Inflammatory and oxidative stress airway markers in premature newborns of hypertensive mothers

Although oxidative stress and inflammation are important mechanisms in the pathophysiology of preeclampsia and preterm diseases, their contribution to the respiratory prognosis of premature infants of hypertensive mothers is not known. Our objective was to determine the levels of oxidative stress and inflammation markers in the airways of premature infants born to hypertensive and normotensive mothers, in the first 72 h of life, and to investigate whether they are predictors of bronchopulmonary dysplasia (BPD)/death. This was a prospective study with premature infants less than 34 weeks’ gestation on respiratory support who were stratified into 2 groups: 32 premature infants of hypertensive mothers and 41 of normotensive women, with a mean gestational age of 29 weeks. Exclusion criteria were as follows: diabetes mellitus, chorioamnionitis, malformation, congenital infection, and death within 24 h after birth. The outcome of interest was BPD/death. Malondialdehyde (MDA), nitric oxide (NO), and interleukin 8 (IL-8) were measured in airway aspirates from the first and third days of life and did not differ between the groups. Univariate and multivariate statistical analyses were performed. The concentrations of MDA, NO, and IL-8 were not predictors of BPD/death. Premature infants who developed BPD/death had higher levels of IL-8 in the first days of life. The gestational age, mechanical ventilation, and a small size for gestational age were risk factors for BPD/death. In conclusion, the biomarkers evaluated were not increased in premature infants of hypertensive mothers and were not predictors of BPD/death.

Efeitos da fisioterapia respiratoria convencional versus aumento do fluxo expiratorio na saturacao de O2, frequencia cardiaca e frequencia respiratoria, em prematuros no periodo pos-extubacao / Effects of conventional chest physical therapy versus increased expiratory flow on oxygen saturation, heart rate and respiratory rate in premature infants following extubation

Recem-nascidos (RN) prematuros apresentam elevada morbidade respiratoria e necessiade de ventilacao mecanica, assim, a fisioterapia respiratoria e a parte integrante da assistencia neonatal. Objetivo: comparar os efeitos da fisioterapia respiratoria convencional (FRC) versus aumento do fluxo expiratorio (AFE), na saturacao de O2 (SPO2), frequencia cardiaca (FC) e na frequencia respiratoria (FR) em prematuros no periodo pos-extubacao. Metodo: ensaio clinico randomizado realizado na UTI Neonatal do Hospital das Ckinicas de Botucatu - UNESP, comparando duas tecnicas fisioterapeuticas, aplicadas em recem-nascidos prematuros, nas primeiras 48 horas pos-extubacao. Para a analise estatistica foram utilizadas o teste t Student, Mann-Whimey, Qui-quadrado e o teste exato de Fisher, com nivel de significancia em 5 por cento. Resultados: os dois grupos de estudo: Grupo FRC(n=20) e grupo AFE(n=20), nao diferiram quanto a idade gestacional (media de 28 semanas) e peso de nascimento (media de 1100 gramas). Em ambos os grupos a sindrome do desconforto respiratorio (SDR) foi o principal diagnostico. A mediana da idade no inicio da fisioterapia foi de sete dias no grupo AFE e 11 dias na FRC. Ambas as tecnicas produziram aumento significativo da SpO2 aos 10 e 30 minutos, sem alteracoes na FR. A FC aumentou significativamente apos a FRC e nao se alterou apos o AFE. Conclusao: os resultados sugerem que o AFE e menos estressante que a FRC e pode ser aplicado em prematuros no periodo pos-extubacao. Nestes recem-nascidos o AFE parece ser seguro e benefico a curto prazo

Standardization the PCR technique for the detection of delta toxin in Staphylococcus spp

Coagulase-negative staphylococci (CNS), components of the normal flora of neonates, have emerged as important opportunistic pathogens of nosocomial infections that occur in neonatal intensive care units. Some authors have reported the ability of some CNS strains, particularly Staphylococcus epidermidis, to produce a toxin similar to S. aureus delta toxin. This toxin is an exoprotein that has a detergent action on the membranes of various cell types resulting in rapid cell lysis. The objectives of the present study were to standardize the Polymerase Chain Reaction (PCR) technique for the detection of the gene responsible for the production of delta toxin (hld gene) in staphylococcal species isolated from catheters and blood cultures obtained from neonates, and to compare the results to those obtained with the phenotypic synergistic hemolysis method. Detection of delta toxin by the phenotypic and genotypic method yielded similar results for the S. aureus isolates. However, in S. epidermidis, a higher positivity was observed for PCR (97.4 por cento) compared to the synergistic hemolysis method (86.8 por cento). Among CNS, S. epidermidis was the most frequent islate and was a delta toxin producer. Staphylococcus simulans and S. warneri tested positive by the phenotypic method, but their positivity was not confirmed by PCR for the hld gene detection. These results indicate that different genes might be responsible for the production of this toxin in different CNS species, requiring highly specific primers for their detection. PCR was found to be rapid and reliable method for the detection of the hld gene in S. aureus and S. epidermidis

Saude da crianca no final do seculo XX: analise dos indicadores de saude publicados pelo UNICEF em 1990. II - no mundo / Health of the child in the final of century XX: evaluation of the indicators published by UNICEF in 1990. II - in the world

Analisamos um conjunto de indicadores de saude infantil em 30 paises do mundo e caracterizamos 4 grupos de paises: G1 compreende 18 paises nos quais a condicao de saude infantil e satisfatoria, destacando-se neste grupo o predominio de paises desenvolvidos, os paises europeus e o Japao como os melhores. Os EUA situam-se isoladamente em G1 em decorrencia de seus baixos indices de vacinacao. G2 onde se encontra o Brasil e G3 sao intermediarios. E finalmente G4 que compreende Bolivia, Camaroes, Republica Centro Africana, Paquistao, India e Bamgladesh, paises com as piores condicoes economicas, de desenvolvimento e de saude infantil. Esses dados alertam para a necessidade de maior investimento na area de saude infantil nos paises em desenvolvimento a fim de se tentar atingir a meta "Saude para todos no ano 2000" .

Saude da crianca no final do seculo XX: Avaliacao dos indicadores publicados pelo UNICEF em 1990 - I - Nas Americas / Health of the child in the final of the century XX: evaluation of the indicators published by UNICEF in 1990. I - In the Americans

Analisamos um conjunto de indicadores de saude a fim de avaliar as condicoes de saude da crianca em paises das Americas do Sul e do Norte. Caracterizamos 3 grupos de paises: G1 (Argentina, Uruguai, Chile, Canada e Estados Unidos) com melhores condicoes de saude; G2 (Brasil, Guiana, Mexico, Colombia e Venezuela) intermediarios e G3 (Equador, Peru, Paraguai e no extremo Bolivia) onde as condicoes de saude sao menos favoraveis. Os EUA embora pertencam ao primeiro grupo, situam-se isoladamente em decorrencia de seus baixos indices de vacinacao. Esses dados demonstram que a saude da crianca nao e um privilegio de paises desenvolvidos e deve ser encarada como prioridade social na maioria dos paises americanos .