Carnitine supplementation for preterm infants with recurrent apnea

Role of leptin and Insulin like growth Factor-1 In regulation of growth in children with congenital cyanotic heart disease

BACKGROUND

Congenital cyanotic heart disease (CHD) in children is associated with several complications, amongst these complications is growth retardation which is believed to be multifactorial.

OBJECTIVES

The objective of this study is to find out the role of leptin and Insulin-Like Growth Factor-1 (IGF-1) in the growth of paediatric patients with cyanotic CHD of different anatomical defects.

DESIGN/METHODS

This is a cross-sectional study involving thirty-nine children known to suffer from congenital cyanotic heart disease followed by the cardiology outpatient department, and forty-seven matched controls. Serum leptin and IGF-1 were evaluated in all the enrolled subjects besides anthropometric measurement and assessment of average oxygen saturation.

RESULTS

The patients' group showed statistically significant lower height, weight, Body mass index (BMI), leptin levels, and IGF-1. In addition, the patient group had a significant positive correlation between serum leptin and BMI, as well as a positive correlation of IGF-1 with average oxygen saturation.

CONCLUSION

Children suffering from congenital cyanotic heart disease have a higher probability of developing poor growth. Serum leptin and IGF-1 are lower in affected children with congenital cyanotic cardiac defects suggesting that they may play a role in their poor growth.

Apnea in the newborn

Apnea, defined as cessation of breathing resulting in pathological changes in heart rate and oxygen saturation, is a common occurrence especially in preterm neonates. It is due to immaturity of the central nervous system (apnea of prematurity) or secondary to other causes such as metabolic disturbances etc. Secondary causes of apnea should be excluded before a diagnosis of apnea of prematurity is made. Methylxanthines and continuous positive airway pressure form the mainstay of treatment. Mechanical ventilation is reserved for apnea resistant to the above therapy. An approach to the management of apnea in neonates is described.

Carnitine supplementation for preterm infants with recurrent apnea

BACKGROUND

Apnea of prematurity is a common problem in preterm infants in the neonatal intensive care setting (NICU), often delaying their discharge home or transfer to a step down unit. Premature infants are at increased risk of carnitine deficiency. Carnitine supplementation has been used for both prevention and treatment of apnea.

OBJECTIVES

To determine whether treatment with carnitine will reduce the frequency of apnea, the duration of ventilation and the duration of hospital stay in preterm infants with recurrent apnea.

SEARCH STRATEGY

Computerised searches were carried out by two reviewers independently. Searches were made of MEDLINE (1966 to May 2004), EMBASE (1980 to May 2004), CINAHL (1982-2004 June 2004,1st week), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2004), abstracts of annual meetings of the Society for Pediatric Research (1995-2004), and contacts were made with the subject experts.

SELECTION CRITERIA

Only randomized or quasi-randomized treatment trials of preterm infants with a diagnosis of recurrent apnea of prematurity were considered. Trials were included if they involved treatment with carnitine compared to placebo or no treatment, and measured at least one of the following outcomes: failure of resolution of apneas, the duration of ventilation and the duration of hospital stay.

DATA COLLECTION AND ANALYSIS

Two reviewers evaluated the papers for inclusion criteria and quality. Corresponding authors were contacted for further information where needed.

MAIN RESULTS

No eligible trials were identified.

REVIEWERS' CONCLUSIONS

Despite the plausible rationale for the treatment of apnea of prematurity with carnitine, there are insufficient data to support its use for this indication. Further studies are needed to determine the role of this treatment in clinical practice.