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Background: Feeding skill acquisition is commonly a limiting factor determining when an infant born prematurely can be discharged., Purpose: This study aimed to determine if the addition of a novel feeding progression algorithm (combination of objective data from a suck measurement device and slow flow/low variability nipples) to current neonatal intensive care unit (NICU) standards could decrease feeding-related length of stay (primary outcome). We hypothesized that by timing the initiation of oral feedings to coincide with adequate sensory-motor skill development, feeding-related length of stay may be decreased., Methods: This was a prospective intervention study, with a historical control cohort, of infants born less than 30 weeks' gestational age without comorbidities affecting feeding skill acquisition at a Regional Level III-S NICU at a women and infant's hospital in Louisiana. A novel feeding progression algorithm utilized objective assessment of sucking to determine progression in nipple flow rates with slow flow/low variability nipples (flow rates from 0 to 9 mL/min) for infants receiving intervention (n = 18). Thirty-six controls who did not receive the feeding progression algorithm were identified via electronic medical record retrospective chart review., Results: Eighteen completed the study. Compared to the control group, infants receiving feeding interventions had delayed sequencing initiation, extended time between initially off positive pressure ventilation and initiation of sequencing, and decreased feeding-related length of stay, with similar total length of stay., Implications for Practice and Research: This study adds to existing research supporting the effectiveness of novel feeding progression algorithms and interventions to support the health and outcomes of infants born prematurely. Future research should focus on implementation studies for feeding progression algorithm integration into standard NICU care., (Copyright © 2024 by The National Association of Neonatal Nurses.)

Ageism in the manager-employee relationship is one of the main obstacles towards an age-inclusive workplace. Ageism in the labour market is rooted in the use of age as an organising principle of employment relations. This article contributes to the study of ageism in the workplace by investigating how stages of life, as normalised age categories, are mobilised through discursive practices in performance appraisals. Based on the analysis of video recordings of actual performance appraisal interviews at an Italian labour union, three discursive ways of 'doing age' - or of how age, as a constructed social category, is performed and enacted - were identified: quantification (e.g. number of years in the organisation), 'ageing within the organisation' and age-group membership identification (e.g. 'young' vs. 'old'). The analysis suggests that stages of life categories and age attributes are 'done' in social interactions and employed by both employees and managers as shared culture to sustain ongoing organisational activities, thereby reproducing discriminatory age norms and stereotypes. The study demonstrates how the ordering power of the stages of life categories is situated in organisational culture and challenges the implementation of equal and inclusive workplace policies., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Early life heart rate (HR) and heart rate variability (HRV) reflect autonomic system maturation. Intervention with n-3 long chain polyunsaturated fatty acids (LCPUFAs) during pregnancy favorably affects fetal HR and HRV, complementing previous observations for n-3 LCPUFA intervention during infancy. The relationship between maternal fatty acid status during pregnancy and infant HR/HRV has not previously been assessed. The aim of this study was to explore associations between maternal n-6 and n-3 fatty acid status during pregnancy and infant HR and HRV at 2 weeks, 4 months, and 6 months of age using linear regression models. Maternal n-3 fatty acids were inversely related to infant HR and positively related to HRV. Conversely, maternal n-6 fatty acids were positively related to infant HR and inversely related to HRV. These data build on existing literature evidencing a role for n-3 fatty acids in accelerating autonomic development and link n-6 fatty acids to HR/HRV., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objective: To evaluate and refine indirect calorimetry measurement techniques so that accurate metabolic measurements can be performed in mechanically ventilated and convalescing preterm infants who require supplemental oxygen., Design: Laboratory validation of an indirect calorimeter; clinical and laboratory assessments of technical problems in performing metabolic measurements; and clinical indirect calorimetry studies in mechanically ventilated and nonventilated preterm infants., Setting: Neonatal intensive care unit (ICU) in a tertiary care university hospital., Patients: Level II and level III mechanically ventilated (n = 10) and nonventilated (n = 14) neonatal ICU patients who required FIO2 levels ranging from 0.21 to 0.42., Interventions: None., Measurements and Main Results: System calibration was assessed by combustion of 100% ethanol; the mean respiratory quotient was 0.667 +/- 0.001 (SEM). In addition, oxygen consumption (Vo2) and CO2 production (Vco2) were simulated by CO2/nitrogen infusions within the range expected for 0.5- to 7-kg infants. Mean relative errors were 0.6 +/- 0.3% and 1.8 +/- 0.3% for expected Vo2 and Vco2 values, respectively. In 27 mechanically ventilated patients with no audible endotracheal tube leak, measured endotracheal tube leak ranged from 0.0% to 7.5%. Fluctuations in FIO2 during mechanical ventilation were monitored in 30-min studies, using wall-source (n = 27) or tank-source (n = 11) supplemental oxygen. Mean FIO2 variation was 0.00075 +/- 0.00013 vs. 0.00011 +/- 0.00001 using wall-source and tank-source oxygen, respectively. Some of the difficulties of obtaining accurate measurements in supplemental hood oxygen studies were overcome by using tank-source vs. wall-source oxygen and a unique hood design., Conclusions: Accurate indirect calorimetry studies can be performed in both ventilated and nonventilated infants weighing as little as 500 g, providing that sufficient attention is paid to technical and methodologic measurement details.

To investigate fetal development of protein C, a pregnant ovine model was used. Protein C was isolated from ovine plasma, and a polyclonal antibody was raised. Citrated plasma was obtained from undisturbed chronically catheterized fetal lambs. On Western blot, nonreduced adult ovine protein C had a molecular mass of 70 kD. Fetal ovine protein C was determined to have a molecular mass of 4 to 6 kD larger than the adult molecule. Crossed immunoelectrophoresis demonstrated slightly increased anodal migration of the fetal form. Isoelectric focusing demonstrated a decreased pI of the fetal molecule (4.45 versus 4.6). The ovine protein C molecules were deglycosylated with N-glycanase. Deglycosylated fetal protein C migrated more similarly to the adult form, although a portion of the fetal form persisted. These experiments demonstrate the first example of a unique fetal form of a vitamin K-dependent protein and are compatible with increased glycosylation of fetal ovine protein C. It is speculated that altered posttranslational processing may exist as a general process by which certain coagulation proteins are modified during fetal development. mRNA was isolated from maternal and fetal hepatic tissue and analyzed by Northern hybridization. Fetal plasma concentration and hepatic mRNA for protein C were both 40% of normal maternal values from midgestation onward. At term, protein C mRNA increased to adult range (p < 0.025), although plasma protein C concentration decreased slightly (p < 0.001). A transition from fetal to adult protein C form was found beginning 6 d before term birth, with a doubling time of 24 h. These data are compatible with a gestationally determined maturation of ovine protein C.(ABSTRACT TRUNCATED AT 250 WORDS)

Human milk pH was measured in 309 samples obtained from 52 women who had delivered at term and lactated for as long as 10 months thereafter. The mean pH decreased from 7.45 for colostrum to a nadir of 7.04 during the second week of lactation. Thereafter, the pH of milk remained between 7.0 and 7.1 until 3 months postpartum and then increased gradually to 7.4 by 10 months. The change in hydrogen ion concentration in milk was associated with corresponding changes throughout lactation in the concentration of citrate but not with the concentration of lactose. Lactose concentration increased gradually for 3 weeks; the concentration of saturated medium-chain fatty acids increased more rapidly. One interpretation of these findings is that the hydrogen ions and citrate generated by mammary secretory cell metabolism are used after the second week of lactation for de novo synthesis of fatty acids more rapidly than they are synthesized. Milk samples from ruminants were found to have concentrations of hydrogen ions and citrate that are greater than and pH that is less than the respective measurements in human milk. The significance for the recipient infant of the predictable changes in human milk pH during lactation and of the higher pH of human milk throughout lactation relative to bovine milk is unknown. However, drug excretion into milk, milk enzyme activity, milk leukocyte function, and neonatal gastrointestinal function are affected by ambient pH and may be influenced by the pH of milk.

The purpose of the present study was to investigate the postnatal development of lower esophageal sphincter (LES) competence in the beagle and to determine the role of gastrin in LES functional ontogeny. Eleven beagle puppies taken from two litters were studied. All puppies were allowed to suckle during the first 3 postnatal wk. In the 4th wk, all puppies were weaned, and by the 5th wk only solid chow was offered. Intraluminal manometric pressure determinations were obtained in unanesthetized, unsedated puppies using twin-lumen, 1.7 mm OD, 1 mm ID polyvinyl catheters. A 12-15 min baseline period of intraluminal pressure was monitored, after which the puppies received successive doses of 0.03, 0.1, 1.0, and 8.0 micrograms/kg pentagastrin (PG) SC spaced at 45-min intervals. Progressive increases in LES pressure both during basal periods and during gastric contractions and in gastric fundus (GF) pressures during gastric contractions occurred during the 1st 5 weeks of life. An increase in pressure gradient between the LES and GF during gastric contraction occurred from birth through 5 wk of age. There was no response to 0.1-8.0 micrograms/kg PG until postnatal days 5-6 when the LES pressure gradient in the basal state increased in response to each of these doses. There was also no significant response by the LES to PG during gastric contraction until days 11-12 when all doses of PG evoked enhancement of LES pressure. These studies suggest that an increase in LES-GF intraluminal pressure gradient develops during the initial 2 postnatal wk in this species and that this development does not involve the hormone gastrin. Later, however, the pressure gradient may depend upon both age and gastrin since a two-way analysis of variance indicated that not only is LES pressure affected by postnatal age and by PG dose, but that there is an interaction between postnatal age and PG dose which is significant. By the fifth wk, there was an apparent dose-response effect in which the lower two doses produced increased LES pressure and the larger two doses produced decreased LES pressures.