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Prasath A, Aronoff N, Chandrasekharan P, Diggikar S. Antenatal Magnesium Sulfate and adverse gastrointestinal outcomes in Preterm infants-a systematic review and meta-analysis. J Perinatol 2023; 43:1087-1100. [PMID: 37391507 DOI: 10.1038/s41372-023-01710-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/03/2023] [Accepted: 06/20/2023] [Indexed: 07/02/2023]
Abstract
INTRODUCTION To evaluate the effect of antenatal magnesium sulfate (MgSO4) on mortality and morbidity outcomes related to the gastrointestinal system (GI) in preterm infants. METHODS Data sources: A systematic literature search was conducted in November 2022. PubMed, CINAHL Plus with Full Text (EBSCOhost), Embase (Elsevier), and CENTRAL (Ovid) were searched. There were 6695 references. After deduplication, 4332 remained. Ninety-nine full-text articles were assessed and forty four articles were included in the final analysis. STUDY ELIGIBILITY CRITERIA Randomized or quasi-randomized clinical trials and observational studies that evaluated at least one of the pre-specified outcomes were included. Preterm infants whose mothers were given antenatal MgSO4 were included and whose mothers did not receive antenatal MgSO4 were the comparators. The main outcomes and measures were: Necrotizing enterocolitis (NEC) (stage ≥ 2), surgical NEC, spontaneous intestinal perforation (SIP), feeding intolerance, time to reach full feeds, and GI-associated mortality. STUDY APPRAISAL AND SYNTHESIS METHODS A random-effects model meta-analysis was performed to yield pooled OR and its 95% CI for each outcome due to expected heterogeneity in the studies. The analysis for each predefined outcome was performed separately for adjusted and unadjusted comparisons. All included studies were assessed for methodological quality. The risk of bias was assessed using elements of the Cochrane Collaboration's tool 2.0 and the Newcastle-Ottawa Scale for randomized controlled trials (RCTs) and non-randomized studies (NRS), respectively. The study findings were reported as per PRISMA guidelines. RESULTS A total of thirty-eight NRS and six RCTs involving 51,466 preterm infants were included in the final analysis. There were no increased odds of stage ≥2 NEC, (NRS : n = 45,524, OR: 0.95; 95% CI: 0.84-1.08, I2- 5% & RCT's: n = 5205 OR: 1.00; 95% CI: 0.89-1.12, I2- 0%), SIP (n = 34,186, OR: 1.22, 95% CI: 0.94-1.58, I2-30%), feeding intolerance (n = 414, OR: 1.06, 95% CI: 0.64-1.76, I2-12%) in infants exposed to antenatal MgSO4. On the contrary, the incidence of surgical NEC was significantly lower in MgSO4 exposure infants (n = 29,506 OR:0.74; 95% CI: 0.62-0.90, ARR: 0.47%). Studies assessing the effect on GI-related mortality were limited to make any conceivable conclusion. The certainty of evidence (CoE) for all outcomes was adjudged as 'very low' as per GRADE. CONCLUSION Antenatal magnesium sulfate did not increase the incidence of gastrointestinal-related morbidities or mortality in preterm infants. With the current evidence concerns, regarding the adverse effects of MgSO4 administration leading to NEC/SIP or GI-related mortality in preterm infants should not be a hurdle in its routine use in antenatal mothers.
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Affiliation(s)
- Arun Prasath
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Nell Aronoff
- University Libraries, University at Buffalo, Buffalo, NY, USA
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Conley HE, Sheats MK. Targeting Neutrophil β 2-Integrins: A Review of Relevant Resources, Tools, and Methods. Biomolecules 2023; 13:892. [PMID: 37371473 DOI: 10.3390/biom13060892] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Neutrophils are important innate immune cells that respond during inflammation and infection. These migratory cells utilize β2-integrin cell surface receptors to move out of the vasculature into inflamed tissues and to perform various anti-inflammatory responses. Although critical for fighting off infection, neutrophil responses can also become dysregulated and contribute to disease pathophysiology. In order to limit neutrophil-mediated damage, investigators have focused on β2-integrins as potential therapeutic targets, but so far these strategies have failed in clinical trials. As the field continues to move forward, a better understanding of β2-integrin function and signaling will aid the design of future therapeutics. Here, we provide a detailed review of resources, tools, experimental methods, and in vivo models that have been and will continue to be utilized to investigate the vitally important cell surface receptors, neutrophil β2-integrins.
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Affiliation(s)
- Haleigh E Conley
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27607, USA
| | - M Katie Sheats
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27607, USA
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Chandran S, Tergestina M, Ross B, Joshi A, Rebekah G, Kumar M. Effects of Antenatal Magnesium Sulfate on the Gut Function of Preterm (<32 weeks) Very Low Birth Weight Neonates: Experience from a Tertiary Institute in South India. J Trop Pediatr 2021; 67:6294506. [PMID: 34100090 DOI: 10.1093/tropej/fmab040] [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] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Antenatal magnesium sulfate (MgSO4) is found to have various adverse effects in newborn, but the effect on preterm gut is still unclear. This study aimed to evaluate the effects of antenatal MgSO4 on preterm gut function by assessing the clinical outcomes and mesenteric blood flow. METHODS This was a prospective cohort study on all preterm very low birth weight (VLBW) neonates born at a tertiary care center in South India from November 2016 to August 2017. Neonates with antenatal magnesium (Mg) exposure were compared with those with no exposure for various neonatal outcome variables like time to reach full feeds, feed intolerance, necrotizing enterocolitis (NEC) and other preterm complications, serial serum Mg levels and superior mesenteric artery (SMA) Doppler velocity measurements at two time points (24-48 h and 4-5 days after birth). RESULTS Out of 84 neonates, 56 neonates were exposed to antenatal Mg with a median cumulative maternal dose of 28 g and the rest 28 neonates had no exposure. The mean time to reach full feeds was the same in both groups (10.5 days). Feed intolerance episodes were similar in the first week of life between the exposed and unexposed groups (48.2% vs. 46.4%; p = 0.88). Univariate analysis revealed no difference between groups concerning rates of NEC (p = 0.17) or mortality (p = 0.39). There was no significant difference in SMA Doppler parameters and hypermagnesemia between the two groups. CONCLUSION Our study found no significant impact on postnatal feed tolerance and mesenteric blood flow among preterm VLBW neonates with antenatal MgSO4 exposure.
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Affiliation(s)
- Shanu Chandran
- Department of Neonatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mintoo Tergestina
- Department of Neonatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Benjamin Ross
- Department of Neonatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Avadhesh Joshi
- Department of Neonatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Grace Rebekah
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Manish Kumar
- Department of Neonatology, Christian Medical College, Vellore, Tamil Nadu, India
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Köstlin-Gille N, Flaig LA, Ginzel M, Arand J, Poets CF, Gille C. Granulocytic Myeloid-Derived Suppressor Cells in Breast Milk (BM-MDSC) Correlate with Gestational Age and Postnatal Age and Are Influenced by Infant's Sex. Nutrients 2020; 12:nu12092571. [PMID: 32854237 PMCID: PMC7551580 DOI: 10.3390/nu12092571] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/18/2020] [Accepted: 08/24/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Infections are the main cause of death in preterm infants. Causative agents often descend from the intestinal flora of the infected neonate, indicating insufficient protection by the mucosal barrier. Breast milk (BM) contains different subsets of immune cells. We recently showed that BM contains significant numbers of myeloid-derived suppressor cells (MDSC)-immune cells that actively suppress pro-inflammatory immune responses-and hypothesized that the transfer of BM-MDSC may modulate the mucosal immunity of the newborn. METHODS Percentages of MDSC in the BM from mothers of 86 preterm infants between 23 + 0 and 36 + 6 weeks of gestation during their first five postnatal weeks were analyzed by flow cytometry and correlated with maternal and infant characteristics. RESULTS Percentages of BM-MDSC positively correlated with gestational age and postnatal age. The expression of activation markers on BM-MDSC did not change with gestational age, but it decreased with postnatal age. Mothers who received antepartum tocolytics had lower percentages of BM-MDSC, and infant's sex strongly influenced percentages of BM-MDSC. CONCLUSION Our results point toward a role of BM-MDSC for immune regulation in the neonatal gut, making them a potential target of immune-based therapies shortly after birth.
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Ho TTB, Groer MW, Kane B, Yee AL, Torres BA, Gilbert JA, Maheshwari A. Dichotomous development of the gut microbiome in preterm infants. MICROBIOME 2018; 6:157. [PMID: 30208950 PMCID: PMC6136210 DOI: 10.1186/s40168-018-0547-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 09/03/2018] [Indexed: 05/31/2023]
Abstract
BACKGROUND Preterm infants are at risk of developing intestinal dysbiosis with an increased proportion of Gammaproteobacteria. In this study, we sought the clinical determinants of the relative abundance of feces-associated Gammaproteobacteria in very low birth weight (VLBW) infants. Fecal microbiome was characterized at ≤ 2 weeks and during the 3rd and 4th weeks after birth, by 16S rRNA amplicon sequencing. Maternal and infant clinical characteristics were extracted from electronic medical records. Data were analyzed by linear mixed modeling and linear regression. RESULTS Clinical data and fecal microbiome profiles of 45 VLBW infants (gestational age 27.9 ± 2.2 weeks; birth weight 1126 ± 208 g) were studied. Three stool samples were analyzed for each infant at mean postnatal ages of 9.9 ± 3, 20.7 ± 4.1, and 29.4 ± 4.9 days. The average relative abundance of Gammaproteobacteria was 42.5% (0-90%) at ≤ 2 weeks, 69.7% (29.9-86.9%) in the 3rd, and 75.5% (54.5-86%) in the 4th week (p < 0.001). Hierarchical and K-means clustering identified two distinct subgroups: cluster 1 started with comparatively low abundance that increased with time, whereas cluster 2 began with a greater abundance at ≤ 2 weeks (p < 0.001) that decreased over time. Both groups resembled each other by the 3rd week. Single variants of Klebsiella and Staphylococcus described variance in community structure between clusters and were shared between all infants, suggesting a common, hospital-derived source. Fecal Gammaproteobacteria was positively associated with vaginal delivery and antenatal steroids. CONCLUSIONS We detected a dichotomy in gut microbiome assembly in preterm infants: some preterm infants started with low relative gammaproteobacterial abundance in stool that increased as a function of postnatal age, whereas others began with and maintained high abundance. Vaginal birth and antenatal steroids were identified as predictors of Gammaproteobacteria abundance in the early (≤ 2 weeks) and later (3rd and 4th weeks) stool samples, respectively. These findings are important in understanding the development of the gut microbiome in premature infants.
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Affiliation(s)
- Thao T. B. Ho
- Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL USA
| | - Maureen W. Groer
- Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL USA
- College of Nursing, University of South Florida, Tampa, FL USA
| | - Bradley Kane
- College of Nursing, University of South Florida, Tampa, FL USA
| | - Alyson L. Yee
- Interdisciplinary Scientist Training Program, University of Chicago, Chicago, IL USA
- Microbiome Center, University of Chicago, Chicago, IL USA
- Department of Surgery, University of Chicago, Chicago, IL USA
| | - Benjamin A. Torres
- Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL USA
| | - Jack A. Gilbert
- Microbiome Center, University of Chicago, Chicago, IL USA
- Department of Surgery, University of Chicago, Chicago, IL USA
- Argonne National Laboratory, Chicago, IL USA
| | - Akhil Maheshwari
- Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL USA
- Department of Pediatrics, Johns Hopkins University, 1800 Orleans St, JHCC 8530, Baltimore, MD 21287 USA
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Raymond SL, Mathias BJ, Murphy TJ, Rincon JC, López MC, Ungaro R, Ellett F, Jorgensen J, Wynn JL, Baker HV, Moldawer LL, Irimia D, Larson SD. Neutrophil chemotaxis and transcriptomics in term and preterm neonates. Transl Res 2017; 190:4-15. [PMID: 28873345 PMCID: PMC5705589 DOI: 10.1016/j.trsl.2017.08.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/08/2017] [Accepted: 08/11/2017] [Indexed: 12/17/2022]
Abstract
Neutrophils play a crucial role in combating life-threatening bacterial infections in neonates. Previous studies investigating neonatal cell function have been limited because of restricted volume sampling. Here, using novel microfluidic approaches, we provide the first description of neutrophil chemotaxis and transcriptomics from whole blood of human term and preterm neonates, as well as young adults. Ex vivo percent cell migration, neutrophil velocity, and directionality to N-formylmethionyl-leucyl-phenylalanine were measured from whole blood using time-lapse imaging of microfluidic chemotaxis. Genome-wide expression was also evaluated in CD66b+ cells using microfluidic capture devices. Neutrophils from preterm neonates migrated in fewer numbers compared to term neonates (preterm 12.3%, term 30.5%, P = 0.008) and at a reduced velocity compared to young adults (preterm 10.1 μm/min, adult 12.7 μm/min, P = 0.003). Despite fewer neutrophils migrating at slower velocities, neutrophil directionality from preterm neonates was comparable to adults and term neonates. 3607 genes were differentially expressed among the 3 groups (P < 0.001). Differences in gene expression between neutrophils from preterm and term neonates were consistent with reduced pathogen recognition and antimicrobial activity but not neutrophil migration, by preterm neonates. In summary, preterm neonates have significant disturbances in neutrophil chemotaxis compared to term neonates and adults, and these differences in phenotype appear at the transcriptional level to target inflammatory pathways in general, rather than in neutrophil migration and chemotaxis.
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Affiliation(s)
- Steven L Raymond
- Department of Surgery, University of Florida College of Medicine, Gainesville, Fla
| | - Brittany J Mathias
- Department of Surgery, University of Florida College of Medicine, Gainesville, Fla
| | - Tyler J Murphy
- Department of Surgery, University of Florida College of Medicine, Gainesville, Fla
| | - Jaimar C Rincon
- Department of Surgery, University of Florida College of Medicine, Gainesville, Fla
| | - María Cecilia López
- Department of Molecular Genetics and Microbiology, University of Florida College of Medicine, Gainesville, Fla
| | - Ricardo Ungaro
- Department of Surgery, University of Florida College of Medicine, Gainesville, Fla
| | - Felix Ellett
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Shriners Burns Hospital, Boston, Mass
| | - Julianne Jorgensen
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Shriners Burns Hospital, Boston, Mass
| | - James L Wynn
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Fla
| | - Henry V Baker
- Department of Molecular Genetics and Microbiology, University of Florida College of Medicine, Gainesville, Fla
| | - Lyle L Moldawer
- Department of Surgery, University of Florida College of Medicine, Gainesville, Fla
| | - Daniel Irimia
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Shriners Burns Hospital, Boston, Mass
| | - Shawn D Larson
- Department of Surgery, University of Florida College of Medicine, Gainesville, Fla.
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Lawrence SM, Corriden R, Nizet V. Age-Appropriate Functions and Dysfunctions of the Neonatal Neutrophil. Front Pediatr 2017; 5:23. [PMID: 28293548 PMCID: PMC5329040 DOI: 10.3389/fped.2017.00023] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 01/30/2017] [Indexed: 12/12/2022] Open
Abstract
Neonatal and adult neutrophils are distinctly different from one another due to well-defined and documented deficiencies in neonatal cells, including impaired functions, reduced concentrations of microbicidal proteins and enzymes necessary for pathogen destruction, and variances in cell surface receptors. Neutrophil maturation is clearly demonstrated throughout pregnancy from the earliest hematopoietic precursors in the yolk sac to the well-developed myeloid progenitor cells in the bone marrow around the seventh month of gestation. Notable deficiencies of neonatal neutrophils are generally correlated with gestational age and clinical condition, so that the least functional neutrophils are found in the youngest, sickest neonates. Interruption of normal gestation secondary to preterm birth exposes these shortcomings and places the neonate at an exceptionally high rate of infection and sepsis-related mortality. Because the fetus develops in a sterile environment, neonatal adaptive immune responses are deficient from lack of antigen exposure in utero. Newborns must therefore rely on innate immunity to protect against early infection. Neutrophils are a vital component of innate immunity since they are the first cells to respond to and defend against bacterial, viral, and fungal infections. However, notable phenotypic and functional disparities exist between neonatal and adult cells. Below is review of neutrophil ontogeny, as well as a discussion regarding known differences between preterm and term neonatal and adult neutrophils with respect to cell membrane receptors and functions. Our analysis will also explain how these variations decrease with postnatal age.
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Affiliation(s)
- Shelley Melissa Lawrence
- Pediatrics, Neonatal-Perinatal Medicine, UCSD, La Jolla, CA, USA; Division of Host-Microbe Systems and Therapeutics, UCSD, La Jolla, CA, USA
| | - Ross Corriden
- Division of Host-Microbe Systems and Therapeutics, UCSD, La Jolla, CA, USA; Pharmacology, UCSD, La Jolla, CA, USA
| | - Victor Nizet
- Division of Host-Microbe Systems and Therapeutics, UCSD, La Jolla, CA, USA; Skaggs School of Pharmacy and Pharmaceutical Sciences, UCSD, La Jolla, CA, USA
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Lloreda-Garcia JM, Lorente-Nicolás A, Bermejo-Costa F, Martínez-Uriarte J, López-Pérez R. [Need for resuscitation in preterm neonates less than 32 weeks treated with antenatal magnesium sulphate for neuroprotection]. ACTA ACUST UNITED AC 2016; 87:261-7. [PMID: 26778008 DOI: 10.1016/j.rchipe.2015.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 10/27/2015] [Accepted: 11/26/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Magnesium sulphate administration is recommended for foetal neuroprotection in pregnant women at imminent risk of early preterm birth. OBJECTIVE To evaluate the relationship between intrapartum magnesium sulphate for foetal neuroprotection and delivery room resuscitation of preterm infants less 32 weeks. PATIENTS AND METHOD A prospective observational study was conducted on preterm infants less 32 weeks exposed to magnesium sulphate for neuroprotection, and a comparison made with another historic group immediately before starting this treatment. Cases in both groups that had not reached lung maturity with corticosteroids were rejected. The rates of resuscitation, morbidity and mortality for each of the groups were analysed and compared. RESULTS There was a total of 107 preterm, with 56 exposed to magnesium sulphate. Rate of advanced resuscitation were similar between the two groups. There were no other differences in mortality, invasive mechanical ventilation, time to first stool, and other comorbidities. CONCLUSIONS Intrapartum magnesium sulphate for foetal neuroprotection was not associated with an increased need for intensive delivery room resuscitation and other morbidities in these cohorts of less than 32 weeks preterm infants.
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Affiliation(s)
- Jose María Lloreda-Garcia
- Unidad de Cuidados Intensivos Neonatales, Servicio de Pediatría, Hospital General Universitario Santa Lucía, Cartagena, Murcia, España.
| | - Ana Lorente-Nicolás
- Unidad de Cuidados Intensivos Neonatales, Servicio de Pediatría, Hospital General Universitario Santa Lucía, Cartagena, Murcia, España
| | - Francisca Bermejo-Costa
- Unidad de Cuidados Intensivos Neonatales, Servicio de Pediatría, Hospital General Universitario Santa Lucía, Cartagena, Murcia, España
| | - Juan Martínez-Uriarte
- Unidad de Medicina Fetal, Servicio de Ginecología y Obstetricia, Hospital Universitario Santa Lucía, Complejo Hospitalario Universitario de Cartagena, Murcia, España
| | - Rocío López-Pérez
- Unidad de Medicina Fetal, Servicio de Ginecología y Obstetricia, Hospital Universitario Santa Lucía, Complejo Hospitalario Universitario de Cartagena, Murcia, España
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Nussbaum C, Sperandio M. Innate immune cell recruitment in the fetus and neonate. J Reprod Immunol 2011; 90:74-81. [DOI: 10.1016/j.jri.2011.01.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 01/26/2011] [Accepted: 01/27/2011] [Indexed: 01/13/2023]
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Abstract
OBJECTIVE Investigation of magnesium (Mg) homeostasis has re-emerged as an area of interest in preterm born neonates who are at risk for brain pathology. However, data regarding the association between the biologically active ionized form of Mg and gestational age (GA) at an early stage of life in newborn infants are controversial. METHODS We evaluated the total and ionized Mg electrolyte (TMg and IMg) as well as the calcium (TCa and ICa) and pH in the cord blood and on day 2 of life in 22 neonates born at different gestational ages (< 32, 32-34 and > or =35 week) without magnesium tocolysis and absence of serious complications during pregnancy and delivery. RESULTS The IMg fraction that accounted for 68.1+/-5.1% of the TMg in the cord blood and 67.9+/-4.5% of the TMg on day 2 of life, was significantly higher in very preterm infants (GA< 32 week) as compared to neonates with GA > 35 week. Higher IMg levels were correlated with the lower pH that was recorded in the cord blood of the very preterm infants (correlation coefficient, r=-0.80, p< 0.0001) and ICa (r = -0.52, P< 0.01). Lower pH also was correlated with the GA (P< 0.0001). However, standard multiple regression analysis showed significant association between IMg levels and decreased pH but not the gestational age or ICa (beta=-1.10+/-0.21, p< 0.00009). CONCLUSION Extremely preterm infants even without additional exposure to tocolytic magnesium are at risk for the lower pH associated elevation of ionized Mg, which should be considered during the management of these infants in order to prevent hypermagnesemia-related pathology.
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Affiliation(s)
- Rajeev Mehta
- Department of Pediatrics, Division of Neonatal Medicine, Robert Wood Johnson Medical School-UMDNJ, New Brunswick, New Jersey, USA.
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Abstract
The neutrophils and complement system are the critical elements of innate immunity mainly due to participation in the first line of defense against microorganisms by means of phagocytosis, lysis of bacteria and activation of naive B-lymphocytes. In this report we provide an overview of the up to date information regarding the neutrophil and complement system's functional ability in newborn infants in association with the maternal conditions that exist during the intrauterine stage, gestational age and post-neonatal pathology. The neonates' capacity to control the neutrophil and complement protein activation process has also been discussed because of the evidence that uncontrolled activation of these immune elements provides a significant contribution to the tissue damage and subsequent pathology. The authors are confident that despite the many unanswered questions this review updates their knowledge and points the need for further research to clarify the role of the age-associated dysfunction of neutrophils and complement system in the infection and inflammation related pathology of newborn infants.
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Affiliation(s)
- Anna Petrova
- Department of Pediatrics, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey 08903-0019, USA
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