After a trip to Europe for ongoing planning for the HIP trial, (link on the side bar) and several days getting over the jet-lag and trying to catch up, I am ready to get going again.
So here is my usual idiosyncratic and personal selection of things that have recently caught my eye from trawling through recent publications,
First something related to the HIP trial hypotheses:
Wong FY, Silas R, Hew S, Samarasinghe T, Walker AM: Cerebral oxygenation is highly sensitive to blood pressure variability in sick preterm infants. PLoS One 2012, 7(8):e43165. (open access) There are a number of ways of addressing how BP variability affects cerebral oxygen delivery, this group used a couple of techniques, and show that variability of BP is often associated with variability in the cerebral oxygenation measured by NIRS. The association was closer in the infants who were most critically ill.
Olhager E, Nold-Petry CA, Joshi MS, Doery JCG, Samarasinghe T, Walker AM, Wong FY: Preterm lambs given intravenous dopamine show increased dopamine in their cerebrospinal fluid. Acta Paediatrica 2013. Also HIP relevant, this study shows that preterm lambs do not have an intact blood brain barrier when it comes to dopamine. As dopamine is an important neurotransmitter, this might be very significant. Apparently there is already some data that this occurs in preterm babies as well, which I was not aware of, but I should have been as it was published in J Pediatr by Istvan Seri some time ago, (1984). That paper only included a very small number of infants, but looks like reliable data that sometimes CSF dopamine levels do go up when you give preterm babies dopamine. Another reason for trying to find out if it is a good thing to do, or not.
Combs CA, Gravett M, Garite TJ, Hickok DE, Lapidus J, Porreco R, Rael J, Grove T, Morgan TK, Clewell W et al: Amniotic fluid infection, inflammation, and colonization in preterm labor with intact membranes. American journal of obstetrics and gynecology 2013. In preterm labour with intact membranes, the authors performed amniocentesis, and using molecular and culture techniques looked for bacteria and or IL6 concentrations. They had 27 samples that were ‘infected’ (which means either a positive culture or microbial 16s rDNA detected, as well as an increase in IL6) and another 36 with high IL6 concentrations but no bugs. The outcome of interest was a composite of stillbirth; neonatal death; respiratory distress syndrome (RDS); grade 3 or 4 intraventricular hemorrhage; necrotizing enterocolitis; or culture-positive neonatal sepsis. Amniotic fluid that showed either infection or severe inflammation had significantly worse outcomes than those that were either neither or had positive cultures with no inflammation. A group with mild inflammation were intermediate. This really interesting data is only compromised by the authors inventing a term Amniotic Inflammatory Response Syndrome (AIRS) which think we can do without!
More buggy stuff:
Beckstrom AC, Cleman PE, Cassis-Ghavami FL, Kamitsuka MD: Surveillance study of bacterial contamination of the parent’s cell phone in the nicu and the effectiveness of an anti-microbial gel in reducing transmission to the hands. J Perinatol 2013, 33(12):960-963. We have just started allowing cell phone use in the hospital, as they don’t interfere with medical equipment, any more than they cause planes to crash. Unfortunately they are dirty, and the hands that carry them are dirty with the same bugs, and using antibacterial gel after using your cell phone doesn’t get them clean. Maybe we shall have to go back to leaving them at home, or, in my case, in my office or wherever it was I put it down last time, or maybe I left it in the car…