Berardi A (1), Lugli L (1), Rossi C (2), Morini MS (3), Vagnarelli F
(4), Ferrari F (1)
1 Unità Operativa di Neonatologia, Dipartimento Materno-Infantile,
Azienda Ospedaliero-Universitaria Policlinico di Modena
2 Unità Operativa di Pediatria, Dipartimento Materno-Infantile,
Azienda Ospedaliero-Universitaria Policlinico di Modena
3 Unità Operativa di Pediatria, Ospedale Pierantoni, Forlì
4 Unità Operativa di Neonatologia, Azienda Ospedaliera S Maria Nuova
Reggio Emilia
To the editor
We find Trijbels-Smeulders and co-workers epidemiology report very
interesting (1). They studied early (EOD) and late (LOD) neonatal group B
streptococcal (GBS) disease in the Netherlands before and after the
introduction of prevention guidelines. The best strategy in European
countries is still a matter of debate and we need data which enable
reliable comparisons to be made between countries. In the USA EODs have
significantly decreased from 1.7 to 0.34 per 1000 live births (70 %
reduction) after the adoption of guidelines and use of antibiotic
prophylaxis(2). In contrast, the incidence of EODs is lower in the UK
(0.48 per 1000 live births), despite prophylaxis being rarely used in this
country(3).
Following a risk-based strategy, women who received prophylaxis in the
Netherlands increased from 1.0 to 5.9 % of all deliveries, but the authors
found only a limited decrease of proven early infections (from 0.54 to
0.36/1000 live births) and no changes in the rate of reported cases of
meningitis, EOD case fatalities or the incidence of LODs. Therefore they
recommended a change in their prevention guidelines (possibly from risk to
a screening approach).
However if the rate of EOD incidence without any prevention policy is
lower than 0.65 per 1000 live births, some authors do not recommend any
strategies, because prevention it is not cost-effective(4).
These data need a comment. The incidence of EOD in the Netherlands is
close to the incidence found in Emilia-Romagna (0.27 per 1000 live
births), where a screening-based strategy is in place and approximately 25
-35% of women receive prophylaxis(5). A critical point which needs to be
considered prior to comparing strategies (before and after the
introduction of guidelines) is to define precisely the true burden of this
disease. This can be assessed only if most infants with suspected sepsis
receive systemic cultures. Trijbels-Smeulders and co-workers reported that
lumbar puncture was performed in 37% and 61% of EODs and LODs
respectively. This rate of lumbar punctures was very close to the number
found in Emilia-Romagna during 2003-2005 (30% and 58% respectively) (5),
These data suggest that cases of meningitis have possibly been
underestimated in both studies.
The prospective study, still ongoing in our region, is a remarkable source
of information. As a consequence of periodical meetings of our group, the
attention given by clinicians to neonatal GBS disease presumably increased
during the study period. Nevertheless, during 2003-2006 we observed a
progressive increase of GBS disease incidence (34 cases in 2003-2004, 51
cases in 2005-2006, unpublished data). This change, mostly due to an
increase of LODs, was probably a consequence of a more accurate diagnosis.
In confirmation of our hypothesis, GBS infections have been reported in
some centres in which no disease was found during the first period of the
study.
We believe that the true burden of GBS diseases could be significantly
higher than that reported in some European studies. Efforts should be made
to improve diagnostic approaches, so that disease incidence can be
assessed more accurately and the best preventive strategy be adopted.
References
1. Trijbels-Smeulders M, de Jonge GA, Pasker-de Jong PC, et al.
Epidemiology of neonatal group B streptococcal disease in the Netherlands
before and after introduction of guidelines for prevention. Arch Dis Child
Fetal Neonatal Ed. 2007;92:F271-6.
2. Schrag SJ, Zywicki S, Farley MM, et al. Group B streptococcal
disease in the era of intrapartum antibiotic prophylaxis. N Engl J Med.
2000;342:15-20.
3. Heath PT, Balfour G, Weisner AM, et al. Group B Streptococcus
Working Group. Group B streptococcal disease in UK and Irish infants
younger than 90 days. Lancet 2004;363:292-4
4. Mohle Boetani JC, Schuchat A, Plikaytis BD, et al. Comparison of
prevention strategies for neonatal group B streptococcal infection. A
population-based economic analysis. JAMA 1993;270: 1442-48
5. Berardi A, Lugli L, Baronciani D, et al. Group B streptococcal
infections in a Northern region of Italy. Pediatrics. 2007;120:e487-93
It is my hypothesis that all tissues rely on DHEA for optimal
function. Low DHEA has been found in preterm infants (Acta Paediatr. 2007
Nov;96(11):1600-5). I suggest this may be due to reduced availability of
maternal DHEA as the infant does not start producing its own DHEA until
birth.
It is also my hypothesis that SIDS results from excessively low DHEA
during sleep which results in lack of support of brainst...
It is my hypothesis that all tissues rely on DHEA for optimal
function. Low DHEA has been found in preterm infants (Acta Paediatr. 2007
Nov;96(11):1600-5). I suggest this may be due to reduced availability of
maternal DHEA as the infant does not start producing its own DHEA until
birth.
It is also my hypothesis that SIDS results from excessively low DHEA
during sleep which results in lack of support of brainstem activity.
SIDS, as well as other negative "residual causes" of morbidity, may be
increased in SGA infants because of low DHEA.
Conversely, large for gestational age infants may represent infants
that have developed within a milieu of readily available DHEA. Infants
that have developed with readily available DHEA should exhibit a "reduced
risk of mortality for all causes."
We read with interest the use of blood gas analysis for estimation of
haemoglobin concentration compared with laboratory measurement performed
by Lucy et al at the Royal Hallamshire Hospital (1).
In the neonatal unit in Homerton University Hospital, we record the
haematocrit in the observation charts. The measurements of haematocrit
used are from blood gas results obtained from the Radiometer ABL 700
series blo...
We read with interest the use of blood gas analysis for estimation of
haemoglobin concentration compared with laboratory measurement performed
by Lucy et al at the Royal Hallamshire Hospital (1).
In the neonatal unit in Homerton University Hospital, we record the
haematocrit in the observation charts. The measurements of haematocrit
used are from blood gas results obtained from the Radiometer ABL 700
series blood gas analyser. We took 20 paired heel prick capillary blood
samples from 10 babies for both laboratory full blood count and on site
blood gas analysis inclusive of haematocrit over the course of a week as
part of routine care. The gestational ages of the babies ranged form 26
to 32 weeks and their ages ranged from 1 to 44 days. The birth weight of
the babies ranged from 0.73kg to 1.83kg. The median laboratory
haemoglobin concentration was 13.8 g/dl (range 10.7-20.5 g/dl). The
median packed cell volume(PCV) on blood gas analysis was 43.4% (range 34.4
-66.5%).
We found good correlation of blood gas analysis PCV to laboratory
haemoglobin concentration(See Chart 1). The ratio of PCV to laboratory
haemoglobin concentration was 3.1 with a correlation of 0.98. Herzog et
al previously described a ratio of 3 (2).
Discussion
On the neonatal unit in Homerton University Hospital; blood gas
analysis of haematocrit gives useful correlation to laboratory haemoglobin
concentration with a ratio of 3.1. Blood gas analysis values are recorded
on nursing observation charts with lactate, glucose and bilirubin.
Nursing and medical staff are able to use the haematocrit as part of the
clinical picture to decide when to transfuse critically ill babies or
babies with sudden gastrointestinal, pulmonary or intraventricular
haemorrhage.
S Tang, S Fang
Neonatal Unit, Homerton University Hospital, Homerton Row, London E9 6SR
References
(1) Hinds L, Brown C, Clark S. Point of care estimation of
haemoglobin in neonates. Arch Dis Child Fetal Neonatal Ed 2007;92:378-380
(2) Herzog B, Felton B. Haemoglobin screening for normal newborns.
J Perinatol 1994;14(4):285-289
We read with interest Pignotti et al’s paper on perinatal care at an
extremely low gestational age (22-25 weeks).1 This consensus document
represents “an Italian approach” and it was evaluated by several
scientific societies.
It is a very interesting document, but, unfortunately, it does not fit
with the opinion of the Italian neonatologists. For example, the document
suggests “palliative care, unless the infant shows s...
We read with interest Pignotti et al’s paper on perinatal care at an
extremely low gestational age (22-25 weeks).1 This consensus document
represents “an Italian approach” and it was evaluated by several
scientific societies.
It is a very interesting document, but, unfortunately, it does not fit
with the opinion of the Italian neonatologists. For example, the document
suggests “palliative care, unless the infant shows survival capacities,
with the parent(s)’ consent” when faced with an infant with 23.0-23.6
weeks gestation. Recently, we sent a questionnaire to the heads of the 86
Italian tertiary centres provided with on-site delivery to survey the
practice and the approach to neonatal resuscitation. 2,3
When confronted with the birth of an extremely preterm infant (gestational
age 23 weeks) only 4 out of 76 (5.2%) centres would withhold
resuscitation, and the parents’ wishes would influence the therapeutic
choice in only 34 (44.7%) of the surveyed centres.3
The application of NRP guidelines in clinical setting is low,3,4 but this
aspect may be more relevant for ethical recommendations.
The contribute of the “Carta di Firenze” working group is well appreciated
and provides the basis for a debate, but the Italian situation regarding
these aspects of neonatal resuscitation remains still controversial.
Competing interests: None.
References
1. Pignotti MS, Scarselli G, Barberi I, et al. Perinatal care at an
extremely low gestational age (22 25 weeks). An Italian approach: the
"Carta di Firenze". Arch Dis Child Fetal Neonatal Ed. 2007;92:F515-6.
2. Trevisanuto D, Doglioni N, Ferrarese P, Bortolus R, Zanardo V.
Neonatal resuscitation of extremely low birth weight infants: a survey of
practice in Italy. Arch Dis Child Fetal Neonatal Ed 2006;91:F123-4.
3. Trevisanuto D, Doglioni N, Micaglio M, Bortolus R, Zanardo V.
Neonatal resuscitation in Italy: an ethical perspective. Arch Dis Child
Fetal Neonatal Ed. 2006;91:F466.
4. Carbine DN, Finer NN, Knodel E, Rich W. Video recording as a means
of evaluating neonatal resuscitation performance. Pediatrics 2000;106:654-
8.
It is my hypothesis that all tissues rely on DHEA for optimal
function. Low DHEA has been found in preterm infants (Acta Paediatr. 2007
Nov;96(11):1600-5). Protective effects of DHEA against many infectious
agents has also been determined.
I suggest the findings of Bartels, et al., may be explained by low
DHEA. That is, a common cause of low DHEA may be involved in growth
retardation in preterm infants and th...
It is my hypothesis that all tissues rely on DHEA for optimal
function. Low DHEA has been found in preterm infants (Acta Paediatr. 2007
Nov;96(11):1600-5). Protective effects of DHEA against many infectious
agents has also been determined.
I suggest the findings of Bartels, et al., may be explained by low
DHEA. That is, a common cause of low DHEA may be involved in growth
retardation in preterm infants and their increased vulnerability to
infections.
Saito et al.1 showed, by means of a two channel NIRS, a differential
response of the neonatal brain to maternal Infant Directed Speech (IDS),
in comparison to Adult Directed Speech (ADS). Their study is very
interesting. They hypothesize that a newborn is able to distinguish
between different emotional communications in the first days of life.
These results reignite the discussion on early predisposition for
newborns’...
Saito et al.1 showed, by means of a two channel NIRS, a differential
response of the neonatal brain to maternal Infant Directed Speech (IDS),
in comparison to Adult Directed Speech (ADS). Their study is very
interesting. They hypothesize that a newborn is able to distinguish
between different emotional communications in the first days of life.
These results reignite the discussion on early predisposition for
newborns’ recognition of their mothers, and on how early relational skills
in newborns correlate with fetal learning abilities in the intrauterine
environment.
There seem to be a few points that deserve further clarification.
First, the operative definitions (or the acoustic characteristics that
differentiated mothers’ voices) of IDS and ADS are not clear. IDS has been
characterized by parameters such as emphasized pitch, longer breaks,
increase in fundamental frequency, stressing of accented syllables and
slower rhythm2. In fact, most of these shortfalls are mentioned in a
previous paper by the same authors (Saito et al. 3). In our opinion, an
unequivocal control of acoustic parameters present in verbal stimulation
heard by newborns is highly desirable.
Second, the depiction of the possible roles played by frontal and
prefrontal cortex appears to be incompletely explained, especially
considering their functional subdivisions and their complex and reciprocal
antagonistic actions4. Furthermore, the maturational process of these
cortical areas in the neonate may deserve a more extensive discussion.
Third: the statistical analyses performed do not demonstrate any
significant effect and do not seem to support the authors’main claim
(i.e., the right cerebral hemisphere is more activated than the left in
IDS vs. ADS). There was only a trend toward a significant difference in
the cortical activation evoked by IDS vs ADS (p = .07). This data was
obtained in a post-hoc test done without interaction between factors, and
standard deviations appeared to be excessively wide. Although this is a
fascinating research, we would obviously agree with statements such as
“IDS functions as a positive stimulation for the emotional development of
infants” but at the same time consider rather premature on the scarce data
available, and even more so about the suggested functional lateralization
for IDS (emotional) processing in the neonatal brain. A multichannel NIRS
system, such as the Optical Topography, is needed to detect the
distribution of cortical activation. Improved spatial resolution is
required in mapping cerebral regions involved in complex functions such as
emotional expression.
References
1 Saito Y, Aoyama S, Kondo T, et al. Frontal cerebral blood flow
change associated with infant-directed speech. Arch Dis Child Fetal
Neonatal Ed 2007; 92: 113-6.
2 Fernald A, Kuhl PK. Acoustic determinants of infant preference for
motherese speech. Inf Behav Dev 1987; 10: 864-81.
3 Saito Y, Kondo T, Aoyama S, et al. The function of the frontal lobe
in neonates for response to a prosodic voice. Early Hum Dev 2007; 83: 225-
230.
4 Goldman-Rakic PS, Cools AR, Srivastava K. The Prefrontal Landscape:
Implications of Functional Architecture for Understanding Human Mentation
and the Central Executive Philos Trans R Soc Lond B Biol Sci 1996; 351
(1346): 1445-1453.
We read with interest the article by Hinds et al [1] comparing
laboratory and blood gas analyser haemoglobin on their NICU. They found a
good correlation between laboratory measures and the ABL725 Radiometer
blood gas analyser in 127 babies on their unit. However, we feel that the
focus of their article was somewhat limited, as they assessed haemoglobin
and haematocrit alone. Blood gas analysers ha...
We read with interest the article by Hinds et al [1] comparing
laboratory and blood gas analyser haemoglobin on their NICU. They found a
good correlation between laboratory measures and the ABL725 Radiometer
blood gas analyser in 127 babies on their unit. However, we feel that the
focus of their article was somewhat limited, as they assessed haemoglobin
and haematocrit alone. Blood gas analysers have become more sophisticated
and are now able to perform many different analyses on a single blood
sample including: electrolytes, calcium, glucose, lactate and bilirubin
measurement.
We recently assessed the performance of the Roche OMNI-S blood gas
analyser, with point of care (POC) systems in use on our NICU including:
Ascensia Elite XL Blood Glucometers, bilimeters and hematocrit readers
against laboratory tests, across a wide range of haematological markers
[2]. This particular gas analyser has been rigorously assessed over a
number of years [3,4]. An excellent correlation between the existing POC
systems, laboratory and blood gas analyser measurements was demonstrated,
not only with regard to haematocrit (correlation 0.85), but also
bilirubin, sodium and potassium (correlations of 0.98, 0.83 and 0.80
respectively). We found a similar accuracy of haematocrit levels in our
study (the maximum difference between measurements was 15%) compared to
Hinds et al.
The OMNI-S gas analyser was also assessed against the Ascensia Elite
XL portable glucometer with regard to serum glucose measures, as we
frequently seemed to duplicate these measures on our unit. The gas
analyser performed well over a wide range of glucose levels (up to 300
mg/dL; correlation of 0.91), but, like Hinds et al., with respect to
haematocrit, we also found that the spread of the difference in
measurements appeared to increase at the higher and lower range of values,
although this failed to reach statistical significance.
We therefore agree with the authors that each neonatal unit should
review their blood gas analysis procedures with the aim of reducing blood
sampling for laboratory assays. We feel that modern gas analyser systems
can reduce and even replace conventional laboratory testing. This is
particularly pertinent where only one test is required (e.g. glucose or
bilirubin). We recommend caution at high and low ends of the measurement
spectrum (e.g. low blood glucose measurements), where clinical importance
would be sufficient to warrant confirmatory laboratory analysis. We have
shown that point of care testing in our unit does not differ significantly
from laboratory measurements across a wide range of values with well-
validated quality control settings. The use of a single blood analysis
system simplifies staff training, equipment maintenance, reduces running
costs and the volumes of blood samples required.
Yours sincerely
O J Arthurs, A W Kelsall
Neonatal Intensive Care Unit, Rosie Hospital, Box 226, Addenbrooke’s
Hospital, Cambridge University NHS Foundation Trust, Hills Road,
Cambridge, CB2 2QQ. United Kingdom
References
1. Hinds LE et al., Point of care estimation of haemoglobin in
neonates. Arch Dis Child Fetal Neonatal Ed 2007; 92: F378-F380
2. Arthurs OJ, et al., Point of care measurements on a Neonatal
Intensive Care Unit using the OMNI-S gas analyzer. Point of Care: The
Journal of Near-Patient Testing & Technology; 2007; 6: 112 – 117
3. Bewley B, Creed G, Goerlach-Graw et al. Multicenter study on the
analytic performance of a new point of care blood gas analyzer and its use
in critical testing. Point of Care 2004; 4:149-155.
4. Rolinski B, Okorodudu AO, Kost G et al. Evaluation of total
bilirubin determination in neonatal whole blood samples by multiwavelength
photometry on the Roche OMNI-S point of care analyzer. Point of Care 2005;
4:3-8.
I am very proud to be a mother of twin girls, now 9 months old. They
were born at home at 35 weeks 1 day, each double footling breech with no
complications. Their weights were 2414 grams and 1647 grams. I chose to
exclusively breastfeed them and they both nursed great from birth until
they were 24 hours, when the smaller baby fell weak and had to be
supplemented, first with glucose as she had low blood sugar on entry to...
I am very proud to be a mother of twin girls, now 9 months old. They
were born at home at 35 weeks 1 day, each double footling breech with no
complications. Their weights were 2414 grams and 1647 grams. I chose to
exclusively breastfeed them and they both nursed great from birth until
they were 24 hours, when the smaller baby fell weak and had to be
supplemented, first with glucose as she had low blood sugar on entry to
the hospital.
I felt discouraged there where the common practice was to stop all
breastfeeding and entirely supplement with high concentrate formula.
Had the doctors and other staff been more knowledgeable and
supportive about breastmilk, fortificationn of the breastmilk, and various
other preemie care such as kangaroo care, our breastfeeding relationships
wouldn't be in the dire straights they are now in.
Please research all the benefits of breastmilk for these special
infants and encourage and support moms by any means neccessary to
breastfeed their multiples, even if supplementation is required.
Exclusivity can be had at a later date, which we were successful with
until I took some decongestant for allergies and dried my supply (for
which I was told even by lactation consultants to supplement with formula
which has further hindered our breastfeeding relationship.) Please all
doctors and Nurses, suggest a prescription medication to increase milk
supply in instances of low weight gain due to milk deficiency while
testing the mother for helath problems such as hypothyroidism (our current
American Doctor Drama - how cute I have ADD, lol)
The cover illustration of the September 2007 issue of the Fetal and
Neonatal edition of the Archives Disease in Childhood, shows a severely
jaundiced infant with a nasogastric tube in situ being bottlefed. If the
message of the picture is to make a wake-up call to prevent kernicterus,
then there is no need to promote a bottle feeding picture in the front
page of this esteemed journal. The results o...
The cover illustration of the September 2007 issue of the Fetal and
Neonatal edition of the Archives Disease in Childhood, shows a severely
jaundiced infant with a nasogastric tube in situ being bottlefed. If the
message of the picture is to make a wake-up call to prevent kernicterus,
then there is no need to promote a bottle feeding picture in the front
page of this esteemed journal. The results of the prospective surveillance
study of severe hyperbilirubinemia in the newborn in the UK and Ireland by
Manning and colleagues should cause concern for all (1).
The Baby Friendly Hospital Initiative (BFHI) recommends the use of
cup feeding for infants intending to breastfeed, so that no artificial
nipples are introduced to these infants (2). The answer to lack of breast
milk jaundice is not to take the baby off the breast or to give bottle
feeds. The safety and advantages of cup feeding as a method of providing
supplemental feedings to breastfed infants is supported by several
studies.Cup feeding is a simple procedure, early positive body and eye
contact is fostered and the infant receives positive tactile and olfactory
stimulation. The cardio-respiratory and oxygen saturation can be
maintained and minimal energy is expended. The infant controls the feed
and can pace the intake and the total volume of milk taken, and there is
minimal risk of aspiration.
The randomized clinical trial of pacifier use and bottle feeding or
cup feeding and their effect on breastfeeding by Cynthia R. Howard and
colleagues found detrimental effects from pacifier use begun in the first
week of life on exclusive breastfeeding at 1 month and on overall
breastfeeding duration (3). This study supports the BFHI recommendations
to use cup feeding as the method of choice when providing supplemental
feedings and hence any message promoting bottle feeding is not welcome.
References:
1) Manning D, Todd P, Maxwell M, Jane Platt M. Prospective
surveillance study of severe hyperbilirubinaemia in the newborn in the UK
and Ireland. Arch Dis Child Fetal Neonatal Ed. 2007;92:F342-6.
2) World Health Organization, United Nations Children’s Fund. Baby
Friendly Hospital Initiative, Part III, Assessor’s Manual. Geneva,
Switzerland: WHO; 1992:10–11.
3) Cynthia R. Howard, Fred M. Howard, Bruce Lanphear, Shirley Eberly,
et al. Randomized Clinical Trial of Pacifier Use and Bottle-Feeding or
Cupfeeding and Their Effect on Breastfeeding. Pediatrics 2003;111;511-518.
We read with interest the article by Vanhaesebrouck S et al[1]. We
support the author's aims to properly study the role of conservative
management of PDA, but advise caution in accepting their conclusions from
results of such a small study.
In their introduction the authors refer to the known consequences of a
left to right shunt when a PDA is clinically significant, including IVH,
NEC and chronic...
We read with interest the article by Vanhaesebrouck S et al[1]. We
support the author's aims to properly study the role of conservative
management of PDA, but advise caution in accepting their conclusions from
results of such a small study.
In their introduction the authors refer to the known consequences of a
left to right shunt when a PDA is clinically significant, including IVH,
NEC and chronic lung disease. These significant clinical outcomes need to
be properly assessed in an appropriately powered study prior to
recommending changes in management. The authors also state that the aim of
their study is to evaluate the need for prophylactic ibuprofen when
infants are managed conservatively, in this study defined as mild fluid
restriction and more PEEP. The study is not however designed to answer
this question - rather it examines the role of conservative management
versus any treatment of the PDA.
In their 5 year retrospective study the authors describe their management
of clinically diagnosed PDA. It is unclear as to whether any infants in
their unit at this time received ibuprofen or indomethacin, either
prophylactically or as treatment. If so the reported cohort would be a
biased population sample. They have not explained either the physiological
or theoretical rationale behind each of their strategies in closing the
PDA. Restricting to a total daily fluid intake of 130 ml/kg in preterm
neonates has the potential to cause significant electrolyte disturbances,
oliguria and hyperbilirubinaemia, particularly in infants <1000gms. The
duration of fluid restriction required and the occurrence of any adverse
effects has not been reported. The PEEP of 4.5 cm of H2O used in the
strategy is not really ¡§high¡¨ PEEP as PEEP settings of 6-10 cm of H2O
are often used [2].
The 1 year prospective study includes only 30 babies of whom only 10
developed a ¡§haemodynamically important¡¨ PDA. These numbers are far too
small to report on meaningful outcomes such as NEC, IVH and chronic lung
disease or even the incidence of any adverse effects of fluid restriction.
Again the authors should clarify if this cohort represents all ventilated
infants < 30 weeks gestation admitted to their unit in this time period
or a selected subgroup. Are the outcomes of non ventilated/CPAP babies
< 30 weeks also available? In their 5 year retrospective study there
was a 6% incidence of ductal ligation. As there is mounting evidence that
ductal ligation itself may be harmful [3], avoiding early use of PG
synthetase inhibitors which results in an increase in ductal ligation
rates may not be optimal management. The prospective study again is too
small to assess the effect of conservative management of PDA on ductal
ligation rates.
We strongly agree with the authors¡¦ conclusions that the best way to
properly assess the role of prophylaxis or conservative management is to
undertake a properly powered randomized controlled trial. We are presently
undertaking such a trial using early echocardiography to target
prophylactic treatment in infants with haemodynamically important PDA.
Rajeshwar Reddy Angiti, MD, DM
Martin Kluckow*, MBBS, FRACP, PhD
Department of Neonatology,
Royal North Shore Hospital,
St Leonards NSW 2065,
Australia
Email: mkluckow@med.usyd.edu.au
*Corresponding author
Competing interests: None
References:
1) Vanhaesebrouck S, Zonnenberg I, Vandervoort P, Bruneel E, Van
Hoestenberghe MR, Theyskens C, Conservative treatment for patent ductus
arteriosus in the preterm.Arch Dis Child Fetal Neonatal Ed. 2007 ;92: F244
-7. Epub 2007 Jan 9.
2) Wiswell TE, Srinivasan P, Continuous Positive Airway Pressure, In
Assisted Ventilation of the neonate, Goldsmith JP, Karotkin EH Eds
Saunders, Philadelphia 2003, p 127.
3) Kabra NS, Schmidt B, Roberts RS, Doyle LW, Papile L, Fanaroff A,
Neurosensory impairment after surgical closure of patent ductus arteriosus
in extremely low birth weight infants: results from the Trial of
Indomethacin Prophylaxis in Preterms; Trial of Indomethacin Prophylaxis in
Preterms Investigators. J Pediatr. 2007;150:229-34, 234.e1.
Berardi A (1), Lugli L (1), Rossi C (2), Morini MS (3), Vagnarelli F (4), Ferrari F (1)
1 Unità Operativa di Neonatologia, Dipartimento Materno-Infantile, Azienda Ospedaliero-Universitaria Policlinico di Modena
2 Unità Operativa di Pediatria, Dipartimento Materno-Infantile, Azienda Ospedaliero-Universitaria Policlinico di Modena
3 Unità Operativa di Pediatria, Ospedale Pierantoni, Forlì
...It is my hypothesis that all tissues rely on DHEA for optimal function. Low DHEA has been found in preterm infants (Acta Paediatr. 2007 Nov;96(11):1600-5). I suggest this may be due to reduced availability of maternal DHEA as the infant does not start producing its own DHEA until birth.
It is also my hypothesis that SIDS results from excessively low DHEA during sleep which results in lack of support of brainst...
We read with interest the use of blood gas analysis for estimation of haemoglobin concentration compared with laboratory measurement performed by Lucy et al at the Royal Hallamshire Hospital (1).
In the neonatal unit in Homerton University Hospital, we record the haematocrit in the observation charts. The measurements of haematocrit used are from blood gas results obtained from the Radiometer ABL 700 series blo...
We read with interest Pignotti et al’s paper on perinatal care at an extremely low gestational age (22-25 weeks).1 This consensus document represents “an Italian approach” and it was evaluated by several scientific societies. It is a very interesting document, but, unfortunately, it does not fit with the opinion of the Italian neonatologists. For example, the document suggests “palliative care, unless the infant shows s...
It is my hypothesis that all tissues rely on DHEA for optimal function. Low DHEA has been found in preterm infants (Acta Paediatr. 2007 Nov;96(11):1600-5). Protective effects of DHEA against many infectious agents has also been determined.
I suggest the findings of Bartels, et al., may be explained by low DHEA. That is, a common cause of low DHEA may be involved in growth retardation in preterm infants and th...
Saito et al.1 showed, by means of a two channel NIRS, a differential response of the neonatal brain to maternal Infant Directed Speech (IDS), in comparison to Adult Directed Speech (ADS). Their study is very interesting. They hypothesize that a newborn is able to distinguish between different emotional communications in the first days of life. These results reignite the discussion on early predisposition for newborns’...
Dear Editor,
We read with interest the article by Hinds et al [1] comparing laboratory and blood gas analyser haemoglobin on their NICU. They found a good correlation between laboratory measures and the ABL725 Radiometer blood gas analyser in 127 babies on their unit. However, we feel that the focus of their article was somewhat limited, as they assessed haemoglobin and haematocrit alone. Blood gas analysers ha...
I am very proud to be a mother of twin girls, now 9 months old. They were born at home at 35 weeks 1 day, each double footling breech with no complications. Their weights were 2414 grams and 1647 grams. I chose to exclusively breastfeed them and they both nursed great from birth until they were 24 hours, when the smaller baby fell weak and had to be supplemented, first with glucose as she had low blood sugar on entry to...
Dear Editor,
The cover illustration of the September 2007 issue of the Fetal and Neonatal edition of the Archives Disease in Childhood, shows a severely jaundiced infant with a nasogastric tube in situ being bottlefed. If the message of the picture is to make a wake-up call to prevent kernicterus, then there is no need to promote a bottle feeding picture in the front page of this esteemed journal. The results o...
Dear Editor,
We read with interest the article by Vanhaesebrouck S et al[1]. We support the author's aims to properly study the role of conservative management of PDA, but advise caution in accepting their conclusions from results of such a small study. In their introduction the authors refer to the known consequences of a left to right shunt when a PDA is clinically significant, including IVH, NEC and chronic...
Pages