Preterm infants require close surveillance for gross motor delay after neonatal discharge. The Bayley Scales of Infant Development, 3rdedition (Bayley-III) is used widely in research settings, but is ...too resource intensive for routine clinical use. The Alberta Infant Motor Scale (AIMS) is an alternative test of motor development that can be administered by a range of providers, but little is known about its validity in the preterm population. The purpose of this study was to validate the AIMS as a measure of motor development in preterm infants ≤32 weeks' gestation, as compared with the Bayley-III.
Children born before 28 weeks’ gestation are at increased risk of chronic kidney disease (CKD). Urine biomarkers may shed light on mechanistic pathways and improve the ability to forecast CKD. We ...evaluated whether urinary biomarkers in neonates of low gestational age (GA) are associated with a reduced estimated glomerular filtration rate (eGFR) over time.
A cohort study of neonates with an exploratory case-control study of a subset of the cohort.
327 neonates born at 24-27 weeks’ gestation with 2-year eGFR data from the PENUT (Preterm Erythropoietin Neuroprotection Trial) and the REPaIReD (Recombinant Erythropoietin for Prevention of Infant Renal Disease) study.
11 urinary biomarkers measured at 27, 30, and 34 weeks’ postmenstrual age for the primary cohort study and 10 additional biomarkers for the exploratory case-control study.
eGFR<90mL/min/1.73m2 at 2 years corrected for GA.
Linear mixed models to assess differences in biomarker values between neonates in whom CKD did and did not develop, accounting for multiple comparisons using Bonferroni-Holm correction in the cohort study only. Cohort analyses were adjusted for sex, GA, and body mass index. Cases were matched to controls on these variables in the case-control study.
After adjusting for weeks of GA, urinary levels of α-glutathione-S-transferase (log difference, 0.27; 95% CI, 0.12-0.43), albumin (log difference, 0.13; 95% CI, 0.02-0.25), and cystatin C (log difference, 0.19; 95% CI, 0.04-0.34) were higher in those in whom CKD developed than in those in whom it did not. Urinary albumin and cystatin C levels did not remain significantly different after Bonferroni-Holm correction. In the exploratory case-control analysis, there were no differences in any biomarkers between cases and controls.
Early deaths and a high number of subjects without eGFR at 2 years corrected for GA.
Measurement of urinary biomarkers may assist in monitoring neonates who are at risk for CKD. Additional studies are needed to confirm these findings.
Grants from government (National Institutes of Health).
Registered at ClinicalTrials.gov with study number NCT01378273.
Approximately 15 million neonates worldwide are born prematurely, and 2 million are born before 28 weeks’ gestation. Many of these children go on to experience chronic kidney disease. Urine biomarkers may allow for early recognition of those at risk for the development of kidney disease. In this study of more than 300 children born before 28 weeks’ gestational age, we found higher mean urinary levels of α-glutathione-S-transferase at 27, 30, and 34 weeks in children whose estimated glomerular filtration rate was<90mL/min/1.73m2 at 2 years compared with children whose estimated glomerular filtration rate was>90mL/min/1.73m2 at 2 years. Measurement of urinary biomarkers may assist in monitoring neonates who are at risk for chronic kidney disease. Additional studies are needed to confirm our findings.
To evaluate whether extremely low gestational age neonates (ELGANs) randomized to erythropoietin have better or worse kidney-related outcomes during hospitalization and at 22-26 months of corrected ...gestational age (cGA) compared with those randomized to placebo.
We performed an ancillary study to a multicenter double-blind, placebo-controlled randomized clinical trial of erythropoietin in ELGANs.
The prevalence of severe (stage 2 or 3) acute kidney injury (AKI) was 18.2%. We did not find a statistically significant difference between those randomized to erythropoietin vs placebo for in-hospital primary (severe AKI) or secondary outcomes (any AKI and serum creatinine/cystatin C values at days 0, 7, 9, and 14). At 22-26 months of cGA, 16% of the cohort had an estimated glomerular filtration rate (eGFR) <90 mL/min/1.73 m2, 35.8% had urine albumin/creatinine ratio >30 mg/g, 23% had a systolic blood pressure (SBP) >95th percentile for age, and 40% had a diastolic blood pressure (DBP) >95th percentile for age. SBP >90th percentile occurred less often among recipients of erythropoietin (P < .04). This association remained even after controlling for gestational age, site, and sibship (aOR 0.6; 95% CI 0.39-0.92). We did not find statistically significant differences between treatment groups in eGFR, albumin/creatinine ratio, rates of SBP >95th percentile, or DBP >90th or >95th percentiles at the 2 year follow-up visit.
ELGANs have high rates of in-hospital AKI and kidney-related problems at 22-26 months of cGA. Recombinant erythropoietin may protect ELGANs against long-term elevated SBP but does not appear to protect from AKI, low eGFR, albuminuria, or elevated DBP at 22-26 months of cGA.
To examine the feasibility, effectiveness, and safety of the cranial cup for the correction of visible head shape deformities in premature infants.
A prospective descriptive research design.
Two ...study sites, an urban Level 4 NICU and a suburban Level 2 special care nursery.
The study sample consisted of 23 neonates and infants with deformational plagiocephaly who were born at less than or equal to 35 weeks gestation, weighed greater than 1 kg, and were in the convalescent phase (stable) of their hospitalizations.
All participants received the experimental treatment with the cranial cup. Infants were positioned on the cranial cup for a minimum of 12 hours per day. They also received routine position changes at least every 3 to 4 hours. Demographic data and baseline and discharge cranial measurements were obtained for each infant.
All participants (N = 23) had visible deformational plagiocephaly on study entry, and 86% (n = 19) had corresponding abnormal cranial measurements. The median hours per day on the cranial cup was 12.7 (range = 6.3 to 18.0). At hospital discharge, 83% (n = 19) of participants had normal cranial measurements. Furthermore, there were no reported safety concerns associated with use of the cranial cup.
Use of the cranial cup during the convalescent phase of hospitalization is feasible and safe, and it provides effective correction of DP for premature neonates and infants.
Premature infants are predisposed to developing deformational plagiocephaly. Deformational plagiocephaly may affect the infant's social well-being and neurobehavioral development.
This pilot study ...investigated the feasibility and safety of the preemie orthotic device (POD); a noncommercial, supportive orthotic device to manage deformational plagiocephaly.
The setting for this prospective, descriptive, phase 1 clinical trial was 2 urban and 1 suburban neonatal intensive care units that provided care for critically ill premature and term infants. Participants included a convenience sample of 10 premature extremely low-birth-weight infants weighing less than 1 kg. All participants received the experimental treatment with the POD. Time spent on the device with and without the supportive foam insert, provider perception, adverse events, and head shape measurements were collected to assess feasibility and safety of the device.
Participants had a median gestational age of 25.4 weeks and median birth weight of 0.673 kg. The POD was used a median of 21.2 hours per day and the foam insert was used a median of 11.1 hours per day. At enrollment, 1 participant had a normal cranial index compared with 5 participants at study completion. All participants had normal cranial symmetry at study enrollment and completion. No device-related adverse events were reported.
The POD was found to be feasible and safe. Staff had favorable responses to the device. Recommendations by nursing staff included enlarging the device to extend its use.
Further studies are warranted to assess the POD's effectiveness.
The classic organisms associated with central nervous system infection in the neonate are herpes simplex, Listeria monocytogenes, Escherichia coli, and Streptococcus agalactiae; we describe an ...unusual case of neonatal meningoencephalitis caused by Bacillus cereus.
Warmer winters with less snowfall are increasing the frequency of soil freeze–thaw cycles across temperate regions. Soil microbial responses to freeze–thaw cycles vary and some of this variation may ...be explained by microbial conditioning to prior winter conditions, yet such linkages remain largely unexplored. We investigated how differences in temperature history influenced microbial community composition and activity in response to freeze–thaw cycles.
We collected soil microbial communities that developed under colder (high elevation) and warmer (low elevation) temperature regimes in spruce‐fir forests, then added each of these soil microbial communities to a sterile bulk‐soil in a laboratory microcosm experiment. The inoculated high‐elevation cold and low‐elevation warm microcosms were subjected to diurnal freeze–thaw cycles or constant above‐freezing temperature for 9 days. Then, all microcosms were subjected to a 7‐day above‐freezing recovery period.
Overall, we found that the high‐elevation cold community had, relative to the low‐elevation warm community, a smaller reduction in microbial respiration (CO2 flux) during freeze–thaw cycles. Further, the high‐elevation cold community, on average, experienced lower freeze–thaw‐induced bacterial mortality than the warm community and may have partly acclimated to freeze–thaw cycles via increased lipid membrane fluidity. Respiration of both microbial communities quickly recovered following the end of the freeze–thaw treatment period and there were no changes in soil extractable carbon or nitrogen.
Our results provide evidence that past soil temperature conditions may influence the responses of soil microbial communities to freeze–thaw cycles. The microbial community that developed under a colder temperature regime was more tolerant of freeze–thaw cycles than the community that developed under a warmer temperature regime, although both communities displayed some level of resilience. Taken together, our data suggest that microbial communities conditioned to less extreme winter soil temperatures may be most vulnerable to rapid changes in freeze–thaw regimes as winters warm, but they also may be able to quickly recover if mortality is low.
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