Term Newborn Infants Research Articles

Tear Film Volume and Protein Analysis in Full-term Newborn Infants

To investigate infant tear film secretion and protein profile, and to compare major tear proteins, such as immunoglobulin A, lactoferrin, and lysozyme, with those of adult controls. Tears were collected, with a cellulose rod, from 40 healthy infants (19 female infants and 21 male infants, gestational duration: 39.71 ± 1.27 weeks) within 48 hours of birth and 22 adults (10 female infants and 12 male infants, mean age: 24.95 ± 3.63 years). A second collection was obtained from 14 of the infants (8 female infants and 6 male infants, postnatal age: 7.76 ± 6.14 weeks). The tear volume was measured, and protein in the samples was analyzed by Bradford assay and gel electrophoresis. Median tear volume (interquartile range) was 0.5 μL (0.6-2 μL) for newborn infants, 2.5 μL (1.4-7.75 μL) for these infants at an older age, and 6 μL (2.73-12.75 μL) in adults (P < 0.001, Kruskall-Wallis test). Immunoglobulin A concentration was significantly lower in newborns (P < 0.001, analysis of variance). Lipocalin was present in 36% of the newborn tear samples, whereas serum albumin was found in 86%. Mean protein concentration (μg/μL ± SD) was 10.95 ± 5.51 in the newborns, 12.93 ± 3.99 in the older infants, and 13.04 ± 3.46 in the adults (P > 0.5, analysis of variance). This is the first study reporting an investigation of unstimulated infant tears, using a noninvasive collection method. Tear protein content demonstrated that the infant tear film is different to that in adults.

Perspective on Neonatal Hyperbilirubinemia

Jaundice in newborns provides a different response from the parents whencompared to jaundice in older children and adults. Physiologic hyperbilirubinemia occurs commonly in term newborn infants in the absence of any underlying pathologic cause. Yet, the jaundice itself is commonly regarded as a problem in the transition to extrauterine life.In Neonatal hyperbilirubinemia (NHB) the total bilirubin level is greater than 15mg/dL in 15 day or less old neonates and 2mg/dL in neonates above 15 days of age. Estimation of total bilirubin is preferred in the routine analyses for NHB compared to measurement of direct bilirubin. If certain conditions like sepsis, hepatic infections and other liver diseasesare present it may be prudent to use direct bilirubin measurement. Yet contrary to the usual assumption of pathology, there are several lines of evidence supporting an adaptive role for neonatal hyperbilirubinemia. First, experimental and clinical evidence indicate that neonatal enzyme systems are not yet mature at birth; bilirubin has been demonstrated toscavenge potentially toxic oxygen free radicals that in later life are removed by the mature antioxidant enzyme system. Second, presence of bilirubin in mammals, similar patterns of expression of neonatal hyperbilirubinemia in nonhuman primates, and significant interpopulation variation in newborn serum bilirubin levels among humans all suggest that bilirubin production, metabolism, and excretion are under genetic control. Therefore bilirubin metabolism and its understanding may help improve its diagnosis and prognosis.

Cerebral measurements made using cranial ultrasound in term Ugandan newborns

Background Few cUS studies of cerebral measurements are available for normal term infants. Normative data is important for evaluating cerebral structure size in symptomatic term infants and assessing preterm brain growth by term age. Objectives To (i) make linear measurements using cranial ultrasound (cUS) for major cerebral structures and intracranial spaces in normal newborn term infants, (ii) correlate these measurements with gestational age (GA), birth weight (BW), head circumference (HC), gender and within one infant (iii) examine inter/intra-observer variation, and (iv) compare these data with those currently available. Design, setting and patients Linear cUS measurements of major cerebral structures were made in well term-born Ugandan infants at Mulago University Hospital, Kampala. Correlations between the measurements and gender, HC, BW and GA were calculated. Intra- and inter-observer agreements were assessed. Results Data from 106 infants (mean GA 39.20 ± 1.4SD weeks) were analysed. Intra/inter-observer agreement was substantial/excellent. Significant correlations were found between HC and pons anterior–posterior diameter (p < 0.01), corpus callosal (CC) length (p = 0.02) and transverse cerebellar diameter (TCD, p < 0.01) and between BW and CC length (p = 0.02), vermis height (< 0.01) and thalamo-occipital distance (p = 0.03); no significant correlation was found with GA. Within infants CC length and TCD correlated significantly (p = 0.019). Males had larger left ventricular indices than females (p = 0.04). The data was similar to those from other populations. Conclusions These data provide reliable reference values for linear measurements of many cerebral structures made using cUS. The data agree well with those from other populations suggesting that cerebral size is similar in different ethnic groups.

Subcutaneous fat necrosis in newborn—an unusual case and review of literature

Subcutaneous fat necrosis (SCFN) of the newborn is an uncommon, self-limiting panniculitis mostly occurring within the first few weeks after birth. SCFN has been described mostly in term or post-term newborn infants in literature. We report a preterm infant developing extensive subcutaneous fat necrosis within the first week of life after significant perinatal hypoxic injury. The infant was conservatively managed for subcutaneous fat necrosis but developed hypercalcaemia and required prolonged medical treatment. Hypercalcaemia is a rare but serious complication of subcutaneous fat necrosis and needs prolonged follow-up. The etiopathogenesis of both subcutaneous fat necrosis in newborn and the resultant hypercalcaemia are poorly understood. Significant subcutaneous fat necrosis can develop in both preterm and term infants, and preterm infants also develop significant complications including hypercalcaemia.

High‐intensity phototherapy for the treatment of severe nonhaemolytic neonatal hyperbilirubinemia

To describe the clinical approach to term and near-term newborn infants with severe hyperbilirubinaemia and to analyse the effect of high-intensity phototherapy on total serum bilirubin (TSB) levels. We analysed a cohort of 116 newborn infants with severe nonhaemolytic hyperbilirubinaemia (TSB ≥20 mg/dL/342 μmol/L). All patients were treated with high-intensity phototherapy. The main outcomes were reduction in TSB levels in the first 24 h of phototherapy, incidence of exchange transfusion, pathological brainstem auditory evoked responses and pathological findings on neurological examination at discharge. The mean birth weight and gestational age were 3161±466 g and 37.8±1.6 weeks. Mean initial TSB concentration was 22.4±2.4 mg/dL. Per cent decreases in TSB after 2, 4, 6, 12, 18 and 24 h of phototherapy were 9.4%, 16%, 23%, 40%, 44% and 50%, respectively. No infant was treated with exchange transfusion. Brainstem evoked response audiometry (BAER) was performed in 100% of the patients, and in three of them, this examination was altered. However, when repeated 3 months later, these BAER examinations were normal. Neurological examination was normal in all patients. High-intensity phototherapy significantly reduces TSB in nonhaemolytic severe hyperbilirubinaemia and decreases the need for exchange transfusion.

Effects of Hydrocortisone on the Differentiation of Human T Helper 2 Cells

We investigated the effects of the neuroendocrine modulator hydrocortisone (HC) on Th2 differentiation of human naive CD4+ T cells with and without CD28 co-stimulation. Human naive CD4+ T cells were isolated and purified from umbilical cord blood mononuclear cells from full-term newborn infants. CD4+ T cells were treated with different concentrations of HC under Th0 or Th2 culture conditions. Th0 conditions included stimulation by immobilized monoclonal antibodies (mAbs) against CD3 and CD28; Th2 conditions were the same + rhIL-4. Parallel cultures excluded the CD28 mAb. Th1 (IL-2, INF-γ)- and Th2 (IL-4, IL-5)-type cytokines were quantified in culture supernatants by ELISA and within cells by flow cytometry. For both Th0 and Th2 culture conditions, HC significantly inhibited Th1 cytokines' release (IL-2 and INF-γ). For Th0 culture conditions, HC slightly increased IL-4 expression (Th2 cytokine). However, for Th2 culture conditions, HC inhibited the IL4-induced production of IL-4. Although the absolute cytokine amounts were decreased, absence of CD28 co-stimulation did not alter these 'trends'. Our findings indicate that HC can alter the Th1/Th2 balance by inhibiting the production of Th1-type cytokines. HC can also diminish the extensive Th2 differentiation induced by IL-4.

Baby Massage Ameliorates Neonatal Jaundice in Full-Term Newborn Infants

Neonatal jaundice is a common physiological problem affecting over half of all full term and most preterm infants. Thus, newborn infants must be monitored for signs of hyperbilirubinemia to prevent acute bilirubin encephalopathy or kernicterus. Evidence exists supporting the benefits of baby massage as a form of mild hand to skin contact, to increase neonatal physical and mental development. In the present study, the effects of gentle baby massage on neonatal jaundice in full term newborn infants were evaluated by a controlled clinical trial. The inclusion criteria of newborn neonates were as follows: (1) gestational age of 37-41 weeks, (2) birth weight of 2,800-3,600 g, (3) Apgar score at birth of 8-10, and (4) being a healthy neonate without neonatal asphyxia and hemolytic condition. Breastfed newborns without phototherapy were included: 20 in the massage group and 22 in the control group. We found the mean stool frequency of the massaged infants on day 1 and day 2 (4.6 and 4.3) was significantly higher than that of the control group (3.3 and 2.6) (p<0.05). The transcutaneous bilirubin levels on the second to fifth day and serum total bilirubin levels on fourth day were significantly decreased in the massage group, compared to the control group. In conclusion, baby massage at an early stage after birth could reduce neonatal bilirubin levels. We suggest baby massage is beneficial for ameliorating neonatal jaundice.

Hyperinsulinism associated with gestational exposure to bupropion in a newborn infant

This case report describes severe hyperinsulinism in a term newborn infant without typical perinatal risk factors for transient hyperinsulinism. The mother had received bupropion, an antidepressant and aid to smoking cessation, throughout pregnancy. The infant presented with profound hypoglycemia and seizures on the 3rd day of life. Laboratory investigation confirmed hyperinsulinism. Stable euglycemia could be achieved only after starting diazoxide. The infant was weaned from diazoxide by 10 weeks of age without recurrence of hypoglycemia, signifying the transient nature of hyperinsulinism. This is the first reported case of a potential association between maternal bupropion use during pregnancy and neonatal hyperinsulinism, and highlights the importance of close monitoring of similar infants.

The experience of new mothers who are separated from their newborn infants: a qualitative systematic review.

REVIEW OBJECTIVES/QUESTIONS: The objective of this review is to explore the experience of separation for mothers and their term newborn infants in order to understand the effect this has on the mother and infant couple. This knowledge will be used to enhance the care experience and minimise harm for mothers and infants when there is or has been an admission to special care nursery within 72 hours of birth. This review aims to answer the following specific question:What is the experience of mothers who are separated from their term infants within 72 hours of birth? INCLUSION CRITERIA Types of Participants This review will consider publications that include experiences of new mothers whose term infants were admitted to special care nursery within 72 hours of birth. Publications will not be excluded on the basis of mode of birth, parity or age of the women. Studies that include the experiences of women who have a condition that prevents their participation in the care of their baby will not be included in this study. Such conditions may require admission to adult intensive or critical care areas and would include severe obstetric haemorrhage, eclampsia or stroke. Infants that are premature (those born before 37 completed weeks) and those that have structural deformities such as clefts of the lip and palate, babies that are admitted to or have been admitted to NICU or maternal or neonatal conditions in which breastfeeding may be contraindicated (chemotherapy, radioactive treatments, HIV-Aids or neonatal gastro-intestinal deformities) will not be included in this review. Phenomena of interest: This qualitative review will consider studies that investigate mother’s experiences of separation on physiological, psychological and social factors when their term infants are admitted to special care nursery within 72 hours of birth. Babies are considered to be separated from their mothers when there is an alteration to the constant close presence of the infant remaining in the same room as the mother (rooming-in) from the time of birth and continuously during the postnatal stay. A second phenomenon of interest is the impact of this separation on the mode of feeding for these mothers and their infants.

A Dynamical System Analysis of the Development of Spontaneous Lower Extremity Movements in Newborn and Young Infants

This study's aim was to evaluate the characteristics of newborn and young infants' spontaneous lower extremity movements by using dynamical systems analysis. Participants were 8 healthy full-term newborn infants (3 boys, 5 girls, mean birth weight and gestational age were 3070.6 g and 39 weeks). A tri-axial accelerometer measured limb movement acceleration in 3-dimensional space. Movement acceleration signals were recorded during 200 s from just below the ankle when the infant was in an active alert state and lying supine (sampling rate 200 Hz). Data were analyzed linearly and nonlinearly. As a result, the optimal embedding dimension showed more than 5 at all times. Time dependent changes started at 6 or 7, and over the next four months decreased to 5 and from 6 months old, increased. The maximal Lyapnov exponent was positive for all segments. The mutual information is at its greatest range at 0 months. Between 3 and 4 months the range in results is narrowest and lowest in value. The mean coefficient of correlation for the x-axis component was negative and y-axis component changed to a positive value between 1 month old and 4 months old. Nonlinear time series analysis suggested that newborn and young infants' spontaneous lower extremity movements are characterized by a nonlinear chaotic dynamics with 5 to 7 embedding dimensions. Developmental changes of an optimal embedding dimension showed a U-shaped phenomenon. In addition, the maximal Lyapnov exponents were positive for all segments (0.79-2.99). Infants' spontaneous movement involves chaotic dynamic systems that are capable of generating voluntary skill movements.

Human Neonatal Neutrophils Are Resistant to Apoptosis with Lower Caspase-3 Activity

The incidence of neonatal inflammatory diseases remains high despite improved strategies for dealing with infection. Neutrophils are believed to play a significant role in neonatal inflammatory diseases due to their secretion of harmful mediators. Neutrophils rapidly undergo apoptosis following activation; dysregulation of the neutrophil apoptotic pathway may be an underlying mechanism of neonatal inflammatory disorders. In this study, we determined whether neonatal neutrophils are intrinsically resistant to apoptosis relative to their adult counterparts. Twelve healthy full-term newborn infants and 12 healthy adult volunteers, aged 20 to 45 years, were enrolled in this study. Neutrophils were isolated from umbilical cord blood or fresh venous peripheral blood, and neutrophils of each subject were cultured for up to 48 hours. Flow cytometric analysis revealed that spontaneous apoptosis of adult neutrophils increased with culture time (23% ± 2% at 12 h, 49% ± 4% at 24 h and 76% ± 3% at 48 h), whereas the frequency of apoptosis was significantly lower in neutrophils from neonates (9% ± 2% at 12 h, 30% ± 4% at 24 h and 49% ± 3% at 48 h) (p < 0.01 for each time point). Importantly, the expression levels of caspase-3 mRNA and a precursor form of caspase-3 protein were lower in neonatal neutrophils than adult neutrophils, as judged by RT-PCR and Western blot analyses. Moreover, caspase-3 activity was lower in neonatal neutrophils, compared to adult neutrophils. These findings suggest that neonatal neutrophils are intrinsically apoptosis-resistant, which may be due to the low expression of caspase-3.

Selectively High Level of Serum Interleukin 5 in a Newborn Infant With Cow's Milk Allergy

Cow's milk allergy (CMA) in the neonatal period is thought to include several clinical conditions, yet the pathophysiology remains unclear. We report here the case of a term newborn infant who showed hematochezia 36 hours after the first feeding with cow's milk formula. His serum immunoglobulin E levels were not elevated, although eosinophils were detected in the stool. Elimination of cow's milk formula resolved the symptoms, and from the clinical course and laboratory data the infant was diagnosed with CMA. The serum interleukin 5 (IL-5) (125 pg/mL) level in this patient was selectively elevated. However, serum levels of other T-helper 2 (Th2) cytokines (including IL-4 and IL-13), Th1 cytokines (including interferon γ), and proinflammatory cytokines (including tumor necrosis factor α) were not elevated. These findings suggest that, for this patient, IL-5 and eosinophils might have played a role in the development of neonatal CMA. Although this finding is reported from only 1 case, it highlights the need for serum IL-5 to be determined in more neonatal patients with CMA to further clarify the pathophysiology of this condition in the neonatal period.

Effect of Antenatal Corticosteroid Treatment on Lung Function in Full-Term Newborn Infants

Background: Antenatal treatment of pregnant women with corticosteroids in order to stimulate surfactant production has been shown to be effective. However, lung structure is also affected by the treatment. Objective: We tested the hypothesis that changes within lung acini, induced by maternal corticosteroid treatment, persist during lung development. Methods: Twenty-two healthy infants, whose mothers were treated with up to three doses of betamethasone at 25–33 weeks of pregnancy because of preterm labour, but where labour terminated and the infants were born at term, were studied at term and compared to a group of 50 healthy newborn infants without prenatal treatment with corticosteroids. Gas-mixing efficiency was measured in terms of moment ratio with a nitrogen washout method together with functional residual capacity. Mechanical parameters were assessed with the single occlusion technique. Results: There were no signs of disturbed gas mixing or changed lung volume or mechanics in the treated group. Conclusion: The result contributes to an emerging body of evidence that antenatal treatment with corticosteroids does not permanently affect lung structure or function.

Effects on Anti-Human Platelet Antigen 1 (HPA-1a) Antibodies on Neonatal Megakaryocytopoiesis

AbstractAbstract 551 Background:Neonatal alloimmune thrombocytopenia (NAIT) is the most common cause of severe thrombocytopenia and of intracranial hemorrhage (ICH) in term newborn infants. NAIT is caused by fetomaternal incompatibility in one of the platelet-specific surface antigens, and is mediated by maternally produced antibodies against the fetal antigen. The platelet antigen most commonly involved is human platelet antigen-1 (HPA-1, also known as PLA-1), which is responsible for approximately 75% of cases. While the mechanisms underlying the thrombocytopenia in fetuses and neonates have not been thoroughly studied, it is widely accepted that it is predominantly due to antibody-mediated platelet destruction. However, in adults with immune thrombocytopenic purpura (ITP), studies have shown that the anti-platelet antibodies also act by suppressing megakaryocyte (MK) proliferation and maturation, which contributes to the thrombocytopenia. Objective:This study was designed to test the hypothesis that anti-HPA-1 antibodies would affect MK proliferation and maturation, in a manner similar to anti-platelet antibodies in ITP. Methods:To test this hypothesis, we obtained serum samples from pregnant women known to have anti-HPA-1a antibodies and a history of previously affected pregnancies (NAIT sera; n=5), and from healthy pregnant women without anti-HPA-1 antibodies (control sera; n=2). We then obtained cord blood samples from healthy full-term infants delivered by elective C-section, and isolated CD34+ cells from HPA-1a/1a (PLA-1 positive) samples. These CD34+ cells (>90% purity) were then cultured in a liquid culture system, in the presence of thrombopoietin and 10% NAIT or control serum. To avoid any potential confounding effects from anti-A or anti-B antibodies on megakaryocytopoiesis, only blood type O cord blood samples were used for this study. The number of cells in each culture was quantified on days 7, 11, and 14. At the end of the culture period (day 14), the percentage of MKs (CD41+ cells) and their maturational status were evaluated by flow cytometry, using CD42b (GPIb alpha) expression as a marker of mature MKs. Results:These studies revealed a significant reduction in the number of cells generated in the presence of NAIT compared to control sera on days 7, 11, and 14 of culture (approximately 40% of control counts at all time points). This finding was associated with an increased percentage of dead cells (by trypan blue exclusion assay) in NAIT vs. control cultures, particularly on day 7 (19.4±3.1% vs. 12.2±5.3% dead cells; p=0.03) and day 11 of culture (12.8±1.3 vs. 6.5±2.0% dead cells; p=0.002). At the end of the culture period, there were no significant differences in the percentages of MKs between NAIT and control cultures (94.3±0.7% vs. 95.2±0.7% CD41+ cells, respectively). In regard to the maturational level, only one of the five NAIT sera induced a reduction in the percentage of CD42b+ MKs (to 83%), which was also associated with the strongest reduction in cell number. All other NAIT serum samples did not affect MK maturation, as evidenced by a percentage of CD42b+ MKs similar to that in control cultures (93.7±0.6% vs. 94.2±0.25% in NAIT vs. control cultures, respectively). Given the combination of reduced cell number and increased cell death in the NAIT cultures, we then evaluated the rate of apoptosis (by TUNEL assay) and proliferation (using Ki67 as a marker of proliferation) in two additional NAIT and two control cultures. In these experiments, the percentage of cells undergoing apoptosis was approximately 2-fold higher in NAIT compared to control cultures, on both day 7 and day 11 of culture, while there were no significant differences in Ki67 expression. Conclusions:In conclusion, our studies indicate that human serum containing anti-HPA-1 antibodies reduces the number of MKs generated in culture, without affecting MK differentiation. Preliminary studies suggest that the decreased number of MKs is associated with increased apoptosis. Additional studies are in progress to establish the specific mechanisms underlying these observations. Disclosures:Bussel:Portola: Consultancy; Eisai: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; GlaxoSmithKline: Consultancy, Equity Ownership, Research Funding, Speakers Bureau; Amgen Inc.: Equity Ownership, Research Funding, Speakers Bureau; Cangene: Research Funding; Genzyme: Research Funding; Immunomedics: Research Funding; Ligand: Research Funding, Speakers Bureau; Shionogi: Research Funding, Speakers Bureau; Sysmex: Research Funding.

Newborn Infant Pain Assessment Using Heart Rate Variability Analysis

Systems controlling cardiovascular function are closely coupled with the perception of pain. Heart rate variability (HRV) is a well-established noninvasive measure of cardiac autonomic control. We hypothesized that pain may alter HRV in the newborn infant and that HRV analysis could be used as an indicator of prolonged pain in the newborn infant. To test the hypothesis, we measured the magnitude of the heart rate high-frequency variations using an innovative High Frequency Variability Index (HFVI) in newborn infants at risk of postoperative pain. We investigated newborn infants with a gestational age (GA) more than 34 weeks, and who were admitted after a major surgical procedure. Inclusions ranged from 2 to 72 hours after the surgery. The postoperative pain was scored using EDIN scale (neonatal pain and discomfort scale) at the end of the 2 hours recording period. The infants were separated in: (1) Group "Low EDIN," when EDIN<5; and (2) Group "High EDIN," when EDIN >=5. Predictive positive and negative values of a threshold value of HFVI in assessing pain have been studied. Twenty-eight newborn infants were enrolled in the study (mean GA=37.8+/-1.5 wk) at a median delay between the surgery and the recording of 5 hours. Mean EDIN were 2+/-1 and 7+/-2 in respectively the groups "Low EDIN" and "High EDIN." The 2 groups were similar for GA, basal heart and respiratory rates, SpO2, mean arterial blood pressure, and morphine infusion rate. HFVI was significantly lower in the group "High EDIN" than in the group "Low EDIN" (0.7+/-0.2 vs. 1.2+/-0.3, respectively; P<0.01). An HFVI <0.9 was able to predict an EDIN score >=5, with a sensitivity of 90%, and a specificity of 75%. The results of this study indicate that postoperative pain is associated with a decreased high-frequency HRV in full-term newborn infants. Our findings suggest that HRV could be used as an indicator to assess prolonged pain in the newborn infants.

88 Expression of αEnac in Airways Correlates with Endogenous Cortisol in Newborn Term Infants

Objective: Reabsorption of lung fluid is critical for the adaptation of the newborn infant. Defective reabsorption may result in transient tachypnea of the newborn or contribute to respiratory distress syndrome. Perinatally, epithelial sodium channel (ENaC) is crucial for lung fluid reabsorption. ENaC is composed of 3 homologous subunits, the α-subunit being indispensable to ENaC function. Exogenous glucocorticoids (GC) regulate ENaC gene expression, but little is known whether an association exists between endogenous cortisol and ENaC. Subjects and methods: 69 term infants delivered vaginally (n=22) or by elective cesarean section (CS) (n=47) were included. We collected cord blood and saliva for cortisol analyzes with ELISA. Airway epithelium ENaC mRNA was quantified with real-time RT-PCR and normalized to cytokeratin 18 (CK18). Saliva and airway epithelial sampling was performed < 3h, 24 ± 5 and 48 ± 8 h postnatally. In a subset of infants delivered by elective CS (n = 26) first airway samples were obtained < 30 min postnatally. Results: αENaC mRNA < 30 min postnatally correlated with cord cortisol; r = 0.64, p = 0.001 (n=22). Adjusted for GA the correlation remained significant; r = 0.59, p = 0.005. At < 3h postnatally αENaC correlated with salivary cortisol; r = 0.52, p = 0.004 (n=29). Conclusion: Cortisol seems to be an important physiologic regulator of ENaC expression at birth. Our finding suggests that lung fluid transport may respond to GC even in the term infant. This underlines the potentials of regulation of perinatal lung fluid reabsorption by GC.

852 Under Agarose Migration Assay - a Method to Study Graded Chemotactic Activity of Leukocytes in Newborn Infants

Background: Preterm newborn infants are at risk of developing chronic inflammation and tissue injury in their lungs and CNS due to prolonged and exaggerated accumulation of leukocytes.Aim: To study migration of leukocytes from newborn infants with a modified under agarose cell migration assay.Methods: Blood was collected from healthy adults (n=9) and from healthy, term newborn infants (umbilical cord; caesarean section; spinal anaesthesia; n=9). Isolated leukocytes were added to outer wells and chemoattractants to central wells. Gels were incubated for 2 hours whereby only polymorphonuclear (PMN) leukocytes migrated. Dose responses of intermediate (n=4; IL-8) and end-target (n=5; fMLP) chemoattractants were tested on PMN.Results: Similar dose response curves of PMN migration to gradients of IL-8 and fMLP were observed in newborn infants as in adults, but with less PMN migrating with newborns than with adults. The PMN leukocyte migration per distance in newborns was 80% of adults with IL-8, and >90% of adults with fMLP. There was a high linear correlation between the number of PMN and the distance of migration irrespective of chemoattractant studied (IL-8: r=0.85 and r=0.65 respectively for newborns and adults; p< 0.001 for both) (fMLP: r=0.76 and r=0.87; p< 0.001). The pattern of migration differed between fMLP and IL-8.Conclusion: Similar graded chemotaxis of PMN was observed with under agarose cell migration assay in newborn infants as in adults, making this an attractive method for functional clinical studies of leukocytes in newborn infants during different stages of maturity and disease.

Analgesic Effects of Sweet-Tasting Solutions for Infants: Current State of Equipoise

The goal was to review published studies of analgesic effects of sweet solutions, to ascertain areas with sufficient evidence of effectiveness and areas of uncertainty. Databases searched included Medline, Embase, the Cumulative Index to Nursing and Allied Health Literature database, and PsycINFO, using the terms pain*, infant*, neonat*, newborn*, sucrose, glucose, and alternative sugars. Publications were sorted according to type, year, painful procedure studied, placebo/no-treatment groups, population studied, and country of publication. A total of 298 relevant unique publications involving human infants were identified; 125 (42%) were primary research studies, of which 116 (93%) were randomized controlled trials. Healthy preterm or term newborns were included in 82 studies (65%), and sick or very low birth weight infants were included in 22 (18%). Most studies included single episodes of painful procedures, with only 3 (2%) conducted over long periods. Procedures investigated most frequently were heel lance (49%), venipuncture (14%), and intramuscular injection (14%). Placebo or no-treatment groups were included in 111 studies (89%); in 103 (93%) of those studies, sweet solutions reduced behavioral responses, compared with placebo/ no treatment. Clinical equipoise relating to analgesic effects of sweet solutions no longer exists for single episodes of procedures for healthy preterm and term newborn infants. Uncertainties include outcomes after prolonged use of sweet solutions, concomitant use of other analgesics, and effectiveness beyond the newborn period. Future research should focus on addressing these knowledge and research gaps.

347 Brain Tissue Oxygenation in Very Low Birth Weigth Infants (VLBWI) Immediately After Delivery During Resuscitation Using Sustained Inflations

Background: Near-Infrared Spectroscopy (NIRS) has been used to study cerebral oxygenation during various conditions in the NICU. However, essentially no information is available on brain tissue oxygenation in VLBWI immediately after delivery. Objective: To study the timely relationship of brain tissue oxygenation (Sto2) as measured by NIRS in VLBWI immediately after delivery. Methods: A Foresight laser diod NIRS device was attached to the head of 14 VLBWI (GA 28.2±3.1 wks, BW 907±301 g) immediately after delivery. Preductal arterial oxygenation (Spo2) was measured using pulse oxymetry and infants were exposed to CPAP 5 cmH2o, an initial Fio2 = 0.40 and a sustained inflation (15 s) with a pressure of 20 cmH2o. Depending on the response of the heart rate and Spo2 a second inflation with 25 cmH2o and a third inflation with 30 cmH2o was allowed. Fio2 was adjusted according to pulse oximetry readings and was increased to 1.0 if heart rate did not increase within one minute. Thereafter, infants were supported with nasal IMV. Results: Heart rate, preductal Spo2, Sto2 during the first 6 minutes of life are given in the graph (medians, lower and upper quartiles). Figure Conclusions: Sto2 monitoring is feasible in VLBWI immediately after delivery. Sto2 values are lower immediately after delivery as compared to reference values obtained from healthy full-term newborn infants (Fauchere et al. J. Pediatr 2010) and remain low for the first minute of life to raise slowly with increasing heart rate.

612 Myocardial Performance Index (TEI Index) in Term Neonates-Preliminary Study

Background: To define age-related changes in left and right ventricular function using myocardial performance index (Tei Index) in healthy term newborn infants. Materials and Methods: 9 newborn infants were selected from normal full-term healthy neonates with gestational age 38-42 weeks, mean birth weight 3572 g (min. 2870, max. 4160 g). The Tei Index is a Doppler myocardial performance tool which can be used to evaluate of systolic and diastolic function. The first measurement was taken as soon as possible after birth, the second one was taken on day 3 of life. Results: The higher Tei index were obtained in the right ventricle (mean value - 0,44; SD +/-;0,11) then the left ventricle (mean value - 0,31; SD +/-;0,07) in the first day of life. In the left ventricle the Tei index were converted during the first three days of life (from mean value 0,31 to 0,37), and we observed the convertion in the right ventricle too between the first and the third day of life (mean value 0,44- day 1 to 0,26 -day 3). Conclusion: In neonates, the diastolic and systolic fuction of the right ventricle were higher then those measured in the left ventricle during the first day of life and this ratio changing in the third day of life. Higher mean value Tei index in the right ventricle might be reflecting the “persistent” fetal status of this ventricle in the first day of life. Further investigations are needed in a greater population of neonates. (granted MZiNSW nr NN407414336).