Early Neonates Research Articles

Clinical and genetic analysis of a case of late onset carbamoyl phosphate synthase I deficiency caused by CPS1 mutation and literature review

BackgroundCarbamoyl phosphate synthetase I defect (CPS1D) is a rare disease with clinical case reports mainly in early neonates or adults, with few reports of first onset in late neonatal to childhood. We studied the clinical and genotypic characteristics of children with childhood onset CPS1D caused by two loci mutations (one of these is a rarely reported non-frame shift mutation) in the CPS1.Case presentationWe present a rare case of adolescent-onset CPS1D that had been misdiagnosed due to atypical clinical features, and further investigations revealed severe hyperammonemia (287µmol/L; reference range 11.2 ~ 48.2umol/L). MRI of the brain showed diffuse white matter lesions. Blood genetic metabolic screening showed elevated blood alanine (757.06umol/L; reference range 148.8 ~ 739.74umol/L) and decreased blood citrulline (4.26umol/L; reference range 5.45 ~ 36.77umol/L). Urine metabolic screening showed normal whey acids and uracil. Whole-exome sequencing revealed compound heterozygous mutations in the CPS1, a missense mutation (c.1145 C > T) and an unreported de novo non-frame shift mutation (c.4080_c.4091delAGGCATCCTGAT), respectively, which provided a clinical diagnosis.ConclusionA comprehensive description of the clinical and genetic features of this patient, who has a rare age of onset and a relatively atypical clinical presentation, will facilitate the early diagnosis and management of this type of late onset CPS1D and reduce misdiagnosis, thus helping to reduce mortality and improve prognosis. It also provides a preliminary understanding of the relationship between genotype and phenotype, based on a summary of previous studies, which reminds us that it may help to explore the pathogenesis of the disease and contribute to genetic counselling and prenatal diagnosis.

Intestinal and pharyngeal microbiota in early neonates: an analysis based on high-throughput sequencing

To investigate the distribution characteristics and correlation of intestinal and pharyngeal microbiota in early neonates. Full-term healthy neonates who were born in Shanghai Pudong New Area Maternal and Child Health Hospital from September 2021 to January 2022 and were given mixed feeding were enrolled. The 16S rRNA sequencing technique was used to analyze the stool and pharyngeal swab samples collected on the day of birth and days 5-7 after birth, and the composition and function of intestinal and pharyngeal microbiota were analyzed and compared. The diversity analysis showed that the diversity of pharyngeal microbiota was higher than that of intestinal microbiota in early neonates, but the difference was not statistically significant (P>0.05). On the day of birth, the relative abundance of Proteobacteria in the intestine was significantly higher than that in the pharynx (P<0.05). On days 5-7 after birth, the relative abundance of Actinobacteria and Proteobacteria in the intestine was significantly higher than that in the pharynx (P<0.05), and the relative abundance of Firmicutes in the intestine was significantly lower than that in the pharynx (P<0.05). At the genus level, there was no significant difference in the composition of dominant bacteria between the intestine and the pharynx on the day of birth (P>0.05), while on days 5-7 after birth, there were significant differences in the symbiotic bacteria of Streptococcus, Staphylococcus, Rothia, Bifidobacterium, and Escherichia-Shigella between the intestine and the pharynx (P<0.05). The analysis based on the database of Clusters of Orthologous Groups of proteins showed that pharyngeal microbiota was more concentrated on chromatin structure and dynamics and cytoskeleton, while intestinal microbiota was more abundant in RNA processing and modification, energy production and conversion, amino acid transport and metabolism, carbohydrate transport and metabolism, coenzyme transport and metabolism, and others (P<0.05). The Kyoto Encyclopedia of Genes and Genomes analysis showed that compared with pharyngeal microbiota, intestinal microbiota was more predictive of cell motility, cellular processes and signal transduction, endocrine system, excretory system, immune system, metabolic diseases, nervous system, and transcription parameters (P<0.05). The composition and diversity of intestinal and pharyngeal microbiota of neonates are not significantly different at birth. The microbiota of these two ecological niches begin to differentiate and gradually exhibit distinct functions over time.

Sonographic prediction of fetal main pulmonary artery (MPA) Doppler indices of lung maturity and neonatal respiratory distress syndrome (RDS) development

PurposeThe aim of this study is to highlight the predictive role of perinatal fetal main pulmonary artery (MPA) Doppler measurements in neonatal respiratory distress syndrome development. Respiratory distress syndrome (RDS) is one of the lead causes of neonatal respiratory distress as well as neonatal death. Thus, it seems logic to evaluate fetal lung maturity before labour.MethodsThe study is a prospective cohort study performed in tertiary hospital over a period of one-year duration. 70 pregnant ladies between 34 and 38 weeks of gestation were referred for fetal echo, when pregnancy was considered a high risk. A trained radiologist using dedicated ultrasound machine with updated obstetric and fetal echo software performed the fetal echo. Doppler mode and curvilinear probe of 5.7 MHz transducer. Pediatric neonatologist observed the neonatal outcome post-natally.ResultsA total of 70 pregnant patients with risk factors underwent fetal echo, 26/70 (37.1%) were diagnosed with RDS conforming to the neonatal criteria. The mean acceleration time/ejection time ratio (At/Et ratio) of the fetal pulmonary artery was significantly reduced in fetuses that subsequently developed RDS than those without RDS. Contrarily, the mean pulsatility index (PI), resistance index (RI), and peak systolic velocity (PSV) of the fetal pulmonary artery were significantly high in fetuses who later developed RDS than in those who did not.ConclusionFetal MPA Doppler measurements have a major role in anticipating the development of neonatal RDS in preterm and early term neonates.

Timing of elective term deliveries and its association with adverse neonatal outcomes

Background: Pre and early term birth are one of the major causes of neonatal mortality and morbidity as compared to term infants. The risk of neonatal morbidity and mortality decreases with gestational age. Thus, this study aimed to determine the association of neonatal outcomes among early term and full-term elective deliveries. Methods: A prospective cohort study was conducted at the department of obstetrics and gynecology, Aga Khan University Hospital, Pakistan. A total of 390 women, 195 in each study group were selected using a non-probability consecutive sampling. Demographic was presented as simple descriptive statistics giving mean and standard-deviation. Pearson’s chi-square and Fisher-Freeman-Halton exact test were used to compare qualitative data. Risk-ratios (RR) and confidence-intervals (CI) were calculated by using binary logistic regression. STATA V.17 SE software was used for data analysis. Results: A total of 390 participants were recruited, including 195 patients in each group. The high prevalence of low Apgar score 5.6%, low birth weight 5.6% was found among early term when compared with full term. The respiratory distress was also reportedly high in early term neonates with 7.2%. Likewise, the prolonged hospital stays and NICU admissions were also more evident in early term elective deliveries i.e. 8.7% and 5.6%. Conclusions: Early-term births are associated with adverse neonatal outcome of low APGAR score, low birth weight, hospital stay, NICU admission and respiratory distress when compared with neonates born as full term through elective deliveries. Similarly, the risk of prolonged hospital stay and NICU admissions were higher among the early term neonates.

Comparison of the Effects of Bathing and the Dry Technique on the Skin Condition of Early Neonates: A Prospective Observational Study.

In Japan, neonates have typically been bathed in a bathtub immediately after birth because bathing is a custom for cleansing impurities. However, dry technique has been introduced into many institutions since 2000. There is little scientific evidence on the benefit or harmfulness of either method to neonatal skin, and consequently, opinion remains split on which method is superior. The purpose of the present study was to determine whether bathing or the dry technique of cleaning is better in maintaining skin health in the early neonatal period. Transepidermal water loss (TEWL) and skin pH, considered an index of skin barrier function, were measured in each group. Tumor necrosis factor (TNF)-alpha and interleukin (IL)-6, which are inflammatory cytokines released by keratinocytes, were measured by skin blotting. TEWL and skin pH of neonates were lower with the dry technique than with bathing. The expression level of IL-6 and TNF-α in chest skin of neonates was higher with bathing than with the dry technique. These results suggest that the dry technique may maintain skin health better than bathing in the early neonatal period.

Factors influencing neonatal outcomes in twin pregnancies undergoing cesarean section: a cross-sectional study

This study aimed to evaluate maternal and fetal characteristics and factors affecting fetal outcomes in twin pregnancies delivered by cesarean section. This was a cross-sectional study in a tertiary care referral hospital. The primary outcome was to ascertain the effects of independent factors on the 1st and 5th minute APGAR scores, neonatal intensive care unit admissions, the need for mechanical ventilation, and neonatal mortality. A total of 453 pregnant women and 906 newborns were included in the analysis. The final logistic regression model revealed that early gestational weeks and neonates <3rd weight percentile at the time of delivery were the most significant predictors of all poor outcome parameters in at least one of the twins (p<0.05). General anesthesia for cesarean section was associated with 1st minute APGAR<7 and the need for mechanical ventilation, and emergency surgery was correlated with the need for mechanical ventilation (p<0.05) in at least one of the twins. General anesthesia, emergency surgery, early gestational weeks, and birth weight <3rd weight percentile were strongly associated with poor neonatal outcomes in at least one of the twins delivered by cesarean section.

EFFECT OF PAD WARM FOR PREVENTION HYPOTHERMIA IN NEWBORN AT THE HOUSEHOLD LEVEL AT KABUPATEN KARAWANG

Background: The body temperature of newborns is very vulnerable to changes in room temperature, especially during the first day of birth and the neonatal period. Baby care has an important role in ensuring the stability of body temperature during the adaptation period. Prevention of hypothermia in newborns aims to maintain a stable body temperature by avoiding exposure to cold and wind. Most parachute materials contain plastic, the basic ingredients of which are polyester, which have the properties of a waterproof and heat-resistant material, often used as a material for warm jackets in cold climates because of its ability to withstand the wind. Research objective: to determine the effect of a Padwarm or warm sleeping bag in preventing hypothermia in normal newborns. Method: this type of research is Quasy Experiment with the design "One group pre test-post test design" the study sample is 35 normal newborns. The sampling technique is accidental sampling, the analytical test used is the Wilcoxon Signed Rank Test. Results: there is a significant difference between before using Padwarm and after using Padwarm where the average temperature before use was 36.26°C; 95% CI (36.21 -36.31) and the average temperature after use was 36.709°C; 95% CI ( 36.652 -36.765) p value of 0.000. Suggestion: Padwarm warm sleeping bags can be an alternative choice for baby sleeping bags in early neonates.

PM2.5-related neonatal encephalopathy due to birth asphyxia and trauma: a global burden study from 1990 to 2019.

Long-term exposure to fine particulate matter (PM2.5) may increase the risk of neonatal encephalopathy due to birth asphyxia and trauma. However, little is known about the trends of PM2.5-related neonatal encephalopathy burden under different levels of social and economic development. We studied the burden of PM2.5-related neonatal encephalopathy due to birth asphyxia and trauma measured by the age-standardized mortality rate (ASMR) and the age-standardized disability-adjusted life years rate (ASDR), and its trends with the socio-demographic index (SDI) in 192 countries and regions from 1990 to 2019. This is a retrospective study using the Global Burden of Disease Study 2019 (GBD2019) database. The age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life years rate (ASDR) are used to measure the burden of PM2.5-related neonatal encephalopathy in different countries and regions. The mortality rate (per 100 thousand) is used to evaluate the differences of PM2.5-related neonatal encephalopathy burden in sex and age. The annual percentage changes (APCs) and the average annual percentage changes (AAPCs) are used to reflect the trends of PM2.5-related neonatal encephalopathy burden over years (1990-2019) and are calculated using a Joinpoint model. The relationship of the socio-demographic index with the ASMR and ASDR is calculated using Gaussian process regression. In summary, the global burden of PM2.5-related neonatal encephalopathy increased since 1990, especially in boys, early neonates, and regions with low-middle SDI. Globally, the ASMR and ASDR of PM2.5-related neonatal encephalopathy burden in 2019 were 0.59 (95% CI: 0.40, 0.83) per 100,000 people and 52.59 (95% CI: 35.33, 73.67) per 100,000 people, respectively. From 1990 to 2019, the ASMR and ASDR of PM2.5-related neonatal encephalopathy increased by 44.39% and 44.19%, respectively. The global average annual percentage changes of ASMR and ASDR were 1.3 (95% CI: 1.0, 1.6). The relationship between the socio-demographic index and the burden of PM2.5-related neonatal encephalopathy presented negative correlation when the socio-demographic index was more than 0.60. Middle, high-middle, and high SDI regions had decreasing trends of PM2.5-related neonatal encephalopathy, of which the AAPCs for both ASMR and ASDR ranged from - 0.3 to - 3.1. Besides improving the progress in national policy and the coverage rate of maternal and neonatal health care and facility-based delivery, air pollution control may also be a better way for countries with large and increasing amounts of exposure to PM2.5 pollution to reduce neonatal encephalopathy. And our results also suggest that low and low-middle SDI countries should appropriately pay more attention to early newborns and boys.

Coronary conductance in the normal development of sheep during the perinatal period.

Birth is associated with substantial shifts in cardiovascular physiology. Little is known about coronary vascular adaptations during this period. We used fetal and neonatal lambs to measure coronary function at late gestation (92% of term) and shortly after birth (5-6 days postnatal age). In each animal we measured unanesthetized myocardial perfusion and oxygen delivery using a circumflex artery flow probe. We used inflatable occluders and adenosine to determine coronary conductance and flow reserve. In a subset of animals, we used myocardial contrast echocardiography (MCE, anesthetized) to assess its utility as a tool for studying changes in regional myocardial perfusion in normal development. Separate age-matched animals were instrumented with aortic and coronary sinus sampling catheters to determine myocardial oxygen extraction (unanesthetized). With an average of 17 days of developmental time separating our neonatal and fetal cohorts we found that heart-to-body weight ratio was significantly greater in neonates than fetuses. In resting animals, we found significant decreases in weight-normalized perfusion of, and oxygen delivery to, neonatal relative to fetal myocardium. Similar results were seen when measuring baseline MCE-derived perfusion. Pressure-flow relationship studies revealed lower baseline and maximal coronary conductance in neonates than fetuses, with similar coronary flow reserve between groups. There was greater oxygen extraction in neonates than fetuses. Combined analysis of oxygen extraction with coronary flow suggested greater oxygen consumption by the fetal than neonatal myocardium. We conclude that, during the immediate perinatal period, cardiac growth outpaces coronary microvascular growth resulting in lower capacity for microvascular perfusion in the early neonate.

Changes in microvascular perfusion of heart and skeletal muscle in sheep around the time of birth.

What is the central question of this study? How does the microvascular perfusion of striated muscle change during the dynamic developmental period between the late gestation fetus and early neonate? What is the main finding and its importance? In both myocardium and skeletal muscle, perfusion of striated muscle is significantly reduced in the neonate compared to the late term fetus, but flow reserve is unchanged. The results suggest striated muscle capillary networks grow more slowly relative to the myofibres they nourish during the perinatal period. Microvascular perfusion of striated muscle is an important determinant of health throughout life. Birth is a transition with profound effects on the growth and function of striated muscle, but the regulation of microvascular perfusion around this transition is poorly understood. We used contrast-enhanced ultrasound perfusion imaging (CEUS) to study the perfusion of left ventricular myocardium and hindlimb biceps femoris, which are populations of muscle with different degrees of change in pre- to postnatal workloads and different capacities for postnatal proliferative growth. We studied separate groups of lambs in late gestation (135days' gestational age; 92% of term) and shortly after birth (5days' postnatal age). We used CEUS to quantify baseline perfusion, perfusion during hyperaemia induced by adenosine infusion (myocardium) or electrically stimulated unloaded exercise (skeletal muscle), flow reserve and oxygen delivery. We found heart-to-body weight ratio was greater in neonates than fetuses. Microvascular volume and overall perfusion were lower in neonates than fetuses in both muscle groups at baseline and with hyperaemia. Flux rate differed with muscle group, with myocardial flux being faster in neonates than fetuses, but skeletal muscle flux being slower. Oxygen delivery to skeletal muscle at baseline was lower in neonates than fetuses, but was not significantly different in myocardium. Flow reserve was not different between ages. Given the significant somatic growth, and the transition from hyperplastic to hypertrophic myocyte growth occurring in the perinatal period, we postulate that the primary driver of lower neonatal striated muscle perfusion is faster growth of myofibres than their associated capillary networks.

Determinant Analysis of Early Neonatal Mortality at the Datu Beru Takengon General Hospital, Central Aceh Regency, in 2022

Background: Attention to efforts to reduce neonatal mortality is important because neonatal mortality contributes to 74% of under-five deaths in Aceh. Of all neonatal mortality, 81% occurred in the 0-6 day age group (early neonates). This study aims to determine the analysis of the determinants of early neonatal mortality at the Datu Beru Takengon General Hospital, Central Aceh Regency.&#x0D; Methods: The research design is an observational case-control approach. 84 case subjects and 84 control subjects were included in this study. Univariate, bivariate, and multivariate data analysis was performed to determine the determinants of early neonatal mortality, p&lt;0.05.&#x0D; Results: Asphyxia increases the risk of premature neonatal mortality by 6.8 times. Low birth weight infants increase the risk of early neonatal by 8.4 times. Prematurity increases the risk of early neonatal mortality by 7.1 times. A parity of more than 3 times increases the risk of early neonatal mortality by 8.9 times, and maternal gestational age of fewer than 20 years increases the occurrence of early neonatal mortality by 14.2 times.&#x0D; Conclusion: Asphyxia, low birth weight, prematurity, parity with risk, and a young mother's gestational age are risk factors that contribute to early neonatal mortality.

Prevalence and Pattern of Congenital Malformations among Neonates in the Neonatal Unit of a Tertiary Care Hospital

Background and Aim: Globally, congenital anomalies (CA) are a major contributing factor for neonate’s admission in NICU causing neonatal morbidity and mortality particularly in developing countries. Congenital anomalies generally indicate the morphogenesis defect in an early neonate’s life. The leading cause for perinatal mortality is congenital anomalies that arise with advancement of delivery and care for newborn babies. The present study aimed to evaluate the prevalence and pattern of congenital anomalies among neonates admitted to neonatal unit. Methodology: This retrospective study was carried out on 1620 neonates (newborns to age 28 days) admitted to the neonatal unit of Services Hospital, Lahore from April 2020 to March 2022. The incidence, risk factors, and pattern of congenital anomalies were measured. Detailed examinations such as radiological, laboratory, ultrasonography, and echocardiography were recorded. Different outcomes such as hospital stay, morbidity, and mortality were determined with 95% confidence intervals. SPSS version 25 was used for data analysis. Results: Of the total 1620 admitted neonates, the prevalence of neonates with congenital anomalies were 112 (6.9%). Out of 112 neonates diagnosed with congenital anomalies, 64 (57.1%) were male and 48 (42.9%) were females. The incidence of cesarean and other modes of delivery were 74 (66%) and 38 (34%) respectively. Cardiovascular system malformation was the most prevalent affected system in 36 (31.9%) neonates followed by central nerve system 28 (25%), genitourinary system 19 (17%), musculoskeletal system 16 (14.3%), gastrointestinal tract 6 (5.4%), digestive system 4 (3.6%), and syndromes and skin 3 (2.7%). Congenital anomalies were significantly increasing over time. The incidence of discharged, referred to higher centers for intervention, and expired babies were 77 (68.8%), 19 (16.7%), and 16 (14.3%) respectively. Conclusion: The present study found that the prevalence of congenital anomalies was 6.9%. Cardiovascular system malformation was the most prevalent congenital anomaly followed by the central nerve system. The overall mortality rate was 14.3% caused by congenital anomalies. A better health care strategies and management must be developed in terms of early detection, supplementation facilitation, decreasing drug usage, and better antenatal care to prevent the impacts of congenital anomalies on neonates. Keywords: Prevalence, Pattern, Congenital anomalies, neonates

Prevalence and Risk Factors of Apnea in Preterm Neonates Admitted to the French Medical Institute for Mothers and Children Hospital in Kabul City: An Analytic Cross-Sectional Study

Introduction: Prematurity is one of the leading causes of neonatal death in Afghanistan and complicates many serious problems including apnea. Although recurrent and prolong apnea of prematurity (AOP) may be directly or indirectly associated with significant adverse outcomes, there isn’t enough scientific information regarding the prevalence and risk factors of this problem in Afghanistan, therefore, this study is performed to obtain such information. Objective: To determine the prevalence rate and risk factors for apnea of prematurity in neonates admitted to the Neonatal Intensive Care Unit of the French Medical Institute for Mothers and Children Hospital, Kabul City. Patients and Methods: This analytic cross-sectional study was conducted at the Neonatal Intensive Care Unit of the French Medical Institute for Mothers and Children Hospital in Kabul City, Afghanistan. The study participants were preterm neonates. Statistical analysis was performed by SPSS 24. Results: 75 preterm newborns were enrolled in this study and the apnea of prematurity were developed in 48% of them. Extremely low birth weight preterm neonates had a 71.4% prevalence rate of such apnea, while in very low birth weight and low birth weight the rates were 47.4% and 36.4% respectively. Based on gestational age, the prevalence rates of apnea in the early and moderate preterm neonates were 55.6% and 52.8% respectively, whilst also in late preterm neonates it was 42.8%. The apnea of prematurity appeared more prevalent in boys (54.3%) than girls (45.7%). The preterm neonates in the apnea group versus the non-apnea group had the mean birth weight of (1233.33 ± 235.25g vs 1333.46 ± 274.44g, 90%CI= -198 _ -1.4), mean maternal age of (24.78 ± 3.68y vs 26.62 ± 4.58y, 90%CI= -3.44_-0.23) and RR of anemia (2.2, P=0.05). Conclusion: The overall prevalence rate of AOP in preterm neonates was 48% and the highest rates were seen within extremely low birth weight and early preterm neonates. The lower neonatal birth weight, neonatal anemia and younger maternal age were found to be the risk factors for apnea of prematurity.

Time to death and its predictors among early neonatal patients in neonatal intensive care unit of Dessie referral hospital, South Wollo Zone, Northeast Ethiopia

Background: Early neonatal death is a serious concern, both in the developing and developed worlds. Early neonatal death remains a health problem and is the biggest component of the neonatal mortality rate. Therefore, substantial reduction in early neonatal mortality is a crucial pre-requisite for achieving further gains in child survival in the country. However, the distribution of deaths in the community within the first week is poorly understood. Therefore, this study was conducted to assess time to death and its predictors among early neonates in the neonatal intensive care unit of Dessie Referral Hospital. Method: A retrospective cohort study was conducted in the early neonatal patient in Dessie referral hospital on the total sample size of 416 selected patients by using a simple random sampling technique. Data were collected by document review. Life table used to estimate the probability of survival, log-rank test to compare survival in two or more groups and the Cox proportional hazard model was used to determine factors associated with time to death of early neonate. The hazard ratio with 95% confidence level was used to declare statistical significant association. Result: A total of 416 early neonates were included in the study. There were 224(53.8%) male neonates. The overall early neonatal mortalities were 47(11.3%), of which 23.41% of them died on the first day of age. early neonatal mortality was associated with neonatal sepsis (AHR=3.349,95% CI,1.842-6.089), low birth weight of neonates (AHR=3.563%,95% CI,1.925-6.595), unable to breastfeeding during delivery (AHR=4.094,95% CI,1.603-10.452), neonatal respiratory distress (AHR=4.018,95% CI,1.733-9.371), perinatal asphyxia (AHR =2.540,95% CI,1.186-5.847). Conclusion: The causes of early neonatal death described in this study were preventable. Managing low birth weight, initiating exclusive breastfeeding, refining quality of service, and confirming the continuity of care are recommended to increase the survival of neonates.

The Association between the Burden of PM2.5-Related Neonatal Preterm Birth and Socio-Demographic Index from 1990 to 2019: A Global Burden Study.

Background: Preterm birth (PTB) leads to short-term and long-term adverse effects on newborns. Exposure to fine particulate matter (PM2.5) was positively related to PTB. However, the global annual average PM2.5 was three times than the recommended value in 1998–2014. Socio-demographic index (SDI) is a new indicator that comprehensively reflects the overall development level of a country, partly because of “the epidemiological transition”. Among other countries with higher and similar SDI levels, policy makers have the opportunity to learn from their successful experiences and avoid their mistakes by identifying whether their burdens of disease are higher or lower than the expected. However, it is unclear about the trends of the burden of PM2.5-related preterm birth in different countries and different levels of SDI regions. Additionally, the relationship between the SDI and the burden in 1990–2019 is also unclear. Methods: This was a retrospective study based on the Global Burden of Disease Study 2019 (GBD2019) database from 1990 to 2019. The burden of PM2.5-related PTB was measured by the age-standardized mortality rate (ASMR), age-standardized disability-adjusted life years rate (ASDR), mortality rate, and the disability-adjusted life years (DALYs). The annual percentage changes (APCs) and the average annual percentage changes (AAPCs) were used to reflect the trends over the past 30 years, which were calculated using a joinpoint model. The relationships between the ASMR, ASDR, and SDI were calculated using a Gaussian process regression. Findings: In 2019, the entire burden of PM2.5-related PTB was relatively high, where the ASMR and the ASDR were 0.76 and 67.71, increasing by 7.04% and 7.12%, respectively. It mainly concentrated on early neonates, boys, and on low-middle SDI regions. The increase in the burden of PM2.5-related PTB in low and low-middle SDI regions is slightly higher than the decrease in other SDI regions. In 2019, the burden varied greatly among different levels of SDI regions where ASMRs varied from 0.13 in high SDI regions to 1.19 in low-middle regions. The relationship between the expected value of the burden of PM2.5-related PTB and SDI presented an inverted U-shape, and it reached the maximum when SDI is around 0.50. The burdens in four regions (South Asia, North Africa and the Middle East, western sub-Saharan Africa, and southern sub-Saharan Africa) were much higher than the mean value. Boys bore more burden that girls. The sex ratio (boys:girls) of the burden showed a dramatically increasing trend in low SDI regions and a decreasing trend in middle SDI regions and high-middle SDI regions. These differences reflect the huge inequality among regions, countries, ages, and sex in the burden of PM2.5-related PTB. Conclusion: The overall burden of PM2.5-related PTB in 2019 was relatively high, mainly concentrated on early neonates, boys, and on low-middle SDI regions. It showed an increasing trend in low-middle and low SDI regions. The association between the burden and the SDI presented an inverted U-shape. It is very necessary to promulgate policies to prevent and control air pollution in countries with large and increasing exposure to PM2.5 pollution because it does not need action at an individual level. Focusing on public educational interventions, public and professional policies, and improving accessibility of prenatal care are other feasible ways for low and low-middle SDI countries. Policy makers should also appropriately allocate medical resources to boys and early newborns.

Prolonged Myocardial Regenerative Capacity in Neonatal Opossum.

Early neonates of both large and small mammals are able to regenerate the myocardium through cardiomyocyte proliferation for only a short period after birth. This myocardial regenerative capacity declines in parallel with withdrawal of cardiomyocytes from the cell cycle in the first few postnatal days. No mammalian species examined to date has been found capable of a meaningful regenerative response to myocardial injury later than 1 week after birth. We examined cardiomyocyte proliferation in neonates of the marsupial opossum (Monodelphis domestica) by immunostaining at various times after birth. The regenerative capacity of the postnatal opossum myocardium was assessed after either apex resection or induction of myocardial infarction at postnatal day 14 or 29, whereas that of the postnatal mouse myocardium was assessed after myocardial infarction at postnatal day 7. Bioinformatics data analysis, immunofluorescence staining, and pharmacological and genetic intervention were applied to determine the role of AMPK (5'-AMP-activated protein kinase) signaling in regulation of the mammalian cardiomyocyte cell cycle. Opossum neonates were found to manifest cardiomyocyte proliferation for at least 2 weeks after birth at a frequency similar to that apparent in early neonatal mice. Moreover, the opossum heart at postnatal day 14 showed substantial regenerative capacity both after apex resection and after myocardial infarction injury, whereas this capacity had diminished by postnatal day 29. Transcriptomic and immunofluorescence analyses indicated that AMPK signaling is activated in postnatal cardiomyocytes of both opossum and mouse. Pharmacological or genetic inhibition of AMPK signaling was sufficient to extend the postnatal window of cardiomyocyte proliferation in both mouse and opossum neonates as well as of cardiac regeneration in neonatal mice. The marsupial opossum maintains cardiomyocyte proliferation and a capacity for myocardial regeneration for at least 2 weeks after birth. As far as we are aware, this is the longest postnatal duration of such a capacity among mammals examined to date. AMPK signaling was implicated as an evolutionarily conserved regulator of mammalian postnatal cardiomyocyte proliferation.

Prematurity and Congenital Heart Disease: A Contemporary Review.

Congenital heart disease (CHD) is the most commonly reported birth defect in newborns. Neonates with CHD are more likely to be born prematurely, and a higher proportion of preterm neonates have CHD than their term counterparts. The implications of preterm birth on the cardiac and noncardiac organ systems are vast and require special management considerations. The feasibility of surgical interventions in preterm neonates is frequently limited by patient size and delicacy of immature cardiac tissues. Thus, special care must be taken when considering the appropriate timing and type of cardiac intervention. Despite improvements in neonatal cardiac surgical outcomes, preterm and early term gestational ages and low birthweight remain important risk factors for in-hospital mortality. Understanding the risks of early delivery of neonates with prenatally diagnosed CHD may help guide perioperative management in neonates who are born preterm. In this review, we will describe the risks and benefits of early delivery, postnatal cardiac and noncardiac evaluation and management, surgical considerations, overall outcomes, and future directions regarding optimization of perinatal evaluation and management of fetuses and preterm and early term neonates with CHD.

A Comparative Study of Neonatal Outcome in Early-Term Neonates versus Full-Term Neonates in a Tertiary Care Hospital in North India

Background: Neonatal morbidity due to physiologic immaturity has been extensively studied in preterm infants delivered in less than 37 weeks gestation. However, evidence indicates that the infants delivered between 37+0 and 38+6 weeks gestation are also at increased risk for morbidity compared with the infants delivered at 39+0 to 40+6 weeks. Methodology: The present hospital-based prospective observational study was conducted among 150 neonates [75 babies each of early term (37+0 to 38+6 weeks) and full term (39+0 to 40+6 weeks)], born to consenting mothers in a tertiary care referral and teaching hospital, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly. Apart from maternal demographic and obstetric factors, features of the newborn - APGAR score at 1 &amp; 5 minutes, admission to NICU, and other morbidity indicators such as respiratory distress, hyperbilirubinemia, neonatal sepsis, and prolonged hospital stay (&gt;7 days), etc were recorded and compared. SPSS v21.0 was used for statistical analysis. Results: The mean age of mothers was 25.27+3.93 years (age range 19-40 years). Early term deliveries were common among older age groups, and full term among younger ones. Full term neonates had a higher APGAR 1-minute score than early term (p = 0.049), but this difference was not significant at 5-minute score (p &gt; 0.05). NICU admission, respiratory distress and jaundice were more common among early term as compared to full term neonates (*p &lt; 0.05). Conclusion: Early term neonates have a significantly higher morbidity and distress as compared to full term neonates. Studies are recommended to develop strategies to reduce early delivery of high-risk pregnancies.

Glucagon, cyclic AMP, and hepatic glucose mobilization: A half‐century of uncertainty

For at least 50 years, the prevailing view has been that the adenylate cyclase (AC)/cyclic AMP (cAMP)/protein kinase A pathway is the predominant signal mediating the hepatic glucose‐mobilizing actions of glucagon. A wealth of evidence, however, supports the alternative, that the operative signal most of the time is the phospholipase C (PLC)/inositol‐phosphate (IP3)/calcium/calmodulin pathway. The evidence can be summarized as follows: (1) The consensus threshold glucagon concentration for activating AC ex vivo is 100 pM, but the statistical hepatic portal plasma glucagon concentration range, measured by RIA, is between 28 and 60 pM; (2) Within that physiological concentration range, glucagon stimulates the PLC/IP3 pathway and robustly increases glucose output without affecting the AC/cAMP pathway; (3) Activation of a latent, amplified AC/cAMP pathway at concentrations below 60 pM is very unlikely; and (4) Activation of the PLC/IP3 pathway at physiological concentrations produces intracellular effects that are similar to those produced by activation of the AC/cAMP pathway at concentrations above 100 pM, including elevated intracellular calcium and altered activities and expressions of key enzymes involved in glycogenolysis, gluconeogenesis, and glycogen synthesis. Under metabolically stressful conditions, as in the early neonate or exercising adult, plasma glucagon concentrations often exceed 100 pM, recruiting the AC/cAMP pathway and enhancing the activation of PLC/IP3 pathway to boost glucose output, adaptively meeting the elevated systemic glucose demand. Whether the AC/cAMP pathway is consistently activated in starvation or diabetes is not clear. Because the importance of glucagon in the pathogenesis of diabetes is becoming increasingly evident, it is even more urgent now to resolve lingering uncertainties and definitively establish glucagon’s true mechanism of glycemia regulation in health and disease.

MP11-13 SHORT AND LONG TERM RENAL OUTCOMES IN CLINICALLY MATCHED COHORTS OF NEWBORNS WITH PUV MANAGED BY PRIMARY VESICOSTOMY VERSUS PRIMARY VALVE ABLATION

You have accessJournal of UrologyCME1 May 2022MP11-13 SHORT AND LONG TERM RENAL OUTCOMES IN CLINICALLY MATCHED COHORTS OF NEWBORNS WITH PUV MANAGED BY PRIMARY VESICOSTOMY VERSUS PRIMARY VALVE ABLATION Nora Haney, Shwetha Mudalegundi, Angelica Griggs-Demmin, Tamir Sholklapper, Edwin Smith, and Charlotte Wu Nora HaneyNora Haney More articles by this author , Shwetha MudalegundiShwetha Mudalegundi More articles by this author , Angelica Griggs-DemminAngelica Griggs-Demmin More articles by this author , Tamir SholklapperTamir Sholklapper More articles by this author , Edwin SmithEdwin Smith More articles by this author , and Charlotte WuCharlotte Wu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002533.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Some controversy exists regarding whether primary valve ablation (PVA) or primary vesicostomy (PVES) provides superior drainage in neonates with posterior urethral valves. We previously demonstrated progressive urethral dilation (PUD) as a means to achieve PVA in low birth weight and early gestational age neonates, who otherwise disproportionately require PVES. Management with PUD has provided a novel opportunity for comparative analysis of primary intervention on outcomes between similar cohorts with fewer clinical confounders. In this multi-institutional study, our objectives were to determine the short and long term renal outcomes in clinically matched cohorts of neonates with PVES versus PVA. METHODS: This is a retrospective study. Institution A performs PUD to achieve PVA in all neonates. Institution B performs PVES when PVA is unfeasible. Patients were matched primarily by creatinine at intervention and then by clinical features of gestational age, age at ablation, and weight at ablation. We excluded children who had intervention beyond 9 months of age or with incomplete creatinine data. We included all patients who met criteria over 25 years of follow up. RESULTS: 24 patients (12 PVES, 12 PVA) were included with mean follow up 98.8 (+/- 15.9) months. Clinical demographics were matched similarly between groups (Table 1). Creatinine nadir within 6 weeks and 1 year of intervention was not statistically significantly different between groups at 1.4 and 1.2 mg/dL respectively for PVES and 1.3 and 0.9 mg/dL respectively for PVA. A time to event analysis with Mantel-Cox Log Rank was performed and did not show a statistically significant difference in the long-term distribution of ESRD outcomes over time, p = 0.819). CONCLUSIONS: In these clinically matched cohorts comparing PVA to PVES, there was no statistically significant difference in renal outcomes in the short term as determined by creatinine nadir within 6 weeks and 1 year of primary intervention. Long-term results similarly show no statistically significant difference in ESRD outcomes. Although these are preliminary findings based on a small sample, this is the first study of this kind to provide insight into the effect of primary intervention on renal outcomes while reducing critical biases of inherently heterogeneous cohorts. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e161 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nora Haney More articles by this author Shwetha Mudalegundi More articles by this author Angelica Griggs-Demmin More articles by this author Tamir Sholklapper More articles by this author Edwin Smith More articles by this author Charlotte Wu More articles by this author Expand All Advertisement PDF DownloadLoading ...