Ability Of Neonates Research Articles

All Tied Up! Influences of Oral Frenulae on Breastfeeding and their Recommended Management Strategies.

Recently, there has been an increased awareness of the role of the labial and lingual frenulae on a neonate's ability to latch and breastfeed efficiently. This critical review explores the (i) oral physiology of a baby nursing (ii) factors that can decrease a baby's ability to nurse efficiently, the problems these cause and their management and the (iii) relation between poor nursing efficacy and the risk of early childhood caries (ECC) Study design: An expansive search of the literature was performed using four electronic databases. Most studies assessing the role of labial and lingual frenulae on breastfeeding were of a low quality. The relation between ECC and poor nursing efficacy was found to be largely speculative. Hence, the results of these studies should be interpreted with caution. Despite the limited quality and external validity of the current evidence, in cases where breastfeeding difficulties are identified, surgical management of labial or lingual frenulae may provide some subjective improvements in breastfeeding outcome.

Global Foot-and-Mouth Disease Research Update and Gap Analysis: 6 - Immunology.

This study assessed gaps and priorities for FMDV (foot-and-mouth disease virus) research in the field of immunology. The study took the form of a literature review (2011-15) combined with research updates collected in 2014 from 33 institutes from across the world. Findings were used to identify priority areas for future FMD research. Improved understanding of FMDV immunology facilitates the development of vaccines, adjuvants and diagnostic tests, and will allow better assessment and prediction of vaccine potency and match, with reduced use of animals, particularly large animals, in experimental studies. Continued characterization of the immune systems of several FMD host species has underpinned substantial advances in knowledge of their interaction with FMDV. Recent studies have shed light on the mechanisms underlying formation of the bovine B- and T-cell response; there is also a greater understanding of the significance of non-neutralizing antibodies during FMDV infection and the interactions of antibody-bound virus with immune cells. This knowledge is directly relevant to vaccine development, as well as understanding protection and cross-protection. Despite ongoing research, significant knowledge gaps remain in the areas of neonatal and mucosal immunity. The impact of maternally derived antibody upon the neonate's ability to respond to FMD vaccination has received some attention, but few firm conclusions can be drawn at this stage, and little is known of the cellular response of young animals in general. The mucosal immune system of FMDV-susceptible species requires continued characterization, especially if the potential of mucosal vaccine-delivery systems is to be realized for FMD immunization.

Is the developmentally immature immune response in paediatric sepsis a recapitulation of immune tolerance?

Immunologically immature neonates suffer the highest incidence of paediatric sepsis. Postnatal immunological maturation is characterized by a relatively hypo-inflammatory immune response. The mechanisms that differentiate the mature and immature immune responses resemble those that differentiate the hyper- and hypo-inflammatory responses in severe sepsis. Immunological maturational differences likely affect the neonate's ability to mount an appropriate hyper-inflammatory response, a counteractive hypo-inflammatory response, and subsequent return to immune system homeostasis. To better understand the role of the hypo-inflammatory response in paediatric sepsis, we will explore the maturation of the immune system and the effect it may have on the sepsis-induced hypo-inflammatory response.

Impact of diet on development of bronchial-associated immunity in the neonatal piglet

Bronchial-associated immune development is critically important to protect neonates from respiratory infections. Herein, bronchial-associated immune development in formula-fed and sow-reared pigs is described. Colostrum-fed newborn piglets were fed medicated sow milk replacer formula beginning at 48h of life or remained with the sow. Blood and tissues were sampled at one-week (d7) and three-weeks (d21) of age. Lymphocyte subpopulations, including T helper 2, cytotoxic T, memory T, and NK cells, in peripheral blood, mediastinal lymph nodes, and thoracic lymph nodes were identified using flow cytometry. Additionally, IL-1β, IL-6, IL-12, TNFα, TGF-β1, TGF-β2, IFNα, IFNβ, and dectin gene expression were analyzed by quantitative RT-PCR. Total IgG, IgM, and IgA concentrations in serum were analyzed. Dietary and developmental effects were observed. This set of baseline measurements provides a framework for future respiratory challenge studies where the effects of diet on the neonate's ability to resist and/or recover from infection can be tested.

Riluzole disrupts autoresuscitation from hypothermic respiratory arrest in neonatal hamsters but not rats

We examined the effect of riluzole on expression of the central respiratory rhythm and the ability of neonates to autoresuscitate from hypothermic respiratory arrest using in vitro brainstem-spinal cord preparations of rats and hamsters. At a constant temperature of 27 degrees C, riluzole (5-200 microM) decreased the burst amplitude of respiratory-related motor discharge, but had little effect on the fictive respiratory frequency in rat preparations. In contrast, in hamster preparations, riluzole reduced fictive respiratory frequency, but had little effect on burst amplitude. Hamster preparations were more cold-tolerant than rat preparations, with respiratory arrest and autoresuscitation occurring at lower temperatures during cooling of the preparation. This difference was removed by incubation with riluzole (5 microM); riluzole significantly increased the temperature at which fictive respiration arrested and restarted in hamster preparations, but had no effect in rat preparations. The species differences observed in this study may reflect fundamental differences in the relative role of riluzole-sensitive mechanisms in the expression of the respiratory rhythm in early development of an altricial vs. a more precocial species.

Functional MRI in neonates using neonatal head coil and MR compatible incubator

Structural and functional magnetic resonance imaging of the newborn brain is a complex and challenging task. Term and preterm neonates require a controlled microenvironment and close monitoring during the MRI study to maintain respiratory and cardiovascular functions, body temperature, and fluid and electrolyte homeostasis. In addition, to minimize motion artifacts, most neonates also need to be sedated, which carries the risk of respiratory depression compromising the neonate's ability to maintain appropriate ventilation and oxygenation during the procedure. Finally, because of their small head size, the use of the standard MR head coils results in suboptimal picture quality in the neonate. Thus, these limitations affect our ability to obtain both high quality structural and functional MRI studies. To overcome these difficulties, we have utilized an MR compatible incubator with a built-in radiofrequency head coil optimized for the neonatal brain volume. In this study we demonstrate that functional MRI and high-resolution structural MRI of the newborn brain can be achieved with this novel design. The use of this equipment offers potential for studying the development of the preterm and term neonatal brain and obtaining state-of-the-art, high-resolution structural and functional imaging in this most vulnerable patient population.

Carnitine deprivation adversely affects cardiovascular response to bacterial endotoxin (LPS) in the anesthetized neonatal pig.

Sepsis and endotoxemia are important stressors for the neonate. Newborn infants receiving total parenteral nutrition are routinely deprived of carnitine. To investigate whether carnitine deprivation affects the neonate's ability to respond to endotoxin, 19 newborn piglets received parenteral nutrition for 2-3 weeks that was either carnitine free (CARN-) or supplemented (CARN+) with L-carnitine (400 mg/L). Cardiovascular performance, i.e., heart rate; blood pressure (BP); cardiac output (CO); systemic vascular resistance (SVR), and metabolic response, i.e., plasma glucose; lactate; tumor necrosis factor alpha; tissue nitric oxide; and urinary nitrites, were studied serially in anesthetized piglets for 3 h after endotoxin (lipopolysaccharide (LPS), 250 microg/kg intravenous bolus) or vehicle administration. Plasma and tissue carnitine values were lower in CARN- than in CARN+ piglets. Prior to LPS, no differences were found for most parameters (excepting lower diastolic BP and SVR in CARN- animals). Systolic, diastolic, and mean BP fell after LPS but recovered by the end of the experiment. Nadirs were lower in CARN- than in CARN+ piglets. CO tended to be higher in CARN- than in CARN+ animals and fell after LPS. SVR fell after LPS and was lower in CARN- than in CARN+ piglets. LPS-treated animals transiently increased urinary flow. By all measures (plasma tumor necrosis factor alpha, glucose and lactate, tissue nitric oxide, and urinary nitrite excretion), LPS provocation was similar for both groups. Chronologically, BP changes were more closely related to SVR than to CO. Our findings suggest that carnitine deprivation diminishes tissue carnitine concentrations and adversely affects cardiovascular response to LPS, in part mediated by the peripheral vasculature.

Comparison of dam and neonatal trace mineral levels in Nebraska sandhills beef cattle

Trace mineral deficiencies in copper, selenium, zinc, and manganese have been reported from neonates and perinatal calves in Western Nebraska, including the Gudmundsen Sandhills Laboratory (GSL) at Whitman, NE. Deficiencies or imbalances of trace minerals such as copper and selenium may play an independent or interacting role in the neonate's ability to produce immunity.

Early postoperative lipid administration after neonatal surgery.

The ability of neonates to eliminate and utilize lipid emulsions after surgery was investigated in 12 patients. All were subjected to major surgery within 29 h of birth. All neonates were given 10% glucose iv intraoperatively. Six patients continued with 10% glucose iv for 24 h postoperatively and 6 patients received a combination of 5% glucose and soy bean emulsion (Intralipid 20%). Both regimes provided equal amounts of fluid and energy. Blood glucose, lactate, triglycerides, free fatty acids, fractions of fatty acids in triglycerides, 3-hydroxybutyrate and arterial blood gases were measured at predetermined intervals throughout this period. Administration of a lipid emulsion early after neonatal surgery was well tolerated and utilized, with some latency. Concentrations of triglycerides, free fatty acids and 3-hydroxybutyrate were higher in the lipid group, but no accumulation of these substances was found. Palmitinic and linoleic acid were also higher in the lipid group.

Controversy in fatty acid balance

It is uncertain whether preterm infants can synthesize C20 and C22 (omega-6) and (omega-3) fatty acids required for structural lipids. Dietary intake of C18:2 omega-6 and C18:3 omega-3 in formulae lacking long-chain polyunsaturated fatty acids can result in reduced levels of C20 and C22 homologues in membrane phospholipids as compared with breast-fed infants. Supplementation of fish oil has been shown to alleviate this problem in part only, as synthesis and incorporation of arachidonic acid into membrane phospholipids is reduced. Presently, infant formulae do not contain C20 and C22 fatty acids. Feeding an experimental infant formula with a balance between C20 and C22 (omega-6) and (omega-3) fatty acids within the range of human milk results in plasma phospholipid levels of C20 and C22 long-chain polyunsaturated (omega-6) and (omega-3) fatty acids similar to those in breast-fed infants. On the basis of clinical studies and evolutionary data, an increase of the linolenic and a decrease of the linoleic acid content in infant formula are suggested. Balanced incorporation of both (omega-6) and (omega-3) long-chain polyunsaturated fatty acids seems advisable in view of the lack of knowledge concerning the neonate's ability to chain elongate and desaturate essential fatty acids. Recommendations for the essential fatty acid content of preterm infant formula are suggested.

Olfaction in utero: can the rodent model be generalized?

In this article we discuss five requirements that theoretically must be fulfilled for transnatal chemosensory learning to occur in three placental species, the rat, the sheep, and the human, viz. (1) minimum or partial maturity of nasal chemoreceptor systems, (2) efficient odorivector compounds in the fetal environment, (3) the ability to memorize chemosensory information across birth, (4) perinatal continuity in chemical signals, (5) neonatal ability to detect air-borne odorants previously experienced in the aquatic environment. A substantial body of data is reviewed for the rat, in which fetal chemosensation is now firmly established. The less studied ovine perinate also shows preliminary evidence of nasal chemoreception and of postnatal retention of prenatally experienced odorants. Concerning the human species, we discuss extensive anatomical data supporting nasochemoreception in utero, but as yet no direct or indirect functional demonstration is provided. Furthermore, the strongest evidence of odorivector compounds in amniotic fluid is from human data. The results presented allow generalization of chemosensory functioning in utero in the species considered.

Effect of Intravenous L‐Carnitine on Growth Parameters and Fat Metabolism during Parenteral Nutrition in Neonates

To determine whether intravenous carnitine can improve nutritional indices, neonates requiring parenteral nutrition were randomized into carnitine treatment (n = 23) and control (n = 20) groups. Observed plasma lipid indices, carnitine and nitrogen balances, and plasma carnitine concentrations were not different in the prestudy period. Under standardized, steady-state conditions, 0.5 g/kg Intralipid was administered intravenously over 2 hr prior to carnitine administration, after infants received 7 days of 50 mumol/kg/day, and after a second 7 days of 100 mumol/kg/day of continuous intravenous L-carnitine as part of parenteral nutrition. Triglyceride (TGY), free fatty acid (FFA), acetoacetate (AA), beta-hydroxybutyrate (BOB), and plasma carnitine concentrations were measured prior to and at 2, 4, and 6 hr after the initiation of the lipid bolus. Twenty-four-hour urine collections for nitrogen and carnitine balance were obtained on days 7 and 14. Neonates receiving carnitine had significantly greater concentrations of plasma carnitine on days 7 and 14 (p less than 0.001). Greater nitrogen (p less than 0.05) and carnitine (p less than 0.001) balances and weight gain (week 2, p less than 0.05) were found in the carnitine-supplemented group when compared with controls. On day 14, (BOB + AA)/FFA ratios were significantly higher (p less than 0.05), and peak TGY concentrations and 6-hr FFA concentrations were significantly lower (p less than 0.05) in the treatment group. Carnitine supplementation was associated with modest increases in growth and nitrogen accretion possibly by enhancing the neonate's ability to utilize exogenous fat for energy.

High Incidence of Hypogammaglobulinemia in Infants with Diarrhea

Summary:Examination of 136 children who were referred to the Pediatric Gastroenterology Clinic at Yale‐New Haven Hospital for chronic or severe diarrhea between 1977 and 1981 revealed that 31 patients (22.8%) had serum immunoglobulin levels below the 5th percentile for age. Twenty‐four of these 31 patients (77.4%) had normal or near normal serum immunoglobulin levels by their third birthday and most could therefore be classified under the heading “transient hypogammaglobulinemia of infancy,” an unexpected finding, as this condition has previously been thought to be rare; only 27 patients with this disorder were reported prior to 1978. While the basic cause of the defect is unknown, it has been linked to a slower than normal maturation of the neonate's ability to secrete immunoglobulins. Comparison of our patients with hypogammaglobulinemia and those with chronic diarrhea but normal immunoglobulins revealed that the former group are younger at presentation (mean, 8.2 months) and at the onset of their diarrhea (3.1 months); the figures for patients without hypogammaglobulinemia were 18.2 and 8.2 months, respectively. Males and females were equally affected, and the diarrhea, which was responsive to a hypoallergenic diet, resolved by 3 years of age as did the hypogammaglobulinemia in nearly all cases. While the etiology of the diarrhea remains obscure, significant problems outside the gastrointestinal tract did not occur. Circumstantial evidence suggests that the most likely cause for the failure of production of IgG, and to a lesser extent IgA antibody, in infants seen with diarrhea may result from a failure of maturation of T cell helper systems rather than any intrinsic defect in the B cell system itself.

High incidence of hypogammaglobulinemia in infants with diarrhea.

Examination of 136 children who were referred to the Pediatric Gastroenterology Clinic at Yale-New Haven Hospital for chronic or severe diarrhea between 1977 and 1981 revealed that 31 patients (22.8%) had serum immunoglobulin levels below the 5th percentile for age. Twenty-four of these 31 patients (77.4%) had normal or near normal serum immunoglobulin levels by their third birthday and most could therefore be classified under the heading "transient hypogammaglobulinemia of infancy," an unexpected finding, as this condition has previously been thought to be rare; only 27 patients with this disorder were reported prior to 1978. While the basic cause of the defect is unknown, it has been linked to a slower than normal maturation of the neonate's ability to secrete immunoglobulins. Comparison of our patients with hypogammaglobulinemia and those with chronic diarrhea but normal immunoglobulins revealed that the former group are younger at presentation (mean, 8.2 months) and at the onset of their diarrhea (3.1 months); the figures for patients without hypogammaglobulinemia were 18.2 and 8.2 months, respectively. Males and females were equally affected, and the diarrhea, which was responsive to a hypoallergenic diet, resolved by 3 years of age as did the hypogammaglobulinemia in nearly all cases. While the etiology of the diarrhea remains obscure, significant problems outside the gastrointestinal tract did not occur. Circumstantial evidence suggests that the most likely cause for the failure of production of IgG, and to a lesser extent IgA antibody, in infants seen with diarrhea may result from a failure of maturation of T cell helper systems rather than any intrinsic defect in the B cell system itself.

Effects of inhaled CO2 on airway stretch receptors in the newborn dog.

The response of 96 slowly adapting airway stretch receptors (SARs) to inhaled CO2 was studied in 26 puppies, which were anesthetized, paralyzed, and passively ventilated with the chest open. Both inhibitory and excitatory influences were obtained during CO2 inhalation depending on the presence or absence of a partially intact parasympathetic innervation and the receptor location. In puppies in the vagotomized condition, tracheal SARs of the youngest puppies (1-10 days) were inhibited (68% of control discharge), whereas bronchial SARs were unaffected by CO2. In the older age groups (12-17 and 26-30 days) there was a gradual acquisition of the adult response with a progressive increase in the inhibitory action of CO2 on bronchial SARs, whereas tracheal SARs became less affected. An excitatory action of CO2 could be found if the contralateral vagus nerve was intact. This response, which was abolished by vagotomy or atropine, was limited to tracheal SARs (occurring in 8 out of 23 receptors with the remainder inhibited) and was not accompanied by changes in transpulmonary pressure. Considering that only one-half of the functional efferent innervation of the trachea was present (i.e., left vagus only) and that the response has never been reported in the adult, the stimulation of SAR activity via smooth muscle contraction may represent a mechanism that could severely limit the neonate's ability to respond to periods of apnea or asphyxia.

Development of thermoregulation in Richardson's ground squirrel, Spermophilus richardsonii

Development of thermoregulation in Spermophilus richardsonii was investigated by determining the ability of neonates to maintain a normal body temperature when exposed to 30 and 25 °C, to maintain an elevated oxygen consumption (cubic centimetre oxygen per gram per hour) at 21 °C compared with that at 35 °C, and to move toward a warm object and assume curling postures when exposed to the cold. Newborn animals were essentially poikilothermic but by day 5 showed strong thermotaxis. By 30 days, the age of emergence from natal burrows, homeothermy had developed to the point at which normal body temperature could be maintained for at least 2 h at an ambient temperature of 25 °C. This process was correlated with improvements in heat production and heat retention. Subsequent growth was marked by a decreased metabolic response to cold (21 °C) owing to decreasing thermal conductance.

Perinatal infection

The majority of clinically recognizable acute infections in the neonate are bacterial. Such infections may be acquired from the mother prior to or at birth or from environmental sources. Because of the limited ability of neonates--especially those born prematurely--to express symptoms, even minor deviations from normal behavior should suggest bacterial disease. Chronic congenital and perinatal infections, unlike acute bacterial disease, are generally asymptomatic in mother and neonate and may remain latent or subclinically active in host tissue for prolonged periods, possibly causing insidious injury to the central nervous and perceptual systems. When overt, these infections almost invariably cause mental or perceptual handicaps or both. In view of the significant mortality and morbidity associated with either acute or chronic infections, diagnosis and treatment should be aggressive.

Drug-Induced Localized Sweating in Full-Size and Low-Birth-Weight Neonates

THE postnatal development of the sweating mechanism is still incompletely understood. The basis for the presumed delay in the onset of sweating in full-term neonates is as puzzling as the reason why prematurely born infants are unable to sweat for some time after birth. Neonatal sweating deficiency is cited as an example of functional immaturity, but the state of the development of the component parts of this mechanism—sweat glands, peripheral neural pathways, and automic centers—is unknown. With few exceptions, the available data on neonatal sweating concern thermal reflex sweating, which depends upon the functional status of the glands proper and on the competence of the nervous elements comprising the reflex arc. Recent studies have provided evidence, direct 1 and indirect, 2 of the mature neonate's ability to sweat naturally on the first day of life, earlier than was generally believed. 3 On the other hand, thermal sweating is a unique

SENSORY HABITUATION AND DISCRIMINATION IN THE HUMAN NEONATE

In summary, in the process of exploring the neonates' behavioral and autonomic repertoire for the purpose of devising techniques that would enable us to measure temperamental differences, we have come across two phenomena that we would like to emphasize. First we described the neonate's ability to habituate his responses to sensory stimuli and pointed out its possible relations to the neurophysiological structure subserving arousal, inhibition and attention; second we demonstrated that neonates have the capacity for sensory discrimination but noted that this primitive discrimination and habituation need not be dependent on the functioning of cerebral cortex and does not appear to be identical with the same phenomena in the mature organism.

Metabolism of carbon 14-labeled pyruvate by the newborn rat.

Pyruvate labeled with carbon-14 was administered intraperitoneally to newborn rats which were subsequently subjected to periods of aerobiosis or anaerobiosis. Expired air was analyzed for carbon dioxide, and blood, liver and carcass were analyzed for pyruvate, lactate, glycogen and total lipids. Small quantities of CO2 were produced anaerobically but this was not derived from the direct decarboxylation of pyruvate. Anaerobiosis resulted in a five-fold increase in blood lactate. The liver glycogen content of 10–24-hr-old rats treated anaerobically was only 10% of that of those kept in oxygen. The premature and newborn rats were apparently unable to mobilize glycogen in response to anoxia. The amounts of liver or carcass lipids were not significantly different after aerobic or anaerobic conditions. Lipogenesis occurred anaerobically at a rate not greatly different from that observed in aerobic conditions. In contrast, the data suggest that the utilization of lipids is reduced by anaerobiosis. No gross changes were found that could entirely explain the ability of neonates to survive prolonged oxygen deprivation but part, at least, of the energy for survival was provided by accelerated glycolysis.