Changes in the fatty acid composition of plasma and red blood cell membrane during the first hours of life in human neonates

The objective of this work was to examine the changes in the fatty acid profiles of plasma lipid fractions and red blood cell membrane phospholipids in newborn infants during the first 6-8 h of life. Methyl esters of fatty acids from plasma free fatty acids and phospholipids and from membrane phosphatidylethanolamine, phosphatidylcholine and sphingomyelin for cord blood (n = 20) and venous blood (n = 19) were analyzed by GLC. Important changes were observed in plasma fatty acids. Palmitic and palmitoleic acid increased from birth to 6-8 h of age for both free fatty acids and phospholipids. Palmitic acid also increased in membrane phosphatidylcholine and phosphatidylethanolamine. In the former, stearic acid declined whereas oleic and docosatetraenoic acids increased. Phosphatidylethanolamine and sphingomyelin were less affected than phosphatidylcholine probably because the internal location of the two first fractions in erythrocyte membrane. Polyunsaturated fatty acids dropped slightly during the first hours of life in most lipid fractions. This may be a consequence of the interruption of placental fatty acid supply and the limited capacity of the newborn to desaturate their essential fatty acid tissue stores.     

Serum potassium level in healthy neonates and infants with asphyxia in the first 144 hours of life

Postpartal increase in the plasma potassium concentration of asphyxiated newborn infants is a very rare complication with possibly deleterious outcome. In a group of 98 asphyxiated and 87 healthy infants we have not seen either a case of severe hyperkalemia or rhythm disturbances. We found lower reference-ranges for plasma potassium concentration in the group of healthy infants than previously published, which we would like to introduce. The pathogenesis of hyperkalemia in hypoxia is not yet fully understood. Further experimental investigations will be necessary.     

Plasma testosterone and βHCG levels in the first twently-four hours of life in neonates with cryptorchidism

We determined serum concentrations of HCG and testosterone by specific radioimmunoassays in eight cryptorchid and 13 normal newborns in the first 24h of life.Mean serum HCG concentration in the cryptorchid infants (18.9±9.7 miu/ml) did not differ significantly from the control group (26.7±7.6 miu/ml). Mean serum testosterone level in the cryptorchid newborns (271±27 ng/dl) also did not differ significantly from the control group (333±30 ng/dl).These data suggest that HCG and testosterone concentrations on the first day of life are of the same magnitude in normal and cryptorchid infants.     

Transcutaneous bilirubin nomogram for healthy term and late preterm neonates in first 96 hours of life

Objective

To develop nomogram of Transcutaneous Bilirubin among healthy term and late-preterm neonates during first 96 hours of age.

Design

Longitudinal observational study.

Setting

Neonatal unit of a tertiary care Hospital of Central Gujarat, India.

Participants

1075 healthy term and late preterm neonates (≥35weeks).

Intervention

Six-hourly transcutaneous bilirubin was obtained from birth to 96 hour of life using Drager JM 103 Transcutaneous Bilirubinometer.

Main outcome measures

Nomogram of Transcutaneous Bilirubin with percentile values was obtained, rate of rise of bilirubin was calculated and predictive ability of normative data was analyzed for subsequent need of phototherapy.

Results

The age-specific percentile curves and nomogram were developed from the transcutaneous bilirubin readings of 1,010 neonates. Rate of rise in first 12 hour was 0.2 mg/dL and was 0.17 mg/dL in 12 to 24 hour of life which decreased on second day of life. Neonates who required phototherapy had consistently higher readings of transcutaneous bilirubin and also higher rate of rise in first 48 hrs.

Conclusion

Neonates whose transcutaneous bilirubin is above the 50th percentile should be monitored for the development of significant hyperbilirubinemia.

     

Apolipoprotein and lipid composition of plasma lipoproteins in neonates during the first month of life

In this study the lipid and apoprotein profiles were investigated in newborns at 0, 7, and 30 days of life. The plasma lipoproteins were separated both by ultracentrifugation and gel filtration in order to compare the patterns obtained by the two techniques. At birth, the apo E concentration is comparable to that measured in adults, but its distribution among lipoproteins is significantly different as more than 80% of the plasma apo E belongs to high-density lipoproteins (HDL). At 7 and 30 days the plasma apo E concentrations are close to the values at birth, but a significant redistribution occurs from HDL to very low-density lipoproteins. By analogy with apo B, the plasma apo CIII concentration is low at birth and increases between 0 and 7 days by a factor of about two. Plasma triglycerides increase significantly during the first week of life so that the apo CIII increase is most pronounced in very low-density lipoproteins. These lipoproteins therefore become enriched in apo E, apo CIII and triglycerides between 0 and 7 days. At birth, a distinct HDL fraction, enriched in apo E, apo AII and cholesterol (HDLE), could be detected. To compensate for the low LDL levels, this HDLE fraction might function as an additional source for cholesterol delivery to peripheral tissues via the apo (B, E) receptor. At later age, low-density lipoprotein synthesis is enhanced, apo E is transferred to very low-density lipoproteins, and cholesterol delivery via the HDLE becomes less important.(ABSTRACT TRUNCATED AT 250 WORDS)     

Necrotizing enterocolitis in the first 24 hours of life

Necrotizing enterocolitis (NEC) is commonly thought of as occurring in the sick premature infant, usually in the first one to two weeks of life. A review of NEC at the Children's Hospital of Denver over a 5-year period, found that 13 of 79 infants (16.1%) had onset of NEC during the first day of life. These infants were larger (mean birth weight 2,624 +/- 849 g), more mature (mean gestational age 37.9 +/- 2.5 weeks), and less asphyxiated as judged by Apgar scores (mean five-minute score 8.15 +/- 1.07) than infants with onset of NEC after the first day of life (mean birth weight 1,519 +/- 586 g, mean gestational age 32.0 +/- 3.5 weeks, P less than .001, and mean five-minute Apgar score 6.81 +/- 1.84, P less than .05). Despite their large size and degree of maturity, eight of these infants (62%) showed signs of respiratory distress; four (31%) were polycythemic; four (31%) had either a partial or double-volume exchange transfusion performed; and 11 (85%) were fed prior to developing NEC. Presenting signs of disease, occurrence of sepsis (31%), requirement for surgical intervention (62%), and mortality (30%) were similar for the two groups of infants. It is suggested that term and near-term infants who have significant illness after delivery be treated more like their premature counterparts with cautious introduction of feedings after an adequate period of stabilization.     

Open heart surgery in the first 24 hours of life

Summary The results of open heart surgery in infants have steadily improved. The performance of corrective surgery very early in life has thereby been encouraged. We report four patients who underwent successful surgical correction within 24 h of birth. Two patients with total anomalous pulmonary venous drainage and one patient with pulmonary atresia and intact septum were corrected with the aid of profound hypothermia by the combined surface and bypass cooling technique. Cardiopulmonary bypass alone was used for the fourth patient with aortic stenosis. The usual surgical techniques can be applied successfully to infants even within 24 h of life.     

Breast-feeding frequency during the first 24 hours after birth in full-term neonates

The relation between the frequency of breast-feeding and intake, weight loss, meconium passage, and bilirubin levels was studied in 140 healthy, full-term, breast-fed, Japanese neonates born vaginally without complications. Factors affecting the frequency of breast-feeding were also evaluated. Mothers nursed their neonates, on average, 4.3 +/- 2.5 (SD) times (range 0 to 11) during the first 24 hours after birth, and this frequency increased significantly to 7.4 +/- 3.9 times during the next 24 hours (P less than .001). There was a significant correlation between the frequency of breast-feeding during the first and second 24 hours after birth (r = .69, P less than .001). The frequency of breast-feeding during the first 24 hours correlated significantly with frequency of meconium passage (r = .37, P less than .01), maximum weight loss (r = -.22, P less than .05), breast milk intake on day 3 (r = .50, P less than .01) and day 5 (r = .34, P less than .05), transcutaneous bilirubin readings on day 6 (r = -.18, P less than .05), and weight loss from birth to time of discharge (day 7) (r = -.32, P less than .01). There was a strong dose-response relationship between feeding frequency and a decreased incidence of significant hyperbilirubinemia (transcutaneous bilirubin readings greater than or equal to 23.5) on day 6. The time of birth also affected the frequency of breast-feeding during the first 24 hours.(ABSTRACT TRUNCATED AT 250 WORDS)     

Oxygen saturation during the first 24 hours of life

AIM: To determine normative data for arterial oxygen saturation, measured by pulse oximetry (SpO2), in healthy full term infants throughout their first 24 hours of life. METHODS: Long term recordings of SpO2, pulse waveform, and breathing movements were made on 90 infants. Recordings were analysed for baseline SpO(2), episodes of desaturation (SpO2 /= four seconds, and periodic apnoea (>/= three apnoeic pauses, each separated by /= 20 seconds) were identified in six recordings. Four desaturations fell to 相似文献   

Ductus arteriosus blood flow during first 48 hours of life.

A volumetric Doppler technique was used to measure net ductus arteriosus shunt during the first 48 hours of life in 30 infants of less than 33 weeks'' gestation, and in 10 full term infants. In the full term infants a left to right shunt of 62 ml/kg/minute (95% confidence limits 43-82) shortly after birth decreased rapidly over the first 12 hours and was not measurable by 48 hours. The preterm infants had smaller left to right shunts shortly after birth--49 ml/kg/minute (95% confidence limits 38-59). There was no obvious subsequent change in the mean shunt, although by 48 hours there was greater variation in the size of the shunt. The respiratory distress syndrome did not affect the size of the ductal shunt, but the shorter the gestation period the larger the shunt by 48 hours. A ductal flow of greater than 70 ml/kg/minute at 48 hours of age predicted the subsequent development of a ductal murmur with 75% sensitivity and 100% specificity.     

A prospective pilot study of prophylactic treatment of preterm neonates with recombinant activated factor VII during the first 72 hours of life.

OBJECTIVE: Intraventricular hemorrhage (IVH) in the preterm infant is a devastating complication, causing marked mortality and morbidity. A general hemostatic agent such as recombinant activated factor VII (rFVIIa) might have the potential to reduce the extent of severe IVH. DESIGN: Prospective, single-arm pilot study. SETTING: Level III neonatal intensive care unit. PATIENTS: Ten preterm infants between 23 and 28 wks of gestation. INTERVENTION: Administration of a 100-microg/kg rFVIIa bolus injection within the first 2 hrs of life, followed by 100 microg/kg rFVIIa every 4 hrs, for the first 72 hrs of life. MEASUREMENTS AND MAIN RESULTS: Cranial ultrasonography and flow studies of the major arteries and the venae cava, aorta, vena portae, and venae renales, was performed at study enrollment and at 12 hrs, 24 hrs, 48 hrs, and 72 hrs. Blood cell counts and coagulation studies were performed. End points of the study were occurrences of adverse events, with an emphasis on thrombotic events or disseminated intravascular coagulation (DIC). Ten preterm infants with a gestational age of 23 wks 1 day to 28 wks 3 days were included. None had venous thrombosis or cerebral infarction during or after the treatment. Neither platelet consumption nor DIC was observed. Two infants with an umbilical artery catheter had a thrombus at the catheter tip (one during infusion of the study drug), which was successfully treated with heparin. One had grade III IVH and died on day 6 of life; in another, grade II IVH progressed to grade III after termination of the drug. CONCLUSION: One hundred microg/kg rFVIIa does not accumulate if administered prophylactically to preterm infants of <28 wks of gestation every 4 hrs in the first 72 hrs of life. In this population, rFVIIa does not cause DIC. Thrombus formation was observed in two infants with umbilical artery catheters but in none of the infants with venous catheters. Embolic events were not observed. In this pilot study, which did not provide the sample size to assess any effect of rFVIIa on the incidence of IVH, 20% of the neonates went on to have grade III or IV IVH, which is similar to the rate in studies in which rFVIIa was not given.     

Risk factors associated with feed intolerance in very low birthweight infants following initiation of enteral feeds during the first 72 hours of life

An observational study was carried out in the Kuala Lumpur Maternity Hospital to determine the risk factors associated with feed intolerance in very low birthweight (VLBW, <1501 g) infants given intermittent 3-hourly enteral feeds within 72h after birth. Feed intolerance developed in 85 (64.4 per cent) of 132 infants. Logistic regression analysis showed that the only significant risk factor associated with feed intolerance was the age when the first feed was commenced. For each hour delay in the age of the infants when the first feed was given, the adjusted odds ratios of feed intolerance was 1.03 (95 per cent confidence intervals: 1.01-1.05; p = 0.01). Other factors (modes of delivery, Apgar score at 1 min, sex, ethnicity, history of resuscitation at birth, birthweight, gestation, multiple pregnancy, perinatal asphyxia, types of milk, hypothermia before first feed, hypotension before first feed, respiratory distress syndrome, patent ductus arteriosus, septicaemia, theophylline therapy, indomethacin therapy, ventilatory support, continuous positive airway pressure, umbilical catheterization, and surfactant therapy) were not significantly associated with feed intolerance. Our study suggests that to promote tolerance of enteral feeds in VLBW infants, intermittent orogastric feeds should be commenced as soon as possible during the first 72 h of life.