The Frequency of Asymptomatic Hypoglycemia in High Risk Newborn Infants

PEDIATRICS ◽  
1970 ◽  
Vol 46 (6) ◽  
pp. 933-936
Author(s):  
Richard Guthrie ◽  
G. Van leeuwen ◽  
Linda Glenn
Keyword(s):  
Blood Glucose ◽  
High Risk ◽  
Clinical Significance ◽  
Current Practice ◽  
Newborn Infants ◽  
Term Infants ◽  
Serial Blood ◽  
Normal Term ◽  
High Risk Infants

Serial blood glucose determinations were performed on 109 high risk and 25 normal term infants. Eight of these risk infants (7.3%) had at least two glucose determinations of less than 20 mg/100 ml; 20 (18%) had at least one determination less than 20 mg/100 ml. Although no documented clinical significance of transient asymptomatic hypoglycemia is known to date, it occurs very frequently in high risk infants. Therefore, we advocate that the current practice of very early oral or intravascular feeding in risk infants be continued.

119 Communicating Sensitive Information - An Exploration of Parental Perspectives on Prognostication of High Risk Infants

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e85-e85
Author(s):  
Emily Fong ◽  
Ronit Mesterman
Keyword(s):  
High Risk ◽  
Preterm Infants ◽  
Average Length ◽  
Sensitive Information ◽  
Neurocognitive Deficits ◽  
Biological Father ◽  
Perinatal Medicine ◽  
Term Infants ◽  
Neurologic Recovery ◽  
High Risk Infants

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Preterm infants are at high risk of experiencing a range of impairments that may contribute to long-term challenges such as neurocognitive deficits. Physicians are often expected to give an outlook on future developmental outcomes of high-risk infants, often before sufficient time has elapsed to observe whether that particular child will demonstrate neurologic recovery from the initial injury. Clinicians often struggle with communicating this information, especially a poor prognosis, because of the worry about how these conversations affect families and their future expectations of the child. Objectives Our aim was to capture parents' retrospective perceptions of how their infant’s prognosis was communicated to them during their NICU stay. Design/Methods Semi-structured interviews were conducted over the phone with parents of former preterm infants with a birthweight below 1500 grams or parents of term infants who have sustained HIE requiring cooling. Parents were invited to participate when their child was between 12-36 months old at the time of the interview, so that parents would be able to have a sense of their child’s development and possible impairments. The data was analyzed thematically, with particular focus around the discourse of communication and prognostication. Results Twenty-three interviews were conducted: 20 with the biological mother, two with both biological parents, and one with the biological father. The average length of the interviews was 30 minutes. The main themes that recurred in the interviews included parental loss of control, needing to prepare for the unexpected, the value of shared decision making between the health care practitioners and parents, recognition and conveyance of uncertainty by the physician, and the importance of celebrating the present. Above all, a recurring theme mentioned by the majority of interviewees was the power of hope. While wanting to receive transparent and honest updates, parents felt strongly that giving them realistic hope was of utmost importance. Conclusion Although clinicians often feel pressured to deliver answers, parents found it helpful when clinicians acknowledged and explained the uncertainty that surrounds prognostication. While healthcare providers may feel the need to prepare parents for the worst, the importance of balancing this information with hope and positivity is what families remember and value years after the prognosis was given.

PHYSIOLOGIC HYPERBILIRUBINEMIA AND HEMOLYSIS OF ERYTHROCYTES BY HYDROGEN PEROXIDE SOLUTION IN THE NEWBORN: INVESTIGATION OF A POSSIBLE RELATIONSHIP

PEDIATRICS ◽  
1957 ◽  
Vol 20 (1) ◽  
pp. 92-97
Author(s):  
Jo-Anne E. Richards ◽  
Richard B. Goldbloom ◽  
Ronald L. Denton
Keyword(s):  
Hydrogen Peroxide ◽  
Statistical Analysis ◽  
Vitamin E ◽  
Clinical Significance ◽  
Newborn Infant ◽  
Newborn Infants ◽  
Control Group ◽  
Term Infants ◽  
Mean Values ◽  
Relative Deficiency

Forty-three full-term infants have been studied with respect to hemolysis of erythrocytes in solutions of hydrogen peroxide and concentrations of bilirubin in the serum. Mean values for concentration of bilirubin in the serum and percentage of hemolysis followed similar patterns in the first few days of life. However, statistical analysis of the data in individual cases showed no significant correlation between the degree of hemolysis in solutions of hydrogen peroxide and the concentrations of bilirubin in the serum. Administration of vitamin E prevented an increase in hemolysis of erythrocytes in solutions of hydrogen peroxide but failed to produce any significant change in concentrations of bilirubin as compared with the control group. The evidence suggests that the relative deficiency of vitamin E which exists in most newborn infants does not play a part in the causation or maintenance of physiologic hyperbilirubinemia. The clinical significance of increased hemolysis of the erythrocytes of the newborn infant in solutions of hydrogen peroxide remains a mystery. Possible approaches to the clarification of this problem are suggested.

scholarly journals Oral Dextrose Gel Reduces the Need for Intravenous Dextrose Therapy in Neonatal Hypoglycemia

2016 ◽  
Vol 1 (3) ◽  
pp. 1-9 ◽  
Author(s):  
Munmun Rawat ◽  
Praveen Chandrasekharan ◽  
Stephen Turkovich ◽  
Nancy Barclay ◽  
Katherine Perry ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Blood Glucose Level ◽  
Glucose Level ◽  
Neonatal Intensive Care ◽  
Newborn Infants ◽  
Large For Gestational Age ◽  
Term Infants ◽  
Glucose Levels ◽  
Lower Baseline ◽  
Before And After

Background: Newborn infants with risk factors may require intravenous (IV) dextrose for asymptomatic hypoglycemia. Administration of IV dextrose and transfer to the neonatal intensive care unit (NICU) may interfere with parent-infant bonding. Objective: To study the effect of implementing dextrose gel supplement with feeds in late preterm/term infants affected by asymptomatic hypoglycemia on reducing IV dextrose therapy. Method: A retrospective study was conducted before and after dextrose gel use: 05/01/2014 to 10/31/2014 and 11/01/2014 to 04/30/2015, respectively. Asymptomatic hypoglycemic (blood glucose level <45 mg/dl) infants in the newborn nursery (NBN) were given a maximum of 3 doses of dextrose gel (200 mg/kg of 40% dextrose) along with feeds. Transfer to the NICU for IV dextrose was considered treatment failure. Results: Dextrose gel with feeds increased the blood glucose level in 184/250 (74%) of asymptomatic hypoglycemic infants compared to 144/248 (58%) with feeds only (p < 0.01). Transfer from the NBN to the NICU for IV dextrose decreased from 35/1,000 to 25/1,000 live births (p < 0.01). Exclusive breastfeeding improved from 19 to 28% (p = 0.03). Conclusions: Use of dextrose gel with feeds reduced the need for IV fluids, avoided separation from the mother and promoted breastfeeding. Neonates who failed dextrose gel therapy were more likely to be large for gestational age, delivered by cesarean section and had lower baseline blood glucose levels.

“Womb” Literacy: Reading to Infants in the NICU

2004 ◽  
Vol 23 (4) ◽  
pp. 65-69 ◽  
Author(s):  
Martha Wilson Jones ◽  
Donna Englestad
Keyword(s):  
High School ◽  
Academic Achievement ◽  
High Risk ◽  
Preterm Infants ◽  
Cognitive Outcomes ◽  
Term Infants ◽  
Medical Needs ◽  
Iq Scores ◽  
Repeating A Grade ◽  
High Risk Infants

PROMOTING LITERACY IS NOT generally one of the top priorities in the care of high-risk infants in the NICU. Basic survival and tending to medical needs are obviously the most pressing concerns. However, we know from various studies that high-risk infants are at greater risk for less-than-optimal cognitive outcomes.1–3 For example, preterm infants are at greater risk than term infants for lower overall IQ scores, repeating a grade, and failing to graduate from high school.1,2 Interventions to improve the academic achievement of children are most effective when begun in the preschool years.4

Role of umbilical interleukin-6, procalcitonin and C-reactive protein measurement in the dia gnosis of fetal inflammatory response syndrome

2021 ◽  
Vol 86 (2) ◽  
pp. 80-85
Author(s):  
Zbyněk Straňák ◽  
◽  
Ivan Berka ◽  
Jan Širc ◽  
Jan Urbánek ◽  
...  
Keyword(s):  
High Risk ◽  
Inflammatory Response ◽  
Neonatal Mortality ◽  
Interleukin 6 ◽  
C Reactive Protein ◽  
Term Infants ◽  
Mortality And Morbidity ◽  
Reactive Protein ◽  
High Risk Infants ◽  
Fetal Inflammatory Response

Overview Objective: Fetal Inflammatory Response Syndrome (FIRS) is a serious complication accompanied by increased neonatal mortality and morbidity. Early dia­gnosis of FIRS is essential to detect high risk infants. The aim of the study was to evaluate the correlation between interleukin-6 
(IL-6), procalcitonin (PCT), C-reactive protein (CRP) in cord blood and histologically proven funisitis/ chorioamnionitis in high-risk infants after preterm birth. Methods: Blood sampling for the measurement of inflammatory bio­markers was performed immediately after placental delivery and umbilical cutting. Umbilical and placental inflammatory changes were assessed using a recently released scoring system (Amsterdam Placental Workshop Group Consensus). Results: One hundred preterm infants (30.5 ± 2.5 gestational week, birth weight 1,443 ± 566 grams) and 21 health term infants were analyzed. Histologic chorioamnionitis was confirmed in 19% cases and chorioamnionitis with funisitis in 7% cases. Thirty-three infants (33%) fulfilled criteria of FIRS (funistis and/ or umbilical IL-6 > 11 ng/ L). The presence of FIRS correlated significantly with maternal leukocytosis (P < 0.001), preterm premature rupture of membrane (P < 0.001) and preterm uterine contraction (P < 0.0001). In comparison to preterm and healthy term infants we found statistically significant higher levels of umbilical inflammatory bio­markers (IL-6, PCT, CRP) in FIRS group (P < 0.0001). Composite mortality and morbidity (bronchopulmonary dysplasia, intraventricular haemorrhage, periventricular leukomalacia) was higher in FIRS group (28.1 vs 22.4% in preterm group). However, the difference was not statistically significant (P = 0.53). Conclusion: Our study confirmed the correlation of umbilical inflammatory bio­markers levels (IL-6, PCT, CRP) and the presence of FIRS. We did not find significant adverse impact of FIRS on neonatal mortality and morbidity. Nevertheless, our results could be influenced by the size of study group and strict inclusion criteria (only cases after C-section were analyzed). Keywords: fetal inflammatory response syndrome – neonatal mortality – morbidity – interleukin-6 – C-reactive protein – procalcitonin – chorioamnionitis and funisitis

IMPAIRMENT OF INTESTINAL HYDROLYSIS OF LACTOSE IN NEWBORN INFANTS

PEDIATRICS ◽  
1965 ◽  
Vol 36 (4) ◽  
pp. 542-550
Author(s):  
Samuel W. Boellner ◽  
Alice G. Beard ◽  
Theodore C. Panos ◽  
Ann Ross
Keyword(s):  
Blood Glucose ◽  
Premature Infants ◽  
Fasting Blood Glucose ◽  
Age Groups ◽  
Newborn Infants ◽  
Intestinal Epithelial ◽  
Term Infants ◽  
Glucose Levels ◽  
Hydrolysis Of ◽  
Galactose Tolerance

A total of 122 oral lactose, glucose, glucose-galactose, and intravenous galactose tolerance tests were performed on 38 premature infants age 0-44 days and on 11 term infants age 0-3 days with the following conclusions: 1. Median fasting blood glucose levels were lower in premature infants than in term infants; values in premature infants rose steadily from 36 mg/100 ml in infants less than 3 days of age to 70 mg/100 ml in infants over 15 days of age. 2. Following orally administered lactose, 30- and 60-minute increments in blood glucose values were significantly less in premature and term infants younger than 3 days than in older infants. This was not true following oral administration of glucose. 3. In premature infants 0-3 days of age, 30- and 60-minute increments were significantly less following lactose than after either glucose or glucose-galactose. After 2 weeks of age, lactose tolerance tests were similar to glucose tolerance tests. 4. Intravenous galactose tolerance tests showed competent conversion of galactose to glucose in all age groups. 5. Significantly greater increments in blood glucose values were observed in premature and term infants less than 3 days of age when lactase was introduced into the duodenum prior to lactose administration. From the present study, it appears that hydrolysis of lactose in the intestine of the newborn infant is relatively impaired during the first few days of life. Further studies with quantitative assays of lactase activity in the intestinal epithelial cells will be necessary to determine whether an absolute insufficiency of lactase exists at birth.

Comparison of infant heart rate assessment by auscultation, ECG and oximetry in the delivery room

2018 ◽  
Vol 103 (5) ◽  
pp. F490-F492 ◽  
Author(s):  
Madeleine C Murphy ◽  
Laura De Angelis ◽  
Lisa K McCarthy ◽  
Colm Patrick Finbarr O’Donnell
Keyword(s):  
Heart Rate ◽  
High Risk ◽  
Pulse Oximetry ◽  
Clinical Assessment ◽  
Newborn Infants ◽  
Mean Difference ◽  
Low Risk ◽  
Delivery Room ◽  
Reasonable Accuracy ◽  
High Risk Infants

Clinical assessment of an infant’s heart rate (HR) in the delivery room (DR) has been reported to be inaccurate. We compared auscultation of the HR using a stethoscope with electrocardiography (ECG) and pulse oximetry (PO) for determining the HR in 92 low-risk newborn infants in the DR. Caregivers auscultated the HR while masked to the HR on the monitor. Auscultation underestimated ECG HR (mean difference (95% CI) by −9 (−15 to –2) beats per minute (bpm)) and PO HR (mean difference (95% CI) by −5 (−12 to 2) bpm). The median (IQR) time to HR by auscultation was 14 (10–18) s. As HR was determined quickly and with reasonable accuracy by auscultation in low-risk newborns, study in high-risk infants is warranted.

scholarly journals 21 Communicating Sensitive Information - An Exploration of Parental Perspectives on Prognostication of High Risk Infants

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e8-e8
Author(s):  
Emily Fong
Keyword(s):  
High Risk ◽  
Preterm Infants ◽  
Average Length ◽  
Sensitive Information ◽  
Neurocognitive Deficits ◽  
Structured Interviews ◽  
Biological Father ◽  
Term Infants ◽  
Neurologic Recovery ◽  
High Risk Infants

Abstract Background Preterm infants are at high risk of experiencing a range of impairments that may contribute to long-term challenges such as neurocognitive deficits. Physicians are often expected to give an outlook on future developmental outcomes of high risk infants, often before sufficient time has elapsed to observe whether that particular child will demonstrate neurologic recovery from the initial injury. Clinicians often struggle with communicating this information, especially a poor prognosis because of the worry about how these conversations affect families and their future expectations of the child. Objectives Our aim was to capture parents’ retrospective perception of how their infant’s prognosis was communicated to them during their NICU stay. Design/Methods Semi-structured interviews were conducted over the phone with parents of former preterm infants with a birthweight below 1500 grams or parents of term infants who have sustained HIE requiring cooling. Parents were invited to participate when their child was between 12-36 months old at the time of the interview, so that parents would be able to have a sense of their child’s development and possible impairments. The data was analyzed thematically, with particular focus around the discourse of communication and prognostication. Results Twenty-three interviews were conducted, 20 with the biological mother, 2 with both biological parents, and 1 with the biological father. The average length of the interviews was 30 minutes. The main themes that recurred in the interviews include parental loss of control, needing to prepare for the unexpected, the value of shared decision making between the health care practitioners and parents, recognition and conveyance of uncertainty by the physician, and the importance of celebrating the present. Above all, a recurring theme mentioned by the majority of interviewees was the power of hope. While wanting to receive transparent and honest updates, parents felt strongly that giving them realistic hope was of utmost importance. Conclusion Although clinicians often feel pressured to deliver answers, parents found it helpful when clinicians acknowledged and explained the uncertainty that surrounds prognostication. While healthcare providers may feel the need to prepare parents for the worst, the importance of balancing this information with hope and positivity is what families remember and value years after the prognosis was given.

EFFECTS OF VITAMIN K ON VITAMIN K DEPENDENT PROTEINS IN NEWBORN INFANTS

1987 ◽  
Author(s):  
K YAMADA ◽  
T MEGURO ◽  
A SHIRAHATA ◽  
T NAKAMURA ◽  
A ASAKURA
Keyword(s):  
High Risk ◽  
Vitamin K ◽  
Protein C ◽  
High Performance ◽  
Newborn Infants ◽  
Total Activity ◽  
Functional Assay ◽  
Factor X ◽  
Before And After ◽  
High Risk Infants

Plasma levels of vitamin K (VK) and VK dependent proteins ( factor E, factor VH, factor X, protein C and osteocalcin)were determined before and after VK administration to 22 newborn infants. Vitamin K2 syrup ( 2 mg/kg of body weight ) was orally administered to 9 healthy premature, 11 high risk and 2 VK deficient infants under 3 days of age. VK families extracted from plasma were separated by high performance liquid chromatography using a Cosmosil 5 Ci8 column, and separated VK families were detected by a fluorometry after their reaction with ethanolic sodium borohydride in a reaction coil connected by one-line to a chromatographic column. Total activity of factor E, factor VE and factor X was assayed by a Normotest ( Nyegaard ), and protein C was measured by protac/APTT and protac/chromogenic substrate ( S-2366 ) functional assay system ( American Diagnostica ). Osteocalcin levels were assayed by using of a RIA method before and after the absorption of plasma by hydroxyapatite.After VK administration, plasma VK2 ( menaquinone-4 ) content increased from levels less than 0.012yg/ml to levels between 15.9 and 70.9μg/ml, excluding one case in whom plasma VK was not detected after VK administration. Compared with Normotest values and osteocalcin levels of age-matched healthy newborn infants treated without VK, premature, high risk and VK deficient infant levels significantly increased after 24 hrs and after 7 days of VK administration. No correlation was seen between the increase of plasma VK contents and the increase of Normotest values after VK administration. On the other hand, no significant increase of protein C assayed by both methods was observed in healthy premature and high risk infants after VK administration.These results indicate that the change of protein C after VK treatment is different from that of factor II, VII, X and osteocalcin.

Pathogenesis and Prevention of Necrotizing Enterocolitis: A Hypothesis Based on Personal Observation and a Review of the Literature

PEDIATRICS ◽  
1984 ◽  
Vol 74 (6) ◽  
pp. 1086-1092 ◽  
Author(s):  
Ann M. Kosloske
Keyword(s):  
High Risk ◽  
Necrotizing Enterocolitis ◽  
Neonatal Intensive Care ◽  
Pathogenic Bacteria ◽  
Bacterial Colonization ◽  
Intestinal Flora ◽  
Intestinal Lumen ◽  
Term Infants ◽  
Intestinal Necrosis ◽  
High Risk Infants

The hypothesis is, that necrotizing enterocolitis (NEC) of the neonate occurs by the coincidence of two of three pathologic events: (1) intestinal ischemia, (2) colonization by pathogenic bacteria, and (3) excess protein substrate in the intestinal lumen. NEC is more likely to appear following quantitative extremes, ie, severe ischemia highly pathogenic flora, or marked excess of substrate. NEC develops only if a threshhold of injury, sufficient to initiate intestinal necrosis, is exceeded. The hypothesis is derived from previous theories by Santulli, which implicated all three events, and by Lawrence, in which a single event, abnormal bacterial colonization, was considered sufficient to induce NEC. This hypothesis may explain both typical occurrences of NEC among high-risk premature infants in neonatal intensive care units (NICUs), and atypical occurrences among infants considered at low-risk, eg, previously healthy term infants, infants fed breast milk exclusively, and infants never fed. It may further explain why NEC fails to develop in most high-risk infants in NICUs. Preventive measures might include: (1) pharmacologic stabilization of intestinal perfusion, (2) modification of the intestinal flora, or (3) feeding colostrum or other protective substances. Each theoretical benefit is accompanied by potential risks. The prevention of NEC may require favorable intervention in two of the three pathologic events.

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