Activin-A is a protein over-expressed and secreted by the brain after neuronal destruction. We evaluated whether serum activin-A increases in asphyxiated full-term newborns (AFTNs) at risk of hypoxic-ischemic-encephalopathy (HIE). 105 consecutive infants (35 affected by perinatal asphyxia due to acute fetal distress; 70 healthy gestational-age matched newborns) underwent cranial assessment and neurologic examination at 12, 24 and 72 hours after birth and, on discharge from the hospital and; activin-A and monitoring laboratory variables assessment at birth. According to the occurrence of HIE within 7-days after birth, AFTNs were subdivided in Group A (n= 20; no/mild HIE with good prognosis) and Group B (n= 15; moderate/severe HIE with a greater risk of neurological handicap). Activin-A was significantly (P less than 0.0001) higher in Groups A and B than controls and highest (P less than 0.001) in Group B. At 0.66 ng/L activin-A achieved a sensitivity of 93.33 per cent and a specificity of 96.63 per cent, respectively, as HIE diagnostic test. These findings show that activin A increased in AFTNs with HIE before the appearance of related signs.
Urinary S100A1B and S100BB were measured to detect cases at risk of hypoxic-ischemic encephalopathy (HIE) in asphyxiated newborns. We recruited 42 asphyxiated infants and 63 healthy term neonates. S100A1B and S100BB were measured at first urination (time 0) and at 4 (time 1), 8 (time 2), 12 (time 3), 16 (time 4), 20 (time 5), 24 (time 6), 72 (time 7) hours after birth. 20 infants had no/mild HIE with good prognosis (Group A) and 22 had moderate/severe HIE with a greater risk of neurological handicap (Group B). Urine S100A1B and S100BB levels were significantly (P less than 0.0.01, for all) higher at all monitoring time-points in Group B than Group A and controls, but not between Group A and controls. Both S100A1B and S100BB have great sensitivity and specificity for HIE since their first measurement. In conclusion, S100A1B and S100BB are increased in urine collected from asphyxiated newborns who will develop HIE since first urination, and their measurement may be useful to early predict HIE when monitoring procedures are still of no avail.
Fetal growth restriction (intra-uterine growth restriction [IUGR]) has a considerable impact on perinatal morbidity. Preterm IUGR infants are prone to impaired intestine function. Near-infrared spectroscopy (NIRS) has been used to monitor oxygenation status of the brain and of the intestine.We conducted a prospective case-control study at our NICU in 20 preterm infants of whom 10 infants complicated by compared with 10 non-IUGR preterm infants. Splanchnic and cerebral regional oximetry values were measured with NIRS. Three hours of consecutive recordings were performed in the first 24 h of life, T0, and during the transitional period, T1. The cerebral/splanchnic oxygenation ratio, CSOR, (cerebral regional saturations [rScO2]/splanchnic regional saturations [rSsO2]) was also calculated.Both in the IUGR and the non-IUGR infants, at T0 and T1 monitoring time-points, the rSO2 values were higher in the cerebral district when compared to those of the splanchnic area. Comparison of the NIRS parameters between the IUGR and non-IUGR infants at T0 showed no difference in rScO2, while rSsO2 was significantly lower in the IUGR group. At T1, rScO2 was significantly lower and rSsO2 higher in the IUGR group.Cerebral/splanchnic vascular adaptation of IUGR infants to the extra-uterine environment is characterized by a postnatal persistence of the brain sparing effect with reperfusion in the transitional period.
In utero exposure to maternal hyperglycemia and obesity can trigger detrimental effects in the newborn through epigenetic programming. We aimed to assess the DNA methylation levels in the promoters of
With this study, we evaluated the short-term effects of different modes and settings of noninvasive respiratory support on gas exchange, breathing parameters, and thoracoabdominal synchrony in preterm infants in the acute phase of moderate respiratory distress syndrome.A feasibility crossover trial was conducted in neonates < 32 weeks' gestation on nasal continuous positive airway pressure (n-CPAP) or bilevel n-CPAP. Infants were delivered the following settings in consecutive order for 10 minutes each: • n-CPAP (5 cm H2O) • bilevel n-CPAP 1 (Pres low = 5 cm H2O, Pres high = 7 cm H2O, T-high = 1 second, rate = 30/min) • n-CPAP (5 cm H2O) • bilevel n-CPAP 2 (Pres low = 5 cm H2O, Pres high = 7 cm H2O, T-high = 2 second, rate = 15/min) • n-CPAP (5 cm H2O). During each phase, physiologic parameters were recorded; the thoracoabdominal synchrony expressed by the phase angle (Φ) and other respiratory patterns were monitored by noncalibrated respiratory inductance plethysmography.Fourteen preterm infants were analyzed. The mean CPAP level was significantly lower in the n-CPAP period compared with bilevel n-CPAP 1 and 2 (p = 0.03). Higher values were achieved with bilevel n-CPAP 2 (6.2 ± 0.6 vs. 5.7 ± 0.5 cm H2O, respectively; p < 0.05). No statistical difference in the Φ was detected, nor between the three settings.Our study did not show any superiority of bilevel n-CPAP over n-CPAP. However, nonsynchronized bilevel n-CPAP might be helpful when additional pressure is needed.· There is currently a high degree of uncertainty about the superiority of one modality and setting of noninvasive respiratory over another.. · Our study confirmed that non-synchronized bilevel n-CPAP might be helpful when additional pressure is needed for recruitment.. · A T-high of 1 second could possibly be better tolerated in this population, but further research is needed..
In the last decades, the prevention and treatment of neonatal respiratory distress syndrome with antenatal steroids and surfactant replacement allowed the survival of infants born at extremely low gestational ages. These extremely preterm infants are highly vulnerable to the detrimental effects of oxidative stress and infection, and are prone to develop lung and brain diseases that eventually evolve in severe sequelae: The so-called new bronchopulmonary dysplasia (BPD) and the noncystic, diffuse form of periventricular leukomalacia (PVL). Tissue simplification and developmental arrest (larger and fewer alveoli and hypomyelination in the lungs and brain, respectively) appears to be the hallmark of these emerging sequelae, while fibrosis is usually mild and contributes to a lesser extent to their pathogenesis. New data suggest that loss of stem/progenitor cell populations in the developing brain and lungs may underlie tissue simplification. These observations constitute the basis for the application of stem cell-based protocols following extremely preterm birth. Transplantation of different cell types (including, but not limited to, mesenchymal stromal cells, endothelial progenitor cells, human amnion epithelial cells) could be beneficial in preterm infants for the prevention and/or treatment of BPD, PVL and other major sequelae of prematurity. However, before this new knowledge can be translated into clinical practice, several issues still need to be addressed in preclinical in vitro and in vivo models.
Intrauterine growth retardation (IUGR) is thought to reflect suppression of genetic growth potential by decreased supplies of oxygen and substrate (1). NO supplementation may be useful in IUGR to increase uteroplacental circulation (2)(3)(4)(5). The use of biochemical markers to assess the extent of brain distress associated with NO treatment could be appropriate. S100B is an acidic calcium-binding protein of the EF-hand family concentrated in the nervous system (6). The appearance of S100B in biological fluids is an indicator of brain distress in both infants and adults (7)(8)(9)(10). Recently, blood S100B concentrations in the perinatal period have been shown to correlate with brain maturation and damage (11)(12)(13)(14).
We investigated the effect of maternal NO supplementation on brain distress in IUGR fetuses as assessed by cord blood S100B. We selected 51 pregnant women (gestational age, 27–35 weeks) with IUGR fetuses and impaired uteroplacental blood flow. Exclusion criteria included multiple pregnancies, gestational and type 1 diabetes, maternal infections and fever, fetal malformations and chromosomal abnormalities, metabolic diseases, and maternal diseases of the central nervous system. Patients were assigned, by use of computer-generated random numbers, to receive either placebo (n = 25) or transdermal glyceryl trinitrate (Nitroderm TTS; Ciba-Geigy) at a dose of 5 mg/16 h daily until delivery (n = 26). Placebo and glyceryl trinitrate patches were indistinguishable and were numbered and contained in identical envelopes so that patients did not know the group to which they were recruited. Similarly, neither the physicians nor the investigators who analyzed the samples knew which patients were treated with placebo and which with glyceryl trinitrate patches. The local ethics committee approved the study, and written informed consent was obtained from all participants.
Two patients in the glyceryl …
