scholarly journals A Study of Histopathological Findings in Neonatal Necrotizing Enterocolitis in Early and Late Term Infants

2021 ◽  
Vol 8 (04) ◽  
pp. 184-189
Author(s):  
Radhika Krishna O.H. ◽  
Mohammed Abdul Aleem ◽  
Mandakini Kotaiah ◽  
Ramesh Reddy Kota
Keyword(s):  
Surgical Resection ◽  
Villous Atrophy ◽  
Pneumatosis Intestinalis ◽  
Term Infants ◽  
Early Presentation ◽  
Term Neonates ◽  
Microscopic Features ◽  
Neonatal Necrotising Enterocolitis ◽  
Neonatal Necrotizing Enterocolitis ◽  
Resected Bowel

BACKGROUND Neonatal necrotising enterocolitis (NNEC) is very common among premature infants. However, its incidence in term babies has also been on the rise. It is a potentially devastating condition with variable mortality. The diagnosis and management of NNEC is clinically supported by modified Bell’s grading. In cases where surgical resection of bowel is performed, histological findings are rarely given much importance. In this study, we have studied the histopathology of resected bowel in NNEC in term babies and correlated these findings with the age of the neonate and also with modified Bell’s grading. METHODS 25 cases of small bowel specimens of term infants received at the pathology department of a tertiary paediatric referral hospital were studied in detail for gross and microscopic features. The histological parameters considered were transmural coagulative necrosis, granulation tissue, crypt distortion, pseudomembrane formation, villous atrophy and pneumatosis intestinalis. These findings were compared with the age of the neonates and also correlated with the modified Bell’s grading. The clinical presentation and histology were also compared in early presenting term neonates less than a week in age and term infants of more than a week. RESULTS We found early neonates of age less than a week to have higher Bell’s grading and more severe histology. CONCLUSIONS Term neonates also present with severe NNEC, requiring surgical resection of the bowel. Early presentation and higher Bell’s grading are associated with more severe histopathological changes. KEYWORDS NNEC, Term Neonates, Bell’s Grading, Histopathology

Low incidence of surgical pathology in infants with bilious vomiting

2021 ◽  
Author(s):  
David Andrew Cummins ◽  
Carl Kuschel
Keyword(s):  
Imaging Study ◽  
Hirschsprung Disease ◽  
Abdominal Distension ◽  
Surgical Pathology ◽  
Term Infants ◽  
Term Neonates ◽  
Bilious Vomiting ◽  
Highly Sensitive ◽  
Abdominal Radiographs ◽  
Low Incidence

Abstract Background: Bilious vomiting in the neonate is an important presenting sign of intestinal obstruction. We conducted a review of the presentation and management of term neonates admitted with bilious vomiting (BV) to determine the incidence of a surgical pathology in our population.  Design: Retrospective cohort study using a prospectively maintained database.  Participants: All term infants admitted to NICU with BV at the Royal Women’s Hospital Melbourne during a 5-calendar year period.  Results: All 153 babies had at least one imaging study. 128 (83.7%) had plain abdominal radiographs. 127 (83%) underwent upper gastrointestinal contrast scan (UGI) and 103 (67.3%) had both. 6 (3.9%) UGI studies were abnormal, with 3 babies (1.9%) subsequently having surgical pathology (2 volvulus, 1 Hirschsprung disease). Only 6 (3.9%) babies in our cohort had a surgical pathology identified (4 Hirschsprung disease, 2 malrotation). Babies with surgical pathology were more likely to present later (median 40 hours versus 23 hours). Abdominal distension was highly sensitive for surgical pathology.  Conclusion: The incidence of surgical pathology in this cohort was low compared to other studies. It is more likely in infants presenting with BV after 24 hours. 

Predictability of transcutaneous bilirubinometry in late preterm and term infants at risk for pathological hyperbilirubinemia

2020 ◽  
pp. 1-7
Author(s):  
E. Dianova ◽  
J. Fogel ◽  
R.P. Verma
Keyword(s):  
At Risk ◽  
Serum Bilirubin Level ◽  
Late Preterm ◽  
Term Infants ◽  
Term Neonates ◽  
Transcutaneous Bilirubin ◽  
Immune Mediated ◽  
Positive Direct ◽  
Neonatal Population ◽  
Transcutaneous Bilirubinometry

BACKGROUND: The aim was to assess the predictability of transcutaneous bilirubinometry in late preterm and term neonates at risk for pathological hyperbilirubinemia, and to identify the neonatal population in which transcutaneous bilirubin most accurately predicts serum bilirubin level (SB, mg/dl). METHODS: The correlations between transcutaneous bilirubin (TCB, mg/dl) and SB in different neonatal population subsets; and between ΔTSB (TCB-SB) and relevant neonatal variables and clinical groups were analyzed. RESULTS: TCB correlated with SB (r = 0.82, p <  0.05) in the cohort (n = 350) and in population subsets (r = 0.81–0.9, p <  0.001). Black infants with gestational age (GA) >35 weeks and chronological age (CA) >3 days recorded strongest correlation (r = 0.9, p <  0.001) followed by Blacks, and non-Black infants with CA >3 days and GA >35 weeks. ΔTSB was positive in Blacks, and in infants with CA <3 days, or with no phototherapy. ΔTSB was negative in non-Blacks, in infants with positive direct Coombs test (DC+) or those receiving phototherapy. Black race [beta (SE) = 1.3(0.33), p <  0.001] had positive, while CA [beta (SE) =−1.74 (0.36), p <  0.001], DC + status [beta (SE) =−0.72 (0.25), p = 0.004] and receipt of phototherapy [beta (SE) =−0.84 (0.21), p <  0.001] each had negative correlation with ΔTSB. ΔTSB for Blacks was >Whites, Hispanics and Asians. CONCLUSION: SB is best predicted by TCB in Black infants with CA over 3 days and GA over 35 weeks. Variability in SB estimation by TCB is race, CA and immune mediated hemolysis specific.

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 Production of granulocyte colony-stimulating factor in vitro by monocytes from preterm and term neonates [see comments]

Blood ◽  
1993 ◽  
Vol 82 (8) ◽  
pp. 2478-2484 ◽  
Author(s):  
KR Schibler ◽  
KW Liechty ◽  
WL White ◽  
RD Christensen
Keyword(s):  
Newborn Infants ◽  
Preterm Neonates ◽  
Granulocyte Colony Stimulating Factor ◽  
Serum Concentrations ◽  
Colony Stimulating Factor ◽  
Term Infants ◽  
Term Neonates ◽  
And Function ◽  
Stimulating Factor

Abstract We postulated that defective generation of granulocyte colony- stimulating factor (G-CSF) by cells of newborn infants might underlie their deficiencies in upregulating neutrophil production and function during bacterial infection. To test this, we isolated monocytes from the blood of preterm neonates, term neonates, and adults and, after stimulation with various concentrations of interleukin-1 alpha (IL-1 alpha) or lipopolysaccharide (LPS), quantified G-CSF concentrations in cell supernatants and G-CSF mRNA in cell lysates. When stimulated with plateau concentrations of IL-1 alpha for 24 hours, G-CSF concentrations were higher in supernatants of adult cells (8,699 +/- 5,529 pg/10(6) monocytes) than in those from term infants (2,557 +/- 442 pg, P < .05) or from preterm infants (879 +/- 348 pg, P < .05 v adults). When stimulated with plateau concentrations of LPS, supernatants of monocytes from preterm neonates had less G-CSF than did those from term neonates or adults. G-CSF mRNA content was low in cells from preterm infants, higher in those from term infants, and highest in those from adults. On the basis of the in vitro studies, we speculated that serum G-CSF concentrations might be less elevated in neutropenic neonates than in neutropenic adults. Indeed, serum concentrations were relatively low in all nonneutropenic subjects; 92 +/- 34 pg/mL (mean +/- SEM) in 10 preterm neonates, 114 +/- 21 pg/mL in 16 term neonates, and 45 +/- 13 pg/mL in 11 healthy adults. Serum concentrations were not elevated in 7 neutropenic neonates (39 +/- 17 pg/mL) but were in 8 neutropenic adults (2101 +/- 942 pg/mL, P < .05 v healthy adults). Other studies suggested that the lower G-CSF production in neonates is not counterbalanced by a heightened sensitivity of G-CSF--responsive progenitors to G-CSF. Therefore, we speculate that newborn infants, particularly those delivered prematurely, generate comparatively low quantities of G-CSF after inflammatory stimulation, and that this might constitute part of the explanation for their defective upregulation of neutrophil production and function during infection.

Thromboelastographic profiles of healthy very low birthweight infants serially during their first month

2019 ◽  
Vol 105 (4) ◽  
pp. 412-418 ◽  
Author(s):  
Genny Raffaeli ◽  
Armando Tripodi ◽  
Giacomo Cavallaro ◽  
Valeria Cortesi ◽  
Erica Scalambrino ◽  
...  
Keyword(s):  
Neonatal Intensive Care ◽  
Low Birthweight ◽  
Maximum Amplitude ◽  
Very Low Birthweight ◽  
Term Infants ◽  
Term Neonates ◽  
Outcomes Measures ◽  
Very Low Birthweight Infants ◽  
Α Angle

ObjectiveWe determined thromboelastographic (TEG) profiles of healthy very low birthweight infants (VLBWIs) of the day of birth and at set intervals during their first month.DesignProspective observational study with blinded clinical and laboratory follow-up.SettingLevel III neonatal intensive care unit (June 2015 to June 2018).PatientsConsecutive qualifying VLBWIs were enrolled at birth and followed up for 30 days.Interventions and main outcomes measuresLaboratory (citrated-native TEG, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, blood count) and clinical variables were retrieved at birth, 3rd–5th, 10th and 30th day of life. Blood samples temporally related to events with a potential hemostatic impact (sepsis, bleeding, platelets/plasma transfusions, ibuprofen/indomethacin administration) were excluded from analysis.ResultsWe enrolled 201 VLBWIs and 72 full-term neonates. Sixty-seven of the healthy VLBWIs completed the 30-day follow-up. 541 TEG traces were analysed.On day 1, the median (minimum–maximum) TEG values were as follows: reaction time (R), 8.2 min (1–21.8); kinetics (K), 2.8 min (0.8–16); α angle, 51° (14.2–80.6); maximum amplitude (MA), 54.9 mm (23.9–76.8). PT and APTT were 15.9 s (11.7–51.2) and 59 s (37.8–97.5), respectively. The above parameters suggest minor hypocoagulability compared with term infants. On day 30, the median (minimum–maximum) R was 5 (1–16.9), K 1 (0.8–4.1), α 74.7 (41.1–86.7) and MA 70.2 (35.8–79.7). PT and APTT were 12.1 (10.4–16.6) and 38.8 (29.6–51.4), respectively. Those parameters are consistent with a relatively hypercoagulable phenotype, compared with term infants.ConclusionsHealthy VLBWIs have a prolonged PT and APTT, but their TEG profiles suggest a relatively balanced hemostatic system, with slight hypocoagulability initially (compared with term neonates), gradually evolving to a somewhat more procoagulant phenotype over the first month.

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

Production of granulocyte colony-stimulating factor in vitro by monocytes from preterm and term neonates [see comments]

Blood ◽  
1993 ◽  
Vol 82 (8) ◽  
pp. 2478-2484 ◽  
Author(s):  
KR Schibler ◽  
KW Liechty ◽  
WL White ◽  
RD Christensen
Keyword(s):  
Newborn Infants ◽  
Preterm Neonates ◽  
Granulocyte Colony Stimulating Factor ◽  
Serum Concentrations ◽  
Colony Stimulating Factor ◽  
Term Infants ◽  
Term Neonates ◽  
And Function ◽  
Stimulating Factor

We postulated that defective generation of granulocyte colony- stimulating factor (G-CSF) by cells of newborn infants might underlie their deficiencies in upregulating neutrophil production and function during bacterial infection. To test this, we isolated monocytes from the blood of preterm neonates, term neonates, and adults and, after stimulation with various concentrations of interleukin-1 alpha (IL-1 alpha) or lipopolysaccharide (LPS), quantified G-CSF concentrations in cell supernatants and G-CSF mRNA in cell lysates. When stimulated with plateau concentrations of IL-1 alpha for 24 hours, G-CSF concentrations were higher in supernatants of adult cells (8,699 +/- 5,529 pg/10(6) monocytes) than in those from term infants (2,557 +/- 442 pg, P < .05) or from preterm infants (879 +/- 348 pg, P < .05 v adults). When stimulated with plateau concentrations of LPS, supernatants of monocytes from preterm neonates had less G-CSF than did those from term neonates or adults. G-CSF mRNA content was low in cells from preterm infants, higher in those from term infants, and highest in those from adults. On the basis of the in vitro studies, we speculated that serum G-CSF concentrations might be less elevated in neutropenic neonates than in neutropenic adults. Indeed, serum concentrations were relatively low in all nonneutropenic subjects; 92 +/- 34 pg/mL (mean +/- SEM) in 10 preterm neonates, 114 +/- 21 pg/mL in 16 term neonates, and 45 +/- 13 pg/mL in 11 healthy adults. Serum concentrations were not elevated in 7 neutropenic neonates (39 +/- 17 pg/mL) but were in 8 neutropenic adults (2101 +/- 942 pg/mL, P < .05 v healthy adults). Other studies suggested that the lower G-CSF production in neonates is not counterbalanced by a heightened sensitivity of G-CSF--responsive progenitors to G-CSF. Therefore, we speculate that newborn infants, particularly those delivered prematurely, generate comparatively low quantities of G-CSF after inflammatory stimulation, and that this might constitute part of the explanation for their defective upregulation of neutrophil production and function during infection.

Light deprivation increases plasma levels of melatonin during the first 72 h of life in human infants

1993 ◽  
Vol 129 (5) ◽  
pp. 442-445 ◽  
Author(s):  
F Jaldo-Alba ◽  
A Muñóz-Hoyos ◽  
A Molina-Carballo ◽  
JA Molina-Font ◽  
D Acuña-Castroviejo
Keyword(s):  
Pineal Gland ◽  
Continuous Light ◽  
Full Term ◽  
Light Deprivation ◽  
Suprachiasmatic Nuclei ◽  
Melatonin Secretion ◽  
Human Infants ◽  
Term Infants ◽  
Term Neonates ◽  
Plasma Bilirubin

The development of rhythmic melatonin secretion in full-term neonates seems to occur at about 12 weeks of age, but activity of the pineal gland from 1 to 12 weeks of age is not well documented. To determine whether the pineal gland actively secretes melatonin and reacts to photoperiodic information during this period, we analyzed 45 full-term infants exposed to continuous artificial light during 24, 48 and 72 h after birth for treatment of hyperbilirubinemia. During this light treatment, the eyes of the neonates were completely covered to avoid damage, thus the infants were under continuous light deprivation. Phototherapy significantly decreased plasma bilirubin during treatment. With regard to pineal gland activity, the shortest period of light deprivation tested, 24 h, significantly increased plasma melatonin levels from 152.66±11.57 to 244.86±19.49 ng/l (mean±sem; p<0.001). The other periods tested, 48 and 72 h of light deprivation, led to similar percentages of melatonin stimulation. These results suggest that the pineal gland of neonates, before displaying rhythmic metabolic activity, is sensitive to changes in environmental illumination, indicating maturity of some features of suprachiasmatic nuclei function.

Cryptococcosis at the University Hospital, Kuala Lumpur

1998 ◽  
Vol 28 (1) ◽  
pp. 34-39 ◽  
Author(s):  
S A R Doi ◽  
C T Tan ◽  
C K Liam ◽  
K Naganathan
Keyword(s):  
Amphotericin B ◽  
Surgical Resection ◽  
Cumulative Dose ◽  
Chest Radiographs ◽  
University Hospital ◽  
Low Grade ◽  
Kuala Lumpur ◽  
Early Presentation ◽  
Intracranial Pressures ◽  
The University

We review our experience with 27 cases of pulmonary and meningeal cryptococcosis at the University Hospital, (Kuala Lumpar, Malaysia) where this is the most common cause of adult meningitis in patients without debilitating illnesses. Of the 27 cases analysed, six presented primarily with pulmonary symptomatology which usually were mainly cough, chest pain and low grade fever. The rest presented with primarily central nervous system (CNS) symptomatology of which headaches and fever were the most consistent symptoms although a third of these patients also had pulmonary lesions noted on chest radiographs. Treatment in all cases was with amphotericin B and 5-fluorocytosine and usually till a total cumulative dose of 1.5 g of amphotericin had been reached (an average of 10 weeks). Primary pulmonary presentations, if symptomatic, were treated as per CNS cryptococcosis due to the high likelihood of CNS dissemination. Incidental pulmonary cryptococcoma found on routine chest radiographs were confirmed by biopsy under ultrasound or fluoroscopy guidance and booked for surgical resection. Death usually occurred early in patients who presented late. Once patients responded to therapy, mortality was usually avoided. The only cause of morbidity in survivors was visual impairment or blindness, and this was attributed mainly to intracranial hypertension with residual deficits determined by the measures taken to lower intracranial pressures. Our experience suggests that: (i) symptomatic patients should have combination therapy with 5-fluorocytosine and amphotericin B till at least a cumulative dose of 1.5 g amphotericin B is reached irrespective of whether they have primary CNS or pulmonary symptomatology; (ii) non-symptomatic pulmonary cryptococcoma could be treated primarily by surgical resection; (iii) visual failure or papilloedema should be treated aggressively; and (iv) prognosis is good with adequate therapy and early presentation.

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