Objective. The aim of the study was to establish if lung ultrasound findings could anticipate the need for intubation and mechanical ventilation in neonates with respiratory distress and if lung ultrasound and aEEG criteria could be used in appreciation of the readiness for extubation of the neonatal patients resulting in a decrease of the rate of extubation failure. Material and method. There were analyzed the cases of 50 late preterm and early term neonates presenting with respiratory distress. Lung ultrasound was performed during the first 4 hours after delivery in all the neonates and then as clinically indicated in the case of ventilated patients. A lung ultrasound was performed in all the ventilated patients before extubation. 12 of the 25 ventilated patients were also monitored by aEEG. The decisions regarding the intubation and mechanical ventilation and the moment of extubation of the patients were taken by the clinicians in accordance with the local and international guidelines. The extubation failure was defined as the need to re-intubate the patient in the first 24 hours after the extubation. The lung ultrasound pattern was considered as normal if the image was consisting of A lines with rare B lines or ”double lung point” as in the case of the delayed absorption of fetal lung fluid and abnormal in the case of “white lung” appearance (coalescent B lines) or an image of consolidation. A normal aEEG was defined as the presence of a continuous normal voltage pattern with sleep-wake cycles present and an abnormal aEEG as either discontinuous normal voltage, burst-suppression, low voltage or flat background patterns. The lung ultrasound patterns in the first hours of life were compared between patients that needed intubation and those that did not need mechanical ventilation. The lung ultrasound and aEEG patterns before extubation were compared between the patients that did not need re-intubation and those with extubation failure. Results. An abnormal image on lung ultrasound was significantly associated with the risk of intubation (p < 0.001) (sensitivity 84%, specificity 100%, positive predictive value 100% and negative predictive value 86.2%) An abnormal lung ultrasound pattern before extubation was associated with a significant risk of extubation failure (p < 0.049) (sensitivity 75%, specificity 85%, positive predictive value 50%, negative predictive value 94.7%). In the case of the subset of patients in which aEEG was performed, an abnormal aEEG pattern was significantly associated with extubation failure (p < 0.034) (sensitivity 100%, specificity 88%, positive predictive value 75%, negative predictive value 100%). In the case of association of the two parameters (lung ultrasound and aEEG pattern) there was again a statistically significant association between the abnormal patterns and extubation failure. Conclusions. An abnormal lung ultrasound during the first hours of life is a strong predictor for the need of intubation and mechanical ventilation in the neonates with respiratory distress. The normal lung ultrasound pattern just before extubation is predictive of a good evolution without the need for re-intubation of the patient. A normal aEEG pattern at the same time is associated also with a decreased risk of extubation failure.
The aim of the review was to present the state of knowledge about the respiratory pathology in former premature neonates (children that were born preterm—before 37 weeks of gestation—and are examined and evaluated after 40 weeks corrected age) other than chronic lung disease, in order to provide reasons for a respiratory follow-up program for this category of patients. After a search of the current evidence, we found that premature infants are prone to long-term respiratory consequences due to several reasons: development of the lung outside of the uterus, leading to dysmaturation of the structures, pulmonary pathology due to immaturity, infectious agents or mechanical ventilation and deficient control of breathing. The medium- to long-term respiratory consequences of being born before term are represented by an increased risk of respiratory infections (especially viral) during the first years of life, a risk of recurrent wheezing and asthma and a decrease in pulmonary volumes and airway flows. Late preterm infants have risks of pulmonary long-term consequences similar to other former premature infants. Due to all the above risks, premature neonates should be followed in an organized fashion, being examined at regular time intervals from discharge from the maternity hospital until adulthood—this could lead to an early detection of the risks and preventive therapies in order to improve their prognosis and assure a normal and productive life. The difficulties related to establishing such programs are represented by the insufficient standardization of the data gathering forms, clinical examinations and lung function tests, but it is our belief that if more premature infants are followed, the experience will allow standards to be established in these fields and the methods of data gathering and evaluation to be unified.
Autistic spectrum disease (ASD) is an increasingly common diagnosis nowadays with a prevalence of 1–2% in most countries. Its complex causality—a combination of genetic, immune, metabolic, and environmental factors—is translated into pleiomorphic developmental disorders of various severity, which have two main aspects in common: repetitive, restrictive behaviors and difficulties in social interaction varying from awkward habits and verbalization to a complete lack of interest for the outside world. The wide variety of ASD causes also makes it very difficult to find a common denominator—a disease biomarker and medication—and currently, there is no commonly used diagnostic and therapeutic strategy besides clinical evaluation and psychotherapy. In the CORDUS clinical study, we have administered autologous cord blood to ASD kids who had little or no improvement after other treatments and searched for a biomarker which could help predict the degree of improvement in each patient. We have found that the neuron-specific enolase (NSE) was elevated above the normal clinical range (less than 16.3 ng/mL) in the vast majority of ASD kids tested in our study (40 of 41, or 97.5%). This finding opens up a new direction for diagnostic confirmation, dynamic evaluation, and therapeutic intervention for ASD kids.
Autistic spectrum disease (ASD) is an increasingly common diagnosis nowadays with a prevalence of 1-2% in most countries. Its complex causality – a combination of genetic, immune, metabolic and environmental factors - is translated into pleiomorphic developmental disorders of various severity, which have in common two main aspects: repetitive, restrictive behaviors, and difficulties in social interaction varying from awkward habits and verbalization to complete lack of interest from the ASD child for the outside world. The wide variety of ASD causes also makes it very difficult to find a common denominator – a disease biomarker and medication – and currently there is no commonly used diagnostic and therapeutic strategy besides clinical evaluation and psychotherapy.It is known that inflammation is present in a majority of ASD children, and blood inflammatory markers, together with metabolic, electrophysiological markers and imagistics are useful for ASD diagnostic validation and treatment; however, they tend to leave out a sizeable proportion of ASD kids who do not have such modifications. Genetic testing – whole exome sequencing or targeted profiling on about 500 ASD-linked genes- may also provide good insight into pathophysiology, however many times its results are more restrictive rather than offering additional therapeutic options.Here we describe a new biomarker for ASD - the neuron-specific enolase (NSE) - which was elevated above the normal clinical range (less than 16.3 ng/mL) in the vast majority of ASD kids tested in our study (40 of 41, or 97.5%). This finding opens up a new direction for diagnostic confirmation, dynamic evaluation and therapeutic intervention for ASD kids.
The research aims to identify the respiratory pathology during the first two years of life in premature infants with gestational ages between 30-34 weeks and the risk factors for these conditions (familial, prenatal, and neonatal). There were investigated 31 premature infants with gestational ages between 30-34 weeks and the incidence of bronchopulmonary dysplasia, infections with the respiratory syncytial virus, or other viral infections requiring hospitalization, recurrent wheezing, and nasal colonization with pathogenic bacteria were noted. Also, regression models for each type of respiratory pathology as a function of the antenatal (smoking in the family, atopy, mother’s age) and neonatal (gestational age, respiratory distress syndrome, duration of the treatment with antibiotics, use of the reserve antibiotics) factors were elaborated. Respiratory distress syndrome was present in 20 premature infants, and 19 infants received respiratory support. Two former premature infants presented with bronchopulmonary dysplasia, 3 with severe respiratory syncytial virus infections, 7 with recurrent wheezing, and 16 with viral infections requiring hospitalization. Respiratory distress syndrome and severe viral infections were more frequently found in families of smokers. Low gestational age and familial atopy were identified as good predictors of severe respiratory syncytial virus infections (p< 0.03) Premature infants with gestational ages between 30-34 weeks present with the risk of appearance of respiratory diseases during the first two years of life, especially disorders of the airways. Familial atopy and low gestational age represent independent risk factors for severe respiratory syncytial virus infections.
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