Objective:The aim of this study is to characterize baseline regional oxygen saturations (rSO2) in stable preterm infants during the first weeks of life.Study Design:Cerebral, renal and abdominal rSO2 were continuously monitored from the time of birth to 21 days in twelve preterm infants of 29–34 weeks gestation. Regional saturations were evaluated for trends over time, variability and differences between gestational ages (GAs) and reported pediatric values.Result:Both cerebral (66–83%) and renal (64–87%) rSO2 baselines were within the range of reported neonatal values but consistently decreased over the first weeks of life (P<0.01). The baseline abdominal rSO2 was 32–66% and increased with GA (P=0.05). The rSO2 variability was lowest for cerebral measurements and highest at the abdomen. Abdominal rSO2 variability decreased over time (P⩽0.05).Conclusion:Daily baseline rSO2 in preterm infants changes over the first weeks of life, especially at the abdomen. Evolution in baseline rSO2 over time may indicate regional developmental maturation of physiological oxygen balance.

IMPORTANCE Although opioids are used to treat neonatal abstinence syndrome (NAS), the best pharmacologic treatment has not been established. OBJECTIVE To compare the safety and efficacy of methadone and morphine in NAS. DESIGN, SETTING, AND PARTICIPANTS In this randomized, double-blind, intention-to-treat trial, term infants from 8 US newborn units whose mothers received buprenorphine, methadone, or opioids for pain control during pregnancy were eligible. A total of 117 infants were randomized to receive methadone or morphine from February 9, 2014, to March 6, 2017. Mothers who declined randomization could consent to data collection and standard institutional treatment. INTERVENTIONS Infants were assessed with the Finnegan Neonatal Abstinence Scoring System every 4 hours and treated with methadone or placebo every 4 hours or morphine every 4 hours. Infants with persistently elevated Finnegan scores received dose increases. Infants who exceeded a predetermined opioid dose received phenobarbital. Dose reductions occurred every 12 to 48 hours when signs of NAS were controlled with therapy, stopping at 20% of the original dose. MAIN OUTCOMES AND MEASURES The primary end point was length of hospital stay (LOS). The secondary end points were LOS attributable to NAS and length of drug treatment (LOT). RESULTS A total of 183 mothers consented to have their infants in the study; 117 infants required treatment. Because 1 parent withdrew consent, data were analyzed on 116 infants (mean [SD] gestational age, 39.1 [1.1] weeks; mean [SD] birth weight, 3157 [486] g; 58 [50%] male). Demographic variables and risk factors were similar except for more prenatal cigarette exposure in infants who received methadone. Adjusting for study site and maternal opioid type, methadone was associated with decreased mean number of days for LOS by 14%

, and the prognostic impact of FMS-like tyrosine kinase 3/internal tandem duplication (FLT3/ITD) mutation was evaluated in the context of other clinical prognostic factors. Patients with FLT3/ITD þ AML had significantly inferior DFS (2-year DFS: 19% vs 64%, P ¼ 0.0027), increased risk of relapse (1-year: 59% vs 19%, P ¼ 0.01), and a trend towards decreased OS (P ¼ 0.08) compared with patients without FLT3/ITD. Multivariate analysis confirmed FLT3/ITD þ independently predicted a shorter DFS (HR, 3.0; 95% CI), 1.4-6.5; P ¼ 0.01) and increased risk of relapse (HR, 4.9; 95% CI, 2.0-12.3, P ¼ 0.01). Time to relapse in patients with FLT3/ITD þ was short with 100-day cumulative risk of 45% (95% CI, 33-57). Our data suggest that the poor prognostic implication of FLT3/ITD positivity remains even after early allo-SCT in patients with FLT3/ITD þ AML, and patients remain at high risk of early relapse. FLT3/ITD positivity also outweighs other conventional prognostic markers in predicting relapse.

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