Change in the body temperature of healthy term infant over the first 72 hours of life

Objective: To determine the range of body temperature in a group of healthy Chinese term neonates over the first 72 hours of life and to assess the influence of body weight, gestational age and route of delivery. Method: All 200 consecutive cases of neonates delivered at our hospital from March to August 2001 were included in this retrospective study. Temperatures were measured immediately after delivery, after 30 minutes, 1 hour, 2 hours, 8 hours and 15 hours and on the 2nd and 3rd day. Axillary temperatures ranging from 36.5 篊 to 37 篊 were regarded as normal. No cases of maternal fever or systemic infection of the newborns were discovered. All infants were discharged in good general condition. Results: The mean rectal temperature at birth was 37.19 篊. The lowest average temperature was reached at 1 hour after delivery (36.54 篊) with a significant difference between natural delivery (36.48 篊) and section (36.59 篊) (P<0.05). Temperature subsequently rose to 36.70 篊 at 8 hours and 36.78 篊 at 15 hours (P<0.05). Hypothermia was seen in 51.8% and hypothermia in 42.5% of the patients. On the 3rd day after delivery, 96% of all temperatures were in the normal range. A significant relation was found between hypothermia and both low birth weight (P<0.001) and low gestational age (P<0.05). Conclusion: The ref-erence range presently used did not include all physiological temperatures in the first 72 hours of life. Considering other factors, such as birth weight, route of delivery, gestational age and body temperature on the 2nd and 3rd day of life, may help to correctly assess the significance of temperatures beyond the reference range.

Correlation between Transcutaneous Bilirubinemia and Blood Bilirubinemia in Screening Term Newborn for Neonatal Jaundice at the Essos Hospital Centre (EHC), Yaoundé, Cameroon

Background: Early and non-invasive diagnosis of neonatal hyperbilirubinemia remains critical in dark skinned babies of low resource settings. Objective: To assess correlation/agreement between transcutaneous bilirubin (Tcb) and serum bilirubin (Tsb) values in full term neonates with jaundice. Methodology: An analytical cross-sectional study was conducted at the neonatology unit of the Essos Hospital Centre (EHC) from January to June 2019. All full-term neonates aged 0 to 7 days with suspected jaundice who did not receive phototherapy were eligible for the study. The enrolled neonates in the study were assessed clinically, then with the MBJ20 transcutaneous bilirubinometer (TcB). The MBJ20 transcutaneous bilirubinometer highest measurement over the forehead and the sternum were compared to TsB. Data were entered and then analysed with the CsPro7.2 and R (version 3.6.0) software. Correlation was captured by Bland & Alman plots and Concordance Correlation Coefficient (CCC) estimates. The Pearson correlation coefficient and Student test for paired data were used for descriptions purposes, and the significance level was 5%. Results: We recruited 88 neonates. The sex ratio of the babies included was 1.25 favouring males. Median Post-natal age was 3 days with 62% aged 72 hours or more. The mean TcB corresponding to the maximum average between frontal and sternal measurement was 153 mg/dl ± 48 and the average Tsb was 123.80 mg/dl ± 50.48. A good linear correlation was found between TcB and total serum bilirubin level r = 0.86 [0.80;0.91]. Positive correlation was noted between both (forehead and sternum) TcB measurements sites, namely r = 0.78 and r = 0.86. The Bland & Altman plot measured the bias at -29.68 mg/l (confidence interval at 95%, 21.14 - 80.50). The CCC estimate was 0.2 varying from -0.22 to 0.76 according to TcB measurement threshold and post-natal age. The ROC area under the curve value for a threshold < 100 mg/l equals 90% proving to be a good predictor for this threshold. Conclusion: A good linear correlation was found despite a poor agreement between TcB and Tsb. TcB method systematically overestimated the value of TsB.

Response to Pain by Different Gestational Age Neonates

One hundred infants were divided into the following 3 gestational age (GA) groups: (Ⅰ) premature infants ( n =30) with the gestational age between 29 and 32 weeks; (Ⅱ) premature infants ( n =30) with the gestational age between 33 and 36 weeks; (Ⅲ) full term infants ( n =40). The recorded responses of all infants to pain included the behavioral responses to painful stimuli (cry, facial activity and limbs movement) and the variety of heart rate. The results indicated that the infants of 3 groups had different degree response to various painful stimuli. Pain expression in full term infants was more significant than premature infants to same stimuli. 33 weeks GA infants were differential from 29 weeks GA infants. Full term infants showed more vertical mouth stretch and more taut tongue and more hand to mouth than premature infants, but more horizontal mouth stretch in premature infants.

Kangaroo Care (Skin-to-Skin) for Clustered Pain Procedures: Case Study

Background: Pain management for term newborns undergoing clustered painful procedures has not been tested. Kangaroo Care (chest-to-chest, skin-to-skin position of infant on mother) effectively reduces pain of single procedures, but its effect on pain from clustered procedures is not known. Aim: The aim was to test Kangaroo Care’s effect on pain in one term infant who received clustered painful procedures while determining feasibility of the Kangaroo Care intervention. Design, Setting, and Participant: A case study design was used with one healthy term newborn who received two heel sticks and one injection in one session in the mother’s postpartum room. Method: Heart rate and oxygen saturation (recorded from Massimo Pulse Oximeter every 30 seconds), crying time (total seconds of crying on videotape) and behavioral state (using Anderson Behavioral State Scoring system every 30 seconds) were measured before (5 minutes), during (10.5 minutes) and after (30 minutes) the three clustered painful procedures in a newborn who was in Kangaroo Care during all observations. One staff nurse administered the clustered procedures. Results: Heart rate increased sequentially with each heelstick, oxygen saturation remained unchanged, sleep predominated, and crying was minimal throughout the procedures. Conclusion: Kangaroo Care appeared to reduce pain from clustered painful procedures and can be further tested.

Effects of Bifidobacterium supplementation on intestinal microbiota composition and the immune response in healthy infants

Background:Intestinal microbiotas are thought to be the most important source of maturational stimuli to the development of the immune system.However,few studies have focused on the development of T helper(Th)1 immune response and antibody response to vaccinations in healthy infants,especially in a large cohort.Through this randomized,double-blind control trial,we investigated the effects of Bifidobacterium longum BB536(BB536)supplementation on intestinal microbiota composition and the immune response in term infants.Methods:In total,300 healthy newborns were recruited,randomized and fed formula either supplemented with BB536 or with no supplementation.Stool samples were analyzed at months 2,4 and 11.The representative cytokine for Th1[interferon-γ(IFN-γ)]and Th2[interleukin-4(IL-4)]secretion cells were measured using enzyme-linked immunospot assay at 4 and 7 months of age.The antibody response to vaccines was measured at months 7 and 11.Results:A total of 264 infants completed the study.The amount of bifidobacteria and the bifidobacteria/Enterobacteriaceae ratio(B/E)were signifi cantly higher in the BB536 supplementation group at months 2 and 4.The number of IFN-γsecretion cells and the ratio of IFN-γ/IL-4 secretion cells were increased in the BB536 supplementation group at 7 months.Moreover,the higher value of B/E in the early stages seems to be related to the increased Th1 response.No difference was observed between groups in the antibody response after vaccination.Conclusions:BB536 has positive effects on establishing a healthy intestinal microbiota early in life,and it also plays an important role in improving the Th1 immune response.