Limiting early intubation and mechanical ventilation in extremely low gestational age neonates (ELGAN) may decrease neonatal morbidity and mortality. The aim of our study was to demonstrate the feasibility, efficacy, and tolerability of a delivery room respiratory management protocol, including delayed umbilical cord clamping (DUCC) in combination with optimized nCPAP with high PEEP levels and less invasive surfactant administration (LISA). This cohort quality improvement study analyzed the respiratory and neonatal outcomes of all consecutive infants born between 24 and 26 weeks' gestation before (period 1, = 40) and after (period 2, = 52) implementing the new protocol. Compared with the period 1 infants, the period 2 infants had a lower rate of intubation in the delivery room (31 vs. 90%, = 0.001) and were less likely to need mechanical ventilation on day 3 (28 vs. 62%, = 0.002) and during the hospital stay (75 vs. 92.5%, < 0.05). The two groups did not differ in terms of mortality or neonatal morbidity. A delivery room respiratory management protocol based on DUCC, optimized nCPAP with high PEEP levels, and LISA procedure is both feasible and safe, and improved ELGAN respiratory outcomes.

Prenatal MRI is less accurate than postnatal CT scan, which remains the most reliable diagnostic modality to specify the location and extent and kind of lesions.

IntroductionGlobisporangium ultimum is an oomycetal pathogen causing damping-off on over 300 different plant hosts. Currently, as for many phytopathogens, its control relies in the use of chemicals with negative impact on health and ecosystems. Therefore, many biocontrol strategies are under investigation to reduce the use of fungicides.ResultsIn this study, the soil bacterium Pseudomonas sp. NCIMB 10586 demonstrates a strong iron-repressed in vitro antagonism against G. ultimum MUCL 38045. This antagonism does not depend on the secretion of the broad-range antibiotic mupirocin or of the siderophore pyoverdine by the bacterial strain. The inhibitor molecule was identified as a novel non-ribosomal peptide synthetase (NRPS) siderophore named mupirochelin. Its putative structure bears similarities to other siderophores and bioactive compounds. The transcription of its gene cluster is affected by the biosynthesis of pyoverdine, the major known siderophore of the strain. Besides mupirochelin, we observed the production of a third and novel NRPS-independent siderophore (NIS), here termed triabactin. The iron-responsive transcriptional repression of the two newly identified siderophore gene clusters corroborates their role as iron scavengers. However, their respective contributions to the strain fitness are dissimilar. Bacterial growth in iron-deprived conditions is greatly supported by pyoverdine production and, to a lesser extent, by triabactin. On the contrary, mupirochelin does not contribute to the strain fitness under the studied conditions.ConclusionAltogether, we have demonstrated here that besides pyoverdine, Pseudomonas sp. NCIMB 10586 produces two newly identified siderophores, namely mupirochelin, a weak siderophore with strong antagonism activity against G. ultimum, and the potent siderophore triabactin.

Insulin-like growth factor I (IGF-I) is necessary for normal growth and development in infants. Recent research suggested that IGF-I deficiency is associated with the development of oxygen-induced retinopathy of prematurity (1). We hypothesized that low IGF-I levels might be a risk factor for oxygen-induced pulmonary damage in preterm infants, which leads to chronic lung disease (CLD) of prematurity. Methods: We measured growth hormone (GH) secretory patterns and levels of IGF-I and IGF binding protein 3 (IGFBP-3) in 34 preterm infants (gestational age(GA): 25-32 weeks, weights 526-1985 grams) at risk to develop chronic lung disease. Measurements were performed in clinically stable infants, requiring respiratory support. Between the 4th and 12th day of life, 6 h (with hourly intervals) and 24 h (with 6 h intervals) blood samples were taken for the determination of GH. In addition, IGF-I and IGFBP-3 levels were measured in the first blood sample. Results were adjusted for GA and birth weight SD score (BWSDS). Results: No significant differences in GH concentration were found between the different time points studied either in the 6 h or 24 h profiles; GH concentration between infants who developed CLD vs no CLD was not different (mean GH respectively 77Ϯ11 vs 79Ϯ8 mg/l, pϭ0.86, adjusted pϭ 0.56). IGF-I levels were significantly lower in CLD vs no CLD infants even adjusted for GA and BWSDS (respectively 1.3Ϯ0.1 vs 1.9Ϯ0.2 nmol/l, pϭ0.02, adjusted pϭ0.04). IGFBP-3 levels were not different between both groups (CLD 0.60Ϯ0.04 mg/l vs no CLD 0.71Ϯ0.05 mg/l, pϭ0.11, adjusted pϭ0.94). Conclusion: Our results support the hypothesis that IGF-1 deficiency may increase the risk to develop CLD. Since GH levels do not differ between infants who develop CLD and those who do not , differences in IGF-I levels may be explained by a relative GH resistance. Alternatively, levels of IGF-I may be lower due to a decreased production in preterm infants. With respect to the relationship between IGF-I and the development of serious sequelae associated with prematurity (1) our findings are comparable with observations by others). We therefore suggest that IGF-I may play an important role in the development of chronic lung disease of prematurity. Reference: Hellstrom A, Carlsson B, Niklasson A, et al. IGF-I is critical for normal vascularisation of the human retina.