SUMMARYWe report a case of haemolytic disease of the fetus and newborn due to anti-S antibodies. Baby G was born by emergency caesarean section at 35 weeks due to reduced fetal movement. Prior to delivery, antenatal screening revealed the mother's blood group was AB rhesus positive with anti-S antibody titres. The baby was pale but non-hydropic at birth with hepatosplenomegaly. Haemoglobin at birth was 5.23 g/dl and serum bilirubin 138 mmol/l. The baby required phototherapy, γ-globulin infusion and exchange transfusion with post-transfusion complications. BACKGROUND
Background and Aims Bronchopulmonary dysplasia (BPD) is a chronic lung disease associated with premature birth and early lung injury. The pathogenesis is multifactorial, including fluid and electrolytes balance that is dependent to renal development during the first weeks of life.We previously found a correlation between renal development during the first weeks of life and urinary neutrophil gelatinase-associated lipocalin (UNGAL) at birth in very low birth weight infants (VLBW). The aim of this study was to examine the relationship between urinary (UNGAL) and serum NGAL (SNGAL) at birth and BPD. Methods UNGAL and SNGAL were determined at birth in VLBW. BPD was defined as oxygen need at 36 week gestational age (GA). Statistical analysis was performed with chi square. Results 44 VLBW admitted at birth in our NICU were included in the study; 2 of them died during stay in NICU. 20/42 infants developed BPD: all were born at ≤ 29 week (GA) and 14 of them needed diuretics. High values of UNGAL (> 100 ng/ml) were observed more frequently among BPD treated with diuretics infants than in the other subjects (57% vs 28%, p=0.04).High levels of SNGAL (>150 ng/ml) were not significantly more frequent in VLBW with BPD. Conclusions These preliminary data show that high UNGAL at birth is a marker of impaired renal development and fluid balance in preterm newborns, that determine increased lung water and consequently contribute to BPD development.
Background Prescribing postnatal corticosteroids (PCS) for ventilator dependent preterm infant remains controversial. PCS improve short term lung function but may increase the risk of disability in later life. The DART study 1 was designed to address this risk using a 10-day tapering protocol with a total dose of dexamethasone of 0.89 mg/kg. We aimed to audit practice and calculate the total dose of PCS at a single centre using the DART protocol. Method Over a four year period patients were identified from an electronic database and hospital charts reviewed. Infants receiving peri-extubation steroids were excluded. Results Forty six infants with mean (SD) gestational age 25.0 (1.3) weeks, birth weight 685 (192) g received PCS as per DART protocol at a median (range) age of 25(6-197) days. Ventilatory support at the start of treatment: 6 infants on CPAP, 24 conventional and 16 high frequency ventilation. Mean FiO 2 prior to PCS was 0.55 (0.22) with mean airway pressure of 10.9 (2.7) falling to 9.1 (2.3) cm H 2 O after three days. Median duration of therapy was 20 (3-86)days, with a total dexamethasone dose of 1.44 (0.375-9.1) mg/kg. Glycosuria was common (67%), one infant developed NEC and there were seven deaths with a 93% rate of either death or BPD (oxygen dependency at 36 weeks). Conclusions PCS prescribed beyond three weeks has minimal impact on reducing BPD despite the total dose of PCS often exceeding those used in published studies. Long term follow up of these patients is recommended. REFERENCE1 Doyle et al.
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