Search

Background: Alpha‐1‐acid glycoprotein is an acute‐phase protein with a high affinity for amide local anesthetics. Compared to adults, neonates have lower concentrations of this glycoprotein in plasma, and are therefore at higher risk of developing local anesthetic toxicity. Alpha‐1‐acid glycoprotein concentrations rise in adults after surgery as a response to stress as well as in inflammatory conditions. Previous studies have shown that concentrations of alpha‐1‐acid‐glycoprotein in neonates vary postpartum, influenced by gestational age and mode of delivery. Aim: This study aims to determine the concentrations of alpha‐1‐acid glycoprotein pre‐ and postoperatively in neonates undergoing major surgery. This information is important for determining safe and effective dosage of local anesthetic in this vulnerable group of patients. Methods: In this prospective observational study, 25 neonates (median 3 days of age) undergoing major surgery were included. Blood sampling was performed preoperatively and at four occasions postoperatively. Alpha‐1‐acid‐glycoprotein plasma concentrations were analyzed using an immunoturbidimetric assay. Mann–Whitney U test, Kruskal–Wallis and Spearman ranking correlation test were used for the statistical analysis. Results: Higher plasma concentrations of alpha‐1‐acid‐glycoprotein were found 48 h postoperatively compared to preoperatively [median (inter‐quartile range) 0.815 g L−1 (0.663–0.983 g L−1) vs. 0.300 g L−1 (0.205–0.480 g L−1p < 0.001)], respectively. It was not possible to detect any influence of sex, postnatal age, gestational age, or delivery mode on alpha‐1‐acid‐glycoprotein concentrations in our data. Conclusions: Alpha‐1‐acid‐glycoprotein concentrations increase in neonates as a response to surgery regardless of gestational age, sex, or mode of delivery. [ABSTRACT FROM AUTHOR]

Coronaviruses are a family of viruses that cause disease in mammals and birds. In humans, coronaviruses cause infections on the respiratory tract that can be fatal. These viruses can cause both mild illnesses such as the common cold and lethal illnesses such as SARS, MERS, and COVID-19. Air transmission represents the principal mode by which people become infected by SARS-CoV-2. To reduce the risks of air transmission of this powerful pathogen, we devised a method of inactivation based on the propagation of electromagnetic waves in the area to be sanitized. We optimized the conditions in a controlled laboratory environment mimicking a natural airborne virus transmission and consistently achieved a 90% (tenfold) reduction of infectivity after a short treatment using a Radio Frequency (RF) wave emission with a power level that is safe for people according to most regulatory agencies, including those in Europe, USA, and Japan. To the best of our knowledge, this is the first time that SARS-CoV-2 has been shown to be inactivated through RF wave emission under conditions compatible with the presence of human beings and animals. Additional in-depth studies are warranted to extend the results to other viruses and to explore the potential implementation of this technology in different environmental conditions. [ABSTRACT FROM AUTHOR]

Introduction: Perinatal management of extremely preterm births in Sweden has changed toward active care from 22-23 gestational weeks during the last decades. However, considerable regional differences exist. This study evaluates how one of the largest perinatal university centers has adapted to a more active care between 2004-2007 and 2012-2016 and if this has influenced infant survival. Material and methods: In this historical cohort study, women admitted with at least one live fetus and delivered at 22-25 gestational weeks (stillbirths included) at Karolinska University Hospital Solna during April 1, 2004-March 31, 2007, and January 1, 2012-December 31, 2016, were compared regarding rates of obstetric and neonatal interventions, and infant mortality and morbidity. Maternal, pregnancy and infant data from 2004-2007 were obtained from the Extreme Preterm Infants in Sweden Study while data from 2012-2016 were extracted from medical journals and quality registers. The same definitions of interventions and diagnoses were used for both study periods. Results: A total of 106 women with 118 infants during 2004-2007 and 213 women with 240 infants during 2012-2016 were included. Increases between the study periods were seen regarding cesarean delivery (overall rate 14% [17/118] during 2004-2007 vs. 45% [109/240] during 2012-2016), attendance of a neonatologist at birth (62% [73/118] vs. 85% [205/240]) and surfactant treatment at birth in liveborn infants (60% [45/75] vs. 74% [157/211]). Antepartum stillbirth rate decreased (13% [15/118] vs. 5% [12/240]) and the proportion of live births increased (80% [94/118] vs. 88% [211/240]) while 1-year survival (64% [60/94] vs. 67% [142/211]) and 1-year survival without major neonatal morbidity (21% [20/94] vs. 21% [44/211]) among liveborn infants did not change between the study periods. At 22 gestational weeks, interventions rates were still low during 2012-2016, most obvious regarding antenatal steroid treatment (23%), attendance of a neonatologist (51%), and intubation at birth (24%). Conclusions: Both obstetric and neonatal interventions at births below 26 gestational weeks increased between 2004-2007 and 2012-2016 in this single center study; however, at 22 gestational weeks they were still at a low level during 2012-2016. Despite more infants being born alive, 1-year survival did not increase between the study periods. [ABSTRACT FROM AUTHOR]

Few studies have evaluated whether topical anesthetic cream reduces pain during pneumococcal vaccination. This is crucial, since effective pain management should be evidence‐based. Previous studies have shown that topical lidocaine‐prilocaine (EMLA®) reduces vaccination‐related pain, measured using pain‐rating instruments and observation of crying time. This intervention study aimed to compare the efficacy of topical lidocaine‐prilocaine cream with that of the standard of care on the expression of pain during the first pneumococcal vaccination administered at age 3 months under the Swedish national vaccination program. A randomized controlled trial included 72 infants receiving their first pneumococcal vaccination (Prevenar 13®). The study showed that topical lidocaine‐prilocaine before pneumococcal vaccination significantly reduced infants' expression of pain according to the Face, Legs, Activity, Cry, Consolability (FLACC) score (P =.006) and increased latency to cry (P =.001). There were no statistically significant differences in the total crying time (P =.146) between the groups. Topical lidocaine‐prilocaine cream reduced pain expression and increased latency to cry in infants receiving their first pneumococcal vaccine. Systematic efforts are needed to successfully implement the use of topical anesthetic cream and other effective non‐pharmacological pain‐relieving strategies during infant vaccination procedures. [ABSTRACT FROM AUTHOR]

SARS-CoV-2 is inactivated in aerosol (its primary mode of transmission) by means of radiated microwaves at frequencies that have been experimentally determined. Such frequencies are best predicted by the mathematical model suggested by Taylor, Margueritat and Saviot. The alignment between such mathematical prediction and the outcomes of our experiments serves to reinforce the efficacy of the radiated microwave technology and its promise in mitigating the transmission of SARS-CoV-2 in its naturally airborne state. [ABSTRACT FROM AUTHOR]

Aim: The aim was to determine whether preterm and full-term newborn infants could process maternal breast odour at a cortical level.Methods: Newborn infants were exposed to cloths containing their own mother's breast odour and freshly laundered control cloths for 10 seconds, while functional near-infrared spectroscopy measured cortical activation in their olfactory processing areas. We studied 45 newborn infants born at 28-41 weeks of gestation and divided them into three groups: full-term (37-41 weeks), late preterm (33-36 weeks) and very preterm (28-32 weeks). Cortical activation was defined as a regional increase of oxyhaemoglobin following maternal breast odour stimuli.Results: Full-term infants demonstrated bilateral activation of their olfactory cortices following exposure to maternal breast odour. Late preterm infants and very preterm boys exhibited unilateral cortical activation, unlike very preterm girls.Conclusion: Infants born from 32 weeks, and possibly earlier, could process low concentration maternal odours at a cortical level, which suggests they were more aware of their environment. These findings could make a significant contribution to improving the sensory environment of preterm infants and improve bonding. [ABSTRACT FROM AUTHOR]

Background/purpose To test the hypothesis that clinical and radiological features of necrotizing enterocolitis vary with gestational age in all neonates with NEC and in subgroup of surgically treated patients. Methods This was a retrospective study case series. NEC cases treated in Stockholm County from 2009 to 2014 were identified in the National Quality Register. Patients were included in the study if they had a verified NEC diagnosis and they were divided into 2 groups according to the gestational age. Results A total of 89 patients were included. Of these 60 (67.4%) neonates had a gestational age < 28 and 29 (32.6%) infants ≥ 28 weeks. Surgical NEC patients were 57 (64%). Pneumatosis intestinalis at the abdominal radiographs was noted significantly more often in neonates born at ≥ 28 weeks of gestation (86.2%) compared to extremely preterm newborns (60.0%). Neonates born at ≥ 28 weeks of gestation presented more often bloody stools (58.6%) compared to extremely preterm newborns (20.0%). In surgical NEC patients gasless abdomen was detected in 35.6% of the neonates born < 28 weeks compared to 6.7% of the more mature neonates. Conclusions Extremely preterm neonates with NEC show less specific clinical and radiological signs of NEC compared to more mature neonates. This suggests that Bell's classification is not adequate for the diagnosis and staging of NEC in extremely preterm neonates. Level of evidence III. [ABSTRACT FROM AUTHOR]

Aninnovative and effective photonics-based radio frequency (RF) spectrum scanner is presented and demonstrated, enabling the detection in the 0.5--28.5 GHz range. The proposed receiver scans the whole frequency range at discrete steps, downconverting at baseband single portions of the detected spectrum, where they can be precisely acquired, without using RF bandpass filters nor optical filters. The wideband scansion is achieved by simply tuning an optical carrier only, avoiding the use of an RF synthesizer or of multiple parallel local oscillators. In more detail, the optical carrier is modulated by the detected RF signal through an electro-optical modulator, and photomixed with an optical local oscillator to down-convert themodulation sideband to baseband. The optical carrier also feeds an optical frequency comb generator-- driven by a fixed RF oscillator at 1 GHz--whose output injects the local oscillator. This way, the optical carrier and oscillator are phase locked and can be tuned at steps of 1 GHz. The developed demonstrator achieves an input range up to 28.5 GHz, and a simulative analysis suggests the capability of exceeding the 0.5--40 GHz range employing commercially available devices.Moreover, it shows a linear dynamic range of 160 dB/Hz and a spuriousfree dynamic range of 109 dB/Hz2/3, aligned with the state-of-the-art broadband RF receivers. The proposed solution appears to fulfill the performance requirements of the demanding electronic support measures applications, with the potentials for largely reducing the receiver size. [ABSTRACT FROM AUTHOR]

In this study, the authors present a 36:1 relative bandwidth active front-end low-noise amplifier (LNA) with power limiter that has been developed for airborne ultra-wideband receiver systems. The proposed system is driven by an external antenna with a balanced mode with an input impedance of 150 Ω. The whole microwave monolithic integrated circuit (MMIC) embeds a protection from the presence of high-level signals, an ultra-wideband amplifier circuit, an active balun and an impedance transformer. It has a bandwidth ranging from 0.5 to 18.0 GHz with 14 dB gain, 4.5 dB noise figure (NF), 20 dB common-mode rejection and 30 dBm input overload protection. The circuit has a single bias from the output port greatly simplifying its use within a receiving system and can be directly integrated into the antenna mechanical support. Test measurements are also provided. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to determine whether a correlation exists between the sonographic findings and the clinical outcomes, defined as surgery or death, in neonates with radiographically and/or histopathologically confirmed necrotizing enterocolitis (NEC). Material and Methods In this retrospective study, the case notes of 58 patients admitted to Karolinska University Hospital, Stockholm, Sweden, with radiographically confirmed NEC from September 2010 to August 2013, were reviewed. We included all newborns who underwent both plain abdominal radiographs and an abdominal ultrasound on the same day. The images were reviewed retrospectively. Patients' characteristics, clinical data, and histopathological data were recorded from the case notes. We excluded newborns who developed free gas before surgery. Abdominal ultrasound images were reviewed for free intraperitoneal gas, peritoneal fluid, pneumatosis intestinalis, portal gas, bowel vascularity, bowel wall thickness, and peristalsis. We correlated the sonographic features with the clinical outcomes; defined as the need for surgery or death. Results Overall, 25 neonates were included. Out of these, 11 patients underwent surgery and 5 patients died. The sonographic finding of complex fluid collection was statistically significant, predicting severe NEC that needed surgery. No other sonographic features were related to the need for surgery or death. Conclusion Complex fluid collection shown with abdominal ultrasound appears to be strongly correlated to the need for surgery in newborn infants with severe NEC. [ABSTRACT FROM AUTHOR]

Background Acute inflammatory demyelinating polyneuropathy (AIDP), also known as Guillain-Barré syndrome, is an immune-mediated polyneuropathy usually triggered by infections or vaccinations. In childhood AIDP is commonly described after the first year of life. Here, we present a case of a newborn infant with AIDP manifestation directly after delivery. Case study A newborn girl with a healthy mother, without known exposure to immunomodulating factors, was admitted to the neuropediatric department due to ascending hypotonia, weakness, pain and areflexia in the lower extremities. The clinical presentation, laboratory and neurophysiological studies supported the diagnosis of AIDP. The infant showed first signs of clinical improvement following administration of intravenous immunoglobulin and her recovery was complete at one year. Conclusion AIDP should be considered as a differential diagnosis in ascending hypotonia also in the neonatal period. [ABSTRACT FROM AUTHOR]

Background: Epidurals may be challenging in neonatal patients due to technical difficulties relating to insertion and the risk of local anaesthesia toxicity. The use of wound catheters with an infusion of local anaesthetic has been shown to be well tolerated in adults and older children. There are few data concerning wound catheter techniques in neonatal patients.Objectives: The primary aim of this study was to analyse plasma levels of levobupivacaine associated with continuous wound infiltration via a catheter following neonatal surgical procedures. Secondary parameters, including the quality of postoperative analgesia and wound healing, were also noted.Design: A prospective, observational study.Setting: Paediatric ICU at the Karolinska University Hospital, Stockholm, Sweden, from March 2008 to December 2010.Patients: Twenty newborn infants (median weight 3.48 kg) scheduled for major abdominal or thoracic surgery were included. Exclusion criteria were known or suspected hepatic dysfunction. Before skin closure, a subcutaneous catheter was inserted into the wound followed by a 0.5 mg kg(-1) bolus of levobupivacaine (0.125%, 0.4 ml kg(-1)) through the catheter. A continuous infusion was started 20 to 30 min later at a rate of 0.2 mg kg(-1)h(-1) (0.16 ml kg(-1) h(-1)).Main Outcome Measures: Plasma concentrations of levobupivacaine (total and unbound) at 12, 24, 48 and 72 h postoperatively. Morphine consumption, pain scores and wound healing were also analysed.Results: Median concentrations of unbound and total levobupivacaine at 72 h were 0.018 and 1.305 μg ml(-1), respectively. In 18 out of 20 infants [90%; 95% confidence interval (CI) 68.3 to 98.8], the unbound plasma concentration of levobupivacaine remained relatively stable and below 0.05 μg ml(-1) throughout the 72 h observation period. Pain scores and morphine consumption levels were low. All wounds except one healed within 10 days.Conclusion: The studied infusion regimen was associated with plasma levels of levobupivacaine well below those associated with toxicity. Adequate wound healing, low pain scores and a reduced need for opioids were also noted. [ABSTRACT FROM AUTHOR]

The aim was to investigate the association of gestational age (GA), echocardiographic markers and levels of plasma N-terminal pro-B-type natriuretic peptide (NTproBNP) with the closure rate of a haemodynamically significant patent ductus arteriosus (hsPDA). Ninety-eight Swedish extremely preterm infants, mean GA 25.7 weeks (standard deviation 1.3), born in 2012–2014, were assessed with echocardiography and for levels of NTproBNP. Thirty-three (34%) infants had spontaneous ductal closure within three weeks of age. Infants having spontaneous closure at seven days or less had significantly lower NTproBNP levels on day three, median 1810 ng/L (IQR 1760–6000 ng/L) compared with: infants closing spontaneously later, 10,900 ng/L (6120–19,200 ng/L); infants treated either with ibuprofen only, 14,600 ng/L (7740–28,100 ng/L); or surgery, 32,300 ng/L (29,100–35,000 ng/L). Infants receiving PDA surgery later had significantly higher NTproBNP values on day three than other infants. Day three NTproBNP cut-off values of 15,001–18,000 ng/L, predicted later PDA surgery, with an area under the curve in ROC analysis of 0.69 (0.54–0.83). In conclusion, the spontaneous PDA closure rate is relatively high in extremely preterm infants. Early NTproBNP levels can be used with GA in the management decisions of hsPDA. [ABSTRACT FROM AUTHOR]

Abstract: Objective: In spite of its known negative effects on brain development, phenobarbital is the most commonly used drug for neonatal seizures. We conducted a national survey among neonatologists and child neurologists to determine the variation in practice and attitudes. Methods: Surveys were sent to all board-certified child neurologists and neonatologists in Sweden as well as to residents in subspecialty training. In addition to questions concerning respondent demographic characteristics, the survey contained questions related to overall attitudes and practices and specific patient scenarios. Results: Responses were obtained from 170 physicians (corresponding to approximately 50% of all eligible respondents). We found a high level of agreement concerning the initiation of treatment of neonatal seizures, as well as choice of first- (phenobarbital) and second-line (midazolam) drugs. In contrast, third-line drug choice differed between specialties, with neurologists being more prone to use levetiracetam or other drugs. Neonatologists were more likely to treat premature infants differently. For continued phenobarbital treatment there was less agreement among respondents. Whereas almost 75% of neonatologists felt that phenobarbital should “seldom” or “never” be used in long term treatment following neonatal seizures, a majority of child neurologists indicated “often” or “always”. The same pattern was seen in responses to individual scenarios. Conclusion: The discrepancies between different specialties involved in treating neonatal seizures may reflect differences in training, but is also likely due to the lack of uniform guidelines. This highlights the importance of designing and carrying out clinical trials determining optimal treatment of neonatal seizures. [Copyright &y& Elsevier]

An introduction to the journal is presented in which the editor discusses the facial preferences during first two days of life and comparing reaction of preterm and term newborn infants to exposure to natural and distorted faces.

Few studies have evaluated whether topical anesthetic cream reduces pain during pneumococcal vaccination. This is crucial, since effective pain management should be evidence-based. Previous studies have shown that topical lidocaine-prilocaine (EMLA ® ) reduces vaccination-related pain, measured using pain-rating instruments and observation of crying time. This intervention study aimed to compare the efficacy of topical lidocaine-prilocaine cream with that of the standard of care on the expression of pain during the first pneumococcal vaccination administered at age 3 months under the Swedish national vaccination program. A randomized controlled trial included 72 infants receiving their first pneumococcal vaccination (Prevenar 13 ® ). The study showed that topical lidocaine-prilocaine before pneumococcal vaccination significantly reduced infants' expression of pain according to the Face, Legs, Activity, Cry, Consolability (FLACC) score ( P  = .006) and increased latency to cry ( P  = .001). There were no statistically significant differences in the total crying time ( P  = .146) between the groups. Topical lidocaine-prilocaine cream reduced pain expression and increased latency to cry in infants receiving their first pneumococcal vaccine. Systematic efforts are needed to successfully implement the use of topical anesthetic cream and other effective non-pharmacological pain-relieving strategies during infant vaccination procedures., (© 2021 The Authors. Paediatric and Neonatal Pain published by John Wiley & Sons Ltd.)