Premature birth and the microbiome

About one in 10 babies is born prematurely. Most premature births are due either to infection or unknown causes. Recently scientists have started to think that mothers’ microbiomes – the bacteria that live, with no ill effects on and within us – contribute to premature births and in this article Lindsay A. Parnell, from Washington University School of Medicine in St Louis, led a team of researchers looking into this issue. The researchers looked at the latest research on the links between premature birth and the bacteria in mothers’ intestines, vagina, cervixes and placentas and the article describes the most commonly-used ways of analysing people’s microbiomes.

You can read an abstract of this article here.

The value of serum pro-oxidant/antioxidant balance in the assessment of asphyxia in term neonates

Abstract

Objective: Asphyxia is a major cause of disabilities in term-born infants. Here we have explored the value in HIE (hypoxic-ischemic-encephalopathy) of using a combination of serum pro-oxidant/antioxidant balance (PAB) assay for predicting the prognosis of asphyxia.

Method: Ninety term neonates with asphyxia were enrolled and followed up for two years. Serum PAB, demographic/biochemical characteristics of mothers, and their neonates were determined. The Denver II test was used to assess outcomes.

Results: Of the 90 asphyxiated neonates, 47 (52.2%) had a normal outcome and 43 babies (47.8%) had abnormal outcome. Serum PAB levels in neonates with normal and abnormal outcomes were 17.1?±?9.23 and 48.27?±?41.30 HK, respectively. A combination of HIE intensity and PAB, compared to other indicators, had a higher predictive-value (95.2%) for outcomes in asphyxiated babies.

Conclusion: We demonstrate that PAB in combination with HIE grade may have a better predictive value for the prognosis of asphyxiated babies and predicting future neurologic problems in asphyxiated term infants.
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Neonatal haemodynamic effects following foetal exposure to labetalol in hypertensive disorders of pregnancy

Abstract

Objective: Hypertensive disorders of pregnancy (HDP) affect foetal outcome. Labetalol is frequently used to lower maternal blood pressure and prolong pregnancy. Conflicting evidence exists for specific neonatal side effects described after maternal labetalol treatment. Our aim was to investigate neonatal effects of foetal exposure to labetalol on cerebral oxygenation and extraction.

Methods: In a prospective observational study, clinical characteristics, vital parameters and cerebral oxygen delivery and extraction were collected during the first 24?h of life in labetalol-exposed preterm neonates and compared with two control groups.

Results: Twenty-two infants with a mean gestational age of 28.9 weeks, born from labetalol-treated mothers with HDP were included and matched with 22 infants with non-labetalol-treated mothers with HDP and 22 infants without maternal HDP. No significant differences between groups were found neither in heart rate, blood pressure and inotropic support, nor in mean regional cerebral oxygen saturation and fractional tissue oxygen extraction.

Conclusion: Foetal labetalol exposure associated effects on preterm heart rate, blood pressure, cerebral oxygenation and extraction are not demonstrated. Maternal disease severity seems to play a more important role in neonatal cerebral haemodynamics. Maternal labetalol treatment has no clinically important short term side effects in the preterm neonate.

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Cortisol intermediates and hydrocortisone responsiveness in critical neonatal disease

Abstract
Objective: Therapy-resistant hypotension complicates diseases in neonates. Our objective was to investigate whether lack of therapeutic response to plasma expanders and inotropes associates with serum levels of cortisol and its precursors.

Methods: We investigated 96 infants with hypotension and critical neonatal disease for cortisol metabolism and are divided into responders and non-responders to plasma expanders and inotropes. Serum concentrations of steroids were analysed soon after the onset of volume expansion and inotrope treatment for shock. The 48 non-responders were treated with intravenous hydrocortisone (HC) and serum cortisol concentrations were monitored a week later.

Results: The mean cortisol concentrations did not differ between the responders and non-responders: 13.6?±?2.5 and 12.5?±?4.5?µg/dL, respectively. Dehydroepiandrosterone (37.3?±?19.5 versus 324.0?±?106.3; p < 0.0001) and 17-hydroxy-pregnenolone concentrations were lower in responders than in non-responders. Dehydroepiandrosterone levels in non-responders were inversely associated with postnatal age (r?=?0.50, p < 0.0001). There were no differences in 17-hydroxy-progesterone, 11-deoxy-cortisol and cortisone between the responders and non-responders. Hydrocortisone administration acutely increased blood pressure. Six non-responders who died despite HC administration had low levels of cortisol. The responders had normal serum cortisol after HC treatment.

Conclusion: Precursors of cortisol, proximal to the 3ß-hydroxysteroid dehydrogenase activity, accumulated in neonates with hypotension, responding to HC treatment.
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Significance of neutrophilic CD64 as an early marker for detection of neonatal sepsis and prediction of disease outcome

Abstract
Background: Neonatal sepsis (NS) is a global health problem owing to its significant contribution to morbidity and mortality. We evaluated the significance of neutrophilic CD64 (nCD64) expression as an early marker for diagnosis of NS compared to CRP and assessed its relation to disease outcome.

Methods: High sensitivity CRP (hs-CRP) and nCD64 were measured in 60 neonates with symptoms and signs of sepsis (40% were culture-proved) and 30 age- and sex-matched controls.

Results: Baseline hs-CRP and nCD64% were significantly higher among septic neonates compared with the controls (p?<?0.05), while, no significant difference was found between the two septic groups (p?>?0.05). nCD64 cutoff value?>?34.1% was able to discriminate septic neonates from controls with higher sensitivity and specificity than hs-CRP. The mortality rate was 21.7% among septic neonates. Baseline nCD64% was significantly higher among died patients compared with recovered neonates (p?=?0.009) while no significant difference was found between baseline hs-CRP and disease outcome (p?=?0.117).

Conclusion: Flow cytometric assessment of nCD64 was able to discriminate neonates with sepsis from controls with higher accuracy than hs-CRP; however, the combination of both nCD64% and hs-CRP enhances the ability to diagnose NS. Quantitative measurement of nCD64 can predict disease outcome in NS.

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Biomarkers for diagnosis of neonatal sepsis: a literature review

Abstract
Sepsis is an important cause of mortality and morbidity in neonatal populations. There has been constant search of an ideal sepsis biomarker that have high sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), so that both the diagnosis and exclusion of neonatal sepsis can be made at the earliest possible and appropriate antibiotics can be started to neonate. Ideal sepsis biomarker will help in guiding us when not to start antibiotics in case of suspect sepsis and total duration of antibiotics course in case of proven sepsis. There are numerous sepsis biomarkers that have been evaluated for early detection of neonatal sepsis but till date there is no single ideal biomarker that fulfills all essential criteria’s for being an ideal biomarker. The most commonly used biomarkers are C-reactive protein (CRP) and procalcitonin (PCT), but both have shown varied sensitivity, specificity, PPV and NPV in different studies. We conducted literature search for various neonatal sepsis biomarkers and this review article will cover briefly all the markers with current available evidence.

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Assessment of sickness severity of illness in neonates: review of various neonatal illness scoring systems

Abstract
Sickness severity scores are widely used for neonates admitted to neonatal intensive care units to predict severity of illness and risk of mortality and long-term outcome. These scores are also used frequently for quality assessment among various neonatal intensive care unit and hospital. Accurate and reliable measures of severity of illness are required for unbiased and reliable comparisons especially for benchmarking or comparative quality improvement care studies. These scores also serve to control for population differences when performing studies such as clinical trials, outcome evaluations, and evaluation of resource utilisation. Although presently there are multiple scores designed for neonates’ sickness assessment but none of the score is ideal. Each score has its own advantages and disadvantages. We did literature search for identifying all neonatal sickness severity score and in this review article, we discuss these scores along with their merits and demerits.
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