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  • 1
    Online Resource
    Online Resource
    Does Interleukin-6 Genotype Influence Cerebral Injury or Developmental Progress After Preterm Birth?
    American Academy of Pediatrics (AAP) ; 2004
    In:  Pediatrics Vol. 114, No. 4 ( 2004-10-01), p. 941-947
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 114, No. 4 ( 2004-10-01), p. 941-947
    Abstract: Objective. The severity of the proinflammatory response may determine outcome in the critically ill. Genetic variation in the promoter region of the gene encoding the proinflammatory cytokine interleukin-6 (IL-6; −174 CC genotype) may encode enhanced production of IL-6. Our objective was to determine whether the CC genotype is associated with worse early illness severity, neurologic injury, and lower developmental scores among surviving preterm children. Methods. Genotype was determined from dried blood spots that were taken for neonatal screening tests 7 days or more after birth; outcome was independently assessed as part of a longitudinal study of children of ≤32 weeks’ gestational age. Results. CC genotype was associated with worse intensive care indices. Significant hemorrhagic brain injuries occurred in 5 (19%) of 27 children with CC genotype compared with 7 (6%) of 121 children with GC or GG genotype, and images consistent with white matter damage (ventriculomegaly or cystic periventricular leukomalacia) occurred in 9 (26%) of CC patients compared with 9 (7%) in GC/GG children. Disability occurred significantly more often in CC children: 8 (31%) compared with 16 (13%). A similar trend was also noted in children with cerebral palsy (15% compared with 7%, respectively). Developmental, cognitive, and motor scores at 2 years and 5.5 years were independent of genotype among children with or without disability. Conclusions. In a population of surviving children who were born at ≤32 weeks’ gestational age, variation of the gene that may increase IL-6 synthesis is associated with disabling brain injury but not cognitive development despite association with worse early critical care indices.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2003-0494-F
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2004
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  • 2
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    Online Resource
    Cardiovascular Changes During Mild Therapeutic Hypothermia and Rewarming in Infants With Hypoxic–Ischemic Encephalopathy
    American Academy of Pediatrics (AAP) ; 2000
    In:  Pediatrics Vol. 106, No. 1 ( 2000-07-01), p. 92-99
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 106, No. 1 ( 2000-07-01), p. 92-99
    Abstract: Clinical trials of mild cooling to 35°C or below in infants with early hypoxic–ischemic encephalopathy are under way. The objective of this study was to systematically document cardiovascular changes associated with mild therapeutic hypothermia and rewarming in such infants. Patients and Methods. Nine infants with gestational ages of 36 to 42 weeks, with 10-minute Apgar scores of 5 or less, clinical encephalopathy, and an abnormal electroencephalogram before 6 hours were cooled by surface cooling the trunk (n = 3) or by applying a cap perfused with cooled water (n = 6) for a median of 72 hours. The target core temperature was 34.0°C to 35.0°C for head-cooled infants and 33.0°C to 34.0°C for surface-cooled infants. Maintenance heating and rewarming were provided by an overhead heater. Results. Mean arterial blood pressure increased by a median of 10 mm Hg during cooling and fell by a median of 8 mm Hg on rewarming. Heart rate decreased by a median of 34 beats/minute on cooling and increased by a median of 32 beats/minute on rewarming. A large increase in the output of the overhead heater decreased mean arterial blood pressure in 5 infants. Anticonvulsant drugs, sedatives, or intercurrent hypoxemia also produced falls in temperature. The inspired oxygen fraction had to be increased by a median of .14 to maintain oxygenation during cooling with 2 infants requiring 100% oxygen, an effect probably attributable to pulmonary hypertension, which was reversible with rewarming. Conclusions. Therapeutic cooling produces changes in heart rate and blood pressure that are not hazardous, but the combination of inadvertent overcooling and inappropriately rapid rewarming, together with sedative drugs that can impair normal thermoregulatory vasoconstriction, can cause hypotension in posthypoxic newborn infants. Infants who already require 50% oxygen should be cooled cautiously because pulmonary hypertension may develop. Knowledge of these cardiovascular changes, careful monitoring, anticipation, and correction should help to avoid potential adverse effects in the upcoming clinical trials.
    Type of Medium: Online Resource
    ISSN: 1098-4275 , 0031-4005
    URL: Article
    DOI: 10.1542/peds.106.1.92
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2000
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  • 3
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    Online Resource
    Mortality and Growth of Low Birth Weight Infants on the Kangaroo Mother Program in Bogota, Colombia
    American Academy of Pediatrics (AAP) ; 1994
    In:  Pediatrics Vol. 94, No. 6 ( 1994-12-01), p. 931-932
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 94, No. 6 ( 1994-12-01), p. 931-932
    Abstract: The kangaroo mother program was started by Drs Rey and Martinez at the Instituto Materno Infantile in Bogota, Colombia in 1978. Mortality was high among low birth weight infants when hospital care was attempted. Neonatal intensive care was virtually nonexistent, and nosocomial infection was common. The essentials of the kangaroo mother program were: (a) educating and motivating the mother as the baby's main resource; b) discharge home regardless of weight as early as possible to minimize nosocomial infection; c) exclusive breast-feeding; d) encouraging bonding and keeping the baby warm by skin-to-skin contact inside the mother's clothes; and e) vertical position between the mother's breasts to minimize reflux and aspiration.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.94.6.931
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 1994
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  • 4
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    Online Resource
    Randomized Trial of Drainage, Irrigation and Fibrinolytic Therapy for Premature Infants with Posthemorrhagic Ventricular Dilatation: Developmental Outcome at 2 years
    American Academy of Pediatrics (AAP) ; 2010
    In:  Pediatrics Vol. 125, No. 4 ( 2010-04-01), p. e852-e858
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 125, No. 4 ( 2010-04-01), p. e852-e858
    Abstract: Preterm infants who develop posthemorrhagic ventricular dilatation (PHVD) have a high risk of cognitive and motor disability. No clinical intervention has been proven to reduce neurodevelopmental disability in such infants. We investigated whether drainage, irrigation, and fibrinolytic therapy (DRIFT), which aims to lower pressure, distortion, free iron, and cytokines, reduces death or severe disability in PHVD. Methods: We randomly assigned 77 preterm infants with PHVD to either DRIFT or standard treatment (ie tapping off cerebrospinal fluid to control excessive expansion). Severe disability was assessed at 2 years' corrected age and included severe sensorimotor disability and cognitive disability ( & lt;55 on the Bayley Mental Development Index). Results: Of 39 infants assigned to DRIFT, 21 (54%) died or were severely disabled versus 27 of 38 (71%) in the standard group (adjusted odds ratio 0.25 [95% confidence interval: 0.08–0.82]). Among the survivors, 11 of 35 (31%) in the DRIFT group had severe cognitive disability versus 19 of 32 (59%) in the standard group (adjusted odds ratio: 0.17 [95% confidence interval: 0.05–0.57] ). Median Mental Development Index was 68 with DRIFT and & lt;50 with standard care. Severe sensorimotor disability was not significantly reduced. Conclusions: Despite an increase in secondary intraventricular bleeding, DRIFT reduced severe cognitive disability in survivors and overall death or severe disability.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2009-1960
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2010
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  • 5
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    Online Resource
    Mild Hypothermia and the Distribution of Cerebral Lesions in Neonates With Hypoxic-Ischemic Encephalopathy
    American Academy of Pediatrics (AAP) ; 2005
    In:  Pediatrics Vol. 116, No. 4 ( 2005-10-01), p. 1001-1006
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 116, No. 4 ( 2005-10-01), p. 1001-1006
    Abstract: Hypothermia induced by whole-body cooling (WBC) and selective head cooling (SHC) both reduce brain injury after hypoxia-ischemia in newborn animals, but it is not known how these treatments affect the incidence or pattern of brain injury in human newborns. To assess this, 14 term infants with hypoxic-ischemic encephalopathy (HIE) treated with SHC, 20 infants with HIE treated with WBC, and 52 noncooled infants with HIE of similar severity were studied with magnetic resonance imaging in the neonatal period. Infants fulfilling strict criteria for HIE were recruited into the study after assessment of an amplitude-integrated electroencephalography (aEEG). Cooling was commenced within 6 hours of birth and continued for 48 to 72 hours. Hypothermia was not associated with unexpected or unusual lesions, and the prevalence of intracranial hemorrhage was similar in all 3 groups. Both modes of hypothermia were associated with a decrease in basal ganglia and thalamic lesions, which are predictive of abnormal outcome. This decrease was significant in infants with a moderate aEEG finding but not in those with a severe aEEG finding. A decrease in the incidence of severe cortical lesions was seen in the infants treated with SHC.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2005-0328
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2005
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  • 6
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    Randomized Clinical Trial of Prevention of Hydrocephalus After Intraventricular Hemorrhage in Preterm Infants: Brain-Washing Versus Tapping Fluid
    American Academy of Pediatrics (AAP) ; 2007
    In:  Pediatrics Vol. 119, No. 5 ( 2007-05-01), p. e1071-e1078
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 119, No. 5 ( 2007-05-01), p. e1071-e1078
    Abstract: OBJECTIVE. Hydrocephalus is a serious complication of intraventricular hemorrhage in preterm infants, with adverse consequences from permanent ventriculoperitoneal shunt dependence. The development of hydrocephalus takes several weeks, but no clinical intervention has been shown to reduce shunt surgery in such infants. The aim of this study was to test a new treatment intended to prevent hydrocephalus and shunt dependence after intraventricular hemorrhage. METHODS. We randomly assigned 70 preterm infants who had gestational ages of 24 to 34 weeks and were progressively enlarging their cerebral ventricles after intraventricular hemorrhage to either (1) drainage, irrigation, and fibrinolytic therapy to wash out blood and cytokines or (2) tapping of cerebrospinal fluid by reservoir as required to control excessive expansion and signs of pressure (standard treatment). We evaluated outcomes at 6 months of age or hospital discharge (if later). RESULTS. Of 34 infants who were assigned to drainage, irrigation, and fibrinolytic therapy, 2 died and 13 underwent shunt surgery (dead or shunt: 44%). Of 36 infants who were assigned to standard therapy, 5 died and 14 underwent shunt surgery (dead or shunt: 50%). This difference was not significant. Twelve (35%) of 34 infants who received drainage, irrigation, and fibrinolytic therapy had secondary intraventricular hemorrhage compared with 3 (8%) of 36 in the standard group. Secondary intraventricular hemorrhage was associated with an increased risk for subsequent shunt surgery and more blood transfusions. CONCLUSIONS. Despite its logical basis and encouraging pilot data, drainage, irrigation, and fibrinolytic therapy did not reduce shunt surgery or death when tested in a multicenter, randomized trial. Secondary intraventricular hemorrhage is a major factor that counteracts any possible therapeutic effect from washing out old blood.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2006-2841
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2007
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  • 7
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    Online Resource
    Is Interleukin-6 −174 Genotype Associated With the Development of Septicemia in Preterm Infants?
    American Academy of Pediatrics (AAP) ; 2003
    In:  Pediatrics Vol. 112, No. 4 ( 2003-10-01), p. 800-803
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 112, No. 4 ( 2003-10-01), p. 800-803
    Abstract: Objective. Systemic infection affects one quarter of preterm infants. Defense from infection is in part mediated by the cytokine interleukin-6 (IL-6). We tested the hypothesis that the IL-6 −174 GG genotype, associated with lower IL-6 response to inflammation, is also associated with the development of septicemia in preterm infants. Methods. The study group comprised 157 infants who were born at ≤32 weeks. Genotype distribution (34% [54] GG, 46% [72] GC, 20% [31] CC) and C allele frequency (0.43; 95% confidence interval [CI] : 0.37–0.48) were similar to the UK adult population. Among the patients who developed bacterially confirmed septicemia (n = 51 [33%]), there was a significantly higher prevalence of the IL-6 −174 GG genotype than that observed in those who did not develop infection (47% vs 28% for GG: odds ratio [OR] : 2.3; 95% CI: 1.1–4.5). This association remained statistically significant (OR: 2.7; 95% CI: 1.2–6.3) after multiple binary logistic regression adjustment for other significant predictors of the development of septicemia. Late infection alone was similarly associated with GG genotype (septicemia 47% vs no septicemia 29% for GG: OR: 2.2; 95% CI: 1.1–4.3). Conclusions. Variation in the IL-6 gene seems to influence the defense against bacterial pathogens in the very preterm infant.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.112.4.800
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2003
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  • 8
    Online Resource
    Online Resource
    Kangaroo Baby Care: Just a Nice Experience or an Important Advance for Preterm Infants?
    American Academy of Pediatrics (AAP) ; 1990
    In:  Pediatrics Vol. 85, No. 4 ( 1990-04-01), p. 604-605
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 85, No. 4 ( 1990-04-01), p. 604-605
    Abstract: "Kangaroo baby care" or "skin-to-skin contact" describes the practice of holding a preterm infant naked (except for a diaper) between the mother's breasts. The baby's face pokes out of the top of the mother's dress like a baby kangaroo's. Rey and Martinez in Bogota, Colombia1 pioneered the home care of premature infants as small as 1000 g, the mother being taught to hold her baby head-up kangaroo-style to encourage lactation, prevent aspiration, and reduce rejection. Education and motivation of the mother in the care of preterm infants makes obvious sense in the developing world, but kangaroo baby care has also been applied in many developed countries in conjunction with neonatal intensive care rather than as a replacement for incubators and monitors.2-4
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.85.4.604
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 1990
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  • 9
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    Online Resource
    Historical Perspectives
    American Academy of Pediatrics (AAP) ; 2007
    In:  NeoReviews Vol. 8, No. 11 ( 2007-11-01), p. e455-e458
    Details
    In: NeoReviews, American Academy of Pediatrics (AAP), Vol. 8, No. 11 ( 2007-11-01), p. e455-e458
    Type of Medium: Online Resource
    ISSN: 1526-9906
    URL: Article
    DOI: 10.1542/neo.8-11-e455
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2007
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  • 10
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    Online Resource
    Blood Pressure Fluctuation and Intraventricular Hemorrhage in the Preterm Infant of Less Than 31 Weeks' Gestation
    American Academy of Pediatrics (AAP) ; 1989
    In:  Pediatrics Vol. 83, No. 5 ( 1989-05-01), p. 657-661
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 83, No. 5 ( 1989-05-01), p. 657-661
    Abstract: A total of 22 infants of less than 31 weeks' gestation who were mechanically ventilated for a minimum of 12 hours for respiratory distress syndrome were studied. The coefficient of variation of direct systolic pressure was measured each minute from six to 36 hours of age and averaged per hour after birth with a microcomputer-based system of data collection. At the start of recording, the ultrasound scan appeared normal in each infant, but intraventricular hemorrhage developed in ten infants less than 36 hours of age. Twelve infants remained free of intraventricular hemorrhages. BP fluctuation was greater for a longer proportion of measured time in infants in whom intraventricular hemorrhage did not develop compared with those in whom it did develop P & lt; .05). These findings do not support a causal relationship between BP fluctuation and intraventricular hemorrhage within the range of coefficient of variation studied.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.83.5.657
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 1989
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