Staphylococcus lugdunensis sepsis and endocarditis in a newborn following lotus birth.

A term newborn, who underwent lotus birth, developed Staphylococcus lugdunensis sepsis and endocarditis on the 1st day of life. This case reports an uncommon pathogen known to cause destructive endocarditis in the adult and paediatric populations, causing endocarditis in a neonate. We speculate that lotus birth, an atypical birthing practice, may have contributed to the development of this infection.

2015 Section on Pediatrics Knowledge Translation Lecture: Pediatric Vestibular-Related Impairments.

KEY POINTS: Until recently, the incidence and effect of vestibular system impairments in children has been grossly underidentified and thus not addressed. Because of incidence reports (approximately 10% of the US population younger than 21 years) and evidence of the efficacy of evaluation methods and interventions, researchers and clinicians are focusing on development of optimal interventions to enhance function, thus minimizing the negative effect of vestibular hypofunction on reading, motor development, and postural control. However, research progress has been slow. How can clinicians and researchers collaborate so that (1) vestibular deficits and related impairments can be identified in children, and (2) optimal interventions can be identified and implemented so that children with peripheral and/or central vestibular dysfunction can benefit? SUMMARY: Our participation in knowledge translation is presented, to include discussion of possible barriers, challenges, and opportunities for facilitating collaboration and joint efforts of clinical and research practice.

A neonate with left pulmonary artery thrombosis and left lung hypoplasia: a case report.

INTRODUCTION: Spontaneous intrauterine arterial thrombosis and congenital pulmonary hypoplasia are rare conditions and have not been reported to occur together. The literature rather includes two reports of babies with neonatal pulmonary artery occlusion and post-infarction cysts of the lungs. CASE PRESENTATION: We report a case of a live Caucasian male newborn with left lung hypoplasia that occurred in association with left pulmonary artery thrombosis. Despite a critical neonatal course, including extracorporeal membrane oxygenation, this infant is alive and well at 18 months of age without any neurodevelopmental sequelae or reactive airway disease. CONCLUSION: This association suggests the possibility of an intrauterine vascular event between the fifth and eighth weeks of gestation during early pulmonary artery and lung development.

Growth status related to brain responses, nutrition, home environment, and behavior in infants and toddlers.

To investigate whether growth status in infants and toddlers affects processes involved in speech perception and discrimination, cortical event-related potentials (ERPs) to consonant-vowel syllables were recorded from 48 healthy babies: 26 low in growth status (LGS, < 25 th percentile in growth measures) and from 22 normal in growth status (NGS, 25t--75 th percentile in growth measures). Food records indicated no significant differences in the amounts of various nutrients consumed in the two groups, but LGS babies consumed slightly more of most nutrients than NGS babies. In response to speech stimuli (either /pa/ or /ba/ presented with 20 and 80% randomized occurrence), brain ERPs showed two prominent post-stimulus components: a large positive wave peaking at about 484 msec and a negative but positive going slow wave (SW) between 867 and 1199 msec. Principal components analysis followed by promax rotation revealed four additional important components. Maximum peak and latency values-for these components showed that NGS and LGS babies differed from one another on all measures in either amplitude, latency, or both. Comparing the two groups of babies, only the LGS group demonstrated a deficit in the phonetic discrimination of speech sounds. The growth deficiencies of the LGS group could not be attributed to the lack of an adequate diet. These negative findings are present in babies generally considered to be healthy (lowest 10-25% in growth measures). This underscores the need for research examining in more detail the relationship between growth status and cognitive growth.

Effects of a carbohydrate supplement upon resting brain activity.

Glucose is a major energy source for the brain, and along with several monosaccharide derivatives as components of brain gangliosides, they play important roles in neurologic function. However, there is little information available on the role of glucose and other monosaccharides on resting brain activity. This study was designed to evaluate the effects of a single dose of a carbohydrate supplement containing glucose and several of its derivatives on resting brain activity in 20 healthy male college students. The supplement provided an insignificant amount of carbohydrate (3.9 g), protein (0.28 g), fat (0 g), and calories (14 kcal). The amount of glucose in the supplement was 0.5 g (1% the amount of glucose used in adult studies of cognitive functioning and memory). We hypothesized that the glyconutrient supplement would enhance brain activity associated with alertness and attention. The study design was double blind, with subjects randomly assigned to one of two orders, either carbohydrate supplement week one followed by placebo a week later, or the opposite. Electrical brain activity was monitored by 15 electrodes positioned at nine standard international 10-20 system locations, including three bilateral pairs at frontal, parietal, and occipital sites. Thirty minutes following ingestion of a placebo or carbohydrate supplement drink, EEG activity was recorded for 10-mins while subjects focused on a stationary visual target. Spectral power of resting brain activity was computed and analyzed contrasting the placebo and supplement groups. Relative to placebo, the carbohydrate supplement significantly enhanced power in three brain wave frequencies (theta, alpha, and beta) that are known to be associated with attention and arousal. Since changes were observed in the supplement but not placebo group, our study suggests that additional sugars in the glyconutritional supplement facilitate enhancement of brain electrical activity. Whether the apparent enhancement of arousal in baseline recordings is associated with improved task performance remains to be determined.

Growth and development of premature infants fed predominantly human milk, predominantly premature infant formula, or a combination of human milk and premature formula.

BACKGROUND: In a recent meta-analysis, human milk feeding of low birth-weight (LBW) infants was associated with a 5.2 point improvement in IQ tests. However, in the studies in this meta-analysis, feeding regimens were used (unfortified human milk, term formula) that no longer represent recommended practice. OBJECTIVE: To compare the growth, in-hospital feeding tolerance, morbidity, and development (cognitive, motor, visual, and language) of LBW infants fed different amounts of human milk until term chronologic age (CA) with those of LBW infants fed nutrient-enriched formulas from first enteral feeding. METHODS: The data in this study were collected in a previous randomized controlled trial assessing the benefit of supplementing nutrient-enriched formulas for LBW infants with arachidonic acid and docosahexaenoic acid. Infants (n = 463, birth weight, 750-1,800 g) were enrolled from nurseries located in Chile, the United Kingdom, and the United States. If human milk was fed before hospital discharge, it was fortified (3,050-3,300 kJ/L, 22-24 kcal/oz). As infants were weaned from human milk, they were fed nutrient-enriched formula with or without arachidonic and docosahexaenoic acids (3,300 kJ/L before term, 3,050 kJ/L thereafter) until 12 months CA. Formula fed infants were given nutrient-enriched formula with or without added arachidonic and docosahexaenoic acids (3,300 kJ/L to term, 3,050 kJ/L thereafter) until 12 months CA. For the purposes of this evaluation, infants were categorized into four mutually exclusive feeding groups: 1) predominantly human milk fed until term CA (PHM-T, n = 43); 2) >/= 50% energy from human milk before hospital discharge (>/= 50% HM, n = 98); 3) < 50% of energy from human milk before hospital discharge (< 50% HM, n = 203); or 4) predominantly formula fed until term CA (PFF-T, n = 119). RESULTS: PFF-T infants weighed approximately 500 g more at term CA than did PHM-T infants. This absolute difference persisted until 6 months CA. PFF-T infants were also longer (1.0-1.5 cm) and had larger head circumferences (0.3-1.1 cm) than both PHM-T and >/= 50% HM infants at term CA. There was a positive association between duration of human milk feeding and the Bayley Mental Index at 12 months CA (P = 0.032 full and P = 0.073 reduced, statistical models) after controlling for the confounding variables of home environment and maternal intelligence. Infants with chronic lung disease fed >/= 50% HM until term CA (n = 22) had a mean Bayley Motor Index about 11 points higher at 12 months CA compared with infants PFF-T (n = 24, P = 0.033 full model). CONCLUSION: Our data suggest that, despite a slower early growth rate, human milk fed LBW infants have development at least comparable to that of infants fed nutrient-enriched formula. Exploratory analysis suggests that some subgroups of human milk fed LBW infants may have enhanced development, although this needs to be confirmed in future studies.