Data reported here are the first from a large national data set on the use of different medications for neonates admitted for intensive care and should be helpful in establishing priority agendas for future drug studies in this population.

ABSTRACT. Background. Leptin, the protein product of the ob gene, is produced by the adipocyte and seems to function as a link between adiposity, satiety, and activity. Leptin has also been found to be necessary for pubertal development, conception, and pregnancy in mice, and is increased in prepubertal children, independent of adiposity, suggesting a role in childhood growth and development. This study investigated 100 mother/newborn pairs to determine the role of leptin in neonatal development. Placental tissue was assayed for leptin mRNA to evaluate it as a source of leptin production in utero.Methods. One hundred mother/newborn pairs were enrolled in this study. Radioimmunoassay was performed for leptin on maternal venous and newborn cord blood. Leptin concentrations were measured in 43 children in Tanner stages 1 and 2 as a control group. Placental tissue was obtained from five mothers and assayed for leptin mRNA by reverse transcription/polymerase chain reaction (RT/PCR). Human placental cell lines JAR and JEG-3 were also assayed for leptin mRNA expression.Results. Leptin was present in all newborns studied at a mean concentration of 8.8 ng/mL (؎9.6 standard deviations). Leptin concentrations in cord blood correlated with newborn weight (r ‫؍‬ .51), body mass index (BMI) (r ‫؍‬ .48), and arm fat (r ‫؍‬ .42). There was no correlation between leptin and insulin. When statistically covarying for adiposity for newborns and Tanner stages 1 and 2 children, newborns had greater concentrations of leptin (mean, 10.57 ng/mL) than children (mean, 3.04 ng/mL). Leptin was present in all mothers at a mean value of 28.8 ng/mL (؎22.2 standard deviations). Leptin concentration correlated with prepregnancy BMI (r ‫؍‬ .56), BMI at time of delivery (r ‫؍‬ .74), and arm fat (r ‫؍‬ .73). Maternal leptin correlated with serum insulin (r ‫؍‬ .49). There was no correlation between maternal and newborn leptin concentrations. Thirteen percent of newborns had higher leptin concentrations than their mothers. Placental tissue from five separate placentas expressed leptin mRNA at comparable or greater levels than adipose tissue. Two human trophoblastic placental cell lines, JAR and JEG-3, also expressed leptin mRNA. Conclusions.The correlation between leptin and adiposity found in children and adults was also found in newborns. Serum leptin concentrations in newborns were increased more than three-fold compared with children in Tanner stages 1 and 2 when controlling for adiposity, suggesting that leptin concentrations in the newborn are not explained by adiposity alone. Maternal leptin concentrations correlated with measures of adiposity at delivery but did not correlate with newborn adiposity or leptin. Leptin mRNA was expressed both in placental tissue and in two human placental cell lines. These data suggest that leptin has a role in intrauterine and neonatal development and that the placenta provides a source of leptin for the growing fetus. Pediatrics 1997; 100(1). URL: http://www.pediatrics.org/cgi/content/full/ 100/1/e1; leptin, ...

Our proposed scoring system may be a valuable tool to quantify changes during CFM more objectively, reflecting variations in CNS activity in newborn infants and allowing for better statistical comparisons between amplitude-integrated electroencephalogram tracings from different patients as well as from the same patient at different points of time.

From 2004 through 2013, the neonatal abstinence syndrome was responsible for a substantial and growing portion of resources dedicated to critically ill neonates in NICUs nationwide.

For patients receiving ampicillin, the concurrent use of cefotaxime during the first 3 days after birth either is a surrogate for an unrecognized factor or is itself associated with an increased risk of death, compared with the concurrent use of gentamicin.

Higher doses of amino acid supplementation did not improve neonatal growth and were associated with increased blood amino acid and urea nitrogen levels.

In recent years, neonatal abstinence syndrome (NAS), which commonly occurs after opioid use in pregnant women, has increased, nearly tripling in the United States between 2000 and 2009. There are limited data on the treatment of infants with NAS or changes in neonatal intensive care units. Previous studies have focused on specific geographic areas or used hospital billing records, not infant-specific clinical information, to identify cohorts. This study aims to analyze changes in incidence as well as treatment of infants with NAS in neonatal intensive care units (NICUs) across the United States from 2004 to 2013.Data were collected from Pediatrix Clinical Data Warehouse, which includes information from NICUs in 33 states and Puerto Rico. Infants were excluded if they had major congenital anomalies, if they were born before 34 weeks, if they were admitted only for suspected cases or to rule out NAS, or if they had exposure to narcotics but were not diagnosed with NAS. Infants were grouped by year of discharge in 1-year periods. Multiple cross-sectional analyses were performed using general linear regression.A total of 10,327 infants from 299 centers met diagnostic criteria for NAS. The frequency of infants with NAS admitted to NICUs increased from 7 cases per 1000 admissions to 27 cases per 1000 admissions between 2004 and 2013 and increased more rapidly between 2009 and 2013 than between 2004 and 2008. The length of hospital stay also increased from 13 to 19 days between 2004 and 2013, and the number of NICU hospital days attributed to NAS increased from 0.6% in 2004 to 4.0% in 2013 (P < 0.001 for trend). The proportion of infants treated for NAS with pharmacotherapy increased from 74% to 87% (P < 0.001 for trend), and the mean duration of therapy increased (P < 0.001 for trend). Whereas the ratio of days of therapy to NICU days increased (P = 0.004 for trend), the proportion of infants discharged while receiving medications decreased (4% in 2004-2005 vs 2% in 2012-2013, P < 0.001 for trend). The most commonly used medication was morphine, and the proportion of infants on morphine increased from 49% in 2004 to 72% in 2013 (P < 0.001 for trend). Between 2004Between and 2013Between , clonidine use increased, and between 2011Between and 2013 The study found that between 2012 and 2013, many mothers of affected infants used opioid pain relievers rather than illicit drugs, which is consistent with reports suggesting that increased opioid use in pregnant women is in part causing the increase in the incidence of NAS. The study also found increases in the utilization of resources for infants with NAS in NICUs between 2004 and 2013, and effective strategies for antenatal prevention and postnatal treatment of NAS are needed. These findings also support the need to address the current opioid use and abuse epidemic in the United States. 551Newborn Medicine

Objective To determine whether exposure to any antenatal corticosteroids is associated with a lower rate of death at each gestational age at which administration is currently recommended.Design Prospective cohort study.Settings 300 participating neonatal intensive care units of the Pediatrix Medical Group in the United States.Participants 117 941 infants 23 0/7 to 34 6/7 weeks’ gestational age born between 1 January 2009 and 31 December 2013.Exposure Any antenatal corticosteroids.Main outcomes measures Death or major hospital morbidities analyzed by gestational age and exposure to antenatal corticosteroids with models adjusted for birth weight, sex, mode of delivery, and multiple births.Results Infants exposed to antenatal corticosteroids (n=81 832) had a significantly lower rate of death before discharge at each gestation 29 weeks or less, 31 weeks, and 33-34 weeks compared with infants without exposure (range of adjusted odds ratios 0.32 to 0.55). The number needed to treat with antenatal corticosteroids to prevent one death before discharge increased from six at 23 and 24 weeks’ gestation to 798 at 34 weeks’ gestation. The rate of survival without major hospital morbidity was higher among infants exposed to antenatal corticosteroids at the lowest gestations. Infants exposed to antenatal corticosteroids had lower rates of severe intracranial hemorrhage or death, necrotizing enterocolitis stage 2 or above or death, and severe retinopathy of prematurity or death compared with infants without exposure at all gestations less than 30 weeks and most gestations for infants born at 30 weeks’ gestation or later.Conclusion Among infants born from 23 to 34 weeks’ gestation, antenatal exposure to corticosteroids compared with no exposure was associated with lower mortality and morbidity at most gestations. The effect size of exposure to antenatal corticosteroids on mortality seems to be larger in infants born at the lowest gestations.