Entropy Analysis of Neonatal Electrodermal Activity during the First Three Days after Birth.

The entropy-based parameters determined from the electrodermal activity (EDA) biosignal evaluate the complexity within the activity of the sympathetic cholinergic system. We focused on the evaluation of the complex sympathetic cholinergic regulation by assessing EDA using conventional indices (skin conductance level (SCL), non-specific skin conductance responses, spectral EDA indices), and entropy-based parameters (approximate, sample, fuzzy, permutation, Shannon, and symbolic information entropies) in newborns during the first three days of postnatal life. The studied group consisted of 50 healthy newborns (21 boys, average gestational age: 39.0 ± 0.2 weeks). EDA was recorded continuously from the feet at rest for three periods (the first day-2 h after birth, the second day-24 h after birth, and the third day-72 h after birth). Our results revealed higher SCL, spectral EDA index in a very-low frequency band, approximate, sample, fuzzy, and permutation entropy during the first compared to second and third days, while Shannon and symbolic information entropies were lower during the first day compared to other periods. In conclusion, EDA parameters seem to be sensitive in the detection of the sympathetic regulation changes in early postnatal life and which can represent an important step towards a non-invasive early diagnosis of the pathological states linked to autonomic dysmaturation in newborns.

A novel SPINK5 mutation and successful subcutaneous immunoglobulin replacement therapy in a child with Netherton syndrome.

We report a 2-year-old patient with Netherton syndrome presenting with generalized exfoliative erythroderma, ichthyosiform dermatitis, trichorrhexis invaginata, hypernatremic dehydration, failure to thrive, and recurrent respiratory infections. Molecular analysis of SPINK5 identified a novel mutation (c.1530CA). Our case report also verifies and supports the safety and efficacy of subcutaneous immunoglobulin substitution in chronic generalized skin disorders associated with primary immunodeficiencies such as Netherton syndrome.

Heart rate variability in healthy term newborns is related to delivery mode: a prospective observational study.

BACKGROUND: Early postnatal period is characterized by dramatic adaptation changes of cardiovascular and respiratory systems in newborns. There is still insufficient data regarding maturation of autonomic regulatory mechanisms in neonates early after delivery. Aim of this study was to analyze cardiac autonomic regulation in newborns within the first few postnatal days in relation to different modes of delivery using time and spectral heart rate variability analysis. METHODS: Eutrophic healthy term newborns (n = 46) were divided into three groups according to the delivery mode: vaginal delivery (VD group; n = 16), vaginal delivery with epidural analgesia (EDA group; n = 16), and caesarean section under general anesthesia (CS group; n = 14). Heart rate variability (HRV), blood pressure (BP), and blood oxygen saturation (SpO2) were measured within the first two hours after birth and on the third to fourth postnatal day. HRV parameters were evaluated in the time domain (RR intervals, mean square of successive differences - MSSD) and frequency domain (total spectral power - TP, absolute and relative low and high frequency powers). RESULTS: The HRV spectral analysis showed significantly higher relative power of the high-frequency band (HF%) in the VD group compared to the CS group early after delivery (p = 0.002). HRV parameters and BP significantly increased on the third to fourth postnatal day in all groups (p < 0.05). No significant differences in basic characteristics, BP and SpO2 were identified between groups during both measurements. CONCLUSIONS: HRV analysis revealed higher cardiovagal modulation in spontaneously born newborns without analgesia compared to neonates born by caesarean section. It could represent a potential pathomechanism that leads to discrete abnormal neurocardiac regulation associated with higher risk for worsened postnatal adaptation of cardiovascular system in surgically delivered neonates.

The Value of High-frequency 20 MHz Ultrasonography for Preoperative Measurement of Cutaneous Melanoma Thickness.

High-frequency ultrasonography has become an important diagnostic tool in dermatovenerology. It is used for assessment of the cutaneous layers in diverse benign and malignant skin lesions and diseases. Herein we present the practical value of preoperative measurement of cutaneous melanoma thickness, the explanation of the possible reasons for different sonographic and histologic Breslow thickness, and the practical importance of high-frequency 20 MHz ultrasonography in preoperative measurements of cutaneous melanoma thickness. Fifty patients (31 women aged 41.6±15.4 years, 19 males aged 54.5±11.4 year (mean ± Standard Deviation) were examined in the Skin Cancer Clinic from January 2014 to December 2015. Suspected cutaneous melanomas were investigated with skin ultrasound Dermascan C (Cortex Technology, Denmark) before surgical removal. The Breslow thickness of cutaneous melanomas was analyzed by precise pathological examination after extirpation. Statistical analysis revealed a significant positive correlation between ultrasonographic melanoma thickness and Breslow thickness (r=0.92, P<0.001). The mean thickness of invasive tumors evaluated by high frequency ultrasonography was 6.77 % higher compared with the mean Breslow thickness. The high-frequency ultrasonography provides a sensitive, noninvasive and reproducible method of skin evaluation, which enables objective visualization in vivo, providing valuable information, especially about cutaneous melanoma. The results of our study indicate that high frequency ultrasonography may be a useful adjunctive tool in the evaluation of cutaneous melanoma in daily practice.

Changes of cardiovascular regulation during rewarming in newborns undergoing whole-body hypothermia.

OBJECTIVES: The aim of the study was to determine changes of oxygenation and cardiovascular parameters during body temperature recovery in newborns undergoing therapeutic hypothermia. DESIGN AND SETTINGS: Three full-term newborns treated by whole-body hypothermia according to TOBY trial were included in the study. They were cooled to body temperature of 33.5 °C for 72 hours, thereafter gradual rewarming was initiated. During rewarming period following parameters were measured: heart rate and heart rate variability, blood pressure, core body temperature, blood oxygen saturation, cerebral and splanchnic tissue oxygenation. In one of the infants Doppler sonography examination of truncus coeliacus and arteria mesenterica superior was performed to assess blood flow in these arteries. RESULTS: During rewarming period the heart rate increased, whereas blood pressure tended to decrease. It was observed ascending trend in parameters of heart rate variability (MSSD and total spectral power) due to increasing spectral activity in LF and also HF bands. Blood oxygen saturation and cerebral tissue oxygenation remained stable, but significant decrease of splanchnic tissue oxygenation was noticed. This finding corresponded to Doppler sonography parameters in arteria mesenterica superior. THE MAIN FINDING: Therapeutic hypothermia and subsequent rewarming in newborns influenced cardiovascular regulation (blood pressure, heart rate, heart rate variability). Body temperature recovery was accompanied by reduction in splanchnic oxygenation and blood flow in superior mesenteric artery. CONCLUSIONS: Body temperature recovery in neonates led to changes in autonomic cardiovascular regulation resulting in redistribution of blood flow to vital organs. Reduction of blood flow to splanchnic organs during heating is a finding that has not been described yet. Further studies are needed to confirm these findings.