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Zhou P, Chen R, Zou CY, Zhang M, Chen ZH, Ma LY. [Effect of perinatal factors on postnatal development of lymphocyte subsets in early preterm infants]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2016; 18:953-959. [PMID: 27751210 PMCID: PMC7389549 DOI: 10.7499/j.issn.1008-8830.2016.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 08/11/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To study the postnatal changes in lymphocyte subsets in early preterm infants and the effect of perinatal factors on lymphocyte subsets. METHODS A total of 61 early preterm infants were enrolled. Flow cytometry was used to measure the absolute counts of lymphocytes and lymphocyte subsets at 1, 7, 14, and 28 days after birth, as well as at 6 months after birth for 17 of these early preterm infants. The effects of perinatal factors, such as antepartum use of hormone, intrauterine infection, gestational age at birth, and Ureaplasma urealyticum (UU) colonization, on lymphocyte subsets were analyzed. RESULTS The absolute counts of lymphocyte subsets except natural killer (NK) cells were lowest at birth, increased rapidly at 1 week after birth, and reached the levels in healthy infants at 6 months; the count of NK cells remained at a low level and increased significantly at 6 months after birth. Compared with those with a gestational age of <28 weeks, the early preterm infants with a gestational age of ≥28 weeks had significantly higher absolute counts of T cells, T helper (Th) cells, and NK cells at 7 days after birth, a significantly higher absolute count of T cells at 14 days after birth, and significantly higher absolute counts of lymphocytes and Th cells at 28 days after birth (P<0.05). Compared with the group not using hormone, the group using hormone showed a significantly higher absolute count of T cells at 7 days after birth and significantly higher absolute counts of lymphocytes and all subsets at 14 days after birth (P<0.05). There was no significant difference in lymphocyte subsets at 1 day after birth between the intrauterine infection and non-infection groups (P>0.05); the intrauterine infection group had significantly higher absolute counts of B cells at 7 and 14 days after birth than the non-infection group. Compared those without UU colonization, the infants with UU colonization had significantly higher absolute counts of lymphocytes, T cells, Th cells, and Ts cells at 1 day after birth and a significantly higher absolute count of B cells at 14 days after birth. CONCLUSIONS Early preterm infants have deficiencies in innate immune cells at birth and normal levels at about 6 months after birth. Various perinatal factors including antepartum use of hormone, gestational age at birth, intrauterine infection, and UU colonization have long-term effects on lymphocyte subsets in early preterm infants.
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Affiliation(s)
- Ping Zhou
- Department of Neonatology, Bao'an Maternal and Child Health Hospital, Shenzhen, Guangdong 518133, China.
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202
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Septic Arthritis of the Pediatric Shoulder: From Infancy to Adolescence. Int J Pediatr 2016; 2016:3086019. [PMID: 27635147 PMCID: PMC5011222 DOI: 10.1155/2016/3086019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 07/25/2016] [Indexed: 11/18/2022] Open
Abstract
Background. Septic arthritis of the glenohumeral joint in the pediatric population (<18 yo) is not commonly described in the literature. There is a corresponding paucity of information regarding its presentation and treatment. Methods. An IRB approved review of patients treated with irrigation and debridement by the Orthopaedic Department was completed. This retrospective study includes four patients, presenting from 2005 to 2015, with septic arthritis of the shoulder. Results. The mean age (M age) at presentation was 5 years, with a range of 1 month to 15 years. Patients presented on average after 7 days with pain and a mean temperature of 39°C, erythrocyte sedimentation rate of 66 mm/hr, a C-reactive protein level of 11.17 g/dL, and a white blood cell count of 20.2 × 10(3)/mcL. Staphylococcus aureus, Candida albicans, and Pseudomonas aeruginosa were cultured from the wounds. All cases were treated operatively with irrigation and debridement and with antimicrobial therapy. Patients received antibiotics for an average of 6 weeks. Conclusion. Septic arthritis of the shoulder occurs in all pediatric ages. Successful treatment of septic arthritis of the shoulder was accomplished in four cases without division of the biceps sheath, with an average follow-up of 8 months.
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203
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Zhang SF, Tang ZS, Tong L, Tao XX, Suo QF, Xu XM. Effects of clostridium butyricum and bifidobacterium on BTLA expression on CD4 + T cells and lymphocyte differentiation in late preterm infants. Microb Pathog 2016; 100:112-118. [PMID: 27622346 DOI: 10.1016/j.micpath.2016.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/08/2016] [Accepted: 09/09/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND & AIMS Probiotics is recognized to promote growth performance and immune function via balancing the intestinal microflora. Live clostridium butyricum and bifidobacterium combined powder (LCBBCP) has been widely to treat intestinal dysbacteriosis in newborns in China. This study was undertaken to investigate the effects of the combined probiotics on the expression of B and T lymphocyte attenuator (BTLA) on CD4+ T cells and the differentiation of lymphocyte subsets in late preterm infants. METHODS Eighty eligible late preterm infants were equally randomized into LCBBCP therapy group (oral LCBBCP dissolved in formula milk before intake) and control group (treated with simple formula milk for preterm infants) by random digit table. Flow cytometry was used to determine the expression level of BTLA on CD4+ T cells and the percentage of individual subpopulation of lymphocytes in peripheral-blood mononuclear cells (PBMCs) obtained from the late preterm infants in both groups. RESULTS BTLA protein expression on CD4+ T cells showed no significant change in LCBBCP therapy group before and after intervention, yet was rapidly and significantly down-regulated in the controls. The percentage of increased CD4+ T cells, decreased CD8+ T cells and increased ratio of CD4+/CD8+ T cell proportion were seen in both groups after treatment, yet the increasing or decreasing extent in LCBBCP therapy group was more obvious than in control group. The proportion of NK cells and B lymphocytes remained no significant difference between the two groups before and after therapy. CONCLUSIONS LCBBCP appears capable of facilitating the activation, proliferation and differentiation of T lymphocytes, which is beneficial to improving immunity in late preterm infants. The continuous high expression of BTLA on CD4+ T cells in LCBBCP therapy group may be involved in the inhibiting of excessive activation of T lymphocytes. Our findings may lay a basis for further clinical evaluation of the efficacies and wider clinical recommendation of probiotics containing live clostridium butyricum and bifidobacterium for late preterm infants.
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Affiliation(s)
- Shi-Fa Zhang
- Department of Pediatrics, Yijishan Hospital, Wannan Medical College, Wuhu 241001, Anhui, China
| | - Zong-Sheng Tang
- Department of Central Laboratory, Yijishan Hospital, Wannan Medical College, Wuhu 241001, Anhui, China.
| | - Ling Tong
- Department of Pediatrics, Yijishan Hospital, Wannan Medical College, Wuhu 241001, Anhui, China
| | - Xiang-Xiang Tao
- Office of Educational Administration, Wannan Medical College, Wuhu 241001, Anhui, China
| | - Qi-Feng Suo
- Department of Central Laboratory, Yijishan Hospital, Wannan Medical College, Wuhu 241001, Anhui, China
| | - Xue-Mei Xu
- Department of Pediatrics, Yijishan Hospital, Wannan Medical College, Wuhu 241001, Anhui, China
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204
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Fink NH, Collins CT, Gibson RA, Makrides M, Penttila IA. Targeting inflammation in the preterm infant: The role of the omega-3 fatty acid docosahexaenoic acid. JOURNAL OF NUTRITION & INTERMEDIARY METABOLISM 2016. [DOI: 10.1016/j.jnim.2016.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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205
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Silveira-Lessa AL, Quinello C, Lima L, Redondo ACC, Ceccon MEJR, Carneiro-Sampaio M, Palmeira P. TLR expression, phagocytosis and oxidative burst in healthy and septic newborns in response to Gram-negative and Gram-positive rods. Hum Immunol 2016; 77:972-980. [PMID: 27450230 DOI: 10.1016/j.humimm.2016.07.230] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 06/30/2016] [Accepted: 07/18/2016] [Indexed: 02/08/2023]
Abstract
The objective was to investigate whether phagocytes from healthy and septic newborns have a developmental deficiency in their capacity to recognize, phagocytize and generate hydrogen peroxide (H2O2) in response to Escherichia coli and Staphylococcus aureus. TLR expression and phagocytic ability of neutrophils and monocytes from 44 healthy preterm and term neonates, from 13 newborns with late-onset sepsis and from 24 healthy adults were determined using flow cytometry, and H2O2 production was measured by dihydrorhodamine test. TLR-2 and TLR-4 expressions were similar among the groups. The phagocytic ability of monocytes and neutrophils exposed to E. coli and S. aureus in healthy and septic neonates was significantly reduced compared to that of adults. Monocytes from septic newborns exposed to E. coli had higher H2O2 production than those of the other groups. The oxidative burst of monocytes exposed to S. aureus was reduced in preterm newborns compared with term ones and those with sepsis, and no differences were found in the oxidative burst of neutrophils. Even with the ability to recognize bacteria, a decreased clearance of pathogens can cause an imbalance in the immune response, which could lead to a predisposition to sepsis. Once established, the increased production of cytokines and ROS in an attempt to control the infection as well as the lack of full phagocytic activity leads to persistence of the pathogen and a state of constant inflammation.
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Affiliation(s)
- Ana Lúcia Silveira-Lessa
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil; Laboratory of Medical Investigation (LIM-36), Department of Pediatrics, Medical School, University of São Paulo, São Paulo, Brazil.
| | - Camila Quinello
- Laboratory of Medical Investigation (LIM-36), Department of Pediatrics, Medical School, University of São Paulo, São Paulo, Brazil
| | - Laila Lima
- Laboratory of Medical Investigation (LIM-36), Department of Pediatrics, Medical School, University of São Paulo, São Paulo, Brazil
| | - Ana Carolina Costa Redondo
- Neonatal Intensive Care Unit, Instituto da Criança, Hospital das Clínicas, Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Magda Carneiro-Sampaio
- Laboratory of Medical Investigation (LIM-36), Department of Pediatrics, Medical School, University of São Paulo, São Paulo, Brazil
| | - Patricia Palmeira
- Laboratory of Medical Investigation (LIM-36), Department of Pediatrics, Medical School, University of São Paulo, São Paulo, Brazil
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206
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Non-malaria fevers in a high malaria endemic area of Ghana. BMC Infect Dis 2016; 16:327. [PMID: 27400781 PMCID: PMC4940727 DOI: 10.1186/s12879-016-1654-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 06/07/2016] [Indexed: 12/04/2022] Open
Abstract
Background The importance of fevers not due to malaria [non–malaria fevers, NMFs] in children in sub-Saharan Africa is increasingly being recognised. We have investigated the influence of exposure-related factors and placental malaria on the risk of non-malaria fevers among children in Kintampo, an area of Ghana with high malaria transmission. Methods Between 2008 and 2011, a cohort of 1855 newborns was enrolled and followed for at least 12 months. Episodes of illness were detected by passive case detection. The primary analysis covered the period from birth up to 12 months of age, with an exploratory analysis of a sub-group of children followed for up to 24 months. Results The incidence of all episodes of NMF in the first year of life (first and subsequent) was 1.60 per child-year (95 % CI 1.54, 1.66). The incidence of NMF was higher among infants with low birth weight [adjusted hazard ratio (aHR) 1.22 (95 % CI 1.04–1.42) p = 0.012], infants from households of poor socio-economic status [aHR 1.22 (95 % CI 1.02–1.46) p = 0.027] and infants living furthest from a health facility [aHR 1.20 (95 % CI 1.01–1.43) p = 0.037]. The incidence of all episodes of NMF was similar among infants born to mothers with or without placental malaria [aHR 0.97 (0.87, 1.08; p = 0.584)]. Conclusion The incidence of NMF in infancy is high in the study area. The incidence of NMF is associated with low birth weight and poor socioeconomic status but not with placental malaria. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1654-4) contains supplementary material, which is available to authorized users.
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207
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Sava F, Toldi G, Treszl A, Hajdú J, Harmath Á, Tulassay T, Vásárhelyi B. Expression of lymphocyte activation markers of preterm neonates is associated with perinatal complications. BMC Immunol 2016; 17:19. [PMID: 27328920 PMCID: PMC4915083 DOI: 10.1186/s12865-016-0159-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 06/16/2016] [Indexed: 02/10/2023] Open
Abstract
Background Inappropriate activation of T lymphocytes plays an important role in perinatal complications. However, data on T lymphocyte activation markers of preterm infants is scarce. We investigated the association between gender, gestational and postnatal age, preeclampsia (PE), premature rupture of membranes (PROM) as well as prenatal steroid treatment (PS) and the frequency of activated T lymphocyte subsets (HLA-DR+, CD69+, CD25+, CD62L+) and major T lymphocyte subpopulations (CD4, CD8, Th1, Th2, naïve, memory) in peripheral blood during the first postnatal week in preterm infants. Results Cord blood and peripheral blood samples were collected from 43 preterm infants on the 1st, 3rd, and 7th days of life. We assessed the frequency of the above T lymphocyte subsets using flow cytometry. The ‘mixed effect model’ was used to analyze the effects of clinical parameters on T lymphocyte markers. The frequency of CD25+ T lymphocytes was higher in PROM. The frequency of CD4+ and CD8+ cells and the CD4+/CD8+ cell ratio was decreased in PE. The frequency of CD62L+ T lymphocytes was higher in male compared with female infants. PS did not affect the frequency of the investigated markers. CD4+ CD25+ cells had a lower frequency at birth than on day 7. Th2 lymphocytes had a lower frequency on postnatal days 1 and 3 when compared to day 7. Conclusions Our observations indicate that alterations affecting the expression of T lymphocyte activation markers are associated with the above factors and may play a role in the development of perinatal complications.
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Affiliation(s)
- Florentina Sava
- First Department of Obstetrics and Gynecology, Semmelweis University, Baross u. 27, H-1088, Budapest, Hungary
| | - Gergely Toldi
- First Department of Obstetrics and Gynecology, Semmelweis University, Baross u. 27, H-1088, Budapest, Hungary.
| | - András Treszl
- First Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Júlia Hajdú
- First Department of Obstetrics and Gynecology, Semmelweis University, Baross u. 27, H-1088, Budapest, Hungary
| | - Ágnes Harmath
- First Department of Obstetrics and Gynecology, Semmelweis University, Baross u. 27, H-1088, Budapest, Hungary
| | - Tivadar Tulassay
- First Department of Pediatrics, Semmelweis University, Budapest, Hungary.,MTA-SE Research Group of Pediatrics and Nephrology, Hungarian Academy of Sciences, Budapest, Hungary
| | - Barna Vásárhelyi
- MTA-SE Research Group of Pediatrics and Nephrology, Hungarian Academy of Sciences, Budapest, Hungary.,Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
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208
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Development of immune organs and functioning in humans and test animals: Implications for immune intervention studies. Reprod Toxicol 2016; 64:180-90. [PMID: 27282947 DOI: 10.1016/j.reprotox.2016.06.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/10/2016] [Accepted: 06/03/2016] [Indexed: 12/23/2022]
Abstract
A healthy immune status is mostly determined during early life stages and many immune-related diseases may find their origin in utero and the first years of life. Therefore, immune health optimization may be most effective during early life. This review is an inventory of immune organ maturation events in relation to developmental timeframes in minipig, rat, mouse and human. It is concluded that time windows of immune organ development in rodents can be translated to human, but minipig reflects the human timeframes better; however the lack of prenatal maternal-fetal immune interaction in minipig may cause less responsiveness to prenatal intervention. It is too early to conclude which immune parameters are most appropriate, because there are not enough comparative immune parameters. Filling these gaps will increase the predictability of results observed in experimental animals, and guide future intervention studies by assessing relevant parameters in the right corresponding developmental time frames.
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209
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Pierro M, Thébaud B. MSCS in Scenarios of Infection and Inflammation: Focus on Neonatal Diseases. CURRENT STEM CELL REPORTS 2016. [DOI: 10.1007/s40778-016-0045-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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210
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Hansen CF, Thymann T, Andersen AD, Holst JJ, Hartmann B, Hilsted L, Langhorn L, Jelsing J, Sangild PT. Rapid gut growth but persistent delay in digestive function in the postnatal period of preterm pigs. Am J Physiol Gastrointest Liver Physiol 2016; 310:G550-60. [PMID: 26822913 PMCID: PMC4836131 DOI: 10.1152/ajpgi.00221.2015] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 01/22/2016] [Indexed: 01/31/2023]
Abstract
Preterm infants often tolerate full enteral nutrition a few weeks after birth but it is not known how this is related to gut maturation. Using pigs as models, we hypothesized that intestinal structure and digestive function are similar in preterm and term individuals at 3-4 wk after birth and that early enteral nutrition promotes maturation. Preterm or term cesarean-delivered pigs were fed total parenteral nutrition, or partial enteral nutrition [Enteral (Ent), 16-64 ml·kg(-1)·day(-1) of bovine colostrum] for 5 days, followed by full enteral milk feeding until day 26 The intestine was collected for histological and biochemical analyses at days 0, 5, and 26 (n = 8-12 in each of 10 treatment groups). Intestinal weight (relative to body weight) was reduced in preterm pigs at 0-5 days but ENT feeding stimulated the mucosal volume and peptidase activities. Relative to term pigs, mucosal volume remained reduced in preterm pigs until 26 days although plasma glucagon-like peptide 2 (GLP-2) and glucose-dependent insulin-trophic peptide (GIP) levels were increased. Preterm pigs also showed reduced hexose absorptive capacity and brush-border enzyme (sucrase, maltase) activities at 26 days, relative to term pigs. Intestinal structure shows a remarkable growth adaptation in the first week after preterm birth, especially with enteral nutrition, whereas some digestive functions remain immature until at least 3-4 wk. It is important to identify feeding regimens that stimulate intestinal maturation in the postnatal period of preterm infants because some intestinal functions may show long-term developmental delay.
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Affiliation(s)
- Carl Frederik Hansen
- 1Comparative Pediatrics and Nutrition, University of Copenhagen, Copenhagen, Denmark;
| | - Thomas Thymann
- 1Comparative Pediatrics and Nutrition, University of Copenhagen, Copenhagen, Denmark;
| | | | - Jens Juul Holst
- 2Novo Nordisk Foundation Center for Basic Metabolic Research, and Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;
| | - Bolette Hartmann
- 2Novo Nordisk Foundation Center for Basic Metabolic Research, and Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;
| | - Linda Hilsted
- 4Department of Clinical Biochemistry, Copenhagen University Hospital, Cophenhagen Denmark; and
| | - Louise Langhorn
- 1Comparative Pediatrics and Nutrition, University of Copenhagen, Copenhagen, Denmark;
| | | | - Per Torp Sangild
- 1Comparative Pediatrics and Nutrition, University of Copenhagen, Copenhagen, Denmark; ,5Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Denmark
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211
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Hansen CF, Thymann T, Andersen AD, Holst JJ, Hartmann B, Hilsted L, Langhorn L, Jelsing J, Sangild PT. Rapid gut growth but persistent delay in digestive function in the postnatal period of preterm pigs. Am J Physiol Gastrointest Liver Physiol 2016. [PMID: 26822913 DOI: 10.1152/ajpgi.00221.201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Preterm infants often tolerate full enteral nutrition a few weeks after birth but it is not known how this is related to gut maturation. Using pigs as models, we hypothesized that intestinal structure and digestive function are similar in preterm and term individuals at 3-4 wk after birth and that early enteral nutrition promotes maturation. Preterm or term cesarean-delivered pigs were fed total parenteral nutrition, or partial enteral nutrition [Enteral (Ent), 16-64 ml·kg(-1)·day(-1) of bovine colostrum] for 5 days, followed by full enteral milk feeding until day 26 The intestine was collected for histological and biochemical analyses at days 0, 5, and 26 (n = 8-12 in each of 10 treatment groups). Intestinal weight (relative to body weight) was reduced in preterm pigs at 0-5 days but ENT feeding stimulated the mucosal volume and peptidase activities. Relative to term pigs, mucosal volume remained reduced in preterm pigs until 26 days although plasma glucagon-like peptide 2 (GLP-2) and glucose-dependent insulin-trophic peptide (GIP) levels were increased. Preterm pigs also showed reduced hexose absorptive capacity and brush-border enzyme (sucrase, maltase) activities at 26 days, relative to term pigs. Intestinal structure shows a remarkable growth adaptation in the first week after preterm birth, especially with enteral nutrition, whereas some digestive functions remain immature until at least 3-4 wk. It is important to identify feeding regimens that stimulate intestinal maturation in the postnatal period of preterm infants because some intestinal functions may show long-term developmental delay.
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Affiliation(s)
- Carl Frederik Hansen
- Comparative Pediatrics and Nutrition, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Thymann
- Comparative Pediatrics and Nutrition, University of Copenhagen, Copenhagen, Denmark
| | | | - Jens Juul Holst
- Novo Nordisk Foundation Center for Basic Metabolic Research, and Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bolette Hartmann
- Novo Nordisk Foundation Center for Basic Metabolic Research, and Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Linda Hilsted
- Department of Clinical Biochemistry, Copenhagen University Hospital, Cophenhagen Denmark; and
| | - Louise Langhorn
- Comparative Pediatrics and Nutrition, University of Copenhagen, Copenhagen, Denmark
| | | | - Per Torp Sangild
- Comparative Pediatrics and Nutrition, University of Copenhagen, Copenhagen, Denmark; Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Denmark
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Neill S, Haithcock S, Smith PB, Goldberg R, Bidegain M, Tanaka D, Carriker C, Ericson JE. Sustained Reduction in Bloodstream Infections in Infants at a Large Tertiary Care Neonatal Intensive Care Unit. Adv Neonatal Care 2016; 16:52-9. [PMID: 25915573 PMCID: PMC4619157 DOI: 10.1097/anc.0000000000000164] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Bloodstream infections (BSI) cause significant morbidity and mortality among hospitalized infants. PURPOSE Reduction of BSIs has emerged as an important patient safety goal. Implementation of central line insertion bundles, standardized line care protocols, and health care provider education programs have reduced BSI in NICUs around the country. The ability of large tertiary care centers to decrease nosocomial infections, including BSI, has been demonstrated. However, long-term BSI reductions in infants are not well documented. We sought to demonstrate that a low incidence of BSI can be maintained over time in a tertiary care NICU. RESULTS Baseline BSI incidence for infants admitted to the NICU was 5.15 and 6.08 episodes per 1000 infant-days in 2005 and 2006, respectively. After protocol implementation, the incidence of BSI decreased to 2.14/1000 infant-days and 2.44/1000 infant-days in 2008 and 2009, respectively. Yearly incidence remained low over the next 4 years and decreased even further to 0.20 to 0.45 infections per 1000 infant-days. This represents a 92% decrease in BSI over a period of more than 5 years. IMPLICATIONS FOR PRACTICE Implementation of a nursing-led comprehensive infection control initiative can effectively produce and maintain a reduction in the incidence of BSI in infants at a large tertiary care NICU. IMPLICATIONS FOR RESEARCH Additional research is needed to effectively expand prevention of central line-associated BSIs to BSIs of all etiologies.
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Affiliation(s)
- Sara Neill
- Department of Advanced Practice Nursing, Duke University, Durham, NC
| | | | - P. Brian Smith
- Department of Pediatrics, Duke University, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | | | | | - David Tanaka
- Department of Pediatrics, Duke University, Durham, NC, USA
| | | | - Jessica E. Ericson
- Department of Pediatrics, Duke University, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
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213
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Survival, Hospitalization, and Acute-Care Costs of Very and Moderate Preterm Infants in the First 6 Years of Life: A Population-Based Study. J Pediatr 2016; 169:61-8.e3. [PMID: 26561378 DOI: 10.1016/j.jpeds.2015.10.028] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/22/2015] [Accepted: 10/07/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To investigate survival, hospitalization, and acute-care costs of very (28-31 weeks' gestation) and moderate preterm (32-33 weeks' gestation) infants in the first 6 years of life and compare outcomes with the more widely studied extremely preterm infants (24-27 weeks' gestation) and to full term (low risk) infants (39-40 weeks' gestation). STUDY DESIGN Birth data from all women residing in New South Wales, Australia, with gestational ages between 24-33 and 39-40 weeks in 2001-2011 were linked probabilistically to hospitalization and mortality data. Study outcomes were evaluated with the use of descriptive and multivariable analyses at birth (N = 559,532), discharge (N = 540,240), and at 1 (N = 487,447) and 6 years of age (N = 230,498). RESULTS Mortality was greatest among extremely preterm infants (eg, 31.2% within 6 years) and decreased with increasing gestational age. Likewise, hospitalization within the first year of life increased with decreasing gestational age (aOR 5.5 [95% CI 4.7-6.4], 3.7 [3.4-4.0], and 2.6 [2.5-2.8] for birth at 24-27, 28-31, and 32-33 weeks' gestation, relative to 39-40 weeks' gestation). Hospitalization remained significantly increased with preterm birth at each year of age up to 6 years (aORs 1.3-1.6 at 6 years). Cumulative costs were significantly greater with preterm birth within the first year of life, and also between 1 and 6 years of age. CONCLUSIONS The risks of adverse health outcomes were significantly greater in very and moderately preterm infants relative to full term infants but lower than extremely preterm infants. Crucially, preterm birth was associated with prolonged increased odds of hospitalization (up to age 6 years), contributing to greater resource use.
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214
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Abstract
Premature infants are at increased risk for morbidity and mortality due to necrotizing enterocolitis (NEC) and sepsis. Probiotics decrease the risk of NEC and death in premature infants; however, mechanisms of action are unclear. A wide variety of probiotic species have been evaluated for potential beneficial properties in vitro, in animal models, and in clinical trials of premature infants. Although there is variation by species and even strain, common mechanisms of protection include attenuation of intestinal inflammation, apoptosis, dysmotility, permeability, supplanting other gut microbes through production of bacteriocins, and more effective use of available nutrients. Here, we review the most promising probiotics and what is known about their impact on the innate and adaptive immune response.
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Affiliation(s)
- Mark A Underwood
- Chief Division of Neonatology, School of Medicine, University of California at Davis, Sacramento, CA
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215
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Pancham K, Perez GF, Huseni S, Jain A, Kurdi B, Rodriguez-Martinez CE, Preciado D, Rose MC, Nino G. Premature infants have impaired airway antiviral IFNγ responses to human metapneumovirus compared to respiratory syncytial virus. Pediatr Res 2015; 78:389-94. [PMID: 26086642 PMCID: PMC5529168 DOI: 10.1038/pr.2015.113] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 03/09/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND It is unknown why human metapneumovirus (HMPV) and respiratory syncytial virus (RSV) cause severe respiratory infection in children, particularly in premature infants. Our aim was to investigate if there are defective airway antiviral responses to these viruses in young children with history of prematurity. METHODS Nasal airway secretions were collected from 140 children ≤ 3 y old without detectable virus (n = 80) or with PCR-confirmed HMPV or RSV infection (n = 60). Nasal protein levels of IFNγ, CCL5/RANTES, IL-10, IL-4, and IL-17 were determined using a multiplex magnetic bead immunoassay. RESULTS Full-term children with HMPV and RSV infection had increased levels of nasal airway IFNγ, CCL5, and IL-10 along with an elevation in Th1 (IFNγ)/Th2 (IL-4) ratios, which is expected during antiviral responses. In contrast, HMPV-infected premature children (< 32 wk gestation) did not exhibit increased Th1/Th2 ratios or elevated nasal airway secretion of IFNγ, CCL5, and IL-10 relative to uninfected controls. CONCLUSION Our study is the first to demonstrate that premature infants have defective IFNγ, CCL5/RANTES, and IL-10 airway responses during HMPV infection and provides novel insights about the potential reason why HMPV causes severe respiratory disease in children with history of prematurity.
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Affiliation(s)
- Krishna Pancham
- Division of Pulmonary and Sleep Medicine, Children’s National Medical Center, Washington, DC
| | - Geovanny F. Perez
- Division of Pulmonary and Sleep Medicine, Children’s National Medical Center, Washington, DC,Department of Pediatrics, George Washington University, Washington, DC,Department of Integrative Systems Biology, George Washington University, Washington, DC,Center for Genetic Research Medicine, Children’s National Medical Center, Washington, DC
| | - Shehlanoor Huseni
- Division of Pulmonary and Sleep Medicine, Children’s National Medical Center, Washington, DC
| | - Amisha Jain
- Division of Pulmonary and Sleep Medicine, Children’s National Medical Center, Washington, DC
| | - Bassem Kurdi
- Department of Pediatrics, George Washington University, Washington, DC
| | - Carlos E. Rodriguez-Martinez
- Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia,Department of Pediatric Pulmonology and Pediatric Critical Care Medicine, School of Medicine, Universidad El Bosque, Bogota, Colombia,Research Unit, Military Hospital of Colombia, Bogota, Colombia
| | - Diego Preciado
- Department of Pediatrics, George Washington University, Washington, DC,Department of Integrative Systems Biology, George Washington University, Washington, DC,Center for Genetic Research Medicine, Children’s National Medical Center, Washington, DC,Division of Pediatric Otorhinolaryngology, Department of Surgery, George Washington University, Washington, DC,Division of Pediatric Otorhinolaryngology, Department of Pediatrics, George Washington University, Washington, DC
| | - Mary C. Rose
- Division of Pulmonary and Sleep Medicine, Children’s National Medical Center, Washington, DC,Department of Pediatrics, George Washington University, Washington, DC,Department of Integrative Systems Biology, George Washington University, Washington, DC,Center for Genetic Research Medicine, Children’s National Medical Center, Washington, DC,Department of Biochemistry and Molecular Medicine, George Washington University, Washington, DC
| | - Gustavo Nino
- Division of Pulmonary and Sleep Medicine, Children’s National Medical Center, Washington, DC,Department of Pediatrics, George Washington University, Washington, DC,Department of Integrative Systems Biology, George Washington University, Washington, DC,Center for Genetic Research Medicine, Children’s National Medical Center, Washington, DC
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216
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Jin C, Londono I, Mallard C, Lodygensky GA. New means to assess neonatal inflammatory brain injury. J Neuroinflammation 2015; 12:180. [PMID: 26407958 PMCID: PMC4583178 DOI: 10.1186/s12974-015-0397-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 09/10/2015] [Indexed: 01/23/2023] Open
Abstract
Preterm infants are especially vulnerable to infection-induced white matter injury, associated with cerebral palsy, cognitive and psychomotor impairment, and other adverse neurological outcomes. The etiology of such lesions is complex and multifactorial. Furthermore, timing and length of exposure to infection also influence neurodevelopmental outcomes. Different mechanisms have been posited to mediate the observed brain injury including microglial activation followed by subsequent release of pro-inflammatory species, glutamate-induced excitotoxicity, and vulnerability of developing oligodendrocytes to cerebral insults. The prevalence of such neurological impairments requires an urgent need for early detection and effective neuroprotective strategies. Accordingly, noninvasive methods of monitoring disease progression and therapy effectiveness are essential. While diagnostic tools using biomarkers from bodily fluids may provide useful information regarding potential risks of developing neurological diseases, the use of magnetic resonance imaging/spectroscopy has emerged as a promising candidate for such purpose. Various pharmacological agents have demonstrated protective effects in the immature brain in animal models; however, few studies have progressed to clinical trials with promising results.
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Affiliation(s)
- Chen Jin
- Department of Pediatrics, Sainte-Justine Hospital and Research Center, Université de Montréal, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, Québec, H3T 1C5, Canada.
| | - Irene Londono
- Department of Pediatrics, Sainte-Justine Hospital and Research Center, Université de Montréal, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, Québec, H3T 1C5, Canada.
| | - Carina Mallard
- Perinatal Center, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30, Gothenburg, Sweden.
| | - Gregory A Lodygensky
- Department of Pediatrics, Sainte-Justine Hospital and Research Center, Université de Montréal, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, Québec, H3T 1C5, Canada. .,Montreal Heart Institute, 5000 Rue Bélanger, Montréal, Québec, Canada. .,Department of Neuroscience and Pharmacology, Université de Montréal, Montréal, Québec, Canada.
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217
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Trend S, de Jong E, Lloyd ML, Kok CH, Richmond P, Doherty DA, Simmer K, Kakulas F, Strunk T, Currie A. Leukocyte Populations in Human Preterm and Term Breast Milk Identified by Multicolour Flow Cytometry. PLoS One 2015; 10:e0135580. [PMID: 26288195 PMCID: PMC4545889 DOI: 10.1371/journal.pone.0135580] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 07/24/2015] [Indexed: 12/12/2022] Open
Abstract
Background Extremely preterm infants are highly susceptible to bacterial infections but breast milk provides some protection. It is unknown if leukocyte numbers and subsets in milk differ between term and preterm breast milk. This study serially characterised leukocyte populations in breast milk of mothers of preterm and term infants using multicolour flow cytometry methods for extended differential leukocyte counts in blood. Methods Sixty mothers of extremely preterm (<28 weeks gestational age), very preterm (28–31 wk), and moderately preterm (32–36 wk), as well as term (37–41 wk) infants were recruited. Colostrum (d2–5), transitional (d8–12) and mature milk (d26–30) samples were collected, cells isolated, and leukocyte subsets analysed using flow cytometry. Results The major CD45+ leukocyte populations circulating in blood were also detectable in breast milk but at different frequencies. Progression of lactation was associated with decreasing CD45+ leukocyte concentration, as well as increases in the relative frequencies of neutrophils and immature granulocytes, and decreases in the relative frequencies of eosinophils, myeloid and B cell precursors, and CD16- monocytes. No differences were observed between preterm and term breast milk in leukocyte concentration, though minor differences between preterm groups in some leukocyte frequencies were observed. Conclusions Flow cytometry is a useful tool to identify and quantify leukocyte subsets in breast milk. The stage of lactation is associated with major changes in milk leukocyte composition in this population. Fresh preterm breast milk is not deficient in leukocytes, but shorter gestation may be associated with minor differences in leukocyte subset frequencies in preterm compared to term breast milk.
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Affiliation(s)
- Stephanie Trend
- Centre for Neonatal Research and Education, The University of Western Australia, Perth, Western Australia, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Emma de Jong
- Centre for Neonatal Research and Education, The University of Western Australia, Perth, Western Australia, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia, Australia
- School of Veterinary and Life Sciences, Murdoch University, Perth, Western Australia, Australia
| | - Megan L. Lloyd
- Centre for Neonatal Research and Education, The University of Western Australia, Perth, Western Australia, Australia
- School of Pathology and Laboratory Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Chooi Heen Kok
- Centre for Neonatal Research and Education, The University of Western Australia, Perth, Western Australia, Australia
- Neonatal Clinical Care Unit, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia
| | - Peter Richmond
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Dorota A. Doherty
- School of Women’s and Infants’ Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Karen Simmer
- Centre for Neonatal Research and Education, The University of Western Australia, Perth, Western Australia, Australia
- Neonatal Clinical Care Unit, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia
| | - Foteini Kakulas
- School of Chemistry and Biochemistry, The University of Western Australia, Perth, Australia
| | - Tobias Strunk
- Centre for Neonatal Research and Education, The University of Western Australia, Perth, Western Australia, Australia
- Neonatal Clinical Care Unit, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia
| | - Andrew Currie
- Centre for Neonatal Research and Education, The University of Western Australia, Perth, Western Australia, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia, Australia
- School of Veterinary and Life Sciences, Murdoch University, Perth, Western Australia, Australia
- * E-mail:
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218
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Migale R, Herbert BR, Lee YS, Sykes L, Waddington SN, Peebles D, Hagberg H, Johnson MR, Bennett PR, MacIntyre DA. Specific Lipopolysaccharide Serotypes Induce Differential Maternal and Neonatal Inflammatory Responses in a Murine Model of Preterm Labor. THE AMERICAN JOURNAL OF PATHOLOGY 2015. [PMID: 26212908 DOI: 10.1016/j.ajpath.2015.05.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Intrauterine inflammation is recognized as a key mediator of both normal and preterm birth but is also associated with neonatal neurological injury. Lipopolysaccharide (LPS) is often used to stimulate inflammatory pathways in animal models of infection/inflammation-induced preterm labor; however, inconsistencies in maternal and neonatal responses to LPS are frequently reported. We hypothesized that LPS serotype-specific responses may account for a portion of these inconsistencies. Four different Escherichia coli LPS serotypes (O111:B4, O55:B5, O127:B8, and O128:B12) were administered to CD1 mice via intrauterine injection at gestational day 16. Although control animals delivered at term 60 ± 15 hours postinjection (p.i.), those administered with O111:B4 delivered 7 ± 2 hours p.i., O55:B5 delivered 10 ± 3 hours p.i., O127:B8 delivered 16 ± 10 hours p.i., and O128:B12 delivered 17 ± 2 hours p.i. (means ± SD). A correlation between the onset of preterm labor and myometrial activation of the inflammatory transcription factor, activator protein 1, but not NF-κB was observed. Specific LPS serotypes induced differential activation of downstream contractile and inflammatory pathways in myometrium and neonatal pup brain. Our findings demonstrate functional disparity in inflammatory pathway activation in response to differing LPS serotypes. Selective use of LPS serotypes may represent a useful tool for targeting specific inflammatory response mechanisms in these models.
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Affiliation(s)
- Roberta Migale
- Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom
| | - Bronwen R Herbert
- Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom; Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, United Kingdom
| | - Yun S Lee
- Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom
| | - Lynne Sykes
- Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom
| | - Simon N Waddington
- Gene Transfer Technology Group, Institute for Women's Health, University College London, London, United Kingdom; Antiviral Gene Therapy Research Unit, Faculty of Health Sciences, University of the Witswatersrand, Johannesburg, South Africa
| | - Donald Peebles
- UCL Centre for Perinatal Brain Protection & Repair, Institute for Women's Health, University College London, London, United Kingdom
| | - Henrik Hagberg
- Department of Clinical Sciences, Perinatal Center, University of Gothenburg, Gothenburg, Sweden; Division of Imaging Sciences and Biomedical Engineering, Centre for the Developing Brain, King's College London, King's Health Partners, St. Thomas' Hospital, London, United Kingdom
| | - Mark R Johnson
- Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom; Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, United Kingdom
| | - Phillip R Bennett
- Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom
| | - David A MacIntyre
- Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom.
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Parets SE, Conneely KN, Kilaru V, Menon R, Smith AK. DNA methylation provides insight into intergenerational risk for preterm birth in African Americans. Epigenetics 2015; 10:784-92. [PMID: 26090903 DOI: 10.1080/15592294.2015.1062964] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
African Americans are at increased risk for spontaneous preterm birth (PTB). Though PTB is heritable, genetic studies have not identified variants that account for its intergenerational risk, prompting the hypothesis that epigenetic factors may also contribute. The objective of this study was to evaluate DNA methylation from maternal leukocytes to identify patterns specific to PTB and its intergenerational risk. DNA from peripheral leukocytes from African American women that delivered preterm (24-34 weeks; N = 16) or at term (39-41 weeks; N = 24) was assessed for DNA methylation using the HumanMethylation450 BeadChip. In maternal samples, 17,829 CpG sites associated with PTB, but no CpG site remained associated after correction for multiple comparisons. Examination of paired maternal-fetal samples identified 5,171 CpG sites in which methylation of maternal samples correlated with methylation of her respective fetus (FDR < 0.05). These correlated sites were enriched for association with PTB in maternal leukocytes. The majority of correlated CpG sites could be attributed to one or more genetic variants. They were also significantly more likely to be in genes involved in metabolic, cardiovascular, and immune pathways, suggesting a role for genetic and environmental contributions to PTB risk and chronic disease. The results of this study may provide insight into the factors underlying intergenerational risk for PTB and its consequences.
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Affiliation(s)
- Sasha E Parets
- a Genetics and Molecular Biology Program; Emory University ; Atlanta , GA USA
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220
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Stephens AS, Lain SJ, Roberts CL, Bowen JR, Simpson JM, Nassar N. Hospitalisations from 1 to 6 years of age: effects of gestational age and severe neonatal morbidity. Paediatr Perinat Epidemiol 2015; 29:241-9. [PMID: 25846900 DOI: 10.1111/ppe.12188] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND To investigate whether the adverse infant health outcomes associated with early birth and severe neonatal morbidity (SNM) persist beyond the first year of life and impact on paediatric hospitalisations for children up to 6 years of age. METHODS The study population included all singleton live births, >32 weeks gestation in New South Wales, Australia, in 2001-2005, with follow-up to 6 years of age. Birth data were probabilistically linked to hospitalisation data (n = 392 964). The odds of hospitalisation, mean hospital length of stay (LOS) and costs, and cumulative LOS were evaluated by gestational age and SNM using multivariable analyses. RESULTS A total of 74 341 (18.9%) and 41 404 (10.5%) infants were hospitalised once and more than once, respectively. SNM was associated with increased odds of hospitalisation once (adjusted odds ratio [aOR] 1.16 [95% confidence interval 1.10, 1.22]) and more than once [aOR 1.51 (1.43, 1.61)]. Decreasing gestational age was associated with increasing odds of hospitalisation more than once from aOR 1.19 at 37-38 weeks to 1.49 at 33-34 weeks. Average LOS and costs per hospital admission were increased with SNM but not with decreasing gestational age. Cumulative LOS was significantly increased with SNM and decreasing gestational age. CONCLUSIONS Adverse effects of SNM and early birth persist between 1 and 6 years of age. Strategies to prevent early birth and reduce SNM, and to increase health monitoring of vulnerable infants throughout childhood may help reduce paediatric hospitalisations.
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Affiliation(s)
- Alexandre S Stephens
- NSW Biostatistical Officer Training Program, NSW Ministry of Health, Sydney, NSW, Australia; Kolling Institute of Medical Research, Clinical and Population Perinatal Health Research, University of Sydney, Sydney, NSW, Australia
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221
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Carvalho CG, Silveira RC, Procianoy RS. Ventilator-induced lung injury in preterm infants. Rev Bras Ter Intensiva 2015; 25:319-26. [PMID: 24553514 PMCID: PMC4031878 DOI: 10.5935/0103-507x.20130054] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 10/11/2013] [Indexed: 01/31/2023] Open
Abstract
In preterm infants, the need for intubation and mechanical ventilation is associated
with ventilator-induced lung injuries and subsequent bronchopulmonary dysplasia. The
aim of the present review was to improve the understanding of the mechanisms of
injury that involve cytokine-mediated inflammation to contribute to the development
of new preventive strategies. Relevant articles were retrieved from the PubMed
database using the search terms "ventilator-induced lung injury preterm", "continuous
positive airway pressure", "preterm", and "bronchopulmonary dysplasia". The resulting
data and other relevant information were divided into several topics to ensure a
thorough, critical view of ventilation-induced lung injury and its consequences in
preterm infants. The role of pro-inflammatory cytokines (particularly interleukins 6
and 8 and tumor necrosis factor alpha) as mediators of lung injury was assessed.
Evidence from studies conducted with animals and human newborns is described. This
evidence shows that brief periods of mechanical ventilation is sufficient to induce
the release of pro-inflammatory cytokines. Other forms of mechanical and non-invasive
ventilation were also analyzed as protective alternatives to conventional mechanical
ventilation. It was concluded that non-invasive ventilation, intubation followed by
early surfactant administration and quick extubation for nasal continuous positive
airway pressure, and strategies that regulate tidal volume and avoid volutrauma (such
as volume guarantee ventilation) protect against ventilator-induced lung injury in
preterm infants.
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Affiliation(s)
- Clarissa Gutierrez Carvalho
- Hospital de Clínicas de Porto Alegre, Unidade de Terapia Intensiva Neonatal, Porto AlegreRS, Brasil, Unidade de Terapia Intensiva Neonatal, Hospital de Clínicas de Porto Alegre - HCPA - Porto Alegre (RS), Brasil
| | - Rita C Silveira
- Hospital de Clínicas de Porto Alegre, Unidade de Terapia Intensiva Neonatal, Porto AlegreRS, Brasil, Unidade de Terapia Intensiva Neonatal, Hospital de Clínicas de Porto Alegre - HCPA - Porto Alegre (RS), Brasil
| | - Renato Soibelmann Procianoy
- Hospital de Clínicas de Porto Alegre, Unidade de Terapia Intensiva Neonatal, Porto AlegreRS, Brasil, Unidade de Terapia Intensiva Neonatal, Hospital de Clínicas de Porto Alegre - HCPA - Porto Alegre (RS), Brasil
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Martinón-Torres F, Czajka H, Center KJ, Wysocki J, Majda-Stanislawska E, Omeñaca F, Bernaola Iturbe E, Blazquez Gamero D, Concheiro-Guisán A, Gimenez-Sanchez F, Szenborn L, Giardina PC, Patterson S, Gruber WC, Scott DA, Gurtman A. 13-valent pneumococcal conjugate vaccine (PCV13) in preterm versus term infants. Pediatrics 2015; 135:e876-86. [PMID: 25780077 DOI: 10.1542/peds.2014-2941] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This study evaluated the immune response and safety profile of 13-valent pneumococcal conjugate vaccine (PCV13) in preterm infants compared with term infants. METHODS This Phase IV, open-label, 2-arm, multicenter, parallel-group study enrolled 200 healthy infants (preterm, n = 100; term, n = 100) aged 42 to 98 days. All subjects received PCV13 at ages 2, 3, 4 (infant series), and 12 (toddler dose [TD]) months, together with routine vaccines (diphtheria-tetanus-acellular pertussis, hepatitis B, inactivated poliovirus, and Haemophilus influenzae type b vaccine and meningococcal group C conjugate vaccine). RESULTS Most subjects achieved an anticapsular immunoglobulin G (IgG) antibody concentration ≥ 0.35 μg/mL for all serotypes: >85% after the infant series (except preterm infants for serotypes 5, 6A, and 6B) and >97% after TD (except for serotype 3). Preterm infants had overall lower IgG geometric mean concentrations compared with term infants; however, geometric mean fold increases after TD were similar for all serotypes. Opsonophagocytic activity results were consistent with IgG results and titers increased after TD in both groups for all serotypes, including serotype 3. PCV13 was generally well tolerated, with similar safety profiles in all preterm subgroups. CONCLUSIONS Immune responses were lower in preterm infants than in term infants. However, the majority of subjects in both groups achieved both pneumococcal serotype-specific IgG antibody levels after the infant series that exceeded the World Health Organization-established threshold of protection and functional antibody responses. Responses were uniformly higher after TD, reinforcing the importance of a timely booster dose. PCV13 was well tolerated regardless of gestational age.
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Affiliation(s)
- Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela and Vaccine Research Unit, Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago, Santiago de Compostela, Spain;
| | - Hanna Czajka
- Wojewodzki Specjalistyczny Szpital Dzieciecy im. sw. Ludwika-Regional Infectious Diseases Outpatient Clinic, Krakow, Poland
| | | | - Jacek Wysocki
- Poznań University of Medical Sciences, Poznań, Poland
| | | | | | - Enrique Bernaola Iturbe
- Servicio de Pediatría y Unidad de Investigación en Vacunas Fundación Miguel Servet Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Daniel Blazquez Gamero
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Leszek Szenborn
- Department of Pediatric Infectious Diseases, Medical University, Wroclaw, Poland; and
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Zhang J, Zhou J, Xu B, Chen C, Shi W. Different expressions of TLRs and related factors in peripheral blood of preterm infants. Int J Clin Exp Med 2015; 8:4108-4114. [PMID: 26064317 PMCID: PMC4443151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 02/21/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE TLR insufficiency increases newborn's susceptibility to infectious disease. METHODS The peripheral blood of four premature births has been collected weekly from the 28(th) gestational week (GW) until maturity at 36(th) GW. Microarray assays were used to derive dynamic follow-up data of TLR1-10 and other TLR signaling pathway associated factor changes. RESULTS The follow-up results showed that the transcription level of TLR1 increased at the 36(th), TLR 3 decreased at the 33(rd) and TLR7 increased at the 34(th) GW significantly, whereas NFkB and its activator TBK1 were highest transcribed in the 28(th) and 32(nd) GW. Low TLR4 transcription in addition to late MD-2 maturation (33(rd) GW) indicated a lack of defense mechanisms against bacterial infections in preterm births particular in the first weeks after birth. Late transcriptional enhancements of TLR1 and MYD88 (35(th) week) as well as β 2 microglobulin (35(th) GW) also indicated a weak immune system in the early maturation stages. CONCLUSION The transcription levels of TLR1, 3, 7 and the signaling pathway associated cofactors were different transcribed during the 28(th) and 36(th) GWs of the premature newborns. In the early stage after preterm birth, beside peak transcriptions of NFkB and TBK1, the immune system is not fully developed and maturation takes place mainly between the 33th and 35(th) GW.
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Affiliation(s)
- Jinping Zhang
- Division of Neonatology, Children's Hospital of Fudan University No. 399 Wanyuan Road, Shanghai 201102, China
| | - Jianguo Zhou
- Division of Neonatology, Children's Hospital of Fudan University No. 399 Wanyuan Road, Shanghai 201102, China
| | - Baogan Xu
- Division of Neonatology, Children's Hospital of Fudan University No. 399 Wanyuan Road, Shanghai 201102, China
| | - Chao Chen
- Division of Neonatology, Children's Hospital of Fudan University No. 399 Wanyuan Road, Shanghai 201102, China
| | - Wenjing Shi
- Division of Neonatology, Children's Hospital of Fudan University No. 399 Wanyuan Road, Shanghai 201102, China
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Ernst W, Kusi E, Fill Malfertheiner S, Reuschel E, Deml L, Seelbach-Göbel B. The effect of Indomethacin and Betamethasone on the cytokine response of human neonatal mononuclear cells to gram-positive bacteria. Cytokine 2015; 73:91-100. [PMID: 25743243 DOI: 10.1016/j.cyto.2015.01.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 10/14/2014] [Accepted: 01/23/2015] [Indexed: 11/29/2022]
Abstract
Intrauterine infections with gram-positive bacteria pose a serious threat to neonates since they can result in neonatal sepsis, induce a fetal inflammatory response and also cause preterm birth. Despite intensive care, prematurity remains a leading cause of neonatal death, and is often accompanied by a number of morbidities. In order to prevent premature birth, tocolytic agents like Indomethacin are administered. Betamethasone is used to promote lung maturation and prevent respiratory distress syndrome. A combination of both drugs is assumed to prevent premature delivery while simultaneously facilitating lung maturation. This study investigates the effect of Betamethasone, Indomethacin and a combination of both on the cytokine production of neonatal cord blood mononuclear cells (CBMC) after stimulation with lysates of the gram-positive pathogens Streptococcus agalactiae and Enterococcus faecalis. The aim of the study is to determine the impact of these drugs on the function of the neonatal immune system which should aid clinicians in choosing the optimal therapy in case of preterm birth associated with intrauterine infection. Betamethasone reduced the production of the pro-inflammatory cytokines IL-6, IL-12p40, MIP-1α and TNF and increased the expression of the anti-inflammatory cytokine IL-10, depending on the pathogen used for stimulation. In contrast to Betamethasone, Indomethacin almost exclusively increased IL-10 production. The combination of both drugs decreased the expression of IL-6, IL-12p40, MIP-1α and TNF while increasing IL-10 production, depending on the concentration of Indomethacin and the pathogen used for stimulation. Based on our results, the combination therapy with Indomethacin and Betamethasone has a similar effect on cytokine production as Betamethasone alone, which is generally administered in case of impending preterm birth. However, the combination therapy has the advantage of promoting lung maturation while simultaneously blocking preterm labor effectively.
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Affiliation(s)
- Wolfgang Ernst
- Clinic of Gynecology and Obstetrics St. Hedwig, University of Regensburg, Regensburg, Germany.
| | - Evelyn Kusi
- Clinic of Gynecology and Obstetrics St. Hedwig, University of Regensburg, Regensburg, Germany
| | - Sara Fill Malfertheiner
- Clinic of Gynecology and Obstetrics St. Hedwig, University of Regensburg, Regensburg, Germany
| | - Edith Reuschel
- Clinic of Gynecology and Obstetrics St. Hedwig, University of Regensburg, Regensburg, Germany
| | - Ludwig Deml
- Institute of Medical Microbiology, University of Regensburg, Regensburg, Germany; Lophius Biosciences GmbH, Josef-Engert Straße 13, 93053 Regensburg, Germany
| | - Birgit Seelbach-Göbel
- Clinic of Gynecology and Obstetrics St. Hedwig, University of Regensburg, Regensburg, Germany
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Patrick SW, Kawai AT, Kleinman K, Jin R, Vaz L, Gay C, Kassler W, Goldmann D, Lee GM. Health care-associated infections among critically ill children in the US, 2007-2012. Pediatrics 2014; 134:705-12. [PMID: 25201802 DOI: 10.1542/peds.2014-0613] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Health care-associated infections (HAIs) are harmful and costly and can result in substantial morbidity for hospitalized children; however, little is known about national trends in HAIs in neonatal and pediatric populations. Our objective was to determine the incidence of HAIs among a large sample of hospitals in the United States caring for critically ill children from 2007 to 2012. METHODS In this cohort study, we included NICUs and PICUs located in hospitals reporting data to the Centers for Disease Control and Prevention's National Healthcare Safety Network for central line-associated bloodstream infections (CLABSIs), ventilator-associated pneumonias, and catheter-associated urinary tract infections. We used a time-series design to evaluate changes in HAI rates. RESULTS A total of 173 US hospitals provided data from NICUs, and 64 provided data from PICUs. From 2007 to 2012, rates of CLABSIs decreased in NICUs from 4.9 to 1.5 per 1000 central-line days (incidence rate ratio (IRR) per quarter = 0.96, 95% confidence interval 0.94-0.97) and in PICUs from 4.7 to 1.0 per 1000 central-line days (IRR per quarter = 0.96 [0.94-0.98]). Rates of ventilator-associated pneumonias decreased in NICUs from 1.6 to 0.6 per 1000 ventilator days (IRR per quarter = 0.97 [0.93-0.99]) and PICUs from 1.9 to 0.7 per 1000 ventilator-days (IRR per quarter = 0.95 [0.92-0.98]). Rates of catheter-associated urinary tract infections did not change significantly in PICUs. CONCLUSIONS Between 2007 and 2012 there were substantial reductions in HAIs among hospitalized neonates and children.
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Affiliation(s)
- Stephen W Patrick
- Department of Pediatrics, and Mildred Stahlman Division of Neonatology, Vanderbilt University, Nashville, Tennessee; Vanderbilt Center for Health Services Research, Nashville, Tennessee;
| | - Alison Tse Kawai
- Center for Child Health Care Studies, Department of Population Medicine, Harvard Pilgrim Health Care Institute & Harvard Medical School, Boston, Massachusetts
| | - Ken Kleinman
- Center for Child Health Care Studies, Department of Population Medicine, Harvard Pilgrim Health Care Institute & Harvard Medical School, Boston, Massachusetts
| | - Robert Jin
- Center for Child Health Care Studies, Department of Population Medicine, Harvard Pilgrim Health Care Institute & Harvard Medical School, Boston, Massachusetts
| | - Louise Vaz
- Center for Child Health Care Studies, Department of Population Medicine, Harvard Pilgrim Health Care Institute & Harvard Medical School, Boston, Massachusetts; Division of Infectious Diseases, Departments of Medicine and Laboratory Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Charlene Gay
- Center for Child Health Care Studies, Department of Population Medicine, Harvard Pilgrim Health Care Institute & Harvard Medical School, Boston, Massachusetts
| | - William Kassler
- Centers for Medicare and Medicaid Services, Boston, Massachusetts; and
| | - Don Goldmann
- Institute for Healthcare Improvement, Boston, Massachusetts
| | - Grace M Lee
- Center for Child Health Care Studies, Department of Population Medicine, Harvard Pilgrim Health Care Institute & Harvard Medical School, Boston, Massachusetts; Division of Infectious Diseases, Departments of Medicine and Laboratory Medicine, Boston Children's Hospital, Boston, Massachusetts
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227
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The burden of single virus and viral coinfections on severe lower respiratory tract infections among preterm infants: a prospective birth cohort study in Brazil. Pediatr Infect Dis J 2014; 33:997-1003. [PMID: 25361184 DOI: 10.1097/inf.0000000000000349] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is associated with severe lower respiratory tract infection (LRTI), especially in preterm infants. Other viruses, co-detected with RSV, may play a role in the severity of respiratory outcomes. METHODS This prospective epidemiologic study of severe LRTI incidence among children born ≤35 weeks gestational age at 3 sites in Brazil (2008-2010) followed a birth cohort for 1 year post-enrollment. Nasal washes from subjects with LRTI were tested for respiratory viruses using polymerase chain reaction. The primary outcome was the incidence of severe LRTI requiring hospitalization associated with RSV infection. Secondary outcomes included identification of viruses associated with LRTI, alone or coinfections, and risk factors associated with severe LRTI. RESULTS Among 303 subjects, 176 (58.1%) experienced LRTI. Among these subjects, 162 had samples tested using polymerase chain reaction; 27.8% (45/162) experienced severe LRTI. More subjects with severe LRTI were infected with RSV (30/45, 66.7%) than with other viruses. RSV was present in 33.1% (143/432) of LRTI events tested, 57.3% (82/143) were coinfections. RSV was the virus most frequently associated with severe LRTIs (34/56 events, 60.7%); 50% (17/34 events) single and 50% coinfections. Significantly longer hospital stays were associated with LRTI events involving RSV coinfections compared with RSV single infections (P = 0.012). Infants with severe LRTIs had significantly lower mean RSV-IgG levels at study entry compared with those with nonsevere or no LRTIs (P < 0.05). CONCLUSIONS This study confirms the association of RSV alone or as a coinfection with severe LRTI and reinforces the importance of providing adequate prophylaxis for susceptible infants.
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228
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Tran K, Gibson A, Wong D, Tilahun D, Selock N, Good T, Ram G, Tolosa L, Tolosa M, Kostov Y, Woo HC, Frizzell M, Fulda V, Gopinath R, Prasad JS, Sudarshan H, Venkatesan A, Kumar VS, Shylaja N, Rao G. Designing a Low-Cost Multifunctional Infant Incubator. ACTA ACUST UNITED AC 2014; 19:332-7. [PMID: 24713428 DOI: 10.1177/2211068214530391] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Indexed: 12/22/2022]
Abstract
Every year, an unacceptably large number of infant deaths occur in developing nations, with premature birth and asphyxia being two of the leading causes. A well-regulated thermal environment is critical for neonatal survival. Advanced incubators currently exist, but they are far too expensive to meet the needs of developing nations. We are developing a thermodynamically advanced low-cost incubator suitable for operation in a low-resource environment. Our design features three innovations: (1) a disposable baby chamber to reduce infant mortality due to nosocomial infections, (2) a passive cooling mechanism using low-cost heat pipes and evaporative cooling from locally found clay pots, and (3) insulated panels and a thermal bank consisting of water that effectively preserve and store heat. We developed a prototype incubator and visited and presented our design to our partnership hospital site in Mysore, India. After obtaining feedback, we have determined realistic, nontrivial design requirements and constraints in order to develop a new prototype incubator for clinical trials in hospitals in India.
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Affiliation(s)
- Kevin Tran
- Center for Advanced Sensor Technology and Department of Chemical, Biochemical, and Environmental Engineering UMBC, Baltimore, MD, USA
| | - Aaron Gibson
- Center for Advanced Sensor Technology and Department of Chemical, Biochemical, and Environmental Engineering UMBC, Baltimore, MD, USA
| | - Don Wong
- Center for Advanced Sensor Technology and Department of Chemical, Biochemical, and Environmental Engineering UMBC, Baltimore, MD, USA
| | - Dagmawi Tilahun
- Center for Advanced Sensor Technology and Department of Chemical, Biochemical, and Environmental Engineering UMBC, Baltimore, MD, USA
| | - Nicholas Selock
- Center for Advanced Sensor Technology and Department of Chemical, Biochemical, and Environmental Engineering UMBC, Baltimore, MD, USA
| | - Theresa Good
- Center for Advanced Sensor Technology and Department of Chemical, Biochemical, and Environmental Engineering UMBC, Baltimore, MD, USA
| | - Geetha Ram
- Center for Advanced Sensor Technology and Department of Chemical, Biochemical, and Environmental Engineering UMBC, Baltimore, MD, USA
| | - Leah Tolosa
- Center for Advanced Sensor Technology and Department of Chemical, Biochemical, and Environmental Engineering UMBC, Baltimore, MD, USA
| | - Michael Tolosa
- Center for Advanced Sensor Technology and Department of Chemical, Biochemical, and Environmental Engineering UMBC, Baltimore, MD, USA
| | - Yordan Kostov
- Center for Advanced Sensor Technology and Department of Chemical, Biochemical, and Environmental Engineering UMBC, Baltimore, MD, USA
| | - Hyung Chul Woo
- Department of Pediatrics, Neonatology, and Neonatal Intensive Care Unit, University of Maryland Medical Center, Baltimore, MD, USA
| | - Michael Frizzell
- Center for Advanced Sensor Technology and Department of Chemical, Biochemical, and Environmental Engineering UMBC, Baltimore, MD, USA
| | - Victor Fulda
- Center for Advanced Sensor Technology and Department of Chemical, Biochemical, and Environmental Engineering UMBC, Baltimore, MD, USA
| | | | | | | | | | - V Sashi Kumar
- Phoenix Medical Systems, Ekkattuthangal, Chennai, India
| | - N Shylaja
- Chandrakala Hospital and Institute of Medical Research, Mysore, India
| | - Govind Rao
- Center for Advanced Sensor Technology and Department of Chemical, Biochemical, and Environmental Engineering UMBC, Baltimore, MD, USA
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Adly AA, Ismail EA, Andrawes NG, El-Saadany MA. Circulating soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) as diagnostic and prognostic marker in neonatal sepsis. Cytokine 2014; 65:184-91. [DOI: 10.1016/j.cyto.2013.11.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 10/02/2013] [Accepted: 11/05/2013] [Indexed: 11/16/2022]
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Flohr C. Following in the footsteps of David Barker: the association between extreme prematurity and atopic dermatitis risk. Br J Dermatol 2013; 169:1175-6. [DOI: 10.1111/bjd.12708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- C. Flohr
- Department of Paediatric Dermatology; St John's Institute of Dermatology; Guy's & St Thomas’ Hospital NHS Foundation Trust and King's College London; Westminster Bridge Road London SE1 7EH U.K
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