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Objectives: To compare the ultrasound examination with pH-metry in order to evaluate the diagnostic accuracy of sonography for diagnosis of gastro-oesophageal reflux (GOR) in preterm infants. Methods: A prospective study was conducted on 31 premature infants Results: Twenty-one patients (67.7%) had significant GOR with a reflux index >5 (GOR group). The median (range) reflux index in this group was 9.19% (6.04–20.1). Ten newborns (32.3%) did not have significant GOR with a reflux index 5. Therefore, sonographic diagnosis did not produce false positives. Sonography was negative in 23 newborns (74.2%); 13 of these were positive to pH-monitoring and may therefore be considered as false negatives. Respect to continuous 24-hour pH-monitoring, sonography showed a specificity of 100% but a very low sensitivity of 38% with a positive prediction value of 100% and a negative prediction value of 43%. Conclusions: Sonography should not replace 24-hour pH monitoring for detecting GOR in preterm infants. However, sonography has a very high specificity and a positive predictive value of 100%. When clinicians suspect GOR in preterm infants, it could be useful for selection of cases to refer for pH-metry.

Background: Doxapram is a respiratory stimulant widely used for the treatment of idiopathic apnea of prematurity, although it has been demonstrated that it can induce a transient decrease of cerebral blood flow and that isolated mental delay in infants weighing Objectives: To evaluate the effects of doxapram on cerebral hemodynamics in preterm infants using cerebral Doppler ultrasonography and near-infrared spectroscopy. Methods: Preterm infants who required treatment with doxapram for apnea of prematurity unresponsive to caffeine were treated with doxapram at an hourly dose of 0.5 mg·kg–1·h–1, followed by 1.5 and 2.5 mg·kg–1·h–1. Results: 20 preterm infants were studied. Doxapram induced a significant decrease of oxygenated hemoglobin (O2Hb) and cerebral intravascular oxygenation (HbD = O2Hb – HHb) and an increase of HHb and CtOx concentrations, while cerebral blood volume and cerebral blood flow velocity did not change. Conclusions: Doxapram infusion induces the increase of cerebral oxygen consumption and requirement and the contemporary decrease of oxygen delivery probably mediated by a decrease of cerebral blood flow. Caution must be recommended in prescribing this drug for apnea of prematurity.

Background: It has been suggested that probiotics can reduce the overgrowth of pathogens in the bowels of preterm infants and contribute to the reduction of the incidence of nosocomial infections in neonatal intensive care units (NICUs). The purpose of this study was to evaluate the effectiveness of Lactobacillus GG supplementation in reducing the incidence of urinary tract infections (UTIs), bacterial sepsis and necrotizing enterocolitis (NEC) in preterm infants. Methods: A double-blind study was conducted in 12 Italian NICUs. Newborn infants with a gestational age Lactobacillus GG (Dicoflor®, Dicofarm, Rome, Italy) in a dose of 6 × 109 colony-forming units (cfu) once a day until discharge, starting with the first feed or placebo. Results: Five hundred eighty-five patients were studied. The probiotics group (n = 295) and the placebo group (n = 290) exhibited similar clinical characteristics. The duration of Lactobacillus GG and placebo supplementation was 47.3 ± 26.0 and 48.2 ± 24.3 days, respectively. Although UTIs (3.4 vs. 5.8%) and NEC (1.4 vs. 2.7%) were found less frequently in the probiotic group compared to the control group, these differences were not significant. Bacterial sepsis was more frequent in the probiotics group (4.4%, n = 11) than in the placebo group (3.8%, n = 9), but the difference was not significant. Conclusion: Seven days of Lactobacillus GG supplementation starting with the first feed is not effective in reducing the incidence of UTIs, NEC and sepsis in preterm infants. Further studies are required to confirm our results in lower birthweight populations.

In this study we evaluate the effect of eight cord-care regimens on cord separation time and other secondary outcomes: omphalitis, sepsis, death, cord bleeding, compliance, satisfaction or dissatisfaction with regard to the type of treatment, umbilical cord colonization – in 1,535 healthy term infants. The eight cord-care regimens studied were: 70% alcohol, natural drying, salicylic sugar powder, triple dye, micronized green clay powder, colloid silver-benzyl-peroxide powder, neomycin-bacitracin powder, 1% basic fuchsine. None of the newborns developed sepsis or died and we found only sporadic cases of omphalitis. With regard to cord separation time the best results were obtained with salicylic sugar powder (5.6 ± 2.3 days) and green clay powder (6.7 ± 2.2 days). Both forms of treatment proved to be more effective (p < 0.05) than all the others. We found that salicylic sugar powder allows for early cord detachment resulting in excellent parent treatment compliance and reduction of their concern, notwithstanding higher percentages of cord bleeding. The rate of positive umbilical swabs was low and was significantly higher only than the results obtained with neomycin-bacitracin powder treatment. This study demonstrates that, in hospital nurseries of developed countries, salicylic sugar powder can be effectively and safely used for umbilical cord care of healthy term infants.

Objective: To investigate the acute effects of low-dose caffeine and aminophylline on cerebral blood flow in preterm infants, using both near-infrared spectroscopy (NIRS) and cerebral Doppler ultrasonography. Methods: Preterm infants with a gestational age of 2Hb), deoxygenated hemoglobin (HHb), oxidized-reduced cytochrome aa3 (CtOx), and mean cerebral oxygen saturation (SmO2 = O2Hb/total Hb). Changes in cerebral blood volume (ΔCBV) after caffeine or aminophylline administration were calculated. Cerebral blood flow velocity (CBV) in the pericallosal artery was evaluated by cerebral Doppler ultrasounds. Results: Data collected by NIRS and cerebral Doppler ultrasounds did not show significant differences before and after caffeine treatment. We observed a significant increase in O2Hb and HHb concentration and in CBV at 30 min after the infusion of aminophylline, which tended to return to baseline at the end of the study period. Conclusion: Caffeine does not significantly affect brain hemodynamics, while aminophylline induces a significant transient increase in O2Hb and HHb concentration and CBV.

Objective: To determine the effect of phototherapy on serum conjugated bilirubin fractions, an index of bilirubin conjugation, in hyperbilirubinemic neonates. Method: Serum was sampled from 21 jaundiced (serum diazo total bilirubin ≥274 µmol/l), term, otherwise healthy neonates prior to starting phototherapy, and 24 h after the commencement of treatment. Alkaline methanolysis followed by reverse-phase, high-performance liquid chromatography, specific for determination of unconjugated bilirubin and the monoconjugated and diconjugated fractions of total conjugated bilirubin in serum, was used for the analysis. Prephototherapy values were compared to those at 24 h. Results: Serum total bilirubin and total conjugated bilirubin values decreased during the study period, from 220 (211–239) to 177 (157–213) µmol/l (median (25–75% range)) p = 0.001, for the former, and from 1.4 (0.87–1.57) to 0.93 (0.69–1.84) µmol/l, p = 0.005, for the latter. These parameters decreased by a similar percentage (–16.6 ± 14.8% and –14.0 ± 23.4%, respectively; p > 0.05). Both monoconjugated and diconjugated bilirubin, calculated as a percentage of total conjugated bilirubin, remained constant over the study period (88.2 (72.2–96.4)% before phototherapy and 92.5 (87.3–96.8)% after 24 h, p > 0.05, for monoconjugated bilirubin, and 11.8 (3.6–27.8)% and 7.5 (3.2–12.7)%, respectively, p > 0.05, for diconjugated bilirubin). Conclusions: Serum total conjugated bilirubin values decreased in parallel to serum total bilirubin levels during phototherapy, maintaining a constant relationship between these two parameters. The ratios of monoconjugated and diconjugated bilirubin to total conjugated bilirubin remained constant. These findings imply that phototherapy does not alter bilirubin conjugation in hyperbilirubinemic neonates.

A prospective 3-month survey of neonatal respiratory disorders in 17,192 Italian infants born in 65 hospitals, located in 17 Italian regions representative of northern, central and southern Italy, was performed to evaluate the incidence of neonatal acute respiratory disorders and their risk factors. The prematurity rate was 7.3%, while the extremely low birth weight (34 years are risk factors for acute respiratory disorders.

Ketotifen, a histamine (Hi) antagonist, inhibits PAF-induced eosinophil accumulation and airway hyperreactivity. Bronchopulmonary dysplasia (BPD) is a complex disorder in which bronchial hyperreactivity is usually present. An open randomized trial was carried out with this agent in infants with chronic BPD who were followed up for 6 months. The efficacy of the drug was evaluated according to respiratory symptom and medication scores, in which numerical values were assigned to various other antiasthmatic agents used to control wheezing. No adverse clinical or biochemical sequelae were noted during treatment. The mean respiratory symptom and mean medication scores were significantly higher worse in the control group in comparison with the infants treated with ketotifen.

One thousand four hundred and fifty-four consecutive full-term neonates, delivered over a period extending from February 1, 1991 to January 31, 1992 were prospectively studied during the first days of life to determine if breast-feeding and hyperbilirubinemia were related. Six hundred and five infants were exclusively breast-fed on demand, 623 received both breast- and formula-feeding, and 226 were exclusively formula-fed. Of the 1,454 newborns studied, 70 (4.8%) presented with a bilirubin serum concentration > 12.9 mg/dl (4.62% in the breast-fed group, 5.45% in the group fed with mother’s milk with supplements, and 3.54% in the artificial formula group; the differences were not significant). Percent mean weight losses on the 3rd and 5th days were not significantly different. Babies breast-fed on demand seem to have a low incidence of hyperbilirubinemia similar to that found in formula-fed neonates.

The process of conjugation and secretion of bilirubin was studied in a group of healthy, full-term, exclusively breast-fed newborns and a control group of exclusively formula-fed infants by means of a reverse-phase high-performance liquid chromatographic analysis of bilirubins present in serum. The serum concentrations of unconjugated bilirubin, esterified bilirubin, and the proportion of diesterified bilirubin (as percent of esterified bilirubin) were not significantly different in breast- and formula-fed infants on the 3rd and 5th days of life. These data suggest that both bilirubin production and conjugation are not different in breast-fed and in formula-fed newborns.

BSP clearance from the plasma was studied during phototherapy in a group of jaundiced newborns. This therapy did not have any influence on the plasma dye disappearance curve. The obtained results are consistent with the hypothesis that this therapy causes the photodegradation of bilirubin, and that the increased excretion of unconjugated bilirubin is not mediated by a generalized enhancement of the hepatic output.

A good correlation between the amniotic fluid surface tension and gestational age was found in 51 amniotic fluid samples from normal pregnancies. The samples were obtained between the 20th and 43rd week of gestation. A good relation also exists between amniotic fluid lecithin concentration and fluid surface tension, and between said surface tension and the foam test carried out according to Clements et al. (4).

The effect of carnitine administration on neonatal lipid metabolism was studied during endovenous loading with Intralipid® (1 g/kg body weight over a 4-hour period). During a 6-hour period the plasma level of triglycerides, glycerol, free fatty acids (FFA), β-hydroxybutyrate (β-OHB), and acetoacetate were monitored in a group of newborns infused with carnitine and compared with a control group infused only with Intralipid. Carnitine administration caused an increased plasma concentration of ketone bodies, probably consequent to an increased rate of FFA mitochondrial β-oxidation. An increased plasma level of glycerol and FFA was also observed, whereas the triglyceride plasma levels were not different between the two groups. Carnitine administration in the neonatal period seems to act by increasing ketogenesis and lipolysis.

The blood concentration of S-adenosylmethionine in 18 premature neonates affected by hyaline membrane disease did not differ from that found in a control group of healthy premature newborns. However, these values are higher than those found in full-term infants: this fact suggests that the methionine cycle is active in both the fetus and premature neonate with consequent conservation of homocysteine sulfur. These data provide ancillary evidence in support of the hypothesis that in premature babies cyst(e)ine is an essential amino acid. The concentration of S-adenosylmethionine reaches its lowest level 30 days after birth and then stabilizes at the age of 2–5 months with blood levels similar to those of the normal adult.

In order to investigate the main sites of action of phototherapy in the treatment of neonatal jaundice we studied (a) the in vivo and in vitro relationship between the hematocrit and the effectiveness of phototherapy, and (b) the effect of varying the skin area exposed to light. The results show that the hematocrit does not influence in vivo the efficacy of phototherapy, while they confirm that the total skin surface exposed to light is important in determining the effectiveness of light treatment. The authors have also studied the possible action of phototherapy on bilirubin solutions placed into the postmortem brain or the stomach. The results suggest that blue light does not penetrate strongly enough to photomodify the exposed pigment.

T cell immune function in 20 newborn infants was investigated. Previous studies showing increased spontaneous transformation and higher 3H-thymidine incorporation at lower PHA concentration in newborn infants were confirmed. A net increase in the number of active E rosette-forming lymphocytes and a slight decrease in the percentage of total E rosette-forming cells was also found. Our results suggest the presence of a subpopulation of activated T lymphocytes in the peripheral blood of newborns during the first days of life. Possible mechanisms of this activation are discussed.