scholarly journals Microcirculatory Changes in Term Newborns with Suspected Infection: An Observational Prospective Study

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Irene Alba-Alejandre ◽  
Stephan Hiedl ◽  
Orsolya Genzel-Boroviczény
Keyword(s):  
Imaging Techniques ◽  
Clinical Status ◽  
External Ear ◽  
Term Infants ◽  
Term Neonates ◽  
Suspected Infection ◽  
Microcirculatory Flow ◽  
Ops Imaging ◽  
Term Newborns ◽  
Optimal Site

Background. In adults severely disturbed microcirculatory flow can be observed by Orthogonal Polarized Spectral (OPS) imaging techniques during sepsis. Therefore we set out to assess for microcirculatory changes in term newborns with suspected early onset infection using OPS.Methods. OPS images were obtained prospectively from the vascular bed of the ear conch and upper arm of 47 newborns on their 1st, 2nd, and 3rd day of life. OPS sequences were analyzed semiquantitatively offline and blinded to clinical status of the infant. Flow in vessels was classified as continuous or noncontinuous flow and given as proportion of total vessels per image as in the studies in adults.Results. The proportion of vessels with continuous flow was significantly lower in the infants with infection (69% [56–81] versus 90% [87–94](P=0.0003)). None of the infants with infection was in shock or severely septic.Conclusion. In term neonates the microcirculatory flow is impaired in a large proportion of vessels even in mild to moderate infection. These changes can be observed at the onset of disease at the external ear, an optimal site for microcirculatory measurements in term infants.

scholarly journals Early neonatal morbidities in late preterm compared to term neonates born in a tertiary care private hospital

2020 ◽  
Vol 7 (3) ◽  
pp. 565
Author(s):  
Yogesh P. Mehta ◽  
Manjusha Bhicurao Naik ◽  
Kinnera Putrevu
Keyword(s):  
Preterm Infants ◽  
Tertiary Care ◽  
Full Term ◽  
Late Preterm ◽  
Term Infants ◽  
Term Neonates ◽  
Late Preterm Infants ◽  
Increased Risk ◽  
Preterm Babies ◽  
Term Newborns

Background: Late preterm babies, born between 34 completed weeks of gestation through 36 weeks 6/7 gestation, tend to be physiologically less mature than term infants, subjecting them to an increased risk of developing various morbidities. Limited information is available regarding the current scenario in India. Therefore, the objective of this study was to understand and compare the early morbidities in late preterm newborns with those in full term babies in a tertiary hospital in India.Methods: The current prospective, observational study consisted of total 150 babies divided into two groups equally; late preterm neonates born between 34 and 36 weeks of gestation and full-term neonates. Weight (at birth, at 72 hours), heart rate, temperature and respiratory parameters were noted of all babies. The newborns were examined for respiratory morbidities, ability to breastfeed, hypoglycemia, hypothermia, neonatal jaundice and signs of sepsis. The need for resuscitation, admission to neonatal intensive care unit (NICU) and parenteral nutrition was also assessed. Data was expressed as mean±SD and was analyzed using the Student ‘t’ and Mann Whitney U tests.Results: The mean length and weight at birth in late preterm babies was significantly lesser than term newborns. Late preterm babies were found to have significantly higher incidence of complications like hyperbilirubinemia (62.7% vs 13.3%), respiratory morbidities (16% vs 4%), poor feeding, hypothermia, hypoglycemia, and sepsis compared to term newborns (p<0.01).Conclusions: Late preterm infants are at a higher risk than term infants for a number of neonatal complications. Initiatives imparting special care to late preterm infants are required in order to lower the morbidities endured by this population.

scholarly journals Levels of Predominant Intestinal Microorganisms in 1 Month-Old Full-Term Babies and Weight Gain During the First Year of Life

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2412
Author(s):  
Sonia González ◽  
Marta Selma-Royo ◽  
Silvia Arboleya ◽  
Cecilia Martínez-Costa ◽  
Gonzalo Solís ◽  
...  
Keyword(s):  
Weight Gain ◽  
Gut Microbiota ◽  
Early Life ◽  
Later Life ◽  
Full Term ◽  
First Year ◽  
Term Infants ◽  
Term Newborns ◽  
Infant Weight Gain ◽  
First Year Of Life

The early life gut microbiota has been reported to be involved in neonatal weight gain and later infant growth. Therefore, this early microbiota may constitute a target for the promotion of healthy neonatal growth and development with potential consequences for later life. Unfortunately, we are still far from understanding the association between neonatal microbiota and weight gain and growth. In this context, we evaluated the relationship between early microbiota and weight in a cohort of full-term infants. The absolute levels of specific fecal microorganisms were determined in 88 vaginally delivered and 36 C-section-delivered full-term newborns at 1 month of age and their growth up to 12 months of age. We observed statistically significant associations between the levels of some early life gut microbes and infant weight gain during the first year of life. Classifying the infants into tertiles according to their Staphylococcus levels at 1 month of age allowed us to observe a significantly lower weight at 12 months of life in the C-section-delivered infants from the highest tertile. Univariate and multivariate models pointed out associations between the levels of some fecal microorganisms at 1 month of age and weight gain at 6 and 12 months. Interestingly, these associations were different in vaginally and C-section-delivered babies. A significant direct association between Staphylococcus and weight gain at 1 month of life was observed in vaginally delivered babies, whereas in C-section-delivered infants, lower Bacteroides levels at 1 month were associated with higher later weight gain (at 6 and 12 months). Our results indicate an association between the gut microbiota and weight gain in early life and highlight potential microbial predictors for later weight gain.

Outcomes of full-term infants with bilious vomiting: observational study of a retrieved cohort

2014 ◽  
Vol 100 (1) ◽  
pp. 14-17 ◽  
Author(s):  
Syed Mohinuddin ◽  
Pankaj Sakhuja ◽  
Benjie Bermundo ◽  
Nandiran Ratnavel ◽  
Stephen Kempley ◽  
...  
Keyword(s):  
Posterior Probability ◽  
Abdominal Distension ◽  
Clinical Findings ◽  
Likelihood Ratios ◽  
Term Infants ◽  
X Ray ◽  
Bilious Vomiting ◽  
Term Newborns ◽  
Time Critical ◽  
Surgical Condition

Bilious vomiting in a neonate may be a sign of intestinal obstruction often resulting in transfer requests to surgical centres. The aim of this study was to assess the use of clinical findings at referral in predicting outcomes and to determine how often such patients have a time-critical surgical condition (eg, volvulus, where a delay in treatment is likely to compromise gut viability).Methods4-year data and outcomes of all term newborns aged ≤7 days with bilious vomiting transferred by a regional transfer service were analysed. Specificity, sensitivity, likelihood ratios, correlations, prior and posterior probability of clinical findings in predicting newborns with surgical diagnosis were calculated.ResultsOf 163 neonates with bilious vomiting, 75 (46%) had a surgical diagnosis and 23 (14.1%) had a time-critical surgical condition. The diagnosis of a surgical condition in neonates with bilious vomiting was significantly associated with abdominal distension (χ2=5.17, p=0.023), abdominal tenderness (χ2=5.90, p=0.015) and abnormal abdominal X-ray findings (χ2=5.68, p=0.017) but not with palpation findings of a soft as compared with a tense abdomen (χ2=3.21, p=0.073). Abnormal abdominal X-ray, abdominal distension and tenderness had 97%, 74% and 62% sensitivity, respectively, with regard to association with an underlying surgical diagnosis. Normal abdominal X-ray reduced the posterior probability of surgical diagnosis from 50% to 16%. Overall, clinical findings at referral did not differentiate between infants with or without surgical or time-critical condition.ConclusionsWe recommend that term neonates with bilious vomiting referred for transfer are prioritised as time critical.

Low incidence of surgical pathology in infants with bilious vomiting

2021 ◽  
Author(s):  
David Andrew Cummins ◽  
Carl Kuschel
Keyword(s):  
Imaging Study ◽  
Hirschsprung Disease ◽  
Abdominal Distension ◽  
Surgical Pathology ◽  
Term Infants ◽  
Term Neonates ◽  
Bilious Vomiting ◽  
Highly Sensitive ◽  
Abdominal Radiographs ◽  
Low Incidence

Abstract Background: Bilious vomiting in the neonate is an important presenting sign of intestinal obstruction. We conducted a review of the presentation and management of term neonates admitted with bilious vomiting (BV) to determine the incidence of a surgical pathology in our population.  Design: Retrospective cohort study using a prospectively maintained database.  Participants: All term infants admitted to NICU with BV at the Royal Women’s Hospital Melbourne during a 5-calendar year period.  Results: All 153 babies had at least one imaging study. 128 (83.7%) had plain abdominal radiographs. 127 (83%) underwent upper gastrointestinal contrast scan (UGI) and 103 (67.3%) had both. 6 (3.9%) UGI studies were abnormal, with 3 babies (1.9%) subsequently having surgical pathology (2 volvulus, 1 Hirschsprung disease). Only 6 (3.9%) babies in our cohort had a surgical pathology identified (4 Hirschsprung disease, 2 malrotation). Babies with surgical pathology were more likely to present later (median 40 hours versus 23 hours). Abdominal distension was highly sensitive for surgical pathology.  Conclusion: The incidence of surgical pathology in this cohort was low compared to other studies. It is more likely in infants presenting with BV after 24 hours. 

Predictability of transcutaneous bilirubinometry in late preterm and term infants at risk for pathological hyperbilirubinemia

2020 ◽  
pp. 1-7
Author(s):  
E. Dianova ◽  
J. Fogel ◽  
R.P. Verma
Keyword(s):  
At Risk ◽  
Serum Bilirubin Level ◽  
Late Preterm ◽  
Term Infants ◽  
Term Neonates ◽  
Transcutaneous Bilirubin ◽  
Immune Mediated ◽  
Positive Direct ◽  
Neonatal Population ◽  
Transcutaneous Bilirubinometry

BACKGROUND: The aim was to assess the predictability of transcutaneous bilirubinometry in late preterm and term neonates at risk for pathological hyperbilirubinemia, and to identify the neonatal population in which transcutaneous bilirubin most accurately predicts serum bilirubin level (SB, mg/dl). METHODS: The correlations between transcutaneous bilirubin (TCB, mg/dl) and SB in different neonatal population subsets; and between ΔTSB (TCB-SB) and relevant neonatal variables and clinical groups were analyzed. RESULTS: TCB correlated with SB (r = 0.82, p <  0.05) in the cohort (n = 350) and in population subsets (r = 0.81–0.9, p <  0.001). Black infants with gestational age (GA) >35 weeks and chronological age (CA) >3 days recorded strongest correlation (r = 0.9, p <  0.001) followed by Blacks, and non-Black infants with CA >3 days and GA >35 weeks. ΔTSB was positive in Blacks, and in infants with CA <3 days, or with no phototherapy. ΔTSB was negative in non-Blacks, in infants with positive direct Coombs test (DC+) or those receiving phototherapy. Black race [beta (SE) = 1.3(0.33), p <  0.001] had positive, while CA [beta (SE) =−1.74 (0.36), p <  0.001], DC + status [beta (SE) =−0.72 (0.25), p = 0.004] and receipt of phototherapy [beta (SE) =−0.84 (0.21), p <  0.001] each had negative correlation with ΔTSB. ΔTSB for Blacks was >Whites, Hispanics and Asians. CONCLUSION: SB is best predicted by TCB in Black infants with CA over 3 days and GA over 35 weeks. Variability in SB estimation by TCB is race, CA and immune mediated hemolysis specific.

Kernicterus in Otherwise Healthy, Breast-fed Term Newborns

PEDIATRICS ◽  
1995 ◽  
Vol 96 (4) ◽  
pp. 730-733 ◽  
Author(s):  
M. Jeffrey Maisels ◽  
Thomas B. Newman
Keyword(s):  
The United States ◽  
Full Term ◽  
Term Infants ◽  
Know How ◽  
Neurologic Sequelae ◽  
Sporadic Cases ◽  
Term Newborns ◽  
Breast Fed ◽  
Apparently Healthy

Objective. To document the occurrence of classical kernicterus in full-term, otherwise healthy, breast-fed infants. Methods. We reviewed the files of 22 cases referred to us by attorneys throughout the United States during a period of 18 years, in which neonatal hyperbilirubinemia was alleged to be responsible for brain damage in apparently healthy, nonimmunized, full-term infants. To qualify for inclusion, these infants had to be born at 37 or more weeks' gestation, manifest the classic signs of acute bilirubin encephalopathy, and have the typical neurologic sequelae. Results. Six infants, born between 1979 and 1991, met the criteria for inclusion. Their peak recorded bilirubin levels occurred 4 to 10 days after birth and ranged from 39.0 to 49.7 mg/dL. All had one or more exchange transfusions. One infant had an elevated reticulocyte count (9%) but no other evidence of hemolysis. The other infants had no evidence of hemolysis, and no cause was found for the hyperbilirubinemia (other than breast-feeding). Conclusions. Although very rare, classic kernicterus can occur in apparently healthy, full-term, breast-fed newborns who do not have hemolytic disease or any other discernible cause for their jaundice. Such extreme elevations of bilirubin are rare, and we do not know how often infants with similar serum bilirubin levels escape harm. We also have no reliable method for identifying these infants early in the neonatal period. Closer follow-up after birth and discharge from the hospital might have prevented some of these outcomes, but rare, sporadic cases of kernicterus might not be preventable unless we adopt an approach to follow-up and surveillance of the newborn that is significantly more rigorous than has been practiced. The feasibility, risks, costs, and benefits of this type of intervention need to be determined.

Jaundice in Healthy, Term Neonates: Do We Need New Action Levels or New Approaches?

PEDIATRICS ◽  
1992 ◽  
Vol 89 (5) ◽  
pp. 827-829
Author(s):  
AUDREY K. BROWN ◽  
DANIEL S. SEIDMAN ◽  
DAVID K. STEVENSON
Keyword(s):  
Neurodevelopmental Outcome ◽  
Alexander Pope ◽  
Neurologic Injury ◽  
Term Infants ◽  
Ample Evidence ◽  
Term Neonates ◽  
Neurodevelopmental Impairment ◽  
New Guidelines ◽  
Action Levels

All seems infected that th' infected spy, As all looks yellow to the jaundiced eye. —Alexander Pope An Essay on Criticism, 1711 We take note of Alexander Pope's admonition, and we are reminded by others that, from their perspective, the evidence is unconvincing that moderate neonatal hyperbilirubinemia adversely affects the neurodevelopmental outcome of healthy, term infants. Moreover, although there is ample evidence that high levels of bilirubin may be associated with neurologic injury, a linear relationship between neonatal serum bilirubin levels and long-term neurodevelopmental impairment does not seem to exist.1 Such observations have been recognized for some time2,3 and have encouraged some of our colleagues to propose new guidelines for the treatment of jaundice in well, term infants.4,5

scholarly journals Head circumference and anterior fontanel measurements in newborns

2012 ◽  
Vol 52 (3) ◽  
pp. 145 ◽  
Author(s):  
Rizal Agus Tiansyah ◽  
Irawan Mangunatmadja ◽  
Aman Pulungan
Keyword(s):  
Gestational Age ◽  
Head Circumference ◽  
Full Term ◽  
Brain Growth ◽  
Anterior Fontanel ◽  
Term Infants ◽  
Head Growth ◽  
Term Newborns ◽  
Male Subjects ◽  
The Brain

Background Head growth and anterior fontanel (AP) closureare passive processes in response to brain growth. The growthof the brain and skull starts in the third week of intrauterinegestation. roth processes run simultaneously as a part of integralgrowth, along 'With increasing gestational age, until post􀀿birth.Measurement of head circumference (He) and AF in newbornsis done to determine if the brain and skull grew normally duringthe intrauterine period.Objectives To investigate the differences in He and AF sizebetween preterm and full􀀿term infants, and the relationshipbetween gestational age (GA) and birth weight (BW) to Heand AF size.Methods This was a descriptive analytic study on preterm andfull􀀿term newborns. Measurement of HC and AF was conductedin three phases: just after birth, 1x24 and 2x24 hours of age.Analysis of HC and AF size differences between preterm and fullterm subjects was performed, as well as analysis of the correlationbetween GA and BW to HC and AF size.Results Two hundred fifty newborns completed the study. Therewere 180 full􀀿term and 70 preterm subjects. Median HC in full􀀿term and preterm male subjects were 34 cm (range 31􀀿37 cm)and 31 cm (27􀀿34 cm), respectively. Median HC in full􀀿termand preterm female subjects were 33 cm (31􀀿36 cm) and 32 cm(27􀀿3S.S cm), respectively. Median AF in full􀀿term and pretermmale subjects were 2.17 cm (1.0SA.6 cm) and 2.22 cm (1.3SA.Scm), respectively, and in full􀀿term and preterm female subjectswere 2.02 cm (lA.1S cm) and 2.22 cm (0.7SA cm), respectively.The HC of preterms were significantly lower than the fullterms(P<O.OOl), however the AF size was not different between these2 groups of newborns (P =0 .28). Correlation test between GA andBW to HC size revealed a positive correlation (r=0.620, P<O.OO 1and r=0.801, P<O.OOl, respectively), but not to AF size (r=􀀿 0.06,p􀁀 0.279 and F- 0.049, P􀁀0.44, respectively).Concl usions We found that the HC size of pre terms wassignificantly lower than thefullterms, but no significant differences in AF size between the two groups. GA and BW were associatedwith HC size, but not associated to AF size. [paediatr lndones.2012;52:145-51].

scholarly journals Production of granulocyte colony-stimulating factor in vitro by monocytes from preterm and term neonates [see comments]

Blood ◽  
1993 ◽  
Vol 82 (8) ◽  
pp. 2478-2484 ◽  
Author(s):  
KR Schibler ◽  
KW Liechty ◽  
WL White ◽  
RD Christensen
Keyword(s):  
Newborn Infants ◽  
Preterm Neonates ◽  
Granulocyte Colony Stimulating Factor ◽  
Serum Concentrations ◽  
Colony Stimulating Factor ◽  
Term Infants ◽  
Term Neonates ◽  
And Function ◽  
Stimulating Factor

Abstract We postulated that defective generation of granulocyte colony- stimulating factor (G-CSF) by cells of newborn infants might underlie their deficiencies in upregulating neutrophil production and function during bacterial infection. To test this, we isolated monocytes from the blood of preterm neonates, term neonates, and adults and, after stimulation with various concentrations of interleukin-1 alpha (IL-1 alpha) or lipopolysaccharide (LPS), quantified G-CSF concentrations in cell supernatants and G-CSF mRNA in cell lysates. When stimulated with plateau concentrations of IL-1 alpha for 24 hours, G-CSF concentrations were higher in supernatants of adult cells (8,699 +/- 5,529 pg/10(6) monocytes) than in those from term infants (2,557 +/- 442 pg, P < .05) or from preterm infants (879 +/- 348 pg, P < .05 v adults). When stimulated with plateau concentrations of LPS, supernatants of monocytes from preterm neonates had less G-CSF than did those from term neonates or adults. G-CSF mRNA content was low in cells from preterm infants, higher in those from term infants, and highest in those from adults. On the basis of the in vitro studies, we speculated that serum G-CSF concentrations might be less elevated in neutropenic neonates than in neutropenic adults. Indeed, serum concentrations were relatively low in all nonneutropenic subjects; 92 +/- 34 pg/mL (mean +/- SEM) in 10 preterm neonates, 114 +/- 21 pg/mL in 16 term neonates, and 45 +/- 13 pg/mL in 11 healthy adults. Serum concentrations were not elevated in 7 neutropenic neonates (39 +/- 17 pg/mL) but were in 8 neutropenic adults (2101 +/- 942 pg/mL, P < .05 v healthy adults). Other studies suggested that the lower G-CSF production in neonates is not counterbalanced by a heightened sensitivity of G-CSF--responsive progenitors to G-CSF. Therefore, we speculate that newborn infants, particularly those delivered prematurely, generate comparatively low quantities of G-CSF after inflammatory stimulation, and that this might constitute part of the explanation for their defective upregulation of neutrophil production and function during infection.

Thromboelastographic profiles of healthy very low birthweight infants serially during their first month

2019 ◽  
Vol 105 (4) ◽  
pp. 412-418 ◽  
Author(s):  
Genny Raffaeli ◽  
Armando Tripodi ◽  
Giacomo Cavallaro ◽  
Valeria Cortesi ◽  
Erica Scalambrino ◽  
...  
Keyword(s):  
Neonatal Intensive Care ◽  
Low Birthweight ◽  
Maximum Amplitude ◽  
Very Low Birthweight ◽  
Term Infants ◽  
Term Neonates ◽  
Outcomes Measures ◽  
Very Low Birthweight Infants ◽  
Α Angle

ObjectiveWe determined thromboelastographic (TEG) profiles of healthy very low birthweight infants (VLBWIs) of the day of birth and at set intervals during their first month.DesignProspective observational study with blinded clinical and laboratory follow-up.SettingLevel III neonatal intensive care unit (June 2015 to June 2018).PatientsConsecutive qualifying VLBWIs were enrolled at birth and followed up for 30 days.Interventions and main outcomes measuresLaboratory (citrated-native TEG, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, blood count) and clinical variables were retrieved at birth, 3rd–5th, 10th and 30th day of life. Blood samples temporally related to events with a potential hemostatic impact (sepsis, bleeding, platelets/plasma transfusions, ibuprofen/indomethacin administration) were excluded from analysis.ResultsWe enrolled 201 VLBWIs and 72 full-term neonates. Sixty-seven of the healthy VLBWIs completed the 30-day follow-up. 541 TEG traces were analysed.On day 1, the median (minimum–maximum) TEG values were as follows: reaction time (R), 8.2 min (1–21.8); kinetics (K), 2.8 min (0.8–16); α angle, 51° (14.2–80.6); maximum amplitude (MA), 54.9 mm (23.9–76.8). PT and APTT were 15.9 s (11.7–51.2) and 59 s (37.8–97.5), respectively. The above parameters suggest minor hypocoagulability compared with term infants. On day 30, the median (minimum–maximum) R was 5 (1–16.9), K 1 (0.8–4.1), α 74.7 (41.1–86.7) and MA 70.2 (35.8–79.7). PT and APTT were 12.1 (10.4–16.6) and 38.8 (29.6–51.4), respectively. Those parameters are consistent with a relatively hypercoagulable phenotype, compared with term infants.ConclusionsHealthy VLBWIs have a prolonged PT and APTT, but their TEG profiles suggest a relatively balanced hemostatic system, with slight hypocoagulability initially (compared with term neonates), gradually evolving to a somewhat more procoagulant phenotype over the first month.

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