Paediatrics and Child Health - Journal Articles

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    Early cardiac and cerebral hemodynamics with umbilical cord milking compared with delayed cord clamping in infants born preterm
    (Elsevier Inc., 2020-07-22) Katheria, Anup C.; Szychowski, Jeff M.; Essers, Jochen; Mendler, Marc R.; Dempsey, Eugene M.; Schmölzer, Georg M.; Arnell, Kathy; Rich, Wade D.; Hassen, Kasim; Allman, Phillip; Varner, Michael; Cutter, Gary R.; Finer, Neil
    Objective: To evaluate changes in cerebral oxygenation, peripheral arterial oxygenation, respiratory status, and administered fraction of inspired oxygen during the first 10 minutes of life in premature infants receiving umbilical cord milking compared with delayed cord clamping (DCC). Study design: Premature infants born at 230/7 to 276/7 weeks of gestation were randomized to umbilical cord milking or DCC. A near infrared spectroscopy sensor, pulse oximeter, and electrocardiogram electrodes were placed. Pulse rate, cerebral tissue oxygenation, peripheral oxygen saturation, airway pressure, and fraction of inspired oxygen were collected for 10 minutes in the delivery room. Longitudinal models were used to compare effects of umbilical cord milking and DCC. Results: Fifty-six infants had cerebral oximetry and advanced monitoring at birth. There was an increased incidence of severe intraventricular hemorrhage in infants who received umbilical cord milking compared with DCC (P = .0211). Longitudinal models suggested that peripheral oxygen saturation was higher in the umbilical cord milking group in the first 4 minutes (P = .0221) and that mean airway pressures were lower in the umbilical cord milking group after the first 7 minutes (P = .0072). No statistical differences were observed for fraction of inspired oxygen, cerebral tissue oxygenation, or heart rates. Conclusions: The data suggest that the rapid transfer of blood during umbilical cord milking may facilitate lung expansion with improved pulmonary blood flow, but may also increase cerebral blood flow, resulting in severe intraventricular hemorrhage.
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    Maternal mid-gestation cytokine dysregulation in mothers of children with autism spectrum disorder
    (Springer, 2021-09-09) Casey, Sophie; Carter, Michael; Looney, Ann-Marie; Livingstone, Vicki; Moloney, Gerard M.; O'Keeffe, Gerard W. ; Taylor, Rennae S.; Kenny, Louise C.; McCarthy, Fergus P.; McCowan, Lesley M. E.; Thompson, John M. D.; Murray, Deirdre M.; SCOPE Consortium; Irish Research Council; National Children's Research Centre, Ireland; Health Research Board; Science Foundation Ireland; Health Research Board of Ireland; New Enterprise Research Fund, New Zealand; Foundation for Research, Science and Technology; Health Research Council of New Zealand; Evelyn Bond Fund, New Zealand; Auckland District Health Board Charitable Trust, New Zealand
    Autism spectrum disorder (ASD) is a developmental disorder characterised by deficits in social interactions and communication, with stereotypical and repetitive behaviours. Recent evidence suggests that maternal immune dysregulation may predispose offspring to ASD. Independent samples t-tests revealed downregulation of IL-17A concentrations in cases, when compared to controls, at both 15 weeks (p = 0.02), and 20 weeks (p = 0.02), which persisted at 20 weeks following adjustment for confounding variables. This adds to the growing body of evidence that maternal immune regulation may play a role in foetal neurodevelopment.
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    Early life exposure of infants to benzylpenicillin and gentamicin is associated with a persistent amplification of the gut resistome
    (BioMed Central Ltd, 2024) Patangia, Dhrati; Grimaud, Ghjuvan; O’Shea, Carol-Anne; Ryan, C. A.; Dempsey, Eugene M.; Stanton, Catherine; Ross, R. Paul; Seventh Framework Programme; Science Foundation Ireland; Department of Agriculture, Food and the Marine, Ireland
    Background Infant gut microbiota is highly malleable, but the long-term longitudinal impact of antibiotic exposure in early life, together with the mode of delivery on infant gut microbiota and resistome, is not extensively studied. Methods Two hundred and eight samples from 45 infants collected from birth until 2 years of age over five time points (week 1, 4, 8, 24, year 2) were analysed. Based on shotgun metagenomics, the gut microbial composition and resistome profile were compared in the early life of infants divided into three groups: vaginal delivery/no-antibiotic in the first 4 days of life, C-section/no-antibiotic in the first 4 days of life, and C-section/antibiotic exposed in first 4 days of life. Gentamycin and benzylpenicillin were the most commonly administered antibiotics during this cohort’s first week of life. Results Newborn gut microbial composition differed in all three groups, with higher diversity and stable composition seen at 2 years of age, compared to week 1. An increase in microbial diversity from week 1 to week 4 only in the C-section/antibiotic-exposed group reflects the effect of antibiotic use in the first 4 days of life, with a gradual increase thereafter. Overall, a relative abundance of Actinobacteria and Bacteroides was significantly higher in vaginal delivery/no-antibiotic while Proteobacteria was higher in C-section/antibiotic-exposed infants. Strains from species belonging to Bifidobacterium and Bacteroidetes were generally persistent colonisers, with Bifidobacterium breve and Bifidobacterium bifidum species being the major persistent colonisers in all three groups. Bacteroides persistence was dominant in the vaginal delivery/no-antibiotic group, with species Bacteroides ovatus and Phocaeicola vulgatus found to be persistent colonisers in the no-antibiotic groups. Most strains carrying antibiotic-resistance genes belonged to phyla Proteobacteria and Firmicutes, with the C-section/antibiotic-exposed group presenting a higher frequency of antibiotic-resistance genes (ARGs). Conclusion These data show that antibiotic exposure has an immediate and persistent effect on the gut microbiome in early life. As such, the two antibiotics used in the study selected for strains (mainly Proteobacteria) which were multiple drug-resistant (MDR), presumably a reflection of their evolutionary lineage of historical exposures—leading to what can be an extensive and diverse resistome.
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    The use of cardiotonic drugs in neonates
    (W.B. Saunders, 2019) Dempsey, Eugene; Rabe, Heike; Seventh Framework Programme; Science Foundation Ireland
    There is a distinct lack of age-appropriate cardiotonic drugs, and adult derived formulations continue to be administered, without evidence-based knowledge on their dosing, safety, efficacy, and long-term effects. Dopamine remains the most commonly studied and prescribed cardiotonic drug in the neonatal intensive care unit (NICU), but evidence of its effect on endorgan perfusion still remains. Unlike adult and pediatric critical care, there are significant gaps in our knowledge on the use of various cardiotonic drugs in various forms of circulatory failure in the NICU. © 2019 Elsevier Inc.
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    Growth hormone treatment for non-GHD disorders: Excitement tempered by biology
    (Oxford University Press, 2023-07-14) Grimberg, Adda; Hawkes, Colin P.; National Institutes of Health
    The success of growth hormone (GH) replacement in children with classical GH deficiency has led to excitement that other causes of short stature may benefit similarly. However, clinical experience has shown less consistent and generally less dramatic effects on adult height, perhaps not surprising in light of increased understanding of GH and growth plate biology. Nonetheless, clinical demand for GH treatment continues to grow. Upon the 20th anniversary of the US Food and Drug Administration's approval of GH treatment for idiopathic short stature, this review will consider the factors underlying the expansion of GH treatment, the biological mechanisms of GH action, the non-GH–deficient uses of GH as a height-promoting agent, biological constraints to GH action, and future directions.