Neonates In Group Research Articles

L-carnitine serum level in healthy and septic neonates

Objective The aim was to measure plasma l-carnitine concentration in healthy and septic neonates, and the relation between l-carnitine concentration and gestational age, birth weight, and presence of neonatal sepsis. Background Neonatal sepsis and endotoxemia result in impaired lipid metabolism and hepatic energy generation from fatty acid oxidation which could put those neonates at risk of l-carnitine deficiency. Materials and methods The study was carried out at the Menoufiya University Hospital over 1 year on 40 of healthy and septic neonates. All neonates were subjected to full history taking, clinical examination, and laboratory investigations included measurement of serum l-carnitine level, sepsis workup, and other laboratory investigations. Results Our study included 40 neonates, They were divided into four groups. Group 1: 10 healthy preterm neonates with a mean gestational age of between 33.50±1.18 weeks and mean birth weight of between 1.82±0.18 kg. Group 2: 10 healthy full-term neonates with a mean gestational age of between 38.80±1.03 weeks and mean birth weight of 2.98±0.23 kg. Group 3: 13 septic preterm neonates with a mean gestational age of between 33.46±1.13 weeks, and mean birth weight of 1.95±0.31 kg. Group 4: seven septic full-term neonates with a mean gestational age of between 38.57±1.27 weeks and mean birth weight of between 3.00±0.34 kg. Septic neonates groups (groups 3 and 4) have a low level of l-carnitine than healthy neonates groups (groups 1 2) and among septic groups the septic preterm neonates group (group 3) have a high level of l-carnitine than septic full-term neonates group (group 4). Also among healthy groups, the healthy preterm neonates group (group 1) have a high level of l-carnitine than healthy full-term neonates group (group 2). There was no correlation between l-carnitine and maternal age, gestational age, birth weight, and laboratory investigations in all groups. Conclusion There is a significant decrease of serum l-carnitine level in septic neonates, so they need assessment and supplementation. There is no correlation between serum level of l-carnitine and both gestational age and birth weight.

Pregnancy Induced Hypertension Versus Small Weight for Gestational Age: Cause of Neonatal Hematological Disorders.

Pregnancy-induced hypertension (PIH) is a multifactorial disorder that increases the risk of morbidity and mortality in both mother and newborn. Although there are many studies that track the effects of PIH on maternal and neonatal outcome, the results are contradictory. This retrospective study focuses on the effect of maternal PIH on neonatal hematological changes (thrombocytopenia and neutropenia). It also tries to determine whether neonatal thrombocytopenia and neutropenia are direct consequences of maternal PIH, rather than of the small for gestational age (SGA) status of the newborn. A three year restrospective observational study was conducted, from 1st of January 2014 to 31st of December 2016, on 6,077 newborns registered at the Neonatology Department of the Clinic of Obstetrics, Gynecology, and Neonatology, Emergency County Hospital, Timișoara, România. Selection of newborns with maternal PIH was made using the case-mix records RO DRG v1., according to which PIH was classified in gestational hypertension, preeclampsia and eclampsia. Patients were divided into four study groups, according to birth weight for gestational age and presence or absence of maternal PIH: 5,867 appropriate for gestational age (AGA) neonates form healthy mothers (AGA-Controls), 152 small for gestational age neonates from healthy mothers (SGA-Controls), 40 AGA newborns with maternal PIH (AGA-PIH) and 18 SGA newborns with maternal PIH (SGA-PIH). Regression and correlation analysis using the XLSTAT Microsoft Excel® tool pack, was performed to compare data from the study groups of neonates from mothers with PIH and the control groups of neonates from normotensive mothers. SGA-PIH neonates were the most affected with regard to the hematological abnormalities (33.3% neutropenic and 27.7% thrombocytopenic newborns) followed by AGA-PIH neonates (22.5% neutropenia and 17.5% thrombocytopenia). SGA-Controls had much lower percentages of both neutropenia and thrombocytopenia (2.63% and 1.97% respectively), whereas AGA-Controls had no record of any hematological changes. Maternal PIH has a strong influence on the development of newborn hematologic abnormalities, such as neutropenia and thrombocytopenia. The incidence and severity of these hematological changes are increased in neonates of mothers with PIH, that are born preterm and/or SGA.

Clinical implication of spontaneous gastrointestinal perforation in pediatric patients: its difference according to age group.

PurposeSpontaneous gastrointestinal perforations (SGIPs; not associated with injury or disease) occur rarely in pediatric patients. This study aimed to define age-specific features associated with SGIPs in pediatric patients.MethodsRetrospectively reviewed the clinical data of children (before adolescence) who received surgery due to a SGIP at a single institution. Thirty-nine patients were enrolled. Characteristics were compared between the 2 age groups: neonates (group A) and beyond neonates (group B).ResultsGroup A included 24 patients (61.5%) an group B included 15 patients (38.5%). Thirteen perforations occurred in the stomach (33.3%), 12 in the small intestine (30.8%), and 14 in the large intestine (35.9%). A significantly higher proportion of perforations occurred in the stomach and small intestine in group A, while more perforations occurred in the large intestine in group B (P = 0.01). Several associated conditions during the preoperative period were identified in both groups. The overall mortality rate was 15.4% (6 of 39). Mortality was relatively high in group A (5 of 24, 20.8%) and for perforations of stomach (3 of 13, 23.1%) and small intestine (3 of 12, 25.0%); however, there were no significant differences with regard to age or perforation site (P = 0.244, P = 0.122, respectively).ConclusionSGIPs in pediatric patients had diverse clinical features and different perforation patterns according to age group. However, no significant group differences in mortality were found. Thus, favorable results regardless of age can be expected with prompt recognition, medical resuscitation, and adequate surgical management.

501: Differences in neonatal outcome and placental pathology in relation to the severity of fetal growth restriction

We aimed to investigate neonatal outcome and placental pathology in pregnancies complicated with small for gestational age (SGA) neonates, in relation to the severity of growth restriction and in comparison to appropriate for gestational age (AGA) neonates. The medical records and placental histology reports of all neonates with a birth-weight (BW) ≤10th percentile, born between 24-42 weeks of gestation, during 2010-2015, were reviewed. Placental lesions were classified into maternal and fetal vascular malperfusion (MVM and FVM) lesions, according to the Amsterdam classification. Results were compared between neonates with BW< 5th percentile (severe SGA group), neonates with BW between 5th-10th percentile (mild SGA group) and a control group of AGA neonates, adjusted to the study groups for gestational age (GA), maternal age, and mode of delivery. Composite neonatal outcome was defined as one or more of early complications. Overall, 753 neonates were included, 238 in the severe SGA group, 266 in the mild SGA group, and 249 in the control group. There were no differences in maternal age, maternal diabetes or thrombophilia, GA at delivery and mode of labor between the groups. In the severe SGA group there were higher rates of severe preeclampsia compared with the mild SGA and control groups (10.1% vs. 5.6% vs. 2.8%, respectively, p=0.003), and higher rates of composite adverse neonatal outcome compared with the mild SGA and control groups (37.2% vs. 17.6%, vs. 24.5%, respectively, p<0.001). Mean placental weight was significantly lower in the severe SGA group as compared to the mild SGA group as compared to the controls (323±82gr vs. 365±79gr vs. 471 ±107gr, respectively, p<0.001). The SGA groups was characterized by higher rates of placental MVM and FVM lesions, compared with controls (p<0.001 for both). After controlling for confounders, using a multivariate regression analysis, we found that as growth restriction was more severe there was an increased likelihood of detecting placental MVM and FVM lesions (table). Worse neonatal outcome and more placental maternal and fetal vascular malperfusion lesions correlate with the severity of fetal growth restriction in a 'dose dependent' manner.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Vitamin D deficiency and vitamin D receptor gene polymorphisms as a risk factor for severe early-onset neonatal sepsis

Background It is well known that vitamin D, which is one of the fat-soluble vitamins, is responsible for sustaining normal calcium balance and mineralization of the skeletal system. It is now widely considered as a pleiotropic hormone that modulates and regulates many biological processes of different organs including neural, endocrinal, immune processes, and cardiovascular differentiation of cells and apoptosis. Furthermore, vitamin D has a crucial immune-modulatory effect on innate and adaptive immune responses, endothelial cell function and mucosal barriers. Aim We aimed to study the relation between vitamin D level and vitamin D receptor (VDR) gene polymorphisms and the risk of severe early-onset sepsis (EOS) among a group of Egyptian neonates. Participants and methods We carried out a case–control study on 80 newborns with culture-proven EOS and their mothers. Eighty sex and age harmonized healthy neonates and their mothers were selected as controls. Maternal and neonatal serum (25-hydroxy-vitamin D) levels were analyzed using enzyme-linked immunosorbent assay. Genotyping of both cases and controls for the VDR gene (Fok1, Apa1, Taq1, and Bsm1) polymorphisms were performed using polymerase chain reaction-restriction fragment length polymorphism. Cases were followed-up to detect the outcome. Results Cases and their mothers had a significant deficient vitamin D level compared with controls (P=0.000). Genotype frequency for all studied VDR gene polymorphisms, was in accordance with Hardy–Weinberg equilibrium among cases and controls, except for Fok1 genotype frequency in cases. VDR Fok1 F/f and f/f genotype and f allele were significantly higher in frequency among neonatal cases than among controls with odd ratio (95% confidence interval), and P value of 9.18 (4.31–19.81); P=0.000, 8.25 (2.36–28.83); P=0.000 and 4.52 (2.65–7.71); P=0.000, respectively. There was a significant association between low vitamin D level and increased Fok1 F/f, f/f genotype and f allele frequency and severity of sepsis and poor outcome. Conclusion Vitamin D deficiency and VDR gene Fok1 polymorphism are associated with increased severity of neonatal EOS.

A novel thermal imaging approach to computational prediction of shock in pediatric ICU: Results from a tertiary care hospital in India

Background : Hemodynamic shock is a life-threatening yet reversible condition in children admitted to ICU. Early detection of shock can prevent the cascading sequelae of secondary organ failure. While existing literature reports Shock Index as a reliable indicator of shock, this requires accurate measurement of Heart Rate and Blood Pressure. A non-contact, non-invasive method for shock detection is highly desirable, especially for pediatric and neonatal age groups. Imaging is an underutilized modality and literature-evidence exists for computational extraction of heart rate from head-bobbing and forehead-flushing from normal videos. However, heart rate alone is not a reliable indicator of shock, and other physiological markers of shock such as centre-to-periphery difference (CPD) of temperature in body surface temperature are underexplored. Methods : The study was conducted between September 2016 and February- April 2017 in the PICU of a tertiary care hospital in India. Images were recorded using an affordable commercial device- Seek Compact Thermal Imager for Android [Seek Thermal Inc., CA, USA)] attached to an android phone. A standard operating procedure was followed for recording the images to minimize the device, patient or environmental factors. CPD was manually extracted by 3 independent annotators using FIJI, an image processing software platform. Shock index adjusted by age was computationally extracted from the continuous BP, Heart Rate and patient age stored in the SAFE-ICU warehouse, the first Big-data resource for PICU in India. Age-specific thresholds for shock index were used to label patients into positive/negative classes. The predictors were checked for assumption of normality and Generalised Linear Mixed Effects Models using Penalized Quasi-Likelihood were constructed to account for the longitudinal structure and non-normal distribution of data. Results : 307 images from 62 patients were used for the study (34 males, 28 females, age range = 0.2 - 144 months). Since CPD were non-normally distributed (and negative in some cases), log-transformation could not be applied. Hence, a Penalized Quasi- likelihood approach to General Linear Mixed Effects models was taken. Data were randomly partitioned into 10-fold 75% training and 25% testing sets. CPD was found to be a statistically significant predictor of thresholded and age-adjusted shock- index (p-value < 0.005) and with a positive coefficient (0.023), thus, indicating that a positive CPD is an important indicator of higher shock index. Model prediction on the testing set showed an accuracy of 79 ± 0.04% (AUC = 83 ± 0.06%, sensitivity = 0.73±0.09, specificity = 0.83±0.04). Conclusion : Computational modeling upon thermal imaging is a potentially useful method for non-contact detection of shock in children. Since our model required only age and manual identification of abdomen and foot in the thermal image, our method is potentially applicable in tele-diagnostic settings for detection of shock in the community, in the absence of domain experts through the application of computational models.

Impact of antenatal diagnosis on management of congenital heart diseases: A retrospective study from 2010 to 2015

Congenital heart diseases (CHD) are a serious pathology, their prognosis is sometimes uncertain but they can be treated with rapid and adapted care at birth. The benefit of antenatal diagnosis is no longer demonstrable, since it significantly reduces morbidity and mortality. The aim of the study is to evaluate the cardiological consequences of antenatal screening of CHD, its impact on pregnancy outcomes and to determine the prognostic factors associated with early and late survival. A retrospective, monocentric study was performed at CHU Amiens, Picardie, between 2010 and 2015. 205 fetuses with CHD were included. Main outcome measures were the evolution in the performance of antenatal diagnosis, the impact of extracardiac abnormalities and pronostic factors of survival. Prenatal diagnosis rate of CHD increased from 41% in 2010 to 57% in 2015. Termination of pregnancy (TOP) rate has remained stable over time (25,8%). The prognostic factors associated with the outcome of pregnancy were extracardiac abnormalities (32% in TOP group versus 14.6% in the live neonates group, P < 0,01) and type of heart disease (64.1% univentricular cardiac disease in TOP group versus 35,8% in live neonates group, P < 0,01). Survival was 98% at 1 week and 93% at 1 year. The univentricular character of CHD and absence of surgical management were prognostic factors of survival ( P < 0.01). Progress in the antenatal diagnosis rate of CHD and reduction in neonatal mortality are due to close collaboration between the different actors of care. The long-term neurodevelopmental consequences must be evaluated.

Factores Asociados a Hemorragia Intraventricular En Neonatos Atendidos En Un Hospital de Segundo Nivel

Intraventricular hemorrhage (HIV) is a complication in neonates. It originates in the subependymal germinal matrix. This area is irrigated by a network of poorly differentiated vessels without a basement membrane. Also, it is fragile and vulnerable to the hemodynamic instability of cerebral blood flow. It is an important risk factor for periventricular leukomalacia, ventriculomegaly, and hydrocephalus. These neurological pathologies can generate sequelae in the pediatric population such as cerebral palsy (CP). Objective: To identify the factors associated with HIV in neonates treated in the early intervention program of the hospital of specialties of the child and the woman of the Secretary of Health of the State of Querétaro (HENMSESEQ). Material and Methods: Through the review of the clinical files, the factors associated with HIV present in the children attended to in the HENMSESEQ early intervention service were observed in 2015. Cases of HIV were corroborated by means of transfontanel ultrasound, statistical analysis with measures of central tendency, and comparison of the medians of children diagnosed with HIV and without diagnosis. Results: A group of 69 infants attended to in the early intervention program was studied. Out of them, 65.2% (45) were women and 34.3% (24) were men. They had a gestational age of 34.19 ± 4.22 weeks, birth weight of 2116.09 ± 859.36 g, and height of 44.06 ± 6.02 cm. Their stay in the Neonatal Intensive Care Unit (NICU) for the sample was 11.88 ± 16.84 days and they were 8.65 ± 12.20 days with invasive mechanical ventilation. There were 25 cases of HIV diagnosed by transfontanel ultrasound. Out of the 25 cases, 7 (10%) were HIV grade I, 14 (20%) II, 4 (5.7%) III, and no cases of grade IV were diagnosed. Using the Mann-Whitney U test, a difference was found between the groups of neonates diagnosed with HIV and without diagnosis in weeks of gestation, height, weight, APGAR, days of intubation, and days of stay in NICU.

Arterioportal shunting, splanchnic capillary perfusion, and the effects of colloids during capnoperitoneum in neonatal and adolescent pigs

Clinical and experimental data indicate that neonates are sensitive to the CO2 pneumoperitoneum. An impaired splanchnic perfusion during laparoscopy in adults has been reported. We recently confirmed that intravenous colloids improve macrocirculatory function in neonates. We aimed to determine the impact of CO2 pneumoperitoneum on the perfusion of splanchnic organs in the young including effects of colloid application. Male piglets (n = 25) were divided into four groups: (1) neonatal controls, (2) neonates with crystalloid restitution, (3) neonates with colloidal restitution, and (4) adolescents with crystalloid restitution. Animals were ventilated and subjected to a 3-h, 10mmHg CO2 pneumoperitoneum followed by 2h resuscitation. Hepatic, splanchnic, and arteriovenous shunt perfusion was assessed via central and portal venous catheters. Capillary organ flow was detected by fluorescent microspheres. The rate of bile flow was measured. The neonatal crystalloid group showed a significant decrease in the intestinal capillary perfusion at the end of the recovery period. This was not detectable in the adolescent and colloid group. There was a significant increase in microcirculatory arterioportal shunt flow during the CO2 pneumoperitoneum in both neonatal groups but not in the sham and adolescent groups (p < 0.05). Hepatic arterial perfusion increased after insufflation in all groups and dropped during capnoperitoneum to levels of about 70% baseline. There was no significant impairment of splanchnic perfusion or bile flow as a result of the pneumoperitoneum in all groups. Capillary perfusion of the abdominal organs was stable during capnoperitoneum and recovery in adolescents and neonates with colloid restitution, but not with crystalloid restitution. Significant arterioportal shunting during capnoperitoneum could affect hepatic microcirculation in neonates. Our data confirm that moderate pressure capnoperitoneum has no major effect on the perfusion of abdominal organs in neonates with adequate substitution.

Follow-Up on 107 Fetuses with Normal Us + Echo After 37TH Week of Gestation

Abstract Introduction: Echocardiography of the fetal heart is an ultrasound examination that allows the evaluation of the anatomical structure and cardiovascular system usually performed in first half of pregnancy. Material and methods: This work presents the data of 107 fetuses with normal heart anatomy (NHA) and normal heart study (NHS) and their neonatal follow-up. In this group (in an addition to routine prenatal work-up) has been performed also a echocardiography examination in the third trimester of pregnancy, after 37th week of gestation: 61% of pregnant women were referred to the prenatal cardiology center due to the presence of high-risk pregnancies and 39% were low-risk pregnancies. Results: In two cases episodes of fetal arrhythmias were present during obstetrical examinations. After birth in the study group of 107 fetuses, 72% of newborns left the hospital during the 4 days and 28% newborns stayed in the hospital for longer time. In 16 cases their stay was extended due to maternal reasons and in 14 for newborns reasons. Conclusions: 1) In the neonate group, after prenatal cardiac evaluation &gt; the 37th week of gestation such as “ normal fetal heart anatomy &amp; normal heart study”, all newborns in our center were born in good general condition. 2) Late prenatal echocardiography in 3rd trimester of pregnancy maybe considered as additional tool to prove fetal well being, specially in high risk pregnancies.

Early Neonatal Morbidities of Late Preterm Neonates Admitted to SNCU in the Government District Hospital

Introduction: The rate of preterm birth is increasing worldwide primarily at the expense of late preterm newborns. Late preterm infants are the fastest growing sub group of neonates and constitute approximately75% of all preterm birth sin2009. The birth rate of late preterm new borns has increased by 25% from 1990 to 2005 in the United States. Methodology: Details regarding maternal risk factors were collected by detailed history taking and the medical records with them. The infants in the sample were followed throughout their stay in the SNCU and postnatal wards, up until hospital discharge. Data were collected from infants and mothers medical records and supplemented with additional information collected at discharge using a structured form covering the variables of interest. Results: Hyperbilirubinaemia, Sepsis, Birth asphyxia and respiratory distress constitute the major neonatal morbidities which accounts for 68%, 68%, 41% &amp; 34% respectively. Conclusion: Rate of re hospitalization is high in late preterm neonates.

Morbilidad y mortalidad de neonatos < 1,500 g ingresados a la UCIN de un hospital de tercer nivel de atención

IntroductionWith the advances of perinatal and neonatal care, the survival of premature infants has increased. The birth weight and gestational age are the most important determinants of morbidity and neonatal mortality rates. The objective of this study was to determine the morbidity and mortality of neonates with birth weight <1500g who required admission into NICU. Material and methodsAn analysis of a cohort of neonates <1500g admitted to the NICU was carried out consecutively from January to December 2016, with the determination of prenatal care variables (prenatal steroids, use of magnesium sulphate, delivery mode), and neonatal variables (birth weight, gestational age, morbidity and mortality). Statistical analyses in the group of neonates who survived and those who died, included the calculation of chi squared test, Student t test, and Odds Ratio, with 95% confidence interval (OR, 95%CI). ResultsThe study included 135 neonates, 113 (83.71%) of whom survived and 22 (16.29%) died. Birth weight was significantly lower for patients who died (969g vs 842g, P=.0074) as well as gestational age (29 vs 27.9, P=.01). As regards the morbidity of those who survived, severe BPD was present in 38%, severe IVH grade III/IV in 20%, and severe ROP in 2.6%. The principal cause of mortality was sepsis. DiscussionIn this study, mortality was similar to other countries such as Norway, Spain, and some Latin American countries. ConclusionSurvival occurred with increasing gestational age and birth weight, with a mortality of 16.29%.

DDH Epidemiology Revisited: Do We Need New Strategies?

Although the developmental dysplasia of the hip (DDH) is well known to pediatric orthopedists, its etiology has still remained unknown and despite dedication of a vast majority of research, the results are still inadequate and confusing. The exact incidence of DDH and its relationship with known risk factors in Iran is still unknown. Here we represent the results of one year study on the incidence and related conditions of DDH. Sonography was performed on the hip joints of 1073 full term healthy newborns at Imam Khomeini Hospital from March 2013 to March 2014. The results were classified according to Graf's classification. Pathologic hips were cross checked by the known risk factors for DDH. A significant correlation was found between DDH and breech presentation (P=0.000), torticollis (P=0.004), metatarsus adductus (P=0.024). The incidence of DDH is significantly high in the studied group of neonates, suggesting reevaluation of current approach to DDH. The screening protocols need to be improved with the help of trained pediatricians and other health professions.

Role of HIV exposure and infection in relation to neonatal GBS disease and rectovaginal GBS carriage: a systematic review and meta-analysis

Streptococcus agalactiae (GBS) is the leading cause worldwide of neonatal sepsis. We sought to assess to which extent HIV exposure of neonates is associated with GBS neonatal disease. Furthermore, we assessed to which extent HIV infection in women is associated with maternal rectovaginal GBS carriage, the single most important risk factor for GBS neonatal disease. We searched Pubmed, Embase, and Web of Science for studies assessing the association between neonatal GBS disease and HIV-status of the mother and studies that assessed the association between rectovaginal GBS colonization and HIV status in women. HIV-exposed uninfected neonates were more than twice as likely to have neonatal GBS disease compared to unexposed neonates. HIV-exposed neonates were not at increased risk for early-onset neonatal disease, but were 4.43 times more likely to have late-onset neonatal GBS disease. There was no significant association between HIV infection status and rectovaginal GBS carriage. Public health interventions preventing neonatal GBS disease are urgently needed for the increasing group of HIV-exposed neonates. A framework integrating and explaining our findings highlights opportunities for the clinical practice and global health policy to prevent disease. Well-designed studies should clarify the relation between HIV-status and GBS carriage.

Spatial variation in the hemoglobin phase of oxygenation and deoxygenation in the developing cortex of infants.

Spontaneous low-frequency oscillatory changes in oxygenated hemoglobin (oxy-Hb) and deoxygenated hemoglobin (deoxy-Hb) are observed using functional near-infrared spectroscopy (fNIRS). A previous study showed that the time-averaged phase difference between oxy-Hb and deoxy-Hb changes, referred to as hemoglobin phase of oxygenation and deoxygenation (hPod), is sensitive to the development of the cortex. We examined phase-locking index of hPod, referred to as [Formula: see text], in addition to hPod, in neonates and 3- and 6-month-old infants using the 94-channel fNIRS data, which covered large lateral regions of the cortex. The results showed that (1)developmental changes in hPod exhibited spatial dependency; (2)[Formula: see text] increased between the neonate group and 3-month-old infant group over the posterior, but not anterior, regions of the cortex; and (3) the cortical regions of each age group were clustered in several domains with specific characteristics of hPod and [Formula: see text]. This study indicates that the neonatal cortex is composed of regions with specific characteristics of hPod and [Formula: see text], and drastic changes occur between the neonatal period and 3 months of age. This study suggests that hPod and [Formula: see text] are sensitive to the cortical region-specific development of the circulatory, blood flow, metabolic, and neurovascular functions in young infants.

Correlation between UGT1A1 polymorphism and neonatal hyperbilirubinemia of neonates in Wuhan.

This study attempts to discuss the correlation between UGT1A1*28 as uridine diphosphate glucuronosyltransferase gene promoter and coding region Gly71Arg gene polymorphism with neonatal hyperbilirubinemia of neonates in Wuhan. A total of 168 neonates were divided into the hyperbilirubinemia group (case group, n=108) and healthy neonates group (control group, n=60). Their DNA was obtained through blood extraction. The gene exon mutation of UGT1A1 was detected by Sanger sequencing, which revealed the relationship between UGT1A1*28 and Gly71Arg polymorphism with neonatal hyperbilirubinemia of neonates. The results showed that: (1) The frequency of UGT1A1*28 allele mutation in the case group and the control group was 9.3% and 10% respectively, with the difference being not significant between the two groups (P>0.05). (2) The frequency of Gly71Arg allele mutation in the case group and the control group was 35.1% and 21.7% respectively, with the difference being significant between the two groups (P<0.01). (3) The serum bilirubin level of Gly71Arg mutant homozygous and heterozygous subgroups (n=66) in the case group was 302.7±31.4 μmol/L, which was significantly higher than 267.3±28.5 μmol/L of the wild subgroup (n=42) (P<0.01). It was suggested that the occurrence of neonatal hyperbilirubinemia of neonates in Wuhan was not associated with UGT1A1*28 gene polymorphism, but closely with the Gly71Arg gene polymorphism. Meanwhile, the Arg allele mutation was related to the degree of jaundice.

Role of Zc3h12a in enhanced IL-6 production by newborn mononuclear cells in response to lipopolysaccharide

The uncontrolled inflammatory response following infection is closely related to the morbidity and mortality of neonates. Interleukin 6 (IL-6) plays an important role in the pathogenesis and prognosis of this process. To better elucidate the secretion of IL-6 following infection in neonates, we investigated the IL-6 level and mechanism of IL-6/TLR4 signaling pathways. We compared the IL-6, procalcitonin (PCT), and CRP levels between septic neonates and toddlers. Invitro cord blood samples from healthy term neonates and peripheral venous blood from healthy adult volunteers were collected. Protein expression was analyzed by Western blotting, mRNA expression by real-time PCR and membrane molecule expression by flow cytometry. The IL-6 concentrations were significantly higher in the neonate group than in the toddler group (p<0.05). In the toddler group, the IL-6 concentrations were correlated positively with both PCT and CRP (PCT: r=0.451, p=0.001; CRP: r=0.243, p=0.023). Invitro, the secretion of IL-6 increased with the rising concentrations of LPS; at 1000ng/ml LPS, IL-6 secretion from the monocytes of neonates was significantly higher than that of adults. There was a marked decreased level of MyD88 in neonate monocytes compared with that in adult monocytes. Additionally, the mRNA levels of Zc3h12a in neonate monocytes were significantly lower than those in adult monocytes following LPS stimulation. Neonates displayed enhanced IL-6 production after infection. Our study, for the first time, reported a significant decrease in the expression of Zc3h12a in neonates. Thus, Zc3h12a may be a key factor for the aberrant increase in IL-6 after neonate infection.

Relationship of Cord Blood Immunoglobulin E and Maternal Immunoglobulin E with Birth Order and Maternal History of Allergy in Albanian Mother/Neonate Pairs.

BACKGROUND:Previous studies reported that familial factors such as birth order and mothers atopy might influence cord blood levels and development of allergies.AIM:The aim of the study was to evaluate the relationship of cord blood IgE and maternal IgE with birth order and mothers history of allergy in Albanian mother/neonate pairs.MATERIAL AND METHODS:Study population represented 291 mother-infant pairs. Mothers were interviewed with a questionnaire for personal history of allergy and pregnancy history whereas serum IgE levels were determined using sandwich IRMA assay.RESULTS:The mean level of cIgE in neonates with detectable levels was 1.59 (n = 78). No significant difference in means of cIgE was found between first born and later born neonates (p = 0.232) and between neonates of mothers with a negative and positive history of allergy (p = 0.125). Also, no significant difference was found between means of mIgE by birth order, whereas there was a significant difference of mIgE between mothers with and without a history of allergy (p = 0.01). In a group of neonates with detectable cIgE levels, maternal IgE levels were moderately correlated with cIgE levels.CONCLUSION:Cord blood IgE is not affected by birth order and mothers history of allergy, whereas mothers IgE are affected by the history of allergy but not by birth order.

Improving the efficiency of Auditory Brainstem Responses in newborns, using a 60 clicks/s stimulation rate

Recent evidence suggests that Auditory Brainstem Responses (ABR), in neonates with risk factors for neurological damage, may show auditory brainstem abnormalities, even in patients with normal hearing. To compare the recording and diagnostic accuracy of neonatal Auditory Brainstem Responses (ABR), using 10 and 60clicks/s stimulation rates, two groups of neonates were prospectively studied: 30 healthy full-term neonates, with no peri- or postnatal complications; and 30 high-risk newborns with two or more of the following conditions: hyperbilirubinemia, use of ototoxic drugs, birth weight inferior to 1500g, perinatal sepsis, intraventricular hemorrhage, and/or mechanical ventilation. Correlation between ABR trials, recording duration, and the absolute and interpeak latencies of ABR waves I, III and V, were measured. ROC-curve analysis assessed the diagnostic accuracy of both stimulation rates. The correlations between ABRs trials were significantly higher at 60clicks/s than at 10clicks/s (F(1,116)=14.5, p<0.0002). Recording duration at 60clicks/s was significantly lower (t=20.9, p<0.0001). ROC-curve comparisons showed increased diagnostic accuracy at the stimulation rate of 60clicks/s, for waves I (D=2.04, p=0.04), V (D=2.02, p=0.04), interpeak latencies III-V (D=2.2, p=0.02), and I-V (D=2.86, p=0.004). In neonates, the use of 60clicks/s stimulation rate permits a substantial shortening of the ABR recording, with greater diagnostic accuracy and replicability.

Prenatal Therapy with Magnesium Sulfate and Its Correlation with Neonatal Serum Magnesium Concentration.

Antenatal magnesium sulfate (MgSO4) administration has shown to be effective in minimizing cerebral palsy and severe motor dysfunction at the age of 2 years. The aim of this study is to determine the relationship between the magnesium dose delivered to the mother and the magnesium concentration in the neonates. A prospective cohort study was conducted on neonates of less than 32 weeks' gestation admitted to the neonatal intensive care unit of University Hospital Complex of Vigo from December 2012 to July 2015. Comparative analysis of magnesium levels between the groups of neonates exposed to MgSO4 and the control group. A total of 118 neonates were included in the study. The mothers of 62 of them had received MgSO4 as a neuroprotective agent. There was a significant correlation between the full dose of MgSO4 received by the mother and the levels of magnesium in the neonate in the first 24 hours of life (r2 = 0.397; p < 0.001). The MgSO4 dose received by the mother has a linear relationship with the magnesium levels obtained in neonates.