Echographic features of brain structures in children born with very low and extremely low body weight, in comparison with the clinical picture

Immature brain structures of very premature infants determine the features of the echographic picture at birth, as well as in the neoand postneonatal period. The article presents an analysis of the results of ultrasound studies of the brain (from birth to 18 months of corrected age) in comparison with the clinical and laboratory data of 489 very premature infants born with very low and extremely low body weight. The comparison of neurosonographic data and the results of clinical examination indicate that the echographic picture of the brain structures of very premature infants may differ from that of the mature infants and it does not require medical correction in the absence of neurological manifestations. The most characteristic echographic features in the first years of life are moderate dilatation of the intrathecal spaces, lateral ventricles and cisterns of the brain. Intraventricular hemorrhages in deeply premature infants occur with a high frequency, while degree III intraventricular hemorrhages, as well as periventricular and diffuse leukomalacia, are prognostically unfavorable factors leading to the development of severe neurological defects.

Prophylactic Use of Fluconazole in Very Premature Infants

Objective: To evaluate the efficacy, safety, and fungal sensitivity of prophylactic fluconazole use in very premature infants.Methods: We performed a retrospective historical comparative analysis of 196 very premature infants (113 in the prophylaxis group and 83 in the rescue group). The incidence of nosocomial fungal infection (NCFI) and pathogenic fungi, their drug sensitivity, and the minimum inhibitory concentration (MIC) of fluconazole were compared between the two groups. We also analyzed differences in short-term adverse outcomes, such as drug-induced liver or renal function disruption, fungal-attributable death, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), periventricular leukomalacia (PVL), intraventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC), between the groups. The effects of the prophylactic fluconazole strategy on NCFI and short-term adverse outcomes were assessed by multivariate logistic regression.Results:Candida albicans (46.7%) and Candida glabrata (43.3%) were the main culprit pathogens causing NCFI. The incidence of NCFI was significantly lower in the prophylaxis group than in the rescue group (15.9 vs. 45.8%, P < 0.001). However, fewer fungi were completely sensitive to fluconazole (40 vs. 85%, P < 0.05) and the MIC of fluconazole was higher [16.0 (3.5 ~ 16.0) vs. 3.0 (1.0 ~ 8.0) μg/ml, P < 0.001] in the prophylaxis group than in the rescue group. Compared with the rescue group, the prophylaxis group had a lower risk of NCFI (adjusted OR 0.25; 95% CI 0.11, 0.55). Additionally, the prophylaxis group had significantly lower risks of combined outcomes (one or more complications, such as BPD, ROP needing interventions, PVL/IVH (grade > 2), NEC stage ≥2, and fungal-attributable death) (adjusted OR 0.44; 95% CI 0.21, 0.92). There was no significant difference in serum alanine transferase (ALT), aspartate transaminase (AST), creatinine (Cr), or direct bilirubin (DBIL) levels between the two groups.Conclusions: Fluconazole prophylaxis reduced NCFI and improved combined clinical outcomes in very premature infants, with no increased risks of serious short-term adverse side effects; however, the MIC of fluconazole showed significant increases. Therefore, further optimization of preventive strategies is necessary to maintain the sensitivity of fluconazole against fungal isolates.

Platelet is the Early Predictor of Bronchopulmonary Dysplasiaa in Very Premature Infants: An Observational Cohort Study

Background: A previous study showed that the lungs are involved in the biogenesis of platelets (PLTs). Thus, the present study aimed to investigate the association between bronchopulmonary dysplasia (BPD), a chronic lung disease, and PLT parameters in very premature infants.Methods: The study subjects were premature infants with a gestational age of < 30 weeks and birth weight of < 1500 g in a preterm birth cohort study recruited between January 1, 2015, and August 31, 2019. BPD was defined as the need for oxygen supplementation more than 28 days after birth. The PLT count, mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) level were compared between BPD and non-BPD infants. A generalized estimating equation model was used to adjust for confounding factors. A forward stepwise logistic regression model was used to calculate the adjusted odds ratio (OR) for thrombocytopenia in the BPD group.Results: The final study subjects were 134 very premature infants, namely, 64 infants with BPD and 70 infants without BPD. The BPD infants had lower PLT counts (F=25.39, P=0.00) and PCT levels (F=41.16, P=0.00) than the non-BPD infants. However, the MPV (F=37.65, P=0.00) and PDW (F=28.43, P=0.00) were higher in the BPD group. After adjusting for potential confounding factors, the BPD infants had a higher risk of thrombocytopenia than the non-BPD infants (adjusted OR 3.18, 95% CI 1.21, 8.35), and the risk of BPD was increased in very premature infants with a PLT count ≤ 177*109/l (OR 4.74, 95% CI 1.93–11.62) at the end of the second week.Conclusions: Abnormal PLT parameters were observed in BPD infants, and a PLT count ≤ 177*109/l was an early predictor for BPD in very premature infants.

Severe hypercalcemia associated with hypophosphatemia in very premature infants: a case report

Background Severe hypercalcemia is rare in newborns; even though often asymptomatic, it may have important sequelae. Hypophosphatemia can occur in infants experiencing intrauterine malnutrition, sepsis and early high-energy parenteral nutrition (PN) and can cause severe hypercalcemia through an unknown mechanism. Monitoring and supplementation of phosphate (PO4) and calcium (Ca) in the first week of life in preterm infants are still debated. Case presentation We report on a female baby born at 29 weeks’ gestation with intrauterine growth retardation (IUGR) experiencing sustained severe hypercalcemia (up to 24 mg/dl corrected Ca) due to hypophosphatemia while on phosphorus-free PN. Hypercalcemia did not improve after hyperhydration and furosemide but responded to infusion of PO4. Eventually, the infant experienced symptomatic hypocalcaemia (ionized Ca 3.4 mg/dl), likely exacerbated by contemporary infusion of albumin. Subsequently, a normalization of both parathyroid hormone (PTH) and alkaline phosphatase (ALP) was observed. Conclusions Although severe hypercalcemia is extremely rare in neonates, clinicians should be aware of the possible occurrence of this life-threatening condition in infants with or at risk to develop hypophosphatemia. Hypophosphatemic hypercalcemia can only be managed with infusion of PO4, with strict monitoring of Ca and PO4 concentrations.

Echocardiographic Monitoring of Cardiac Parameters to Predict Bronchial Dysplasia in Very Premature Infants

Echocardiography was used to measure the cardiac parameters in high-risk premature infants prone to bronchopulmonary dysplasia (BPD). These measurements were used to determine the correlation between the parameters and BPD and whether they could be used to predict the parameters associated with cardiac health of BPD in very premature infants at a very early stage. Seventy-four very premature infants (gestational age < 32 weeks) were recruited in this retrospective, single-center, observational studies. All infants were examined using echocardiography within a week after birth, and the cardiac chamber parameters were recorded. Of these, 14 infants with BPD were reexamined at 4 weeks after birth. Statistical analysis and comparison of the data of these 14 infants indicated that 1-week after birth, the inner diameters of PA/AS/AO/LA/ROVT/LVPW/LV were significantly smaller (P < 0.05), and that of AS/AO/LA/LV were highly significantly smaller (P < 0.001) in the BPD group compared with the non-BPD group. Comparing the cardiac parameters between 1 and 4 weeks after birth in infants with BPD showed a significant difference in the diameter of PA/AS/AO/ROVT/IVS/LVPW/LV, suggesting that the ventricular cavity developed more efficiently during growth.

Can Mozart Improve Weight Gain and Development of Feeding Skills in Premature Infants? A Randomized Trial

Objective The study aimed to assess in a prospective randomized study the effect of Mozart's music on time to regain birth weight (BW) and development of oral feeding skills in babies born between 280/7 and 316/7 weeks of gestation. Study Design Healthy premature infants born between 280/7 and 316/7 completed weeks of gestation were randomized within 3 days of birth to either music or no music exposure. Infants in the music group were exposed to Mozart's double piano sonata twice per day for 14 days. The primary outcome was time to regain birth weight. The secondary outcome was development of oral feeding skills as evaluated by a speech/language pathologist blinded to the intervention. We hypothesized that exposure to Mozart's double piano sonata would decrease time to regain BW and improve feeding skills. A total of 32 newborns were needed to detect a 3-day difference in time to regain BW. Results Forty infants were enrolled and randomized. There were no significant differences between the two groups regarding the time to regain BW (p = 0.181) and the time to achievement of full oral feeds (p = 0.809). Conclusion Exposure to Mozart's double piano sonata for 14 days after birth did not significantly improve time to regain BW or time to achieve full oral feedings in very premature infants. It is possible that Mozart's music has no effect or that the duration of music exposure was not sufficient to have a physiologic effect on growth and oral feeding skills. Key Points