Neonates Of Different Gestational Ages Research Articles

Improved neonatal outcomes by multidisciplinary simulation-a contemporary practice in the demonstration area of China.

Simulation-based training improves neonatal resuscitation and decreases perinatal mortality in low- and middle-income countries. Interdisciplinary in-situ simulation may promote quality care in neonatal resuscitation. However, there is limited information regarding the effect of multidisciplinary in-situ simulation training (MIST) on neonatal outcomes. We aimed to investigate the impact of MIST on neonatal resuscitation in reducing the incidence of neonatal asphyxia and related morbidities. Weekly MIST on neonatal resuscitation has been conducted through neonatal and obstetrical collaboration at the University of Hong Kong-Shenzhen Hospital, China, since 2019. Each simulation was facilitated by two instructors and performed by three health care providers from obstetric and neonatal intensive care units, followed by a debriefing of the participants and several designated observers. The incidence of neonatal asphyxia, severe asphyxia, hypoxic-ischemic encephalopathy (HIE), and meconium aspiration syndrome (MAS) before (2017-2018) and after (2019-2020) the commencement of weekly MIST were analyzed. There were 81 simulation cases including the resuscitation of preterm neonates of different gestational ages, perinatal distress, meconium-stained amniotic fluid, and congenital heart disease with 1,503 participant counts (225 active participants). The respective incidence of neonatal asphyxia, severe asphyxia, HIE, and MAS decreased significantly after MIST (0.64%, 0.06%, 0.01%, and 0.09% vs. 0.84%, 0.14%, 0.10%, and 0.19%, respectively, all P < 0.05). Weekly MIST on neonatal resuscitation decreased the incidence of neonatal asphyxia, severe asphyxia, HIE, and MAS. Implementation of regular resuscitation simulation training is feasible and may improve the quality of neonatal resuscitation with better neonatal outcomes in low- and middle-income countries.

Clinical characteristics of meconium aspiration syndrome in neonates with different gestational ages and the risk factors for neurological injury and death: A 9-year cohort study.

The presence of meconium is associated with gestational age, and the incidence of meconium aspiration syndrome (MAS) increases with gestational age. Our study compared the differences in the clinical characteristics of patients with MAS at different gestational ages and discussed the risk factors for neurological injury and death from MAS. A total of 294 neonates diagnosed with MAS between 2013 and 2021 were included. Patients were divided into preterm, early-term, full-term, and late-term groups according to gestational age. We compared the patients' basic demographic, treatment, complications, and clinical outcomes in the different groups. We also analyzed the risk factors of neurological injury and death in patients with MAS. The mean age at admission (0.55 ± 0.9 h) was lower and the proportion of cesarean deliveries (90.00%, 27/30) was higher in the preterm group than in the other three groups. There was no statistically significant difference among the four groups regarding 1- and 5-min Apgar scores and the need for delivery room resuscitation. In terms of complications, early-term infants had the highest incidence of neurological injury (52.9%, 27/51), and late-term infants had the highest incidence of pneumothorax (37.8%, 17/45). The overall mortality rate of children with MAS was 7.80% (23/294), and the difference in mortality rates among the four groups was not significant. Low 1-min Apgar score and gestational age, metabolic acidosis, and respiratory failure were independent risk factors for neurological injury; metabolic acidosis, respiratory failure, and sepsis were independent risk factors for death in neonates with MAS. The clinical characteristics of MAS neonates of different gestational age are different mainly in complications. Early-term infants are more likely to complicate with neurological injury, and late-term infants are more likely to complicate with pneumothorax. Low 1-min Apgar score and gestational age, metabolic acidosis, and respiratory failure were established as risk factors for neurological injury; metabolic acidosis, respiratory failure, and sepsis were independent risk factors for death in neonates with MAS.

Birth growth curves of neonates in high-altitude areas: A cross-sectional study.

Since the current commonly used birth growth curves are unsuitable for neonates in high-altitude areas; this study aimed to establish birth growth curves for full-term neonates residing at 2,000-3,000 m. This cross-sectional study retrospectively analyzed the physical measurement data of 1,546 full-term neonates delivered at the Red Cross Hospital of Qinghai province, China, from July 2021 to April 2022. The percentile curves of birth weight, length, and head circumference of neonates of different gestational ages and genders were developed using curve fitting. The newly developed birth-weight percentile reference was compared with the INTERGROWTH-21st Neonatal Growth Curve (International Standard) and the Chinese Neonate Growth Curve (Chinese Standard). The median birth weight, length, and head circumference of the study population were 3,200 g, 52.0 cm, and 32.8 cm, respectively, except for the group with a gestational age of 37 weeks. The growth indicators of male infants in all groups were higher than those of the female infants (P < 0.05). We found differences between the newly developed birth-weight percentile curves in the high-altitude areas and the International and Chinese Standards. Establishing birth growth curves corresponding to altitude may be more suitable than the existing standards for local medical staff to conduct health assessments of neonates.

A morphometric study of anterior fontanel in eastern Indian population and its clinical correlation

Introduction: The fontanels are soft membrane covered gaps and the meeting of more than two cranial bones placed side by side. There are six fontanels, of which anterior fontanel is most prominent. We tried to determine the anterior fontanel dimension of the neonates of different gestational age. This in turn will help in diagnosing newborns with serious medical conditions and ensuring their prompt care. Objectives: Estimation of neonatal anterior fontanel area, for use in neonatal screening. Methods: A cross sectional study was conducted in a tertiary care hospital with 530 consecutively live born new born of 28 -41 weeks gestation. After three days of life anterior fontanel area was measured. The values were summarized using descriptive statistics, including percentile values. Results: In index study, we deducted anterior fontanel dimensions of newborns of gestational age ranging from 28 to 41 weeks. The mean anterior fontanel size was 3.20 ± 1.71. Anterior fontanel variation with gestational age showed that anterior fontanel area increases with increase in gestational age. However, another study with greater number of participants and in a community setting may be helpful. Conclusion: Anterior fontanel area can be used as a tool for identifying newborns with grave ailments. Abnormal fontanel measurement can be either large or small anterior fontanel. These are associated with many important consequences. Detecting them early will help in seeking appropriate medical guidance.

Dynamic Changes of the Gut Microbiota in Preterm Infants With Different Gestational Age

The gut microbiota plays a key role in the pathogenesis of diseases affecting preterm infants and gestational age is one of the important factors which affect the gut microbiota of infants. To determine the characteristics of the gut microbiota in preterm infants of different gestational ages from birth to 1 year after birth, we collected 622 fecal samples from neonates of different gestational ages at different time points after birth. According to the gestational ages, the samples were divided into four groups, extremely preterm, very preterm, moderate to late preterm, and term group. Meconium and fecal samples at day 14, 28, 120, and 365 after birth were collected. 16S rRNA sequencing was performed and the composition and structure of the gut microbiota in preterm infants of different gestational age was compared with that of term infants. In our study, alpha diversity of meconium in extremely preterm group was higher than very preterm group, moderate to late preterm group and term group and alpha diversity of meconium in preterm group was decreased with increasing of gestational age. At day 14 to day 120 after birth, alpha diversity of term and moderate to late preterm group were significantly higher than other two preterm groups. However, moderate to late preterm group owned the highest alpha diversity which was higher than term group at day 365 after birth. Besides, the results shown the duration of opportunistic pathogen such as Klebsiella and Enterococcus which dominant colonization was different in different gestational age groups. As well as the probiotics, such as Bifidobacterium, which abundance enriched at different time point in different gestational age groups. We profiled the features of dynamic changes of gut microbiome from different gestational ages infants. The results of our research provide new insights for individualized interventions of specific microbes of preterm infants with different gestational ages at different time points after birth.

Validation of reference genes for whole blood gene expression analysis in cord blood of preterm and full-term neonates and peripheral blood of healthy adults

BackgroundPreterm birth is the leading cause of neonatal morbidity and mortality, but research efforts in neonatology are complicated due to the unavailability of large volume blood samples. Whole blood assays can be used to overcome this problem by performing both functional and gene expression studies using small amounts of blood. Gene expression studies using RT-qPCR estimate mRNA-levels of target genes normalized to reference genes. The goal of this study was to identify and validate stable reference genes applicable to cord blood samples obtained from developing neonates of different gestational age groups as well as to adult peripheral blood samples. Eight reference gene candidates (ACTB, B2M, GAPDH, GUSB, HPRT, PPIB, RPLP0, RPL13) were analyzed using the three published software algorithms Bestkeeper, GeNorm and NormFinder.ResultsA normalization factor consisting of ACTB and PPIB allows for comparative expression analyses of neonatal samples from different gestational age groups. Normalization factors consisting of GAPDH and PPIB or ACTB and GAPDH are suitable when samples from preterm and full-term neonates and adults are compared. However, all candidate reference genes except RPLP0 exhibited significant intergroup gene expression variance and a higher gene expression towards an older age which resulted in a small but statistically significant systematic bias. Systematic analysis of RNA-seq data revealed new reference gene candidates with potentially superior stability.ConclusionsThe current study identified suitable normalization factors and proposed the use of the additional single gene RPLP0 to avoid systematic bias. This combination will enable comparative analyses not only between neonates of different gestational ages, but also between neonates and adults, as it facilitates more detailed investigations of developmental gene expression changes. The use of software algorithms did not prevent unintended systematic bias. This generally highlights the need for careful validation of such results to prevent false interpretation of potential age-dependent changes in gene expression. To identify the most stable reference genes in the future, RNA-seq based global approaches are recommended.

Cerebral superb microvascular imaging in preterm neonates: in vivo evaluation of thalamic, striatal, and extrastriatal angioarchitecture.

To explore the potential of superb microvascular imaging (SMI) in visualizing brain microvessels in preterm neonates of different gestational ages (GA). In this retrospective, observational pilot study, 15 preterm newborns were equally divided into GA groups: extremely (GA < 28weeks), very (28-31weeks), and moderate to late (32-37weeks) preterm. All patients underwent conventional transcranial ultrasounds during the first day of life following the American Institute of Ultrasound in Medicine practice guidelines. SMI was then performed; based on their SMI morphology and location, brain microvessels were classified as extrastriatal (cortical and medullary), striatal, or thalamic. Two examiners independently classified vessels as visible or invisible. To assess the association between vessel visibility and GA, binomial logistic regression analysis (separate for each microvessel group) was performed, taking visibility as a dependent variable and both examiners and GA as predictor variables. A statistically significant difference among GA groups was found in sex (P= 0.030), birth weight (P= 0.007), and Apgar score within 1min after birth (P= 0.024). Microvascular visibility increased with GA for superficial vessels (P< 0.05 for both cortical and medullary), while striatal and thalamic vessels were visible in all neonates irrespective of their GA. SMI technology shows promise to assess brain microvasculature in preterm neonates, even potentially providing data on early brain development.

Renal Function Profiles in Preterm Neonates With Birth Asphyxia Within the First 24 H of Life.

The characteristics of early renal function in preterm neonates of different gestational ages (GAs) with birth asphyxia (BA) remain unclear. Kidneys are sensitive to oxygen deprivation, and renal insufficiency may occur within 24 h of BA. We aimed to elucidate the renal function profiles within the first 24 h after the development of BA among vulnerable preterm neonates of different GAs. The medical records of 128 preterm neonates born to mothers with normal renal function were retrospectively analyzed. Data regarding the serum creatinine (SCr) and urea nitrogen (BUN) levels in venous blood, estimated creatinine clearance (eCCI) within the first hours after birth, and urinary output (UOP) in the first 24 h after birth were compared between the preterm with BA population and GA-matched population without BA (n = 64 and n = 64, respectively). Significantly higher SCr levels and lower eCCI were observed in mid-late preterm neonates with BA than in preterm neonates without BA (84.05 versus [vs.] 64.20 μmol/L, z = 4.41, p < 0.001; 15.02 vs. 21.30 mL/min/1.73 m2, z = 3.57, p < 0.001, respectively). Very preterm neonates showed a higher UOP (2.01 vs. 1.66 mL/kg/h, z = 2.01, p = 0.045) after the development of BA than before. In preterm neonates with BA, the incidence of SCr > 133 μmol/L, CCI < 16 mL/min/1.73 m2 and UOP < 1.0 ml/kg/h, was 10.94%, 62.50%, and 20.31%, respectively. Within 24 h after birth, BA was associated with eCCI < 16 mL/min/1.73 m2 (p = 0.016, odds ratio = 2.83, 95% confidence interval: 1.210–6.613) in preterm neonates. Different renal function profiles were observed in preterm neonates of different GAs within the first 24 h of life after the development of BA. Candidate therapies based on different renal function statuses will bring these vulnerable patient populations of different GAs closer to receiving precision medicine.

Acute pain measured with the modified Bernese Pain Scale for Neonates is influenced by individual contextual factors.

Individual contextual factors like gestational age (GA) or previous painful experiences have an influence on neonates' pain responses and may lead to inaccurate pain assessment when not appropriately considered. We set out to determine the influence of individual contextual factors on variability in pain response in neonates, measured with the modified Bernese Pain Scale for Neonates (BPSN), and, if necessary, to incorporate relevant individual factors into a revised version of the BPSN. We videotaped 154 full-term and preterm neonates of different GAs during 1-5 capillary heel sticks in their first 14days of life. For each heel stick, we produced three video sequences: baseline, heel stick, and recovery. The randomized sequences were rated on the BPSN by five blinded nurses. Individual contextual factors were retrospectively extracted from patient charts and from the video recordings. We analysed the data in single and multiple linear mixed models. Premature birth (b=-0.721), caffeine (b=-0.302), and the behavioural states quiet and awake (b=-0.283), active and asleep (b=-0.158), and quiet and asleep (b=-0.498) were associated with changes in behavioural pain scores. Premature birth (b=-0.232), mechanical ventilation (b=-0.196), and duration of the heel stick procedure (b=0.0004) were associated with changes in physiological pain scores. Premature birth (b=-0.907), Caffeine (b=-0.402), the behavioural states quiet and awake (b=-0.274), and quiet and asleep (b=-0.459), and duration of the heel stick procedure (b=0.001) were associated with changes in the modified BPSN total scores. Postmenstrual age, behavioural state, caffeine, and ventilation status have an influence on neonates' pain response and should be incorporated in the revised BPSN to enhance clinical pain assessment in neonates with different GAs. We identified individual contextual factors associated with dampened pain response in neonates and will incorporate them into a revised version of the Bernese Pain Scale for Neonates to provide clinicians with a tool they can use to more accurately assess and manage pain in this vulnerable population.

Propofol for endotracheal intubation in neonates: a dose-finding trial

ObjectiveTo find propofol doses providing effective sedation without side effects in neonates of different gestational ages (GA) and postnatal ages (PNA).Design and settingProspective multicentere dose-finding study in 3 neonatal intensive...

The influence of gestational age in the psychometric testing of the Bernese Pain Scale for Neonates

BackgroundAssessing pain in neonates is challenging because full-term and preterm neonates of different gestational ages (GAs) have widely varied reactions to pain. We validated the Bernese Pain Scale for Neonates (BPSN) by testing its use among a large sample of neonates that represented all GAs.MethodsIn this prospective multisite validation study, we assessed 154 neonates between 24 2/7 and 41 4/7 weeks GA, based on the results of 1–5 capillary heel sticks in their first 14 days of life. From each heel stick, we produced three video sequences: baseline; heel stick; and, recovery. Five blinded nurses rated neonates’ pain responses according to the BPSN. The underlying factor structure of the BPSN, interrater reliability, concurrent validity with the Premature Infant Pain Profile-Revised (PIPP-R), construct validity, sensitivity and specificity, and the relationship between behavioural and physiological indicators were explored. We considered GA and gender as individual contextual factors.ResultsThe factor analyses resulted in a model where the following behaviours best fit the data: crying; facial expression; and, posture. Pain scores for these behavioural items increased on average more than 1 point during the heel stick phases compared to the baseline and recovery phases (p < 0.001). Among physiological items, heart rate was more sensitive to pain than oxygen saturation. Heart rate averaged 0.646 points higher during the heel stick than the recovery phases (p < 0.001). GA increased along with pain scores: for every additional week of gestation, the average increase of behavioural pain score was 0.063 points (SE = 0.01, t = 5.49); average heart rate increased 0.042 points (SE = 0.01, t = 6.15). Sensitivity and specificity analyses indicated that the cut-off should increase with GA. Modified BPSN showed good concurrent validity with the PIPP-R (r = 0.600–0.758, p < 0.001). Correlations between the modified behavioural subscale and the item heart rate were low (r = 0.102–0.379).ConclusionsThe modified BPSN that includes facial expression, crying, posture, and heart rate is a reliable and valid tool for assessing acute pain in full-term and preterm neonates, but our results suggest that adding different cut-off points for different GA-groups will improve the BPSN’s clinical usefulness.Trial registrationThe study was retrospectively registered in the database of Clinical Trial gov. Study ID-number: NCT 02749461. Registration date: 12 April 2016.

Determination of the diagnostic value of early symptoms in the prognosis of necrotizing enterocolitis in neonates of different gestational age

Necrotizing enterocolitis in newborns - non-specific inflammation of the intestine, predominantly in preterm infants, which puts a child's life at risk when it progresses. Despite the large number of studies of foreign and domestic scientists in the study of etiology and pathogenesis, clinical, laboratory and instrumental diagnosis of NEC, this disease remains one of the leading causes of infant mortality in intensive care units. Clinical symptoms of NEC can be manifested from intolerance to nutrition and intestinal paresis to severe peritonitis and multiple organ failure, and most diagnostic methods have high specificity but insufficient sensitivity or vice versa. The detection of early symptoms and progression symptoms of the NEC allows you to choose the best treatment tactics and improve your results. Therefore, differential diagnosis on the basis of clinical, instrumental and laboratory studies plays an important role in the diagnosis and determination of the stages of the NEC. The success of NEC treatment depends not only on timely diagnosis and evidence of surgical treatment, but also on the depth and distribution of bowel damage. Currently, there are no reliable non-invasive methods for diagnosis of the spread and depth of damage to the intestinal wall under the NEC. The terms of pre-operative preparation, the scope and type of surgical treatment remain controversial.Objective. The purpose of the study is to determine the diagnostic value of early symptoms in the development and progression of necrotizing enterocolitis in newborns of different gestational age.Materials and Methods. The work is based on studying the results of treatment of 94 newborns with NECs who were on treatment in the department of intensive care and pathology of newborns "Dniepropetrovsk Specialized Clinical Medical Center of Mother and Child. prof. MFRudneva "DOR" in 2015-2018. The diagnosis was established on the basis of clinical, instrumental (ultrasound, doppler, x-ray), laboratory and bacteriological studies. Patients were divided in terms of treatment tactics into two groups: the first group consisted of patients with NEC who did not require surgical intervention (uncomplicated NEC) (n = 71), the second group included patients requiring surgery (complicated by the NEC) ( n = 23). Additionally, patients in both groups performed intra-abdominal pressure measurements.Measurement of abdominal circumference in all patients with NECs was performed at the navel level in at least three measurements taken at intervals of 4-6 hours.Initial treatment was the same for patients in both groups and included: decompression of the stomach, complete parenteral nutrition, antibiotic therapy.Results and discussion. Increased symptoms of inability to enter into the stomach (inferiority syndrome), congestive growth in the stomach, auscultation of peristaltic bowel sounds, bloating, pain and / or tightness of the stomach accompanied the deterioration of the general condition of patients and the development of complicated forms of NEC.The appearance of a venous figure on the anterior abdominal wall and its pronounced nature over time, hyperemia and edema of the anterior abdominal wall and external genital organs revealed the presence of intraperitoneal hypertension and intra-abdominal circulation disturbance as a result of reduced perfusion pressure and inflammatory changes in the peritoneum.The increase in the abdominal circumference in patients of the I group was not more than 5 mm in the previous measurement, with the progression of the HEC and the development of complicated forms of NEC, the increase in abdominal circumference was 7 mm larger than the previous results.The main diagnostic tool for detecting progression and complications of NEC was the performance of X-ray of the abdominal cavity. X-ray of the abdominal cavity was performed for all patients with a suspicion on a NEC in a straight projection in an upright position. The most common X-ray symptoms of complicated NECs were the discovery of pneumoperitoneum, free fluid in the abdominal cavity and non-peristaltic static bowel loop. Also, the data obtained indicate that patients with complicated forms of NEC disease are accompanied by a significant increase in intraabdominal pressure, mainly due to sequestration of fluid in the third space, increasing intestinal paresis and its edema. If you do not diagnose and not eliminate a significant increase in intra-abdominal pressure, this leads to a violation of capillary perfusion of the internal organs, which leads to further ischemia and the development of abdominal compartment - a syndrome.When diagnosing pneumoperitoneum, ascites on the background of NEC or with the advent of clinical symptomatology, the progression of HEC (to exclude a hidden perforation) under ultrasound control was performed for all patients under local anesthesia abdominocentesis. In the case of a positive result of abdominocentesis, drainage of the abdominal cavity was performedConclusions. Among the early clinical syndromes that characterize the progression of the NEC, it is necessary to pay attention to the growth of the syndrome of enteral insufficiency. An increase in the incidence of intra-abdominal hypertension is an early symptom of the progression of the NEC.

A Human Proximal Tubular Epithelial Cell Model to Explore a Knowledge Gap on Neonatal Drug Disposition.

Finding the right drug-dosage for neonates is still a challenge. Until now, neonatal doses are extrapolated from adults and children doses. However, there are differences between neonatal and adult kidney physiology that should be considered, especially when it comes to drug metabolism and/or transport. Studying renal drug disposition in neonates is limited by the lack of reliable human cell models. To illustrate the feasibility of developing an in vitro model for neonatal proximal tubule epithelial cells (nPTECs) to study renal drug disposition at this age. nPTECs were isolated from urine samples of neonates of different gestational ages and were conditionally immortalized using a temperature sensitive SV40T antigen and human telomerase hTERT. Cell clones were characterized on gene expression level for PTEC markers such as P-glycoprotein (ABCB1), aquaporin1 (AQP1), and organic cation transport protein 2 (SLC22A2), and for kidney progenitor cell and podocyte markers. In addition, protein expression and functional assessment were performed for P-gp and OCT2. We established 101 clonal cell lines of conditionally immortalized nPTECs derived from neonatal urines. Characterization of primary cells lines showed expression of genes from different cell types such as progenitors, PTECs and podocytes, however the developed conditionally immortalized nPTECs only expressed proximal tubule markers. Quantitative PCR analysis confirmed the expression of proximal tubule markers in nPTECs similar to the adult control PTECs. P-gp was expressed in nPTECs derived from the different gestational ages with a similar functionality compared with adult derived PTECs. In contrast, OCT2 functionality was significantly lower in nPTEC cell lines compared with adult PTECs. We demonstrate the feasibility of culturing proximal tubule epithelial cells with high efficiency from urine of neonates. These cells expressed PTEC-specific genes and functional drug transporters. The cell model presented is a valuable tool to study proximal tubule physiology and pharmacology in newborns. In addition, we demonstrate the physiological differences between the neonatal and adult kidney, which emphasizes the importance of studying drug disposition in neonatal models instead of extrapolating from adult data.

O-36 A human proximal tubular epithelial cell model to explore a knowledge gap on neonatal drug disposition

Background Finding the right drug-dosage for neonates is still a medical challenge. Up to now, neonatal doses are extrapolated from adult and children doses. However, there are differences between neonatal and adult kidney physiology that should be put into consideration, especially when it comes to active drug metabolism. Studying renal drug clearances in neonates is limited by the lack of reliable human cell models. Our aim was to illustrate the feasibility to develop an in vitro model for neonatal proximal tubule epithelial cells (nPTECs) for studying renal drug clearances at this age. Method nPTECs were isolated from urine samples of ne-onates of different gestational age (GA) and conditionally immortalised using a temperature sensitive SV40T anti-gen and human telomerase hTERT. The cell clones were characterised on gene expression level for PTECs markers such as P-glycoprotein (P-gp), aquaporin1 (AQP1), and organic cation transport protein 2 (OCT2). In addition, protein expression and functional assessment were per-formed for P-gp and OCT2. Results We established 101 clonal cell lines of cinPTECs derived from neonatal urine. Gene expression analy-sis confirmed the expression of the PTECs (P-gp, AQP1, and OCT2), similar to the expression in the adult control ciPTECs. P-gp was expressed in cinPTECs from the differ-ent gestational ages and exhibited similar functionality as the adult derived ciPTECs. In contrast, OCT2 functionality was significantly lower in the cinPTECs cell lines com-pared to the adult ciPTECs. Conclusion We demonstrate the feasibility of culturing cinPTECs expressing mature ciPTECs markers with high efficiency out of the urine samples of neonates. The cell model presented here can serve as a valuable tool to study proximal tubule physiology and pharmacology in new-borns. In addition, we demonstrate the physiolog-ical differences between the neonatal and adult kidney, which puts emphasise on the importance of studying drug pharmacokinetics in neonatal models instead of ex-trapolating from adult models.

Clinical features of respiratory distress syndrome in neonates of different gestational ages

To study clinical features of respiratory distress syndrome (RDS) in neonates of different gestational ages (GA). According to GA, 133 neonates with RDS were classified into GA <34 weeks group (n=66), GA 34-36 weeks group (late preterm neonates; n=31), and GA ≥37 weeks group (full-term neonates; n=36). The mothers' medical history during pregnancy and the condition of the neonates at birth were retrospectively analyzed, and the clinical data were compared between groups. Prenatal corticosteroids supplementation in the GA <34 weeks group was more common than that in the GA 34-36 weeks group (P<0.05). Compared with the GA ≥37 weeks group and the GA 34-36 weeks group, the GA <34 weeks group showed a significantly lower rate of primary diseases, a significantly later time of the development of dyspnea (P<0.05), and a higher rate of intraventricular hemorrhage (P<0.05). Serum albumin levels in the GA <34 weeks group were significantly lower than in the GA ≥37 weeks group (P<0.05). The GA ≥37 weeks group and the GA 34-36 weeks group showed a significantly higher reuse rate of pulmonary surfactant (P<0.05). Use of high-frequency oscillatory ventilation was more common in the GA ≥37 weeks group compared with the GA <34 weeks group (P<0.05). The clinical features of RDS are different across neonates of different GA, suggesting that the pathogenesis of RDS may be different in neonates of different GA.

Feasibility and precision of transcutaneous very-high resolution ultrasound for quantification of arterial structures in human neonates – Comparison with conventional high resolution vascular ultrasound imaging

BackgroundNon-invasive transcutaneous very-high resolution ultrasound (VHRU, 25–55 MHz) has recently been developed to quantify superficial vascular structures in humans. The performance of the method has yet not been evaluated in vivo in neonates. The aim of the study was to compare VHRU with conventional high-resolution ultrasound (HRU, 7–12 MHz), and to assess the feasibility and precision of VHRU in this population. Methods150 images from central elastic (common carotid, CCA) and peripheral muscular (brachial, BA; femoral, FA) arteries were obtained in 25 neonates of different gestational ages (range 33 + 0 to 41 + 5 gestational weeks) and weights (range 1570–4950 g) with VHRU, and the use of HRU for comparison assessed in five. ResultsImages were captured from CCAs with 35 MHz, FAs using 35 and 55 MHz, and BAs using 55 MHz. 12 MHz was unable to assess FAs and BAs, and the CCA IMT was grossly overestimated compared with 35–55 MHz. IMTs of the smallest BAs and FAs were beyond the axial resolution of VHRU (<0.05 mm), thus immeasurable. For VHRU, the intra-, inter- and test-retest coefficients of variation (CV) were for LDs (range 1.44–2.62 mm, CVs between 1.6 and 4.8%), IMATs (range 0.141–0.161 mm, CVs between 8.8 and 19.9%), and IMTs (range 0.062–0.165 mm, CVs between 12.8 and 24.8%) for the different arteries. ConclusionVHRU is feasible, accurate and precise in the assessment of superficial proximal conduit arteries but unable to assess the abdominal aorta in human neonates HRU-derived neonatal conduit arterial wall layer thicknesses are below the ultrasound axial resolution.

PO-0423 Differences In Cerebral Oxygenation And Perfusion Of Sga Neonates According To Gestational Age During The First Postnatal Week: Abstract PO-0423 Table 1

<h3>Background and aims</h3> Low birth weight in conjuction with the immature autoregulation mechanisms noted in preterm neonates may influence brain perfusion and consequently the neurodevelopmental outcome. The aim of this study was to assess the potential variations in brain oxygenation and perfusion in SGA neonates of different gestational age during the first postnatal week with the use of Near Infrared Spectroscopy (NIRS). <h3>Patients/methods</h3> SGA neonates born at 28–32 weeks and 32⁺¹–36 weeks respectively consisted the two study groups. Three measurements of forty minutes each were performed with NIRO-200 NX instrument in the first, third and seventh day of life. Tissue oxygenation index (TOI), fraction tissue oxygen extraction (FTOE) and tissue haemoglobin index (THI) were the recorded parameters. <h3>Results</h3> 38 neonates were prospectively enrolled; 12 were born at 28–32 weeks gestation and 26 at 32⁺¹–36 weeks. Mean birth weight and head circumference were 1.062 ± 265 vs 1.656 ± 401 and 26.0 ± 2.5 vs 30.4 ± 1.8 respectively in the study populations. Haemoglobin in the first day didn’t show any significant difference between the two subgroups (16.4 vs 17.8). NIRS monitoring found higher FTOE at the right side in more preterm SGA neonates (p = 0.018) in the first postnatal day. All the other parameters were similar in the two groups. <h3>Conclusion</h3> It seems there aren’t significant differences in cerebral oxygenation and perfusion between SGA neonates of different gestational age during the first postnatal week.

Complement Profile in Neonates of Different Gestational Ages

Blood levels of regulators of the complement system in preterm babies were reported in few studies only. The aim of this study was to set up a complement profile in premature and term babies focusing on the development of blood levels of MBL, key regulatory proteins and on classical pathway activity, which may allow an estimation of potential susceptibility to infection. Complement activity (CH50), levels of mannan-binding lectin (MBL), complement regulators (factors H and I, C1 inhibitor, properdin) and C3a as marker of complement activation were assessed in three groups of healthy newborns: (1) prematures (≤34 weeks); (2) late prematures (>34-<37 weeks) and (3) term neonates (≥37 weeks). CH50 increased with gestational age with lower titres in cord blood than in day 5 post-delivery venous blood. MBL concentrations were not significantly different among groups. Quantitative and functional C1 inhibitor were below adult normal range in prematures <34 weeks and lower in cord blood as compared to day 5. Factor I, factor H and properdin remained below adult values in all groups. Low C3a levels excluded that low complement titres were due to activation-induced consumption. These results demonstrate the relative immaturity of the complement system and its regulation, especially in premature infants.

1H NMR-based metabolomic analysis of urine from preterm and term neonates

Metabolomics is a technique used to non-invasively determine metabolic status of an organism. Aim of our study was to analyze urinary metabolic profiles in term and preterm infants in order to identify gestational age-related metabolic differences and to predict metabolic maturity at birth. Twenty-six healthy term infants and 41 preterm infants were prospectively enrolled. A urine sample was collected non-invasively within the first hours of life. Samples were analyzed by proton nuclear magnetic resonance (1H NMR) spectroscopy and NMR urine spectra were analyzed by multivariate statistical analysis. Distinct metabolic patterns were found between term infants and preterm infants, as well as between preterm infants of 23-32 weeks' gestation and those of 33-36 weeks' gestation. Individual metabolites discriminating between these groups were hippurate, tryptophan, phenylalanine, malate, tyrosine, hydroxybutyrate, N-acetyl-glutamate, and proline. Metabolomic analysis revealed distinct urinary metabolic profiles in neonates of different gestational ages, and identified the discriminating metabolites. This holistic approach appears to be a promising tool for investigating newborn metabolic maturation over time, and might lead to a tailored management of neonatal disorders.

Impairment of stimulation ability of very-preterm neonatal monocytes in response to lipopolysaccharide

Little is known about innate immunity of neonates, particularly for very-preterm ones, which are more susceptible to immunologic damage due to their immature immune response. This cross-sectional, descriptive study in umbilical cord blood mononuclear cells describes the differences in innate immune response between 64 healthy neonates of different gestational ages (very-preterm, preterm, full-term). CD14 + monocytes cultured with lipopolysaccharide (LPS) or LPS + interferon-γ showed significant lower human leukocyte antigen-DR percentages for the very-preterm group in both unstimulated and LPS-stimulated cells. No differences were found for CD40 +-cell percentages. We observed an increase in CD80 and a decrease in CD86 within all groups when stimulated with LPS or LPS + interferon-γ. Interleukin-12 production was lower in very-preterm neonates. Adhesion capability of neonatal monocytes was similar and independent of gestational age. In summary, very-preterm–neonatal monocytes do not completely respond to LPS and, therefore, have diminished functions compared with preterm or full-term neonates.