Early Recognition Of Infants Research Articles

Cerebral palsy in children: A clinical practice review

Cerebral palsy is a disorder characterized by abnormal tone, posture, and movement. In clinical practice, it is often useful to approach cerebral palsy based on the predominant motor system findings – spastic hemiplegia, spastic diplegia, spastic quadriplegia, extrapyramidal or dyskinetic, and ataxic. The prevalence of cerebral palsy is between 1.5 and 3 per 1,000 live births with higher percentage of cases in low to middle income countries and geographic regions. Pre-term birth and low birthweight are recognized as the most frequent risk factors for cerebral palsy; other risk factors include hypoxic-ischemic encephalopathy, maternal infections, and multiple gestation. In most cases of cerebral palsy, the initial injury to the brain occurs during early fetal brain development. Intracerebral hemorrhage and periventricular leukomalacia are the main pathologic findings found in preterm infants who develop spastic cerebral palsy. The diagnosis of cerebral palsy is primarily based on clinical findings. Early recognition of infants at risk for cerebral palsy as well as those with cerebral palsy is possible based on a combination of clinical history, use of standardized neuromotor assessment and findings on magnetic resonance imaging; however, in clinical practice, cerebral palsy is more reliably diagnosed by 2 years of age. Magnetic resonance imaging scan is indicated to delineate the extent of brain lesions and to identify congenital brain malformations. Genetic testing and tests for inborn errors of metabolism are indicated to identify specific disorders, especially treatable disorders. Because cerebral palsy is associated with multiple associated and secondary medical conditions, its management requires a sustained and consistent collaboration among multiple disciplines and specialties. With appropriate support, most children with cerebral palsy grow up to be adults with good functional abilities.

Respiratory Severity Score during the First 3 Hours of Life as a Predictor for Failure of Noninvasive Respiratory Support and Need for Late Rescue Surfactant Administration.

Preterm infants often develop failure of noninvasive respiratory support. These infants miss the advantages of early rescue surfactant therapy. In this study, we evaluate the utility of respiratory severity score (RSS) during the first 3 hours of life (HOL) as a predictor for failure of noninvasive respiratory support. We conducted a post hoc analysis of infants between 23 and 40 weeks' gestational age who received usual care in the AERO-02 clinical trial. Univariate and multivariable logistic regression analysis were used to assess whether the RSS summary measures were associated with the odds of surfactant administration. Study involved 146 infants. Sixty-four infants (45%) received surfactant within the first 72 hours. Administration of surfactant was associated with the mean RSS (p < 0.01) and the linear trend (p < 0.01). We demonstrated that RSS during the first 3 HOL can predict failure of noninvasive respiratory support and need for late rescue surfactant administration. Optimal RSS cutoffs for early rescue surfactant therapy need to be determined in large cohort studies. · Early recognition of infants at risk of failure of noninvasive ventilation is important to prevent complications.. · It is desirable to identify patients who would benefit from early rescue surfactant treatment.. · RSS in first 3 hours can be used as a predictor of failure of noninvasive respiratory support..

Predictive factors for surgical treatment in preterm neonates with necrotizing enterocolitis: a multicenter case-control study

Necrotizing enterocolitis (NEC) is one of the most common and lethal gastrointestinal diseases in preterm infants. Early recognition of infants in need for surgical intervention might enable early intervention. In this multicenter case-control study, performed in nine neonatal intensive care units, preterm born infants (< 30 weeks of gestation) diagnosed with NEC (stage ≥ IIA) between October 2014 and August 2017 were divided into two groups: (1) medical (conservative treatment) and (2) surgical NEC (sNEC). Perinatal, clinical, and laboratory parameters were collected daily up to clinical onset of NEC. Univariate and multivariate logistic regression analyses were applied to identify potential predictors for sNEC. In total, 73 preterm infants with NEC (41 surgical and 32 medical NEC) were included. A low gestational age (p value, adjusted odds ratio [95%CI]; 0.001, 0.91 [0.86–0.96]), no maternal corticosteroid administration (0.025, 0.19 [0.04–0.82]), early onset of NEC (0.003, 0.85 [0.77–0.95]), low serum bicarbonate (0.009, 0.85 [0.76–0.96]), and a hemodynamically significant patent ductus arteriosus for which ibuprofen was administered (0.003, 7.60 [2.03–28.47]) were identified as independent risk factors for sNEC.Conclusions: Our findings may support the clinician to identify infants with increased risk for sNEC, which may facilitate early decisive management and consequently could result in improved prognosis.What is Known:• In 27–52% of the infants with NEC, a surgical intervention is indicated during its disease course.• Absolute indication for surgical intervention is bowel perforation, whereas fixed bowel loop or clinical deterioration highly suggestive of bowel perforation or necrosi, is a relative indication.What is New:• Lower gestational age, early clinical onset, and no maternal corticosteroids administration are predictors for surgical NEC.• Low serum bicarbonate in the 3 days prior clinical onset and patent ductus arteriosus for which ibuprofen was administered predict surgical NEC.

A 10-year retrospective study of neonatal lupus erythematous in China.

Neonatal lupus erythematosus (NLE) is not a common disease. The death rate of complete congenital heart block (CCHB), which is the most severe clinical manifestation, is as high as 20% to 30%, so early recognition of infants at risk is important. To investigate the clinical features and long-term prognosis of NLE. Twenty-five cases with NLE were reviewed. The clinical manifestations of patients and their mothers were summarized and analyzed. Autoantibodies were detected, and long-term follow-up was carried out. There were 25 patients (male:female ratio of 11:14). CCHB was detected in only 3 of the 25 patients (12%). Cutaneous neonatal lupus erythematosus (CNLE) was seen in 22 of the 25 patients (88%). Eight babies were treated with intravenous immunoglobulin (IVIG), five of whom had a prolonged PR interval that reverted to normal sinus rhythm. During the follow-up of the patients, we found only two patients with CCHB without a pacemaker, who both exhibited growth delay. One patient with CCHB without a pacemaker died. Children with NLE have an excellent outcome when only skin lesions are present. Even the hepatic, hematological and neurological abnormalities are transient, with generally good outcomes. IVIG might have some effectiveness due to enhanced anti-inflammatory activity to treat early diseases that may be reversible (e.g. prolonged PR interval). The long-term prognosis for patients with NLE is still under investigation, and some infants with NLE may progress to other autoimmune diseases later in childhood.

Serum Enzymes in Predicting the Severity of Meconium Aspiration Syndrome in Newborn

Purpose: Meconium aspiration syndrome (MAS), often progresses to respiratory failure and its’ serious com­ plication, persistent pulmonary hypertension of the newborn (PPHN) is a major cause of neonatal mortality. Early recognition of infants at the risk for respiratory failure in MAS patients is necessary for treatment. So we aimed to identify serum enzymes such as lactate dehydrogenase (LDH), aspartate transaminase (AST), and alanine transaminase (ALT) as serum biologic marker for early detection of respiratory failure in MAS patients. Methods: Infants admitted within 24 hours after birth to Neonatal Intensive Care Unit of Dongguk University Ilsan Hospital and diagnosed with MAS from August 2005 to March 2014 were analyzed retrospectively. Serum enzymes were measured on admission. Results: Of the total 60 patients diagnosed with MAS, 28 were in the positive pressure ventilation (PPV) group and 32 were in the non­PPV group. Six patients progressed to PPHN. Only serum LDH was significantly higher in the PPV group than the non­PPV group (median 1,123 vs. 831, P=0.01). Using the ROC curves, the cut­off value of 964 U/L for LDH offered the best predictive value for PPV requirement (sensitivity 61% and specificity 81%). Serum LDH was significantly higher in MAS with PPHN group than MAS without PPHN group (median 1,791 vs. 904, P=0.013). But serum AST, ALT were not predicting factor for the requirement of respiratory support and development of PPHN among MAS patients. Conclusion: LDH might be a good predicting factor for the requirement of respiratory support and develop­ ment of PPHN among MAS patients.

Blood lactate level and meconium aspiration syndrome.

Approximately 5% of infants born with a meconium-stained amniotic fluid (MSAF) develop meconium aspiration syndrome (MAS). Early recognition of infants at highest risk for the development of MAS and the prediction of disease severity are important for optimizing the clinical strategies for prevention and treatment. The aim of the present study was to identify the risk factors for MAS and to investigate the effect of blood lactate level on the development of MAS. Between January 2011 and January 2012, data were recorded with regard to gender, mode of delivery, gestational week, birth weight, 5-min Apgar score, and need for resuscitation of the meconium-stained depressed infants who underwent tracheal aspiration. Moreover, the number of cases developing MAS, blood pH value, and lactate level in capillary blood gases obtained during the first hour after delivery, duration of oxygen supplementation, the number of cases receiving mechanical ventilation and surfactant therapy, duration of hospital stay, and outcomes of the infants were recorded. The number of live births during the study period was 17,202, and of them, 1,341 (7.8%) infants were born through MSAF. Of 195 infants who were meconium-stained depressed, 90 were girls and 105 were boys. Their mean gestational week was 39.37 ± 0.89 weeks and mean birth weight was 3,426 ± 634 g. Eighty-four of them were born through cesarean section (C/S), and 111 were born via normal spontaneous labor. For 40 infants, Apgar score at fifth minute was less than 6. In total, resuscitation was performed on 43 (22.9%) infants. Of the infants, 141 did not develop MAS and 54 developed MAS. While there were no significant differences between infants with and without MAS with regard to gender, delivery route, gestational week, and birth weight, a significant difference was observed regarding the Apgar score (p = 0.0001). The blood pH value in capillary blood gas analysis was less than 7.25 in 18 (28.5%) cases with MAS and four (3.2%) cases without MAS. There was no significant difference between infants with and without MAS with regard to blood pH levels (p = 0.031). The mean blood lactate level was 8.5± 3.4 mmol/L in the patients with MAS, and there was a significant difference between infants with and without MAS regarding blood lactate level (p = 0.0001). The mean duration of oxygen supplementation was 86.62 ± 66.52 and 44.36 ± 19.03 h in patients with MAS and without MAS, respectively. In total, 30 infants required mechanical ventilation (24 infants with MAS and 6 infants without MAS). In addition to mechanical ventilation, 16 infants with MAS were administered surfactant therapy. The mean duration of hospital stay of infants with MAS was significantly higher than infants without MAS (p = 0.0001). There was a correlation between blood lactate levels, blood pH value, and hospitalization duration (p < 0.05). All of the infants, except one patient, were discharged from the NICU. In addition to the blood pH value and 5-min Apgar score, increased blood lactate level may be a risk factor for the development of MAS in infants born with MSAF. This may aid in the early detection of MAS and, with appropriate measures taken sooner, reduce morbidity and mortality. Further studies are needed to elucidate the role of lactate level, which is an important indicator of hypoxia during the development of MAS.

Asthma as a nonlinear complex dynamic system: a novel approach to understand the temporal behaviour of chronic asthma and its response to β-agonists

I am a paediatric pulmonologist, Professor and Head of the Division of Paediatric Respiratory Medicine at the University Children's Hospital in Bern, Switzerland. I graduated in 1989, wrote my MD thesis in paediatrics and trained as a paediatrician in Bern. I then spent some time in research and clinical training at Boston University (Boston, MA, USA), Hammersmith Hospital (London, UK) and Leicester University (Leicester, UK) and wrote a PhD in medical physics/biomedical engineering. My major research interests include the developmental physiology of newborns with wheezing disorders and asthma, and the potential role of environmental pollutants in lung growth and development. I was also involved in the development of new noninvasive lung function and nitric oxide measurement tests in infants. Such tests can be carried out in unsedated infants during natural sleep, and facilitate lung function studies in larger healthy cohorts and early recognition of infants at risk for later wheezing disorders and asthma. I was also significantly involved in the European Respiratory Society (ERS)/American Thoracic Society standardisation of infant lung function testing. My research has been supported by the Swiss National Science Foundation and by ERS long-term research fellowships. In 1999, I won the ERS Paediatric Respiratory Research in Europe Award and, in 2003, the Swiss Theodor-Kocher Research Award. The structure as well as the function of the respiratory system is complex. It includes subsystems involved in host defence, immunity and inflammation, as well as lung mechanics; these are inhomogeneous and irregular. More importantly, none of these subsystems function independently of each other but are highly interlinked, constituting a network with various tiers ranging from the molecular through cellular to organ level. Additional interactions occur within the organism, as well as within the external environment. Most studies that have led to advances in the understanding of the pathophysiology of the …

Avoidance of allergens and air pollutants in respiratory allergy

Avoidance of allergens and air pollutants in respiratory allergy

SOLUBLE E-SELECTIN: AN EARLY PROGNOSTIC INDICATOR FOR THE DEVELOPMENT OF BRONCHOPULMONARY DYSPLASIA † 1014

Bronchopulmonary dysplasia (BPD) continues to be a major complication in prematurely born infants. Early recognition of infants at greatest risk for BPD would allow intervention prior to the development of lung injury. We have reported that E-Selectin, an inflammatory adhesion molecule, increased in the lungs and serum (sE-Selectin) of animals exposed to hyperoxia. We tested the hypothesis that sE-Selectin would increase in infants at risk for the development of BPD. We measured sE-Selectin in cord blood and in samples on days 1, 3, and 7 from neonates born at ≤29 wks gestation. The infants were evaluated at one month of life to determine whether they met criteria for the diagnosis of BPD, characterized as mild (stage 1-2) or severe (stage 3-4) by the Northway radiographic stages of BPD. Table

Early recognition of infants at high risk for cerebral palsy: examination at age four months.

More than 32,000 children in a prenatally-defined cohort were examined four months after birth, and were re-examined at the age of seven years to determine the presence of cerebral palsy. Observations from the examination at four months were investigated as predictors of cerebral palsy, and the most reliable individual sign was increased muscle tone in neck, arms, legs or trunk. On completion of the physical examination at four months, the neurological status of each infant was assessed. Of the children considered to be normal, one in 1000 had cerebral palsy by the age of seven years, compared with one in 100 of those thought to be suspect. Of the children who had been definitely neurologically abnormal at four months, one in seven had disabling cerebral palsy by early school-age. The predictive power of abnormal physical findings increased with the number of abnormal findings with failure to meet motor milestones. Four-month-old infants who passed all milestone measures had a very low rate of later cerebral palsy, even if they had had abnormal physical findings. Examination of four-month-old infants permits the clinician to recognize children at widely different levels of risk of chronic motor handicap.

Early Recognition of Infants at Risk for Developmental Retardation

The pediatrician has a primary responsibility for the early detection of developmental problems. Attention is focused on high-risk predisposing factors aiding in early recognition of infants with developmental retardation or milder handicaps of educational importance.