Comprehensive Clinical and Neuroimaging Review of Posterior Fossa Hemorrhage in Preterm and Term Newborns

Term and preterm newborns have differences in skin structure. Preterm newborns have skin structures that are more susceptible to various disorders. These differences are believed to impact skin pH regulation and bacterial colonization, particularly Staphylococcus spp. This study investigates the acidity difference and skin Staphylococcus spp. colonization in preterm and term newborns. This is a descriptive observational study with a cross-sectional design. The study compared skin pH and Staphylococcus spp. colonization between term (37-41 weeks) and preterm (28-36 weeks) newborns. Skin pH was measured using a skin pH meter, and Staphylococcus spp. colonization was assessed through bacterial identification and colony-forming unit (CFU) testing. Assessments were conducted within the first 24 hours of life. There were 29 participants in this study: 16 preterm newborns and 13 term newborns. The preterm group was dominated by subjects with alkaline skin pH (80%), and the term group was dominated by subjects with acidic skin pH (71%). Positive Staphylococcus spp. colonization was more prevalent in the preterm group (62%) than in the term group (38%). Skin pH differed between preterm and term newborns, with relatively higher skin pH in the preterm group. Staphylococcus spp. was also more prevalent in the preterm group.

Aim: 1) To present the percentiles of oxygen saturation for newborns from Northern Indian set-up and to compare it with the reference range provided. 2) To analyze and compare the progression of oxygen saturation in term and preterm newborns. Background: Even after knowing that preterm newborns may have different physiological requirements, they are being treated as similar entity as term newborns. No separate reference oxygen saturation ranges are available for them. Also little data is available about the percentiles of oxygen saturations for newborns in Indian set-up. Material Methods: This was a Prospective Observational study done over a period of one year at a tertiary care hospital. 500 newborns with gestational age of 28-42 weeks, requiring routine care were enrolled. Oxygen saturation readings were recorded separately for term and preterm newborns till 10 minutes of life. Results: SpO2 values of preterm newborns rises slowly as compared to term newborns. It took a mean time of 7.77±1.45 min (IQR of 6.3-9 minutes) for term newborns and 8.78 ± 0.97 min (IQR of 8.3-9.3 minutes) for preterm newborns to reach ≥ 85% SpO2. The 3rd, 10th, 25th, 50th, 75th, 90th and 97th percentiles of oxygen saturation have been calculated for both term and preterm newborns from birth till 10 minutes of life. Conclusion: Preterm newborns should be treated as separate entity from term newborns to keep them safe from hazards of oxygen toxicity. This study provides the reference percentiles of oxygen saturation for term and preterm newborns from Northern India separately.

Features of cardiovascular autonomic regulation in infants are poorly studied compared with adults. However, the clinical significance of autonomic dysfunction in infants is very high. The goal of our research was to study the temporal and frequency-dependent features, as well as low-frequency synchronization in cardiovascular autonomic regulation in full-term vs. preterm newborns, based on the analysis of their heart rate variability (HRV) and photoplethysmographic waveform variability (PPGV). The study included three groups of newborns: 64 full-term newborns (with a gestational age at birth of 37-40 weeks) with a physiological course of the neonatal adaptation; 23 full-term newborns (with a gestational age at birth of 37-40 weeks) with a pathological course of the neonatal adaptation; and 17 preterm newborns (with a postconceptional age of 34 weeks or more). We conducted spectral analysis of HRV and PPGV, along with an assessment of the synchronization strength between low-frequency oscillations in HRV and in PPGV (synchronization index). We employed several options for the boundaries of the high-frequency (HF) band: 0.15-0.40 Hz, 0.2-2 Hz, 0.15-0.8 Hz, and 0.24-1.04 Hz. Preterm newborns had higher heart rate, RMSSD, and PNN50 values relative to both groups of full-term newborns. Values of SDNN index and synchronization index (S index) were similar in all groups of newborns. Differences in frequency domain indices of HRV between groups of newborns depended on the considered options of HF band boundaries. Values of frequency domain indices of PPGV demonstrated similar differences between groups, regardless of the boundaries of considered options of HF bands and the location of PPG signal recording (forehead or leg). An increase in sympathetic influences on peripheral blood flow and a decrease in respiratory influences were observed along the following gradient: healthy full-term newborns → preterm newborns → full-term newborns with pathology. Differences in frequency domain indices of autonomic regulation between the studied groups of newborns depended on the boundaries of the considered options of the HF band. Frequency domain indices of PPGV revealed significantly more pronounced differences between groups of newborns than analogous HRV indicators. An increase in sympathetic influences on peripheral blood flow and a decrease in respiratory influences were observed along the following gradient: healthy full-term newborns → preterm newborns → full-term newborns with pathology.

The myocardial performance index (MPI) is a noninvasive method to measure global systolic and diastolic myocardial function. In both term and premature neonates, changes in the systolic and diastolic function of the left ventricle (LV) and right ventricle (RV) reflect the degree of neonatal myocardial immaturity and the co-existence of foetal circulation. To assess MPI (or Tei indices) of both ventricles in term and preterm newborns, and to observe MPI trends throughout the neonatal period. Heart ultrasound imaging was performed on the first day of life (DOL), after patent ductus arteriosus (PDA) closure, and on the 28th DOL, in 29 term and 29 preterm newborns. RVMPI and LVMPI were measured within the preterm group at 40 weeks of post-conception age (PCA). A statistically significant reduction in RVMPI was observed in both term and preterm newborns. In term newborns, the RVMPI value on the first DOL was 0.42 ± 14, dropping to 0.29 ± 0.09 after PDA closure, and finally reaching 0.22 ± 0.09 on the 28th DOL. The respective RVMPI values for the preterm newborns were 0.44 ± 0.15, 0.30 ± 0.12, and 0.21 ± 0.08. Little variability in the mean values of LVMPI was observed in both groups throughout the neonatal period. The LVMPI for term neonates in successive measurements was 0.37 ± 0.10, 0.39 ± 0.07, and 0.37 ± 0.11, respectively, and for the preterm neonates it was 0.37 ± 0.10, 0.35 ± 0.09, and 0.36 ± 0.10, respectively. The MPI values from preterm newborns taken at 40 weeks PCA (RVMPI = 0.28 ± 0.09; LVMPI = 0.37 ± 0.05) were comparable to those measured in term newborns after PDA closure. Observed postnatal changes in RVMPI correspond to changes in ventricular function, reflecting the haemodynamic changes of the transitional circulation. The relatively small postnatal changes in LVMPI in term and preterm newborns may reflect an immature myocardium. The RVMPI and LVMPI values at 40 weeks PCA in preterm newborns correlate best with MPI values in term newborns just after PDA closure.

Estradiol (E), testosterone (T), and their ratio are crucial axis in life. Especially during intrauterine growth, they orchestrate the complex development of organs and their interaction, which have lifelong impact on health and an organism’s capacity to respond to environmental stressors. The aim of this study was to compare for the first time E, T, and their ratio levels with aromatase (CYP19) gene methylation levels between preterm newborns (PN) and full-term newborns (FN) with respect to their mother’s environmental exposure and diet. In this study, 56 FN of 37–42 weeks of gestation age (GA) and 46 PN at GA 27–36 weeks were analysed for E and T levels and CYP19A1 gene pI.3/II promoter region methylation. Results showed there was no difference in E levels between PN and FN, but there were significantly lower levels of T in PN than in FN (2.81 nmol vs. 3.76 nmol, respectively) and consequently a significantly higher E/T ratio in PN than in FN (5278.04 vs. 2891.23, respectively). CYP19A1 methylation was significantly lower in PN than in FN (86.04% vs. 90.04%, respectively). CYP19A1 methylation was significantly reduced in newborns whose mothers reported daily milk consumption. Our study is the first to provide referent values for CYP19A1 methylation levels in FN and PN and shows that PN and FN significantly differ in CYP19A1 methylation levels, T levels, and E/T ratio. Future research should further investigate the mechanisms involved in GA-dependent CYP19A1 methylation levels and mechanisms of sex hormone disturbances which may contribute to preterm birth.

Objective To investigate the voiding patterns of term and preterm newborns and whether voiding in term and preterm neonates was accompanied by any cortical arousal. Methods Between May 2013 and September 2013, 64 hospitalized newborns at Neonatal Intensive Cave Unit in the Frist Affiliated Hospital of Zhengzhou University were recruited in this study.In these patients, 31 cases were term newborns (20 male, 11 female) and 33 cases were preterm newborns(19 male, 14 female). The term and preterm newborns gestational ages at birth were(38.2±1.2) weeks and (32.1±1.6) weeks, weighted (3.3±0.4) kg and(1.7±0.3) kg, respectively and postnatal ages at study were[4-16(10.5±3.6)] days and [4-16(11.2±3.1)] days.The voiding volume (VV), post-void residual volumes(PRV), body movement rate and voiding frequency (VF) in 4 hours as well as the volume of milk and liquid fed at the same time frame were recorded and analyzed, retrospectively.At the same time electrocardiogram (ECG) and electroencephalogram (EEG) were recorded.The changes of heart rate (HR), EEG frequency, respiratory frequency (RF) during the 5 s period and 30 s before and after voiding onset were compared respectively.For cortical arousal definition the recommendations of the International Pediatric Work Group on Arousals (2005) were used. Results A total of 184 times of voiding were recorded.In preterm newborns, the VV and body movements rate were significantly lower compared with the term newborns[(21.8±7.9) mL and (41±21)% vs (26.4±8.7) mL and (62±19)%, t=3.75, 4.20, all P<0.05]. However, the VF and PRV were significantly higher in preterm newborns[(1.7±0.9) mL and (3.2±1.1) times vs (1.2±0.7) mL and (2.6±0.9) times, t=2.47, 2.38, all P<0.05]. Bladder voiding in these infants happened only during QS.In term newborns, HR frequency was higher during the 5 s interval before and after voiding onset when compared with the 30 s period before voiding onset[(152±6) times/min and (152±5) times/min vs (147±6) times/min, t=5.30, 5.76, all P<0.05] and the EEG frequency[(2.6±0.1) Hz and (2.6±0.1) Hz vs (1.5±0.1) Hz, t=70.0, 70.0, all P<0.05]. While the HR and EEG frequency of preterm neonate was not changed before and after bladder voiding onset.The RF of both term and preterm neonates were not changed before and after bladder voiding onset. Conclusions The voiding patterns between term and preterm were significantly different and cortical arousal was found only in term neonates, which indicate the term newborns have better mature bladder function and development of nervous system. Key words: Infant, newborn; Voiding; Cortical arousal

In newborns, both term and preterm, cochlear hearing loss is common due to different pathologies. Currently accepted methods for hearing screening in newborns are otoacoustic emission (OAE) and auditory brainstem responses. Among these two, OAE is quicker, economical and more accessible. In the present study we assessed OAEs in sick newborns, both term and preterm, having different pathological conditions. This descriptive study was conducted over 3months in sick newborn care unit (SNCU) in a tertiary care hospital. All sick newborns admitted to SNCU in the study period were tested for otoacoustic emission. The results were subjected to the Chi square test (test of independence). Among 640 sick newborns, 184 were preterm; the rest being term newborns. Among the term sick newborns, 4.8% of those with birth asphyxia, 8.6% of those having septicaemia, 25% of those with hyperbilirubinemia needing exchange transfusion, 22.9% of those having meningitis and 33.3% of those with major congenital anomalies, had "refer" on OAE. Among preterm sick newborns, 30.8% of those with birth asphyxia, 32.5% of those having septicaemia, 75% of those with hyperbilirubinemia needing exchange transfusion, 41.7% of those having meningitis, 40% of those with major congenital anomalies and 8.7% of those with no co-morbidity had "refer" on OAE. Upon computing the p value of Chi square test performed on the results, the results were not significant (p = 0.85). Hence we didn't find any statistically significant difference between term and preterm sick newborns on OAE. The incidence of "refer" result in OAE increases with co-morbidities in both term and preterm sick newborns, somewhat more in preterm newborns. But preterm sick newborns do not seem to have an increased incidence of hearing impairment.

IntroductionJaundice is a clinical condition that is often present in pediatric practice and constitutes one of the major issues within the neonatal period. It occurs in both the physiological and pathological processes in newborns.1 Although most newborns with jaundice are otherwise healthy, they need to be monitored because bilirubin is potentially toxic to the central nervous system.2 The American Academy of Pediatrics (AAP) in 2004 recommended that newborns discharged within 48h should have follow up visits after 2–3days to detect significant jaundice.3 Aim of the workThis study was done to evaluate the predictive value of umbilical cord bilirubin in identifying infants for subsequent hyperbilirubinemia, in full-term (FT) and late pre-term (PT) newborns. Subjects and methodsThis study is a prospective clinical study which was carried out on 94 newborns taken from the delivery room (DR) and neonatal intensive care unit (NICU) of Ismailia General Hospital at Ismailia Governorate. The study population was followed up clinically and by laboratory investigations from birth and daily during the first week of life. ResultsThe study population consisted of 50 males and 44 females with the mean gestational age of 38.70±1.38weeks in FT compared to 35.62±0.64 in late PT. It was shown that 40.4% of PT needed treatment in the form of phototherapy compared to 29.8% of FT, and no one of both groups needed exchange transfusion. The mean total cord bilirubin was higher among males, preterm, cesarean deliveries, and ABO and RH incompatibility positive newborns. It was found that when cord blood in late PT newborns was ⩾1.75mg/dl and ⩾1.85mg/dl in FT newborns, there was a probability that those newborns may need phototherapy and when the levels of total cord bilirubin were ⩾2.05mg/dl in PT newborns and ⩾2.15mg/dl in FT it means that those babies are in actual need of phototherapy. Thus the cut-off points for total cord bilirubin level in PT and FT groups were 2.05 and 2.15mg/dl respectively. ConclusionIt was concluded that total serum bilirubin in cord blood was indicative of the jaundice severity developed by healthy FT and late PT newborns without complications, during the first week of life. RecommendationsCord blood bilirubin could be a useful indicator of developing jaundice in newborns and the use of cut off cord bilirubin levels could be a useful predictor of significant hyperbilirubinemia.

Objective To explore the testis development and epididymis in the preterm and term newborns so as to provide the scientific evidence for early clinical diagnosing early. Methods From October 2016 to March 2018, 456 hospitalized neonates at Department of Neonatology, the First Affiliated Hospital of Zhengzhou University were recruited within 7 days at birth in this study.In these patients, 224 cases were preterm newborns and 232 cases were term newborns.These gestational ages of newborns at birth were (36.18±3.13) weeks (27-41+ 6 weeks) and weighted (2.66±0.67) kg(0.90-3.82 kg). The size of the testis and epididymis were measured by ultrasonography. Results The mean testicular volume of the preterm was (0.24±0.07) mL.The mean length of epididymal head, thickness of epididymal head and body and tail of the preterm newborns were (4.17±0.59) mm, (2.58±0.39) mm, (1.78±0.26) mm, (1.91±0.24) mm, respectively.The mean testicular volume of the term newborns was (0.38±0.13) mL, the mean length of epididymal head, thickness of epididymal head and body and tail of the term newborns were (4.49±0.45) mm, (2.78±0.34) mm, (1.95±0.20) mm, (1.99±0.16) mm, respectively.The mean testi-cular volume, length of epididymal head, thickness of epididymal head and body and tail of the preterm newborns were significantly lower compared with the term newborns (t=12.810, 8.261, 6.819, 8.058, 3.591, all P 0.05). Conclusions The testicular volume, the length of epididymal head, thickness of epididymal head and body increase with gestational age, birth weight and birth length in early neonates.The growth of reproductive system in the preterm newborns at PMA 37 weeks catch-up with term newborns.If this catch-up growth was incomplete at PMA 37 weeks, special attention should be given to monitor underlying diseases. Key words: Infant, newborn; Infant, premature; Infant, preterm; Testicular volume; Epididymis

The immune system of neonates has been considered functionally immature, and due to their high susceptibility to infections, the aim of this study was to analyse the phenotypic differences in leucocyte populations in healthy preterm and full-term newborns. We evaluated the absolute numbers and frequencies of dendritic cells (DCs) and DC subsets, monocytes and T and B lymphocytes and subsets in the cord blood of healthy moderate and very preterm (Group 1), late preterm (Group 2) and full-term (Group 3) newborns and in healthy adults, as controls, by flow cytometry. The analyses revealed statistically higher absolute cell numbers in neonates compared with adults due to the characteristic leucocytosis of neonates. We observed a lower frequency of CD80(+) myeloid and plasmacytoid DCs in Group 1 and reduced expression of TLR-4 on myeloid DCs in all neonates compared with adults. TLR-2(+) monocytes were reduced in Group 1 compared with Groups 2 and 3, and TLR-4(+) monocytes were reduced in Groups 1 and 2 compared with Group 3. The frequencies and numbers of naïve CD4(+) T and CD19(+) B cells were higher in the three groups of neonates compared with adults, while CD4(+) effector and effector memory T cells and CD19(+) memory B cells were elevated in adults compared with neonates, as expected. Our study provides reference values for leucocytes in cord blood from term and preterm newborns, which may facilitate the identification of immunological deficiencies in protection against extracellular pathogens.

BACKGROUND AND OBJECTIVEPulmonary problems are vitally important in newborns. Increased intense and mucoid secretions may lead to atelectasis, pulmonary infections, respiratory distress, prolonged mechanical ventilation or even death. The aim of this study was to evaluate the safety of recombinant human deoxyribonuclease (rhDNase) in the management of persistent atelectasis in term and preterm newborns, unresponsive to the conventional treatment.DESIGN AND SETTINGProspective study of patients admitted to a general community setting of a neonatal intensive care unit between December 2007 and December 2009.PATIENTS AND METHODSThe study included 22 patients (12 premature and 10 term) who were admitted to the neonatal intensive care unit because of respiratory distress and developed atelectasis, and were unresponsive to conventional treatment. Nebulized rhDNase was administered to all patients at a dose of 1 mg/m2 twice daily for 3 days. In patients who did not respond to 3 days of treatment, endotracheal rhDNase was administered at a dose of 1 mg/m2. We assessed the clinical (respiratory rate and oxygen requirement) and radiologic responses (chest radiographic score), recurrence of atelectasis, the need for a repetitive treatment, and mortality rate.RESULTSA clinical and radiologic improvement of atelectasis was observed in 18 of 22 patients following 3 days of nebulized rhDNase treatment. Atelectasis relapsed in 4 patients. Following the administration of combined endotracheal and nebulized rhDNase treatment, an improvement of atelectasis was noted in all four recurrent cases. No adverse events were observed in patients because of the rhDNase treatment.CONCLUSIONSrhDNase treatment is a safe option and may be used as an effective method for the management of persistent atelectasis in newborns, which is resistant to other conventional treatment methods.

Objective: Growth Arrest-Specific 6 (GAS6) is a vitamin K-dependent protein. Despite a similar structure to Protein S, it has no anticoagulant activity. An association between GAS6 and some diseases for adults has been reported. In the absence of prospective clinical studies of GAS6 in neonates, so far, the objective of this study is to obtain, for the first time, plasma GAS6 levels before and after vitamin K1 prophylaxis in full-term and pre-term newborns. Methods: 80 newborns (40 term and 40 preterm) were recruited for this study. Cord blood samples and peripheral blood samples 48 h after vitamin K1 injection were collected into EDTA-tubes. GAS6 levels were measured in platelet-poor plasma by ELISA. Results: Cord blood plasma GAS6 levels in preterm and term newborns were 9.07 ± 5.30 ng/mL and 9.75 ± 4.34 ng/mL, respectively. In response to vitamin K1 injection, GAS6 levels increased in preterm newborns (10.50 ± 5.28 ng/mL) (p < .05), but not in term newborns (9.12 ± 3.42 ng/mL, p > .05). Conclusion: This pilot study provided, to the best of our knowledge, the first report that GAS6 levels increased significantly after vitamin K1 prophylaxis in preterm newborns but not in term infants. This study may serve as a first step toward more extensive studies in neonates.

Neonatal sepsis: Epidemiology and comparison between preterm and term newborns.

The purpose of this study is to assess whether pacifier use is associated with breastfeeding success in term and preterm newborns and whether it influences hospitalization time in preterm newborns. Four databases were searched for randomized controlled trials (RCTs), and a systematic review and meta-analysis were conducted. The risk of bias and evidence quality, according to the GRADE methodology, were analyzed. Risk ratios with 95% confidence intervals (CI) for dichotomous outcomes and mean difference (MD) for continuous outcomes were used. The random effect model was used if heterogeneity was high (I2 over 40%). We screened 772 abstracts, assessed 44 full texts, and included 10 studies, of which 5 focused on term and 5 on preterm newborns. There were a few concerns about the risk of bias in 9 of the 10 studies. Breastfeeding rates were analyzed at 2, 3, 4, and 6 months, and the success rates were similar between the restricted and free pacifier use groups (evidence quality was moderate to high). In preterm neonates, the use of a pacifier shortened the duration of hospitalization by 7 days (MD 7.23, CI 3.98–10.48) and the time from gavage to total oral feeding by more than 3 days (MD 3.21 days, CI 1.19–5.24) (evidence quality was ranked as moderate). Conclusions: Based on our meta-analysis, pacifier use should not be restricted in term newborns, as it is not associated with lower breastfeeding success rates. Furthermore, introducing pacifiers to preterm newborns should be considered, as it seems to shorten the time to discharge as well as the transition time from gavage to total oral feeding.What is Known:• Observational studies show that infants who use a pacifier are weaned from breastfeeding earlier.• Previous randomized studies have not presented such results, and there have been no differences in the successful breastfeeding rates regardless of the use of pacifier.What is New:• Term and preterm newborns do not have worse breastfeeding outcomes if a pacifier is introduced to them, and additionally preterm newborns have shorter hospitalization times.• The decision to offer a pacifier should depend on the caregivers instead of hospital policy or staff recommendation, as there is no evidence to support the prohibition or restriction.

Assessment of bone turnover in term and preterm newborns at birth: measurement of urinary collagen crosslink excretion.