P Sasidharan

Neonatal Cord Blood Leptin: Its Relationship to Birth Weight, Body Mass Index, Maternal Diabetes, and Steroids

Leptin is a 16-kD protein encoded by the ob/ob (obesity) gene. In rodents it plays a role in obesity, diabetes, fertility, and neuroendocrine function. In humans serum concentrations of leptin correlate with total body fat in both adults and children. We measured cord blood leptin in 186 neonates that included 82 appropriate for gestational age (AGA), 47 large for gestational age (LGA), 20 infants of diabetic mothers, 52 preterm infants, and 15 intrauterine growth-retarded (IUGR) infants. There were 16 pairs of twins. The mothers of 17 preterm infants were treated with steroids before delivery. Leptin (mean ± SD) concentration in term, AGA infants (39.4 ± 1.1 wk) with birth weight (BW) of 3.2 ± 0.3 kg, body mass index (BMI) of 12.6 ± 1.1 was 4.01 ± 3.5 ng/mL. BW correlated with cord leptin (p = 0.002) in a multivariate analysis controlling for potential confounders. Both LGA infants and infants of diabetic mothers had higher cord leptin concentration 7.3 ± 3.8 and 6.1 ± 4.8 ng/mL, respectively, compared with AGA infants (p < 0.05). Preterm infants had a mean leptin level of 1.8 ± 0.97 ng/mL and a 3-fold elevation was seen if mothers received steroids antenatally (p = 0.006). IUGR infants had increased leptin (6.5 ± 3.9 ng/mL, p= 0.03). Concerning the twin pairs, the smaller had a higher leptin level compared with larger twin (4.1 ± 9.51 versus 2.8 ± 5.14, p = NS). Neonatal cord leptin concentrations correlate well with BW and BMI. No gender differences were found in cord blood leptin. Maternal obesity had no effect on cord leptin, whereas exogenous maternal steroids increased neonatal leptin concentrations.

The effect of inhaled nitric oxide on the pulmonary circulation of the neonatal pig

ABSTRACT: To study the pulmonary vasodilator selectivity of low levels of inhaled nitric oxide (NO) in a model of neonatal pulmonary hypertension, we sequentially exposed anesthetized, spontaneously breathing neonatal pigs to each of four different inspired gas mixtures: room air, room air with 25 parts per million NO, hypoxia (14% O2 in N2), and hypoxia with 25 parts per million NO. The room air, room air with NO, hypoxia, and hypoxia with NO exposures were of 15-min duration. The following measurements were made: mean systemic arterial, mean pulmonary arterial, and wedge pressures; thermodilution cardiac output; esophageal pressure; tracheal flow; and arterial Po2, Pco2, pH, hemoglobin, and methemoglobin. Inhalation of NO decreased pulmonary arterial pressure in both room air and hypoxia conditions (mean pulmonary arterial pressure 16 ± 1 torr room air, 13 ± 1 torr room air with NO, p < 0.005; and mean pulmonary arterial pressure 21 ± 2 torr hypoxia, 14 ± 1 torr hypoxia with NO, p < 0.005). NO had no significant effect on systemic arterial pressure, cardiac output, dynamic lung compliance, pulmonary resistance, or the measured blood variables during either control or hypoxic conditions. The results indicate that inhaled NO was a selective pulmonary vasodilator that could effectively reverse acute hypoxic pulmonary vasoconstriction. The normoxic vasodilation produced by NO inhalation also indicates the existence of basal vasomotor tone in the anesthetized, spontaneously breathing neonatal pig. The short-term exposures used produced no detectable manifestations of toxic side effects.

Hospital Readmission and Morbidity Following Early Newborn Discharge

To examine causes of newborn hospital readmission and morbidity related to early nursery discharge, we reviewed the charts of 664 newborns readmitted from home under the age of 15 days, between 1993 and 1995. Early discharge (ED) was defined as nursery length of stay of <2 days. Morbidity related to ED: onset of symptoms within 1 day of ED; and in diseases with insidious onset: serum bilirubin level >20 mg/dL (340 pmol/L), or dehydration following poor breastfeeding since birth. Seventeen percent of all readmitted infants had ED-related morbidity; 9% had major morbidity. Onset of symptoms prior to the age of 3 days occurred in 43% of ductal-dependent cardiac lesions, intestinal obstruction, seizures, and major infections. Morbidity was less pronounced in infants who were followed up within 2 days following ED. Specific findings related to subsequent morbidity were identified in the perinatal history of infants who were readmitted with major infections and with hyperbilirubinemia. Our findings suggest that: (1) close to half of the cases with acute-onset major morbidity can be identified within 3 days of birth, and (2) attention to the perinatal history and timely follow-up will contribute to a reduction in both morbidity and complications.

Chronic lung disease in premature infants: a retrospective evaluation of underlying factors

A retrospective case-control study involving 99 premature infants requiring vigorous respiratory support was conducted to investigate the relative contribution of various etiologic factors in the development of chronic lung disease (CLD). Nineteen of the 99 developed CLD. Background and management factors up to the development of CLD, with attention to mode of ventilation (tube, or face mask/nasal prongs) were investigated. Infants in the CLD group had significantly lower birth weights (BW) (p less than .001) and gestational ages (p less than .01) than those in the non-CLD group. There was no difference in the incidence of intrathoracic airleak or symptomatic patent ductus arteriosus. Of the CLD group, 74% were intubated compared with 35% in the non-CLD group (p less than .002). There was no difference between the groups in the morbidity score of initial pulmonary disease or in the duration of ventilation with various pressures and oxygen concentrations. Multiple logistic regression analysis revealed that intubated infants were 4.8 times more likely to develop CLD than nonintubated infants, and infants with low BW had a 3.2-fold greater risk of developing the disease.

Identification of Sepsis in Neonates Following Maternal Antibiotic Therapy

To examine the value of current diagnostic tests identifying neonatal sepsis related to intrapartum treatment with antibiotics, we reviewed the charts of 219 mother-infant pairs, of which 139 mothers received intrapartum antibiotics (group 1) and 80 mothers did not (group 2). When compared with group 2 infants, group 1 infants had fewer positive blood cultures (4.3% vs 20%, P<0.003), blood cultures positive for group B streptococci (GBS) (P<0.001), and positive urine GBS latex agglutination (LA) tests (P <0.001). Although the sensitivity of the white blood cell count (WBC) was 81 %, the specificity was <60% in both groups. The specificity of the urine GBS LA test was 92%. These results suggest (1) the WBC will neither confirm nor rule out neonatal septicemia; (2) blood cultures are indicated in suspected neonatal sepsis even if there was maternal intrapartum treatment with antibiotics; and (3) a urine GBS LA test is a useful adjunct in the diagnosis of neonatal GBS septicemia.

Alterations in pulmonary mechanics after transfusion in anemic preterm infants

Pulmonary mechanics were studied in ten anemic preterm infants using an esophageal balloon and mask, before and after transfusion with 10 ml/kg of packed RBC. Their mean birth weight was 1212 ± 323 g and gestational age was 29.27 ± 2.4 wk. Transfusions were carried out at a mean postnatal age of 41.9 ± 21.8 days. The mean Hct increased from 28 ± 3.1 to 38.3 ± 3.3%. Dynamic lung compliance decreased in all infants after transfusion. There was a 33.8% increase in resistance; the work of breathing increased after transfusion. These changes might be due to volume overload or increased lung water content.

APPROACHING THE MANAGEMENT OF THE NEONATAL INTENSIVE CARE UNIT GRADUATE THROUGH HISTORY AND PHYSICAL ASSESSMENT

NICU graduates, often ex-premature infants, offer unusual challenges to the primary care provider. History and physical assessment require an organized approach with meticulous attention to detail. These infants are at high risk for multiple problems including growth delays, nutrition and feeding problems, pulmonary sequelae, neurological sequelae and developmental delays, vision and hearing disturbances, as well as abnormalities in parent-infant bonding. This article emphasizes particular aspects of the history and physical examination that signify pathophysiology and sequelae common to the NICU graduate.

Neurodevelopmental and audiological outcome of healthy term newborns with moderately severe non-haemolytic hyperbilirubinemia

Objective:  Our objective was to examine the outcome of term infants who developed moderate non‐haemolytic jaundice as information regarding the neurodevelopmental outcome of term infants with moderately severe non‐haemolytic hyperbilirubinemia remains controversial.

Meta-analysis of the Randomized controlled trials (RCT's) of Recombinant human Erythropoietin (EPO) in Anemia of Prematurity (AOP). ▴ 1731

Meta-analysis of the Randomized controlled trials (RCTs) of Recombinant human Erythropoietin (EPO) in Anemia of Prematurity (AOP). ▴ 1731

Morbidity of Newborn Infants (NB) after Nursery Discharge; relationship to Early Discharge. 1588

We hypothesized that early discharge (ED) contributes to significant morbidity of the NB. Charts of 500 infants (under age 15 days) admitted 7/93-6/95 were reviewed. Eighty-four percent were discharged early (ED≤ age 2 d); 49% had onset of symptoms (OS) at ≤4d of age. OS does not always concur with age at readmission. Poor social conditions were defined in 39%. Of infants aged 1-7d, 50% had hyperbilirubinemia (HB). Of infants aged 8-14d, 3% had HB; 56% had ruled out sepsis (ROS). GA <39 weeks was significantly more common in HB cases (51%) compared to non-jaundiced infants (17%),(p<0.0001). Of infants with HB, 78% were breast fed (BF) compared to 48% of non-jaundiced infants (p<0.0001). OS of HB was at age 2.4±1.2d.