonatal severe Hyperparathyroidism (NSHPT) is a life-threatening condition with severe hypercalcemia, hypotonia, bone demineralization, respiratory distress, failure to thrive, feeding difficulties, vomiting, skeletal abnormalities, kidney stones, hypertension and hypercalciuria (7,8).NSHPT is a rare autosomal dominant disease associated with an inactivating homozygous mutation of the CASR. CASR is a G-protein-coupled receptor found in the cell membranes in the parathyroid glands. It plays a key role in calcium homeostasis, activates phospholipase C when there is an increase in calcemia, and decreases PTH secretion (1,3). CASR is also expressed in other tissues, including bone marrow, brain, intestine and kidney. Activation of the parathyroid CASR by extracellular ionized calcium inhibits secretion of PTH, while in the distal renal tubule cells receptor activation leads to enhanced urinary excretion of calcium (10).We here present a newborn case of NSHPT with a novel mutation which has never been described before neither as a mutation nor as a polymorphism, and discuss the treatment in relation to the defined mutation.A-3500 g-male newborn with 40 weeks gestation was bom to a 41-year-old mother by normal vaginal delivery after an uneventful pregnancy. On the postnatal 6th day he was brought to the regional hospital for hypoactivity, difficulty in sucking and poor oral intake.Although his physical examination was unremarkable, biochemical analysis showed severe hypercalcemia (29.8 mg/dl) (N; 8.6-10.2 mg/ dl) with hypophosphatemia (2.1 mg/dl) (N; 3.5-7J mg/dl) and normal serum alkaline phosphatase (ALP) activity (224 U/L) (N; He was diagnosed as severe hyperparathyroidism and referred to our hospital after control of hypercalcemia with intravenous biphosphanate (Pamidronat) (Aredia, Novartis Pharma, Switzerland).He was admitted to our neonatal intensive care unit (NICU) on the postnatal 1 llh day with a Ca level of 14.2 mg/dl. The physical examination was recorded as normal except his cachectic appearance. His weight, length and head circumference were 2775 g (10-25 p), 51 cm (75-90 p) and 34 cm (50-75p), respectively. Family history revealed second degree consanguinity between parents and the patient was the youngest of nine siblings. There was no history of another hypercalcemie case in his family.The follow-up of the patient for Ca and PTH levels are shown in Figures 1-2. X-rays showed no signs of calcification but mild bone resorption in the extremities. Although cranial ultrasonography (USG) was normal, abdominal USG revealed renal echogenity secondary to nephrolithiasis. Parathyroid and thyroid USG was unrevealing.Genomic DNA was extracted from the patient and his mothers and sequencing analysis for the six coding exons and junctions for intron/ exon was conducted. Genetic evaluation was performed at The University Hospital of Limoges, France. Homozygous p.MlLys point mutation ( c.242T>A) was detected in the patient and both of the parents were heterozygote for the mutation.The patient was given pamidronate treatment on the postnatal 7th and 8lh days of life at a dose of 0.5 mg/kg/d to control hypercalcemia which was persistent to hydration and fiirosemide treatments at the regional hospital. Patient showed a stable normocalcemic period at upper margins until the postnatal 33th day when Ca level was 14.1 mg/dl and cinacalcet (Mimpara, Eczacibaci, Turkey) treatment at a dose of 0.5 mg/ kg/d was started, and increased to 3 mg/kg/d. The patient was given a single intravenous pamidronate at a dose of 0. …
Observation: This case report describes atypical presentation of iatrogenic calcinosis cutis in neonate.Iatrogenic calcinosis cutis usually presents by swelling erythema, induration, and soft tissue necrosis.Thus calcinosis cutis is usually easy to diagnose for clinicians.However, when extravasation is minor, the etiological relation of extravasation and calcification may not be obvious.Because of these reason, radiological findings are very important and they are usually the key to the diagnosis.A careful differential diagnosis from hematoma, abscess, or cellulitis prevent the patients from misdiagnosed and overtreatment.
This study aimed to compare the storage properties of red blood cell (RBC) concentrates of umbilical cordblood (UCB) and adult donor blood (ADB), and to evaluate the feasibility of UCB-RBC concentrate as an autologoussource for blood transfusion in very low birth weight (VLBW) preterm neonates.In all, 30 newborn (10 preterm, 20 full term) UCB and 31 ADB units were collected.RBC concentrates were stored and compared with regard to pH, potassium (K(+)), 2,3-biphosphoglycerate (2-3-BPG),adenosine tri-phosphate (ATP), plasma Hb, and bacterial contamination on d 1, 21, and 35 of storage.The K(+) level increased with time and differed significantly between storage d 1 and 21, and between storaged 1 and 35 in both the UCB and ADB units. Initial and d 21 K(+) levels were higher in the UCB units than in the ADBunits. The 2,3-BPG level did not differ significantly between the UCB-PRC and ADB-PRC samples. After 35 d of storageboth UCB-PRC and ADB-PRC samples exhibited significant differences from the initial free Hb, intracellular ATP, andpH values. Significant differences in intracellular ATP and pH were also observed between the UCB-PRC and ADB-PRCsamples.The volume of harvested and prepared UCB-PRC can be used for some of the blood transfusions requiredduring the neonatal period and thus may decrease the number of allogeneic transfusions, especially in preterm newborns.The hematological and biochemical changes that occurred in UCB during storage were comparable with those observedin ADB, and do not pose a risk to the immature metabolism of neonates. UCB-RPC prepared and stored under standardconditions can be a safe alternative RBC source for transfusions in VLBW newborns.Amaç: Çalışmada kordon kanı ile erişkin bağışçı kanlarından elde edilen eritrosit süspansiyonlarının özelliklerini ve saklama sırasında oluşan değişiklikleri izleyerek, kordon kanından elde edilen eritrosit süspansiyonlarının çok düşük doğum ağırlıklı yenidoğanlarda otolog bir transfüzyon kaynağı olarak kullanılabilirliğini değerlendirmek amaçlanmıştır. Gereç ve Yöntemler: 30 yenidoğan (20 preterm, 10 term) kordon kanı ile 31 erişkin bağışçı kanı toplandı. Hazırlanan eritrosit süspansiyonları standard koşullarda saklanarak 1., 21. ve 35. günlerde pH, potasyum (K+), 2,3-BPG, adenozin trifosfat (ATP), plazma Hb ve bakteriyel kontaminasyon bakımından incelendi. Bulgular: Potasyum değerlerinin zamanla artarak, hem kordon kanı hem de erişkin kanlarında 1.-21. ve 1-35. günler arasında anlamlı farklar saptandı. İlk ve 21. Gün değerlerinin kordon kanında erişkin kanlarından daha yüksek olduğu saptandı. 2,3-BPG değerleri kordon kanı ve erişkin kanlarında anlamlı fark göstermedi.Saklamanın 35. gününde hem kordon kanı hem de erişkin kanlarında serbest Hb, ATP ve pH değerlerinin ilk değerlere gore anlamlı fark gösterdiği belirlendi.Bu parametreler açısından kordon kanı ve erişkin kanı grupları arasında da fark olduğu görüldü. Sonuç: Toplanan ve hazırlanan kordon kanı eritrosit süspansiyonları yenidoğan dönemindeki transfüzyon gereksinimini kısmen karşılayabilir ve böylece allogeneik transfüzyonları azaltabilir. Saklama sırasında oluşan hematolojik ve biyokimyasal değişiklikler erişkin bağışçı kanlarındakilere benzerlik göstermekte olup yenidoğan metabolizması için bir risk oluşturacak düzeyde değildir. Kordon kanından hazırlanıp standart koşullarda saklanan eritrosit süspansiyonları çok düşük doğum ağırlıklı yenidoğanlar için bir seçenek olabilir.
The aim of this study was to evaluate the effects of umbilical cord milking (UCM) on the need for packed red blood cell (PRBC) transfusion and hematologic and haemodynamic parameters in very-low–birth-weight infants.
Methods
The infants were randomised into 2 groups: group 1 (UCM) and group 2 (control). The primary outcome was the number of PRBC transfusions during the first 35 days of life. The secondary outcome measures were the haemodynamic variables during the first 24 h of life.
Results
A total of 44 infants were included with 22 infants in each group. Two of 21 infants in group 1 and 4 of 21 infants in group 2 received transfusion in the first 3 days of life (p = 0.384). The number and volume of PRBC transfusions were similar in both groups (Table 1). Comparison of laboratory outcomes resulted in statistically significance only in median Hb values at first (16.8 g/dL [range, 14.1 to 18.8 g/dL] and 15.4 g/dL [range, 12.3 to 18.5 g/dL]; p = 0.019) and 24th hour after birth (16.1 g/dL [range, 13.4 to 21 g/dL] and 14.9 g/dL [range,10.2 to 18 g/dL]; p = 0.021) between UCM and control groups, respectively. Phlebotomy volume was found as a statistically significant risk factor for the need for PRBC transfusion (p = 0.005).
Conclusions
UCM in delivery room results in a higher Hb level in the first day of life. In these groups of infants, phlebotomy losses may impact the transfusion need.
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