First Few Weeks Of Life Research Articles

Maternal transfer of phenol derivatives in the Baltic grey seal Halichoerus grypus grypus

Studies of circulating levels in difference sex and age classes, and maternal transfer of bisphenol A, 4-tert-octylphenol and 4- nonylphenol in the Baltic grey seal were performed from 2014-2017. Blood was collected from long-term captive adult males, pregnant females and pups. Milk was collected from nursing females. The aim of this study was not only to determine the concentrations of phenol derivatives, i.e. bisphenol A (BPA), 4-tert-octylphenol (OP) and 4-nonylphenol (NP), but also to try to evaluate the transfer of these compounds to the next generation in the final stage of foetal life and in the first few weeks of life in juvenile marine mammals. The measurements were carried out using high performance liquid chromatography. The obtained data show that all phenol derivatives are present in the blood of males, females and pups (range <0.07–101 ng·cm−3) and in female milk (range <0.1–406.3 ng·cm−3). The main source of phenol derivatives in organisms is food exposure. Gender, age, or number of births were not observed to have a significant effect on changes in phenol derivative levels in seal blood within the breeding group. In the prenatal stage of life, a small amount of BPA and alkylphenols was passed on to the offspring through the placenta. In the blood of the offspring the concentration of these compounds exceeded the concentration in the mother's blood 1.5-fold. During nursing, females detoxified their systems. Level of phenol derivatives in the pups blood increased linearly with its increasing concentrations in the mother's milk. On the other hand, the seafood diet which started after the physiological fasting stage of the pup, stabilised the levels of phenol derivatives below 10 ng ∙ cm−3.

Bilateral congenital choanal atresia in a 16-year old girl at Muhimbili National Hospital, Tanzania

Background: Bilateral choanal atresia refers to a congenital anomaly whereby a child is born with bilateral imperforate posterior nares. In most cases the diagnosis is established soon after birth. Establishment of the diagnosis requires a high index of suspicion by clinicians. The objective was thus to report an unusual case which went undiagnosed for many years and review the few available literatures.Case presentation: A 16-year old girl presented to the otorhinolaryngology clinic of Muhimbili National Hospital in Tanzania with a long standing history of bilateral nasal obstruction. The condition was reported to be present since birth and this was accompanied by mouth breathing and persistent bilateral nasal discharge. The patient also reported a history suggestive of respiratory distress after birth which necessitated oxygen therapy and difficulty in breastfeeding where she was kept on expressed breast milk during the first few weeks of life. Nasal endoscopy was done clinic and the diagnosis of bilateral congenital choanal atresia was made. Computerized tomography scan of the nose and paranasal sinuses revealed bilateral choanal atresia of mixed type. Surgical perforation of the atretic choanae without stenting was done endoscopically under general anaesthesia.Conclusion: Bilateral congenital choanal atresia is an otorhinolaryngological emergency and should be established promptly both in resource limited settings and in areas where advanced tools are in situ to prevent its morbidity and mortality if it goes unestablished.

Late neuroimaging predicts neurodevelopmental outcomes in preterm infants.

Commentary on: Hintz S, Barnes P, Bulas D, Slovis T, Finer N, Wrage L, et al. Neuroimaging and neurodevelopmental outcome in extremely preterm infants. Pediatrics 2015; 135: e32–42. Neurodevelopmental outcomes are a crucial part of prognosis and are pivotal in ongoing conversations between neonatologists and parents 1, 2. Recent studies show greater predictive value in near-term cranial ultrasound (CUS) and MRI versus traditional CUS performed in the first few weeks of life 1-3. MRI detects white matter injury more accurately while US detects intraventricular haemorrhages, ventriculomegaly and cystic periventricular leukomalacia 2, 4, 5. However, studies have found former preterm infants with developmental impairments despite normal NICU ultrasounds, and, importantly, others have reported transient findings of cystic periventricular leukomalacia (resolving by near-term) are associated with developmental impairments 2, 6, 7. The NEURO prospective study by Hintz et al. 8 analysed the predictive ability of early CUS, near-term CUS and near-term MRI in a cohort of 480 extremely preterm neonates, born at 24–27 weeks. Negative outcomes were defined as neurodevelopmental impairment, significant gross motor impairment or death. The authors provided multivariable modelling to consider perinatal and neonatal demographic and clinical risk factors. Results were presented as OR and AUC of ROC curves. Further statistical calculations of Tables 2–5 show sensitivity and specificity of 0.27 and 0.92, respectively, for the association between major findings in early CUS and negative outcomes of neurodevelopmental impairment or death, compared to sensitivity of 0.28 and specificity of 0.97 for major findings in late CUS. The calculated sensitivity and specificity of MRI WMA are similar to that reported by Woodward et al. 4 in 2006 (92% vs 84% and 23% vs 34%, respectively), demonstrating that MRI has potential for higher sensitivity than CUS. The major findings of the NEURO study were that early CUS is not predictive of future neurodevelopmental outcomes, despite taking into account perinatal and neonatal demographic and clinical risk factors. The ability to predict outcomes is only mildly enhanced by the addition of MRI to late CUS. Therefore, in environments where MRI is not easily available, late CUS may be sufficient in predicting prognosis. The strengths of the NEURO study included large population size, blinded imaging evaluations, required temporal proximity of late CUS and MRI. Limitations included that CUS was obtained by local centre protocol with possibility for technical inconsistencies, and there were low rates of adverse outcomes, leading to wide confidence intervals. While multivariable modelling taking into account neonatal risk factors scrutinises results, a drawback is potential over-analysis. Near-term CUS and MRI have been shown to be more reliable alternatives to early CUS in predicting outcomes, but imaging is only mildly effective in formulating predictions of neurodevelopmental outcomes in extremely premature neonates 2, 4, 9. There is still considerable uncertainty regardless of imaging modality or combination of imaging modalities used. Studies have shown that MRI before discharge is too early to detect posterior limb internal capsule myelination abnormalities, which have been shown to be associated with gross motor deficits 3, 5. Extending outcomes to include cognitive and behavioural difficulties of school-age ex-premature neonates will detect deficits not fully appreciated on Bayley or GMFCS testing 2, 9. https://ebneo.org/2018/06/late-neuroimaging-predicts-neurodevelopmental-outcomes-in-preterm-infants/ None. None.

Fifteen-minute consultation: Breastfeeding in the first 2 weeks of life—a hospital perspective

The beneficial health and economic impacts of breastfeeding are considerable. However the majority of babies in the UK are not exclusively breastfeeding by 6 weeks of age. The first few...

Postnatal DNA demethylation and its role in tissue maturation

Development in mammals is accompanied by specific de novo and demethylation events that are thought to stabilize differentiated cell phenotypes. We demonstrate that a large percentage of the tissue-specific methylation pattern is generated postnatally. Demethylation in the liver is observed in thousands of enhancer-like sequences associated with genes that undergo activation during the first few weeks of life. Using a conditional gene ablation strategy we show that the removal of these methyl groups is stable and necessary for assuring proper hepatocyte gene expression and function through its effect on chromatin accessibility. These postnatal changes in methylation come about through exposure to hormone signaling. These results define the molecular rules of 5-methyl-cytosine regulation as an epigenetic mechanism underlying cellular responses to a changing environment.

Pavlik Harness Initiation on Barlow Positive Hips: Can We Wait?

Background: Developmental dysplasia of the hip (DDH), a common disorder found in newborn infants, can often be treated with the Pavlik Harness (PH). In many cases, over 80% of children with unstable hips will naturally stabilize within two months of age. Infants are examined with the Ortolani and Barlow maneuvers as well as ultrasounds when the present to clinic within the first few weeks of life to …

Parenteral nutrition for preterm infants: Issues and strategy

Due to transient gut immaturity, most very preterm infants receive parenteral nutrition (PN) in the first few weeks of life. Yet providing enough protein and energy to sustain optimal growth in such infants remains a challenge. Extrauterine growth restriction is frequently observed in very preterm infants at the time of discharge from hospital, and has been found to be associated with later impaired neurodevelopment. A few recent randomized trials suggest that intensified PN can improve early growth; whether or not such early PN improves long-term neurological outcome is still unclear. Several other questions regarding what is optimal PN for very preterm infants remain unanswered. Amino acid mixtures designed for infants contain large amounts of branched-chain amino acids and taurine, but there is no consensus on the need for some nonessential amino acids such as glutamine, arginine, and cysteine. Whether excess growth in the first few weeks of life, at a time when very preterm infants receive PN, has an imprinting effect, increasing the risk of metabolic or vascular disease at adulthood continues to be debated. Even though uncertainty remains regarding the long-term effect of early PN, it appears reasonable to propose intensified initial PN. The aim of the current position paper is to review the evidence supporting such a strategy with regards to the early phase of nutrition, which is mainly covered by parenteral nutrition. More randomized trials are, however, needed to further support this type of approach and to demonstrate that this strategy improves short- and long-term outcome.

Calf immunology and the role of vaccinations in dairy calves

The risk of mortality and morbidity in calves is highest during the first few weeks of life. The main causes of mortality change throughout the preweaning period: septicaemia is most...

Conjugated Hyperbilirubinemia in the Neonate and Young Infant.

Cholestatic jaundice in the first few weeks of life may herald potentially life-threatening pathology. It is therefore incumbent upon the pediatric practitioner to have a high index of suspicion for severe disease when investigating jaundice in a young infant. This article outlines the epidemiology, pathophysiology, differential diagnosis, and diagnostic workup for both the most common and the most severe causes of cholestasis in the neonatal period.

Intermittent hypoxia suppression of growth hormone and insulin-like growth factor-I in the neonatal rat liver

ObjectivesExtremely low gestational age neonates with chronic lung disease requiring oxygen therapy frequently experience fluctuations in arterial oxygen saturation or intermittent hypoxia (IH). These infants are at risk for multi-organ developmental delay, reduced growth, and short stature. The growth hormone (GH)/insulin-like growth factor-I (IGF-1) system, an important hormonal regulator of lipid and carbohydrate metabolism, promotes neonatal growth and development. We tested the hypothesis that increasing episodes of IH delay neonatal growth by influencing the GH/IGF-I axis. DesignNewborn rats were exposed to 2, 4, 6, 8, 10, or 12 hypoxic episodes (12% O2) during hyperoxia (50% O2) from P0-P7, P0-P14 (IH), or allowed to recover from P7-P21 or P14-P21 (IHR) in room air (RA). RA littermates at P7, P14, and P21 served as RA controls; and groups exposed to hyperoxia only (50% O2) served as zero IH controls. Histopathology of the liver; hepatic levels of GH, GHBP, IGF-I, IGFBP-3, and leptin; and immunoreactivities of GH, GHR, IGF-I and IGF-IR were determined. ResultsPathological findings of the liver, including cellular swelling, steatosis, necrosis and focal sinusoid congestion were seen in IH, and were particularly severe in the P7 animals. Hepatic GH levels were significantly suppressed in the IH groups exposed to 6–12 hypoxic episodes per day and were not normalized during IHR. Deficits in the GH levels were associated with reduced body length and increase body weight during IHR suggesting increased adiposity and catchup fat. Catchup fat was also associated with elevations in GHBP, IGF-I, leptin. ConclusionsIH significantly impairs hepatic GH/IGF-1 signaling during the first few weeks of life, which is likely responsible for hepatic GH resistance, increased body fat, and hepatic steatosis. These hormonal perturbations may contribute to long-term organ and body growth impairment, and metabolic dysfunction in preterm infants experiencing frequent IH and/or apneic episodes.

Does Multicolor Lineage Tracing of Endothelial Cells Provide a Black and White Answer on Clonal Expansion in Post-Natal Angiogenesis?

Postnatal angiogenesis occurs in physiological (ie, blood vessel growth in muscle in response to exercise and with cyclic changes within menstrual tissue) and pathological conditions (eg, diabetic retinopathy). Many attempts to promote postnatal angiogenesis have been attempted to drive revascularization of ischemic tissues. Surprisingly, we continue to lack fundamental information on which endothelial cells possess replicative potential in blood vessels. Prior work established that infusion of H3 thymidine into young mammals revealed endothelial cell proliferation in small and large vessels that is high at birth, varies within and among organ vasculature, and declines rapidly over the first few weeks of life. In adult animals, the rate of homeostatic endothelial cell turnover has been quantified as <1% in rodents. Despite these pieces of information, we do not know specifics about the individual proliferative capacities of endothelial cells, whether this activity is restricted to a small subset or is a feature ubiquitously present within all endothelial cells in a blood vessel.1 Article, see p 670 Manavski et al2 in this issue have used inducible endothelial cell–restricted multicolor reporter (Confetti) transgenic mice to interrogate the clonal expansion of individual endothelial cells within normally developing murine tissue vasculature or within tissues challenged by ischemia and hypoxia. This system has permitted quantification of all the endothelial cells within a fixed sampling volume of the tissue vasculature to detect an increase in local distribution of a singular color of endothelial cells within areas of clonal expansion compared with near equivalent levels of random color distribution in areas lacking clonal expansion. In brief, the authors failed to detect significant color enrichment (<10% clonal expansion) in the developing retinal vasculature at postnatal day 5, consistent with prior work in zebrafish that had identified random integration or cell mixing accounting for endothelial cell distributions in developmental …

Calf age and sex affect maternal diving behaviour in Shark Bay bottlenose dolphins

Maternal care varies across taxa from brief, minimal care to long-term, intensive care. Mammalian mothers provide extensive and energetically expensive care by definition through pregnancy and lactation, which can extend for years, resulting in behavioural trade-offs between resource acquisition and direct care. In marine environments, mammalian mothers face unique challenges, such as the inability to cache or den their offspring while diving for prey. Dolphin newborns are precocious, accomplishing shallow dives in the first few weeks of life, however, fully mature diving and breath-holding capabilities take years to develop. Consequently, mothers are faced with a trade-off between diving and foraging or remaining close to and protecting their calves at the surface. Here we examined this trade-off, specifically by investigating whether mothers change their dive durations, especially during foraging, as a function of calf age. We used a longitudinal (1988–2014) data set on wild bottlenose dolphins, Tursiops aduncus, in Shark Bay, Western Australia, which included 27 388 dive bouts from mothers (N = 26) and calves (N = 41). Our results show that maternal diving behaviour changes in response to calf age and sex. While both male and female calves increased their dive durations with age as expected, mothers were more likely to adjust their diving behaviour to accommodate female but not male calves, especially when daughters were in close proximity. This is consistent with findings that vertical social learning is more critical for daughters than for sons, and may reflect the sex-specific foraging and social tactics of the males and females more generally.

Razumevanje problema fenilketonurije kroz istoriju

Phenylketonuria (PKU) is an autosomal recessive, metabolic disease that leads to mental retardation and other neurological problems, when treatment is not started within the first few weeks of life. It occurs due to the lack of phenylalanine hydroxylase enzyme (PAH) and phenylalanine is accumulated in the body, and the tyrosine level decreases. An excessive amount of phenylalanine in the bloodstream leads to brain damage in children. Insufficient tyrosine leads to a decrease in the production of melanin pigments, so children with PKU are blond, with soft white skin and blue eyes. Phenylalanine is excreted in the form of phenylketone in the urine. Due to these ketones, sweat and urine of sufferers have a stronger smell than of a healthy persons (resembling budding). The Guthrie test is carried out as a mass, screening method for phenylketonuria and it is a part of mandatory national child health care program. Treatment is carried out by a diet that limits the intake of phenylalanine.

Pitoz ve Disfaji ile Prezente Olan Geç Başlangıçlı Pompe Hastalığı

Pompe disease PD is an autosomal recessive glycogen storage disease of childhood which is caused by deficiency of lysosomal enzyme acid-α-glucosidase. PD is classified into two; infantile onset and late onset. Infantile onset disease, typically present during the first few weeks of life with hypotonia, hepatomegaly and hypertrophic cardiomyopathy and usually infantile death within the first year of life. Late-onset Pompe disease usually presents with proximal muscle weakness and respiratory insufficiency in childhood or late adulthood. In this case report we describe a two-year-old boy diagnosed with late-onset PD with enzyme level and genetic analysis who did not have any major signs other than pitosis and disarthria which could be easily misdiagnosed

Surprisingly good outcome in antenatal diagnosis of severe hydrocephalus related to CCDC88C deficiency

Non-syndromic congenital hydrocephalus is aetiologically diverse and while a genetic cause is frequently suspected, it often cannot be confirmed. The most common genetic cause is L1CAM-related X-linked hydrocephalus and that explains only 5%–10% of all male cases. This underlines a current limitation in our understanding of the genetic burden of non-syndromic congenital hydrocephalus, especially for those cases with likely autosomal recessive inheritance. Additionally, the prognosis for most cases of severe congenital hydrocephalus is poor, with most of the surviving infants displaying significant intellectual impairment despite surgical intervention. It is for this reason that couples with an antenatal diagnosis of severe hydrocephalus are given the option, and may opt, for termination of the pregnancy. We present two families with CCDC88C-related recessive congenital hydrocephalus with children who had severe hydrocephalus. Those individuals who were shunted within the first few weeks of life, who did not require multiple surgical revisions, and who had a more distal truncating variant of the CCDC88C gene met their early childhood developmental milestones in some cases. This suggests that children with CCDC88C-related autosomal recessive hydrocephalus can have normal developmental outcomes under certain circumstances. We recommend CCDC88C analysis in cases of severe non-syndromic congenital hydrocephalus, especially when aqueduct stenosis with or without a medial diverticulum is seen, in order to aid prognosis discussion.

Uptake and predictors of early postnatal follow-up care amongst mother-baby pairs in South Africa: Results from three population-based surveys, 2010-2013.

BackgroundAchieving World Health Organization (WHO) recommendations for postnatal care (PNC) within the first few weeks of life is vital to eliminating early mother–to–child transmission of HIV (MTCT) and improving infant health. Almost half of the annual global deaths among children under five occur during the first six weeks of life. This study aims to identify uptake of three PNC visits within the first six weeks of life as recommended by WHO among South African mother–infant pairs, and factors associated with uptake.MethodsWe analyzed data from three facility–based, nationally representative surveys (2010, 2011/12 and 2012/13) primarily designed to determine the effectiveness of the South African program to prevent MTCT. This analysis describes the proportion of infants achieving the WHO recommendation of at least 3 PNC visits. Interviews from 27 699 HIV–negative and HIV–positive mothers of infants aged 4–8 weeks receiving their six week immunization were included in analysis. Data were analyzed using STATA 13.0 and weighted for sample ascertainment and South African live births. We fitted a multivariable logistic regression model to estimate factors associated with early PNC uptake.ResultsOver half (59.6%, 95% confidence interval (CI) = 59.0–60.3) of mother–infant pairs received the recommended three PNC visits during the first 6 weeks; uptake was 63.1% (95% CI = 61.9–64.3) amongst HIV exposed infants and 58.1% (95% CI = 57.3–58.9) amongst HIV unexposed infants. Uptake of early PNC improved significantly with each survey, but varied significantly by province. Multivariable analysis of the pooled data, controlling for survey year, demonstrated that number of antenatal visits (4+ vs <4 Adjusted odds ratio (aOR) = 1.13, 95% CI = 1.04–1.23), timing of initial antenatal visits (≤12 weeks vs >12 weeks, aOR = 1.13, 95% CI = 1.04–1.23), place of delivery (clinic vs hospital aOR = 1.5, 1.3–1.6), and infant HIV exposure (exposed vs unexposed aOR = 1.2, 95% CI = 1.1–1.2) were the key factors associated with receiving recommended PNC visits.ConclusionsApproximately 40% of neonates did not receive three or more postnatal care visits in the first 6 weeks of life from 2010–2013. To improve uptake of early PNC, early antenatal booking, more frequent antenatal care attendance, and attention to HIV negative women is needed.

Disruption of Trim9 function abrogates macrophage motility in vivo.

The vertebrate immune response comprises multiple molecular and cellular components that interface to provide defense against pathogens. Because of the dynamic complexity of the immune system and its interdependent innate and adaptive functionality, an understanding of the whole-organism response to pathogen exposure remains unresolved. Zebrafish larvae provide a unique model for overcoming this obstacle, because larvae are protected against pathogens while lacking a functional adaptive immune system during the first few weeks of life. Zebrafish larvae were exposed to immune agonists for various lengths of time, and a microarray transcriptome analysis was executed. This strategy identified known immune response genes, as well as genes with unknown immune function, including the E3 ubiquitin ligase tripartite motif-9 (Trim9). Although trim9 expression was originally described as "brain specific," its expression has been reported in stimulated human Mϕs. In this study, we found elevated levels of trim9 transcripts in vivo in zebrafish Mϕs after immune stimulation. Trim9 has been implicated in axonal migration, and we therefore investigated the impact of Trim9 disruption on Mϕ motility and found that Mϕ chemotaxis and cellular architecture are subsequently impaired in vivo. These results demonstrate that Trim9 mediates cellular movement and migration in Mϕs as well as neurons.

Cradling Bias Occurrence and Purpose

Maternal cradling bias is the act of human females to tend to cradle newborns to the left side in the first few weeks of life. Many factors contributing to the occurrence of leftward cradling bias have been explored including handedness and hemispheric dominance, neural development in neonates, breast-feeding influences and early communicative acts [1-7]. Accepted best practices for developmental support for premature infants incorporate positioning and holding neonates in their protocols [8,9]. Questions as to what function leftward cradling serves and what impact it has on the developmental trajectory of the infant in the first few weeks of life is the subject of much research [1,10-13]. This paper will review the literature focusing on maternal cradling bias and explore implications on best practices for pediatric professionals.

Congenital melanocytic nevus mimicking a turban tumour in an 18-year-old Filipino male

Congenital melanocytic nevi (CMN) are nevi that are present at birth or arise within the first few weeks of life. They are often found on the trunk, head and neck...

Study of Thyroid Hormone Status in Normal Newborn and Preterm, Low Birth Weight Baby

Background: Screening for thyroid hormones in the newborn baby is extremely important to detect the newborns who are borned with hypofunctional state of thyroid gland. This screening program in first few weeks of life is essential to prevent serious complications of hypothyroidism in future such as mental retardation.Objective: To assess the thyroid hormone levels in normal newborn and preterm, low birth weight babies and comparison of thyroid dysfunction between these two groups.Method: This cross - sectional analytical type of study was conducted in the department of physiology and paediatrics of Rajshahi Medical College &amp; Hospital (RMCH) from July 2015 to June 2016. A total of 70 newborn baby were enrolled by systematic sampling of which 40 were normal healthy newborn and 30 were preterm, low birth weight babies. Data was collected from the parents and they were filled out standard questionnaire. Then venous blood was collected from each and every neonate and blood was sent to laboratory for estimation of thyroid hormone levels. FT4 and TSH values were estimated as these two are the most important parameters for determination of thyroid function.Result: In this study, the mean (±SD) serum FT4 level in term and preterm neonates were 14.17±2.14 and 12.25±3.16 (pg/ml) respectively. This FT4 value is significantly higher in term neonates than preterm neonates (P&lt;0.05). The mean (±SD) serum TSH level in term and preterm neonates were 3.37±2.12 and 4.23±3.23 (?IU/ml) respectively. Statistically there was no significant difference in TSH values between these two groups (P 0.05).Conclusion: From this study it was evident that preterm, low birth weight babies are more likely to develop hypofunctional state of thyroid gland than normal term babies. The newborns who were found hypothyroid, were informed to their parents for consultation with the concerned physicians. The physicians then took necessary steps to correct the hypofunctional state of thyroid gland.KYAMC Journal Vol. 7, No.-2, Jan 2017, Page 787-790