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PubMed1995

Increased numbers of Sertoli and germ cells in adult rat testes induced by synergistic action of transient neonatal hypothyroidism and neonatal hemicastration.

The combined effects of transient neonatal hypothyroidism and neonatal hemicastration were investigated to see whether they were additive. Hypothyroidism was induced in litters of ten male rats for 25 days from the day of birth by administration of 0.1% (w/v) 6-propyl-2-thiouracil in the mother's drinking water; hemicastration was performed on the day of birth. Controls included both normal and sham-operated animals. Numbers of Sertoli cells and round spermatids were quantified at age 135 days using stereological methods. Sham-operation had no effect on testis mass, or numbers of Sertoli or germ cells. Transient neonatal hypothyroidism resulted in an increase in testicular mass of 27% (P < 0.05), whereas neonatal hemicastration resulted in a 33% (P < 0.05) increase over control; the combination of the two procedures resulted in a 62% (P < 0.05) increase. There were corresponding significant increases in the number of Sertoli cells: 82% with hypothyroidism, 18% with hemicastration and 123% with the combination of the two procedures. Numbers of round spermatids showed similar increases: 59% with hypothyroidism, 45% with hemicastration and 95% with the combination of the two procedures. It is concluded that the effects of the combination of transient neonatal hypothyroidism and hemicastration are additive with respect to testicular mass, and numbers of Sertoli and germ cells.

Animals↗
PubMed2003

Unresponsiveness to lymphoid-mediated signals at the neonatal follicular dendritic cell precursor level contributes to delayed germinal center induction and limitations of neonatal antibody responses to T-dependent antigens.

The factors limiting neonatal and infant IgG Ab responses to T-dependent Ags are only partly known. In this study, we assess how these B cell responses are influenced by the postnatal development of the spleen and lymph node microarchitecture. When BALB/c mice were immunized with alum-adsorbed tetanus toxoid at various stages of their immune development, a major functional maturation step for induction of serum IgG, Ab-secreting cells, and germinal center (GC) responses was identified between the second and the third week of life. This correlated with the development of the follicular dendritic cell (FDC) network, as mature FDC clusters only appeared at 2 wk of age. Adoptive transfer of neonatal splenocytes into adult SCID mice rapidly induced B cell follicles and FDC precursor differentiation into mature FDC, indicating effective recruitment and signaling capacity of neonatal B cells. In contrast, adoptive transfer of adult splenocytes into neonatal SCID mice induced primary B cell follicles without any differentiation of mature FDC and failed to correct limitations of tetanus toxoid-induced GC. Thus, unresponsiveness to lymphoid-mediated signals at the level of neonatal FDC precursors delays FDC maturation and GC induction, thus limiting primary Ab-secreting cell responses to T-dependent Ags in early postnatal life.

Aging↗
PubMed2007

The postnatal maturation of the immunoglobulin heavy chain IgG repertoire in human preterm neonates is slower than in term neonates.

During the perinatal period the development of the IgH chain CDR3 (CDR-H3) repertoire of IgM transcripts is maturity-dependent and not influenced by premature exposure to Ag. To study whether maturity-dependent restrictions also predominate in the perinatal IgG repertoire we compared 1000 IgG transcripts from cord blood and venous blood of extremely preterm neonates (24-28 wk of gestation) and of term neonates from birth until early infancy with those of adults. We found the following. First, premature contact with the extrauterine environment induced the premature development of an IgG repertoire. However after preterm birth the diversification of the IgG repertoire was slower than that after term birth. Second, the IgG repertoire of preterm neonates retained immature characteristics such as short CDR-H3 regions and overrepresentation of D(H)7-27. Third, despite premature exposure to the extrauterine environment, somatic mutation frequency in IgG transcripts of preterm infants remained low until they reached a postconceptional age corresponding to the end of term gestation. Thereafter, somatic mutations accumulated with age at similar rates in preterm and term neonates and reached 30% of the adult level after 6 mo. In conclusion, class switch was inducible already at the beginning of the third trimester of gestation, but the developing IgG repertoire was characterized by similar restrictions as those of the developing IgM repertoire. Those B cells expressing more "mature" H chain sequences were not preferentially selected into the IgG repertoire. Therefore, the postnatal IgG repertoire of preterm infants until the expected date of delivery differs from the postnatal repertoire of term neonates.

Antibody Diversity↗
PubMed2003

[Neonatal outcome multiple pregnancies at the Neonatal Department of Research Institute of Polish Mother's Memorial Hospital].

OBJECTIVES: The purpose of this study was to analyze the course of neonatal period among babies born from truly higher-order multiple pregnancies (> or = 3). DESIGN: The retrospective analysis included 81 infants born from multiple pregnancies (> or = 3), hospitalized in Neonatal Department of Research Institute of Polish Mother's Memorial Hospital between 1995-2001. MATERIALS AND METHODS: Studied population contained 63 babies delivered from 21 triplet pregnancies, 8 newborns from 2 quadruplet pregnancies and ten quintuplets. The groups were analyzed according to gestational age, birth weight, ventilation and hospitalization time as well as early and late consequences of prematurity. RESULTS: Among the multiples (> or = 3) the mean birth weight of triplets, quadruplets and quintuplets was respectively: 1656 g vs 1166 g vs 725 g, the diminished gestational age was also noticed: 32.4 vs 30 vs 26.5 GA. The cesarean section ratio in triplet deliveries was 95%, while quadruplets and quintuplets pregnancies were always delivered by operative interventions. The increase in number of fetuses was significantly associated with prolonged ventilation time (mean 9.5 vs 22.2 vs 57.5 days) as well as the hospitalization (mean 29.1 vs 64.1 s 79.6 days). The differences between mentioned above values reached statistical significance (p < 0.001). One out of three neonates born from triplet pregnancy required ventilatory support (36.6%), whereas in quadruplets and quintuplets this ratio reached 100%. The respiratory distress syndrome treated with surfactant was diagnosed in 7.9% (5/63) of triplets, 37.5% (3/8) quadruplets and 100% of quintuplets among whom 8 babies needed more than one dose of surfactant. The increased risk of unfavorable prematurity outcome (PDA, ROP, BPD, IVH) and neonatal death was highly related to plurality of pregnancy. CONCLUSIONS: Multiple pregnancies resulting from infertility treatment cause many medical problems. Undesirable outcome among neonates delivered from higher-order multiple pregnancies (> or = 3 fetuses) predestine to more judicious approach in the application of assisted reproductive techniques and multiple pregnancies prophylaxis.

Female↗
PubMed2003

Clinical training of undergraduate communication pathology students in neonatal assessment and neonate-caregiver interaction in South Africa.

Developing an undergraduate clinical training module in Early Communication Intervention (ECI) that provides sufficient opportunity for students' learning experiences, and that allows contextually relevant and ethically accountable services to clients, as well as the dissemination of the latest scientific findings to both students and clients, poses a significant challenge. The article describes the development of a clinical training block and the development of an appropriate instrument for the assessment of neonatal communication skills that was used in this student practical. A qualitative research approach, employing a series of formative assessments, was used to refine the instrument. The results indicated changes in the content and use of the neonatal assessment instrument regarding the approach to infant and caregiver risk assessment; caregiver beliefs about neonatal capabilities; newborn state observation; caregiver training; language, cultural and age barriers; collaboration with nurses; kangaroo mother care; involvement of caregivers during the assessment; and adolescent mothers. The results confirmed the need for the ongoing refinement of an instrument to ensure quality training of students in the difficult field of neonatal assessments and neonate-caregiver interaction. The results also highlighted to the importance of initiating ECI services before birth in communities at risk for infant neglect and abuse, and the close relationship between ECI service delivery and student training.

Caregivers↗
PubMed1991

[Classification of perinatal and neonatal deaths. Fetal, obstetrical and neonatal causes].

A new method of classification of causes of death which may be employed in connection with perinatal and neonatal deaths is presented. The classification of causes of death proposed by the authors identifies the factor which probably initiated the train of events leading to death. This classification includes nine main categories and illustrates foetal conditions, happenings in pregnancy, the course of delivery and also the neonatal period. Employment of classification is proposed in regional registration of perinatal and neonatal deaths and as an aid in the current assessment of the quality of antenatal, obstetric and neonatal care as these are employed in medical audits of the perinatal and neonatal deaths in many Danish counties.

Cause of Death↗
PubMed1990

[Clinical and electrophysiological investigations of hearing in neonates. I. Behavioral audiometry and auditory brainstem response in evaluation of the auditory apparatus in pre- and full-term neonates].

Auditory Brain stem Responses (ABRs) and behavioural thresholds were studied in 130 neonates born between 25 to 42 weeks of gestational age. ABR thresholds were determined by the weakest stimulus that elicited a recognizable and replicable wave V. Behavioural audiometric thresholds for 1 and 2 kHz pure tones were determined by taking the lowest of threshold for eliciting auro-palpebral reflex. In 130 tested neonates ABR responses were normal in 102 (78.5%) while 28 babies (21.5%) elicited a pathological response. In the normal ABR group mean thresholds values ranged between 24.7-35 dBHL, and it was observed that the thresholds diminished with neonatal maturation. Behavioural audiometry disclosed that 77.5% normal full-term neonates responded to pure tone 1000 Hz, with mean threshold of 92.83 dBHL, while only 59.09% of pre-term neonates responded to pure tone stimuli at 101 dBHL.

Audiometry↗
PubMed1985

A preliminary study on the mechanism of neonatal allotransplantation tolerance. Participation of suppressor cells in the mediation of neonatal allotransplantation tolerance.

Using a method from Billingham, an animal model of the neonatal allotransplantation tolerance of SWI to C57BL inbred mice was established and the mechanism of neonatal tolerance established by us was preliminarily studied. Our experiment indicates that the clonal deletion theory is not the unique explanation for the neonatal tolerance and a peripheral active inhibitory mechanism including suppressor cells may participate in mediating and maintaining the neonatal tolerance. The suppressor cells in the neonatal tolerance are radioresistant, but rather sensitive to mitomycin C treatment. These results suggest that suppressor cell population may be nonhomogenous. Further studies about this problem are needed.

Animals↗
PubMed1981

Valproic acid and its metabolites: placental transfer, neonatal pharmacokinetics, transfer via mother's milk and clinical status in neonates of epileptic mothers.

The pharmacokinetics of valproic acid (VPA) and several metabolites were measured in 11 epileptic mothers and their 12 newborns. VPA was found in higher concentrations in cord serum than in maternal serum [(factor 1.7 +/- 0.6; (n = 6)]. VPA was excreted in the neonates with a mean half-life of 47 +/- 15 hr (n = 8) which is approximately 4 times the mean value found in adult epileptics. Maternal comedication (primidone and phenytoin) resulted in slightly reduced half-lives. The transplacental kinetics of the two main VPA metabolites in blood were similar to those of VPA. The very low levels of VPA in mother's milk (3% of maternal serum concentrations) suggest apparent safety of breast feeding. The [13C]aminopyrine breath test indicated neonatal hepatic enzyme activities which were slightly above those of unexposed neonates, but much below those of neonates which had been exposed to primidone and phenytoin in utero. Six of eight neonates exposed to VPA-monotherapy, but only one exposed to primidone or phenytoin comedication, developed an icterus neonatorum. A number of minor anomalies (four to eight per child) were observed, particularly hernias, diastasis of musculus rectus abdominis and weak abdominal walls. Two children were microcephalic and in another four children the head circumferences were below the 10th percentile. Significant withdrawal symptoms were not observed. Also hypoplasia of the nails and phalanges and facial dysmorphism associated with the "fetal hydantoin syndrome" did not occur in VPA-exposed children except in one case in which primidone had been administered as comedication.

Abnormalities, Drug-Induced↗
PubMed1999

CpG oligodeoxynucleotides can circumvent the Th2 polarization of neonatal responses to vaccines but may fail to fully redirect Th2 responses established by neonatal priming.

Neonatal murine responses to a panel of conventional vaccines differ qualitatively from adult responses by a particular polarization toward a Th2 pattern and a frequent limitation of the Th1 and CTL responses required for protection against intracellular microorganisms. In contrast, DNA vaccines induce adult-like Th1/CTL neonatal responses against the same vaccine Ags. In this report, we show that this can be related to their content in unmethylated CpG motifs. Oligodeoxynucleotides (ODN) containing CpG motifs activate neonatal APCs to produce IL-12 in vitro and induce adult-like Th1 responses to tetanus toxoid and measles Ags in vivo, with production of IgG2a-specific Abs and adult-like secretion of IFN-gamma and IL-5 by Ag-specific T cells. However, in spite of their capacity to trigger neonatal B cell proliferation in vitro, CpG-ODN only partially enhanced early life Ab responses. Finally, using Th1-driving CpG-ODN with the boosting dose of a protein vaccine was sufficient to redirect adult but not neonatally primed Th2 responses. These observations could be important for the development of novel vaccines that will have to be effective early in life.

Animals↗
PubMed2002

Handheld, portable ultrasound in the neonatal intensive care nursery: a new, inexpensive tool for the rapid diagnosis of common neonatal problems.

The use of ultrasound imaging in the neonatal intensive care unit (NICU) has become an essential part of the evaluation and delivery of care for most neonates. Until recently, ultrasound machines were large, expensive, and often not immediately available, particularly at night and during weekends. Additionally, serial studies to define the evolution of an acute clinical situation were often not practical because of the dedicated time required and the expense involved. The recent introduction into our NICU of a high-quality, reasonably priced, and completely portable neonatal ultrasound unit (Sonosite, Bothell, WA) has now made it possible for neonatologists to rapidly obtain the hour-by-hour information that can be extremely helpful in the evaluation of a critically ill neonate. This paper illustrates some of the capabilities of this simplified device, and the value of having continuous on-site ultrasound availability in the NICU.

Cost-Benefit Analysis↗
PubMed2000

Identification of neonatal hearing impairment: characteristics of infants in the neonatal intensive care unit and well-baby nursery.

OBJECTIVE: The objective of this study was to describe the demographic data, medical status, and incidence of risk factors for hearing impairment in the neonatal intensive care unit (NICU) and well-baby populations in a multicenter prospective study designed to assess neonatal hearing impairment and to evaluate factors that might affect neonatal hearing test performance. DESIGN: This was a prospective multicenter study funded by the National Institutes of Health-National Institute on Deafness and Other Communication Disorders to evaluate the effectiveness of auditory brain stem response, transient evoked otoacoustic emissions, and distortion product otoacoustic emissions for newborn hearing screening. Research staff at each site obtained informed consent and detailed demographic and medical data, including information on established risk factors for hearing loss on 4478 high-risk infants cared for in the NICU, 2348 infants from the well-baby nurseries with no risk factor, and 353 infants from the well-baby nurseries with risk factors. For follow-up purposes the sample was divided further to include a subgroup called selects. Selects were either infants from the well-baby nursery who had an established risk factor for hearing impairment (N = 353) or did not pass the neonatal hearing screen protocol (N = 80). In this study, we focus on the distribution of infants by nursery and risk factors only. Particular effort was made to enroll infants with risk factors for hearing loss in both the NICU and well-baby nurseries. Descriptive analyses are used to describe characteristics of this sample. RESULTS: All 10 of the risk factors established by the Joint Committee on Infant Hearing in 1994 were identified in the NICU population. The four most common were ototoxic medications (44.4%), very low birth weight (17.8%), assisted ventilation > 5 days (16.4%), and low Apgar scores at 1 or 5 min (13.9%). In contrast, only six risk factors were present in the well-baby nurseries: family history (6.6%), craniofacial abnormalities (3.4%), low Apgar scores (2.8%), syndromes (0.5%), ototoxic medications (0.2%), and congenital infection (0.1%). CONCLUSION: These descriptive risk factor data reflect both the newborn populations at the study sites and the bias for enrolling infants at risk for hearing loss. The high-risk NICU sample reflects the characteristics typically found in graduates of the NICU. The data summarized in this study will be used to assess the relationships between risk factor and hearing test outcome.

Adult↗
PubMed1993

Requirements for neonatal cots. Northern Neonatal Network.

A prospective survey of activity in neonatal nurseries associated with 17 specialist maternity units delivering some 38,700 babies in the Northern region was undertaken during 1991. Data were collected concerning the numbers of babies requiring various forms of neonatal care, using a nursing dependency scale validated by work study. Facilities for prolonged high dependency care are partially decentralised in the Northern region, with a network of five units operating on a flexible and collaborative basis. The data collected suggest that, with such arrangements, even peak demands for non-surgical high dependency nursing care can be met by the provision of 1.0 cot per 1000 births. The requirement for high dependency cots would increase by some 50% if the referral centres were required to function independently for administrative or financial reasons. Because neonatal units act independently in providing low dependency care, allowance must be made for day to day variations in the pattern of admission of infants requiring such care. These variations will have a lesser impact in larger obstetric units than in those with small caseloads. Within an apparent average regional requirement for only 2.1 cots per 1000 births, a unit with 6000 births per year would need 4.5 cots per 1000 births to accommodate low dependency neonates, apart from those admitted for no other reason than relatively low birth weight; for a unit dealing with only 1000 births, this level of provision would need to be increased to 9.0 cots per 1000 births.(ABSTRACT TRUNCATED AT 250 WORDS)

Bed Occupancy↗
PubMedDate not supplied

The Neonatal Skin Risk Assessment Scale for predicting skin breakdown in neonates.

An instrument was developed to assess neonates at risk for skin breakdown, based on the Braden Scale for Predicting Pressure Sore Risk in adults. Using such an instrument to predict, and thus prevent, skin breakdown could decrease costs associated with prolonged hospital stays in neonates. The Neonatal Skin Risk Assessment Scale (NSRAS) was piloted with 32 neonates. Reliability was high for the subscales of general physical condition, activity, and nutrition, but low in the other three subscales. For predictive validity, sensitivity was 83% and specificity was 81%. The NSRAS appears to be useful in predicting days most likely for skin breakdown to occur.

Humans↗
PubMed2002

Detection of anti-Candida antibodies in neonates from a Neonatal Intensive Care Unit.

Anti-Candida antibodies were determined in a group of preterm neonates from a neonatal intensive care unit with serious diseases including candidemia. Antibodies to C. albicans blastospores, i.e. antibodies to C. albicans surface mannan and to C. albicans germ tubes were detected. Higher titers of antibodies to blastospores (1:320) occurred in all patients examined while antibodies to C. albicans germ tubes (with the highest titer of 1:160) were present in 32 out of 66 neonates examined. The highest titers of both anti-C. albicans blastospore antibodies and anti-C. albicans germ tube antibodies were detected in neonates with candidemia and disorders of saccharide metabolism.

Antibodies, Fungal↗
PubMedDate not supplied

Neonatal transportation: the effects of a national neonatal transportation programme.

BACKGROUND: The transport of critically ill newborns by specialised transport teams has been shown to be associated with a significant improvement in their clinical condition on arrival at the receiving hospital. AIM: To determine if the National Neonatal Transport Programme introduced in 2001 improved clinical condition of newborns at the end of transfer. METHODS: A retrospective study of all 176 patients transported by the National Neonatal Transport Programme between March 2001 and March 2002. RESULTS: Before transfer, 17% of patients were hypothermic, 2% hypoglycaemic and 11% acidotic as were 7%, 3% and 5% respectively at the end of transfer. A review of 172 neonatal transports between 1987 and 1989 revealed that 21% of patients were hypothermic, 13% hypoglycaemic and 20% acidotic at the end of transfer. CONCLUSIONS: The National Neonatal Transport Programme has resulted in improved clinical condition of newborns at the end of transfer when compared to their condition before transfer and compared to outcomes prior to the introduction of the programme.

Critical Illness↗
PubMed2005

[Three-dimensional ultrasound (3DUS) of the neonatal brain: clinical application in patients of the neonatal intensive care unit (NICU)].

AIM: To prospectively evaluate the potential role of 3DUS of the neonatal brain. METHOD: 60 patients from the NICU (gestational age: 25-42 weeks, mean: 31.6 weeks, age: 0 to 90 days, median: 10 days) underwent 2D- and 3D-neurosonography. Both studies were evaluated independently by two observers for comparison. Inter- and intraobserver variability were calculated. RESULTS: All 3DUS were of diagnostic quality and could be performed without sedation. 3DUS missed no essential diagnosis as established by conventional ultrasound (2DUS). Diagnosis included normal or physiologically immature neonatal brains (n = 21), plexus cysts (n = 4), plexus bleedings (n = 10), intraventricular haemorrhages grade I-III (n = 8), periventricular pathology such as periventricular echodensities (n = 4) and periventricular haemorrhages or cerebral infarctions (n = 6), hydrocephalus (n = 4), widened subdural spaces (n = 2) and one suprasellar midline tumour. 3DUS imaging time at the patient (4.8 +/- 2.6 min) was significantly shorter than for 2DUS (9.1 +/- 6.1 min). The additional axial plane provided by 3DUS improved the sonographic potential for differential diagnosis. 3DUS allowed an improved standardisation and documentation potentially valuable for follow-up. No statistically significant differences in intra- and interobserver variability were noted compared to 2DUS. Restrictions of 3DUS were the lack of directional Doppler data and the lower resolution particularly of the purely reconstructed plane. CONCLUSION: Bedside neonatal 3D-neurosonography at the NICU is feasible with diagnostic quality without sedation. 3DUS improves comparison during follow-up, as well as standardisation and documentation, and can be considered a useful adjunct in neonatal 2D-neurosonography.

Cerebral Arteries↗
PubMed1987

Access to intensive neonatal care and neonatal survival in low birthweight infants: a population study in Norway.

This study evaluates the impact of regional differences in access to intensive neonatal care on neonatal survival in geographically defined populations of 4,692 low birthweight births in Norway 1979-81. For infants weighting 1,250 to 2,499 g our results are consistent with the existence of a dose-response association between neonatal survival and the level of immediate access to intensive neonatal care. Although not statistically significant, there was a clear gradient in the risk of mortality within 24 hours. A similar pattern of survival could not be consistently demonstrated for infants weighing less than 1,250 g.

Birth Weight↗