Background: It has been suggested that probiotics can reduce the overgrowth of pathogens in the bowels of preterm infants and contribute to the reduction of the incidence of nosocomial infections in neonatal intensive care units (NICUs). The purpose of this study was to evaluate the effectiveness of Lactobacillus GG supplementation in reducing the incidence of urinary tract infections (UTIs), bacterial sepsis and necrotizing enterocolitis (NEC) in preterm infants. Methods: A double-blind study was conducted in 12 Italian NICUs. Newborn infants with a gestational age <33 weeks or birthweight <1,500 g were randomized to receive standard milk feed supplemented with Lactobacillus GG (Dicoflor^®, Dicofarm, Rome, Italy) in a dose of 6 × 10⁹ colony-forming units (cfu) once a day until discharge, starting with the first feed or placebo. Results: Five hundred eighty-five patients were studied. The probiotics group (n = 295) and the placebo group (n = 290) exhibited similar clinical characteristics. The duration of Lactobacillus GG and placebo supplementation was 47.3 ± 26.0 and 48.2 ± 24.3 days, respectively. Although UTIs (3.4 vs. 5.8%) and NEC (1.4 vs. 2.7%) were found less frequently in the probiotic group compared to the control group, these differences were not significant. Bacterial sepsis was more frequent in the probiotics group (4.4%, n = 11) than in the placebo group (3.8%, n = 9), but the difference was not significant. Conclusion: Seven days of Lactobacillus GG supplementation starting with the first feed is not effective in reducing the incidence of UTIs, NEC and sepsis in preterm infants. Further studies are required to confirm our results in lower birthweight populations.

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In this study we evaluate the effect of eight cord-care regimens on cord separation time and other secondary outcomes: omphalitis, sepsis, death, cord bleeding, compliance, satisfaction or dissatisfaction with regard to the type of treatment, umbilical cord colonization – in 1,535 healthy term infants. The eight cord-care regimens studied were: 70% alcohol, natural drying, salicylic sugar powder, triple dye, micronized green clay powder, colloid silver-benzyl-peroxide powder, neomycin-bacitracin powder, 1% basic fuchsine. None of the newborns developed sepsis or died and we found only sporadic cases of omphalitis. With regard to cord separation time the best results were obtained with salicylic sugar powder (5.6 ± 2.3 days) and green clay powder (6.7 ± 2.2 days). Both forms of treatment proved to be more effective (p < 0.05) than all the others. We found that salicylic sugar powder allows for early cord detachment resulting in excellent parent treatment compliance and reduction of their concern, notwithstanding higher percentages of cord bleeding. The rate of positive umbilical swabs was low and was significantly higher only than the results obtained with neomycin-bacitracin powder treatment. This study demonstrates that, in hospital nurseries of developed countries, salicylic sugar powder can be effectively and safely used for umbilical cord care of healthy term infants.

Objective: To assess the hypothesis that changes in plasma total bilirubin levels (Btot) can influence the antioxidant system and oxidative stress in preterm infants. Methods: Twenty two healthy preterm infants who presented with visible non-haemolytic hyperbilirubinaemia were studied at the mean (SD) age of 3.7 (1.5) days. Btot, plasma total hydroperoxide concentration (TH), plasma protein SH group concentration, and total antioxidant capacity of the plasma (TAC) were measured at study entry and after 24 hours. Results: Btot did not correlate with TH, TAC, or protein SH group concentration, but a significant correlation was found between TH and TAC, TH and protein SH groups, and TAC and protein SH groups, both at study entry and after 24 hours. Conclusion: The decrease in plasma bilirubin was contemporary with an increase in plasma antioxidant capacity and decrease in oxidative stress in preterm infants. This may be the result of the pro-oxidant effect of haem oxygenase, mediated by iron release, which may outcompete the antioxidant properties of bilirubin.M any illnesses in preterm infants, such as chronic lung disease, necrotising enterocolitis, retinopathy of prematurity, and intracranial haemorrhage, are thought to be related to the action of reactive oxygen species. They occur because the antioxidant system of preterm infants is highly stressed and incompletely developed.1 Several reports have emphasised the antioxidant role of bilirubin, which in human neonatal plasma seems to have a greater antioxidant capacity than urates, α-tocopherol, or ascorbates.2 Bilirubin reactions involving free radicals or toxic products of oxygen reduction have been well documented. In particular, unconjugated bilirubin is able to scavenge singlet oxygen with high efficiency, to react with superoxide anions and peroxyl radicals, and to serve as a reducing substrate for peroxidases in the presence of hydrogen peroxide or organic hydroperoxides.3 4 However, although the antioxidant effect of bilirubin as a scavenger of reactive oxygen species is well documented in vitro [5][6][7][8] and animal studies, 9 its role in vivo has not been clarified in preterm infants. [10][11][12][13] Yigit et al 10 reported that serum malondialdehyde concentrations were higher in infants with hyperbilirubinaemia than in controls, and other authors [11][12][13] have found a significant correlation between serum bilirubin and total antioxidant capacity of the plasma.The hypothesis of our study was that changes in plasma bilirubin levels may influence the antioxidant system and oxidative stress in newborn infants. Therefore, our aim was to investigate the possible correlation between plasma bilirubin level and oxidative stress and the antioxidant capacity of plasma in preterm infants. To this end, we planned a prospective study in which the plasma levels of total bilirubin (Btot), total hydroperoxide (TH), and protein SH groups, and the total antioxidant capacity of plasma (TAC) were concurrently measured. METHODSThe study was conducted in the neonatal...

Aim: To assess the possible cerebral haemodynamic changes occurring in preterm infants after blood transfusions. Methods: Preterm infants who had undergone blood transfusions were prospectively studied using both near infrared spectroscopy and cerebral Doppler ultrasonography. Results: Fourteen infants (mean gestational age 29.6 wk, SD 2.6; mean birthweight 1430 g, SD 332) were studied at the mean age of 29 (SD 14) d. A significant increase in oxygenated haemoglobin (O2Hb), deoxygenated haemoglobin (HHb), mixed cerebral oxygen saturation (SmO2) and change in cerebral blood volume occurred after transfusion. Between ultrasound parameters, we found a decrease in diastolic velocity and an increase in resistance index. Conclusion: Blood transfusions improve cerebral oxygen supply and induce a decrease in cerebral blood volume, probably due to an increase in cerebral vessel resistance.