Neonatal Blood Samples Research Articles

Therapeutic Drug Monitoring of caffeine in preterm neonates

BackgroundThe methylxanthine caffeine reduces the frequency of apnoea in prematurity and the need for mechanical ventilation. The pharmacokinetics of caffeine in preterm infants shows inter- and intraindividual variability. Therefore therapeutic...

Early urinary aldosterone excretion in very low birth weight infants

HYPOTHESIS/ INTRODUCTION: In the neonatal period, many factors may interfere with aldosterone production but data currently available are few and controversial. In this study we aim to assess the early urinary aldosterone excretion (UAE) in very low birth weight (VLBW) infants and to identify some possible clinical and biochemical variables that may influence this excretion. We conducted a prospective study in 30 VLBW infants. Aldosterone was measured in the first 72 hours of life in the urine and plasma and urinary electrolytes were determined. Demographic and clinical data were also recorded. The exploratory analysis showed that a significant positive correlation exists between UAE and gestational age and birth weight and that infants with respiratory distress syndrome have higher urinary aldosterone levels than infants without respiratory distress, but only plasma sodium resulted a significant independent factor that negatively influenced UAE at linear regression analysis (coefficient -0.02, 95% confidence interval [-0.03; -0.004]; adjusted R(2) 0.33). The renin-angiotensin-aldosterone system of VLBW infants seems to be able, even immediately after birth, to respond to variations of plasma sodium concentrations; measurement of UAE constitutes an interesting method to determine aldosterone production, avoiding blood sampling in neonates so small and frail as VLBW infants.

KI, WU, and Merkel Cell Polyomavirus DNA was not Detected in Guthrie Cards of Children who Later Developed Acute Lymphoblastic Leukemia

Neonatal dried blood spots (Guthrie cards) have been used to demonstrate a prenatal origin of clonal leukemia-specific genetic aberrations in several subgroups of childhood acute lymphoblastic leukemia (ALL). One hypothesis suggests that an infectious agent could initiate genetic transformation already in utero. In search for a possible viral agent, Guthrie cards were analyzed for the presence of 3 newly discovered polyomavirus Karolinska Institutet polymavirus (KIPyV), Washington University polyomavirus (WUPyV), and Merkel cell polyomavirus (MCPyV). Guthrie cards from 50 children who later developed ALL and 100 matched controls were collected and analyzed by standard or real-time polymerase chain reaction for the presence of the VP1 region of KIPyV, WUPyV, and MCPyV, and the LT region for MCPyV. DNA from KIPyV, WUPyV, and MCPyV was not detected in neonatal blood samples from children with ALL or controls. Prenatal infections with these viruses are not likely to be etiological drivers for childhood leukemogenesis.

Co-ordinate expression of Th1/Th2 phenotypes in maternal and fetal blood: evidence for a transplacental nexus

If maternal atopy and environmental exposure affect prenatal Th cell development, the maternal and fetal immune systems should display common Th1/Th2 phenotypes. To test this hypothesis, we studied maternal and neonatal blood samples from mothers with total serum IgE <300 IU/mL. Basal levels of IFN-γ, IL-4, and eotaxin in paired maternal and fetal sera were tightly correlated. Polyclonal T cell activation in vitro by Staphylococcal exotoxin B induced co-ordinate IFN-γ production from paired maternal and fetal mononuclear cells, accompanied by co-ordinate increases in activated CD4+CD69+ cells that display the CCR4+Th2 and CXCR3+ Th1 phenotypes. Maternal and fetal CD4+CXCR3+ T cells were subsequently identified as the major producers of IFN-γ. The data established that a transplacental nexus exists during normal pregnancy and that fetal Th cell responses may be biased by the maternal immune system.

Candidate Genes and Risk for CP: A Population-Based Study

Studies suggest that genetic polymorphisms may increase an individual's susceptibility to CP. Most findings have yet to be corroborated in an independent cohort. This case-control study is nested within all 334,333 infants ≥36 wk gestation born at Kaiser Permanente Medical Care Program, 1991-2002. We included only non-Hispanic whites who had a neonatal blood sample available. Case patients (n = 138) were identified from medical records to have spastic or dyskinetic CP. Controls (n = 165) were randomly selected from the population. We genotyped polymorphisms previously associated with CP: inducible NOS (iNOS)-231, apolipoprotein E (apoE) ε2 and ε4 alleles, TNF-α-308, IL-8 -251, lymphotoxin 60, endothelial NOS -922, endothelial protein C receptor 219, mannose-binding lectin 54 and 52, factor V Leiden, methyltetrahydrofolate reductase 1298 and 667, prothrombin 20210, and platelet activator inhibitor 11053. Similar to previous reports, the iNOS-231 T allele (25.7 versus 18.9%, p = 0.04) and the apoE ε4 allele (19.3 versus 13.2%, p = 0.04) were more common in patients with CP than in controls. However, there was no statistically significant association between any genetic polymorphism and CP after correction for multiple comparisons.

Venepuncture versus heel lance for blood sampling in term neonates

Heel lance has been the conventional method of blood sampling in neonates for screening tests. Neonates undergoing heel lance experience pain which cannot be completely alleviated. To determine whether venepuncture or heel lance is less painful and more effective for blood sampling in term neonates. Randomized or quasi-randomised controlled trials comparing pain response to venepuncture versus heel lance were identified by searching the Cochrane Central Regsiter of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE, EMBASE, CINAHL, and clinical trials registries in May 2011. Trials comparing pain response to venepuncture versus heel lance with or with out the use of a sweet tasting solution as a co-intervention in term neonates. Outcomes included pain response to venepuncture versus heel lance with or without the use of a sweet tasting solution using validated pain measures, the need of repeat sampling and cry characteristics. Analyses included typical relative risk (RR), risk difference (RD), number needed to treat (NNT), weighted mean difference (WMD) and standardized mean difference (SMD) with their 95% confidence intervals (CI). Between study heterogeneity was reported including the I squared (I(2)) test. Six studies (n = 478) of variable quality were included. A composite outcome of Infant Pain Scale (NIPS), Neonatal Facial Action Coding System (NFCS) and/or Premature Infant Pain Profile (PIPP) score was reported in 288 infants, who did not receive a sweet tasting solution. Meta-analysis showed a significant reduction in the venepuncture versus the heel lance group (SMD -0.76, 95% CI -1.00 to -0.52; I(2) = 0%). When a sweet tasting solution was provided the SMD remained significant favouring the venepuncture group (SMD - 0.38, 95% CI -0.69 to -0.07). The typical RD for requiring more than one skin puncture for venepuncture versus heel lance (reported in 4 studies; n = 254) was -0.34 (95% CI -0.43 to -0.25; I(2) = 97%). The NNT to avoid one repeat skin puncture was 3 (95% CI 2 to 4). Cry characteristics favoured the venepuncture group but the differences were reduced by the provision of sweet tasting solutions prior to either procedure. Venepuncture, when performed by a skilled phlebotomist, appears to be the method of choice for blood sampling in term neonates. The use of a sweet tasting solution further reduces the pain.Further well designed randomised controlled trials should be conducted in settings where several individuals perform the procedures.

Fabrication and characterisation of an artificial vascularised human skin

"Fabrication and characterisation of an artificial vascularised human skin." Computer Methods in Biomechanics and Biomedical Engineering, 14(sup1), pp. 253–254Keywords: skin mechanicsartificial skinmicrofabricationYoung's modulus Acknowledgements This work is supported by the French Health Ministry through a Hospital Protocol for Clinical Research. The authors would also like to acknowledge the help of Jean Marie Sainthillier and the staff of the society Skinexigence (Besançon, France). Tensile tests were performed within the Applied Mechanics Department (FEMTO-ST) by Vincent Placet and Emmanuelle Jacquet.

Evaluation of the nucleated red blood cell count in neonates using the Beckman Coulter UniCel DxH 800 analyzer

Nucleated red blood cell (NRBC) count is closely associated with the prognosis of neonates. The analysis of NRBC has traditionally been measured manually. Recently, a newly developed automated hematology analyzer, the UniCel DxH 800 (DxH 800), was released. The goal of our study was to evaluate the performance of the DxH 800 NRBC method in neonates with the reference manual method and against previous generation hematology analyzers. NRBCs were counted in 162 neonatal blood samples using the DxH 800, LH 750, and ADVIA 2120 vs. the reference manual technique. The concordance rate, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were obtained. The DxH 800 showed an R(2) value of 0.945 and the concordance rate of 93.8%. Further assessment revealed 85.3% sensitivity, 96.1% specificity, 85.3% PPV, and 96.1% NPV, resulting in the highest area under the curve (0.961). The LH 750 and ADIVA 2120 demonstrated R(2) values of 0.851 and 0.529, respectively. The results obtained indicate the UniCel DxH 800 to be an excellent test on neonatal blood and superior to the other analyzers. Therefore, the DxH 800 is an effective and highly sensitive system for the analysis of NRBCs on newborns.

Blood Protein Concentrations in the First Two Postnatal Weeks That Predict Bronchopulmonary Dysplasia Among Infants Born Before the 28th Week of Gestation

Lung inflammation contributes to the pathogenesis of bronchopulmonary dysplasia (BPD) and may be accompanied by a systematic inflammatory response. The objective of this study was to investigate the role of systemic inflammation in the development of BPD in a cohort of extremely low GA newborns (ELGANs) by examining the relationships between inflammation-associated proteins in neonatal blood samples and pulmonary outcomes. Proteins were measured in blood specimens collected on postnatal d 1-3, 5-8, and 12-15 from 932 ELGANs. Increased risk of BPD was associated with elevated blood concentrations of a variety of proinflammatory cytokines, adhesion molecules, and proteases. Reduced risk was prominently associated with increased concentrations of one chemokine, RANTES. Elevations of inflammatory proteins associated with BPD risk occurred during the first days after birth and inflammation intensified thereafter. Therefore, exposures that promote inflammation after the first postnatal days may be more critical in the pathogenesis of BPD. Fetal growth restriction, a known BPD risk factor, was not accompanied by proteins elevations and therefore does not seem to be mediated by systemic inflammation. By contrast, mechanical ventilation altered protein levels and may be associated with systemic inflammation

Serum procalcitonin as a diagnostic marker for neonatal sepsis: a systematic review and meta-analysis

To assess the value of serum procalcitonin (PCT) for the differentiation between patients with and without neonatal sepsis. We systematically searched PubMed, Scopus, and the Cochrane Library for studies evaluating PCT in neonatal sepsis. PCT had to be measured in neonatal blood samples, at the initial presentation of patients with suspected sepsis, before the administration of antibiotics. We performed a bivariate meta-analysis of sensitivity and specificity, and constructed a hierarchical summary receiver-operating characteristic (HSROC) curve. Overall, 29 studies eligible for inclusion were identified. We analyzed the 16 studies (involving 1,959 neonates) that evaluated PCT in neonates with culture-proven or clinically diagnosed sepsis in comparison with ill neonates with other conditions. The pooled (95% confidence interval) sensitivity and specificity were 81% (74-87%) and 79% (69-87%), respectively. The area under the HSROC curve (AUC) was 0.87. The diagnostic accuracy of PCT seemed higher for neonates with late-onset sepsis (>72h of life) than for those with early onset sepsis; the AUC for these analyses was 0.95 and 0.78, respectively. However, fewer data were available for late-onset sepsis. High statistical heterogeneity was observed for all analyses. Our findings suggest that serum PCT at presentation has very good diagnostic accuracy (AUC=0.87) for the diagnosis of neonatal sepsis. However, in view of the marked observed statistical heterogeneity, along with the lack of a uniform definition for neonatal sepsis, the interpretation of these findings should be done with appropriate caution.

Hyperglycemia and Adverse Pregnancy Outcome Study: Neonatal Glycemia

The goal was to describe the temporal pattern of neonatal plasma glucose levels and associations with maternal glucose levels, cord serum C-peptide levels, and neonatal size and adiposity. A total of 17,094 mothers and infants were included in the Hyperglycemia and Adverse Pregnancy Outcome Study (15 centers in 9 countries). Mothers underwent a 75-g, 2-hour, oral glucose tolerance test (OGTT) at 24 to 32 weeks of gestation. Cord blood and neonatal blood samples were collected. Biochemical neonatal hypoglycemia was defined as glucose levels of <10th percentile (2.2 mmol/L). Clinically identified hypoglycemia was ascertained through medical record review and associations were assessed. Plasma glucose concentrations were stable during the first 5 hours after birth. Maternal glucose levels were weakly positively associated with biochemical neonatal hypoglycemia (odds ratios: 1.07-1.14 for 1-SD higher OGTT glucose levels). Frequency of neonatal hypoglycemia was higher with higher cord C-peptide levels (odds ratio: 11.6 for highest versus lowest C-peptide category). Larger and/or fatter infants were more likely to have hypoglycemia (P < .001), and infants with hypoglycemia tended to have a higher frequency of cord C-peptide levels of >90th percentile. Mean neonatal plasma glucose concentrations varied little in the first 5 hours after birth, which suggests normal postnatal adjustment. Biochemical and clinical hypoglycemia were weakly related to maternal OGTT glucose measurements but were strongly associated with elevated cord serum C-peptide levels. Larger and/or fatter infants were more likely to develop hypoglycemia and hyperinsulinemia. These relationships suggest physiologic relationships between maternal glycemia and fetal insulin production.

Developmental Vitamin D Deficiency and Risk of Schizophrenia: A 10-Year Update

There is an urgent need to generate and test candidate risk factors that may explain gradients in the incidence of schizophrenia. Based on clues from epidemiology, we proposed that developmental vitamin D deficiency may contribute to the risk of developing schizophrenia. This hypothesis may explain diverse epidemiological findings including season of birth, the latitude gradients in incidence and prevalence, the increased risk in dark-skinned migrants to certain countries, and the urban-rural gradient. Animal experiments demonstrate that transient prenatal hypovitaminosis D is associated with persisting changes in brain structure and function, including convergent evidence of altered dopaminergic function. A recent case-control study based on neonatal blood samples identified a significant association between neonatal vitamin D status and risk of schizophrenia. This article provides a concise summary of the epidemiological and animal experimental research that has explored this hypothesis.

Point-of-care determination of neonatal bilirubin with the blood gas analyzer RapidLab 1265

The aim of the study was to evaluate the comparability of the new neonatal bilirubin method on the RapidLab 1265 blood gas analyzer. This point-of-care testing (POCT) device has the option for the determination of neonatal bilirubin, making it potentially valuable for use in neonate intensive care units or in outpatient ambulances. We paired 240 patient samples for intermethod comparisons between the new POCT method and the routine laboratory method (Vitros 350 chemistry system with BuBc slide). In parallel, a transcutaneous jaundice meter (JM-103) was applied to the newborns. Low birthweight and premature neonates were excluded from the trial. The turn-around-time (TAT) for the POCT method was also compared with the routine method, and the practicality of the new analyzer was evaluated for clinical purposes. Bilirubin measurements using the RapidLab 1265 are suitable for the application in newborns. For imprecision, coefficients of variation between 5.6% and 23% were found. The correlation between the Vitros 350 (x) and RapidLab 1265 (y) was y=1.0x-0.1 (r=0.91), with a mean bias of +0.1 mg/dL and a 95% limit of agreement of ±2.5 mg/dL. As in all POCT methods, the TAT was significantly lower than that of the core laboratory. In contrast to the JM-103, the results of the RapidLab 1265 correlated closely with the Vitros 350, although occasional results of both methods were more different than expected. In general, the RapidLab 1265 blood gas analyzer provides clinically useful bilirubin results using neonatal whole blood samples, although imprecision data are higher than for the laboratory method. The POCT device is suitable for neonatal intensive care units after thoroughly training the employees that will use the device.

New evidence for the fetal insulin hypothesis: fetal angiotensinogen M235T polymorphism is associated with birth weight and elevated fetal total glycated hemoglobin at birth

Low birth weight is associated with an increased risk of cardiovascular events in later life. Insulin resistance is a key finding in adult patients with cardiovascular diseases. The neonatal phenotype of an individual with insulin resistance might be low birth weight, as insulin influences fetal growth. The renin-angiotensin-aldosterone system has been associated with cardiovascular disease and insulin resistance. We analyzed whether fetal polymorphisms of the angiotensinogen (AGT) and angiotensin-converting enzyme genes influence birth weight and/or fetal total glycated hemoglobin (fTGH), a surrogate parameter of fetal insulin resistance at birth. In 1132 white women delivering singletons, neonatal umbilical blood samples and clinical data of the mothers and newborns were obtained. Newborns were genotyped with respect to the AGT M235T and angiotensin-converting enzyme insertion/deletion polymorphism. The AGT M235T TT polymorphism is associated with reduced birth weight (TT: 3288 g versus TM + MM: 3435 g, P < 0.05). Furthermore, newborns with a high percentage of fTGH (>6.5%) are more likely to have the TT genotype than those with normal fTGH (<or=6.5%, P < 0.05). With higher cutoffs for fTGH, the significance increases to P less than 0.005. No association was seen between these parameters and the fetal angiotensin-converting enzyme insertion/deletion phenotype. The fetal AGT M235T polymorphism is associated with low birth weight and elevated fetal fTGH at birth. Previous findings show that elevated fetal fTGH correlates with low birth weight and that higher activity of the renin-angiotensin-aldosterone system is an independent risk factor for the development of diabetes mellitus and coronary artery disease. Therefore, our data are supportive of the fetal insulin hypothesis.

Development and validation of a dried blood spot–HPLC assay for the determination of metronidazole in neonatal whole blood samples

A selective and sensitive high-performance liquid chromatography method with UV detection for the determination of metronidazole in dried blood spots (DBS) has been developed and validated. DBS samples [spiked or patient samples] were prepared by applying blood (30 microL) to Guthrie cards. Discs (6 mm diameter) were punched from the cards and extracted using water containing the internal standard, tinidazole. The extracted sample was chromatographed without further treatment using a reversed phase system involving a Symmetry(R) C18 (5 microm, 3.9 x 150 mm) preceded by a Symmetry(R) guard column of matching chemistry and a detection wavelength of 317 nm. The mobile phase comprised acetonitrile/0.01 M phosphate solution (KH(2)PO(4)), pH 4.7, 15:85, v/v, with a flow rate of 1 mL/min. The calibration was linear over the range 2.5-50 mg/mL. The limits of detection and quantification were 0.6 and 1.8 microg/mL, respectively. The method has been applied to the determination of 203 DBS samples from neonatal patients for a phamacokinetic/pharmacodynamic study.

Recombinant Chromosome 4 with Partial 4p Deletion and 4q Duplication Inherited from Paternal Pericentric Inversion

Pericentric inversion of chromosome 4 can give rise to 2 alternate recombinant (rec) chromosomesby duplication or deletion of 4p. The deletion of distal 4p manifests as Wolf-Hirschhorn syndrome (WHS). Here, we report the molecular cytogenetic findings and clinical manifestations observed in an infant with 46,XX,rec(4)dup(4q)inv(4)(p16q31.3)pat. The infant was delivered by Cesarean section at the 33rd week of gestation because pleural effusion and polyhydramnios were detected on ultrasonography. At birth, the infant showed no malformation or dysfunction, except for a preauricular skin tag. Array comparative genomic hybridization analysis of neonatal peripheral blood samples showed a gain of 38 Mb on 4q31.3-qter and a loss of 3 Mb on 4p16.3, and these results were consistent with WHS. At the last follow-up at 8 months of age (corrected age, 6 months), the infant had not achieved complete head control.

Quinpristin-Dalfopristin resistance among methicillin-resistant strains of staphylococci

I have read the case report “Emergence of Pristinamycin resistance in India” by Keshari et al[1] The authors have reported two cases of neonatal septicemia, caused by Methicillin-resistant Staphylococcus aureus (MRSA), showing primary in vitro pristinamycin resistance. We would like to share our observations with the readership of the IJP. Methicillin resistant Staphylococcus aureus has become an important nosocomial pathogen. Glycopeptides have been the drugs of choice for treating MRSA infections. However, with the emergence of intermediate susceptibility to glycopeptides, other treatment alternatives, such as, quinpristin–dalfopristin and linezolid have become important. Quinpristin–dalfopristin is a combination of streptogramin B and A compounds with a synergistic activity against most gram-positive bacteria.[2] Quinpristin-dalfopristin is approved in the United States for treatment of infections caused by vancomycin-resistant strains of E. faecium and skin infections caused by MRSA and Streptococcus pyogenes. In Europe, it is also being used in the treatment of nosocomial pneumonia and other infections caused by MRSA. We have isolated a total of 63 Staphylococci from blood cultures in the last six months. The blood cultures were processed by the automated and computerized blood culture system (BACTEC BD). The blood culture medium used was trypticase soya broth. Positive blood samples were subcultured and their growth was identified by standard biochemical reactions. Antibiotic sensitivity was conducted with the help of the API-BioMerieux machine. This instrument used a computer-assisted analysis of growth in plastic cards to calculate the minimum inhibition concentration (MIC). The ATB STAPH strip was designed following the National Committee for Clinical Laboratory Standards (NCCLS) / Clinical and Laboratory Standards Institute (CLSI) recommendations.[3–5] Out of 38 Staphylococcus aureus isolated from the blood samples, 17 were MRSA. Three MRSA were found to be resistant to vancomycin (MIC > 16 mg/l), teicoplanin, and to quinpristin-dalfopristin (MIC > 2 mg/l). Out of the 17 MRSA, 14 showed sensitivity to vancomycin and quinpristin-dalfopristin. A total of 25 Coagulase negative staphylococci (CONS) were isolated from the blood samples. Out of nine methicillin-resistant CONS, four were detected to be vancomycin, teicoplanin, and quinpristin–dalfopristin resistant. All these seven vancomycin, quinpristin-dalfopristin-resistant staphylococci were isolated from the blood samples of neonates and pediatric patients. Out of these 63 isolates of staphylococci, 61 were found to be sensitive to minocycline. One interesting observation was that all the seven resistant isolates were sensitive to minocyclin [Table 1]. Table 1 Antibiotic resistance pattern of Staphylococci isolated from clinical samples Although vancomycin and quinpristine–dalfopristin have been recommended as alternative treatments for MRSA, Staphylococci resistant to qinpristin–dalfopristin have been reported. Deep et al. studied the drug resistance of Staphylococci in north India.[6] They isolated 54% MRSA and 64% quinpristin–dalfopristin resistant Staphylococcus aureus from pus and urine samples. Four quinpristin–dalfopristin resistant CONS were also reported. Our findings are similar to your report. Quinpristin–dalfopristin is not used routinely in our hospital for treatment. Infections by gram-positive cocci are becoming more difficult to treat, because of the rapid emergence of antibiotic resistance. Many MRSA and MRCONS are found to be sensitive to quinpristin–dalfopristin. We also agree that more comprehensive region-wise laboratory work is needed, before advocating this drug for multidrug–resistant, gram-positive infections.

404: Tandem mass spectrometry for characterization of amniotic fluid

To describe the Tandem Mass Spectrometry (TMS) pattern of amniotic fluid collected from normal pregnancies and those with non-immune hydrops (NIH) and severe symmetric growth restriction (ssIUGR), for the intent of detecting inborn errors of metabolism (IEM) Newborn screening utilizing TMS is available for over 50 inherited metabolic disorders. Presently, such screening is done in the immediate newborn period and has become common practice. Given that such diseases impinge upon fetal growth and development, we believe this test has the potential to be utilized in the fetal period for prenatal diagnosis of IEM. This marks the first attempt at describing the TMS pattern of AF from normal pregnancies, as well as those at risk for IEM, including NIH and ssIUGR fetuses. AF from study patients undergoing amniocenteses for other indications were sent for TMS analysis. These samples were then compared with corresponding maternal and neonatal blood samples that underwent the same TMS analysis. Results from this cohort were compared against samples obtained from a control group (normal appearing fetuses undergoing routine genetic amniocentesis) analyzed by TMS. 48 total patients were enrolled: 16 with NIH, 11 with ssIUGR, 21 patients without apparent risk factors. There were no cases of IEM. In all study patients, the overall TMS profile was characterized as “normal.” However, individual variations within the specific markers tested are noted as well as gestational age variations and will be fully described in the presentation. This study is the first to characterize normal AF TMS patterns derived from patients at low and higher risk for IEM. Since TMS has the potential to serve as a way to identify fetuses affected with IEM, it is important to characterize normal AF patterns first and this has been accomplished in this study. We seek to further refine the characteristic AF profiles of affected fetuses and are considering a larger patient population for study.

Spectroscopic Noninvasive Measurement of Hemoglobin Compared with Capillary and Venous Values in Neonates

Background: Venepuncture-related blood loss is a common cause of neonatal anemia. Currently, this is the only way to obtain hemoglobin levels. This causes distress for the infant but can also lead to the need for blood transfusions. Recently, a new technique for measuring hemoglobin levels non-invasively has been developed to reduce iatrogenic blood loss and pain. Objective: To compare hemoglobin levels obtained using a transcutaneous spectroscopic device (Mediscan 2000, MBR Optical Systems, Wuppertal, Germany) with venous or capillary blood samples in neonates. Methods: Single-center prospective cohort study of term and preterm infants. The white light spectroscopic device was placed on the forearm for 60 s to measure hemoglobin content within 4 h of venous or capillary blood sampling. Pain reactions of the infants were assessed by using a neonatal pain assessment tool. Results were analyzed by Bland-Altman comparison and Wilcoxon signed-rank test. Results: 80 infants (mean gestational age 29.8 ± 3.8 weeks, mean birth weight 1,300 ± 690 g) were enrolled into the study. A total of 313 spectroscopic recordings within 2 h of a clinically indicated blood sample (181 capillary, 142 venous) were taken. The correlation coefficient R² was 0.96 for capillary/spectroscopic and 0.99 for venous/spectroscopic pairs. Pain scores were significantly less for the spectroscopic measurements (p < 0.01). Conclusion: The results show good correlation between the hemoglobin blood levels and spectroscopic measurements. The slightly lower correlation coefficient for the capillary samples demonstrates a naturally higher variance in these values due to the laboratory method.

Confirmation of the validity of using birth MCV for the diagnosis of alpha thalassemia trait

Thirty-four blood samples of neonates in Dubai, UAE, with an MCV below 90 fL were checked by high performance liquid chromatography (HPLC) for hemoglobin variants to confirm a previous study carried out in Western Province of Saudi Arabia which showed a very high predictive index of such MCV for alpha (α-) thalassemia minor (ATM). MCH below 30 pg was an additional factor which supported such a prediction. The Dubai study confirmed the original finding with 100% of such neonates showing Hb Barts band. A control group of 26 neonates with an MCV between 90 and 95 fl showed Hb Barts in only 11 cases (42.3%). Of these, 6 (23.1%) were preterm babies, expected to have higher MCV. Five cases (19.2%) had an MCH below 30 pg, though MCV was 90 or higher. Three of the preterm babies also had MCH below 30. The study confirmed the Saudi results in neonates. It seems very highly probable that a term neonate with MCV below 90 and MCH below 30 has ATM.