To date, there is no overarching proposition for the ontogenetic-neurobiological basis of self-re... more To date, there is no overarching proposition for the ontogenetic-neurobiological basis of self-regulation. This paper suggests that the balanced self-regulatory reaction of the fetus, newborn and infant is based on a complex mechanism starting from early brainstem development and continuing to progressive control of the cortex over the brainstem. It is suggested that this balance occurs through the synchronous reactivity between the sympathetic and parasympathetic systems, both which originate from the brainstem. The paper presents an evidence-based approach in which molecular excitation-inhibition balance, interchanges between excitatory and inhibitory roles of neurotransmitters as well as cardiovascular and white matter development across gestational ages, are shown to create sympathetic-parasympathetic synchrony, including the postnatal development of electroencephalogram waves and vagal tone. These occur in developmental milestones detectable in the same time windows (sensitive ...
on behalf of the International Network for Evaluating Outcomes of Neonates (iNeo) Investigators* ... more on behalf of the International Network for Evaluating Outcomes of Neonates (iNeo) Investigators* Objectives To assess associations between neonatal intensive care unit (NICU)-level patent ductus arteriosus (PDA) treatment rates (pharmacologic or surgical) and neonatal outcomes. Study design This cohort study included infants born at 24-28 weeks of gestation and birth weight <1500 g in 2007-2015 in NICUs caring for ³100 eligible infants in 6 countries. The ratio of observed/expected (O/E) PDA treatment rates was derived for each NICU by estimating the expected rate using a logistic regression model adjusted for potential confounders and network. The primary composite outcome was death or severe neurologic injury (grades III-IV intraventricular hemorrhage or periventricular leukomalacia). The associations between the NICU-level O/E PDA treatment ratio and neonatal outcomes were assessed using linear regression analyses including a quadratic effect (a square term) of the O/E PDA treatment ratio. Results From 139 NICUs, 39 096 infants were included. The overall PDA treatment rate was 45% in the cohort (13%-77% by NICU) and the O/E PDA treatment ratio ranged from 0.30 to 2.14. The relationship between the O/ E PDA treatment ratio and primary composite outcome was U-shaped, with the nadir at a ratio of 1.13 and a significant quadratic effect (P<.001). U-shaped relationships were also identified with death, severe neurologic injury, and necrotizing enterocolitis. Conclusions Both low and high PDA treatment rates were associated with death or severe neurologic injury, whereas a moderate approach was associated with optimal outcomes. (J Pediatr 2020;-:1-6). N eonatologists have debated treatment strategies for hemodynamically significant patent ductus arteriosus (PDA) in preterm infants for decades. 1-3 The presence and treatment of a PDA have been variably associated with mortality as well as short-and long-term adverse outcomes. 4-8 Although some studies support conservative management that minimizes PDA treatment, 9-12 other studies report that early, active PDA treatment prevented mortality, pulmonary hemorrhage, and severe intraventricular hemorrhage (IVH). 13-15 The consequences of the left to right shunt via ductus arteriosus include pulmonary edema, congestive heart failure, and reduced systemic flow leading to ischemia of peripheral organs. These have been cited to justify active PDA treatment, however, both pharmacologic 16,17 and surgical treatments 8,18-20 have potential adverse effects. Furthermore, meta-analyses of PDA treatment trials have not shown improvements in outcomes, prompting calls against treating PDAs in preterm infants. 21,22 Because most previous trials allowed open-label rescue PDA treatment in placebo or control group, the meta-analyses did not assure the safety of complete abandonment of PDA treatment. Furthermore, PDA treatment may vary in timing (prophylaxis, early, or late), modalities (pharmacologic or surgical treatment), and target populations (gestational ages, PDA severity). The current From the
OBJECTIVE To compare length of stay (LOS) in neonatal care for extremely preterm babies admitted ... more OBJECTIVE To compare length of stay (LOS) in neonatal care for extremely preterm babies admitted to networks participating in the International Network for Evaluating Outcomes of Neonates (iNeo). STUDY DESIGN Data were extracted for babies admitted from 2014 to 2016 and born at 24 to 28 weeks' gestational age (n= 28,204). Median LOS was calculated for each network for babies who survived and those who died while in neonatal care. A linear regression model was used to investigate differences in LOS between networks after adjusting for gestational age, birthweight z-score, sex, and multiplicity. A sensitivity analysis was conducted for babies who were discharged home directly. RESULTS Observed median LOS for babies who survived was longest in Japan (107 days); this result persisted after adjustment (20.7 days more than reference, 95% CI: 19.3 to 22.1). Finland had the shortest adjusted LOS (-4.8 days less than reference, 95% CI: -7.3 to -2.3). For each week's increase in gestational age at birth, LOS decreased by 12.1 days (95% CI: -12.3 to -11.9). Multiplicity and male sex predicted mean increases in LOS of 2.6 (95% CI: 2.0 to 3.2) and 2.1 (95% CI: 1.6 to 2.6) days, respectively.results CONCLUSIONS: We identified between-network differences in LOS of up to three weeks for extremely preterm babies. Some of these may be partly explained by differences in mortality, but unexplained variations may also be related to differences in clinical care practices and healthcare systems between countries. CONCLUSION
CPK-BB (CK-BB) isoenzyme is an intracellular enzyme released in various neurologic conditions, in... more CPK-BB (CK-BB) isoenzyme is an intracellular enzyme released in various neurologic conditions, including central nervous system (CNS) infections. Activity of CK-BB in cerebrospinal fluid (CSF) was determined in 80 children by electrophoresis and densitometry. The possible correlation between CNS infection and CK concentrations was assessed. Significantly elevated concentrations of CK activity (P <0.01) in the CSF were found in children with bacterial meningitis as compared with children with either aseptic meningitis or normal CSF findings. The data suggest the possibility of utilizing CSF CK activity to differentiate between bacterial and viral meningitis in situations where a routine CSF examination is inconclusive.
PROBLEM: To investigate whether the mode of delivery or the drugs given to the mother during labo... more PROBLEM: To investigate whether the mode of delivery or the drugs given to the mother during labor may affect the newborns' immune system. METHOD OF STUDY Three groups of term newborns were included: A, spontaneously delivered with i.v. analgesia (n = 37); B, spontaneously delivered with epidural analgesia (n = 26); and C, delivered by cesarean section under general anesthesia (n = 29). Natural killer (NK) cell cytotoxicity, mitogenic response, and the capacity of peripheral blood mononuclear cells (PBMCs) to produce interleukin (1L)-1 p, IL-2, IL-3, IL-6, and tumor necrosis factor (TNF)-a were examined. RESULTS: NK cell cytotoxicity increased significantly in all three groups of newborns on the second day of life. Decreased IL-2 production was observed in newborns delivered by cesarean section. Spontaneous IL-1p secretion was higher in newborns to mothers treated with epidural analgesia. Spontaneous IL-6 secretion was elevated in infants to mothers undergoing general anesthesia and surgery or epidural analgesia. TNF-a production was increased in newborns delivered by cesarean section. CONCLUSION: The immune response of the newborn is affected by the mode of delivery and/or drugs given to the mother during labor.
Cannabis, commonly called marijuana, is often used during pregnancy, likely due to the perception... more Cannabis, commonly called marijuana, is often used during pregnancy, likely due to the perception that it is a "safe" drug. Changes in legislation in many countries have lead to the increased availability of this drug and to its increasing use during pregnancy, often with other concomitant exposures such as alcohol, tobacco, and other drugs. Herein, we review the medical literature regarding effects of marijuana on the fetus and newborn. Possible effects of in utero exposure to marijuana focus on fetal growth, increase in the rates of stillbirth and preterm delivery, congenital malformations, and neurodevelopmental effects on the child. Published studies for all these outcomes are inconsistent. Fetal weight growth may be somewhat decreased, but the magnitude of this decrease is no greater than 100 g. There is insufficient evidence to conclude on any effect on the stillbirth rate. Although there are some reports of a slight increase in the rate of prematurity, most reports ...
Scandinavian Journal of Urology and Nephrology, 1998
We performed a retrospective analysis of all patients admitted to our institution with a diagnosi... more We performed a retrospective analysis of all patients admitted to our institution with a diagnosis of infantile hypertrophic pyloric stenosis (IHPS) during a 10-year period from 1985-95 in order to assess the possible association between IHPS and urinary tract infections (UTIs). All 285 patients with IHPS had radiological or ultrasonographic confirmation of that diagnosis and underwent the Ramstedt procedure. Those who continued to be symptomatic were evaluated for UTI by urine analysis and culture. Positive cases were further evaluated for urinary system anomalies. The male:female ratio of IHPS was 3.4:1. Concomitant UTI was diagnosed in 8 patients by suprapubic aspiration or bladder catheterization. The prevalence of UTI in this series was 2.8%, 20-fold higher than the expected prevalence. Three of the 8 patients with UTI (37.5%) had urinary tract anomalies. These findings suggest an association between IHPS and UTI. We recommend that all IHPS patients be evaluated for UTI and positive cases undergo further evaluation for urinary anomalies.
Objective To compare the efficacy and reliability of two pulse-oximeters (POx) (Masimo Radical-7 ... more Objective To compare the efficacy and reliability of two pulse-oximeters (POx) (Masimo Radical-7 and Nellcor ™ Oxymax Bedside) and evaluate the feasibility of routine ECG monitoring during delivery room transition. Study design Prospective observational comparative study. Sixty newborns were connected simultaneously to both POxs and ECG monitor (as a gold standard for HR). Times to achieve a stable signal were compared. Heart rates were compared to simultaneous ECG. Results A significant difference in times to stable signal was found: Mean, Median (Interquartile range) for Nellcor and Masimo, were 15, 8.5 (6-18) and 27, 12 (9-34) seconds, respectively. Compared to ECG, false bradycardia was displayed in 18 of 55 (35%) newborns by the Masimo POx and in no newborns by the Nellcor POx. Attaching the ECG monitor was feasible but consumed additional resources. Conclusions The time for achievement of a stable saturation reading in an uncomplicated resuscitation setting differed significantly between POxs.
Objectives: Neonatal late-onset sepsis work-up is a frequent occurrence in every neonatal departm... more Objectives: Neonatal late-onset sepsis work-up is a frequent occurrence in every neonatal department. Blood cultures are the diagnostic gold standard, however, a negative culture prior to 48–72 h is often considered insufficient to exclude sepsis. We aimed to develop a decision tree which would enable exclusion of late-onset sepsis within 24 h using clinical and laboratory variables. Study Design: Infants evaluated for late-onset sepsis during the years 2016–2019, without major malformations, in a tertiary neonatal center were eligible for inclusion. Blood cultures and clinical and laboratory data were extracted at 0 and 24 h after sepsis work-up. Infants with bacteriologically confirmed late-onset sepsis were compared to matched control infants. Univariate logistic regression identified potential risk factors. A decision tree based on Chi-square automatic interaction detection methodology was developed and validated. Results: The study cohort was divided to a development cohort (10...
Background: Hepatitis B virus (HBV) vaccination has decreased the prevalence of chronic HBV infec... more Background: Hepatitis B virus (HBV) vaccination has decreased the prevalence of chronic HBV infections and their sequelae. However, whether vaccination at birth provides lifelong protection is unclear. Objective: To assess long-term immunity following neonatal HBV immunization in a large populationbased cohort. Methods: Using the database of a 2 million member sick fund in Israel, we identified all subjects born after introduction of universal HBV vaccination in Israel (January 1992 through December 2014), that were tested for hepatitis B surface antibody (anti-HBs Ab's). Years since vaccination were categorized into 5-year groups and linear trends in the seroprevalence of HBV immunity were calculated. Anamnestic response and presence of Hepatitis B surface antigen (HBs Ag) were assessed. Results: Included were 20,634 tested individuals. Mean (±SD) age at testing was 14.8 (±5.4) years. Mean anti-HBs Ab levels declined with time to 16.39 mIU/ml in the 15-20 year group (P < 0.001). The proportion of negative results increased gradually (P < 0.001) to 66.7% after 15 years. Anamnestic response assessment showed that 604 of 644 seronegative subjects (93.8%, 95% CI: 91.6-95.5%) became seropositive after a booster dose. HBs Ag was identified in 91 of the 20,634 (4.4 per 1000 study participants). Conclusions: Following vaccination, anti-HB's Ab's progressively decline, with only a third of the population retaining protective levels after 15 years. In adolescence, anamnestic response shows that nearly all revaccinated adolescents exhibit immunity. A low rate of Hepatitis B infection was demonstrated despite vaccination of nearly all newborns.
The Israel Neonatal Network (INN) is a voluntary consortium of all neonatal departments in Israel... more The Israel Neonatal Network (INN) is a voluntary consortium of all neonatal departments in Israel. The Israel National Very Low Birth Weight (VLBW) Infant Database was established in 1995 under the auspices of the INN. The main objectives of the database are the application of quality data for the assessment of morbidity and mortality trends of VLBW infants; benchmarking of individual neonatal unit performance in comparison to national data; quality of care and management; planning of national, regional and institutional structure and policy development; longitudinal developmental assessment and for collaborative research programs. Data are reported for all live born infants of birthweight ≤1,500 g, irrespective of the gestational age at birth. From 1995 through 2019, the database includes reports on 39,000 VLBW infants and 33,000 mothers encompassing over 99.5% of all VLBW live births in Israel. The minimal data set includes parental demographic details, maternal pregnancy history, treatments and complications, antenatal care, details of the delivery, infant's status at delivery, infant's diagnoses, procedures and complications during hospitalization and outcome at discharge. The predominant activity of the database relates to data collection, collation and presentation of the data in unique annual reports for each of the participating Neonatal intensive care units (NICUs) and an annual national report presented to departmental, institutional and governmental health care leaders. The database provides a research platform for all participants in the INN. More than 60 neonatologists, obstetricians and epidemiologists from 15 different hospitals and organizations have undertaken and published studies in the context of the database. The Israel Neonatal Society has promoted, initiated and coordinated two major quality improvement programs encompassing all INN collaborators, aimed at reducing the rate of blood stream infections and the rate of severe intraventricular hemorrhage among very preterm infants.
Objective Normal initial blood glucose values in healthy newborns are not well defined and are su... more Objective Normal initial blood glucose values in healthy newborns are not well defined and are subject to controversy. Despite substantive research, there is no single initial value of glucose that can be used with certainty of safety in newborns, and thus various protocols and cutoffs have been proposed. Study Design We sought to characterize the normal values of blood glucose levels in a large cohort of neonates admitted to the well-baby nursery in Shaare Zedek Medical Center. The blood glucose levels were measured with a point of care (POC) glucometer (Accu-Chek Performa) within 180 minutes after birth. Results The study population included 3,912 newborns with a mean birth weight of 3,322 ± 439 g and a mean gestational age of 39.4 ± 1.3 weeks. Sampling was performed at a median age of 73 minutes (interquartile range [IQR], 55–92 minutes). Median glucose concentration was 58 (IQR, 51–67) mg/dL, and first, third, and fifth percentiles were 34, 39, and 41 mg/dL, respectively. Conclu...
The incidence of psychotic disorders during the postpartum period is higher than at any other tim... more The incidence of psychotic disorders during the postpartum period is higher than at any other time during a women's life and coincides with the time when breastfeeding is most recommended. As a result, safety data on use of antipsychotic drugs during lactation is essential. Our aim was to analyze the medical literature for information on antipsychotic drug use during breastfeeding and to determine the safety of their use for the exposed infant. Medline (U.S. National Library of Medicine), LactMed (U.S. National Library of Medicine) and Reprotox (Reproductive Toxicology Center) databases were searched to identify all relevant medical literature on antipsychotic medications and lactation. The database search, updated to March, 2012, used the generic name of each antipsychotic drug in combination with the terms breastfeeding or lactation or breast-milk. 4 prospective studies, 12 case series, 28 case reports and 1 pharmaceutical registry were included. Infant outcomes focusing on lo...
Introduction: Aldosterone mediates sodium and water retention in hypovolemia. In normovolemia, al... more Introduction: Aldosterone mediates sodium and water retention in hypovolemia. In normovolemia, aldosterone primarily mediates kaliuresis. To mediate kaliuresis, aldosterone downregulates the sodium chloride cotransporters NCC and up-regulates the epithelial sodium channel ENaC. NCC downregulation increases sodium chloride transport to ENaC, where it is reabsorbed in turn for potassium, which is then excreted. We investigated whether kaliuresis is associated with the aldosterone receptor polymorphism rs3857080 in normovolemic healthy volunteers. Patients (or Materials) and Methods: We genotyped 195 healthy young men for rs3858070. In a triple-crossover study, 101 of them had ingested a sodium-chloride restricted diet 3 times for each a diet run-in day, a second diet day and a third diet plus verum day. Verums were 25-mg hydrochlorothiazide (HCT), 100-mg HCT and 200-mg triamterene. In a second triple-crossover study, 94 men took single oral doses of bumetanide (2 mg), furosemide (80 mg), and torsemide (10 mg). To avoid hypovolemia, the subjects were repetitively encouraged to drink in both studies. Results: Potassium excretion was in both studies associated with rs3857080, which had a minor allele frequency of 0.111. Comparatively high potassium excretion was associated with the minor A-allele under most conditions (Table). After torsemide, which is a loop diuretic such as bumetanide and furosemide but in addition blocks the aldosterone receptor, potassium excretion was similar between the A-and the G-allele of rs3857080.
Objective We aimed to determine the independent effect of maternal antepartum hemorrhage (APH) on... more Objective We aimed to determine the independent effect of maternal antepartum hemorrhage (APH) on mortality and major neonatal morbidities among very low birth weight (VLBW), very preterm infants. Study design A population-based cohort study of VLBW singleton infants born at 24 to 31 weeks of gestation between 1995 and 2016 was performed. Infants born with the following pregnancy associated complications were excluded: maternal hypertensive disorders, prolonged rupture of membranes, amnionitis, maternal diabetes, and small for gestational age. APH included hemorrhage due to either placenta previa or placental abruption. Univariate and multivariable logistic regression analyses were performed to assess the effect of maternal APH on mortality and major neonatal morbidities. Results The initial cohort included 33,627 VLBW infants. Following exclusions, the final study population comprised 6,235 infants of whom 2,006 (32.2%) were born following APH and 4,229 (67.8%) without APH. In the ...
Children born small for gestational age without early catch-up of somatic growth and head circumf... more Children born small for gestational age without early catch-up of somatic growth and head circumference subsequently remain short and suffer from various degrees of neurocognitive and psychological impairment. Based upon the role of growth hormone (GH) and insulin-like growth factor-I on early brain growth and maturation, we propose that GH treatment of these infants be instituted prior to their 2nd birthday.
Background Very preterm infants are at high risk of death or severe morbidity. The objective was ... more Background Very preterm infants are at high risk of death or severe morbidity. The objective was to determine the significance of severe congenital heart defects ( CHDs ) for these risks. Methods and Results This cohort study included infants from 10 countries born from 2007–2015 at 24 to 31 weeks’ gestation with birth weights <1500 g. Severe CHDs were defined by International Classification of Diseases, Ninth Revision ( ICD‐9 ) and Tenth ( ICD‐10 ) codes and categorized as those compromising systemic output, causing sustained cyanosis, or resulting in congestive heart failure. The primary outcome was in‐hospital mortality. Secondary outcomes were neonatal brain injury, necrotizing enterocolitis, bronchopulmonary dysplasia, and retinopathy of prematurity. Adjusted and propensity score–matched odds ratios ( ORs ) were calculated. Analyses were stratified by type of CHD , gestational age, and network. A total of 609 (0.77%) infants had severe CHD and 76 371 without any malformation...
B108. NEONATAL LUNG DISEASE AND BRONCHOPULMONARY DYSPLASIA, 2011
B108 NEONATAL LUNG DISEASE AND BRONCHOPULMONARY DYSPLASIA 16/2:00 PM-4:30 PM / Room 501-502 (Stre... more B108 NEONATAL LUNG DISEASE AND BRONCHOPULMONARY DYSPLASIA 16/2:00 PM-4:30 PM / Room 501-502 (Street Level), Colorado Convention Center ... Excellent Pulmonary Outcome For Very Low Birth Weight Infants Born In The Post Surfactant Era
To date, there is no overarching proposition for the ontogenetic-neurobiological basis of self-re... more To date, there is no overarching proposition for the ontogenetic-neurobiological basis of self-regulation. This paper suggests that the balanced self-regulatory reaction of the fetus, newborn and infant is based on a complex mechanism starting from early brainstem development and continuing to progressive control of the cortex over the brainstem. It is suggested that this balance occurs through the synchronous reactivity between the sympathetic and parasympathetic systems, both which originate from the brainstem. The paper presents an evidence-based approach in which molecular excitation-inhibition balance, interchanges between excitatory and inhibitory roles of neurotransmitters as well as cardiovascular and white matter development across gestational ages, are shown to create sympathetic-parasympathetic synchrony, including the postnatal development of electroencephalogram waves and vagal tone. These occur in developmental milestones detectable in the same time windows (sensitive ...
on behalf of the International Network for Evaluating Outcomes of Neonates (iNeo) Investigators* ... more on behalf of the International Network for Evaluating Outcomes of Neonates (iNeo) Investigators* Objectives To assess associations between neonatal intensive care unit (NICU)-level patent ductus arteriosus (PDA) treatment rates (pharmacologic or surgical) and neonatal outcomes. Study design This cohort study included infants born at 24-28 weeks of gestation and birth weight <1500 g in 2007-2015 in NICUs caring for ³100 eligible infants in 6 countries. The ratio of observed/expected (O/E) PDA treatment rates was derived for each NICU by estimating the expected rate using a logistic regression model adjusted for potential confounders and network. The primary composite outcome was death or severe neurologic injury (grades III-IV intraventricular hemorrhage or periventricular leukomalacia). The associations between the NICU-level O/E PDA treatment ratio and neonatal outcomes were assessed using linear regression analyses including a quadratic effect (a square term) of the O/E PDA treatment ratio. Results From 139 NICUs, 39 096 infants were included. The overall PDA treatment rate was 45% in the cohort (13%-77% by NICU) and the O/E PDA treatment ratio ranged from 0.30 to 2.14. The relationship between the O/ E PDA treatment ratio and primary composite outcome was U-shaped, with the nadir at a ratio of 1.13 and a significant quadratic effect (P<.001). U-shaped relationships were also identified with death, severe neurologic injury, and necrotizing enterocolitis. Conclusions Both low and high PDA treatment rates were associated with death or severe neurologic injury, whereas a moderate approach was associated with optimal outcomes. (J Pediatr 2020;-:1-6). N eonatologists have debated treatment strategies for hemodynamically significant patent ductus arteriosus (PDA) in preterm infants for decades. 1-3 The presence and treatment of a PDA have been variably associated with mortality as well as short-and long-term adverse outcomes. 4-8 Although some studies support conservative management that minimizes PDA treatment, 9-12 other studies report that early, active PDA treatment prevented mortality, pulmonary hemorrhage, and severe intraventricular hemorrhage (IVH). 13-15 The consequences of the left to right shunt via ductus arteriosus include pulmonary edema, congestive heart failure, and reduced systemic flow leading to ischemia of peripheral organs. These have been cited to justify active PDA treatment, however, both pharmacologic 16,17 and surgical treatments 8,18-20 have potential adverse effects. Furthermore, meta-analyses of PDA treatment trials have not shown improvements in outcomes, prompting calls against treating PDAs in preterm infants. 21,22 Because most previous trials allowed open-label rescue PDA treatment in placebo or control group, the meta-analyses did not assure the safety of complete abandonment of PDA treatment. Furthermore, PDA treatment may vary in timing (prophylaxis, early, or late), modalities (pharmacologic or surgical treatment), and target populations (gestational ages, PDA severity). The current From the
OBJECTIVE To compare length of stay (LOS) in neonatal care for extremely preterm babies admitted ... more OBJECTIVE To compare length of stay (LOS) in neonatal care for extremely preterm babies admitted to networks participating in the International Network for Evaluating Outcomes of Neonates (iNeo). STUDY DESIGN Data were extracted for babies admitted from 2014 to 2016 and born at 24 to 28 weeks' gestational age (n= 28,204). Median LOS was calculated for each network for babies who survived and those who died while in neonatal care. A linear regression model was used to investigate differences in LOS between networks after adjusting for gestational age, birthweight z-score, sex, and multiplicity. A sensitivity analysis was conducted for babies who were discharged home directly. RESULTS Observed median LOS for babies who survived was longest in Japan (107 days); this result persisted after adjustment (20.7 days more than reference, 95% CI: 19.3 to 22.1). Finland had the shortest adjusted LOS (-4.8 days less than reference, 95% CI: -7.3 to -2.3). For each week's increase in gestational age at birth, LOS decreased by 12.1 days (95% CI: -12.3 to -11.9). Multiplicity and male sex predicted mean increases in LOS of 2.6 (95% CI: 2.0 to 3.2) and 2.1 (95% CI: 1.6 to 2.6) days, respectively.results CONCLUSIONS: We identified between-network differences in LOS of up to three weeks for extremely preterm babies. Some of these may be partly explained by differences in mortality, but unexplained variations may also be related to differences in clinical care practices and healthcare systems between countries. CONCLUSION
CPK-BB (CK-BB) isoenzyme is an intracellular enzyme released in various neurologic conditions, in... more CPK-BB (CK-BB) isoenzyme is an intracellular enzyme released in various neurologic conditions, including central nervous system (CNS) infections. Activity of CK-BB in cerebrospinal fluid (CSF) was determined in 80 children by electrophoresis and densitometry. The possible correlation between CNS infection and CK concentrations was assessed. Significantly elevated concentrations of CK activity (P <0.01) in the CSF were found in children with bacterial meningitis as compared with children with either aseptic meningitis or normal CSF findings. The data suggest the possibility of utilizing CSF CK activity to differentiate between bacterial and viral meningitis in situations where a routine CSF examination is inconclusive.
PROBLEM: To investigate whether the mode of delivery or the drugs given to the mother during labo... more PROBLEM: To investigate whether the mode of delivery or the drugs given to the mother during labor may affect the newborns' immune system. METHOD OF STUDY Three groups of term newborns were included: A, spontaneously delivered with i.v. analgesia (n = 37); B, spontaneously delivered with epidural analgesia (n = 26); and C, delivered by cesarean section under general anesthesia (n = 29). Natural killer (NK) cell cytotoxicity, mitogenic response, and the capacity of peripheral blood mononuclear cells (PBMCs) to produce interleukin (1L)-1 p, IL-2, IL-3, IL-6, and tumor necrosis factor (TNF)-a were examined. RESULTS: NK cell cytotoxicity increased significantly in all three groups of newborns on the second day of life. Decreased IL-2 production was observed in newborns delivered by cesarean section. Spontaneous IL-1p secretion was higher in newborns to mothers treated with epidural analgesia. Spontaneous IL-6 secretion was elevated in infants to mothers undergoing general anesthesia and surgery or epidural analgesia. TNF-a production was increased in newborns delivered by cesarean section. CONCLUSION: The immune response of the newborn is affected by the mode of delivery and/or drugs given to the mother during labor.
Cannabis, commonly called marijuana, is often used during pregnancy, likely due to the perception... more Cannabis, commonly called marijuana, is often used during pregnancy, likely due to the perception that it is a "safe" drug. Changes in legislation in many countries have lead to the increased availability of this drug and to its increasing use during pregnancy, often with other concomitant exposures such as alcohol, tobacco, and other drugs. Herein, we review the medical literature regarding effects of marijuana on the fetus and newborn. Possible effects of in utero exposure to marijuana focus on fetal growth, increase in the rates of stillbirth and preterm delivery, congenital malformations, and neurodevelopmental effects on the child. Published studies for all these outcomes are inconsistent. Fetal weight growth may be somewhat decreased, but the magnitude of this decrease is no greater than 100 g. There is insufficient evidence to conclude on any effect on the stillbirth rate. Although there are some reports of a slight increase in the rate of prematurity, most reports ...
Scandinavian Journal of Urology and Nephrology, 1998
We performed a retrospective analysis of all patients admitted to our institution with a diagnosi... more We performed a retrospective analysis of all patients admitted to our institution with a diagnosis of infantile hypertrophic pyloric stenosis (IHPS) during a 10-year period from 1985-95 in order to assess the possible association between IHPS and urinary tract infections (UTIs). All 285 patients with IHPS had radiological or ultrasonographic confirmation of that diagnosis and underwent the Ramstedt procedure. Those who continued to be symptomatic were evaluated for UTI by urine analysis and culture. Positive cases were further evaluated for urinary system anomalies. The male:female ratio of IHPS was 3.4:1. Concomitant UTI was diagnosed in 8 patients by suprapubic aspiration or bladder catheterization. The prevalence of UTI in this series was 2.8%, 20-fold higher than the expected prevalence. Three of the 8 patients with UTI (37.5%) had urinary tract anomalies. These findings suggest an association between IHPS and UTI. We recommend that all IHPS patients be evaluated for UTI and positive cases undergo further evaluation for urinary anomalies.
Objective To compare the efficacy and reliability of two pulse-oximeters (POx) (Masimo Radical-7 ... more Objective To compare the efficacy and reliability of two pulse-oximeters (POx) (Masimo Radical-7 and Nellcor ™ Oxymax Bedside) and evaluate the feasibility of routine ECG monitoring during delivery room transition. Study design Prospective observational comparative study. Sixty newborns were connected simultaneously to both POxs and ECG monitor (as a gold standard for HR). Times to achieve a stable signal were compared. Heart rates were compared to simultaneous ECG. Results A significant difference in times to stable signal was found: Mean, Median (Interquartile range) for Nellcor and Masimo, were 15, 8.5 (6-18) and 27, 12 (9-34) seconds, respectively. Compared to ECG, false bradycardia was displayed in 18 of 55 (35%) newborns by the Masimo POx and in no newborns by the Nellcor POx. Attaching the ECG monitor was feasible but consumed additional resources. Conclusions The time for achievement of a stable saturation reading in an uncomplicated resuscitation setting differed significantly between POxs.
Objectives: Neonatal late-onset sepsis work-up is a frequent occurrence in every neonatal departm... more Objectives: Neonatal late-onset sepsis work-up is a frequent occurrence in every neonatal department. Blood cultures are the diagnostic gold standard, however, a negative culture prior to 48–72 h is often considered insufficient to exclude sepsis. We aimed to develop a decision tree which would enable exclusion of late-onset sepsis within 24 h using clinical and laboratory variables. Study Design: Infants evaluated for late-onset sepsis during the years 2016–2019, without major malformations, in a tertiary neonatal center were eligible for inclusion. Blood cultures and clinical and laboratory data were extracted at 0 and 24 h after sepsis work-up. Infants with bacteriologically confirmed late-onset sepsis were compared to matched control infants. Univariate logistic regression identified potential risk factors. A decision tree based on Chi-square automatic interaction detection methodology was developed and validated. Results: The study cohort was divided to a development cohort (10...
Background: Hepatitis B virus (HBV) vaccination has decreased the prevalence of chronic HBV infec... more Background: Hepatitis B virus (HBV) vaccination has decreased the prevalence of chronic HBV infections and their sequelae. However, whether vaccination at birth provides lifelong protection is unclear. Objective: To assess long-term immunity following neonatal HBV immunization in a large populationbased cohort. Methods: Using the database of a 2 million member sick fund in Israel, we identified all subjects born after introduction of universal HBV vaccination in Israel (January 1992 through December 2014), that were tested for hepatitis B surface antibody (anti-HBs Ab's). Years since vaccination were categorized into 5-year groups and linear trends in the seroprevalence of HBV immunity were calculated. Anamnestic response and presence of Hepatitis B surface antigen (HBs Ag) were assessed. Results: Included were 20,634 tested individuals. Mean (±SD) age at testing was 14.8 (±5.4) years. Mean anti-HBs Ab levels declined with time to 16.39 mIU/ml in the 15-20 year group (P < 0.001). The proportion of negative results increased gradually (P < 0.001) to 66.7% after 15 years. Anamnestic response assessment showed that 604 of 644 seronegative subjects (93.8%, 95% CI: 91.6-95.5%) became seropositive after a booster dose. HBs Ag was identified in 91 of the 20,634 (4.4 per 1000 study participants). Conclusions: Following vaccination, anti-HB's Ab's progressively decline, with only a third of the population retaining protective levels after 15 years. In adolescence, anamnestic response shows that nearly all revaccinated adolescents exhibit immunity. A low rate of Hepatitis B infection was demonstrated despite vaccination of nearly all newborns.
The Israel Neonatal Network (INN) is a voluntary consortium of all neonatal departments in Israel... more The Israel Neonatal Network (INN) is a voluntary consortium of all neonatal departments in Israel. The Israel National Very Low Birth Weight (VLBW) Infant Database was established in 1995 under the auspices of the INN. The main objectives of the database are the application of quality data for the assessment of morbidity and mortality trends of VLBW infants; benchmarking of individual neonatal unit performance in comparison to national data; quality of care and management; planning of national, regional and institutional structure and policy development; longitudinal developmental assessment and for collaborative research programs. Data are reported for all live born infants of birthweight ≤1,500 g, irrespective of the gestational age at birth. From 1995 through 2019, the database includes reports on 39,000 VLBW infants and 33,000 mothers encompassing over 99.5% of all VLBW live births in Israel. The minimal data set includes parental demographic details, maternal pregnancy history, treatments and complications, antenatal care, details of the delivery, infant's status at delivery, infant's diagnoses, procedures and complications during hospitalization and outcome at discharge. The predominant activity of the database relates to data collection, collation and presentation of the data in unique annual reports for each of the participating Neonatal intensive care units (NICUs) and an annual national report presented to departmental, institutional and governmental health care leaders. The database provides a research platform for all participants in the INN. More than 60 neonatologists, obstetricians and epidemiologists from 15 different hospitals and organizations have undertaken and published studies in the context of the database. The Israel Neonatal Society has promoted, initiated and coordinated two major quality improvement programs encompassing all INN collaborators, aimed at reducing the rate of blood stream infections and the rate of severe intraventricular hemorrhage among very preterm infants.
Objective Normal initial blood glucose values in healthy newborns are not well defined and are su... more Objective Normal initial blood glucose values in healthy newborns are not well defined and are subject to controversy. Despite substantive research, there is no single initial value of glucose that can be used with certainty of safety in newborns, and thus various protocols and cutoffs have been proposed. Study Design We sought to characterize the normal values of blood glucose levels in a large cohort of neonates admitted to the well-baby nursery in Shaare Zedek Medical Center. The blood glucose levels were measured with a point of care (POC) glucometer (Accu-Chek Performa) within 180 minutes after birth. Results The study population included 3,912 newborns with a mean birth weight of 3,322 ± 439 g and a mean gestational age of 39.4 ± 1.3 weeks. Sampling was performed at a median age of 73 minutes (interquartile range [IQR], 55–92 minutes). Median glucose concentration was 58 (IQR, 51–67) mg/dL, and first, third, and fifth percentiles were 34, 39, and 41 mg/dL, respectively. Conclu...
The incidence of psychotic disorders during the postpartum period is higher than at any other tim... more The incidence of psychotic disorders during the postpartum period is higher than at any other time during a women's life and coincides with the time when breastfeeding is most recommended. As a result, safety data on use of antipsychotic drugs during lactation is essential. Our aim was to analyze the medical literature for information on antipsychotic drug use during breastfeeding and to determine the safety of their use for the exposed infant. Medline (U.S. National Library of Medicine), LactMed (U.S. National Library of Medicine) and Reprotox (Reproductive Toxicology Center) databases were searched to identify all relevant medical literature on antipsychotic medications and lactation. The database search, updated to March, 2012, used the generic name of each antipsychotic drug in combination with the terms breastfeeding or lactation or breast-milk. 4 prospective studies, 12 case series, 28 case reports and 1 pharmaceutical registry were included. Infant outcomes focusing on lo...
Introduction: Aldosterone mediates sodium and water retention in hypovolemia. In normovolemia, al... more Introduction: Aldosterone mediates sodium and water retention in hypovolemia. In normovolemia, aldosterone primarily mediates kaliuresis. To mediate kaliuresis, aldosterone downregulates the sodium chloride cotransporters NCC and up-regulates the epithelial sodium channel ENaC. NCC downregulation increases sodium chloride transport to ENaC, where it is reabsorbed in turn for potassium, which is then excreted. We investigated whether kaliuresis is associated with the aldosterone receptor polymorphism rs3857080 in normovolemic healthy volunteers. Patients (or Materials) and Methods: We genotyped 195 healthy young men for rs3858070. In a triple-crossover study, 101 of them had ingested a sodium-chloride restricted diet 3 times for each a diet run-in day, a second diet day and a third diet plus verum day. Verums were 25-mg hydrochlorothiazide (HCT), 100-mg HCT and 200-mg triamterene. In a second triple-crossover study, 94 men took single oral doses of bumetanide (2 mg), furosemide (80 mg), and torsemide (10 mg). To avoid hypovolemia, the subjects were repetitively encouraged to drink in both studies. Results: Potassium excretion was in both studies associated with rs3857080, which had a minor allele frequency of 0.111. Comparatively high potassium excretion was associated with the minor A-allele under most conditions (Table). After torsemide, which is a loop diuretic such as bumetanide and furosemide but in addition blocks the aldosterone receptor, potassium excretion was similar between the A-and the G-allele of rs3857080.
Objective We aimed to determine the independent effect of maternal antepartum hemorrhage (APH) on... more Objective We aimed to determine the independent effect of maternal antepartum hemorrhage (APH) on mortality and major neonatal morbidities among very low birth weight (VLBW), very preterm infants. Study design A population-based cohort study of VLBW singleton infants born at 24 to 31 weeks of gestation between 1995 and 2016 was performed. Infants born with the following pregnancy associated complications were excluded: maternal hypertensive disorders, prolonged rupture of membranes, amnionitis, maternal diabetes, and small for gestational age. APH included hemorrhage due to either placenta previa or placental abruption. Univariate and multivariable logistic regression analyses were performed to assess the effect of maternal APH on mortality and major neonatal morbidities. Results The initial cohort included 33,627 VLBW infants. Following exclusions, the final study population comprised 6,235 infants of whom 2,006 (32.2%) were born following APH and 4,229 (67.8%) without APH. In the ...
Children born small for gestational age without early catch-up of somatic growth and head circumf... more Children born small for gestational age without early catch-up of somatic growth and head circumference subsequently remain short and suffer from various degrees of neurocognitive and psychological impairment. Based upon the role of growth hormone (GH) and insulin-like growth factor-I on early brain growth and maturation, we propose that GH treatment of these infants be instituted prior to their 2nd birthday.
Background Very preterm infants are at high risk of death or severe morbidity. The objective was ... more Background Very preterm infants are at high risk of death or severe morbidity. The objective was to determine the significance of severe congenital heart defects ( CHDs ) for these risks. Methods and Results This cohort study included infants from 10 countries born from 2007–2015 at 24 to 31 weeks’ gestation with birth weights <1500 g. Severe CHDs were defined by International Classification of Diseases, Ninth Revision ( ICD‐9 ) and Tenth ( ICD‐10 ) codes and categorized as those compromising systemic output, causing sustained cyanosis, or resulting in congestive heart failure. The primary outcome was in‐hospital mortality. Secondary outcomes were neonatal brain injury, necrotizing enterocolitis, bronchopulmonary dysplasia, and retinopathy of prematurity. Adjusted and propensity score–matched odds ratios ( ORs ) were calculated. Analyses were stratified by type of CHD , gestational age, and network. A total of 609 (0.77%) infants had severe CHD and 76 371 without any malformation...
B108. NEONATAL LUNG DISEASE AND BRONCHOPULMONARY DYSPLASIA, 2011
B108 NEONATAL LUNG DISEASE AND BRONCHOPULMONARY DYSPLASIA 16/2:00 PM-4:30 PM / Room 501-502 (Stre... more B108 NEONATAL LUNG DISEASE AND BRONCHOPULMONARY DYSPLASIA 16/2:00 PM-4:30 PM / Room 501-502 (Street Level), Colorado Convention Center ... Excellent Pulmonary Outcome For Very Low Birth Weight Infants Born In The Post Surfactant Era
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