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.

     

Serum creatinine and creatinine clearance in healthy neonates and prematures during the first 10 days of life

Normal serum creatinine (Scr) and creatinine clearance (Ccr) values during the first 10 days of life were obtained in 63 very premature (28–32 weeks of gestation), premature (33–37 weeks) and term infants (38–42 weeks). Scr fell, and Ccr rose less markedly in the very premature infants. Scr was 80 mol/l on the 1st day of life both in very premature and premature infants, and 77 mol/l in full-term neonates. After 10 days, Scr was 73, 53 and 35 mol/l respectively. There was an exponential correlation between Ccr and gestational age, indicating rapid maturation of glomerular function.Abbreviations Scr serum creatinine - Ccr creatinine clearance - GA gestational age - GFR glomerular filtration rate     

Serum ghrelin concentration and weight gain in healthy term infants in the first year of life

OBJECTIVES: Ghrelin, a recently discovered hormone mainly secreted by the stomach, has several metabolic functions including regulation of food intake, energy homeostasis and body weight. There are few studies on this hormone in healthy infants during the first year of life. The aim of this study was to examine the correlations between ghrelin and weight gain in healthy term infants in the first year of life. METHODS: 104 healthy term infants aged 0 to 12 months were included in a cross-sectional study. Anthropometric measurements were assessed and mean weight gain was calculated. Serum ghrelin concentrations have been determined at least 3 hours after feeding by radioimmunoassay test. RESULTS: Ghrelin concentrations were correlated negatively to weight gain (r=-0.302; P=0.003) and positively to age (r = 0.412; P < 0.001), weight (r = 0.374; P < 0.001) and length (r=0.387; P<0.001). In breastfed infants a statistically significant negative correlation between ghrelin concentration and infant weight gain (r=-0.407; P=0.001) was observed, whereas in formula-fed infants this correlation was not statistically significant (r=-0.067; P=0.719). CONCLUSIONS: The negative correlation observed between ghrelin concentration and infant weight gain suggests that ghrelin might also play a role in the regulation of body weight in healthy infants with a physiologic energy balance. Further studies are needed to clarify how ghrelin might be involved in both short-term and long-term energy balance.     

足月窒息儿24小时内脑血流动力学变化

目的　研究足月新生儿窒息 2 4h内脑血流速度及阻力指数的改变 ,探讨新生儿窒息并发缺氧缺血性脑病 (HIE)的发病机制。方法　应用经颅彩色多普勒超声检测 3 7例有出生窒息史的新生儿脑血流速度及阻力指数变化 ,并与同期无出生窒息史 10例新生儿进行比较。结果　重度窒息尤其并发HIE新生儿于生后6± 2h、12± 3h右侧大脑中动脉血流速度明显增快 ,阻力指数明显降低 ;直至出生 2 4h ,中、重度HIE组脑血流速度仍明显增快 ,阻力指数明显降低。结论　窒息并发HIE新生儿多数在出生 12h内大脑中动脉存在血管麻痹和过度灌注 ,至出生 2 4h中、重度HIE患儿仍未能恢复     

新生儿窒息血中胃泌素水平改变及其临床意义的探讨

目的：探讨新生儿窒息血中胃泌素水平的改变及其临床意义。方法：对36例窒息足月新生儿血中胃泌素浓度进行了放免测试,并与38例正常足月新生儿相比较,同时探讨了与其它临床因素间的关系。结果：窒息足月新生儿血清胃泌素浓度(115±5) ng/L明显低于正常足月新生儿对照组(t=2.854,P<0.01),窒息后患儿开奶前胃泌素浓度与1分钟Apgar评分、采血时日龄(h)、第7日龄时进奶量(ml/日)因素影响呈正相关(r=0.82)。结论：窒息新生儿血清胃泌素浓度明显低于正常;1分钟Apgar评分对窒息后新生儿生后胃泌素水平影响最大且呈正相关;胃泌素对新生儿消化道成熟起促进作用。     

窒息新生儿血清同型半胱氨酸与叶酸的变化

目的：探讨血清中高同型半胱氨酸（Hcy）血症及低叶酸水平与新生儿窒息的发生是否具有相关性,并对性别、胎龄等因素对血清中同型半胱氨酸及叶酸水平是否有一定影响进行分析。方法：应用酶联免疫吸附实验方法检测血清中Hcy水平,应用放射免疫法测定血中叶酸浓度。结果：①与无窒息对照组相比, 新生儿窒息患儿血清Hcy水平显著升高,而叶酸水平显著降低;②窒息组男婴血清Hcy、叶酸水平分别为15.82 ±2.51 μmol/L; 2.49 ±0.19 ng/mL,女婴为10.50±2.19 μmol/L; 2.38±0.40 ng/mL,男、女婴之间比较差异无显著性;③窒息组足月儿血清Hcy、叶酸水平为12.34 ±2. 01 μmol/L,2.58 ±0.19 ng/mL;早产儿为21.25±5.01 μmol/L; 2.14±0.34 ng/mL。早产儿Hcy水平显著高于足月儿（P<0.05）。结论：①新生儿窒息与血清Hcy及叶酸水平具有显著相关性。②血清Hcy及叶酸水平在性别上无显著差异。③缺氧窒息合并早产者血清Hcy水平升高最为显著。     

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.     

母乳喂养早产儿血清维生素E水平动态变化

目的：探讨母乳喂养健康早产儿血清维生素E水平的动态变化以及临床对于健康早产儿是否需要常规补给维生素E。方法：38例母乳喂养的健康早产儿随机分成干预组(n=20)和对照组(n=18),干预组早产儿于出生当天第1次采血后每天给予维生素E 50 mg肌肉注射,连续3 d;对照组不给予维生素E。用荧光分光光度计测定两组早产儿出生后0,10,30 d的血清维生素E水平,并作比较分析。结果：两组早产儿出生时血清维生素E水平,干预组1.64±0.68 mg/dL;对照组1.76±0.74 mg/dL差异无显著性(P>0.05);两组早产儿在生后10 d时血清维生素E均呈升高趋势,干预组2.54±1.23 mg/d l,对照组2.64±1.13 mg/dL,两组间差异无显著性,(P>0.05)。生后30 d时,干预组血清维生素E仍维持原增高水平,而对照组血清维生素E呈下降趋势,干预组2.77±1.56 mg/dL,对照组为2.37±1.07两组差异无显著性(P>0.05)。各时间点,两组早产儿血清维生素E均高于0.5 mg/dL(范围0.59~6.45 mg/dL)。结论：母乳喂养健康早产儿生后30 d内血清维生素E与用维生素E干预组比较无显著差别,且两组早产儿都无维生素E缺乏发生。故认为对于母乳喂养早产儿无需常规补给维生素E。[中国当代儿科杂志,2005,7(6):503-505]     

Pulse oximetry saturations in the first 6 hours of life in normal term infants

The pulse oximetry saturation values and the average percentage of time that normal newborns spend at different saturation ranges in the first 6 hours of life were determined in a cross-sectional study. Pulse oximetry saturation values were measured for a single 20-minute period in 101 normal term newborns between 20 minutes and 6 hours of age. The 25th percentile saturation values in the first postnatal hour (range 91%-100%) were lower than those from the second postnatal hour (range 96%-100%) onward. There was no significant difference between the 50th percentile (range 96%-100%) and the 75th percentile (range 97%-100%) saturation values in all postnatal hours. The babies spent a majority of time with saturations > or = 96% in all postnatal hours. A newborn more than 20 minutes old who does not achieve a pulse oximetry saturation value of 96% over several minutes of observation may need evaluation or continuous monitoring.     

Enzyme activity in serum of healthy newborn infants. Normal values of CPK, gamma-GT, GOT, GLDH. LAP, LDH and HBDH in the first 144 hours of life]

QUESTION: There are no available enzyme determinations for the neonatal period taking in account the considerable changes during the first hours of life. Moreover, in former studies the number of probands has been small and no standardized and optimized methods have been used for the determinations. It was the aim of the presented study to evaluate reference ranges for these enzymes in healthy newborns for the first week of life. METHODS: We realized a controlled-prospective study about the serum activities of CPK, GGT, GOT, GLDH, LAP, LDH, and HBDH in healthy newborns (n = 87). The enzyme determinations were done for the first time in a serial manner at five fixed times: post partum (cord), 12, 24, 72, and 144 hours post partum with optimized test-kits. RESULTS: The evaluated serum enzyme activities are stated with median, 25th, and 75th percentile by rank. We propose these results as reference ranges for these enzyme activities during the first 144 hours of life. CONCLUSION: For the first time reference ranges for serum enzyme activities concerning the striking activity changes during the first hours of life are evaluated for healthy newborn infants. These results enable comparative investigations in the case of newborn diseases.     

Coagulation and fibrinolytic factors in the first week of life in healthy infants

Coagulation and fibrinolytic factors were determined daily in 74 healthy term and preterm infants to obtain a reference standard. A gestational age dependency was determined for antithrombin III, factor II, and plasminogen. The mean concentrations of antithrombin III and factor II in preterm infants increased to term values within the first week of life. Factor X levels declined independent of vitamin K administration. The values for the fibrinolytic system (alpha 2-antiplasmin and plasminogen) remained stable.     

新生儿血浆胆红素水平与窒息的关系探讨

目的探讨窒息新生儿血浆胆红素水平的变化。方法对39例窒息新生儿(重度组20例,轻度组19例)及同期出生的正常足月新生儿22例(对照组),分别于出生后4～5天胆红素高峰期进行足跟毛细血管血胆红素水平测定。结果重度组低于轻度组,P＜0.01;轻度组低于对照组,P＜0.01,各组间均存在显著性差异。结论新生儿室息后胆红素水平的降低与如下因素有关①胆红素作为抗氧化剂被窒息后再灌注损伤产生的大量氧自由基所消耗,②宫内室息后胎粪排出,肠肝循环减少,③窒息时胆囊扩张、胆汁潴留。