Neonatal Serum Research Articles

Bacterial DNA detection in very preterm infants assessed for risk of early onset sepsis

The aim of this study is to evaluate the diagnostic ability of multiplex real-time polymerase chain reaction (PCR) in very preterm infants assessed for risk of early onset neonatal sepsis (EOS). Prospective observational cohort study. Blood samples of preterm neonates≤32weeks of gestation were evaluated by commercial multiplex real-time PCR within 2h after delivery. The definition of EOS was based on positive blood culture and clinical signs of infection or negative blood culture, clinical signs of infection and abnormal neonatal blood count and serum biomarkers. Among 82 subjects analyzed in the study, 15 had clinical or confirmed EOS. PCR was positive in four of these infants (including the only one with a positive blood culture), as well as in 15 of the 67 infants without sepsis (sensitivity 27%, specificity 78%). Out of 19 PCR positive subjects, Escherichia coli was detected in 12 infants (63%). Statistically significant association was found between vaginal E.coli colonization of the mother and E.coli PCR positivity of the neonate (p=0.001). No relationship was found between neonatal E.coli swab results and assessment findings of bacterial DNA in neonatal blood stream. Multiplex real-time PCR had insufficient diagnostic capability for EOS in high risk very preterm infants. The study revealed no significant association between PCR results and the diagnosis of clinical EOS. Correlation between maternal vaginal swab results and positive PCR in the newborn needs further investigation to fully understand the role of bacterial DNA analysis in preterm infants.

Comparison of enzyme-linked immunosorbent assay and Fassisi® bovine immunoglobulin G (IgG) immunoassay for quantification of bovine IgG in neonatal calf serum.

Background and Aim:Rapid tests are routinely used to estimate serum immunoglobulin G (IgG) concentrations in diagnosing a failure of passive transfer (FPT) in calves. The study aimed to compare the Fassisi® Bovine IgG (FB-IgG) immunoassay and an enzyme-linked immunosorbent assay for quantifying bovine IgG in neonatal calf serum.Materials and Methods:A total of 277 calves of 1-10 days of age were used in this study. Blood samples were obtained, and serum was extracted by centrifuging the samples at 2740× g for 5 min at 20°C. The serum was analyzed using the FB-IgG according to the manufacturer’s specifications. Serum IgG concentrations were also determined by enzyme-linked immunosorbent assay (ELISA-IgG). FPT was defined as a serum IgG concentration <10 mg/mL.Results:The mean ELISA-IgG serum concentration was 8.40 mg/mL (SD=7.02, range=0.10-47.50 mg/mL). FPT prevalence based on the ELISA measurements was 66.8%. The prevalence of partial and full FPT based on the FB-IgG was 54.5%. The ELISA-IgG and FB-IgG results were subjected to correlation and regression analysis. Overall sensitivity and specificity of the FB-IgG were 61.1% and 58.7%, respectively. A statistically significant dependence on age was identified in the results.Conclusion:Our findings suggest that the FB-IgG rapid method is less accurate and provides no other advantages over established methods.

Immune Response of Neonates Born to Mothers Infected With SARS-CoV-2

Although several studies have provided information on short-term clinical outcomes in children with perinatal exposure to SARS-CoV-2, data on the immune response in the first months of life among newborns exposed to the virus in utero are lacking. To characterize systemic and mucosal antibody production during the first 2 months of life among infants who were born to mothers infected with SARS-CoV-2. This prospective cohort study enrolled 28 pregnant women who tested positive for SARS-CoV-2 infection and who gave birth at Policlinico Umberto I in Rome, Italy, from November 2020 to May 2021, and their newborns. Maternal and neonatal systemic immune responses were investigated by detecting spike-specific antibodies in serum, and the mucosal immune response was assessed by measuring specific antibodies in maternal breastmilk and infant saliva 48 hours after delivery and 2 months later. Maternal infection with SARS-CoV-2 in late pregnancy. The systemic immune response was evaluated by the detection of SARS-CoV-2 IgG and IgA antibodies and receptor binding domain-specific IgM antibodies in maternal and neonatal serum. The mucosal immune response was assessed by measuring spike-specific antibodies in breastmilk and in infant saliva, and the presence of antigen-antibody spike IgA immune complexes was investigated in breastmilk samples. All antibodies were detected using an enzyme-linked immunosorbent assay. In total, 28 mother-infant dyads (mean [SD] maternal age, 31.8 [6.4] years; mean [SD] gestational age, 38.1 [2.3] weeks; 18 [60%] male infants) were enrolled at delivery, and 21 dyads completed the study at 2 months' follow-up. Because maternal infection was recent in all cases, transplacental transfer of virus spike-specific IgG antibodies occurred in only 1 infant. One case of potential vertical transmission and 1 case of horizontal infection were observed. Virus spike protein-specific salivary IgA antibodies were significantly increased (P = .01) in infants fed breastmilk (0.99 arbitrary units [AU]; IQR, 0.39-1.68 AU) vs infants fed an exclusive formula diet (0.16 AU; IQR, 0.02-0.83 AU). Maternal milk contained IgA spike immune complexes at 48 hours (0.53 AU; IQR, 0.25-0.39 AU) and at 2 months (0.09 AU; IQR, 0.03-0.17 AU) and may have functioned as specific stimuli for the infant mucosal immune response. In this cohort study, SARS-CoV-2 spike-specific IgA antibodies were detected in infant saliva, which may partly explain why newborns are resistant to SARS-CoV-2 infection. Mothers infected in the peripartum period appear to not only passively protect the newborn via breastmilk secretory IgA but also actively stimulate and train the neonatal immune system via breastmilk immune complexes.

Timing of SARS-CoV-2 vaccination during the third trimester of pregnancy and transplacental antibody transfer: a prospective cohort study

ObjectiveWe aimed to assess the impact of early versus late third-trimester maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination on transplacental transfer and neonatal levels of SARS-CoV-2 antibodies. MethodsMaternal and cord blood sera were collected following term delivery after antenatal SARS-CoV-2 BNT162b2 mRNA vaccination, with the first vaccine dose administered between 27 and 36 weeks of gestation. SARS-CoV-2 spike protein (S) and receptor-binding domain (RBD) -specific, IgG levels and neutralizing potency were evaluated in maternal and cord blood samples. ResultsThe study cohort consisted of 171 parturients—median age 31 years (interquartile range (IQR) 27–35 years); median gestational age 39+5 weeks (IQR 38+5–40+4 weeks)–83 (48.5%) were immunized in early thrird-trimester (first dose at 27–31 weeks) and 88 (51.5%) were immunized in late third trimester (first dose at 32–36 weeks). All mother–infant paired sera were positive for anti S- and anti-RBD-specific IgG. Anti-RBD-specific IgG concentrations in neonatal sera were higher following early versus late third-trimester vaccination (median 9620 AU/mL (IQR 5131–15332 AU/mL) versus 6697 AU/mL (IQR 3157–14731 AU/mL), p 0.02), and were positively correlated with increasing time since vaccination (r = 0.26; p 0.001). Median antibody placental transfer ratios were increased following early versus late third-trimester immunization (anti-S ratio: 1.3 (IQR 1.1–1.6) versus 0.9 (IQR 0.6–1.1); anti-RBD-specific ratio: 2.3 (IQR 1.7–3.0) versus 0.7 (IQR 0.5–1.2), p < 0.001). Neutralizing antibodies placental transfer ratio was greater following early versus late third-trimester immunization (median 1.9 (IQR 1.7–2.5) versus 0.8 (IQR 0.5–1.1), p < 0.001), and was positively associated with longer duration from vaccination (r = 0.77; p < 0.001). ConclusionsEarly compared with late third-trimester maternal SARS-CoV-2 immunization enhanced transplacental antibody transfer and increased neonatal neutralizing antibody levels. Our findings highlight that vaccination of pregnant women early in the third trimester may enhance neonatal seroprotection.

Therapeutic Hypothermia Modulates the Relationships Between Indicators of Severity of Neonatal Hypoxic Ischemic Encephalopathy and Serum Biomarkers.

Objective: To determine the changes due to therapeutic hypothermia (TH) exposure in the strength of association between traditional clinical and biochemical indicators of severity of neonatal hypoxic-ischemic encephalopathy (HIE) and serum biomarkers. We hypothesized that culmination of TH changes the strength of the relationships between traditional indicators of severity of HIE and serum biomarkers.Methods: This was a single-center observational cohort study of 178 neonates with HIE treated with TH and followed with serum biomarkers: (i) brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF) (neurotrophins); (ii) tau and glial fibrillary acidic protein (GFAP) (neural cell injury); and (iii) interleukin 6 (IL-6), IL-8, and IL-10 (cytokines), during their first week of life. Adjusted mixed-effect models tested associations with HIE indicators in relation to TH exposure.Results: At admission, lower Apgar scores and base excess (BE) and higher lactate and nucleated red blood cell (NRBC) count correlated with higher Sarnat scores. These indicators of worse HIE severity, including higher Sarnat score, correlated with lower VEGF and higher tau, GFAP, and IL-10 levels at different time points. Within the first 24 h of life, patients with a Sarnat score >2 had lower VEGF levels, whereas only those with score of 3 also had higher GFAP and IL-10 levels. Tau levels increased during TH in patients with Sarnat score of 3, whereas tau and GFAP increased after TH in those with scores of 2. After adjustments, lower VEGF levels during TH and higher tau, GFAP, and IL-10 levels during and after TH were associated with worse Sarnat scores. Tau and GFAP relationship with Sarnat score became stronger after TH.Conclusion: Therapeutic hypothermia exerts an independent modulatory effect in the relationships between traditional indicators of severity of HIE and serum biomarkers after adjustments. Thus, the timing of biomarker testing in relation to TH exposure must be carefully considered if biomarkers are proposed for patient stratification in novel clinical trials.

Maternal Exposure to Air Pollution Is Associated with Neonatal Jaundice: A Retrospective Cohort Study

To evaluate the association between maternal ambient pollutant exposure and neonatal jaundice in multiple pollutant species and examine sex differences. Epidemiologic study: Records of 13 297 newborns (6153 male, 7144 female) born in Taichung, Taiwan were obtained from a national database. Average concentrations of prenatal air pollutants 3months prior to birth were divided into low, middle, and high levels. Neonatal jaundice phototherapy rates between mothers who suffered varying air pollutant levels were compared. Clinical study: Three hundred seventy-six newborns (189 male, 187 female) born and received jaundice treatment with phototherapy in a hospital in Taichung, Taiwan were recruited. The correlation between prenatal exposure to air pollutants 3months prior to birth, newborn's serum bilirubin, and serum hemoglobin were calculated. Epidemiologic study: Male newborns born to mothers exposed to high carbon monoxide (CO), nitric oxide (NO), nitrogen dioxide (NO2), and methane (CH4) levels had higher phototherapy rates. In female newborns, the same was noted for CO and CH4. Clinical study: Male newborns had a positive correlation between CO, ≤2.5μm diameter particles, ≤10μm diameter particles, NO, NO2, nonmethane hydrocarbon, and CH4 exposure 3months prior to birth and serum bilirubin levels. Female newborns had a positive correlation for CH4. A positive correlation between CO, ≤2.5μm diameter particles, ≤10μm diameter particles, NO2, nonmethane hydrocarbon, CH4 exposure, and serum hemoglobin levels was noted in male newborns. Maternal exposure to air pollutants may increase neonatal jaundice treatment rates for phototherapy and higher neonatal serum total bilirubin level. Higher hemoglobin levels because of higher pollutant exposures may explain our findings. The association was more obvious in male newborns.

PSI-14 Effects of maternal nutrient restriction during late gestation on neonatal beef calf serum chemistry and complete blood cell count

Abstract To determine effects of late gestational nutrient restriction (NR) on neonatal blood chemistry and hematology, primiparous fall-calving crossbred beef heifers [BW: 451 ± 28 (SD) kg; BCS: 5.4 ± 0.7] were individually fed either 100% (control; CON; n = 12) or 70% (n = 13) of NASEM net energy and metabolizable protein requirements for maintenance, pregnancy, and growth from d 160 of gestation to parturition. Calf jugular blood was obtained at 0 (pre-suckling), 6, 12, 24, and 48 h postnatally to determine serum chemistry and complete blood cell count. Data were analyzed with fixed effects of treatment, hour, and their interaction, using repeated measures. Calving date was a fixed effect; calf sex was included when P &amp;lt; 0.25. The treatment x hour interaction (P &amp;lt; 0.10) affected total protein, globulin, gamma-glutamyl transferase (GGT), aspartate aminotransferase (AST), creatinine, creatine kinase, red blood cells (RBC), hemoglobin, hematocrit, sodium, anion gap, and potassium. Total protein and globulin at 6 to 48 h were greater (P ≤ 0.02) in NR calves. Calves from NR heifers had greater (P &amp;lt; 0.08) GGT at 6, 12, and 48 h and greater (P ≤ 0.07) AST at 0 to 24 h. Creatinine at 24 h and creatine kinase at 6 to 24 h were greater (P &amp;lt; 0.04) in NR calves. Hematocrit from 6 to 24 h and RBC and hemoglobin at 6 and 12 h were greater (P ≤ 0.09) in CON calves. Sodium from 0 to 48 h and anion gap at 6 h were greater (P &amp;lt; 0.09) in CON calves. Calves from NR heifers had greater (P = 0.03) 0 h potassium. Treatment affected chloride, which was greater (P = 0.08) in CON calves. These data indicate calves born to nutrient restricted heifers may experience more trauma at calving but have improved passive transfer.

Maternal and neonatal serum lipid levels in preeclamptic females and its correlation with neonatal respiratory distress syndrome

Maternal and neonatal serum lipid levels in preeclamptic females and its correlation with neonatal respiratory distress syndrome

Establishment of the reference interval for high-sensitivity cardiac troponin T in healthy children of Chongqing Nan’an district

Objective To detect the concentration of high-sensitivity cardiac troponin T (hs-cTnT) in healthy children aged 0–14 years by electrochemiluminescence immunoassay (ECLIA), so as to explore the differences in different ages and genders. The aim of this study is to establish the reference interval for hs-cTnT in healthy children aged 0–14 years. Methods After screening, 3463 healthy children, including 1924 boys and 1539 girls, were selected from 4617 children aged 0–14 years. They were divided into nine groups: one day (umbilical cord blood; ‘UCB’), one day (venous blood; ‘VB’), 2–28 days, 29 days–<3 months, 3–<6 months, 6 months–<1 year old, 1–< 3 years old, 3–< 6 years old and 6–14 years old. A nonparametric test was used to detect the hs-cTnT concentration. The upper limit of the reference interval is the mean of the 99th percentile after bootstrap sampling. Results Hs-cTnT levels conformed to a non-Gaussian distribution. There was no significant difference in the concentration of hs-cTnT between boys and girls in the general data, but there were differences between boys and girls in the 3–<6 years old and 6–14 years old age groups. Except for UCB and 2–28 days, the concentration of hs-cTnT was significantly different in other age groups. The level of hs-cTnT in neonatal serum (2–28 days) was the highest. In other groups, it decreased gradually with age and dropped to the reference range of adults (0–14ng/L) at one-year old. The upper limit of reference interval of hs-cTnT concentration in each group was, respectively, 60.8, 78.8, 96.6, 58.6, 34.2, 16.2, 11.4, 8.0 (7.8 female), and 7.9 (7.3 female) ng/L. Conclusions Referring to WS/T 402-2012 establishment of reference intervals for clinical laboratory testing projects and CLSI (Clinical and Laboratory Standards Institute) C28-A3 documents and the joint expert consensus of ESC (European Society of Cardiology) and ACC (American College of Cardiology) in 2007, we established the reference interval of hs-cTnT concentration in children aged 0–14 years in Chongqing Nan’an district of China which can provide certain reference value for clinical diagnosis and treatment of myocarditis and myocardial (micro) injury in children.

Neonatal Feeding Trajectories in Mothers With Bipolar Disorder Taking Lithium: Pharmacokinetic Data.

Purpose: Women who take lithium during pregnancy and continue after delivery may choose to breastfeed, formula feed, or mix these options. The aim of the study was to evaluate the neonatal lithium serum concentrations based on these three feeding trajectories.Methods: We followed 24 women with bipolar disorder treated with lithium monotherapy during late pregnancy and postpartum (8 per trajectory). Lithium serum concentrations were determined by an AVL 9180 electrolyte analyser with a 0.10 mEq/L detection limit and a 0.20 mEq/L limit of quantification (LoQ).Results: There was complete lithium placental passage at delivery, with a mean ratio of lithium concentration in the umbilical cord to maternal serum of 1.12 ± 0.17. The median times to LoQ were 6–8, 7–8, and 53–60 days for formula, mixed, and exclusive breastfeeding respectively. The generalized log-rank testing indicated that the median times to LoQ differ according to feeding trajectory (p = 0.037). According to the multivariate analysis-adjusted lithium serum concentrations at birth, times to LoQ are, on average, longer under exclusive breastfeeding (formula, p = 0.015; mixed, p = 0.012). No lithium accumulation was observed in infants under either exclusive or mixed breastfeeding. During the lactation follow-up, there was no acute growth or developmental delays in any neonate or infant. Indeed, lithium concentrations in the three trajectories declined in all cases. However, the time needed to reach the LoQ was much longer for those breastfeeding exclusively.Conclusions: In breastfeed infant no sustained accumulation of lithium and no adverse effects on development or growth were observed.

Maternal and newborn effects of gestational diabetes mellitus: A prospective cohort study

BackgroundGestational diabetes mellitus (GDM) is a high glucose level detected during pregnancy and usually it disappears after 42 days of post partum. The aim of this research was to assess the maternal and newborn effects of GDM in resource limited settings. MethodsA prospective cohort was implemented in the five referral hospitals of Amhara region. Data were collected using both primary data collection tool and reviewing the patients’ charts. Descriptive statistics were used to describe the effects of GDM on the pregnancy outcomes, fractional regression was used to estimate the proportion of weight gain in the first 3 months, Poisson regression was used to identify the effects of GDM on the episodes of childhood infectious diseases, independent sample t-test was used to estimate the effects of GDM on the newborn serum zinc and vitamin D levels. ResultsA total of 3459 women were included with a response rate of 85.56%. Cesarean section rate among GDM mother was 40.3% and among GDM free mothers was 7.1%. In the first 3 months, the weight gains of infant born from GDM mothers were 53% higher than infant born from GDM free mothers. GDM increases the risk of infectious disease episodes by 4 folds. GDM decreases the neonatal serum zinc and vitamin D levels. ConclusionGDM increases the maternal complications of pregnancy; GDM significantly depletes the newborn micronutrient levels and increase the episodes of infectious diseases during the infancy periods.

Maternal-Neonatal Serum Albumin Level and Neonatal Respiratory Distress Syndrome in Late-Preterm Infants.

Background: To determine the correlation between maternal-neonatal serum albumin level and respiratory distress syndrome (RDS) in late-preterm infants.Methods: This case-control study included 112 late-preterm newborns admitted to the neonatal intensive care unit of our hospital between January 2018 and July 2019. Those infants were divided into the RDS group (n = 56) and the non-RDS group (n = 56). Levels of maternal-neonatal serum albumin, pregnancy complications, and baseline information of the infants were compared between the two groups.Results: 1. There was no correlation between maternal and neonatal serum albumin measures. The maternal albumin level in the RDS group was lower than that in the control group (33.38 ± 3.31 vs. 33.60 ± 3.31, P > 0.05), but the difference was not statistically significant. The neonatal albumin level in the RDS group was significantly lower than that in the control group (32.70 ± 2.48 vs. 35.66 ± 3.27, P < 0.05). To predict RDS in late-preterm infants, using the albumin cutoff level of 34 g/L provides a sensitivity of 83.9% with a specificity of 62.5%. 2. Gestational age, primipara, placenta previa, antenatal corticosteroid therapy, delivery mode, and neonatal serum albumin level were associated with RDS in the late-preterm infant. 3. After adjustment for gestational age, logistic regression analysis showed that neonatal serum albumin level, placenta previa, and delivery mode were independent risk factors for RDS in late-preterm infants. However, albumin level did not related to the severity of RDS.Conclusion: The decrease in serum albumin within the first day after birth was closely related to the occurrence of RDS in late-preterm infants.

Neurotrophic factor levels in the serum and cerebrospinal fluid of neonates infected with human cytomegalovirus.

Human cytomegalovirus (HCMV) is most likely to damage the central nervous system (CNS) during early embryonic development; however, the early neurodevelopmental abnormalities caused by HCMV infection and the regulation of cytokines remain unclear. Therefore, we investigated neuronal factors in the serum and cerebrospinal fluid (CSF) of newborns infected with HCMV using protein microarray technology with a view to elucidating the changes in specific neuronal factors for use in the development of a reliable index for predicting CNS injury caused by HCMV infection. Serum and CSF were collected from four newborns with HCMV infection and CNS injury (HCMV-infected group) and from four newborns without CNS infection (control group). A protein microarray containing 29 kinds of CNS-related cytokines was used to identify differentially expressed neuronal factors in the serum and CSF of the HCMV-infected and control groups. The levels of the differentially expressed proteins were verified further in 30 CSF samples from an HCMV-infected group using enzyme-linkedimmunosorbent assay (ELISA). Between newborns in the HCMV-infected and control groups, the protein microarray analysis identified three differentially expressed neurotrophic factors in the CSF samples: Acrp30, MMP-3, and interleukin-1 alpha (IL-1α). No differential cytokine expression was seen in the serum. ELISA showed significantly higher expression levels of Acrp30 and MMP-3 in the CSF of the 30 newborns with HCMV infection and CNS injury than in those in the control group, whereas the expression of IL-1α was significantly lower. Our results demonstrate that changes in the expression levels of Acrp30, MMP-3, and IL-1α in the CSF of newborns infected with HCMV may be related to the pathogenesis of CNS infection.

Effects of delayed cord clamping on neonatal hyperbilirubinemia in pre-gestational diabetes at term

Objective To evaluate the effects of delayed cord clamping on neonatal hyperbilirubinemia in infants born to patients diagnosed with pre-gestational diabetes (type I or type II). Methods In January 2016, our institution implemented an organization-wide thirty-second delayed cord clamping protocol. This retrospective cross-sectional study represents infants of mothers diagnosed with pre-gestational diabetes who delivered before and after protocol implementation. The study period was from October 2014 to August 2017. The primary outcome was peak neonatal transcutaneous bilirubin (mg/dL) level during neonatal hospital stay. The secondary outcomes included neonatal serum bilirubin (mg/dL), jaundice requiring phototherapy, hypoglycemia, polycythemia, respiratory distress, and neonatal intensive care unit (NICU) admission. A subgroup analysis for outcomes stratified by type of pre-gestational diabetes was also performed. Results 145 patients were included in the final analysis. The mean peak neonatal transcutaneous bilirubin level was 10.1 mg/dL ± 3.4 mg/dL for immediate cord clamping and 9.5 mg/dL ± 3.4 mg/dL for delayed cord clamping (p = .25). There were no significant differences between groups for neonatal jaundice requiring phototherapy, hypoglycemia, polycythemia, respiratory distress, or NICU admission. No differences were observed in neonatal outcome by subgroup analysis of pre-gestational diabetes type. Conclusion In our study, there was no significant increase in peak neonatal transcutaneous bilirubin in term (≥37 week) infants of mothers with pre-gestational diabetes after undergoing thirty-seconds of delayed cord clamping. In the absence of contraindications, we advocate for continued use of delayed cord clamping for these infants.

Vitamin D Levels in Mother-Baby Pairs: A Cross-Sectional Prospective Study in a Rwandan Tertiary Hospital.

Exposure to the sunlight contributes largely to the production of vitamin D. However, vitamin D deficiency is a reality in tropical countries, despite enjoying enough sunlight, especially bearing women in their last trimester whose foetuses exclusively depend on their reserves. This work aimed at demonstrating the state of vitamin D in mother-baby pairs and associated factors in one of the University Hospitals in Rwanda. This cross-sectional prospective study was performed on mother-baby pairs at Kigali University Hospital. Mother's serum 25-hydroxyvitamin D levels were considered as outcomes compared with demographic, clinical and biological markers. Correlation analysis was conducted in order to assess the association between serum 25-hydroxyvitamin D levels for the couple mothers-babies. Approximately 38% of women and 65% of neonates had deficiency in 25-hydroxyvitamin D (<20 ng/ml). The use of a vitamin D rich diet within 24 h recall (p < 0.01) or 1 week recall (p < 0.001) before delivery was associated with appropriate vitamin D levels in mothers. Interestingly, a strong positive correlation was found between maternal and neonatal serum 25-hydroxyvitamin D levels (r = 0.760). There was a high rate of vitamin D deficiency in mothers and their babies. Babies born from women with deficiency were likely to develop low levels of vitamin D. This stresses on the need to strengthen the interventions for preventing vitamin D deficiency in the couple mothers-babies such as supplement in vitamin D before and after delivery, improving the quality of meals and regular contact with sunlight.

Longitudinal Vitamin D Deficiency Among Malaysian Pregnant Women and Its Correlation With Neonatal Serum 25-Hydroxyvitamin D Levels.

Objective: This study aimed to investigate the longitudinal relationship between maternal vitamin D concentrations during pregnancy and neonatal vitamin D concentrations at birth.Materials and Methods: A prospective cohort of 236 healthy pregnant women from various ethnicity in early pregnancy (≤20 weeks of pregnancy) was followed at late pregnancy (28–40 weeks of pregnancy) and birth. Maternal serum 25-hydroxyvitamin D (25(OH)D) was assessed at early pregnancy (baseline) and late pregnancy, while neonatal cord serum 25(OH)D at birth. General estimating equations (GEE) were used to analyze the longitudinal association of maternal serum 25(OH)D levels during pregnancy and neonatal cord serum 25(OH)D levels at birth with adjusting for the time exposure, maternal weight gain, ethnicity, and skin type.Results: The results showed that the prevalence of vitamin D deficiency (25(OH)D <50 nmol/L) was at 89.9, 92.2, and 96.1% in early, late pregnancy and in neonatal cord serum, respectively. The GEE analysis showed a trend that longitudinal vitamin D deficiency during pregnancy leads to lower vitamin D concentrations in neonatal cord blood (RR = 1.17; 95% CI (1.05–1.36); p = 0.04).Conclusion: Longitudinal vitamin D deficiency during pregnancy leads to vitamin D deficiency in neonates at birth. A further trial is needed to affirm this association.

A Comparison Between Maternal and Neonatal Serum Level of Vitamin D and Its Relationship with Anthropometric Neonatal Factors

A Comparison Between Maternal and Neonatal Serum Level of Vitamin D and Its Relationship with Anthropometric Neonatal Factors

Щодо окремих клініко-параклінічних маркерів сепсис-індукованої міокардіальної дисфункції в новонароджених

The problem of neonatal sepsis continues to be one of the leading places in neonatal practice. The issues of early diagnostics of cardiovascular disorders in neonates with sepsis by means of up-to-date methods of examination remain relevant. They can be used as screening methods with the purpose to verify possible development of cardiovascular dysfunction. Purpose — to study the meaning of certain clinical and paraclinical markers of myocardial dysfunction in neonates with sepsis. Materials and methods. In order to realize the objective we have observed 69 neonates with signs of generalized infectious-inflammatory process. Group I (32 patients — 46,4%) included neonates with the term of gestation 37–42 weeks, group II included 37 preterm neonates (53,6%) with the term of gestation under 36 week inclusive. Results. It was found that in mothers who gave birth prematurely, compared to mothers of newborns of group I, premature rupture of membranes occurred more often, but 1.5 times less often — indications of infectious diseases of the genitourinary system of the pregnant woman. Generalized infectious-inflammatory process during the neonatal period of term infants is accompanied by electrocardiographic signs of left ventricular overload associated with female sex (r=0,30), delivery by cesarean section (r=0,27), and assessment of neonatal condition by a 5=minute Apgar score (r=-0,33). Conclusions. Increased values of lactate dehydrogenase activity in the blood serum of both term and preterm neonates are associated with left ventricular over-load in the term ones, and right ventricular overload in the preterm infants. Changes found in electrophysiological heart activity promote the necessity of a routine use of electrocardiography in neonates with signs of septic process. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: neonatal sepsis; myocardial dysfunction.

Yinzhihuang Oral Liquid Ameliorates Hyperbilirubinemia Induced by δ-Aminolevulinic Acid and Novobiocin in Neonatal Rats.

Yinzhihuang oral liquid (YZH) is a traditional Chinese medicine that has been widely used in Asia to prevent and treat neonatal hyperbilirubinemia, but the published preclinical studies on its anti-hyperbilirubinemia effect are conducted in adult animals, partly due to the lack of preclinical neonatal hyperbilirubinemia animal models. In the present study, we tested six reagents to induce hyperbilirubinemia in neonatal rats, and established two appropriate neonatal hyperbilirubinemia rat models by subcutaneous injection of δ-Aminolevulinic acid (ALA, 200 mg/kg) or novobiocin (NOVO, 200 mg/kg). Oral treatment of YZH (80, 160 and 320 mg/kg) significantly decreased serum conjugated bilirubin levels in ALA-treated neonatal rats and serum unconjugated bilirubin levels in NOVO-treated neonatal rats, respectively. Additionally, pre-treatment of YZH also prevented the increase of serum bilirubin levels in both ALA- and NOVO-treated rats. Mechanistically, YZH significantly up-regulated the mRNA expression of genes involved in hepatic bilirubin disposition (organic anion-transporting polypeptide 1b2, Oatp1b2; multidrug resistance-associated protein 2, Mrp2) and bilirubin conjugation (UDP-glucuronosyltransferase 1a1, Ugt1a1). Additionally, YZH up-regulated the mRNA expression of cytochrome P450 1A1 (Cyp1a1), the target gene of aryl hydrocarbon receptor (AhR), and increased the nuclear protein levels of AhR in livers of neonatal rats. YZH and its two active ingredients, namely baicalin (BCL) and 4'-hydroxyacetophenone (4-HT), up-regulated the mRNA expression of AhR target genes (CYP1A1 and UGT1A1) and increased nuclear protein levels of AhR in HepG2 cells. In conclusion, the present study provides two neonatal hyperbilirubinemia animal models and evaluates the anti-hyperbilirubinemia effect and mechanisms of YZH in neonatal animals.

Genetic causes of neonatal and infantile hypercalcaemia

The causes of hypercalcaemia in the neonate and infant are varied, and often distinct from those in older children and adults. Hypercalcaemia presents clinically with a range of symptoms including failure to thrive, poor feeding, constipation, polyuria, irritability, lethargy, seizures and hypotonia. When hypercalcaemia is suspected, an accurate diagnosis will require an evaluation of potential causes (e.g. family history) and assessment for physical features (such as dysmorphology, or subcutaneous fat deposits), as well as biochemical measurements, including total and ionised serum calcium, serum phosphate, creatinine and albumin, intact parathyroid hormone (PTH), vitamin D metabolites and urinary calcium, phosphate and creatinine. The causes of neonatal hypercalcaemia can be classified into high or low PTH disorders. Disorders associated with high serum PTH include neonatal severe hyperparathyroidism, familial hypocalciuric hypercalcaemia and Jansen’s metaphyseal chondrodysplasia. Conditions associated with low serum PTH include idiopathic infantile hypercalcaemia, Williams-Beuren syndrome and inborn errors of metabolism, including hypophosphatasia. Maternal hypocalcaemia and dietary factors and several rare endocrine disorders can also influence neonatal serum calcium levels. This review will focus on the common causes of hypercalcaemia in neonates and young infants, considering maternal, dietary, and genetic causes of calcium dysregulation. The clinical presentation and treatment of patients with these disorders will be discussed.