Newborns Of Different Gestational Ages Research Articles

Food intolerance in premature babies: possibilities of additional diagnostics

Due to the immaturity of the digestive system and gastrointestinal motility the preterm infants have a critical challenge in establishing adequate enteral nutrition, which is a frequent cause of gastrointestinal complications such as food intolerance and necrotizing enterocolitis. Modern clinical methods of assessing the maturity of the intestines and the child's readiness for enteral nutrition are subjective, this slows down the expansion of enteral nutrition, increases the duration of parenteral nutrition, and accordingly , period of a child`s hospitalizing. Objective methods of diagnosis are needed, which would contribute to the effective diagnosis and monitoring of food intolerance in preterm infants. Therefore, the purpose of our review was to search and summarize literature data on objective methods of diagnosing impaired food tolerance in premature baby, which could to provide daily monitoring, would be safe, cost-effective and easily accessible. Results and their discussion. Accordingly, three leading and most promising methods of examining the newborns gastrointestinal tract were analyzed. The were ultrasound examination (absence or reverse diastolic blood flow in the umbilical artery, high pulsation index in the fetal venous duct, indicators of blood flow in the upper mesenteric artery of the newborn), near-infrared spectroscopy (estimation of oxygen saturation of splanchnic tissue), and auscultation of intestinal sounds (phonoenterogram). Each of these methods has advantages and disadvantages, but to solve these existing problems, there has been recently an increasing amount of research on the bowel sounds using (namely their computerized assessment) as a new diagnostic tool. New research and further study of intestinal murmurs in premature newborns of different gestational ages with the development of clear criteria for data interpretation are needed to assess the maturity of the gastrointestinal tract, to create a diagnosis plan of food intolerance, and to develop an algorithm for early intervention.

The influence of cytokine reactions on the nature of the course of adaptive mechanisms in newborns of different gestational ages

Introduction. The study of the mechanisms of adaptation and consequences of deadaptation in newborns, and especially premature babies in the first days of life is an integral part of neonatal practice. The cytokine system is considered as sensitive and informative indicators of homeostatic disorders in newborns of different gestational ages.Aim. To assess the features of the early neonatal period in newborns of different gestational ages according to the nature of changes in the levels of interleukin-1, -4, -8 in the cord blood and on the 3-4th day of the infant's life.Materials and methods. 108 newborns were examined, of which 64 premature infants of the gestational age of 32 (0/7) - 36 (6/7) weeks were included in the treatment group: moderately premature infants (32 (0/7) - 33 (6/7) weeks) and late premature infants (34 (0/7) - 36 (6/7) weeks). The control group included 44 conditionally healthy full-term infants born between 37 (0/7) and 41 (6/7) week of gestation: early full-term (37 (0/7) - 38 (6/7) weeks) and full-term intants (more than 39 (0/7) weeks).Results and discussion. The full-term infants, as well as late premature infants, whose clinical status was assessed as satisfactory, usually showed minimum levels of all studied cytokines. If the early neonatal period was complicated, high levels of interleukin-1 and -8 with underlying slightly elevated levels of anti-inflammatory interleukin-4 were observed. This fact supports the activation of cytokine reactions during manifestation of pathological symptom groups generated by various organs and systems in the early neonatal period.Conclusion. The nature of cytokine reactions can serve as a marker of unfavourable course of the early neonatal period in premature infants and a criterion that justifies the implementation of necessary corrective measures.

Examining time–frequency mechanisms of full-fledged deep sleep development in newborns of different gestational age in the first days of their postnatal development

Early age-related changes in EEG time–frequency characteristics during the restful sleep of newborns of different gestational ages result in the development of conventional EEG signs of deep sleep already during the first postnatal week of their life. Allocating newborns to different groups based on their gestational age and duration of postnatal period allowed demonstrating substantial intergroup differences in brain activity during sleep and wakefulness, along with significant variability in the time–frequency characteristics of brain activity. The process of conventional deep sleep development in infants born prior to the week 35 of gestation is associated with an increase in the power of alpha activity in the sensorimotor cortex of the brain.

Correlation between body surface area of newborns of different gestational ages with urine total proteins and urine microalbumin

Objective: To establish a correlation between body surface area of newborns at different gestational ages and urine total proteins and urine microalbumin. Methods: Cross sectional study was conducted at a tertiary hospital in India. We randomly selected 175 normal newborns of different gestational ages. Systemic random spot second urine samples of normal newborns were selected (urine which baby had passed for the first time after birth was not used for sampling. Samples were used to estimate urinary proteins (total) (mg/dl), and urine albumin (mg/dl). Results: Proteinuria is common in newborns at all gestational ages. Tubular proteins are major constituents of urine proteins in neonatal urine, but a small amount of albumin is also lost in urine and their amounts increase linearly and proportionately as body surface area of newborn increases. This is a clear reflection of renal immaturity in newborns. Conclusion: All newborns have abnormally high proteinuria at all gestational ages, which increase with increase in gestational age. Urine microalbumin also showed a very mild increase with age, but it was very insignificant in comparison to UTP.

Reference values and growth curves of weight/length, body mass index, and ponderal index of Chinese newborns of different gestational ages

Objective: To establish the reference values and growth curves of weight/length, body mass index, and ponderal index for Chinese newborns with gestational ages of 24 to 42 weeks, in order to provide a reference for the assessment of body proportionality and nutritional status at birth. Methods: Cross-sectional study design was applied. From June 2015 to November 2018, a total of 24 375 singleton live birth newborns with gestational ages of 24 to 42 weeks from 13 cities including Beijing, Harbin, Xi'an, Shanghai, Nanjing, Wuhan, Guangzhou, Fuzhou, Kunming, Tianjin, Shenyang, Changsha, and Shenzhen were selected, excluding those impacting the establishment of the reference values. The generalized additive model for location, scale, and shape (GAMLSS) was employed to establish percentile (P3, P10, P25, P50, P75, P90, P97) reference values and growth curves of weight/length, body mass index, and ponderal index for male and female newborns with gestational ages of 24 to 42 weeks. The established growth standards in this study were compared with the standards from the 1988 Chinese data, the INTERGROWTH project, and the USA reference values. Results: A total of 24 375 newborns with 12 264 preterm newborns (7 042 males and 5 222 females) and 12 111 full-term newborns (6 155 males and 5 956 females) were included in this study. The percentile reference values and growth curves of weight/length, body mass index, and ponderal index were obtained for male and female newborns with gestational ages of 24 to 42 weeks. Weight/length of males in all gestational ages at P10, P50 and P90 was 0 to 0.2 kg/m higher than that of females, and body mass index of males in all gestational ages at the P10, P50 and P90 was 0.1 to 0.3 kg/m2 higher than that of females. The established growth curves of weight/length and body mass index at the upper percentile and ponderal index at both upper and lower percentiles were greatly different from those of the 1988 Chinese data, which, for example, reported the difference ranges at P90 as -1.09 to 0.40 kg/m for weight/length, -1.19 to 0.92 kg/m2 for body mass index, and -0.64 to 0.81 kg/m3 for ponderal index. The established weight/length curves were generally consistent with the reference values from the INTERGROWTH project with a difference of -0.17 to 0.20 kg/m at P50, while being 0.02 to 0.40 kg/m lower at P90 and 0.13 to 0.41 kg/m higher at P10 than that of the INTERGROWTH reference values at gestational ages of ≤32 weeks. The established body mass index curves differed from that of the USA reference values with a difference of -0.47 to 0.17 kg/m2 at P50, while being 0.53 to 1.10 kg/m2 lower at gestational ages of ≥37 weeks but 0.17 to 0.45 kg/m2 higher at gestational ages of ≤28 weeks than that of the USA reference values at P90. Conclusion: The establishment of the new standardized growth reference values of weight/length, body mass index, and ponderal index for Chinese newborns by different gestational ages are useful for clinical practice and scientific research.

A study of postnatal foot length to determine gestational maturity in neonates

Background: Gestational age is a major determinant of newborn prognosis. Early identification of gestational age is a major priority to reduce global mortality from preterm birth. Therefore this study was conducted with an aim to find out an alternate simple, low cost and reliable method to identify accurate gestational ages.Methods: The cross sectional study was carried out at Rukmani Chainani Maternity and Neonatal Unit, SSGH and Medical College, Baroda from December 2019 to May 2020. Total 500 live newborns of different gestational ages within 72 hrs of birth which were appropriate for gestational age were enrolled in this study. Foot length, head circumference, crown heel length and weight were measured. Gestational age was estimated by antenatal USG, Ballard scoring and LMP. Correlation of foot length to gestational age and other anthropometric variables was done.Results: There was statistically significant positive correlation found between foot length and gestational age (correlation coefficient of 0.944 and p value of <0.0001). There was also positive correlation found between foot length and weight, head circumference and length with correlation coefficient of 0.942, 0.888 and 0.906, respectively. Using ROC curve, foot length cut-off value of 7.2 cm can be used for identifying preterm babies with sensitivity of 94.4% and specificity of 95.6%. Regression equation for gestational age calculation was GA=6.669+4.0601[FL].Conclusions: This study had demonstrated that Foot length is a simple and reliable anthropometric measurement to assess gestational age and to screen prematurity.

Relationship Between Oxidative Stress Markers and Endothelin-1 Levels in Newborns of Different Gestational Ages.

Oxidative stress results from excessive reactive oxygen species formation and/or inadequate antioxidant defense. Premature and critically ill infants are especially susceptible due to an immature intrinsic antioxidant system that cannot fully compensate for a free radical load. Oxidative stress is also associated with endothelial dysfunction and alterations in Endothelin-1 (ET-1) signaling pathways. However, the effects of the complex interaction between oxidative stress and ET-1 in newborns are not well-understood. The objective of this pilot study was to determine the relationship between levels of common oxidative stress biomarkers [glutathione (GSH), malondialdehyde (MDA)] and ET-1 in newborns of different gestational ages. In a level IV NICU, 63 neonates were prospectively enrolled and divided into groups based on gestational age at birth: Early Preterm (24 0/7–30 6/7 weeks), Late Preterm (31 0/7–36 6/7 weeks), and Term (37 0/7–42 weeks). Umbilical cord (1.5 mL) and 24(±4) h of life (24 h) (1 mL) blood samples were collected for GSH, MDA, and ET-1 analyses. GSH, MDA, and ET-1 were determined using established methodology. Mean cord MDA levels for all age groups, Early Preterm (2.93 ± 0.08 pg/ml), Late Preterm (2.73 ± 0.15 pg/ml), and Term (2.92 ± 0.13 pg/ml), were significantly higher than those at 24 h of life (p < 0.001). Mean cord ET-1 levels were significantly higher than 24 h samples in both Early and Late Preterm groups (p < 0.05). Cord and 24 h ET-1 levels did not correlate with MDA and GSH levels at birth (r2 = 0.03, p > 0.05 and r2 = 0.001, p > 0.05, respectively) or 24 h of life (r2 = 0.001, p > 0.05 and r2 = 0.03, p > 0.05, respectively). Preterm neonates exposed to prenatal corticosteroids (1.87 ± 0.31 pg/ml) had lower cord MDA levels than non-exposed neonates (2.85 ± 0.12 pg/ml) (p < 0.05). Both cord and 24 h OS markers were significantly higher in neonates treated with oxygen therapy (p < 0.005 and p < 0.05, respectively) than those who did not receive supplemental oxygen. Oxidative stress markers (MDA and GSH) and ET-1 levels act independently. MDA is higher in cord blood than at 24 h of life regardless of gestational age. In preterm neonates, ET-1 levels are higher in umbilical cord blood compared to 24 h of life.

The clinical relevance of the microelements content in newborns after perinatal asphyxia

Research purpose. To identify the correlation between the clinical signs of neonatal adaptation in the dynamics and the content of trace elements in the serum of newborns of different gestational ages who underwent perinatal asphyxia (main group): 41 premature infants and 27 full-term children.Results. It was found that there was a direct significant correlation between the concentration of trace elements (Mg, Fe, Zn, Cu), gestational age and Apgar grades (5th minute) in n prematurely born babies during the period of acute adaptation (3-5 days). Reliable feedback was established between the clinical signs of posthypoxic damage to the central nervous system, suppression syndrome and the content of Fe, Mg and Zn, as well as a weakening of muscle tone and the content of Zn and Mg. In full-term babies, the correlation between the content of Fe, Zn, Mg in the blood serum and clinical indicators was expressed more clearly. In these children, a significant positive correlation was observed between the Ca content in the blood and the syndrome of neuro-reflex excitability.Conclusion. The determination of trace elements in blood serum in newborns in the dynamics of the neonatal period (3-5th and 21-28th days of life) makes it possible to predict the course and severity of hypoxic-ischemic damage to the Central nervous system.

CRYSTALLOGRAPHIC INVESTIGATION OF URINE IN NEWBORN WITH RENAL DISTURBANCE DUE TO ASPHYXIA

The aim is to increase the efficiency of diagnosis of renal injury in neonates with asphyxia by identifying of structural markers according to research facies of urine in newborns of different gestational ages. Materials and methods: The study involved 150 full-term with signs of kidney damage due to asphyxia: 75 babies with severe asphyxia, and 75 children with moderate asphyxia and 100 preterm infants: 50 children with severe asphyxia and 50 children with moderate. Comparison groups: group 1 consisted of 20 full-term infants, group 2 which included 20 preterm neonates. Material for the study - morning portion of urine, which was collected at 8-10 a.m. on 1-2 and 7-8 days of life. Results: morphological picture of facies of newborns with asphyxia depends on the severity of pathological changes in the urine (proteinuria) and urine output. Structure of facies in babies with renal distorbance due to severe asphyxia indicates a significant loss of organic and mineral substances in the urine. The width of the peripheral zone facies, the amount of solid particles transferred depends on the severity of asphyxia, the difference in morphology facies is maintained even at the end of the early neonatal period. Conclusions: Analysis of dried drops of urine in infants with renal impairment on the background of asphyxia can be used as one of the criteria for assessing kidney function and have prognostic value.

Neurologic manifestations of cerebral ischemia in infants at 1 year of age

Hypoxic-ischemic brain damage of the newborn infant to date is the one of the major problems in neonatology. The comprehensive clinical, laboratory and neurological examination of newborns of different gestational ages with perinatal CNS disorder was executed with the use of informative diagnostic technologies. Structural and functional disorders caused by cerebral ischemia, were established to be accompanied by significant changes in brain activity, the severity of which increases with decreasing gestational age of newborns. Certain concentrations of plasma factors of hemostasis in newborns were shown to be markers of the severity of cerebral ischemia and efficiency of complex neuroprotective therapy. Positive neurotrophic effects of gliatilin in the treatment of infants with cerebral ischemia were established to manifest by normalization of the clinical state, neurological symptoms and stabilization of plasma hemostasis, which determined the rate of regenerative treatment of ischemic brain injuries.

Characterization of Stem Cells and Immune Cells in Preterm and Term Mother's Milk.

Human milk is known to be rich in cellular components, including stem cells and immune cells. However, the dynamics of these cellular components at different lactation stages, and the differences between milk for preterm and term infants, are poorly understood. To identify changes in the cellular components of human milk at different lactation stages, and to explore the associations of these changes with maternal and infant characteristics. Forty mothers of newborns of different gestational ages were enrolled. Colostrum, transitional, and mature milk samples were collected. Stem cell and immune cell molecule markers were detected using flow cytometry. Pluripotent genes (SOX2, NANOG, OCT4, and KLF4) were detected via quantitative real-time PCR. Human milk contained some stem cells but more immune cells. The percentages of hemopoietic stem cells were significantly higher in mature milk than in colostrum, and the percentages of total immune cells were lower in mature milk than in colostrum. The percentages of hemopoietic stem cells in colostrum and transitional milk were influenced by gestational age. Some minor differences in the cell composition of human milk could be explained by maternal body mass index, the mode of delivery, and parity. Our results again confirmed that human milk contains stem cells. Additionally, the percentages of hemopoietic stem cells and major immune cells changed dynamically at different lactation stages and were associated with gestational age at delivery.

Autonomic cardiac control of very preterm newborns: A prolonged dysfunction

Background Autonomic nervous system (ANS) activity is fundamental to infant health. ANS activity of preterm newborns seems to be reduced at term equivalent age, but follow-up of ANS activity has rarely been performed in that population during the weeks after birth. The aim of the study was to perform such a follow-up in preterm newborns of different gestational ages, up to their term equivalent ages. Methods Prolonged electrocardiographic recordings were prospectively performed in a group of 39 premature newborns, each week, up to term equivalent age before discharge. Control values were obtained from a group of 19 full-term newborns, recorded at the first week of their life. ANS indices were calculated from recordings during quiet sleep periods by spectral-domain analysis (Fourier transform): Ptot (total power), VLF (very low-frequencies), LF (low-frequencies), HF (high-frequencies), LF/HF ratio, LFnu (normalized low-frequencies) and HFnu (normalized high-frequencies) values. Results Ptot, VLF, LF and HF were significantly lower in the preterm group at birth compared to the control group, while LFnu, HFnu and LF/HF ratio were not significantly different. The results were similar when comparing the control group to any ANS values at a given post-natal corrected age of preterm newborns. Furthermore, preterm newborns did not demonstrate any significant increase in ANS values from birth to theoretical term. Conclusion The finding of substantial reduced ANS activity and failure of maturation in preterm infants up to term equivalent age needs confirming by other research groups, and mechanisms and implications for infant health explored.

Thyroid volumes in newborns of different gestational ages: normative data

Reference ranges for thyroid volumes in newborns of different gestational ages have not been previously determined. We assessed thyroid volume within the first week of life in a sufficient number...

Gastric electrical activity and gastric emptying in term and preterm newborns.

The aims of this study were to evaluate the gastric electrical activity and gastric emptying in preterm and term newborns and to assess the development of gastric motility by comparing newborns of different gestational ages. The cutaneous electrogastrography and the ultrasonographic study of the gastric emptying were performed before and after milk formula in three groups of infants: 12 preterm newborns with a gestational age of 28-32 weeks, 11 preterm newborns with a gestational age of 32-36 weeks, and 10 full-term newborns with a gestational age of 36-40 weeks. All recording sessions were performed 1 week after infants had reached full enteral feeding. The percentage of normal slow waves was similar in the three groups but it was not predominant compared to tachygastria in the earliest premature infants (59.3% (12.7-92.3) vs. 29.6% (3.7-78.8); P < 0.05). In addition, a progressive increase in the normal slow wave percentage (59.3% (17.4-87.4), 60.9% (38.1-89.7), 77.8% (66.4-84.8); P < 0.05) was observed as gestation advanced. As regards gastric emptying parameters, the antral area was greater and T(1/2) was longer in the preterm newborns of 28-32 weeks than preterm newborns of 32-36 weeks and full-term newborns (fasting antral area: 0.96 cm2 (0.6-1.5), 0.63 cm2 (0.4-1.2), 0.55 cm2 (0.1-0.9) respectively, P < 0.05; T(1/2): 83.4 min (76.0-108.5), 70 min (57.5-89.5) and 71.8 min (54.9-81.2), respectively P < 0.05). The comparisons of gastric emptying curves made among the three groups showed a reduced antral dilatation in preterm newborns of 28-32 weeks compared to full-term newborns at 30 and 60 min after a meal. In conclusion, although enteral feeding is important for the development process of gastrointestinal motility, gastric electrical activity and gastric emptying show an intrinsic maturation depending on the gestational age.

Cerebral Oxygen Metabolism in Newborns

A better understanding of the developmental changes in brain energy metabolism that occur in human neonates is critically important for designing rational treatment strategies that ensure an adequate supply of nutrients to the brain and minimize deleterious side effects of therapeutic interventions in sick newborns. Cerebral metabolic rate for oxygen (CMRO2) was measured with positron emission tomography in 11 sick newborns of different gestational ages. In five preterm infants, mean hemispheric CMRO2 was 0.06 to 0.54 mL 100 g-1 min-1. Two of these preterm infants with virtually absent CMRO2 (0.06 mL 100 g-1 min-1) had minimal or no evidence of parenchymal brain injury detected in the newborn period. In six term infants, mean hemispheric CMRO2 was 0.0 to 1.3 mL 100 g-1 min-1. Two with no neurological disease had mean hemispheric CMRO2 of 0.4 and 0.7 mL 100 g-1 min-1 and were normal at 6 and 7 months, respectively. CMRO2 in four newborns who had minimal or no detectable brain injury was considerably below the threshold for brain viability in adults of 1.3 mL 100 g-1 min-1. This indicates that energy requirements in fetal and newborn brain are minimal or can be met by nonoxidative metabolism.

Oxygen transport in newborns at different gestational ages

Oxygen (O2) transport was assessed through the affinity between O2 and hemoglobin (Hb) in 123 newborns of 28 to 40 week gestational ge, with a minimum of 9 newborns for each gestational age group (see table). In order to assess the O2-Hb affinity, we studied the correlation between the pO2 and the Hb saturation for each gestational age, obtaining estimates of the oxy-hemoglobin dissociation curves corresponding to each gestational age (see fig. 3). The pO2 levels corresponding to the 50% saturation (P50) for each gestational age were estimated from there. All newborns were from single vaginal deliveries with no fetal distress before birth and with an adequate weight for gestational age. The latter was calculated according to the date of the last menstrual period (78% of the cases), echography (10.6% of the cases) or neonatal physical exam (11.4% of the cases). A P50 vs. gestational age linear regression showed a high determination rate (r2 = 0.957, p less than 0.00001) (see fig. 2) which supports the hypothesis of the P50 linear growth; decrease in the Hb-O2 affinity with increasive gestational age (Hb-O2 affinity is different in newborns of different gestational ages). With these results one may conclude that the Hb-O2 uptake varies according to gestational age (P50 changes linearly as gestational age increases) and that a single measurement of pO2 in a newborns, blood does not accurately evaluate the amount of O2 that is transported to the tissues, because the transport capacity depends, among other factors, upon gestational age. The Hb saturation better represents the amount of O2 that can get to the cell level.(ABSTRACT TRUNCATED AT 250 WORDS)

Intestinal Absorption of D(+) Xylose in Newborns of Different Gestational Ages and Sizes

Intestinal Absorption of D(+) Xylose in Newborns of Different Gestational Ages and Sizes