Objective. Bronchopulmonary dysplasia (BPD) is the endpoint of many intervention trials in neonatology, yet the outcome measure when based solely on oxygen administration may be confounded by differing criteria for oxygen administration between physicians. We previously reported a technique to standardize the definition of BPD between sites by using a timed room-air challenge in selected infants. We hypothesized that a physiologic definition of BPD would reduce the variation in observed rates of BPD among different neonatal centers. Methodology. A total of 1598 consecutive inborn premature infants (501–1249 g birth weight) who remained hospitalized at 36 weeks9 postmenstrual age were prospectively assessed and assigned an outcome with both a clinical definition and physiologic definition of BPD. The clinical definition of BPD was oxygen supplementation at exactly 36 weeks9 postmenstrual age. The physiologic definition of BPD was assigned at 36 ± 1 weeks9 postmenstrual age and included 2 distinct subpopulations. First, neonates on positive pressure support or receiving >30% supplemental oxygen with saturations between 90% and 96% were assigned the outcome BPD and not tested further. Second, those receiving ≤30% oxygen or effective oxygen >30% with saturations >96% underwent a room-air challenge with continuous observation and oxygen-saturation monitoring. Outcomes of the room-air challenge were “no BPD” (saturations ≥90% during weaning and in room air for 30 minutes) or “BPD” (saturation Results. A total of 560 (35.0%) neonates were diagnosed with BPD by the clinical definition of oxygen use at 36 weeks9 postmenstrual age. The physiologic definition diagnosed BPD in 398 (25.0%) neonates in the cohort. All infants were safely studied. There were marked differences in the impact of the definition on BPD rates between centers (mean reduction: 10%; range: 0–44%). Sixteen centers had a decrease in their BPD rate, and 1 center had no change in their rate. Conclusions. The physiologic definition of BPD reduced the overall rate of BPD and reduced the variation among centers. Significant center differences in the impact of the physiologic definition were seen, and differences remained even with the use of this standardized definition. The magnitude of the change in BPD rate is comparable to the magnitude of treatment effects seen in some clinical trials in BPD. The physiologic definition of BPD facilitates the measurement of BPD as an outcome in clinical trials and the comparison between and within centers over time.

Impact of a physiologic definition on bronchopulmonary dysplasia rates.

OBJECTIVE: Bronchopulmonary dysplasia (BPD) is the focus of many intervention trials, yet the outcome measure when based solely on oxygen administration may be confounded by differing criteria for oxygen administration between physicians. Thus, we wished to define BPD by a standardized oxygen saturation monitoring at 36 weeks corrected age, and compare this physiologic definition with the standard clinical definition of BPD based solely on oxygen administration. METHODOLOGY: A total of 199 consecutive very low birthweight infants (VLBW, 501 to 1500 g birthweight) were assessed prospectively at 36±1 weeks corrected age. Neonates on positive pressure support or receiving >30% supplemental oxygen were assigned the outcome BPD. Those receiving ≤30% oxygen underwent a stepwise 2% reduction in supplemental oxygen to room air while under continuous observation and oxygen saturation monitoring. Outcomes of the test were “no BPD” (saturations ≥88% for 60 minutes) or “BPD” (saturation <88%). At the conclusion of the test, all infants were returned to their baseline oxygen. Safety (apnea, bradycardia, increased oxygen use), inter-rater reliability, test–retest reliability, and validity of the physiologic definition vs the clinical definition were assessed. RESULTS: A total of 199 VLBW were assessed, of whom 45 (36%) were diagnosed with BPD by the clinical definition of oxygen use at 36 weeks corrected age. The physiologic definition identified 15 infants treated with oxygen who successfully passed the saturation monitoring test in room air. The physiologic definition diagnosed BPD in 30 (24%) of the cohort. All infants were safely studied. The test was highly reliable (inter-rater reliability, κ=1.0; test–retest reliability, κ=0.83) and highly correlated with discharge home in oxygen, length of hospital stay, and hospital readmissions in the first year of life. CONCLUSIONS: The physiologic definition of BPD is safe, feasible, reliable, and valid and improves the precision of the diagnosis of BPD. This may be of benefit in future multicenter clinical trials.

Safety, reliability, and validity of a physiologic definition of bronchopulmonary dysplasia.

Achieving appropriate growth and nutrient accretion of preterm and low birth weight (LBW) infants is often difficult during hospitalization because of metabolic and gastrointestinal immaturity and other complicating medical conditions. Advances in the care of preterm-LBW infants, including improved nutrition, have reduced mortality rates for these infants from 9.6 to 6.2% from 1983 to 1997. The Food and Drug Administration (FDA) has responsibility for ensuring the safety and nutritional quality of infant formulas based on current scientific knowledge. Consequently, under FDA contract, an ad hoc Expert Panel was convened by the Life Sciences Research Office of the American Society for Nutritional Sciences to make recommendations for the nutrient content of formulas for preterm-LBW infants based on current scientific knowledge and expert opinion. Recommendations were developed from different criteria than that used for recommendations for term infant formula. To ensure nutrient adequacy, the Panel considered intrauterine accretion rate, organ development, factorial estimates of requirements, nutrient interactions and supplemental feeding studies. Consideration was also given to long-term developmental outcome. Some recommendations were based on current use in domestic preterm formula. Included were recommendations for nutrients not required in formula for term infants such as lactose and arginine. Recommendations, examples, and sample calculations were based on a 1000 g preterm infant consuming 120 kcal/kg and 150 mL/d of an 810 kcal/L formula. A summary of recommendations for energy and 45 nutrient components of enteral formulas for preterm-LBW infants are presented. Recommendations for five nutrient:nutrient ratios are also presented. In addition, critical areas for future research on the nutritional requirements specific for preterm-LBW infants are identified.

/pdf/nutrient-requirements-for-preterm-infant-formulas-4ixx0nh1x1.pdf

Nutrient Requirements For Preterm Infant Formulas

Rationale: Pure oxygen causes more oxidative stress than room air in resuscitation of asphyctic neonates, and consequently could be associated with increased tissue damage.Objectives: To compare damage caused to heart and kidneys on reoxygenation in severely asphyctic term neonates resuscitated with room air (RAR) or 100% oxygen (OxR). Nonasphyctic term newborn infants served as a control group.Methods and Measurements: This is a prospective randomized clinical trial masked for the gas mixture. Reduced glutathione (GSH), oxidized glutathione (GSSG), and superoxide dismutase (SOD) activity were measured to assess oxidative stress. Plasma cardiac troponin T (cTnT) and urinary N-acetyl-glucosaminidase (NAG) assessed cardiac and renal damage, respectively. Daily determinations of NAG for a 2-wk period were performed to monitor postasphyctic renal damage.Main Results: Both asphyctic groups showed oxidative stress when compared with the control group as evidenced by diminished GSH/GSSG ratios, adaptive increase...

https://www.atsjournals.org/doi/pdf/10.1164/rccm.200412-1740OC

Room-Air Resuscitation Causes Less Damage to Heart and Kidney than 100% Oxygen

Changing patterns of red blood cell transfusion in very low birth weight infants.

Effect on neonate of maternal treatment with indomethacin

Cardiac troponin T (TnT) is a regulatory contractile protein whose detection in the circulation has been shown to be a specific and sensitive marker for ischemic myocardial cell injury both in adult a

Cardiac Troponin T in Newborn Infants with Transient Myocardial Ischemia

Objectives To report the complications and outcome of 10 newborns affected by acute renal failure (ARF), treated by continuous peritoneal dialysis (CPD). Design All newborns admitted for tertiary treatment to the Neonatal Intensive Care Unit of the University of Padova, who underwent CPD between February 1986 and December 1990, were analyzed retrospectively. Patients Ten newborns (mean weight 2077 g, range 540-4930 g) received CPD, 6 of whom were preterm. All the survivors completed the study. Interventions A number 9, 5 French Tenckhoff catheter was used, and a closed circuit was created by means of a modified continuous ambulatory peritoneal dialysis (CAPD) technique. The mean duration of dialytic therapy was 7 days. Results At the end of the dialytic period, 7 of the 10 patients had normal serum potassium and sodium values. CPD produced two different types of complications: leakage of the dialytic fluid in very low weight newborns and one episode of peritonitis during a chronic dialysis treatment. Six died of severe respiratory failure (in no case, however, was this attributable to ARF or CPD procedure). All but one of the survivors regained normal renal function. The only exception necessitated a kidney transplant. Conclusion We believe that this technique, although invasive, improves the outcome of both preterm and low birth weight newborns affected by ARF.

Continuous Peritoneal Dialysis in Newborns

Premature neonates with bronchopulmonary dysplasia (BPD) frequently present borderline hypoxemia and the risk for oxygen desaturation may increase in relation to the posture Our aim was to see if infants with BPD experience severe hypoxemia (SaO2 25%, < 40%) The analysis of the data, that have a rough gaussian distribution, indicates a worsening of SaO2 in the hammock position In fact, mean +/- SEM, median and range of the SaO2 values in pre- and posthammock position are comparable, but are significantly different at 999% confidence level (CL) in prehammock vs hammock posture and at 98% CL in posthammock vs hammock posture Moreover, the percent of time with SaO2 < 85% during the periods recorded increased about 10 +/- 5% in a hammock (24 +/- 4%), in comparison to pre- (14 +/- 3%) and posthammock position (15 +/- 3%) These results suggest that oxygen-dependent BPD preterm infants in the hammock posture may experience severe hypoxemia that in part limits the possible advantages of the 'containment'

Oxygen saturation in premature neonates with bronchopulmonary dysplasia in a hammock.

The authors report three cases of unexplained prenatal intraventricular haemorrhage (IVH) in three term infants. In the first two cases the suspected diagnosis of prenatal IVH was made a few hours after delivery, in accordance with the ultrasonographic feature of clots in the ventricles, whereas in the third case prenatal ultrasonography was suggestive of hydrocephalus with intraventricular clots.

Spontaneous intraventricular haemorrhage in utero

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