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Sample records for term neonates population

  1. Population Pharmacokinetics of Intravenous Paracetamol (Acetaminophen) in Preterm and Term Neonates: Model Development and External Evaluation.

    Science.gov (United States)

    Cook, Sarah F; Roberts, Jessica K; Samiee-Zafarghandy, Samira; Stockmann, Chris; King, Amber D; Deutsch, Nina; Williams, Elaine F; Allegaert, Karel; Wilkins, Diana G; Sherwin, Catherine M T; van den Anker, John N

    2016-01-01

    The aims of this study were to develop a population pharmacokinetic model for intravenous paracetamol in preterm and term neonates and to assess the generalizability of the model by testing its predictive performance in an external dataset. Nonlinear mixed-effects models were constructed from paracetamol concentration-time data in NONMEM 7.2. Potential covariates included body weight, gestational age, postnatal age, postmenstrual age, sex, race, total bilirubin, and estimated glomerular filtration rate. An external dataset was used to test the predictive performance of the model through calculation of bias, precision, and normalized prediction distribution errors. The model-building dataset included 260 observations from 35 neonates with a mean gestational age of 33.6 weeks [standard deviation (SD) 6.6]. Data were well-described by a one-compartment model with first-order elimination. Weight predicted paracetamol clearance and volume of distribution, which were estimated as 0.348 L/h (5.5 % relative standard error; 30.8 % coefficient of variation) and 2.46 L (3.5 % relative standard error; 14.3 % coefficient of variation), respectively, at the mean subject weight of 2.30 kg. An external evaluation was performed on an independent dataset that included 436 observations from 60 neonates with a mean gestational age of 35.6 weeks (SD 4.3). The median prediction error was 10.1 % [95 % confidence interval (CI) 6.1-14.3] and the median absolute prediction error was 25.3 % (95 % CI 23.1-28.1). Weight predicted intravenous paracetamol pharmacokinetics in neonates ranging from extreme preterm to full-term gestational status. External evaluation suggested that these findings should be generalizable to other similar patient populations.

  2. Term neonatal encephalopathy antecedent cerebral palsy: a retrospective population-based study.

    Science.gov (United States)

    Kyriakopoulos, Paulina; Oskoui, Maryam; Dagenais, Lynn; Shevell, Michael I

    2013-05-01

    To compare the clinical profile of term-born cerebral palsy children with or without antecedent moderate to severe neonatal encephalopathy. We hypothesized that antecedent neonatal encephalopathy is associated with a spastic quadriparesis cerebral palsy clinical profile, a higher severity of functional motor impairment, and a greater number of associated comorbidities. Using the Quebec Cerebral Palsy Registry, neurologic subtype, Gross Motor Function Classification System stratification, and comorbidities were compared in children with cerebral palsy with and without antecedent neonatal encephalopathy. Differences between groups were evaluated using chi square analysis for categorical variables and student t test for continuous variables. We identified 132 children with cerebral palsy born full term over a 4 year-interval (1999-2002 inclusive) within the Quebec Cerebral Palsy Registry, of which 44 (33%) had an antecedent neonatal encephalopathy. Spastic quadriplegia subtype of cerebral palsy and Gross Motor Function Classification System Level III-V (non-independent ambulation) were significantly associated with antecedent neonatal encephalopathy. The mean number of comorbidities experienced was not different in the two groups. Of five documented comorbidities, only severe communication difficulties were found to be associated (p cerebral palsy born at term and with a history of neonatal encephalopathy. Copyright © 2012 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  3. Customized versus population-based birth weight charts for the detection of neonatal growth and perinatal morbidity in a cross-sectional study of term neonates.

    Science.gov (United States)

    Carberry, Angela E; Raynes-Greenow, Camille H; Turner, Robin M; Jeffery, Heather E

    2013-10-15

    Customized birth weight charts that incorporate maternal characteristics are now being adopted into clinical practice. However, there is controversy surrounding the value of these charts in the prediction of growth and perinatal outcomes. The objective of this study was to assess the use of customized charts in predicting growth, defined by body fat percentage, and perinatal morbidity. A total of 581 term (≥37 weeks' gestation) neonates born in Sydney, Australia, in 2010 were included. Body fat percentage measurements were taken by using air displacement plethysmography. Objective composite measurements of perinatal morbidity were used to identify neonates who had poor outcomes; these data were extracted from medical records. The value of customized charts was assessed by calculating positive predictive values, negative predictive values, and odds ratios with 95% confidence intervals. Customized versus population-based charts did not improve the prediction of either low body fat percentage (59% vs. 66% positive predictive value and 87% vs. 89% negative predictive value, respectively) or high body fat percentage (48% vs. 53% positive predictive value and 90% vs. 89% negative predictive value, respectively). Customized charts were not better than population-based charts at predicting perinatal morbidity (for customized charts, odds ratio = 1.02, 95% confidence interval: 1.01, 1.04; for population-based charts, odds ratio = 1.03, 95% confidence interval: 1.01, 1.05) per percentile decrease in birth weight. Customized birth weight charts do not provide significant improvements over population-based charts in predicting neonatal growth and morbidity.

  4. Population pharmacokinetic modelling of total and unbound cefazolin plasma concentrations as a guide for dosing in preterm and term neonates.

    Science.gov (United States)

    De Cock, R F W; Smits, A; Allegaert, K; de Hoon, J; Saegeman, V; Danhof, M; Knibbe, C A J

    2014-05-01

    Cefazolin is frequently administered for antimicrobial prophylaxis and treatment of infections. In neonates, pharmacokinetic observations are limited and dosing regimens variable. The aim of this study was to describe the pharmacokinetics of cefazolin in neonates based on total and unbound concentrations to optimize cefazolin dosing. Thirty-six neonates [median birth body weight 2720 (range 540-4200) g, current body weight (cBW) 2755 (830-4200) g and postnatal age (PNA) 9 (1-30) days] receiving intravenous cefazolin (50 mg/kg/8 h) were included. Based on 119 total and unbound plasma concentrations, a population pharmacokinetic analysis with a covariate analysis was performed. Monte Carlo simulations were performed aiming for unbound concentrations above an MIC of 8 mg/L (>60% of the time) in all patients. A one-compartment pharmacokinetic model was developed in which total and unbound concentrations were linked by maximum protein binding (Bmax) of 136 mg/L and a dissociation constant (KD) for cefazolin protein binding of 46.5 mg/L. cBW was identified as covariate for volume of distribution (V), bBW and PNA for clearance and albumin plasma concentration for Bmax, explaining 50%, 58% and 41% of inter-individual variability in V, clearance and Bmax, respectively. Based on Monte Carlo simulations, a body weight- and PNA-adapted dosing regimen that resulted in similar exposure across different weight and age groups was proposed. A neonatal pharmacokinetic model taking into account total and unbound cefazolin concentrations with saturable plasma protein binding was identified. As cBW and PNA were the most important covariates, these may be used for individualized dosing in neonates.

  5. Population pharmacokinetic modelling of total and unbound cefazolin plasma concentrations as a guide for dosing in preterm and term neonates

    National Research Council Canada - National Science Library

    De Cock, R F W; Smits, A; Allegaert, K; de Hoon, J; Saegeman, V; Danhof, M; Knibbe, C A J

    2014-01-01

    .... In neonates, pharmacokinetic observations are limited and dosing regimens variable. The aim of this study was to describe the pharmacokinetics of cefazolin in neonates based on total and unbound concentrations to optimize cefazolin dosing...

  6. Testicular volume of healthy term neonates: Determination of ...

    African Journals Online (AJOL)

    Background: Testicular volume (TV) in neonates has some predictive values of clinical importance. Establishing the normal values of TV among term newborn males of every population is important as differences exist among different populations. Much is not known on TV among Igbo newborns. Aim: The aim of this study ...

  7. [Neonatal morbidity in early-term newborns].

    Science.gov (United States)

    Martínez-Nadal, S; Demestre, X; Raspall, F; Alvarez, J A; Elizari, M J; Vila, C; Sala, P

    2014-07-01

    In the last decades has increased significantly The birth of children from 37 to 38 weeks of gestation, a period called early term, has significantly increased in the past twenty years or so, parallel to the increase in induced deliveries and the cesarean rate. Retrospective cohorts population study, which included those babies born between 37 and 41 weeks of gestation in the period 1992-2011 (n=35.539). This population was divided into two cohorts, early term newborn (RNTP) of 37-38 weeks (n=11,318), and full term newborn (RNTC), of 39-41 weeks of gestation (n=24,221). The rates of cesarean section, neonatal unit admission, respiratory morbidity, apnea and need for assisted ventilation, hyperbilirubinemia requiring phototherapy, hypoglycemia, seizures, hypoxic-ischemia encephalopathy, need for parenteral nutrition and early sepsis were all reviewed. There was a progressive increase in the number of caesarean sections throughout the period studied (from 30.9% to 40.3%). The cesarean section rate was higher in RNTP than in the RNTC (38.3% vs 31.3%, P<.0001). On comparing the two groups, significant differences were found in the rate of admission to neonatal unit, 9.1% vs 3.5% (P<.0001); respiratory morbidity (hyaline membrane 0.14% vs 0.007% [P<.0001], transient tachypnea 1.71% vs 0.45% [P<.0001], mechanical ventilation 0.2% vs 0.07% [P<.009], continuous positive airway pressure 0.11% vs 0.01% [P<.0001]), phototherapy 0.29% vs 0.07% (P<.0001), hypoglycemia 0.54% vs 0.11% (P<.0001), parenteral nutrition 0.16% vs 0.04% (P<.0001). There were no significant differences in the rate of early sepsis, pneumothorax, aspiration syndromes, seizures and hypoxic-ischemic encephalopathy. In our environment, there is a significant number of RNTP, which have a significantly higher morbidity than newborns RNTC registered. After individualizing each case, it is essential not end a pregnancy before 39 weeks of gestation, except for maternal, placental or fetal conditions indicating

  8. Developmental pharmacokinetics of propylene glycol in preterm and term neonates.

    Science.gov (United States)

    De Cock, Roosmarijn F W; Knibbe, Catherijne A J; Kulo, Aida; de Hoon, Jan; Verbesselt, Rene; Danhof, Meindert; Allegaert, Karel

    2013-01-01

    Propylene glycol (PG) is often applied as an excipient in drug formulations. As these formulations may also be used in neonates, the aim of this study was to characterize the pharmacokinetics of propylene glycol, co-administered intravenously with paracetamol (800 mg PG/1000 mg paracetamol) or phenobarbital (700 mg PG/200 mg phenobarbital) in preterm and term neonates. A population pharmacokinetic analysis was performed based on 372 PG plasma concentrations from 62 (pre)term neonates (birth weight (bBW) 630-3980 g, postnatal age (PNA) 1-30 days) using NONMEM 6.2. The model was subsequently used to simulate PG exposure upon administration of paracetamol or phenobarbital in neonates (gestational age 24-40 weeks). In a one compartment model, birth weight and PNA were both identified as covariates for PG clearance using an allometric function (CL(i) = 0.0849 × {(bBW/2720)(1.69) × (PNA/3)(0.201)}). Volume of distribution scaled allometrically with current bodyweight (V(i) = 0.967 × {(BW/2720)(1.45)}) and was estimated 1.77 times higher when co-administered with phenobarbital compared with paracetamol. By introducing these covariates a large part of the interindividual variability on clearance (65%) as well as on volume of distribution (53%) was explained. The final model shows that for commonly used dosing regimens, the population mean PG peak and trough concentrations range between 33-144 and 28-218 mg l(-1) (peak) and 19-109 and 6-112 mg l(-1) (trough) for paracetamol and phenobarbital formulations, respectively, depending on birth weight and age of the neonates. A pharmacokinetic model was developed for PG co-administered with paracetamol or phenobarbital in neonates. As such, large variability in PG exposure may be expected in neonates which is dependent on birth weight and PNA. © 2012 The Authors. British Journal of Clinical Pharmacology © 2012 The British Pharmacological Society.

  9. Short-acting sulfonamides near term and neonatal jaundice

    DEFF Research Database (Denmark)

    Klarskov, Pia; Andersen, Jon Trærup; Jimenez-Solem, Espen

    2013-01-01

    To investigate the association between maternal use of sulfamethizole near term and the risk of neonatal jaundice.......To investigate the association between maternal use of sulfamethizole near term and the risk of neonatal jaundice....

  10. Maternal haemoglobin and short-term neonatal outcome in preterm neonates.

    Directory of Open Access Journals (Sweden)

    Elodie Savajols

    Full Text Available To determine whether there is a significant association between maternal haemoglobin measured before delivery and short-term neonatal outcome in very preterm neonates.We included prospectively all live births occurring from 25 to 32+6 weeks of gestation in a tertiary care centre between January 1(st 2009 and December 31(st 2011. Outborn infants and infants presenting with lethal malformations were excluded. Three hundred and thirty-nine mothers and 409 infants met the inclusion criteria. For each mother-infant pair a prospective record of epidemiologic data was performed and maternal haemoglobin concentration recorded within 24 hours before delivery was retrospectively researched. Maternal haemoglobin was divided into quartiles with the second and the third one regarded as reference as they were composed of normal haemoglobin values. Short-term outcome was defined as poor in case of death during hospital stay and/or grades III/IV intraventricular haemorrhage and/or periventricular leukomalacia and/or necessity of ventriculoperitoneal shunt.The global rate of poor short-term neonatal outcome was 11.4% and was significantly associated with low maternal haemoglobin values. This association remained significant after adjustment for antenatal corticosteroids therapy, gestational age, parity, mechanism of preterm birth, mode of delivery and birth weight (aOR = 2.97 CI 95% [1.36-6.47]. There was no relation between short-term neonatal outcome and high maternal haemoglobin concentration values.We show that low maternal haemoglobin concentration at delivery is an independent risk factor for poor short-term neonatal outcome in very preterm neonates. This study is one of the first to show such an association within the preterm population.

  11. Developmental pharmacokinetics of gentamicin in preterm and term neonates

    DEFF Research Database (Denmark)

    Nielsen, Elisabet I; Sandström, Marie; Honoré, Per Hartvig

    2009-01-01

    for concentration monitoring. This study was performed to characterize the population pharmacokinetics of gentamicin in preterm and term neonates and to identify and quantify relationships between patient characteristics and IIV. A secondary aim was to evaluate cystatin C as a marker for gentamicin clearance...... in this patient population. METHODS: Data were collected in a prospective study performed in the Neonatal Intensive Care Unit at the University Children's Hospital, Uppsala, Sweden. Population pharmacokinetic modelling was performed using nonlinear mixed-effects modelling (NONMEM) software. Bodyweight...... 0-45 days) were enrolled in the study. In total, 894 serum gentamicin samples were included in the analysis. The concentration-time profile was described using a three-compartment model. Gentamicin clearance increased with the GA and PNA (included in a nonlinear fashion). The GA was also identified...

  12. Maternal and neonatal outcomes of vaginal breech delivery for singleton term pregnancies in a carefully selected Cameroonian population: a cohort study.

    Science.gov (United States)

    Dohbit, Julius Sama; Foumane, Pascal; Tochie, Joel Noutakdie; Mamoudou, Fadimatou; Temgoua, Mazou N; Tankeu, Ronni; Aletum, Veronica; Mboudou, Emile

    2017-11-22

    Vaginal breech delivery (VBD) is known to be associated with more perinatal and maternal complications. Very few studies on the subject have been carried out in poor-resource settings. The aim of this study was to determine maternal and neonatal outcomes in carefully selected cases of VBD for singleton term pregnancies in a tertiary centre in Cameroon. A retrospective cohort study. A tertiary hospital in Yaounde, Cameroon. Cases of VBD of newborns weighing 2500-3500 g were matched in a ratio of 1:4 to consecutive vaginal cephalic deliveries (VCDs) of newborns weighing 2500-3500 g over a 5-year period. Both groups were matched for maternal age and parity. We excluded cases of multiple gestations, footling breech, clinically inadequate maternal pelvis, preterm delivery, post-term pregnancies, fetal demise prior to the onset of labour, placenta praevia and fetal anomaly incompatible with vaginal delivery. Neonatal and maternal adverse outcomes of VBD observed till 6 weeks after delivery analysed using Bonferroni correction. Fifty-three (53) VBDs were matched against 212 VCD. Unlike women who had VCD, those who underwent VBD were more likely to have prolonged labour (OR 8.05; 95% CI 3.00 to 11.47; P<0.001), and their newborns were more likely to suffer from birth asphyxia (OR 10.24; 95% CI 4.92 to 21.31; P<0.001). The study infers a strong association between VBD of singleton term pregnancies and maternofetal morbidity when specific protocols are applied. This, however, failed to translate into higher differences in perinatal mortality. This finding does not discount the role of VBD in low-income countries, but we emphasise the need for specific precautions like close monitoring of labour and adequate anticipation for neonatal resuscitation in order to reduce these complications. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly

  13. Hypernatremic Dehydration in Term and Preterm Neonates

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    K. Kamrani

    2015-10-01

    Full Text Available Introduction & Objective: Hypernatremia is associated with serious complications in infants. Given the high morbidity and mortality of neonatal hypernatremia, and since some complica-tions can be prevented, this study was aimed to examine the prevalence of hypernatremia in hospitalized infants and related risk factors. Materials & Methods: This cross-sectional study was performed on 1923 neonates hospitalized in Bahrami Hospital affiliated to Tehran University from October 2011 to October 2012. Demographic data , ward ,gender ,mode of feeding ,gravidity, admission season and method of delivery related to the infants were recorded. For infants with a serum sodium above 150 meq/lit, additional information were collected, including serum urea level, gestational age, date of birth, birth weight, admission weight, head circumference and clinical symptoms. Fi-nally, the data were analyzed using the SPSS software. Results: 74 out of 1923 neonates had serum sodium above 150 meq per liter, which their mean Na was significantly associated with their age groups (P=0.04 and weight loss (P=0.008. Furthermore, the mean of urea in these neonates was significantly related to weight loss (P a few days after birth or to the non-exact weight at the birth time (risk factors. The study results confirmed that weighing the neonates at 72 to 96 hours after birth can prevent hypernatremia in infants. (Sci J Hamadan Univ Med Sci 2015; 22 (3: 203-209

  14. Cell population data in neonates: differences by age group and associations with perinatal factors.

    Science.gov (United States)

    Lee, J; Kim, S Y; Lee, W; Han, K; Sung, I K

    2015-10-01

    Cell population data (CPD) describe physical parameters of white blood cell subpopulations and are reported to be of some value in the diagnosis of sepsis in neonates. Before using the CPD for diagnosing sepsis, the baseline features of the CPD distribution in healthy neonates should be clarified. The aim of this study was to compare the CPD distributions of healthy neonates and other age groups and to identify perinatal factors that are associated with changes in the CPD distribution of healthy neonates. The CPD distribution of 69 samples from term neonates was compared with adolescents and adults. The CPD distribution of 163 samples from healthy neonates was analyzed in association with perinatal factors, including gestational age, chronologic age, birthweight, delivery mode, premature rupture of membranes, diabetes, and pregnancy-induced hypertension. The CPD distribution for term neonates was significantly different from those in adolescents and adults. The mean lymphocyte volume showed a negative correlation with gestational age at birth (r = -0.305; P group than in the normal delivery group. The small for gestational age (SGA) group had smaller mean neutrophil volume and mean monocyte volume than the appropriate for gestational age group. The CPD distribution of healthy neonates differed from those of adolescents or adults, and the differences were associated with gestational age, delivery mode, and being SGA. © 2015 John Wiley & Sons Ltd.

  15. Can neonatal TSH screening reflect trends in population iodine intake?

    LENUS (Irish Health Repository)

    Burns, Robert

    2008-08-01

    The distribution of neonatal blood thyroid-stimulating hormone (TSH) concentrations has been used as an index reflecting population dietary iodine intake, with higher concentrations being indicative of lower iodine intake. We examined this distribution in neonates born in Ireland, where the pregnant population has shown a recent decline in urinary iodine (UI) excretion. Our objectives were to determine if any alteration was observed in the percentage of values > 5.0 mIU\\/L and whether a trend in neonatal blood TSH was apparent.

  16. Fluid overload and mortality are associated with acute kidney injury in sick near-term/term neonate.

    Science.gov (United States)

    Askenazi, David J; Koralkar, Rajesh; Hundley, Hayden E; Montesanti, Angela; Patil, Neha; Ambalavanan, Namasivayam

    2013-04-01

    Acute kidney injury (AKI) is common and portends mortality in several neonatal cohorts. Fluid overload is independently associated with poor outcomes in children and adults but has not been extensively studied in neonates. Between February 2010 and May 2011, we followed 58 neonates who met the following criteria: birth weight >2,000 g, gestational age ≥ 34 weeks, 5-min Apgar ≤ 7, and parental consent. Serum creatinine (SCr) was measured daily for first 4 days of life. AKI was defined as a rise in SCr of > 0.3 mg/dl or persistent SCr above 1.5 mg/dl. AKI was present in 9/58 (15.6 %) neonates and was associated with higher birth weight, being male, lower 5-min Apgar scores, lower cord pH, delivery room intubation, and absence of maternal pre-eclampsia. Percent weight accumulation at day 3 of life was higher in those with AKI [median=8.2, interquartile range (IQR) =4.4-21.6)] than without AKI (median= -4 (IQR= -6.5 to 0.0) (p<0.001). Infants with AKI had lower survival rates than those without AKI [7/9 (72 %) vs. 49/49 (100 %) (p<0.02)]. AKI incidence in this neonatal population is similar to other neonatal cohorts. Near-term/term infants with AKI have a higher mortality rate and a net positive fluid balance over the first few days of life.

  17. Testicular volume of healthy term neonates: Determination of ...

    African Journals Online (AJOL)

    Subjects and Methods: This was a hospital.based, cross.sectional and descriptive study. Eight hundred and eleven apparently healthy term Igbo male neonates within the first 3 days of life were studied. The TV was measured with Prader Orchidometer (ZKL.135.H), ESP Model. Smoothed centiles (3.97th percentile values) ...

  18. Risk factors for serious morbidity in term nonanomalous neonates.

    Science.gov (United States)

    Spain, Janine E; Tuuli, Methodius G; Macones, George A; Roehl, Kimberly A; Odibo, Anthony O; Cahill, Alison G

    2015-06-01

    The purpose of this study was to identify ante- and intrapartum risk factors for serious morbidity in term nonanomalous neonates. We analyzed the first 5000 subjects within an ongoing prospective cohort study of consecutive term births from 2010-2012. The primary outcome was a composite of serious neonatal morbidity defined as ≥1 cases of hypoxic ischemic encephalopathy, meconium aspiration with pulmonary hypertension, requirement of hypothermia therapy, respiratory distress syndrome, seizures, sepsis or suspected sepsis, or death. We calculated odds ratios for the composite morbidity that is associated with ante- and intrapartum factors. Multivariable logistic regression was used to estimate adjusted odds ratios. Of 5000 term nonanomalous births, 393 had the composite morbidity. Significant risk factors for morbidity were nulliparity, presence of meconium, first stage of labor >95th percentile, second stage of labor >95th percentile, pregestational diabetes mellitus, chronic hypertension, obesity, maternal intrapartum fever, and cesarean delivery. In contrast, induction of labor and gestational age ≥41 weeks were not associated with significant morbidity. We identified several significant risk factors for serious morbidity in term nonanomalous neonates. Clinicians may use these risk factors to help anticipate the potential need for additional neonatal support at delivery. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Carboplatin therapeutic monitoring in preterm and full-term neonates.

    Science.gov (United States)

    Veal, Gareth J; Errington, Julie; Hayden, James; Hobin, David; Murphy, Dermot; Dommett, Rachel M; Tweddle, Deborah A; Jenkinson, Helen; Picton, Susan

    2015-09-01

    Administration of the most appropriate dose of chemotherapy to neonates is particularly challenging and frequently not standardised based on any scientific rationale. We report the clinical utility of carboplatin therapeutic drug monitoring in preterm and full-term neonates within the first month of life. Carboplatin therapeutic monitoring was performed to achieve target drug exposures area under the plasma concentration-time curve (AUC values) in nine preterm and full-term neonates diagnosed with retinoblastoma or neuroblastoma treated over an 8 year period. Carboplatin was administered over 3 days with therapeutic drug monitoring utilised to target cumulative AUC values of 5.2-7.8 mg/ml min. AUC values achieved were within 15% of target values for the individual courses of treatment in all but one patient (12/13 courses of treatment), with dose modifications of up to 215% required to achieve target AUC values, based on initial mg/kg dosing schedules. Carboplatin clearance determined across three consecutive chemotherapy courses in two patients increased from 3.4 to 7.1 ml/min and from 7.2 to 16.5 ml/min, representing increases of 210-230% over several weeks of treatment. Complete remission was observed in 8/9 patients, with no renal toxicity reported and only one patient experiencing ototoxicity. The study highlights the benefits of utilising therapeutic drug monitoring to achieve target carboplatin AUC values in preterm and full-term neonates treated within the first few weeks of life, particularly in view of marked increases in drug clearance observed over consecutive chemotherapy courses. In the absence of therapeutic drug monitoring, body-weight based dosing is recommended, with dosing guidance provided for both approaches to inform future treatment. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  20. Bioelectrical impedance spectroscopy for the assessment of body fluid volumes of term neonates

    Directory of Open Access Journals (Sweden)

    Ferreira D.M.

    2004-01-01

    Full Text Available The assessment of fluid volume in neonates by a noninvasive, inexpensive, and fast method can contribute significantly to increase the quality of neonatal care. The objective of the present study was to calibrate an acquisition system and software to estimate the bioelectrical impedance parameters obtained by a method of bioelectrical impedance spectroscopy based on step response and to develop specific equations for the neonatal population to determine body fluid compartments. Bioelectric impedance measurements were performed by a laboratory homemade instrument. The volumes were estimated in a clinical study on 30 full-term neonates at four different times during the first month of life. During the first 24 hours of life the total body water, extracellular water and intracellular water were 2.09 ± 0.25, 1.20 ± 0.19, and 0.90 ± 0.25 liters, respectively. By the 48th hour they were 1.87 ± 0.27, 1.08 ± 0.17, and 0.79 ± 0.21 liters, respectively. On the 10th day they were 2.02 ± 0.25, 1.29 ± 0.21, and 0.72 ± 0.14 liters, respectively, and after 1 month they were 2.34 ± 0.27, 1.62 ± 0.20, and 0.72 ± 0.13 liters, respectively. The behavior of the estimated volume was correlated with neonatal body weight changes, leading to a better interpretation of such changes. In conclusion, this study indicates the feasibility of bioelectrical impedance spectroscopy as a method to help fluid administration in intensive care neonatal units, and also contribute to the development of new equations to estimate neonatal body fluid contents.

  1. Prognostic Factors of Developmental Outcome in Neonatal Seizures in Term Infants

    Directory of Open Access Journals (Sweden)

    Yin-Hsuan Lai

    2013-06-01

    Conclusion: In term infants with neonatal seizures, several risk factors related to adverse outcome were recognized. Physicians should pay more attention to these factors when handling patients with neonatal seizures.

  2. Elective caesarean section and respiratory morbidity in the term and near-term neonate

    DEFF Research Database (Denmark)

    Hansen, Anne Kirkeby; Wisborg, Kirsten; Uldbjerg, Niels

    2007-01-01

    AIM: The aim of this review was to assess the relationship between delivery by elective caesarean section and respiratory morbidity in the term and near-term neonate. METHODS: Searches were made in the MEDLINE database, EMBASE, Cochrane database and Web of Science to identify peer-reviewed studies...

  3. Brainstem evoked response auditory in healthy term neonates with hyperbilirubinemia

    Directory of Open Access Journals (Sweden)

    Isman Jafar

    2010-06-01

    bilirubin> 12 mg/dL will be subject for phototherapy. Objectives To determine the association between total bilirubin > 12 mg/dL and BERA abnonnalities in healthy tenn neonates, and the value of total bilirubin and free bilirubin that initiate abnonnal BERA. Methods This cross sectional study was carried out between March 31August 8, 2008, in healthy term neonates at roomingin ward, Department of Obstetric & Gy necology, Cipto Mangunkusumo Hospital (CMH. All eligible subjects were examined for Bf and BERA using standard methods.  Results The prevalence of abnormal BERA was 15.4%. There was no significant relation between hy perbilirubinemia (> 12 mg/ dL and abnonnal BERA in healthy tenn neonates. Lowest total bilirubin and Bf level related to abnonnal BERA were 12.4 mg/dL (mean 12.8 mg/dL and O.oSLg/dL (mean l.3Lg/dL, respectively. All BERA abnonnalities were unilateral. Conclusions There is no association between abnormal BERA and hyperbilirubinemia (total bilirubin> 12 mg/dL in jaundiced infants who undergo phototherapy.

  4. Nursing and midwifery management of hypoglycaemia in healthy term neonates.

    Science.gov (United States)

    Hewitt, Vivien; Watts, Robin; Robertson, Jeanette; Haddow, Gaby

    2005-08-01

    EXECUTIVE SUMMARY: The primary objective of this review was to determine the best available evidence for maintenance of euglycaemia* in healthy term neonates, and the management of asymptomatic hypoglycaemia in otherwise healthy term neonates. TYPES OF STUDIES: The review included any relevant published or unpublished studies undertaken between 1995 and 2004. Studies that focus on the diagnostic accuracy of point-of-care devices for blood glucose screening and/or monitoring in the neonate were initially included as a subgroup of this review. However, the technical nature and complexity of the statistical information published in diagnostic studies retrieved during the literature search stage, as well as the considerable volume of published research in this area, suggested that it would be more feasible to analyse diagnostic studies in a separate systematic review. The review focused on studies that included healthy term (37- to 42-week gestation) appropriate size for gestational age neonates in the first 72 h after birth. •  preterm or small for gestational age newborns; •  term neonates with a diagnosed medical or surgical condition, congenital or otherwise; •  babies of diabetic mothers; •  neonates with symptomatic hypoglycaemia; •  large for gestational age neonates (as significant proportion are of diabetic mothers). TYPES OF INTERVENTION: All interventions that fell within the scope of practice of a midwife/nurse were included: •  type (breast or breast milk substitutes), amount and/or timing of feeds, for example, initiation of feeding, and frequency; •  regulation of body temperature; •  monitoring (including screening) of neonates, including blood or plasma glucose levels and signs and symptoms of hypoglycaemia. Interventions that required initiation by a medical practitioner were excluded from the review. Outcomes that were of interest included: •  occurrence of hypoglycaemia; •  re-establishment and maintenance

  5. Association between delivery of small-for-gestational-age neonate and long-term maternal chronic kidney disease.

    Science.gov (United States)

    Almasi, Ofir; Pariente, Gali; Kessous, Roy; Sergienko, Ruslan; Sheiner, Eyal

    2016-09-01

    To investigate whether delivery of a small for gestational age (SGA) neonate poses a risk for subsequent long-term maternal renal disease. A population-based study was conducted. Comparison was performed regarding the incidence of long-term renal morbidity in a cohort of women with and without a previous delivery of a SGA neonate. Deliveries occurred during a 25-year period, with a mean follow-up duration of 11.2 years. Renal morbidity included kidney transplantation, chronic renal failure and hypertensive renal disease. Cox proportional hazards model was used to estimate the adjusted hazards ratio (HR) for renal-related hospitalizations and mortality. Out of 99 342 deliveries that met the inclusion criteria, 10 701 (10.7%) occurred in patients who had at least one previous delivery of a SGA neonate. During the follow-up period, patients with a delivery of an SGA neonate had higher rates of renal-related hospitalizations (0.2% versus 0.1%; OR = 1.6, 95% CI 1.01-2.5; p = 0.04). In a Cox proportional hazards model, adjusted for confounders, previous delivery of a SGA neonate was independently associated with subsequent maternal renal-related hospitalizations (adjusted HR, 1.7; 95% CI 1.1-2.8). Delivery of a SGA neonate is an independent risk factor for long-term maternal renal disease.

  6. [New population curves in spanish extremely preterm neonates].

    Science.gov (United States)

    García-Muñoz Rodrigo, F; García-Alix Pérez, A; Figueras Aloy, J; Saavedra Santana, P

    2014-08-01

    Most anthropometric reference data for extremely preterm infants used in Spain are outdated and based on non-Spanish populations, or are derived from small hospital-based samples that failed to include neonates of borderline viability. To develop gender-specific, population-based curves for birth weight, length, and head circumference in extremely preterm Caucasian infants, using a large contemporary sample size of Spanish singletons. Anthropometric data from neonates ≤ 28 weeks of gestational age were collected between January 2002 and December 2010 using the Spanish database SEN1500. Gestational age was estimated according to obstetric data (early pregnancy ultrasound). The data were analyzed with the SPSS.20 package, and centile tables were created for males and females using the Cole and Green LMS method. This study presents the first population-based growth curves for extremely preterm infants, including those of borderline viability, in Spain. A sexual dimorphism is evident for all of the studied parameters, starting at early gestation. These new gender-specific and population-based data could be useful for the improvement of growth assessments of extremely preterm infants in our country, for the development of epidemiological studies, for the evaluation of temporal trends, and for clinical or public health interventions seeking to optimize fetal growth. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  7. BiliCheck transcutaneous bilirubinometer: a screening tool for neonatal jaundice in the Chinese population.

    Science.gov (United States)

    Ho, E Y W; Lee, S Y R; Chow, C B; Chung, J W Y

    2006-04-01

    To verify the usefulness of the BiliCheck transcutaneous bilirubin meter as a screening device for neonatal jaundice in a Chinese population compared with the Minolta bilirubin meter. A prospective correlation study that compared transcutaneous bilirubin measurements with serum bilirubin levels. Obstetric ward and a neonatal unit of a regional hospital in Hong Kong. Neonates with gestation above 32 weeks with neonatal jaundice who were admitted between April 2001 and February 2002. Transcutaneous measurements of serum bilirubin obtained from the forehead and the sternum with two instruments: BiliCheck and Minolta Airshields JM 102. A total of 77 term and six near-term babies (gestation, 32-37 weeks) were recruited. The mean age at the time of data collection was 3.96 days (range, 2-9 days). The correlations between serum bilirubin and transcutaneous bilirubin measurements of the two devices at the two sites were high, with a coefficient of 0.718 (95% confidence interval, 0.610-0.800; n=100) for forehead measurements, and 0.814 (95% confidence interval, 0.740-0.870; n=99) for sternum using the Minolta Airshields JM 102; and a coefficient of 0.757 (95% confidence interval, 0.657-0.827; n=98) for forehead measurements, and 0.794 (95% confidence interval, 0.700-0.862; n=92) for sternum using the BiliCheck. For BiliCheck, a cut-off point of 250 micromol/L at the forehead and 260 micromol/L at the sternum had a specificity of 61.9% and 70.0%, respectively with a sensitivity of 100% for the detection of serum bilirubin concentrations of 250 micromol/L or higher. This level is commonly used as the level for initiation of treatment such as phototherapy. BiliCheck is a useful screening tool for neonatal jaundice in the Chinese population and is comparable with the Minolta Airshields JM 102.

  8. Surfactant replacement therapy for preterm and term neonates with respiratory distress.

    Science.gov (United States)

    Polin, Richard A; Carlo, Waldemar A

    2014-01-01

    Respiratory failure secondary to surfactant deficiency is a major cause of morbidity and mortality in preterm infants. Surfactant therapy substantially reduces mortality and respiratory morbidity for this population. Secondary surfactant deficiency also contributes to acute respiratory morbidity in late-preterm and term neonates with meconium aspiration syndrome, pneumonia/sepsis, and perhaps pulmonary hemorrhage; surfactant replacement may be beneficial for these infants. This statement summarizes the evidence regarding indications, administration, formulations, and outcomes for surfactant-replacement therapy. The clinical strategy of intubation, surfactant administration, and extubation to continuous positive airway pressure and the effect of continuous positive airway pressure on outcomes and surfactant use in preterm infants are also reviewed.

  9. Perinatal risk indicators for long-term neurological morbidity among preterm neonates

    NARCIS (Netherlands)

    Teune, M.J.; Wassenaer, A.G. van; Dommelen, P. van; Mol, B.W.J.; Opmeer, B.C.

    2011-01-01

    Objective: Many obstetric interventions are performed to improve long-term neonatal outcome. However, long-term neonatal outcome is usually not a primary outcome because it is time-consuming and expensive. The aim of this project was to identify different perinatal risk indicators and to develop

  10. In Vitro Model Simulating Gastro-Intestinal Digestion in the Pediatric Population (Neonates and Young Infants).

    Science.gov (United States)

    Kamstrup, Danna; Berthelsen, Ragna; Sassene, Philip Jonas; Selen, Arzu; Müllertz, Anette

    2017-02-01

    The focus on drug delivery for the pediatric population has been steadily increasing in the last decades. In terms of developing in vitro models simulating characteristics of the targeted pediatric population, with the purpose of predicting drug product performance after oral administration, it is important to simulate the gastro-intestinal conditions and processes the drug will encounter upon oral administration. When a drug is administered in the fed state, which is commonly the case for neonates, as they are typically fed every 3 h, the digestion of the milk will affect the composition of the fluid available for drug dissolution/solubilization. Therefore, in order to predict the solubilized amount of drug available for absorption, an in vitro model simulating digestion in the gastro-intestinal tract should be utilized. In order to simulate the digestion process and the drug solubilization taking place in vivo, the following aspects should be considered; physiologically relevant media, media volume, use of physiological enzymes in proper amounts, as well as correct pH and addition of relevant co-factors, e.g., bile salts and co-enzymes. Furthermore, physiological transit times and appropriate mixing should be considered and mimicked as close as possible. This paper presents a literature review on physiological factors relevant for digestion and drug solubilization in neonates. Based on the available literature data, a novel in vitro digestion model simulating digestion and drug solubilization in the neonate and young infant pediatric population (2 months old and younger) was designed.

  11. Cranial ultrasonographic findings in healthy full-term neonates: A retrospective review

    Directory of Open Access Journals (Sweden)

    Chien-Lun Hsu

    2012-08-01

    Conclusion: The incidence of minor and major anomalies detected by cranial ultrasonographic screening examinations in healthy full-term neonates is 6.3% and 0.06%, respectively. Thus, cranial ultrasonographic screening testing may play a role in the early diagnosis of intracranial anomalies of otherwise healthy neonates. However, this examination cannot exclude or detect all cranial abnormalities, including many potential neurologic diseases of neonates, so continuing clinical diligence is still important for all infants.

  12. Neonatal Pneumopericardium in a Nonventilated Term Infant: A Case Report and Review of the Literature

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    Smita Roychoudhury

    2017-01-01

    Full Text Available Neonatal pneumopericardium (PPC is a rare form of neonatal air leak syndrome with high morbidity and mortality. Air leak syndrome in the newborn is usually associated with active resuscitation, respiratory distress syndrome, meconium aspiration syndrome, mechanical ventilation, or trauma associated with labour. Neonatal PPC can be associated with other air leak syndromes such as pneumomediastinum, pneumothorax, pneumoperitoneum, and subcutaneous and interstitial emphysema. Spontaneous PPC is a rare event in the neonatal period. We report a case of PPC in association with pneumothorax in a nonventilated term infant. The infant responded to thoracocentesis without the need for pericardiocentesis.

  13. Severe methemoglobinemia caused by continuous lidocaine infusion in a term neonate.

    Science.gov (United States)

    Bohnhorst, Bettina; Hartmann, Hans; Lange, Matthias

    2017-05-01

    Neonates and young infants are especially prone to develop drug-induced methemoglobinemia. Therefore, lidocaine is not licensed as local anesthetic in children below the age of 3 months. However, its systemic use is advocated for neonatal seizures. Cardiac arrhythmia has been reported as sole major side effect. Here we report a case of severe methemoglobinemia caused by continuous infusion of lidocaine in a term neonate with neonatal seizures. The increase of methemoglobin up to 13.8% was accompanied by hypoxemia and cyanosis, necessitating additional inspired oxygen and CPAP ventilation. After stopping lidocaine infusion methemoglobin levels fell and the neonate could be weaned from ventilation. Neonates treated with lidocaine for seizures must be monitored for the occurrence of methemoglobinemia. Copyright © 2017 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  14. Coagulase-Negative Staphylococci in Human Milk From Mothers of Preterm Compared With Term Neonates.

    Science.gov (United States)

    Soeorg, Hiie; Metsvaht, Tuuli; Eelmäe, Imbi; Metsvaht, Hanna Kadri; Treumuth, Sirli; Merila, Mirjam; Ilmoja, Mari-Liis; Lutsar, Irja

    2017-05-01

    Human milk is the preferred nutrition for neonates and a source of bacteria. Research aim: The authors aimed to characterize the molecular epidemiology and genetic content of staphylococci in the human milk of mothers of preterm and term neonates. Staphylococci were isolated once per week in the 1st month postpartum from the human milk of mothers of 20 healthy term and 49 preterm neonates hospitalized in the neonatal intensive care unit. Multilocus variable-number tandem-repeats analysis and multilocus sequence typing were used. The presence of the mecA gene, icaA gene of the ica-operon, IS 256, and ACME genetic elements was determined by PCR. The human milk of mothers of preterm compared with term neonates had higher counts of staphylococci but lower species diversity. The human milk of mothers of preterm compared with term neonates more often contained Staphylococcus epidermidis mecA (32.7% vs. 2.6%), icaA (18.8% vs. 6%), IS 256 (7.9% vs. 0.9%), and ACME (15.4% vs. 5.1%), as well as Staphylococcus haemolyticus mecA (90.5% vs. 10%) and IS 256 (61.9% vs. 10%). The overall distribution of multilocus variable-number tandem-repeats analysis (MLVA) types and sequence types was similar between the human milk of mothers of preterm and term neonates, but a few mecA-IS 256-positive MLVA types colonized only mothers of preterm neonates. Maternal hospitalization within 1 month postpartum and the use of an arterial catheter or antibacterial treatment in the neonate increased the odds of harboring mecA-positive staphylococci in human milk. Limiting exposure of mothers of preterm neonates to the hospital could prevent human milk colonization with more pathogenic staphylococci.

  15. Long-term outcome in survivors of neonatal tetanus following specialist intensive care in Vietnam.

    Science.gov (United States)

    Trieu, Huynh T; Anh, Nguyen Thi Kim; Vuong, Huynh Ngoc Thien; Dao, T T M; Hoa, Nguyen Thi Xuan; Tuong, Vo Ngoc Cat; Dinh, Pham Tam; Wills, Bridget; Qui, Phan Tu; Van Tan, Le; Yen, Lam Minh; Sabanathan, Saraswathy; Thwaites, Catherine Louise

    2017-09-25

    Neonatal tetanus continues to occur in many resource-limited settings but there are few data regarding long-term neurological outcome from the disease, especially in settings with critical care facilities. We assessed long-term outcome following neonatal tetanus in infants treated in a pediatric intensive care unit in southern Vietnam. Neurological and neurodevelopmental testing was performed in 17 survivors of neonatal tetanus and 18 control children from the same communities using tools previously validated in Vietnamese children. The median age of children assessed was 36 months. Eight neonatal tetanus survivors and 9 community control cases aged < 42 months were tested using the Bayley III Scales of Infant and Toddler Development (Bayley III-VN) and 8 neonatal tetanus survivors and 9 community controls aged ≥42 months were tested using the Movement Assessment Battery for Children. No significant reductions in growth indices or neurodevelopmental scores were shown in survivors of neonatal tetanus compared to controls although there was a trend towards lower scores in neonatal tetanus survivors. Neurological examination was normal in all children except for two neonatal tetanus survivors with perceptive deafness and one child with mild gross motor abnormality. Neonatal tetanus survivors who had expienced severe disease (Ablett grade ≥ 3) had lower total Bayley III-VN scores than those with mild disease (15 (IQR 14-18) vs 24 (IQR 19-27), p = 0.05) with a significantly lower cognitive domain score (3 (IQR 2-6) severe disease vs 7 (IQR 7-8) mild disease, p = 0.02). Neonatal tetanus is associated with long-term sequelae in those with severe disease. In view of these findings, prevention of neonatal tetanus should remain a priority.

  16. The Placental Microbiome Varies in Association with Low Birth Weight in Full-Term Neonates

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    Jia Zheng

    2015-08-01

    Full Text Available Substantial evidence indicated that low birth weight was an independent risk factor for obesity, impaired glucose regulation, and diabetes later in life. However, investigations into the association between low birth weight and placental microbiome in full-term neonates are limited. Placentas were collected from low birth weight (LBW and normal birth weight (NBW full-term neonates (gestational age 37 w0d–41 w6d consecutively born at Peking Union Medical College Hospital. The anthropometric measurements were measured and 16S ribosomal DNAamplicon high-throughput sequencing were utilized to define bacteria within placenta tissues. It showed that birth weight, ponderal index, head circumference, and placenta weight were significantly lower in LBW than NBW neonates (p < 0.05. The operational taxonomic units (OTUs (p < 0.05 and the estimators of community richness (Chao indexes (p < 0.05 showed a significantly lower diversity in LBW than NBW neonates. There were significant variations in the composition of placenta microbiota between the LBW and NBW neonates at the phylum and genus level. Furthermore, it indicated that Lactobacillus percentage was positively associated with birth weight (r = 0.541, p = 0.025. In conclusion, our present study for the first time detected the relationship between birth weight and placental microbiome profile in full-term neonates. It is novel in showing that the placental microbiome varies in association with low birth weight in full-term neonates.

  17. Reevaluating Reference Ranges of Oxygen Saturation for Healthy Full-term Neonates Using Pulse Oximetry

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    Ying-Chun Lu

    2014-12-01

    Conclusion: The delivery modes did not affect the SpO2 values of full-term healthy neonates. Discrepancies in SpO2 changes in full-term neonates not requiring resuscitation between this study and the AAP/AHA guidelines were significant. SpO2 ranges for each time point within the first 10 minutes after birth should therefore be reevaluated locally.

  18. Phototherapy and DNA changes in full term neonates with ...

    African Journals Online (AJOL)

    Maha Youssif Zein El-Abdin

    2011-11-29

    Nov 29, 2011 ... tative assay of its product, (BCL2) protein, by ELISA and BAX gene expression status was assessed by PCR. Results: The frequency of micronuclei in circulating lymphocytes of neonates who received photo- therapy has significantly increased before and after phototherapy compared to controls, (p < 0.001;.

  19. Neonatal vitamin A supplementation for the prevention of mortality and morbidity in term neonates in low and middle income countries.

    Science.gov (United States)

    Haider, Batool A; Sharma, Renee; Bhutta, Zulfiqar A

    2017-02-24

    Vitamin A deficiency is a major public health problem in low and middle income countries. Vitamin A supplementation in children six months of age and older has been found to be beneficial, but no effect of supplementation has been noted for children between one and five months of age. Supplementation during the neonatal period has been suggested to have an impact by increasing body stores in early infancy. To evaluate the role of vitamin A supplementation for term neonates in low and middle income countries with respect to prevention of mortality and morbidity. We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 2), MEDLINE via PubMed (1966 to 13 March 2016), Embase (1980 to 13 March 2016) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 13 March 2016). We also searched clinical trials databases, conference proceedings and reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. Randomised and quasi-randomised controlled trials. Also trials with a factorial design. Two review authors independently assessed trial quality and extracted study data. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the quality of evidence. We included 12 trials (168,460 neonates) in this review, with only a few trials reporting disaggregated data for term infants. Therefore, we analysed data and presented estimates for term infants (when specified) and for all infants.Data for term neonates from three studies did not show a statistically significant effect on the risk of infant mortality at six months in the vitamin A group compared with the control group (typical risk ratio (RR) 0.80; 95% confidence interval (CI) 0.54 to 1.18; I2 = 63%). Analysis of data for all infants from 11 studies revealed no evidence of a significant reduction in the risk of

  20. Impact of structured programs on breastfeeding initiation rates in preterm neonates in a socioeconomically deprived area in France: A 10-year population-based study.

    Science.gov (United States)

    Charkaluk, M-L; Bomy, H; Delguste, S; Courdent, M; Rousseau, S; Zaoui-Grattepanche, C; Pierrat, V

    2018-01-01

    Structured programs have a positive impact on breastfeeding (BF) but have rarely been evaluated for preterm neonates, frequently combining prematurity and socioeconomic deprivation as risk factors of a low BF rate. We aimed to assess BF initiation rates in very preterm (preterm (33-36 weeks), and term neonates from 2002 to 2011 in a French administrative district characterized by socioeconomic deprivation. Structured activities to promote and support BF have been implemented in this area since 2002; they all started in neonatal units. This retrospective population-based study analyzed 302,102 first health certificates. Overall, the BF initiation rate significantly increased, from 52.9% [95% CI: (52.3; 53.4)] in 2002 to 61.0% [95% CI: (60.4; 61.6)] in 2011. In 2002, BF initiation rates did not differ between groups, but in 2011, it was higher for very preterm than for term and moderately preterm neonates [74.7% (69.7; 79.6)] vs. 60.9% (60.3; 61.5) and 59.9% (57.6; 62.2), respectively, both Ppreterm children and term-born children (P=0.40). The 2.2% yearly increase observed in very preterm neonates significantly differed from the 0.9% yearly increase in the French general population (Ppreterm neonates, but not in moderately preterm neonates, whose specific needs should be further evaluated. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  1. Neonatal overfeeding attenuates acute central pro-inflammatory effects of short-term high fat diet

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    Guohui eCai

    2015-01-01

    Full Text Available Neonatal obesity predisposes individuals to obesity throughout life. In rats, neonatal overfeeding also leads to early accelerated weight gain that persists into adulthood. The phenotype is associated with dysfunction in a number of systems including paraventricular nucleus of the hypothalamus (PVN responses to psychological and immune stressors. However, in many cases weight gain in neonatally overfed rats stabilizes in early adulthood so the animal does not become more obese as it ages. Here we examined if neonatal overfeeding by suckling rats in small litters predisposes them to exacerbated metabolic and central inflammatory disturbances if they are also given a high fat diet in later life. In adulthood we gave the rats normal chow, 3 days, or 3 weeks high fat diet (45% kcal from fat and measured peripheral indices of metabolic disturbance. We also investigated hypothalamic microglial changes, as an index of central inflammation, as well as PVN responses to lipopolysaccharide (LPS. Surprisingly, neonatal overfeeding did not predispose rats to the metabolic effects of a high fat diet. Weight changes and glucose metabolism were unaffected by the early life experience. However, short term (3 day high fat diet was associated with more microglia in the hypothalamus and a markedly exacerbated PVN response to LPS in control rats; effects not seen in the neonatally overfed. Our findings indicate neonatally overfed animals are not more susceptible to the adverse metabolic effects of a short-term high fat diet but may be less able to respond to the central effects.

  2. The Effects of Lavender Scent on Pain of Blood Sampling in Term Neonates

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    Naghmeh Razaghi

    2015-04-01

    Full Text Available Introduction  After birth, many infants were in hospital undergo repeated invasive procedures and because there is increasing evidence of short-term and long-term adverse neurodevelopment consequences, pain management in neonates is very important. Methods and Materials This was a quasi experimental study of clinical trial type that carried out on 80 term neonate that were allocated to two intervention (40 neonates and control (40 neonates groups. In experimental group, infants at night for 8 hours before blood sampling were exposed to the scent of lavender. And the next day, at the time of blood sampling was used of the scent of lavender. Simultaneously with the needle, pain assessment scale scores Douleur Aigue Nouveau-ne (DAN or neonatal pain discomfort by a trained person, was calculated and recorded. Duration of crying in seconds from start cry to silence that lasted at least 5 seconds interval was measured. The control group did not receive additional action for pain relief. Data were analyzed by using SPSS version 16 software. Results Average rating of DAN score was in control group 5.97 ± 1.94 and in experimental group 4.47+1.81. Mann–Whitney test results showed a significant difference in pain scores in the two groups (P=0.001. The crying time between groups was not significant difference (P = 0.12. Conclusion The results of this study indicate that the scent of lavender is effective in reducing the pain caused by sampling in term neonates but had no effect on the duration of crying infants. Since neonatal pain management is an important task for nurse, using of the scent of lavender as a non pharmacological method of pain management in neonates requires further investigation.

  3. Population Pharmacokinetic Characteristics of Amikacin in Suspected Cases of Neonatal Sepsis in a Low-Resource African Setting: A Prospective Nonrandomized Single-Site Study

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    Seth K. Amponsah, PhD

    2017-01-01

    Conclusions: The V and half-life of amikacin in this cohort varied from that reported in non-African populations, and the high trough and low peak amikacin concentrations in both term and preterm neonates suggest strategies to optimize amikacin dosing are required in this population.

  4. Determinants of neonatal mortality in rural Northern Ethiopia: A population based nested case control study.

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    Robel Yirgu

    Full Text Available In low income and middle income countries, neonatal mortality remains high despite the gradual reduction in under five mortality. Newborn death contributes for about 38% of all under five deaths. This study has identified the magnitude and independent predictors of neonatal mortality in rural Ethiopia.This population based nested case control study was conducted in rural West Gojam zone, Northern Ethiopia, among a cohort of pregnant women who gave birth between March 2011 and Feb 2012. The cohort was established by Maternal and Newborn Health in Ethiopia Partnership (MaNHEP project in 2010 by recruiting mothers in their third trimester, as identified by trained community volunteers. Once identified, women stayed in the cohort throughout their pregnancy period receiving Community Maternal and Newborn Health (CMNH training by health extension workers and community volunteers till the end of the first 48 hours postpartum. Cases were 75 mothers who lost their newborns to neonatal death and controls were 150 randomly selected mothers with neonates who survived the neonatal period. Data to identify cause of death were collected using the WHO standard verbal autopsy questionnaire after the culturally appropriate 40 days of bereavement period. Binomial logistic regression model was used to identify independent contributors to neonatal mortality.The neonatal mortality rate was AOR(95%CI = 18.6 (14.8, 23.2 per 1000 live births. Neonatal mortality declined with an increase in family size, neonates who were born among a family of more than two had lesser odds of death in the neonatal period than those who were born in a family of two AOR (95% CI = 0.13 (0.02, 0.71. Mothers who gave birth to 2-4 AOR(95%CI = 0.15 (0.05, 0.48 and 5+ children AOR(95%CI = 0.08 (0.02, 0.26 had lesser odds of losing their newborns to neonatal mortality. Previous history of losing a newborn to neonatal death also increased the odds of neonatal mortality during the last birth AOR

  5. Specific memory impairment following neonatal encephalopathy in term-born children

    NARCIS (Netherlands)

    Handel, M. van; Sonneville, L. de; Vries, L.S. de; Jongmans, M.C.J.; Swaab, H.

    2012-01-01

    This study examines short-term memory, verbal working memory, episodic long-term memory, and intelligence in 32 children with mild neonatal encephalopathy (NE), 39 children with moderate NE, 10 children with NE who developed cerebral palsy (CP), and 53 comparison children, at the age of 9 to 10

  6. Assessment of thymus size in healthy term neonates using sonography - A study from tertiary care hospital of Central India.

    Science.gov (United States)

    Mehta, S

    2015-01-01

    A cross-sectional study was done to assess the size of thymus in term healthy infants using sonography and to assess its variation in size, shape, location, echogenicity and echotexture for both male and female reference population. A total of 250 term healthy neonates of either sex were subjected to thymic sonography. The shape, size in maximal anteroposterior, longitudinal, and transverse dimensions of both right and left lobes of thymus was evaluated. Their echotexture and echogenicity were determined and standards for reference population were calculated. The results were statistically evaluated. According to the shape; the thymus was quadrilateral in 156 neonates (62%), round in 37 (15%), bilobate in 32 (13%), and crescent shaped in 25 (10%) in transverse scan. According to the echo texture, the thymus echogenicity was homogeneous and almost similar or slightly less to that of the liver and spleen in most cases 200 [80%] and was coarse in 50 (20%). In all subjects, the echogenicity of the thymus was less than that of the thyroid gland. Variations in location of the thymus were found in 70 (28%) neonates. The range of mean AP diameter was 0.39-2.36 cm (mean 1.43 ± 0.3), that of transverse 1.4 - 4.3 cm (mean 2.16 ± 0.54) and that of thymic index 1.2-5.1 cm2 (mean 2.98 ± 0.64). A normative range was calculated for standard population, which can be used as a reference for comparing thymus size for both normal and diseased neonates for various immunological diseases.

  7. Neonatal hypertension – a long-term pilot follow-up study

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    Chaudhari T

    2013-06-01

    Full Text Available Tejasvi Chaudhari,1 Michael C Falk,2,3 Rajeev Jyoti,2,4 Susan Arney,5 Wendy Burton,5 Alison L Kent1,2 1Department of Neonatology, Canberra Hospital, Woden, ACT, Australia; 2Australian National University Medical School, Canberra, ACT, Australia; 3Department of Nephrology, 4Medical Imaging Department, 5Centre for Newborn Care, Canberra Hospital, Woden, ACT, Australia Background: Neonatal hypertension occurs in up to 3% of neonates, more commonly in those admitted to neonatal intensive care. The aims of this study were to review renal function and renal volumes in children who had a history of neonatal hypertension. Methods: Children with a history of neonatal hypertension from January 2001 to December 2008 were included in the study during 2011. Blood pressure, weight, height, and body mass index were recorded. Renal ultrasound with 3D volume, urine for electrolytes, albumin, ß2 microglobulin, and blood for electrolytes, urea, creatinine, calcium, phosphate, renin, and aldosterone were collected depending on parental consent. Results: Of the 41 neonates with neonatal hypertension, eleven (27% were included in the study (six died; 24 moved interstate or declined involvement. One child (9% was still on antihypertensive medication and one was found to be hypertensive on review. This child had small volume kidneys and albuminuria. Three out of nine renal volume measurements were low (33% and two out of eleven had renal scarring (18%. The six available renin/aldosterone results were normal. Conclusion: This study suggests there are long-term renal and blood pressure implications for neonates with hypertension and ongoing surveillance of blood pressure and renal function should be performed throughout childhood and into early adulthood. Keywords: neonate, hypertension, renal ultrasound, 3D

  8. Aorta Structural Alterations in Term Neonates: The Role of Birth and Maternal Characteristics

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    Marco Matteo Ciccone

    2013-01-01

    Full Text Available Aim. To evaluate the influence of selected maternal and neonatal characteristics on aorta walls in term, appropriately grown-for-gestational age newborns. Methods. Age, parity, previous abortions, weight, height, body mass index before and after delivery, smoking, and history of hypertension, of diabetes, of cardiovascular diseases, and of dyslipidemia were all assessed in seventy mothers. They delivered 34 males and 36 females healthy term newborns who underwent ultrasound evaluation of the anteroposterior infrarenal abdominal aorta diameter (APAO, biochemical profile (glucose, insulin, total cholesterol, HDL and LDL cholesterol, triglycerides, fibrinogen, and D-dimers homeostasis model assessment [HOMAIR]index, and biometric parameters. Results. APAO was related to newborn length (r=+0.36; P=0.001, head circumference (r=+0.37; P=0.001, gestational age (r=+0.40, P=0.0005, HOMA index (r=+0.24; P=0.04, and D-dimers (r=+0.33, P=0.004. Smoke influenced APAO values (odds ratio: 1.80; confidence interval 95%: 1.05–3.30, as well as diabetes during pregnancy (r=+0.42, P=0.0002. Maternal height influenced neonatal APAO (r=+0.47, P=0.00003. Multiple regression analysis outlined neonatal D-dimers as still significantly related to neonatal APAO values. Conclusions. Many maternal and neonatal characteristics could influence aorta structures. Neonatal D-dimers are independently related to APAO.

  9. Effect of breast-feeding frequency on hyperbilirubinemia in breast-fed term neonate.

    Science.gov (United States)

    Chen, Ying-Juang; Yeh, Tsu-Fu; Chen, Chung-Ming

    2015-12-01

    Hyperbilirubinemic neonates have significantly less bodyweight gain from nursery discharge to outpatient department (OPD) follow up. We tested the hypothesis that discharge instructions encouraging frequent breast-feeding given in the nursery would increase infant bodyweight gain and decrease the incidence of hyperbilirubinemia. We enrolled consecutively live-born neonates who were discharged from the nursery and who received OPD follow up within the first 2 weeks of birth in 2011. The nursing staff discussed the discharge instructions with the parents at the time of nursery discharge. Parents were asked to fill in a nursing information form to record the frequency of breast-feeding and diaper change per day. Parents of 98 breast-fed term neonates provided complete nursing information forms. These 98 neonates were classified into two groups according to breast-feeding frequency, namely breast-feeding frequency and diaper change frequency per day indicated that the data were highly reliable. The gestational age, Apgar score, birthweight, and bodyweight at nursery discharge and at OPD were similar between the two groups. Neonates who were breast-fed ≥8 times/day had a significantly lower incidence of hyperbilirubinemia. Nursery discharge instructions that encouraged mothers to breast-feed their newborns frequently decreased the rate of hyperbilirubinemia in exclusively breast-fed term neonates. © 2015 Japan Pediatric Society.

  10. Transcutaneous Bilirubin Nomogram for Healthy Term and Late Preterm Neonates in First 96 Hours of Life.

    Science.gov (United States)

    Thakkar, Pareshkumar; Chavda, Hardas; Doshi, Vikas

    2017-05-15

    To develop nomogram of Transcutaneous Bilirubin among healthy term and late-preterm neonates during first 96 hours of age. Longitudinal observational study. Neonatal unit of a tertiary care Hospital of Central Gujarat, India. 1075 healthy term and late preterm neonates (≥35weeks). Six-hourly transcutaneous bilirubin was obtained from birth to 96 hour of life using Drager JM 103 Transcutaneous Bilirubinometer. Main outcome measures: Nomogram of Transcutaneous Bilirubin with percentile values was obtained, rate of rise of bilirubin was calculated and predictive ability of normative data was analyzed for subsequent need of phototherapy. The age-specific percentile curves and nomogram were developed from the transcutaneous bilirubin readings of 1,010 neonates. Rate of rise in first 12 hour was 0.2 mg/dL and was 0.17 mg/dL in 12 to 24 hour of life which decreased on second day of life. Neonates who required phototherapy had consistently higher readings of transcutaneous bilirubin and also higher rate of rise in first 48 hrs. Neonates whose transcutaneous bilirubin is above the 50th percentile should be monitored for the development of significant hyperbilirubinemia.

  11. Care seeking for fatal illness episodes in Neonates: a population-based study in rural Bangladesh

    Directory of Open Access Journals (Sweden)

    Ali Mohammed

    2011-10-01

    Full Text Available Abstract Background Poor neonatal health is a major contributor to under-five mortality in developing countries. A major constraint to effective neonatal survival programme has been the lack of population level data in developing countries. This study investigated the consultation patterns of caregivers during neonatal fatal illness episodes in the rural Matlab sub-district of eastern Bangladesh. Methods Neonatal deaths were identified through a population-based demographic surveillance system in Matlab ICDDR,B maternal and child health (MCH project area and an adjoining government service area. Trained project staff administered a structured questionnaire on care seeking to mothers at home who had experienced a neonatal death. Univariate, bivariate and binary multivariate logistic regressions were performed to describe care seeking during the fatal illness episode. Results Of the 365 deaths recorded during 2003 and 2004, 84% died in the early (0-7 days neonatal period, with the remaining deaths occurring over the subsequent 8 to 28 days. The first resort of care by parents was a qualified doctor or paramedic in 37% of cases, followed by traditional and unqualified health care providers in 25%, while 38% sought no care. Thus, almost two thirds (63% of neonates who died received only traditional and unqualified care or no care at all during their final illness episode. About 22% sought care from more than one provider, including 6% from 3 or more providers. Such plurality in care seeking was more likely among male infants, in the late neonatal period, and in the MCH project area. Conclusions The high proportion of neonatal deaths that had received traditional care or no medical care in a rural area of Bangladesh highlights the need to develop community awareness about prompt medical care seeking for neonatal illnesses and to improve access to effective health care. Integration of traditional care providers into mainstream health programs should

  12. Frequency of neonatal hyperglycaemia at Gaafar Ibnauf Children's Hospital: Clinical aspects and short term outcome.

    Science.gov (United States)

    Mohammed, Monera Mm; Abdel Rahman, Sirageldin Mk

    2016-01-01

    Hyperglycaemia has become a significant risk factor for morbidity and mortality of the smaller fragile infants surviving the neonatal period. Its risk is inversely related to gestational age, birth weight and baby's clinical condition. The aim of this study was to determine the frequency, some clinical aspects and immediate outcome of hyperglycaemia in neonates admitted to the neonatal intensive care unit (NICU) at Gaafar Ibnauf Children's Hospital, Khartoum. The study was a prospective, descriptive and hospital-based, conducted during the period of 1st January to 31st December 2014. Eighty-five neonates out of 345 had neonatal hyperglycaemia with a frequency rate of (24.6%). Fifty-two (61.2%) were males (male: female ratio=1.6:1), 61.2% of the babies were in the age group (0-7) days, and 25.9% in age group (8-14) days. Forty-two (49.4%) were preterm, while 43 (50.6%) were term babies. Four (4.7%) of the mothers had diabetes, and 6(7.1%) had hypertension. Neonatal sepsis was a predominant risk factor of hyperglycaemia occurring in 67 babies (78.8%), followed by respiratory distress syndrome in 28 (32.9%) babies. Ten babies (11.8%) were diagnosed as acute kidney injury, four babies (4.7%) had hypernatraemic dehydration and seven babies (8.3%) were having hypoxic ischemic encephalopathy. Out of 85 hyperglycaemic neonates death was reported in 10 babies (11.8%), 75 (88.2%) survived. All cases had transient hyperglycaemia; therefore insulin intervention was not necessary. Currently, at Gaafar Ibnauf Children's Hospital, specific protocol for management of hyperglycaemia is lacking. Further studies are recommended to assess long term sequels of hyperglycaemia in neonates.

  13. Maternal and neonatal FTO rs9939609 polymorphism affect insulin sensitivity markers and lipoprotein profile at birth in appropriate-for-gestational-age term neonates.

    Science.gov (United States)

    Gesteiro, Eva; Sánchez-Muniz, Francisco J; Ortega-Azorín, Carolina; Guillén, Marisa; Corella, Dolores; Bastida, Sara

    2016-06-01

    The influence of maternal fat mass and obesity (FTO) gene polymorphism on neonatal insulin sensitivity/resistance biomarkers and lipoprotein profile has not been tested. The study aimed to assess the association between the FTO rs9939609 polymorphism in mother-neonate couples and neonatal anthropometrical measurements, insulin sensitivity/resistance, and lipid and lipoprotein concentrations at birth. Fifty-three term, appropriate-for-gestational-age, Caucasian newborns together with their respective mothers participated in a cross-sectional study. Sixty-six percent of mothers and neonates carried the A allele (being AA or AT). TT mothers gained less weight during pregnancy, but non-significant maternal gene influence was found for neonatal bodyweight, body mass index, or ponderal index. Neonates from AA + AT mothers showed lower glucose, insulin, and homeostatic model assessment insulin resistance (HOMA-IR) but higher homeostatic model assessment insulin sensitivity (HOMA-IS) and homocysteine than neonates whose mothers were TT. AA + AT neonates had higher insulin and HOMA-IR than TT. The genotype neonatal × maternal association was tested in the following four groups of neonates: TT neonates × TT mothers (nTT × mTT), TT neonates × AA + AT mothers (nTT × mAA + AT), AA + AT neonates × TT mothers (nAA + AT × mTT), and AA + AT neonates × AA + AT mothers (nAA + AT × mAA + AT). Non-significant interactions between neonatal and maternal alleles were found for any parameter tested. However, maternal alleles affected significantly glucose, insulin, HOMA-IR, and homocysteine while neonatal alleles the arylesterase activity. Most significant differences were found between nATT + AA × mTT and nATT + AA × mAA + AT. Glycemia, insulinemia, and HOMA-IR were lower, while the Mediterranean diet adherence (MDA) was higher in the mAA + AT vs. mTT whose children were AA + AT. This dietary fact seems to counterbalance the potential negative effect on glucose homeostasis of

  14. Follow-up Of Neonatal Jaundice In Term And Late Premature Newborns.

    OpenAIRE

    Facchini, Fernando P; Mezzacappa,Maria Aparecida; Rosa, Izilda R; Mezzacappa Filho,Francisco; Aranha-Netto, Abimael; Marba, Sergio Tadeu

    2015-01-01

    Objective: To report on the results of a project following term and near term newborn infants who were jaundiced during the neonatal period. Methods: Neonates were referred to the follow-up clinic with weight ≥ 2,000 g and/or gestational age ≥ 35 weeks, and jaundice at discharge was initially assessed with an Ingram icterometer or Bilicheck and, if indicated, with a Unistat bilirubinometer (Leica). These newborn infants had bilirubinemia at or above the 40th percentile on the nomogram develop...

  15. Antioxidant vitamins and glucose-6-phosphate dehydrogenase deficiency in full-term neonates

    Directory of Open Access Journals (Sweden)

    Obediat, Ahmad D.

    2008-09-01

    Full Text Available Objective: The mechanism by which glucose-6-phosphate dehydrogenase (G6PD deficiency causes neonatal hyperbilirubinemia is not completely understood. However, the genetic disorder G6PD deficiency predisposes red blood cells to oxidative stress. The aim of this study was to establish the relationship between plasma antioxidant vitamin (E and C levels and the development of hyperbilirubinemia in full-term neonates with deficient G6PD. Methods: A total of 196 live birth neonates of healthy mothers were included in this study. Twelve of them were deficient in G6PD. In addition to demographic data, serum total bilirubin, hemoglobin, hematocrit, and vitamin E and C levels were measured on the first day after birth.Results: Neonates with G6PD deficiency (n=7 who did not develop hyperbilirubinemia (mean serum bilirubin level of 70.8±23 µmol/l, median 71.8 and neonates with G6PD deficiency (n=4 who developed hyperbilirubinemia (mean serum bilirubin level of 226.7±79 µmol/l, median 233.4 on the first day of life had similar gestational weights and age. The second group, however, had lower hemoglobin and hematocrit as well as plasma vitamin C and E levels. None of these results showed significant difference. Conclusion: The results of the present study indicate that red blood cell hemolysis as a result of inadequate antioxidants system in G6PD-deficient neonates is not the only contributing factor for hyperbilirubinemia.

  16. The relation between pre-eclampsia at term and neonatal encephalopathy

    OpenAIRE

    Impey, L; Greenwood, C; Sheil, O; MacQuillan, K; Reynolds, M.; Redman, C

    2001-01-01

    OBJECTIVES—To determine whether pre-eclampsia, hypothesised to be an inflammatory condition, is associated with fever in term labour, and confirm and examine the reported association of pre-eclampsia at term with neonatal encephalopathy.
DESIGN—Prospective cohort study.
SETTING—A Dublin teaching hospital.
PARTICIPANTS—6163 women in labour with singleton pregnancies at term at low risk for intrapartum hypoxia, recruited to a randomised trial examining the effect of admi...

  17. Effect of White Plastic Cover around the Phototherapy Unit on Hyperbilirubinemia in Full Term Neonates.

    Science.gov (United States)

    Babaei, Homa; Alipour, Ali-Asghar; Hemmati, Mitra; Ghaderi, Mohammad; Rezaei, Mansour

    2013-04-01

    Jaundice is a common problem in neonatal period. Phototherapy is the most common treatment for neonatal jaundice. The purpose of this study was to determine the effect of adding white plastic cover around the phototherapy unit on hyperbilirubinemia in full term neonates with jaundice. In this randomized controlled trial, over 12 months (October 2009 - September 2010), 182 term neonates with uncomplicated jaundice, admitted to neonatal unit of Imam Reza Hospital (AS) in Kermanshah province of Iran, were selected. They were randomized in two groups. Control group received conventional phototherapy without cover around the apparatus and covered group received conventional phototherapy with plastic cover around the unit. After enrolment, total serum bilirubin was measured every 12 hours. Phototherapy was continued until the total serum bilirubin decreased to or less than 12.5 mg/dl. There were no significant differences between the two groups for gestational age, birth weight, postnatal age, weight (at admission), serum level of hemoglobin, hematocrit and reticulocyte count. Total serum bilirubin in covered group, during the first 48 hours of treatment, declined significantly than in control group (P. value=0.003). The cover around the phototherapy unit not only did not increase the side effects of phototherapy, but also had a positive impact in reducing duration of jaundice (P. value plastic cover around the phototherapy unit can increase the therapeutic effect of phototherapy.

  18. Complement activity in the cord blood of term neonates with the ...

    African Journals Online (AJOL)

    Cord blood samples from 11 term neonates whose placentas showed histological changes typical of the amniotic fluid infection syndrome were analysed in order to determine haemolytic activity of the classic and alternative complement pathways and serum levels of complement proteins and immunoglobulins. Although the ...

  19. Midazolam and amplitude-integrated EEG in asphyxiated full-term neonates

    NARCIS (Netherlands)

    van Leuven, K; Groenendaal, F; Toet, MC; Schobben, AFAM; Bos, SAJ; de Vries, LS; Rademaker, CMA

    Aim: In the present, prospective study, the relation between the levels of midazolam, its two active metabolites-1-hydroxy-midazolam (OH-midazolam) and 1-hydroxy-midazolam-glucuronide (glumidazolam)-and the aEEG were examined. Patients and methods: Fifteen full-term neonates with seizures due to

  20. Neonatal Outcome of Term Breech Births: A 15-Year Review at the ...

    African Journals Online (AJOL)

    was associated with significantly increased risk of perinatal death and neonatal morbidity. Keywords breech birth; vaginal delivery; cesarean section; perinatal mortality; Cameroon. 1 Introduction. Breech presentation occurs in about 3% of all term singleton pregnancies [5]. Compared with a fetus with cephalic pre- sentation ...

  1. Neonatal jaundice and stool production in breast- or formula-fed term infants

    NARCIS (Netherlands)

    Buiter, Hannah D.; Dijkstra, Sebastiaan S. P.; Elferink, Rob F. M. Oude; Bijster, Peter; Woltil, Henk A.; Verkade, Henkjan J.

    It has remained unclear whether the amount of fecal fat excreted in the stool and stool production influences the severity of neonatal jaundice. We determined the relationship between stool production, fecal fat excretion and jaundice in healthy breast-fed (BF) or formula-fed (FF) (near-)term

  2. Long-term Follow-up of Children Treated with Neonatal Extracorporeal Membrane Oxygenation: neuropsychological outcome

    NARCIS (Netherlands)

    M.J. Madderom (Marlous)

    2013-01-01

    textabstractThis thesis aims to describe the long-term neuropsychological outcome of children and adolescents treated with neonatal extracorporeal membrane oxygenation (ECMO). ECMO is a pulmonary bypass technique providing temporary life support in potentially acute reversible (cardio)respiratory

  3. Neonatal Pain in Very Preterm Infants: Long-Term Effects on Brain, Neurodevelopment and Pain Reactivity

    Directory of Open Access Journals (Sweden)

    Ruth Eckstein Grunau

    2013-10-01

    Full Text Available Effects of early life psychosocial adversity have received a great deal of attention, such as maternal separation in experimental animal models and abuse/neglect in young humans. More recently, long-term effects of the physical stress of repetitive procedural pain have begun to be addressed in infants hospitalized in neonatal intensive care. Preterm infants are more sensitive to pain and stress, which cannot be distinguished in neonates. The focus of this review is clinical studies of long-term effects of repeated procedural pain-related stress in the neonatal intensive care unit (NICU in relation to brain development, neurodevelopment, programming of stress systems, and later pain sensitivity in infants born very preterm (24–32 weeks’ gestational age. Neonatal pain exposure has been quantified as the number of invasive and/or skin-breaking procedures during hospitalization in the NICU. Emerging studies provide convincing clinical evidence for an adverse impact of neonatal pain/stress in infants at a time of physiological immaturity, rapidly developing brain microstructure and networks, as well as programming of the hypothalamic-pituitary-adrenal axis. Currently it appears that early pain/stress may influence the developing brain and thereby neurodevelopment and stress-sensitive behaviors, particularly in the most immature neonates. However, there is no evidence for greater prevalence of pain syndromes compared to children and adults born healthy at full term. In addressing associations between pain/stress and outcomes, careful consideration of confounding clinical factors related to prematurity is essential. The need for pain management for humanitarian care is widely advocated. Non-pharmacological interventions to help parents reduce their infant’s stress may be brain-protective.

  4. Association between oxidative stress and cord serum lipids in relation to delayed cord clamping in term neonates.

    Science.gov (United States)

    Moustafa, Asmaa N; Ibrahim, Mahmoud H; Mousa, Suzan Omar; Hassan, Ebtesam E; Mohamed, Hashem F; Moness, Hend M

    2017-11-09

    Although delayed cord clamping (DCC) is a recent WHO recommendation, early cord clamping (ECC) is still a routine practice in many countries. Limited researches studied the effect of delayed cord clamping on oxidative stress in term neonates; In this study we aim to assess the influence of cord clamping either early or late on oxidative stress in term neonates and to evaluate the association of oxidative stress and cord blood lipids. One-hundred mothers and their term neonates were included in the present study. Umbilical cord blood samples were collected from the umbilical vein and umbilical artery immediately following labor. Total cholesterol, total triglycerides and phospholipids levels were significantly higher in the ECC group than the DCC group (p cord blood lipids and an augmented antioxidant activity. This suggests the protective effect of DCC on the future health of the term neonates and supports the application of DCC in active management of 3rd stage of labor in term neonates.

  5. Streptococcus bovis Bacteremia in Neonates in a Predominantly Hispanic Population

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    YI eJIA

    2015-10-01

    Full Text Available Background: Streptococcus bovis bacteremia has been associated with gastrointestinal diseases, especially colon cancer, neoplastic colon polyps and other malignancies of the GI tract in adults. Sporadic cases of S. bovis disease have also been reported in neonates and young infants. Although uncommon, S. bovis infection can cause fulminant neonatal sepsis and meningitis. Objectives: We report a series of pediatric patients with S. bovis bacteremia in a county hospital in a United States - Mexico border city in order to examine the demographic and clinical associations. Methods: We characterized the demographic and clinical features in all pediatric patients with blood cultures positive for S. bovis at University Medical Center in El Paso, Texas between January 2000 and December 2010. Hospital records were systematically reviewed by using a standardized protocol.Results: A total of 7 episodes of S. bovis bacteremia were documented in 7 pediatric patients (4 female and 3 male. Mean age was 1.2 days (range 1-3 days, all were Hispanic, average birth weight (3.25 kg. Mode of delivery was spontaneous vaginal delivery (5 and Caesarian section (2. All of our patients developed early (< 1 week onset disease and presented with signs of respiratory distress. Five out of 7 babies presented with abdominal distention and diarrhea. Six had clinical evidence of sepsis at presentation. Respiratory distress was the most common manifestation of sepsis (7. Aspiration pneumonia was diagnosed in 2 of them. Most patients were treated with a combination of antibiotics (6, either ampicillin and gentamicin or ampicillin and cefotaxime, and one with ampicillin alone. None of the pediatric patients had endoscopy and none of them died.Conclusions: S. bovis is considered an uncommon pathogen in the newborn, but can be associated with substantial morbidity and mortality if not identified and treated early. Physicians should be alert to the less common presentation of neonatal

  6. Predicting outcome in term neonates with hypoxic-ischaemic encephalopathy using simplified MR criteria

    Energy Technology Data Exchange (ETDEWEB)

    Jyoti, Rajeev; O' Neil, Ross [Canberra Hospital, Medical Imaging, Canberra, ACT (Australia)

    2006-01-01

    MRI is an established investigation in the evaluation of neonates with suspected hypoxic-ischaemic encephalopathy (HIE). However, its role as a predictor of neurodevelopmental outcome remains complex. To establish reproducible simplified MR criteria and evaluate their role in predicting neurodevelopmental outcome in term neonates with HIE. Term neonates with suspected HIE had MRI at 7-10 days of age. MR scans were interpreted according to new simplified criteria by two radiologists blinded to the clinical course and outcome. The new simplified criteria allocated grade 1 to cases with no central and less than 10% peripheral change, grade 2 to those with less than 30% central and/or 10-30% peripheral area change, and grade 3 to those with more than 30% central or peripheral change. MRI changes were compared with clinical neurodevelopmental outcome evaluated prospectively at 1 year of age. Neurodevelopmental outcome was based upon the DQ score (revised Griffith's) and cerebral palsy on neurological assessment. Of 20 subjects, all those showing severe (grade 3) MR changes (35%) died or had poor neurodevelopmental outcome. Subjects with a normal MR scan or with scans showing only mild (grade 1) MR changes (55%) had normal outcomes. One subject showing moderate (grade 2) changes on MRI had a moderate outcome (5%), while another had an atypical pattern of MR changes with a normal outcome (5%). Assessment of full-term neonates with suspected HIE using the simplified MR criteria is highly predictive of neurodevelopmental outcome. (orig.)

  7. A Comparison between Transcutaneous Bilirubin (TcB) and Total Serum Bilirubin (TSB) Measurements in Term Neonates

    OpenAIRE

    Majid Mansouri; Amir Mahmoodnejad; Razieh Taghizadeh Sarvestani; Fardin Gharibi

    2015-01-01

    Background: Transcutaneous bilirubinometry (TCB) is a simple method for estimating bilirubin levels in neonates. This method is noninvasive, quick, and painless. We aimed to compare serum and cutaneous bilirubin measurements in term neonates.Method: In this descriptive cross-sectional study, 200 neonates with icter with birth weights of at least 2500 grams were studied. TCB was measured using a bilirubinometer three times on the forehead and mean levels were calculated. Then, during the subse...

  8. Prevalence and outcomes of acute kidney injury in term neonates ...

    African Journals Online (AJOL)

    Background: The kidney is the most damaged organ in asphyxiated full-term infants. The severity of its damage is correlated with the severity of neurological damage. We determined the prevalence of perinatal asphyxia-associated acute kidney injury (AKI). Methods: We conducted a prospective cohort study including 60 ...

  9. Intestinal stenosis caused by perinatal intussusception in a full-term neonate.

    Science.gov (United States)

    Ogundoyin, Olakayode O; Ogunlana, Dare I; Onasanya, Omolara M

    2007-01-01

    Perinatal intussusception is rare, but can be seen in both premature and full-term neonates. The symptoms and signs are similar to those seen in necrotizing enterocolitis (NEC), causing the diagnosis of intussusception to be delayed. We report a case of intussusception that presented with features suggestive of NEC in a 3.4-kg, full-term female neonate. Diagnosis of intussusception was made with a plain abdominal x-ray and abdominal ultrasound. During surgery, an ileocolic intussusception with intestinal stenosis was found. Although intestinal stenosis and atresia are commonly found in premature infants, these entities can also occur in a full-term infant. Early diagnosis is needed to reduce the high morbidity and mortality in these infants.

  10. Electronic fetal monitoring patterns associated with respiratory morbidity in term neonates.

    Science.gov (United States)

    Liu, Lucy; Tuuli, Methodius G; Roehl, Kimberly A; Odibo, Anthony O; Macones, George A; Cahill, Alison G

    2015-11-01

    The purpose of this study was to identify electronic fetal monitoring patterns that are associated with neonatal respiratory morbidity. In an on-going prospective cohort study of >8000 consecutive term, vertex, nonanomalous singleton pregnancies during labor, we performed this analysis within the first 5000 women as a representative sample. Electronic fetal monitoring patterns in the 30 minutes preceding delivery were extracted by trained obstetrics research nurses, who were blinded to clinical data, using the National Institute of Child Health and Human Development system; the data were compared between those with respiratory morbidity and healthy infants (no morbidities). The primary outcome was neonatal respiratory morbidity, which was defined as either oxygen requirement at ≥6 hours of life or any mechanical ventilation in the first 24 hours. Multivariable logistic regression was used to adjust for confounders. Of 4736 neonates, 175 (3.4%) experienced respiratory morbidity. Most electronic fetal monitoring patterns were category II (96.6%; n = 4575). Baseline tachycardia (adjusted odds ratio [aOR], 2.9; 95% confidence interval [CI], 1.9-4.4), marked variability (aOR, 2.7; 95% CI, 1.5-5.0), and prolonged decelerations (aOR,2.7; 95% CI, 1.5-5.0) were significantly associated with an increased likelihood of term neonatal respiratory morbidity. Accelerations and persistent moderate variability were both significantly associated with a decreased likelihood of respiratory morbidity. Specific features of category II electronic fetal monitoring patterns make respiratory morbidity more likely in nonanomalous term infants. Tachycardia, marked variability, or prolonged decelerations before delivery can assist providers in anticipating the potential need for neonatal respiratory support. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Neonatal Hyperbilirubinemia in a Marginalized Population on the Thai-Myanmar Border : A study protocol

    NARCIS (Netherlands)

    Thielemans, Laurence; Trip-Hoving, Margreet; Bancone, Germana; Turner, Claudia; Simpson, Julie A.; Hanboonkunupakarn, Borimas; van Hensbroek, Michael Boele; van Rheenen, Patrick; Paw, Moo Kho; Nosten, Francois; McGready, Rose; Carrara, Verena I.

    2017-01-01

    Background: This study aims to identify risk factors and the neurodevelopmental impact of neonatal hyperbilirubinemia in a limited-resource setting among a refugee and migrant population residing along the Thai-Myanmar border, an area with a high prevalence of glucose-6-phosphate

  12. Neonatal Hyperbilirubinemia in a Marginalized Population on the Thai-Myanmar Border: a study protocol

    NARCIS (Netherlands)

    Thielemans, Laurence; Trip-Hoving, Margreet; Bancone, Germana; Turner, Claudia; Simpson, Julie A.; Hanboonkunupakarn, Borimas; van Hensbroek, Michaël Boele; van Rheenen, Patrick; Paw, Moo Kho; Nosten, François; McGready, Rose; Carrara, Verena I.

    2017-01-01

    This study aims to identify risk factors and the neurodevelopmental impact of neonatal hyperbilirubinemia in a limited-resource setting among a refugee and migrant population residing along the Thai-Myanmar border, an area with a high prevalence of glucose-6-phosphate dehydrogenase-deficiency. This

  13. Population pharmacokinetics and relationship between demographic and clinical variables and pharmacokinetics of gentamicin in neonates

    NARCIS (Netherlands)

    Stolk, L M L; Degraeuwe, P L J; Nieman, F H M; de Wolf, M C; de Boer, A|info:eu-repo/dai/nl/075097346

    Population pharmacokinetic parameter estimates were calculated from 725 routine plasma gentamicin concentrations obtained in 177 neonates of 24 to 42 weeks' gestational age in their first week of life. Kel increases and V/W decreases with increasing gestational age. Almost identical results were

  14. Lidocaine response rate in aEEG-confirmed neonatal seizures : Retrospective study of 413 full-term and preterm infants

    NARCIS (Netherlands)

    Weeke, Lauren C.|info:eu-repo/dai/nl/413986446; Toet, Mona C.|info:eu-repo/dai/nl/28827024X; Van Rooij, Linda G M; Groenendaal, Floris|info:eu-repo/dai/nl/073282596; Boylan, Geraldine B.; Pressler, Ronit M.; Hellström-Westas, Lena; Van Den Broek, Marcel P H; De Vries, Linda S.|info:eu-repo/dai/nl/072995408

    2016-01-01

    OBJECTIVE: To investigate the seizure response rate to lidocaine in a large cohort of infants who received lidocaine as second- or third-line antiepileptic drug (AED) for neonatal seizures. METHODS: Full-term (n = 319) and preterm (n = 94) infants, who received lidocaine for neonatal seizures

  15. Isolated single umbilical artery is an independent risk factor for perinatal mortality and adverse outcomes in term neonates.

    Science.gov (United States)

    Gutvirtz, Gil; Walfisch, Asnat; Beharier, Ofer; Sheiner, Eyal

    2016-11-01

    To determine whether an isolated single umbilical artery (iSUA) is an independent risk factor for perinatal mortality in term neonates with normal estimated fetal weight (EFW) prior to delivery. A population-based study was conducted, including all deliveries occurring between 1993 and 2013, in a tertiary medical center. Pregnancies with and without iSUA were compared. Multiple gestations, chromosomal, and structural abnormalities were excluded from the cohort. Only pregnancies delivered at term with normal EFW evaluated prior to delivery were included. Stratified analysis was performed using multiple logistic regression models to evaluate the risk of adverse outcomes and perinatal mortality for iSUA fetuses. During the study period, 233,123 deliveries occurred at "Soroka" University Medical Center, out of which 786 (0.3 %) were diagnosed with iSUA. Different pregnancy complications were more common with iSUA fetuses including: placental abruption (OR = 3.4), true knot of cord (OR = 3.5) and cord prolapse (OR = 2.8). Induction of labor and cesarean delivery were also more common in these pregnancies (OR = 1.5 and OR = 1.9, respectively). iSUA neonates had lower Apgar scores at 1 and 5 min (OR = 1.8, OR = 1.9, respectively) compared to the control group and perinatal mortality rates were higher both antenatally (IUFD, OR = 8.1) and postnatally (PPD, OR = 6.1). iSUA appears to be an independent predictor of adverse perinatal outcomes in term neonates.

  16. Effect of Probiotics on Serum Bilirubin Level in Term Neonates with Jaundice; A Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Yadollah Zahed Pasha

    2017-10-01

    Full Text Available Background In recent years, tendency to use drugs has been increasing in the treatment of neonatal jaundice. Several drugs have been used since then, but the effect of probiotics on serum bilirubin level (SBL is not so clear. This study was conducted to evaluate the effect of probiotics on SBL and the duration of phototherapy in term neonates with hyperbilirubinemia. Materials and Methods: In this randomized clinical trial, we studied 150 term neonate with jaundice hospitalized for phototherapy in Amirkola Children’s Hospital, Babol- Iran, during October 5, 2016 till May 19, 2017. Eligible neonates were randomly divided into two; intervention (n=75, and control (n=75 groups. Both groups received standard conventional phototherapy, but the intervention group received 10 drop/day of probiotics (Pedilact Zisttakhmir. Co. Iran, until hospital discharge. The outcome variables were SBL and the duration of phototherapy. The data was analyzed by SPSS 22.0 and   the P 0.05.After 24, 48 and 72hours it decreased to 13.73±1.72, 10.92±1.87 and 10.25±1.32 in the intervention and 13.66±1.91, 11.01±1.69 and10.09 ±1.38 in the control groups, respectively but comparison of the amount of SBL reduction  between the two groups was not significant (P>0.05. The duration of phototherapy in the intervention group and the control group was 3.61±1.17 days and 3.72±1.18 days respectively (P>0.05. Conclusion Oral probiotics in neonates with jaundice has no significant effect on SBL and the duration of phototherapy. Further studies are needed to with longer time follow-up.

  17. Impact of Diuretic Therapy in the Treatment of Bronchopulmonary Dysplasia and Acute Kidney Injury in the Neonatal Population.

    Science.gov (United States)

    Johnson, Alexandra Kesler; Lynch, Natalie; Newberry, Desi; Jnah, Amy J

    2017-10-01

    Diuretics are among the most frequently prescribed medications in the neonatal intensive care unit (NICU), despite minimal data regarding the safety and efficacy of their use in the neonatal population. Off-label diuretic therapy is used in preterm and full-term infants to both optimize kidney function and improve respiratory status. This article examines the literature specific to the impact of diuretic therapy in the NICU and compares the benefits versus risks of utilization as they pertain to the prevention and treatment of renal and pulmonary dysfunction in this population. A comprehensive literature search of online databases was performed, utilizing: CINAHL via EBSCO, PubMed, and ProQuest. Full-text, peer-reviewed, clinical trials, and review articles published in the English language between 2005 and 2015 were searched. Diuretics rank as the seventh most frequently prescribed medication in the NICU. More than 8% of all NICU patients and 37% of infants born at less than 32 gestational weeks and weighing less than 1500 g are exposed to diuretics. Benefits include lung fluid resorption acceleration, improved urine output, fluid retention counteraction, and augmentation of physiologic weight loss. Diuretics are currently utilized in the NICU at an alarming rate, without adequate clinical trials regarding their safety and efficacy of use. Updated studies are needed regarding short- and long-term outcomes of diuretic use, as well as overall general outcome data regarding the impact and evaluation of diuretic usage in the NICU population.

  18. Heart transplantation in neonates and children. Intermediate-term results

    Directory of Open Access Journals (Sweden)

    Estela Azeka

    2000-03-01

    Full Text Available OBJECTIVE: To assess intermediate-term outcome in children who have undergone orthotopic heart transplantation. METHODS: We carried out a longitudinal and prospective study between October '92 and June '99 comprising 20 patients with ages ranging from 12 days to 7 years (mean of 2.8 years. We employed a double immunosuppression protocol with cyclosporine and azathioprine and induction therapy with polyclonal antithymocyte serum. Survival and complications resulting from the immunosuppression protocol were analyzed. RESULTS:The double immunosuppression protocol and the induction therapy with polyclonal antithymocyte serum resulted in an actuarial survival curve of 90% and 78.2% at 1 and 6 years, respectively, with a mean follow-up period of 3.6 years. One patient died due to acute rejection 40 days after transplantation; another patient died 2 years after transplantation due to lymphoproliferative disorder; a third patient died because of primary failure of the graft; and a fourth patient died due to bronchopneumonia. The major complications were as follows: acute rejection, infection, nephrotoxicity, and systemic hypertension. The means of rejection and infection episodes per patient were 2.9 and 3.4, respectively. After one year of transplantation, a slight reduction in the creatinine clearance and systemic hypertension were observed in 7 (38.9% patients. CONCLUSION: Heart transplantation made life possible for those patients with complex congenital heart diseases and cardiomyopathies in refractory congestive heart failure constituting a therapeutical option for this group of patients in the terminal phase.

  19. Intermediate-term results of the Ross procedure in neonates and infants.

    Science.gov (United States)

    Shinkawa, Takeshi; Bove, Edward L; Hirsch, Jennifer C; Devaney, Eric J; Ohye, Richard G

    2010-06-01

    Although good intermediate-term results for the Ross procedure in adults and older children have been reported, only short-term outcomes of this procedure in neonates and infants have been published. The objective of this study was to review our intermediate-term results of the Ross procedure for neonates and infants. The records of all 31 neonates and infants undergoing a Ross procedure between March 1993 and June 2008 were reviewed. Major study outcomes included patient survival, autograft function, and need for reoperation. The median age at the time of operation was 18 days, and median weight was 3.95 kg. Fifteen patients had aortic stenosis with or without insufficiency, 2 patients had isolated severe aortic insufficiency, and 14 patients had aortic stenosis with other left-side heart lesions, such as arch obstruction or mitral valve disease. Twenty-five patients required aortic annular enlargement (Ross-Konno procedure), and 14 required concomitant arch or mitral valve surgery. There were 5 early and 2 late deaths at a median follow-up of 6.0 years (range, 1.1 to 15.4 years). All early deaths were in patients requiring concomitant arch or mitral valve repair. Actuarial survival rate was 76.7% at 5, 10, and 15 years. There were 19 reinterventions, including 2 procedures on the autograft. Overall freedom from reoperation was 59.1% at 5 years and 50.6% at 10 years. Freedom from autograft reoperation was 95.2% at 5 and 10 years and 63.5% at 15 years. The Ross procedure for neonates and infants has good intermediate-term results with low mortality and acceptable rates of reintervention. The patients requiring concomitant arch or mitral valve surgery have higher initial operative risks although conditional survival remains good. 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  20. Follow-up of neonatal jaundice in term and late premature newborns.

    Science.gov (United States)

    Facchini, Fernando P; Mezzacappa, Maria Aparecida; Rosa, Izilda R; Mezzacappa Filho, Francisco; Aranha-Netto, Abimael; Marba, Sergio Tadeu

    2007-01-01

    To report on the results of a project following term and near term newborn infants who were jaundiced during the neonatal period. Neonates were referred to the follow-up clinic with weight >/= 2,000 g and/or gestational age >/= 35 weeks, and jaundice at discharge was initially assessed with an Ingram icterometer or Bilicheck and, if indicated, with a Unistat bilirubinometer (Leica). These newborn infants had bilirubinemia at or above the 40th percentile on the nomogram developed by Bhutani. All infants treated with phototherapy while in hospital were reassessed by laboratory methods 24 hours after withdrawal of treatment. Patients were rehospitalized for intensive phototherapy if their level was greater than or equal to 20 mg/dL. From a total sample of 11,259 neonates, 2,452 (21.8%) were referred to the follow-up clinic, 87.2% (2,140) of whom did return. Eighty returned neonates were readmitted. Return appointments were set for 2,452 patients, 180 (7.3%) of whom had bilirubinemia >/= 15 mg/dL at discharge. Of these 180, 151 returned for follow-up. Twenty (13.2%) were readmitted for treatment. Of the total number of readmitted patients, two newborn infants had levels >/= 25 mg/dL and none >/= 30 mg/dL. All responded rapidly to intensive phototherapy, and there was no need for exchange transfusions. Our results suggest that the regime adopted is effective for detecting and preventing hyperbilirubinemia at risk of causing bilirubin-induced encephalopathy in term and near term newborn infants.

  1. Attitudes among the general Austrian population towards neonatal euthanasia: a survey.

    Science.gov (United States)

    Goldnagl, Lena; Freidl, Wolfgang; Stronegger, Willibald J

    2014-10-07

    The Groningen Protocol aims at providing guidance in end-of-life decision-making for severely impaired newborns. Since its publication in 2005 many bioethicists and health care professionals have written articles in response. However, only very little is known about the opinion among the general population on this subject. The aim of this study was to present the general attitude towards neonatal euthanasia (NE) among the Austrian population and the factors associated with the respondents' opinion. A cross-sectional study was conducted among the general Austrian population. Computer-assisted telephone interviews were performed with 1,000 interviewees aged 16 years and older. Binary logistic regression was performed in order to determine factors that are independently associated with the respondents' opinion about neonatal euthanasia. While 63.6% of the participants rejected the idea of neonatal euthanasia for severely impaired newborns, 36.4% opted either in favor or were undecided. Regression analysis has shown the respondents' educational level (p = 0.005) and experience in the care of terminally ill persons (p = 0.001) to be factors that are positively associated with the rejection of neonatal euthanasia, whereas a higher age was associated with a lower degree of rejection (p = 0.021). We found that the majority of the Austrian population rejects the idea of neonatal euthanasia for severely impaired newborns. However, given the increasing levels of rejection of NE among the younger generations and among people with a higher educational level, it cannot be precluded that the rejection rate might in future increase even further, rather than decrease.

  2. Nephrocalcinosis in pre-term neonates: A study of incidence and risk factors

    Directory of Open Access Journals (Sweden)

    Gamal B Mohamed

    2014-01-01

    Full Text Available The objective of this study was to determine the incidence and risk factors of nephrocalcinosis (NC in pre-term neonates in the neonatal intensive care unit (NICU at the Al-Minya University, Egypt. The study included 97 pre-term neonates with a gestational age 34 weeks. Data on duration of hospitalization, sex, gestation, birth weight, family history of renal stone, need for respiratory support, intake of calcium and use of total parenteral nutrition (TPN and nephrotoxic drugs were collected. Blood urea nitrogen, serum creatinine, sodium, potassium, calcium and phosphate were measured within the first week of life and again at term. Blood gases, urinary pH, urinary calcium/creatinine (U Ca/Cr ratio and urinary oxalate/creatinine (U Ox/Cr ratio were measured once at term. Three renal ultrasound (US scans were performed; one before the first week of life, the second at term and the third at a corrected age of one year. Of the 97 infants studied, 14 (14.4% developed NC diagnosed by renal US at term. NC was bilateral in 11 infants. Factors significantly associated with NC were gestational age, need for respiratory support, high calcium intake, TPN, use of post-natal dexamethasone, furosemide, theophylline, and/or aminoglycosides and U Ca/Cr ratio and U Ox/Cr ratio (all P < 0.05. Low gestational age (P = 0.004, use of respiratory support (P = 0.005, furosemide therapy (P = 0.002 and increased U Ca/Cr ratio (P = 0.001 were the strongest independent risk factors after logistic regression analysis. Eight of the 14 infants (57.1% with NC had spontaneous resolution of calcification at a corrected age of one year. Screening at term with a renal US scan and long-term follow-up of renal function is needed for early diagnosis and better management of NC. Future research pertaining to prevention of NC in pre-term neonates is required.

  3. Neutrophil chemotaxis in cord blood of term and preterm neonates is reduced in preterm neonates and influenced by the mode of delivery and anaesthesia.

    Science.gov (United States)

    Birle, Alexandra; Nebe, C Thomas; Hill, Sandra; Hartmann, Karin; Poeschl, Johannes; Koch, Lutz

    2015-01-01

    Bacterial infections, even without any perinatal risk factors, are common in newborns, especially in preterm neonates. The aim of this study was to evaluate possible impairment of neutrophil chemotaxis in term and preterm neonates compared with adults as well as neonates with different modes of delivery and anaesthesia. We analysed the expression of the adhesion molecule L-Selectin as well as shape change, spontaneous and N-formyl-methionyl-leucyl-phenylalanine (fMLP)-induced transmigration of neutrophils in a flow cytometric assay of chemotaxis after spontaneous delivery with Cesarian Section (CS) under spinal anaesthesia (mepivacaine, sufentanil), epidural anaesthesia (ropivacaine or bupivacaine, sufentanil) or general anaesthesia (ketamine, thiopental, succinylcholine). Chemokinesis was higher (p=0.008) in cord blood neutrophils than in the adult ones, whereas those could be more stimulated by fMLP (p=0.02). After vaginal delivery neutrophils showed a higher spontaneous and fMLP-stimulated chemotactic response compared to neonates after CS without labor. Comparing different types of anaesthesia for CS, spinal anaesthesia resulted in less impairment on chemotaxis than general anaesthesia or epidural anaesthesia. The new flow cytometric assay of neutrophil chemotaxis is an appropriate and objective method to analyse functional differences even in very small volumes of blood, essential in neonatology. Term neonates do not show reduced chemotaxis compared to adults. Preterm neonates present with reduced chemotaxis and chemokinesis, confirming the well known deficits in their neutrophil function. The side effects of maternal drugs on the neonatal immune system have to be considered especially when the immune response is already impaired, as in preterm infants.

  4. N-terminal pro-brain natriuretic peptide in the assessment of respiratory distress in term neonates.

    Science.gov (United States)

    Markovic-Sovtic, Gordana; Kosutic, Jovan; Jankovic, Borisav; Bojanin, Dragana; Sovtic, Aleksandar; Radojicic, Zoran; Rakonjac, M Zorica

    2014-06-01

    N-terminal pro-brain natriuretic peptide (NT-proBNP) is used as a biomarker to differentiate congestive heart failure from lung disease in adults and children. The clinical significance of its use in term neonates has not yet been extensively studied. NT-proBNP level was measured in 62 term neonates admitted for respiratory distress (RD): 38 with congenital heart disease (CHD) and 24 with pulmonary disease. The control group consisted of 28 healthy neonates. Findings of auscultation, chest radiography, Silverman-Anderson score and echocardiography were recorded for each patient. Blood samples for measuring NT-proBNP were collected on admission, when blood sampling was indicated for the clinical management of the newborn. In the control group NT-proBNP was significantly higher during the first week of life compared to the rest of the neonatal period (P < 0.001). The RD group, regardless of etiology, had significantly higher NT-proBNP than the control group (P < 0.001). Neonates with more severe RD had significantly higher NT-proBNP (P = 0.002). No significant difference was found between the RD group with CHD and those with pulmonary disease. Neonates with CHD and myocardial hypocontractility had significantly higher NT-proBNP than those with normal contractility (P = 0.022). Term neonates with RD have significantly higher NT-proBNP than healthy neonates. A single measurement of NT-proBNP level cannot be used as the sole biomarker for distinguishing between cardiac and pulmonary cause of RD in term neonates. © 2013 The Authors. Pediatrics International © 2013 Japan Pediatric Society.

  5. EEG background features that predict outcome in term neonates with hypoxic ischaemic encephalopathy: A structured review.

    Science.gov (United States)

    Awal, Md Abdul; Lai, Melissa M; Azemi, Ghasem; Boashash, Boualem; Colditz, Paul B

    2016-01-01

    Hypoxic ischaemic encephalopathy is a significant cause of mortality and morbidity in the term infant. Electroencephalography (EEG) is a useful tool in the assessment of newborns with HIE. This systematic review of published literature identifies those background features of EEG in term neonates with HIE that best predict neurodevelopmental outcome. A literature search was conducted using the PubMed, EMBASE and CINAHL databases from January 1960 to April 2014. Studies included in the review described recorded EEG background features, neurodevelopmental outcomes at a minimum age of 12 months and were published in English. Pooled sensitivities and specificities of EEG background features were calculated and meta-analyses were performed for each background feature. Of the 860 articles generated by the initial search strategy, 52 studies were identified as potentially relevant. Twenty-one studies were excluded as they did not distinguish between different abnormal background features, leaving 31 studies from which data were extracted for the meta-analysis. The most promising neonatal EEG features are: burst suppression (sensitivity 0.87 [95% CI (0.78-0.92)]; specificity 0.82 [95% CI (0.72-0.88)]), low voltage (sensitivity 0.92 [95% CI (0.72-0.97)]; specificity 0.99 [95% CI (0.88-1.0)]), and flat trace (sensitivity 0.78 [95% CI (0.58-0.91)]; specificity 0.99 [95% CI (0.88-1.0)]). Burst suppression, low voltage and flat trace in the EEG of term neonates with HIE most accurately predict long term neurodevelopmental outcome. This structured review and meta-analysis provides quality evidence of the background EEG features that best predict neurodevelopmental outcome. Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  6. Admission to neonatal intensive care with respiratory morbidity following 'term' elective caesarean section.

    Science.gov (United States)

    Alderdice, F; McCall, E; Bailie, C; Craig, S; Dornan, J; McMillen, R; Jenkins, J

    2005-06-01

    Delaying the timing of elective caesarean section (ELCS) from 37/38 weeks to 39/40 weeks reduces the risk of respiratory morbidity in otherwise healthy neonates. The aims of this study were to clarify the number and clinical details of term infants delivered by ELCS who were admitted to neonatal intensive care (NIC) from 1st April 2001 to 31st March 2002 in Northern Ireland, to record the level of care required by these infants and to identify infants who were diagnosed with transient tachypnoea of the newborn (TTN) and/or Respiratory Distress Syndrome (RDS). Two hundred and ten (8%) of babies born by ELCS were admitted to NIC. Term infants delivered by ELCS used 343 days of level 1 & 2 care with 230 (68%) of these days being used by infants with RDS/TTN (n=105) the majority of whom were delivered at 37/38 weeks. Definitions of 'term' and clinical indications for ELCS urgently need to be debated to avoid unnecessary morbidity following ELCS in so called 'term' infants.

  7. Neonatal morbidity mortality outcomes in pre-term premature rupture of membranes.

    Science.gov (United States)

    Gezer, A; Parafit-Yalciner, E; Guralp, O; Yedigoz, V; Altinok, T; Madazli, R

    2013-01-01

    We present a retrospective review of 228 pre-term premature rupture of membranes (PPROM) singleton pregnancies followed-up in our clinic between 1996 and 2005. The most common neonatal morbidities in PPROM cases are respiratory distress syndrome (RDS), sepsis and intraventricular haemorrhage (IVH). The route of delivery does not affect newborn intensive care unit (NICU) requirements, perinatal asphyxia, sepsis and IVH rates in PPROM cases. NICU and PPV requirements, RDS, sepsis and IVH rates increase if the Apgar score is < 5. Neonatal morbidity and mortality rates increase as the latent period lengthens. C reactive protein (CRP) on admission, last CRP, birth weight and the 5 min Apgar score was found to be associated with NICU requirements; only the 5 min Apgar score was found to be associated with RDS; and last leukocyte count and maternal haemotocrit was found to be associated with sepsis and pneumonia, independently. In PPROM cases, CRP on admission, last CRP, birth weight, the 5 min Apgar score, last leukocyte count and maternal haemotocrit, should be considered to predict neonatal outcomes.

  8. Invasive disease due to group B Streptococcus in pregnant women and neonates from diverse population groups.

    Science.gov (United States)

    Zaleznik, D F; Rench, M A; Hillier, S; Krohn, M A; Platt, R; Lee, M L; Flores, A E; Ferrieri, P; Baker, C J

    2000-02-01

    From 1993 through 1996, surveillance for invasive disease due to group B Streptococcus (GBS) in neonates aged <7 days and in peripartum pregnant women was performed in a racially and ethnically diverse cohort in 4 cities in the United States. In a birth population of 157,184, 130 neonatal cases (0.8 per 1000) and 54 maternal cases (0.3 per 1000) were identified. Significant correlates with neonatal disease were black or Hispanic race and a birth weight <2500 g. The attack rate for peripartum maternal infection varied widely by city and may have been influenced by the frequency of administration of intrapartum antibiotics or of evaluating febrile women by performance of blood cultures. Pregnancy loss or GBS disease in the infant occurred in 28% of these maternal cases. Among neonatal and maternal GBS isolates, serotypes Ia (34%-37%) and III (25%-26%) predominated, and type V was frequent (14%-23%). These results provide a description of invasive GBS perinatal infection during the period in which guidelines for prevention were actively disseminated.

  9. Transcutaneous bilirubin nomogram for predicting neonatal hyperbilirubinemia in healthy term and late-preterm Chinese infants.

    Science.gov (United States)

    Yu, Zhang-Bin; Dong, Xiao-Yue; Han, Shu-Ping; Chen, Yu-Lin; Qiu, Yu-Fang; Sha, Li; Sun, Qing; Guo, Xi-Rong

    2011-02-01

    Identifying infants that will develop significant hyperbilirubinemia with the risk of kernicterus, and planning appropriate follow-up strategies, is particularly challenging. In this study, 36,921 transcutaneous bilirubin (TcB) measurements were obtained from 6,035 healthy neonates (gestational age ≥ 35 weeks and birth weight ≥ 2,000 g) between January 1 and December 31, 2009. All measurements were performed with the JM-103 bilirubinometer at designated times between 0 and 168 postnatal hours. TcB percentiles were calculated and used to develop an hour-specific nomogram. The rate of increase in TcB was higher during the first 72 h of age, after which levels declined to a plateau by 72-108 h of age. We constructed a TcB nomogram by using the 40th, 75th, and 95th percentile values of TcB for every 12 h of the studied interval. The 75th percentile curve of the nomogram may be an ideal cutoff point for intensive follow-up of the neonate for hyperbilirubinemia as it carries very high sensitivity (78.7%) and negative predictive value (98.5%). The specificity (45.7%) and positive predictive value (15.5%) decreased to reach their lowest levels at the 40th percentile. Of the neonates in the high-risk zone, 167 (48.8%) infants had persistent subsequent hyperbilirubinemia post-discharge, compared with 292 (27.0%) infants in the high-intermediate-risk zone at discharge. One-hundred and seventeen (5.5%) infants in the low-intermediate-risk zone moved into the high-risk zone during follow-up. No newborn infants in the low-risk zone became high-risk during follow-up. We provide an hour-specific TcB nomogram to predict neonatal hyperbilirubinemia in healthy term and late-preterm Chinese infants.

  10. Acute liver failure in a term neonate after repeated paracetamol administration

    Directory of Open Access Journals (Sweden)

    Fabio Bucaretchi

    2014-03-01

    Full Text Available Objective: Severe hepatotoxicity caused by paracetamol is rare in neonates. We report a case of paracetamol-induced acute liver failure in a term neonate. Case description: A 26-day-old boy was admitted with intestinal bleeding, shock signs, slight liver enlargement, coagulopathy, metabolic acidosis (pH=7.21; bicarbonate: 7.1mEq/L, hypoglycemia (18mg/dL, increased serum aminotransferase activity (AST=4,039IU/L; ALT=1,087IU/L and hyperbilirubinemia (total: 9.57mg/dL; direct: 6.18mg/dL after receiving oral paracetamol (10mg/kg/dose every 4 hours for three consecutive days (total dose around 180mg/kg; serum concentration 36-48 hours after the last dose of 77µg/ mL. Apart from supportive measures, the patient was successfully treated with intravenous N-acetylcysteine infusion during 11 consecutive days, and was discharged on day 34. The follow-up revealed full recovery of clinical and of laboratory findings of hepatic function. Comments: The paracetamol pharmacokinetics and pharmacodynamics in neonates and infants differ substantially from those in older children and adults. Despite the reduced rates of metabolism by the P-450 CYP2E1 enzyme system and the increased ability to synthesize glutathione - which provides greater resistance after overdoses -, it is possible to produce hepatotoxic metabolites (N-acetyl-p-benzoquinone that cause hepatocellular damage, if glutathione sources are depleted. Paracetamol clearance is reduced and the half-life of elimination is prolonged. Therefore, a particular dosing regimen should be followed due to the toxicity risk of cumulative doses. This report highlights the risk for severe hepatotoxicity in neonates after paracetamol multiple doses for more than two to three days.

  11. Acute liver failure in a term neonate after repeated paracetamol administration.

    Science.gov (United States)

    Bucaretchi, Fábio; Fernandes, Carla Borrasca; Branco, Maíra Migliari; De Capitani, Eduardo Mello; Hyslop, Stephen; Caldas, Jamil Pedro S; Moreno, Carolina Araújo; Porta, Gilda

    2014-03-01

    Severe hepatotoxicity caused by paracetamol is rare in neonates. We report a case of paracetamol-induced acute liver failure in a term neonate. A 26-day-old boy was admitted with intestinal bleeding, shock signs, slight liver enlargement, coagulopathy, metabolic acidosis (pH=7.21; bicarbonate: 7.1 mEq/L), hypoglycemia (18 mg/dL), increased serum aminotransferase activity (AST=4,039 IU/L; ALT=1,087 IU/L) and hyperbilirubinemia (total: 9.57 mg/dL; direct: 6.18 mg/dL) after receiving oral paracetamol (10 mg/kg/dose every 4 hours) for three consecutive days (total dose around 180 mg/kg; serum concentration 36-48 hours after the last dose of 77 µg/ mL). Apart from supportive measures, the patient was successfully treated with intravenous N-acetylcysteine infusion during 11 consecutive days, and was discharged on day 34. The follow-up revealed full recovery of clinical and of laboratory findings of hepatic function. The paracetamol pharmacokinetics and pharmacodynamics in neonates and infants differ substantially from those in older children and adults. Despite the reduced rates of metabolism by the P-450 CYP2E1 enzyme system and the increased ability to synthesize glutathione--which provides greater resistance after overdoses--, it is possible to produce hepatotoxic metabolites (N-acetyl-p-benzoquinone) that cause hepatocellular damage, if glutathione sources are depleted. Paracetamol clearance is reduced and the half-life of elimination is prolonged. Therefore, a particular dosing regimen should be followed due to the toxicity risk of cumulative doses. This report highlights the risk for severe hepatotoxicity in neonates after paracetamol multiple doses for more than two to three days.

  12. Long-term cognitive functions in neonatal short bowel syndrome patients.

    Science.gov (United States)

    Huang, J; Cai, W; Tang, Q; Feng, Y; Tao, Y; Wang, Y; Wu, J

    2008-04-01

    The aim of the study was to evaluate the long-term effects of neonatal short bowel syndrome on cognitive functions during development. Nine patients diagnosed with short bowel syndrome during the neonatal period were enrolled in this study. Their medical records were reviewed; anthropometric measurements and blood tests were assayed; IQ tests (the Chinese versions of WAIS-R, WPPSI-R and WISC-R) were performed depending on their age, and a BSID assessment was carried out in those patients less than 4 years old. Eight of 9 patients were followed up except for one patient who died in a car accident at the age of three. All patients had been weaned off parenteral nutrition for more than 2 years. The average residual small bowel length was 58.1 cm (range 35-70 cm), and the mean parenteral nutrition (PN) duration was 73.1 days (43-147 days). The mean duration of the period without PN was 7.4 years (range 2.1-17.1 years). Weight, height and BMI for age were normal in 7 children except for 1 child, who was overweight. Hemoglobin and albumin concentrations were normal in all 8 patients. Evaluation of cognitive development showed normal results for all 8 patients while a verbal/performance discrepancy was found in 2. Patients with neonatal SBS who were weaned off PN for more than 2 years were found to have normal growth and cognitive development during this long-term follow-up. There was no evidence for a strong correlation between SBS and nutritional/cognition disorder. Longer term and controlled studies with a larger sample size are warranted.

  13. Long-term population studies of seabirds.

    Science.gov (United States)

    Wooller, R D; Bradley, J S; Croxall, J P

    1992-04-01

    Long-term studies of seabirds, some now 30-40 years old, have begun to reveal significant age-related changes in the survival and reproduction o f these long-lived animals. Evidence for density-dependent regulation of seabird numbers, however, remains sparse whereas unpredictable, disastrous breeding years may be an important influence. Critical evaluation will require better data on (1) the extent of movements of seabirds between colonies, (2) the characteristics of those individuals that contribute disproportionately to the next generation, and (3) the importance of year and/or cohort effects on population processes. Copyright © 1992. Published by Elsevier Ltd.

  14. Long-term follow-up of neonatal coarctation and left-sided cardiac hypoplasia.

    Science.gov (United States)

    Gray, Robert G; Tani, Lloyd Y; Weng, Hsin Yi; Puchalski, Michael D

    2013-05-01

    Neonatal coarctation of the aorta (CoA) is often associated with hypoplastic left-sided cardiac structures. Limited data are available regarding the long-term clinical outcomes. Our purposes were to assess the following in neonates with CoA and left-sided cardiac hypoplasia: (1) left-sided cardiac structure growth over time, (2) echocardiographic parameters predicting reintervention, and (3) long-term outcomes and reintervention rates. Data were collected for all patients born with isolated CoA, along with a mitral or aortic Z-score of parameters were not associated with reintervention. The overall freedom from reintervention was 76% at 15 years of follow-up. In conclusion, the long-term outcomes after isolated CoA repair with associated left-sided cardiac hypoplasia were excellent. Both aortic and mitral valve sizes had increased substantially by intermediate follow-up but tended to normalize afterward. Although 24% of the patients required reintervention, significant left ventricular inflow or outflow tract obstruction was uncommon. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Early life host-bacteria relations and development: long-term individual differences in neuroimmune function following neonatal endotoxin challenge.

    Science.gov (United States)

    Walker, Frederick R; Hodyl, Nicolette A; Krivanek, Klara M; Hodgson, Deborah M

    2006-01-30

    Neonatal animals have a proportionately greater risk, relative to the adult animal, of developing a bacterial infection. Research has revealed that such infections can influence biological processes long after the actual infection has been resolved. Indeed, studies examining the long-term alterations induced by early-life infection, simulated using endotoxin, have indicated that some aspects of the systemic inflammatory response in the adult animal are susceptible to modification. Available evidence suggests that altered inflammatory activities observed in the neonatally endotoxin challenged adult may be the result of potentiated hypothalamic pituitary adrenal (HPA) activity, specifically increased corticosterone production. Few studies, however, have examined whether altered corticosterone production is actually associated with changes in systemic inflammation in the neonatally endotoxin challenged adult animal. The aim, therefore, of the current study was to simultaneously examine the relationship between altered inflammatory activities and corticosterone production in the neonatally endotoxin challenged adult rat. Our findings demonstrate no significant differences exist between adults neonatally treated with saline or endotoxin in terms of their production of corticosterone following endotoxin challenge. While not appearing to influence the production of corticosterone neonatal endotoxin challenge did result in a marked attenuation in the adult's febrile response following endotoxin challenge. Interestingly, circulating levels of IL-1beta and TNF-alpha were found to be equivalent in neonatal treatment groups following endotoxin administration in adulthood, indicating that the reduction in fever was unlikely to be the result of altered pro-inflammatory cytokine production. Further, no differences were found between neonatal treatment groups in net food consumption, water consumption or weight loss following endotoxin challenge in adulthood. Collectively, these

  16. Olfactive stimulation interventions for managing procedural pain in preterm and full-term neonates: a systematic review protocol.

    Science.gov (United States)

    De Clifford-Faugère, Gwenaëlle; Lavallée, Andréane; Aita, Marilyn

    2017-10-17

    While hospitalized in the NICU, preterm neonates undergo many painful procedures. This may be the same for full-term neonates when longer hospitalization is required. Untreated and repeated pain has short-term as well as long-term consequences for these neonates. Pharmacological pain management methods have many limitations in their applications for both preterm and full-term neonates. A combination of different non-pharmacological methods is recommended for pain management. The effect of olfactive stimulation as a non-pharmacological pain management method was investigated by a few studies in the past years with premature and term neonates, but no systematic review has been conducted. The objective of this systematic review is to evaluate the effect of olfactive stimulation intervention on the pain response of preterm and full-term neonates during painful procedures. An electronic search will be conducted in various databases such as PubMed (1946 to date), MEDLINE (1946 to date), CINAHL (1981 to date), Embase (1947 to date), PsycINFO (1806 to date), Web of Science (1945 to date), CENTRAL and Scopus (1960 to date), and Proquest, without restriction for the year of publication. Only studies published in English or French will be included. The search will be conducted using the following three concepts: pain, odors, and neonates. Selection of articles, data extraction, and assessment of risk of bias will be conducted by two independent researchers. A third researcher will intervene in case of disagreement. According to the availability of studies and data homogeneity, the results will be combined to perform a meta-analysis, or they will be described by a narrative synthesis. This systematic review will provide light on the current state of knowledge on the effectiveness of olfactive stimulation interventions for managing pain in preterm and full-term neonates. This review will guide clinical practice as well as research to improve preterm and full-term neonates' pain

  17. Treating perinatal asphyxia with theophylline at birth helps to reduce the severity of renal dysfunction in term neonates.

    Science.gov (United States)

    Raina, Alok; Pandita, Aakash; Harish, Rekha; Yachha, Monika; Jamwal, Ashu

    2016-10-01

    Perinatal asphyxia is a common neonatal problem and contributes significantly to neonatal morbidity and mortality. This study was designed to determine whether theophylline could prevent or ameliorate renal dysfunction in term neonates with perinatal asphyxia. We randomised 159 severely asphyxiated term newborns to receive a single dose of 5 mg/kg intravenous theophylline (n = 78) or a placebo (n = 81) during the first hour of life. The infant's 24-hour fluid intake, urine volume, serum creatinine, creatinine clearance and sodium excretion were recorded during days one, three and five of life, starting 12 hours after the theophylline or placebo infusion. Neonates in the theophylline group had lower serum creatinine levels (0.83 ± 0.35 versus 1.47 ± 0.61; p = 0.00) and higher endogenous creatinine clearance (32.16 ± 16.34 versus 17.73 ± 7.92; p = 0.00) than the placebo group. Severe renal dysfunction, namely acute kidney injury, was present in 36 (15%) of the neonates in the theophylline group versus 117 (48%) in the placebo group (p theophylline administered to term neonates with perinatal asphyxia within the first hour of life significantly decreased serum creatinine levels and significantly increased creatinine clearance. ©2016 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  18. Predictive Value of Nucleated Red Blood Cell Counts in Cord and Peripheral Blood of Asphyxiated Term Neonates in the First Week of Life

    Directory of Open Access Journals (Sweden)

    B Bahman Bijari

    2010-03-01

    Full Text Available Introduction: Increased numbers of nucleated red blood cells (NRBC circulating in the blood of neonates can be associated with relative hypoxia and adverse outcomes. Thus, the aim of this study was to assess the NRBC count during the first week of life in neonates diagnosed with asphyxia as compared to healthy neonates and to determine the short-term morbidity and mortality for the affected babies. Methods: The cross-sectional study compared 15 healthy neonates with 15 neonates diagnosed with asphyxia confirmed by pH of cord blood or Apgar scores. The nucleated red blood cell (NRBC counts were calculated right after birth, and on days 3 and 7, and the hematological parameters of umbilical cord blood were also evaluated. The infants were followed for mortality and associated morbidity. Statistical analysis was conducted using the Mann-Whitney U test, analysis of variance, chi-square tests, and Pearson’s correlation coefficient. A p-value < 0.05 was considered as statistically significant. Results: The initial NRBC counts were significantly higher in the asphyxiated group than in the control group and the difference remained significant through the end of first week. All of the umbilical cord blood parameters were significantly lower in the study group and were negatively correlated with the NRBC count. At birth, higher NRBC count correlated with higher mortality. conclution: Results show that NRBC count is a useful predictive factor for neonatal asphyxia through the end of the first week of life, although a larger study population and a longer follow up period seems to be necessary.

  19. Population pharmacokinetic characteristics of amikacin in suspected cases of neonatal sepsis in a low-resource African setting

    DEFF Research Database (Denmark)

    Amponsah, Seth K; Adjei, George O; Enweronu-Laryea, Christabel C

    2017-01-01

    BACKGROUND: Amikacin exhibits marked pharmacokinetic (PK) variability and is commonly used in combination with other drugs in the treatment of neonatal sepsis. There is a paucity of amikacin PK information in neonates from low-resource settings. OBJECTIVES: To determine the PK parameters...... of amikacin, and explore the influence of selected covariates, including coadministration with aminophylline, on amikacin disposition in neonates of African origin. METHODS: Neonates with suspected sepsis admitted to an intensive care unit in Accra, Ghana, and treated with amikacin (15 mg/kg loading followed...... by 7.5 mg/kg every 12 hours), were recruited. Serum amikacin concentration was measured at specified times after treatment initiation and analyzed using a population PK modeling approach. RESULTS: A total of 419 serum concentrations were available for 247 neonates. Mean (SD) trough amikacin...

  20. Video-EEG recordings in full-term neonates of diabetic mothers: observational study.

    Science.gov (United States)

    Castro Conde, José Ramón; González González, Nieves Luisa; González Barrios, Desiré; González Campo, Candelaria; Suárez Hernández, Yaiza; Sosa Comino, Elena

    2013-11-01

    To determine whether full-term newborn infants of diabetic mothers (IDM) present immature/disorganised EEG patterns in the immediate neonatal period, and whether there was any relationship with maternal glycaemic control. Cohort study with an incidental sample performed in a tertiary hospital neonatal unit. 23 IDM and 22 healthy newborns born between 2010 and 2013. All underwent video-EEG recording lasting >90 min at 48-72 h of life. We analysed the percentage of indeterminate sleep, transient sharp waves per hour and mature-for-gestational age EEG patterns (discontinuity, maximum duration of interburst interval (IBI), asynchrony, asymmetry, δ brushes, encoches frontales and α/θ rolandic activity). The group of IDM was divided into two subgroups according to maternal HbA1c: (1) HbA1c≥6% and (2) HbA1cIDM presented significantly higher percentage of indeterminate sleep (57% vs 25%; pIDM with maternal HbA1c≥6% showed greater percentage of δ brushes in the burst (14% vs 4%; p=0.007). Full-term IDM newborns showed video-EEG features of abnormal development of brain function. Maternal HbA1c levels<6% during pregnancy could minimise the risk of cerebral dysmaturity.

  1. Brain Biomarkers of Long-Term Outcome of Neonatal Onset Urea Cycle Disorder

    Directory of Open Access Journals (Sweden)

    Maha Mourad

    2016-11-01

    Full Text Available Urea cycle disorders (UCDs are common inborn errors of metabolism, with an incidence of one in 30,000 births. They are caused by deficiencies in any of six enzymes and two carrier proteins, the most common being Ornithine Transcarbamylase Deficiency (OTCD. OTCD results in impairment to excrete nitrogen, causing toxic buildup of ammonia with resultant encephalopathy. Hyperammonemia (HA induces the conversion of glutamate to glutamine in the brain. Excess glutamine in the brain causes osmotic changes, cerebral edema, changes in astrocyte morphology, and cell death. Acute symptoms of HA include vomiting, hyperventilation, seizures, and irritability. Long-term neurological effects include deficits in working memory and executive function. To date, there are no predictors of prognosis of infants with neonatal onset OTCD outside of the plasma ammonia level at presentation and duration of a hyperammonemic coma. We provide a comprehensive analysis of a 16-year-old male with neonatal onset of OTCD as an example of how brain biomarkers may be useful to monitor disease course and outcome. This male presented at 8 days of life with plasma ammonia and glutamine of 677 and 4024 micromol/L respectively, and was found to have a missense mutation in Exon 4 (p. R129H. Treatment included protein restriction, sodium benzoate, and citrulline, arginine, and iron. Despite compliance, he suffered recurrent acute hyperammonemic episodes triggered by infections or catabolic stressors. We discuss the long-term effects of the hyperammonemic episodes by following MRI-based disease biomarkers.

  2. Term neonates with infection and shock display high cortisol precursors despite low levels of normal cortisol.

    Science.gov (United States)

    Khashana, Abdelmoneim; Ojaniemi, Marja; Leskinen, Markku; Saarela, Timo; Hallman, Mikko

    2016-02-01

    Neonatal therapy-resistant septic shock is a common problem in middle and low-income countries. We investigated whether newborn infants with infection and therapy-resistant hypotension showed evidence of abnormal levels of cortisol or cortisol precursors. A total of 60 term or near term neonates with evidence of infection were enrolled after informed consent. Of these, 30 had an infection and refractory shock and 30 had an infection without shock. There were no detectable differences between the groups in the length of gestation, birth weight or gender distribution. Serum was obtained during days four and 14 after birth. Cortisol and cortisol precursor concentrations were analysed using liquid chromatography-tandem mass spectrometry. The cortisol concentrations were low considering the expected responses to stress and they did not differ between the groups. The infants with infection and shock had higher serum dehydroepiandrosterone (DHEA) levels than those without shock (319.0 ± 110.3 μg/dL, versus 22.3 ± 18.3 μg/dL; p cortisol, cortisol or cortisone. Septic newborn infants with therapy-resistant hypotension had very high DHEA levels, suggesting that 3-beta-hydroxysteroid dehydrogenase activity limited the rate of cortisol synthesis. ©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  3. Preeclampsia; short and long-term consequences for mother and neonate.

    Science.gov (United States)

    Bokslag, Anouk; van Weissenbruch, Mirjam; Mol, Ben Willem; de Groot, Christianne J M

    2016-11-01

    Preeclampsia is a common pregnancy specific disease, that presents with hypertension and a variety of organ failures, including malfunction of kidneys, liver and lungs. At present, the only definitive treatment of preeclampsia is end the pregnancy and deliver the neonate and placenta. For women with mild preeclampsia in the preterm phase of pregnancy, expectant management is generally indicated to improve fetal maturity, often requiring maternal medical treatment. Last decades, more evidence is available that the underlying mechanism of preeclampsia, endothelial disease, is not limited to pregnancy but increases cardiovascular risk in later life. In this review, we present the most recent insight in preeclampsia with focus on impact on the fetus, short and long-term outcome of offspring's, and long-term outcome of women with a history of preeclampsia. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  4. The perinatal outcomes of asymptomatic isolated single umbilical artery in full-term neonates.

    Science.gov (United States)

    Mu, Shu-Chi; Lin, Cheng-Hui; Chen, Yi-Ling; Sung, Tseng-Chen; Bai, Chyi-Huey; Jow, Guey-Mei

    2008-12-01

    Neonates with a single umbilical artery (SUA) are considered at increased risk for chromosomal and structural abnormalities, and an increased adverse perinatal outcome. The specific aims of our study were to evaluate (1) the association of asymptomatic infants with isolated SUA and perinatal outcomes and (2) whether asymptomatic neonates with isolated SUA at birth need full investigation. The inclusion criteria for the study were full-term neonates with isolated SUA delivered from January 1996 to December 2006. For a control group, we used the next consecutive two newborns delivered after the SUA case in the same maternity ward with matched gestational age and without phenotypic features suspicious for aneuploidy delivered after each SUA group subject. All prenatal, peripartum and delivery records were reviewed for maternal demographics, associated anomalies, karyotypic analysis, pregnancy complications and perinatal outcomes. All SUA cases had undergone sonogram for renal anomalies. We enrolled 14 and 28 cases into the SUA and control groups respectively. There was all normal karyotyping for the 14 cases. The placental weight in SUA was significantly Lighter compared to that in the control group (597.1+/-175.4 vs. 709.3+/-95.2 g, p=0.010). All renal sonographic screens and karyotyping in the SUA group were normal. The incidence of small for gestational age (SGA) in SUA group was higher compared to control group (SGA, 5/14, 35.7% vs. 1/28, 3.6%, p=0.011) and less body length (48.7+/-5.0 vs. 50.8+/-1.8 cm, p=0.028). SUA is a relatively rare finding. When a SUA is identified, the routine check of karyotyping and kidney sonography for possible chromosome and associated renal anomalies may be unnecessary. According to lighter placental weight probably causing the higher incidence of small for gestational age (SGA), pregnancies with isolated SUA should be carefully monitored for evidence of fetal growth restriction.

  5. Customized versus Population-Based Birth Weight References for Predicting Fetal and Neonatal Undernutrition.

    Science.gov (United States)

    Fernández-Alba, Juan Jesús; González-Macías, Carmen; León Del Pino, Raquel; Prado Fernandes, Fabiana; Lagares Franco, Carolina; Moreno-Corral, Luis Javier; Torrejón Cardoso, Rafael

    2016-01-01

    The aim of our study was to construct a model of customized birth weight curves based on a Spanish population and to compare the ability of this customized model to our population-based chart to predict a neonatal ponderal index (PI) percentile. We developed a model that can predict the 10th percentile for a fetus according to gestational age and gender as well as maternal weight, height, and age. We compared the ability of this customized model to that of our own population-based model to predict a neonatal PI percentile. Data from a large database were used (32,854 live newborns, from 1993 through 2012). Only singleton pregnancies with a gestational age at delivery of 32-42 weeks were included. In the entire pregnant population, the customized method was superior to the population-based method for detecting newborns with a PI percentile (sensitivity: 55 vs. 40.96%; specificity: 99.6 vs. 91.23%; positive predictive value: 11.49 vs. 9.55%, and negative predictive value: 98.84 vs. 98.55%, respectively). In pregnant women with a BMI >90th percentile, the sensitivity was 75%, compared to 50% in the population-based method. In pregnant women with a height >90th percentile, the sensitivity was almost as high as in the population-based method (61.53 vs. 33.33%). The customized birth weight curve is superior to the population-based method for the detection of newborns with a PI percentile. This is especially the case in women in the higher scales of height and weight as well as in preterm babies. © 2015 S. Karger AG, Basel.

  6. Serum copeptin and neuron specific enolase are markers of neonatal distress and long-term neurodevelopmental outcome.

    Science.gov (United States)

    Kelen, Dorottya; Andorka, Csilla; Szabó, Miklós; Alafuzoff, Aleksander; Kaila, Kai; Summanen, Milla

    2017-01-01

    The objective of this study was to evaluate the early changes in serial serum levels of copeptin and neuron-specific enolase (NSE) in neonates diagnosed with birth asphyxia, and to determine whether these biomarkers measured in the first 168 hours after birth are predictive of long-term neurodevelopmental outcome. Copeptin and NSE levels were measured from serum samples collected 6, 12, 24, 48, 72, and 168 hours after birth from 75 term neonates diagnosed with hypoxic-ischemic encephalopathy (HIE) and treated with therapeutic hypothermia for 72 hours. In addition, serum copeptin levels after birth were measured from 10 HIE diagnosed neonates, who were randomized to the normothermic arm of the TOBY cohort. All neonates underwent neurodevelopmental assessment using the Bayley Scales of Infant and Toddler Development-II at two years of age. Copeptin levels were highest at 6 hours after birth and steadily decreased, whereas the highest NSE levels were measured at 24 hours after birth. The biomarker levels correlated with blood-gas parameters (base excess, pH and lactate) at 6 and 12 hours after birth. Copeptin and NSE levels in the early postnatal period were significantly higher in neonates with poor outcome compared to those with favorable outcome at two years of age. Furthermore, in the TOBY cohort, copeptin levels were significantly lower in hypothermic compared to normothermic neonates. To conclude, copeptin and NSE measured in the early postnatal period are potential prognostic biomarkers of long-term neurodevelopmental outcome in term neonates diagnosed with HIE and treated with therapeutic hypothermia.

  7. Serum copeptin and neuron specific enolase are markers of neonatal distress and long-term neurodevelopmental outcome.

    Directory of Open Access Journals (Sweden)

    Dorottya Kelen

    Full Text Available The objective of this study was to evaluate the early changes in serial serum levels of copeptin and neuron-specific enolase (NSE in neonates diagnosed with birth asphyxia, and to determine whether these biomarkers measured in the first 168 hours after birth are predictive of long-term neurodevelopmental outcome. Copeptin and NSE levels were measured from serum samples collected 6, 12, 24, 48, 72, and 168 hours after birth from 75 term neonates diagnosed with hypoxic-ischemic encephalopathy (HIE and treated with therapeutic hypothermia for 72 hours. In addition, serum copeptin levels after birth were measured from 10 HIE diagnosed neonates, who were randomized to the normothermic arm of the TOBY cohort. All neonates underwent neurodevelopmental assessment using the Bayley Scales of Infant and Toddler Development-II at two years of age. Copeptin levels were highest at 6 hours after birth and steadily decreased, whereas the highest NSE levels were measured at 24 hours after birth. The biomarker levels correlated with blood-gas parameters (base excess, pH and lactate at 6 and 12 hours after birth. Copeptin and NSE levels in the early postnatal period were significantly higher in neonates with poor outcome compared to those with favorable outcome at two years of age. Furthermore, in the TOBY cohort, copeptin levels were significantly lower in hypothermic compared to normothermic neonates. To conclude, copeptin and NSE measured in the early postnatal period are potential prognostic biomarkers of long-term neurodevelopmental outcome in term neonates diagnosed with HIE and treated with therapeutic hypothermia.

  8. Population pharmacokinetics of unbound hydrocortisone in critically ill neonates and infants with vasopressor-resistant hypotension

    Science.gov (United States)

    Vezina, Heather E.; Ng, Chee M.; Vazquez, Delia M.; Barks, John D.; Bhatt-Mehta, Varsha

    2014-01-01

    Objective To determine the population pharmacokinetics of unbound hydrocortisone (HC) in critically ill neonates and infants receiving intravenous HC for treatment of vasopressor-resistant hypotension and to identify patient-specific sources of pharmacokinetic variability. Design Prospective observational cohort study. Setting Level 3 neonatal intensive care unit. Patients Sixty-two critically ill neonates and infants receiving intravenous HC as part of standard of care for the treatment of vasopressor-resistant hypotension: median gestational age 28 weeks (range, 23 to 41), median weight 1.2 kg (range, 0.5 to 4.4), 29 females. Interventions None. Measurements Unbound baseline cortisol and post-dose HC concentrations measured from blood samples being drawn for routine laboratory tests. Main Results A one compartment model best described the data. Allometric weight and postmenstrual age (PMA) were significant covariates on unbound HC clearance (CL) and volume of distribution (V). Final population estimates for CL, V, and baseline cortisol concentration were 20.2 L/h, 244 L, and 1.37 ng/mL, respectively. Using the median weight and PMA of our subjects (i.e. 1.2 kg and 28 weeks) in the final model, the typical unbound HC CL and V were 1.0 L/h and 4.2 L, respectively. The typical half-life for unbound HC was 2.9 hours. A sharp and continuous increase in unbound HC CL was observed at 35 weeks PMA. Conclusions We report the first pharmacokinetic data for unbound HC, the pharmacologically active moiety, in critically ill neonates and infants with vasopressor-resistant hypotension. Unbound HC CL increased with body weight and was faster in children with an older PMA. Unbound HC CL increased sharply at 35 weeks PMA and continued to mature thereafter. This study lays the groundwork for evaluating unbound HC exposure-response relationships and drawing definitive conclusions about the dosing of intravenous HC in critically-ill neonates and infants with vasopressor

  9. Tolerance of skin care regimen in healthy, full-term neonates

    Directory of Open Access Journals (Sweden)

    Iarkowski LE

    2013-05-01

    Full Text Available Laura Ellen Iarkowski,1 Neena K Tierney,1 Paul Horowitz21Johnson & Johnson Consumer Companies, Inc, Skillman, NJ, USA; 2Discovery Pediatrics, Valencia, CA, USAPurpose: To assess the tolerance of a baby cleanser and lotion (both lightly fragranced on healthy, full-term neonates.Materials and methods: Twenty-six infant–mother pairs were enrolled in a 6-week, nonrandomized, controlled-use study that took place in the routine setting of a pediatric clinic and mothers’ homes. During study weeks 1 to 6, neonates were bathed by their mother with water and a test cleanser (JOHNSON'S® HEAD-TO-TOE® Baby Wash. During study weeks 1 to 3, mothers also applied test lotion (JOHNSON'S® Baby Lotion to the babies’ skin immediately after bathing and one to three times/day on bathing and non-bathing days. During study weeks 4 to 6, no lotion was applied. At baseline and weeks 3 and 6, the infants’ pediatrician or mother or both performed visual skin assessments.Results: Twenty-three infant–mother pairs completed the study. The mean age of neonates at enrolment was 17.4 days (range, 13–28 days. Pediatrician observations found no clinical signs of irritation, erythema, or dryness with any significant difference in scores of these parameters compared with baseline throughout the study. Assessment of skin softness, smoothness, dryness, and overall skin condition was very good at baseline and remained so with minimal changes throughout the study. Mothers reported improvements versus baseline (P ≤ 0.05 in overall skin appearance, moisturization, softness, and smoothness on the arms and legs at weeks 3 and 6. A total of four (15.4% subjects experienced adverse events. For three of the subjects, the investigator suspected that the adverse events were unrelated to either of the test products. In one participant, the cause of the adverse event could not be determined.Conclusion: The use of a lightly fragranced nonstinging baby cleanser, with or without a

  10. Noninvasive measurements of regional cerebral perfusion in preterm and term neonates by magnetic resonance arterial spin labeling

    DEFF Research Database (Denmark)

    Miranda Gimenez-Ricco, Maria Jo; Olofsson, K; Sidaros, Karam

    2006-01-01

    Magnetic resonance arterial spin labeling (ASL) at 3 Tesla has been investigated as a quantitative technique for measuring regional cerebral perfusion (RCP) in newborn infants. RCP values were measured in 49 healthy neonates: 32 preterm infants born before 34 wk of gestation and 17 term-born neon......Magnetic resonance arterial spin labeling (ASL) at 3 Tesla has been investigated as a quantitative technique for measuring regional cerebral perfusion (RCP) in newborn infants. RCP values were measured in 49 healthy neonates: 32 preterm infants born before 34 wk of gestation and 17 term...

  11. Bifidobacterium longum and Bifidobacterium breve isolates from preterm and full term neonates: comparison of cell surface properties.

    Science.gov (United States)

    Andriantsoanirina, Valérie; Teolis, Anne-Claire; Xin, Liu Xin; Butel, Marie Jose; Aires, Julio

    2014-08-01

    We compared autoaggregation, surface hydrophobicity and Caco-2 cells adhesion capabilities of independent Bifidobacterium breve (n = 22) and Bifidobacterium longum (n = 25) strains isolated from preterm (n = 20) and full term neonates (n = 27). Concerning strains properties, a correlation between autoaggregation and surface hydrophobicity was found for B. longum (r = 0.40, p = 0.048), B. breve (r = 0.57, p = 0.005), and all strains independently of the species consideration (r = 0.46, p = 0.001). The absence of difference in adhesion capabilities between preterm and full term neonate strains suggests a strain-dependent property. However, B. longum strains from preterm neonates (n = 10) showed higher autoaggregation ability (p = 0.044). Additionally, independently of species consideration, preterm neonates strains showed lower surface hydrophobicity (p = 0.027). As far as species are considered, preterm neonate B. breve strains (n = 10) showed significantly lower surface hydrophobicity percentages (p = 0.043). Our results suggest the existence of variations in bifidobacteria membrane structure and/or composition that may reflect adaptation of these bacteria to the intestinal environment of either preterm or full term neonates. Such information is of interest when considering the use of bifidobacteria probiotic strains for modulation of preterm neonates gut microbiota. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. Presepsin (Soluble CD14 Subtype): Reference Ranges of a New Sepsis Marker in Term and Preterm Neonates.

    Science.gov (United States)

    Pugni, Lorenza; Pietrasanta, Carlo; Milani, Silvano; Vener, Claudia; Ronchi, Andrea; Falbo, Mariella; Arghittu, Milena; Mosca, Fabio

    2015-01-01

    Presepsin (soluble CD14 subtype) has been shown to be beneficial as a sepsis marker in adults. Nevertheless, very few data are available in neonates. The aim of the present study was to determine reference ranges of presepsin in term and preterm neonates. Healthy term neonates and preterm neonates without clinical signs of infection admitted to the Neonatal Unit were consecutively enrolled. Presepsin concentrations in whole blood were measured using a point-of-care assay system located in the Unit. Demographic data, antenatal and perinatal variables commonly affecting C-reactive protein and procalcitonin values were considered. Of the 684 neonates enrolled in the study, 484 (70.8%) were born at term and 200 (29.2%) were preterm (24-36 weeks' gestation). In term infants, presepsin median value was 603.5 pg/mL (interquartile range: 466.5-791 pg/mL; 5th and 95th centiles: 315 and 1178 pg/mL respectively). In preterm infants, presepsin median value was slightly higher, equal to 620 pg/mL (interquartile range: 503-864 pg/mL; 5th and 95th centiles: 352 and 1370 pg/mL respectively). The reference ranges of presepsin we determined were much higher than those seen in healthy adults. No correlation between presepsin levels and postnatal age was observed, as well as no significant difference was demonstrated in preterm neonates at different gestational ages. None of the variables analyzed affected presepsin levels at a clinical significant extent. For the first time, this study provides reference ranges of presepsin in term and preterm neonates. Having reliable reference values is crucial for obtaining an adequate diagnostic accuracy. Based on our results, most variables commonly affecting C-reactive protein and procalcitonin values do not affect presepsin levels, which suggests that presepsin could be an effective sepsis marker. Further investigations in large groups of neonates with sepsis are needed to determine the diagnostic and prognostic value of this biomarker.

  13. Prediction of neonatal respiratory distress syndrome in term pregnancies by assessment of fetal lung volume and pulmonary artery resistance index.

    Science.gov (United States)

    Laban, Mohamed; Mansour, Ghada M; Elsafty, Mohammed S E; Hassanin, Alaa S; EzzElarab, Sahar S

    2015-03-01

    To develop reference cutoff values for mean fetal lung volume (FLV) and pulmonary artery resistance index (PA-RI) for prediction of neonatal respiratory distress syndrome (RDS) in low-risk term pregnancies. As part of a cross-sectional study, women aged 20-35 years were enrolled and admitted to a tertiary hospital in Cairo, Egypt, for elective repeat cesarean at 37-40 weeks of pregnancy between January 1, 2012, and July 31, 2013. FLV was calculated by virtual organ computer-aided analysis, and PA-RI was measured by Doppler ultrasonography before delivery. A total of 80 women were enrolled. Neonatal RDS developed in 11 (13.8%) of the 80 newborns. Compared with neonates with RDS, healthy neonates had significantly higher FLVs (P<0.001) and lower PA-RIs (P<0.001). Neonatal RDS is less likely with FLV of at least 32 cm(3) or PA-RI less than or equal to 0.74. Combining these two measures improved the accuracy of prediction. The use of either FLV or PA-RI predicted neonatal RDS. The predictive value increased when these two measures were combined. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  14. A Comparison between Transcutaneous Bilirubin (TcB and Total Serum Bilirubin (TSB Measurements in Term Neonates

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    Majid Mansouri

    2015-05-01

    Full Text Available Background: Transcutaneous bilirubinometry (TCB is a simple method for estimating bilirubin levels in neonates. This method is noninvasive, quick, and painless. We aimed to compare serum and cutaneous bilirubin measurements in term neonates.Method: In this descriptive cross-sectional study, 200 neonates with icter with birth weights of at least 2500 grams were studied. TCB was measured using a bilirubinometer three times on the forehead and mean levels were calculated. Then, during the subsequent 30 minutes blood samples were obtained and sent to the laboratory for determining the total serum bilirubin (TSB levels. Findings: Of the 200 neonates, 124 (62% were boys and 76 (38% were girls, with an age range of 1-22 days. The mean±SD serum and cutaneous bilirubin levels were 18.75±5.38 and 17.85±4.46 mg/dl, respectively. A high correlation (r=0.89 was observed between TSB and TCB. The sensitivity and specificity of cutaneous bilirubin measurement were 95.1% and 68%, respectively.Conclusions: Because of its high sensitivity, TCB can be a suitable tool for predicting neonatal icter. However, it is not a suitable substitute for TSB measurement in neonates at a high risk of jaundice.

  15. [Neonatal bacterial meningitis: prospective study of the long-term outcome of 55 children].

    Science.gov (United States)

    Jornada Krebs, V L; De Albuquerque Diniz, E M; Costa Vaz, F A; Marques Dias, M J; Takiguti, C; Araújo Ramos, J L

    1996-03-01

    Fifty-five infants who presented bacterial neonatal meningitis were prospectively studied to analyze the frequency and the type of sequelae. All the infants were full term newborns. There were 38 boys and 17 girls; the age of disease onset varied from 3 to 28 days. The causative organism was represented mainly by enterobacteriae. The median time of follow-up was 5 years. The frequency of neurologic sequelae was 63.7%, represented mainly by neuropsychomotor development delay (58.2%), hydrocephaly (45.5%) and convulsions (34.5%). Severe motor abnormalities ocurred in 23.6% of children (quadriplegia, diplegia, hemiparesia and ataxia). Convulsions in the acute phase of the disease and the positive cerebrospinal fluid culture were highly associated to sequelae. The school performance, obtained in 25 children, showed presence of disabilities in 48% of cases, which were significantly associated to mental retardation.

  16. Preterm birth by vacuum extraction and neonatal outcome: a population-based cohort study.

    Science.gov (United States)

    Åberg, Katarina; Norman, Mikael; Ekéus, Cecilia

    2014-01-22

    Very few studies have investigated the neonatal outcomes after vacuum extraction delivery (VE) in the preterm period and the results of these studies are inconclusive. The objective of this study was to describe the use of VE for preterm delivery in Sweden and to compare rates of neonatal complications after preterm delivery by VE to those found after cesarean section during labor (CS) or unassisted vaginal delivery (VD). Data was obtained from Swedish national registers. In a population-based cohort from 1999 to 2010, all live-born, singleton preterm infants in a non-breech presentation at birth, born after onset of labor (either spontaneously, by induction, or by rupture of membranes) by VD, CS, or VE were included, leaving a study population of 40,764 infants. Logistic regression analyses were used to calculate adjusted odds ratios (AOR), using unassisted vaginal delivery as reference group. VE was used in 5.7% of the preterm deliveries, with lower rates in earlier gestations. Overall, intracranial hemorrhage (ICH) occurred in 1.51%, extracranial hemorrhage (ECH) in 0.64%, and brachial plexus injury in 0.13% of infants. Infants delivered by VE had higher risks for ICH (AOR = 1.84 (95% CI: 1.09-3.12)), ECH (AOR = 4.48 (95% CI: 2.84-7.07)) and brachial plexus injury (AOR = 6.21 (95% CI: 2.22-17.4)), while infants delivered by CS during labor had no increased risk for these complications, as compared to VD. While rates of neonatal complications after VE are generally low, higher odds ratios for intra- and extracranial hemorrhages and brachial plexus injuries after VE, compared with other modes of delivery, support a continued cautious use of VE for preterm delivery.

  17. A comparison of tympanic and rectal temperatures in term NIGERIAN neonates

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    Duru Chika O

    2012-06-01

    Full Text Available Abstract Background Tympanic thermometry has come as a suitable alternative to traditional thermometry because of its safety and ease of use. However, it is still yet to gain wide acceptance in African settings due to conflicting results on its accuracy, thus rectal thermometry remains the gold standard in the newborn. The aim of this study was to compare tympanic and rectal temperatures in term Nigerian neonates. Methods Rectal and tympanic temperatures were measured simultaneously in 300 consecutive term neonates between the ages of 37 and 42 weeks gestation using mercury-in-glass and the Infrared tympanic thermometers respectively. Paired t test, Pearson correlation coefficient and the Bland-Altman plot were used to compute data. Using rectal thermometry as gold standard, the sensitivity, specificity and predictive values of tympanic thermometry at various rectal temperature cut-offs were determined. Receiver Operating Curves (ROC were constructed and the Areas Under the Curves (AUC were compared. Results The mean rectal temperature (37.34 ± 0.55°C was significantly higher than the mean tympanic temperature (37.25 ± 0.56°C (p  Conclusions The sensitivity of tympanic thermometry was relatively low in detecting rectal temperatures despite the good correlation and agreement between them. The specificities and predictive values of tympanic temperatures in detecting rectal temperatures were high and accuracy increased with higher temperatures. Though using the tympanic route for measuring temperature in the newborn is relatively safe and non-invasive, its low sensitivity limits its use. Further studies would be required to further assess the accuracy of tympanic temperature measurements in the newborn.

  18. Coagulation profile in normal full-term neonate in the first week of life in Lagos-Nigeria

    Directory of Open Access Journals (Sweden)

    Garba N

    2016-03-01

    Full Text Available Normal reference values of haemostatic profile are frequently needed to assist in diagnosis and management of bleeding disorders. Because of the anatomical and physiological differences between neonates and adults, it is essential to know the reference range of coagulation profile in neonates in the first week of life. The aim of this study is to establish a normal reference range for coagulation profile in normal full-term neonates in the first week of life in Lagos-Nigeria. This is a cross-sectional study carried out among normal full-term neonates born in Lagos Island Maternity Hospital and Lagos University Teaching Hospital. Neonates’ demographic data were documented. Citrated plasma was collected and tested for Prothrombin Time (PT, Partial Thromboplastin Time with Kaolin (PTTK and Thrombin Time (TT using Coatron M2 Coagulation Analyzer (TECO GmbH in Germany. Reference values were established for neonates in the 1st week of life by using the formula of Mean ± 2 Stan dard Deviation (SD that is at 95% confidence level. Comparative analysis was carried out between the mean values of neonates and adults established mean values. The Mean ± Stan dard Deviation of PT, PTTK and TT at the first week of life were 13.41 ± 1.33 seconds, 43.38 ± 6.75 seconds and 24.01 ± 3.03 seconds respectively. Using the formu la of Mean ± 2SD, the reference ranges of PT, PTTK and TT were 10.7-16.07seconds, 29.88-56.88 seconds and 17.95-30.07 seconds respectively. Statistically significant difference was observed when mean values of PT, PTTK and TT of neonates at the 1st week of life were compared with adults established values done in the country and elsewhere in the world (p-value < 0.05. This research provides a reference range of PT, PTTK and TT for the management of neonates in the 1st week of life in Lagos, Nigeria. It indicates that reference values of PT, PTTK and TT in neonates during the 1st week of life are different from that of adults as described

  19. A phase II/III, multicenter, safety, efficacy, and pharmacokinetic study of dexmedetomidine in preterm and term neonates.

    Science.gov (United States)

    Chrysostomou, Constantinos; Schulman, Scott R; Herrera Castellanos, Mario; Cofer, Benton E; Mitra, Sanjay; da Rocha, Marcelo Garcia; Wisemandle, Wayne A; Gramlich, Lisa

    2014-02-01

    To investigate the safety, efficacy, and pharmacokinetic profile of dexmedetomidine in preterm and full-term neonates ≥ 28 to ≤ 44 weeks gestational age. Forty-two intubated, mechanically ventilated patients (n = 42) were grouped by gestational age into group I (n = 18), ≥ 28 to sedation as determined by the Neonatal Pain, Agitation, Sedation Scale. During dexmedetomidine infusion, 5% of Neonatal Pain, Agitation, Sedation Scale scores were >3, indicating agitation/pain, with 4 patients (10%) requiring more sedation and 17 (40%) requiring more analgesia. Though there was significant variability in pharmacokinetic variables, group I appeared to have lower weight-adjusted plasma clearance (0.3 vs 0.9 L · h(-1) · kg(-1)) and increased elimination half-life (7.6 vs 3.2 hours) compared with group II. Fifty-six adverse events (AEs) were reported in 26 patients (62%); only 3 AEs (5%) were related to dexmedetomidine. There were no serious AEs and no AEs or hemodynamic changes requiring dexmedetomidine discontinuation. Dexmedetomidine is effective for sedating preterm and full-term neonates and is well-tolerated without significant AEs. Preterm neonates had decreased plasma clearance and longer elimination half-life. Copyright © 2014 The Authors. Published by Mosby, Inc. All rights reserved.

  20. Neonatal size in term children is associated with asthma at age 7, but not with atopic dermatitis or allergic sensitization.

    Science.gov (United States)

    Sevelsted, A; Bisgaard, H

    2012-05-01

    We hypothesized that anthropometrics in the newborn is associated with development of asthma later in life. The study included a prospective, longitudinal clinical study of a birth cohort of 411 Danish neonates born at term of mothers with a history of asthma. The primary endpoint was physician-diagnosed asthma at age 7 years. Allergic sensitization and atopic dermatitis (AD) were also investigated. Infant size was measured at the research clinic on four occasions during the first year of life. Risk for asthma, AD, and allergic sensitization at age 6-7 were estimated from logistic regression. Time to first asthma and AD were investigated by Cox regression. Multivariate models were adjusted for gender, gestational age, and mothers smoking during pregnancy. Neonatal weight, length, body mass index and head circumference (z-score) were all significantly associated with asthma at age 7. Adjusted odds ratio for asthma by estimated birth weight z-score: 1.87 [1.23-2.84]; P = 0.004. Adjusted HR for onset of asthma by neonatal weight z-score: 1.46 [1.08-1.96]; P = 0.013. Neonatal size did not associate with AD or allergic sensitization. Increased neonatal size was significantly associated with asthma at age 7 but not AD or allergic sensitization in at-risk children born at term. The findings suggest some common prenatal mechanisms linking body size and asthma. © 2012 John Wiley & Sons A/S.

  1. Time trend in the risk of delivery-related perinatal and neonatal death associated with breech presentation at term.

    Science.gov (United States)

    Pasupathy, Dharmintra; Wood, Angela M; Pell, Jill P; Fleming, Michael; Smith, Gordon C S

    2009-04-01

    To determine the factors associated with the risk of delivery-related perinatal and neonatal death among term infants presenting by the breech and the effect of changes in the mode of delivery on the overall rates of perinatal and neonatal mortality associated with breech presentation. We studied 32,776 singleton term infants presenting breech excluding anomalous and antepartum losses in Scotland between 1985 and 2004, using linked Scottish national registries of pregnancy outcome data and perinatal death data. The event was delivery-related perinatal and neonatal death (i.e. intrauterine fetal death during labour or death of infant in the first 4 weeks of life), subdivided according to intrapartum anoxia or mechanical cause of death. Analysis was by multivariate logistic regression. During the study period, the risk of delivery-related perinatal and neonatal death decreased by 72% (95% CI -1% to 93%), due to a 90% (95% CI 33-99%) reduction in anoxic or mechanical deaths. Both intrapartum (OR 0.16, 95% CI 0.02-0.75) and planned (OR 0.01, 95% CI 0.00-0.09) caesarean delivery were protective against anoxic or mechanical deaths and increased use of planned caesarean delivery accounted for 16% of the decline in anoxic and mechanical deaths over the study period. Increased use of planned caesarean delivery only partly explains the decline in delivery-related perinatal and neonatal death between 1985 and 2004 in Scotland.

  2. Neonatal outcomes in spontaneous versus obstetrically indicated late preterm births in a nova scotia population.

    Science.gov (United States)

    Feldman, Kayla; Woolcott, Christy; O'Connell, Colleen; Jangaard, Krista

    2012-12-01

    To examine the indications for late preterm delivery in Nova Scotia and to compare the short-term outcomes by type of labour (spontaneous, induced, none). We conducted a population-based retrospective cohort study of late preterm births (34+0 to 36+6 weeks' gestation) between 1988 and 2009 using the Nova Scotia Atlee Perinatal Database. The association between labour type and neonatal outcomes was examined with logistic regression to estimate odds ratios with 95% confidence intervals. Of the 10 315 late preterm births, 6228 followed spontaneous labour, 2338 followed induction of labour, and 1689 followed Caesarean section with no labour. Babies born following induction were at higher risk of developing hyperbilirubinemia (OR 1.14; 95% CI 1.03 to 1.27) and needing total parenteral nutrition (OR 1.52; 95% CI 1.15 to 1.99) than those born spontaneously. Those born without labour were at higher risk of needing resuscitation (OR 2.43; 95% CI 1.84 to 3.21) and total parenteral nutrition (OR 2.54; 95% CI 1.93 to 3.33) and developing transient tachypnea of the newborn (OR 1.43; 95% CI 1.10 to 1.85), hypoglycemia (OR 1.97; 95% CI 1.63 to 2.39), respiratory distress syndrome (OR 2.33; 95% CI 1.89 to 2.88), necrotizing enterocolitis (OR 3.20; 95% CI 1.07 to 9.53), and apneic spells (OR 1.29; 95% CI 1.05 to 1.59). When adjusted for maternal and fetal factors, odd ratios were only slightly attenuated. Among late preterm babies, those born by Caesarean section without labour are at increased risk of many adverse outcomes, while those born following induction of labour are at increased risk of few of the outcomes studied. Maternal and fetal factors other than those for which adjustment was made may contribute to the differences in outcome by labour type.

  3. No correlation between neonatal fitness and heterozygosity in a reintroduced population of Père David's deer

    Directory of Open Access Journals (Sweden)

    Yan ZENG, Chunwang LI, Linyuan ZHANG, Zhenyu ZHONG, Zhigang JIANG

    2013-04-01

    Full Text Available Considering the severe impacts of genetic bottlenecks and small numbers of founders in populations of reintroduced animals, it is necessary to study inbreeding and its effect on fitness in species of conservation concern. Père David’s deer is one of few large mammal species extinct in the wild but safely preserved in captivity. Its specific background gives us the opportunity to study the relationships between heterozygosity and neonatal fitness in relocated populations. We employed five microsatellite loci to explore heterozygosity-fitness correlations in a population of Père David’s deer at the Beijing Milu Ecological Research Center. We observed associations between microsatellite-based variables sMLH, IR, MD2 and HL, and two components of fitness expressed early in life (birth weight and the neonatal mortality of 123 Père David’s deer calves born over six consecutive years. We found that neonatal mortality was 19.1 ± 7.6%, not higher than the 19% or 18% reported in other ungulates. The heterozygosity of calves was not associated with neonatal mortality, nor birth weight. Our study implies that low genetic variability of microsatellite loci has no overt effect on birth weight and neonatal mortality in reintroduced populations of Père David’s deer [Current Zoology 59 (2: 249–256, 2013].

  4. Creatine, Glutamine plus Glutamate, and Macromolecules Are Decreased in the Central White Matter of Premature Neonates around Term.

    Directory of Open Access Journals (Sweden)

    Meriam Koob

    Full Text Available Preterm birth represents a high risk of neurodevelopmental disabilities when associated with white-matter damage. Recent studies have reported cognitive deficits in children born preterm without brain injury on MRI at term-equivalent age. Understanding the microstructural and metabolic underpinnings of these deficits is essential for their early detection. Here, we used diffusion-weighted imaging and single-voxel 1H magnetic resonance spectroscopy (MRS to compare brain maturation at term-equivalent age in premature neonates with no evidence of white matter injury on conventional MRI except diffuse excessive high-signal intensity, and normal term neonates. Thirty-two infants, 16 term neonates (mean post-conceptional age at scan: 39.8±1 weeks and 16 premature neonates (mean gestational age at birth: 29.1±2 weeks, mean post-conceptional age at scan: 39.2±1 weeks were investigated. The MRI/MRS protocol performed at 1.5T involved diffusion-weighted MRI and localized 1H-MRS with the Point RESolved Spectroscopy (PRESS sequence. Preterm neonates showed significantly higher ADC values in the temporal white matter (P<0.05, the occipital white matter (P<0.005 and the thalamus (P<0.05. The proton spectrum of the centrum semiovale was characterized by significantly lower taurine/H2O and macromolecules/H2O ratios (P<0.05 at a TE of 30 ms, and reduced (creatine+phosphocreatine/H2O and (glutamine+glutamate/H2O ratios (P<0.05 at a TE of 135 ms in the preterm neonates than in full-term neonates. Our findings indicate that premature neonates with normal conventional MRI present a delay in brain maturation affecting the white matter and the thalamus. Their brain metabolic profile is characterized by lower levels of creatine, glutamine plus glutamate, and macromolecules in the centrum semiovale, a finding suggesting altered energy metabolism and protein synthesis.

  5. Effect of multisensory stimulation on analgesia in term neonates: a randomized controlled trial.

    Science.gov (United States)

    Bellieni, Carlo Valerio; Bagnoli, Franco; Perrone, Serafina; Nenci, Anna; Cordelli, Duccio Maria; Fusi, Mara; Ceccarelli, Simona; Buonocore, Giuseppe

    2002-04-01

    Many attempts have been made to obtain safe and effective analgesia in newborns. Oral glucose-water has been found to have analgesic properties in neonates. We investigated whether other sensory stimulation added to oral glucose provided more effective analgesia than oral glucose alone. In a randomized prospective double-blind trial, we studied 120 term newborns during heel prick. The babies were divided randomly into six groups of 20, and each group was treated with a different procedure during heel prick: A) control; B) 1 mL 33% oral glucose given 2 min before the heel prick; C) sucking; D) 1 mL 33% oral glucose plus sucking; E) multisensory stimulation including 1 mL 33% oral glucose (sensorial saturation); F) multisensory stimulation without oral glucose. Sensorial saturation consisted in massage, voice, eye contact, and perfume smelling during heel prick. Each heel prick was filmed and assigned a point score according to the Douleur Aiguë du Nouveau-né (DAN) neonatal acute pain scale. Camera recording began 30 s before the heel prick, so it was impossible for the scorers to distinguish procedure A (control) from B (glucose given 2 min before), C (sucking water) from D (sucking glucose), and E (multisensory stimulation and glucose) from F (multisensory stimulation and water) from the video. Procedure E (multisensory stimulation and glucose) was found to be the most effective procedure, and the analgesia was even more effective than that produced by procedure D (sucking glucose). We conclude that sensorial saturation is an effective analgesic technique that potentiates the analgesic effect of oral sugar. It can be used for minor painful procedures on newborns.

  6. Neonatal hypertension – a long-term pilot follow-up study

    OpenAIRE

    Chaudhari, Tejasvi; Falk, Michael; Jyoti, Rajeev; Arney,Susan; Burton,Wendy; Kent, Alison

    2013-01-01

    Tejasvi Chaudhari,1 Michael C Falk,2,3 Rajeev Jyoti,2,4 Susan Arney,5 Wendy Burton,5 Alison L Kent1,2 1Department of Neonatology, Canberra Hospital, Woden, ACT, Australia; 2Australian National University Medical School, Canberra, ACT, Australia; 3Department of Nephrology, 4Medical Imaging Department, 5Centre for Newborn Care, Canberra Hospital, Woden, ACT, Australia Background: Neonatal hypertension occurs in up to 3% of neonates, more commonly in those admitted to neonatal intensive care. T...

  7. Long-term neurological outcome of term-born children treated with two or more anti-epileptic drugs during the neonatal period

    NARCIS (Netherlands)

    van der Heide, Mariska J.; Roze, Elise; van der Veere, Christa N.; ter Horst, Hendrik J.; Brouwer, Oebele F.; Bos, Arend F.

    Background: Neonatal seizures may persist despite treatment with multiple anti-epileptic drugs (AEDs). Objective: To determine in term-born infants with seizures that required two or more AEDs, whether treatment efficacy and/or the underlying disorder were related to neurological outcome.

  8. A pilot study on the rate of hemoglobinopathies in hyperbilirubinemic term neonates at Nemazee Hospital Shiraz, Iran

    Directory of Open Access Journals (Sweden)

    M Karimi

    2006-01-01

    Full Text Available Introduction: Neonatal hyperbilirubinemia is a common disorder and if untreated is potentially neurotoxic. Methods: In order to investigate the correlation between hyperbilirubinemia and hemoglobinopathies, in a prospective study we studied a total 100 full term neonates at Nemazi Hospital with total bilirubin greater than 15 mg/dl and direct bilirubin less than 1.5mg/dl. Other known causes of hyperbilirubinemia such as G6PD deficiency and blood group incompatibility, septicemia and common metabolic disorders were excluded and then hemoglobin electrophoresis was done. Results: In this study we found two infants with abnormal HbD (2%. None of them had alpha thalassemia or sickle cell anemia. Conclusion: Hemoglobinopathies can be considered as one of the causes of neonatal hyperbilirubinemia. Further studies are recommended on a larger scale in the form of multi center study.

  9. Magnesium Sulfate Prevents Neurochemical and Long-Term Behavioral Consequences of Neonatal Excitotoxic Lesions: Comparison Between Male and Female Mice.

    Science.gov (United States)

    Daher, Ismaël; Le Dieu-Lugon, Bérénice; Dourmap, Nathalie; Lecuyer, Matthieu; Ramet, Lauriane; Gomila, Cathy; Ausseil, Jérôme; Marret, Stéphane; Leroux, Philippe; Roy, Vincent; El Mestikawy, Salah; Daumas, Stéphanie; Gonzalez, Bruno; Leroux-Nicollet, Isabelle; Cleren, Carine

    2017-10-01

    Magnesium sulfate (MgSO4) administration to mothers at risk of preterm delivery is proposed as a neuroprotective strategy against neurological alterations such as cerebral palsy in newborns. However, long-term beneficial or adverse effects of MgSO4 and sex-specific sensitivity remain to be investigated. We conducted behavioral and neurochemical studies of MgSO4 effects in males and females, from the perinatal period to adolescence in a mouse model of cerebral neonatal lesion. The lesion was produced in 5-day-old (P5) pups by ibotenate intracortical injection. MgSO4 (600 mg/kg, i.p.) prior to ibotenate prevented lesion-induced sensorimotor alterations in both sexes at P6 and P7. The lesion increased glutamate level at P10 in the prefrontal cortex, which was prevented by MgSO4 in males. In neonatally lesioned adolescent mice, males exhibited more sequelae than females in motor and cognitive functions. In the perirhinal cortex of adolescent mice, the neonatal lesion induced an increase in vesicular glutamate transporter 1 density in males only, which was negatively correlated with cognitive scores. Long-term sequelae were prevented by neonatal MgSO4 administration. MgSO4 never induced short- or long-term deleterious effect on its own. These results also strongly suggest that sex-specific neuroprotection should be foreseen in preterm infants. © 2017 American Association of Neuropathologists, Inc. All rights reserved.

  10. Population-based study of incidence and clinical outcome of neonatal cholestasis in patients with Down syndrome.

    Science.gov (United States)

    Arnell, Henrik; Fischler, Björn

    2012-11-01

    To study the incidence and outcome of Down syndrome-associated neonatal cholestasis in a population-based cohort. This retrospective study included all neonates diagnosed with Down syndrome born between January 2005 and September 2011 in the County of Stockholm, Sweden. Clinical and biochemical data related to cholestasis, early gastrointestinal (GI) involvement, congenital heart defects (CHD), and bone marrow disease were obtained from the computer-based hospital chart system. A total of 206 newborns with Down syndrome were identified, for an incidence of 1 in 880 newborns. Prevalences of other diseases in these newborns included 47% for CHD, 11.2% for GI involvement, 3.9% for neonatal cholestasis, and 3.4% for bone marrow disease. Neonatal cholestasis was more common in the newborns with GI involvement (3 of 23 vs 5 of 183 of those without GI involvement; P = .047), CHD (8 of 96 vs 0 of 110 of those without CHD; P = .0019), and bone marrow disease (3 of 7 vs 5 of 199 of those without bone marrow disease; P = .0013). Cholestasis was severe in 3 patients (all of whom had bone marrow disease, with liver failure and early death in 2), and transient in 5 patients. Neonatal cholestasis occurs in a significant percentage of patients with Down syndrome and is always associated with involvement of other organs. The outcome is variable, being most severe in newborns with the combination of neonatal cholestasis and bone marrow disease. Copyright © 2012 Mosby, Inc. All rights reserved.

  11. Neonatal morbidity by week of gestational age for twins compared to singletons: a population-based cohort study.

    Science.gov (United States)

    Wolfe, Katherine; Tabangin, Meredith; Meinzen-Derr, Jareen; Snyder, Candice; Lewis, David; DeFranco, Emily

    2014-02-01

    Quantify neonatal morbidity by week of gestation for twins compared with singletons. We performed a population-based retrospective cohort study of all Ohio births from 2006 to 2007. Composite neonatal morbidity consisting of Apgar score 6 hours, neonatal transport, or seizures was compared between singletons and twins from 34 to 41 weeks. Neonatal morbidity was the lowest in twins delivered at 37 completed weeks and 2 weeks later for singletons at 39 weeks. Twin morbidity rapidly increased after 37 weeks and reached 15.8% at 41 weeks versus the singleton morbidity rate of 3.4% at 41 weeks. Twins delivered at 39 weeks and beyond were more than twice as likely to incur neonatal morbidity compared with singletons. The lowest rate of neonatal morbidity occurs at 37 weeks for twins versus 39 weeks for singleton births. The increased risk after 37 weeks for twins accelerates at a faster rate compared with that for singletons born past 39 weeks. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  12. [Use of subcutaneous route for comfort care in neonatal palliative population: Systematic review and survey of practices in France].

    Science.gov (United States)

    Pouvreau, N; Tandonnet, J; Tandonnet, O; Renesme, L

    2017-09-01

    Subcutaneous hydration (hypodermoclysis) and drug administration is a widely used method of analgesic therapy in adult palliative care medicine. Very little is known about its use in neonatal medicine. Evidence-based guidelines do not exist due to a lack of data. In this study, the advantages of subcutaneous analgesic therapy in terms of comfort in neonatal palliative care situations were investigated. This report details the results of a systematic review associated with a survey in neonatal intensive care units (NICUs) and pediatric palliative care departments (PPCTs) in France. No article was available in the Medline database. In Google®, we found six guidelines that described the use of the subcutaneous route in the pediatric palliative population. The participation rate in the survey was approximately 83 % for French NICUs and 74 % for PPCTs. Eleven percent of NICUs and 27 % of PPCTs had already used subcutaneous drug administration for palliative care, mainly for analgesia and terminal sedation. Limiting factors of its use were mainly alternative options and the lack of data. Nevertheless, 76 % of NICUs and 73 % of PPCTs expressed an interest in the use of the subcutaneous route in NICUs. Ninety-one percent of French NICUs and 80 % of PPCTs were interested in elaborating a protocol using the subcutaneous route for analgesia, anxiolysis, or terminal sedation. The subcutaneous route can be advantageous for comfort care in the neonatal palliative population. Studies are needed to define the modalities, pharmacodynamics, and pharmacokinetics of therapeutics in this population. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  13. Behavior and EEG concordance of active and quiet sleep in preterm very low birth weight and full-term neonates at matched conceptional age.

    Science.gov (United States)

    Dos Santos, Aline Ávila; Khan, Richard Lester; Rocha, Gibsi; Nunes, Magda Lahorgue

    2014-09-01

    Sleep organization in neonates is an established predictor of neurological outcome and can be evaluated through the concordance between EEG and behavioral parameters. To evaluate the correlation between sleep stages and behavioral states in neonates. Longitudinal study performed in a birth-cohort of preterm low birth weight neonates. Twenty five neonates, 15 preterm (gestational age between 27 and 33 weeks) and low birth weight (800-1500g) and 10 full-term neonates that served as controls. All neonates were submitted to video-electroencephalography of, at least, 60 minute duration. The preterm during the first 15 days of life and, subsequently, at 38-42 weeks of conceptional age. The full-term between the 1st and 2nd days of life. The characterization of sleep stages by EEG parameters and behavioral states (based on Prechtl scale) was performed independently by previously trained researchers. Active sleep (AS) was the predominant sleep stage in the three groups. Preterm neonates had an increase in concordance between state 1 and quiet sleep (QS) from the 1st to the 2nd EEG (pEEG and behavior is lower in QS in preterm and full-term neonates when compared to AS. Extra-uterine development of preterm neonates seems to accelerate concordance in QS. Prechtl behavior scale proved to be useful in preterm as percentage of concordance was similar in AS in the groups studied. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. Long-term effects of recurrent intermittent hypoxia and hyperoxia on respiratory system mechanics in neonatal mice.

    Science.gov (United States)

    Dylag, Andrew M; Mayer, Catherine A; Raffay, Thomas M; Martin, Richard J; Jafri, Anjum; MacFarlane, Peter M

    2017-04-01

    Premature infants are at increased risk for wheezing disorders. Clinically, these neonates experience recurrent episodes of apnea and desaturation often treated by increasing the fraction of inspired oxygen (FIO2). We developed a novel paradigm of neonatal intermittent hypoxia with subsequent hyperoxia overshoots (CIHO/E) and hypothesized that CIHO/E elicits long-term changes on pulmonary mechanics in mice. Neonatal C57BL/6 mice received CIHO/E, which consisted of 10% O2 (1 min) followed by a transient exposure to 50% FIO2, on 10-min repeating cycles 24 h/d from birth to P7. Baseline respiratory mechanics, methacholine challenge, RT-PCR for pro and antioxidants, radial alveolar counts, and airway smooth muscle actin were assessed at P21 after 2-wk room air recovery. Control groups were mice exposed to normoxia, chronic intermittent hyperoxia (CIHE), and chronic intermittent hypoxia (CIHO). CIHO/E and CIHE increased airway resistance at higher doses of methacholine and decreased baseline compliance compared with normoxia mice. Lung mRNA for NOX2 was increased by CIHO/E. Radial alveolar counts and airway smooth muscle actin was not different between groups. Neonatal intermittent hypoxia/hyperoxia exposure results in long-term changes in respiratory mechanics. We speculate that recurrent desaturation with hyperoxia overshoot may increase oxidative stress and contribute to wheezing in former preterm infants.

  15. Transcutaneous bilirubinometry is not influenced by term or skin color in neonates.

    Science.gov (United States)

    Afanetti, Mickael; Eleni Dit Trolli, Sergio; Yousef, Nadya; Jrad, Ikram; Mokhtari, Mostafa

    2014-08-01

    The utility of transcutaneous bilirubin measurements (TcB) in screening for hyperbilirubinemia in preterm infants (bilirubinometer. The Draeger JM-103® device was used to measure TcB. Eighty five measurements of TcB and total serum bilirubin (TSB) were retrospectively compared. Neonates were stratified into groups according to gestational age: 34 weeks (group 2, n=41), and according to ethnic origin: Caucasians (group A, n=49) and non-Caucasians (group B, n=36). Statistical analysis, using Pearson's correlation coefficient (r) and Bland-Altman analysis were performed to evaluate correlation and agreement between TSB and TcB values. Multiple linear regression was used to control for confounders for TSB values. Correlation between TSB and TcB was high. Pearson's correlation coefficients were over 0.9 in all groups (0.910, 0.908, 0.916 and 0.934, p<0.0001 in groups 1, 2, A, and B respectively). Bland-Altman plots showed acceptable and close limits of agreements (56.8/-57.7, 54.2/-67.2, 57.7/-55.8, and 51.3/-69.9μmol/L in groups 1, 2, A and B respectively) with a trend for TcB to overestimate TSB in groups 2 and B. Birth term and skin color were not identified as confounding factors for predicting TSB in multiple linear regression. TcB measurements using the Draeger JM-103® device correlate significantly with TSB, regardless of term and skin color. Transcutaneous bilirubinometry seems to be a safe and cost-effective screening method for severe hyperbilirubinemia in newborns of different terms and ethnic origins. Copyright © 2014 Elsevier Ltd. All rights reserved.

  16. Inborn Errors of Metabolism That Cause Sudden Infant Death : A Systematic Review with Implications for Population Neonatal Screening Programmes

    NARCIS (Netherlands)

    van Rijt, Willemijn J.; Koolhaas, Genevieve D.; Bekhof, Jolita; Fokkema, M. Rebecca Heiner; de Koning, Tom J.; Visser, Gepke; Schielen, Peter C. J. I.; Spronsen, van FrancJan; Derks, Terry G. J.

    2016-01-01

    BACKGROUND: Many inborn errors of metabolism (IEMs) may present as sudden infant death (SID). Nowadays, increasing numbers of patients with IEMs are identified pre-symptomatically by population neonatal bloodspot screening (NBS) programmes. However, some patients escape early detection because their

  17. Inborn Errors of Metabolism That Cause Sudden Infant Death : A Systematic Review with Implications for Population Neonatal Screening Programmes

    NARCIS (Netherlands)

    van Rijt, Willemijn J.; Koolhaas, Geneviève D.; Bekhof, Jolita; Heiner Fokkema, M. Rebecca; de Koning, Tom J.; Visser, Gepke; Schielen, Peter C J I; van Spronsen, Francjan J.; Derks, Terry G J

    Background: Many inborn errors of metabolism (IEMs) may present as sudden infant death (SID). Nowadays, increasing numbers of patients with IEMs are identified pre-symptomatically by population neonatal bloodspot screening (NBS) programmes. However, some patients escape early detection because their

  18. Treatment of neonatal withdrawal with clonidine after long-term, high-dose maternal use of tramadol.

    Science.gov (United States)

    O'Mara, Keliana; Gal, Peter; Davanzo, Christie

    2010-01-01

    To describe a case of tramadol withdrawal in a neonate and treatment with clonidine after exposure to long-term maternal use of high-dose tramadol. A 34-week gestational age neonate displayed symptoms of tramadol withdrawal within 48 hours of delivery. Due to a confusing initial clinical picture, including presumed congenital Chlamydia, questionable seizures, and an original report of maternal use of ketorolac (Toradol), diagnosis was delayed until day of life 5. Symptoms included jitteriness, myoclonic movements, and irritability. Upon further questioning of the mother, it was revealed that she was actually taking tramadol 600-800 mg daily. The infant was placed on maintenance therapy with oral clonidine (from 1 to 3 microg/kg orally every 3 hours) until discontinuation on day of life 11. After 3 days off treatment, he began to display symptoms of withdrawal again. Clonidine was restarted at 1 microg/kg orally every 8 hours and he was discharged home on maintenance clonidine therapy at 18 days postnatal age. A 7-day tapering regimen was initiated 2 weeks after discharge, and no further withdrawal symptoms occurred. Few published articles are available to guide clinicians on the clinical course and treatment strategies for tramadol dependence and withdrawal. In neonates, the reports are particularly sparse. Traditional agents used in neonatal opioid withdrawal are narcotics (morphine, tincture of opium, methadone), benzodiazepines (diazepam, lorazepam), and phenobarbital. Clonidine use for neonatal abstinence syndrome from narcotics has been shown to be effective alone or in combination with agents such as other opiates and chloral hydrate. Potential benefits of clonidine therapy include shorter duration of therapy, reduced withdrawal symptoms, and decreased length of hospital stay. Withdrawal can be prolonged in infants exposed to maternal tramadol use. Clonidine may be a safe and effective option for managing symptoms of neonatal tramadol abstinence.

  19. Functional development of fat absorption in term and preterm neonates strongly correlates with ability to absorb long-chain fatty acids from intestinal lumen

    NARCIS (Netherlands)

    Rings, EHHM; Minich, DM; Vonk, RJ; Stellaard, F; Fetter, WPF; Verkade, HJ

    Our goal for this study was to determine whether the maturation of fat absorption in neonatal life is functionally related to an increased ability to hydrolyze dietary fat, to absorb long-chain fatty acids, or to do both. In 16 preterm and in eight term neonates, the intestinal ability to hydrolyze

  20. Public-private differences in short-term neonatal outcomes following birth by prelabour caesarean section at early and full term.

    Science.gov (United States)

    Adams, Nicole; Gibbons, Kristen S; Tudehope, David

    2017-04-01

    Prelabour caesarean section (CS) at early term (37(0) -38(6)  weeks) is associated with higher rates of adverse short-term neonatal outcomes and higher costs than those performed at full term (39(0) -40(6)  weeks). Prelabour CS is more common in private than in public hospitals in Australia, particularly at early term. To evaluate the impact of hospital sector (public or private) and timing of delivery on short-term neonatal outcomes following prelabour CS at term. A retrospective cohort study of 22 954 viable singleton prelabour CS births at term (37(0) -40(6)  weeks) at a single centre encompassing co-located public and private hospitals during 1998-2013 was undertaken. Propensity score analysis was used to adjust for confounding differences between sectors. The primary outcome was Neonatal Critical Care Unit (NCCU) admission with serious morbidity. Secondary outcomes included respiratory distress, vigorous resuscitation and jaundice. The private hospital performed prelabour CS at over double the rate of the public hospital (33.7% of all private births vs 14.7% public) and more private than public prelabour CSs occurred at early term (66.8% vs 47.9%). Public babies were more than twice as likely as private babies to require admission to NCCU with serious morbidity (adjusted odds ratio (AOR) 2.54, 95% CI 1.77-3.65) but were less likely to need vigorous resuscitation (AOR 0.53, 95% CI 0.45-0.62). Disparities in outcomes between public and private cohorts were accentuated at full term. Despite early-term prelabour CSs occurring more often in the private hospital, public babies had more adverse outcomes and treatment escalations. © 2017 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  1. Detection of hyperbilirubinaemia in jaundiced full-term neonates by eye or by bilirubinometer?

    Science.gov (United States)

    Szabo, Peter; Wolf, Martin; Bucher, Hans Ulrich; Fauchère, Jean-Claude; Haensse, Daniel; Arlettaz, Romaine

    2004-12-01

    The aim of this study was to compare predictions of hyperbilirubinaemia by eye, performed by trained physicians and nurses, with predictions obtained using two commercial bilirubinometers. Jaundice was assessed in 92 white and 48 non-white healthy full-term neonates using three non-invasive methods and by total serum bilirubin as the reference method. Clinical assessment of cephalocaudal progression of jaundice was carried out independently by a physician and by nurses. Simultaneously, the Minolta Airshields JM-102 was applied on the sternum, the BiliCheck on both the forehead and the sternum, and finally, serum bilirubin concentrations were determined. The Minolta JM-102 showed the best performance with r2 = 0.90, an intraclass correlation coefficient (ICC) of 0.93, and a 95% confidence interval (CI) of +/- 4 units (approx. 56 micromol/l). The BiliCheck performed slightly better on the forehead than over the sternum with r2=0.90, an ICC of 0.88, and a CI of +/- 62 microtmol/l. Assessment of jaundice by eye was least accurate with r2 = 0.74, an ICC of 0.67, and a CI of +/- 1.5 zones (corresponding to 75 Lmol/l). Skin pigmentation and ambient light both adversely affected noninvasive bilirubin estimation. All three non-invasive methods are well suited for estimation of serum bilirubin but show large confidence intervals. In healthy term newborns, hyperbilirubinaemia (>250 Lmol/l) can be safely ruled out by eye if jaundice does not reach the abdomen or the extremities (Kramer zones 1 and 2), with < 22 units ( < 230 micromol/l) for the Minolta JM-102, or with a cut-off of 190 microlmol/l for the Bili-Check. If these respective thresholds are exceeded, serum bilirubin concentrations should be measured.

  2. Causes of death among full term stillbirths and early neonatal deaths in the Region of Southern Denmark

    DEFF Research Database (Denmark)

    Basu, Millie; Johnsen, Iben Birgit Gade; Wehberg, Sonja

    2018-01-01

    OBJECTIVE: We examined the causes of death amongst full term stillbirths and early neonatal deaths. METHODS: Our cohort includes women in the Region of Southern Denmark, who gave birth at full term to a stillborn infant or a neonate who died within the first 7 days from 2010 through 2014....... Demographic, biometric and clinical variables were analyzed to assess the causes of death using two classification systems: causes of death and associated conditions (CODAC) and a Danish system based on initial causes of fetal death (INCODE). RESULTS: A total of 95 maternal-infant cases were included. Using...... the CODAC and INCODE classification systems, we found that the causes of death were unknown in 59/95 (62.1%). The second most common cause of death in CODAC was congenital anomalies in 10/95 (10.5%), similar to INCODE with fetal, genetic, structural and karyotypic anomalies in 11/95 (11.6%). The majority...

  3. Serratia marcescens in a neonatal intensive care unit: two long-term multiclone outbreaks in a 10-year observational study.

    Science.gov (United States)

    Casolari, Chiara; Pecorari, Monica; Della Casa, Elisa; Cattani, Silvia; Venturelli, Claudia; Fabio, Giuliana; Tagliazucchi, Sara; Serpini, Giulia Fregni; Migaldi, Mario; Marchegiano, Patrizia; Rumpianesi, Fabio; Ferrari, Fabrizio

    2013-10-01

    We investigated two consecutive Serratia marcescens (S. marcescens) outbreaks which occurred in a neonatal intensive care unit (NICU) of a tertiary level hospital in North Italy in a period of 10 years (January 2003-December 2012). Risk factors associated with S. marcescens acquisition were evaluated by a retrospective case-control study. A total of 21,011 clinical samples was examined: S. marcescens occurred in 127 neonates: 43 developed infection and 3 died. Seven clusters were recorded due to 12 unrelated clones which persisted for years in the ward, although no environmental source was found. The main epidemic clone A sustaining the first cluster in 2003 reappeared in 2010 as an extended spectrum ?-lactamase (ESBL)-producing strain and supporting the second epidemic. Birth weight, gestational age, use of invasive devices and length of stay in the ward were significantly related to S. marcescens acquisition. The opening of a new ward for non-intensive care-requiring neonates, strict adherence to alcoholic hand disinfection, the timely identification and isolation of infected and colonized neonates assisted in containing the epidemics. Genotyping was effective in tracing the evolution and dynamics of the clones demonstrating their long-term persistence in the ward.

  4. Evidências científicas no controle da dor no período neonatal Evidencias científicas en el control del dolor en el periodo neonatal Scientific evidences for managing pain in the neonatal population

    Directory of Open Access Journals (Sweden)

    Mariana Bueno

    2009-12-01

    with larger sample size and stronger research design. These studies would provide further evidence regarding the best approaches for adequate for managing pain in the neonatal population.

  5. Automatic segmentation of the hippocampus for preterm neonates from early-in-life to term-equivalent age

    Directory of Open Access Journals (Sweden)

    Ting Guo

    2015-01-01

    Conclusions: MAGeT-Brain is capable of segmenting hippocampi accurately in preterm neonates, even at early-in-life. Hippocampal asymmetry with a larger right side is demonstrated on early-in-life images, suggesting that this phenomenon has its onset in the 3rd trimester of gestation. Hippocampal volume assessed at the time of early-in-life and term-equivalent age is linearly associated with GA at birth, whereby smaller volumes are associated with earlier birth.

  6. Sevoflurane exposure during the neonatal period induces long-term memory impairment but not autism-like behaviors.

    Science.gov (United States)

    Chung, Woosuk; Park, Saegeun; Hong, Jiso; Park, Sangil; Lee, Soomin; Heo, Junyoung; Kim, Daesoo; Ko, Youngkwon

    2015-10-01

    To examine whether neonatal exposure to sevoflurane induces autism-like behaviors in mice. There are continuing reports regarding the potential negative effects of anesthesia on the developing brain. Recently, several studies suggest that neurotoxicity caused by anesthesia may lead to neurodevelopmental impairments. However, unlike reports focusing on learning and memory, there are only a few animal studies focusing on neurodevelopmental disorders after general anesthesia. Therefore, we have focused on autism, a representative neurodevelopmental disorder. Neonatal mice (P6-7) were exposed to a titrated dose of sevoflurane for 6 h. Apoptosis was evaluated by assessing the expression level of cleaved (activated) caspase-3. Autism-like behaviors, general activity, anxiety level, and long-term memory were evaluated with multiple behavioral assays. Western blotting confirmed that neonatal exposure to sevoflurane increased the expression level of activated caspase-3, indicative of apoptosis. Mice exposed to sevoflurane also showed impaired long-term memory in fear tests. However, sevoflurane-exposed mice did not exhibit autism-like features in all of the following assays: social interaction (three-chamber test, caged social interaction), social communication (ultrasonic vocalization test), or repetitive behavior (self-grooming test, digging). There were also no differences in general activity (open field test, home cage activity) and anxiety (open field test, light-dark box) after sevoflurane exposure. Our results confirm previous studies that neonatal sevoflurane exposure causes neurodegeneration and long-term memory impairment in mice. However, sevoflurane did not induce autism-like features. Our study suggests that mice are more vulnerable to long-term memory deficits than autism-like behaviors after exposure to sevoflurane. © 2015 John Wiley & Sons Ltd.

  7. Global epidemiology of sickle haemoglobin in neonates: a contemporary geostatistical model-based map and population estimates.

    Science.gov (United States)

    Piel, Frédéric B; Patil, Anand P; Howes, Rosalind E; Nyangiri, Oscar A; Gething, Peter W; Dewi, Mewahyu; Temperley, William H; Williams, Thomas N; Weatherall, David J; Hay, Simon I

    2013-01-12

    Reliable estimates of populations affected by diseases are necessary to guide efficient allocation of public health resources. Sickle haemoglobin (HbS) is the most common and clinically significant haemoglobin structural variant, but no contemporary estimates exist of the global populations affected. Moreover, the precision of available national estimates of heterozygous (AS) and homozygous (SS) neonates is unknown. We aimed to provide evidence-based estimates at various scales, with uncertainty measures. Using a database of sickle haemoglobin surveys, we created a contemporary global map of HbS allele frequency distribution within a Bayesian geostatistical model. The pairing of this map with demographic data enabled calculation of global, regional, and national estimates of the annual number of AS and SS neonates. Subnational estimates were also calculated in data-rich areas. Our map shows subnational spatial heterogeneities and high allele frequencies across most of sub-Saharan Africa, the Middle East, and India, as well as gene flow following migrations to western Europe and the eastern coast of the Americas. Accounting for local heterogeneities and demographic factors, we estimated that the global number of neonates affected by HbS in 2010 included 5,476,000 (IQR 5,291,000-5,679,000) AS neonates and 312,000 (294,000-330,000) SS neonates. These global estimates are higher than previous conservative estimates. Important differences predicted at the national level are discussed. HbS will have an increasing effect on public health systems. Our estimates can help countries and the international community gauge the need for appropriate diagnoses and genetic counselling to reduce the number of neonates affected. Similar mapping and modelling methods could be used for other inherited disorders. The Wellcome Trust. Copyright © 2013 Elsevier Ltd. All rights reserved.

  8. Antibiotics for pre-term pre-labour rupture of membranes: prevention of neonatal deaths due to complications of pre-term birth and infection.

    Science.gov (United States)

    Cousens, Simon; Blencowe, Hannah; Gravett, Michael; Lawn, Joy E

    2010-04-01

    In high-income countries, it is standard practice to give antibiotics to women with pre-term, pre-labour rupture of membranes (pPROM) to delay birth and reduce the risk of infection. In low and middle-income settings, where some 2 million neonatal deaths occur annually due to complications of pre-term birth or infection, many women do not receive antibiotic therapy for pPROM. To review the evidence for and estimate the effect on neonatal mortality due to pre-term birth complications or infection, of administration of antibiotics to women with pPROM, in low and middle-income countries. We performed a systematic review to update a Cochrane review. Standardized abstraction forms were used. The quality of the evidence provided by individual studies and overall was assessed using an adapted GRADE approach. Eighteen RCTs met our inclusion criteria. Most were from high-income countries and provide strong evidence that antibiotics for pPROM reduce the risk of respiratory distress syndrome [risk ratio (RR) = 0.88; confidence interval (CI) 0.80, 0.97], and early onset postnatal infection (RR = 0.61; CI 0.48, 0.77). The data are consistent with a reduction in neonatal mortality (RR = 0.90; CI 0.72, 1.12). Antibiotics for pPROM reduce complications due to pre-term delivery and post-natal infection in high-income settings. There is moderate quality evidence that, in low-income settings, where access to other interventions (antenatal steroids, surfactant therapy, ventilation, antibiotic therapy) may be low, antibiotics for pPROM could prevent 4% of neonatal deaths due to complications of prematurity and 8% of those due to infection.

  9. Pain relief effect of breast feeding and music therapy during heel lance for healthy-term neonates in China: a randomized controlled trial.

    Science.gov (United States)

    Zhu, Jiemin; Hong-Gu, He; Zhou, Xiuzhu; Wei, Haixia; Gao, Yaru; Ye, Benlan; Liu, Zuguo; Chan, Sally Wai-Chi

    2015-03-01

    to test the effectiveness of breast feeding (BF), music therapy (MT), and combined breast feeding and music therapy (BF+MT) on pain relief in healthy-term neonates during heel lance. randomised controlled trial. in the postpartum unit of one university-affiliated hospital in China from August 2013 to February 2014. among 288 healthy-term neonates recruited, 250 completed the trial. All neonates were undergoing heel lancing for metabolic screening, were breast fed, and had not been fed for the previous 30 minutes. all participants were randomly assigned into four groups - BF, MT, BF+MT, and no intervention - with 72 neonates in each group. Neonates in the control group received routine care. Neonates in the other three intervention groups received corresponding interventions five minutes before the heel lancing and throughout the whole procedure. Neonatal Infant Pain Scale (NIPS), latency to first cry, and duration of first crying. mean changes in NIPS scores from baseline over time was dependent on the interventions given. Neonates in the BF and combined BF+MT groups had significantly longer latency to first cry, shorter duration of first crying, and lower pain mean score during and one minute after heel lance, compared to the other two groups. No significant difference in pain response was found between BF groups with or without music therapy. The MT group did not achieve a significantly reduced pain response in all outcome measures. BF could significantly reduce pain response in healthy-term neonates during heel lance. MT did not enhance the effect of pain relief of BF. healthy-term neonates should be breast fed to alleviate pain during heel lance. There is no need for the additional input of classical music on breast feeding in clinic to relieve procedural pain. Nurses should encourage breast feeding to relieve pain during heel lance. Copyright © 2014 Elsevier Ltd. All rights reserved.

  10. Diagnostic accuracy of S100B urinary testing at birth in full-term asphyxiated newborns to predict neonatal death.

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    Diego Gazzolo

    Full Text Available BACKGROUND: Neonatal death in full-term infants who suffer from perinatal asphyxia (PA is a major subject of investigation, since few tools exist to predict patients at risk of ominous outcome. We studied the possibility that urine S100B measurement may identify which PA-affected infants are at risk of early postnatal death. METHODOLOGY/PRINCIPAL FINDINGS: In a cross-sectional study between January 1, 2001 and December 1, 2006 we measured S100B protein in urine collected from term infants (n = 132, 60 of whom suffered PA. According to their outcome at 7 days, infants with PA were subsequently classified either as asphyxiated infants complicated by hypoxic ischemic encephalopathy with no ominous outcome (HIE Group; n = 48, or as newborns who died within the first post-natal week (Ominous Outcome Group; n = 12. Routine laboratory variables, cerebral ultrasound, neurological patterns and urine concentrations of S100B protein were determined at first urination and after 24, 48 and 96 hours. The severity of illness in the first 24 hours after birth was measured using the Score for Neonatal Acute Physiology-Perinatal Extension (SNAP-PE. Urine S100B levels were higher from the first urination in the ominous outcome group than in healthy or HIE Groups (p1.0 microg/L S100B had a sensitivity/specificity of 100% for predicting neonatal death. CONCLUSIONS/SIGNIFICANCE: Increased S100B protein urine levels in term newborns suffering PA seem to suggest a higher risk of neonatal death for these infants.

  11. Mary Crosse project: systematic reviews and grading the value of neonatal tests in predicting long term outcomes

    Directory of Open Access Journals (Sweden)

    Khan Khalid S

    2009-10-01

    Full Text Available Abstract Background Events before birth, condition at birth, events immediately following birth, and condition in early childhood are linked together, and have implications for health and disease in adulthood. At present, there is lack of clarity about the tests that purport to link these various stages. This is partly because there is paucity of collated information about the best strategies for predicting longer-term outcomes before (using tests in fetal period or after birth (using tests in neonatal period, infancy as well as early childhood. Methods/Design A series of systematic reviews and meta-analyses will be undertaken to determine, amongst neonates, the ability of various tests and measures to predict infant, childhood and adult outcomes. We will search Medline, Embase, Cochrane Library, MEDION, citation lists of review articles and eligible primary articles and will contact experts in the field. Independent reviewers will select studies, extract data and assess study quality according to established criteria. Language restrictions will not be applied. Data synthesis will involve meta-analysis (where appropriate, exploration of heterogeneity and publication bias. Evidence collated will be graded for its quality to support decision making. Discussion The project will collate, synthesise and evaluate the available evidence concerning the value of tests of neonatal wellbeing to predict long term outcomes. The systematic reviews will assess the quality of available evidence and identify tests with the strongest association with outcomes, and assess their economic value. The output of this project will help formulate practice recommendations.

  12. Exercise capacity, daily activity, and severity of fatigue in term born young adults after neonatal respiratory failure.

    Science.gov (United States)

    van der Cammen-van Zijp, M H M; Spoel, M; Laas, R; Hop, W C J; de Jongste, J C; Tibboel, D; van den Berg-Emons, R J G; IJsselstijn, H

    2014-02-01

    Little is known about long-term effects of neonatal intensive care on exercise capacity, physical activity, and fatigue in term borns. We determined these outcomes in 57 young adults, treated for neonatal respiratory failure; 27 of them had congenital diaphragmatic hernia with lung hypoplasia (group 1) and 30 had normal lung development (group 2). Patients in group 2 were age-matched, with similar gestational age and birth weight, and similar neonatal intensive care treatment as patients in group 1. All patients were born before the era of extracorporeal membrane oxygenation, nitric oxide administration, and high frequency ventilation. Exercise capacity was measured by cycle ergometry, daily physical activity with an accelerometry-based activity monitor, and fatigue by the fatigue severity scale. Median (range) VO2peak in mL/kg/min was 35.4 (19.6-55.0) in group 1 and 37.6 (15.7-52.7) in group 2. There was a between-group P-value of 0.65 for exercise capacity. Daily activity and fatigue were also similar in both groups. So, residual lung hypoplasia did not play an important role in this cohort. There were no significant associations between exercise capacity and perinatal characteristics. Future studies need to elucidate whether exercise capacity is impaired in patients with more severe lung hypoplasia who nowadays survive. © 2012 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  13. AAV-based neonatal gene therapy for hemophilia A: long-term correction and avoidance of immune responses in mice.

    Science.gov (United States)

    Hu, C; Lipshutz, G S

    2012-12-01

    Hemophilia A gene therapy has been hampered by immune responses to vector-associated antigens and by neutralizing antibodies or inhibitors against the factor VIII (FVIII) protein; these 'inhibitors' more commonly affect hemophilia A patients than those with hemophilia B. A gene replacement strategy beginning in the neonatal period may avoid the development of these immune responses and lead to prolonged expression with correction of phenotype, thereby avoiding long-term consequences. A serotype rh10 adeno-associated virus (AAV) was developed splitting the FVIII coding sequence into heavy and light chains with the chicken β-actin promoter/CMV enhancer for dual recombinant adeno-associated viral vector delivery. Virions of each FVIII chain were co-injected intravenously into mice on the second day of life. Mice express sustained levels of FVIII antigen ≥5% up to 22 months of life without development of antibodies against FVIII. Phenotypic correction was manifest in all AAV-FVIII-treated mice as demonstrated by functional assay and reduction in bleeding time. This study demonstrates the use of AAV in a gene replacement strategy in neonatal mice that establishes both long-term phenotypic correction of hemophilia A and lack of antibody development against FVIII in this disease model where AAV is administered shortly after birth. These studies support the consideration of gene replacement therapy for diseases that are diagnosed in utero or in the early neonatal period.

  14. Isotonic versus hypotonic fluid supplementation in term neonates with severe hyperbilirubinemia - a double-blind, randomized, controlled trial.

    Science.gov (United States)

    Balasubramanian, Karthik; Kumar, Praveen; Saini, Shiv Sajan; Attri, Savita Verma; Dutta, Sourabh

    2012-03-01

    To compare the incidence of hyponatremia in full-term neonates with severe hyperbilirubinemia, receiving intravenous fluid supplementation with 0.2% saline in 5% dextrose versus 0.9% saline in 5% dextrose, to prevent blood exchange transfusion (BET). In this double-blind, randomized, controlled trial, full-term newborns (≥37 weeks), appropriate for gestational age, with severe non-haemolytic hyperbilirubinemia (serum bilirubin ≥ 20 mg/dL) were enrolled. Eligible neonates were randomized to receive either 0.2% saline in 5% dextrose (hypotonic fluid group) or 0.9% saline in 5% dextrose (isotonic fluid group) over 8 hrs, in addition to phototherapy. The primary outcome was proportion of neonates developing hyponatremia (serum Na hypotonic fluid group as compared to isotonic fluid group (48.8% vs. 10.5%, p hypotonic fluid to prevent BET was associated with a higher incidence of hyponatremia while isotonic fluid was associated with an increased incidence of hypernatremia. © 2011 The Author(s)/Acta Paediatrica © 2011 Foundation Acta Paediatrica.

  15. Isolated single umbilical artery poses neonates at increased risk of long-term respiratory morbidity.

    Science.gov (United States)

    Beharier, Ofer; Sheiner, Eyal; Sergienko, Ruslan; Landau, Daniela; Szaingurten-Solodkin, Irit; Walfisch, Asnat

    2017-12-01

    To investigate whether children born with isolated single umbilical artery (iSUA) at term are at an increased risk for long-term pediatric hospitalizations due to respiratory morbidity. Design: a population-based cohort study compared the incidence of long-term, pediatric hospitalizations due to respiratory morbidity in children born with and without iSUA at term. Soroka University Medical Center. all singleton pregnancies of women who delivered between 1991 and 2013. hospitalization due to respiratory morbidity. Kaplan-Meier survival curves were used to estimate cumulative incidence of respiratory morbidity. A Cox hazards model analysis was used to establish an independent association between iSUA and pediatric respiratory morbidity of the offspring while controlling for clinically relevant confounders. The study included 232,281 deliveries. 0.3% were of newborns with iSUA (n = 766). Newborns with iSUA had a significantly higher rate of long-term respiratory morbidity compared to newborns without iSUA (7.6 vs 5.5%, p = 0.01). Using a Kaplan-Meier survival curve, newborns with iSUA had a significantly higher cumulative incidence of respiratory hospitalizations (log rank = 0.006). In the Cox model, while controlling for the maternal age, gestational age, and birthweight, iSUA at term was found to be an independent risk factor for long-term respiratory morbidity (adjusted HR = 1.39, 95% CI 1.08-1.81; p = 0.012). Newborns with iSUA are at an increased risk for long-term respiratory morbidity.

  16. Pathophysiology of the Cardiovascular System and Neonatal Hypotension.

    Science.gov (United States)

    Shead, Sandra L

    2015-01-01

    Hypotension is common in low birth weight neonates and less common in term newborns and is associated with significant morbidity and mortality. Determining an adequate blood pressure in neonates remains challenging for the neonatal nurse because of the lack of agreed-upon norms. Values for determining norms for blood pressure at varying gestational and postnatal ages are based on empirical data. Understanding cardiovascular pathophysiology, potential causes of hypotension, and assessment of adequate perfusion in the neonatal population is important and can assist the neonatal nurse in the evaluation of effective blood pressure. This article reviews cardiovascular pathophysiology as it relates to blood pressure and discusses potential causes of hypotension in the term and preterm neonate. Variation in management of hypotension across centers is discussed. Underlying causes and pathophysiology of hypotension in the neonate are described.

  17. Diminished HLA-DR expression on monocyte and dendritic cell subsets indicating impairment of cellular immunity in pre-term neonates: a prospective observational analysis.

    Science.gov (United States)

    Schefold, Joerg C; Porz, Linn; Uebe, Barbara; Poehlmann, Holger; von Haehling, Stephan; Jung, Andreas; Unterwalder, Nadine; Meisel, Christian

    2015-09-01

    The risk of neonates for severe infection/sepsis is reciprocally proportional to gestational age and birth weight. As monocytes and dendritic cells (DC) are recognised key antigen-presenting immune cells, we aimed to elucidate whether neonatal age is associated with reduced expression of human-leukocyte antigen-DR (HLA-DR) antigens on subsets of monocytes and DCs. Forty-three consecutive neonates (20 male, mean gestational age 236.0±26.8 days; mean 1-min Apgar score 7.5±2.0) were included in a monocentric prospective observational analysis. Patients were grouped according to gestational age (n=15 full-term, n=28 pre-term defined as DR expression was performed in subsets of peripheral blood myeloid and plasmacytoid DCs (MDC and PDC) and monocytes (CD14brightCD16negative/CD14positiveCD16positive/CD14dimCD16positive). Clinical and routine laboratory data were followed up. At birth, leukocyte counts were increased in full-term neonates. Monocyte counts were significantly increased in neonates when compared with adults (all PDR expression in these subsets was significantly diminished (most pronounced in pre-term infants, PDR expression was reduced also (all PDR expression on monocyte and DC subsets in pre-term and full-term neonates, which may contribute to impaired antimicrobial defence mechanisms in the early days of life.

  18. Automatic segmentation of the hippocampus for preterm neonates from early-in-life to term-equivalent age.

    Science.gov (United States)

    Guo, Ting; Winterburn, Julie L; Pipitone, Jon; Duerden, Emma G; Park, Min Tae M; Chau, Vann; Poskitt, Kenneth J; Grunau, Ruth E; Synnes, Anne; Miller, Steven P; Mallar Chakravarty, M

    2015-01-01

    The hippocampus, a medial temporal lobe structure central to learning and memory, is particularly vulnerable in preterm-born neonates. To date, segmentation of the hippocampus for preterm-born neonates has not yet been performed early-in-life (shortly after birth when clinically stable). The present study focuses on the development and validation of an automatic segmentation protocol that is based on the MAGeT-Brain (Multiple Automatically Generated Templates) algorithm to delineate the hippocampi of preterm neonates on their brain MRIs acquired at not only term-equivalent age but also early-in-life. First, we present a three-step manual segmentation protocol to delineate the hippocampus for preterm neonates and apply this protocol on 22 early-in-life and 22 term images. These manual segmentations are considered the gold standard in assessing the automatic segmentations. MAGeT-Brain, automatic hippocampal segmentation pipeline, requires only a small number of input atlases and reduces the registration and resampling errors by employing an intermediate template library. We assess the segmentation accuracy of MAGeT-Brain in three validation studies, evaluate the hippocampal growth from early-in-life to term-equivalent age, and study the effect of preterm birth on the hippocampal volume. The first experiment thoroughly validates MAGeT-Brain segmentation in three sets of 10-fold Monte Carlo cross-validation (MCCV) analyses with 187 different groups of input atlases and templates. The second experiment segments the neonatal hippocampi on 168 early-in-life and 154 term images and evaluates the hippocampal growth rate of 125 infants from early-in-life to term-equivalent age. The third experiment analyzes the effect of gestational age (GA) at birth on the average hippocampal volume at early-in-life and term-equivalent age using linear regression. The final segmentations demonstrate that MAGeT-Brain consistently provides accurate segmentations in comparison to manually

  19. Pregestational body mass index is related to neonatal abdominal circumference at birth--a Danish population-based study

    DEFF Research Database (Denmark)

    Tanvig, M; Wehberg, S; Vinter, C A

    2013-01-01

    OBJECTIVES: To examine the impact of maternal pregestational body mass index (BMI) and smoking on neonatal abdominal circumference (AC) and weight at birth. To define reference curves for birth AC and weight in offspring of healthy, nonsmoking, normal weight women. DESIGN: Population-based study...... MEASURES: Birth AC and weight in relation to pregestational maternal BMI, maternal smoking and medical conditions (any). RESULTS: Birth AC and weight increased with increasing pregestational BMI, and decreased with smoking (P ...

  20. Long-term impact of perinatal bereavement. Comparison of grief reactions after intrauterine versus neonatal death

    NARCIS (Netherlands)

    Schaap, A. H.; Wolf, H.; Bruinse, H. W.; Barkhof-van de Lande, S.; Treffers, P. E.

    1997-01-01

    OBJECTIVE: To investigate possible differences in emotional impact on parents following either a deliberate intrauterine death or a neonatal death in extremely preterm growth retarded infants. DESIGN: Retrospectively matched study by audiotaped semi-structured interview, 3-9 years after the

  1. Long-Term Oocyte-Like Cell Development in Cultures Derived from Neonatal Marmoset Monkey Ovary

    Directory of Open Access Journals (Sweden)

    Bentolhoda Fereydouni

    2016-01-01

    Full Text Available We use the common marmoset monkey (Callithrix jacchus as a preclinical nonhuman primate model to study reproductive and stem cell biology. The neonatal marmoset monkey ovary contains numerous primitive premeiotic germ cells (oogonia expressing pluripotent stem cell markers including OCT4A (POU5F1. This is a peculiarity compared to neonatal human and rodent ovaries. Here, we aimed at culturing marmoset oogonia from neonatal ovaries. We established a culture system being stable for more than 20 passages and 5 months. Importantly, comparative transcriptome analysis of the cultured cells with neonatal ovary, embryonic stem cells, and fibroblasts revealed a lack of germ cell and pluripotency genes indicating the complete loss of oogonia upon initiation of the culture. From passage 4 onwards, however, the cultured cells produced large spherical, free-floating cells resembling oocyte-like cells (OLCs. OLCs strongly expressed several germ cell genes and may derive from the ovarian surface epithelium. In summary, our novel primate ovarian cell culture initially lacked detectable germ cells but then produced OLCs over a long period of time. This culture system may allow a deeper analysis of early phases of female primate germ cell development and—after significant refinement—possibly also the production of monkey oocytes.

  2. Effect of Barely flour on jaundice in full-term neonates

    Directory of Open Access Journals (Sweden)

    azam Mohsenzadeh

    2005-08-01

    Conclusions: Our study indicated that phototherapy in conjuction with barely flour therapy is more effective than phototherapy alone. But, people must be informed that affected neonates have to be underwent medical therapy, and barely flour therapy alone is not a reliable treatment.

  3. Long-Term Trends in the Epidemiology of Neonatal Sepsis and Antibiotic Susceptibility of Causative Agents

    NARCIS (Netherlands)

    van den Hoogen, Agnes; Gerards, Leo J.; Verboon-Maciolek, Malgorzata A.; Fleer, Andre; Krediet, Tannette G.

    2010-01-01

    Background: In an era with increased maternal antibiotic use, patterns in early- and late-onset sepsis and antibiotic susceptibility may have changed. Objectives: To identify longitudinal trends in causative microorganisms for neonatal sepsis and analyze antibiotic susceptibility of all blood

  4. Neonatal Maturation of Paracetamol (Acetaminophen) Glucuronidation, Sulfation, and Oxidation Based on a Parent-Metabolite Population Pharmacokinetic Model.

    Science.gov (United States)

    Cook, Sarah F; Stockmann, Chris; Samiee-Zafarghandy, Samira; King, Amber D; Deutsch, Nina; Williams, Elaine F; Wilkins, Diana G; Sherwin, Catherine M T; van den Anker, John N

    2016-11-01

    This study aimed to model the population pharmacokinetics of intravenous paracetamol and its major metabolites in neonates and to identify influential patient characteristics, especially those affecting the formation clearance (CL formation ) of oxidative pathway metabolites. Neonates with a clinical indication for intravenous analgesia received five 15-mg/kg doses of paracetamol at 12-h intervals (paracetamol, paracetamol-glucuronide, paracetamol-sulfate, and the combined oxidative pathway metabolites (paracetamol-cysteine and paracetamol-N-acetylcysteine) were simultaneously modeled in NONMEM 7.2. The model incorporated 259 plasma and 350 urine samples from 35 neonates with a mean gestational age of 33.6 weeks (standard deviation 6.6). CL formation for all metabolites increased with weight; CL formation for glucuronidation and oxidation also increased with postnatal age. At the mean weight (2.3 kg) and postnatal age (7.5 days), CL formation estimates (bootstrap 95% confidence interval; between-subject variability) were 0.049 L/h (0.038-0.062; 62 %) for glucuronidation, 0.21 L/h (0.17-0.24; 33 %) for sulfation, and 0.058 L/h (0.044-0.078; 72 %) for oxidation. Expression of individual oxidation CL formation as a fraction of total individual paracetamol clearance showed that, on average, fractional oxidation CL formation increased paracetamol and its metabolites in neonates. Maturational changes in the fraction of paracetamol undergoing oxidation were small relative to between-subject variability.

  5. Low but inducible contribution of renal elimination to clearance of propylene glycol in preterm and term neonates.

    Science.gov (United States)

    De Cock, Roosmarijn F W; Allegaert, Karel; Vanhaesebrouck, Sophie; de Hoon, Jan; Verbesselt, Rene; Danhof, Meindert; Knibbe, Catherijne A J

    2014-06-01

    Despite limited information being available on the pharmacokinetics of excipients, propylene glycol (PG) is often used as an excipient in both adults and children. The aim of this study is to characterize the renal and hepatic elimination of PG in preterm and term neonates. The pharmacokinetic analysis of PG was performed in NONMEM 6.2. on the basis of PG concentrations in plasma and/or urine samples for a total of 69 (pre)term neonates (birth weight 630-3980 g, gestational age 24-41 weeks, postnatal age 1-29 days) who received PG coadministered with intravenous paracetamol (5-10 mg/kg per 6 hours), phenobarbital (5 mg·kg(-1)·d(-1)), or both. To capture the time-dependent trend in the renal excretion of PG, different models based on time after the first dose, urine volume, and creatinine amount in urine were tested. A one-compartment model parameterized in terms of renal clearance, hepatic clearance, and volume of distribution was found to adequately describe the observations in both plasma and urine. After the first dose was administered, the renal elimination of PG was 15% of total clearance, which increased over time to 25% at 24 hours after the first dose of PG. This increase was best described using a hyperbolic function based on time after the first dose. Renal elimination of PG in (pre)term neonates is low, particularly compared with the reported percentage of 45% in adults, but it may increase with time after the first dose of PG. To study whether this increase is caused by an autoinduced increase in the renal secretion or a reduction of tubular reabsorption of PG, further research is needed.

  6. Mechanical-tactile stimulation (MTS) intervention in a neonatal stress model improves long-term outcomes on bone.

    Science.gov (United States)

    Haley, S; O'Grady, S; Gulliver, K; Bowman, B; Baldassarre, R; Miller, S; Lane, R H; Moyer-Mileur, L J

    2011-09-01

    Neonatal stress impairs postnatal bone mineralization. Evidence suggests that mechanical tactile stimulation (MTS) in early life decreases stress hormones and improves bone mineralization. Insulin-like growth factor (IGF1) is impacted by stress and essential to bone development. We hypothesized that MTS administered during neonatal stress would improve bone phenotype in later life. We also predicted an increase in bone specific mRNA expression of IGF1 related pathways. Neonatal stress (STRESS) and MTS (STRESS+10 min of MTS) were given from D6 to D10 of rat life and tissue was harvested on D60 of life. Dual energy x-ray absorptiometry (DXA), bone morphometry, serum osteocalcin, type I procollagen N-terminal propeptide (PINP), tartrate-resistant acid phosphatase (TRAP), and bone and liver mRNA levels of IGF1, IGF1 receptor (IGF1R), and growth hormone receptor (GHR) were measured. Stress resulted in reduced bone area and bone mineral content (BMC) compared to naive control (CTL). MTS intervention increased BMC and tibial growth plate width compared to STRESS. MTS also resulted in higher osteocalcin, and, in males, lower TRAP (pMTS resulted in three-fold, two-fold, and six-fold higher bone specific IGF1, IGF1R, and GHR, respectively (p ≤ 0.001) compared to STRESS. MTS in early postnatal life improves long-term bone mineralization. IGF1 and related pathways may explain improved BMC.

  7. Longitudinal Analysis of Pre-Term Neonatal Cerebral Ventricles From 3D Ultrasound Images Using Spatial-Temporal Deformable Registration.

    Science.gov (United States)

    Qiu, Wu; Chen, Yimin; Kishimoto, Jessica; de Ribaupierre, Sandrine; Chiu, Bernard; Fenster, Aaron; Menon, Bijoy K; Yuan, Jing

    2017-04-01

    Preterm neonates with a very low birth weight of less than 1,500 grams are at increased risk for developing intraventricular hemorrhage (IVH), which is a major cause of brain injury in preterm neonates. Quantitative measurements of ventricular dilatation or shrinkage play an important role in monitoring patients and evaluating treatment options. 3D ultrasound (US) has been developed to monitor ventricle volume as a biomarker for ventricular changes. However, ventricle volume as a global indicator does not allow for precise analysis of local ventricular changes, which could be linked to specific neurological problems often seen in the patient population later in life. In this work, a 3D+t spatial-temporal deformable registration approachis proposed, which is applied to the analysis of the detailed local changes of preterm IVH neonatal ventricles from 3D US images. In particular, a novel sequential convex/dual optimization algorithm is introduced to extract the optimal 3D+t spatial-temporal deformable field, which simultaneously optimizes the sequence of 3D deformation fieldswhile enjoying both efficiencyand simplicity in numerics. The developed registration technique was evaluated by comparing two manually extracted ventricle surfaces from the baseline and the registered follow-up images using the metrics of Dice similarity coefficient (DSC), mean absolute surface distance (MAD), and maximum absolute surface distance (MAXD). The performed experiments using 14 patients with 5 time-point images per patient show that the proposed 3D+t registration approach accurately recovered the longitudinal deformation of ventricle surfaces from 3D US images. The proposed approach may be potentially used to analyse the change pattern of cerebral ventricles of IVH patients, their response to different treatment options, and to elucidate the deficiencies that a patient could have later in life. To the best of our knowledge, this paper reports the first study on the

  8. Size of the intracranial optic nerve and optic tract in neonates at term-equivalent age at magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Oyama, Jun; Mori, Kouichi [Tsuchiura Kyodo General Hospital, Department of Radiology, Tsuchiura, Ibaraki (Japan); Imamura, Masatoshi [Tsuchiura Kyodo General Hospital, Department of Neonatology, Tsuchiura, Ibaraki (Japan); Mizushima, Yukiko [Tsuchiura Kyodo General Hospital, Department of Ophthalmology, Tsuchiura, Ibaraki (Japan); Tateishi, Ukihide [Tokyo Medical and Dental University, Departments of Diagnostic Radiology and Nuclear Medicine, Tokyo (Japan)

    2016-04-15

    The expected MRI-based dimensions of the intracranial optic nerve and optic tract in neonates are unknown. To evaluate the sizes of the intracranial optic nerve and optic tract in neonates at term-equivalent age using MRI. We retrospectively analyzed brain MRI examinations in 62 infants (28 boys) without intracranial abnormalities. The images were obtained in infants at term-equivalent age with a 1.5-tesla MRI scanner. We measured the widths and heights of the intracranial optic nerve and optic tract and calculated the cross-sectional areas using the formula for an ellipse. The means ± standard deviation of the width, height and cross-sectional area of the intracranial optic nerve were 2.7 ± 0.2 mm, 1.7 ± 0.2 mm and 3.5 ± 0.5 mm{sup 2}, respectively. The width, height and cross-sectional area of the optic tract were 1.5 ± 0.1 mm, 1.6 ± 0.1 mm and 2.0 ± 0.2 mm{sup 2}, respectively. Using univariate and multivariate analyses, we found that postmenstrual age showed independent intermediate positive correlations with the width (r = 0.48, P < 0.01) and cross-sectional area (r = 0.40, P < 0.01) of the intracranial optic nerve. The lower bounds of the 95% prediction intervals for the width and cross-sectional area of the intracranial optic nerve were 0.07 x (postmenstrual age in weeks) - 0.46 mm, and 0.17 x (postmenstrual age in weeks) - 4.0 mm{sup 2}, respectively. We identified the sizes of the intracranial optic nerve and optic tract in neonates at term-equivalent age. The postmenstrual age at MRI independently positively correlated with the sizes. (orig.)

  9. Long-term sex-differential effects of neonatal vitamin A supplementation on in vitro cytokine responses

    DEFF Research Database (Denmark)

    Jensen, Kristoffer Jarlov; Søndergaard, Mia J.; Andersen, Andreas

    2017-01-01

    High-dose vitamin A supplementation (VAS) may affect mortality to infectious diseases in a sex-differential manner. Here, we analysed the long-term immunological effects of neonatal vitamin A supplementation (NVAS) in 247 children, who had been randomly allocated to 50 000 or 25 000 IU vitamin...... A (15 mg and 7·5 mg retinol equivalents, respectively) or placebo at birth. At 4-6 months of age, we assessed bacille Calmette-Guerin (BCG) scarification, and we analysed in vitro responses of TNF-α, IL-5, IL-10, IL-13 and IFN-γ in whole blood stimulations to phytohaemagglutinin (PHA), purified protein...

  10. Effects of Administration of Perinatal Bupropion on the Population Spike Amplitude in Neonatal Rat Hippocampal Slice

    Directory of Open Access Journals (Sweden)

    Soomaayeh Heysieat-talab

    2010-09-01

    Full Text Available Objective(sBupropion is an atypical antidepressant that is widely used in smoke cessation under FDA approval. The study of synaptic effects of bupropion can help to finding out its mechanism(s for stopping nicotine dependence. In this study the effects of perinatal bupropion on the population spike (PS amplitude of neonates were investigated. Materials and Methods Hippocampal slices were prepared from 18-25 days old rat pups. The experimental groups included control and bupropion-treated. Bupropion (40 mg/Kg, i.p. was applied daily in perinatal period as pre-treatment. Due to the studying acute effects, bupropion was also added to the perfusion medium (10, 50, 200 μM for 30 min. The evoked PS was recorded from pyramidal layer of CA1 area, following stimulation of Schaffer collaterals. ResultsA concentration of 10 μM bupropion had no significant effects on the PS amplitude. The 50 μM concentration of bupropion reduced the amplitude of responses in 50% of the studied cases. At a concentration of 200 μM, the recorded PS amplitudes were reduced in all slices (n= 22. Amplitude was completely abolished in 8 out of the 22 slices. The decrease of the PS amplitude was found to be more in the non-pre-treated slices than in the pre-treated slices when both were perfused with 200 μM bupropion.Conclusion The results showed the perinatal exposure to bupropion and its acute effects while indicating that at concentrations of 50 and 200 μM bupropion reduced the PS amplitude. It was also found that there was evidence of synaptic adaptation in comparison of bupropion-treated and non-treated slices whereas they were both perfused with 200 µM.

  11. Lateral ventricle segmentation of 3D pre-term neonates US using convex optimization.

    Science.gov (United States)

    Qiu, Wu; Yuan, Jing; Kishimoto, Jessica; Ukwatta, Eranga; Fenster, Aaron

    2013-01-01

    Intraventricular hemorrhage (IVH) is a common disease among preterm infants with an occurrence of 12-20% in those born at less than 35 weeks gestational age. Neonates at risk of IVH are monitored by conventional 2D ultrasound (US) for hemorrhage and potential ventricular dilation. Compared to 2D US relying on linear measurements from a single slice and visually estimates to determine ventricular dilation, 3D US can provide volumetric ventricle measurements, more sensitive to longitudinal changes in ventricular volume. In this work, we propose a global optimization-based surface evolution approach to the segmentation of the lateral ventricles in preterm neonates with IVH. The proposed segmentation approach makes use of convex optimization technique in combination with a subject-specific shape model. We show that the introduced challenging combinatorial optimization problem can be solved globally by means of convex relaxation. In this regard, we propose a coupled continuous max-flow model, which derives a new and efficient dual based algorithm, that can be implemented on GPUs to achieve a high-performance in numerics. Experiments demonstrate the advantages of our approach in both accuracy and efficiency. To the best of our knowledge, this paper reports the first study on semi-automatic segmentation of lateral ventricles in neonates with IVH from 3D US images.

  12. Effect of supine, prone and kangaroo care (KC Positions on diminishing the pain response in term neonates during venopuncture

    Directory of Open Access Journals (Sweden)

    mozhgan Saki

    2009-01-01

    Full Text Available Saki M¹, Mohsenzade A², Tarrahi MJ³, Saki M4 1. Instructor, Department of Health, Faculty of Health, Lorestan University of Medical Sciences 2. Assistant Professor, Department of Pediatrics, Faculty of Medicine, Lorestan University of Medical Sciences 3. Instructor, Department of Health, Faculty of Health, Lorestan University of Medical Sciences 4. Instructor, Department of Nursing, Faculty of Nursing and Midwifery, Lorestan University of Medical Sciences Abstract Background: Neonates expose to painful procedures even when come to birth healthy. Pain reduction is a definite right for each living creature during medical intervention. It has bee proved by many studies that painful experiences during babyhood, besides the early complications such as tachycardia, tachypnea and increase of body metabolic needs, can intensify individual’s physiologic and behavioral responses to pain in next stages of life. The purpose of this study is to examine the efficacy of supine, prone and kangaroo care (KC positions on diminishing the pain response of term neonates during acute pain of venopuncture. Materials and methods: In this clinical trial study, 50 healthy neonates between 39 to 40 weeks of gestational age with physiologic icter requiring bilirubin estimation were assigned to receive a venous puncture and assessed for their responses to the pain of venopuncture performed in a standard manner. Blood sampling was performed by an expert nurse in charge of each neonate in three positions including supine, kangaroo care (KC at a 24-hour interval during 3 days. The place and condition of sampling were equal for all neonates. Pain responses were assessed using DAN scale, then the gathered data were analyzed using SPSS software and statistical tests. Results: According to the obtained results there was no significant differences between pain score in supine and prone positions. Limb movements score in supine position was significantly higher than two other

  13. [Clinical effect of endotracheal lavage with porcine pulmonary surfactant in term neonates with severe meconium aspiration syndrome].

    Science.gov (United States)

    Lin, Xin-Zhu; Lai, Ji-Dong; Lan, Zhao-Yang; Lin, Ya-Yin

    2014-07-01

    To evaluate the clinical effect of endotracheal lavage with porcine pulmonary surfactant (PS) in term neonates with severe meconium aspiration syndrome (MAS). A total of 136 full-term infants with severe MAS who were admitted to the neonatal intensive care unit between January 2010 and June 2013 were randomly and equally divided into PS lavage and PS injection groups. In the PS lavage group, patients were treated with endotracheal lavage using 3-5 mL of diluted PS (12 mg/mL) each time, and the PS injection group was given PS by intratracheal injection at the first dose of 200 mg/kg. Blood gas, oxygenation index (OI), and PaO2/FiO2 (P/F) of the two groups were evaluated before and 2, 12, 24, and 48 hours after the treatment, and the duration of mechanical ventilation, complication rate, and cure rate were compared between the two groups. Compared with the PS injection group, the PS lavage group had significantly higher PaO2 and P/F ration and significantly lower PaCO2 and OI at 12, 24, and 48 hours post-treatment (Pneonates with severe MAS can increase ventilation and oxygenation efficiency, shorten the duration of mechanical ventilation, reduce the complication rate, and increase the cure rate, indicating that this method is a safe and effective therapeutic strategy.

  14. Follow-up of neonatal jaundice in term and late premature newborns

    OpenAIRE

    Fernando Perazzini Facchini; Maria Aparecida Mezzacappa; Izilda Rodrigues Machado Rosa; Francisco Mezzacappa Filho; Abimael Aranha Netto; Sergio Tadeu Martins Marba

    2007-01-01

    OBJETIVO: Relatar os resultados de um projeto de acompanhamento de recém-nascidos de termo e próximos ao termo ictéricos no período neonatal. MÉTODOS: Foram encaminhados a ambulatório especializado neonatos com peso > 2.000 g e/ou idade gestacional > 35 semanas, cuja icterícia na alta foi avaliada inicialmente com o icterômetro de Ingram, Bilicheck® e, se indicado, com bilirrubinômetro Unistat (Leica). A bilirrubinemia destes recém-nascidos situava-se no ou acima do percentil 40 do nomograma ...

  15. Do antenatal corticosteroids in term elective cesarean sections reduce neonatal respiratory morbidity?

    OpenAIRE

    Felipe Petour Gazitúa

    2015-01-01

    INTRODUCCIÓN El síndrome de distrés respiratorio neonatal se relaciona con la edad gestacional y vía de parto. Menor edad gestacional y parto vía cesárea se asocian a mayor riesgo. Con lo anterior, surge la necesidad de evaluar estrategias que reduzcan su incidencia. El uso de corticoides antenatales en la inducción de maduración pulmonar en partos prematuros, podría ser beneficioso en fetos de término en que se programe cesárea. OBJETIVO Buscar evidencia bibliográfica que determin...

  16. Acute kidney injury in the neonate.

    Science.gov (United States)

    Jetton, Jennifer G; Askenazi, David J

    2014-09-01

    Critically ill neonates are at risk for acute kidney injury (AKI). AKI has been associated with increased risk of morbidity and mortality in adult and pediatric patients, and increasing evidence suggests a similar association in the neonatal population. This article describes the current AKI definitions (including their limitations), work on novel biomarkers to define AKI, diagnosis and management strategies, long-term outcomes after AKI, and future directions for much-needed research in this important area. Published by Elsevier Inc.

  17. Are intrapartum and neonatal deaths in breech delivery at term potentially avoidable?--a blinded controlled audit

    DEFF Research Database (Denmark)

    Krebs, Lone; Langhoff-Roos, Jens; Bødker, Birgit

    2002-01-01

    The aim of the study was to investigate whether deaths in term breech deliveries could have been avoided with improved care during pregnancy and delivery. All cases of intrapartum/early neonatal death of nonmalformed infants in breech presentation delivered at term in Denmark in the period 1982......-92 were studied. For each of the 12 deaths two controls matched by presentation and planned mode of delivery were selected. Eleven obstetricians assessed the care through narratives that ended when the infant was delivered to umbilicus and stated if the infant died, and whether the "possible death......" was potentially avoidable. The majority thought that 42% of cases and 9% of the controls had died. Antenatal and intrapartum care was suboptimal respectively in 17% and 25% of cases and 4% and 26% of controls. The assumed death was found to have been potentially avoidable in 58% of cases and 17% of controls. Care...

  18. Population pharmacokinetics and pharmacodynamics of teicoplanin in neonates: making better use of C-reactive protein to deliver individualized therapy.

    Science.gov (United States)

    Ramos-Martín, V; Neely, M N; McGowan, P; Siner, S; Padmore, K; Peak, M; Beresford, M W; Turner, M A; Paulus, S; Hope, W W

    2016-11-01

    There is uncertainty about the optimal teicoplanin regimens for neonates. The study aim was to determine the population pharmacokinetics (PK) of teicoplanin in neonates, evaluate currently recommended regimens and explore the exposure-effect relationships. An open-label PK study was conducted. Neonates from 26 to 44 weeks post-menstrual age were recruited (n = 18). The teicoplanin regimen was a 16 mg/kg loading dose, followed by 8 mg/kg once daily. Therapeutic drug monitoring and dose adjustment were not conducted. A standard two-compartment PK model was developed, followed by models that incorporated weight. A PK/pharmacodynamic (PD) model with C-reactive protein serial measurements as the PD input was fitted to the data. Monte Carlo simulations (n = 5000) were performed using Pmetrics. The AUCs at steady state and the proportion of patients achieving the recommended drug exposures (i.e. Cmin >15 mg/L) were determined. The study was registered in the European Clinical Trials Database Registry (EudraCT: 2012-005738-12). The PK allometric model best accounted for the observed data. The PK parameters medians were: clearance = 0.435 × (weight/70)0.75 (L/h); volume = 0.765 (L); Kcp = 1.3 (h-1); and Kpc = 0.629 (h-1). The individual time-course of C-reactive protein was well described using the Bayesian posterior estimates for each patient. The simulated median AUC96-120 was 302.3 mg·h/L and the median Cmin at 120 h was 12.9 mg/L; 38.8% of patients attained a Cmin >15 mg/L by 120 h. Teicoplanin population PK is highly variable in neonates, weight being the best descriptor of PK variability. A low percentage of neonates were able to achieve Cmin >15 mg/L. The routine use of therapeutic drug monitoring and improved knowledge on the PD of teicoplanin is required. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  19. Population-based surveillance of neonatal herpes simplex virus infection in Australia, 1997-2011.

    Science.gov (United States)

    Jones, Cheryl A; Raynes-Greenow, Camille; Isaacs, David

    2014-08-15

    Neonatal herpes simplex virus (HSV) infection is uncommon, but mortality after disseminated disease and morbidity after encephalitis are high. For the last decade, increased dose and duration of acyclovir has been advised to prevent disease progression and recurrence. We sought to determine prospectively the epidemiologic, clinical, and secular trends of this condition in Australia. This was prospective national active surveillance for neonatal HSV disease through the Australian Paediatric Surveillance Unit from 1997 to 2011. Case notification triggered a questionnaire requesting de-identified data from the pediatric clinician. We identified 131 confirmed cases of neonatal HSV disease in 15 years from 261 notifications (95% response). The reported incidence (3.27 cases per 100 000 live births overall; 95% confidence interval [CI], 2.73-3.86) was stable. Overall mortality was 18.8% (95% CI, 12.1-25.5); the mortality rate was significantly lower in the latter part of the study period, 2005-2011, compared with 1997-2004 (P = .04). There were significantly more young mothers (<20 years of age) compared with Australian birth record data (18.5% vs 4.8%; P < .001). HSV-1 infection was more common than HSV-2 (62.7% vs 37.3%; P < .001), and the rate of HSV-1 infections increased significantly over the surveillance period (P < .05). From 2002, most infants received high-dose acyclovir. The time from symptom onset to initiation of therapy in survivors did not change over time. Mortality from neonatal HSV infection has fallen but remains high. HSV-1 is the major serotype causing neonatal disease in Australia. Young mothers represent an important target group for prevention. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  20. [Neonatal screening of sickle cell disease in the Balearic Islands Autonomous Community. Pilot study in anonymous unrelated population].

    Science.gov (United States)

    López-Escribano, H; Vila Vidal, M; Barceló Bennassar, A; Riesco Prieto, M; Ayllón Gatnau, O

    2009-05-01

    Sickle cell disease (SCD) describes a group of inherited disorders caused by the presence of the sickle haemoglobin (HbS) which results from a point mutation affecting codon 6 of the beta globin chain (beta codon 6, Glu 6 Val). The pathophysiology involves polymerisation of HbS under low oxygen conditions causing vaso-occlusion and chronic haemolysis and anaemia. Due to increase in immigrants within our population and the majority of this group being a risk population for different haemoglobinopathies, the aim of our study is to determine the incidence of SCD and others structural haemoglobinopathies in the neonatal population of the Balearic Islands Autonomous Community, by means of an unrelated pilot study and determine the need to include this pathology in a newborn screening program. The study was performed with the same blood spot specimen dried on filter paper used for congenital hypothyroidism, phenylketonuria and cystic fibrosis screening. High-performance liquid chromatography (HPLC), using the VARIANTs (Biorad) automated system, was used to detect variants haemoglobin variants. The overall incidence was 9.9 per 1000 specimens. The incidence of SCD was 1/6756 (FS) and the incidence of sickle cell traits was 1/199 (FAS). These results confirm the need to include screening for SCD and other haemoglobinopathies in our neonatal screening program.

  1. Reference Values for Interleukin-6 and Interleukin-8 in Cord Blood of Healthy Term Neonates and Their Association with Stress-Related Perinatal Factors

    Science.gov (United States)

    Barug, Daan; Goorden, Susan; Herruer, Martien; Müller, Moira; Brohet, Richard; de Winter, Peter

    2014-01-01

    Background Automated interleukin assays are promising diagnostic aids for early-onset neonatal sepsis, however, reference values for healthy term neonates are incompletely known. The goal of this study is to determine reference values for interleukin-6 (IL-6) and interleukin-8 (IL-8) in cord blood of healthy term neonates. Methods and Findings Women were recruited from April 2012 to August 2012. IL-6 and IL-8 levels were measured using an automated immunometric assay (Immulite) in cord blood of 93 healthy term newborns, 60 of them were born via vaginal delivery and 33 by elective caesarean section (ECS). A mean value for IL-8 of 8.1±3.0 pg/mL was found in cord blood of healthy term neonates, which apply to both vaginal delivery and ECS. Regarding IL-6, two values apply. For vaginal delivery, a median value of 3.3 pg/mL (range, <2 to 9.53 pg/mL) was found, while for ECS, a median value of <2 pg/mL (range, <2 to 48 pg/mL) applies. Conclusions We propose a reference value of <14.1 pg/mL for IL-8 (mean + 2SD), applying to vaginally delivered and ECS-delivered healthy term newborns. From a clinical point of view, we also propose one reference value for IL-6 to be applied to vaginally delivered and ECS-delivered healthy term newborns, which is <10.2 pg/mL (97.5th percentile total group). These values have to be validated in larger cohorts of neonates, inclusive of those with and without early-onset neonatal sepsis. PMID:25485809

  2. Treatment of Persistent Pulmonary Hypertension of the Newborn: Use of Pulmonary Vasodilators in Term Neonates.

    Science.gov (United States)

    Luecke, Caitlyn; McPherson, Christopher

    2017-05-01

    Persistent pulmonary hypertension of the newborn (PPHN) represents a challenging condition associated with significant morbidity. A successful transition from intrauterine to extrauterine life is contingent on adequate pulmonary vasodilation. Several pathophysiologies contribute to the failure of this cascade and may result in life-threatening hypoxia and acidosis in the newborn. Management includes optimal respiratory support, adequate sedation and analgesia, and support of vascular tone and cardiac function. Pulmonary vasodilation has the potential to overcome the cycle of hypoxia and acidosis, improving outcome in these infants. Oxygen and inhaled nitric oxide represent the foundation of therapy. Tertiary pulmonary vasodilators represent a greater challenge, selecting between therapies that include prostanoids, sildenafil, and milrinone. Variable levels of evidence exist for each agent. Thorough review of available data informing efficacy and adverse effects contributes to the development of an informed approach to neonates with refractory PPHN.

  3. Isolated acute non-cystic white matter injury in term infants presenting with neonatal encephalopathy.

    LENUS (Irish Health Repository)

    Barrett, Michael Joseph

    2013-03-01

    We discuss possible aetiological factors, MRI evolution of injury and neuro-developmental outcomes of neonatal encephalopathy (NE). Thirty-six consecutive infants diagnosed with NE were included. In this cohort, four infants (11%) were identified with injury predominantly in the deep white matter on MRI who were significantly of younger gestation, lower birthweight with higher Apgars at one and five minutes compared to controls. Placental high grade villitis of unknown aetiology (VUA) was identified in all four of these infants. Our hypothesis states VUA may induce white matter injury by causing a local inflammatory response and\\/or oxidative stress during the perinatal period. We underline the importance of continued close and systematic evaluation of all cases of NE, including examination of the placenta, in order to come to a better understanding of the clinical presentation, the patterns of brain injury and the underlying pathophysiological processes.

  4. Sucrose and naltrexone prevent increased pain sensitivity and impaired long-term memory induced by repetitive neonatal noxious stimulation: Role of BDNF and β-endorphin.

    Science.gov (United States)

    Nuseir, Khawla Q; Alzoubi, Karem H; Alhusban, Ahmed; Bawaane, Areej; Al-Azzani, Mohammed; Khabour, Omar F

    2017-10-01

    Pain in neonates is associated with short and long-term adverse outcomes. Data demonstrated that long-term consequences of untreated pain are linked to the plasticity of the neonate's brain. Sucrose is effective and safe for reducing painful procedures from single events. However, the mechanism of sucrose-induced analgesia is not fully understood. The role of the opioid system in this analgesia using the opioid receptor antagonist Naltrexone was investigated, plus the long-term effects on learning and memory formation during adulthood. Pain was induced in rat pups via needle pricks of the paws. Sucrose solution and/or naltrexone were administered before the pricks. All treatments started on day one of birth and continued for two weeks. At the end of 8weeks, behavioral studies were conducted to test spatial learning and memory using radial arm water maze (RAWM), and pain threshold via foot-withdrawal response to a hot plate. The hippocampus was dissected; levels of brain derived neurotrophic factor (BDNF) and endorphins were assessed using ELISA. Acute repetitive neonatal pain increased pain sensitivity later in life, while naltrexone with sucrose decreased pain sensitivity. Naltrexone and/or sucrose prevented neonatal pain induced impairment of long-term memory, while neonatal pain decreased levels of BDNF in the hippocampus; this decrease was averted by sucrose and naltrexone. Sucrose with naltrexone significantly increased β-endorphin levels in noxiously stimulated rats. In conclusion, naltrexone and sucrose can reverse increased pain sensitivity and impaired long-term memory induced by acute repetitive neonatal pain probably by normalizing BDNF expression and increasing β-endorphin levels. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Neonatal Acute Kidney Injury.

    Science.gov (United States)

    Selewski, David T; Charlton, Jennifer R; Jetton, Jennifer G; Guillet, Ronnie; Mhanna, Maroun J; Askenazi, David J; Kent, Alison L

    2015-08-01

    In recent years, there have been significant advancements in our understanding of acute kidney injury (AKI) and its impact on outcomes across medicine. Research based on single-center cohorts suggests that neonatal AKI is very common and associated with poor outcomes. In this state-of-the-art review on neonatal AKI, we highlight the unique aspects of neonatal renal physiology, definition, risk factors, epidemiology, outcomes, evaluation, and management of AKI in neonates. The changes in renal function with gestational and chronologic age are described. We put forth and describe the neonatal modified Kidney Diseases: Improving Global Outcomes AKI criteria and provide the rationale for its use as the standardized definition of neonatal AKI. We discuss risk factors for neonatal AKI and suggest which patient populations may warrant closer surveillance, including neonates neonates with AKI to identify those children who will go on to develop chronic kidney disease. This review highlights the deficits in our understanding of neonatal AKI that require further investigation. In an effort to begin to address these needs, the Neonatal Kidney Collaborative was formed in 2014 with the goal of better understanding neonatal AKI, beginning to answer critical questions, and improving outcomes in these vulnerable populations. Copyright © 2015 by the American Academy of Pediatrics.

  6. Early life stress and hippocampal neurogenesis in the neonate: sexual dimorphism, long term consequences and possible mediators. A minireview.

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    Naima eLajud

    2015-02-01

    Full Text Available Adverse early life experience decreases adult hippocampal neurogenesis and results in increased vulnerability to neuropsychiatric disorders. Despite that the effects of postnatal stress on neurogenesis have been widely studied in adult individuals, few efforts have been done to evaluate its immediate effects on the developing hippocampus. Moreover, it is not clear whether postnatal stress causes a differential impact in hippocampus development in male and female neonates that could be related to emotional deficits in adulthood. It has been proposed that the long term effects of early stress exposure rise from a persistent HPA axis activation during sensitive time windows; nevertheless the exact mechanisms and mediators remain unknown. Here, we summarize the immediate and late effects of early life stress on hippocampal neurogenesis in male and female rat pups, compare its later consequences in emotionality, and highlight some relevant mediator peptides that could be potentially involved in programming.

  7. Neonatal Venous Thromboembolism

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    Kristina M. Haley

    2017-06-01

    Full Text Available Neonates are the pediatric population at highest risk for development of venous thromboembolism (VTE, and the incidence of VTE in the neonatal population is increasing. This is especially true in the critically ill population. Several large studies indicate that the incidence of neonatal VTE is up almost threefold in the last two decades. Central lines, fluid fluctuations, sepsis, liver dysfunction, and inflammation contribute to the risk profile for VTE development in ill neonates. In addition, the neonatal hemostatic system is different from that of older children and adults. Platelet function, pro- and anticoagulant proteins concentrations, and fibrinolytic pathway protein concentrations are developmentally regulated and generate a hemostatic homeostasis that is unique to the neonatal time period. The clinical picture of a critically ill neonate combined with the physiologically distinct neonatal hemostatic system easily fulfills the criteria for Virchow’s triad with venous stasis, hypercoagulability, and endothelial injury and puts the neonatal patient at risk for VTE development. The presentation of a VTE in a neonate is similar to that of older children or adults and is dependent upon location of the VTE. Ultrasound is the most common diagnostic tool employed in identifying neonatal VTE, but relatively small vessels of the neonate as well as frequent low pulse pressure can make ultrasound less reliable. The diagnosis of a thrombophilic disorder in the neonatal population is unlikely to change management or outcome, and the role of thrombophilia testing in this population requires further study. Treatment of neonatal VTE is aimed at reducing VTE-associated morbidity and mortality. Recommendations for treating, though, cannot be extrapolated from guidelines for older children or adults. Neonates are at risk for bleeding complications, particularly younger neonates with more fragile intracranial vessels. Developmental alterations in the

  8. Efeitos de longo prazo do estresse neonatal com lipopolissacarídeo em ratos = Long-term effects of neonatal stress using lipopolysaccharide in rats

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    Lunardelli, Adroaldo

    2014-01-01

    Full Text Available Introdução: Diversos modelos experimentais têm sido utilizados para demonstrar que intervenções no início da vida podem gerar alterações permanentes que perduram ao longo da vida. A administração de lipopolissacarídeo (LPS no período neonatal gera um estímulo imunológico estressante capaz de alterar muitas respostas fisiológicas ao estresse na vida adulta. Objetivo: Revisar a literatura acerca das influências, em longo prazo, que a administração de LPS no período neonatal pode gerar na vida adulta em modelos experimentais. Materiais e Métodos: O presente estudo consiste em uma revisão integrativa da literatura com base na busca de artigos científicos disponíveis nas bases de dados Medline/PubMed e Science Direct, utilizando os descritores neonatal programming, neonatal stress, neonatal LPS e neonatal lipopolysaccharide. Foram incluídas publicações cuja temática abordasse os resultados da utilização de LPS como estressor neonatal em protocolos experimentais, sem limite de data. Resultados: Foram selecionados 15 artigos que mostram modelos experimentais em que a injeção de LPS em ratos neonatos causa modificações funcionais da resposta do eixo hipotálamo-hipófise-adrenal (HPA quando adultos, incluindo elevação nos níveis plasmáticos de corticosterona. Ainda, há diminuição das concentrações circulantes de citocinas pró-inflamatórias, hiperalgesia, aumento na sensibilidade ao estresse e aumento do comportamento de ansiedade e depressão. Conclusão: Os resultados demonstram que a administração neonatal de LPS consiste em um modelo experimental efetivo de programming, provocando uma série de alterações imunológicas e comportamentais na vida adulta

  9. Increase of long-term 'diabesity' risk, hyperphagia, and altered hypothalamic neuropeptide expression in neonatally overnourished 'small-for-gestational-age' (SGA) rats.

    Science.gov (United States)

    Schellong, Karen; Neumann, Uta; Rancourt, Rebecca C; Plagemann, Andreas

    2013-01-01

    Epidemiological data have shown long-term health adversity in low birth weight subjects, especially concerning the metabolic syndrome and 'diabesity' risk. Alterations in adult food intake have been suggested to be causally involved. Responsible mechanisms remain unclear. By rearing in normal (NL) vs. small litters (SL), small-for-gestational-age (SGA) rats were neonatally exposed to either normal (SGA-in-NL) or over-feeding (SGA-in-SL), and followed up into late adult age as compared to normally reared appropriate-for-gestational-age control rats (AGA-in-NL). SGA-in-SL rats displayed rapid neonatal weight gain within one week after birth, while SGA-in-NL growth caught up only at juvenile age (day 60), as compared to AGA-in-NL controls. In adulthood, an increase in lipids, leptin, insulin, insulin/glucose-ratio (all pSGA-in-SL as compared to both SGA-in-NL and AGA-in-NL rats (pSGA-in-SL rats (pSGA-in-SL regarding Npy/Pomc expression (pSGA rats developed increased 'diabesity' risk only if exposed to neonatal overfeeding. Hypothalamic malprogramming towards decreased anorexigenic activity was involved into the pathophysiology of this neonatally acquired adverse phenotype. Neonatal overfeeding appears to be a critical long-term risk factor in 'small-for-gestational-age babies'.

  10. Increase of Long-Term ‘Diabesity’ Risk, Hyperphagia, and Altered Hypothalamic Neuropeptide Expression in Neonatally Overnourished ‘Small-For-Gestational-Age’ (SGA) Rats

    Science.gov (United States)

    Schellong, Karen; Neumann, Uta; Rancourt, Rebecca C.; Plagemann, Andreas

    2013-01-01

    Background Epidemiological data have shown long-term health adversity in low birth weight subjects, especially concerning the metabolic syndrome and ‘diabesity’ risk. Alterations in adult food intake have been suggested to be causally involved. Responsible mechanisms remain unclear. Methods and Findings By rearing in normal (NL) vs. small litters (SL), small-for-gestational-age (SGA) rats were neonatally exposed to either normal (SGA-in-NL) or over-feeding (SGA-in-SL), and followed up into late adult age as compared to normally reared appropriate-for-gestational-age control rats (AGA-in-NL). SGA-in-SL rats displayed rapid neonatal weight gain within one week after birth, while SGA-in-NL growth caught up only at juvenile age (day 60), as compared to AGA-in-NL controls. In adulthood, an increase in lipids, leptin, insulin, insulin/glucose-ratio (all pSGA-in-SL as compared to both SGA-in-NL and AGA-in-NL rats (pSGA-in-SL rats (pSGA-in-SL regarding Npy/Pomc expression (pSGA rats developed increased ‘diabesity’ risk only if exposed to neonatal overfeeding. Hypothalamic malprogramming towards decreased anorexigenic activity was involved into the pathophysiology of this neonatally acquired adverse phenotype. Neonatal overfeeding appears to be a critical long-term risk factor in ‘small-for-gestational-age babies’. PMID:24265718

  11. Neonatal glucocorticoid treatment: long-term effects on the hypothalamus-pituitary-adrenal axis, immune system, and problem behavior in 14-17 year old adolescents.

    Science.gov (United States)

    Ter Wolbeek, Maike; Kavelaars, Annemieke; de Vries, Willem B; Tersteeg-Kamperman, Marijke; Veen, Sylvia; Kornelisse, René F; van Weissenbruch, Mirjam; Baerts, Wim; Liem, Kian D; van Bel, Frank; Heijnen, Cobi J

    2015-03-01

    Neonatal glucocorticoid (GC) treatment is used to prevent bronchopulmonary dysplasia (BPD) in prematurely born babies. In the 1990s, treatment regimens with relatively high doses of dexamethasone (DEX) were common. As an alternative, hydrocortisone (HC) was used. Earlier, we compared long-term effects of both GCs in children aged 7-10 and detected adverse effects of neonatal DEX treatment, but not of HC, on a range of outcomes. The aim of the current cohort study was to investigate whether long-term effects of neonatal DEX were maintained and whether effects of HC remained absent at adolescent age (14-17years). We compared 71 DEX-treated and 67 HC-treated adolescents. In addition, 71 adolescents who were not neonatally treated with GCs participated. All were born dexamethasone suppression test did not differ between groups. In contrast to our observations at the age of 7-10years, we did not observe group differences in mitogen-induced cytokine production at the age of 14-17years. DEX-treated girls showed more social problems and anxious/depressed behavior than HC-treated girls. Untreated girls showed more problem behavior as well. In conclusion, our results suggest that, especially in girls, neonatal DEX has a programming effect on the HPA-axis and on the ability to adjust to the environment. The loss of group differences on immune system measures indicate that potentially negative effects detected at a younger age subsided. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Short-term exposure and long-term consequences of neonatal exposure to Δ(9)-tetrahydrocannabinol (THC) and ibuprofen in mice.

    Science.gov (United States)

    Philippot, Gaëtan; Nyberg, Fred; Gordh, Torsten; Fredriksson, Anders; Viberg, Henrik

    2016-07-01

    Both Δ(9)-tetrahydrocannabinol (THC) and ibuprofen have analgesic properties by interacting with the cannabinoid receptor type 1 (CB1R) and the cyclooxygenase (COX) systems, respectively. Evaluation of these analgesics is important not only clinically, since they are commonly used during pregnancy and lactation, but also to compare them with acetaminophen, with a known interaction with both CB1R and the COX systems. Short-term exposure of neonatal rodents to acetaminophen during the first weeks of postnatal life, which is comparable with a period from the third trimester of pregnancy to the first years of postnatal life in humans, induces long-term behavioral disturbances. This period, called the brain growth spurt (BGS) and is characterized by series of rapid and fundamental changes and increased vulnerability, peaks around postnatal day (PND) 10 in mice. We therefore exposed male NMRI mice to either THC or ibuprofen on PND 10. At 2 months of age, the mice were subjected to a spontaneous behavior test, consisting of a 60min recording of the variables locomotion, rearing and total activity. Mice exposed to THC, but not ibuprofen, exhibited altered adult spontaneous behavior and habituation capability in a dose-dependent manner. This highlights the potency of THC as a developmental neurotoxicant, since a single neonatal dose of THC was enough to affect adult cognitive function. The lack of effect from ibuprofen also indicates that the previously seen developmental neurotoxicity of acetaminophen is non-COX-mediated. These results might be of importance in future research as well as in the ongoing risk/benefit assessment of THC. Copyright © 2016. Published by Elsevier B.V.

  13. Risk of poor neonatal outcome at term after medically assisted reproduction: a propensity score-matched study.

    Science.gov (United States)

    Ensing, Sabine; Abu-Hanna, Ameen; Roseboom, Tessa J; Repping, Sjoerd; van der Veen, Fulco; Mol, Ben Willem J; Ravelli, Anita C J

    2015-08-01

    To study risk of birth asphyxia and related morbidity among term singletons born after medically assisted reproduction (MAR). Population cohort study. Not applicable. A total of 1,953,932 term singleton pregnancies selected from a national registry for 1999-2011. None. Primary outcome Apgar score Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  14. Long-Term Survival of Neonatal Porcine Islets Without Sertoli Cells in Rabbits

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    Rafael Vald and eacute;s-Gonz and aacute;lez

    2013-04-01

    Full Text Available Cell-based therapy is a promising treatment for metabolic disorders such as type-1 diabetes. Transplantation protocols have investigated several anatomical sites for cell implantation; however, some of these procedures, such as intraportal infusion, can cause organ failure or thrombosis secondarily. Bio-artificial organs could be the choice, although concerns still remain. Using a subcutaneous device, we are able to preserve neonatal porcine islets without sertoli cells in healthy New Zealand rabbits. Devices were implanted in the back of the animals underneath the skin, and after 3 months the islets were transplanted. Histology showed the presence of inflammatory cells, predominantly eosinophils; however, insulin- and glucagon-positive cell clusters were identified inside the device at different time points for at least 90 days, and porcine C-peptide was also detected during the follow-up, indicating graft functionality. We have found that our device induces the deposition of a fibrous matrix enriched in blood vessels, which forms a good place for cell grafting, and this model is probably able to induce an immunoprivileged site. Under these conditions, transplanted porcine islet cells have the capability of producing insulin and glucagon for at least three months. [Arch Clin Exp Surg 2013; 2(2.000: 101-108

  15. Acute kidney injury in the fetus and neonate.

    Science.gov (United States)

    Nada, Arwa; Bonachea, Elizabeth M; Askenazi, David J

    2017-04-01

    Acute kidney injury (AKI) is an under-recognized morbidity of neonates; the incidence remains unclear due to the absence of a unified definition of AKI in this population and because previous studies have varied greatly in screening for AKI with serum creatinine and urine output assessments. Premature infants may be born with less than half of the nephrons compared with term neonates, predisposing them to chronic kidney disease (CKD) early on in life and as they age. AKI can also lead to CKD, and premature infants with AKI may be at very high risk for long-term kidney problems. AKI in neonates is often multifactorial and may result from prenatal, perinatal, or postnatal insults as well as any combination thereof. This review focuses on the causes of AKI, the importance of early detection, the management of AKI in neonates, and long-term sequela of AKI in neonates. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Maternal protein deficiency during a gastrointestinal nematode infection alters developmental profile of lymphocyte populations and selected cytokines in neonatal mice.

    Science.gov (United States)

    Odiere, Maurice R; Scott, Marilyn E; Leroux, Louis-Philippe; Dzierszinski, Florence S; Koski, Kristine G

    2013-01-01

    Neonatal immune development begins in pregnancy and continues into lactation and may be affected by maternal diet. We investigated the possibility that maternal protein deficiency (PD) during a chronic gastrointestinal (GI) nematode infection could impair neonatal immune development. Beginning on d 14 of pregnancy, mice were fed protein-sufficient (PS; 24%) or protein-deficient (PD; 6%) isoenergetic diets and were infected weekly with either 0 (sham) or 100 Heligmosomoides bakeri larvae. Pups were killed on d 2, 7, 14, and d 21 and dams on d 20 of lactation. Lymphoid organs were weighed. Cytokine concentration in maternal and pup serum and in milk from pup stomachs and lymphoid cell populations in pup spleen and thymus were determined using luminex and flow cytometry, respectively. GI nematode infection increased Th2 cytokines (IL-4, IL-5, IL-13), IL-2, IL-10, and eotaxin in serum of dams whereas PD reduced IL-4 and IL-13. The lower IL-13 in PD dams was associated with increased fecal egg output and worm burdens. Maternal PD increased vascular endothelial growth factor in pup milk and eotaxin in pup serum. Maternal infection increased eotaxin in pup serum. Evidence of impaired neonatal immune development included reduced lymphoid organ mass in pups associated with both maternal infection and PD and increased percentage of T cells and T:B cell ratio in the spleen associated with maternal PD. Findings suggest that increases in specific proinflammatory cytokines as a result of the combination of infection and dietary PD in dams can impair splenic immune development in offspring.

  17. Feasibility of a Comfort Care Protocol Using Oral Transmucosal Medication Delivery in a Palliative Neonatal Population.

    Science.gov (United States)

    Drolet, Caroline; Roy, Helene; Laflamme, Julie; Marcotte, Marie-Eve

    2016-04-01

    The oral transmucosal (OTM) route for administration of comfort medication in infants at the end-of-life has long been favored by our pediatric palliative care team but has rarely been described in the literature. To determine the feasibility of implementing a standardized comfort care protocol using OTM medications in dying neonates. A comfort protocol prescribing medication by the OTM route and standardized assessment were established. Each infant included in the study was assessed with the Neonatal Pain, Agitation, and Sedation Scale (N-PASS). Caretakers' satisfaction was assessed using a questionnaire. The feasibility of implementing the protocol was determined by the proportion of assessments done when required, the rate of termination of the protocol, and the feedback from nurses using the protocol. Twelve patients were enrolled. Regular evaluations were performed 85% of the time. When the medication was given as needed, 71% of cases were evaluated before versus 63% when regular doses were given. The as-needed doses were followed by an assessment 30 minutes later in 49% of cases and in 41%, 60 minutes later, for a total of 64% in the hour after medication administration. The protocol was discontinued only for two patients who were discharged to continue end-of-life care at home. There were no significant adverse events reported. Finally, 17 of 18 nurses said they would recommend this protocol to other institutions. In the context of neonatal palliative care, the implementation of a standardized protocol for administration of drugs by the OTM route is feasible and safe. However, in the context of this study, adherence was limited because of too-frequent evaluations and misunderstanding of the protocol.

  18. Effect of Breast-Feeding and Maternal Holding in Relieving Painful Responses in Full-Term Neonates: A Randomized Clinical Trial.

    Science.gov (United States)

    Obeidat, Hala M; Shuriquie, Mona A

    2015-01-01

    This randomized clinical trial was conducted to determine the efficacy of breast-feeding with maternal holding as compared with maternal holding without breast-feeding in relieving painful responses during heel lance blood drawing in full-term neonates. A convenience sample of 128 full-term newborn infants, in their fourth to sixth days of life, undergoing heel lance blood drawing for screening of hypothyroidism were included in the study. The neonates were randomly assigned into 2 equivalent groups. During heel lance blood drawing for infants, they either breast-fed with maternal holding (group I) or were held in their mother's lap without breast-feeding (group II). The painful responses were assessed simultaneously by 2 neonatal nurses blinded to the purpose of the study. Outcome measures for painful responses of the full-term neonates were evaluated with the Premature Infant Pain Profile scale. Independent t test showed significant differences in Premature Infant Pain Profile scale scores among the 2 groups (t = -8.447, P = .000). Pain scores were significantly lower among infants who were breast-fed in addition to maternal holding. Evidence from this study indicates that the combination of breast-feeding with maternal holding reduces painful responses of full-term infants during heel lance blood drawing.

  19. Intramuscular adrenaline does not reduce the incidence of respiratory distress and hypoglycaemia in neonates delivered by elective caesarean section at term

    DEFF Research Database (Denmark)

    Pedersen, Pernille; Avlund, O L; Pedersen, B L

    2008-01-01

    AIM: To test whether intramuscular injection of 30 microg adrenaline decreased the incidence of respiratory distress and hypoglycaemia in term infants delivered by elective caesarean section before active labour. METHOD: The study was randomised and double-blinded. A total of 270 neonates were...

  20. Long term prognosis of patients with cystic fibrosis in relation to early detection by neonatal screening and treatment in a cystic fibrosis centre

    NARCIS (Netherlands)

    Dankert-Roelse, J E; te Meerman, G J

    BACKGROUND: A study was undertaken to evaluate whether an early diagnosis by neonatal screening may improve the long term prognosis of patients with cystic fibrosis and to assess the influence of expert management started immediately after the diagnosis. METHODS: Comparative clinical follow up in

  1. Neonatal glucocorticoid treatment : Long-term effects on the hypothalamus-pituitary-adrenal axis, immune system, and problem behavior in 14-17 year old adolescents

    NARCIS (Netherlands)

    ter Wolbeek, Maike; Kavelaars, Annemieke; de Vries, Willem B.; Tersteeg-Kamperman, Marijke; Veen, Sylvia; Kornelisse, René F.; van Weissenbruch, Mirjam; Baerts, Wim; Liem, Kian D.; van Bel, Frank; Heijnen, Cobi J.

    2015-01-01

    Neonatal glucocorticoid (GC) treatment is used to prevent bronchopulmonary dysplasia (BPD) in prematurely born babies. In the 1990s, treatment regimens with relatively high doses of dexamethasone (DEX) were common. As an alternative, hydrocortisone (HC) was used. Earlier, we compared long-term

  2. Neonatal glucocorticoid treatment: Long-term effects on the hypothalamus-pituitary-adrenal axis, immune system, and problem behavior in 14-17 year old adolescents

    NARCIS (Netherlands)

    Wolbeek, M. ter; Kavelaars, A.; Vries, W.B. de; Tersteeg-Kamperman, M.; Veen, S.; Kornelisse, R.F.; Weissenbruch, M. van; Baerts, W.; Liem, K.D.; Bel, F. van; Heijnen, C.J.

    2015-01-01

    Neonatal glucocorticoid (GC) treatment is used to prevent bronchopulmonary dysplasia (BPD) in prematurely born babies. In the 1990s, treatment regimens with relatively high doses of dexamethasone (DEX) were common. As an alternative, hydrocortisone (HC) was used. Earlier, we compared long-term

  3. Considerations in the management of hypoxemic respiratory failure and persistent pulmonary hypertension in term and late preterm neonates.

    Science.gov (United States)

    Lakshminrusimha, S; Konduri, G G; Steinhorn, R H

    2016-06-01

    Recent advances in our understanding of neonatal pulmonary circulation and the underlying pathophysiology of hypoxemic respiratory failure (HRF)/persistent pulmonary hypertension of the newborn (PPHN) have resulted in more effective management strategies. Results from animal studies demonstrate that low alveolar oxygen tension (PAO2) causes hypoxic pulmonary vasoconstriction, whereas an increase in oxygen tension to normoxic levels (preductal arterial partial pressure of oxygen (PaO2) between 60 and 80 mm Hg and/or preductal peripheral capillary oxygen saturation between 90% and 97%) results in effective pulmonary vasodilation. Hyperoxia (preductal PaO2 >80 mm Hg) does not cause further pulmonary vasodilation, and oxygen toxicity may occur when high concentrations of inspired oxygen are used. It is therefore important to avoid both hypoxemia and hyperoxemia in the management of PPHN. In addition to oxygen supplementation, therapeutic strategies used to manage HRF/PPHN in term and late preterm neonates may include lung recruitment with optimal mean airway pressure and surfactant, inhaled and intravenous vasodilators and 'inodilators'. Clinical evidence suggests that administration of surfactant or inhaled nitric oxide (iNO) therapy at a lower acuity of illness can decrease the risk of extracorporeal membrane oxygenation/death, progression of HRF and duration of hospital stay. Milrinone may be beneficial as an inodilator and may have specific benefits following prolonged exposure to iNO plus oxygen owing to inhibition of phosphodiesterase (PDE)-3A. Additionally, sildenafil, and, in selected cases, hydrocortisone may be appropriate options after hyperoxia and oxidative stress owing to their effects on PDE-5 activity and expression. Continued investigation into these and other interventions is needed to optimize treatment and improve outcomes.

  4. Frequency of neonatal hyperglycaemia at Gaafar Ibnauf Children’s Hospital: Clinical aspects and short term outcome

    OpenAIRE

    Mohammed, Monera MM; Abdel Rahman, Sirageldin MK

    2016-01-01

    Hyperglycaemia has become a significant risk factor for morbidity and mortality of the smaller fragile infants surviving the neonatal period. Its risk is inversely related to gestational age, birth weight and baby’s clinical condition. The aim of this study was to determine the frequency, some clinical aspects and immediate outcome of hyperglycaemia in neonates admitted to the neonatal intensive care unit (NICU) at Gaafar Ibnauf Children’s Hospital, Khartoum. The study was a prospective, desc...

  5. Do antenatal corticosteroids in term elective cesarean sections reduce neonatal respiratory morbidity?

    Directory of Open Access Journals (Sweden)

    Felipe Petour Gazitúa

    2015-10-01

    Full Text Available INTRODUCCIÓN El síndrome de distrés respiratorio neonatal se relaciona con la edad gestacional y vía de parto. Menor edad gestacional y parto vía cesárea se asocian a mayor riesgo. Con lo anterior, surge la necesidad de evaluar estrategias que reduzcan su incidencia. El uso de corticoides antenatales en la inducción de maduración pulmonar en partos prematuros, podría ser beneficioso en fetos de término en que se programe cesárea. OBJETIVO Buscar evidencia bibliográfica que determine si el uso de corticoides antenatales disminuyen la incidencia de síndrome de distrés respiratorio en cesáreas electivas de término. MÉTODOS Se realizó búsqueda de literatura médica en PubMed, LILACS, UpToDate, Trip, SciELO y Cochrane. Se incluyeron estudios terapéuticos aleatorizados y controlados, en humanos, cuya intervención fuera con corticoides en cesáreas electivas de término. RESULTADOS Se seleccionaron dos estudios cuya intervención fueron dos dosis de 12 mg de dexametasona previas a la cesárea. El objetivo primario de ambos estudios fue analizar la incidencia de síndrome de distrés respiratorio y el ingreso a unidad de cuidados intensivos. En ambos hubo menor incidencia de síndrome de distrés respiratorio en el grupo tratado, con resultados estadísticamente significativos. CONCLUSIÓN Se concluye que el uso de corticoides en cesáreas electivas de término disminuye la incidencia de distrés respiratorio e ingreso a unidad de cuidados intensivos. Sin embargo, evidenciamos debilidades que afectan la validez interna de ambos estudios, por lo que es necesario el desarrollo de nuevos estudios que avalen los resultados encontrados para poder cambiar las conductas clínicas en este grupo de estudio.

  6. Oxidative stress in term small for gestational age neonates born to undernourished mothers: a case control study

    Directory of Open Access Journals (Sweden)

    Banerjee BD

    2004-07-01

    Full Text Available Abstract Background The objective of this study was to assess the status of oxidative stress in term small for gestational age (SGA newborn infants born to undernourished mothers by estimating levels of erythrocyte superoxide dismutase (SOD, catalase, reduced glutathione, and serum malondialdehyde (MDA in cord blood and comparing them to healthy appropriate for gestational age (AGA controls. This was done in a case control design at a tertiary level teaching hospital. Methods We included 20 singleton healthy SGA newborn infants born between 38–40 weeks to undernourished mothers with a post-pregnancy weight Results The activity of MDA was increased (5.33 ± 0.72 vs 2.55 ± 0.22 nmol/mL; P vs. 786.8 ± 79.1 U/g Hb; P vs. 2.31 ± 0.20 U/g Hb; P vs 6.42 ± 0.23 Umol/g Hb, P P Conclusions Intrauterine malnutrition is associated with significant oxidative stress in small for gestational age neonates born at term to malnourished mothers.

  7. Different populations and sources of human mesenchymal stem cells (MSC): A comparison of adult and neonatal tissue-derived MSC

    Science.gov (United States)

    2011-01-01

    The mesenchymal stroma harbors an important population of cells that possess stem cell-like characteristics including self renewal and differentiation capacities and can be derived from a variety of different sources. These multipotent mesenchymal stem cells (MSC) can be found in nearly all tissues and are mostly located in perivascular niches. MSC have migratory abilities and can secrete protective factors and act as a primary matrix for tissue regeneration during inflammation, tissue injuries and certain cancers. These functions underlie the important physiological roles of MSC and underscore a significant potential for the clinical use of distinct populations from the various tissues. MSC derived from different adult (adipose tissue, peripheral blood, bone marrow) and neonatal tissues (particular parts of the placenta and umbilical cord) are therefore compared in this mini-review with respect to their cell biological properties, surface marker expression and proliferative capacities. In addition, several MSC functions including in vitro and in vivo differentiation capacities within a variety of lineages and immune-modulatory properties are highlighted. Differences in the extracellular milieu such as the presence of interacting neighbouring cell populations, exposure to proteases or a hypoxic microenvironment contribute to functional developments within MSC populations originating from different tissues, and intracellular conditions such as the expression levels of certain micro RNAs can additionally balance MSC function and fate. PMID:21569606

  8. In Vitro Model Simulating Gastro-Intestinal Digestion in the Pediatric Population (Neonates and Young Infants)

    DEFF Research Database (Denmark)

    Kamstrup, Danna; Berthelsen, Ragna; Sassene, Philip Jonas

    2017-01-01

    , it is important to simulate the gastro-intestinal conditions and processes the drug will encounter upon oral administration. When a drug is administered in the fed state, which is commonly the case for neonates, as they are typically fed every 3 h, the digestion of the milk will affect the composition...... of the fluid available for drug dissolution/solubilization. Therefore, in order to predict the solubilized amount of drug available for absorption, an in vitro model simulating digestion in the gastro-intestinal tract should be utilized. In order to simulate the digestion process and the drug solubilization...... taking place in vivo, the following aspects should be considered; physiologically relevant media, media volume, use of physiological enzymes in proper amounts, as well as correct pH and addition of relevant co-factors, e.g., bile salts and co-enzymes. Furthermore, physiological transit times...

  9. Contribution of prepregnancy body mass index and gestational weight gain to adverse neonatal outcomes: population attributable fractions for Canada.

    Science.gov (United States)

    Dzakpasu, Susie; Fahey, John; Kirby, Russell S; Tough, Suzanne C; Chalmers, Beverley; Heaman, Maureen I; Bartholomew, Sharon; Biringer, Anne; Darling, Elizabeth K; Lee, Lily S; McDonald, Sarah D

    2015-02-05

    Low or high prepregnancy body mass index (BMI) and inadequate or excess gestational weight gain (GWG) are associated with adverse neonatal outcomes. This study estimates the contribution of these risk factors to preterm births (PTBs), small-for-gestational age (SGA) and large-for-gestational age (LGA) births in Canada compared to the contribution of prenatal smoking, a recognized perinatal risk factor. We analyzed data from the Canadian Maternity Experiences Survey. A sample of 5,930 women who had a singleton live birth in 2005-2006 was weighted to a nationally representative population of 71,200 women. From adjusted odds ratios, we calculated population attributable fractions to estimate the contribution of BMI, GWG and prenatal smoking to PTB, SGA and LGA infants overall and across four obstetric groups. Overall, 6% of women were underweight (<18.5 kg/m(2)) and 34.4% were overweight or obese (≥25.0 kg/m(2)). More than half (59.4%) gained above the recommended weight for their BMI, 18.6% gained less than the recommended weight and 10.4% smoked prenatally. Excess GWG contributed more to adverse outcomes than BMI, contributing to 18.2% of PTB and 15.9% of LGA. Although the distribution of BMI and GWG was similar across obstetric groups, their impact was greater among primigravid women and multigravid women without a previous PTB or pregnancy loss. The contributions of BMI and GWG to PTB and SGA exceeded that of prenatal smoking. Maternal weight, and GWG in particular, contributes significantly to the occurrence of adverse neonatal outcomes in Canada. Indeed, this contribution exceeds that of prenatal smoking for PTB and SGA, highlighting its public health importance.

  10. Lidocaine response rate in aEEG-confirmed neonatal seizures: Retrospective study of 413 full-term and preterm infants.

    Science.gov (United States)

    Weeke, Lauren C; Toet, Mona C; van Rooij, Linda G M; Groenendaal, Floris; Boylan, Geraldine B; Pressler, Ronit M; Hellström-Westas, Lena; van den Broek, Marcel P H; de Vries, Linda S

    2016-02-01

    To investigate the seizure response rate to lidocaine in a large cohort of infants who received lidocaine as second- or third-line antiepileptic drug (AED) for neonatal seizures. Full-term (n = 319) and preterm (n = 94) infants, who received lidocaine for neonatal seizures confirmed on amplitude-integrated EEG (aEEG), were studied retrospectively (January 1992-December 2012). Based on aEEG findings, the response was defined as good (>4 h no seizures, no need for rescue medication); intermediate (0-2 h no seizures, but rescue medication needed after 2-4 h); or no clear response (rescue medication needed Lidocaine had a good or intermediate effect in 71.4%. The response rate was significantly lower in preterm (55.3%) than in full-term infants (76.1%, p lidocaine was significantly better than midazolam as second-line AED (21.4% vs. 12.7%, p = 0.049), and there was a trend for a higher response rate as third-line AED (67.6% vs. 57%, p = 0.086). Both lidocaine and midazolam had a higher response rate as third-line AED than as second-line AED (p lidocaine were the following: higher gestational age, longer time between start of first seizure and administration of lidocaine, lidocaine as third-line AED, use of new lidocaine regimens, diagnosis of stroke, use of digital aEEG, and hypothermia. Multivariable analysis of seizure response to lidocaine included lidocaine as second- or third-line AED and seizure etiology. Seizure response to lidocaine was seen in ~70%. The response rate was influenced by gestational age, underlying etiology, and timing of administration. Lidocaine had a significantly higher response rate than midazolam as second-line AED, and there was a trend for a higher response rate as third-line AED. Both lidocaine and midazolam had a higher response rate as third-line compared to second-line AED, which could be due to a pharmacologic synergistic mechanism between the two drugs. Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.

  11. Neonatal complications of postterm gestation.

    Science.gov (United States)

    Mannino, F

    1988-03-01

    Postterm gestation infants represent about 10% of the newborn population and, as compared to term gestation infants, have an increased incidence of perinatal and neonatal problems. Most postterm infants are normal appearing, although changes in the skin and a loss of subcutaneous fat occur in some. A smaller number experience the onset of fetal wasting late in gestation and appear dysmature (postmature) at birth. The incidence of infants with dysmaturity increases as postterm gestation continues; however, the prevalence of dysmaturity is greater in term infants. The most significant neonatal problems in the postterm gestation infant are the result of fetal distress and perinatal asphyxia. Those infants affected most severely may have hypoxic encephalopathy, seizures and meconium aspiration syndrome. Other problems are birth trauma (due to the large size of some postterm infants) and polycythemia. Anencephaly is associated with postterm gestation. The later intellectual development of postterm gestation infants appears normal except for those with perinatal asphyxia or severe neonatal problems. The long-term somatic growth is normal, even in dysmature-appearing infants. Postterm infants are at increased risk for perinatal asphyxia; however, with careful obstetric management, most neonatal problems can be prevented.

  12. Ultrasound assessment of placental function: the effectiveness of placental biometry in a low-risk population as a predictor of a small for gestational age neonate.

    LENUS (Irish Health Repository)

    McGinty, Patricia

    2012-07-01

    The aims of the study were to establish reference ranges for placental length and thickness in a low-risk obstetric population and to assess the likelihood of a small for gestational age (SGA) neonate on the basis of placental length at 18-24 weeks\\' gestation.

  13. Significant effects on neonatal morbidity and mortality after regional change in management of post-term pregnancy.

    Science.gov (United States)

    Grunewald, Charlotta; Håkansson, Stellan; Saltvedt, Sissel; Källén, Karin

    2011-01-01

    To evaluate the effects on neonatal morbidity of a regional change in induction policy for post-term pregnancy from 43(+0) to 42(+0) gestational weeks (GWs). Nationwide retrospective register study between 2000 and 2007. All singleton pregnancies with a gestational age of >41(+2) GW (n= 119,198). All Swedish counties were divided into three groups where study group allocation was designated by the proportion of pregnancies >42(+2) GW among all pregnancies of >41(+2) GW. Stockholm county formed a separate group. Perinatal morbidity. In counties with the most active management, 19% of pregnancies >41(+2) GW were delivered at >42(+2) GW during 2000-2004 compared to 7.1% in 2005-2007. In the least active counties, corresponding figures were 21.0% compared to 19.4%. During 2005-2007, the odds ratios for meconium aspiration and 5-minute Apgar score of ≤6 in the least compared to most active counties, were 1.55 (95% CI: 1.03-2.33) and 1.26 (95% CI: 1.06-1.51). In Stockholm >42(+2) GW seen among pregnancies of >41(+2) decreased from 21.0% in 2000-2004 to 5.9% in 2005-2007. Reduced perinatal death risks by 48%, meconium aspiration of 51% and low Apgar scores by 31% in 2005-2007 compared with 2000-2004 were observed. Rates of operative deliveries at >41(+2) GW in Stockholm were unaltered. A significant reduction in perinatal morbidity was found, with no influence on operative delivery rates for post-term pregnancy in Stockholm. We advocate a nationwide change toward more active management of post-term pregnancies. © 2010 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2010 Nordic Federation of Societies of Obstetrics and Gynecology.

  14. The neonatal lung--physiology and ventilation.

    Science.gov (United States)

    Neumann, Roland P; von Ungern-Sternberg, Britta S

    2014-01-01

    This review article focuses on neonatal respiratory physiology, mechanical ventilation of the neonate and changes induced by anesthesia and surgery. Optimal ventilation techniques for preterm and term neonates are discussed. In summary, neonates are at high risk for respiratory complications during anesthesia, which can be explained by their characteristic respiratory physiology. Especially the delicate balance between closing volume and functional residual capacity can be easily disturbed by anesthetic and surgical interventions resulting in respiratory deterioration. Ventilatory strategies should ideally include application of an 'open lung strategy' as well avoidance of inappropriately high VT and excessive oxygen administration. In critically ill and unstable neonates, for example, extremely low-birthweight infants surgery in the neonatal intensive care unit might be an appropriate alternative to the operating theater. Best respiratory management of neonates during anesthesia is a team effort that should involve a joint multidisciplinary approach of anesthetists, pediatric surgeons, cardiologists, and neonatologists to reduce complications and optimize outcomes in this vulnerable population. © 2013 John Wiley & Sons Ltd.

  15. Cord plasma concentrations of visfatin, adiponectin and insulin in healthy term neonates: positive correlation with birthweight.

    Science.gov (United States)

    Cekmez, Ferhat; Pirgon, Ozgur; Tanju, Asya; Ipcioglu, Osman Metin

    2009-09-01

    The aims of this study were to examine the relationships between adiponectin, insulin, visfatin and weight at birth in healthy term infants. Anthropometric parameters including weight, length were measured and plasma lipid profiles, insulin, visfatin and adiponectin concentrations in cord blood samples from 50 LGA and 50 AGA singleton infants born at term after uncomplicated pregnancies were assayed. Mean visfatin and adiponectin levels were significantly higher in the LGA group than AGA group (11.8 ± 8 vs. 6.3 ± 5.5 ng/ml, pCord plasma adiponectin, visfatin and insulin levels correlated significantly and positively with birthweight (p=0.01, pCord plasma adiponectin concentration correlated positively with visfatin level (p=0.005), but not with insulin level (p=0.8), and cord plasma visfatin concentration correlated positively with insulin level (pcord blood in LGA group. Cord plasma adiponectin and visfatin levels are positively correlated with birthweight. This suggests that adiponectin and visfatin may be involved in regulating fetal growth.

  16. Bayesian automated cortical segmentation for neonatal MRI

    Science.gov (United States)

    Chou, Zane; Paquette, Natacha; Ganesh, Bhavana; Wang, Yalin; Ceschin, Rafael; Nelson, Marvin D.; Macyszyn, Luke; Gaonkar, Bilwaj; Panigrahy, Ashok; Lepore, Natasha

    2017-11-01

    Several attempts have been made in the past few years to develop and implement an automated segmentation of neonatal brain structural MRI. However, accurate automated MRI segmentation remains challenging in this population because of the low signal-to-noise ratio, large partial volume effects and inter-individual anatomical variability of the neonatal brain. In this paper, we propose a learning method for segmenting the whole brain cortical grey matter on neonatal T2-weighted images. We trained our algorithm using a neonatal dataset composed of 3 fullterm and 4 preterm infants scanned at term equivalent age. Our segmentation pipeline combines the FAST algorithm from the FSL library software and a Bayesian segmentation approach to create a threshold matrix that minimizes the error of mislabeling brain tissue types. Our method shows promising results with our pilot training set. In both preterm and full-term neonates, automated Bayesian segmentation generates a smoother and more consistent parcellation compared to FAST, while successfully removing the subcortical structure and cleaning the edges of the cortical grey matter. This method show promising refinement of the FAST segmentation by considerably reducing manual input and editing required from the user, and further improving reliability and processing time of neonatal MR images. Further improvement will include a larger dataset of training images acquired from different manufacturers.

  17. Maternal marijuana use and neonatal morbidity.

    Science.gov (United States)

    Conner, Shayna N; Carter, Ebony B; Tuuli, Methodius G; Macones, George A; Cahill, Alison G

    2015-09-01

    Marijuana use is becoming increasingly common in the obstetric population; however, it is unknown whether it is associated with poor neonatal outcomes. We sought to determine the prevalence and risk factors for marijuana use in pregnancy and to evaluate whether marijuana use is independently associated with poor neonatal outcomes. This was a retrospective cohort study of all consecutive, nonanomalous, term deliveries at 1 institution over a 4-year study period. Women with marijuana use during pregnancy, either by self-report or positive urine drug screen, were compared with women who did not use marijuana. The primary outcome was a composite neonatal morbidity including birthweight less than 2500 g, neonatal intensive care unit admission, 5-minute Apgar score less than 7, and umbilical artery pH less than 7.10. Univariate, bivariate, and multiple logistic regression analyses were performed. Among the 8138 women in the cohort, 680 (8.4%) used marijuana during pregnancy. Women who used marijuana were younger; more likely to be of African American race; have inadequate prenatal care; and use tobacco, alcohol, and other drugs. Medical comorbidities did not differ between groups. After adjusting for smoking, other drug use, and African American race, the composite and all individual markers of poor neonatal outcome were not significantly higher among women who used marijuana during pregnancy. Marijuana use is common in pregnancy but may not be an independent risk factor for poor neonatal outcomes in term pregnancies. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. A study of birth weight of full term neonates and its′ determinants

    Directory of Open Access Journals (Sweden)

    Yugantara R Kadam

    2014-01-01

    Full Text Available Background: Low birth weight (LBW is highly prevalent in India and has a multifactorial causation. There is a need to study and identify the modifiable and non-modifiable risk factors determining birth weight. This will help in planning ante natal care more effectively. Materials and Methods : Study-type-cross-sectional study-setting: Hospital based. Study-subject: Mothers and their new borns. Sample size: All the births taken place during the study period. Study period: July 2010-June 2011. Study tools : (0 i Questionnaire. (ii pediatric weighing machine. Inclusion criteria : m0 others attending ante natal care (ANC clinic from 1 st trimester with minimum three antenatal visits, non-anemic at the end of 2 nd trimester, had full-term and singleton delivery. Exclusion criteria : H/O pregnancy induced hypertension (PIH, diabetes mellieutus (DM, tuberculosis (TB, urinary tract infection (UTI, delivered preterm and tobacco chewers or mishri users. Statistical Analysis : Percentages, mean and SD of birth weight, χ2 test, ANOVA, Z-test, and Binary logistic. Results: By using birth weight as a continuous data it was observed that birth-weight was significantly associated with maternal age (F = 3.360, df = 2, P = 0.035, education (F = 4.401, df = 4, P = 0.002 and breakfast (z = 3.970, P = 0.00. Proportion of LBW was 42.4%. For analysis, groups of newborns on the basis of birth weight showed significant association between LBW and maternal education (χ2 = 12.734, df = 4, P = 0.013, breakfast (χ2 = 13.241, df = 1, P = 0.00 and evening snacks (χ2 = 4.275, df = 1, P = 0.013. According to the binary logistic regression, breakfast and education were significant and best predictors for birth weight. Conclusion: Education and breakfast are strong determinants of birth-weight. Less educated women need more intense health education.

  19. Validation of transcutaneous bilirubin nomogram for identifying neonatal hyperbilirubinemia in healthy Chinese term and late-preterm infants: a multicenter study

    Directory of Open Access Journals (Sweden)

    Zhangbin Yu

    2014-06-01

    Full Text Available OBJECTIVE: to prospectively validate a previously constructed transcutaneous bilirubin (TcB nomogram for identifying severe hyperbilirubinemia in healthy Chinese term and late-preterm infants. METHODS: this was a multicenter study that included 9,174 healthy term and late-preterm infants in eight hospitals of China. TcB measurements were performed using a JM-103 bilirubinometer. TcB values were plotted on a previously developed TcB nomogram, to identify the predictive ability for subsequent significant hyperbilirubinemia. RESULTS: in the present study, 972 neonates (10.6% developed significant hyperbilirubinemia. The 40th percentile of the nomogram could identify all neonates who were at risk of significant hyperbilirubinemia, but with a low positive predictive value (PPV (18.9%. Of the 453 neonates above the 95th percentile, 275 subsequently developed significant hyperbilirubinemia, with a high PPV (60.7%, but with low sensitivity (28.3%. The 75th percentile was highly specific (81.9% and moderately sensitive (79.8%. The area under the curve (AUC for the TcB nomogram was 0.875. CONCLUSIONS: this study validated the previously developed TcB nomogram, which could be used to predict subsequent significant hyperbilirubinemia in healthy Chinese term and late-preterm infants. However, combining TcB nomogram and clinical risk factors could improve the predictive accuracy for severe hyperbilirubinemia, which was not assessed in the study. Further studies are necessary to confirm this combination.

  20. Neonatal morbidity associated with late preterm and early term birth: the roles of gestational age and biological determinants of preterm birth.

    Science.gov (United States)

    Brown, Hilary K; Speechley, Kathy Nixon; Macnab, Jennifer; Natale, Renato; Campbell, M Karen

    2014-06-01

    The aim of this study was to elucidate the role of gestational age in determining the risk of neonatal morbidity among infants born late preterm (34-36 weeks) and early term (37-38 weeks) compared with those born full term (39-41 weeks) by examining the contribution of gestational age within the context of biological determinants of preterm birth. This was a retrospective cohort study. The sample included singleton live births with no major congenital anomalies, delivered at 34-41 weeks of gestation to London-Middlesex (Canada) mothers in 2002-11. Data from a city-wide perinatal database were linked with discharge abstract data. Multivariable models used modified Poisson regression to directly estimate adjusted relative risks (aRRs). The roles of gestational age and biological determinants of preterm birth were further examined using mediation and moderation analyses. Compared with infants born full term, infants born late preterm and early term were at increased risk for neonatal intensive care unit triage/admission [late preterm aRR=6.14, 95% confidence interval (CI) 5.63, 6.71; early term aRR=1.54, 95% CI 1.41, 1.68] and neonatal respiratory morbidity (late preterm aRR=6.16, 95% CI 5.39, 7.03; early term aRR=1.46, 95% CI 1.29, 1.65). The effect of gestational age was partially explained by biological determinants of preterm birth acting through gestational age. Moreover, placental ischaemia and other hypoxia exacerbated the effect of gestational age on poor outcomes. Poor outcomes among infants born late preterm and early term are not only due to physiological immaturity but also to biological determinants of preterm birth acting through and with gestational age to produce poor outcomes. Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2013; all rights reserved.

  1. Neonatal orbital abscess

    Directory of Open Access Journals (Sweden)

    Pratik Y Gogri

    2015-01-01

    Full Text Available Orbital abscess generally occurs in older children but it can rarely affect infants and neonates too. We report a case of community acquired methicillin resistant staphylococcus aureus (CA-MRSA neonatal orbital abscess in a 12-day-old term female neonate with no significant past medical history or risk factor for developing the infection. The case highlights the importance of consideration of CA-MRSA as a causative agent of neonatal orbital cellulitis even in a neonate without any obvious predisposing condition. Prompt initiation of appropriate medical therapy against MRSA and surgical drainage of the abscess prevents life threatening complications of orbital cellulitis which more often tend to be fatal in neonates.

  2. Neonatal Herpes Simplex Viral Infections and Acyclovir: An Update

    Science.gov (United States)

    Holmes, Amy P.

    2017-01-01

    Neonatal herpes simplex virus (HSV) infections have high morbidity and mortality rates. Optimization of treatment and prevention strategies are imperative to improve the care and outcomes of neonates infected with HSV. Management of HSV includes reducing neonatal transmission, treating acute infections, and limiting adverse neurodevelopmental outcomes and future cutaneous outbreaks after acute infections. Transmission risk may be affected by route of delivery and maternal suppressive therapy. Neonatal HSV infections are divided into 3 categories: localized skin, eyes, or mouth; localized central nervous system; or disseminated infections. Parenteral acyclovir, the pharmacologic agent of choice, is used when treating each type of infection. However, dosage strategies and durations of therapy may vary based on disease state severity, presentation, and patient characteristics. Oral acyclovir may be used as suppressive therapy after acute treatment completion in specific neonatal populations, reducing long-term adverse neurodevelopmental outcomes and future skin eruptions. The mortality rate remains high even with treatment. PMID:28469532

  3. Exposure to prescription opioid analgesics in utero and risk of neonatal abstinence syndrome: population based cohort study.

    Science.gov (United States)

    Desai, Rishi J; Huybrechts, Krista F; Hernandez-Diaz, Sonia; Mogun, Helen; Patorno, Elisabetta; Kaltenbach, Karol; Kerzner, Leslie S; Bateman, Brian T

    2015-05-14

    To provide absolute and relative risk estimates of neonatal abstinence syndrome (NAS) based on duration and timing of prescription opioid use during pregnancy in the presence or absence of additional NAS risk factors of history of opioid misuse or dependence, misuse of other substances, non-opioid psychotropic drug use, and smoking. Observational cohort study. Medicaid data from 46 US states. Pregnant women filling at least one prescription for an opioid analgesic at any time during pregnancy for whom opioid exposure characteristics including duration of therapy: short term (opioid prescriptions, corresponding to an absolute risk of 5.9 per 1000 deliveries (95% confidence interval 5.6 to 6.2). Long term opioid use during pregnancy resulted in higher absolute risk of NAS per 1000 deliveries in the presence of additional risk factors of known opioid misuse (220.2 (200.8 to 241.0)), alcohol or other drug misuse (30.8 (26.1 to 36.0)), exposure to other psychotropic medications (13.1 (10.6 to 16.1)), and smoking (6.6 (4.3 to 9.6)) than in the absence of any of these risk factors (4.2 (3.3 to 5.4)). The corresponding risk estimates for short term use were 192.0 (175.8 to 209.3), 7.0 (6.0 to 8.2), 2.0 (1.5 to 2.6), 1.5 (1.0 to 2.0), and 0.7 (0.6 to 0.8) per 1000 deliveries, respectively. In propensity score matched analyses, long term prescription opioid use compared with short term use and late use compared with early use in pregnancy demonstrated greater risk of NAS (risk ratios 2.05 (95% confidence interval 1.81 to 2.33) and 1.24 (1.12 to 1.38), respectively). Use of prescription opioids during pregnancy is associated with a low absolute risk of NAS in the absence of additional risk factors. Long term use compared with short term use and late use compared with early use of prescription opioids are associated with increased NAS risk independent of additional risk factors. © Desai et al 2015.

  4. Exposure to prescription opioid analgesics in utero and risk of neonatal abstinence syndrome: population based cohort study

    Science.gov (United States)

    Huybrechts, Krista F; Hernandez-Diaz, Sonia; Mogun, Helen; Patorno, Elisabetta; Kaltenbach, Karol; Kerzner, Leslie S; Bateman, Brian T

    2015-01-01

    Objective To provide absolute and relative risk estimates of neonatal abstinence syndrome (NAS) based on duration and timing of prescription opioid use during pregnancy in the presence or absence of additional NAS risk factors of history of opioid misuse or dependence, misuse of other substances, non-opioid psychotropic drug use, and smoking. Design Observational cohort study. Setting Medicaid data from 46 US states. Participants Pregnant women filling at least one prescription for an opioid analgesic at any time during pregnancy for whom opioid exposure characteristics including duration of therapy: short term (opioid prescriptions, corresponding to an absolute risk of 5.9 per 1000 deliveries (95% confidence interval 5.6 to 6.2). Long term opioid use during pregnancy resulted in higher absolute risk of NAS per 1000 deliveries in the presence of additional risk factors of known opioid misuse (220.2 (200.8 to 241.0)), alcohol or other drug misuse (30.8 (26.1 to 36.0)), exposure to other psychotropic medications (13.1 (10.6 to 16.1)), and smoking (6.6 (4.3 to 9.6)) than in the absence of any of these risk factors (4.2 (3.3 to 5.4)). The corresponding risk estimates for short term use were 192.0 (175.8 to 209.3), 7.0 (6.0 to 8.2), 2.0 (1.5 to 2.6), 1.5 (1.0 to 2.0), and 0.7 (0.6 to 0.8) per 1000 deliveries, respectively. In propensity score matched analyses, long term prescription opioid use compared with short term use and late use compared with early use in pregnancy demonstrated greater risk of NAS (risk ratios 2.05 (95% confidence interval 1.81 to 2.33) and 1.24 (1.12 to 1.38), respectively). Conclusions Use of prescription opioids during pregnancy is associated with a low absolute risk of NAS in the absence of additional risk factors. Long term use compared with short term use and late use compared with early use of prescription opioids are associated with increased NAS risk independent of additional risk factors. PMID:25975601

  5. Tirosinemia neonatal Neonatal tyrosinemia

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    Rafael J. Manotas Cabarcas

    1995-04-01

    Full Text Available Mediante la técnica de Udenfriend y Cooper, se midieron los niveles de tirosina en la sangre del cordón de 26 prematuros y 31 niños de término, con el fin de comparar las concentraciones según la edad gestacional y detectar la presencia de la tirosinemia neonatal. Se encontró un caso de esta entidad en un niño de 31 semanas de edad gestacional, lo cual correspondió al 3.8% de los prematuros y al 1.8% del grupo total. La concentración de tirosina en el paciente fue de 53 JJ.M. El promedio de las concentraciones en los prematuros menores de 32 semanas fue de 16.8 :t 6.3 JJ.M; el de los niños entre 33 y 36 semanas fue de 19.3 :t 7.6 JJ.M y el de los niños de término, de 17.2 :t 9.4 JJ.M. Las pruebas estadísticas no mostraron tendencias ni diferencias significativas entre estas concentraciones. El promedio ponderado para el grupo total fue 17.7 :t 7.3 JJ.M. Se recomienda establecer programas de tamizaje para detectar este problema porque puede presentar repercusiones neurológicas posteriores.

    By means of the Udenfriend-Cooper technique, levels of tyrosine were measured in the cord blood of 26 preterm and 31 term Infants; the objective was to compare tyrosine concentrations according to gestational age and to detect the presence of neonatal tyrosinemia. A case of this disease was found In an Infant with 31 weeks of gestational age; this case represented 3.8% of preterm Infants and 1.8% of the total group. Average tyrosine concentration according to age was as follows: 16.8: ± 6.3  µM in Infants under 32 weeks of gestational age; 19.3: ±: 7.6 µM In those between 33 and 36 weeks and 17.2 : ±: 9.4 µM In the term Infants

  6. Intramuscular adrenaline does not reduce the incidence of respiratory distress and hypoglycaemia in neonates delivered by elective caesarean section at term

    DEFF Research Database (Denmark)

    Pedersen, Pernille; Avlund, O L; Pedersen, B L

    2008-01-01

    AIM: To test whether intramuscular injection of 30 microg adrenaline decreased the incidence of respiratory distress and hypoglycaemia in term infants delivered by elective caesarean section before active labour. METHOD: The study was randomised and double-blinded. A total of 270 neonates were...... assigned to intramuscular treatment with saline (0.30 ml) or 30 microg adrenaline (0.30 ml) immediately after birth. The primary endpoint was referral to the neonatal ward because of respiratory distress or a blood glucose level ... with pulse oximetry to disclose potential side effects. RESULTS: Pulse-oximetry recordings revealed a modest systemic effect by intramuscular adrenaline as the heart rate and the haemoglobin oxygen saturation were significantly higher in infants who received adrenaline. In contrast, the incidence...

  7. [QTc interval in the neonatal period in a Mexican population. A pilot study].

    Science.gov (United States)

    Peña-Juárez, Rocio Alejandra; Garcia-Canales, Adrián; Garrido-García, Luis Martin; Valerio-Carballo, Cesar Augusto

    2017-11-10

    QT interval prolongation is associated with ventricular arrhythmias and sudden death syndrome. To determine the value of QTc interval in healthy newborns in a general hospital in Jalisco, Mexico, and their outcome during their first months of life. The study included healthy newborns from March to November 2016, in the Hospital General of Occidente in Jalisco, Mexico. A 12-lead electrocardiogram was performed at a speed of 25mm/s during the first 48h of life. The QT interval was measured in lead DII, and the QTc interval was calculated using the Bazett formula. Patients detected with QTc prolongation were assessed monthly with an ECG and echocardiogram. If they persisted with prolonged QTc interval, they were re-evaluated at 6 months with an ECG, 24h Holter, and electrocardiography study on parents and siblings. Those who persisted with prolonged QTc interval were evaluated with an ECG at 9 months. The study included 548 patients. The mean QTc interval at birth was 459 ms; during this period 33 patients has a QTc greated that 470 ms; which were evaluated monthly with a new electrocardiographic study, obtaining a mean QTc interal of 446 ms. At 6 months 16 patients were evaluated, with a mean QTc interval of 434ms. At 9 months, 6 patients were found to have a mean QTc interval of 438ms, and only 4 patients persisted with a prolonged QTc interval. The QTc interval in our population is prolonged compared to other populations and with a gradual return to normal. Copyright © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

  8. PREDICTION OF SIGNIFICANT NEONATAL HYPERBILIRUBINAEMIA IN HEALTHY TERM NEW BORNS USING 22-26 HOURS’ SPECIFIC SERUM BILIRUBIN – A PROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Reddy

    2016-03-01

    Full Text Available INTRODUCTION Hyperbilirubinemia invariably occurs in the newborns and is discerned as clinical jaundice in nearly 50% of infants. It is a cause of concern not only for the parents but also for the paediatricians. Bilirubin production is 2-3 times higher in normal term newborns compared with adults. The colour in jaundice usually results from accumulation of unconjugated, non-polar, lipid soluble, bilirubin pigment in the skin which is formed from haemoglobin by the action of heme oxygenase, biliverdin reductase and non-enzymatic reducing agents in the reticulo-endothelial cells. AIMS & OBJECTIVE To determine hour specific serum bilirubin (22-26 hrs which will predict, subsequent significant hyperbilirubinemia in healthy term newborns. MATERIALS & METHODS A total of 250 healthy full term newborns were enrolled into the study. First bilirubin estimation (TSB 1 was estimated at 22- 26 hrs. The neonates were followed up clinically every 12 hrs for 72 hrs (till discharge. Second bilirubin estimation (TSB S was done whenever clinical suspicion of jaundice was present (usually at 72 hours. Depending upon the TSB 1 value, the infants were evaluated by using two available protocols (Arbitrary cut off value of 5 mg/dl and average value of 4.06 mg%. Sensitivity, specificity, negative and positive predictive values and likelihood ratio of the test were calculated. P-value was used to determine the level of significance. RESULTS Of 250 neonates included in the study, 13 neonates developed hyperbilirubinemia and were subjected to phototherapy. No infants with average bilirubin value of ≤4.06 mg% developed subsequent hyperbilirubinemia. However, 2 infants with arbitrary cut off value of ≤5 mg/dl developed hyperbilirubinemia. There was significant difference in TSB I value of neonates who subsequently did and those who did not developed significant hyperbilirubinemia (P-value-<0.01. The negative predictive value to these two applied protocol is very high

  9. Acompanhamento da icterícia neonatal em recém-nascidos de termo e prematuros tardios Follow-up of neonatal jaundice in term and late premature newborns

    Directory of Open Access Journals (Sweden)

    Fernando Perazzini Facchini

    2007-08-01

    Full Text Available OBJETIVO: Relatar os resultados de um projeto de acompanhamento de recém-nascidos de termo e próximos ao termo ictéricos no período neonatal. MÉTODOS: Foram encaminhados a ambulatório especializado neonatos com peso > 2.000 g e/ou idade gestacional > 35 semanas, cuja icterícia na alta foi avaliada inicialmente com o icterômetro de Ingram, Bilicheck® e, se indicado, com bilirrubinômetro Unistat (Leica. A bilirrubinemia destes recém-nascidos situava-se no ou acima do percentil 40 do nomograma elaborado por Bhutani. Todos recém-nascidos tratados com fototerapia durante internação foram reavaliados laboratorialmente 24 horas após suspensão do tratamento. A indicação de reinternação para tratamento fototerápico intensivo foi para paciente com nível > 20 mg/dL. RESULTADOS: De um total de 11.259 neonatos, 2.452 (21,8% foram encaminhados para acompanhamento, dos quais 87,2% (2.140 retornaram. Oitenta neonatos retornados foram reinternados. Dos 2.452 encaminhados para retorno, 180 (7,3% tinham bilirrubinemia > 15 mg/dL na alta. Destes, 151 retornaram para acompanhamento. Vinte (13,2% foram reinternados para tratamento. Do total de reinternados, dois recém-nascidos apresentaram nível > 25 mg/dL e nenhum > 30 mg/dL. Todos responderam rapidamente à fototerapia intensiva, e não houve necessidade de utilizar exsangüinotransfusões. CONCLUSÕES: Nossos resultados sugerem que o esquema adotado é eficiente na detecção e prevenção de hiperbilirrubinemias de risco para produzir encefalopatia bilirrubínica em recém-nascidos de termo e próximos ao termo.OBJECTIVE: To report on the results of a project following term and near term newborn infants who were jaundiced during the neonatal period. METHODS: Neonates were referred to the follow-up clinic with weight > 2,000 g and/or gestational age > 35 weeks, and jaundice at discharge was initially assessed with an Ingram icterometer or Bilicheck and, if indicated, with a Unistat

  10. Long-term effects of neonatal glutamine-enriched nutrition in very-low-birth-weight infants

    NARCIS (Netherlands)

    van Zwol, Annelies; Neu, Josef; van Elburg, Ruurd M.

    2011-01-01

    Several studies in very-low-birth-weight (VLBW) infants have investigated the effect of parenteral or enteral glutamine supplementation on morbidity, mortality, and outcome in the neonatal period. No evidence of toxicity of glutamine supplementation was found in these clinical trials, but the

  11. Ureaplasma infections in pre-term infants: Recent information regarding the role of Ureaplasma species as neonatal pathogens

    OpenAIRE

    Sung, Tae-Jung

    2010-01-01

    Although numerous clinical observational studies have been conducted over a period of over 30 years, the clinical significance of Ureaplasma infection is still under debate. The Ureaplasma speices. is a commensal in the female genital tract and considered to have of low virulence; however, Ureaplasma colonization has been associated with infertility, stillbirth, preterm delivery, histologic chorioamnionitis, and neonatal morbidities, including congenital pneumonia, meningitis, bronchopulmonar...

  12. The effects of labor and delivery on maternal and neonatal outcomes in term twins: a retrospective cohort study.

    Science.gov (United States)

    Wenckus, D J; Gao, W; Kominiarek, M A; Wilkins, I

    2014-08-01

    To compare maternal and neonatal outcomes in twins undergoing a trial of labor versus pre-labor caesarean. Retrospective cohort study. 19 US hospitals from the Consortium on Safe Labor. Of 2225 twin sets ≥36 weeks' gestation. Maternal (abruption, estimated blood loss, postpartum haemorrhage, transfusion, chorioamnionitis, hysterectomy, ICU admission, death) and neonatal outcomes (birth injury, 5-minute Apgar twin sets, 1078 had a trial of labour, and 65.9% of those delivered vaginally. There was an increased risk for postpartum haemorrhage [OR 2.5, 95% confidence interval (CI) 1.4-4.5] and blood transfusion (OR 1.9, 95%CI 1.2-3.2) for the trial of labour compared with pre-labour caesarean groups. Birth injury only occurred in the trial of labour group, 1% Twin A, 0.4% Twin B. Both twins had a higher risk of 5-minute Apgar twins undergoing a trial of labour have increased maternal haemorrhage and transfusions along with neonatal birth trauma and lower Apgar scores, but these absolute neonatal occurrences were rare. Trial of labour in twins remains a safe and reasonable option in appropriately selected cases. © 2014 Royal College of Obstetricians and Gynaecologists.

  13. Unreported births and deaths, a severe obstacle for improved neonatal survival in low-income countries; a population based study

    Directory of Open Access Journals (Sweden)

    Wallin Lars

    2008-03-01

    Full Text Available Abstract Background In order to improve child survival there is a need to target neonatal mortality. In this pursuit, valid local and national statistics on child health are essential. We analyze to what extent births and neonatal deaths are unreported in a low-income country and discuss the consequences at local and international levels for efforts to save newborn lives. Methods Information on all births and neonatal deaths in Quang Ninh province in Northern Vietnam in 2005 was ascertained by systematic inventory through group interviews with key informants, questionnaires and examination of health facility records. Health care staff at 187 Community Health Centers (CHC and 18 hospitals, in addition to 1372 Village Health Workers (VHW, were included in the study. Results were compared with the official reports of the Provincial Health Bureau. Results The neonatal mortality rate (NMR was 16/1000 (284 neonatal deaths/17 519 births, as compared to the official rate of 4.2/1000. The NMR varied between 44/1000 and 10/1000 in the different districts of the province. The under-reporting was mainly attributable to a dysfunctional reporting system and the fact that families, not the health system, were made responsible to register births and deaths. This under-reporting has severe consequences at local, national and international levels. At a local level, it results in a lack of awareness of the magnitude and differentials in NMR, leading to an indifference towards the problem. At a national and international level the perceived low mortality rate is manifested in a lack of investments in perinatal health programs. Conclusion This example of a faulty health information system is reportedly not unique in low and middle income countries where needs for neonatal health reforms are greatest. Improving reporting systems on births and neonatal deaths is a matter of human rights and a prerequisite for reducing neonatal mortality in order to reach the fourth

  14. Comparison between oscillometric and intra-arterial blood pressure measurements in ill preterm and full-term neonates.

    Science.gov (United States)

    Lalan, Shwetal; Blowey, Douglas

    2014-01-01

    Conflicting data exist regarding the accuracy of the oscillometric method of blood pressure (BP) measurement in neonates. There is limited data regarding intra-arterial BP trends in neonates. We aimed to determine the accuracy of oscillometric BP measurements and to evaluate the BP distributions in ill neonates. A total of 1492 simultaneously obtained oscillometric and intra-arterial (umbilical arterial [UAC] or radial arterial) BP measurements were used for comparisons and 125,580 intra-arterial BP readings were used to the evaluate BP distribution. There was a statistically significant difference (P oscillometric and radial mean arterial BP (MAP) 4.8 ± 9.8 mm Hg, systolic BP 8.3 ± 11.6 mm Hg, diastolic BP 4.3 ± 9.3 mm Hg and between the oscillometric and UAC systolic BP 5.2 ± 11.9 mm Hg and diastolic BP -0.8 ± 10.4 mm Hg. The MAP increased with increases in weight (35.3 ± 4.92 mm Hg/kg), post-menstrual age (-0.29 ± 1.41 mm Hg/week) and advanced gestational age at birth (13.12 ± 0.90 mm Hg/week). Oscillometric BP measurements are not equivalent to the intra-arterial (UAC or radial arterial) BP in ill neonates. The BP increases with increase in weight, gestational age at birth, and post-menstrual age in ill neonates. Copyright © 2014 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.

  15. Transport, monitoring, and successful brain MR imaging in unsedated neonates

    Energy Technology Data Exchange (ETDEWEB)

    Mathur, Amit M. [St. Louis Children' s Hospital at the Washington University School of Medicine, Department of Pediatrics and Newborn Medicine, St. Louis, MO (United States); St. Louis Children' s Hospital, Division of Newborn Medicine, St. Louis, MO (United States); Neil, Jeffrey J. [St. Louis Children' s Hospital at the Washington University School of Medicine, Department of Neurology, St. Louis, MO (United States); Mallinckrodt Institute of Radiology, St. Louis, MO (United States); McKinstry, Robert C. [Mallinckrodt Institute of Radiology, St. Louis, MO (United States); Inder, Terrie E. [St. Louis Children' s Hospital at the Washington University School of Medicine, Department of Pediatrics and Newborn Medicine, St. Louis, MO (United States); St. Louis Children' s Hospital at the Washington University School of Medicine, Department of Neurology, St. Louis, MO (United States); Mallinckrodt Institute of Radiology, St. Louis, MO (United States)

    2008-03-15

    Neonatal cerebral MR imaging is a sensitive technique for evaluating brain injury in the term and preterm infant. In term encephalopathic infants, MR imaging reliably detects not only the pattern of brain injury but might also provide clues about the timing of injury. In premature infants, MR imaging has surpassed US in the detection of white matter injury, a common lesion in this population. Concerns remain about the safety and transport of sedated neonates for MR examination to radiology suites, which are usually located at a distance from neonatal intensive care units. We present our own institutional experience and guidelines used to optimize the performance of cerebral MR examinations in neonates without sedation or anesthesia. (orig.)

  16. Challenges in the diagnosis and management of neonatal sepsis.

    Science.gov (United States)

    Zea-Vera, Alonso; Ochoa, Theresa J

    2015-02-01

    Neonatal sepsis is the third leading cause of neonatal mortality and a major public health problem, especially in developing countries. Although recent medical advances have improved neonatal care, many challenges remain in the diagnosis and management of neonatal infections. The diagnosis of neonatal sepsis is complicated by the frequent presence of noninfectious conditions that resemble sepsis, especially in preterm infants, and by the absence of optimal diagnostic tests. Since neonatal sepsis is a high-risk disease, especially in preterm infants, clinicians are compelled to empirically administer antibiotics to infants with risk factors and/or signs of suspected sepsis. Unfortunately, both broad-spectrum antibiotics and prolonged treatment with empirical antibiotics are associated with adverse outcomes and increase antimicrobial resistance rates. Given the high incidence and mortality of sepsis in preterm infants and its long-term consequences on growth and development, efforts to reduce the rates of infection in this vulnerable population are one of the most important interventions in neonatal care. In this review, we discuss the most common questions and challenges in the diagnosis and management of neonatal sepsis, with a focus on developing countries. © The Author [2015]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  17. Validation of transcutaneous bilirubin nomogram for identifying neonatal hyperbilirubinemia in healthy Chinese term and late-preterm infants: a multicenter study.

    Science.gov (United States)

    Yu, Zhangbin; Han, Shuping; Wu, Jinxia; Li, Mingxia; Wang, Huaiyan; Wang, Jimei; Liu, Jiebo; Pan, Xinnian; Yang, Jie; Chen, Chao

    2014-01-01

    to prospectively validate a previously constructed transcutaneous bilirubin (TcB) nomogram for identifying severe hyperbilirubinemia in healthy Chinese term and late-preterm infants. this was a multicenter study that included 9,174 healthy term and late-preterm infants in eight hospitals of China. TcB measurements were performed using a JM-103 bilirubinometer. TcB values were plotted on a previously developed TcB nomogram, to identify the predictive ability for subsequent significant hyperbilirubinemia. in the present study, 972 neonates (10.6%) developed significant hyperbilirubinemia. The 40(th) percentile of the nomogram could identify all neonates who were at risk of significant hyperbilirubinemia, but with a low positive predictive value (PPV) (18.9%). Of the 453 neonates above the 95(th) percentile, 275 subsequently developed significant hyperbilirubinemia, with a high PPV (60.7%), but with low sensitivity (28.3%). The 75(th) percentile was highly specific (81.9%) and moderately sensitive (79.8%). The area under the curve (AUC) for the TcB nomogram was 0.875. this study validated the previously developed TcB nomogram, which could be used to predict subsequent significant hyperbilirubinemia in healthy Chinese term and late-preterm infants. However, combining TcB nomogram and clinical risk factors could improve the predictive accuracy for severe hyperbilirubinemia, which was not assessed in the study. Further studies are necessary to confirm this combination. Copyright © 2014 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  18. Long-term projections of national, regional, and state population

    Energy Technology Data Exchange (ETDEWEB)

    McDonald, J.F.; South, D.W.

    1986-07-01

    The projections prepared by the US Bureau of the Census are the best available projections of total US population. The DRI projections of population at the regional and state level to the year 2008 are the best available and are consistent with the US Bureau of the Census projections of total US population. The DRI regional and state projections can be extended from 2008 to 2030 with a simple model based on economic opportunity, although an even simpler model - constant shares - is used for the 1985 test runs. The US Bureau of the Census prepares the best available projections of the US age-sex distribution.

  19. Role of vasopressin and terlipressin in refractory shock compared to conventional therapy in the neonatal and pediatric population: a systematic review, meta-analysis, and trial sequential analysis.

    Science.gov (United States)

    Masarwa, Reem; Paret, Gideon; Perlman, Amichai; Reif, Shimon; Raccah, Bruria Hirsh; Matok, Ilan

    2017-01-05

    Vasopressin (AVP) and terlipressin (TP) have been used as last-line therapy in refractory shock in children. However, the efficacy and safety profiles of AVP and TP have not been determined in pediatric refractory shock of different origins. We aimed to assess the efficacy and safety of the addition of AVP/TP therapy in pediatric refractory shock of all causes compared to conventional therapy with fluid resuscitation and vasopressor and inotropic therapy. We conducted a systematic review, meta-analysis, and trial sequential analysis (TSA) comparing AVP and TP to conventional therapy. MEDLINE, EMBASE, Cochrane Library, and ClinicalTrials.gov were searched up to February 2016. The systematic review included all reports of AVP/TP use in the pediatric population. Reports of clinical trials were pooled using random-effects models and TSA. Main outcomes were mortality and tissue ischemia. Three randomized controlled trials and five "before-and-after clinical" trials (without comparator) met the inclusion criteria. Among 224 neonates and children (aged 0 to 18 years) with refractory shock, 152 received therapy with AVP or TP. Pooled analyses showed no association between AVP/TP treatment and mortality (relative risk (RR),1.19; 95% confidence interval (CI), 0.71-2.00), length of stay in the pediatric intensive care unit (PICU) (mean difference (MD), -3.58 days; 95% CI, -9.05 to 1.83), and tissue ischemia (RR, 1.48; 95% CI, 0.47-4.62). In TSA, no significant effect on mortality and risk for developing tissue ischemia was observed with AVP/TP therapy. Our results emphasize the lack of observed benefit for AVP/TP in terms of mortality and length of stay in the PICU, and suggest an increased risk for ischemic events. Our TSA suggests that further large studies are necessary to demonstrate and establish benefits of AVP/TP in children. PROSPERO registry: CRD42016035872.

  20. Universal salt iodization is successful in Kashmiri population as iodine deficiency no longer exists in pregnant mothers and their neonates: Data from a tertiary care hospital in North India

    Directory of Open Access Journals (Sweden)

    Bashir Ahmed Charoo

    2013-01-01

    Full Text Available Introduction: Normal pregnancy results in a number of important physiological and hormonal changes that alter thyroid function. In pregnancy, the thyroid gland being subjected to physiological stress undergoes several adaptations to maintain sufficient output of thyroid hormones for both mother and fetus. Consequently, pregnant women have been found to be particularly vulnerable to iodine deficiency disorders (IDD, and compromised iodine status during pregnancy has been found to affect the thyroid function and cognition in the neonates. Objectives: Two decades after successful universal salt iodization (USI in the country, there is scarce data on the iodine status of the pregnant women and their neonates. This is more relevant in areas like Kashmir valley part of sub-Himalayan belt, an endemic region for IDD in the past.The objective was to estimate Urinary Iodine status in pregnant women, the most vulnerable population. Materials and Methods: We studied thyroid function [free T3 (FT3, T3, free T4 (FT4, T4, thyroid stimulating hormone (TSH] and urinary iodine excretion (UIE in the 1 st , 2 nd , and 3 rd trimesters and at early neonatal period in neonates in 81 mother-infant pairs (hypothyroid women on replacement and compared them with 51 control mother-infant pairs (euthyroid. Results: Mean age of cases (29.42 + 3.56 years was comparable to that of controls (29.87 + 3.37 years. The thyroid function evaluation done at baseline revealed the following: FT3 2.92 ± 0.76 versus 3.71 ± 0.54 pg/ml, T3 1.38 ± 0.37 versus 1.70 ± 0.35 ng/dl, FT4 1.22 ± 0.33 versus 1.52 ± 0.21 ng/dl, T4 9.54 ± 2.34 versus 13.55 ± 2.16 μg/dl, and TSH 7.92 ± 2.88 versus 4.14 ± 1.06 μIU/ml in cases versus controls ( P < 0.01, respectively. The 2 nd to 6 th day thyroid function of neonates born to case and control mothers revealed T3 of 1.46 ± 0.44 versus 1.48 ± 0.36 ng/dl, T4 of 12.92 ± 2.57 versus 11.76 ± 1.78 μg/dl, and TSH of 3.64 ± 1.92 versus 3.82 ± 1

  1. Long-term outcome of early childhood wheezing : Population data

    NARCIS (Netherlands)

    Strachan, D; Gerritsen, J

    The adult prognosis of early childhood wheezing is reviewed using data from three studies (in Melbourne, Tasmania and Britain) which have followed population-based samples of 7 year old children with a history of asthma or wheezing illness into their early thirties. About one quarter of these wheezy

  2. Neonatal and postneonatal mortality by maternal education a population-based study of trends in the Nordic countries, 1981 2000

    DEFF Research Database (Denmark)

    Arntzen, Annett; Mortensen, Laust; Schnor, Ole

    2008-01-01

    educational groups, and the educational level increased in the study period. The time-trends differed between neonatal and postneonatal death. For neonatal death, both the absolute and relative educational differences decreased in Finland and Sweden, increased in Denmark, whereas in Norway a decrease...... in absolute differences and a slight increase in relative differences occurred. For postneonatal death, the relative educational differences increased in all countries, whereas the absolute differences decreased. CONCLUSIONS: All educational groups experienced a decline in infant mortality during the period...... under study. Still, the inverse association between maternal education and RR of postneonatal death has become more pronounced in all Nordic countries....

  3. The neonatal chest

    Energy Technology Data Exchange (ETDEWEB)

    Lobo, Luisa [Servico de Imagiologia Geral do Hospital de Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisbon (Portugal)]. E-mail: mluisalobo@gmail.com

    2006-11-15

    Lung diseases represent one of the most life threatening conditions in the newborn. Important progresses in modern perinatal care has resulted in a significantly improved survival and decreased morbidity, in both term and preterm infants. Most of these improvements are directly related to the better management of neonatal lung conditions, and infants of very low gestational ages are now surviving. This article reviews the common spectrum of diseases of the neonatal lung, including medical and surgical conditions, with emphasis to the radiological contribution in the evaluation and management of these infants. Imaging evaluation of the neonatal chest, including the assessment of catheters, lines and tubes are presented.

  4. Velocimetria Doppler no período neonatal em recém-nascidos a termo pequenos para idade gestacional Neonatal Doppler velocimetry in full term small-for-gestational age newborns

    Directory of Open Access Journals (Sweden)

    Iracema Augusta Carvalho Cortez Muniz

    2003-09-01

    Full Text Available Este estudo teve como objetivo avaliar o fluxo sanguíneo cerebral em recém-nascidos a termo pequenos para idade gestacional, utilizando ultra-sonografia Doppler craniana ao nascimento. O estudo foi desenvolvido no CAISM/UNICAMP (Centro de Saúde Terciário para Mulheres. Foram selecionados sessenta recém-nascidos e divididos em 2 grupos: 36 adequados para idade gestacional (AIG e 24 pequenos para idade gestacional (PIG. Foi realizada a avaliação de ultra-sonografia Doppler craniana nos grupos, entre 24-48 horas após o nascimento. A velocidade de fluxo sanguíneo cerebral foi menor no grupo PIG na artéria cerebral anterior (ACA. As medidas Doppler foram estatisticamente diferentes entre os grupos apenas para valores relacionados à velocidade de fluxo de pico sistólico (VFPS e velocidade de fluxo médio (VFM na ACA. Não houve diferenças significantes para nenhum dos parâmetros avaliados de velocidade de fluxo na artéria cerebral média (ACM. Concluiu-se que recém-nascidos PIG apresentaram VFPS e VFM significativamente menores apenas na ACA. A adequação peso/idade gestacional, presença de policitemia neonatal e valores de pressão arterial média estiveram estatisticamente associados a VFM na ACA. A presença de sofrimento fetal, valores de pressão arterial média e hábito de fumar durante a gestação estiveram estatisticamente associados a VFM na ACM.This study aimed to evaluate the cerebral blood flow of full term small-for-gestational age newborns, using cranial ultrasound Doppler at birth. This study was performed at CAISM/UNICAMP (Tertiary Health Center for Women. Sixty term newborns were selected and divided in two groups: appropriate-for-gestational age (AGA (36 neonates and small-for-gestational age (SGA (24 neonates. Cranial ultrasound Doppler evaluation was performed on both groups, between 24 and 48 hours after birth. Cerebral blood flow velocity (CBFV was lower in the small-for-gestational age group, in the anterior

  5. Pharmacotherapy for Neonatal Seizures: Current Knowledge and Future Perspectives.

    Science.gov (United States)

    Donovan, Maria D; Griffin, Brendan T; Kharoshankaya, Liudmila; Cryan, John F; Boylan, Geraldine B

    2016-04-01

    Seizures are the most common neurological emergencies in the neonatal period and are associated with poor neurodevelopmental outcomes. Seizures affect up to five per 1000 term births and population-based studies suggest that they occur even more frequently in premature infants. Seizures are a sign of an underlying cerebral pathology, the most common of which is hypoxic-ischaemic encephalopathy in term infants. Due to a growing body of evidence that seizures exacerbate cerebral injury, effective diagnosis and treatment of neonatal seizures is of paramount importance to reduce long-term adverse outcomes. Electroencephalography is essential for the diagnosis of seizures in neonates due to their subtle clinical expression, non-specific neurological presentation and a high frequency of electro-clinical uncoupling in the neonatal period. Hypoxic-ischaemic encephalopathy may require neuroprotective therapeutic hypothermia, accompanying sedation with opioids, anticonvulsant drugs or a combination of all of these. The efficacy, safety, tolerability and pharmacokinetics of seven anticonvulsant drugs (phenobarbital, phenytoin, levetiracetam, lidocaine, midazolam, topiramate and bumetanide) are reviewed. This review is focused only on studies reporting electrographically confirmed seizures and highlights the knowledge gaps that exist in optimal treatment regimens for neonatal seizures. Randomised controlled trials are needed to establish a safe and effective treatment protocol for neonatal seizures.

  6. Do Smoking Bans Improve Neonatal Health?

    Science.gov (United States)

    Hankins, Scott; Tarasenko, Yelena

    2016-10-01

    To estimate the effects of smoking bans on neonatal health outcomes and maternal smoking behavior during pregnancy. Restricted-use 1991-2009 Natality Detail Files, a Clean Air Dates Table Report, and the Tax Burden of Tobacco. A quasi-experimental study using difference-in-differences estimation based on legislative history of smoking restrictions or bans by type/place/county/state level. Dependent variables included average monthly percentage of healthy neonates, of term neonates born with low and very low birth weight, of premature births, of maternal smokers, and average number of cigarettes smoked daily during pregnancy. The analyses were restricted to singleton births and those that occurred in the same county as mother's county of residence. The data from three data sources were combined using Federal Information Processing Standard codes. Results of the overall and stratified by maternal smoking status, educational level, and age regression analyses suggested no appreciable effect of smoking bans on neonatal health. Smoking bans had also no effect on maternal smoking behavior. While there are health benefits to the general population from smoking bans, their effects on neonatal health outcomes and maternal smoking during pregnancy seem to be limited. © Health Research and Educational Trust.

  7. Asfixia perinatal associada à mortalidade neonatal precoce: estudo populacional dos óbitos evitáveis Asfixia perinatal asociada a la mortalidad neonatal temprana: estudio de población de los óbitos evitables Perinatal asphyxia associated with early neonatal mortality: populational study of avoidable deaths

    Directory of Open Access Journals (Sweden)

    Mandira Daripa

    2013-03-01

    TODOS: Cohorte de población constituida por 2.873 óbitos evitables hasta seis días de vida asociados a la asfixia perinatal ocurridos entre enero de 2001 y diciembre de 2003. Se consideró como asfixia perinatal la presencia de hipoxia intraútero, asfixia al nacer o síndrome de aspiración de meconio en cualquier línea de la Declaración de Óbito original. Variables epidemiológicas también fueron extraídas de las Declaraciones de Nacido Vivo. RESULTADOS: En el trienio, 1,71 muertes por 1.000 nacidos vivos estaban asociadas a la asfixia perinatal, correspondiendo al 22% de los óbitos neonatales tempranos. De los 2.873 óbitos evitables, 761 (27% tuvieron lugar en São Paulo, capital; 640 (22%, en la región metropolitana de la capital; y 1.472 (51% en el interior de la provincia. En las dos primeras regiones predominaron las muertes en hospitales públicos, recién nacidos con edad gestacional inferior a 37 semanas y peso inferior a 2.500g. En el interior, los óbitos fueron más frecuentes en entidades benéficas, recién nacidos a término y con peso superior a 2.500g. La mayoría de los bebés nació durante el día en el municipio de residencia materna y evolucionó a óbito en el hospital de nacimiento hasta 24 horas después del parto. El síndrome de aspiración de meconio estuvo presente en el 18% de los óbitos. CONCLUSIONES: La asfixia perinatal es un contribuyente frecuente a la muerte neonatal temprana evitable en la provincia con el más grande producto interno bruto per capita de Brasil, lo que evidencia la necesidad de intervenciones específicas con enfoque regionalizado en la asistencia al parto y al nacimiento.OBJECTIVE: To compare the epidemiological profile of avoidable early neonatal deaths associated with perinatal asphyxia according to region of death in the State of São Paulo, Brazil. METHODS: Population-based cohort study including 2,873 avoidable deaths up to six days of life associated with perinatal asphyxia from January 2001 to December

  8. Cooling combined with immediate or delayed xenon inhalation provides equivalent long-term neuroprotection after neonatal hypoxia-ischemia.

    Science.gov (United States)

    Thoresen, Marianne; Hobbs, Catherine E; Wood, Tommy; Chakkarapani, Ela; Dingley, John

    2009-04-01

    Hypothermia (HT) improves outcome after neonatal hypoxia-ischemia. Combination therapy may extend neuroprotection. The noble anesthetic gas xenon (Xe) has an excellent safety profile. We have shown earlier that 3 h of 50% Xe plus HT (32 degrees C) additively gives more protection (72%) than either alone (HT=31.1%, Xe=10.2%). Factors limiting clinical use include high-cost and specialist administration requirements. Thus, combinations of 1 h of 50% Xe were administered concurrently for either the first (1 h(Immediate)Xe) or last (1 h(Delayed)Xe) of 3 h of posthypoxic-ischemic HT as compared with 3 h of 50%Xe/HT to investigate how brief Xe exposure with a delay would affect efficacy. An established neonatal rat hypoxia-ischemia model was used. Serial functional neurologic testing into adulthood was performed, followed by neuropathological examination. Xenon with HT was more effective with longer Xe duration (3 h versus 1 h) (P=0.015). However, 1 h Xe/3 h HT resulted in better neuroprotection than 3 h HT alone (P=0.03), this significant effect was also present with 1 h Xe after a 2-h delay. One (immediate or with a delay) or 3 h Xe also significantly improved motor function (P=0.024). Females had significantly better motor scores than males, but no sex-dependent difference in pathology results. The neuroprotection of short, delayed Xe treatment would allow transport to specialist facilities to receive Xe.

  9. Implementing a practice change: early initiation of continuous renal replacement therapy during neonatal extracorporeal life support standardizes care and improves short-term outcomes.

    Science.gov (United States)

    Murphy, Heidi J; Cahill, John B; Twombley, Katherine E; Annibale, David J; Kiger, James R

    2017-10-30

    We hypothesized that a standardized approach to early continuous renal replacement therapy (CRRT) during neonatal extracorporeal life support (ECLS) results in greater homogeneity of CRRT initiation times with improvements in fluid balance and outcomes. Retrospective analysis of data (2007-2015) obtained from neonates treated prior to (E1; n = 32) and after (E2; n = 31) a 2011 practice change: CRRT initiation within 48 h of ECLS. Birthweight, gestational age, ECLS mode, and age at ECLS initiation were similar to each epoch. Survival [E1: median 75%, E2: 71%] and length of ECLS [E1: median 221 h, E2: 180 h] were comparable. During E2, 100% of infants received CRRT (vs. E1: 37%; p CRRT within 48 h of ECLS (vs. E1: 13%; p CRRT differed between Epochs [E1: median 105 h, E2: 9 h; p CRRT initiation [E1: 4.13 kg (29% above baseline), E2: 3.19 kg (0%); p CRRT within 48 h of ECLS cannulation, leading to decreased practice variation and improved short-term outcomes including decreased weight gain at CRRT initiation and faster return to baseline weight during the first 7 days of ECLS. We did not demonstrate changes in duration of ECLS, invasive ventilation, or survival.

  10. Risk of Adverse Obstetric and Neonatal Outcomes by Maternal Age: Quantifying Individual and Population Level Risk Using Routine UK Maternity Data.

    Directory of Open Access Journals (Sweden)

    Laura Oakley

    Full Text Available The objective of this study was to investigate whether moderately increased maternal age is associated with obstetric and neonatal outcome in a contemporary population, and to consider the possible role of co-morbidities in explaining any increased risk.Secondary analysis of routinely collected data from a large maternity unit in London, UK. Data were available on 51,225 singleton deliveries (≥22 weeks occurring to women aged ≥20 between 2004 and 2012. Modified Poisson regression was used to estimate risk ratios for the association between maternal age and obstetric and neonatal outcome (delivery type, postpartum haemorrhage, stillbirth, low birthweight, preterm birth, small for gestational age, neonatal unit admission, using the reference group 20-24 years. Population attributable fractions were calculated to quantify the population impact.We found an association between increasing maternal age and major postpartum haemorrhage (≥1000ml blood loss (RR 1.36 95% CI 1.18-1.57 for age 25-29 rising to 2.41 95% CI 2.02-2.88 for age ≥40. Similar trends were observed for caesarean delivery, most notably for elective caesareans (RR 1.64 95% CI 1.36-1.96 for age 25-29 rising to 4.94 95% CI 4.09-5.96 for age ≥40. There was evidence that parity modified this association, with a higher prevalence of elective caesarean delivery in older nulliparous women. Women aged ≥35 were at increased risk of low birthweight and preterm birth. We found no evidence that the risk of stillbirth, small for gestational age, or neonatal unit admission differed by maternal age.Our results suggest a gradual increase in the risk of caesarean delivery and postpartum haemorrhage from age 25, persisting after taking into account maternal BMI, hypertension and diabetes. The risk of low birthweight and preterm birth was elevated in women over 35. Further research is needed to understand the reasons behind the high prevalence of elective caesarean delivery in nulliparous

  11. Neonatal pain management

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    Tarun Bhalla

    2014-01-01

    Full Text Available The past 2-3 decades have seen dramatic changes in the approach to pain management in the neonate. These practices started with refuting previously held misconceptions regarding nociception in preterm infants. Although neonates were initially thought to have limited response to painful stimuli, it was demonstrated that the developmental immaturity of the central nervous system makes the neonate more likely to feel pain. It was further demonstrated that untreated pain can have long-lasting physiologic and neurodevelopmental consequences. These concerns have resulted in a significant emphasis on improving and optimizing the techniques of analgesia for neonates and infants. The following article will review techniques for pain assessment, prevention, and treatment in this population with a specific focus on acute pain related to medical and surgical conditions.

  12. PPARγ-induced upregulation of CD36 enhances hematoma resolution and attenuates long-term neurological deficits after germinal matrix hemorrhage in neonatal rats.

    Science.gov (United States)

    Flores, Jerry J; Klebe, Damon; Rolland, William B; Lekic, Tim; Krafft, Paul R; Zhang, John H

    2016-03-01

    Germinal matrix hemorrhage remains the leading cause of morbidity and mortality in preterm infants in the United States with little progress made in its clinical management. Survivors are often afflicted with long-term neurological sequelae, including cerebral palsy, mental retardation, hydrocephalus, and psychiatric disorders. Blood clots disrupting normal cerebrospinal fluid circulation and absorption after germinal matrix hemorrhage are thought to be important contributors towards post-hemorrhagic hydrocephalus development. We evaluated if upregulating CD36 scavenger receptor expression in microglia and macrophages through PPARγ stimulation, which was effective in experimental adult cerebral hemorrhage models and is being evaluated clinically, will enhance hematoma resolution and ameliorate long-term brain sequelae using a neonatal rat germinal matrix hemorrhage model. PPARγ stimulation (15d-PGJ2) increased short-term PPARγ and CD36 expression levels as well as enhanced hematoma resolution, which was reversed by a PPARγ antagonist (GW9662) and CD36 siRNA. PPARγ stimulation (15d-PGJ2) also reduced long-term white matter loss and post-hemorrhagic ventricular dilation as well as improved neurofunctional outcomes, which were reversed by a PPARγ antagonist (GW9662). PPARγ-induced upregulation of CD36 in macrophages and microglia is, therefore, critical for enhancing hematoma resolution and ameliorating long-term brain sequelae. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Neonatal health in Nepal: analysis of absolute and relative inequalities and impact of current efforts to reduce neonatal mortality.

    Science.gov (United States)

    Paudel, Deepak; Shrestha, Ishwar B; Siebeck, Matthias; Rehfuess, Eva A

    2013-12-28

    -demographic variables. This study clearly shows that much remains to be achieved in terms of reducing neonatal mortality across different socio-economic, ethnic and geographical population groups in Nepal. In moving forward it will be important to scale up programs of proven effectiveness, conduct in-depth evaluation of promising new approaches, target unreached and hard-to-reach populations, and maximize use of financial and personnel resources through integration across programs.

  14. Is the difference in neonatal blood glucose concentration of caesarian and vaginally delivered term infants requiring separated reference intervals?

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    Melkie Mulugeta

    2012-09-01

    Full Text Available Abstract Background Mode of delivery has been reported to affect the cord blood glucose level of newborns. Vaginally delivered (VD newborns were found to have relatively increased concentration of cord blood glucose than those delivered by cesarean section (CS. The aim of this study is thus to determine whether the difference in cord blood glucose concentration among VD and CS newborns is necessitating partitioned reference intervals (RIs for the laboratory diagnosis of neonatal hypoglycemia. Methods A total of 60 newborns were included from Tikur Anbessa Specialized Hospital (TASH. Cord blood samples were collected and analyzed for glucose by Glucose-oxidase (GOD-PAP method in TASH laboratory using HumaStar 300 from November 2010 to April 2011. All pre-analytical, analytical and post-analytical aspects were thoroughly controlled. A robust method was used for the determination of reference intervals using MedCalc® software Version 11.6.1. Results VD newborns accounted for 71.7% (n = 43 while the CS newborns accounted for 28.3% (n = 17. No statistically significant difference was noted in the studied demographic variables among VD and CS newborns except for blood glucose level. The RIs were then determined to be 2.46-6.85 mmol/l and 2.46-5.04 mmol/l for VD and CS newborns respectively. The combined RI was 2.24-6.48 mmol/l. Conclusion Combined RI better be used for the interpretation of cord blood glucose values in VD and CS newborns. Cord blood glucose concentrations of 2.24 mmol/l can be used as statistical estimates of cut off points for neonatal hypoglycemia in newborns irrespective of their mode of deliveries.

  15. A three year descriptive study of early onset neonatal sepsis in a refugee population on the Thailand Myanmar border.

    Science.gov (United States)

    Turner, Claudia; Turner, Paul; Hoogenboom, Gabie; Aye Mya Thein, Naw; McGready, Rose; Phakaudom, Kawalee; De Zoysa, Aruni; Efstratiou, Androulla; Heath, Paul T; Nosten, François

    2013-12-21

    Each year an estimated four million neonates die, the majority in the first week of life. One of the major causes of death is sepsis. Proving the incidence and aetiology of neonatal sepsis is difficult, particularly in resource poor settings where the majority of the deaths occur. We conducted a three year observational study of clinically diagnosed early onset (neonatal sepsis (EONS) in infants born to mothers following antenatal care at the Shoklo Malaria Research Unit clinic in Maela camp for displaced persons on the Thailand-Myanmar border. Episodes of EONS were identified using a clinical case definition. Conventional and molecular microbiological techniques were employed in order to determine underlying aetiology. From April 2009 until April 2012, 187 infants had clinical signs of EONS, giving an incidence rate of 44.8 per 1000 live births (95% CI 38.7-51.5). One blood culture was positive for Escherichia coli, E. coli was detected in the cerebrospinal fluid specimen in this infant, and in an additional two infants, by PCR. Therefore, the incidence of bacteriologically proven EONS was 0.7 per 1000 live births (95% CI 0.1-2.1). No infants enrolled in study died as a direct result of EONS. A low incidence of bacteriologically proven EONS was seen in this study, despite a high incidence of clinically diagnosed EONS. The use of molecular diagnostics and nonspecific markers of infection need to be studied in resource poor settings to improve the diagnosis of EONS and rationalise antibiotic use.

  16. Maternal overweight and obesity and risks of severe birth-asphyxia-related complications in term infants: a population-based cohort study in Sweden.

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    Martina Persson

    2014-05-01

    Full Text Available BACKGROUND: Maternal overweight and obesity increase risks of pregnancy and delivery complications and neonatal mortality, but the mechanisms are unclear. The objective of the study was to investigate associations between maternal body mass index (BMI in early pregnancy and severe asphyxia-related outcomes in infants delivered at term (≥37 weeks. METHODS AND FINDINGS: A nation-wide Swedish cohort study based on data from the Medical Birth Register included all live singleton term births in Sweden between 1992 and 2010. Logistic regression analyses were used to obtain odds ratios (ORs with 95% CIs for Apgar scores between 0 and 3 at 5 and 10 minutes, meconium aspiration syndrome, and neonatal seizures, adjusted for maternal height, maternal age, parity, mother's smoking habits, education, country of birth, and year of infant birth. Among 1,764,403 term births, 86% had data on early pregnancy BMI and Apgar scores. There were 1,380 infants who had Apgar score 0-3 at 5 minutes (absolute risk  = 0.8 per 1,000 and 894 had Apgar score 0-3 at 10 minutes (absolute risk  = 0.5 per 1,000. Compared with infants of mothers with normal BMI (18.5-24.9, the adjusted ORs (95% CI for Apgar scores 0-3 at 10 minutes were as follows: BMI 25-29.9: 1.32 (1.10-1.58; BMI 30-34.9: 1.57 (1.20-2.07; BMI 35-39.9: 1.80 (1.15-2.82; and BMI ≥40: 3.41 (1.91-6.09. The ORs for Apgar scores 0-3 at 5 minutes, meconium aspiration, and neonatal seizures increased similarly with maternal BMI. A study limitation was lack of data on effects of obstetric interventions and neonatal resuscitation efforts. CONCLUSION: Risks of severe asphyxia-related outcomes in term infants increase with maternal overweight and obesity. Given the high prevalence of the exposure and the severity of the outcomes studied, the results are of potential public health relevance and should be confirmed in other populations. Prevention of overweight and obesity in women of reproductive age is important

  17. Maternal overweight and obesity and risks of severe birth-asphyxia-related complications in term infants: a population-based cohort study in Sweden.

    Science.gov (United States)

    Persson, Martina; Johansson, Stefan; Villamor, Eduardo; Cnattingius, Sven

    2014-05-01

    Maternal overweight and obesity increase risks of pregnancy and delivery complications and neonatal mortality, but the mechanisms are unclear. The objective of the study was to investigate associations between maternal body mass index (BMI) in early pregnancy and severe asphyxia-related outcomes in infants delivered at term (≥37 weeks). A nation-wide Swedish cohort study based on data from the Medical Birth Register included all live singleton term births in Sweden between 1992 and 2010. Logistic regression analyses were used to obtain odds ratios (ORs) with 95% CIs for Apgar scores between 0 and 3 at 5 and 10 minutes, meconium aspiration syndrome, and neonatal seizures, adjusted for maternal height, maternal age, parity, mother's smoking habits, education, country of birth, and year of infant birth. Among 1,764,403 term births, 86% had data on early pregnancy BMI and Apgar scores. There were 1,380 infants who had Apgar score 0-3 at 5 minutes (absolute risk  = 0.8 per 1,000) and 894 had Apgar score 0-3 at 10 minutes (absolute risk  = 0.5 per 1,000). Compared with infants of mothers with normal BMI (18.5-24.9), the adjusted ORs (95% CI) for Apgar scores 0-3 at 10 minutes were as follows: BMI 25-29.9: 1.32 (1.10-1.58); BMI 30-34.9: 1.57 (1.20-2.07); BMI 35-39.9: 1.80 (1.15-2.82); and BMI ≥40: 3.41 (1.91-6.09). The ORs for Apgar scores 0-3 at 5 minutes, meconium aspiration, and neonatal seizures increased similarly with maternal BMI. A study limitation was lack of data on effects of obstetric interventions and neonatal resuscitation efforts. Risks of severe asphyxia-related outcomes in term infants increase with maternal overweight and obesity. Given the high prevalence of the exposure and the severity of the outcomes studied, the results are of potential public health relevance and should be confirmed in other populations. Prevention of overweight and obesity in women of reproductive age is important to improve perinatal health.

  18. Perinatal risk-indicators for long-term respiratory morbidity among preterm or very low birth weight neonates

    NARCIS (Netherlands)

    Teune, M.J.; Wassenaer, A.G. van; Buuren, S. van; Mol, B.W.; Opmeer, B.C.; Kollee, L.A.A.

    2012-01-01

    OBJECTIVES: To develop prediction models for long-term respiratory morbidity. To explore if respiratory distress syndrome (RDS) is a risk-indicator for long-term respiratory morbidity and to identify other perinatal risk-indicators for long-term respiratory morbidity. STUDY DESIGN: In the Dutch POPS

  19. Perinatal risk-indicators for long-term respiratory morbidity among preterm or very low birth weight neonates

    NARCIS (Netherlands)

    Teune, M.J.; Wassenaer, A.G. van; Buuren, S. van; Mol, B.W.J.; Opmeer, B.C.

    2012-01-01

    Objectives: To develop prediction models for long-term respiratory morbidity. To explore if respiratory distress syndrome (RDS) is a risk-indicator for long-term respiratory morbidity and to identify other perinatal risk-indicators for long-term respiratory morbidity. Study design: In the Dutch POPS

  20. Effects of basic developmental care on neonatal morbidity, neuromotor development, and growth at term age of infants who were born at <32 weeks.

    Science.gov (United States)

    Maguire, Celeste M; Veen, Sylvia; Sprij, Arwen J; Le Cessie, Saskia; Wit, Jan M; Walther, Frans J

    2008-02-01

    The goal of this study was to investigate the effect of basic elements of developmental care (incubator covers and positioning aids) on days of respiratory support and intensive care, growth, and neuromotor development at term age in infants who were born at Neuromotor development was defined as definitely abnormal (presence of a neonatal neurologic syndrome, such as apathy or hyperexcitability, hypotonia or hypertonia, hyporeflexia or hyperreflexia, hypokinesia or hyperkinesia, or a hemisyndrome), mildly abnormal (presence of only part of such a syndrome), or normal. A total of 192 infants were included (developmental care: 98; control: 94). Thirteen infants (developmental care: 7; control: 6) were excluded according to protocol (admitted for less than or died within the first 5 days: n = 12; taken out at parents' request: n = 1), which left a total of 179 infants who met inclusion criteria. In-hospital mortality was 12 (13.2%) of 91 in the developmental care group and 8 (9.1%) of 88 in the control group. There was no significant difference in the number of days of respiratory support, number of intensive care days, short-term growth, or neuromotor developmental outcome at term age between the developmental care and control groups. Duration of the intervention, whether only during the intensive care period or until hospital discharge, had no significant effect on outcome. Providing basic developmental care in the NICU had no effect on short-term physical and neurologic outcomes in infants who were born at <32 weeks' gestation.

  1. Neonatal intensive care and radiation

    Energy Technology Data Exchange (ETDEWEB)

    Mazzi, E.; Herrera, A.J.; Herbert, L.

    1978-01-01

    Radiography plays an important role in a neonatal intensive care nursery. Diagnostic radiation was measured in 96 newborns. Mean exposure per neonate was 68.1 milliroentgens (mR) (SD = 132.7) with a median exposure per neonate of 28 mR. Radiation received by neonates was low, but further studies are needed to show the safety of radiation or its delayed effects. The measurement of radiation is simple, and routine radiation recording can prove useful in future evaluations of this high-risk population.

  2. Placental pathology in full-term infants with hypoxic-ischemic neonatal encephalopathy and association with magnetic resonance imaging pattern of brain injury.

    Science.gov (United States)

    Harteman, Johanna C; Nikkels, Peter G J; Benders, Manon J N L; Kwee, Anneke; Groenendaal, Floris; de Vries, Linda S

    2013-10-01

    To investigate the relationship between placental pathology and pattern of brain injury in full-term infants with neonatal encephalopathy after a presumed hypoxic-ischemic insult. The study group comprised full-term infants with neonatal encephalopathy subsequent to presumed hypoxia-ischemia with available placenta for analysis who underwent cerebral magnetic resonance imaging (MRI) within the first 15 days after birth. Macroscopic and microscopic characteristics of the placenta were assessed. The infants were classified according to the predominant pattern of brain injury detected on MRI: no injury, predominant white matter/watershed injury, predominant basal ganglia and thalami (BGT) injury, or white matter/watershed injury with BGT involvement. Maternal and perinatal clinical factors were recorded. Placental tissue was available for analysis in 95 of 171 infants evaluated (56%). Among these 95 infants, 34 had no cerebral abnormalities on MRI, 27 had white matter/watershed injury, 18 had BGT injury, and 16 had white matter/watershed injury with BGT involvement. Chorioamnionitis was a common placental finding in both the infants without injury (59%) and those with white matter/BGT injury (56%). On multinomial logistic regression analysis, white matter/watershed injury with and without BGT involvement was associated with decreased placental maturation. Hypoglycemia was associated with an increased risk of the white matter/BGT injury pattern (OR,5.4; 95% CI, 1.4-21.4). The BGT injury pattern was associated with chronic villitis (OR, 12.7; 95% CI, 2.4-68.7). A placental weight brain injury, especially for the BGT pattern (OR, 0.1; 95% CI, 0.01-0.7). Placental weight <10th percentile was mainly associated with normal cerebral MRI findings. Decreased placental maturation and hypoglycemia <2.0 mmol/L were associated with increased risk of white matter/watershed injury with or without BGT involvement. Chronic villitis was associated with BGT injury irrespective of white

  3. Neonatal cranial ultrasound: current perspectives

    Directory of Open Access Journals (Sweden)

    Franco A

    2013-09-01

    Full Text Available Arie Franco, Kristopher Neal Lewis Department of Radiology, Medical College of Georgia at Georgia Regents University, Augusta, GA, USA Abstract: Ultrasound is the most common imaging tool used in the neonatal intensive care unit. It is portable, readily available, and can be used at bedside. It is the least expensive cross sectional imaging modality and the safest imaging device used in the pediatric population due to its lack of ionizing radiation. There are well established indications for cranial ultrasound in many neonatal patient groups including preterm infants and term infants with birth asphyxia, seizures, congenital infections, etc. Cranial ultrasound is performed with basic grayscale imaging, using a linear array or sector transducer via the anterior fontanel in the coronal and sagittal planes. Additional images can be obtained through the posterior fontanel in preterm newborns. The mastoid fontanel can be used for assessment of the posterior fossa. Doppler images may be obtained for screening of the vascular structures. The normal sonographic neonatal cranial anatomy and normal variants are discussed. The most common pathological findings in preterm newborns, such as germinal matrix-intraventricular hemorrhage and periventricular leukomalacia, are described as well as congenital abnormalities such as holoprosencephaly and agenesis of the corpus callosum. New advances in sonographic equipment enable high-resolution and three-dimensional images, which facilitate obtaining very accurate measurements of various anatomic structures such as the ventricles, the corpus callosum, and the cerebellar vermis. Limited studies have been performed to predict that longitudinal measurements of these anatomic structures might predict the clinical outcome of high-risk preterm newborns. Hemodynamic Doppler studies may offer the potential for early intervention and treatment to counter the hazards of developmental delay and a moribund clinical outcome

  4. The Effect of Kangaroo Mother Care on Neonatal Outcomes in Iranian Hospitals: A Review

    Directory of Open Access Journals (Sweden)

    Leila Sarparast

    2015-01-01

    Full Text Available Context: Kangaroo Mother Care (KMC is a supportive technique that beings at the neonatal period and is one of the skin-to-skin contact methods of holding neonate by mother. This method has an important role in exclusive breastfeeding and thermal care of neonates. This study aimed to investigate the application of KMC and evaluate the effect of this technique in different neonatal outcomes, particularly in Iranian neonates. Moreover, this review can be a tool for formative evaluation for this newly introduced treatment intervention in Iran. Evidence Acquisition: This review was conducted in national and international databases concerning experience with KMC on term and preterm neonates admitted in Iranian hospitals from 2006 to 2014. The measured outcomes included physiologic, psychologic, and clinical effects of this practice on newborn infants. Results: In this study, 42 Persian and English language papers were reviewed and finally 26 articles were selected. Various effects of KMC on different factors such as analgesia; physiological effects, breastfeeding, icterus, length of hospitalization, infection, psychologic effects, and weight gain were found. Conclusions: The results showed that as a simple and suitable strategy for increasing the health status of the mothers and newborns, KMC had an important role in improvement of neonatal outcomes in neonatal wards of Iranian hospitals in recent ten years. Therefore, promoting this technique in all neonatal wards of the country can promote health status of this population.

  5. Trends and risk factors of stillbirths and neonatal deaths in Eastern Uganda (1982-2011): a cross-sectional, population-based study.

    Science.gov (United States)

    Kujala, Sanni; Waiswa, Peter; Kadobera, Daniel; Akuze, Joseph; Pariyo, George; Hanson, Claudia

    2017-01-01

    To identify mortality trends and risk factors associated with stillbirths and neonatal deaths 1982-2011. Population-based cross-sectional study based on reported pregnancy history in Iganga-Mayuge Health and Demographic Surveillance Site (HDSS) in Uganda. A pregnancy history survey was conducted among women aged 15-49 years living in the HDSS during May-July 2011 (n = 10 540). Time trends were analysed with cubic splines and linear regression. Potential risk factors were examined with multilevel logistic regression with adjusted odds ratios (AOR) and 95% confidence intervals (CI). 34 073 births from 1982 to 2011 were analysed. The annual rate of decrease was 0.9% for stillbirths and 1.8% for neonatal mortality. Stillbirths were associated with several risk factors: multiple births (AOR 2.57, CI 1.66-3.99), previous adverse outcome (AOR 6.16, CI 4.26-8.88) and grand multiparity among 35- to 49-year-olds (AOR 1.97, CI 1.32-2.89). Neonatal deaths were associated with multiple births (AOR 6.16, CI 4.80-7.92) and advanced maternal age linked with parity of 1-4 (AOR 2.34, CI 1.28-4.25) and grand multiparity (AOR 1.44, CI 1.09-1.90). Education, marital status and household wealth were not associated with the outcomes. The slow decline in mortality rates and easily identifiable risk factors calls for improving quality of care at birth and a rethinking of how to address obstetric risks, potentially a revival of the risk approach in antenatal care. © 2016 John Wiley & Sons Ltd.

  6. Meningite bacteriana neonatal: estudo prospectivo da evolução a longo prazo de 55 crianças Neonatal bacterial meningitis: prospective study of the long term outcome of 55 children

    Directory of Open Access Journals (Sweden)

    Vera Lúcia Jornada Krebs

    1996-03-01

    Full Text Available Foram estudadas prospectivamente 55 crianças que apresentaram meningite bacteriana no período neonatal, com o objetivo da analisar a frequência e o tipo de sequelas neurológicas. Todas as crianças nasceram a termo, sendo 38 do sexo masculino e 17 do feminino; a idade de início da doença variou de 3 a 28 dias. Os principais agentes etiológicos foram as enterobactérias. O tempo médio de seguimento foi 5 anos. A frequência de sequelas neurológicas foi 67,3%, representadas principalmente pelo atraso do desenvolvimento neuropsicomotor (58,2%, hidrocefalia (45,5% e convulsões (34,5%. As alterações motoras graves ocorreram em 23,6% dos pacientes (tetraplegia, diplegia, hemiparesia e ataxia. As convulsões na fase aguda da doença e a cultura positiva do líquido cefalorraqueano estiveram associadas significativamente com a presença de sequelas. Na avaliação do desempenho escolar, realizada em 25 crianças, observaram-se dificuldades na aprendizagem em 48% dos casos, associadas significativamente à deficiência mental.Fifty-five infants who presented bacterial neonatal meningitis were prospectively studied to analyze the frequency and the type of sequelae. All the infants were full term newborns.There were 38 boys and 17 girls; the age of disease onset varied from 3 to 28 days. The causative organism was represented mainly by enterobacteriae. The median time of follow-up was 5 years. The frequency of neurologic sequelae was 63.7%, represented mainly by neuropsychomotor development delay (58.2%, hydrocephaly (45.5% and convulsions (34.5%. Severe motor abnormalities ocurred in 23.6% of children (quadriplegia, diplegia, hemiparesia and ataxia. Convulsions in the acute phase of the disease and the positive cerebrospinal fluid culture were highly associated to sequelae. The school performance, obtained in 25 children, showed presence of disabilities in 48% of cases, which were significantly associated to mental retardation.

  7. Transcutaneous bilirubin levels for the first 120 postnatal hours in healthy neonates.

    Science.gov (United States)

    Fouzas, Sotirios; Mantagou, Lito; Skylogianni, Eleni; Mantagos, Stefanos; Varvarigou, Anastasia

    2010-01-01

    The objective of this study was to provide data on transcutaneous bilirubin (TcB) levels for the first 120 postnatal hours and to develop an hour-specific TcB nomogram for healthy term and near-term neonates. From September 2005 to August 2008, we obtained 14864 TcB measurements from 2818 healthy neonates (gestational age >or= 35 weeks and birth weight >or= 2000 g). All measurements were performed with the BiliCheck bilirubinometer, at designated times from 12 to 120 postnatal hours. TcB percentiles for each designated time were calculated and used for the development of an hour-specific nomogram. TcB percentiles for neonates who required phototherapy are also presented. The developed TcB nomogram reflects the natural history of TcB levels in healthy neonates up to the fifth postnatal day. A different pattern of TcB increasing rate was noted in neonates who did and did not require phototherapy but with substantial overlap of TcB values between the 2 groups. We provide data on TcB levels for the first 120 postnatal hours from a large population of white, healthy, term and near-term neonates. We also present a percentile-based TcB nomogram designated for noninvasive and hour-specific evaluation of neonatal hyperbilirubinemia.

  8. Predicting patterns of long-term adaptation and extinction with population genetics.

    Science.gov (United States)

    Bertram, J; Gomez, K; Masel, J

    2017-02-01

    Population genetics struggles to model extinction; standard models track the relative rather than absolute fitness of genotypes, while the exceptions describe only the short-term transition from imminent doom to evolutionary rescue. But extinction can result from failure to adapt not only to catastrophes, but also to a backlog of environmental challenges. We model long-term adaptation to long series of small challenges, where fitter populations reach higher population sizes. The population's long-term fitness dynamic is well approximated by a simple stochastic Markov chain model. Long-term persistence occurs when the rate of adaptation exceeds the rate of environmental deterioration for some genotypes. Long-term persistence times are consistent with typical fossil species persistence times of several million years. Immediately preceding extinction, fitness declines rapidly, appearing as though a catastrophe disrupted a stably established population, even though gradual evolutionary processes are responsible. New populations go through an establishment phase where, despite being demographically viable, their extinction risk is elevated. Should the population survive long enough, extinction risk later becomes constant over time. © 2016 The Author(s). Evolution © 2016 The Society for the Study of Evolution.

  9. Neonatal and infantile acne vulgaris: an update.

    Science.gov (United States)

    Serna-Tamayo, Cristian; Janniger, Camila K; Micali, Giuseppe; Schwartz, Robert A

    2014-07-01

    Acne may present in neonates, infants, and small children. Neonatal and infantile acne vulgaris are not considered to be rare. The presentation of acne in this patient population sometimes represents virilization and may portend later development of severe adolescent acne. Neonatal and infantile acne vulgaris must be distinguished from other cutaneous disorders seen in newborns and infants. Infantile acne tends to be more pleomorphic and inflammatory, thus requiring more vigorous therapy than neonatal acne.

  10. Neonatal tetanus mortality in coastal Kenya

    DEFF Research Database (Denmark)

    Bjerregaard, P; Steinglass, R; Mutie, D M

    1993-01-01

    In a house-to-house survey in Kilifi District, Kenya, mothers of 2556 liveborn children were interviewed about neonatal mortality, especially from neonatal tetanus (NNT). The crude birth rate was 60.5 per 1000 population, the neonatal mortality rate 21.1 and the NNT mortality rate 3.1 per 1000 li...... indicates that over the past decade the surveyed area has greatly reduced neonatal and NNT mortality. Possible strategies for accelerated NNT control have been identified by the survey....

  11. Studies of Health and Long-Term Care Expenditure Growth in Aging Populations

    NARCIS (Netherlands)

    C.A.M. de Meijer (Claudine)

    2012-01-01

    textabstractIn recent decades, elderly populations in most developed countries have increased considerably, both in absolute and relative terms. This growth of the elderly share of the population is mainly attributable to two demographic transitions: the (simultaneous) increase in longevity and

  12. The long-term effect of the timing of fertility decline on population size

    NARCIS (Netherlands)

    O'Neill, BC; Scherbov, S; Lutz, W

    1999-01-01

    Existing long-range population projections imply that the timing of the fertility transition has a relatively unimportant effect on long-term population size when compared with the impact of the level at which fertility is assumed eventually to stabilize. However, this note shows that the effect of

  13. Neonatal vitamin D status and risk of multiple sclerosis: A population-based case-control study.

    Science.gov (United States)

    Nielsen, Nete Munk; Munger, Kassandra L; Koch-Henriksen, Nils; Hougaard, David M; Magyari, Melinda; Jørgensen, Kristian T; Lundqvist, Marika; Simonsen, Jacob; Jess, Tine; Cohen, Arieh; Stenager, Egon; Ascherio, Alberto

    2017-01-03

    As previous research has suggested that exposure to vitamin D insufficiency in utero may have relevance for the risk of multiple sclerosis (MS), we aimed to examine the direct association between level of neonatal vitamin D and risk of MS. We carried out a matched case-control study. Dried blood spots samples (DBSS) belonging to 521 patients with MS were identified in the Danish Newborn Screening Biobank. For every patient with MS, 1-2 controls with the same sex and birth date were retrieved from the Biobank (n = 972). Level of 25-hydroxyvitamin D (25[OH]D) in the DBSS was measured using liquid chromatography tandem mass spectroscopy. The association between different levels of 25(OH)D and risk of MS was evaluated by odds ratios (OR) calculated in conditional logistic regression models. We observed that lower levels of 25(OH)D in neonates were associated with an increased risk of MS. In the analysis by quintiles, MS risk was highest among individuals in the bottom quintile (vitamin D are associated with an increased risk of MS. In light of the high prevalence of vitamin D insufficiency among pregnant women, our observation may have importance for public health. © 2016 American Academy of Neurology.

  14. Recurrence risk of low Apgar score among term singletons: a population-based cohort study

    NARCIS (Netherlands)

    Ensing, Sabine; Schaaf, Jelle M.; Abu-Hanna, Ameen; Mol, Ben W. J.; Ravelli, Anita C. J.

    2014-01-01

    To examine the risk of recurrence of low Apgar score in a subsequent term singleton pregnancy. Population-based cohort study. The Netherlands. A total of 190,725 women with two subsequent singleton term live births between 1999 and 2007. We calculated the recurrence risk of low Apgar score after

  15. Effects of short-term supplementation of clinoptilolite in colostrum and milk on the concentration of some serum minerals in neonatal dairy calves.

    Science.gov (United States)

    Mohri, M; Seifi, H A; Maleki, M

    2008-01-01

    In recent years, the use of both natural and synthetic zeolites in animal nutrition has increased mainly to improve their performance, health, and to protect against mycotoxin intoxication. Thirty calves were used in the present study for the determination of some physiologic effects of clinoptilolite supplementation. The animals were divided equally into three groups (control, test 1, and test 2). The three groups of calves were homogeneous for parity of dams, sex, and month of birth. For group test 1, clinoptilolite in the concentration of 2% of each colostrum meal was added for 48 h, and for group test 2, clinoptilolite in the concentration of 2% was added to each colostrum and milk meal for 14 days. Blood samples were taken from all calves 12 h after birth and at the end of the first, second, third, forth, fifth, and sixth weeks of life. Calcium (Ca), phosphorus (P), magnesium (Mg), iron (Fe), sodium (Na), and potassium (K) were determined in the serum. For statistical analysis of data, a repeated measures approach using analysis of variance (ANOVA) with mixed linear models was used. Clinoptilolite supplementation had significant effect on the concentrations of calcium, phosphorus, sodium, and iron. The concentrations of Fe significantly higher in test group 2 than other trial groups (p importance of dietary phosphorus in many physiologic processes, the level of phosphorus in diet of neonatal dairy calves must be considered and adapted when clinoptilolite was supplemented. With an adequate supply of good quality drinking water, cattle can tolerate large quantities of dietary sodium chloride. Thus, it seems that significant increase in serum Na concentration during short-term supplementation of clinoptilolite in neonatal calves could be well tolerated without any adverse effects.

  16. Effect of position of infant during phototherapy in management of hyperbilirubinemia in late preterm and term neonates: a randomized controlled trial.

    Science.gov (United States)

    Bhethanabhotla, S; Thukral, A; Sankar, M J; Agarwal, R; Paul, V K; Deorari, A K

    2013-10-01

    To evaluate the effect of supine position when compared with periodic change of position during phototherapy in late preterm and term neonates (35 to 42 weeks) with hyperbilirubinemia on the duration of phototherapy. We randomly allocated enrolled neonates with hyperbilirubinemia to either no change in position (supine group (SG); n=54) or two-hourly change of position from supine to prone and vice versa (turning group (TG); n=46). All the infants received single surface phototherapy by two dedicated compact fluorescent light units. Total serum bilirubin (TSB) was measured at the start of phototherapy and then every 12 ± 2 h until the end of phototherapy. Phototherapy was stopped when two values were below the cut-off for age and gestational age as per the American Academy of Pediatrics Subcommittee on Hyperbilirubinemia guidelines nomogram for the management of hyperbilirubinemia in infants >35 weeks of gestation. The primary outcome was duration of phototherapy and secondary outcome was rate of fall of bilirubin within the first 24 ± 2 h after the initiation of phototherapy. Baseline characteristics including birth weight (g, 2752 ± 478 vs 2748 ± 416 P=0.96), gestation (week, 37.1 ± 1.2 vs 37.4 ± 1.3, P=0.26) were similar in the two groups. There was no difference in the duration of phototherapy between the SG (mean ± s.d., hour, 25.5 ± 8) and TG (mean ± s.d., hour, 24.8 ± 5), mean difference (95% confidence interval), hour, 0.7 (-2.03, 3.44, P=0.6). Rate of fall of bilirubin was also similar in both supine and turning groups with mean difference of -0.020 (95% confidence interval: -0.061, 0.021, P=0.34). Nursing babies in supine position when compared with periodic position change during phototherapy does not decrease the duration of phototherapy.

  17. Rates of Very Preterm Birth in Europe and Neonatal Mortality Rates

    DEFF Research Database (Denmark)

    Field, David John; Draper, Elizabeth S; Fenton, Alan

    2008-01-01

    OBJECTIVE: To estimate the influence of variation in the rate of very preterm delivery on the reported rate of neonatal death in ten European regions. DESIGN: Comparison of 10 separate geographically defined European populations, from nine European countries, over a one year period (seven months......) a standardised rate of very preterm delivery and b) the existing death rate for babies born at this gestation in the individual region. This produced much greater homogeneity in terms of neonatal mortality. CONCLUSIONS: Variation in the rate of very preterm delivery has a major influence on reported neonatal...

  18. Pharmacotherapy for neonatal seizures: current knowledge and future perspectives

    OpenAIRE

    Donovan, Maria D.; Griffin, Brendan T; Kharoshankaya, Liudmila; Cryan, John F.; Boylan, Geraldine B.

    2016-01-01

    Seizures are the most common neurological emergencies in the neonatal period and are associated with poor neurodevelopmental outcomes. Seizures affect up to five per 1000 term births and population-based studies suggest that they occur even more frequently in premature infants. Seizures are a sign of an underlying cerebral pathology, the most common of which is hypoxic-ischaemic encephalopathy in term infants. Due to a growing body of evidence that seizures exacerbate cerebral injury, effecti...

  19. Effects of climate change on long-term population growth of pronghorn in an arid environment

    Science.gov (United States)

    Gedir, Jay V.; Cain, James W.; Harris, Grant; Turnbull, Trey T.

    2015-01-01

    Climate often drives ungulate population dynamics, and as climates change, some areas may become unsuitable for species persistence. Unraveling the relationships between climate and population dynamics, and projecting them across time, advances ecological understanding that informs and steers sustainable conservation for species. Using pronghorn (Antilocapra americana) as an ecological model, we used a Bayesian approach to analyze long-term population, precipitation, and temperature data from 18 populations in the southwestern United States. We determined which long-term (12 and 24 months) or short-term (gestation trimester and lactation period) climatic conditions best predicted annual rate of population growth (λ). We used these predictions to project population trends through 2090. Projections incorporated downscaled climatic data matched to pronghorn range for each population, given a high and a lower atmospheric CO2 concentration scenario. Since the 1990s, 15 of the pronghorn populations declined in abundance. Sixteen populations demonstrated a significant relationship between precipitation and λ, and in 13 of these, temperature was also significant. Precipitation predictors of λ were highly seasonal, with lactation being the most important period, followed by early and late gestation. The influence of temperature on λ was less seasonal than precipitation, and lacked a clear temporal pattern. The climatic projections indicated that all of these pronghorn populations would experience increased temperatures, while the direction and magnitude of precipitation had high population-specific variation. Models predicted that nine populations would be extirpated or approaching extirpation by 2090. Results were consistent across both atmospheric CO2 concentration scenarios, indicating robustness of trends irrespective of climatic severity. In the southwestern United States, the climate underpinning pronghorn populations is shifting, making conditions increasingly

  20. Prenatal stress alters amygdala functional connectivity in preterm neonates.

    Science.gov (United States)

    Scheinost, Dustin; Kwon, Soo Hyun; Lacadie, Cheryl; Sze, Gordon; Sinha, Rajita; Constable, R Todd; Ment, Laura R

    2016-01-01

    Exposure to prenatal and early-life stress results in alterations in neural connectivity and an increased risk for neuropsychiatric disorders. In particular, alterations in amygdala connectivity have emerged as a common effect across several recent studies. However, the impact of prenatal stress exposure on the functional organization of the amygdala has yet to be explored in the prematurely-born, a population at high risk for neuropsychiatric disorders. We test the hypothesis that preterm birth and prenatal exposure to maternal stress alter functional connectivity of the amygdala using two independent cohorts. The first cohort is used to establish the effects of preterm birth and consists of 12 very preterm neonates and 25 term controls, all without prenatal stress exposure. The second is analyzed to establish the effects of prenatal stress exposure and consists of 16 extremely preterm neonates with prenatal stress exposure and 10 extremely preterm neonates with no known prenatal stress exposure. Standard resting-state functional magnetic resonance imaging and seed connectivity methods are used. When compared to term controls, very preterm neonates show significantly reduced connectivity between the amygdala and the thalamus, the hypothalamus, the brainstem, and the insula (p amygdala and the thalamus, the hypothalamus, and the peristriate cortex (p amygdala connectivity associated with preterm birth. Functional connectivity from the amygdala to other subcortical regions is decreased in preterm neonates compared to term controls. In addition, these data, for the first time, suggest that prenatal stress exposure amplifies these decreases.

  1. Gentamicin resistance among Escherichia coli strains isolated in neonatal sepsis.

    Science.gov (United States)

    Hasvold, J; Bradford, L; Nelson, C; Harrison, C; Attar, M; Stillwell, T

    2013-01-01

    Neonatal sepsis is a significant cause of morbidity and mortality among term and preterm infants. Ampicillin and gentamicin are standard empiric therapy for early onset sepsis. Four cases of neonatal sepsis secondary to Escherichia coli (E. coli) found to be gentamicin resistant occurred within a five week period in one neonatal intensive care unit (NICU). To determine whether these cases could be tied to a single vector of transmission, and to more broadly evaluate the incidence of gentamicin resistant strains of E. coli in the neonatal population at our institution compared to other centers, we reviewed the charts of the four neonates (Infants A through D) and their mothers. The E. coli isolates were sent for Pulse Field Gel Electrophoresis (PFGE) to evaluate for genetic similarity between strains. We also reviewed all positive E. coli cultures from one NICU over a two year period. Infants A and B had genetically indistinguishable strains which matched that of urine and placental cultures of Infant B's mother. Infant C had a genetically distinct organism. Infant D, the identical twin of Infant C, did not have typing performed. Review of all cultures positive for E. coli at our institution showed a 12.9 percent incidence of gentamicin-resistance. A review of other studies showed that rates of resistance vary considerably by institution. We conclude that gentamicin-resistant E. coli is a relatively uncommon cause of neonatal sepsis, but should remain a consideration in patients who deteriorate despite initiation of empiric antibiotics.

  2. Neonatal RIFLE.

    Science.gov (United States)

    Ricci, Zaccaria; Ronco, Claudio

    2013-09-01

    A standardized classification of acute kidney injury (AKI) has recently been proposed with the RIFLE (Risk, Injury, Failure, Loss of function, End-stage kidney disease) score. Such definition/classification has been applied both in adult and in paediatric patients. Neonatal definition of AKI likely results as a challenging task due to the peculiar renal pathophysiology of newborn critically ill patients. Their so-called 'immature kidneys' require careful management and neonatal AKI is frequently complicated by unfavourable outcomes. A recent attempt to implement the RIFLE score with a neonatal modification might lead to improvement on the knowledge of AKI incidence and epidemiology.

  3. Falling population incidence of eclampsia. A case-control study of short term outcome.

    Science.gov (United States)

    Geirsson, R T; Arngrimsson, R; Apalset, E; Einarsson, A; Snaedal, G

    1994-07-01

    Eclampsia remains a serious complication of pregnancy and childbirth and factors related to morbidity require continued evaluation. Retrospective case-control study on the incidence and outcome of eclampsia. A defined total island population over 20 years. All centrally collected birth registration returns in Iceland for the years 1972-1991 were reviewed to identify women with the diagnosis of eclampsia, selecting women delivering immediately before and after the eclamptic case as controls. Information from all places where women had delivered was obtained to ensure that no case was missed. Maternity records were reviewed to verify the diagnosis and obtain maternal and neonatal data. Forty women had eclampsia (0.046% of deliveries). The incidence diminished between the decades 1972-81 and 1982-91 (p < 0.05), as did the incidence of eclamptic convulsions before delivery. Eclamptic women were more often primiparous, younger and delivered earlier than controls. Preterm delivery and a low ponderal index were more common among offspring of the eclamptic mothers and the male/female ratio was lower. The incidence of eclampsia in the population is falling. Common features related to the condition were confirmed. Severe maternal illness is rare, but the babies often appear growth-retarded and are delivered preterm.

  4. Branched-chain amino acid requirements for enterally fed term neonates in the first month of life

    NARCIS (Netherlands)

    de Groof, Femke; Huang, Lisha; van Vliet, Ineke; Voortman, Gardi J.; Schierbeek, Henk; Roksnoer, Lodi C. W.; Vermes, Andras; Chen, Chao; Huang, Ying; van Goudoever, Johannes B.

    2014-01-01

    Knowledge of essential amino acid requirements in infants is important because excessive intake of protein can lead to increased long-term morbidity such as obesity. A deficient intake may lead to suboptimal growth and impaired neurodevelopment. The current recommended branched-chain amino acid

  5. Previous abortion and risk of pre-term birth: a population study.

    Science.gov (United States)

    Freak-Poli, Rosanne; Chan, Annabelle; Tucker, Graeme; Street, Jackie

    2009-01-01

    This population study was undertaken to determine whether previous abortion is an independent risk factor for pre-term birth and to calculate population-attributable risks for risk factors. All South Australian first singleton births in 1998-2003 (n = 42 269) were included in a multivariable logistic regression analysis, comparing pre-term births with term births. Risk factors for pre-term birth were found to be: being indigenous, single, a smoker [adjusted odds ratio (AOR) 1.28, 95% confidence interval 1.17-1.41], age 40 years or older, reproductive technology assistance, threatened miscarriage, antepartum haemorrhage, urinary tract infection, pregnancy hypertension and suspected intra-uterine growth restriction. A previous spontaneous abortion was of borderline statistical significance, whereas a previous induced abortion (AOR 1.25, 1.13-1.40) was an independent risk factor. A dose-response relationship was found with increasing number of previous spontaneous or induced abortions. Population-attributable risks were highest for pregnancy hypertension (12.4%) and antepartum haemorrhage (9.2%). Smoking and previous induced abortion had risks of 4.7% and 2.7%, respectively. Among indigenous women, 51% of whom smoked, 16.4% of pre-term birth could be attributed to smoking. A previous induced abortion and smoking during pregnancy (particularly among indigenous women) are preventable risk factors for pre-term birth. Their population-attributable risks are likely to be under-estimates from under-reporting.

  6. Sevoflurane postconditioning improves long-term learning and memory of neonatal hypoxia-ischemia brain damage rats via the PI3K/Akt-mPTP pathway.

    Science.gov (United States)

    Lai, Zhongmeng; Zhang, Liangcheng; Su, Jiansheng; Cai, Dongmiao; Xu, Qingxiu

    2016-01-01

    Volatile anesthetic postconditioning has been documented to provide neuroprotection in adult animals. Our aim was to investigate whether sevoflurane postconditioning improves long-term learning and memory of neonatal hypoxia-ischemia brain damage (HIBD) rats, and whether the PI3K/Akt pathway and mitochondrial permeability transition pore (mPTP) opening participate in the effect. Seven-day-old Sprague-Dawley rats were subjected to brain HI and randomly allocated to 10 groups (n=24 each group) and treated as follows: (1) Sham, without hypoxia-ischemia; (2) HI/Control, received cerebral hypoxia-ischemia; (3) HI+Atractyloside (Atr), (4) HI+Cyclosporin A (CsA), (5) HI+sevoflurane (Sev), (6) HI+Sev+ LY294002 (LY), (7) HI+Sev+ L-NAME (L-N), (8) HI+Sev+ SB216763 (SB), (9) HI+Sev+Atr, and (10) HI+Sev+CsA. Twelve rats in each group underwent behavioral testing and their brains were harvested for hippocampus neuron count and morphology study. Brains of the other 12 animals were harvested 24h after intervention to examine the expression of Akt, p-Akt, eNOS, p-eNOS, GSK-3β, p-GSK-3β by Western bolting and mPTP opening. Sevoflurane postconditioning significantly improved the long-term cognitive performance of the rats, increased the number of surviving neurons in CA1 and CA3 hippocampal regions, and protected the histomorphology of the left hippocampus. These effects were abolished by inhibitors of PI3K/eNOS/GSK-3β. Although blocking mPTP opening simulated sevoflurane postconditioning-induced neuroprotection, it failed to enhance it. Sevoflurane postconditioning exerts a neuroprotective effect against HIBD in neonatal rats via PI3K/Akt/eNOS and PI3K/Akt/GSK-3β pathways, and blockage of mPTP opening may be involved in attenuation of histomorphological injury. Copyright © 2015 Elsevier B.V. All rights reserved.

  7. Profile of newborns undergoing early stimulation in a neonatal intensive care unit

    National Research Council Canada - National Science Library

    Karla Camila Lima de Souza; Nataly Gurgel Campos; Francisco Fleury Uchoa Santos Júnior

    2014-01-01

    Objective: To describe the profile of newborns undergoing early stimulation in a neonatal intensive care unit, characterizing the study population according to their neonatal variables and risk factors...

  8. Profile of newborns undergoing early stimulation in a neonatal intensive care unit

    National Research Council Canada - National Science Library

    Karla Camila Lima de Souza; Nataly Gurgel Campos; Francisco Fleury Uchoa Santos Júnior

    2013-01-01

    Objective: To describe the profile of newborns undergoing early stimulation in a neonatal intensive care unit, characterizing the study population according to their neonatal variables and risk factors...

  9. Hidrocolpos neonatal Neonatal hydrocolpos

    Directory of Open Access Journals (Sweden)

    Yanett Sarmiento Portal

    2009-12-01

    Full Text Available Se presenta el caso de un recién nacido del sexo femenino, raza blanca, hija de matrimonio no consanguíneo e historia familiar negativa de defectos congénitos, a quien se detectó, a las 62 h de nacida, una tumoración de aproximadamente 2 cm de diámetro, de aspecto deslustrado, renitente, que protruía a través del introito vaginal al llanto. Se realizó valoración conjunta con especialistas en cirugía pediátrica, urología pediátrica, ginecoobstetricia, radiología, genética clínica y cardiología, y se iniciaron los estudios necesarios. Se diagnosticó un hidrocolpos neonatal por himen imperforado. Se realizó una himenotomía al cuarto día de vida y se evacuó abundante cantidad de secreción seromucosa. Se dio el alta a la paciente con 16 días y evolución satisfactoria. Se realiza una caracterización clínica de la patología y se ofrece una revisión actualizada sobre el tema. Se presentan además fotografías del caso.This is the case of a white female newborn, child of a non-consanguinity married couple and a with negative family history of congenital defects in whom at 62 hours of born a dull, renitent tumor of almost 2 cm diameter, and protruding through the vaginae introitus when she cried was detected. Authors made a joint assessment with specialists in pediatric and urology surgery, gynecology-obstetrics, radiology, clinical genetics and cardiology. A hymenotomy was performed at 4 days of life voiding an abundant amount of seromucous secretion. Patient was discharged at 16 days and a satisfactory course. A clinical characterization of pathology was made offering an updated review on thus matter. Photographies from this case are showed.

  10. Neonatal conjunctivitis

    Science.gov (United States)

    Newborn conjunctivitis; Conjunctivitis of the newborn; Ophthalmia neonatorum; Eye infection - neonatal conjunctivitis ... diseases spread through sexual contact to prevent newborn conjunctivitis caused by these infections. Putting eye drops into ...

  11. Neonatal Death

    Science.gov (United States)

    ... a premature baby include pneumonia (a lung infection), sepsis (a blood infection) and meningitis (an infection in the fluid around the brain and spinal cord). What birth defects most often cause neonatal death? The most common birth defects that cause ...

  12. Neonatal rotavirus infections.

    Science.gov (United States)

    Haffejee, I E

    1991-01-01

    Rotavirus (RV) infections in newborns differ from those in older infants; the majority of RV infections that occur in neonates are mild or asymptomatic. Generally, fewer than one-third of RV-infected neonates have diarrhea, although rates have reached 77% in some hospital nursery populations. Cases with severe diarrhea, necrotizing enterocolitis, bowel perforation, and death have been reported, but such cases are very rare. Infection usually occurs during the first week of life and generally invokes a mucosal antibody response without a concomitant serologic antibody response. Neonatal RV infections appear to incite an immune response that affords significant protection against severe RV-associated diarrhea, although not necessarily against a symptomatic RV infection later in life. Strains that cause neonatal infections differ from those that infect older infants; the outer-capsid protein VP4 is highly conserved in "nursery" RV strains, a property that probably plays a key role in their attenuated virulence. Immaturity of proteolytic enzymes in the neonatal gut and presence of secretory anti-RV IgA and trypsin inhibitors in breast milk are other factors that could account for the asymptomatic nature of RV infections in newborns. Natural "nursery" strains of RV are currently being evaluated as vaccine candidates.

  13. A model program: neonatal nurse practitioners providing community health care for high-risk infants.

    Science.gov (United States)

    Vasquez, Elias Provencio; Pitts, Kathleen; Mejia, Nilson Enrique

    2008-01-01

    Perinatal drug exposure costs our communities millions of dollars each year in hospital fees and in services such as foster care, child protection, and drug treatment. Infants and their families in this group require substantial long-term health care and community resources. Neonatal health care providers should take an active role in developing and implementing home visitation programs to support early hospital discharge and continuity of care for these high-risk infants and their families. Neonatal nurse practitioners should prepare in the future to practice not only in secondary-- and tertiary--level neonatal centers, but also in follow-up clinics, long-term developmental centers, and the community This article describes a home intervention program delivered by neonatal nurse practitioners for high-risk infants and their mothers. The target population is infants exposed prenatally to drugs and/or alcohol.

  14. Effects of ultrasound pregnancy dating on neonatal morbidity in late preterm and early term male infants: a register-based cohort study.

    Science.gov (United States)

    Kullinger, Merit; Haglund, Bengt; Kieler, Helle; Skalkidou, Alkistis

    2016-10-31

    Assessing gestational age by ultrasound can introduce a systematic bias due to sex differences in early growth. This cohort study included data on 1,314,602 births recorded in the Swedish Medical Birth Register. We compared rates of prematurity-related adverse outcomes in male infants born early term (gestational week 37-38) or late preterm (gestational week 35-36), in relation to female infants, between a time period when pregnancy dating was based on the last menstrual period (1973-1978), and a time period when ultrasound was used for pregnancy dating (1995-2010), in order to assess the method's influence on outcome by fetal sex. As expected, adverse outcomes were lower in the later time period, but the reduction in prematurity-related morbidity was less marked for male than for female infants. After changing the pregnancy dating method, male infants born early term had, in relation to female infants, higher odds for pneumothorax (Cohort ratio [CR] 2.05; 95 % confidence interval [CI] 1.33-3.16), respiratory distress syndrome of the newborn (CR 1.99; 95 % CI 1.33-2.98), low Apgar score (CR 1.26; 5 % CI 1.08-1.47), and hyperbilirubinemia (CR 1.12; 95 % CI 1.06-1.19), when outcome was compared between the two time periods. A similar trend was seen for late preterm male infants. Misclassification of gestational age by ultrasound, due to size differences, can partially explain currently reported sex differences in early term and late preterm infants' adverse neonatal outcomes, and should be taken into account in clinical decisions and when interpreting study results related to fetal sex.

  15. Short-term outcomes of inborn v. outborn very-low-birth-weight neonates (<1 500 g) in the neonatal nursery at Groote Schuur Hospital, Cape Town, South Africa.

    Science.gov (United States)

    Gibbs, L; Tooke, L; Harrison, M C

    2017-09-22

    The Groote Schuur Hospital (GSH) neonatal nursery provides level 3 care for the Metro West Health District in the Western Cape Province of South Africa. Worldwide, very-low-birth-weight (VLBW) neonates delivered in level 3 neonatal units have better outcomes than those transported from other facilities. To identify the characteristics and outcomes of VLBW neonates at GSH, with emphasis on differences between inborns and outborns. This was a retrospective cohort study. VLBW neonates admitted to the GSH neonatal nursery between 1 January 2012 and 31 December 2013 were enrolled on the Vermont Oxford Network database and reviewed. Of 1 032 VLBW neonates enrolled, 906 (87.8%) were delivered at GSH and 126 (12.2%) were outborn. Access to antenatal care, antenatal steroids and inborn status were statistically significant predictors of mortality and survival without morbidity. The mothers of inborn patients were more likely than those of outborn patients to have received antenatal care (89.1% v. 57.9%; p<0.0001) and antenatal steroids (64.2% v. 15.2%; p<0.0001). Inborns required less ventilatory support (16.2% v. 57.9%; p<0.0001) and surfactant administration than outborns (25.3% v. 65.1%; p<0.0001), and developed less late infection (8.8% v. 23.4%; p<0.0001), severe intraventricular haemorrhage (3.7% v. 13.9%; p<0.0001) and chronic lung disease (5.3% v. 13.4%; p=0.003). The incidence of necrotising enterocolitis was similar in the two groups (5.9% v. 8.7%; p=0.227). The mortality rate was 18.4% for inborns and 33.3% for outborns (p<0.0001). Mortality declined as birth weight increased. Of the survivors, 85.0% of inborns and 70.2% of outborns did not develop serious morbidity (p=0.003). VLBW neonates delivered at GSH had better outcomes than their outborn counterparts. Perinatal regionalisation is beneficial to our patients, with antenatal care, timeous transfer in utero and antenatal steroids contributing to excellent outcomes.

  16. Short-term outcomes of inborn v. outborn very-low-birth-weight neonates (<1 500 g in the neonatal nursery at Groote Schuur Hospital, Cape Town, South Africa

    Directory of Open Access Journals (Sweden)

    L Gibbs

    2017-10-01

    Full Text Available Background. The Groote Schuur Hospital (GSH neonatal nursery provides level 3 care for the Metro West Health District in the Western Cape Province of South Africa. Worldwide, very-low-birth-weight (VLBW neonates delivered in level 3 neonatal units have better outcomes than those transported from other facilities. Objectives. To identify the characteristics and outcomes of VLBW neonates at GSH, with emphasis on differences between inborns and outborns. Methods. This was a retrospective cohort study. VLBW neonates admitted to the GSH neonatal nursery between 1 January 2012 and 31 December 2013 were enrolled on the Vermont Oxford Network database and reviewed. Results. Of 1 032 VLBW neonates enrolled, 906 (87.8% were delivered at GSH and 126 (12.2% were outborn. Access to antenatal care, antenatal steroids and inborn status were statistically significant predictors of mortality and survival without morbidity. The mothers of inborn patients were more likely than those of outborn patients to have received antenatal care (89.1% v. 57.9%; p<0.0001 and antenatal steroids (64.2% v. 15.2%; p<0.0001. Inborns required less ventilatory support (16.2% v. 57.9%; p<0.0001 and surfactant administration than outborns (25.3% v. 65.1%; p<0.0001, and developed less late infection (8.8% v. 23.4%; p<0.0001, severe intraventricular haemorrhage (3.7% v. 13.9%; p<0.0001 and chronic lung disease (5.3% v. 13.4%; p=0.003. The incidence of necrotising enterocolitis was similar in the two groups (5.9% v. 8.7%; p=0.227. The mortality rate was 18.4% for inborns and 33.3% for outborns (p<0.0001. Mortality declined as birth weight increased. Of the survivors, 85.0% of inborns and 70.2% of outborns did not develop serious morbidity (p=0.003. Conclusions. VLBW neonates delivered at GSH had better outcomes than their outborn counterparts. Perinatal regionalisation is beneficial to our patients, with antenatal care, timeous transfer in utero and antenatal steroids contributing to

  17. Transcutaneous bilirubin nomograms in African neonates

    Science.gov (United States)

    Mabogunje, Cecilia A.; Imosemi, Donald O.; Emokpae, Abieyuwa A.

    2017-01-01

    Background The use of transcutaneous bilirubin (TcB) as a screening tool, based on relevant population-specific nomogram, or proxy for total serum bilirubin (TSB) levels in assessing the risk of subsequent hyperbilirubinemia is supported by several clinical guidelines on the management of neonatal hyperbilirubinemia. However, while TcB has been found to significantly over-estimate TSB in neonates of African-American ancestry, with variations across TcB devices, no nomogram has been specifically reported for this racial group. This study therefore set out to develop TcB nomograms for healthy late pre-term and term black African neonates derived from two widely used bilirubinometers. Methods A retrospective analysis of 12,377 TcB measurements obtained from 6,373 neonates in the first postnatal week, over a period of 48 months using Bilichek and JM-103 bilirubinometers. TcB percentiles were computed from hour-specific TcB values and nomograms developed for each of the screening devices. Predictive ability of the 75th and 95th percentiles to detect significant hyperbilirubinemia was evaluated between 24–96 hours of age. The 95th percentile curve was compared with those from other populations. Results The velocity of TcB rise at 75th and 95th percentiles was generally higher with JM-103 than Bilichek. Both percentiles also peaked at higher TcB levels with JM-103. The 95th percentile for both instruments showed a downward trend as from approximately 114 hours. Both instruments had high negative predictive values across the selected time-epochs and lower discriminatory ability than reported in non-black populations. Conclusions The predictive utility of TcB as a potential screening tool varies across devices in black African neonates with or without risk of significant hyperbilirubinemia, and lower than levels reported in non-black populations. Equipment-specific nomograms should be considered for TcB monitoring in this racial population where TSB is not routinely

  18. Following the ontogeny of retinal waves: pan-retinal recordings of population dynamics in the neonatal mouse

    Science.gov (United States)

    Maccione, Alessandro; Hennig, Matthias H; Gandolfo, Mauro; Muthmann, Oliver; van Coppenhagen, James; Eglen, Stephen J; Berdondini, Luca; Sernagor, Evelyne

    2014-01-01

    The immature retina generates spontaneous waves of spiking activity that sweep across the ganglion cell layer during a limited period of development before the onset of visual experience. The spatiotemporal patterns encoded in the waves are believed to be instructive for the wiring of functional connections throughout the visual system. However, the ontogeny of retinal waves is still poorly documented as a result of the relatively low resolution of conventional recording techniques. Here, we characterize the spatiotemporal features of mouse retinal waves from birth until eye opening in unprecedented detail using a large-scale, dense, 4096-channel multielectrode array that allowed us to record from the entire neonatal retina at near cellular resolution. We found that early cholinergic waves propagate with random trajectories over large areas with low ganglion cell recruitment. They become slower, smaller and denser when GABAA signalling matures, as occurs beyond postnatal day (P) 7. Glutamatergic influences dominate from P10, coinciding with profound changes in activity dynamics. At this time, waves cease to be random and begin to show repetitive trajectories confined to a few localized hotspots. These hotspots gradually tile the retina with time, and disappear after eye opening. Our observations demonstrate that retinal waves undergo major spatiotemporal changes during ontogeny. Our results support the hypotheses that cholinergic waves guide the refinement of retinal targets and that glutamatergic waves may also support the wiring of retinal receptive fields. PMID:24366261

  19. Accuracy of transcutaneous bilirubin measured by the BiliCare device in late preterm and term neonates.

    Science.gov (United States)

    Kitsommart, Ratchada; Yangthara, Buranee; Wutthigate, Punnanee; Paes, Bosco

    2016-11-01

    The objective of this study is to explore the accuracy and performance of a new transcutaneous bilirubinometer (TCB) for the screening of jaundice in late preterm and term infants. A cross-sectional study was conducted. TCB measurements were performed using the BiliCare(TM) bilirubinometer. Paired TCB and serum bilirubin (SB) measurements were analysed. One hundred and fourteen paired samples were collected from 93 healthy late preterm and term infants. Bilirubin measurements were done at median (interquartile range) of 50.5 (34, 72) hours. The mean (SD) difference between the TCB and SB was 1.87 (1.98) mg/dL. A TCB cut-off level at 8.0 mg/dL provides a sensitivity of 97.3% with a negative predictive value (NPV) of 87.5% to detect a SB level of at least 8.0 mg/dL. For SB levels of at least 10.0 mg/dL, a TCB cut-off at 9.0 mg/dL shows a sensitivity of 97.5%; NPV 95.4%. For a SB level of at least 13.0 mg/dL, a TCB cut-off at 12 or 13 mg/dL had a sensitivity of 92.9% and NPV of 98.7%. The BiliCare(TM) demonstrated good performance with positive bias for the screening of jaundice in healthy late preterm or term infants. However, if adopted, proper cut-off levels should be chosen because of sub-optimal device precision.

  20. Restrictive management of neonatal polycythemia.

    Science.gov (United States)

    Morag, Iris; Strauss, Tzipora; Lubin, Daniel; Schushan-Eisen, Irit; Kenet, Gili; Kuint, Jacob

    2011-10-01

    Partial exchange transfusion (PET) is traditionally suggested as treatment for neonates diagnosed with polycythemia. Nevertheless, justification of this treatment is controversial. We evaluated the risk for short-term complications associated with a restrictive treatment protocol for neonatal polycythemia. A retrospective cross-sectional analytical study was conducted. Three treatment groups were defined and managed according to their degree of polycythemia, defined by capillary tube filled with venous blood and manually centrifuged hematocrit: group 1, hematocrit 65 to 69% and no special treatment was recommended; group 2, hematocrit 70 to 75% and intravenous fluids were given and feedings were withheld until hematocrit decreased to polycythemia. The overall rate of short-term complications was 15% (28 neonates). Seizures, proven necrotizing enterocolitis, or thrombosis did not occur in any participating neonates. PET was performed in 31 (16%) neonates. The groups did not differ in their rate of early neonatal morbidities or length of hospitalization. Restrictive treatment for neonatal asymptomatic polycythemia is not associated with an increased risk of short-term complications. © Thieme Medical Publishers.

  1. Interpretation of neonatal chest radiography

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Hye Kyung [Dept. of Radiology, Kangwon National University Hospital, Chuncheon (Korea, Republic of)

    2016-05-15

    Plain radiographs for infants in the neonatal intensive care unit are obtained using the portable X-ray equipment in order to evaluate the neonatal lungs and also to check the position of the tubes and catheters used for monitoring critically-ill neonates. Neonatal respiratory distress is caused by a variety of medical or surgical disease conditions. Clinical information about the gestational week, respiratory symptoms, and any events during delivery is essential for interpretation of the neonatal chest radiographs. Awareness of common chest abnormality in the prematurely born or term babies is also very important for chest evaluation in the newborn. Furthermore, knowledge about complications such as air leaks and bronchopulmonary dysplasia following treatment are required to accurately inform the clinicians. The purpose of this article was to briefly review radiographic findings of chest diseases in newborns that are relatively common in daily practice.

  2. Effect of maternal and neonatal factors on cord blood thyroid stimulating hormone

    Directory of Open Access Journals (Sweden)

    Sheetal G Lakshminarayana

    2016-01-01

    Full Text Available Background: Congenital hypothyroidism (CH is most common preventable cause of mental retardation in children. Cord blood Thyroid Stimulating Hormone (CBTSH level is an accepted screening tool for CH. Objectives: To study CBTSH profile in neonates born at tertiary care referral center and to analyze the influence of maternal and neonatal factors on their levels. Design: Cross retrospective sectional study. Methods: Study population included 979 neonates (males = 506 to females = 473. The CBTSH levels were estimated using electrochemiluminescence immunoassay on Cobas analyzer. Kit based cut-offs of TSH level were used for analysis. All neonates with abnormal CBSTH levels, were started on levothyroxine supplementation 10 μg/Kg/day and TSH levels were reassessed as per departmental protocol. Results: The mean CBTSH was 7.82 μIU/mL (Range 0.112 to 81.4, SD = 5.48. The mean CBTSH level was significantly higher in first order neonates, neonates delivered by assisted vaginal delivery and normal delivery, delivered at term or preterm, neonates with APGAR score 16.10 and 16.1 μIU/mL was significantly higher in neonates delivered by assisted vaginal delivery and normal delivery, term and preterm neonates, APAGR score of 16.10 and <1.0 led to a recall of 5.41% of neonates which is practicable given the scenario in our Country. The mode of delivery and perinatal stress factors have a significant impact on CBTSH levels and any rise to be seen in the light of these factors. The prevalence rate of CH after recall was ~3 in 1000 live births.

  3. A prospective crossover comparison of neurally adjusted ventilatory assist and pressure-support ventilation in a pediatric and neonatal intensive care unit population.

    LENUS (Irish Health Repository)

    Breatnach, Cormac

    2012-02-01

    OBJECTIVE: To compare neurally adjusted ventilatory assist ventilation with pressure-support ventilation. DESIGN: Prospective, crossover comparison study. SETTING: Tertiary care pediatric and neonatal intensive care unit. PATIENTS: Sixteen ventilated infants and children: mean age = 9.7 months (range = 2 days-4 yrs) and mean weight = 6.2 kg (range = 2.4-13.7kg). INTERVENTIONS: A modified nasogastric tube was inserted and correct positioning was confirmed. Patients were ventilated in pressure-support mode with a pneumatic trigger for a 30-min period and then in neurally adjusted ventilatory assist mode for up to 4 hrs. MEASUREMENTS AND MAIN RESULTS: Data collected for comparison included activating trigger (neural vs. pneumatic), peak and mean airway pressures, expired minute and tidal volumes, heart rate, respiratory rate, pulse oximetry, end-tidal CO2 and arterial blood gases. Synchrony was improved in neurally adjusted ventilatory assist mode with 65% (+\\/-21%) of breaths triggered neurally vs. 35% pneumatically (p < .001) and 85% (+\\/-8%) of breaths cycled-off neurally vs. 15% pneumatically (p = .0001). The peak airway pressure in neurally adjusted ventilatory assist mode was significantly lower than in pressure-support mode with a 28% decrease in pressure after 30 mins (p = .003) and 32% decrease after 3 hrs (p < .001). Mean airway pressure was reduced by 11% at 30 mins (p = .13) and 9% at 3 hrs (p = .31) in neurally adjusted ventilatory assist mode although this did not reach statistical significance. Patient hemodynamics and gas exchange remained stable for the study period. No adverse patient events or device effects were noted. CONCLUSIONS: In a neonatal and pediatric intensive care unit population, ventilation in neurally adjusted ventilatory assist mode was associated with improved patient-ventilator synchrony and lower peak airway pressure when compared with pressure-support ventilation with a pneumatic trigger. Ventilating patients in this new mode

  4. Effect of early-onset sepsis evaluations on in-hospital breastfeeding practices among asymptomatic term neonates.

    Science.gov (United States)

    Mukhopadhyay, Sagori; Lieberman, Ellice S; Puopolo, Karen M; Riley, Laura E; Johnson, Lise C

    2015-04-01

    To examine the effect of separation for early-onset sepsis (EOS) evaluations due to perinatal risk factors on breastfeeding practices among asymptomatic term newborns. This observational study included 692 nulliparous women with term, singleton uncomplicated pregnancies who intended to breastfeed and whose infants were well appearing at birth. We examined the rate of early breastfeeding initiation (within 2 hours of birth) and formula supplementation (in the first 24 hours) among this mother-infant cohort. Asymptomatic infants separated for EOS evaluation within 2 hours of birth were more likely to have delayed initiation of breastfeeding (46.5% vs 12.5%; P1.5 hours with their mothers. In bivariate analysis, both separation and initiation were associated with formula supplementation. After adjusting for confounders, only delayed initiation remained significantly associated with supplementation (aOR: 1.9 [95% CI: 1.1-3.5]; P=.03). Early separation of asymptomatic infants from their mothers for EOS evaluation was significantly associated with delayed initiation of breastfeeding, which in turn was associated with increased formula supplementation in the first day of life. This unintended consequence of EOS evaluations among asymptomatic infants may be minimized by delaying early separation for performance of the evaluation, attempting breastfeeding initiation before separation, and/or applying more efficient criteria for identifying infants requiring evaluation. Copyright © 2015 by the American Academy of Pediatrics.

  5. [Prenatal treatment with magnesium sulphate: Initial clinical outcomes in pre-term infants less than 29 weeks and correlation with neonatal magnesium levels].

    Science.gov (United States)

    García Alonso, Laura; Pumarada Prieto, Marcelino; González Colmenero, Eva; Concheiro Guisán, Ana; Suárez Albo, María; Durán Fernández-Feijoo, Cristina; González Durán, Luisa; Fernández Lorenzo, José Ramón

    2017-03-01

    Antenatal magnesium sulphate (MgSO4) administration has shown to be effective in minimising cerebral palsy and severe motor dysfunction at the age of 2 years. The aim of this study is to analyse the initial clinical outcome of preterm neonates less than 29 weeks who have received prenatal MgSO4, as well as to determine the relationship between the magnesium dose delivered to the mother and the magnesium concentration in the neonates. A prospective cohort study was conducted on neonates of less than 29 weeks gestation admitted to the Neonatal Intensive Care Unit (NICU) of Hospital Universitario de Vigo from December 2012 to July 2015. Comparative analysis was performed on the perinatal outcomes, neonatal morbidity, mortality, and magnesium levels between the groups of neonates exposed to magnesium sulphate and the control group. A total of 42 neonates were included in the study. The mothers of 28 of them had received MgSO4 as a neuroprotective agent. Statistical significance was obtained in the mortality variable. There were no significant differences in the rest of studied variables. There was a significant correlation between the full dose of MgSO4 received by the mother and the levels of magnesium in the neonate in the first 24hours of life (r(2) 0.436; P<.001). A lower mortality was observed in the group that had been exposed to MgS04. No significant side effects were found as a result of administering of MgS04. The MgS04 dose received by mother has a linear relationship with the magnesium levels obtained in neonates. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Developmental delay associated with normal thyroidal function and long-term amiodarone therapy during fetal and neonatal life.

    Science.gov (United States)

    Mikovic, Zeljko; Karadzov, Natasa; Jovanovic, Ida; Milic, Vedrana; Tomovic, Branislav; Egic, Amira; Dragovic Lukic, Gordana

    2010-07-01

    We reported a case of a child with neurodevelopment delay induced by long-term amiodarone exposure due to a treatment of fetal supraventricular tachycardia (FSVT), subtype permanent junctional reciprocating tachycardia (PJRT) with the normal thyroidal function. Refractory persistent FSVT was treated intrautero with digoxin (0.5 mg QD) until delivery and amiodarone (100 mg QD) from 26 to 35 weeks of gestation. A baby weighing 3550 g with normal acid-base status was delivered at 38 weeks of gestation. The PJRT recurred 28 hours after delivery and reverted to sinus rhythm with amiodarone and propranolol for another 24 months. The neurological disturbances were manifested at the age of 12 months, when hypotonia and delayed motor milestones were recognised. At the age of 18 months, the child had mildly neurological development delay with hypotonia, ataxia and foot deformities. At the age of 24 months, motor milestones were mildly delayed with the usage of a few words without the ability to connect them into the sentence. The developmental quotient (DQ) was 68. Electroencephalogram and magnetic resonance imaging of the central nervous system were all normal. At the age of 30 months, motor milestones were still delayed together with speech development and language delay, only some words were used, not distinctly, DQ was 78. Thyroid function was normal on each examination. All blood and urine analyses were in normal ranges. Chromosome analysis did not show any abnormalities. Since we excluded all possible reasons, we could only bring an indirect link between the long-term amiodarone exposure during fetal and postnatal life and neurodevelopment delay. Copyright 2010 Elsevier Masson SAS. All rights reserved.

  7. Short-Term and Long-Term Biological Effects of Chronic Chemical Contamination on Natural Populations of a Marine Bivalve.

    Science.gov (United States)

    Breitwieser, Marine; Viricel, Amélia; Graber, Marianne; Murillo, Laurence; Becquet, Vanessa; Churlaud, Carine; Fruitier-Arnaudin, Ingrid; Huet, Valérie; Lacroix, Camille; Pante, Eric; Le Floch, Stéphane; Thomas-Guyon, Hélène

    2016-01-01

    Understanding the effects of chronic chemical contamination on natural populations of marine organisms is complex due to the combined effects of different types of pollutants and environmental parameters that can modulate the physiological responses to stress. Here, we present the effects of a chronic contamination in a marine bivalve by combining multiple approaches that provide information on individual and population health. We sampled variegated scallops (Mimachlamys varia) at sites characterized by different contaminants and contamination levels to study the short and long-term (intergenerational) responses of this species to physiological stress. We used biomarkers (SOD, MDA, GST, laccase, citrate synthase and phosphatases) as indicators of oxidative stress, immune system alteration, mitochondrial respiration and general metabolism, and measured population genetic diversity at each site. In parallel, concentration of 14 trace metals and 45 organic contaminants (PAHs, PCBs, pesticides) in tissues were measured. Scallops were collected outside and during their reproductive season to investigate temporal variability in contaminant and biomarker levels. Our analyses revealed that the levels of two biomarkers (Laccase-type phenoloxidase and malondialdehyde) were significantly correlated with Cd concentration. Additionally, we observed significant seasonal differences for four of the five biomarkers, which is likely due to the scallop reproductive status at time of sampling. As a source of concern, a location that was identified as a reference site on the basis of inorganic contaminant levels presented the same level of some persistent organic pollutants (DDT and its metabolites) than more impacted sites. Finally, potential long-term effects of heavy metal contamination were observed for variegated scallops as genetic diversity was depressed in the most polluted sites.

  8. Short-Term and Long-Term Biological Effects of Chronic Chemical Contamination on Natural Populations of a Marine Bivalve.

    Directory of Open Access Journals (Sweden)

    Marine Breitwieser

    Full Text Available Understanding the effects of chronic chemical contamination on natural populations of marine organisms is complex due to the combined effects of different types of pollutants and environmental parameters that can modulate the physiological responses to stress. Here, we present the effects of a chronic contamination in a marine bivalve by combining multiple approaches that provide information on individual and population health. We sampled variegated scallops (Mimachlamys varia at sites characterized by different contaminants and contamination levels to study the short and long-term (intergenerational responses of this species to physiological stress. We used biomarkers (SOD, MDA, GST, laccase, citrate synthase and phosphatases as indicators of oxidative stress, immune system alteration, mitochondrial respiration and general metabolism, and measured population genetic diversity at each site. In parallel, concentration of 14 trace metals and 45 organic contaminants (PAHs, PCBs, pesticides in tissues were measured. Scallops were collected outside and during their reproductive season to investigate temporal variability in contaminant and biomarker levels. Our analyses revealed that the levels of two biomarkers (Laccase-type phenoloxidase and malondialdehyde were significantly correlated with Cd concentration. Additionally, we observed significant seasonal differences for four of the five biomarkers, which is likely due to the scallop reproductive status at time of sampling. As a source of concern, a location that was identified as a reference site on the basis of inorganic contaminant levels presented the same level of some persistent organic pollutants (DDT and its metabolites than more impacted sites. Finally, potential long-term effects of heavy metal contamination were observed for variegated scallops as genetic diversity was depressed in the most polluted sites.

  9. Term perinatal mortality audit in the Netherlands 2010-2012 : a population-based cohort study

    NARCIS (Netherlands)

    Eskes, Martine; Waelput, Adja J. M.; Erwich, Jan Jaap H. M.; Brouwers, Hens A. A.; Ravelli, Anita C. J.; Achterberg, Peter W.; Merkus, Hans (J) M. W. M.; Bruinse, Hein W.

    2014-01-01

    Objective: To assess the implementation and first results of a term perinatal internal audit by a standardised method. Design: Population-based cohort study. Setting: All 90 Dutch hospitals with obstetric/ paediatric departments linked to community practices of midwives, general practitioners in

  10. First-Pass Meconium Samples from Healthy Term Vaginally-Delivered Neonates: An Analysis of the Microbiota.

    Directory of Open Access Journals (Sweden)

    Richard Hansen

    Full Text Available Considerable effort has been made to categorise the bacterial composition of the human gut and correlate findings with gastrointestinal disease. The infant gut has long been considered sterile at birth followed by rapid colonisation; however, this view has recently been challenged. We examined first-pass meconium from healthy term infants to confirm or refute sterility.Healthy mothers were approached following vaginal delivery. First-pass meconium stools within 24 hours of delivery were obtained from healthy, breastfed infants with tight inclusion/exclusion criteria including rejecting any known antibiotic exposure - mother within 7 days preceding delivery or infant after birth. Stools were processed in triplicate for fluorescent in-situ hybridisation (FISH with 16S rRNA-targeted probes including Bifidobacterium; Bacteroides-Prevotella; Lactobacillaceae/Enterococcaceae; Enterobacteriaceae; Streptococcaceae; Staphylococcaceae and Enterococcaceae. Absolute counts of all bacteria and proportional identification of each bacterial group were calculated. Confirmation of bacterial presence by PCR was undertaken on FISH-positive samples.The mothers of 31 newborn infants were recruited, 15 met inclusion/exclusion criteria and provided a sample within 24 hours of birth, processed in the lab within 4 hours. All babies were 37-40 weeks gestation. 8/15 were male, mean birth weight was 3.4 kg and mean maternal age was 32 years. Meconium samples from 10/15 (66% infants had evidence of bacteria based on FISH analysis. Of these, PCR was positive in only 1. Positive FISH counts ranged from 2.2-41.8 x 10(4 cells/g with a mean of 15.4 x 10(4 cells/g. (The limit of detection for automated counting is 10(6 cells/g. Cell counts were too low to allow formal diversity analysis. Amplification by PCR was not possible despite positive spiked samples demonstrating the feasibility of reaction. One baby was dominated by Enterobacteriaceae. The others contained 2-5 genera

  11. Ecological interpretation of short-term toxicity results: Development of a population model for Arbacia

    Energy Technology Data Exchange (ETDEWEB)

    Munns, W.R. Jr.; Nacci, D.E. [SAIC, Narragansett, RI (United States); Walker, H.A. [Environmental Protection Agency, Narragansett, RI (United States); Johnston, R.K. [NCCOSC, Narragansett, RI (United States). RDTE Division

    1994-12-31

    The Arbacia punctulata fertilization and larval development tests are used extensively in regulatory and research programs to evaluate toxicity associated with contaminants in aqueous media. These short-term assays are inexpensive, easy to use, and provide information regarding the effects of environmental contaminants on critical life history stages of the sea urchin. Despite substantial consideration of the precision of assay methods, and a clear understanding of the statistical significance of treatment differences, an appreciation of the ecological significance of treatment effects is lacking. To address this problem, a stage classified population projection model was developed to relate short-term test endpoints to potential effects at the population level. The model was applied to evaluate population-level effects using short-term toxicity data obtained in an estuarine ecological risk assessment conducted for Portsmouth Naval Shipyard, Kittery, Maine. The model also was used to examine which test endpoints provide useful information relative to population growth dynamics. Population modeling approaches can be extremely valuable in extrapolating single species toxicity information to higher level ecological endpoints and for identifying appropriate measurement endpoints during toxicity test development.

  12. Avaliação de sintomas de ansiedade e depressão em mães de neonatos pré-termo durante e após hospitalização em UTI-Neonatal Anxiety and depression symptoms assessment in pre-term neonates' mothers during and after hospitalization in neonatal intensive care unit

    Directory of Open Access Journals (Sweden)

    Flávia Helena Pereira Padovani

    2004-12-01

    Full Text Available OBJETIVO: Identificar sintomas em nível clínico de ansiedade, disforia e depressão em mães de neonatos pré-termo, comparando dois momentos, durante e após a hospitalização do bebê em Unidade de Terapia Intensiva Neonatal (UTIN. MÉTODOS: 43 mães de neonatos pré-termo de muito baixo peso, sem antecedentes psiquiátricos, foram avaliadas através dos Inventários de Ansiedade Traço-Estado e de Depressão de Beck. Foram realizadas duas avaliações, uma durante a hospitalização do bebê e outra após a alta hospitalar. RESULTADOS: Na primeira avaliação, 44% das mães apresentaram sintomas clínicos de ansiedade, disforia e/ou depressão. Após a alta hospitalar do bebê, houve redução significativa do número de mães (26% com esses sintomas clínicos em relação à primeira avaliação (pOBJECTIVE: To identify clinical level of anxiety, dysphoria and depression symptoms of pre-term infants' mothers between two moments, during and after hospitalization in Neonatal Intensive Care Unit (NICU. METHODS: Previously, mothers with psychiatric background were excluded of the study. Forty-three pre-term and very low birthweight infants' mothers were assessed through State-Trait Anxiety Inventory and Beck Depression Inventory. The assessments were done during and after hospitalization, respectively. RESULTS: In the first assessment, 44% mothers showed clinical level in one or more of the emotional symptoms, such as anxiety, dysphoria or depression. After infants' discharge, the number of mothers with clinical level of emotional symptoms decreased significantly (26% in comparison of the first assessment (p<0.008. The anxiety-state level decreased significantly from the first to the second assessment (from 35% to 12%; p<0.006. No difference in depression and dysphoria symptoms between two assessments were found. CONCLUSION:The pre-term infants' mothers presented situational anxiety and required emotional support to cope with the infants

  13. Change-point analysis data of neonatal diffusion tensor MRI in preterm and term-born infants

    Directory of Open Access Journals (Sweden)

    Dan Wu

    2017-06-01

    Full Text Available The data presented in this article are related to the research article entitled “Mapping the Critical Gestational Age at Birth that Alters Brain Development in Preterm-born Infants using Multi-Modal MRI” (Wu et al., 2017 [1]. Brain immaturity at birth poses critical neurological risks in the preterm-born infants. We used a novel change-point model to analyze the critical gestational age at birth (GAB that could affect postnatal development, based on diffusion tensor MRI (DTI acquired from 43 preterm and 43 term-born infants in 126 brain regions. In the corresponding research article, we presented change-point analysis of fractional anisotropy (FA and mean diffusivities (MD measurements in these infants. In this article, we offered the relative changes of axonal and radial diffusivities (AD and RD in relation to the change of FA and FA-based change-points, and we also provided the AD- and RD-based change-point results.

  14. Evaluation of the Predictive Value of Umbilical Cord Serum Bilirubin Level for the Development of Subsequent Hyperbilirubinemia in Term and Late-Preterm Neonates

    Directory of Open Access Journals (Sweden)

    Fariba Hemmati

    2016-03-01

    Conclusion: Based on the findings, UCS bilirubin level could not predict subsequent hyperbilirubinemia. Therefore, the best predictive marker for neonatal jaundice is the assessment of clinical risk factors and predischarge bilirubin level.

  15. Neonatal neurosonography

    Energy Technology Data Exchange (ETDEWEB)

    Riccabona, Michael, E-mail: michael.riccabona@klinikum-graz.at

    2014-09-15

    Paediatric and particularly neonatal neurosonography still remains a mainstay of imaging the neonatal brain. It can be performed at the bedside without any need for sedation or specific monitoring. There are a number of neurologic conditions that significantly influence morbidity and mortality in neonates and infants related to the brain and the spinal cord; most of them can be addressed by ultrasonography (US). However, with the introduction of first CT and then MRI, neonatal neurosonography is increasingly considered just a basic first line technique that offers only orienting information and does not deliver much relevant information. This is partially caused by inferior US performance – either by restricted availability of modern equipment or by lack of specialized expertise in performing and reading neurosonographic scans. This essay tries to highlight the value and potential of US in the neonatal brain and briefly touching also on the spinal cord imaging. The common pathologies and their US appearance as well as typical indication and applications of neurosonography are listed. The review aims at encouraging paediatric radiologists to reorient there imaging algorithms and skills towards the potential of modern neurosonography, particularly in the view of efficacy, considering growing economic pressure, and the low invasiveness as well as the good availability of US that can easily be repeated any time at the bedside.

  16. The effects of landscape modifications on the long-term persistence of animal populations.

    Directory of Open Access Journals (Sweden)

    Jacob Nabe-Nielsen

    Full Text Available BACKGROUND: The effects of landscape modifications on the long-term persistence of wild animal populations is of crucial importance to wildlife managers and conservation biologists, but obtaining experimental evidence using real landscapes is usually impossible. To circumvent this problem we used individual-based models (IBMs of interacting animals in experimental modifications of a real Danish landscape. The models incorporate as much as possible of the behaviour and ecology of four species with contrasting life-history characteristics: skylark (Alauda arvensis, vole (Microtus agrestis, a ground beetle (Bembidion lampros and a linyphiid spider (Erigone atra. This allows us to quantify the population implications of experimental modifications of landscape configuration and composition. METHODOLOGY/PRINCIPAL FINDINGS: Starting with a real agricultural landscape, we progressively reduced landscape complexity by (i homogenizing habitat patch shapes, (ii randomizing the locations of the patches, and (iii randomizing the size of the patches. The first two steps increased landscape fragmentation. We assessed the effects of these manipulations on the long-term persistence of animal populations by measuring equilibrium population sizes and time to recovery after disturbance. Patch rearrangement and the presence of corridors had a large effect on the population dynamics of species whose local success depends on the surrounding terrain. Landscape modifications that reduced population sizes increased recovery times in the short-dispersing species, making small populations vulnerable to increasing disturbance. The species that were most strongly affected by large disturbances fluctuated little in population sizes in years when no perturbations took place. SIGNIFICANCE: Traditional approaches to the management and conservation of populations use either classical methods of population analysis, which fail to adequately account for the spatial configurations

  17. Metabolomics: the "new clinical chemistry" for personalized neonatal medicine.

    Science.gov (United States)

    Antonucci, R; Atzori, L; Barberini, L; Fanos, V

    2010-06-01

    Metabolomics is a new approach based on the systematic study of the full complement of metabolites in a biological sample. This technology consists of two sequential steps: (1) an experimental technique, based on mass spectrometry or nuclear magnetic resonance (NMR) spectroscopy, designed to profile low molecular weight compounds, and (2) multivariate data analysis. Metabolomic analysis of biofluids or tissues has been successfully used in the fields of physiology, diagnostics, functional genomics, pharmacology, toxicology and nutrition. Recent studies have evaluated how physiological variables or pathological conditions can affect metabolomic profiles of different biofluids in pediatric populations. Little is known about the overall metabolic status of the term and preterm neonate. On the other hand, the management of sick or preterm newborns might be improved if more information on perinatal/neonatal maturational processes and their metabolic background were available. At present, the use of metabolomics in Neonatology is still in the pioneering phase. Meaningful diagnostic information and simple, non-invasive collection techniques make urine a particularly suitable biofluid for metabolomic approach in neonatal medicine. Using NMR-based metabolomic analysis of urine, distinct metabolic patterns have been shown to be associated with different classes of gestational age in a population of preterm and term infants. Together with genomics and proteomics, metabolomics appears to be a promising tool in Neonatology for the monitoring of postnatal metabolic maturation, the identification of biomarkers as early predictors of outcome, the diagnosis and monitoring of various diseases and the "tailored" management of neonatal disorders.

  18. Neonatal pneumonia.

    OpenAIRE

    Webber, S; Wilkinson, A R; Lindsell, D; Hope, P L; Dobson, S R; Isaacs, D

    1990-01-01

    All babies admitted to the neonatal unit during a period of 41 months were prospectively studied to find out the incidence, aetiology, and outcome of neonatal pneumonia, and the value of routine cultures of endotracheal tubes. Pneumonia of early onset (before age 48 hours) occurred in 35 babies (incidence 1.79/1000 live births). In 20 (57%) it was caused by group B streptococci. Blood cultures showed the presence of organisms in 16 of the 35 (46%). There were 41 episodes of pneumonia of late ...

  19. Neonatal Jaundice

    DEFF Research Database (Denmark)

    Maimburg, Rikke Damkjær; Væth, Michael; Schendel, Diana

    2008-01-01

    In a previous study, we found that infants transferred to a neonatal ward after delivery had an almost twofold increased risk of being diagnosed with infantile autism later in childhood in spite of extensive controlling of obstetric risk factors. We therefore decided to investigate other reasons .......7]). No associations were found between infantile autism and low Apgar scores, acidosis or hypoglycaemia. Our findings suggest that hyperbilirubinaemia and neurological abnormalities in the neonatal period are important factors to consider when studying causes of infantile autism....

  20. Ictericia Neonatal

    OpenAIRE

    Blanco de la Fuente, María Isabel

    2014-01-01

    El motivo que ha llevado a la realización de este trabajo fin de grado sobre el tema de la ICTERICIA NEONATAL se debe a la elevada frecuencia de su aparición en la población. Un porcentaje elevado de RN la padecen al nacer siendo, en la mayor parte de los casos, un proceso fisiológico resuelto con facilidad debido a una inmadurez del sistema hepático y a una hiperproducción de bilirrubina. La ictericia neonatal es la pigmentación de color amarillo de la piel y mucosas en ...

  1. Leukocyte Populations in Human Preterm and Term Breast Milk Identified by Multicolour Flow Cytometry.

    Science.gov (United States)

    Trend, Stephanie; de Jong, Emma; Lloyd, Megan L; Kok, Chooi Heen; Richmond, Peter; Doherty, Dorota A; Simmer, Karen; Kakulas, Foteini; Strunk, Tobias; Currie, Andrew

    2015-01-01

    Extremely preterm infants are highly susceptible to bacterial infections but breast milk provides some protection. It is unknown if leukocyte numbers and subsets in milk differ between term and preterm breast milk. This study serially characterised leukocyte populations in breast milk of mothers of preterm and term infants using multicolour flow cytometry methods for extended differential leukocyte counts in blood. Sixty mothers of extremely preterm (mature milk (d26-30) samples were collected, cells isolated, and leukocyte subsets analysed using flow cytometry. The major CD45+ leukocyte populations circulating in blood were also detectable in breast milk but at different frequencies. Progression of lactation was associated with decreasing CD45+ leukocyte concentration, as well as increases in the relative frequencies of neutrophils and immature granulocytes, and decreases in the relative frequencies of eosinophils, myeloid and B cell precursors, and CD16- monocytes. No differences were observed between preterm and term breast milk in leukocyte concentration, though minor differences between preterm groups in some leukocyte frequencies were observed. Flow cytometry is a useful tool to identify and quantify leukocyte subsets in breast milk. The stage of lactation is associated with major changes in milk leukocyte composition in this population. Fresh preterm breast milk is not deficient in leukocytes, but shorter gestation may be associated with minor differences in leukocyte subset frequencies in preterm compared to term breast milk.

  2. Leukocyte Populations in Human Preterm and Term Breast Milk Identified by Multicolour Flow Cytometry

    Science.gov (United States)

    Trend, Stephanie; de Jong, Emma; Lloyd, Megan L.; Kok, Chooi Heen; Richmond, Peter; Doherty, Dorota A.; Simmer, Karen; Kakulas, Foteini; Strunk, Tobias; Currie, Andrew

    2015-01-01

    Background Extremely preterm infants are highly susceptible to bacterial infections but breast milk provides some protection. It is unknown if leukocyte numbers and subsets in milk differ between term and preterm breast milk. This study serially characterised leukocyte populations in breast milk of mothers of preterm and term infants using multicolour flow cytometry methods for extended differential leukocyte counts in blood. Methods Sixty mothers of extremely preterm (leukocyte subsets analysed using flow cytometry. Results The major CD45+ leukocyte populations circulating in blood were also detectable in breast milk but at different frequencies. Progression of lactation was associated with decreasing CD45+ leukocyte concentration, as well as increases in the relative frequencies of neutrophils and immature granulocytes, and decreases in the relative frequencies of eosinophils, myeloid and B cell precursors, and CD16- monocytes. No differences were observed between preterm and term breast milk in leukocyte concentration, though minor differences between preterm groups in some leukocyte frequencies were observed. Conclusions Flow cytometry is a useful tool to identify and quantify leukocyte subsets in breast milk. The stage of lactation is associated with major changes in milk leukocyte composition in this population. Fresh preterm breast milk is not deficient in leukocytes, but shorter gestation may be associated with minor differences in leukocyte subset frequencies in preterm compared to term breast milk. PMID:26288195

  3. Methodological issues in the design and analyses of neonatal research studies: Experience of the NICHD Neonatal Research Network.

    Science.gov (United States)

    Das, Abhik; Tyson, Jon; Pedroza, Claudia; Schmidt, Barbara; Gantz, Marie; Wallace, Dennis; Truog, William E; Higgins, Rosemary D

    2016-10-01

    Impressive advances in neonatology have occurred over the 30 years of life of The Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (NRN). However, substantial room for improvement remains in investigating and further developing the evidence base for improving outcomes among the extremely premature. We discuss some of the specific methodological challenges in the statistical design and analysis of randomized trials and observational studies in this population. Challenges faced by the NRN include designing trials for unusual or rare outcomes, accounting for and explaining center variations, identifying other subgroup differences, and balancing safety and efficacy concerns between short-term hospital outcomes and longer-term neurodevelopmental outcomes. In conclusion, the constellation of unique patient characteristics in neonates calls for broad understanding and careful consideration of the issues identified in this article for conducting rigorous studies in this population. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Climate Effects and Feedback Structure Determining Weed Population Dynamics in a Long-Term Experiment

    Science.gov (United States)

    Lima, Mauricio; Navarrete, Luis; González-Andujar, José Luis

    2012-01-01

    Pest control is one of the areas in which population dynamic theory has been successfully applied to solve practical problems. However, the links between population dynamic theory and model construction have been less emphasized in the management and control of weed populations. Most management models of weed population dynamics have emphasized the role of the endogenous process, but the role of exogenous variables such as climate have been ignored in the study of weed populations and their management. Here, we use long-term data (22 years) on two annual weed species from a locality in Central Spain to determine the importance of endogenous and exogenous processes (local and large-scale climate factors). Our modeling study determined two different feedback structures and climate effects in the two weed species analyzed. While Descurainia sophia exhibited a second-order feedback and low climate influence, Veronica hederifolia was characterized by a first-order feedback structure and important effects from temperature and rainfall. Our results strongly suggest the importance of theoretical population dynamics in understanding plant population systems. Moreover, the use of this approach, discerning between the effect of exogenous and endogenous factors, can be fundamental to applying weed management practices in agricultural systems and to controlling invasive weedy species. This is a radical change from most approaches currently used to guide weed and invasive weedy species managements. PMID:22272362

  5. Climate effects and feedback structure determining weed population dynamics in a long-term experiment.

    Directory of Open Access Journals (Sweden)

    Mauricio Lima

    Full Text Available Pest control is one of the areas in which population dynamic theory has been successfully applied to solve practical problems. However, the links between population dynamic theory and model construction have been less emphasized in the management and control of weed populations. Most management models of weed population dynamics have emphasized the role of the endogenous process, but the role of exogenous variables such as climate have been ignored in the study of weed populations and their management. Here, we use long-term data (22 years on two annual weed species from a locality in Central Spain to determine the importance of endogenous and exogenous processes (local and large-scale climate factors. Our modeling study determined two different feedback structures and climate effects in the two weed species analyzed. While Descurainia sophia exhibited a second-order feedback and low climate influence, Veronica hederifolia was characterized by a first-order feedback structure and important effects from temperature and rainfall. Our results strongly suggest the importance of theoretical population dynamics in understanding plant population systems. Moreover, the use of this approach, discerning between the effect of exogenous and endogenous factors, can be fundamental to applying weed management practices in agricultural systems and to controlling invasive weedy species. This is a radical change from most approaches currently used to guide weed and invasive weedy species managements.

  6. Climate effects and feedback structure determining weed population dynamics in a long-term experiment.

    Science.gov (United States)

    Lima, Mauricio; Navarrete, Luis; González-Andujar, José Luis

    2012-01-01

    Pest control is one of the areas in which population dynamic theory has been successfully applied to solve practical problems. However, the links between population dynamic theory and model construction have been less emphasized in the management and control of weed populations. Most management models of weed population dynamics have emphasized the role of the endogenous process, but the role of exogenous variables such as climate have been ignored in the study of weed populations and their management. Here, we use long-term data (22 years) on two annual weed species from a locality in Central Spain to determine the importance of endogenous and exogenous processes (local and large-scale climate factors). Our modeling study determined two different feedback structures and climate effects in the two weed species analyzed. While Descurainia sophia exhibited a second-order feedback and low climate influence, Veronica hederifolia was characterized by a first-order feedback structure and important effects from temperature and rainfall. Our results strongly suggest the importance of theoretical population dynamics in understanding plant population systems. Moreover, the use of this approach, discerning between the effect of exogenous and endogenous factors, can be fundamental to applying weed management practices in agricultural systems and to controlling invasive weedy species. This is a radical change from most approaches currently used to guide weed and invasive weedy species managements.

  7. Short-term neonatal/prepubertal exposure of dibutyl phthalate (DBP) advanced pubertal timing and affected hypothalamic kisspeptin/GPR54 expression differently in female rats.

    Science.gov (United States)

    Hu, Jialei; Du, Guizhen; Zhang, Wei; Huang, Hongyu; Chen, Danni; Wu, Di; Wang, Xinru

    2013-12-06

    Dibutyl phthalate (DBP) had been widely used and its exposure in children has been thought to be one of the reasons causing a trend of advanced pubertal timing in girls. Puberty starts from hypothalamic gonadotropin-releasing hormone release which is controlled by many factors including neurotransmitter kisspeptin and its receptor GPR54. These neural organization or reorganization happens in hypothalamus during neonatal or prepubertal period which may be two target windows of DBP exposure. The present study was designed to determine: (1) the difference between the effects of neonatal and prepubertal DBP exposure on female pubertal timing; (2) whether kisspeptin/GPR54 expression in hypothalamus would respond to neonatal and prepubertal DBP exposure differently. Female Sprague-Dawley rats were exposed by subcutaneous injection of 0.5, 5 and 50mg/kg DBP during Postnatal day (P)1-5 (neonatal) or P26-30 (prepubertal). Physiological data demonstrated that both neonatal and prepubertal DBP exposure could advance pubertal timing significantly accompanied by irregular estrous cycles but only a little gonadal impairment. Exposure-period-related difference was found significant with prepubertal exposure groups having longer estrous cycle duration, heavier at vaginal opening and having higher serum estradiol level compared with neonatal exposure groups. Molecular data showed an up-regulated trend in kisspeptin mRNA and immunoreactivity levels of hypothalamic area arcuate but a down-regulation in GPR54 mRNA expression after P1-5 DBP treatment. In P26-30 groups, kisspeptin mRNA and immunoreactivity levels tended to be lower after DBP treatment. These results demonstrated small dose of DBP could induce earlier pubertal timing in females and both neonatal and prepubertal periods were critical windows for DBP exposure. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  8. Changes in tonal audiometry in children with progressive sensorineural hearing loss and history of Neonatal Intensive Care Unit discharge. A 20 year long-term follow-up.

    Science.gov (United States)

    Martínez-Cruz, Carlos F; Poblano, Adrián; García-Alonso Themann, Patricia

    2017-10-01

    Newborns from Neonatal intensive care units (NICU) are at high-risk for sensorineural hearing loss (SNHL) a follow-up is needed for early diagnosis and intervention. Our objective here was to describe the features and changes of SNHL at different periods during a follow-up of almost 20 years. Risk factors for SNHL during development were analyzed. The audiological examination included: Brainstem auditory evoked potentials (BAEP), and Transient evoked otoacoustic emissions (TEOAE). At birth; tonal audiometry (between 125 and 8000 Hz), and tympanometry were performed at 5, 10, 15, and 20 years of age. Sixty-five percent of cases presented bilateral absence of BAEP. At 5 years of age, the most frequent SNHL level was severe (42.5%), followed by moderate (22.5%), and profound level (20%), in all cases, the SNHL was symmetrical with a predominance of lesion for the high frequencies. Exchange transfusion was associated with a higher degree of SNHL (OR = 6.00, CI = 1.11-32.28, p < 0.02). In 55%, SNHL remained stable, but in 40% of the cases it was progressive. At the end of the study six cases with moderate loss progressed to the severe level and seven cases with severe level progressed to profound. Forty percent of infants with SNHL discharged from NICU may present a progression in the hearing loss. Exchange transfusion was associated with a higher degree of SNHL. NICU graduates with SNHL merit a long-term audiological follow-up throughout their lifespan. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Early-term birth is a risk factor for wheezing in childhood: A cross-sectional population study.

    Science.gov (United States)

    Edwards, Martin O; Kotecha, Sarah J; Lowe, John; Richards, Louise; Watkins, W John; Kotecha, Sailesh

    2015-09-01

    Early term-born (37-38 weeks' gestation) infants have increased respiratory morbidity during the neonatal period compared with full term-born (39-42 weeks' gestation) infants, but longer-term respiratory morbidity remains unclear. We assessed whether early term-born children have greater respiratory symptoms and health care use in childhood compared with full term-born children. We surveyed 1- to 10-year-old term-born children (n = 13,361). Questionnaires assessed respiratory outcomes with additional data gathered from national health databases. Of 2,845 eligible participants, 545 were early term-born and 2,300 were full term-born. Early term-born children had higher rates of admission to the neonatal unit (odds ratio [OR], 1.7; 95% CI, 1.2-2.5) and admission to the hospital during their first year of life (OR, 1.6; 95% CI, 1.2-2.1). Forty-eight percent of early term-born children less than 5 years old reported wheeze ever compared with 39% of full term-born children (OR, 1.5; 95% CI, 1.1-1.9), and 26% versus 17% reported recent wheezing (OR, 1.7; 95% CI, 1.3-2.4). Early term-born children older than 5 years reported higher rates of wheeze ever (OR, 1.4; 95% CI, 1.05-1.8) and recent wheezing over the last 12 months than full-term control subjects (OR, 1.4; 95% CI, 1.02-2.0). Increased rates of respiratory symptoms in early term-born children persisted when family history of atopy and delivery by means of cesarean sections were included in logistic regression models. Early term-born children had significantly increased respiratory morbidity and use of health care services when compared with full term-born children, even when stratified by mode of delivery and family history of atopy. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  10. Neonatal hyperbilirubinemia and a common mutation of the bilirubin uridine diphosphate-glucuronosyltransferase gene in Japanese.

    Science.gov (United States)

    Akaba, K; Kimura, T; Sasaki, A; Tanabe, S; Wakabayashi, T; Hiroi, M; Yasumura, S; Maki, K; Aikawa, S; Hayasaka, K

    1999-01-01

    Neonatal hyperbilirubinemia, which is prevalent among Asian peoples, has been considered as a physiological phenomenon, and its metabolic basis has not been clearly explained. Gilbert syndrome is a common inherited disease of unconjugated hyperbilirubinemia due to decreased bilirubin uridine diphosphate-glucuronosyltransferase (B-UGT), and its role in neonatal jaundice has recently been considered. We have previously reported that the Gly71Arg mutation of the B-UGT gene associated with Gilbert syndrome is prevalent in Japanese, Korean, and Chinese populations and was more frequently detected in neonates with severe hyperbilirubinemia than in control subjects. We have studied 159 Japanese full-term neonates, evaluating the relationship between the B-UGT genotype and the severity of jaundice, as assessed with a transcutaneous bilirubinometer. The gene frequency of the Gly71Arg mutation in these neonates was 0.19, and neonates carrying the Gly71Arg mutation had significantly increased bilirubin levels on days 2-4, manifested in a gene dose-dependent manner. The frequency of the Gly71Arg mutation was 0.47 in the neonates who required phototherapy (i.e., those with more severe hyperbilirubinemia), significantly higher than 0.16 in the neonates who did not require the therapy. The gene frequency of the TA repeat promoter polymorphism, the (TA)7 mutation, was 0.07, and neonates carrying this mutation did not have an increase in bilirubin. These results suggested that the Gly71Arg mutation contributes to the high incidence of neonatal hyperbilirubinemia in Japanese.

  11. Voluntary angler logbooks reveal long-term changes in a lentic pike, Esox lucius, population

    DEFF Research Database (Denmark)

    Jansen, Teunis; Arlinghaus, R.; Als, Thomas Damm

    2013-01-01

    Sixty-two years of voluntarily collected angling logbook data from a large natural Danish lake were used to 2 study variation in pike, Esox lucius L., CPUE (expressed as no. of captured per boat trip) as an index of stock size. Pike CPUE was positively related to pike release rate by anglers...... by revealing long-term population trends. Further, state space modelling, a statistical technique not yet seen in recreational fisheries science, is recommended as a tool to model proxies for population dynamics from angler logbook data...

  12. Climate change and population dynamics at the tree line: the importance of long-term studies

    Directory of Open Access Journals (Sweden)

    Anfodillo T

    2007-01-01

    Full Text Available Temperature-limited ecosystems are believed to be extremely sensitive to global warming and the upward treeline migration is one of the most relevant phenomenon. Long term monitoring of demographic trends appears essential in order to understand possible effects of higher temperatures on cold ecosystems. Long-term monitoring of natality and mortality of a Pinus sylvestris population in the Swedish Scandes from 1973 to 2005 (Kullman 2007 showed that number of trees increased in the study plots due to higher natality rate, especially in the last decade. This reverses a natural trend of treeline decline and recession occurred in the past.

  13. Neonatal compartment syndrome.

    Science.gov (United States)

    Martin, B; Treharne, L

    2016-09-01

    A term neonate was born with a grossly swollen and discoloured left hand and forearm. He was transferred from the local hospital to the plastic surgical unit, where a diagnosis of compartment syndrome was made and he underwent emergency forearm fasciotomies at six hours of age. Following serial debridements of necrotic tissue, he underwent split-thickness skin grafting of the resultant defects of his forearm, hand and digits. At the clinic follow-up appointment two months after the procedure, he was found to have developed severe flexion contractures despite regular outpatient hand therapy and splintage. He has had further reconstruction with contracture release, use of artificial dermal matrix, and K-wire fixation of the thumb and wrist. Despite this, the long term outcome is likely to be an arm with poor function. The key learning point from this case is that despite prompt transfer, diagnosis and appropriate surgical management, the outcome for neonatal compartment syndrome may still be poor.

  14. Long-term population demography of Trillium recurvatum on loess bluffs in western Tennessee, USA

    Science.gov (United States)

    Moore, James E.; Franklin, Scott B.; Wein, Gary; Collins, Beverly S.

    2012-01-01

    Background and aims Understanding the demography of long-lived clonal herbs, with their extreme modularity, requires knowledge of both their short- and long-term survival and ramet growth patterns. The primary objective of this study was to understand the dynamics of a clonal forest herb, Trillium recurvatum, by examining temporal and small-scale demographic patterns. We hypothesized: (i) there would be more variability in the juvenile age class compared with non-flowering adult and flowering adult classes due to year-to-year fluctuations in recruitment; (ii) rates of population growth (λ) and increase (r) would be highest in non-flowering ramets due to a combination of transitions from the juvenile stage and reversions from flowering adults; and (iii) inter-ramet distances would be most variable between flowering and juvenile ramets due to a combination of clonal growth, seed dispersal by ants and ramet death over time. Methodology Census data were collected on the total number of stems in the population from 1990 to 2007, and placed within one of three life stages (juvenile, three-leaf non-flowering and three-leaf flowering). Modified population viability equations were used to assess temporal population viability, and spatial structure was assessed using block krigging. Correlations were performed using current and prior season weather to current population demography. Principal results The first hypothesis was rejected. The second hypothesis was supported: population increase (r) and growth rate (λ) were highest in non-flowering ramets. Finally, the third hypothesis was rejected: there was no apparent density dependence within this population of Trillium and no apparent spatial structure among life stages. Conclusions Overall population density fluctuated over time, possibly due to storms that move soil, and prior year's temperature and precipitation. However, density remained at some dynamic stable level. The juvenile age class had greater variability for

  15. Crises epilépticas no período neonatal: análise descritiva de uma população hospitalar Neonatal epileptic seizures: descriptive analysis in a hospital population

    Directory of Open Access Journals (Sweden)

    Soniza Vieira Alves-Leon

    2009-06-01

    Full Text Available OBJETIVO: Investigar a incidência e a letalidade de crises epilépticas neonatais e as condições associadas à sua presença. MÉTODOS: Estudo retrospectivo observacional de base hospitalar com crianças nascidas de janeiro de 1995 a dezembro de 2004 acompanhadas por quatro semanas após o parto. Analisaram-se os dados referentes aos períodos pré-natal, intraparto e neonatal. RESULTADOS: Foram identificados 6.600 nascidos vivos de 6.483 partos, encontrando-se 61 casos incidentes de crises epilépticas neonatais (0,9%. A primeira crise ocorreu até 12 horas após o parto em 45,3% dos neonatos. Das mães analisadas, 32,8% apresentaram síndromes hipertensivas. Entre os 61 pacientes, 91,8% eram conceptos únicos e 4,9% eram primeiro e segundo gemelares. O peso foi menor que 2500g em 50,8% e a restri��ão do crescimento intrauterino ocorreu em 25,9% das gestações analisadas. Obervaram-se: hipoglicemia neonatal (56,5%, icterícia neonatal (52,1% e asfixia perinatal (70,7%. Desenvolveram sepse bacteriana 32 crianças e 17 apresentaram síndrome de aspiração meconial ao nascer. O desequilíbrio ácido-básico ocorreu em 68,1% ao longo de 28 dias pós-parto. A letalidade foi de 47,4%, sendo mais frequente no sexo masculino (65,6% e em filhos de mães afro-descendentes (67,2%. CONCLUSÕES: A incidência de crises epilépticas no período neonatal identificada neste estudo foi três a quatro vezes superior à incidência relatada em hospitais de países desenvolvidos, embora as características dos casos fossem semelhantes. A letalidade foi de 47,4% e a asfixia grave foi a condição patológica intraparto mais frequente.OBJECTIVE:To investigate their incidence and lethality of neonatal epileptic seizures and their associated conditions. METHODS: A retrospective observational hospital-based study was carried out in infants born between January 1995 and December 2004. The infants were followed up for four weeks after birth. Data on the

  16. Anemia on Admission Is an Independent Predictor of Long-Term Mortality in Hip Fracture Population

    OpenAIRE

    Zhang, Licheng; Yin, Pengbin; Lv, Houchen; Long, Anhua; Gao, Yuan; Zhang, Lihai; Tang, Peifu

    2016-01-01

    Abstract Anemia is a disputable factor for long-term mortality in hip fracture population in previous studies. Previous studies indicated that the level of hemoglobin (Hb) might fluctuate due to various factors, such as comorbidities and in-hospital interventions, and the changing level of Hb, may lead to discordance diagnosis of anemia and thus to the conflicting conclusions on prognostic value of anemia. So in this study, we aim to compare factors affecting the diagnosis of anemia at differ...

  17. Declines revisited: Long-term recovery and spatial population dynamics oftailed frog larvae after wildfire

    Science.gov (United States)

    Hossack, Blake R.; Honeycutt, Richard

    2017-01-01

    Drought has fueled an increased frequency and severity of large wildfires in many ecosystems. Despite an increase in research on wildfire effects on vertebrates, the vast majority of it has focused on short-term (population recovery for species that decline in abundance after fire. In 2003, a large wildfire in Montana (USA) burned the watersheds of four of eight streams that we sampled for larval Rocky Mountain tailed frogs (Ascaphus montanus) in 2001. Surveys during 2004–2005 revealed reduced abundance of larvae in burned streams relative to unburned streams, with greater declines associated with increased fire extent. Rocky Mountain tailed frogs have low vagility and have several unusual life-history traits that could slow population recovery, including an extended larval period (4 years), delayed sexual maturity (6–8 years), and low fecundity ( 58% within 12 years after the fire. We also found moderate synchrony among populations in unburned streams and negative spatial autocorrelation among populations in burned streams. We suspect negative spatial autocorrelation among spatially-clustered burned streams reflected increased post-fire patchiness in resources and different rates of local recovery. Our results add to a growing body of work that suggests populations in intact ecosystems tend to be resilient to habitat changes caused by wildfire. Our results also provide important insights into recovery times of populations that have been negatively affected by severe wildfire.

  18. A population-based cohort study of breastfeeding according to gestational age at term delivery.

    Science.gov (United States)

    Lutsiv, Olha; Giglia, Lucia; Pullenayegum, Eleanor; Foster, Gary; Vera, Claudio; Chapman, Barbara; Fusch, Christoph; McDonald, Sarah D

    2013-11-01

    Because breastfeeding is the optimal form of infant feeding, this study was conducted to determine the effect of gestational age on breastfeeding in term infants. A retrospective population-based cohort study of singleton/twin hospital births was conducted in Ontario, Canada between April 1, 2009, and March 31, 2010. Multivariate logistic regression was used to determine the adjusted effect of gestational age on breastfeeding. Our study population comprised 92,364 infants, of whom 80,297 (86.9%) were exclusively or partially breastfed at the time of hospital discharge. Multivariate logistic regression analyses demonstrated that early-term infants had lower odds of being breastfed compared with infants born at 41 weeks gestation (40 weeks: aOR, 0.93; 95% CI, 0.86-0.99; 39 weeks: aOR, 0.87; 95% CI, 0.81-0.93; 38 weeks: aOR, 0.81; 95% CI, 0.75-0.88; 37 weeks: aOR, 0.74; 95% CI, 0.67-0.82). Using a population-based approach, we found that infants born at 40, 39, 38, and 37 weeks gestation had increasingly lower odds of being breastfed compared with infants born at 41 weeks. Clinicians need to be made aware of the differences in outcomes of infants delivered at early and late term, so that appropriate breastfeeding support can be provided to women at risk for not breastfeeding. Copyright © 2013 Mosby, Inc. All rights reserved.

  19. Term perinatal mortality audit in the Netherlands 2010–2012: a population-based cohort study

    Science.gov (United States)

    Eskes, Martine; Waelput, Adja J M; Erwich, Jan Jaap H M; Brouwers, Hens A A; Ravelli, Anita C J; Achterberg, Peter W; Merkus, Hans (J) M W M; Bruinse, Hein W

    2014-01-01

    Objective To assess the implementation and first results of a term perinatal internal audit by a standardised method. Design Population-based cohort study. Setting All 90 Dutch hospitals with obstetric/paediatric departments linked to community practices of midwives, general practitioners in their attachment areas, organised in perinatal cooperation groups (PCG). Population The population consisted of 943 registered term perinatal deaths occurring in 2010–2012 with detailed information, including 707 cases with completed audit results. Main outcome measures Participation in the audit, perinatal death classification, identification of substandard factors (SSF), SSF in relation to death, conclusive recommendations for quality improvement in perinatal care and antepartum risk selection at the start of labour. Results After the introduction of the perinatal audit in 2010, all PCGs participated. They organised 645 audit sessions, with an average of 31 healthcare professionals per session. Of all 1102 term perinatal deaths (2.3/1000) data were registered for 86% (943) and standardised anonymised audit results for 64% (707). In 53% of the cases at least one SSF was identified. Non-compliance to guidelines (35%) and deviation from usual professional care (41%) were the most frequent SSF. There was a (very) probable relation between the SSF and perinatal death for 8% of all cases. This declined over the years: from 10% (n=23) in 2010 to 5% (n=10) in 2012 (p=0.060). Simultaneously term perinatal mortality decreased from 2.3 to 2.0/1000 births (pperinatal audit is implemented nationwide in all obstetrical units in the Netherlands in a short time period. It is possible that the audit contributed to the decrease in term perinatal mortality. PMID:25763794

  20. Leukocyte Populations in Human Preterm and Term Breast Milk Identified by Multicolour Flow Cytometry.

    Directory of Open Access Journals (Sweden)

    Stephanie Trend

    Full Text Available Extremely preterm infants are highly susceptible to bacterial infections but breast milk provides some protection. It is unknown if leukocyte numbers and subsets in milk differ between term and preterm breast milk. This study serially characterised leukocyte populations in breast milk of mothers of preterm and term infants using multicolour flow cytometry methods for extended differential leukocyte counts in blood.Sixty mothers of extremely preterm (<28 weeks gestational age, very preterm (28-31 wk, and moderately preterm (32-36 wk, as well as term (37-41 wk infants were recruited. Colostrum (d2-5, transitional (d8-12 and mature milk (d26-30 samples were collected, cells isolated, and leukocyte subsets analysed using flow cytometry.The major CD45+ leukocyte populations circulating in blood were also detectable in breast milk but at different frequencies. Progression of lactation was associated with decreasing CD45+ leukocyte concentration, as well as increases in the relative frequencies of neutrophils and immature granulocytes, and decreases in the relative frequencies of eosinophils, myeloid and B cell precursors, and CD16- monocytes. No differences were observed between preterm and term breast milk in leukocyte concentration, though minor differences between preterm groups in some leukocyte frequencies were observed.Flow cytometry is a useful tool to identify and quantify leukocyte subsets in breast milk. The stage of lactation is associated with major changes in milk leukocyte composition in this population. Fresh preterm breast milk is not deficient in leukocytes, but shorter gestation may be associated with minor differences in leukocyte subset frequencies in preterm compared to term breast milk.

  1. Neonatal infectious diseases: evaluation of neonatal sepsis.

    Science.gov (United States)

    Camacho-Gonzalez, Andres; Spearman, Paul W; Stoll, Barbara J

    2013-04-01

    Neonatal sepsis remains a feared cause of morbidity and mortality in the neonatal period. Maternal, neonatal, and environmental factors are associated with risk of infection, and a combination of prevention strategies, judicious neonatal evaluation, and early initiation of therapy are required to prevent adverse outcomes. This article reviews recent trends in epidemiology and provides an update on risk factors, diagnostic methods, and management of neonatal sepsis. Copyright © 2013 Elsevier Inc. All rights reserved.

  2. Long-term inhibition of glycosphingolipid accumulation in Fabry model mice by a single systemic injection of AAV1 vector in the neonatal period.

    Science.gov (United States)

    Ogawa, Koichi; Hirai, Yukihiko; Ishizaki, Masamichi; Takahashi, Hiroshi; Hanawa, Hideki; Fukunaga, Yoshitaka; Shimada, Takashi

    2009-03-01

    Fabry disease is caused by the deficiency of lysosomal alpha-galactosidase A (alpha-gal A) and usually develops clinical manifestations during childhood/adolescence. Adult Fabry model mice have been successfully treated by various viral vectors. Here, in order to examine the feasibility of preventive gene therapy, we compared AAV vector-mediated gene transfer into neonatal and adult model mice. AAV serotype 1 vector (AAV1) carrying human alpha-gal A cDNA driven by the CAG promoter was intravenously injected into adult (12 weeks old) and neonatal (2 days old) Fabry model mice, and were sacrificed for detailed examination 25 weeks after vector injection. AAV1 vector preferentially transduced the liver in male adult and sustained high concentration of alpha-gal A was detected in the liver, heart and plasma. In contrast, AAV1-mediated gene expression was suppressed in similarly treated female adult mice. When the vector was systemically injected into neonates, moderate increase in plasma alpha-gal A and cardiac-specific expression of alpha-gal A were observed independently of mouse sex. The high levels of alpha-gal A activity in the heart appear to be due to the strong activity of the CAG promoter in the heart. Globotriaosylceramide (Gb3) accumulation was efficiently inhibited in the liver and heart by a single injection into both adult and neonatal animals. The biodistribution of the AAV1 vector and levels of alpha-gal A expression are markedly different between adult and neonatal mice. Neonatal injection is effective to inhibit Gb3 accumulation and therefore, might help prevent failure of major organs during adulthood.

  3. The long-term population dynamics of common wasps in their native and invaded range.

    Science.gov (United States)

    Lester, Philip J; Haywood, John; Archer, Michael E; Shortall, Chris R

    2017-03-01

    Populations of introduced species are often thought to perform differently, or experience different population dynamics, in their introduced range compared to their native habitat. Differences between habitats in climate, competition or natural enemies may result in populations with varying density dependence and population dynamics. We examined the long-term population dynamics of the invasive common wasp, Vespula vulgaris, in its native range in England and its invaded range in New Zealand. We used 39 years of wasp density data from four sites in England, and 23 years of data from six sites in New Zealand. Wasp population time series was examined using partial rate correlation functions. Gompertz population models and multivariate autoregressive state-space (MARSS) models were fitted, incorporating climatic variation. Gompertz models successfully explained 59-66% of the variation in wasp abundance between years. Density dependence in wasp populations appeared to act similarly in both the native and invaded range, with wasp abundance in the previous year as the most important variable in predicting intrinsic rate of increase (r). No evidence of cyclic population dynamics was observed. Both the Gompertz and MARSS models highlighted the role of weather conditions in each country as significant predictors of annual wasp abundance. The temporal evolution of wasp populations at all sites was best modelled jointly using a single latent dynamic factor for local trends, with the inclusion of a latent spring weather covariate. That same parsimonious multivariate model structure was optimal in both the native and invaded range. Density dependence is overwhelmingly important in predicting wasp densities and 'wasp years' in both the native and invaded range. Spring weather conditions in both countries have a major influence, probably through their impact on wasp colony initiation and early development. The population dynamics in the native range and invaded range show no

  4. China's rapidly aging population creates policy challenges in shaping a viable long-term care system.

    Science.gov (United States)

    Feng, Zhanlian; Liu, Chang; Guan, Xinping; Mor, Vincent

    2012-12-01

    In China, formal long-term care services for the large aging population have increased to meet escalating demands as demographic shifts and socioeconomic changes have eroded traditional elder care. We analyze China's evolving long-term care landscape and trace major government policies and private-sector initiatives shaping it. Although home and community-based services remain spotty, institutional care is booming with little regulatory oversight. Chinese policy makers face mounting challenges overseeing the rapidly growing residential care sector, given the tension arising from policy inducements to further institutional growth, a weak regulatory framework, and the lack of enforcement capacity. We recommend addressing the following pressing policy issues: building a balanced system of services and avoiding an "institutional bias" that promotes rapid growth of elder care institutions over home or community-based care; strengthening regulatory oversight and quality assurance with information systems; and prioritizing education and training initiatives to grow a professionalized long-term care workforce.

  5. Antecedents and neuroimaging patterns in cerebral palsy with epilepsy and cognitive impairment: a population-based study in children born at term.

    Science.gov (United States)

    Ahlin, Kristina; Jacobsson, Bo; Nilsson, Staffan; Himmelmann, Kate

    2017-07-01

    Antecedents of accompanying impairments in cerebral palsy and their relation to neuroimaging patterns need to be explored. A population-based study of 309 children with cerebral palsy born at term between 1983 and 1994. Prepartum, intrapartum, and postpartum variables previously studied as antecedents of cerebral palsy type and motor severity were analyzed in children with cerebral palsy and cognitive impairment and/or epilepsy, and in children with cerebral palsy without these accompanying impairments. Neuroimaging patterns and their relation to identified antecedents were analyzed. Data were retrieved from the cerebral palsy register of western Sweden, and from obstetric and neonatal records. Children with cerebral palsy and accompanying impairments more often had low birthweight (kg) (odds ratio 0.5, 95% confidence interval 0.3-0.8), brain maldevelopment known at birth (p = 0.007, odds ratio ∞) and neonatal infection (odds ratio 5.4, 95% confidence interval 1.04-28.4). Moreover, neuroimaging patterns of maldevelopment (odds ratio 7.2, 95% confidence interval 2.9-17.2), cortical/subcortical lesions (odds ratio 5.3, 95% confidence interval 2.3-12.2) and basal ganglia lesions (odds ratio 7.6, 95% confidence interval 1.4-41.3) were more common, wheras white matter injury was found significantly less often (odds ratio 0.2, 95% confidence interval 0.1-0.5). In most children with maldevelopment, the intrapartum and postpartum periods were uneventful (p Cerebral maldevelopment was associated with prepartum antecedents, whereas subcortical/cortical and basal ganglia lesions were associated with intrapartum and postpartum antecedents. No additional factor other than those related to motor impairment was associated with epilepsy and cognitive impairment in cerebral palsy. Timing of antecedents deemed important for the development of cerebral palsy with accompanying impairments were supported by neuroimaging patterns. © 2017 Nordic Federation of Societies of Obstetrics

  6. The association of cerebral palsy and death with small-for-gestational-age birthweight in preterm neonates by individualized and population-based percentiles.

    LENUS (Irish Health Repository)

    Grobman, William A

    2013-10-01

    The objective of the study was to determine whether an individualized growth standard (IS) improves the identification of preterm small-for-gestational-age (SGA) neonates at risk of developing moderate\\/severe cerebral palsy (CP) or death.

  7. Radiologic findings of neonatal sepsis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sam Soo; Han, Dae Hee; Choi, Guk Myeong; Jung, Hye Won [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of); Yoon, Hye Kyung; Han, Bokyung Kim; Lee, Nam Yong [Sansung Medical Center, Seoul (Korea, Republic of)

    1997-06-01

    To review the simple radiographic and sonographic findings in infants with neonatal sepsis. We retrospectively analyzed simple chest and abdominal radiographs, and brain sonograms in 36 newborn infants (preterm : term=23 :13). With neonatal sepsis diagnosed by blood culture and clinical manifestations. Pulmonary parenchymal infiltrate excluding respiratory distress syndrome and pulmonary edema or atelectasis was found in 22 infants (61%). Paralytic ileus, hepatosplenomegaly, and necrotizing enterocolitis were present in 18(50%), 9(25%), and 1(3%) infants, respectively, while skeletal changes suggesting osteomyelitis were found in three. Brain sonography was performed in 29 infants and in four, abnormalities were seen ; these comprised three germinal matrix hemorrhages and one intraparenchymal hemorrhage. In six patients(17%) radiologic examinations revealed no abnormality. In patients with neonatal sepsis, pulmonary infiltrates and paralytic ileus were common abnormalities. Although these were nonspecific, radiologic findings may be used to supplement clinical and laboratory findings in diagnosing neonatal sepsis and planning its treatment.

  8. Influence of melanin on mutation load in Drosophila populations after long-term irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Mosse, I.B.; Lyakh, I.P. [Belarus Academy of Sciences, Minsk (Belarus)

    1994-09-01

    The effect of melanin on the level of mutation load has been studied in experimental Drosophila populations exposed to radiation for 115 generations. Four types of populations have been analyzed: (1) control; (2) treated with melanin; (3) irradiated; (4) irradiated and treated with melanin. Melanin was produced by auto-oxidation of 1-dioxyphenylallanine and was constantly added to food. Populations were X-irradiated twice in each generation (at the larvae stage with 6 Gy and at the imago stage with 9 Gy). The level of recessive mutation on the third chromosome was analyzed by a standard genetic method of balanced lethals. The data obtained have shown that the populations exposed to long-term irradiation have the greatest number of mutations decreasing viability. Melanin exhibited radioprotective properties-it reduced the percentage of lethal, semilethal and subvital mutations. Thus the possibility of effective protection of populations exposed to radiation for many generations by melanin has been shown for the first time. 19 refs., 1 fig., 1 tab.

  9. Prolonged parenteral nutrition after neonatal gastrointestinal surgery

    DEFF Research Database (Denmark)

    Estmann, Anne; Qvist, Niels; Husby, Steffen

    2002-01-01

    INTRODUCTION: Long-term treatment with parenteral nutrition (PN) may be essential for survival in infants after neonatal gastrointestinal surgery. It seemed well indicated in a population-based study to estimate the need for long-term PN and to characterize the infants that received TPN with regard...... to diagnosis and clinical course. METHODOLOGY: This study reviews the clinical course of infants with gastrointestinal disease (gastroschisis, intestinal atresia, omphalocele, volvulus, Hirschsprung's disease and necrotizing enterocolitis) with a prolonged need for parenteral nutrition in the Western part...... of Denmark over a period of 11 1/2 years. RESULTS: A total of 21 patients with need for PN for 55 days or more due to gastrointestinal disease were registered with a cumulative hospital stay of 4462 days. The study showed a low incidence of long-term PN due to gastro-intestinal surgical illness...

  10. Neonatal Kraniefraktur

    DEFF Research Database (Denmark)

    Johannesen, Katrine Marie Harries; Stantchev, Hristo

    2015-01-01

    During the latest decades the incidence of birth traumas has decreased significantly. Even so the traumas still contribute to an increased mortality and morbidity. We present a case of spontaneous neonatal skull fracture following a normal vaginal delivery. Abnormal facial structure was seen, and......, and the fracture was identified with an MRI. The fractures healed without neurosurgical intervention. Case reports show that even in uncomplicated vaginal deliveries skull fractures can be seen and should be suspected in children with facial abnormalities.......During the latest decades the incidence of birth traumas has decreased significantly. Even so the traumas still contribute to an increased mortality and morbidity. We present a case of spontaneous neonatal skull fracture following a normal vaginal delivery. Abnormal facial structure was seen...

  11. When is birthweight at term abnormally low? A systematic review and meta-analysis of the association and predictive ability of current birthweight standards for neonatal outcomes

    NARCIS (Netherlands)

    Malin, G. L.; Morris, R. K.; Riley, R.; Teune, M. J.; Khan, K. S.

    2014-01-01

    Intrauterine growth restriction is a cause of neonatal morbidity and mortality. A variety of definitions of low birthweight are used in clinical practice, with a lack of consensus regarding which definitions best predict adverse outcomes. To evaluate the relationship between birthweight standards

  12. Developmental hemostasis: A lifespan from neonates and pregnancy to the young and elderly adult in a European white population.

    Science.gov (United States)

    Nowak-Göttl, Ulrike; Limperger, Verena; Kenet, Gili; Degenhardt, Frauke; Arlt, Roman; Domschikowski, Justus; Clausnizer, Hartmut; Liebsch, Jürgen; Junker, Ralf; Steppat, Dagmar

    2017-09-01

    Absolute values of reference ranges for coagulation assays in humans vary within the entire lifespan and confirm the concept of developmental hemostasis. It is known that physiologic concentrations of coagulation factors (F) gradually increase over age: they are lower in premature infants as compared to full-term babies, healthy children or adults. Here we demonstrate in a cohort of 1011 blood donors and in a group of 193 healthy pregnant women, that the process of developmental hemostasis proceeds in adults. During the course of pregnancy F and activation markers steadily increase until delivery with a parallel decrease noticed for protein S. From adolescents, young adults to the elderly there is a further increase of F, reaching significance starting between 35 and 50years of age compared to younger subjects. Covering the entire lifespan FVIII and von-Willebrand-factor showed the lowest values in carriers of blood group "O". Apart from pregnancy differences related to gender, pill users, smoking habits or the presence of thrombophilic variants were reported. Laboratory test results should be compared to age-related reference intervals when hemostatic defects are suspected to avoid misclassifications as being "healthy", prone to "bleeding" or vice versa to "thrombosis". Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Neonatal Listeriosis

    Directory of Open Access Journals (Sweden)

    Shih-Yu Chen

    2007-01-01

    Full Text Available In Western developed countries, Listeria monocytogenes is not an uncommon pathogen in neonates. However, neonatal listeriosis has rarely been reported in Taiwan. We describe two cases collected from a single medical institute between 1990 and 2005. Case 1 was a male premature baby weighing 1558 g with a gestational age of 31 weeks whose mother had fever with chills 3 days prior to delivery. Generalized maculopapular rash was found after delivery and subtle seizure developed. Both blood and cerebrospinal fluid culture collected on the 1st day yielded L. monocytogenes. In addition, he had ventriculitis complicated with hydrocephalus. Neurologic development was normal over 1 year of follow-up after ventriculoperitoneal shunt operation. Case 2 was a 28-weeks' gestation male premature baby weighing 1180 g. Endotracheal intubation and ventilator support were provided after delivery due to respiratory distress. Blood culture yielded L. monocyto-genes. Cerebrospinal fluid showed pleocytosis but the culture was negative. Brain ultrasonography showed ventriculitis. Sudden deterioration with cyanosis and bradycardia developed on the 8th day and he died on the same day. Neonatal listeriosis is uncommon in Taiwan, but has significant mortality and morbidity. Early diagnosis of perinatal infection relies on high index of suspicion in perinatal health care professionals. [J Formos Med Assoc 2007;106(2:161-164

  14. Remifentanil: applications in neonates.

    Science.gov (United States)

    Kamata, Mineto; Tobias, Joseph D

    2016-06-01

    Remifentanil is a synthetic opioid derivative that was introduced into clinical practice in the United States in 1996. The unique modification of its chemical structure to include a methyl-ester ring allows its hydrolysis by non-specific plasma and tissue esterases. This molecular configuration results in its rapid metabolism thereby providing a rapid onset, easy titration by continuous infusion, and a short context-sensitive half-life with rapid elimination. These principles are stable and consistent across all age groups regardless of the infusion characteristics. Owing to these pharmacokinetic characteristics, it is an effective agent in the neonatal population allowing the provision of intense analgesia and anesthesia with a rapid recovery profile in various clinical scenarios. Here, we review the pharmacokinetics of remifentanil in neonates, discuss its clinical applications including intraoperative administration for anesthetic care, unique applications for procedural sedation including endotracheal intubation, and its potential use for sedation in the Intensive Care Unit setting during mechanical ventilation.

  15. Term perinatal mortality audit in the Netherlands 2010-2012: a population-based cohort study.

    Science.gov (United States)

    Eskes, Martine; Waelput, Adja J M; Erwich, Jan Jaap H M; Brouwers, Hens A A; Ravelli, Anita C J; Achterberg, Peter W; Merkus, Hans J M W M; Bruinse, Hein W

    2014-10-14

    To assess the implementation and first results of a term perinatal internal audit by a standardised method. Population-based cohort study. All 90 Dutch hospitals with obstetric/paediatric departments linked to community practices of midwives, general practitioners in their attachment areas, organised in perinatal cooperation groups (PCG). The population consisted of 943 registered term perinatal deaths occurring in 2010-2012 with detailed information, including 707 cases with completed audit results. Participation in the audit, perinatal death classification, identification of substandard factors (SSF), SSF in relation to death, conclusive recommendations for quality improvement in perinatal care and antepartum risk selection at the start of labour. After the introduction of the perinatal audit in 2010, all PCGs participated. They organised 645 audit sessions, with an average of 31 healthcare professionals per session. Of all 1102 term perinatal deaths (2.3/1000) data were registered for 86% (943) and standardised anonymised audit results for 64% (707). In 53% of the cases at least one SSF was identified. Non-compliance to guidelines (35%) and deviation from usual professional care (41%) were the most frequent SSF. There was a (very) probable relation between the SSF and perinatal death for 8% of all cases. This declined over the years: from 10% (n=23) in 2010 to 5% (n=10) in 2012 (p=0.060). Simultaneously term perinatal mortality decreased from 2.3 to 2.0/1000 births (pperinatal audit is implemented nationwide in all obstetrical units in the Netherlands in a short time period. It is possible that the audit contributed to the decrease in term perinatal mortality. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  16. Long-term population patterns of rodents and associated damage in German forestry.

    Science.gov (United States)

    Imholt, Christian; Reil, Daniela; Plašil, Pavel; Rödiger, Kerstin; Jacob, Jens

    2017-02-01

    Several rodent species can damage forest trees, especially at young tree age in afforestation. Population outbreaks of field voles (Microtus agrestis L.) and bank voles (Myodes glareolus Schreber) in particular can cause losses. Analyses of long-term time series indicate good synchrony of population abundance in rodent species associated with damage in forestry. This synchrony could be related to the effect of beech (Fagus spec.) mast in the previous year on population growth rates of both species. In shorter time series from Eastern Germany, damage in forestry was mostly associated with autumn abundances of rodents. Environmental factors such as beech mast and snow cover did not explain additional variation in rodent damage to trees. Beech mast is a good indicator of long-term rodent abundance in Northern German afforestation areas. However, rodent damage to forestry in Central Germany did not seem to depend on environmental parameters other than rodent abundance at large scale. As a result, there is still uncertainty about the link between environmental predictors and rodent damage to forestry, and further experimental work is required to identify suitable environmental drivers and their interplay with other potential factors such as the local predator community. © 2016 Society of Chemical Industry. © 2016 Society of Chemical Industry.

  17. Evaluation of knowledge of the term "nephrology" in a population sample.

    Science.gov (United States)

    Di Luca, Daniel Garbin; de Oliveira, Diogo Costa Leandro; Guimarães, Luis Eduardo Reis; Tamiasso, Gabriel Cruz; Goulart, Lis Bastos Zampier; Rosa, Maria Luiza Garcia; Lugon, Jocemir Ronaldo

    2013-01-01

    The consolidation of nephrology as a medical specialty is relatively new and its denomination does not intuitively reflects its true scope. To assess the degree of knowledge from a population sample regarding the term "nephrology". We carried out a cross-sectional study in Niterói, RJ, with adult passerby individuals answering to the question "Do you know what nephrology is?". The variables recorded included: gender, age, skin-color, residence, income, educational level and kidney-disease history in the family. p values 30 years. The mean age among participants was 39 (22-56) years, 49% were males and 56% caucasians. Twenty-eight percent of the interviewees knew the term "nephrology". Their knowledge came from school (39%) and family (30%). Those who knew about the term "nephrology" were older (42 ± 17 vs. 39 ± 17 years, p nephrology", illustrating the specialty's low penetration. We must strive to popularize this field of medicine aiming at better educating the population concerning the prevention and care of kidney diseases.

  18. Inclusion of psyllium in milk replacer for neonatal calves. 2. Effects on volatile fatty acid concentrations, microbial populations, and gastrointestinal tract size.

    Science.gov (United States)

    Cannon, S J; Fahey, G C; Pope, L L; Bauer, L L; Wallace, R L; Miller, B L; Drackley, J K

    2010-10-01

    Fermentable fibers such as psyllium increase volatile fatty acid (VFA) concentrations in the lower digestive tract and increase the gastrointestinal tract (GIT) mass of many mammals. We reasoned that psyllium inclusion in milk replacer might produce similar effects in neonatal dairy calves, which could lead to improved growth and health. Male Holstein calves were fed a milk replacer (22% crude protein, 20% fat) either without or with psyllium (1.1% of dry matter, DM) from 2 d through 28 d of age. Milk replacer was reconstituted to 12.5% DM and fed at 12% of calf body weight, adjusted weekly. Water was offered ad libitum but no starter was fed. Three calves per treatment were harvested weekly to sample digesta from the reticulo-rumen, abomasum, jejunum, proximal colon, and distal colon, and to determine length and mass of GIT components. Psyllium in milk replacer increased the proportion of butyrate in reticulo-rumen contents from 2.4 to 3.2% of total but did not affect total VFA concentrations. Total VFA concentrations were very low in the jejunum but psyllium tended to increase total VFA, acetate, and valerate concentrations; valerate accounted for 15.9 and 16.7% of total VFA (molar basis) for control and psyllium calves, respectively. Psyllium increased total VFA concentrations in the proximal and distal colon by 104.4 and 45.6%, respectively, but had little effect on the profile of VFA. Psyllium in milk replacer increased populations of bifidobacteria (from 9.7 to 10.3 log(10) cfu/g of DM) and lactobacilli (from 8.2 to 9.4 log(10) cfu/g of DM) in the reticulo-rumen, but did not affect populations in jejunum or colon. Calves fed psyllium had 12.0% greater total GIT mass and 9.4% greater GIT as a percentage of body weight. Psyllium tended to increase mass of the reticulo-rumen and significantly increased mass of duodenum (34.2%), jejunum (14.5%), and colon (14.6%). Density of intestinal tissues from calves fed psyllium-supplemented milk replacer was 25.9% greater

  19. Prevalence, perceptions and practices surrounding neonatal breast ...

    African Journals Online (AJOL)

    These lead to increased morbidity such as abscess formation and cellulitis. Objective: To document prevalence of, and perceptions about neonatal breast enlargement in newborns and interventions if any in south east Nigeria. Results: Neonatal breast enlargement was present in 50.8% of the target population with females ...

  20. Neonatal Tele-Homecare

    DEFF Research Database (Denmark)

    Holm, Kristina Garne

    Neonatal homecare (NH) implies that parents manage tube feeding and care of their preterm infant at home supported by home visits from neonatal nurses, to monitor infant growth and the well-being of the family. Home visits are costly and time consuming in rural areas. The overall aim of this study...... identified the need for NH to support the parents at home instead of in the NICU, as NH was highly demanded by the parents. The aim in the second phase of the study was to test, develop and design a telehealth service for NH (paper II). A creative workshop was conducted to generate ideas based...... on the identified needs in phase one. Participants in the creative workshop were parents, infants, clinicians, researchers, an IT-company and innovation engineers. Parents requested an app, which should gather all the requested functionalities; however, the clinicians were concerned of increased workload in terms...

  1. LONG TERM SURVIVAL FOLLOWING TRAUMATIC BRAIN INJURY: A POPULATION BASED PARAMETRIC SURVIVAL ANALYSIS

    Science.gov (United States)

    Fuller, Gordon Ward; Ransom, Jeanine; Mandrekar, Jay; Brown, Allen W

    2017-01-01

    Background Long term mortality may be increased following traumatic brain injury (TBI); however the degree to which survival could be reduced is unknown. We aimed to model life expectancy following post-acute TBI to provide predictions of longevity and quantify differences in survivorship with the general population. Methods A population based retrospective cohort study using data from the Rochester Epidemiology Project (REP) was performed. A random sample of patients from Olmsted County, Minnesota with a confirmed TBI between 1987 and 2000 was identified and vital status determined in 2013. Parametric survival modelling was then used to develop a model to predict life expectancy following TBI conditional on age at injury. Survivorship following TBI was also compared with the general population and age and gender matched non-head injured REP controls. Results 769 patients were included in complete case analyses. Median follow up time was 16.1 years (IQR 9.0–20.4) with 120 deaths occurring in the cohort during the study period. Survival after acute TBI was well represented by a Gompertz distribution. Victims of TBI surviving for at least 6 months post-injury demonstrated a much higher ongoing mortality rate compared to the US general population and non-TBI controls (hazard ratio 1·47, 95% CI 1·15–1·87). US general population cohort life table data was used to update the Gompertz model’s shape and scale parameters to account for cohort effects and allow prediction of life expectancy in contemporary TBI. Conclusions Survivors of TBI have decreased life expectancy compared to the general population. This may be secondary to the head injury itself or result from patient characteristics associated with both the propensity for TBI and increased early mortality. Post-TBI life expectancy estimates may be useful to guide prognosis, in public health planning, for actuarial applications and in the extrapolation of outcomes for TBI economic models. PMID:27165161

  2. Long-term population dynamics of a managed burrowing owl colony

    Science.gov (United States)

    Barclay, John H.; Korfanta, Nicole M.; Kauffman, Matthew J.

    2011-01-01

    We analyzed the population dynamics of a burrowing owl (Athene cunicularia) colony at Mineta San Jose International Airport in San Jose, California, USA from 1990-2007. This colony was managed by using artificial burrows to reduce the occurrence of nesting owls along runways and within major airport improvement projects during the study period. We estimated annual reproduction in natural and artificial burrows and age-specific survival rates with mark-recapture techniques, and we estimated the relative contribution of these vital rates to population dynamics using a life table response experiment. The breeding colony showed 2 distinct periods of change: high population growth from 7 nesting pairs in 1991 to 40 pairs in 2002 and population decline to 17 pairs in 2007. Reproduction was highly variable: annual nesting success (pairs that raised =1 young) averaged 79% and ranged from 36% to 100%, whereas fecundity averaged 3.36 juveniles/pair and ranged from 1.43 juveniles/pair to 4.54 juveniles/pair. We estimated annual adult survival at 0.710 during the period of colony increase from 1996 to 2001 and 0.465 during decline from 2002 to 2007, but there was no change in annual survival of juveniles between the 2 time periods. Long-term population growth rate (lambda) estimated from average vital rates was lambdaa=1.072 with lambdai=1.288 during colony increase and lambdad=0.921 (DELTA lambda=0.368) during decline. A life table response experiment showed that change in adult survival rate during increasing and declining phases explained more than twice the variation in growth rate than other vital rates. Our findings suggest that management and conservation of declining burrowing owl populations should address factors that influence adult survival.

  3. Impacts of neonicotinoid use on long-term population changes in wild bees in England

    Science.gov (United States)

    Woodcock, Ben A.; Isaac, Nicholas J. B.; Bullock, James M.; Roy, David B.; Garthwaite, David G.; Crowe, Andrew; Pywell, Richard F.

    2016-08-01

    Wild bee declines have been ascribed in part to neonicotinoid insecticides. While short-term laboratory studies on commercially bred species (principally honeybees and bumblebees) have identified sub-lethal effects, there is no strong evidence linking these insecticides to losses of the majority of wild bee species. We relate 18 years of UK national wild bee distribution data for 62 species to amounts of neonicotinoid use in oilseed rape. Using a multi-species dynamic Bayesian occupancy analysis, we find evidence of increased population extinction rates in response to neonicotinoid seed treatment use on oilseed rape. Species foraging on oilseed rape benefit from the cover of this crop, but were on average three times more negatively affected by exposure to neonicotinoids than non-crop foragers. Our results suggest that sub-lethal effects of neonicotinoids could scale up to cause losses of bee biodiversity. Restrictions on neonicotinoid use may reduce population declines.

  4. Epidemiology and resistance patterns in urinary pathogens from long-term care facilities and GP populations.

    LENUS (Irish Health Repository)

    Brabazon, E D

    2012-06-01

    Urinary tract infections (UTIs) are a major source of antimicrobial prescribing in the clinical setting and a potential reservoir for the emergence of resistant organisms. Although studies have been published on resistance rates for urinary pathogens from both hospital and general practitioner (GP) settings, there is little information from Long-Term Care Facilities (LTCFs) in Ireland. This study aimed to document the epidemiology and resistance rates in urinary isolates, in the LTCF and GP setting, from samples submitted to a typical microbiology laboratory. In 2010, there were 963 urinary isolates from LTCFs and 1,169 urinary isolates from GPs, identified from patients 65 years and over, with cytology suggestive of infection. E. coil was the most common causative organism identified. There were significantly higher levels of resistance to ampicillin, co-amoxiclav, ciprofloxacin, nitrofurantoin, trimethoprim, and piperacillin\\/tazobactam in the LTCF population compared to the GP population (e.g. for E. coli, 86%-v-69%; 30%-v- 21%; 58%-v-26%, 10%-v-3%, 68%-v-48%, 10%-v- 4% respectively). Isolates with resistance mechanisms to beta-lactams, were identified in both populations. Results presented in this paper demonstrate significant differences between resistance rates in LTCF and GP populations which suggest that there are implications for empiric antimicrobial prescribing for UTIs in the LTCF setting.

  5. Propofol for procedural sedation/anaesthesia in neonates.

    Science.gov (United States)

    Shah, Prakeshkumar S; Shah, Vibhuti S

    2011-03-16

    Elective medical or surgical procedures are commonplace for neonates admitted to NICU. Agents such as opioids are commonly used for achieving sedation/analgesia/anaesthesia for such procedures; however, these agents are associated with adverse effects. Propofol is used widely in paediatric and adult populations for this purpose. The efficacy and safety of the use of propofol in neonates has not been defined. To determine the efficacy and safety of propofol treatment compared to placebo or no treatment or alternate active agents in neonates undergoing sedation or anaesthesia for procedures. To conduct subgroup analyses according to method of propofol administration (bolus or continuous infusion), type of active control agent (neuromuscular blocking agents with or without the use of sedative, analgesics or anxiolytics), type of procedure (endotracheal intubation, eye examination, other procedure), and gestational age (preterm and term). We searched MEDLINE (1950 to September 30, 2010), EMBASE (1980 to September 30, 2010) and the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2010, Issue 2) for eligible studies without language restriction. We searched reference lists of identified articles and abstracts submitted to Pediatric Academic Societies (2002 to 2009), and international trials registries for eligible articles. We included randomised or quasi-randomised controlled trials of propofol versus placebo, no treatment or other sedative/anaesthetic/analgesic agents in isolation or combination used in neonates for procedures. We collected and analysed data in accordance with the standard methods of the Cochrane Neonatal Review Group. One open-label randomised controlled trial of 63 neonates was eligible for inclusion. Thirty-three neonates in the propofol group were compared to 30 infants in the morphine-atropine-suxamethonium group. There was no statistically significant difference in the number of infants who required multiple

  6. Trends in profiles of bacteria causing neonatal sepsis in Central ...

    African Journals Online (AJOL)

    Developing countries suffer from a huge burden of neonatal sepsis. Neonatal mortality and long term sequelae or morbidity portends huge costs for the poor Nigerian economy. We identified trends in bacterial agents implicated in neonatal sepsis and their antibiotic susceptibility profiles at the National Hospital Abuja over ...

  7. Preterm prelabour rupture of membranes: effect of latency on neonatal and maternal outcomes.

    Science.gov (United States)

    Frenette, Priscilla; Dodds, Linda; Armson, B Anthony; Jangaard, Krista

    2013-08-01

    To compare risks of infection and prematurity-related outcomes according to latency periods among women with preterm prelabour rupture of membranes (PPROM). Women with PPROM occurring between 24+0 and 36+6 weeks of gestation were identified from a provincial population-based perinatal database in Nova Scotia. The primary outcomes included composite variables for serious maternal and neonatal infectious morbidity and neonatal prematurity-related morbidity. Logistic regression was used to quantify the relationship between latency period (prematurity-related morbidity were significantly decreased at the latency periods of 48 hours or more compared with prematurity-related morbidity at 48 hours to prematurity-related morbidity, even close to term, without putting mother or neonate at substantial risk for serious infectious morbidity. Generalization of these findings to other obstetric populations should be informed by the underlying risk of infection.

  8. The efficacy of non-pharmacological interventions in the management of procedural pain in preterm and term neonates. A systematic literature review.

    Science.gov (United States)

    Cignacco, Eva; Hamers, Jan P H; Stoffel, Lilian; van Lingen, Richard A; Gessler, Peter; McDougall, Jane; Nelle, Mathias

    2007-02-01

    Neonates in a neonatal intensive care unit are exposed to a high number of painful procedures. Since repeated and sustained pain can have consequences for the neurological and behaviour-oriented development of the newborn, the greatest attention needs to be paid to systematic pain management in neonatology. Non-pharmacological treatment methods are being increasingly discussed with regard to pain prevention and relief either alone or in combination with pharmacological treatment. To identify effective non-pharmacological interventions with regard to procedural pain in neonates. A literature search was conducted via the MedLine, CINAHL, Cochrane Library databases and complemented by a handsearch. The literature search covered the period from 1984 to 2004. Data were extracted according to pre-defined criteria by two independent reviewers and methodological quality was assessed. 13 randomised controlled studies and two meta-analyses were taken into consideration with regard to the question of current nursing practice of non-pharmacological pain management methods. The selected interventions were "non-nutritive sucking", "music", "swaddling", "positioning", "olfactory and multisensorial stimulation", "kangaroo care" and "maternal touch". There is evidence that the methods of "non-nutritive sucking", "swaddling" and "facilitated tucking" do have a pain-alleviating effect on neonates. Some of the non-pharmacological interventions have an evident favourable effect on pulse rate, respiration and oxygen saturation, on the reduction of motor activity, and on the excitation states after invasive measures. However, unambiguous evidence of this still remains to be presented. Further research should emphasise the use of validated pain assessment instruments for the evaluation of the pain-alleviating effect of non-pharmacological interventions.

  9. Etiologies of Prolonged Unconjugated Hyperbilirubinemia in Neonates Admitted to Neonatal Wards

    Directory of Open Access Journals (Sweden)

    Mohammad Kazem Sabzehei

    2015-12-01

    Full Text Available Background: Jaundice is a common condition among neonates. Prolonged unconjugated hyperbilirubinemia occurs when jaundice persists beyond two weeks in term neonates and three weeks in preterm neonates. This study aimed to determine the etiologies of prolonged unconjugated hyperbilirubinemia in infants admitted to the neonatal ward of Besat Hospital in Hamadan, Iran. Methods: This study was conducted on all infants diagnosed with prolonged unconjugated hyperbilirubinemia during 2007-2012 in the neonatal ward of Besat Hospital in Hamadan, Iran. Demographic characteristics of infants, physical examination and laboratory findings were collected and analyzed to determine the etiologies of neonatal hyperbilirubinemia. Results: In total, 100 infants diagnosed with neonatal hyperbilirubinemia were enrolled in this study, including 49 male and 51 female neonates with mean age of 20±1 days and mean bilirubin level of 17.5±4.0 mg/dL. Main causes of hyperbilirubinemia were urinary tract infection, ABO incompatibility, hypothyroidism and glucose-6-phosphate dehydrogenase deficiency in 14%, 5%, 6% and 5% of neonates, respectively. Moreover, unknown etiologies, such as breastfeeding, were detected in 70% of the studied infants. Conclusion: According to the results of this study, determining the main causes of prolonged unconjugated hyperbilirubinemia in neonates is of paramount importance. In the majority of cases, neonatal hyperbilirubinemia is associated with physiological factors, such as breastfeeding.

  10. Congenital hypothyroidism in neonates

    Directory of Open Access Journals (Sweden)

    Aneela Anjum

    2014-01-01

    Full Text Available Context: Congenital hypothyroidism (CH is one of the most common preventable causes of mental retardation in children and it occurs in approximately 1:2,000-1:4,000 newborns. Aims and Objectives: The aim of this study is to determine the frequency of CH in neonates. Settings and Design: This cross-sectional study was conducted in neonatal units of the Department of Pediatrics Unit-I, King Edward Medical University/Mayo Hospital, Lahore and Lady Willington Hospital Lahore in 6 months (January-June 2011. Materials and Methods: Sample was collected by non-probability purposive sampling. After consent, 550 newborn were registered for the study. Demographic data and relevant history was recorded. After aseptic measures, 2-3 ml venous blood analyzed for thyroid-stimulating hormone (TSH level by immunoradiometric assay. Treatment was started according to the individual merit as per protocol. Statistical Analysis Used: Data was analyzed by SPSS 17 and Chi-square test was applied to find out the association of CH with different variables. Results: The study population consisted of 550 newborns. Among 550 newborns, 4 (0.8% newborns had elevated TSH level. CH had statistically significant association with mother′s hypothyroidism (P value 0.000 and mother′s drug intake during the pregnancy period (P value 0.013. Conclusion: CH is 0.8% in neonates. It has statistically significant association with mother′s hypothyroidism and mother′s drug intake during pregnancy.

  11. Long Term Population, City Size and Climate Trends in the Fertile Crescent: A First Approximation.

    Science.gov (United States)

    Lawrence, Dan; Philip, Graham; Hunt, Hannah; Snape-Kennedy, Lisa; Wilkinson, T J

    2016-01-01

    Over the last 8000 years the Fertile Crescent of the Near East has seen the emergence of urban agglomerations, small scale polities and large territorial empires, all of which had profound effects on settlement patterns. Computational approaches, including the use of remote sensing data, allow us to analyse these changes at unprecedented geographical and temporal scales. Here we employ these techniques to examine and compare long term trends in urbanisation, population and climate records. Maximum city size is used as a proxy for the intensity of urbanisation, whilst population trends are modelled from settlement densities in nine archaeological surveys conducted over the last 30 years across the region. These two measures are then compared with atmospheric moisture levels derived from multiple proxy analyses from two locations close to the study area, Soreq Cave in Israel and Lake Van in south-eastern Turkey, as well as wider literature. The earliest urban sites emerged during a period of relatively high atmospheric moisture levels and conform to a series of size thresholds. However, after the Early Bronze Age maximum urban size and population levels increase rapidly whilst atmospheric moisture declines. We argue that although the initial phase of urbanization may have been linked to climate conditions, we can see a definitive decoupling of climate and settlement patterns after 2000 BC. We relate this phenomenon to changes in socio-economic organisation and integration in large territorial empires. The complex relationships sustaining urban growth during this later period resulted in an increase in system fragility and ultimately impacted on the sustainability of cities in the long term.

  12. Long Term Population, City Size and Climate Trends in the Fertile Crescent: A First Approximation.

    Directory of Open Access Journals (Sweden)

    Dan Lawrence

    Full Text Available Over the last 8000 years the Fertile Crescent of the Near East has seen the emergence of urban agglomerations, small scale polities and large territorial empires, all of which had profound effects on settlement patterns. Computational approaches, including the use of remote sensing data, allow us to analyse these changes at unprecedented geographical and temporal scales. Here we employ these techniques to examine and compare long term trends in urbanisation, population and climate records. Maximum city size is used as a proxy for the intensity of urbanisation, whilst population trends are modelled from settlement densities in nine archaeological surveys conducted over the last 30 years across the region. These two measures are then compared with atmospheric moisture levels derived from multiple proxy analyses from two locations close to the study area, Soreq Cave in Israel and Lake Van in south-eastern Turkey, as well as wider literature. The earliest urban sites emerged during a period of relatively high atmospheric moisture levels and conform to a series of size thresholds. However, after the Early Bronze Age maximum urban size and population levels increase rapidly whilst atmospheric moisture declines. We argue that although the initial phase of urbanization may have been linked to climate conditions, we can see a definitive decoupling of climate and settlement patterns after 2000 BC. We relate this phenomenon to changes in socio-economic organisation and integration in large territorial empires. The complex relationships sustaining urban growth during this later period resulted in an increase in system fragility and ultimately impacted on the sustainability of cities in the long term.

  13. Short-term genetic changes: evaluating effective population size estimates in a comprehensively described brown trout (Salmo trutta) population

    National Research Council Canada - National Science Library

    Serbezov, Dimitar; Jorde, Per Erik; Bernatchez, Louis; Olsen, Esben Moland; Vøllestad, L Asbjørn

    2012-01-01

    The effective population size (N(e)) is notoriously difficult to accurately estimate in wild populations as it is influenced by a number of parameters that are difficult to delineate in natural systems...

  14. Transient neonatal diabetes or neonatal hyperglycaemia

    African Journals Online (AJOL)

    owner

    2012-05-26

    May 26, 2012 ... frequency of neonatal disease and when it does occur, it will worsen neonatal morbidity and mortality. Blood glucose levels in babies on dextrose infusion should be moni- tored regularly in order to help indi- vidualise glucose requirements. Introduction. Neonatal hyperglcaemia has been defined by ...

  15. The path to chronic kidney disease following acute kidney injury: a neonatal perspective.

    Science.gov (United States)

    Chaturvedi, Swasti; Ng, Kar Hui; Mammen, Cherry

    2017-02-01

    The risk of acute kidney injury (AKI) in hospitalized critically ill neonatal populations without primary renal disease continues to be high, in both term and premature infants. Observational studies have revealed high rates of chronic kidney disease (CKD) in survivors of neonatal AKI. Proposed mechanisms underlying the progression of CKD following AKI include nephron loss and hyperfiltration, vascular insufficiency and maladaptive repair mechanisms. Other factors, including prematurity and low birth weight, have an independent relationship with the development of CKD, but they may also be positive effect modifiers in the relationship of AKI and CKD. The large degree of heterogeneity in the literature on AKI in the neonatal population, including the use of various AKI definitions and CKD outcomes, has hampered the medical community's ability to properly assess the relationship of AKI and CKD in this vulnerable population. Larger prospective cohort studies with control groups which utilize recently proposed neonatal AKI definitions and standardized CKD definitions are much needed to properly quantify the risk of CKD following an episode of AKI. Until there is further evidence to guide us, we recommend that all neonates with an identified episode of AKI should have an appropriate longitudinal follow-up in order to identify CKD at its earliest stages.

  16. Geriatrics and the triple aim: defining preventable hospitalizations in the long-term care population.

    Science.gov (United States)

    Ouslander, Joseph G; Maslow, Katie

    2012-12-01

    Reducing preventable hospitalizations is fundamental to the "triple aim" of improving care, improving health, and reducing costs. New federal government initiatives that create strong pressure to reduce such hospitalizations are being or will soon be implemented. These initiatives use quality measures to define which hospitalizations are preventable. Reducing hospitalizations could greatly benefit frail and chronically ill adults and older people who receive long-term care (LTC) because they often experience negative effects of hospitalization, including hospital-acquired conditions, morbidity, and loss of functional abilities. Conversely, reducing hospitalizations could mean that some people will not receive hospital care they need, especially if the selected measures do not adequately define hospitalizations that can be prevented without jeopardizing the person's health and safety. An extensive literature search identified 250 measures of preventable hospitalizations, but the measures have not been validated in the LTC population and generally do not account for comorbidity or the capacity of various LTC settings to provide the required care without hospitalization. Additional efforts are needed to develop measures that accurately differentiate preventable from necessary hospitalizations for the LTC population, are transparent and fair to providers, and minimize the potential for gaming and unintended consequences. As the new initiatives take effect, it is critical to monitor their effect and to develop and disseminate training and resources to support the many community- and institution-based healthcare professionals and emergency department staff involved in decisions about hospitalization for this population. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

  17. Increased short- and long-term mortality among patients with infectious spondylodiscitis compared with a reference population

    DEFF Research Database (Denmark)

    Kehrer, Michala; Pedersen, Court; Jensen, Thøger Gorm

    2015-01-01

    patients were compared with rates among a reference population using Kaplan-Meier plots and mortality rate ratios (MRRs). Short-term mortality was defined as deaths within first year after admission and long-term mortality was deaths thereafter. Factors associated with death were determined. RESULTS: Among...... the first year after admission and thereafter decreased with time to a level close to the reference population. Short-term mortality was especially related to infection with abscess formation and neurologic deficits and long-term mortality was related to alcohol dependency....

  18. Long-term results of percutaneous balloon valvuloplasty in pulmonary valve stenosis in the pediatric population.

    Science.gov (United States)

    Merino-Ingelmo, Raquel; Santos-de Soto, José; Coserria-Sánchez, Félix; Descalzo-Señoran, Alfonso; Valverde-Pérez, Israel

    2014-05-01

    Percutaneous pulmonary valvuloplasty is the preferred interventional procedure for pulmonary valve stenosis. The aim of this study was to evaluate the effectiveness of this technique, assess the factors leading to its success, and determine the long-term results in the pediatric population. The study included 53 patients with pulmonary valve stenosis undergoing percutaneous balloon valvuloplasty between December 1985 and December 2000. Right ventricular size and functional echocardiographic parameters, such as pulmonary regurgitation and residual transvalvular gradient, were assessed during long-term follow-up. Peak-to-peak transvalvular gradient decreased from 74 mmHg [interquartile range, 65-100 mmHg] to 20 mmHg [interquartile range, 14-34 mmHg]. The procedure was unsuccessful in 2 patients (3.77%). The immediate success rate was 73.58%. Follow-up ranged from 10 years to 24 years (median, 15 years). During follow-up, all patients developed late pulmonary regurgitation which was assessed as grade II in 58.4% and grade III in 31.2%. There was only 1 case of long-term restenosis (2.1%). Severe right ventricular dilatation was observed in 27.1% of the patients. None of the patients developed significant right ventricular dysfunction. Pulmonary valve replacement was not required in any of the patients. Percutaneous balloon valvuloplasty is an effective technique in the treatment of pulmonary valve stenosis with good long-term results. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  19. An observational study of blood concentrations and kinetics of methyl- and propyl-parabens in neonates.

    Science.gov (United States)

    Mulla, H; Yakkundi, S; McElnay, J; Lutsar, I; Metsvaht, T; Varendi, H; Nellis, G; Nunn, A; Duncan, J; Pandya, H; Turner, M

    2015-03-01

    Systemic exposure to parabens in the neonatal population, in particular propyl-parabens (PPB), remains a concern. Blood concentrations and kinetics of methyl-parabens (MPB) and PPB were therefore determined in neonates receiving medicines containing these excipients. A multi-centre, non-interventional, observational study of excipient-kinetics in neonates. 'Dried Blood Spot' samples were collected opportunistically at the same time as routine samples and the observations modelled using a non-linear mixed effects approach. A total of 841 blood MPB and PPB concentration data were available for evaluation from 181 pre- and term-neonates. Quantifiable blood concentrations of MPB and PPB were observed in 99% and 49% of patients, and 55% and 25% of all concentrations were above limit of detection (10 ng/ml), respectively. Only MPB data was amenable to modelling. Oral bioavailability was influenced by type of formulation and disposition was best described by a two compartment model with clearance (CL) influenced by post natal age (PNA); CL PNA21 days 0.88 L/h. Daily repeated administration of parabens containing medicines can result in prolonged systemic exposure to the parent compound in neonates. Animal toxicology studies of PPB that specifically address the neonatal period are required before a permitted daily exposure for this age group can be established.

  20. The effect of methadone dose regimen on neonatal abstinence syndrome.

    Science.gov (United States)

    McCarthy, John J; Leamon, Martin H; Willits, Neil H; Salo, Ruth

    2015-01-01

    To evaluate the effects of a multiple daily dose methadone regimen in pregnancy on neonatal outcomes. Although methadone maintenance has been the standard for the treatment of opioid dependence in pregnancy, there is no consensus on proper dosing. Single daily dosing is the most common strategy. Because of accelerated metabolism of methadone in pregnancy, this regimen may expose mother and fetus to daily episodes of withdrawal and possibly contribute to more severe Neonatal Abstinence Syndrome (NAS). This study reports on a protocol that increased both methadone dose and dose frequency in response to maternal reports of withdrawal. Treatment of NAS was needed in 29% of neonates, compared to a published rate of 60% to 80%. The mean methadone dose was 152 mg at delivery, divided into 2 to 6 doses per day. Ninety-two percent of mothers were free of illicit drug use at delivery. There was no relationship between methadone dose and treatment of NAS. Female babies had a treatment rate of 16% versus 38% for male babies. Beyond abstinence symptoms, cohort outcomes in terms of gestational age, birth weight, prematurity, Caesarian sections, and breastfeeding equaled or approximated US population norms. The protocol was associated with low rates of treatment of NAS and high rates of maternal recovery. High rates of treatment for NAS reported in methadone-exposed neonates might relate in part to iatrogenic factors and be reduced through the use of divided daily doses and protocols that minimize maternal withdrawal.

  1. Bat Species Occurrence and Long-Term Bat Population Monitoring on Refuges Using Acoustical Detection - 2012-2015 Summary

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — Long-term trend monitoring efforts for bats on National Wildlife Refuges have been prompted by a paucity of significant population information and precipitous...

  2. Building a case for neonatal palliative care.

    Science.gov (United States)

    Romesberg, Tricia L

    2007-01-01

    The concept of palliative care, well recognized in the adult population, has not been fully implemented in the pediatric population. Yet there is an urgent need to define and provide excellence in end-of-life care for infants and their families. Beneficent end-of-life care for the dying neonate includes efforts directed at comfort care, assistance with end-of-life decision making, and bereavement support. Through research and education, the challenges to implementing neonatal palliative care programs can be overcome. This article describes the components of neonatal palliative care, identifies the challenges associated wiith the implementation of such programs, and proposes strategies for addressing these challenges.

  3. Neonatal Gram Negative and Candida Sepsis Survival and Neurodevelopmental Outcome at the Corrected Age of 24 Months

    NARCIS (Netherlands)

    T.R. de Haan (Timo Robert); L. Beckers (Loes); R.C.J. de Jonge (Rogier); L. Spanjaard (Lodewijk); L. van Toledo (Letty); D. Pajkrt (Dasja); A.G. van Wassenaer (Aleid); J.H. van der Lee (Johanna)

    2013-01-01

    textabstractObjectives: To evaluate the long term neurodevelopmental outcome of premature infants exposed to either gram- negative sepsis (GNS) or neonatal Candida sepsis (NCS), and to compare their outcome with premature infants without sepsis. Methods: Historical cohort study in a population of

  4. Neonatal opioid withdrawal syndrome.

    Science.gov (United States)

    Sutter, Mary Beth; Leeman, Lawrence; Hsi, Andrew

    2014-06-01

    Neonatal opioid withdrawal syndrome is common due to the current opioid addiction epidemic. Infants born to women covertly abusing prescription opioids may not be identified as at risk until withdrawal signs present. Buprenorphine is a newer treatment for maternal opioid addiction and appears to result in a milder withdrawal syndrome than methadone. Initial treatment is with nonpharmacological measures including decreasing stimuli, however pharmacological treatment is commonly required. Opioid monotherapy is preferred, with phenobarbital or clonidine uncommonly needed as adjunctive therapy. Rooming-in and breastfeeding may decease the severity of withdrawal. Limited evidence is available regarding long-term effects of perinatal opioid exposure. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Prostate-specific antigen and long-term prediction of prostate cancer incidence and mortality in the general population

    DEFF Research Database (Denmark)

    Orsted, David D; Nordestgaard, Børge G; Jensen, Gorm B

    2012-01-01

    It is largely unknown whether prostate-specific antigen (PSA) level at first date of testing predicts long-term risk of prostate cancer (PCa) incidence and mortality in the general population.......It is largely unknown whether prostate-specific antigen (PSA) level at first date of testing predicts long-term risk of prostate cancer (PCa) incidence and mortality in the general population....

  6. Standardizing flow cytometric assays in long-term population-based studies

    Science.gov (United States)

    Melzer, Susanne; Bocsi, Jozsef; Tárnok, Attila

    2015-03-01

    Quantification of leukocyte subpopulations and characterization of antigen-expression pattern on the cellular surface can play an important role in diagnostics. The state of cellular immunology on the single-cell level was analyzed by polychromatic flow cytometry in a recent comparative study within the average Leipzig population (LIFE - Leipzig Research Centre for Civilization Diseases). Data of 1699 subjects were recorded over a long-time period of three years (in a total of 1126 days). To ensure compatibility of such huge data sets, quality-controls on many levels (stability of instrumentation, low intra-laboratory variance and reader independent data analysis) are essential. The LIFE study aims to analyze various cytometric pattern to reveal the relationship between the life-style, the environmental effects and the individual health. We therefore present here a multi-step quality control procedure for long-term comparative studies.

  7. Clinical pharmacokinetics of phenobarbital in neonates

    NARCIS (Netherlands)

    Touw, D J; Graafland, O; Cranendonk, A; Vermeulen, R J; van Weissenbruch, M M

    2000-01-01

    Demographic and clinical pharmacokinetic data collected from term and preterm neonates who were treated with intravenous phenobarbital have been analysed to evaluate the role of patient characteristics in pharmacokinetic parameters. Significant relationships between total body weight (TBW) or body

  8. Neonatal sepsis

    Directory of Open Access Journals (Sweden)

    Angelica Dessì

    2014-06-01

    Full Text Available In this paper on neonatal sepsis, after a short presentation of etiopathogenesis and physiopathology, we will briefly present the clinical picture, the diagnosis and the therapy. Concerning diagnosis, we will focus our attention on procalcitonin (PCT, serum amyloid A (SAA, presepsin (sCD14 and metabolomics. Three practical tables complete the review. Proceedings of the International Course on Perinatal Pathology (part of the 10th International Workshop on Neonatology · October 22nd-25th, 2014 · Cagliari (Italy · October 25th, 2014 · The role of the clinical pathological dialogue in problem solving Guest Editors: Gavino Faa, Vassilios Fanos, Peter Van Eyken

  9. Orthostatic Hypotension and the Long-Term Risk of Dementia: A Population-Based Study.

    Directory of Open Access Journals (Sweden)

    Frank J Wolters

    2016-10-01

    of dementia was particularly increased in those with OH who lacked a compensatory increase in heart rate (within lowest quartile of heart rate response: aHR 1.39, 95% CI 1.04-1.85, p-interaction = 0.05. Limitations of this study include potential residual confounding despite rigorous adjustments, and potentially limited generalisability to populations not of European descent.In this population predominantly of European descent, OH was associated with an increase in long-term risk of dementia.

  10. Orthostatic Hypotension and the Long-Term Risk of Dementia: A Population-Based Study.

    Science.gov (United States)

    Wolters, Frank J; Mattace-Raso, Francesco U S; Koudstaal, Peter J; Hofman, Albert; Ikram, M Arfan

    2016-10-01

    dementia was particularly increased in those with OH who lacked a compensatory increase in heart rate (within lowest quartile of heart rate response: aHR 1.39, 95% CI 1.04-1.85, p-interaction = 0.05). Limitations of this study include potential residual confounding despite rigorous adjustments, and potentially limited generalisability to populations not of European descent. In this population predominantly of European descent, OH was associated with an increase in long-term risk of dementia.

  11. Injury patterns in long-term refugee populations: a survey of Afghan refugees.

    Science.gov (United States)

    Hyder, Adnan A; Ghaffar, Abdul; Masud, Tayyeb I; Bachani, Abdulgafoor M; Nasir, Khurram

    2009-03-01

    Injuries account for approximately 15% of global disability- adjusted life years lost each year and have an even greater impact on loss of life in vulnerable populations. For refugees, injuries reflect consequences of previous actions in their location of origin, current behavioral trends, and assimilation of risk factors from their adopted location. The Afghan Refugee Injury Survey (ARIS) was undertaken to describe the epidemiology of injuries in the long-term Afghan refugee population residing in Pakistan in 2002. ARIS is a cross-sectional survey of injuries, injury-related deaths, and disability administrated on a representative sample of households in selected Afghan refugee camps in Pakistan. The sample design was a stratified, systematic sample of all households in the study area. Altogether, 1,123 households, with 8,809 persons (51% males; mean age, 20 years +/- 17 years) were surveyed. One hundred twelve persons (1.27%, 95% CI = 1.0-1.5%) were injured during a 3-month recall period (69% males), reflecting an all-injury incidence of 50.8 per 1,000 persons/year. Our study provides an epidemiologic profile of injuries in Afghan refugees in Pakistan which can be used to inform policy makers, public health professionals, and healthcare providers to support injury prevention as a component of refugee health care.

  12. The Association between Natural Amenities, Rural Population Growth, and Long-Term Residents' Economic Well-Being

    Science.gov (United States)

    Hunter, Lori M; Boardman, Jason D.; Saint Onge, Jarron M.

    2005-01-01

    Population growth in rural areas characterized by high levels of natural amenities has recently received substantial research attention. A noted concern with amenity-driven rural population growth is its potential to raise local costs-of-living while yielding only low-wage service sector employment for long-term residents. The work presented here…

  13. Context-dependence of long-term responses of terrestrial gastropod populations to large-scale disturbance.

    Science.gov (United States)

    Christopher P. Bloch; Michael R. Willi

    2006-01-01

    Large-scale natural disturbances, such as hurricanes, can have profound effects on animal populations. Nonetheless, generalizations about the effects of disturbance are elusive, and few studies consider long-term responses of a single population or community to multiple large-scale disturbance events. In the last 20 y, twomajor hurricanes (Hugo and Georges) have struck...

  14. Using Long-Term Removal Data to Manage a Crown-of-Thorns Starfish Population

    Directory of Open Access Journals (Sweden)

    Masako Nakamura

    2016-11-01

    Full Text Available Background: Removal programs are effective strategies for short-term management of Crown-of-Thorns Starfish (Acanthaster spp. populations, especially on a small scale. However, management programs are costly, and, in order to be effective, they must be based on local Acanthaster spp. population dynamics. We have developed simple models to predict the annual number of removable A. cf. solaris along the Onna coast of western central Okinawa Island, where chronic outbreaks have continued for several decades. Methods: The Onna coastal area was divided into five sectors, and annual abundance of small A. cf. solaris individuals was used to predict the total number of removable individuals of a cohort in each sector. Three models were developed, based on size class data collected by the Onna Village Fisheries Cooperative (OVFC for 2003–2015, according to possible patterns of recruitment and adult occurrence. Using the best-fit models selected for each of the five sectors, the number of individuals that potentially escaped removal was calculated. Results: Best-fit models were likely to differ among the five sectors instead of small differences in the coefficients of determination. The models predict differences in the number of residual starfish among sectors; the northernmost sector was predicted to have a high number of residuals and the potential density of A. cf. solaris in the sector exceeded the outbreak criterion. Conclusions: These results suggest how to allocate resources to reduce the population of A. cf. solaris along the Onna coast in 2016. The OVFC implemented a control program for A. cf. solaris based on three model predictions.

  15. [Effects of long-term heavy metals stress on farmland soil microbial population, biomass and activity].

    Science.gov (United States)

    Zhang, Yan; Zhang, Hui-Wen; Su, Zhen-Cheng; Zhang, Cheng-Gang

    2007-07-01

    An in situ investigation on the farmland soil heavy metals pollution caused by long-term irrigation with heavy metals containing wastewater was carried out in the Zhangshi Irrigation Area of Shenyang. The indices soil microbial population, biomass, and activity were used to evaluate the effects of long-term heavy metals pollution on farmland soil ecosystem. The results showed that in Zhangshi Irrigation Area, soils were heavily polluted by cadmium, with the cadmium content ranged from 1.75 to 3.89 mg x kg(-1), and parts of them were co-contaminated by cadmium, copper and zinc. At the present pollution level, the increased soil heavy metals content resulted in a substantial decrease in soil free-living nitrogen fixing bacteria, microbial biomass carbon (C(mic)), microbial quotient (qM) and dehydrogenase activity, and a significant increase of metabolic quotient (qCO2). No significant changes were observed in soil bacteria, actinomyces, fungi, and substrate-induced respiration (SIR). Correlation analysis showed that the changes of soil microbial parameters were mainly caused by soil cadmium pollution. Comparing with other test microbial parameters, microbial quotient and metabolic quotient were more sensitive to soil heavy metals pollution.

  16. OXYTOCIN INDUCED NEONATAL HYPERBILIRUBINEMIA

    Directory of Open Access Journals (Sweden)

    Smita S.

    2015-05-01

    Full Text Available INTRODUCTION: Hyperbilirubinemia is one of the most common causes of health problems, observed in 60% of term and 80% of preterm infants in the first week of life . Hyperbilirubinemia leads to neurotoxicity in severe condition. Some studies suggests that liberal use of oxytocin for inducing labour is one of the factor which lead to neonatal hyperbilirubinemia. OBJECTIVE: To compare the effect of oxytocin and neonatal bilirubin levels with spontaneous vaginal delivery . MATERIALS AND METHOD S : 100 full term parturients were selected for this study. The subjects were divided into two groups. 50 healthy babies of women who had oxytocin induced labour and 50 healthy babies of women with normal vaginal delivery following spontaneous onset of labour formed the control group. Neon atal serum bilirubin was measured on day 1, 3 and 5 after delivery. Bilirubin was measured by spectrophotometry. Data was analysed in ms excel sheet using spss 19.0v. Statistical analysis was done by using unpaired‘t’ test. RESULTS: There was significant i ncrease in bilirubin level in oxytocin induced group compared to control group on day 1 and 3. There was insignificant increase in bilirubin level in oxytocin induced group on day 5. However the level of serum bilirubin is within normal limits as bilirubin level normally rises on till 4 th day and decreases thereafter. CONCLUSION: Neonatal hyperbilirubinemia may be due to oxytocin administration by continues IV infusion which results in erythrocyte swell and rupture. Increase in bilirubin level in oxytocin i nduced group is within physiological limits

  17. Long-term effects of neonatal malnutrition on microbicide response, production of cytokines, and survival of macrophages infected by Staphylococcus aureus sensitive/resistant to methicillin

    Directory of Open Access Journals (Sweden)

    Natália Gomes de Morais

    2014-10-01

    Full Text Available OBJECTIVE: To assess microbicide function and macrophage viability after in vitro cellular infection by methicillin-sensitive/resistant Staphylococcus aureus in nourished rats and rats subjected to neonatal malnutrition. METHODS: Male Wistar rats (n=40 were divided in two groups: Nourished (rats suckled by dams consuming a 17% casein diet and Malnourished (rats suckled by dams consuming an 8% casein diet. Macrophages were recovered after tracheotomy, by bronchoalveolar lavage. After mononuclear cell isolation, four systems were established: negative control composed exclusively of phagocytes; positive control composed of macrophages plus lipopolysaccharide; and two testing systems, macrophages plus methicillin-sensitive Staphylococcus aureus and macrophages plus methicillin-resistant Staphylococcus aureus. The plates were incubated in a humid atmosphere at 37 degrees Celsius containing 5% CO2 for 24 hours. After this period tests the microbicidal response, cytokine production, and cell viability were analyzed. The statistical analysis consisted of analysis of variance (p<0.05. RESULTS: Malnutrition reduced weight gain, rate of phagocytosis, production of superoxide anion and nitric oxide, and macrophage viability. Production of nitrite and interleukin 18, and viability of macrophages infected with methicillin-resistant Staphylococcus aureus were lower. CONCLUSION: The neonatal malnutrition model compromised phagocyte function and reduced microbicidal response and cell viability. Interaction between malnutrition and the methicillin-resistant strain decreased the production of inflammatory mediators by effector cells of the immune response, which may compromise the immune system's defense ability.

  18. Occurrence of Cleft Lip and Palate in terms of Maternal Health, Parents' Kinship, and Neonate Weight: a Case Study in the Infants of Southeastern part of Iran

    Directory of Open Access Journals (Sweden)

    Sirous Risbaf Fakour

    2016-12-01

    Full Text Available Oral clefts including cleft lip (CL, cleft palate with or without cleft lip (CP/L are one of the most common congenital deformities. The present study was conducted through a descriptive-retrospective study to examine the frequency of cleft lip and palate based on demographic factors including mother's health condition, parents kinship and weight of infants born in hospitals of Zahedan during 2001_2011 years. The result is based on the available hospital records of 142534 live births (there were 71717 boys and 70817 girls collected from 4 hospitals of Zahedan city. Results indicate that mothers of about 0.12% of neonates were not having any disease history whereas 0.15% neonates born with cleft palate, lip, or lip and palate were from such mothers who were suffering from some diseases during pregnancy. Conclusively, the higher occurrence rate of clefts among baby boys was from such mothers who had the positive history of illness during pregnancy time or parents were kinship.

  19. Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 7. shared characteristics of projects with evidence of long-term mortality impact.

    Science.gov (United States)

    Perry, Henry B; Rassekh, Bahie M; Gupta, Sundeep; Freeman, Paul A

    2017-06-01

    There is limited evidence about the long-term effectiveness of integrated community-based primary health care (CBPHC) in improving maternal, neonatal and child health. However, the interventions implemented and the approaches used by projects with such evidence can provide guidance for ending preventable child and maternal deaths by the year 2030. A database of 700 assessments of the effectiveness of CBPHC in improving maternal, neonatal and child health has been assembled, as described elsewhere in this series. A search was undertaken of these assessments of research studies, field project and programs (hereafter referred to as projects) with more than a single intervention that had evidence of mortality impact for a period of at least 10 years. Four projects qualified for this analysis: the Matlab Maternal Child Health and Family Planning (MCH-FP) P in Bangladesh; the Hôpital Albert Schweitzer in Deschapelles, Haiti; the Comprehensive Rural Health Project (CRHP) in Jamkhed, India; and the Society for Education, Action and Research in Community Health (SEARCH) in Gadchiroli, India. These four projects have all been operating for more than 30 years, and they all have demonstrated reductions in infant mortality, 1- to 4-year mortality, or under-5 mortality for at least 10 years. They share a number of characteristics. Among the most notable of these are: they provide comprehensive maternal, child health and family planning services, they have strong community-based programs that utilize community health workers who maintain regular contact with all households, they have develop strong collaborations with the communities they serve, and they all have strong referral capabilities and provide first-level hospital care. The shared features of these projects provide guidance for how health systems around the world might improve their effectiveness in improving maternal, neonatal and child health. Strengthening these features will contribute to achieving the goal of

  20. Realized population change for long-term monitoring: California spotted owl case study

    Science.gov (United States)

    Mary M. Conner; John J. Keane; Claire V. Gallagher; Gretchen Jehle; Thomas E. Munton; Paula A. Shaklee; Ross A. Gerrard

    2013-01-01

    The annual rate of population change (λt) is a good metric for evaluating population performance because it summarizes survival and recruitment rates and can be used for open populations. Another measure of population performance, realized population change (Δt...

  1. Disturbance frequency and vertical distribution of seeds affect long-term population dynamics: a mechanistic seed bank model.

    Science.gov (United States)

    Eager, Eric Alan; Haridas, Chirakkal V; Pilson, Diana; Rebarber, Richard; Tenhumberg, Brigitte

    2013-08-01

    Seed banks are critically important for disturbance specialist plants because seeds of these species germinate only in disturbed soil. Disturbance and seed depth affect the survival and germination probability of seeds in the seed bank, which in turn affect population dynamics. We develop a density-dependent stochastic integral projection model to evaluate the effect of stochastic soil disturbances on plant population dynamics with an emphasis on mimicking how disturbances vertically redistribute seeds within the seed bank. We perform a simulation analysis of the effect of the frequency and mean depth of disturbances on the population's quasi-extinction probability, as well as the long-term mean and variance of the total density of seeds in the seed bank. We show that increasing the frequency of disturbances increases the long-term viability of the population, but the relationship between the mean depth of disturbance and the long-term viability of the population are not necessarily monotonic for all parameter combinations. Specifically, an increase in the probability of disturbance increases the long-term viability of the total seed bank population. However, if the probability of disturbance is too low, a shallower mean depth of disturbance can increase long-term viability, a relationship that switches as the probability of disturbance increases. However, a shallow disturbance depth is beneficial only in scenarios with low survival in the seed bank.

  2. [The genetic history of long-term Russian resident populations of polar northeastern Siberia based on mitochondrial DNA variability].

    Science.gov (United States)

    Sukernik, R I; Volod'ko, N V; Mazunin, I O; El'tsov, N P; Starikovskaia, E B

    2010-11-01

    The mtDNA variation has been studied in representatives of the Russkoe Ust'e (n = 30), Kolyma (n = 31), and Markovo (n = 26) ethnic subgroups originating from Russian military men, hunters, and fishers who married local Yukaghir women and settled at the Arctic Ocean coast and on the Anadyr' River more than 350 years ago. The mtDNA haplotypes characteristic of indigenous Siberian peoples have been demonstrated to form the basis of the mitochondrial gene pool of long-term Russian resident populations of the region. Only one of 30 identified haplotypes belonging to 11 haplogroups (H2a) is characteristic of European populations. The C and D haplogroups are the most diverse. The analysis has revealed the characteristics of the population structure of the long-term Russian resident populations and allowed them to be interpreted in terms of recent historical and environmental processes.

  3. Therapeutic hypothermia in neonatal asphyxia

    OpenAIRE

    Cornette, L.

    2012-01-01

    Hypoxic ischemic encephalopathy is a serious condition affecting newborn infants which can result in death and disability. There is now strong clinical evidence that moderate post-asphyxial total body cooling or hypothermia in full term neonates results in long-term neuroprotection, allowing us to proclaim this innovative therapy as “standard of care.” The treatment is a time-critical emergency and should be started within 6 hours after the insult. Such requires optimal collaboration among lo...

  4. Perinatal pharmacology: applications for neonatal neurology.

    Science.gov (United States)

    Smits, Anne; Allegaert, Karel

    2011-11-01

    The principles of clinical pharmacology also apply to neonates, but their characteristics warrant a tailored approach. We focus on aspects of both developmental pharmacokinetics (concentration/time relationship) and developmental pharmacodynamics (concentration/effect relationship) in neonates. We hereby aimed to link concepts used in clinical pharmacology with compound-specific observations (anti-epileptics, analgosedatives) in the field of neonatal neurology. Although in part anecdotal, we subsequently illustrate the relevance of developmental pharmacology in the field of neonatal neurology by a specific intervention (e.g. whole body cooling), specific clinical presentations (e.g. short and long term outcome following fetal exposure to antidepressive agents, the development of new biomarkers for fetal alcohol syndrome) and specific clinical needs (e.g. analgosedation in neonates, excitocytosis versus neuro-apoptosis/impaired synaptogenesis). Copyright © 2011 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  5. Vulnerable populations in terms of health care and their right to decent work

    Directory of Open Access Journals (Sweden)

    Stojković-Zlatanović Sanja

    2016-01-01

    Full Text Available Vulnerability may arise from individual characteristics of individuals or social groups, employment conditions or as a result of difficulties in exercising fundamental social human rights. Principle of equity in terms of labor and employment as well as equity in health are closely linked and represented in a concept of decent work for all, promoted by the International Labor Organization. The concept of decent work aims to improve work conditions for the marginalized and vulnerable workers, where the notions “vulnerable” and “marginalized” represent people on the periphery of formal, standard employment, people working in an environment where the risk of being denied employment rights is high and also those who do not have the capacity to protect themselves from the abuse. The labor status of social groups whose personal characteristics, i.e. health characteristics, make them vulnerable in terms of work conditions and labor rights has been analyzed. In international, comparative and Serbian law, workers with disabilities are already protected by the special law provisions of professional rehabilitation and employment of people with disabilities. On the contrary, the status of workers who are not considered as people with disabilities but who are faced with some health problems are not recognized in the labor legislation and protected by the law. People with health problems may be those who are chronically ill i.e. people in a remission of a disease. Considering the current demographic process of population aging, an increase of elderly in economically active population/labor force could be expected, which also means the increase of chronically ill workers. This fact, argue in favor of regulation the labor status of people with health problems. Furthermore, according to the World Health Organization, health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, where the third

  6. Intermediate-term and long-term mortality among acute medical patients hospitalized with community-acquired sepsis: a population-based study.

    Science.gov (United States)

    Henriksen, Daniel P; Pottegård, Anton; Laursen, Christian B; Jensen, Thøger G; Hallas, Jesper; Pedersen, Court; Lassen, Annmarie T

    2017-12-01

    Admission with severe sepsis is associated with an increased short-term mortality, but it is unestablished whether sepsis severity has an impact on intermediate-term and long-term mortality following admission to an acute medical admission unit. This was a population-based study of all adults admitted to an acute medical admission unit, Odense University Hospital, Denmark, from September 2010 to August 2011, identified by symptoms and clinical findings. We categorized the mortality periods into intermediate-term (31-180 days) and long-term (181-365, 366-730, and 731-1096 days). Mortality hazard ratios (HRs), comparing patients admitted with sepsis with those of a well-defined background population, were estimated using multivariable Cox regression. HRs were presented with 95% confidence intervals. In total, 621 (36.3%) presented with sepsis, 1071 (62.5%) presented with severe sepsis, and 21 (1.2%) presented with septic shock. Thirty-day all-cause mortality for patients with sepsis, severe sepsis, and septic shock was 6.1, 18.8, and 38.1%, respectively. The adjusted HR among patients with sepsis of any severity within the time periods 31-180, 181-365, 366-720, and 721-1096 days was 7.1 (6.0-8.5), 2.8 (2.3-3.5), 2.1 (1.8-2.6), and 2.2 (1.7-2.9), respectively. Long-term mortality was unrelated to sepsis severity [721-1096 days: sepsis HR: 2.2 (1.5-3.2), severe sepsis HR: 2.1 (1.5-3.0)]. Patients admitted with community-acquired sepsis showed high intermediate-term mortality, increasing with sepsis severity. Long-term mortality was increased two-fold compared with sepsis-free individuals, but might be explained by unmeasured confounding. Further, long-term mortality was unrelated to sepsis severity.

  7. Uptake of external cephalic version for term breech presentation: an Australian population study, 2002-2012.

    Science.gov (United States)

    Bin, Yu Sun; Roberts, Christine L; Nicholl, Michael C; Ford, Jane B

    2017-07-26

    The safety, efficacy, and cost-effectiveness of external cephalic version (ECV) for term breech presentation has been demonstrated. Clinical guidelines recommend ECV for all eligible women, but the uptake of this procedure in the Australian healthcare setting is unknown. This study aimed to describe ECV uptake in New South Wales, the most populous state of Australia, during 2002 to 2012. Data from routine hospital and birth records were used to identify ECVs conducted at ≥36 weeks' gestation. Women with ECV were compared to women who were potentially eligible for but did not have ECV. Eligibility for ECV was based on clinical guidelines. For those with ECV, birth outcomes following successful and unsuccessful procedures were examined. In N = 32,321 singleton breech pregnancies, 10.5% had ECV, 22.3% were ineligible, and 67.2% were potentially eligible but did not undergo ECV. Compared to women who were eligible but who did not attempt ECV, those who had ECV were more likely to be older, multiparous, overseas-born, public patients at delivery, and to deliver in tertiary hospitals in urban areas (p ECV smoked during pregnancy, fewer were morbidly obese, and fewer had a hypertensive disorder of pregnancy, compared to those who were eligible. Caesarean section occurred in 25.9% of successful compared to 95.6% of unsuccessful ECVs. Infant outcomes did not differ by ECV success. The majority of women with a breech presentation did not receive ECV. It is unclear whether this is attributable to issues with service provision or low acceptability among women. Policies to improve access to and information about ECV appear necessary to improve uptake among women with term breech presentation. Improved data collection around the diagnosis of breech presentation, ECV attempts, and outcomes may help to identify specific barriers to ECV uptake.

  8. Recurrence risk of low Apgar score among term singletons: a population-based cohort study.

    Science.gov (United States)

    Ensing, Sabine; Schaaf, Jelle M; Abu-Hanna, Ameen; Mol, Ben W J; Ravelli, Anita C J

    2014-09-01

    To examine the risk of recurrence of low Apgar score in a subsequent term singleton pregnancy. Population-based cohort study. The Netherlands. A total of 190,725 women with two subsequent singleton term live births between 1999 and 2007. We calculated the recurrence risk of low Apgar score after adjustment for possible confounders. Women with an elective cesarean delivery, fetus in breech presentation or a fetus with congenital anomalies were excluded. Results were reported separately for women with a vaginal delivery or a cesarean delivery at first pregnancy. Prevalence of birth asphyxia, a 5-min Apgar score Apgar score of Apgar score in the subsequent pregnancy was 1.1% (odds ratio 2.1, 95% confidence interval 1.4-3.3). This recurrence risk was present in women with a previous vaginal delivery (odds ratio 2.1, 95% confidence interval 1.2-3.5) and in women with a previous cesarean delivery (odds ratio 3.8, 95% confidence interval 1.7-8.5). Among women with a small-for-gestational-age infant in the subsequent pregnancy and a previous vaginal delivery, the recurrence risk was 4.8% (adjusted odds ratio 5.8, 95% confidence interval 2.0-16.5). Women with birth asphyxia of the first born have twice the risk of renewed asphyxia at the next birth compared to women without birth asphyxia of the first born. This should be incorporated in the risk assessment of pregnant women. © 2014 Nordic Federation of Societies of Obstetrics and Gynecology.

  9. Neonatal euthanasia.

    Science.gov (United States)

    Kon, Alexander A

    2009-12-01

    Despite advances in the care of infants, there remain many newborns whose medical conditions are incompatible with sustained life. At times, healthcare providers and parents may agree that prolonging life is not an appropriate goal of care, and they may redirect treatment to alleviate suffering. While pediatric palliative treatment protocols are gaining greater acceptance, there remain some children whose suffering is unrelenting despite maximal efforts. Due to the realization that some infants suffer unbearably (ie, the burdens of suffering outweigh the benefits of life), the Dutch have developed a protocol for euthanizing these newborns. In this review, I examine the ethical aspects of 6 forms of end of life care, explain the ethical arguments in support of euthanasia, review the history and verbiage of the United States regulations governing limiting and withdrawing life-prolonging interventions in infants, describe the 3 categories of neonates for whom the Dutch provide euthanasia, review the published analyses of the Dutch protocol, and finally present some practical considerations should some form of euthanasia ever be deemed appropriate.

  10. Successful long-term weight loss maintenance in a rural population

    Directory of Open Access Journals (Sweden)

    Milsom VA

    2011-11-01

    Full Text Available Vanessa A Milsom1,2, Kathryn M Ross Middleton2, Michael G Perri21Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 2Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USABackground: Few investigations of successful long-term weight loss beyond two years have been conducted, and none has examined weight changes in medically underserved rural populations of older adults. The purpose of this study was to assess long-term weight loss maintenance 3.5 years after the completion of an initial six-month lifestyle intervention for obesity among women aged 50–75 years residing in rural communities.Methods: One hundred and ten obese women with a mean (± standard deviation age of 60.08 ± 6.17 years and mean body mass index of 36.76 ± 5.10 kg/m2 completed an in-person assessment during which their weight and adherence to behavioral weight management strategies were evaluated.Results: Participants showed a mean weight reduction of 10.17% ± 5.0% during the initial six-month intervention and regained 6.95% ± 9.44% from the completion of treatment to follow-up assessment 3.5 years later. A substantial proportion of participants (41.80% were able to maintain weight reductions of 5% or greater from baseline to follow-up. "Successful" participants (those who maintained losses of 5% or greater at follow-up reported weighing themselves, self-monitoring their intake and calories, planning meals in advance, and choosing lower calorie foods with greater frequency than "unsuccessful" participants (those who lost less than 5%.Conclusion: Collectively, these findings indicate that a large proportion of participants were able to maintain clinically significant weight losses for multiple years after treatment, and that self-monitoring was a key component of successful long-term weight management.Keywords: obesity, weight loss, weight maintenance, lifestyle intervention, rural, health disparities

  11. Short-term effects of air temperature and mitochondrial DNA lesions within an older population.

    Science.gov (United States)

    Peng, Cheng; Sanchez-Guerra, Marco; Wilson, Ander; Mehta, Amar J; Zhong, Jia; Zanobetti, Antonella; Brennan, Kasey; Dereix, Alexandra E; Coull, Brent A; Vokonas, Pantel; Schwartz, Joel; Baccarelli, Andrea A

    2017-06-01

    Previous studies have linked both extreme and sub-optimal air temperature to cardiopulmonary morbidity and mortality, especially in older individuals. However, the underlying mechanisms are yet to be determined. We hypothesized that short-term increases in air temperature may induce blood mitochondrial DNA (mtDNA) lesions in older individuals, which could contribute to temperature-related pathogenesis. We repeatedly measured mtDNA lesions in blood samples from 654 participants in the Normative Aging Study from 1999 to 2013 (1142 observations) by quantitative long-amplicon polymerase chain reaction assay. Hourly temperature data were obtained from the Boston Logan Airport weather station (located approximately 12km from the clinical site). We calculated 2-, 7-, and 14-day moving averages of 24-hour mean and 24-hour variability of temperature. We fit covariate-adjusted linear-mixed models accounting for repeated measures to evaluate the association between short-term increases in mean and variability of temperature with mtDNA lesions within each season. Interquartile increases in 7- and 14-day moving averages of 24-hour mean temperature in summer were associated with a 0.17 (95% CI: 0.07, 0.27; p=0.0007) and 0.21 (95% CI: 0.10, 0.32; p=0.0001) increase in the number of mtDNA lesions per 10kb, respectively. Results were similar when we further adjusted for temperature variability. We also observed significant associations between increases in temperature variability and mtDNA lesions independent of mean air temperature. An interquartile range increase in the 7-day moving average of 24-hour standard deviation in summer was associated with a 0.19 (95% CI: 0.07, 0.31; p=0.0023) increase in the number of mtDNA lesions per 10kb. Short-term exposure to higher mean air temperature was associated with increased mtDNA lesions in older adults, supporting the hypothesis that sub-optimal meteorological conditions may induce pathophysiological responses among susceptible

  12. Long-term central venous access in a pediatric leukemia population.

    Science.gov (United States)

    Fu, Aurelia B; Hodgman, Erica I; Burkhalter, Lorraine S; Renkes, Rachel; Slone, Tamra; Alder, Adam C

    2016-10-01

    Central venous access devices (CVADs) play an important role in the management of pediatric oncology patients; unfortunately, they are also associated with potentially serious complication rates. We hypothesized that, despite the significantly different disease courses typical of acute lymphoblastic leukemia and acute myelogenous leukemia, there would be identifiable risk factors for premature CVAD removal. We retrospectively studied clinical characteristics and procedure records for all patients admitted with a leukemia diagnosis at our institution from May 2009 to July 2014. Our observed perioperative complication rate was 6%; over 70% of lines had at least one long-term complication (thrombosis, catheter-related bloodstream infection, or unexplained line malfunction). Obesity (odds ratio [OR], 6.9; 95% CI, 1.62-29.43), preoperative dosage of packed red blood cells (in mL/kg; OR, 3.13; 1.07-9.21), bloodstream infection (OR, 5.75; 1.69-19.56) were associated with increased risk of premature catheter removal; unexplained malfunction was associated with a lower risk (OR, 0.28; 0.09-0.93). Obesity, the preoperative dosage of packed red blood cells, the presence of a bloodstream infection, and unexplained line malfunction are significant predictors of premature CVAD removal in a pediatric leukemia population. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Long-term visual outcome in a Danish population of patients with idiopathic intracranial hypertension.

    Science.gov (United States)

    Hatem, Christina F; Yri, Hanne M; Sørensen, Anne L; Wegener, Marianne; Jensen, Rigmor H; Hamann, Steffen

    2018-02-06

    Idiopathic intracranial hypertension (IIH) is characterized by raised intracranial pressure (ICP), normal cerebrospinal composition and exclusion of alternative causes to increased ICP. The aim of this study was to evaluate long-term visual outcome in a Danish population of IIH patients. Retrospective chart review of 41 women diagnosed with IIH between June 2007 and March 2013. Best-corrected visual acuity (BCVA), colour vision, grade and type of visual field (VF) defects and grade of papilloedema according to the Modified Frisén Score were recorded at baseline visit (V0), 2-6 months (V1) and 13 months follow-up visit (V2) from time of diagnosis. Best-corrected visual acuity (BCVA) was reduced in 25% of eyes at V0, in 10% at V1 and in 15% at V2. Colour vision was barely affected. Visual field (VF) was affected (>grade 0) in 87% of eyes at V0 and VF defect grade significantly improved by 0.58 at V1 (p-value visual function, and relevant treatment strategies need to be improved. © 2018 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  14. Long-term growth of Desert Tortoises (Gopherus agassizii) in a southern Nevada population

    Science.gov (United States)

    Medica, P.A.; Nussear, Kenneth E.; Esque, Todd C.; Saethre, Mary B.

    2012-01-01

    Knowledge of growth rates, age at maturity, and longevity are important aspects of a species life history and are directly applicable to life table creation and population viability analyses. We measured the growth of a cohort of 17 semi-wild Desert Tortoises (Gopherus agassizii) located in Rock Valley, Nevada over a 47-yr period beginning in 1963. The tortoises were initially marked as hatchling and juvenile animals between the years 1963 and 1965 and ranged in size from 47 to 77 mm in plastron length. We assigned ages of 1-4 yr to the tortoises at initial capture based on their body size. These tortoises were recaptured, measured, and weighed approximately annually since their initial capture. Growth of male and female tortoises did not differ significantly until animals reached the age of 23-25 yr. Annual tortoise growth was correlated with the production of ephemeral vegetation, while accounting for size, sex, and repeated measurements of the animals as well as the interval between measurements. However, the production of ephemeral plants was likewise highly correlated (non-linearly) with winter rainfall. Stochastic predation events between 2003 and 2007 decimated this cohort of tortoises. The average age of the long-term surviving tortoises from this cohort was 43 yr with a range of 39-47 yr. Twelve of the tortoises survived to the age of 39 yr and 11 of the 12 reached 40 yr.

  15. Neonatal hypokalemia

    Directory of Open Access Journals (Sweden)

    Sarici D

    2012-03-01

    Full Text Available Dilek Sarici1, S Umit Sarici21Kecioren Research and Education Hospital, Kecioren, Ankara, 2Chief of Division of Neonatology, Division of Neonatology, Department of Pediatrics, Gulhane Military Medical Academy, Ankara, TurkeyAbstract: In this article, distribution of potassium (K+ in body fluids, pathophysiology, causes, clinical signs and symptoms, and the evaluation and treatment of neonatal hypokalemia are reviewed. K+ is the most important intracellular cation and normal serum K+ is stabilized between 3.5 and 5.5 mEq/L. Hypokalemia may be caused by increased renal losses, increased extrarenal (gastrointestinal losses, redistribution or prolonged insufficient K+ intake. Clinical signs and symptoms occur as the result of functional changes in striated muscle, smooth muscle, and the heart. Hypokalemia is usually asymptomatic when K+ levels are between 3.0 and 3.5 mEq/L; however, there may sometimes be slight muscle weakness. Moderate hypokalemia is observed when serum K+ is between 2.5 and 3.0 mEq/L. Proximal muscle weakness is observed most commonly in lower extremities; cranial muscles are normal, but constipation and distention are prominent. Severe hypokalemia develops when serum K+ falls below 2.5 mEq/L. Rhabdomyolysis, myoglobinuria, severe muscle weakness, paralysis, respiratory distress, and respiratory arrest are observed. The clinical signs and symptoms may be unremarkable in cases of chronically developing hypokalemia; however, appropriate treatment is essential when serum K+ level falls below 2.5 mEq/L as the most dangerous complication of hypokalemia is fatal cardiac arrythmia, and changes visible with electrocardiography may not always correlate with the level of hypokalemia. Sodium (Na+, K+, chloride (Cl-, bicarbonate, creatinine, blood sugar, magnesium (Mg, plasma renin activity, aldosterone, and blood gases should be investigated by laboratory testing. Aspartate aminotransferase, alanine aminotransferase, creatinine kinase, and

  16. [Neonatal tumors].

    Science.gov (United States)

    Costa, Carla; Rocha, Gustavo; Grilo, Marta; Bianchi, Ricardo; Sotto Mayor, Tânia; Monteiro, Joaquim; Guimarães, Hercília

    2010-01-01

    Tumors affecting the fetus and newborn differ from those found in older children and adults, leading to new diagnostic and therapeutic challenges. To evaluate the main clinical aspects related to neonatal tumors. Retrospective analysis of clinical data from newborn patients admitted to the Service of Neonatology of São João Hospital between 1996 and 2006, with the diagnosis of tumor or neoplasia. Total = 32 cases, 16M/16F, birth weight: 3146 g (965-4590), gestational age 38 weeks (28-41), seven (22%) preterm, C-section rate 75% (n = 24), two with EXIT procedure. Teratoma (n = 8); lymphangioma (n = 7), neuroblastoma (n = 6), haemangioma (n = 5), other solid tumors (n = 6); acute lymphoblastic leukemia (n = 1). Prenatal diagnosis 50% (n = 16). Teratoma: immature (n = 3); mature (n = 5), sacrococcygeal location (n = 5); cervical (n = 3); total macroscopic resection (n = 8). Cystic lymphangioma: cervical location (n = 5); cervicothoracic location (n = 1); thoracoabdominal location (n = 1); total macroscopic resection (n = 7). NEUROBLASTOMA: abdominal location (n = 5); cervical location (n = 1); deletion 1p (n = 0); oncogene n-myc amplification (n = 0); stage I (n = 1); IIB (n = 1); III (n = 3); IV (n = 1). Chemotherapy (n = 5), according to the (n = 2), surgical resection (n = 4). Four patients remain without disease and two present with residual disease. OTHER SOLID TUMORS: Large haemangiomas (n = 5); scaly papiloma (n = 1); juvenile xanthogranuloma (n = 1); lipoblastoma (n = 1); nephroma (n = 1); nonclassified neoplasm, possible nervous sheath sarcoma (n = 1). All patients showed a good clinical evolution. Acute lymphoblast leukemia (n = 1), deceased. Pre-natal diagnosis allows the planning of a careful multidisciplinary approach. In these rare entities it is crucial to pursue international collaboration, ideally workgroup committees, aiming for better clinical knowledge and an improved prognosis.

  17. [Treatment strategies for neonatal pulmonary morbidity in Europe].

    Science.gov (United States)

    Desnoulez, L; Empana, J; Anceschi, M; Breart, G; Truffert, P

    2005-01-01

    To survey practices in 14 European countries and to describe strategies for the prevention and treatment of pulmonary morbidity in very preterm newborns. Questionnaires covering the use of prenatal steroids, surfactant and postnatal steroids were sent in 1999-2000 to every neonatal unit taking very preterm newborns in charge in population-based areas covering at least 20,000 births annually. One questionnaire was sent by surveyed unit. Results are given concerning these three treatments and compared to evidence based recommendations. Antenatal steroids were given at recommended terms. Surfactant was prescribed with respect of best practices. Postnatal steroids utilisation was not well described.

  18. Burns and long-term infectious disease morbidity: A population-based study.

    Science.gov (United States)

    Duke, Janine M; Randall, Sean M; Wood, Fiona M; Boyd, James H; Fear, Mark W

    2017-03-01

    There is a growing volume of data that indicates that serious injury suppresses immune function, predisposing individuals to infectious complications. With recent evidence showing long-term immune dysfunction after less severe burn, this study aimed to investigate post-burn infectious disease morbidity and assess if burn patients have increased long-term hospital use for infectious diseases. A population-based longitudinal study using linked hospital morbidity and death data from Western Australia for all persons hospitalised for a first burn (n=30,997) in 1980-2012. A frequency matched non-injury comparison cohort was randomly selected from Western Australia's birth registrations and electoral roll (n=123,399). Direct standardisation was used to assess temporal trends in infectious disease admissions. Crude annual admission rates and length of stay for infectious diseases were calculated. Multivariate negative binomial and Cox proportional hazards regression modeling were used to generate adjusted incidence rate ratios (IRR) and hazard ratios (HR), respectively. After adjustment for demographic factors and pre-existing health status, the burn cohort had twice (IRR, 95% confidence interval (CI): 2.04, 1.98-2.22) as many admissions and 3.5 times the number of days in hospital (IRR, 95%CI: 3.46, 3.05-3.92) than the uninjured cohort for infectious diseases. Higher rates of infectious disease admissions were found for severe (IRR, 95%CI: 2.37, 1.89-2.97) and minor burns (IRR, 95%CI: 2.22, 2.11-2.33). Burns were associated with significantly increased incident admissions: 0-30days (HR, 95%CI: 5.18, 4.15-6.48); 30days-1year (HR, 95%CI: 1.69, 1.53-1.87); 1-10 years (HR, 95%CI: 1.40:1.33-1.47); >10years (HR, 95%CI: 1.16, 1.08-1.24). Respiratory, skin and soft tissue and gastrointestinal infections were the most common. The burn cohort had a 1.75 (95%CI: 1.37-2.25) times greater rate of mortality caused by infectious diseases during the 5-year period after discharge than

  19. Spatial Analysis of Factors Influencing Long-Term Stress in the Grizzly Bear (Ursus arctos) Population of Alberta, Canada

    OpenAIRE

    Bourbonnais, Mathieu L.; Trisalyn A. Nelson; Cattet, Marc R. L.; Darimont, Chris T.; Stenhouse, Gordon B.

    2013-01-01

    Non-invasive measures for assessing long-term stress in free ranging mammals are an increasingly important approach for understanding physiological responses to landscape conditions. Using a spatially and temporally expansive dataset of hair cortisol concentrations (HCC) generated from a threatened grizzly bear (Ursus arctos) population in Alberta, Canada, we quantified how variables representing habitat conditions and anthropogenic disturbance impact long-term stress in grizzly bears. We cha...

  20. Dental Implants in the Elderly Population: A Long-Term Follow-up.

    Science.gov (United States)

    Compton, Sharon M; Clark, Danielle; Chan, Stephanie; Kuc, Iris; Wubie, Berhanu A; Levin, Liran

    The objectives of this study were to evaluate implant survival and success in the elderly population and to assess indicators and risk factors for success or failure of dental implants in older adults (aged 60 years and older). This historical prospective study was developed from a cohort of patients born prior to 1950 who received dental implants in a single private dental office. Implant survival and marginal bone levels were recorded and analyzed with regard to different patient- and implant-related factors. The study examined 245 patient charts and 1,256 implants from one dental clinic. The mean age at the time of implant placement was 62.18 ± 8.6 years. Smoking was reported by 9.4% of the cohort studied. The overall survival rate of the implants was 92.9%; 7.1% of the implants had failed. Marginal bone loss depicted by exposed threads was evident in 23.3% of the implants. Presenting with generalized periodontal disease and/or severe periodontal disease negatively influenced the survival probability of the implant. Implants placed in areas where bone augmentation was performed prior to or during implant surgery did not have the same longevity compared with those that did not have augmentation prior to implantation. The overall findings concluded that implants can be successfully placed in older adults. A variety of factors are involved in the long-term success of the implant, and special consideration should be taken prior to placing implants in older adults to limit the influence of those risk factors.

  1. Neonatal intensive care unit nosocomial bacterial infections

    Directory of Open Access Journals (Sweden)

    Ghazvini

    2008-08-01

    Full Text Available Background: Nosocomial infections increase patients' morbidity, mortality and length of hospital stay especially in neonatal intensive care units (NICUs and have become a matter of major concern. Controlling and preventing nosocomial infections need enough information about epidemiology of these infections. This study aims at estimating the incidence rate and the most frequent bacteria which cause these infections in neonatal intensive care unit of Ghaem university hospital, Mashhad. Methods: In this study which is performed during a twelve month period in 2004 and 2005 at neonatal intensive care unit of Ghaem hospital, 971 hospitalized neonates were studied. Data were collected considering the standard surveillance protocols. Early onset neonatal nosocomial infections and late onset neonatal infections were defined as illness appearing from birth to seven days and from eight to twenty-eight days postnatal age respectively. Statistical analysis was performed using the χ2 test. Results: In this study 32 cases of nosocomial infections were identified so the incidence rate of nosocomial infection in this ward was 3.29%. Fifteen babies identified with early onset neonatal nosocomial infection and the rest have presented with late onset neonatal infections. In order of frequency, the sites of infection were: primary bloodstream (84.4% and pneumonia (15.62%. Coagulase negative staphylococci were the most common bacteria (43.74% isolated in these patients. Other isolated bacteria were Klebsiella pneumonia (31.42% and other gram negative bacilli such as E.coli, Pseudomonas aeroginosa and Acintobacter spp. The mechanical ventilation and umbilical catheter were associated with nosocomial infections as risk factors in our study (p<0.01. Conclusion: Our findings show that the neonatal intensive care unit of Ghaem hospital has low rate of nosocomial infections. However, as neonatal intensive care unit is an area of great concern in terms of nosocomial

  2. Prognostic Impact of Mild Hypokalemia in Terms of Death and Stroke in the General Population-A Prospective Population Study

    DEFF Research Database (Denmark)

    Mattsson, Nick; Nielsen, Olav Wendelboe; Johnson, Linda

    2017-01-01

    ), normokalemia (3.7-4.5 mmol/L, n = 4973), and high potassium (>4.5 mmol/L, n = 185). Hypokalemia was further divided as potassium AMI......) as compared with normokalemia (hazard ratio [HR] 1.40; 95% confidence interval [CI], 1.00-1.98). The subgroup with potassium AMI......, and no increased risk of mortality was seen with concomitant AMI and hypokalemia. No associations were seen with high potassium. CONCLUSION: In a general population mild hypokalemia is associated with increased stroke risk and, to a lesser degree, increased mortality risk....

  3. An early treatment with 17-β-estradiol is neuroprotective against the long-term effects of neonatal ionizing radiation exposure.

    Science.gov (United States)

    Caceres, Lucila G; Uran, Soledad L; Zorrilla Zubilete, María A; Romero, Juan I; Capani, Francisco; Guelman, Laura R

    2011-08-01

    Ionizing radiations can induce oxidative stress on target tissues, acting mainly through reactive oxygen species (ROS). The aim of this work was to investigate if 17-β-estradiol (βE) was able to prevent hippocampal-related behavioral and biochemical changes induced by neonatal ionizing radiation exposure and to elucidate a potential neuroprotective mechanism. Male Wistar rats were irradiated with 5 Gy of X-rays between 24 and 48 h after birth. A subset of rats was subcutaneously administered with successive injections of βE or 17-α-estradiol (αE), prior and after irradiation. Rats were subjected to different behavioral tasks to evaluate habituation and associative memory as well as anxiety levels. Hippocampal ROS levels and protein kinase C (PKC) activity were also assessed. Results show that although βE was unable to prevent radiation-induced hippocampal PKC activity changes, most behavioral abnormalities were reversed. Moreover, hippocampal ROS levels in βE-treated irradiated rats approached control values. In addition, αE administered to irradiated animals was effective in preventing radiation-induced alterations. In conclusion, βE was able to counteract behavioral and biochemical changes induced in irradiated animals, probably acting through an antioxidant mechanism. © 2011 The Authors. Journal of Neurochemistry © 2011 International Society for Neurochemistry.

  4. Long-Term Trends and Role of Climate in the Population Dynamics of Eurasian Reindeer.

    Science.gov (United States)

    Uboni, Alessia; Horstkotte, Tim; Kaarlejärvi, Elina; Sévêque, Anthony; Stammler, Florian; Olofsson, Johan; Forbes, Bruce C; Moen, Jon

    2016-01-01

    Temperature is increasing in Arctic and sub-Arctic regions at a higher rate than anywhere else in the world. The frequency and nature of precipitation events are also predicted to change in the future. These changes in climate are expected, together with increasing human pressures, to have significant impacts on Arctic and sub-Arctic species and ecosystems. Due to the key role that reindeer play in those ecosystems, it is essential to understand how climate will affect the region's most important species. Our study assesses the role of climate on the dynamics of fourteen Eurasian reindeer (Rangifer tarandus) populations, using for the first time data on reindeer abundance collected over a 70-year period, including both wild and semi-domesticated reindeer, and covering more than half of the species' total range. We analyzed trends in population dynamics, investigated synchrony among population growth rates, and assessed the effects of climate on population growth rates. Trends in the population dynamics were remarkably heterogeneous. Synchrony was apparent only among some populations and was not correlated with distance among population ranges. Proxies of climate variability mostly failed to explain population growth rates and synchrony. For both wild and semi-domesticated populations, local weather, biotic pressures, loss of habitat and human disturbances appear to have been more important drivers of reindeer population dynamics than climate. In semi-domesticated populations, management strategies may have masked the effects of climate. Conservation efforts should aim to mitigate human disturbances, which could exacerbate the potentially negative effects of climate change on reindeer populations in the future. Special protection and support should be granted to those semi-domesticated populations that suffered the most because of the collapse of the Soviet Union, in order to protect the livelihood of indigenous peoples that depend on the species, and the multi

  5. Long-Term Trends and Role of Climate in the Population Dynamics of Eurasian Reindeer.

    Directory of Open Access Journals (Sweden)

    Alessia Uboni

    Full Text Available Temperature is increasing in Arctic and sub-Arctic regions at a higher rate than anywhere else in the world. The frequency and nature of precipitation events are also predicted to change in the future. These changes in climate are expected, together with increasing human pressures, to have significant impacts on Arctic and sub-Arctic species and ecosystems. Due to the key role that reindeer play in those ecosystems, it is essential to understand how climate will affect the region's most important species. Our study assesses the role of climate on the dynamics of fourteen Eurasian reindeer (Rangifer tarandus populations, using for the first time data on reindeer abundance collected over a 70-year period, including both wild and semi-domesticated reindeer, and covering more than half of the species' total range. We analyzed trends in population dynamics, investigated synchrony among population growth rates, and assessed the effects of climate on population growth rates. Trends in the population dynamics were remarkably heterogeneous. Synchrony was apparent only among some populations and was not correlated with distance among population ranges. Proxies of climate variability mostly failed to explain population growth rates and synchrony. For both wild and semi-domesticated populations, local weather, biotic pressures, loss of habitat and human disturbances appear to have been more important drivers of reindeer population dynamics than climate. In semi-domesticated populations, management strategies may have masked the effects of climate. Conservation efforts should aim to mitigate human disturbances, which could exacerbate the potentially negative effects of climate change on reindeer populations in the future. Special protection and support should be granted to those semi-domesticated populations that suffered the most because of the collapse of the Soviet Union, in order to protect the livelihood of indigenous peoples that depend on the species

  6. An Evaluation of Growth Hormone and IGF-1 Responses in Neonates with Hyperinsulinaemic Hypoglycaemia

    Directory of Open Access Journals (Sweden)

    Senthil Senniappan

    2013-01-01

    Full Text Available Background. Hyperinsulinaemic Hypoglycaemia (HH is the most common cause of severe and persistent hypoglycemia in the neonatal period. It has been shown that the neonates with HH fail to generate adequate serum cortisol counterregulatory response to symptomatic hypoglycemia. However the role played by growth hormone (GH and Insulin-like Growth Factor 1 (IGF-1 is not clear. Objectives. To compare the serum GH, IGF-1, and IGFBP3 responses to HH in neonates undergoing diagnostic fasting studies. Population and Methods. Data was retrospectively collected on full-term neonates who presented with severe and persistent hypoglycemia and were confirmed to have HH. Neonates born with intrauterine growth retardation or those on medical therapy (diazoxide or octreotide were excluded. Results. 31 neonates with HH (mean gestational age: 38 weeks and mean birth weight: 3.9 kg were included in the study. The mean age at the time of diagnostic fast was 4 weeks, the mean glucose concentration during the fast was 2.2 mmol/L (, and the mean insulin level was 11.9 mU/L (±2.12. The mean serum GH concentration during the hypoglycaemia was 12.5 µg/L (±1.53. The mean serum IGF-1 and Insulin-like Growth Factor Binding Protein 3 (IGFBP3 levels were 29.2 ng/ml (±7.8 and 1.21 mg/L (±0.13, respectively. The mean cortisol concentration was 201 nmol/L (±33. Conclusions. Whilst the serum IGF-1 and IGFBP3 levels are relatively low during hypoglycaemia, the serum GH level does reflect an appropriate counterregulatory response to HH. The serum cortisol counterregulatory hormonal responses are blunted. Further studies are required to understand the mechanism(s of these hormonal alterations in neonates with HH.

  7. Evaluation of a point-of-care transcutaneous bilirubinometer in Chinese neonates at an accident and emergency department

    National Research Council Canada - National Science Library

    Lam, Tommy S K; Tsui, K L; Kam, C W

    2008-01-01

    To evaluate the use of a point-of-care transcutaneous bilirubinometer, JM-103 Minolta, for estimation of the serum bilirubin level in the management of neonatal jaundice in term or near-term Chinese neonates...

  8. Transcutaneous bilirubin nomogram for prediction of significant neonatal hyperbilirubinemia.

    Science.gov (United States)

    Varvarigou, Anastasia; Fouzas, Sotirios; Skylogianni, Eleni; Mantagou, Lito; Bougioukou, Dorothea; Mantagos, Stefanos

    2009-10-01

    The goal was to develop a predictive nomogram, based on transcutaneous bilirubin (TcB) measurements, for assessment of the risk of significant hyperbilirubinemia in healthy term and near-term neonates. A total of 10382 TcB measurements were performed with 2039 healthy neonates (gestational age of > or =35 weeks and birth weight of > or =2000 g), with a BiliCheck bilirubinometer (SpectRx, Norcross, GA), at designated time points between 12 and 120 hours of life. According to their severity, these TcB measurements were selectively cross-checked with a direct spectrophotometric device, and significant hyperbilirubinemia was defined on the basis of the hour-specific threshold values for phototherapy proposed by the American Academy of Pediatrics. With the use of likelihood ratios (LRs), the high- and low-risk demarcators for each designated time were calculated and presented on an hour-specific nomogram. Significant hyperbilirubinemia was documented for 122 neonates (6%). At 24 hours of life, the high-risk zone of the nomogram had 73.9% sensitivity and a positive LR of 12.1 in predicting significant hyperbilirubinemia, whereas the low-risk zone had 97.7% sensitivity and a negative LR of 0.04. At 48 hours, the high-risk zone had 90% sensitivity and a positive LR of 12.1, whereas the low-risk zone had 98.8% sensitivity and a negative LR of 0.02. In our study population, the probability of significant hyperbilirubinemia would be >35% for values in the high-risk zone and <0.5% for values in the low-risk zone of the nomogram. We provide a predictive TcB tool that could allow for a noninvasive, risk-based approach to neonatal hyperbilirubinemia.

  9. LONG-TERM VARIABILITY OF BRONCHIAL RESPONSIVENESS TO HISTAMINE IN A RANDOM-POPULATION SAMPLE OF ADULTS

    NARCIS (Netherlands)

    RIJCKEN, B; SCHOUTEN, JP; WEISS, ST; ROSNER, B; DEVRIES, K; VANDERLENDE, R

    1993-01-01

    Long-term variability of bronchial responsiveness has been studied in a random population sample of adults. During a follow-up period of 18 yr, 2,216 subjects contributed 5,012 observations to the analyses. Each subject could have as many as seven observations. Bronchial responsiveness was assessed

  10. Caffeine impact on neonatal morbidities.

    Science.gov (United States)

    Aranda, Jacob V; Beharry, Kay; Valencia, Gloria B; Natarajan, Girija; Davis, Jonathan

    2010-10-01

    Caffeine is a silver bullet in neonatology. This ubiquitous trimethylxanthine, pervasively used in the human diet and beverages, significantly impacts on major acute neonatal morbidities including apnea of prematurity, bronchopulmonary dysplasia, patent ductus arteriousus with or without surgical ligation and post-operative apnea. Potential uses in respiratory distress syndrome as suggested by improved lung function in primate models is supported by the decreased time on mechanical ventilation and need for oxygen therapy. Improved later outcomes at 18 to 22 months include clinically significant decreases in cerebral palsy, cognitive impairment, and severe retinopathy of prematurity in those babies who received caffeine during the neonatal period compared to non-caffeine treated placebo neonates. Ongoing and future research studies focus on optimizing current dose regimens to determine whether benefits can be maximized while maintaining an impressive safety profile. Molecular pharmacologic studies focused on the molecular and the biochemical mechanisms underlying the protective effects of caffeine are also being done to optimize treatment regimes and to target potential molecular pathways leading to further decreases in acute and long term neonatal morbidities. Since its use in newborns three decades ago, caffeine is now one of the safest, most cost-beneficial and effective therapies in the newborn.

  11. Long-term monitoring of endangered Laysan ducks: Index validation and population estimates 1998–2012

    Science.gov (United States)

    Reynolds, Michelle H.; Courtot, Karen; Brinck, Kevin W.; Rehkemper, Cynthia; Hatfield, Jeffrey

    2015-01-01

    Monitoring endangered wildlife is essential to assessing management or recovery objectives and learning about population status. We tested assumptions of a population index for endangered Laysan duck (or teal; Anas laysanensis) monitored using mark–resight methods on Laysan Island, Hawai’i. We marked 723 Laysan ducks between 1998 and 2009 and identified seasonal surveys through 2012 that met accuracy and precision criteria for estimating population abundance. Our results provide a 15-y time series of seasonal population estimates at Laysan Island. We found differences in detection among seasons and how observed counts related to population estimates. The highest counts and the strongest relationship between count and population estimates occurred in autumn (September–November). The best autumn surveys yielded population abundance estimates that ranged from 674 (95% CI = 619–730) in 2003 to 339 (95% CI = 265–413) in 2012. A population decline of 42% was observed between 2010 and 2012 after consecutive storms and Japan’s To¯hoku earthquake-generated tsunami in 2011. Our results show positive correlations between the seasonal maximum counts and population estimates from the same date, and support the use of standardized bimonthly counts of unmarked birds as a valid index to monitor trends among years within a season at Laysan Island.

  12. Short- and long-term effects of neonatal pharmacotherapy with epigallocatechin-3-gallate on hippocampal development in the Ts65Dn mouse model of Down syndrome.

    Science.gov (United States)

    Stagni, Fiorenza; Giacomini, Andrea; Emili, Marco; Trazzi, Stefania; Guidi, Sandra; Sassi, Martina; Ciani, Elisabetta; Rimondini, Roberto; Bartesaghi, Renata

    2016-10-01

    Cognitive disability is an unavoidable feature of Down syndrome (DS), a genetic disorder due to the triplication of human chromosome 21. DS is associated with alterations of neurogenesis, neuron maturation and connectivity that are already present at prenatal life stages. Recent evidence shows that pharmacotherapies can have a large impact on the trisomic brain provided that they are administered perinatally. Epigallocatechin-3-gallate (EGCG), the major polyphenol of green tea, performs many actions in the brain, including inhibition of DYRK1A, a kinase that is over-expressed in the DS brain and contributes to the DS phenotype. Young adults with DS treated with EGCG exhibit some cognitive benefits, although these effects disappear with time. We deemed it extremely important, however, to establish whether treatment with EGCG at the initial stages of brain development leads to plastic changes that outlast treatment cessation. In the current study, we exploited the Ts65Dn mouse model of DS in order to establish whether pharmacotherapy with EGCG during peak of neurogenesis in the hippocampal dentate gyrus (DG) enduringly restores hippocampal development and memory performance. Euploid and Ts65Dn mice were treated with EGCG from postnatal day 3 (P3) to P15. The effects of treatment were examined at its cessation (at P15) or after one month (at P45). We found that at P15 treated trisomic pups exhibited restoration of neurogenesis, total hippocampal granule cell number and levels of pre- and postsynaptic proteins in the DG, hippocampus and neocortex. However, at P45 none of these effects were still present, nor did treated Ts65Dn mice exhibit any improvement in hippocampus-dependent tasks. These findings show that treatment with EGCG carried out in the neonatal period rescues numerous trisomy-linked brain alterations. However, even during this, the most critical time window for hippocampal development, EGCG does not elicit enduring effects on the hippocampal physiology

  13. Neonatal management and outcome in red cell alloimmunization

    NARCIS (Netherlands)

    Smits-Wintjens, Vivianne Elise Huberta Johanna

    2012-01-01

    In this thesis, several studies on neonatal red cell alloimmune hemolytic disease are presented, including various management options, associated complications and co-morbidities and the short-term and long-term outcome of children with Rhesus hemolytic disease.

  14. Laser Photoradiation Therapy For Neonatal Jaundice

    Science.gov (United States)

    Hamza, Mostafa; Hamza, Mohammad

    1987-04-01

    This paper describes our leading experience in the clinical application of laser in the treatment of neonatal jaundice. Currently, the irradiation of jaundiced infants during neonatal life to fluorescent light is the most common treatment of neonatal hyperbilirubinemia. The authors have investigated the photodegradation of bilirubin by laser in vitro and in Gunn rats before embarking on its clinical application in the treatment of jaundice in the new born child. This work was done to study the theraputic effect of laser compared to the currently used phototherapy in the treatment of neonatal jaundice. We selected 16 full term neonates with jaundice to be the subject of this study. The neonates of the study were devided into two groups. The first group was treated with continuous phototherapy . The second group recieved photoradiation therapy with gas laser The laser used was a CW argon-ion laser tuned to oscillate at 488.0 nm wavelength. This wavelength selection was based on our previous studies on the effect of laser irradiation of Gunn rats at different wavelengths. Comparison of the results of both methods of treatment will be reported in detail. The advantages and limitations of laser photoradiation therapy for neonatal jaundice will be discussed.

  15. Neonatal Hypoxia Ischaemia: Mechanisms, Models, and Therapeutic Challenges

    OpenAIRE

    Millar, Lancelot J.; Shi, Lei; Hoerder-Suabedissen, Anna; Molnár, Zoltán

    2017-01-01

    Neonatal hypoxia-ischaemia (HI) is the most common cause of death and disability in human neonates, and is often associated with persistent motor, sensory, and cognitive impairment. Improved intensive care technology has increased survival without preventing neurological disorder, increasing morbidity throughout the adult population. Early preventative or neuroprotective interventions have the potential to rescue brain development in neonates, yet only one therapeutic intervention is currentl...

  16. Quantifying long-term population growth rates of threatened bull trout: challenges, lessons learned, and opportunities

    Science.gov (United States)

    Budy, Phaedra; Bowerman, Tracy; Al-Chokhachy, Robert K.; Conner, Mary; Schaller, Howard

    2017-01-01

    Temporal symmetry models (TSM) represent advances in the analytical application of mark–recapture data to population status assessments. For a population of char, we employed 10 years of active and passive mark–recapture data to quantify population growth rates using different data sources and analytical approaches. Estimates of adult population growth rate were 1.01 (95% confidence interval = 0.84–1.20) using a temporal symmetry model (λTSM), 0.96 (0.68–1.34) based on logistic regressions of annual snorkel data (λA), and 0.92 (0.77–1.11) from redd counts (λR). Top-performing TSMs included an increasing time trend in recruitment (f) and changes in capture probability (p). There was only a 1% chance the population decreased ≥50%, and a 10% chance it decreased ≥30% (λMCMC; based on Bayesian Markov chain Monte Carlo procedure). Size structure was stable; however, the adult population was dominated by small adults, and over the study period there was a decline in the contribution of large adults to total biomass. Juvenile condition decreased with increasing adult densities. Utilization of these different information sources provided a robust weight-of-evidence approach to identifying population status and potential mechanisms driving changes in population growth rates.

  17. Management of Shock in Neonates.

    Science.gov (United States)

    Bhat, B Vishnu; Plakkal, Nishad

    2015-10-01

    Shock is characterized by inadequate oxygen delivery to the tissues, and is more frequent in very low birth weight infants, especially in the first few days of life. Shock is an independent predictor of mortality, and the survivors are at a higher risk of neurologic impairment. Understanding the pathophysiology helps to recognize and classify shock in the early compensated phase and initiate appropriate treatment. Hypovolemia is rarely the primary cause of shock in neonates. Myocardial dysfunction is especially common in extremely preterm infants, and in term infants with perinatal asphyxia. Blood pressure measurements are easy, but correlate poorly with cerebral and systemic blood flows. Point-of-care cardiac ultrasound can help in individualized assessment of problems, selecting appropriate therapy and monitoring response, but may not always be available, and long-term benefits need to be demonstrated. The use of near-infrared spectroscopy to guide treatment of neonatal shock is currently experimental. In the absence of hypovolemia, excessive administration of fluid boluses is inappropriate therapy. Dobutamine and dopamine are the most common initial inotropes used in neonatal shock. Dobutamine has been shown to improve systemic blood flow, especially in very low birth weight infants, but dopamine is better at improving blood pressure in hypotensive infants. Newer inodilators including milrinone and levosimendan may be useful in selected settings. Data on long-term survival and neurologic outcomes following different management strategies are scarce and future research efforts should focus on this.

  18. Incidence of Hearing Abnormality in Neonate Intensive Care Unit Hospitalized Neonate

    Directory of Open Access Journals (Sweden)

    Mohammad Mahdi Ghasemi

    2006-12-01

    Full Text Available Background and Aim: Risk factors including asphyxia, meningitis, form of delivery, etc may cause hearing loss in neonates results in speech and language deprivation, emotional and educational problems. The aim of this study was to determine the prevalence of hearing loss and its relationship with risk factors among neonates hospitalized in neonate intensive care unit (NICU. Materials and Methods: It was a cross-sectional study on 234 NICU hospitalized neonates in Ghaem and Imam-Reza hospitals of Mashhad. Epidemiologic and pathologic information were obtained. Otoacoustic emissions were done in all of neonates. Patients referred to the second otoacoustic emissions (OAEs and patients failed in the second test controlled by auditory brainstem response (ABR. Results: Hearing abnormality was found in 11 neonates (4.7% including 2 girls and 9 boys. (1 neonate with mild, 2 with mild to moderate, 2 with moderate to severe, 1 with sever to profound hearing loss and 4 with auditory neuropathy. Hearing abnormality has a significant greater incidence in group with apgar 5 and in patients with icterus (in need with transfusion. Conclusion: Incidence of hearing loss in NICU hospitalized neonates is greater in comparison with general population. It has a greater incidence in group with icterus (in need with transfusion and apgar 5, so, a comprehensive hearing screening program must be applied for early identification and intervention.

  19. Prenatal exposure to mercury and neurobehavioral development of neonates in Zhoushan City, China.

    Science.gov (United States)

    Gao, Yu; Yan, Chong-Huai; Tian, Ying; Wang, Yu; Xie, Han-Fang; Zhou, Xin; Yu, Xiao-Dan; Yu, Xiao-Gang; Tong, Shilu; Zhou, Qing-Xin; Shen, Xiao-Ming

    2007-11-01

    Exposure to hazardous Hg can adversely affect children's neurodevelopment. However, few data are available on either Hg levels in neonates and their mothers or the impact of prenatal exposure to Hg on neonates' neurobehavioral development in the Chinese population. Therefore, this study examined Hg levels in neonates and their mothers and the relationship between prenatal exposure to Hg and neonates' neurobehavioral development in Zhoushan City, Zhejiang Province, China. Between August and October 2004, 417 women who delivered their babies at Zhoushan Women's and Children's Health Hospital, an island city in east China were invited to take part in this study. A total of 408 complete questionnaires, 405 maternal hair samples, and 406 umbilical cord samples were collected. Neonatal behavioral neurological assessments (NBNA) were conducted for 384 neonates. The geometric mean (GM) of Hg level in cord blood was 5.58 microg/L (interquartile range: 3.96-7.82 microg/L), and the GM of maternal hair Hg level was 1246.56 microg/kg (interquartile range: 927.34-1684.67 microg/kg), a level much lower than other reported fish-eating populations, indicating Hg exposure in Zhoushan city is generally below those considered hazardous. However, according to the reference dose of Hg levels (RfD 5.8 microg/L) derived by EPA, 69.9% of newborns had levels at or above the RfD, an estimated level assumed to be without appreciable harm. There was a strong correlation between maternal hair and cord blood Hg levels (r = 0.82, P exposure was associated with decreased behavioral ability for males (OR = 1.235, 95%CI of OR = 1.078-1.414, P exposure resulting from fish consumption. But the findings of this study may be due to chance, and long-term follow-up research is needed to evaluate cumulative effects of exposure to mercury.

  20. Biomarkers of acute kidney injury in neonatal encephalopathy.

    LENUS (Irish Health Repository)

    Sweetman, D U

    2013-03-01

    Acute kidney injury (AKI) is a common complication of neonatal encephalopathy (NE). The accurate diagnosis of neonatal AKI, irrespective of the cause, relies on suboptimal methods such as identification of rising serum creatinine, decreased urinary output and glomerular filtration rate. Studies of AKI biomarkers in adults and children have shown that biomarkers can improve the early diagnosis of AKI. Hypoxia-ischaemia is the proposed aetiological basis of AKI in both NE and cardiopulmonary bypass (CPB). However, there is a paucity of studies examining the role of AKI biomarkers specifically in NE. Urinary cystatin C (CysC), neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18, kidney injury molecule-1, liver-type fatty acid-binding protein, serum CysC and serum NGAL all show good ability to predict early AKI in a heterogeneous critically ill neonatal population including infants post-CPB. Moreover, serum and urinary NGAL and urinary CysC are early predictors of AKI secondary to NE. These findings are promising and open up the possibility of biomarkers playing a significant role in the early diagnosis and treatment of NE-related AKI. There is an urgent need to explore the role of AKI biomarkers in infants with NE as establishing the diagnosis of AKI earlier may allow more timely intervention with potential for improving long-term outcome.

  1. The effective concentration of epsilon-aminocaproic Acid for inhibition of fibrinolysis in neonatal plasma in vitro.

    Science.gov (United States)

    Yurka, Heather G; Wissler, Richard N; Zanghi, Christine N; Liu, Xiang; Tu, Xin; Eaton, Michael P

    2010-07-01

    Pediatric patients, particularly neonates, are at high risk for bleeding complications after cardiovascular surgery because of their immature hemostatic system, small size, and the complex operations they require. Activation of intravascular fibrinolysis is one of the principle effects of cardiopulmonary bypass that causes poor postoperative hemostasis. This complication has long been recognized and treated with antifibrinolytic medications, including the lysine analog epsilon aminocaproic acid (EACA). The therapeutic plasma concentration of EACA has been scientifically determined for the adult population, but the current recommended dosage for neonates has been empirically derived from adult studies. Therefore, we investigated the appropriate concentration of EACA for neonates undergoing bypass. We conducted an in vitro study using neonatal plasma derived from the placenta/cord units from 20 term, elective cesarean deliveries. Graded concentrations of EACA were added to aliquots of the plasma pool before activating fibrinolysis with tissue-type plasminogen activator. Standard kaolin-activated thromboelastograms were then run with the primary outcome variable being estimated percent lysis. These procedures were repeated on samples of commercially available pooled adult normal plasma for comparison. We found that neonatal plasma required significantly lower concentrations of EACA to completely prevent fibrinolysis than did adult plasma (44.2 microg/mL and 47.8 microg/mL for neonatal plasma and 94.4 and 131.4 microg/mL in adult plasma for 400 and 1000 U/mL of plasminogen activator, respectively, P < 0.001). Our data establish the minimal effective concentration of EACA necessary to completely prevent fibrinolysis in neonatal blood in vitro. This concentration is significantly less than that targeted by current dosing schemes, indicating that neonates are possibly being exposed to greater levels of EACA than is clinically necessary.

  2. The Long Term Recovery of New Orleans' Population after Hurricane Katrina.

    Science.gov (United States)

    Fussell, Elizabeth

    2015-09-01

    Hurricane Katrina created a catastrophe in the city of New Orleans when the storm surge caused the levee system to fail on August 29, 2005. The destruction of housing displaced hundreds of thousands of residents for varying lengths of time, often permanently. It also revealed gaps in our knowledge of how population is recovered after a disaster causes widespread destruction of urban infrastructure, housing and workplaces, and how mechanisms driving housing recovery often produce unequal social, spatial and temporal population recovery. In this article, I assemble social, spatial and temporal explanatory frameworks for housing and population recovery and then review research on mobility - both evacuation and migration - after Hurricane Katrina. The review reveals a need for a comprehensive social, spatial and temporal framework for explaining inequality in population recovery and displacement. It also shows how little is known about in-migrants and permanent out-migrants after a disaster.

  3. Bat Species Occurrence and Long-Term Bat Population Monitoring on Refuges using Acoustical Detection.

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This is a proposal to: Determine baseline occurrence of bat species on refuges in the southeast during the breeding season. 2. Index bat populations on a species by...

  4. Incidence of fever in labor and risk of neonatal sepsis.

    Science.gov (United States)

    Towers, Craig V; Yates, Angela; Zite, Nikki; Smith, Casey; Chernicky, Lindsey; Howard, Bobby

    2017-06-01

    The current recommendation regarding the management of a term newborn delivered of a mother with an intrapartum fever or a diagnosis of clinical chorioamnionitis is that the neonate should have baseline laboratory work drawn along with blood cultures and be universally treated with antibiotics until culture results return. These guidelines report that the rate of intrapartum fever is about 3%; however, a few large studies suggest that the rate is higher at about 7%. We sought to prospectively evaluate the rate of fever during labor in a large number of deliveries and determine the rate of early-onset neonatal sepsis in newborns delivered from mothers with an intrapartum fever compared with newborns delivered from mothers without intrapartum fever. This was a prospective cohort study of all temperatures obtained in women in labor from Jan. 1, 2011, through June 30, 2014. Every patient with a fever of ≥38°C at ≥36 weeks' gestation was evaluated for gestational age, parity, spontaneous or induced labor, group B streptococcus status, regional anesthesia, mode of delivery, treatment with intrapartum antibiotics, and whether a clinical diagnosis of chorioamnionitis was made by the managing physician. Neonates were assessed for blood culture results, neonatal intensive care unit admission, length of stay, and any major newborn complications. Statistical analysis involved χ2, Fisher exact, and Student t test. A total of 412 patients (6.8%; 95% confidence interval, 6.2-7.5%) developed a fever in 6057 deliveries at ≥36 weeks' gestation. No cases of maternal sepsis occurred. Of the 417 newborns (5 sets of twins), only 1 (0.24%; 95% confidence interval, 0.01-1.3%) developed early-onset neonatal sepsis with a positive blood culture for Escherichia coli. There were 4 cases (0.07%; 95% confidence interval, 0.02-0.18%) of early-onset neonatal sepsis in the 5697 newborns (52 sets of twins) delivered from mothers who were not febrile and this difference was not significant

  5. High genetic variation in leopards indicates large and long-term stable effective population size.

    Science.gov (United States)

    Spong, G; Johansson, M; Björklund, M

    2000-11-01

    In this paper we employ recently developed statistical and molecular tools to analyse the population history of the Tanzanian leopard (Panthera pardus), a large solitary felid. Because of their solitary lifestyle little is known of their past or present population dynamics. Eighty-one individuals were scored at 18 microsatellite loci. Overall, levels of heterozygosity were high (0.77 +/- 0.03), with a small heterozygote deficiency (0.06 +/- 0.03). Effective population size (Ne) was calculated to be 38 000-48 000. A Ne:N ratio of 0.42 (average from four cat studies) gives a present population size of about 100 000 leopards in Tanzania. Four different bottleneck tests indicated that this population has been large and stable for a minimum of several thousand years. FST values were low and no significant genetic structuring of the population could be detected. This concurs well with the large migration values (Nm) obtained (>3.3 individuals/generation). Our analysis reveals that ecological factors (e.g. disease), which are known to have had major impact on other carnivore populations, are unlikely to have impacted strongly on the population dynamics of Tanzanian leopards. The explanation may be found in their solitary life-style, their often nonconfrontational behaviour toward interspecific competitors, or that any bottlenecks have been of limited size, localized, or too short to have affected genetic variation to any measurable degree. Since the genetic structuring is weak, gene flow is not restricted to within protected areas. Local loss of genetic variation is therefore not of immediate concern.

  6. Long-term e-cigarette use and smoking cessation: a longitudinal study with US population.

    Science.gov (United States)

    Zhuang, Yue-Lin; Cummins, Sharon E; Sun, Jessica Y; Zhu, Shu-Hong

    2016-10-01

    E-cigarettes have grown popular. The most common pattern is dual use with conventional cigarettes. Dual use has raised concerns that it might delay quitting of cigarette smoking. This study examined the relationship between long-term use of e-cigarettes and smoking cessation in a 2-year period. A nationally representative sample of 2028 US smokers were surveyed in 2012 and 2014. Long-term e-cigarette use was defined as using e-cigarettes at baseline and follow-up. Use of e-cigarettes only at baseline or at follow-up was defined as short-term use. Non-users did not use e-cigarettes at either survey. Quit attempt rates and cessation rates (abstinent for 3 months or longer) were compared across the three groups. At 2-year follow-up, 43.7% of baseline dual users were still using e-cigarettes. Long-term e-cigarette users had a higher quit attempt rate than short-term or non-users (72.6% vs 53.8% and 45.5%, respectively), and a higher cessation rate (42.4% vs 14.2% and 15.6%, respectively). The difference in cessation rate between long-term users and non-users remained significant after adjusting for baseline variables, OR=4.1 (95% CI 1.5 to 11.4) as did the difference between long-term users and short-term users, OR=4.8 (95% CI 1.6 to 13.9). The difference in cessation rate between short-term users and non-users was not significant, OR=0.9 (95% CI 0.5 to 1.4). Among those making a quit attempt, use of e-cigarettes as a cessation aid surpassed that of FDA-approved pharmacotherapy. Short-term e-cigarette use was not associated with a lower rate of smoking cessation. Long-term use of e-cigarettes was associated with a higher rate of quitting smoking. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  7. Long-term e-cigarette use and smoking cessation: a longitudinal study with US population

    Science.gov (United States)

    Zhuang, Yue-Lin; Cummins, Sharon E; Y Sun, Jessica; Zhu, Shu-Hong

    2016-01-01

    Background E-cigarettes have grown popular. The most common pattern is dual use with conventional cigarettes. Dual use has raised concerns that it might delay quitting of cigarette smoking. This study examined the relationship between long-term use of e-cigarettes and smoking cessation in a 2-year period. Methods A nationally representative sample of 2028 US smokers were surveyed in 2012 and 2014. Long-term e-cigarette use was defined as using e-cigarettes at baseline and follow-up. Use of e-cigarettes only at baseline or at follow-up was defined as short-term use. Non-users did not use e-cigarettes at either survey. Quit attempt rates and cessation rates (abstinent for 3 months or longer) were compared across the three groups. Results At 2-year follow-up, 43.7% of baseline dual users were still using e-cigarettes. Long-term e-cigarette users had a higher quit attempt rate than short-term or non-users (72.6% vs 53.8% and 45.5%, respectively), and a higher cessation rate (42.4% vs 14.2% and 15.6%, respectively). The difference in cessation rate between long-term users and non-users remained significant after adjusting for baseline variables, OR=4.1 (95% CI 1.5 to 11.4) as did the difference between long-term users and short-term users, OR=4.8 (95% CI 1.6 to 13.9). The difference in cessation rate between short-term users and non-users was not significant, OR=0.9 (95% CI 0.5 to 1.4). Among those making a quit attempt, use of e-cigarettes as a cessation aid surpassed that of FDA-approved pharmacotherapy. Conclusions Short-term e-cigarette use was not associated with a lower rate of smoking cessation. Long-term use of e-cigarettes was associated with a higher rate of quitting smoking. PMID:27697953

  8. The Neurodevelopmental Impact of Neonatal Morphine Administration

    Directory of Open Access Journals (Sweden)

    Stephanie Attarian

    2014-04-01

    Full Text Available Medical management of newborn infants often necessitates recurrent painful procedures, which may alter nociceptive pathways during a critical developmental period and adversely effect neuropsychological outcomes. To mitigate the effects of repeated painful stimuli, opioid administration for peri-procedural analgesia and ICU (intensive care unit sedation is common in the NICU (neonatal intensive care unit. A growing body of basic and animal evidence suggests potential long-term harm associated with neonatal opioid therapy. Morphine increases apoptosis in human microglial cells, and animal studies demonstrate long-term changes in behavior, brain function, and spatial recognition memory following morphine exposure. This comprehensive review examines existing preclinical and clinical evidence on the long-term impacts of neonatal pain and opioid therapy.

  9. Assessment of long-term safety and efficacy of intranasal mesenchymal stem cell treatment for neonatal brain injury in the mouse

    NARCIS (Netherlands)

    Donega, Vanessa; Nijboer, Cora H.A.; Van Velthoven, Cindy T J; Youssef, Sameh A.; De Bruin, Alain; Van Bel, Frank; Kavelaars, Annemieke; Heijnen, Cobi J.; Nijboer, CHA

    2015-01-01

    Background:For clinical translation, we assessed whether intranasal mesenchymal stem cell (MSC) treatment after hypoxia-ischemia (HI) induces neoplasia in the brain or periphery at 14 mo. Furthermore, the long-term effects of MSCs on behavior and lesion size were determined.Method:HI was induced in

  10. A meta-analysis and systematic review of the prevalence of mitochondrially encoded 12S RNA in the general population: Is there a role for screening neonates requiring aminoglycosides?

    Directory of Open Access Journals (Sweden)

    Titus S Ibekwe

    2015-01-01

    Full Text Available Background: This was a meta-analysis and systematic review to determine the global prevalence of the mitochondrially encoded 12S RNA (MT-RNR1 genetic mutation in order to assess the need for neonatal screening prior to aminoglycoside therapy. Materials and Methods: A comprehensive search of MEDLINE, EMBASE, Ovid, Database of Abstracts of Reviews of Effect, Cochrane Library, Clinical Evidence and Cochrane Central Register of Trials was performed including cross-referencing independently by 2 assessors. Selections were restricted to human studies in English. Meta-analysis was done with MetaXL 2013. Results: Forty-five papers out of 295 met the criteria. Pooled prevalence in the general population for MT-RNR1 gene mutations (A1555G, C1494T, A7445G was 2% (1-4% at 99%. Conclusion: Routine screening for MT-RNR1 mutations in the general population prior to treatment with aminoglycosides appear desirable but poorly supported by the weak level of evidence available in the literature. Routine screening in high-risk (Chinese and Spanish populations appear justified.

  11. Heat-treated (in single aliquot or batch) colostrum outperforms non-heat-treated colostrum in terms of quality and transfer of immunoglobulin G in neonatal Jersey calves.

    Science.gov (United States)

    Kryzer, A A; Godden, S M; Schell, R

    2015-03-01

    The objective of this randomized clinical trial was to describe the effect on colostrum characteristics and passive transfer of IgG in neonatal calves when using the Perfect Udder colostrum management system (single-aliquot treatment; Dairy Tech Inc., Greeley, CO) compared with a negative control (fresh refrigerated or fresh frozen colostrum) and a positive control (batch heat-treated colostrum). First-milking Jersey colostrum was pooled to achieve 31 unique batches with a minimum of 22.8 L per batch. The batch was then divided into 4 with 3.8 L allocated to each treatment group: (1) heat-treated in Perfect Udder bag at 60°C for 60 min and then stored at -20°C (PU); (2) heat-treated in a batch pasteurizer (Dairy Tech Inc.) at 60°C for 60 min and then stored at -20°C in Perfect Udder bag (DTB; positive control); (3) fresh frozen colostrum stored at -20°C in Perfect Udder bag (FF; negative control); and (4) fresh refrigerated colostrum stored at 4°C in Perfect Udder bag (FR; negative control). Colostrum from all treatments was sampled for analysis of IgG concentration and bacterial culture immediately after batch assembly, after processing, and before feeding. Newborn Jersey calves were randomly assigned to be fed 3.8 L of colostrum from 1 of the 4 treatment groups. A prefeeding, 0-h blood sample was collected, calves were fed by esophageal tube within 2 h of birth, and then a 24-h postfeeding blood sample was collected. Paired serum samples from 0- and 24-h blood samples were analyzed for IgG concentration (mg/mL) using radial immunodiffusion analysis. The overall mean IgG concentration in colostrum was 77.9 g/L and was not affected by treatment. Prefeeding total plate counts (log10 cfu/mL) were significantly different for all 4 treatments and were lower for heat-treated colostrum (PU=4.23, DTB=3.63) compared with fresh colostrum (FF=5.68, FR=6.53). Total coliform counts (log10 cfu/mL) were also significantly different for all 4 treatments and were lower for

  12. Neonatal pain management.

    Science.gov (United States)

    Carter, Brian S; Brunkhorst, Jessica

    2017-03-01

    Pain management in the neonatal ICU remains challenging for many clinicians and in many complex care circumstances. The authors review general pain management principles and address the use of pain scales, non-pharmacologic management, and various agents that may be useful in general neonatal practice, procedurally, or at the end of life. Chronic pain and neonatal abstinence are also noted. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Neonatal pain-related stress predicts cortical thickness at age 7 years in children born very preterm.

    Directory of Open Access Journals (Sweden)

    Manon Ranger

    Full Text Available Altered brain development is evident in children born very preterm (24-32 weeks gestational age, including reduction in gray and white matter volumes, and thinner cortex, from infancy to adolescence compared to term-born peers. However, many questions remain regarding the etiology. Infants born very preterm are exposed to repeated procedural pain-related stress during a period of very rapid brain development. In this vulnerable population, we have previously found that neonatal pain-related stress is associated with atypical brain development from birth to term-equivalent age. Our present aim was to evaluate whether neonatal pain-related stress (adjusted for clinical confounders of prematurity is associated with altered cortical thickness in very preterm children at school age.42 right-handed children born very preterm (24-32 weeks gestational age followed longitudinally from birth underwent 3-D T1 MRI neuroimaging at mean age 7.9 yrs. Children with severe brain injury and major motor/sensory/cognitive impairment were excluded. Regional cortical thickness was calculated using custom developed software utilizing FreeSurfer segmentation data. The association between neonatal pain-related stress (defined as the number of skin-breaking procedures accounting for clinical confounders (gestational age, illness severity, infection, mechanical ventilation, surgeries, and morphine exposure, was examined in relation to cortical thickness using constrained principal component analysis followed by generalized linear modeling.After correcting for multiple comparisons and adjusting for neonatal clinical factors, greater neonatal pain-related stress was associated with significantly thinner cortex in 21/66 cerebral regions (p-values ranged from 0.00001 to 0.014, predominately in the frontal and parietal lobes.In very preterm children without major sensory, motor or cognitive impairments, neonatal pain-related stress appears to be associated with thinner cortex

  14. Long-term prognosis and comorbidities associated with psoriasis in the Newfoundland and Labrador founder population.

    Science.gov (United States)

    Gulliver, Wayne P; Macdonald, Don; Gladney, Neil; Alaghehbandan, Reza; Rahman, Proton; Adam Baker, K

    2011-01-01

    Psoriasis is a common chronic immune-mediated inflammatory disorder of the skin with several associated comorbidities. To assess the prevalence of comorbidities in a cohort of psoriasis patients within the Canadian province of Newfoundland and Labrador (NL). This cross-sectional observational study investigated hospital-coded comorbidities associated with psoriasis in comparison to the general NL hospitalized population. Patients died significantly younger than the general population, with patients having an earlier disease onset (≤ 25 years) dying at a younger age than those with a later onset (> 25 years; 59.3 vs 71.2; p  =  .001). Patients were hospitalized more frequently for several system disorders than the general population, and a potential association was observed between prognostic factors such as age at onset, disease severity, and HLA-Cw6 genotype and certain comorbid conditions. This study supports an association between psoriasis and other conditions, such as circulatory and endocrine diseases.

  15. Mountain gorilla genomes reveal the impact of long-term population decline and inbreeding.

    Science.gov (United States)

    Xue, Yali; Prado-Martinez, Javier; Sudmant, Peter H; Narasimhan, Vagheesh; Ayub, Qasim; Szpak, Michal; Frandsen, Peter; Chen, Yuan; Yngvadottir, Bryndis; Cooper, David N; de Manuel, Marc; Hernandez-Rodriguez, Jessica; Lobon, Irene; Siegismund, Hans R; Pagani, Luca; Quail, Michael A; Hvilsom, Christina; Mudakikwa, Antoine; Eichler, Evan E; Cranfield, Michael R; Marques-Bonet, Tomas; Tyler-Smith, Chris; Scally, Aylwyn

    2015-04-10

    Mountain gorillas are an endangered great ape subspecies and a prominent focus for conservation, yet we know little about their genomic diversity and evolutionary past. We sequenced whole genomes from multiple wild individuals and compared the genomes of all four Gorilla subspecies. We found that the two eastern subspecies have experienced a prolonged population decline over the past 100,000 years, resulting in very low genetic diversity and an increased overall burden of deleterious variation. A further recent decline in the mountain gorilla population has led to extensive inbreeding, such that individuals are typically homozygous at 34% of their sequence, leading to the purging of severely deleterious recessive mutations from the population. We discuss the causes of their decline and the consequences for their future survival. Copyright © 2015, American Association for the Advancement of Science.

  16. Scope of neonatal care services in major Nigerian hospitals

    African Journals Online (AJOL)

    2015-10-12

    Oct 12, 2015 ... Abstract: Background: Neonatal survival bespeaks the quality of neonatal care services available and accessible to the population. Intensive care improves outcome of high-risk infants with serious illness. The tiered level of care is yet to be applied to newborn care in Nigeria. Classification of care is key to ...

  17. Effects of long-term population fluctuations of a top predator on invertebrate communities in subalpine ponds in Colorado

    OpenAIRE

    Wissinger, S.; Whiteman, H.; Denoël, Mathieu; Greig, H.; Butkas, K.

    2006-01-01

    Experimental and comparative data from subalpine ponds with and without tiger salamanders (Ambystoma tigrinum nebulosum) suggest that this species is a keystone predator on benthic and planktonic prey communities. At our study site in central Colorado, the population size of salamanders has fluctuated cyclically over the past 20 years from fewer than 100 to over 5000 individuals. Here we present long-term benthic data that reveal taxon- and habitat-specific correlations with fluctuations in s...

  18. Effects of long-term population fluctuations in a top predator on invertebrate community composition in Alpine ponds

    OpenAIRE

    Wissinger, Scott; Whiteman, Howard; Denoël, Mathieu

    2006-01-01

    At our remote study site in central Colorado, the population size of tiger salamanders (Ambystoma tigrinum nebulosum) has fluctuated cyclically over the past 20 years from fewer than 100 to over 5000 individuals. Comparative data between ponds with and without salamanders, and experimental studies suggest that this species is a keystone predator on benthic and planktonic prey communities. Here we present long-term community data that reveal taxon- and habitat-specific correlations in the popu...

  19. Randomised controlled trial of the effect of long-term selenium supplementation on plasma cholesterol in an elderly Danish population

    DEFF Research Database (Denmark)

    Cold, Frederik; Winther, Kristian H; Pastor-Barriuso, Roberto

    2015-01-01

    Although cross-sectional studies have shown a positive association between Se and cholesterol concentrations, a recent randomised controlled trial in 501 elderly UK individuals of relatively low-Se status found that Se supplementation for 6 months lowered total plasma cholesterol. The Danish......:HDL-cholesterol ratio between intervention and placebo groups. The effect of long-term supplementation with Se on plasma cholesterol concentrations or its sub-fractions did not differ significantly from placebo in this elderly population....

  20. Probiotics in neonatal intensive care - back to the future.

    Science.gov (United States)

    Deshpande, Girish; Rao, Shripada; Patole, Sanjay

    2015-06-01

    Survival of extremely preterm and critically ill neonates has improved significantly over the last few decades following advances in neonatal intensive care. These include antenatal glucocorticoids, surfactant, continuous positive airway pressure support, advanced gentle modes of ventilation and inhaled nitric oxide. Probiotic supplementation is a recent significant milestone in the history of neonatal intensive care. Very few, if any, interventions match the ability of probiotics to significantly reduce the risk of death and definite necrotising enterocolitis while facilitating enteral feeds in high-risk preterm neonates. Probiotics also have a potential to benefit neonates with surgical conditions with significant gastrointestinal morbidity. Current evidence for the benefits of probiotic supplementation for neonates in an intensive care unit is reviewed. The mechanisms for the benefits of probiotics in this population are discussed, and guidelines for clinicians are provided in the context of the regulatory framework in Australia. © 2015 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  1. Tetanus and diphtheria immunity among term and preterm infant-mother pairs in Turkey, a country where maternal and neonatal tetanus have recently been eliminated.

    Science.gov (United States)

    Erener-Ercan, Tugba; Aslan, Mustafa; Vural, Mehmet; Erginoz, Ethem; Kocazeybek, Bekir; Ercan, Gokmen; Turkgeldi, Lale Wetherilt; Perk, Yildiz

    2015-03-01

    The aim of our study was to investigate the anti-tetanus and anti-diphtheria antibody titres and the placental transfer of these antibodies in a group of vaccinated and unvaccinated mothers and their term or preterm offsprings. Anti-tetanus and anti-diphtheria toxoid IgG antibodies were measured quantitatively by ELISA in 91 infant-mother pairs. Protective concentrations of anti-tetanus and anti-diphtheria were found in 58.3 and 50% of mothers in the unvaccinated group and 94.5 and 85.5% of the mothers in the vaccinated group. Protective concentrations were found in 63.9 and 50% of cord samples, respectively, in the unvaccinated group and in 96.4 and 85.5% of cord samples, respectively, in the vaccinated group (p = 0.0001). There were no differences in the maternal and cord geometric mean concentrations (GMCs) of anti-toxoid antibodies between those who received two doses or one dose of Td. The GMCs of maternal and cord anti-tetanus and anti-diphtheria were statistically similar between preterm and term groups. Placental transfer ratios (TR) for anti-tetanus and anti-diphtheria were 175 and 150%, respectively, in the preterm group and 213 and 178%, respectively, in the term group. There was a strong correlation between maternal and cord anti-toxoid antibody levels. Maternal vaccination was the only predictor of having protective concentrations of anti-toxoid antibodies in cord blood. Vaccinating pregnant women with at least one dose of Td would confer protection for both the term and preterm infant-mother pairs. Therefore, health personnel caring for pregnant women have the responsibility to emphasize the importance of Td vaccination to avoid missed immunization opportunities.

  2. Long-Term Benefits of Full-Day Kindergarten: A Longitudinal Population-Based Study

    Science.gov (United States)

    Brownell, M. D.; Nickel, N. C.; Chateau, D.; Martens, P. J.; Taylor, C.; Crockett, L.; Katz, A.; Sarkar, J.; Burland, E.; Goh, C. Y.

    2015-01-01

    In the first longitudinal, population-based study of full-day kindergarten (FDK) outcomes beyond primary school in Canada, we used linked administrative data to follow 15 kindergarten cohorts (n ranging from 112 to 736) up to grade 9. Provincial assessments conducted in grades 3, 7, and 8 and course marks and credits earned in grade 9 were…

  3. Long-term e-cigarette use and smoking cessation: a longitudinal study with US population

    OpenAIRE

    Zhuang, Yue-Lin; Cummins, Sharon E.; Y Sun, Jessica; Zhu, Shu-Hong

    2016-01-01

    Background E-cigarettes have grown popular. The most common pattern is dual use with conventional cigarettes. Dual use has raised concerns that it might delay quitting of cigarette smoking. This study examined the relationship between long-term use of e-cigarettes and smoking cessation in a 2-year period. Methods A nationally representative sample of 2028 US smokers were surveyed in 2012 and 2014. Long-term e-cigarette use was defined as using e-cigarettes at baseline and follow-up. Use of e-...

  4. Audit of a clinical guideline for neonatal hypoglycaemia screening.

    Science.gov (United States)

    Sundercombe, Samantha L; Raynes-Greenow, Camille H; Carberry, Angela E; Turner, Robin M; Jeffery, Heather E

    2013-10-01

    This study aims to evaluate adherence to a clinical guideline for screening and prevention of neonatal hypoglycaemia on the post-natal wards. Retrospective chart review of 581 healthy term neonates born at a tertiary maternity hospital. Indications for hypoglycaemia screening included small for gestational age (SGA), infants of diabetic mothers (IDM; gestational, Type 1 or 2), symptomatic hypoglycaemia, macrosomia and wasted (undernourished) appearance. Outcomes were protocol entry and adherence with hypoglycaemia prevention strategies including early and frequent feeding and timely blood glucose measurement. Of 115 neonates screened for hypoglycaemia, 67 were IDM, 19 were SGA (including two both IDM and SGA), and two were macrosomic. One IDM and one SGA were not screened. Twenty-two neonates were screened for a reason not identifiable from the medical record, and 13 neonates were SGA by a definition different to the guideline definition, including five who were also IDM. Guideline adherence was variable. Few neonates (41 of 106, 39%) were fed in the first post-natal hour, and blood glucose measurement occurred later than recommended for 41 of 106 (39%) of neonates. Most IDM and SGA neonates were screened. While guideline adherence overall was comparable with other studies, neonates were fed late. We recommend staff education about benefits of early (within the first hour) frequent breastfeeding for neonates at risk. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  5. Ectopic Intralaryngo-Tracheal Thyroid Tissue Causing Neonatal Death.

    Science.gov (United States)

    Furnas, Lauren; Safa, Huda; Hutchinson, Fiona; Joseph, Lindsay; Armes, Jane E

    2017-10-01

    Ectopic thyroid tissue can be found anywhere along the embryologic path of thyroid descent. Intralaryngo-tracheal thyroid tissue is the least common site of ectopia and can present with upper airways obstruction. Its presentation in the neonate is exceptional. We describe a term female neonate with subglottic thyroid tissue causing near-total occlusion of the larynx, which led to upper airways obstruction and neonatal death. This emphasizes the importance of considering intralaryngo-tracheal tumors as a cause of acute and otherwise unexplainable respiratory distress immediately after birth. The cause of this neonatal death would not have been elucidated without careful autopsy examination.

  6. Fetal thrombotic vasculopathy in the placenta : A thrombophilic connection between pregnancy complications and neonatal thrombosis?

    NARCIS (Netherlands)

    Leistra-Leistra, MJ; Timmer, A; van Spronsen, FJ; Geven, WB; van der Meer, J; Erwich, JJHM

    Objective: Fetal thrombotic vasculopathy (FTV) has been related to pregnancy complications and neonatal thrombosis separately. We assessed whether a relationship existed in our population of women with neonates who were admitted to our Neonatal Intensive Care Unit (NICU). In addition, the presence

  7. Long-term cognitive outcomes following out-of-hospital cardiac arrest: a population-based study.

    Science.gov (United States)

    Mateen, F J; Josephs, K A; Trenerry, M R; Felmlee-Devine, M D; Weaver, A L; Carone, M; White, R D

    2011-10-11

    To report the neurologic outcomes in long-term survivors of out-of-hospital cardiac arrest with ventricular fibrillation as the presenting rhythm (OHCA VF) at a population level. All adults who experienced OHCA VF in Olmsted County, MN, from 1990 to 2008, survived more than 6 months postarrest, and were alive at the time of study recruitment were invited to participate in structured neuropsychological testing and a neurologic examination. Cognitive test results were compared to the normal population using the Mayo's Older Adults Normative Studies. Linear regression models were fit to evaluate each neuropsychological test result in relation to call-to-shock time, sex, age at cardiac arrest, time elapsed since event, witnessed vs unwitnessed arrest, and administration of bystander cardiopulmonary resuscitation. Of 332 OHCA VF arrests, 140 people (42.2%, 95% confidence interval 36.9%-47.5%) survived to discharge. No patient entered a minimally conscious or permanent vegetative state. Long-term survivors (n = 47, median survival 7.8 years postarrest) had lower scores on measures of long-term memory and learning efficiency (p = 0.001) but higher than average scores on verbal IQ (p = 0.001). Nearly all survivors were functionally independent and scored high on the Mini-Mental State Examination (MMSE) (median Barthel Index 100/100, median MMSE 29/30). Long-term survivors of OHCA VF have long-term memory deficits compared to the normal population at the same age and education level. These findings provide a baseline for cognitive outcomes studies of OHCA VF as new techniques are developed to improve survival.

  8. Long-term drug use and polypharmacy among the elderly population in the Republic of Srpska, Bosnia and Herzegovina

    Directory of Open Access Journals (Sweden)

    Marković-Peković Vanda

    2016-01-01

    Full Text Available Background/Aim. Prescription of drugs is a fundamental care component of the elderly. Elderly patients often take multiple drugs, and it is known that polypharmacy may lead to drug interactions and adverse events. The aim of this study was to analyze the long-term drug use and the prevalence of polypharmacy among the elderly population in the Republic of Srpska, Bosnia and Herzegovina. Methods. A retrospective study of outpatient drug use in 2005 and 2010 was conducted, analyzing prescriptions for patients aged ≥ 65 years reimbursed by the Health Insurance Fund. The study population was stratified by gender and age. Long-term drug use was defined as continuous drug dispensing for a whole year or at least two thirds of the year. Polypharmacy was defined as the use of 5 or more different reimbursed drugs. Results. Of all insured people aged ≥ 65 years, long-term drug use was identified in 10% (2005 and in 19% (2010, of whom 62% were women. Two to four different drugs were used by almost 49% (2005 and 54% (2010 of the elderly patients. The polypharmacy prevalence increased from 1.4% (2005 to 3.6% (2010; it increased in all the age groups of both genders. The largest increase was observed in the age group 65-74 years. Polypharmacy prevalence increase was higher in women. The most commonly used drugs were those for to treatment of cardiovascular diseases, in particular drugs for hypertension and cardiac treatment. Conclusion. The study findings point out to the increase of elderly population with a long-term drug use. Over a half of elderly patients use 2-4 different drugs on the long-term basis. The polypharmacy prevalence was low. It increased in the period of 5 years in both genders. The increase was more prominent in women of all the age groups. The use of multiple drugs and polypharmacy increased with ageing.

  9. Long-term population-based divorce rates amo