American journal of perinatology
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Intravenous indomethacin and intravenous ibuprofen are widely used for the treatment of patent ductus arteriosus (PDA) in premature infants. Intravenous indomethacin may lead to renal impairment, enterocolitis, and intraventricular hemorrhage. Intravenous ibuprofen was shown to be as effective and to cause fewer side effects. ⋯ Late outcome showed 15 cases (37.5%) of nosocomial sepsis, 3 cases (7.5%) of chronic lung disease, 2 cases (5%) of periventricular leukomalacia, and 17 cases of death. In this study, oral ibuprofen was effective and well tolerated for early curative closure of PDA in very premature infants. Nevertheless, larger randomized comparative studies with pharmacokinetics measures are warranted.
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Randomized Controlled Trial
Immediate versus delayed umbilical cord clamping in premature neonates born < 35 weeks: a prospective, randomized, controlled study.
The purpose of this study was to test whether delayed versus immediate cord clamping would result in higher blood pressure (BP) and hematocrit (Hct), and to assess its clinical effects on the neonatal course in premature neonates (< 35 weeks). This was a prospective, masked, randomized, controlled study. Prior to delivery, 35 neonates were randomly assigned to immediate cord clamping (ICC) at 5 to 10 seconds, and a comparable group of 30 neonates were randomly assigned to delayed cord clamping (DCC) at 30 to 45 seconds. ⋯ Infants with DCC did not experience more polycythemia (Hct > 60%), but had a trend toward higher bilirubin levels with no differences in the phototherapy needs. DCC seems to be safe and may be beneficial when compared with ICC in premature neonates. However, the differences between the two methods were modest and the clinical relevance needs to be assessed further by larger studies and additional meta-analysis of randomized trials.
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The purpose of this study was to characterize the effects of doubling minute ventilation (either by doubling ventilator frequency [Freq] or tidal volume [V T]) and of normal minute ventilation prolonged to 12-fold duration, synchronously at biophysical, biochemical/cellular, histological, and transcriptional levels in a model of mild lung injury. A prospective, randomized study was performed on adolescent New-Zealand white rabbits. The rabbits were randomly assigned to one of the following groups: control (normal minute ventilation for 0.5 hours); 1 x V T, 12-fold prolongation at normal V T (normal minute ventilation for 6 hours [12 x 0.5 hours]); 2 x Freq at normal V T (double minute ventilation for 6 hours); and 2 x V T at normal Freq (double minute ventilation for 6 hours). ⋯ At the transcriptional level, lung IL-8 mRNA expression increased 11-fold in the 2 x V T group ( P = 0.002), 9-fold ( P = 0.02) in the 2 x Freq group, and 4-fold in the 1 x V T group as compared with control. Not only doubling V T, but also doubling Freq at normal V T injures the lung significantly, although to a lesser extent. A concept of weighted risk for increases of V T and Freq is proposed.
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Randomized Controlled Trial
Efficacy and renal toxicity of one daily dose of amikacin versus conventional dosage regime.
This study assessed the efficacy and renal toxicity of one daily dose of amikacin versus several doses in infected full-term newborns. A clinical trial was conducted with 120 patients who were divided into two groups: group A (n = 60), infants who received amikacin 20 mg/kg/d in one dose; and group B (n = 60), infants who received amikacin 10 mg/kg/d every 12 hours. Both groups also received ampicillin 100 mg/kg/day. ⋯ No significant difference was found in efficacy or renal toxicity in either group. We recommend using amikacin in one daily dose. It could diminish the manipulation of intravenous access, reducing the risk of nosocomial infections.
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Randomized Controlled Trial Comparative Study
A comparison of a new, ultrathin-walled two-stage twin endotracheal tube and a conventional endotracheal tube in very premature infants with respiratory distress syndrome: a pilot study.
This was a pilot study to test the feasibility of use of the ultrathin-walled two-stage twin endotracheal tube (UTTS-T-ETT), with one half to one third the resistance to gas flow and one third to one seventh the dead space of a conventional tracheal tube, in very premature infants. Twenty-eight infants with gestational age 24 to 28 weeks and birthweight >/= 500 g with respiratory distress syndrome requiring intubation and mechanical ventilation were randomly assigned to be intubated with either the UTTS-T-ETT (13 infants) or with a conventional ETT (15 infants). The infants in the two groups were similar in GA, birthweight, age of entry in the study, and initial ventilator settings. ⋯ The use of the UTTS-T-ETT is feasible in preterm infants. There was no difference in adverse events associated with its use compared with a conventional ETT. Given the proven in vitro advantages and a favorable trend toward facilitation of extubation in this pilot study, a larger randomized trial to assess clinical benefit and confirm safety is indicated.