American journal of perinatology
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Comparative Study Clinical Trial Controlled Clinical Trial
Diagnostic value of cytokines and C-reactive protein in the first 24 hours of neonatal sepsis.
The first objective of this article was to determine the diagnostic accuracy of tumor necrosis factor-alpha, interleukin-6 (IL-6), and interleukin-8 (IL-8) in differentiating infected from noninfected neonates during the first 24 hours of suspected sepsis and to compare them to the currently used laboratory parameters: C-reactive protein (CRP), immature-to-total neutrophil ratio, and leukocyte and platelet count. The secondary objective was to compare the cytokine levels in subpopulations of neonates. Seventy-five premature and 30 term infants were enrolled. ⋯ A combination of CRP > 10 pg/mL plus IL-6 > 18 pg/mL (sensitivity = 89%, specificity = 73%, PPV = 70%, NPV = 90%) was the best "0-hour" test, and CRP (sensitivity = 78%, specificity = 94%) was the best "24-hours" test. Lower IL-6 at 0-hour (p = 0.018) and IL-8 at 24 hours (p = 0.023) were detected among the patients infected with coagulase-negative staphylococci then with other bacteria. In conclusion, a combination of CRP + IL-6 provided additional diagnostic accuracy for differentiation between septic and nonseptic patients during the first 24 hours of suspected sepsis.
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The objective of this article is to determine whether low-birth-weight (LBW) infants have the capacity to modulate minute ventilation to achieve a CO (2) set-point within ranges acceptable to clinicians during a procedure designed to identify the best dynamic compliance loops. By using dynamic flow-loop mechanics, we performed a prospective stepwise reduction of tidal volume (by reduction of peak inspiratory pressure, keeping end-expiratory pressure constant), in a group of LBW infants to identify the steepest slope of the dynamic flow-loop. We used flow-synchronized, assist-control mechanical ventilation with termination sensitivity set at 5%. ⋯ LBW infants have the capacity to alter respiratory rate to change minute ventilation in response to a reduction of tidal volume created by lowering the PIP. Using this model of endogenous CO(2) challenge in ventilated infants, we conclude that LBW neonates have the capacity to select a CO(2) set-point. This approach suggests an important avenue through which a clinician can minimize volutrauma through a reduction of PIP and use of expiratory trigger to limit excessive PIP and an overall lower mean airway pressure.
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A premature twin infant presented with clinical signs of shoulder injury shortly after birth. He had been delivered by cesarean section due to malpresentation. ⋯ Ultrasound examination in these infants can be helpful in determining the true extent of skeletal injury. Immobilization and pain control are then indicated to optimize the outcome.
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The objective of this study was to determine if newborn premature infants with severe respiratory distress syndrome (RDS) who developed bronchopulmonary dysplasia (BPD) demonstrate, within the first 3 days of life, lower blood levels of antioxidants and higher urine levels of lipid peroxidation products than premature infants who recovered from RDS. Perinatal variables (gestational age, birth weight, and Apgar scores) and antioxidant indices in cord and in third day of life plasma and red blood cell (RBC) samples from healthy premature infants (n = 35), infants with RDS (n = 23) and infants with BPD (n = 23) were examined. Antioxidant indices included selenium, alpha-tocopherol, total and oxidized glutathione, glutathione peroxidase, superoxide dismutase, and urinary malondialdehyde. ⋯ In this study, there was no relationship between lipid peroxidation and BPD. There was a higher rate of patent ductus arteriosus, congestive heart failure, and retinopathy of prematurity in infants with BPD. This study confirms that low plasma selenium and alpha-tocopherol levels in premature infants (< or = 30 weeks' gestational age or lower) were significantly associated with an increased respiratory morbidity.
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Review Case Reports
Maternal Arnold-Chiari type I malformation and syringomyelia: a labor management dilemma.
Arnold-Chiari type I malformations consists of elongation of the cerebellar tonsils with their displacement below the foramen magnum. Syringomyelia is an associated cyst that accumulates cerebrospinal fluid in the cord that can impinge on local nerve fibers. Pregnant women with either of these disorders are of special concern due to the potential risk of brain stem herniation and or spinal column compression from physiological changes that occur during labor. ⋯ Although these are rare disorders with significant potential morbidity, labor can be managed by either mode of delivery with careful patient selection. We caution that this review has insufficient numbers of patients to address the safety and efficacy of either delivery mode but rather focuses on alternatives for delivery. This report is the first to document a case of a patient with an Arnold-Chiari malformation and syringomyelia successfully managed in labor with a vaginal delivery.