Infants In Neonatal Period Research Articles

COL4A1 gene mutations and perinatal intracranial hemorrhage in neonates: case reports and literature review.

Intracranial hemorrhage may represent a complication of the perinatal period that affects neonatal morbidity and mortality. Very poor data exist about a possible association between mutations of the type IV collagen a1 chain (COL4A1) gene and the development of intracranial hemorrhage, and only sporadic reports focus on intracerebral bleedings already developing in utero or in the neonatal period in infants with such a mutation. This study presents a case series of term neonates affected by intracranial hemorrhage, with no apparent risk factors for the development of this condition, who were carriers of COL4A1 gene variants. This study also provides a review of the most recent scientific literature on this topic, specifically focusing on the available scientific data dealing with the perinatal period.

Survival time and its predictors in preterm infants in the post-discharge neonatal period: a prospective cohort study in Busoga Region, Uganda

BackgroundGlobally, out of 15 million babies born preterm every year, around 1 million will die. In Uganda, deaths in preterm infants make up 30% of all neonatal deaths. There is a paucity of information on the most critical time to conduct high-impact interventions among neonates born preterm especially after discharge from hospital. In this study, we determined the survival time to mortality and its predictors in preterm infants in the neonatal period after discharge from hospital. MethodsWe conducted a prospective cohort study in preterm infants in six district hospitals in Busoga Region, Uganda. Prematurity was confirmed using gestational age and birthweight. We assessed participants' background characteristics then followed them up prospectively until 28 days of life. We used Kaplan-Meier survival analysis to estimate survival probabilities while time-to-preterm mortality was described using the 5th percentile. We used Cox proportional hazards regression to determine predictors of survival. FindingsBetween June 1, 2017, and July 14, 2017, we recruited 128 preterm infants to the study. Mean gestational age was 4 days (SD 3) and mean birthweight was 1·8 kg (0·6). Overall, 8% (10/128) of preterm infants died; the 5th percentile survival time was 17 days. We noted a six-fold increase in hazard of mortality in preterm infants who did not have kangaroo mother care (KMC) compared with those who did (adjusted HR 6·4 [95%CI 1·7–24·5]), a five-fold increase in mortality hazard in preterm infants born to HIV-positive mothers compared with babies who had HIV-negative mothers (4·9 [1·1–22·2]); and a four-fold increase in the mortality hazard in preterm infants who were not exclusively breastfed compared with those who were exclusively breastfed (4·4 [1·1–18·3]). InterpretationTo reduce neonatal mortality in Uganda, we recommend follow-up care for preterm infants following hospital discharge, implementation of prevention of mother-to-child transmission of HIV, and exclusive breastfeeding of preterm babies. FundingEast Africa Preterm Birth Initiative sponsored by the Bill & Melinda Gates Foundation.

LABORATORY CRITERIA OF PERINATAL DAMAGE OF CENTRAL NERVOUS SYSTEM AT PREMATURE NEWBORNS

Fetal and neonatal hypoxia takes a special place among the damaging factors of central nervous system (CNS). All forms of oxygen deficiency are accompanied by the development of bioenergetic hypoxia, which leads to tension of metabolic processes of the organism. Metabolic effect of hypoxia includes stark reduce of mitochondrial activity due to a significant inhibition enzymes of the Krebs cycle: succinate dehydrogenase (SDH) and lactate dehydrogenase (LDH). In newborn babies is not always possible to objectively assess the condition of the CNS defeat, because very often the severity of lesions does not correspond to clinical symptoms, especially in premature newborns. So far determination the severity of hypoxic-ischemic CNS lesions is still very actual in modern medicine. More objective method of such an assessment is determine the activity of neurospecific enolase (NSE). The aim of the paper is to increase the efficiency of diagnosis of hypoxic CNS lesions in premature infants by determining the activity of NSE and study energy supply during the neonatal period. The concentration of NSE, SDH and LDH were determined in 15 conventionally healthy preterm infants (CHPI), which made the comparison group, and 64 premature babies with hypoxic-ischemic CNS lesions, which were divided into three groups: I group – 26 premature children with mild CNS lesions; II group – 20 premature children with severe hypoxic lesions and low birth weight; III group – 18 premature newborns with severe damage of central nervous system and extremely low birth weight. NSE activity was determined by enzyme immunoassay using reagents of the company «Fujirebio» (Sweden) on an automatic analyzer «Multiscan Plus» company «Labsystems» (Finland). Material for investigation was peripheral venous blood of newborns, which collected by vein punction at morning on an empty stomach. Metabolic effect of hypoxia in premature infants manifested by severe inhibition of mitochondrial respiratory activity, which appears in the reduction of aerobic enzyme activity of SDH and activation serum LDH. During the neonatal period in infants with perinatal hypoxic- ischemic lesions of the CNS levels of the of NSE, SDH and LDG aren’t normalized, that indicated on energy deficiency and requires the development of effective methods of correcting this condition. Perinatal hypoxia in premature neonates causes significant alteration of neuronal membranes and increase concentration in blood such neurospecific protein as NSE, whose concentration correlates with the degree of severity of CNS injury.

The Problems of Late Preterm Infants in Neonatal Period

GIRIS ve AMAC: Premature dogumlarin 34 0/7 ve 36 6/7 gebelik haftasi arasinda olanlari icin “gec preterm” terimi kullanilmaktadir. Premature dogumlarin buyuk bir kismini “gec preterm” bebekler olusturmaktadirlar. Antropometrik olcumleri term bebeklere yakin olmasina ragmen artmis mortalite ve morbidite riskleri vardir. Bu calismada ucuncu basamak hastanedeki gec dogumlarin erken donem sorunlarini incelemeyi amacladik. YONTEM ve GERECLER: Bu calismada 3. basamak referans hastanesinde 01/01/2016-31/12/2016 tarihleri arasinda dogan 210 gec bebek, retrospektif olarak incelenmistir. BULGULAR: Bir yillik surede gerceklesen dogumlarin, %20,1’i gec olarak saptandi ve tum premature dogumlarin %65’i gec pretermlerden olusmaktaydi. Gec bebeklerin %58’inin yenidogan yogun bakim unitesine yatisi gerekti. En sik yatis nedenlerinin gecici takipne (%31,1), konjenital anomali (%18,8) ve tedavi gerektiren sarilik (%16,3) oldugu goruldu. Dusuk gestasyonel hafta ve sezaryan dogum varligi, yatis gereken hastalarda istatistiksel olarak anlamli oranda yuksek saptandi. Mortalite orani %2,7 olup, konjenital anomali varliginda (%30,43’e %0,53, p<0,001) ve erkek cinsiyette (%87,5’e %12,5, p=0,033) bu oraninin arttigi goruldu. TARTISMA ve SONUC: Gec bebeklerin artmis mortalite ve morbidite risklerine ragmen, bu haftalardaki endikasyonsuz sezaryan dogumlar devam etmektedir. Anne yaninda izleme alinan gec bebekler solunum sorunlari, beslenme sorunlari, hiperbilirubinemi, hipoglisemi ve hipotermi acisindan yakin takip edilmelidir. ABSTRACT INTRODUCTION: The preterm term is used for premature births between 34 0/7 and 36 6/7 gestational week. Most premature babies are preterm babies. Although anthropometric measurements are close to term infants, there is increased risk of mortality and morbidity. In this study, we aimed to investigate in the neonatal period problems of late labor in the tertiary referral hospital. METHODS: In this study, 210 late infants born between 01/01/2016-31/12/2016 in the tertiary referral hospital were retrospectively examined. RESULTS: Twenty percent of births in one year were detected as late preterm, and 65% of all premature births were of late preterm. Fifty eight percent of late infants were admitted to the neonatal intensive care unit. The most frequent causes of hospitalization were transient tachypnea (31.1%), congenital anomaly (18.8%) and jaundice requiring treatment (16.3%). Low gestational week and cesarean birth were statistically significantly higher in patients requiring hospitalization. The mortality rate was 2.7%, and increased in the presence of congenital anomalies (30.43%, 0.53%, p <0.001) and male gender (87.5%, 12.5%, p = 0.033). DISCUSSION and CONCLUSION: Despite the increased mortality and morbidity risks of late infants, cesarean births without indications are still continuing in these weeks. Late infants who are followed up with mother care should be followed closely for respiratory problems, nutritional problems, hyperbilirubinemia, hypoglycemia and hypothermia. Keywords: Late preterm, premature, newborn

IMPACT OF CHRONIC ARTERIAL HYPERTENSION ON CLINICAL AND METABOLIC NEONATAL ADAPTATION

Aim. To assess the impact of chronic arterial hyper-tension on clinical and metabolic adaptation of fullterm newborns. Methods. 65 full-term neonates born to women with chronic arterial hypertension were included in the study. 42 neonates born to women with arterial hypertension stage I were enrolled into Group 1, and 23 neonates born to mothers with arterial hypertension stage II were included in Group 2. Levels of renin, angiotensin II, aldosterone, natriuretic peptides, endothelin-1 in umbilical cord blood and peripheral blood were measured with the ELISA. Stable nitric oxide metabolites levels were measured using the Griess assay. Results. Chronic high blood pressure during pregnancy has been found to affect fetal central nervous system and cardiovascular system. Early neonatal period in infants of women with chronic arterial hypertension is associated with a high incidence of perinatal CNS injury, continuing with little change during the first three months of life. The features of the cardiovascular system in neonates of women with arterial hypertension stage II include hypertension and tachycardia at birth, violation of atrioventricular conduction on the first three days of life, open patent foramen ovale up to the first three months of life, whereas neonates born to women with arterial hyper-tension stage I have hypotension on the first day of life. Elevated levels of angiotensin II in neonates born to women with chronic arterial hypertension at birth and reduced levels of endogenous nitrite in the first three months of life suggest the activation of the renin-angiotensin-aldosterone system in the antenatal period, which may cause endothelial dysfunction in early infancy. Conclusions. 1. Chronic high blood pressure in pregnancy is as-sociated with perinatal CNS damage in the newborn, continued during the first three months of life. 2. Stage 1 of hypertension in pregnancy associated with hypotension in newborns on the first day of life; and stage 2 of hypertension in pregnancy associated with hypertension and tachycardia newborn at birth, a violation of his atrioventricular conduction on the 3rd day of life and preservation until the age of three open oval window. 3. Chronic high blood pressure in pregnancy is as-sociated with an increase in cord blood levels of angiotensin II decrease in peripheral blood concentration of endogenous nitrite in the age of three months.

The Relationship of Novel Plasma Proteins in the Early Neonatal Period With Retinopathy of Prematurity.

PurposeRetinopathy of prematurity (ROP) is a vision-threatening disease associated with abnormal retinal vascular development. Proteins from the insulin-like growth factor pathway are related to ROP. However, there is a paucity of research on the role of other proteins in ROP. The aim of this study was to identify plasma proteins related to clinically significant ROP.MethodsWe measured 1121 plasma proteins in the early neonatal period in infants at risk for ROP using an aptamer-based proteomic technology. The primary aim of the study was to compare plasma protein concentrations in infants who did (n = 12) and did not (n = 23) subsequently develop clinically significant ROP using logistic regression. As a secondary aim, we examined patterns in the proteins across categories of clinically significant, low-grade, and no ROP groups.ResultsLower levels of 16 proteins were associated with an increased risk of clinically significant ROP. In this group, superoxide dismutase (Mn), mitochondrial (MnSOD), and chordin-like protein 1 (CRDL1) were highly ranked. Other proteins in this group included: C-C motif chemokine 14 (HCC-1), prolactin, insulin-like growth factor-binding protein 7 (IGFBP-7), and eotaxin. Higher levels of 12 proteins were associated with a higher risk for ROP. Fibroblast growth factor 19 (FGF-19) was the top-ranked protein target followed by hepatocyte growth factor-like protein (MSP), luteinizing hormone (LH), cystatin M, plasminogen, and proprotein convertase subtilisin/kexin type 9 (PCSK9). We also noted different patterns in the trend of concentrations of proteins across the clinically significant, low-grade, and no ROP groups.ConclusionsWe discovered plasma proteins with novel associations with clinically significant ROP (MnSOD, CRDL1, PCSK9), proteins with links to established ROP signaling pathways (IGFBP-7), and proteins such as MnSOD that may be a target for future therapeutic interventions.

Posterior urethral valves: Creatinine velocity, a new early predictor of renal insufficiency

AimAntenatal screening has led to early detection of posterior urethral valves (PUV). However, despite early intervention, a proportion of children will develop chronic renal insufficiency. We studied the trend of serum creatinine following urinary tract decompression during the neonatal period in infants as a possible predictor of chronic renal insufficiency. MethodsPatients treated by endoscopic resection of posterior urethral valves between 1993 and 2004 were identified. From these, infants treated within the first 30days of life were identified. Serum creatinine values taken within the first 5days following initial drainage were recorded. A creatinine velocity for each patient was calculated by linear regression analysis. Creatinine was considered rising if velocity was >3μmol/L/day, or falling if velocity was <−3μmol/L/day. Chronic renal insufficiency was defined as CKD2 or higher. ResultsSixty-four neonates had decompression of the urinary tract. Of these, 16 had rising creatinine despite drainage, 10 had a plateau in creatinine level, and 36 had falling creatinine following drainage. Insufficient data were available in two to calculate creatinine velocity. Progression to renal insufficiency was significantly higher in patients with an initial rise in creatinine (62.5%) than in those with plateau creatinine (40%) or falling creatinine (8.6%) (P≤0.0005 by Fisher exact test). Mean follow-up was 9.2years. ConclusionsRising creatinine, even transiently, following urinary tract drainage in neonates with posterior urethral valves is significant and is a new and important indicator of long-term prognosis.

A retrospective cohort study of mortality among children with birth defects in New York State, 1983–2006

Birth defects, which occur in about 3% of live births in the United States each year, have remained the leading cause of infant mortality, although the infant mortality rate in the United States has decreased significantly over the past decades. The objective of this study was to conduct a retrospective cohort study with long-term follow-up of the children in New York State Congenital Malformations Registry (CMR) for up to 24 years on their mortality status to evaluate the mortality risk of children with birth defects by age at death, birth defect category and other possible contributing factors. Children born in 1983-2006 with reportable birth defects were included in the study cohort. A sub-cohort was also constructed containing children born in 1983-2006 with selected major birth defects that are relatively severe congenital conditions identified at birth. New York State live births in 1983-2006 were used as the comparison population. The deaths among the study cohort were identified through linking CMR cases to the death certificate files. A Poisson regression model was used to calculate mortality rate ratios (mortality risk) adjusting for selected infant and maternal risk factors. Compared to children without birth defects, the overall mortality risk was 6.7 times higher for children with any of the reportable birth defects and 23.6 times higher for children with selected major birth defects. The mortality risk decreased with increasing age of children. The top 5 most significantly high mortality risks were found among infants in neonatal period with anencephaly (RR = 200.5, 95% CI:180.6-222.5) and renal agenesis/dysgenesis (RR = 69.5, 95% CI:64.2-75.2), and among children aged 1-2 years with Trisomy 18 (RR = 206.4, 95% CI:28.5-331.6), Trisomy 13 (RR = 157.3, 95% CI:83.5-296.4), and hypoplastic left heart (RR = 161.5, 95% CI:20.1-217.2). Low birth weight and gestational age, multiple malformations and high lethality of anomalies involved were the major contributors to the high risk of mortality among children with selected major birth defects compared to those without birth defects. Using the state-wide, population-based birth defects surveillance data to conduct a long-term follow-up of a large cohort of New York children, we were able to examine mortality and survival experience of the affected children during infancy and childhood period by individual birth defects of interest. As expected, children born with birth defects had a higher risk of mortality compared to children without birth defects. The magnitude of the risk varied by children's age, birth and maternal characteristics and the lethality of the specific birth defects involved.

Distinctive Hematological Abnormalities and GATA1 Mutation Spectra In East Asian Neonates and Children with Down Syndrome

AbstractAbstract 4837 Background:Many hematological abnormalities have been reported during the neonatal period in infants with Down syndrome (DS). Neonates with DS are predisposed to developing transient abnormal myelopoiesis (TAM) and acute megakaryblastic leukemia (AMKL). However, there is a paucity of data on hematological aberrations and GATA1 gene mutations in neonates with DS in East Asian populations. We therefore investigated the spectrum of hematological abnormalities in infants and children with DS in one such population, and analyzed the frequency and pathophysiological role of GATA1 mutations in DS-TAM and DS-AMKL in this group. Patients and Methods:A total 148 patients with DS were identified from January 2000 to December 2009. Of these, 109 had had blood drawn for a complete blood count (CBC) with differential. There were 37 neonates (°Â4 weeks of age), 55 children (<18 years of age), and 17 adults °Ã 18 years of age) in the study. A comprehensive molecular study of the GATA1 gene was performed using PCR, RT-PCR and direct sequencing for all six exons (7,757 bp) and cDNA sequence of GATA1 gene. Results:Thrombocytopenia was most common hematological abnormality (35%) in the neonates. Leukocytosis and polycythemia were each detected in 4 cases (11%). Blasts were identified in the differential count of 6 (16%) neonates. Of the 55 children with DS, 11 (20%) had thrombocytopenia, 10 (18%) had anemia, and 7 (13%) had neutropenia (< 1,500/uL). There were also 4 (7%) cases of AMKL and 2 (4%) cases of acute lymphoblastic leukemia in the children with DS. GATA1 mutations were identified in all of the TAM samples and in 2 of the 3 AMKL samples, but were not detected in the 1 remission sample or the 2 samples from normal DS children. Conclusions:East Asian DS neonates showed distinctive hematological abnormalities such as uncommon neutrophilia, relatively common neutropenia, and increased prevalence of TAM compared with reports from Western countries. The GATA1 mutation analysis may offer the potential to accelerate and refine the diagnosis of TAM and AMKL, and to accurately measure the kinetics of the mutant GATA1 clone as a tool for minimal residual disease measurement because virtually all cases of TAM and AMKL harbored this mutation. [Display omitted] Disclosures:No relevant conflicts of interest to declare.

Serum thrombopoietin level and thrombocytopenia during the neonatal period in infants with Down's syndrome

The pathogenesis of thrombocytopenia during the neonatal period in Down's syndrome (DS) infants remains unclear. To elucidate kinetic changes of serum thrombopoietin (TPO) level and platelet count, and their correlation in DS neonates. Twelve DS infants (male/female: 7/5, term/late preterm: 10/2) born between 1997 and 2007 were included. Blood samples were serially collected during the neonatal period and serum TPO levels were determined in 44 sera using an enzyme-linked immunosorbent assay. Thrombocytopenia <150 x 10(9) per liter was observed in seven (58%) patients. In 12 DS patients, the median TPO value showed 2.86 fmol ml(-1) on day 0, rose to 4.64 fmol ml(-1) on day 2, and thereafter decreased to 4.30 fmol ml(-1) on day 5, 2.40 fmol ml(-1) on days 11-15, and 1.75 fmol ml(-1) on days 28-30. This kinetics parallels that in historical non-DS controls. In 35 pair sample analysis from 11 patients without transient myeloproliferative disease, TPO level inversely correlated with platelet count (r=-0.38, P=0.023). However, there was no significant difference in TPO concentrations between thrombocytopenic and non-thrombocytopenic DS individuals. This is the first study to describe the relationship between TPO level and platelet count in neonates with DS. Median TPO levels and their kinetic changes in DS neonates are comparable to those in non-DS controls. In contrast to earlier findings in several studies showing higher TPO concentrations in thrombocytopenic non-DS newborns than those in non-thrombocytopenic counterparts, the response of the TPO system to thrombocytopenia in DS during the neonatal period seems suboptimal.

Primary CMV Colitis in an Immunocompetent Infant, Successfully Treated by Gancyclovir

Primary CMV Colitis in an Immunocompetent Infant, Successfully Treated by Gancyclovir

Osobennosti adaptatsii novorozhdennykh u materey s ozhireniem

According to various authors, obesity among pregnant recorded at a frequency of 15.5 to 26.9%. There is strong evidence that obesity contributes to complications of pregnancy, childbirth and the postpartum period, provoking the development of gestosis, placental insufficiency, abnormalities of labor, bleeding, et al., Which suggests the possibility of adjustment disorder in the neonatal period in infants of obese mothers. It should be recognized, however, that the available information on the subject are scarce and fragmentary. The purpose of this study was to investigate the features of postnatal adaptation of newborns of mothers with obesity. According to the study found that obesity in women is associated with a high incidence of reproductive disorders, gestational complications and pathological course of labor, resulting in abnormalities in the neonatal adaptation in the postnatal period. Disadaptation syndrome is manifested by the development of jaundice sustained over, edema, transient changes of the cardiovascular system, hypoglycemia. Violations in health are detected in the majority of infants (83.3%) born to mothers with obesity. The most significant pathologies are infections specific to the perinatal period (40.5%), respiratory distress syndrome (3.6%), diabetic fetopathy (4.8%), congenital malformations (2.4%).

The incidence of dorsal and pelvis asymmetries in school-age children with hip dysplasia in the neonatal-infancy period

Dorsal asymmetry was found in ninety percent of test group children, including a small asymmetry of 2–4 Bunnell degrees [2] in seventy-eight percent. In the control group, dorsal asymmetry was found in fifty percent of children, including a small asymmetry in forty-six percent. Pelvis asymmetry was found in eighty percent of test group children, predominantly an eight-type deformation with a right-side anterior superior iliac spine (ASIS) lowering in sixty-six percent and a left-side posterior superior iliac spine (PSIS) lowering in forty-six percent of children. In the control group, pelvis asymmetry was found only in forty-two percent of children.

Esophageal replacement in the neonatal period in infants with esophageal atresia and tracheoesophageal fistula

Aim The aim of the study was to assess the outcome after esophageal replacement using gastric pull-up performed in critically ill neonates with esophageal atresia (EA) and tracheoesophageal fistula. Methods During 1998 to 2005, gastric transposition was performed in 27 neonates (mean birth weight, 2.32 kg [1.86-3.0 kg]; mean age, 6.08 days) for post–EA and tracheoesophageal fistula leaks in 17, long gap in 6, and pure EA in 4, using transhiatal route in all. Pyloromyotomy as the drainage procedure was added for all 27 neonates. Patients were followed up at 3, 6, and 12 months for clinical evaluation, gastric clearance, duodenogastric reflux, and gastric pressure profile. Results Six neonates had ongoing serious chest infection, 3 had lung collapse, and 2 had associated congenital heart disease. Postoperative elective ventilation was provided to all neonates for 2 to 40 days (mean, 10.6 days). Nine neonates developed postoperative leaks in the neck; all healed spontaneously before discharge. Mean hospital stay was 32.6 days (range, 9-87 days). Four newborns died on postoperative days 9, 13, 15, and 29 because of existing severe sepsis in 3 and major congenital heart disease in 1. Functional evaluations were done at 3, 6, and 12 months postoperatively. Values at 6 months revealed normal gastric emptying in 16 of 23, presence of duodenal gastric reflux in 11 of 23, and mass contractions with significant rise in intragastric pressure after bolus feeds in 16 of 23 cases. Values at 12months revealed normal gastric emptying in 14 of 20, presence of duodenal gastric reflux in 8 of 20, and mass contractions with significant rise in intragastric pressure after bolus feeds in 13 (65%) of 20cases. Conclusion Gastric transposition could be a lifesaving alternative to diversion, even in the critically ill newborns after major leaks. However, it requires technical surgical expertise and an effective pain relief and neonatal intensive care.

Sequential Neurological Examinations in Infants with Neonatal Encephalopathy and Low Apgar Scores: Relationship with Brain MRI

The aims of this study were to (a) describe the evolution of neurological signs after the neonatal period in infants with neonatal encephalopathy and abnormal outcome and (b) to establish the relationship between the evolution of neurological signs and patterns of lesions on brain MRI. Fifteen children with low Apgar scores, abnormal neurological signs at the end of the neonatal period, and abnormal outcome were examined at 1 - 2 weeks, 5 - 7 weeks, and 6 months. All the infants had at least one MRI scan performed in the neonatal period. All infants had persistent abnormalities on all examinations performed but the severity of neurological impairment was variable and was related to the pattern of brain lesions. Infants with severe basal ganglia and white matter lesions showed abnormal axial and limb tone, movements, and visual function on all the examinations and none achieved independent sitting. In infants with moderate basal ganglia lesions and/or severe white matter changes, visual function and feeding improved by 5 - 7 weeks and were still normal at 6 months while limb tone, which was reduced in the first weeks, appeared to be normal at 5 - 6 weeks but was found to be increased at 6 months; all were able to sit unsupported at 2 years and most of them achieved the ability to walk with support. Our results suggest that the evolution of the neurological patterns after the neonatal period in infants with persisting neonatal abnormalities depends on their pattern of brain lesions.

Idiopathic Thrombocytopenic Purpura

Idiopathic Thrombocytopenic Purpura

Effects of Prenatal Drug Exposure on Neurobehavioral Functioning in Young Infants

In the newborn period, infants prenatally exposed to cocaine and other drugs show low scores on the Neonatal Behavioral Assessment Scale. Beyond that period, research is limited on the effects of prenatal drug exposure on neurobehavioral functioning. In this study we compared infants exposed to cocaine and other drugs and control infants from low socioeconomic backgrounds on measures of neurobehavioral functioning during neuromotor assessment at 1, 4 and 7 months of life. None of the measures of neurobehavioral functioning showed any significant group differences. This study did not support the hypothesis of disrupted neurobehavioral functioning beyond the neonatal period in infants exposed to drugs prenatally.

Effects of Prenatal Drug Exposure on Neurobehavioral Functioning in Young Infants

In the newborn period, infants prenatally exposed to cocaine and other drugs show low scores on the Neonatal Behavioral Assessment Scale. Beyond that period, research is limited on the effects of prenatal drug exposure on neurobehavioral functioning. In this study we compared infants exposed to cocaine and other drugs and control infants from low socioeconomic backgrounds on measures of neurobehavioral functioning during neuromotor assessment at 1, 4 and 7 months of life. None of the measures of neurobehavioral functioning showed any significant group differences. This study did not support the hypothesis of disrupted neurobehavioral functioning beyond the neonatal period in infants exposed to drugs prenatally.

Prevention of Neonatal HBV Infection with the Combination of HBIG and HBV Vaccine and Its Long‐Term Efficacy in Infants Born to HBeAg Positive HBV Carrier Mothers

Seventy-three infants born to HBeAg positive HBV carrier mothers were protected from neonatal HBV infection with our standard prevention schedule consisting of two doses of HBIG (0,2 mo) and three doses of HBV vaccine (2, 3, 5 mo). In 62 infants who successfully responded to HBV vaccine with a titer of anti-HBs greater than 2(3), anti-HBs titer was monitored for as long as 48 months (25.6 +/- 11.0 mo) and found to decrease as follows: 5.1 +/- 1.7 at 12 mo., 4.5 +/- 1.8 at 18 mo., 4.2 +/- 1.8 at 24 mo., 4.0 +/- 1.6 at 30 mo., 3.7 +/- 1.7 at 36 mo., 3.2 +/- 2.0 at 48 mo. During the follow-up period, eight HBV events (11.9%) were demonstrated: one case showed an increase of anti-HBs, three showed a reappearance of anti-HBc alone, three showed a reappearance of anti-HBc with increase of anti-HBs, and one became a chronic HBV carrier. All infants were further divided into three groups by their maximal response of anti-HBs to HBV vaccine: Group I (greater than or equal to 2(6)), Group II (2(3)-2(5)), and Group III (2(2) greater than or equal to). Group I sustained a higher titer from 12 to 30 months of age and had less HBV events than G-II and G-III. Our study suggests that acquisition of a high titer of anti-HBs is important in long-term prevention of HBV infection as well as in the neonatal period in infants born to HBeAg positive HBV carrier mothers.

Metabolic adaptations during the neonatal period in infants of diabetic mothers.

Infants of diabetic mothers (IDM's) are prone to develop severe but usually asymptomatic hypoglycaemia during the first postnatal hours. High maternal plasma glucose concentrations at the time of delivery increase this risk, especially if the mode of delivery is cesarean section. Newborn IDM's are hyperinsulinaemic and the neonatal hypoglycaemia seems to result from this together with a retarded increase in plasma glucagon levels. Despite very high plasma insulin concentrations, lipolysis, as indicated by a rise in plasma glycerol concentrations, appears to be normal in IDM's. The IDM's are able to respond to both physiologic and metabolic stress with an increased catecholamine secretion during the first hours of life, and the catecholamines seem to counteract the inhibitory effect of insulin on lipolysis and, at least partly, to oppose the blood glucose lowering effect of insulin.