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1.
Afr J Paediatr Surg ; 19(1): 46-51, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34916352

RESUMO

Background: Gastroschisis (GS) and omphalocele (OC) are congenital abdominal wall defects, the main difference between is the direct exposure of intestinal loops in amniotic fluid in children with a GS. This leads to a reduced primary closure rate and a higher number of intraoperative abnormalities and post-operative complications. Aims and Objectives: We analysed abdominal wall defect patients over an 11-year period, aiming to assess the influence of meconium-contaminated amniotic fluid. This study has different objectives to show the consequence of functional outcome of abdominal wall defects (AWD) children in reliance to colour of amniotic fluid, to assess the effect of reduced bowel exposure time to meconium contaminated amniotic fluid on edematous inflammatory thickening of the bowel loops, to show an positively influence in the number of primary AWD closures, to demonstrate a reduced incidence of post-natal complications and to verify a better outcome of OC children because of failing exposure to amniotic fluid. Methods: A retrospective, observational case-control design was used to compare GS (n = 36) and OC (n = 18) children. Physical data, colour of amniotic fluid, pre- and perinatal problems, operative complications and surgical technique, post-operative complications, duration of intensive care unit (ICU) stay, mechanical ventilation, parenteral nutrition, commencement of oral feeding and total hospital stay were collected. Data were analysed with descriptive methods, t-test and non-parametric tests such as Wilcoxon and Kruskal-Wallis were performed in addition to the analysis of variance, including post hoc testing accepting a confidence interval of 95% (P < 0.05) by using IBM SPSS software, version 23 (IBM, Illinois, USA). Results: Rate of meconium-contaminated amniotic fluid is significantly higher in GS compared to OC (P < 0.001), delivery problems such as congenital infections are also significantly higher (P < 0.001), this yields in significantly more bowel loops anomalies and problems during surgery (P < 0.036) but had no significant influence on primary abdominal wall closures rate (P = 0.523). The post-surgical outcome of OC was significantly better as compared to GS. Within the GS, those with swollen intestines had significantly longer ICU stays (P = 0.045) due to extended mechanical ventilation (P = 0.007), parenteral nutrition (P = 0.011) and delayed initiation of oral feeding (P < 0.001. Same results were found for the duration of ICU stay (P = 0.008), mechanical ventilation (P = 0.006), parenteral nutrition (P = 0.011) and delayed initiation of oral feeding (P < 0.001) in secondary closures as compared to primary abdominal wall closures in the GS group. Conclusions: Worsen functional short-term outcome of GS children was directly addicted to meconium contamination of amniotic fluid due to swollen intestines and because of this more post-surgical problem including significantly extended hospital stays were observed.


Assuntos
Parede Abdominal , Parede Abdominal/cirurgia , Líquido Amniótico , Criança , Feminino , Humanos , Recém-Nascido , Intestinos , Mecônio , Gravidez , Estudos Retrospectivos
2.
An Pediatr (Engl Ed) ; 95(5): 307-320, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34635463

RESUMO

INTRODUCTION: Early identification of neonates exposed to drugs of abuse during pregnancy allows a more precise clinical management. OBJECTIVES: To describe the clinical characteristics and to identify risk factors associated with the early detection of neonates exposed to drugs of abuse in a Neonatal Intermediate and Intensive Care Unit. METHODS: Prospective observational study of neonates with and without clinical suspicion of prenatal exposure to drugs of abuse. Meconium was analyzed using standard chromatographic techniques. Univariate and multivariate statistical analyzes were performed. RESULTS: 372 neonates were included. Exposure to drugs of abuse was detected in 49 (13.2%) cases: in 41 (83.7%) one drug and in 8 (16.3%) more than one. Somatometry at birth revealed: a) lower length percentile in those exposed to some drug, more than one and cannabis; b) lower weight percentile in those exposed to cannabis and of these compared to those exposed to alcohol. In neonates older than 34 pregnancy weeks (PW): a) lower length percentile in those exposed to any substance; b) lower percentile of length and weight in exposed to more than one. The most clinically relevant independent risk factors useful to detect cases of prenatal exposure to drugs of abuse were (Odds ratio (95% CI)): reason for admission other than prematurity (5.52 (2.55-1.93)), length percentile less than 33 (1.95 (1.05-3.60) and 2.14 (1.04-3.40) in older than 34 PW) and social dystocia/uncontrolled pregnancy in older than 34 PW (4.47 (1.03-19.29)). CONCLUSIONS: There are somatometric alterations and risk factors that can help in the early detection of neonates exposed to drugs of abuse. The somatometric alterations identified can be useful to extend the differential diagnosis of these alterations and to study their causes.


Assuntos
Cannabis , Preparações Farmacêuticas , Efeitos Tardios da Exposição Pré-Natal , Idoso , Humanos , Recém-Nascido , Mecônio , Gravidez , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Fatores de Risco
3.
BMC Pediatr ; 21(1): 454, 2021 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-34657609

RESUMO

BACKGROUND: Enemas are used in preterm infants to promote meconium evacuation, but frequent high-volume enemas might contribute to focal intestinal perforation (FIP). To replace a regime consisting of frequent enemas of varying volume and composition, we implemented a once-daily, low-volume lipid enema (LE) regimen. We investigated its impact on meconium evacuation, enteral nutrition, and gastrointestinal complications in preterm infants. METHODS: We performed a single-center retrospective study comparing cohorts of preterm infants < 28 weeks gestation or < 32 weeks, but with birth weight < 10th percentile, before and after implementing LE. Outcomes were rates of FIP, necrotizing enterocolitis (NEC), and sepsis. We assessed stooling patterns, early enteral and parenteral nutrition. We used descriptive statistics for group comparisons and logistic regression to identify associations between LE and gastrointestinal complications and to adjust for group imbalances and potential confounders. Exclusion criteria were gastrointestinal malformations or pre-determined palliative care. RESULTS: Data from 399 infants were analyzed, 203 before vs. 190 after implementing LE; in the latter period, 55 protocol deviations occurred where infants received no enema, resulting in 3 groups with either variable enemas, LE or no enema use. Rates of FIP and sepsis were 11.9% vs. 6.4% vs. 0.0% and 18.4% vs. 13.5% vs. 14.0%, respectively. NEC rates were 3.0% vs. 7.8% vs. 3.5%. Adjusted for confounders, LE had no effect on FIP risk (aOR 1.1; 95%CI 0.5-2.8; p = 0.80), but was associated with an increased risk of NEC (aOR 2.9; 95%CI 1.0-8.6; p = 0.048). While fewer enemas were applied in the LE group resulting in a prolonged meconium passage, no changes in early enteral and parenteral nutrition were observed. We identified indomethacin administration and formula feeding as additional risk factors for FIP and NEC, respectively (aOR 3.5; 95%CI 1.5-8.3; p < 0.01 and aOR 3.4; 95%CI 1.2-9.3; p = 0.02). CONCLUSION: Implementing LE had no clinically significant impact on meconium evacuation, early enteral or parenteral nutrition. FIP and sepsis rates remained unaffected. Other changes in clinical practice, like a reduced use of indomethacin, possibly affected FIP rates in our cohorts. The association between LE and NEC found here argues against further adoption of this practice. TRIAL REGISTRATION: Registered at the German Register of Clinical Trials (no. DRKS00024021 ; Feb 022021).


Assuntos
Enterocolite Necrosante , Mecônio , Enema/efeitos adversos , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Lipídeos , Estudos Retrospectivos
4.
BMC Pediatr ; 21(1): 437, 2021 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-34620131

RESUMO

BACKGROUND: Anastomotic or perianastomotic ulcers present with symptoms such as chronic anaemia and occult bleeding as long-term complications of bowel resection performed in infancy. CASE PRESENTATION: Herein, we describe a 15-year-old girl with a history of surgery for meconium obstruction without mucoviscidosis in infancy who was hospitalized with chief complaints of presyncope and convulsions. Seven hours after admission, she developed melena and went into shock. An emergency laparotomy was performed, and a Dieulafoy lesion was detected near the site of ileal anastomosis from the surgery that had been performed during infancy. CONCLUSIONS: Although overt massive lower gastrointestinal bleeding necessitating emergency care is rare in the long term after infant bowel resection, Dieulafoy lesions can cause serious bleeding, requiring rapid life-saving haemostatic procedures.


Assuntos
Fibrose Cística , Obstrução Intestinal , Adolescente , Anastomose Cirúrgica/efeitos adversos , Feminino , Humanos , Lactente , Recém-Nascido , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Mecônio , Úlcera
5.
Eur J Obstet Gynecol Reprod Biol ; 266: 55-62, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34592650

RESUMO

OBJECTIVE: Stillbirth is one of the most devastating adverse pregnancy outcome, but it is often associated with a missing post-mortem histological examination. We aimed at evaluating whether the staining of amniotic fluid reflects the fetal conditions surrounding the death and if it correlates with any histologic sign of fetal distress. STUDY DESIGN: Terminal gasping (represented by the massive presence of intra-alveolar squamous cells), thymic and adrenal cortex modifications were evaluated as histologic signs of fetal distress in stillbirths, and stratified according to the degree of staining of the amniotic fluid. RESULTS: The presence of meconium-stained amniotic fluid did not correlate with the presence of gasping and/or thymic and/or adrenal cortex changes. Clear amniotic fluid was not associated with the absence of histologic signs of distress. CONCLUSIONS: The evaluation of the staining of the amniotic fluid fails to identify distressed fetuses. A histologic evaluation of fetal organs provides detailed information, irrespective of the presence/absence of meconium-stained amniotic fluid.


Assuntos
Sofrimento Fetal , Síndrome de Aspiração de Mecônio , Líquido Amniótico , Feminino , Sofrimento Fetal/diagnóstico , Humanos , Recém-Nascido , Mecônio , Gravidez , Natimorto
6.
Bioengineered ; 12(1): 2616-2626, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34499011

RESUMO

Meconium aspiration syndrome (MAS) is a disease closely related to inflammation and oxidative stress. Glycyrrhizic acid (GA) is a triterpenoid isolated from licorice with multiple bioprotective properties. In the present study, impacts of GA against MAS rats, as well as the potential mechanism, will be investigated. MAS model was established on newborn rats, followed by the treatment of 12.5, 25, and 50 mg/kg GA. The wet/dry weight ratio of lung tissues was calculated. The production of IL-6, IL-1ß, TNF-α, malonaldehyde (MDA), superoxide dismutase (SOD), glutathione (GSH) was measured using ELISA assay. HE staining was used to evaluate the pathological state of lung tissues and TUNEL assay was used to detect the apoptotic state. The protein expression of Nrf2, Keap1, HO-1, Bcl-2, Bax, and cleaved-Caspase3 was measured by Western blotting assay. The elevated W/D ratio, release of inflammatory factors, lung injury score, and apoptotic index, as well as the activated oxidative stress and suppressed Keap1/Nrf2/HO-1 pathway, in MAS rats were significantly alleviated by GA. After introducing the inhibitor of Nrf2, ML385, the protective property of GA on the pathological state, apoptotic index, and oxidative stress in MAS rats was pronouncedly abolished. Taken together, glycyrrhizin alleviated GAH in rats by suppressing Keap1/Nrf2/HO-1 signaling mediated oxidative stress.


Assuntos
Lesão Pulmonar Aguda/metabolismo , Lesão Pulmonar Aguda/patologia , Ácido Glicirrízico/farmacologia , Heme Oxigenase-1/metabolismo , Proteína 1 Associada a ECH Semelhante a Kelch/metabolismo , Mecônio/fisiologia , Fator 2 Relacionado a NF-E2/metabolismo , Estresse Oxidativo , Animais , Animais Recém-Nascidos , Apoptose/efeitos dos fármacos , Pulmão/efeitos dos fármacos , Pulmão/patologia , Síndrome de Aspiração de Mecônio/patologia , Estresse Oxidativo/efeitos dos fármacos , Substâncias Protetoras/farmacologia , Ratos , Transdução de Sinais/efeitos dos fármacos
7.
Molecules ; 26(15)2021 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-34361828

RESUMO

The parents' addictions and eating habits have a significant influence on the child's growth. The first stool of a newborn baby provides a large amount of information about xenobiotics transmitted by the mother's body. The analytical technique used in the study is ion chromatography with pulsed amperometric detection (IC-PAD). The biological samples, which were obtained from women staying in a maternity ward and their partners, revealed cyanide concentrations in urine samples spanning 1.30-25.3 µg L-1. Meanwhile, the results of the meconium samples were in the range of 1.54 µg L-1 to 24.9 µg L-1. Under the optimized chromatographic conditions, the IC-PAD system exhibited satisfactory repeatability (R < 3%, n = 3) and good linearity in the range of 1-100 µg L-1. Thus, it proved to be an effective tool for monitoring trace cyanide concentration in a series of human body fluid matrices, including meconium. Based on the literature review, this is the first application of the IC-PAD analytical technique for the determination of cyanide ions in meconium samples.


Assuntos
Cromatografia por Troca Iônica/métodos , Cianetos/análise , Mecônio/metabolismo , Urinálise/métodos , Adulto , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Adulto Jovem
8.
Artigo em Inglês | MEDLINE | ID: mdl-34360212

RESUMO

(1) This longitudinal study aimed to investigate the link between prenatal alcohol exposure and prenatal maternal depression with the offspring's low-grade inflammatory status. (2) Prenatal alcohol exposure was determined via maternal self-report during the 3rd trimester of pregnancy (self-report+: n = 29) and the meconium alcohol metabolite Ethyl Glucuronide (EtG), collected at birth (≥30 ng/g: n = 23). The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for prenatal maternal depressive symptoms during the 3rd trimester (≥10: n = 35). Fifteen years later, 122 adolescents (M = 13.32 years; 48.4% female) provided blood samples for the analysis of high sensitivity C-reactive protein (hsCRP; M = 0.91; SD = 1.28). (3) Higher hsCRP levels were found in EtG positive adolescents (p = 0.036, ηp2 = 0.04) and an inverse non-significant dose-response relation with hsCRP (r = -0.35, p = 0.113). For maternal self-reported prenatal alcohol consumption (p = 0.780, ηp2 = 0.00) and prenatal depressive symptoms (p = 0.360, ηp2 = 0.01) no differences for hsCRP levels between the affected and unaffected groups were found. (4) Adolescents with prenatal alcohol exposure are at risk for low-grade systemic inflammation. The EtG biomarker may be more accurate compared to self-reports. The findings suggest that prenatal maternal depression does not evoke low-grade systemic inflammation.


Assuntos
Depressão , Efeitos Tardios da Exposição Pré-Natal , Adolescente , Consumo de Bebidas Alcoólicas/efeitos adversos , Depressão/epidemiologia , Feminino , Humanos , Recém-Nascido , Inflamação , Estudos Longitudinais , Masculino , Exposição Materna/efeitos adversos , Mecônio , Gravidez
9.
Anal Bioanal Chem ; 413(21): 5493-5507, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34286357

RESUMO

New psychoactive substances (NPS) have been introduced into the market in recent years, with new analytes reported every year. The use of these substances in women can occur at any stage of life, even in the childbearing age. Drug use during pregnancy presents significant risks for the mother and the fetus, so it is important to have tools that allow to detect prenatal exposure to these substances of abuse. Therefore, an analytical method for the determination of 137 NPS and other drugs of abuse in meconium by UHPLC-QTOF was developed and validated for semi-quantitative purpose. Linearity range, limit of detection (LOD), precision, matrix effect, selectivity, and specificity were evaluated. For all analytes, the calibration curves were studied in the ranges between 2, 10, or 50 ng/g and 750 or 1000 ng/g, (depending on the analyte) and the LOD ranged between 0.04 and 2.4 ng/g. The method was applied to 30 meconium specimens from cases in which fentanyl had been administered as epidural anesthesia at the time of delivery or cases in which the maternal hair was positive to other drug of abuse. Four meconium samples tested positive for fentanyl (range concentration = 440-750 ng/g) and two samples tested positive to acetylfentanyl (range concentration = 190-1400 ng/g).


Assuntos
Analgésicos Opioides/análise , Cromatografia Líquida de Alta Pressão/métodos , Espectrometria de Massas/métodos , Mecônio/química , Psicotrópicos/análise , Feminino , Fentanila/análise , Humanos , Recém-Nascido , Limite de Detecção , Gravidez , Detecção do Abuso de Substâncias/métodos
10.
Sci Total Environ ; 796: 148898, 2021 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-34280640

RESUMO

Phthalates are chemicals suspected to adversely affect fetal neurodevelopment, but quantifying the fetal exposure is challenging. While prenatal phthalate exposure is commonly quantified in maternal urine, the newborn's meconium may better capture cumulative prenatal exposure. Currently, data on phthalates measured in meconium is sparse. We measured phthalate metabolites in 183 maternal second and 140 third trimester (T2, T3) urine, and in 190 meconium samples collected in an autism enriched-risk pregnancy cohort of 236 mothers. Eleven and eight metabolites were detected in over 90% of urine and meconium samples, respectively. Hydrophilic and hydrophobic metabolites were detected in both biosamples. Most urine phthalate metabolite distributions were similar between T2 and T3. Among metabolites detected in both biosamples, those of di(2-ethylhexyl) phthalate displayed a similar pattern in magnitude across metabolite type. Specifically, T2 creatinine adjusted distribution [median (25%, 75%)] of urine measured mono(2-ethylhexyl-carboxypentyl) (MECPP), mono(2-ethyl-5-hydroxyhexyl) (MEHHP), and mono(2-ethyl-5-oxohexyl) phthalate (MEOHP) were 18.8(11.9, 31.4), 11.8(7.2, 19.1), and 8.9(6.2, 14.2) ng/mg. In meconium these were 16.6(10.9, 23.7), 2.5(1.5, 3.8), and 1.3(0.8, 2.3) ng/g, respectively. Metabolite-to-metabolite correlations were lower in meconium than urine, but patterns were similar. For example, correlation (95% CI) between mono(2-ethylhexyl) phthalate and MECPP was 0.73 (0.66, 0.78), and between MEOHP and MEHHP was 0.96 (0.95, 0.97) in urine as compared to 0.10 (-0.04, 0.24) and 0.31 (0.18, 0.43) respectively in meconium. Correlations between same metabolites measured in urine and meconium were low and differed by metabolite and trimester. Correlation between MEHHP in urine and meconium, for example, was 0.20 (0.008, 0.37) at T3, but 0.05 (-0.12, 0.21) at T2. Our study provides evidence of general population-level prenatal phthalate exposure in a population at high risk for neurodevelopmental disorders and supports the utility of meconium to measure prenatal phthalate exposure but provides little evidence of correlation with exposure measured in prenatal maternal urine.


Assuntos
Dietilexilftalato , Ácidos Ftálicos , Estudos de Coortes , Exposição Ambiental , Feminino , Humanos , Recém-Nascido , Exposição Materna , Mecônio , Gravidez , Terceiro Trimestre da Gravidez
11.
Tokai J Exp Clin Med ; 46(2): 101-104, 2021 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-34216484

RESUMO

Thus far, few reports have described the rare, non-obstructive type of fetal diffuse bowel dilatation. We describe such a case in the fetus of a 31-year-old Pakistani pregnant woman, gravida 3, para 2. A series of ultrasonographic examinations in the third trimester showed a "honeycomb" appearance of fetal d iffuse dilated bowel loops, a mildly enlarged stomach, and mild polyhydramnios. Magnetic resonance imaging further revealed fluid-filled dilated bowel loops extending to the colon and rectum. The male neonate was born at 36 weeks and had marked abdominal distension but did not show signs of mechanical bowel obstruction. He passed a profuse amount of liquid with meconium at 4 h of life. Thereafter, his distended abdomen and bowel dilatation subsided, and he became asymptomatic within a week of life. Taken together with previous case reports, among infants who show the "honeycomb" sign in utero, there definitely exists a subset with a favorable outcome and an unknown etiology. This case alerts physicians who are responsible for perinatal care to the fact that careful assessment is required for a newborn when the "honeycomb" sign is observed via fetal imaging. Without evidence of mechanical bowel obstruction, alternative etiologies should be sought to avoid unnecessary laparotomy.


Assuntos
Obstrução Intestinal , Adulto , Dilatação , Feminino , Humanos , Lactente , Recém-Nascido , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Imageamento por Ressonância Magnética , Masculino , Mecônio , Gravidez , Diagnóstico Pré-Natal
12.
BMJ Case Rep ; 14(6)2021 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-34083196

RESUMO

A 10-day-old newborn was taken to the paediatric emergency room due to scrotal swelling. Physical examination showed scrotal enlargement and palpable intrascrotal hard formations. Laboratory blood tests revealed no significant alterations. Testicular ultrasonography showed thickened and hypoechoic scrotal walls and bilateral intrascrotal isoechoic nodules with small internal calcifications. An abdominal X-ray confirmed evidence of bilateral scrotal microcalcifications and small calcifications in the left hypochondrium. Urgent laparotomy performed for scrotal exploration verified the presence of nodular formations on the vaginal tunic of both testicles; the nodules were removed. Bilateral orchidopexy was performed in the same surgical session. When dealing with an acute scrotum in a newborn both emergency radiologists and clinicians should consider the possibility of scrotal meconium pseudocyst as a rare but possible cause of periorchitis.


Assuntos
Doenças dos Genitais Masculinos , Orquite , Criança , Feminino , Doenças dos Genitais Masculinos/diagnóstico por imagem , Doenças dos Genitais Masculinos/etiologia , Doenças dos Genitais Masculinos/cirurgia , Humanos , Recém-Nascido , Masculino , Mecônio , Orquite/diagnóstico por imagem , Orquite/etiologia , Escroto/diagnóstico por imagem , Escroto/cirurgia
14.
BMC Med ; 19(1): 120, 2021 05 27.
Artigo em Inglês | MEDLINE | ID: mdl-34039350

RESUMO

BACKGROUND: Gestational diabetes mellitus (GDM) is a metabolic disease that occurs in pregnant women and increases the risk for the development of diabetes. The relationship between GDM and meconium microbiota and metabolome remains incompletely understood. METHODS: Four hundred eighteen mothers (147 women with GDM and 271 normal pregnant women) and their neonates from the GDM Mother and Child Study were included in this study. Meconium microbiota were profiled by 16S rRNA gene sequencing. Meconium and maternal serum metabolome were examined by UPLC-QE. RESULTS: Microbial communities in meconium were significantly altered in neonates from the GDM mothers. A reduction in alpha diversity was observed in neonates of GDM mothers. At the phylum level, the abundance of Firmicutes and Proteobacteria changed significantly in neonates of GDM mothers. Metabolomic analysis of meconium showed that metabolic pathways including taurine and hypotaurine metabolism, pyrimidine metabolism, beta-alanine metabolism, and bile acid biosynthesis were altered in GDM subjects. Several changed metabolites varying by the similar trend across the maternal serum and neonatal meconium were observed. CONCLUSION: Altogether, these findings suggest that GDM could alter the serum metabolome and is associated with the neonatal meconium microbiota and metabolome, highlighting the importance of maternal factors on early-life metabolism.


Assuntos
Diabetes Gestacional , Microbioma Gastrointestinal , Feminino , Humanos , Recém-Nascido , Mecônio , Metaboloma , Gravidez , RNA Ribossômico 16S/genética
15.
Nat Microbiol ; 6(7): 865-873, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33972766

RESUMO

Microbial colonization of the human intestine impacts host metabolism and immunity; however, exactly when colonization occurs is unclear. Although many studies have reported bacterial DNA in first-pass meconium samples, these samples are typically collected hours to days after birth. Here, we investigated whether bacteria could be detected in meconium before birth. Fetal meconium (n = 20) was collected by rectal swab during elective breech caesarean deliveries without labour and before antibiotics and compared to technical and procedural controls (n = 5), first-pass meconium (neonatal meconium; n = 14) and infant stool (n = 25). Unlike first-pass meconium, no microbial signal distinct from negative controls was detected in fetal meconium by 16S ribosomal RNA gene sequencing. Additionally, positive aerobic (n = 10 of 20) and anaerobic (n = 12 of 20) clinical cultures of fetal meconium (13 of 20 samples positive in at least one culture) were identified as likely skin contaminants, most frequently Staphylococcus epidermidis, and not detected by sequencing in most samples (same genera detected by culture and sequencing in 2 of 13 samples with positive culture). We conclude that fetal gut colonization of healthy term infants does not occur before birth and that microbial profiles of neonatal meconium reflect populations acquired during and after birth.


Assuntos
Feto/microbiologia , Mecônio/microbiologia , Bactérias/classificação , Bactérias/genética , Bactérias/isolamento & purificação , Cesárea , Fezes/microbiologia , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Masculino , Microbiota , Gravidez , Reto/microbiologia
16.
J Nepal Health Res Counc ; 19(1): 107-110, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33934143

RESUMO

BACKGROUND: Intrauterine meconium passage in near term or term fetuses has been associated with feto-maternal stress factors and/or infection and is contributing to the increased rate of cesarean section. This study aimed to evaluate effect of mode of delivery on fetal outcome in pregnancy with meconium-stained liquor. METHODS: A cross sectional study was done in 2019 at a tertiary care center. Data was collected from women in labor, in whom meconium was seen after rupture of membrane. Out of these, 115 cases, who underwent cesarean delivery for meconium-stained liquor were enrolled in one group; while in another group 115 cases who delivered vaginally were enrolled and the fetal outcome was compared in between these two groups. RESULTS: Out of 230 cases, most participants were from 21 to 25 years age group. Most of patients were primigravida accounting for 63%, and with mean gestational age of 39.4 weeks. Low Apgar score at one and 5 minutes, percentage of respiratory distress, perinatal asphyxia, need of bag and mask ventilation as mode of resuscitation were associated more with vaginal deliveries. Incidence of Neonatal Intensive Care Unit admission, meconium aspiration syndrome, and neonatal death were seen more in vaginal delivery in comparison to cesarean delivery. CONCLUSIONS: There was no much difference in Apgar score at 5 minutes in either mode of delivery. Incidence of respiratory distress, perinatal asphyxia, Neonatal Intensive Care Unit admission, meconium aspiration syndrome and neonatal death were higher in vaginal delivery. Fetal morbidity and mortality were seen more in moderate to thick meconium-stained liquor.


Assuntos
Síndrome de Aspiração de Mecônio , Mecônio , Cesárea , Estudos Transversais , Parto Obstétrico , Feminino , Humanos , Lactente , Recém-Nascido , Síndrome de Aspiração de Mecônio/epidemiologia , Nepal/epidemiologia , Gravidez , Resultado da Gravidez/epidemiologia
17.
BMC Microbiol ; 21(1): 140, 2021 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-33952201

RESUMO

BACKGROUND: Group B Streptococcus (GBS) infection is the leading cause of septicemia, meningitis, and pneumonia in neonates. Aberrant gut colonization in early life may predispose children to various diseases in adulthood. However, the associations between gut microbial changes and GBS colonization is still unclear. RESULTS: The composition and diversity of meconium microbiota in GBS group were similar to that of healthy controls. However, we identified several specific taxa that were differentially abundant between the two groups (linear discriminant analysis (LDA) effect size (LEfSe): p < 0.05, LDA > 2.0). Particularly, the relative abundance of Lactobacillus paracasei was significantly reduced, indicating a role in GBS colonization. CONCLUSIONS: Our study presented a series of bacterial species colonized by GBS, thus providing novel evidence in support of initial intestinal microbiota dysbiosis in the neonates with mother's GBS colonization.


Assuntos
Biodiversidade , Microbioma Gastrointestinal/fisiologia , Mecônio/microbiologia , Infecções Estreptocócicas/microbiologia , Feminino , Humanos , Recém-Nascido , Streptococcus/fisiologia
19.
J Emerg Med ; 61(3): 265-270, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34006421

RESUMO

BACKGROUND: Commercial large-bore suction catheters and makeshift large-bore suction catheters with an endotracheal tube (ETT) attached to a meconium aspirator have been shown to have superior suction rates compared with a standard Yankauer. OBJECTIVES: To compare suction rates between a commercial large-bore suction catheter and a makeshift endotracheal tube-meconium aspirator (ETTMA) combination. METHODS: We measured suction rates between a standard bulb-tip Yankauer catheter (Model: K86; Cardinal Health, Waukegan, IL), a commercial large-bore catheter (Part: 43200; The Big Stick®, SSCOR, Inc., Sun Valley, CA), and an 8.0-mm standard ETT connected to a meconium aspirator (NeotechTM Products, Inc., Valencia, CA; Ref: N0101 Clear) with high-, medium-, and low-viscosity fluids. Median suction rates were calculated with interquartile ranges. The relative differences with 95% confidence intervals (CI) between the Yankauer and both the large-bore catheter and the ETTMA combination were calculated using a linear mixed-effects model. RESULTS: Each device was trialed five times with each of the three different viscosity fluids for a total of 45 trials. Overall, suction rates were faster for the large-bore suction catheter compared with the Yankauer (relative difference 22 mL/s; 95% CI 17-28) and ETTMA (8 mL/s; 95% CI 5-10). The large-bore catheter had consistently faster suction rates compared with the Yankauer and ETTMA combination across all fluid viscosities. CONCLUSIONS: The commercial large-bore suction catheter had faster suction rates than the makeshift ETTMA combination when compared with the standard Yankauer.


Assuntos
Intubação Intratraqueal , Mecônio , Cateterismo , Cateteres , Humanos , Recém-Nascido , Sucção
20.
J Pediatr Surg ; 56(8): 1287-1292, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33789802

RESUMO

BACKGROUND: Contemporary early outcome data of meconium Ileus (MI) in cystic fibrosis (CF) are lacking on a population level. We describe these and explore factors associated with successful non-operative management. METHODS: A prospective population-cohort study using an established surveillance system (BAPS-CASS) was conducted October 2012-September 2014. Live-born infants with bowel-obstruction from inspissated meconium in the terminal ileum and CF were reported. Data are described as median (interquartile range, IQR). RESULTS: 56 infants were identified. 14/56(25%) had primary laparotomy (13/23 complicated MI, 1/33 simple), the remainder underwent contrast enema. Twelve, (12/33 (36%) with simple MI) achieved decompression. 8/12 (67%) who decompressed had >1 enema vs 3/20 (15%) with simple MI who had laparotomy after enema. The number of enemas per infant (1-4), contrast agents and their concentration, were highly variable. Enterostomy was formed at 24/44(55%) of laparotomies. In infants with simple MI, time to full enteral feeds was 6 (2-10) days in those decompressing with enema vs 15 (9-19) days with laparotomy after enema. Case fatality was 4% (95% CI 0.4-12%). Two infants, both preterm died, both in the second month after birth. CONCLUSIONS: Infants with simple MI achieving successful enema decompression were more likely to have had repeat enemas than those who proceeded to laparotomy. Successful non-operative management was associated with a shorter time to full feeds. The early management of infants with MI is highly variable and not standardised across the UK and Ireland.


Assuntos
Fibrose Cística , Íleus , Obstrução Intestinal , Íleo Meconial , Estudos de Coortes , Fibrose Cística/complicações , Fibrose Cística/terapia , Enema , Humanos , Íleus/etiologia , Íleus/terapia , Lactente , Recém-Nascido , Mecônio , Íleo Meconial/etiologia , Íleo Meconial/terapia , Estudos Prospectivos
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