Nonnutritive sucking during heelstick procedures decreases behavioral distress in the newborn infant

We investigated if nonnutritive sucking (NNS) during heelstick procedures alleviates behavioral distress in neonates. In our NICU, 26 neonates without severe complications (mean Minde score 0.8, range 0-3), undergoing heelstick procedures at least twice a day, in the first 2 weeks of life, were enrolled in the trial (mean gestational age 33.9 weeks, range 26-39 weeks, mean birth weight 1, 988.5 g, range 1,200-4,010 g, mean Apgar score at the first minute 6. 7, range 4-10, at the fifth minute 8.5, range 6-10). Two heelpricks were performed in each neonate with NNS randomly assigned. Behavioral states, transcutaneous oxygen tension (TcPO(2)), heart rate, and respiratory rate were monitored before, during and after the heelstick procedures. Heelstick procedures lasted for a mean of 109 s (range 50-230 s) with NNS, and a mean of 128.8 s (range 20-420 s) without NNS. Compared with baseline, heart rate and behavioral distress increased and respiratory rate decreased during heelstick and after heelstick. Oxygen tension did not change. Nonnutritive sucking had no effect on respiratory rate or transcutaneous oxygen tension, but reduced the time of crying and the heart rate increase during the procedure. In conclusion, NNS can be recommended to reduce distress in newborns undergoing invasive routine procedures. Further studies are needed to evaluate the effects of NNS on respiratory rate and blood gas levels.     

Effect of colostrum feeding on protein metabolism in the small intestine of newborn lambs

In a first experiment with 24 newborn lambs, the promoting effect of colostrum feeding on the fresh weight of the small intestine and its protein content was demonstrated by comparison with that of other dietary treatments (fasting, lactose, protein hydrolysate feeding). In a second experiment, the amounts of colostral IgG1 entrapped within the intestine wall and the valine incorporation rates into the intestinal protein were determined in 3-, 8- and 18-hour-old lambs fed either cow milk, cow colostrum or ewe colostrum. The amounts of IgG1 in the small intestine wall and the valine incorporation rates were higher in the lambs fed colostrum (ewe or cow) than in the milk-fed animals. The intestinal protein increase resulted primarily from the retention of colostral proteins in the colostrum-fed newborn lambs. However, colostrum feeding stimulated intestinal protein synthesis more actively than milk feeding.     

Health factors in colostrum

Colostrum is a breast milk produced after the birth of the newborn and lasts for 2–4 days. Colostrum is very important part of breast milk and lays down the immune system and confers growth factors and other protective factors for the young ones in mammals. This is the source of passive immunity achieved by the mother and is transferred to the baby. This is the major source of secretory IgA and gives protection against gastrointestinal infections. In view of so many health factory through colostrum, the use of colostrum has been extended to so many health problems of mankind. Human and bovine colostrums have many similarities barring that bovine colostrum can be obtained in large quantity, so bovine colostrum has been used in various disorders in human beings. This is the nature’s gift that is for the young ones to grow as well as for the treatment of many health problems in older age group     

Anti-infective factors in preterm human colostrum

Feeding of the infection prone preterm neonate with concentrated immunologically active ingredients in the form of colostrum may have even more significant clinical implications than in the full term infants. The scarcity of knowledge on anti-infective factors in colostrum of mothers delivering prematurely prompted us to carry out this study. Colostrum was collected and analysed from 25 mothers delivering prematurely (Study group) and 10 delivering at term (Control group). Major anti-infective factors namely IgA, IgG, IgM, lactoferrin and lysozyme were quantitated and total cell, macrophage, lymphocyte and neutrophil counts were performed. The mean concentrations of IgA, lysozyme and lactoferrin of preterm colostrum were significantly higher than in full term colostrum (p less than 0.001). IgG and IgM were found to be similar in both groups. The absolute counts of total cells, macrophages, lymphocytes and neutrophils were found to be significantly higher in the preterm colostrum as compared to the full term colostrum (p less than 0.001). Though in both the groups IgA was the predominant immunoglobulin, the mean percentage of IgA in the study group was significantly higher as compared to the control group. Degree of prematurity did not have any influence on the anti-infective protein levels in colostrum. However total cells and macrophages were significantly higher in colostrum of mothers delivering severely preterm babies.     

Intestinal development and fatty acid binding protein activity of newborn pigs fed colostrum or milk.

Newborn pigs (n = 20) were gavage-fed sow's colostrum, defatted colostrum, milk, defatted milk or a 5% lactose solution over 24 h in order to evaluate effects on growth and functional differentiation of small intestine. Colostrum-fed pigs had greater (p less than 0.01) mucosal mass in the proximal half of the small intestine than did the milk- or lactose-fed groups. Total fatty acid binding protein (FABP) activity and FABP activity per mg DNA in proximal intestines of colostrum-fed pigs exceeded that for the lactose group. FABP activities (per g mucosa or mg soluble protein) were greater (p less than 0.01) in the proximal segments of small intestines of pigs fed whole versus the corresponding defatted secretion. These results indicate that the feeding of colostrum specifically augments perinatal intestinal growth and differentiation as manifested by increased cellular hypertrophy and FABP activity. Milk lipid and unidentified factor(s) enriched in colostrum are inducers of intestinal FABP activity.     

Intestinal apolipoprotein synthesis in the newborn piglet

To determine the effects of dietary and biliary lipid absorption on intestinal apo B-48 and apo A-I synthesis in the newborn piglet, 2-d-old female piglets were prepared with a duodenal infusion catheter. After recovery, animals were given either low triglyceride (Vivonex; VIV group) or high triglyceride (Intralipid; FAT group) diets by continuous intraduodenal infusion for 24 h. A bile-diverted group was also studied. Segments of proximal jejunum and distal ileum were then pulse-radiolabeled in vivo with 3H-leucine. Mucosal apo B-48 and apo A-I were immunoprecipitated, and apoprotein synthesis was expressed as percentage of total protein synthesis. Mucosal apoprotein content (ng apoprotein/microgram total protein) was measured by competitive ELISA assays. In jejunum and ileum, apo B-48 synthesis was not different in the three groups. However, apo B content increased 2.4-fold in jejunum and 1.7-fold in ileum in the FAT group compared with the VIV group. Immunoblotting revealed the majority of jejunal apo B to be apo B-48, not apo B-100 from contaminating plasma lipoproteins, in all three experimental groups. Bile-diverted animals had decreased jejunal apo B content compared with the VIV group. Jejunal apo A-I synthesis and content were approximately 2-fold higher in FAT animals compared with the VIV group. Although ileal apo A-I synthesis was also 2-fold higher in the FAT group, apo A-I content was not different from the VIV group. Neither jejunal nor ileal apo A-I synthesis was significantly affected by bile diversion, even though jejunal apo A-I content was decreased by over two thirds compared with the VIV animals. In the newborn piglet, intestinal synthesis of apo B-48 and apo A-I is differentially regulated by luminal lipid absorption. Although fat feeding and bile diversion regulate mucosal apo B-48 content, synthesis is unchanged, indicating a posttranslational regulatory mechanism.(ABSTRACT TRUNCATED AT 250 WORDS)     

Association between maternal vitamin E status and alpha‐tocopherol levels in the newborn and colostrum

Vitamin E is important because of its antioxidant activity in situations of oxidative stress, especially postnatally. Hence, the objective was to verify whether maternal alpha‐tocopherol level is associated with the alpha‐tocopherol levels of the newborn and colostrum. This is a cross‐sectional study of 58 women and their term newborns from a public hospital. Blood and colostrum were collected to measure alpha‐tocopherol levels by high‐performance liquid chromatography. Mothers with serum alpha‐tocopherol levels <16.2 mmol L^?1 and newborns <11.6 mmol L^?1 were indicative of deficiency or low levels. Mothers were divided into two groups: <16.2 mmol L^?1 and those with levels ≥16.2 mmol L^?1. The mean (95% confidence interval) serum alpha‐tocopherol levels of mothers, umbilical cords and colostrum were 28 (24–32), 6 (5–8) and 39 mmol L^?1 (32–45), respectively (P < 0.001); 19% of the women and 90% of the newborns had low alpha‐tocopherol levels. Maternal alpha‐tocopherol level was associated with that of the umbilical cord. Newborns from mothers at risk of deficiency had low alpha‐tocopherol levels (P < 0.001). Colostrum levels of vitamin E were not influenced by maternal serum. Maternal deficiency influenced the vitamin E level of the umbilical cord but does not in the colostrum, evidencing distinct transfer mechanisms via the mammary gland.     

Risk factors in mothers and newborn

One hundred and fifty mothers and their newborn babies were studied over a period of two years in villages around Hyderabad to collect vital data regarding their sociobiological factors, customs and beliefs and to observe the impact of maternal and child health services. A positive correlation was observed between the maternal hemoglobin weight and mid-arm circumference and infants weight; the birth weight rising with an increase in these values. Better results were observed in mothers who received antenatal care. The important risk factors emerging were primigravida, very young mothers, severe anemia (Hb<8 g/dl) malnutrition in mothers (wt<40 kg), lack of antenatal care, unhygienic practices during labour, non-availability of trained midwife and harmfuls uperstitions, taboos and customs prevailing in the area.     

Surfactant protein D in newborn infants: factors influencing surfactant protein D levels in umbilical cord blood and capillary blood

Surfactant protein D (SP-D) is a collectin that plays an important role in the innate immune system. The role of SP-D in the metabolism of surfactant is as yet quite unclear. The aims of this study were to establish normal values of SP-D in the umbilical cord blood and capillary blood of mature newborn infants and to assess the influence of perinatal conditions on these levels. A total of 458 infants were enrolled in the present study. Umbilical cord blood was drawn at the time of birth and capillary blood at age 4 to 10 d. The concentration of SP-D in umbilical cord blood and capillary blood was measured by enzyme-linked immunosorbent assay. The median concentration of SP-D in umbilical cord blood was 392.1 ng/mL and was found to be influenced by maternal smoking and labor. The median concentration of SP-D in capillary blood was 777.5 ng/mL and was found to be influenced by the mode of delivery, the highest levels being observed in infants born by cesarean section. It was concluded that SP-D concentrations in umbilical cord blood and capillary blood are highly variable and depend on several perinatal conditions. Further studies are needed to elucidate the effect of respiratory distress and infection on SP-D concentrations.     

Myeloid colony-stimulating factors: use in the newborn.

Bacterial and fungal sepsis are major causes of morbidity and mortality in the newborn. Multiple factors contribute to this increased susceptibility to infection, including quantitative and qualitative neutrophil defects, with a reduction in neutrophil number and function. Neutropenia in the newborn may occur in association with sepsis and has a poor prognosis. In addition to antibiotic therapy and supportive care, granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) have been used to reduce morbidity and mortality. Granulocyte CSF is the physiological regulator of neutrophil production and function. Administration of G-CSF results in increased neutrophil production and counts and improved neutrophil function. Several studies of animal and human newborns having neutropenia or suspected sepsis investigated the use of G-CSF and GM-CSF to elevate neutrophil counts and reduce morbidity and mortality in this population. Results of small clinical trials using G-CSF and GM-CSF in very low-birth-weight infants having neutropenia show increased neutrophil counts and a reduced incidence of sepsis during the neonatal period. Despite these promising early results, further studies of the safety and efficacy of G-CSF and GM-CSF administration in neonates are required before their routine use can be recommended as either prophylaxis or treatment for neonatal sepsis.     

新生儿肺出血的高危因素

目的　探讨新生儿肺出血的高危因素及有效的基层防治方法。方法　将 38例新生儿随机分为治疗组和对照组。对照组应用综合治疗 ,治疗组在此基础上应用气管内给药和气囊加压辅助呼吸。分析高危因素、治疗措施与疗效的关系。结果　早产、低体质量、窒息、寒冷刺激、男性患儿等是新生儿肺出血的高危因素。对照组死亡 18例 ,存活 1例 ;治疗组死亡 13例 ,存活 6例。结论　早期发现 ,并在综合治疗基础上选用气管内用药、配合气囊辅助通气可有效减低死亡率     

Effect of prematurity on protein glycosylation in the newborn

Background: Glycohemoglobins (GHb) are the products of irreversible non‐enzymatic reactions between glucose and the hemoglobin molecule. Glycosylation of proteins in general can modify protein structure and alter catalytic properties, thereby causing cellular dysfunction. The aim of the present study was to test the hypothesis that protein glycosylation levels in premature infants are elevated compared with full‐term infants (neonates). Blood GHb levels in pre‐term and full‐term infants were studied, and the in vitro glycosylation of erythrocytes obtained from both pre‐term and full‐term infants was assessed. Methods: Cord‐blood from 31 pre‐term and 11 full‐term infants was collected and GHb levels were determined using affinity columns. Erythrocytes from the cord blood of 17 additional infants (eight pre‐term, ≤36 weeks gestation, and nine full‐term, ≥37 weeks gestation) were obtained and incubated for 24 h in a high‐glucose medium. Baseline and post‐incubation GHb levels were calculated to determine the in vitro susceptibility of pre‐term versus full‐term infants to glycosylation. Results: Blood GHb levels were significantly higher (P < 0.01) in full‐term compared with pre‐term infants. The percent increase in GHb formation in vitro was similar between the erythrocytes of full‐term and those of pre‐term infants. Conclusion: Contrary to the original hypothesis, the erythrocytes of pre‐term infants do not show increased glycosylation of proteins when compared with those of full‐term infants.     

Apolipoprotein synthesis in newborn piglet intestinal explants.

To determine the effects of hormones and epidermal growth factor (EGF) on the small intestinal synthesis of apolipoproteins B-48, A-I, and A-IV in the neonatal mammal, apolipoprotein synthesis by proximal jejunal explants from 2-d-old female piglets was studied in tissue culture. Initial comparison studies with various media showed optimal total protein and apo A-I synthesis with Williams' medium E without fetal bovine serum. Sets of explants were prepared containing EGF and various hormones in the medium. After 35S-methionine radiolabeling, explants were homogenized, and specific apolipoprotein synthesis was quantitated by immunoprecipitation as the percentage of total protein synthesis. Apo B-48 synthesis was not affected by any additives except the combination of EGF and hydrocortisone, which slightly decreased synthesis. Apo A-I synthesis was significantly increased by EGF. This EGF-induced increase in apo A-I synthesis was blunted by concomitant treatment with hydrocortisone. In contrast, the combination of insulin and hydrocortisone induced a significant increase in apo A-I synthesis. Although EGF and insulin modestly increased apo A-IV synthesis, the combination of insulin and hydrocortisone treatment up-regulated apo A-IV synthesis by 2.6-fold. Thyroid hormone lacked effect on synthesis of any of the apolipoproteins. EGF, glucocorticoids, and insulin may play regulatory roles in the developmental expression of apolipoprotein synthesis in the neonatal small intestine.