Catch-up of body weight did not occur in the first 18 months CA in preeclamptic infants. Neurodevelopment outcome was better in infants delivered by preeclamptic mothers than in controls at 18 months CA.
Increased pulmonary vascular resistance in preterm newborn infants with respiratory distress syndrome is suggested, and endothelin-1 plays an important role in pulmonary vascular reactivity in newborns. We determined umbilical cord blood and neonatal (second sample) levels of endothelin-1 in 18 preterm newborns with respiratory distress syndrome who had no clinical or echocardiographic diagnosis of pulmonary hypertension and 22 without respiratory distress syndrome (gestational ages: 31.4 ± 1.6 and 29.3 ± 2.3 weeks, respectively). Umbilical cord blood and a second blood sample taken 18 to 40 h after birth were used for endothelin-1 determination by enzyme immunoassay. Median umbilical cord blood endothelin-1 levels were similar in both groups (control: 10.9 and respiratory distress syndrome: 11.4 pg/ mL) and were significantly higher than in the second sample (control: 1.7 pg/mL and respiratory distress syndrome: 3.5 pg/mL, P < 0.001 for both groups). Median endothelin-1 levels in the second sample were significantly higher in children with respiratory distress syndrome than in control infants (P < 0.001). There were significant positive correlations between second sample endothelin-1 and Score for Neonatal Acute Physiology and Perinatal Extension II (r = 0.36, P = 0.02), and duration of mechanical ventilation (r = 0.64, P = 0.02). A slower decline of endothelin-1 from birth to 40 h of life was observed in newborns with respiratory distress syndrome when compared to controls. A significant correlation between neonatal endothelin-1 levels and some illness-severity signs suggests that endothelin-1 plays a role in the natural course of respiratory distress syndrome in preterm newborns.
Objective: to assess the efficacy of erythropoietin in the prevention and treatment of anemia of prematurity, correlating the use of this drug with weight gain, length, and head circumference and comparing two administration schemes of he same weekly dose: daily use and twice a week.Methods: the study comprised 42 premature newborns with gestational age up to 33 weeks, birthweight up to 1550 g, and postnatal age between 10 and 35 days. The newborns were randomized into three groups: patients in group 1 received seven daily doses of 100 U/kg erythropoietin per week; patients in group 2 received two 350 U/kg erythropoietin doses per week; and patients in group 3 did not receive the drug. Hematologic measurements, blood transfusion requirements, and growth rates were followed during therapy.Results: cases and controls did not differ with respect to weight, length, head circumference, and total time of hospital stay. At the end of the study, no significant difference was observed in the platelet count measurement means, white blood cell count, and ferritin levels in the three groups. However, the final hematocrit and hemoglobin values of patients who did not receive erythropoietin were significantly lower than those of patients who received the drug. The absolute reticulocyte count mean was significantly higher in patients who received erythropoietin after two weeks of treatment when compared with those patients who did not receive the drug. Patients in group 1 e 2 received fewer excessive transfusions (2 or more) than patients in group 3. The administration of 700 U/kg/week erythropoietin significantly reduced the number of excessive blood transfusions. There is no significant difference in blood transfusion volume between patients who received erythropoietin on a daily basis and those who received the drug twice weekly.Conclusions: the use of erythropoietin did not influence weight gain and growth. The administration of 700 U/kg/week erythropoietin in premature infants with gestational age up to 33 weeks and birthweight up to 1550 g stimulates erythropoiesis and significantly reduces excessive blood transfusion requirements. Erythropoietin showed to be a safe and well tolerated medication, with no short-term side effects in the study population.J Pediatr (Rio J) 2001; 77 (2): 75-83: erythropoietin, anemia of prematurity, transfusion, premature. ResumoObjetivos: a proposta do presente estudo foi avaliar a eficácia da eritropoetina na prevenção e tratamento da anemia da prematuridade, correlacionar o uso desta medicação com o ganho de peso, comprimento e perímetro cefálico dos pacientes. Foi realizada também uma comparação entre o uso de eritropoetina diariamente e o uso duas vezes por semana, na mesma dose semanal.Métodos: ensaio clínico que avaliou 42 recém-nascidos prematuros, com até 33 semanas de idade gestacional, peso de nascimento até 1550g e idade pós-natal entre 10 e 35 dias de vida. Os recém-nascidos foram randomizados em três grupos. Os pacientes do grupo 1 receberam 7 doses diárias, de 100U/kg c...
Background: Accuracy of neonatal length measurement may be influenced by the reluctance of the measurer to forcefully extend both lower limbs against the normal flexor posture. On the other hand, during the first days after birth the measured length may increase because of the gradual decrease of the intrauterine state of flexion. Objective: To assess potential differences in discomfort during length measurement with one or both lower limbs extended and any variation in measured length within the first two days after birth.Methods: Seventy healthy full-term neonates born at Hospital Dona Estefânia were systematically sampled. Crown-heel length was measured using a 1 mm precision neonatometer, at circa 8 hours and 32 hours after birth, with one and both lower limbs completely extended. The Neonatal Facial Coding System was used to assess discomfort during measurements. Data were analyzed by parametric and nonparametric tests as appropriate.Results: Discomfort scores are significantly higher during length measurement than at baseline, whatever the measurement method. Whenever length measurements are performed, discomfort scores are significantly higher extending two rather than one lower limb (pϽ0.006). Measured length is higher with one lower limb extended, the difference decreases in time: at circa 32 hours of age 0.19 cm (95% CI: 0.1-0.3; pϭ0.000). No significant differences on length were found between measurements at circa 8 or 32 hours after birth, for both one and two lower limbs extended. The best correlation between measurements with one or two extended lower limbs was observed at circa 32 hours after birth (rϭ0.98). Conclusion:The best balance between the comfort of the neonate and the accuracy of crown-heel length measurement is achieved at circa 32 hours after birth extending one lower limb. OSMOLALITY OF PRETERM FORMULAS SUPPLEMENTED WITH GLUCOSE POLY-MERS AND MEDIUM CHAIN TRIGLYCERIDES PortugalBackground: Addition of energy supplements to preterm formulas is a possible strategy to increase the enteral energy intake, without exceeding the protein intake or the potential renal solute load, in infants submitted to fluid restriction, such as in bronchopulmonary dysplasia. This manipulation of standard formulas may lead to undesirable increase in osmolality of feedings, 400 mOsm/kg is the maximum recommended limit. Objective: To measure the osmolality of some commercialized preterm formulas supplemented with glucose polymers (PG) and medium chain triglycerides (MCT).Methods: Osmolality was measured by freezing point depression. Powdered formulas Aptamil Prematil® (NumicoMilupa), Enfamil Premature® (Mead-Johnson), Nenatal® (Numico-Nutricia) Nutribén Bajo Peso® (Alter) and Pre Nan® (Nestlé), at concentrations of 14g/100ml (14%) and 16g/100ml (16%), and the liquid formula Humana 0® (Humana) were analyzed. All powdered formulas at both mentioned concentrations, and the liquid formula, were supplemented with 10% (low supplementation -LS) and 20% (high supplementation -HS) of calories, respectively, as PG (Mod...
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