Term Newborn Infants Research Articles

Cardiovascular Drug Therapy for Human Newborn: Review of Pharmacodynamic Data.

Circulatory failure in preterm and term newborn infants is commonly treated with inotropes or vasoactive medications. In this structured literature review, the available data on pharmacodynamic effects of the inotropes adrenaline, dobutamine, dopamine, levosimendan, milrinone, noradrenaline, and the vasoactive drugs vasopressin and hydrocortisone are presented. Structured searches were conducted to identify relevant articles according to pre-defined inclusion criteria which were human clinical trials published after 2000. Out of 101 identified eligible studies only 22 studies met the criteria for evidence based practice guidelines level I to IV. The most prevalent pharmacodynamic effects were increase in blood pressure and/or heart rate, which were also the most frequently studied circulatory parameters. This review demonstrates the need for further systematic studies on all reviewed drugs with incorporation of novel non-invasive biomarkers in this vulnerable patient group, for more timely and appropriate treatment for clinical efficacy.

Knowledge and health-seeking practices of mothers attending primary health-care centers in Baghdad Al-Karkh sector about danger signs in newborns

Background: High-risk neonate defines as one who requires more than the standard monitoring and care offered to a healthy term newborn infant; therefore, early detection of neonatal illness is an important step toward improving newborn survival. Objectives: The objective of this study is to assess the knowledge and health-seeking practices of mothers attending primary health-care centers about WHO recognized danger signs in newborns. Subjects and Methods: A cross-sectional study was carried out in primary health-care centers selected conveniently in Baghdad-Alkarkh district. Participants were 275 mothers of child-bearing age group selected conveniently; the data were collected during the period from March 1 to June 30, 2017. A general questionnaire used for the data collection. Results: About 81% of mothers in study sample listed three or more of the who recognized danger signs. About 71.7% of mothers tend to seek advice or treatment for the illness outside the home. The proportion of good knowledge and health-seeking practices was higher in (Educated, employee, mothers who had a history of antenatal care attendance with higher number of visits). There was no relationship between number of children and family support with seeking care outside the home. Mothers who had good knowledge of danger signs of their babies tend to seek care from health facilities more frequently 75%, and this relation was statistically significant, 61.2% of mothers who perceive illness in newborns delayed seeking advice or treatment outside the home, 66% not taking newborn to the health facilities because they expect self-resolution of the illness. There is good knowledge and perception of mothers toward some danger signs such as fever, poor feeding, and jaundice while fair toward others such as cold body, chest indrawing, and signs of local infections. Conclusion: There are good knowledge and perception of mothers about the WHO recognized danger signs in newborns; however, there is a gap between mothers' knowledge and their health-seeking behavior for sick newborn and explored their deep perceptions, constraints, and various treatments.

Surfactant proteins gene variants in premature newborn infants with severe respiratory distress syndrome

ObjectiveGenetic surfactant dysfunction causes respiratory failure in term and near-term newborn infants, but little is known of such condition in prematures. We evaluated genetic surfactant dysfunction in premature newborn infants with severe RDS.Patients and methodsA total of 68 preterm newborn infants with gestational age ≤32 weeks affected by unusually severe RDS were analysed for mutations in SFTPB, SFTPC and ABCA3. Therapies included oxygen supplementation, nasal CPAP, different modalities of ventilatory support, administration of exogenous surfactant, inhaled nitric oxide and steroids. Molecular analyses were performed on genomic DNA extracted from peripheral blood and Sanger sequencing of whole gene coding regions and intron junctions. In one case histology and electron microscopy on lung tissue was performed.ResultsHeterozygous previously described rare or novel variants in surfactant proteins genes ABCA3, SFTPB and SFTPC were identified in 24 newborn infants. In total, 11 infants died at age of 2 to 6 months. Ultrastructural analysis of lung tissue of one infant showed features suggesting ABCA3 dysfunction.DiscussionRare or novel genetic variants in genes encoding surfactant proteins were identified in a large proportion (35%) of premature newborn infants with particularly severe RDS. We speculate that interaction of developmental immaturity of surfactant production in association with abnormalities of surfactant metabolism of genetic origin may have a synergic worsening phenotypic effect.

Identification of generic and pathogen-specific cord blood monocyte transcriptomes reveals a largely conserved response in preterm and term newborn infants.

E. coli and S. epidermidis elicit common transcriptional changes in cord monocytes. The common transcriptional response is mediated by TLR/NF-κB/TREM-1 signalling. IFN-genes are differentially regulated by E. coli and S. epidermidis in monocytes. These responses are largely unaffected by GA or exposure to chorioamnionitis.

Critères cliniques en faveur d’un portage de germe pathogène chez le nouveau-né à terme suspect d’infection néonatale bactérienne précoce

Neonatal early onset sepsis (EOS) remains an important etiology of neonatal morbidity and mortality. Diagnosis is difficult due to a lack of sensitivity and specificity markers. In France, the management of newborn infants suspected of infection includes the analysis of gastric suction. The objective of the study was to identify early clinical signs in newborn infants with suspected neonatal sepsis to differentiate a likely infection with pathogen bacteria in the gastric suction culture (Streptococcus agalactiae or Escherichia coli) from a possible infection without such pathogen bacteria. We conducted a retrospective study in the Amiens University Hospital. All term newborn infants born between 1January and 31December 2013and hospitalized for suspected EOS were included. Suspicion of EOS was considered when there were arguments to treat by antibiotics for a period of at least 5days. Fifty-eight newborn infants were included, 25had a likely EOS and 33a possible EOS. Newborn infants with a likely EOS were less mature (P<0.01) with more clinical signs at birth (P<0.01). The most common clinical signs were: hyperthermia (P=0.01), somnolence (P<0.01), and hypotonia (P=0.01). After adjusting for the term, the presence of hyperthermia was no longer significantly different between the two groups (P=0.059), the other clinical signs remained significantly different. The presence of neonatal symptoms at birth appears to be a useful clinical marker of probable neonatal EOS.

Barriers to enrollment in a randomized controlled trial of hydrocortisone for cardiovascular insufficiency in term and late preterm newborn infants.

ObjectiveTo analyze reasons for low enrollment in an RCT of the effect of hydrocortisone for cardiovascular insufficiency on survival without neurodevelopmental impairment (NDI) in term/late-preterm newborns.Study DesignThe original study was a multicenter RCT. Eligibility: ≥34 weeks’ gestation, <72° old, mechanically ventilated, receiving inotrope. Primary outcome was NDI at 2 years; infants with diagnoses at high risk for NDI were excluded. This paper presents an analysis of reasons for low patient enrollment.Result257 of 932 otherwise eligible infants received inotropes; however, 207(81%) had exclusionary diagnoses. Only 12 infants were randomized over 10 months; therefore, the study was terminated. Contributing factors included few eligible infants after exclusions, open-label steroid therapy, and a narrow enrollment window.ConclusionDespite an observational study to estimate the population, very few infants were enrolled. Successful RCTs of emergent therapy may require fewer exclusions, a short-term primary outcome, waiver of consent, and/or other alternatives.Clinical trial registrationClinicaltrials.gov, NCT01954056

The Role of Amplitude Integrated Electroencephalogram in Very Low-Birth-Weight Preterm Infants: A Literature Review.

AbstractNeurological sequelae are common in very low-birth-weight preterm infants. The prevention of brain injury and development of neuroprotective strategies have been the main objectives of modern neonatal neurology. Amplitude integrated electroencephalogram (aEEG) is a continuous brain monitoring method that can aid in early diagnosis and detect patients who are at risk. While its role in the assessment of full-term newborn infants is already well established, there are still doubts about its use in preterm infants. The objective of this review was to describe the main recommendations for the use of aEEG in very low-birth-weight preterm infants and its accuracy in assessing the prognosis and detecting epileptic seizures in this population.

Fluid supplementation for neonatal unconjugated hyperbilirubinaemia.

Fluid supplementation for neonatal unconjugated hyperbilirubinaemia.

Early predictors of brain damage in full-term newborns with hypoxic ischemic encephalopathy.

Objective of the studyTo evaluate the value of serum creatine phosphokinase-brain specific (CK-BB) and urinary lactate/creatinine (L/C) ratio as early indicators of brain damage in full-term newborns with hypoxic ischemic encephalopathy (HIE).Patients and methodsA case–control study including 25 full-term new-born infants with perinatal asphyxia who were admitted to neonatal intensive care unit (NICU) with a proven diagnosis of HIE, compared to 20 healthy age- and sex-matched full-term newborns. All newborn infants were subjected to full history taking, clinical examination, routine investigations (cord blood gases and complete blood picture), and assessment of serum CK-BB (cord blood, 6 and 24 hours after birth) and urinary L/C ratio (collected within the first 6 hours, on the 2nd and 3rd day after birth).ResultsThe serum CK-BB and urinary L/C ratio in infants with HIE were significantly higher in samples collected throughout the monitoring period when compared with the control group (all P<0.001). The cord CK-BB and urinary L/C ratio within the first 6 hours were significantly higher in infants with severe HIE than in infants with mild and moderate HIE (P<0.001). Cord CK-BB level at 12.5 U/L had 100% sensitivity and 84% specificity in the detection of severe HIE infants. Urinary L/C ratio of more than 10.5 collected within the first 6 hours after birth had 100% sensitivity and 78% specificity for the detection of severe HIE infants.ConclusionThe serum CK-BB and urinary L/C ratio in HIE infants were significantly increased early in the course of the disease, which can be used as useful indicators for predicting the development of HIE.

Thoracic fluid content by electric bioimpedance correlates with respiratory distress in newborns.

The objective of the study was to compare thoracic fluid content (TFC) between newborn infants with and without respiratory distress. We tested the hypothesis that TFC would be higher in infants with respiratory distress. A total of 96 newborn infants, gestational age 37.9 (2.6) weeks, were enrolled at birth. TFC by electrical bioimpedance was recorded within 3 h after birth (TFC1) and at 24 h of life (TFC2). TFC1 was higher in infants with respiratory distress at birth (76.8 (24.9) versus 61.6 (16.1) 1 KOhm-1, P<0.0005). The association was independent from gestational age and mode of delivery. TFC2 was independently associated with respiratory distress at 24 h of life (adjusted coefficient b=0.5 (s.d. 0.02), P=0.02). TFC by electric bioimpedance independently correlated with the presence of respiratory distress at birth and at 24 h of life in late preterm and term newborn infants.

Effect of unconjugated hyperbilirubinemia on neonatal autonomic functions: evaluation by heart rate variability

Background: Serum bilirubin levels beyond the physiological limits, may lead to alterations in autonomic regulation in a newborn infant. Heart rate variability (HRV), is a noninvasive and quantitative marker of the activity of the autonomic nervous system (ANS). To date, few studies have demonstrated the undesirable effects of severe unconjugated hyperbilirubinemia (UHB) on autonomic functions, and only one study has used HRV as a marker of the autonomic activity. However, the relationship between altered cardiac autonomic functions and UHB by using the HRV derived from 24-hour Holter electrocardiography (ECG) recording has not been investigated previously.Objective: We aimed to assess whether a relationship exists between severe UHB and cardiac autonomic dysfunction by evaluating HRV via 24-hour Holter ECG recording.Methods: This single-center, prospective, case-control study was conducted on 50 full-term newborn infants with severe UHB requiring phototherapy and 50 healthy infants as controls. HRV assessment was performed by using 24-hour Holter ECG recording.Results: There was no significant difference in terms of mean average heart rate, mean maximum heart rate and mean RR duration between the groups. However, mean minimum heart rate was significantly lower in the study group. When 24-hour time and frequency domain parameters were compared, time and frequency domain parameters rMSDD as well as high frequency (HF), which represent parasymphathetic activity, were significantly higher in the study group. Furthermore, low frequency to high frequency (LF/HF) ratio, that serves as an indicator of sympathovagal balance, was significantly lower in the study group.Conclusion: Severe UHB may cause cardiac autonomic dysfunction in favor of parasympathetic predominance in jaundiced neonates.

Craniocerebral birth injuries in term newborn infants: a retrospective series.

In an attempt to further define the spectrum of cranial birth injuries, we analyzed 21 consecutive cranial birth injuries in term neonates presenting to the neurosurgical department of our institution over the period 1994-2015. We performed a retrospective chart review from the medical records of the University Hospitals of the KU Leuven, from 1994 to 2015. We included 21 infants of 36-week gestational age or older with a diagnosis of cranial birth injury. The types and locations of injuries, the presenting signs, symptoms and their timing, and the required treatment(s) were recorded. Various maternal and neonatal factors and the mode of delivery were recorded. We recorded the different modes of delivery rates at our institution in the year 2013 and the rates in the Flemish community between 1995 and 2013, in order to compare the mode of delivery rates in the study group with current practice at our institution and with general practice over the years in the Flemish community. The most common clinical presentations were swelling (43% of cases) and seizures (19% of cases). Average Apgar scores were 6.57 at 1min and 8.43 at 5min; 48% of children had abnormally low Apgar scores at 1min and 9.5% had abnormally low scores at 5min. The most common intracranial lesion was skull fractures (33%). Operative treatment was required in 11 infants (52%). One infant died. Assisted mechanical delivery by either forceps and/or vacuum extraction occurred in 43% of infants. In comparison, in the year 2013, only 13.97% of deliveries at our institution were mechanically assisted. Over the period 1995-2013, the highest mechanically assisted delivery rates in the Flemish community were 14.1% in 1996. Although our series is too small to make firm conclusions, it is remarkable that the rates of assisted mechanical deliveries in our series far exceeded the assisted mechanical delivery rates at our institution in the year 2013 and even the highest vacuum and forceps delivery rates in the Flemish community over the period 1995-2013.

Salivary and serum cortisol levels in newborn infants.

Given that serum cortisol level interpretation in newborn infants (NBIs) is hard, the objective of this study was to correlate baseline salivary and serum cortisol levels and to describe salivary cortisol levels in the first month of life. Descriptive, prospective, longitudinal, and correlational study. Term NBIs were selected from the Division of Neonatology of Hospital Nacional Profesor Alejandro Posadas in 2014. Cortisol was measured in saliva specimens while cortisol, cortisol-binding globulin, and albumin were measured in blood specimens. A linear correlation was performed to relate serum and salivary cortisol levels; Friedman test was conducted to compare cortisol levels during the first month of life, and the difference was used to analyze the performance of values equal to or lower than the first quartile. Fifty-five NBIs were studied. Serum cortisol: 7.65 (1.0-18.1 gg/dL); salivary cortisol: 35.88 (5.52-107.64 mmol/L); cortisol-binding globulin: 22.07 (16.5-33.0 gg/mL), expressed as median and range. The correlation coefficient between serum and salivary cortisol was 0.54, P = 0.001. Cortisol performance during the first month of life showed no statistically significant differences, and the difference between the second and the first specimen of values equal to or lower than the first quartile increased in 10 out of 12 patients. The measurement of cortisol in saliva reflects serum cortisol levels in normal NBIs. Some patients had low levels of cortisol at 36 hours of life and showed a trend towards a spontaneous increase during the first month of life.

Clonidine for sedation and analgesia for neonates receiving mechanical ventilation.

Although routine administration of pharmacologic sedation or analgesia during mechanical ventilation in preterm neonates is not recommended, its use in clinical practice remains common. Alpha-2 agonists, mainly clonidine and dexmedetomidine, are used as adjunctive (or alternative) sedative agents alongside opioids and benzodiazepines. Clonidine has not been systematically assessed for use in neonatal sedation during ventilation. To assess whether clonidine administered to term and preterm newborn infants receiving mechanical ventilation reduces morbidity and mortality rates. To compare the intervention versus placebo, no treatment, and dexmedetomidine; and to assess the safety of clonidine infusion for potential harms.To perform subgroup analyses according to gestational age; birth weight; administration method (infusion or bolus therapy); dose, duration, and route of clonidine administration; and pharmacologic sedation as a co-intervention. We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 12) in the Cochrane Library, MEDLINE via PubMed (1966 to January 10, 2017), Embase (1980 to January 10, 2017), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to January 10, 2017). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomized controlled trials and quasi-randomized trials. We searched for randomized controlled trials, quasi-randomized controlled trials, and cluster trials comparing clonidine versus placebo, no treatment, or dexmedetomidine administered to term and preterm newborns receiving mechanical ventilation via an endotracheal tube. For the included trial, two review authors independently extracted data (e.g. number of participants, birth weight, gestational age, all-cause death during initial hospitalization, duration of respiratory support, sedation scale, duration of hospital stay) and assessed risk of bias (e.g. adequacy of randomization, blinding, completeness of follow-up). This review considered primary outcomes of all-cause neonatal death, all-cause death during initial hospitalization, and duration of mechanical ventilation in days. One trial, which included 112 infants, met the inclusion criteria for this review. Term newborn infants on mechanical ventilation with the need for continuous analgesia and sedation with fentanyl and midazolam were eligible for enrollment during the first 96 hours of ventilation. Study authors administered clonidine 1 μg/kg/h or placebo on day 4 after intubation.We found no differences between the two groups in all-cause death during hospitalization (risk ratio [RR] 0.69, 95% confidence interval [CI] 0.12 to 3.98). The quality of the evidence supporting these findings is low owing to imprecision of the estimates (one study; few events). The median (interquartile range) duration of mechanical ventilation was 7.1 days (5.7 to 9.1 days) in the clonidine group and 5.8 days (4.9 to 7.9 days) in the placebo group, respectively (P = 0.070). Among secondary outcomes, we found no differences in terms of duration of stay in the intensive care unit. Sedation scale values (COMFORT) and analgesia scores (Hartwig) during the first 72 hours of infusion of study medication were lower in the clonidine group than in the placebo group. At present, evidence is insufficient to show the efficacy and safety of clonidine for sedation and analgesia in term and preterm newborn infants receiving mechanical ventilation.

Umbilical Cord Milking in Term Infants: Blood Volume Associated With Cut and Intact Umbilical Cords [23M

INTRODUCTION: Placental-to-newborn transfusion through delayed cord clamping and umbilical cord milking (UCM) is associated with reduced risk of transfusion, intraventricular hemorrhage, and necrotizing enterocolitis in preterm infants, and increased iron stores in term infants. Total blood volume (BV) transferred during UCM is not well studied. We sought to determine BV associated with both cut UCM (C-UCM) and intact UCM (I-UCM) methods in term infants. METHODS: Forty-five term infants were enrolled at a single center. To determine BV with C-UCM, umbilical cords from 30 infants (10 per group) were cut at 10, 20, or 30 centimeters, milked 4 times, and BV recorded. To determine BV with I-UCM, intact umbilical cords of 15 infants were milked 3 times and BV recorded. Demographic data and pregnancy data were obtained. Descriptive statistics were performed. RESULTS: In the C-UCM group, BV increased proportional to umbilical cord length, whereas BV/cm of cord decreased with cord length. C-UCM of a 30 cm segment contained a mean BV of 24.8±4.0 mL, or 8.0±1.3 mL/kg of birth weight. Most of the BV was obtained with the first milking (90.1±11.0%). In the I-UCM group, the mean BV was 46.3±24.1 mL, or 13.4±7.1 mL/kg of birth weight. No correlation existed between birth weight, placental weight, or BV. CONCLUSION: When performing C-UCM, cutting a long cord segment and milking 1 to 2 times delivers the highest BV. Compared to C-UCM, I-UCM provided greater average BV to newborn term infants. Future research should compare the clinical outcomes of infants who undergo C-UCM and I-UCM.

Criteria for hospital discharge of the healthy term newborn after delivery

Abstract Criteria for newborn hospital discharge have to include physiological stability and family competence to provide newborn care at home. In this document, the Committee of Standards of the Spanish Society of Neonatology reviews the minimum criteria to be met before hospital discharge of a term newborn infant. We include a review of hospital discharge criteria for the late preterm infants, as these infants are often not hospitalised and remain with their mother after birth. A shortened hospital stay (less than 48 h after delivery) for healthy term newborns can be considered, but it is not appropriate for every mother and newborn. Newborn infants discharged before 48 h of age, should be examined within 3–4 days of life.

Bacterial N-formyl Peptides Reduce PMA- and Escherichia coli-Induced Neutrophil Respiratory Burst in Term Neonates and Adults.

Neutrophil migration and respiratory burst are the prerequisite for efficient first line defense against invading microorganisms. However, migration and respiratory burst can be compromised in adults and especially in newborn infants, where sustained neutrophil accumulation, uncontrolled burst and reduced scavenging of ROS might cause inadvertent tissue damage due to uncontrolled inflammation. The aim of this study was to investigate the modulatory effect of the chemoattractants formyl-methionyl-leucyl-phenylalanine (fMLP) and IL-8 on respiratory burst in neutrophils from term newborn infants and adults. Whole blood from the umbilical cord of 17 healthy term newborn infants delivered by caesarean section and from 17 healthy adults as reference was preincubated with fMLP or IL-8 and stimulated with PMA or Escherichia coli bacteria. Respiratory burst was quantified by flow cytometry analysis of dihydrorhodamine 123 fluorescence. fMLP reduced the PMA-induced respiratory burst of neutrophils from newborn infants and adults by 12% and 21%, respectively (P<0.05). E.coli-induced burst was also reduced by fMLP in neutrophils from newborn infants (10%; P<0.01) and adults (6%; P<0.05). No such changes were observed with IL-8. Similar respiratory burst in response to single stimulus with PMA or E.coli was observed in both newborn infants and adults. fMLP reduced PMA- and E.coli-induced respiratory burst of neutrophils in whole blood from term newborn infants as well as in adults. The reduced respiratory burst by fMLP might be a mechanism to reduce the detrimental effects of uncontrolled inflammation during neutrophil migration.

Multimodal neurophysiological monitoring in healthy infants born at term: normative continuous somatosensory evoked potentials data.

To describe accurate, standardized 1h-multimodal neurophysiological monitoring (1h-MNM), while simultaneously recording VEEG, aEEG, and SEP-C bilaterally from median nerves, and to collect neonatal normative SEP-C data related to behavioural states. Twenty healthy, term newborn infants (13 males, 7 females; gestational age 37-42wks; mean 39.6wks, standard deviation [SD] 1.3wks) underwent 1h-MNM within 2 days of life, with focus on recording of the SEP-C (band-pass setting 1-100 Hz, rate of stimulation 1.1 Hz, 50 alternate stimuli). 1h-MNM was easily obtained with identification of cervical (N13) and cortical (N1, P1) SEP-C responses in all infants. SEP-C minimal and maximum N1 latencies/N1-P1 amplitudes were identified, bilaterally, during periods of spontaneous sleep active-quiet-active (AS-QS-AS) and quiet-wakefulness. Minimal latencies and amplitudes occurred in 60% of active sleep/quiet-wakefulness, with the maximums in 70% of quiet sleep. The SEP-C mean values were latencies of N13=13.6ms (SD 1.4ms) and N1=33.6ms (SD 3.9ms) to 34.2ms (SD 4.8ms) in left and right hemisphere respectively; central-conduction-time (CCT) (N13-N1), 20.0ms (SD 4.3ms) to 20.6ms (SD 4.8ms); N1-P1 amplitude=4.6ms (SD 2.7ms) to 3.8μV (SD 2.2μV). 1h-MNM can record simultaneously VEEG/aEEG/SEP-C in newborn infants, showing the modulation of SEP cortical responses in relation to behavioural states in all infants studied using an appropriate neonatal method. We emphasize the importance of obtaining neonatal SEP-C normative data to better identify pathological findings in neonatal brain injury.

Routine oro/nasopharyngeal suction versus no suction at birth.

Oro/nasopharyngeal suction is a method used to clear secretions from the oropharynx and nasopharynx through the application of negative pressure via a suction catheter or bulb syringe. Traditionally, airway oro/nasopharyngeal suction at birth has been used routinely to remove fluid rapidly from the oropharynx and nasopharynx in vigorous and non-vigorous infants at birth. Concerns relating to the reported adverse effects of oro/nasopharyngeal suctioning led to a practice review and routine oro/nasopharyngeal suctioning is no longer recommended for vigorous infants. However, it is important to know whether there is any clear benefit or harm for infants whose oro/nasopharyngeal airway is suctioned compared to infants who are not suctioned. To evaluate the effect of routine oropharyngeal/nasopharyngeal suction compared to no suction on mortality and morbidity in newly born infants. We used the standard search strategy of the Cochrane Neonatal Review group to search the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 3), MEDLINE via PubMed (1966 to April 18, 2016), Embase (1980 to April 18, 2016), and CINAHL (1982 to April 18, 2016). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. Randomised, quasi-randomised controlled trials and cluster randomised trials that evaluated the effect of routine oropharyngeal/nasopharyngeal suction compared to no suction on mortality and morbidity in newly born infants with and without meconium-stained amniotic fluid. The review authors extracted from the reports of the clinical trials, data regarding clinical outcomes including mortality, need for resuscitation, admission to neonatal intensive care, five minute Apgar score, episodes of apnoea and length of hospital stay. Eight randomised controlled trials met the inclusion criteria and only included term infants (n = 4011). Five studies included infants with no fetal distress and clear amniotic fluid, one large study included vigorous infants with clear or meconium-stained amniotic fluid, and two large studies included infants with thin or thick meconium-stained amniotic fluid. Overall, there was no statistical difference between oro/nasopharyngeal suction and no oro/nasopharyngeal suction for all reported outcomes: mortality (typical RR 2.29, 95% CI 0.94 to 5.53; typical RD 0.01, 95% CI -0.00 to 0.01; I2 = 0%, studies = 2, participants = 3023), need for resuscitation (typical RR 0.85, 95% CI 0.69 to 1.06; typical RD -0.01, 95% CI -0.03 to 0.00; I2 = 0%, studies = 5, participants = 3791), admission to NICU (typical RR 0.82, 95% CI 0.62 to 1.08; typical RD -0.03, 95% CI -0.08 to 0.01; I2 = 27%, studies = 2, participants = 997) and Apgar scores at five minutes (MD -0.03, 95% CI -0.08 to 0.02; I2 not estimated, studies = 3, participants = 330). The currently available evidence does not support or refute the benefits or harms of routine oro/nasopharyngeal suction over no suction. Further high-quality studies are required in preterm infants or term newborn infants with thick meconium amniotic fluid. Studies should investigate long-term effects such as neurodevelopmental outcomes.

Effects of birth weight on profiles of dried blood amino-acids and acylcarnitines.

Background Birth weight influences profiles of dried blood amino-acids and acylcarnitines in newborn screening. This study aimed to define a more appropriate cut-off value to reduce the false positive rate and the number of recalled patients in newborn screening. Methods All babies who underwent newborn screening in our center were included; they were divided into groups by birth weight: 2500-3999 g (comparator group), <1000 g (group 1), 1000-1499 g (group 2), 1500-2499 g (group 3), and >4000 g (group 4). The 0.5th and 99.5th percentiles were used as the cut-off values. Comparisons were done on amino acid and acylcarnitines concentrations between the groups. False positive rate, positive predictive value, corrected false positive rate by birth weights were determined. Results Data on a total of 578,287 newborn infants were included in the analysis. The total false positive rate was 0.75%, and positive predictive value 2.89%. The false positive rate was 0.69%, 0.54% and 5.31% in infants with normal birth weight, birth weight of >4000 (group 4) and low birth weight of < 2500 g (groups 1, 2 and 3), respectively. Low-birth weight infants had much higher phenylalanine, tyrosine, methionine, arginine, propionylcarnitine, isovalerylcarnitine and octadecanoylcarnitine concentrations. Free carnitines and palmitoylcarnitine concentrations were lower. After adjusting for birth weight, false positive rate of all indices decreased to 0.53%, and positive predictive value increased to 4.31%. Conclusions Amino acid and carnitine concentrations in low-birth weight newborn infants may differ from the normal term newborn infants. The cut-off values of individual metabolites should be adjusted based on birth weight, to reduce false positive rate and increase positive predictive value.