Extrauterine Life Research Articles

Perinatal iron deficiency alters the cardiac proteome and mitochondrial function in neonatal offspring.

Aims: Iron deficiency (ID) is common during gestation and early infancy and can alter developmental trajectories with lasting consequences on cardiovascular health. Iron plays a critical role in systemic oxygen transport (via hemoglobin) and aerobic respiration (as a component of mitochondrial complexes). Perinatal ID has been shown to cause cardiac dysfunction in neonates, but the mechanisms underlying these changes have not been characterized. Here, we examined the effects of perinatal ID on cardiac mitochondrial function in the early postnatal period in rats. Methods and Results: Female rats were fed an iron-restricted or iron-replete diet before and during pregnancy. Offspring hearts were collected postmortem for quantitative shotgun proteomic analysis (postnatal days [PD]0 and 28) and mitochondrial function was assessed by high-resolution respirometry (at PD0, 14 and 28). Markers of oxidative stress were measured by fluorescence microscopy and assessment of antioxidant gene expression profiles. Both male and female ID pups had reduced body weight and increased relative heart weights at all time points assessed, despite recovering from anemia by PD28. Proteomics analysis revealed dysregulation of mitochondrial proteins by ID, and these differences were most pronounced in males. In male hearts, ID increased mitochondrial content and decreased normalized mitochondrial respiration through the NADH-pathway, succinate-pathway, and FAO-pathway. Conclusions: ID causes changes in cardiac mitochondrial function in neonates, which may reflect an inadequate or maladaptive compensation during the transition from intrauterine to extrauterine life. Further, the results presented herein, which were stratified by offspring sex, underscore the need for follow-up studies to directly assess differences in the way male and female offspring cope with ID as a perinatal stressor.

Association of cytochrome P450 CYP2C9 (rs1057910) gene polymorphism and ibuprofen response in preterm neonates diagnosed with patent ductus arteriosus

Background Patent ductus arteriosus (PDA) closure is one of the most significant changes necessary to transition to extrauterine life. The failure of closure in preterm infants has been associated with a variety of complications. Aim and objectives This study aim to investigate the correlation between cytochrome P450 CYP2C9 gene polymorphism and the response to ibuprofen treatment in preterm neonates with PDA. Subjects and methods This prospective study was conducted on 64 preterm neonates with patent ductus arteriosus (hsPDA). The neonates were treated with ibuprofen and diagnosed using clinical and echocardiographic examinations. The study was carried out at the Neonatal Intensive Care Unit (NICU), Pediatric Department, Kasr Alainy and ElMounira Pediatric Hospitals, Cairo University, in June 2018. Results A statistically significant difference in respiratory rate was observed between both groups ( p = 0.047). Additionally, there was a significant difference in the duration of treatment with ibuprofen ( p = 0.021). Treatment with ibuprofen had no impact on renal function parameters. The platelet count decreased after treatment with no statistical difference. Conclusion Use of Oral ibuprofen is a highly effective treatment for HsPDA in preterm neonates, demonstrating a remarkable success rate of 92.2% and fewer adverse effects. Whilst no correlation between the CYP2C9 (rs1057910) gene polymorphism and the efficacy of oral ibuprofen response, Other factors affecting the response of oral ibuprofen and subsequent PDA closure include gestational age, birth weight, Apgar score at 5 min, ductal diameter, RDS, and sepsis.

Septic Thrombophlebitis of the Umbilical Vein Complicating an Intrahepatic Umbilical Venous Catheter in a Premature Newborn

Septic thrombophlebitis of the umbilical vein (SVT) is a serious pathology in neonates, characterized by inflammation of the umbilical vein due to bacterial infection, with 90% of cases linked to the use of central venous catheters (CVCs). This inflammation can lead to thrombus formation as part of the immune system's response. Premature newborn, 33 weeks gestation, delivered vaginally, with history of gestational diabetes, twin pregnancy, macrosomia and premature rupture of membranes (57 hours), initially well adapted to extrauterine life, with a birth weight of 1575 g. The infant was admitted to neonatology for respiratory distress, and an intrahepatic umbilical catheter was inserted. On the 5th day of hospitalization, the infant developed a nosocomial Klebsiella pneumoniae infection, complicated by a fulminant hemorrhagic syndrome with hematemesis and melena. The clinical course was further complicated by multivisceral failure, requiring hepatic Doppler ultrasound, which revealed umbilical vein thrombosis. The newborn was treated with curative doses of Lovenox, while targeted antibiotic therapy was maintained for three weeks after negative blood cultures, resulting in significant clinical and biological improvement. Based on this case, we conclude that it is advisable to think about umbilical vein thrombosis and to perform an abdominal ultrasound in the presence of any digestive hemorrhage in a newborn or an intrahepatic or peripheral umbilical venous catheter, or in subjects at risk (hypotrophy, polycythemia, transfusion on the catheter) in order to screen for possible umbilical or portal vein thrombosis.

Nesting Technique : It’s Effects on Preterm Cardiorespiratory Indicators

Background: Premature infant born with immature body system, their organs are not ready for extra uterine life, and they are unable to deal with external stress, which could alter body functions such as cardio-respiratory function. In addition, poor muscle tone increases the chance of developing an abnormal posture. To reduce this instability, applying developmental care such as nesting is vital to promote cardio-respiratory stability, maintain position, and reduce stress in preterm. Objectives: The study aims to assess the impact of the nesting technique on preterm cardio-respiratory parameters in various positions (supine, prone, and right lateral). Methodology: The research used randomized controlled trial design. By simple random sampling technique was choose 60 preterm infant, and they were divided into four groups equally (supine, prone, right lateral, and control group). The cardio-respiratory parameters (heart rate, respiratory rate, and oxygen saturation) were measured before and after applying the nesting and positioning techniques for 3 consecutive days. Data were analyzed by Statistical Package for Social Sciences (SPSS) program. Results: The study results showed a significant difference in the mean score of cardio-respiratory after three days of nesting technique with lateral, supine, and prone position groups at p= 0.000. While the control group showed there was non-significant change in the mean score of HR, RR, and Spo2 at p > 0.05. Conclusion: The Study concluded that the nesting technique was effective for stabilizing the cardio-respiratory parameters of preterm infants. The authors recommended routinely using nesting with the ideal position technique in preterm as a part of developmental care at the neonatal intensive care unit

Revolutionizing Neonatal Care: A Comprehensive Review of Intact Cord Resuscitation in Newborns.

Neonatal resuscitation is a critical procedure aimed at ensuring the successful transition of newborns from intrauterine to extrauterine life. Traditionally, this involves immediate clamping and cutting of the umbilical cord, but recent advances have introduced intact cord resuscitation (ICR) as an alternative approach. This review aims to comprehensively analyze ICR, exploring its evolution, scientific basis, and clinical evidence. It seeks to evaluate the benefits and challenges associated with ICR and assess its impact on neonatal outcomes compared to traditional practices. A thorough review of the literature was conducted, including historical perspectives on neonatal resuscitation, the physiological rationale behind ICR, and critical clinical studies and trials. Current guidelines and recommendations were also examined, along with technological advancements and practical implementation issues. Evidence indicates that ICR offers significant benefits, including improved blood volume, better cardiovascular stability, and reduced risk of anemia in newborns. Comparative studies suggest that ICR can enhance neonatal outcomes and support a smoother transition to extrauterine life. Despite these benefits, challenges related to implementation and adherence to new practices persist. ICR represents a promising advancement in neonatal care, potentially improving newborns' health outcomes. Continued research and refinement of guidelines are necessary to fully integrate ICR into standard practice and address existing implementation challenges. This review highlights the need for ongoing evaluation and adaptation of resuscitation practices to optimize neonatal health and care.

From intra- to extra-uterine: early phase design of a transfer to extra-uterine life support through medical simulation.

Extra-uterine life support technology could provide a more physiologic alternative for the treatment of extremely premature infants, as it allows further fetal growth and development ex utero. Animal studies have been carried out which involved placing fetuses in a liquid-filled incubator, with oxygen supplied through an oxygenator connected to the umbilical vessels. Hence, by delaying lung exposure to air, further lung development and maturation can take place. This medical intervention requires adjustments to current obstetric procedures to maintain liquid-filled lungs through a so-called transfer procedure. Our objective was to develop obstetric device prototypes that allow clinicians to simulate this birth procedure to safely transfer the infant from the mother's uterus to an extra-uterine life support system. To facilitate a user-centered design, implementation of medical simulation during early phase design of the prototype development was used. First, the requirements for the procedure and devices were established, by reviewing the literature and through interviewing direct stakeholders. The initial transfer device prototypes were tested on maternal and fetal manikins in participatory simulations with clinicians. Through analysis of recordings of the simulations, the prototypes were evaluated on effectiveness, safety and usability with latent conditions being identified and improved. This medical simulation-based design process resulted in the development of a set of surgical prototypes and allowed for knowledge building on obstetric care in an extra-uterine life support context.

Thalamic volume in very preterm infants: associations with severe brain injury and neurodevelopmental outcome at two years.

Several studies demonstrate the relationship between preterm birth and a reduced thalamus volume at term-equivalent age. In contrast, this study aims to investigate the link between the thalamic growth trajectory during the early postnatal period and neurodevelopment at two years of age. Thalamic volume was extracted from 84 early MRI scans at postmenstrual age of 32.33 (± 2.63) weeks and 93 term-equivalent age MRI scans at postmenstrual age of 42.05 (± 3.33) weeks of 116 very preterm infants (56% male) with gestational age at birth of 29.32 (± 2.28) weeks and a birth weight of 1158.92 (± 348.59) grams. Cognitive, motor, and language outcomes at two years of age were assessed with Bayley Scales of Infant and Toddler Development Third Edition. Bivariate analysis was used to describe the clinical variables according to neurodevelopmental outcomes and multilevel linear regression models were used to examine the impact of these variables on thalamic volume and its relationship with neurodevelopmental outcomes. The results suggest an association between severe brain injury and thalamic growth trajectory (β coef = -0.611; p < 0.001). Moreover, thalamic growth trajectory during early postnatal life was associated with the three subscale scores of the neurodevelopmental assessment (cognitive: β coef = 6.297; p = 0.004; motor: β coef = 7.283; p = 0.001; language: β coeficient = 9.053; p = 0.002). These findings highlight (i) the impact of severe brain injury on thalamic growth trajectory during early extrauterine life after preterm birth and (ii) the relationship of thalamic growth trajectory with cognitive, motor, and language outcomes.

Including magnesium sulfate in the diet of twin-bearing ewes in the last week of gestation improves the adaptation of lambs to extrauterine life

Including magnesium sulfate in the diet of twin-bearing ewes in the last week of gestation improves the adaptation of lambs to extrauterine life

Premature Closure of the Ductus Arteriosus and Veno-Arterial Extracorporeal Membrane Oxygenation in Critically Ill Neonates: A 10-Year Single-Center Retrospective Study.

To describe critically ill neonates with premature closure of the ductus arteriosus (DA) and assess the frequency as well as predictive factors for extracorporeal membrane oxygenation (ECMO) support in the latter. This was a monocentric retrospective observational study conducted in the NICU of a French academic medical center between 01/01/2013 and 01/01/2023. All neonates diagnosed with premature closure of the DA were included. Exclusion criteria were associated congenital heart disease amenable to urgent surgeryor contraindication for ECMO. Eleven neonates with complete premature closure of the DA were included. Births were full-term with a weight of 3.60kg [3.16-3.89]. Only one case (9%) was diagnosed antenatally. Premature closure of the DA was idiopathic in seven neonates (64%) and associatedto maternal exposure to non-steroidal anti-inflammatory drugs (NSAIDs) in three (27%). All newborns had pulmonary hypertension (PH) and right ventricular hypertrophy. Three neonates (27%) were supported on veno-arterial ECMO and appeared to have more pathological adaptation to extra-uterine life, greater need for vasopressor and/or inotropic support, and higher frequency of bi-ventricular failure (100%) or morphological anomaly of the tricuspid valve (67%). No patient died but more than half had non-cardiological sequelae. Veno-arterial ECMO support is not uncommon in critically ill neonates with premature DA closure and appeared to be associated with more pathological adaptation to extra-uterine life, greater need for vasoactive-inotropic support and higher frequency of bi-ventricular failure or morphological anomaly of the tricuspid valve. These parameters can help clinicians to identify neonates likely to require such an assistance.

Analysis of physical traits, clinical parameters, and energy metabolism of invivo- and invitro-derived Flemish newborn calves during the first day of life.

Studies investigating physiological deviations from normality in newborn calves derived from invitro fertilization procedures remain important for the understanding of factors that reduce calf survival after birth. The aim of this study was to investigate parameters affecting health and welfare of newborn Flemish calves derived from invitro embryo production (IVP) in the first hours of life in comparison to invivo-derived calves. Physical traits of newborn calves and fetal membranes (FM) were recorded soon after birth. Newborn venous blood samples were collected at several time points within the first 24 h of life for analyses of energy substrates, electrolytes, blood gases, acid-base balance, blood chemistry, and haematology. A liver biopsy was taken within the first hour after birth for analysis of gene expression of key enzymes of the fructolytic and glycolytic pathways. Newborn IVP calves were heavier and larger at birth, which was associated with heavier FM. At several time points during the first 24 h of life, IVP-derived calves had altered rectal temperature, blood gases, electrolyte concentrations, blood parameters for liver, kidney and muscle function, and acid-base balance, plasma lipid metabolism, and hemogram parameters. The relative mRNA abundances for triokinase and lactate dehydrogenase-B were greater in IVP calves. In summary, IVP-derived newborn calves were at higher risk of clinical problems after birth, which was markedly greater in heavier and larger calves. Such animals take longer to adapt to extrauterine life and should receive a special attention during the immediate neonatal period.

Oestrogen and progesterone concentrations in intrapartum cows with insufficient cervix dilation

AbstractThe cervix is an important organ that has to dilate sufficiently at delivery to allow the foetus to transition to extrauterine life. Insufficient dilatation of the cervix (IDC) is a frequent cause of dystocia in cattle. The mechanisms underlying cervical opening and the pathogenesis of IDC are still widely unclear. Systematic studies on the relationship between IDC and steroid hormones have been limited and have yielded inconsistent findings. This study aimed to measure oestrogen and progesterone (P4) concentrations in intrapartum cows presented with dystocia due to IDC and in a comparison (C) group of cows with eutocic delivery. Before any obstetrical procedures, and right after the initial evaluation, blood samples were taken from IDC and C animals. Concentrations of P4, oestradiol‐17β (E2), free total oestrogens (FTE) and conjugated total oestrogens (CTE) were measured by established radioimmunoassays. Concentrations of P4 (p = .538), FTE (p = .065) and CTE (p = .605) were not statistically different between C and IDC groups. However, E2 levels in group C were significantly lower when compared to those in the IDC group (p = .013), which is inconsistent with the function of oestrogens in cervical dilatation. The correlation analysis demonstrated significant positive correlations between the pairs P4 versus FTE, P4 versus E2 and FTE versus E2 in group C and between the pair FTE versus E2 in group IDC. In conclusion, the results suggest that local activities of steroids relevant to the aetiology of IDC are not reflected by concentrations in the systemic circulation or that other factors are clearly more important.

OBJECTIVE ASSESSMENT AND COMMUNICATION OF THE PHYSIOLOGIC STATUS OF THE SICK INFANT

The practice of midwifery involves the initial and ongoing assessment of newborn infants in terms of their maturity, transition to extrauterine life, completeness of resuscitation and ongoing health status. The universally familiar Apgar score is an essential tool for initial neonatal assessment for midwives as for other medical professionals.1 The score was developed by Virginia Apgar as an objective measure of the physiologic status of the infant after birth, and to quantify the progress through, and adequacy of, resuscitation and adaptation to extra-uterine life. While elements of the Apgar score are relevant for assessing and describing the status of the infant after 10 minutes of age, the score as a whole is not used routinely beyond this time. The Pediatric Assessment Triangle (PAT) is a newly developed tool for ongoing, objective assessment of an infant's (or child's) physical appearance.2,3 The PAT can be used to describe the presence of abnormal physiology, define whether an infant is in distress or actually experiencing system failure, and assess the infant's response to intervention by observing the resolution or progression of the clinical problem. The PAT has the potential to be a valuable tool for midwives, both for ongoing assessment, and as a means of describing the status of an infant to other health care professionals using objective terminology. The use of objective criteria and precise terminology can strengthen the impact and relevance of communication and contribute to logical decision-making about immediate care and long-term disposition. A consistent framework is also valuable when providing follow-up, particularly where a treatment or intervention has been suggested and it is important to communicate whether the infant has responded. The purpose of this paper is to describe the Pediatric Assessment Triangle, explain how it is applied and to suggest the use of this tool by midwives in practice.

New ideas about the maternal gut microbiome as a source of fetal programming

New genetic technologies that have emerged and been introduced into practice over the past 20 years, including 16s rRNA sequencing, have significantly expanded our understanding of the microbial composition of the human body. The gut is one of the most densely populated microbial niches in the human body. Numerous studies have shown the relationship of the gut microbiome with various non-communicable diseases, including diabetes mellitus, obesity, allergies and even mental disorders. The perinatal period, as one of the most hormonally dependent ones in human ontogenesis, has a direct impact on the composition of the intestinal microbiota, just as the microbiota itself can be a precursor and etiological cause of pregnancy complications. In this regard, the aim of this review article was to systematize data on the gut microbiota of the maternal body in normal and pathological pregnancy, as well as to analyze data on the interaction of the maternal gut microbiome with the fetal immune system. The review presents data on changes in the maternal intestinal microbiome in normal pregnancy, during infertility, as well as in pregnancy complicated with obesity, gestational diabetes mellitus and preeclampsia. The review also shows how the maternal microbiome is able to “educate” the fetal immune system in utero, thereby preparing the child, who develops in a sterile womb, for extrauterine life surrounded by a large number of various microorganisms. These mechanisms include the direct effect of not only the microorganisms themselves, but also, even largely, their metabolites — primarily short-chain fatty acids. All these presented data allow for concluding that the maternal microbiome is essentially a separate regulatory homeostatic system, along with the immune, endocrine and cardiovascular systems, which may determine the development of certain complications of pregnancy and shape the health of the unborn child. Interventions in the composition of the maternal gut microbiota may be a way to modulate the course of pregnancy and prevent major obstetric syndromes.

Fetal cardiac troponin I levels decline toward birth in sheep.

Elevated cardiac troponin I (cTnI), a myocardial damage biomarker, has been reported in cord blood of neonates delivered vaginally or by cesarean section. Although the neonatal peak likely reflects the physiological adjustment to extrauterine life, a better understanding of serial prepartum changes is required to determine physiological causes of fetal cTnI release. We longitudinally sampled eight healthy lambs (20 days before spontaneous birth to 5 days postnatal), and from three fetuses receiving intravenous IGF-1. Samples were collected into heparin, and the plasma was stored at -80°C for later determination of high-sensitivity (hs) cTnI levels (BeckmanCoulter UniCel DxI Access IA; log transformed detection limit = 0.30, quantification limit = 0.78, 99th percentile = 1.78). Positive and negative control samples were drawn from an adult ewe during a terminal experiment (myocardial ischemia) and similarly assessed. hs-cTnI data were log transformed from ng/L. Log(hs-cTnI) was 1.47 ± 0.30 (means ± SD) at 20 days before birth and declined to 1.02 ± 0.65 in fetuses 12 ± 4 h before birth (P < 0.0001, R2 = 0.7869). Birth stimulated a delayed, transient peak in hs-cTnI (P = 0.0058). Newborn (43 ± 19 min postnatal) levels were 1.39 ± 0.40 (P = 0.0650 vs. fetus on day of birth) and 2.14 ± 0.63 the day after birth (P = 0.0331 vs. newborn). The second day after birth, levels declined to 1.65 ± 0.48 (P = 0.0238 vs. day 1). IGF-1 infusion increased hs-cTnI levels 25-50% over baseline (P = 0.0252, R2 = 0.9938). Baseline adult ewe log(hs-cTnI) was below the limit of detection; 3 h following coronary artery ligation, levels were 3.21. In conclusion, we newly report that fetal hs-cTnI levels decline concomitantly with reduced proliferation of cardiomyocytes toward term.NEW & NOTEWORTHY Serial blood samples were collected from catheterized, normally developing fetal and newborn lambs and high-sensitivity cardiac troponin I (hs-cTnI) levels were assessed, providing unprecedented insight into the physiological processes leading to high levels in the perinatal period. Moderately high levels of hs-cTnI found in the normally developing fetus declined toward term. An elevation to high levels peaked the day after birth, after which hs-cTnI declined again. Stimulation of fetal cardiomyocyte proliferation with IGF-1 also elevated hs-cTnI.

Canine pulmonary clearance during feto-neonatal transition according to the type of delivery

The success of immediate adaptation to extrauterine life depends on appropriate lung function, however, elective cesarean section can increase the risk of respiratory distress as a result of reduced pulmonary fluid absorption. This study aimed to evaluate the influence of birth mode on pulmonary clearance and respiratory performance of canine neonates in the transition period. For this purpose, 37 neonates were selected according to the obstetric condition: Vaginal Eutocia (n = 17) and Elective C-section (n = 20). Neonates were evaluated for neonatal vitality score, as well as evaluation of heart and respiratory rates, body temperature and body weight, venous hemogasometric evaluation, blood lactate and glucose, pulse oximetry and radiographic evaluation during the first 24 h of life. Additionally, amniotic fluid electrolyte composition of each puppy was evaluated. There was no influence of the type of delivery on electrolyte composition of canine amniotic fluid and neonatal pulmonary liquid content, analyzed by thoracic X-Rays. On the other hand, elective cesarean section delayed pulmonary adaptation, resulting in hypoxemia and less efficient compensatory response to acid-base imbalance and thermoregulation. In conclusion, elective c-section does not delay pulmonary clearance, whilst alters pulmonary adaptation by less efficient gas exchange and lower oxygenation, hindering the compensatory response to acid-base imbalance during the fetal-neonatal transition in dogs.

Cardiac output calculation using the Liljestrand and Zander formula: is this method applicable during immediate transition after birth? — A post hoc analysis

The transition from intrauterine to extrauterine life is a critical period for neonates. Assessing the cardiovascular transition during this period immediately after birth is crucial but challenging. The present study compares adjusted estimated cardiac output values calculated by the Liljestrand and Zander formula (COest/adj LaZ) with non-invasively measured cardiac output values (CO-bioimpedance) during immediate transition after birth. We performed a secondary outcome analysis of a prospective observational study in preterm and term neonates. Ten and 15 min after birth, arterial blood pressure and heart rate were assessed, and CO-bioimpedance was measured using electrical bioimpedance method (Aesculon monitor, Osypka, Germany). We calculated COest/adj LaZ and compared it to CO-bioimpedance. Further, we performed a correlation analysis. Thirty-two neonates with a median (IQR) gestational age of 37.0 (32.0–39.4) weeks were included. Mean ± SD CO-bioimpedance was 0.62 ± 0.15 l/min, and COest/adj LaZ was calculated to be 0.64 ± 0.10 l/min, whereby both correlated significantly (p = 0.025, r = 0.359) with each other. Conclusion: The present study demonstrates high comparability of COest/adj LaZ and CO-bioimpedance in neonates during immediate transition after birth, suggesting that cardiac output can be derived in a cost-effective and feasible manner if other methods are not available.What is Known:• Echocardiography is considered the gold standard for non-invasive CO evaluation, but its feasibility during the immediate transition period is limited.What is New:• Non-invasive methods such as CO-bioimpedance for cardiac output (CO) measurement and the Liljestrand and Zander (LaZ) formula for estimating CO offer promising alternatives during the immediate transition period.

Frequency and immediate neonatal prognosis of low birth weight neonates in Parakou (Benin) in 2018

Introduction: Infant and child mortality remains high in Benin and is sustained by neonatal mortality which has stagnated for decades. Low birth weight (LBW) is recognized to be an important risk factor for neonatal death worldwide and serves as an indicator of perinatal death. Objective: The objective is to establish the relationship between LBW and immediate neonatal prognosis in the city of Parakou (Benin). Patients and methods: This was a cross-sectional study with a descriptive and analytical aim. A prospective collection of data on neonates born from pregnancies with a gestational age of at least 22 weeks of amenorrhea was carried out. It was conducted in three health structures drawn randomly from ten structures in the city of Parakou from May 15 to July 14, 2018. The study included all live neonates. The recruitment of neonates was subject to an oral informed consent of their mothers. We excluded from this study any malformed neonate, any neonate who died in utero and any neonate born from a multiple pregnancy. The data collected were processed and analyzed using Epi Data 3.1, Microsoft Excel 2007 and Epi Info version 7.1.5.0 software. Statistical inferences (Chi-Square test, Person test, Yates correction, Ficher's exact test and their confidence intervals) were used to check the level of association between LBW and morbid situations and then immediate mortality. The research protocol was submitted to the local ethics committee of the University of Parakou and obtained its approval under the reference 0121/CLERB-UP/P/SP/R/SA of May 5, 2018. Results: The frequency of LBW was 16.9%. LBW was associated with poor adaptation to extrauterine life (p=0.000), neonatal resuscitation (p=0.000) and early neonatal mortality (p=0.000). Birth weight in neonates with LBW was inversely related to the risk of death within 24 hours of life. Conclusion: One in six neonates had LBW in the city of Parakou in 2018. LBW at birth was a state at risk of neonatal resuscitation and early death. Reducing neonatal mortality requires preventing low birth weight.

A REVIEW ON ROLE OF TRIDOSHA IN HEALTH AND DISEASES

Healthy and unhealthy state of a human being depends on normal and abnormal functional state of Tridosha, considering the physiological importance of Dosha in maintenance of homeostasis of the body. Tridosha have been called as root (Dosha Dhatu Mala Moolam hi Shariram) of the body. All the functions of the body could be explained in terms of Dosha, Dhatu, and Mala. Panchamahabhuta are chief controllers of universe. By Loka purusha saamyavaada existence of entities in universe and living body is similar. Hence controllers in human body must also be Panchabhoutika. Since Dosha are functional representatives of Panchamahabhuta, they are controllers of body functions. They are structurally Panchabhoutika in nature. Synthesis of Dosha is brought about in two stages. Those synthesized in unicellular zygote and impress every cell after differentiation are Prakruta Dosha, which are decisive factors for body characteristics. Those synthesized from food material which control routine body metabolism are called Vaikrata Dosha, which are decisive factors for homeostasis. Both stages are observed in intra uterine as well as extra uterine life. Both these kinds of Dosha work in synergism to carry out all bodily functions. Vatadosha is divided into five types and These types are according to function, chief location etc. Similarly, Pitta as well as Kaphadosha are also divided into five types. Within limits Doshas are maintaining living body, as they maintain homeostasis. Doshas are only and direct responsible factors for genesis of diseases. Even though there are exogenous and endogenous etiological factors in pathogenesis, Ayurveda suggests that any cause leads to vitiation of Dosha in the first place and then next events start for generation of diseases. Doshas control other two entities namely Dhatu and Mala. Aim &amp; Objectives: Observing the role of Doshas in health and disease conditions Materials and Methods: All the classical texts of Ayurveda with available commentaries, published research papers, PUB med, Google scholar, research Gate, subject related data on Internet and other sources were reviewed for the present study Results and Conclusion: The Doshas having the primary role in maintaining health and any disturbance in Doshas will causes disease KEY WORDS: Doshas, Ahara, vihara, Vikruti, vyadhi

Asuhan Kebidanan Pada Bayi Baru Lahir dengan Perawatan Tali Pusat Di Klinik Pratama Medical Center Kota Batam

Newborns also called neonates are individuals who are growing and have just experienced birth trauma and must be able to make adjustments from intra uterine life to extra uterine life. A normal newborn is a baby born at 37-42 weeks gestation and weighs 2,500-4,000 grams. Care taken of newborns is care of hair, eyes, nose, mouth, ears and one of them is umbilical cord care. Umbilical cord care is needed to prevent the umbilical cord from becoming a breeding medium for pathogenic microorganisms: Incorrect care techniques can lead to tetanus neonatorum infection which can affect the length of cord detachment. This type of research is descriptive by applying a case study approach. The implementation of this study was carried out at the Pratama Medical Center Clinic on Mrs. W's baby by providing umbilical cord care to her baby.

Comparative assessment of myocardial function between late premature newborns and term neonates using the 2D speckle tracking method.

Assessment of myocardial function through speckle tracking echocardiography (STE) can bring benefits to conventional echocardiography in premature newborns, a particular vulnerable group in terms of adaptation to extra-uterine life. Furthermore, it represents a non-invasive imagistic method which can guide therapeutic approach in the hemodynamically unstable newborn. This study aims to highlight the particularities of myocardial function in late premature newborns, by conducting a comparison with a group of healthy neonates, by using STE. Conducted over a timespan of two years, this prospective study enrolled 64 term neonates and 21 premature newborns, with gestational ages ranging between 28 and 36 weeks, who prior to discharge underwent a cardiac ultrasound, involving two-dimensional image acquisitions of the apical four-chamber view of both ventricles. Afterwards, the images were offline analyzed, by using the autostrain function. After segmental strain analysis, no significant discrepancies between the two groups in terms of interventricular values were found. However, left ventricle and right ventricle strain measurements differed significantly (p < 0.01), for each of the analyzed segments (basal, medial or apical). Moreover, a linear increase in interventricular (IV) basal strain with corrected gestational age progression was noted (p = 0.04). Peak global longitudinal strain (pGLS) and EF were similar between the two study groups. Premature newborns presented significantly more negative mean values of right ventricular free wall longitudinal strain (RVFWSL), (-24.19 ± 4.95 vs. -18.05 ± 5.88, p < 0.01) and of right ventricle global four chamber longitudinal strain (RV4CSL), (-19.71 ± 3.62 vs. -15.46 ± 5.59, p < 0.01), when compared to term neonates. The 2D STE is a reliable method for cardiac assessment of late preterm newborns. The evaluation of two-dimensional global longitudinal LV and RV strains might represent a useful tool in clinical practice. A better response of the right ventricle to the longitudinal deformation within premature neonates was noted. Thus, this study facilitates the identification of accurate reference values for this particular population segment, which will enable the evaluation of ventricular function in premature newborns with concurring disorders. Future longitudinal studies, assessing the fetal heart, could provide more insight into the development of myocardial function.