BACKGROUND: Mechanical ventilation induces changes in intrapleural, intrathoracic and intra-abdominal pressure. These changes have various implications on cardiac output (CO). AIMS: The aim of this study was to determine the feasibility of measuring changes in CO after elective extubation in neonates using the principle of transthoracic bioreactance (TBR). STUDY DESIGN: This was a prospective observational cohort study in a level III neonatal centre. CO, stroke volume (SV) and heart rate were measured continuously for 2 h before and 2 h after elective extubation by TBR. SUBJECTS: Neonates undergoing elective extubation were eligible for enrolment. OUTCOME MEASURES: The primary outcome of the study was change in CO post elective extubation. RESULTS: Ten neonates were enrolled, seven (70 %) had a statistically significant decrease in CO after extubation, three (30 %) infants had a statistically significant increase in CO after extubation. Changes in CO were primarily driven by changes in SV and the pattern of change was related to patent ductus arteriosus (PDA) status prior to extubation. CONCLUSION: Extubation significantly influences CO in neonatal patients and the pattern of change appears to be related to PDA status.
OBJECTIVE: Exposure to stress in pregnancy has been shown to affect fetal development with short- and long-term physiological and behavioral consequences for the offspring. Although social support is known to lower perceived stress, no prior study has investigated the buffering role of social support in the context of prenatal stress effects on infant temperament. The aim of this study was to examine interactive effects of prenatal stress and social support on several dimensions of infant temperament at 9 months postpartum. STUDY DESIGN: A total of 272 mothers completed the Perceived Stress Scale and the Perceived Social Support Scale in the 3rd trimester of pregnancy. Infant temperament was assessed by mothers at 9 months postpartum using the Infant Characteristics Questionnaire. Linear regression models were performed to assess the effects of perceived stress, social support, and their interaction on infant temperament. RESULTS: Prenatal stress interacted with social support, such that prenatal stress increased infant unpredictability when social support was below -0.5 SD. CONCLUSIONS: Prenatal stress was found to be a risk factor for infant temperamental unpredictability when combined with low social support perceived by the mother during pregnancy. Support of others, not previously examined in this context, can reduce the impact of prenatal stress.
BACKGROUND: Recently a new continuous non-invasive cardiac output measurement, bioreactance, has become available. Bioreactance measurement of cardiac output has been shown to correlate with left ventricular output detected by echocardiography in healthy term and preterm neonates. AIMS: Our aim was to correlate cardiac output measurements by bioreactance in the first 48 h of life with adverse outcomes attributable to hypoperfusion (peri/intraventricular haemorrhage (PIVH) and/or necrotising enterocolitis (NEC)) in the cohort of extremely preterm infants. STUDY DESIGN: A prospective observational cohort study. SUBJECTS: Preterm infants with birth weight less than 1250 g. OUTCOME MEASURES: Cardiac output was measured between six and 48 h of age by bioreactance. Our primary outcome was a difference in cardiac output between infants with an adverse outcome attributable to hypoperfusion (Group 1), and infants without the predefined adverse outcome (Group 2). RESULTS: There were 39 infants enrolled in the study. There were six infants in Group 1. These infants had a significantly lower minimal cardiac output measurement compared to Group 2 (mean 36.7 ml/kg/min vs 64.5 ml/kg/min, p = .0006). The mean cardiac output in Group 1 was significantly lower on day one of life, followed by a significant increase in cardiac output on day two of life compared to Group 2. CONCLUSIONS: Infants with birth weight less than 1250 g and PIVH and/or NEC had significantly lower cardiac output compared to infants without these complications on day one of life. This low cardiac output was then followed by a significant increase on day two of life.
- MeSH
- elektrokardiografie metody MeSH
- intraventrikulární krvácení do mozku epidemiologie patofyziologie MeSH
- lidé MeSH
- minutový srdeční výdej * MeSH
- nekrotizující enterokolitida epidemiologie patofyziologie MeSH
- novorozenec s velmi nízkou porodní hmotností fyziologie MeSH
- novorozenec MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
BACKGROUND: Neonatal hyperbilirubinemia is a common condition that frequently requires treatment with phototherapy and less commonly by exchange transfusion, especially in preterm infants. It is important to identify and monitor infants at risk of severe unconjugated hyperbilirubinemia early in the postnatal period to instigate appropriate management plans. AIMS: To evaluate transcutaneous bilirubinometry (TCB) as a screening tool at 24 and 48 h of age to predict the need for phototherapy during hospital stay in preterm infants. STUDY DESIGN: A single centre prospective cohort study in a level III perinatal centre. SUBJECTS: Preterm infants (23+0 to 36+6 weeks of gestation) were eligible for enrolment. OUTCOME MEASURES: Primary outcome was to assess the predictive value of TCB at 24 and 48 h of age for the need of phototherapy during hospital stay. RESULTS: A total of 338 preterm infants were enrolled. The majority of infants (98.1%) born below 32 weeks of gestation required phototherapy. For infants born at >31 + 6 weeks of gestation, TCB at 24 h of age ≥81 μmol/l had sensitivity 83%, specificity 56%, positive predictive value (PPV) 54.7% and negative predictive value (NPV) 84%. TCB at 48 h of age ≥145 μmol/l had sensitivity 65%, specificity 62%, PPV 24% and NPV 90%. CONCLUSION: TCB performed poorly at 24 and 48 h of age as a predictor of phototherapy during hospital stay in preterm infants. The negative predictive value of the test at 48 h of age might be helpful for infants born after 31 + 6 weeks of gestation.
- MeSH
- bilirubin krev MeSH
- biochemická analýza krve přístrojové vybavení metody MeSH
- délka pobytu MeSH
- dospělí MeSH
- fototerapie MeSH
- lidé MeSH
- novorozenci extrémně nezralí MeSH
- novorozenec nedonošený MeSH
- novorozenec MeSH
- novorozenecká hyperbilirubinemie diagnóza terapie MeSH
- novorozenecký screening metody MeSH
- prospektivní studie MeSH
- senzitivita a specificita MeSH
- věk matky MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
BACKGROUND: Cerebral oxygenation (crSO2) monitoring is increasingly used in high-risk infants. Monochorionic twins suffer from specific fetal pathologies that can affect cerebral hemodynamics. Limited data are available on crSO2 and blood flow patterns in this population after birth. OBJECTIVE: To evaluate crSO2 changes in preterm monochorionic and dichorionic twins during the first 72 h of life. METHODS: Near-infrared spectroscopy was used to measure crSO2 in 62 infants from 31 twin pregnancies <32 weeks of gestation. The study group was divided into 4 subgroups: donor (1) and recipient (2) monochorionic twins (with twin-twin transfusion syndrome), fetal growth restriction (FGR) infants (3) and twins without fetal compromise (4). RESULTS: There was significant difference in birth weight (p < 0.001) among 4 subgroups. We observed significant variation in crSO2 among the subgroups using mixed model analysis (p < 0.001). The recipient twins exhibited the lowest crSO2 (mean ± SE) throughout the study period (76 ± 0.3%), whereas the FGR and donor twins presented with the highest values (86 ± 0.3% and 83 ± 0.4% respectively). We found no statistically significant differences in neonatal mortality and morbidity among subgroups. CONCLUSION: Our study revealed significant correlation between crSO2 values postnatally and underlying fetal pathology in monochorionic and dichorionic preterm twins.
- MeSH
- blízká infračervená spektroskopie MeSH
- chorion MeSH
- dvojčata dizygotní * MeSH
- fetofetální transfuze etiologie MeSH
- kyslík analýza MeSH
- lidé MeSH
- mozkový krevní oběh * MeSH
- novorozenec nedonošený MeSH
- novorozenec MeSH
- porodní hmotnost MeSH
- prospektivní studie MeSH
- růstová retardace plodu etiologie MeSH
- těhotenství s dvojčaty * MeSH
- těhotenství MeSH
- vývoj plodu MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
BACKGROUND: Maternal characteristics may be associated with human milk macronutrients but no definite conclusions have been made to date. AIM: This study aimed to determine the relationship of maternal-associated factors on the content of macronutrients in human milk for the first six weeks after preterm delivery. STUDY DESIGN: Prospective observational cohort study. SUBJECTS: Milk samples were collected from mothers after premature birth between 24 + 0-35 + 6 weeks. OUTCOME MEASURES: Macronutrients and energy content were analyzed by mid-infrared transmission spectroscopy. Demographic and anthropometric data from mothers were systematically recorded. RESULTS: A total 1.558 human milk samples from 192 mothers were analyzed. Colostrum: higher protein (p = 0.001) and lower carbohydrate content (p = 0.003) were present in primiparous compared to multiparous milk. Vaginal birth was associated with increased carbohydrate content (p = 0.021). Fat and energy content in colostrum was not related to any maternal characteristics. Mature human milk: similarly to colostrum, higher protein content (p = 0.001) and lower carbohydrates content (p = 0.022) were observed in primiparous compared to multiparous milk. The mode of delivery was found to be another factor possibly influencing protein and carbohydrate levels (p = 0.036, p = 0.003, respectively). Pre-pregnancy obesity was associated with increased fat (p = 0.030) and energy content (p = 0.020) in human milk. On the contrary, smoking had a negative relationship to fat and energy content (p = 0.026, p = 0.007, respectively). CONCLUSION: Human milk macronutrient concentration after preterm delivery is associated with pre-pregnancy obesity, parity, mode of delivery and smoking. The impact of maternal factors on human milk composition should be taken into account in a strategy of feeding in premature infants.
- MeSH
- dospělí MeSH
- index tělesné hmotnosti * MeSH
- kouření škodlivé účinky epidemiologie MeSH
- lidé MeSH
- mateřské mléko chemie metabolismus MeSH
- parita * MeSH
- předčasný porod epidemiologie metabolismus MeSH
- těhotenství MeSH
- živiny analýza MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Treatment of the patent ductus arteriosus (PDA) in the preterm infant remains contentious. There are numerous options of the PDA management from early targeted treatment, late (symptomatic) treatment to no treatment at all. AIMS: To evaluate a three different PDA management approaches in very low birth weight (VLBW) infants. STUDY DESIGN: A retrospective observational time series study of three cohorts of VLBW infants born between 2004 and 2011. SUBJECTS: Infants in Symptomatic Treatment Group (STG) were echocardiographically evaluated when clinical signs suggestive of a PDA were present and treated if a haemodynamically significant PDA was confirmed. Early Targeted Group (ETG) underwent echocardiography within the first 48h and infants received ibuprofen if a large PDA was present. Conservative Treatment Group (CTG) was screened by echocardiography on day seven of life; patients with PDA were managed with increased positive end expiratory pressure and fluid restriction as a first line intervention. OUTCOMES: The primary outcome was medical and surgical treatment in the three time periods. Secondary outcomes included mortality, severe periventricular and intraventricular haemorrhage, respiratory distress syndrome and chronic lung disease. RESULTS: There were 138 infants diagnosed with PDA; 52 infants in STG, 52 infants in ETG and 34 infants in CTG. Ibuprofen therapy and ligation were less frequent in CTG. There was significantly decreased incidence of chronic lung disease in CTG compared to STG (18% vs. 51%; p=0.003) and to ETG (18% vs. 46%; p=0.02). There was no difference in the other short term outcomes. CONCLUSION: Conservative treatment of persistent ductus arteriosus in VLBW infants is a feasible option and future randomized trials of conservative management are warranted.
- MeSH
- antiflogistika nesteroidní aplikace a dávkování škodlivé účinky terapeutické užití MeSH
- ibuprofen aplikace a dávkování škodlivé účinky terapeutické užití MeSH
- lidé MeSH
- novorozenec s velmi nízkou porodní hmotností fyziologie MeSH
- novorozenec MeSH
- otevřená tepenná dučej diagnostické zobrazování farmakoterapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
BACKGROUND: Early and late operations of the cleft lip represent exposure to general anesthesia during the first year of life. The early exposure to the anesthetics may influence long term neurological outcome. Timing of the operation may also influence the quality of life as babies with early repair might be accepted better by their families. AIMS: The aim of the study was to compare outcomes between two groups of patients operated on for the cleft lip in the first year of life. STUDY DESIGN: Observational cohort study. SUBJECTS: Early repair group included patients operated on in the first eight days of life and late repair group those operated on between 3 and 10 months. OUTCOME MEASURES: Intelligence quotient (IQ) and psychosocial development of children who were operated on for cleft lip were compared at the age of 3-7 years. RESULTS: No differences were found between early (n=15) and late (n=17) repair group in terms of IQ. In both IQ was within the normal range: 100.00 (SD 13.867), 98.76 (SD 10.109), respectively. Significantly better results in physical functioning (P=0.042) and self-esteem (P=0.014) concepts in early repair group were found. CONCLUSIONS: We compared outcomes of two groups of patients operated on for cleft lip in the first year of life. The earlier anesthesia did not show a negative impact on intelligence quotient in 3-7 years compared to later anesthesia. The earlier repair of the cleft lip showed a significant positive impact on psychosocial development in 2 out of 13 concepts tested.
- MeSH
- celková anestezie škodlivé účinky psychologie MeSH
- inteligence * MeSH
- inteligenční testy MeSH
- kojenec MeSH
- lidé MeSH
- rozštěp patra chirurgie MeSH
- stomatochirurgické výkony škodlivé účinky psychologie MeSH
- věkové faktory MeSH
- vývoj dítěte * MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Toxoplasmosis, a zoonosis caused by a protozoan, Toxoplasma gondii, is probably the most widespread human parasitosis in developed countries. Pregnant women with latent toxoplasmosis have seemingly younger fetuses especially in the 16th week of gestation, which suggests that fetuses of Toxoplasma-infected mothers have slower rates of development in the first trimester of pregnancy. In the present retrospective cohort study, we analyzed data on postnatal motor development of infants from 331 questionnaire respondents including 53 Toxoplasma-infected mothers to search for signs of early postnatal development disorders. During the first year of life, a slower postnatal motor development was observed in infants of mothers with latent toxoplasmosis. These infants significantly later developed the ability to control the head position (p=0.039), to roll from supine to prone position (p=0.022) and were slightly later to begin crawling (p=0.059). Our results are compatible with the hypothesis that the difference in the rates of prenatal and early postnatal development between children of Toxoplasma-negative and Toxoplasma-positive mothers might be caused by a decreased stringency of embryo quality control in partly immunosuppressed Toxoplasma-positive mothers resulting in a higher proportion of infants with genetic or developmental disorders in offspring. However, because of relatively low return rate of questionnaires and an associated risk of a sieve effect, our results should be considered as preliminary and performing a large scale prospective study in the future is critically needed.
- MeSH
- kojenec MeSH
- lidé MeSH
- novorozenec MeSH
- parazitární komplikace těhotenství * MeSH
- pohybová aktivita * MeSH
- průzkumy a dotazníky MeSH
- studie případů a kontrol MeSH
- těhotenství MeSH
- toxoplazmóza * epidemiologie MeSH
- vývoj dítěte * MeSH
- vývoj plodu MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
BACKGROUND AND AIMS: Most diseases in premature neonates are secondary to immaturity of various organ systems. Also the inadequate capacity of mitochondrial energy production may play an important role in the neonatal morbidity. SUBJECTS AND METHODS: The activities and amount of respiratory chain (RC) complexes, pyruvate dehydrogenase (PDH) and citrate synthase (CS) were analysed in isolated muscle mitochondria obtained at autopsy in 19 premature neonates using spectrophotometric and radioenzymatic methods and blue-native electrophoresis and Western blotting. Two groups of children recommended for muscle biopsy at the age of 0.5-2 and 3-18 years served as controls. RESULTS: In premature neonates, the activities of RC complexes III, IV, PDH and CS were markedly lower in comparison with older children. On the contrary, the activity of complex I was higher in premature neonates than in older children. The ratios between RC complexes I, II and III and CS were significantly higher in premature neonates in comparison with older children. In addition, the protein amount of RC complexes and PDH subunits were lower in premature neonates in comparison with older children. CONCLUSION: The results of our study document the age-dependent differences in activities of PDH and respiratory chain complexes in early childhood. Lower functional capacity of mitochondrial energy-providing system in critically ill neonates may be explained by combination of various factors including the delay in maturation of PDH and respiratory chain complexes in very premature neonates and increased degradation of mitochondrial proteins in connection with sepsis, tissue hypoperfusion or hypoxemia.
- MeSH
- citrátsynthasa metabolismus MeSH
- dítě MeSH
- kojenec MeSH
- kosterní svaly cytologie enzymologie fyziologie MeSH
- lidé MeSH
- mladiství MeSH
- následné studie MeSH
- novorozenec nedonošený fyziologie metabolismus MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- pyruvátdehydrogenasový komplex metabolismus MeSH
- respirační komplex III metabolismus MeSH
- respirační komplex IV metabolismus MeSH
- stárnutí metabolismus MeSH
- svalové mitochondrie enzymologie MeSH
- tělesná teplota fyziologie MeSH
- transport elektronů fyziologie MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
