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, ...

In our population of VLBW infants, sepsis is frequently associated with thrombocytopenia and an elevation in MPV. However, fungal and Gram-negative pathogens are associated with a lower platelet count and more prolonged thrombocytopenia compared with Gram-positive pathogens. We conclude that common pathogens causing sepsis have different effects on platelet kinetics.

ABSTRACT. Objective. Leptin, a hormone present in breast milk, is involved in energy regulation and metabolism. The purpose of this investigation was to determine whether leptin is present in either preterm breast milk (PBM) or preterm formula (PF). The effects of delivery methods and pasteurization on leptin levels also were evaluated.Methods. PBM samples were obtained from 29 mothers who delivered infants at between 23 and 34 weeks' gestation. Leptin levels were measured in PBM and PF with the use of a radioimmunoassay specific for human and bovine leptin, respectively. Milk samples were pasteurized by fast-and slow-heating methods. PBM and PF spiked with human leptin were delivered through catheters by bolus and continuous administration to determine the effects of delivery method on recoverable leptin levels.Results. Median PBM leptin concentration was 5.28 ng/mL (intraquartile range: 24.79). Birth gestational age, birth weight, and gender of the infant did not significantly influence PBM leptin levels. Neither bolus nor continuous feeding practices affected leptin levels in PBM or spiked PF. However, pasteurization significantly reduced the amount of detectable leptin in PBM.Conclusions. PBM leptin levels were highly variable and similar to levels reported for term breast milk. There was no effect of postnatal age on PBM leptin concentrations. Sterilization decreased detectable leptin levels, whereas feeding practices had no adverse effect on the quantity of leptin delivered. Although no infant formula contained leptin, leptin could be added to formula and delivered through various feeding methods without loss. Pediatrics 2001;108(1). URL: http://www.pediatrics.org/ cgi/content/full/108/1/e15; delivery method, infant formula, leptin, pasteurization, preterm breast milk.ABBREVIATIONS. PBM, preterm breast milk; PF, preterm formula; RIA, radioimmunoassay. L eptin can no longer be viewed as solely an antiobesity hormone. Although leptin plays an important role in modulating adaptation to energy regulation and utilization in the fasting state, 1 it also affects angiogenesis, 2 wound healing, 3 hematopoiesis, 4,5 bone metabolism systems, 6 and the neuroendocrine 7 and immune systems. 8 In utero, the fetus is exposed to leptin derived primarily from the placenta 9,10 and from its own tissues. 11 Premature delivery separates the infant from its principal source of leptin before the late-gestation rise in leptin levels. 9 Premature infants have significantly lower serum leptin levels than full-term infants. 12 This has significant implications for the premature infant, who is in a catabolic state.Breast milk and formula are the only sources of nutrition and growth factors for the infant in the postnatal environment. Mammary epithelial cells produce leptin, 13 and leptin is secreted into term breast milk. [13][14][15] A previous study 15 showed that leptin can pass from mother's milk into the circulation of rat pups, suggesting that term breast milk is an exogenous source of leptin. Whether preterm breast milk (PBM) ...

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Objectives:To determine what sources of information are most helpful for neonatal intensive care unit (NICU) parents, who provides NICU parents with the information, and also what expectations parents have regarding obtaining information.Study design: A 19-item questionnaire was given to the parents of infants 32 weeks or younger prior to discharge from the NICU.Results: Out of the 101 parents who consented, almost all of the parents (96%) felt that 'the medical team gave them the information they needed about their baby' and that the 'neonatologist did a good job of communicating' with them (91%). However, the nurse was chosen as 'the person who spent the most time explaining the baby's condition, 'the best source of information,' and the person who told them 'about important changes in their baby's condition' (P<0.01). Conclusion:Although the neonatologist's role in parent education is satisfactory, the parents identified the nurses as the primary source of information. Journal of Perinatology (2006) IntroductionOne out of every eight babies is born prematurely in the United States. The birth of a premature infant is a stressful event. The major concerns of neonatal intensive care unit (NICU) parents' during this stressful time are their informational needs, their grief response, their parent-child role development, stress and coping, and social support. [1][2][3][4] In most studies, parents communicated that their need for information was one of their most important concerns. Parents want 'clear and honest information,' 3,5 and have commented that they have had 'difficulty in obtaining accurate and up-to-date information'. 6 Obtaining information is important because it helps parents assume their parenting role, gives them some sense of involvement and control while decreasing their feelings of stress, and helps them cope with the fear and uncertainty of the situation.2,7 Without adequate communication with the medical team and adequate teaching, parents are at risk for maladjustment and preterm infants are at risk for abuse and neglect, failure to thrive and poor social adjustment. 2,7,8 Owing to the profound consequences of poor doctor--patient communication and the concerns of NICU parents, communication was made one of the priorities of the 'Principles of Family Centered Care' published in 1993. 9 The number one principle states that 'family centered neonatal care should be based on open and honest communication between parents and professionals on medical and ethical issues'. Although previous research has focused on parent education, 10 the times for teaching, 5,7 and the internet as a source of information, 12 there has been little research in regards to the specifics of 'open and honest communication'. It is not known from whom or from what source parents want to receive the 'clear and honest information'.The objectives of this study were to determine what sources of medical information are most helpful for NICU parents, who provides parents with the medical information, and also what expectations ...

The purpose of this investigation is to assess family stress, coping, perceptions of their infant, and alterations in mood that may result from the hospitalization of their critically ill newborn infant. Eligible patients were those infants hospitalized in the Special Care Nursery (SCN) at Christiana Care Health Services, who were born up to 31 weeks' gestational age. Twenty-seven families (mothers and/or fathers) completed four questionnaires at 2-week intervals during the course of their premature infants' hospitalization. Data were primarily evaluated by using analysis of variance (ANOVA)/multivariate analysis of variance (MANOVA). A score for neonatal acute physiology (SNAP) was obtained in each infant to assess the effect of the severity of neonatal illness on the questionnaire variables. Families with high stress scores on the Parental Stressor Scale had different coping strategies than those with less stress scores. A high level of maternal depressive symptomatology was associated with altered methods of coping, general stress, and perception of infant health. There was no relationship between the SNAP score on the overall level of stress families. Families who completed more than two questionnaires differed from those who only completed two or less questionnaires, although the sample size was too small to assess longitudinal changes in this study population. Level of stress and depressive symptoms are two major influences of how families cope with the current hospitalization of a premature infant. The degree of neonatal illness is not a major contributor to the parents' coping ability. Healthcare providers need to understand these dynamics when supporting families during the hospitalization of their premature infant.

In our population of very low birth weight infants, TH has an incidence of 85%. Very low T4 values on initial newborn screening are associated with increased odds of death and IVH. Additional investigation is needed to determine whether low serum thyroxine level contributes to IVH and neonatal death or whether it is simply an associated factor.

Transfusion with 20 mL/kg red blood cells produces a significantly greater increase in hemoglobin and hematocrit levels than does a transfusion with 10 mL/kg, without any detrimental effects on pulmonary function.