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Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator that is used as a treatment for persistent pulmonary hypertension in neonates (PPHN) with hypoxic respiratory failure. The generation of reactive oxygen and nitrogen species might induce oxidative/nitrosative damage to multiple organs. There is an increasing scientific and clinical interest in the determination of specific biomarkers to measure the degree of oxidative/nitrosative stress in non-invasively collected biofluids. A method for the simultaneous detection of a panel of oxidative and nitrosative stress-related biomarkers for quantifying damage to proteins and DNA/RNA in 20 μL of infant urine samples based on reversed-phase ultra-performance liquid chromatography coupled to tandem mass spectrometry operating in positive electrospray ionization mode (ESI + ) was optimized and validated. Infant urine samples from two different studies were analyzed: (i) term and preterm infants from a nutrition study (Nutrishield, N = 50) and (ii) infants with respiratory insufficiency, including infants with PPHN (N = 16) that required iNO treatment and a control group without treatment (N = 14). Eleven of 14 metabolites were detected in >50 % of infant urine samples, with ranges between 0.008 and 1400 μmol/g creatinine. When comparing across groups, differences in samples collected after iNO treatment in comparison to the rest of the groups were found for m-tyrosine (m-Tyr and m-Tyr/Phe) and ortho-tyrosine (o-Tyr and o-Tyr/Phe) (p-values <0.001, Wilcoxon rank-sum test). Positive linear relationships were found with NO exposure corrected by infant weight for m-Tyr, m-Tyr/Phe, o-Tyr, o-Tyr/Phe and 3-nitrotyrosine. Future studies will focus on the evaluation of the impact of iNO treatment on health and oxidative/nitrosative stress-related morbidities associated with prematurity., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Julia Kuligowski reports financial support was provided by Carlos III Health Institute. Abel Albiach-Delgado reports financial support was provided by Carlos III Health Institute. Aljandro Pinilla-González reports financial support was provided by Carlos III Health Institute. Inmaculada Lara Cantón reports financial support was provided by Carlos III Health Institute. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 Elsevier Inc. All rights reserved.)

Introduction: Moderate and late preterm (MLPT) infants represent a substantial percentage of all preterm infants and frequently need support in the delivery room. Deferred cord clamping (DCC) improves SpO2 and heart rate (HR) stabilization in term infants. However, data on MLPT infants are limited., Methods: We performed a prospective observational study collecting SpO2 and HR by pulse oximetry in healthy MLPT infants with DDC to construct percentile graphs for the first 10 min after birth., Results: A total of 96 MLPT infants were monitored for preductal SpO2 and HR, and percentiles were calculated. SpO2 mean was significantly lower for MLPT than for term infants during the first 6 min after birth, and 15% did not achieve SpO2 ≥85% in the first 5 min after birth. HR was significantly lower in MLPT infants in the first 4 min after birth; however, HR consistently remained above bradycardic values (>100 bpm). NICU admission and postnatal complications were not different between MLPT achieving SpO2 ≥85% or not., Conclusion: MLPT infants with DCC achieved stable SpO2 and HR significantly later, 6 min and 4 min, respectively, than term infants. In addition, 15% of MLPT infants did not achieve SpO2 ≥85% at 5 min after birth. However, admission to the NICU and clinical evolution did not differ from newborns with SpO2 ≥85% at 5 min. Larger studies including long-term follow-up are needed to assess if lower SpO2 in the first 5 min has clinical consequences in non-resuscitated MLPT., (© 2024 S. Karger AG, Basel.)

Introduction: Intraventricular hemorrhages remain a major problem in neonatology, because their complications affect neonatal morbidity, mortality, and long-term neurodevelopmental outcomes., Aim: The aim of this project was to prevent intraventricular hemorrhage in premature infants during their first days of life in a neonatal intensive care unit (NICU)., Methods: This pre- and post-implementation clinical audit project used the JBI Evidence Implementation Framework and was conducted in a tertiary-level Spanish NICU with a consecutive sample. A baseline audit was conducted using 13 audit criteria derived from JBI summaries of the best available evidence. This was followed by the implementation of an action plan, which included a care bundle and health care professionals' education. These improvement strategies were then evaluated using a follow-up audit., Results: The baseline and follow-up audits evaluated 54 and 56 infants, respectively. The follow-up audit showed 100% improvement for Criteria 2, 3, 6, and 7, which covered sleep safety and noise. Criteria 12 and 13, which covered cord clamping and positioning the infant, improved by 25.99%. Criterion 9, on antenatal corticosteroids, showed a slight improvement of 5.56%., Conclusions: This study increased compliance with an evidence-based, family-centered care approach to preventing intraventricular hemorrhage in premature infants. This was achieved by conducting a baseline and follow-up audit, implementing a training program, and keeping more comprehensive nursing records. Further studies could assess the long-term effectiveness of interventions and/or the incidence of intraventricular hemorrhage and neurodevelopmental disorders in premature infants., Spanish Abstract: http://links.lww.com/IJEBH/A262., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 JBI. Unauthorized reproduction of this article is prohibited.)

Introduction: Ventilator-associated pneumonia (VAP) constitutes a serious nosocomial infection. Our aim was to evaluate the reliability of cytokines and oxidative stress/inflammation biomarkers in bronchoalveolar lavage fluid (BALF) and tracheal aspirates (TA) as early biomarkers of VAP in preterm infants., Methods: Two cohorts were enrolled, one to select candidates and the other for validation. In both, we included preterms with suspected VAP, according to BALF culture, they were classified into confirmed VAP and no VAP. Concentration of 16 cytokines and 8 oxidative stress/inflammation biomarkers in BALF and TA was determined in all patients., Results: In the first batch, IL-17A and TNF-α in BALF, and in the second one IL-10, IL-6, and TNF-α in BALF were significantly higher in VAP patients. BALF TNF-α AUC in both cohorts was 0.86 (sensitivity 0.83, specificity 0.88). No cytokine was shown to be predictive of VAP in TA. A statistically significant increase in the VAP group was found for glutathione sulfonamide (GSA) in BALF and TA., Conclusions: TNF-α in BALF and GSA in BALF and TA were associated with VAP in preterm newborns; thus, they could be used as early biomarkers of VAP. Further studies with an increased number of patients are needed to confirm these results., Impact: We found that TNF-α BALF and GSA in both BALF and TA are capable of discriminating preterm infants with VAP from those with pulmonary pathology without infection. This is the first study in preterm infants aiming to evaluate the reliability of cytokines and oxidative stress/inflammation biomarkers in BALF and TA as early diagnostic markers of VAP. We have validated these results in two independent cohorts of patients. Previously studies have focused on full-term neonates and toddlers and determined biomarkers mostly in TA, but none was exclusively conducted in preterm infants., (© 2022. The Author(s).)

This is a narrative review about the mechanisms involved in bacterial sepsis in preterm infants, which is an illness with a high incidence, morbidity, and mortality. The role of the innate immune response and its relationship with oxidative stress in the pathogenesis are described as well as their potential implementation as early biomarkers. Moreover, we address the impact that all the mechanisms triggered by sepsis have on the dysbiosis and the changes on neonatal microbiota.

Introduction: We aimed to investigate the cerebral fractional tissue oxygen extraction (FtOE) during kangaroo care (KC) in premature infants and compare cardiorespiratory stability and hypoxic or bradycardic events between KC and incubator care., Methods: A single-center prospective observational study was carried out at the NICU of a level 3 perinatal center. Preterm infants &lt;32 weeks gestational age were subjected to KC. Patients were subjected to continuous monitoring of regional cerebral oxygen saturation (rScO2), peripheral oxygen saturation (SpO2), and heart rate (HR) during KC, before KC (pre-KC), and after KC (post-KC). The monitoring data were stored and exported to MATLAB for synchronization and signal analysis including the calculation of the FtOE and events analysis (i.e., desaturations and bradycardias counts and anormal values). Furthermore, the event counts and the mean SpO2, HR, rScO2, and FtOE were compared between studied periods employing the Wilcoxon rank-sum test and the Friedman test, respectively., Results: A total of forty-three KC sessions with their corresponding pre-KC and post-KC segments were analyzed. The distributions of the SpO2, HR, rScO2, and FtOE showed different patterns according to the respiratory support, but not differences between the studied periods were detected. Accordingly, no significant differences in monitoring events were evidenced. However, cerebral metabolic demand (FtOE) was significantly lower during KC compared with post-KC (p = 0.019)., Conclusion: Premature infants remain clinically stable during KC. Moreover, cerebral oxygenation is significantly higher and cerebral tissular oxygen extraction is significantly lower during KC compared with incubator care in post-KC. No differences in HR and SpO2 were shown. This novel data analysis methodology could be expanded to other clinical situations., (© 2023 S. Karger AG, Basel.)

Introduction: Venous sinus thrombosis (VST) is a rare entity in pediatrics, probably under-diagnosed and poten tially serious, described as a cause of stroke in childhood., Objective: To describe the clinical presenta tion, risk factors, treatment, and evolution of pediatric patients with VST., Patients and Method: Re trospective study of patients admitted to a referral hospital, diagnosed with VST, aged between one month and seventeen years, from January 2011 to December 2019. The following data were re viewed: age at diagnosis, sex, signs and symptoms of presentation, predisposing mechanisms, study of thrombophilias, treatment and duration of treatment, follow-up protocol, long-term sequelae, and mortality. Due to their differences in clinical presentation, the sample was divided into two age groups: young children between 1 month and 5 years and older children and adolescents between 6 and 17 years., Results: 17 patients were diagnosed with VST, 45% were women, with a median age of 4.5 years. The most frequent symptoms in older children (6-17 years old) were headache (80%) and diplopia (60%). In children under 5 years old, the most frequent clinical presentation was cerebellar ataxia (42%), asymptomatic (34%), and headache (25%). In 23.5% of the total, VST was a casual fin ding in neuroimaging. 13 patients presented relevant histories such as complicated otitis media with mastoiditis (53%), severe traumatic head injury (6%), and resection of a space-occupying lesion of the brain (6%). 23% of the cases were idiopathic and in 23% there were prothrombotic factors. The treatment of choice in all patients was low-molecular-weight heparin. During the short-term follow- up, 11.8% presented self-limited neurological symptoms. One patient presented long-term paresis of the sixth paired cranial nerve. There were no deaths or recurrences of the episode in our series., Conclusions: VST is a rare entity and it usually appears with signs and symptoms of intracranial hy pertension. It is a potentially serious condition and early diagnosis and treatment can help minimize long-term sequelae.