Searching molecular biomarkers correlating with BSID-III at 24 months in infants with neonatal hypoxic-ischemic encephalopathy.

An early prediction of outcomes of neonatal hypoxic-ischemic encephalopathy (NE) is of key importance in reducing neonatal mortality and morbidity. The objectives were (i) to analyze the characteristics of miRNA expression and metabolic patterns of neonates with NE and (ii) to assess their predictive performance for neurodevelopmental outcomes. Plasma samples from moderate/severe NE patients (N = 92) of the HYPOTOP study were collected before, during, and after therapeutic hypothermia (TH) and compared to a control group (healthy term infants). The expression of miRNAs and concentrations of metabolites (hypoxia-related and energy, steroid, and tryptophan metabolisms) were analyzed. Neurodevelopmental outcomes were evaluated at 24 months postnatal age using Bayley Scales of Infant Development, ed. III, BSID-III. Differences in miRNA and metabolic profiles were found between NE vs. control infants, abnormal (i.e., mildly and moderately abnormal and severe) vs. normal, and severe vs. non-severe (i.e., normal and mildly and moderately abnormal) BSID-III. 4-Androstene-3,17-dione, testosterone, betaine, xanthine, and lactate were suitable for BSID-III outcome prediction (receiver operating characteristic areas under the curve (AUCs) ≥ 0.6), as well as 68 miRNAs (AUCs of 0.5-0.9). Significant partial correlations of xanthine and betaine levels and the expression of several miRNAs with BSID-III sub-scales were found. Conclusion: We have identified metabolites/miRNAs that might be useful to support the prediction of middle-term neurodevelopmental outcomes of NE. What is known and what is new: • The early prediction of outcomes of neonatal hypoxic-ischemic encephalopathy (NE) is of key importance in reducing neonatal mortality and morbidity. • Alterations of the metabolome and miRNAs had been observed in NE. • We performed miRNA sequencing and quantified selected metabolites (i.e., lactate, pyruvate, ketone bodies, Krebs cycle intermediates, tryptophan pathway, hypoxia-related metabolites, and steroids) by GC- and LC-MS. • Specific miRNAs and metabolites that allow prediction of middle-term neurodevelopmental outcomes of newborns with NE undergoing hypothermia treatment were identified.

Uso de la espectroscopia cercana al infrarrojo en las perforaciones gástricas en neonatología / Use of near infrared spectroscopy in neonatal gastric perforation

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[Effect of adding fortifiers and protein supplements on the osmolality of donated maternal milk]. / Efecto de la adición de fortificantes y de módulo de proteínas en la osmolalidad de la leche materna donada.

INTRODUCTION AND OBJECTIVES: The fortification of maternal milk (MM) is a standard practice in order to achieve the requirements needed for the growth and development of the premature newborn. However, its osmolality could increase. According to the American Paediatrics Academy, it is recommended not to exceed 450 mOsm/kg (approximately 400 mOsm/L) in the diet of the infant, even though the safety limit is estimated to be between 400 and 600 mOsm/kg. The aim of this study is to determine the osmolality of thawed and fortified donated MM (DMM). METHOD: An analysis was performed on DMM of 6 healthy mothers, without fortifying, and with 4 levels of fortification. Measurement of the samples was carried out in triplicate at 0, 4, 9, and 24hours after their preparation. They were stored refrigerated (2-8°C) between measurements. The study groups were: (A) Non-fortified DMM; (B) DMM with vitamins added; (C) with the addition of a fortifier; (D) with the addition of a low-dose protein formula; and (E) with the addition of a high-dose protein formula. The osmolality determinations were carried out using a freezing-point osmometer. The data analysis was performed using R software (v.3.5.1). RESULTS: A total of 30 samples were analysed with 360 measurements. The osmolality of the DMM at t=0h was 301 mOsm/kg (SD 5.2) and slightly increased with time to 308.11 mOsm/kg (SD 5.21) after 24hours (t=24h), being maintained within the safety limits. The addition of vitamins (Group B) did not significantly increase the osmolality. The addition of a fortifier (C) and a low dose (D) or high dose (E) protein formula produced an increase in the baseline osmolality that increased statistically significantly in time (P=.007), but with no differences between the C, D, and E types. There were differences between the osmolality at t=0 with the fortification according to the manufacturer's data sheet (339 mOsm/l) and the findings in our laboratory (432.33 mOsm/l). CONCLUSION: The osmolality values found in the thawed DMM samples were similar to those of other studies. The fortification of the DMM samples and their storage refrigerated at 2-8°C for 24h increased the osmolality, but keeping them within the safety limits.

Intraperitoneal vancomycin in neonates during peritoneal dialysis: A case report.

WHAT IS KNOWN AND OBJECTIVE: Guidelines for prevention and treatment of peritonitis in paediatric patients recommend vancomycin. We present the clinical practice in neonates during peritoneal dialysis and evaluate dosage and serum levels of vancomycin. CASE SUMMARY: This case report describes a newborn with acute renal failure under continuous peritoneal dialysis therapy and intraperitoneal vancomycin. We report the treatment dosage and serum vancomycin levels. WHAT IS NEW AND CONCLUSION: There is great variability in the recommended dose of vancomycin for continuous peritoneal dialysis and the available clinical experience. Further investigation of dosing in children particularly in newborns, especially in loading dose, is necessary.