Blood antioxidant activity in preterm neonates with and without respiratory distress

Concentrations of circulating antioxidants were considered being important in the pathogenesis of diseases in preterm infants. Plasma total antioxidant status [TAS], some preventive and chain breaking antioxidants were studied in 20 preterm infants with respiratory distress on the first and fifth day of life. Ten preterm infants without respiratory distress and ten full term healthy neonates were also evaluated. On the first day of life, the plasma TAS, uric acid, transferrin % saturation levels were significantly high in the preterm infants with respiratory distress. On the contrary, serum albumin, total iron binding capacity [TIBC], ceruloplasmin, red blood cell superoxide dismutase [SOD] and red blood cell glutathione peroxidase [GSHPx] levels were significantly low, By the fifth postnatal day, plasma TAS, uric acid, transferrin % saturation, and red cell GSHPx levels were significantly decreased while, serum bilirubin, ceruloplasmin, TIBC and red cell SOD levels were significantly increased in preterm infants with respiratory distress. The duration of oxygen therapy was negatively correlated with plasma TIBC and was positively correlated with transferrin % saturation on the first and fifth day of life. Plasma TAS, uric acid, serum bilirubin and transferrin % saturation were significantly high while, serum albumin and TIBC were significantly low in non-survived preterm infants who had respiratory distress. Recurrent apneas, elevated uric acid levels and decreased TlBC on the first day of life in addition to increased duration of oxygen therapy and high transferrin % saturation on the fifth day of life, were significant predictors of mortality. These major postnatal changes in blood antioxidant activity in preterm infants with respiratory distress may influence their susceptibility to oxygen toxicity

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

Blood transfusion and development of necrotizing enterocolitis in preterm infants

Necrotizing enterocolitis [NEC] is a common problem of preterm infants. Blood transfusion is usually prescribed for such babies. The aim of this study was to review preterm infants with necrotizing enterocolitis and to determine if blood transfusion was associated with severe manifestations of illness in this population. This was a retrospective analysis of preterm infants with NEC between January 1995 and January 2000. Fifty-six infants who received blood transfusion [group I] were compared to 12 infants who did not have any transfusion [group II]. Results showed that the mean gestational age and 5 minutes Apgar score of group infants [29.8 weeks and 7.55 min. respectively] was significantly less than those of group II [32.6 weeks and 8.58 min.]. The incidence of hyaline membrane disease [33.9% vs 25%], intrauterine growth retardation [12.5% vs 16.7%], patent ductus arteriosus [32.1% vs 16.7%], intraventricular hemorrhage [10.7% vs 8.3%] and culture-proved sepsis [46.4% vs 33.3%] were comparable in both groups. The majority of infants were fed before the occurrence of NEC, and they had mainly expressed breast milk. Manifestations related to the severity of illness were significantly observed in-group I infants. These include; colloid administration [91.1% vs 58.3%], inotropic therapy [66.1% vs 25%], and plasma products transfusion [64.3% vs 25%]. There was no significant hemolysis in both groups [14.3% vs 16.7%]. Group I infants spent more days on the ventilator [7.36 vs 1.08] and had more days of total parenteral nutrition [12.98 vs 7-42] than group II infants had. The overall mortality and surgery for NEC [37.5% vs 25%] were not statistically different in both groups. Chronic lung disease and retinopathy of prematurity [8.9% vs 8.3%] were similar in the two groups. The mean duration of hospital stay was significantly longer in-group I infants [51.02 vs 24.33]

Conclusion: RBC transfusions will continue to be necessary in the care of high-risk neonates. Sick premature infants with NEC required frequent transfusions of packed RBCs that may reflect the severity of the disease

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

Indomethacin prophylaxis for lntraventricular hemorrhage in very low birth babies a randomized controlled trial

This work aimed at studying the efficacy and complications of low dose Indomethacin in the reduction of major intraventricular hemorrhage [IVH] in very low birth weight [VLBW] babies. The study was a prospective randomized controlled trial [mid term interim analysis]. The setting was level III neonatal intensive care unit of a perinatal tertiary care centre. Newborn babies with two birth weight categories [a]750 999 and [b]1000 -1250 gm born from January 1998 to March 2001 at Royal Hospital were randomized to one of two groups : Indomethacin or control. Three doses of indomethacin were administered to the indomethacin group in each birth weight category in the dose of 0.1 mg/kg/dose intravenously over a period of not less than 30 minutes. First dose was commenced between 6 to 12 hrs of age, and two additional doses were administered at 12 hourly intervals if the head ultra sound [U/S] detected no IVH. The control group did not receive any specific intervention other than normal neonatal intensive care. The primary outcome measure was the occurrence of NH and the secondary outcome measures were Necrotizing enterocolitis [NEC], Symptomatic patent ductus arteriosus [PDA], Bleeding episodes, Renal Failure, Chronic Lung disease [CLD] and death

Results: 115 eligible newborn babies were available. Fifty babies belonged to the first birth weight category [750-999 gm] and 65 to the second [1000-1250 gm]. After randomization 24 babies in the first category and 32 in the second received indomethacin. Perinatal characteristics were similar between the indomethacin and control groups in both the birth weight categories. The incidence of major IVH [grades III and IV] were signihcantly increased in babies with a birth weight between 750-999 gm [p= 0. 045, RR 6.7, CI 0.013 - 0.0413] who received indomethacin. The incidence of Chronic Lung Disease [CLD] was also significantly increased in the same group of babies [p= 0.04 RR 2.7 Ci 0.013 -0.479]. Indomethacin did not have any significant effect on the incidence of IVH, both major [grades III and IV] or minor [grades I and II] in the infants with birth weight between 1000-1250 gm but there was a significant reduction in the incidence of symptomatic patent ductus arteriosus [PDA] [p < 0.05] in the same group and weight category. There were no significant differences in the other outcome measures studied

Conclusions: Indomethacin prophylaxis did not confer any protection against the occurrence of NH in very low birth weight babies in our set up, instead it has shown an increase in the risk of NH and CLD in babies with birth weight <1000 gm. The numbers of the babies studied are small but based on our preliminary data we felt that we were not ethicallyjustified in continuing the use of Indomethacin and we have since terminated this study. More data from this population group is necessary to confirm our disturbing results