Importance of Milk Expression for Preterm Infants

Mothers of preterm infants may find it difficult to express breast milk. There is a low breast milk rate among preterm infants at discharge at our hospital, and here we tested the hypothesis that milk expression factors were the cause of the low rate. The study subjects were born before 33 gestational weeks at our hospital between March 2005 and June 2014. Nutritional evaluation was performed at discharge and noted whether breast milk, infant formula, or a mix of the 2 was being given. We compared the group given breast milk or the mix versus the group given formula. Of the 337 infants, 40 cases were excluded. Data from 297 infants were analyzed. The mean (SD) gestational age and birth weight were 29.5 (2.4) weeks and 1,230 (391) g, respectively. At discharge, 26 (8.8%), 102 (33.3%), and 174 (57.9%) infants were given breast milk, formula, and the mix, respectively. A multivariate logistic regression analysis showed that the first milk expression (h) was the risk factor for the formula group: adjusted odds ratio (95% confidence interval) 1.06 (1.02-1.09) and p=0.002. Delayed first milk expression could affect the low breast milk rate at discharge. Improvement of milk expression should be achieved to promote breastfeeding

Survival and Neurodevelopmental Outcomes of Very Low Birth Weight Infants in a Regional Core Hospital in Kochi, Japan

We sought to clarify the survival and neurodevelopmental outcomes of very low birth weight infants (VLBWIs) and to identify risk factors for death or neurodevelopmental impairment (NDI) in VLBWIs at our hospital. The total study population was 217 infants born in 2005-2012 weighing ≤1,500 g. We compared their outcomes with those from previous reports analyzed the causes of death. Risk factors for death after discharge or NDI were evaluated by a multivariate logistic regression analysis. The incidences of death or NDI reported revealed in this study and the database of Neonatal Research Network of Japan were 25.3% and 19.6% (p＝0.039), respectively. The main causes of death before discharge were intraventricular hemorrhage, sepsis, and persistent pulmonary hypertension of the newborn. The significant risk factors for death after discharge or NDI were early gestational age (weeks) and periventricular leukomalacia (adjusted odds ratio [95% confidence interval, p-value], 0.72 [0.54-0.94, 0.017] and 6.90 [1.35-38.25, 0.021], respectively). These factors must be addressed in order to improve treatment strategies for VLBWIs

On the evolution and environmental dependence of the star formation rate versus stellar mass relation since z ˜ 2.

This paper discusses the evolution of the correlation between galaxy star formation rates (SFRs) and stellar mass (M*) over the last ∼10 Gyr, particularly focusing on its environmental dependence. We first present the mid-infrared (MIR) properties of the Hα-selected galaxies in a rich cluster Cl 0939+4713 at z = 0.4. We use wide-field Spitzer/MIPS 24 μm data to show that the optically red Hα emitters, which are most prevalent in group-scale environments, tend to have higher SFRs and higher dust extinction than the majority population of blue Hα sources. With an MIR stacking analysis, we find that the median SFR of Hα emitters is higher in higher density environment at z = 0.4. We also find that star-forming galaxies in high-density environment tend to have higher specific SFR (SSFR), although the trend is much less significant compared to that of SFR. This increase of SSFR in high-density environment is not visible when we consider the SFR derived from Hα alone, suggesting that the dust attenuation in galaxies depends on environment; galaxies in high-density environment tend to be dustier (by up to ∼0.5 mag), probably reflecting a higher fraction of nucleated, dusty starbursts in higher density environments at z = 0.4. We then discuss the environmental dependence of the SFR–M* relation for star-forming galaxies since z ∼ 2, by compiling our comparable, narrow-band-selected, large Hα emitter samples in both distant cluster environments and field environments. We find that the SSFR of Hα-selected galaxies (at the fixed mass of log (M*/M⊙) = 10) rapidly evolves as (1 + z)3, but the SFR–M* relation is independent of the environment since z ∼ 2, as far as we rely on the Hα-based SFRs (with M*-dependent extinction correction). Even if we consider the possible environmental variation in the dust attenuation, we conclude that the difference in the SFR–M* relation between cluster and field star-forming galaxies is always small (≲0.2 dex level) at any time in the history of the Universe since z ∼ 2

Ventriculoperitoneal Shunt Outcomes among Infants

Ventriculoperitoneal shunts (VPSs) are used for the treatment of hydrocephalus. Here we analyzed the outcomes of VPS placements in 24 infants to determine the risk factors for shunt failure. The infants had undergone the initial VPS operation in our hospital between March 2005 and December 2013. They were observed until the end of January 2014. We obtained Kaplan-Meier curves and performed a multivariate Cox regression analysis of shunt failure. Of the 24 cases, the median (range) values for gestational age, birth weight, and birth head circumference (HC) were 37 (27-39) wks, 2,736 (686-3,788) g, and 35.3 (23.0-45.3) cm, respectively. The total number of shunt procedures was 45. Shunt failure rates were 0.51/shunt and 0.0053/shunt/year. Shunt infection rates were 0.13/shunt and 0.0014/shunt/year. The Kaplan-Meier analysis revealed an increased risk for shunt failure in infants ＜1 month old or in the HC ＞90ｵtile. The Cox regression analysis yielded hazard ratios (HRs) of 2.93 (95ｵ confidence interval (CI), 0.96-10.95, p＝0.059) for age ＜1 month, and 4.46 (95ｵCI:1.20-28.91,p＝0.023) for the HC ＞90ｵtile. The multivariate Cox regression analysis showed adjusted HRs of 17.56 (95ｵCI:2.69-202.8, p＝0.001) for age ＜1 month, and 2.95 (95ｵCI:0.52-24.84, p＝0.228) for the HC ＞90ｵtile. Our findings thus revealed that the risk factors for shunt failure in infants include age ＜1 month at the initial VPS placement

Changes in the Features of Invasive Pneumococcal Disease after Introduction of the Seven-valent Pneumococcal Conjugate Vaccine in a Regional Core Hospital of Kochi, Japan

Since the introduction of the seven-valent pneumococcal conjugate vaccine (PCV7) in 2007, invasive pneumococcal disease has declined, but the incidence of Streptococcus pneumoniae serotype 19A has risen worldwide. The present study examined changes in the features of invasive pneumococcal disease since the introduction of the PCV7 in Kochi, Japan. Pediatric cases of invasive pneumococcal disease were investigated before and after vaccine introduction (January 2008 to December 2013). Cases of invasive pneumococcal disease tended to decrease after PCV7 introduction. In addition, before introduction of the vaccine, most serotypes causing invasive pneumococcal disease were those included in the vaccine. However, after the introduction, we found cases infected by serotypes not covered by vaccine. Penicillin-resistant S. pneumoniae was the predominant serotype causing invasive pneumococcal disease before introduction of the PCV7, and the susceptibility of this serotype to antibiotics improved after vaccine introduction. Serotype isolates identified after vaccine introduction were also relatively susceptible to antibiotic therapy, but decreased susceptibility is expected

Erythroblastosis of the Donor Twin of Twin Anemia-Polycythemia Sequence

Twin anemia-polycythemia sequence (TAPS) is a group of disorders in monochorionic twins characterized by a large intertwin hemoglobin difference without amniotic fluid discordance. Reticulocyte count is used to diagnose this condition, but little is known about the role of erythroblasts, which are the prior stage of reticulocytes. In the present case of TAPS, the 25-yr-old Japanese mother showed no signs of oligohydramnios or polyhydramnios throughout gestation. The twins were born at 36 weeks and 6 days, weighing 2,648g and 1,994g. The intertwin hemoglobin difference in umbilical cord blood was (21.1－5.0＝) 16.1g/dL and the donor twin showed signs of chronic anemia, including myocardial hypertrophy and pericardial effusion. Erythroblastosis of the donor twin was prolonged (53,088.5, 42,114.8 and 44,217.9/μL on days 0, 1 and 2, respectively). Erythroblastosis, which indicates chronic anemia, is also a good diagnostic indicator of TAPS

The nature of H-alpha star-forming galaxies at z~0.4 in and around Cl 0939+4713:the environment matters

Cluster star-forming galaxies are found to have an excess of Far-Infrared emission relative to H-alpha (Ha), when compared to those in the field, which could be caused by intense AGN activity, dust and/or declining star formation histories. Here we present spectroscopic observations of Ha emitters in the Cl 0939+4713 (Abell 851) super-cluster at z=0.41, using AF2+WYFFOS on the WHT. We measure [OII], Hbeta (Hb), [OIII], Ha and [NII] for a sample of 119 Ha emitters in and around the cluster. We find that 17+-5% of the Ha emitters are AGN, irrespective of environment. For star-forming galaxies, we obtain Balmer decrements, metallicities and ionisation parameters with different methods, individually and by stacking. We find a strong mass-metallicity relation at all environments, with no significant dependence on environment. The ionisation parameter declines with increasing stellar mass for low-mass galaxies. Ha emitters residing in intermediate environments show the highest ionisation parameters (along with high [OIII]/Ha and high [OIII]/[OII] line ratios, typically twice as large as in the highest and lowest densities), which decline with increasing environmental density. Dust extinction (A$_{H\alpha}$) correlates strongly with stellar mass, but also with environmental density. Star-forming galaxies in the densest environments are found to be significantly dustier (A$_{H\alpha}$~1.5-1.6) than those residing in the lowest density environments (A$_{H\alpha}$~0.6), deviating significantly from what would be predicted given their stellar masses