Cystatin C as a Renal Function Marker for Neonates

The prediction of acute kidney injury (AKI) is important in the management of neonates, and several renal biomarkers have been tested for clinical application. Cystatin C (CysC) is a promising marker of renal function, and its application in neonatal care showed several benefits. First, CysC levels are not affected by endogenous substances such as bilirubin, hemoglobin, and ketones in laboratory tests. Second, its level is not influenced by inflammation (e.g., sepsis), muscle mass, age, gender, or nutritional status. Third, CysC is not transmitted through the placenta. Fourth, standardized automated measurement methods are available. Fifth, CysC was shown to reflect renal maturation better than creatinine. Lastly, CysC was reported to change with a wider amplitude than creatinine, which allows a more sensitive detection of renal deterioration. Recently, several reference CysC levels for neonates, including premature infants, were reported. In the present review, we summarized information on serum CysC reference values from different studies. Few studies investigated the usefulness of CysC for predicting AKI in neonates with various diseases such as neonatal respiratory distress syndrome, sepsis, and neonatal asphyxia. Recent studies showed an association between serum CysC level and cardiovascular diseases or Alzheimer's disease, indicating that CysC may play a role as a marker for various diseases in the future. Although the use of CysC as a marker in neonatal care showed several benefits, reliable and detailed reference ranges need to be established, including those for neonates with diseases. In addition, other novel renal markers need to be tested in neonates.

Low Basophil Count and Red Cell Distribution Width at Birth May Predict the Development of Neonatal Necrotizing Enterocolitis: A Matched Control Study

OBJECTIVE: The pathophysiology of necrotizing enterocolitis (NEC) is incompletely understood. There were some reports that the pathogenesis of NEC involves intrauterine process and infants with fulminant NEC had low lymphocyte count. Thus, we investigated complete blood count (CBC) parameters of infants at birth and their mothers near delivery. METHODS: We retrospectively reviewed the medical records of NEC patients and controls. The CBC parameters were compared between infants with NEC (modified Bell's criteria stage > or =Ia, n=82) and controls matched for gestational age, birth weight, gender, and race (n=169). The blood test findings were obtained from infants within the first 2 hours of life and from mothers as the latest one before delivery. RESULTS: Statistically different findings at birth were found in NEC infants; red cell distribution width (RDW) and basophil count. In the multiple logistic regression analysis after adjustment for gestational age, birth weight, and gender, several infantile independent risk factors were identified; basophil count <40/microL (odds ratio [OR], 4.60; 95% confidence interval [CI], 2.18 to 9.73; P<0.001) and low RDW (OR, 7.15; 95% CI, 2.93 to 17.41; P<0.001). CONCLUSION: We found that NEC was associated with low infantile RDW and basophil count at birth. These findings might support roles of red blood cell and basophil in the pathogenesis of NEC, which might predict development of NEC with neonatal findings at birth.

Comparison of Clinical Features of Norovirus and Rotavirus Gastroenteritis in Hospitalized Children and Norovirus Genotype Analysis

BACKGROUND: Norovirus is one of the most prevalent pathogens causing acute gastroenteritis in children. We compared the clinical features of noroviral gastroenteritis to those of rotaviral gastroenteritis and analyzed the noroviruses' genotype frequencies. MATERIALS AND METHODS: Stool samples were obtained form 433 children hospitalized with acute gastroenteritis from May 2008 through February 2009 at Soonchunhyang University Cheonan Hospital and examined for the presence of norovirus or rotavirus. We then analyzed the clinical features of noroviral gastroenteritis in comparison with rotaviral gastroenteritis and observed the capsid protein gene sequences from the isolated norovirus for genotyping. RESULTS: Norovirus was isolated from 69 patients (16.4%) and rotavirus from 49 patients (11.6%). The noroviral gastroenteritis patients experienced vomiting (77.4%), diarrhea (73.2%), and respiratory symptoms (53.6%); the rotaviral gastroenteritis patients experienced diarrhea (71.4%), dehydration (69.3%), and vomiting (65.3%). Dehydration in patients with noroviral gastroenteritis (43.4%) was rare compared with rotavirus (69.3%) (P=0.008). The isolated norovirus belonged primarily to the GII.4 genogroup (85.5%). Our phylogenetic analysis of the GII.4 isolates revealed 3 clusters, including novel cluster C. CONCLUSIONS: Vomiting was the most common symptom in noroviral gastroenteritis patients. Dehydration in noroviral gastroenteritis patients was less common compared with rotavirus gastroenteritis patients. The majority of the norovirus strains isolated from children with acute gastroenteritis belonged to the GII.4 genogroup.

A case of Werner Syndrome Complicated by Bone Metastasis of Rhabdomyosarcoma

Werner syndrome (WRN), or adult progeria, is a very rare, autosomal recessive disorder characterized by the appearance of accelerated aging, including cataracts, gray hair, skin atrophy, and atherosclerosis. This syndrome is caused by mutations in the WRN gene and had a high risk of a spectrum of rare neoplasms including: i) non-epithelial malignant or pre-malignant tumors/conditions, osteosarcomas and soft tissue sarcomas, malignant melanomas, myeloid leukemia and myelodysplastic syndrome; ii) an epithelial neoplasm, thyroid carcinoma, and iii) meningiomas. Recently, authors experienced a case of Werner syndrome complicated by bone metastasis of rhabdomyosarcoma in a 20-year old Korean man. The patient revealed a painful mass on his right knee and progeroid features, short stature, scalp alopecia, abnormal dentition, craniofacial disproportion, hypothyroidsm, cataracts and osteoporosis. The onset of symptoms of Werner syndrome generally precedes any later symptoms of associated conditions, such as malignant tumor. Therefore, early recognition of Werner syndrome is important to assist identification of malignant tumors at an early stage in this patient group.