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PubMed2003

Newborn endothelin receptor type B mutant (piebald) mice have a higher resting anal sphincter pressure than newborn C57BL/6 mice.

Hirschsprung's disease is characterized by aganglionosis of the distal colon and hypertonicity of the anal sphincter. Endothelin receptor type B mutant (piebald) mice phenotypically resemble infants with Hirschsprung's disease in that these mice are susceptible to developing toxic megacolon because of the absence of ganglion cells in their distal colon. Therefore, we hypothesized that newborn piebald mice would have a higher resting anal sphincter pressure than would newborn wild-type mice. To test this hypothesis, we developed a reliable and reproducible technique for measuring the resting anal sphincter pressure in mice. Heterozygote breeding pairs of endothelin receptor type B mutant mice were purchased and bred in our animal facility. Pregnant, time-dated C57BL/6J mice provided control newborn mice. One-day-old newborn mice were evaluated for resting anal sphincter pressure. Under the operating microscope, a 24-gauge open-tip epidural catheter was placed into the anus until a deflection (approximately 3 to 5 mm) was noticed on a polygraph pressure monitor. Three consecutive measurements were obtained for each mouse. Mean values for each group were determined and compared using Student's t test. The resting anal sphincter pressure (mean +/- standard deviation) in newborn C57BL/6J mice was 13.3 +/- 2.6 mmHg, whereas that in piebald mice 22.7 +/- 2.5 mmHg (P < 0.0001). Therefore, because of their increased resting anal sphincter pressure, piebald mice may provide a useful animal model for the study of Hirschsprung's disease.

Anal Canal↗

PubMed2000

Intravenous dexamethasone for extubation of newborn infants.

BACKGROUND: Endotracheal tubes are foreign bodies that may injure the upper airway causing laryngeal edema. This in turn may result in failure of extubation in preterm infants. Corticosteroids have been used prophylactically to reduce upper airway obstruction and facilitate extubation. OBJECTIVES: In newborn infants having their endotracheal tube removed following a period of intermittent positive pressure ventilation (IPPV), what are the effects of intravenous corticosteroids on the incidence of endotracheal reintubation, stridor, atelectasis and adverse side effects? SEARCH STRATEGY: Searches were made of the Oxford Database of Perinatal Trials, Medline (MeSH search terms "dexamethasone", "extubat*" and "exp infant, newborn"), previous reviews including cross references, abstracts of conferences and symposia proceedings, expert informants, journal handsearching mainly in the English language and expert informant searches in the Japanese language by Prof. Y. Ogawa. SELECTION CRITERIA: Trials were included which used random or quasi-random patient allocation, and which compared intravenous steroids given immediately prior to a planned extubation with placebo. DATA COLLECTION AND ANALYSIS: Data were extracted independently by the two authors and analysed in Revman for all trials. Prespecified subgroup analyses were performed to examine differences in response between infants at high risk for upper airway edema and those receiving routine prophylaxis prior to extubation. MAIN RESULTS: Administration of dexamethasone prior to extubation significantly reduced the need for reintubation of the trachea. This result applies to both the high risk group and to the total population of infants enrolled. However, the incidence of extubation failure was zero in the trial that attempted to exclude infants at high risk of airway edema. The side effects of higher blood sugar levels and glycosuria were found in the 2 trials where these were sought. REVIEWER'S CONCLUSIONS: Implications for practice Dexamethasone reduces the need for endotracheal reintubation of neonates after a period of IPPV. In view of the lack of effect in low risk infants and the documented and potential side effects, it appears reasonable to restrict its use to infants at increased risk for airway edema and obstruction, such as those who have received repeated or prolonged intubations. Implications for research Issues of dosage and applicability to the extremely low birthweight population could be addressed in future trials. Longer term outcomes such as chronic lung disease, duration of assisted ventilation and length of hospital stay should also be examined.

Anti-Inflammatory Agents↗

PubMed1987

Human cyclic motility: fetal-newborn continuities and newborn state differences.

The spontaneous movement of 41 healthy human newborns was analyzed for cyclic patterns during different behavioral states and also compared to similar data obtained during their last few months of gestation. Spectral analysis was used to identify and quantify the motility cycles, except in quiet sleep, for which the instantaneous frequency of the isolated movements was analyzed. Cyclic motility (CM) was common in all states, and measures of its cyclic organization were similar in the non-sleep states in spite of very large differences in the total amount of movement. During active sleep, CM was weaker and less regular than during the non-sleep states, but similar to fetal CM during the last month of gestation. Thus cyclic variation in spontaneous motor activity, a basic feature of fetal behavior, is also a nearly constant feature of newborn spontaneous movement. Fetal CM persists relatively unchanged in the newborn during active sleep, and the cyclic organization of newborn movement is independent of the level of motor output.

Activity Cycles↗

PubMed2005

Universal newborn hearing screening follow-up in two Georgia populations: newborn, mother and system correlates.

BACKGROUND: Nearly half of babies who "fail" their newborn hearing screening do not receive appropriate follow-up. Various explanations have been suggested. OBJECTIVE: To investigate, in two contrasting populations of newborns in Georgia, contemporaneous medical, socio-demographic and screening correlates of follow-up after newborn hearing screening. Three hypotheses were addressed: (1) follow-up correlated with particular medical, social and demographic features; (2) screening performance indicators correlated with follow-up; and (3) screening policies and procedures correlated with follow-up. METHODS: The studied babies, born July 2001 through June 2003 at Atlanta's Piedmont Hospital and Waycross Health District, had failed screening in both ears. Each site had about 4000 births per year, and a plan for outpatient follow-up of in-patient "fail" babies. RESULTS: At Piedmont, where Medicaid funded less than 7% of the births, 57% (130/230) had known follow-up to outpatient screening. In contrast, at Waycross, where Medicaid funded 89.6% of the births, 100% (38/38) had follow-up. The first study hypothesis was only partially supported by the data-from Piedmont, but not Waycross. White race and maternal age 30 years or older correlated with following-up: odds ratios 2.07 (95% CI 1.17, 3.68) and 1.83 (1.05, 3.17), respectively. Private health insurance and marriage trended with following-up. Follow-up rates did not correlate with the rates of screening refusal, missed screening and "fail" rates. Follow-up was unrelated to mothers witnessing the screening, receiving in-person explanations and having appointments arranged for them. The Piedmont and Waycross programs were quite different. Piedmont's began in 2001, mothers typically learned about screening when it was done and "fail" babies were reported to many public health entities. In contrast, the Waycross program was more than 20 years old, prenatal care included teaching about screening and reporting was to one public health entity. CONCLUSIONS: Though maternal socio-demographic features (poor, non-white, young) and access problems have been considered factors for non-follow-up, this study found two program characteristics most important: the lack of prenatal education about newborn hearing screening, and the lack of functionally integrated hospital hearing information with Public Health.

Adult↗

PubMed2002

[Universal newborn hearing screening program in Würzburg. Experience with more than 4000 newborns and the influence of non-pathological factors on the test results].

BACKGROUND: The BERAphon(R) method employing a special headphone and the time-course step-stimulus algorithm offers a quick and reliable tool for universal hearing screening in newborns. An ABR-based universal newborn hearing screening program has been established in Würzburg since August, 1997. Until August 2001, 4115 newborns have undergone primary and/or control-screening with the BERAphon(R). The validity of this method was further examined by testing the effects of non-pathological factors such as gender, age, Apgar score, pH value of the umbilical cord, head circumference and duration of pregnancy on the ABR wave V latency in 415 infants. RESULTS: Out of 3930 infants who were primary screened, 27 infants were diagnosed to have hearing loss. Furthermore, hearing loss was detected in 35 out of 185 infants referred for control screening. Non-pathological factors showed a minor effect on the test results. Apgar score, gender or chronological age did not have any significant effects on the latency of wave V. Duration of pregnancy, pH value of the umbilical cord or head circumference showed a significant but weak correlation with wave V latency. CONCLUSIONS: Only non-pathological factors related to maturation had a minor effect on ABR measurements using the time-course-step-stimulus algorithm. The BERAphon(R) method has proven to be a reliable, robust method giving information related to the hearing threshold and accordingly can be used reliably for hearing screening in newborn infants.

Audiometry, Evoked Response↗

PubMed2004

[Cranial sonography for newborn screening: a 10-year retrospective study in 11,887 newborns].

We retrospectively analyzed the results of a sonographic cranial screening study, performed between 1985 and 1994 to determine the incidence of intracranial hemorrhage and cerebral anomalies based on obstetrical risk factors. In the Department of Obstetrics and Gynecology of the University Giessen, Giessen, Germany, 94.6 % (n = 11,887) of all children born during the study period were included and underwent sonographic cranial screening within the first 10 days after birth. Cerebral abnormalities were found in 653 (= 5.5 %) cases, and peri-/intraventricular hemorrhages (PIVH, grade I-IV) in 303 cases. Periventricular leucomalacia, porencephaly, subarachnoidal hemorrhage and hydrocephaly were rare (< or = 0.2 %). The Apgar index proved to be a good prognostic factor, particularly at 1 and 5 minutes after birth (p < 0.0001). In contrast, correlation between PIVH and cardiotocography, arterial cord blood gases, and pH was poor. We did not observe a higher incidence of PIVH in newborns with growth retardation, preeclampsia and premature ruptures of membranes or prolonged labor. With decreasing gestational age, the frequency of PIVH increased progressively from 0.4 % at 39 weeks to 53.2 % at 27 weeks (p < 0.001). We also found a higher risk of intracranial hemorrhage in preterm newborns with amniotic infections (38.1 %, p < 0.001). In mature babies, we did not find a difference between the incidence of PIVH and delivery-modes; however, we noted a higher risk of PIVH Grade IV in preterm newborns with breech presentation for vaginal delivery versus caesarean section (38.5 % versus 7.4 %, p = 0.005). The incidence of PIVH over this 10 year time period did not increase despite an increasing number of preterm newborns over time. In conclusion, this study, which represents one of the largest patient cohorts studied for PIVH, indicates that neonatal sonographic cranial screening is an important tool to define quality control in obstetrics.

Apgar Score↗

PubMed2005

Parent-of-origin transmission of thrombophilic alleles to intrauterine growth-restricted newborns and transmission-ratio distortion in unaffected newborns.

Findings on the role of thrombophilic polymorphisms in adverse pregnancy outcomes, particularly intrauterine growth restriction, are inconsistent. Such inconsistencies may be partly due to two types of effects which have not been considered before with regard to thrombophilic genes: parent-of-origin effects (imprinting) and transmission-ratio distortion effects (allele transmission differing from that expected in unaffected subjects). In this study of infants born at a Canadian hospital (1998-2000), the authors investigated both types of effects. Cases (n = 493) were defined as newborns whose birth weight for gestational age and sex was below the 10th percentile by national standards, and controls (n = 472) as newborns at or above the 10th percentile. Log-linear models were used to analyze the transmission of variant alleles among case- and control-parent trios. A single copy of a common polymorphism, Val34Leu in factor XIII, increased the risk of intrauterine growth restriction approximately 70% when the parent of origin was the father as opposed to the mother (p < 0.05). Among unaffected newborns, transmission of A1298C in the methylenetetrahydrofolate reductase gene (p < 0.005), transmission of the G1691A variant in factor V Leiden (p < 0.002), and transmission of the G20210A variant in the prothrombin (factor II) gene (p < 0.001) occurred significantly less often than expected (transmission-ratio distortion). Affected newborns also inherited the prothrombin G20210A variant significantly less often than expected. These results suggest that these three genes exhibit segregation distortion or reduce gestational survival.

Alleles↗

PubMed1986

Naturally occurring, spleen-associated suppressor activity of the newborn mouse. Biochemical and functional identification of three monokines secreted by newborn suppressor-inducer monocytes.

Immature monocytes residing in the spleens of newborn mice less than 6-7 days of age are known to suppress T-dependent and T-independent immune responses in vitro and in vivo. Suppression is mediated in part through products secreted by the newborn monocytes. In the present study, we have identified 3 monokines secreted by newborn, but not adult, monocytes correlating with materials possessing significant suppressor activity in vitro. These monokines have molecular weights of 58, 10.8, and 10 kilodaltons, appear to be proteins, and are insensitive to heat inactivation. The 58 kd material is antigenically distinct from alpha-fetoprotein, while the lower molecular weight materials are too large to be prostaglandins. Although these monokines can be shown to have activity in vitro, they are not as efficient as newborn monocytes in preventing alloreactivity in vivo.

Aging↗

PubMed1979

The excretion of C6-C10-dicarboxylic acids in the urine of newborn infants during starvation. Evidence for omega-oxidation of fatty acids in the newborn.

The excretion of C6-C10-dicarboxylic acids, i.e. adipic, suberic and sebacic acids, was measured during the three first days of life in 3 fasting newborns, 2 newborns fed with isocaloric glucose and 2 newborns given mothers'-milk. On the second and third day of life the starved children excreted 27-84 mmol adipic acid/mol creatinine, 6-22 mmol suberic acid/mol creatinine and 4-7 mmol sebacic acid/mol creatinine. The excretion of C6-C10-dicarboxylic acids in the neonates given glucose or mothers'-milk was, for the first three days of life, 0-9 mmol adipic acid/mol creatinine, 0-10 mmol suberic acid/mol creatinine and 0-4 mmol sebacic acid/mol creatinine. The latter amounts are equivalent to the excretion of dicarboxylic acids in older children. It is argued that the detected dicarboxylic acids are formed by omega-oxidation of long-chain monocarboxylic acids followed by beta-oxidation, and that the excreted amounts reflect omega-oxidation activity. It is speculated that the substantial omega-oxidation activity in the starving newborn serve to provide succinyl-CoA-substrate for the citric acid cycle and for gluconeogenesis.

Adipates↗

PubMed1990

Coagulation and anticoagulation systems in newborns--correlation with their mothers at delivery. Lower levels of anticoagulants and fibrinolytic activity in the newborn.

The neonatal period is probably the only time when a higher incidence of spontaneous thromboembolic complications may occur in the otherwise normal healthy individual, and this may be related to the activation of the coagulation system at the time of parturition. This study was performed to look at the newborn coagulation and anticoagulation systems and compare these with the changes in the maternal circulation in normal cases. Paired umbilical cord venous and maternal venous blood samples were obtained and plasma levels of protein C, protein S, antithrombin III, fibrinopeptide A, fibrinogen, plasminogen, and fibrinolytic inhibitory activity were measured. The maternal plasma level was significantly higher in all cases except for fibrinopeptide A which was similar, and for fibrinolytic inhibitory activity which was lower (p less than 0.05). A significant correlation exists between maternal and newborn protein C levels (p less than 0.02) and fibrinolytic inhibitory activity (p less than 0.05). The findings indicate that parturition leads to a similar degree of activation of the newborn coagulation system as shown by the fibrinopeptide A level. As their anticoagulants and fibrinolytic activity levels are lower and the fibrinolytic inhibitory activity is higher, the newborns are thus predisposed to thrombosis even in the absence of complications such as sepsis.

Antithrombin III↗

PubMed1976

Calcium metabolism in newborn animals: the interrelationship of calcium, magnesium, and inorganic phosphorus in newborn rats, foals, lambs, and calves.

The plasma concentrations of calcium, inorganic phosphorus, and magnesium were studied during the early postnatal period in a rodent (rats), in ruminants (lambs and calves), and in foals. Decreases in plasma calcium after birth were observed only in newborn rats and foals. In rats the postnatal fall in plasma calcium level was already evident 1 hr after cesarean section (9.20 mg/100 ml) as opposed to 11.90 mg/100 ml in utero) and reached a nadir within 6 hr (-4.05 mg/100 ml). Newborn foals showed a small decrease in plasma calcium (-0.73/100 ml) 48 hr after birth. In the four species plasma inorganic phosphorus increased in the days after birth; plasma magnesium levels were only slightly affected over the first week of life. In ruminants and in foals, the high plasma calcitonin levels were not always related to plasma calcium, nor with plasma inorganic phosphorus over the first week of life. Newborn calves showed at birth detectable levels of plasma parathyroid hormone, similar to those found in their mothers, with individual values ranging from 0.80-3.50 ng/ml. These results are discussed in light of the well known early neonatal nypocalcemia occurring in normal human newborns.

Animals↗

PubMed1990

[Clinical and electrophysiological studies of the organ of hearing of newborn infants. III. Evaluation of the organ of hearing of newborn infants from high risk pregnancy using brain stem evoked response audiometry (ABR)].

In a group of 130 tested newborns, pathological brain stem responses derived from acoustic stimulus was achieved in 28 cases (21.5%). 85.2% of newborns in this group of birthed babies comprised a high-risk pregnancy group. Based on criteria evaluating monitoring and parameters achieved ABR responses: conduction hearing disorders were found in 7 newborns, sensori-neural in 12 cases, and neurological dysfunction was observed in 9 cases. Control testing was carried through for three months following the initial evaluation allowing for the elimination of 12 children in a group of 19 for further testing and observation. This represents 42.85% of children initially evaluated as possessing a hearing disorder and 9.2% from the total of those tested. Results obtained during successive control testing were carried-out in a 3-6 month period following the initial examination and allowed for decisions to be made. Conforming to: 4 children (3.07%) were supplied with hearing aids and hearing rehabilitation begun, 1 child (0.76%) was referred to rehabilitation the deaf, whereas the 2 remaining children (1.53%) are currently under neurological observation. Nonetheless, testing older children eliminates cases that present with lack of success at the initial evaluation or transitory hearing impairment that is self-limited, although ABR testing, while the child is on the unit, allows for the introduction of hearing-organ controls of newborns based on population testing.

Audiometry, Evoked Response↗

PubMed1989

[Immunologic findings in the newborn infant. II. Studies of humoral immunity, reference values of immunologic studies in the newborn infant].

After dealing with cellular immune aspects in the first part of the paper the authors describe in the second part the state of humoral immunity in healthy full-term newborns aged one to three days. The number of complementreceptor lymphocytes was 17.0 +/- 8.9% or 0.75 +/- 0.51 (mean +/- S.D.) respectively, with the EAC-rosette method. The percentage value equalled that of adults but the absolute count is higher. Using the immunodiffusion method IgA was detectable in 4 out of 132 newborns only 8.86 +/- 2.52 g/l (mean +/- S.D.) was measured as an average IgG concentration. With regard to the IgM content the values often exceeded 0.30 g/l in newborns of mothers who had been suffering from pre-eclampsia. Their mean value of 0.35 +/- 0.21 g/l, too, was significantly higher than 0.13 +/- 0.08 in the resting infants. Raised IgM values frequently coincided with high spontaneous transformation activities in lymphocyte cultures. The possible causes are discussed. Complement C3-component was measured on average with 0.78 +/- 0.18 g/l and C4-component with 0.34 +/- 0.11 g/l. When calculating reference values for newborns the results of infants with maternal pre-eclampsia have been omitted.

Complement C3↗

PubMed1983

Red cell creatine in term and preterm, adequate and small for gestational age newborns after normal pregnancy or risk conditions. I. Statistical analysis of creatine in various groups of newborns.

The red cell creatine concentration was determined in 174 newborns (cord blood) and in 50 healthy adults. Normal values for term adequate for gestational age newborns without intrauterine and perinatal risk (n = 53) were established to lie significantly above those for adults. Newborns after risk pregnancies had higher mean creatine concentrations than those born after uneventful gestation. Small for gestational age (SGA) infants proved to have the lowest creatine concentration of all newborn groups. The creatine values of our SGA children suggested that not more than 20% of them had chronic intrauterine hypoxia. It is concluded that red cell creatine at birth may serve to characterize in retrospect erythropoietic dynamics in cases of intrauterine growth retardation and intrauterine risk.

Creatine↗

PubMed1980

[Cardiovascular adaptation of the newborn to stress situations: effects of hypoxia on newborn and 14-day-old piglets (author's transl)].

-Newborn and 14-day-old piglets (in a developmental stage equivalent to that of a 3-month-old infant) compensate sustained hypoxemia by increasing cardiac performance. -This compensation can be maintained for only roughly 30 min. -Newborn piglets free from hypoxemia are able to tolerate the stress of anesthesia, artificial respiration, and operation significantly longer than those with additional hypoxemia. -14 day-old piglets without hypoxemia are not able to tolerate the stress of anesthesia, artificial respiration, and operation longer than those with additional hypoxemia. -The reactions of the cardiovascular system to anesthesia, artificial respiration, and operation in present or absent additional hypoxemia are qualitatively identical and are also identical in time in the newborn hypoxic, the 14-day-old hypoxic, and normoxic animals, whereas they appear significantly later in newborn control piglets.

Animals↗

PubMed1977

Absence of phosphatidylglycerol (PG) in respiratory distress syndrome in the newborn. Study of the minor surfactant phospholipids in newborns.

Phosphatidylglycerol (PG) was absent from lung effluent in 41 infants with respiratory distress syndrome of the newborn (RDS), whereas effluent from healthy control subjects of similar gestational age contained this phospholipid (4.9 +/- 2.4% of lipidphosphorus (P), n = 32). Control infants of 28 weeks of gestation or less with various respiratory disturbances other than RDS also had low PG (0.2 +/- 0.2% of lipid-P, n = 5). In RDS surfactant complex often could be isolated from the airways using differential and density gradient centrifugation. The material thus obtained had prominent phosphatidylinositol (PI) (13.6 +/- 2.8% of lipid-P, n = 6), but no PG. Of those 18 infants who had such surfactant even in the early stages of RDS, 13 were 35 weeks of gestation or more, 3 were offspring of diabetic mothers, and 2 had severe perinatal asphyxia. In healthy control subjects PG sometimes appeared first within an hour of birth, but in RDS PG did not appear until recovery from RDS. In RDS type II (transient tachypnea of the newborn) PG in lung effluent also was abnormally low (1.3 +/- 0.6% of lipid-P, n = 5) and PI was correspondingly prominent (9.7 +/- 3.6% of lipid-P, n = 5), indicating immaturity of surfactant similar to RDS. Surfactant with PG and PI has superior surface-active properties compared to that containing PI, but no PG. Surfactant without PG does not seem to stabilize the alveoli of the newborn as well as does surfactant with PG. The failure of PG appearance following birth therefore may precipitate RDS, especially beyond 35 weeks of gestation.

Asphyxia Neonatorum↗

PubMed1997

Failure to screen newborns for inborn disorders: a potential consequence of changes in newborn care.

OBJECTIVES: To determine how changes in the structure of the hospital care of infants, such as shortened post-natal stays, affect the completeness of newborn screening. DESIGN: Cohort. SETTING: Two large maternity hospitals. PARTICIPANTS: 8751 consecutive births at the study hospitals during 1993. MAIN OUTCOME MEASURE: The completeness of initial specimen collection and processing as determined by matching of birth and screening records. RESULTS: At least one specimen was received by the screening program for 8675 (99.1%) of the births. Most non-screened patients (71/76, 93%) had been admitted to the neonatal intensive care unit (NICU). Of these, 53/71 (75%) were low birth weight infants who died within 48 h of birth. Even after excluding these non-survivors, NICU patients were 37 times more likely to be unscreened than their healthy counterparts (22 vs. 0.6 per 1000 infants, 95% C.I. 12.8, 92.8 P < 0.01). A common characteristic of non-screened NICU survivors, (12/18) was interhospital transfer for sub-specialty care. Among patients in the healthy-baby nursery, early discharge (i.e. < 24 h of age) accounted for 2/5 (40%) of the cases of non-screening. The non-screening rate among patients discharged early was 25 times higher than for those discharged after 24 h (9.8 vs. 0.4 per 1000 infants, 95% C.I. 4.2, 149 P < 0.01). CONCLUSIONS: Although the overall rate of screening was high, NICU patients, especially those requiring transfer, are disproportionately at risk for non-screening. Early discharge of healthy newborns was also significantly associated with non-screening. This latter finding is of special importance given the current trend toward shorter hospital stays for newborns. Increased attention to ensuring the collection of specimens from these two high-risk populations is warranted.

Cohort Studies↗

PubMed1978

[Postnatal monitoring of the newborn infant with cardiotachography. II. Significance of cardiotachography for diagnosis of existing conditions in the newborn infant].

Eighty-five cardiotachograms of newborns aged between 34 and 42 weeks of gestation were studied. Fifty newborns were delivered spontaneously. In seventeen cases caesarean sections were used and in eighteen cases vacuum extractions. Cardiotachograms were recorded continuously throughout the immediate postnatal period until the stabilisation of the heart rate. Cardiotachograms were divided into three typical groups based on their cours of heart rate and fluctuation. The relation between these groups and the methods and duration of delivery and the condition of newborns were discussed. We found a correlation between the pathological cardiotachograms (tachycardiac and bradycardiac type of cardiotachogram) and long expulsion time, existent history of intrauterine disorder and low Apgar score. No relationship could be established between pathological cardiotachograms and the method of delivery.

Arrhythmias, Cardiac↗