Martyna E. Berej, Joanna J. Kośka, Maria Marta Orzeł, Beata Borek-Dzięcioł
Alpha-1-fetoprotein (AFP) is a protein produced by the liver. Although its biological function is not fully understood, it is often used as a marker for cancer. High levels of AFP are also observed in premature infants. Reference ranges for AFP levels in premature infants are not specified. The authors present a case of a male newborn born at 25+5/7 weeks of gestational age. The boy underwent oncological diagnostics due to the detection, on the 24th day of life, of a liver lesion in an abdominal ultrasound examination, as well as significantly elevated AFP levels (>430,000 ng/mL). With each passing day, the AFP level gradually decreased, and the suspicious lesion was not visualized on abdominal ultrasound or magnetic resonance imaging on the 59th day of life. Based on the conducted examinations, prematurity and its treatment were considered the cause of high AFP levels. The aim of the study was to present the diagnostic difficulties associated with the lack of AFP norms for premature infants.
{"title":"Highly Elevated Alpha-fetoprotein Concentration in a Premature Infant","authors":"Martyna E. Berej, Joanna J. Kośka, Maria Marta Orzeł, Beata Borek-Dzięcioł","doi":"10.4103/jcn.jcn_16_24","DOIUrl":"https://doi.org/10.4103/jcn.jcn_16_24","url":null,"abstract":"Alpha-1-fetoprotein (AFP) is a protein produced by the liver. Although its biological function is not fully understood, it is often used as a marker for cancer. High levels of AFP are also observed in premature infants. Reference ranges for AFP levels in premature infants are not specified. The authors present a case of a male newborn born at 25+5/7 weeks of gestational age. The boy underwent oncological diagnostics due to the detection, on the 24th day of life, of a liver lesion in an abdominal ultrasound examination, as well as significantly elevated AFP levels (>430,000 ng/mL). With each passing day, the AFP level gradually decreased, and the suspicious lesion was not visualized on abdominal ultrasound or magnetic resonance imaging on the 59th day of life. Based on the conducted examinations, prematurity and its treatment were considered the cause of high AFP levels. The aim of the study was to present the diagnostic difficulties associated with the lack of AFP norms for premature infants.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"91 2","pages":""},"PeriodicalIF":0.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141711868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adrenal hypoplasia congenita is a relatively rare disorder characterized by atrophy or hypoplasia of the adrenal gland. It was first described by Sikl H in 1948 in 33-day-old infant. It is inherited as an autosomal recessive or X-linked disorder. It presents usually with adrenal insufficiency. In this article, we are presenting a case of congenital adrenal hypoplasia which presented with hypoglycemia, adrenal insufficiency, hyperbilirubinemia, and acquired hyperpigmentation in the neonatal period.
先天性肾上腺功能减退症是一种相对罕见的疾病，其特征是肾上腺萎缩或功能减退。Sikl H 于 1948 年首次在出生 33 天的婴儿身上描述了这种疾病。它是一种常染色体隐性遗传或 X 连锁遗传疾病。通常表现为肾上腺功能不全。本文将介绍一例先天性肾上腺功能减退症患者，该患者在新生儿期表现为低血糖、肾上腺功能不全、高胆红素血症和获得性色素沉着。
{"title":"Adrenal Hypoplasia Congenita Presenting as Adrenal Crisis, Unconjugated Hyperbilirubinemia, and Hyperpigmentation","authors":"Ammara Naeem, Sajjad Rahman, Mohammad Hassan Abdulghany, Yamen Alnakshi, Muath Hosin Alsayady","doi":"10.4103/jcn.jcn_20_24","DOIUrl":"https://doi.org/10.4103/jcn.jcn_20_24","url":null,"abstract":"Adrenal hypoplasia congenita is a relatively rare disorder characterized by atrophy or hypoplasia of the adrenal gland. It was first described by Sikl H in 1948 in 33-day-old infant. It is inherited as an autosomal recessive or X-linked disorder. It presents usually with adrenal insufficiency. In this article, we are presenting a case of congenital adrenal hypoplasia which presented with hypoglycemia, adrenal insufficiency, hyperbilirubinemia, and acquired hyperpigmentation in the neonatal period.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"42 4","pages":""},"PeriodicalIF":0.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140783662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Raghavendra, Sruthi Nair, A. Mujeeb, A. Haribalakrishna
A female infant of a diabetic mother born through LSCS at 39 weeks of gestation with a birth weight of 2908 grams was noted to have a paucity of movement of the left upper limb soon after birth. The extremity was pale, had markedly deranged perfusion, and was cold to touch with absent brachial, radial, and ulnar arterial pulsations. There was a swelling noted over the middle of the left arm, which was tender and associated with crepitus suspicious of a fracture. The right upper limb and lower limbs were normal. An urgent X-ray of the left upper limb showed a displaced fracture of the left humerus fracture and the Doppler study revealed absent flow in the brachial artery distal to the fracture site without thrombus. Urgent close reduction of the fracture following which the doppler showed a thrombus in the brachial artery extending up to its bifurcation. The thrombosis was managed medically with low molecular weight heparin and aspirin. There was a gradual improvement of limb perfusion with normalcy achieved on day 3 of life with no residual complications even on follow-up. The workup of neonatal thrombosis, its immediate management and current evidence for the same have been discussed in detail.
{"title":"An Unusual Case of Brachial Artery Thrombosis in a Neonate Following Humerus fracture at Birth","authors":"P. Raghavendra, Sruthi Nair, A. Mujeeb, A. Haribalakrishna","doi":"10.4103/jcn.jcn_2_24","DOIUrl":"https://doi.org/10.4103/jcn.jcn_2_24","url":null,"abstract":"A female infant of a diabetic mother born through LSCS at 39 weeks of gestation with a birth weight of 2908 grams was noted to have a paucity of movement of the left upper limb soon after birth. The extremity was pale, had markedly deranged perfusion, and was cold to touch with absent brachial, radial, and ulnar arterial pulsations. There was a swelling noted over the middle of the left arm, which was tender and associated with crepitus suspicious of a fracture. The right upper limb and lower limbs were normal. An urgent X-ray of the left upper limb showed a displaced fracture of the left humerus fracture and the Doppler study revealed absent flow in the brachial artery distal to the fracture site without thrombus. Urgent close reduction of the fracture following which the doppler showed a thrombus in the brachial artery extending up to its bifurcation. The thrombosis was managed medically with low molecular weight heparin and aspirin. There was a gradual improvement of limb perfusion with normalcy achieved on day 3 of life with no residual complications even on follow-up. The workup of neonatal thrombosis, its immediate management and current evidence for the same have been discussed in detail.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"18 4","pages":""},"PeriodicalIF":0.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140770191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Samaha S Mustapha, Idris Abiodun Adedeji, Amina Bashir Dogara, Muhammad Shamsuddeen Yusuf, Shamsudin Aliyu, Isa Abdulkadir
Neonatal sepsis has remained a major cause of neonatal morbidity and mortality. Despite advances in neonatal diagnostics, its diagnosis has remained challenging majorly because its symptoms are vague and blood culture which remains the gold standard for diagnosis is cumbersome and has poor yield and other forms of sepsis are usually not sought for (anaerobes, viral fungal). The search for newer diagnostic methods is still on going and procalcitonin has shown some promise. The aim of the study is to examine the role procalcitonin plays in neonatal sepsis. A total of 248 neonates with suspicion of sepsis were enrolled and had their samples taken for blood culture, full blood count, C-reactive and procalcitonin assay based on which the neonates were classified as proven, suspected and clinical sepsis. The behaviour of procalcitonin in the different sepsis groups (more elevated in proven and suspected than clinical), ages (to accommodate the physiologic variation seen in the first 72hours of life) and according to isolates (more elevated in gram negative than gram positive sepsis). The diagnostic value of procalcitonin was also determined and found have sensitivity 74.5%, specificity 38.3%, positive predictive value 42.4% and negative predictive value 71.1%, which were better after >72hours of life. For now, procalcitonin should continue to serve as a supportive marker for sepsis as its levels are affected by age of the neonate, sepsis mimics, and type of offending organism causing the infection.
{"title":"The Role of Procalcitonin in Neonatal Sepsis-examining Facts and Misconceptions","authors":"Samaha S Mustapha, Idris Abiodun Adedeji, Amina Bashir Dogara, Muhammad Shamsuddeen Yusuf, Shamsudin Aliyu, Isa Abdulkadir","doi":"10.4103/jcn.jcn_7_24","DOIUrl":"https://doi.org/10.4103/jcn.jcn_7_24","url":null,"abstract":"\u0000 \u0000 Neonatal sepsis has remained a major cause of neonatal morbidity and mortality. Despite advances in neonatal diagnostics, its diagnosis has remained challenging majorly because its symptoms are vague and blood culture which remains the gold standard for diagnosis is cumbersome and has poor yield and other forms of sepsis are usually not sought for (anaerobes, viral fungal). The search for newer diagnostic methods is still on going and procalcitonin has shown some promise.\u0000 \u0000 \u0000 \u0000 The aim of the study is to examine the role procalcitonin plays in neonatal sepsis.\u0000 \u0000 \u0000 \u0000 A total of 248 neonates with suspicion of sepsis were enrolled and had their samples taken for blood culture, full blood count, C-reactive and procalcitonin assay based on which the neonates were classified as proven, suspected and clinical sepsis.\u0000 \u0000 \u0000 \u0000 The behaviour of procalcitonin in the different sepsis groups (more elevated in proven and suspected than clinical), ages (to accommodate the physiologic variation seen in the first 72hours of life) and according to isolates (more elevated in gram negative than gram positive sepsis). The diagnostic value of procalcitonin was also determined and found have sensitivity 74.5%, specificity 38.3%, positive predictive value 42.4% and negative predictive value 71.1%, which were better after >72hours of life.\u0000 \u0000 \u0000 \u0000 For now, procalcitonin should continue to serve as a supportive marker for sepsis as its levels are affected by age of the neonate, sepsis mimics, and type of offending organism causing the infection.\u0000","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"59 ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140769840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Premature newborns face significant risks of reduced bone mineral content ensuing osteopenia which are more likely to occur in high-risk newborns, particularly preterms who are on corticosteroids or diuretics for an extended period or have neuromuscular issues. The methodology prescribed by Arksey and O’Malley was followed. Database searches using PubMed, Scopus, and PEDro were performed for original research published in English between 2011 and 2022. Nine studies have shown that there are few papers on the role of physical therapy in preventing osteopenia of prematurity among newborns. The ability of a newborn to perform functionally is improved by early identification and exercise exposure. This scoping review aims to identify relevant and reliable studies that discuss the use of physical therapy to treat preterm newborns as this will decrease the chances of future complications among children.
{"title":"Interventions to Minimize the Risk of Metabolic Bone Disease of Prematurity among Neonates: A Scoping Review","authors":"Pooja Mehra, Nitesh Verma, Geetanjali Kaul","doi":"10.4103/jcn.jcn_15_24","DOIUrl":"https://doi.org/10.4103/jcn.jcn_15_24","url":null,"abstract":"Premature newborns face significant risks of reduced bone mineral content ensuing osteopenia which are more likely to occur in high-risk newborns, particularly preterms who are on corticosteroids or diuretics for an extended period or have neuromuscular issues. The methodology prescribed by Arksey and O’Malley was followed. Database searches using PubMed, Scopus, and PEDro were performed for original research published in English between 2011 and 2022. Nine studies have shown that there are few papers on the role of physical therapy in preventing osteopenia of prematurity among newborns. The ability of a newborn to perform functionally is improved by early identification and exercise exposure. This scoping review aims to identify relevant and reliable studies that discuss the use of physical therapy to treat preterm newborns as this will decrease the chances of future complications among children.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"175 ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140779072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Osama Y. Muthaffar, Abdullah A. Aldail, Imad M. Khojah, A. Alyazidi, Taif K Alotibi, Lama T. Makki
Despite the vast developments in medical sciences in recent decades, seizures remain a common occurrence among neonates, associated with high rates of morbidity and mortality. The aim of this study was to assess and analyze the presentation and outcome of neonates who were previously exposed to seizures. Following a retrospective research design, this study included 50 cases of neonatal seizures (29 males and 21 females), who were admitted to the neonatal intensive care unit at King Abdulaziz University Hospital, Jeddah City, Saudi Arabia. Data were collected from the hospital records and included all visits between January 2022 and December 2022. The most common types of neonatal seizures were clonic and myoclonic seizures (44% and 28%, respectively). Apgar score at 5 min was <7 in 30% of cases. The main diagnosis was hypoxic-ischemic encephalopathy (HIE) in 28 children (56%), and central nervous system (CNS) infection in 18 children (36%). Children with neonatal seizures mainly received phenobarbital, benzodiazepines, or levetiracetam (48%, 46%, and 36%, respectively). Mechanical ventilation was applied to 20 children (40%). A total of 15 children (30%) had developmental delays, being global delay in 7 children (14%), or motor in 8 children (16%), while 6 children died (12%). Seizures could be controlled in 37 children (74%). Children who presented early (during the 1st week of life) and those who had Apgar scores <7 at 5 min had significantly worse outcomes, with higher case fatality and less seizure control than those who had Apgar scores of 7–10 (P < 0.001). Seizures are a common occurrence among neonates, especially males during the 1st week of their lives. HIE and CNS infections are the main diagnoses. The most administered medications are phenobarbital, benzodiazepines, and levetiracetam. Children who present during their 1st week of life and those who have 5-min Apgar scores <7 have significantly higher case fatality and less seizure control.
{"title":"Etiologies and Seizure Outcome of Neonatal Seizures: A Tertiary University Hospital Experience","authors":"Osama Y. Muthaffar, Abdullah A. Aldail, Imad M. Khojah, A. Alyazidi, Taif K Alotibi, Lama T. Makki","doi":"10.4103/jcn.jcn_8_24","DOIUrl":"https://doi.org/10.4103/jcn.jcn_8_24","url":null,"abstract":"\u0000 \u0000 Despite the vast developments in medical sciences in recent decades, seizures remain a common occurrence among neonates, associated with high rates of morbidity and mortality.\u0000 \u0000 \u0000 \u0000 The aim of this study was to assess and analyze the presentation and outcome of neonates who were previously exposed to seizures.\u0000 \u0000 \u0000 \u0000 Following a retrospective research design, this study included 50 cases of neonatal seizures (29 males and 21 females), who were admitted to the neonatal intensive care unit at King Abdulaziz University Hospital, Jeddah City, Saudi Arabia. Data were collected from the hospital records and included all visits between January 2022 and December 2022.\u0000 \u0000 \u0000 \u0000 The most common types of neonatal seizures were clonic and myoclonic seizures (44% and 28%, respectively). Apgar score at 5 min was <7 in 30% of cases. The main diagnosis was hypoxic-ischemic encephalopathy (HIE) in 28 children (56%), and central nervous system (CNS) infection in 18 children (36%). Children with neonatal seizures mainly received phenobarbital, benzodiazepines, or levetiracetam (48%, 46%, and 36%, respectively). Mechanical ventilation was applied to 20 children (40%). A total of 15 children (30%) had developmental delays, being global delay in 7 children (14%), or motor in 8 children (16%), while 6 children died (12%). Seizures could be controlled in 37 children (74%). Children who presented early (during the 1st week of life) and those who had Apgar scores <7 at 5 min had significantly worse outcomes, with higher case fatality and less seizure control than those who had Apgar scores of 7–10 (P < 0.001).\u0000 \u0000 \u0000 \u0000 Seizures are a common occurrence among neonates, especially males during the 1st week of their lives. HIE and CNS infections are the main diagnoses. The most administered medications are phenobarbital, benzodiazepines, and levetiracetam. Children who present during their 1st week of life and those who have 5-min Apgar scores <7 have significantly higher case fatality and less seizure control.\u0000","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"352 3","pages":""},"PeriodicalIF":0.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140778663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Valeria Silecchia, Andrea Cattarozzi, Stefano Piermarocchi, Marco Tavolato
A term male newborn small for gestational age and with microcephaly was born from uncomplicated vaginal delivery. Pregnancy was not followed up until 32 weeks. Maternal serologies and vaginal/rectal swabs were negative. Routine ophthalmoscopy revealed hemovitreous in the right eye and massive retinal hemorrhages (RH) in the left eye; subsequent RetCam II examination with fluorescein angiography revealed bilateral RH, involving the fovea in the left eye. Retinal vascularization was normal in both eyes, without signs of ischemic injury or pathological angiogenesis. Complete blood count, coagulation, and thrombophilic studies were normal; a toxicology screen, performed on a hair sample from both mother and infant, was positive for cocaine. With its significant vasoconstrictive effects, cocaine may induce ischemic-hypoxic damage in the developing retinal vascular system of the fetus, leading to extensive RH. Although cocaine-related RH is indistinguishable from other birth-related RH, the formers persist for longer periods, warranting prolonged follow-up and long-term evaluation of visual function.
{"title":"Retinal Hemorrhages in a Newborn with Prenatal Cocaine Exposure","authors":"Valeria Silecchia, Andrea Cattarozzi, Stefano Piermarocchi, Marco Tavolato","doi":"10.4103/jcn.jcn_18_24","DOIUrl":"https://doi.org/10.4103/jcn.jcn_18_24","url":null,"abstract":"A term male newborn small for gestational age and with microcephaly was born from uncomplicated vaginal delivery. Pregnancy was not followed up until 32 weeks. Maternal serologies and vaginal/rectal swabs were negative. Routine ophthalmoscopy revealed hemovitreous in the right eye and massive retinal hemorrhages (RH) in the left eye; subsequent RetCam II examination with fluorescein angiography revealed bilateral RH, involving the fovea in the left eye. Retinal vascularization was normal in both eyes, without signs of ischemic injury or pathological angiogenesis. Complete blood count, coagulation, and thrombophilic studies were normal; a toxicology screen, performed on a hair sample from both mother and infant, was positive for cocaine. With its significant vasoconstrictive effects, cocaine may induce ischemic-hypoxic damage in the developing retinal vascular system of the fetus, leading to extensive RH. Although cocaine-related RH is indistinguishable from other birth-related RH, the formers persist for longer periods, warranting prolonged follow-up and long-term evaluation of visual function.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"416 ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140763661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Manuela Cardoso, Leonor Figueiredo, André Moreira-Rosário, José Camolas, D. Virella, Israel Macedo, Luís Pereira-da-Silva
In standard fortification of human milk (HM), the HM macronutrient content is assumed, and a fixed amount of a multinutrient fortifier is added to achieve recommended nutrient intakes. In target fortification, the HM macronutrient content is regularly measured, guiding the addition of modular macronutrient supplements to the fortified HM, to achieve the nutritional targets more precisely. The study aimed to investigate whether this addition of modular supplements, unaccompanied by mineral supplementation, predispose to metabolic bone disease (MBD). This is a secondary analysis of a larger study of infants born with <33 weeks gestational age. Fortifications based on the assumed (Group 1) or measured (Group 2) of the HM macronutrient content were compared, using low serum phosphate levels as an indicator of MBD, and length growth as a surrogate of bone growth. Eighty-four infants were included, 35 in Group 1 and 49 in Group 2. During the exposure period, infants of Group 2 received higher mean fat (6.1 vs. 5.3 g/kg/day, P < 0.001) and carbohydrate (13.0 vs. 11.7 g/kg/day, P < 0.001) intakes; in addition, they exhibited lower mean serum phosphate (5.5 vs. 6.0 mg/dL, P = 0.022) and faster mean length velocity (1.06 vs. 0.89 cm/week, P = 0.003). These findings suggest that feeding fortified HM with extra fat and carbohydrate content, unaccompanied by mineral supplementation, promotes increased bone growth, as indicated by accelerated length growth, but with insufficiently mineralized osteoid, indicated by low serum phosphate levels. Intervention studies using direct biomarkers of bone mass content and mineral density are necessary to corroborate our findings.
{"title":"The Effect of Unadjusted Mineral Supplementation on Bone Health of Preterm Infants Fed Fortified Human Milk: An Exploratory Analysis","authors":"Manuela Cardoso, Leonor Figueiredo, André Moreira-Rosário, José Camolas, D. Virella, Israel Macedo, Luís Pereira-da-Silva","doi":"10.4103/jcn.jcn_10_24","DOIUrl":"https://doi.org/10.4103/jcn.jcn_10_24","url":null,"abstract":"\u0000 \u0000 In standard fortification of human milk (HM), the HM macronutrient content is assumed, and a fixed amount of a multinutrient fortifier is added to achieve recommended nutrient intakes. In target fortification, the HM macronutrient content is regularly measured, guiding the addition of modular macronutrient supplements to the fortified HM, to achieve the nutritional targets more precisely.\u0000 \u0000 \u0000 \u0000 The study aimed to investigate whether this addition of modular supplements, unaccompanied by mineral supplementation, predispose to metabolic bone disease (MBD).\u0000 \u0000 \u0000 \u0000 This is a secondary analysis of a larger study of infants born with <33 weeks gestational age. Fortifications based on the assumed (Group 1) or measured (Group 2) of the HM macronutrient content were compared, using low serum phosphate levels as an indicator of MBD, and length growth as a surrogate of bone growth.\u0000 \u0000 \u0000 \u0000 Eighty-four infants were included, 35 in Group 1 and 49 in Group 2. During the exposure period, infants of Group 2 received higher mean fat (6.1 vs. 5.3 g/kg/day, P < 0.001) and carbohydrate (13.0 vs. 11.7 g/kg/day, P < 0.001) intakes; in addition, they exhibited lower mean serum phosphate (5.5 vs. 6.0 mg/dL, P = 0.022) and faster mean length velocity (1.06 vs. 0.89 cm/week, P = 0.003).\u0000 \u0000 \u0000 \u0000 These findings suggest that feeding fortified HM with extra fat and carbohydrate content, unaccompanied by mineral supplementation, promotes increased bone growth, as indicated by accelerated length growth, but with insufficiently mineralized osteoid, indicated by low serum phosphate levels. Intervention studies using direct biomarkers of bone mass content and mineral density are necessary to corroborate our findings.\u0000","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"98 ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140783895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Afshari, Soleyman Saravani, Ali Azarsa, M. Moosazadeh
Introduction: Sistan area is a developing region located in the eastern part of Iran. According to the literature reviews, no evidence of the frequency of breastfeeding during the last decade in this area was found. Therefore, the aim of this study is determining the frequency of breastfeeding and its related factors in this region. Materials and Methods: This cross-sectional study was carried out in the rural areas of Sistan region in 2019 among 408 mothers with infants under 2 years. Samples were randomly selected proportional to the size of the target population of the health centers. Data collection tool was a checklist including the mother age, infant's gender, birth rank, parents' job, parents' education, weight/height of mother, infant's birth weight, gestational age, family income, ethnicity, type of delivery, exclusive breastfeeding in 4-, 5-, and 6-month age, breastfeeding in 12-month age, and skin contact immediately after birth and rooming in during the first 24 h. Results: Frequency of early initiation of breastfeeding (EIBF) in the 1st h, 4, 5, and 6 months after childbirth were 80.1%, 95.8%, 73.8%, and 71.7%, respectively. The frequency of EIBF during the 1st h of life was higher in boy neonates than girl ones (87.8% vs. 75.5%, respectively, P = 0.001). Moreover, it was significantly higher among Fars ethnicities than Baloch ethnicities (83.1% vs. 69.8%, respectively, P = 0.021). Logistic regression models showed that the father's job, parents' education, family income, ethnicity, and duration of pregnancy were determinant factors of exclusive breastfeeding in the 1st h of childbirth. Conclusion: The present study showed that one-fifth of the infants are deprived from exclusive breastfeeding, especially in the 1st h after birth. Such situation is affected by several socioeconomic and cultural factors which should be managed by effective interventions for promotion of the exclusive breastfeeding indicators.
{"title":"Breastfeeding in sistan area: A cross-sectional survey in Eastern Iran","authors":"M. Afshari, Soleyman Saravani, Ali Azarsa, M. Moosazadeh","doi":"10.4103/jcn.jcn_22_23","DOIUrl":"https://doi.org/10.4103/jcn.jcn_22_23","url":null,"abstract":"Introduction: Sistan area is a developing region located in the eastern part of Iran. According to the literature reviews, no evidence of the frequency of breastfeeding during the last decade in this area was found. Therefore, the aim of this study is determining the frequency of breastfeeding and its related factors in this region. Materials and Methods: This cross-sectional study was carried out in the rural areas of Sistan region in 2019 among 408 mothers with infants under 2 years. Samples were randomly selected proportional to the size of the target population of the health centers. Data collection tool was a checklist including the mother age, infant's gender, birth rank, parents' job, parents' education, weight/height of mother, infant's birth weight, gestational age, family income, ethnicity, type of delivery, exclusive breastfeeding in 4-, 5-, and 6-month age, breastfeeding in 12-month age, and skin contact immediately after birth and rooming in during the first 24 h. Results: Frequency of early initiation of breastfeeding (EIBF) in the 1st h, 4, 5, and 6 months after childbirth were 80.1%, 95.8%, 73.8%, and 71.7%, respectively. The frequency of EIBF during the 1st h of life was higher in boy neonates than girl ones (87.8% vs. 75.5%, respectively, P = 0.001). Moreover, it was significantly higher among Fars ethnicities than Baloch ethnicities (83.1% vs. 69.8%, respectively, P = 0.021). Logistic regression models showed that the father's job, parents' education, family income, ethnicity, and duration of pregnancy were determinant factors of exclusive breastfeeding in the 1st h of childbirth. Conclusion: The present study showed that one-fifth of the infants are deprived from exclusive breastfeeding, especially in the 1st h after birth. Such situation is affected by several socioeconomic and cultural factors which should be managed by effective interventions for promotion of the exclusive breastfeeding indicators.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"12 1","pages":"109 - 114"},"PeriodicalIF":0.2,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47828423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Hypoglycemia is common among healthy babies in the hours following delivery, as part of their necessary adjustments needed to survive outside the uterus. Although this condition has been proven to be temporary and remits spontaneously, the use of prelacteal feeds is still common due to the false impression of low blood glucose levels in newborns who are thought to have not been breastfed adequately. Objective: The objectives were to proffer a profile of blood glucose levels for healthy newborns in the first 24 h of life and to document signs of hypoglycemia among newborns with low blood glucose levels. Materials and Methods: This was a longitudinal study conducted over 6 weeks among 240 exclusively breastfed, healthy newborns delivered at Obio Cottage Hospital. The Finetest glucometer was used to measure blood glucose at the bedside at birth, three, 12, and 24 h. Results: The newborns comprised 137 (57.1%) males and 103 (42.9%) females. One hundred and ninety (79.2%) babies were born by spontaneous vertex delivery (SVD) and 50 (20.8%) by elective cesarean section. One (0.4%) newborn, delivered by SVD had asymptomatic hypoglycemia with a blood glucose level of 2.1 mmol/L at 3 h of life. A repeat random blood glucose testing done after an additional feed was 3.5 mmol/L and remained normal throughout the study. The mean blood glucose profile for the study population were 4.48 ± 1.09, 3.68 ± 0.65, 3.71 ± 0.55, and 4.09 ± 0.51 mmol/L at birth, 3, 12, and 24 h of life, respectively. Conclusion: Healthy newborns have normal blood glucose profiles in the first 24 h of life.
{"title":"Blood glucose profile of exclusively breastfed healthy newborns in the first 24 H of life at Obio Cottage Hospital, Rivers State","authors":"Chidiebere Chukwuma, P. Tabansi, P. Opara","doi":"10.4103/jcn.jcn_39_23","DOIUrl":"https://doi.org/10.4103/jcn.jcn_39_23","url":null,"abstract":"Background: Hypoglycemia is common among healthy babies in the hours following delivery, as part of their necessary adjustments needed to survive outside the uterus. Although this condition has been proven to be temporary and remits spontaneously, the use of prelacteal feeds is still common due to the false impression of low blood glucose levels in newborns who are thought to have not been breastfed adequately. Objective: The objectives were to proffer a profile of blood glucose levels for healthy newborns in the first 24 h of life and to document signs of hypoglycemia among newborns with low blood glucose levels. Materials and Methods: This was a longitudinal study conducted over 6 weeks among 240 exclusively breastfed, healthy newborns delivered at Obio Cottage Hospital. The Finetest glucometer was used to measure blood glucose at the bedside at birth, three, 12, and 24 h. Results: The newborns comprised 137 (57.1%) males and 103 (42.9%) females. One hundred and ninety (79.2%) babies were born by spontaneous vertex delivery (SVD) and 50 (20.8%) by elective cesarean section. One (0.4%) newborn, delivered by SVD had asymptomatic hypoglycemia with a blood glucose level of 2.1 mmol/L at 3 h of life. A repeat random blood glucose testing done after an additional feed was 3.5 mmol/L and remained normal throughout the study. The mean blood glucose profile for the study population were 4.48 ± 1.09, 3.68 ± 0.65, 3.71 ± 0.55, and 4.09 ± 0.51 mmol/L at birth, 3, 12, and 24 h of life, respectively. Conclusion: Healthy newborns have normal blood glucose profiles in the first 24 h of life.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"12 1","pages":"86 - 90"},"PeriodicalIF":0.2,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42003366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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