Human milk is the biological fluid with the highest exosome amount and is rich in microRNAs (miRNAs). These are key regulators of gene expression networks in both normal physiologic and disease ...contexts, miRNAs can influence many biological processes and have also shown promise as biomarkers for disease. One of the key aspects in the regeneration of the nervous system is that there are practically no molecules that can be used as potential drugs. In the first weeks of lactation, we know that human breast milk must contain the mechanisms to transmit molecular and biological information for brain development. For this reason, our objective is to identify new modulators of the nervous system that can be used to investigate neurodevelopmental functions based on miRNAs. To do this, we collected human breast milk samples according to the time of delivery and milk states: mature milk and colostrum at term; moderate and very preterm mature milk and colostrum; and late preterm mature milk. We extracted exosomes and miRNAs and realized the miRNA functional assays and target prediction. Our results demonstrate that miRNAs are abundant in human milk and likely play significant roles in neurodevelopment and normal function. We found 132 different miRNAs were identified across all samples. Sixty-nine miRNAs had significant differential expression after paired group comparison. These miRNAs are implicated in gene regulation of dopaminergic/glutamatergic synapses and neurotransmitter secretion and are related to the biological process that regulates neuron projection morphogenesis and synaptic vesicle transport. We observed differences according to the delivery time and with less clarity according to the milk type. Our data demonstrate that miRNAs are abundant in human milk and likely play significant roles in neurodevelopment and normal function.
Different lung ultrasound (LUS) scanning protocols have been used, and the results in terms of diagnostic accuracy are heterogeneous.
What is the diagnostic accuracy of the LUS score to predict ...moderate to severe bronchopulmonary dysplasia (msBPD)? Does scanning of posterior lung fields improve the diagnostic accuracy?
This was a multicenter prospective, observational study in six centers. Two LUS aeration scores, one involving only anterolateral lung fields and the other adding the posterior fields were obtained at birth, on the third day of life (DOL), on the seventh DOL, on the 14th DOL, and on the 21st DOL. The diagnostic accuracy of both scores to predict msBPD was assessed at each time point.
Eight hundred thirty-two LUS examinations in 298 infants were included. Both LUS score using anterolateral and posterior fields and LUS score using only anterolateral fields showed a similar moderate diagnostic accuracy to predict msBPD on the third DOL (area under the receiver operating characteristic curve AUC 95% CI, 0.68-0.85 vs 0.68-0.85; P = .97), seventh DOL (AUC 95% CI, 0.74-0.85 vs 0.74-0.84; P = .26), and 21st DOL (AUC 95% CI, 0.72-0.86 vs 0.74-0.88; P = .17). The LUS score using anterolateral and posterior fields was slightly more accurate at 14th DOL (AUC 95% CI, 0.69-0.83 vs 0.66-0.80; P = .01). A cutoff of 8 points in the LUS score using only anterolateral fields on the seventh DOL provided a sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 70%, 79%, 3.3, and 0.38, respectively, to predict msBPD. Adding gestational age (GA) and sex improved the discriminative value without significant differences compared with a predictive model based on multiple clinical variables: AUC 95% CI, 0.77-0.88 vs 0.80-0.91 (P = .52).
The LUS score is able to predict msBPD from the third DOL with a moderate diagnostic accuracy. Scanning posterior lung fields slightly improved diagnostic accuracy only at the 14th DOL. Adding GA and sex improves the diagnostic accuracy of the LUS scores. The LUS score is useful to stratify BPD risk early after birth.
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BACKGROUND // Bronchiolitis is the leading cause of hospitalization in children under one year of age, with annual epidemics. Since
the onset of the SARS-CoV-2 coronavirus disease pandemic ...(COVID-19), there has been a change in the transmission of other respiratory
viruses. Our aim in this paper was to describe how COVID-19 had affected the distribution of acute bronchiolitis in our country.
METHODS // We conducted a retrospective descriptive study of the cases of bronchiolitis treated in a sample of Spanish hospitals belonging
to four autonomous communities. A chi-square test and Student’s t- test were used to compare epidemiological and demographic
variables between patients attending the hospital with bronchiolitis during January 2021-June 2021 with patients attending the hospital
in the previous three years (2018-2020).
RESULTS // We analyzed 6,124 cases of bronchiolitis (58.8% males and 41.2% females). The mean age was 0.5 years (SD: 0.4). In 2020, we
observed a decrease of bronchiolitis cases compared to 2019 of 67%. During 2020 and 2021, the epidemic season started in January-February
and peaked in June. During the first half of 2021, the highest percentage of admissions for bronchiolitis associated with RSV
infection was observed in hospitals in central Spain corresponding to the Autonomous Community of Madrid (78.5% of admissions).
CONCLUSIONS // The COVID-19 pandemic significantly modifies the seasonality of bronchiolitis. In our country, the flow and distribution
of the disease are not uniform. It starts in the center of Spain and ends on the coast.
FUNDAMENTOS // La bronquiolitis es la primera causa de hospitalización en menores de un año, presentándose en forma de epidemias
anuales. Desde el inicio de la pandemia por la enfermedad causada por el coronavirus SARS-CoV-2 (COVID-19) se ha producido un
cambio en la transmisión de otros virus respiratorios. Nuestro objetivo en este trabajo fue describir cómo había afectado la pandemia
de la COVID-19 a la distribución de la bronquiolitis aguda en nuestro país.
MÉTODOS // Realizamos un estudio descriptivo retrospectivo de los casos de bronquiolitis atendidos en una muestra de hospitales
españoles que pertenecían a cuatro comunidades autónomas. Empleado el test chi-cuadrado y la prueba t de Student comparamos
variables epidemiológicas y demográficas de los casos de bronquiolitis atendidos durante enero de 2021 y junio 2021, con los tres
años anteriores (2018-2020).
RESULTADOS // Analizamos 6.124 casos de bronquiolitis (58,8% varones y 41,2% mujeres). La media de edad fue de 0,5 años (DE:
0,4). En 2020 observamos un descenso de casos de bronquiolitis con respecto a 2019 del 67%. Durante 2020 y 2021 la temporada
epidémica empezó en enero-febrero y alcanzó su pico máximo en junio. Durante el primer semestre de 2021, el porcentaje más
elevado de ingresos por bronquiolitis asociados a infección VRS fue observado en hospitales del centro de España correspondientes
a la Comunidad Autónoma de Madrid (78,5% de los ingresos).
CONCLUSIONES // La pandemia por la COVID-19 modifica de manera significativa la estacionalidad de la bronquiolitis. En nuestro
país, el flujo y distribución de la enfermedad no es uniforme, comenzado por el centro peninsular y, por último, la zona litoral.
Different lung ultrasound (LUS) scanning protocols have been used, and the results in terms of diagnostic accuracy are heterogeneous.
What is the diagnostic accuracy of the LUS score to predict ...moderate to severe bronchopulmonary dysplasia (msBPD)? Does scanning of posterior lung fields improve the diagnostic accuracy?
This was a multicenter prospective, observational study in six centers. Two LUS aeration scores, one involving only anterolateral lung fields and the other adding the posterior fields were obtained at birth, on the third day of life (DOL), on the seventh DOL, on the 14th DOL, and on the 21st DOL. The diagnostic accuracy of both scores to predict msBPD was assessed at each time point.
Eight hundred thirty-two LUS examinations in 298 infants were included. Both LUS score using anterolateral and posterior fields and LUS score using only anterolateral fields showed a similar moderate diagnostic accuracy to predict msBPD on the third DOL (area under the receiver operating characteristic curve AUC 95% CI, 0.68-0.85 vs 0.68-0.85; P = .97), seventh DOL (AUC 95% CI, 0.74-0.85 vs 0.74-0.84; P = .26), and 21st DOL (AUC 95% CI, 0.72-0.86 vs 0.74-0.88; P = .17). The LUS score using anterolateral and posterior fields was slightly more accurate at 14th DOL (AUC 95% CI, 0.69-0.83 vs 0.66-0.80; P = .01). A cutoff of 8 points in the LUS score using only anterolateral fields on the seventh DOL provided a sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 70%, 79%, 3.3, and 0.38, respectively, to predict msBPD. Adding gestational age (GA) and sex improved the discriminative value without significant differences compared with a predictive model based on multiple clinical variables: AUC 95% CI, 0.77-0.88 vs 0.80-0.91 (P = .52).
The LUS score is able to predict msBPD from the third DOL with a moderate diagnostic accuracy. Scanning posterior lung fields slightly improved diagnostic accuracy only at the 14th DOL. Adding GA and sex improves the diagnostic accuracy of the LUS scores. The LUS score is useful to stratify BPD risk early after birth.
Cannabis consumption has been increasing worldwide among pregnant women. Due to the negative effects of prenatal cannabis exposure, it is necessary to develop an objective, sensitive, and specific ...method to determine cannabinoids use during pregnancy. In this study, we compared four different biological samples, maternal hair, meconium, umbilical cord, and placenta, for the detection of in utero cannabis exposure. The biological samples were collected from 627 mother-newborn dyads. All hair and meconium samples were analyzed, and umbilical cord and placenta if hair and/or meconium were positive for cannabinoids. Meconium and hair showed to complement each other, with an agreement between hair and meconium results of 96.7% but only 34.3% if just positive results were considered. Umbilical cord and placenta results showed a better agreement with meconium (91.3% and 92.6%, respectively) than with hair (39.1% and 34.6%, respectively). The predominant metabolites in meconium were 11-nor-carboxy-THC (THCCOOH) and 8,11-dihydroxy-THC (diOHTHC), and in umbilical cord and placenta was THCCOOH-glucuronide. Cannabidiol (CBD) and cannabinol (CBN) were detected in meconium but not in any umbilical cord or placenta. For the first time, prenatal marijuana exposure was analyzed and compared in paired hair, meconium, umbilical cord, and placental samples. Hair and meconium positivity rate was similar, but a more sensitive and specific analytical method for the hair may resolve discrepancies between the matrices. Umbilical cord and placenta may be considered suitable alternative matrices to meconium through the determination of THCCOOH-glucuronide as a biomarker of cannabis exposure.
Purpose
Psychiatric disorders and drugs used for their treatment, can have negative consequences for the pregnancy and the development of the newborn. Therefore, meconium, maternal hair and maternal ...medical records were compared for the detection of antidepressants and benzodiazepines exposure during pregnancy. Moreover, correlations between neonatal outcomes and meconium or maternal hair results were evaluated.
Methods
Two liquid chromatography-tandem mass spectrometric methods for the determination of the most common benzodiazepines and antidepressants in meconium and maternal hair were applied to the analysis of 145 matched samples. Statistical analyses were performed with IBM SPSS Statistics software.
Results
According to the medical records, 5.5% of the mothers used prescribed antidepressants during pregnancy and 23.1% benzodiazepines (10.5% at the time of delivery). For antidepressants, 5.5% of meconium and 24.8% of maternal hair specimens were positive; for benzodiazepines, 16.6 and 15.9% of meconium and hair specimens, respectively, were positive. Overall agreement meconium/hair, and medical records/hair, for positive cases, was very poor (28.1 and 18.9%, respectively), while improved between medical records/meconium (60%). Regarding the evaluated neonatal parameters, we only found a significant negative correlation between male weight and meconium-positive results for benzodiazepines.
Conclusion
Maternal hair was more sensitive to detect antidepressants use, while meconium analysis can provide detection of neonatal benzodiazepines exposure at the time of delivery. Therefore, combination of both matrices is recommended, since it shows a more complete picture of prenatal exposure to these drugs. No clear influence of prenatal exposure to antidepressants or benzodiazepines on neonatal outcomes was noticed.
Smoking during pregnancy can have serious obstetric and fetal complications. Therefore, it is essential to identify in utero exposure to tobacco, being meconium the matrix of choice for this purpose. ...Meconium (n = 565) was analyzed for nicotine, cotinine and hydroxycotinine by LC-MS-MS. Then, tobacco meconium results were compared with smoking habits during pregnancy and neonatal outcomes measures (birth weight, length, head circumference, gestational age and Apgar scores). Although meconium analysis increased identification of in-utero exposure to tobacco (17.7% meconium positive specimens vs 13.5% mothers admitting tobacco use during pregnancy), there was a statistically significant relationship between meconium results and interview answers (P < 0.001). Birth weight was significantly lower for newborns with meconium positive results in males (P = 0.023) and females (P = 0.001), while for length significance was only observed in females (P = 0.001); however, when excluding meconium specimens positive for other drugs, a statistically significant difference was only found for female weight (P = 0.045). Meconium analysis proved to be more reliable for tobacco prenatal exposure detection than maternal interview. In addition, positive meconium results increased the probability for low birth weight, especially in females.
Ante la posible coexistencia de la infección por el virus SARS-CoV-2 con otras infecciones estacionales, se pretende identificar síntomas diferenciales. Se ha estudiado el papel de los niños en el ...contagio intrafamiliar y la sensibilidad de la reacción en cadena de la polimerasa con transcriptasa inversa (RT-PCR) en un área con baja transmisión comunitaria.
Estudio observacional transversal. Pacientes entre 0-15 años estudiados por técnica RT-PCR por sospecha clínica de infección por virus SARS-CoV-2 en los meses de marzo-mayo del 2020. Encuesta sobre síntomas y contactos. Determinación de anticuerpos anti-SARS-CoV-2 al menos 21 días después del test RT- PCR.
Se incluyó a 126 pacientes, 33 con infección confirmada y edad media 8,4 años (IC del 95%, 6,8-10,0), edad superior a los no infectados. La fiebre fue el síntoma más común y con mayor sensibilidad. Las diferencias encontradas fueron una mayor frecuencia de anosmia (p=0,029) y cefalea (p=0,009) entre los niños infectados con una especificidad del 96,7 y el 81,5% respectivamente. No hubo diferencias en la duración de los síntomas.
Un 81,8% de los infectados fue probablemente contagiado en el núcleo familiar, en un 85,2% por un progenitor que trabajaba fuera del hogar. La sensibilidad de RT-PCR fue 70,9% y su valor predictivo negativo 91,1%.
El cuadro clínico es inespecífico y los síntomas más específicos difíciles de detectar en niños más pequeños. Los niños tuvieron un papel reducido en la transmisión intrafamiliar. La sensibilidad de la RT-PCR podría estar relacionada con una menor contagiosidad infantil tras una semana de infección.
Given the possible coexistence of infection by the SARS-CoV-2 with other seasonal infections, the aim is to identify differential symptoms. There has been studied the role of children in intrafamily contagion and the sensitivity of reverse transcriptase polymerase chain reaction (RT-PCR) in an area with low community transmission.
Cross-sectional observational study. Patients between 0-15 years studied by RT-PCR technique due to clinical suspicion of infection by SARS-CoV-2 virus in the months of March-May 2020. Survey on symptoms and contacts. Determination of Anti-SARS-CoV-2 antibodies at least 21 days after the RT-PCR test.
126 patients were included, 33 with confirmed infection and mean age 8.4 years (95% CI 6.8-10,5), age higher than not infected. Fever was the most common symptom and with greater sensitivity. The differences found were a greater frequency of anosmia (P=0.029) and headache (P=.009) among children infected with a specificity of 96.7% and 81.5% respectively. There were no differences in the duration of the symptoms. 81.8% of those infected were probably infected in the family nucleus, 85.2% by a parent who worked outside the home. The sensitivity of RT-PCR was 70.9% and its negative predictive value 91.1%.
The clinical picture is nonspecific and the more specific symptoms difficult to detect in younger children. Children had a reduced role in the intrafamily transmission. The sensitivity of RT-PCR could be related to a less contagiousness in children after one week of infection.
Drug of abuse consumption throughout pregnancy is a serious public health problem and an important economic cost to the health system. The aim of this work was to compare maternal interview and hair ...analysis to determine drug consumption throughout pregnancy and to study relations among maternal interview, hair results, and neonatal outcomes.
Two hundred nine mothers agreed to participate. After delivery, they were interviewed and a hair sample collected. Hair samples were segmented in trimesters and analyzed for 35 drugs opioids, cocaine, amphetamines, Δ-tetrahydrocannabinol (THC), ketamine, methadone, antidepressants, benzodiazepines, and hypnotics; limits of quantification 5-100 pg/mg and for ethyl glucuronide (limit of quantification 10 pg/mg) by liquid chromatography-tandem mass spectrometry. Statistical analysis was performed with χ test and t test.
In the interview, 4.3% mothers declared using illicit drugs during pregnancy (cocaine 1.4%, THC 2.9%, and opiates 1%), 3.3% medicines (methadone 1.9%, benzodiazepines 1.9%, and antidepressants 0.5%), 21.5% tobacco, and 13.7% alcohol. Hair analysis showed 15.4% prevalence in illicit drugs (cocaine 12.4%, THC 3.8%, opiates 1%, and ketamine 1%), 22.5% in medicines (methadone 3.3%, benzodiazepines 11%, antidepressants 9.1%, zopiclone 1%, and fentanyl 1.4%), and 3.9% in alcohol. Neonatal abstinence syndrome was developed in 8.1% newborns, all of them from mothers with high methadone-positive hair results (>926.2 pg/mg). Statistically significant lower newborn weight and length were found in neonates from declared smokers compared with nonsmokers (P < 0.05).
Maternal hair analysis showed to be more sensitive than maternal interview to detect drug use during pregnancy, except for alcohol. In this preliminary study, no statistically significant differences were found between exposed and nonexposed newborns to drugs, except for tobacco consumption.
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