Occurrence In Newborns Research Articles

Inhibition of Microglial Activation Ameliorates Inflammation, Reduced Neurogenesis in the hippocampus, and Impaired Brain Function in a Rat Model of Bilirubin Encephalopathy.

Hyperbilirubinemia is one of the most common occurrence in newborns and is toxic to the brain, resulting in neurological sequelae such as auditory impairment, with potential to evolve to chronic bilirubin encephalopathy and long-term cognitive impairment in adults. In the early postnatal period, neurogenesis is rigorous and neuroinflammation is detrimental to the brain. What are the alterations in neurogenesis and the underlying mechanisms of bilirubin encephalopathy during the early postnatal period? This study found that, there were a reduction in the number of neuronal stem/progenitor cells, an increase in microglia in the dentate gyrus (DG) and an inflammatory state in the hippocampus, characterized by increased levels of IL-6, TNF-α, and IL-1β, as well as a decreased level of IL-10 in a rat model of bilirubin encephalopathy (BE). Furthermore, there was a significant decrease in the number of newborn neurons and the expression of neuronal differentiation-associated genes (NeuroD and Ascl1) in the BE group. Additionally, cognitive impairment was observed in this group. The administration of minocycline, an inhibitor of microglial activation, resulted in a reduction of inflammation in the hippocampus, an enhancement of neurogenesis, an increase in the expression of neuron-related genes (NeuroD and Ascl1), and an improvement in cognitive function in the BE group. These results demonstrate that microglia play a critical role in reduced neurogenesis and impaired brain function resulting from bilirubin encephalopathy model, which could inspire the development of novel pharmaceutical and therapeutic strategies.

Predictability of Umbilical Cord Serum Bilirubin in Estimating the Risk of Hyperbilirubinemia in Term Neonates with ABO Incompatibility- A Prospective Cohort Study

Introduction: Neonatal hyperbilirubinemia is a significant cause of morbidity among term neonates. Delayed follow- up of newborns may lead to considerable morbidity and encephalopathy. High bilirubin levels may necessitate exchange transfusion, especially in infants with ABO or Rh blood incompatibility. Measurement of Umbilical Cord Bilirubin (UCB) is an easily available, inexpensive and non invasive method to predict the development of hyperbilirubinemia in newborns. Aim: To determine the predictive value of UCB in estimating the risk of subsequent hyperbilirubinemia in term neonates with ABO incompatibility and to establish a UCB cut-off associated with the risk of hyperbilirubinemia development. Materials and Methods: This prospective cohort study was conducted at the Punjab Institute of Medical Sciences (PIMS) in Jalandhar, Punjab, India, from June 2022 to March 2023. A total of 113 term babies born to O+ mothers were included in the study. At the time of delivery, cord blood was drawn from the placental side of the cord for blood group, Direct Coomb’s Test (DCT), and serum bilirubin analysis. Infants were followed-up every 12 hours while inpatient and every 48 hours after discharge until day 5 for assessment of clinical jaundice. Significant hyperbilirubinemia was managed with phototherapy according to American Academy of Paediatrics (AAP) guidelines. The data was collected and subjected to statistical analysis using IBM Statistical Package for Social Sciences (SPSS) 20.0 software, with a significance level set at p-value <0.05, utilising Receiver Operating Characteristic (ROC) curve analysis. Results: A total of 113 term neonates were enrolled in the study, of which 57 (50.4%) were females. The mean cord bilirubin level was 2.6±1.06 mg/dL. A total of 40 (35.3%) babies developed significant jaundice requiring phototherapy, with a mean highest bilirubin level of 15±3.2 mg/dL. Using a cord bilirubin level of ≥2.0 mg/dL, significant hyperbilirubinemia could be predicted with a sensitivity of 80%, specificity of 54%, positive predictive value of 57.97%, and negative predictive value of 75%. There was a positive correlation between cord bilirubin and postnatal serum bilirubin in the present study, as determined by ROC analysis {Area Under Curve (AUC) >0.5}. Conclusion: The present study concluded that UCB is an important predictor of significant hyperbilirubinemia occurrence in newborns with ABO incompatibility.

Does the Blood-Brain Barrier Integrity Change in Regard to the Onset of Fetal Growth Restriction?

The aim of the study was to determine whether early-onset and late-onset fetal growth restriction (FGR) differentially affects the blood-brain barrier integrity. Furthermore, the purpose of the study was to investigate the relationship between the blood-brain barrier breakdown and neurological disorders in FGR newborns. To evaluate the serum tight junction (TJ) proteins and the placental TJ proteins expression, an ELISA method was used. A significant difference in serum OCLN concentrations was noticed in pregnancies complicated by the early-onset FGR, in relation to the intraventricular hemorrhage (IVH) occurrence in newborns. No significant differences in concentrations of the NR1 subunit of the N-methyl-d-aspartate receptor (NR1), nucleoside diphosphate kinase A (NME1), S100 calcium-binding protein B (S100B), occludin (OCLN), claudin-5 (CLN5), zonula occludens-1 (zo-1), the CLN5/zo-1 ratio, and the placental expression of OCLN, CLN5, claudin-4 (CLN4), zo-1 were noticed between groups. The early-onset FGR was associated with a higher release of NME1 into the maternal circulation in relation to the brain-sparing effect and premature delivery. Additionally, in late-onset FGR, the higher release of the S100B into the maternal serum in regard to fetal distress was observed. Furthermore, there was a higher release of zo-1 into the maternal circulation in relation to newborns' moderate acidosis in late-onset FGR. Blood-brain barrier disintegration is not dependent on pregnancy advancement at the time of FGR diagnosis. NME1 may serve as a biomarker useful in the prediction of fetal circulatory centralization and extremely low birth weight in pregnancies complicated by the early-onset FGR. Moreover, the serum zo-1 concentration may have prognostic value for moderate neonatal acidosis in late-onset FGR pregnancies.

Residency patterns and site fidelity of Grampus griseus (Cuvier, 1812) in the Gulf of Taranto (Northern Ionian Sea, Central-Eastern Mediterranean Sea)

The residency pattern and site fidelity of Risso’s dolphin Grampus griseus were studied using sightings data collected during standardized vessel-based surveys carried out from 2013 to 2018 in the Gulf of Taranto (Northern Ionian Sea, Central-Eastern Mediterranean Sea). The photo-identification of 91 individuals of G. griseus and the occurrence of re-sighted dolphins up to 8 times provide the evidence that this mid-sized odontocetes persistently occurred in the study area. The presence of transient individuals, visitors, and seasonal residents in the Gulf of Taranto, along with the 29 multi-year resident Risso’s dolphins observed from 2 to 4 times on different years, indicated some degree of inter-annual variability in its temporal use of the area. Moreover, the occurrence of newborns and calves through the study period suggests the possibility to consider the Gulf of Taranto as both nursery and feeding area for females caring for their offspring. The importance of the Gulf of Taranto as critical habitat for the Risso’s dolphin as well as the common bottlenose dolphin and the striped dolphin candidates this area as potential Important Marine Mammal Area, in which enforce specific conservation measures are aimed to mitigate the anthropogenic pressure on different cetacean species according to ACCOBAMS and the MMPATF indication.

Predicting macrosomic newborns using postprandial glycemia of pregnancy in diabetic women

Purpose: To determine the mean two-hour postprandial (2hPP) blood glucose level and to analyze the maternal variables that can predict macrosomic or large for gestational age (LGA) newborns in diabetic mothers such as the type of diabetes mellitus, pre-gestational body mass index (BMI), previous macrosomic newborn, and parity. Materials and Methods: A prospective, longitudinal study was conducted with 200 pregnant women who had either gestational (103) or pre-gestational (97) diabetes. The mean 2hPP blood glucose levels, which were obtained by capillary glycemia, were calculated for all pregnant women >24 weeks gestation and divided into three groups: group 1 ≤100 mg/dl, group 2 100–120 mg/dl, and group 3 ≥120 mg/dl. The analysis of variance (ANOVA) was used to investigate the differences between groups for the occurrence of macrosomia or LGA. The receiver operator characteristics (ROC) curve was used to identify the significant cutoff point for the mean level of 2hPP blood glucose. Results: Pre-gestational BMI and previous macrosomia were associated with the occurrence of newborns with weight alterations of 32.8% and 35.7%, respectively (p 109 mg/dl, with a sensitivity of 81%, specificity of 40%, positive predictive value of 27.8%, and negative predictive value of 88.1%. Conclusion: Macrosomic and LGA were associated with maternal 2hPP blood glucose values > 109 mg/dl between 24 and 34 weeks gestation.

Acute lymphoblastic congenital leukemia as a cause of perinatal death following massive cerebral hemorrhage

Abstract Background Congenital leukemia is a rare condition and most commonly found in infants with Down syndrome. The occurrence in newborns without a genetically predisposing syndrome is extremely infrequent. Highlights We describe a case of peripartal fetal death at 30 weeks and 4 days of gestation. Emergency cesarean section was performed after a previously uncomplicated pregnancy because of pathologic fetal heart rate tracing and suspected intracranial hemorrhage on ultrasound imaging. Resuscitation of the newborn was unsuccessful and stopped after 30 min, when ultrasound of the fetus confirmed very severe intracranial and intraabdominal bleeding. Autopsy was performed after informed consent and demonstrated evidence of acute lymphoblastic leukemia in the bone marrow, associated with wide spread visceral involvement. Conclusion Perinatal fetal demise due to congenital leukemia is exceedingly rare and can occur unexpectedly in the third term after a normal pregnancy. We here report the clinical and pathologic findings, discuss the pathogenesis of fetal leukemia and its clinical manifestations along with a thorough review of the relevant literature.

Birth-related retinal hemorrhages in healthy full-term newborns and their relationship to maternal, obstetric, and neonatal risk factors

The purpose was to explore underlying maternal, obstetric, and neonatal risk factors of retinal hemorrhages (RH) in healthy full-term newborns. A total of 1199 full-term infants, with gestational age more than 37 weeks and Apgar score of 7 or above, were included in this study. Infants with severe systemic diseases or any other eye diseases were excluded. Eye examinations with RetCamIII within 1 week of birth were performed in all infants. Maternal, obstetric, and neonatal parameters were analyzed and compared between newborns with RH and those without RH. RH was seen in 294 of the 1199 infants (24.5 %) in this study. Among factors examined in the study, spontaneous vaginal delivery (SVD) (odds ratio [OR] =3.811 [95 % CI2.649-5.483], P < 0.001) and cephalhematoma (OR = 1.823 [95 % CI1.009-3.296], P = 0.047) correlated positively with RH occurrence in newborns, while a history of cesarean delivery correlated negatively with RH occurrence (OR = 0.296 [95 % CI0.139-0.630], P = 0.002). There was no statistical correlation found between RH and the other risk factors examined in this study. These factors included gender, gestational age, birth weight, maternal age, volume, and turbidity of amniotic fluid, duration of the first or second stage of labor, anemia, hypertensive disorders complicating pregnancy (HDCP), fetal distress, intracranial hemorrhage, and neonatal hyperbilirubinemia. RH is common in full-term newborns. A lower prevalence of newborn RH was found in infants delivered by mothers with a history of cesarean delivery. In contrast, SVD and cephalhematoma were found to be potential risk factors for the development of newborn RH in full-term infants. Infants with these risk factors may, therefore, require greater attention in regard to RH development.

Gastro-esophageal reflux: spitting and possetting in a neonate.

Gastro-esophageal reflux (GER) is a common occurrence in newborns and a cause of anxiety to most parents. This physiological process needs to be closely differentiated from pathological reflux. The clinical signs in infants are generally non-specific which makes the distinction difficult. The diagnostic options in infants are limited, have low sensitivity and not readily available. Treatment of GER is challenging both for the clinician and family. The mainstay of therapy involves use of conservative modalities with limited use of pharmacological agents and surgical methods. This review aims to amalgamate evidence based guidelines to our current clinical practice.

Neonatal Kerion Celsi: Report of Three Cases

Tinea capitis is a fungal infection caused by dermatophytes, frequent in children but uncommon in the neonatal period. Kerion Celsi is the inflammatory manifestation of tinea capitis secondary to host immunologic responses and its occurrence in newborns is extremely infrequent. We describe three neonates with the diagnosis of kerion Celsi. The isolated dermatophytes were Trichophyton mentagrophytes var. mentagrophytes in two patients and Trichophyton rubrum in the third. Both patients with T. mentagrophytes referred an indirect contact with rabbits and were successfully treated with systemic antifungal (griseofulvin and fluconazole). The patient with T. rubrum had a father with a tinea manuum and both received just topical antimycotic treatment.

Hyperbilirubinemia and Transcutaneous Bilirubinometry

Neonatal jaundice or hyperbilirubinemia is a common occurrence in newborns. Although most cases of neonatal jaundice have a benign course, severe hyperbilirubinemia can lead to kernicterus, which is preventable if the hyperbilirubinemia is identified early and treated appropriately. This review discusses neonatal jaundice and the use of transcutaneous bilirubin (TcB) measurements for identification of neonates at risk of severe hyperbilirubinemia. Such a practice requires appropriate serial testing and result interpretation according to risk level from a nomogram that provides bilirubin concentrations specific for the age of the neonate in hours. In this context, we have evaluated the potential impact on clinical outcome and limitations of TcB methods in current use. TcB measurement is a viable option in screening neonates to determine if they are at risk for clinically significant hyperbilirubinemia. Total serum bilirubin should be measured by a clinical laboratory if a newborn is shown to be at higher risk for clinically significant hyperbilirubinemia. In addition, external quality assessment to identify biases and operator training issues should be part of any TcB monitoring program.

Management of neonatal cholestasis

Cholestasis is a frequent occurrence in newborns, affecting one in every 2500 infants. Immaturity of hepatic metabolic and excretory functions contributes to decreased bile production and transport. The potential causes of neonatal cholestasis are extensive, but most cases fall into a few categories, including anatomic, metabolic and infectious. Pruritus and malabsorption are common manifestations of neonatal cholestasis, regardless of etiology. Medical management of cholestasis is largely supportive, treating the complications of cholestasis rather than the underlying mechanism. Medications for pruritus have variable efficacy and include ursodeoxycholic acid, cholestyramine and rifampin. Fat-soluble vitamin supplementation is often required secondary to fat malabsorption. Enteral absorption of long-chain triglycerides is also decreased, necessitating formulas high in medium-chain triglycerides. Infants may require 125% of the recommended daily allowance of calories for adequate growth and supplementation...

Granular Cell Tumor of the Esophagus: Report of a Pediatric Case and Literature Review

Granular Cell Tumor of the Esophagus: Report of a Pediatric Case and Literature Review

Enterohepatic cycling of bilirubin as a cause of 'black' pigment gallstones in adult life.

In contrast to bile salts, which undergo a highly efficient enterohepatic circulation with multiple regulatory and physiologic functions, glucuronic acid conjugates of bilirubin are biliary excretory molecules that in health do not have a continuing biologic life. Intestinal absorptive cells are devoid of recapture transporters for bilirubin conjugates, and their large size and polarity prevent absorption by passive diffusion. However, unconjugated bilirubin, the beta-glucuronidase hydrolysis product of bilirubin glucuronides can be absorbed passively from any part of the small and large intestines. This can occur only if unconjugated bilirubin is kept in solution and does not undergo rapid bacterial reduction to form urobilinoids. Here we collect, and in some cases reinterpret, experimental and clinical evidence to show that in addition to the well-known occurrence in newborns, enterohepatic cycling of unconjugated bilirubin can reappear in adult life. This happens as a result of several common conditions, particularly associated with bile salt leakage from the small intestine, the most notable ileal dysfunction resulting from any medical or surgical cause. We propose that when present in excess, colonic bile salts solubilize unconjugated bilirubin, delay urobilinoid formation, prevent calcium complexing of unconjugated bilirubin and promote passive absorption of unconjugated bilirubin from the large intestine. Following uptake, reconjugation, and resecretion into bile, this source of 'hyperbilirubinbilia' may be the important pathophysiological risk factor for 'black' pigment gallstone formation in predisposed adult humans.

Paneth cells in experimental amyloidosis.

The effect of experimental amyloidosis on the morphology of the Paneth cells of the mouse was investigated by using light and fluorescence microscopy. Amyloidosis was induced by daily subcutaneous casein injections for 4 weeks. It was found that the number of secretory granules of the Paneth cells increased in the jejunum, but remained normal in the duodenum. Small morphological alterations took place in the Paneth cells during the induction of amyloidosis, and occasionally the Paneth cells were totally lost. These changes suggest that the function of the Paneth cells of the jejunum may be partly inhibited during experimental amyloidosis.