Rapid correction of early metabolic acidaemia in comparison with placebo, no intervention or slow correction in LBW infants (Review)

BACKGROUND: Metabolic or mixed (metabolic and respiratory) acidosis are commonly encountered problems in the low birth weight (LBW) infant after delivery, and they may contribute to mortality and morbidity. Causes for the lactic acidosis are multiple and include maternal, placental and fetal factors. It is unclear whether metabolic acidaemia in the first 24 hours of life in LBW infants should be corrected by rapid infusion of alkali. OBJECTIVES: The main objective was to assess the short and long-term effects of the rapid correction of early (first 24 hours) metabolic acidaemia in LBW

Neonatal umbilical cord blood cardiac troponin as reflecting fetal growth, age and well being

Objectives: It has been proposed that an elevated concentration of cardiac troponin in umbilical cord blood may function as a surrogate marker of ischemic damage sustained in utero and/or during labour and delivery. The objective of this study is to document the umbilical cord blood concentrations of troponins I (cTnI) and T (cTnT) using high sensitivity assays and correlate these with maternal and fetal clinical history.Methods: Umbilical cord blood was collected immediately following delivery from 416 babies, including 12 sets of twins. Clinical history was obtained from clinical notes. Ethics permission was obtained from ACT Health Human Research and Ethics Committee for the study and consent was obtained from mothers for their participation. Cardiac troponins were assayed using hs- cTnI on Abbott Architect (LoD 1.0 ng/L) and hs-cTnT on Roche E4111 (LoD 5.0 ng/L). Data are expressed as median and 25th and 75th percentiles.Results: Umbilical cord blood consistently has higher median values of cTnT than cTnI such that the median ratios are 6.8 and 5.4 at <32 week gestation and 41 week babies respectively compared with T:I of 0.8 in adults. Babies of early gestation have higher concentrations of cTnT and cTnI as do babies with APGAR scores ≤4 at 1 min. Median cTn concentrations show a 50% decrease between babies born< 32 weeks and those at full term.Relationship of birth weight and umbilical cord cardiac troponin concentrations. Low Birth Weight babies have~50% higher cTn concentrationsConclusions: These findings are consistent with a differential expression of cTnT and cTnI in utero with potential contributions from growth and re-modelling of the heart in addition to “ectopic” production in less differentiated non-cardiac muscle. The effect of intermittent ischemia which occurs as part of normal labour and delivery may superimpose on this increments

Comparing very low birth weight versus very low gestation cohort methods for outcome analysis of high risk preterm infants

© 2017 The Author(s). Background: Compared to very low gestational age (<32 weeks, VLGA) cohorts, very low birth weight (<1500 g; VLBW) cohorts are more prone to selection bias toward small-for-gestational age (SGA) infants, which may impact upon the validity of data for benchmarking purposes. Method: Data from all VLGA or VLBW infants admitted in the 3 Networks between 2008 and 2011 were used. Two-thirds of each network cohort was randomly selected to develop prediction models for mortality and composite adverse outcome (CAO: mortality or cerebral injuries, chronic lung disease, severe retinopathy or necrotizing enterocolitis) and the remaining for internal validation. Areas under the ROC curves (AUC) of the models were compared. Results: VLBW cohort (24,335 infants) had twice more SGA infants (20.4% vs. 9.3%) than the VLGA cohort (29,180 infants) and had a higher rate of CAO (36.5% vs. 32.6%). The two models had equal prediction power for mortality and CAO (AUC 0.83), and similarly for all other cross-cohort validations (AUC 0.81-0.85). Neither model performed well for the extremes of birth weight for gestation (<1500 g and ≥32 weeks, AUC 0.50-0.65; ≥1500 g and <32 weeks, AUC 0.60-0.62). Conclusion: There was no difference in prediction power for adverse outcome between cohorting VLGA or VLBW despite substantial bias in SGA population. Either cohorting practises are suitable for international benchmarking

Biallelic VARS variants cause developmental encephalopathy with microcephaly that is recapitulated in vars knockout zebrafish

Aminoacyl tRNA synthetases (ARSs) link specific amino acids with their cognate transfer RNAs in a critical early step of protein translation. Mutations in ARSs have emerged as a cause of recessive, often complex neurological disease traits. Here we report an allelic series consisting of seven novel and two previously reported biallelic variants in valyl-tRNA synthetase (VARS) in ten patients with a developmental encephalopathy with microcephaly, often associated with early-onset epilepsy. In silico, in vitro, and yeast complementation assays demonstrate that the underlying pathomechanism of these mutations is most likely a loss of protein function. Zebrafish modeling accurately recapitulated some of the key neurological disease traits. These results provide both genetic and biological insights into neurodevelopmental disease and pave the way for further in-depth research on ARS related recessive disorders and precision therapies

Structural and mechanical properties of TiB 2 and TiC prepared by self-propagating high-temperature synthesis/dynamic compaction

Titanium-diboride and titanium-carbide compacts with diameters of 100 mm and thicknesses of 25 mm were fabricated by self-propagating high-temperature synthesis/dynamic compaction (SHS/DC) of the elemental powders. Under the best conditions, the densities were greater than 99% and 96.8% of the theoretical densities for TiB 2 and TiC, respectively. The microhardness, compressive strength, and elastic modulus of the TiB 2 prepared by the SHS/DC method were comparable to reported values for hot-pressed TiB 2 . While the microhardness and elastic modulus of the TiC compacts were comparable to those for hotpressed TiC, the compressive strength was lower due to extensive cracks in the compacts. The TiB 2 prepared using a low-purity boron powder (1–5% carbon impurity) compacted to higher densities and had less cracking than that prepared using a high-purity boron powder (0.2% carbon). This result could have an impact on the cost of producing TiB 2 /TiC structural components by the SHS/DC process.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44732/1/10853_2005_Article_BF01162518.pd

Outcomes of Two Trials of Oxygen-Saturation Targets in Preterm Infants

BACKGROUN

Poor outcome of very low birthweight babies with serious congenital heart disease

Objective: To evaluate incidence and mortality of congenital heart disease in very low birthweight babies. Method: Retrospective analysis of a 12 year period. Results: Forty seven babies were diagnosed with severe congenital heart disease. The most common lesions were ventricular septal defect and coarctation of the aorta. Mortality attributed to congenital heart disease was 32%. Coarctation of the aorta, the second most common lesion, was fatal in 62% of cases. Closure of a patent ductus arteriosus with indomethacin proved to be detrimental in babies with undiagnosed coarctation, causing rapid deterioration in some. Conclusion: Very low birthweight neonates with severe congenital heart disease have a higher mortality than babies with higher birth weight. A contributing factor is closure of a patent ductus arteriosus if an underlying lesion has not been recognised. This could be of significance if the use of prophylactic treatment with indomethacin becomes more common