Efficacy of saccharomyces boulardii on necrotizing enterocolitis or sepsis in very low birth weight infants: A randomised controlled trial

Background

Probiotics have strain specific effects and the effects of fungi in preventing diseases in preterm infants have been investigated poorly. Saccharomyces boulardii is a yeast which acts both as a probiotic and a polyamine producer.

Aim

The objective of this study was to investigate the efficacy of S. boulardii in preventing necrotizing enterocolitis (NEC) or sepsis in very low birth weight infants.

Study design and subjects

A prospective, double blind, placebo controlled trial was conducted in preterm infants (≤ 32 GWs, ≤ 1500 g birth weight). They were randomized either to receive feeding supplementation with S. boulardii 50 mg/kg every 12 h or placebo, starting with the first feed until discharged.

Outcome measures

Necrotizing enterocolitis (NEC) or sepsis and NEC or death.

Results

Birth weight and gestational age of the study (n = 104) and the control (n = 104) groups were 1126 ± 232 vs 1162 ± 216 g and 28.8 ± 2.2 vs 28.7 ± 2.1 weeks, respectively. Neither the incidence of stage ≥ 2 NEC or death nor stage ≥ 2 NEC or late onset culture proven sepsis was significantly lower in the study group when compared with the control group (9.6% vs 7.7%, p = 0.62; 28.8% vs 23%, p = 0.34). Time to reach 100 mL/kg/day of enteral feeding (11.9 ± 7 vs 12.6 ± 7 days, p = 0.37) was not different between the groups.

Conclusions

Saccharomyces boulardii did not decrease the incidence of NEC or sepsis.     

Presepsyna (rozpuszczalny podtyp CD14-ST) jako diagnostyczny biomarker posocznicy u noworodków

Background

Determination of sCD14-ST (presepsin) concentration as a marker for infections in newborns was not performed till now.

Aim

1. Assessment of blood presepsin concentration in newborns, including their sex, fetal maturity, birth weight, early-onset sepsis. 2. Determination of correlation between presepsin value and CRP, procalcitonin concentrations and some hematological parameters.

Material and methods

The study comprised 45 newborns, among them 27 septic and 18 without infection, but with perinatal risk factors or symptoms suggesting infection, in which by rapid chemiluminescent enzyme immunoassay, using Pathfast TM analyser from Mitsubishi Kagaku Iatron, sCD14-ST concentration in whole blood was measured.

Results

The mean presepsin concentration in septic newborns (1772 ± 1009 pg/ml) was significantly higher than in group without infection (556 ± 158). Positive correlations between sCD14-ST and CRP, procalcitonin concentrations and negative correlations between the value of presepsin and Ht, Hb, platelet count, birth weight and fetal maturity were noted.

Conclusions

1. In newborns with early-onset sepsis, independently of their sex, birth weight, fetal maturity, significant increase presepsin concentration, correlating with increase of CRP and procalcitonin values and with decrease of platelet count, Hb and Ht. 2. Measurement of presepsin concentration in neonatal whole blood may be usefulness in diagnosis of early-onset sepsis.     

Longitudinal follow-up of ventricular performance in healthy neonates

Background

Specific follow-up of newly introduced echocardiographic parameters in healthy neonates and infants is limited.

Aim

To prospectively describe follow-up of left ventricular (LV) tissue Doppler imaging (TDI) and speckle tracking strain parameters in healthy subjects up to two months after birth.

Design

This is a longitudinal follow-up study.

Subjects

Twenty-eight (10 male) healthy newborns were included and underwent transthoracic echocardiography 1–3 days, 3 weeks and 6–7 weeks after birth.

Outcome measures

In each echocardiogram, parameters describing cardiac growth, including LV mass (LVM), were assessed. Additionally, TDI derived peak systolic velocity (S′) and peak early (E′) and late (A′) diastolic velocities were assessed in the basal LV free wall and interventricular septum (IVS). Finally LV longitudinal, radial and circumferential global peak strain parameters were assessed using speckle tracking strain imaging.

Results

LVM significantly increased during follow-up (7.6 ± 2.4 versus 12.4 ± 3.2 g, p = 0.002). Similarly at 1–3 days versus 6–7 weeks after birth, an increase in LV and IVS systolic (LV S′ 4.1 ± 1.5 versus 6.3 ± 1.5 cm/s, p = 0.001; IVS S′ 3.6 ± 0.9 versus 6.4 ± 1.3 cm/s, p < 0.001) and diastolic (LV E′ 6.1 ± 2.2 versus 9.7 ± 2.9 cm/s, p = 0.002; IVS E′ 5.1 ± 1.4 versus 10.7 ± 3.3 cm/s, p < 0.001) TDI parameters was observed. In contrast, global peak longitudinal, radial and circumferential strain parameters did not significantly change during follow-up.

Conclusions

A significant increase in LV systolic and diastolic TDI parameters was observed up to two months after birth. Yet this increase may be (cardiac) growth-dependent. No significant changes were observed in speckle tracking strain derived global peak strain parameters; this may render the technique particularly valuable in evaluation of LV systolic performance during periods of significant growth, such as the neonatal period.     

Sunflower oil versus no oil moderate pressure massage leads to greater increases in weight in preterm neonates who are low birth weight

Background

Growth velocity is one of the most important problems in low birth weight (LBW) neonates.

Aims

The purpose of this study was to compare the effects of body massage with and without sunflower oil on the growth of LBW preterm neonates in Iran.

Study design

A single-blinded randomized clinical trial

Subjects

This study examined neonates admitted to NICU with gestational age of 33–37 weeks and birth weight of 1500–1999 g, without birth asphyxia and medically stable

Outcome measures

Neonates were randomly assigned to two groups to receive moderate pressure massage alone or the same massage with sunflower oil by their mothers, three times a day for 14 consecutive days. The primary variables were increases in mean of growth parameters (weight, height and head circumference) that were evaluated 14 days after intervention, at ages 1 and 2 months. Secondary variables were clinical side effects.

Results

Fifty-four neonates including 25 girls and 29 boys with mean gestational age of 35.3 ± 1.26 weeks were evaluated. Means of gestational age, birth weight and length of NICU stay were not different in both groups. In the oil massage group, mean weight at ages 1 month (mean ± SD: 2339 ± 135 vs. 2201 ± 93 g, P = 0.04) and 2 months (mean ± SD: 3301 ± 237 vs. 3005 ± 305 g, P = 0.005) was significantly greater than that of the body massage group. No adverse events were seen in the two groups.

Conclusion

Sunflower oil massage might be used as an effective and safe intervention for weight gain in LBW preterm neonates.     

Cerebral tissue oxygenation index,cardiac output and superior vena cava flow in infants with birth weight less than 1250 grams in the first 48 hours of life

Background

Near-infrared spectroscopy is a non-invasive method of assessing cerebral oxygenation. Functional echocardiography is increasingly used by neonatologists in the assessment of cardiovascular function.

Aims

To correlate cerebral tissue oxygenation index (cTOI) and cardiac output in infants less than 1250 g at 6, 12, 24 and 48 hours of age.

Study design

A prospective observational study.

Subjects

Newborns with birth weight < 1250 g.

Outcome measures

Serial assessments of superior vena cava (SVC) flow, right and left ventricular outputs, ductus arteriosus and cTOI were performed at 6, 12, 24 and 48 hours of age. Clinical parameters, including mean blood pressure, mean airway pressure, blood gas parameters and oxygen saturations were recorded.

Results

22 neonates were enrolled following parental consent. The mean birth weight was 851 g (SD ± 201), mean gestational age was 25.9 weeks (SD ± 1.7). Mean SVC flow at 6 hours of age was 56.8 ml/kg/min and increased to 68.6 ml/kg/min at 48 hours of age. 9 infants (41%) had at least one measurement of low SVC flow (< 41 ml/kg/min) in the first 48 hours. Mean cTOI was 65.2% at 6 hours of age, 63.9% at 12 hours of age, 68.8% at 24 hours of age and 67.2% at 48 hours of age. Cerebral fractional tissue oxygen extraction values were highest at 12 hours (0.31 ± 0.09). There was no correlation between SVC flow and cTOI values.

Conclusion

SVC flow, left and right ventricular output increased during first 48 hours of life. cTOI decreased at 12 hours of age with a concomitant increase in fractionated oxygen extraction. These changes reflect transitional changes in both cardiac and cerebral hemodynamics in extremely low gestational age newborns during the first 48 hours.     

Effect of neonatal hemoglobin concentration on long-term outcome of infants affected by fetomaternal hemorrhage

Background

Fetomaternal hemorrhage (FMH) can cause severe morbidity. However, perinatal risk factors for long-term poor outcome due to FMH have not been extensively studied.

Aims

To determine which FMH infants are likely to have neurological sequelae.

Study design

A single-center retrospective observational study. Perinatal factors, including demographic characteristics, Kleihauer–Betke test, blood gas analysis, and neonatal blood hemoglobin concentration ([Hb]), were analyzed in association with long-term outcomes.

Subjects

All 18 neonates referred to a Neonatal Intensive Care Unit of Kagoshima City Hospital and diagnosed with FMH during a 15-year study period. All had a neonatal [Hb] < 7.5 g/dL and 15 of 17 neonates tested had Kleihauer–Betke test result > 4.0%.

Outcome measures

Poor long-term outcome was defined as any of the following determined at 12 month old or more: cerebral palsy, mental retardation, attention deficit/hyperactivity disorder, and epilepsy.

Results

Nine of the 18 neonates exhibited poor outcomes. Among demographic characteristics and blood variables compared between two groups with poor and favorable outcomes, significant differences were observed in [Hb] (3.6 ± 1.4 vs. 5.4 ± 1.1 g/dL, P = 0.01), pH (7.09 ± 0.11 vs. 7.25 ± 0.13, P = 0.02) and base deficits (17.5 ± 5.4 vs. 10.4 ± 6.0 mmol/L, P = 0.02) in neonatal blood, and a number of infants with [Hb] ≤ 4.5 g/dL (78%[7/9] vs. 22%[2/9], P = 0.03), respectively. The base deficit in neonatal arterial blood increased significantly with decreasing neonatal [Hb].

Conclusions

Severe anemia causing severe base deficit is associated with neurological sequelae in FMH infants.     

Newborn length predicts early infant linear growth retardation and disproportionately high weight gain in a low-income population

Background

Stunting is prevalent by the age of 6 months in the indigenous population of the Western Highlands of Guatemala.

Aim

The objective of this study was to determine the time course and predictors of linear growth failure and weight-for-age in early infancy.

Study design and subjects

One hundred and forty eight term newborns had measurements of length and weight in their homes, repeated at 3 and 6 months. Maternal measurements were also obtained.

Results

Mean ± SD length-for-age Z-score (LAZ) declined from newborn − 1.0 ± 1.01 to − 2.20 ± 1.05 and − 2.26 ± 1.01 at 3 and 6 months respectively. Stunting rates for newborn, 3 and 6 months were 47%, 53% and 56% respectively. A multiple regression model (R² = 0.64) demonstrated that the major predictor of LAZ at 3 months was newborn LAZ with the other predictors being newborn weight-for-age Z-score (WAZ), gender and maternal education ∗ maternal age interaction. Because WAZ remained essentially constant and LAZ declined during the same period, weight-for-length Z-score (WLZ) increased from − 0.44 to + 1.28 from birth to 3 months. The more severe the linear growth failure, the greater WAZ was in proportion to the LAZ.

Conclusion

The primary conclusion is that impaired fetal linear growth is the major predictor of early infant linear growth failure indicating that prevention needs to start with maternal interventions.     

Maternal sounds elicit lower heart rate in preterm newborns in the first month of life

Background

The preferential response to mother's voice in the fetus and term newborn is well documented. However, the response of preterm neonates is not well understood and more difficult to interpret due to the intensive clinical care and range of medical complications.

Aim

This study examined the physiological response to maternal sounds and its sustainability in the first month of life in infants born very pretermaturely.

Methods

Heart rate changes were monitored in 20 hospitalized preterm infants born between 25 and 32 weeks of gestation during 30-minute exposure vs. non-exposure periods of recorded maternal sounds played inside the incubator. A total of 13,680 min of HR data was sampled throughout the first month of life during gavage feeds with and without exposure to maternal sounds.

Results

During exposure periods, infants had significantly lower heart rate compared to matched periods of care without exposure on the same day (p < .0001). This effect was observed in all infants, across the first month of life, irrespective of day of life, gestational age at birth, birth weight, age at testing, Apgar score, caffeine therapy, and requirement for respiratory support. No adverse effects were observed.

Conclusion

Preterm newborns responded to maternal sounds with decreased heart rate throughout the first month of life. It is possible that maternal sounds improve autonomic stability and provide a more relaxing environment for this population of newborns. Further studies are needed to determine the therapeutic implications of maternal sound exposure for optimizing care practices and developmental outcomes.     

Comparison of the right and left ventricular performance during the fetal development using velocity vector imaging

Background

Studies on myocardial characteristics examined by speckle-tracking echocardiography are limited.

Aims

To compare myocardial performance between the right and left ventricles during the fetal development using velocity vector imaging (VVI).

Subjects and study design

Echocardiograms of 95 uncomplicated singleton fetuses (19–36 weeks pregnancy) were retrospectively analyzed by VVI to measure global longitudinal peak velocity, strain, and strain rate of both the right ventricle (RV) and left ventricle (LV). The regional values were calculated for three segments (base, mid, and apex) of the ventricular free wall and segment.

Outcome measures

The VVI-derived measurements were examined for gestational age and compared between ventricles.

Results

The global peak systolic and diastolic velocity values of both ventricles significantly increased over gestation examined, whereas the global systolic strain and strain rate were stable (RV: strain − 22.6 ±5.0%, strain rate − 2.6 ± 0.7/s; LV: strain − 21.5 ± 5.6%, strain rate − 2.5 ± 0.7/s). Compared to the LV, the RV showed significantly higher global velocity in systole and diastole (P = 0.001 for systole, P < 0.001 for diastole). The global systolic velocity of the LV increased close to the RV toward term, whereas the RV was dominant in diastole throughout the examined gestation. Basal strain and strain rate in the RV were significantly greater than that of the LV, although there were no significant differences in the middle and apical values between ventricles.

Conclusion

Our findings suggest the RV predominance of longitudinal contraction and dilatation, compared to the LV in uncomplicated fetuses.     

Pain evaluation after a non-nociceptive stimulus in preterm infants during the first 28 days of life

Background

Protective mechanisms that modulate and lead to habituation to pain are immature in preterm newborn infants.

Aims

To evaluate if a routine non-painful handling will be perceived as painful throughout the neonatal period in newborn infants with 28–32 weeks of gestational age.

Study design

Prospective cohort study.

Subjects

36 preterm infants without malformations evaluated for pain during a diaper change.

Outcome measures

Patients were studied at three times (5 min prior, during, and 3 min after the diaper change) during five moments (72 h, 7, 14, 21 and 28 days of life) by evaluation of heart rate, oxygen saturation and 3 validated pain assessment tools: the Neonatal Infant Pain Scale (NIPS), the Behavioral Indicators of Infant Pain (BIIP) and Premature Infant Pain Profile (PIPP). Results were analyzed by repeated measures ANOVA adjusted for gender, gestational age at birth, number of painful procedures and use of opioids.

Results

Patients had, at birth, mean gestational age of 30.2 ± 1.4 weeks, birthweight of 1257 ± 238 g, with 50% males. Analysis of pain assessment tools did not show increase of pain presence or pain scores at the five sequential evaluation moments. The variation of oxygen saturation during the three study times was similar at the different post-natal ages, but heart rate variation increased significantly from 72 h until the 28th day of life.

Conclusions

In preterm infants, the non-nociceptive handling does not trigger pain responses even after 28 days of neonatal care, which includes the experience of repetitive procedural pain.     

Motor skills at 23 years of age in young adults born preterm with very low birth weight

Background

Motor skills have previously not been reported in young adults born with very low birth weight (VLBW), although they are commonly reported in children and adolescents.

Aim

To compare fine and gross motor skills in VLBW young adults with matched term-born controls, and to study longitudinal changes in the VLBW group.

Study design

A geographically based follow-up study of a VLBW group and a control group.

Subjects

Thirty-six VLBW (birth weight ≤ 1500 g) young adults, including four participants with cerebral palsy (CP), and 37 matched controls (birth weight ≥ 10th centile) were examined at 14 and 23 years of age.

Outcome measures

Fine and gross motor skills were assessed using Grooved Pegboard test (GP), Trail Making Test-5 (TMT-5), Movement Assessment Battery for Children-2 (Movement ABC-2) and High-level Mobility Assessment Tool (HiMAT).

Results

VLBW young adults were slower than controls on GP (p = 0.026) and TMT-5 (p < 0.001). Mean total Movement ABC-2 score was 69.7 ± 20.2 in the VLBW group compared with 74.1 ± 14.4 in the control group (p = 0.017). Differences were also seen in manual dexterity and balance. Additionally, HiMAT showed reduced balance and speed in gross motor skills in the VLBW group. The proportion of participants with motor problems did not change between age 14 and 23. After exclusion of participants with CP, scores were essentially the same.

Conclusion

VLBW young adults had overall poorer fine and gross motor skills compared with controls. Reduced speed seemed to be an underlying problem. Longitudinal findings indicate that VLBW children have not outgrown their motor problems when entering adulthood.     

Circulating PCSK9 levels correlate with the serum LDL cholesterol level in newborn infants

Background and aims

Protein convertase subtilisin/Kexin type-9 (PCSK9) is a substantial player in lipoprotein metabolism. This study was designed to elucidate the role of PCSK9 in the regulation of lipoprotein during the fetal period.

Study design and subjects

This study was a cross-sectional study. Eighty-one neonates (45 males, 36 females) who were admitted to the neonatal intensive care unit were enrolled in the study. The median age in gestational weeks and weight at birth were 37.1 weeks and 2493 g, respectively. There were no gender differences, but the proportion of infants who were small-for-gestational age (SGA) was significantly higher among females than males. The prefed serum PCSK9 level was assayed with ELISA kits.

Results

The median PCSK9 concentration in male newborns was significantly lower than that in females (148.2 ng/ml vs. 171.4 ng/ml, respectively, p < 0.001). Circulating serum PCSK9 levels were positively correlated with total cholesterol (r = 0.281, p < 0.05) and low-density lipoprotein cholesterol (LDL-C; r = 0.272, p < 0.05). However, there were no correlations between PCSK9 levels and birth weight, gestational age or SGA. Multivariate forward stepwise linear regression analysis revealed that gestational age and circulating PCSK9 levels were independent predictors of the serum LDL-C levels in newborn infants.

Conclusion

Our first quantitative analysis of neonatal serum PCSK9 levels at birth showed that circulating PCSK9 levels show gender-based differences and are significantly correlated with LDL-C. These results suggest that PCSK9 could play an important role in regulating LDL-C levels during the fetal period.     

Neonatal neurobehavioral abnormalities and MRI brain injury in encephalopathic newborns treated with hypothermia

Background

Neonatal Encephalopathy (NE) is a prominent cause of infant mortality and neurodevelopmental disability. Hypothermia is an effective neuroprotective therapy for newborns with encephalopathy. Post-hypothermia functional–anatomical correlation between neonatal neurobehavioral abnormalities and brain injury findings on MRI in encephalopathic newborns has not been previously described.

Aim

To evaluate the relationship between neonatal neurobehavioral abnormalities and brain injury on magnetic resonance imaging (MRI) in encephalopathic newborns treated with therapeutic hypothermia.

Study design

Neonates with hypoxic ischemic encephalopathy (HIE) referred for therapeutic hypothermia were prospectively enrolled in this observational study. Neurobehavioral functioning was assessed with the NICU network neurobehavioral scale (NNNS) performed at target age 14 days. Brain injury was assessed by MRI at target age 7–10 days. NNNS scores were compared between infants with and without severe MRI injury.

Subjects & outcome measures

Sixty-eight term newborns (62% males) with moderate to severe encephalopathy underwent MRI at median 8 days (range 5–16) and NNNS at median 12 days of life (range 5–20). Fifteen (22%) had severe injury on MRI.

Results

Overall Total Motor Abnormality Score and individual summary scores for Non-optimal Reflexes and Asymmetry were higher, while Total NNNS Z-score across cognitive/behavioral domains was lower (reflecting poorer performance) in infants with severe MRI injury compared to those without (p < 0.05).

Conclusions

Neonatal neurobehavioral abnormalities identified by the NNNS are associated with MRI brain injury in encephalopathic newborns post-hypothermia. The NNNS can provide an early functional assessment of structural brain injury in newborns, which may guide rehabilitative therapies in infants after perinatal brain injury.     

Pre-eclampsia—An additional risk factor for cognitive impairment at school age after intrauterine growth restriction and very preterm birth

Objective

To explore the possible influence of pre-eclampsia on cognitive outcome in children born very preterm after intrauterine growth restriction (IUGR) and abnormal umbilical artery blood flow.

Methods

Cognitive function was evaluated at 5–8 years of age with Wechsler scales in 34 children born before 30 gestational weeks after IUGR (PT-IUGR) (11 children were exposed to maternal pre-eclampsia, 23 non-exposed) and in 34 children with no maternal pre-eclampsia and birth weight appropriate-for-gestational age (PT-AGA) matched for gestational age at birth, gender and age at examination.

Results

The subjects in the PT-IUGR group exposed to maternal pre-eclampsia had lower mean verbal IQ (VIQ) (mean ± SD 74 ± 16) and lower full scale IQ (FSIQ) (70 ± 19) in comparison with both the non-exposed PT-IUGR (VIQ 89 ± 15; p = 0.013; FSIQ 83 ± 14, p = 0.029), and, the PT-AGA group (VIQ 96 ± 15, p < 0.001; FSIQ 90 ± 14, p = 0.001). The differences remained significant after adjustment for known confounders. VIQ and FSIQ did not differ between the non-exposed IUGR and PT-AGA children.

Conclusion

Fetal exposure to maternal pre-eclampsia seems to have an additional negative impact to that of IUGR on cognitive function in children born very preterm.     

Advanced intrauterine growth restriction is associated with reduced excretion of asymmetric dimethylarginine

Background

High blood levels of asymmetric dimethylarginine (ADMA) are associated with future development of adverse cardiovascular events. The ADMA/symmetric dimethylarginine (SDMA) ratio is a marker of ADMA catabolism, with a high ADMA/SDMA ratio being suggestive of reduced ADMA excretion.

Aims

This study aimed a) to verify the presence of a statistically significant difference between ADMA/SDMA ratio levels in a group of young adult subjects who were born preterm with an extremely low birth weight (ex-ELBW) and a group of healthy adults born at term and b) to seek correlations between ADMA/SDMA ratio levels in ex-ELBW and anthropometric and clinical parameters (gender, chronological age, gestational age, birth weight, and length of stay in the Neonatal Intensive Care Unit).

Subjects, study design, outcome measures

Thirty-seven ex-ELBW subjects (11 males [M] and 26 females [F], aged 17–28 years, mean age: 22.2 ± 1.8 years) were compared with 37 controls (11 M and 26 F). ADMA/SDMA ratio levels were assessed for each patient included in the study.

Results

ADMA/SDMA ratio in ex-ELBW subjects was higher compared to controls (1.42 ± 0.31 vs 0.95 ± 0.14, p < 0.002) and inversely correlated with birth weight (r = − 0.68, p < 0.0001) and gestational age (r = − 0.54, p < 0.0005).

Conclusions

ADMA catabolism is significantly decreased in ex-ELBW subjects compared to controls, underlining a probable correlation with restriction of intrauterine growth. These results suggest the onset of early circulatory dysfunction predictive of increased cardiovascular risk in ex-ELBW.     

Effect of the specific infant formula mixture of oligosaccharides on local immunity and development of allergic and infectious disease in young children: randomized study

Aim

The aim of our open prospective randomized nutritional intervention study was to evaluate the effect of feeding with a standard infant formula enriched with the specific mixture of oligosaccharides on local digestive immunity system and further development of allergic and infectious diseases in young children.

Material and methods

Depending on the type of feeding the infants were divided into 3 groups (with random allocation to one of the formula feeding groups): 80 infants who were breastfed, 80 infants consuming the formula supplemented with oligosaccharides, 80 infants fed with a standard formula.

Results

Breastfed infants had the highest content of Bifidobacteria and Lactobacilli in feces (9.047 ± 1.075 and 7.26 ± 0.65 CFU/g accordingly). In infants fed with formula supplemented with scGOS/lcFOS fecal concentrations of Bifidobacteria and Lactobacilli were similar to those in breastfed infants (8.92 ± 1.011 and 7.22 ± 0.74 CFU/g accordingly). It was found that infants fed with breast milk and supplemented formula had significantly less allergic reactions to food products compared to the babies from the third group (3.92% and 4.84% vs. 16.98% accordingly; p < 0,05).

Conclusions

The mixture of prebiotic oligosaccharides (scGOS/lcFOS – 9:1; 8 g/L) has a similar to breast milk positive impact on the factors of local digestive immunity system in formula-fed infants. This effect may reduce the risk of allergic and infectious diseases in children aged up to 18 months of life, compared with babies fed with the standard formula without oligosaccharides.     

Analysis of acute pain scores and skin conductance measurements in infants

Background

Skin conductance (SC) has been previously used to measure acute post-operative pain in adults and older children (> 1 year old).We have investigated the ability of SC to predict the severity of post-operative pain scores in the exclusively infant population.

Methods

Infants (ages 6–12 months) scheduled for elective surgery were recruited for the study. Data for behavioral pain scores and SC values — frequency of electrodermal responses per second (EDR/s), peak and basal levels, were recorded in the post-anesthesia care unit (PACU). Blood samples were collected for genomic studies, including single nucleotide polymorphisms (SNP) in morphine opioid receptor (MOR) A118G and the catechol-O-methyltransferase (COMT) G1947A genes.

Results

31 infants, mean age 8.9 months (± 1.9); mean weight 8.5 kg (± 1.1) were included in the final study analysis. With every 0.1 unit increase in peak values noted on SC, the odds of higher pain scores were found to be 5% greater (p = 0.03). For predictability of moderate to severe pain, the area under the curve, sensitivity and specificity were 0.64, 90.9% and 51.4% respectively for peak values and 0.66, 54.5% and 79.4% respectively for EDR/s values. Genotyping performed in 16 out of 31 infants demonstrated that the carriers of MOR 118G allele had consistently higher basal SC values in the PACU.

Conclusion

Peak SC values may serve as indicators of unmitigated pain. Further studies are needed to fully investigate the effect of MOR A118G SNP on the post operative pain scores and SC values in the larger infant population in order to validate both the clinical significance of the skin conductance for routine pain assessment in infants and the observed genetic effect.     

Acute cardiovascular responses in preterm infants at 34–39 weeks of gestational age

Background

Premature infants demonstrate immature physiological control mechanisms; however their acute cardiovascular control has not yet been widely studied.

Aim

The aim of this study was to analyze heart rate (HR) and blood pressure (BP) control in preterm infants.

Subjects

Twenty preterm infants with a mean gestational age of 31 ± 2.4 (26–34) weeks at birth were evaluated at a gestational age of 36 ± 1.5 (34–39) weeks. Results were compared to twenty, healthy, full-term, control infants studied at the age of 12 ± 3 weeks.

Outcome measures

HR and BP responses to 45° head-up tilt and side motion tests during non-rapid eye movement sleep were analyzed. In addition, HR responses to spontaneous arousals from non-rapid eye movement sleep were evaluated.

Results

Preterm infants showed significantly smaller initial HR and BP responses compared with controls in head-up tilt (HR p = 0.0005, systolic BP p = 0.02, diastolic BP p = 0.01) and side motion tests (HR p = 0.002, systolic BP p < 0.0001, diastolic BP p < 0.0001). Furthermore, in tilt tests, preterm infants presented with greater intersubject variability in BP responses than controls (systolic BP p = 0.009, diastolic BP p = 0005). Preterm HR responses to spontaneous arousals were similar to controls.

Conclusions

This study indicates immature vestibulo-mediated cardiovascular control in preterm infants compared with term infants. This is seen as attenuated BP responses to side motion test and more labile acute BP control to postural challenge.     

Mode of delivery may influence neonatal responsiveness to maternal separation

Introduction

Maternal–infant separation (MIS) is a highly stressful situation for the neonate.

Materials and methods

A study was conducted to observe and describe the reactions of term neonates to brief maternal separation and restoration of skin contact within the first 48 h of life, and to assess whether the mode of delivery influences neonatal responsiveness. A brief maternal–infant separation situation was videotaped to observe the reactions of the newborns within the first 12–48 h of life. Characteristics observed in the newborns were: the Moro reflex, spreading out arms and feet, looking at the mother, presence/lack of crying, and some dichotomous variables (present or lacking); in mothers: adult speech, “motherese” speech, speaking to another adult present in the room, singing, clicking, tapping on the diaper, rocking, kissing the baby, touching toes, touching hands, changing position, making loving comments, calling the newborn by his/her name and touching his/her back. Crying on restoration of contact was measured.

Results

Ten neonates born by planned C-section and 21 neonates born by oxytocin-induced vaginal delivery were included. No behavioral differences were observed according to the mode of delivery. Neonates born by vaginal delivery took longer (64.8 ± 8.6 s) to calm down than those born by C-section (0.9 ± 1.4 s) (p = 0.004). A correlation was observed between cortisol concentrations at birth and the time required to calm the baby down (r = 0.41; p = 0.02).

Conclusion

Neonates born by a planned C-section cried much less on maternal separation, which might indicate an altered attachment behavior and altered response to stress. Further studies are needed to determine the potential long-term implications of variations in mother–infant attachment during the first days of life.     

The effect of socioeconomic status on the language outcome of preterm infants at toddler age

Background

Independently, both prematurity and low socioeconomic status (SES) compromise language outcome but less is known regarding the effects of low SES on outcome of prior preterm infants at toddler age.

Aim

To assess SES effects on the language outcome of prior preterm infants at toddler age.

Study design

Retrospective chart review of infants born at ≤ 32 weeks, matched for gestational age (GA), birth weight (BW), chronic lung disease (CLD), periventricular leukomalacia (PVL), right and left intraventricular hemorrhage (IVH-R, L), and age at Bayley Scales of Infant Development III (BSID-III) testing.

Subjects

Using insurance status as a proxy for SES, 65 children with private insurance (P-Ins) were matched with 65 children with Medicaid-type insurance (M-Ins).

Outcome measures

Bayley Scales of Infant Development-III Language Composite.

Results

M-Ins vs. P-Ins were similar in GA, BW, and age at BSID-III testing (mean 22.6 months adjusted), as well as other matched characteristics (all p ≥ 0.16). BSID-III Language Composite scores were lower in M-Ins than P-Ins (87.9 ± 11.3 vs. 101.9 ± 13.6) with a clinically significant effect size of 0.93 (p < 0.001). Overall, 45% of M-Ins exhibited mild to moderate language delay compared to 8% of P-Ins. Receptive and Expressive subscale scores also were lower in M-Ins than in P-Ins (both p < 0.001).

Conclusions

In this preterm cohort, by toddler age, M-Ins was associated with lower scores on measures of overall language as well as receptive and expressive language skills. Our findings, showing such an early influence of SES on language outcome in a cohort matched for biomedical risk, suggest that very early language interventions may be especially important for low SES preterm toddlers.