Prothrombin time in first week of life with special reference to vitamin K administration

Prothrombin time was estimated in 100 neonates (80 full term and 20 preterm). Among the full term infants 50 were healthy and 30 sick. Prothrombin time was altered in neonates with birth hypoxia and prematurity (p less than 0.001). Vitamin K administration to anoxic babies resulted in improvement in prothrombin time after 48-72 hours (p less than 0.001). Four newborns has bleeding, 2 had anoxia and 2 were only in preterms who did not receive vitamin K after birth. It is concluded that vitamin K should be given to all preterms and those with difficult deliveries; term, healthy newborns do not need it.     

Serum apolipoproteins and lipoprotein (a) during the first week of life

The levels of apolipoproteins, A-I, A-II, B and E, lipoprotein (a) and of total cholesterol and triglycerides were determined in cord serum and in capillary serum at the fifth day of life in a group of 44 term newborns. Additionally, cord serum lipoproteins were estimated. Sera from 26 healthy adults were studied for comparison. The concentrations of lipids and lipoproteins in cord serum were diminished as compared to adult levels. The occurrence of lipoprotein (a) in cord serum in concentrations significantly lower than in adults could be established. Serum apolipoproteins A-I, A-II and B were significantly lower at birth than in the adult, whereas apolipoprotein E levels did not differ from adult concentrations. During the first five days apolipoprotein B levels more than doubled, apolipoprotein A-I increased moderately and apolipoprotein E rose slightly. In contrast, serum lipoprotein (a) and apolipoprotein A-II did not change significantly. Unlike serum cholesterol, the levels of apolipoproteins B and E at day five were significantly correlated to those measured at birth in the same infants. The changes of the apolipoprotein pattern during the first week of life reflect the evolution of the lipid transport system of the newborn and may be related to the increasing utilisation of fat and to hormonal factors.     

Relationship of milk intake and vitamin K supplementation to vitamin K status in newborns

Vitamin K status was evaluated by measuring blood acarboxyprothrombin (PIVKA-II) levels on the fifth day of life. The incidence of PIVKA-II-positive infants was higher in breast-fed babies than in those given supplementary (mixed) feeding. The median of total amount of milk intake during the first 3 days was significantly lower in PIVKA-II-positive infants than in PIVKA-II-negative infants among infants given both types of feedings. In addition, there was a significant negative correlation between a positive PIVKA-II proportion and the amount of milk intake in the breast-fed babies. The minimum dose of vitamin K2 necessary to prevent a positive PIVKA-II reading was 15 micrograms among babies with a normal absorption potential.     

Breastfeeding and vitamin D status in Greece during the first 6 months of life

Since no foods are vitamin D supplemented in Greece, vitamin D status was assessed in mothers at birth and their infants up to the first 6 months of life, while they were exclusively breast-fed. This was a prospective study. Full-terms ( n =35) born during the summer-autumn months and their mothers were assigned to the summer group and the remainder ( n =31) to the winter group. One week after birth, serum 25-hydroxyvitamin D (25OHD) was significantly lower in the winter-born than in the summer-born neonates (6.7±0.7 vs. 10.1±0.9 ng/ml, P <0.01). The respective levels of parathyroid hormone (iPTH) were 64.9±13.4 and 33.9±4.4 pg/ml ( P <0.01). The mothers had serum 25OHD levels of 10.8±1.0 ng/ml and iPTH levels of 15.2±3.5 pg/ml in the winter and 12.9±1.3 ng/ml and 24.8±4.8 pg/ml in the summer. During the 6-month follow-up, a steady increase in circulating 25OHD (up to 19.4±2.8 ng/ml, P <0.0001) and a decrease in iPTH (to 26.8±3.5 pg/ml, P =0.10) were observed in the infants born in the winter. In the summer-born infants, serum 25OHD did not change but iPTH had increased significantly by the 3rd month (59.4±21.8, P <0.05). Serum calcium (Ca) increased within normal limits during the study period in both groups. Serum phosphorus (Pi) started higher in the winter group (7.43±0.38 vs. 6.27±0.23 mg/dl, P <0.01) but thereafter, it was similar in both groups. Total alkaline phosphatase (ALP) increased in both groups during the study (164±15 vs. 219±17 IU/l, P <0.05 and 189±14 vs. 288±35 IU/l, P <0.001, respectively). Serum osteocalcin (OC) decreased in the winter-born neonates (32.0±3.4 vs. 21.5±3.4 ng/ml, P <0.05) and did not change in the summer group (28.9±3.5 vs. 26.5±2.8 ng/ml). Conclusion:Neonates who are breast-fed exclusively during the first 6 months of life are in need of vitamin D supplementation irrespective of the season even in a sunny country like Greece where foods are not supplemented.     

Oral vitamin K1 prophylaxis for newborns with a new mixed-micellar preparation of phylloquinone: 3 years experience in Switzerland

In 1995, a new water-soluble mixed-micellar analogue of vitamin K₁ (Konakion MM paediatric) was introduced in Switzerland to replace the formerly used fat-soluble Konakion drops for the prevention of vitamin K₁-deficiency-bleeding (VKDB) in infants. According to the new guidelines, an oral dose of 2 mg is given after birth and again on the 4th day of life. We examined the compliance with these guidelines and the impact on the incidence of VKDB. To assess compliance, questionnaires were sent to all hospitals with delivery services 6 months after the introduction of the new guidelines. Using the database of the Swiss Paediatric Surveillance Unit (SPSU) which records rare paediatric diseases, we assessed the incidence of VKDB in Switzerland between July 1995 and June 1998. In addition, we determined the precise circumstances under which the episodes of VKDB occurred. More than 99% of infants received vitamin K₁ prophylaxis. Since July 1995, 93% of newborns have received prophylaxis according to the new guidelines; the remaining infants were given fat-soluble Konakion drops or parenteral vitamin K₁. Within 3 years, one case of classical and 12 cases of late-onset VKDB (11 confirmed, 1 probable) were reported to the SPSU. Of the 11 confirmed late-onset cases, 7 received the recommended prophylaxis, whereas 3 had not and 1 had been given fat-soluble Konakion drops. All confirmed cases of late-onset VKDB occurred in fully breast-fed infants and 8 of 11 had hepatobiliary disease. Conclusion With the introduction of two oral doses of a mixed-micellar vitamin K₁ preparation administered in the 1st week of life, the incidence of late vitamin K₁-deficiency-bleeding has decreased from 7.2:100 000 between 1986–1987 to 2.8:100 000 between 1995 and 1998. This regimen may be suitable for prophylaxis of vitamin K₁-deficiency-bleeding, however, it does not fully protect infants with cholestatic disease from late-onset bleeding. If oral prophylaxis is considered for these infants, vitamin K₁ has to be administered repeatedly to all infants during the breast feeding period. Received: 13 October 1998 / Accepted in revised form: 5 January 1999     

临床和血流动力学稳定的早产儿生后第1周灌注指数变化

重症监护病房的新生儿,尤其是早产儿,生后第1周患病和死亡率较高,因而早期诊断新生儿各种并发症是新生儿医务工作者面临的巨大挑战。近年来,脉搏血氧仪(简称脉氧仪)已成为新生儿重症监护病房(NICU)的重要监测仪器之一。据报道,通过脉氧仪信号得出的灌注指数(perfusion index,PI)能反映外周血流的实时变化,并识别外周循环灌注不足的重症新生儿。近期已有报道新生儿PI值的相关文献,但关于早产儿的还较少。本研究旨在监测临床和血流动力学稳定早产儿生后第1周的PI值,从而为临床上推广应用提供依据。研究方法一、研究对象2007年11月至2008年4月入住意大利某儿童医院NICU的30例早产儿。入选     

临床和血流动力学稳定的早产儿生后第1周灌注指数变化

重症监护病房的新生儿,尤其是早产儿,生后第1周患病和死亡率较高,因而早期诊断新生儿各种并发症是新生儿医务工作者面临的巨大挑战。近年来,脉搏血氧仪（简称脉氧仪）已成为新生儿重症监护病房（NICU）的重要监测仪器之一。     

Net acid excretion during first week of life

Metabolic acidosis occurs frequently in newborns. Net acid excretion (NAE) in 34 preterm and 12 term infants was measured during the first week of life. Twenty preterm infants received breast milk or formula; the remaining infants received total parenteral nutrition (TPN) -- synthetic amino acids or casein hydrolysate solution. NAE for breast milk vs formula fed infants was 5.4 +/- 0.4 and 7.8 +/- 0.6 muEq/min/m2 (mean +/- SEM). The corresponding values for the two TPN solutions in preterm infants were significantly higher at 12.5 +/- 1.4 and 19.4 +/- 3.5 muEq/min/m2. Term infants produced even greater amount of net acid, 20.6 +/- 2.9 and 35 +/- 3.7 muEq/min/m2 respectively for the two TPN solutions. Milk fed infants are less prone to acidosis because of base generated from milk consumption. Due to its inherent acidogenic effect, TPN solutions induce acidosis more readily. Infants receiving TPN are therefore required to generate a higher NAE rate to maintain acid-base homeostasis compared to milk fed infants.     

Heme oxygenase-1 expression in premature and mature neonates during the first week of life

Newborns are exposed to mechanical and oxidative stress during labor and to relative hyperoxia thereafter during the course of adaptation to the extrauterine conditions. Part of the adaptation mechanism is the rapid degradation of fetal hemoglobin and the oxidation of its heme moiety by heme oxygenases (HOs). Heme oxygenase-1 enzyme (HO-1) is the inducible isoform, which is induced by and protective against oxidative stress. We hypothesized that HO-1 may play a role in the physiological adaptation of newborns. We therefore measured the HO-1 mRNA expression with cRT-PCR during the first week after birth in healthy mature and premature newborns. We found that HO-1 was induced until day 2 or 3 after birth, but its level had dropped below the birth HO-1 mRNA level by the end of the first week. HO-1 levels and inducibility were similar in mature newborns and premature newborns. The fact that HO-1 was inducible even in gestation week 26 suggests that HO-1 plays an important role in the early adaptation processes.     

Lipoproteins in preterm and small-for-gestational-age infants during the first week of life

Plasma lipoprotein levels and composition have been determined in preterm and small-for-gestational-age (SGA) infants, and compared to full-term infants, during the first week of life. Significantly lower levels of HDL and higher levels of VLDL were found in both preterm and SGA infants in comparison to full-term healthy infants. These results suggest a low capacity to metabolize VLDL. Preterm infants showed a behaviour similar to full-term infants with regard to the changes in lipoprotein composition. Small-for-gestational-age infants showed a higher lipoprotein lipid content than preterm infants. A low ratio of cholesteryl ester to free cholesterol (CE/FC) was found in both preterm and SGA infants suggesting a reduced lecithin: cholesterol acyl transferase (LCAT) activity. In preterm infants we observed no changes in the CE/FC ratio during the first week of life, whereas in SGA infants this ratio increased after birth.     

Fever in healthy asymptomatic newborns during the first days of life

OBJECTIVE: To determine the characteristics of febrile full term infants during the first days of life, and to discover the rate of serious bacterial infections among low risk neonates with systemic fever. DESIGN: A retrospective case-control study of 122 cases and 122 controls in a single institution. RESULTS: Weight loss, breast feeding, caesarean section delivery, and high birth weight were found to be the most significant predictors of developing fever during the first days of life. Of the 122 patients in the study group, only one had a serious bacterial infection (a positive urine culture for group B streptococcus). CONCLUSIONS: In low risk full term infants, fever with no other symptoms during the first days of life (but after the first day) is related primarily to dehydration, breast feeding, caesarean section, and high birth weight. Infection is the least common explanation.