MyMedR

Amnion is a membrane that surrounds and structurally protects the developing fetus during pregnancy. The rupture of amniotic membranes prior to both normal and preterm deliveries involves stretch forces acting on a biochemically triggered weak zone of the membranes. Fracture toughness is an important mechanical property describing how the membranes containing a defect resist fracture, but this property has never been investigated in amniotic membranes. In this work, the fracture toughness of many samples cut from four pieces of amniotic membrane from different mothers was examined by uniaxial and pure shear (mode I) fracture tests. The measurement was checked for dependence on the sample geometry and notch length. Results from the uniaxial tensile test show J-shaped stress-strain curves and confirm that the amniotic membrane is a nonlinear material. The measured fracture toughness of four amniotic membranes ranged from 0.96 ± 0.11 to 1.83 ± 0.18 kJ m-2. Despite considering the effect of the presence of the defect on mechanical property measurement, similar fracture behaviour was observed for pre-notched and unnotched specimens, indicating that the membranes were extremely tolerant to defects. This defect-tolerant characteristic provides insight into the understanding of fetal membrane rupture.

Matched MeSH terms: Infant, Newborn

Fulltext Bilateral neonatal breast abscess in a well-appearing neonate

Muhammad Yusoff Mohd Ramdzan, Jamil Aiman Mohd Baharuddin, Nordiyana Azmi, Noraida Ramli, Nor Rosidah Ibrahim, Rostenberghe, Hans Van

Malaysian Journal of Paediatrics and Child Health, 2019;25(1):27-29.

MyJurnal

Neonatal mastitis and abscess are rare and most often unilateral. Neonatal breast massage for physiological breast hypertrophy is suspected to be a predisposing factor in the case reported here: a 14-day-old neonate with bilateral neonatal breast abscess, treated effectively with intravenous cloxacillin and surgical aspiration.

Matched MeSH terms: Infant, Newborn

Epilepsy in pregnancy - a primary care approach

Zainuddin Z, Tan CK

Family Physician, 2003;12:9-11.

Epilepsy is the most common neurological disorder in pregnancy. The effects of epilepsy include congenital abnormalities which are increased 2-3 fold. The babies born suffer from haemorrhagic disease of newborn. Preconception management and folic acid supplementation is important in optimizing outcome. With close monitoring and proper management, more than 90% of mothers have no complications throughout their pregnancy. Hormonal contraception dosage need to be increased due to the enzyme inducing nature of the anti epileptics drugs.

Matched MeSH terms: Infant, Newborn

Maternal and neonatal effects of Acinetobacter colonisation in preterm premature rupture of membrane and term labour

Sood M, Mohd Zain Z, Abu NA, Chee SC, Mohd Nor NS

Med J Malaysia, 2019 02;74(1):40-44.

PMID: 30846661

INTRODUCTION: Some anecdotal reports suggest that maternal colonisation with Acinetobacter baumannii during pregnancy is associated with adverse maternal and neonatal effects, including preterm premature rupture of membrane (PPROM). The objective of this study was to compare the maternal and neonatal effects of A. baumannii colonisation in cases with PPROM and those with spontaneous onset of labour at term.

METHODS: The recruitment of participants' was carried out at Selayang Hospital, Selangor, Malaysia. Vaginal swabs were prospectively taken from 104 patients of PPROM and 111 with spontaneous onset of labour at term. Swabs were also taken from the axillae and ears of their babies. These swabs were cultured to isolate A. baumannii. Maternal and neonatal adverse outcomes were documented.

RESULTS: Sixteen mothers were A. baumannii positive, eight from each group respectively. None of the cases developed chorioamnionitis or sepsis. Those positive were four cases of PPROM and two babies of term labour. None of the babies developed sepsis.

CONCLUSIONS: This study does not support the suggestion that A. baumannii colonisation during pregnancy is associated with adverse maternal and neonatal outcomes.

Matched MeSH terms: Infant, Newborn; Infant, Newborn, Diseases/etiology; Infant, Newborn, Diseases/microbiology*

Fulltext Late presentation of turner syndrome and its complications

Huzairi Sani, Nada Syazana Zulkufli

Journal of Clinical and Health Sciences, 2018;3(2):51-55.

MyJurnal

Turner syndrome is one of the most common sex chromosome abnormalities with an estimated true prevalence of 1 in 2,000 in newborns. This case report is of a girl who presented to the adult endocrinologist at 16 years of age and subsequently diagnosed with Turner syndrome. Despite frequenting clinics for unrelated ailments, her short stature was overlooked hence not investigated for a causative pathology. The aim of this report is to explore the diagnostics of Turner syndrome, hormone treatments available and the importance of starting treatment early.

Matched MeSH terms: Infant, Newborn

Fulltext Population pharmacokinetic meta-analysis of individual data to design the first randomized efficacy trial of vancomycin in neonates and young infants

Jacqz-Aigrain E, Leroux S, Thomson AH, Allegaert K, Capparelli EV, Biran V, et al.

J Antimicrob Chemother, 2019 08 01;74(8):2128-2138.

PMID: 31049551 DOI: 10.1093/jac/dkz158

OBJECTIVES: In the absence of consensus, the present meta-analysis was performed to determine an optimal dosing regimen of vancomycin for neonates.

METHODS: A 'meta-model' with 4894 concentrations from 1631 neonates was built using NONMEM, and Monte Carlo simulations were performed to design an optimal intermittent infusion, aiming to reach a target AUC0-24 of 400 mg·h/L at steady-state in at least 80% of neonates.

RESULTS: A two-compartment model best fitted the data. Current weight, postmenstrual age (PMA) and serum creatinine were the significant covariates for CL. After model validation, simulations showed that a loading dose (25 mg/kg) and a maintenance dose (15 mg/kg q12h if <35 weeks PMA and 15 mg/kg q8h if ≥35 weeks PMA) achieved the AUC0-24 target earlier than a standard 'Blue Book' dosage regimen in >89% of the treated patients.

CONCLUSIONS: The results of a population meta-analysis of vancomycin data have been used to develop a new dosing regimen for neonatal use and to assist in the design of the model-based, multinational European trial, NeoVanc.

Matched MeSH terms: Infant, Newborn

Fulltext A case series of hereditary congenital cataract

Nurul Faaiqah Jainuddin, Azlindarita Aisyah Mohd Abdullah, Visvaraja Subrayan, Norlina Ramli, Nurliza Khaliddin

Malaysian Journal of Medicine and Health Sciences, 2020;16(2):336-338.

MyJurnal

Congenital cataract is a major cause of preventable blindness in children. It can be either hereditary or non-hereditary. In this case series, we present three cases of congenital cataract with a strong family history. The grandparents
and parents of these patients had cataract diagnosed in late childhood whilst the patients in this case series were
diagnosed with congenital cataract earlier. There was no history of consanguineous marriage in any of the families.
These cases show that, in the presence of a strong family history, a child will present with congenital cataract earlier
in their life. Hence, babies from such families should be screened at birth and at regular intervals within the first
year of life to enable early diagnosis and subsequent surgical intervention to reduce the incidence and burden of
amblyopia.

Matched MeSH terms: Infant, Newborn

Fulltext The Role of Heme Oxygenase-1 Promoter Polymorphisms in Perinatal Disease

Nakasone R, Ashina M, Abe S, Tanimura K, Van Rostenberghe H, Fujioka K

Int J Environ Res Public Health, 2021 03 29;18(7).

PMID: 33805292 DOI: 10.3390/ijerph18073520

Heme oxygenase (HO) is the rate-limiting enzyme in the heme catabolic pathway, which degrades heme into equimolar amounts of carbon monoxide, free iron, and biliverdin. Its inducible isoform, HO-1, has multiple protective functions, including immune modulation and pregnancy maintenance, showing dynamic alteration during perinatal periods. As its contribution to the development of perinatal complications is speculated, two functional polymorphisms of the HMOX1 gene, (GT)n repeat polymorphism (rs3074372) and A(-413)T single nucleotide polymorphism (SNP) (rs2071746), were studied for their association with perinatal diseases. We systematically reviewed published evidence on HMOX1 polymorphisms in perinatal diseases and clarified their possible significant contribution to neonatal jaundice development, presumably due to their direct effect of inducing HO enzymatic activity in the bilirubin-producing pathway. However, the role of these polymorphisms seems limited for other perinatal complications such as bronchopulmonary dysplasia. We speculate that this is because the antioxidant or anti-inflammatory effect is not directly mediated by HO but by its byproducts, resulting in a milder effect. For better understanding, subtyping each morbidity by the level of exposure to causative environmental factors, simultaneous analysis of both polymorphisms, and the unified definition of short and long alleles in (GT)n repeats based on transcriptional capacity should be further investigated.

Matched MeSH terms: Infant, Newborn

Aspiration Avoiding Tracheostomy in Neonatal Cystic Oral Lesion

Nasir MSNM, Ishak MN, Abd Wahid FH, Asif JA, Mohamad I

Medeni Med J, 2019;34(4):400-403.

PMID: 32821468 DOI: 10.5222/MMJ.2019.44977

Oral cyst is uncommon in the neonatal period. Depending on the size and site of occurrence, its symptoms may vary. If not diagnosed and managed expeditiously, these oral cysts may cause significant and potentially fatal morbidity and mortality. We report a successfully managed case of oral cyst in neonate that presented with huge tongue at birth and complaints of impending airway obstruction. She was referred for tracheostomy as intubation was impossible. We attempted needle aspiration and the airway successfully relieved without the need for tracheostomy.

Matched MeSH terms: Infant, Newborn

Neonatal aortic thrombosis: A life threatening complication of umbilical artery catheterisation

Thay WY, Aisha Fadhilah AA, Faizah MJ, Zainudin Z

Med J Malaysia, 2020 03;75(2):173-174.

PMID: 32281603

Umbilical artery catheterisation is considered the standard of care for arterial access in neonatal intensive care unit. It is routinely used for blood sampling and blood pressure monitoring. Unfortunately, an indwelling umbilical catheter have been associated with thrombotic complication which may result in either partial or complete occlusion of the aorta. We report here our experience in the diagnosis and treatment of a neonate with this condition.

Matched MeSH terms: Infant, Newborn

Magnetic resonance imaging of obesity and metabolic disorders: Summary from the 2019 ISMRM Workshop

Hu HH, Branca RT, Hernando D, Karampinos DC, Machann J, McKenzie CA, et al.

Magn Reson Med, 2020 05;83(5):1565-1576.

PMID: 31782551 DOI: 10.1002/mrm.28103

More than 100 attendees from Australia, Austria, Belgium, Canada, China, Germany, Hong Kong, Indonesia, Japan, Malaysia, the Netherlands, the Philippines, Republic of Korea, Singapore, Sweden, Switzerland, the United Kingdom, and the United States convened in Singapore for the 2019 ISMRM-sponsored workshop on MRI of Obesity and Metabolic Disorders. The scientific program brought together a multidisciplinary group of researchers, trainees, and clinicians and included sessions in diabetes and insulin resistance; an update on recent advances in water-fat MRI acquisition and reconstruction methods; with applications in skeletal muscle, bone marrow, and adipose tissue quantification; a summary of recent findings in brown adipose tissue; new developments in imaging fat in the fetus, placenta, and neonates; the utility of liver elastography in obesity studies; and the emerging role of radiomics in population-based "big data" studies. The workshop featured keynote presentations on nutrition, epidemiology, genetics, and exercise physiology. Forty-four proffered scientific abstracts were also presented, covering the topics of brown adipose tissue, quantitative liver analysis from multiparametric data, disease prevalence and population health, technical and methodological developments in data acquisition and reconstruction, newfound applications of machine learning and neural networks, standardization of proton density fat fraction measurements, and X-nuclei applications. The purpose of this article is to summarize the scientific highlights from the workshop and identify future directions of work.

Matched MeSH terms: Infant, Newborn

Fulltext Candida Chorioamnionitis in Mothers with Gestational Diabetes Mellitus: A Report of Two Cases

Shazniza Shaaya E, Halim SAA, Leong KW, Ku KBP, Lim PS, Tan GC, et al.

Int J Environ Res Public Health, 2021 07 13;18(14).

PMID: 34299901 DOI: 10.3390/ijerph18147450

Background:Candida chorioamnionitis is rarely encountered, even though vulvovaginal candidiasis incidence is about 15%. Interestingly, it has characteristic gross and histological findings on the umbilical cord that are not to be missed. Case Report: We report two cases of Candida chorioamnionitis with presence of multiple yellowish and red spots of the surface of the umbilical cord. Microscopically, these consist of microabscesses with evidence of fungal yeasts and pseudohyphae. The yeasts and pseudohyphae were highlighted by periodic acid- Schiff and Grocott methenamine silver histochemical stains. Both cases were associated with a history of gestational diabetes mellitus. Discussion: Peripheral funisitis is a characteristic feature of Candida chorioamnionitis. It is associated with high risk of adverse perinatal and neonatal outcomes, such as preterm delivery, stillbirth and neonatal death. We recommend careful examination of the umbilical cord of mothers with gestational diabetes mellitus.

Matched MeSH terms: Infant, Newborn

Fulltext Neonatal intensive care unit (NICU) exposures exert a sustained influence on the progression of gut microbiota and metabolome in the first year of life

Yap PSX, Chong CW, Ahmad Kamar A, Yap IKS, Choo YM, Lai NM, et al.

Sci Rep, 2021 01 14;11(1):1353.

PMID: 33446779 DOI: 10.1038/s41598-020-80278-1

Emerging evidence has shown a link between the perturbations and development of the gut microbiota in infants with their immediate and long-term health. To better understand the assembly of the gut microbiota in preterm infants, faecal samples were longitudinally collected from the preterm (n = 19) and term (n = 20) infants from birth until month 12. 16S rRNA gene sequencing (n = 141) and metabolomics profiling (n = 141) using nuclear magnetic resonance spectroscopy identified significant differences between groups in various time points. A panel of amino acid metabolites and central metabolism intermediates significantly correlated with the relative abundances of 8 species of bacteria were identified in the preterm group. In contrast, faecal metabolites of term infants had significantly higher levels of metabolites which are commonly found in milk such as fucose and β-hydroxybutyrate. We demonstrated that the early-life factors such as gestational age, birth weight and NICU exposures, exerted a sustained effect to the dynamics of gut microbial composition and metabolism of the neonates up to one year of age. Thus, our findings suggest that intervention at this early time could provide 'metabolic rescue' to preterm infants from aberrant initial gut microbial colonisation and succession.

Matched MeSH terms: Infant, Newborn

Multiple Small Bowel Atresia: Resection or Conservation?

Govindarajan KK, Annamalai M

J Coll Physicians Surg Pak, 2021 Jun;30(6):740-742.

PMID: 34102795 DOI: 10.29271/jcpsp.2021.06.740

Multiple small bowel atresia is a relatively uncommon cause of intestinal obstruction in neonates. About one-third of the neonatal intestinal obstruction is caused by intestinal atresia. As suggested by Louw and Barnard, the vascular accident in utero is the principal reason, resulting in bowel atresia.1 The condition presents soon after birth, with bilious vomiting and abdominal distension, requiring emergency surgical intervention. A subtype of small bowel atresia (type IV), which presents with involvement of multiple segments, is unique due to the difficulties in management, accompanied by a variety of postoperative morbidities, which are highlighted in this case. The choice lies between resection of all the atretic segments with resultant single anastomosis and conservation with anastomoses of multiple small bowel segments involving meticulous repair by fine sutures, taking care to maintain luminal patency. The dilemma of whether to conserve the atretic segments of bowel, which is a time consuming procedure but preserves the bowel length or to proceed with excision of the atretic bowel segments, accepting the likelihood of short bowel, in order to provide a quick, safe and stable single anastomosis in a timely manner, is a valid challenge. The background of limited resource setting also need to be taken into consideration. Key Words: Atresia, Neonates, Bowel segments, Anastomosis.

Matched MeSH terms: Infant, Newborn

A retrospective analysis of oral and maxillofacial biopsied specimens in Malaysian newborns and infants

Binti Shuhairi NN, Bt Abdul Jalil A, Lau SH, Bt Mohd Ghazali S, Kee CC

Int J Paediatr Dent, 2021 Jul;31(4):496-503.

PMID: 32815206 DOI: 10.1111/ipd.12719

BACKGROUND: Globally, research on oral and maxillofacial lesions among newborns and infants remains limited.

AIM: To describe demographic patterns, histopathological findings, and locations of oral and maxillofacial lesions in newborns (birth-1 month) and infants (>1 month-2 years) reported over 51 years.

DESIGN: A retrospective cross-sectional study on histopathological records of newborns and infants was conducted. Patients' demographic characteristics (age, gender, and race), histopathological diagnosis, and lesion's location were gathered. Pearson's chi-square or Fisher's exact test was performed to determine associations between demographic characteristics and different categories of lesions.

RESULTS: Out of 66,546 specimens received, 0.44% (290 specimens) were from patients aged 2 years and younger (27 newborns and 263 infants). The most common category was inflammatory/reactive (44.2%), followed by tumour/tumour-like (42.0%), cystic/pseudocystic (6.6%), and miscellaneous lesions (5.5%). Mucous extravasation cysts (23.4%) and Langerhans cell histiocytosis (7.2%) were the most common histopathological diagnoses. Tumour/tumour-like lesions were significant in newborns (P = .021), and majority were congenital epulis (40.7%). Inflammatory/reactive lesions were significantly higher in male (P = .025) and infants (P = newborns and infants are the key to early detection of lesions.

Matched MeSH terms: Infant, Newborn

Spontaneous neonatal scrotal haematoma: an early manifestation of severe haemophilia

Lee JS, Chieng CH, Martin M, Toh TH

BMJ Case Rep, 2021 Apr 28;14(4).

PMID: 33910804 DOI: 10.1136/bcr-2020-241482

We report a term newborn who presented on day 3 of life with unilateral, tender scrotal swelling with skin discolouration, which was subsequently diagnosed as haemophilia A at about 6 months of age. He received intramuscular vitamin K and hepatitis B vaccine at birth uneventfully. The scrotal swelling was treated as an infected hydrocoele, considering the absence of a family history of bleeding disorder and other risks of bleeding tendency, as well as the ultrasonographic features. He also had congenital pneumonia requiring venepuncture, non-invasive oxygen supplementation and intravenous antibiotics, without any complication. The swelling slowly improved over 2 months. He later developed post-trial vaccine injection haematoma at 4 months of age, and multiple non-traumatic bruises when he was 6 months old, leading to the diagnosis. This case demonstrates an uncommon, but a possible, early manifestation of haemophilia A at birth with a unilateral scrotal haematoma.

Matched MeSH terms: Infant, Newborn

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