Caffeine and Bronchopulmonary dysplasia ：Clinical Benefits and Its Mechanisms

Bronchopulmonary dysplasia (BPD) is a chronic respiratory disease caused by a combination of prenatal and postnatal factors that leads to the disruption of lung development and abnormal repair, this is a condition that is commonly seen in premature infants. With the improvement of treatment technology, the survival rate of very early preterm infants has increased significantly compared with before, and the incidence of severe BPD has decreased, however, the prevalence of BPD has not decreased. The overall prevalence of BPD is 45%.The prevention of prematurity, the systematic use of non-aggressive ventilator measures, the avoidance of supra-physiological oxygen exposure, and the administration of diuretics, caffeine and vitamin A have all been shown to lead to a significant reduction in the risk of BPD development. A growing number of clinical studies have shown that caffeine not only prevents apnea, but also reduces the incidence of BPD. We review the clinical value of caffeine in the treatment of BPD and its potential mechanisms of action, include anti-inflammatory, antioxidant, anti-fibrotic, anti-apoptotic pathways, and the regulation of angiogenesis. Our aim was to provide a new theoretical basis for the clinical treatment of BPD.

Prematurity and Body Fat at 6, 18, and 30 Years of Age: Pelotas (Brazil) 2004, 1993, and 1982 Birth Cohorts

Background: Our aim was to investigate the association between preterm birth and body fat at 6, 18, and 30 years of age using data from three population-based birth cohort studies. Methods: Information on gestational age (GA) gathered in the hospital of birth in the first 24-hours after the delivery was obtained for all live births occurring in the city of Pelotas, Brazil, in the years 2004, 1993 and 1982. GA was defined by the date of last menstrual period and was later categorized in ≤33, 34-36 and ≥37 weeks. Body fat was assessed by air-displacement plethysmography. Outcomes included fat mass (FM, kg), percent fat mass (%FM), fat mass index (FMI, kg/m2), and body mass index (BMI, kg/m2 at 18 years in the 1993 cohort and at 30 years in the 1982 cohort; and BMI Z-score, at 6 years in the 2004 cohort). Crude and adjusted linear regression provided beta coefficients with 95% confidence intervals (95%CI).Results: A total of 3036, 3027, and 2417 participants, respectively, from the 2004, 1993, and 1982 cohorts were analyzed. At 6 years, boys born at 34-36 weeks GA presented lower adjusted mean %FM (β: -2.91%; -4.45--1.36), FMI (β: -0.70 kg/m2 ; -1.13--0.28) and BMI Z-score (β: -0.48 kg/m2; -0.79--0.16), when compared to boys born at term (≥37). At 30 years, FM (15.6kg; 0.40-30.90), %FM (13.65%; 1.38-25.92) and FMI (5.3kg/m2; 0.30-10.37) were higher among males born at ≤33 weeks, with no statistical difference as compared to those born at term. No association was found between GA and body fat at the 1993 cohort (18 years) for both sexes. Conclusions: Given the large number of preterm infants born each year, prevention of prematurity is essential as there are possible links between body composition and diseases later in life.

ASSESSMENT OF NEONATAL OUTCOMES IN ECLAMPTIC MOTHERS ADMITTED TO NMCH, PATNA, BIHAR

Hypertension during pregnancy is a highly variable disorder unique to pregnancy and a leading cause of maternal and fetal/neonatal morbidity and mortality. Pregnancy-induced hypertension is the general classification for hypertension diseases during pregnancy, which include pregnancy-induced hypertension usually after 20th week of gestation (without proteinuria), pre-eclampsia (with proteinuria), and eclampsia (pre-eclampsia with convulsions). This disease is responsible for high maternal and perinatal morbidity and mortality rates, and is one of the main public health problems. Hence based on above findings the present study was planned for Assessment of Neonatal Outcomes in Eclamptic Mothers Admitted to NMCH, Patna, Bihar. The present study was planned in Department of Pediatrics, Nalanda Medical College and Hospital, Patna, Bihar, India. The study was planned from March 2019 to October 2019. In the present study 50 females admitted with eclampsia or with pre-eclampsia but subsequently developing eclampsia were enrolled. Also the control females were also evaluated for comparative evaluation. The data generated from the present study concludes that Prevention of prematurity, treatment of morbidities & prevention of infection among infants should be done to reduce the PMR and improve perinatal outcome. Thus High risk pregnancy should be identified prospectively and then given special care, perhaps a major impact on overall perinatal loss could be reduced. Keywords: Eclamptic Mothers, Patna, Bihar, etc.

Preterm births

This chapter highlights the increasing burden and significance of preterm births. Direct complications of preterm birth are now the leading cause of mortality in neonates and children under five. There is also a higher risk of neurodevelopmental impairment in survivors. Preterm birth related mortality and morbidity can be reduced through clinical interventions targeted across the continuum of care, from optimising preconception and pregnancy care, to postnatal care of a premature baby. Prevention of prematurity is complex, with some interventions available but with limited impact. With universal coverage of interventions for small and sick newborns, an estimated 84% of deaths could be prevented, but this requires more investment in skilled personnel and robust technology. When scaling up inpatient care for small and sick newborns, improved measurement of outcomes, follow-up to prevent/manage impairment, and family support are all vital.

Risk Factors for Mortality in Neonates with Birth Weight <1500 gm

Background and objective: Neonates with birth weight <1500 gm constitute approximately 4-7% of all live births. Mortality in this group is very high, contributing to as much as 30% of early neonatal death. This study was done to evaluate the morbidities associated with preterm neonates with birth weight < 1500 gm and possible factors determining the death of these babies. Methods: This study was done at Special Care Baby Unit (SCABU), BIRDEM Hospital from January to October 2010. The medical records of neonates with birth weight <1500 gm admitted in SCABU during the study period were retrospectively reviewed. The outcome measure was in-hospital death. Univariate analysis was done to determine the risk factors of mortality. Results: Total 64 babies with birth weight <1500 gm were admitted during this study period. Mean gestational age was 30.76 (± 2.97) weeks, mean birth weight was 1182 (±283) gm. Jaundice (59.4%), Thrombocytopenia (57.8%), apnoea (53.15), sepsis (45.3%) feeding intolerance (43.8%), and RDS (23.4%) were common co-morbidities in these neonates. Among 64 babies more than one-third died (36%). Risk factors for mortality were gestational age less than 30 wks (OR: 7.73; 95% CI: 2.43-24.53), weight <1000 gm (OR: 4.93; 95% CI: 1.28-18.87), RDS (OR: 13.81; 95% CI: 13.81- 57.86) and baby who required mechanical ventilation (OR: 61.66; 95% CI: 12.54- 303.22). Conclusion: Extreme low birth weight (birth weight <1000 gm), prematurity (gestational age <30 wks) and RDS were the significant risk factors for mortality in this study population. Prevention of prematurity and appropriate management of RDS may reduce the mortality of these neonates. DOI: http://dx.doi.org/10.3329/birdem.v2i1.12356 Birdem Med J 2012; 2(1) 19-22