Objectives: To evaluate the effectiveness of high-dose erythromycin to treat feeding intolerance in preterm infants predominantly fed milk formula. Design: This study is a prospective randomized controlled trial on 60 premature infants suffering from feeding intolerance. Thirty infants were given oral erythromycin ethylsuccinate at a dose of 50 mg/kg/day for 10 days or until they reached full enteral feeds. Randomization was stratified according to gestational age <32 weeks or ≧32 weeks gestation. The primary end point was the time taken to establish full enteral feeding since enrollment. Potential adverse effects associated with erythromycin were also monitored. Student’s t test was used for comparison of continuous variables and χ²for categorical data. Results: In infants <32 weeks, the use of erythromycin was associated with more daily weight gain (12.8 ± 2.6 g vs. 9.2 ± 5.3 g, p = 0.04) compared to the control group. Time to reach full feed did not differ between the erythromycin (13.8 ± 3.9 days) and the control (17.46 ± 4.9 days) groups (p = 0.07). In infants ≧32 weeks, there were no differences between the erythromycin and the control groups. Conclusion: High-dose erythromycin is associated with greater weight gain in preterm infants <32 weeks gestational age, who are predominantly fed cow’s milk-based protein formulas.

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Hyperbilirubinemia is also the most common cause for readmission during the early neonatal period [2].Many efforts have been made to identify infants likely to develop neonatal jaundice. Reliable strategies can reduce hospital stay for normal babies and identify significant hyperbilirubinemia that may happen in the future [3].There have been a few studies which predicted postnatal hyperbilirubinemia by estimating cord blood bilirubin levels but vary in opinions [4][5][6].Usually albumin binds with unconjugated bilirubin and protects against kernicterus [7].

Background: It has been hypothesized that phototherapy leads to increased calcium absorption by the bones through irradiating the pineal gland and reducing melatonin level. There is some evidence that the use of a stockinet cap to cover the head prevents phototherapy-induced hypocalcemia. Study design: This was a randomized controlled trial, including 124 full-term neonates, weighing .2,500 g, in the first 7 days of life, who developed a bilirubin level ranging from 15 to 20 mg/dL and needed treatment with phototherapy. Our neonates were divided into two groups: Group A without the hat, and Group B with the hat. We designed a dark-colored hat that covered the entire head, including the occipital area, ears, and neck, to prevent passage of light. The hat was used from the time of admission and for the 48 hours of treatment with phototherapy. Ca levels were measured on admission and after 48 hours of phototherapy. The variables were compared using Student's t-test, chi-square test, and the repeated-measures test. Results: There was no difference in the mean Ca levels in the two groups on admission. However, after 48 hours of phototherapy, there was a trend toward an increased Ca level in the group with the hat; 8.74±0.95 mg/dL vs 8.51±0.24 mg/dL in the control group. Moreover, there was a statistically significant decrease in the incidence of neonates with hypocalcemia in Group B (with hat) in only six cases (9.7%), compared to 15 cases (24.2%) in Group A (without hat; P=0.031). Conclusion: Phototherapy-induced hypocalcemia can be prevented by covering the head during phototherapy. This seems to be a safe, effective, and cheap method to prevent hypocalcemia and its complications, with no need for prophylactic administration of calcium.

Objectives: To determine the safety, efficacy, and cost of a second course of oral ibuprofen (OI) in closure of patent ductus arteriosus (PDA) in preterm infants.Material and methods: Preterm infants ≤34 weeks gestational age (GA) who had clinically significant PDA at a postnatal age from 48-120 hours were subjected to initial oral ibuprofen course and evaluated by echocardiography. Failure of PDA closure was followed by a second course of three doses of OI. Results of echocardiography and laboratory investigations were compared before and after each ibuprofen course. The cost of ibuprofen was calculated for each patient.Results: One-hundred patients were enrolled; their mean gestational age was 31.3 ± 1.3 weeks and mean birth weight was 1350 ± 271 g. A total of 76 infants (76%) had PDA closed after the first course and an additional 9/19 patients (47.5%) had PDA closure after the second course. Respiratory improvement and significant decrease in the fraction of inspired oxygen were observed (P < 0.001 and P = 0.02, respectively). Nonsignificant changes regarding urine output, renal function and platelet count were encountered after the second course. Among the 19 infants who received two courses of ibuprofen, only one (5%) had intraventricular hemorrhage. The cost of oral ibuprofen dosage was trivial ($0.20).Conclusion: Oral ibuprofen is an inexpensive drug that can be used effectively for PDA closure in premature infants. A second course of ibuprofen further improves the efficacy of the drug without clear short-term complications. Large scale trials are needed to examine side effects and long term sequelae.