Infants treated with Infasurf have a modest benefit in the acute phase of RDS. Infasurf seems to produce a longer duration of effect than Survanta.
ABSTRACT. Blood monocytes produce two well-defined cytokines, tumor necrosis factor/cachectin (TNF) and 11-1, that have multiple immunologic and inflammatory functions. This study examined the secretion of these cytokines by cord blood monocytes from preterm and term neonates stimulated with or without lipopolysaccharide (LPS). Seventeen samples (eight preterm, nine term) were collected. Supernatants of monocytes were assayed for activities of IL-1 (mitogenesis for mouse thymocytes) and TNF (cytotoxicity for L929 cells). IL-1 and TNF activities were not significant in supernatants of unstimulated monocytes from either preterm or term infants. IL-1 secretion by LPSstimulated monocytes from term and preterm neonates was comparable to IL-1 activity by monocytes from adults, but TNF activity by LPS-stimulated monocytes from preterm neonates was significantly less than that from monocytes of either term or adult groups (p < 0.05). TNF activity in supernatants of LPS-stimulated monocytes was neutralized 100% by monoclonal antibody to TNF-a; IL-1 activity was neutralized 80% by polyclonal antiserum to IL-1-P. Given the multifactorial biologic activities of TNF, the decreased secretion of TNF by monocytes from preterm neonates may be significant in describing mechanisms for the increased susceptibility of the preterm neonate to infection. (Pediatr Res 25342-346, 1989) (6,(8)(9)(10) (13,14 Abbreviations TNF, tumor necrosis factor LPS, lipopolysaccharide The immunologic competence o f the neonate has been an area o f concern both for the clinician and the researcher because neonates have an increased risk for sepsis and often do not manifest the typical signs, such as fever, that are seen in older children ( I ) . Most studies o f the immune and inflammatory response from neonates have examined the functions o f lymphocytes and neutrophils. For example, lymphocytes from neonates respond adequately to mitogens and antigens (2-4), but lymphokine production is variable (2, 5). Polymorphonuclear cells o f . Blood monocytes are derived from a granulocyte-macrophage progenitor cell ( 1 1 ) and probably first appear in the circulation during the 20th-22nd wk o f gestation (10). Effector functions o f monocytes obtained from neonates such as phagocytosis and bactericidal activity are comparable to those o f monocytes from adults but chemotaxis is decreased ( 10). IL-1 and TNF, also known as cachectin, are two well-defined cytokines produced by mononuclear phagocytes responsible for induction o f fever and possibly cachexia (8, 12). IL-1 and TNF are distinct proteins with mol wt o f 17 kD (8). Both are produced by blood monocytes and tissue macrophages when stimulated with bacterial LPS. The production o f these cytokines, however, alters as blood monocytes differentiate into tissue macrophages
BackgroundFor the premature infant, extrauterine life is a pathological condition which greatly amplifies the challenges to the brain in establishing functional oromotor behaviors. The extent to which suck can be entrained using a synthetically patterned orocutaneous input to promote its development in preterm infants who manifest chronic lung disease is unknown.ObjectiveTo evaluate the effects of a frequency-modulated orocutaneous pulse train delivered through a pneumatically-charged pacifier capable of enhancing non-nutritive suck (NNS) activity in tube-fed premature infants.MethodsA randomized trial to evaluate the efficacy of pneumatic orocutaneous stimulation 3x/day on NNS development and length of stay (LOS) in the NICU among 160 newborn infants distributed among 3 subpopulations, including healthy preterm infants (HI), respiratory distress syndrome (RDS), and chronic lung disease (CLD). Study infants received a regimen of orocutaneous pulse trains through a PULSED pressurized silicone pacifier or a SHAM control (blind pacifier) during gavage feeds for up to 10 days.ResultsMixed modeling, adjusted for the infant’s gender, gestational age, postmenstrual age, and birth weight, was used to handle interdependency among repeated measures within subjects. A significant main effect for stimulation mode (SHAM pacifier vs PULSED orosensory) was found among preterm infants for NNS Bursts/minute (p=.003), NNS events/minute (p=.033), and for Total Oral Compressions/minute [NNS+nonNNS] (p=.016). Pairwise comparison of adjusted means using Bonferroni adjustment indicated RDS and CLD infants showed the most significant gains on these NNS performance indices. CLD infants in the treatment group showed significantly shorter LOS by an average of 2.5 days.ConclusionFrequency-modulated PULSED orocutaneous pulse train stimuli delivered through a silicone pacifier are effective in facilitating NNS burst development in tube-fed RDS and CLD preterm infants, with an added benefit of reduced LOS for CLD infants.
PURPOSE: To determine the interrater and test-retest reliabilities and construct validity of the Premie-Neuro, a standardized neurologic assessment tool for preterm infants. SUBJECTS: Thirty-four preterm infants (mean gestational age at birth 29 Ϯ 3.7 weeks, mean birth weight 1343.2 Ϯ 696.3 g) participated in the study. DESIGN: A prospective repeated-measures design was used to assess the reliability and validity of the Premie-Neuro. METHODS:The Premie-Neuro was administered twice on consecutive days and then weekly through 37-weeks postmenstrual age or hospital discharge. At discharge, infants' medical histories were reviewed and a Neurobiologic Risk Score (NBRS) was used to determine risk for poor neurodevelopmental outcomes. MAIN OUTCOME MEASURE: Premie-Neuro raw scores and classifications were analyzed to determine the tool's reliability. Construct validity was measured by determining whether the Premie-Neuro could discriminate between infants identified as high-risk or low-risk for neurodevelopmental delays by using a NBRS of 5 as the cutoff for high-and low-risk infants. RESULTS: The intraclass correlation coefficients for interrater and test-retest reliability varied from 0.391 to 0.556 and from 0.493 to 0.592, respectively. Analysis of variance revealed that the Premie-Neuro raw scores for infants with NBRS Ͼ 5 were significantly worse than those for infants with NBRS Ͻ 5 (P ϭ .000-.010). C CONCLUSIONS: The Premie-Neuro is a valid assessment tool for discriminating between preterm infants at high and low risk for neurodevelopmental delay. Interrater reliability of the Premie-Neuro was poor, and test-retest reliability of the Premie-Neuro was fair to moderate. The Premie-Neuro may be acceptable for assessing groups of infants, but there is no evidence that reliability is sufficient for clinical decision-making for individual infants. More research needs to be done to improve the reliability of the Premie-Neuro and assess other facets of the Premie-Neuro's reliability.
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