Search

Treatment with surfactant may increase the risk of intracranial hemorrhage in newborn infants with a low birth weight. Surfactant is a substance occurring naturally in the lungs that is used to treat respiratory distress syndrome in premature infants. Intracranial hemorrhage is bleeding within the cranium, or the upper part of the head. Researchers reviewed studies that examined the association between surfactant replacement therapy and intracranial hemorrhage in newborn infants. Treatment with the surfactant beractant elevated the risk of grade I or grade II intracranial hemorrhage in infants with a birth weight of 600 to 750 grams. Surfactant replacement therapy with beractant did not increase the risk of a grade III or IV intracranial hemorrhage among this group of infants. Grades I and II are less serious than grades III and IV, which may lead to neurological handicaps. Infants treated with surfactant should be monitored closely for potential complications.

Survanta appears to be safe in the prevention and treatment of respiratory distress syndrome (RDS) among premature infants. Survanta is a synthetic lung surfactant that reduces surface tension and improves the elasticity of the lungs. Of 8,168 premature infants, 2,670 were given Survanta for the prevention of RDS, and 5,498 were given Survanta for the treatment of RDS. Overall, 56.8% of the infants required more than one dose, and 23% received the maximum four doses. There were problems with the administration of Survanta at least once in 30.4% of the infants. Adverse events occurred in 0.5% of the infants, but only one event was attributed to Survanta treatment. The overall survival rate was 84.4%., From September 1989 through July 1991, before commercial availability, Survanta (beractant intratracheal suspension), a modified bovine-derived surfactant used for prevention and treatment of neonatal respiratory distress syndrome, was made available to 231 neonatal intensive care units in the United States and Canada under a Treatment Investigational New Drug protocol. Results of this open clinical experience are reported. Investigators could give one dose of Survanta soon after birth to neonates weighing 600 to 1250g (prevention strategy). Neonates weighing 600 to 1750g who were not treated at birth could begin Survanta therapy if respiratory distress syndrome developed within 8 hours of birth (rescue strategy). All neonates could receive up to three more doses over the first 48 hours of life at minimum intervals of 6 hours if they met retreatment criteria. Qualifications for enrollment closely matched those used in previous randomized controlled clinical trials. This report includes results from 8168 neonates who completed the study. Treatment Investigational New Drug rates for intracranial hemorrhage, patent ductus arteriosus, pulmonary hemorrhage, pulmonary air leaks, bronchopulmonary dysplasia, death or bronchopulmonary dysplasia, pulmonary interstitial emphysema, pretreatment sepsis, and posttreatment sepsis were less than for treated neonates in the controlled trials and survival was equivalent across studies. Problems with treatment administration were reported with 30.4% of doses, while adverse events were reported in 0.5% of neonates. The results of the Treatment Investigational New Drug protocol revealed no new safety concerns associated with the widespread use of Survanta and confirmed the safety profile established in earlier controlled trials. Pediatrics 1993; 91:546-551; Treatment Investigational New Drug, pulmonary surfactant, bovine surfactant, respiratory distress syndrome, hyaline membrane disease, prematurity, neonatal mortality.

Infants born prematurely have an increased risk of respiratory distress syndrome, a lung disorder, because the lungs are still immature and do not produce adequate quantities of a substance called surfactant. This condition can be fatal. Studies have shown that a natural surfactant derived from other species given once at birth to these infants can reduce the severity of respiratory distress syndrome, but survival rates have not been shown to increase. This study examined whether giving multiple doses of a natural surfactant derived from cows (bovine surfactant) to these infants could increase their chances of surviving respiratory distress syndrome. Infants born at 23 to 29 weeks gestation weighing between 600 and 1,250 grams (1.3 to 2.8 pounds) were included in the study. A total of 430 infants participated, with 210 assigned to the treatment group and 220 to the control group. The treatment group received the surfactant at birth and again when needed (delivered into the trachea, or windpipe), while the control group received a dose of air, which functioned as a placebo. Results showed that in the first 28 days after birth, 1.9 percent of the treated and 15.6 percent of the untreated infants died from respiratory problems, a significant difference. Respiratory distress syndrome developed in 28 percent of the treated and in 56.9 percent of the control infants. The treated infants also had lower rates of developing pulmonary interstitial emphysema, at 23.3 percent versus 36.9 percent for the control group. These results indicate that multiple treatments with a natural surfactant at birth and again when needed can reduce the rates of illness and death from respiratory problems in infants born prematurely. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infants born prematurely often suffer from lung problems such as respiratory distress syndrome that increase their risk of illness and death above that of full-term infants. Premature infants lack a substance called surfactant in the lungs which is essential for respiratory function. In the past decade, it was found that a surfactant derived from cows (bovine surfactant) could be given to these infants, and that this decreased the need for oxygen and ventilation (use of a breathing machine). Further studies found that a single dose given at birth reduced the severity of the symptoms of respiratory distress syndrome, but did not necessarily increase survival rates. This study examined if giving more than a single dose of the surfactant when disease persisted would increase survival rates in these infants. The study involved 798 infants born prematurely weighing between 600 and 1,750 grams (1.3 and 3.9 pounds) that developed respiratory distress syndrome within six hours after birth. The infants were randomly assigned to one of two groups; one was the control group (396 infants) and the other received an initial dose of the surfactant with repeated doses if needed (402 infants). Results showed that in the first 28 days after birth, 36 treated infants (9 percent) and 80 untreated infants (20 percent) died from respiratory distress syndrome. Deaths from all causes during this period were 74 (18 percent) in the treated group and 108 (27 percent) in the untreated group. Mean airway pressure and oxygenation values, measures of respiratory function, during the first 72 hours of life were significantly better in the treated than in the untreated infants. The treated infants also developed significantly fewer cases of pulmonary interstitial emphysema and of pulmonary air leaks than the untreated infants. These results indicate that multiple doses of bovine surfactant given to premature infants with respiratory distress syndrome can reduce the incidence of illness and death. (Consumer Summary produced by Reliance Medical Information, Inc.)

In the future, large language models (LLMs) may enhance the delivery of healthcare, but there are risks of misuse. These methods may be trained to allocate resources via unjust criteria involving multimodal data - financial transactions, internet activity, social behaviors, and healthcare information. This study shows that LLMs may be biased in favor of collective/systemic benefit over the protection of individual rights and could facilitate AI-driven social credit systems., Competing Interests: Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Artificial intelligence (AI) methods have been proposed for the prediction of social behaviors which could be reasonably understood from patient-reported information. This raises novel ethical concerns about respect, privacy, and control over patient data. Ethical concerns surrounding clinical AI systems for social behavior verification can be divided into two main categories: (1) the potential for inaccuracies/biases within such systems, and (2) the impact on trust in patient-provider relationships with the introduction of automated AI systems for "fact-checking", particularly in cases where the data/models may contradict the patient. Additionally, this report simulated the misuse of a verification system using patient voice samples and identified a potential LLM bias against patient-reported information in favor of multi-dimensional data and the outputs of other AI methods (i.e., "AI self-trust"). Finally, recommendations were presented for mitigating the risk that AI verification methods will cause harm to patients or undermine the purpose of the healthcare system.

Large language models (LLMs) have been proposed to support many healthcare tasks, including disease diagnostics and treatment personalization. While AI may be applied to assist or enhance the delivery of healthcare, there is also a risk of misuse. LLMs could be used to allocate resources via unfair, unjust, or inaccurate criteria. For example, a social credit system uses big data to assess "trustworthiness" in society, penalizing those who score poorly based on evaluation metrics defined only by a power structure (e.g., a corporate entity or governing body). Such a system may be amplified by powerful LLMs which can evaluate individuals based on multimodal data - financial transactions, internet activity, and other behavioral inputs. Healthcare data is perhaps the most sensitive information which can be collected and could potentially be used to violate civil liberty or other rights via a "clinical credit system", which may include limiting access to care. The results of this study show that LLMs may be biased in favor of collective or systemic benefit over protecting individual rights, potentially enabling this type of future misuse. Moreover, experiments in this report simulate how clinical datasets might be exploited with current LLMs, demonstrating the urgency of addressing these ethical dangers. Finally, strategies are proposed to mitigate the risk of developing large AI models for healthcare., Competing Interests: Disclosures / Conflicts of Interest: The content of this manuscript does not necessarily reflect the views, policies, or opinions of the National Institutes of Health (NIH), the U.S. Government, nor the U.S. Department of Health and Human Services. The mention of commercial products, their source, or their use in connection with material reported herein is not to be construed as an actual or implied endorsement by the U.S. government nor the NIH.

Artificial intelligence (AI) methods have been proposed for the prediction of social behaviors that could be reasonably understood from patient-reported information. This raises novel ethical concerns about respect, privacy, and control over patient data. Ethical concerns surrounding clinical AI systems for social behavior verification can be divided into two main categories: (1) the potential for inaccuracies/biases within such systems, and (2) the impact on trust in patient-provider relationships with the introduction of automated AI systems for "fact-checking", particularly in cases where the data/models may contradict the patient. Additionally, this report simulated the misuse of a verification system using patient voice samples and identified a potential LLM bias against patient-reported information in favor of multi-dimensional data and the outputs of other AI methods (i.e., "AI self-trust"). Finally, recommendations were presented for mitigating the risk that AI verification methods will cause harm to patients or undermine the purpose of the healthcare system., Competing Interests: Competing interestsThe authors declare no competing interests., (© The Author(s) 2024.)

Objectives: To assess whether preterm infants with postnatal cytomegalovirus infection develop neurologic sequelae in early childhood., Methods: Infants <32 weeks' gestation were prospectively screened for cytomegalovirus (CMV) at term-equivalent age. Neurodevelopment was compared between CMV-positive and CMV-negative infants by using the Griffiths Mental Development Scales (GMDS) at 16 months' corrected age (CA); the Bayley Scales of Infant and Toddler Development, Third Edition or the GMDS at 24 to 30 months' CA; and the Wechsler Preschool and Primary Scale of Intelligence, Third Edition and Movement Assessment Battery for Children, Second Edition at 6 years of age. At 6 years old, hearing was assessed in CMV-positive children., Results: Neurodevelopment was assessed in 356 infants at 16 months' CA, of whom 49 (14%) were infected and 307 (86%) were noninfected. Infected infants performed significantly better on the GMDS locomotor scale. There were no differences at 24 to 30 months' CA on the Bayley Scales of Infant and Toddler Development, Third Edition or GMDS. At 6 years of age, infected children scored lower on the Wechsler Preschool and Primary Scale of Intelligence, Third Edition, but mean scores were within normal range, reaching significance only in verbal IQ (96 [SD 17] vs 103 [SD 15] points; P = .046). Multiple regression indicated no impact of CMV status but significant influence of maternal education and ethnicity on verbal IQ. No significant differences in motor development were found and none of the infected children developed sensorineural hearing loss., Conclusions: In this cohort study, postnatal cytomegalovirus infection in preterm children did not have an adverse effect on neurodevelopment within the first 6 years of life., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2018 by the American Academy of Pediatrics.)

Background: Congenital cytomegalovirus (cCMV) infections are the most prevalent intrauterine infections worldwide and are the result of maternal primary or non-primary infections. Early maternal primary infections are thought to carry the highest risk of fetal developmental abnormalities as seen by ultrasound; however, non-primary infections may prove equally detrimental., Methods/results: This case series presents 5 cases with fetal abnormalities detected in the second and third trimester, in which cCMV infection was ruled out due to negative maternal CMV-IgM., Discussion: This series highlights the possible pitfalls in serology interpretation and fetal diagnosis necessary for appropriate parental counseling. Once fetal abnormalities have been confirmed and cCMV is suspected, maternal CMV serostatus and fetal infection should be determined. Maternal CMV serology may be ambiguous; therefore, caution should be exercised when interpreting the results., (© 2017 The Author(s) Published by S. Karger AG, Basel.)

Background: Congenital cytomegalovirus (cCMV) infection early in pregnancy may result in major disabilities. Cerebral abnormalities detected using cranial ultrasound (cUS) and magnetic resonance imaging (MRI) have been related to neurological sequelae., Objective: To evaluate the additional value of MRI and assess the relationship between time of infection during pregnancy and outcome in infants with cCMV infection., Methods and Study Design: Demographic and clinical data were collected in infants with cCMV infection (1992-2013). Trimester of infection, neuro-imaging results and outcome were reviewed. Cerebral abnormalities were categorized into none, mild (lenticulostriate vasculopathy, germinolytic cysts, high signal intensity on T2-weighted images) and severe (migrational disorder, ventriculomegaly, cerebellar hypoplasia). Results were statistically analysed., Results: Thirty-six infants were eligible for analysis. cUS was performed in all and cranial MRI in 20 infants. Migrational disorders were only diagnosed using MRI (p < 0.01). In 17 infants trimester of infection was ascertained. Seven out of 10 infants infected during the first trimester had severe abnormalities on cUS (5 confirmed on MRI) and adverse sequelae; 3 had no/mild abnormalities on cUS/MRI and normal outcome. Two out of 3 infants infected during the second trimester with no/mild abnormalities on cUS/MRI had normal outcome; 1 with mild cUS and MRI abnormalities developed sensorineural hearing loss. Four infants infected during the third trimester with no/mild abnormalities on cUS/MRI had normal outcome., Conclusion: Infants with a first trimester cCMV infection are most at risk of severe cerebral abnormalities and neurological sequelae. MRI, and not cUS, enables an early diagnosis of migrational disorders, which can improve prediction of outcome., (© 2015 S. Karger AG, Basel.)

Postnatal cytomegalovirus (CMV) infection is common in neonates and is mostly acquired through infected breast milk from seropositive mothers. In this review, risk factors of postnatal CMV transmission and predictors of severity, preventive measures and treatment of symptomatic postnatal CMV infection in preterm infants are discussed. Several viral, transmission route and host factors have been associated with a higher risk of postnatal CMV transmission from mother to child. Severity predictors of symptomatic postnatal CMV infection may include extreme prematurity (gestational age <26 weeks), timing of postnatal infection as well as comorbidities. Further research in postnatally infected preterm infants at risk for severe symptoms is essential with respect to preventive measures involving the infected breast milk and antiviral treatment.

Background: Detection of white matter (WM) abnormalities on MRI is important regarding the neurodevelopmental outcome in preterm infants. The long-term neurodevelopmental outcome of preterm infants with postnatal cytomegalovirus (CMV) infection has not been studied extensively., Objectives: We aimed to assess WM microstructure in preterm infants with postnatal CMV infection using diffusion tensor imaging., Methods: Infants <32 weeks' gestational age (GA) admitted to our hospital between 2007 and 2010, who had cerebral diffusion tensor imaging at term-equivalent age (40 weeks' GA) were included. CMV PCR in urine collected at term-equivalent age was performed to diagnose postnatal CMV infection. Congenital infection was excluded. In the frontal, parietal and occipital WM mean diffusivity, fractional anisotropy (FA), radial and axial diffusivity were calculated. Neurodevelopmental outcome was assessed at 16 months' corrected age using Griffiths' Mental Developmental Scales., Results: Twenty-one postnatally infected and 61 noninfected infants were eligible. Both groups were comparable regarding GA, birth weight and age at MRI. There was a significant difference in median FA of the occipital WM between infected and noninfected infants (0.13 [IQR 0.11-0.16] versus 0.16 [IQR 0.14-0.18], p = 0.002). There were no differences in short-term neurodevelopmental outcome between infected and noninfected infants., Conclusions: A significantly reduced FA suggests microstructural changes in the occipital WM of postnatally infected infants. These microstructural changes do not appear to result in impaired neurodevelopmental outcome at 16 months' corrected age., (Copyright © 2013 S. Karger AG, Basel.)

Collodion baby is a rare congenital disorder whereby affected infants are born encased in a thick, taut, shiny, translucent membrane. The majority of babies with collodion membrane have associated disorders, most commonly nonbullous congenital ichthyosiform erythroderma and lamellar ichthyosis. The authors report a case of collodion baby with rare complication of acral contracture, ischemia and nail dystrophy. Topical treatment with tazarotene 0.1% gel resulted in rapid improvement. The patient developed normal nail plates and full motor function in both hands and feet following treatment. To the authors' knowledge, this is the first report demonstrating the benefit of topical tazarotene for management of this rare condition in a neonate.

Objectives: To evaluate the effects of different surfactants on pulmonary infection with group B streptococci in premature rabbits and to examine the effects of different surfactants on pulmonary alveolar macrophage function of newborn rabbits., Model: Preterm and term rabbit pups., Methods: Rabbit pups were infected with GBS aerosols followed by intratracheal administration of either calf lung surfactant extract, minced porcine lung surfactant (Curosurf), synthetic surfactant (Exosurf Neonatal), minced bovine lung surfactant (Survanta), human amniotic fluid-derived surfactant, rabbit surfactant, saline vehicle, or no treatment. Intrapulmonary clearance of GBS was determined by comparing bacterial counts in left lungs cultured immediately after aerosol infection with similarly infected lungs analyzed 4 hours after surfactant therapy. Phagocytosis of streptococci was ascertained by microscopic examination of the right lungs fixed in situ at 4 hours. For comparison, an in vitro method was used to measure growth of GBS in the different surfactants., Results: Preterm animals had a sixfold increase in pulmonary bacterial growth compared with a slight decrease in intrapulmonary GBS in term animals when all were delivered by cesarean section (p < 0.05). In premature rabbits, GBS proliferation was lowest in animals treated with Exosurf Neonatal and highest in animals receiving Curosurf and human amniotic fluid-derived surfactant (p < 0.05). None of the surfactants promoted accelerated growth of GBS in comparison with control animals. Similar growth of GBS was seen in in vitro cultures. Intrapulmonary phagocytosis of GBS in premature pups was not altered by any of the surfactants. In term rabbit pups, the following measures of macrophage population kinetics remained normal at 1 and 24 hours after surfactant administration: viability, cell numbers based on lung lavage, and in vivo incorporation of thymidine., Conclusions: Surfactants used in clinical practice do not accelerate the in vivo growth of group B streptococci in the lungs of preterm rabbits. Some surfactants inhibit streptococcal proliferation. The effects of different surfactants are not explained by changes in macrophage function.

Nine cases of a syndrome are described, which is known as the "Currarino triad" and which belongs to the group of malformations in which there is a persistent neurenteric communication. The features of the triad consist of ano-rectal anomalies (particularly ano-rectal stenoses), a curved, but limited, sacro-coccygeal defect ("scimitar sacrum") and a presacral tumour, which may be an anterior sacral meningocoele, a teratoma, a cyst (dermoid or neurenteric a cyst (dermoid or neurenteric cyst) or a mixture of these. In at least 50% of cases, the triad is familial and autosomal dominant. Of our nine cases, seven were familial. A dangerous complication is meningitis due to infection of the cystic component, or fistula formation between the colon and spinal canal (one of our cases). Other complications are a fixed filum terminale ("tethered cord") and malformations of the urogenital tract. The risk of malignancy in a teratoma is low, but exists. When considering the indications for surgery, this must be kept in mind, as must the risk of infection, and damage to neural structures during operation. In all cases of early obstipation the sacrum should be x-rayed in order to exclude a Currarino triad. The finding of a sacral defect and a presacral mass makes it essential to obtain CT of the pelvis with contrast in the distal gut and in the meningeal sac. The same is true for screening of the family (including views of the sacrum).