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PubMed2005

Iqmik--a form of smokeless tobacco used by pregnant Alaska natives: nicotine exposure in their neonates.

OBJECTIVE: To determine the concentration of nicotine and cotinine in maternal blood and neonatal cord blood among pregnant Alaska Native women and to assess the neonates for neurobehavioral effects. METHODS: In a nonrandomized, clinical observational pilot trial, 60 pregnant Alaska Native women were enrolled for assessment of Iqmik (a mixture of leaf tobacco and ash) and other tobacco use during pregnancy and at delivery. Neonatal cord blood, nicotine and cotinine concentrations were obtained, and neonatal neurobehavioral effects were assessed using the Lipsitz scale. RESULTS: At delivery, there were 22 subjects who reported using only Iqmik, and 10 who used other tobacco products. Subjects who reported using only Iqmik prior to delivery had higher concentrations of cotinine (167+/-116 vs. 81+/-100) in maternal blood (rank sum test, p=0.036) and higher concentrations of nicotine (8.4+/-7.3 vs. 4.4+/-5.1, p=0.048) and cotinine (153+/-115 vs. 70+/-95, p=0.048) in cord blood compared to subjects who reported using other tobacco products. Neurobehavioral signs as assessed by the Lipsitz score were increased in neonates born to mothers using only Iqmik (3.7+/-1.8, p=0.011), or to mothers using other tobacco products (3.4+/-1.4, p=0.034) compared to neonates born to women who reported no tobacco use (1.8+/-1.4). CONCLUSIONS: Mothers who use Iqmik and their neonates have higher cotinine concentrations compared to mothers who use cigarettes and/or other forms of tobacco. Neurobehavioral signs occur in neonates born to women who use Iqmik but also in neonates born to mothers who use other forms of tobacco during pregnancy.

Adult↗
PubMed1962

Immunologic response of neonatal and older rabbits to antigens of rabbit leucocytes.

The immunologic response of neonatal and of older rabbits to the tissue (transplantation) antigens of pooled rabbit leucocytes was studied, the test system being the suppression of formation of agglutinin to Shigella paradysenteriae by transferred lymph node cells which had been incubated with Shigella antigen. In the active induction of the suppressive effect on the transferred cells it was found that neonatal rabbits reacted as vigorously as 1 kg rabbits to the prior injection of a given number of rabbit leucocytes pooled from prospective donors of lymph node cells. The suppressive effect was dose-related, and within the range of number of leucocytes used was similar for both age groups of recipients. An attempt to detect a difference in the response during the first few days after leucocyte injection, before the full suppressive effect is reached, failed to show any difference between rabbits of the two age groups. Since it had been found possible to transfer the suppressive effect passively with sera obtained from older rabbits injected with rabbit leucocytes, attempts were made to do so with sera obtained from neonatal rabbits injected with similar numbers of pooled adult rabbit leucocytes. No consistent suppression of transferred lymph node cells was observed with sera from neonatal rabbits, even with relatively large amounts of such serum. In sera of rabbits which had been injected with rabbit leucocytes at the age of 4 to 6 weeks, suppressive antibody could be detected. When anti-rabbit-leucocyte serum obtained in adult rabbits was injected into neonatal and 1 kg recipients at a given volume per gram of animal weight the suppressive effect of the serum was of similar extent in the two groups of recipients. In the adoptive transfer of the lymph node cell suppressive effect, by cells of lymph nodes draining the sites of injection of pooled rabbit leucocytes, it was found that the popliteal lymph node cells of neonatal rabbits were as effective as those of 1 kg rabbits. Splenic cells of neonatal rabbits were also effective, when an adequate number of rabbit leucocytes had been injected intravenously. Thus, in conferring adoptive immunologic response, as in active immunization, the neonatal rabbits were as effective as the older rabbits in their response to homotransplantation antigens, in contrast to the considerable difference in concentration of the suppressive antibody in sera of neonatal and older rabbits injected with rabbit leucocytes.

Animals↗
PubMed1975

The characterization fo the B-cell repertoire specific for the 2,4-dinitrophenyl and 2,4,6-trinitrophenyl determinants in neonatal BALB/c mice.

The (B-cell) repertoire responsive to the DNP and TNP haptenic determinants in BALB/c neonates was analyzed in terms of the specificity of stimulation of neonatal B cells as well as the diversity of specificities available in neonatal populations. The results indicate that the parameters of stimulation of neonatal B cells are similar to those of nonimmune adults, particularly in the exquisitely specific stimulatory process which readily discriminates between haptens as closely related as 2,4-dinitrophenyl (DNP) and 2,4,6-trinitrophenyl (TNP). The clonotypes of monoclonal anti-DNP and anti-TNP antibodies derived from isolated neonatal BALB/c splenic B cells in fragment culture were analyzed by isoelectric focusing. During the first 4 days of neonatal life almost all of the anti-DNP-specific clones were of clonotypes displaying IgM antibodies with pI's of 5.05, 5.25, or 5.55. These could be distinguished from clonotypes responding to TNP which were also predominantly of three distinct pI's, 5.00, 5.15 or 5.40. These clonotypes, which represent the vast majority of the DNP- and TNP-specific antibody capability during the first 4 days of life, represented less than half of the clones by day 6 and were a small minority by day 9. The observation that individual 1--4-day-old donors had many B cells representative of a given predominant clonotype is evidence for cellular precommitment of specificity and indicates that clones of precommitted B cells exist as the products of normal, antigen-independent, generative processes. The observation of frequently recurring clonotypes in inbred neonates attests to the "germ line" origin of these clonotypes; however, variance in the occurrence of these clonotypes from donor to donor implies a random element in their expression. The finding that several clonotypes occur repeatedly in high numbers early in neonatal development, while other clonotypes occur only sporadically at early times, has been interpreted as a reflection of a sequential ontogenic expression of clonotypes. Thus the DNP- and TNP-specific clonotypes which predominate in neonates may be seen as representative of a total of 5,000-10,000 clonotypes which are expressed as early as the 15th to 17th day of gestation while most clonotypes appear after the 18th day of gestation.

Age Factors↗
PubMed2000

Essential fatty acids in mothers and their neonates.

Essential fatty acids (EFAs) and their long-chain polyenes (LCPs) are indispensable for human development and health. Because humans cannot synthesize EFAs and can only ineffectively synthesize LCPs, EFAs need to be consumed as part of the diet. Consequently, the polyunsaturated fatty acid (PUFA) status of the developing fetus depends on that of its mother, as confirmed by the positive relation between maternal PUFA consumption and neonatal PUFA status. Pregnancy is associated with a decrease in the biochemical PUFA status, and normalization after delivery is slow. This is particularly true for docosahexaenoic acid (DHA) because, on the basis of the current habitual diet, birth spacing appeared to be insufficient for the maternal DHA status to normalize completely. Because of the decrease in PUFA status during pregnancy, the neonatal PUFA status may not be optimal. This view is supported by the lower neonatal PUFA status after multiple than after single births. The neonatal PUFA status can be increased by maternal PUFA supplementation during pregnancy. For optimum results, the supplement should contain both n-6 and n-3 PUFAs. The PUFA status of preterm neonates is significantly lower than that of term infants, which is a physiologic condition. Because the neonatal DHA status correlates positively with birth weight, birth length, and head circumference, maternal DHA supplementation during pregnancy may improve the prognosis of preterm infants. In term neonates, maternal linoleic acid consumption correlates negatively with neonatal head circumference. This suggests that the ratio of n-3 to n-6 PUFAs in the maternal diet should be increased. Consumption of trans unsaturated fatty acids appeared to be associated with lower maternal and neonatal PUFA status. Therefore, it seems prudent to minimize the consumption of trans fatty acids during pregnancy.

Dietary Fats↗
PubMed2006

Estimating the causes of 4 million neonatal deaths in the year 2000.

BACKGROUND: Information on cause-of-death is lacking for 98% of the world's 4 million neonatal deaths that occur in countries with inadequate vital registration (VR). Our aim was to estimate, by country for the year 2000, the distribution of neonatal deaths across programme-relevant causes including: asphyxia, preterm birth, congenital abnormalities, sepsis/pneumonia, neonatal tetanus, diarrhoea, and 'other'. METHODS: Two sources of neonatal cause-of-death data were examined: VR datasets for countries with high coverage (>90%), and published and unpublished studies identified through systematic searches. Multinomial regression was used to model the distribution of neonatal deaths. A VR-based model was used to estimate the distribution of causes of death for 37 low-mortality countries without national data. A study-based model was applied to obtain estimates for 111 high-mortality countries. Uncertainty estimates were derived using the jackknife approach. RESULTS: Data from 44 countries with VR (96 797 neonatal deaths) and from 56 studies (29 countries, 13 685 neonatal deaths) met inclusion criteria. The distribution of reported causes of death varied substantially between countries and across studies. Based on 193 countries, the major causes of neonatal death globally were estimated to be infections (sepsis/pneumonia, tetanus, and diarrhoea, 35%), preterm birth (28%), and asphyxia (23%). Regional variation is important. Substantial uncertainty surrounds these estimates. CONCLUSIONS: This exercise highlights the lack of reliable cause-of-death data in the settings in which most neonatal deaths occur. Complex statistical models are not a panacea. Representative data with comparable case definitions and consistent hierarchical cause-of-death attribution are required.

Asphyxia Neonatorum↗
PubMed1999

Development of T-B cell collaboration in neonatal mice.

The neonatal immune response is impaired during the first weeks after birth. To obtain a better understanding of this immaturity, we investigated the development of T cell interactions with B cells in mice. For this purpose, we analyzed the immune response to three T-dependent antigens in vivo: (i) the polyclonal antibody response induced by vaccinia virus; (ii) the production of polyclonal and specific antibodies following immunization with hapten-carrier conjugates; (iii) the mouse mammary tumor virus superantigen (sAg) response involving an increase in sAg-reactive T cells and induction of polyclonal antibody production. After vaccinia virus injection into neonates, the polyclonal antibody response was similar to that observed in adult mice. The antibody response to hapten-carrier conjugates, however, was delayed and reduced. Injection with sAg-expressing B cells from neonatal or adult mice allowed us to determine whether B cells, T cells or both were implicated in the reduced immune response. In these sAg responses, neonatal T cells were stimulated by both neonatal and adult sAg-presenting B cells but only B cells from adult mice differentiated into IgM- and IgG-secreting plasma cells in the neonatal environment in vivo. Injecting neonatal B cells into adult mice did not induce antibody production. These results demonstrate that the environment of the neonatal lymph node is able to support a T and B cell response, and that immaturity of B cells plays a key role in the reduced immune response observed in the neonate.

Adoptive Transfer↗
PubMed2003

Decreased CD154 expression by neonatal CD4+ T cells is due to limitations in both proximal and distal events of T cell activation.

Neonatal CD4(+) T cells express less CD154 protein and mRNA than adult CD4(+) T cells after activation by calcium ionophore and phorbol ester, but the mechanism for this reduced expression and its relevance to the primary immune response remain unclear. We compared expression of CD154 protein and mRNA and CD154 gene promoter activity by purified naive (CD45RA(high)CD45RO(low)) neonatal and adult CD4(+) T cells after activation by calcium ionophore (ionomycin) and phorbol myristate acetate (PMA) treatment or by engagement of alphabeta TCR-CD3 complex. Substantial and consistent reductions in expression by neonatal cells were found in all cases and were paralleled by decreased CD154-dependent activation of a B cell line. CD69 expression by neonatal CD4(+) T cells after alphabeta TCR-CD3 engagement was also reduced compared to adult cells, which suggested that limitations in activation-induced signaling by neonatal CD4(+) T cells occurred at a point upstream of where the signaling pathways leading to CD154 and CD69 expression diverge. Decreased CD154 expression by neonatal cells after alphabeta TCR-CD3 engagement was paralleled by a lower free intracellular calcium concentration, a key event for CD154 gene transcription. Reduced CD154 promoter activity by neonatal cells persisted when proximal signaling events were bypassed using ionomycin and PMA, suggesting an additional and more distal mechanism for decreased transcription. In contrast, CD154 mRNA stability was similar in neonatal and adult cells after either ionomycin and PMA stimulation or engagement of the alphabeta TCR-CD3 complex. We conclude that decreased CD154 production by neonatal CD4(+) T cells is due to limitations in both proximal and distal activation events, which together ultimately limit CD154 gene transcription.

Adult↗
PubMed2003

Age and dose dependency of the pharmacokinetics and metabolism of bisphenol A in neonatal sprague-dawley rats following oral administration.

Previous studies demonstrated the rapid clearance of bisphenol A (BPA) from blood following oral administration to adult rats with the principal metabolite being BPA-monoglucuronide (BPA-glucuronide). Since the ontogeny of glucuronyl transferases (GT) differs with age, the pharmacokinetics of BPA were studied in neonatal animals. (14)C-BPA was administered via gavage at 1 or 10 mg/kg body weight to rats at postnatal day (pnd) 4, pnd 7, pnd 21, or to 11 week old adult rats (10 mg/kg dose only). Blood (neonates and adults) and selected tissues (neonates) were collected at 0.25, 0.75, 1.5, 3, 6, 12, 18, and 24 h postdosing. BPA and BPA-glucuronide in the plasma were quantified by high-performance liquid chromatography; radioactivity in the plasma and tissues was quantified by liquid scintillation spectrometry. The data indicate that neonatal rats at all three ages metabolized BPA to BPA-glucuronide, although an age dependency in the number and concentration of plasma metabolites was observed, consistent with the ontogeny of GT. BPA-glucuronide and BPA concentrations in the plasma were greater in neonates than in adults, except at 24 h postdosing, suggesting an immaturity in the development of hepatic excretory function in neonatal rats. Nevertheless, the half-lives for the elimination of BPA-glucuronide in plasma were more rapid in neonatal animals than in adults, likely due to reduced microflora beta-glucuronidase activity and an absence of enterohepatic recirculation. A dose dependency in the metabolism and pharmacokinetics of BPA administered to neonates was also observed with nearly complete metabolism of BPA to BPA-glucuronide (94-100% of the plasma radioactivity) at a dose of 1 mg/kg. This was in contrast to finding up to 13 different plasma metabolites observed at the 10 mg/kg dose. These data indicate that, from early in neonatal life through pnd 21, there is sufficient GT activity in rats to efficiently metabolize BPA to its nonestrogenic metabolite at low doses.

Administration, Oral↗
PubMed1994

Pregnancy in B-cell-deficient mice: postpartum transfer of immunoglobulins prevents neonatal runting and death.

Mice lacking functional B cells because of a genetic deletion of the mu chain (IgM) gene were used to investigate the role of perinatal and postnatal transfer of maternal IgG in neonatal growth. Our results confirmed that immunoglobulin (Ig)-deficient mice successfully complete pregnancy and deliver healthy offspring. However, neonates nursed by Ig-deficient mothers showed growth retardation (runting) and high mortality during their first 10 days of life. This fatal course was seen whether or not the neonates were Ig-deficient. Cross-switching litters from phenotypically normal mothers to Ig-deficient mothers immediately after birth showed that perinatal Ig transfer normalized neonatal development for 10 days, but was not sufficient to sustain survival during the later part of the neonatal period. On the other hand, all Ig-deficient litters nursed by normal foster mothers showed normal development and 0% neonatal mortality. Administration of mouse IgG to an Ig-deficient mother or a neonate during the first critical week prevented runting. We assume that the growth- and health-promoting effects of IgG during early neonatal life are attributable mainly to the transfer of passive immunity to environmental pathogens. However, the finding that monoclonal IgG antibodies also enhanced neonatal growth and survival suggests that IgG-dependent growth-promoting mechanisms could be involved as well.

Animals↗
PubMed1996

Hearing threshold as measured by auditory brain stem response in human neonates.

OBJECTIVES: This article evaluates the concept of auditory threshold and discusses the limitations of assessing threshold in human neonates. The advantages and limitations of assessing neonatal threshold by means of auditory brain stem response (ABR) are discussed, and data from several studies of newborn ABR threshold are compared. The authors report data from their own study designed to compare adult and neonatal ABR threshold using tonal stimuli. EXPERIMENTAL DESIGN: Several studies are compared. Data from the authors are ABR thresholds for tone bursts of 0.5, 1.5, 4, and 8 kHz, determined from 2-channel recordings in full-term neonates and adults. Stimuli were calibrated in SPL by means of a probe microphone inserted into the ear canal along with the insert transducer of each subject. RESULTS: All studies find a degree of threshold elevation in neonates relative to adult threshold. Neonatal ABR thresholds from our laboratory for stimuli from 500 through 8000 Hz are elevated relative to adult thresholds by 5 to 25 dB. Threshold elevation in our data and in other studies has found that neonatal ABR thresholds to high-frequency stimuli show the largest elevation relative to adults and low-frequency stimuli the most mature. CONCLUSIONS: Thresholds of neonates, as measured by the ABR, are immature especially for high-frequency stimuli. Proper stimulus calibrations, which removes the influence of ear canal resonance, are important for comparisons of data across age groups. Developmental differences in the conductive mechanism and neural immaturity are the most harmonious explanations for elevation of neonatal ABR thresholds.

Adult↗
PubMed1992

Prolonged adult skin allograft survival as a result of cotransplantation with neonatal tissue. The requirement for antigen sharing between graft and cotransplant.

The survival of an adult skin allograft can be prolonged by a cotransplant of neonatal, but not adult, skin on the same recipient. We demonstrated this phenomenon using a C3HeB/FeJ (H-2k; C3H) adult graft and neonatal cotransplant donors. The median survival time (MST) for adult graft survival on B6AF1 (H-2a/b) recipients was 59 days on recipients treated with antilymphocyte serum and donor bone marrow cells. With adult or neonatal cotransplants, the MSTs for adult graft survival were 55 and > 100 days, respectively. Our current experiments explore the specificity of this phenomenon by substituting neonatal cotransplants of several allogeneic and partially allogeneic strains. Cotransplants that do not share the antigens presented by the adult graft to the recipient as foreign do not produce any prolongation of adult graft survival. Thus, cotransplants of adult or neonatal C57BL/6J (H-2b) or A/J (H-2a) strain skins had no significant effect on adult C3H graft survival. In contrast to these results, neonatal (but not adult) cotransplants that share presented antigens produce a significant cotransplant effect. The presence, on a recipient, of a neonatal cotransplant of CBA/J (H-2k) resulted in significant prolongation of adult skin grafts (MST > 150 days; P < 0.05). As well, on a different recipient strain (CAF1; H-2a/d), neonatal C3H-H-2o2/SfSn (H-2o2) skin cotransplants, sharing only background antigens and H-2Dk with the adult graft donor, caused a significant prolongation of adult graft survival relative to that seen on recipients bearing only a single adult graft (MSTs = 53 and 31 days; P < 0.05). Our results suggest that this graft-prolonging effect of neonatal cotransplantation requires that the cotransplant shares antigens with the adult graft that are presented as foreign to the recipient.

Aging↗
PubMed1994

Tolerogenic behavior of skin allografts from neonatal mice.

Neonatal skin allografts can be tolerogenic when transplanted to appropriately immunosuppressed hosts. Single grafts of neonatal skin survive longer than adult skin grafts when recipients are treated with antilymphocyte serum (ALS) and donor bone marrow cells (BMC). Neonatal skin grafts can also prolong the survival of adult grafts of the same donor strain simultaneously cotransplanted with the neonatal grafts. To probe the mechanisms involved in this cotransplantation phenomenon, we delayed placement of the neonatal cotransplants relative to grafting with adult skin. Neonatal allografts placed either 7-9 days or 14 days after grafting with adult skin significantly prolonged adult graft survival in mice treated with ALS and BMC. However, day 0-placed neonatal cotransplants must remain on the recipient for > 2 weeks to prolong adult graft survival. Removal of cotransplants from ALS- and BMC-treated recipients after 7 or 14 days abrogated the cotransplantation effect. If left in place until day 21, neonatal cotransplants could significantly prolong adult graft survival, but did not induce the long-term graft survival observed in approximately 50% of the recipients whose cotransplants were not removed. Cotransplant removal after 1 year did not affect subsequent adult graft survival. Additionally, cotransplants were removed from recipients either on day 14 or from long-term graft-bearing mice and retransplanted to other ALS/BMC-treated recipients. These retransplanted grafts were unable to prolong survival of adult grafts on the new recipients. After transplant, but not before transplant, cyclophosphamide treatment of recipients prevented expression of the cotransplant effect in ALS-treated mice. However, recipient splenectomy > or = 1 week before grafting did not interfere with the effect. These results reflect on the contributions of the donor tissue, and the recipients' response, to the tolerogenic signals that permit a neonatal cotransplant to prolong adult graft survival.

Animals↗
PubMed1996

Association between epidermal interleukin-10 secretion and the ability of cotransplanted skin from neonatal donors to prolong adult allograft survival.

Cotransplantation of skin from neonatal donors prolongs the survival of adult skin allografts on rabbit anti-mouse lymphocyte serum-treated and donor bone marrow cell-treated mice relative to controls (the cotransplant effect). In B6AF1 (H2a/b) recipients, cotransplants of skin from C3HeB/FeJ (C3H; H2k) neonates up to 6-7 days old prolonged the survival of adult C3H skin grafts. Skin from 9- to 10-day-old neonates was inactive. The magnitude of the cotransplant effect declined with increasing cotransplant age. Although few class II+ cells are present in skin from < 24-hr-old mice, the numbers of these cells increase rapidly after birth. On days 3-4, when the cotransplant effect is strong, their numbers in neonatal skin are greater than in adult skin. Development of class II expression continues when neonatal skin is grafted, but with an apparent 2-day lag. Because class II+ cell numbers decline in grafted adult skin, we speculate that this apparent developmental lag may be due to Langerhans cells migrating from the graft as they mature. Epidermal cells from litters of neonates were cultured overnight and supernatants were tested for interleukin (IL)-10. All 11 samples from 0- to 4-day-old neonates and 4 of 9 samples from 4- to 7-day-old neonates were positive. IL-10 was found in 1 of 9 samples from donors 8-16 days old and 1 of 7 samples from individual adult mice. Thus, there is a temporal association between the ability of neonatal skin to produce a cotransplant effect and its ability to secrete IL-10.

Age Factors↗
PubMed2004

Low maternal age and neonatal survival of extremely preterm twins (20-28 weeks of gestation).

OBJECTIVE: We investigated the relationship between low maternal age and neonatal survival among extremely preterm twins. METHODS: This was a retrospective cohort study on live births of extremely preterm twins delivered to teenaged mothers (aged 15-19 years) in the United States within the period 1995 through 1998. Overall neonatal and early and late neonatal mortality in this category was compared with that of a similar group of twins born to young adult mothers (aged 20-29 years). We used the generalized estimating equation framework in computing relative risks after adjusting for intracluster correlations. RESULTS: Analysis involved 2,290 extremely preterm liveborn twins of teenaged mothers and 8,709 born to young adult mothers. Overall, neonatal mortality was 29% higher among the extremely preterm twins born to teenaged mothers (adjusted odds ratio [OR] 1.29; 95% confidence interval [CI] 1.04%, 1.59%). The disparity in neonatal survival was chiefly in the early neonatal period (adjusted OR 1.34; 95% CI 1.07%, 1.67%), while late neonatal mortality was comparable (adjusted OR 0.91; 95% CI 0.58%, 1.42%). In addition, twins of teenaged mothers had significantly higher level of mortality, except for the birth weight category of 1,000-1,499 g. CONCLUSION: Low maternal age was found to be associated with elevated risk of neonatal death among extremely preterm twins. The preponderance of deaths among extremely preterm twins of teenaged mothers in the early neonatal period appeared to be responsible for the disparity in survival. This information may be useful for targeted interventions aimed at enhancing survival of extremely preterm twins born to teenagers, as well as for instituting optimal management options in the clinical setting. LEVEL OF EVIDENCE: II-2

Adolescent↗
PubMed2006

Survival advantage associated with cesarean delivery in very low birth weight vertex neonates.

OBJECTIVE: To identify the indications for and any survival advantage associated with very low birth weight (VLBW) neonates delivered by cesarean. METHODS: Maternal and infant data from the National Center for Health Statistics linked birth/death data set for 1999 to 2000 were analyzed. Maternal conditions associated with cesarean delivery were compared among birth weight groups for vertex neonates. Birth weight-specific 28-day mortality rates and relative risks were calculated with 95% confidence intervals. Multivariate logistic regression was performed to adjust for other factors that may be associated with survival. RESULTS: Cesarean delivery occurred frequently, more than 40% in most VLBW birth weight groups. Conditions associated with cesarean delivery in VLBW vertex neonates differed from those seen in non-VLBW vertex neonates. A survival advantage was associated with cesarean delivery in the birth weight analysis up to 1,300 g (P < .05). This decreased mortality for VLBW neonates delivered by cesarean persisted after adjusting for other factors associated with mortality. CONCLUSION: Very low birth weight vertex neonates are often born by cesarean delivery and have different maternal risk profiles from non-VLBW vertex neonates born by this route. Neonatal mortality was decreased in VLBW neonates delivered by cesarean. Further study is warranted to determine whether this may be a causal relationship or a marker of quality of care. LEVEL OF EVIDENCE: II-2.

Adult↗
PubMed2005

Simple clinical criteria to identify sepsis or pneumonia in neonates in the community needing treatment or referral.

BACKGROUND: Sepsis, meningitis and pneumonia annually kill 1.1 million neonates in developing countries; most deaths occur at home. OBJECTIVES: To develop simple clinical criteria, enabling health workers in communities to identify neonates with potentially fatal sepsis; and to identify the danger signs alerting mothers to seek care. METHODS: In a field trial in 39 villages in Gadchiroli, India, trained health workers visited all neonates at home 8 times during the first 28 days of life, recording signs and outcome without interventions during 1995-1996 and with home-based management of sick neonates during 1996-1999. An independent neonatologist assigned the cause of death. We use the term "sepsis" to include sepsis, meningitis and pneumonia. We evaluated 31 signs as predictors of 43 sepsis deaths among 3567 neonates. We also evaluated mothers' observations as the danger signs to seek care. RESULTS: Simultaneous presence of any 2 of 7 signs (reduced or stopped sucking; weak or no cry; limbs becoming limp; vomiting or abdominal distension; baby cold to touch; severe chest indrawing; umbilical infection) predicted sepsis death with sensitivity 100%, specificity 92%, positive predictive value 27.2% and negative predictive value 100% in the nonintervention period. The criteria identified 10.6% of the neonates in the community as suspected sepsis, at a mean of 5.4 days before death. The criteria remained valid in the postintervention period. Any 1 of the 5 maternally observed danger signs (reduced sucking, drowsy or unconscious, baby cold to touch, fast breathing and chest indrawing) gave 100% sensitivity and identified 23.9% neonates for seeking care. CONCLUSION: These criteria identify neonates in the community who are at risk for dying of infection with excellent sensitivity, specificity and negative predictive value but a moderate positive predictive value. They can be used by health workers to select sick neonates for treatment or referral. One potentially fatal case would be treated per 4 presumptive cases treated.

Adult↗
PubMed2006

Neonatal enterovirus infections reported to the national enterovirus surveillance system in the United States, 1983-2003.

BACKGROUND: Neonatal enterovirus (EV) infections lead to a wide range of clinical manifestations, from mild febrile illness to severe, sometimes fatal, sepsislike disease. METHODS: To determine the relationship of EV serotypes with the risk of neonatal infection and its fatal outcome, we analyzed data reported to the National Enterovirus Surveillance System (NESS) during 1983-2003. RESULTS: Of the 26,737 EV detections reported during this period, neonates accounted for 2544 (11.4% of those with known age). Serotypes most commonly isolated from neonates included echovirus (E) 11 (14.0% of EV with known serotype), coxsackievirus (CV) B2 (8.9%), CVB5 (7.5%), E6, E9 and CVB4 (6.8% each). CVB1-4, E11, and E25 were significantly more common, whereas CVA16, E4, E9, E21, E30, and human parechovirus 1 (formerly E22) were less common among neonates than among persons aged > or =1 month. Fatal outcome was noted for 3.3% of reports, with neonates at a higher risk of death than persons aged > or =1 month (11.5% versus 2.5%; odds ratio [OR] 5.1; 95% confidence interval [CI] = 3.3-7.8). Neonates infected with CVB4 were at a higher risk of death (OR 6.5; 95% CI = 2.4-17.7) than those infected with other EV. CONCLUSION: EV are important neonatal pathogens associated with high risk of infection and death. Because of the limitations of the NESS (incomplete reporting, limited clinical data, bias towards more severe and younger cases), additional studies are needed to better evaluate the role of different EV in neonatal infections.

Age Factors↗
PubMed2026

Management of neonates born to mothers with reactive serologic tests for syphilis.

PURPOSE OF REVIEW: The dramatic resurgence of maternal and congenital syphilis in the United States highlights the need for their optimal management as syphilis in pregnancy can result in substantial neonatal morbidity and mortality. This review summarizes current epidemiology and discusses guidance on the management of neonates born to mothers with reactive serologic tests for syphilis. RECENT FINDINGS: Timely communication with local health department professionals is essential for optimal management of mothers with reactive serologic tests for syphilis and their neonates. Knowledge of maternal syphilis treatment history by partnering with local jurisdictions can circumvent much of the incertitude surrounding neonatal management. All neonates born to mothers with reactive serologic tests for syphilis should be tested using a nontreponemal ('lipoidal antigen') test. However, a reactive test may only indicate maternal nontreponemal IgG antibodies that are transferred transplacentally to the fetus. Therefore, neonatal management depends on maternal history and treatment for syphilis as well as clinical, laboratory, and radiographic findings in the neonatal evaluation. Existing management algorithms are complex, highlighting the need for a more practical, yet safe, approach. SUMMARY: A neonatal management guideline is proposed that may simplify the management of neonates born to mothers with reactive serologic tests for syphilis while advocating for expanded use of single-dose benzathine penicillin G therapy.

Humans↗