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Neonates
Kinds of Neonates Terms modified by Neonates Selected AbstractsA NOVEL WAY TO DIAGNOSE CYSTIC FIBROSIS IN THE NEONATE WITH A BOWEL OBSTRUCTION AND POSSIBLE MECONIUM ILEUSJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 9 2003V Sung No abstract is available for this article. [source] LONG-DISTANCE MOVEMENT OF A PINNIPED NEONATEMARINE MAMMAL SCIENCE, Issue 4 2007Julie K. Young First page of article [source] MMP-2 contributes to the development of the mouse ventral prostate by impacting epithelial growth and morphogenesisDEVELOPMENTAL DYNAMICS, Issue 9 2010Alexandre Bruni-Cardoso Abstract Epithelial growth, branching, and canalization are important morphogenetic events of the rodent ventral prostate (VP) that take place during the first postnatal week. In this study, we evaluated the effect of knocking out MMP-2 (MMP-2,/,), by examining developmental and structural aspects of the VP in MMP-2,/, mice. Neonate (day 6) MMP-2,/, mice showed fewer epithelial tips, a lower epithelial cell proliferation rate, and also reticulin fiber accumulation. The VP of adult MMP-2,/, mice showed lower relative weight, smaller epithelial and smooth-muscle cell volume, and a larger amount of thicker reticulin fibers. No differences in cell proliferation or apoptotic index were noted between adult MMP-2,/, and wild-type mice. MMP-9 was found in the adult MMP-2,/,, but not in the wild-type. In conclusion, MMP-2 function is essential for the epithelial morphogenesis of the mouse VP, and expression of MMP-9 is not sufficient for acquisition of the normal adult histology. Developmental Dynamics 239:2386,2392, 2010. © 2010 Wiley-Liss, Inc. [source] Lamotrigine in Pregnancy: Pharmacokinetics During Delivery, in the Neonate, and During LactationEPILEPSIA, Issue 6 2000Inger Ohman Summary: Purpose: To investigate the pharmacokinetics of lamotrigine (LTG) during delivery, during the neonatal period, and lactation. Methods: High-performance liquid chromatography was used to determine plasma and milk levels of LTG in nine pregnant women with epilepsy treated with LTG, and plasma levels in their 10 infants. Samples were obtained at delivery, the first 3 days postpartum, and at breast-feeding 2,3 weeks after delivery. Results: At delivery, maternal plasma LTG concentrations were similar to those from the umbilical cord, indicating extensive placental transfer of LTG. There was a slow decline in the LTG plasma concentration in the newborn. At 72 h postpartum, median LTG plasma levels in the infants were 75% of the cord plasma levels (range, 50,100%). The median milk/maternal plasma concentration ratio was 0.61 (range, 0.47,0.77) 2,3 weeks after delivery, and the nursed infants maintained LTG plasma concentrations of ,30% (median, range 23,50%) of the mother's plasma levels. Maternal plasma LTG concentrations increased significantly during the first 2 weeks after parturition, the median increase in plasma concentration/dose ratio being 170%. Conclusions: Our data demonstrate a marked change in maternal LTG kinetics after delivery, possibly reflecting a normalization of an induced metabolism of LTG during pregnancy. LTG is excreted in considerable amounts in breast milk (the dose to the infant can be estimated to 0.2,1 mg/kg/day 2,3 weeks postpartum), which in combination with a slow elimination in the infants, may result in LTG plasma concentrations comparable to what is reported during active LTG therapy. No adverse effects were observed in the infants, however. [source] The influence of common gene variants of the xenobiotic receptor (PXR) in genetic susceptibility to intrahepatic cholestasis of pregnancyALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 5 2010G. CASTAÑO Aliment Pharmacol Ther,31, 583,592 Summary Background, The xenobiotic nuclear pregnane X receptor is implicated in many physiological pathways and diseases, including bile acid detoxification and cholestasis. Aim, To estimate the contribution of common gene variants of the xenobiotic receptor (pregnane X receptor, PXR) to genetic susceptibility to intrahepatic cholestasis of pregnancy. Methods, A total of 101 intrahepatic cholestasis of pregnancy patients and 171 healthy pregnant women in the third trimester of their pregnancies were included. Four tag single nucleotide polymorphisms (SNPs) (rs12488820 C/T, rs2472671 C/T, rs2461823 A/G, and rs1054191 A/G) encompassing 36 kb in chromosome 3, with a minor allele frequency ,0.10 and representing 33 polymorphic sites were genotyped. Besides these, three additional SNPs (rs3814057, rs6785049, and rs7643645) were included because they showed previous evidence of functionality. Results, Genotypic test for single SNPs showed that rs2461823 genotypes were significantly associated with intrahepatic cholestasis of pregnancy (P < 0.0069), OR per G allele: 1.44, 95% CI: 1.01,2.05, P < 0.042. The Cochran-Armitage test for trend and the allelic test showed a significant association with disease status (P < 0.04 and 0.03 respectively), G being the risk allele. A positive association between rs2461823 and ALT, AST, and bilirubin concentrations was observed. Neonate birth weight adjusted by the Capurro index was significantly associated with rs2461823 (P < 0.05); the proportion of the total variation attributed to rs2461823 genotypes was 7.8%. Conclusion, Common PXR polymorphisms may contribute to the genetic susceptibility to intrahepatic cholestasis of pregnancy. [source] Arrhythmias from Neonate to Adult, Part IIPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2008Freek Van Den Heuvel M.D., Ph.D. No abstract is available for this article. [source] Approach to procedures in neonatesDERMATOLOGIC THERAPY, Issue 2 2005Valerie B. Lyon ABSTRACT:, Physical constraints and metabolic differences in neonates require that special attention is given to performing procedures in this patient group. Neonates have a thinner dermis and a greater surface-to-weight ratio, allowing for easier invasion through the skin barrier. The enzymes for metabolism of agents and defense against organisms inside the body are not fully developed in infants. Very premature neonates also have less circulating albumin, making the effective concentration of circulating agent even greater. The infant is prone to unanticipated movement during procedures, such as rolling on the procedure table. The neonatal period is the most common time period for malformations to become manifest on the skin, and invasion of some of these lesions can produce morbidity. These and other factors affect the choice of the type of procedure used, the timing for intervention, and the approach to intervention in this age group. This article reviews the important considerations for approaching procedures and offers suggestions for safe and effective methods of reliably producing the intended outcome. [source] Management issues for women with epilepsy,Focus on pregnancy (an evidence-based review): II.EPILEPSIA, Issue 5 2009Teratogenesis, perinatal outcomes Summary A committee assembled by the American Academy of Neurology (AAN) reassessed the evidence related to the care of women with epilepsy (WWE) during pregnancy, including antiepileptic drug (AED) teratogenicity and adverse perinatal outcomes. It is highly probable that intrauterine first-trimester valproate (VPA) exposure has higher risk of major congenital malformations (MCMs) compared to carbamazepine (CBZ), and possibly compared to phenytoin (PHT) or lamotrigine (LTG). It is probable that VPA as part of polytherapy and possible that VPA as monotherapy contribute to the development of MCMs. AED polytherapy probably contributes to the development of MCMs and reduced cognitive outcomes compared to monotherapy. Intrauterine exposure to VPA monotherapy probably reduces cognitive outcomes and monotherapy exposure to PHT or phenobarbital (PB) possibly reduces cognitive outcomes. Neonates of WWE taking AEDs probably have an increased risk of being small for gestational age and possibly have an increased risk of a 1-minute Apgar score of <7. If possible, avoidance of VPA and AED polytherapy during the first trimester of pregnancy should be considered to decrease the risk of MCMs. If possible, avoidance of VPA and AED polytherapy throughout pregnancy should be considered and avoidance of PHT and PB throughout pregnancy may be considered to prevent reduced cognitive outcomes. [source] Do ,Quiet' Places Make Animals Placid?ETHOLOGY, Issue 6 2005Island vs. Most animals that possess potent venom display a wide variety of warning messages to discourage predators. Tiger snakes are large and highly venomous elapids that exhibit these anti-predator behaviours. We compared the anti-predator behaviours of two neighbouring and genetically indistinguishable populations in Western Australia (Herdsman Lake, HL and Carnac Island, CI). CI is free from human, native and feral predation. All of these factors represent a continual threat on HL situated on the mainland. Neither body size, nor sex influenced defensive behaviours. However, we observed a marked inter-population difference among adults in the degree to which anti-predator behaviours were displayed when snakes were continually aggravated: HL snakes exhibited a typical warning signal (flat-neck) and bite, while CI snakes remained very docile. In stark contrast, neonates of both populations exhibited marked anti-predator behaviours and both populations were indistinguishable in terms of the intensity of display. Neonates reared in captivity, hence regularly confronted by human predators, became more defensive in comparison with neonates exposed to natural conditions on CI; similarly several adult CI snakes kept in captivity became more defensive. Our results highlight the extreme behavioural plasticity of snakes. We also hypothesize that CI snakes may become more placid over time as they grow up in an environment free from predation. [source] Impact of inter-individual differences in drug metabolism and pharmacokinetics on safety evaluationFUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 6 2004J.L.C.M. Dorne Abstract Safety evaluation aims to assess the dose,response relationship to determine a dose/level of exposure for food contaminants below which no deleterious effect is measurable that is ,without appreciable health risk' when consumed daily over a lifetime. These safe levels, such as the acceptable daily intake (ADI) have been derived from animal studies using surrogates for the threshold such as the no-observed-adverse-effect-level (NOAEL). The extrapolation from the NOAEL to the human safe intake uses a 100-fold uncertainty factor, defined as the product of two 10-fold factors allowing for human variability and interspecies differences. The 10-fold factor for human variability has been further subdivided into two factors of 100.5 (3.16) to cover toxicokinetics and toxicodynamics and this subdivsion allows for the replacement of an uncertainty factor with a chemical-specific adjustment factor (CSAF) when compound-specific data are available. Recently, an analysis of human variability in pharmacokinetics for phase I metabolism (CYP1A2, CYP2A6, CYP2C9, CYP2C19, CYP2D6, CYP2E1, CYP3A4, hydrolysis, alcohol dehydrogenase), phase II metabolism (N-acetyltransferase, glucuronidation, glycine conjugation, sulphation) and renal excretion was used to derive pathway-related uncertainty factors in subgroups of the human population (healthy adults, effects of ethnicity and age). Overall, the pathway-related uncertainty factors (99th centile) were above the toxicokinetic uncertainty factor for healthy adults exposed to xenobiotics handled by polymorphic metabolic pathways (and assuming the parent compound was the proximate toxicant) such as CYP2D6 poor metabolizers (26), CYP2C19 poor metabolizers (52) and NAT-2 slow acetylators (5.2). Neonates were the most susceptible subgroup of the population for pathways with available data [CYP1A2 and glucuronidation (12), CYP3A4 (14), glycine conjugation (28)]. Data for polymorphic pathways were not available in neonates but uncertainty factors of up to 45 and 9 would allow for the variability observed in children for CYP2D6 and CYP2C19 metabolism, respectively. This review presents an overview on the history of uncertainty factors, the main conclusions drawn from the analysis of inter-individual differences in metabolism and pharmacokinetics, the development of pathway-related uncertainty factors and their use in chemical risk assessment. [source] Developmental toxicity of UV filters and environmental exposure: a reviewINTERNATIONAL JOURNAL OF ANDROLOGY, Issue 2 2008Margret Schlumpf Summary Several ultraviolet (UV) filters exhibit estrogenic, some also anti-androgenic activity. They are present in waste water treatment plants, surface waters and biosphere including human milk, suggesting potential exposure during development. Developmental toxicity was studied in rats for the UV filters 4-methylbenzylidene camphor (4-MBC, 0.7, 7, 24, 47 mg/kg/day) and 3-benzylidene camphor (3-BC, 0.07, 0.24, 0.7, 2.4, 7 mg/kg/day) administered in chow to the parent generation before mating, during pregnancy and lactation, and to the offspring until adulthood. Neonates exhibited enhanced prostate growth after 4-MBC and altered uterine gene expression after both chemicals. 4-MBC and 3-BC delayed male puberty and affected reproductive organ weights of adult offspring. Effects on the thyroid axis were also noted. Expression and oestrogen sensitivity of oestrogen-regulated genes and nuclear receptor coregulator levels were altered at mRNA and protein levels in adult uterus, prostate and brain regions involved in gonadal control and sexual behaviour. Female sexual behaviour was impaired by both filters; 3-benzylidene camphor caused irregular cycles. Classical endpoints exhibited lowest observed adverse effect levels (LOAELs) and no observed adverse effect levels (NOAELs) of 7/0.7 mg/kg for 4-MBC and 0.24/0.07 mg/kg for 3-BC. Molecular endpoints were affected by the lowest doses studied. Our data indicate that the potential risk posed by endocrine active UV filters warrants further investigations. [source] Baseline susceptibility of western corn rootworm (Coleoptera: Chrysomelidae) to clothianidinJOURNAL OF APPLIED ENTOMOLOGY, Issue 4 2007L. C. Magalhaes Abstract:, Western corn rootworm, Diabrotica virgifera virgifera LeConte, neonate susceptibility to clothianidin, a contact and systemic neonicotinoid insecticide, was determined from both laboratory and field-collected populations. Neonates were exposed to filter paper treated with increasing clothianidin concentrations and mortality was evaluated after 24 h. Additionally, two populations were exposed to an artificial diet which was surface treated with clothianidin. Although larvae were five- to six-fold more sensitive to treated diet, results with treated filter paper were more reliable in terms of control mortality and required much less manipulation of rootworm larvae. Therefore, initial baseline comparisons were conducted using the filter paper assays. The variation among populations exposed to treated filter paper was generally low, 4.4-fold among laboratory populations tested; however, there was a 14.5-fold difference in susceptibility among all populations tested. In general, clothianidin was very toxic to rootworm neonates, with LC50 values ranging from 1.5 to 21.9 ng/cm2. These results indicate the practicability and sensitivity of the paper filter disc assay to establish baseline susceptibility levels, which is an essential first step in resistance management. A baseline response provides a reference for tracking shifts in susceptibility following commercialization of a control agent so that early changes in susceptibility can be detected. [source] Critical analysis of potential body temperature confounders on neurochemical endpoints caused by direct dosing and maternal separation in neonatal mice: a study of bioallethrin and deltamethrin interactions with temperature on brain muscarinic receptorsJOURNAL OF APPLIED TOXICOLOGY, Issue 1 2003Jürgen Pauluhn Abstract The present investigation was conducted to understand better possible confounding factors caused by direct dosing of neonatal mice during the pre-weaning developmental period. By direct dosing, pups might encounter thermal challenges when temporarily removed from their ,natural habitat'. Typically, this leads to a cold environment and food deprivation (impaired lactation) and modulation of the toxic potency of the substance administered. Growth retardation as a consequence of such behavioural changes in pups makes it increasingly difficult to differentiate specific from non-specific mechanisms. Neonatal NMRI mice were dosed daily by gavage (0.7 mg kg,1 body wt.) from postnatal day (PND) 10,16 with S -bioallethrin, deltamethrin or the vehicle. Then the pups, including their non-treated foster dams, were subjected temporarily for 6 h day to a hypo-, normo- or hyperthermic environment, which was followed by normal housing. The measured temperatures in the environmental chambers were ca. 21, 25 and 30°C, respectively. Thus, temperatures in the hypo- and normothermic groups are comparable to the temperatures commonly present in testing laboratories, whereas the hyperthermic condition is that temperature typically present in the ,natural habitat' of pups. A deviation from the normal behaviour of both pups and dams was observed in the hypo- and normothermic groups. In these groups the rectal temperatures of pups were markedly decreased, especially in the early phase of the study (PND 10,12). Neonates that received either test substance displayed changes in body weights and brain weights at terminal sacrifice (PND 17) when subjected temporarily to a non-physiological environment. An enormous influence of environmental temperature on the density of muscarinic receptors in the crude synaptosomal fraction of the cerebral cortex was ascertained. In summary, these results demonstrate that the direct dosing of thermolabile neonatal mice by gavage is subject to significant artefacts that render the interpretation of findings from such studies difficult. It appears that if direct dosing of neonatal pups is mandated, and inhalation is a relevant route of exposure, the combined inhalation exposure of dams with their litters is an alternative procedure that does not cause disruption of the ,natural habitat' of pups. However, owing to their higher ventilation, under such conditions the pups may receive dosages at least double those of the dams. Copyright © 2003 John Wiley & Sons, Ltd. [source] TRANSPLANTATION AND MECHANICAL SUPPORT Original Articles: Heart Transplantation Techniques after Hybrid Single-Ventricle PalliationJOURNAL OF CARDIAC SURGERY, Issue 5 2010Vinod A. Sebastian M.D. The hybrid palliative strategy of pulmonary artery banding and ductal stenting has emerged as an alternative treatment for neonates with HLHS. Neonates who have undergone a hybrid Norwood but are not candidates for the three-stage single-ventricle pathway may need heart transplantation. Patients who have undergone hybrid Norwood or those with visceral heterotaxy who have undergone ductal stenting and bilateral PA bands represent a technically challenging group of patients for heart transplantation, but it appears to be a favorable approach and we describe our experience with three patients who underwent heart transplant after a hybrid Norwood procedure. (J Card Surg 2010;25:596-600) [source] Biochemical and white blood cell profiles of baboon neonates consuming formulas with moderate and high dietary long-chain polyunsaturated fatty acidsJOURNAL OF MEDICAL PRIMATOLOGY, Issue 2 2008A.T. Hsieh Abstract Background, Clinical chemistry and complete blood count (CBC) values were determined in 14 term baboons (Papio species) consuming formula with moderate or high levels of dietary long-chain polyunsaturated fatty acids (LCPUFA) from 2,12 weeks of age. Method, Neonates were randomized to three groups: C: Control, no LCPUFA; L: 0.33% docosahexaenoic acid (DHA)/0.67% arachidonic acid (ARA) (w/w); L3:1.00% DHA/0.67% ARA (w/w). Blood chemistries were assessed at 6 and 12 weeks and CBC parameters were measured at 2, 4, 8, 10, 12 weeks of age. Results, Dietary LCPUFA had significant effects on serum triglyceride (C > L,L3) and calcium (L > C,L3). No other significant effects of diet were detected; pooled values are presented for all other parameters. Conclusion, These data provide longitudinal biochemical and white cell/platelet/immunological data on LCPUFA-fed baboons over the first 12 weeks of life. Data ranges are similar to reference data in cases for which values exist and hematological changes reflect trends observed during human neonatal development. [source] A Review of Psychometric Properties of Feeding Assessment Tools Used in NeonatesJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 3 2008Tsu-Hsin Howe ABSTRACT Objective:, To appraise the psychometric properties of clinical feeding assessment tools used in a neonatal population. Data sources:, PubMed, OvidMedline, CINHAL, and PsycINFO databases from 1980 to 2007. Reference lists of all identified articles were also reviewed. Study selection:, Research reports written in English that utilized or validated clinical feeding assessment tools. Data extraction:, In total, 941 articles were reviewed. Seven neonatal clinical feeding assessment tools were identified and categorized into three groups: tools used for assessing either bottle-feeding or breastfeeding behaviors, tools used only for assessing bottle-feeding behaviors, and tools used only for assessing breastfeeding behaviors. Results:, The psychometric properties of none of the seven assessment tools identified were satisfactory, and the limited representativeness of the samples of the psychometric research was noted in all assessment tools identified. The Neonatal Oral-Motor Assessment Scale appeared to have been examined more thoroughly and showed more consistent results in psychometric properties than the others, despite its own limitations. Conclusions:, A psychometrically sound neonate feeding assessment tool has not yet been empirically validated. Clinicians who use these tools for clinical and research purposes should take into account this lack of evidence of psychometric soundness and interpret results of assessment with precautions. Well-designed research is needed to study the scientific integrity of these instruments for program evaluations in neonatal care. [source] Smoking Cessation Counseling for Pregnant Women Who Smoke: Scientific Basis for Practice for AWHONN's SUCCESS ProjectJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 3 2004FAAN, Susan A. Albrecht PhD Objectives: To review the literature addressing smoking cessation in pregnant women. To develop the project protocol for the Association of Women's Health, Obstetric and Neonatal Nurse's (AWHONN) 6th research-based practice project titled "Setting Universal Cessation Counseling, Education and Screening Standards (SUCCESS): Nursing Care of Pregnant Women Who Smoke." To evaluate the potential of systematic integration of this protocol in primary care settings in which women seek care at the preconception, pregnant, or postpartum stages. Literature Sources: Computerized searches in MEDLINE and CINAHL, as well as references cited in articles reviewed. Key concepts in the searches included low-birth-weight infants and effects of prenatal smoking on the infant and the effects of preconception and prenatal smoking cessation intervention on premature labor and birth weight. Literature Selection: Comprehensive articles, reports, and guidelines relevant to key concepts and published after 1964 with an emphasis on new findings from 1996 through 2002. Ninety-eight citations were identified as useful to this review. Literature Synthesis: Tobacco use among pregnant women and children's exposure to tobacco use (secondhand smoke) are associated with pregnancy complications such as placental dysfunction (including previa or abruption), preterm labor, premature rupture of membranes, spontaneous abortions, and decreased birth weight and infant stature. Neonates and children who are exposed to secondhand smoke are at increased risk for developing otitis media, asthma, other respiratory disorders later in childhood; dying from sudden infant death syndrome; and learning disorders. The "5 A's" intervention and use of descriptive statements for smoking status assessment were synthesized into the SUCCESS project protocol for AWHONN's 6th research-based practice project. Conclusions: The literature review generated evidence that brief, office-based assessment, client-specific tobacco counseling, skill development, and support programs serve as an effective practice guideline for clinicians. Implementation and evaluation of the guideline is under way at a total of 13 sites in the United States and Canada. [source] Use of Record Linkage to Examine Alcohol Use in PregnancyALCOHOLISM, Issue 4 2006Lucy Burns Background: To date, no population-level data have been published examining the obstetric and neonatal outcomes for women with an alcohol-related hospital admission during pregnancy compared with the general obstetric population. This information is critical to planning and implementing appropriate services. Methods: Antenatal and delivery admissions to New South Wales (NSW) hospitals from the NSW Inpatient Statistics Collection were linked to birth information from the NSW Midwives Data Collection over a 5-year period (1998,2002). Birth admissions were flagged as positive for maternal alcohol use where a birth admission or any pregnancy admission for that birth involved an alcohol-related International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10-AM) code. Key demographic, obstetric, and neonatal variables were compared for births to mothers in the alcohol group with births where no alcohol-related ICD10-AM was recorded. Results: A total of 416,834 birth records were analyzed over a 5-year period (1998,2002). In this time, 342 of these were coded as positive for at least 1 alcohol-related ICD-10-AM diagnosis. Mothers in the alcohol group had a higher number of previous pregnancies, smoked more heavily, were not privately insured, and were more often indigenous. They also presented later on in their pregnancy to antenatal services and were more likely to arrive at hospital unbooked for delivery. Deliveries involved less epidural and local and more general anesthesia. Cesarean sections were more common to women in the alcohol group and were performed more often for intrauterine growth retardation. Neonates born to women in the alcohol group were smaller for gestational age, had lower Apgar scores at 5 minutes, and were admitted to special care nursery more often. Conclusions: This study shows that linked population-level administrative data provide a powerful new source of information for examining the maternal and neonatal outcomes associated with alcohol use in pregnancy. [source] Maternal Anesthesia: What are the Effects on Neonates?NURSING FOR WOMENS HEALTH, Issue 5 2007Kathleen Courtney MSN First page of article [source] Parenteral Nutrition,associated Cholestasis in Neonates: The Role of AluminumNUTRITION REVIEWS, Issue 9 2003Chris J. Arnold RD Parenteral nutrition (PN) is an essential component in the care of premature and ill infants. The incidence of parenteral nutrition,associated cholestasis (PNAC) ranges from 7.4 to 84%. One substance in PN solutions that has been implicated in PNAC is aluminum. Aluminum loading in animals and humans causes hepatic accumulation and damage. The degree of aluminum contamination of PN solutions has decreased over time, but contamination still significantly exceeds levels that are safe for human neonates. Further study into the relationship between aluminum contamination in neonatal PN solutions and the development of PNAC is necessary. [source] A randomized, controlled trial of aprotinin in neonates undergoing open-heart surgeryPEDIATRIC ANESTHESIA, Issue 9 2008GLYN D. WILLIAMS MBChB Summary Background:, Neonates undergoing open-heart surgery are especially at risk for massive bleeding and pronounced inflammation. The efficacy of aprotinin, a serine protease inhibitor, at ameliorating these adverse effects of cardiopulmonary bypass has not been clearly demonstrated in neonates. Methods:, Term neonates were enrolled and randomly assigned in a blinded fashion to receive saline (group P, placebo) or high-dose aprotinin (group A). Intraoperative management was standardized: surgeon, anesthesia, cardiopulmonary bypass and hemostasis therapy. Patients were admitted postoperatively to a pediatric cardiac intensive care unit. Primary outcome measure of efficacy was duration of the postoperative mechanical ventilation. Secondary outcome measures were total volume and units of blood products transfused intraoperatively and for 24 h after surgery, duration of chest tube in situ, and intensive care and hospital stays after surgery. Results:, Twenty-six neonates were enrolled; 13 received aprotinin and 13 received placebo. The study was halted prematurely because of US Food and Drug Administation's concerns about aprotinin's safety. Baseline patient, surgery and cardiopulmonary bypass characteristics were similar between groups. No outcome variables differed between groups (P > 0.05). Duration of postoperative ventilation was 115 ± 139 h (group A); 126 ± 82 h (group P); P = 0.29, and total blood product exposure was 8.2 ± 2.6 U (group A); 8.8 ± 1.4 U (group P); P = 0.1. Postoperative blood creatinine values did not differ between groups. In-hospital mortality rate was 4%. Conclusions:, Aprotinin was not shown to be efficacious in neonates undergoing open-heart surgery. It is unclear whether adult aprotinin safety data are relevant to neonates undergoing open-heart surgery. [source] Prevalence of Cutaneous Findings in Hospitalized Neonates: A Prospective Observational StudyPEDIATRIC DERMATOLOGY, Issue 2 2009Ayten Ferahbas M.D. Methods:, All of newborn infants hospitalized in the Newborn Unit of Erciyes University Medical School Hospital in Central Anatolia, Turkey from February 1 to November 30, 2003, were included prospectively in the study. A questionnaire regarding maternal gestational history, maternal and family history was administered to the parents of each child. All skin lesions were recorded and mapped on a body chart. Results:, Of the 816 newborns, parents of 650 gave informed consent. Only 28 (4.3%) of the infants had no dermatologic examination findings. The most common 10 diagnoses were: xerosis/desquamation 257 (39.5%), sebaceous hyperplasia 207 (31.8%), transient toxic erythema 201 (30.9%), salmon patch 125 (19.2%), Mongolian spot 86 (13.2%), cutis marmorata 69 (10.6%), suction bulla 67 (10.3%), miliaria 55 (8.5%), hypertrichosis 51 (7.8%), and dermatitis (irritant, seborrheic, or diaper) 14 (2.1%). Conclusions:, This study confirms that skin changes in the newborn are common, particularly desquamation, sebaceous hyperplasia, and transient toxic erythema. [source] Lung Function Tests in Neonates and Infants with Chronic Lung Disease: Forced Expiratory ManeuversPEDIATRIC PULMONOLOGY, Issue 3 2006Sooky Lum PhD Abstract This fourth paper in a review series on the role of lung function testing in infants and young children with acute neonatal disorders and chronic lung disease of infancy (CLDI) addresses measurements of forced expiration using rapid thoraco-abdominal compression (RTC) techniques and the forced deflation technique. Following orientation of the reader to the subject area, we focus our comments on the areas of inquiry proposed in the introductory paper to this series. The quality of the published literature is reviewed critically, and recommendations are provided to guide future investigation in this field. All studies on infants and young children with CLDI using forced expiratory or deflation maneuvers demonstrated that forced flows at low lung volume remain persistently low through the first 3 years of life. Measurement of maximal flow at functional residual capacity (V,maxFRC) is the most commonly used method for assessing airway function in infants, but is highly dependent on lung volume and airway tone. Recent studies suggested that the raised volume RTC technique, which assesses lung function over an extended volume range as in older children, may be a more sensitive means of discriminating changes in airway function in infants with respiratory disease. The forced deflation technique allows investigation of pulmonary function during the early development of CLDI in intubated subjects, but its invasive nature precludes its use in the routine setting. For all techniques, there is an urgent need to establish suitable reference data and evaluate within- and between-occasion repeatability, prior to establishing the clinical usefulness of these techniques in assessing baseline airway function and/or response to interventions in subjects with CLDI. Pediatr Pulmonol. © 2005 Wiley-Liss, Inc. [source] Lung Function Tests in Neonates and Infants with Chronic Lung Disease: Global and Regional Ventilation InhomogeneityPEDIATRIC PULMONOLOGY, Issue 2 2006J. Jane Pillow FRACP Abstract This review considers measurement of global and regional ventilation inhomogeneity (VI) in infants and young children with acute neonatal respiratory disorders and chronic lung disease of infancy (CLDI). We focus primarily on multiple-breath inert gas washout (MBW) and electrical impedance tomography (EIT). The literature is critically reviewed and the relevant methods, equipment, and studies are summarized, including the limitations and strengths of individual techniques, together with the availability and appropriateness of any reference data. There has been a recent resurgence of interest in using MBW to monitor lung function within individuals and between different groups. In the mechanically ventilated, sedated, and paralyzed patient, VI indices can identify serial changes occurring following exogenous surfactant. Similarly, global VI indices appear to be increased in infants with CLDI and to differentiate between infants without lung disease and those with mild, moderate, and severe lung disease following preterm birth. While EIT is a relatively new technique, recent studies suggest that it is feasible in newborn infants, and can quantitatively identify changes in regional lung ventilation following alterations to ventilator settings, positive end expiratory pressure (PEEP), and administration of treatments such as surfactant. As such, EIT represents one of the more exciting prospects for continuous bedside pulmonary monitoring. For both techniques, there is an urgent need to establish guidelines regarding data collection, analysis, and interpretation in infants both with and without CLDI. © 2005 Wiley-Liss, Inc. [source] Lung Function Tests in Neonates and Infants with Chronic Lung Disease of Infancy: Functional Residual CapacityPEDIATRIC PULMONOLOGY, Issue 1 2006Georg Hülskamp MD Abstract This is the second paper in a review series that will summarize available data and discuss the potential role of lung function testing in infants and young children with acute neonatal respiratory disorders and chronic lung disease of infancy. The current paper addresses the expansive subject of measurements of lung volume using plethysmography and gas dilution/washout techniques. Following orientation of the reader to the subject area, we focus our comments on areas of inquiry proposed in the introductory paper to this series. The quality of the published literature is reviewed critically, and recommendations are provided to guide future investigation in this field. Measurements of lung volume are important both for assessing growth and development of lungs in health and disease, and for interpreting volume-dependent lung function parameters such as respiratory compliance, resistance, forced expiratory flows, and indices of gas-mixing efficiency. Acute neonatal lung disease is characterized by severely reduced functional residual capacity (FRC), with treatments aimed at securing optimal lung recruitment. While FRC may remain reduced in established chronic lung disease of infancy, more commonly it becomes normalized or even elevated due to hyperinflation, with or without gas-trapping, secondary to airway obstruction. Ideally, accurate and reliable bedside measurements of FRC would be feasible from birth, throughout all phases of postnatal care (including assisted ventilation), and during subsequent long-term follow-up. Although lung volume measurements in extremely preterm infants were described in a research environment, resolution of several issues is required before such investigations can be translated into routine clinical monitoring. Pediatr Pulmonol. © 2005 Wiley-Liss, Inc. [source] Neonates with severe infantile hepatic hemangioendothelioma: Limitations of liver transplantationPEDIATRIC TRANSPLANTATION, Issue 5 2009Enke Grabhorn Abstract:, IHHE as the most common vascular tumor of the liver in infancy can present with acute postnatal liver and congestive heart failure. LTx may be a lifesaving option, but can be complicated by extrahepatic involvement and bleeding complications, especially in neonates. Here we discuss the benefit of LTx in cases of acute postnatal deterioration and massive extent of the hepatic tumor. Three infants with IHHE were transplanted at our institution between 2005 and 2007. Two were neonates with acute postnatal decompensation and progressive liver and heart failure within days. Treatment with steroids and chemotherapy was ineffective; resection surgery and interventional treatment were not considered appropriate. LTx was performed at the age of 7 and 24 days, respectively. An additional infant with a bilobar tumor that evolved more slowly was transplanted on day-of-life 56. Patients 1 and 2 had to be resuscitated during the LTx procedure because of massive bleeding and both died during the procedure. Patient 3 had a complicated post-operative course but is doing well one-yr post-LTx. Neonates with extended hepatic and extrahepatic involvement of IHHE should be evaluated carefully prior to LTx. Whenever possible, alternative interventional treatment options should be considered. [source] Thrombin activatable fibrinolysis inhibitor activity, thrombin-antithrombin complex and D-dimer levels in preterm neonates with early respiratory distress syndromeAMERICAN JOURNAL OF HEMATOLOGY, Issue 1 2008Tugba Gursoy Intraalveolar fibrin deposition found in neonates with respiratory distress syndrome (RDS) is explained by the activation of the coagulation system and inefficient fibrinolysis. However, thrombin activatable fibrinolysis inhibitor activity (TAFIa), an inhibitor of fibrinolysis, and the ratio of D-dimer to thrombin,antithrombin complex (D-dimer/TAT), an index of fibrinolytic activity, have not been reported previously in neonatal RDS. Aim of this study is to evaluate the influence of plasma TAFIa levels on the fibrinolytic state in neonatal RDS. The RDS group (Group 1) consisted of 29 neonates, and 18 neonates served as the control group (Group 2). Plasma TAFIa levels and D-dimer/TAT ratios were evaluated in all neonates in the first 6 hr of life. Neonates in the RDS group were further divided into two subgroups; Group 1a consisted of 12 neonates with evidence of mild asphyxia (Apgar score at 5 min <7 and cord pH <7.26), and Group 1b consisted of 17 nonasphyxiated neonates. No significant difference was found in TAFIa levels and D-dimer/TAT ratios between Groups 1 and 2 [214% (56.2,361%) and 124.3 (4.4,3,921) in Group 1 and 201% (60.3,381%) and 147 (5.9,1,426) in Group 2]. There were negative correlations between cord pH and TAFIa levels in both groups. Increased TAFIa levels and decreased D-dimer/TAT ratios and platelet counts were detected in mildly asphyxiated neonates when compared with nonasphyxiated ones. TAFIa is not responsible for the hypofibrinolytic state reported in RDS. However, asphyxia influences TAFIa levels and increased TAFIa levels depress fibrinolysis. Am. J. Hematol., 2008. © 2007 Wiley-Liss, Inc. [source] Distribution and Quantity of Contractile Tissue in Postnatal Development of Rat Alveolar InterstitiumTHE ANATOMICAL RECORD : ADVANCES IN INTEGRATIVE ANATOMY AND EVOLUTIONARY BIOLOGY, Issue 1 2008Renée Dickie Abstract Alpha,smooth muscle actin (,-SMA) -expressing cells are important participants in lung remodeling, during both normal postnatal ontogeny and after injury. Developmental dysregulation of these contractile cells contributes to bronchopulmonary dysplasia in newborns, and aberrant recapitulation in adults of the normal ontogeny of these cells has been speculated to underlie disease and repair in mature lungs. The significance of airway smooth muscle has been widely investigated, but contractile elements within the pulmonary parenchyma, although also of structural and functional consequence in developing and mature lungs, are relatively unstudied and little quantitative information exists. Here, we quantify the areal density of ,-SMA expression in lung parenchyma and assess changes in its spatiotemporal distribution through postnatal ontogeny. Using an antibody against ,-SMA, we immunofluorescently labeled contractile elements in lung sections from a postnatal growth series of rats. Images were segmented using thresholded pixel intensity. Alpha-SMA areal density in the alveolar interstitium was calculated by dividing the area of ,-SMA,positive staining by the tissue area. The areal density of ,-SMA in 2-day neonates was 3.7%, almost doubled, to 7.2% by 21 days, and decreased to 3% in adults. Neonates had large, elongate concentrations of ,-SMA, and ,-SMA localized both at septal tips and within the interstitium. In adults, individual areas of ,-SMA expression were smaller and more round, and located predominately in alveolar ducts, at alveolar ends and bends. The results are consistent with increasing ,-SMA expression during the period of peak myofibroblast activity, corresponding to the phase of rapid alveolarization in the developing lung. Anat Rec, 291:83,93, 2007. © 2007 Wiley-Liss, Inc. [source] Remifentanil in paediatric anaesthetic practiceANAESTHESIA, Issue 3 2009D. F. Marsh Summary Remifentanil is a synthetic opioid, first introduced into clinical practice in 1996. Its unique pharmacokinetic profile has resulted in a gradual increase in its popularity in paediatric anaesthesia. It is an opioid of high potency and rapid clearance, consequently lacking problems of accumulation. These characteristics give it a high degree of predictability and it has become an attractive choice for a wide variety of anaesthetic challenges, from premature neonates to the elderly. Neonates and infants have a higher clearance than older children and, as a result, remifentanil has additional benefits in this group. Remifentanil can be described as the only consistently predictable opioid in paediatric practice. [source] Anticoagulants in pediatric cerebral sinovenous thrombosis: A safety and outcome studyANNALS OF NEUROLOGY, Issue 5 2010Mahendranath D. Moharir MBBS Objective Clinical trials are lacking in pediatric cerebral sinovenous thrombosis (CSVT). Neonates and children increasingly receive anticoagulant therapy (ACT) based on adult studies. Safety data for ACT in pediatric CSVT are scant and urgently needed. The objective was to assess the safety and outcome of ACT in pediatric CSVT. Methods In a single-center prospective study, neonates and children with CSVT received ACT (standard/low molecular weight heparin, warfarin) by standardized protocol. A study neuroradiologist (M.S.) assessed all initial and follow-up neuroimaging for intracranial hemorrhage (ICH), thrombus propagation, and recanalization. Clinical outcome was assessed with the Pediatric Stroke Outcome Measure. Results Among 162 pediatric patients, 85 received ACT at diagnosis, including 29/83 (35%) neonates and 56/79 (71%) children. Major hemorrhage occurred in 6% (6/99) of treated patients, including 14% (3/21 neonates, 2/15 children) with and 2% (0/17 neonates, 1/46 children) without pretreatment ICH. ACT-associated bleeds were all nonfatal, and clinical outcome was favorable in 50%, similar to the remaining patients (53%). Early follow-up imaging demonstrated thrombus propagation in 11/57 neonates (10/35 [28%] without and 1/22 [4%] with ACT [p = 0.037]) and 10/63 children (7/19 [37%] without and 3/44 [7%] with ACT [p = 0.006]). Propagation was associated with new venous infarcts in 10% neonates and 40% children and worse clinical outcome in children (p = 0.053). Recanalization occurred earlier and more completely in neonates (p = 0.002). Clinical outcome was unfavorable in 47%. Interpretation In pediatric CSVT, ACT appears safe. Nontreatment with ACT is associated with thrombus propagation, observed in ¼ of untreated neonates and over , of children. Anticoagulants merit strong consideration in pediatric CSVT. ANN NEUROL 2010;67:590,599 [source] | |||||||||||||||||||||||||||||||||||||