Our findings confirm that, by comparison with indomethacin, ibuprofen has fewer effects on renal function in terms of urine output and fluid retention, with much the same efficacy and safety in closing patent ductus arteriosus in preterm infants with respiratory distress syndrome. In particular, no increased incidence of intracranial haemorrhage was observed after ibuprofen treatment.

This study presents a new measure of the hemodynamic changes to an auditory stimulus in newborns. Nineteen newborns born at 28-41 wk and aged 1 to 49 d were studied in waking and/or sleeping state, for a median time of 4 min 40 s before, 2 min 40 s during, and 3 min 5 s after an acustic stimulus (tonal sweep of frequency increasing from 2 to 4 kHz, intensity 90 dB SPL) originating 5 cm from the external auditory meatus. The emitter and detector optodes were placed over the left or right temporal region, corresponding to T3 or T4 EEG electrodes. Near-infrared transmission spectroscopy (NIRS) through tissue is made possible by the transparency of biologic tissue to light in the near-infrared region (750 -1000 nm). The noninvasive nature of the technique and the portability of the device, combined with the relative transparency of the neonatal head, explain the early applications of the machine in neonatal intensive care units, to the observation of hemodynamic brain responses. Our study presents a method for applying NIRS to the testing of central auditory response in newborns by using an acustic stimulus, a tonal sweep with a frequency increasing from 2 to 4 KHz. The incident near-infrared light from the transmitting optode is scattered through the tissues, and the reflected light is read by a receiving optode. The amount of the light that a compound absorbs is dependent upon the wavelength of the incident light upon it, and is described by the spectrum of a single compound. Brain absorption of the light is due to the main cerebral chromophores, oxyhemoglobin (HbO 2 ), deoxyhemoglobin (Hb), and oxidized cytochrome oxidase (CtOx) and is determined by the oxygenation status of the compound. Through NIRS we measured the loss of the intensity due to absorption of the incident photons by these solutes; this loss or attenuation is usually measured in units of OD (OD) and can be calculated using the Beer-Lambert law. For an absorbing compound dissolved in a nonabsorbing medium, the attenuation (A) is proportional to the concentration of the compound in the solution (c), the specific extinction coefficient of the compound (␣) and the optical path length (

The reticulocyte count reflects the erythropoietic activity of the bone marrow and is thus useful in both the diagnosis of anemias and in monitoring bone marrow response to therapy. Starting in the mid-1990s, automated flow-cytometric analysis has replaced traditional microscopic quantitation of reticulocytes. Reticulocyte analysis now includes measurements mRNA content and the maturity of reticulocytes, cell volume, hemoglobin concentration and content. The immature reticulocyte fraction is a reliable early predictor of hematopoietic engraftment following allogeneic stem cell transplantation, while the reticulocyte hemoglobin content provides an indirect measure of the functional iron available for new red blood cell production over the previous 3-4 days. Especially in anemic newborns, reticulocyte analysis is useful to help clinicians follow erythropoietic changes, to monitor response to recombinant human erythropoietin therapy, to gauge transfusion needs, and to evaluate jaundice. Despite improved accuracy and precision, significant problems still persist in maintaining adequate levels of precision and comparability across different laboratories. In the absence of better laboratory standardization, having a single reference range for the parameters provided by flow-cytometric studies of reticulocytes remains problematic.

In critically ill neonates, peripheral perfusion and oxygenation assessment may provide indirect information on the circulatory failure of vital organs during circulatory shock. The development of pulse oximetry has recently made it possible to calculate the perfusion index (PI), obtained from the ratio between the pulsatile and nonpulsatile signals of absorbed light. The main goals of this study were: (1) to study foot PI; and (2) to evaluate the relationship between foot PI, obtained continuously by pulse oximetry, and a number of variables, i.e. blood flow (BF), oxygen delivery (DO 2 ), oxygen consumption (VO 2 ), and fractional oxygen extraction (FOE), measured indirectly by near-infrared spectroscopy (NIRS) on the calf in 43 healthy term neonates (weight 3474.6±466.9 g; gestational age 39.1±1.4 weeks). STUDY DESIGN:Calf BF, DO 2 and VO 2 were assessed by NIRS on short-lived venous and arterial occlusion maneuvers. PI was measured on the contralateral foot. RESULTS:Foot PI was 1.26±0.39. There was a positive correlation between foot PI and both calf BF (r ¼ 0.32, p ¼ 0.03) and DO 2 (r ¼ 0.32, p ¼ 0.03), but no correlation was found between foot PI and calf FOE and between foot PI and VO 2 . CONCLUSIONS:In the neonatal intensive care unit, continuously measuring foot PI by pulse oximetry seems clinically more feasible for peripheral perfusion monitoring than spot measurements of the calf BF and/or VO 2 by indirect NIRS.

Coenzyme Q10 deficiency is a clinically and genetically heterogeneous disorder, with manifestations that may range from fatal neonatal multisystem failure, to adult-onset encephalopathy. We report a patient who presented at birth with severe lactic acidosis, proteinuria, dicarboxylic aciduria, and hepatic insufficiency. She also had dilation of left ventricle on echocardiography. Her neurological condition rapidly worsened and despite aggressive care she died at 23 h of life. Muscle histology displayed lipid accumulation. Electron microscopy showed markedly swollen mitochondria with fragmented cristae. Respiratory-chain enzymatic assays showed a reduction of combined activities of complex I+III and II+III with normal activities of isolated complexes. The defect was confirmed in fibroblasts, where it could be rescued by supplementing the culture medium with 10 μM coenzyme Q10. Coenzyme Q10 levels were reduced (28% of controls) in these cells. We performed exome sequencing and focused the analysis on genes involved in coenzyme Q10 biosynthesis. The patient harbored a homozygous c.545T>G, p.(Met182Arg) alteration in COQ2, which was validated by functional complementation in yeast. In this case the biochemical and morphological features were essential to direct the genetic diagnosis. The parents had another pregnancy after the biochemical diagnosis was established, but before the identification of the genetic defect. Because of the potentially high recurrence risk, and given the importance of early CoQ10 supplementation, we decided to treat with CoQ10 the newborn child pending the results of the biochemical assays. Clinicians should consider a similar management in siblings of patients with CoQ10 deficiency without a genetic diagnosis.