Neonatal Organ and Tissue Donation for Research: Options Following Death by Natural Causes.

The donation of organs and tissues from neonates (birth to 28 days) for transplantation has been a relatively infrequent occurrence. Less common has been the use of neonatal organs and tissues for research. Specific ethical and legal questions beg for rational and transparent guidelines with which to evaluate referrals of potential donors. Donation of organs and tissues from a neonate can play a key role in the care and support provided to families by health care professionals around the time of a neonate's death. We report on the recovery of neonatal organs and tissues for research. A working group made up of bioethicists, neonatologists, lawyers, obstetric practioners as well as organ procurement and tissue banking professionals evaluated legal, ethical and medical issues. Neonatal donor family members were also consulted. Our primary goals were (a) to ensure that referrals were made in compliance with all applicable federal and state laws, regulations and institutional protocols, and (b) to follow acceptable ethical standards. Algorithms and policies designed to assist in the evaluation of potential neonatal donors were developed. Neonatal donation is proving increasingly valuable for research into areas including diabetes, pulmonary, gastrointestinal, genitourinary and neurological development, rheumatoid arthritis, autism, childhood psychiatric and neurologic disorders, treatment of MRSA infection and pediatric emergency resuscitation. The development of policies and procedures will assist medical professionals who wish to offer the option of donation to family members anticipating the death of a neonate.

Update on group B streptococcal infections: perinatal and neonatal periods.

Group B Streptococcus (GBS), one of the beta-Hemolytic streptococci, remains a leading cause of neonatal sepsis in the United States. The first consensus guidelines for the prevention of neonatal GBS disease were published in 1996, recommending intrapartum antibiotic prophylaxis on the basis of screening-based or risk-based strategies. Since then, there has been a 70% decrease in the rate of early-onset GBS disease. On the basis of evidence-validating superiority of this screening-based strategy, new national guidelines were released in 2002. Data from the Centers for Disease Control and Prevention in 2005 showed a continued decrease in the annual incidence of early-onset GBS infection. The screening-based strategy involves universal screening of all pregnant women at 35 to 37 weeks' gestation for vaginal and rectal GBS colonization and recommends intrapartum antibiotic prophylaxis for all GBS carriers (unless delivered by planned cesarean section before the onset of labor in a woman with intact membranes) with penicillin-G (or ampicillin). For mothers with severe penicillin allergy, clindamycin or erythromycin is recommended, when GBS' sensitivity is known; otherwise, vancomycin is recommended. Cefazolin is recommended for individuals with mild penicillin allergy. Severe anaphylactic reactions to penicillin were extremely rare. Emergence of antibiotic resistance to penicillin is still a theoretical possibility. This article provides a detailed account of recommendations for screening, diagnosing, and treating GBS disease in newborns.

Relationship of caffeine dosing with serum alkaline phosphatase levels in extremely low-birth-weight infants.

OBJECTIVE: To determine whether patients receiving higher doses of caffeine have increased alkaline phosphatase (ALP) levels, as a biomarker for osteopenia. METHODS: This descriptive, retrospective study included 152 extremely low-birth-weight infants (ie, <1 kg) admitted from January 1, 2007, to September 30, 2009, who received caffeine for >2 weeks. Patients were divided into a low-dose (<7.5 mg/kg/day) and high-dose (≥7.5 mg/kg/day) group based on maximum caffeine dose received. The primary objective was to compare peak ALP levels between groups. Secondary objectives included a comparison of caffeine regimens and risk factors for osteopenia between groups and identification of factors significantly related to increase in ALP. Between-group analysis was performed using the chi-squared or Fisher exact test and Wilcoxon Mann-Whitney median test or t-tests where appropriate. A linear regression model was used, with peak ALP as the dependent variable. RESULTS: A majority of the patients (n=122) were included in the high-dose caffeine group. No significant difference in maximum ALP level between groups (median, 599.5, versus 602.5 units/L, p=0.72). Gestational age and birth weight were inversely related to ALP, whereas parenteral nutrition duration was directly related. No significant relationship between caffeine dose and ALP was identified. CONCLUSIONS: In this preliminary study, using ALP as a biochemical marker for bone turnover, there does not appear to be a dose-related effect between ALP and caffeine dose.