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PubMed2003

Newborn early discharge revisited: are California newborns receiving recommended postnatal services?

CONTEXT: Responding to safety concerns, federal and state legislation mandated coverage of minimum postnatal stays and state legislation in California mandated coverage of follow-up after early discharge. Little is known about the postnatal services newborns are receiving. OBJECTIVE: To describe rates of early discharge and of timely follow-up for early-discharged newborns. DESIGN AND SETTING: Retrospective, population-based cohort study using a 1999 postpartum survey in California. PARTICIPANTS: A total of 2828 infants of mothers with medically low-risk singleton births. MAIN OUTCOME MEASURES: Rates of early discharge (<or=1-night stay after vaginal delivery and <or=3-night stay after cesarean section) and untimely follow-up (no home or office visit within 2 days of early discharge). RESULTS: Overall, 49.4% of newborns were discharged early. Of these, 67.5% had untimely follow-up. The odds of early discharge were greater with lower incomes: the adjusted odds ratios (AORs) (with 95% confidence intervals) were 2.06 (1.50-2.83) for incomes <or=100% of poverty, 2.20 (1.65-2.93) for incomes from 101%-200% of poverty, and 2.24 (1.63-3.08) for incomes from 201%-300% of poverty. Untimely follow-up was more likely for infants of women with incomes <or=100% of poverty (AOR = 1.89 [1.13-3.17]) and 201%-300% of poverty (AOR = 1.78 [1.09-2.91]), Medicaid coverage (AOR = 1.73 [1.20-2.47]), Latina ethnicity (AOR = 1.47 [1.02-2.14]), and non-English language (AOR = 1.72 [1.16-2.55]). CONCLUSIONS: Despite an apparent decline in short stays after legislation, many newborns--particularly from lower-income families--continue to be discharged early. Most newborns discharged early--particularly those with Medicaid and those from low-income, Latina, and non-English-speaking homes--do not receive recommended follow-up. The most socioeconomically vulnerable newborns are receiving fewer postnatal services.

Adolescent↗
PubMed2004

Population-based newborn screening for genetic disorders when multiple mutation DNA testing is incorporated: a cystic fibrosis newborn screening model demonstrating increased sensitivity but more carrier detections.

OBJECTIVES: Newborn screening for cystic fibrosis (CF) provides a model to investigate the implications of applying multiple-mutation DNA testing in screening for any disorder in a pediatric population-based setting, where detection of affected infants is desired and identification of unaffected carriers is not. Widely applied 2-tiered CF newborn screening strategies first test for elevated immunoreactive trypsinogen (IRT) with subsequent analysis for a single CFTR mutation (DeltaF508), systematically missing CF-affected infants with any of the >1000 less common or population-specific mutations. Comparison of CF newborn screening algorithms that incorporate single- and multiple-mutation testing may offer insights into strategies that maximize the public health value of screening for CF and other genetic disorders. The objective of this study was to evaluate technical feasibility and practical implications of 2-tiered CF newborn screening that uses testing for multiple mutations (multiple-CFTR-mutation testing). METHODS: We implemented statewide CF newborn screening using a 2-tiered algorithm: all specimens were assayed for IRT; those with elevated IRT then had multiple-CFTR-mutation testing. Infants who screened positive by detection of 1 or 2 mutations or extremely elevated IRT (>99.8%; failsafe protocol) were then referred for definitive diagnosis by sweat testing. We compared the number of sweat-test referrals using single- with multiple-CFTR-mutation testing. Initial physician assessments and diagnostic outcomes of these screened-positive infants and any affected infants missed by the screen were analyzed. We evaluated compliance with our screening and follow-up protocols. All Massachusetts delivery units, the Newborn Screening Program, pediatric health care providers who evaluate and refer screened-positive infants, and the 5 Massachusetts CF Centers and their affiliated genetic services participated. A 4-year cohort of 323 506 infants who were born in Massachusetts between February 1, 1999, and February 1, 2003, and screened for CF at approximately 2 days of age was studied. RESULTS: A total of 110 of 112 CF-affected infants screened (negative predictive value: 99.99%) were detected with IRT/multiple-CFTR-mutation screening; 2 false-negative screens did not show elevated IRT. A total of 107 (97%) of the 110 had 1 or 2 mutations detected by the multiple- CFTR-mutation screen, and 3 had positive screens on the basis of the failsafe protocol. In contrast, had we used single-mutation testing, only 96 (87%) of the 110 would have had 1 or 2 mutations detectable by single-mutation screen, 8 would have had positive screens on the basis of the failsafe protocol, and an additional 6 infants would have had false-negative screens. Among 110 CF-affected screened-positive infants, a likely "genetic diagnosis" was made by the multiple-CFTR-mutation screen in 82 (75%) versus 55 (50%) with DeltaF508 alone. Increased sensitivity from multiple-CFTR-mutation testing yielded 274 (26%) more referrals for sweat testing and carrier identifications than testing with DeltaF508 alone. CONCLUSIONS: Use of multiple-CFTR-mutation testing improved sensitivity and postscreening prediction of CF at the cost of increased referrals and carrier identification.

Algorithms↗
PubMed1991

Comparison of newborn screening records and birth certificates to estimate bias in newborn HIV serosurveys.

Implicit in the New York State Newborn HIV Seroprevalence Study is the assumption that newborns of all New York State residents are tested for human immunodeficiency virus (HIV) antibodies. We examined this assumption by describing that part of the 1988 New York newborn population not tested in the HIV seroprevalence study and assessing any bias contributed by this group. Of the expected total HIV specimens 1.5 percent were never received by the Newborn Screening Program, 0.5 percent were invalid specimens for which no repeat specimen could be obtained, and 1.7 percent were unsuitable or of insufficient quantity to be tested for HIV antibody. Thus 96.3 percent of all 1988 New York newborns were tested for HIV antibody. Black infants from New York City and low-birthweight infants were represented disproportionately among those not tested. Assignment of all untested newborn to HIV-positive status increased the seroprevalence rate 17 percent (0.64 percent to 0.75 percent).

Bias↗
PubMed2005

Two newborns with nutritional vitamin B12 deficiency: challenges in newborn screening for vitamin B12 deficiency.

Vitamin B12 deficiency causes decreased Methionine Synthase and L-Methylmalonyl-CoA Mutase activity and results in accumulation of Homocysteine, Methylmalonic acid and Propionylcarnitine. Propionylcarnitine is included in tandem mass spectrometry-based newborn screening programs for detection of certain inborn errors of metabolism. We report two asymptomatic newborns with Vitamin B12 deficiency due to maternal deficiencies. One was detected incidentally at 3 weeks of age; the second on supplemental newborn screening based on elevated Propionylcarnitine at 2 days of age. This illustrates the potential for false negative results for Vitamin B12 deficiency screening by acylcarnitine profiling in newborn screening. Homocysteine and Methylmalonic acid may be better markers of Vitamin B12 deficiency. In conclusion, we suggest measuring Methylmalonic acid, Propionylcarnitine and Homocysteine levels in blood spots in expanded newborn screening in order to detect asymptomatic newborns with Vitamin B12 deficiency. Further studies are needed to establish the sensitivity of these three markers in screening for Vitamin B12 deficiency.

Acyl-CoA Dehydrogenase, Long-Chain↗
PubMed1990

[Clinical and electrophysiological studies of the organ of hearing in newborn infants. II. Study of maturity of the auditory pathway by brain stem responses (ABR) in newborn infants].

In a group of 130 tested children, 102 of whom a property had evaluated on brain stem responses, we tested the influence of newborn maturation on values of response parameters, their configuration and threshold values. It was shown that newborn maturation lowers in a statistically significant way the threshold values of acoustic stimulus. Also, the configuration of the monitoring changes with age of child tested. Newborn maturation increases the frequency of occurrence of waves II, IV, V and VI though decreases of incidence IV/V complex. In the group of the youngest pre-term babies IV/V complex were present in 50% of cases, whereas in the group of newborns carried to term its present could be verified only in 5-11% of cases. Newborn maturity also influences in an essential way the average latent time consecutive waves as well as central conduction time determined by interpeak latency I-V. Coefficient correlation values for these parameters shows a negative statistical significance correlation. That is, a decreasing of average values of these parameters with maturation of the newborn. It was also shown that structures of the hearing pathway responsible for generation of early and late components of brain stem responses nature at different periods. Peripheral structures of the hearing pathway are significantly more mature at birth than are central structures.

Age Factors↗
PubMed1991

A comparison of fathers of high-risk newborns and fathers of healthy newborns.

Eighteen fathers of healthy newborns were matched and compared with 18 fathers of newborns with health problems at birth to determine if there is a relationship between the newborn's health status and paternal perceptions, behaviors, and adjustment to fatherhood. A series of questionnaires were administered during the newborn's hospitalization and at 1 and 3 months after discharge. Fathers of newborns with health problems performed significantly more infant care (p less than 0.005) behaviors and were found to have higher adjustment to parenthood scores (p less than 0.0381) 1 month after discharge than fathers of healthy newborns. No differences were found between the two groups 3 months after discharge.

Adaptation, Psychological↗
PubMed2006

The clinical aspects of newborn screening: importance of newborn screening follow-up.

The aim of newborn screening is to identify presymptomatic healthy infants that will develop significant metabolic or endocrine derangements if left undiagnosed and untreated. The goal of ultimately reducing or eliminating irreversible sequelae is reached by maximizing test sensitivity of the primary newborn screening that measures specific analytes by a number of methodologies. Differentiation of true from false negatives is accomplished by the test specificity. This review discusses disorders for which, in general, there are available therapies and that are detected by routine and expanded newborn screening. Recommendations are presented for evaluation by a primary care physician, with confirmation by a metabolic or endocrinology specialist. Disorders are organized in tabular format by class of pathway or analyte, with attention to typical clinical presentations, confirmatory biochemical and molecular tests, and therapies. There are numerous challenges in clinical follow-up, including diagnosis and appropriate understanding of the consequences of the disorders. The data required to meet these challenges can be acquired only by large scale longitudinal comprehensive studies of outcome in children identified by newborn screening. Only with such data can newborn screening fully serve families.

Diagnostic Errors↗
PubMed1999

Morbidity assessment index for newborns: a composite tool for measuring newborn health.

OBJECTIVE: The objective was to develop, validate, and recommend a scaling model for a discriminative obstetric outcome measure named the Morbidity Assessment Index for Newborns. The purpose of this tool is to allow comparison of obstetric therapeutic strategies on neonatal morbidity, particularly in the mild to moderate morbidity range. STUDY DESIGN: A list of 66 check-mark (yes or no) items of readily available clinical and laboratory data from the early neonatal period was compiled by a panel of obstetric and neonatal experts. These data were collected on 411 neonates born at >/=28 weeks' gestation and representing all grades of morbidity. Detailed psychometric testing included dimensionality testing and item analysis with the item response theory. The scores obtained with this new assessment tool were correlated with newborn and maternal disease conditions or events and with other measures of newborn morbidity. RESULTS: The Morbidity Assessment Index for Newborns is easy to apply in prospective or retrospective studies. Detailed psychometric evaluation resulted in modification of the list to 47 items, each item with a relative scale value according to severity of morbidity. The test was demonstrated to be a reliable and generalizable scaled index that performs optimally for the mild to moderate neonatal morbidity range. CONCLUSION: The Morbidity Assessment Index for Newborns is a validated outcome measurement scale of neonatal morbidity. This new tool may facilitate the conduct of obstetric clinical trials or epidemiologic population-based studies in obstetrics.

Birth Weight↗
PubMed1999

Experimental small bowel transplantation using newborn intestine in rats: II. Revascularization of newborn intestine is independent of vascular endothelial growth factor.

BACKGROUND: Fetal and newborn intestine often are revascularized after subcutaneous transplantation without surgical vascular anastomosis. However, the mechanism of this ability remains unclear. METHODS: First, the ability of natural revascularization in newborn organs was tested. Newborn organs in whole (liver, kidney, heart, intestine, spleen, and pancreas) were grafted i nto the subcuta neous tissue of the adult rat and evaluated histopathologically 2 weeks after transplantation. Second, expression of vascular endothelial growth factor (VEGF) mRNA in the intestinal graft was determined before and after transplantation. Finally, we tested whether the free graft survival of newborn intestine was interrupted by TNP-470, an antiangiogenic agent. RESULTS: Spleen and intestine were revascularized at a higher rate (91.6%, 75%, respectively), and kidney and heart grafts survived at a lower rate (41.7%, 25%, respectively). But all of liver and pancreas grafts failed to be revascularized. VEGF mRNA was not induced in the course of revascularizing. Furthermore, TNP-470 did not interfere with neovascularization of the newborn intestinal graft in vivo. CONCLUSIONS: Each organ had an organ-specific angiogenic activity. Neovascularization of intestinal graft was not dependent on VEGF expression.

Angiogenesis Inhibitors↗
PubMed2000

Factors affecting newborn bone mineral content: in utero effects on newborn bone mineralization.

Several factors have been found recently to have a significant impact on newborn bone mineral content (BMC) and developing fetal bone. Recently we showed that maternal vitamin D deficiency may affect fetal bone mineralization. Korean winter-born newborn infants had extremely low serum 25-hydroxyvitamin D (25-OHD), high serum cross-linked carboxy-terminal telopeptide of type I collagen (ICTP; a bone resorption marker), and markedly lower (8 %) total body BMC than summer-born newborn infants. Infant total body BMC was positively correlated with cord serum 25-OHD and inversely correlated with ICTP, which was also negatively correlated with vitamin D status. In three separate studies on North American neonates we found markedly lower (8-12 %) BMC in summer newborn infants compared with winter newborn infants, the opposite of the findings for Korean neonates. The major reason for the conflicting BMC results might be the markedly different maternal vitamin D status of the North American and Korean subjects. Recently, we found evidence of decreased bone formation rates in infants who were small-for-gestational age (SGA) compared with infants who were appropriate-for-gestational age; we reported reduced BMC, cord serum osteocalcin (a marker of bone formation) and 1,25-dihydroxyvitamin D (the active metabolite of vitamin D), but no alterations in indices of fetal bone collagen metabolism. In theory, reduced utero-placental blood flow in SGA infants may result in reduced transplacental mineral supply and reduced fetal bone formation. Infants of diabetic mothers (IDM) have low BMC at birth, and infant BMC correlated inversely with poor control of diabetes in the mother, specifically first trimester maternal mean capillary blood glucose concentration, implying that factors early in pregnancy might have an effect on fetal BMC. The low BMC in IDM may be related to the decreased transplacental mineral transfer. Cord serum ICTP concentrations were higher in IDM than in control subjects, implying increased intrauterine bone resorption. BMC is consistently increased with increasing body weight and length in infants. Race and gender differences in BMC appear in early life, but not at birth. Ethanol consumption and smoking by the mother during pregnancy affect fetal skeletal development.

Animals↗
PubMed2001

Neonatal-perinatal risk factors for the development of persistent pulmonary hypertension of the newborn in preterm newborns.

There is a long-held belief that preterm newborns lack sufficient arteriolar musculature to maintain a prolonged elevated pulmonary vascular resistance (PVR) after birth. Net ductal flow is thought to be minimal, with the developing pulmonary circulation incapable of significant vasoconstriction. We identified retrospectively 15 premature newborns over a 10-year period weighing < or = 1500 g and with a gestational age of < or = 30 weeks with documented persistent pulmonary hypertension of the newborn (PPHN) in the first 24 hours after birth. We matched 36 newborns of similar weight and gestation with no clinical evidence of shunting. The control group weaned to an FiO2 < or = 0.50 by 12 hours after birth. Despite similar gestational ages, the PPHN group (n = 15) had significantly higher birth weights than the control group (n = 36). The duration of ruptured membranes, maternal tobacco use, and use of antenatal steroids were significantly higher in the PPHN group. We speculate that these three factors might act in a synergistic relationship with which to accelerate pulmonary vascular smooth muscle development in premature newborns.

Female↗
PubMed2000

Evaluation of protein S-100 serum concentrations in healthy newborns and seven newborns with perinatal acidosis.

UNLABELLED: We measured Protein S-100 serum levels in 66 healthy newborns during the first week of life and in 7 newborns with perinatal acidosis. Normal values (n = 66) constantly ranged between 0.66 and 3.33 microg/l (2.5 and 97.5 percentiles) during the evaluation period. CONCLUSIONS: Newborns with signs of hypoxic-ischaemic encephalopathy (HIE) after perinatal acidosis showed elevated Protein S-100 serum levels, whereas newborns without these signs had normal concentrations. S-100 might thus be a marker of central nervous system damage in newborns. Key words: Asphyxia, brain damage, neonate

Acidosis↗
PubMed1984

Naturally occurring spleen-associated suppressor activity of the newborn mouse. Requirement for two genetic restrictions in suppression of lethal graft-versus-host disease by newborn spleen cells.

Spleens from newborn mice less than 6-7 days of age are known to contain naturally occurring suppressor cells, which can suppress the immune reactivity of third-party adult cells. In the present study newborn spleen cell populations are shown to possess the potential to inhibit lethal graft-versus-host (GVH) disease in sublethally gamma-irradiated hosts injected with allogeneic adult cells. However, this capacity to suppress GVH disease is controlled by at least two genetic restrictions: (1) the newborn spleen cells and the adult donor cells must be histocompatible at an H-2-linked region apparently telomeric of H-2DL, and (2) the newborn spleen cells must express a strongly stimulating non-H-2 (perhaps M1s) alloantigenic phenotype. Host animals that survive GVH remain chimeric for at least 3-4 weeks but return to the host phenotype by 8-10 weeks. Thus, it appears that in sublethally irradiated hosts the newborn cells suppress donor cell reactivity long enough for the host system to recover from the effects of irradiation.

Aging↗
PubMed1996

Comparison of newborn circumcision pain to calcaneal heel puncture pain: is newborn circumcision pain control clinically warranted?

In newborns, elective male circumcision and calcaneal puncture for obtaining blood samples both cause pain. With elective male circumcision, dorsal penile nerve block (DPNB) is recommended for pain control, but no pain control is routinely recommended or used during calcaneal puncture. A prospective investigation was conducted to compare pain during elective circumcision (with and without DPNB) and calcaneal puncture to determine whether pain control should be used with the latter procedure. The study was conducted at a community hospital during a 4-month period. Two nurses observed newborn behavior during elective circumcision and routine calcaneal puncture and rated pain reactions by using a modified Gronigen Distress Scale. Ninety-one male newborns were circumcised without DPNB, and eight male newborns were circumcised with DPNB. Calcaneal puncture for blood samples was performed in 97 newborns (males and females). Pain scores during circumcision with and without DPNB were comparable with those during calcaneal puncture (2.1, 2.4, and 2.2, respectively). Pain control during circumcision may thus be considered, but caution should be taken that measures to prevent pain do not create new patient risk or additional pain.

Blood Specimen Collection↗
PubMed1998

[Preliminary assessment of transient evoked acoustic emissions (TEOAE) in newborns depending on selected parameters of delivery complications with particular analysis of newborns with hypotrophy].

OBJECTIVES: Transient evoked otoacoustic emission (TEOAE) is accepted as a good and universal test for screening of the cochlea function in newborns. This method is particularly useful in the newborn group with risk-factors of hearing losses. Early identification of the cochlear pathology gives possibility of supplying with hearing aid instrument and rehabilitation. MATERIAL AND METHODS: In this study 300 newborns was tested with TEOAE, besides such parameters as birth mass, Apgar scale, bilirubinemy were analysed. Then the same results of the newborns with hypotrophy consisted of 40 subjects were analysed. RESULTS: The study did not indicate any tendency of changing TEOAE in particular parts within the cochlea in newborns with hypotrophy. Hypotrophy does not seem to influence the cochlea function monitored by TEOAE half-octave band analysis.

Acoustic Stimulation↗
PubMed2001

Tandem mass spectrometric analysis for amino, organic, and fatty acid disorders in newborn dried blood spots: a two-year summary from the New England Newborn Screening Program.

BACKGROUND: Tandem mass spectrometry (MS/MS) is rapidly being adopted by newborn screening programs to screen dried blood spots for >20 markers of disease in a single assay. Limited information is available for setting the marker cutoffs and for the resulting positive predictive values. METHODS: We screened >160 000 newborns by MS/MS. The markers were extracted from blood spots into a methanol solution with deuterium-labeled internal standards and then were derivatized before analysis by MS/MS. Multiple reaction monitoring of each sample for the markers of interest was accomplished in approximately 1.9 min. Cutoffs for each marker were set at 6-13 SD above the population mean. RESULTS: We identified 22 babies with amino acid disorders (7 phenylketonuria, 11 hyperphenylalaninemia, 1 maple syrup urine disease, 1 hypermethioninemia, 1 arginosuccinate lyase deficiency, and 1 argininemia) and 20 infants with fatty and organic acid disorders (10 medium-chain acyl-CoA dehydrogenase deficiencies, 5 presumptive short-chain acyl-CoA dehydrogenase deficiencies, 2 propionic acidemias, 1 carnitine palmitoyltransferase II deficiency, 1 methylcrotonyl-CoA carboxylase deficiency, and 1 presumptive very-long chain acyl-CoA dehydrogenase deficiency). Approximately 0.3% of all newborns screened were flagged for either amino acid or acylcarnitine markers; approximately one-half of all the flagged infants were from the 5% of newborns who required neonatal intensive care or had birth weights <1500 g. CONCLUSIONS: In screening for 23 metabolic disorders by MS/MS, an mean positive predictive value of 8% can be achieved when using cutoffs for individual markers determined empirically on newborns.

Amino Acid Metabolism, Inborn Errors↗
PubMed1981

[Interferons produced by the cells of newborn mice in the presence of sera from newborn and adult animals].

Fibroblasts of newborn mice produced far less amount of interferon in the presence of sera from newborn animals than in the presence of sera from adult animals. The interferons obtained were purified by adsorption chromatography on porous glass and were analyzed by electrophoresis in polyacrylamide gel. It has been shown that antiviral activity of interferon preparations obtained in the presence of sera from newborn mice was associated with the fraction of 45 Kd. Addition into the growth medium of sera from adult animals led to the production by the same cells of interferon activity associated with 41 and 28 Kd fractions. It is assumed that the sera of newborn mice contained the components influencing the molecular content of interferon produced by the cells of newborn animals.

Age Factors↗
PubMed1982

Spleen cells from adult mice given total lymphoid irradiation (TLI) or from newborn mice have similar regulatory effects in the mixed leukocyte reaction (MLR). II. Generation of antigen-specific suppressor cells in the MLR after the addition of spleen cells from newborn mice.

Spleen cells from newborn BALB/c mice were added to the mixed leukocyte reaction (MLR) between a variety of responder and stimulator cells. The newborn cells nonspecifically suppressed the uptake of (3H)-thymidine and the generation of cytolytic cells regardless of the responder-stimulator combination used. Suppressor cell activity fell rapidly during the first 4 days after birth, and could not be detected by day 20. Newborn spleen cells inhibited the generation of nonspecific suppressor cells during the MLR but did not inhibit the generation of antigen-specific suppressor cells. Thus, newborn spleen cells exhibit a pattern of regulation of the MLR similar to that reported previously for spleen cells from adult mice given total lymphoid irradiation (TLI). These regulatory interactions provide a model that explains the ease of induction of transplantation tolerance in vivo in newborn mice and in TLI-treated adult mice.

Animals↗