Oxidative stress and free radicals related diseases of the newborn

Free radicals (FRs) generation is an unavoidable consequence of the life in an oxygen-rich atmosphere. FRs can be considered a double-edged sword. Beneficial effects of FRs occur at moderate concentrations and involve physiological roles in cellular responses to noxia, as in defense against infectious agents, in the function of a number of cellular signaling pathways and the induction of a mitogenic response. The over-production of FRs and the insufficiency of an antioxidant mechanism result in oxidative stress (OS), a deleterious process and important mediator of damage to cell structures and tissues. It occurs at birth in all newborns as a consequence of the hyperoxic challenge after the transition from the hypoxic intrauterine environment to extrauterine life. During the perinatal period, OS can be magnified by others predisposing conditions such as hyperoxia, hypoxia, ischemia, hypoxia-reperfusion, inflammation and high levels of non-protein bound iron. Epidemiological studies linked OS occurring during fetal stages and early infancy with adverse health outcomes later in life, indicating that OS is an early event in the etiology of these chronic diseases. Newborns, especially if preterm, are particularly susceptible to OS and damage due to the increased generation of FRs, the lack of adequate antioxidant protection, and the inability to induce antioxidant defenses during the hyperoxic challenge at birth. This impairment of the oxidative balance has been thought to be the common factor of pathologies grouped together as “free radical disease in the neonate” that include retinopathy of prematurity (which may lead to blindness in severe cases), bronchopulmonary dysplasia (a particularly debilitating pulmonary lesion of the preterm infant), periventricular leukomalacia (an important cause of severe neurodisability) and necrotizing enterocolitis. In this review we discuss in detail these perinatal diseases. Particularly, we analyze the current knowledge about the role of OS in their pathogenesis.

STUDY ON THE GROWTH OF CEREBELLUMIN NEWBORN INFANTS

Objective To know the growth of the cerebellum in newborn infants. Methods The centraivermian area (CVA) of the cerebellum was measured by head ultrasonography in 90 newborns including 65full - terms, 14 preterms and 11 small for gestational age infants (SGA). Results The average age of the newborninfants were 4.7d (3~7d). The mean CVA in full-terms was 5.81±0.8cm2, which was significantly greater thanthat in preterms (3.7±1.0cm2), and SGA (5.1±0.8cm2), respectively. However, when corrected for birth weight(BW), the ratio of CVA/BW in term SGA was 2.07, being signoficantly higher than the ratio of 1.72 in normalfull- term newborns. There was no dillerence between male and female infants. Statistically significantrelationships were lound between CVA and BW (r=0.8129, P<0.01) and between CVA and gestational age(r=0.7450, P<0.01). Conclusion The study provide some understanding on the grouth of the cerebellum, and thecerebellar measurement by cranial ultrasound is helpful for the assessment of neurological maturation in newborninfants.

The Distribution and Morphological Diversity of GABA-containing Neurons in The Prefrontal Cortex of Human Newborn Baby Infant

The prefrontal cortex of a human full termnewborn infant just after accidental death was studies by mcans of immunocytochemical technique with antibody directedagainst GABA(Immunonuclear Corp.)and ABC kit(Vector)。GABA-containing neurons were found over all layers and all were nonpyramidal cells.The laminar distribution of GABA-containing ne-urons was not even between different layers,density in laye Ⅱ was prominently higher than any other layers,density in layer Ⅲ and layer Ⅳ was higher than that in layer V and Ⅵ.

Assessment of Awareness and Understanding of Hemolytic Disease of the Fetus and Newborn in the Beninese Population

Background: Hemolytic Disease of the Fetus and Newborn (HDFN) arises from blood group incompatibility, especially the RhD antigen. In Benin, systematic ABO RhD blood grouping is poorly understood by many midwives and nurses. Nearly one in ten women risk having children with HDFN. This study aimed to determine the level of knowledge of the Beninese population on HDFN. Methods: Data were collected from June 2023 to March 2024. Participants completed a Kobotoolbox questionnaire on WhatsApp, with in-person assistance for illiterate participants. The study involved 521 participants from across Benin. Data were analyzed using SigmaPlot version 14.0. Results: Among the 521 participants, 298 were women (57.20%) aged 18 to 77 years. The majority (40.69%) were aged 26 - 35. Over a third (35.51%) did not know their RhD blood group. Most (59.12%) were unaware of the risks for RhD discordant couples. Among those with a partner, 25.16% were in at-risk couples for HDFN, and over half (59.12%) were unaware of this risk. There was no significant association between being in a high-risk union and knowledge of the risk or education level. Conclusion: Only 40.88% of the Beninese population are aware of HDFN, indicating a low level of knowledge.

A multicenter prospective study of next-generation sequencing-based newborn screening for monogenic genetic diseases in China

Background Newborn screening(NBS)is an important and successful public health program that helps improve the long-term clinical outcomes of newborns by providing early diagnosis and treatment of certain inborn diseases.The develop-ment of next-generation sequencing(NGS)technology provides new opportunities to expand current newborn screening methodologies.Methods We designed a a newborn genetic screening(NBGS)panel targeting 135 genes associated with 75 inborn disorders by multiplex PCR combined with NGS.With this panel,a large-scale,multicenter,prospective multidisease analysis was conducted on dried blood spot(DBS)profiles from 21,442 neonates nationwide.Results We presented the positive detection rate and carrier frequency of diseases and related variants in different regions;and 168(0.78%)positive cases were detected.Glucose-6-Phosphate Dehydrogenase deficiency(G6PDD)and phenylketonuria(PKU)had higher prevalence rates,which were significantly different in different regions.The positive detection of G6PD variants was quite common in south China,whereas PAH variants were most commonly identified in north China.In addi-tion,NBGS identified 3 cases with DUOX2 variants and one with SLC25A13 variants,which were normal in conventional NBS,but were confirmed later as abnormal in repeated biochemical testing after recall.Eighty percent of high-frequency gene carriers and 60%of high-frequency variant carriers had obvious regional differences.On the premise that there was no significant difference in birth weight and gestational age,the biochemical indicators of SLC22A5 c.1400C>G and ACADSB c.1165A>G carriers were significantly different from those of non-carriers.Conclusions We demonstrated that NBGS is an effective strategy to identify neonates affected with treatable diseases as a supplement to current NBS methods.Our data also showed that the prevalence of diseases has significant regional charac-teristics,which provides a theoretical basis for screening diseases in different regions.

“AFGP” bundles for an extremely preterm infant who underwent difficult removal of a peripherally inserted central catheter:A case report

BACKGROUND There have been few reports on level 3 difficult removal of peripherally inserted central catheter(PICC)in neonates.Here,we reported a case of an extremely preterm infant who underwent level 3 difficult removal of a PICC.CASE SUMMARY Female baby A,weighing 1070 g at 27^(+1) wk of gestational age,was diagnosed with extremely preterm infant and neonatal respiratory distress syndrome.She underwent PICC insertion twice.The first PICC insertion went well;the second PICC was inserted in the right lower extremity,however,phlebitis occurred on the second day after the placement.On the third day of catheterization,phlebitis was aggravated,while the right leg circumference increased by 2.5 cm.On the fourth day of catheterization,more red swelling was found in the popliteal part,covering an area of about 1.5 cm×4 cm,which was diagnosed as phlebitis level 3;thus,we decided to remove the PICC.During tube removal,the catheter rebounded and could not be pulled out(several conventional methods were performed).Finally,we successfully removed the PICC using a new approach termed“AFGP”.On the 36th day of admission,the baby fully recovered and was discharged.CONCLUSION The“AFGP”bundle approach was effective for an extremely preterm infant,who underwent level 3 difficult removal of a PICC.

Investigation of regurgitation and other symptoms of gastroesophageal reflux in Indonesian infants

AIM:To evaluate the incidence of regurgitation and other symptoms of gastroesophageal reflux in Indonesian infants. METHODS:In a cross-sectional study at the University Outpatient Clinic for vaccination in Jakarta,138 mothers of healthy infants less than 12-mo old were prospectively asked to report the frequency of regurgitation. RESULTS:Whatever the age was,some infants did not regurgitate(from 10% during the first month of life to 67% in 1-year-old infants).Regurgitation of at least once a day was reported in 77% of infants younger than 3 too.Daily regurgitation decreased to 12% in the 9-12 mo old group. Reported peak prevalence was 81%(26/32)during the first month of life.Regurgitation decreased sharply between the 4-6 and 7-9 mo old groups(from 44% to 9%).The longer the regurgitation persisted,the more frequently the mother perceived regurgitation as a problem.Volume and frequency of regurgitation,back arching,irritability,crying and refusal of feeding were the symptoms causing maternal anxiety.The longer the regurgitation persisted,the more frequently the mothers viewed it as a health problem. CONCLUSION:Regurgitation occurs frequently in Indonesian infants,and is a frequent cause of concern to mothers.

Cardiac changes in infants of diabetic mothers

Diabetes mellitus(DM)is a systemic chronic metabolic disorder characterized by increased insulin resistance and/orβ-cell defects.It affects all ages from the foetal life,neonates,childhood to late adulthood.Gestational diabetes is a critical risk factor for congenital heart diseases(CHDs).Moreover,the risk increases with low maternal education,high body mass index at conception,undiagnosed pregestational diabetes,inadequate antenatal care,improper diabetes control,and maternal smoking during pregnancy.Maternal DM significantly affects the foetal heart and foetal-placental circulation in both structure and function.Cardiac defects,myocardial hypertrophy are three times more prevalent in infants of diabetic mothers(IDMs).Antenatal evaluation of the cardiac function and structures can be performed with foetal electrocardiography and echocardiography.Postnatal cardiac evaluation can be performed with natal and postnatal electrocardiography and echocardiography,detection of early atherosclerotic changes by measuring aortic intima-media thickness,and retinal vascular changes by retinal photography.Ameliorating the effects of diabetes during pregnancy on the offspring depends mainly on pregestational and gestational diabetes prevention.However,other measures to reduce the risk,such as using medications,nutritional supplements,or probiotics,still need more research.This review discusses the mechanism of foetal sequels and the risk factors that increase the prevalence of CHDs in gestational DM,the various cardiac outcomes of gestational DM on the foetus and offspring,cardiac evaluation of foetuses and IDMs,and how to alleviate the consequences of gestational DM on the offspring.

Lipid infusion and intravenous access in newborn infants

The spectacular development of neonatal intensive care since the 1960s allowed a drop in neonatal mortality of very-low-birth-weight （VLBW） infants from 50% to less than 15% in the last decade.

Effect of caffeine in the intraventricular hemorrhage of the preterm newborn

There are around 15 million preterm newborns(PT) eve ry year(Atienza-Navarro et al., 2020).With these figures in mind,prematurity represents a major health problem worldwide and it is a leading cause of infant mortality,accounting for up to 35%of all deaths among newborns(Atienza-Navarro et al.,2020) and up to 18% of the deaths among children under 5 years of age.

Rh-incompatible hemolytic disease of the newborn in Hefei

BACKGROUND Anti-D antibody is not the common cause of Rh-isoimmunization in Chinese neonatal jaundice.Recent change in national population policy has followed by an increase in Rh-isoimmunization related hemolytic disease of the newborn(HDN).Unfortunately,regional status of Rh-HDN is unavailable.We hypothesize that Rh-HDN in our region is most commonly due to anti-E antibody.AIM To investigate the prevalence of hemolytic disease of the newborn due to Rhisoimmunization in Hefei City.METHODS Retrospective review of data obtained from Children’s Hospital of Anhui and Hefei Blood Center between January 2017 and June 2019.Status of minor blood group antibody was studied in the corresponding mothers.RESULTS Totally 4138 newborns with HDN admitted during the study period and 116(2.8%)received blood exchange transfusion(BET).Eighteen newborns(0.43%)with proven Rh-incompatible HDN were identified.All were not the first-born baby.Thirteen mothers were RhD(+)(72%)and five were RhD(-).The distribution of Rh-related antibodies in mothers was ten anti-E(55%),five anti-D(27%),and for one anti-C,anti-c,and anti-E/c(6%)each.Thirteen(72.2%)were qualified for BET,relative risk for BET was 28.9 as compared to other types of HDN,but only 10 received due to parenteral refusal.All(100%)RhD related HDN received BET which is not significantly different from RhE related HDN(81.8%).CONCLUSION As expected,all Rh-incompatible HDN newborns were not the first-born.Contrary to the Caucasian population,anti-D induced HDN is not the most common etiology.In our region,anti-E(11/18,61%)is the most common cause of Rh-HDN.

Beyond the Pediatric end-stage liver disease system: Solutions for infants with biliary atresia requiring liver transplant

Biliary atresia(BA), a chronic progressive cholestatic disease of infants, is the leading cause for liver transplant in children, especially in patients under two years of age. BA can be successfully treated with the Kasai portoenterostomy; however most patients still require a liver transplant, with up to one half of BA children needing a transplant by age two. In the current pediatric end-stage liver disease system, children with BA face the risk of not receiving a liver in a safe and timely manner. In this review, we discuss a number of possible solutions to help these children. We focus on two general approaches:(1) preventing/delaying need for transplantation, by optimizing the success of the Kasai operation; and(2) expediting transplantation when needed, by performing techniques other than the standard deceased-donor, whole, ABO-matched organ transplant.

Experience of Clinical Management for Pregnant Women and Newborns with Novel Coronavirus Pneumonia in Tongji Hospital,China

Based on the New Diagnosis and Treatment Scheme for Novel Coronavirus Infected Pneumonia(Trial Edition 5),combined with our current clinical treatment experience,we recently proposed a revision of the first edition of“Guidance for maternal and fctal management during pneumonia epidemics of novel coronavirus infection in the Wuhan Tongji Hospital".This article focused on the issues of greatest concern of pregnant women including severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection diagnostic criteria,inspection precautions,drug treatment options,indications and methods of termination of pregnancy,postpartum fever,breastfeeding considerations,mode of mother-to-child transmission,neonatal isolation and advice on nconatal nursing,to provide valuable experience for better management of SARS-CoV-2 infection in pregnant women and newborns.

Prevalence and outcome of acute kidney injury,as defined by the new Kidney Disease Improving Global Outcomes guideline,in very low birth weight infants

AIMTo evaluate the prevalence, risk factors and outcome of acute kidney injury （AKI） in very low birth weight （VLBW） infants. METHODSIn this retrospective study of VLBW infants, we analyzed the prevalence of AKI, as defined by changes in serum creatinine and urine output, associated risk factors and outcomes.RESULTSA total of 293 VLBW infants （mean gestational age 28.7 wk） were included, of whom 109 weighed less than 1000 g at birth. The overall prevalence of AKI was 11.6% （22% in infants with a birth weight under 1000 g and 5.4% those heavier）. A total of 19 （55%） affected infants died, with a mortality rate of 58% in infant less than 1000 g and 50% in those heavier. After adjusting for confounding variables, only necrotizing enterocolitis （NEC） remained associated with AKI, with odds ratio of 4.9 （95%CI： 1.9-18.6）. Blood pressure and glomerular filtration rate （GFR） were not different between affected infants and the others upon discharge from hospital. A normal GFR was documented in all affected infants at one year of age.CONCLUSION Using Kidney Disease Improving Global Outcomes defnition of AKI, it occurred in over 10% of VLBW infants, more commonly in infants with lower birth weight. NEC was an independent associated risk factor. Renal function, as defined by GFR, was normal in all surviving affected infants 10 to 12 mo later.

A CASE OF HEMOLYTIC DISEASE OF THE NEWBORN CAUSED BY ANTI-HRO AND ANTI-E

A Chinese woman of blood group B,D-and her husband of blood group AB,CCDeewere examined.The woman had not been transfused before.Their first two babiesdied.Anti-Hro and anti-e were found in the mother’s serum.During her third pregnancy,the titer of antibodies went up quickly,approximately one titer per month.After 36 weeksof pregnancy,the baby was delivered by Caesarean section.The cord blood Hb was 88g/L,his red blood cell count 2.7×1012/L,and total biIirubin 114.6 mol/L.The baby was ofblood group AB,and CDe-D-genotype.Exchangetransfusion was begun 2.5 hours afterbirth.O,ccDEE washed red cells together with group AB plasma were used.Two dayslater,7Oml washed O,ccDEE concentrated red cells were administered.The baby is aliveand in good health.

Study on the Effects of Infant Fostering Interventions in Xuhui District,Shanghai

Objective To assess the effects of fostering interventions on the infants and their families through the community. Methods A total of 309 infants born on 1st August, 2003 to 30th August, 2004 and their families were recruited as participants by cluster sampling in Longhua and Kantian sub-districts of Xuhui district, Shanghai. The newborns were randomly assigned to intervention group （156 cases） and control group （153 cases）. The infants and their families will be followed up during 3-year interventions. Results After 6 months＇ intervention, the proportion of infants who could turn over the body in the intervention group （88.46%） was higher than that in control group （75.16%）. The morbidity of upper-respiratory tract infection in intervention group （20.51%） was significantly lower than that in control group （32.68%）. The incidence rates of pneumonia, diarrhea and anemia in intervention group were all lower than that in control group, except for pneumonia, the differences were not significant. Both of the knowledge about how to foster infants and service utility in intervention group were higher than that in control group. Conclusion The fostering interventions through the community promote the prevention and control of infants disease, increase the knowledge level and service util ity of families.

Gastrointestinal cytomegalovirus disease secondary to measles in an immunocompetent infant

Yang et al reported an immunocompetent infant with gastrointestinal cytomegalovirus disease secondary to measles infection.We express our opinion about the diagnosis and treatment of this rare disease.

Incidence of Parenteral Nutrition-Associated Liver Disease in Infants on Prolonged Parenteral Nutrition with a Soybean-Based Lipid Emulsion: A 7-Year Experience

Parenteral nutrition associated liver disease (PNALD) is a significant complication in infants receiving long-term parenteral nutrition (PN). Chronic administration of PN has been associated with its development. Our purpose is to characterize our incidence of PNALD over an extended period and identify risk factors for its development, including administration of soybean-based injectable lipid emulsions (ILEs) as we transit to novel ILEs in our practice. Infants receiving 30 days or more of PN were included. PNALD was defined as a direct bilirubin ≥ 2 mg/dL. Data collected included: patient demographics, clinical and enteral feeding characteristics. Macronutrient intake was recorded using these cut-offs: glucose infusion rate (GIR) of ≤14 mg/kg/min or above, protein doses of ≤3 g/kg/day or above and lipid doses of ≤2 g/kg/day or above. A total of 349 infants were included, with an annual incidence of PNALD ranging between 34% - 54%. Infants with PNALD were younger by gestation (27 vs. 29.5 weeks) and smaller by birthweight (900 vs. 1248 grams). Sepsis, GI disease including necrotizing enterocolitis and bowel resection were significantly associated with an increased risk for development of PNALD. PNALD infants received lower protein doses (3.0 vs 3.3 g/kg/day, p = 0.014) while receiving higher GIR (11.4 vs 10.7 mg/kg/min, p = 0.012) compared to non-PNALD infants. Low birth weight, sepsis and bowel resection remain strong indicators of risk for PNALD. No single macronutrient increased our infants’ risk for PNALD. The use of newer ILEs when available should be evaluated for their impact on PNALD development.