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Kota S, Jasti K, Liu Y, Liu H, Zhang R, Chalak L. EEG Spectral Power: A Proposed Physiological Biomarker to Classify the Hypoxic-Ischemic Encephalopathy Severity in Real Time. Pediatr Neurol 2021; 122:7-14. [PMID: 34243047 DOI: 10.1016/j.pediatrneurol.2021.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/16/2021] [Accepted: 06/07/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mild hypoxic-ischemic encephalopathy (HIE) constitutes a large unstudied population with considerable debate on how to define and treat due to the dynamic evolution of the clinical signs of encephalopathy. We propose to address this gap with quantitative physiological biomarkers to aid in stratification of the disease severity. The objectives of this prospective cohort study were to measure the electroencephalographic (EEG) power as an objective biomarker of the evolution of the clinical encephalopathy in newborns with mild to severe HIE. METHODS EEG was collected in infants with HIE using four bipolar electrodes analyzed for the first three hours of the recording. Delta power (DP, 0.5 to 4 Hz) and total power (TP, 0.5 to 20 Hz) were compared between groups with different HIE severity using a univariate ordinal logistic regression model and receiver operating characteristic curves. RESULTS A total of 44 term-born infants with mild to severe HIE were identified within six hours of birth. The DP and TP values were significantly higher for the mild group than for the moderate group for all bipolar electrodes. A one-unit increase in DP was associated with significantly lower odds of encephalopathy. DP best distinguished mild from higher encephalopathy grades by area under the curve. CONCLUSIONS We conclude that DP and TP are sensitive real-time biomarkers for monitoring the dynamic evolution of the encephalopathy severity in the first day of life. The quantitative EEG power may lead to timely recognition of the worsening of the encephalopathy and guide future therapeutic interventions targeting mild HIE.
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Affiliation(s)
- Srinivas Kota
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kaushik Jasti
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Yulun Liu
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Hanli Liu
- Department of Bioengineering, University of Texas at Arlington, Arlington, Texas
| | - Rong Zhang
- Departments of Neurology and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lina Chalak
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas.
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2
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Cordero González G, Valdés Vázquez NO, Izaguirre Alcántara DD, Michel Macías C, Carrera Muiños S, Morales Barquet DA, Fernández Carrocera LA. Management of abdominal distension in the preterm infant with noninvasive ventilation: Comparison of cenit versus 2x1 technique for the utilization of feeding tube. J Neonatal Perinatal Med 2021; 13:367-372. [PMID: 31929124 DOI: 10.3233/npm-190301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Preterm infants are fed by orogastric / nasogastric tube until they reach maturation and coordination of sucking, swallowing and respiration at approximately 32-34 weeks of corrected age. While being on non-invasive ventilation (NIV), they frequently present abdominal distension. Currently at our institution two techniques are used for the management of abdominal distension in preterm infants fed by bolus via orogastric tube: cenit and 2 x 1.The aim of this study was to compare the proportion of preterm infants presenting NIV-associated abdominal distension with each of these techniques. STUDY DESIGN We conducted a randomized clinical trial including infants of < 36.6 weeks of gestation and < 1500 g of birth weight who were admitted to our NICU during the period of April 1, 2016 to April 1, 2018 and received NIV. The presence of abdominal distension > 2 cm was the primary outcome. Secondary outcomes were presence of reflux, regurgitation, oxygen saturation during feeding and days to reach full feedings. Feeding tube drainage, stool characteristics and the use of prokinetics were confounding variables. RESULTS A total of 97 patients were included. Forty-six in the cenit group and 51 in the 2 x 1 group. There was no difference in the proportion of infants with abdominal distension > 2 cm between groups. Oxygen saturation during feeding at volume of 150 ml/kg/day was higher in the cenit group with statistical significance. CONCLUSION The use of cenit or 2 x 1 technique in preterm infants with NIV did not improve abdominal distension or other indicators of feeding tolerance.
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3
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Liu CY, Al-Ward H, Ngaffo Mekontso F, Liu N, Zeng HQ, Liu M, Yu ZR, Zhang L, Han YC, Xu H. Experimental Study on the Correlation between miRNA-373 and HIF-1 α, MMP-9, and VEGF in the Development of HIE. Biomed Res Int 2021; 2021:5553486. [PMID: 33997006 PMCID: PMC8112928 DOI: 10.1155/2021/5553486] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/12/2021] [Accepted: 04/26/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Microribonucleic acids (miRNAs) have short (approximately 18 to 25) nucleotides and are evolutionarily conserved and endogenously expressed RNAs belonging to a family of noncoding RNA molecules. miRNA-373 regulates cell proliferation, migration, apoptosis, invasion, and repairing damaged DNA after hypoxia stress. Neonatal hypoxic-ischemic encephalopathy (HIE) refers to perinatal asphyxia caused by partial or complete hypoxia, reduced or suspended cerebral blood flow, and fetal or neonatal brain damage. We aim to investigate the relationship between miRNA-373 and HIF-1α, between miRNA-373 MMP-9, and between miRNA-373 VEGF in the occurrence and development of HIE. METHODS Human (children) samples were divided into four groups (n = 15 in each group) according to HIE severity. The patient group was divided into middle, moderate, and severe HIE groups. The control group included healthy children or children with nonneurological diseases. The expressions of miRNA-373, HIF-1α, MMP-9, and VEGF were assayed in the serum samples. RESULTS Our study showed a strong relationship between miRNA-373 and HIF-1α, between miRNA-373 and MMP-9, and between miRNA-373 and VEGF. The expression levels of miRNA-373, HIF-1α, MMP-9, and VEGF in the HIE groups were much higher than those of the control group. CONCLUSION The increased change in miRNA-373 expression has a certain diagnostic significance on neonatal HIE. In the occurrence and development of HIE, miRNA-373 is positively correlated with HIF-1α, MMP-9, and VEGF.
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MESH Headings
- Computational Biology
- Humans
- Hypoxia-Inducible Factor 1, alpha Subunit/blood
- Hypoxia-Inducible Factor 1, alpha Subunit/genetics
- Hypoxia-Inducible Factor 1, alpha Subunit/metabolism
- Hypoxia-Ischemia, Brain/genetics
- Hypoxia-Ischemia, Brain/metabolism
- Hypoxia-Ischemia, Brain/physiopathology
- Infant, Newborn
- Infant, Newborn, Diseases/genetics
- Infant, Newborn, Diseases/metabolism
- Infant, Newborn, Diseases/physiopathology
- Matrix Metalloproteinase 9/blood
- Matrix Metalloproteinase 9/genetics
- Matrix Metalloproteinase 9/metabolism
- MicroRNAs/blood
- MicroRNAs/genetics
- MicroRNAs/metabolism
- Vascular Endothelial Growth Factor A/blood
- Vascular Endothelial Growth Factor A/genetics
- Vascular Endothelial Growth Factor A/metabolism
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Affiliation(s)
- Chun-Yang Liu
- Department of Biochemistry and Molecular Biology, Jiamusi University School of Basic Medical Sciences, Jiamusi, China
- AnKang University, School of Medicine, Ankang, Shanxi Province 725000, China
| | - Hisham Al-Ward
- Department of Biochemistry and Molecular Biology, Jiamusi University School of Basic Medical Sciences, Jiamusi, China
| | | | - Ning Liu
- Department of Biochemistry and Molecular Biology, Jiamusi University School of Basic Medical Sciences, Jiamusi, China
| | - Hui-Qin Zeng
- First Affiliated Hospital of Xiamen University, Xiamen 361003, China
| | - Min Liu
- Beijing Friendship Hospital, Capital Medical University, Beijing 100000, China
| | - Zi-Rui Yu
- Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Lin Zhang
- Jiamusi University, School of Clinical Medicine, Jiamusi, China
| | - Yu-Chun Han
- Jiamusi University, School of Clinical Medicine, Jiamusi, China
| | - Hui Xu
- Department of Biochemistry and Molecular Biology, Jiamusi University School of Basic Medical Sciences, Jiamusi, China
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4
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Benninger KL, Inder TE, Goodman AM, Cotten CM, Nordli DR, Shah TA, Slaughter JC, Maitre NL. Perspectives from the Society for Pediatric Research. Neonatal encephalopathy clinical trials: developing the future. Pediatr Res 2021; 89:74-84. [PMID: 32221474 PMCID: PMC7529683 DOI: 10.1038/s41390-020-0859-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/27/2020] [Accepted: 02/20/2020] [Indexed: 12/18/2022]
Abstract
The next phase of clinical trials in neonatal encephalopathy (NE) focuses on hypothermia adjuvant therapies targeting alternative recovery mechanisms during the process of hypoxic brain injury. Identifying infants eligible for neuroprotective therapies begins with the clinical detection of brain injury and classification of severity. Combining a variety of biomarkers (serum, clinical exam, EEG, movement patterns) with innovative clinical trial design and analyses will help target infants with the most appropriate and timely treatments. The timing of magnetic resonance imaging (MRI) and MR spectroscopy after NE both assists in identifying the acute perinatal nature of the injury (days 3-7) and evaluates the full extent and evolution of the injury (days 10-21). Early, intermediate outcome of neuroprotective interventions may be best defined by the 21-day neuroimaging, with recognition that the full neurodevelopmental trajectory is not yet defined. An initial evaluation of each new therapy at this time point may allow higher-throughput selection of promising therapies for more extensive investigation. Functional recovery can be assessed using a trajectory of neurodevelopmental evaluations targeted to a prespecified and mechanistically derived hypothesis of drug action. As precision medicine revolutionizes healthcare, it should also include the redesign of NE clinical trials to allow safe, efficient, and targeted therapeutics. IMPACT: As precision medicine revolutionizes healthcare, it should also include the redesign of NE clinical trials to allow faster development of safe, effective, and targeted therapeutics. This article provides a multidisciplinary perspective on the future of clinical trials in NE; novel trial design; study management and oversight; biostatistical methods; and a combination of serum, imaging, and neurodevelopmental biomarkers can advance the field and improve outcomes for infants affected by NE. Innovative clinical trial designs, new intermediate trial end points, and a trajectory of neurodevelopmental evaluations targeted to a prespecified and mechanistically derived hypothesis of drug action can help address common challenges in NE clinical trials and allow for faster selection and validation of promising therapies for more extensive investigation.
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MESH Headings
- Biomarkers/blood
- Biomedical Research/trends
- Brain Diseases/diagnostic imaging
- Brain Diseases/etiology
- Brain Diseases/physiopathology
- Brain Diseases/therapy
- Clinical Trials as Topic
- Consensus
- Delphi Technique
- Diffusion of Innovation
- Forecasting
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/diagnostic imaging
- Infant, Newborn, Diseases/etiology
- Infant, Newborn, Diseases/physiopathology
- Infant, Newborn, Diseases/therapy
- Neonatology/trends
- Neuroimaging
- Research Design/trends
- Societies, Medical
- Societies, Scientific
- Time Factors
- Treatment Outcome
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Affiliation(s)
- Kristen L Benninger
- Division of Neonatology and Center for Perinatal Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.
| | - Terrie E Inder
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Amy M Goodman
- Division of Child Neurology, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | | | - Douglas R Nordli
- Section of Child Neurology, Department of Pediatrics, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Tushar A Shah
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Children's Hospital of The King's Daughters, Eastern Virginia Medical School, Norfolk, VA, USA
| | - James C Slaughter
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nathalie L Maitre
- Division of Neonatology and Center for Perinatal Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
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Xiang X, Wang F, Zhao N, Zhou Z. Treatment of pregnancy-induced hypertension compared with labetalol, low dose aspirin and placebo. Cell Mol Biol (Noisy-le-grand) 2020; 66:9-13. [PMID: 34174970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 06/13/2023]
Abstract
This study aimed to evaluate the maternal and fetal results in women undergoing antihypertensive therapy (low aspirin or labetalol) with mild to severe chronic hypertension relative to women without medicines. This randomized multi-center clinical trial was performed with random division into three groups of 393 pregnant women with mild to moderate chronic hypertension. From the beginning of the pregnancy to the end of the puerperium, the low dosage aspirin group (n = 129), the labetalol group (n = 127), and the drug-free or control group (n = 126) reported both mother and child results. Major variations in the presence of severely motherly hypertension, pre-eclampsia, renal failure, ECG shifts, and cardiovascular rupture between treatment groups (low doses of aspirin and labetalol) and control groups were noted. Repeated placenta and blood pressure control hospitalizations. (P<0.001) in the control group more often (untreated). The new babies were more vulnerable to gestational age (SGA), neonatal hypotension, neonatal Hyperbilirubinemia, and ICU (p <0.001 in contrast with the low-dose aspirin and control groups). In the control group, the proportion of premature babies was considerably higher than in the treatment group (p<0,05). A mild to moderate persistent high blood pressure during pregnancy therapy helps minimize mother and child occurrence. The use of labetalol is correlated with a higher incidence of SGA, neonatal hypotension, and neonatal hyperbilirubinemia relative to low-dose aspirin or control group.
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MESH Headings
- Adult
- Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
- Antihypertensive Agents/therapeutic use
- Aspirin/therapeutic use
- Blood Pressure/drug effects
- Blood Pressure/physiology
- Dose-Response Relationship, Drug
- Female
- Humans
- Hypertension/physiopathology
- Hypertension/prevention & control
- Hypertension, Pregnancy-Induced/drug therapy
- Hypertension, Pregnancy-Induced/physiopathology
- Infant, Newborn
- Infant, Newborn, Diseases/physiopathology
- Infant, Newborn, Diseases/prevention & control
- Labetalol/therapeutic use
- Outcome Assessment, Health Care/methods
- Outcome Assessment, Health Care/statistics & numerical data
- Pre-Eclampsia/physiopathology
- Pre-Eclampsia/prevention & control
- Pregnancy
- Young Adult
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Affiliation(s)
- Xuewen Xiang
- Department of Obstetrics, Jiaozhou Central Hospital, Qingdao 266300, China
| | - Fang Wang
- Department of Obstetrics, Jiaozhou Central Hospital, Qingdao 266300, China
| | - Ni Zhao
- Department of Obstetrics, Jiaozhou Central Hospital, Qingdao 266300, China
| | - Zhao Zhou
- Department of Obstetrics, Jiaozhou Central Hospital, Qingdao 266300, China
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6
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Olander RFW, Sundholm JKM, Ojala TH, Andersson S, Sarkola T. Differences in cardiac geometry in relation to body size among neonates with abnormal prenatal growth and body size at birth. Ultrasound Obstet Gynecol 2020; 56:864-871. [PMID: 31909531 DOI: 10.1002/uog.21972] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 12/16/2019] [Accepted: 12/20/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Both excessive and restricted fetal growth are associated with changes in cardiac geometry and function at birth. There are significant issues when indexing cardiac parameters for body size in the neonatal period. The aims of this study were to determine to what extent cardiac geometry is dependent on body size in term and preterm neonates with restricted or excessive fetal growth and how this is affected by adiposity. METHODS This was a cross-sectional study of neonates born between 31 and 42 weeks of gestation, divided into three groups: (1) small-for-gestational age (SGA, birth weight > 2 SD below the mean); (2) large-for-gestational age (LGA, birth weight > 2 SD above the mean); and (3) appropriate-for-gestational-age controls (AGA, birth weight ≤ 2 SD from the mean). Cardiac geometry and function were compared between the study groups, adjusting for body size. The potential impact of infant adiposity and maternal disease was assessed. RESULTS In total, 174 neonates were included, of which 39 were SGA, 45 were LGA and 90 were AGA. Body size was reflected in cardiac dimensions, with differences in cardiac dimensions disappearing between the SGA and AGA groups when indexed for body surface area (BSA) or thoracic circumference. The same was true for the differences in atrial and ventricular areas between the LGA and AGA groups. However, left ventricular inflow and outflow tract dimensions did not follow this trend as, when indexed for BSA, they were associated negatively with adiposity, resulting in diminished dimensions in LGA compared with AGA and SGA neonates. Adiposity was associated positively with left ventricular mass, right ventricular length and area and right atrial area. The SGA group showed increased right ventricular fractional area change, possibly reflecting differences in the systolic function of the right ventricle. We found evidence of altered diastolic function between the groups, with the mitral valve inflow E- to lateral E'-wave peak velocity ratio being increased in the LGA group and decreased in the SGA group. CONCLUSIONS Cardiac geometry is explained by body size in both term and preterm AGA and SGA infants. However, the nature of the relationship between body size and cardiac dimensions may be influenced by adiposity in LGA infants, leading to underestimation of left ventricular inflow and outflow tract dimensions when adjusted for BSA. Adjustments for thoracic circumference provide similar results to those for BSA. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- R F W Olander
- Children's Hospital, Paediatric Research Centre, Helsinki University Hospital, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
| | - J K M Sundholm
- Children's Hospital, Paediatric Research Centre, Helsinki University Hospital, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
| | - T H Ojala
- Children's Hospital, Paediatric Research Centre, Helsinki University Hospital, Helsinki, Finland
| | - S Andersson
- Children's Hospital, Paediatric Research Centre, Helsinki University Hospital, Helsinki, Finland
| | - T Sarkola
- Children's Hospital, Paediatric Research Centre, Helsinki University Hospital, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
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Rashidian T, Sharifi N, Fathnezhad-Kazemi A, Mirzamrajani F, Nourollahi S, Ghaysouri A. Death of a neonate with suspected coronavirus disease 2019 born to a mother with coronavirus disease 2019 in Iran: a case report. J Med Case Rep 2020; 14:186. [PMID: 33023635 PMCID: PMC7537954 DOI: 10.1186/s13256-020-02519-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/01/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION A novel coronavirus named severe acute respiratory syndrome coronavirus 2, was first reported in Wuhan, China, in December 2019. The virus, known as COVID-19, is recognized as a potentially life-threatening disease by causing severe respiratory disease. Since this virus has not previously been detected in humans, there is a paucity of information regarding its effects on humans. In addition, only limited or no information exists about its impact during pregnancy. CASE PRESENTATION In the present case study, we report the death of a neonate born to a 32-year-old mother with coronavirus disease 2019 in Ilam, Iran, with Kurdish ethnicity. We report the infection and death of a neonate in Iran with a chest X-ray (CXR) marked abnormality 2 hours after birth demonstrating coronavirus disease 2019 disease. The neonate was born by elective cesarean section, the fetal health was assessed using fetal heart rate and a non-stress test before the birth, and there was no evidence of fetal distress. All the above-mentioned facts and radiographic abnormalities suggested that coronavirus disease 2019 is involved. CONCLUSIONS In this case study, we report the death of a neonate born to a mother with coronavirus disease 2019, 11 hours after birth. There is a paucity of data on the vertical transmission and the adverse maternal-fetal consequences of this disease, so vertical transmission from mother to child remains to be confirmed.
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MESH Headings
- Adult
- Betacoronavirus/isolation & purification
- COVID-19
- Cesarean Section/methods
- Clinical Deterioration
- Coronavirus Infections/diagnosis
- Coronavirus Infections/physiopathology
- Coronavirus Infections/therapy
- Coronavirus Infections/transmission
- Critical Care/methods
- Fatal Outcome
- Female
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/physiopathology
- Infant, Newborn, Diseases/therapy
- Infectious Disease Transmission, Vertical
- Iran
- Neonatal Screening/methods
- Pandemics
- Perinatal Death
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/physiopathology
- Pneumonia, Viral/therapy
- Pneumonia, Viral/transmission
- Pregnancy
- Pregnancy Complications, Infectious/diagnosis
- Pregnancy Complications, Infectious/physiopathology
- Pregnancy Complications, Infectious/therapy
- Respiration, Artificial/methods
- SARS-CoV-2
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Affiliation(s)
- Tayebeh Rashidian
- Department of Obstetrics and Gynecology, Medical School, Ilam University of Medical Sciences, Ilam, Iran
| | - Nasibeh Sharifi
- Department of Midwifery, School of Nursing & Midwifery, Ilam University of Medical Sciences, Ilam, Iran
| | - Azita Fathnezhad-Kazemi
- Department of Midwifery, Faculty of Nursing and Midwifery Islamic Azad University, Tabriz Branch, Tabriz, Iran
| | - Fatemeh Mirzamrajani
- Department of Obstetrics and Gynecology, Medical School, Ilam University of Medical Sciences, Ilam, Iran
| | - Sajad Nourollahi
- Department of Pediatrics, Medical School, Ilam University of Medical Sciences, Ilam, Iran
| | - Abas Ghaysouri
- Department of Internal Medicine, Medical School, Ilam University of Medical Sciences, Ilam, Iran
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Kapur N, Nixon G, Robinson P, Massie J, Prentice B, Wilson A, Schilling S, Twiss J, Fitzgerald DA. Respiratory management of infants with chronic neonatal lung disease beyond the NICU: A position statement from the Thoracic Society of Australia and New Zealand. Respirology 2020; 25:880-888. [PMID: 32510776 PMCID: PMC7496866 DOI: 10.1111/resp.13876] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/16/2020] [Accepted: 05/21/2020] [Indexed: 12/17/2022]
Abstract
Chronic neonatal lung disease (CNLD) is defined as continued need for any form of respiratory support (supplemental oxygen and/or assisted ventilation) beyond 36 weeks PMA. Low-flow supplemental oxygen facilitates discharge from hospital of infants with CNLD who are hypoxic in air and is widely used despite lack of evidence on the most appropriate minimum mean target oxygen saturations. Furthermore, there are minimal data to guide the home monitoring, titration or weaning of supplemental oxygen in these infants. The purpose of this position statement is to provide a guide for the respiratory management of infants with CNLD, with special emphasis on role and logistics of supplemental oxygen therapy beyond the NICU stay. Reflecting a variety of clinical practices and infant comorbidities (presence of pulmonary hypertension, retinopathy of prematurity and adequacy of growth), it is recommended that the minimum mean target range for SpO2 during overnight oximetry to be 93-95% with less than 5% of total recording time to be below 90% SpO2 . Safety of short-term disconnection from supplemental oxygen should be assessed before discharge, with majority of infants with CNLD not ready for discharge until supplemental oxygen requirement is ≤0.5 L/min. Sleep-time assessment of oxygenation with continuous overnight oximetry is recommended when weaning supplemental oxygen. Palivizumab is considered safe and effective for the reduction of hospital admissions with RSV infection in this group. This statement would be useful for paediatricians, neonatologists, respiratory and sleep physicians and general practitioners managing children with CNLD.
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Affiliation(s)
- Nitin Kapur
- Department of Respiratory and Sleep MedicineQueensland Children's HospitalBrisbaneQLDAustralia
- School of MedicineUniversity of QueenslandBrisbaneQLDAustralia
| | - Gillian Nixon
- Melbourne Children's Sleep CentreMonash Children's HospitalMelbourneVICAustralia
- Department of PaediatricsMonash UniversityMelbourneVICAustralia
| | - Philip Robinson
- Respiratory and Sleep MedicineRoyal Children's Hospital, Murdoch Children's Research InstituteMelbourneVICAustralia
- Department of PaediatricsUniversity of MelbourneMelbourneVICAustralia
| | - John Massie
- Department of Respiratory MedicineRoyal Children's HospitalMelbourneVICAustralia
| | - Bernadette Prentice
- Department of Respiratory MedicineSydney Children's HospitalSydneyNSWAustralia
| | - Andrew Wilson
- Department of Respiratory and Sleep MedicinePrincess Margaret Hospital for ChildrenPerthWAAustralia
| | - Sandra Schilling
- Department of Respiratory and Sleep MedicineQueensland Children's HospitalBrisbaneQLDAustralia
- School of MedicineUniversity of QueenslandBrisbaneQLDAustralia
| | - Jacob Twiss
- Respiratory DepartmentStarship Children's HospitalAucklandNew Zealand
| | - Dominic A. Fitzgerald
- Discipline of Child and Adolescent Health, Faculty of Medicine and HealthUniversity of Sydney and the Children's Hospital at WestmeadSydneyNew South WalesAustralia
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9
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Das Y, Liu H, Tian F, Kota S, Zhang R, Chalak LF. Rigor of Neurovascular Coupling (NVC) Assessment in Newborns Using Different Amplitude EEG Algorithms. Sci Rep 2020; 10:9183. [PMID: 32514166 PMCID: PMC7280505 DOI: 10.1038/s41598-020-66227-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/07/2020] [Indexed: 11/08/2022] Open
Abstract
Birth asphyxia constitutes a major global public health burden for millions of infants with a critical need for real time physiological biomarkers. This proof of concept study targets the translational rigor of such biomarkers and aims to examine whether the variability in the amplitude-integrated EEG (aEEG) outputs impact the determination of neurovascular coupling (NVC) in newborns with encephalopathy. A convenience sample with neonatal asphyxia were monitored for twenty hours in the first day of life with EEG and near infrared spectroscopy (NIRS)-based cerebral tissue oxygen saturation (SctO2). NVC between aEEG and NIRS-SctO2 was assessed using wavelet transform coherence (WTC) analysis, specifically by the wavelet total pixel number of significant coherences within 95% confidence interval. The raw EEG was converted to aEEG using three different methods: Method (M1) derives from the algorithm by Zhang and Ding. Method (M2) uses a Neonatal EEG Analysis Toolbox (WU-NEAT). Method (M3) extracts output directly from a commercial platform with an undisclosed algorithm. Our results demonstrate excellent agreement with Bland Altman comparisons for WTC-based NVC irrespective of the algorithms used, despite significant heterogeneities in the aEEG tracings produced by three algorithms. Our findings confirm the robustness of NVC wavelet analysis in Neonatal Encephalopathy related to HIE.
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Affiliation(s)
- Yudhajit Das
- Department of Bioengineering, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hanli Liu
- Department of Bioengineering, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Fenghua Tian
- Department of Bioengineering, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Srinivas Kota
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rong Zhang
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lina F Chalak
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Abstract
There are few cases of pregnant women with novel corona virus 2019 (COVID-19) in the literature, most of them with a mild illness course. There is limited evidence about in utero infection and early positive neonatal testing. A 41-year-old G3P2 with a history of previous cesarean deliveries and diabetes mellitus presented with a 4-day history of malaise, low-grade fever, and progressive shortness of breath. A nasopharyngeal swab was positive for COVID-19, COVID-19 serology was negative. The patient developed respiratory failure requiring mechanical ventilation on day 5 of disease onset. The patient underwent a cesarean delivery, and neonatal isolation was implemented immediately after birth, without delayed cord clamping or skin-to-skin contact. The neonatal nasopharyngeal swab, 16 hours after delivery, was positive for severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) real-time polymerase chain reaction (RT-PCR), and immunoglobulin (Ig)-M and IgG for SARS-CoV-2 were negative. Maternal IgM and IgG were positive on postpartum day 4 (day 9 after symptom onset). We report a severe presentation of COVID-19 during pregnancy. To our knowledge, this is the earliest reported positive PCR in the neonate, raising the concern for vertical transmission. We suggest pregnant women should be considered as a high-risk group and minimize exposures for these reasons. KEY POINTS: · We report a severe presentation of COVID-19 in pregnancy requiring invasive ventilatory support.. · This is a case of positive RT-PCR in first day of life, suggesting possible vertical transmission.. · There were no detectable maternal antibodies for COVID-19 until after delivery..
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MESH Headings
- Adult
- Betacoronavirus/isolation & purification
- Betacoronavirus/pathogenicity
- COVID-19
- COVID-19 Testing
- COVID-19 Vaccines
- Cesarean Section/methods
- Clinical Laboratory Techniques/methods
- Coronavirus Infections/diagnosis
- Coronavirus Infections/physiopathology
- Coronavirus Infections/therapy
- Coronavirus Infections/transmission
- Female
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/physiopathology
- Infant, Newborn, Diseases/therapy
- Infant, Newborn, Diseases/virology
- Infectious Disease Transmission, Vertical
- Pandemics
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/physiopathology
- Pneumonia, Viral/therapy
- Pneumonia, Viral/transmission
- Pregnancy
- Pregnancy Complications, Infectious/physiopathology
- Pregnancy Complications, Infectious/therapy
- Pregnancy Complications, Infectious/virology
- Pregnancy Outcome
- Respiration, Artificial/methods
- Respiratory Insufficiency/etiology
- Respiratory Insufficiency/physiopathology
- Respiratory Insufficiency/therapy
- SARS-CoV-2
- Severity of Illness Index
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Affiliation(s)
| | - Tania Paredes
- Division of Neonatology, British American Hospital, Lima, Peru
| | - David Caceres
- Division of Pulmonary Medicine, British American Hospital, Lima, Peru
| | - Camille M. Webb
- Division of Infectious Disease, University of Texas Medical Branch, Texas
- Tropical Medicine Institute “Alexander von Humbolt,” Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luis M. Valdez
- Tropical Medicine Institute “Alexander von Humbolt,” Universidad Peruana Cayetano Heredia, Lima, Peru
- Division of Infectious Disease, British American Hospital, Lima, Peru
| | - Mauricio La Rosa
- Division of Maternal Fetal Medicine, British American Hospital, Lima, Peru
- Division of Maternal Fetal Medicine, University of Texas Medical Branch, Texas
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11
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Hofheimer JA, Smith LM, McGowan EC, O'Shea TM, Carter BS, Neal CR, Helderman JB, Pastyrnak SL, Soliman A, Dansereau LM, DellaGrotta SA, Lester BM. Psychosocial and medical adversity associated with neonatal neurobehavior in infants born before 30 weeks gestation. Pediatr Res 2020; 87:721-729. [PMID: 31600769 PMCID: PMC7082182 DOI: 10.1038/s41390-019-0607-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/19/2019] [Accepted: 09/25/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Psychosocial adversity escalates medical risk for poor outcomes in infants born <30 weeks gestation. Neonatal neurobehavior and maternal psychological and socioenvironmental assessments may identify the earliest specific intervention needs. We hypothesized that maternal prenatal anxiety, depression, and adverse medical and socioenvironmental conditions would be associated with less optimal neonatal neurobehavior at neonatal intensive care unit (NICU) discharge. METHODS We studied 665 infants at 9 university NICUs. Risk indices of socioenvironmental, maternal, and neonatal medical factors were obtained from standardized, structured maternal interviews and medical record reviews. Brain injuries were classified by consensus ultrasonogram readings. NICU Network Neurobehavioral Scale (NNNS) exams were conducted at NICU discharge. RESULTS On the NNNS, generalized estimating equations indicated infants of mothers with prenatal anxiety had less optimal attention, and those born to mothers with prenatal depression had increased lethargy. Maternal medical complications predicted suboptimal reflexes. Socioenvironmental risk predicted lower self-regulation and movement quality. Infants with more severe neonatal medical complications had lower attention, increased lethargy, and suboptimal reflexes. CONCLUSIONS Combined information from the observed associations among adverse prenatal maternal medical and psychosocial conditions, and neonatal complications may assist in the early identification of infants at elevated neurobehavioral risk.
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MESH Headings
- Adult
- Age Factors
- Anxiety/epidemiology
- Anxiety/psychology
- Child Development
- Depression/epidemiology
- Depression/psychology
- Female
- Gestational Age
- Humans
- Infant Behavior
- Infant, Newborn
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/physiopathology
- Infant, Newborn, Diseases/psychology
- Infant, Premature/growth & development
- Infant, Premature/psychology
- Intensive Care Units, Neonatal
- Male
- Maternal Health
- Mental Health
- Mother-Child Relations
- Mothers/psychology
- Nervous System/growth & development
- Neurologic Examination
- Predictive Value of Tests
- Pregnancy
- Premature Birth
- Risk Assessment
- Risk Factors
- Social Determinants of Health
- Socioeconomic Factors
- United States/epidemiology
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Affiliation(s)
- Julie A Hofheimer
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
| | - Lynne M Smith
- Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Elisabeth C McGowan
- Department of Pediatrics, Brown Alpert Medical School and Women and Infants Hospital, Providence, RI, USA
| | - T Michael O'Shea
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Brian S Carter
- Department of Pediatrics-Neonatology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Charles R Neal
- Department of Pediatrics, University of Hawaii John A. Burns School of Medicine, Honolulu, HI, USA
| | - Jennifer B Helderman
- Department of Pediatrics, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Steven L Pastyrnak
- Department of Pediatrics, Spectrum Health-Helen DeVos Hospital, Grand Rapids, MI, USA
| | - Antoine Soliman
- Department of Pediatrics, Miller Children's and Women's Hospital Long Beach, Long Beach, CA, USA
| | - Lynne M Dansereau
- Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, RI, USA
| | - Sheri A DellaGrotta
- Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, RI, USA
| | - Barry M Lester
- Department of Pediatrics, Brown Alpert Medical School and Women and Infants Hospital, Providence, RI, USA
- Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown Alpert Medical School, Providence, RI, USA
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12
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Abstract
OBJECTIVE The association between birth weight and infants' neurodevelopment is not well understood. We aimed to examine the impact of birth weight on neurodevelopment of infants at age 1-6 months using data from the Wuhan Healthy Baby Cohort (WHBC) study. SETTING AND PARTICIPANTS This is a prospective cohort study of 4026 infants from the WHBC study who were born at the Women and Children's Hospital of Wuhan, China between October 2012 and September 2013 and who had complete healthcare records within 6 months after birth. Participants were categorised into three groups according to their birth weight: low birth weight (LBW; birth weight <2500 g), normal birth weight (2500 g ≤ birth weight <4000 g) and macrosomia (birth weight ≥4000 g). MAIN OUTCOME MEASURES The main outcomes were development quotient (DQ) and clinical diagnosis of neurodevelopmental delay. Both adjusted regression coefficients and ORs were estimated for LBW and macrosomia. RESULTS Of the 4026 infants, 166 (4.12%) were of LBW and 237 (5.89%) were with macrosomia. Adjusted regression coefficients of LBW and macrosomia for gross motor DQ were -11.18 (95% CI -11.36 to 10.99) and 0.49 (95% CI 0.36 to 0.63), fine motor DQ -6.57 (95% CI -6.76 to -6.39) and -2.73 (95% CI -2.87 to -2.59), adaptability DQ -4.87 (95% CI -5.05 to -4.68) and -1.19 (95% CI -1.33 to -1.05), language DQ -6.23 (95% CI -6.42 to -6.05) and 0.43 (95% CI 0.29 to 0.57), and social behaviour DQ -6.82 (95% CI -7.01 to -6.64) and 1.10 (95% CI 0.96 to 1.24). Adjusted OR of LBW for clinical diagnosis of 'neurodevelopmental delay' in gross motor was 2.43 (95% CI 1.65 to 3.60), fine motor 1.49 (95% CI 1.01 to 2.19) and adaptability 1.56 (95% CI 1.06 to 2.31). LBW has no significant effects on 'neurodevelopmental delay' in language and social behaviour, and macrosomia has no significant effects on clinical diagnosis of 'neurodevelopmental delay' in all domains. CONCLUSION Both LBW and macrosomia are associated with infants' DQ, and LBW increases the risk of being diagnosed with 'neurodevelopmental delay' in gross motor, fine motor and adaptability among infants aged 1-6 months.
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Affiliation(s)
- Man Zhang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong, China
| | | | - Zhong Chen
- Department of Child Health Care, Wuhan Medical and Healthcare Center for Women and Children, Wuhan, China
| | - Bin Zhang
- Department of Child Health Care, Wuhan Medical and Healthcare Center for Women and Children, Wuhan, China
| | - Yanru Chen
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yizhen Yu
- Child and Women Health Care, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jie Tang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong, China
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13
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Ibrahim A, Hussain N. Brief report: Metabolic acidosis in newborn infants following maternal use of acetazolamide during pregnancy. J Neonatal Perinatal Med 2020; 13:419-425. [PMID: 31771084 DOI: 10.3233/npm-190333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The information regarding fetal effects of acetazolamide use during pregnancy and lactation is sparse. We report the clinical and pharmacodynamic characteristics of maternal acetazolamide use and the timing of its effects on acid-base balance in three cases who presented with metabolic acidosis in the newborn period. We found that the infants' clinical status soon after birth was inconsistently correlated with maternal drug dose and concentrations of medication in maternal serum. However, there was low transfer of the drug in breast milk and its use did not affect clinical symptomatology. We also present a review of literature on this subject to help consolidate our current knowledge on this topic.
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Affiliation(s)
- A Ibrahim
- Department of Volunteer Services, Connecticut Children's Medical Center and University of Connecticut School of Medicine, Farmington, CT, USA
| | - N Hussain
- Department of Pediatrics, Division of Neonatology, Connecticut Children's Medical Center and University of Connecticut School of Medicine, Farmington, CT, USA
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14
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Critser PJ, Higano NS, Tkach JA, Olson ES, Spielberg DR, Kingma PS, Fleck RJ, Lang SM, Moore RA, Taylor MD, Woods JC. Cardiac Magnetic Resonance Imaging Evaluation of Neonatal Bronchopulmonary Dysplasia-associated Pulmonary Hypertension. Am J Respir Crit Care Med 2020; 201:73-82. [PMID: 31539272 PMCID: PMC6938152 DOI: 10.1164/rccm.201904-0826oc] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 09/19/2019] [Indexed: 12/25/2022] Open
Abstract
Rationale: Patients with bronchopulmonary dysplasia (BPD)-associated pulmonary hypertension (PH) have increased morbidity and mortality. Noninvasive assessment relies on echocardiograms (echos), which are technically challenging in this population. Improved assessment could augment decisions regarding PH therapies.Objectives: We hypothesized that neonatal cardiac magnetic resonance imaging (MRI) will correlate with BPD severity and predict short-term clinical outcomes, including need for PH therapies for infants with BPD.Methods: A total of 52 infants (31 severe BPD, 9 moderate BPD, and 12 with either mild or no BPD) were imaged between 39 and 47 weeks postmenstrual age on a neonatal-sized, neonatal ICU-sited 1.5-T magnetic resonance (MR) scanner. MR left ventricular eccentricity index (EI), main pulmonary artery-to-aorta (PA/AO) diameter ratio, and pulmonary arterial blood flow were determined. Echos obtained for clinical indications were reviewed. MRI and echo indices were compared with BPD severity and clinical outcomes, including length of stay (LOS), duration of respiratory support, respiratory support at discharge, and PH therapy.Measurements and Main Results: PA/AO ratio increased with BPD severity. Increased PA/AO ratio, MR-EI, and echo-EIs were associated with increased LOS and duration of respiratory support. No correlation was seen between pulmonary arterial blood flow and BPD outcomes. Controlling for gestational age, birth weight, and BPD severity, MR-EI was associated with LOS and duration of respiratory support. Increased PA/AO ratio and MR-EI were associated with PH therapy during hospitalization and at discharge.Conclusions: MRI can provide important image-based measures of cardiac morphology that relate to disease severity and clinical outcomes in neonates with BPD.
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Affiliation(s)
| | - Nara S. Higano
- Center for Pulmonary Imaging Research
- Division of Pulmonary Medicine
| | | | - Emilia S. Olson
- Center for Pulmonary Imaging Research
- Department of Radiology, and
| | - David R. Spielberg
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Pulmonary Medicine Service, Texas Children’s Hospital, Houston, Texas; and
| | - Paul S. Kingma
- Division of Neonatology and Pulmonary Biology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Robert J. Fleck
- Department of Radiology, and
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Sean M. Lang
- Division of Cardiology
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ryan A. Moore
- Division of Cardiology
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Michael D. Taylor
- Division of Cardiology
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jason C. Woods
- Center for Pulmonary Imaging Research
- Division of Pulmonary Medicine
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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15
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Schneider S, DiBartolomeo M, Brennan G. Case 1: Lethal Pulmonary Hemorrhage in a 3-day-old Term Infant. Neoreviews 2019; 20:e737-e739. [PMID: 31792160 DOI: 10.1542/neo.20-12-e737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Simone Schneider
- Comer Children's Hospital at the University of Chicago, Chicago, IL
| | | | - Gillian Brennan
- Comer Children's Hospital at the University of Chicago, Chicago, IL
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16
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Abstract
The transition from fetal to neonatal life is a dramatic and complex process involving extensive physiologic changes, which are most obvious at the time of birth. Individuals who care for newly born infants must monitor the progress of the transition and be prepared to intervene when necessary. In the majority of births, this transition occurs without a requirement for any significant assistance. If newborns require assistance, the majority of the time respiratory support is all that is required. In some instances, however, there are circulatory emergencies that need to be rapidly identified or there may be dire consequences including death in the delivery room. This chapter will review various pathologies that are circulatory emergencies, and discuss how to assess them. We will also review new technologies which may help providers better understand the circulatory status or hemodynamic changes in the delivery room including heart rate, cardiac output, cerebral oxygenation and echocardiography.
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Affiliation(s)
- Anup C Katheria
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, 3003 Health Center Dr., San Diego, CA 92123, USA.
| | - Wade D Rich
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, 3003 Health Center Dr., San Diego, CA 92123, USA.
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17
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Houzé de l'Aulnoit A, Génin M, Boudet S, Demailly R, Ternynck C, Babykina G, Houzé de l'Aulnoit D, Beuscart R. Use of automated fetal heart rate analysis to identify risk factors for umbilical cord acidosis at birth. Comput Biol Med 2019; 115:103525. [PMID: 31698240 DOI: 10.1016/j.compbiomed.2019.103525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 10/14/2019] [Accepted: 10/27/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To identify clinical parameters and intrapartum fetal heart rate parameters associated with a risk of umbilical cord acidosis at birth, using an automated analysis method based on empirical mode decomposition. METHODS Our single-center study included 381 cases (arterial cord blood pH at birth pHa ≤7.15) and 1860 controls (pHa ≥7.25) extracted from a database comprising 8,383 full datasets for over-18 mothers after vaginal or caesarean non-twin, non-breech deliveries at term (>37 weeks of amenorrhea). The analysis of a 120-min period of the FHR recording (before maternal pushing or the decision to perform a caesarean section during labor) led to the extraction of morphological, frequency-related, and long- and short-term heart rate variability variables. After univariate analyses, sparse partial least square selection and logistic regression were applied. RESULTS Several clinical factors were predictive of fetal acidosis in a multivariate analysis: nulliparity (odds ratio (OR) 95% confidence interval (CI)]: 1.769 [1.362-2.300]), a male fetus (1.408 [1.097-1.811]), and the term of the pregnancy (1.333 [1.189-1.497]). The risk of acidosis increased with the time interval between the end of the FHR recording and the delivery (OR [95%CI] for a 1-min increment: 1.022 [1.012-1.031]). The risk factors related to the FHR signal were mainly the difference between the mean baseline and the mean FHR (OR [95%CI]: 1.292 [1.174-1.424]), the baseline range (1.027 [1.014-1.040]), fetal bradycardia (1.038 [1.003-1.075]) and the late deceleration area (1.002 [1.000-1.005]). The area under the curve for the multivariate model was 0.79 [0.76; 0.81]. CONCLUSION In addition to clinical predictors, the automated FHR analysis highlighted other significant predictors, such as the baseline range, the instability of the FHR signal and the late deceleration area. This study further extends the routine application of automated FHR analysis during labor and, ultimately, contributes to the development of predictive scores for fetal acidosis.
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Affiliation(s)
- A Houzé de l'Aulnoit
- Univ. Lille, EA 2694, Santé Publique, épidémiologie et Qualité des Soins, F-59000, Lille, France; Department of Obstetrics, Lille Catholic Hospital, Lille Catholic University, F-59020, Lille, France.
| | - M Génin
- Univ. Lille, EA 2694, Santé Publique, épidémiologie et Qualité des Soins, F-59000, Lille, France
| | - S Boudet
- Biomedical Signal Processing Unit (UTSB), Lille Catholic University, F-59800, Lille, France
| | - R Demailly
- Department of Obstetrics, Lille Catholic Hospital, Lille Catholic University, F-59020, Lille, France
| | - C Ternynck
- Univ. Lille, EA 2694, Santé Publique, épidémiologie et Qualité des Soins, F-59000, Lille, France
| | - G Babykina
- Univ. Lille, EA 2694, Santé Publique, épidémiologie et Qualité des Soins, F-59000, Lille, France
| | - D Houzé de l'Aulnoit
- Department of Obstetrics, Lille Catholic Hospital, Lille Catholic University, F-59020, Lille, France
| | - R Beuscart
- Univ. Lille, EA 2694, Santé Publique, épidémiologie et Qualité des Soins, F-59000, Lille, France
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18
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Govindan RB, Massaro A, Vezina G, Chang T, du Plessis A. Identifying an optimal epoch length for spectral analysis of heart rate of critically-ill infants. Comput Biol Med 2019; 113:103391. [PMID: 31446320 PMCID: PMC7040438 DOI: 10.1016/j.compbiomed.2019.103391] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 08/15/2019] [Accepted: 08/15/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND OBJECTIVE To identify the optimal epoch length for power spectral analysis of cardiac beat-to-beat intervals (BBi) in critically ill newborns. MATERIALS AND METHOD BBi of 49 term newborns undergoing therapeutic hypothermia for hypoxic-ischemic encephalopathy with well-defined outcomes (good outcome (n = 28): no or mild brain injury and adverse outcome (n = 21): moderate or severe brain injury or death) served as test population. A power spectrum of BBi was calculated with an autoregressive model in three different epoch lengths: 2 min, 5 min, and 10 min. Spectral power was quantified in three different frequency bands: very low-frequency (0.016-0.04 Hz), low-frequency (0.05-0.25 Hz), and high-frequency (0.3-1 Hz). In each frequency band, the absolute power and the normalized power were calculated. Furthermore, standard deviation (SDNN) of BBi was calculated. These metrics were compared between the outcome groups with a receiver operator characteristic (ROC) analysis in 3-h windows. The ROC curve area >0.7 was regarded as a significant separation. RESULTS The absolute spectral powers in all three epoch lengths in all three frequency bands and SDNN distinguished the two outcome groups consistently for most time points. The spectral metrics calculated with a 2-min epoch length performed as well as the five- and 10-min epoch lengths (paired t-test P < 0.05). CONCLUSION Spectral analysis of BBi in 2-min epoch shows a similar discriminatory power as longer epoch lengths. A shorter epoch also has clinical advantages for translation into a continuous real-time bedside monitor of heart rate variability in the intensive care unit.
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Affiliation(s)
- R B Govindan
- Fetal Medicine Institute, Children's National Medical Center, Washington, DC, USA; The George Washington University School of Medicine, USA.
| | - An Massaro
- The George Washington University School of Medicine, USA; Neonatology, Children's National Medical Center, Washington, DC, USA
| | - Gilbert Vezina
- The George Washington University School of Medicine, USA; Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC, USA
| | - Taeun Chang
- The George Washington University School of Medicine, USA; Neurology, Children's Medical Center, Washington, DC, USA
| | - Adre du Plessis
- Fetal Medicine Institute, Children's National Medical Center, Washington, DC, USA; The George Washington University School of Medicine, USA
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19
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Brewer CL, Baccei ML. The development of pain circuits and unique effects of neonatal injury. J Neural Transm (Vienna) 2019; 127:467-479. [PMID: 31399790 DOI: 10.1007/s00702-019-02059-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 08/03/2019] [Indexed: 12/15/2022]
Abstract
Pain is a necessary sensation that prevents further tissue damage, but can be debilitating and detrimental in daily life under chronic conditions. Neuronal activity strongly regulates the maturation of the somatosensory system, and aberrant sensory input caused by injury or inflammation during critical periods of early postnatal development can have prolonged, detrimental effects on pain processing. This review will outline the maturation of neuronal circuits responsible for the transmission of nociceptive signals and the generation of pain sensation-involving peripheral sensory neurons, the spinal cord dorsal horn, and brain-in addition to the influences of the neuroimmune system on somatosensation. This summary will also highlight the unique effects of neonatal tissue injury on the maturation of these systems and subsequent consequences for adult somatosensation. Ultimately, this review emphasizes the need to account for age as an independent variable in basic and clinical pain research, and importantly, to consider the distinct qualities of the pediatric population when designing novel strategies for pain management.
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Affiliation(s)
- Chelsie L Brewer
- Neuroscience Graduate Program, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267, USA
- Department of Anesthesiology, Pain Research Center, University of Cincinnati Medical Center, 231 Albert Sabin Way, Cincinnati, OH, 45267, USA
| | - Mark L Baccei
- Neuroscience Graduate Program, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267, USA.
- Department of Anesthesiology, Pain Research Center, University of Cincinnati Medical Center, 231 Albert Sabin Way, Cincinnati, OH, 45267, USA.
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20
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Moxon SG, Blencowe H, Bailey P, Bradley J, Day LT, Ram PK, Monet JP, Moran AC, Zeck W, Lawn JE. Categorising interventions to levels of inpatient care for small and sick newborns: Findings from a global survey. PLoS One 2019; 14:e0218748. [PMID: 31295262 PMCID: PMC6623953 DOI: 10.1371/journal.pone.0218748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 06/08/2019] [Indexed: 12/22/2022] Open
Abstract
Background In 2017, 2.5 million newborns died, mainly from prematurity, infections, and intrapartum events. Preventing these deaths requires health systems to provide routine and emergency care at birth, and quality inpatient care for small and sick newborns. Defined levels of emergency obstetric care (EmOC) and standardised measurement of “signal functions” has improved tracking of maternal care in low- and middle-income countries (LMICs). Levels of newborn care, particularly for small and sick newborns, and associated signal functions are still not consistently defined or tracked. Methods Between November 2016-November 2017, we conducted an online survey of professionals working in maternal and newborn health. We asked respondents to categorise 18 clinical care interventions that could act as potential signal functions for small and sick newborns to 3 levels of care they thought were appropriate for health systems in LMICs to provide: “routine care at birth”, “special care” and “intensive care”. We calculated the percentage of respondents that classified each intervention at each level of care and stratified responses to look at variation by respondent characteristics. Results Six interventions were classified to specific levels by more than 50% of respondents as “routine care at birth,” three interventions as “special care” and one as “intensive care”. Eight interventions were borderline between these care levels. Responses were more consistent for interventions with relevant WHO clinical care guidelines while more variation in respondents’ classification was observed in complex interventions that lack standards or guidelines. Respondents with experience in lower-income settings were more likely to assign a higher level of care for more complex interventions. Conclusions Results were consistent with known challenges of scaling up inpatient care in lower-income settings and underline the importance of comprehensive guidelines and standards for inpatient care. Further work is needed to develop a shortlist of newborn signal functions aligned with emergency obstetric care levels to track universal health coverage for mothers and their newborns.
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Affiliation(s)
- Sarah G. Moxon
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Hannah Blencowe
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Patricia Bailey
- Averting Maternal Death & Disability, Mailman School of Public Health, Columbia University, New York, United States of America
| | - John Bradley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Louise Tina Day
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Pavani K. Ram
- Office of Maternal and Child Health and Nutrition, US Agency for International Development, Washington DC, United States of America
| | - Jean-Pierre Monet
- Technical Division, United Nations Population Fund (UNFPA), New York, United States of America
| | - Allisyn C. Moran
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organisation, Geneva, Switzerland
| | - Willibald Zeck
- UNICEF Health Section, United Nations Children’s Fund (UNICEF), New York, United States of America
| | - Joy E. Lawn
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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21
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Abstract
We evaluated the clinical value of the cerebroplacental ratio (CPR) in predicting neonatal acidosis according to the gestational weeks in late pregnancy.From July 2016 to June 2017, 1018 neonates without acidosis and 218 neonates with acidosis (confirmed postpartum) underwent a prenatal examination and hospital delivery at 28 to 41 weeks in our hospital. The CPR was calculated as the ratio of the prenatal middle cerebral artery-pulsation index (MCA-PI) to the umbilical artery-pulsation index (UA-PI).In neonates without acidosis, the fetal UA-PI decreased with increased gestational age during late pregnancy. Similarly, the MCA-PI decreased with increased gestational age, and decreased significantly during the full pregnancy term. Additionally, the CPR peaked in the middle of the late pregnancy period and then decreased. In contrast, in neonates with acidosis, the prenatal UA-PI increased significantly, MCA-PI declined significantly, and CPR declined significantly in relation to normal values (P < .05). For the prediction of neonatal acidosis, the UA-PI was suitable after 32 weeks and the MCA-PI was suitable before 37 weeks. The cutoff values of the CPR for the prediction of neonatal acidosis at 28 to 31 weeks, 32 to 36 weeks, and 37 to 41 weeks were 1.29, 1.36, and 1.22, respectively. Unlike the UA-PI and MCA-PI, the CPR was suitable as an independent predictor of neonatal acidosis at all late pregnancy weeks. In neonates with acidosis, the z score of the UA-PI increased significantly, whereas the z scores of the MCA-PI and CPR decreased significantly, in relation to normal values (P < .05).The CPR can be used to evaluate the adverse status of fetuses during late pregnancy, providing an early prediction of neonatal acidosis.
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MESH Headings
- Acidosis/diagnosis
- Case-Control Studies
- Early Diagnosis
- Female
- Fetus/metabolism
- Fetus/physiopathology
- Gestational Age
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/metabolism
- Infant, Newborn, Diseases/physiopathology
- Middle Cerebral Artery/diagnostic imaging
- Predictive Value of Tests
- Pregnancy
- Prenatal Diagnosis/methods
- Prognosis
- Pulsatile Flow
- Ultrasonography, Doppler, Color/methods
- Ultrasonography, Prenatal/methods
- Umbilical Arteries/diagnostic imaging
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22
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Carlson HL, Sugden C, Brooks BL, Kirton A. Functional connectivity of language networks after perinatal stroke. Neuroimage Clin 2019; 23:101861. [PMID: 31141787 PMCID: PMC6536856 DOI: 10.1016/j.nicl.2019.101861] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 04/17/2019] [Accepted: 05/19/2019] [Indexed: 02/06/2023]
Abstract
Successful language acquisition during development is imperative for lifelong function. Complex language networks develop throughout childhood. Perinatal stroke may cause significant language disabilities but function can also be remarkably normal. Studying such very early brain injury populations may inform developmental plasticity models of language networks. We examined functional connectivity (FC) of language networks in children with arterial and venous perinatal stroke and typically developing controls (TDC) in a population-based, controlled, cohort study. Resting state functional MRI was performed at 3 T (TR/TE = 2000/30 ms, 150 volumes, 3.6mm3 voxels). Seed-based analyses used bilateral inferior frontal and superior temporal gyri. A subset of stroke participants completed clinical language testing. Sixty-six children participated (median age: 12.85±3.8y, range 6-19; arterial N = 17; venous N = 15; TDC N = 34]. Children with left hemisphere strokes had comparable FC in their right hemispheres compared to TDC. Inter- and intra-hemispheric connectivity strengths were similar between TDC and PVI but lower for AIS. Reduced FC was associated with poorer language comprehension. Language networks can be estimated using resting-state fMRI in children with perinatal stroke. Altered connectivity may occur in both hemispheres, is more pronounced with arterial lesions, and is associated with clinical function. Our results have implications for therapeutic language interventions after early stroke.
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Affiliation(s)
- Helen L Carlson
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada; Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada; Department of Pediatrics, University of Calgary, Calgary, AB, Canada.
| | - Cole Sugden
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada
| | - Brian L Brooks
- Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada; Department of Pediatrics, University of Calgary, Calgary, AB, Canada; Neuropsychology Service, Alberta Children's Hospital, Calgary, AB, Canada; Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Adam Kirton
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada; Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada; Department of Pediatrics, University of Calgary, Calgary, AB, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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23
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Abstract
Clinical service, educational, and research components of a fetal/neonatal neurology program are anchored by the disciplines of developmental origins of health and disease and life-course science as programmatic principles. Prenatal participation provides perspectives on maternal, fetal, and placental contributions to health or disease for fetal and subsequent neonatal neurology consultations. This program also provides an early-life diagnostic perspective for neurologic specialties concerned with brain health and disease throughout childhood and adulthood. Animal models and birth cohort studies have demonstrated how the science of epigenetics helps to understand gene-environment interactions to better predict brain health or disease. Fetal neurology consultations provide important diagnostic contributions during critical or sensitive periods of brain development when future neurotherapeutic interventions will maximize adaptive neuroplasticity. Age-specific normative neuroinformatics databases that employ computer-based strategies to integrate clinical/demographic, neuroimaging, neurophysiologic, and genetic datasets will more accurately identify either symptomatic patients or those at risk for brain disorders who would benefit from preventive, rescue, or reparative treatment choices throughout the life span.
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Affiliation(s)
- Mark S Scher
- Division of Pediatric Neurology, Case Western Reserve University, Cleveland, OH, United States.
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24
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Abstract
Inborn errors of metabolism, also known as inherited metabolic diseases, constitute an important group of conditions presenting with neurologic signs in newborns. They are individually rare but collectively common. Many are treatable through restoration of homeostasis of a disrupted metabolic pathway. Given their frequency and potential for treatment, the clinician should be aware of this group of conditions and learn to identify the typical manifestations of the different inborn errors of metabolism. In this review, we summarize the clinical, laboratory, electrophysiologic, and neuroimaging findings of the different inborn errors of metabolism that can present with florid neurologic signs and symptoms in the neonatal period.
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MESH Headings
- Adult
- Female
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/diagnostic imaging
- Infant, Newborn, Diseases/physiopathology
- Infant, Newborn, Diseases/therapy
- Metabolism, Inborn Errors/diagnosis
- Metabolism, Inborn Errors/diagnostic imaging
- Metabolism, Inborn Errors/physiopathology
- Metabolism, Inborn Errors/therapy
- Neuroimaging
- Pregnancy
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Affiliation(s)
- Carlos R Ferreira
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States; Rare Disease Institute, Children's National Health System, Washington, DC, United States
| | - Clara D M van Karnebeek
- Departments of Pediatrics and Clinical Genetics, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Department of Pediatrics, Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, BC, Canada.
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25
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Abstract
The differential diagnosis of neonatal hypotonia is a complex task, as in newborns hypotonia can be the presenting sign of different underlying causes, including peripheral and central nervous system involvement and genetic and metabolic diseases. This chapter describes how a combined approach, based on the combination of clinical signs and new genetic techniques, can help not only to establish when the hypotonia is related to peripheral involvement but also to achieve an accurate and early diagnosis of the specific neuromuscular diseases with neonatal onset. The early identification of such disorders is important, as this allows early intervention with disease-specific standards of care and, more importantly, because of the possibility to treat some of them, such as spinal muscular atrophy, with therapeutic approaches that have recently become available.
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Affiliation(s)
- Eugenio Mercuri
- Department of Pediatric Neurology, Catholic University, Rome, Italy.
| | | | - Claudia Brogna
- Department of Pediatric Neurology, Catholic University, Rome, Italy
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26
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Johns EC, Denison FC, Norman JE, Reynolds RM. Gestational Diabetes Mellitus: Mechanisms, Treatment, and Complications. Trends Endocrinol Metab 2018; 29:743-754. [PMID: 30297319 DOI: 10.1016/j.tem.2018.09.004] [Citation(s) in RCA: 386] [Impact Index Per Article: 64.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 08/29/2018] [Accepted: 09/06/2018] [Indexed: 12/12/2022]
Abstract
Gestational diabetes mellitus (GDM) is the most common metabolic disturbance during pregnancy. The prevalence is rising and correlates with the increase in maternal obesity over recent decades. The etiology of GDM is complex, with genetic and environmental factors implicated in mechanistic and epidemiological studies. GDM begets important short- and long-term health risks for the mother, developing fetus, and offspring. This includes the high likelihood of subsequent maternal type 2 diabetes (T2DM), and possible adverse cardiometabolic phenotypes in the offspring. The most clinically and cost-effective methods of screening for GDM remain uncertain. Whilst treatments with lifestyle and pharmacological interventions have demonstrated short-term benefits, the long-term impact for the offspring of intrauterine exposure to antidiabetic medication remains unclear.
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MESH Headings
- Diabetes Complications/etiology
- Diabetes, Gestational/diagnosis
- Diabetes, Gestational/drug therapy
- Diabetes, Gestational/etiology
- Female
- Humans
- Hypertension, Pregnancy-Induced/etiology
- Hypoglycemic Agents/adverse effects
- Hypoglycemic Agents/therapeutic use
- Infant, Newborn
- Infant, Newborn, Diseases/etiology
- Infant, Newborn, Diseases/metabolism
- Infant, Newborn, Diseases/pathology
- Infant, Newborn, Diseases/physiopathology
- Obstetric Labor Complications/etiology
- Pregnancy
- Prenatal Exposure Delayed Effects/chemically induced
- Prenatal Exposure Delayed Effects/metabolism
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Affiliation(s)
- Emma C Johns
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Fiona C Denison
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Jane E Norman
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Rebecca M Reynolds
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK; BHF/University Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK.
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27
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Wheeler AC, Ventura CV, Ridenour T, Toth D, Nobrega LL, Silva de Souza Dantas LC, Rocha C, Bailey DB, Ventura LO. Skills attained by infants with congenital Zika syndrome: Pilot data from Brazil. PLoS One 2018; 13:e0201495. [PMID: 30048541 PMCID: PMC6062124 DOI: 10.1371/journal.pone.0201495] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/16/2018] [Indexed: 11/29/2022] Open
Abstract
The recent Zika outbreak and its link to microcephaly and other birth defects in infants exposed in utero have garnered widespread international attention. Based on the severity of birth defects the extent of impairment in these infants is expected to be profound; however, virtually nothing is known regarding the developmental and behavioral sequela of congenital Zika syndrome. This pilot study collected parent-reported patterns of development and sleep in 47 infants with confirmed congenital Zika syndrome who are being followed for clinical services at the Altino Ventura Foundation (FAV) in Recife, Brazil. With assistance from clinicians at FAV, caregivers completed Brazilian Portuguese versions of the Ages and Stages Questionnaire, 3rd edition (ASQ-3) and the Brief Infant Sleep Questionnaire (BISQ). All infants were between 13–22 months of age at the time of the assessment. At 16 months of age, none of the children displayed age appropriate developmental skills. Most (~ 75%) mastered some communication and gross motor skills at around a 6–8-month level. Communication and gross motor skills were relative strengths for the sample, while problem-solving and fine motor skills were relative weaknesses. Sleep was noted to be a problem for around 18% of the sample. In utero exposure to the Zika virus will have lifelong consequences for affected children and their families. Understanding the developmental and behavioral trajectories of affected infants will help identify appropriate family supports to improve quality of life.
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MESH Headings
- Adolescent
- Adult
- Brazil/epidemiology
- Child Development/physiology
- Cognition/physiology
- Female
- Humans
- Infant
- Infant, Newborn
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/physiopathology
- Infant, Newborn, Diseases/psychology
- Male
- Microcephaly/epidemiology
- Microcephaly/physiopathology
- Microcephaly/psychology
- Microcephaly/virology
- Motor Skills/physiology
- Pilot Projects
- Pregnancy
- Pregnancy Complications, Infectious/epidemiology
- Pregnancy Complications, Infectious/physiopathology
- Pregnancy Complications, Infectious/psychology
- Retrospective Studies
- Young Adult
- Zika Virus Infection/congenital
- Zika Virus Infection/epidemiology
- Zika Virus Infection/physiopathology
- Zika Virus Infection/psychology
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Affiliation(s)
- Anne C. Wheeler
- RTI Center for Newborn Screening, Ethics, and Disability Studies, RTI International, Research Triangle Park, NC, United States of America
- * E-mail:
| | - Camila V. Ventura
- Rehabilitation Center “Menina dos Olhos”, Altino Ventura Foundation (FAV), Recife, Brazil
| | - Ty Ridenour
- RTI Center for Newborn Screening, Ethics, and Disability Studies, RTI International, Research Triangle Park, NC, United States of America
| | - Danielle Toth
- RTI Center for Newborn Screening, Ethics, and Disability Studies, RTI International, Research Triangle Park, NC, United States of America
| | - Lucélia Lima Nobrega
- Rehabilitation Center “Menina dos Olhos”, Altino Ventura Foundation (FAV), Recife, Brazil
| | | | - Camilla Rocha
- Rehabilitation Center “Menina dos Olhos”, Altino Ventura Foundation (FAV), Recife, Brazil
| | - Donald B. Bailey
- RTI Center for Newborn Screening, Ethics, and Disability Studies, RTI International, Research Triangle Park, NC, United States of America
| | - Liana O. Ventura
- Rehabilitation Center “Menina dos Olhos”, Altino Ventura Foundation (FAV), Recife, Brazil
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28
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Gao XY, Feng L, Xu J, Pan XN. [Follow-up observation of catch-up growth of preterm infants after discharge and risk factors for extrauterine growth retardation]. Zhongguo Dang Dai Er Ke Za Zhi 2018; 20:438-443. [PMID: 29972115 PMCID: PMC7389948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 04/16/2018] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To investigate the catch-up growth of preterm infants within a corrected age of 6 months and the risk factors for extrauterine growth retardation (EUGR). METHODS A total of 321 preterm infants who were discharged after treatment in the neonatal intensive care unit and had regular follow-up documents with complete follow-up records were enrolled. According to the Prenatal Health Care Norms in 2015, these infants were divided into low-risk group with 69 infants and high-risk group with 252 infants. The Z-score method was used to evaluate body weight, body length, and head circumference, and the catch-up growth of the preterm infants within a corrected age of 6 months was analyzed. A multivariate logistic regression analysis was performed to identify the risk factors for EUGR at the corrected age of 6 months. RESULTS The percentage of preterm infants with Z scores of body weight, body length, and head circumference of < -2 (not reach the standard for catch-up growth) in both groups decreased gradually with increasing corrected age. At the corrected age of 6 months, the percentages of preterm infants whose body weight, body length, and head circumference did not reach the standard for catch-up growth in the low-risk group were reduced to 1.4% (1/69), 2.9% (2/69), and 1.4% (1/69) respectively, while in the high-risk group, these percentages were reduced to 1.2% (3/252), 1.6% (4/252), and 3.6% (9/252) respectively. The high-risk group had a significantly higher incidence rate of EUGR at the corrected age of 6 months than the low-risk group (28.2% vs 15.9%, P=0.039). The multivariate logistic regression analysis showed that multiple birth (OR=2.68, P=0.010), low birth weight (<1 000 g: OR=14.84, P<0.001; 1 000-1 499 g: OR=2.85, P=0.005), and intrauterine growth retardation (IUGR) (OR=11.41, P<0.001) were risk factors for EUGR at the corrected age of 6 months, while nutritional enhancement after birth (OR=0.25, P<0.001) reduced the risk of EUGR. CONCLUSIONS Most preterm infants can achieve catch-up growth at the corrected age of 6 months. High-risk preterm infants have a high incidence rate of EUGR at the corrected age of 6 months. Multiple birth, low birth weight, and IUGR are risk factors for EUGR, while rational nutritional enhancement after birth can reduce the incidence rate of EUGR in preterm infants.
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Affiliation(s)
- Xiao-Yan Gao
- Department of Neonatology, Maternal and Child Health Care Hospital of Guangxi Zhuang Autonomous Region, Nanning 530000, China.
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29
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Gao XY, Feng L, Xu J, Pan XN. [Follow-up observation of catch-up growth of preterm infants after discharge and risk factors for extrauterine growth retardation]. Zhongguo Dang Dai Er Ke Za Zhi 2018; 20:438-443. [PMID: 29972115 PMCID: PMC7389948 DOI: 10.7499/j.issn.1008-8830.2018.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 04/16/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate the catch-up growth of preterm infants within a corrected age of 6 months and the risk factors for extrauterine growth retardation (EUGR). METHODS A total of 321 preterm infants who were discharged after treatment in the neonatal intensive care unit and had regular follow-up documents with complete follow-up records were enrolled. According to the Prenatal Health Care Norms in 2015, these infants were divided into low-risk group with 69 infants and high-risk group with 252 infants. The Z-score method was used to evaluate body weight, body length, and head circumference, and the catch-up growth of the preterm infants within a corrected age of 6 months was analyzed. A multivariate logistic regression analysis was performed to identify the risk factors for EUGR at the corrected age of 6 months. RESULTS The percentage of preterm infants with Z scores of body weight, body length, and head circumference of < -2 (not reach the standard for catch-up growth) in both groups decreased gradually with increasing corrected age. At the corrected age of 6 months, the percentages of preterm infants whose body weight, body length, and head circumference did not reach the standard for catch-up growth in the low-risk group were reduced to 1.4% (1/69), 2.9% (2/69), and 1.4% (1/69) respectively, while in the high-risk group, these percentages were reduced to 1.2% (3/252), 1.6% (4/252), and 3.6% (9/252) respectively. The high-risk group had a significantly higher incidence rate of EUGR at the corrected age of 6 months than the low-risk group (28.2% vs 15.9%, P=0.039). The multivariate logistic regression analysis showed that multiple birth (OR=2.68, P=0.010), low birth weight (<1 000 g: OR=14.84, P<0.001; 1 000-1 499 g: OR=2.85, P=0.005), and intrauterine growth retardation (IUGR) (OR=11.41, P<0.001) were risk factors for EUGR at the corrected age of 6 months, while nutritional enhancement after birth (OR=0.25, P<0.001) reduced the risk of EUGR. CONCLUSIONS Most preterm infants can achieve catch-up growth at the corrected age of 6 months. High-risk preterm infants have a high incidence rate of EUGR at the corrected age of 6 months. Multiple birth, low birth weight, and IUGR are risk factors for EUGR, while rational nutritional enhancement after birth can reduce the incidence rate of EUGR in preterm infants.
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Affiliation(s)
- Xiao-Yan Gao
- Department of Neonatology, Maternal and Child Health Care Hospital of Guangxi Zhuang Autonomous Region, Nanning 530000, China.
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30
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Kaneko M, Sato M, Ogasawara K, Imamura T, Hashimoto K, Momoi N, Hosoya M. Serum cytokine concentrations, chorioamnionitis and the onset of bronchopulmonary dysplasia in premature infants. J Neonatal Perinatal Med 2018; 10:147-155. [PMID: 28409755 DOI: 10.3233/npm-171669] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the relationships between serum cytokine concentrations and chorioamnionitis (CAM) and CAM-related bronchopulmonary dysplasia (BPD) in premature infants. METHODS Serum was collected at 0 and 7 days after birth from 36 premature infants born at <32 weeks of gestation. We examined the relationships between 30 cytokine concentrations and CAM, BPD, and other perinatal factors. RESULTS On day 0, GM-CSF, IL-15, IL-17, IL-2, IL-2R, VEGF, and MIG concentrations were significantly higher in the CAM group (n = 17) than in the non-CAM group (n = 19). These concentrations had decreased by day 7 and were similar in both groups. The IL-12p70 concentration on day 0 was significantly lower in the BPD group (n = 16) than in the non-BPD group (n = 15). BPD incidence was similar between the CAM and non-CAM groups. CONCLUSIONS These data support the hypothesis that intrauterine inflammation is not a primary risk factor for BPD. The immunological environment at birth or soon after, rather than intrauterine fetal inflammation (e.g., CAM), is a primary risk factor for BPD onset in preterm infants. Decreased inflammatory responses are particularly relevant, as indicated by the relationship between BPD and low serum IL-12p70 concentrations on day 0.
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31
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Abstract
AIMS Hypoxic ischaemic encephalopathy (HIE) remains a significant cause of long term neurodisability despite therapeutic hypothermia (TH). Infants with mild HIE, representing 50% of those with HIE, are perceived as low risk and are currently not eligible for TH [1]. This review examines the available evidence of outcome in term infants with mild HIE. METHODS Medline, Embase and Cochrane Clinical Trials databases were searched in March 2017. Studies with well-defined HIE grading at birth and standardised neurodevelopmental assessment at ≥18 months were included. Abnormal outcome was defined as death, cerebral palsy or standardised neurodevelopmental test score more than 1 standard deviation below the mean. RESULT Twenty studies were included. Abnormal outcome was reported in 86/341 (25%) of infants. There was insufficient evidence to examine the effect of TH on outcome. CONCLUSION A significant proportion of infants with mild HIE have abnormal outcome at follow up.
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Affiliation(s)
- J M Conway
- Irish Central for Fetal and Neonatal Translational Research-INFANT Centre, Department of Pediatrics and Child Health, University College Cork, Cork University Hospital, Wilton, Cork, Ireland.
| | - B H Walsh
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - G B Boylan
- Irish Central for Fetal and Neonatal Translational Research-INFANT Centre, Department of Pediatrics and Child Health, University College Cork, Cork University Hospital, Wilton, Cork, Ireland.
| | - D M Murray
- Irish Central for Fetal and Neonatal Translational Research-INFANT Centre, Department of Pediatrics and Child Health, University College Cork, Cork University Hospital, Wilton, Cork, Ireland.
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32
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Abstract
Diabetes mellitus (DM) is not a single disease, but several pathophysiological conditions where synthesis, release, and/or action of insulin are disturbed. A progressive autoimmune/autoinflammatory destruction of islet cells is still considered the main pathophysiological event in the development of T1DM, but there is evidence that T1DM itself is a heterogeneous disease. More than 50 gene regions are closely associated with T1DM and a variety of epigenetic factors and metabolic patterns have been characterized, which may play a role in the development of T1DM. The pathogenesis and genetics of type 2 DM (T2DM) are distinct from T1DM. Genes associated with T2DM are distinct from those in T1DM. Characteristic metabolic patterns, different from those in T1DM were reported in T2DM, and some children with T2DM also express islet-antibodies. Huge progress has been made in the characterization of other specific types of DM, which had been considered very rare before. The molecular clarification of maturity-onset diabetes of the young (MODY) has greatly improved our understanding of the pathophysiology of DM. There are genetic overlaps between T2DM and monogenetic DM. Neonatal DM has been shown to be monogenetic in most cases, and genetic elucidation leads to more precise and individualized therapies. Cystic fibrosis related DM (CFRDM) should be considered a genuine part of cystic fibrosis, and not a complication, since pancreatic fibrosis does not sufficiently explain the pathophysiology of CFRDM. Disturbances of cystic fibrosis transmembrane conductance regulator (CFTR) as well as autoimmunity are involved in the pathogenesis of CFRDM.
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MESH Headings
- Adolescent
- Age of Onset
- Autoantibodies/immunology
- Autoimmunity
- Blood Glucose/metabolism
- Child
- Child, Preschool
- Cystic Fibrosis/epidemiology
- Cystic Fibrosis/genetics
- Cystic Fibrosis/metabolism
- Cystic Fibrosis/physiopathology
- Cystic Fibrosis Transmembrane Conductance Regulator/genetics
- Cystic Fibrosis Transmembrane Conductance Regulator/metabolism
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/epidemiology
- Diabetes Mellitus, Type 1/genetics
- Diabetes Mellitus, Type 1/physiopathology
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes Mellitus, Type 2/genetics
- Diabetes Mellitus, Type 2/physiopathology
- Energy Metabolism/genetics
- Genetic Predisposition to Disease
- Humans
- Infant
- Infant, Newborn
- Infant, Newborn, Diseases/blood
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/genetics
- Infant, Newborn, Diseases/physiopathology
- Insulin/blood
- Islets of Langerhans/immunology
- Islets of Langerhans/metabolism
- Islets of Langerhans/pathology
- Islets of Langerhans/physiopathology
- Risk Factors
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Affiliation(s)
- Juergen Grulich-Henn
- University Children´s Hospital, University of Heidelberg, Im Neuenheimer Feld 430, Heidelberg, D-69120, Germany.
| | - Daniela Klose
- University Children´s Hospital, University of Heidelberg, Im Neuenheimer Feld 430, Heidelberg, D-69120, Germany
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33
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De Angelis LC, Witte MH, Bellini T, Bernas M, Boccardo F, Ramenghi LA, Bellini C. Brain lymphatic drainage system in fetus and newborn: Birth of a new era of exploration. Lymphology 2018; 51:140-147. [PMID: 31119904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A peculiar brain lymphatic drainage system has been recently fully recognized in animals and humans. It comprises different draining pathways, including the lymphatic system, the perivascular drainage pathway, and the cerebrospinal fluid (CSF) drainage routes. Although scant data are available about its function during the neonatal period, it may play a role in neonatal brain diseases. In this review, we focus on the actual knowledge of brain lymphatic drainage system, and we hypothesize potential implications of its impairment and dysfunction in major neonatal neurological diseases.
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Affiliation(s)
- L C De Angelis
- Department of Mother and Child, Neonatal Intensive Care Unit, Gaslini Institute, Genova, Italy
| | - M H Witte
- Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - T Bellini
- Department of Mother and Child, Neonatal Intensive Care Unit, Gaslini Institute, Genova, Italy
| | - M Bernas
- Department of Medical Education, TCU and UNTHSC School of Medicine, Fort Worth, Texas, USA
| | - F Boccardo
- Department of Surgery, University of Genova, Italy
| | - L A Ramenghi
- Department of Mother and Child, Neonatal Intensive Care Unit, Gaslini Institute, Genova, Italy
| | - C Bellini
- Department of Mother and Child, Neonatal Intensive Care Unit, Gaslini Institute, Genova, Italy
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Lemouakni S, Knouni H, Barakat A. Thrombopénie sévère chez un nouveau né de mère splénectomisé pour purpura thrombopénique idiopathique. Pan Afr Med J 2017; 28:143. [PMID: 29599880 PMCID: PMC5851671 DOI: 10.11604/pamj.2017.28.143.13880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 09/25/2017] [Indexed: 11/11/2022] Open
Abstract
Neonatal thrombopenia is the most common hemostatic abnormality in newborns. It is defined as a platelet count below 150.000/mm3. 40% of newborns to mothers with a history of autoimmune thrombopenia are at risk of developing neonatal thrombopenia while 10-15% of them are at risk of developing severe thrombopenia. We here report the case of a 20 days old newborn to mother splenectomized for idiopathic thrombopenic purpura in order to highlight the relationship between the severity of maternal disease and the severity of the neonatal thrombopenia and thereby to avoid the risk of intracranial hemorrhage resulting in death or neurological sequelae.
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MESH Headings
- Adult
- Female
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/physiopathology
- Male
- Pregnancy
- Pregnancy Complications, Hematologic/physiopathology
- Pregnancy Complications, Hematologic/surgery
- Purpura, Thrombocytopenic, Idiopathic/complications
- Purpura, Thrombocytopenic, Idiopathic/physiopathology
- Purpura, Thrombocytopenic, Idiopathic/surgery
- Severity of Illness Index
- Splenectomy
- Thrombocytopenia/diagnosis
- Thrombocytopenia/physiopathology
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Affiliation(s)
- Sihame Lemouakni
- Equipe de Recherche en Santé et Nutrition du Couple Mère-Enfant, Faculté de Médecine et de Pharmacie de Rabat, Université Mohamed V, Service de Médecine et Réanimation Néonatales, Centre Hospitalier Ibn Sina, Rabat, Maroc
| | - Houria Knouni
- Equipe de Recherche en Santé et Nutrition du Couple Mère-Enfant, Faculté de Médecine et de Pharmacie de Rabat, Université Mohamed V, Service de Médecine et Réanimation Néonatales, Centre Hospitalier Ibn Sina, Rabat, Maroc
| | - Amina Barakat
- Equipe de Recherche en Santé et Nutrition du Couple Mère-Enfant, Faculté de Médecine et de Pharmacie de Rabat, Université Mohamed V, Service de Médecine et Réanimation Néonatales, Centre Hospitalier Ibn Sina, Rabat, Maroc
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Daglar K, Tokmak A, Kirbas A, Kara O, Biberoglu E, Uygur D, Danisman N. Anterior placenta previa is associated with increased umbilical cord blood hematocrit concenrations. J Neonatal Perinatal Med 2017; 9:279-84. [PMID: 27589555 DOI: 10.3233/npm-16915145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We aimed to evaluate the umbilical cord blood (CB) hematocrit (Hct) levels in women with anterior located placenta previa (PP). METHODS This is a prospective case-control study performed in a tertiary level maternity hospital. Thirty seven pregnant women diagnosed with anterior PP (study group) and 37 women without PP (control group) included into the study. Groups were matched with regard to age, gestational age, and fetal gender. All women underwent Cesarean section. Umbilical CB Hct levels of the newborns were measured. Demographics, operative features, and neonatal outcomes were recorded. RESULTS Umbilical CB Hct levels were statistically significantly higher in the PP patients compared with controls (p: 52.6±5.0 vs. 47.5±5.0, p < 0.001). Preoperative maternal hemoglobin (Hgb) and Hct levels were similar in the two groups. However, postoperative Hb and Hct levels were significantly lower in the study group (p: 0.003, p < 0.001, respectively). Intraoperative complication rates were higher in this group. Neonatal Apgar scores were lower and neonatal intensive care unit admission was more common in the PP group when compared with controls. CONCLUSION We think that anterior PP is associated with increased umbilical CB Hct levels. Neonatologists should consider this condition in the infants born to mothers with anterior PP.
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Abstract
Gestational diabetes mellitus (GDM) is defined as glucose intolerance with onset during pregnancy. During pregnancy, women with GDM develop insulin resistance, which results in altered glucose tolerance. As a result, there are frequent episodes of hyperglycemia and high levels of circulating amino acids, increasing the transfer of nutrients to the fetus. This article discusses the role of the mother-baby nursing in the care of neonates born to women with gestational diabetes.
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Abstract
OBJECTIVE Episodes of bradycardia are common and recur sporadically in preterm infants, posing a threat to the developing brain and other vital organs. We hypothesize that bradycardias are a result of transient temporal destabilization of the cardiac autonomic control system and that fluctuations in the heart rate signal might contain information that precedes bradycardia. We investigate infant heart rate fluctuations with a novel application of point process theory. METHODS In ten preterm infants, we estimate instantaneous linear measures of the heart rate signal, use these measures to extract statistical features of bradycardia, and propose a simplistic framework for prediction of bradycardia. RESULTS We present the performance of a prediction algorithm using instantaneous linear measures (mean area under the curve = 0.79 ± 0.018) for over 440 bradycardia events. The algorithm achieves an average forecast time of 116 s prior to bradycardia onset (FPR = 0.15). Our analysis reveals that increased variance in the heart rate signal is a precursor of severe bradycardia. This increase in variance is associated with an increase in power from low content dynamics in the LF band (0.04-0.2 Hz) and lower multiscale entropy values prior to bradycardia. CONCLUSION Point process analysis of the heartbeat time series reveals instantaneous measures that can be used to predict infant bradycardia prior to onset. SIGNIFICANCE Our findings are relevant to risk stratification, predictive monitoring, and implementation of preventative strategies for reducing morbidity and mortality associated with bradycardia in neonatal intensive care units.
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Abstract
Hemodynamic disturbance in the sick neonate is common, highly diverse in underlying pathophysiology and dynamic. Dysregulated systemic and cerebral blood flow is hypothesized to have a negative impact on neurodevelopmental outcome and survival. An understanding of the physiology of the normal neonate, disease pathophysiology, and the properties of vasoactive medications may improve the quality of care and lead to an improvement in survival free from disability. In this review we present a modern approach to cardiovascular therapy in the sick neonate based on a more thoughtful approach to clinical assessment and actual pathophysiology. Targeted neonatal echocardiography offers a more detailed insight into disease processes and offers longitudinal assessment, particularly response to therapeutic intervention. The pathophysiology of common neonatal conditions and the properties of cardiovascular agents are described. In addition, we outline separate treatment algorithms for various hemodynamic disturbances that are tailored to clinical features, disease characteristics and echocardiographic findings.
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Affiliation(s)
- Regan E Giesinger
- Division of Neonatology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Patrick J McNamara
- Division of Neonatology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; Department of Paediatrics, University of Toronto, Toronto, ON, Canada; Department of Physiology, University of Toronto, Toronto, ON, Canada.
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Romero L, Ros B, Arráez MA, Ríus F, González L, Martín A, Carrasco A, Segura M. Analysis of risk factors for hydrocephalus development in newborn infants with germinal matrix hemorrhage. Minerva Pediatr 2015; 67:401-406. [PMID: 26377778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM The aim of this study was to analyze risk factors for the development of hydrocephalus in newborn infants with germinal matrix (GM) hemorrhage. METHODS The study comprised 271 patients admitted to Carlos Haya University Hospital in Malaga with GM hemorrhage. The following data were recorded: gestational age, gender, twin birth, head circumference at birth, weight at birth, and Papile grade. Severe obstetrical (abruption, chorioamnionitis, pregnancy-induced hypertension, tocolytic treatment) and neonatal disorders (respiratory distress syndrome, neonatal infection, coagulation disorder, patent ductus arteriosus, necrotizing enterocolitis) were also recorded. Symptomatic hydrocephalus was diagnosed in the event of a progressive increase in head circumference and ventricular indices requiring shunting. RESULTS Of the 271 patients, 139 (51%) developed posthemorrhagic ventriculomegaly; 47 patients (17%) developed symptomatic hydrocephalus and needed shunt implantation. We found a significant relationship between the development of symptomatic hydrocephalus and Papile grade, lower gestational age, lower birth weight, twin birth, and neonatal infection. CONCLUSION Awareness of risk factors for the development of hydrocephalus in newborn infants with GM hemorrhage should be emphasized in order to enable an early diagnosis of ventriculomegaly and symptomatic hydrocephalus and thus make a correct therapeutic decision.
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Affiliation(s)
- L Romero
- Department of Neurosurgery, HRU Carlos Haya, Malaga, Spain -
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Abstract
With the advances in biomedical research and neonatal intensive care, our understanding of cardiovascular developmental physiology and pathophysiology has significantly improved during the last few decades. Despite this progress, the current management of circulatory compromise depends primarily on experts' opinions rather than high level of evidence. The lack of reliable, accurate, continuous and preferably non-invasive monitoring techniques has further limited our ability to collect the information needed for the design and execution of more sophisticated clinical trials with a better chance to provide the evidence we need. Given the lack of randomized, placebo-controlled trials investigating clinically relevant outcomes of novel treatments of neonatal cardiovascular compromise, we must now use the available lower level of evidence and our present understanding of developmental physiology and pathophysiology when providing cardiovascular supportive care to critically ill neonates. However, with recent advances in cardiovascular monitoring capabilities, direct and more objective assessment of the changes in cardiovascular function, organ blood flow, and tissue oxygenation have become possible. These advances have helped in our clinical assessment and enabled us to start designing more sophisticated interventional clinical trials using clinically relevant endpoints.
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Affiliation(s)
- Shahab Noori
- Division of Neonatology and the Center for Fetal and Neonatal Medicine, Department of Pediatrics, Children's Hospital Los Angeles and the LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Istvan Seri
- Sidra Medical and Research Center, Doha, Qatar
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Monzani A, Genoni G, Cassone R, Binotti M, Ferrero F, Bona G. Hyperexcitability as the main sign of neonatal hypoxia. Minerva Pediatr 2015; 67:276-277. [PMID: 25604590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- A Monzani
- Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale "Amedeo Avogadro", Novara, Italy -
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Demirbilek H, Arya VB, Ozbek MN, Houghton JAL, Baran RT, Akar M, Tekes S, Tuzun H, Mackay DJ, Flanagan SE, Hattersley AT, Ellard S, Hussain K. Clinical characteristics and molecular genetic analysis of 22 patients with neonatal diabetes from the South-Eastern region of Turkey: predominance of non-KATP channel mutations. Eur J Endocrinol 2015; 172:697-705. [PMID: 25755231 PMCID: PMC4411707 DOI: 10.1530/eje-14-0852] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 03/09/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND Neonatal diabetes mellitus (NDM) is a rare form of monogenic diabetes and usually presents in the first 6 months of life. We aimed to describe the clinical characteristics and molecular genetics of a large Turkish cohort of NDM patients from a single centre and estimate an annual incidence rate of NDM in South-Eastern Anatolian region of Turkey. DESIGN AND METHODS NDM patients presenting to Diyarbakir Children State Hospital between 2010 and 2013, and patients under follow-up with presumed type 1 diabetes mellitus, with onset before 6 months of age were recruited. Molecular genetic analysis was performed. RESULTS Twenty-two patients (59% males) were diagnosed with NDM (TNDM-5; PNDM-17). Molecular genetic analysis identified a mutation in 20 (95%) patients who had undergone a mutation analysis. In transient neonatal diabetes (TNDM) patients, the genetic cause included chromosome 6q24 abnormalities (n=3), ABCC8 (n=1) and homozygous INS (n=1). In permanent neonatal diabetes (PNDM) patients, homozygous GCK (n=6), EIF2AK3 (n=3), PTF1A (n=3), and INS (n=1) and heterozygous KCNJ11 (n=2) mutations were identified. Pancreatic exocrine dysfunction was observed in patients with mutations in the distal PTF1A enhancer. Both patients with a KCNJ11 mutation responded to oral sulphonylurea. A variable phenotype was associated with the homozygous c.-331C>A INS mutation, which was identified in both a PNDM and TNDM patient. The annual incidence of PNDM in South-East Anatolian region of Turkey was one in 48 000 live births. CONCLUSIONS Homozygous mutations in GCK, EIF2AK3 and the distal enhancer region of PTF1A were the commonest causes of NDM in our cohort. The high rate of detection of a mutation likely reflects the contribution of new genetic techniques (targeted next-generation sequencing) and increased consanguinity within our cohort.
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Affiliation(s)
- Huseyin Demirbilek
- Departments of Paediatric EndocrinologyGreat Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UKThe Institute of Child HealthUniversity College London, London WC1N 1EH, UKDepartments of Paediatric EndocrinologyChildren State Hospital, 21100 Diyarbakir, TurkeyInstitute of Biomedical and Clinical ScienceUniversity of Exeter Medical School, Exeter EX2 5DW, UKDepartments of NeonatologyChildren State Hospital, 21100 Diyarbakir, TurkeyDepartment of Medical Biology and GeneticsDicle University, 21100 Diyarbakir, TurkeyFaculty of MedicineUniversity of Southampton, Southampton SO16 6YD, UK Departments of Paediatric EndocrinologyGreat Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UKThe Institute of Child HealthUniversity College London, London WC1N 1EH, UKDepartments of Paediatric EndocrinologyChildren State Hospital, 21100 Diyarbakir, TurkeyInstitute of Biomedical and Clinical ScienceUniversity of Exeter Medical School, Exeter EX2 5DW, UKDepartments of NeonatologyChildren State Hospital, 21100 Diyarbakir, TurkeyDepartment of Medical Biology and GeneticsDicle University, 21100 Diyarbakir, TurkeyFaculty of MedicineUniversity of Southampton, Southampton SO16 6YD, UK Departments of Paediatric EndocrinologyGreat Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UKThe Institute of Child HealthUniversity College London, London WC1N 1EH, UKDepartments of Paediatric EndocrinologyChildren State Hospital, 21100 Diyarbakir, TurkeyInstitute of Biomedical and Clinical ScienceUniversity of Exeter Medical School, Exeter EX2 5DW, UKDepartments of NeonatologyChildren State Hospital, 21100 Diyarbakir, TurkeyDepartment of Medical Biology and GeneticsDicle University, 21100 Diyarbakir, TurkeyFaculty of MedicineUniversity of Southampton, Southampton SO16 6YD, UK
| | - Ved Bhushan Arya
- Departments of Paediatric EndocrinologyGreat Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UKThe Institute of Child HealthUniversity College London, London WC1N 1EH, UKDepartments of Paediatric EndocrinologyChildren State Hospital, 21100 Diyarbakir, TurkeyInstitute of Biomedical and Clinical ScienceUniversity of Exeter Medical School, Exeter EX2 5DW, UKDepartments of NeonatologyChildren State Hospital, 21100 Diyarbakir, TurkeyDepartment of Medical Biology and GeneticsDicle University, 21100 Diyarbakir, TurkeyFaculty of MedicineUniversity of Southampton, Southampton SO16 6YD, UK Departments of Paediatric EndocrinologyGreat Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UKThe Institute of Child HealthUniversity College London, London WC1N 1EH, UKDepartments of Paediatric EndocrinologyChildren State Hospital, 21100 Diyarbakir, TurkeyInstitute of Biomedical and Clinical ScienceUniversity of Exeter Medical School, Exeter EX2 5DW, UKDepartments of NeonatologyChildren State Hospital, 21100 Diyarbakir, TurkeyDepartment of Medical Biology and GeneticsDicle University, 21100 Diyarbakir, TurkeyFaculty of MedicineUniversity of Southampton, Southampton SO16 6YD, UK
| | - Mehmet Nuri Ozbek
- Departments of Paediatric EndocrinologyGreat Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UKThe Institute of Child HealthUniversity College London, London WC1N 1EH, UKDepartments of Paediatric EndocrinologyChildren State Hospital, 21100 Diyarbakir, TurkeyInstitute of Biomedical and Clinical ScienceUniversity of Exeter Medical School, Exeter EX2 5DW, UKDepartments of NeonatologyChildren State Hospital, 21100 Diyarbakir, TurkeyDepartment of Medical Biology and GeneticsDicle University, 21100 Diyarbakir, TurkeyFaculty of MedicineUniversity of Southampton, Southampton SO16 6YD, UK
| | - Jayne A L Houghton
- Departments of Paediatric EndocrinologyGreat Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UKThe Institute of Child HealthUniversity College London, London WC1N 1EH, UKDepartments of Paediatric EndocrinologyChildren State Hospital, 21100 Diyarbakir, TurkeyInstitute of Biomedical and Clinical ScienceUniversity of Exeter Medical School, Exeter EX2 5DW, UKDepartments of NeonatologyChildren State Hospital, 21100 Diyarbakir, TurkeyDepartment of Medical Biology and GeneticsDicle University, 21100 Diyarbakir, TurkeyFaculty of MedicineUniversity of Southampton, Southampton SO16 6YD, UK
| | - Riza Taner Baran
- Departments of Paediatric EndocrinologyGreat Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UKThe Institute of Child HealthUniversity College London, London WC1N 1EH, UKDepartments of Paediatric EndocrinologyChildren State Hospital, 21100 Diyarbakir, TurkeyInstitute of Biomedical and Clinical ScienceUniversity of Exeter Medical School, Exeter EX2 5DW, UKDepartments of NeonatologyChildren State Hospital, 21100 Diyarbakir, TurkeyDepartment of Medical Biology and GeneticsDicle University, 21100 Diyarbakir, TurkeyFaculty of MedicineUniversity of Southampton, Southampton SO16 6YD, UK
| | - Melek Akar
- Departments of Paediatric EndocrinologyGreat Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UKThe Institute of Child HealthUniversity College London, London WC1N 1EH, UKDepartments of Paediatric EndocrinologyChildren State Hospital, 21100 Diyarbakir, TurkeyInstitute of Biomedical and Clinical ScienceUniversity of Exeter Medical School, Exeter EX2 5DW, UKDepartments of NeonatologyChildren State Hospital, 21100 Diyarbakir, TurkeyDepartment of Medical Biology and GeneticsDicle University, 21100 Diyarbakir, TurkeyFaculty of MedicineUniversity of Southampton, Southampton SO16 6YD, UK
| | - Selahattin Tekes
- Departments of Paediatric EndocrinologyGreat Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UKThe Institute of Child HealthUniversity College London, London WC1N 1EH, UKDepartments of Paediatric EndocrinologyChildren State Hospital, 21100 Diyarbakir, TurkeyInstitute of Biomedical and Clinical ScienceUniversity of Exeter Medical School, Exeter EX2 5DW, UKDepartments of NeonatologyChildren State Hospital, 21100 Diyarbakir, TurkeyDepartment of Medical Biology and GeneticsDicle University, 21100 Diyarbakir, TurkeyFaculty of MedicineUniversity of Southampton, Southampton SO16 6YD, UK
| | - Heybet Tuzun
- Departments of Paediatric EndocrinologyGreat Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UKThe Institute of Child HealthUniversity College London, London WC1N 1EH, UKDepartments of Paediatric EndocrinologyChildren State Hospital, 21100 Diyarbakir, TurkeyInstitute of Biomedical and Clinical ScienceUniversity of Exeter Medical School, Exeter EX2 5DW, UKDepartments of NeonatologyChildren State Hospital, 21100 Diyarbakir, TurkeyDepartment of Medical Biology and GeneticsDicle University, 21100 Diyarbakir, TurkeyFaculty of MedicineUniversity of Southampton, Southampton SO16 6YD, UK
| | - Deborah J Mackay
- Departments of Paediatric EndocrinologyGreat Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UKThe Institute of Child HealthUniversity College London, London WC1N 1EH, UKDepartments of Paediatric EndocrinologyChildren State Hospital, 21100 Diyarbakir, TurkeyInstitute of Biomedical and Clinical ScienceUniversity of Exeter Medical School, Exeter EX2 5DW, UKDepartments of NeonatologyChildren State Hospital, 21100 Diyarbakir, TurkeyDepartment of Medical Biology and GeneticsDicle University, 21100 Diyarbakir, TurkeyFaculty of MedicineUniversity of Southampton, Southampton SO16 6YD, UK
| | - Sarah E Flanagan
- Departments of Paediatric EndocrinologyGreat Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UKThe Institute of Child HealthUniversity College London, London WC1N 1EH, UKDepartments of Paediatric EndocrinologyChildren State Hospital, 21100 Diyarbakir, TurkeyInstitute of Biomedical and Clinical ScienceUniversity of Exeter Medical School, Exeter EX2 5DW, UKDepartments of NeonatologyChildren State Hospital, 21100 Diyarbakir, TurkeyDepartment of Medical Biology and GeneticsDicle University, 21100 Diyarbakir, TurkeyFaculty of MedicineUniversity of Southampton, Southampton SO16 6YD, UK
| | - Andrew T Hattersley
- Departments of Paediatric EndocrinologyGreat Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UKThe Institute of Child HealthUniversity College London, London WC1N 1EH, UKDepartments of Paediatric EndocrinologyChildren State Hospital, 21100 Diyarbakir, TurkeyInstitute of Biomedical and Clinical ScienceUniversity of Exeter Medical School, Exeter EX2 5DW, UKDepartments of NeonatologyChildren State Hospital, 21100 Diyarbakir, TurkeyDepartment of Medical Biology and GeneticsDicle University, 21100 Diyarbakir, TurkeyFaculty of MedicineUniversity of Southampton, Southampton SO16 6YD, UK
| | - Sian Ellard
- Departments of Paediatric EndocrinologyGreat Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UKThe Institute of Child HealthUniversity College London, London WC1N 1EH, UKDepartments of Paediatric EndocrinologyChildren State Hospital, 21100 Diyarbakir, TurkeyInstitute of Biomedical and Clinical ScienceUniversity of Exeter Medical School, Exeter EX2 5DW, UKDepartments of NeonatologyChildren State Hospital, 21100 Diyarbakir, TurkeyDepartment of Medical Biology and GeneticsDicle University, 21100 Diyarbakir, TurkeyFaculty of MedicineUniversity of Southampton, Southampton SO16 6YD, UK
| | - Khalid Hussain
- Departments of Paediatric EndocrinologyGreat Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UKThe Institute of Child HealthUniversity College London, London WC1N 1EH, UKDepartments of Paediatric EndocrinologyChildren State Hospital, 21100 Diyarbakir, TurkeyInstitute of Biomedical and Clinical ScienceUniversity of Exeter Medical School, Exeter EX2 5DW, UKDepartments of NeonatologyChildren State Hospital, 21100 Diyarbakir, TurkeyDepartment of Medical Biology and GeneticsDicle University, 21100 Diyarbakir, TurkeyFaculty of MedicineUniversity of Southampton, Southampton SO16 6YD, UK Departments of Paediatric EndocrinologyGreat Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UKThe Institute of Child HealthUniversity College London, London WC1N 1EH, UKDepartments of Paediatric EndocrinologyChildren State Hospital, 21100 Diyarbakir, TurkeyInstitute of Biomedical and Clinical ScienceUniversity of Exeter Medical School, Exeter EX2 5DW, UKDepartments of NeonatologyChildren State Hospital, 21100 Diyarbakir, TurkeyDepartment of Medical Biology and GeneticsDicle University, 21100 Diyarbakir, TurkeyFaculty of MedicineUniversity of Southampton, Southampton SO16 6YD, UK
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Tina LU, Calcagno PL. Edema of the preterm and term infant. Contrib Nephrol 2015; 15:67-77. [PMID: 428243 DOI: 10.1159/000402596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Nagaraj SB, Stevenson NJ, Marnane WP, Boylan GB, Lightbody G. Neonatal seizure detection using atomic decomposition with a novel dictionary. IEEE Trans Biomed Eng 2015; 61:2724-32. [PMID: 25330152 DOI: 10.1109/tbme.2014.2326921] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Atomic decomposition (AD) can be used to efficiently decompose an arbitrary signal. In this paper, we present a method to detect neonatal electroencephalogram (EEG) seizure based on AD via orthogonal matching pursuit using a novel, application-specific, dictionary. The dictionary consists of pseudoperiodic Duffing oscillator atoms which are designed to be coherent with the seizure epochs. The relative structural complexity (a measure of the rate of convergence of AD) is used as the sole feature for seizure detection. The proposed feature was tested on a large clinical dataset of 826 h of EEG data from 18 full-term newborns with 1389 seizures. The seizure detection system using the proposed dictionary was able to achieve a median receiver operator characteristic area of 0.91 (IQR 0.87-0.95) across 18 neonates.
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Chen CY, Tafone S, Lo W, Heathcock JC. Perinatal stroke causes abnormal trajectory and laterality in reaching during early infancy. Res Dev Disabil 2015; 38:301-308. [PMID: 25577180 DOI: 10.1016/j.ridd.2014.11.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 11/18/2014] [Accepted: 11/20/2014] [Indexed: 06/04/2023]
Abstract
The developmental progression of reaching and early signs of upper extremity neglect is common concern for infants at risk for hemiparesis and cerebral palsy. We investigated the emergence of reaching and laterality in infants at risk for hemiplegic cerebral palsy. Eight infants with perinatal stroke (PS) and thirteen infants with typical development (TD) were assessed bimonthly from 2 to 7 months of age for 10 visits per infant. Reaching number and hand-toy contact duration were measured. Infants with PS demonstrated a linear trajectory of reaching behaviors with asymmetrical upper extremity performance. Infants with TD demonstrated a linear and quadratic trajectory of reaching behaviors and symmetrical upper extremity performance over the same age range. These results suggest that infants with PS have delay reaching and early signs of neglect not currently accounted for in clinical practice.
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Affiliation(s)
- Chao-Ying Chen
- The Ohio State University, School of Health and Rehabilitation Sciences, Division of Physical Therapy, United States
| | - Sara Tafone
- The Ohio State University, School of Health and Rehabilitation Sciences, Division of Physical Therapy, United States
| | - Warren Lo
- Nationwide Children's Hospital, Department of Neurology, United States
| | - Jill C Heathcock
- The Ohio State University, School of Health and Rehabilitation Sciences, Division of Physical Therapy, United States; Nationwide Children's Hospital, Center for Perinatal Research, United States.
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Nur BG, Cetin Z, Clark OA, Mihci E, Oygur N, Karauzum SB. 22q11.2 syndrome due to maternal translocation t(18;22) (pl1.2;q11.2). Genet Couns 2015; 26:67-75. [PMID: 26043510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
22q11.2 deletion syndrome is a pattern of malformations resulting from abnormalities during cephalic neural crest migration and during the development of the third and fourth branchial arch. It is also known as DiGeorge syndrome, as it is most often associated with a de novo 3 Mb hemizygous 22q11.2 deletion. The recognition of similarities and phenotypic overlap between DiGeorge syndrome and other disorders associated with genetic defects in 22q11 has led to an expanded description of the phenotypic features of this syndrome. Indeed, the extent of this phenotypic variability can often make it difficult to accurately diagnose DiGeorge syndrome. Tertiary monosomy resulting from the 3:1 segregation of the respective chromosomal segments of the chromosomes involved in a balanced translocation in meiosis is rarely reported in the literature. In this report, we present a female infant with dysmorphic facial features, microcephaly, a cleft palate, unilateral membranous choanal atresia, convulsions, hypocalcemia, semilobar holoporencephaly and echocardiographic abnormalities. To the best of our knowledge, this is the first description of a newborn displaying both DiGeorge syndrome and deletion 18p syndromes.
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MESH Headings
- Chromosome Deletion
- Chromosome Disorders/genetics
- Chromosome Disorders/pathology
- Chromosome Disorders/physiopathology
- Chromosomes, Human, Pair 18/genetics
- DiGeorge Syndrome/genetics
- DiGeorge Syndrome/pathology
- DiGeorge Syndrome/physiopathology
- Female
- Humans
- Infant
- Infant, Newborn
- Infant, Newborn, Diseases/genetics
- Infant, Newborn, Diseases/pathology
- Infant, Newborn, Diseases/physiopathology
- Translocation, Genetic/genetics
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Abstract
Seizures are most often the only sign of a central nervous dysfunction in the neonate. Neonatal seizures are a symptom of a specific disease entity. The search for a cause of neonatal seizures should focus on perinatal history or acute metabolic changes in the neonate. There are four classifications of neonatal seizures: clonic, tonic, myoclonic, and subtle. Simultaneous electroencephalogram and video recording are tools to assist the practitioner in the evaluation of difficult-to-assess subtle behaviors. Although many seizures may be prevented by careful attention to metabolic changes and the neonate's overall condition, those that cannot be prevented may require pharmacologic treatment. First-generation antiepileptic drugs such as phenobarbital and phenytoin are still the first and second lines of therapy, even as questions concerning their limited clinical effectiveness and concern for potential neurotoxicity continue.
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MESH Headings
- Anticonvulsants/classification
- Anticonvulsants/pharmacology
- Electroencephalography/methods
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/drug therapy
- Infant, Newborn, Diseases/etiology
- Infant, Newborn, Diseases/metabolism
- Infant, Newborn, Diseases/physiopathology
- Medication Therapy Management
- Video Recording/methods
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Kale Y, Isik DU, Celik U, Hekimoglu E, Celik IH, Bas AY, Demirel N. Neonatal Marfan syndrome with angle-closure glaucoma, tricuspid and mitral insufficiency. Genet Couns 2015; 26:95-98. [PMID: 26043516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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50
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MESH Headings
- Adolescent
- Brachial Plexus Neuropathies/rehabilitation
- Cerebral Palsy/therapy
- Child
- Child, Preschool
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/physiopathology
- Infant, Newborn, Diseases/rehabilitation
- Infant, Newborn, Diseases/therapy
- Limb Deformities, Congenital/therapy
- Outcome Assessment, Health Care
- Paresis/physiopathology
- Patient Satisfaction
- Severity of Illness Index
- Spinal Dysraphism/rehabilitation
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