Investigating short-stay admission to a neonatal intensive care unit as a risk factor for reduced breast feeding at discharge in infants ≥36 weeks' gestation: a retrospective cohort study.

OBJECTIVE: This study aims to determine the effect of infant-mother separation following a short-stay (≤72 hours) admission to a Level 5 neonatal unit versus no admission on infant-feeding outcomes at hospital discharge. DESIGN: Retrospective cohort study. SETTING: An Australian Level 5 neonatal unit within a tertiary referral hospital. PARTICIPANTS: Mothers and their infants born between 1 January 2018 and 31 December 2020 had a short-stay admission to the neonatal unit or no admission. All participants met admission criteria to the postnatal ward and were discharged home at ≤72 hours (n=12 540). Postnatal ward admission criteria included ≥36 weeks' gestation and birth weight ≥2.2 kg. MAIN OUTCOME MEASURES: Infant feeding at discharge from hospital. Multivariate logistic regression analysis was conducted, adjusting for confounders associated with known breastfeeding issues. These included age, ethnicity, parity, obesity, socioeconomic score, hypertensive disorders of pregnancy, diabetes, infant gestation and birthweight centile, caesarean section birth, postpartum haemorrhage and skin-to-skin contact. RESULTS: Of the 12 540 live births meeting inclusion criteria, 1000 (8%) infants were admitted to the neonatal unit. The primary reasons for admission were suspicion of sepsis (24%), maternal diabetes (19%) and jaundice (16%). We found a reduction in full breast feeding at hospital discharge in cases of a short admission to the neonatal unit compared with no admission (aOR 0.40; 95% CI 0.34 to 0.47; p<0.001). We identified that women of different ethnicities had differing levels of risk for formula supplementation at hospital discharge. The ethnic grouping least likely to be fully breast feeding at discharge was Southeast Asian women (aOR 0.47; 95% CI 0.39 to 0.57; p<0.001). CONCLUSIONS: Identifying mother-infant dyads at risk of non-exclusive breast feeding at hospital discharge will help target resources for practice improvement.

Role of a radiopaque agent and surveillance radiographs for peripherally inserted central catheters in newborn infants.

BACKGROUND: Controversy exists regarding the use of a radiopaque agent to identify peripherally inserted central catheter (PICC) tip positions in newborn infants and of serial radiography to monitor PICC tip migration. OBJECTIVE: To investigate the roles of (1) the injection of a radiopaque agent to identify PICC tip position and (2) the performance of weekly radiography to monitor PICC migration. MATERIALS AND METHODS: This retrospective single-centre cohort study included newborn infants who received a PICC between 1 January 2016 and 31 December 2020. A radiopaque agent was injected to identify PICC tip position and radiographs were performed weekly to detect PICC migration. RESULTS: We identified 676 PICC episodes in 601 infants. A radiopaque agent was used for 590 of these episodes. There was no difference in the proportion of central PICC tip positions based on radiopaque agent use status (490/590, 83% for the radiopaque agent used group versus 73/85, 85.8% for the radiopaque agent not used group, P=0.51). Irrespective of the site of PICC insertion, outward migration was observed for most centrally placed PICCs over their entire in situ duration. Inward migration was identified in 23 out of 643 PICC episodes (3.6%) only on radiographs obtained on or before day 7. Based on serial radiographs, the odds for PICC tips remaining in a central position were lower the longer the PICC remained in situ (adjusted odds ratio-OR 0.93; 95% confidence interval 0.92-0.95). There was no difference in PICC migration between side and limb of insertion. CONCLUSION: PICC tips can be identified without injection of a radiopaque agent. Serial radiographs identified PICC migration over the in situ duration. This study has implications for reducing exposure to a radiopaque agent and ongoing migration surveillance practices.

Systemic postnatal corticosteroid use for the prevention of bronchopulmonary dysplasia and its relationship to early neurodevelopment in extremely preterm infants.

BACKGROUND: Systemic postnatal corticosteroid use in extremely preterm infants poses a risk of adverse neurodevelopmental outcomes. This study explores their use beyond seven days of age with early neurodevelopmental assessments during the fidgety period (9-20 weeks postterm age). METHODS: This retrospective single-center cohort study included inborn extremely preterm infants from 1 January 2014 to 31 December 2018. Outborn infants, those with congenital or genetic abnormalities, and those who received postnatal corticosteroids for nonrespiratory reasons were excluded. The cohort was dichotomized based on the status of corticosteroid receipt. Early neurodevelopmental outcomes were reported using Prechtl's General Movements Assessment. RESULTS: Of the 282 infants, 67 (23.75%) received corticosteroids. Of these, 34 (50.75%) received them for dependency on invasive ventilation (intermittent positive-pressure ventilation), and the remainder received them for dependency on non-invasive ventilation continuous positive airway pressure (CPAP) or bi-level positive airway pressure (BiPAP). Abnormal or absent fidgety movements were observed in 13% of infants (7/54) who received corticosteroids compared to 2% of infants (3/146) who did not. An increased odds for an abnormal general movements assessment from corticosteroid use after adjusting for gestational age [adjusted odds ratio (aOR) = 5.5, 95% confidence interval (CI) = 1.14-26.56] was observed. The motor optimality scores differed between the two groups [corticosteroid group: 25.5 (23-26) versus no-corticosteroid group: 26 (24-28); z = - 2.02]. A motor optimality score < 20 was observed in 14.8% of infants (8/54) in the corticosteroid group compared to 2% of infants (3/146) in the noncorticosteroid group. This difference was significant after adjustment for gestational age (aOR 5.96, 95% CI 1.28-27.74). CONCLUSIONS: Abnormal early neurodevelopment was observed in infants who received systemic postnatal corticosteroids. The relationship between these findings and other factors influencing early neurodevelopment needs further exploration.

Clinical Outcomes of Single vs. Two-Strain Probiotic Prophylaxis for Prevention of Necrotizing Enterocolitis in Preterm Infants.

Background: The administration of live microbiota (probiotic) via enteral route to preterm infants facilitates intestinal colonization with beneficial bacteria, resulting in competitive inhibition of the growth of pathogenic bacteria preventing gut microbiome dysbiosis. This dysbiosis is linked to the pathogenesis of necrotizing enterocolitis (NEC), an acquired multi-factorial intestinal disease characterized by microbial invasion of the gut mucosa, particularly affecting preterm infants. Probiotic prophylaxis reduces NEC; however, variations in strain-specific probiotic effects, differences in administration protocols, and synergistic interactions with the use of combination strains have all led to challenges in selecting the optimal probiotic for clinical use. Aim: To compare any differences in NEC rates, feeding outcomes, co-morbidities in preterm infants receiving single or two-strain probiotics over a 4-year period. The two-strain probiotic prophylaxis was sequentially switched over after 2 years to the single strain probiotic within this 4-year study period, in similar cohort of preterm infants. Methods: During two consecutive equal 2-year epochs, preterm infants (<32 weeks and or with birth weight <1,500 g) receiving two-strain (Lactobacillus acidophilus and Bifidobacterium bifidum) and single strain (Bifidobacterium breve M-16 V,) probiotic prophylaxis for prevention of NEC were included in this retrospective, observational study. The primary outcome included rates of NEC; secondary outcomes included prematurity related co-morbidities and feeding outcomes. Time to reach full enteral feeds was identified as the first day of introducing milk feeds at 150 ml/kg/day. Results: There were 180 preterm infants in the two-strain, 196 in the single strain group from the two equal consecutive 2-year epochs. There were no differences in the NEC rates, feeding outcomes, all-cause morbidities except for differences in rates of retinopathy of prematurity. Conclusion: In our intensive-care setting, clinical outcomes of single vs. two-strain probiotic prophylaxis for prevention of NEC were similar. Although our study demonstrates single strain probiotic may be equally effective than two-strain in the prevention of NEC, small sample size and low baseline incidence of NEC in our unit were not sufficiently powered to compare single vs. two-strain probiotic prophylaxis in preventing NEC. Further clustered randomized controlled trials are required to study the effects of single vs. multi-strain probiotic products for NEC prevention in preterm infants.

Evaluation of infrared thermography as a non-invasive method of measuring the autonomic nervous response in sheep.

Eye temperature measured using infrared thermography (IRT) can be used as a non-invasive measure of autonomic nervous system (ANS) activity in cattle. The objective of this study was to evaluate if changes in eye temperature (measured using IRT) can be used to non-invasively measure ANS activity in sheep. Twenty, 2 to 4-year-old, Romney ewes were randomly assigned to receive either epinephrine (EPI) or physiological saline (SAL) for 5 min administered via jugular catheter (n = 10 ewes/treatment). Eye temperature (°C) was recorded continuously using IRT for approximately 25 min before and 20 min after the start of infusion. Heart rate and heart rate variability, measured using the root mean square of successive differences (RMSSD) and the standard deviation of all inter-beat intervals (SDNN), were recorded for 5 min before and up to 10 min after the start of infusion. Blood samples were taken before and after the infusion period to measure plasma epinephrine, norepinephrine, cortisol and packed cell volume (PCV) concentrations. During the infusion period, maximum eye temperature was on average higher (P<0.05) in sheep that received epinephrine than those that received saline. On average, heart rate was higher (SAL: 87.5 beats/min, EPI: 123.2 beats/min, SED = 7.07 beats/min; P<0.05), and RMSSD (SAL: 55.3 ms, EPI: 17.3 ms, SED = 14.18 ms) and SDNN (SAL: 54.3 ms, EPI: 21.5 ms, SED = 10.00 ms) lower (P<0.05) in ewes during the 5 min post-infusion period compared with ewes that received saline. An infusion of epinephrine resulted in higher geometric mean epinephrine (P<0.05) and cortisol (P<0.05) but not norepinephrine (P>0.05) concentrations in ewes compared to an infusion of saline. PCV concentrations were higher (P<0.001) by 7 ± 1.0% (mean±SED) in ewes after an epinephrine infusion. These results suggest that heart rate variability is a sensitive, non-invasive method that can be used to measure ANS activity in sheep, whereas change in eye temperature measured using IRT is a less sensitive method.

Automated Collection and Analysis of Infrared Thermograms for Measuring Eye and Cheek Temperatures in Calves.

As the reliance upon automated systems in the livestock industry increases, technologies need to be developed which can be incorporated into these systems to monitor animal health and welfare. Infrared thermography (IRT) is one such technology that has been used for monitoring animal health and welfare and, through automation, has the potential to be integrated into automated systems on-farm. This study reports on an automated system for collecting thermal infrared images of calves and on the development and validation of an algorithm capable of automatically detecting and analysing the eye and cheek regions from those images. Thermal infrared images were collected using an infrared camera integrated into an automated calf feeder. Images were analysed automatically using an algorithm developed to determine the maximum eye and cheek (3 × 3-pixel and 9 × 9-pixel areas) temperatures in a given image. Additionally, the algorithm determined the maximum temperature of the entire image (image maximum temperature). In order to validate the algorithm, a subset of 350 images analysed using the algorithm were also analysed manually. Images analysed using the algorithm were highly correlated with manually analysed images for maximum image (R2 = 1.00), eye (R2 = 0.99), cheek 3 × 3-pixel (R2 = 0.85) and cheek 9 × 9-pixel (R2 = 0.90) temperatures. These findings demonstrate the algorithm to be a suitable method of analysing the eye and cheek regions from thermal infrared images. Validated as a suitable method for automatically detecting and analysing the eye and cheek regions from thermal infrared images, the integration of IRT into automated on-farm systems has the potential to be implemented as an automated method of monitoring calf health and welfare.

Infrared Thermography-A Non-Invasive Method of Measuring Respiration Rate in Calves.

Respiration rate (RR) is a common measure of cattle health and welfare. Traditionally, measuring RR involves counting flank movements as the animal inhales and exhales with each breath. This method is often considered difficult, labour-intensive and impractical. We validated the use of infrared thermography (IRT) as an alternative method of non-invasively measuring RR in young calves. RR was simultaneously recorded in two ways: (1) by observing flank movements from video recordings; and (2) by observing thermal fluctuations around the nostrils during inhalations and exhalations from infrared recordings. For each method, the time taken to complete five consecutive breaths (a breath being a complete inhalation/exhalation cycle) was recorded and used to calculate RR (breaths/min). From a group of five calves, a total of 12 video recordings and 12 infrared recordings were collected. For each procedure, 47 sets of five consecutive breaths were assessed. The RRs measured from video recordings of flank movements and thermal fluctuations around the nostrils from infrared recordings were highly correlated (R2 = 0.93). Validated as a suitable method for recording RR, future research can now focus on the development of algorithms to automate the use of IRT to support its integration into existing automated systems to remotely monitor calf health and welfare.

Effect of isoflurane alone or in combination with meloxicam on the behavior and physiology of goat kids following cautery disbudding.

Cautery disbudding of goat kids is painful, but may be alleviated with pain mitigation. We therefore evaluated the effect of administering general anesthesia (isoflurane) or a nonsteroidal anti-inflammatory drug (meloxicam) on goat kid behavior and physiology following cautery disbudding. Trial 1 (n = 12/treatment) evaluated behavioral responses in 72 female Saanen dairy goat kids (mean ± standard error of the mean; 3.9 ± 0.15 d old) and trial 2 (n = 10/treatment) evaluated physiological responses in 60 female Saanen dairy goat kids (4.3 ± 0.14 d old). Goat kids were randomly assigned to 1 of 6 treatment groups that were either (1) sham-handled only (simulated disbudding; SHAM) or disbudded with (2) no pain relief (CAUT), (3) isoflurane gas (ISO), (4) isoflurane and s.c. meloxicam combined (ISO+MEL), (5) meloxicam s.c. (0.5 mg/kg of body weight; I-MEL), or (6) oral meloxicam (0.2 mg/kg of body weight; O-MEL). Head shaking, head scratching, self-grooming, feeding, and body shaking were continuously video recorded for 24 h pre- and post-treatment. Lying behavior was recorded continuously for 24 h pre- and post-treatment using accelerometers. Plasma cortisol, glucose, and lactate concentrations were measured from blood samples collected immediately before treatment (baseline) and at 15, 60, and 120 min post-treatment. Body temperature was measured immediately after blood sampling at all blood sampling time points. Head shaking and body shaking frequencies were 50% higher in CAUT than SHAM kids 5 min post-treatment; ISO+MEL and ISO kids performed 25% less body shakes than CAUT kids. Head scratching durations 1 h post-treatment were higher in CAUT than SHAM kids, whereas O-MEL were similar to SHAM kids from 2 h post-treatment. Self-grooming, feeding, and lying did not differ between groups. Cortisol concentrations were higher in CAUT than SHAM kids (156.4 ± 26.41 and 104.1 ± 26.41 nmol/L, respectively), whereas ISO+MEL and ISO kids (88.3 ± 26.41 and 113.2 ± 26.41 nmol/L, respectively) had lower cortisol concentrations than CAUT kids over the 2-h sampling period. Moreover, O-MEL and I-MEL kids (163.0 ± 26.41 and 130.9 ± 26.41 nmol/L, respectively) had similar cortisol concentrations to CAUT kids. We found no evidence that plasma glucose and lactate concentrations or body temperature were affected by treatment. The administration of isoflurane, with or without meloxicam, appeared to reduce pain associated with cautery disbudding.

Helokinestatin-7 peptides from the venoms of Heloderma lizards.

Helokinestatins 1-6 constitute a family of bradykinin antagonist peptides originally isolated from the venoms of the Gila Monster, Heloderma suspectum and the Mexican beaded lizard, Heloderma horridum. Here we report the identification, isolation and preliminary pharmacological characterization of two novel tridecapeptides, named helokinestatin-7S (FDDDSTELILEPR - 1550 Da) and helokinestatin-7H (FDDDSRKLILEPR - 1604 Da), whose primary structures were predicted from cDNAs cloned from venom libraries of respective Heloderma lizards. Computed molecular masses of putative helokinestatin-7 peptides were used as tools to locate these peptides in archived LC/MS fractions from respective venoms and sequences were confirmed by MS/MS fragmentation. A synthetic replicate of helokinestatin-7H was found to antagonize the relaxation effect of bradykinin on rat arterial smooth muscle but to have no measurable effects alone. In contrast, synthetic helokinestatin-7S was found to directly contract this preparation. Studies on related natural peptides with subtle differences in primary structure can provide the tools for structure/activity studies in pharmacological investigations directed toward unraveling the molecular basis of venom toxicity and for the evaluation of potential therapeutic leads.