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Tan FH, Bronner ME. Regenerative loss in the animal kingdom as viewed from the mouse digit tip and heart. Dev Biol 2024; 507:44-63. [PMID: 38145727 PMCID: PMC10922877 DOI: 10.1016/j.ydbio.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 11/30/2023] [Accepted: 12/19/2023] [Indexed: 12/27/2023]
Abstract
The myriad regenerative abilities across the animal kingdom have fascinated us for centuries. Recent advances in developmental, molecular, and cellular biology have allowed us to unearth a surprising diversity of mechanisms through which these processes occur. Developing an all-encompassing theory of animal regeneration has thus proved a complex endeavor. In this chapter, we frame the evolution and loss of animal regeneration within the broad developmental constraints that may physiologically inhibit regenerative ability across animal phylogeny. We then examine the mouse as a model of regeneration loss, specifically the experimental systems of the digit tip and heart. We discuss the digit tip and heart as a positionally-limited system of regeneration and a temporally-limited system of regeneration, respectively. We delve into the physiological processes involved in both forms of regeneration, and how each phase of the healing and regenerative process may be affected by various molecular signals, systemic changes, or microenvironmental cues. Lastly, we also discuss the various approaches and interventions used to induce or improve the regenerative response in both contexts, and the implications they have for our understanding regenerative ability more broadly.
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Affiliation(s)
- Fayth Hui Tan
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA
| | - Marianne E Bronner
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA.
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2
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Mehdipour M, Park S, Huang GN. Unlocking cardiomyocyte renewal potential for myocardial regeneration therapy. J Mol Cell Cardiol 2023; 177:9-20. [PMID: 36801396 PMCID: PMC10699255 DOI: 10.1016/j.yjmcc.2023.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/28/2023] [Accepted: 02/14/2023] [Indexed: 02/19/2023]
Abstract
Cardiovascular disease remains the leading cause of mortality worldwide. Cardiomyocytes are irreversibly lost due to cardiac ischemia secondary to disease. This leads to increased cardiac fibrosis, poor contractility, cardiac hypertrophy, and subsequent life-threatening heart failure. Adult mammalian hearts exhibit notoriously low regenerative potential, further compounding the calamities described above. Neonatal mammalian hearts, on the other hand, display robust regenerative capacities. Lower vertebrates such as zebrafish and salamanders retain the ability to replenish lost cardiomyocytes throughout life. It is critical to understand the varying mechanisms that are responsible for these differences in cardiac regeneration across phylogeny and ontogeny. Adult mammalian cardiomyocyte cell cycle arrest and polyploidization have been proposed as major barriers to heart regeneration. Here we review current models about why adult mammalian cardiac regenerative potential is lost including changes in environmental oxygen levels, acquisition of endothermy, complex immune system development, and possible cancer risk tradeoffs. We also discuss recent progress and highlight conflicting reports pertaining to extrinsic and intrinsic signaling pathways that control cardiomyocyte proliferation and polyploidization in growth and regeneration. Uncovering the physiological brakes of cardiac regeneration could illuminate novel molecular targets and offer promising therapeutic strategies to treat heart failure.
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Affiliation(s)
- Melod Mehdipour
- Cardiovascular Research Institute and Department of Physiology, University of California, San Francisco, San Francisco, CA 94158, USA; Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research, University of California, San Francisco, San Francisco, CA 94158, USA; Bakar Aging Research Institute, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Sangsoon Park
- Cardiovascular Research Institute and Department of Physiology, University of California, San Francisco, San Francisco, CA 94158, USA; Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research, University of California, San Francisco, San Francisco, CA 94158, USA; Bakar Aging Research Institute, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Guo N Huang
- Cardiovascular Research Institute and Department of Physiology, University of California, San Francisco, San Francisco, CA 94158, USA; Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research, University of California, San Francisco, San Francisco, CA 94158, USA; Bakar Aging Research Institute, University of California, San Francisco, San Francisco, CA 94158, USA.
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3
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Treesirichod A, Eiamkulbutr S, Laohathai P, Vongbhavit K, Panburana J. The efficacy of infrared filter window film to prevent hyperthermia in neonatal hyperbilirubinemia with conventional phototherapy: a randomized control trial. Pediatr Neonatol 2022; 63:489-495. [PMID: 35697592 DOI: 10.1016/j.pedneo.2021.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/06/2021] [Accepted: 12/06/2021] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Phototherapy is the first-line treatment of neonatal hyperbilirubinemia. Possible side effects caused by phototherapy include hyperthermia and dehydration. Currently, there are many types of infrared blocking film for potential use in reducing infrared radiation exposure and preventing hyperthermia. This study aims to evaluate the efficacy of infrared blocking film in preventing hyperthermia during the first 24 h of phototherapy. METHODS The randomized controlled trial study was carried out in 44 newborns with hyperbilirubinemia. Infrared filter film with 75% visible light transmission and 90% infrared rejection was used in the study. Body temperature was measured for the assessment of the efficacy of filter film from axillary and rectal routes. RESULTS There was a significantly lower incidence of hyperthermia from the axillary temperature in the group with infrared blocking film compared to the control group (p = 0.031). The axillary temperature between before and after initiation of phototherapy in filter film group was significantly better (p = 0.008). According to efficacy of treatment, the study demonstrated that infrared filter film did not interfere with the efficacy of phototherapy in reducing bilirubin level. CONCLUSIONS The infrared filter film was significantly more effective in preventing hyperthermia from phototherapy in the first 24 h without causing any significant difference in reduction of bilirubin level. THAI CLINICAL TRIALS REGISTRY TCTR20190619001.
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Affiliation(s)
- Arucha Treesirichod
- Department of Pediatrics, Faculty of Medicine, Srinakharinwirot University, Thailand.
| | - Sutha Eiamkulbutr
- Department of Pediatrics, Faculty of Medicine, Srinakharinwirot University, Thailand
| | - Phakwan Laohathai
- Department of Pediatrics, Faculty of Medicine, Srinakharinwirot University, Thailand
| | - Kannikar Vongbhavit
- Department of Pediatrics, Faculty of Medicine, Srinakharinwirot University, Thailand
| | - Jantana Panburana
- Department of Pediatrics, Faculty of Medicine, Srinakharinwirot University, Thailand
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Colnot E, Cardoit L, Cabirol MJ, Roudier L, Delville MH, Fayoux A, Thoby-Brisson M, Juvin L, Morin D. Chronic maternal exposure to titanium dioxide nanoparticles alters breathing in newborn offspring. Part Fibre Toxicol 2022; 19:57. [PMID: 35982496 PMCID: PMC9386967 DOI: 10.1186/s12989-022-00497-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/08/2022] [Indexed: 12/01/2022] Open
Abstract
Background Over the last two decades, nanotechnologies and the use of nanoparticles represent one of the greatest technological advances in many fields of human activity. Particles of titanium dioxide (TiO2) are one of the nanomaterials most frequently found in everyday consumer products. But, due in particular to their extremely small size, TiO2 nanoparticles (NPs) are prone to cross biological barriers and potentially lead to adverse health effects. The presence of TiO2 NPs found in human placentae and in the infant meconium has indicated unequivocally the capacity for a materno-fetal transfer of this nanomaterial. Although chronic exposure to TiO2 NPs during pregnancy is known to induce offspring cognitive deficits associated with neurotoxicity, the impact of a gestational exposure on a vital motor function such as respiration, whose functional emergence occurs during fetal development, remains unknown. Results Using in vivo whole-body plethysmographic recordings from neonatal mice, we show that a chronic exposure to TiO2 NPs during pregnancy alters the respiratory activity of offspring, characterized by an abnormally elevated rate of breathing. Correspondingly, using ex vivo electrophysiological recordings performed on isolated brainstem-spinal cord preparations of newborn mice and medullary slice preparations containing specific nuclei controlling breathing frequency, we show that the spontaneously generated respiratory-related rhythm is significantly and abnormally accelerated in animals prenatally exposed to TiO2 NPs. Moreover, such a chronic prenatal exposure was found to impair the capacity of respiratory neural circuitry to effectively adjust breathing rates in response to excitatory environmental stimuli such as an increase in ambient temperature. Conclusions Our findings thus demonstrate that a maternal exposure to TiO2 NPs during pregnancy affects the normal development and operation of the respiratory centers in progeny. Supplementary Information The online version contains supplementary material available at 10.1186/s12989-022-00497-4.
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Affiliation(s)
- Eloïse Colnot
- Univ. Bordeaux, CNRS, INCIA, UMR 5287, F-33000, Bordeaux, France
| | - Laura Cardoit
- Univ. Bordeaux, CNRS, INCIA, UMR 5287, F-33000, Bordeaux, France
| | | | - Lydia Roudier
- Univ. Bordeaux, CNRS, Bordeaux INP, ICMCB, UMR 5026, F-33608, Pessac, France
| | | | - Anne Fayoux
- Univ. Bordeaux, CNRS, INCIA, UMR 5287, F-33000, Bordeaux, France
| | | | - Laurent Juvin
- Univ. Bordeaux, CNRS, INCIA, UMR 5287, F-33000, Bordeaux, France
| | - Didier Morin
- Univ. Bordeaux, CNRS, INCIA, UMR 5287, F-33000, Bordeaux, France. .,Univ. Bordeaux, Department of Health, Safety and Environment, Bordeaux Institute of Technology, F-33175, Gradignan, France.
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5
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Tourneux P, Thiriez G, Renesme L, Zores C, Sizun J, Kuhn P. Optimising homeothermy in neonates: a systematic review and clinical guidelines from the French Neonatal Society. Acta Paediatr 2022; 111:1490-1499. [PMID: 35567516 DOI: 10.1111/apa.16407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 11/28/2022]
Abstract
AIM Thermal instability is harmful on the newborn infant. We sought to draw up practical guidelines on maintaining homeothermy alongside skin-to-skin contact. METHODS A systematic analysis of the literature identified relevant studies between 2000 and 2021 in the PubMed database. Selected publications were evaluated, and their level of evidence were graded, in order to underpin the development of clinical guidelines. RESULTS We identified 7 meta-analyses and 64 clinical studies with a focus on newborn infants homeothermy. Skin-to-skin contact is the easiest and most rapidly implementable method to prevent body heat loss. Alongside skin-to-skin contact, monitoring the newborn infant's body temperature with a target of 37.0°C is essential. For newborn infants <32 weeks of gestation, a skullcap and a polyethylene bag should be used in the delivery room or during transport. To limit water loss, inhaled gases humidification and warming is recommended, and preterm infants weighing less than 1600 g should be nursed in a closed, convective incubator. With regard to incubators, there are no clear benefits for single vs. double-wall incubators as well as for air vs. skin servo control. CONCLUSION Alongside skin-to-skin contact, a bundle of practical guidelines could improve the maintenance of homeothermy in the newborn infant.
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Affiliation(s)
- Pierre Tourneux
- Neonatal Intensive Care Unit, Amiens University Hospital, Amiens, France
- PériTox Laboratory UMR_I 01, UFR de Médecine, University of Picardie Jules Verne, Amiens, France
| | - Gérard Thiriez
- Pediatric Intensive Care, Neonatology and Pediatric Emergencies Departments, Besancon University Hospital, Besancon, France
| | - Laurent Renesme
- Neonatal Intensive Care Unit, University Hospital of Bordeaux, Bordeaux, France
| | - Claire Zores
- Neonatal Intensive Care Unit, Hôpital de Hautepierre, Strasbourg University Hospital, Strasbourg, France
- Institut des Neurosciences Cellulaires et Intégratives, UPR 3212, CNRS et Université de Strasbourg, France
| | - Jacques Sizun
- Neonatal Intensive Care Unit, Toulouse University Hospital, Toulouse, France
| | - Pierre Kuhn
- Neonatal Intensive Care Unit, Hôpital de Hautepierre, Strasbourg University Hospital, Strasbourg, France
- Institut des Neurosciences Cellulaires et Intégratives, UPR 3212, CNRS et Université de Strasbourg, France
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6
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Dubos C, Querne L, Brenac W, Tourneux P. Association between hypothermia in the first day of life and survival in the preterm infant. Arch Pediatr 2021; 28:197-203. [PMID: 33750613 DOI: 10.1016/j.arcped.2021.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/15/2020] [Accepted: 02/13/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Hypothermia is associated with elevated mortality in the preterm infant. The preterm infant's thermoregulatory capacity is limited, and the thermal environment in an incubator is often perturbed by nursing procedures. We evaluated the incidence of a postnatal low body temperature and hypothermia in preterm infants and its association with mortality. METHODS We measured the lowest body temperature during the first 24h of life (TBody Nadir 24h) and hypothermia (TBody Nadir 24h<36.0°C) in preterm infants (gestational age: 230-316 weeks) in a neonatal intensive care unit. Prenatal and neonatal characteristics associated with mortality were identified in univariate and multivariable analyses. RESULTS A total of 102 preterm infants were included, with a mean gestational age at birth of 28.4±2.3 weeks. The incidence of hypothermia during the first 24h was 53%. A Cox multivariate regression model indicated that TBody Nadir 24h (hazard ratio (HR) [95% confidence interval]: 0.57 [0.36-0.90]; P=0.017), gestational age (0.62 [0.50-0.76]; P<0.001), and amine use (4.55 [2.01-10.28]; P=0.001) were significantly associated with mortality. When considering a threshold for TBody Nadir 24h, a value of 35.0°C had the highest HR (3.30 [1.42-7.68]; P<0.01). CONCLUSION In preterm infants, the incidence of hypothermia during the first 24h of life was 53%. TBody Nadir 24h had an influence on mortality, independently of other factors (notably birth weight and amine use). Within the framework of a quality improvement strategy, the implementation of a thermoregulation bundle is required to prevent hypothermia and decrease mortality in preterm infants.
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Affiliation(s)
- C Dubos
- Paediatric intensive care unit, Amiens university hospital, 80054 Amiens, France; PériTox Laboratory UMR_I 01, UFR de médecine, University of Picardie-Jules-Verne, 80054 Amiens, France
| | - L Querne
- INSERM U-1105, Paediatric neurology unit, Amiens university hospital, Amiens, France
| | - W Brenac
- Gynaecology-Obstetrics Unit, Amiens university hospital, 80054 Amiens, France
| | - P Tourneux
- Paediatric intensive care unit, Amiens university hospital, 80054 Amiens, France; PériTox Laboratory UMR_I 01, UFR de médecine, University of Picardie-Jules-Verne, 80054 Amiens, France.
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7
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Cutie S, Huang GN. Vertebrate cardiac regeneration: evolutionary and developmental perspectives. CELL REGENERATION 2021; 10:6. [PMID: 33644818 PMCID: PMC7917145 DOI: 10.1186/s13619-020-00068-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 11/04/2020] [Indexed: 02/07/2023]
Abstract
Cardiac regeneration is an ancestral trait in vertebrates that is lost both as more recent vertebrate lineages evolved to adapt to new environments and selective pressures, and as members of certain species developmentally progress towards their adult forms. While higher vertebrates like humans and rodents resolve cardiac injury with permanent fibrosis and loss of cardiac output as adults, neonates of these same species can fully regenerate heart structure and function after injury - as can adult lower vertebrates like many teleost fish and urodele amphibians. Recent research has elucidated several broad factors hypothesized to contribute to this loss of cardiac regenerative potential both evolutionarily and developmentally: an oxygen-rich environment, vertebrate thermogenesis, a complex adaptive immune system, and cancer risk trade-offs. In this review, we discuss the evidence for these hypotheses as well as the cellular participators and molecular regulators by which they act to govern heart regeneration in vertebrates.
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Affiliation(s)
- Stephen Cutie
- Cardiovascular Research Institute and Department of Physiology, University of California, San Francisco, San Francisco, CA, 94158, USA.,Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research, University of California, San Francisco, San Francisco, CA, 94158, USA
| | - Guo N Huang
- Cardiovascular Research Institute and Department of Physiology, University of California, San Francisco, San Francisco, CA, 94158, USA. .,Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research, University of California, San Francisco, San Francisco, CA, 94158, USA.
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8
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Dubos C, Delanaud S, Brenac W, Chahin Yassin F, Carpentier M, Tourneux P. The newborn infant's thermal environment in the delivery room when skin-to-skin care has to be interrupted. J Matern Fetal Neonatal Med 2020; 35:3707-3713. [PMID: 33106055 DOI: 10.1080/14767058.2020.1838479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Newborns are prone to hypothermia immediately following birth. Hypothermia is associated with increased morbidity and mortality rates. We sought to assess the thermal environment and metabolic costs associated with exposure to various situations in the delivery room when skin-to-skin care (SSC) has to be curtailed. METHODS Environmental variables (air temperature: T a; relative humidity: RH; radiative temperature: T r; and air convection velocity) were recorded during sequences reproducing SSC, in the maternity unit's various rooms ("passive environments") and in incubators ("active environments"). Analytical calorimetry was then used to calculate the body heat loss (BHL) from these data. RESULTS The analysis of 1280 measurements of T a, RH, T r, and air convection velocity in SSC, passive and active environments revealed that (i) the thermohygrometric environment during SSC was optimal (T a: 32.7 ± 3.2 °C; RH: 50.9 ± 5.6%), (ii) BHL rose when SSC had to be interrupted, and (iii) the use of a radiant incubator prevented hypothermia and reduced dry BHL but not humid BHL (9.4 ± 1.5 kcal/kg/h; p < .001), relative to SSC (5.8 ± 2.0 kcal/kg/h; p < .001). CONCLUSION The newborn infant's thermohygrometric environment is optimal during SSC in the delivery room. When SSC was interrupted, Ta and RH always decreased, and BHL increased in all passive environments.
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Affiliation(s)
- Céline Dubos
- Pediatric Intensive Care Unit, CHU Amiens-Picardie, Amiens, France.,PériTox Laboratory UMR_I 01, UFR de Médecine, Jules Verne University of Picardie, Amiens, France
| | - Stéphane Delanaud
- PériTox Laboratory UMR_I 01, UFR de Médecine, Jules Verne University of Picardie, Amiens, France.,Health Engineering Institute (2IS), Jules Verne University of Picardie, Amiens, France
| | - William Brenac
- Gynecology-Obstetrics Unit, CHU Amiens-Picardie, Amiens, France
| | - Fatima Chahin Yassin
- PériTox Laboratory UMR_I 01, UFR de Médecine, Jules Verne University of Picardie, Amiens, France
| | | | - Pierre Tourneux
- Pediatric Intensive Care Unit, CHU Amiens-Picardie, Amiens, France.,PériTox Laboratory UMR_I 01, UFR de Médecine, Jules Verne University of Picardie, Amiens, France
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9
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Abstract
Humans show marked variation in body size around the world, both within and among populations. At present, the tallest people in the world are from the Netherlands and the Balkan countries, while the shortest populations are central African Pygmies. There are genetic, genetic plasticity, developmental, and environmental bases for size variation in Homo sapiens from the recent past and the present. Early populations of Homo species also have shown considerable size variation. Populations from the present and the past are also marked by sexual dimorphism, which, itself, shows group variation. There is abundant evidence for the effects of limited food and disease on human growth and resultant adult body size. This environmental influence has been reflected in "secular trends" (over a span of years) in growth and adult size from socioeconomic prosperity or poverty (availability of resources). Selective and evolutionary advantages of small or large body size also have been documented. Heritability for human height is relatively great with current genome-wide association studies (GWAS) identifying hundreds of genes leading to causes of growth and adult size variation. There are also endocrinological pathways limiting growth. An example is the reduced tissue sensitivity to human growth hormone (HGH) and insulin-like growth factor (IGF-1) in Philippine and African hunter-gatherer populations. In several short-statured hunter-gatherer populations (Asian, African, and South American), it has been hypothesized that short life expectancy has selected for early maturity and truncated growth to enhance fertility. Some island populations of humans and other mammals are thought to have been selected for small size because of limited resources, especially protein. The high-protein content of milk as a staple food may contribute to tall stature in East African pastoral peoples. These and other evolutionary questions linked to life history, male competition, reproduction, and mobility are explored in this paper.
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Kurniawati, Rustina Y, Budiati T. Peer Support Increases Maternal Confidence, Kangaroo Mother Care Implementation and Weight Gain in LBW Infants. Compr Child Adolesc Nurs 2019; 42:252-260. [PMID: 31192719 DOI: 10.1080/24694193.2019.1594457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Kurniawati
- Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia
| | - Yeni Rustina
- Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia
| | - Tri Budiati
- Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia
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11
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Lahana A, Delanaud S, Erbani R, Glusko-Charlet A, Durand E, Haraux E, Ghyselen L, Libert JP, Tourneux P. Warming the premature infant in the delivery room: Quantification of the risk of hyperthermia. Med Eng Phys 2018; 59:70-74. [PMID: 30131113 DOI: 10.1016/j.medengphy.2018.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 04/20/2018] [Accepted: 06/11/2018] [Indexed: 10/28/2022]
Abstract
AIM The efficacy and safety of three polyethylene bags commonly used to prevent hypothermia in premature infants was assessed. METHODS To simulate transfer from the delivery room to a secondary care unit, a thermally stable, bonneted mannequin (skin temperature: 34.4 °C) was placed in a climate chamber under different conditions: with a radiant warmer, with various polyethylene bags (open on one side, closed by a draw-string at the neck, or a "life support pouch" with several access points) or without a bag. RESULTS With the radiant warmer turned on, the mean reduction in heat loss from the nude mannequin was 50.8 ± 1.7% (p < 0.0001, vs. warmer off). The mean reduction in heat loss (vs. no bag) was 55.0 ± 0.9% for the drawstring bag, 49.0 ± 2.2% for the standard bag (p = 0.0001), and 48.1 ± 0.7% for the life support pouch (p = 0.006). When a radiant warmer + polyethylene bag were used, heat stress (body temperature: 38 °C) and severe hyperthermia (40 °C) occurred after 11 and 34 min, respectively. CONCLUSION Caution must be taken when using a radiant warmer and polyethylene bag with a premature infant. Heat stress can occur in only 11 min. Continuous body temperature monitoring is therefore required.
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Affiliation(s)
- Armand Lahana
- Réanimation Néonatale, Pôle Femme - Couple - Enfant, CHU, avenue René Laennec, F-80480, Amiens, France
| | | | - Romain Erbani
- Réanimation Néonatale, Pôle Femme - Couple - Enfant, CHU, avenue René Laennec, F-80480, Amiens, France
| | - Anaïs Glusko-Charlet
- Réanimation Néonatale, Pôle Femme - Couple - Enfant, CHU, avenue René Laennec, F-80480, Amiens, France
| | - Estelle Durand
- PériTox, UMI INERIS-01, UFR de Médecine UPJV, Amiens, France
| | - Elodie Haraux
- PériTox, UMI INERIS-01, UFR de Médecine UPJV, Amiens, France; Chirurgie viscérale pédiatrique, Pôle Femme - Couple - Enfant, CHU, Amiens, France
| | | | | | - Pierre Tourneux
- Réanimation Néonatale, Pôle Femme - Couple - Enfant, CHU, avenue René Laennec, F-80480, Amiens, France; PériTox, UMI INERIS-01, UFR de Médecine UPJV, Amiens, France.
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12
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Erbani R, Dégrugilliers L, Lahana A, Glusko-Charlet A, Haraux E, Durand E, Tourneux P. Failing to meet relative humidity targets for incubated neonates causes higher heat loss and metabolic costs in the first week of life. Acta Paediatr 2018; 107:1177-1183. [PMID: 28880399 DOI: 10.1111/apa.14063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/20/2017] [Accepted: 09/04/2017] [Indexed: 11/27/2022]
Abstract
AIM Frequent nursing procedures can modify a newborn infant's thermal environment when their incubator is opened. This study evaluated the impact of relative humidity (RH) on preterm infants in closed incubators and calculated their heat loss and additional metabolic cost. METHODS We studied 45 preterm infants born before 32 + 0 weeks, nursed at the neonatal intensive care unit at Amiens University Hospital, France from January 2009 to November 2011. Their body, skin and air temperatures and the incubator's RH were continuously recorded from day 1 to 8 of life, and the differences between the measured and target RH were calculated. Body heat loss (BHL) was also calculated. RESULTS On day one, the measured RH (68.7 ± 1.0%) was significantly lower than the target RH (75%, p < 0.05), but this difference, together with BHL (p < 0.001) and evaporative heat loss (p < 0.001), fell significantly over time (p < 0.05). The additional metabolic cost correlated with the difference between measured and target RH (p < 0.001). CONCLUSION RH from day 1 to 8 was below the recommended target value for preterm infants and resulted in high evaporative and greater total BHL and additional metabolic cost. The findings pose numerous challenges, including nursing care and incubator design.
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Affiliation(s)
- Romain Erbani
- Réanimation et Surveillance Continue Pédiatriques; CHU Amiens; Amiens France
| | - Loïc Dégrugilliers
- Réanimation et Surveillance Continue Pédiatriques; CHU Amiens; Amiens France
- PeriTox-UMI 01; UFR de Médecine; Université de Picardie Jules Verne; Amiens France
| | - Armand Lahana
- Réanimation et Surveillance Continue Pédiatriques; CHU Amiens; Amiens France
| | | | - Elodie Haraux
- PeriTox-UMI 01; UFR de Médecine; Université de Picardie Jules Verne; Amiens France
| | - Estelle Durand
- PeriTox-UMI 01; UFR de Médecine; Université de Picardie Jules Verne; Amiens France
| | - Pierre Tourneux
- Réanimation et Surveillance Continue Pédiatriques; CHU Amiens; Amiens France
- PeriTox-UMI 01; UFR de Médecine; Université de Picardie Jules Verne; Amiens France
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13
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Thermal management in closed incubators: New software for assessing the impact of humidity on the optimal incubator air temperature. Med Eng Phys 2017. [PMID: 28645849 DOI: 10.1016/j.medengphy.2017.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Low-birth-weight (LBW) neonates are nursed in closed incubators to prevent transcutaneous water loss. The RH's impact on the optimal incubator air temperature setting has not been studied. METHODS On the basis of a clinical cohort study, we modelled all the ambient parameters influencing body heat losses and gains. The algorithm quantifies the change in RH on the air temperature, to maintain optimal thermal conditions in the incubator. RESULTS Twenty-three neonates (gestational age (GA): 30.0 [28.9-31.6] weeks) were included. A 20% increase and a 20% decrease in the RH induced a change in air temperature of between -1.51 and +1.85°C for a simulated 650g neonate (GA: 26 weeks), between -1.66 and +1.87°C for a 1000g neonate (GA: 31 weeks), and between -1.77 and +1.97°C for a 2000g neonate (GA: 33 weeks) (p<0.001). According to regression analyses, the optimal incubator air temperature=a+b relative humidity +c age +d weight (p<0.001). CONCLUSIONS We have developed new mathematical equations for calculating the optimal temperature for the incubator air as a function of the latter's relative humidity. The software constitutes a decision support tool for improving patient care in routine clinical practice.
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Vivien CJ, Hudson JE, Porrello ER. Evolution, comparative biology and ontogeny of vertebrate heart regeneration. NPJ Regen Med 2016; 1:16012. [PMID: 29302337 PMCID: PMC5744704 DOI: 10.1038/npjregenmed.2016.12] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/01/2016] [Accepted: 06/15/2016] [Indexed: 12/19/2022] Open
Abstract
There are 64,000 living species of vertebrates on our planet and all of them have a heart. Comparative analyses devoted to understanding the regenerative potential of the myocardium have been performed in a dozen vertebrate species with the aim of developing regenerative therapies for human heart disease. Based on this relatively small selection of animal models, important insights into the evolutionary conservation of regenerative mechanisms have been gained. In this review, we survey cardiac regeneration studies in diverse species to provide an evolutionary context for the lack of regenerative capacity in the adult mammalian heart. Our analyses highlight the importance of cardiac adaptations that have occurred over hundreds of millions of years during the transition from aquatic to terrestrial life, as well as during the transition from the womb to an oxygen-rich environment at birth. We also discuss the evolution and ontogeny of cardiac morphological, physiological and metabolic adaptations in the context of heart regeneration. Taken together, our findings suggest that cardiac regenerative potential correlates with a low-metabolic state, the inability to regulate body temperature, low heart pressure, hypoxia, immature cardiomyocyte structure and an immature immune system. A more complete understanding of the evolutionary context and developmental mechanisms governing cardiac regenerative capacity would provide stronger scientific foundations for the translation of cardiac regeneration therapies into the clinic.
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Affiliation(s)
- Celine J Vivien
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
- Centre for Cardiac and Vascular Biology, The University of Queensland, Brisbane, QLD, Australia
| | - James E Hudson
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
- Centre for Cardiac and Vascular Biology, The University of Queensland, Brisbane, QLD, Australia
| | - Enzo R Porrello
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
- Centre for Cardiac and Vascular Biology, The University of Queensland, Brisbane, QLD, Australia
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Delanaud S, Decima P, Pelletier A, Libert JP, Stephan-Blanchard E, Bach V, Tourneux P. Additional double-wall roof in single-wall, closed, convective incubators: Impact on body heat loss from premature infants and optimal adjustment of the incubator air temperature. Med Eng Phys 2016; 38:922-8. [PMID: 27387899 DOI: 10.1016/j.medengphy.2016.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/28/2016] [Accepted: 05/20/2016] [Indexed: 10/21/2022]
Abstract
Radiant heat loss is high in low-birth-weight (LBW) neonates. Double-wall or single-wall incubators with an additional double-wall roof panel that can be removed during phototherapy are used to reduce Radiant heat loss. There are no data on how the incubators should be used when this second roof panel is removed. The aim of the study was to assess the heat exchanges in LBW neonates in a single-wall incubator with and without an additional roof panel. To determine the optimal thermoneutral incubator air temperature. Influence of the additional double-wall roof was assessed by using a thermal mannequin simulating a LBW neonate. Then, we calculated the optimal incubator air temperature from a cohort of human LBW neonate in the absence of the additional roof panel. Twenty-three LBW neonates (birth weight: 750-1800g; gestational age: 28-32 weeks) were included. With the additional roof panel, R was lower but convective and evaporative skin heat losses were greater. This difference can be overcome by increasing the incubator air temperature by 0.15-0.20°C. The benefit of an additional roof panel was cancelled out by greater body heat losses through other routes. Understanding the heat transfers between the neonate and the environment is essential for optimizing incubators.
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Affiliation(s)
- Stéphane Delanaud
- PériTox UM-I 01, UFR de Médecine, Université de Picardie Jules Verne, Amiens, France
| | - Pauline Decima
- PériTox UM-I 01, UFR de Médecine, Université de Picardie Jules Verne, Amiens, France
| | - Amandine Pelletier
- PériTox UM-I 01, UFR de Médecine, Université de Picardie Jules Verne, Amiens, France
| | - Jean-Pierre Libert
- PériTox UM-I 01, UFR de Médecine, Université de Picardie Jules Verne, Amiens, France
| | | | - Véronique Bach
- PériTox UM-I 01, UFR de Médecine, Université de Picardie Jules Verne, Amiens, France
| | - Pierre Tourneux
- PériTox UM-I 01, UFR de Médecine, Université de Picardie Jules Verne, Amiens, France; Réanimation et Soins Continus Pédiatriques, Pôle Femme-Couple- Enfant, CHU Amiens, Picardie, France.
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Carpentier E, Fontaine C, Blanchard MC, Boniface A, Tourneux P. Impact sur le personnel et les parents du mode de monitorage cardio-respiratoire lors de la photothérapie. Arch Pediatr 2015; 22:1008-14. [DOI: 10.1016/j.arcped.2015.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 05/04/2015] [Accepted: 05/07/2015] [Indexed: 12/01/2022]
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Degorre C, Décima P, Dégrugilliers L, Ghyselen L, Bach V, Libert JP, Tourneux P. A mean body temperature of 37°C for incubated preterm infants is associated with lower energy costs in the first 11 days of life. Acta Paediatr 2015; 104:581-8. [PMID: 25661668 DOI: 10.1111/apa.12965] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 11/10/2014] [Accepted: 02/02/2015] [Indexed: 11/28/2022]
Abstract
AIM This randomised trial compared the energy costs of providing incubated preterm infants born before 32 weeks of gestation with homeothermia using either air temperature control (ATC) or skin servocontrol (SSC). METHODS We studied 38 incubated preterm infants for the first 11 days of life, calculating the frequency of hypothermia (<36.0°C), hyperthermia (>37.5°C) and thermal challenge, together with energy costs, based on a change in incubator air temperature of 2°C above or below thermoneutrality. RESULTS The daily mean incubator air temperature was higher in ATC than SSC (p < 0.05) for the first 6 days, and the mean body temperature was higher in ATC (37.0 ± 0.03°C) than SSC (36.8 ± 0.02; p < 0.01) over the whole study period. The frequency of moderate hyperthermia was higher in ATC (p < 0.001), whereas warm and cold thermal challenges were higher in SSC (p < 0.001). The two groups did not differ in terms of energy costs. The time to recover birthweight was shorter in ATC (p < 0.05). CONCLUSION In incubators using ATC, a body temperature of 37°C was associated with lower energy costs and greater weight gain at 11 days of life for preterm infants. Future studies should test SSC shielded abdominal skin temperature set to 37°C.
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Affiliation(s)
- C Degorre
- Réanimation et Soins Continus Pédiatriques; CHU Amiens; Amiens France
- PériTox (UMR_I 01); UFR de Médecine; Université de Picardie Jules Verne; Amiens France
| | - P Décima
- PériTox (UMR_I 01); UFR de Médecine; Université de Picardie Jules Verne; Amiens France
| | - L Dégrugilliers
- Réanimation et Soins Continus Pédiatriques; CHU Amiens; Amiens France
- PériTox (UMR_I 01); UFR de Médecine; Université de Picardie Jules Verne; Amiens France
| | - L Ghyselen
- Réanimation et Soins Continus Pédiatriques; CHU Amiens; Amiens France
- PériTox (UMR_I 01); UFR de Médecine; Université de Picardie Jules Verne; Amiens France
| | - V Bach
- PériTox (UMR_I 01); UFR de Médecine; Université de Picardie Jules Verne; Amiens France
| | - JP Libert
- PériTox (UMR_I 01); UFR de Médecine; Université de Picardie Jules Verne; Amiens France
| | - P Tourneux
- Réanimation et Soins Continus Pédiatriques; CHU Amiens; Amiens France
- PériTox (UMR_I 01); UFR de Médecine; Université de Picardie Jules Verne; Amiens France
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Peau-à-peau en salle de naissance : impact du monitorage de la saturation pulsée en oxygène. Arch Pediatr 2015; 22:166-70. [DOI: 10.1016/j.arcped.2014.10.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 05/15/2014] [Accepted: 10/26/2014] [Indexed: 11/24/2022]
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Molgat-Seon Y, Daboval T, Chou S, Jay O. Assessing neonatal heat balance and physiological strain in newborn infants nursed under radiant warmers in intensive care with fentanyl sedation. Eur J Appl Physiol 2014; 114:2539-49. [PMID: 25115506 DOI: 10.1007/s00421-014-2964-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 07/24/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE To assess heat balance status of newborn infants nursed under radiant warmers (RWs) during intensive care. METHODS Heat balance, thermal status and primary indicators of physiological strain were concurrently measured in 14 newborns nursed under RWs for 105 min. Metabolic heat production (M), evaporative heat loss (E), convective (C) and conductive heat flow (K), rectal temperature (T re) and mean skin temperatures (T sk) were measured continuously. The rate of radiant heat required for heat balance (R req) and the rate of radiant heat provided (R prov) were derived. The rate of body heat storage (S) was calculated using a two-compartment model of 'core' (T re) and 'shell' (T sk) temperatures. RESULTS Mean M, E, C and K were 10.5 ± 2.7 W, 5.8 ± 1.1 W, 6.2 ± 0.8 W and 0.1 ± 0.1 W, respectively. Mean R prov (1.7 ± 2.6 W) and R req (1.7 ± 2.7 W) were similar (p > 0.05). However, while the resultant mean change in body heat content after 105 min was negligible (-0.1 ± 3.7 kJ), acute time-dependent changes in S were evidenced by a mean positive heat storage component of +6.4 ± 2.6 kJ and a mean negative heat storage component of -6.5 ± 3.7 kJ. Accordingly, large fluctuations in both T re and T sk occurred that were actively induced by changes in RW output. Nonetheless, no active physiological responses (heart rate, breathing frequency and mean arterial pressure) to these bouts of heating and cooling were observed. CONCLUSIONS RWs maintain net heat balance over a prolonged period, but actively induce acute bouts of heat imbalance that cause rapid changes in T re and T sk. Transient bouts of heat storage do not exacerbate physiological strain, but could in the longer term.
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Affiliation(s)
- Yannick Molgat-Seon
- Thermal Ergonomics Laboratory, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
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Samra NM, Taweel AE, Cadwell K. Effect of intermittent kangaroo mother care on weight gain of low birth weight neonates with delayed weight gain. J Perinat Educ 2014; 22:194-200. [PMID: 24868132 DOI: 10.1891/1058-1243.22.4.194] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To evaluate intermittent Kangaroo Mother Care (KMC) with additional opportunities to breastfeed on weight gain of low birth weight (LBW) neonates with delayed weight gain. METHODS 40 LBW neonates were followed to see whether KMC with additional opportunities to breastfeed improved weight gain. RESULTS In the KMC group, the mean age of regaining birth weight was significantly less (15.68 vs. 24.56 days) and the average daily weight gain was significantly higher (22.09 vs. 10.39 g, p < .001) than controls. CONCLUSION KMC with additional opportunities to breastfeed was found to be an effective intervention for LBWs with delayed weight gain and should be considered to be an effective strategy.
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Ghyselen L, Fontaine C, Dégrugilliers L, Degorre C, Léké A, Tourneux P. Polyethylene bag wrapping to prevent hypothermia during percutaneous central venous catheter insertion in the preterm newborn under 32 weeks of gestation. J Matern Fetal Neonatal Med 2014; 27:1922-5. [DOI: 10.3109/14767058.2014.885498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Amadi HO, Mokuolu OA, Obasa T. Effect of high sun intensity on neonatal incubator functionality in a tropical climate. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.jnn.2012.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Deguines C, Dégrugilliers L, Ghyselen L, Chardon K, Bach V, Tourneux P. Impact of nursing care on temperature environment in preterm newborns nursed in closed convective incubators. Acta Paediatr 2013. [PMID: 23190392 DOI: 10.1111/apa.12109] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS Very-low-birth-weight (VLBW) neonates require regular nursing procedures with frequent opening of the incubator resulting in a decrease in incubator air temperature. This study was designed to assess changes in the thermal status of VLBW neonates according to the type of nursing care and incubator openings. METHODS Thirty-one VLBW neonates (mean gestational age: 28.7 ± 0.3 weeks of gestation) were included. Over a 10-day period, each opening of the incubator was recorded together with details about caregiving. Body temperature was recorded continuously, and door opening and closing events were recorded by a video camera. RESULTS This study analysed 1,798 caregiving procedures with mean durations ranging from 6.2 ± 2.1 to 88.5 ± 33.4 min. Abdominal skin temperature decreased by up to 1.08°C/h for procedures such as tracheal intubation (p < 0.01). The temperature decrease was strongly correlated with the type of procedure (p < 0.01), incubator opening (p < 0.01) and procedure duration (p < 0.01). The procedure duration accounted for only 10% of the abdominal skin temperature change (p < 0.01). CONCLUSIONS For VLBW neonates nursed in skin temperature servo-control incubators, the decrease in abdominal skin temperature during caregiving was correlated with the type of procedure, incubator opening modalities and procedure duration. These parameters should be considered to optimize the thermal management of VLBW neonates.
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Affiliation(s)
| | | | | | - K Chardon
- PériTox (EA 4285 - UMI 01 INERIS); UFR de Médecine; Université de Picardie Jules Verne; Amiens; France
| | - V Bach
- PériTox (EA 4285 - UMI 01 INERIS); UFR de Médecine; Université de Picardie Jules Verne; Amiens; France
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Abstract
Appropriate thermal protection of the newborn prevents hypothermia and its associated burden of morbidity and mortality. Yet, current global birth practices tend to not adequately address this challenge. Here, we discuss the pathophysiology of hypothermia in the newborn, its prevention and therapeutic options with particular attention to resource-limited environments. Newborns are equipped with sophisticated mechanisms of body temperature regulation. Neonatal thermoregulation is a critical function for newborn survival, regulated in the hypothalamus and mediated by endocrine pathways. Hypothermia activates cellular metabolism through shivering and non-shivering thermogenesis. In newborns, optimal temperature ranges are narrow and thermoregulatory mechanisms easily overwhelmed, particularly in premature and low-birth weight infants. Hyperthermia most commonly is associated with dehydration and potentially sepsis. The lack of thermal protection promptly leads to hypothermia, which is associated with detrimental metabolic and other pathophysiological processes. Simple thermal protection strategies are feasible at community and institutional levels in resource-limited environments. Appropriate interventions include skin-to-skin care, breastfeeding and protective clothing or devices. Due to poor provider training and limited awareness of the problem, appropriate thermal care of the newborn is often neglected in many settings. Education and appropriate devices might foster improved hypothermia management through mothers, birth attendants and health care workers. Integration of relatively simple thermal protection interventions into existing mother and child health programs can effectively prevent newborn hypothermia even in resource-limited environments.
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