Healthy Term Neonates Research Articles

Reference Values of Thromboelastometry Parameters in Healthy Term Neonates Using NATEM in Cord Blood Samples.

Background: ROTEM assay has gained increasing acceptance as a method for rapid and specific coagulation pathway assessment. However, its use in the neonatal population remains limited since reference ranges have not yet been established. Aims: (1) to determine reference ranges for healthy term neonates of ROTEM parameters using non-activated assay (NATEM) in cord blood samples; (2) to assess whether delivery mode, gender, gestational age, birth weight and blood group (ABO and Rhesus) of the neonate, coagulation disorder and anticoagulant medication of the mother have an impact on NATEM parameters. Methods: NATEM assay was conducted in cord blood samples of 189 term neonates without any medical history. Results: Reference ranges (2.5th and 97.5th percentiles) are established for clotting time (CT), clot formation time (CFT), α-angle, clot amplitude at 5, 10 and 20 min (A5, A10, A20), maximum clot firmness (MCF), lysis index at 30 and 60 min (LI30, LI60, %) and maximum clot elasticity (MCE). Reference ranges for NATEM are CT 182–499 s, CFT 63–176 s, α-angle 58–78°, A5 28–52 mm, A10 37–61 mm, A20 42–66 mm, MCF 43–67 mm, LI30 97–100%, LI60 87–98% and MCE 75–203. Male neonates appear to be more hypocoagulable than females. Conclusions: We demonstrate reference ranges for healthy term neonates in NATEM assay that could be used as a reference group for future studies of neonates with an underlying pathology.

Effect of Intravenous Fluid Adjuvant Therapy on Decreasing Serum Bilirubin during Intensive Phototherapy in Healthy Term Neonate with Severe Nonhemolytic Hyperbilirubinemia.

Phototherapy is the most common form of treatment and prevention of neonatal nonconjugated hyperbilirubinemia. It seems that intravenous fluid therapy as a complementary method of phototherapy can accelerate the healing process in affected infants. This study aimed at investigating intravenous fluid therapy's effect in decreasing serum bilirubin in healthy term neonates with nonhemolytic hyperbilirubinemia under intensive phototherapy. As many as 160 healthy term infants with severe nonhemolytic hyperbilirubinemia and without exclusion criteria were enrolled. Infants were randomized to the two treatment groups (phototherapy alone and combination with intravenous fluid therapy). Serum bilirubin at admission time, 6, 12, 24, and 48 h later were measured. We evaluated decreasing serum bilirubin levels and duration of hospitalization in both groups. In this study, the mean levels of serum bilirubin on admission time, 6, 12, 24, and 48 h after treatment gradually reduced in both groups; still, the decrease was not statistically significant between the two groups. Intravenous fluids therapy does not have a significant advantage in the process of phototherapy in healthy term neonates with severe nonhemolytic hyperbilirubinemia.

Roles of Probiotics in Reduction of Neonatal Jaundice in Term Newborns.

the primary objective was to examine the effect of Bifidobacterium on decreasing the bilirubin level in term neonates delivered by Caesarean Section (CS). A total of 153 healthy term neonates delivered by CS were included in this study and were divided into the non-probiotic group (n=99) and probiotic group (n=54) based on the history of probiotics administration. There were no infants who underwent phototherapy. A total of 20 doses of probiotics were given orally from the first day of life. The transcutaneous bilirubin (TcB) levels were measured every day for the first 5 days of life. Data of each infant and mother were gathered from medical records. The bilirubin level per day (day-1 to day-5) in the non-probiotic group was no different from the probiotic group. Differences in bilirubin level between day-5 and day-1, and also between day-5 and day-2 were not different between the two groups. There was a significant (p = 0.03) body weight gain in the probiotic groups with a mean of 36.09 ± 8.23 gram/day. No obvious adverse reactions were seen in both the non-probiotic group and probiotic group. Our findings suggest no significant effects of probiotics on lowering bilirubin levels in the first five days of life. Also, probiotics have a positive effect on body weight gain in healthy term infants, and it is safe to be given to newborns.

Neonatal intestinal malrotation: A diagnostic pitfall

Intestinal malrotation is a rare abnormality, resulting in intestinal malrotation and impaired fixation. This clinical entity encompasses spectrum of anatomical conditions and associated clinical disorders. Main symptoms of intestinal obstruction related to malrotation are sudden bilious emesis in a previously healthy term neonate. Upper gastrointestinal (UGI) contrast study is the examination of choice and remains as gold standard for intestinal malrotation. With 90% positive predictive value, misdiagnosis in rotational abnormalities could still happen in UGI contrast study. We report a case of pitfall diagnosis in an 8-day-old male neonate, in which obstruction has been misinterpreted as duodenal web rather than malrotation that was furthered found during surgery.

Risk factors for early hyperbilirubinemia in neonates: A cross-sectional study

Background: Neonatal hyperbilirubinemia is a commonly encountered problem in the early neonatal period. Hence, this study was undertaken in babies with significant hyperbilirubinemia to find out the factors which had caused an early rise of bilirubin (≤48 h) in some neonates compared to those who develop hyperbilirubinemia by 72 h. Factors that can predict early hyperbilirubinemia will help in early intervention.Methodology: This cross-sectional study was conducted in the neonatal intensive care unit of a tertiary care center from March 2021 to January 2022 among 405 healthy term neonates with significant hyperbilirubinemia. Serum bilirubin values were routinely done at 72 h, and earlier at 48 h if clinical icterus was noted by Kramer's rule and divided into two groups – one with hyperbilirubinemia at 48 h and another with hyperbilirubinemia by 72 h. Statistical analysis was done to find out the factors which could predict early hyperbilirubinemia.Results: Of the 405 neonates with significant hyperbilirubinemia, 270 (66.6%) had early hyperbilirubinemia and 135 (33.3%) had hyperbilirubinemia by 72 h. There were no statistically significant differences between the two groups with respect to sex, birth weight, mode of delivery, and baby blood group. Forty-two (49.4%) neonates with umbilical cord bilirubin (UCB) <2 mg/dl, 113 (65.6%) with UCB 2–2.5 mg/dl, 75 (72.1%) with UCB 2.5–3 mg/dl, 34 (89.5%) with UCB 3–3.5 mg/dl, and 6 (100%) with UCB >3.5 mg/dl developed early hyperbilirubinemia. Sixty-four (79%) neonates with bilirubin–albumin ratio (BAR) ≥0.79 developed early hyperbilirubinemia compared to 206 (63.6%) neonates with BAR <0.79 who had early hyperbilirubinemia.Conclusions: The UCB and bilirubin–albumin ratio correlated well with the development of early hyperbilirubinemia. Hence, it was concluded that those babies with a high UCB >2.1 mg/dl and/or high BAR ≥0.79 should be screened early for the development of hyperbilirubinemia.

Study of hemoglobin and red blood cell indices during first week of life in normal term neonates

Background: Transition from foetal to neonatal life is associated with major changes in hemogram due to homeostatic control. There are very wide ranges of hemogram levels that seem to be abnormally high or low in healthy term neonate at birth and during first week of life but these were actually normal for that neonatal period depending upon gestational and post-natal age.Method: Hemogram was studied in 100 normal term neonates born in RNT medical college during June 2009 to Dec 2009.Results: The ranges of various hemogram indices at birth, 24 hours, 48 hours and 7 days are as follows: Hemoglobin 12.2-23.2 gm/dl, 11.6-22.8 gm/dl, 11.5-21.3 gm/dl and 11.3-21.3 gm/dl respectively. Hematocrit 36.8-64.3%, 35.2-61.3%, 34.4-60.6% and 32.2-60.1% respectively. Mean corpuscular volume (MCV) 82.2-126.5 fl, 82.5-126.1 fl, 82.1-126.3 fl and 80.5-126.4 fl respectively. Mean corpuscular hemoglobin (MCH) 26.2-40.9 pg, 26.0-39.7 pg, 26-40.5 pg and 25.4-39.4 pg respectively. MCH concentration (MCHC) 29.6-38 g/dl, 28.5-37.7 g/dl, 28.4-38.6 g/dl and 28.4-38.5 g/dl respectively. Total red blood cell count (TRBC) 3.7-6.9×106/µl, 3.3-6.9×106/µl, 3.3-6.7×106/µl and 3.3-6.3×106/µl respectively.Conclusions: Hemoglobin level falls in early life in healthy term neonate. Also, there is wide range of RBC parameters in healthy term neonates. The normal values of hemogram in neonates are different from other age groups and it varies with postnatal age and gestational age. A reference range derived from large neonatal datasets of varied gestational and postnatal age should be used such as those presented here for healthy term neonates.

Effectiveness of short duration phototherapy in government hospital setup

Background: Neonatal hyperbilirubinemia is most common presentation of neonates. Phototherapy remains standard treatment for neonatal hyperbilirubinemia. Overcrowding in government hospital makes it difficult to give phototherapy for more than 1-2 days. The objectives of the study were to determine the effectiveness of short duration of phototherapy in treating hyperbilirubinemia and to determine the risk of rebound hyperbilirubinemia.Methods: Study was hospital based retrospective study. The study place was GIMS kalaburagi. The study was conducted from September 2019 to December 2019. All healthy full-term neonates with serum bilirubin above cut off range according to (American academy of pediatrics) nomogram were included in the study. Requirement of phototherapy was decided on serum bilirubin levels as per AAP (American academy of pediatrics) nomogram. Phototherapy was used as treatment modality.Results: Total 110 neonates were included in the study. Total of 56 neonates (50.9%) required 1 day of phototherapy to fall within normal limits for discharge and 46 neonates (41.8%) required 2 days of phototherapy to fall within normal limits for discharge with a significant p&lt;0.05. Rebound hyperbilirubinemia requiring repeat phototherapy was seen in 6(10%) neonates who were discharged after 1 day of phototherapy and in 5 neonates (10%) who were discharged after 1 day of phototherapy with a p value of 0.05.Conclusions: Short duration phototherapy is the effective means of treatment for most neonates in government hospital set up. Serum bilirubin has to be reviewed during follow up to assess rebound hyperbilirunemia.

Increased Risk for Cerebral Hypoxia During Immediate Neonatal Transition After Birth in Term Neonates Delivered by Caesarean Section With Prenatal Tobacco Exposure.

Introduction: Maternal tobacco smoking during pregnancy is a global health problem leading to an increased risk for fetal and neonatal morbidities. So far, there are no data of the potential impact of maternal smoking during pregnancy on the most vulnerable period after birth – the immediate postnatal transition. The aim of the present study was therefore, to compare cerebral oxygenation during immediate postnatal transition in term neonates with and without prenatal tobacco exposure.Methods: Included in this post-hoc analysis were healthy term neonates, with measurements of cerebral oxygenation (INVOS 5100C) during the first 15 min after birth, and for whom information on maternal smoking behavior during pregnancy was available. Neonates with prenatal tobacco exposure (smoking group) were matched 1:1 according to gestational age (±1 week), birth weight (±100 grams) and hematocrit (±5 %) to neonates without (non-smoking group). Cerebral regional tissue oxygen saturation (crSO2), cerebral fractional tissue oxygen extraction (cFTOE), arterial oxygen saturation (SpO2) and heart rate (HR) within the first 15 min after birth were compared between the two groups.Results: Twelve neonates in the smoking group with a median (IQR) gestational age of 39.1 (38.8–39.3) weeks and a birth weight of 3,155 (2,970–3,472) grams were compared to 12 neonates in the non-smoking group with 39.1 (38.7–39.2) weeks and 3,134 (2,963–3,465) grams. In the smoking group, crSO2 was significantly lower and cFTOE significantly higher until min 5 after birth. HR was significantly higher in the smoking group in min 3 after birth. Beyond this period, there were no significant differences between the two groups.Conclusion: Cerebral oxygenation within the first 5 min after birth was compromised in neonates with prenatal tobacco exposure. This observation suggests a higher risk for cerebral hypoxia immediately after birth due to fetal tobacco exposure.

Asociación entre el vínculo madre-hijo y los síntomas depresivos en madres de la Unidad de Cuidados Intensivos Neonatales: estudio caso-control

ObjectivesMaternal perinatal depression has been associated with impaired mother-infant bonding. The adverse effect of this impaired bonding has been reported. This study aimed to investigate and compare the posnatal depressive symptoms and the mother-infant bonding in a Neonatal Intensive Care Unit (NICU) and of mothers with healthy newborns respectively. Secondly, was to explore the association between depressive symptomatology and bonding in both groups. MethodsIn this case study, mothers in the early pospartum period who gave birth in the same perinatal center of Greece were recruited to participate. The cases consisted of 88 mothers of neonates who were hospitalized in the NICU and controls were 100 mothers of full-term healthy neonates. For the collection of the data questionnaires including demographics and perinatal variables were used. For the bonding and posnatal assessment, the Mother to Infant Bonding Scale, the Postpartum Bonding Questionnaire, and the Hospital Anxiety and Depression Scale were used. ResultsThere was a significant difference between the mean of bonding scores of NICU mothers and the control group (t=-2.696, P=.008). NICU mothers presented lower scores in bonding with the newborn compared to the control group and presented higher depression scores compared to those of controls (χ2=28.588, P=.000). The depression scores were correlated with bonding scores in both groups. DiscussionA NICU admission has an impact on bonding and in some way interacts with maternal pospartum mental health, therefore more research is needed. ConclusionsNICU mothers have been presented as more vulnerable than mothers of healthy infants since they expressed a lower mother-infant bonding and higher depression scores. The support of these vulnerable mothers and the facilitation of mother-infant bonding by the NICU staff is of utmost importance.

Functional near-infrared spectroscopy to assess pain in neonatal circumcisions.

Pain assessment is challenging in neonates. Behavioral and physiological pain scales do not assess neocortical nociception, essential to pain encoding and central pain pathway development. Functional near-infrared spectroscopy (fNIRS) can assess neocortical activation to noxious stimuli from changes in oxy-(HbO) and total-hemoglobin concentrations (HbT). This study aims to assess fNIRS nociceptive functional activation in the prefrontal cortex of neonates undergoing circumcision through changes in HbO and HbT, and the correlation between changes in fNIRS and Neonatal Infant Pain Scale (NIPS), a behavioral pain assessment scale. In healthy term neonates, HbO, HbT, and NIPS were recorded during sequential circumcision events 1-Prep before local anesthetic injection; 2-Local anesthetic injection; 3-Prep before incision; 4-Oral sucrose; 5-Incision; 6-Gomco (hemostatic device) attached; 7-Gomco twisted on; and 8-Gomco removed. fNIRS and NIPS changes after each event were assessed with Wilcoxon signed-rank test and summarized as median and interquartile range (IQR). Changes in fNIRS vs. NIPS were correlated with Spearman coefficient. In 31 neonates fNIRS increased (median [IQR] µmol/L) with noxious events: Local injection (HbO: 1.1 [0.5, 3.1],p<.001; HbT: 2.3 [0.2, 7.6],p<.001), Gomco attached (HbO: 0.7 [0.1, 1.7],p=.002; HbT: 0.7 [-0.2, 2.9],p=.02), and Gomco twisted on (HbO: 0.5 [-0.2, 1.7],p=.03; HbT: 0.8 [-0.1, 3.3],p=.02). fNIRS decreased with non-noxious event: Prep before incision (HbO: -0.6 [-1.2, -0.2]p<.001; HbT: -1 [-1.8, -0.4],p<.001). Local anesthetic attenuated fNIRS increases to subsequent sharp stimuli. NIPS increased with subsequent sharp stimuli despite local anesthetic. Although fNIRS and NIPS changed in the same direction, there was not a strong correlation between them. During neonatal circumcision, changes in fNIRS differed between different types of painful stimuli, which was not the case for NIPS, suggesting that fNIRS may complement NIPS to assess the quality of pain.

Pregnancy outcome in women with childhood onset autoimmune hepatitis and autoimmune sclerosing cholangitis on long-term immunosuppressive treatment

IntroductionAutoimmune hepatitis and autoimmune sclerosing cholangitis may lead to maternal and fetal complications in pregnant women diagnosed during childhood and treated long-term with immunosuppressive drugs. Immunosuppressive treatment with azathioprine is usually employed during pregnancy to maintain remission but his safety is still controversial. The aim of our study is to investigate pregnancy outcomes after maternal long-term immunosuppressive treatment for autoimmune hepatitis/sclerosing cholangitis. MethodsWe conducted a retrospective cohort study including all pregnant women who received a diagnosis of autoimmune hepatitis or autoimmune sclerosing cholangitis during childhood and followed-up from 1989 to 2021. ResultsFifteen pregnancies in 12 women were observed. The median follow-up from disease onset was 26.7 years. All patients had been treated with prednisone and azathioprine (AZA) as first line therapy. At the beginning of the pregnancy, 11/12 (91.6%) patients were in spontaneous or pharmacologically induced clinical and biochemical remission and one had received a liver transplant. During pregnancy, 8 patients continued azathioprine. No relapse during pregnancy occurred in any patient. One woman presented a flare five months after delivery and a second one, one year after delivery when AZA was discontinued. The 15 pregnancies resulted in 13 livebirths (86.6%) with 9 (69.2%) full-term healthy neonates. Two miscarriages (13.3%) were recorded and cesarean section was performed in 3 women (23%). No congenital malformations were observed. ConclusionsPregnancy in women diagnosed during pediatric age with autoimmune hepatitis or autoimmune sclerosing cholangitis and treated long-term with immunosuppressants is possible with good maternal and neonatal outcomes. Azathioprine allows, in most cases, to maintain remission with a good safety profile. Careful monitoring of these patients during pregnancy is, however, mandatory.

Quantification of androgens and their precursors in full-term human placenta.

The two major androgens in humans are testosterone (T) and dihydrotestosterone (DHT). DHT is produced via the classical, backdoor, and alternative steroidogenic pathways. In addition, recent studies have identified C11-oxy C19 steroids as novel human androgens. Although the placenta is known to be involved in steroid metabolism, androgen levels in full-term placentas have poorly been investigated. Ten placentas of healthy full-term neonates (five males and five females) were examined. We quantified progesterone, androstenedione (A4), T, allopregnanolone, androsterone, and estradiol, as well as four C11-oxy androgens (11β-hydroxyandrostenedione, 11β-hydroxytestosterone, 11-ketoandrostenedione (11KA4), and 11-ketotestosterone (11KT)), using liquid chromatography-tandem mass spectrometry. In all samples, levels of the ten steroids were above the detection limit. Progesterone was by far most abundant, while levels of T and androsterone were relatively low. Levels of 11KT and 11KA4 were higher than those of T and A4, respectively. There were no differences in steroid levels between male and female samples. This study demonstrates that full-term placentas contain several steroids in the classical, backdoor, and alternative pathways. Placentas are likely to function as the supplier of progesterone to other steroidogenic tissues. More importantly, we found that placentas comprise relatively large amounts of 11KA4 and 11KT, which may be produced through steroid transfer from the adrenal gland or from the maternal circulation. These results indicate that the placenta participates in a feto-maternal multi-organ network for androgen biosynthesis.

Single-surface Intensive Phototherapy or Double-Surface Intensive Phototherapy in Neonatal Non-Hemolytic Hyperbilirubinemia: A Comparison of Effectiveness and Complications.

Background: Severe indirect hyperbilirubinemia causes neurotoxicity, leading to potential permanent injuries to the neonatal nervous system. The present study intended to compare the effectiveness and complications of Single-Surface Intensive Phototherapy (SSIP) and Double-Surface Intensive Phototherapy (DSIP) in treating non-hemolytic hyperbilirubinemia in the neonatal ward of the Besat Hospital, Hamadan, Iran. Methods: In this prospective randomized clinical trial, 150 healthy full-term neonates born between 37-42 weeks gestation with ages <14 days old and birth weights ≥2500 gr who were affected by non-hemolytic hyperbilirubinemia with total serum bilirubin of 15-20 mg/dL were randomly allocated to two groups. Each group (n=75) underwent either SSIP or DSIP. Demographics, bilirubin level alterations, weight, platelet count, number of defecation per day, and body temperature of the patients were monitored and recorded in a specific questionnaire. Data analysis was performed using SPSS version 26.0 software, with the Chi-square and independent t-test. Results: The pre-intervention levels of indirect bilirubin were 17.07±1.46 mg/dL in the SSIP group and 17.10±1.54 mg/dL in the DSIP group (P-value = 0.853). After 24 and 48 hours of treatment, the mean indirect bilirubin level of the SSIP group reduced to 13.12±1.71 mg/dL and 9.69±1.68 mg/dL, respectively. In the DSIP group, the levels were 11.85±2.17 mg/dL and 8.43±1.56 mg/dL after 24 and 48 hours of treatment, respectively. The absolute reductions of indirect bilirubin were 7.76±3.28 mg/dL for the SSIP group and 8.96±4.49 mg/dL for the DSIP group (P-value = 0.458). Therefore, the indirect bilirubin levels were significantly different between the groups after 24 and 48 hours of treatment and at the time of discharge (P<0.05). There were no significant inter-group differences in weight, platelet count, and incidence of skin rash, while the number of defecation and body temperature were higher in the DSIP group (P <0.05). However, body temperature alterations had no clinical relevance. Conclusion: Compared to the SSIP, the DSIP showed faster effectiveness and led to a shorter hospital stay, while it did not entail higher levels of complications.

Systematic Review of Neonatal Pain Management with 25% Dextrose Versus Direct Breast Feed Milk During Painful Procedure

This systematic review is the product of 25 top published journals. The search engines adopted in this study werePubMed, Medline, CINHAL, Cochrane Library, Google Scholar, and Research gate. The inclusion criteria were:1.Papers published between 2000-2020, 2.Top tier journal articles (High quality), 3. Term Healthy neonates and preterm neonates, 4.Neonates undergoing various painful procedures and Neonates receive different pain relief interventions. The key searching words were Neonates, Painful Procedures, BCG Vaccination, 25% Dextrose. The present paper highlights that 25% dextrose and direct breastfeed milk relieves neonatal pain. The gate-control theory also discusses the idea of central control through modulation of nerve impulses in descending fibbers from the brain. The gate tends to close when cognitive activities such as distraction (e.g., breastfeeding) are processed along these fibres, therefore preventing the transmission of pain through a “descending blocking action.” This mechanism also affects various pain entities such as anxiety, anticipation, and memory of prior experiences.This paper shows the research gaps from different studies in the review of the literature. In this present study of systematic review, 25 recent multiple interventions based on RCTs studies between 2010 to 2020 were systematically reviewed using the keywords search method. The findings are discussed and research gaps related to the RCTs are listed accordingly.

Neonatal encephalopathy plasma metabolites are associated with neurodevelopmental outcomes.

Background:To investigate mechanisms of injury and recovery in neonatal encephalopathy (NE), we performed targeted metabolomic analysis of plasma using LC/MS/MS from healthy term neonates or neonates with NE.Methods:Plasma samples from the NE (n=45, day of life 0–1) or healthy neonatal (n=30, ≥36 weeks’ gestation) cohorts had LC/MS/MS metabolomic profiling with a 193-plex targeted metabolite assay covering >366 metabolic pathways. Metabolite levels were compared to two-year neurodevelopmental outcomes measured by the Bayley Scales of Infant and Toddler Development III (Bayley-III).Results:57/193 metabolites met pre-defined quality control criteria for analysis. Significant (after FDR correction) KEGG pathways included aminoacyl-tRNA biosynthesis, arginine biosynthesis, and metabolism of multiple amino acids. Significant disease pathways included seizures. In regression models, histidine and C6 sugar amine were significantly associated with cognitive, motor, and language and betaine with cognitive and motor Bayley-III composite scores. Addition of histidine, C6 sugar amine, and betaine to a Sarnat score based clinical regression model significantly improved model performance (AIC and adjusted r2) for Bayley-III cognitive, motor, and language scores.Conclusion:Plasma metabolites may help to predict neurological outcomes in neonatal brain injury and enhance current clinical predictors.

Maternal Obesity during Pregnancy is Associated with Lower Cortical Thickness in the Neonate Brain.

Recent studies have suggested that maternal obesity during pregnancy is associated with differences in neurodevelopmental outcomes in children. In this study, we aimed to investigate the relationships between maternal obesity during pregnancy and neonatal brain cortical development. Forty-four healthy women (28 normal-weight, 16 obese) were prospectively recruited at <10 weeks' gestation, and their healthy full-term neonates (23 boys, 21 girls) underwent brain MR imaging. All pregnant women had their body composition (fat mass percentage) measured at ∼12 weeks of pregnancy. All neonates were scanned at ∼2 weeks of age during natural sleep without sedation, and their 3D T1-weighted images were postprocessed by the new iBEAT2.0 software. Brain MR imaging segmentation and cortical surface reconstruction and parcellation were completed using age-appropriate templates. Mean cortical thickness for 34 regions in each brain hemisphere defined by the UNC Neonatal Cortical Surface Atlas was measured, compared between groups, and correlated with maternal body fat mass percentage, controlled for neonate sex and race, postmenstrual age at MR imaging, maternal age at pregnancy, and the maternal intelligence quotient and education. Neonates born to obese mothers showed significantly lower (P ≤ .05, false discovery rate-corrected) cortical thickness in the left pars opercularis gyrus, left pars triangularis gyrus, and left rostral middle frontal gyrus. Mean cortical thickness in these frontal lobe regions negatively correlated (R = -0.34, P = .04; R = -0.50, P = .001; and R = -0.42, P = .01; respectively) with the maternal body fat mass percentage measured at early pregnancy. Maternal obesity during pregnancy is associated with lower neonate brain cortical thickness in several frontal lobe regions important for language and executive functions.

Unexpected inconsistency of cranial MRI and cranial US measurements: new normative values in the neonatal period

Cranial ultrasonography (US) enables diff erentiation of normal from abnormal in a reasonable scanning time and without radiation. However, there is not enough data comparing measurements of cranial US and magnetic resonance imaging (MRI) for some intracranial structures in the neonatal period. We aimed to assess the reliability of cranial US compared with brain MRI. We also sought reference values of the pituitary gland and infundibulum, which is important in searching for growth retardation or abnormal growth in this population. Normative measurements of the width of the 4th, 3rd and lateral ventricles, length and width of the corpus callosum (CC), biventricular width (BVW), and biparietal diameter (BPD) were prospectively obtained from 95 healthy fullterm neonates on both cranial US and brain MRI. Besides the well-known structures, the height of the pituitary gland, thickness of the infundibulum, height and width of the cerebellum were measured on MRI. Comparison of cranial US and brain MRI showed good correlation in the BPD, width of the splenium and genu of CC, anteroposterior length of CC, and width of the 3rd ventricle (κ=0.88- 0.99). Correlation was poor in BVW, width of the corpus of CC, and width of the lateral ventricles (κ=0.28-0.56). New normative values of the height of pituitary gland and thickness of the stalk in the neonatal period are novel fi ndings of this prospective study. In conclusion, cranial US and MRI measurements were not consistent in some brain structures. It is crucial to know the normative values, and to diff erentiate congenital and developmental brain anomalies in the neonatal period. The new reference values of the pituitary gland and infundibulum were also established in this period. Key words: MAGNETIC RESONANCE IMAGING; INFANT, NEWBORN; PEDIATRICS; ULTRASONOGRAPHY

Increased circulating cytokeratin 19 fragment levels in preterm neonates receiving mechanical ventilation are associated with poor outcome.

Invasive mechanical ventilation and oxygen toxicity are postnatal contributors to chronic lung disease of prematurity, also known as bronchopulmonary dysplasia (BPD). Cyfra 21-1 is a soluble fragment of cytokeratin 19, which belongs to the cytoskeleton stabilizing epithelial intermediate filaments. As a biomarker of structural integrity, Cyfra 21-1 might be associated with airway injury and lung hypoplasia in neonates. Serum Cyfra 21-1 concentrations for 80 preterm and 80 healthy term newborns were measured within 48 h after birth. Preterm infants with the combined endpoint BPD/mortality had significantly higher Cyfra 21-1 levels compared with those without fulfilling BPD/mortality criteria (P = 0.01). Also, severe RDS (>grade III) was associated with higher Cyfra levels (P = 0.01). Total duration of oxygen therapy was more than five times longer in neonates with high Cyfra 21-1 levels (P = 0.01). Infants with higher Cyfra 21-1 values were more likely to receive mechanical ventilation (50% vs. 17.5%). However, the duration of mechanical ventilation was similar between groups. The median Cyfra value was 1.93 ng/mL (IQR: 1.68-2.53 ng/mL) in healthy term neonates and 8.5 ng/mL (IQR: 3.6-16.0 ng/mL) in preterm infants. Using ROC analysis, we calculated a Cyfra cutoff > 8.5 ng/mL to predict BPD/death with an AUC of 0.795 (P = 0.004), a sensitivity of 88.9%, and a specificity of 55%. Mortality was predicted with a cutoff > 17.4 ng/mL (AUC: 0.94; P = 0.001), a sensitivity of 100%, and a specificity of 84%. These findings suggest that Cyfra 21-1 concentration might be useful to predict poor outcome in premature infants.

Cerebral hemodynamics during neonatal transition according to mode of delivery

Cerebral haemodynamics during the immediate transition period in neonates may differ depending on whether delivery is vaginal or by caesarean section. However, these differences have never been confirmed by near-infrared time-resolved spectroscopy (TRS). Therefore, the purpose of this study was to compare cerebral blood volume (CBV) and cerebral haemoglobin oxygen saturation (ScO2) between healthy term neonates by mode of delivery. Subjects were 31 healthy term neonates who did not require resuscitation. Thirteen neonates were delivered vaginally (VD group) and 18 were delivered by elective caesarean section (CS group). Absolute oxyhaemoglobin, deoxyhaemoglobin, and total haemoglobin concentrations were measured continuously by TRS; oxyHb × 100/totalHb (ScO2) (%) and CBV (mL/100 g brain tissue) were also calculated. Measurements were started as soon as possible after birth, obtained from 1 to 2 min after birth, and continued until 15 min after birth. CBV was significantly higher in the VD group than in the CS group in the 4 min after birth but not thereafter. There were no significant between-group differences in ScO2 and SpO2. These findings indicate that there is a difference in cerebral haemodynamic patterns in the first 4 min after delivery between term neonates by mode of delivery when CBV is monitored by TRS.

Adrenal steroids reference ranges in infancy determined by LC-MS/MS

Interpretation of the results of steroid hormone measurements is challenging at early infancy. The liquid chromatography-tandem mass spectrometry (LC-MS/MS) method provides a powerful tool for diagnosing steroidogenesis disorders. We aimed to develop normative data for a 14-steroid panel and four adrenal enzyme activity indices, determined by LC-MS/MS from 3 days to 6 months of age. Age- and sex-specific plasma steroid concentrations were calculated in 324 healthy full-term neonates and infants (151 females). Percentile curves were devised. Steroid ratios were evaluated as biomarkers of adrenal enzyme activities. The steroid profiles of four patients with adrenal enzyme deficiencies were included to test the diagnostic efficiency. Nine steroids showed age, but none showed sex specificity. The concentrations of progestins and androgens were higher at 7-14 days than at 3-7 days. After the first month, adrenal androgen concentrations decreased significantly. Adrenal enzyme activities changed towards increasing cortisol over the first 6 months. There were several-fold differences in diagnostic steroids and related adrenal enzyme activity indices between the patients and the healthy group. The majority of adrenal steroids show age-related variations in the neonatal period and early infancy. Our data will enable accurate interpretation of steroid measurements for etiologic diagnosis of disorders of steroidogenesis. LC-MS/MS method is capable of quantitating numerous analytes simultaneously, which provides an integrated picture of adrenal steroidogenesis in a small amount of sample. The development of LC-MS/MS-based normative data of steroid hormones in healthy infants is crucial to differentiate physiologic alterations from steroidogenic defects during the first 3-6 months of infancy. Previous studies had limitations due to the small numbers of samples available by sex and by age groups. Our detailed normative data and percentile curves will enable accurate interpretation of steroid measurements for etiologic diagnosis of disorders of steroidogenesis without the need for further invasive testing.