Cytomegalovirus in neonates and infants with conjugated hyperbilirubinemia

This work aimed at studying the frequency of cytomegalovirus [CMV] infection in neonates and infants with conjugated hyperbilirubinemia admitted to Alexandria University Children's Hospital. Forty three patients with conjugated hyperbilirubinemia were subjected to a through history taking, clinical examination, laboratory investigations [complete blood picture and liver function tests], cytological examination of urine using Papanicolaou method for detection of viral inclusion bodies, measurement of anti-CMV IgM and IgG by Enzyme Linked immune Sorbent Assay [ELlSA] method, and detection of CMV in the serum by using the polymerase Chain Reaction [PCR] technique. Ultrasonography was done for all patients. The results showed that history of fever during the last trimester was obtained in 4 mothers [three mothers had urinary tract infection and one mother had viral upper respiratory tract infection], low birth weight was reported in 3 infants, the age at onset of jaundice ranged from 5-130 days with a mean of 51.2 days, thirty nine patients had hepatomegaly, fifteen had splenomegaly and ascites was present in 5 infants. Clinical manifestations of hemorrhagic tendency as purpura and/or ecchymosis, or manifestations of CNS involvement as encephalitis were absent. Severe anemia and thrombocytopenia was reported only in one patient. The average values of serum transaminases and alkaline phosphatase showed increased levels in all cases. The average value of serum albumin was normal for age. Ultrasonography revealed no abnormal findings in the biliary system, moderate degree of increased liver echogenicity was seen in 10 infants. Serum PCR for CMV was positive in 6 infants, serum IgM antibodies for CMV were positive in only 4 infants, and the IgG antibodies were positive in 9 cases. Three patients had inclusion bodies bearing cells in the urinary sediment

Conclusion: cytomegalovirus is an important cause of direct hyperbilirubinemia in pediatric age. Diagnosis depending on PCR is more accurate than serology and urinary inclusion bodies bearing cells

Study of some hemostatic factors in premature infants with respiratory distress syndrome [type I]

Respiratory distress syndrome [RDS] and its complications are responsible for a large percentage of neonatal morbidity and mortality. Hemostatic disturbances are frequently observed in sick preterm infants. Disseminated intravascular coagulation [DIC] usually follows the development of RDS or the establishment of severe sepsis. The aim of the present study was to identify the frequency of DIC and consumptive thrombocytopenia in premature infants with RDS, to assess the activity of the main natural inhibitors of coagulation [Antithrombin III [ATIII] and Protein C [PC]], and to correlate the clinical findings of possible relation to DIC with the laboratory markers of DIC in the investigated preterm infants. The study was conducted on 50 premature infants with RDS and 10 normal preterm infants as a control group. Infants were subjected to full monitoring of their clinical status, vital signs and blood gases. Coagulation study included measurement of prothrombin activity, activated partial thromboplastin time [APTT], serum fibrinogen, fibrin degradation products [FDPs], the activity of antithrombin Ill and protein C. Analysis of the results showed incomplete development of the coagulation system in preterm infants as indicated by decreased prothrombin activity %, the prolonged APTT, decreased ATIII and PC activity percentages. There was a significant reduction of platelet count, ATIII and PC activity % in the group of preterm infants with RDS. There was a significant correlation between the severity of RDS and the hemocoagulative parameters of DIC. Eight [16%] of the preterm infants with RDS had abnormal results suggestive of DIC. Six [12%] of our patients had compensated DIC and seven [14%] of them had consumptive thrombocytopenia

Conclusion: the results of this study highlighted the immaturity of the coagulation mechanism in Preterm infants. Consumptive thrombocytopenia and DIC are common complications of severe RDS

influence of maternal diabetic control and insulin antibodies on fetal pancreatic beta-cell function and neonatal complications in infants of insulin treated diabetic mothers

The current work aimed at studying the influence of maternal diabetic control on fetal beta cell function and neonatal morbidity. It was conducted on 30 insulin treated diabetic mothers and their neonates who were matched with 15 infants of non diabetic mothers [INDMs] for gestational age, mode of delivery, and Apgar score. They were subjected to clinical assessment and laboratory investigations including estimation of cord blood insulin Abs and C- peptide and determination of serum levels of glucose, calcium, magnesium, hematocrit, and bilirubin. It was found that diabetic mothers had higher blood HbA1c concentrations than non diabetic mothers. Also, maternal HbA1c concentrations were proportionally correlated to the cord blood insulin Abs, and C- peptide levels; also to the birth weights of IDMs. There was an association between increased cord blood insulin Abs among IDMs and the development of macrosomia and hypoglycemia. Also, there was an increase in cell function with the increase of cord blood insulin Ab level. Strict antenatal control of diabetes is strongly recommended to decrease the frequency of macrosomia and neonatal hypoglycemia. The use of purified insulin preparations with minimal immunogenicity would be the best

Study of the efficacy of acetaminophen prophylaxis on the reaction to DTP vaccination

To determine the effect of prophylactic acetaminophen on reactions after diphtheria and tetanus toxoids and pertussis vaccination, 1600 infants and children received either acetaminophen or placebo using a systemic sampling technique, before, 4 and 8 hours after vaccination. Fever, local and systemic reactions were monitored. Overall, the reaction score of acetaminophen recipient was significantly less than that of the placebo recipient was significantly less than that of the placebo recipients. The rates of occurrence of fever and crying and the degree of pain at the injection site were significantly reduced by acetaminophen administration. Infants who received acetaminophen were less likely to be switched to a known antipyretic than placebo recipients. We can conclude that prophylactic acetaminophen had a moderating effect on the adverse reactions to DTP vaccination

Effect of severe protein energy malnutrition on duodenal secretory IgA

Estimation of secretory IgA in the duodenal fluid of 12 marasmic, 8 kwashiorkor patients and 10 matched healthy infants as controls showed a significant decrease in both marasmic and kwashiorkor patients. The level of duodenals sIgA was lower in kwashiorkor than in marasmic patients but the differences was statistically insignificant

head circumference in infants of diabetic mothers during the first year of life

The present study was carried out on 108 full term infants of diabetic mothers [IDM] and 105 normal infants as a control group, to assess the head circumference as an indicator of brain growth during their first year of life. The mean head circumference of both male and female IDM was smaller than the corresponding controls. The difference, however, was not statistically significant. None of the cases had microcephaly. The centile distribution of head circumference and weight /height ratio in IDM were not comparable, while a comparable distribution was noted in the control group. From the results of the study, it could be concluded that the postnatal growth of infants of diabetic mothers was characterized by continued increase in weight and height. Head growth, however, proceeded at slower rate to body proportions

Urinary tract infection in malnutrition

Sixty protein-calorie-malnourished [PCM] children without evidence of infection were evaluated for the presence of urinary tract infection [UTI]. Twenty children of matched age and sex served as controls. The urine sample was obtained by supra-pubic bladder tap. Five malnourished children [8.33%] had positive urine cultures and significant bacteruria by colony count, while all the controls were negative. Significant pyuria [> 5 pus Cells/ H.P.F.] was present in 15 PCM children [25%] but not in any of the control children. All cases with positive urine culture had pyuria > 15 pus cells/ H.P.F