Facing the outcome of prematurity – opinions from the general practitioner

Preterm birth is a leading cause of neonatal mortality and morbidity, affecting more than 15 million babies worldwide each year. Preterm infants also have higher rates of motor, functional, and cognitive deficits. Modern imaging has contributed significantly to a better understanding of the etiology of various forms of brain injury in neonates. The follow-up of premature newborns is essential to prevent and diminish neurological sequelae in time. A multi-disciplinary team is needed to adequately monitor this category of children, in which the family doctor has a significant role. The variety of adverse events that preterm infants can be exposed to before, during, and after birth poses significant obstacles to developing therapeutic interventions to prevent brain damage, including developmental vulnerability to injury during a particular gestational age. In addition, several procedures required for neonatal critical care, reduce mortality but increase the risk of brain injury. This review is aimed to update the reader about the complications of preterm birth, current therapeutic uses, imaging techniques, as well as present and future research on preterm birth.

A Multicenter Cohort Study Evaluating the Teratogenic Effects of Isotretinoin on Neonates

(1) Background: Isotretinoin (ISO) is a systemic retinoid known for its teratogenic effects on embryos and fetuses. The aim of this study was to compare the pregnancy outcomes of women who were exposed to isotretinoin with those of women without such exposure from a teratogenic point of view. (2) Methods: A total of 1459 female patients from three clinical hospitals in Poland and Romania, segregated into two groups depending on their ISO exposure, were evaluated between January and December 2019. Medical records were screened to identify the pregnancy outcomes and congenital malformation rates. (3) Results: The congenital malformation rate for the exposed group was 1.2% (four cases), and no specific signs of Accutane embryopathy were identified. Women from the unexposed group were more likely to deliver preterm and through cesarean deliveries and had a higher rate of newborn congenital malformations as compared to women from the exposed group. (4) Conclusions: Even though we could not find a significant association between ISO exposure and teratogenic effects in newborns, effective contraceptive measures are key to preventing unfavorable pregnancy outcomes.

A new pandemic – new questions: postnatal care of infants born to mothers with suspected or confirmed COVID-19

COVID-19 infection is primarily a community-acquired airborne respiratory infection, making pediatric and neonatal populations extremely vulnerable to the disease. Since the beginning of the coronavirus pandemic, many questions regarding mother and infant health have arisen, one of the most discussed issues being the management of infants born to mothers with suspected or confirmed COVID-19. Is it advisable to separate the child from the positive mother immediately after birth? What are the recommendations for breastfeeding? Are there any short and long-term follow-up indications or are there any possible long-term complications that we should take into account in those children? And not lastly, what are the most respectful and ethical measures both for mother and infant? We aim to analyze and compare the existing guidelines regarding the management of infants born to mothers with suspected or confirmed COVID-19 and to discuss the similarities and discrepancies between the available protocols.

Fatal neonatal persistent pulmonary hypertension caused by vegetations of infective endocarditis - case report and review of the literature

Neonatal infective endocarditis is a rare condition and usually pertains to a specific class of immunologically depressed preterm infants, with a long history of invasive procedures in the Neonatal Intensive Care Unit. We report the case of an aggressive and fatal neonatal infective endocarditis in a full-term infant, who developed massive endocardial vegetations on the tricuspid valve, leading to persistent pulmonary hypertension of the newborn, unresponsive to nitric oxide ventilation. Post-mortem cardiac cultures were positive with Serratia marcescens, an unusual germ for an early-onset infection, which was absent in blood cultures.

Endocan - a potential diagnostic marker for early onset sepsis in neonates

INTRODUCTION

Neonatal early onset sepsis assessment is based on the history of pregnancy and delivery and nonspecific clinical signs. None of the biomarkers currently in use for clinical practice has adequate prognostic value, so it is not possible to clearly distinguish neonates with culture-proven sepsis from those with only risk factors or clinical suspicion. Endocan is an endothelial mediator involved in the inflammatory response that is present in low concentrations in the serum of healthy subjects, and in much higher concentrations in patients with SIRS and septic shock. The purpose of this study is to evaluate the utility of serum endocan serum levels as a biomarker for the diagnosis of neonatal early onset sepsis (EOS).

METHODOLOGY

Serum endocan concentration was measured in newborns with clinical suspicion of EOS admitted to the Neonatal Intensive Care Unit on day 1, 3 and 7.

RESULTS

Serum endocan levels were significantly increased in septic compared to non-septic neonates in the early stages of sepsis (2.43 ± 0.95 vs. 1.77 ± 0.57, p = 0.004), continued to rise up to 72 hours from onset and then decreased by the seventh day under treatment.

CONCLUSIONS

These results suggest a potential role for endocan as an early marker for diagnosis and follow-up in neonatal EOS. Studies on a larger number of cases are needed in order to establish the practical utility of this molecule as a diagnostic tool for clinical practice.

Total antioxidant status in fresh and stored human milk from mothers of term and preterm neonates

BACKGROUND

Antioxidant defense of the body is assured by both endogenous and exogenous factors comprising several enzymes, vitamins, protein components and derivates and oligoelements. Breast milk has been proven to have important and essential antioxidant composition to prevent and protect against diseases in infancy. The objective of this study was to determine the total antioxidant status (TAS) of human milk and to evaluate the differences between premature milk and term milk at different moments of lactation (colostrum, transitional milk and mature milk). A second objective was to evaluate how TAS varies whether the human milk is refrigerated or frozen.

METHODS

Pumped human milk samples of the third, seven and 30th day were collected from women who had term deliveries (30 cases) and preterm deliveries (60 cases). Samples were refrigerated (+4 °C) or frozen in domestic conditions (-20 °C) for various durations and TAS was determined using the ABTS® technique with Randox® reagents and compared for the two groups.

RESULTS

Higher values were found in term versus preterm fresh milk at 30 days of lactation. A slight reduction in TAS was found after 72 h of refrigeration, while 1 week freezing produced significant decrease of total antioxidants. Freezing for 12 weeks reduced more than 50% of TAS in fresh milk.

CONCLUSION

Breastfeeding provides the optimal antioxidant for neonates, regardless of gestational age. Fresh milk has the higher antioxidant power. When it is not available, refrigerated milk for 24 h is better than for 72 h and preferable than frozen milk. Freezing human milk for 3 months in household conditions markedly diminishes TAS.

COMPARISON OF THE EFFICIENCY OF CAFFEINE VERSUS AMINOPHYLLINE FOR THE TREATMENT OF APNOEA OF PREMATURITY

Purpose. Comparison of the efficiency of caffeine and aminophylline for the treatment of apnoea in premature neonates. Material and method. We conducted a retrospective study on two lots of premature infants admitted in the Regional Centre of Neonatal Intensive Care Unit of the “Cuza-Vodă” Clinical Hospital of Obstetrics and Gynaecology of Iasi during June 2012 – June 2015. Results. Neonates treated with caffeine had significantly less apnoea on day 3 and 14 of treatment comparing with those who received aminophylline. Caffeine treatment was associated with less need for CPAP and mechanical ventilation comparing with aminophylline, but there was no statistical significance. Anemia, intraventricular hemorrhage, persistent ductus arteriosus and chronic lung disease were correlated with an increased duration of the treatment for apnoea of prematurity. Neonates from the caffeine group had more episodes of agitation, tachycardia and digestive intolerance, but at the same time a reduced incidence of necrotizing enterocolitis, weight loss and hypertension, compared to those from the aminophylline group. The hospital stay duration was reduced in the infants that received caffeine treatment compared to those that received aminophylline. Conclusion. The therapeutic advantages of caffeine are remarkable due to low incidence of significant adverse effects and its long-term cost/efficiency ratio, which recommend it as the best treatment for apnoea of prematurity. These facts justify the initiation of a multicenter national study including a higher number of premature neonates for the evaluation of the efficiency of caffeine therapy in all gestational age groups.

Early intrauterine development of mixed giant intracranial teratoma in newborn: a case report

Teratoma is one of the most frequent fetal intracranial tumors, but it usually grows very quickly and the fetus is generally a stillborn. Rare cases have slow development or are located in areas that afford immediate surgery after birth with variable chances of survival. Even more rare cases survive days or weeks, but with no chance of surgical treatment and with prolonged palliative care. We present a 34 weeks premature infant, born by C-section with a giant intracranial tumor, whose origin could not be ascertained, occupied almost all-intracranial space and survived 25 days with supportive care. The histological examination established a G3 mixed teratoma, predominantly with immature cells from all three embryonic layers. The cerebellum was normal and infra-mesencephalic structures were present. The infant presented with severe anemia and mild respiratory distress, and was out of neurosurgical therapeutic resources. Antenatal examination was normal until 30 weeks, when fetal ultrasound described a degree of hydrocephalus, but no tumor was individualized.

CONCLUSIONS

G3 type complex teratoma, even rare, can be localized at cerebral level and get giant development and growth only in the third trimester of pregnancy, ending with a neonate that has no chance of survival. Such cases cannot benefit of therapeutic interruption of pregnancy and generate serious difficulties for parents and clinicians.

Thapsigargin-induced endoplasmic reticulum stress is not accompanied by mitochondrial membrane potential dissipation in murine pro-B cells

There are almost no data concerning the involvement of endoplasmic reticulum stress (Ca2+ fluxes) in the apoptosis of the pro-B cell type Ba/F3. Thus, we aimed the characterization of thapsigargin-induced effects on Ba/F3 cells in vitro.

MATERIAL AND METHOD

For some experiments Ba/F3 cells were treated with 1 microM thapsigargin for 24 hours. To compare, we used as positive control the effects of valinomycin 10 microM. The negative control Ba/F3 cells received no treatment for 24 hours. After that, all batches of Ba/F3 cells were incubated in the presence of 1 mimcroM JC-1 (Sigma-Aldrich) at 37 degrees C for 30 minutes.

RESULTS

From the normal Ba/F3 JC-1-control cells (20.000 events gated by flow cytometry) 77.61 +/- 2.90% are associating high and 22.39 = 2.90% lower mitochondrial membrane potential. In the case of thapsigargin, 75.49 +/- 1.78% of the Ba/F3 cells are associating high and 24.51 +/- 1.78% lower mitochondrial membrane potential.

CONCLUSIONS

While mitochondrial permeability transition pore (MPTP) opening necessarily correlates with a loss of mitochondrial membrane potential (Psi(mt)), a decrease in Psi(mt) does not necessarily indicate MPTP opening. Also, endoplasmic reticulum stress regulation of high cytosolic calcium levels by thapsigargin may prompt the opening of the MPTP without necessarily triggering irreversible pore activation or subsequent apoptogenic factors in Ba/F3 cells.