LUS is a non-invasive, bedside and reproducible method that could improve the management of neonatal respiratory distress. It is accurate and reliable to early identify patients who will need treatment with surfactant allowing both an early treatment and a reduction of radiation exposure.

ObjectiveTo assess changes in neonatal lung ultrasonography score (nLUS) after surfactant administration in preterm infants with respiratory distress syndrome (RDS).Working HypothesisThe reduction of nLUS score before (nLUSpre), 2 hours (nLUS2h), and 12 hours (nLUS12h) after surfactant administration to identify patients who will not need a second treatment.Study Design and SettingProspective observational study in the tertiary neonatal intensive care unit.Patients SelectionForty‐six preterm neonates with RDS of 32 weeks median gestational age (IQR 30‐33) and mean birth weight of 1650 ± 715 g.MethodologyLung ultrasonography was performed before, 2 hours, and 12 hours after surfactant administration in preterm infants with RDS needing surfactant treatment. Resulting nLUS was analyzed.ResultsThe Wilcoxon signed‐rank test demonstrated an nLUS lowering after 2 hours (P < .001) and 12 hours (P < .001) from surfactant administration. Sixteen newborns required surfactant retreatment with median gestational age of 32 weeks (IQR 29‐33) and mean birth weight of 1519 ± 506 g.The receiver operating characteristic analysis for the nLUS2h yielded an area under the curve of 0.80 (95% confidence interval, 0.76‐0.85; P < .001). A nLUS2h ≥7 showed a sensitivity of 94% and a specificity of 60% for needing a second treatment with surfactant.ConclusionsIn preterm infants with RDS requiring surfactant treatment, nLUS evaluated 2 hours after surfactant administration can be used to identify patients who will not need a second treatment.

BackgroundContinuous glucose monitoring using subcutaneous sensors has been validated in adults and children with diabetes, and was found to be useful in the management of glucose control. We aimed to assess feasibility and reliability of a new continuous glucose monitoring system (CGMS) in a population of preterm neonates using a Clarke error grid (CEG) specifically modified for preterm infants.MethodsPreterm infants were recruited within 24 h from delivery. A subcutaneous sensor connected to a CGMS was inserted and maintained for 6 days. Data collected from CGMS were compared with data obtained using a glucometer. Management of the infants followed standard protocols and was not influenced by CGMS readings.ResultsTwenty patients (9 males) were included. Median (range) gestational age was 32 weeks (27–36) and median (range) birth weight was 1350 g (860–3360). Average CGMS recording time was 137 h, for a total of 449 paired glucose levels. CEG and modified CEG criteria for clinical significance were met.ConclusionCGMS is a safe and clinically adequate method to estimate glucose levels in preterm infants. As the glucose level can be evaluated in real time, this CGMS could be useful to reduce the number of heel sticks, to observe glycaemic trends and to promptly detect episodes of both hypo- and hyper-glycaemia.

We investigated whether children with a previous Kawasaki disease (KD) have evidence of abnormal vascular and/or platelet function. We included 14 patients with previous KD and 14 matched controls. We assessed endothelial function by flow-mediated dilation (FMD), carotid intima-media thickness (cIMT), coronary microvascular function by coronary blood flow response (CBFR) to cold pressor test, and platelet reactivity by measuring monocyte-platelet aggregates (MPAs) and CD41-platelet expression by flow cytometry. No differences were found between the groups in FMD, cIMT, or CBFR to cold pressor test. The MPAs were similar in patients with KD and controls. CD41-platelet expression, however, was significantly increased in patients with KD compared with controls, both at rest (14.3 ± 1.9 vs 12.4 ± 1.9 mean fluorescence intensity [mfi], P = .01) and after adenosine diphosphate stimulation (19.3 ± 1.3 vs 17 ± 1.7 mfi, P < .001). In conclusion, children with a previous episode of KD showed increased platelet activation, compared with healthy participants despite no apparent vascular abnormality at follow-up.

Aim This article aims to assess whether perfusion index is significantly different in infants with positive C-reactive protein and/or positive cultures compared with a control group. Methods This was a prospective observational cohort study. Perfusion index was evaluated in 80 neonates at the start of antibiotic therapy for suspected sepsis. Antibiotic therapy was started based on the antenatal history or the presence of clinical signs of sepsis such as hypo/hyperthermia, feed intolerance, lethargy, hypotonia, irregular cardiac rhythms, bradycardia, cyanosis, apnea, respiratory distress, and metabolic acidosis. A case group of 23 neonates with abnormal C- reactive protein (> 10 mg/L) and/or positive cultures (blood, liquor, or bronchoalveolar lavage cultures) was compared with a control group of 23 neonates. Results Cases (mean gestational age [GA], 33 ± 5) and controls (mean GA, 33 ± 5) were matched according to the following criteria: GA (±2 weeks), postmenstrual age (±2 weeks), early (< 72 hours), or late (> 72 hours) onset of suspected infection. Mean perfusion index was 0.8 ± 0.3 in the case group and 1.2 ± 0.4 in the control group; p-value of < 0.001. Conclusions Perfusion index can be considered a noninvasive, reproducible, and easy-to-apply tool for early diagnosis of a neonatal acute inflammation in course of sepsis.