Assessment of bone status for newborn infants by dual energy X-Ray absorptionmetry

Dual Energy X-ray Absorptiometry DXA was used to follow postnatal changes in the bone mineral content BMC of 20 premature newborn infants with gestational age [32.2 +/- 0.90] weeks and birth weight [1.981 +/- 0.41]g. BMC was measured at birth and then, when these infants reached maturity by age [38.5 +/- 0.17]weeks. Also BMC of an equal number of full term newborn infants was measured at birth. Results of this study showed that: BMC and body weight of premature infants increased significantly at term [45.15 +/- 0.31g and 3.250 +/- 00.367 g respectively] compared with BMC and body weight measured at birth [16.0 +/- 0.73 g and 1.981 +/- 0.41 g respectively], P <0.007. Also, at term, the BMC and body weight of premature infants are still significantly low compared with BMC and body weight of full term newborn infants [56.32 +/- 0.39 g and 3.492 +/- 0.365 g] respectively, P<0.001. Serum calcium, phosphorus, alkaline phosphatase and osteocalcin concentrations were not significantly different between the preterm and full term newborn infants at any time point. We conclude that BMC of preterm newborn infants increased at expected term but is still low compared with BMC of full term infants. This difference may be related to the difference in body size between full term and preterm at expected term

Recurrent abdominal pain in children does toxocariasis play a role?

Recurrent abdominal pain [RAP] of unexplained etiology is a relatively common pediatric problem. It is often referred to as functional abdominal pain with only 5-10% of the affected children have organic causes for their pains. Toxocariasis, a helminthic zoonosis, causes a spectrum of diseases in man: two major syndromes; visceral larva migrans [VLM], Ocular larva migrans [OLM] and a third more common condition, covert toxocariasis in which positive toxocara serology [both anti-toxocara excretory-secretory IgG and IgE] are associated with a number of systemic and localized symptoms and signs; notably recurrent abdominal pain. It has been implicated as a cause of RAP which might be otherwise interpreted as an idiopathic. Aim of this study is to assess the role of toxocariasis as a causative agent of unexplained recurrent abdominal pain in our children based on clinical, serological and therapeutic criteria. One hundred fifty children suffering from RAP were included in our prospective study. After detailed history, thorough clinical examination and relevant investigations, patients were divided into two groups: the first with organic RAP and the second with unexplained RAP. Patients in the second group were subjected to complete blood count, eosinophilic count, urine and stool analysis, ELISA serotesting for anti-Toxocara excretory- secretory [TES] IgG and IgE and were followed-up for three months. Seropositive [IgG] patients were treated with Albendazole and re-tested for specific antibodies at the end of our study. Out of 150 children with RAP, 26.6% [40 patients] showed definite organic causes with intestinal parasites, particularly Giardia lamblia, represented the most common etiology. Among the remaining 73.4% [110 patients] who were addressed as unexplained RAP, 21.8% [24 patients] were anti [TES] IgG positive. Almost half of them [13 patients] were seropositive for anti [TES] IgE also [covert toxocariasis]. Unexplained RAP was the sole presentation in 61% [8/13] of them and high blood esinophils [>5% of TBL] was a common finding 77% [10/13]. Anti [TES] IgE was positive in 92% of chemoresponsive patients and was negative in all non-respenders. Post treatment mean of anti [TES] IgE showed significant decrease [P <0.05] when compared to pre-treatment level [45 +/- 9.8 Vsl90 +/- 13.3] while no difference can be proved regarding anti [TES] IgG [1.22 +/- 0.35 Vs 1.28 +/- 0.32]. Covert Toxocariasis may be a hidden cause of unexplained RAP in children and should be enlisted in its differential diagnosis particularly if associated with eosinophilia. ELISA quantitative assay of anti TES IgE, not only provide a specific diagnostic indicator for covert Toxocariasis but is a useful tool in monitoring drug therapy as well

Effect of exchange transfusion on oxygen free radicals and some antioxidants in newborn infants

Exchange transfusion rapidly produces variable changes in pro-oxidants and antioxidants plasma concentrations in neonates which may be responsible for free radical metabolism. So our study aimed to evaluate the effect of exchange transfusion on some pro-oxidants [iron, and ferritin] and primary antioxidants [ceruloplasmin and transferrin] in newborn infants. The study included 25 neonates [16 males and 9 females] with mean gestational age of 34.4 +/- 3.9 weeks. They were divided into 2 groups according to clinical presentation, 17 with hyperbilirubinemia [6 haemolytic and 11 non haemolytic] and 8 hyperbilirubinemia with sepsis. All neonates were subjected to full clinical history, Gestational age assessment, thorough clinical examinations for all systems and laboratory investigations [before and after exchange transfusion] in the form of complete blood count, serum levels of total and direct bilirubin, serum levels of ferritin, Iron and T.I.B.C., serum level of malondialdehyde and serum levels of ceruloplasmin and transferrin.Regarding to our results, serum level of total bilirubin showed statistically highly significant decrease after exchange transfusion [E.T.] and primary antioxidant [ceruloplasmin and transferrin] were significantly elevated after E.T. As regard pro oxidants, there was highly significant decrease in serum levels of ferritin, iron and malondialdehyde after E.T. and highly significant rise in serum level of T.I.B.C. after E.T. The differences between the mean values of serum ferritin, iron, T.I.B.C., transferrin and - ceruloplasmin before and after exchange transfusion were statistically significant in preterm and neonates with birth weight less than 2kg. Transferrin showed positive correlation with gestational age.After exchange transfusion there was significant decrease in serum levels of ferritin and iron and significant increase in T.I.B.C. in both groups of neonataI hyperbilirubinemia and neonatal hyperbilirubinemia with septicemia. Serum levels of transferrin and ceruloplasmin were also increased after exchange transfusion in both groups but without significant statistical difference. Finally we can conclude that elevation of serum levels of primary antioxidants [ceruloplasmin and transferrin] and lowering serum levels of oxygen free radicals [MDA as an index] after exchange transfusion indicate its important role not only in decreasing the serum bilirubin level but also in improving the defence mechanism against oxygen free radical injury especially in preterm neonates. Preterm and neonates with low birth weight are more vulnerable to neonatal oxygen radical diseases because of their developmentally low iron associated antioxidant proteins [transferrin]