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The aim of the study was to develop and validate a prediction model for hemorrhage in critically ill neonates which combines rotational thromboelastometry (ROTEM) parameters and clinical variables. This cohort study included 332 consecutive full-term and preterm critically ill neonates. We performed ROTEM and used the neonatal bleeding assessment tool (NeoBAT) to record bleeding events. We fitted double selection least absolute shrinkage and selection operator logit regression to build our prediction model. Bleeding within 24 hours of the ROTEM testing was the outcome variable, while patient characteristics, biochemical, hematological, and thromboelastometry parameters were the candidate predictors of bleeding. We used both cross-validation and bootstrap as internal validation techniques. Then, we built a prognostic index of bleeding by converting the coefficients from the final multivariable model of relevant prognostic variables into a risk score. A receiver operating characteristic analysis was used to calculate the area under curve (AUC) of our prediction index. EXTEM A10 and LI60, platelet counts, and creatinine levels were identified as the most robust predictors of bleeding and included them into a Neonatal Bleeding Risk (NeoBRis) index. The NeoBRis index demonstrated excellent model performance with an AUC of 0.908 (95% confidence interval [CI]: 0.870–0.946). Calibration plot displayed optimal calibration and discrimination of the index, while bootstrap resampling ensured internal validity by showing an AUC of 0.907 (95% CI: 0.868–0.947). We developed and internally validated an easy-to-apply prediction model of hemorrhage in critically ill neonates. After external validation, this model will enable clinicians to quantify the 24-hour bleeding risk.

Introduction Altered maternal inflammatory responses may play a role in the development of hypertensive disorders of pregnancy like preeclampsia, its more severe early-onset form and intrauterine growth restriction. We evaluated the relation of common allelic variants of Toll-like receptor 4 (TLR4), known to impair the inflammatory response, with the susceptibility to early-onset preeclampsia in Central Greece. Methods We compared the occurrence of TLR4 (Asp299Gly and Thr399Ile) alleles in heterozygous (A/G, C/T) and homozygous (G/G, T/T) states in 84 women with a history of early-onset preeclampsia and 94 age matched controls with a history of only uneventful pregnancies, by direct sequencing. Results Heterozygous TLR4 allelic variants were more common in women with a history of early-onset preeclampsia than in controls (GA for Asp299Gly: 14.3% vs 6.4% (AA), p = 0.053 & CT for Thr399Ile: 16.7% vs. 6.4% (CC), p = 0.019) and a stronger association was obtained when homozygous allelic carriers were also included (GA/GG for Asp299Gly: 16.7% vs. 6.4% (AA), p = 0.03 & TC/TT for Thr399Ile: 19.0% vs. 6.4% (CC), p = 0.01). Discussion We recorded association between common TLR4 gene variants and early-onset preeclampsia. Our findings support the involvement of maternal innate immune system in severe hypertensive disorders of pregnancy and point to the potential value of maternal TLR4 polymorphisms as predictors-risk factors of susceptibility to early-onset preeclampsia in Central Greece.

To determine the prevalence, examine the influence of hospital practices and investigate potential determinants of breast-feeding in Athens.Three hundred twelve mothers provided information regarding feeding practices at certain maternity hospitals in Athens, at 40 days and 6 months postpartum. Multiple logistic regression analysis was performed to evaluate the association between the initiation and maintenance of breast-feeding and potential risk factors.Although almost 90% of newborn infants were given a breast milk substitute one or more times during the first 2 days at the maternity hospital, the exclusive breast-feeding percentage on the last day of hospital stay reached 85%. Breast-feeding and exclusive breast-feeding percentages dropped to 55% and 35%, respectively, at 40 days postpartum and to 16% and 12%, respectively, at 6 months postpartum. While in the hospital, 3% of mothers initiated breast-feeding within 1 hour of labor, only 34% were informed about the advantages of breast-feeding by health professionals and 42% were trained to breast-feed by the midwives. "Rooming-in" was not practiced in the private hospitals. The educational level was positively associated with the initiation of breast-feeding [odds ratio (OR): 1.36, confidence interval (CI): 1.02-1.81], the mother's body mass index was negatively associated with the maintenance of breast-feeding for 40 days (OR: 0.56, CI: 0.32-0.98) and 6 months (OR: 0.28, CI: 0.06-1.26) and a caesarean section was negatively associated with the initiation (OR: 0.24, CI: 0.11-0.49) and maintenance of breast-feeding (OR: 0.42, CI: 0.20-0.89).Breast-feeding is not appropriately supported in certain maternity hospitals in Athens, and this is probably the cause of observed low breast-feeding prevalence.

UNLABELLED The aim of the study was a prospective survey of the effects of low-dose cisapride on gastric emptying and QTc interval in very low birthweight infants. Twenty low birthweight infants were studied: mean (SD) gestation 30.5 (2.2) wk; birthweight 1320 (150)g. Gastric emptying was assessed ultrasonically in 15 of these infants, in a randomized blind crossover study, following 24-h low-dose oral cisapride administration (0.1 mg/kg given 8 hourly), or placebo. The QTc interval was also determined in all 20 infants following a 7-d course of cisapride or placebo. CONCLUSIONS Cisapride significantly shortened both gastric emptying time and QTc interval (p < 0.05) compared to placebo. All infants completed the study without any apparent adverse effects. In conclusion, low-dose cisapride administration significantly improves gastric emptying without increasing the QTc interval.

Nasal continuous positive airway pressure (NCPAP) is frequently used for prolonged periods in very low birth weight infants. We asked if NCPAP affects gastric emptying.Preterm newborn infants (n = 16) with a mean body weight of 935 g (SD, 155) and a mean gestational age of 27.7 weeks (SD, 1.9) were treated with NCPAP and fed by orogastric tube. A comparison group of 20 newborn infants with a mean body weight of 1090 grams (SD, 130) and a mean gestational age of 28.2 weeks (SD, 1.2) were not receiving NCPAP. All newborn infants received a milk formula containing 81 kcal/dL given in similar quantities. The antral cross-sectional area was measured by means of an ultrasound technique.Mean half-time of antral cross-sectional area was 28 minutes (SD, 12) in the NCPAP group and 40 minutes (SD, 17) in the comparison group ( P.05). There were no differences in gastrointestinal complications between the two groups.The gastric emptying time was shorter for newborn infants treated with NCPAP.

The goal of the present study is to investigate the relationship between anthropometric and bone metabolism markers in a sample of neonates and their mothers. A sample of 20 SGA (small for the gestational age), AGA (appropriate for the gestational age) and LGA (large for the gestational age) term neonates and their 20 mothers was analyzed at birth and at exit. Elisa method was used to measure the OPG (Osteoprotegerin), RANK (Receptor activator of nuclear factor-kappaB), RANKL (Receptor activator of nuclear factor-kappaB Ligand), IGF-1 (Insulin-like growth factor 1), IGFBP3 (Insulin-like Growth Factor Binding Protein 3) and Leptin levels. Birth weight and length were positively correlated with RANKL, IGF-1 and IGFBP3 and negatively with the ratio OPG/RANKL. SGA neonates presented lower RANKL values and higher OPG/RANKL ratio while LGA neonates had higher RANK levels than AGA neonates. Positive association was shown between neonatal IGFBP3 and maternal IGF-1 values and between neonatal and maternal RANK values at birth and at exit. These results reveal a remarkable upregulation of OPG/RANKL ratio in SGA neonates, pointing out the role of bone turnover in compensating for the delayed neonatal growth.

Background Common clinical practice for the provision of parenteral nutrition of neonates is to administer the nutrients in separate solutions. The aim of this study was to introduce and examine an alternative way of parenteral feeding for neonates, providing all-in-one parenteral regimes. Methods Stability studies were carried out on 2 all-in-one admixtures. Stability assays consisted of the assessment of the admixture's (1) macroscopic aspect, (2) drop size measurement, (3) pH measurement, (4) peroxide value, and (5) alpha-tocopherol concentration. For the measurements, the admixtures were stored at 2 different temperatures, 4 degrees C (storage) and 25 degrees C (compounding), and then analyzed at a starting time, 24 hours, 48 hours, and 7 days after compounding. Results The 2 all-in-one parenteral admixtures for neonates were shown to be physically stable under analysis conditions, and there were no particles larger than 1 mum. The maximum loss of alpha-tocopherol was approximately 24%. In all-in-one admixtures, lipid peroxide occurred within 24 hours after the addition of the lipid emulsion. Conclusions The addition of fat emulsion and fat-soluble vitamins did not alter the physical stability of parenteral admixtures for neonates. Moreover, the admixtures examined were relatively chemically stable for 24 hours, as far as vitamin E is concerned. Lipid peroxidation was the limiting factor for application stability of an all-in-one neonatal parenteral regimen.

Background: Theophylline treatment causes side effects such as tachycardia, hyperglycaemia, abdominal distension, and vomiting. The latter two are probably the result of delayed gastric evacuation. Objective: To study the effect of theophylline on gastric emptying time in preterm infants. Patients: The subjects were 18 premature neonates with a mean (SD) birth weight of 1302 (240) g and a mean (SD) gestational age of 28.7 (1.9) weeks. Main outcome measures: In each case, gastric emptying was measured on two occasions: once when the newborns were being treated with theophylline and once when they were not. Half of the cases were randomised to receive theophylline before the initial measurement. The opposite was applied for the rest. Gastric emptying was assessed ultrasonically by measuring the change in antral cross sectional area (ACSA) at regular intervals over 120 minutes. Results: The mean (SD) ACSA half time in the newborns receiving theophylline was 52 (19) minutes compared with 37 (16) minutes in those not receiving theophylline. This difference is significant (p

Gastrin, vasoactive intestinal peptide (VIP) and neurotensin plasma levels were measured in three groups of healthy term newborn infants, on the 3rd, 4th and 5th days of life. Group A consisted of 15 babies without jaundice. Group B comprised of 15 babies with mild jaundice (bilirubin levels256 mumol/l) and group C included 15 babies with marked jaundice (bilirubin levels256 mumol/l) who received phototherapy for at least 24 h. There was no significant difference in gut hormone levels between groups A and B. Infants in group C had significantly lower gastrin levels compared to infants in groups A and B, on both days 4 and 5. VIP levels on the 4th day of life were significantly higher in group C in comparison to groups A and B. Neurotensin levels in the three groups did not differ significantly. Increased stool number was noted in infants in group C. Increased VIP levels in jaundiced infants under phototherapy may be the cause of increased stool frequency, through stimulation of intestinal water and electrolyte secretion.

Blood levels of gastrin, neurotensin and vasoactive peptide (VIP) were estimated in 14 premature infants with necrotizing enterocolitis (NEC) and in 12 controls. In comparison to the control group, infants with NEC had (a) significantly lower gastrin levels both before [9.3 (7.8) versus 33.7 (27.1)] and after [52.4 (48.1) versus 100.8 (50.9)] the development of NEC; (b) significantly lower neurotensin levels only after the development of NEC [37.8 (10.4) versus 54.5 (20.6)1; and (c) no significant difference in VIP values [25.4 (9.7) versus 18.9 (9.9) and 24.5 (15.7) versus 26.1 (19.1)]. It is concluded that NEC can adversely affect gastrin and neurotensin concentrations in the blood.