Choledochal cysts (CCs) are rare, congenital cystic dilations of the hepatobiliary tree that require surgical resection to avoid complications such as increased risk of malignancy. A 25‑week gestational age male infant developed acholic stools, elevated alkaline phosphatase, and ultrasound findings consistent with CC Todani Type IVA. Surgery was deferred due to the patient’s low weight. The patient’s symptoms and radiographic findings subsequently resolved spontaneously. CCs have not been previously reported in extremely preterm infants. There are rare reported cases of spontaneously resolving hepatic cysts, all containing key differences from our patient. In patients in whom immediate surgery is not feasible, conservative management with close follow‑up and serial ultrasound examinations would appear to be a reasonable course of action.

Abstract Chlamydiae are obligatory intracellular gram-negative bacteria with a unique growth cycle. They are very successful pathogens and responsible for a wide variety infections in humans and different animal species. In addition, they have a tendency to cause recurrent, persistent or chronic infections with potentially severe sequelae years or decades later. The general purpose of this work was to study the possible serological associations between chronic chlamydial infection, systemic inflammation and reproductive health in a general population. The chlamydial heat shock proteins 60 and 10 (Hs10 and Hsp60) have been suggested to contribute to the pathogenesis of chronic chlamydial infections. Thus, the antibodies to chlamydial Hsp10 and Hsp60 were also investigated in complications of pregnancy. The present study was a longitudinal population-based birth cohort study, and all of the original papers of this dissertation are based on a nested case - control design. Our results confirmed the serological association between C. trachomatis infections and subfertility and the rather high incidence of undiagnosed C. trachomatis infections in the male partners of subfertile couples. We further demonstrated a serological association between previous C. trachomatis infections, immunity to chlamydial Hsps and female subfertility. We also showed that serological markers of chronic chlamydial infection present as early as the first trimester are associated with preterm delivery among nulliparous women. When elevated levels of C. trachomatis IgG and hsCRP were present, the estimated risk for preterm delivery was over 4-fold. According to our study, nulliparous women who subsequently developed preeclampsia leading to preterm delivery, which was used as a marker of more serious illness, had significantly more often serum IgG antibodies to C. pneumoniae during the first trimester of pregnancy compared to the preeclamptic women who delivered at term. In conclusion, chronic C. trachomatis infection was found to associate with subfertility both in men and in women. In addition, a subclinical chronic inflammatory process associated at least partly with chronic C. trachomatis infection and present in the first trimester already may be important in the development of preterm delivery. Chronic C. pneumoniae infection and systemic low-grade inflammation were found to associate with pregnancies that lead to preeclampsia and preterm delivery.

Clinicians use growth curves to assess infant health. Most children are measured on growth curves that contain percentiles for height, weight, and head circumference by sex. Preterm infants have their own growth curves. Infants who present with measurements below the 10th percentile are considered small-for-gestational age (SGA), and infants who present with measurements above the 90th percentile are considered large-for-gestational age (LGA). Growth curves and centiles can be generated using 3 and 4 parameter distribution models. To date, no studies have been published to investigate whether growth curves generated using a 3- or 4-parameter model differ significantly. Additionally, researchers have found mixed results when exploring the association between race and pregnancy/delivery. Black mothers may have greater risks and babies with lower weights than babies born to White mothers (Borrell, Rodriguez-Alvarez, Savitz, & Baquero, 2016), and growth curves that do not consider race may misclassify non-White babies (Buck-Louis et al., 2015). In this study, I had two specific aims: (1) to compare the preterm infant growth curves and centiles generated using 3 and 4 parameter methods (Lamba Mu Sigma [LMS] and Box-Cox Power Exponential [BCPE], respectively) and assess each model for adequate fit, and (2) to use percentile cut points from race-specific and non-race-specific LMS curves to classify babies in a validation dataset as SGA or LGA. Regarding the differences in curves generated from the LMS and BCPE distributions, the curves produced using the BCPE distribution had a lower GAIC in some cases but model fit criteria for the LMS curves were adequate. The simpler models generated by the LMS method were retained for birth length, head circumference, and weight by sex with an explanatory variable of gestational age. For aim 2, results indicated that race-specific curves classified babies within expected ranges. Non-race-specific curves overidentified Black babies as SGA and underidentified them as LGA. More research is required to test if this relationship persists for babies delivered at full term.

The overall aim of this thesis was to describe the prevalence of breastfeeding in preterm infants and to evaluate the effectiveness and mother’s experiences of proactive person-centred telephone support after discharge. Furthermore, to describe the duration of breastfeeding and risks of ceasing breastfeeding up to 12 months. The first study, a register study with data from the Swedish Neonatal Quality register (SNQ), included breastfeeding data at discharge from 29 445 preterm infants born from 2004-2013. The results demonstrated that the prevalence of exclusive breastfeeding among preterm infants in Sweden decreased during the study period, especially among extremely preterm infants (<28 weeks). We also performed a multicentre randomised controlled trial (RCT) of 493 breastfeeding mothers of preterm infants discharged from six neonatal units in Sweden. The intervention consisted of a proactive breastfeeding telephone support system in which a breastfeeding support team called the mothers once everyday up to 14 days after discharge. The control group received reactive support; the mothers were invited to call the breastfeeding support team if they wanted to talk or ask any questions (i.e., usual care). The RCT demonstrated that the intervention did not affect exclusive breastfeeding at eight weeks after discharge (primary outcome) or up to 12 months. The proactive support did not affect maternal breastfeeding satisfaction, attachment, quality of life or method of feeding (secondary outcomes). However, parental stress was significantly reduced in mothers in the intervention group. Mothers in the intervention group were significantly more satisfied and involved in the support and felt empowered compared with mothers in the control group, who experienced reactive support as dual. Further findings showed that a lower maternal educational level, partial breastfeeding at discharge and longer stay in the neonatal unit increased the risk of ceasing breastfeeding during the first 12 months of postnatal age. In conclusion, the trend for exclusive breastfeeding at discharge in preterm infants is declining, which necessitates concern. The evaluated intervention of telephone support did not affect breastfeeding, in the short-or long-term. However, maternal stress was reduced and mothers were significantly more satisfied with the proactive support and felt empowered by the support.

OBJECTIVE: Prior studies suggested rapid weight gain in infancy as a risk factor for the development of obesity. Our aim was to determine if early-childhood treatment for malnutrition is associated with the development of obesity in later-childhood. METHODS: This was a retrospective chart review of 194 children who had been treated and discharged from the Growth and Nutrition Program (GNP) from 1/1/2000 to 7/30/2014, with at least one height and weight recorded after discharge. Subjects predisposed to obesity due to medical conditions or medications were excluded. Obesity was defined using WHO and CDC growth charts, body mass index ≥95th percentile for age and sex, and compared to published prevalence rates. Potential predictors of obesity prevalence were also examined. RESULTS: None of the 194 subjects were obese at time of discharge from GNP. Over the 20-year follow-up period, 7% became obese (well below the national obesity prevalence of 18.5%1. 3 of 11 (27.3%) patients prescribed preterm infant formula became obese in contrast to 10 of 173 (5.8%) who were not prescribed (p=0.007). 6 of 27 (22.2%) subjects identified as African American became obese in contrast to 7 of 157 (4.5%) who did not identify (p=0.001). CONCLUSION: While overall prevalence of obesity was lower than that of the general population, children requiring preterm infant formula and/or identified as African American were more likely to develop obesity in childhood. Findings support the need for more anticipatory guidance regarding preterm infant formula and aggressive weight management and planning prior to GNP discharge. / 2022-06-07T00:00:00Z

Structured summary Aim of the study: To compare the diagnostic reliability, accuracy, and safety of amniocentesis and amniotic fluid Interleukin-6 testing in the diagnosis of intrauterine inflammation of patients with preterm premature rupture of membranes. Type of study: Prospective cohort study Name and location of study site: Department of Gynaecology and Obstetrics, Faculty of Medicine, Charles University in Pilsen Set and methodology: We prospectively examined patients with pPROM between the 23rd and 34th week of gestation in 2014 - 2017. All of them underwent amniocentesis and determination of IL-6 levels in amniotic fluid, leukocytes and bacteria in amniotic fluid as well as maternal blood examination for inflammation parameters. The results were compared to histological examination of the placenta after delivery for the presence of chorioamnionitis. Based on the values mentioned above the sensitivity, specificity, negative and positive predictive value, false positive and negative predictive value and accuracy of the test were determined together with an assessment of statistical significance. Furthermore, the feasibility and incidence of perioperative complications as well as the risk of secondary infection when pregnancy continued were evaluated by serial aniocenteses at weekly intervals. The...

京都大学 / 新制・論文博士 / 博士(医学) / 乙第13439号 / 論医博第2238号 / 新制||医||1054(附属図書館) / (主査)教授 万代 昌紀, 教授 小杉 眞司, 教授 稲垣 暢也 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

Objective: To describe the breastfeeding characteristics of late-preterm infants (LPIs) in a kangaroo mother care unit (KMC). Materials and methods: In a 20-bed KMC unit, the breastfeeding of 73 purposively-selected LPIs’ (mean gestational age: 34.8 weeks) was observed once-off, using the Preterm Infant Breastfeeding Behavior Scale. Participants’ mean age was 9.5 days, mean number of days in the unit was 3.1 days, and mean number of days breastfeeding was 7.5 days on observation. Results: Only 13.7% of participants were directly breastfeeding without supplementary tube-feeding/cupfeeding and 86.3% received supplementary cup-feeding of expressed breast milk. Most participants did not exhibit obvious rooting (83.5%) and although most latched-on (97.3%), those who did, latched shallowly (93%). The mean longest sucking burst was 18.8 (SD: 10.5) and approximately half the participants swallowed repeatedly (53.4%). The mean breastfeeding session duration was 17.8 minutes but most participants breastfed less than 10 minutes (76.7%). No statistically significant associations were found between chronological age and breastfeeding characteristics. A general trend towards more mature behaviors in participants breastfeeding for more days was present for many breastfeeding characteristics. More infants exhibited the most mature behavior for each breastfeeding characteristic when the environment was quiet, rather than noisy and disturbing, except for depth of latching (quiet: 0%, disturbance: 15.2%). Conclusion: LPIs in this sample presented with subtle, moderate breastfeeding difficulties, highlighting their need for breastfeeding support. Further research is required to examine the effect of KMC on breastfeeding in LPIs. / Dissertation (MA)- University of Pretoria, 2017. / Speech-Language Pathology and Audiology / MA / Unrestricted

Orientador: Maria Regina Bentlin / Resumo: Introdução: A sepse e choque séptico são importantes causas de morbimortalidade no período neonatal. A implantação de protocolos permite uma condução sequencial e rápida na sepse/ choque, o que pode melhorar o prognóstico desses pacientes. Objetivo: Investigar nos prematuros de muito baixo peso (PT-MBP) se o quadro séptico está sendo conduzido de forma sistematizada de acordo com o protocolo e se essa sistematização melhorou o prognóstico em curto prazo. Métodos: Estudo retrospectivo, do tipo coorte realizado na UTI Neonatal do Hospital das Clinicas da Faculdade de Medicina de Botucatu no período de janeiro de 2013 a dezembro de 2015, após aprovação do CEP. Foram selecionados todos os recém-nascidos (RN) prematuros com peso ao nascer inferior a 1500g (muito baixo peso), internados na UTI, nascidos ou não no Serviço, que sobreviveram por mais de 72 horas de vida. Foram incluídos todos os prematuros menores de 34 semanas e que apresentaram diagnóstico de sepse / choque séptico na Unidade. Não foram incluídos aqueles com malformações múltiplas e infecções congênitas. Variáveis estudadas: maternas, gestacionais, neonatais e variáveis do protocolo de choque da Unidade. Os recém-nascidos (RN) foram comparados inicialmente em dois grupos: sepse e choque séptico; para a avaliação do protocolo foram estudados apenas os que evoluíram para choque: com protocolo VS sem protocolo. Desfechos: displasia broncopulmonar (DBP), hemorragia periintraventricular (HPIV) grave, retinopatia da prema... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

Preterm birth (PTB) is defined as birth before the 37th week of pregnancy and affects 15 million infants per year. Presently, there is no clinical test to determine PTB risk. A 3D printed microfluidic device is being developed as a clinical test for PTB risk via detection of a panel of biomarkers. A significant step is extraction of the PTB biomarkers from blood serum. In this work, I developed 3D printed microfluidic devices in which monoliths can be polymerized. Using the monolith as a solid support to attach antibody, I show that ferritin, one of the PTB biomarkers, can be selectively extracted from human blood serum. This is the first study where a monolith has been formed in a 3D printed microfluidic device and used to perform an immunoaffinity extraction. This work is an important step in developing a clinical test for PTB risk. The realization of this work also demonstrates that 3D printing can be used to fabricate functional microfluidic devices.