The Rising Incidence of Hyperinsulinemic Hypoglycemia: Connection With Maternal Health.

OBJECTIVE: Due to a perceived rise in hyperinsulinemic hypoglycemia (HH) cases over time, notably during the COVID-19 pandemic, institutional experiences between 2013 and 2021 were reviewed to evaluate trends, characteristics, and outcomes in children with HH. METHODS: Charts of all children diagnosed with HH during the study period and evaluated by Pediatric Endocrinology were reviewed. HH was defined per Pediatric Endocrine Society guidelines. Regression analysis compared rates of change in HH cases and maternal risk factors over time. RESULTS: The incidence of HH began to rise in April 2016 and became significant in March 2017 (P < .001), with a more rapid rate of rise during the first year of the COVID-19 pandemic (P < .001). Seventy-four children with HH were identified over 9 years; 43% (n = 32) were diagnosed in 2020-2021. Maternal hypertensive disorders demonstrated longitudinal association with hyperinsulinism cases (P < .001). CONCLUSION: While HH diagnoses were on the rise for much of the 9-year study period, nearly half of all infants were diagnosed during the COVID-19 pandemic in 2020 to 21. The trends in HH diagnoses correlated with maternal hypertensive disorders. More studies exploring the roles of maternal health, hypertension, and stress and development of HH in offspring are needed.

An E-Textile Respiration Sensing System for NICU Monitoring: Design and Validation.

The world is witnessing a rising number of preterm infants who are at significant risk of medical conditions. These infants require continuous care in Neonatal Intensive Care Units (NICU). Medical parameters are continuously monitored in premature infants in the NICU using a set of wired, sticky electrodes attached to the body. Medical adhesives used on the electrodes can be harmful to the baby, causing skin injuries, discomfort, and irritation. In addition, respiration rate (RR) monitoring in the NICU faces challenges of accuracy and clinical quality because RR is extracted from electrocardiogram (ECG). This research paper presents a design and validation of a smart textile pressure sensor system that addresses the existing challenges of medical monitoring in NICU. We designed two e-textile, piezoresistive pressure sensors made of Velostat for noninvasive RR monitoring; one was hand-stitched on a mattress topper material, and the other was embroidered on a denim fabric using an industrial embroidery machine. We developed a data acquisition system for validation experiments conducted on a high-fidelity, programmable NICU baby mannequin. We designed a signal processing pipeline to convert raw time-series signals into parameters including RR, rise and fall time, and comparison metrics. The results of the experiments showed that the relative accuracies of hand-stitched sensors were 98.68 (top sensor) and 98.07 (bottom sensor), while the accuracies of embroidered sensors were 99.37 (left sensor) and 99.39 (right sensor) for the 60 BrPM test case. The presented prototype system shows promising results and demands more research on textile design, human factors, and human experimentation.

Enhancing the NICU language environment with a neonatal Cuddler program.

OBJECTIVE: To compare effects of a language intervention on Cuddler and parent adult word counts (AWC), and to compare Cuddler versus parent and nurse-care times. DESIGN: Prospective pilot cohort intervention study. Twelve Cuddler-low-visit (≤2/week) infant pairs and 17 high-visit (≥3/week) parent-infant pairs were enrolled. Each had a 16-hour baseline recording (R1) followed by a language curriculum with linguistic feedback and an outcome recording (R2) 1 week later. Bivariate group analyses and longitudinal negative binomial regressions were run. RESULTS: After the intervention, there were non-significant increases in AWC/h for Cuddlers and high-visit parents. Cuddler AWCs were similar to high-visit parents and significantly higher than nurse-care times on both recordings. Within the low-visit group, hourly AWCs were higher when Cuddlers were present versus absent (R1 = 1779 versus 552, R2 = 2530 versus 534, p < 0.0001). CONCLUSIONS: NICU language environments are different for low-visit and high-visit infants and Cuddlers can increase infant language exposure in the NICU.

Randomised control language intervention for infants of adolescent mothers.

AIM: Create a Language ENvironment Analysis (LENA)-based intervention to increase adolescent and infant speech and improve 12-month language outcomes. METHODS: Randomised control trial of adolescent (15-19 years) mother-infant pairs comparing language-motor (intervention) and motor (control) groups. Intervention included reviewing language-motor curriculums, formative feedback on 4 LENA recordings (baseline, post-curriculum, 4 and 12-months) and 16-weekly language-motor texts. Controls reviewed a motor curriculum, summative feedback of four recordings after study completion and 4-monthly motor texts. Primary outcome was 12-month MacArthur scores. Secondary outcomes were LENA counts and social impacts to language outcomes. RESULTS: A total of 108 infants were randomised. Groups had similar baseline characteristics and LENA counts. Both groups had low maternal Peabody Picture Vocabulary age-equivalents (14.2 years). On post-curriculum recording, intervention infants had higher vocalisations (188 vs 109, P = .02) and conversations (49 vs 30, P = .005) than controls. Group 4-month and 12-month LENA counts and 12-month MacArthur scores were similar. In regression analyses, more people in the home and cohabiting with the infant's father were associated with higher MacArthur scores. CONCLUSIONS: Linguistic feedback and a simple curriculum resulted in short-term increased vocalisations and conversational turns for infants of adolescent mothers that were not sustained over time. Household characteristics provided protective effects on outcomes.

Neonatal oesophageal and axilla temperatures in the neonatal intensive care unit care.

AIM: To compare oesophageal and axilla temperatures in routine neonatal intensive care unit (NICU) care. METHODS: Prospective observational study of NICU infants with indwelling oral/nasogastric tubes. Three simultaneous temperature measurements were taken: Physitemp axilla, digital Premie Faichney axilla in predictive mode and Physitemp oesophageal. Temperatures were measured on two separate days. RESULTS: Fifty infants were studied over a range of gestational ages (median 28.9 weeks, IQR 25.8-30.6 weeks) and birthweights (median 1140 g, IQR 742-1498 g). Mean Physitemp oesophageal temperatures were 0.3 ± 0.1°C (range 0.1-0.6°C) higher than Physitemp axilla temperatures. After adjustment for weight, the Physitemp oesophageal-Physitemp axilla difference remained constant over the average oesophageal-axilla temperature range studied (p = 0.07). Physitemp oesophageal temperatures were not affected by weight (p = 0.2) or postmenstrual age (p = 0.51). Physitemp axilla temperatures decreased with increasing weight (p = 0.03) and postmenstrual age (p = 0.048). The Physitemp oesophageal-Physitemp axilla difference was greater for infants in cribs (mean ± SD = 0.4 ± 0.1°C) than in incubators (mean ± SD = 0.3 ± 0.1°C, p < 0.001). The relationship between oesophageal and digital Premie Faichney axilla temperature was similar to oesophageal and axilla Physitemp temperatures. CONCLUSION: Over a range of infant temperatures encountered in routine NICU care, oesophageal temperature is higher than axilla temperature, although the difference is small. Axillary temperatures measured by digital thermometers in predictive mode are comparable to core oesophageal temperatures.

Developmental outcomes of extremely preterm infants born to adolescent mothers.

BACKGROUND AND OBJECTIVES: Extremely preterm infants and infants born to adolescent mothers are at risk for adverse developmental. The objectives were to evaluate development and behavior outcomes of extremely low birth weight (ELBW) infants born to adolescent mothers <20 compared with adult mothers ≥20 years and to identify socioeconomic risk factors that affect outcomes. METHODS: Retrospective cohort analysis of 211 infants >27 weeks of adolescent mothers and 1723 infants of adult mothers at Neonatal Research Network centers from 2008 to 2011. Groups were compared and regression models were run to predict 18- to 22-month adverse outcomes. Primary outcomes were Bayley-III scores, neurodevelopmental impairment, and Brief Infant Toddler Social Emotional Assessment problem scores (BITSEA/P) ≥75th percentile. RESULTS: Adolescent mothers were more often single, Hispanic, less educated, and had public insurance. By 18 to 22 months, their children had significantly increased rates of having lived ≥3 places (21% vs 9%), state supervision (7% vs 3%), rehospitalization (56% vs 46%), and BITSEA/P ≥75th percentile (50% vs 32%) and nonsignificant Bayley-III language scores <85 (56% vs 49%, P = .07). In regression analysis, children of adolescent mothers were more likely to have BITSEA/P ≥75th percentile (relative risk 1.50, 95% confidence interval 1.08-2.07). Living ≥3 places and nonwhite race were predictors of adverse behavior. State supervision was an independent predictor of each Bayley-III composite <70 and neurodevelopmental impairment. CONCLUSIONS: ELBW infants of adolescent mothers experience high social and environmental risks that are associated with adverse behavior outcomes. These findings inform the need for comprehensive follow-up, coordinated care services, and behavior interventions for ELBW infants of adolescent mothers.

Extensive placental choriovascular infiltration by maturing myeloid cells in down syndrome-associated transient abnormal myelopoiesis.

Transient abnormal myelopoiesis (TAM), a clonal proliferation of predominantly megakaryocytic precursor cells, affects 4%-10% of newborns with Down syndrome. Approximately 20%-30% of TAM survivors are at risk of development of acute myeloid leukemia (myeloid leukemia associated with Down syndrome, ML-DS). We report unusual placental findings in a female infant with trisomy 21 born at 38 weeks of gestation. In line with previous descriptions of placental pathology in infants with TAM, abundant blast-like cells were present in the lumen of chorionic and stem villous vessels. In addition, there was multifocal extensive infiltration of the wall of chorionic vessels by maturing myeloid cells in a pattern reminiscent of TAM- or leukemia-associated systemic infiltration. The clinical significance of this unusual choriovascular involvement of the placenta in TAM is undetermined.

Physiological and behavioral evidence for focal nociception induced by epidural glutamate infusion in rats.

STUDY DESIGN: Blinded animal study. OBJECTIVES: To determine if an increased concentration of epidural glutamate can cause a focal nociceptive response in the lower extremities that is consistent with sciatica. SUMMARY OF BACKGROUND DATA: It is believed that the origin of sciatic pain is related to more than physical pressure on the nerve roots. Recently, it was determined that disc material may be a significant source of free glutamate, resulting from the enzymatic degradation of matrix aggrecan proteins. We believe that this free glutamate acts as a neurotransmitter at glutamate receptors on the dorsal root ganglion (DRG) cell bodies, thereby initiating a nociceptive response. METHODS: Rats were subject to a 72-hour epidural glutamate infusion via a mini osmotic pump. Von Frey behavioral testing was performed 24 hours before, and 24 and 72 hours after the onset of the infusion. DRG and dorsal horn tissues were analyzed for changes in receptor expression, which have been previously shown to correlate with a nociceptive state. RESULTS: Von Frey behavioral tests showed focal hyperalgesia that was maximal at the 0.02 mmol/L glutamate concentration. Significant changes in DRG glutamate receptor expression were seen for alpha-amino-3-hydroxy-5-methyl-4-isoxazoleproprionic acid, kainite, and N-methyl-D aspartate receptors. Analysis of dorsal horn glutamate receptors also showed patterns in alpha-amino-3-hydroxy-5-methyl-4-isoxazoleproprionic acid and kainate receptor expression that were consistent with a nociceptive state. CONCLUSIONS: Epidural glutamate elicits a focal nociceptive response. Free glutamate that has been liberated from the disc material may be an important factor in the development of sciatic pain.