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Abstract
AbstractThe treatment of newborns in a disaster zone can be extremely challenging. The effects of the disaster combine with local health care disparity to give these neonates little chance of survival in the event of even minor complications. Rescue teams arriving at such locations must be prepared to handle and to aid these difficult situations using improvisation and ingenuity to overcome many of the unexpected hurdles. A discussion of the difficulties faced in the Philippines following a typhoon and recommendations for future teams are presented.MendlovicJ, AlbukrekD, DaganD, MerinO, WeiserG. Improvised neonatal care‒realizing the gaps in a disaster zone. Prehosp Disaster Med. 2016;31(1):111–113.
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102
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Abstract
Gene-environment interactions likely account for some degree of the variance in response rates that are clinically observed with antenatal corticosteroids, breast milk prophylaxis, surfactant administration, early recognition and treatment of sepsis, utility of non-invasive ventilation, and judicious exposure to supplemental oxygen. While these therapies and practice guidelines have significantly decreased overall neonatal mortality in the NICU, they have not made a marked impact on the frequency and severity of conditions such as bronchopulmonary dysplasia (BPD), necrotizing enterocolitis, and periventricular leukomalacia. One possible explanation is that genetic factors in the neonate modulate response to external intervention or preventative agents, culminating in variable levels of injury and different degrees of resolution and repair. Gene-environment explanations are supported by the observed heritability of BPD in twin studies, but they do not differentiate the interactions between neonate and offending toxin or pathogen, from interactions between neonate and intervention or therapeutic agent. Likely, both kinds of interactions are important in determining outcome.
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Affiliation(s)
- Vineet Bhandari
- Division of Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT; Yale Child Health Research Center, Department of Pediatrics, Yale University School of Medicine, New Haven, CT.
| | - Jeffrey R Gruen
- Division of Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT; Yale Child Health Research Center, Department of Pediatrics, Yale University School of Medicine, New Haven, CT; Department of Genetics, Yale University School of Medicine, New Haven, CT; Department of Investigative Medicine, Yale University School of Medicine, New Haven, CT
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103
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Duppré P, Sauer H, Giannopoulou EZ, Gortner L, Nunold H, Wagenpfeil S, Geisel J, Stephan B, Meyer S. Cellular and humoral coagulation profiles and occurrence of IVH in VLBW and ELWB infants. Early Hum Dev 2015; 91:695-700. [PMID: 26529174 DOI: 10.1016/j.earlhumdev.2015.09.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 08/05/2015] [Accepted: 09/14/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND STUDY PURPOSE Intraventricular hemorrhage (IVH) is a major complication in preterm neonates with significant long-term morbidity and an increased mortality rate. The role of the immature coagulation system in the pathogenesis of IVH in these infants is still under debate. The aim of this study was to provide reference values for coagulation studies within the first 24h of life, and to relate these findings to the incidence of IVH. PATIENTS AND METHODS In this retrospective study, a total of 250 (male: 123/female: 127; VLBW: 150 and ELBW: 100) infants were included over a 4-year-period. Coagulation studies were performed within the first 24h of life in all infants. Multiple regression analysis was employed to demonstrate a potential association between IVH and a number of known risk and protective factors for IVH (antenatal steroids, birth weight, gender, IUGR, APGAR score at 10minutes, platelet count, INR, PTT, fibrinogen). RESULTS Mean birth weight was 1047.9±305.6 (range: 320-1490g). Both cellular (platelets, nucleated red blood cells) and plasmatic coagulation parameters (INR, fibrinogen and antithrombin III) were dependent on birth weight. Moreover, INR levels (p<0.05) were significantly increased in neonates with IVH of any grade. Also, INR was positively correlated with the severity of IVH (Spearman's correlation coefficient: 0.193; p=0.003). While overall fibrinogen levels were not associated with IVH, a fibrinogen level<100mg/dL significantly increased the risk for IVH (p<0.01). CONCLUSIONS Our data provide a robust set of reference values for both cellular and humoral coagulation studies in VLBW and ELBW infants for the first 24h of life. The results of our study indicate that abnormal INR levels and fibrinogen levels<100mg/dL are significantly associated with the occurrence of IVH in this susceptible cohort.
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Affiliation(s)
- Perrine Duppré
- University Hospital of Saarland, Medical School, Germany
| | - Harald Sauer
- University Children's Hospital of Saarland, Department of Pediatric Cardiology, Germany
| | - Eleni Z Giannopoulou
- University Children's Hospital of Saarland, Department of Pediatrics and Neonatology, Germany
| | - Ludwig Gortner
- University Hospital of Saarland, Medical School, Germany; University Children's Hospital of Saarland, Department of Pediatrics and Neonatology, Germany
| | - Holger Nunold
- University Children's Hospital of Saarland, Department of Pediatrics, Germany
| | - Stefan Wagenpfeil
- University Hospital of Saarland, Institute of Medical Biometry, Epidemiology, and Medical Informatics, Germany
| | - Jürgen Geisel
- University Hospital of Saarland, Clinical Chemistry and Laboratory Diagnostics, Germany
| | - Bernhard Stephan
- University Hospital of Saarland, Department of Clinical Hemostaseology, Germany
| | - Sascha Meyer
- University Hospital of Saarland, Medical School, Germany; University Children's Hospital of Saarland, Department of Pediatrics and Neonatology, Germany.
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104
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Tang J, Tao Y, Jiang B, Chen Q, Hua F, Zhang J, Zhu G, Chen Z. Pharmacological Preventions of Brain Injury Following Experimental Germinal Matrix Hemorrhage: an Up-to-Date Review. Transl Stroke Res 2015; 7:20-32. [PMID: 26561051 DOI: 10.1007/s12975-015-0432-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 10/24/2015] [Accepted: 11/02/2015] [Indexed: 12/19/2022]
Abstract
Germinal matrix hemorrhage (GMH) is defined as the rupture of immature blood vessels in the subependymal zone of premature infants with significant mortality and morbidity. Considering the notable social and ecological stress brought by GMH-induced brain injury and sequelae, safe and efficient pharmacological preventions are badly needed. Currently, several appropriate animal models are available to mimic the clinical outcomes of GMH in human patients. In the long run, hemorrhagic strokes are the research target. Previously, we found that minocycline was efficient to alleviate GMH-induced brain edema and posthemorrhagic hydrocephalus (PHH) in rats, which may be closely related to the activation of cannabinoid receptor 2 (CB2R). However, how the two molecules correlate and the underlined molecular pathway remain unknown. To extensively understand current experimental GMH treatment, this literature review critically evaluates existing therapeutic strategies, potential treatments, and potentially involved molecular mechanisms. Each strategy has its own advantages and disadvantages. Some of the mechanisms are still controversial, requiring an increasing number of animal experiments before the therapeutic strategy would be widely accepted.
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Affiliation(s)
- Jun Tang
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, No. 30, Gaotanyan Street, Chongqing, 400038, People's Republic of China
| | - Yihao Tao
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, No. 30, Gaotanyan Street, Chongqing, 400038, People's Republic of China
| | - Bing Jiang
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, No. 30, Gaotanyan Street, Chongqing, 400038, People's Republic of China
| | - Qianwei Chen
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, No. 30, Gaotanyan Street, Chongqing, 400038, People's Republic of China
| | - Feng Hua
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, No. 30, Gaotanyan Street, Chongqing, 400038, People's Republic of China
| | - John Zhang
- Department of Neurosurgery, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Gang Zhu
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, No. 30, Gaotanyan Street, Chongqing, 400038, People's Republic of China.
| | - Zhi Chen
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, No. 30, Gaotanyan Street, Chongqing, 400038, People's Republic of China.
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105
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Neary E, McCallion N, Kevane B, Cotter M, Egan K, Regan I, Kirkham C, Mooney C, Coulter-Smith S, Ní Áinle F. Coagulation indices in very preterm infants from cord blood and postnatal samples. J Thromb Haemost 2015; 13:2021-30. [PMID: 26334448 DOI: 10.1111/jth.13130] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 08/22/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Very premature infants are at high risk of bleeding complications; however, few data exist on ranges for standard coagulation tests. OBJECTIVES The primary objective of this study was to measure standard plasma coagulation tests and thrombin generation in very premature infants compared with term infants. The secondary objective was to evaluate whether an association existed between coagulation indices and intraventricular hemorrhage (IVH). PATIENTS/METHODS Cord and peripheral blood of neonates < 30 weeks gestational age (GA) was drawn at birth, on days 1 and 3 and fortnightly until 30 weeks corrected gestational age. Prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen and coagulation factor levels were measured and tissue factor-stimulated thrombin generation was characterized. Control plasma was obtained from cord blood of term neonates. RESULTS One hundred and sixteen infants were recruited. Median (range) GA was 27.7 (23.7-29.9) weeks and mean (SD) birth weight was 1020 (255) g. Median (5th-95th percentile) day 1 PT, APTT and fibrinogen were 17.5 (12.7-26.6) s, 78.7 (48.7-134.3) s and 1.4 (0.72-3.8) g L(-1) , respectively. No difference in endogenous thrombin potential between preterm and term plasma was observed, where samples were available. Levels of coagulation factors II, VII, IX and X, protein C, protein S and antithrombin were reduced in preterm compared with term plasma. Day 1 APTT and PT were not associated with IVH. CONCLUSION In the largest cross-sectional study to date of very preterm infants, typical ranges for standard coagulation tests were determined. Despite long clotting times, thrombin generation was observed to be similar in very preterm and term infants.
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Affiliation(s)
- E Neary
- Department of Neonatology, Rotunda Hospital, Dublin, Ireland
| | - N McCallion
- Department of Neonatology, Rotunda Hospital, Dublin, Ireland
- Department of Paediatrics, Royal College of Surgeons, Dublin, Ireland
| | - B Kevane
- Department of Haematology, Rotunda Hospital, Dublin, Ireland
- School of Medicine and Medical Science, University College Dublin (UCD) Conway Institute, Dublin, Ireland
| | - M Cotter
- Department of Haematology, Rotunda Hospital, Dublin, Ireland
- Department of Haematology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - K Egan
- School of Medicine and Medical Science, University College Dublin (UCD) Conway Institute, Dublin, Ireland
| | - I Regan
- Department of Haematology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - C Kirkham
- Department of Research, Rotunda Hospital, Dublin, Ireland
| | - C Mooney
- Department of Haematology, Rotunda Hospital, Dublin, Ireland
| | - S Coulter-Smith
- Department of Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland
| | - F Ní Áinle
- Department of Haematology, Rotunda Hospital, Dublin, Ireland
- School of Medicine and Medical Science, University College Dublin (UCD) Conway Institute, Dublin, Ireland
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106
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Gong A, Johnson YR, Livingston J, Matula K, Duncan AF. Newborn intensive care survivors: a review and a plan for collaboration in Texas. Matern Health Neonatol Perinatol 2015; 1:24. [PMID: 27057341 PMCID: PMC4823685 DOI: 10.1186/s40748-015-0025-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 09/15/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Neonatal intensive care is a remarkable success story with dramatic improvements in survival rates for preterm newborns. Significant efforts and resources are invested to improve mortality and morbidity but much remains to be learned about the short and long-term effects of neonatal intensive care unit (NICU) interventions. Published guidelines recommend that infants discharged from the NICU be in an organized follow-up program that tracks medical and neurodevelopmental outcomes. Yet, there are no standardized guidelines for provision of follow-up services for high-risk infants. The National Institute of Child Health and Human Development Neonatal Research Network and the Vermont Oxford Network have made strides toward standardizing practices and conducting outcomes research, but only include a subset of developmental follow-up programs with a focus on extremely preterm infants. Several studies have been conducted to gain a better understanding of current practices in developmental follow-up. Some of the major themes in these studies are the lack of personnel and funding to provide comprehensive follow-up care; feeding difficulties as a primary issue for NICU survivors, families, and programs; wide variability in referral and follow-up care practices; and calls for standardized, systematic developmental surveillance to improve outcomes. FINDINGS We convened a one-day summit to discuss developmental follow-up practices in Texas involving four academic and three nonacademic centers. All seven centers described variable age and weight criteria for follow-up of NICU patients and a unique set of developmental practices, including duration of follow-up, types and timing of developmental assessments administered, education and communication with families and other health care providers, and referrals for services. Needs identified by the centers focused on two main themes: resources and comprehensive care. Participants identified key challenges for developmental follow-up, generated recommendations to address these challenges, and outlined components of a quality program. CONCLUSIONS The long-term goal is to ensure that all children maximize their potential; a goal supported through quality, comprehensive developmental follow-up care and outcomes research to continuously improve evidence-based practices. We aim to contribute to this goal through a statewide working group collaborating on research to standardize practices and inform policies that truly benefit children and their families.
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Affiliation(s)
- Alice Gong
- Department of Pediatrics, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio Texas, 78229 USA
| | - Yvette R Johnson
- Cook Children's Hospital, 1500 Cooper St., Dodson Specialty Building, 2nd Floor, Fort Worth, TX 76104 USA
| | - Judith Livingston
- Department of Pediatrics, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio Texas, 78229 USA
| | - Kathleen Matula
- Department of Pediatrics, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio Texas, 78229 USA
| | - Andrea F Duncan
- The University of Texas Health Science Center-Houston, 6431 Fannin St.,, Houston Texas, 77030 USA
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107
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Ahn SY, Shim SY, Sung IK. Intraventricular Hemorrhage and Post Hemorrhagic Hydrocephalus among Very-Low-Birth-Weight Infants in Korea. J Korean Med Sci 2015; 30 Suppl 1:S52-8. [PMID: 26566358 PMCID: PMC4641064 DOI: 10.3346/jkms.2015.30.s1.s52] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 09/15/2015] [Indexed: 11/20/2022] Open
Abstract
Here, we aimed to evaluate the incidence and mortality of intraventricular hemorrhage (IVH) and post-hemorrhagic hydrocephalus (PHH) among very-low-birth-weight (VLBW) infants in Korea and assess the associated factors of PHH. This cohort study used prospectively collected data from the Korean Neonatal Network (KNN). Among 2,386 VLBW infants in the KNN database born between January 2013 and June 2014, 63 infants who died without brain ultrasonography results were excluded. Maternal demographics and neonatal clinical characteristics were assessed. The overall incidence of IVH in all the VLBW infants was 42.2% (987 of 2,323), while those of IVH grade 1, 2, 3, and 4 were 25.1%, 7.0%, 4.8%, and 5.5%, respectively. The incidence and severity of IVH showed a negatively correlating trend with gestational age and birth weight. PHH developed in 0%, 3.5%, 36.1%, and 63.8% of the surviving infants with IVH grades 1, 2, 3, and 4, respectively. Overall, in the VLBW infants, the IVH-associated mortality rate was 1.0% (24/2,323). Only IVH grade severity was proven to be an associated with PHH development in infants with IVH grades 3-4. This is the first Korean national report of IVH and PHH incidences in VLBW infants. Further risk factor analyses or quality improvement studies to reduce IVH are warranted.
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Affiliation(s)
- So Yoon Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So-Yeon Shim
- Departmemt of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea
| | - In Kyung Sung
- Department of Pediatrics, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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108
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Sarkar S, Shankaran S, Laptook AR, Sood BG, Do B, Stoll BJ, Van Meurs KP, Bell EF, Das A, Barks J. Screening Cranial Imaging at Multiple Time Points Improves Cystic Periventricular Leukomalacia Detection. Am J Perinatol 2015; 32:973-9. [PMID: 25730135 PMCID: PMC4697863 DOI: 10.1055/s-0035-1545666] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study is to determine whether the cystic periventricular leukomalacia (cPVL) detection rate differs between imaging studies performed at different time points. DESIGN We retrospectively reviewed the prospectively collected data of 31,708 infants from the NICHD Neonatal Research Network. Inclusion criteria were infants < 1,000 g birth weight or < 29 weeks' gestational age who had cranial imaging performed using both early criterion (cranial ultrasound [CUS] < 28 days chronological age) and late criterion (CUS, magnetic resonance imaging, or computed tomography closest to 36 weeks postmenstrual age [PMA]). We compared the frequency of cPVL diagnosed by early and late criteria. RESULTS About 664 (5.2%) of the 12,739 infants who met inclusion criteria had cPVL using either early or late criteria; 569 using the late criterion, 250 using the early criterion, and 155 patients at both times. About 95 (14.3%) of 664 cPVL cases seen on early imaging were no longer visible on repeat screening closest to 36 weeks PMA. Such disappearance of cPVL was more common in infants < 26 weeks' gestation versus infants of 26 to 28 weeks' gestation (18.5 vs. 11.5%; p = 0.013). CONCLUSIONS Cranial imaging at both < 28 days chronological age and closest to 36 weeks PMA improves cPVL detection, especially for more premature infants.
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Affiliation(s)
- Subrata Sarkar
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Seetha Shankaran
- Department of Pediatrics, Wayne State University, Detroit, Michigan
| | - Abbot R. Laptook
- Department of Pediatrics, Women and Infants’ Hospital, Brown University, Providence, Rhode Island
| | - Beena G. Sood
- Department of Pediatrics, Wayne State University, Detroit, Michigan
| | - Barbara Do
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina
| | - Barbara J. Stoll
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Krisa P. Van Meurs
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Edward F. Bell
- Department of Pediatrics, University of Iowa, Iowa City, Iowa
| | - Abhik Das
- Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, Maryland
| | - John Barks
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
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109
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Li Q, Tsuneki M, Krauthammer M, Couture R, Schwartz M, Madri JA. Modulation of Sox10, HIF-1α, Survivin, and YAP by Minocycline in the Treatment of Neurodevelopmental Handicaps following Hypoxic Insult. THE AMERICAN JOURNAL OF PATHOLOGY 2015. [PMID: 26209807 DOI: 10.1016/j.ajpath.2015.05.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Premature infants are at an increased risk of developing cognitive and motor handicaps due to chronic hypoxia. Although the current therapies have reduced the incidence of these handicaps, untoward side effects abound. Using a murine model of sublethal hypoxia, we demonstrated reduction in several transcription factors that modulate expression of genes known to be involved in several neural functions. We demonstrate the induction of these genes by minocycline, a tetracycline antibiotic with noncanonical functions, in both in vitro and in vivo studies. Specifically, there was induction of genes, including Sox10, Hif1a, Hif2a, Birc5, Yap1, Epo, Bdnf, Notch1 (cleaved), Pcna, Mag, Mobp, Plp1, synapsin, Adgra2, Pecam1, and reduction in activation of caspase 3, all known to affect proliferation, apoptosis, synaptic transmission, and nerve transmission. Minocycline treatment of mouse pups reared under sublethal hypoxic conditions resulted in improvement in open field testing parameters. These studies demonstrate beneficial effects of minocycline treatment following hypoxic insult, document up-regulation of several genes associated with improved cognitive function, and support the possibility of minocycline as a potential therapeutic target in the treatment of neurodevelopmental handicaps observed in the very premature newborn population. Additionally, these studies may aid in further interpretation of the effects of minocycline in the treatment trials and animal model studies of fragile X syndrome and multiple sclerosis.
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Affiliation(s)
- Qi Li
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Masayuki Tsuneki
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut; Division of Cancer Biology, National Cancer Center Research Institute, Chuo-ku, Tokyo, Japan
| | - Michael Krauthammer
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Rachael Couture
- Department Neuroscience, Yale University School of Medicine, New Haven, Connecticut
| | - Michael Schwartz
- Department Neuroscience, Yale University School of Medicine, New Haven, Connecticut
| | - Joseph A Madri
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut.
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110
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Fares S, Sethom MM, Kacem S, Khouaja-Mokrani C, Feki M, Kaabachi N. Plasma arachidonic and docosahexaenoic acids in Tunisian very low birth weight infants: status and association with selected neonatal morbidities. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2015; 33:1. [PMID: 26825799 PMCID: PMC5026025 DOI: 10.1186/s41043-015-0011-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 05/26/2015] [Indexed: 06/05/2023]
Abstract
To study plasma arachidonic acid (AA) and docosahexaenoic acid (DHA) status in Tunisian very low birth weight (VLBW) infants and their association with selected neonatal morbidities. A total of 709 VLBW infants and 339 term infants were included. Plasma fatty acids were analyzed using capillary gas chromatography. VLBW infants had significantly (p < 0.001) lower plasma AA (9.44 ± 2.12 vs. 10.8 ± 2.10) and DHA (2.56 ± 0.89 vs. 3.46 ± 1.09) levels, but higher n-6:n-3 ratio (5.58 ± 1.22 vs. 5.17 ± 1.46) than term infants. In VLBW infants, plasma AA and DHA were related to gestational age (r = 0.156; p = 0.001 and r = 0.134; p = 0.003, respectively), birthweight (r = 0.242; p < 0.001 and r = 0.181; p < 0.001, respectively) and head circumference (r = 0.138; p = 0.005 and r = 0.108; p = 0.027, respectively). Infants with respiratory distress syndrome have decreased plasma AA and DHA and those with intraventricular hemorrhage have decreased plasma AA and n-6:n-3 ratio. Sepsis was associated with decreased DHA levels. Plasma long chain polyunsaturated fatty acids status is low in VLBW infants. These deficits may enhance the risk of common neonatal morbidities, rendering their prevention and correction greatly warranted.
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MESH Headings
- Arachidonic Acid/blood
- Arachidonic Acid/deficiency
- Cerebral Hemorrhage/epidemiology
- Cerebral Hemorrhage/etiology
- Deficiency Diseases/blood
- Deficiency Diseases/physiopathology
- Docosahexaenoic Acids/blood
- Docosahexaenoic Acids/deficiency
- Female
- Fetal Growth Retardation/epidemiology
- Fetal Growth Retardation/etiology
- Hospitals, Maternity
- Hospitals, Urban
- Humans
- Infant, Newborn
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/etiology
- Infant, Small for Gestational Age
- Infant, Very Low Birth Weight
- Male
- Neonatal Sepsis/epidemiology
- Neonatal Sepsis/etiology
- Nutritional Status
- Premature Birth/blood
- Premature Birth/physiopathology
- Respiratory Distress Syndrome, Newborn/epidemiology
- Respiratory Distress Syndrome, Newborn/etiology
- Risk
- Tunisia/epidemiology
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Affiliation(s)
- Samira Fares
- UR05/08-08, Department of Biochemistry, Rabta Hospital & Faculty of Medicine of Tunis, El Manar University, Tunis, Jebbari, 1007, Tunisia.
| | - Mohamed M Sethom
- UR05/08-08, Department of Biochemistry, Rabta Hospital & Faculty of Medicine of Tunis, El Manar University, Tunis, Jebbari, 1007, Tunisia
| | - Samia Kacem
- Service of Neonatalogy, Centre of Maternity and Neonatology & Faculty of Medicine of Tunis, El Manar University, 1007, Tunis, Tunisia
| | - Chahnez Khouaja-Mokrani
- Service of Neonatalogy, Centre of Maternity and Neonatology & Faculty of Medicine of Tunis, El Manar University, 1007, Tunis, Tunisia
| | - Moncef Feki
- UR05/08-08, Department of Biochemistry, Rabta Hospital & Faculty of Medicine of Tunis, El Manar University, Tunis, Jebbari, 1007, Tunisia
| | - Naziha Kaabachi
- UR05/08-08, Department of Biochemistry, Rabta Hospital & Faculty of Medicine of Tunis, El Manar University, Tunis, Jebbari, 1007, Tunisia
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111
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Esiaba I, Angeles DM, Holden MS, Tan JBC, Asmerom Y, Gollin G, Boskovic DS. Urinary Allantoin Is Elevated in Severe Intraventricular Hemorrhage in the Preterm Newborn. Transl Stroke Res 2015; 7:97-102. [PMID: 25994284 DOI: 10.1007/s12975-015-0405-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 04/06/2015] [Accepted: 05/08/2015] [Indexed: 11/27/2022]
Abstract
Germinal matrix intraventricular hemorrhage (IVH) is the most common type of intracranial hemorrhage observed in preterm neonates. It is a precursor of poor neurocognitive development, cerebral palsy, and death. The pathophysiology is not well defined, but damage to the fragile germinal matrix vasculature may be due to free radicals generated during inflammation and as a consequence of ischemia followed by reperfusion. Assessment of the oxidative stress status in these infants is therefore important. Urinary allantoin concentration was measured in preterm neonates as a marker of oxidative stress associated with IVH. Urine was collected from 44 preterm neonates at four time points between 24 and 72 hours of life (HOL), and the allantoin content was determined by gas chromatography mass spectrometry (GCMS). Records were retrospectively reviewed, and the incidence and severity of IVH was categorized as follows: no IVH (n = 24), mild (grade 1-2) IVH (n = 13), and severe (grade 3-4) IVH (n = 7). Neonates with severe IVH showed significantly elevated allantoin levels vs subjects with no IVH from 36 HOL (0.098 ± 0.013 μmol and 0.043 ± 0.007 μmol, respectively, p = 0.002). The allantoin concentration remained elevated even at 72 HOL (0.079 ± 0.014 μmol and 0.033 ± 0.008 μmol, respectively, p = 0.021). There were no significant differences in allantoin levels in the no IVH and mild IVH groups. IVH was diagnosed by head imaging on average at about 11th postnatal day. Urinary allantoin levels were significantly elevated during the first 3 days of life in the neonates subsequently diagnosed with severe IVH, suggesting that oxidative stress might be a crucial factor in IVH pathogenesis. Further studies are needed to assess the usefulness of urinary allantoin in early identification of preterm infants at risk for or with severe IVH and monitoring of the response to interventions designed to prevent or treat it.
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Affiliation(s)
- Ijeoma Esiaba
- Department of Earth and Biological Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, 92350, USA
| | - Danilyn M Angeles
- Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, 92350, USA
| | - Megan S Holden
- Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, 92350, USA.,Division of Biochemistry, School of Medicine, Loma Linda University, Loma Linda, CA, 92350, USA
| | - John B C Tan
- Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, 92350, USA.,Division of Biochemistry, School of Medicine, Loma Linda University, Loma Linda, CA, 92350, USA
| | - Yayesh Asmerom
- Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, 92350, USA
| | - Gerald Gollin
- Division of Pediatric Surgery, School of Medicine, Loma Linda University, Loma Linda, CA, 92350, USA
| | - Danilo S Boskovic
- Department of Earth and Biological Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, 92350, USA. .,Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, 92350, USA. .,Division of Biochemistry, School of Medicine, Loma Linda University, Loma Linda, CA, 92350, USA.
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112
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Exploratory laparotomy in the management of confirmed necrotizing enterocolitis. ANNALS OF PEDIATRIC SURGERY 2015. [DOI: 10.1097/01.xps.0000463166.88394.24] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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113
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Lee HJ, Lee BS, Do HJ, Oh SH, Choi YS, Chung SH, Kim EAR, Kim KS. Early sodium and fluid intake and severe intraventricular hemorrhage in extremely low birth weight infants. J Korean Med Sci 2015; 30:283-9. [PMID: 25729251 PMCID: PMC4330483 DOI: 10.3346/jkms.2015.30.3.283] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 10/24/2014] [Indexed: 12/03/2022] Open
Abstract
Hypernatremic dehydration is an important cause of intracranial hemorrhage. A possible association of intraventricular hemorrhage (IVH) with hypernatremia and/or high sodium intake has been suggested in preterm infants. To investigate the associations of early fluid and sodium intake or serum sodium concentrations with severe intraventricular hemorrhage (IVH) in extremely low birth weight (ELBW) infants, we reviewed the medical records of 169 inborn ELBW infants. Daily fluid and sodium intake, urine output, weight loss and serum sodium concentration during the first 4 days of life were obtained. Patients were divided into the severe IVH (grade 3/4) and the control (no or grade 1/2 IVH) group. The maximum serum sodium concentration and the incidence of hypernatremia did not differ between the two groups. Related to the fluid balance and sodium intake, the risk for severe IVH was strongly associated with total fluid and sodium intake during the initial four days of life. With respect to the fluids other than transfusion, severe IVH can be discriminated only by sodium intake but not by fluid intake. Large randomized controlled trials are required to clarify the causal relationship between the early sodium intake and severe IVH in ELBW infants.
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Affiliation(s)
- Hye Jin Lee
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Byong Sop Lee
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hyun-Jeong Do
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seong-Hee Oh
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yong-Sung Choi
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sung-Hoon Chung
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Ellen Ai-Rhan Kim
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ki-Soo Kim
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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114
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Vlasyuk VV. Damages of spinal cord in newborns after intraventricular hemorrhage. Bull Exp Biol Med 2014; 157:718-20. [PMID: 25339585 DOI: 10.1007/s10517-014-2650-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Indexed: 10/24/2022]
Abstract
We studied the spinal cords of 14 dead premature newborn with intraventricular hemorrhages. In all cases, grade III intraventricular hemorrhage was followed by the translocation of blood into the subarachnoid space of the cervical, dorsal, and lumbar parts of the spinal cord. Ischemic changes were found in neurons of the cervical intumescence and other parts of the spinal cord. These changes are important during thanatogenesis. Three stages in the development of intraventricular hemorrhage were distinguished. Imperfections of clinical classification of this pathology were demonstrated.
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Affiliation(s)
- V V Vlasyuk
- Research Institute of Pediatric Infections, Federal Medical-and-Biological Agency, St. Petersburg, Russia,
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115
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Different patterns of punctate white matter lesions in serially scanned preterm infants. PLoS One 2014; 9:e108904. [PMID: 25279755 PMCID: PMC4184838 DOI: 10.1371/journal.pone.0108904] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 08/28/2014] [Indexed: 11/19/2022] Open
Abstract
Background and Purpose With the increased use of MRI in preterm infants, punctate white matter lesions (PWML) are more often recognized. The aim of this study was to describe the incidence and characteristics of these lesions as well as short-term outcome in a cohort of serially scanned preterm infants, using both conventional imaging, diffusion (DWI) and susceptibility (SWI) weighted imaging. Materials and Methods 112 preterm infants with 2 MRIs in the neonatal period, with evidence of punctate white matter lesions, were included. Appearance, lesion load, location, and abnormalities on DWI and SWI were scored and outcome data were collected. Results Different patterns of punctate white matter lesions did appear: a linear appearance associated with signal loss on SWI, and a cluster appearance associated with restricted diffusion on DWI on the first MRI. Cluster and mixed lesions on the first scan changed in appearance in over 50% on the second scan, whereas linear lesions generally kept their appearance. Lesions were only visible on the early scan in 33%, and were only seen at term equivalent age in 20%. Nine infants developed cerebral palsy, due to additional overt white matter lesions in six. Conclusion Two patterns of punctate white matter lesions were identified: one with loss of signal on SWI in a linear appearance, and the other with DWI lesions with restricted diffusion in a cluster appearance. These different patterns are suggestive of a difference in underlying pathophysiology. To reliably classify PWML in the preterm infant in either pattern, an early MRI with DWI and SWI sequences is required.
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116
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Schreiner C, Suter S, Watzka M, Hertfelder HJ, Schreiner F, Oldenburg J, Bartmann P, Heep A. Genetic variants of the vitamin K dependent coagulation system and intraventricular hemorrhage in preterm infants. BMC Pediatr 2014; 14:219. [PMID: 25179312 PMCID: PMC4236669 DOI: 10.1186/1471-2431-14-219] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 08/19/2014] [Indexed: 01/10/2023] Open
Abstract
Background Pathogenesis of intraventricular hemorrhage (IVH) in premature infants is multifactorial. Little is known about the impact of genetic variants in the vitamin K-dependent coagulation system on the development of IVH. Methods Polymorphisms in the genes encoding vitamin K epoxide reductase complex 1 (VKORC1 -1639G>A) and coagulation factor 7 (F7 -323Ins10) were examined prospectively in 90 preterm infants <32 weeks gestational age with respect to coagulation profile and IVH risk. Results F7-323Ins10 was associated with lower factor VII levels, but not with individual IVH risk. In VKORC1-wildtype infants, logistic regression analysis revealed a higher IVH risk compared to carriers of the -1639A allele. Levels of the vitamin K-dependent coagulation parameters assessed in the first hour after birth did not differ between VKORC1-wildtype infants and those carrying -1639A alleles. Conclusions Our data support the assumption that genetic variants in the vitamin K-dependent coagulation system influence the coagulation profile and the IVH risk in preterm infants. Further studies focussing on short-term changes in vitamin K-kinetics and the coagulation profile during the first days of life are required to further understand a possible link between development of IVH and genetic variants affecting the vitamin K-metabolism.
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Affiliation(s)
| | | | | | | | | | | | | | - Axel Heep
- School of Clinical Sciences, University of Bristol, Neonatal Intensive Care Unit, Southmead Road, Bristol BS10 NB5, UK.
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Zhu D, Wallace EM, Lim R. Cell-based therapies for the preterm infant. Cytotherapy 2014; 16:1614-28. [PMID: 25154811 DOI: 10.1016/j.jcyt.2014.06.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 06/14/2014] [Accepted: 06/26/2014] [Indexed: 12/31/2022]
Abstract
The severely preterm infant receives a multitude of life-saving interventions, many of which carry risks of serious side effects. Cell therapy is an important and promising arm of regenerative medicine that may address a number of these problems. Most forms of cellular therapy use stem/progenitor cells or stem-like cells, which have the capacity to migrate, engraft and exert anti-inflammatory effects. Although some of these cell-based therapies have made their way to clinical trials in adults, little headway has been made in the neonatal patient group. This review discusses the efficacy of cell therapy in preclinical studies to date and their potential applications to diseases that afflict many prematurely born infants. Specifically, we identify the major hurdles that must be overcome before cell therapies can be safely used in the neonatal intensive care unit.
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Affiliation(s)
- Dandan Zhu
- The Ritchie Centre, Monash Institute of Medical Research, Clayton, Victoria, Australia
| | - Euan M Wallace
- The Ritchie Centre, Monash Institute of Medical Research, Clayton, Victoria, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Rebecca Lim
- The Ritchie Centre, Monash Institute of Medical Research, Clayton, Victoria, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.
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118
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Marseglia L, D'Angelo G, Manti S, Arrigo T, Barberi I, Reiter RJ, Gitto E. Oxidative stress-mediated aging during the fetal and perinatal periods. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2014; 2014:358375. [PMID: 25202436 PMCID: PMC4151547 DOI: 10.1155/2014/358375] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 07/18/2014] [Accepted: 08/05/2014] [Indexed: 12/14/2022]
Abstract
Oxidative stress is worldwide recognized as a fundamental component of the aging, a process that begins before birth. There is a critical balance between free radical generation and antioxidant defenses. Oxidative stress is caused by an imbalance between the production of free radicals and the ability of antioxidant system to detoxify them. Oxidative stress can occur early in pregnancy and continue in the postnatal period; this damage is implicated in the pathophysiology of pregnancy-related disorders, including recurrent pregnancy loss, preeclampsia and preterm premature rupture of membranes. Moreover, diseases of the neonatal period such as bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, and periventricular leukomalacia are related to free radical damage. The specific contribution of oxidative stress to the pathogenesis and progression of these neonatal diseases is only partially understood. This review summarizes what is known about the role of oxidative stress in pregnancy and in the pathogenesis of common disorders of the newborn, as a component of the early aging process.
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Affiliation(s)
- Lucia Marseglia
- Neonatal and Pediatric Intensive Care Unit, Department of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Gabriella D'Angelo
- Neonatal and Pediatric Intensive Care Unit, Department of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Sara Manti
- Unit of Pediatric Genetics and Immunology, Department of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Teresa Arrigo
- Unit of Pediatric Genetics and Immunology, Department of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Ignazio Barberi
- Neonatal and Pediatric Intensive Care Unit, Department of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Russel J. Reiter
- Department of Cellular and Structural Biology, University of Texas Health Science Center at San Antonio, San Antonio, TX 40729, USA
| | - Eloisa Gitto
- Neonatal and Pediatric Intensive Care Unit, Department of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
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119
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Shankaran S, Lin A, Maller-Kesselman J, Zhang H, O’Shea TM, Bada HS, Kaiser JR, Lifton RP, Bauer CR, Ment LR. Maternal race, demography, and health care disparities impact risk for intraventricular hemorrhage in preterm neonates. J Pediatr 2014; 164:1005-1011.e3. [PMID: 24589078 PMCID: PMC4095864 DOI: 10.1016/j.jpeds.2014.01.036] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 12/19/2013] [Accepted: 01/17/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine whether risk factors associated with grade 2-4 intraventricular hemorrhage (IVH) differs between infants of African ancestry and white infants. STUDY DESIGN Inborn, appropriate for gestational age infants with birth weight 500-1250 g and exposure to at least 1 dose of antenatal steroids were enrolled in 24 neonatal intensive care units. Cases had grade 2-4 IVH and controls matched for site, race, and birth weight range had 2 normal ultrasounds read centrally. Multivariate logistic regression modeling identified factors associated with IVH across African ancestry and white race. RESULTS Subjects included 579 African ancestry or white race infants with grade 2-4 IVH and 532 controls. Mothers of African ancestry children were less educated, and white case mothers were more likely to have more than 1 prenatal visit and multiple gestation (P ≤ .01 for all). Increasing gestational age (P = .01), preeclampsia (P < .001), complete antenatal steroid exposure (P = .02), cesarean delivery (P < .001), and white race (P = .01) were associated with decreased risk for IVH. Chorioamnionitis (P = .01), 5-minute Apgar score <3 (P < .004), surfactant use (P < .001), and high-frequency ventilation (P < .001) were associated with increased risk for IVH. Among African ancestry infants, having more than 1 prenatal visit was associated with decreased risk (P = .02). Among white infants, multiple gestation was associated with increased risk (P < .001), and higher maternal education was associated with decreased risk (P < .05). CONCLUSION The risk for IVH differs between infants of African ancestry and white infants, possibly attributable to both race and health care disparities.
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Affiliation(s)
- Seetha Shankaran
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI.
| | - Aiping Lin
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | | | - Heping Zhang
- Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT
| | - T. Michael O’Shea
- Department of Pediatrics, Wake Forest School of Medicine, Winston Salem, NC
| | - Henrietta S. Bada
- Department of Pediatrics, University of Kentucky College of Medicine
| | - Jeffrey R. Kaiser
- Departments of Pediatrics and Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Richard P. Lifton
- Department of Genetics and the Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, CT
| | - Charles R. Bauer
- Department of Pediatrics, University of Miami Miller School of Medicine
| | - Laura R. Ment
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT,Department of Neurology, Yale University School of Medicine, New Haven, CT
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Abstract
Intraventricular hemorrhage (IVH) is a major neurologic complication of prematurity. Pathogenesis of IVH is attributed to intrinsic fragility of germinal matrix vasculature and to the fluctuation in the cerebral blood flow. Germinal matrix exhibits rapid angiogenesis orchestrating formation of immature vessels. Prenatal glucocorticoid exposure remains the most effective means of preventing IVH. Therapies targeted to enhance the stability of the germinal matrix vasculature and minimize fluctuation in the cerebral blood flow might lead to more effective strategies in preventing IVH.
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Affiliation(s)
- Praveen Ballabh
- Department of Pediatrics, Cell Biology and Anatomy, Regional Neonatal Center, New York Medical College, Maria Fareri Children's Hospital, Westchester Medical Center, 100 Woods Road, Valhalla, NY 10595, USA.
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121
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Luque MJ, Tapia JL, Villarroel L, Marshall G, Musante G, Carlo W, Kattan J. A risk prediction model for severe intraventricular hemorrhage in very low birth weight infants and the effect of prophylactic indomethacin. J Perinatol 2014; 34:43-8. [PMID: 24113396 DOI: 10.1038/jp.2013.127] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 08/22/2013] [Accepted: 08/27/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Develop a risk prediction model for severe intraventricular hemorrhage (IVH) in very low birth weight infants (VLBWI). STUDY DESIGN Prospectively collected data of infants with birth weight 500 to 1249 g born between 2001 and 2010 in centers from the Neocosur Network were used. Forward stepwise logistic regression model was employed. The model was tested in the 2011 cohort and then applied to the population of VLBWI that received prophylactic indomethacin to analyze its effect in the risk of severe IVH. RESULT Data from 6538 VLBWI were analyzed. The area under ROC curve for the model was 0.79 and 0.76 when tested in the 2011 cohort. The prophylactic indomethacin group had lower incidence of severe IVH, especially in the highest-risk groups. CONCLUSION A model for early severe IVH prediction was developed and tested in our population. Prophylactic indomethacin was associated with a lower risk-adjusted incidence of severe IVH.
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Affiliation(s)
- M J Luque
- Division de Pediatria, Hospital Clinico Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - J L Tapia
- Seccion de Neonatologia, Hospital Clinico Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - L Villarroel
- Departamento Salud Publica, Pontificia Universidad Catolica, Santiago, Chile
| | - G Marshall
- Facultad de Matematicas, Pontificia Universidad Catolica, Santiago, Chile
| | - G Musante
- Servicio de Neonatologia, Hospital Universitario Austral, Pilar, Argentina
| | - W Carlo
- Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J Kattan
- Seccion de Neonatologia, Hospital Clinico Pontificia Universidad Catolica de Chile, Santiago, Chile
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122
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Mirza H, Oh W, Laptook A, Vohr B, Tucker R, Stonestreet BS. Indomethacin prophylaxis to prevent intraventricular hemorrhage: association between incidence and timing of drug administration. J Pediatr 2013; 163:706-10.e1. [PMID: 23522865 PMCID: PMC3939677 DOI: 10.1016/j.jpeds.2013.02.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 01/29/2013] [Accepted: 02/12/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To test the hypothesis that administration of indomethacin prophylaxis before 6 hours of life results in a lower incidence of intraventricular hemorrhage (IVH) compared with administration after 6 hours of life, and that the effects of early prophylaxis depend on gestational age (GA) and sex in very low birth weight infants (birth weight <1250 g). STUDY DESIGN Very low birth weight infants admitted to our neonatal intensive care unit between 2003 and 2010 who received indomethacin prophylaxis were analyzed retrospectively. Exclusion criteria included unknown time of indomethacin prophylaxis, death at <12 hours of life, congenital anomalies, and unavailable head ultrasound report. Infants were dichotomized based on the timing of indomethacin prophylaxis (<6 hours or >6 hours of life) to compare incidence of IVH all grades and severe (grade 3-4) IVH. Secondary analyses examined the effects of the time of indomethacin prophylaxis initiation by GA and sex on the incidence of IVH. RESULTS A total of 868 infants (431 males and 437 females) met the criteria for analysis. Indomethacin prophylaxis was given at <6 hours of life in 730 infants and at >6 hours of life to 168 infants. The 2 groups differed with respect to antenatal steroid exposure, GA, outborn prevalence, and pneumothoraces. After multivariate analysis, there were no between-group differences in all-grade or severe IVH. However, females, but not males, treated at <6 hours of life had a lower incidence of severe IVH (P < .05), particularly at lower GAs. CONCLUSION Prophylactic indomethacin administered before 6 hours of life is not associated with lower incidence of IVH.
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123
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Perrone S, Tataranno LM, Stazzoni G, Ramenghi L, Buonocore G. Brain susceptibility to oxidative stress in the perinatal period. J Matern Fetal Neonatal Med 2013; 28 Suppl 1:2291-5. [PMID: 23968388 DOI: 10.3109/14767058.2013.796170] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Oxidative stress (OS) occurs at birth in all newborns as a consequence of the hyperoxic challenge due to the transition from the hypoxic intrauterine environment to extrauterine life. Free radical (FRs) sources such as inflammation, hyperoxia, hypoxia, ischaemia-reperfusion, neutrophil and macrophage activation, glutamate and free iron release, all increases the OS during the perinatal period. Newborns, and particularly preterm infants, have reduced antioxidant defences and are not able to counteract the harmful effects of FRs. Energy metabolism is central to life because cells cannot exist without an adequate supply of ATP. Due to its growth, the mammalian brain can be considered as a steady-state system in which ATP production matches ATP utilisation. The developing brain is particularly sensitive to any disturbances in energy generation, and even a short-term interruption can lead to long-lasting and irreversible damage. Whenever energy failure develops, brain damage can occur. Accumulating evidence indicates that OS is implicated in the pathogenesis of many neurological diseases, such as intraventricular haemorrhage, hypoxic-ischaemic encephalopathy and epilepsy.
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Affiliation(s)
- Serafina Perrone
- a Department of Pediatrics , Obstetrics and Reproduction Medicine, University of Siena , Siena , Italy and
| | - Luisa M Tataranno
- a Department of Pediatrics , Obstetrics and Reproduction Medicine, University of Siena , Siena , Italy and
| | - Gemma Stazzoni
- a Department of Pediatrics , Obstetrics and Reproduction Medicine, University of Siena , Siena , Italy and
| | - Luca Ramenghi
- b Neonatal Pathology Unit , Giannina Gaslini Hospital , Genova , Italy
| | - Giuseppe Buonocore
- a Department of Pediatrics , Obstetrics and Reproduction Medicine, University of Siena , Siena , Italy and
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Fink S, Kunzmann S, Andres O, Eyrich M, Wiegering V. Haemophilia in extreme immature preterm infants: increased risk for intracranial haemorrhage? J Matern Fetal Neonatal Med 2013; 27:621-4. [PMID: 23865671 DOI: 10.3109/14767058.2013.825600] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Haemophiliacs and extremely premature infants are both at an increased risk for intracranial haemorrhage; both conditions might be further elevating the risk. We report a case of a very immature preterm-infant of 26 gestational weeks (birth weight 635 g) with severe haemophilia A. Furthermore, we provide an overview of the published literature on this subject matter. Until now, deficiency of factor VIII or IX as a potential risk factor for ICH in preterm infants remains controversial. However, prophylactic substitution of factor VIII or IX in preterm infants with haemophilia may minimize the risk of bleeding complications and neurologic sequelae.
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Affiliation(s)
- Susanne Fink
- University of Würzburg, Paediatric Intensive Care and Neonatology Unit, Children's Hospital , Germany and
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Smyser CD, Snyder AZ, Shimony JS, Blazey TM, Inder TE, Neil JJ. Effects of white matter injury on resting state fMRI measures in prematurely born infants. PLoS One 2013; 8:e68098. [PMID: 23874510 PMCID: PMC3706620 DOI: 10.1371/journal.pone.0068098] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 05/24/2013] [Indexed: 01/16/2023] Open
Abstract
The cerebral white matter is vulnerable to injury in very preterm infants (born prior to 30 weeks gestation), resulting in a spectrum of lesions. These range from severe forms, including cystic periventricular leukomalacia and periventricular hemorrhagic infarction, to minor focal punctate lesions. Moderate to severe white matter injury in preterm infants has been shown to predict later neurodevelopmental disability, although outcomes can vary widely in infants with qualitatively comparable lesions. Resting state functional connectivity magnetic resonance imaging has been increasingly utilized in neurodevelopmental investigations and may provide complementary information regarding the impact of white matter injury on the developing brain. We performed resting state functional connectivity magnetic resonance imaging at term equivalent postmenstrual age in fourteen preterm infants with moderate to severe white matter injury secondary to periventricular hemorrhagic infarction. In these subjects, resting state networks were identifiable throughout the brain. Patterns of aberrant functional connectivity were observed and depended upon injury severity. Comparisons were performed against data obtained from prematurely-born infants with mild white matter injury and healthy, term-born infants and demonstrated group differences. These results reveal structural-functional correlates of preterm white matter injury and carry implications for future investigations of neurodevelopmental disability.
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Affiliation(s)
- Christopher D Smyser
- Department of Neurology, Washington University, Saint Louis, Missouri, United States of America.
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126
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Ehrhardt H, Zimmer KP. Prevention at the beginning of life: cerebral hemorrhage in very preterm infants. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:487-488. [PMID: 24000296 PMCID: PMC3752579 DOI: 10.3238/arztebl.2013.0487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Harald Ehrhardt
- Department of General Pediatrics and Neonatology, University Children’s Hospital Gießen
| | - Klaus-Peter Zimmer
- Department of General Pediatrics and Neonatology, University Children’s Hospital Gießen
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Myall NJ, Yeom KW, Yeatman JD, Gaman-Bean S, Feldman HM. Case series: fractional anisotropy along the trajectory of selected white matter tracts in adolescents born preterm with ventricular dilation. J Child Neurol 2013; 28:774-80. [PMID: 22859695 PMCID: PMC4277874 DOI: 10.1177/0883073812449693] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This case series assesses white matter microstructure in 3 adolescents born preterm with nonshunted ventricular dilation secondary to intraventricular hemorrhage. Subjects (ages 12-17 years, gestational age 26-29 weeks, birth weight 825-1624 g) were compared to 3 full-term controls (13-17 years, 39-40 weeks, 3147-3345 g) and 3 adolescents born preterm without ventricular dilation (10-13 years, 26-29 weeks, 630-1673 g). Tractography using a 2 region of interest method reconstructed the following white matter tracts: superior longitudinal/arcuate fasciculus, inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, uncinate fasciculus, and corticospinal tract. Subjects showed increased fractional anisotropy and changes in the pattern of fractional anisotropy along the trajectory of tracts adjacent to the lateral ventricles. Tensor shape at areas of increased fractional anisotropy demonstrated increased linear anisotropy at the expense of planar and spherical anisotropy. These findings suggest increased axonal packing density and straightening of fibers secondary to ventricular enlargement.
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Affiliation(s)
| | - Kristen W. Yeom
- Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jason D. Yeatman
- Department of Psychology, Stanford University, Palo Alto, CA, USA
| | - Shayna Gaman-Bean
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Heidi M. Feldman
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
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128
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Treatment of intraventricular hemorrhages in premature infants: where is the evidence? Adv Neonatal Care 2013; 13:127-30. [PMID: 23532032 DOI: 10.1097/anc.0b013e31828ac82e] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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129
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Rong Z, Liu H, Xia S, Chang L. Risk and protective factors of intraventricular hemorrhage in preterm babies in Wuhan, China. Childs Nerv Syst 2012; 28:2077-84. [PMID: 22868531 DOI: 10.1007/s00381-012-1875-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 07/24/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study is to identify prenatal and perinatal risk and protective factors for the development of IVH, using a retrospective and case-control clinical study. METHODS Prenatal and perinatal data were collected from three NICUs between January 2010 and December 2010. Univariate analysis was performed between case and control groups, and multivariate analysis was done to find out risk and protective factors for development of IVH. Further analysis of these variables was undertaken for gestational age strata <30, 30-34, and 35-37 weeks. RESULTS By univariate analysis, factors related with IVH were C-section, prenatal steroid, pregnancy-induced hypertension, transport from other hospital, hypothermia, Apgar score at 1 and 5 min < 4, luminal, pathological jaundice, RDS, hypotension, volume expansion/inotropics, PO(2), repeat suctioning, and mechanical ventilation (P < 0.05). Five variables remained significant in multivariate analysis. C-section and prenatal steroid use were protective variables while mechanical ventilation, hypotension, and transport from other hospital were risk factors. Further analysis of these variables was undertaken for gestational age strata <30, 30-34, and 35-37 weeks. Prenatal steroid use remained significant as a protective variable in gestational age less than 35 weeks; hypotension was shown to be a risk factor just in the time period between 30-34 weeks; transport from other hospital was a risk factor in gestational age more than 30 weeks; mechanical ventilation remained non-significant during the gestational age strata studied. CONCLUSION In the present study, factors that related to neonatal IVH included hypotension, prenatal steroid use, and transportation.
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Affiliation(s)
- Zhihui Rong
- Department of Neonatology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan 430030, China
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130
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Patterns of placental pathology in preterm infants with a periventricular haemorrhagic infarction: Association with time of onset and clinical presentation. Placenta 2012; 33:839-44. [DOI: 10.1016/j.placenta.2012.06.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 06/04/2012] [Accepted: 06/19/2012] [Indexed: 11/22/2022]
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131
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Does risk-based coagulation screening predict intraventricular haemorrhage in extreme premature infants? Blood Coagul Fibrinolysis 2012; 23:532-6. [DOI: 10.1097/mbc.0b013e3283551145] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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132
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Majed BH, Khalil RA. Molecular mechanisms regulating the vascular prostacyclin pathways and their adaptation during pregnancy and in the newborn. Pharmacol Rev 2012; 64:540-82. [PMID: 22679221 DOI: 10.1124/pr.111.004770] [Citation(s) in RCA: 173] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Prostacyclin (PGI(2)) is a member of the prostanoid group of eicosanoids that regulate homeostasis, hemostasis, smooth muscle function and inflammation. Prostanoids are derived from arachidonic acid by the sequential actions of phospholipase A(2), cyclooxygenase (COX), and specific prostaglandin (PG) synthases. There are two major COX enzymes, COX1 and COX2, that differ in structure, tissue distribution, subcellular localization, and function. COX1 is largely constitutively expressed, whereas COX2 is induced at sites of inflammation and vascular injury. PGI(2) is produced by endothelial cells and influences many cardiovascular processes. PGI(2) acts mainly on the prostacyclin (IP) receptor, but because of receptor homology, PGI(2) analogs such as iloprost may act on other prostanoid receptors with variable affinities. PGI(2)/IP interaction stimulates G protein-coupled increase in cAMP and protein kinase A, resulting in decreased [Ca(2+)](i), and could also cause inhibition of Rho kinase, leading to vascular smooth muscle relaxation. In addition, PGI(2) intracrine signaling may target nuclear peroxisome proliferator-activated receptors and regulate gene transcription. PGI(2) counteracts the vasoconstrictor and platelet aggregation effects of thromboxane A(2) (TXA(2)), and both prostanoids create an important balance in cardiovascular homeostasis. The PGI(2)/TXA(2) balance is particularly critical in the regulation of maternal and fetal vascular function during pregnancy and in the newborn. A decrease in PGI(2)/TXA(2) ratio in the maternal, fetal, and neonatal circulation may contribute to preeclampsia, intrauterine growth restriction, and persistent pulmonary hypertension of the newborn (PPHN), respectively. On the other hand, increased PGI(2) activity may contribute to patent ductus arteriosus (PDA) and intraventricular hemorrhage in premature newborns. These observations have raised interest in the use of COX inhibitors and PGI(2) analogs in the management of pregnancy-associated and neonatal vascular disorders. The use of aspirin to decrease TXA(2) synthesis has shown little benefit in preeclampsia, whereas indomethacin and ibuprofen are used effectively to close PDA in the premature newborn. PGI(2) analogs have been used effectively in primary pulmonary hypertension in adults and have shown promise in PPHN. Careful examination of PGI(2) metabolism and the complex interplay with other prostanoids will help design specific modulators of the PGI(2)-dependent pathways for the management of pregnancy-related and neonatal vascular disorders.
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Affiliation(s)
- Batoule H Majed
- Harvard Medical School, Brigham and Women's Hospital, Division of Vascular Surgery, 75 Francis St., Boston, MA 02115, USA
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133
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Malusky S, Donze A. Neutral head positioning in premature infants for intraventricular hemorrhage prevention: an evidence-based review. Neonatal Netw 2012; 30:381-96. [PMID: 22052118 DOI: 10.1891/0730-0832.30.6.381] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
With the advancement of neonatal medicine during the past several decades, premature and critically ill infants are living past the neonatal period and surviving. The survival of these infants at smaller birth weights and younger gestational ages puts them at an increased risk for intraventricular hemorrhages (IVHs). Although shifts in cerebral perfusion have been linked to the development of these brain bleeds, many seemingly benign care activities have been linked to changes in cerebral blood flow patterns, possibly contributing to IVHs. The purpose of this article is to evaluate the current evidence to determine if the practice of midline positioning for infants born less than 32 weeks gestation for possible IVH prevention is supported by the literature. Many of the researchers involved in these studies attributed the consequential venule leakage of blood to occlusion of the jugular venous drainage system following a turn in the position of the head. Additionally, the articles that examined the connection between the effects of head tilting on brain hemodynamics attributed changes on the infants' potential inability to autoregulate cerebral blood flow adequately. Both of these findings were linked to the development of IVHs. Based on physiologic data and expert opinion, the authors found support in the literature and recommend implementing a plan of care that includes midline head positioning for premature infants.
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134
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Fiala M, Baumert M, Walencka Z, Paprotny M. Umbilical activin A concentration as an early marker of perinatal hypoxia. J Matern Fetal Neonatal Med 2012; 25:2098-101. [DOI: 10.3109/14767058.2012.675373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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135
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Robinson S. Neonatal posthemorrhagic hydrocephalus from prematurity: pathophysiology and current treatment concepts. J Neurosurg Pediatr 2012; 9:242-58. [PMID: 22380952 PMCID: PMC3842211 DOI: 10.3171/2011.12.peds11136] [Citation(s) in RCA: 158] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECT Preterm infants are at risk for perinatal complications, including germinal matrix-intraventricular hemorrhage (IVH) and subsequent posthemorrhagic hydrocephalus (PHH). This review summarizes the current understanding of the epidemiology, pathophysiology, management, and outcomes of IVH and PHH in preterm infants. METHODS The MEDLINE database was systematically searched using terms related to IVH, PHH, and relevant neurosurgical procedures to identify publications in the English medical literature. To complement information from the systematic search, pertinent articles were selected from the references of articles identified in the initial search. RESULTS This review summarizes the current knowledge regarding the epidemiology and pathophysiology of IVH and PHH, primarily using evidence-based studies. Advances in obstetrics and neonatology over the past few decades have contributed to a marked improvement in the survival of preterm infants, and neurological morbidity is also starting to decrease. The incidence of IVH is declining, and the incidence of PHH will likely follow. Currently, approximately 15% of preterm infants who suffer severe IVH will require permanent CSF diversion. The clinical presentation and surgical management of symptomatic PHH with temporary ventricular reservoirs (ventricular access devices) and ventriculosubgaleal shunts and permanent ventriculoperitoneal shunts are discussed. Preterm infants who develop PHH that requires surgical treatment remain at high risk for other related neurological problems, including cerebral palsy, epilepsy, and cognitive and behavioral delay. This review highlights numerous opportunities for further study to improve the care of these children. CONCLUSIONS A better grasp of the pathophysiology of IVH is beginning to impact the incidence of IVH and PHH. Neonatologists conduct rigorous Class I and II studies to advance the outcomes of preterm infants. The need for well-designed multicenter trials is essential because of the declining incidence of IVH and PHH, variations in referral patterns, and neonatal ICU and neurosurgical management. Well-designed multicenter trials will eventually produce evidence to enable neurosurgeons to provide their smallest, most vulnerable patients with the best practices to minimize perioperative complications and permanent shunt dependence, and most importantly, optimize long-term neurodevelopmental outcomes.
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Affiliation(s)
- Shenandoah Robinson
- Rainbow Babies and Children’s Hospital, Neurological Institute, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio
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136
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Buhimschi IA, Buhimschi CS. Proteomics/diagnosis of chorioamnionitis and of relationships with the fetal exposome. Semin Fetal Neonatal Med 2012; 17:36-45. [PMID: 22100864 PMCID: PMC3242873 DOI: 10.1016/j.siny.2011.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Proteomics, a relatively young science, originally emerged as a complement to genomics research. By definition, the goal of proteomics is to provide a snapshot of all the proteins within an organism, tissue or biological sample at a given moment. Proteomics has the ability to single out one or more proteins (biomarkers) that change consistently in affected subjects as compared to those disease-free. From a proteomics perspective, chorioamnionitis poses both challenges and opportunities. Challenges relate to the dynamic course of the inflammatory process, and compartmentalization of the gestational sac in relation to the maternal compartment. An inability to evaluate the amniotic fluid non-invasively and repeatedly for meaningful changes in its proteome, and lack of a true gold standard for diagnosis of inflammation and/or infection, represent additional challenges. On the other hand, the unbiased and holistic nature of proteomics offers a real opportunity to improve the current diagnostic and prognostic algorithms for chorioamnionitis. Even at this current stage there are reasons to believe that proteomic biomarkers will improve the understanding of how chorioamnionitis programs or affects the fetus in utero, thus defining its exposome (sum of interactions between genetic make-up of the fetus and the intrauterine environment) of pregnancies affected by infection and/or inflammation. This review summarizes the results of proteomics studies that have aimed or reached these goals.
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Affiliation(s)
- Irina A Buhimschi
- Department of Obstetrics, Gynecology and Reproductive Science, Yale University School of Medicine, 333 Cedar Street, LLCI 804, New Haven, CT 06520, USA.
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137
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Magnesium sulfate tocolysis and intraventricular hemorrhage in very preterm infants. Indian J Pediatr 2012; 79:43-7. [PMID: 21625843 DOI: 10.1007/s12098-011-0440-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2010] [Accepted: 04/27/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To estimate the contributory effect of tocolytic magnesium sulfate (MgSO4) exposure to intraventricular hemorrhage (IVH) in preterm infants born at 23-31 wks gestation to mothers without evidence of pregnancy induced hypertension and/or preeclampsia. METHODS Cases with IVH and controls without IVH were selected from a population-based cohort of preterm infants admitted from January 2004 through May 2008 to the Level III Neonatal Intensive Care Unit (NICU) at Robert Wood Johnson University Hospital. Cases and controls were matched primarily by exact gestational age in completed weeks and secondarily by the birth weight that was same or similar (+/-100 g). The odds of tocolytic MgSO(4) exposure among the cases and controls was tested in a regression model to control the difference in demographic and clinical factors between the IVH cases (IVH+) and controls without IVH (IVH-). RESULTS Eighty-nine IVH cases and 89 controls were comparable for parity, mode of delivery, antenatal corticosteroid exposure, and surfactant administration. IVH cases were less likely to have preterm premature rupture of membranes and were more likely to be born with low Apgar scores and require ventilation. Among the IVH cases, 30.3% of infants were exposed to tocolytic MgSO4 as compared to 47.2% of controls (Odds Ratio adjusted 0.471, 95% Confidence Interval 0.241, 0.906). CONCLUSIONS Among the preterm born infants with gestational age 23-31 wks and IVH, tocolytic MgSO4 exposure was less likely to be observed than in neonates with similar clinical characteristics but without IVH, thereby suggesting that antenatal exposure to MgSO(4) may have a protective effect against IVH.
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138
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Perrone S, Tataranno ML, Stazzoni G, Buonocore G. Oxidative stress and free radicals related diseases of the newborn. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/abb.2012.327127] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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139
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Poralla C, Hertfelder HJ, Oldenburg J, Müller A, Bartmann P, Heep A. Elevated interleukin-6 concentration and alterations of the coagulation system are associated with the development of intraventricular hemorrhage in extremely preterm infants. Neonatology 2012; 102:270-5. [PMID: 22906886 DOI: 10.1159/000341266] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Accepted: 06/24/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pathogenesis of intraventricular hemorrhage (IVH) in premature infants is multifactorial. Little is known about the influence of pro-inflammatory cytokine activation on the coagulation system in extremely preterm infants and its impact on the development of IVH. OBJECTIVE To determine the interaction between serum interleukin-6 (IL-6) and the coagulation system in preterm infants predisposed to the development of IVH. METHODS Vitamin K-dependent coagulation factors were examined retrospectively in 132 extremely preterm infants prior to vitamin K administration at the first day of life. Patients were grouped according to the occurrence of IVH and serum concentration of IL-6 >/<100 pg/ml. RESULTS Occurrence of IVH was associated with clinical diagnosis of chorioamnionitis, low gestational age, high CRIB score, air leak, catecholamine treatment, low initial hematocrit and increased serum concentration of IL-6. Infants developing IVH showed a diminished coagulation profile. Multivariable logistic regression analysis revealed decreased activity of coagulation factor VII, development of pneumothorax and low hematocrit as independent risk factors for the development of IVH. An increased IL-6 serum concentration was associated with a significantly decreased activity of coagulation factor VII and increased levels of fibrinogen. CONCLUSIONS The association of elevated IL-6 levels with alterations of the coagulation profile and development of IVH found in our study supports the assumption of a close pathophysiological relation between inflammation and IVH.
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140
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Relationship between cerebrovascular dysautoregulation and arterial blood pressure in the premature infant. J Perinatol 2011; 31:722-9. [PMID: 21372795 DOI: 10.1038/jp.2011.17] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate cerebrovascular autoregulation as a function of arterial blood pressure (ABP) in the critically ill, premature infant. STUDY DESIGN A prospective observational pilot study was conducted in two tertiary care Neonatal Intensive-Care Units. Premature infants (n=23, ≤30 weeks estimated gestational age with invasive ABP monitoring) were enrolled and received routine care while undergoing continuous autoregulation monitoring, using the cerebral oximetry index (COx). The COx is a moving, linear correlation coefficient between cortical reflectance oximetry and ABP. COx values were stratified as a function of ABP for individual subject recordings and for the cohort. RESULT The mean duration of autoregulation monitoring was 3.2 days (median: 2.97, range: 0.61-3.99). A total of 10 of 23 (43%) developed intraventricular hemorrhage and 1 of 23 (4%) developed periventricular leukomalacia by head ultrasound. No association was found between neurologic injury and percentage of the monitoring periods with autoregulation impairment (defined as COx>0.5). Lower ABP was associated with dysautoregulation (higher COx values, P<0.01). The percentage of time with impaired autoregulation was greater with lower ABP (P=0.013, Spearman r=0.51). CONCLUSION All infants studied had periods with intact and periods with impaired cerebrovascular autoregulation, measured with the COx. Low ABP was associated with impaired autoregulation.
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141
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Buhimschi CS, Bhandari V, Dulay AT, Nayeri UA, Abdel-Razeq SS, Pettker CM, Thung S, Zhao G, Han YW, Bizzarro M, Buhimschi IA. Proteomics mapping of cord blood identifies haptoglobin "switch-on" pattern as biomarker of early-onset neonatal sepsis in preterm newborns. PLoS One 2011; 6:e26111. [PMID: 22028810 PMCID: PMC3189953 DOI: 10.1371/journal.pone.0026111] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 09/19/2011] [Indexed: 12/14/2022] Open
Abstract
Background Intra-amniotic infection and/or inflammation (IAI) are important causes of preterm birth and early-onset neonatal sepsis (EONS). A prompt and accurate diagnosis of EONS is critical for improved neonatal outcomes. We sought to explore the cord blood proteome and identify biomarkers and functional protein networks characterizing EONS in preterm newborns. Methodology/Principal Findings We studied a prospective cohort of 180 premature newborns delivered May 2004-September 2009. A proteomics discovery phase employing two-dimensional differential gel electrophoresis (2D-DIGE) and mass spectrometry identified 19 differentially-expressed proteins in cord blood of newborns with culture-confirmed EONS (n = 3) versus GA-matched controls (n = 3). Ontological classifications of the proteins included transfer/carrier, immunity/defense, protease/extracellular matrix. The 1st-level external validation conducted in the remaining 174 samples confirmed elevated haptoglobin and haptoglobin-related protein immunoreactivity (Hp&HpRP) in newborns with EONS (presumed and culture-confirmed) independent of GA at birth and birthweight (P<0.001). Western blot concurred in determining that EONS babies had conspicuous Hp&HpRP bands in cord blood (“switch-on pattern”) as opposed to non-EONS newborns who had near-absent “switch-off pattern” (P<0.001). Fetal Hp phenotype independently impacted Hp&HpRP. A Bayesian latent-class analysis (LCA) was further used for unbiased classification of all 180 cases based on probability of “antenatal IAI exposure” as latent variable. This was then subjected to 2nd-level validation against indicators of adverse short-term neonatal outcome. The optimal LCA algorithm combined Hp&HpRP switch pattern (most input), interleukin-6 and neonatal hematological indices yielding two non-overlapping newborn clusters with low (≤20%) versus high (≥70%) probability of IAI exposure. This approach reclassified ∼30% of clinical EONS diagnoses lowering the number needed to harm and increasing the odds ratios for several adverse outcomes including intra-ventricular hemorrhage. Conclusions/Significance Antenatal exposure to IAI results in precocious switch-on of Hp&HpRP expression. As EONS biomarker, cord blood Hp&HpRP has potential to improve the selection of newborns for prompt and targeted treatment at birth.
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Affiliation(s)
- Catalin S Buhimschi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University, School of Medicine, New Haven, Connecticut, United States of America.
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Tsitouras V, Sgouros S. Infantile posthemorrhagic hydrocephalus. Childs Nerv Syst 2011; 27:1595-608. [PMID: 21928026 DOI: 10.1007/s00381-011-1521-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 06/28/2011] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Intraventricular/germinal matrix hemorrhage affects 7-30% of premature neonates, 25-80% of whom (depending on the grade of the hemorrhage) will develop hydrocephalus requiring shunting. Predisposing factors are low birth weight and gestational age. MATERIAL There is increasing evidence for the role of TGF-β1 in the pathogenesis of hydrocephalus, but attempts to develop treatment modalities to clear the cerebrospinal fluid (CSF) from blood degradation products have not succeeded so far. Ultrasound is a valuable screening tool for high-risk infants and magnetic resonance imaging is increasingly utilized to differentiate progressive hydrocephalus from ex vacuo ventriculomegaly, evaluate periventricular parenchymal damage, decide on the surgical treatment of hydrocephalus, and follow up these patients in the long term. Treatment of increasing ventriculomegaly and intracranial hypertension in the presence of hemorrhagic CSF can involve a variety of strategies, all with relative drawbacks, aiming to drain the CSF while gaining time for it to clear and the neonate to reach term and become a suitable candidate for shunting. Eventually, patients with progressive ventriculomegaly causing intracranial hypertension, who have reached term and their CSF has cleared from blood products, will need shunting. CONCLUSION Cognitive long-term outcome is influenced more by the effect of the initial hemorrhage and other perinatal events and less by hydrocephalus, provided that this has been addressed timely in the early postnatal period. Shunting can have many long-term side effects due to mechanical complications and overdrainage. In particular, patients with posthemorrhagic hydrocephalus are more susceptible to multiloculated hydrocephalus and encysted fourth ventricle, both of which are challenging to treat.
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Affiliation(s)
- Vasilios Tsitouras
- Department of Neurosurgery, Mitera Childrens Hospital, Erythrou Stavrou 6, Marousi, 151 23 Athens, Greece
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143
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Martin JB. Prevention of Intraventricular Hemorrhages and Periventricular Leukomalacia in the Extremely Low Birth Weight Infant. ACTA ACUST UNITED AC 2011. [DOI: 10.1053/j.nainr.2011.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Rim HR, Hwang SK, Kwon SH, Kim HM. Intraparenchymal pericatheter cyst as a complication of a ventriculo-peritoneal shunt in a premature infant. J Korean Neurosurg Soc 2011; 50:143-6. [PMID: 22053237 DOI: 10.3340/jkns.2011.50.2.143] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 12/31/2010] [Accepted: 08/08/2011] [Indexed: 11/27/2022] Open
Abstract
A ventriculo-peritoneal shunt is a standard surgical management for hydrocephalus, but complications may impede the management of this disease. Obstruction of the catheter is one of the most common complications and manifests clinically in various ways. Intraparenchymal cyst development after shunt malfunction has been reported by several authors, but the underlying mechanism and optimal treatment methods are debatable. The authors report a case of intraparenchymal cyst formation around a proximal catheter in a premature infant after a ventriculo-peritoneal shunt and discuss its pathogenesis and management.
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Affiliation(s)
- Hae-Ri Rim
- Department of Pediatrics, Kyungpook National University Hospital, Daegu, Korea
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Calling S, Li X, Sundquist J, Sundquist K. Socioeconomic inequalities and infant mortality of 46,470 preterm infants born in Sweden between 1992 and 2006. Paediatr Perinat Epidemiol 2011; 25:357-65. [PMID: 21649678 DOI: 10.1111/j.1365-3016.2011.01200.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Studies on possible sociodemographic inequities in the survival of preterm infants are scarce. Individual and neighbourhood sociodemographic factors are related to preterm birth and to infant mortality in full-term infants. The aim here was to examine whether infant mortality in Swedish preterm infants is related to individual and neighbourhood sociodemographic factors, and to study whether the hypothesised association between neighbourhood deprivation and infant mortality persists after accounting for individual sociodemographic factors. The study included 46,470 infants with a gestational length of <37 weeks, born in Sweden between 1992 and 2006. Neighbourhood deprivation was assessed by an index (education, income, unemployment, welfare assistance) in small geographical units, and categorised into low, moderate and high deprivation. Adjusted odds ratios for infant mortality were examined in relation to individual and neighbourhood sociodemographic factors. After adjusting for maternal age, infant mortality was associated with the following sociodemographic variables: maternal non-married/non-cohabiting status, low family income, low maternal education and rural status. After full adjustment, the odds ratio [95% confidence interval] was 2.98 [2.42, 3.67] for low family income compared with high family income. An increase in infant mortality was also associated with high neighbourhood deprivation; however, this increased risk no longer remained statistically significant after adjusting for individual sociodemographic factors. In conclusion, this study showed an increased infant mortality in preterm infants born to women with a less favourable sociodemographic profile.
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Affiliation(s)
- Susanna Calling
- Center for Primary Health Care Research, Lund University, Malmö, Sweden.
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146
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Ryckman KK, Dagle JM, Kelsey K, Momany AM, Murray JC. Replication of genetic associations in the inflammation, complement, and coagulation pathways with intraventricular hemorrhage in LBW preterm neonates. Pediatr Res 2011; 70:90-5. [PMID: 21659962 PMCID: PMC3117229 DOI: 10.1203/pdr.0b013e31821ceb63] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intraventricular hemorrhage (IVH) is a significant morbidity seen in very LBW infants. Genes related to the inflammation, infection, complement, or coagulation pathways have been implicated as risk factors for IVH. We examined 10 candidate genes for associations with IVH in 271 preterm infants (64 with IVH grades I-IV and 207 without IVH) weighing <1500 g. The heterozygous genotype OR = 8.1, CI = 2.5-26.0, p = 4 × 10(-4)) and the A allele (OR = 7.3, CI = 2.4-22.5, p = 1 × 10(-4)) of the coagulation factor V (FV) Leiden mutation (rs6025) were associated with an increased risk of developing IVH grade I or II but not grade III or IV after correction for multiple testing with Bonferroni. Lack of association in the severe grades of IVH may be a result of lack of power to detect an effect given the small sample size (n = 8). However, this result is consistent with previous research that demonstrates that the heterozygous genotype of the FV mutation is associated with increased risk for the development of IVH but a decreased risk for the progression or extension to more severe grades of IVH.
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Affiliation(s)
- Kelli K Ryckman
- Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242, USA
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Malhotra A, Veldman A. Recombinant activated Factor VII for prevention and treatment of intraventricular haemorrhage in neonates. Hippokratia 2011. [DOI: 10.1002/14651858.cd009032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Atul Malhotra
- Monash Medical Centre; Monash Newborn; 246 Clayton Road Clayton Victoria Australia 3168
| | - Alex Veldman
- Monash Medical Centre; Monash Newborn; 246 Clayton Road Clayton Victoria Australia 3168
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148
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Fan LW, Tien LT, Zheng B, Pang Y, Lin RCS, Simpson KL, Ma T, Rhodes PG, Cai Z. Dopaminergic neuronal injury in the adult rat brain following neonatal exposure to lipopolysaccharide and the silent neurotoxicity. Brain Behav Immun 2011; 25:286-97. [PMID: 20875849 PMCID: PMC3025048 DOI: 10.1016/j.bbi.2010.09.020] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 09/07/2010] [Accepted: 09/22/2010] [Indexed: 01/17/2023] Open
Abstract
Our previous studies have shown that neonatal exposure to lipopolysaccharide (LPS) resulted in motor dysfunction and dopaminergic neuronal injury in the juvenile rat brain. To further examine whether neonatal LPS exposure has persisting effects in adult rats, motor behaviors were examined from postnatal day 7 (P7) to P70 and brain injury was determined in P70 rats following an intracerebral injection of LPS (1 mg/kg) in P5 Sprague-Dawley male rats. Although neonatal LPS exposure resulted in hyperactivity in locomotion and stereotyped tasks, and other disturbances of motor behaviors, the impaired motor functions were spontaneously recovered by P70. On the other hand, neonatal LPS-induced injury to the dopaminergic system such as the loss of dendrites and reduced tyrosine hydroxylase immunoreactivity in the substantia nigra persisted in P70 rats. Neonatal LPS exposure also resulted in sustained inflammatory responses in the P70 rat brain, as indicated by an increased number of activated microglia and elevation of interleukin-1β and interleukin-6 content in the rat brain. In addition, when challenged with methamphetamine (METH, 0.5 mg/kg) subcutaneously, rats with neonatal LPS exposure had significantly increased responses in METH-induced locomotion and stereotypy behaviors as compared to those without LPS exposure. These results indicate that although neonatal LPS-induced neurobehavioral impairment is spontaneously recoverable, the LPS exposure-induced persistent injury to the dopaminergic system and the chronic inflammation may represent the existence of silent neurotoxicity. Our data further suggest that the compromised dendritic mitochondrial function might contribute, at least partially, to the silent neurotoxicity.
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Affiliation(s)
- Lir-Wan Fan
- Department of Pediatrics, Division of Newborn Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Lu-Tai Tien
- School of Medicine, Fu-Jen Catholic University, Hsin-Chuang, Taipei County 24205, Taiwan
| | - Baoying Zheng
- Department of Pediatrics, Division of Newborn Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Yi Pang
- Department of Pediatrics, Division of Newborn Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Rick C. S. Lin
- Departments of Anatomy, Psychiatry & Human Behavior, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Kimberly L. Simpson
- Departments of Anatomy, Psychiatry & Human Behavior, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Tangeng Ma
- Department of Pharmacology & Toxicology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Philip G. Rhodes
- Department of Pediatrics, Division of Newborn Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Zhengwei Cai
- Department of Pediatrics, Division of Newborn Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA,Corresponding author: Dr. Zhengwei Cai, Ph.D., Department of Pediatrics, Division of Newborn Medicine, University of Mississippi Medical Center, Jackson, MS 39216-4504, USA, Tel.: +1-601-984-2786; Fax: +1-601-815-3666, (Z. Cai)
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149
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Rama-Maceiras P, Ingelmo-Ingelmo I, Fàbregas-Julià N, Hernández-Palazón J. Rol del factor VII recombinante activado en pacientes neuroquirúrgicos y neurocríticos. Neurocirugia (Astur) 2011. [DOI: 10.1016/s1130-1473(11)70016-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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150
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Baer VL, Lambert DK, Henry E, Snow GL, Butler A, Christensen RD. Among very-low-birth-weight neonates is red blood cell transfusion an independent risk factor for subsequently developing a severe intraventricular hemorrhage? Transfusion 2010; 51:1170-8. [DOI: 10.1111/j.1537-2995.2010.02980.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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