Term Neonatal Research Articles

Effect of β-lactam antibiotics on the gut microbiota of term neonates

β-Lactam antibiotics are a class of antibiotics commonly used to treat bacterial infections. However, the effects of β-lactam antibiotics on term neonatal intestinal flora have not been fully elucidated. Hospitalized full-term newborns receiving β-lactam antibiotics formed the antibiotic group (n = 67), while those without antibiotic treatment comprised the non-antibiotic group (n = 47). A healthy group included healthy full-term newborns (n = 16). Stool samples were collected for 16 S rDNA sequencing to analyze gut microbiota variations. Further investigation was carried out within the β-lactam antibiotic group, exploring the effects of antibiotic use on the newborns’ gut microbiota in relation to the duration and type of antibiotic administration, delivery method, and feeding practices. The antibiotic group exhibited significant difference of microbial community composition compared to the other groups. Genera like Klebsiella, Enterococcus, Streptococcus, Alistipes, and Aeromonas were enriched, while Escherichia-Shigella, Clostridium sensu stricto 1, Bifidobacterium, and Parabacteroides were reduced. Klebsiella negatively correlated with Escherichia-Shigella, positively with Enterobacter, while Escherichia-Shigella negatively correlated with Enterococcus and Streptococcus. Regardless of neonatal age, β-lactam antibiotics induced an elevated abundance of Klebsiella and Enterococcus. The impact on gut microbiota varied with the duration and type of antibiotic (cefotaxime or ampicillin/sulbactam). Compared to vaginal delivery, cesarean delivery after β-lactam treatment heightened the abundance of Klebsiella, Enterobacteriaceae_Unclassified, Lactobacillales_Unclassified, and Pectobacterium. Feeding patterns minimally influenced β-lactam-induced alterations. In conclusion, β-lactam antibiotic treatment for neonatal pneumonia and sepsis markedly disrupted intestinal microbiota, favoring Klebsiella, Enterococcus, Streptococcus, Alistipes, and Aeromonas. The impact of β-lactam varied by duration, type, and delivery method, emphasizing heightened disruptions post-cesarean delivery.

Volumetric apparent diffusion coefficient histogram analysis in term neonatal asphyxia treated with hypothermia.

Our aim is to estimate the long-term neurological sequelae and prognosis in term neonatal asphyxia treated with hypothermia via volumetric apparent diffusion coefficient (ADC) map histogram analysis (HA). Brain MRI studies of 83 term neonates with asphyxia who received whole-body hypothermia treatment and examined between postnatal (PN) fourth and sixth days were retrospectively re-evaluated by 2 radiologists. Volumetric HA was performed for the areas frequently affected in deep and superficial asphyxia (thalamus, lentiform nucleus, posterior limb of internal capsule, corpus callosum forceps major, and perirolandic cortex-subcortical white matter) on ADC map. The quantitative ADC values were obtained separately for each region. Qualitative-visual (conventional) MRI findings were also re-evaluated. Neonates were examined neurodevelopmentally according to the Revised Brunet-Lezine scale. The distinguishability of long-term neurodevelopmental outcomes was statistically investigated. With HA, the adverse neurodevelopmental outcomes could only be distinguished from mild-moderated impairment and normal development at the thalamus with 10th percentile ADC (P = .02 and P = .03, respectively) and ADCmin (P = .03 and P = .04, respectively). Also with the conventional MRI findings, adverse outcome could be distinguished from mild-moderated impairment (P = .04) and normal development (P = .04) via cytotoxic oedema of the thalamus, corpus striatum, and diffuse cerebral cortical. The long-term adverse neurodevelopmental outcomes in newborns with asphyxia who received whole-body hypothermia treatment can be estimated similarly with volumetric ADC-HA and the conventional assessment of the ADC map. This study compares early MRI ADC-HA with neurological sequelae in term newborns with asphyxia who received whole-body hypothermia treatment. We could not find any significant difference in predicting adverse neurological sequelae between the visual-qualitative evaluation of the ADC map and HA.

A prospective observational study to evaluate the association of various maternal risk factors with increasing incidence of term neonatal jaundice

<p><strong><em>Background: </em></strong><em>In our setting majority of the mothers were discharged on postnatal day 3.but over the past few years the NICU admissions also increased prolonging the hospital stay of mothers leading to increase in the hospital acquired infections for both mother and baby. This study was developed in this context. <strong></strong></em></p><p><strong><em>Objectives:</em></strong><em> The present study was performed with the purpose of establishing the incidence of neonatal jaundice in term neonates and the role of the various maternal factors being responsible for exaggerated physiological hyperbilirubinemia in term neonates. <strong></strong></em></p><p><strong><em>Methods: </em></strong><em>Using the NICE gestational age-based phototherapy chart, this study analysed serum bilirubin of the term newborns on their day 2 of life. Total 155 antenatal mothers were taken for study. Associations between maternal risk factors and neonatal jaundice and comparing risk factors in early-term, term, and late-term newborns were assessed using chi-squared or Fisher’s exact tests</em></p><p><strong><em>Results: </em></strong><em>Incidence of neonatal jaundice is 58.1% in this study. Age, BMI, weight gain of the mother had no significant correlation with neonatal jaundice. Blood group incompatibility had a positive corelation (P=.001) Gestational age at the time of delivery determines the neonatal outcome. (P=.001). As gestation advances the neonatal outcomes are better. Hyperbilirubinemia incidence more at 37 -38 weeks when compared to 39 weeks. Maternal comorbidities, amniotic fluid volume changes, mode of delivery didn’t have statistical significance. when new-born factors are considered birth weight, gender growth problems, blood group has no statistical significance whereas dehydration proved to be significant (P=.001). meconium-stained amniotic fluid[P-0.034] were found to be associated with the development of neonatal jaundice.</em></p><p><strong><em>Conclusions: </em></strong><em>The prevalence of jaundice is higher in this study. maternal and foetal blood group incompatibility, gestational age at delivery, meconium-stained amniotic fluid, neonatal dehydration was found to be associated with the development of neonatal jaundice.</em></p>

Myeloid-KLF2 knockout neonatal mice experience mortality from lipopolysaccharide in an age-dependent and cell-specific manner

Abstract Background: Preterm neonates exhibit increased mortality from Gram negative sepsis as compared to term neonates. The innate immune system is at a critical phase of development during the neonatal period. Mechanisms underlying activation of the preterm neonatal innate immune response are poorly understood. Our prior data has shown that Kruppel-like factor (KLF)-2 is a critical transcription factor to maintain murine myeloid cells in a quiescent state. We hypothesize that myeloid KLF2 plays a critical role in the neonatal immune response in Gram negative sepsis. Methods: Preterm neonatal (P4) and term neonatal (P12) myeloid KLF2 knockout (MyK2KO) and age matched Cre mice were given 5ug/gm of E. coli O55:B5 lipopolysachharide (LPS) via intraperitoneal (i.p.) injection. For cell depletion studies, antibodies were injected i.p. 24 hours prior to LPS injection, followed by a repeat dose 24h after LPS. Ly6G antibody was used for neutrophil depletion, CD115 for monocyte depletion and equal dose of both for depletion of both cell lines. Results: P4 MyK2KO mice have significantly increased mortality within 48 h of LPS exposure as compared to P4 Cre mice (81% vs 41%, n=19, p<0.01 χ2test). At P12, there is 100% survival of both groups of mice. Depletion of either neutrophils, monocytes or both together, decreased the mortality in P4 MyK2KO mice from 81% to 55%. Conclusion: Preterm neonatal mice lacking myeloid KLF2 have an exaggerated response to LPS as compared to term neonatal MyK2KO or age-matched control mice. In vivo depletion of neutrophils, monocytes or both prior to LPS attenuates this response. Future studies will focus on the mechanism underlying the postnatal age-specific and cell-specific role of KLF2 in the neonatal innate immune response. Supported by grants from Rainbow Faculty Pilot Grant (Mukherjee PI) and NIH (R01 HL142647 Nayak PI)

Feasibility of a Pragmatic PBPK Modeling Approach: Towards Model-Informed Dosing in Pediatric Clinical Care.

More than half of all drugs are still prescribed off-label to children. Pharmacokinetic (PK) data are needed to support off-label dosing, however for many drugs such data are either sparse or not representative. Physiologically-based pharmacokinetic (PBPK) models are increasingly used to study PK and guide dosing decisions. Building compound models to study PK requires expertise and is time-consuming. Therefore, in this paper, we studied the feasibility of predicting pediatric exposure by pragmatically combining existing compound models, developede.g. for studies in adults, with a pediatric and preterm physiology model. Seven drugs, with various PK characteristics, were selected (meropenem, ceftazidime, azithromycin, propofol, midazolam, lorazepam, and caffeine) as a proof of concept. Simcyp® v20 was used to predict exposure in adults, children, and (pre)term neonates, by combining an existing compound model with relevant virtual physiology models. Predictive performance was evaluated by calculating the ratios of predicted-to-observed PK parameter values (0.5- to 2-fold acceptance range) and by visual predictive checks with prediction error values. Overall, modelpredicted PK in infants, children and adolescents capture clinical data. Confidence in PBPK model performance was therefore considered high. Predictive performance tends to decrease when predicting PK in the (pre)term neonatal population. Pragmatic PBPK modeling in pediatrics, based on compound models verified with adult data, is feasible. A thorough understanding of the model assumptions and limitations is required, before model-informed doses can be recommended for clinical use.

Body composition in term neonates of mothers with hypertensive disorders of pregnancy.

Neonates of gravidas with hypertensive disorders of pregnancy (HDP) are at increased lifelong risk of cardiometabolic complications. Neonatal adiposity measured by body composition (BC) is a better surrogate of nutritional status than birth weight. Data comparing BC in term neonates of hypertensive and normotensive pregnant patients is lacking. Our objective was to compare body composition in both groups of neonates. This was a retrospective cohort study from March 2018 to June 2019 at our tertiary institution where term neonatal BC are routinely measured. Neonates of patients with HDP and matched controls were included. Skin fold thickness (SFT) and percent body fat (PBF) were calculated using a validated anthropometric formula and compared using Mann-Whitney U and chi-square tests. One hundred and forty-two neonates of patients with HDP were compared to 150 controls. Demographic characteristics were similar except for higher pre-pregnancy BMI (29.7 ± 8.4 vs 26.75 ± 7.1, p = <0.01) in the HDP group. SFT was not significantly different (4.6 vs 4.4 mm, p = 0.09) but PBF was higher in the hypertensive group (13.15 vs 11.72, p = 0.01). PBF is higher in neonates of mothers with HDP, which may contribute to an increased risk of cardiometabolic complications later in life. Birth weight percentiles do not explain the predisposition to cardiovascular complications in offspring of hypertensive mothers. Body composition estimation may provide an explanation for this increased risk. Percent body fat is higher in term neonates of mothers with hypertensive disorders of pregnancy than neonates of normotensive mothers. Body composition is different in term neonates of mothers with hypertensive disorders of pregnancy.

Clinical presentation of hypoglycemic brain injury suggested by neuroimaging in unanticipated term neonates

Objective- To evaluate the clinical characteristics of hypoglycemic brain injury (HBI) in unanticipated term neonates, confirmed by neuroimaging. Methodology- We reviewed Magnetic resonance imaging (MRI) of brain of term neonatal encephalopathy cases, from January 2018 to November 2020. Neonates with MRI topography suggestive HBI and documented hypoglycemia from case records were enrolled in study. Perinatal data, clinical characteristics and management of cases was recorded. Descriptive statistics was used to analyse the data. Result-Total 13 term neonates had brain MRI suggestive of HBI conducted at median postnatal age of 7 days. The mean birth weight of HBI neonates was 2582 ± 285 gram, mean gestational age 38.15± 0.48 weeks and five (38.4%) babies were low birth weight. Eight (61.5%) babies were delivered by caesarean section, eleven (84.6%) were first born, twelve (92.3%) were male and nine (69.2%) were on exclusive breastfeeding. Out of thirteen neonates twelve (92.3%) were outborn, mean age of symptom noticed was 2.83±0.53 days and mean age of admission was 3.84± 0.82 days. Mean blood glucose at admission was 28.84±3.23 mg/dl and four (30.7%) were diagnosed with hypoglycemia at referral hospital.

Maternal risk factors for ''adverse neonatal outcome” after term deliveries in Sri Lanka

Background: Even though forty to seventy percent of neonatal mortality are recorded among term neonates, information on neonatal outcomes of term neonates is scarce. The high volume of term neonatal admissions to neonatal care units(NCU)signifies the importance of studying the maternal risk factors for such neonatal outcomes. Objectives:The present study aims to identify the maternal risk factors for' “adverse neonatal outcome'' (ANO) following term deliveries at Teaching Hospital Kandy. Methods:An unmatched case-control study was nested within a descriptive follow-up study. A sample of 1105 neonates, delivered at termat Teaching Hospital Kandy, was followed up until their initial discharge point. Results:Multivariate analysis, found that caesarean section with labour increases the risk of ANOamong term neonates by 3.37 ( CI- 2.13-5.33) times compared to normal vaginal delivery. Further, 37 completed weeks of Period of Amenorrhea (POA) (OR-2.91,1.57-5.42), Pregnancy Induced Hypertension (PIH) (OR-2.46, CI- 1.27-4.75), Gestational Diabetes Mellitus (GDM) (OR-2.33, CI- 1.0-5.15), primiparity (OR-1.53, CI- 1.02-2.30) and maternal occupation as professionals (OR-3.45, CI- 1.46-8.13) was identified as independent risk factors of ANO among term neonates. Conclusions: Caesarean section with labour, 37 completed weeks of POA, PIH, GDM, primiparity and maternal occupation as professional are independent risk factors for ANOin term neonates.

Short Term Outcomes of Early Term Neonates in a Tertiary Care Centre: A Descriptive Study

Introduction: The number of babies delivered between 37 weeks to 38 weeks and 6 days has been on the rise with increase in lower segment caesarian section (LSCS). These early term neonates have increased risk of developing respiratory distress syndrome, neonatal hyperbilirubinemia, transient tachypnoea, prolonged hospital stays, hypothermia, and feeding difficulty, when compared to a term neonate. An audit of early term neonatal short-term outcomes was undertaken at our institute.&#x0D; Methodology: A retrospective descriptive cross- sectional study was carried out between July 2020 and December 2020 at a private medical college Neonatal Intensive Care Unit. Neonates with a gestation age of 37 weeks and 0 days to 38 weeks and 6 days born were included.&#x0D; Results: A total of 137 early term delivery data were obtained. Hypothyroidism (23%) and gestational diabetes (23%) were found to be the most common associated antenatal problems. The most common morbidity out of 137 early term neonates was neonatal jaundice 91(66.4%) followed by respiratory distress which affected 38 (28%) neonates.&#x0D; Conclusion: This study establishes the high incidence of neonatal jaundice and respiratory morbidities in early term neonates. Hence it is better to avoid elective LSCS before 39 weeks of gestation provided there are no medical indications for the same.

Incidental findings on brain MR imaging of asymptomatic term neonates in the Developing Human Connectome Project.

BackgroundInterpretation of incidental findings on term neonatal MRI brain imaging can be challenging as there is a paucity of published normative data on asymptomatic term neonates. Reporting radiologists and clinicians need to be familiar with these incidental findings to avoid over-investigation and misinterpretation particularly in relation to neurodevelopmental outcome. This study aimed to determine the prevalence of incidental findings in a large group of asymptomatic term neonates participating in the Developing Human Connectome Project (dHCP) who were invited for neurodevelopmental assessment at 18 months.MethodsWe retrospectively reviewed MRI brain scans performed on 500 term neonates enrolled in the dHCP study between 2015 and 2019 with normal clinical examination. We reviewed the results of the Bayley Scales of Infant and Toddler Development (Bayley III) applied to participants who attended for neurodevelopmental follow-up at 18 months. Scores considered “delayed” if <70 on language, cognitive or motor scales.FindingsIncidental findings were observed in 47% of term infants. Acute cerebral infarcts were incidentally noted in five neonates (1%). More common incidental findings included punctate white matter lesions (PWMLs) (12%) and caudothalamic subependymal cysts (10%). The most frequent incidental finding was intracranial haemorrhage (25%), particularly subdural haemorrhage (SDH). SDH and PWMLs were more common in infants delivered with ventouse-assistance versus other delivery methods.Neurodevelopmental results were available on 386/500 (77%). 14 infants had a language score < 70 (2 SD below the mean). Of the 386 infants with neurodevelopmental follow up at 18 months, group differences in motor and language scores between infants with and without incidental findings were not significant (p = 0·17 and p = 0·97 respectively). Group differences in cognitive scores at 18 months between infants with (median (interquartile range) -100 (95–105)) and without (100 (95–110)) incidental findings were of small effect size to suggest clinical significance (Cliff's d = 0·15; p<0·05).InterpretationIncidental findings are relatively common on brain MRI in asymptomatic term neonates, majority are clinically insignificant with normal neurodevelopment at 18 months.FundingThis work was supported by the European Research Council under the European Union's Seventh Framework Programme (FP7/20072013/ERC grant agreement no. [319456] dHCP project), by core funding from the Wellcome/EPSRC Centre for Medical Engineering [WT203148/Z/16/Z] and by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas’ NHS Foundation Trust and King's College London and/or the NIHR Clinical Research Facility. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

403 Parity adjusted term neonatal growth chart modifies neonatal morbidities and mortality risk stratification

To investigate the impact of parity-customized (CUST) and population-based (POP) birth weight charts on the identification of neonatal risk for adverse outcome in small (SGA) - or large (LGA) birth weight as compared to the appropriate for gestational age (AGA). Data for this observational, retrospective, cohort study was obtained from electronic medical charts for births at a single center in 2006–2017. Singleton, live, term neonates born to mothers with no background disease were included. Neonates were categorized as SGA, LGA or AGA, with the 10th and 90th percentiles as boundaries in a standard population-based model adjusted for gender only and a customized model adjusted for gender and parity. A multivariable logistic regression model was applied to investigate the risk of a neonatal composite adverse outcome for subgroups defined as LGA or SGA according to one model but not the other. A 132,815 neonates met inclusion criteria. The customized model defined 53% more neonates as SGA compared to the population-based model. Neonates defined as SGA by the customized model but not by the population-based model (SGA CUST) had significantly higher rates of morbidity and mortality compared to those with normal birth weight (OR=1.33 95%CI [1.16–1.53]; p<0.0001). The customized and population-base models defined comparable groups of neonates as LGA. Those defined as LGA by the customized model and AGA by the population-based model (LGA-CUST) had significantly higher risk for morbidity compared to AGA neonates. (OR=1.36 95%CI [1.09–1.71]; p=0.007). Neonatal mortality occurred solely in the SGA groups. Both groups of LGA had a significantly higher risk for shoulder dystocia The application of a parity-customized birth weight chart in a high-parity population of singleton, term neonates may become a simple platform to better identify neonates with a significant high risk for morbidity and mortality.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Platelet count and function in umbilical cord blood versus peripheral blood in term neonates

Platelet function in neonates is sparsely investigated. The majority of previous studies investigated platelets in umbilical cord (UC) blood rather than in peripheral blood. We included 20 term neonates and sampled UC blood and peripheral blood within 20 min and 24 h after birth. Platelet count and mean platelet volume (MPV) were measured. Platelet surface glycoproteins (GP) and platelet activation (bound fibrinogen, CD63 and p-selectin) after agonist stimulation were examined by flow cytometry. Platelet aggregation was evaluated by impedance aggregometry. The significance level was set after Bonferroni correction. Platelet count and MPV did not differ between UC and peripheral blood (p-values >0.08). Expression of platelet surface GP was similar in UC and peripheral blood (all p-values >0.02). Platelet activation was lower in UC blood than in peripheral blood for bound fibrinogen (four out of eight p-values <0.001) but did not differ for CD63 (all p-values >0.01) or P-selectin (all p-values >0.01). Platelet aggregation was significantly higher in UC than in peripheral blood (p-values <0.001). In conclusion, platelet count, MPV and expression of platelet surface GP measured in term neonatal UC blood represented that of peripheral blood. Platelet activation and aggregation in UC blood did not reflect that of peripheral blood.

Anticoagulation in preterm and term neonates: Why are they special?

The preterm and term neonatal population is most at risk for thrombotic complications in pediatrics. Among various treatment modalities, anticoagulation is primarily used in the management of thrombosis. Developmental differences in preterm and term infants compared to older infants and children and limitations of anticoagulation agents currently used are important considerations for treatment. Additionally, dosages and durations of anticoagulant treatment are widely variable across countries. This article will highlight the differences in anticoagulation in neonates compared to other populations due to developmental hemostatic changes, epidemiology of neonatal thrombosis, pharmacokinetic and pharmacodynamic properties of drugs used and presence of neonatal co-morbidities.

1099: Individualized Neonatal Jaundice Prediction Score: “tandem” approach of machine learning algorithm complemented by traditional statistics

Jaundice is the most common cause of readmission for term neonates. We aimed to evaluate the use of a novel combined technique to predict an early individualized probability score for term neonatal jaundice (NJ), in a large heterogeneous population. We used a machine learning algorithm (gradient boosting model - GBM), including multiple unselected clinical and laboratory data available prior and during birth to predict an individualized probability score for NJ in a single center; 2005-2018. Model accuracy was evaluated by ROC Curve (AUC) ;10-fold cross validation. Next, multivariable logistic models were applied to check for significance, magnitude and direction of the associations identified by the GBM algorithm. We identified 147,667 consecutive term live neonates delivered vaginally; 6,093 (4.12%) diagnosed with NJ. GBM AUC to predict NJ was 0.76±0.03 (Fig). The most important features used by the GBM (in order of importance/weight): maternal blood type, gestational age at delivery, duration of labor, BW, maternal age, maternal blood pressure and CBC at admission. Next, we fitted multivariable regression models. We identified within the “blood group”, that maternal blood type O (- and +) was independently and significantly associated with an increased rate of NJ; OR=5.13 95% CI [4.77-5.52]; P< 0.0001. Markedly, an additional model based on the same algorithm and applied on a subgroup of very low risk population for NJ (excluded known risks factors for NJ; SGA, hypertensive disorders, previous cesarean, induction of labor; n=62,756) strengthened even more the association between maternal blood type O and NJ: OR=8.88 95% CI [7.7-10.2]; p< 0.0001. AUC=0.75 95% CI [0.74-0.76] (Table). We present a novel implementation of the GBM algorithm that achieved high accuracy in early prediction of term NJ. This model, using features routinely measured before and during labor, without need for neonatal blood bilirubin level, can identify neonates with high risk for NJ ; potentially alleviating the need for the routine bilirubin test while maintaining low readmission rates.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Study on risk factors of respiratory distress syndrome in term neonates: a retrospective case-control study

Background: Respiratory distress syndrome (RDS) is one of the most common causes of neonatal respiratory failure and neonatal death. It is more common in preterm neonates but also been found in term and late preterm neonates. This study aims at studying the risk factors for developing RDS in term neonates. Objectives was to study the maternal and perinatal risk factors for RDS in term neonates.Methods: This is a retrospective case control study conducted in neonatal intensive care unit of tertiary care centre. A total of 100 term neonates with RDS were taken as cases and 150 normal term neonates were taken as control. Data were collected from the hospital NICU records, maternal and neonatal history was taken. The χ2 tests or Fisher’s exact text were used for one-way risk factor analysis. The effects of multiple factors on term neonatal RDS were analyzed using logistic regression analysis.Results: In our study RDS in term neonates was significantly associated with following risk factors like selective cesarean section, male sex, SGA, oligohydramnios, MSAF, severe fetal distress, birth asphyxia, PROM, and maternal-fetal infection. Among the significant risk factors severe birth asphyxia, maternal-fetal infection, PROM, MSAF were showing positive association with RDS in full-term neonates.Conclusions: Several high-risk factors such as severe birth asphyxia, maternal-fetal infection, PROM, and MSAF were closely correlated with full-term neonatal RDS. Hence these could provide a significant reference for the diagnosis and treatment of term neonatal RDS.

Unexpected term NICU admissions: a marker of obstetrical care quality?

Unexpected admissions of term neonates to the neonatal intensive care unit and unexpected postnatal complications have been proposed as neonatal-focused quality metrics for intrapartum care. Previous studies have noted significant variation in overall hospital neonatal intensive care unit admission rates; however, little is known about the influence of obstetric practices on these rates or whether variation among unanticipated admissions in low-risk, term neonates can be attributed to systemic hospital practices. The objective of the study was to examine the relative effects of patient characteristics and intrapartum events on unexpected neonatal intensive care unit admissions and to quantify the between-hospital variation in neonatal intensive care unit admission rates among this group of neonates. We performed a retrospective cross-sectional study using data collected as part of the Consortium for Safe Labor study. Women who delivered term (≥37 weeks), singleton, nonanomalous, liveborn infants without an a priori risk for neonatal intensive care unit admission were included. The primary outcome was neonatal intensive care unit admission among this population. Multilevel mixed-effect models were used to calculate adjusted odds ratios for demographics (age, race, insurer), pregnancy characteristics (parity, gestational age, tobacco use, birthweight), maternal comorbidities (chronic and pregnancy-induced hypertension), hospital characteristics (delivery volume, hospital and neonatal intensive care unit level, academic affiliation), and intrapartum events (prolonged second stage, induction of labor, trial of labor after cesarean delivery, chorioamnionitis, meconium-stained amniotic fluid, and abruption). Intraclass correlation coefficients were used to estimate the between-hospital variance in a series of hierarchical models. Of the 143,951 infants meeting all patient and hospital inclusion criteria, 7995 (5.6%) were admitted to the neonatal intensive care unit after birth. In the fully adjusted model, the factors associated with the highest odds for neonatal intensive care unit admission included: nulliparity (adjusted odds ratio, 1.62 [95% confidence interval, 1.53-1.71]), large for gestational age (adjusted odds ratio, 1.59 [95% confidence interval, 1.47-1.71]), and small for gestational age (adjusted odds ratio, 1.60 [95% confidence interval, 1.47-1.73]). Induction of labor (adjusted odds ratio, 0.95 [95% confidence interval, 0.89-1.01]) was not associated with increased odds of neonatal intensive care unit admission compared with women who labored spontaneously. The events associated with higher odds of neonatal intensive care unit admission included: prolonged second stage (adjusted odds ratio, 1.66 [95% confidence interval, 1.51-1.83]); chorioamnionitis (adjusted odds ratio, 3.89 [95% confidence interval, 3.42-4.44]), meconium-stained amniotic fluid (adjusted odds ratio, 1.96 [95% confidence interval, 1.82-2.10]), and abruption (adjusted odds ratio, 2.64 [95% confidence interval, 2.16-.21]). Compared with women who did not labor, the odds of neonatal intensive care unit admission were lower for women who labored: adjusted odds ratio, 0.48 (95% confidence interval, 0.45-0.52) for women with no uterine scar and adjusted odds ratio, 0.83 (95% confidence interval, 0.73-0.94) for women with a uterine scar. There was significant variation in neonatal intensive care unit admission rates by hospital, ranging from 2.9% to 11.2%. After accounting for case mix and hospital characteristics, the between-hospital variance was 1.9%, suggesting that little of the variation was explained by the effect of the hospital. This study contributes to the currently limited understanding of term, neonatal intensive care unit admission rates as a marker of obstetrical care quality. We demonstrated that significant variation exists in hospital unexpected neonatal intensive care unit admission rates and that certain intrapartum events are associated with an increased risk for neonatal intensive care unit admission after delivery. However, the between-hospital variation was low. Unmeasured confounders and extrinsic factors, such as neonatal intensive care unit bed availability, may limit the ability of unexpected term neonatal intensive care unit admissions to meaningfully reflect obstetrical care quality.

Neonatal outcome of term deliveries in Sri Lanka

Major proportion (40-70%) of neonatal mortality is among ‘term neonates’. Even though, information on neonatal outcomes of term neonates is scarce. The high volume of term neonatal admissions to neonatal care units signify the importance of studying the neonatal outcomes among term neonates. The aim of this study is to describe the neonatal outcomes, of term neonates following term deliveries (37 completed weeks - 41 completed weeks and 6 days) at Teaching Hospital (TH) Kandy, Sri Lanka. A descriptive cross-sectional study was conducted to describe neonatal outcomes of term neonates before the initial hospital discharge point. A sample of 1,105 neonates, delivered at term were studied during the study period. Mean gestational age at delivery is 38.85 weeks and 41% of term neonates are delivered before completion of 39 weeks of Period of Amenorrhoea (POA). The mean birth weight of the term neo-nates is 2925.24 grams. Out of all term neonates, 15.84% (n=175) were admitted to Neonatal Care Unit (NCU) and 23.3% (n=257) had at least one diagnosed neonatal condition. The commonest neonatal condition was bacterial sepsis of newborn (n=138, 12.48%), followed by neonatal jaundice from other and unspecified causes (n=84, 7.6%), and respiratory distress of newborn (n=44, 3.94%). Median hospital stay of term neonates is 3 days. Majority of term neo-nates admitted to NCU are normal weight term neonates. Nearly one-fourth of term neonates had at least one diag-nosed neonatal condition. Prevention and control of infection from the time of birth to the time of discharge from the hospital should be given due attention to reducing bacterial sepsis among term neonates.South East Asia Journal of Public Health Vol.7(2) 2017: 34-39

Comparison between preterm and full term neonatal cord selenium in correlation to maternal serum selenium levels

BackgroundLower concentrations of selenium and glutathione peroxidase activities have been reported in pregnant women. An exposure to a high oxygen concentration at birth, an infection, inflammation, and a deficient antioxidant system make the newborn more susceptible to oxidative stress that can result in bronchopulmonary dysplasia, retinopathy of prematurity, persistent ductus arteriosus, necrotizing enterocolitis, intracranial hemorrhage, and hypoxic ischemic encephalopathy, especially in extremely low-birth-weight infants. AimThe current study aimed at the detection and comparison of maternal serum and neonatal umbilical cord selenium levels. MethodsA prospective study on 80 mothers and their healthy neonates (40 full term and 40 preterm) enrolled over the period from June to December 2016. Selenium concentrations were measured in the maternal serum and umbilical cord using a spectrophotometer. ResultsA significantly higher mean selenium level was detected in term neonates than preterm neonates (P = 0.015) with no gender difference but the difference in selenium concentration between their mothers was not significant. No significant relations found between maternal serum selenium levels and maternal age, weight, height, BMI or pregnancy weeks. The maternal serum selenium was positively correlated with the cord selenium in full-term group (r = 0.59 & P = 0.006). Significantly positive correlations between umbilical cord selenium levels in both full-term and preterm neonates with their gestational age and birth weight. ConclusionThis study indicated that cord Se concentration was different in term and preterm neonates being higher in full terms, so we recommend selenium supplementation to preterm neonates and their mothers to avoid sequelae of selenium deficiency on their health and to reach the levels obtained in full term neonates.

Imaging the term neonatal brain

Brain imaging is important for the diagnosis and management of sick term neonates. Although ultrasound and computed tomography may provide some information, magnetic resonance imaging is now the brain imaging modality of choice because it is the most sensitive technique for detecting and quantifying brain abnormalities and does not expose infants to radiation. This statement describes the principles, roles and limitations of these three imaging modalities and makes recommendations for appropriate use in term neonates. The primary focus is the brain of term infants with neonatal encephalopathy, many of whom are diagnosed with hypoxic-ischemic encephalopathy.

CD71+ erythroid cells from neonates born to women with preterm labor regulate cytokine and cellular responses.

Neonatal CD71+ erythroid cells are thought to have immunosuppressive functions. Recently, we demonstrated that CD71+ erythroid cells from neonates born to women who underwent spontaneous preterm labor (PTL) are reduced to levels similar to those of term neonates; yet, their functional properties are unknown. Herein, we investigated the functionality of CD71+ erythroid cells from neonates born to women who underwent spontaneous preterm or term labor. CD71+ erythroid cells from neonates born to women who underwent PTL displayed a similar mRNA profile to that of those from term neonates. The direct contact between preterm or term neonatal CD71+ erythroid cells and maternal mononuclear immune cells, but not soluble products from these cells, induced the release of proinflammatory cytokines and a reduction in the release of TGF-β. Moreover, PTL-derived neonatal CD71+ erythroid cells (1) modestly altered CD8+ T cell activation; (2) inhibited conventional CD4+ and CD8+ T-cell expansion; (3) suppressed the expansion of CD8+ regulatory T cells; (4) regulated cytokine responses mounted by myeloid cells in the presence of a microbial product; and (5) indirectly modulated T-cell cytokine responses. In conclusion, neonatal CD71+ erythroid cells regulate neonatal T-cell and myeloid responses and their direct contact with maternal mononuclear cells induces a proinflammatory response. These findings provide insight into the biology of neonatal CD71+ erythroid cells during the physiologic and pathologic processes of labor.