Breastfeeding Disparities between Multiples and Singletons by NICU Discharge.

Multiple pregnancy increases the risk of a range of adverse perinatal outcomes, including breastfeeding failure. However, studies on predictive factors of breastfeeding duration in preterm twin infants have a conflicting result. The purpose of this observational study was to compare feeding practices, at hospital discharge, of twin and singleton very low birth weight infants. The study is part of a prospective survey of a national Spanish cohort of very low birth weight infants (SEN1500) that includes 62 neonatal units. The study population comprised all infants registered in the network from 2002 to 2013. They were grouped into singletons and multiples. The explanatory variables were first analyzed using univariate models; subsequently, significant variables were analyzed simultaneously in a multiple stepwise backward model. During the twelve-year period, 32,770 very low birth weight infants were included in the database, of which 26.957 were discharged alive and included in this analysis. Nine thousand seven hundred and fifty-eight neonates were multiples, and 17,199 were singletons. At discharge, 31% of singleton infants were being exclusively breastfed, 43% were bottle-fed, and 26% were fed a combination of both. In comparison, at discharge, only 24% of multiple infants were exclusively breastfed, 43% were bottle-fed, and 33% were fed a combination of both (p < 0.001). On multivariable analysis, twin pregnancy had a statistically significant, but small effect, on cessation of breastfeeding before discharge (OR 1.10; 95% CI: 1.02, 1.19). Risks of early in-hospital breastfeeding cessation were also independently associated with multiple mother-infant stress factors, such as sepsis, intraventricular hemorrhage, retinopathy, necrotizing enterocolitis, intubation, and use of inotropes. Instead, antibiotic treatment at delivery, In vitro fertilization and prenatal steroids were associated with a decreased risk for shorter in-hospital breastfeeding duration. Multiple pregnancy, even in the absence of pathological conditions associated to very low birth weight twin infants, may be an impeding factor for in-hospital breastfeeding.

Morbidity and mortality of very low birth weight multiples compared with singletons.

BACKGROUND: Previous studies comparing the neonatal outcome of very low birth weight (VLBW) multiples and singletons have suggested a worse outcome for multiples at gestational ages on the limits of viability. OBJECTIVES: The objective of this study is to determine the neonatal mortality and morbidity of VLBW multiples compared to singletons. METHODS: This is a retrospective study including all infants registered in the Spanish network for infants under 1500 g (SEN1500), over a 12-year period (from 2002 to 2013). Mortality and major morbidities were compared between singletons and multiples. RESULTS: About 32,770 infants were included: 21,123 singletons (64.5%) and 11,647 multiples (35.5%), with a mean gestational age of 29.5 weeks (22-38), and mean birth weight of 1115 g (340-1500). When adjusted by other perinatal factors, multiple pregnancy has a significantly higher risk of mortality than singleton pregnancy (odds ratio (OR) 1.15; IC 95% 1.05-1.26, p = .002), but not a higher risk of major morbidity or composite adverse outcome. In the subgroup of infants born before 26 weeks, multiples showed a higher risk of mortality (63.9% versus 51%, OR 1.7; 95% CI 1.47-1.96) and a higher risk of composite adverse outcome (88.9% versus 81.5%, OR 1.82, 95% CI 1.28-2.24). CONCLUSIONS: In preterm infants born with less than 1500 g, multiple pregnancy is a prognostic factor that can slightly increase mortality. Extremely preterm infants born before 26 weeks have a greater risk of mortality and major morbidity if they come from a multiple pregnancy.

Hiperinsulinisme en una unitat neonatal / Hiperinsulinismo en una unidad neonatal / Hyperinsulinism in a newborn unit

Introducció: lhiperinsulinisme (HI) és la causa més freqüent dhipoglucèmia neonatal mantinguda. Es pot dividir en transitori o secundari i persistent o congènit. Es presenta una revisió del tema, a partir de quatre casos diagnosticats a la nostra unitat durant set anys. Observació clínica: dels quatre casos, tres són transitoris o secundaris i un persistent. Els factors predisposants dels transitoris són la pèrdua del benestar fetal i la diabetis gestacional. El persistent, amb una ressonància magnètica (RM) cranial i un estudi genètic normals, no va respondre al tractament amb diazòxid (DI) i va millorar amb dextrinomaltosa i alimentació contínua. Cap cas va presentar seqüeles neurològiques. Comentaris: els nostres casos compleixen els criteris diag-nòstics dHI. La incidència dHI al nostre centre és d1/4.500 nascuts vius i la dHI persistent d1/20.000 nascuts vius en set anys. LHI transitori o secundari es relaciona amb lasfíxia neonatal, el retard del creixement intrauterí i la diabetis gestacional. Els casos descrits presen-ten pèrdua del benestar fetal i diabetis. El tractament inicial és laportació de glucosa. Després, el fàrmac de primera línia és el DI. LHI persistent acostuma a no respondre al tractament i pot ser focal o difús, el primer dels quals es pot beneficiar de cirurgia. El màxim objectiu és la prevenció de seqüeles neurològiques. És fonamental el maneig conjunt amb un especialista endocrinòleg

Introducción. El hiperinsulinismo (HI) es la causa más frecuente de hipoglucemia neonatal mantenida. Se puede dividir en transitorio o secundario y persistente o congénito. Se presenta una revisión del tema, a partir de cuatro casos diagnosticados en nuestra unidad durante siete años. Observación clínica. De los cuatro casos, tres son transitorios o secundarios y uno persistente. Los factores predisponentes de los transitorios son la pérdida del bienestar fetal y la diabetes gestacional. El persistente, con una resonancia magnética (RM) craneal y un estudio genético normales, no respondió al diazóxido (DI) y mejoró con dextrinomaltosa y alimentación continua. Ningún caso presentó secuelas neurológicas. Comentarios. Nuestros casos cumplen los criterios diagnósticos de HI. La incidencia de HI en nuestro centro es de 1/4.500 nacidos vivos y la de HI persistente de 1/20.000 nacidos vivos en siete años. El HI transitorio o secundario se relaciona con la asfixia neonatal, el retraso del crecimiento intrauterino y la diabetes gestacional. Los casos descritos presentan pérdida del bienestar fetal y diabetes. El tratamiento inicial es el aporte de glucosa. Después, el fármaco de primera linea es el DI. El HI persistente acostumbra a no responder al tratamiento y puede ser focal o difuso, el primero de los cuales puede beneficiarse de cirugía. El máximo objetivo es la prevención de secuelas neurológicas. Es fundamental el manejo conjunto con un especialista endocrinólogo (AU)

Introduction. Hyperinsulinism (HI) is the most frequent cause of sustained neonatal hypoglycemia; it can be transient (secondary) or persistent (congenital). We describe four cases of neonatal HI seen in a neonatal unit over a seven-year period. Clinical observation. Three of the four cases were transient or secondary, and the other was persistent. Loss of fetal wellbeing and gestational diabetes were the predisposing factors in the three transient cases. The case of persistent HI had normal brain magnetic resonance imaging and genetics; it did not respond to treatment wth diazoxide (DI) but improved with continuous feeding and dextrinomaltose. All four cases recovered with no neurological sequelae. Comments. Our fours cases met the diagnosis criteria for HI. Over the seven-year period, the overall incidence of HI was 1 in 4,500 live births, while the incidence of persistent HI was 1 in 20,000 live births. Transient or secondary HI is related to birth asphyxia, intrauterine growth retardation, and gestational diabetes. The initial treatment of HI is with glucose and DI. Persistent or congenital HI seldom responds to treatment and it can be the result of focal or diffuse pancreatic disease, the first of which anomalies could benefit from surgery. Prevention of neurological sequelae is the main objective of the treatment. A multidisciplinary management with endocrinology is recommended (AU)

Evolució postnatal dels infants nascuts després d'una seroconversió materna a Toxoplasma gondiidurant lagestació / Evolución postnatal de los neonatos nacidos después de una seroconversión materna a toxoplasma gondii durante la gestación / Postnatal evolutionof children born after a maternal toxoplasma gondii seroconversion during pregnancy

Fonament: la toxoplasmosi congènita és transmissible alfetus, habitualment assimptomàtica i només detectableper serologies. L'eficàcia del tractament fetal i postnatal éscontrovertida. Objectiu: explorar l'evolució postnatal dels fills de mares infectades per Toxoplasma gondiidurant la gestació. Mètode: l'estudi és retrospectiu. Inclou tots els nadonsnascuts vius, entre gener del 1999 i desembre del 2011, de mares seroconvertides a T. gondiidurant la gestació. Esdescriuen la confirmació d'infecció congènita en cada cas,el tractament rebut i el seguiment posterior. Resultats: s'inclouen 29 nadons nascuts vius, en 26 delsquals es va realitzar la reacció en cadena de la polimerasaen líquid amniòtic (PCR-LA) a T. gondii. En dos casos varesultar positiva i es va iniciar tractament. Dels 24 casosamb PCR-LA negativa, tres es van diagnosticar d'infeccióen el seguiment postnatal. Dels tres casos en què no es varealitzar la PCR-LA, un va ser una seroconversió molt tardana. En els altres dos, les serologies es van negativitzar alcap de 6 mesos. El total d'infants amb infecció congènitaconfirmada és de 6/29 (20,69%). Conclusions: el tractament prenatal no exclou la infecció fetal. Destaca l'absència de símptomes en néixer i de lesionsal sistema nerviós i a la retina en tots els infectats. La incidència d'infecció congènita és similar a la d'altres sèries. Una PCR-LA negativa no la descarta, només l'absènciad'IgG en sang als 12 mesos n'exclou el diagnòstic. Cal fercontrols oftalmològics i del neurodesenvolupament. Malgratun tractament correcte, hi ha risc de lesions retinianes finsa la vida adulta

Fundamento. La toxoplasmosis congénita es transmisible al feto, habitualmente asimptomática y sólo detectable por serología. La eficacia del tratamiento fetal y postnatal es controvertida. Evolució postnatal dels infants nascuts després d’una seroconversió materna a Toxoplasma gondii durant la gestació Eva Capdevila, Roser Porta, Josep Maria Cubells, Xavier Viñallonga, Mariona Roger, Vicente Molina Unitat Neonatal. Institut Universitari Dexeus. Barcelona Objectivo. Explorar la evolución postnatal de los hijos de madres infectadas por Toxoplasma gondii durante la gestación. Método. El estudio es retrospectivo. Incluye a todos los recién nacidos vivos, entre enero del 1999 y diciembre del 2011, de madres seroconvertidas a T. gondii durante la gestación. Se describen la confirmación de infección congénita en cada caso, el tratamiento recibido y el seguimiento posterior. Resultados. Se incluyen 29 niños nacidos vivos, en 26 de los cuales se realizó la reacción en cadena de la polimerasa en líquido amniótico (PCR-LA) a T. gondii. En dos casos resultó positiva y se les inició tratamiento. De los 24 casos con PCR-LA negativa, tres se diagnosticaron de infección en el seguimiento postnatal. De los tres casos en los que no se realizó PCR-LA, uno fue una seroconversión muy tardía. En los otros dos las serologías se negativizaron a los 6 meses. El total de niños con infección congénita confirmada es de 6/29 (20,69%). Conclusiones. El tratamiento prenatal no excluye la infección fetal. Destaca la ausencia de síntomas al nacer y de lesiones en sistema nervioso y retina en todos los infectados. La incidencia de infección congénita es similar a la de otras series. Una PCR-LA negativa no la descarta, sólo la ausencia de IgG en sangre a los 12 meses excluirá el diagnóstico. Se deben realizar controles oftalmológicos y del neurodesarrollo. A pesar de un tratamiento correcto existe riesgo de lesiones retinianas hasta la vida adulta (AU)

Background. Toxoplasmosis can be transmitted to the fetus. Congenital toxoplasmosis is usually asymptomatic and can only be detected by serology. The efficacy of fetal and postnatal treatment has not been well established. Objective. To describe the postnatal outcome of children born to mothers infected with Toxoplasma gondii during pregnancy. Method. Retrospective study including all children born to mothers who seroconverted to T. gondii during pregnancy between January 1999 and December 2011. Confirmation of congenital infection, indication of treatment, and ophthalmological and neurological follow-up are described. Results. Twenty-nine children were evaluated. In 26 cases polymerase chain reaction to T. gondii in amniotic fluid (PCR-AF) was performed. The test was positive in 2 cases, and treatment was started. Of the 24 cases with negative PCR-AF, 3 were diagnosed with infection with positive serology during postnatal follow-up. In 1 of the 3 cases that did not have PCR-AF done, a very late seroconversion was seen. Serologies in the other 2 cases were negative at 6 months. In total, 6 children (20.7%) had a congenital infection confirmed. Conclusions. Prenatal treatment does not avoid fetal infection. The absence of symptoms in all newborns and the lack of neurological and ophthalmological damage is highlighted. The incidence of congenital infection after maternal seroconversion is similar to other studies. A negative PCR-AF does not rule out infection; only negative serology at 12 months will exclude it. Ophthalmological and neurological evaluations are mandatory. Even with the early initiation of therapy, there is a risk of retinal damage until adult age (AU)

Formoterol treatment downregulates the myostatin system in skeletal muscle of cachectic tumour-bearing rats.

Cachexia is a common systemic manifestation. Additionally, myostatin is known to be a negative regulator of skeletal muscle development. The present study aimed to investigate whether formoterol down-regulates the myostatin system in skeletal muscle of tumour-bearing rats. Real-time PCR and Western blotting were used for the analysis. Results showed that rats bearing the Yoshida AH-130 ascites hepatoma, a cachexia-inducing tumour, exhibited marked muscle wasting that affected the mass of the muscles studied. The cachectic animals exhibited a significant increase in the mRNA levels of the myostatin receptor (ActIIB) in gastrocnemius muscles. Notably, the expression of the various forms of follistatin, a protein with the opposite effects to those of myostatin, was significantly reduced as a result of the implantation of the tumour. When the animals were treated with formoterol, a ß-agonist with anti-cachectic potential, increases in skeletal muscle weights were observed. The ß-agonist significantly increased levels of various follistatin isoforms and significantly decreased the expression levels of the myostatin receptor. In addition, formoterol treatment resulted in a significant decrease of the myostatin protein content of the gastrocnemius muscle. In conclusion, the results presented indicate that certain anabolic actions of formoterol on the skeletal muscle of cachectic animals may be mediated via the myostatin system.

L-Carnitine: an adequate supplement for a multi-targeted anti-wasting therapy in cancer.

BACKGROUND & AIMS: Tumour growth is associated with weight loss resulting from both adipose and muscle wasting. METHODS: Administration of L-carnitine (1 g/kg body weight) to rats bearing the AH-130 Yoshida ascites hepatoma, a highly cachectic rat tumour. RESULTS: The treatment results in a significant improvement of food intake and in muscle weight (gastrocnemius, EDL and soleus). These beneficial effects are directly related to improved physical performance (total physical activity, mean movement velocity and total travelled distance). Administration of L-carnitine decreases proteasome activity and the expression of genes related with this activity, such as ubiquitin, C8 proteasome subunit and MuRF-1. Interestingly, L-carnitine treatment also decreases caspase-3 mRNA content therefore suggesting a modulation of apoptosis. Moreover, addition of 50 µM of L-carnitine to isolated EDL muscles results in a significant decrease in the proteolytic rate suggesting a direct effect. CONCLUSIONS: It can be concluded that L-carnitine supplementation may be a good approach for a multi-targeted therapy for the treatment of cancer-related cachexia.

Myostatin blockage using actRIIB antagonism in mice bearing the Lewis lung carcinoma results in the improvement of muscle wasting and physical performance.

BACKGROUND: Cachexia is a multiorganic syndrome associated with cancer, characterized by body weight loss, muscle and adipose tissue wasting and inflammation. METHODS: The aim of this investigation was to examine the effect of the soluble receptor antagonist of myostatin (sActRIIB) in cachectic tumor-bearing animals analyzing changes in muscle proteolysis and in quality of life. RESULTS: Administration of sActRIIB resulted in an improvement in body and muscle weights. Administration of the soluble receptor antagonist of myostatin also resulted in an improvement in the muscle force. CONCLUSIONS: These results suggest that blocking myostatin pathway could be a promising therapeutic strategy for the treatment of cancer cachexia.

Està augmentant la incidència d’infecció perinatal per Listeria monocytogenes? / No disponible

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Evolución de los prematuros alimentados con leche humana de donante / Course of premature infants fed with donor human milk

Objetivo. El objetivo de este estudio piloto es presentar los resultados preliminares de la evolución clínica dentro de la Unidad Neonatal de los neonatos alimentados con leche humana de donante, en general como complemento de la leche materna, y ocasionalmente como sustituto de la leche materna. Método. La muestra estudiada está formada por 33 neonatos de menos de 1500 gramos de peso de nacimiento, procedentes de tres centros asistenciales y docentes de Barcelona, nacidos entre el uno de Abril de 2009 y el uno de Agosto de 2010. Resultados. Tres prematuros han sido exitus. Entre los superviventes, ha habido una hemorragia intraventricular grave y cuatro leves. Entre los exitus ha habido una hemorragia intraventricular grave y una leucomalacia periventricular. Conclusiones. La principal limitación de este estudio es el pequeño tamaño de la muestra. De todas maneras los resultados son esperanzadores y justifican un estudio más amplio(AU)

Objective. To report the course of premature infants fed with donor human milk as a supplement or, in some cases, as a substitute for maternal milk. Method. Retrospective study of 33 very low weight infants (birth weight less than 1.500 g) attended at 3 maternity hospitals in Barcelona from April 2009 through August 2010. Results. Three babies died, 1 with severe intraventricular hemorrhage (IVH) and 1 with periventricular leucomalacia (PVLM). Among the 30 survivors, 1 developed severe IVH. Conclusions. Results seem to be encouraging. However, considering the small sample size, further research in needed(AU)

Polimorfismos del gen receptor de la vitamina D en personas con síndrome de Down / Vitamin D receptor gene polymorphisms in persons with Down’s syndrome

Fundamento: El síndrome de Down (SD) es una alteración genética debida a la presencia de tres copias del cromosoma 21. Variaciones en los alelos del gen receptor de la vitamina D se han asociado a gran variedad de fenotipos y se han considerado factores de riesgo en determinadas poblaciones. En el presente trabajo se analiza si alguno de los genotipos del polimorfismo B s mI del receptor de la vitamina D se presenta con mayor frecuencia en personas con SD con respecto a la población general y la influencia que puede tener en diferentes fenotipos del SD. Pacientes y métodos: Se estudiaron los polimorfismos del gen del receptor de la vitamina D en DNA de sangre periférica de 85 personas con SD y de 122 controles sin el síndrome. La determinación de cada genotipo se realizó con amplificación por técnica de reacción en cadena de la polimerasa (PCR) de los segmentos que contienen los polimorfismos situados en el intron 8 (BsmI). Se analizaron las diferencias de distribución de genotipos entre los dos grupos, en el grupo con SD se relacionaron con diferentes parámetros antropono métricos (edad, talla e índice de masa corporal),bioquímicos (calcio, vitamina D y paratohormona intacta) y con valores de masa ósea por densitometría(DEXA). Resultados: El análisis de distribución del polimorfismo para B s mI muestra una mayor frecuencia del alelo B en el grupo con SD y del b en los controles (p = 0,015). En las personas con SD la combinación de genotipos con respecto a los datos bioquímicos analizados y el resultado de la densitometría no muestra diferencias estadísticamente significativas. Sin embargo, el genotipo homocigoto bb es más frecuente en los de talla alta (p = 0,04) y el genotipo homocigoto BB en los de mayor edad (p = 0,03)...(AU)

Background: Down syndrome (DS) is a genetic alteration associated to the presence of three copies of chromosome 21. Variations in the presence of alleles in the vitamin D receptor (VDR) gene have been linked to a variety in the phenotype and also considered a risk factor in some populations. In the present paper, we analyze if a variation of the B s mI polymorphism in the VDR gene is over expressed in patients with DS and if it is related to any phenotype of the patients. Patients and methods: We studied the B s mI polymorphism of the vitamin D receptor in DNA from peripheral blood of 85 patients with DS and 122 controls. The detection of each phenotype is performed by amplification of the DNA sequences of intron 8 of the VDR gene by polymerase chain reaction (PCR). We analyzed the differences in distribution of the alleles inpatients with DS and the correlation of the genotype to different anthropometric (age, height, body mass index)and biochemical parameters (calcium, vitamin D,PTH hormone, bone mass).Results: The analysis of the distribution of the BsmIpolymorphism showed a higher frequency of the B a llelein the DS patients with respect to controls. In the same group of patients, the regression analysis showed no link with any biochemical parameter. However, the homozygous genotype b b is more frequently found in individuals with more height (p = 0.04) and the B B in individuals with more age (p = 0.03). Conclusions: The allele B of the B s mI polymorphism of the VDR gene is more frequent in people with DS. The genotypes b b and B B are more frequent in taller and aged DS patients respectively. This result points out the possibility that VDR genotype could have influence in these two phenotypic characteristics of the DS patients (AU)