Neonatal Iron: Factors Influencing its Level and Associated Complications - a Review Article.

BACKGROUND: Iron is an essential micronutrient which plays a significant role, particularly vital for early brain growth and function. Maternal iron condition influences the iron status of neonates since iron transferred from the mother is the only source for fetal iron. A depletion in iron as a result of rapid growth leads to iron deficiency which is common in neonates. Although there are inconsistencies with regard to the normal reference ranges for neonatal iron level, the current review summarized literature to provide compressive information about neonatal iron status and factors that influence its level. METHODS: This is a narrative review on the basis of relevant literatures mainly on neonatal iron from peer-reviewed journals. Electronic databases such as PubMed, PMC, Scopus, Science Direct, Google scholar, Google, and Yahoo were used to retrieve relevant literatures using key terms like "newborn iron, neonatal iron, iron overload, maternal factors, complication, iron level and neonates" separately and in combination. RESULTS: Several factors had been postulated as factors associated with neonatal iron status. The current review figured out that maternal obesity, gestational diabetes mellitus, preterm delivery, placental transferrin receptor, inappropriate iron supplementation, use of iron fortified formula, uses of recombinant erythropoietin therapy, smoking, maternal iron deficiency anemia, umbilical cord clamping, and transfusion are the major factors which can influence neonatal iron level. These factors may have either positive or negative effects on neonatal iron level. Both iron deficiency and iron overload at some stage in the fetal development or at early stage of neonatal development cause abnormal functions of multiple organ system of neonates and subsequently contributed to neonatal and childhood morbidity and mortality. CONCLUSIONS: By one and other means insufficient, late and extra maternal iron supplementation, early and delayed umbilical cord clamping have negative effects on the iron level of neonates. Therefore, careful prenatal and antenatal follow-up need to be strengthened with due emphasis for maternal iron assessment.

The impact of lactation and gestational age on the composition of branched-chain fatty acids in human breast milk.

Breast milk consumption reduces the incidence of necrotizing enterocolitis (NEC) in preterm infants compared to formula. Branched-chain fatty acids (BCFAs) are present in breast milk but not in most formulas intended for preterm infants. We aimed to determine the composition of BCFAs in the breast milk of mothers with preterm infants, and to understand the impact of gestational age at birth and stage of lactation on BCFA content. The main BCFAs in preterm breast milk were iso-14:0, iso-15:0, anteiso-15:0, iso-16:0, iso-17:0, and anteiso-17:0. Breast milk BCFAs as a percent of total fatty acids (g per 100 g, %) were significantly different across lactation stages, with the highest concentration in colostrum, followed by transitional and mature breast milk (median: 0.41, 0.31, and 0.28%, respectively, p < 0.05). Lower BCFAs in preterm breast milk compared to term breast milk may have been related to maternal intake, or the ability of the mammary gland to extract BCFA from plasma, or differences in mammary gland BCFA synthesis. BCFAs were mainly in the sn-2 position (52-65%), similar to palmitic acid. Overall, preterm and term breast milk BCFAs were similar and showed specific concentration patterns, resembling 16:0 with respect to sn-2 positional distribution. BCFAs were reduced with lactation stage, similar to highly unsaturated fatty acids.

Uso da sacarose para o alívio da dor: repercussão na amamentação materna durante a internação do recém-nascido a termo / Use of sucrose for pain relief: consequences on breastfeeding of fullterm newborns during hospitalization

Introdução: Durante o período de internação, o recém-nascido (RN) é submetido a uma série de procedimentos dolorosos ou não, que podem incidir sobre o seu comportamento e sobre a confiança da mãe para o cuidado e para a amamentação materna. Temos como questionamento, se sacarose 25% que é oferecida como medida de alivio da dor em RN a termo internado em alojamento conjunto interfere negativamente na amamentação materna exclusiva durante a internação. Objetivo: Verificar a associação entre uso da sacarose 25% que é oferecida como medida de alívio dor aguda em RN a termo, e a amamentação materna durante a internação em alojamento conjunto. Métodos: Trata-se de um estudo observacional, transversal, descritivo e analítico. A amostra foi constituída por 215 binômios cujo nascimento e internação ocorreram entre os meses de Junho a Setembro de 2017 em uma maternidade do interior paulista intitulada "Amiga da Criança". Os binômios foram incluídos no estudo somente após autorização da mãe, com assinatura de um termo de consentimento livre e esclarecido. Os dados foram coletados por meio do prontuário e planilhas especificas. Os RN foram divididos em dois grupos: RN expostos e não expostos ao uso da sacarose durante a internação. Como houve diferença estatística entre os grupos para o tempo de internação, para analisar a influência do uso da sacarose na amamentação durante toda internação, foi feita uma relativização das variáveis de aleitamento materno pelo total de dias de internação do RN. As associações foram verificadas pelo teste "U" de Mann-Whitney, com valor de p significativo para ? <= 0,05. Resultado: Dos 215 RN estudados durante toda internação, 111 (51,6%) RN foram expostos ao uso da sacarose. Foi utilizado sacarose para 188 (60,1%) dos procedimentos dolorosos, sendo que a mesma foi usada associada a outros métodos como o colo em 18 (5,7%) e sucção não nutritiva 64 (20,4%) dos procedimentos. Somando-se o uso isolado ou em associação a outras medidas, a sacarose foi utilizada 270 (86,2%) vezes sendo a medida mais aplicada na prática clínica da maternidade. No grupo que utilizou sacarose as médias de frequência de mamadas, uso de copo, translactação, tempo médio por mamada e amamentação assistida foram respectivamente: 7,9, 0,2, 0,5, 11,4 e 1,0 . No grupo que não utilizou a sacarose, respectivamente, as a médias das mesmas variáveis foram de 8,7, 0,03, 0,06, 18,6 e 0,8. Houve diferença estatisticamente significativa entre os grupos para as variáveis de alimentação: frequência de mamada (p=0,03), utilização de copo (p=0,01), realização de translactação (p=0,00), tempo médio por mamada (p=0,00) e amamentação assistida (p=0,02). Conclusão: As associações dos dados encontrados comprovaram a hipótese do presente estudo, ou seja o uso da sacarose a 25% para alívio da dor aguda influenciou negativamente na amamentação materna do RN durante a internação, pois, o grupo de RN que recebeu esta substância adocicada durante os procedimentos de punção arterial, venosa e capilar, apresentou menor frequência de mamada, menor tempo médio por mamada, maior uso de complemento lácteo, mais necessidade de translactação e necessitou de mais amamentação assistida por um profissional de enfermagem, quando comparado ao grupo de RN não expostos a ela. Faz-se necessária a inclusão de medidas não farmacológicas com a participação da mãe em substituição à sacarose, uma vez que tratou-se de pesquisa em uma Maternidade Amiga da Criança

Introduction: During the period of hospitalization, full-term newborns (NB) undergo a series of painful procedures, which may affect his behavior and the mother's confidence in both taking care of and breastfeeding the baby. We question whether 25% sucrose, which is offered as a measure of pain relief in hospitalized NB infants, negatively interferes with exclusive mother's breastfeeding during hospitalization in rooming-in care. Aim: Verify the association between the use of 25% sucrose offered as pain relief in full-term newborns and exclusive mother's breastfeeding during hospitalization in shared rooms. Methods: This is a study based on observation, and it is transversal, descriptive and analytical study. The sample consisted of 215 binomials whose birth and hospitalization occurred between June and September of 2017 in a maternity hospital in the countryside of São Paulo, in a Child-Friendly Maternity. The binomials were included in the study only after authorization obtained from the mother, with the signing of a free and previously informed consent form. The data were collected through medical records and specific worksheets. The NB were divided into two groups: NB exposed and not exposed to the use of sucrose during hospitalization, respectively. There was a statistical difference between the groups due to the hospitalization period; thus, to analyze the influence of sucrose use on breastfeeding during all hospitalization, a relative analysis of the variables of breastfeeding by the total number of days of hospitalization of the newborn was made. Associations were verified by the Mann-Whitney "U" test, with a significant p value for ? <= 0.05. Results: From 215 NBs studied during all hospitalization, 111 (51.6%) were exposed to the use of sucrose. Sucrose was applied for 188 (60.1%) of the painful procedures, and it was used in association with other methods such as lap in 18 (5.7%) and non-nutritive suction in 64 (20.4%) of the procedures. Added the isolate use or in association with other measures, sucrose was used 270 (86.2%) times, being the most applied measure in clinical practice of maternity. In the sucrose group, the average of frequency of feeding, cupping, translactation, average time per feeding and assisted breastfeeding were respectively: 7.9, 0.2, 0.5, 11.4 and 1.0. In the nonsucrose group, the average of the same variables were 8.7, 0.03, 0.06, 18.6 and 0.8, respectively. There was a statistically significant difference between the groups for feeding variables: feeding frequency (p = 0.03), cup use (p = 0.01), translactation (p = 0.00), average time per feed (p = 0.00) and assisted breastfeeding (p = 0.02). Conclusion: The associations of the data confirmed the hypothesis of the present study, that is, the use of sucrose at 25% for acute pain relief influenced negatively the maternal breastfeeding of newborns during hospitalization, since the group of newborns who received this sugary substance during the venous and capillary puncture procedures, presented lower breastfeeding frequency, lower average time for breastfeeding, greater use of milky complement, higher need for translactation and required more breastfeeding assisted by a nursing professional, when compared to the NB group who was not exposed to it. It is necessary to include non-pharmacological measures with the participation of the mother instead of sucrose, since it was a research in a Child-Friendly Maternity

Calcium, phosphorus, and bone metabolism in the fetus and newborn.

The placenta actively transports minerals whereas the intestines and kidneys may be nonessential for fetal mineral homeostasis. Mineral concentrations are higher in fetal blood than in adults in order for the developing skeleton to accrete adequate mineral content. Fetal bone development and serum mineral regulation are dependent upon parathyroid hormone (PTH) and PTH-related protein (PTHrP), but not calcitriol, fibroblast growth factor-23, calcitonin, or the sex steroids. After birth, a switch from fetal to neonatal regulatory mechanisms is triggered by loss of the placental calcium infusion, onset of a breathing, and a postnatal fall in serum calcium and rise in phosphorus. This is followed by an increase in PTH, then a rise in calcitriol, and developmental changes in kidneys and intestines. Serum calcium increases and phosphorus declines over days. The intestines become the main source of mineral, while kidneys reabsorb mineral, and bone turnover contributes additional mineral to the circulation.

Determinants of maternal pregnancy one-carbon metabolism and newborn human DNA methylation profiles.

Maternal one-carbon (1-C) metabolism provides methylgroups for fetal development and programing by DNA methylation as one of the underlying epigenetic mechanisms. We aimed to investigate maternal 1-C biomarkers, folic acid supplement use, and MTHFR C677T genotype as determinants of 1-C metabolism in early pregnancy in association with newborn DNA methylation levels of fetal growth and neurodevelopment candidate genes. The participants were 463 mother-child pairs of Dutch national origin from a large population-based birth cohort in Rotterdam, The Netherlands. In early pregnancy (median 13.0 weeks, 90% range 10.4-17.1), we assessed the maternal folate and homocysteine blood concentrations, folic acid supplement use, and the MTHFR C677T genotype in mothers and newborns. In newborns, DNA methylation was measured in umbilical cord blood white blood cells at 11 regions of the seven genes: NR3C1, DRD4, 5-HTT, IGF2DMR, H19, KCNQ1OT1, and MTHFR. The associations between the 1-C determinants and DNA methylation were examined using linear mixed models. An association was observed between maternal folate deficiency and lower newborn DNA methylation, which attenuated after adjustment for potential confounders. The maternal MTHFR TT genotype was significantly associated with lower DNA methylation. However, maternal homocysteine and folate concentrations, folic acid supplement use, and the MTHFR genotype in the newborn were not associated with newborn DNA methylation. The maternal MTHFR C677T genotype, as a determinant of folate status and 1-C metabolism, is associated with variations in the epigenome of a selection of genes in newborns. Research on the implications of these variations in methylation on gene expression and health is recommended.

Vitamin D in the maternal-fetal-neonatal interface: clinical implications and requirements for supplementation.

Identification of the current evidence regarding the pathophysiological and clinical facets of vitamin D in the maternal-fetal-neonatal interface is of value because of the significance of the vitamin D endocrine system in human health and high prevalence of vitamin D deficiency in mothers and their infants. Although many questions have still not been answered by the existing literature, we found evidence that: (i) during pregnancy vitamin D participates in fetal skeletal mineralization and growth, (ii) neonatal vitamin D levels are dependent on the maternal vitamin D status at delivery, (iii) a vitamin D sufficient status at birth may decrease the risk for the development of asthma and type 1 diabetes mellitus in later life, (iv) recommendations for maintaining serum 25-hydroxyvitamin D [25(OH)D] levels ≥32 ng/mL to avoid secondary hyperparathyroidism in adults have not been applied to mothers and their infants, (v) American Academy of Pediatrics recommended supplementation of 400 IU of vitamin D per day is sufficient only for infants who are born with normal vitamin D levels and (vii) supplementation of lactating mothers with high doses of vitamin D (4000 IU/d) allows the achievement of optimal 25(OH)D concentrations (>32 ng/mL) in the maternal and infant serum without any risk of hypervitaminosis D in the mother. We believe that inconsistency in the recognition of sufficient levels of vitamin D in mothers and their infants affects the identification of adequate doses for vitamin D supplementation during pregnancy, lactation and infancy.

Evaluation of iodine, iron, and selenium in biological samples of thyroid mother and their newly born babies.

BACKGROUND: There is accumulating facts that the metabolism of essential trace elements is altered in thyroid patients. AIM: The aim of present study was to compare the status of essential trace elements, iodine, iron (Fe), and selenium (Se) in biological samples (serum and urine) of goitrous mothers (age ranged 30-40) and their newly born infants (n=76). An age matched 68 non-goitrous mothers and their infants, residing in the same locality, were selected as referents. For a comparative study, the biological samples of non-goitrous and goitrous pregnant and non pregnant female subjects of the same age group and socio-economic status were also analyzed. METHODS: The Fe and Se concentrations in biological samples were determined by a flame and hydride generation atomic absorption spectrometry respectively, while iodine was measured by iodide-ion selective electrode, prior to microwave assisted acid digestion. The validity and accuracy of the methodology was checked by certified reference materials. RESULTS: The mean values of iodine, Fe and Se in serum and urine samples of thyroid mothers and their infants were significantly lower as compared to the referent mothers-infants pairs (p<0.01). CONCLUSIONS: The deficiencies of essential trace elements may adversely affect the health of women and their neonates.

Inositol and mannose utilization rates in term and late-preterm infants exceed nutritional intakes.

Nonglucose carbohydrates such as mannose and inositol are important in early growth and development, although little is known about their metabolism. Our aim in this study was to determine the plasma appearance rates (Ra) for mannose and inositol in newborns as an index of utilization and as an improved guide to supplementation practices. We studied late-preterm (n = 9) and term (n = 5) infants (median 34 wk gestation, range 33-41 wk) using a multiple isotope infusion start time protocol to determine Ra for each carbohydrate. The plasma mannose concentration [median (range)] was 69.83 (48.60-111.75) micromol/L and the Ra was 0.59 (0.42-0.98) micromol x kg(-1) x min(-1) (854 micromol x kg(-1) x d(-1)). The plasma inositol concentration was 175.74 (59.71-300.60) micromol/L and Ra was 1.06 (0.33-1.75) micromol x kg(-1).min(-1) (1521 micromol x kg(-1) x d(-1)). The Ra for mannose and inositol are >10-fold higher than the amounts a breast-fed infant typically ingests, which are approximately 6 micromol x kg(-1) x d(-1) mannose and 150 micromol x kg(-1) x d(-1) inositol. Thus, for both mannose and inositol, the newborn infant must produce these compounds from glucose at rates sufficient to meet nutritional requirements.

The relationship between breast milk leptin and neonatal weight gain.

AIM: To investigate whether change in leptin content of breast milk during lactation acts on neonatal body weight gain. METHODS: In total 15 lactating women and their 15 term infants were involved in the study. Breast milk and neonatal serum samples were obtained from the same women and their neonates on the 1st day and any day between the 21st and 30th days after birth. Breast milk and serum leptin concentrations were determined by radioimmunoassay. Anthropometric indexes of the infants were recorded. RESULTS: The study was completed with 15 multiparious mothers aged 19-37 years and their infants. The mean collection time of the first samples after birth was 6.07 +/- 1.94 h. The leptin level in the mature milk was significantly higher than in the colostrum (p < 0.001). Neonatal weight and height were significantly increased on 21-30 lactation days compared to 1st day of lactation (p < 0.05 and p < 0.001, respectively). The leptin concentration in the mature milk was negatively correlated with delta BMI (r =-0.53; p < 0.05). The delta breast milk leptin concentration was also found to be inversely correlated with delta BMI (r =-0.529; p < 0.05). CONCLUSION: The results of this study have suggested that change in the leptin content of breast milk during lactation might play a role in the regulation of weight gain in healthy neonates.

Induction of early meconium evacuation promotes feeding tolerance in very low birth weight infants.

BACKGROUND: A delay in reaching full enteral feeding is linked to poorer outcome in preterm neonates. Meconium retention has been viewed as a cause of bowel dysfunction in very low birth weight infants (VLBWI). Thus, adequate evacuation of meconium could help to promote feeding tolerance. OBJECTIVES: Our goal was to determine the effect of the induction of early meconium evacuation on feeding tolerance in VLBWI. METHODS: An observational study involving two subsequent periods was performed in inborn infants with birth weights of <1,500 g, before (control) and after (study) the induction of early meconium evacuation by routine glycerin enema. The total duration of these periods was from January 2003 to December 2005. To evaluate feeding tolerance, we measured time to achieve full enteral feeding. Complications such as sepsis and necrotizing enterocolitis were compared. RESULTS: The study group achieved full enteral feeding significantly faster than the control group (hazard ratio (HR) = 2.9; 95% confidence interval (CI) = 1.8-4.8), and this effect was more definite in infants with a birth weight of <1,000 g (HR = 4.6; 95% CI = 1.9-11.1). The study group passed first meconium faster than the control group (median = 1.4 vs. 3.7 days; p < 0.001). Sepsis, especially as determined by positive culture in central venouscatheter, was significantly reduced in the study group (7.7 vs. 27.8%; p = 0.02). CONCLUSIONS: The induction of early meconium evacuation had a significantly positive effect on feeding tolerance and sepsis prevention in VLBWI.

Body-composition assessment in infancy: air-displacement plethysmography compared with a reference 4-compartment model.

BACKGROUND: A better understanding of the associations of early infant nutrition and growth with adult health requires accurate assessment of body composition in infancy. OBJECTIVE: This study evaluated the performance of an infant-sized air-displacement plethysmograph (PEA POD Infant Body Composition System) for the measurement of body composition in infants. DESIGN: Healthy infants (n = 49; age: 1.7-23.0 wk; weight: 2.7-7.1 kg) were examined with the PEA POD system. Reference values for percentage body fat (%BF) were obtained from a 4-compartment (4-C) body-composition model, which was based on measurements of total body water, bone mineral content, and total body potassium. RESULTS: Mean (+/- SD) reproducibility of %BF values obtained with the PEA POD system was 0.4 +/- 1.3%. Mean %BF obtained with the PEA POD system (16.9 +/- 6.5%) did not differ significantly from that obtained with the 4-C model (16.3 +/- 7.2%), and the regression between %BF for the 4-C model and that for the PEA POD system (R2 = 0.73, SEE = 3.7%BF) did not deviate significantly from the line of identity (y = x). CONCLUSIONS: The PEA POD system provided a reliable, accurate, and immediate assessment of %BF in infants. Because of its ease of use, good precision, minimum safety concerns, and bedside accessibility, the PEA POD system is highly suitable for monitoring changes in body composition during infant growth in both the research and clinical settings.

Splanchnic metabolism of ingested amino acids in neonates.

PURPOSE OF REVIEW: Neonates typically show rapid growth. Nutrient absorption in the neonatal period is higher than during any other time in life so as to meet the requirements for this rapid growth. Generally, nutrients are administered enterally, and in the past the gut was considered to absorb and digest these nutrients without major metabolism. Recent animal and human work has, however, revealed that the intestine and other splanchnic tissues contribute significantly to whole-body metabolism, and have their own specific functions. This review focuses on these observations. RECENT FINDINGS: The splanchnic tissues take up greatly different proportions of each of the amino acids, ranging from 80-100% for threonine and several nonessential amino acids to 15-30% for lysine. The metabolic fates of the utilized substrates differ as well. Some are predominantly used for constitutive protein synthesis, others for energy generation or for formation of (glyco-)proteins that are secreted into the lumen. Glucose appears to be the major contributor to energy generation, but amino acids are important as well. SUMMARY: Both animal and human studies have shown that the intestine uses substantial amounts of dietary amino acids. This has several implications for the nutritional needs of infants to maintain growth, especially during times of inadequate enteral nutrition.

Intestinal amino acid metabolism in neonates.

The portal-drained viscera (stomach, intestine, pancreas and spleen) have a much higher rate of both energy expenditure and protein synthesis than can be estimated on the basis of their weight. A high utilization rate of dietary nutrients by the portal-drained viscera might result in a low systemic availability which determines whole-body growth. From studies in our multiple catheterized piglet model, we conclude that more than half of the dietary protein intake is utilized within the portal-drained viscera and that amino acids are a major fuel source for the visceral organs. Specific stable isotope studies reveal that there are large differences in the utilization rate amongst the different amino acids. The majority of the results obtained from the piglet studies can be extrapolated to the human (preterm) infant. First-pass, splanchnic uptake of lysine and threonine differ substantially, while non-essential amino acids are oxidized to a great extend in the human gut. Overall, these studies indicate that gut amino acid metabolism has a great impact on systemic availability and hence growth in the neonate.

Calcium nutrition and metabolism during infancy.

Calcium is a vital mineral for the developing newborn infant. This review discusses perinatal and neonatal calcium metabolism, with an emphasis on enteral calcium absorption and the nutritional factors affecting calcium bioavailability including the three major endocrine hormones involved in calcium metabolism: parathyroid hormone, vitamin D, and calcitonin. The placenta transports calcium to the fetus throughout pregnancy, with the largest amount of fetal calcium accumulation occurring in the third trimester. At birth, the newborn transitions to intestinal absorption to meet the body's calcium needs. Most calcium is absorbed by paracellular passive diffusion in the small intestine. Calcium intestinal absorption is affected by the type and amount of calcium ingested. It is also affected by the amount of intestinal calcium that is bound to dietary fats and proteins. One major consequence of decreased calcium absorption is metabolic bone disease in which there is a failure of complete mineralization of the bone osteoid.

[Evaluation of relationship between early brain response and neurodevelopment in newborns by using near infrared spectroscopy].

OBJECTIVE: To study the relationship between early brain response to extrinsic stimulation and neurodevelopment in preterm infants, assess the brain function of preterm infants in the early stage, and thereby to provide objective evidence for the degree of neurodevelopment in preterm infants and to evaluate prognosis. METHODS: Using near infrared spectroscopy (NIRS), the brain response to sound stimulation of 90 preterm infants at different gestational age was observed and compared with the result obtained from 20 full term infants. The neonatal behavioral neurological assessment (NBNA) was performed at corrected age of 40 weeks, and the infants were followed up for 2 years. The effect of gestational age and brain damage on preterm infants, the relation between early brain response in preterm infants and their neurodevelopment was evaluated. RESULTS: All the preterm infants responded to different degrees to auditory stimulation after birth. The time to beginning to react and the time to appearance of the peak reaction were attained after auditory stimulation and the time to beginning to resume when the auditory stimulation was stopped was (278 +/- 94) s, (446 +/- 67) s and (199 +/- 52) s, respectively, which were significantly longer than those observed in the full term infants (107 +/- 30) s, (264 +/- 51) s and (131 +/- 46) s, respectively. The maximum reactions of hemoglobin, oxyhemoglobin and regional oxygen saturation in the infants after gestational age 32 weeks was (0.3 +/- 0.3)%, (0.7 +/- 0.5)% and (0.3 +/- 0.3)%, respectively, which were significantly lower than those in the full term infants (1.7 +/- 0.7)%, (1.7 +/- 0.8)% and (1.6 +/- 0.7)%, respectively. When the brain response of preterm infants was compared with that in infants without brain damage, the speed of the reaction was slow, the maximum reaction was low. The brain response in preterm infant was correlated with NBNA at corrected age of 40 weeks. It was found during the following-up that abnormal neurodevelopment was associated with poor brain reaction. CONCLUSIONS: NIRS can be used to evaluate brain response of infants. Preterm infants display brain response to auditory stimulation. Early brain response is correlated with neurodevelopment.

Infusion of di-2-ethylhexylphthalate for neonates: a review of potential health risk.

Plasticizers leach from polyvinyl chloride medical devices into infusion fluids. One plasticizer frequently found is di-2-ethylhexylphthalate. The Food and Drug Administration estimates that di-2-ethylhexylphthalate exposure exceeding a daily tolerable intake of 0.6 mg/kg per day may harm newborns, especially males. Exposure 20 times the tolerable intake or more may be given daily to certain infants, neonates, and premature infants in the neonatal intensive care unit. Currently, scant data exist on the exact dosage to this population. Furthermore, the exact potential for harm, either subtle or overt, is unknown or disputed. Thus, the recording of exposure history and "dose" in the medical record is warranted.

Tratramento neonatal com inibidor seletivo da recaptação de noradrenalina altera o consumo alimentar e a ingestão hídrica na vida adulta em ratos / Neonatal treatment with selective noradrenaline reuptake inhibitor alter the food and water intake in adult life in rats

RESUMO: Durante o período crítico de desenvolvimento do sistema nervoso, o organismo é vulnerável a agressões de diversas naturezas, que podem acarretar transtornos morfofuncionais na vida adulta. A construção do comportamento alimentar é vulnerável a estas agressões, sendo importante para a sobrevivência da espécie e, portanto, alvo de estudos. O objetivo deste trabalho foi estudar o efeito da manipulação farmacológica do sistema noradrenérgico, através da inibição da recaptação de noradrenalina, durante o período neonatal e as repercussões dessa agressão sobre o consumo alimentar, na vida adulta. Os animais foram tratados diariamente, durante os 21ºdias de vida com reboxetina (20mg/Kg de peso), um inibidor seletivo da recaptação de noradrenalina (NARI) ou solução salina (NaCI 0,9por cento). Aos 60 dias foi avaliado o consumo alimentar e a ingestão hídrica. Os animais tratados com salina. Concluímos que a agressão farmacológica do sistema noradrenérgico durante o perídoso neonatal, pode alterar de forma duradoura o consumo alimentar e a ingestão hídrica. Essas alterações sugerem que o tratamento pode alterar morfofucionalmente estruturas relacionadas a regulação do comportamento alimentar e da ingestão hídrica, levando a alterações comportamentais na vida adulta

[Neonatal vitamin D status and calcium-phosphorus homeostasis in the third week of life]. / Zasoby ustrojowe witaminy D a homeostaza wapniowo-fosforowa u noworodków donoszonych w 3 tygodniu zycia.

AIM: Assessment of vitamin D status and calcium -phosphorus homeostasis in term newborns before routine supplementation. MATERIAL AND METHOD: Calcidiol (25OHD), calcium, phosphorus and alkaline phosphatase in serum and Ca (urine)/creatinine (urine) ratio (mg/mg), P (urine)/creatinine (urine) ratio (mg/mg) and tubular phosphate reabsorption rate (TRP= [1-(P(urine) / P(serum). creatinine serum/urine)].100%) in 3rd week of life in 56 appropriate for gestational age term neonates was measured. First group contains 35 newborns (62.5%) with normal 25OHD values and second group 21 newborns (37.5%) with hypovitaminosis D (25OHD < 11 ng/ml). RESULT: Mean 25OHD concentration was 15.23 ng/ml + 8.57 ng/ml. Maternal vitamin D supplementation (10 ug/day) for more than 4 months of pregnancy was similar in both groups (55.9% vs. 52.4%) (p>0.05). There were 51.43% breastfed newborns in group one and 85.71% in group two (p=0.009). Median 25OHD concentration in breastfed newborns was 11.2 ng/ml and 18.5 ng/ml in formula fed babies (p=0.017). There were no statistical differences between groups in calcium (2.44 vs. 2.41 mmol/l), phosphorus (2.27 vs. 2.22 mmol/l) and alkaline phosphatase (261 vs. 266 U/L) blood concentration and Ca (urine)/creatinine (urine) ratio (0,34 vs. 0,25mg/mg) and TRP (86% vs. 88%) (p>0.05). The P (urine) /creatinine (urine) ratio in the first group was 2.3mg/mg and 1.42 mg/mg in the second group (p=0.048). CONCLUSIONS: Neonatal vitamin D stores in the 3rd week of life are not more dependent on maternal vitamin D supplementation during pregnancy. Breastfed infants are at greater risk of hypovitaminosis D than formula fed infants, therefore earlier vitamin D supply should be considered. The hypovitaminosis D has no influence on basic parameters of Ca-P homeostasis in the 3rd week of life.