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Patel, Sweta M., Sabelle Jallow, Sefelani Boiditswe, Shabir A. Madhi, Kristen A. Feemster, Andrew P. Steenhoff, Tonya Arscott-Mills, et al. "Placental Transfer of Respiratory Syncytial Virus Antibody Among HIV-Exposed, Uninfected Infants." Journal of the Pediatric Infectious Diseases Society 9, no. 3 (September 24, 2019): 349–56. http://dx.doi.org/10.1093/jpids/piz056.
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Abstract Background Maternal human immunodeficiency virus (HIV) infection is associated with lower placental transfer of antibodies specific to several childhood pathogens. Our objective for this study was to evaluate the effect of maternal HIV infection on the placental transfer of respiratory syncytial virus (RSV)-neutralizing antibodies. Methods We conducted a cross-sectional study of mothers and their newborn infants at a tertiary hospital in Gaborone, Botswana, between March 2015 and December 2015. We measured serum RSV antibody levels by using a microneutralization assay. We used multivariable linear regression to evaluate the effect of maternal HIV infection on maternal RSV antibody levels, placental transfer of RSV antibodies, and newborn RSV antibody levels. Results Of 316 mothers, 154 (49%) were infected with HIV. The placental transfer ratios for RSV antibodies to HIV-exposed, uninfected (HEU) and HIV-unexposed, uninfected infants were 1.02 and 1.15, respectively. The geometric mean titer (95% confidence interval) of RSV-neutralizing antibodies was 2657 (2251–3136) among HEU newborns and 2911 (2543–3331) among HIV-unexposed, uninfected newborns. In multivariable analyses, maternal HIV infection was associated with lower placental transfer of RSV antibodies (P = .02) and a lower level of RSV antibodies among newborns (P = .002). Among HEU newborns, higher birth weight (P = .004) and an undetectable maternal antenatal viral load (P = .01) were associated with more effective placental transfer of RSV antibodies. Conclusions Maternal human immunodeficiency virus (HIV) infection is associated with lower mother-to-fetus transfer of serum RSV-neutralizing antibodies. HEU infants should be prioritized for preventive interventions for RSV. Maternal viral suppression through combination antiretroviral therapy has the potential to improve immunity to RSV among HIV-exposed infants.
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Namgung, Ran, and Reginald C. Tsang. "Factors affecting newborn bone mineral content: in utero effects on newborn bone mineralization." Proceedings of the Nutrition Society 59, no. 1 (February 2000): 55–63. http://dx.doi.org/10.1017/s0029665100000070.
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Several factors have been found recently to have a significant impact on newborn bone mineral content (BMC) and developing fetal bone. Recently we showed that maternal vitamin D deficiency may affect fetal bone mineralization. Korean winter-born newborn infants had extremely low serum 25-hydroxyvitamin D (25-OHD), high serum cross-linked carboxy-terminal telopeptide of type I collagen (ICTP; a bone resorption marker), and markedly lower (8 %) total body BMC than summer-born newborn infants. Infant total body BMC was positively correlated with cord serum 25-OHD and inversely correlated with ICTP, which was also negatively correlated with vitamin D status. In three separate studies on North American neonates we found markedly lower (8–12 %) BMC in summer newborn infants compared with winter newborn infants, the opposite of the findings for Korean neonates. The major reason for the conflicting BMC results might be the markedly different maternal vitamin D status of the North American and Korean subjects. Recently, we found evidence of decreased bone formation rates in infants who were small-for-gestational age (SGA) compared with infants who were appropriate-for-gestational age; we reported reduced BMC, cord serum osteocalcin (a marker of bone formation) and 1,25-dihydroxyvitamin D (the active metabolite of vitamin D), but no alterations in indices of fetal bone collagen metabolism. In theory, reduced utero-placental blood flow in SGA infants may result in reduced transplacental mineral supply and reduced fetal bone formation. Infants of diabetic mothers (IDM) have low BMC at birth, and infant BMC correlated inversely with poor control of diabetes in the mother, specifically first trimester maternal mean capillary blood glucose concentration, implying that factors early in pregnancy might have an effect on fetal BMC. The low BMC in IDM may be related to the decreased transplacental mineral transfer. Cord serum ICTP concentrations were higher in IDM than in control subjects, implying increased intrauterine bone resorption. BMC is consistently increased with increasing body weight and length in infants. Race and gender differences in BMC appear in early life, but not at birth. Ethanol consumption and smoking by the mother during pregnancy affect fetal skeletal development.
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Helve, Otto, Katri Korpela, Kaija-Leena Kolho, Terhi Saisto, Kirsi Skogberg, Evgenia Dikareva, Vedran Stefanovic, Anne Salonen, Willem M. de Vos, and Sture Andersson. "2843. Maternal Fecal Transplantation to Infants Born by Cesarean Section: Safety and Feasibility." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S68. http://dx.doi.org/10.1093/ofid/ofz359.148.
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Abstract Background A complication of cesarean section delivery is its interference with the normal intestinal colonization of the infant, affecting the development of immune system in early life—a process that has been associated with long-term morbidity, such as allergy and diabetes. We evaluated, in CS-delivered infants, whether the normal intestinal microbiome and its early life development could be restored by immediate postnatal transfer of maternal fecal microbiota to the newborn. Methods Seventeen healthy mothers with planned elective CS were recruited and screened thoroughly for infections, after which 7 mothers were included in the study. A fecal sample was processed according to a transplantation protocol and an aliquot (3–7 mg) was orally administered in breast-milk to the newborn during the first feeding. The infants were followed and fecal samples were gathered during the first 12 weeks of age and subsequently at the age of 8–18 months. Results The bacterial communities in the fecal samples of the mothers and their offspring were analyzed by sequencing of 16S rRNA amplicons from isolated fecal DNA and compared with that of 11 nontreated CS-delivered infants and 34 vaginally delivered infants. The fecal microbiota at 3 and 12 weeks was similar between treated CS and vaginally delivered infants, in contrast to that of the untreated CS-delivered infants both in overall composition (P = 0.001, Figure) and development of early-life signature bacteria, i.e., bacteroides and bifidobacteria and clostridia (P < 0.0001). Conclusion The seeding of maternal fecal microbes to the newborn intestine can be safely and successfully mimicked in elective CS by transferring a small amount of maternal fecal microbiome orally to the newborn infant. In these infants, this process results in a microbial development that is highly similar to that of the vaginally born infants, and provides support for the hypothesis that microbial colonization in early life results from a maternal fecal transfer. Disclosures All Authors: No reported Disclosures.
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Rendina, Mark C., Noel Carrasco, Brian Wood, Andrew Cameron, and Carl Bose. "A LOGIT MODEL FOR THE EFFECT OF TELECARDIOLOGY ON ACUTE NEWBORN TRANSFERS." International Journal of Technology Assessment in Health Care 17, no. 2 (April 2001): 244–49. http://dx.doi.org/10.1017/s0266462300105100.
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The deregionalization of neonatal intensive care in the United States has shifted the site of care for many newborn infants away from academic medical centers where subspecialty support is available.Objective: To investigate the effect of immediate echocardiogram interpretation via telemedicine on rates of neonatal transfer to academic medical centers.Methods: A logit model was developed to predict the probability of transfer from two regional level 3 neonatal intensive care units to academic medical centers. One of these units implemented a telecardiology program and the other acted as a comparison institution with on-site cardiology expertise. The telecardiology intervention began 18 months into the 36-month study period.Subjects: Infants (n = 2,142) admitted to neonatal intensive care at either of the two institutions during calendar years 1994 through 1996.Results: A statistically significant reduction in the rate of transfer to academic medical centers was observed. Telecardiology was associated with a 58% reduction of such transfers (p = .001, 95% CI = 30%, 75%). No such reduction was noted at the comparison institution. It is estimated that approximately 30 transfers were eliminated during the study period, resulting in the elimination of approximately $150,000 in hospital charges. In addition, the infants that were transferred after the adoption of telemedicine were more often transferred to their telemedicine partner institution (p < .02).
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Beebe, Susan A., John R. Britton, Helen L. Britton, Pelly Fan, and Bryan Jepson. "Neonatal Mortality and Length of Newborn Hospital Stay." Pediatrics 98, no. 2 (August 1, 1996): 231–35. http://dx.doi.org/10.1542/peds.98.2.231.
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Objective. To investigate the effect of hospital discharge time on neonatal mortality of term newborns. Design. Infants who were discharged home at 5 days of age or younger and who subsequently died were compared with control infants using a retrospective casecontrol design. Descriptive information was collected from records of infants who were not discharged home from the hospital of birth (because of death or transfer to a tertiary care hospital) to determine the age at which their illnesses presented. Methods. We reviewed death certificates for all infacts with birth weights of 2500 g or greater born at 37 weeks' gestational age or greater who died in the first 28 days of life and who were born in one of four Utah counties (1985 through 1989). Of the 109 256 eligible births, 115 infants were found who had died in the neonatal period. Eighty-four infants had not been discharged home from the hospital of birth, 5 infants had had hospital stays of more than 5 days, 9 records could not be located, 17 presumed healthy infants were discharged from the hospital at 5 days of age or younger. These 17 infants were each matched with 3 control infants. Newborn nursery charts were reviewed to determine hospital discharge times for case and control infants. Descriptive information regarding the time of presentation of illness was collected for the other 89 infants. Results. The mean age of hospital discharge was 43 ± 21 hours for the 17 case infants and 47 ± 25 hours for the 51 control infants. The odds ratio for neonatal mortality for discharge at less than 24 hours was 1.65 (95% confidence interval, 0.42 to 3.34) and for discharge at less than 48 hours was 1.16 (95% confidence interval, 0.4 to 3.34). Of the 84 infants who were not discharged home from the hospital of birth, 93% had been symptomatic by 12 hours of age, and 99% were symptomatic by 18 hours. Conclusions. Most full-term infants who die in the neonatal period are symptomatic within the first 18 hours after birth. We could not demonstrate an association between early hospital discharge and neonatal mortality in those infants who died after discharge home.
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Makino, Hiroshi, Akira Kushiro, Eiji Ishikawa, Delphine Muylaert, Hiroyuki Kubota, Takafumi Sakai, Kenji Oishi, et al. "Transmission of Intestinal Bifidobacterium longum subsp.longumStrains from Mother to Infant, Determined by Multilocus Sequencing Typing and Amplified Fragment Length Polymorphism." Applied and Environmental Microbiology 77, no. 19 (August 5, 2011): 6788–93. http://dx.doi.org/10.1128/aem.05346-11.
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ABSTRACTThe gastrointestinal tracts of neonates are colonized by bacteria immediately after birth. It has been discussed that the intestinal microbiota of neonates includes strains transferred from the mothers. Although some studies have indicated possible bacterial transfer from the mother to the newborn, this is the first report confirming the transfer of bifidobacteria at the strain level. Here, we investigated the mother-to-infant transmission ofBifidobacterium longumsubsp.longumby genotyping bacterial isolates from the feces of mothers before delivery and of their infants after delivery. Two hundred seven isolates from 8 pairs of mothers and infants were discriminated by multilocus sequencing typing (MLST) and amplified fragment length polymorphism (AFLP) analysis. By both methods, 11 strains ofB. longumsubsp.longumwere found to be monophyletic for the feces of the mother and her infant. This finding confirms that these strains were transferred from the intestine of the mother to that of the infant. These strains were found in the first feces (meconium) of the infant and in the feces at days 3, 7, 30, and 90 after birth, indicating that they stably colonize the infant's intestine immediately after birth. The strains isolated from each family did not belong to clusters derived from any of the other families, suggesting that each mother-infant pair might have unique family-specific strains.
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Sanjaya, Ayling, Nurhayati Masloman, Rocky Wilar, and Josef Tuda. "Toxoplasma gondii immunoglobulin G in paired infant-and-mother sera." Paediatrica Indonesiana 49, no. 2 (April 30, 2009): 65. http://dx.doi.org/10.14238/pi49.2.2009.65-8.
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Background Toxoplasmosis is a worldwide zoonotic diseasecaused by Toxoplasma gondii. Congenital toxoplasmosis (CT)is the result of vertical transmission during pregnancy thatmay cause pathologic effects on the newborn such as classicaltriad of congenital toxoplasmosis. Newborn humans are notimmunologically competent and the infant must be protected by passive lgG antibodies that are selectively transported across the placenta during development. We studied the transfer of passive lgG from the mother to developing infant using blood specimen taken from the infant within one month of birth.Objective To determine the seropositivity of lgG to T. gondii in paired sera of infants and mothers.Methods A cross sectional study was carried out on 50 pairedsera of infants of less than one month of age and their mothers. The study was carried out between November 2007 and January 2008 at Prof. R. D. Kandou Hospital in Manado. T. gondii lgG was detected using the Latex Agglutination method. The seropositivity ofT. gondii lgG was analyzed descriptively.Results A total of 28 mothers from 50 infant-mother pairs wereseropositive for T. gondii IgG. Of the 28 seropositive mothers, 22 of their paired infants were seropositive. The remaining six seropositive mothers had infants that were not seropositive for T. gondii.Conclusions The identification of seropositive lgG for T. gondii in infants less than one months age indicates that the lgGs in infants are mostly derived from their mothers. CT must be considered and further examinations are needed.
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Norman, E., P. Westrin, and V. Fellman. "Placental transfer and pharmacokinetics of thiopentone in newborn infants." Archives of Disease in Childhood - Fetal and Neonatal Edition 95, no. 4 (May 20, 2010): F277—F282. http://dx.doi.org/10.1136/adc.2009.177626.
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Rawat, Munmun, Praveen Chandrasekharan, Stephen Turkovich, Nancy Barclay, Katherine Perry, Eileen Schroeder, Lisa Testa, and Satyan Lakshminrusimha. "Oral Dextrose Gel Reduces the Need for Intravenous Dextrose Therapy in Neonatal Hypoglycemia." Biomedicine Hub 1, no. 3 (September 10, 2016): 1–9. http://dx.doi.org/10.1159/000448511.
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Background: Newborn infants with risk factors may require intravenous (IV) dextrose for asymptomatic hypoglycemia. Administration of IV dextrose and transfer to the neonatal intensive care unit (NICU) may interfere with parent-infant bonding. Objective: To study the effect of implementing dextrose gel supplement with feeds in late preterm/term infants affected by asymptomatic hypoglycemia on reducing IV dextrose therapy. Method: A retrospective study was conducted before and after dextrose gel use: 05/01/2014 to 10/31/2014 and 11/01/2014 to 04/30/2015, respectively. Asymptomatic hypoglycemic (blood glucose level <45 mg/dl) infants in the newborn nursery (NBN) were given a maximum of 3 doses of dextrose gel (200 mg/kg of 40% dextrose) along with feeds. Transfer to the NICU for IV dextrose was considered treatment failure. Results: Dextrose gel with feeds increased the blood glucose level in 184/250 (74%) of asymptomatic hypoglycemic infants compared to 144/248 (58%) with feeds only (p < 0.01). Transfer from the NBN to the NICU for IV dextrose decreased from 35/1,000 to 25/1,000 live births (p < 0.01). Exclusive breastfeeding improved from 19 to 28% (p = 0.03). Conclusions: Use of dextrose gel with feeds reduced the need for IV fluids, avoided separation from the mother and promoted breastfeeding. Neonates who failed dextrose gel therapy were more likely to be large for gestational age, delivered by cesarean section and had lower baseline blood glucose levels.
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Demers-Mathieu, Veronique, Robert K. Huston, Andi M. Markell, Elizabeth A. McCulley, Rachel L. Martin, Melinda Spooner, and David C. Dallas. "Differences in Maternal Immunoglobulins within Mother’s Own Breast Milk and Donor Breast Milk and across Digestion in Preterm Infants." Nutrients 11, no. 4 (April 24, 2019): 920. http://dx.doi.org/10.3390/nu11040920.
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Maternal antibody transfer to the newborn provides essential support for the infant’s naïve immune system. Preterm infants normally receive maternal antibodies through mother’s own breast milk (MBM) or, when mothers are unable to provide all the milk required, donor breast milk (DBM). DBM is pasteurized and exposed to several freeze–thaw cycles, which could reduce intact antibody concentration and the antibody’s resistance to digestion within the infant. Whether concentrations of antibodies in MBM and DBM differ and whether their survival across digestion in preterm infants differs remains unknown. Feed (MBM or DBM), gastric contents (MBM or DBM at 1-h post-ingestion) and stool samples (collected after a mix of MBM and DBM feeding) were collected from 20 preterm (26–36 weeks gestational age) mother–infant pairs at 8–9 and 21–22 days of postnatal age. Samples were analyzed via ELISA for the concentration of secretory IgA (SIgA), total IgA (SIgA/IgA), total IgM (SIgM/IgM) and IgG. Total IgA, SIgA, total IgM and IgG concentrations were 55.0%, 71.6%, 98.4% and 41.1% higher in MBM than in DBM, and were 49.8%, 32.7%, 73.9% and 39.7% higher in gastric contents when infants were fed with MBM than when infants were fed DBM, respectively. All maternal antibody isotypes present in breast milk were detected in the infant stools, of which IgA (not sIgA) was the most abundant.
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Alissa, Rana, Christopher Dudek, Laura Travers, Carmen Smotherman, Mark Hudak, and Kartikeya Makker. "Glucose Gel in Infants at Risk for Transitional Neonatal Hypoglycemia." American Journal of Perinatology 35, no. 11 (March 26, 2018): 1050–56. http://dx.doi.org/10.1055/s-0038-1639338.
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Objective To evaluate whether glucose gel as a supplement to feedings in infants admitted to the newborn nursery at risk for neonatal hypoglycemia (NH) reduces the frequency of transfer to a higher level of care for intravenous dextrose treatment. Study Design We revised our newborn nursery protocol for management of infants at risk for NH to include use of 40% glucose gel (200 mg/kg). Study population included late preterm, small and large for gestational age infants, and infants of diabetic mothers. We compared outcomes before (4/1/14–3/31/15: Year 1) and after (4/1/15–3/31/16: Year 2) initiation of the revised protocol. Our prospective primary outcome was transfer to the neonatal intensive care unit (NICU) for treatment with a continuous infusion of dextrose. Results NICU transfer for management of NH fell from 8.1% in Year 1 (34 of 421 at-risk infants screened) to 3.7% in Year 2 (14 of 383 at-risk infants screened). Rate of exclusive breastfeeding increased from 6% in Year 1 to 19% in Year 2. Hospital charges for the study population decreased from 801,276 USD to 387,688 USD in Year 1 and Year 2, respectively. Conclusion Our study supports the adjunctive use of glucose gel to reduce NICU admissions and total hospitalization expense.
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Buckmaster, Adam, Gaston Arnolda, Louise Owen, Calum Roberts, Peter Davis, and Brett Manley. "Lost in Transition: Is Early Respiratory Support in Newborn Infants the Best Option?" Neonatology 117, no. 4 (2020): 517–21. http://dx.doi.org/10.1159/000508554.
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<b><i>Background:</i></b> Late preterm and term newborns with respiratory distress are increasingly treated with non-invasive ventilation (NIV) including nasal high-flow or continuous positive airway pressure. For infants with mild distress, NIV may be unnecessary. <b><i>Objectives:</i></b> We speculated that treatment with supplemental oxygen (SO) prior to NIV could help clinicians select infants for NIV treatment, and examined this hypothesis using data from a recently completed trial. <b><i>Method:</i></b> Post hoc analysis of data from a subset of infants enrolled in the HUNTER trial. Infants born at ≥36 weeks’ gestation were categorized by whether they were receiving SO prior to randomization. The 2 groups were compared for illness severity (indicated by treatment failure at 72 h, mechanical ventilation, need for up-transfer, SO requirement post-randomization, and length of time receiving respiratory support), use of selected medical interventions (antibiotics, intravenous fluids), and breastfeeding at discharge. <b><i>Results:</i></b> Analysis included 380 infants. Infants not receiving SO had less severe illness; lower rates of treatment failure (7.3 vs. 17.2%), mechanical ventilation (0.6 vs. 5.9%), need for transfer (6.8 vs. 13.8%), and more often did not receive any SO post-randomization (75.1 vs. 3.0%). Most infants in both groups received intravenous fluids (93 and 98%) and antibiotics (81 and 93%); the rate of full breastfeeding was low in both groups (51 and 45%). <b><i>Conclusions:</i></b> Late preterm and term newborn infants without SO requirement at the time of commencing NIV for respiratory distress are at lower risk of requiring treatment escalation. Close observation of these infants (watch and wait strategy) may avoid unnecessary treatment.
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Kapil, Parul, Lindsey I. Zimmerman, Leslie D. Wagner, James F. Papin, and Tod J. Merkel. "Maternal Pertussis Vaccination with a Mono-component Pertussis Toxoid Vaccine is Sufficient to Protect Newborns." Journal of Immunology 198, no. 1_Supplement (May 1, 2017): 147.22. http://dx.doi.org/10.4049/jimmunol.198.supp.147.22.
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Abstract Bordetella pertussis is a highly infectious human pathogen causing serious illness in infants, children and adults. The first pertussis vaccination is administered at two months of age, therefore, infants under two months of age are most vulnerable to infection. Rising incidence of pertussis resulted in the 2012 recommendation by the Advisory Committee on Immunization Practices (ACIP) to immunize all pregnant women to protect infants from birth until their first vaccination. Using a baboon model, we demonstrated that maternal vaccination with the three or four component acellular pertussis vaccines protected newborn baboons from the disease but not from the colonization. We hypothesized this protection was due to the transfer of maternal anti-PT antibodies to the infant. Therefore we evaluated the protection conferred by maternal vaccination with a pertussis toxoid (PTx) only vaccine. Infant baboons born to mothers vaccinated with the PTx-only vaccine were free from disease and had low WBC counts following exposure to B. pertussis at five weeks of age. In contrast, infants born to unvaccinated mothers experienced severe disease with high WBC counts. Our results demonstrate that vaccination of baboons during pregnancy with a PTx-only vaccine is sufficient to protect newborn baboons from disease following exposure to pertussis. Because pertussis toxin is a secreted protein that can be purified from bacterial supernatants, a single-component vaccine comprised of pertussis toxoid is very likely the most cost-effective acellular pertussis vaccine possible. The development and use of mono-component PTx vaccines may enable the extension of maternal vaccine programs to low and middle income countries.
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Stoffel, Nicole Ursula, Michael Bruce Zimmermann, Ana Carla Cepeda Lopez, Karla I. Cervantes Gracia, Elida E. Lee Bazaldua, Zeder Christophe, Katharina Quack-Loetscher, Sueppong Gowachirapant, and Isabelle Herter-Aeberli. "Compared to Normal-Weight Pregnant Women, Overweight Pregnant Women Fail to Upregulate Iron Absorption in the Third Trimester Despite Iron Deficiency and Their Infants Are Born with Lower Body Iron Stores." Blood 136, Supplement 1 (November 5, 2020): 51–52. http://dx.doi.org/10.1182/blood-2020-139453.
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Introduction: Overweight/obesity (OWOB) causes low-grade systemic inflammation which induces hepcidin and a reduces fractional iron absorption (FIA) even when iron stores are low. Pregnancy increases iron needs because of the expansion of maternal blood volume and fetal needs. It is unclear whether and/or to what extent OWOB during pregnancy influences FIA, iron supply of the fetus and risk of iron deficiency in mother and newborn. In this study, we (1) determined the impact of maternal OWOB on FIA in pregnancy and on the transfer of iron to the fetus and newborn iron status; (2) confirmed the relationship between BMI, hepcidin, serum ferritin (SF) and inflammatory markers. Methods: In this prospective experimental multi-center case-control study (normal-weight (NW) n=40; OWOB n=37) we administered labeled [57Fe]- or [58Fe]-FeSO4 to women during the 2nd and 3rd trimester of pregnancy. We measured FIA by determining erythrocyte incorporation of iron stable isotopes 14 days after administration. From pregnancy week (PW) 12 until PW 36, iron-, inflammation and hepcidin were monitored. Iron transfer to the fetus was determined isotopically as the concentration of circulating iron in the infant aged three days. We assessed iron status in infants born to NW (n=29) and OWOB (n=31) at age three days, three months and six months. Results: Subject characteristics in PW 12 for the NW/OWOB were: mean (±SD) age: 29±6/ 30±6 years, median (IQR) pre-pregnancy BMI: 21.6 (20.3-23.7)/ 31.6 (28.4-35.9) kg/m2 (p<0.001), mean (±SD) hemoglobin: 12.3±1.1/ 12.4±0.9 g/dL, median (IQR) SF: 27.7 (17.3-48.2)/ 30.6 (16.6-64.4) µg/L and median (IQR) interleukin-6: 1.41 (1.03-1.95)/ 2.37 (1.91-3.85) pg/ml (p<0.001). Independent sample t-test showed no difference in FIA between NW and OWOB in the 2nd trimester with median FIA (IQR) 12.3 (7.2-20.6) and 10.1 (6.9-17.2) % (p=0.788). Despite the OWOB had ≈30% lower body iron stores (BIS) and comparable hepcidin concentrations to the NW in the 3rd trimester, FIA was significantly higher in the NW compared to the OWOB with median FIA (IQR) 22.3 (10.6-33.8) and 12.7 (10.4-18.1) % (p=0.042). In the NW, FIA was upregulated by 80% in the 3rd trimester compared to the 2nd trimester, whereas in the OWOB FIA, it was only upregulated by 25%. Linear mixed effect model analysis (LMM) showed a significant group-effects on weight, IL-6 and CRP throughout pregnancy (all p<0.05), but surprisingly no group-effect on hepcidin. In multiple regression analysis, the main predictor of hepcidin throughout pregnancy was BIS, not inflammation. Iron transfer to the newborn was non-significantly higher in the NW compared to the OWOB with mean (±SD) circulating iron in the newborn at age three days 136.6 ± 42.7 and 126.3 ± 32.4 mg. LMM on infant BIS and on infant serum transferrin receptor (sTfR) over the first six months showed significant group (p=0.024, p=0.046) and time-effects (both p<0.001) with lower BIS and higher sTfR in infants born to OWOB. Median (IQR) BIS at age six months were 7.7 (6.3-8.8) and 6.6 (4.6-9.2) mg/kg bodyweight in infants born to NW and OWOB. Conclusion: In normal pregnancy, FIA increases over time to support increased iron needs of mother and fetus. Our data show a dramatically reduced increase in FIA in OWOB pregnant women in the 3rd trimester, despite low BIS and low hepcidin, and this results in less iron transfer to the fetus. Future molecular studies are needed to clarify the mechanism of reduced FIA and fetal iron transfer in OWOB. To our knowledge, this is the first study assessing the impact of maternal OWOB on infant iron status at multiple time points over the first six months. Our findings strongly argue for careful monitoring of iron status in OWOB pregnancy and for defining a more effective iron supplementation regimen for this population group. Prevalence of anemia in pregnancy and infancy is high, especially in low and middle income countries and is often associated with severe health consequences. If iron status of OWOB pregnant women and their infants could be improved by optimizing iron supplementation guidelines for OWOB, this could have major benefits. Disclosures No relevant conflicts of interest to declare.
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Irzhak, L. I., and T. A. Potapova. "Acid-base and gas-transfer properties of the blood of newborn infants." Human Physiology 34, no. 1 (January 2008): 50–53. http://dx.doi.org/10.1134/s0362119708010076.
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Tran, Dat, Bridgette Dingle, Yuying Liu, Nicole Fatheree, and J. Marc Rhoads. "Protective function of FoxP3+ regulatory T cells in experimental necrotizing enterocolitis (P1010)." Journal of Immunology 190, no. 1_Supplement (May 1, 2013): 65.6. http://dx.doi.org/10.4049/jimmunol.190.supp.65.6.
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Abstract Necrotizing enterocolitis (NEC) results from severe intestinal inflammation in premature infants. FoxP3+ regulatory T cells (Tregs) are central to gut homeostasis. While Tregs are reduced in the ileums of premature infants with NEC, it is unknown whether they play a critical function in preventing NEC. This study investigated Treg development in newborn rat pups and their function in regulating experimental NEC induction. Utilizing a rat model of experimental NEC, the ontogeny of T cells and Tregs in newborn pups was characterized by flow cytometry. To investigate the functions of Tregs, newborn pups were given Tregs harvested from adult rats prior to NEC induction to assess clinical improvement and mechanisms of immune regulation. The results revealed that there were few Treg numbers in the terminal ileums of newborn rats and 8-fold reduction after NEC (p=0.002). Adoptive transfer of Tregs significantly improved weight loss, survival from 53% to 88%, and NEC incidence from 87% to 35% (p<0.05). The Tregs suppressed the upregulation of costimulatory molecule CD80 on dendritic cells and inhibited the trafficking of effector cells from leaving the MLN. These findings suggest that there is a developmental delay in Tregs which contributes to the excessive inflammatory state in NEC. Adoptive transfer of Tregs attenuates the induction of NEC by regulating DCs and modulating effector cell trafficking. Treg immunotherapy has a therapeutic potential in the prevention of NEC.
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Araki, Shunsuke, and Akira Shirahata. "Vitamin K Deficiency Bleeding in Infancy." Nutrients 12, no. 3 (March 16, 2020): 780. http://dx.doi.org/10.3390/nu12030780.
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Vitamin K is essential for the synthesis of few coagulation factors. Infants can easily develop vitamin K deficiency owing to poor placental transfer, low vitamin K content in breast milk, and poor intestinal absorption due to immature gut flora and malabsorption. Vitamin K deficiency bleeding (VKDB) in infancy is classified according to the time of presentation: early (within 24 h), classic (within 1 week after birth), and late (between 2 week and 6 months of age). VKDB in infancy, particularly late-onset VKDB, can be life-threatening. Therefore, all infants, including newborn infants, should receive vitamin K prophylaxis. Exclusive breastfeeding and cholestasis are closely associated with this deficiency and result in late-onset VKDB. Intramuscular prophylactic injections reduce the incidence of early-onset, classic, and late-onset VKDB. However, the prophylaxis strategy has recently been inclined toward oral administration because it is easier, safer, and cheaper to administer than intramuscular injection. Several epidemiological studies have shown that vitamin K oral administration is effective in the prevention of VKDB in infancy; however, the success of oral prophylaxis depends on the protocol regimen and parent compliance. Further national surveillance and studies are warranted to reveal the optimal prophylaxis regimen in term and preterm infants.
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Weiler, Hope A., Catherine A. Vanstone, Maryam Razaghi, Nathalie Gharibeh, Sharina Patel, Shu Q. Wei, and Dayre McNally. "Disparities in Vitamin D Status of Newborn Infants from a Diverse Sociodemographic Population in Montreal, Canada." Journal of Nutrition 152, no. 1 (October 6, 2021): 255–68. http://dx.doi.org/10.1093/jn/nxab344.
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ABSTRACT Background Vitamin D status at birth is reliant on maternal–fetal transfer of vitamin D during gestation. Objectives We aimed to examine the vitamin D status of newborn infants in a diverse population and to subsequently identify the modifiable correlates of vitamin D status. Methods In this cross-sectional study, healthy mother–infant dyads (n = 1035) were recruited within 36 h after term delivery (March 2016–March 2019). Demographic and lifestyle factors were surveyed. Newborn serum 25-hydroxyvitamin D [25(OH)D] was measured (standardized chemiluminescence immunoassay) and categorized as deficient [serum 25(OH)D <30 nmol/L] or adequate (≥40 nmol/L). Serum 25(OH)D was compared among categories of maternal characteristics using ANOVA; each characteristic was tested in a separate model. Subgroups (use of multivitamins preconception and continued in pregnancy compared with during pregnancy only) were matched (n = 352/group) for maternal factors (ancestry, age, income, education, parity, and prepregnancy BMI) using propensity scores; logistic regression models were generated for odds of deficiency or adequacy. Results Infants’ mean serum 25(OH)D was 45.9 nmol/L (95% CI: 44.7, 47.0 nmol/L) (n = 1035), with 20.8% (95% CI: 18.3%, 23.2%) deficient and 60.7% (95% CI: 55.2%, 66.2%) adequate. Deficiency prevalence ranged from 14.6% of white infants to 41.7% of black infants. Serum 25(OH)D was higher (P < 0.0001) in infants of mothers with higher income, BMI < 25 kg/m2, exercise and sun exposure in pregnancy, and use of multivitamins preconception. In the matched-subgroup analysis, multivitamin supplementation preconception plus during pregnancy relative to only during pregnancy was associated with lower odds for vitamin D deficiency (ORadj: 0.55; 95% CI: 0.36, 0.86) and higher odds for adequate vitamin D status (ORadj: 1.47; 95% CI: 1.04, 2.07). Conclusions In this study most newborn infants had adequate vitamin D status, yet one-fifth were vitamin D deficient with disparities between population groups. Guidelines for a healthy pregnancy recommend maternal use of multivitamins preconception and continuing in pregnancy. An emphasis on preconception use may help to achieve adequate neonatal vitamin D status. This trial was registered at clinicaltrials.gov as NCT02563015.
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Köstlin-Gille, Natascha, Lara-Antonia Flaig, Marco Ginzel, Jörg Arand, Christian F. Poets, and Christian Gille. "Granulocytic Myeloid-Derived Suppressor Cells in Breast Milk (BM-MDSC) Correlate with Gestational Age and Postnatal Age and Are Influenced by Infant’s Sex." Nutrients 12, no. 9 (August 25, 2020): 2571. http://dx.doi.org/10.3390/nu12092571.
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Background: Infections are the main cause of death in preterm infants. Causative agents often descend from the intestinal flora of the infected neonate, indicating insufficient protection by the mucosal barrier. Breast milk (BM) contains different subsets of immune cells. We recently showed that BM contains significant numbers of myeloid-derived suppressor cells (MDSC)—immune cells that actively suppress pro-inflammatory immune responses—and hypothesized that the transfer of BM-MDSC may modulate the mucosal immunity of the newborn. Methods: Percentages of MDSC in the BM from mothers of 86 preterm infants between 23 + 0 and 36 + 6 weeks of gestation during their first five postnatal weeks were analyzed by flow cytometry and correlated with maternal and infant characteristics. Results: Percentages of BM-MDSC positively correlated with gestational age and postnatal age. The expression of activation markers on BM-MDSC did not change with gestational age, but it decreased with postnatal age. Mothers who received antepartum tocolytics had lower percentages of BM-MDSC, and infant’s sex strongly influenced percentages of BM-MDSC. Conclusion: Our results point toward a role of BM-MDSC for immune regulation in the neonatal gut, making them a potential target of immune-based therapies shortly after birth.
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Elahi, Shokrollah, Rachelle M. Buchanan, Lorne A. Babiuk, and Volker Gerdts. "Maternal Immunity Provides Protection against Pertussis in Newborn Piglets." Infection and Immunity 74, no. 5 (May 2006): 2619–27. http://dx.doi.org/10.1128/iai.74.5.2619-2627.2006.
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ABSTRACT Pertussis continues to be a significant cause of morbidity and mortality in infants and young children worldwide. Methods to control the disease are based on vaccination with either whole-cell or acellular vaccines or treatment with antibiotics. However, despite worldwide vaccination infants are still at the highest risk for the disease. Here we used our newly developed newborn-piglet model to investigate whether transfer of maternal immunity can protect newborn piglets against infection with Bordetella pertussis. Pregnant sows were vaccinated with heat-inactivated B. pertussis or treated with saline (controls). Newborn piglets were allowed to suckle colostrum and milk for 4 to 5 days before they were challenged with 5 × 109 CFU of bacteria intrapulmonarily. Elevated levels of B. pertussis-specific secretory immunoglobulin A (S-IgA) and IgG antibodies were found in the colostrum and serum of vaccinated sows but not in those of control sows. Subsequently, significant levels of specific IgG and S-IgA were detected in the serum and bronchoalveolar lavage fluid of piglets born to vaccinated sows. Following infection with 5 × 109 CFU of B. pertussis, clinical symptoms, pathological alterations, and bacterial shedding were significantly reduced in piglets that had received passively transferred immunity. Thus, our results demonstrate that maternal immunization might represent an alternative approach to provide protection against pertussis in young infants.
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Streri, Arlette, and Edouard Gentaz. "The haptic abilities of the human newborn." Zeitschrift für Entwicklungspsychologie und Pädagogische Psychologie 41, no. 4 (October 2009): 173–80. http://dx.doi.org/10.1026/0049-8637.41.4.173.
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Abstract. How do human babies gain knowledge by touch? This review presents information on the haptic abilities of human newborns and preterm infants which sheds light on this question. How do full-term and preterm newborns perceive information and form a perceptual representation of objects extracted from the hands alone? How do full-term newborns transfer this information to vision in an intermodal process? Using a habituation/dishabituation procedure, experiments have revealed that preterm and full-term newborns are able to discriminate object shapes in the manual, as well as in the visual modalities for full-term newborns. These abilities are a prerequisite for the establishment of relations between haptic and visual sensory information in cross-modal transfer tasks. We discuss several experiments performed using an intersensory successive preference procedure which provide evidence for cross-modal recognition from touch to vision from birth in full-term newborns. The links, however, are limited, partial, and not always reciprocal. We discuss these results in the light of recent theories on visual-haptic links.
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Kumar, Praveen, Debra A. Hoppensteadt, M. Margaret Prechel, Ruth B. Deddish, and Jeanine M. Walenga. "Prevalance of Heparin-Dependent Platelet-Activating Antibodies in Preterm Newborns After Exposure to Unfractionated Heparin." Clinical and Applied Thrombosis/Hemostasis 10, no. 4 (October 2004): 335–39. http://dx.doi.org/10.1177/107602960401000405.
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Heparin is frequently used in preterm infants to prolong the patency of intravascular catheters. The aim of this study was to evaluate the prevalence of heparin-dependent platelet-activating antibodies in newborns. A cross-section of all preterm newborn infants expected to require heparin to maintain patency of a central venous access line were enrolled. A blood sample was obtained soon after birth before heparin exposure to exclude the possibility of placental transfer of maternal heparin-dependent platelet-activating antibodies. A second sample was obtained at termination of heparin use (mean duration of heparin exposure was 23 ± 13 days; range, 6-67). Paired samples, at birth and after heparin use, were available for 42 infants with a mean gestational age of 27.8 ± 2.2 weeks and birth weight of 1036 ± 267 g. Thrombocytopenia developed in 57% (24/42) of the infants. None of these infants had clinical suspicion of thrombosis during the study period. The etiology of thrombocytopenia was confirmed sepsis in six, presumed sepsis in three, necrotizing enterocolitis in one, and unclear in 14 infants. Anti-heparin/platelet factor 4 antibodies measured using the standard assays for heparin-induced thrombocytopenia (two commercially available enzyme-linked immunosorbent assay tests and the functional platelet serotonin release assay) were negative on all infants. Although it could be related to the poor ability of these infants to mount an immunologic response, further research is necessary to fully understand this lack of response to heparin and to elucidate further the reasons for thrombocytopenia in very-low-birth-weight infants.
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Lyons, Katríona E., C. Anthony Ryan, Eugene M. Dempsey, R. Paul Ross, and Catherine Stanton. "Breast Milk, a Source of Beneficial Microbes and Associated Benefits for Infant Health." Nutrients 12, no. 4 (April 9, 2020): 1039. http://dx.doi.org/10.3390/nu12041039.
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Human breast milk is considered the optimum feeding regime for newborn infants due to its ability to provide complete nutrition and many bioactive health factors. Breast feeding is associated with improved infant health and immune development, less incidences of gastrointestinal disease and lower mortality rates than formula fed infants. As well as providing fundamental nutrients to the growing infant, breast milk is a source of commensal bacteria which further enhance infant health by preventing pathogen adhesion and promoting gut colonisation of beneficial microbes. While breast milk was initially considered a sterile fluid and microbes isolated were considered contaminants, it is now widely accepted that breast milk is home to its own unique microbiome. The origins of bacteria in breast milk have been subject to much debate, however, the possibility of an entero-mammary pathway allowing for transfer of microbes from maternal gut to the mammary gland is one potential pathway. Human milk derived strains can be regarded as potential probiotics; therefore, many studies have focused on isolating strains from milk for subsequent use in infant health and nutrition markets. This review aims to discuss mammary gland development in preparation for lactation as well as explore the microbial composition and origins of the human milk microbiota with a focus on probiotic development.
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Williams, Leslie, Thomas Shaffer, and Jay Greenspan. "Inhaled Nitric Oxide Therapy in the Near-Term or Term Neonate with Hypoxic Respiratory Failure." Neonatal Network 23, no. 1 (January 2004): 5–13. http://dx.doi.org/10.1891/0730-0832.23.1.5.
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Inhaled nitric oxide (iNO) has altered the management strategy for treating near-term and term infants with hypoxic respiratory failure (HRF) There is a strong relationship between HRF and persistent pulmonary hypertension of the newborn (PPHN). PPHN is characterized by elevated pulmonary resistance, pulmonary vasoconstriction, and altered vascular reactivity. The resulting high pulmonary pressure may lead to HRF, which is defined as a relative deficiency of oxygen in arterial blood and insufficient minute ventilation. iNO improves oxygenation and decreases the need for extracorporeal membrane oxygenation. Although iNO therapy is effective, its efficacy can depend on the fine points of its use and on other care the infant is receiving. Even in NICUs that do not have iNO available, those who care for term infants with HRF must be familiar with its use and know when and how to transfer these infants and how to help families through this difficult period. Because iNO therapy will probably be used more frequently in nurseries over the next few years, more information on the safety and efficacy of its use in the broader neonatal population needs to be available.
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Balistreri, William F., Michael K. Farrell, and Kevin E. Bove. "Lessons From the E-Ferol Tragedy." Pediatrics 78, no. 3 (September 1, 1986): 503–6. http://dx.doi.org/10.1542/peds.78.3.503.
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"Those who cannot remember the past are condemned to repeat it."—G. Sabtatana Several factors combined to suggest that supplemental vitamin E should be administered to low birth weight infants. The persistent concern and controversy, the latter confounded by a paucity of data, have been discussed in recent editorials.1,2 At birh, tissue stores of the naturally occurring lipidsoluble antioxidant vitamin E (α-tocopherol) are low. The amount of total tocopherol in the tissue of premature infants is approximately one half that of full-term infants. 3 Maternal vitamin E supplementation seems to have minimal effect on serum vitamin E levels in the newborn because there is poor placental transfer; maternal blood levels are higher than cord levels.1-3
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Ando, Mitsuru, Hiroshi Saito, and Ichiro Wakisaka. "Transfer of polychlorinated biphenyls (PCBs) to newborn infants through the placenta and mothers' milk." Archives of Environmental Contamination and Toxicology 14, no. 1 (January 1985): 51–57. http://dx.doi.org/10.1007/bf01055761.
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Selvamani, Shanmugaprakasham, Daniel Dailin, Vijai Gupta, Mohd Wahid, Ho Keat, Khairun Natasya, Roslinda Malek, et al. "An Insight into Probiotics Bio-Route: Translocation from the Mother’s Gut to the Mammary Gland." Applied Sciences 11, no. 16 (August 6, 2021): 7247. http://dx.doi.org/10.3390/app11167247.
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Human breast milk (HBM) is unique in its composition as it is adapted to fulfil the newborns’ nutritional requirement and helps in improving the health of newborns. Besides various nutrients, the human milk also contains diverse group of microbiotas. The human milk microbiota has a remarkable impact on the growth and development of a newborn. Additionally, the human milk microbiota enhances the colonization of microbes in the gut of infants. Debates about the origin of HBM microbial flora remain premature and contradictory in some cases. Recent data suggest that the maternal gut microbiota has a major impact on microbial composition, areolar skin, and from the infant’s oral cavity. The current review investigates the possible route of microbial transfer from the maternal gut to mammary gland and suggests that it might occur through the entero-mammary pathway. It involves precise selection of probiotic microorganisms from the gut, as the human gut hosts trillions of microorganisms involved in gut homeostasis and other metabolic pathways. Gastrointestinal lymphatic vessels, macrophages, and dendritic cells are shown to play a significant role in the microbial transmission. Furthermore, the role of microbial factors in the development of neonatal immunity and translocation of secretory IgA (SIgA) cells from the intestinal lumen to GALT and finally to mammary glands via entero-mammary link are discussed.
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Khan, Ghulam Mostafa. "Selection of Blood (Packed RBCs) for Transfusion in Newborn Baby up to the Age of 4 Months." Journal of Enam Medical College 1, no. 1 (July 9, 2012): 36–40. http://dx.doi.org/10.3329/jemc.v1i1.11138.
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Proper selection of donors blood group is essential to prevent transfusion hazards. It is known that ABO antigen is fully developed at birth but the newborn baby does not produce ABO antibodies until 3 to 6 months of age. The ABO antibodies present in the serum of newborn babies are derived from mothers blood due to placental transfer. So the blood group of the newborn baby is done by ABO antigen grouping (forward grouping) only, antibody grouping (reverse grouping) is not required. In case of transfusion of blood in newborn under 4 months of age, cross-matching of donors blood is done with the mothers blood if it is available. We know, recipients same group of blood is always preferable in case of transfusion in adults or older children. But selection of blood for transfusion in the infants under 4 months of age depends on the mothers blood group as well. If the mothers blood group differs from the infants blood group, the infants same group of blood may not be selected for transfusion. For example, if the mothers blood group is O and the newborn blood group is A or B, infants same group A or B group blood could not be transfused, because the anti-A & anti-B antibodies can be derived in the infants serum from mothers blood which may react with the A or B antigen of the donors blood. In this case O group packed RBCs should be selected for transfusion. O group whole blood may contain IgG anti-A and anti-B antibodies in the plasma which can react with the A or B antigen of the infants blood. So to avoid anti-A & anti-B antibodies in O group, plasma should be discarded and the packed RBCs should be transfused. In case of Rh-negative mother with Rh positive baby, Rh antibody may develop in mothers blood and Rh antibody may enter into babys circulation, in this case the infant should be transfused with Rh-negative blood to avoid Rh antigen & antibody reaction. So for the selection of blood for transfusion in newborn baby up to the age of 4 months mothers blood group is important to select the appropriate blood. DOI: http://dx.doi.org/10.3329/jemc.v1i1.11138J Enam Med Col 2011; 1(1): 36-40
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Bashir, Muhammad Faruk, Hassan Abdullahi Elechi, Mohammed Garba Ashir, Adamu Ibrahim Rabasa, David Nadeba Bukbuk, Ahmadu Baba Usman, Modu Gofama Mustapha, and Mohammad Arab Alhaji. "Neonatal Tetanus Immunity in Nigeria: The Effect of HIV Infection on Serum Levels and Transplacental Transfer of Antibodies." Journal of Tropical Medicine 2016 (2016): 1–6. http://dx.doi.org/10.1155/2016/7439605.
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Background. Tetanus toxoid immunisation of pregnant mother has remained the most effective strategy in eliminating neonatal tetanus. Impaired production and/or transplacental transfer of antibodies may affect the effectiveness of this strategy. We studied the effect of maternal HIV infection on serum levels and transplacental transfer of anti-tetanus antibodies.Methods. A total of 162 mother-baby paired serum samples were taken and analysed for anti-tetanus antibody levels using ELISA. Maternal HIV status was also determined by double ELISA technique. Maternal TT vaccination status was also documented.Results. Thirty-eight (23.5%) mothers and 41 (25.3%) babies were seronegative, out of whom 8 mothers were HIV positive and 9 babies were HIV exposed. HIV infected mothers and HIV exposed infants were, respectively, 16.27 times (OR = 16.27, 95% CI = 3.28 to 80.61) and 33.75 times (OR = 33.75, 95% CI = 4.12 to 276.40) more likely to be seronegative for anti-tetanus antibody. Similarly, HIV positive mother-newborn pairs were 7.46 times more likely to have a poor transplacental transfer of tetanus antibodies (OR = 7.46, 95% CI = 1.96 to 28.41).Conclusions. Maternal HIV infection is associated with impaired maternofoetal transfer of anti-tetanus antibodies and seronegativity among mothers and their newborns. Hence, this may hinder efforts to eliminate neonatal tetanus.
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Thoene, Melissa, Haley Haskett, Jeremy Furtado, Maranda Thompson, Matthew Van Ormer, Corrine Hanson, and Ann Anderson-Berry. "Effect of Maternal Retinol Status at Time of Term Delivery on Retinol Placental Concentration, Intrauterine Transfer Rate, and Newborn Retinol Status." Biomedicines 8, no. 9 (August 31, 2020): 321. http://dx.doi.org/10.3390/biomedicines8090321.
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Retinol (vitamin A) is essential, so the objective of this Institutional Review Board approved study is to evaluate retinol placental concentration, intrauterine transfer, and neonatal status at time of term delivery between cases of maternal retinol adequacy, insufficiency, and deficiency in a United States population. Birth information and biological samples were collected for mother–infant dyads (n = 260). Maternal and umbilical cord blood retinol concentrations (n = 260) were analyzed by HPLC and categorized: deficient (≤0.7 umol/L), insufficient (>0.7–1.05 umol/L), adequate (>1.05 umol/L). Intrauterine transfer rate was calculated: (umbilical cord blood retinol concentration/maternal retinol concentration) × 100. Non-parametric statistics used include Spearman’s correlations, Mann–Whitney U, and Kruskal–Wallis tests. p-values <0.05 were statistically significant. Only 51.2% of mothers were retinol adequate, with 38.4% insufficient, 10.4% deficient. Only 1.5% of infants were retinol adequate. Placental concentrations (n = 73) differed between adequate vs. deficient mothers (median 0.13 vs. 0.10 μg/g; p = 0.003). Umbilical cord blood concentrations were similar between deficient, insufficient, and adequate mothers (0.61 vs. 0.55 vs. 0.57 μmol/L; p = 0.35). Intrauterine transfer increased with maternal deficiency (103.4%) and insufficiency (61.2%) compared to adequacy (43.1%), p < 0.0001. Results indicate that intrauterine transfer rate is augmented in cases of maternal retinol inadequacy, leading to similar concentrations in umbilical cord blood at term delivery.
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Erickson, Elise N., C. Sue Carter, and Cathy L. Emeis. "Oxytocin, Vasopressin and Prolactin in New Breastfeeding Mothers: Relationship to Clinical Characteristics and Infant Weight Loss." Journal of Human Lactation 36, no. 1 (April 29, 2019): 136–45. http://dx.doi.org/10.1177/0890334419838225.
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Background: Maternal milk production requires the neuropeptide oxytocin. Individual variation in oxytocin function is a compelling target for understanding low milk production, a leading cause of breastfeeding attrition. Complicating the understanding of oxytocin pathways is that vasopressin may interact with oxytocin receptors, yet little is known about the role of vasopressin in lactation. Research aims: The aims of this study were (1) to describe maternal plasma oxytocin, vasopressin, and prolactin patterns during breastfeeding following low-risk spontaneous labor and birth in healthy first-time mothers and (2) to relate hormone patterns to maternal characteristics and breastfeeding measures. Methods: Eligible women were recruited before hospital discharge. Forty-six participants enrolled and 35 attended the study visit. Participants kept a journal of breastfeeding frequency, symptoms of lactogenesis, and infant weight. Plasma samples were obtained at breastfeeding onset on Day 4–5 postpartum, and repeated after 20 min. Hormones were measured with immunoassays. Infant weight change, milk transfer, and onset of lactogenesis were also measured. Results: Baseline oxytocin and vasopressin were inversely related to one another. Oxytocin and prolactin increased significantly across the 20-min sampling period while vasopressin decreased. Higher oxytocin was associated with higher maternal age, lower BMI, shorter active labor, physiologic labor progression, and less weight loss in the newborn. Higher vasopressin correlated with younger maternal age, higher BMI, and greater newborn weight loss. Conclusions: Oxytocin and vasopressin have contrasting relationships with maternal clinical characteristics and newborn weight gain in early breastfeeding infants. Further study is needed to understand how oxytocin and vasopressin influence lactation outcomes.
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Robinson, David L., Mark S. Craig, Ronald S. Wells, Kirk N. Liesemer, and Matthew A. Studer. "Newborn Screening Pulse Oximetry to Detect Critical Congenital Heart Disease: A Follow-Up Survey of Current Practice at Army, Navy and Air Force Hospitals." Military Medicine 184, no. 11-12 (May 15, 2019): 826–31. http://dx.doi.org/10.1093/milmed/usz116.
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Abstract Introduction The purpose of this study was to assess the evolution of newborn pulse oximetry screening (+POx) among Army, Air Force, and Naval military hospitals (MH), including prevalence, protocol use, quality assurance processes, access to echocardiography, and use of telemedicine. This is a follow-up from a prior study published in 2011. Materials and Methods An Internet-based questionnaire was forwarded to the chief pediatrician at MH worldwide which support newborn deliveries. Descriptive data were reported using percentages. Grouped responses, as applicable, were further compared using the chi-square test. A p-value < 0.05 was considered statistically significant. Results Seventy-eight percent (36/46) of MH supporting deliveries worldwide responded to the survey (17 Army hospitals, 11 Navy Hospitals, 8 Air Force hospitals). All responding hospitals utilize +POx, of which 94% endorsed protocol compliance with the American Academy of Pediatrics guidelines. Nine (25%) hospitals were located outside of the United States. Delivery volumes (infants per month) range between 1–49 (36%), 50–99 (28%), 100–199 (19%), and 200–300 (17%). Eleven hospitals reported regular review of +POx data, with most reviewing them monthly. Four MH share findings with state institutions. Ten hospitals either have a staff pediatric cardiologist or use tele-echocardiography for on-site evaluations. Ten hospitals are located greater than 60 miles from the nearest center with echocardiography capabilities. Of the five hospitals using tele-echocardiography, four confirmed critical congenital heart disease (CCHD) using this practice, and all five reported averting transfer of an infant using this technology. Of the 22 hospitals lacking the ability to obtain on-site echocardiography, 12 (55%) are interested in implementing a tele-echocardiography protocol. Conclusions All responding MH use +POx, representing significant increase from the 30% of MH reporting use of +POx seven years ago. The majority of MH follow AAP +POx guidelines, and though most have providers review results prior to discharge, only one-third report periodic chart review for quality assurance. Most MH transfer infants with positive +POx results for evaluation due to a lack of on-site echocardiography. Tele-echocardiography was reported as a potential solution to diagnose or rule out CCHD. Over half of remaining hospitals without cardiologists are interested in using this technology to evaluate stable infants with positive CCHD screening.
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Saso, Anja, Alasdair Bamford, Karen Grewal, Muna Noori, James Hatcher, Felice D'Arco, Edward Guy, and Hermione Lyall. "Fifteen-minute consultation: Management of the infant born to a mother with toxoplasmosis in pregnancy." Archives of disease in childhood - Education & practice edition 105, no. 5 (February 18, 2020): 262–69. http://dx.doi.org/10.1136/archdischild-2018-316603.
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Congenital toxoplasmosis occurs following transplacental transfer of Toxoplasma gondii. Irrespective of symptom status at birth, infants with congenital infection may develop serious long-term sequelae, including learning disability, seizures, hydrocephalus, motor and hearing deficits, chorioretinitis and retinal scarring with impaired vision. Timely diagnosis facilitates early initiation of therapy, aimed at prevention or amelioration of adverse clinical consequences. Diagnosis can be difficult, however, since acutely infected mothers are often asymptomatic and laboratory testing can be complex. Moreover, any decision to start treatment in the newborn must include careful consideration of the benefits and risks. This paper outlines a structured approach for managing an infant born to a woman with possible or confirmed T. gondii infection during pregnancy, including key aspects of the antenatal history, interpretation and timing of investigations, treatment and appropriate follow-up. Our recommendations are based on current evidence in the literature, consensus from two UK paediatric infectious disease centres and the UK specialist Toxoplasma Reference Unit.
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Le Duc, Kévin, Sébastien Mur, Thameur Rakza, Mohamed Riadh Boukhris, Céline Rousset, Pascal Vaast, Nathalie Westlynk, Estelle Aubry, Dyuti Sharma, and Laurent Storme. "Efficacy of Intact Cord Resuscitation Compared to Immediate Cord Clamping on Cardiorespiratory Adaptation at Birth in Infants with Isolated Congenital Diaphragmatic Hernia (CHIC)." Children 8, no. 5 (April 26, 2021): 339. http://dx.doi.org/10.3390/children8050339.
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Resuscitation at birth of infants with Congenital Diaphragmatic Hernia (CDH) remains highly challenging because of severe failure of cardiorespiratory adaptation at birth. Usually, the umbilical cord is clamped immediately after birth. Delaying cord clamping while the resuscitation maneuvers are started may: (1) facilitate blood transfer from placenta to baby to augment circulatory blood volume; (2) avoid loss of venous return and decrease in left ventricle filling caused by immediate cord clamping; (3) prevent initial hypoxemia because of sustained uteroplacental gas exchange after birth when the cord is intact. The aim of this trial is to evaluate the efficacy of intact cord resuscitation compared to immediate cord clamping on cardiorespiratory adaptation at birth in infants with isolated CDH. The Congenital Hernia Intact Cord (CHIC) trial is a prospective multicenter open-label randomized controlled trial in two balanced parallel groups. Participants are randomized either immediate cord clamping (the cord will be clamped within the first 15 s after birth) or to intact cord resuscitation group (umbilical cord will be kept intact during the first part of the resuscitation). The primary end-point is the number of infants with APGAR score <4 at 1 min or <7 at 5 min. One hundred eighty participants are expected for this trial. To our knowledge, CHIC is the first study randomized controlled trial evaluating intact cord resuscitation on newborn infant with congenital diaphragmatic hernia. Better cardiorespiratory adaptation is expected when the resuscitation maneuvers are started while the cord is still connected to the placenta.
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Fleer, A., L. J. Gerards, P. Aerts, N. A. C. Westerdaal, H. Bruinse, R. C. Senders, and J. Verhoef. "Opsonic defences in newborn infants: decreased transfer of opsonic antibodies as a determinant of enhanced susceptibility to infection." European Journal of Obstetrics & Gynecology and Reproductive Biology 19, no. 5 (May 1985): 331. http://dx.doi.org/10.1016/0028-2243(85)90053-x.
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Singh, Ameeta E., Paul N. Levett, Kevin Fonseca, Gayatri C. Jayaraman, and Bonita E. Lee. "Canadian Public Health Laboratory Network Laboratory Guidelines for Congenital Syphilis and Syphilis Screening in Pregnant Women in Canada." Canadian Journal of Infectious Diseases and Medical Microbiology 26, supplement a (2015): 23A—28A. http://dx.doi.org/10.1155/2015/589085.
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Despite universal access to screening for syphilis in all pregnant women in Canada, cases of congenital syphilis have been reported in recent years in areas experiencing a resurgence of infectious syphilis in heterosexual partnerships. Antenatal screening in the first trimester continues to be important and should be repeated at 28 to 32 weeks and again at delivery in women at high risk of acquiring syphilis. The diagnosis of congenital syphilis is complex and is based on a combination of maternal history and clinical and laboratory criteria in both mother and infant. Serologic tests for syphilis remain important in the diagnosis of congenital syphilis and are complicated by the passive transfer of maternal antibodies which can affect the interpretation of reactive serologic tests in the infant. All infants born to mothers with reactive syphilis tests should have nontreponemal tests (NTT) and treponemal tests (TT) performed in parallel with the mother’s tests. A fourfold or higher titre in the NTT in the infant at delivery is strongly suggestive of congenital infection but the absence of a fourfold or greater NTT titre does not exclude congenital infection. IgM tests for syphilis are not currently available in Canada and are not recommended due to poor performance. Other evaluation in the newborn infant may include long bone radiographs and cerebrospinal fluid tests but all suspect cases should be managed in conjunction with sexually transmitted infection and/or pediatric experts.
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Razaghi, Maryam, Catherine Vanstone, Olusola Sotunde, Nathalie Gharibeh, Shu Qin Wei, Dayre McNally, Frank Rauch, Glenville Jones, Sarah Kimmins, and Hope Weiler. "Interrelationships Among Vitamin D Status and Body Composition in Mother-Infant Dyads." Current Developments in Nutrition 4, Supplement_2 (May 29, 2020): 1061. http://dx.doi.org/10.1093/cdn/nzaa054_133.
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Abstract Objectives To explore the associations between postpartum maternal vitamin D status and body composition to neonatal serum 25-hydroxyvitamin D (25(OH)D) and body composition. Methods Healthy mothers and term-born infants of appropriate size for gestational age were recruited from Greater Montreal (March 2016 through March 2019). The present analysis includes data from mothers and infants (n = 144). Maternal characteristics and lifestyle factors were surveyed and newborn capillary blood samples were taken within 36 h of delivery to assess vitamin D status using total serum 25(OH)D (Liaison, Diasorin). Maternal and infant anthropometry and body composition (Dual-energy X-ray absorptiometry) and maternal serum 25(OH)D were measured within 1 mo postpartum. Mothers were classified into 2 groups (group 1: ≥50 nmol/L; group 2: <50 nmol/L). Data were analyzed descriptively (mean ± SD or n (%)) and using a mixed model with Tukey post hoc tests accounting for neonatal sex, gestational age, season, family income, maternal age, education, and race. Correlation tests were used to identify linear relationships between continuous variables. Results Neonates (85 males, 59 females) were 39.7 ± 1.0 wk GA and 3393 ± 363 g at birth. Mothers (32.1 ± 4.5 years) in group 1 had considerably higher serum 25(OH)D concentrations compared to mothers in group 2 (80.3 ± 22.0 n = 96 vs. 38.7 ± 9.0 n = 48, nmol/L, P < 0.0001). Moreover, maternal serum 25(OH)D concentrations were positively associated with their % whole body lean mass (r = 0.28, P = 0.0009) and inversely associated with their % whole body fat mass (r = −0.25, P = 0.003). At birth, infants of mothers in group 1 had higher serum 25(OH)D concentrations compared to infants in group 2 (51.0 ± 18.1 vs. 27.0 ± 12.0 nmol/L, P < 0.0001), and were correlated with maternal 25(OH)D (r = 0.74, P < 0.0001). Maternal lean body mass and lean mass index (LMI) (kg/m2) explained some positive variations in infant lean body mass and LMI (Estimate = 0.01, P = 0.004; Estimate = 27.7, P = 0.04). Conclusions Higher maternal vitamin D status is associated with higher neonatal vitamin D with possible implications to neonatal lean body mass. This study reinforces the importance of ensuring adequate maternal-fetal transfer of vitamin D. Funding Sources Canadian Institutes of Health Research.
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Sysyn, Gregory D., Katherine H. Petersson, Clifford S. Patlak, Grazyna B. Sadowska, and Barbara S. Stonestreet. "Effects of postnatal dexamethasone on blood-brain barrier permeability and brain water content in newborn lambs." American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 280, no. 2 (February 1, 2001): R547—R553. http://dx.doi.org/10.1152/ajpregu.2001.280.2.r547.
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We showed that antenatal corticosteroids reduced blood-brain barrier permeability in fetuses at 60 and 80%, but not 90% of gestation, and decreased brain water content in fetuses. Our objective was to examine the effects of postnatal corticosteroids on regional blood-brain barrier permeability and brain water content in newborn lambs. Three dexamethasone treatment groups were studied in 3- to 5-day-old lambs. A 0.01 mg/kg dose was selected to estimate the amount of dexamethasone that might have reached fetuses via antenatal treatment of ewes in our previous studies. The other doses (0.25 and 0.5 mg/kg) were chosen to approximate those used clinically to treat infants with bronchopulmonary dysplasia. Lambs were randomly assigned to receive four intramuscular injections of dexamethasone or placebo given 12 h apart on days 3 and 4 of age. Blood-brain barrier function was measured with the blood-to-brain transfer constant ( K i) to α-aminoisobutyric acid, brain plasma volume was measured with polyethylene glycol for the calculation of K i, and brain water was measured by wet-to-dry tissue weights. Postnatal treatment with corticosteroids did not reduce barrier permeability in newborn lambs. Brain blood volume was higher in the 0.25 and 0.5 mg/kg dose dexamethasone groups than in the placebo group. Brain water content did not differ among the groups. We conclude that postnatal treatment with corticosteroids did not reduce regional blood-brain barrier permeability or brain water content but increased the brain plasma volume in newborn lambs. These findings are consistent with our previous work indicating that barrier permeability is responsive to corticosteroids at 60 and 80% of gestation and brain water regulation at 60% of gestation, but not in near-term fetuses or newborn lambs.
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Casey, F., D. Brown, N. Corrigan, B. G. Craig, M. Quinn, B. Mccord, J. Rogers, and H. C. Mulholland. "Value of a low-cost telemedicine link in the remote echocardiographic diagnosis of congenital heart defects." Journal of Telemedicine and Telecare 4, no. 1_suppl (March 1998): 46–48. http://dx.doi.org/10.1258/1357633981931416.
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We established a low-cost telemedicine link from a district general hospital to the regional paediatric cardiology department about 120km away. The link was used to transmit echocardiographic images of newborn infants suspected of having congenital heart disease (CHD) to the referral centre, with simultaneous video and audio contact for consultation. Echocardiograms were transmitted for 61 patients suspected of having CHD, aged from 1 to 42 days. The transmitted images were of adequate quality for the paediatric cardiologist to make a diagnosis in 59 (97%). Congenital heart abnormalities were diagnosed in 38 (64%). Twelve patients (20%) had major CHD diagnosed on the transmitted scan and required transfer to the regional cardiology unit either urgently or electively after initial measures to stabilize the patient. Our findings suggest that, for babies suspected of having CHD, ultrasound images of diagnostic quality can be obtained and transmitted using a low-cost telemedicine system.
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Harris, Andrew P., Roderick Robinson, Raymond C. Koehler, Richard J. Traystman, and Christine A. Gleason. "Blood-brain barrier permeability during dopamine-induced hypertension in fetal sheep." Journal of Applied Physiology 91, no. 1 (July 1, 2001): 123–29. http://dx.doi.org/10.1152/jappl.2001.91.1.123.
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Dopamine is often used as a pressor agent in sick newborn infants, but an increase in arterial blood pressure could disrupt the blood-brain barrier (BBB), especially in the preterm newborn. Using time-dated pregnant sheep, we tested the hypothesis that dopamine-induced hypertension increases fetal BBB permeability and cerebral water content. Barrier permeability was assessed in nine brain regions, including cerebral cortex, caudate, thalamus, brain stem, cerebellum, and spinal cord, by intravenous injection of the small tracer molecule [14C]aminoisobutyric acid at 10 min after the start of dopamine or saline infusion. We studied 23 chronically catheterized fetal sheep at 0.6 (93 days, n = 10) and 0.9 (132 days, n = 13) gestation. Intravenous infusion of dopamine increased mean arterial pressure from 38 ± 3 to 53 ± 5 mmHg in 93-day fetuses and from 55 ± 5 to 77 ± 8 mmHg in 132-day fetuses without a decrease in arterial O2content. These 40% increases in arterial pressure are close to the maximum hypertension reported for physiological stresses at these ages in fetal sheep. No significant increases in the brain transfer coefficient of aminoisobutyric acid were detected in any brain region in dopamine-treated fetuses compared with saline controls at 0.6 or 0.9 gestation. There was also no significant increase in cortical water content with dopamine infusion at either age. We conclude that a 40% increase in mean arterial pressure during dopamine infusion in normoxic fetal sheep does not produce substantial BBB disruption or cerebral edema even as early as 0.6 gestation.
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Sanford, Chris A., Douglas H. Keefe, Yi-Wen Liu, Denis Fitzpatrick, Ryan W. McCreery, Dawna E. Lewis, and Michael P. Gorga. "Sound-Conduction Effects on Distortion-Product Otoacoustic Emission Screening Outcomes in Newborn Infants: Test Performance of Wideband Acoustic Transfer Functions and 1-kHz Tympanometry." Ear and Hearing 30, no. 6 (December 2009): 635–52. http://dx.doi.org/10.1097/aud.0b013e3181b61cdc.
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Zurgil, N., R. Bakimer, A. Tincani, D. Faden, J. Cohen, M. Lorber, G. Valesini, and Y. Shoenfeld. "Detection of Anti-Phospholipid and Anti-DNA Antibodies and their Idiotypes in Newborns of Mothers with Anti-Phospholipid Syndrome and Sle." Lupus 2, no. 1_suppl (February 1993): 233–37. http://dx.doi.org/10.1177/0961203393002001091.
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The titers, isotypes and idiotypes of antiphospholipid and anti-dsDNA antibodies were determined in seven pairs of mothers with antiphospholipid syndrome (APLS) and their offspring, in 11 pairs of SLE mothers and their matched infants and in seven respective pairs of healthy subjects. In addition, maternal as well as fetal sera were evaluated for the presence of anti-SSA (Ro), anti-SSB (La) and anti-70 kd RNP autoantibodies. In the sera from APLS patients, as well as in the sera from their offspring, the mean antibody titer of IgG aCL was found to be significantly higher then the corresponding value in the control group (P < 0.01). Highly significant increased titers of IgG anti-DNA antibodies were found in the sera of SLE mothers and their matched offspring (P < 0.0008). The prevalance of anti-SSA, anti-SSA, and anti-7OKd RNP antibodies was lower then that of antiphospholipid and anti-dsDNA antibodies. Only one of the respective offspring had increased levels of these antibodies. The quantity of maternal antibodies transferd to the fetus was depended on their concentration in the maternal circulation, as well as on their type and specificity. Follow-up of newborn sera showed a progressive decrease in the antiphospholipid antibody titers during 3 months. After 6 months it was undetected. Our results point to a transplacental transfer of aCL and anti-DNA antibodies, a phenomenon which is not necessarily associated with respective clinical manifestations, in contrast to the classical humoral mediated autoimmune diseases (e.g. myasthenia gravis).
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Santeiro, Maria L., Carine Stromquist, and Lance Wyble. "Phenoxybenzameve Placental Transfer during the Third Trimester." Annals of Pharmacotherapy 30, no. 11 (November 1996): 1249–51. http://dx.doi.org/10.1177/106002809603001108.
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OBJECTIVE: To report phenoxybenzamine placental transfer in the treatment of maternal hypertension secondary to pheochromocytoma. CASE SUMMARY: A 22-year-old woman diagnosed with pheochromocytoma was medically managed at 33 weeks gestation with oral phenoxybenzamine and labetalol until delivery 26 days later. To determine phenoxybenzamine placental passage, at the time of cesarean section simultaneous samples were obtained from the cord blood, maternal blood, and amniotic fluid. Additional blood samples were obtained from the newborn at 32 and 80 hours of life. Mean concentrations of phenoxybenzamine from cord and maternal plasma and in amniotic fluid were 103.3,66, and 79.3 ng/mL, respectively; the newborn's plasma concentration at 32 hours of life was 22.3 ng/mL. At the time of delivery, the 2475-g male infant exhibited perinatal depression; mild transient hypotension was also noted for the first few days of life. DISCUSSION: The fetal—maternal plasma accumulation ratio of 1.6:1 indicates that at this gestational age after 26 days of therapy, the placental transfer of phenoxybenzamine occurs and is accompanied by accumulation in the fetal blood. CONCLUSIONS: Because of the placental transfer of phenoxybenzamine, mild perinatal depression and transient hypotension may occur in newborns of mothers receiving this medication. These newborns must be closely monitored during the first few days of life for respiratory depression and hypotension.
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Pusey, Anne E., and Kara Schroepfer-Walker. "Female competition in chimpanzees." Philosophical Transactions of the Royal Society B: Biological Sciences 368, no. 1631 (December 5, 2013): 20130077. http://dx.doi.org/10.1098/rstb.2013.0077.
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Female chimpanzees exhibit exceptionally slow rates of reproduction and raise their offspring without direct paternal care. Therefore, their reproductive success depends critically on long-term access to high-quality food resources over a long lifespan. Chimpanzee communities contain multiple adult males, multiple adult females and their offspring. Because males are philopatric and jointly defend the community range while most females transfer to new communities before breeding, adult females are typically surrounded by unrelated competitors. Communities are fission–fusion societies in which individuals spend time alone or in fluid subgroups, whose size depends mostly on the abundance and distribution of food. To varying extents in different populations, females avoid direct competition by foraging alone or in small groups in distinct, but overlapping core areas within the community range to which they show high fidelity. Although rates of aggression are low, females compete for space and access to food. High rank correlates with high reproductive success, and high-ranking females win direct contests for food and gain preferential access to resource-rich sites. Females are aggressive to immigrant females and even kill the newborn infants of community members. The intensity of such aggression correlates with population density. These patterns are compared to those in other species, including humans.
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Bowman, J. D., and M. Choudhury. "Phthalates in neonatal health: friend or foe?" Journal of Developmental Origins of Health and Disease 7, no. 6 (July 4, 2016): 652–64. http://dx.doi.org/10.1017/s2040174416000349.
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Exposure to environmental chemicals has adverse effects on the health and survival of humans. Emerging evidence supports the idea that exposure to endocrine-disrupting compounds (EDCs) can perturb an individual’s physiological set point and as a result increase his/her propensity toward several diseases. The purpose of this review is to provide an update on di-(2-ethylhexyl) phthalate, the primary plasticizer found in plastic medical devices used in neonatal intensive care units, its effects on the fetus and newborn, epidemiological studies, pharmacokinetics, toxicity and epigenetic implications. We searched the PubMed databases to identify relevant studies. Phthalates are known EDCs that primarily are used to improve the flexibility of polyvinyl chloride plastic products and are called plasticizers in lay terms. Neonates and infants are particularly vulnerable to the effects of phthalates, beginning with maternal exposure and placental transfer during gestation and during infancy following birth. In line with the developmental origins of adult disease, a focus on the effects of environmental chemicals in utero or early childhood on the genesis of adult diseases through epigenome modulation is timely and important. The epigenetic effects of phthalates have not been fully elucidated, but accumulating evidence suggests that they may be associated with adverse health effects, some of which may be heritable. Phthalate exposure during pregnancy and the perinatal period is particularly worrisome in health-care settings. Although the clinical significance of phthalate exposure has been difficult to assess with epidemiologic studies, the evidence that physiological changes occur due to exposure to phthalates is growing and points toward the need for more investigation at a molecular, specifically epigenetic level.
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Nichols, Virginia G., and Diana W. Bianchi. "Prenatal Pediatrics: Traditional Specialty Definitions No Longer Apply." Pediatrics 97, no. 5 (May 1, 1996): 729–32. http://dx.doi.org/10.1542/peds.97.5.729.
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These four cases illustrate different aspects of the impact of prenatal sonography on the practice of newborn medicine. The themes illustrated by these cases are summarized below. Diagnostic Sensitivity Prenatal sonographic diagnosis is not a precise science. The technical and cognitive limitations of this developing technology demand an appreciation of the distinction between identification and diagnosis. Although the sensitivity of the technology for detecting fetal abnormalities is quite good in many settings, the "total picture" is not always apparent in utero. This is not to deny the clinical benefit of identifying a fetus likely to require specialized postnatal care even if a precise diagnosis cannot be made, but to emphasize the difficulty of counseling a woman contemplating pregnancy termination when the underlying syndromic diagnosis for an affected fetus is not technically possible before birth. Furthermore, the sensitivity of fetal ultrasound examination appears to vary by site and type of obstetric service. The Helsinki study demonstrated a far greater ascertainment rate for fetal abnormalities in an academic practice dedicated to the provision of high-risk services when compared with a community setting,9 and the multisite RADIUS study demonstrated a low detection rate for fetal abnormalities.10 Case 1 demonstrates that while the sensitivity of sonography for a specific anatomic abnormality may be great, the comprehensive diagnosis can still be missed. In this case, the antenatal detection of a cardiac malformation triggered a postnatal echocardiogram within the first hour after birth and prompted prostaglandin infusion. Work-up and treatment of the cardiac disease would not have been the first priority had the likelihood of a lethal chromosomal abnormality been appreciated by the admitting team, who were significantly influenced by the antenatal diagnosis of structural heart disease. Case 2 demonstrates the confusion that can be generated when an anatomic sonographic finding becomes a diagnosis without full appreciation of important details. In this case, the subtle but important prognostic difference between a hypoplastic left ventricle and a single ventricle with left ventricular morphology made an enormous difference in the predicted outcome for the infant. In both cases 1 and 4, neonatal demise occurred but autopsy permission was denied. The absence of autopsy limits the opportunity to correlate prenatal and postnatal findings. The importance of autopsy consent should be emphasized to all involved in the perinatal care of fetuses and infants with anomalies. Postnatal Interpretation of Prenatal Findings The interpretation of what appear to be fetal abnormalities is often not an entirely straightforward process. The technical capabilities of fetal sonography have resulted in the discovery of a new natural history for a number of conditions that may be variants of normal fetal development, or are of minor clinical significance in childhood. Examples include hydronephrosis and choroid plexus cysts. Pediatricians cians are left to sort out which of these conditions require postnatal confirmation, which require follow-up surveillance, and which can be ignored. The antenatal detection of conditions that are normally detected later in infancy or childhood or remain undetected due to lack of clinical symptoms can also create serious therapeutic dilemmas. For example, adrenal masses consistent with neuroblastoma can now be detected prenatally. In one study, 11 patients with prenatally diagnosed neuroblastoma had surgical resection of the tumor. In 7 of these cases, histologic studies were consistent with neuroblastoma in situ.11 The natural history of neuroblastoma in situ includes spontaneous regression. Thus, one might question whether surgical resection is truly warranted. Yet, how many parents, knowing that their fetus has an adrenal tumor, are comfortable with conservative care when surgical removal is an option at birth? Case 3 demonstrates that prenatal diagnosis can be a double-edged sword, in that infants who are clinically well at birth can undergo extensive diagnostic testing in an attempt to elucidate prenatal findings that may no longer be relevant clinically. For example, one of the infants in Case 3 was labeled as "abnormal," and normal newborn management, including feeding, was delayed. The other twin underwent a cardiac work-up in the setting of a normal physical examination with no heart murmur. The adverse psychological effects of this "labeling" for parents and subsequent care of the child or children are unexplored. The implications of such labeling for insurance purposes have also not been addressed. Coordination of Multidisciplinary Services: Prenatal and Postnatal Care Optimal management of prenatal patients requires clinicians who are able to cross traditional subspecialty definitions to work as a multidisciplinary team.12-16 Unless specific mechanisms for the transfer of prenatal records are devised, perinatologists, neonatologists and pediatricians can be unaware of important information, as they were in Case 4. Even within the same institution, breaches of communication can occur both between and within specialties, particularly when prenatal records are not centralized and available to all clinicians taking care of both the mother and the infant. Although neonatologists are more likely to have opportunities for face to face communication with obstetricians and perinatologists, general pediatricians must often rely on thirdhand information transcribed into the perinatal summaries in newborn charts to ascertain prenatal findings that may have implications for postnatal management. Prenatal diagnosis does not conclude with delivery or pregnancy termination. All these cases demonstrate the importance of coordinating prenatal and postnatal care. The logistical difficulty of this endeavor should not be underestimated. In a regionalized system of prenatal care, whereby pregnant women with suspected fetal abnormalities are referred from community sites into tertiary centers for diagnosis and delivery, then sent back to their primary care sites for follow-up, the window of opportunity for postnatal counseling can be very short. Karyotype results obtained at delivery or at pregnancy termination are rarely available before the mother leaves the tertiary center. The postnatal management of all cases described was complicated by transfer of both mothers and infants. In Cases 1 and 4, the infants died and the mothers' care was transferred back to the referring health care sites before chromosome results were available. The twins in Case 3 were transferred to a Level II nursery before assumption of care by their pediatrician, and the infant in Case 2 was transferred from the tertiary pennatal center to an adjacent children's hospital before discharge to the care of his pediatrician. Given the expected patient movement between tertiary site and referral center, mechanisms need to be created for improved communication between health care providers. In some cases, patients may need to return to tertiary centers for appropriate postnatal counseling and work-up if these cannot be provided at the referring health care site. Clinical Outcomes Research: The New Natural History of Malformations and Genetic Diseases The clinical outcomes for children with specific prenatal diagnoses have not been gathered into a comprehensive shared resource suitable for use by obstetricians, pediatricians, genetic counselors, pediatric subspecialists, and pediatric surgeons. In large part, this has resulted because data on functional outcomes in children with many of these conditions have not been collected systematically. In some important areas, pediatric surgical and medical therapies have advanced so rapidly that prognostic information is quickly outdated. For example, the prognosis for surgical repair of patients with hypoplastic left heart syndrome has dramatically improved, yet this information may not be readily available to all obstetricians performing sonography and counseling parents. In other diseases our understanding of the relationship between genotype and phenotype (information that can be a major factor in decisions regarding pregnancy termination) changes so quickly that prenatal counseling demands a sophisticated and cautious appreciation of the dynamic state of this field. Further complexity is introduced by the fact that prenatal diagnosis may in fact alter expected outcomes by permitting pediatricians to initiate therapy before symptoms appear. Infants whose duct-dependent cardiac malformations have been detected prenatally can be treated before they present with cyanosis and acidosis. Infants with unsuspected disease might be expected to present later as outpatients with more severe symptoms. In a similar fashion, infants with significant hydronephrosis detected prenatally can be treated with prophylactic antibiotics and urinary decompression, if necessary, while their undetected counterparts will be diagnosed only when they present as outpatients with urinary tract infections and diminution of renal function.
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Rakover, Y., O. Sadeh, E. Sobel, A. Shneyour, and Z. Kraiem. "A case of transient hypothyroidism: Sequential serum measurements of autoantibodies inhibiting thyrotropin-stimulated thyroid cAMP production in a neonate." Acta Endocrinologica 123, no. 1 (July 1990): 118–22. http://dx.doi.org/10.1530/acta.0.1230118.
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Abstract. Transient neonatal hypothyroidism has been observed in three successive offspring of a mother with autoimmune thyroiditis. Thyroxine replacement therapy was initiated in a 23-year-old woman with overt clinical and laboratory findings of non-goitrous primary hypothyroidism. While on such treatment, she gave birth to three infants manifesting hypothyroidism immediately after birth. The neonates were treated with thyroxine replacement therapy which was discontinued in the three siblings at ages 2½ years, 3½ years, and 13 months. Continuous observation following cessation of therapy revealed clinical and biochemical euthyroidism in the children. Thyroid scanning during the neonatal period in the first child failed to identify functional thyroid tissue, suggesting thyroid agenesis, whereas thyroid scan performed on subsequent follow-up revealed a normal gland. Sequential serum measurements of autoantibodies directed towards the thyrotropin receptor were made in the mother and third child by a cAMP bioassay. High titres (five-six fold above normal) of blocking antibodies (tested by measuring the inhibition of TSH-stimulated cAMP production of cultured human thyroid cells by serum immunoglobulin preparations) were present in the mother and newborn 10 days after birth. The levels remained persistently high in the mother, whereas they declined and were undetectable in the child at four months. Thyroid-stimulating immunoglobulin was absent in both mother and child. The data are compatible with transient neonatal hypothyroidism caused by transplacental transfer of antibodies which block thyroid response to TSH. The half-life of the maternally-derived blocking antibody in the infant was estimated as 1-2 months. This is the first report on sequential serum measurements and estimate of half-life of the blocking antibodies performed by a cAMP bioassay (using thyroid cells of human origin). Unlike the radioreceptor assay employed so far in such cases, this assay can distinguish between stimulating and blocking TSH receptor antibodies.
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Kopelman, Arthur E., and Oommen P. Mathew. "Common Respiratory Disorders of the Newborn." Pediatrics In Review 16, no. 6 (June 1, 1995): 209–17. http://dx.doi.org/10.1542/pir.16.6.209.
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Respiratory distress is a frequently encountered problem in the first few days of life. The general pediatrician must assess the infant's condition, make a tentative diagnosis, institute appropriate care, and decide whether to transfer the infant to a neonatal intensive care unit. The decision to transfer an infant should be based on the interest and training of the physician as well as on readily available resources for optimal management. In general, any infant who needs mechanical ventilation for more than a few hours should be transferred to a regional intensive care nursery. An infant who is in respiratory distress of any cause may present with tachypnea, nasal flaring, sternal and intercostal retractions, cyanosis, and even apnea. The differential diagnosis of respiratory disorders in the newborn is extensive and includes disorders of the major airways, diseases of the pulmonary parenchyma, and rib cage abnormalities. Review of the history of pregnancy, labor, delivery, and resuscitation; careful physical examination; analysis of laboratory tests such as blood gases, hematocrit, and blood glucose; and evaluation of a chest radiograph usually permit a tentative diagnosis. Additional challenges arise when an infant who has chronic lung disease is returned to the community hospital for continuing care. This review covers three of the most common forms of neonatal respiratory distress: transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), and bronchopulmonary dysplasia (BPD).
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Chasalow, Fred I. "Spiral Steroids During Pregnancy - It’s All About Potassium." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A816—A817. http://dx.doi.org/10.1210/jendso/bvab048.1664.
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Abstract This presentation has two parts. The 1st section describes processes during pregnancy with unknown, underlying biochemistry. The 2nd section shows the role of spiral steroids (SS) in these processes. 1] Fetal nutrition is provided through the placenta. Plasma electrolytes are 145 mM Na+ and 3-5 mM K+. Fetal K+ requirements reach a maximum during the 3rd trimester and must be pumped into cells against the plasma- intracellular gradient. 2] During the 3rd trimester, aldosterone is present in fetal plasma but the signal for endothelial sodium channel (ENaC) synthesis is blocked, leading to fetal Na+ wasting. The mechanism is unknown. 3] After parturition, infants are fed by nursing. Human milk contains 100 mM K+ and 10 mM Na+. Newborn infants are Na+ wasting, despite normal levels of aldosterone. Na+ wasting ends during the 2nd week post-partum without change in serum aldosterone levels. Infant physiology changes from K+ saving to Na+ saving by an unknown mechanism.4] Pre-eclampsia syndrome (proteinuria and hypertension during the 2nd half of pregnancy) affects 3-5 % of pregnant women. These symptoms usually resolve after parturition. 5] Women who have had pre-eclampsia have long-term, excess risk of cardiac and renal disorders. In 2018, we discovered Ionotropin, a SS. SS are phosphocholine esters of steroids with a lactone E-ring, similar to that of spironolactone. SS compounds function as aldosterone antagonists and regulate the NaK-ATPase. SS are involved in each of the 5 steps.1] SS are present in high levels in cord serum and were probably present in fetal plasma throughout gestation. SS stimulate the NaK-ATPase to pump K+ into cells against the gradient, just as does spironolactone.2] SS interfere with aldosterone signaling, just as does amiloride. This leads to increased fetal Na+ wasting, which becomes amniotic fluid.3] SS disappear from the infant circulation during the 1st week after parturition and decrease to adult levels during the 2nd week post-partum. Simultaneously, Na+ wasting ends and growth resumes.4] Women with pre-eclampsia have excess precursors for SS. These would be converted to SS in the fetal-placental unit and, during the 3rd trimester, diffuse into the maternal circulation and could cause pre-eclampsia.5] Ouabain, a plant toxin with a lactone E ring, causes renal and cardiac disorders in rat models. In women with pre-eclampsia, persistent excess SS may cause long-term damage. During gestation, the fetus requires K+ for growth. Our theory is, if (when) a fetus has inadequate K+ (hypokalemia), [a] the mother is signaled to produce SS precursors, [b] the feto-placental unit converts the precursors to SS, [c] fetal SS increase K+ transfer into tissues, and [d] excess SS transfuse back into the maternal circulation and damage maternal organs. We propose that pre-eclampsia is a side effect of fetal efforts to increase supply of K+. There are many possible origins of fetal hypokalemia.
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Vulturar, Romana, Adina Chiș, Sebastian Pintilie, Ilinca Maria Farcaș, Alina Botezatu, Cristian Cezar Login, Adela-Viviana Sitar-Taut, et al. "One Molecule for Mental Nourishment and More: Glucose Transporter Type 1—Biology and Deficiency Syndrome." Biomedicines 10, no. 6 (May 26, 2022): 1249. http://dx.doi.org/10.3390/biomedicines10061249.
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Glucose transporter type 1 (Glut1) is the main transporter involved in the cellular uptake of glucose into many tissues, and is highly expressed in the brain and in erythrocytes. Glut1 deficiency syndrome is caused mainly by mutations of the SLC2A1 gene, impairing passive glucose transport across the blood–brain barrier. All age groups, from infants to adults, may be affected, with age-specific symptoms. In its classic form, the syndrome presents as an early-onset drug-resistant metabolic epileptic encephalopathy with a complex movement disorder and developmental delay. In later-onset forms, complex motor disorder predominates, with dystonia, ataxia, chorea or spasticity, often triggered by fasting. Diagnosis is confirmed by hypoglycorrhachia (below 45 mg/dL) with normal blood glucose, 18F-fluorodeoxyglucose positron emission tomography, and genetic analysis showing pathogenic SLC2A1 variants. There are also ongoing positive studies on erythrocytes’ Glut1 surface expression using flow cytometry. The standard treatment still consists of ketogenic therapies supplying ketones as alternative brain fuel. Anaplerotic substances may provide alternative energy sources. Understanding the complex interactions of Glut1 with other tissues, its signaling function for brain angiogenesis and gliosis, and the complex regulation of glucose transportation, including compensatory mechanisms in different tissues, will hopefully advance therapy. Ongoing research for future interventions is focusing on small molecules to restore Glut1, metabolic stimulation, and SLC2A1 transfer strategies. Newborn screening, early identification and treatment could minimize the neurodevelopmental disease consequences. Furthermore, understanding Glut1 relative deficiency or inhibition in inflammation, neurodegenerative disorders, and viral infections including COVID-19 and other settings could provide clues for future therapeutic approaches.