Oral pharmacological treatment for patent ductus arteriosus in premature neonates with hemodynamic repercussions

Objective: To evaluate the efficacy of oral indomethacin, ibuprofen, and paracetamol in oral dosage form on patent ductus arteriosus(PDA) in premature neonates with significant clinical and hemodynamic repercussions(CHRs) and to determine the effect of these respective treatments on renal function.Methods: A retrospective study of cases of PDA in premature neonates in the Neonatal Intensive Care Unit was conducted. The treatments consisted of indomethacin[0.2 mg/(kg$d), 3-day cycle], ibuprofen [10 mg/(kg$d) followed by 5 mg/(kg$d), 3-day cycle], and paracetamol(15 mg/kg every 6 h, 5-day cycle). The drugs were administered as an oral solution. The following variables were considered: gestational age,newborn weight at birth, Apgar score, diuresis, serum creatinine and urea levels, and serum electrolyte levels(sodium and potassium).Results: Treatment with indomethacin presented efficacy of 87.5% in closure of the ductus with a mean outcome period of 3.5 d. In premature neonates with CHRs and contraindications for indomethacin, the initial treatment with either ibuprofen or paracetamol failed to close the ductus. However, when this treatment was followed by indomethacin, closure occurred in 66.7% of the neonates, with an outcome period of9.66 d. The initial treatment with one cycle of ibuprofen followed by one or two cycles of paracetamol failed to close the ductus.Conclusions: Oral indomethacin was effective for closure of the PDA in premature neonates with severe CHRs. Oral paracetamol or ibuprofen for PDA closure in premature neonates with severe CHRs and contraindications for indomethacin was ineffective.However, results in clinical improvements of neonates allowed the subsequent use of indomethacin and successful closure of the ductus. A significant reduction of diuresis occurred in neonates who were treated with indomethacin, either as a first-line treatment or after the failure of ibuprofen or paracetamol.

The Impact of the Block Freeze Concentration Process on Human Milk Properties Intended for Feeding Newborns

Human milk is the ideal nutritional support for premature neonates. Considering the need for aggregating nutritional value to human milk provided to such vulnerable group of infants, human milk was concentrated by the block freeze concentration technique. The effects of freeze concentration on the physicochemical properties, the efficiency of the process, color parameters, and the density and dynamic viscosity of human milk were assessed. The freeze concentration technology was used to successfully concentrate human milk to a factor equal to 180.48% and 72% of total solid retention in the second stage of freeze concentration. The values observed in the concentrates for the biochemical properties showed that the fraction of concentrated fluid human milk of the second stage (C2) presented elevated amounts of carbohydrates, protein and energy. The elevated caloric value observed in the ice fraction of the first stage (I1) refers to the retention of lipids in it. When added to human milk, C2 and I1 may satisfy the special requisites of nutrients and energy to guarantee the growth and development of preterm neonates.

Manual and alternative therapies as non-pharmacological interventions for pain and stress control in newborns:a systematic review

Background Supporting therapies that provide stress and pain control of preterm and term newborns infants contribute positively to the neuropsychomotor development.Non-pharmacological interventions that involve manual techniques are described,considering protocols that can be reproduced by physical therapists,with positive and negative outcomes reports.Data sources Systematic review follows PRISMA 2020 statements guidelines.Primary and specific health sciences databases(Science Direct,Pubmed,Scielo,Embase and Scopus)were consulted between October 2021 and May 2022.Articles con-sidered were clinical trials,randomized or not,that included descriptions of the type of intervention as non-pharmacological and that studied the following outcomes:"pain"and"stress".Results Fifteen articles were selected for analysis,reaching a methodological quality of at least 3 on the Jadad Scale for the Quality of Researched Sources.The non-pharmacological therapies most applied in isolation were massage,swaddling or wrapping,gentle touch and kinesthetic stimulation,and the combined therapies were non-nutritive sucking and swad-dling,oral sucrose and swaddling,sensory stimulation and familiar odors,and sensory saturation.The outcomes found were relaxation,pain,and stress reduction after the application of painful procedures.The behavioral changes included crying,grimacing,yawning,sneezing,jerky arm or leg movements,startles,and finger flaring.The vital signs included heart rate,blood oxygen saturation level,and pulse respiration.Conclusions Combined techniques lead to better results in controlling neonatal pain when compared to isolated techniques.They can be applied both in preterm and term infants in a safe way and are reproducible in any health unit in a simple and economical way.