Spectral analysis of noise in the neonatal intensive care unit

Objective To perform spectral analysis of noise generated by equipments and activities in a level III neonatal intensive care unit (NICU) and measure the real time sequential hourly noise levels over a 15 day period. Methods Noise generated in the NICU by individual equipments and activities were recorded with a digital spectral sound analyzer to perform spectral analysis over 0.5–8 KHz. Sequential hourly noise level measurements in all the rooms of the NICU were done for 15 days using a digital sound pressure level meter. Independent sample t test and one way ANOVA were used to examine the statistical significance of the results. The study has a 90% power to detect at least 4 dB differences from the recommended maximum of 50 dB with 95 % confidence. Results The mean noise levels in the ventilator room and stable room were 19.99 dB (A) sound pressure level (SPL) and 11.81 dB (A) SPL higher than the maximum recommended of 50 dB (A) respectively (p < 0.001). The equipments generated 19.11 dB SPL higher than the recommended norms in 1–8 KHz spectrum. The activities generated 21.49 dB SPL higher than the recommended norms in 1–8 KHz spectrum (p< 0.001). The ventilator and nebulisers produced excess noise of 8.5 dB SPL at the 0.5 KHz spectrum.Conclusion Noise level in the NICU is unacceptably high. Spectral analysis of equipment and activity noise have shown noise predominantly in the 1–8 KHz spectrum. These levels warrant immediate implementation of noise reduction protocols as a standard of care in the NICU.

Neonatal screening for amino acidaemias in Karnataka, south India

Consanguineous marriages are strongly favoured among the peoples of South India. Because of the potential genetic risks resulting from inbreeding, a neonatal screening project was established in 1980 in the state of Karnataka for the identification of amino acidaemias. To date, blood samples obtained by toe-stab from 98,256 neonates have been tested by thin layer chromatography, with 46 single and 70 general amino acidaemias detected. The coefficients of inbreeding (F) for the two groups of neonates were 0.0336 and 0.0350, by comparison with a previously determined F value for the general, new-born population of 0.0298. The most common single abnormality detected was tyrosinaemia, with spontaneous resolution in the majority of cases.

Both Surface Proteins (VP4 and VP7) of an Asymptomatic Neonatal Rotavirus Strain (1321) Have High Levels of Sequence Identity with the Homologous Proteins of a Serotype 10 Bovine Rotavirus

The nucleotide sequence of genes 4 and 9, encoding the outer capsid proteins VP4 and VP7 of a serotype 10 tissue culture-adapted strain, 1321, representative of asymptomatic neonatal rotaviruses isolated from neonates in Bangalore, India, were determined. Comparison of nucleotide and deduced amino acid sequences of 1321 VP4 and VP7 with previously published sequences of various serotypes revealed that both genes were highly homologous to the respective genes of serotype 10 bovine rotavirus, B223. The VP4 of 1321 represents a new human P serotype and the 1321 and related strains represent the first description of neonatal rotaviruses that appear to derive both surface proteins from an animal rotavirus.

Antihyperlipidemic potential of Cedrus deodara extracts in monosodium glutamate induced obesity in neonatal rats

Objective: To study the antihyperlipidemic effect of Cedrus deodara (C. deodara) against monosodium glutamate (MSG) induced obesity in neonatal rats. Materials and Methods: The studies were carried out on newborn neonatal rats and were injected intraperitoneally with 2 mg/g of MSG on the 2(nd) and 4(th) postnatal days and 4 mg/g on 6(th), 8(th) and 10(th) postnatal days. Ethanolic extract (EE) and acetone extract (AE) of C. deodara was administered in a dose of 100 and 200 mg/kg, p.o./day at the age of 65 days. On day 60 of treatment, body weight, locomotor activity, body temperature, and various biochemical parameters like serum glucose, total cholesterol, triglyceride, and organs weights were recorded. Results: There was a significant reduction in body weight, organs and increased body temperature, locomotor activity after treatment with extracts. C. deodara decreased serum glucose, total cholesterol and triglyceride, low density lipoprotein (LDL) and very low density lipoprotein (VLDL) levels and increased high density lipoprotein (HDL) significantly has compared to MSG-control rats. Conclusion: C. deodara extracts exhibited antihyperlipidemic effect and it possesses anti-obesity properties in MSG induced obese rats.

Neonatal exposure to 17 beta-estradiol down-regulates the expression of synaptogenesis related genes in selected brain regions of adult female rats

Aims: Administration of estradiol or compounds with estrogenic activity to newborn female rats results in irreversible masculinization as well as defeminization in the brain and the animals exhibit altered reproductive behavior as adults. The cellular and molecular mechanism involved in inducing the irreversible changes is largely unknown. In the present study, we have monitored the changes in the expression of selected synaptogenesis related genes in the sexually dimorphic brain regions such as POA, hypothalamus and pituitary following 17 beta-estradiol administration to neonatal female rats. Main methods: Female Wistar rats which were administered 17 beta-estradiol on day 2 and 3 after birth were sacrificed 120 days later and the expression levels of genes implicated in synaptogenesis were monitored by semi-quantitative reverse transcription PCR. Since estradiol induced up-regulation of COX-2 in POA is a marker for estradiol induced masculinization as well as defeminization, in the present study only animals in which the increase in expression of COX-2 gene was observed in POA were included in the study. Key findings: Down-regulation of genes such as NMDA-2B, NETRIN-1, BDNF, MT-5 MMP and TNF-alpha was observed in the pre-optic area of neonatally E2 treated female rat brain but not in hypothalamus and pituitary compared to the vehicle- treated controls as assessed by RT-PCR and Western blot analysis. Significance: Our results suggest a possibility that down-regulation of genes associated with synaptogenesis in POA, may be resulting in disruption of the cyclical regulation of hormone secretion by pituitary the consequence of which could be infertility and altered reproductive behavior. (C) 2015 Elsevier Inc. All rights reserved.

Design of a Wearable Remote Neonatal Health Monitoring Device

In this text we present the design of a wearable health monitoring device capable of remotely monitoring health parameters of neonates for the first few weeks after birth. The device is primarily aimed at continuously tracking the skin temperature to indicate the onset of hypothermia in newborns. A medical grade thermistor is responsible for temperature measurement and is directly interfaced to a microcontroller with an integrated bluetooth low energy radio. An inertial sensor is also present in the device to facilitate breathing rate measurement which has been discussed briefly. Sensed data is transferred securely over bluetooth low energy radio to a nearby gateway, which relays the information to a central database for real time monitoring. Low power optimizations at both the circuit and software levels ensure a prolonged battery life. The device is packaged in a baby friendly, water proof housing and is easily sterilizable and reusable.

Impacto de la evolución científico-tecnológica en la Bioética neonatal-perinatal

Resumen: Los avances científico-tecnológicos en neonatología en los últimos 40 años han permitido una importante mejoría en la sobrevida de recién nacidos de extremo bajo peso al nacer, sin embargo la mortalidad neonatal aun representa un porcentaje muy grande de la mortalidad infantil. Esto esta principalmente relacionado a las muertes por prematuridad y sus complicaciones, anomalías congénitas y asfixia perinatal. La mayoría de los recién nacidos son tratados favorablemente en sala de partos y son admitidos a la Unidad de Cuidados Intensivos Neonatales (UCIN). La incertidumbre en el pronóstico de los prematuros extremos en el límite de la viabilidad con alto riesgo de morir en la UCIN o presentar alguna discapacidad, presenta un difícil dilema ético. Se deberá considerar cada caso en forma individual y evaluar el riesgo-beneficio entre las conductas a seguir y el “mejor interés para el niño” y los deseos de los padres que guiarán a decisiones éticas. Diferentes guías de cuidado y variaciones en la práctica médica en los límites de la viabilidad fetal se han descripto dentro y entre países. El objetivo es proveer a los padres una comunicación abierta, directa y transparente con suficiente entendimiento de los factores más relevantes en relación a la situación clínica, el pronóstico y las opciones de tratamiento para que ellos puedan tener una significativa participación en la toma de decisiones. Aceptar que en neonatología, hacer todo lo que uno puede hacer puede ser perjudicial, no útil o beneficioso. No todo lo técnicamente posible es éticamente correcto. El dilema afecta tanto al origen de la vida como a la terminación de la vida.

Enfermería basada en la evidencia. Los cuidados centrados en el desarrollo neonatal: NIDCAP y la disminución de secuelas sensomotoras en prematuros

La neonatología es una modalidad de cuidados relativamente nueva, que ha ido evolucionando paralelamente al desarrollo tecnológico. A pesar de disminuir la mortalidad neonatal, el pronóstico en su desarrollo no se puede predecir. Muchos de los niños prematuros sufren alteraciones en el desarrollo infantil. En la mayoría de los casos, las complicaciones no sólo se deben a la prematuridad, si no que surgen a consecuencia de la traumática estancia hospitalaria. La Dra. Als pionera en los Cuidados Centrados en el Desarrollo en niños prematuros, impulsó la importancia de los factores externos que rodean al neonato, determinantes para el correcto desarrollo sensomotor, cognitivo y conductual. Por ello, Als crea el Programa de Evaluación y Atención Individualizada y Orientada al Desarrollo Neonatal (NIDCAP) que se establece como una metodología de cuidado para mejorar la calidad asistencial del neonato, con el fin de mejorar su desarrollo y disminuir las posibles complicaciones que se dan en la infancia. El objetivo de este trabajo es valorar la eficacia del NIDCAP en la disminución de secuelas en el desarrollo de niños prematuros a largo plazo mediante la evidencia científica, utilizando metodología PBE. Se realiza una búsqueda bibliográfica a través de la base de datos pubmed y The Cochrane library, para contrastar los resultados y hallar la evidencia. Los resultados recogidos no confirman de manera contundente que el NIDCAP sea determinante para la disminución de secuelas sensomotoras en la infancia, aunque si sugiere que el programa no es perjudicial y si en todo caso beneficioso para los cuidados de estos recién nacidos.

Efectividad del método canguro en el tratamiento del dolor en neonatos prematuros y de bajo peso gestacional junto a sacarosa oral en la técnica punción del talón en la Unidad Neonatal.

Durante muchos años se consideró que los neonatos no experimentaban el dolor por su incapacidad para verbalizarlo. Así, concepciones erróneas hicieron que el dolor neonatal no fuese tratado. En la actualidad, existe evidencia científica que corrobora la capacidad para percibir el dolor, siendo necesario su tratamiento. Aun así, el miedo a los posibles efectos secundarios de los fármacos ha obstaculizado el estudio de nuevos fármacos para el tratamiento del dolor. Es por eso que las estrategias no farmacológicas han tomado gran relevancia en el tratamiento de procedimientos dolorosos menores, y como coadyuvantes de los fármacos en procedimientos de mayor intensidad. El método canguro que se define como un contacto piel a piel entre madre e hijo, surgió como una alternativa ante la escasez de incubadoras. Sin embargo, numerosas investigaciones han demostrado los grandes beneficios que aporta, considerándolo también como una medida no farmacológica eficaz en el alivio del dolor neonatal. El objetivo de este estudio es evaluar la efectividad del método canguro junto a la administración de sacarosa oral en la disminución del dolor, en comparación con el procedimiento estándar al realizar la prueba de talón. Para ello, se realizará un ensayo clínico aleatorizado dirigido a los neonatos prematuros y de bajo peso gestacional ingresados en la unidad de neonatal del Hospital universitario de Cruces. La variable principal a estudio es la valoración del dolor medido mediante la escala PIPP. Se compararán los datos recogidos en el grupo control e intervención y el análisis de datos se realizará usando el programa informático SPSS.

Protein-protein recognition: The neonatal Fe receptor and immunoglobulin G

The neonatal Fe receptor (FeRn) binds the Fe portion of immunoglobulin G (IgG) at the acidic pH of endosomes or the gut and releases IgG at the alkaline pH of blood. FeRn is responsible for the maternofetal transfer of IgG and for rescuing endocytosed IgG from a default degradative pathway. We investigated how FeRn interacts with IgG by constructing a heterodimeric form of the Fe (hdFc) that contains one FeRn binding site. This molecule was used to characterize the interaction between one FeRn molecule and one Fe and to determine under what conditions FeRn forms a dimer. The hdFc binds one FeRn molecule at pH 6.0 with a K_d of 80 nM. In solution and with FeRn anchored to solid supports, the heterodimeric Fe does not induce a dimer of FeRn molecules. FcRnhdFc complex crystals were obtained and the complex structure was solved to 2.8 Å resolution. Analysis of this structure refined the understanding of the mechanism of the pH-dependent binding, shed light on the role played by carbohydrates in the Fe binding, and provided insights on how to design therapeutic IgG antibodies with longer serum half-lives. The FcRn-hdFc complex in the crystal did not contain the FeRn dimer. To characterize the tendency of FeRn to form a dimer in a membrane we analyzed the tendency of the hdFc to induce cross-phosphorylation of FeRn-tyrosine kinase chimeras. We also constructed FeRn-cyan and FeRn-yellow fluorescent proteins and have analyzed the tendency of these molecules to exhibit fluorescence resonance energy transfer. As of now, neither of these analyses have lead to conclusive results. In the process of acquiring the context to appreciate the structure of the FcRn-hdFc interface, we developed a study of 171 other nonobligate protein-protein interfaces that includes an original principal component analysis of the quantifiable aspects of these interfaces.

Aderência, invasão e persistência intracelular de estreptococos do grupo B em células epiteliais respiratórias A549

Estreptococos do grupo B (EGB) comumente colonizam adultos saudáveis, sem sintomas, mas sob certas circunstâncias possui a capacidade de invadir tecidos do hospedeiro, evadir da detecção imunológica e causar doenças invasivas graves. Por conseguinte, os EGB continuam sendo uma das principais causas de mortalidade neonatal, pneumonia, sepse e meningite. Contudo, a patogênese desta infecção ainda está pouco elucidada. O sorotipo V é freqüentemente associado à doença invasiva em mulheres adultas não gestantes e o segundo mais prevalente em mulheres grávidas. O principal objetivo deste trabalho foi estudar a aderência, invasão e persistência intracelular de amostras pertencentes ao sorotipo V (88641-vagina/portador e 90186-sangue/paciente) usando as células epiteliais respiratórias A549. As amostras de EGB demonstraram capacidade de aderir e invadir as células epiteliais A549, mas somente a amostra 90186-sangue apresentou maior invasão quando comparada com a de vagina (P <0.001). Ambas as amostras demonstraram persistência intracelular sem replicação no interior das células A549. Apenas o isolado 90186-sangue sobreviveu dentro das células epiteliais até 24h de incubação (P <0,05). A fusão dos lisossomas das células epiteliais com vacúolos contendo bactérias foi observada em células A549 tratadas com Lyso Tracker Grenn DND-26 para todas as amostras testadas. Nossos dados indicam pela primeira vez que as amostras viáveis do sorotipo V permanecem dentro de vacúolos ácidos epiteliais. Curiosamente, a amostra 90186- sangue induziu vacuolização celular e a amostra 88641-vagina promoveu a morte celular após 7h de incubação. Finalmente, nossos resultados aumentam o nosso conhecimento sobre eventos celulares da fagocitose e da patogênese das doenças invasivas promovidas pelos EGB.