After Birth Research Articles

Assessment of Vitality, Blood Profile, and Degree of Meconium Staining on the Skin in Newborn Dogs According to Its Birth Weight.

Neonatal mortality in dogs reaches up to 40%. Due to the high rates, promptly detecting the causes and preventing newborns from dying are extremely important. Vitality evaluation, blood parameters, and the degree of meconium staining on the skin are valuable resources in canine perinatology. In this study, 435 puppies from 85 bitches close to parturition were recruited and divided into four quartiles according to the puppy's birth weight: Q1 (127-200 g) n = 110 puppies, Q2 (201-269 g) n = 108 puppies, Q3 (270-388 g) n = 108 puppies, and Q4 (389-464 g) n = 109 puppies. This experimental article aimed to report the effect of birth weight on the blood profile variables, the vitality of newborn puppies, and the meconium staining degree, integrating these three aspects. It was concluded that the weight of newborns was correlated with the degree of meconium staining, presenting more cases of severe meconium staining in the puppies of the highest birth weight group. The weight of the newborns was correlated with a higher number of stillbirths and alterations in the blood variables, showing the most severe cases of metabolic acidosis, hypoxia, and hypoglycemia in the puppies of the Q4 quartile. On the contrary, no statistically significant correlations were found between the weight of newborns and vitality. Nevertheless, the analysis of the results showed that the most vigorous puppies were found at Q1; however, at minute 60 after birth (AB), all the puppies in the four quartiles standardized their vitality scores.

Is the Weight of the Newborn Puppy Related to Its Thermal Balance?

Hypothermia, a factor associated with neonatal mortality, can occur immediately after birth as a protective mechanism to prevent hypoxic damage in neonates, or to reduce the metabolic rate to improve the chances of survival in the first hours of life. The heat interchange through the superficial temperature of animals can be evaluated with infrared thermography (IRT). However, to date, there is no information on thermal windows in puppies. This study aimed to evaluate, with the use of IRT, the microcirculatory alterations in 8 different thermal windows identified at 7 different times in 289 newborn puppies assigned to different groups. Three thermograms were taken from four zones of each puppy: the facial, frontal, right lateral, and left lateral regions. Newborn puppies were grouped in 4 quartiles according to their weight: Q1 (126-226 g) n = 73, Q2 (227-330 g) n = 72, Q3 (331-387 g) n = 74, and Q4 (388-452 g) n = 70. A total of 8 thermal windows were considered at 7 evaluation times from Wet at birth until 24 h after birth (AB). Two-way mixed ANOVA within and between subjects' design for each thermal window (eight models) was performed. Results revealed a positive correlation between the puppy's weight and its ability to achieve thermostability in all the evaluated thermal windows. Statistically significant differences (p < 0.0001) between the 4 quartiles (Q1, Q2, Q3, and Q4) were found. The lowest temperatures were recorded when the pups were still wet and the highest at 24 h AB. Thermal windows with the highest temperatures were abdominal (34.234 ± 0.056 °C), thoracic (33.705 ± 0.049 °C), nasal (30.671 ± 0.110 °C), and upper left palpebral (34.066 ± 0.052 °C), while the lowest were thoracic limb brachial biceps (27.534 ± 0.051 °C), thoracic limb elbow (27.141 ± 0.049 °C), thoracic limb metacarpal (27.024 ± 0.062 °C), and femoral pelvic limb (27.654 ± 0.055 °C). Assessing the thermal response in newborn puppies can help identify drastic temperature reductions or deficient thermoregulatory compensation during the first hours of life, preventing the consequences of hypothermia.

Nestling skin-to-skin right after birth saves fragile babies’ lives

Nestling skin-to-skin right after birth saves fragile babies’ lives

Failure of non-invasive continuous positive airway pressure as the initial respiratory support in very preterm infants: a multicenter prospective cohort study

Objective: To analyze the risk factors and the adverse outcomes of failure in non-invasive continuous positive airway pressure (CPAP) as the initial respiratory support in very preterm infants with gestational age at birth <32 weeks. Methods: This multicenter prospective cohort study was conducted from January 1, 2019 to December 31, 2019 based on the data from Shandong Neonatal Network (SNN). Perinatal information, clinical treatment, and the short-term outcomes of very preterm infants with gestational age at birth of 25-31+6 weeks in 30 neonatal intensive care units (NICU) in SNN were collected. The very preterm infants with non-invasive CPAP as the initial respiratory support were divided into the group of non-invasive CPAP failure and the group of non-invasive CPAP success. The difference in the risk factors between the two groups were tested by χ2 test or Fisher exact and the Mann-Whitney U test, followed by Logistic regression analysis for all the risk factors with statistically significant difference. Results: A total of 1 040 very preterm infants were included in this study, including 577 males (55.5%) and 463 females (44.5%). There were 195 cases (18.8%) with gestational age of 25-28+6 weeks, 845 cases (81.2%) with gestational age of 29-31+6 weeks, 81 cases (7.8%) with birth weight<1 000 g and 959 cases (92.2%) with birth weight≥1 000 g. Overall, the rate of CPAP success (n=902, 86.7%) was higher than that of CPAP failure (n=138, 13.3%). The incidence of CPAP failure was 24.6% (48/195) and 10.7% (90/845) respectively for infants with gestational age of 25-28+6 weeks and of 29-31+6 weeks. The Logistic regression analysis showed that smaller gestational age at birth, maternal gestational hypertension disease, and severe respiratory distress syndrome (RDS, grade Ⅲ-Ⅳ) requiring pulmonary surfactant (PS) for more than twice and fraction of inspired oxygen (FiO2)>0.30 after birth were independent risk factors for the failure of initially used non-invasive CPAP (OR=0.718, 1.847, 4.003, 6.712, 1.948; 95%CI:0.590-0.873, 1.130-3.018, 2.435-6.579, 3.160-14.259, 1.189-3.192; all P<0.05). The incidence of adverse outcomes in the group of failure was significantly higher than in the group of success, including death, neonatal pulmonary hemorrhage, moderate or severe broncho pulmonary dysplasia (BPD), and severe intraventricular hemorrhage (IVH) (OR=4.436, 26.393, 1.998, 4.545; 95%CI:2.106-9.344, 9.690-71.885, 1.031-3.875, 1.615-12.795; all P<0.05). Conclusions: The very preterm infants with gestational age at birth<32 weeks have a higher incidence of major adverse outcomes after the failure of initially used non-invasive CPAP. Smaller gestational age at birth, maternal gestational hypertension disease and severe RDS (grade Ⅲ-Ⅳ) requiring PS for more than twice and FiO2>0.30 after birth are independent risk factors for the failure of initially used non-invasive CPAP.

How do NSAIDs compare with placebo or codeine for reducing pain due to uterine cramping/involution after birth?

How do NSAIDs compare with placebo or codeine for reducing pain due to uterine cramping/involution after birth?

Effect of weight growth velocity in the early stage after birth on neurodevelopment of preterm infants at the corrected age of 12 months

OBJECTIVE To study the effect of weight growth velocity in the early stage after birth on the neurodevelopment of preterm infants at the corrected age of 12 months. METHODS Related data were collected from the preterm infants who were discharged from the Department of Neonatology, Third Affiliated Hospital of Guangzhou Medical University, from July 1, 2015 to December 31, 2019 and were followed up at the outpatient service of high-risk infants. According to the weight growth velocity from birth to the corrected gestational age of 40 weeks, the infants were divided into two groups: low velocity [< 10 g/(kg·d); n=21] and high velocity [≥10 g/(kg·d); n=87]. At the corrected ages of 3, 6, and 12 months, Gesell Developmental Schedules were used to evaluate and compare neurodevelopment between the two groups. RESULTS At the corrected age of 12 months, the low velocity group had a significantly lower score of fine motor (P < 0.05) and a significantly higher abnormal rate of language ability score compared with high velocity (P < 0.05). For the preterm infants with a birth weight of < 1 500 g or ≥1 500 g, the low velocity group had a significantly lower score of fine motor than the high velocity group (P < 0.05); for the preterm infants with a birth weight of ≥1 500 g, the low velocity group had a significantly higher abnormal rate of language ability score than the high velocity group (P < 0.05). CONCLUSIONS The weight growth velocity from birth to the corrected age of 40 weeks affects the development of fine motor and language in preterm infants at the corrected age of 12 months; however it needs to be further verified by large-sample studies.

Sudden unexpected postnatal collapse in a neonate

A healthy full-term female neonate, aged 3 days and born by vaginal delivery (with a 1-minute Apgar score of 10 and a 5-minute Apgar score of 10), had unexpected cardiac and respiratory arrests in the early morning on day 3 after birth and recovered to spontaneous breathing and heartbeat after a 10-minute resuscitation. The child had poor response and convulsion after resuscitation. Blood gas analysis showed metabolic acidosis, and amplitude-integrated EEG showed a burst-suppression pattern. She was diagnosed with sudden unexpected postnatal collapse but improved after hypothermia and symptomatic/supportive treatment. This article reports the first case of sudden unexpected postnatal collapse in China and summarizes related risk factors, pathophysiological mechanisms, and preventive and treatment measures of this disorder.

Role and mechanism of histone deacetylases in mouse neuronal development

OBJECTIVE To study the role and mechanism of histone deacetylase 1 (HDAC1) and histone deacetylase 2 (HDAC2) in mouse neuronal development. METHODS The mice with Synapsin1-Cre recombinase were bred with HDAC1&2flox/flox mice to obtain the mice with neuron-specific HDAC1&2 conditional knockout (knockout group), and their littermates without HDAC1&2 knockout were used as the control group. The general status of the mice was observed and survival curves were plotted. Brain tissue samples were collected from the knockout group and the control group. Western blot and immunohistochemistry were used to measure the protein expression of related neuronal and axonal markers, neuronal nuclear antigen (NeuN), non-phosphorylated neurofilament heavy chain (np-NF200), and phosphorylated neurofilament heavy chain (p-NF200), as well as the downstream effector of the mTOR signaling pathway, phosphorylated S6 ribosomal protein (p-S6). RESULTS The mice with HDAC1&2 conditional knockout usually died within one month after birth and were significantly smaller than those in the control group, with motor function abnormalities such as tremor and clasping of hindlimbs. Compared with the control group, the knockout group had significant reductions in the protein expression levels of NeuN, np-NF200, p-NF200, and p-S6 (P < 0.05; n=3). CONCLUSIONS Deletion of HDAC1 and HDAC2 in mouse neurons results in reduced neuronal maturation and axonal dysplasia, which may be associated with the mTOR signaling pathway.

Fetal malnutrition assessment program

Objective To study the application of ponderal index (PI), body mass index (BMI), mid-arm circumference/head circumference (MAC/HC), and Clinical Assessment of Nutritional Status (CANS) score in assessing the nutritional status of neonates at birth, and to find a simple and reliable scheme for the assessment of fetal nutritional status. Methods PI, BMI, MAC/HC, and CANS were used to assess the nutritional status of full-term infants and preterm infants shortly after birth. The assessment results of these methods were analyzed. Results Among the 678 full-term infants, 61, 102, 47, and 131 were diagnosed with malnutrition by PI, BMI, MAC/HC, and CANS respectively. Among the 140 preterm infants, 30, 87, 9, and 112 were diagnosed with malnutrition by PI, BMI, MAC/HC, and CANS respectively. The combination of BMI and CANS had a detection rate of 99.3% in full-term infants and 100% in preterm infants. Compared with the single method, the combination significantly improved the detection rate of malnutrition (P 0.05). Conclusions The combination of BMI+CANS can reduce the rate of missed diagnosis of fetal malnutrition. It is therefore a simple and reliable method for the assessment of fetal malnutrition.

What opioid in pregnancy produces the least risk for NAS after birth?

What opioid in pregnancy produces the least risk for NAS after birth?

Finnish Type Congenital Nephrotic Syndrome With Exon Sequencing Confirmation in Taiwan: A Case Report

Congenital nephrotic syndrome Finnish type (CNF) is a rare and severe kidney disorder starting soon after birth, characterized by premature birth, a small size for gestational age, and an enlarged placenta. Early-onset nephrosis with heavy proteinuria, hyperlipidemia, hypercoagulopathy, and an immunocompromised status often causes poor growth and early mortality if not treated promptly. The current treatment strategy of parenteral albumin supplementation, a hyper-caloric and protein-abundant diet, and medications to prevent and treat complications has improved patient outcomes by making curative renal transplantation possible. This report describes a female newborn diagnosed with CNF incidentally before the onset of symptoms. To the best of our knowledge, she was the first CNF case with a diagnosis confirmed by genetic testing (whole-exon sequencing) in Taiwan.

A comparative study of cerebellar development between appropriate-for-gestational age infants and small-for-gestational-age infants

To investigate whether there is a difference in cerebellar development between appropriate -for-gestational-age (AGA) infants and small-for-gestational-age (SGA) infants. A total of 165 AGA infants and 105 SGA infants, with a gestational age of 26-40+6 weeks, were enrolled in this study. Within 24-48 hours after birth, ultrasound examination was performed to measure the transverse diameter of the cerebellum, the height of the vermis, the area of the vermis, the perimeter of the vermis, and the area and perimeter of the cerebellum on transverse section. A Pearson correlation analysis was used to investigate the correlation between cerebellar measurements and gestational age. In both AGA and SGA infants, all cerebellar measurements were positively correlated with gestational age (r=0.50-0.81, P<0.05). In AGA and SGA infants, there were no significant differences in the measurements between the 25-27+6 weeks, 28-30+6 weeks, and 31-33+6 weeks of gestational age subgroups (P>0.05), while in the 34-36+6 weeks and 37-40+6 weeks subgroups, the SGA infants had significantly lower measurements than the AGA infants (P<0.05). The SGA infants with a gestational age of <34 weeks have intrauterine cerebellar development similar to AGA infants, but those with a gestational age of ≥34 weeks have poorer intrauterine cerebellar development than AGA infants.

A Comparative Study of Maternal and ChildHealth Outcomes of Pregnant Women Livingwith and without Disability in kakamegaCounty, Kenya

Objective: To assess the maternal and child health outcomes of pregnant women living with and without disability in Kakamega County, Kenya. Design: A population-based prospective case control study. Setting: The study was done in 12 Sub County in Kakamega County Sample: The study used a multistage probability sampling design to identify the sub counties that would be case and control groups and purposeful and snow balling sampling technique to identify the pregnant women living with disability who in turn identified an able-bodied pregnant woman that she is accessible to (n=196) Analysis: Data was analyzed through descriptive characteristic in which central tendencies and repeated measures ANOVA. Main outcome measures: Maternal and child outcomes before and after birth Results: Results for maternal outcomes 12 weeks into pregnancy showed that The study found that majority of the able-bodied (91.2%, n=31) and the disabled women (95.1%, n=98) did not have any vaginal bleeding, did not have severe abdominal pains (76.5%, n=26 and 84.5%, n=87), did not have paleness (94.1%, n=32 and 91.3%, n=94), neither severe headache or foul smell (88.2%, n=30 and 83.5%, n=94). The findings also showed that there were no significant differences in maternal outcomes amongst schedules one, two and three (f (1,135) =.256, p=.614, E 2 =0.002).In addition, there were significant differences between the able bodied and WLWD in a linear combination of maternal outcome observations from birth up to six weeks after delivery(Greenhouse-Geisser 1, 133 =.117, p=0.03, E 2 =0.246). There were also significant differences between the able bodied and disabled women in a linear combination of child outcome observations from birth up to six weeks after birth (f (1,133) =7.183, p=.008, E 2 =0.076) Conclusion. The study found out that maternal healthcare services lacked the flexibility and responsiveness to meet the unique maternity care needs of WLWD. The study recommends that further research should target the experience, use of services and needs of women with different and multiple disabilities from diverse groups, using qualitative as well as quantitative methodologies.

Certain prenatal problems and their relationship with neonate's anthropometric indices at birth

Background and Objective: Fetal development is a strong predictor of neonate's survival after birth. Investigation of factors that may affect fetal development is important. The present study aimed to investigate certain prenatal problems and their relationship with neonate's anthropometric indices at birth. Materials and Methods: The present cross-sectional descriptive-analytical study was conducted using records registered in Iran’s Integrated Health System (locally know as SIB), including the records of 616 pregnant mothers who had given birth during 2017-18 in the city of Bushehr (Iran). The registered details of the mothers and infants were reviewed from the first prenatal visit to the first postpartum visit. A checklist was prepared to record the information in their records. The collected data were analyzed in SPSS-19 using appropriate statistical tests at a significance level of p<0.05. Results: The mothers' mean age was 30.84±5.30 years, 3.9% of infants weighed under 2500 g and were therefore in LBW group. The frequency of anemia was 16.25% and 22.5% respectively in the first and second trimesters. Gestational age (β=0.157, P 0.001) and mothers’ body mass Index (BMI) (β=0.241, P>0.001) in the first prenatal visit had a direct and significant relationship with the infant's weight-for-age Z-score. Moreover, GA (β=0.229, P>0.001) and mother's BMI (β=0.242, P>0.001) in the first prenatal visit had a direct and significant relationship with the infant's length-for-age Z-score. The infant's anthropometric indices had no significant relationships with perinatal complications such as anemia, controlled diabetes, and urinary tract infections. Conclusion: Prenatal complications such as anemia were prevalent in the study population, and required particular attention. The mother's BMI can predict fetal development and should be the focus of greater attention in prenatal clinics. Closer monitoring of maternal anthropometry and increasing mother's knowledge in nutrition by the antenatal clinics would be beneficial for both the mother and the neonate.

Life After Birth, by Diane S. Speier

Life After Birth, by Diane S. Speier

Expert consensus on nutritional management of preterm infants with bronchopulmonary dysplasia

Inadequate nutrition supply in the early stage after birth is a risk factor for the development of bronchopulmonary dysplasia (BPD) in preterm infants, and it is also closely associated with the progression and clinical outcome of BPD. Optimized nutritional support is of great importance to reduce the incidence and severity of BPD and promote lung development and neurological prognosis. Based on the relevant studies in China and overseas, the expert consensus on BPD nutrition management is developed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method. The consensus includes the following seven aspects: the importance of nutrition in BPD, fluid intake, energy intake, enteral nutrition, parenteral nutrition, post-discharge nutrition, and nutrition monitoring and evaluation.

Increased incidence of congenital heart disease among patients with myelomeningocele and associated increased mortality and length of stay; a database study

Purpose: Myelomeningocele and congenital heart disease (CHD) are independent risk factors for increased morbidity and mortality in the newborn period and each can require significant operations shortly after birth. Few studies have examined the impact of these combined lesions. We sought to examine the incidence of CHD in patients with myelomeningocele, and to evaluate length of stay (LOS), hospital charges, and mortality. Methods Using the Texas Inpatient Public Use Data File, entries of ∼6.9 million newborns born between January 1999 and …

Cerebral Blood flow responses to Hypoxia in Preterm Lambs

BACKGROUND In response to hypoxia, the fetus redistributes blood flow from the periphery to the brain by increasing blood pressure and perhaps decreasing cerebral vascular resistance. This response, which serves to maintain oxygen delivery to the fetal brain, has not been well studied shortly after birth, when a catecholamine surge …

Variant analysis on steroid 5-reductase type 2 deficiency caused by a novel SRD5A2 mutation

This article reported the clinical characteristics and SRD5A2 gene mutation pattern of a child with steroid 5-α reductase type 2 deficiency. The 2-month-old boy showed hypospadias and short penis shortly after birth. DNA was extracted from the peripheral blood of the child and his parents. The endocrine disease-related genes were captured and sequenced by high-throughput sequencing technology, and the family DNA samples were verified by Sanger sequencing. The results showed that c.680G>A(p.R227Q) and c.608G>A(p.G203D) compound heterozygous mutations existed in the SRD5A2 gene of the child. The c.680G>A mutation inherited from his father, which was a known pathogenic mutation. The c.608G>A mutation originated from his mother, which was a novel mutation discovered in this study. These results provide molecular evidence for the etiological diagnosis of the child and genetic counseling for the family, as well as extend the mutation spectrum of SRD5A2 gene.

A case of aplasia cutis type VI (Bart’s syndrome) at University of Abuja Teaching Hospital Gwagwalada, Abuja, Nigeria

Aplasia cutis type VI, commonly referred to as Bart’s syndrome, is a rare genetic disorder characterized by congenital localized absence of skin commonly in the lower limbs, epidermolysis bullosa, and sometimes dystrophic nails. We present a 2-hour-old male infant who presented with congenital absence of skin over both lower limbs at birth. He developed blisters in keeping with epidermolysis bullosa 24 hours after birth. Examination and investigations revealed no systemic involvement. An assessment of aplasia cutis type VI (Bart’s syndrome) was made. He was managed conservatively and wounds showed progressive re-epithelialization.