Abstract: We investigated the relationship between the severity of histological inflammatory responses in the placenta, chorionic plate, and umbilical cord in conjunction with the intra ventricular hemorrhage (IVH) risk in premature infants. Clinical data were prospectively collected for 287 consecutive premature neonates born before 32 completed weeks of gestation, admitted to level III neonatal intensive care unit (NICU) of Pediatric Department of Padua University from January 1999 to December 2004. Placental histology for HCA was graded and scored according to Redline et al. The diagnosis of IVH (grade I to IV) was graded according to Volpe's classification. Among the placentas of the 287 preterm examined infants, 68 (23.6%) were diagnosed with acute HCA. Overall incidence of IVH was 11.8%. Of 68 preterm neonates with HCA, 11 developed IVH (16.1%). Maternal HCA at the higher grades and stages increased the risk of IVH: 7 (64%) of the 11 preterm infant with maternal HCA grade 3 developed IVH (RR; 95% CI 2.05; 1.1-3.6) and 8 (73%) of the 11 preterm neonates with stage 3 developed IVH (RR; 95% CI 1.59; 1.0-2.5), respectively. Conversely, fetal inflammation was not associated with an increased risk of IVH. In conclusion, the IVH risk in preterm infants <32 gestation weeks is significantly associated with severe grade and stage maternal HCA inflammatory scores.
Abstract: Widened pulse pressure is a classic sign of significant left-to-right shunting patent ductus arteriosus (PDA), but little evidence supports this statement in the early life of premature infants with respiratory distress syndrome (RDS) needing nonsteroidal anti-inflammatory drugs (NSAIDs), the pharmacological treatment for PDA. Pulse pressure and urinary endothelin-1 (ET-1) and arginine vasopressin (AVP) vasoactive factors involved in the transitional circulation were measured before and after the NSAIDs treatment of 46 RDS premature infants receiving either ibuprofen (n = 22) or indomethacin (n = 24), with 28 responders and 18 nonresponders to the first NSAIDs course. We found that following pharmacological PDA closure, systolic and diastolic blood pressure significantly increased, maintaining a stable pulse pressure. However, when pharmacological closure failed, the trend (nonsignificant) was for a more consistent increase in systolic than in diastolic blood pressure, which determined a statistically significant widening pulse pressure. In addition, urinary ET-1 excretion rates decreased significantly after PDA closure, whereas persistent more aggressive pharmacological therapy failed. Urinary AVP excretion rates decreased insignificantly after therapy, uninfluenced by the efficacy of the drugs. We concluded that widened pulse pressure is a clinical sign of failed PDA pharmacological closure in RDS premature infants. ET-1 levels remain elevated when NSAIDs fail to interrupt left-to-right PDA shunting that complicates recovery from RDS.
Abstract: Objective: Neonatal mortality has remained steady or increased in many developing countries. A pragmatic approach to the organization of the delivery room setting, where a large part of neonatal deaths occurs, could detect the priorities for potential ameliorative interventions. We evaluated the local health caregivers' opinions regarding the priority areas for improving the hospital delivery room setting in developing countries. Methods: Twenty-eight participants to a World Health Organization (WHO) workshop were asked to fill out an anonymous, written questionnaire regarding the priorities that could significantly improve their hospital delivery room setting. Results: The three most important interventions for improving the delivery room setting were classified as following: education of all staff in newborn care (28%), optimize doctor-nurse/patient ratio (15%), equipment (14%), maternal-antenatal care (13%), role and responsibilities (8%), salary (8%), neonatal intensive care unit facilities (6%), availability of a specialized team for neonatal resuscitation (5%) and improve the building (3%). Conclusion: Education of health staff in newborn care, personnel organization and equipment availability are valued as high priorities by local health caregivers for improving the delivery room setting in developing countries. The opinion of operators involved in maternal and neonatal health may contribute to better design interventions in setting with limited resources.
