We have reported feasibility, safety and ranges for rsSO₂ for a small number of preterm infants in the first 2 weeks of life.

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Feedings of MM advanced more rapidly and were associated with fewer infections than PF. A possible protective effect of MM against PVL, not previously described, may be related to its immune and anti-inflammatory components.

Background Meconium-stained amniotic fluid (MSAF) is a common occurrence among women in spontaneous labor at term, and has been associated with adverse outcomes in both mother and neonate. MSAF is a risk factor for microbial invasion of the amniotic cavity (MIAC) and preterm birth among women with preterm labor and intact membranes. We now report the frequency of MIAC and the presence of bacterial endotoxin in the amniotic fluid of patients with MSAF at term. Materials and methods We conducted a cross-sectional study including women in presumed preterm labor because of uncertain dates who underwent amniocentesis, and were later determined to be at term (n=108). Patients were allocated into two groups: (1) MSAF (n=66) and (2) clear amniotic fluid (n=42). The presence of bacteria was determined by microbiologic techniques, and endotoxin was detected using the Limulus amebocyte lysate (LAL) gel clot assay. Statistical analyses were performed to test for normality and bivariate comparisons. Results Bacteria were more frequently present in patients with MSAF compared to those with clear amniotic fluid [19.6% (13/66) versus 4.7% (2/42); p<0.05]. The microorganisms were Gram-negative rods (n=7), Ureaplasma urealyticum (n=4), Gram-positive rods (n=2) and Mycoplasma hominis (n=1). The LAL gel clot assay was positive in 46.9% (31/66) of patients with MSAF, and in 4.7% (2/42) of those with clear amniotic fluid (p <0.001). After heat treatment, the frequency of a positive LAL gel clot assay remained higher in the MSAF group [18.1% (12/66) versus 2.3% (1/42), p<0.05]. Median amniotic fluid IL-6 concentration (ng/mL) was higher [1.3 (0.7–1.9) versus 0.6 (0.3–1.2), p=0.04], and median amniotic fluid glucose concentration (mg/dL) was lower [6 (0–8.9) versus 9 (7.4–12.6), p<0.001] in the MSAF group, than in those with clear amniotic fluid. Conclusion MSAF at term was associated with an increased incidence of MIAC. The index of suspicion for an infection-related process in postpartum women and their neonates should be increased in the presence of MSAF.

Beneficial impact of ANS on mortality and composite BPD/mortality is evident only after a complete course and persists even with its administration beyond a week from delivery.

Objective Compare rates of initial extubation success in preterm infants extubated to NIPPV or NI-NAVA. Study design In this pilot study, we randomized 30 mechanically ventilated preterm infants at the time of initial elective extubation to NI-NAVA or NIPPV in a 1:1 assignment. Primary study outcome was initial extubation success. Results Rates of continuous extubation for 120 h were 92% in the NI-NAVA group and 69% in the NIPPV group (12/13 vs. 9/13, respectively, p = 0.14). Infants extubated to NI-NAVA remained extubated longer (median 18 vs. 4 days, p = 0.02) and experienced lower peak inspiratory pressures (PIP) than infants managed with NIPPV throughout the first 3 days after extubation. Survival analysis through 14 days post extubation showed a sustained difference in the primary study outcome until 12 days post extubation. Conclusions Our study is the first to suggest that a strategy of extubating preterm infants to NI-NAVA may be more successful.

Objective To prospectively determine the prognostic value of maternal plasma concentrations of placental growth factor (PlGF), soluble endoglin (sEng) and soluble vascular endothelial growth factor receptors-1 and −2 (sVEGFR-1 and −2) in identifying patients with suspected preeclampsia (PE) who require preterm delivery (PTD) or develop adverse outcomes. Study design This prospective cohort study included 85 consecutive patients who presented to the obstetrical triage area at 20–36 weeks with a diagnosis of ‘rule out PE’. Patients were classified as: 1) those who remained stable until term (n=37); and 2) those who developed severe PE and required PTD (n=48). Plasma concentrations of PlGF, sEng and sVEGFR-1 and −2 were determined by ELISA. Results Patients with PlGF/sVEGFR-1 ≤0.05 multiples of the median (MoM) or PlGF/sEng ≤0.07 MoM were more likely to deliver preterm due to PE [adjusted odd ratio (aOR) 7.4 and 8.8], and to develop maternal (aOR 3.7 and 2.4) or neonatal complications (aOR 10.0 and 10.1). Among patients who presented <34 weeks of gestation, PlGF/sVEGFR-1 ≤ 0.035 MoM or PlGF/sEng ≤0.05 MoM had a sensitivity of 89% (16/18), specificity of 96% (24/25) and likelihood ratio for a positive test of 22 to identify patients who delivered within two weeks. The addition of the PlGF/sVEGFR-1 ratio to standard clinical tests improved the sensitivity at a fixed false-positive rate of 3% (p=0.004) for the identification of patients who were delivered due to PE within two weeks. Among patients who had a plasma concentration of PlGF/sVEGFR-1 ratio ≤ 0.035 MoM, 0.036–0.34 MoM and ≥ 0.35 MoM, the rates of PTD < 34 weeks were 94%, 27% and 7%, respectively. Conclusions The determination of angiogenic/anti-angiogenic factors has prognostic value in patients presenting to the obstetrical triage area with suspected preeclampsia for the identification of those requiring preterm delivery and at risk for adverse maternal/neonatal outcomes.

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