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Copyright of Acta Pediatrica de Mexico is the property of Instituto Nacional de Pediatria (INP) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective There is an ongoing debate about the best and comfortable way to administer surfactant. We hypothesized that uninterrupted respiratory support and continuous PEEP implementation while instilling surfactant via endotracheal tube (ETT) with side port will result in higher regional cerebral tissue oxygenation (rcSO2) and the alterations in cerebral hemodynamics will be minimal. Study Design Preterm infants who required intubation in the delivery room and/or in the first 24 hours of life with gestational age <32 were enrolled. Patients were intubated either via conventional ETT or ETT with side port (Vygon) with appropriate sizes. Following neonatal intensive care unit admission a near-infrared spectroscopy (NIRS) probe was placed on the forehead and each infant was started to be monitored with NIRS. In conventional ETT group, patients separated from the ventilator while surfactant was instilled. In ETT with side port group, respiratory support was not interrupted during instillation. Heart rate, oxygen saturation, rcSO 2 , cerebral fractional tissue oxygen extraction (cFTOE), and blood pressures were recorded. Results A total of 46 infants were analyzed. Surfactant was instilled with conventional ETT in 23 and ETT with side port in 23 infants. Birth weights (1,037 ± 238 vs. 1,152 ± 277 g) and gestational ages (28 ± 2.3 vs. 29 ± 1.6 weeks) did not differ between groups. During instillation of surfactant, rcSO2 levels [61.5 (49–90) vs. 70 (48–85)] and cFTOE levels 0.28 (0.10–0.44) vs. 0.23 (0.03–0.44)] were similar (p = 0.58 and 0.82, respectively). Conclusion Interruption of respiratory support during surfactant instillation did not significantly alter the cerebral tissue oxygenation. These results did not support our hypothesis and should be confirmed with further studies. Key Points Monitoring intracerebral oxygenation changes during surfactant administration with NIRS is feasible. The surfactant administration method does not significantly alter the cerebral oxygenation. Surfactant administration itself rather than the method caused a transient drop in cerebral NIRS readings. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of lung lavage with surfactant vs. bolus surfactant treatment in meconium aspiration syndrome (MAS).Patients and Methods: This randomized controlled trial included newborns ventilated with MAS. In lavage group (n = 17) 30 ml/kg of diluted porcine surfactant was instilled into the lung. In bolus group (n = 16) porcine surfactant (100 mg/kg) was administered as bolus. Respiratory outcomes and mortality were compared between groups.Results: Duration of respiratory support was found to be similar between lavage and bolus groups (3 vs. 3.5 days, p = 0.36). Death or requirement for extracorporeal membrane oxygenation (ECMO) was 12% vs. 6%; respectively (RR: 2, 95% CI 0.16-24.48; p = 1.0). Duration of oxygen therapy, high-frequency ventilation or inhaled nitric oxide requirement did not differ among the groups.Conclusion: Lung lavage did not show any advantage over bolus therapy on duration of respiratory support. The incidence of pneumothorax and surfactant re-administration decreased nonsignificantly in lavage group.Clinical Trial Registration: We registered the trial to ClinicalTrials.gov (http://clinicaltrials.gov) under identifier NCT02041546.Registry Name: Lung Lavage With Dilute Poractant Alfa for Meconium Aspiration Syndrome. [ABSTRACT FROM AUTHOR]

Aim: Alkaline phosphatase is perhaps the most important biochemical marker used in the diagnosis and follow-up of metabolic bone disease or osteopenia of prematurity (OP). The aim of this study was to investigate the percentiles of alkaline phosphatase (ALP) levels in premature infants compared to gestational age and to determine cut-off values for the diagnosis of osteopenia. Material Methods: All ALP results sent to our biochemistry laboratory between 2013-2018 were evaluated retrospectively. Of the total 2476 results, 1830 (74%) were found to belong to a separate infant born before 30 weeks of gestation. The results and demographic data of the patients whose clinical information could be reached were statistically analyzed. Results: The mean birth weight of the infants included in the study was 995 g±254 (450-1500 g) and the mean gestational week was calculated as 27±1.7 (24-29,6 weeks). The average alkaline phosphatase level was 510±225 U/L [median: 458 IU/L (159-1554)]. In serum ALP levels; 160.8 IU/L value 5. Percentile, 203 IU/L 10. percentile, 290 U/L 25. percentile 421 IU/L 50. percentile, 583 U/L 75. Percentile, 819 U/L formed 90th percentile and 969 U/L formed 95th percentile. Separate percentiles were also calculated for each gestational week interval. Conclusion: Although the infants included in the study were hospitalized premature infants, this is the reference range study with the largest number of patients in our country. Although the data is retrospective, these percentiles may be helpful in the evaluation and the diagnosis of osteopenia in premature infants. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to compare the efficacy of orally administeredLactobacillus reuteri (L. reuteri)versus nystatin in prevention of fungal colonization and invasive candidiasis in very low birth weight infants. Methods: A prospective, randomized comparative study was conducted in preterm infants with a gestational age of ≤32 weeks and birth weight of ≤1500 g. Patients were randomized into two groups, to receiveL. reuterior nystatin. Skin and stool cultures were performed once a week for colonization and blood cultures for invasive infections. The trial was registered to ClinicalTrials.gov under identifier NCT01531192. Results: A total of 300 preterm infants were enrolled (n = 150, for each group). Gastrointestinal colonization and skin colonization rates were not significantly different between the groups (18.7% versus 16%,p = 0.54 and 14% versus 12%,p = 0.6, respectively). Invasive candidiasis was detected in two patients of the probiotic group and one patient of the antifungal group. Proven sepsis, feeding intolerance, and duration of hospitalization were significantly lower in the probiotics group than in the antifungal group. Conclusions: ProphylacticL. reuterisupplementation is as effective as nystatin, and more effective in reducing the incidence of proven sepsis in addition to its favorable effect on feeding intolerance. [ABSTRACT FROM AUTHOR]

Objectives: We assessed the effects of antenatal steroid treatment on preterm laboratory analysis conducted in the first 24 hours of life., Methods: Medical records of inborn preterm infants whose gestational age was ≤32 weeks were retrospectively reviewed in this study. Preterm infants whose mothers received antenatal betamethasone treatment of either 12 mg or 24 mg and who did not were divided into two groups. Maternal and neonatal demographic characteristics, all preterm morbidities and mortality rates, early laboratory examinations were compared between the two groups., Results: Medical records of 603 infants between 2008 and 2013 were retrospectively reviewed. Data from 515 infants were analyzed. Three hundred and four infants (n=304) were in the antenatal steroid treatment (AST) group and 211 infants were in the group that did not receive the treatment. The incidence of preeclampsia and oligohydramnios was significantly higher in the AST group. Intubation in the delivery room rates decreased in the AST group. APGAR scores at five minutes were significantly higher in the AST group. White blood counts (WBC) significantly decreased, whereas the platelet counts were higher in the AST group. Serum C-reactive protein (CRP) and Interleukin-6 (IL-6) levels did not differ between groups., Conclusion: We did not demonstrate any relationship between inflammatory markers and antenatal steroid treatment in preterm infants., Competing Interests: Conflict of Interest: None declared., (Copyright: © 2020 by The Medical Bulletin of Sisli Etfal Hospital.)

Objective: To determine the risk factors associated with lower respiratory tract infections (LRTI) related hospitalizations in preterm infants receiving palivizumab throughout the high season for respiratory syncytial virus (RSV) infection., Methods: Premature infants who were commenced on palivizumab prophylaxis during the RSV season were included in the study following parental consent. Information on demographic, social, prenatal and postnatal clinical characteristics was recorded and risk factors associated with hospitalization were evaluated for each patient., Findings: While 234 participants (Group 1, 92.8%) did not require hospitalization during the study period, 18 patients (Group 2, 7.2%) were hospitalized at least once for LRTI during the RSV season. The rate of moderate-severe bronchopulmonary dysplasia (BPD) was significantly higher in group 2 compared to group 1 (38.9% vs 16.2%; P=0.016). Of the 18 infants who were hospitalized, 6 (33.3%) tested positive for RSV while the remaining 12 patients (66.7%) were negative for RSV. Odds ratio (OR) analysis of several risk factors revealed the presence of BPD (OR: 3.28; 95%CI: 1.19-9), being from a family with low socioeconomic status (OR: 3.64; 95%CI 1.08-12.3) to be associated with a higher likelihood of LRTI-related hospitalization., Conclusion: Our data demonstrated that RSV is an important LRTI agent and cause of hospitalization especially in preterm infants with additional risks such as BPD, gestational age of <28 weeks and low socioeconomic status. We suggest that improving care conditions and decreased BPD with prematurity would help in prevention of LRTI hospitalization.