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Objectives: There is a theoretical risk for neonatal hypothyroidism after prenatal exposure to iodinated contrast media. Current recommendations are in favour of neonatal thyroid function assessment. Our aim was to check if recommendations were observed, and if neonatal evaluation demonstrated anomalies., Methods: Over the period from 01/01/2010 to 01/08/2015, maternal and newborn records were retrospectively reviewed. All pregnant women who underwent a computed tomography and their newborns were included. We collected thyroid-stimulating hormone (TSH), thyroxine (T4) and tri-iodothyronine (T3) levels., Results: A total of 101 maternal and newborn records were reviewed. Mean gestational age at CT scan was 29.3±7.2 weeks. The mean dose of total iodine administered was 82.6±19.1mL. Only 21 newborns had a biological analysis (20.8%). All newborns had normal TSH and T4 levels at birth. Only 7 newborns had a T3 level above the upper threshold value, but according to expert opinion none have been considered pathological., Conclusion: Our study revealed that recommendations for neonatal thyroid function assessment after prenatal exposure to iodinated contrast media were not observed. This exposure seemed unlikely to have an important effect on thyroid function at birth., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Background: Diagnosis of early neonatal infection remains an emergency. Since clinical symptoms and biological markers are neither sensitive nor specific, many newborns suspected of infection undergo biological analysis and empirical antibiotic treatment while awaiting results. Recent studies underline the benefit of using procalcitonin (PCT) to differentiate inflammatory diseases and viral infections from bacterial infections. Joram shows that it is possible to go beyond the physiological peak of PCT in the first days of life by measuring PCT concentration in cord blood. The aim of this prospective study was to evaluate a new algorithm integrating the value of PCT in blood cord for taking care of newborns who have suspected infection., Patients and Method: The diagnostic value of the new algorithm was compared to the diagnostic value of the algorithm currently in use, by analyzing a 9-month prospective database of 1267 newborns suspected of infection. Infection status was established with the ANAES definition and clinical progression., Results: Each infected newborn (n=8) would have been treated without delay with the current algorithm (based on ANAES guidelines) and this new algorithm. The new algorithm had the same diagnostic value as the current algorithm (P=0.5) with 87.5% sensitivity (95%CI [52-98]) versus 100% (95%CI [87-100]) and 87.4% specificity (95%CI [85-90]) versus 83.8% (95%CI [81-86]). Fewer biological analyses 13.1% (95%CI [11-16]) versus 42.2% (95%CI [39-45]) were performed with the PCT cord-guided algorithm than with the current algorithm (P<0.05), leading to a 64.2% cost reduction. Antibiotics were significantly less used with the new algorithm: 13.1% (95%CI [11-16]) versus 16.7% (95%CI [14-19])., Conclusion: PCT in cord blood could become a new and efficient marker to help neonatologists take care of newborns suspected of infection. These results must be confirmed by a larger multicenter prospective study., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Unlabelled: Thyroid hormones are essential for foetus and newborn development. Preterm newborns present low levels for thyroid hormones. These low levels are related with disorder in psychomotor and neurological development. In the literature, several studies concerning newborns treated with thyroid hormone have been realized in different conditions; however, there is no consensus about preterm newborn supplementation benefit., Objective: The aim of the study was to defined hormonal values used for normal and preterm newborns., Material and Methods: We reported TSH, T3T and T4L levels for 195 normal or preterm newborns, eutrophic or small for gestational age (SGA)., Results: A positive correlation was found between hormonal level and gestational age. This work allowed us to define a threshold for preterm newborn according to their gestational age., Conclusion: Owing to lack of consensus, those values are useful for clinical and biological follow-up of thyroid function for newborns at risk (SGA and preterm before 32 weeks) during the first year of life. Finally, it would be interesting to study systematic supplementation of thyroid hormone for those infants in a prospective study.

A short prospective study was conducted to assess thyroid status in healthy full term newborns (n=90) of a large maternity of Marrakech (Morocco), as part of the validation of a national salt iodisation program. High TSH (>5mU/l) was detected in 89% of infants tested; urinary iodine excretion was measured in 35 of the mothers, and was found to be normal (100-200microg/l) or high (>200microg/l)(n=27) in all of them. Milk iodine concentration was measured in 315 lactating women from the same area. Low values (<41microg/l) were found in 60% of them. The common use of iodinated disinfectants during delivery could be responsible for the high urine iodine values of mothers; however iodine deficiency seems to remain a widespread problem in this population and justifies a large scale survey of iodine status.

Objective: To compare two techniques of lactate measurements in cord blood: either by electrochemical strip method with Lactate Pro of KDK in the umbilical artery alone (series 1) or by enzymatic method with Rapid lab Analyzer of Bayer in the two vessels (series 2) with acid base balance being also determined., Subjects and Methods: Series 1 included 353 neonates with a mean gestational age of 37 (+/- 3.6) weeks and series 2 included 410 newborns with a mean gestational age of 38 (+/- 3.1) weeks., Results: Data was presented as mean and SD. In the first series mean umbilical artery lactate concentration was 3.71 (+/- 1.81) mmol/l. In the second series mean umbilical artery blood gas and lactate levels were as follows: pH = 7.25 (+/- 0.9), pCO2 = 6.55 (+/- 1.39) kPa; BD = 6.61 (+/- 3.33) mmol/l, lactate 3.92 (+/- 1.81) mmol/l. The 3rd percentile of pH was 7.05 whereas the 97th percentile of lactate was 7.54 mmol/l. There was a close correlation between lactate and pH, and lactate and BD. Lactate concentration was higher in case of instrumental delivery compared to spontaneous one: 4.65 versus 3.76 mmol/l (p = 0.0001, Student test). No perfect correlation was found between lactate level and neonatal outcome but there was not a significant number of neonates with immediate complication., Conclusion: Lactate measurements obtained with single use strip method are valuable and easy to perform.

Purpose: This study compares plasma lidocaine concentrations in 16-sets of twin neonates to 16-singleton neonates all of whom were delivered by Cesarean section under lumbar epidural anesthesia (LEA)., Methods: Lidocaine 1.5% with epinephrine 5 microg x mL(-1) was used for activation of LEA. Upon delivery plasma lidocaine concentrations were measured from the maternal vein (MV), neonatal umbilical vein (UV) and umbilical artery (UA) using TDx fluorescence polarization immunoassay., Results: MV lidocaine concentrations were similar in both twin and singleton mothers. Both mean lidocaine UV and UA levels were 35% higher in twin A (first-delivered) compared to the singleton neonate, (P < 0.01, t test). Similarly, twin B mean UV and UA lidocaine levels were 35% and 53% higher than the singleton value (P < 0.01). Mean UV and UA lidocaine fetal/maternal ratios in both twins were at least 18% higher than the singleton value (P < 0.05)., Conclusion: Even though there were no differences in neonatal outcome, a potential does exist for high plasma lidocaine concentrations in twin fetuses, suggesting that the total maternal dose of lidocaine must be regulated carefully.

The prevalence of anaemia remains a major nutritional problem in industrialized countries. The aim of this study was to compare the prevalence of maternal anaemia in southeastern and northeastern areas of New Brunswick and to identify a potential interaction between maternal haematologic indices and the growth, hemoglobin (Hb) and hematocrit (Ht) of newborns. In this retrospective study, 952 obstetric and paediatric records, including 654 from the southeastern area (Greater Moncton) and the rest from the northeastern area (Acadian Peninsula) of New Brunswick, were investigated. The prevalence of maternal anaemia was 21.4% in the Greater Moncton area, compared to 11.5% in the Peninsula. The majority of anaemic women suffered from a light form of anaemia, mainly in the third trimester. Immediately after delivery, 52% of women from Greater Moncton and 40% from the Acadian Peninsula had Hb below normal. A positive correlation was observed between maternal Hb and newborn Hb and between maternal Ht and newborn Hb. Results indicate that maternal anaemia is prevalent in both areas under study and confirm the importance of implementing effective prevention measures.

Neonatal somatotropic function is characterized by a discrepancy between elevated growth hormone (GH) levels and low IGF I levels. This study aimed at explaining this discrepancy, particularly to examining if it could result from low GH bioactivity. Serum concentrations of bioactive GH (bio GH), GH measured by radioimmunoassay (riGH), GH binding protein (GHBP), IGF I and IGF binding proteins (IGFBP) were determined in 27 premature and term newborns during the first month of life. At day 4, riGH and bio GH concentrations were elevated in both premature and term newborns as compared with normal prepubertal children; GHBP and IGF I levels were low, with a positive correlation with gestational age (P < 0.001). There was a positive correlation between GHBP and IGF I levels. IGFBP-1 and IGFBP-2 levels were elevated and negatively correlated with gestational age (P < 0.005). IGFBP-3 levels were within the range of prepubertal children values and positively correlated with gestational age (P < 0.005). During the first month, riGH and bio GH levels decreased in all infants, while IGFI levels increased in premature infants only, and GHBP levels in term infants only. The elevated levels of bio GH during the first days of life appear to be related to the low levels of IGF I due to a reduced number or function of GH receptors. In premature infants the decrease in GH levels observed afterwards appears to be secondary to the increase in IGF I levels. In term infants, in the absence of increase in IGFI levels other(s) factor(s) seem(s) to be involved.

Recent development of microassays and determination of age-specific normal ranges have shed new light on the components and functioning of the neonatal fibrinolytic system. Plasminogen and tissue plasminogen activator levels are low in neonates, who generate plasmin more slowly and in smaller amounts than adults. Quantitative and qualitative changes occur as the fibrinolytic system matures. This is also true of the coagulation system responsible for the production of thrombin, which is the target for plasmin. These data are essential to assess the risk of thrombosis in neonates and, if appropriate, to guide management decisions including selection of a thrombolytic agent, of the optimal dosage, and of the best laboratory tests for monitoring purposes. Ongoing studies are investigating the mechanisms involved in neonatal lysis of thrombin clots occurring naturally or as the result of thrombolytic therapy.

In this study, the authors report the erythrocyte data of 129 in Abidjan. They are 0 to 29 days old and have a birthweight > or = 2.300 g. The rate of HB, HT and the red cell count increase to 10% during the 24 to 48 first hours of life and decrease there after. The cord blood erythrocyte values obtained at birth, in our study are similar to those of other developing countries and also to those of the developed countries. The apparent raising of the decrease of the erythrocyte values observed in our study, from the second week of life on, as compared to MATOH data, might be explained by a latent iron deficiency of the Abidjanese new-born babies.

The transfusion of erythrocytes to neonates and premature infants is common and should be minimized through a reduction in the number of blood samples taken for laboratory tests. The risks to patients have been minimized with current blood-banking techniques, although neonates and premature infants may require special consideration. The indications for transfusion of erythrocytes to neonates include the presence of shock, a loss of 10% or more of the blood volume within 72 hours when further blood sampling is expected, a hemoglobin level of less than 130 g/L in neonates with cardio-respiratory disease who require increased oxygen-carrying capacity, and a hemoglobin level of less than 80 to 100 g/L in neonates with tachypnea, tachycardia, recurrent apnea, poor feeding or failure to gain weight. The attending physician should consider these indications along with clinical judgement to ensure safe and effective erythrocyte transfusion.

Balb/c mice were immunized against papain-treated fetal erythrocytes and splenocytes were fused with Sp2/0-Ag-14 myeloma cells. Several hybrids secreting antibodies directed against antigenic determinants predominantly exposed on fetal and cord cells were selected and cloned twice. Antibodies NaM61-1A2 and NaM61-768 (IgM class) were shown to be specific for an endo-beta-galactosidase-sensitive oligosaccharide chain. The antigen, strongly expressed on fetal and cord cells, was identified as the i blood group antigen. The antibodies represent powerful blood group reagents to be use in conventional agglutination techniques as well as in the gel typing system and in indirect flow cytometry. The antibody NaM46-4A8 (IgG class) is specific for an antigenic structure expressed on fetal cells and accessible only after papain, ficin, bromelin and endo-beta galactosidase treatment. The antigen was not identified.

Thirty women at term presenting with fever greater than or equal to 38 degrees C during labour were given a synergic combination of tobramycin-amoxicillin. Gestational ages ranged from 37 6/7 to 41 2/7 weeks. A single dose of 3 mg/kg of tobramycin was given every day intravenously. Feto-maternal tobramycin concentrations (F/M ratios) were systematically determined at birth and allowed to make a small scale pharmacokinetic study. Two curves were plotted from the pharmacokinetic analysis of maternal and fetal measurements, showing an intravenous and an intramuscular profile respectively. A high positive linear correlation (R = 0.82) was found between the F/M ratios and the time (delta T, -hours-) measured from the last administration to the mother to the time of delivery. Elimination of the aminoglycoside was slowed down in newborns (t1/2 lambda z = 5.1 hours). In newborns tobramycin levels were always less than or equal to 6 mg/l and still greater than or equal to 1 mg/l 6 hours after the last maternal injections. Measurement of F/M ratios allowed to study and compare the fetal and maternal pharmacokinetics facilitating (when necessary) the initial posologic adjustment in newborns. Such small scale pharmacokinetics could be extended, for a given gestational age, to other drugs with narrow therapeutic ranges. However, the size and the homogeneity of the population seem to be most important.

A prospective study was carried out: 1) To compare the pharmacokinetics of propofol in two groups of patients: group 1 (eight pregnant women undergoing a prophylactic caesarean section at term), group 2 (control group: eight non pregnant women anaesthetized for short gynaecological procedures). 2) To study the kinetics of this agent in five newborns. Both groups were similar for weight, age, ASA I, oral premedication, anaesthetic method and duration. Dosages were performed using HPLC and results were statistically compared by Student's t-test. The haemodynamic parameters did not show large variations during induction. Propofol plasma levels were high (4,600 +/- 2,200 ng/ml-1) at intubation time; however, at extraction time (group 1) or 25 minutes after induction (group 2), plasma levels were close to anaesthetic threshold. The decreasing slopes were similar in the two groups. The quality of recovery in both groups was satisfactory. The first measured level in umbilical cord blood after birth was low, close to half of the maternal level, without any constant correlation. During the first hour of life, the drug catabolism is lesser in the newborn than in its mother, then plasmatic concentrations decrease similarly. Apgar scores were excellent in four of the five studied newborns; one child had a mean score notwithstanding a low propofol level (171 ng/ml-1), but recovery was perfect after a short oxygenation. There was no significant difference between pregnant women and control group with the propofol dose of 4 mg/kg-1 used for anaesthesia. Thus propofol appears to be convenient for prophylactic caesarean section without damage for the newborn.

Serum levels of 25-hydroxyvitamin D [25-(OH)D], calcium, phosphate and alkaline phosphatase activity were measured between December and July in 110 pregnant women during the last trimester of pregnancy, and in their infants on the fifth day of life. This study showed a fall, during spring, below 6 ng/ml, of the maternal 25-(OH)D concentration at the time of delivery, and a fall of the 25-(OH)D and calcium concentrations in newborns. The existence of a positive correlation between calcium and 25-(OH)D levels in the newborns suggests that the low calcium concentrations found in the infants born in spring is related to a vitamin D deficiency of the infant and therefore of the mother. The administration of a single low dose of vitamin D3 (100,000 I.U.) on the sixth or seventh month of pregnancy allowed to prevent the seasonal fall in serum calcium and 25-(OH)D concentrations. This dosage appears therefore to be sufficient to reduce the risk of vitamin D deficiency of the newborn and the occurrence of neonatal hypocalcemia.

Monitoring of serum aminoglycosides is useful in neonates to ensure therapeutic efficacy and avoid toxicity. The choice of a method must take in count several informations: sample size, versatility, sensitivity, specificity, precision, rapidity, equipment requirements and reagent cost. Many methods are now available: Microbiological assay, Radioimmunoassay (RIA) techniques, Radioenzymatic assay (REA), "High Pressure" liquid chromatography (HPLC), Fluorescent immunoassay, Enzyme-Multiplied Immunoassay (EMIT) and Fluorescent polarization Immunoassay (FPIA). Microbiological assay is inexpensive but has major disadvantages: lack of specificity, low precision, requires 24 to 48 hours, large sample size. EMIT and FPIA are rapid, sensitive, highly specific and particularly adapted to the pediatric use but reagent are expensive.

The authors have studied the evolution of serum transferrin concentration in relation with age (newborn child, infant, adult). The mean concentration of serum transferrin is the lowest for neonates (2.15 g/l). At 10 months, it increases to reach a value of about 3.10 g/l then reduces at 24 (3.0 g/l) and 48 months (2.8 g/l). By the 4 to 18 years subjects, serum transferrin is approaching that of 10 months children (3.15 g/l). At last it doesn't support any modification during all the adult life. The diversity of the obtained results dependent of the used technique and/or of the laboratory, justifies that each one defines his own reference values.

Gentamicin, as the other aminoglycosides, has a very narrow therapeutic index. The pharmaco-kinetics parameters in neonates depend on the renal maturation which is a function of post-conceptional age. Using an unit dose of 2 mg/kg and adapted time intervals, longer for premature babies and in the first week of life, the frequency of too high trough levels is decreased. A convenient method is proposed for determining when to reduce the time interval between injections. Audiotoxicity is both cochlear and vestibular and can be, only in part, detected by evoked potentials. Nephrotoxicity is initially, a tubular injury with an increase of enzymuria (NAG) and beta 2 microglobulinuria, followed by alterations of glomerular filtration. Blood concentrations monitoring is indicated in all gentamicin treated neonates.

Mancini's technique of simple radial immunodiffusion was used in a study of the alpha-fetoprotein (AFP) content of the amniotic fluid (327 samples), the cord blood (100 samples) and the blood of the newborn infant (28 samples) in the days following birth. The tests for AFP were positive in 26 samples of amniotic fluid: 19 of them were from pregnancies of less than 25 weeks (the levels of AFP varied between 1 and 4.7 mg/100 ml) and 7 were from pregnancies in which grave fetal distress was followed by death of the fetus in utero (levels of AFP varied between 1.3 and 22 mg/100 ml). Fetal distress was connected with Rhesus incompatibility in 3 cases, with a toxaemic syndrome in one case, and was unexplained in the other cases. Analysis of AFP levels in the cord blood of newborn infants of gestational ages between 33 and 42 weeks did not show a close relation with gestational age because of large, individual differences. There was a better correlation with the birthweight of the infant. The fall in the serum level of AFP was followed in 17 newborn infants during the post-natal period. The decrease in the level of AFP was about 50 percent by the 5th day and 90 percent by the 9th day after birth.