Weeks Of Life Research Articles

Early Conservative Physical Therapy Management of Babies With Obstetric Brachial Plexus Injury to Facilitate Spontaneous Recovery.

To evaluate the effect of early immobilization and proper handling techniques in infants with Obstetric Brachial Plexus Injury (OBPI) in the first 2weeks of life. Six 1-day-old infants (2 males and 4 females) with OBPI were included. The assessments were done at baseline, post-intervention, and 3-month follow-up, which involved a physical exam, Narakas classification, Active Movement Scale, and gross and fine motor skills evaluation. All infants had upper Erb's palsy. They had statistically significant improvement in the Active Movement Scale scores post-intervention with a large effect size. These improvements were maintained at follow-up. All infants achieved age-appropriate gross and fine motor skills with the affected upper limb at 3months of age. Early conservative physical therapy management had a statistically significant effect on enhancing spontaneous recovery and preventing further nerve injury in OBPI infants.

Proteomics-Based Mapping of Bronchopulmonary Dysplasia-Associated Changes in Noninvasively Accessible Oral Secretions

ObjectiveTo determine if oral secretions (OS) can be used as a non-invasively collected body fluid, in lieu of tracheal aspirates (TA), to track respiratory status and predict bronchopulmonary dysplasia (BPD) development in infants born <32 weeks. Study DesignThis was a retrospective, single-center cohort study that included data and convenience samples from week-of-life (WoL) 3 from two independent preterm infant cohorts. Using previously banked samples, we applied our sample-sparing, high-throughput proteomics technology to compare OS and TA proteomes in infants born <32 weeks admitted to the Neonatology Intensive Care Unit (NICU) (Cohort 1; N=23 infants). In a separate similar cohort, we mapped the BPD-associated changes in the OS proteome (Cohort 2; N=17 infants including 8 with BPD). ResultsIn samples collected during the first month of life, we identified 607 proteins unique to OS, 327 proteins unique to TA, and 687 overlapping proteins belonging to pathways involved in immune effector processes, neutrophil degranulation, leukocyte mediated immunity, and metabolic processes. Furthermore, we identified 37 OS proteins that showed significantly differential abundance between BPD cases and controls: 13 were associated with metabolic and immune dysregulation, 10 of which (eg, SERPINC1, CSTA, BPI) have been linked to BPD or other prematurity-related lung disease based on blood or TA investigations, but not OS. ConclusionOS are a noninvasive, easily accessible alternative to TA and amenable to high-throughput proteomic analysis in preterm newborns. OS samples hold promise to yield actionable biomarkers of BPD development, particularly for prospective categorization of at-risk infants for timely clinical trial enrollment with novel therapies.

Maternal high fat diet exposure results in maternal microbiome dependent increase in inflammatory cytokines and decrease in neurons in offspring brain.

Abstract Introduction: We hypothesized that maternal high fat diet (mHFD) exposure will result in a microbiota dependent increase in inflammation and inhibition of axonal development in offspring brain. Methods: Conventional and germ-free murine dams were exposed to 60% high fat diet (HFD) or regular diet (RD) prior to mating. Offspring brains were collected at 2-weeks of life and analyzed for inflammatory (TNF-α, IL-6, IL-17A, IL1β and TGF-β) and regulatory markers of neuronal development (Nurr1) by quantitative RT-PCR. RNA seq was performed on whole brain in conventional mice. We quantified differences in regional neurons by histology (Nissl and H&amp;E). Behavioral studies on mHFD and RD offspring are ongoing. Results: mHFD offspring had a significant increase in the inflammatory cytokines IL-17A and IL-6 when compared to controls. Nurr1 was increased 50-fold in mHFD offspring. In germ-free mHFD offspring, there was no difference. Quantification of neurons by Nissl staining demonstrated a decrease in neuron cell count in the cortex (20% decrease), and in hippocampal regions (22% in CA2 and 32% in CA3). Preliminary RNAseq analysis showed upregulation of specific genes involved in immunoregulation, neuron development and migration, and apoptosis in mHFD offspring. Conclusion: mHFD exposure resulted in increased inflammatory cytokines and reduced neurogenesis in the offspring brain. This change was ameliorated in germ free mice, demonstrating a microbiome dependent diet effect. RNAseq findings demonstrate changes in specific immunoregulatory pathways which warrant further exploration. We speculate that maternal diet interacts with the maternal microbiome to increase immune activation in the fetal brain which affects neurogenesis. Supported by grants from NIH (R01 1K12HD068369) and Children’s Medical Center Research Grant

The prevalence and types of advance care planning use in patients with advanced cancer: A retrospective single-centre perspective, Australia

Objectives: In Australia participation rate in Advance Care Directives is 14%, and research is limited on Advance Care Planning (ACP) invitations and uptake among the patients with advanced cancer (PwAC). This study identifies the prevalence and types of documented ACP discussions in PwAC who died within two or four weeks of receiving chemotherapy. Design: A retrospective audit was conducted. Statistical analysis was calculated in SPSS. Difference in ACP invitation and utilization between three groups [control, <2-weeks, and –4 weeks] was measured by Kruskal–Wallis and Chi-square (or Fisher-Exact) tests. Post-hoc follow-up pair-wise comparisons were performed. Adjusted prevalence ratios were estimated using two logistic regression models. Setting: This study was conducted in XXX Coast University Hospital, Australia. Participants: The records of 339 patients were examined and 320 patients were found eligible. Results: Of the 320 PwAC [male: 55%; median age: 65 years], 227 (71%) received ACP invitation, and among the invited patients, 89% used Acute Resuscitation Plan; 54% used Enduring Power-of-Attorney; and 20% completed Advance Health Directives. From 7.5% [n = 24] of the patients who received chemotherapy in their last 2-weeks of life, 42% had not received an ACP invitation, 29% didn’t have Acute Resuscitation Plan and only 4% completed Advance Health Directives. There were significant differences among Control, <2-weeks, and 2–4 weeks groups in completing Acute Resuscitation Plan (P = 0.003) and Advance Health Directives (P = 0.045). A significant difference was also observed between control and <2-weeks groups in number of days since Acute Resuscitation Plan used. Completing an Acute Resuscitation Plan was associated with a lower risk of dying within two-weeks of chemotherapy (OR = 0.246; P = 0.008). Conclusions: Low rates of ACP invitation and use in PwAC, especially who received chemotherapy in 2-weeks of dying confirm a need for embedding and regularly revisiting ACP framework in cancer care and educating staff, patients, and their family caregivers to increase uptake.

Torcular pseudomass in newborns and its association with delivery: follow up or leave it alone?

The cranial epidural space (ES) is a potential space and is not generally recognized unless there is underlying pathology. With MRI in newborns, we have frequently observed T2 hyperintense thickening of the ES posterior to the confluence of sinuses, also referred to as "torcular pseudomass" (TP). We aim to identify the frequency of TP and possible associations with delivery. Retrospectively, brain MRIs of 194 neonates obtained within the first 2weeks of life were evaluated. If TP was present, imaging characteristics and thickness were assessed by two observers, using fat-suppressed T2WI/FLAIR, T1WI, and SWI. Exclusion criteria were motion artifact, lack of sagittal T2WI, and lack of clinical data. Medical records were evaluated for demographic and clinical data. Follow-up exams were evaluated if available. Patients with TP and without were compared using Student t and chi-square tests. TP was present in 64/158 (40%). No difference was found between the groups regarding sex, gestational age, birth weight, delivery type, fetal presentation during delivery, birth difficulty, and neurological sequelae (p > 0.05). Eight patients with TP underwent follow-up imaging, and in 6/8, TP completely resolved. Two patients showed persistent TP, improving from 3.2 to 1mm in one child and from 3.2 to 2.8mm in the other within a week. TP frequently occurs in early newborns. TP does not appear to be associated with factors related to delivery, shows complete resolution in most cases with a follow-up, and is likely of no clinical importance.

The Pandemic Effects on the Microbiome of Infants in the Neonatal Intensive Care Unit (NICU)

The microbiome is an *invisible organ* that affects health and disease. Early life microbial colonization is critical for development of the immune system, postnatal growth, and long‐term health. The dynamic and nascent microbiomes of children are highly individualized. SARS‐CoV‐2(Covid‐19) is known to impact the adult microbiome. However, pandemic impact on the infant microbiome is unknown. In the current study we hypothesized that infants born prior to pandemic regulations may demonstrate differences compared to those born during the pandemic. Fecal samples (n=307) were collected from infants (1‐19 weeks) in the NICU at The University of Chicago. DNA was extracted for 16S rRNA sequencing, and 4576 taxa were analyzed using R. We performed alpha diversity analysis within the samples and beta diversity between the samples to measure and compare bacterial communities. Alpha diversity did not demonstrate a significant difference between before pandemic and during pandemic groups, while Beta diversity did achieve a significant difference between the two groups. Multivariate analysis showed that in before pandemic and during pandemic groups, post menstrual age (PMA), weeks of life (WOL), as well as the interactions of pandemic grouping by PMA, and PMA by WOL were significant. Lastly, we identified the top 5 positively associated and top 5 negatively associated bacteria at the species/genus level associated with the pandemic grouping. Of these, Serratia marcescens and Acinetobacter johnsonii are associated with antibiotic resistance, and reduction of human pathogens such as Shigellaand Salmonella.This study illustrates that differences in microbiome diversity exist between infants before and after pandemic regulations. Any disruptions in microbial colonization can contribute to shifts in normal microbial colonization that persist past the first 1000 days of life. Our study suggests the possible influences of secondary factors during the pandemic on microbiome development. In future studies we plan to further explore the interaction of cofounders (e.g. PMA) as well as follow up on the long‐term effects of the pandemic on the infant microbiome.

Association between acute kidney injury and brain injury on term-equivalent age brain magnetic resonance imaging in very preterm infants.

This study aimed to investigate the relationship between acute kidney injury (AKI) in the first 2weeks of life and brain injury on term-equivalent age magnetic resonance imaging in very preterm infants. We included 116 infants with a birth weight of < 1500g who were born at the King Saud Medical City at ≤ 32 gestational weeks. They were admitted to the neonatal intensive care unit and underwent term-equivalent age and pre-discharge brain magnetic resonance imaging. A negative binomial with generalized linear models and a robust variance estimator (Huber-White) was applied for univariate relative risk analysis. The Kidokoro score was then used to determine the effect of AKI on brain morphology and growth at term-equivalent age. Sixty-eight (64.2%) infants had developed an AKI in the first 2weeks of life. AKI was significantly associated with cerebellum signal abnormalities, cerebellar volume reduction, and a high total cerebellum score (P = 0.04, P < 0.001, P < 0.001, respectively). AKI in the first 2weeks of life is associated with brain insult, especially in the cerebellum. More well-designed studies are required to investigate the association and impact of AKI on the central nervous system. A higher resolution version of the Graphical abstract is available as Supplementary information.

The change over time of vital signs with consideration for opioid use in the last 2weeks of life among cancer patients in a palliative care unit: Continuous measurement of vital signs using a non-wearable monitor.

ObjectivesThe aim of this study was to examine the following by using a non‐wearable monitor: (ⅰ) the trajectory of vital signs (VS) in the last 2 weeks of life among cancer patients, and (ⅱ) the difference in change over time of VS between cancer patients with and without opioid use.MethodsWe conducted a longitudinal study involving cancer patients in a palliative care unit (PCU) from April 2018 to October 2019. VS were collected continuously using a non‐wearable monitor, and we calculated the means of respiratory rate (RR) and heart rate (HR) per hour, and counts of apnea per hour as outcome variables. Explanatory variables were time (subtracting time of death from measurement time of VS, divided by 36) and opioid use. Mean difference (MD) of time represented the slope per hour of VS values. First, we analyzed the associations between VS per hour and time using a linear mixed model (LMM) with random intercepts and slope over time. Second, we analyzed the associations between VS and interaction term between time and opioid use.ResultsWe analyzed 26 cancer patients. RR (MD: 0.27 beats/min [95% CI: 0.27–0.28]), HR (MD: 1.51 beats/min [95% CI: 1.50–1.52]), and apnea (MD: 0.71 count/hour [95% CI: 0.70–0.72]) significantly increased hourly. In addition, RR was significantly associated with interaction term (MD: −1.59 beats/min [95% CI: −3.11 to −0.07]), which indicates that there is a difference in the slope of RR between opioid users and non‐users.ConclusionsWe have successfully described the trajectory of VS in high‐resolution under conditions of a natural end of life in PCU.

Investigation of the effects of maternal separation on the pancreatic oxidative and inflammatory damages along with metabolic impairment in response to chronic social defeat stress in young adult male rats.

Chronic glucocorticoid release during the stress response has been proposed to initiate certain damages, which in turn produce metabolic disorders. The present study is the first work to test whether maternal separation (MS) would impact the metabolic alterations associated with pancreatic oxidative and inflammatory damages under chronic exposure to social defeat stress (CSDS) in adulthood. During the first 2weeks of life, male Wistar rats were exposed to MS or left undisturbed with their mothers (Std). Starting on postnatal day 50, the animals of each group were either left undisturbed in the standard group housing (Con) or underwent CSDS for 3weeks. Thus, there were 4 groups (n = 7/group): Std-Con, Ms-Con, Std-CSDS, MS-CSDS. Each animal was weighed and then decapitated so that we could collect trunk blood for assessment of fasting plasma corticosterone, insulin, glucose, lipid profile, and insulin resistance. Plasma and pancreatic catalase activity, reduced glutathione (GSH), malondialdehyde levels and pancreatic interleukin-1 beta (IL-1β) content were also measured. MS-CSDS animals showed elevated plasma corticosterone and insulin levels (P < 0.01) along with insulin resistance (P < 0.05). According to one-way ANOVA results, chronic exposure to early or adult life adversity decreased body weight (P < 0.0001), Catalase activity and GSH levels (P < 0.0001) and increased malondialdehyde level (P = 0.0006) in plasma. Pancreatic MDA and IL-1β contents elevated just in MS-CSDS rats (P < 0.05). Maternal separation shapes vulnerability to develop corticosterone hypersecretion, insulin resistance, pancreatic oxidative, and inflammatory damages associated with chronic exposure to later social challenges, which could potentially trigger metabolic disorders. The online version contains supplementary material available at 10.1007/s40200-021-00902-3.

The progression of salt-wasting and the body weight change during the first 2weeks of life in classical 21-hydroxylase deficiency patients.

One of the major purposes of newborn screening for 21-hydroxylase deficiency (21OHD) is preventing life-threatening adrenal crisis. However, the details of adrenal crisis in newborns are not precisely documented. We aimed to clarify the clinical details of salt-wasting in newborn 21OHD patients. Based on the follow-up survey of the screening in Tokyo from 1989 to 2017, we retrospectively analysed the conditions of classical 21OHD neonates before the initiation of therapy. One hundred classical 21OHD patients (55 male, 45 female) were analysed. The age at the first hospital visit was 0-20days with sex difference (male: 9.0±3.5days; female: 6.2±3.9days). Thirty-seven (37.4%) patients exhibited severe salt-wasting (SSW), that is, Na<130mEq/L, K>7mEq/L or Na/K ratio<20; except for one case, SSW developed in or after the second week of life. The serum concentrations of Na, K and Na/K were linearly correlated with age in days (R2 =.38, .25, and .34 respectively), suggesting that the risk of SSW increases linearly without a threshold. The age at which the regression lines reached Na<130mEq/L, K>7mEq/L and Na/K<20 was approximately coincided, 11.1, 12.3 and 11.2days, respectively. All SSW patients exhibited decreased body weight from birth in their second week of life. Our data revealed that the risk of developing SSW increases during the second week of life without a threshold, and for preventing SSW, early intervention, ideally during first week of life, is desirable. An increased body weight in the second week of life indicates the absence of SSW.

Melatonin long-lasting beneficial effects on pulmonary vascular reactivity and redox balance in chronic hypoxic ovine neonates.

Pulmonary arterial hypertension of the neonate (PAHN) is a pathophysiological condition characterized by maladaptive pulmonary vascular remodeling and abnormal contractile reactivity. This is a multifactorial syndrome with chronic hypoxia and oxidative stress as main etiological drivers, and with limited effectiveness in therapeutic approaches. Melatonin is a neurohormone with antioxidant and vasodilator properties at the pulmonary level. Therefore, this study aims to test whether a postnatal treatment with melatonin during the neonatal period improves in a long-lasting manner the clinical condition of PAHN. Ten newborn lambs gestated and born at 3600m were used in this study, five received vehicle and five received melatonin in daily doses of 1mgkg-1 for the first 3weeks of life. After 1week of treatment completion, lung tissue and small pulmonary arteries (SPA) were collected for wire myography, molecular biology, and morphostructural analyses. Melatonin decreased pulmonary arterial pressure the first 4days of treatment. At 1month old, melatonin decreased the contractile response to the vasoconstrictors K+ , TX2 , and ET-1. Further, melatonin increased the endothelium-dependent and muscle-dependent vasodilation of SPA. Finally, the treatment decreased pulmonary oxidative stress by inducing antioxidant enzymes and diminishing pro-oxidant sources. In conclusion, melatonin improved vascular reactivity and oxidative stress at the pulmonary level in PAHN lambs gestated and born in chronic hypoxia.

Early life stress induces submissive behavior in adult rats

Maternal-deprivation of rodent pups is a relevant model of extreme early-life stress that can be relevant to the understanding of long-term effects of war, migration, parental loss and displacement. Although even mild stress during infancy affects brain development and behavior, the current study focused on the effects of six hour daily maternal-separation, a model that reflects the severe distress often experienced in those circumstances. This study emphasizes the effect of maternal separation on social behavior in the context of a variety of factors that measure cognitive and emotional behavior which were subject to principle component analysis.Sprague-Dawley pups were separated from the dam for 6 h each day during the first 3-weeks of life and underwent a battery of behavioral tests at 3-months of age.We found that rodents exposed to postnatal maternal deprivation displayed submissive behavior in resident-intruder and dominant-submissive tests, as well as significantly more anxiety and anhedonia than control rats.The results of multivariate statistical analysis show that the dominant-submissive behavior correlates with depressive, anxiety and social behavior and can be predicted with an accuracy of 86.2%. The increased submissive behavior in male rats that had been subjected to severe postnatal stress suggests that exposure to stress during infancy and childhood could have long-term effects on social relationships. The mechanism of the long-term effects on depression, anxiety and submissive behavior requires further investigation.

Mortality Predictive Risk Factors of Limits-Of-Viability Preterm Infants at 23 And 24 Weeks Gestation

Objective: The purpose of this study was to examine perinatal and postnatal events associated with neonatal mortality among 23 and 24 weeks gestation preterm infants. Methods: A population-based retrospective study of infants born at 23 and 24 weeks gestational age over a two-andhalf- year period. Results: A hundred and five preterm infants were investigated during the period of the study: 60 infants born at 23 weeks gestation and 45 infants born at 24 weeks gestation. In total, 79 infants were admitted to the NICU (75%). Twenty-six infants died in the delivery room. Twenty-six infants died within the first two weeks of life (33%) and 12 died beyond the first two weeks of life (15%). The survival rates for infants admitted to the NICU were 35% and 66% for 23 and 24 weeks infants, respectively. Altogether, 41 of all NICU-admitted infants remained alive until discharge (52%). (Figure 1) The majority of deaths occurred during the first two weeks of life (26/38; 68%).Tthe most associated risk factors were a lack of antenatal steroid ( p value &lt; .001), bruises (0.002), gelatinous skin (0.032), and IVH (0.03) . Severe respiratory failure was the main cause of death. Failure to extubate from a respirator by two weeks of age with an FIO2 requirement &gt; 50% was the main risk factor associated with death beyond two weeks of life (OR &gt; 10.0 and p value of&lt; 0.001).In comparison to mothers who did not receive antenatal steroids, an incomplete course showed a significant but lower risk of mortality (OR=3 vs. 13 and P value 0.001 vs 0.3). The rate of ANS administration approached 90% in 24 weeks gestation age vs 53% in the 23 weeks age group. The tendency to perform CS was &lt; 10% in 23 weeks and up to 28 % in 24 weeks. Attending neonatologists decided to offer resuscitation in 93 % of 24 weeks versus 65% of 23 weeks newborn. Conclusions: Antenatal steroids, the degree of immaturity, a birth weight less than 750 grams, and need for IPPV ventilation while requiring more than 50% FIO2 at two weeks of age were the circumstances most associated with death. The survival rates until discharge for 23 and 24 weeks gestational age infants were 35% and 66%. Resuscitation selection criteria for 23 weeks gestation would provide a reasonable platform for forming an approach towards this particular gestational age.

Evaluation and management of the child with hypothyroidism.

Thyroid hormones are critical for early neurocognitive development as well as growth and development throughout childhood. Prompt recognition and treatment of hypothyroidism is, therefore, of utmost importance to optimize physical and neurodevelopmental outcomes. A PubMed search was completed in Clinical Queries using the key terms "hypothyroidism". Hypothyroidism may be present at birth (congenital hypothyroidism) or develop later in life (acquired hypothyroidism). Thyroid dysgenesis and dyshormonogenesis account for approximately 85% and 15% of permanent cases of congenital primary hypothyroidism, respectively. More than 95% of infants with congenital hypothyroidism have few, if any, clinical manifestations of hypothyroidism. Newborn screening programs allow early detection of congenital hypothyroidism. In developed countries, Hashimoto thyroiditis is the most common cause of goiter and acquired hypothyroidism in children and adolescents. Globally, iodine deficiency associated with goiter is the most common cause of hypothyroidism. Central hypothyroidism is uncommon and may be associated with other congenital syndromes and deficiencies of other pituitary hormones. Familiarity of the clinical features would allow prompt diagnosis and institution of treatment. To optimize neurocognitive outcome in infants with congenital hypothyroidism, treatment with levothyroxine should be started as soon as possible, preferably within the first 2weeks of life. Children with acquired hypothyroidism should also be treated early to ensure normal growth and development as well as cognitive outcome. The target is to keep serum TSH < 5mIU/L and to maintain serum free T4 or total T4 within the upper half of the age-specific reference range, with elimination of all symptoms and signs of hypothyroidism.

Association between exposure to macrolides and the development of infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis.

Macrolides are bacteriostatic antibiotics with a broad spectrum of activity against Gram-positive bacteria. The aim of this study was to systematically review and meta-analyze the association between infantile hypertrophic pyloric stenosis (IHPS) and macrolides. Nine databases were searched systematically for studies with information on the association between macrolides and IHPS. We combined findings using random effects models. Our study revealed 18 articles investigating the association between macrolides and IHPS. There was a significant association between the development of IHPS and erythromycin (2.38, 1.06-5.39). The association was strong when erythromycin was used during the first 2weeks of life (8.14, 4.29-15.45). During breastfeeding, use of macrolides showed no significant association with IHPS in infants (0.96, 0.61-1.53). IHPS was not associated with erythromycin (1.11, 0.9-1.36) or macrolides use during pregnancy (1.15, 0.98-1.36).Conclusions: There is an association between erythromycin use during infancy and developing IHPS in infants. However, no significant association was found between macrolides use during pregnancy or breastfeeding. Additional large studies are needed to further evaluate potential association with macrolide use. What is known? • Erythromycin intake in the first 2weeks of life is associated with an increased risk of pyloric stenosis. What is New? • There is currently no evidence of significant association between macrolides use during pregnancy or breastfeeding and pyloric stenosis.

Neonatal gut and respiratory microbiota: coordinated development through time and space

BackgroundPostnatal development of early life microbiota influences immunity, metabolism, neurodevelopment, and infant health. Microbiome development occurs at multiple body sites, with distinct community compositions and functions. Associations between microbiota at multiple sites represent an unexplored influence on the infant microbiome. Here, we examined co-occurrence patterns of gut and respiratory microbiota in pre- and full-term infants over the first year of life, a period critical to neonatal development.ResultsGut and respiratory microbiota collected as longitudinal rectal, throat, and nasal samples from 38 pre-term and 44 full-term infants were first clustered into community state types (CSTs) on the basis of their compositional profiles. Multiple methods were used to relate the occurrence of CSTs to temporal microbiota development and measures of infant maturity, including gestational age (GA) at birth, week of life (WOL), and post-menstrual age (PMA). Manifestation of CSTs followed one of three patterns with respect to infant maturity: (1) chronological, with CST occurrence frequency solely a function of post-natal age (WOL), (2) idiosyncratic to maturity at birth, with the interval of CST occurrence dependent on infant post-natal age but the frequency of occurrence dependent on GA at birth, and (3) convergent, in which CSTs appear first in infants of greater maturity at birth, with occurrence frequency in pre-terms converging after a post-natal interval proportional to pre-maturity. The composition of CSTs was highly dissimilar between different body sites, but the CST of any one body site was highly predictive of the CSTs at other body sites. There were significant associations between the abundance of individual taxa at each body site and the CSTs of the other body sites, which persisted after stringent control for the non-linear effects of infant maturity. Canonical correlations exist between the microbiota composition at each pair of body sites, with the strongest correlations between proximal locations.ConclusionThese findings suggest that early microbiota is shaped by neonatal innate and adaptive developmental responses. Temporal progression of CST occurrence is influenced by infant maturity at birth and post-natal age. Significant associations of microbiota across body sites reveal distal connections and coordinated development of the infant microbial ecosystem.

Early hypophosphatemia in very low birth weight preterm infants.

Refeeding Syndrome (RFS) is a well-known group of symptoms which occur after the introduction of enteral or parenteral nutrition in undernourished patients. Intrauterine growth restriction (IUGR) is the equivalent of postnatal RFS following the beginning of feeding. The aggressive parenteral nutrition of neonates with very low birth weight (VLBW) resulting from the termination of intrauterine transplacental nutrition is a source of biochemical disorders. The aim of this study was to analyze metabolic disorders in preterm infants during the 1st week of life and to determine the hypophosphatemia risk factors in low birth weight neonates receiving parenteral nutrition. The retrospective analysis covered 49 neonates, aged between 24 0/7 and 32 6/7 weeks of gestation. The examined patients were divided into 2 groups according to the level of phosphates during the 1st week of life: HP (n = 18) with aggravated hypophosphatemia (≤3.1 mg/dL) and NP (n = 31) with normal phosphatemia (>3.1 mg/dL). Hypophosphatemia was observed in the first days of life in 61% of children, in 45% of whom a subsequent test revealed a further fall in the phosphate level. In the rest of the preterm neonates (39%), hypophosphatemia was revealed between the 4th and 7th day of life. The risk of early hypophosphatemia was higher in neonates with IUGR (p = 0.0001; RR 5.2, 95% CI 2.2–12.4) and extremely low birth weight (ELBW) preterm infants (p < 0.05). Early hypophosphatemia should be closely monitored early in life, especially in newborns with ELBW and IUGR. Further research is needed to develop an optimal nutritional regimen from the first days of life.

Food intake and energy expenditure in growing cats with and without a predisposition to overweight.

Overweight and obesity are multifactorial diseases caused by an imbalance in energy metabolism. An underlying genetic predisposition is often a factor in these conditions. In the cat breeding family of the Institute of Animal Nutrition at the Vetsuisse Faculty, University of Zurich, a segregating overweight phenotype with a genetic contribution was observed. From this breeding family, 26 kittens were followed from birth up to 8months of age. During this time, food intake was measured using an automatic feeding station, and energy expenditure was investigated using indirect calorimetry at the ages of 4 and 6months. Dual-energy X-ray absorptiometry (DEXA) was performed and blood glucose, leptin and insulin were measured at the ages of 4, 6 and 8months. The kittens were also weighed daily for the first 2weeks of life, every second day until weaning and once per week until 8months of age. The body condition score (BCS) was evaluated monthly between 2 and 8months of age. The main finding of this study is that a predisposition to overweight is connected to a higher food intake early in life, with no significant alterations in energy expenditure. The leptin blood levels were related to body fat percentage, and insulin sensitivity did not seem to be affected.

A validated clinical MRI injury scoring system in neonatal hypoxic-ischemic encephalopathy.

Deep nuclear gray matter injury in neonatal hypoxic-ischemic encephalopathy (HIE) is associated with worse neurodevelopmental outcomes. We previously published a qualitative MRI injury scoring system utilizing serial T1-weighted, T2-weighted and diffusion-weighted imaging (DWI), weighted for deep nuclear gray matter injury. To establish the validity of the MRI scoring system with neurodevelopmental outcome at 18-24months. MRI scans from neonates with moderate to severe HIE treated with therapeutic hypothermia were evaluated. Signal abnormality was scored on T1-weighted, T2-weighted and DWI sequences and assessed using an established system in five regions: (a) subcortical: caudate nucleus, globus pallidus and putamen, thalamus and the posterior limb of the internal capsule; (b) white matter; (c) cortex, (d) cerebellum and (e) brainstem. MRI injury was graded as none, mild, moderate or severe. Inter-rater reliability was tested on a subset of scans by two independent and blinded neuroradiologists. Surviving infants underwent the Bayley Scales of Infant and Toddler Development-III (Bayley-III) at 18-24months. Data were analyzed using univariate and multivariate linear and logistic regression. Fifty-seven eligible neonates underwent at least one MRI scan in the first 2weeks of life. Mean postnatal age at scan 1 was 4±2days in 50/57 (88%) neonates and 48/54 (89%) surviving infants underwent scan 2 at 10±2days. In 54/57 (95%) survivors, higher MRI injury grades were significantly associated with worse outcomes in the cognitive, motor and language domains of the Bayley-III. A qualitative MRI injury scoring system weighted for deep nuclear gray matter injury is a significant predictor of neurodevelopmental outcome at 18-24months in neonates with HIE.

Effects of early parenteral iron combined erythropoietin in preterm infants

Backgroud:The aim of the study was to evaluate the effect of early parenteral iron supplementation combined erythropoietin for prevention of anemia in preterm infants.Methods:In total, 96 preterm infants were randomly assigned to 3 groups: a control group receiving standard parenteral nutrition (group 1: n = 31), an iron-supplemented group (group 2: IS, n = 33), and an iron-supplemented combined erythropoietin group (group 3: IS+EPO, n = 32). The primary objective was to assess hemoglobin (Hb) levels. The secondary objectives included assessment of red blood cell counts (RBC), mean cell volume (MCV), serum iron, ferritin, percentages of reticulocyte (RET), total iron binding capacity (TIBC) and oxidative stress, which was assessed by measuring plasma levels of malondialdehyde and superoxide dismutase at baseline and at 2 weeks. The blood routine indices including Hb, RBC, MCV, and percentages of RET were measured at corrected age of 1 and 3 months.Results:At 2 weeks of life, the percentages of reticulocyte in group 2 and group 3 were significantly higher than those in group 1 (2.1±0.4, 2.5±0.3, and 1.7±0.3, respectively, P < 0.001, P<0.001), whereas TIBC were significantly lower than those in group 1 (36.7±4.6, 36.0±4.7, and 41.6 ± 5.2 respectively, P = 0.011, P = 0.006). There were no significant differences in RBC counts, the levels of hemoglobin, ferritin, malondialdehyde, and superoxide dismutase among the 3 groups at 2weeks of life. RBC, Hb, MCV, body weight, body length, and head circumference at a corrected age of 1 month did not differ among 3 groups. At corrected age of 3months, more infants in the control group had abnormal Hb and MCV levels (Hb levels: 114.3 ± 21.3, 123.7 ± 31.6, and 125.1 ± 21.2, P = 0.021, P = 0.034, respectively; MCV: 74.1 ± 3.5, 78.3 ± 4.7 and 79.1 ± 5.2, P = 0.017, P = 0.012, respectively), whereas cases of oral iron, cases of breastfeeding, RBC, body weight, body length, and head circumference were not different among 3 groups.Conclusion:Early parenteral iron supplementation combined erythropoietin in preterm infants improved the percentages of reticulocyte, decreased total iron binding capacity, and improved the Hb and MCV levels at 3 months of age. Early parenteral iron supplementations with EPO were beneficial for the preterm infants.