Establishing consistent multidisciplinary assessment of tongue-tie in infants with feeding difficulties led to a marked reduction in frenotomy intervention rate. 23% of the frenotomy group in the 2016 audit showed a significant improvement in the ability to breastfeed, but overall there was no difference in the feeding pattern of infants who either received or were declined a frenotomy. The development of a supportive education programme and availability of online information about tongue-tie for health professionals and consumers contributed to successful uptake of the new clinical pathway.
Day 3 NTproBNP is a useful biomarker to predict HsPDA and may be a valuable tool in future trial design. What is Known: • NTproBNP is a cardiac hormone used to diagnose and monitor cardiac dysfunction in adults and has been shown to be higher in premature infants with haemodynamically significant ductus arteriosus (HsPDA). What is new: • NTproBNP is highly predictive of ultrasound-defined HsPDA and may be a useful tool for further triage • Early NTproBNP higher in infants who develop severe BPD and with renal impairment but not affected by gestational age, recent exposure to hypoxia or haemoglobin levels while late levels unexpectedly higher in those without BPD or HsPDA.
Context: C-type natriuretic peptide (CNP) plays an essential role in endochondral bone growth. Insight into CNP's paracrine actions is possible using plasma measurements of the amino-terminal pro C-type natriuretic peptide (NTproCNP). Whether correlations of NTproCNP with linear growth, as found in children and lambs, apply in neonates is unknown.
Objectives:Our objective was to determine the effects of prematurity, gender, and antenatal steroids on plasma NTproCNP at birth, and serial changes in hormone concentrations, linear growth, and markers of bone turnover in the first month of postnatal life.
Design and Setting:This is a prospective study of newborn infants admitted to an intensive care unit.Subjects: A total of 48 infants (four gestation groups) were enrolled. Umbilical cord samples were also obtained from 39 healthy term infants.
Main Outcome Measures:Plasma NTproCNP and CNP were measured in cord plasma. In enrolled neonates, serial measurements of hormone concentrations and markers of bone turnover were related to tibial growth velocity as measured by knemometry.Results: Cord plasma NTproCNP was inversely related to gestational age (r ϭ Ϫ0.35; P ϭ 0.003) and was higher in males (P Ͻ 0.001). Plasma NTproCNP (P ϭ 0.016) and CNP (P Ͻ 0.001) increased within the first week of life, the increase relating inversely to gestational age (r ϭ Ϫ0.64; P Ͻ 0.001). Plasma NTproCNP at 1 wk was strongly correlated with linear growth velocity (r ϭ 0.49; P Ͻ 0.001), and also at 2-4 wk, the relation being stronger than observed between bone turnover markers and growth velocity.
Conclusions:In neonates with diverse disorders affecting growth and nutrition, plasma NTproCNP was strongly correlated with linear growth during the first 4 wk of postnatal life and may prove to be a novel marker of growth plate activity in neonates.
Background: Knemometry has been used to accurately measure linear growth in both neonates and children over the last 20 years. It has been used principally as a research tool. Aim: To investigate whether serial measurement of lower leg length (LLL) by knemometry is a useful addition to other measures of growth in the neonatal unit. Methods: A 1-year prospective hospital-based cohort study from 2004 to 2005. Knemometry was performed every 3-4 days from the time of consent to time of discharge. Infants were grouped by gestation at birth for analysis (<28 weeks, 28-31 weeks, 32-36 weeks and >36 weeks gestation). The main outcome assessed was longitudinal growth. Subgroup analyses were performed on infants <10th percentile for weight, surgical infants and infants who had received antenatal steroids. Results: LLL measured by knemometry correlated well with postmenstrual age (r = 0.93) and weight (r = 0.93). The mean (SD) increase in LLL was 0.45 (0.7) mm/day. Conclusion: Change in LLL correlates well with change in weight and postmenstrual age in the neonatal period but adds little extra information to routine practice in the neonatal unit.
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