Oral mucositis is a common and debilitating side effect of haematopoietic stem cell transplantation. Our study investigated parents' and children's experiences of oral mucositis treatment and whether the parents' perceptions accurately reflected the children's views.
We analysed 71 questionnaires completed by the parents of children who had undergone haematopoietic stem cell transplantation, together with 38 questionnaires completed by children who were 7 years of age or over.
The parent proxy and child self‐reports showed good to excellent agreement. For example, 86% of the parents and 83% of the children reported oral pain and 44% of the parents and 47% of the children reported difficulty swallowing often or very often. The majority of the parents (61%) were satisfied with the pain treatment that had been given to their child. However, the treatment provided for oral mucositis was not altogether consistent.
Oral mucositis affected the majority of the children undergoing haematopoietic stem cell transplantation, causing considerable pain and discomfort. The parent proxy reports proved to be reliable and are an important supplement to child self‐reports on symptoms related to oral mucositis. But there is a clear need to establish more evidence‐based care for children suffering from oral mucositis.
Haematopoietic stem cell transplantation; Oral mucositis; Pain; Parent proxy; Questionnaire
To investigate early medical and family factors associated with later feeding risk in preterm infants.
For this longitudinal study, we enrolled 136 infants born ≤30 weeks gestation. Medical and social background factors were assessed at term equivalent age. Infants underwent magnetic resonance imaging, neurobehavioral evaluation, and feeding assessment. Parent involvement in the neonatal intensive care unit was tracked, and maternal mental health was assessed at discharge. At age two years, feeding outcome was assessed using the Eating Subscale of the Infant-Toddler Social Emotional Assessment (n=80). Associations between feeding problems at age two and 1) early medical factors, 2) neurobehavioral functioning and feeding at term equivalent age, 3) cerebral structure, and 4) maternal mental health were investigated using regression.
Eighteen (23%) children had feeding problems at age two years. Feeding problems were associated with early hypotonia (p=0.03; β=0.29) and lower socioeconomic status (p=0.046; β=−0.22). No associations were observed between early medical factors, early feeding performance, cerebral structure alterations or maternal well-being and feeding outcome.
Early hypotonia may disrupt the development of oral-motor skills. Hypotonia and poor feeding also may share a common etiology. Associations with lower socioeconomic status highlight the influence of family background factors in feeding problems in the preterm infant.
feeding; hypotonia; NICU; outcome; preterm; socioeconomic status
Providing consistent levels of oxygen saturation (SpO2) for infants in neonatal intensive care units is not easy. This study explored how effectively the Auto-Mixer® algorithm automatically adjusted fraction of inspired oxygen (FiO2) levels to maintain SpO2 within an intended range in extremely low birth weight infants receiving supplemental oxygen without mechanical ventilation.
Twenty extremely low birth weight infants were randomly assigned to the Auto-Mixer® group or the manual intervention group and studied for 12 h. The SpO2 target was 85–93%, and the outcomes were the percentage of time SpO2 was within target, SpO2 variability, SpO2 >95%, oxygen received and manual interventions.
The percentage of time within intended SpO2 was 58 ± 4% in the Auto-Mixer® group and 33.7 ± 4.7% in the manual group, SpO2 >95% was 26.5% vs 54.8%, average SpO2 and FiO2 were 89.8% vs 92.2% and 37% vs 44.1%, and manual interventions were 0 vs 80 (p < 0.05). Brief periods of SpO2 < 85% occurred more frequently in the Auto-Mixer® group.
The Auto-Mixer® effectively increased the percentage of time that SpO2 was within the intended target range and decreased the time with high SpO2 in spontaneously breathing extremely low birth weight infants receiving supplemental oxygen.
Auto-mixer; Extremely low birth weight infants; Oxygen administration; Oxygen saturation targets; Pulse oximeter
Neuromuscular blocking agents (NMBAs) are used in a range of critical illnesses in neonates and infants, despite a lack of guidelines and professional standards. This study reviewed the current evidence base and ascertained UK practice regarding the continuous use of these agents in this age range.
We reviewed the literature and carried out a telephone questionnaire of all tertiary units in England and specialist children's hospital neonatal units in the UK.
No best practice guidelines or general consensus statements were found, and the only randomised trial to feature an NMBA protocol expressed concerns about its use in such young babies. Of the 56 units contacted, 54 (96.4%) shared information. Only three of the 56 (5.4%) used intermittent boluses of NMBAs, 91.1% used NMBA infusions, 11 (19.6%) routinely used regular neuromuscular blocker pause to assess depth, and only one (1.8%) used peripheral nerve stimulation monitoring. All the units carried out clinical assessments, but only one (1.8%) had a written protocol.
There is a paucity of literature and professional standards to guide the safe use of NMBAs in infants. Of the 54 units who participated in the survey, only one had a protocol for using NMBAs in babies.
Critical care; Neonatology; Neuromuscular blockade; Neuromuscular monitoring; Pharmacology
The international Trial to Reduce IDDM in the Genetically at Risk (TRIGR) was launched to determine whether weaning to a highly hydrolysed formula in infancy reduces the incidence of type 1 diabetes in children at increased genetic disease susceptibility. We describe here the findings on feasibility and compliance from the pilot study.
The protocol was tested in 240 children. The diet of the participating children was assessed by self-administered dietary forms, a structured questionnaire and a food record. Blood samples were taken and weight and height measured at birth and at 3, 6, 9, 12, 18 and 24 months.
A majority of the subjects (84%) were exposed to the study formula at least for 2 months. Linear growth or weight gain over the first 2 years of life was similar in the two study groups. The levels of IgA and IgG antibodies to cow’s milk and casein were higher in the cow’s milk–based formula group than in the hydrolysed formula group during the intervention period (p < 0.05), reflecting the difference in the intake of cow’s milk protein.
This randomized trial on infant feeding turned out to be feasible, and dietary compliance was acceptable. Valuable experience was gained for the planning and sample size estimation of the study proper.
Compliance; Feasibility; Hydrolysed infant formula; Infants; Primary prevention
Oxygen is a neonatal health hazard that should be avoided in clinical practice. In this review, an international team of neonatologists and nurses assessed oxygen saturation (SpO2) targeting in preterm infants and evaluated the potential weaknesses of randomised clinical trials.
SpO2 of 85–89% can increase mortality and 91–95% can cause hyperoxia and ill effects. Neither of these ranges can be recommended, and wider intermediate targets, such as 87–94% or 88–94%, may be safer.
Hyperoxia; Oximetry; Oxygen saturation; Premature infant; Retinopathy of prematurity
Long-chain polyunsaturated fatty acids (LCPUFAs) are immunomodulatory, but their role in allergy development is controversial. We investigated whether proportions of LCPUFAs in serum phospholipids were related to allergic diagnosis, seafood intake and LCPUFA proportions in cord blood.
Serum was obtained from 148 birth cohort children at 13 years of age. Forty had atopic eczema, 53 had respiratory allergy, and 55 were nonallergic. Proportions of LCPUFAs were determined in serum phospholipids; cord blood from 128 of the individuals was previously analysed. Seafood intake was estimated using questionnaires.
Allergic and nonallergic individuals did not differ significantly regarding individual LCPUFAs. However, arachidonic acid over docosahexaenoic acid (DHA) ratio was higher in allergic, compared with nonallergic, adolescents. In nonallergic individuals, LCPUFA proportions in cord serum and adolescent serum correlated weakly. In individuals with atopic eczema and respiratory allergy, these correlations were weak or absent. A moderate correlation between seafood intake and serum DHA was seen in nonallergic individuals and those with respiratory allergy, but not in those with atopic eczema.
Serum LCPUFA pattern was similar in allergic and nonallergic adolescents. Fatty acid metabolism may be altered in atopic eczema subjects, suggested by poor correlations between fatty acid intake and serum levels.
Allergy; Asthma; Atopic eczema; Fatty acids; Polyunsaturated fatty acids
To determine whether routine echocardiography increases diagnosis and treatment of patent ductus arteriosus (PDA) and whether randomized non-disclosure is a feasible strategy for studying PDA management.
2 center pilot randomized, controlled trial. 88 infants with birth weights ≤1250 grams and gestational ages ≤30 weeks were randomized to disclosure or non-disclosure of serial echocardiogram findings. Echocardiograms were performed at 3–5 and 7–10 days of life. The primary outcome was time to regain birth weight.
100% of echocardiograms in the disclosure group were disclosed; 16% (echocardiogram #1) and 29% (echocardiogram #2) were disclosed in the non-disclosure group. There was a statistically non-significant decrease in drug therapy for PDA in the non-disclosure group (adjusted odds ratio [AOR] 0.56, 95% confidence interval [CI] 0.24–1.34). There was no difference in time to regain birth weight or in other important neonatal outcomes. However, infants in the non-disclosure group were more likely to demonstrate appropriate weight loss and then regain birth weight within 7–14 days (AOR 2.64, 95% CI 1.08–6.44).
Randomized non-disclosure of echocardiograms is a feasible strategy for evaluation of approaches to PDA management in very preterm infants. Avoidance of routine echocardiography may reduce drug therapy for PDA without adverse clinical effects.
Echocardiogram; Echocardiography; Patent ductus arteriosus; Very low birth weight infant; Very premature infant
To compare the early postnatal pattern of systemic inflammation in growth-restricted infants born before the 28th week of gestation to that of appropriately grown peers.
We measured the concentrations of 25 inflammation-related proteins in blood spots collected from 939 newborns during the first 2 postnatal weeks. We calculated the odds ratios (99% confidence intervals) that concentrations would be in the highest quartile.
Severely growth-restricted infants (birth weight Z-score < -2) were not at increased risk of systemic inflammation shortly after birth. On postnatal day 14, however, they were significantly more likely than their peers to have a CRP, IL-1β, IL-6, TNF-α, IL-8, MCP-4, ICAM-1, ICAM-3, E-SEL, MMP-9, VEGF-R2, and/or IGFBP-1 concentration in the highest quartile. These increased risks could not be attributed to delivery indication, bacteremia, or duration of ventilation.
Growth-restricted preterm newborns appear to be at increased risk of elevated concentrations of inflammation-associated proteins by postnatal day 14.
growth-restricted; inflammation; IUGR; neonate; preterm
To test the hypothesis that there are single-nucleotide polymorphisms (SNPs) in genes of the l-arginine/nitric oxide pathway associated with pulmonary hypertension (PH) in neonates with bronchopulmonary dysplasia (BPD).
Neonates with BPD were enrolled (n = 140) and clinical characteristics compared between case (BPD + PH) and control (BPD) groups. DNA was isolated from blood leucocytes and assayed for 17 SNPs in l-arginine/nitric oxide pathway genes by Sequenom massarray. Genes included carbamoyl-phosphate synthetase, ornithine transcarbamylase, argininosuccinate synthase, nitric oxide synthase and arginase. SNPs were selected from the National Center for Biotechnology Information database for their putative functionality. Calculated minor allele frequencies (MAF) of cases and controls were compared using χ2 and logistic regression.
Of the 140 patients with BPD, 26% had echocardiographic evidence of PH. Ventilation days were longer for cases than controls (mean 31 vs. 15 days, p < 0.05). Of the 17 SNPs, rs2781666 in arginase I gene was less common in cases (MAF = 0.23) than controls (MAF = 0.37, p = 0.04). The odds of PH decreased by 43% (p = 0.047) for each copy of the SNP minor allele in arginase I gene in patients with BPD.
Arginase I SNP (rs2781666) may be associated with protection against pulmonary hypertension in preterm neonates with BPD.
arginine; argininosuccinate synthase; carbamoyl-phosphate synthetase; nitric oxide synthase; ornithine transcarbamylase
To investigate risk factors for metabolic syndrome in prepubertal boys with Klinefelter syndrome.
Eighty-nine boys with Klinefelter syndrome, ages 4–12.9 years, and 34 age-matched control boys had height, weight, waist circumference and blood pressure measured and their parents completed a questionnaire about physical activity. The boys with Klinefelter syndrome also had measurement of lipids, fasting glucose and insulin. Insulin-glucose homeostasis model assessment was calculated, and the boys were evaluated for childhood metabolic syndrome.
The Klinefelter syndrome and control groups were similar ages (7.5 ± 2.4 vs. 8.1 ± 2.3 years). Body mass index measurements were similar, but waist circumference was >90‰ in 30% of boys with Klinefelter syndrome versus 21% of controls. The mean daily time spent running was 42 min less in the Klinefelter syndrome versus control groups (p < 0.01). About 37% of the boys with Klinefelter syndrome had elevated LDL cholesterol, 24% had insulin resistance, and 7% met the three criteria for diagnosis of metabolic syndrome.
Truncal obesity, insulin resistance and metabolic syndrome are present in boys as young as 4–12 years with Klinefelter syndrome, and these occur in association with reduced running-type activity.
47; XXY; Insulin resistance; Karyotype; Klinefelter syndrome; Metabolic syndrome; Testicular failure
Perinatal inflammation and neonatal sepsis trigger lung and brain injury. We hypothesized that endotoxin exposure in the immature lung upregulates proinflammatory cytokine expression in the brainstem and impairs respiratory control. Lipopolysaccharide (LPS) or saline was administered intratracheally to vagal intact or denervated rat pups. LPS increased brainstem IL-1β and vagotomy blunted this response. There was an attenuated ventilatory response to hypoxia and increased brainstem IL-1β expression after LPS.
Intratracheal endotoxin exposure in rat pups is associated with upregulation of IL-1β in the brainstem that is vagally mediated and associated with an impaired hypoxic ventilatory response.
Brainstem cytokines; Hypoxic ventilatory response; Neonatal respiratory control
To better understand the impact of non-English language spoken in the home on measures of cognition, language, and behavior in toddlers born extremely preterm.
Eight hundred and fifty children born at <28 weeks gestational ages were studied. 427 male and 423 female participants from three racial/ethnic groups (White, Black, and Hispanic) were evaluated at 18-22 months adjusted age using the Bayley Scales of Infant Development 3rd edition and the Brief Infant Toddler Social Emotional Assessment (BITSEA). Children whose primary language was Spanish (n=98) were compared with children whose primary language was English (n=752), using multivariable regression adjusted for medical and psychosocial factors.
Cognitive scores were similar between groups; however, receptive, expressive and composite language scores were lower for children whose primary language was Spanish. These differences remained significant after adjustment for medical and socio-economic factors. Spanish speaking children scored worse on the BITSEA competence and problem scores using univariate analysis, but not after adjustment for medical and socio-economic factors.
Our finding that preterm children whose primary language was Spanish had similar cognitive but lower language scores than those whose primary language was English suggests that using English language-based testing tools may introduce bias against non-English speaking children born preterm.
development; prematurity; second-language; race/ethnicity
To assess medical and neurodevelopmental effects of Newborn Individualized Developmental Care and Assessment Program (NIDCAP) for a large sample of very early-born infants.
One hundred and seven singleton inborn preterm infants, <29 weeks gestational age (GA), <1250 g birth weight, enrolled in three consecutive phases, were randomized within phase to NIDCAP (treatment, E) or standard care (C). Treatment extended from admission to the Newborn Intensive Care Unit to 2 weeks corrected age (wCA). Outcome included medical, neurobehavioural and neurophysiological status at 2 wCA, and growth and neurobehavioural status at 9 months (m) CA.
The C- and E-group within each of the three consecutive phases and across the three phases were comparable in terms of all background measures; they therefore were treated as one sample. The results indicated for the E-group significant reduction in major medical morbidities of prematurity as well as significantly improved neurodevelopmental (behaviour and electrophysiology) functioning at 2 wCA; significantly better neurobehavioural functioning was also found at 9 mCA.
The NIDCAP is an effective treatment for very early-born infants. It reduces health morbidities and enhances neurodevelopment, functional competence and life quality for preterm infants at 2 w and 9 mCA.
Behaviour; EEG spectral coherence; Neurodevelopment; NIDCAP; Prematurity
To investigate the sodium composition of maintenance intravenous fluids used by paediatric residents throughout the United States in common clinical scenarios of arginine vasopressin excess.
We distributed an online survey to paediatric residency programs asking what type of maintenance intravenous fluids (0.2%, 0.45%, 0.9% NaCl or Lactated Ringers) they would administer in four common clinical scenarios of arginine vasopressin excess (gastroenteritis, pneumonia, meningitis and post-operative) in both a 6-month-old (mo) and a 13-year-old (yo) child.
We had 472 responses, representing 5% of the total paediatric residency population in the US. Hypotonic maintenance intravenous fluids were selected in 78% of children (88.2% of 6 mo and 68.5% of 13 yo). Isotonic maintenance intravenous fluids were selected approximately twice as often for patients with meningitis as for those without (21.4% vs 8.7% 6 mo and 42.8% vs 27.7% 13 yo; p <.0.001).
The majority of US paediatric residents would prescribe hypotonic maintenance intravenous fluids in disease states associated with arginine vasopressin excess. However, a significant number of residents are using isotonic maintenance intravenous fluids. Isotonic fluids are more likely to be prescribed in older children and children with meningitis.
Fluid therapy; sodium; saline; hyponatraemia; children
To evaluate male breast cancer (MBC) risk among Klinefelter Syndrome (KS) patients and relate this to possible biologic explanations.
A literature review was conducted to identify case series and epidemiologic studies that have evaluated MBC risk among KS patients.
Case reports without expected values have often led to false impressions of risk. Problems include that a diagnosis of cancer can prompt a karyotypic evaluation and that many cases of KS are unrecognized, resulting in incomplete denominators. Few carefully conducted epidemiologic studies have been undertaken given that both KS and male breast cancer are rare events. The largest study found 19.2- and 57.8-fold increases in incidence and mortality, respectively, with particularly high risks among 47,XXY mosaics. These risks were still approximately 30% lower than among females, contradicting case reports that KS patients have breast cancer rates similar to females. Altered hormone levels (especially the ratio of estrogens to androgens), administration of exogenous androgens, gynecomastia, and genetic factors have been offered as possible explanations for the high risks.
Additional well-designed epidemiologic studies are needed to clarify which KS patients are at a high risk of developing MBC and to distinguish between possible predisposing factors, including altered endogenous hormones.
Genetics; gynecomastia; hormones; Klinefelter syndrome; male breast cancer; risk
To assess the use of nasal high-frequency ventilation (HFV) to provide noninvasive ventilatory support for very low birthweight (VLBW) infants.
VLBW infants, >7 days of age on nasal continuous positive airway pressure (CPAP), were placed on nasal HFV for 2 h using the Infant Star high-frequency ventilator (Mallinckrodt, Inc., St. Louis, MO, USA). Mean airway pressure was set to equal the previous level of CPAP, and amplitude was adjusted to obtain chest wall vibration. Capillary blood was sampled before starting HFV and after 2 h to determine change in pH and partial pressure of carbon dioxide (pCO2).
Fourteen subjects were studied, 10 males and 4 females. Gestational age was 26–30 weeks (median 27). Age at study was 18–147 days (median 30). Median birth weight was 955 g; median weight at study was 1605 g. Nasal CPAP pressure was 4–7 cm H2O (mean 5). Amplitude was 30–60 (median 50). After 2 h, PCO2 (mean 45 torr) was significantly lower than initial PCO2 (mean 50 torr) (p = 0.01), and pH had increased significantly (7.40 vs. 7.37, p = 0.04).
Nasal HFV is effective in decreasing pCO2 in stable premature infants requiring nasal CPAP support. Long-term use of nasal HFV requires further study.
CPAP; High-frequency ventilation; Nasal ventilation; Premature infant
Preterm birth is associated with a number of physical and mental health issues. The aim of this study was to find out if there was also any association between individuals born preterm in Sweden between 1984 and 2006 and the risk of unintentional injuries during childhood, adolescence and young adulthood.
The study followed 2,297,134 individuals, including 5.9% born preterm, from 1985 to 2007 for unintentional injuries leading to hospitalisation or death (n=244,021). The males and females were divided into four age groups: 1–5 years, 6–12 years, 13–18 years and 19–23 years. Hazard ratios were calculated for falls, transport injuries and other injuries.
After adjusting for a comprehensive set of covariates, some of the preterm subgroups demonstrated slightly increased risks of unintentional injuries, while others showed slightly decreased risks. However, most of the estimates were borderline or non-significant in both males and females. In addition, the absolute risk differences between individuals born preterm and full term were small.
Despite the association between preterm birth and a variety of physical and mental health consequences, this study shows that there is no consistent risk pattern between preterm birth and unintentional injuries in childhood, adolescence and young adulthood.
accidents; adolescence; childhood; preterm birth; injuries
To investigate the relationship between breastmilk feeding in very low birth weight infants in the neonatal intensive care unit and breastmilk feeding rates for all newborns by hospital.
This was a cross-sectional study of 111 California hospitals in 2007 and 2008. Correlation coefficients were calculated between overall hospital breastfeeding rates and very low birth weight infant breastmilk feeding rates. Hospitals were categorized in quartiles by crude and adjusted very low birth weight infant rates to compare rankings between measures.
Correlation between very low birth weight infants and overall breastfeeding rates varied by neonatal intensive care unit level of care, from 0.13 for intermediate hospitals to 0.48 for regional hospitals. For hospitals categorized in the top quartile according to overall breastfeeding rate, only (46%) were in the top quartile for both crude and adjusted very low birth weight infant rates. On the other hand, when considering the lowest quartile for overall breastfeeding hospitals, 3 of 27 (11%) actually were performing in the top quartile of performance for very low birth weight infant rates.
Reporting hospital overall breastfeeding rates and neonatal intensive care unit breastmilk provision rates separately may give an incomplete picture of quality of care.
Preterm infants; Neonatal intensive care; Breastmilk; Breastfeeding; Quality improvement
To test the hypothesis that exposure to ambient language in the womb alters phonetic perception shortly after birth. This two-country study aimed to see if neonates demonstrated prenatal learning by how they responded to vowels in a category from their native language and another nonnative language, regardless of how much postnatal experience the infants had.
A counterbalanced experiment was conducted in Sweden (n=40) and the USA (n=40) using Swedish and English vowel sounds. The neonates (mean postnatal age = 33 hrs) controlled audio presentation of either native or nonnative vowels by sucking on a pacifier, with the number of times they sucked their pacifier being used to demonstrate what vowel sounds attracted their attention. The vowels were either the English /i/ or Swedish /y/ in the form of a prototype plus 16 variants of the prototype.
The infants in the native and nonnative groups responded differently. As predicted, the infants responded to the unfamiliar nonnative language with higher mean sucks. They also sucked more to the nonnative prototype. Time since birth (range: 7–75 hours) did not affect the outcome.
The ambient language to which foetuses are exposed in the womb starts to affect their perception of their native language at a phonetic level. This can be measured shortly after birth by differences in responding to familiar vs. unfamiliar vowels.
fetal; language; learning; neonatal; vowels
Parental behavior described as “scaffolding” has been shown to influence outcomes in at-risk children. The purpose of this study was to compare maternal verbal scaffolding in toddlers born preterm and full term.
The scaffolding behavior of mothers of toddlers born preterm and healthy full term was compared during a 5 minute videotaped free play session with standardized toys. We compared two types of scaffolding and their associations with socio-demographic, neonatal medical factors, and cognition.
The mothers of toddlers born full term used more complex scaffolding. Maternal education was associated with complex scaffolding scores for the preterm children only. Specifically, the preterm children who were sicker in the neonatal period, and whose mothers had higher education, used more complex scaffolding. In addition, children born preterm who had less days of ventilation, had higher cognitive scores when their mothers used more complex scaffolding. Similarly, cognitive and scaffolding scores were higher for children born full term.
Our findings highlight early differences in mother-child interactive styles of toddlers born preterm compared to full term. Teaching parents play methods that support early problem solving skills may support a child’s method of exploration and simultaneously their language development.
Cognition; Maternal Education; Maternal Scaffolding; Preterm
To describe the prevalence of paediatric sleep disordered breathing (SDB) symptoms in extremely low gestational age infants and identify neonatal risk factors, including early exposure to hypoxia and hyperoxia.
Patients <28 weeks gestation were monitored with high-resolution pulse oximetry. Hypoxia/hyperoxia variables were defined as percentage time of first 4 weeks of life that SaO2 < 80% or SaO2 > 98%, respectively. Parents completed part of the OSA-18 questionnaire for symptoms of SDB at 18–22 months. Logistic regression was used to test the association between risk factors and sleep symptoms.
Of 182 patients recruited, 138 (76%) completed the questionnaire. The mean gestation was 26 weeks, and mean birth weight 887 grams. Loud snoring (21%) and restless sleep (24%) were the most prevalent symptoms. Female sex was associated with an increased risk of loud snoring (OR, 2.7; CI, 1.13–6.5). Prolonged mechanical ventilation, necrotizing enterocolitis and prolonged caffeine use, however, were inversely correlated with loud snoring. Neither neonatal hypoxia nor hyperoxia were associated with sleep symptoms.
While the prevalence of sleep disordered breathing symptoms is similar to reported rates, we found a sex difference not previously reported. Interestingly, markers for severity of illness show a pattern of being protective against loud snoring.
Snoring; Sleep disordered breathing; Prematurity
Aim Olfactory sensation is highly functional early in human neonatal life, with studies suggesting that odours can influence behaviour and infant–mother bonding. Due to its good spatial properties, blood oxygen level–dependent (BOLD) contrast functional magnetic resonance imaging (fMRI) has the potential to rapidly advance our understanding of the neural activity which underlies the development of olfactory perception in this key period. We aimed to design an ‘olfactometer’ specifically for use with neonatal subjects for fMRI studies of odour perception.
Methods We describe a fully automated and programmable, fMRI compatible system capable of presenting odorant liquids. To prevent contamination of the system and minimize between-subject infective risk, the majority of the olfactometer is constructed from single-use, readily available clinical equipment. The system was used to present the odour of infant formula milk in a validation group of seven neonatal subjects at term equivalent postmenstrual age (median age 40 weeks).
Results A safe, reliable and reproducible pattern of stimulation was delivered leading to well-localized positive BOLD functional responses in the piriform cortex, amygdala, thalamus, insular cortex and cerebellum.
Conclusions The described system is therefore suitable for detailed studies of the ontology of olfactory sensation and perception during early human brain development.
fMRI; Infant; Newborn; Olfactory
The loop diuretics furosemide and bumetanide are commonly used in neonatal intensive care units (NICUs). Furosemide, due to its actions on the ubiquitous NKCC1 co-transporter and its promotion of prostanoid production and release, also has non-diuretic effects on vascular smooth muscle, airways, the ductus arteriosus, and theoretically the gastrointestinal tract. Loop diuretics also affect the central nervous system through the inhibitory neurotransmitter, GABA.
The loop diuretics have a variety of biological effects that are potentially harmful as well as beneficial. Care should be taken with the use of these agents since the range of their effects may be broader than the single action sought by the prescribing physician.
GABA-A receptor; Na-K-2Cl cotransporter; furosemide; bumetanide; ductus arteriosus
Perturbations in dietary and hormonal components of the calciotropic network may be mediated through the influence of calcium homeostasis on resting energy expenditure (REE). We investigated the association of dietary and hormonal factors involved in the regulation of calcium homeostasis with REE in girls.
Thirty-six girls age 7–11 years participated. REE was assessed by indirect calorimetry, and body composition, dietary intake (calcium, vitamins D and K, phosphorus), and serum hormones (PTH, osteocalcin, 25OHD), were evaluated by DXA, 24h recall and serum assay, respectively.
A positive association between vitamin K and REE and an inverse association of PTH with REE (p=0.05) was observed. PTH and REE were positively related in those having normal adiposity (p=0.03) and inversely related in those with excess adiposity (p=0.01). The association of REE with vitamin K intake was evident in lean individuals (p=0.001), but was null in those with excess adiposity.
Decreased calciotropic hormone levels along with increased related nutrient intakes were associated with greater REE, although these relationships differed according to adiposity. The physiologic response to the diet and subsequent energy partitioning needs to be considered in the context of puberty. In particular, regulation and signaling of the calciotropic network during pubertal maturation warrant investigation.
Calcium homeostasis; puberty; diet; adiposity; calciotropic