Week Of Extrauterine Life Research Articles

Spectrum of cutaneous manifestations in neonates at a tertiary care center

Background: The neonatal period encompasses the initial four weeks of extra-uterine life. Skin lesions in neonates range from transient physiological, self-limiting conditions to pathological dermatoses. An awareness of the physiological skin changes in neonates is needed to differentiate them from pathological dermatoses, thereby avoiding unnecessary treatment and mental stress to the parents. Aim: The aim was to study the clinical pattern of neonatal dermatoses and their prevalence at a tertiary care center. Materials and Methods: An institutional, prospective, observational study was conducted at the outpatient department of dermatology, venereology, and leprosy. A total of 195 neonates from the postnatal ward, pediatric ward, and dermatology department of the same institution with at least one cutaneous manifestation over the period of six months were included in the study. Results: Among the 195 neonates, cutaneous manifestations were noted in 176 neonates (90.8%), among which 82 (46%) were males and 94 (54%) were females; 163(92%) were full-term and 14 (8%) were preterm; 89 (51%) were born through vaginal delivery and 87 (49%) by caesarean section. Skin manifestations may be broadly divided into physiological skin lesions accounting for 80% of cases, transient non-infective conditions (10%), eczematous eruptions (2%), birthmarks (3%), and others (5%). The most common among all was the Mongolian spot accounting for 98 (56%) cases. Conclusion: A majority of the neonatal dermatoses were transient physiological, requiring only reassurance and no medical treatment; however proper understanding and identifying the pathological conditions are critical for early diagnosis and intervention. Key words: Neonatal dermatoses; Mongolian spot; Physiological; Sebaceous gland hyperplasia

Prophylactic Administration of Mesenchymal Stromal Cells Does Not Prevent Arrested Lung Development in Extremely Premature-Born Non-Human Primates.

Premature birth is a leading cause of childhood morbidity and mortality and often followed by an arrest of postnatal lung development called bronchopulmonary dysplasia. Therapies using exogenous mesenchymal stromal cells (MSC) have proven highly efficacious in term-born rodent models of this disease, but effects of MSC in actual premature-born lungs are largely unknown. Here, we investigated thirteen non-human primates (baboons; Papio spp.) that were born at the limit of viability and given a single, intravenous dose of ten million human umbilical cord tissue-derived MSC per kilogram or placebo immediately after birth. Following two weeks of human-equivalent neonatal intensive care including mechanical ventilation, lung function testing and echocardiographic studies, lung tissues were analyzed using unbiased stereology. We noted that therapy with MSC was feasible, safe and without signs of engraftment when administered as controlled infusion over 15 minutes, but linked to adverse events when given faster. Administration of cells was associated with improved cardiovascular stability, but neither benefited lung structure, nor lung function after two weeks of extrauterine life. We concluded that a single, intravenous administration of MSC had no short- to mid-term lung-protective effects in extremely premature-born baboons, sharply contrasting data from term-born rodent models of arrested postnatal lung development and urging for investigations on the mechanisms of cell-based therapies for diseases of prematurity in actual premature organisms.

A Clinical Study of Dermatoses in Neonatal Intensive Care Unit in a Tertiary Health-Care Center

Introduction: Neonatal period is defined as the first 4 weeks of extrauterine life. The skin and appendages of the newborn present different features compared to adults. The imperative knowledge of normal phenomena and their differentiation from the more significant cutaneous disorders of the newborn is critical for dermatologists for timely intervention, which could facilitate a better therapeutic outcome. Materials and Methods: We conducted a hospital-based, observational, cross-sectional study of a total of 128 neonates with cutaneous manifestation from May 2021 to November 2021. Results were analyzed statistically. Results: Of all neonates examined, i.e., 128, 77 (60.15%) were male and 51 (39.85%) were female, with a male: female ratio of 1.5:1. 87 (67.96%) neonates were term, 35 (27.34%) were preterm, and 6 (4.68%) were postterm. 33 (25.78%) neonates had more than one cutaneous lesion. Of all the cutaneous lesions, physiological skin lesions were most common, which accounted for 70% of skin lesions, followed by iatrogenic 8%, transient noninfective conditions 5%, eczema 5%, developmental defects 4%, birthmarks 4%, and others 4%. Conclusion: Neonatal skin lesions are often physiological. Both dermatologists and pediatricians have to be aware of the course of the disease. Nursing mothers have to be explained the natural course of the skin lesions to reduce unnecessary anxiety; whereas to reduce iatrogenic infections, nursing staff has to be explained to handle newborn’s skin with care as they are sensitive.

La cytosteatonecrose du nouveau-ne au chu de Conakry: a propos d’une nouvelle observation

Cytosteatonecrosis is an acute condition of unknown pathogenesis that occurs in the first weeks of extra-uterine life. It presents clinically in the form of a large plaque, indurated and sometimes nodular. It often sits on the trunk, buttocks and thighs (root of the limbs). The course of cytosteatonecrosis is benign but sometimes enamelled with complications such as hypercalcemia and metabolic disorders. The rarity of this affection would be justified by the ignorance of the cutaneous signs. We report here a case of neonatal cytosteatonecrosis remarkable for the delay in diagnosis and the efficacy of low-dose corticosteroid therapy.

A Case Report and Anesthetic Considerations in Subcutaneous Fat Necrosis of the Newborn

Subcutaneous fat necrosis of the newborn (SCFN) is an uncommon, self-limiting panniculitis generally diagnosed in the first few weeks of extrauterine life in term or postterm infants subjected to perinatal physiologic stress. Hallmarks of the process include dramatic hypercalcemia without identifiable cause that may be associated with renal disease, seizures, and death. Herein, we describe the anesthetic approach in an 11-week-old infant, including perioperative laboratory testing, management of hypercalcemia, and intraoperative considerations.

Oral melatonin as a new tool for neuroprotection in preterm newborns: study protocol for a randomized controlled trial

BackgroundPrevention of neurodevelopmental impairment due to preterm birth is a major health challenge. Despite advanced obstetric and neonatal care, to date there are few neuroprotective molecules available. Melatonin has been shown to have anti-oxidant/anti-inflammatory effects and to reduce brain damage, mainly after hypoxic ischemic encephalopathy. The planned study will be the first aiming to evaluate the capacity of melatonin to mitigate brain impairment due to premature birth.MethodIn our planned prospective, multicenter, double-blind, randomized vs placebo study, we will recruit, within 96 h of birth, 60 preterm newborns with a gestational age ≤ 29 weeks + 6 days; these infants will be randomly allocated to oral melatonin, 3 mg/kg/day, or placebo for 15 days. After the administration period, we will measure plasma levels of malondialdehyde, a lipid peroxidation product considered an early biological marker of melatonin treatment efficacy (primary outcome). At term-equivalent age, we will evaluate neurological status (through cerebral ultrasound, cerebral magnetic resonance imaging, vision and hearing evaluations, clinical neurological assessment, and screening for retinopathy of prematurity) as well as the incidence of bronchodysplasia and sepsis. We will also monitor neurodevelopmental outcome during the first 24 months of corrected age (using the modified Fagan Test of Infant Intelligence at 4–6 months and standardized neurological and developmental assessments at 24 months).DiscussionPreterm birth survivors often present long-term neurodevelopmental sequelae, such as motor, learning, social-behavioral, and communication problems. We aim to assess the role of melatonin as a neuroprotectant during the first weeks of extrauterine life, when preterm infants are unable to produce it spontaneously. This approach is based on the supposition that its anti-oxidant mechanism could be useful in preventing neurodevelopmental impairment. Considering the short- and long-term morbidities related to preterm birth, and the financial and social costs of the care of preterm infants, both at birth and over time, we suggest that melatonin administration could lead to considerable saving of resources. This would be the first study addressing the role of melatonin in very low birth weight preterm newborns, and it could provide a basis for further studies on melatonin as a neuroprotection strategy in this vulnerable population.Trial registrationClinicalTrials.gov NCT04235673. Prospectively registered on 22 January 2020.

Attenuated brain responses to speech sounds in moderate preterm infants at term age.

Recent findings have revealed that very preterm neonates already show the typical brain responses to place of articulation changes in stop consonants, but data on their sensitivity to other types of phonetic changes remain scarce. Here, we examined the impact of 7-8weeks of extra-uterine life on the automatic processing of syllables in 20 healthy moderate preterm infants (mean gestational age at birth 33weeks) matched in maturational age with 20 full-term neonates, thus differing in their previous auditory experience. This design allows elucidating the contribution of extra-uterine auditory experience in the immature brain on the encoding of linguistically relevant speech features. Specifically, we collected brain responses to natural CV syllables differing in three dimensions using a multi-feature mismatch paradigm, with the syllable/ba/ as the standard and three deviants: a pitch change, a vowel change to/bo/ and a consonant voice-onset time (VOT) change to/pa/. No significant between-group differences were found for pitch and consonant VOT deviants. However, moderate preterm infants showed attenuated responses to vowel deviants compared to full terms. These results suggest that moderate preterm infants' limited experience with low-pass filtered speech prenatally can hinder vowel change detection and that exposure to natural speech after birth does not seem to contribute to improve this capacity. These data are in line with recent evidence suggesting a sequential development of a hierarchical functional architecture of speech processing that is highly sensitive to early auditory experience.

A clinical study of neonatal dermatosis

Background: The neonatal period is the first 4 weeks of extra-uterine life. Neonatal dermatology encompasses a spectrum of cutaneous disorders from benign to life threatening. The present study was undertaken to evaluate the various dermatoses and hence assess the spectrum of dermatological conditions during the neonatal period and to study the relationship of neonatal dermatoses with maturity and birth weight of the neonates.Methods: Three hundred neonates with cutaneous manifestations, attending the OPD of dermatology and Paediatrics during one year period, were studied. Neonates receiving phototherapy and those with lesions secondary to trauma were excluded. Clinical history coupled with complete general physical, systemic and dermatological examination.Results: Three hundred cases of neonatal dermatoses were included in study. Out of 300 cases, 179 (59.7%) were male babies and 121 (140.3%) were female (sex ratio 1:5), 271 (70.3%) were term babies, 27 (9%) were preterm and 2 (0.7%) were post term. Transient/non-infective cutaneous lesions were the commonest 144 (48%) followed by Infectious 68 (22.67%), eczematous disorder 33 (11%) and pigmentary dermatoses 25 (8.33). Vascular lesions and hematomas accounted for 18 (6%) while genodermatoses were seen 7 (2.33%). 5 cases of subcutaneous fat disorders were observed.Conclusions: As the spectrum of neonatal dermatology is vast, its knowledge to dermatologist is very important so as to differentiate the more common benign disorders from less frequent life-threatening dermatoses, so that timely intervention could facilitate a better therapeutic outcome.

Clinical study of cutaneous manifestations in neonates

The neonatal period constitute the initial 4 weeks of extra-uterine life. A host of clinical manifestations occur in neonates varying from physiological to grossly pathological, hence it is necessary to differentiate between benign and clinically significant skin lesions among the newborn. It is important to be aware of the transient skin lesions in newborn and differentiate them from other serious conditions which will avoid unnecessary therapy to the neonates and the parents can be assured of good prognosis of these skin manifestations. Aims: 1) To study the various patterns of cutaneous manifestations occurring among the newborn. 2) To estimate the prevalence of physiological and pathological skin lesions among the new born. Materials and Methods: An Institutional based, prospective study was conducted in the department of Dermatology, Venereology and Leprosy, Eluru, West Godavari district, A.P. 100 neonates born in the Department of Obstetrics and Gynecology of the same institution and having at-least one cutaneous manifestation were considered in this study. The study was conducted between the period of November 2011 to May 2013. Results: Of 100 neonates, 54 were males, 46 were females, of these, 89 were born at term, 9 were preterm, and 2 were post term. Of the cutaneous lesions in the newborn, physiological skin lesions were more common among all accounting for 57.0%, followed by eczematous eruptions 18.2%, transient non infective conditions 10.2%, birthmarks 9.1% and others 5.5% in decreasing order of frequency. Conclusion: This study of newborn skin provides information about normal variants occurring in neonatal period. It is important to be aware of the fact that most of the skin lesions in the newborn are transient and require no therapy. Keywords: Cutaneous lesions in neonate, Skin Marker, Transient eruptions, Pathological eruptions

Unusual pyloric obstruction in children. Report of six operated cases

Hypertrophic pyloric stenosis (HPS) is a condition present in approxi- mately 0.25-0.5% of all live newborns 1. It usually presents between the third and the twelfth weeks of extrauterine life, predominantly in males in a 4:1 ratio. HPS results from a hypertrophy of the muscle layer, the etiology is unknown and leads to high intestinal obstruc- tion 2. Pyloric obstruction (PO) is present beyond the age-range for HPS, its frequency is unusual, its incidence is unknown, and in most cases it is secondary to other pathologies 1,3. We present six patients between the ages of four months and four years, with pyloric obstruction (PO) seen at the Instituto Nacional de Pediatria, between January 2005 and January 2010. The main post-surgical diagnoses of these cases were fenestrated antral membrane, and pyloric obstruction secondary to peptic ulcer di- sease. While HPS is well known among pediatricians, there are still patients diagnosed very late, as was case-study number 1 in our series. The procedures used in patients with PO were Heineke Mickulicz antropyloroplasty, Jaboulay gastroduodenal anastomosis and Fin- ney pyloroplasty, with good post-surgical results after an average 6 months follow-up.

Effect of sex and gestational age on neonatal body composition

To determine the effects of length of gestation and sex on infant body composition, air displacement plethysmography was performed in forty-six full-term neonates at 3 d of life and during the week prior to hospital discharge in 180 preterm neonates. Fat mass, as a percentage of body weight, was higher in preterm than in term infants (13.4 (SD 4.2) v. 10.1 (sd 3.7) %, respectively; P= 0.001). The absolute amount of fat mass did not differ between preterm and full-term newborns (323 (SD 126) v. 335 (SD 138) g; P= 0.58), whereas lean body mass was lower in preterm than in term infants (2055 (SD 280) v. 2937 (SD 259) g, respectively; P< 0.001). Among full-term infants, fat mass was higher in females than in males (11.1 (SD 3.7) v. 9.0 (SD 3.3) %, respectively; P= 0.047), whereas we did not observe any sex difference in preterm infants (13.5 (SD 4.1) v. 13.4 (SD 4.3) %; P= 0.89). Our data suggest that by the time they are discharged from hospital: (1) preterm infants have a higher percentage of body fat than term neonates and (2) this is presumably due to a lesser accretion in lean body mass in the first few weeks of extra-uterine life, particularly in boys.

Reference intervals for brain natriuretic peptide in healthy newborns and infants measured with an automated immunoassay platform

In order to assess the reference intervals for B-type natriuretic hormone (BNP) in the first days of life, we measured peptide concentrations using the fully automated Access platform. Plasma BNP was measured in 188 apparently healthy newborns and infants throughout the first month of extra-uterine life, as well as in 245 healthy infants ranging from 1 month to 12 years of age. BNP showed the highest concentrations in the first 2 days of life, with a progressive decline afterwards. Moreover, BNP values in the first week of life were significantly higher (p<0.0001) than values observed in the next periods. As a result, a significant negative correlation was found between BNP and age values when considering all 433 samples (rho=-0.816, p<0.0001 by the Spearman rank correlation test). There was no significant difference between BNP values found in males and females. According to this data, our study indicates that at least two reference intervals should be used for newborns and infants. The first, with higher BNP values for neonates in the first week of extra-uterine life, and the other, with lower BNP values for infants aged 2 weeks to 12 years.

Cutaneous lesions in Turkish neonates born in a teaching hospital

The neonatal period is regarded as the first 4 weeks of extrauterine life. In the literature, there are numerous articles about the skin findings in neonates and the results of these studies show differences according to races and environmental factors. Our objective was to evaluate the skin lesions seen in neonates delivered in our hospital and to determine their relationship to gender, gestational age and route of delivery. Newborns delivered at the Obstetrics Clinics of our hospital between November 2007 and April 2008 were included in this study. Dermatologic examination was performed and relationship between the 10 most common skin findings and gender, gestational age and route of delivery were statistically evaluated. A total of 572 newborns were examined for the presence of skin lesions. Most common skin findings were Epstein pearls (58.76%), sebaceous hyperlasia (48.45%) and xerosis (31.29%). Milia and sebaceous hyperplasia in girls, desquamation and xerosis in preterms, Epstein pearls, sebaceous hyperplasia and desquamation in vaginally delivered babies were found to be more frequent and the differences were statistically significant. We found that 90.7% of the neonates had one or more cutaneous lesions. Maturity and type of delivery of the babies were important factors in their causation. In Turkey, this study is the first study performed on the skin lesions seen during the neonatal period. With this study, we want to increase the awareness about the skin findings in neonates.

Electrical brain activity in preterm infants at risk for intracranial hemorrhage.

We studied the effect of preterm birth on electroencephalographic background activity in 20 infants < 32 weeks' gestation. Six infants developed periventricular-intraventricular hemorrhage during the study period. Four-channel 24-h cassette recordings were obtained on day 1, 3-5 and 7-9. For each of the 24-h recordings, the percentage of the time showing stage I (continuous activity), stage II (mixed activity) and stage III (discontinuous activity) epochs was calculated. In infants without periventricular-intraventricular hemorrhage, a positive linear relationship between gestational age and continuous activity and a negative linear relationship between gestational age and discontinuous activity existed in the first day recordings; in infants with periventricular-intraventricular hemorrhage, such relationships were not found. To determine if the changes in continuous and discontinuous activities during the first week of extrauterine life were different from the expected changes during a corresponding time in utero, we calculated the expected amounts of stage I and III changes for each infant. The actual changes were not significantly different from the expected values in both study groups. However, during the onset and/or extension of periventricular-intraventricular hemorrhage, depression of the electroencephalographic background activity was found.

Sex differential patterns in perinatal deaths in Italy.

In industrialized countries, male excess is generally found in early deaths, despite the overall decrease in mortality. We studied the association between sex and some factors generally considered crucial for babies' survival, such as mother's age and education, birth order, and gestational age, in order to gain insight into the causes underlying the persisting higher vulnerability of male sex in early life. The analysis was performed on babies dying during the perinatal period. These were subdivided into those who were stillborn and those who died during the first week of extrauterine life. A higher male excess among babies dying during the neonatal period than among those who were stillborn was always found in all classes of all factors. The finding of such generalized male overmortality in the early extrauterine period of life, together with the patterns shown by the temporal sex ratio in stillbirths and in early deaths, supports the hypothesis of a postponement of male risk from late fetal into neonatal life.

The importance of early management in optimizing IQ in infants with congenital hypothyroidism

The importance of early management in optimizing IQ in infants with congenital hypothyroidism

Postnatal development of the intrinsic nervous system in the circumvallate papilla-vonEbner gland complex.

We have studied the postnatal development of the intrinsic nervous system in the circumvallate papilla-vonEbner gland complex using NADPH-diaphorase cytochemistry, immunocytochemistry (for nitric oxide synthase-1 and alpha-internexin) and electron microscopy. In rats sacrificed in their first day post partum (1 p.p.), only isolated NADPH-diaphorase positive neurons were visible in the organ. At 2 p.p., a small group of neurons was visible at the base of the papillae and positive neurons formed short chains close to the developing glandular tubules. In the following days, the NADPH-diapharase positive cells increased in number and nerve fibres were associated to small ganglia located at the base of the papilla or in the gland. After the first week of extrauterine life, the intrinsic nervous system was similar to the intrinsic system of adult animals. An immunocytochemical positivity for nitric oxide synthase-1 appeared at 4 p.p. in neurons located in the gland and at 7 p.p. in cells located at the base of the papilla. Immunocytochemical staining for alpha-internexin showed that at 1 p.p. developing nerve fibres were present in the connective tissue of the tongue's muscle layer. At 2-3 p.p., developing nerve fibres were also present at the bases and in the core of the papilla. In the following days, the positivity for alpha-internexin was reduced and one week after birth was virtually absent. Ultrastructural examination revealed that since 1 p.p. isolated neurons can be found at the base of the papilla. In conclusion, the intrinsic nervous system originates from neurons present in the organ at the birth which, in the first days, undergo a biochemical and morphological maturation while the nerve fibres rapidly grow. These findings support the hypothesis that the intrinsic nervous system of the circumvallate papilla has a role in the maturation of the vonEbner gland.

Increased energy expenditure and fecal fat excretion do not impair weight gain in small-for-gestational-age preterm infants.

In order to optimize the nutrition of high-risk premature infants beyond the early postnatal period, a more precise knowledge of individual nutritional requirements is needed. We therefore studied the influence of intrauterine growth retardation on energy expenditure and nutrient utilization determined by indirect calorimetry and fecal fat excretion (steatocrit) in nineteen premature infants who were appropriate-for-gestational-age (AGA; mean gestational age 29.9+/-0.3 weeks, mean birth weight 1.30+/-0.05 kg) and thirteen small-for-gestational-age (SGA) premature infants [mean gestational age 32.4+/-0.5 weeks, mean birth weight 1.024+/-0.07 kg (i.e., below the 10th percentile)] during the first and second month of life. All infants were clinically stable during the study period. In nine SGA infants we observed a significantly higher steatocrit compared to twelve AGA infants (29+/-1 vs. 17+/-1% p = 0.0001). SGA infants (n = 12) also showed a slightly (albeit statistically not significantly) higher energy expenditure than AGA infants (n = 15) (58.7+/-1.9 vs. 53.6+/-1.5 kcal/kg per day, p = 0.054). Despite the increased fat excretion and higher energy expenditure, SGA infants gained weight more rapidly during the study period than AGA infants (20+/-1 vs. 17+/-1 g/kg per day, p = 0.026). We conclude that influences of intrauterine growth retardation on energy expenditure and nutrient utilization persist during the first weeks of extrauterine life. However, these metabolic changes do not impair the capability of SGA infants for extrauterine catch-up growth if adequate nutrition is provided.

Intra-epithelial lipids in the dorsoposterior area of the tongue in new-born rats

The mucosa covering the posterior surface of the tongue in new-born rats was studied by scanning and transmission electron microscopy. The results demonstrated that in the first days of extra-uterine life in the epithelium of this mucosa there is an accumulation of lipidic material, which appeared as round or oval droplets with a mean diameter of about 0.8–1.0 μm. Their density was homogeneously low and they did not contain fibrillar or granular material. In the first day of extra-uterine life, the droplets were scarce and mainly localized in the dorsal surface of the vallate papilla. In the following days, the lipid deposit was present in large areas of the posterior surface of the tongue. At the end of the first week of extra-uterine life, as well as in adult animals, the lipids were rather scarce. A multilocular lipid deposit was also visible in superficial cells detaching from the mucosa. With magnetic resonance spectroscopy, lipids extracted from the posterior mucosa of the tongue appeared mainly saturated. Small amounts of unsaturated and polyunsaturated lipid were also detectable. These findings suggest that in the first week of extra-uterine life, specialized areas of the oral epithelium store lipid.

Solitary chemosensory cells in the developing chemoreceptorial epithelium of the vallate papilla.

The solitary chemosensory cells are considered typical of aquatic vertebrates and have never been described in the oral cavity of terrestrial vertebrates. We describe elements with ultrastructural characteristics of the solitary chemosensory cell in the gustatory epithelium of rats in the first week of extrauterine life. These elements appeared isolated, located among keratinocytes, and wrapped by glial-like elements. They showed a bipolar shape with a round cell body, a thin apical process, and a thicker basal one. Nerve fibers contacted the cell body and the processes. The cells showed small dense granules mainly located near nerve contacts. Small bundles of tonofilaments were visible in the perinuclear cytoplasm. Similar elements were not found in rats after the first week of extrauterine life. The present study demonstrates in a mammal that the development of taste buds is preceded by the presence of epithelial elements with ultrastructural characteristics of the solitary chemosensory cells described in lower vertebrates. This finding suggests that the oral chemoreception in the suckling rats may be mediated by three different pathways (i.e., gustatory system, common chemical sense, and solitary chemosensory cell system).