The Difference of Lymphocyte Subsets Including Regulatory T-Cells in Umbilical Cord Blood between AGA Neonates and SGA Neonates

PURPOSE: This study aimed to compare the regulatory T cells in cord blood of appropriate for gestational age (AGA) neonates with those of small for gestational age (SGA) neonates. MATERIALS AND METHODS: Umbilical cord blood was collected upon labor in 108 healthy full-term (between 37 and 41 gestational weeks) neonates, who were born between November 2010 and April 2012. Among them, 77 samples were obtained from AGA neonates, and 31 samples were obtained from SGA neonates. Regulatory T cells and lymphocyte subsets were determined using a flow cytometer. Student's t-test for independent samples was used to compare differences between AGA and SGA neonates. RESULTS: Regulatory T cells in cord blood were increased in the SGA group compared with normal controls (p=0.041). However, cytotoxic T cells in cord blood were significantly decreased in the SGA group compared with normal controls (p=0.007). CONCLUSION: This is the first study to compare the distribution of lymphocyte subsets including regulatory T cells in cord blood between AGA neonates and SGA neonates.

Gases en sangre de arteria umbilical de neonatos a término en altura / Umbilical artery blood gases of term neonates at altitude

Con el objetivo de determinar los valores normales de gases en sangre en la arteria umbilical de neonatos a término a 3400 m de altitud se hizo un estudio transversal, realizado en la sangre de la arteria umbilical de 300 neonatos a término, adecuados para la edad gestacional y cuyo parto se dio entre enero de 2010 a diciembre de 2011 en el Hospital Nacional Adolfo Guevara Velazco de EsSalud (Cusco, Perú). Se encontró que la media del pH de neonatos sanos a término fue de 7,33 ± 0,07, los valores para los percentiles 5 y 95 fueron 7,18 y 7,40 respectivamente. En conclusión, se han construido las tablas con los percentiles 5 al 95 para el pH, pO2, pCO2, SO2, p50, exceso de bases y HCO3, de la arteria umbilical de neonatos a término a 3400 m de altitud.

In order to determine the normal values of arterial blood gases in the umbilical artery of term infants at 3400 m altitude, a cross-sectional study was conducted. It was performed in the umbilical artery blood of 300 term infants, with an adequate gestational age and whose birth took place between January 2010 and December 2011 at the Essalud National Hospital Adolfo Guevara Velazco (Cusco, Peru). It was found that the average pH of healthy term infants was 7.33 ± 0.07; the values for percentiles 5 and 95 were 7.18 and 7.40 respectively. Tables with the 5th and 95th percentiles for pH, pO2, pCO2, SO2, p50, base excess and HCO3 of the umbilical artery of term infants at 3400 m altitude are provided.

Prevalence of glucose-6-phosphate dehydrogenase and thyroid hormones deficiency in neonatal jaundice

G6PD deficiency is the most common inherited metabolic disorder and clinically significant red cell enzyme defect in man. Severe neonatal jaundice proved to be the most common clinical manifestation and a globally important most dangerous consequence of G6PD deficiency. Prolonged jaundice is sometimes associated with congenital hypothyroidism. So the early characterization of G6PD activity and thyroid hormone levels provides an etiological diagnosis for neonatal jaundice as well as the opportunity to give the newborn's family information concerning hemolytic crisis prevention and an early management in case of hypothyroidism. This study was conducted in an attempt to evaluate the prevalence of G6PD deficiency and hypothyroidism in relation to neonatal physiological hyperbilirubinemia. The study included 50 neonates aged between 6 hr - 5 days, forty infants had jaundice and the other ten [control], were healthy neonates, matching the same age. All infants of the study were subjected to C-RP test, routine hematological evaluation, and serum total bilirubin levels, quantitative red blood cells G6PD assay and thyroid hormone levels. All the fifty cases of both jaundiced and healthy neonates were negative for C-RP test indicating that the 40 cases had physiological jaundice .The study revealed that G6PD enzyme was lower than normal level in 2 cases [5%]. TSH level was found to be higher than normal in 13 jaundiced neonates out of 40 [33%]. Seven jaundiced neonates [18%] had T4 hormone lower than normal while all the 40 jaundiced cases had normal T3 level. Correlation of the total bilirubin was significant with TSH and T3 at 0.05 levels, while there was no significance with both T4 and G6PD. statistically there was no correlation between bilirubin and both G6PD enzyme and thyroid hormones, but the incidence of hypothyroidism in this study was high [18%] and the incidence of G6PD deficiency was [5%]. This indicates a role of G6PD deficiency and hypothyroidism in developing neonatal jaundice among neonates. So, early neonatal screening program is recommended for early management

Maternal Anemia and its Effect on Cord Hemoglobin.

Background: Maternal anemia is a common problem during pregnancy and it can lead to adverse consequences in both the mother and the fetus. Aim of study: To determine the effect of maternal anemia on fetal cord blood hemoglobin. Materials and Methods : The study was conducted over a period of one year in Gian Sagar Medical College and Hospital, a rural medical college near Chandigarh. A total of 248 pregnant women in labour were included in the study. 108 of the women were anemic with hemoglobin of less than 11g/dl. 138 women had hemoglobin more than 11gm/dl and they formed the control group. After delivery of the baby, the cord was clamped and divided. Blood for hemoglobin assessment was taken from the cord and sent for analysis. The results of cord hemoglobin were compared between the two groups. Results: Cord blood hemoglobin was lower in neonates born to anemic mothers as compared to non anemic mothers.

Fatores associados com a infecção relacionada ao cateter percutâneo em recém-nascidos de alto risco / Factors associated with catheter-related infections to percutaneous catheter in newborn of high risk

A infecção sanguínea relacionada ao Cateter Central de Inserção Periférica (PICC) se destaca entre as principais intercorrências na utilização deste dispositivo venoso, isto porque indica a necessidade de sua remoção imediata e antecipada, uma vez que a finalidade da instalação do cateter seria permitir um acesso venoso de longa permanência. Esta infecção se dá pela colonização do cateter com migração de microrganismos para o interior da corrente sanguínea, caracterizando uma bacteremia. Diante da possibilidade de ocorrência de complicações pelo uso de cateter, o Center for Disease Control (CDC) disponibilizou o Guidelines for the prevention of intravascular catheter-related infection, cujo objetivo é uniformizar a prática de inserção e manutenção de cateteres intravenosos, entre os quais o PICC. Dentre as muitas recomendações do guia, destaca-se a necessidade de análise periódica da adesão dos profissionais de saúde ao protocolo de controle de infecção, a qual tem por objetivo verificar se medidas de controle e prevenção das complicações infecciosas relacionadas ao uso de cateteres venosos estão surtindo os efeitos esperadosEste estudo, portanto se objetiva a estimar a associação de fatores descritos no formulário de vigilância para dispositivos intravasculares com a incidência de infecção relacionada ao cateter de PICC em recém-nascidos de alto risco. Foram analisados 63 prontuários de recém-nascidos com peso entre 500 a 1500 gramas, que utilizaram PICC quando estavam internados na Unidade de Terapia Intensiva Neonatal do Instituto Fernandes Figueira no período de janeiro de 2009 a dezembro de 2010. Estimou-se que a frequência de infecção pelo uso do cateter nesta população foi de 25,40 por cento...

A bloodstream infection related to Peripherally Inserted Central Catheter (PICC)stands out among the main complications in using this venous device, because it indicates theneed for its immediate removal and anticipated, since the purpose of the installation of thecatheter would allow access Venous long stay. This infection is by colonization of the catheterwith antigen migration into the bloodstream, characterized bacteremia.Faced with the possibility of complications catheter use, the CDC released theGuidelines for the prevention of intravascular catheter-related infection, whose goal is tostandardize the practice of insertion and maintenance of intravascular catheters, including thePICC. Among the many recommendations of the guide, there is the need for periodic reviewof the membership of health professionals to the infection control protocol, which aims todetermine whether measures of control and prevention of infectious complications related tothe use of venous catheters are having an expected effects.This study therefore aims was to assess the association of factors described in the formof surveillance devices with the incidence of intravascular catheter-related infection PICC ininfants at high risk.We analyzed medical records of 63 neonates weighing 500-1500 grams, which whenused PICC were admitted to the Neonatal Intensive Care Unit of the Fernandes FigueiraInstitute from January 2009 to December 2010. It was estimated that the frequency of catheterinfection in this population was 25.40 percent...

Aspectos hematológicos y somatométricos de los recién nacidos en el Callao y en Cerro de Pasco (2008-2011) / Hematological and somatometric aspects of the newborns in Callao and Cerro de Pasco (2008-2011)

Objetivos: Describir y comparar los aspectos hematológicos y somatométricos de los recién nacidos en Cerro de Pasco y en el Hospital Nacional Daniel Alcides Carrión en el período 2008-2011. Material y métodos: Se realizó un estudio observacional, analítico, de casos. Se revisaron 1029 historias clínicas de neonatos a término que cumplían con los criterios de inclusión, siendo 510 historias de recién nacidos en Cerro de Pasco y 519 historias de recién nacidos en el Hospital Nacional Daniel Alcides Carrión. Resultados: En Cerro de Pasco el 59 por ciento eran convivientes; y el 75.7 por ciento tenían grado de instrucción secundaria. En cuanto a las madres atendidas en el Hospital Nacional Daniel Alcides Carrión encontramos que: el 49.5 por ciento eran casadas, y el 75.9 por ciento tenían grado de instrucción secundaria. En el Hospital de Cerro de Pasco la media de la hemoglobina fue de 13.2+/-0.8 gr por ciento, la media de la edad gestacional fue 39.1+/-1 semanas; el promedio del Apgar al minuto fue de 8 y a los 5 minutos fue de 9. En el Hospital de Daniel Alcides Carrión la media de la hemoglobina fue de 12.6+/-0.7 gr por ciento, la media de la edad gestacional fue 39.0+/-1 semanas; el promedio del Apgar al minuto fue de 8 y a los 5 minutos fue de 9. En el Hospital de Cerro de Paseo la media del peso del recién nacido fue de 3038+/-320 gramos; la media de la talla fue 49.3+/-1.4 cm, y el promedio del perímetro cefálico fue 33.7+/-0.91. En el Hospital Daniel Alcides Carrión la media del peso del recién nacido fue de 3042+/-197 gramos; la media de la talla fue 49.1+/-1.2 cm, el promedio del perímetro cefálico fue 33.7+/-0.91. Conclusiones: No hubo diferencias estadísticamente significativas en relación a los datos antropométricos y hematométricos según nivel del mar (P<0.05).

effect of transient and persistent neonatal hypothyroidism on the adult albino rat testis [light and electron microscope study]

thyroid hormone is known to play a critical role in the development and growth of the testis. So, this study was designed to compare between the effect of transient and persistent neonatal hypothyroidism on the testis of adult rats. Thirty newborn rats [1 day old] were classified equally into control group and two experimental groups. In experimental group I, the transient hypothyroidism was induced in neonates by giving their lactating mothers 0.05%, 6-propyl-2 thiouracil [PTU] through drinking water for 30 days after birth then the treatment was withdrawal for 60 days. In experimental group II, the persistent hypothyroidism was induced by giving the neonates 0.05% PTU through their mother's milk until weaning then directly through drinking water for 90 days after birth. After 90 days postpartum, all animals were anesthetized and their testes were dissected out and processed for light and electron microscope examination. In experimental group I, the testes of transient hypothyroid rats appeared with large seminiferous tubules [ST] that the length of their diameters and the height of their lining epithelium were significantly increased as compared to those of control rats. They were lined by many Sertoli cells, primary spermatocytes, secondary spermatocytes, early spermatides and late spermatids. The interstitial spaces contained some Leydig cells and few fluid. In experimental group II, the testes of persistent hypothyroid rats appeared with small ST that the length of their diameters and the height of their lining epithelium were significantly decreased as compared to those of control rats. They were lined by thin disorganized germinal epithelium containing many Sertoli cells and few germ cells. Many sloughed degenerating cells and large multinucleated giant cells were seen in the lumen of ST. The interstitial spaces contained many connective tissue cells, congested blood vessels, excessive collagen fibers and abundant fluid. Electron microscope examination revealed Sertoli cells which were surrounded by wide spaces due to loss of germ cells. They contained distorted mitochondria, nuclei with peripheral heterochromatin condensation. They appeared with free processes due to loss of tight junction between them. the present study revealed that the neonatal transient hypothyroidism enhanced the growth of the testes. They contained large seminiferous tubules with many germ cells. While, the persistent hypothyroidism induced testicular atrophy with degeneration of germ cells. So, estimation of thyroid hormone level is recommended in all neonates immediately after birth for early diagnosis and treatment of thyroid hormone deficiency to prevent serious adverse effect of hypothyroidism on the testis

Características morfológicas y morfométricas de la placenta de término, en recién nacidos pequeños para la edad gestacional (PEG) en la ciudad de Temuco-Chile / Morphometric and morphological characteristics of the placenta at term, in small for gestational age newborns (SGA) in the city of Temuco-Chile

El metabolismo placentario, el intercambio de sustancias y la producción de hormonas son funciones vitales de la placenta para mantener y promover el desarrollo normal del feto. Existen factores de riesgo que alteran este patrón en el caso del retardo del crecimiento intrauterino, cuyo resultado será un recién nacido (RN) pequeño para la edad gestacional (PEG) que presentará una mayor morbilidad, crecimiento físico e intelectual comprometido y una mayor probabilidad de desarrollar durante la vida adulta diferentes patologías. Los objetivos del presente trabajo son: 1. Reconocer las diferencias en los parámetros morfométricos, como el área de las vellosidades, el área de los vasos, el número de vasos y el área del sinciciotrofoblasto de las placentas de PEG en relación con placentas de recién nacidos AEG y 2. Relacionar el diagnóstico neonatal de PEG con las características morfométricas. Se utilizaron 25 placentas de término (37-42 semanas), 12 de recién nacidos adecuados a la edad gestacional (AEG), y 13 de recién nacidos pequeños para la edad gestacional (PEG). Las muestras fueron obtenidas de la maternidad del Hospital Hernán Henríquez Aravena de Temuco, IX Región Chile. De cada placenta se tomaron dos segmentos pericordonales, desde la placa subcorial hasta la placa basal y luego fueron fijadas en formalina tamponada al 10 por ciento. Las técnicas histológicas utilizadas fueron H-E azul de Alcián, Tricrómico de Masson, PAS-Hematoxilina y PAS-Diastasa. El área de las vellosidades mostraron diferencias significativas entre el grupo control (AEG) y el grupo PEG con p = 0,0194. En el grupo de PEG el área de los vasos fue significativamente mayor, con un valor de 234,05 i,m² en comparación con el grupo control cuyo promedio fue de 150.99 lm² (p = 0,0001). El número de vasos sanguíneos por vellosidad libre no mostró diferencias significativas. En relación con el área del sinciciotrofoblasto la diferencia no resultó ser significativamente ...

The placental metabolism, the exchange of substances and the production of hormones are vital functions of the placenta to maintain and promote the normal development of the fetus. There are risk factors that disrupt this pattern in the case of intrauterine growth retardation, whose outcome will be a small for gestational age (SGA) newborn having a higher morbidity, physical and intellectual growth pledged and greater probability of develop different pathologies during adulthood. The aims of this study are: 1 .-recognize the morphometric parameters differences as the area of the villi, the area of the vessel, the number of vessels and the area of placental syncytiotrophoblast SGA in connection with placentas of newborns AGA and 2.- relate the diagnosis of neonatal SGA with morphometric characteristics. We used 25 placenta at term (37-42 weeks), 12 newborns appropriate to the gestational age (AEG), and 13 small for gestational age infants (SGA). The samples were obtained from the Maternity Hospital Hernán Henriquez Aravena of Temuco, Chile IX Región. In each placenta two segments were taken from the subchorionic plate to the basal plate and then were fixed in 10 percent formalin buffered. The histological techniques used were H- E Alcián blue, Masson's Trichromic, Pas-hematoxylin Pas-diastase. The area of the villi showed significant differences between the control group (AEG) and the PEG group with p = 0.0194. In the group of PEG the area of vessels was significantly higher, with a value of 234.05 mm² compared with the control group whose average was 150.99 mm² (p = 0.0001). The number of blood vessels for free villi sampling not significant differences. Regarding the area of syncytiotrophoblast the difference was not significantly (p = 0.1410). In conclusion it was determined that PEG newborns placenta showed significant differences at the blood vessel area and free chorial villi area in relation to the AEG placenta.

Enteral erythropoietin increases plasma erythropoietin level in preterm infants: a randomized controlled trial.

OBJECTIVE: To evaluate the effects of enteral administration of recombinant human erythropoietin (rhEPO) on serum level of erythropoietin and erythropoiesis in preterm infants. STUDY DESIGN: Randomized controlled trial. SETTING: Level III NICU. SUBJECTS: 16 preterm infants less than 34 wk with birth weight less than 1800 g. INTERVENTION: Enteral rhEPO 400 U/kg, three times/week, plus FeSO4,3-6 mg/Kg/day ( Study group, n = 7) or FeSO4 only (Control group, n = 9). OUTCOME MEASURES: Hemoglobin, serum erythropoietin (EPO), reticulocyte count, and serum ferritin levels, measured at baseline, after 10 days and at discharge. RESULTS: Mean birth weight and gestational age for the Study and the Control groups were 1328.5 +/- 267.4 vs. 1392.8 +/- 196.7 g and 30.7 +/- 2.5 vs. 30.2 +/- 0.9 weeks, respectively. At discharge, there was no difference in hemoglobin or hematocrit but the reticulocyte counts were significantly higher in the Study group (1.4 +/- 0.7 vs. 0.7 +/- 0.4, P = 0.03). Serum erythropoietin level was significantly higher in the Study group (18 +/- 11 vs. 8.6 +/- 3.9 mU/mL, P = 0.006). Conversely, serum ferritin level was lower in the study group but did not achieve statistical significance. CONCLUSIONS: Enteral administration of rhEPO in preterm infants resulted in increase in serum erythropoietin and reticulocyte counts at the time of discharge without significantly affecting hemoglobin or hematocrit.

[Correlation between neonatal cord blood hemoglobin and hematocrit with mode of delivery]

Increased level of hemoglobin at birth is one of the essential iron storage in infants against iron deficiency anemia. Different causes could lead to decreased hemoglobin level at birth. To evaluate the association between cord blood hemoglobin and hematocrit levels and the mode of delivery [cesarean section against normal vaginal delivery]. This was an analytic cross-sectional study carried out on 100 normal vaginal delivery infants and equal number of babies delivered by cesarean section infants at Tehran Najmieh Hospital during 2005. Hemoglobin and hematocrit levels were measured using cord blood samples. The data were analyzed by SPSS software using independent t test. In normal vaginal delivery infants, the mean hemoglobin content of cord blood was 15 +/- 1.7 g/dl and the mean hematocrit 46% +/- 4.9%. Similarly, the mean hemoglobin and hematocrit levels of cord blood among cesarean section infants were 14.6 +/- 1.9 g/dl and 45.6% +/- 5.7%, respectively. There was a positive correlation between the cord blood hemoglobin and mode of delivery. The levels of cord blood hemoglobin and hematocrit in cesarean section infants are lower than those in normal vaginal delivery infants hence, the former are more likely to be at risk of developing iron deficiency anemia than the recent group

Prognostic value of direct bilirubin in neonatal hyperbilirubinemia.

OBJECTIVE: To determine the prognostic value of indirect and direct hyperbilirubinemia in neonates with jaundice. METHODS: A cohort of 92 consecutive neonates reporting with hyperbilirubinemia to a tertiary care center were followed up till well and discharged, or, till death to assess risk and rate of mortality. RESULTS: The baseline median values of total, direct and indirect bilirubin in the cohort of 21.8, 1.6 and 18.6 mg/dl, respectively, were used as cut-offs for high and low levels. Using survival analyses i.e. Kaplan-Meier plots, logrank tests and multivariate Cox proportional hazards regression models to adjust for other strong predictors such as receipt of breastfeeding, being small for gestational age (SGA) and exchange transfusion, high direct bilirubin (> or = median value of 1.6 mg/dl) was independently associated with a higher and faster mortality. CONCLUSION: This study showed that direct bilirubin has independent and additive prognostic value and due attention should be given to newborns with raised levels.

Effect of pregnancy induced hypertension on mothers and their babies.

OBJECTIVE: To study the hematological profile of mothers with pregnancy induced hypertension and their infants. METHODS: The effects of maternal hypertension on the hematological profile of neonates were studied in 50 cases comparing the values with that of infants born to normotensive mothers. RESULTS: There was higher number of preterm, Intra-Uterine Growth Restriction (IUGR) and Small for Gestational Age (SGA) babies among the infants of hypertensive mothers. There was a significantly higher incidence of thrombocytopenia and nucleated RBCs seen in these babies. Significant neutropenia was not documented and there was no increased incidence of bleeding when compared to controls. CONCLUSION: Although there were significant changes in the hematological profile of infants born to hypertensive mothers, there was no significant increase in neonatal morbidity as a result of these changes.

Formação de biofilme em amostras de Staphylococcus epidermidis isoladas de sepse relacionada a cateter vascular central em neonatos críticos / Biofilm production in Staphylococcus epidermidis samples isolated fromsepsis associated with central vascular catheter (CVC) in critical neonates

Esta pesquisa teve como objetivo verificar a presença de biofilme em amostras de S. epidermidis isoladas de sangue em casos de sepse relacionados ao uso de CVC em neonatos críticos. O estudo foi realizado na Unidade de Terapia Intensiva Neonatal (UTIN) do Hospital de Clínicas da Universidade Federal de Uberlândia, no período de Jan/02 a Dez/06. Adicionalmente, foi realizado inquéritos de prevalência pontual de colonização por este microrganismo, através da coleta de espécimes da narina e axila com auxílio de swabs, entre Janeiro de 2004 e Junho de 2005. A avaliação de formação de biofilme foi realizada por densidade ótica em placas de poliestireno, após coloração com safranina, utilizando espectrofotômetro (570nm). O teste de suscetibilidadeà oxacilina foi realizado pelo método de diluição de acordo com o “Clinical and Laboratory Standards Institute”.Foram analisadas 109 amostras de S. epidermidis de episódios de sepse, sendo 83 (76,1%) relacionadas ao uso de CVC. Em relação à presença de biofilme, 67/83 (80,7%) das amostras isoladas de neonatos com sepserelacionadas a CVC, apresentaram produção intensa, enquanto que entre as 26 não relacionadas ao uso de CVC apenas seis (23,1%) demonstraram produção de biofilme, assim como, 10 (12,3%) entre as associadas à colonização. Cerca de 73% das amostras foram resistentes à oxacilina (concentração inibitória mínima ³0,5mg/ml), incluindo 56 (83,6%) correspondentes a casos de infecção relacionados à CVC, seis (100%) amostras não relacionadas ao uso de CVC e em quatro (40%) de amostras de colonização. Conclui-se que a maioria das amostras de S. epidermidis isoladas de sepse relacionadas à CVC foram biofilme positivas e resistente à oxacilina

This research aimed to observe the biofilm production by Staphylococcus epidermidis isolated associated with central vascular catheter (CVC) related bacteremia in critical neonates. The study it was carried out in Neonatal Intensive Care Unit of the Hospital das Clínicas da Universidade Federal de Uberlândia, in the period of Jan/02 to Dez/06. Additionally, it was carried out inquiries of prevalence, through the specimen collection of the nostril and armpit with aid of swabs, between Jan/04 and Jun/05. The evaluation of biofilm production was by optical density in polystyrene plates, stained with safranin and measured with ELISA reader at 570nm. The oxacilin susceptibility test was carried out through to the dilution method in accordance with the “Clinical and Laboratory Standards Institute”. It was analyzed 109 S. epidermidis samples, being 83(76.1%) related to the use of CVC. In relation to the biofilm presence, 80.7% of the neonates isolated samples with sepsis related the CVC, had presented intense production, whereas of the 26 unrelated ones to the useof CVC, only six (23.1%) had demonstrated biofilm production as well as 10 (12.3%) of the samples associated to the colonization. About 73% of the samples were oxacilin resistant (minimum inhibitory concentration³0.5mg/ml) . In conclusion, the S. epidermidis samples isolated of CVC related sepsis were biofilm positive and pertaining to oxacilin resistant phenotype

Efeitos da eritropoetina recombinante humana em recém-nascidos pré-termo com doenças infecciosas / Effects of recombinant human erythropoietin in preterm newborns with infectious diseases

OBJETIVO: Analisar os efeitos da eritropoetina recombinante humana (rHuEpo) em recém-nascidos pré-termo com doenças infecciosas graves. MÉTODOS: Foi realizado um estudo controlado, não randomizado, em 34 recém-nascidos com diagnóstico de patologias infecciosas graves, peso de nascimento igual ou inferior a 1500 g, idade gestacional inferior a 35 semanas e estabilidade clínica. Os recém-nascidos designados para o tratamento com rHuEpo receberam a eritropoetina ß na dose de 400 UI/kg, duas vezes por semana, por via subcutânea. A suplementação oral com ferro foi iniciada quando os níveis de ferritina sérica foram inferiores a 60 mcg/L. O estudo foi realizado durante seis semanas ou até a alta hospitalar do paciente. Foram avaliados a eritropoese, o número de transfusões, o número de neutrófilos, a contagem de plaquetas e os episódios de novas infecções durante o tratamento com o hormônio. RESULTADOS: Houve aumento significativo do número de reticulócitos no grupo tratado; entretanto, não houve impacto sobre o número ou volume de transfusões. Não foram observadas alterações no número de neutrófilos ou plaquetas. CONCLUSÃO: O uso de rHuEpo em RNPT com doenças infecciosas, na dose de 800 UI/Kg/semana, foi efetivo para induzir eritropoese, sem ocorrerem alterações significativas sobre o número de neutrófilos ou plaquetas. Essa estratégia, associada ao controle rigoroso do volume de sangue retirado para exames, poderá ser benéfica na prevenção da anemia em RNPT com infecção grave.

OBJECTIVE: To study the effects of recombinant human erythropoietin (rHuEpo) in preterm newborns (PTNs) with serious infectious diseases. METHODS: A not randomized case-control study was carried out in 34 preterm newborns with diagnosis of serious infectious pathologies, gestational age up to 35 weeks, birth weight less than 1500 g and clinical stability. Newborns selected for treatment with rHuEpo received 400 U/kg erythropoietin ß, subcutaneously twice a week. Oral iron supplementation was initiated when the levels of serum ferritin were lower than 60 mcg/l. The study was continued for six weeks or until the patient was discharged from the hospital. Erythropoiesis, granulopoiesis, thrombocytopoiesis, the need for transfusions and the occurrence of new episodes of infectious disease were analyzed. RESULTS: In the treated group there was a significant increase in the number of reticulocytes, although there was no statistically significant difference between the groups with regard to the number or volume of transfusions. There was no significant difference in neutrophils and platelet values. CONCLUSION: The use of rHuEpo, 800 U/kg/week, in PTNs with infectious diseases was effective in inducing erythropoiesis, without significant changes in the number of neutrophils or platelets. This strategy, and the accurate control of the blood collected for laboratory exams, may be beneficial for prevention of the anemia in PTNs with serious infectious diseases.

Evaluation of procalcitonin, C-reactive protein and interleukin-6 level in neonatal sepsis

Bacterial sepsis is a major cause of morbidity and mortality in neonates. Diagnosis of neonatal sepsis may be difficult because clinical presentations are often nonspecific, bacterial cultures are time-consuming and other laboratory tests lack sensitivity and specificity. The aim of the present study was to evaluate the diagnostic use of procalcitonin, circulating cytokine [IL-6] and CRP in neonates with suspected sepsis. Blood was collected from 40 neonates admitted to neonatal intensive care units for suspicion of neonatal sepsis as well as 32 healthy controls. Sepsis group was subdivided into S1 [Proven sepsis n=16] and S2 [clinical sepsis n=24] according to the results of blood culture. Serum IL-6 was measured by Elisa, CRP was measured by nephlelometery and procalcitonin by Immunoluminometric assay. In sepsis group, level of CRP was significantly elevated compared to healthy controls P < 0.05. As regard to IL-6 level, it was significantly elevated in sepsis group compared to healthy control [P < 0.001], in addition it was increased in both patients subgroups S1, S2 with no statistically significant difference between both subgroups. Serum PCT concentration were significantly higher in sepsis group in comparison with the healthy control [P< 0.05]. PCT concentration were also significantly higher at initial suspicion and at 12-24 h and 36-48 h after the onset of symptoms in S1 than S2 subgroups. PCT seems to be a better marker of neonatal sepsis. Also, the combination of IL-6+CRP presented accuracy for differentiation between septic and non septic patients during the first 24 h of suspected sepsis

Avaliação do Programa de Triagem Neonatal na Bahia no ano de 2003 / Assessment of Bahia Neonatal Screening Program in 2003

OBJETIVOS: descrever e avaliar o perfil do Programa de Triagem Neonatal baiano em 2003. MÉTODOS: estudo descritivo baseado no banco de dados do Serviço de Referência de Triagem Neonatal baiano com todos os recém-nascidos que realizaram a triagem na rede de coleta do Estado em 2003. RESULTADOS: observou-se implantação do programa em 94,5 por cento dos municípios. A média mensal de testados foi de 13.991 (72,51 por cento dos recém-nascidos registrados). Na coleta, 63,9 por cento das crianças estavam com idade entre oito dias e um mês, 14,5 por cento com até sete dias e 21,6 por cento com mais de um mês. A incidência observada foi de 1:22.000 para fenilcetonúria, 1:4.000 para o hipotireoidismo congênito e 1:650 para as hemoglobinopatias. CONCLUSÕES: o Programa de Triagem Neonatal baiano mostrou, em 2003, dificuldades quanto a cobertura preconizada em 100 por cento; a faixa etária ideal para realização da coleta; ao tempo entre a coleta e a chegada das amostras ao Serviço de Referência em Triagem Neonatal; ao tempo de entrega dos resultados à família; e ao tempo de reconvocação dos casos positivos. Assim, são necessárias algumas melhorias para agilizar esses processos.

Vitamin D status in pregnant and their newborns

Adequate vitamin D concentrations during pregnancy are necessary for neonatal calcium homeostasis, bone maturation and mineralization. The purpose of this study was to evaluate serum vitamin D in mothers and their newborns. This study comprised 552 pregnant women from Tehran University hospitals. Maternal and cord blood samples were obtained in delivery room just after child birth. The serum samples were assayed for 25-hydroxyvitamin D3, calcium, phosphorus and parathyroid hormone. Prevalence of vitamin D deficiency in mothers and cord blood were 66.8% and 93.3% [<35nmol/l] respectively. There was a significant correlation between maternal and cord blood levels of vitamin D. In mothers with vitamin D deficiency, cord blood vitamin D levels were lower than those of normal mothers [p=0.001]. Furthermore, considering increased requirements of calcium and vitamin D during pregnancy; intake of higher amounts of these nutrients are recommended

Ionized serum calcium not serum total magnesium predicts outcome in neonatal hypoxic-ischemic encephalopathy

Perinatal hypoxic-ischemic encephalopathy [HIE] is a significant cause of neonatal mortality and neurodevelopment impairments. Previous works have attempted to find a sensitive parameter that will accurately predict outcome in infants with perinatal asphyxia. The aim of this study was to whether or not the serum total magnesium [Mg],ionized Ca [iCa], and other electrolytes concentrations in neonate with[HIE] in umbilical cord blood and 48 hours serum samples could be used to predict their outcome. Hospital-based prospective study of admission to newborn intensive care unit between 2001-2004.A total of 60 term neonates fulfilling the criteria for HIE were included in the study. HIE was classified according to the criteria of Sarnat and Sarnat, mild moderate and sever. Twenty full term healthy newborns were chosen as control. Umbilical cord blood on delivery and after 48 hours was collected for the measurement of total Mg, iCa, and Na. Infants was followed by a pediatrician and neurological examination Was done at the age of 6 and 12 month. In the group of normal infants there was a significant increase in serum total Mg and Na concentrations and decrease in iCa concentration by the second day of life compared with umbilical cord blood values. Infant with mild HIE had significantly higher umbilical cord blood total Mg concentrations compared with moderate and severe HIE groups. Infant with severe HIE had significantly lower mean umbilical cord blood total Mg concentration compared with other groups. On the second day of life infants with severe HIE had significantly higher serum concentration of total Mg and lower concentrations of iCa and Na compared with other groups. The serum cord and 48 hour ionized calcium concentrations were significantly lower in HIE group who had a poor outcome. cord serum and 48 hours level of ionized calcium and 48hr Na were predicting variable for poor outcome in HIE group

Adhesion molecules in newborns to mothers suffering from preeclampsia or gestational diabetes

Mother-fetus exchanges at the placental level are found to be altered in women affected by hypertensive or diabetic pregnancies. Endothelial dysfunction in the maternal uterine placental circulation is well recognized in preeclampsia, and is an early marker of macrovascular disease, present in pregnancies complicated by impaired glucose tolerance [IGT] and gestational diabetes mellitus [GDM].To evaluate the levels of adhesion molecules [1CAM-1, VCAM-1, sL-selectin] as markers of endothelial dysfunction in infants of preeclamptic or gestational diabetic mothers. 39 newborns were recruited in the present study and were divided into the following groups; group [1], comprised 13 newborn to mothers suffered from preeclampsia; group [2], consisted of 13 newborns to mothers suffered from gestational diabetes, another 13 healthy newborns to healthy mothers were chosen as controls. Adhesion molecules [ICAM-1, VCAM-1, sL-selectin] from umbilical cord were assayed using ELISA technique in all studied groups A significant high levels of ICAM-1 and VCAM-1 was observed in preeclamptic as well as gestational diabetic groups when compared to the controls [p<0.01, <0.001 respectively]. Interestingly, this increase was more pronounced in VCAM-1 level in group [1] when compared to group [2], [p<0.001]. On the other h and, ICAM-1 did not show any significance between group [1] and group [2], [p>0.05]. Regarding sL-selectin level, no difference was noted on comparing the preeclamptic group [1] and the control or gestational diabetic group [2], [p>0.05]. Meanwhile, sL-selectin was significantly higher in group [2] when compared to the controls [p<0.01]. Analysis of adhesion molecules, which are markers of endothelial dysregulation, in the fetal circulation at delivery might provide insights into the involvement of the fetal circulation in the pathogenesis of preeclampsia as well as gestational diabetes