Different glucose analyzers report different glucose concentration values in term newborns

Background: The American Academy of Pediatrics and Pediatric Endocrine Society neonatal hypoglycemia guidelines based their glucose concentration treatment thresholds on studies that predominantly used Beckman and Yellow Springs Glucose Oxidase Analyzers. Currently, a majority (76%) of U.S. hospital laboratories utilizing glucose oxidase methodology use Vitros® Glucose Analyzers. However, a bias of ~+5% between glucose concentrations from Beckman vs. Vitros Glucose Analyzers has been reported; this could have a clinically significant effect when using published guideline treatment thresholds. Methods: To determine if there is similar instrument bias between Beckman and Vitros Analyzers in reported glucose concentrations from term newborns, we compared plasma glucose concentrations measured within the first 3 h after birth by Beckman vs. Vitros Analyzers in a total of 1,987 newborns (Beckman n = 904, Vitros n = 1,083). Data were fit using nonlinear cubic spline models between collection time and glucose concentration. Results: The non-linear patterns of initial glucose concentrations (during the first 3 h after birth) as measured by Beckman and Vitros Analyzers paralleled each other with no overlap of the fit spline curve 95% confidence intervals, with an approximate +5 mg/dL constant bias. Additionally, in method comparison studies performed in the Chemistry Laboratory on adult samples, there was a +4.2-7.4 mg/dL measured glucose bias for the Beckman vs. Vitros Analyzer. Conclusion: Glucose concentrations from term, appropriate size for gestational age newborns were about 5 mg/dL higher when measured by Beckman vs. Vitros Analyzers. Perhaps, concentrations of 45 mg/dL reported from Beckman Analyzers may be equivalent to 40 mg/dL from Vitros Analyzers. When managing neonatal hypoglycemia, it is important to know which analyzer was used and whether adjusting for potential instrument bias is necessary when following published guidelines. Keywords: glucose; glucose analyzer; guideline; neonatal hypoglycemia; newborn

A neonate with left pulmonary artery thrombosis and left lung hypoplasia: a case report

<p>Abstract</p> <p>Introduction</p> <p>Spontaneous intrauterine arterial thrombosis and congenital pulmonary hypoplasia are rare conditions and have not been reported to occur together. The literature rather includes two reports of babies with neonatal pulmonary artery occlusion and post-infarction cysts of the lungs.</p> <p>Case presentation</p> <p>We report a case of a live Caucasian male newborn with left lung hypoplasia that occurred in association with left pulmonary artery thrombosis. Despite a critical neonatal course, including extracorporeal membrane oxygenation, this infant is alive and well at 18 months of age without any neurodevelopmental sequelae or reactive airway disease.</p> <p>Conclusion</p> <p>This association suggests the possibility of an intrauterine vascular event between the fifth and eighth weeks of gestation during early pulmonary artery and lung development.</p

The impact of prematurity and maternal socioeconomic status and education level on achievement-test scores up to 8^th grade

<div><p>Background</p><p>The relative influence of prematurity vs. maternal social factors (socioeconomic status and education level) on academic performance has rarely been examined.</p><p>Objective</p><p>To examine the impact of prematurity and maternal social factors on academic performance from 3^rd through 8^th grade.</p><p>Methods</p><p>We conducted a retrospective cohort study of infants born in 1998 at the University of Arkansas for Medical Sciences. The study sample included 58 extremely low gestational age newborns (ELGANs, 23‒<28 weeks), 171 preterm (≥28‒<34 weeks), 228 late preterm (≥34‒<37 weeks), and 967 term ((≥37‒<42 weeks) infants. Neonatal and maternal variables were collected including maternal insurance status (proxy measure for socioeconomic status) and education level. The primary outcomes were literacy and mathematics achievement-test scores from 3^rd through 8^th grade. Linear mixed models were used to identify significant predictors of academic performance. All two-way interactions between grade level, gestational-age (GA) groups, and social factors were tested for statistical significance.</p><p>Results</p><p>Prematurity, social factors, gender, race, gravidity, and Apgar score at one minute were critical determinants of academic performance. Favorable social factors were associated with a significant increase in both literacy and mathematic scores, while prematurity was associated with a significant decrease in mathematic scores. Examination of GA categories and social factors interaction suggested that the impact of social factors on test scores was similar for all GA groups. Furthermore, the impact of social factors varied from grade to grade for literacy, while the influence of either GA groups or social factors was constant across grades for mathematics. For example, an ELGAN with favorable social factors had a predicted literacy score 104.1 (P <.001), 98.2 (P <.001), and 76.4 (P <.01) points higher than an otherwise similar disadvantaged term infant at grades 3, 5, and 8, respectively. The difference in their predicted mathematic scores was 33.4 points for all grades (P <.05).</p><p>Conclusion</p><p>While there were significant deficits in academic performance for ELGANs compared to PT, LPT, and term infants, the deficit could be offset by higher SES and better-educated mothers. These favorable social factors were critical to a child’s academic achievement. The role of socioeconomic factors should be incorporated in discussions on outcome with families of preterm infants.</p></div

Multivariate linear mixed model for literacy and mathematics scores^a.

<p>Multivariate linear mixed model for literacy and mathematics scores<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0198083#t002fn002" target="_blank">^a</a>.</p

Difference in predicted literacy scores across grades between ELGANs and term infants.

<p>Difference in predicted literacy scores across grades between ELGANs and term infants.</p

Patient characteristics of the final matched cohort.

<p>Patient characteristics of the final matched cohort.</p

Literacy and mathematics test proficiency by gestational age group and grade level.

<p>Literacy and mathematics test proficiency by gestational age group and grade level.</p

Difference in predicted literacy scores between ELGANs and term infants at different levels of maternal social factors from 3^rd to 8^th grade^a^, ^b.

<p>Difference in predicted literacy scores between ELGANs and term infants at different levels of maternal social factors from 3^rd to 8^th grade<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0198083#t003fn002" target="_blank">^a</a>^, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0198083#t003fn003" target="_blank">^b</a>.</p