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Shaikhkhalil A.K.,Hepatology and Nutrition | Curtiss J.,Section of Neonatology | Puthoff T.D.,Nationwide Childrens Hospital | Valentine C.J.,Cincinnati Childrens Hospital Medical Center
Journal of Pediatric Gastroenterology and Nutrition | Year: 2014

OBJECTIVE: Zinc deficiency causes growth deficits. Extremely-low-birth- weight (ELBW) infants with chronic lung disease (CLD), also known as bronchopulmonary dysplasia, experience growth failure and are at risk for zinc deficiency. We hypothesized that enteral zinc supplementation would increase weight gain and linear growth. METHODS: A cohort of infants was examined retrospectively at a single center between January 2008 and December 2011. CLD was defined as the need for oxygen at 36 weeks postmenstrual age. Zinc supplementation was started in infants who had poor weight gain. Infants' weight gain and linear growth were compared before and after zinc supplementation using the paired t test. RESULTS: A total of 52 ELBW infants with CLD met entry criteria. Mean birth weight was 682 ± 183 g, and gestational age was 25.3 ± 2 weeks. Zinc supplementation started at postmenstrual age 33 ± 2 weeks. Most infants received fortified human milk. Weight gain increased from 10.9 before supplementation to 19.9 g · kg-1 · day-1 after supplementation (P < 0.0001). Linear growth increased from 0.7 to 1.1 cm/week (P = 0.001). CONCLUSIONS: Zinc supplementation improved growth in ELBW infants with CLD receiving human milk. Further investigation is warranted to reevaluate zinc requirements, markers, and balance. Copyright © 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. Source

Hsiao C.-C.,Changhua Christian Hospital | Hsiao C.-C.,Chung Shan Medical University | Tsai M.-L.,China Medical University at Taichung | Chen C.-C.,Section of Neonatology | And 2 more authors.
Nutrition Reviews | Year: 2014

Recent advances in perinatal and neonatal intensive care have resulted in significant improvements in the survival of preterm extremely low-birthweight (PELBW) infants; however, extrauterine growth restriction (EUGR) and undernutrition occur frequently during hospitalization and are associated with adverse outcomes, including bronchopulmonary dysplasia, sepsis, and neurodevelopmental impairment. Early optimal parenteral nutrition with adequate amino acids and lipids, especially long-chain polyunsaturated fatty acids, has been shown to decrease the incidence of EUGR, bronchopulmonary dysplasia, necrotizing enterocolitis, sepsis, and retinopathy of prematurity in animal models and clinical trials. In PELBW infants, breast milk and probiotics have been shown to reduce the incidence of necrotizing enterocolitis, and lactoferrin has been demonstrated to prevent late-onset sepsis. Thus, early administration of optimal postnatal parenteral and enteral nutrients can help prevent neurodevelopmental impairment caused by EUGR, necrotizing enterocolitis, sepsis, bronchopulmonary dysplasia, and retinopathy of prematurity, and recent evidence indicates such treatment is feasible. © 2014 International Life Sciences Institute. Source

Gillam-Krakauer M.,Vanderbilt University | Carter B.S.,Section of Neonatology
Pediatrics in Review | Year: 2012

• Based on observational and animal studies, human newborns are more susceptible to seizures than older children. (5)(6) • Based on observational studies and expert opinion, compared with older children, newborn infants are more likely to manifest seizures with oral-buccallingual movements, oculomotor phenomena, or apnea. (4)(6) • Based on strong research evidence, the degree of severity of hypoxic-ischemic encephalopathy strongly influences the neurodevelopmental outcome of affected infants. (16) • Based on strong research evidence, newborns who have hypoxic-ischemic encephalopathy should be treated with moderate hypothermia (head- or whole-body cooling). (17)(18) • Based on some research evidence and consensus, newborns who have hypoxic-ischemic encephalopathy or clinical concern for seizures should undergo a bedside EEG. (35)(36)(37) • Based on consensus, discontinuation of antiepileptic medications can be considered in infants without congenital brain malformations who are subsequently free of seizures (clinically and electrographically). (6). Source

Rhee C.J.,Section of Neonatology | Rhee C.J.,Baylor College of Medicine | Kibler K.K.,Baylor College of Medicine | Brady K.M.,Baylor College of Medicine | And 3 more authors.
Pediatrics | Year: 2013

New noninvasive methods for monitoring cerebrovascular pressure reactivity coupled with a blood-based assay for brain-specific injury in preterm infants could allow early diagnosis of brain injury and set the stage for improved timing and effectiveness of interventions. Using an adaptation of near-infrared spectroscopy, we report a case of a very low birth weight infant undergoing hemoglobin volume index monitoring as a measure of cerebrovascular pressure reactivity. During the monitoring period, this infant demonstrated significant disturbances in cerebrovascular pressure reactivity that coincided with elevation of serum glial fibrillary acidic protein and new findings of brain injury on head ultrasound. This case report demonstrates the potential of emerging noninvasive monitoring methods to assist in both detection and therapeutic management to improve neurologic outcomes of the very low birth weight neonate. Copyright © 2013 by the American Academy of Pediatrics. Source

Rios D.R.,Section of Neonatology | Kaiser J.R.,Section of Neonatology | Kaiser J.R.,Baylor College of Medicine
Journal of Pediatrics | Year: 2015

Objective To evaluate vasopressin vs dopamine as initial therapy in extremely low birth weight (ELBW) infants with hypotension during the first 24 hours of life. Study design ELBWinfants with hypertension ≤30 weeks' gestation and ≤24 hours old randomly received treatment with vasopressin or dopamine in a blinded fashion. Normotensive infants not receiving vasopressor support served as a comparison group. Results Twenty ELBW infants with hypertension received vasopressin (n = 10) or dopamine (n = 10), and 50 were enrolled for comparison. Mean gestational age was 25.6 ± 1.4 weeks and birth weight 705 ± 154 g. Response to vasopressin paralleled that of dopamine in time to adequate mean blood pressure (Kaplan-Meier curve, P = .986); 90% of infants in each treatment group responded with adequate blood pressure. The vasopressin group received fewer doses of surfactant (P < .05), had lower PaCO2 values (P < .05), and were not tachycardic (P < .001) during vasopressin administration, compared with the dopamine group. Conclusions Vasopressin in ELBW infants as the initial agent for early hypotension appeared safe. This pilot study supports a larger randomized controlled trial of vasopressin vs dopamine therapy in ELBW infants with hypotension. Copyright © 2015 Elsevier Inc. All rights reserved. Source

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