A Pitfall of Measuring Lithium Levels in Neonates
Bibliographic record
Abstract
If lithium therapy is required during pregnancy or lactation, serum lithium monitoring may be indicated in the newborns. In the neonatal population, however, blood samples are often obtained with a sampling device containing lithium heparin. Given the infrequent nature of lithium measurement in the neonatal population, a risk of oversight on the use of these lithium-containing devices for lithium measurements exists. Two such neonatal cases are reported, which may have been mismanaged if the measured levels of lithium were not suspected to be spurious. Patient 1 was a 3-day-old infant with a congenital heart disease born at 31 weeks' gestation to a mother on lithium. After a surgical repair, because of a potential need to monitor lithium in the infant's serum during breastfeeding, a remaining sample of apparently serum from a previous blood testing on day 1 of life was measured for lithium as a baseline value. Despite the lack of toxic signs, the result showed a toxic lithium level of 4.19 mmol/L. Lithium levels in follow-up samples were 0.11 mmol/L (day 4) and undetectable (day 6). Patient 2 was a full-term infant exposed to maternal lithium throughout the fetal life and breastfeeding. Serum lithium at day three of life in a hospital was undetectable, but after discharge, the lithium concentrations increased to 1.1 mmol/L on day 18, with no sign of lithium toxicity or renal dysfunction. This raised a possibility of significant exposure through breastfeeding, but later they were found to be spurious due to the use of lithium-containing devices. Separate investigation of effects of sampling devices on lithium levels indicated that levels of >3 mmol/L were possible if a sampling volume of blood was substantially small compared with the capacity of a tube containing lithium heparin [corrected]
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.017 | 0.054 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.004 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.004 | 0.007 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".