scholarly journals Proposed Plasma Ammonia Reference Intervals in a Reference Group of Hospitalized Term and Preterm Neonates

2020 ◽  
Vol 5 (2) ◽  
pp. 363-369
Author(s):  
Theresa Madigan ◽  
Darci R Block ◽  
William A Carey ◽  
Bethany D Kaemingk ◽  
Robin Patel
Keyword(s):  
Gestational Age ◽  
Reference Group ◽  
Reference Intervals ◽  
Preterm Neonates ◽  
Blood Collection ◽  
Blood Draw ◽  
Inborn Errors ◽  
Term Infants ◽  
Collection Method ◽  
Plasma Ammonia

Abstract Background Plasma ammonia is commonly measured in the diagnostic evaluation of hospitalized newborns, but reference values are not well defined. Methods We prospectively enrolled newborns admitted to the level III/IV neonatal intensive care unit and level II intermediate special care nursery from January 2017 to January 2018. Infants with inborn errors of metabolism or liver disease were excluded. Plasma ammonia concentrations were measured once within the first week of life and evaluated by sex, gestational age, timing of the draw, blood collection method, and type of nutrition. Reference intervals were calculated. Results 127 neonates were included; one third (34%) were term infants born at ≥37 weeks gestation, and two thirds (66%) were born preterm at <37 weeks gestation. Median plasma ammonia concentrations were 32 μmol/L (range <10 to 86 μmol/L). Median ammonia concentrations were higher among preterm compared to term infants (35 vs. 28 μmol/L, p = 0.0119), and term female compared to term male infants (34 vs. 26 μmol/L, p = 0.0228). There was no difference in median ammonia concentrations between female and male preterm infants, based on gestational age within the preterm group, timing of the blood draw, presence of hyperbilirubinemia, blood collection method, or type of nutritional intake. Conclusions Plasma ammonia concentrations among newborns are higher than the expected adult concentrations and may vary by gestational age and sex. Blood collection method, type of nutrition, hyperbilirubinemia, and timing of the draw do not impact concentrations. We propose a reference limit of ≤82 μmol/L for newborns less than one week of age.

scholarly journals Accuracy of Transcutaneous Bilirubinometry in Neonates Receiving Phototherapy

2018 ◽  
Vol 38 (1) ◽  
pp. 1-7
Author(s):  
Pallavi Parag Dagli ◽  
Snehal Vasava
Keyword(s):  
Gestational Age ◽  
Serum Bilirubin ◽  
Preterm Neonates ◽  
Blood Collection ◽  
Limited Data ◽  
Altman Plot ◽  
Term Infants ◽  
The Mean ◽  
Transcutaneous Bilirubinometer ◽  
Transcutaneous Bilirubinometry

Introduction: Phototherapy remains mainstay of treating neonatal hyperbilirubinemia across gestational age spectrum. Neonates under phototherapy (PTx) require frequent estimation of serum bilirubin (TSB) to monitor disease progression. Transcutaneous bilirubinometer (TcB) is widely used for estimation of TSB with limited data for neonates receiving PTx. The aim of study was to assess the diagnostic accuracy of TcB as compared to TSB in preterm and term infants receiving phototherapy.Methods: This prospective study analyzed 385 paired TcB-TSB samples from 234 hemodynamically stable preterm (89) and term (145) neonates receiving in-hospital PTx. Indigenous photo-opaque patch was applied to sternum before starting PTx. TcB was measured from patched area of skin using Dräger JM-103 device at 12 and 24 hours during phototherapy within 5 minutes of blood collection for TSB. Linear regression and Bland-Altman plots were used to compare TcB with TSB.Results: The mean (SD) gestational age and birth weight were 35.8 (2.43) weeks and 2250 (560) grams. Difference of mean of TcB and TSB was ranging between 0.7-1 mg/dl with TcB underestimating TSB. At 12 hours and 24 hours of PTx, the correlation coefficient were (r = 0.84 and 0.81, p<0.01) among preterm and (r = 0.76 and 0.79, p<0.01) among term infants. Bland–Altman plot showed significant agreement between TcB from patched site and TSB in both preterm and term neonates.Conclusion: TcB demonstrated significant accuracy in predicting TSB in both term and preterm neonates receiving PTx with slight underestimation of TSB. The study showed marginally higher correlation for preterm infants.  

Oral acetaminophen administration for patent ductus arteriosus (PDA) closure in preterm neonates

2021 ◽  
Vol 43 (3) ◽  
pp. 254-259
Author(s):  
Mahmood Samadi ◽  
Zahra Nabaee ◽  
Manizheh Mostafagharebaghi ◽  
Majid Mahalei ◽  
Elham Sheykhsaran ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Gestational Age ◽  
Statistical Significance ◽  
Ductus Arteriosus ◽  
Preterm Neonates ◽  
Term Infants ◽  
Treatment Data ◽  
Kolmogorov Smirnov ◽  
Study Population ◽  
Patent Ductus

Background: Patent Ductus Arteriosus (PDA) is considered one of the most prevalent types of congenital heart disease. The closure of the ductus arteriosus physiologically occurs at the first 48-72 hours after the birth in healthy term infants. Different causes can result in the pathological opening of ductus arteriosus. This study aims to investigate the effect of oral acetaminophen on the closure of PDA in preterm neonates. Methods: The present study is a trial without control. Forty-five preterm neonates with a gestational age of <32 weeks were studied. Acetaminophen was orally administered with a dose of 10mg/kg every 6 hours for three days. Closure of ductus arteriosus was considered as the success of treatment. Data were analyzed using SPSS 15. Data were reported as )frequency-percent) and mean ± SD. To evaluate the normal distribution of data, we used a Kolmogorov-Smirnov test. Statistical significance was defined as P<0.05. Results: The study population consisted of 20 male and 25 female infants with the mean gestational age of 28.95 ± 1.66 weeks. Cesarean-born infants and vaginal-born infants consisted 17.8% and 82.2% of the study population, respectively. The proportion of PDA closure after administration of oralacetaminophen was 82.3%. Conclusion: The current study indicates that oral acetaminophen is highly effective in closing PDA. Considering its trivial side effects, it has the potency to be a convenient option for treating this condition.

Effect of a single breath of 100% oxygen on respiration in neonates during sleep

1984 ◽  
Vol 57 (5) ◽  
pp. 1531-1535 ◽  
Author(s):  
T. Aizad ◽  
J. Bodani ◽  
D. Cates ◽  
L. Horvath ◽  
H. Rigatto
Keyword(s):  
Gestational Age ◽  
Minute Ventilation ◽  
Control Period ◽  
Full Term ◽  
Preterm Neonates ◽  
Sleep State ◽  
Quiet Sleep ◽  
Peripheral Chemoreceptor ◽  
Term Infants ◽  
Single Breath

To determine the effect of a single breath of 100% O2 on ventilation, 10 full-term [body wt 3,360 +/- 110 (SE) g, gestational age 39 +/- 0.4 wk, postnatal age 3 +/- 0.6 days] and 10 preterm neonates (body wt 2,020 +/- 60 g, gestational age 34 +/- 2 wk, postnatal age 9 +/- 2 days) were studied during active and quiet sleep states. The single-breath method was used to measure peripheral chemoreceptor response. To enhance response and standardize the control period for all infants, fractional inspired O2 concentration was adjusted to 16 +/- 0.6% for a control O2 saturation of 83 +/- 1%. After 1 min of control in each sleep state, each infant was given a single breath of O2 followed by 21% O2. Minute ventilation (VE), tidal volume (VT), breathing frequency (f), alveolar O2 and CO2 tension, O2 saturation (ear oximeter), and transcutaneous O2 tension were measured. VE always decreased with inhalation of O2 (P less than 0.01). In quiet sleep, the decrease in VE was less in full-term (14%) than in preterm (40%) infants (P less than 0.001). Decrease in VE was due primarily to a drop in VT in full-term infants as opposed to a fall in f and VT in preterm infants (P less than 0.05). Apnea, as part of the response, was more prevalent in preterm than in full-term infants. In active sleep the decrease in VE was similar both among full-term (19%) and preterm (21%) infants (P greater than 0.5). These results suggest greater peripheral chemoreceptor response in preterm than in full-term infants, reflected by a more pronounced decrease in VE with O2. The results are compatible with a more powerful peripheral chemoreceptor contribution to breathing in preterm than in full-term infants.

scholarly journals Necrotizing Enterocolitis in Moderate Preterm Infants

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Jayasree Nair ◽  
Rachel Longendyke ◽  
Satyan Lakshminrusimha
Keyword(s):  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Gestational Age ◽  
Age At Onset ◽  
Late Preterm ◽  
Preterm Neonates ◽  
Term Infants ◽  
Hypertensive Disorders ◽  
Extremely Preterm ◽  
Perinatal Center

Necrotizing enterocolitis (NEC) is a devastating morbidity usually seen in preterm infants, with extremely preterm neonates (EPT ≤28 weeks) considered at highest risk. Moderately preterm infants (MPT 28–34 weeks) constitute a large percentage of NICU admissions. In our retrospective data analysis of NEC in a single regional perinatal center, NEC was observed in 10% of extremely EPT and 7% of MPT, but only 0.7% of late-preterm/term admissions. There was an inverse relationship between postnatal age at onset of NEC and gestational age at birth. Among MPT infants with NEC, maternal hypertensive disorders (29%) and small for gestational age (SGA-15%) were more common than in EPT infants (11.6 and 4.6%, resp.). Congenital gastrointestinal anomalies were common among late preterm/term infants with NEC. SGA MPT infants born to mothers with hypertensive disorders are particularly at risk and should be closely monitored for signs of NEC. Identifying risk factors specific to each gestational age may help clinicians to tailor interventions to prevent NEC.

Assessment of renal functional maturation and injury in preterm neonates during the first month of life

2014 ◽  
Vol 307 (2) ◽  
pp. F149-F158 ◽  
Author(s):  
Lina Gubhaju ◽  
Megan R. Sutherland ◽  
Rosemary S. C. Horne ◽  
Alison Medhurst ◽  
Alison L. Kent ◽  
...  
Keyword(s):  
Renal Function ◽  
Gestational Age ◽  
Renal Injury ◽  
High Capacity ◽  
Tubular Function ◽  
Preterm Neonates ◽  
Urinary Ngal ◽  
Term Infants ◽  
Gestational Age At Birth ◽  
Age At Birth

Worldwide, approximately 10% of neonates are born preterm. The majority of preterm neonates are born when the kidneys are still developing; therefore, during the early postnatal period renal function is likely reflective of renal immaturity and/or injury. This study evaluated glomerular and tubular function and urinary neutrophil gelatinase-associated lipocalin (NGAL; a marker of renal injury) in preterm neonates during the first month of life. Preterm and term infants were recruited from Monash Newborn (neonatal intensive care unit at Monash Medical Centre) and Jesse McPherson Private Hospital, respectively. Infants were grouped according to gestational age at birth: ≤28 wk ( n = 33), 29–31 wk ( n = 44), 32–36 wk ( n = 32), and term (≥37 wk ( n = 22)). Measures of glomerular and tubular function were assessed on postnatal days 3–7, 14, 21, and 28. Glomerular and tubular function was significantly affected by gestational age at birth, as well as by postnatal age. By postnatal day 28, creatinine clearance remained significantly lower among preterm neonates compared with term infants; however, sodium excretion was not significantly different. Pathological proteinuria and high urinary NGAL levels were observed in a number of neonates, which may be indicative of renal injury; however, there was no correlation between the two markers. Findings suggest that neonatal renal function is predominantly influenced by renal maturity, and there was high capacity for postnatal tubular maturation among preterm neonates. There is insufficient evidence to suggest that urinary NGAL is a useful marker of renal injury in the preterm neonate.

scholarly journals 2074

2017 ◽  
Vol 1 (S1) ◽  
pp. 55-55
Author(s):  
Alvaro Moreira ◽  
Caitlyn Winter ◽  
Saloni Balgi ◽  
Shamimunisa Mustafa ◽  
Lauryn Winter ◽  
...  
Keyword(s):  
Cell Motility ◽  
Surface Antigen ◽  
Gestational Age ◽  
Preterm Neonates ◽  
Term Infants ◽  
Hla Dr ◽  
Umbilical Cord Tissue ◽  
Forming Efficiency ◽  
Study Population

OBJECTIVES/SPECIFIC AIMS: To compare functional differences in WJ-MSCs-derived from term Versus preterm infants. METHODS/STUDY POPULATION: WJ-MSCs were enzymatically digested from umbilical cord tissue from Term (gestational age ≥37 wk, n=4) and Preterm (gestational age ≤32 wk, n=5) neonates. Cells were characterized by (1) surface antigen markers using flow cytometry, (2) ability to differentiate into adipogenic, chondrogenic, and osteogenic lineages following in vitro stimulation, (3) colony forming unit efficiency, (4) proliferation rates, and (5) cell motility assay. RESULTS/ANTICIPATED RESULTS: WJ-MSCs were successfully isolated from both Preterm and Term groups. Cells adhered to plastic and displayed characteristic spindle-shaped morphology when cultured under standard conditions. WJ-MSCs from both groups expressed surface antigen markers CD73, CD90, and CD146 (≥90%) and did not express hematopoietic markers HLA-DR, CD79, or CD117 (<5%). Preterm and Term cells were capable of differentiating into osteogenic, chondrogenic, and adipogenic lineages. There were no significant differences between the groups when evaluated by colony forming efficiency, proliferation rates, or cell motility. DISCUSSION/SIGNIFICANCE OF IMPACT: These preliminary findings suggest that WJ-MSCs derived from full-term or preterm neonates have similar functional characteristics. Future studies will focus on the regenerative potential of WJ-MSCs from preterm and term infants following changes in the microenvironment (eg, oxygen tension, inflammatory stimulation).

scholarly journals Etiologies of neonatal seizures in infants of different gestational age

2018 ◽  
Vol 10 (3) ◽  
pp. 19-30 ◽  
Author(s):  
A. N. Zavadenko ◽  
M. I. Medvedev ◽  
M. G. Degtyareva ◽  
S. O. Rogatkin ◽  
N. N. Zavadenko
Keyword(s):  
Intracranial Hemorrhage ◽  
Gestational Age ◽  
Neonatal Seizures ◽  
Inborn Errors ◽  
Term Infants ◽  
Cns Infections ◽  
Epileptic Syndromes ◽  
Genetic Mechanisms ◽  
Term Newborns ◽  
Grade Iii

Aim:To determine main etiologies and clinical features of neonatal seizures (NS) in groups of newborns of different gestational age (GA).Materials and Methods. Main etiologies of NS were evaluated in 165 newborns divided into four groups: I – 84 early preterm newborns with GA of 28 weeks or less, II – 52 newborns with 29-32 weeks GA, III – 12 newborns with 33-36 weeks GA, and IV – 17 term infants with GA between 37 and 41 wks.Results. In the above 165 infants, the following causes of NS were found: perinatal hypoxia-ischemia – 72.1% of cases, grade III-IV intracranial hemorrhage – 6.1%, congenital infections in 9.7%, CNS infections (bacterial meningitis and viral meningoencephalitis) – 9.7%, сerebral dysgenesis – 1.2%, and inborn errors of metabolism and neurodegenerative diseases accounted for 1.2%. Intracranial hemorrhage (grade III-IV) was detected in newborns with GA less than 32 wks only. The etiological role of CNS infections was higher in term newborns (23.5%) than in the other groups.Conclusion.In examining newborns with NS, genetic mechanisms should be taken into consideration, especially when no indications of early brain damage are apparent. This approach is important today as targeted therapies of gene-associated epileptic syndromes are becoming feasible. In the present article, the use of levetiracetam in infants with NS and early onset epilepsy is discussed.

Acute kidney injury in preterm neonates with ≤30 weeks of gestational age and its risk factors

2019 ◽  
Vol 71 (5) ◽  
Author(s):  
Rita Ladeiras ◽  
Filipa Flor-De-Lima ◽  
Henrique Soares ◽  
Bárbara Oliveira ◽  
Hercília Guimarães
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Gestational Age ◽  
Kidney Injury ◽  
Preterm Neonates

Establishment of Early Pregnancy Related Thyroid Hormone Models and Reference Intervals for Pregnant Women in China Based on Real World Data

2021 ◽  
Vol 53 (04) ◽  
pp. 272-279
Author(s):  
Chaochao Ma ◽  
Xiaoqi Li ◽  
Lixin Liu ◽  
Xinqi Cheng ◽  
Fang Xue ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Hormones ◽  
Pregnant Women ◽  
Early Pregnancy ◽  
Gestational Age ◽  
Dynamic Change ◽  
Reference Intervals ◽  
Thyroid Stimulating Hormone ◽  
Free Thyroxine ◽  
Stimulating Hormone

AbstractThyroid hormone reference intervals are crucial for diagnosing and monitoring thyroid dysfunction during early pregnancy, and the dynamic change trend of thyroid hormones during pregnancy can assist clinicians to assess the thyroid function of pregnant women. This study aims to establish early pregnancy related thyroid hormones models and reference intervals for pregnant women. We established two derived databases: derived database* and derived database#. Reference individuals in database* were used to establish gestational age-specific reference intervals for thyroid hormones and early pregnancy related thyroid hormones models for pregnant women. Individuals in database# were apparently healthy non-pregnant women. The thyroid hormones levels of individuals in database# were compared with that of individuals in database* using nonparametric methods and the comparative confidence interval method. The differences in thyroid stimulating hormone and free thyroxine between early pregnant and non-pregnant women were statistically significant (p<0.0001). The reference intervals of thyroid stimulating hormone, free thyroxine and free triiodothyronine for early pregnant women were 0.052–3.393 μIU/ml, 1.01–1.54 ng/dl, and 2.51–3.66 pg/ml, respectively. Results concerning thyroid stimulating hormone and free thyroxine reference intervals of early pregnancy are comparable with those from other studies using the same detection platform. Early pregnancy related thyroid hormones models showed various change patterns with gestational age for thyroid hormones. Early pregnancy related thyroid hormones models and reference intervals for pregnant women were established, so as to provide accurate and reliable reference basis for the diagnosing and monitoring of maternal thyroid disfunction in early pregnancy.

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