Campaign for a Moral, Balanced Immigration Overhaul (CAMBIO), Strategic Review

In March 2014, Campaign for an Accountable, Moral, and Balanced Immigration Reform (CAMBIO) commissioned us to conduct an external review of the CAMBIO campaign. This report summarizes findings based on data gathered during an in-person focus group conducted with members of the CAMBIO Steering Committee in May 2014; a review of approximately 20 CAMBIO corporate documents and 36 internal meeting minutes; and 41 semi-structured telephone interviews conducted principally in June and July 2014

Editorial: Recent advances in our understanding of NEC pathogenesis, diagnosis, and treatment

Necrotizing enterocolitis is a leading cause of death among premature infants, and despite research spanning over six decades, the pathogenesis is still not completely understood. The onset of NEC can be rapid and unpredictable, with clinical signs such as abdominal distension and bloody stools, progressing to fulminant bowel necrosis and death within hours. Even though the clinical and pathological descriptions of NEC were first described many decades ago, the management options have not progressed significantly and continue to be supportive care, such as cessation of feedings, intravenous fluids, antibiotic administration, and, in some cases, surgical bowel resection. Although treatment options for NEC remain limited, one effective preventative strategy is the administration of human milk. Recent advances in identifying the precise nutrients in human milk shed light on its bioactive components and their impact on the intestine. In recent years, several studies have highlighted the benefit of using prebiotics and probiotics as additional preventative options for NEC. Clinical studies focused on diagnostic tools such as using serum biomarkers or big data and artificial intelligence may pave the way for earlier detection to minimize disease progression, avoid the negative impact on other organ systems, and improve the poor neurodevelopmental outcomes associated with NEC. The primary objectives for this topic were to focus on recent advances in our understanding of NEC pathogenesis, new diagnostic strategies such as biomarkers and artificial intelligence, and explore new therapeutic options for treating this devastating disease

A Proposed Machine Learning Based Collective Disease Model to Enable Predictive Diagnostics in Necrotising Enterocolitis

© 2018 IEEE. Despite 60 years of research into necrotising enterocolitis (NEC), our understanding of the disease has not improved enough to achieve better outcomes. Even though NEC has remained the leading cause of death and poor outcomes in preterm infants, there remain vital questions on how to define, differentiate and detect the condition. Numerous international groups have recently highlighted NEC as a research priority and called for broader engagement of the scientific community to move the field forward. The three foremost barriers at present are lack of suitable definition(s), lack of clean datasets and consequently a lack of scope to gain sufficient insights from data. This research paper proposes a new direction of travel to advance neonatal gastro-intestinal monitoring and strengthen our efforts to gain better insights from global databases. An integrated machine learning based model is recommended to produce a comprehensive disease model to manage the complexity of this multi-variate disease. This intelligent disease model would be used in the daily neonatal settings to help aggregate data to support clinical decision making, better capture the complexity of each patient to enrich global datasets to create bigger and better data. This paper reviews current machine learning and CAD technologies in neonatology and suggests an innovative approach for an NEC disease model

Long‐Chain Polyunsaturated Fatty Acids and Lipid Peroxidation Products in Donor Human Milk in the United Kingdom: Results From the LIMIT 2‐Centre Cross‐Sectional Study

Background: Donor human milk is increasingly used as alternative to mother’s own milk to feed preterm infants, however, it may provide less long-chain polyunsaturated fatty acid (LCPUFA), and more oxidised lipids, which may be detrimental for preterm infant health and development. Levels have not been reported for donor human milk in the U.K. Methods: Donor human milk (n=19) from two neonatal units, milk from preterm mothers from a neonatal unit (n=10), and term mothers from the community (n=11) were analysed for fatty acid, malondialdehyde, 4-hydroxy-2-nonenal, and hexanal content. Study registration: NCT03573531 Results: Donor human milk had significantly lower absolute LCPUFA content compared to term milk (P<0.001) and significantly lower omega-3 PUFAs than preterm milk (P<0.05), although relative LCPUFA composition did not differ. Exclusive donor human milk feeding leads to significantly lower fat (3.7 vs. 6.7 g/d) and LCPUFA (DHA: 10.6 vs. 16.8 mg/d; ARA: 17.4 vs. 25.2 mg/d) intake than recommended by ESPGHAN, and provides only 17.3% and 43.1% of the in utero accreted ARA and DHA. Donor human milk also had the highest proportion of lipid peroxidation. Conclusions: This study confirms that donor human milk in the U.K. has insufficient levels of LCPUFAs for preterm infants. It demonstrates for the first time that donor human milk has the highest level of lipid peroxidation, compared to preterm or term milk. This has important implications for preterm infant nutrition, as exclusive donor human milk feeding might not be suitable long-term, and may contribute to the development of major preterm neonatal morbidities

The detection, survival and persistence of Staphylococcus capitis NRCS-A in neonatal units in England

BACKGROUND: The multi-drug resistant Staphylococcus capitis clone, NRCS-A is increasingly associated with late-onset sepsis in low birthweight newborns in neonatal intensive care units (NICUs) in England and globally. Understanding where this bacterium survives and persists within the NICU environment is key to developing and implementing effective control measures. AIM: To investigate the potential for S. capitis to colonise surfaces within NICUs. METHODS: Surface swabs were collected from four NICUs with and without known NRCS-A colonisations/infections present at the time of sampling. Samples were cultured and S. capitis isolates analysed via whole genome sequencing. Survival of NRCS-A on plastic surfaces was assessed over time and compared to that of non-NRCS-A isolates. The bactericidal activity of commonly used chemical disinfectants against S. capitis was assessed. FINDINGS: Of 173 surfaces sampled, 40 (21.1%) harboured S. capitis with 30 isolates (75%) being NRCS-A. Whilst S. capitis was recovered from surfaces across the NICU, the NRCS-A clone was rarely recovered from outside the immediate neonatal bedspace. Incubators and other bedside equipment were contaminated with NRCS-A regardless of clinical case detection. In the absence of cleaning, S. capitis was able to survive for 3 days with minimal losses in viability (< 0.5 log10 reduction). Sodium troclosene and a QAC-based detergent/disinfectant reduced S. capitis to below detectable levels. CONCLUSION: S. capitis NRCS-A can be readily recovered from the NICU environment, even in units with no recent reported clinical cases of S. capitis infection, highlighting a need for appropriate national guidance on cleaning within the neonatal care environment

Fathers in neonatal units: Improving infant health by supporting the baby-father bond and mother-father coparenting

The Family Initiative's International Neonatal Fathers Working Group, whose members are the authors of this paper, has reviewed the literature on engaging fathers in neonatal units, with the aim of making recommendations for improving experience of fathers as well as health outcomes in neonatal practice. We believe that supporting the father-baby bond and supporting co-parenting between the mother and the father benefits the health of the baby, for example, through improved weight gain and oxygen saturation and enhanced rates of breastfeeding. We find, however, that despite much interest in engaging with parents as full partners in the care of their baby, engaging fathers remains sub-optimal. Fathers typically describe the opportunity to bond with their babies, particularly skin-to-skin care, in glowing terms of gratitude, happiness and love. These sensations are underpinned by hormonal and neurobiological changes that take place in fathers when they care for their babies, as also happens with mothers. Fathers, however, are subject to different social expectations from mothers and this shapes how they respond to the situation and how neonatal staff treats them. Fathers are more likely to be considered responsible for earning, they are often considered to be less competent at caring than mothers and they are expected to be “the strong one”, providing support to mothers but not expecting it in return. Our review ends with 12 practical recommendations for neonatal teams to focus on: (1) assess the needs of mother and father individually, (2) consider individual needs and wants in family care plans, (3) ensure complete flexibility of access to the neonatal unit for fathers, (4) gear parenting education towards co-parenting, (5) actively promote father-baby bonding, (6) be attentive to fathers hiding their stress, (7) inform fathers directly not just via the mother, (8) facilitate peer-to-peer communication for fathers, (9) differentiate and analyse by gender in service evaluations, (10) train staff to work with fathers and to support co-parenting, (11) develop a father-friendly audit tool for neonatal units, and (12) organise an international consultation to update guidelines for neonatal care, including those of UNICEF

Systemic Stimulation of TLR2 Impairs Neonatal Mouse Brain Development

Background: Inflammation is associated with perinatal brain injury but the underlying mechanisms are not completely characterized. Stimulation of Toll-like receptors (TLRs) through specific agonists induces inflammatory responses that trigger both innate and adaptive immune responses. The impact of engagement of TLR2 signaling pathways on the neonatal brain is still unclear. The aim of this study was to investigate the potential effect of a TLR2 agonist on neonatal brain development. Methodology/Principal Findings: Mice were injected intraperitoneally (i.p.) once a day from postnatal day (PND) 3 to PND11 with endotoxin-free saline, a TLR2 agonist Pam$_{3}$CSK$_{4}$ (5 mg/kg) or Lipopolysaccharide (LPS, 0.3 mg/kg). Pups were sacrificed at PND12 or PND53 and brain, spleen and liver were collected and weighed. Brain sections were stained for brain injury markers. Long-term effects on memory function were assessed using the Trace Fear Conditioning test at PND50. After 9 days of Pam$_{3}$CSK$_{4}$ administration, we found a decreased volume of cerebral gray matter, white matter in the forebrain and cerebellar molecular layer that was accompanied by an increase in spleen and liver weight at PND12. Such effects were not observed in Pam$_{3}$CSK$_{4}$-treated TLR 2-deficient mice. Pam$_{3}$CSK$_{4}$-treated mice also displayed decreased hippocampus neuronal density, and increased cerebral microglia density, while there was no effect on caspase-3 or general cell proliferation at PND12. Significantly elevated levels of IL-1β, IL-6, KC, and MCP-1 were detected after the first Pam$_{3}$CSK$_{4}$ injection in brain homogenates of PND3 mice. Pam$_{3}$CSK$_{4}$administration did not affect long-term memory function nor the volume of gray or white matter. Conclusions/Significance: Repeated systemic exposure to the TLR2 agonist Pam$_{3}$CSK$_{4}$ can have a short-term negative impact on the neonatal mouse brain

Influence of the calcium concentration in the presence of organic phosphorus on the physicochemical compatibility and stability of all-in-one admixtures for neonatal use

<p>Abstract</p> <p>Background</p> <p>Preterm infants need high amounts of calcium and phosphorus for bone mineralization, which is difficult to obtain with parenteral feeding due to the low solubility of these salts. The objective of this study was to evaluate the physicochemical compatibility of high concentrations of calcium associated with organic phosphate and its influence on the stability of AIO admixtures for neonatal use.</p> <p>Methods</p> <p>Three TPN admixture formulas were prepared in multilayered bags. The calcium content of the admixtures was adjusted to 0, 46.5 or 93 mg/100 ml in the presence of a fixed organic phosphate concentration as well as lipids, amino acids, inorganic salts, glucose, vitamins and oligoelements at pH 5.5. Each admixture was stored at 4°C, 25°C or 37°C and evaluated over a period of 7 days. The physicochemical stability parameters evaluated were visual aspect, pH, sterility, osmolality, peroxide formation, precipitation, and the size of lipid globules.</p> <p>Results</p> <p>Color alterations occurred from the first day on, and reversible lipid film formation from the third day of study for the admixtures stored at 25°C and 37°C. According to the parameters evaluated, the admixtures were stable at 4°C; and none of them presented precipitated particles due to calcium/phosphate incompatibility or lipid globules larger than 5 μm, which is the main parameter currently used to evaluate lipid emulsion stability. The admixtures maintained low peroxide levels and osmolarity was appropriate for parenteral administration.</p> <p>Conclusion</p> <p>The total calcium and calcium/phosphorus ratios studied appeared not to influence the physicochemical compatibility and stability of AIO admixtures.</p