Pediatric research
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Ureaplasma species are the microorganisms most frequently isolated from women with preterm birth and are associated with an increased risk of bronchopulmonary dysplasia. Initiation of ventilation with high tidal volumes (VT) causes lung injury and inflammation. We investigated whether antenatal colonization with Ureaplasma parvum serovar 3 (UP) would alter the inflammatory response to mechanical ventilation of preterm lambs. ⋯ Monocytes in bronchoalveolar lavage were increased by UP, but colonization did not affect lung function. High VT ventilation increased Egr-1 signaling, proinflammatory cytokine expression, and injury scores compared with GV. Antenatal colonization with UP did not change lung function or modulate the lung injury and inflammation caused by high VT ventilation.
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To understand scoliosis, related comorbidities, and phenotype-genotype correlations in individuals with Rett syndrome (RTT), the Rare Disease Clinical Research Network database for RTT was probed. Clinical evaluations included a detailed history and physical examination, comprehensive anthropometric measurements, and two quantitative measures of clinical status, Clinical Severity Scale (CSS) and motor-behavioral analysis (MBA). All data were exported to the Data Technology Coordinating Center (DTCC) at the University of South Florida. ⋯ Two common methyl-CpG-binding protein 2 (MECP2) mutations, R294X and R306C, had reduced risk for scoliosis. These findings corroborated previous reports on scoliosis and extended understanding of comorbidities, clinical severity, and relative risk reduction for specific mutations. Clinical trial design should account for scoliosis and related factors judiciously.
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Review
Use of analgesic and sedative drugs in the NICU: integrating clinical trials and laboratory data.
Recent advances in neonatal intensive care include and are partly attributable to growing attention for comfort and pain control in the term and preterm infant requiring intensive care. Limitation of painful procedures is certainly possible, but most critically ill infants require unavoidable painful or stressful procedures such as intubation, mechanical ventilation, or catheterization. ⋯ Risk/benefit ratios of intermittent boluses or continuous infusions for the commonly used sedative and analgesic agents are discussed in the light of clinical and experimental studies. The limitations of extrapolating experimental results from animals to humans must be considered while making practical recommendations based on the currently available evidence.
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The aim of the study was to determine the incidence of electrographic seizure activity in a prospective cohort of preterm infants and relate it to the presence of cerebral injury. Infants born <30-wk gestation received a median 74 h of continuous 2-channel EEG with amplitude-integrated EEG monitoring in the first week of life. Infants were classified in the abnormal outcome group if they died in the neonatal period and/or had grades 3-4 intraventricular hemorrhage and/or moderate or severe abnormalities on cerebral MRI. ⋯ Three of the four infants with seizures and concurrent physiologic recordings displayed concurrent rises in heart rate and one showed a fall in respiratory rate. In conclusion, electrographic seizures were more likely to occur in the sicker and more premature infants with abnormal outcomes. Seizures detected on continuous amplitude-integrated EEG monitoring with the raw EEG were associated with poor outcome.
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Comparative Study
Feasibility and short-term effects of biphasic positive airway pressure versus assist-control ventilation in preterm lambs.
Biphasic positive airway pressure (BiLevel) ventilation allows utilization of two alternating positive end-expiratory pressures (PEEP) while permitting unrestricted spontaneous breathing with superimposed synchronized pressure support. We aimed to compare whether BiLevel versus assist-control (A-C) ventilation provides effective gas exchange and reduces severity of early lung injury in preterm lambs. Preterm lambs delivered at 134 d (term = 150 d) were quasirandomized to BiLevel (PEEP low/high 5/20 cm H2O) or A-C5 (PEEP 5 cm H2O) ventilation. ⋯ There were no significant differences between groups in baseline characteristics, oxygenation index (p = 0.49), or partial pressure of carbon dioxide (Paco2) (p = 0.08). BiLevel group lambs showed improved pressure-volume relationship (p = 0.006), lower lung inflammatory score (p = 0.013), and trend toward lower messenger RNA expression of markers of lung injury compared with A-C5 group lambs. In unsedated preterm lambs, BiLevel ventilation provides gas exchange equivalent to A-C ventilation and potentially results in reduced lung injury.