Neonatology
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Periventricular leukomalacia (PVL), a common neonatal brain white matter (WM) lesion, is frequently associated with cerebral palsy. Growing evidence has indicated that in addition to ischemia/reperfusion injury, cytokine-induced brain injury associated with maternal or fetal infection may also play an important role in the pathogenesis of PVL. Recent studies have shown that administration of lipopolysaccharide (LPS) to pregnant rats causes enhanced expression of the cytokines, i.e., IL-1 beta, TNF-alpha, and IL-6, in fetal brains. ⋯ While the postnatal EPO treatment prevented LPS-induced brain injury this effect was partial. To our knowledge, this is the first study that demonstrates a protective effect of EPO on LPS-induced WM injury in the developing brain. Regarding the wide use of EPO in premature newborns, this agent maybe potentially beneficial in treating LPS-induced brain injury in the perinatal period.
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Comparative Study
Bruising at birth: antenatal associations and neonatal outcome of extremely low birth weight infants.
Early studies have identified severe cranial bruising as a risk factor for intraventricular hemorrhage (IVH) in premature infants but the nature of this association has not been evaluated. ⋯ Antenatal exposure to steroids and increasing gestational age are associated with a lower incidence of bruising at birth in extremely low birth weight infants. Severe bruising at birth is associated with increased incidence of severe intraventricular hemorrhage and mortality.
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Transient tachypnea of the newborn (TTN) is a mild form of neonatal respiratory distress which early in its course needs to be differentiated from other severe respiratory disorders. At present the diagnosis is based on radiological findings and clinical course. Lung sonography in TTN has not yet been assessed. ⋯ We found lung sonography reliable for the early diagnosis of TTN. We suggest that it should become the first approach for imaging of neonatal respiratory distress although further prospective studies with good blinding need to be performed.
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Treatment with surfactant (S) decreases lung injury in paralyzed, mechanically ventilated animals. The use of nasal continuous positive airway pressure (CPAP) as an alternative to mechanical ventilation may further improve acute pulmonary outcomes. ⋯ Animals treated with surfactant prior to CPAP or SIMV had less acute lung injury. SIMV+S animals had less open air space in nondependent regions. This suggests, during early ventilatory support, surfactant administration may modulate pulmonary inflammation. CPAP alone without surfactant may not provide optimal pulmonary protection. The addition of mechanical breaths may alter and add to injury.
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Inherited disorders of pulmonary surfactant-associated proteins are rare but provide important insights into unique mechanisms of surfactant dysfunction. Recessive loss-of-function mutations in the surfactant protein-B and the ATP-binding cassette family member A3 (ABCA3) genes present as lethal surfactant deficiency in the newborn, whereas other recessive mutations in ABCA3 and dominant mutations in the surfactant protein-C gene result in interstitial lung disease in older infants and children. The molecular basis and the genetic and tissue-based approaches to the evaluation of children suspected of having one of these disorders are discussed.