Normal Newborns Research Articles

Dynamic Changes of Pulmonary Arterial Pressure and Ductus Arteriosus in Human Newborns From Birth to 72 Hours of Age.

Normal pulmonary artery pressure and pulmonary hypertension assessment of newborns is rarely reported. The aim of the study is to explore dynamic changes of pulmonary arterial pressure and ductus arteriosus in human newborns from birth to 72 h of age with echocardiography.A total of 76 cases of normal newborns were prospectively detected by echocardiography after birth of 2 h, 6 h, 12 h, 24 h, 48 h, and 72 h, respectively. Ductus arteriosus diameter, blood shunt direction, blood flow velocity, and pressure gradient were recorded. The brachial artery blood pressure were measured to estimate the pulmonary artery systolic pressure (PASP) and pulmonary artery diastolic pressure (PADP) using patent ductus arteriosus pressure gradient method. The mean pulmonary artery pressure (PAMP) were calculated by equation of PAMP = PADP + 1/3(PASP-PADP).(1) There were 76 cases of normal newborns. Among them, 29 cases (38%) ductus arteriosus closed within 24 h, 59 cases (78%) closed within 48 h, 72 cases (95%) closed within 72 h, and 4 cases (5%) ductus arteriosus not closed within 72 h. (2) The ductus arteriosus diameter of 2 h, 6 h, 12 h, 24 h, 48 h, and 72 h after birth was 4.60 ± 0.59 mm, 3.37 ± 0.59 mm, 2.47 ± 0.49 mm, 1.89 ± 0.41 mm, 1.61 ± 0.35 mm, and 1.20 ± 0.24 mm, respectively. Compared all of the ductus arteriosus diameter of the above time periods, there were statistically differences with P < 0.05, respectively. (3) The mean PASP in 2 h, 6 h, 12 h, 24 h, 48 h, 72 h after birth were 76.58 ± 7.28 mm Hg, 65.53 ± 9.25mm Hg, 52.51 ± 9.07 mm Hg, 43.83 ± 7.90 mm Hg, 38.07 ± 8.26 mm Hg, and 36 ± 6.48 mm Hg, respectively. The PADP of the above time period were 37.88 ± 5.56 mm Hg, 29.93 ± 7.91 mm Hg, 23.43 ± 7.37 mm Hg, 19.70 ± 8.51 mm Hg, 13.85 ± 5.58 mm Hg, 13.25 ± 6.18 mm Hg, respectively. The PAMP of the above time period were 63.41 ± 7.03 mm Hg, 51.78 ± 9.82 mm Hg, 40.94 ± 9.32 mm Hg, 34.39 ± 9.89 mm Hg, 26.23 ± 7.49 mm Hg, 25.25 ± 8.29 mm Hg, respectively. There were statistically differences with P < 0.05 between each time periods of PASP, PADP, and PAMP. (4) The upper 95% limit reference range of PASP of normal newborns of 72 h after birth were 39.97 mm Hg.(1) Normal newborns ductus arteriosus diameter gradually decreased after birth, and 95% of them spontaneous closed within 24 to 72 h. (2) Normal newborns pulmonary artery pressure showed a gradually decline after birth, the upper 95% limit reference range for PASP measured in normal newborns <72 h of age was 39.97 mm Hg. Therefore, the diagnostic criteria of newborns pulmonary hypertension may be >40.00 mm Hg according to our limited study.

Perinatal factors associated with neonatal thyroid-stimulating hormone in normal newborns.

PurposeThis study was to evaluate the effect of neonatal, maternal, and delivery factors on neonatal thyroid-stimulating hormone (TSH) of healthy newborns.MethodsMedical records of 705 healthy infants born through normal vaginal delivery were reviewed. Neonatal TSH levels obtained by neonatal screening tests were analyzed in relation to perinatal factors and any associations with free thyroxine (FT4) and 17-α hydroxyprogesterone (17OHP) levels.ResultsAn inverse relationship was found between TSH and sampling time after birth. Twin babies and neonates born by vacuum-assisted delivery had higher TSH levels than controls. First babies had higher TSH levels than subsequent babies. Birth weight, gestational age, maternal age and duration from the rupture of the membrane to birth were not related to neonatal TSH. There were no significant differences in TSH level according to sex, Apgar scores, labor induction, the presence of maternal disease and maternal medications. There was a positive association between TSH and 17OHP level but not between TSH and FT4 level. Multiple linear regression analyses showed that sampling time, mode of delivery, birth order, and 17OHP level were significant factors affecting neonatal TSH level.ConclusionNeonatal TSH levels of healthy normal newborns are related with multiple factors. Acute stress during delivery may influence the neonatal TSH level in early neonatal period.

Vessels of the umbilical cord: an anatomo-microscopic study in normal and pathological newborns

Intrauterine growth restriction (IUGR) due to placental insufficiency is associated with blood-flow redistribution. Placental insufficiency in late-onset IUGR often goes undetected by umbilical artery Doppler scan. Despite a broad general body of literature referencing placentas of IUGR pregnancies, there are no report on the structural characteristics of the vessels of the umbilical cord in IUGR. Thus, the aim of the present study was to compare the microscopic anatomy of the umbilical arteries and veins in normal, IUGR and small for gestational age (SGA) newborns. Twenty six umbilical cords were taken from 10 IUGR, 5 SGA, and 11 controls newborns. The histological and morphological examination was performed with EE, Azan–Mallory, Sirius Red stains and morphometric evaluation was performed through a computer image analysis approach. In the controls, the umbilical artery shows a muscular tunica, organized by two layers, an outer one with circularly arranged cells, and an inner one, with irregularly arranged cells. In the IUGR longitudinal muscular fibers are observable. In IUGR the percentage of the muscular fibers of the umbilical artery was greater with respect of SGA and controls. In IUGR and SGA the percentage of the muscular fibers was minor with respect to controls. In the umbilical artery in IUGR and SGA the elastic fibers and collagen I was major and collagen III was minor with respect to SGA. In the umbilical vein the collagen III was major in IUGR and SGA with respect to controls. These data agree with those of intrauterine life, in which a major thickness of the abdominal aortic wall was observed in fetuses with abnormalities of Doppler flussimetry. The rearrangement of umbilical artery may affect the mechanical properties of these vessels and disturb fetal blood circulation.

Atherogenic lipid profile of intrauterine growth retarded newborns

Background: Newborns with intrauterine growth restriction are under greater risk of coronary artery disease in future. The objective was to compare the concentration of serum lipids of umbilical cord blood of neonates of intrauterine growth retardation with normal term neonates. Methods: 50 newborns with intrauterine growth retardation and 50 normal term newborns, with 38 to 41 gestational weeks, were studied. Total cholesterol, triglycerides, HDL, LDL and VLDL cholesterol were measured in umbilical cord blood samples. The period of study was from January 2011 to October 2015. Study design: Hospital based prospective study. Blood samples were collected from the study population in the neonatal unit and all serum lipid profile level was measured with all accuracy in a computerized automated biochemical analyzer in Biochemistry department. Statistical analysis were done by using student’s unpaired ‘t’ test by using graph pad prism software. Results: TC concentration was significantly decreased in the IUGR compared AGA groups. LDL-C concentrations were decreased in the IUGR compared to the AGA group. TG concentration was significantly increased in IUGR as compared to the AGA group. Conclusions: Intrauterine growth retarded newborns were with worse lipid profile in Indian IUGR neonates. Further research is needed into the determinants of fetal growth and to the ways preventing fetal under-nutrition.

Lower the Low-density Lipoprotein Cholesterol to the Level When You Born

Lower the Low-density Lipoprotein Cholesterol to the Level When You Born

Value of bedside color Doppler dynamic monitoring in periventricular-intraventricular hemorrhages of infants

Objective To investigate the clinical value of the bedside color Doppler in the assessment infants with periventricular-intraventricular hemorrhages(PIVH). Methods Sixty-eight cases of PIVH newborns and 156 healthy newborns were involved in the study, dynamic monitoring were undergone within a week after birth. The middle cerebral artery(MCA) hemodynamic parameters of velocity systolic (Vs), velocity diastolic(Vd) and resistance index (RI) were recorded, and the differences of the parameters were compared between different grades as well as those of the normal newborns at 1 d, 4 d and 7 d after born. Results Total 68 PIVH infants were diagnosed by bedside color Doppler accurately. Prevalences of premature and low birth weight infants were higher than term infants and normal birth weight children, respectively (P 0.05), the differences of the other three groups compared with normal newborn group in1 d, 4 d and 7 d were statistically significant (P 0.05). Conclusions The diagnostic accuracy rate of PIVH by bedside Doppler is high and the dynamic monitoring of neonatal hemodynamics could provide an important basis for assessing the occurrence and development of PIVH. Key words: Ultrasonograhpy, Doppler; Peri-intraventricular hemorrhages; Middle cerebral artery; Hemodynamics

Improved harmonization of eosin-5-maleimide binding test across different instruments and age groups.

The eosin-5'maleimide (EMA) binding test has been studied extensively for the detection of hereditary spherocytosis (HS). Its performance characteristics have been compared to NaCl-based or glycerol lysis-based red cell osmotic fragility tests and cryohemolysis. HS samples are also better identified when both mean channel fluorescence (MCF) of EMA relative to controls and the coefficient of variation (CV) are analyzed. We looked at 65 normal controls including 30 adults 25-65 years old and 35 newborns and 12 HS cases. In addition to the MCF and the CV, we used a side scatter (SSC) vs. EMA fluorescence gate or "footprint" to depict where normal erythrocytes should appear. Erythrocytes that have reduced band 3 protein appear outside of the footprint. In our study, newborn data did not cluster with the samples from working age individuals. The MCF and the CVs of normal newborns were higher than normal adult group. However, the footprint data of normal samples relative to their controls was around 99.5% for each group, because the footprint was moved to fit the pattern of the normal. The inclusion of footprint parameter will help in better standardization as well as implementation of this test across different age groups as well as different instruments. © 2015 International Clinical Cytometry Society.

Programmed regulation of rat offspring adipogenic transcription factor (PPARγ) by maternal nutrition.

We determined the protein expression of adipogenic transcription factor, peroxisome proliferator-activated receptor gamma (PPARγ) and its co-repressor and co-activator complexes in adipose tissue from the obese offspring of under- and over-nourished dams. Female rats were fed either a high-fat (60% kcal) or control (10% kcal) diet before mating, and throughout pregnancy and lactation (Mat-OB). Additional dams were 50% food-restricted from pregnancy day 10 to term [intrauterine growth-restricted (IUGR)]. Adipose tissue protein expression was analyzed in newborn and adult male offspring. Normal birth weight Mat-OB and low birth weight IUGR newborns had upregulated PPARγ with variable changes in co-repressors and co-activators. As obese adults, Mat-OB and IUGR offspring had increased PPARγ with decreased co-repressor and increased co-activator expression. Nutritionally programmed increased PPARγ expression is associated with altered expression of its co-regulators in the newborn and adult offspring. Functional studies of PPARγ co-regulators are necessary to establish their role in PPARγ-mediated programmed obesity.

Direct assay of iduronate-2-sulfatase for Hunter disease using UPLC-tandem mass spectrometry and fluorogenic substrate

ObjectiveWe devised iduronate-2-sulfatase (IDS) enzyme activity assays by combining fluorometric substrate and LC-MS/MS based detection. Design and methods4-Methylumbelliferyl α-l-idopyranosiduronic acid 2-sulfate (IDS-S) was used as a substrate for IDS. Its enzymatic product, 4-methylumbelliferyl α-l-idopyranosiduronic acid (IDS-P) and internal standard, 4-methylumbelliferyl α-l-idopyranoside (IDS-IS), were directly measured by UPLC-MS/MS. We determined the precision of our enzyme assay and the effects of sample amounts and incubation time based on the results. Dried blood spots (DBSs) of 110 normal newborns and three patients with Hunter disease were analyzed. ResultsIDS-IS, IDS-P and IDS-S were fully separated using UPLC without any ion suppressions. The intra- and inter-assay precisions were 8.5–10.5% and 11.9–15.3%, respectively. The amount of product obtained was proportional to the number of DBSs and increased linearly with the incubation period from 0 to 15h. The enzyme activities in DBSs from three patients with MPS II were markedly lower than those in the DBSs of 110 normal newborns. ConclusionTo the best of our knowledge, this is the first report describing the use of LC-MS/MS for the diagnosis of Hunter disease with a commercially available substrate. Our method would be a rapid and effective screening tool for the diagnosis of Hunter disease with further study.

Low cord blood serum levels of vitamin D: cause or effect of fetal macrosomia?

Aim: The aim of the study was to compare cord blood vitamin D levels of macrosomic large for gestational age (LGA) and appropriate gestational age (AGA) newborns.Seventy-nine healthy, normal term newborns were included in the study. They were divided by birth weight into two groups: 37 in the LGA group above 4,000 g, and 42 newborns in the AGA group birth weight between 3,000 g and 4,000 g. Cord blood samples from groups were collected. Circulating 25(OH)D was measured as 25 hydroxyvitamin D3 (25(OH)D3) by high-performance liquid chromatography (HPLC) in serum using a kit.Maternal characterstics (age, body mass index [BMI], and gestational age) did not differ between the AGA and LGA groups. Cord blood 25 OH vitamin D levels were significantly low in neonates with LGA (p = 0,02).The authors found that macrosomic infants had low levels of vitamin D. Providing vitamin D supplements to pregnant women may prevent macrosomia. Randomized controlled trials are needed to prove this assertion.

Polihidramnios y su relación con anomalías congénitas.

Estudio retrospectivo realizado en el Hospital Nacional Cayetano Heredia, durante 28 meses, que incluyó la revisión de 1033 ecografías, para evaluar la relación entre el diagnóstico de polihidramnios y el hallazgo de anomalías congénitas asociadas al momento del nacimiento. El diagnóstico de polihidramnios realizado en el 20 % (9/45) de los productos con alguna anomalía congénita resultó significativamente mayor que el realizado en el 0,81% (8/988) de los productos normales (p &lt; 0, 001). El 53 % de las gestaciones con polihidramnios estuvo asociada a un recién nacido con anomalía congénita. Esto sugiere que en toda gestación complicada con polihidramnios se realice una evaluación ecográfica cuidadosa para descartar la presencia de anomalías congénitas.

Umbilical venous blood gas analysis for neonatal assessment.

Umbilical venous pH is claimed to mirror fetal acid-base status. Importantly, it is easier to perform. The aim of this study is to : 1. Evaluate the umbilical venous blood gas (UVBG) profile of normal newborns and to compare UVBG in the following situations: presence or absence of asphyxia presence or absence of meconium-stained amniotic fluid presence or absence of respiratory distress: and in newborns that did and did not survive and 2. To study the peripheral venous blood gas (PVBG) profile of newborns that develop cardio-respiratory insufficiency (CRI). Venous blood gas (VBG) was performed in 961 newborns consecutively admitted to the neonatal nursery over one year and in 100 controls. PVBG was also performed in 370 admissions to the nursery that developed signs of CRI. Demographic, clinical and outcome data were collected. Mean UVBG parameters (pH, pCO2, HCO3, base deficit, pO2 and SO2%) were compared between different groups of newborns using t test. This study had ethical approval. Of the 3349 live births over one year, 961 (28.7%) needed intensive care. Of these, 123 (12.8%) died. All the mean cord gas parameters differed significantly between who died and who survived. Metabolic acidosis and hypoxemia were conspicuous on PVBG among babies with CRI. Except for PO2 all the mean parameters of UVBG differed significantly with asphyxia and meconium-stained amniotic fluid. When similar comparison was made among newborns that did or that did not develop respiratory distress, the difference was significant for all the parameters except SO2%. UVBG gives useful information about common neonatal morbidities and appears to be a useful tool for neonatal assessment. PVBG gives objective information about babies with CRI that may need special interventions.

Intima-media complex thickness: preliminary workup of comparative evaluation of abdominal aorta and carotid artery of small-for-gestation-age term newborns and normal size term newborns

Background Increased intima-media thickness (IMT) has shown to be a good predictor of increased incidence of cardiovascular disease. The use of noninvasive measurement of abdominal aortic intima-media thickness (aIMT) and carotid artery intima-media thickness (cIMT) is an attractive modality to further explore and defi ne possible intrauterine factors that may be associated with increased risk of atherosclerosis.Purpose The aim of this study was to compare intima-media thickness of abdominal aorta and carotid artery in small-for-gestation-age (SGA) term newborns with appropriate for gestation age (AGA or normal sized) term newborns.Material and methods We measured the intima-media thickness of the abdominal aorta (aIMT) and carotid artery (cIMT) by high resolution ultrasonography of 50 SGA and 50 AGA term newborns.Results Mean aIMT and cIMT were significantly greater in the SGA term newborns group as compared to AGA term newborns (0.54 0.06 mm and 0.44 ) 0.04 mm in SGA term newborns vs 0.50 0.04 mm and 0.40 0.04 mm in AGA term newborns; P< 0.008 and P< 0.001, respectively). The signifi cance was even more apparent after adjustment for birthweight. A negative correlation of aIMT and cIMT was seen with birthweight, Ponderal index, length and head circumference.Conclusion SGA term newborns have signifi cantly increased aortic and carotid intima-media thickness as compared to AGA term newborns. This might be associated with higher risk for atherosclerosis. Longitudinal studies are required to further enhance the possible correlation between birthweight and intima-media thickness in SGA babies.

Transitional neonatal hypoglycemia

The blood sugar levels of all newborn infants fall after birth from fetal levels and can stay low for several days. The critical level for an intervention to increase the blood sugar remains most contentious, as does the selection of infants for screening and the frequency of screening. Further, quite low blood sugars are relatively common and symptomatic hypoglycemia is uncommon. In this issue of The Journal, a committee of the Pediatric Endocrine Society reports a scholarly analysis of mechanisms causing this normal transitional neonatal hypoglycemia in infants. The low blood sugars are not associated with ketosis, and there is a low glucose threshold for suppression of insulin secondary to an immature pattern of pancreatic beta cell function. The resulting low blood sugar values can confound the identification of infants with persistent and genetic causes of low blood sugars over the first days after birth. Further, the newer technology of measuring continuous subcutaneous glucose with implanted electrodes demonstrates rapid changes in glucose in high-risk preterm or growth-restricted infants in asymptomatic infants for weeks. It seems that the more we know, the less secure the clinician is about how to approach the detection and treatment of hypoglycemia in asymptomatic newborns. This analysis by Stanley et al is a valuable contribution toward further understanding the problem.Article page 1520▶ The blood sugar levels of all newborn infants fall after birth from fetal levels and can stay low for several days. The critical level for an intervention to increase the blood sugar remains most contentious, as does the selection of infants for screening and the frequency of screening. Further, quite low blood sugars are relatively common and symptomatic hypoglycemia is uncommon. In this issue of The Journal, a committee of the Pediatric Endocrine Society reports a scholarly analysis of mechanisms causing this normal transitional neonatal hypoglycemia in infants. The low blood sugars are not associated with ketosis, and there is a low glucose threshold for suppression of insulin secondary to an immature pattern of pancreatic beta cell function. The resulting low blood sugar values can confound the identification of infants with persistent and genetic causes of low blood sugars over the first days after birth. Further, the newer technology of measuring continuous subcutaneous glucose with implanted electrodes demonstrates rapid changes in glucose in high-risk preterm or growth-restricted infants in asymptomatic infants for weeks. It seems that the more we know, the less secure the clinician is about how to approach the detection and treatment of hypoglycemia in asymptomatic newborns. This analysis by Stanley et al is a valuable contribution toward further understanding the problem. Article page 1520▶ Re-Evaluating “Transitional Neonatal Hypoglycemia”: Mechanism and Implications for ManagementThe Journal of PediatricsVol. 166Issue 6PreviewA Committee of the Pediatric Endocrine Society was recently formed to develop guidelines for evaluation and management of hypoglycemia in neonates, infants, and children. To aid in formulating recommendations for neonates, in this review, we analyzed available data on the brief period of hypoglycemia, which commonly is observed in normal newborns during the transition from fetal to extrauterine life, hereafter referred to as transitional neonatal hypoglycemia in normal newborns. The goal was to better understand the mechanism underlying this phenomenon in order to formulate recommendations for recognizing neonates requiring diagnosis and treatment during the first days of life for disorders causing severe and persistent hypoglycemia. Full-Text PDF

TRANSLUCENCIA NUCAL FETAL UN MARCADOR DE ALTERACIONES CROMOSÓMICAS EN EL PRIMER TRIMESTRE

Objetivo: Se evalúa la efectividad de la medición de la translucencia nucal en un examen de ultrasonido rutinario para la detección prenatal de síndrome de Down. Material y métodos: Estudio ecográfico entre las 10 y 14 semanas de edad gestacional para medición de la translucencia nucal, a fin de determinar la asociación de incremento de la translucencia nucal y un cariotipo fetal anormal. Resultados: Un total de 423 pacientes únicas y un embarazo gemelar fueron estudiadas. Hubo 410 fetos con valores de 3 mm o menos, de los cuales nacieron 409 productos normales y un feto con trisomía 13. De un total de 14 fetos con valores mayores de 3 mm de translucencia nucal encontramos 3 bebes normales, 7 bebes con trisomía 21, dos bebes con síndrome de Turner y 2 muertes fetales intrauterinas sin estudio genético. Se realizó 64 amniocentesis para cultivo de células fetales, 5 estudios cromosómicos en productos abortados espontáneamente y un estudio a un bebe nacido vivo con malformaciones. Conclusión: Este estudio demuestra que la medición de la translucencia nucal en el primer trimestre es un método efectivo de despistaje de anomalías cromosómicas fetales y que es posible la implementación de un programa de screening en la práctica rutinaria.

A new serum cystatin C formula for estimating glomerular filtration rate in newborns.

The levels of serum cystatin C (CysC) and creatinine (Cr) were determined in small-for-gestational-age (SGA) babies and compared with those for normal term newborns appropriate for gestational age (AGA), at birth and 3 days later. We then compared a number of cysC-based, Cr-based and combined formulas for estimation of glomerular filtration rate (GFR) with the neonatal reference GFR. Fifty full-term SGA and 50 AGA newborns were enrolled in the study. Kidney volume measurements were performed by ultrasound for each newborn. At birth, the mean level of CysC in SGA babies was 1.48 ± 0.30 mg/l in cord blood and 1.38 ± 0.18 mg/l in day 3 blood samples, and the mean Cr level, determined simultaneously, was 67.08 ± 17.62 and 55.62 ± 14.91 μmol/l, respectively. These levels did not differ significantly from those determined in AGA babies. A 10 % reduction in kidney volume was associated with an increase in CysC value of 9.3 % in cord blood. The Cr-based and Schwartz-combined equations underestimated GFR relative to CysC-based and Zappitelli-based equations at birth and 3 days later. A newly constructed Cys-C based formula which includes kidney volume and body surface area in the calculations for GFR is a reliable marker of GFR compared with neonatal reference clearance values.

Cost-effectiveness of three-stage newborns hearing screening in Beijing

To evaluate the cost-effectiveness of two-stage and three-stage hearing screenings for newborns. Hearing screening was performed for the normal newborns born in 7 hospitals in Beijing from October 2010 to December 2012 by using two stage and three stage strategies as well as hearing diagnostic test, and the cost effectiveness evaluation of two strategies was conducted. The data about the cost of screening and diagnostic test were from the hospitals. The data about car fare and charge for loss of working time of parents were collected through questionnaire survey. The sensitivity was analyzed according to the compliance rate. A total of 62,695 newborns received initial hearing screening, 5,809 newborns failed, the positive rate was 9.30%. A total of 4,933 newborns received rescreening, 972 newborns failed, the positive rate was 19.70%. Among the newborns failed in rescreening, 412 were provided with hearing diagnostic test and 360 received diagnostic test. The diagnostic test indicated that the hearing of 217 newborns were abnormal (60.28%). A total of 276 newborns received the third screening, 163 newborns failed, in which 125 received diagnostic test and 112 had abnormal hearing (45 had moderate and above hearing impairment), the abnormal rate was 89.60%. The average cost for three-stage screening (37,242 yuan RMB per case) was higher than that for two-stage screening (19,985 yuan RMB per case). With the increase of compliance, the cost-effectiveness of three-stage screening increased. The cost-effectiveness of three-stage screening was influenced by screening compliance. It is recommended that three-stage screening strategy might be taken in area where the screening compliance rate is >90%.

Automatic detection of the expiratory and inspiratory phases in newborn cry signals

An analysis of newborn cry signals, either for the early diagnosis of neonatal health problems or to determine the category of a cry (e.g., pain, discomfort, birth cry, and fear), requires a primary and preliminary preprocessing step to quantify the important expiratory and inspiratory parts of the audio recordings of newborn cries. Data typically contain clean cries interspersed with sections of other sounds (generally, the sounds of speech, noise, or medical equipment) or silence. The purpose of signal segmentation is to differentiate the important acoustic parts of the cry recordings from the unimportant acoustic activities that compose the audio signals. This paper reports on our research to establish an automatic segmentation system for newborn cry recordings based on Hidden Markov Models using the HTK (Hidden Markov Model Toolkit). The system presented in this report is able to detect the two basic constituents of a cry, which are the audible expiratory and inspiratory parts, using a two-stage recognition architecture. The system is trained and tested on a real database collected from normal and pathological newborns. The experimental results indicate that the system yields accuracies of up to 83.79%.

Re-Evaluating “Transitional Neonatal Hypoglycemia”: Mechanism and Implications for Management

A Committee of the Pediatric Endocrine Society was recently asked by xxx to develop guidelines for evaluation and management of hypoglycemia in neonates, infants, and children. To aid in formulating recommendations for neonates, in this review, we analyzed available data on the brief period of hypoglycemia which commonly is observed in normal newborns during the transition from fetal to extrauterine life, hereafter referred to as transitional neonatal hypoglycemia in normal newborns. The goal was to better understand the mechanism underlying this phenomenon in order to formulate recommendations for recognizing neonates requiring diagnosis and treatment during the first days of life for disorders causing severe and persistent hypoglycemia. It has long been known that plasma glucose concentrations are lower in the first 1–3 days of life in normal newborn infants than at later ages. Not until the 1960s was it appreciated that hypoglycemia in neonates could sometimes be symptomatic and, as in older infants and children, cause seizures or permanent brain damage (1, 2). Although studies in laboratory animals have demonstrated postnatal developmental changes in specific enzymes involved in hepatic gluconeogenesis and ketogenesis (3, 4), it is unclear that such changes adequately explain transitional neonatal hypoglycemia in human newborns or if other mechanisms may be involved (5, 6). A National Institutes of Health conference outlined many of the “gaps in knowledge” about neonatal hypoglycemia and lamented the lack of a rational basis for defining hypoglycemia in neonates (7). For this re-evaluation of transitional neonatal hypoglycemia in normal newborns, we used the strategy routinely employed by pediatric endocrinologists for evaluation of hypoglycemia in older infants and children. This strategy, based on an examination of the major metabolic fuel and hormone responses to hypoglycemia, makes it possible to discover the mechanism of hypoglycemia and to make a specific diagnosis of the underlying cause (Figure; available at www.jpeds.com) (8). We reviewed published data in normal newborns on metabolic fuel and hormone responses during the period of transitional neonatal hypoglycemia. We focused on mean responses as being most likely representative of normal newborns, recognizing the possibility of heterogeneity, particularly with regard to peri-partum stresses and feeding practices. We found that transitional neonatal hypoglycemia most closely resembles known genetic forms of congenital hyperinsulinism, which cause a lowering of the plasma glucose threshold for suppression of insulin secretion. This conclusion is based on strong evidence supported by two or more independent reports and provides a novel perspective on both the diagnosis and management of hypoglycemia in the first several days after birth. Figure Hypoglycemia diagnosis based on plasma metabolic fuel responses. Measurement of major fuels (lactate as a gluconeogenic substrate, FFA from adipose tissue lipolysis, and beta-hydroxybutyrate as the major ketone from hepatic ketogenesis) at a time of hypoglycemia ...

Evaluation of cord blood ischemia modified albumin in normal pregnancies and pre-eclampsia

Objective: Pre-eclampsia is associated with ischemia and increased oxidative stress, which may lead to modification of plasma albumin to ischemia modified albumin (IMA). Methods: IMA levels were estimated in cord blood of 30 newborns born to pre-eclamptic mothers and compared with 30 normal newborns. IMA was estimated colorimetrically and the results were compared statistically. Results: The levels of IMA were found to be significantly higher (p < 0.001) in newborns born to pre-eclamptic mothers (0.835 ± 0.02 ABSU) as compared to those born to normal mothers (0.325 ± 0.01 ABSU). Conclusion: IMA may act as a marker of ischemia and oxidative stress in newborns delivered to pre-eclamptic mothers.