Low Splanchnic Oxygenation and Risk for Necrotizing Enterocolitis in Extremely Preterm Newborns

Introduction: Necrotizing enterocolitis (NEC) is a disease predominantly affecting preterm infants. The administration of hyperosmolar solutions could lead to the development of NEC. The objective of this study was to measure the osmolality of enteral medications used in clinical practice and to assess the risk of NEC following exposure to hyperosmolar medications. Methods: A retrospective cohort study in extremely preterm infants (gestational age <28 weeks) born between 2010 and 2016 at a tertiary neonatal intensive care unit in Sweden. 465 infants were identified via the Swedish Neonatal Quality register. Data relating to enteral administrations received during a two-week period were collected from the medical records. The osmolalities of medications were measured using an osmometer. Logistic regression was used to calculate the odds ratio of developing NEC. Results: A total of 253 patients met the inclusion criteria. The osmolalities of 5 commonly used medications significantly exceeded the recommended limit of 450 mOsm/kg set by the American Academy of Paediatrics (AAP). Most patients (94%) received at least one hyperosmolar medication. No significant risk of developing NEC could be found. Conclusion: The medications used in clinical practice can significantly exceed the limit set by the AAP. This study does not indicate an increased risk of developing NEC in extremely preterm infants following exposure to hyperosmolar medications. Further studies in larger cohorts are needed to determine the specific cut-off level of osmolality in relation to the pathogenesis of NEC.

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Gestational Age Dependency of Umbilical Cord Serum IL-6 Levels for Detecting Fetal Inflammation

American Journal of Perinatology ◽

10.1055/s-0040-1721373 ◽

2020 ◽

Author(s):

Sota Iwatani ◽

Takao Kobayashi ◽

Sachiko Matsui ◽

Akihiro Hirata ◽

Miwa Yamamoto ◽

...

Keyword(s):

Umbilical Cord ◽

Gestational Age ◽

Area Under The Curve ◽

Roc Curves ◽

Significant Negative Correlation ◽

Cord Serum ◽

Very Preterm ◽

Key Points ◽

Extremely Preterm ◽

Preterm Newborns

Objective The fetal inflammatory response syndrome (FIRS) is characterized by elevated concentrations of inflammatory cytokines in fetal blood, with preterm delivery and morbidity. Umbilical cord serum interleukin-6 (UC-s-IL-6) is an ideal marker for detecting FIRS. However, the effect of gestational age (GA) on UC-s-IL-6 levels has not been reported. This study aimed to determine the relationship between GA and UC-s-IL-6 levels, and GA-dependent cutoff values of UC-s-IL-6 levels for detecting fetal inflammation. Study Design UC-s-IL-6 concentrations were measured in 194 newborns (44 extremely preterm newborns (EPNs) at 22–27 weeks' GA, 68 very preterm newborns (VPNs) at 28–31 weeks' GA, and 82 preterm newborns (PNs) at 32–34 weeks' GA). Linear regression analyses were used to correlate GA and UC-s-IL-6 levels. Receiver operating characteristic (ROC) curves analyses were performed for detecting the presence of funisitis, as the histopathological counterpart of FIRS. Results A significant negative correlation between GA and UC-s-IL-6 levels was found in newborns with severe funisitis (r s = − 0.427, p = 0.004) and those with mild funisitis (r s = − 0.396, p = 0.025). ROC curve analyses revealed the area under the curve for detecting funisitis were 0.856, 0.837, and 0.622 in EPNs, VPNs, and PNs, respectively. The UC-s-IL-6 cutoff value in EPNs (28.1 pg/mL) exceeded those in VPNs and PNs (3.7 and 3.0 pg/mL, respectively). Conclusion UC-s-IL-6 levels were inversely correlated with GA especially in newborns with funisitis. Such GA dependency of UC-s-IL-6 should be considered for detecting fetal inflammation. Key Points

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Anemia in Preterm Infants

Pediatrics in Review ◽

10.1542/pir.17.10.370 ◽

1996 ◽

Vol 17 (10) ◽

pp. 370-370

Author(s):

Philip Roth

Keyword(s):

Preterm Infants ◽

Plasma Volume ◽

Hemoglobin Concentration ◽

Fetal Life ◽

Combined Effects ◽

Third Trimester ◽

The Third ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Preterm Newborns

During fetal life, hemoglobin concentration increases from a level of 9 g/dL at l0 weeks' to 14 to 15 g/dL at 22 to 24 weeks' gestation. By the middle of the third trimester, concentrations close to those observed at birth (16 to 17 g/dL) are reached, and little additional change occurs. As a result, cord hemoglobin concentrations in term and preterm newborns are very similar, with the possible exception of the most extremely preterm infants. Immediately after birth, the hemoglobin concentration begins to rise from the combined effects of placental transfusion and the postnatal readjustment of plasma volume. At approximately 8 to 12 hours of life, the hemoglobin plateaus at levels 1 to 2 g/dL above those observed at birth (about 18 g/dL).

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Oscillatory respiratory mechanics on the first day of life improves prediction of respiratory outcomes in extremely preterm newborns

Pediatric Research ◽

10.1038/s41390-018-0133-6 ◽

2018 ◽

Vol 85 (3) ◽

pp. 312-317 ◽

Cited By ~ 7

Author(s):

Chiara Veneroni ◽

Linda Wallström ◽

Richard Sindelar ◽

Raffaele L. Dellacaʼ

Keyword(s):

Respiratory Mechanics ◽

Extremely Preterm ◽

Respiratory Outcomes ◽

Preterm Newborns

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Supplementation of Lactobacillus acidophilus in prevention of necrotizing enterocolitis in preterm newborns

Alexandria Journal of Pediatrics ◽

10.4103/ajop.ajop_8_19 ◽

2019 ◽

Vol 32 (1) ◽

pp. 1

Author(s):

AmanyM El-Kelany ◽

SoniaG Al Sharkawy ◽

MohamedA Al Said

Keyword(s):

Necrotizing Enterocolitis ◽

Lactobacillus Acidophilus ◽

Preterm Newborns

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Neurodevelopmental and growth outcomes of extremely preterm infants with necrotizing enterocolitis or spontaneous intestinal perforation

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2020.05.013 ◽

2020 ◽

Cited By ~ 2

Author(s):

Carlos Zozaya ◽

Jyotsna Shah ◽

Agostino Pierro ◽

Augusto Zani ◽

Anne Synnes ◽

...

Keyword(s):

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Intestinal Perforation ◽

Growth Outcomes ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Spontaneous Intestinal Perforation

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Conservative Non-intervention Approach for Hemodynamically Significant Patent Ductus Arteriosus in Extremely Preterm Infants

Frontiers in Pediatrics ◽

10.3389/fped.2020.605134 ◽

2020 ◽

Vol 8 ◽

Author(s):

Se In Sung ◽

Yun Sil Chang ◽

So Yoon Ahn ◽

Heui Seung Jo ◽

Misun Yang ◽

...

Keyword(s):

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Ductus Arteriosus ◽

Intervention Approach ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Surgical Treatments ◽

Minimal Evidence ◽

Patent Ductus

While persistent patent ductus arteriosus (PDA) in preterm infants has been known to be associated with increased mortality and morbidities including bronchopulmonary dysplasia, and necrotizing enterocolitis, there is minimal evidence supporting their causal relationships, and most traditional medical and/or surgical treatments have failed to show improvements in these outcomes. As such, the pendulum has swung toward the conservative non-intervention approach for the management of persistent PDA during the last decade; however, the benefits and risks of this approach are unclear. In this mini review, we focused on whom, when, and how to apply the conservative non-intervention approach for persistent PDA, especially in extremely preterm infants.

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