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BONE TURNOVER MARKERS IN PREMATURE INFANTS
Murat ?ak?r,?lke Mungan,Taner Karaka?,Ay?enur ?kten
Marmara Medical Journal , 2008,
Abstract: Objective: We aimed to evaluate the bone turnover markers in preterm infants, and analyze their relationship with growth, urinary calcium (Ca) and phosphorus (P).Subjects and Method: Thirty-nine premature infants with enteral feeding started before the 5th day of life, and 20 full-term infants, as control group, were enrolled for the study. The weight and length of all premature infants were measured at birth and repeated at 4 weeks of age. Blood samples and urine were obtained for bone turnover markers at the second measurement.Results: Serum -CrossLaps and urinary deoxypyridinoline, calcium, tubular phosphate reabsorption (TPR) and TPR/GFR were significantly higher in preterm infants (P<0.05 for all parameters). There was significant correlation of osteocalcin with birth weight (r=0.306, P=0.05) and weight at 4 weeks (r=0.307, P=0.047); and negative correlation of urinary deoxypyridinoline with birth weight (r=-0.310, P=0.05), weight gain (r=-0.625, P=0.001) and weight at 4 weeks (r=-0.387, P=0.015).Conclusion : A significant correlation was found between urinary deoxypyridinoline and TPR (r=0.314, P=0.05). Preterm infants with low birth weight and low weight gain have risk for the osteopenia. Measurement of TPR and calcium excretion may be a good marker of preterm osteopenia.
Premature infants and neurodevelopmental morbidity  [cached]
Serap Uysal
Turk Pediatri Ar?ivi , 2010,
Abstract: major cognitive and motor deficits Periventricular leukomalacia (PVL), is the main type of brain injury. The cerebral white matter, thalamus, basal ganglia, cerebral cortex, brain stem and cerebellum may be affected. Infants with low birth weight are also in high risk. It is difficult to shout a clear, clinico-pathologic correlations in premature infants has been difficult. The neurosensory impairments are complex and often subtle. At school age, children born preterm tend to have soue difficulties in learning, attentional problems and hyperactivity . Early intervention programs have positive influence on cognitive and motor outcomes. (Turk Arch Ped 2010; 45: 80th Year: 20-2)
Mortality and morbidity of premature infants
Zeynep Eras,E. Bahar Bing?ler Pekcici,Gülsüm Atay
Medical Journal of Bakirk?y , 2011,
Abstract: Due to advances in antenatal care and neonatal intensive care conditions, especially in developed countries, perinatal mortality of infants born under 1000 grams, and 22-25 weeks’ gestational age was decreased. In contrast, studies showed that at least 20-25% of these infants had functional limitations in one or more developmental areas, having different findings and requiring different services from early infancy until adulthood. The developmental problems of premature and VLBW infants causing function limitations and disability are serebral palsy, vision and hearing loss and severe cognitive problems. In the recent studies, the rates of severe developmental problems has been reported as 14-17%, and mild developmental problems has been reported as 50-70%.
Mechanism-Based Urinary Biomarkers to Identify the Potential for Aminoglycoside-Induced Nephrotoxicity in Premature Neonates: A Proof-of-Concept Study  [PDF]
Stephen J. McWilliam, Daniel J. Antoine, Venkata Sabbisetti, Mark A. Turner, Tracey Farragher, Joseph V. Bonventre, B. Kevin Park, Rosalind L. Smyth, Munir Pirmohamed
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0043809
Abstract: Premature infants are frequently exposed to aminoglycoside antibiotics. Novel urinary biomarkers may provide a non-invasive means for the early identification of aminoglycoside-related proximal tubule renal toxicity, to enable adjustment of treatment and identification of infants at risk of long-term renal impairment. In this proof-of-concept study, urine samples were collected from 41 premature neonates (≤32 weeks gestation) at least once per week, and daily during courses of gentamicin, and for 3 days afterwards. Significant increases were observed in the three urinary biomarkers measured (Kidney Injury Molecule-1 (KIM-1), Neutrophil Gelatinase-associated Lipocalin (NGAL), and N-acetyl-β-D-glucosaminidase (NAG)) during treatment with multiple courses of gentamicin. When adjusted for potential confounders, the treatment effect of gentamicin remained significant only for KIM-1 (mean difference from not treated, 1.35 ng/mg urinary creatinine; 95% CI 0.05–2.65). Our study shows that (a) it is possible to collect serial urine samples from premature neonates, and that (b) proximal tubule specific urinary biomarkers can act as indicators of aminoglycoside-associated nephrotoxicity in this age group. Further studies to investigate the clinical utility of novel urinary biomarkers in comparison to serum creatinine need to be undertaken.
Human cytomegalovirus infections in premature infants by breastfeeding
K Numazaki
African Journal of Biotechnology , 2005,
Abstract: Human cytomegalovirus (CMV) is the most common cause of congenital and perinatal infections. Understanding the epidemiology of CMV is a key element in development of strategies for prevention of infection in premature infants. Breast-fed infants are susceptible to CMV infection from breast milk. CMV was isolated more frequently from breast milk at more than one month after delivery than from colostrum or early breast milk. CMV particle shedding into milk whey have a more important role. Cytokines in serum and milk are related to the reactivation of CMV, which occurs locally in the mammary gland of the lactating mother after delivery. Premature infants with low concentration of serum antibodies can acquire CMV infection from the fresh breast milk containing the virus. Freezing breast milk may be protective for the preterm infant until the titer of CMV antibody increases. However clinical importance of CMV infection in premature infants by breast-feeding is still unclear. This minireview focuses on recent advances in the study of CMV infection in premature infants by breastfeeding.
Incidence of Retinopathy of Prematurity in Extremely Premature Infants  [PDF]
Alparslan ?ahin,Muhammed ?ahin,Fatih Mehmet Türkcü,Abdullah Kür?at Cingü,Harun Yüksel,Yasin ??nar,?eyhmus Ar?,?hsan ?a?a
ISRN Pediatrics , 2014, DOI: 10.1155/2014/134347
Abstract: Purpose. To investigate the incidence and the severity of retinopathy of prematurity (ROP) in extremely preterm infants born before 28 weeks of gestation in southeastern Turkey. Methods. A retrospective chart review was performed for infants born before 28 weeks of gestation. The following data were reviewed: gender, gestational age (GA), birth weight (BW), zone and stage of ROP, presence of plus disease, and treatment for ROP if needed. Infants were divided into 2 groups according to GA as follows: group 1 included infants of GAs 25 weeks and under; group 2 included infants of GAs less than 28 weeks and over 25 weeks. Results. The incidence of any ROP in the whole cohort, in group 1, and in group 2, was 66.0%, 95.5%, and 58.6%, respectively. Incidence of any ROP was significantly associated with BW and GA ( and , resp.). The overall incidence of type 1 ROP was 35.8% (59.1% in group 1 and 29.9% in group 2). Development of type 1 ROP was independently associated with GA. Conclusion. Any ROP was significantly associated with BW and GA. Extremely premature infants with lower GA were found to be more likely to develop type 1 ROP. BW cannot predict the development of type 1 ROP. 1. Introduction Retinopathy of prematurity (ROP) is an important cause of vision loss in children, especially in extremely premature infants [1]. The survival rates of extremely premature infants have been increased with the improvement in the neonatal intensive care technologies and increased availability of healthcare services in recent years [2]. Infants with gestational age (GA) less than 28 weeks have particularly more risk for the development of ROP in developed countries [3, 4]. In developing countries, the incidence of ROP is rising with the improvement of the survival rates of extremely premature infants [5, 6]. These infants are more tending to develop severe ROP and require treatment [7]. In the present study, we aimed to determine the incidence and the severity of ROP in extremely premature infants in southeast part of Turkey. 2. Materials and Methods Dicle University Health Research Ethics Committee approved the study. The medical records of the premature infants examined between September 2010 and August 2012 in Retina Department of Dicle University Medical Faculty were retrospectively reviewed. The patients with a GA under 28 weeks were included in the study. The patients who died prior to retinal screening examination and had lack of relevant data in their medical records were excluded. All patients were first examined using indirect ophthalmoscope at 31 weeks of GA
Mode of delivery and neurosonographic findings in premature infants
Velisavljev-Filipovi? Gordana
Medicinski Pregled , 2007, DOI: 10.2298/mpns0702007v
Abstract: Introduction Fetal and preterm infant brain is especially vulnerable to hemorrhagic and ischemic damage at the end of the second and at the beginning of the third trimester. This is due to vascular, cellular and anatomic characteristics of the brain during development. In premature babies, there is a physiological instability and limited autoregulation of cerebral circulation. Hemorrhagic and ischemic damages often occur together, though pathophysiological processes leading to lesions are different. Material and methods The paper deals with a detailed analysis of 860 ultrasound brain scans of prematurely born children. The examinations were performed at the Ultrasound Department of the Institute of Child and Youth Health Care in Novi Sad. 707 vaginally born premature infants and 153 premature infants born by Cesarean section were examined. The bleeding was graded according to the Papile classification. Results and Discussion Out of 384 children with diagnosed grade I hemorrhage, 75 premature infants (19.5%) were born by Cesarean section. In the group of children with grade II hemorrhage, operative deliveries account for 14.7%. From the total of 85 children with grade III hemorrhage, (intraventricular bleeding with chamber dilatation), only 6 premature infants were born by Cesarean section (7%). Intra-parenchymal bleeding was diagnosed in a very small number of premature infants; 0.32% of all diagnosed hemorrhages were grade IV hemorrhages. In this group there were no children born by Cesarean section. The increase of hemorrhage grade is accompanied by a greater rate of pelvic presentation and manual assistance by Bracht. There were 240 prematurely born children with no echosonographically diagnosed hemorrhage, 38% of all examined premature infants. From this number, 13.3% of neonates were born by Cesarean section. Conclusion In the etiology of neonatal intracranial hemorrhage, especially prematurely born ones, apart from the trauma, which plays a major role, other factors are also important, above all fetal distress, perinatal hypoxia and functional immaturity of all organs.
An ultrasound protocol in premature infants with intracranial hemorrhage
Velisavljev-Filipovi? Gordana
Medicinski Pregled , 2005, DOI: 10.2298/mpns0504185v
Abstract: Introduction. Prematurity is a great health problem in our country and in the world. There are more than 11% of premature births in America annually, and in Europe this rate is between 5-10%. In Vojvodina, 9% of babies are born prematurely. Intracranial hemorrhage takes a significant place in the morbidity of prematurely born children. Intracranial hemorrhage in premature newborn infants Incomplete CNS development of premature infants causes numerous complications, but it is also the factor which enables survival of extremely immature infants without sequelae. The management protocol depends on the level of hemorrhage. Early diagnosis of intracranial hemorrhage and determination of the level of hemorrhage are of utmost importance for disability prevention. Ultrasound in monitoring intracranial hemorrhage Brain monitoring of prematurely born babies is performed by ultrasound. This type of visualization has several advantages over other techniques: it is mobile, so called "bedside technique", it is relatively cheap, it may be repeated several times, it is possible to define the exact time of hemorrhage and monitor its absorption from day to day. Ultrasound is safe, and there is no ionized radiation. No sedation is required for ultrasound examination. The examination is not painful. Conclusion The frequency of ultrasound depends on the level of hemorrhage, presence or absence of ventriculomegally/ hydrocephalus, as well as on the surrounding cerebral parenchyma. .
Surfactant administration in premature infants with RDS
Kalkan, Ismeta,Heljic, Suada,Cengic, Amra,Misanovic, Verica
Signa Vitae , 2007,
Abstract: Background. The significant advancement in the treatment of respiratory distress syndrome can be attributed to prenatal identification of high risk pregnancies, prevention of illness through antenatal care, prenatal administration of glucocorticoids, advancement in respiratory support and surfactant therapy. These measures resulted in the reduction of mortality and morbidity rates in preterm infants.Patients and methods. We analyzed data of 78 preterm babies with respiratory distress syndrome hospitalized in the NICU of the Pediatric Clinic, KCU Sarajevo. All children included in the study were mechanically ventilated and treated with one or more doses of bovine surfactant (Survanta) as rescue therapy. Surfactant was given to children with clinical and radiological signs of RDS, who required FiO2>0,40. We used the standard procedure of giving surfactant therapy to intubated children in sterile conditions, after we confirmed, by X-ray, correct tube placement.Results. We investigated the clinical efficacy of surfactant in relation to time of administration, O2 requirement and necessity of one or more doses of surfactant. We found that early treatment with surfactant replacement- within 6 hours of birth- is more effective, and resulted in a significant reduction of mortality rate (p
Probiotics in premature infants: focus on necrotising enterocolitis
E Van Niekerk
South African Journal of Clinical Nutrition , 2011,
Abstract: The premature infant may be exposed to an environment that is associated with the development of gastrointestinal complications. In preventing the latter, it is crucial that, if probiotics is chosen as a preventive measure, the selection of a safe product with documented probiotic properties together with close monitoring of patients is mandatory before offering this therapy for routine use in this high-risk deserving population. It is important to note that the effect of a probiotic bacterium is strain-specific. When considering the evidence from randomized control trials, researchers believe that probiotics should be offered as routine therapy for preterm infants, and that additional placebo-controlled trials are not necessary. The available guidelines may be a helpful tool in optimizing the use of probiotics in research setting
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