The Development of a Direct Homologous Radioimmunoassay for Serum Cortisol

Peer Reviewe

Topics on Critical Issues in Neonatal Care

Neonatology is one of the areas of greatest development and evolution within pediatrics. Every year there are advances in the management of the different diseases that newborns develop, which makes it necessary to refresh knowledge on traditional and other emerging issues. This book includes six chapters that address critical and relevant issues in neonatal care and seeks to contribute to the clinical work of health teams in neonatal units

Investigating Task-Free Functional Connectivity Patterns in Newborns Using functional Near-Infrared Spectroscopy

Robust functional connectivity in sensorimotor resting-state network (RSN) has been linked to positive neurodevelopmental outcomes in neonates. In the current study, we aimed to map the developmental trajectory of sensorimotor RSN in awake neonates using functional near-infrared spectroscopy (fNIRS). We acquired fNIRS resting-state data from 41 healthy newborns (17 females, gestational age range=36+0 to 42+1 weeks) within the first 48 hours after birth. At the group level, we observed robust positive connectivity in numerous channel-pairs across the sensorimotor network, especially in the left hemisphere. Next, we examined the relationship between functional connectivity, gestational age and postnatal age, while controlling for sex and subject effects. We found both gestational and postnatal age to be positively associated with an increase in functional connectivity in the posterior portion of sensorimotor RSN. In summary, our findings demonstrate the feasibility of fNIRS for monitoring early developmental changes in functional networks in awake infants

Evaluation of the endothelial glycocalyx in premature neonates by measurement of the perfused boundary region (PBR)

The endothelial glycocalyx (GCX) is acknowledged as a pivotal juncture in the development of vascular pathologies in sepsis [73], diabetes [53, 66-68, 155], cardiovascular [65, 69-72] and other diseases. Moreover, impaired microcirculation leading to perivascular edema [27] and altered rheological behavior [15, 20-22] is likely due to reduced endothelial GCX. Perinatal alterations in GCX have been investigated in vivo and in vitro [77, 104] and functional and structural alterations of the microcirculation in premature neonates have been described in previous studies [86, 89, 109, 118]. However, now the endothelial GCX, as a possible mediator, is increasingly highlighted in understanding perinatal pathologies in microcirculatory vessel development [77, 104]. Further studies on the perinatal glycocalyx and the corresponding microcirculation were the primary aim of this study. A prospective study was conducted including 39 premature infants born at the Perinatalzentrum Frauenklinik Maistrasse of the Ludwig-Maximilian- University, Munich, Germany. Data on the GCX in 85 mature babies obtained in a parallel study, served as control. The ethical committee of the Ludwig-Maximilian-University approved the study. The GCX was assessed indirectly by the capillary endothelial GCX perfused boundary region (PBR), an internationally validated, inverse gauge for microcirculation [30, 105, 106, 138, 145]. PBR was obtained transcutaneously using non-invasive SDF-imaging of blood flow in the microcirculation of the participants’ ear helix [30]. The basic requirements for a valid image quality were guaranteed [115] and the GlycoCheck™- software automatically calculated the PBR of video segments. Longitudinal measurements were planned at the newborn screening (NS) and run around every full postnatal week ± one day; vital und laboratory parameters were also obtained. Within a 12 hours frame before or after measurement, a blood sample was drawn and recorded. PBR measurements of premature neonates were documented in 109 cases and blood samples at the same time were obtained in 106 cases. The measurements were stratified between very premature (group A [gestational age at birth < 30w + 0d]), moderate premature (group B [30w + 0d ≤ gestational age at birth < 37w + 0d]), and mature neonates (control group [gestational age at birth ≥ 37w + 0d]). For further evaluation, the starting point at NS was approached to visualize the PBR at birth. A significant increase between PBR (decrease in GXC size) and gestational age at birth was observed across the three groups. PBR at the first measurement after birth further significantly depended on gestational age at birth corrected for the postnatal age. This was found in all measured premature and mature neonates in a linear regression analysis. Furthermore, the longitudinal development in premature newborns showed an increase in PBR size, which we interpreted as gestational age dependent PBR changes. These changes were significant in group A, than reaching a steady plateau from 32 weeks of gestation and continued with higher PBR values compared to group B between 32nd and 36th gestational week. Also, linear regression analysis showed a significant dependence of PBR on postnatal age in the first four follow-up measurements. From these data a hypothesis was drawn, that the smaller GCX (bigger PBR) indicate a higher susceptibility with increased shedding of the fragile perinatal GCX in the extra-uterine environment compared to intra-uterine physiological maturation. Except for age, further possible influencing factors were tested, but none of the parameters showing a significant change over time as seen by comparing first measurement (FM) vs. last measurement (LM) correlated to PBR size at FM and LM. This could be due to small sample sizes, as general correlations could be detected when all measurements were included. The main limitations of the study were small sample size due to limited availability of stable very preterm babies, and related restrictions in follow-up measurements. Furthermore, PBR measurements only allow concluding on the size of the GXC without giving any information about its functionality. To affirm and strengthen the findings of the present study, further investigations are needed to improve our understanding of the pathophysiology of premature newborns

Effects of Two Commercial Diets on Several Reproductive Parameters in Bitches: Note One-From Estrous Cycle to Parturition

The close link between nutrition management and reproductive efficiency is well known, but there is very little data available concerning this topic in canine species. The present study aimed to compare the effect of two different diets upon the follicular period and gestation in bitches. Eighteen pluriparus medium and large size bitches were recruited and divided into control (CTR) and experimental (EX) groups and fed, respectively, with a commercial kibble diet and a specially formulated diet from two months before the expected onset of proestrus up to the end of the trial. It was possible to observe how the EX group had a better clinical presentation of the estrous phase, a higher number of ovarian follicles (p &lt; 0.05), a lower percentage of fetal resorption (p &lt; 0.05), and lower oxidative status, expressed by d-ROMs (p &lt; 0.01), at the moment of pregnancy diagnosis compared to CTR group. Moreover, the EX group showed a lower fetal resorption rate and higher litter size (p &lt; 0.05). These results highlight how a diet characterized by high protein and fat content and richer in essential fatty acids can improve reproductive performance in dogs

Screening for Neonatal Jaundice by Smartphone Sclera Imaging

Jaundice is observed in over 60% of neonates and must be carefully monitored. Ifsevere cases go unnoticed, death or permanent disability can result. Neonatal jaun-dice causes 100,000 deaths yearly, with low-income countries in Africa and SouthAsia particularly affected. There is an unmet need for an accessible and objectivescreening method. This thesis proposes a smartphone camera-based method forscreening based on quantification of yellow discolouration in the sclera.The primary aim is to develop and test an app to screen for neonatal jaundicethat requires only the smartphone itself. To this end, a novel ambient subtractionmethod is proposed and validated, with less dependence on external hardware orcolour cards than previous app-based methods. Another aim is to investigate thebenefits of screening via the sclera. An existing dataset of newborn sclera images(n=87) is used to show that sclera chromaticity can predict jaundice severity.The neoSCB app is developed to predict total serum bilirubin (TSB) fromambient-subtracted sclera chromaticity via a flash/ no-flash image pair. A studyis conducted in Accra, Ghana to evaluate the app. With 847 capture sessions, thisis the largest study on image-based jaundice detection to date. A model trained onsclera chromaticity is found to be more accurate than one based on skin. The modelis validated on an independent dataset collected at UCLH (n=38).The neoSCB app has a sensitivity of 100% and a specificity of 76% in iden-tifying neonates with TSB≥250μmol/L (n=179). This is equivalent to the TcB(JM-105) data collected concurrently, and as good as the best-performing app in theliterature (BiliCam). Following a one-time calibration, neoSCB works without spe-cialist equipment, which could help widen access to effective jaundice screening

New insights in pediatrics in 2021: choices in allergy and immunology, critical care, endocrinology, gastroenterology, genetics, haematology, infectious diseases, neonatology, neurology, nutrition, palliative care, respiratory tract illnesses and telemedicine

In this review, we report the developments across pediatric subspecialties that have been published in the Italian Journal of Pediatrics in 2021. We highlight advances in allergy and immunology, critical care, endocrinology, gastroenterology, genetics, hematology, infectious diseases, neonatology, neurology, nutrition, palliative care, respiratory tract illnesses and telemedicine

New insights in pediatrics in 2021: choices in allergy and immunology, critical care, endocrinology, gastroenterology, genetics, haematology, infectious diseases, neonatology, neurology, nutrition, palliative care, respiratory tract illnesses and telemedicine

In this review, we report the developments across pediatric subspecialties that have been published in the Italian Journal of Pediatrics in 2021. We highlight advances in allergy and immunology, critical care, endocrinology, gastroenterology, genetics, hematology, infectious diseases, neonatology, neurology, nutrition, palliative care, respiratory tract illnesses and telemedicine

New insights in pediatrics in 2021: choices in allergy and immunology, critical care, endocrinology, gastroenterology, genetics, haematology, infectious diseases, neonatology, neurology, nutrition, palliative care, respiratory tract illnesses and telemedicine

In this review, we report the developments across pediatric subspecialties that have been published in the Italian Journal of Pediatrics in 2021. We highlight advances in allergy and immunology, critical care, endocrinology, gastroenterology, genetics, hematology, infectious diseases, neonatology, neurology, nutrition, palliative care, respiratory tract illnesses and telemedicine