Intestinal Blood Flow by Doppler Ultrasound: The Impact of Gestational Age and Time from First Enteral Feeding in Preterm Neonates

The management of enteral feeds in preterm infants with a hemodynamically significant patent ductus arteriosus (hs-PDA) is a major challenge for neonatologists due to the fear of gastrointestinal (GI) complications. This review aims to analyze the available evidence on the complex relation between the presence and management of PDA, enteral feeding practices, and GI outcomes in the preterm population. There is limited evidence, based on small and heterogeneous trials, that hs-PDA may affect the splanchnic hemodynamic response to enteral feeds. While the presence of PDA seems a risk factor for adverse GI outcomes, the benefits of feeding withholding during pharmacological PDA treatment are controversial. The lack of robust evidence in support of or against a timely feeding introduction or feeding withholding during pharmacological PDA closure in preterm neonates does not allow to draw any related recommendation. While waiting for further data, the feeding management of this population should be carefully evaluated and possibly individualized on the basis of the infants’ hemodynamic and clinical characteristics. Large, multicentric trials would help to better clarify the physiological mechanisms underlying the development of gut hypoperfusion, and to evaluate the impact of enteral feeds on splanchnic hemodynamics in relation to PDA features and treatment.

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Pharmaceutical Expenditure Is Unchanged with Ultrasound-Guided Surfactant Administration

American Journal of Perinatology ◽

10.1055/s-0040-1715821 ◽

2020 ◽

Cited By ~ 2

Author(s):

Daniele De Luca ◽

Nadya Yousef

Keyword(s):

Gestational Age ◽

Financial Management ◽

Lung Ultrasound ◽

Pharmaceutical Expenditure ◽

Surfactant Therapy ◽

Preterm Neonates ◽

Ultrasound Guided ◽

Surfactant Replacement ◽

Surfactant Administration ◽

The Impact

Objective Semiquantitative lung ultrasound improves the timeliness of surfactant replacement, but its financial consequences are unknown. We aim to investigate if the ultrasound-guided surfactant administration influences the general costs of surfactant therapy for preterm neonates affected by respiratory distress syndrome. Study Design This is a pharmacoeconomic, retrospective, and before-and-after study investigating the impact of ultrasound-guided surfactant replacement (echography-guided Surfactant THERapy [ESTHER]) on pharmaceutical expenditure within the ESTHER initiative. Data extracted from the institutional official database hosted by the hospital administration for financial management were used for the analysis. We analyzed the number of surfactant administrations in neonates of gestational age ≤326/7 weeks, and the number of surfactant vials used from January 1, 2014 to June 30, 2014 (i.e., during the period of standard surfactant administration policy) and from July 1, 2016 to December 31, 2018 (that is during ESTHER policy). Results ESTHER did not modify surfactant use, as proportion of treated neonates with RDS receiving at least one surfactant dose (Standard: 21.3% vs. ESTHER: 20.9%; p = 0.876) or as proportion of used vials over the total number of vials opened for neonates of any gestational age (Standard: 37% vs. ESTHER: 35%; p = 0.509). Conclusion Ultrasound-guided surfactant replacement using a semiquantitative lung ultrasound score in preterm infants with RDS does not change the global use of surfactant and the related expenditure. Key Points

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Doppler Ultrasound Measurement of Intestinal Blood Flow in Inflammatory Bowel Disease

Scandinavian Journal of Gastroenterology ◽

10.3109/00365529609009132 ◽

1996 ◽

Vol 31 (6) ◽

pp. 590-593 ◽

Cited By ~ 38

Author(s):

G. Maconi ◽

V. Imbesi ◽

G. Bianchi Porro

Keyword(s):

Inflammatory Bowel Disease ◽

Blood Flow ◽

Doppler Ultrasound ◽

Bowel Disease ◽

Intestinal Blood Flow ◽

Ultrasound Measurement ◽

Inflammatory Bowel

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Impact of umbilical cord arterial pH, gestational age, and birth weight on neurodevelopmental outcomes for preterm neonates

PeerJ ◽

10.7717/peerj.12043 ◽

2021 ◽

Vol 9 ◽

pp. e12043

Author(s):

Roksana Malak ◽

Dorota Sikorska ◽

Marta Rosołek ◽

Ewa Baum ◽

Ewa Mojs ◽

...

Keyword(s):

Birth Weight ◽

Umbilical Cord ◽

Gestational Age ◽

State Regulation ◽

Preterm Neonates ◽

Neurodevelopmental Outcomes ◽

Sensory Stimuli ◽

Arterial Ph ◽

The Impact ◽

Tonic Neck Reflex

Background The aim of this study was to determine the impact of umbilical cord arterial pH, gestational age, and birth weight on neurodevelopmental outcomes for preterm neonates. Methods We examined 112 neonates. Inclusion criteria were: Saturations greater than 88%, and heart rates between 100–205 beats per minute. Measurements We assessed several neurodevelopmental factors as part of the Brazelton Neonatal Behavioral Assessment Scale (NBAS), 4th edition, such as asymmetric tonic neck reflex (ATNR), motor maturity, response to sensory stimuli, habituation, and state regulation. Initial assessment parameters such as APGAR score and umbilical cord arterial pH were used to assess neonates. Results We found a strong correlation between the presence of the sucking reflex and umbilical cord arterial pH (r = 0.32; p = 0.018981). Umbilical cord arterial pH was also correlated with the presence of asymmetric tonic neck reflex (r = 0.27; p = 0.047124), cost of attention (r = 0.31; p = 0.025381) and general motor maturity (r = 0.34; p = 0.011741). Conclusions We found that the sucking reflex may be affected in infants with low umbilical cord arterial pH values. Practitioners and parents can use the NBAS to help determine neurodevelopmental factors and outcomes in preterm infants, possibly leading to safer and more effective feeding practices and interventions.

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Small for Gestational Age Preterm Neonates Exhibit Defective GH/IGF1 Signaling Pathway

Frontiers in Pediatrics ◽

10.3389/fped.2021.711400 ◽

2021 ◽

Vol 9 ◽

Author(s):

Emmanuelle Motte-Signoret ◽

Shivani Shankar-Aguilera ◽

Sylvie Brailly-Tabard ◽

Yohan Soreze ◽

Valentina Dell Orto ◽

...

Keyword(s):

Gestational Age ◽

Small For Gestational Age ◽

Head Circumference ◽

Hormonal Regulation ◽

Plasma Concentrations ◽

Preterm Neonates ◽

Appropriate For Gestational Age ◽

Prospective Comparative Study ◽

Catch Up ◽

The Impact

Objective: To investigate the impact of fetal growth restriction (FGR) on hormonal regulation of post-natal growth and glucose metabolism [via insulin and growth hormone (GH)/Insulin-like Growth factor 1 (IGF1) axis pathways] in small for gestational age (SGA) neonates.Methods: We conducted a monocentric observational prospective comparative study on 73 singleton babies born with a weight inferior to 2,000 g. We analyzed auxological (weight, height and head circumference), and hormonal (GH, IGF1, and insulin plasma concentrations) data comparing SGA and appropriate for gestational age (AGA) neonates, between day 1 and 60.Results: One third (23/73) of the neonates were SGA. Twenty-five percent (18/73) required insulin for idiopathic hyperglycemia of prematurity and were smaller in weight and head circumference at discharge. In the SGA group compared with the AGA group, GH plasma concentrations were higher at day 3 (70.1 vs. 38.0 mIU/L) and IGF1 plasma concentrations were higher at day 10 (29.0 vs. 18.7 ng/ml).Conclusions: SGA neonates displayed resistance to GH and IGF1, concomitant to insulin resistance. This could partially explain the initial defective catch-up growth and, later in life, the higher prevalence of metabolic syndrome in this population.

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Effects of Maternal Magnesium Sulfate Administration on Intestinal Blood Flow Velocity in Preterm Neonates

Neonatology ◽

10.1159/000319049 ◽

2011 ◽

Vol 100 (1) ◽

pp. 44-49 ◽

Cited By ~ 13

Author(s):

Thomas Havranek ◽

Terri L. Ashmeade ◽

Maria Afanador ◽

Jane D. Carver

Keyword(s):

Blood Flow ◽

Magnesium Sulfate ◽

Flow Velocity ◽

Blood Flow Velocity ◽

Intestinal Blood Flow ◽

Preterm Neonates

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ASSOCIATION OF THE IMPACT OF POSTNATAL NUTRITION ON THE GROWTH OF PRETERM INFANTS <34 WEEKS GESTATIONAL AGE FROM BIRTH TO DISCHARGE

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2020.v13i9.38460 ◽

2020 ◽

pp. 63-67

Author(s):

JITENDRA SINGH FAUJDAR ◽

KALPANA SINGH ◽

RAJVEER SINGH YADAV ◽

JITENDRA KUMAR GUPTA ◽

MUNISH KAKKAR ◽

...

Keyword(s):

Preterm Infants ◽

Gestational Age ◽

Neonatal Intensive Care ◽

Nutritional Supplement ◽

Preterm Neonates ◽

Preterm Baby ◽

Medical College ◽

Gandhi Medical College ◽

The Impact

Objectives: The objectives of the study were to measure the actual daily amount of each nutrient (protein, glucose, and fat) energy and fluid as per current ESPGHAN guidelines for preterm infants and to analyze the role of nutrients at different gestational age on growth and weight of preterm infants. Material and Methods: An observational and prospective cohort study was conducted from January 1, 2018, to December 31, 2018. This study included all preterm infants born <34 weeks gestational age admitted in the neonatal intensive care unit during this period at Mahatma Gandhi Medical College and Hospital. A total of 120 preterm neonates were studied. Results: There were mean weight, length, and head circumference continues to rise till the study end. Mean energy at birth was also continues to rise till the end. Conclusion: In the study, proper nutritional supplement as per ESPHAGEN guidelines was used for the development of preterm infant. The study showed that there were statistically significant results with anthropometry parameters with preterm baby growth in all domains.

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