| 1. |
|
|
| 2. |
- Noponen, Tommi, et al.
(författare)
-
Circulatory Effects of Inhaled Iloprost in the Newborn Preterm Lamb.
- 2009
-
Ingår i: Pediatric Research. - 1530-0447. ; 66, s. 416-422
-
Tidskriftsartikel (refereegranskat)abstract
- Inhaled nitric oxide (iNO) has an established role in the treatment of pulmonary hypertension in the newborn. However, costs and potential toxicity associated with iNO have generated interest in alternative inhaled selective pulmonary vasodilators such as iloprost. In a preterm lamb model of respiratory distress syndrome, we studied effects of increasing doses of iloprost followed by iNO on right ventricular pressure (RVP) and circulation including cerebral oxygenation. Fetal sheep were randomized to three doses (0.2 - 4 mg/kg) of iloprost (n=9) or saline (n=10), administered as 15 min inhalations with 15 min intervals after a 60-min postnatal stabilisation. No differences were found in RVP, arterial pO2, or cardiac index according to treatment. The cerebral oxygenation, measured with near-infrared spectroscopy, deteriorated in control lambs, but not in iloprost lambs. Iloprost treatment followed by iNO resulted in a larger decrease (p=0.007) in RVP than saline treatment followed by iNO. In conclusion, iloprost stabilised cerebral oxygenation and when followed by iNO had a larger effect on RVP than iNO alone. Although species differences may be relevant, these results suggest that iloprost should be studied in newborn infants for the treatment of pulmonary hypertension.
|
|
| 3. |
- Perez de Sá, Valéria, et al.
(författare)
-
High brain tissue oxygen tension during ventilation with 100% oxygen after fetal asphyxia in newborn sheep
- 2009
-
Ingår i: Pediatric Research. - 0031-3998 .- 1530-0447. ; 65:1, s. 57-61
-
Tidskriftsartikel (refereegranskat)abstract
- The optimal inhaled oxygen fraction for newborn resuscitation is still not settled. We hypothesized that short-lasting oxygen ventilation after intrauterine asphyxia would not cause arterial or cerebral hyperoxia, and therefore be innocuous. The umbilical cord of fetal sheep was clamped and 10 min later, after delivery, ventilation with air (n = 7) or with 100% oxygen for 3 (n = 6) or 30 min (n = 5), followed by air, was started. Among the 11 lambs given 100% oxygen, oxygen tension (PO2) was 10.7 (1.8-56) kPa [median (range)] in arterial samples taken after 2.5 min of ventilation. In those ventilated with 100% oxygen for 30 min, brain tissue PO2 (PbtO2) increased from less than 0.1 kPa in each lamb to individual maxima of 56 (30-61) kPa, whereas in those given oxygen for just 3 min, PbtO2 peaked at 4.2 (2.9-46) kPa. The maximal PbtO2 in air-ventilated lambs was 2.9 (0.8-5.4) kPa. Heart rate and blood pressure increased equally fast in the three groups. Thus, prolonged ventilation with 100% oxygen caused an increase in PbtO2 of a magnitude previously only reported under hyperbaric conditions. Reducing the time of 100% oxygen ventilation to 3 min did not consistently avert systemic hyperoxia.
|
|
| 4. |
- Pupp, Ingrid, et al.
(författare)
-
Fresh-frozen plasma as a source of exogenous insulin-like growth factor-I in the extremely preterm infant
- 2009
-
Ingår i: J Clin Endocrinol Metab. - : The Endocrine Society. - 1945-7197 .- 0021-972X. ; 94:2, s. 477-482
-
Tidskriftsartikel (refereegranskat)abstract
- CONTEXT: Preterm birth is followed by a decrease in circulatory levels of IGF-I and IGF binding protein (IGFBP)-3, proteins with important neurogenic and angiogenic properties. OBJECTIVE: Our objective was to evaluate the effects of iv administration of fresh-frozen plasma (FFP) from adult donors on circulatory levels of IGF-I and IGFBP-3 in extremely preterm infants. DESIGN, SETTING, AND PATIENTS: A prospective cohort study was performed in 20 extremely preterm infants [mean (SD) gestational age 25.3 (1.3) wk] with clinical requirement of FFP during the first postnatal week. Sampling was performed before initiation of transfusion, directly after, and at 6, 12, 24, and 48 h after completed FFP transfusion. MAIN OUTCOME MEASURES: Concentrations of IGF-I and IGFBP-3 before and after transfusion of FFP were determined. RESULTS: FFP with a mean (SD) volume of 11 ml/kg (3.1) was administered at a median postnatal age of 2 d (range 1-7). Mean (SD) IGF-I and IGFBP-3 concentrations in administered FFP were 130 (39) and 2840 microg/liter (615), respectively. Immediately after FFP transfusion, mean (SD) concentrations of IGF-I increased by 133% from 11 (6.4) to 25 microg/liter (9.3) (P < 0.001) and IGFBP-3 by 61% from 815 (451) to 1311 microg/liter (508) (P < 0.001). Concentrations of IGF-I and IGFBP-3 remained higher at 6 (P < 0.001, P = 0.009) and 12 h (P = 0.017, P = 0.018), respectively, as compared with concentrations before FFP transfusion. Typical half-life of administrated IGF-I was 3.4 h for a 1-kg infant. CONCLUSION: Transfusion of FFP to extremely preterm infants during the first postnatal week elevates levels of IGF-I and IGFBP-3.
|
|
| 5. |
- Pupp, Ingrid, et al.
(författare)
-
Inflammation at birth and the insulin-like growth factor system in very preterm infants.
- 2007
-
Ingår i: Acta Pædiatrica. - : Wiley. - 1651-2227 .- 0803-5253. ; 96:6, s. 830-836
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Foetal inflammation is associated with an increased risk of brain damage in preterm infants whereas IGF-I is essential for cerebral development and exhibits anti-apoptotic properties. Aim: To assess levels of IGF-I and IGF binding proteins at very preterm birth and to evaluate their relationship with foetal pro-inflammation and cerebral damage. Methods: Levels of IGF-I, IGF binding protein 3 (IGFBP-3), high- (hp) and low-phosphorylated (lp) IGFBP-1 in cord blood and neonatal blood at 72 h after delivery were analysed in relation to levels of cytokines and cerebral damage as detected by ultrasound in 74 inborn infants [mean gestational age (GA) 27.1 weeks]. Evaluation was performed separately according to birth weight for GA. Results: In cord blood of infants appropriate for gestational age (AGA) higher levels of IL-6 and IL-8 were associated with lower IGF-I (r = -0.38, p = 0.008 and r = -0.36, p = 0.014). Higher levels of IL-6, IL-8 and TNF-alpha were associated with both higher levels of lpIGFBP-1 (r = 0.54, p < 0.001, r = 0.50, p < 0.001 and r = 0.13, p = 0.012, respectively) and hpIGFBP-1 (r = 0.55, p < 0.001, r = 0.45, p = 0.002 and r = 0.32, p = 0.026, respectively). Infants with intraventricular haemorrhage grade III (n = 5) had higher levels of lp/hpIGFBP-1 in cord blood (p = 0.001 and 0.002, respectively). Conclusion: Pro-inflammation at birth is associated with changes in the IGF-system. This may be of importance for development of brain damage in preterm infants.
|
|
| 6. |
- Pupp, Ingrid, et al.
(författare)
-
Inflammation at Birth is associated with Subnormal Development in Very Preterm Infants.
- 2008
-
Ingår i: Pediatric Research. - 1530-0447. ; 64, s. 183-188
-
Tidskriftsartikel (refereegranskat)abstract
- Preterm birth carries a risk for impaired developmental outcome. We have previously described an association between increased levels of pro-inflammatory cytokines during the first 72 postnatal hours and cerebral damage as detected by ultrasound in a cohort of 74 very preterm infants. Sixty-seven of 71 surviving children with a mean (SD) GA of 27.1 (2.0) weeks were examined at 2 years corrected age with a standardized neurological examination and with Bayley Scales of Infant Development. We hypothesized that pro-inflammatory cytokine concentrations at or shortly after birth would be associated with an adverse developmental outcome. Increased concentrations of TNF-alpha in cord blood OR (95% CI) 3.3 (1.1-10.2), p=0.013 and at 6 h 7.8 (0.9-71.8), p=0.015 and of IL-6 in cord blood 1.7 (1.0-2.9), p=0.048 were associated with psychomotor developmental index <85. Increased concentrations of TNF-alpha in cord blood OR (95% CI) 3.6 (1.002-12.8), p=0.044 and of IL-8 in cord blood 3.5 (1.2-10.6), p=0.023 were associated with cerebral palsy. Associations of TNF-alpha and IL-8 in cord blood with the respective outcome measures remained significant after adjustment for other clinical variables. Pro-inflammation at birth is associated with impaired functional outcome at 2 years of corrected age in children with very preterm birth.
|
|
