The Impact of Maternal Infection on the Neonate

Maternal infection is a common occurrence during pregnancy, with a substantial impact on the infant. Some infections result in impaired development in utero and even death of the fetus. Other infections may be insidious in the mother but result in growth impairment and hearing loss in the infant. A growing body of evidence suggests that even infections such as chorioamnionitis, thought to have no long-term impact on the infant, may alter fetal development. This chapter will review congenital infections and their impact on neonatal outcomes, as well as newer findings suggesting that acute infection may result in adverse changes in the infant. We will explore novel mechanisms of pathogenesis and virulence, as well as areas that continue with ongoing research

Increased Incidence of Asthma in Children with Prenatal Opioid Exposure

Prenatal opioid exposure (POE) has increased dramatically in the last 10 years, with nearly 100 babies born daily in the United States with Neonatal Opioid Withdrawal Syndrome (NOWS). The impact on long-term outcomes continues to be investigated. Given the proinflammatory state that results from POE, we hypothesized that infants with POE or NOWS diagnoses during the newborn hospitalization would have an altered immune reactivity that persisted into childhood, defined by asthma diagnosis within the first 8 years. A retrospective cohort design utilizing a comprehensive CERNER HealthFacts U.S. national database was completed, which accesses clinical data from 800 hospitals across the country. ICD-9-CM and ICD-10-CM diagnosis codes were used to identify infants born at term with known POE or NOWS and were compared to healthy control infants with no diagnoses at birth other than normal newborn codes. The incidence of asthma during the first 8 years of life was determined. Descriptive statistics of frequencies and percentages were calculated for all variables. A Chi-Square test was used to examine the association between asthma diagnosis and POE. A total of 3128 infants were included in the analysis. Approximately 41% were identified as male and 38% identified as female; the remainder were not specified with coding. Almost 52% of subjects were identified as Caucasian. Asthma diagnosis differed significantly by group, X2 (3, n = 3,128) = 12.93 with a p \u3c 0.001. These emerging results suggest infants with POE may have altered immune reactivity that not only impacts the newborn period but persists into childhood. Those with POE were more likely to be diagnosed with asthma by 8 years of age than infants in the healthy control group. Additional investigations are needed to further characterize the impact POE has on the immune system, so that potential follow up strategies and/or interventions can be established

Pilot study shows skin-to-skin care with parents improves heart rate variability in preterm infants in the neonatal intensive care unit

BackgroundSkin-to-skin care in the newborn intensive care unit typically lasts for short periods of time and enhances breastfeeding, attachment, and parental self-esteem. Heart rate variability (HRV) increases with gestational age and is a measure of maturation of parasympathetic vs. sympathetic autonomic nervous system activity. HRV measurements may be useful in capturing changes in autonomic regulation in response to skin-to-skin care.ObjectiveTo analyze the effects of skin-to-skin care on HRV in preterm infants receiving respiratory support. We hypothesized that skin-to-skin care would result in a more mature pattern of parasympathetic activity.MethodsIn this prospective crossover study, infants <30 weeks' gestation and 1–6 weeks postnatal age had HRV recorded for 30 min before, during, and after skin-to-skin care sessions. HRV characteristics analyzed included the standard deviation of the normal-to-normal interval (SDNN), the root mean squared of successive differences of normal-to-normal intervals (RMSSD), and the standard deviation of decelerations (SDDec).Results10 infants between 25 5/7–29 6/7 weeks gestational age and 7–41 days postnatal age completed 22 sessions while receiving respiratory support (positive pressure ventilation or nasal cannula oxygen). Two measures of HRV (SDNN and RMSSD) were significantly decreased by the end of the skin-to-skin sessions, compared to pre-session values. SDNN decreased from a median of 10.44 ms before the session to 6.70 ms after being placed back in bed (p < 0.05), with RMSSD decreasing from a median of 6.80 ms before the session to 4.32 ms while being held at the end of 30 min (p < 0.05).DiscussionSkin-to-skin care with a parent resulted in a more mature autonomic nervous system pattern in preterm infants receiving respiratory support, suggesting physiologic benefit for the infant. No adverse events were seen during any session

Prenatal Alcohol Exposure and Placental Insufficiency Results in Reduced Neuronal Complexity in the Rat Prefrontal Cortex

Prenatal Alcohol Exposure (PAE) can produce long-term neurodevelopmental deficits and impaired executive function. Alcohol exposure during gestation is associated with impaired fetal development caused by placental insufficiency. The impact following PAE and placental insufficiency (PI) remains unknown. Utilizing a three-dimensional (3D) Sholl analysis, we hypothesized that PAE+PI will result in decreased neuronal complexity within the frontal cortex, a region critical to executive functioning. Pregnant Long-Evans rats voluntarily drank 5% ethanol or saccharin water until embryonic day 18 (E18) to mimic moderate PAE. On E19, a laparotomy was performed to occlude the uterine artery for 60 minutes to induce PI. The pups delivered normally. At postnatal day 100 (P100), brains were extracted and Golgi-Cox stained. Coronal sections were imaged utilizing a Leica TCS SP8 Confocal microscope with z-stacking capabilities. A 3D Sholl analysis was conducted within Imaris software to assess variance in neural complexity between treatment groups. Analysis was completed with a 2-way ANOVA and t-test. Five PAE+PI and 5 control brains were collected. In the medial frontal cortex, 3 neurons were analyzed from each hemisphere. No statistical difference was noted between the two hemispheres, so the data was combined for each animal resulting in 6 neurons being analyzed. The proximal dendritic complexity was similar between groups. PAE+PI resulted in significantly diminished complexity more distal from the soma; at 80 mm the PAE+PI group had an average of 2.4 intersections while the control group had an average of 3.3 (p\u3c0.05). At 90 mm, the PAE+PI group continued to have fewer intersections compared to controls (1.8 vs. 2.6). This is the first study to investigate the dendritic complexity following PAE combined with PI within the frontal cortex. Given the importance of this region to executive function, this may provide insight into the long-term deficits that are observed and provide support for interventions

Prenatal Hypoxia–Ischemia Induces Abnormalities in CA3 Microstructure, Potassium Chloride Co-Transporter 2 Expression and Inhibitory Tone

Infants who suffer perinatal brain injury, including those with encephalopathy of prematurity, are prone to chronic neurological deficits, including epilepsy, cognitive impairment, and behavioral problems, such as anxiety, inattention, and poor social interaction. These deficits, especially in combination, pose the greatest hindrance to these children becoming independent adults. Cerebral function depends on adequate development of essential inhibitory neural circuits and the appropriate amount of excitation and inhibition at specific stages of maturation. Early neuronal synaptic responses to γ-amino butyric acid (GABA) are initially excitatory. During the early postnatal period, GABAAR responses switch to inhibitory with the upregulation of potassium-chloride co-transporter KCC2. With extrusion of chloride by KCC2, the Cl− reversal potential shifts and GABA and glycine responses become inhibitory. We hypothesized that prenatal hypoxic–ischemic brain injury chronically impairs the developmental upregulation of KCC2 that is essential for cerebral circuit formation. Following late gestation hypoxia–ischemia (HI), diffusion tensor imaging in juvenile rats shows poor microstructural integrity in the hippocampal CA3 subfield, with reduced fractional anisotropy and elevated radial diffusivity. The loss of microstructure correlates with early reduced KCC2 expression on NeuN-positive pyramidal neurons, and decreased monomeric and oligomeric KCC2 protein expression in the CA3 subfield. Together with decreased inhibitory post-synaptic currents during a critical window of development, we document for the first time that prenatal transient systemic HI in rats impairs hippocampal CA3 inhibitory tone. Failure of timely development of inhibitory tone likely contributes to a lower seizure threshold and impaired cognitive function in children who suffer perinatal brain injury

Capacitating Community: The Writing Innovation Symposium

The topic of this symposium, capacitating community, invites CLJ readers to consider what makes a community possible. This piece showcases one means, small conferences, via a retrospective on the Writing Innovation Symposium (WIS), a regional event with national scope that has hosted writers and writing educators annually in Milwaukee, WI, since 2018. Through a quilted conversation pieced from hours of small-group discussion, twenty-nine participants across academic and nonacademic ranks, roles, and ranges of experience offer insight into the WIS as well as the nature and value of professional community

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely