Search

To examine whether oral administration of paracetamol as a first-line agent had a greater effect on the closure of a patent ductus arteriosus than the intravenous route.We performed a retrospective study of preterm infants (37 weeks of gestation) between 2012 and 2020 treated with oral or intravenous paracetamol as the first line for patent ductus arteriosus (PDA) constriction and compared rates of ductal closure, course duration, cumulative dose, PDA characteristics, and serum levels.Over the study period, 80 preterm infants received paracetamol, of which 50 received paracetamol as first-line treatment to augment constriction of the PDA. Closure rate was higher in the oral group (n = 15/19, 79%) compared to the intravenous group (n = 8/20, 40%, p 0.01), and remained significant after adjusting for gestational age, length of treatment, and postnatal age (OR 0.14, 95% CI 0.03-0.67, p = 0.014, RR 0.51, 95% CI 0.28-0.91). Eleven preterm infants received a combination of both oral and intravenous paracetamol with a closure rate of 45% (n = 5).Oral administration of paracetamol as a first-line agent is more efficacious to constrict the PDA than the intravenous route, irrespective of gestational age or course duration.Our retrospective study comparing the use of oral versus intravenous paracetamol as the first line for patent ductus arteriosus (PDA) constriction in preterm infants demonstrates that oral administration of paracetamol is more efficacious to constrict the PDA than the intravenous route, irrespective of gestational age or course duration. To our knowledge, this is the first published study (prospective or retrospective) to compare the efficacy of oral versus intravenous paracetamol as a first-line treatment for PDA closure in preterm infants. Our finding may improve the rate of PDA closure when paracetamol is used as a first-line agent.

Resuscitation of neonates in the newborn period requires attention to cardiopulmonary health with a focus on ventilation and return of spontaneous circulation.1 Newborn resuscitation at delivery is performed according to the Neonatal Resuscitation Program (NRP) algorithm. Infants and children are resuscitated by Pediatric Advanced Life Support (PALS) guidelines from The American Heart Association (AHA). Resuscitation of infants beyond the 24 hours of age represents a challenge in selecting the most suitable algorithm. In general, both the AHA and NRP recommend using NRP guidelines during the immediate newborn period and through their initial hospitalization.1,2 However, questions remain whether all aspects of NRP are appropriate for infants who have long hospitalization times, well beyond the transition period, especially preterm infants.

The use of point of care ultrasound to assess cardiovascular function performed by a neonatologist who is not a cardiologist, is gaining interest in the neonatal intensive care unit (NICU). Clinical signs such as heart rate, blood pressure and capillary refill time provide limited insight into the adequacy of systemic blood flow and organ perfusion. Functional echocardiography (echo) enables real time evaluation of cardiac performance, identifying the nature of cardiovascular compromise, guiding therapeutic decisions and monitoring response to treatment. Application of functional echo in the NICU includes assessment of patent ductus arteriosus (PDA), pulmonary hypertension, shock and placement of umbilical catheters. There is evidence implicating that functional echo alters neonatal treatment and may improve outcome. Functional echo does not aim to replace the detailed structural assessments provided by consultative services of pediatric cardiologists. Close collaboration with pediatric cardiology is essential. In the past two years there is an increasing awareness for using functional echocardiography by neonatologists in Israel. Three conferences and an educational workshop were held in Israel with world renowned lecturers. Protocols defining how the exam should be performed were prepared, and agreement was reached with pediatric cardiologists on how to implement the use of functional echo by neonatologists, with the intention to create a distinct group of neonatologists with knowledge and skills in functional echo and a profound understanding of cardiac and respiratory physiology and hemodynamics.

A preterm male infant was born at 26+0 weeks of gestation via caesarian section due to pre-eclampsia. Birth weight was 560 g (intrauterine growth restriction). He was vigorous at birth and was transferred to the neonatal intensive care unit with non-invasive respiratory support. While preparing for umbilical catheter insertion, hypoglycaemia was noted. …

Introduction: Melatonin is an antioxidant, a circadian pacemaker, and an immune system stimulator. Studies have demonstrated beneficial effects of melatonin on various conditions in neonat...

Background Methicillin-resistant Staphylococcus aureus (MRSA) is a well-known nosocomial pathogen in neonatal intensive care unit (NICU) patients. Studies on the impact of MRSA colonization on neonatal morbidities are scarce. Methods We conducted a 1:3 matched cohort study among infants with and without MRSA colonization, born between January 2010 and June 2014, in a tertiary NICU to review their demographic characteristics and outcomes. Results During the study period, rates of MRSA colonization and bacteremia were found to be 0.68% and 0.10%, respectively. No differences in demographic characteristics, mortality, and major morbidities were identified among infants with and without MRSA colonization. Conclusions We reported a low rate of MRSA colonization in infants admitted to our NICU, without impact on mortality and inhospital morbidity. Further large-scale studies are needed to understand the implications and cost-effectiveness of active MRSA surveillance.

A term baby was born by spontaneous vaginal delivery. On his first physical examination, a prominent and wide umbilical stump was noticed, as well as congestion of the abdominal wall veins, especially while crying (figure 1). The veins radiated from the umbilicus upwards to the thorax, similar to caput medusa of portal hypertension. No hepatosplenomegaly was noted. An ultrasound …

Obstructive sleep apnea (OSA) is associated with hypertension. In the current study we sought to determine whether the evening-morning differences in blood pressure (BP) would correlate with the severity of OSA and whether there are gender-related differences.A total of 2009 consecutive patients referred to sleep examination because of suspected sleep apnea were retrospectively included. The patients comprised 1566 men, of whom 870 were nonhypertensive (non-HT) and 696 hypertensive (HT) and 443 women, of whom 258 were non-HT and 185 HT. Four BP measurements, two in the evening and two in the morning, were taken. The relationship between evening-morning differences in BP and the number of apneas/hypopneas divided by hours of sleep (AHI) were analyzed separately for HT and non-HT men and women.In men, increase in AHI was associated with increase in morning BP, and the evening-morning difference for both systolic and diastolic BP became negative. These trends were found to be significant by linear regression analyses both for HT (for systolic BP, r = 0.75, P.05, for diastolic BP r = 0.96, P.05) and non-HT patients (for systolic BP r = 0.93, P.05, for diastolic BP r = 0.94, P.05). In women (unlike in men), increasing AHI was not associated with a linear increase in the evening-morning BP differences. None of the regression lines fitted to the data was significant.Our results demonstrate that the evening to morning difference in BP in men with OSA is linearly related to the severity of OSA, both in patients with HT and in those with non-HT. These results may have practical relevance in screening for patients with OSA and may have prognostic clinical value in predicting future cardiovascular events.