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Piotrowski A.,Medical University of Lódz | Dabrowska-Wojciak I.,Medical University of Lódz | Mikinka M.,Medical University of Lódz | Fendler W.,Medical University of Lódz | And 3 more authors.
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2010

Background.The association between intraventricular hemorrhage (IVH) and coagulation in infants has been a subject of controversy. Only few publications assessing risk factors for development of IVH reported results of coagulation studies. Objectives.To evaluate the levels of coagulation and fibrinolysis systems in ELBW infants and determine their influence on IVH. Patients and methods.Following IRB approval coagulation status of 38 ELBW infants was evaluated on first and second day of life. Severity of IVH assessed by cerebral ultrasonography was graded according to Papile classification. Newborns were assigned to either Group A Grade III or IV, or Group B Grade III, or no IVH. Results.Neonates with Grade III/IV IVH had significantly lower plasma Factor VII (FVII) level on first day of life and FVII differed significantly between Groups A and B with sensitivity of 100, specificity 41 for a cut-off value of<7. In Group A there was no improvement of prothrombin and activated partial thromboplastin times on Day 2. A significant decline of platelet count was also observed. Conclusions.High-grade IVH coincides with severe derangement of coagulation in ELBW infants with FVII level being the most sensitive, it is not clear what reason for such low FVII concentration is. Further studies are indicated. © 2010 Informa UK Ltd.


PubMed | Pediatric and Neonatal Intensive Care Unit and University of Geneva
Type: Journal Article | Journal: Clinics and practice | Year: 2014

We report a case of a premature infant presenting with recurrent pulmonary hemorrhage in which we performed a therapeutic lavage with diluted surfactant after an acute episode of bleeding with severe intractable hypoxemia. Repeated small aliquots of diluted surfactant (102 mL) allowed rapid improvement in oxygenation and reduction of required mean airway pressures during high frequency oscillatory ventilation. This observation may suggest that surfactant lavage could be beneficial in massive pulmonary hemorrhage in infants. A randomized controlled trial might be needed to clarify the potential benefit of this therapeutic intervention on outcome of infants suffering from this life-threatening complication.


Doublet J.,Pediatric and Neonatal Intensive Care Unit | Vialet R.,Pediatric and Neonatal Intensive Care Unit | Nicaise C.,Pediatric and Neonatal Intensive Care Unit | Loundou A.,Aix - Marseille University | And 2 more authors.
Minerva Pediatrica | Year: 2013

Aim. The aim of this paper was to determine if the total parenteral nutrition (PN) goals for newborns in the first two weeks of lifer were better achieved with individualized prescriptions (IND-PN) or standardized formulations STD-PN prescriptions. Methods. A retrospective study was conducted in a 16-bed polyvalent pediatric and neonatal intensive care unit in a university hospital, to compare two one-year periods, before and after a move from individualized to standardized formulations. All the prescriptions for newborns who were admitted to our unit on their first day of life and required total PN were evaluated. The primary end-point was the percentage of prescriptions full filling the PN goals defined in the written policy of our unit. Results. More than 3500 prescriptions were included. The goals of PN were better achieved with STD-PN (44.0% vs. 9.4% of the prescriptions)., even after adjustment for term and birth weight. Differences between groups appeared as early as the third day of PN and remained during the first 15 days of PN. Conclusion. The goals of total PN were better achieved with STD-PN. Perhaps because standardized formulations contain fixed and proportional amounts of nutrients, their use results in less deviation from the established policy.


PubMed | Pediatric and Neonatal intensive Care Unit
Type: Journal Article | Journal: Pediatric reports | Year: 2012

Septic shock remains a major cause of morbidity and mortality among children, mainly due to acute hemodynamic compromise and multiple organ failures. In the last decade, international guidelines for the management of septic shock, as well as clinical practice parameters for hemodynamic support of pediatric patients, have been published. Early recognition and aggressive therapy of septic shock, by means of abundant fluid resuscitation, use of catecholamines and other adjuvant drugs, are widely considered of pivotal importance to improve the short and long-term outcome of these patients. The aim of this paper is to summarize the modern approach to septic shock in children, particularly in its very initial phase, when pediatric healthcare providers may be required to intervene in the pre-intensive care unit setting or just on admission in the pediatric intensive care unit.

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