scholarly journals Alternative Cerebral Fuels in the First Five Days in Healthy Term Infants: The Glucose in Well Babies (GLOW) Study

2021 ◽  
Author(s):  
Deborah Harris ◽  
PJ Weston ◽  
JE Harding
Keyword(s):  
New Zealand ◽  
Plasma Lactate ◽  
Term Infants ◽  
Healthy Infants ◽  
Lower Glucose ◽  
Interstitial Glucose ◽  
Acute Hypoglycemia ◽  
Heel Prick ◽  
Beta Hydroxybutyrate ◽  
Clinical Trials Registry

Objectives: To determine plasma lactate and beta-hydroxybutyrate (BHB) concentrations of healthy infants in the first 5 days and their relationships with glucose concentrations. Study design: Prospective masked observational study in Hamilton, New Zealand. Term, appropriately grown singletons had heel-prick blood samples, 4 in the first 24 hours then twice daily. Results: In 67 infants, plasma lactate concentrations were higher in the first 12 hours (median, 20; range, 10-55 mg/dL [median, 2.2 mmol/L; range, 1.1-6.2 mmol/L]), decreasing to 12 mg/dL (range, 7-29 mg/dL [median, 1.4 mmol/L; range, 0.8-3.3 mmol/L]) after 48 hours. Plasma BHB concentrations were low in the first 12 hours (median, 0.9 mg/dL; range, 0.5-5.2 mg/dL [median, 0.1 mmol/L; range, 0.05-0.5 mmol/L]), peaked at 48-72 hours (median, 7.3 mg/dL; range, 1.0-25.0 mg/dL [median, 0.7 mmol/L; range, 0.05-2.4 mmol/L]), and decreased by 96 hours (median, 0.9 mg/dL; range, 0.5-16.7 mg/dL [median, 0.1 mmol/L; range, 0.05-1.6 mmol/L]). Compared with infants with plasma glucose concentrations above the median (median, 67 mg/dL [median, 3.7 mmol/L]), those with lower glucose had lower lactate concentrations in the first 12 hours and higher BHB concentrations between 24 and 96 hours. Lower interstitial glucose concentrations were also associated with higher plasma BHB concentrations, but only if the lower glucose lasted greater than 12 hours. Glucose contributed 72%-84% of the estimated potential adenosine triphosphate throughout the 5 days, with lactate contributing 25% on day 1 and BHB 7% on days 2-3. Conclusions: Lactate on day 1 and BHB on days 2-4 may contribute to cerebral fuels in healthy infants, but are unlikely to provide neuroprotection during early or acute hypoglycemia. Trial registration: The Australian and New Zealand Clinical Trials Registry: ACTRN12615000986572.

scholarly journals Alternative Cerebral Fuels in the First Five Days in Healthy Term Infants: The Glucose in Well Babies (GLOW) Study

2021 ◽  
Author(s):  
Deborah Harris ◽  
PJ Weston ◽  
JE Harding
Keyword(s):  
New Zealand ◽  
Plasma Lactate ◽  
Term Infants ◽  
Healthy Infants ◽  
Lower Glucose ◽  
Interstitial Glucose ◽  
Acute Hypoglycemia ◽  
Heel Prick ◽  
Beta Hydroxybutyrate ◽  
Clinical Trials Registry

Objectives: To determine plasma lactate and beta-hydroxybutyrate (BHB) concentrations of healthy infants in the first 5 days and their relationships with glucose concentrations. Study design: Prospective masked observational study in Hamilton, New Zealand. Term, appropriately grown singletons had heel-prick blood samples, 4 in the first 24 hours then twice daily. Results: In 67 infants, plasma lactate concentrations were higher in the first 12 hours (median, 20; range, 10-55 mg/dL [median, 2.2 mmol/L; range, 1.1-6.2 mmol/L]), decreasing to 12 mg/dL (range, 7-29 mg/dL [median, 1.4 mmol/L; range, 0.8-3.3 mmol/L]) after 48 hours. Plasma BHB concentrations were low in the first 12 hours (median, 0.9 mg/dL; range, 0.5-5.2 mg/dL [median, 0.1 mmol/L; range, 0.05-0.5 mmol/L]), peaked at 48-72 hours (median, 7.3 mg/dL; range, 1.0-25.0 mg/dL [median, 0.7 mmol/L; range, 0.05-2.4 mmol/L]), and decreased by 96 hours (median, 0.9 mg/dL; range, 0.5-16.7 mg/dL [median, 0.1 mmol/L; range, 0.05-1.6 mmol/L]). Compared with infants with plasma glucose concentrations above the median (median, 67 mg/dL [median, 3.7 mmol/L]), those with lower glucose had lower lactate concentrations in the first 12 hours and higher BHB concentrations between 24 and 96 hours. Lower interstitial glucose concentrations were also associated with higher plasma BHB concentrations, but only if the lower glucose lasted greater than 12 hours. Glucose contributed 72%-84% of the estimated potential adenosine triphosphate throughout the 5 days, with lactate contributing 25% on day 1 and BHB 7% on days 2-3. Conclusions: Lactate on day 1 and BHB on days 2-4 may contribute to cerebral fuels in healthy infants, but are unlikely to provide neuroprotection during early or acute hypoglycemia. Trial registration: The Australian and New Zealand Clinical Trials Registry: ACTRN12615000986572.

Renal Injury in Sick Newborn Infants: A Prospective Evaluation Using Urinary β2-Microglobulin Concentrations

PEDIATRICS ◽  
1988 ◽  
Vol 81 (3) ◽  
pp. 432-440
Author(s):  
Eric D. Tack ◽  
Jeffrey M. Perlman ◽  
Alan M. Robson ◽  
Cathy Hausel ◽  
Charles C. T. Chang
Keyword(s):  
Renal Injury ◽  
Confidence Limit ◽  
Newborn Infants ◽  
Tubular Injury ◽  
Creatinine Concentration ◽  
Term Infants ◽  
Urinary Creatinine ◽  
Β2 Microglobulin ◽  
Sick Newborn ◽  
Healthy Infants

Urinary concentrations of β2-microglobulin and creatinine were measured serially in 140 sick infants, of whom 109 were asphyxiated, and in 35 healthy preterm and term infants. First voided urines and samples from days 3 and 7 postpartum were studied. Urinary β2-microglobulin concentrations in healthy infants averaged 1.34 ± 1.34 mg/L (mean ± SD) in first voided specimens and 1.32 ± 0.98 mg/L in day 3 samples; the calculated upper limit of normal (95% confidence limit) was 4.00 mg/L. Elevated values (those exceeding the 95% confidence limit) occurred most often in the sick asphyxiated patients (56%); the first voided sample value in these patients was 10.0 ± 10.4 mg/L. The equivalent value in the sick nonasphyxiated infants was 8.32 ± 7.27 mg/L. Values were significantly and persistently elevated in the sick infants on days 3 and 7. Factoring β2-microglobulin levels by urinary creatinine concentration did not affect the significance of the findings. The increased urinary β2-microglobulin levels were not (1) related to gestational age; low β2-microglobulin values occurred at all gestational ages for both healthy and sick infants; (2) a consequence of urine flow rate; urinary β2-microglobulin did not correlate with urinary creatinine concentration or with urine to plasma creatinine ratio; and (3) a consequence of increased production of β2-microglobulin; urinary and serum β2-microglobulin values did not correlate (r = .03). Thus, we propose that the elevated levels of urinary β2-microglobulin in the sick infants were the consequence of tubular injury. This was associated with hematuria but not with a high incidence of azotemia or oliguria. In the most premature infants (<32 weeks), elevated urinary β2-microglobulin concentrations were associated with significantly increased urinary concentrations of sodium and potassium. These data suggest a higher prevalence of acute tubular injury in sick newborn infants than has been reported in previous studies in which more traditional indices of renal injury were used.

Trials with proxy-reported outcomes registered on the Australian New Zealand Clinical Trials Registry (ANZCTR)

2018 ◽  
Vol 28 (4) ◽  
pp. 955-962 ◽  
Author(s):  
Rebecca Mercieca-Bebber ◽  
◽  
Douglas Williams ◽  
Margaret-Ann Tait ◽  
Claudia Rutherford ◽  
...  
Keyword(s):  
Clinical Trials ◽  
New Zealand ◽  
Clinical Trials Registry

scholarly journals A Randomized Double Blind Controlled Safety Trial Evaluating D-Lactic Acid Production in Healthy Infants Fed a Lactobacillus reuteri-containing Formula

2014 ◽  
Vol 7 ◽  
pp. NMI.S14113 ◽  
Author(s):  
Konstantinos Papagaroufalis ◽  
Aikaterini Fotiou ◽  
Delphine Egli ◽  
Liên-Anh Tran ◽  
Philippe Steenhout
Keyword(s):  
Lactic Acid ◽  
Treatment Effect ◽  
Lactobacillus Reuteri ◽  
Lactic Acid Production ◽  
Fold Increase ◽  
Primary Objective ◽  
Double Blind ◽  
Term Infants ◽  
Healthy Infants ◽  
Colony Forming Units

Background D-Lactic acidosis in infants fed lactic acid bacteria-containing products is a concern. Methods The primary objective of this non-inferiority trial was to compare urinary D-lactic acid concentrations during the first 28 days of life in infants fed formula containing Lactobacillus reuteri (1.2 x 106 colony forming units (CFU)/ml) with those fed a control formula. The non-inferiority margin was set at a two-fold increase in D-lactic acid (0.7 mmol/mol creatinine, log-transformed). Healthy term infants in Greece were enrolled between birth and 72 hours of age, and block randomized to a probiotic ( N = 44) or control ( N = 44) group. They were exclusively fed their formulae until 28 days of age and followed up at 7, 14, 28, 112, and 168 ± 3 days. Anthropometric measurements were taken at each visit and tolerance recorded until 112 days. Urine was collected before study formula intake and at all visits up to 112 days and blood at 14 days. Results D-Lactic acid concentration in the probiotic group was below the non-inferiority margin at 28 days: treatment effect -0.03 (95% confidence interval [CI]: [-0.48 to 0.41]) mmol/mol creatinine but was above the non-inferiority margin at 7 and 14 days–-treatment effect 0.50 (95% CI: [0.05-0.96]) mmol/mol creatinine and 0.45 (95% CI: [0.00-0.90]) mmol/mol creatinine, respectively. Blood acid excess and pH, anthropometry, tolerance, and adverse events (AEs) were not significantly different between groups. Conclusion Intake of L. reuteri-containing formula was safe and did not cause an increase in D-lactic acid beyond two weeks. Trial Registration ClinicalTrials.gov NCT01119170.

scholarly journals External validation of postnatal gestational age estimation using newborn metabolic profiles in Matlab, Bangladesh

eLife ◽  
2019 ◽  
Vol 8 ◽  
Author(s):  
Malia SQ Murphy ◽  
Steven Hawken ◽  
Wei Cheng ◽  
Lindsay A Wilson ◽  
Monica Lamoureux ◽  
...  
Keyword(s):  
Cord Blood ◽  
Gestational Age ◽  
Age Estimation ◽  
External Validation ◽  
Population Level ◽  
Average Deviation ◽  
Term Infants ◽  
Data Set ◽  
Heel Prick ◽  
Gestational Age Estimation

This study sought to evaluate the performance of metabolic gestational age estimation models developed in Ontario, Canada in infants born in Bangladesh. Cord and heel prick blood spots were collected in Bangladesh and analyzed at a newborn screening facility in Ottawa, Canada. Algorithm-derived estimates of gestational age and preterm birth were compared to ultrasound-validated estimates. 1036 cord blood and 487 heel prick samples were collected from 1069 unique newborns. The majority of samples (93.2% of heel prick and 89.9% of cord blood) were collected from term infants. When applied to heel prick data, algorithms correctly estimated gestational age to within an average deviation of 1 week overall (root mean square error = 1.07 weeks). Metabolic gestational age estimation provides accurate population-level estimates of gestational age in this data set. Models were effective on data obtained from both heel prick and cord blood, the latter being a more feasible option in low-resource settings.

Apnea Recordings of Healthy Infants at 40, 44, and 52 Weeks Postconception

PEDIATRICS ◽  
1979 ◽  
Vol 63 (5) ◽  
pp. 724-730
Author(s):  
Israel M. Stein ◽  
Ann White ◽  
Joseph L. Kennedy ◽  
Roberta L. Merisalo ◽  
Harvey Chernoff ◽  
...  
Keyword(s):  
Home Environment ◽  
Respiratory Activity ◽  
Full Term ◽  
Impedance Method ◽  
Term Infants ◽  
Healthy Infants ◽  
Marked Variability ◽  
Highly Correlated

A total of 129 recordings of the respiratory activity of 46 normal full-term infants were obtained continuously for 24 hours in the hospital nursery at 3 days of life and in the home environment at 4 weeks and 12 weeks after birth. The pediatric pneumogram (PPG) technique, an impedance method, was used. Pneumogram data over longer than 16 hours was obtained on 77% of infants monitored. No infants experienced apnea longer than 15 seconds in duration at 40 and 44 weeks postconception. or greater than 11 seconds at 52 weeks postconception. Twenty-four hour plots of hourly apnea frequency revealed a marked variability, with evidence of clustering of apneic episodes during periods of reported sleep. Longest apnea time and hourly frequency of apneic episodes were highly correlated.

Influence of Early Lactation Assistance on Inpatient Exclusive Breastfeeding Rates

2020 ◽  
pp. 089033442095796
Author(s):  
Keyaria D. Gray ◽  
Emily A. Hannon ◽  
Elizabeth Erickson ◽  
Ariana B. Stewart ◽  
Charles T. Wood ◽  
...  
Keyword(s):  
Human Milk ◽  
Private Insurance ◽  
Feeding Preference ◽  
Feeding Rates ◽  
Term Infants ◽  
Lactation Consultant ◽  
Childhood Illnesses ◽  
Healthy Infants ◽  
Birth Hospitalization ◽  
Milk Feeding

Background Human milk feeding reduces the incidence and costs of several maternal and childhood illnesses. Initiation and success of human milk feeding are influenced by race, socioeconomic status, and family support. The influence of early in-hospital lactation assistance in breastfeeding success has been not well described. Research aims We aimed to determine how suspected known factors influencing breastfeeding success influence in-hospital human milk feeding rates. Second, we aimed to examine how timing of lactation assistance is related to success of human milk feeding during the newborn hospitalization for healthy infants. Methods We conducted a retrospective cohort study of term infants born between January 1, 2014 and December 31, 2016 at a large tertiary academic hospital. We considered “success” to be 100% human milk feeding during the birth hospitalization, and compared differences in success by demographics, payor, race, and initial feeding preference. Influences of lactation assistance on success were analyzed using multivariable logistic regression. Results Mean success with exclusive human milk feeding among 7,370 infants was 48.9%, ( n = 3,601). Successful participants were more likely to be 39–40 weeks’ gestation (64.9%, n = 2,340), non-Hispanic/non-Latino (80.0%, n = 2,882), and using private insurance (69.2%, n = 2,491). Participants who had early feeding assisted by an International Board Certified Lactation Consultant (IBCLC) before being fed any formula were more likely to be successful than participants who had a feeding assisted by a non-IBCLC nurse (80% vs. 40% respectively). Conclusions Success for exclusive human milk feeding during newborn hospitalization is strongly associated with several factors. Early intervention with IBCLCs can greatly improve breastfeeding success.

scholarly journals Docosahexaenoic Acid and Neurodevelopmental Outcomes of Term Infants

2016 ◽  
Vol 69 (Suppl. 1) ◽  
pp. 22-28 ◽  
Author(s):  
Suzanne Meldrum ◽  
Karen Simmer
Keyword(s):  
Docosahexaenoic Acid ◽  
Observational Studies ◽  
Chain Polyunsaturated Fatty Acid ◽  
Normal Brain ◽  
Healthy Children ◽  
Neurodevelopmental Outcomes ◽  
Term Infants ◽  
Lactating Women ◽  
Healthy Infants ◽  
Normal Brain Development

Docosahexaenoic acid (DHA), a long-chain polyunsaturated fatty acid, is essential for normal brain development. DHA is found predominantly in seafood, fish oil, breastmilk and supplemented formula. DHA intake in Western countries is often below recommendations. Observational studies have demonstrated an association between DHA intake in pregnancy and neurodevelopment of offspring but cannot fully adjust for confounding factors that influence child development. Randomised clinical trials of DHA supplementation during pregnancy and/or lactation, and of term infants, have not shown a consistent benefit nor harm on neurodevelopment of healthy children born at term. The evidence does not support DHA supplementation of healthy pregnant and lactating women, nor healthy infants.

Effects of sleep deprivation on respiratory events during sleep in healthy infants

1989 ◽  
Vol 66 (3) ◽  
pp. 1158-1163 ◽  
Author(s):  
E. Canet ◽  
C. Gaultier ◽  
A. M. D'Allest ◽  
M. Dehan
Keyword(s):  
Sleep Deprivation ◽  
Total Duration ◽  
Periodic Breathing ◽  
Central Apnea ◽  
Quiet Sleep ◽  
Term Infants ◽  
Event Time ◽  
Respiratory Events ◽  
Healthy Infants ◽  
Respiratory Event

This study was designed to determine the effects of sleep deprivation on respiratory events during sleep in healthy infants. Ten unsedated full-term infants (1–6 mo) were monitored polygraphically during “afternoon naps” on a control day and on the day after sleep deprivation. Respiratory events, i.e., central apnea, obstructive apnea and hypopnea, and periodic breathing were tabulated. Results for respiratory events were expressed as 1) indexes of the total number of respiratory events and of specific respiratory events per hour of total sleep (TST), “quiet” sleep (QS) and “active” sleep (AS) times; 2) total duration of total and specific respiratory events, expressed as a percentage of TST, QS, and AS times. After sleep deprivation, significant increases were observed for 1) respiratory event (P less than 0.001), central apnea (P less than 0.05), and obstructive respiratory event (P less than 0.01) indexes; 2) respiratory event time as a percentage of TST (P less than 0.002) and as a percentage of AS time (P less than 0.001); 3) obstructive respiratory event time as a percentage of TST (P less than 0.01), QS (P less than 0.05), and AS times (P less than 0.002). The present study shows that short-term sleep deprivation in healthy infants increases the number and timing of respiratory events, especially obstructive events in AS.

A tRial Evaluating Mid Cut-Off Value Membrane Clearance of Albumin and Light Chains in HemoDialysis Patients: A Safety Device Study

2020 ◽  
Vol 49 (4) ◽  
pp. 468-478 ◽  
Author(s):  
Rathika Krishnasamy ◽  
Carmel M. Hawley ◽  
Meg J. Jardine ◽  
Matthew A. Roberts ◽  
Yeoungjee Cho ◽  
...  
Keyword(s):  
Quality Of Life ◽  
New Zealand ◽  
Serum Albumin ◽  
Hemodialysis Patients ◽  
Significant Loss ◽  
Light Chains ◽  
High Flux ◽  
Restless Legs ◽  
Clinical Trials Registry

Background: A new class of dialysis membrane, the mid cut-off (MCO) dialyzer, has been developed to improve the clearance of uremic toxins in hemodialysis (HD). The a tRial Evaluating Mid cut-Off Value membrane clearance of Albumin and Light chains in HemoDialysis patients (REMOVAL-HD) study aimed to determine if regular use of MCO dialyzer was safe and specifically did not result in a significant loss of albumin. Methods: This investigator initiated, crossover, longitudinal, device study was conducted across 9 centers in Australia and New Zealand (n = 89). Participants had a 4-week wash-in with high-flux HD, followed by 24-week intervention with MCO HD and a subsequent 4-week wash-out with high-flux HD. The primary outcome was change in serum albumin between weeks 4 and 28. Secondary outcomes included trends in serum albumin, changes in kappa- and lambda-free light chains (FLC), 6-min walk test (6MWT), malnutrition inflammation score (MIS), restless legs score and quality of life. Results: Participants had a mean age of 66 ± 14 years, 62% were men, 45% were anuric, and 51% had ­diabetes. There was no reduction in serum albumin following treatment with MCO HD (mean reduction –0.7 g/L, 95% CI –1.5 to 0.1). A sustained, unexplained reduction in serum albumin (>25%) was not observed in any participant. A reduction in FLC was observed 2 weeks into MCO HD (lambda-FLC: Δ –9.1 mg/L, 95% CI –14.4 to –3.7; kappa-FLC: Δ –5.7 mg/L, 95% CI –9.8 to –1.6) and was sustained for the rest of the study intervention. Both FLC increased after the cessation of MCO use. There was no improvement in restless legs symptoms, quality of life, 6MWT or MIS scores. Conclusions: Regular HD using the MCO dialyzer did not result in a significant fall in serum albumin. There were no effects on quality of life, functional status or nutrition. Trial Registration: Australian New Zealand Clinical Trials Registry Number (ANZCTRN) 12616000804482.

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