Jaundice in Healthy, Term Neonates: Do We Need New Action Levels or New Approaches?

PEDIATRICS ◽  
1992 ◽  
Vol 89 (5) ◽  
pp. 827-829
Author(s):  
AUDREY K. BROWN ◽  
DANIEL S. SEIDMAN ◽  
DAVID K. STEVENSON
Keyword(s):  
Neurodevelopmental Outcome ◽  
Alexander Pope ◽  
Neurologic Injury ◽  
Term Infants ◽  
Ample Evidence ◽  
Term Neonates ◽  
Neurodevelopmental Impairment ◽  
New Guidelines ◽  
Action Levels

All seems infected that th' infected spy, As all looks yellow to the jaundiced eye. —Alexander Pope An Essay on Criticism, 1711 We take note of Alexander Pope's admonition, and we are reminded by others that, from their perspective, the evidence is unconvincing that moderate neonatal hyperbilirubinemia adversely affects the neurodevelopmental outcome of healthy, term infants. Moreover, although there is ample evidence that high levels of bilirubin may be associated with neurologic injury, a linear relationship between neonatal serum bilirubin levels and long-term neurodevelopmental impairment does not seem to exist.1 Such observations have been recognized for some time2,3 and have encouraged some of our colleagues to propose new guidelines for the treatment of jaundice in well, term infants.4,5

scholarly journals Oral melatonin as a new tool for neuroprotection in preterm newborns: study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Francesca Garofoli ◽  
Stefania Longo ◽  
Camilla Pisoni ◽  
Patrizia Accorsi ◽  
Micol Angelini ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Preterm Infants ◽  
Neurodevelopmental Outcome ◽  
Lipid Peroxidation Product ◽  
Cerebral Magnetic Resonance Imaging ◽  
Neurodevelopmental Impairment ◽  
Anti Oxidant ◽  
Preterm Newborns

Abstract Background Prevention of neurodevelopmental impairment due to preterm birth is a major health challenge. Despite advanced obstetric and neonatal care, to date there are few neuroprotective molecules available. Melatonin has been shown to have anti-oxidant/anti-inflammatory effects and to reduce brain damage, mainly after hypoxic ischemic encephalopathy. The planned study will be the first aiming to evaluate the capacity of melatonin to mitigate brain impairment due to premature birth. Method In our planned prospective, multicenter, double-blind, randomized vs placebo study, we will recruit, within 96 h of birth, 60 preterm newborns with a gestational age ≤ 29 weeks + 6 days; these infants will be randomly allocated to oral melatonin, 3 mg/kg/day, or placebo for 15 days. After the administration period, we will measure plasma levels of malondialdehyde, a lipid peroxidation product considered an early biological marker of melatonin treatment efficacy (primary outcome). At term-equivalent age, we will evaluate neurological status (through cerebral ultrasound, cerebral magnetic resonance imaging, vision and hearing evaluations, clinical neurological assessment, and screening for retinopathy of prematurity) as well as the incidence of bronchodysplasia and sepsis. We will also monitor neurodevelopmental outcome during the first 24 months of corrected age (using the modified Fagan Test of Infant Intelligence at 4–6 months and standardized neurological and developmental assessments at 24 months). Discussion Preterm birth survivors often present long-term neurodevelopmental sequelae, such as motor, learning, social-behavioral, and communication problems. We aim to assess the role of melatonin as a neuroprotectant during the first weeks of extrauterine life, when preterm infants are unable to produce it spontaneously. This approach is based on the supposition that its anti-oxidant mechanism could be useful in preventing neurodevelopmental impairment. Considering the short- and long-term morbidities related to preterm birth, and the financial and social costs of the care of preterm infants, both at birth and over time, we suggest that melatonin administration could lead to considerable saving of resources. This would be the first study addressing the role of melatonin in very low birth weight preterm newborns, and it could provide a basis for further studies on melatonin as a neuroprotection strategy in this vulnerable population. Trial registration ClinicalTrials.gov NCT04235673. Prospectively registered on 22 January 2020.

scholarly journals Effect of Elevated Temperature on Immediate Neurodevelopmental Outcome in Term Neonates with Hypoxic-Ischemic Encephalopathy

2019 ◽  
Vol 9 (3) ◽  
pp. 160-165
Author(s):  
Bithi Debnath ◽  
Naila Zaman Khan ◽  
Dilara Begum ◽  
Asma Begum Shilpi ◽  
Shaheen Akter
Keyword(s):  
Elevated Temperature ◽  
Rectal Temperature ◽  
Neurodevelopmental Outcome ◽  
Hypoxic Ischemic Encephalopathy ◽  
Neurodevelopmental Outcomes ◽  
Term Infants ◽  
Term Neonates ◽  
Risk Of Death ◽  
The Mean ◽  
Ischemic Encephalopathy

Background: Among term infants, hypoxic-ischemic encephalopathy due to acute perinatal asphyxia remains an important cause of neurodevelopmental deficits in childhood. Treatment is currently limited to supportive intensive care, without any specific brain-oriented therapy. Objective: To determine whether the risk of death or moderate/severe neurodevelopmental impairment in term infants with hypoxic-ischemic encephalopathy increases with relatively high skin or rectal temperature between 12 and 72 hours of birth. Materials and Methods: This was a prospective observational study. Asphyxiated newborns who came within 12 hours of birth were enrolled in this study. Both axillary and rectal temperature were recorded 6 hourly for 72 hours and each infant`s temperature for each site were rank ordered. Then mean of all axillary and rectal temperatures of each neonate was calculated. Outcomes were related to temperatures in logistic regression analyses for the elevated/relatively high temperatures and normal/low temperatures group, with adjustment of the level of encephalopathy and gender. Results: The mean axillary temperature was 36.07 ± 6.10C and in 25.71%, 11.92% and 6.32% cases axillary temperatures were >370C, >37.50C and >380C respectively. The mean rectal temperature was 36.8 ± 60C, and in 43.53%, 30.02% and 19.97% cases rectal temperatures were >370C, >37.50C and >380C respectively. Mean ambient temperature was 26.170C. There was significant correlation between axillary and rectal temperatures (r=0.889). For elevated temperature, the odds of death or moderate to severe impairment increased 8.9-fold (CI 0.906–88.18) and the odds of death alone increased 4.6-fold (CI 0.373–56.83). The odds of impairment increased 1.84-fold (CI 0.45– 7.50). Conclusion: Relatively high temperature during usual care after hypoxic-ischemia in term neonates was associated with adverse neurodevelopmental outcomes. J Enam Med Col 2019; 9(3): 160-165

scholarly journals Immunoglobulins in Neonates with Rhesus Hemolytic Disease of the Fetus and Newborn: Long-Term Outcome in a Randomized Trial

2015 ◽  
Vol 39 (3) ◽  
pp. 209-213 ◽  
Author(s):  
Jeanine M.M. van Klink ◽  
Suzanne J. van Veen ◽  
Vivianne E.H.J. Smits-Wintjens ◽  
Irene T.M. Lindenburg ◽  
Monique Rijken ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Placebo Group ◽  
Controlled Trial ◽  
Neurodevelopmental Outcome ◽  
Hemolytic Disease ◽  
Follow Up Study ◽  
Randomized Controlled ◽  
Neurodevelopmental Impairment

Objective: Prophylactic intravenous immunoglobulin (IVIg) does neither reduce the need for exchange transfusion nor the rates of other adverse neonatal outcomes in neonates with rhesus hemolytic disease of the fetus and newborn (rhesus HDFN) according to our randomized controlled trial analysis. Our objective was to assess the long-term neurodevelopmental outcome in the children included in the trial and treated with either IVIg or placebo. Methods: All families of the children included in the trial were asked to participate in this follow-up study. The long-term neurodevelopmental outcome in children at least 2 years of age was assessed using standardized tests. The primary outcome was the incidence of neurodevelopmental impairment defined as at least one of the following: cerebral palsy, severe cognitive and/or motor developmental delay (with a test score of less than -2 SD), bilateral deafness or blindness. Results: Sixty-six of the 80 children (82.5%) who had been recruited to the initial randomized controlled trial participated in the follow-up study. The children were assessed at a median age of 4 years (range 2-7). The median cognitive score was 96 (range 68-118) in the IVIg group and 97 (range 66-118) in the placebo group (p = 0.79). There was no difference in the rate of neurodevelopmental impairment between the IVIg and the placebo group [3% (1/34) vs. 3% (1/32); p = 1.00]. Conclusions: The long-term neurodevelopmental outcome in children treated with IVIg was not different from that in children treated with placebo. Standardized long-term follow-up studies with large enough case series and sufficient power are needed to replicate these findings.

scholarly journals HIGH SYSTEMIC BLOOD PRESSURE IN PRETERM INFANTS WITH BRONCHOPULMONARY DYSPLASIA AND LONG-TERM OUTCOMES

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e20-e20
Author(s):  
Florence Cayouette ◽  
Sarah Spénard ◽  
Anie Lapointe ◽  
Véronique Dorval ◽  
Julie Sommer ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Neurodevelopmental Outcome ◽  
Systemic Blood Pressure ◽  
Control Group ◽  
Neurodevelopmental Outcomes ◽  
Systemic Blood ◽  
Neurodevelopmental Impairment

Abstract BACKGROUND Bronchopulmonary dysplasia (BPD) is a known risk factor for neurodevelopmental impairment in preterm infants. BPD is also associated with an increased incidence of high systemic blood pressure (HBP). However, it is not known if a diagnosis of HBP in BPD patients relates to later neurodevelopmental outcomes. OBJECTIVES We aimed to determine the incidence of neonatal HBP diagnosis in a cohort of preterm infants born <29 weeks of gestational age (GA) with BPD. The secondary objective was to assess if a concomitant diagnosis of BPD and HBP influences neurodevelopmental outcomes at 18 months. DESIGN/METHODS We performed a single center retrospective study using data from medical charts. All infants born <29 weeks GA admitted to our level-IV neonatal intensive care unit between January 2010 and December 2012 diagnosed with BPD at 36 weeks of corrected GA were included. Patients transferred before 36 weeks of corrected GA, that died before 18 months or had congenital anomalies were excluded. Patients were classified in the HBP group if HBP was a documented diagnosis in the chart. The control group was the remaining patients with BPD at 36 weeks corrected GA but without HBP. Severe neurodevelopmental impairment at 18 months was defined as either any Bailey-III score <70, cerebral palsy or severe hearing or visual impairment. Descriptive statistics for prenatal and postnatal patients’ characteristics were analyzed. Logistic regression was performed for factors associated with long-term disability. Level of significance was determined as a p value <0.05. RESULTS During the study period, 337 preterm infants <29 weeks of GA were identified and after exclusions, 98 newborns met the criteria of BPD at 36 weeks corrected GA. Mean GA and mean birth weight were 26.7 ± 1.7 weeks and 882 ± 199 g respectively. The majority were males (57%) and received antenatal steroids (87.8%). We identified twenty-five newborns (25.5%) with a diagnosis of HBP. Demographic data was similar between the 2 groups. 56% of the HBP group received a post-natal course of steroids, compared to 36% for the control group (p 0.07). The neurodevelopmental outcome at 18 months was similar between the two groups (p 0.54) and was not influenced by the presence of a HBP diagnosis after regression analysis (p 0.8). CONCLUSION The diagnosis of HBP was frequent in our cohort of preterm infants born <29 weeks GA with BPD but did not seem to be related to long-term neurodevelopmental outcomes.

scholarly journals Postnatal Serum Total Thyroxine of Very Preterm Infants and Long-Term Neurodevelopmental Outcome

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1055
Author(s):  
Yung-Chieh Lin ◽  
Chen-Yueh Wang ◽  
Yu-Wen Pan ◽  
Yen-Ju Chen ◽  
Wen-Hao Yu ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Congenital Hypothyroidism ◽  
Brain Injuries ◽  
Neurodevelopmental Outcome ◽  
Term Infants ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Total Thyroxine ◽  
Tsh Levels

Primary congenital hypothyroidism is a disease associated with low serum thyroxine and elevated thyroid-stimulating hormone (TSH) levels. The processes of screening and treating congenital hypothyroidism, in order to prevent neurodevelopmental impairment (NDI) in newborns, have been well investigated. Unlike term infants, very preterm infants (VPIs) may experience low thyroxine with normal TSH levels (<10.0 μIU/mL) during long-stay hospitalization. In the current literature, thyroxine treatment has been evaluated only for TSH-elevated VPIs. However, the long-term impact of low thyroxine levels in certain VPIs with normal TSH levels deserves more research. Since July 2007, VPIs of this study unit received screenings at 1 month postnatal age (PNA) for serum TSH levels and total thyroxine (TT4), in addition to two national TSH screenings scheduled at 3–5 days PNA and at term equivalent age. This study aimed to establish the correlation between postnatal 1-month-old TT4 concentration and long-term NDI at 24 months corrected age among VPIs with serial normal TSH levels. VPIs born in August 2007–July 2016 were enrolled. Perinatal demography, hospitalization morbidities, and thyroid function profiles were analyzed, and we excluded those with congenital anomalies, brain injuries, elevated TSH levels, or a history of thyroxine treatments. In total, 334 VPIs were analyzed and 302 (90.4%) VPIs were followed-up. The postnatal TT4 concentration was not associated with NDI after multivariate adjustment (odd ratios 1.131, 95% confidence interval 0.969–1.32). To attribute the NDI of TSH-normal VPIs to a single postnatal TT4 concentration measurement may require more research.

scholarly journals Long-Term Neurodevelopmental Outcome in Survivors of Twin-to-Twin Transfusion Syndrome

2016 ◽  
Vol 19 (3) ◽  
pp. 255-261 ◽  
Author(s):  
Jeanine M. M. van Klink ◽  
Hendrik M. Koopman ◽  
Monique Rijken ◽  
Johanna M. Middeldorp ◽  
Dick Oepkes ◽  
...  
Keyword(s):  
Neurodevelopmental Outcome ◽  
Future Research ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Mortality And Morbidity ◽  
Fetal Period ◽  
Neurodevelopmental Impairment ◽  
Twin Pregnancies

Twin–twin transfusion syndrome (TTTS) is a severe complication of monochorionic (MC) twin pregnancies associated with high perinatal mortality and morbidity rates. Management in TTTS is a major challenge for obstetricians and neonatologists. Twins with TTTS are often born prematurely after an extremely distressing and highly hazardous fetal period. Follow-up studies report varying rates of cerebral palsy (CP) and long-term neurodevelopmental impairment (NDI). This review discusses the latest findings on the long-term outcome of TTTS survivors, possible risk factors for long-term impairment, and provides recommendations for future research.

scholarly journals Early Acute Kidney Injury in Preterm and Term Neonates: Incidence, Outcome, and Associated Clinical Features

Neonatology ◽  
2021 ◽  
pp. 1-6
Author(s):  
Dario Gallo ◽  
Karen A. de Bijl-Marcus ◽  
Thomas Alderliesten ◽  
Marc Lilien ◽  
Floris Groenendaal
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Perinatal Asphyxia ◽  
Neurodevelopmental Outcome ◽  
Birth Asphyxia ◽  
Kidney Injury ◽  
Preterm Neonates ◽  
Term Infants

<b><i>Background:</i></b> Critically ill neonates are at high risk of kidney injury, mainly in the first days of life. Acute kidney injury (AKI) may be underdiagnosed due to lack of a uniform definition. In addition, long-term renal follow-up is limited. <b><i>Objective:</i></b> To describe incidence, etiology, and outcome of neonates developing AKI within the first week after birth in a cohort of NICU-admitted neonates between 2008 and 2018. Renal function at discharge in infants with early AKI was assessed. <b><i>Methods and Subjects:</i></b> AKI was defined as an absolute serum Cr (sCr) value above 1.5 mg/dL (132 μmol/L) after the first 24 h or as stage 2–3 of the NIDDK neonatal definition. Clinical data and outcomes were collected from medical records and retrospectively analyzed. <b><i>Results:</i></b> From January 2008 to December 2018, a total of 9,376 infants were admitted to the NICU of Wilhelmina Children’s Hospital/UMC Utrecht, of whom 139 were diagnosed with AKI during the first week after birth. In 72 term infants, the most common etiology was perinatal asphyxia (72.2%), followed by congenital kidney and urinary tract malformations (CAKUT) (8.3%), congenital heart disease (6.9%), and sepsis (2.8%). Associated conditions in 67 preterm infants were medical treatment of a hemodynamic significant PDA (27.2%), ­CAKUT (21%), and birth asphyxia (19.4%). Among preterm neonates and neonates with perinatal asphyxia, AKI was mainly diagnosed by the sCr &#x3e;1.5 mg/dL criterion. Renal function at discharge improved in 76 neonates with AKI associated with acquired conditions. Neonates with stage 3 AKI showed increased sCr values at discharge. Half of these were caused by congenital kidney malformations and evolved into chronic kidney disease (CKD) later in life. Neurodevelopmental outcome (NDO) at 2 years was favorable in 93% of surviving neonates with detailed follow-up. <b><i>Conclusion:</i></b> During the first week after birth, AKI was seen in 1.5% of infants admitted to a level III NICU. Renal function at discharge had improved in most neonates with acquired AKI but not in infants diagnosed with stage 3 AKI. Long-term renal function needs further exploration, whereas NDO appears to be good.

Booksellers and the Book Trade: John Dunton, Edmund Curll, Grub Street, and the Rise of Bernard Lintot

2017 ◽  
Author(s):  
Margaret J. M. Ezell
Keyword(s):  
Book Trade ◽  
Jonathan Swift ◽  
Alexander Pope

Prolific publishers including John Dunton and Edmund Curll sought to provide inexpensive literary entertainments for their readers with periodicals such as The Athenian Oracle and topical publications. Curll earned the animosity of Jonathan Swift, Alexander Pope, and other poets for his unauthorized publications of their works. In contrast, Bernard Lintot sought to secure the leading literary figures of the day including Pope and his friends for long-term relationships to produce important translations and collections. Other publishers frequently employed ‘hack writers’ such Edward ‘Ned’ Ward and Charles Gildon to produce quick translations, satires, fictions, and miscellanies. Women were involved in Grub Street literary productions also as printers, hawkers, and authors.

scholarly journals Introduction and feeding practices of solid food in preterm infants born in Salzburg!

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Edda Hofstätter ◽  
Verena Köttstorfer ◽  
Patricia Stroicz ◽  
Sebastian Schütz ◽  
Lorenz Auer-Hackenberg ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Preterm Infants ◽  
Complementary Feeding ◽  
Study Group ◽  
Early Weaning ◽  
Structured Interviews ◽  
Term Infants ◽  
The Mean ◽  
The Difference

Abstract Background It is shown that meeting the increased nutritional demand of preterm infants from birth is not only important for survival but essentially contributes to the infants` overall development and long-term health. While there are established guidelines for weaning term infants, evidence regarding preterm infants is scarce and less precise. The aim of this study was to identify the current practices on introducing solids to preterm infants amongst caregivers in Salzburg and determine potential reasons for early weaning. Methods Altogether 68 infants born between 24 0/7 and 36 6/7 weeks were recruited and detailed structured interviews with the caregivers were conducted at 17 weeks corrected age. Weight, height and head circumference were collected. Results 52% of the study group received solids before the recommended 17 weeks corrected age. For this group the mean age being 13.77 ± 1.11 weeks corrected age. Premature introduction of solids significantly correlates with exclusively and early formula-feeding. 34% were weaned due to recommendation by their paediatrician. 23% of the preterm infants even received solids before 12 weeks corrected age, putting them at risks for developing obesity, celiac disease and diabetes. Conclusions This study shows the necessity for clear guidelines regarding the introduction of complementary feeding in preterm infants as well as the importance of their implementation. Caregivers should receive information on this topic early enough and they should fully understand the difference between chronological and corrected age.

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