Biomedical subjects

Bosco Paes

Publications and source records attributed to Bosco Paes.

12 recordsLinked to original sources

PubMed2006

Antigen-positive platelet transfusion in neonatal alloimmune thrombocytopenia (NAIT).

Neonatal alloimmune thrombocytopenia (NAIT) is a fetomaternal incompatibility most commonly induced by maternal anti-HPA-1a, IgG alloantibodies against a polymorphic epitope of the glycoprotein IIb/IIIa complex in approximately 97.5% of white patients. Current guidelines recommend transfusion of immunologically compatible platelets to prevent cerebral hemorrhage, the most severe complication in affected newborns. Such platelet concentrates, however, are often not readily available. In a retrospective analysis in German and Canadian centers, 27 newborns with NAIT were identified who received platelets from random donors. Unexpectedly, 24 of 27 newborns showed an increase above a threshold of 40 x 10(9) platelets per liter, with moderate (n = 8) or significant (n = 16) platelet count increments (more than 80 x 10(9)/L). We conclude that transfusion of platelet concentrates from random donors is an appropriate strategy in the management of unexpected, severe NAIT predominantly in first pregnancies, pending the availability of compatible platelets.

Blood Donors↗

PubMed2005

Neonatal hepatoblastoma: two cases posing a diagnostic dilemma, with a review of the literature.

Hepatoblastoma accounts for less than 1% of all pediatric malignancies. However, it remains the most common malignant tumor of the liver in newborns. Less than 10% of hepatoblastoma cases are diagnosed in the neonatal period. The diagnosis can be very difficult due to the wide spectrum of presentation and differences in the size of the lesion at the time of detection either antenatally or during an infant's neonatal course. In this review, we describe the current investigations used to establish the diagnosis of congenital hepatoblastoma and the role of a nuclear red cell scan as an additional strategy in the evaluation of this malignant condition. The report uses two cases of neonatal hepatoblastoma to highlight both the clinical and pathologic findings, and the problems encountered in the evaluation of this disorder.

Age Factors↗

PubMed2004

Role of carnitine supplementation in apnea of prematurity: a systematic review.

OBJECTIVE: To determine the role of carnitine supplementation in premature infants on apnea of prematurity, length of ventilation and duration of hospital stay. METHODS: Two reviewers independently conducted a literature search for relevant studies. No language restrictions were applied. Decisions to include studies for the review, and methodological quality of the included studies were assessed in duplicate based on predetermined criteria. RESULTS: Three studies met the selection criteria (reproducibility-kappa 0.76+/-SE 0.122). One study was later excluded. Both included studies were randomized double-blind placebo control prevention trials among babies <1500 g of weight. There was no difference among the groups for outcomes of bedside nurse recorded frequency of apnea episodes, continuous objective recording of apnea, length of ventilation (WMD -3.24 days, 95% CI -8.39, 1.92) or length of hospital stay (WMD -5.4 days, 95% CI -15.53, 4.72). CONCLUSION: Present evidence does not support the regular use of carnitine for the prevention of apnea of prematurity.

Apnea↗

PubMed2004

Contralateral cerebral infarction following vacuum extraction.

Cerebral infarction is a rare complication following a vacuum-assisted delivery occurring on the side of the vacuum application and often accompanied by a cephalhematoma. We report a case of cerebral infarction that was contralateral to the side of the vacuum application in a term baby. The baby presented with seizures in the immediate neonatal period. There was no fracture of the skull to account for a contusion injury. We discuss the mechanisms of intracranial vascular injuries during the process of natural and assisted birth.

Adult↗

PubMed2004

Streptococcus pneumoniae: an old bug with significant maternal-newborn implications.

Streptococcus pneumoniae is an uncommon organism identified in neonatal bacteremia, but when it occurs, it has serious implications for both the infant and the mother. Despite the similarities in the manifestations between group B streptococcus and S. pneumoniae sepsis, the latter appears to be more virulent and of marked severity, resulting in significant neonatal mortality. In the absence of a routine maternal screening protocol for S. pneumoniae colonization, aggressive newborn management constitutes the mainstay of treatment.

Adult↗

PubMed2004

The Pediatric Investigators Collaborative Network on Infections in Canada study of predictors of hospitalization for respiratory syncytial virus infection for infants born at 33 through 35 completed weeks of gestation.

BACKGROUND: Infants born at 33 through 35 completed weeks of gestation (33-35GA) are at risk for severe respiratory syncytial virus (RSV) infection, and palivizumab prophylaxis lowers hospitalizations for RSV infection by as much as 80%. The 33-35GA cohort comprises 3-5% of annual births; thus expert panels recommend limiting prophylaxis to situations in which frequency or health care impact of RSV infection is high. This study sought to identify independent risk factors for hospitalization for RSV infection. METHODS: This was a multicenter, prospective, observational cohort study of 33-35GA infants followed through their first RSV season (2001/2002 or 2002/2003). Baseline data were collected by interview with parents and review of medical records. Respiratory tract illnesses were identified by monthly phone calls, and medical records were reviewed for emergency room visits or hospitalizations. Risk factors were determined by stepwise logistic regression. RESULTS: Of 1,860 enrolled subjects, 1,832 (98.5%) were followed for at least 1 month, and 1,760 (94.6%) completed all follow-ups. Of 140 (7.6%) subjects hospitalized for respiratory tract illnesses, 66 infants had proven RSV infection. Independent predictors for hospitalization for RSV infection were: day-care attendance (odds ratio, 12.32; 95% confidence interval, 2.56, 59.34); November through January birth (odds ratio, 4.89; 95% confidence interval, 2.57, 9.29); preschool age sibling(s) (odds ratio, 2.76; 95% confidence interval, 1.51, 5.03); birth weight <10th percentile (odds ratio, 2.19; 95% confidence interval, 1.14, 4.22); male gender (odds ratio, 1.91; 95% confidence interval, 1.10, 3.31); > or = 2 smokers in the home (odds ratio, 1.87; 95% confidence interval, 1.07, 3.26); and households with >5 people, counting the subject (odds ratio, 1.79; 95% confidence interval, 1.02, 3.16). Family history of eczema (odds ratio, 0.42; 95% confidence interval, 0.18, 0.996) was protective. CONCLUSIONS: Specific host/environmental factors can be used to identify which 33-35GA infants are at greatest risk of hospitalization for RSV infection and likely to benefit from palivizumab prophylaxis.

Antibodies, Monoclonal↗

PubMed2004

Binding of heparin to plasma proteins and endothelial surfaces is inhibited by covalent linkage to antithrombin.

Unfractionated heparin (UFH) and low molecular weight heparin (LMWH) are used for prophylaxis and treatment of thrombosis. However, UFH has a short plasma half-life and variable anticoagulant response in vivo due to plasma or vessel wall protein binding and LMWH has a decreased ability to inactivate thrombin, the pivotal enzyme in the coagulation cascade. Covalent linkage of antithrombin to heparin gave a complex (ATH) with superior anticoagulant activity compared to UFH and LMWH, and longer intravenous half-life compared to UFH. We found that plasma proteins bound more to UFH than ATH, and least to LMWH. Also, UFH bound significantly more to endothelial cells than ATH, with 100% of UFH and 94% of ATH binding being on the cell surface and the remainder was endocytosed. Competition studies with UFH confirmed that ATH binding was likely through its heparin moiety. These findings suggest that differences in plasma protein and endothelial cell binding may be due to available heparin chain length. Although ATH is polydisperse, the covalently-linked antithrombin may shield a portion of the heparin chain from association with plasma or endothelial cell surface proteins. This model is consistent with ATH's better bioavailability and more predictable dose response.

Adult↗

PubMed2002

Comparison of capillary blood sampling using an automated incision device with and without warming the heel.

OBJECTIVE: To determine if heel warming prior to heelstick increases the volume of blood collected compared to no warming. STUDY DESIGN: Randomized controlled trial involving 100 preterm and term infants requiring capillary blood sampling (CBS), randomized to receive warming (Control) (n=50) or nonwarming (Experimental) (n=50). RESULTS: This sample of infants showed no benefit of warming the heel prior to CBS. Volume of blood, collection time, crying time, and repeat procedures were not different between groups. More infants in the Control group received squeezing during the procedure compared to the Experimental group. CONCLUSION: Heel warming prior to CBS may be an unnecessary technique in preterm and term infants that expends nursing time and hospital financial cost.

Automation↗

PubMed2002

A matched cohort study of feeding practice guidelines for infants weighing less than 1,500 g.

PURPOSE: To evaluate the efficacy and safety of clinical practice guidelines (CPG) for the nutritional management of infants weighing < 1,500 g. SUBJECTS: Infants weighing < 1,500 g (n = 200) admitted to the NICU who had no major congenital anomalies were enrolled. DESIGN AND METHODS: A before-and-after matched cohort study was conducted during 1996/1997 and 1998/1999 enrolling infants in a Standard Practice (SP) group and CPG group, respectively. Weight-stratified CPG were introduced between these 2 study periods. Data on the first 100 babies who could be matched for birth weight and gestational age were analyzed. Data collection continued until full feedings were established and tolerated for 48 hours or the infant was discharged from the hospital, whichever came first. PRIMARY OUTCOME MEASURE: Of the 200 infants in the study (median gestational age 28 weeks), 142 infants attained full feedings. The median time to full feedings was 15 days in both groups, and a paired sample t test showed no significant difference between the 2 groups (P = 0.35). PRINCIPAL RESULTS: No statistically significant differences in the age of feeding commencement, number of feeding interruptions, days on total parenteral nutrition, days to regain birth weight, age at discharge, incidence of sepsis, necrotizing enterocolitis, or use of erythromycin were found. CONCLUSIONS: The CPG was a safe alternative to standardize nutritional practices in the NICU. The lack of differences between groups shown in this study is likely related to gut immaturity limiting the infant's response to changes in feeding practices, inconsistent use of the guidelines, confounding factors, the small sample size, or the similarity between SP and the CPG.

Body Weight↗

PubMed2002

Evidence-based feeding guidelines for very low-birth-weight infants.

Clinical practice guidelines (CPG) for the nutritional management of premature infants are limited. This project focused on the development of a research-based enteral feeding CPG for infants of < 1,500 g. The CPG was based on an extensive literature review and developed through a process of consensus decision making by a team of clinical researchers. Infants that weigh < 1,000 g initiate minimal enteral nutrition (MEN) at 48 hours; nutritional feedings begin on day 5 to 6 of life. For infants between 1,000 and 1,500 g, nutritional feedings begin at 48 hours and are advanced at a rate of less than 30 mL/kg per day. The benefits and risks of continuous versus intermittent nasogastric tube feeding were inconclusive; therefore, the CPG does not stipulate a feeding method. Breast milk is used preferentially, and specific guidelines for the definition and management of feeding intolerance are provided. A follow-up study testing this CPG has been completed and is published in the original research section of this issue.

Consensus↗

PubMedDate not supplied

Closed suctioning of intubated neonates maintains better physiologic stability: a randomized trial.

OBJECTIVE: To evaluate the physiological variance in a closed (CS) vs an open suction (OS) protocol in intubated infants. STUDY DESIGN: Infants were stratified into three weight groups in a randomized crossover trial. Heart rate, respiratory rate, blood pressure, oxygen saturation, transcutaneous oxygen and carbon dioxide, and end-tidal carbon dioxide were recorded prior to suctioning, during suctioning, and recovery to baseline. Following the procedures, recovery time to baseline parameters was measured. Data were analyzed using repeated measures ANOVA. RESULTS: Overall, there was significantly less deviation from baseline physiological parameters with CS. Infants <1000 g had clinically significant decreases in heart rate with the OS method (-18% OS vs -6% CS; p=0.016). Recovery time in the OS group was twice that of the CS cohort (4 vs 2 minutes; p<0.001). CONCLUSION: CS maintains better physiologic stability in intubated infants.

Cross-Over Studies↗

PubMedDate not supplied

Epidural opioid analgesia and neonatal respiratory depression.

Epidural opioid analgesia is commonly employed as a therapeutic modality in the management of pain during labor. The general perception among health-care providers is that administered drugs remain in the maternal epidural space and do not compromise the respiratory status of newborns. We describe the clinical course of two newborns who developed respiratory depression following epidural fentanyl analgesia requiring administration of naloxone. The article further reviews the maternal-fetal-placental pharmacokinetics of epidural fentanyl and the possible mechanisms for the causation of neonatal respiratory depression.

Analgesia, Epidural↗