Healthy Term Neonates Research Articles

Сучасний підхід до діагностики серцево-судинних розладів у новонароджених із груп перинатального ризику в неонатальний період

З метою удосконалення та систематизування підходу до діагностики серцево-судинних розладів у новонароджених шляхом комплексної оцінки допплерехокардіографічних параметрів, біохімічних маркерів (рівень лактатдегідрогенази, γ-глутамілтрансферази) та поліморфними варіантами С786Т у гені ендотеліальної синтази оксиду азоту (еNOS), T58C у гені мітохондріальної супероксиддисмутази (MnSOD2) та Ser49Gly в гені β1-адренорецептора (ADRB1) обстежені 133 новонароджені, із них 73 з групи перинатального ризику (І група) та 60 здорових доношених новонароджених (ІІ група). За результатами обстеження, бівентрикулярна дисфункція встановлена в 19,1 % дітей І групи, серед яких у 4 (5,5 %) обстежених встановлена систоло-діастолічна, у 10 (13,6 %) новонароджених — діастолічна дисфункція шлуночків серця. У 12 (20,0 %) передчасно народжених дітей та в 4 (30,7 %) новонароджених із затримкою внутрішньоутробного розвитку встановлено гіпокінетичний тип центральної гемодинаміки, що супроводжувалося підвищеними рівнями лактатдегідрогенази і γ-глутамілтрансферази в сироватці крові та змінами діастолічного наповнення шлуночків серця. Встановлена наявність асоціації між генотипом СС поліморфізму гена еNOS та скоротливою здатністю міокарда лівого шлуночка, інтегральною функцією лівого шлуночка за індексом Теї у передчасно народжених дітей із групи перинатального ризику, носіїв алелі С за поліморфізмом гена MnSOD2 та з легеневою гіпертензією, в неонатальний період. Наявність генотипу GG поліморфізму гена ADRB1 можна вважати предиктором розвитку гіпокінетичного режиму центральної гемодинаміки.

Diagnostic Accuracy of Longitudinal Evaluation of Central Nervous System Sonoelastography in Preterm and Term Neonates.

The objective of this study was to evaluate the brain elasticity of the central nervous system in preterm and term neonates. Seventy-seven healthy preterm and term neonates (mean gestational age [GA], 37.5 weeks; range, 32.6-40.5 weeks) were included in the study. Periventricular and subcortical white matter, cortical gray matter, and ventricle and subdural spaces were examined with strain elastography ratios. Each patient underwent sonography evaluation twice. The mean age at the time of sonographic evaluation was 9 days (range, 4-15 days) for the first evaluation and 37 days (range, 31-47 days) for the second evaluation. The ratios were correlated with GA, birth weight. The caudate nucleus and cortical gray matter strain ratios were significantly higher than the periventricular and subcortical white matter strain ratios (P < 0.001). There was a positive relationship between GA and periventricular white matter elastographic scores on the two measurements (P = 0.022 and 0.018, respectively). The term neonates have higher strain rations compared with the preterm neonates at the first assessment (P < 0.01). At the evaluation of the area under the curve for the sonographic examination for the receiver operating characteristic curve, the periventricular white matter was 0.742 (95% confidence interval, 0.689-0.790), and it was 0.773 (95% confidence interval, 0.722-0.818) for the subcortical white matter. Neonatal brain development, maturation, and myelination can be assessed by strain elastography. These findings should be evaluated with further larger cohorts that could help to prevent neonatal brain damages.

2021 update of the 2012 ICSH Recommendations for identification, diagnostic value, and quantitation of schistocytes: Impact and revisions

In 2012, the International Council for Standardization in Hematology (ICSH) published recommendations for the identification, quantitation, and diagnostic value of schistocytes. In the present review, the impact of these recommendations is evaluated. This work is based on citations in peer-reviewed papers published since 2012. The first 2012 ICSH Recommendations have also been revised to incorporate newly published data in the literature and current best laboratory practice. Recommended reference ranges have been proposed for healthy adults and full-term neonates of 1% or less schistocytes. More than 1% of morphologically identified schistocytes on the blood film are considered suspicious for thrombotic microangiopathy. For preterm infants, a normal level of 5% or less is recommended. The fragment red cell count (FRC) generated by some automated hematological analyzers provides a valuable screening tool for the presence of schistocytes. Specifically, the absence of FRCs can be used as a valuable parameter to exclude the presence of schistocytes on the blood film. The validity and usefulness of microscope schistocytes and automated FRCs, respectively, are discussed in the context of the laboratory diagnostic tests used for thrombotic microangiopathies.

Calcium and lactate in the fetal-to-neonatal transition

Objective To explore the relationship between calcium and lactate in arterial cord blood of healthy term neonates in response to the stress of labor. Methods This was a prospective cohort study of consecutive, vaginal, term births in a community medical center (April 2029 to February 2020). Calcium and lactate were measured in cord blood gas analysis immediately after delivery. Results In the arterial cord blood of 480 neonates, calcium levels were 1.5 (1.4; 1.5) mmol/L and lactate levels were 3.8 (2.9; 4.9) mmol/L. Calcium and lactate showed a statistically significant positive correlation (Pearson’s correlation, r = 0.15, p = .001). Calcium levels had a significant positive correlation with PaCO2 and a significant negative correlation with pH, PaO2, HCO3 −, and ABE levels. Multivariable analysis models confirmed that calcium levels were associated with HCO3 −, gestational age, and birth weight, all accounting for 7% of the variability. Conclusion In healthy term vaginally delivered neonates, it was found that calcium and lactate were strongly correlated, together pointing to a neonatal response to the stress of labor and delivery. Cord blood calcium regulation may have an ancillary role in defining neonatal adaptation to extrauterine life.

Variation in Oxygen Saturation by Pulse Oximetry During and After Breastfeeding Among Healthy Term Neonates During Early Postnatal Life at Tertiary Care Hospital.

BackgroundBreastfeeding plays a vital role in a newborn’s life as it increases its chances of survival and is considered the optimal nutritional source for newborns. All newborns must have developed the suck, swallow, and breathe coordination in order to safely breastfeed. Studies conducted on breastfeeding in healthy term babies are limited as most studies available on breastfeeding focus on preterm babies. Full-term healthy infants can also present with feeding difficulties but due to a lack of studies conducted on them, there is no existing oxygen saturation pattern for healthy term infants. Thus, our study is designed to observe variations in the oxygen saturation of healthy term infants during breastfeeding.MethodologyA cross-sectional study was conducted in a tertiary care hospital from March 2021 to April 2021. Using a non-probability consecutive sampling technique, 60 neonates were enrolled in the study. The baby was monitored for heart rate and oxygen saturation before, during, and after feeding.ResultsThe oxygen saturation levels were lower during feed while it was significantly high after a feed (p < 0.001). No significant variation was seen between saturation before feeding and during feed (0.635) or before feeding with after feed (p = 0.108). Maximum oxygen saturation drop was observed in 21% at the first minute and cumulatively 73% of neonates within the first five minutes of feeding. Heart rate remained in the physiological range (120-160 b/min) in 85%, above 160 in just 11.6% of the babies.ConclusionEffective breastfeeding is crucial for the growth and development of every infant, which is why there is a need to have an understanding of how infants develop suck, swallow, and breathe coordination. Having breathing and sucking patterns for infants can help medical personal identify when an infant is having difficulty with oral feeding and suggest safer, more effective methods of breastfeeding.

Immature Platelet Counts and Thrombopoietin Plasma Concentrations in Thrombocytopenic and Non-thrombocytopenic Preterm Infants.

Objective: Immature platelet counts (IPC) may prove useful in guiding platelet transfusion management in preterm neonates. However, the relationship between IPCs and thrombopoietin (Tpo) concentrations has not been evaluated in preterm neonates.Methods: Prospective cohort study in thrombocytopenic (n = 31) and non-thrombocytopenic very low birth weight (VLBW) infants (n = 38), and healthy term neonates (controls; n = 41). Absolute platelet counts (APCs), IPCs, and Tpo concentrations were assessed by a fully-automated hematological analyzer (IPC, APC) and by ELISA (Tpo concentrations) in parallel on day 1 of life (d1), d3, and d7.Results: In healthy term neonates, APCs remained stable between d1 and d3. In non-thrombocytopenic VLBW infants, APCs increased from d1 to d7, while in the thrombocytopenia group, APCs declined from d1 to d3, before they slightly increased again by d7. Median IPCs were similar in healthy term vs. non-thrombocytopenic VLBW infants and remained stable between d1 and d3 (p > 0.05). Notably, IPCs significantly increased between d3 and d7 in both non-thrombocytopenic and thrombocytopenic VLBW infants. However, in thrombocytopenic VLBW infants, IPC values were significantly lower at each time point as compared to non-thrombocytopenic VLBWs (p < 0.001). In each subgroup, Tpo concentrations increased from d1 to d3. The median Tpo concentrations were significantly higher in thrombocytopenic as compared to non-thrombocytopenic VLBW infants at d3 (p = 0.01) and d7 (p = 0.002).Discussion: Term infants, thrombocytopenic, and non-thrombocytopenic preterm infants display similar developmental changes in indices of megakaryopoietic activity. In thrombocytopenic preterm infants, however, the responsive increases in Tpo and immature platelets appear to be developmentally limited.

Measurement of optic nerve sheath diameter by ultrasound in healthy term neonates

BackgroundOptic nerve sheath diameter (ONSD) ultrasound is a noninvasive and repeatable tool to dynamically evaluate intracranial pressure with high diagnostic accuracy; however, data in neonates are scarce. The aim of this study was to determine the reference value of ONSD and potential influencing factors in healthy term neonates. MethodsWe retrospectively reviewed 250 full-term neonates who underwent cranial ultrasound as part of selective newborn screening over a 2-year period. Neonates with any of the following conditions were excluded: using mechanical ventilation, sedatives and/or vasopressors, or signs of infection which needed cerebrospinal fluid analysis and/or intracranial pathologies. Data on sex, gestational age, birth body weight, birth body height, birth head circumference, Apgar score and types of delivery were collected. The neurodevelopmental outcomes were reviewed. ResultsA total of 234 neonates (123 girls and 111 boys) were included. The mean ONSD value was 3.30 ± 0.27 mm in the right eye and 3.30 ± 0.23 mm in the left eye, with no significant difference between both eyes (p = 0.797). Male neonates had a larger ONSD than female neonates (3.34 ± 0.22 mm versus 3.26 ± 0.20 mm, p = 0.007), and ONSD was correlated with birth weight in the males. Otherwise, there were no statistically significant associations between ONSD and other birth characteristics in both sexes. Most (63%) cases were followed for at least 12 months, and 98% had normal neurodevelopment. ConclusionThe reference value reported in this study may be used to evaluate the ONSD in healthy term neonates. Sex differences should be considered in this age group.

"Point of Care Blood Ketone and Glucose Concentrations in Full Term Healthy Neonates with in First 48 Hours of Life: The POCK Study"

Metabolic adjustment is the process whereby the newborn adapts from a continuous supply of glucose through the placenta to a fast feed cycle and a diet mostly of maternal milk...

To study the correlation between various levels of cord blood albumin &amp; serum bilirubin at 48 hrs of age in term healthy newborns

Introduction: Neonatal Hyperbilirubinemia is the most common abnormal physical finding and themajor cause of neonatal morbidity during the early neonatal period. Early identification of infants atrisk might help in providing preventative therapy and follow-up. We aimed to assess whether arterialumbilical cord albumin level at birth predicts the development of neonatal hyperbilirubinemia in termnewborns at 48 hrs of life. Methods: This prospective observational cohort study was conducted ina tertiary care hospital over 1 year in 200 term healthy neonates. Cord blood albumin was estimatedat birth followed by serum bilirubin level on the 3rd postnatal day(48 hrs of age). Results: Total of200 neonates were divided into three groups based on cord blood albumin level of &lt;2.8 g/dl(groupI), 2.8-3.4 g/dl(group II) and &gt;3.4 g/dl(groupIII) with 32, 100 and 68 in three respective groups.19 newborns (59.4%) in group I,14 in group II, and 7 newborns (10.3%) in group III developedserum bilirubin levels above an intermediate high-risk zone in Bhutani nomogram at 48 hrs of age.newborn with low cord albumin (&lt;2.8g/dl) were significantly associated with higher bilirubin levelsat 48 hrs of age. Conclusion: Neonates with cord blood albumin &lt;2.8 gm/dl had a significantassociation of the development of hyperbilirubinemia at or above intermediate high-risk zoneaccording to Bhutani nomogram at 48 hrs of life.

Laser acupuncture versus oral glucose administration for pain prevention in term neonates: an observer-blinded non-inferiority randomized controlled clinical trial.

Neonates undergoing intensive care are routinely submitted to minor painful procedures such as heel lances. Pharmacological treatment is limited in neonatal care and not recommended for minor painful interventions. Hence, non-pharmacological acute pain management is an important subject. Acupuncture could be a new strategy for neonatal pain prevention. Accordingly, the aim of the present study was to investigate whether laser acupuncture is non-inferior to oral sweet solutions in pain prevention. In total, 96 healthy term neonates were randomly assigned to receive either laser acupuncture with 10 mW at LI4 bilaterally (AG, acupuncture group) or 30% oral glucose solution (GG, glucose group) before heel lance for metabolic screening. The primary outcome was the difference in premature infant pain profile (PIPP) score between groups in a non-inferiority concept. Secondary outcomes were changes in heart rate and crying time. Median (interquartile range) PIPP scores were comparable in the AG and GG (12 (10-14) vs 12 (9-14), p = 0.981). Nevertheless, the 95% confidence interval (CI) of location shift exceeded the predefined margin for non-inferiority of 1 (95% CI: -1.000006 to 1.000059). Heart rate was found to be significantly lower after intervention (p = 0.048) and after heel lance (p = 0.015) in the AG versus GG. There was no difference in crying time between groups (p = 0.890). Laser acupuncture was not shown to be non-inferior to an oral glucose solution, possibly due to the higher than expected variability in PIPP scores within the studied groups. Future neonatal laser acupuncture studies for pain prevention with higher sample sizes are therefore warranted.

Prevalence of Renal Hypertension In Apparently Healthy Term Newborns.

Introduction: Neonatal hypertension (HT) is an emerging challenge for neonatologists and pediatricians around the world. The prevalence of renal causes of neonatal hypertension due to congenital renal anomalies and malformations including obstructive uropathy and cystic kidney disease is not well estimated up till now. Early diagnosis of congenital renal anomalies is the corner stone of good prognosis and better outcome. Aim of the study: To determine the prevalence of neonatal renal hypertension in apparently healthy term neonates discharged in the first 48 h of life from two university hospitals. Methods: Two thousand apparently healthy appropriate for gestational age (AGA) term newborns had blood pressure (BP) measurements using the oscillometric technique All results of blood pressure were compared to estimated blood pressure values in percentile curves generated by Dionne et al. Results: There were 29 of 2000 (1.45%) screened newborns diagnosed as having systemic hypertension, our study showed that renal anomalies were the main causes of neonatal systemic hypertension. It represent (93.1 %) of total causes in our study, [with pelviureteric junction (PUJ) Obstruction (31%), polycystic kidney (24.1%), nephrocalcinosis (13.7 %), unilateral renal dysplasia (10.3%), renal hypoplasia (3.4%), unilateral multi cystic kidney (3.4%)].The remaining cases (6.9%) were due to aortic coarctation. No endocrinal cases was diagnosed in our study. Conclusion: This study showed that renal anomalies were the most common causes of neonatal systemic hypertension in apparently healthy term newborns. Beside that this study provided normative BP values for healthy full term AGA newborns in the first 48h of life. These values can be used in the evaluation of BP in newborns.

Measurement of Reverse Triiodothyronine Level and the Triiodothyronine to Reverse Triiodothyronine Ratio in Dried Blood Spot Samples at Birth May Facilitate Early Detection of Monocarboxylate Transporter 8 Deficiency.

Background: Monocarboxylate transporter 8 (MCT8) deficiency is an X-chromosome-linked neurodevelopmental disorder resulting from impaired thyroid hormone transport across the cell membrane. The diagnosis of MCT8 deficiency is typically delayed owing to the late appearance of signs and symptoms as well as the inability of standard biomarkers of neonatal screening to provide early detection. In this study, we report, for the first time, the ability to detect MCT8 deficiency at birth using dried blood spot (DBS) samples.Methods: We retrospectively measured triiodothyronine (T3), thyroxine (T4), and reverse T3 (rT3) levels in DBS samples obtained at 4–5 days of life from 6 infants with genetically confirmed MCT8 deficiency and from 110 controls. The latter consisted of 58 healthy term neonates obtained at the same time, 16 were stored for more than 1 year before measurement to match samples from the MCT8-deficient infants. Ten DBS samples were collected at day 1 of life and 42 samples were from prematurely born neonates. Measurements were carried out in extract from eight millimeters diameter DBS using liquid chromatography-tandem mass spectrometry.Results: Contrary to characteristic iodothyronine abnormalities of MCT8 deficiency during later life, T3 and T4 values were not discriminatory from those of other study groups. In contrast, rT3 was significantly lower. The T3/rT3 ratio was higher in the DBS samples from the MCT8-deficient infants compared with all other groups with no overlap (p < 0.0001).Conclusions: rT3 and T3/rT3 ratio in DBS samples obtained from neonates can serve as biomarkers to detect MCT8 deficiency at birth.

Evaluation of Fibroblast Viability Seeded on Acellular Human Amniotic Membrane.

Background Investigating the viability and proliferative rates of fibroblast cells on human amniotic membrane (HAM) as a scaffold will be an important subject for further research. The aim of this study was to assess the fibroblast viability seeded on acellular HAM, since foreskin neonatal allogenic fibroblasts seeded on HAM accelerate the wound healing process. Methods Fibroblasts were retrieved from the foreskin of a genetically healthy male infant, and we exploited AM of healthy term neonates to prepare the amniotic scaffold for fibroblast transfer. After cell culture, preparation of acellular HAM, and seeding of cells on HAM based on the protocol, different methods including 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT), 4′,6-Diamidino-2-phenylindole dihydrochloride (DAPI), and propidium iodide (PI) staining were employed for assessment of fibroblast viability on HAM. Results Based on the results obtained from the DAPI and PI staining, the percentage of viable cells in the former staining was clearly higher than that of the dead cells in the latter one. The results of DAPI and PI staining were in accordance with the findings of MTT assay, confirming that fibroblasts were viable and even proliferate on HAM. Conclusion Our findings showed the viability of fibroblasts seeded on the acellular HAM using MTT assay, DAPI, and PI staining; however, this study had some limitations. It would be an interesting subject for future research to compare the viability and proliferation rate of fibroblasts seeded on both cellular and acellular HAM.

Vitamin D Levels in Neonates With and Without Seizures: A Single Center Cross-Sectional Study

To study the serum vitamin D levels in neonatal seizures and vitamin D status of the mothers whose babies had vitamin D deficiency. For this cross-sectional study, vitamin D levels were studied in term and late preterm neonates admitted to NICU with seizures at our tertiary care center. Controls were term and late preterm healthy neonates admitted in the postnatal ward with the mothers in the same center. 30 cases and 30 controls were enrolled. The mean (SD) serum vitamin D was 19.33 (7.76) ng/mL among cases and 16.83 (6.74) ng/mL among controls (P=0.18). We tested maternal vitamin D levels in babies with seizures and low vitamin D levels. The mean (SD) serum vitamin D level among these mothers (n=11) was 13.25 (6.17) ng/mL. There was no statistically significant association between serum vitamin D levels and seizures among neonates in our study.

This Month in Anesthesiology

This Month in Anesthesiology

Glomerular filtration rate changes in the first week of healthy full-term newborns

Background Renal function − as many other organ functions − is immature in the early neonatal period. Aim A prospective study was carried out that aimed at determining serum creatinine and glomerular filtration rate (GFR) in apparently healthy full-term newborns (NBs) on the first and seventh days of postnatal life. Participants and methods This study included 50 apparently healthy full-term neonates born to healthy mothers at Damanhour Medical Institute in AL-Behera governorate. Half of the neonates were males; 27 babies were delivered vaginally and the remaining by cesarian section. All NBs were subjected to a full assessment of history and clinical examination. Complete blood count, C-reactive protein, alanine transaminase, aspartate transaminase, and abdominal ultrasound were performed for all NBs. Serum creatinine and GFR were estimated on the first and seventh days of life. Maternal serum creatinine was determined for all mothers on day 1. Results Serum creatinine showed a significant decrease on the seventh day. GFR was significantly increased by the seventh day of life. NBs’ serum creatinine showed a negative correlation with the postnatal age, while GFR showed a positive correlation.

Bed sharing versus no bed sharing for healthy term neonates.

There isgreat global variation in the sleeping arrangements for healthy newborn infants. Bed sharingis a type of sleeping practice in which the sleeping surface (e.g. bed, couch or armchair, or some other sleeping surface) is shared between the infant and another person. The possible physiological benefits include better oxygen and cardiopulmonary stability, fewer crying episodes, less risk of hypothermia, and a longer duration of breastfeeding. On the other hand, the most important harmful effect of bed sharing is that it may increase the risk of sudden infant death syndrome (SIDS). Studies have found conflicting evidence regarding the safety and efficacy of bed sharing during infancy. To evaluate the efficacy and safety of bed sharing, started during the neonatal period, on breastfeeding status (exclusive and total duration of breastfeeding), incidence of SIDS, rates of hypothermia, neonatal and infant mortality, and long-term neurodevelopmental outcomes. We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2020, Issue 7) in the Cochrane Library; MEDLINE via PubMed (1966 to 23 July 2020), CINAHL (1982 to 23 July 2020), and LILACS (1980 to23 July 2020). We also searched clinical trials databases, and the reference lists of retrieved articles, for randomised controlled trials (RCTs) and quasi-RCTS. We planned to include RCTs or quasi-RCTs (including cluster-randomised trials) that included term neonates initiated on bed sharingwithin 24 hours of birth (and continuing to bed share with the mother in the first four weeks of life, followed by a variable time period thereafter), and compared them to a 'no bed sharing' group. We used standard methodological procedures as recommended by Cochrane. We planned to use the GRADE approach to assess the certainty of evidence. Our search strategy yielded 6231 records. After removal of duplicate records, we screened 2745 records by title and abstract. We excluded 2739 records that did not match our inclusion criteria. We obtained six full-text studies for assessment. These six studies did not meet the eligibility criteria and were excluded. We did not find any studies that met our inclusion criteria. There is a need for RCTs on bed sharing in healthy term neonates that directly assess efficacy (i.e. studies in a controlled setting, like hospital) or effectiveness (i.e. studies conducted in community or home settings) and safety. Future studies should assess outcomes such asbreastfeeding status and risk of SIDS. They should alsoinclude neonates fromhigh-income countries and low- and middle-income countries, especially those countries wherebed sharing is more prevalent because of cultural practices (e.g. Asian countries).

Quantitative Susceptibility Mapping of Venous Vessels in Neonates with Perinatal Asphyxia.

Cerebral venous oxygen saturation can be used as an indirect measure of brain health, yet it often requires either an invasive procedure or a noninvasive technique with poor sensitivity. We aimed to test whether cerebral venous oxygen saturation could be measured using quantitative susceptibility mapping, an MR imaging technique, in 3 distinct groups: healthy term neonates, injured term neonates, and preterm neonates. We acquired multiecho gradient-echo MR imaging data in 16 neonates with perinatal asphyxia and moderate or severe hypoxic-ischemic encephalopathy (8 term age: average, 40.0 [SD, 0.8] weeks' gestational age; 8 preterm, 33.5 [SD, 2.0] weeks' gestational age) and in 8 healthy term-age controls (39.3 [SD, 0.6] weeks, for a total of n = 24. Data were postprocessed as quantitative susceptibility mapping images, and magnetic susceptibility was measured in cerebral veins by thesholding out 99.95% of lower magnetic susceptibility values. The mean magnetic susceptibility value of the cerebral veins was found to be 0.36 (SD, 0.04) ppm in healthy term neonates, 0.36 (SD, 0.06) ppm in term injured neonates, and 0.29 (SD, 0.04) ppm in preterm injured neonates. Correspondingly, the derived cerebral venous oxygen saturation values were 73.6% (SD, 2.8%), 71.5% (SD, 7.4%), and 72.2% (SD, 5.9%). There was no statistically significant difference in cerebral venous oxygen saturation among the 3 groups (P = .751). Quantitative susceptibility mapping-derived oxygen saturation values in preterm and term neonates agreed well with values in past literature. Cerebral venous oxygen saturation in preterm and term neonates with hypoxic-ischemic encephalopathy, however, was not found to be significantly different between neonates or healthy controls.

Reference intervals for 26 common biochemical analytes in term neonates in Jilin Province, China

BackgroundBiochemical analytes provide information for neonatal disease management and therapy, and population-based reference intervals (RIs) are essential to accurately interpret laboratory test results. This study aimed to establish local RIs for biochemical assays in term neonates.MethodsA total of 195 healthy term neonates from birth to 3rd day were recruited as reference individuals prospectively. Analytes of 26 common biochemistries were measured using the VITROS 5600 Integrated System. The 3-level nested ANOVA was performed to assess the need for partitioning RIs of each analyte, and RIs were derived by a nonparametric method or robust method. Multiple regression analysis was used to evaluate specific correlations between the analytes and individual characteristics including age, gender, gestational age, birthweight and delivery mode.ResultsThere were no between-sex differences in all analytes, whereas there were significant between-day-age differences in 6 analytes. Small between-delivery-mode differences were observed in the results for potassium, phosphorus, and urea. The major related factor of most analytes was postnatal age. During the first 3 days, values of iron, lipids and lipoproteins increased; creatinine, urea, uric acid, creatine kinase and lactate dehydrogenase decreased; other analytes showed slight changes or relatively stable trends. Reference limits of some analytes, particularly lactate dehydrogenase and alkaline phosphatase, were significantly different from adult and pediatric groups.ConclusionsRIs of 26 common biochemical analytes are established for term neonates aged 0 to 3 days in northeast China. Additionally, it is suggested that age-related changes should be valued in the clinical decision-making process for newborns.

From dyad to triad: a survey on fathers\u2019 knowledge and attitudes toward breastfeeding

Fathers are known to impact breastfeeding outcomes. We aimed to explore paternal knowledge and attitude toward breastfeeding, and possible association with breastfeeding rates at discharge. In this cross-sectional study, we enrolled 200 fathers of healthy term neonates. At discharge, fathers were asked to rate their degree of agreement to 12 items on a 5-point Likert scale. A total score was obtained from their answers. Univariate binary logistic regression analysis was used to verify if the total score was predictive of exclusive breastfeeding at discharge. A multivariable logistic regression model was then used to adjust for possible confounders. ROC analysis was performed, and a Youden’s total score cut-off value was determined to define total score’s performance in predicting exclusive breastfeeding at discharge. Fathers showed a solid knowledge of maternal (87%) and neonatal (98%) benefits of breastfeeding, skin-to-skin (99.5%), rooming-in (79%), and responsive feeding (67.5%); conversely, only 51% knew about the recommended use of pacifiers. Fathers felt personally involved in babies’ feeding in 79% of cases. An association was found between total score and exclusive breastfeeding at discharge at univariate (OR: 1.07, p = 0.04) but not at multivariable analysis (OR: 1.07, p = 0.067). ROC analysis was not statistically significant (AUC 0.58, p = 0.083).Conclusion: By using a novel instrument aimed at quantifying fathers’ knowledge and overall attitude toward breastfeeding, this study underlines the importance of including fathers in the promotion of breastfeeding. Expanding the classic mother-baby dyad to a more modern mother-father-baby triad may impact breastfeeding outcomes at discharge.What is known:• Social support plays a major role in improving breastfeeding outcomes.• Fathers may greatly influence initiation and duration of breastfeeding; the more they know, the more helpful they can be.What is new:• A multidisciplinary team created a structured questionnaire aimed at quantifying fathers’ knowledge and attitude toward breastfeeding.• The association between a higher questionnaire total score and exclusive breastfeeding rates at discharge highlights the importance of including fathers in the promotion of breastfeeding, as part of the breastfeeding team.