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PubMed1995

The uncertain 'best interests' of neonates: decision making in the neonatal intensive care unit.

Neonatology is a recently specialized area of medicine in which medical advances continue to save the lives of many ailing infants. However, like most areas of health care, it is not a perfect science, and hence not all infants can be saved, no matter how advanced the technology or how well-trained the physician. Inevitably, decisions regarding when to forego treatment must be made. It is essential to scrutinize the bases upon which these decisions are reached. This article examines the development of the scientific, legal and philosophical theories in Canada, the United States and the United Kingdom in an attempt to delineate a nexus wherein these theories link together to found medical decisions in the neonatal intensive care unit. Legal rules of medical decision making are informed by standards set by the medical profession as well as by principles of moral philosophy. However, in the face of medical uncertainty regarding outcomes, the content of the 'best interests' of the child standard increasingly relies upon a normative conception of the 'sanctity of life'. Ironically, as science pushes at the bounds of the meaning of 'medical futility', the sanctity of life position gains strength and is relied upon more frequently by the judiciary. The author concludes that both subjective and objective factors must inform this decision making in order to protect the best interests of the child optimally.

Canada↗
PubMed1997

Neonatal sepsis in Addis Ababa, Ethiopia: a review of 151 bacteremic neonates.

A retrospective study of 542 neonatal sepsis cases was undertaken. Bacteremia was confirmed in 151 cases. There were a total of 195 (36%) deaths. Fifty nine (39%) of the deaths were from the bacteremia cases. The incidence of sepsis was 11 per 1000 live births. Klebsiella was the leading etiologic agent (38%), with a mortality rate of 54%. Low birth weight was found to be a predisposing factor for the development of sepsis and mortality. The high incidence of sepsis, the increase in mortality rate and the spread of nosocomial infection is discussed.

Bacteremia↗
PubMed1987

Clinical assessment of the neonatal Dinamap 847 during anesthesia in neonates and infants.

Direct measurements of systolic, diastolic, and mean arterial blood pressure and electrocardiogram-derived heart rates were compared with indirect arterial blood pressure measurements using the Dinamap 847XT noninvasive monitor. A total of 260 paired comparisons from 16 patients were analyzed. A regression analysis of paired data over a wide range of blood pressure values gave the following results: for heart rate r = 0.97, for systolic arterial pressure r = 0.84, for mean arterial pressure r = 0.73, and for diastolic arterial pressure r = 0.52. The 95% confidence limits for systolic, mean, and diastolic arterial pressure were +/- 16 mm Hg, +/- 18 mm Hg, and +/- 21 mm Hg, respectively. The Dinamap monitor was found to be an accurate trend recorder of heart rate and blood pressure during anesthesia in neonates and small infants.

Anesthesia, General↗
PubMed1991

Neonatal androgenization increases vasoactive intestinal peptide levels in rat anterior pituitary: possible involvement of vasoactive intestinal peptide in the neonatal androgenization-induced hyperprolactinemia.

Accumulating evidence suggests that vasoactive intestinal peptide (VIP) may be a physiological PRL-releasing factor. In the present study, we examined a possible involvement of VIP in the neonatal androgenization (NA)-induced hyperprolactinemia. Twenty-four hours after birth, newborn female rats were injected sc with 1,000 micrograms of testosterone (NA) or with oil vehicle only (control). Both groups were sacrificed at 8 weeks of age. Compared to controls, NA rats showed significantly higher plasma PRL levels (7.3 fold), anterior pituitary (AP) PRL content (2.1 fold) and plasma estradiol levels (2.1 fold). AP VIP content was extremely higher (61 fold) in NA rats than in controls. However, NA did not affect VIP content in the suprachiasmatic nucleus, paraventricular nucleus or median eminence. These results suggest that the NA-induced hyperprolactinemia may be mediated, at least in part, by paracrine and/or autocrine effects of the increased AP VIP on PRL secretion. However, since the potentiation by NA of the AP VIP content was extremely marked compared to those of the other parameters, the possibility was also raised that the increased AP VIP may be involved in other endocrine and/or nonendocrine events occurring in the AP.

Androgens↗
PubMed1985

Influence of the neonatal suppression of TSH production (neonatal hyperthyroidism) on response to TSH in adulthood.

Six-day treatment of neonatal rats with T3 or T4 resulted in a considerable depression of T4 production in response to exogenous TSH in adulthood. This supports the hypothetical conclusion that hormonal imprinting, i.e. the presence of the hormone and its interaction with the cell during the period of receptor maturation, is important for receptor amplification, which accounts for normal response to the hormone in adulthood.

Animals↗
PubMed1995

The neonatal lesion of the meso-telencephalic dopaminergic pathway increases intrastriatal D2 receptor levels and synthesis and this effect is reversed by neonatal dopaminergic rich-graft.

The ascending dopaminergic pathway of 3-day-old rats has been unilaterally destroyed by the injection of 6-hydroxydopamine into the lateral hypothalamus. Five days later, a suspension containing embryonic dopaminergic neurones was injected in the lesioned neostriatum. Rotational responses to dopaminergic agonists were tested eight months after grafting and animals were killed one month later. Neostriatal dopaminergic D1 and D2 receptors were examined using autoradiography while changes in D2 receptor mRNA levels were studied by in situ hybridization. The lesion induced a behavioural hypersensitivity - as manifested in contralateral rotations - to dopaminergic D1 (SKF 38393) or D2 (LY 171555) agonists which was abolished by the graft. Density of D1 receptors was not affected by the lesion while D2 receptors density was increased by 20-25% in the more rostral part of the neostriatum. Changes in D2 mRNA after the lesion paralleled those observed for D2 receptor density, i.e. D2 mRNA level was increased by 15-19% in the rostral neostriatum. The graft did not influence D1 receptor densities but reversed the post-lesion increase of D2 receptors associated parameters. It is concluded that dopaminergic grafts implanted in neonatal hosts are able to normalise the density of D2 receptors by an action on their synthesis.

Animals↗
PubMed1995

Neonatal lupus erythematosus: discordant disease expression of U1RNP-positive antibodies in fraternal twins--is this a subset of neonatal lupus erythematosus or a new distinct syndrome?

Neonatal lupus erythematosus (NLE) is an uncommon disease that is manifested by cutaneous lesions, cardiac conduction defects, or both, that appear in utero or shortly after birth. In approximately 95% of patients, anti-Ro antibody (Ro[SS-A]) has been identified and has become the serologic marker for NLE. Since 1987 there have been four reported cases of Ro- and anti-La antibody (La[SS-B])-negative, U1RNP antibody-positive, NLE. Our affected twin, as well as all other infants with U1RNP-positive NLE, had cutaneous lesions similar to those in Ro-positive NLE, although they lacked systemic abnormalities, including cardiac conduction defects. HLA typing of mothers with infants with U1RNP-positive NLE revealed the presence of HLA-DR4, DQw1, or DQw3 phenotypes. Our typing confirms these findings. As with Ro-positive NLE, no distinct HLA associations were demonstrated in the infants. Unlike Ro-positive mothers, all mothers with a U1RNP-positive infant with NLE had connective tissue disease at the time of the diagnosis and had a different spectrum of disease. We describe the clinical, serologic, and immunogenetic findings in the first reported case of U1RNP-positive NLE in dizygotic twins in whom the NLE disease expression was discordant.

Adult↗
PubMed1995

Passive immunotherapy in neonatal calves--II. The efficacy of a J5 Escherichia coli hyperimmune plasma as immunotherapy in neonatal calves.

Hyperimmunized bovine plasma containing antibodies to a mutant Escherichia coli O111:B4 (J5) was used to conduct a prospective double-blind clinical trial to evaluate its efficacy as an immunotherapy to bovine neonates in field conditions. Two- to three-day-old calves (N = 150) were randomized into three groups (n = 50) to receive (1) no plasma (NP) or (2) control (traces or no J5 antibody) bovine plasma (CP), or (3) hyperimmune bovine anti J5 plasma (HP) in two subcutaneous total doses of 10 ml kg-1 body weight at a 24 h interval. Various physiological, pathological and clinical parameters of the study subjects were observed up to three weeks while other data such as morbidity, mortality and the effect on heart girth increase were collected up to the end of the eighth week. Weekly serum total protein and immunoglobulin G (IgG) concentrations were preferentially increased from the baseline values in HP calves but not statistically significant (p > 0.05) in group comparison. Mean (geometric) serum J5 ELISA titers in the HP group were significantly (p < 0.001) higher than the other two groups that increased about 1-log by the first week of plasma intervention, followed by a gradual decline by the third week. Out of three total deaths due to septicemia and colitis, one was from the NP group while the other two were from the HP group. Morbidity as measured daily on a 13-point scoring scale were not statistically (p > 0.05) different among the groups. Variation in the mean heart-girth increase was non-significant (p > 0.05) among groups by the eighth week. Higher increase in heart girth was generally associated with higher initial serum IgG (p < 0.01) concentration. Our results suggest that this lot of hyperimmune J5 plasma at this dose was not superior to control plasma or to no intervention in terms of calf morbidity and mortality.

Animals↗
PubMed2006

Adult neurological function following neonatal hypoxia-ischemia in a mouse model of the term neonate: water maze performance is dependent on separable cognitive and motor components.

BACKGROUND AND PURPOSE: Hypoxic-ischemic injury in term neonates remains a significant cause of long-term neurological morbidity. The post-natal day 10 (P10) mouse is accepted as a model for the term human. This study was designed to assess the relationships between the duration of hypoxia-ischemia (HI) on P10 and the structural and functional neurological deficits that appear in the adult mouse as a consequence. METHODS: Post-natal day 10 129T2xC57Bl/6 F1 hybrid mice were subjected to 0, 45, 60 or 75 min of hypoxia-ischemia using the Rice-Vannucci model. Beginning on P50 these mice were tested over the next 8 weeks using zero maze, locomotor activity, novel object recognition, cued, hidden and reduced Morris water mazes, delayed probe trials and response to apomorphine injection. Brain weights and histology were obtained at the end of testing. RESULTS: The degree of structural and behavioral abnormalities in adult mice correlated with the duration of hypoxia-ischemia on P10. Useful behavioral tests for separating adult mice according to duration of hypoxia-ischemia on P10 include locomotor activity, the Morris water mazes and response to apomorphine. We found cued "learning" persisted, although latencies increased, with increasing HI time while spatial learning decayed as a function of HI time. Severe HI injury involving the ventral hippocampus resulted in excessive locomotor activity. CONCLUSIONS: After correcting for motor deficits, there is evidence for persistence of "cued" learning but not spatial learning with increasing hypoxia-ischemia time on P10 in this model system.

Aging↗
PubMed2004

Neonatal haemochromatosis: a rare cause of neonatal death.

Neonatal haemochromatosis is a very rare disorder with an unclear aetiology and an extremely poor outcome. A 24 year-old patient was delivered at 32 week gestation. The new-born presented a liver failure syndrome and died shortly after birth. The diagnosis of haemochromatosis was based on iron deposition revealed by the autopsy. In families at risk, ultrasound foetal follow up should be proposed and the detection of an anomaly suggestive of NH recurrence justifies a MRI in early third trimester. Liver transplantation is the treatment of choice for advanced disease.

Autopsy↗
PubMed2006

Two reports of acute neonatal acalculous cholecystitis (necrotizing cholecystitis) in a 2-week-old premature infant and a term neonate.

We present 2 cases of acute acalculous cholecystitis, an extremely rare entity in newborns. A number of risk factors have been identified, such as inspissated bile, prematurity, sepsis, dehydration, total parenteral nutrition, medications, and Escherichia coli lipopolysaccharide endotoxin. In our cases, gallbladder bile had positive bacterial cultures for E coli. We present the cases of a premature infant and a term neonate who developed acute acalculous cholecystitis: one with several risk factors and the second with a very atypical presentation.

Cholecystitis, Acute↗
PubMed2004

The "Bermuda triangle" of neonatal neurology: cerebral palsy, neonatal encephalopathy, and intrapartum asphyxia.

The terms "cerebral palsy," "neonatal encephalopathy," and "intrapartum asphyxia" are frequently used in pediatric neurology. This article presents concise, verifiable definitions for each of these entities based on our current understanding and formulates the nature of the interrelationships between them. The aim is to provide a level of clarity that will enhance diagnostic and pathogenetic precision and minimize conceptual misunderstanding. This should aid future therapeutic and research efforts in this important area.

Asphyxia Neonatorum↗
PubMed1975

Influence of neonatal castration or neonatal anti-gonadotropin treatment on fertility, phallus development, and male sexual behavior in the mouse.

Male mice were castrated on the day of birth or were treated with anti-gonadotropin serum (AGS) successively on days 1, 3, and 5 of age. When the adult AGS-treated males were compared with normal rabbit serum (NRS)-treated males with respect to fertility, male sexual behavior, gonadotropin release, body size, and penis size it was found that: (1) fertility of AGS-treated males did not differ from that of NRS-treated males; (2) AGS-treated males showed a significant reduction in penis size, compared with NRS-treated males; (3) both groups showed high levels of male sexual behavior; (4) neither group showed the capacity to support ovulation in ovarian grafts from immature mice. It was also observed that the fertility of female mice treated with AGS on days 1, 3, and 5 of age did not differ from that of control females treated with comparable doses of NRS. Male mice castrated at birth showed a significant reduction in male sexual behavior and penis size compared with males first sham-operated at birth then castrated at 25 days of age. Thus, males castrated at birth were similar to males receiving AGS in infancy, except for sex behavior. The results suggest that the neonatal pituitary in the mouse may not have an important role in the process of sexual differentiation. Previous data for the male rat were compared with those for the mouse.

Animals↗
PubMed1992

Retrospective search for bleeding diathesis among premature newborn infants with pulmonary hemorrhage after synthetic surfactant treatment. The American Exosurf Neonatal Study Group I, and the Canadian Exosurf Neonatal Study Group.

In an across study analysis of five multicenter, placebo-controlled trials of the synthetic surfactant, Exosurf Neonatal, involving infants with birth weights 700 gm or greater the incidence of clinical pulmonary hemorrhage was 1.9% in treated infants and 1.0% in control infants. To determine whether this apparent increase in pulmonary hemorrhage was the result of a bleeding diathesis, we retrospectively reviewed charts for 39 of 41 infants with clinical pulmonary hemorrhage. The incidence of nonpulmonary bleeding was the same in control- and surfactant-treated infants. Platelet counts, hematocrit values, and the number of transfusions with platelets or red blood cells did not differ between the two groups. There was no evidence that surfactant treatment was specifically associated with a generalized bleeding diathesis.

Double-Blind Method↗
PubMed1976

Neonatal pneumatosis coli: a mild form of neonatal necrotizing enterocolitis.

A distinctive form of necrotizing enterocolitis was observed in seven newborn infants in a 4 1/2-year period. Characteristically these patients had gross blood in the stools, but other local and systemic signs were mild or absent. Radiography mainly revealed submucosal intramural intestinal gas which was limited to the colon (pneumatosis coli). There was no evidence of small bowel involvement as judged by the absence of small intestinal pneumatosis or distension. This form of colonic disease should be recognized as a benign variety of neonatal necrotizing enterocolitis that carries a favorable prognosis and responds to medical management without sequelae.

Enterocolitis, Pseudomembranous↗
PubMed1978

Neonatal transport: a controlled study of skilled assistance. Mortality and morbidity of neonates less than 1.5 kg birth weight.

To attempt to demonstrate the need for skilled care of sick neonates in transport, a modified randomized controlled study of infants being transported to this institution was carried out. Although special equipment was used, ambulances were not modified. Results of the first phase reported here show that infants weighing less than 1.5 kg at birth, transported by a trained physician and nurse, were significantly warmer, less hypotensive, and less acidotic on admission to the NICU. Mortality was significantly reduced, first week morbidity somewhat lessened, and duration of stay in hospital reduced by more than one third (P less than 0.01).

Ambulances↗
PubMed2001

Prenatal stress and postnatal development of neonatal rats--sex-dependent effects on emotional behavior and learning ability of neonatal rats.

Maternal sound stress (800 Hz; 77 dB, every other minute for 15 min/day, from day 10 to 18 of gestation), combined with forced swimming stress (15 min/day), was found to cause potentiation of sound-induced loss of locomotor activity, referred to as emotional behavior, of male offspring, but not that of female offspring, at 4 weeks of age. Maternal stress also caused an increase in the total number of errors by male, but not female offspring in the water-maze test at 6 weeks of age. These effects of stress on emotional behavior and learning behavior were abolished when dams were pretreated with buspirone (30 min before the stress, from day 8 to 18 of gestation). Thus, prenatal stress might have sex-dependent effects on emotional behavior and learning ability of neonatal rats.

Acoustic Stimulation↗