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PubMed1999

Blood concentrations of pancreatitis associated protein in neonates: relevance to neonatal screening for cystic fibrosis.

AIM: To determine whether pancreatitis associated protein (PAP) is a marker for cystic fibrosis which could be used in neonatal screening for the disease. METHODS: PAP was assayed on screening cards from 202,807 neonates. Babies with PAP > or = 15 ng/ml, or > or = 11.5 ng/ml and immunoreactive trypsinogen (IRT) > or = 700 ng/ml were recalled for clinical examination, sweat testing, and cystic fibrosis transmembrane regulator (CFTR) gene analysis. RESULTS: Median PAP value was 2.8 ng/ml. Forty four cases of cystic fibrosis were recorded. Recalled neonates (n = 398) included only 11 carriers. A receiver operating characteristic curve analysis showed that PAP above 8.0 ng/ml would select 0.76% of babies, including all those with cystic fibrosis, except for one with meconium ileus and two with mild CFTR mutations. Screening 27,146 babies with both PAP and IRT showed that only 0.12% had PAP > 8.0 ng/ml and IRT > 700 ng/ml, including all cases of cystic fibrosis. CONCLUSION: PAP is increased in most neonates with cystic fibrosis and could be used for CF screening. Its combination with IRT looks promising.

Acute-Phase Proteins↗
PubMed2001

Routine neonatal examination: effectiveness of trainee paediatrician compared with advanced neonatal nurse practitioner.

OBJECTIVE: To compare the effectiveness of routine neonatal examination performed by senior house officers (SHOs) and advanced neonatal nurse practitioners (ANNPs). DESIGN: A prospective study of all infants referred to specialist orthopaedic, ophthalmology, and cardiology clinics. A standardised proforma was used to record details of the professional performing the neonatal check, any abnormalities discovered, source of ultimate referral to the specialist clinic, and specialist findings. RESULTS: 527 eligible infants were recruited. For hip abnormalities, ANNPs displayed greater sensitivity than SHOs (96% v 74%; p < 0.05). Similarly for eye abnormalities, ANNPs were more sensitive (100% v 33%; p < 0.05). There were no significant differences between ANNPs and SHOs in terms of positive predictive values or effectiveness of detecting cardiac abnormalities. There was no difference in underlying incidence of abnormalities between the two hospitals. CONCLUSION: ANNPs are significantly more effective in detecting abnormalities during the neonatal check. This has implications both for future workforce planning and current methods of medical training.

Clinical Competence↗
PubMed1998

Saving more neonates in hospital: an intervention towards a sustainable reduction in neonatal mortality in a Nicaraguan hospital.

A process of change was initiated in a Nicaraguan regional hospital in order to achieve a sustainable reduction of early neonatal mortality. A series of organizational, educational and hygienic measures was introduced, involving all staff in antenatal care, delivery care and neonatal care. Neonatal mortality decreased from 56/1000 live births in 1985 to 11/1000 in 1993. A commission of maternal and child health, a weekly perinatal audit, the active involvement of all staff and dedicated work of key individuals, as well as national policy decisions, are considered important determinants of the process. Keeping neonatal mortality in focus through continuous analysis of care routines, and through external exchange of ideas is important in order to sustain improvements and to decrease further the mortality.

Adult↗
PubMed2000

Three-dimensional ultrasonographic imaging of the neonatal brain in high-risk neonates: preliminary study.

The aim of this investigation was to compare the utility of three-dimensional ultrasonography versus two-dimensional ultrasonography in imaging the neonatal brain. Thirty patients in the neonatal intensive care unit underwent two-dimensional and three-dimensional ultrasonography. The resultant two- and three-dimensional images recorded on film and three-dimensional volumes (reviewed on a workstation) were evaluated independently. Comparable numbers of normal and abnormal studies were diagnosed by each modality. Axial images were considered useful in approximately 50% of three-dimensional cases. Image quality, overall and in the far-field, was rated higher on two-dimensional images. Three-dimensional sonographic acquisition time in the neonatal intensive care unit (1.7 min+/-0.7 standard deviation) was significantly shorter than that for two-dimensional sonography (9.0+/-4.5 min). The total time for evaluation on the three-dimensional workstation (4.4+/-1.1 min) was significantly less than that for two-dimensional images on film (10.6+/-4.7 min). In conclusion, three-dimensional ultrasonography is a promising, diagnostically accurate, and efficient imaging tool for evaluation of the neonatal brain; however, visualization must improve before it can replace two-dimensional ultrasonography.

Brain↗
PubMed1999

A model of a computer file for the intensive neonatal practice "Neonatal Intensive Computer File".

INTRODUCTION: The use of computer methods for processing the databases gathered in a neonatal intensive care unit has more than 20 years experience. During the past years various systems for data management in accordance with the nature of the work have been designed. AIM: The aim was to create a method for quick and easy processing of variable clinical material in an uniform format. REQUIREMENTS: The method allows the arrangement of the entire primary information into a standardized database suitable for computer processing, following up an unlimited number of parameters, calculating derivative indices, representing and evaluating data by means of graphic trends, surveying current clinical information not only for routine practice, but also for research purposes. RESULTS: We developed a computer file type method. This is a method enabling the systematic and well arranged structuring of the newborn's history, the recordings of the monitoring and life-supporting equipment, the data from clinical, laboratory examinations and all the other implemented diagnostic-therapeutic procedures, family, social and possibly legal background. CONCLUSION: The proposed method Neonatal Intensive Computer File (NICF) was applied successfully in the management the data of the above mentioned project (Grant L-444, MES-Sofia): organizes the entire information into a form suitable for the everyday clinical practice and for research studies. Neonatal Intensive Computer File (NICF) gives ample possibilities for quick and reliable evaluation of the condition of the newborn infant and the effect of the applied treatment. The introduced panel (complex) of indices with possibilities for its expansion allows early detection of advancing and threatening disturbances, characterizes the type and pinpoints the exact time and location of the disturbances occurring in the system ventilator-patient-physician. The graphic trends visualize the variation of the indices and contributes to the quick evaluation and orientation in them. They are considerably more informative than the single time registered values of any indicator or index. Optimizes the management of the applied ventilation/oxygenation technique and overall treatment, facilitates the timely decision-making process (the change and/or the choice of new therapeutic alternatives) Facilitates the statistical analysis of the total accumulated data or a selected part of it. Allows the use of the same clinical material for the needs of multiple research projects guaranteeing precision and reliability. The accumulated databases (information bank) are important for future prospective and retrospective studies not only in the clinical but also in the social field. The information yielded by Neonatal Intensive Computer File (NICF) can be used for prognostic projections and conclusions in terms of the current condition and outcome as well as ad vitam.

Databases, Factual↗
PubMedDate not supplied

Neonatal septicaemia in the neonatal care unit, Al-Anbar governorate, Iraq.

Neonatal septicaemia is a major cause of morbidity and mortality in developing countries. We studied 118 neonates admitted to the main referral hospital in Al-Anbar with positive blood cultures. The incidence of neonatal septicaemia for babies born at this hospital was 9.2 per 1000 live births, and mortality was 28%. Staphylococcus aureus (39%), Klebsiella pneumoniae (30%) and Escherichia coli (21%) constituted 90% of all isolates. The isolates showed in vitro susceptibility to cefotaxime, chloramphenicol and gentamicin, but resistance to more commonly used antibiotics such as ampicillin and cloxacillin. We recommend initial gentamicin/cefotaxime combined therapy while awaiting culture and sensitivity test results. Our study highlights the importance of understanding the local epidemiology of neonatal septicaemia in formulating a rational antibiotics policy.

Bacteremia↗
PubMed1990

Transcutaneous oxygen tension in preterm neonates during neonatal behavioral assessments and heelsticks.

This study evaluates the effects of neonatal behavioral assessments and heelsticks on transcutaneous oxygen tension (TcPO2) in 37 preterm neonates from a neonatal intensive care unit. Two behavioral assessments were evaluated, the Brazelton Neonatal Behavioral Assessment Scale (BNBAS) and the Neurobehavioral Assessment for Preterm Infants (NAPI). TcPO2 during heelsticks was used as a comparison because reliable decreases have typically been noted during heelsticks. Although the heelsticks resulted in significant declines in TcPO2, the behavioral assessments led to only negligible changes in TcPO2. Observed changes during the behavioral assessments occurred in a small number of infants, primarily during the few test procedures administered to the infants outside of their isolettes. Accordingly, it is suggested that time outside the isolette and associated temperature changes may be more critical variables than the assessments per se.

Arousal↗
PubMed1993

[The influence of neonatal hyperbilirubinemia on neonatal behavior].

Two groups of neonates, 30 cases with hyperbilirubinemia (307.8 +/- 99.86 mumol/L) and 30 normal newborns (control group with bilirubin 80.37 +/- 35.74 mumol/L), were evaluated with Neonatal Behavioral Assessment Scale (NBAS) and followed up at the age of 2 months and 5 months. All cases in the two groups were evaluated with NBAS at ages of 2-3 days, 12-14 days and 26-28 days. The results showed that there were statistically significant differences between the two groups in the aspects of attention and social responsiveness, the ability to modulate state of consciousness, the motor integrity and the reflexes. We also found that while the level of bilirubin was below 205.2 mumol/L, there was no correlation between the level of bilirubin and NBAS (r = -0.095, P > 0.02), but when bilirubin was at or above the level of 205.2 mumol/L, there was significant negative correlation (r = -0.53, P < 0.001) between the two. The follow-up revealed that 9 of 23 jaundiced infants had abnormal auditory reactions or abnormal muscle tonus at the age of 2 months; 8 of the 9 infants recovered, but 1 still had abnormal muscle tonus by the age of 5 months. The study suggests that hyperbilirubinemia above the level of 205.2 mumol/L would affect neonatal behavior and the greater the severity of jaundice, the more significant the influence on neonatal behavior. The effects on some jaundiced infants may last 5 months or more. NBAS is a valuable scale for early detection of mild brain dysfunctions which are less obvious on clinical examination.

Brain↗
PubMed1997

Position statement: early discharge of the high risk neonate. National Association of Neonatal Nurses.

It is the position of the National Association of Neonatal Nurses that in order for the neonate's specialized needs to be met in this era of early discharge, broad guidelines must exist for such discharge. Discharge preparations and follow-up care must be performed by knowledgeable and experienced neonatal registered nurses who can determine readiness for discharge and home care needs. Early discharge may be appropriate and safe if all discharge and teaching criteria are met to assure positive neonatal and family outcomes.

Child, Hospitalized↗
PubMedDate not supplied

Bacterial eye infection in neonates, a prospective study in a neonatal unit.

One hundred and fifty five neonates with conjunctivitis admitted into the neonatal unit at the Lagos University Teaching Hospital were microbiologically investigated. This was to determine the bacterial aetiologic agent(s) in neonatal eye infection and highlight some risk factors. Antimicrobial susceptibility testing was done on the pathogens isolated using the diskagar diffusion method. The incidence of conjuctivitis in the newborn was 18 per 1000 live births. Predisposing factor noted were vaginal delivery, asphyxia neonatorum and prolonged rupture of membrane. Pathogens predominantly isolated were Staphylococcus aureus (37.4%), Coagilase negative Staphylococci (12.3%), Klebsiella pneumoniae (12.9%) and Pseudomonas aeruginosa (8.2%). Antimicrobial suscepibility results revealed varied degrees of susceptibility to ofloxacin (75%), Cloxacillin, erythromycin, Gentamicin and augumentin (30%) by the gram positive bacteria while most of the gram negative were susceptible to colistin and ofloxacin (above 90%). The high incidence of bacterial eye infection should be minimized by the elimination of the risk factors and adoption of stringent aseptic measures in the care of the neonate.

Conjunctivitis, Bacterial↗
PubMed1998

Is common neonatal cephalic pustulosis (neonatal acne) triggered by Malassezia sympodialis?

BACKGROUND: A type of neonatal cephalic pustulosis that is clinically similar to classic neonatal acne recently has been linked to Malassezia furfur infection. To correlate the mycological and clinical findings in neonates with cephalic pustulosis, we carried out a prospective case-control study in a neonatal unit from February to April 1997 using new techniques for classifying Malassezia species. OBSERVATIONS: Nineteen patients with cephalic pustulosis and 19 controls younger than 45 days were studied among 161 consecutively hospitalized infants. Cultures from swabs and smears of pustules were obtained from patients, and swabs from healthy site-matched skin were obtained from controls. Three patients were excluded from the study because another cause of pustulosis was found. A blank sampling of pustules was obtained from 2 patients. Test results for 6 of 16 patients were positive for Malassezia sympodialis on contralateral nonpustular skin, and 4 of those patients also had positive cultures for M sympodialis. Cultures from 6 to 19 controls were positive (4 for M furfur and 2 for M sympodialis). The prevalence of Malassezia species increased with age, and the severity of the pustulosis was correlated with the isolation of M sympodialis. CONCLUSION: Our data suggest that M sympodialis triggers the severe form of common cephalic pustulosis in infants with this benign disorder.

Acne Vulgaris↗
PubMed2000

Neonatal hepatic propranolol elimination: studies in the isolated perfused neonatal sheep liver.

Using the isolated perfused neonatal sheep liver model, we examined the disposition of propranolol (n = 8, age 0.25-10 days) and compared our findings with our previous study from the perfused near-term fetal sheep liver (Ring JA, et al. 1995. Drug Metab Dispos 23:190-196). Within 45 min of dosage, perfusate propranolol levels had fallen by three orders of magnitude to be less than the limit of detection. Perfusate disappearance curves were monoexponential in six experiments and biexponential in two experiments. The mean shunt-corrected hepatic extraction ratio was 0.92 +/- 0.09, much greater than that seen in the fetal sheep liver (0.26 +/- 0.13, P < 0.0001) but still less than values in the adult sheep (0.97). At the conclusion of the perfusion, 4-hydroxypropranolol was the major metabolite present and 5-hydroxypropranolol and N-desisopropylpropranolol were minor metabolites. We conclude that the isolated perfused neonatal sheep liver is a useful model with which to study the maturation of neonatal hepatic drug oxidation. Our study shows that propranolol is rapidly eliminated by the neonatal liver to form several metabolites at rates far greater than in the fetal liver, but rates of elimination have not yet reached that reported in the adult sheep liver.

Adrenergic beta-Antagonists↗
PubMed1995

Increased dexamethasone sensitivity of neonatal leukocytes: different mechanisms of glucocorticoid inhibition of T cell proliferation in adult and neonatal cells.

Glucocorticoids (GC) are known to inhibit the proliferative response of leukocytes after mitogenic activation. Until now, the effects of GC on the immune system have been studied predominantly in adults. However, GC are frequently administered to human fetuses and newborns for the prevention and treatment of respiratory distress syndrome. The immune system of human newborns is still a functionally immature system. Therefore, we wondered whether the immaturity is also reflected by altered responses to hormonal signals such as glucocorticoids. We studied the effects of the GC dexamethasone (DEX) on the proliferation of peripheral blood mononuclear cells and T cells in vitro after stimulation with phytohemagglutinin, anti-CD3, anti-CD3/anti-CD28 or anti-CD2/anti-CD28. Our data demonstrate that neonatal cells are much more sensitive to inhibition of the proliferative response by DEX than adult cells (ED50 1 +/- 0.8 nM vs. 221 +/- 135 nM). This difference in sensitivity is not related to differences in affinity and capacity of binding of [3H] DEX. Moreover, we show that the mechanisms of GC inhibition differ between adult and neonatal cells. In adult cells, addition of interleukin (IL)-2 does not restore DEX inhibition of the proliferative response. In contrast, the proliferative response of neonatal cells can be restored completely by the addition of IL-2. These data suggest that the primary target of GC in neonatal cells is inhibition of IL-2 production. In adult cells, other mechanisms are responsible for inhibition of T cell proliferation.

Adult↗
PubMed1988

Effectiveness of neonatal transport in New York City in neonates less than 2500 grams--a population study.

In the past two decades, there has been a gradual trend to regionalization of perinatal care, categorization of hospitals and transport services for neonatal health care. The literature alludes to both beneficial and deleterious effects of neonatal transport (T) but no controls such as a matched nontransport (NT) population have been utilized to date. The major goal of this study was to evaluate the effect of neonatal transport from Level I and II high risk less than or equal to 2500 gm. neonates (born in NYC in one calendar year, 1979) compared to a cohort nontransported population matched for hospital of birth, weight, race, sex and risk. All transported less than or equal to 2500 gm. from Level I and II (n = 328) were studied and a stratified random sample of the nontransported (NT) infants less than or equal to 2500 gm. from these same hospitals (n = 2042) was used for comparison. The principle outcome variable was survival. The major conclusion of this study is that in Level I and II hospitals the transport group had a significantly increased survival in infants who were sick (Apgar less than 6) compared to cohorted nontransported controls. Interhospital differences in survival were noted among Level I and II but not seen in the subdivisions of (A) and (B) hospitals.

Demography↗
PubMed1994

Accuracy of the middle-cerebral-to-umbilical-artery resistance index ratio in the prediction of neonatal outcome in patients at high risk for fetal and neonatal complications.

OBJECTIVE: The purpose of this study was to determine the accuracy of the middle-cerebral-to-umbilical-artery resistance index ratio in the prediction of fetal outcome in pregnancies at high risk for fetal and neonatal morbidity and mortality. STUDY DESIGN: A prospective controlled nonrandomized study was conducted in the high-risk pregnancy unit of a teaching hospital. The control group was formed by 20 healthy women with uncomplicated singleton pregnancies and healthy children delivered at term. The study group consisted of 115 women referred to the high-risk pregnancy unit because of a variety of pregnancy complications. Longitudinal evaluation of the control group and cross-sectional evaluation of the study group were carried out at different gestational ages by means of duplex Doppler ultrasonography. The main outcome measures were fetal growth retardation, preterm birth, and neonatal morbidity. RESULTS: The middle-cerebral-to-umbilical-artery ratio remains relatively constant (mean +/- SD 1.33 +/- 0.19) between 27 and 37 weeks. A cutoff value of 1.0 (sensitivity 57.9%, specificity 75.6%, false-positive rate 24.4%) was selected from the receiver-operator characteristic curve analysis. This cutoff value successfully identified a population at significant risk of fetal growth retardation (relative risk 3.07, 95% confidence interval 1.73 to 5.45, exact two-tailed p = 0.0009) and severe neonatal morbidity (Mann-Whitney U = 463.5, two-tailed p = 0.03). The middle-cerebral-to-umbilical-artery ratio was not useful in the prediction of preterm birth. CONCLUSIONS: A middle-cerebral-to-umbilical-artery ratio of < or = 1.0 identifies a subgroup of patients at high risk for fetal growth retardation and severe neonatal morbidity.

Adult↗
PubMed1992

Essential fatty acid status of neonates born to Inuit mothers: comparison with Caucasian neonates and effect of diet.

Fatty acid compositions were determined of phospholipids isolated from venous cord plasma and from the walls of umbilical arteries and veins, collected from healthy, a terme, Inuit and Caucasian (Dutch) neonates. The Inuit fatty acid profiles were characterized by a lower essential fatty acid (EFA) status, with higher levels of monounsaturated fatty acids, of Mead acid [20:3(n-9)] and its direct elongation product, and with lower amounts of the longer chain (greater than or equal to 20 carbon atoms), highly unsaturated (greater than or equal to 4 double bonds) fatty acids of both the (n-3) and (n-6) families. Levels of linoleic- and dihomo-gamma-linolenic acids were higher in Inuit as compared to Caucasian neonates, which suggests a low activity of the delta-5-desaturase in the Inuit. Within the Inuit group, a higher intake of marine food was associated with a better neonatal (n-3) status. Although the differences between Inuit and Caucasian neonates may be of genetic rather than of dietary origin, the results imply that dietary long-chain (n-3) or (n-6) fatty acids may be particularly important during pregnancy in Inuit mothers. Further studies are indicated with respect to the EFA content of the habitual Inuit diet and levels of delta-5-desaturase activity in the Inuit.

Diet↗
PubMed1989

Outcome of very-low-birth-weight infants: are populations of neonates inherently different after antenatal versus neonatal referral?

Postnatal transfer of high-risk infants to a neonatal intensive care unit has been an accepted medical practice for more than two decades. More recently, antepartum maternal referral for the smallest infants has been recommended to reduce infant mortality, morbidity, and long-term handicaps. The limited data available to compare in utero and postnatal transfer suggest that maternal risk factors may also influence antenatal referral. We evaluated antepartum maternal and postnatal infant referrals from five metropolitan Denver hospitals with level I facilities. Mothers who were referred to the tertiary perinatal center before delivery were more likely to have one or more high-risk conditions. The presence of a maternal risk factor (preeclampsia, antepartum bleeding, prolonged rupture of the membranes, or chorioamnionitis) was significantly more common in the maternal transfer group (p less than 0.002). Neonatal weight was higher for the maternal referrals compared with neonatal referrals. Neonatal survival was independently improved by transport of mother or infant, increasing birth weight, and higher Apgar scores. We suggest that maternal risk factors were an important determinant in the choice of antenatal referral to our perinatal center for both the community and regional hospitals during this study period. Studies that compare outcome of infants after maternal and infant transfer must control for potentially inherent differences between the antenatally and postnatally transferred infants.

Child Development↗
PubMed2001

Effect of neonatal capsaicin treatment on neural activity in the medullary dorsal horn of neonatal rats evoked by electrical stimulation to the trigeminal afferents: an optical, electrophysiological, and quantitative study.

To elucidate which glutamate receptors, NMDA or non-NMDA, have the main role in synaptic transmission via unmyelinated afferents in the trigeminal subnucleus caudalis (the medullary dorsal horn), and to examine the early functional effects of neonatal capsaicin treatment to the subnucleus caudalis, optical recording, field potential recording, and quantitative study using electron micrographs were employed. A medulla oblongata isolated from a rat 5--7 days old was sectioned horizontally 400-microm thick or parasagittally and stained with a voltage-sensitive dye, RH482 or RH795. Single-pulse stimulation with high intensity to the trigeminal afferents evoked optical responses mainly in the subnucleus caudalis. The optical signals were composed of two phases, a fast component followed by a long-lasting component. The spatiotemporal properties of the optical signals were well correlated to those of the field potentials recorded simultaneously. The fast component was eliminated by 6-cyano-7-nitro-quinoxaline-2,3-dione (CNQX; 10 microM), while the long-lasting component was not. The latter increased in amplitude under a condition of low Mg(2+) but was significantly reduced by DL-2-amino-5-phosphonovaleric acid (AP5; 30 microM). Neonatal capsaicin treatment also reduced the long-lasting component markedly. In addition, the decreases in the ratio of unmyelinated axons to myelinated axons and in the ratio of unmyelinated axons to Schwann cell subunits of trigeminal nerve roots both showed significant differences (P<0.05, Student's t-test) between the control group and the neonatal capsaicin treatment group. This line of evidence indirectly suggests that synaptic transmission via unmyelinated afferents in the subnucleus caudalis is mediated substantially by NMDA glutamate receptors and documented that neonatal capsaicin treatment induced a functional alteration of the neural transmission in the subnucleus caudalis as well as a morphological alteration of primary afferents within several days after the treatment.

2-Amino-5-phosphonovalerate↗