Long chain polyunsaturated fatty acids and immunity in infants.

An infant is usually born with a deficient immune system, and the long chain polyunsaturated fatty acids (LC-PUFA) in breast milk plays an important role in the development and maturation of infant’s immune system. This article reviews the role of LC-PUFA in breast milk in the development of immunity and prevention of atopic manifestations in infants. The review also attempts to assess the correct proportion of these nutrients that needs to be present in infant formulae for babies in whom breast milk is unavailable and formula milk is unavoidable. It was concluded that LC-PUFA plays a vital role in overall development of immunity in the infant. Clinicians should ensure that LC-PUFA are supplied to the term and preterm infant in the form of breastmilk or provided in right proportions in formula, if breast milk is unavailable.

Análise, imputação de dados e interfaces computacionais em estudos de séries temporais epidemiológicas / Analisis, data input and computer interfaces in epidemiological series studies

A poluição do ar é um problema de saúde pública em grandes centros urbanos e seus efeitos são freqüentemente observados na morbidade e mortalidade por doenças respiratórias e cardiovasculares, câncer de pulmão, diminuição da função respiratória, absenteísmo escolare problemas relacionados com a gravidez. Estudos também sugerem que os grupos mais suscetíveis são as crianças e os idosos. Esta tese apresenta estudos sobre o efeito da poluição do ar na saúde na saúde na cidade do Rio de Janeiro e aborda aspectos metodológicos sobre a análise de dados e imputação de dados faltantes em séries temporais epidemiológicas. A análise de séries temporais foi usadapara estimar o efeito da poluição do ar na mortalidade de pessoas idosas por câncer de pulmão com dados dos anos 2000 e 2001. Este estudo teve como objetivo avaliar se a poluição do arestá associada com antecipação de óbitos de pessoas que já fazem parte de uma população de risco. Outro estudo foi realizado para avaliar o efeito da poluição do ar no baixo peso aonascer de nascimentos a termo. O desenho deste estudo foi o de corte transversal usando os dados disponíveis no ano de 2002. Em ambos os estudos foram estimados efeitos moderadosda poluição do ar...

Vacunación del niño prematuro: un tema a veces olvidado / Vaccination in premature infants: an issue many times forgotten

Las infecciones bacterianas o virales pueden adquirir mayor gravedad o incluso ser letales en niños prematuros. El retraso de la vacunación en prematuros es frecuente. Esto se debería a falta de claridad sobre la seguridad y respuesta inmune de las vacunas así como a una subestimación de los riesgos de las infecciones en estos niños. No hay evidencia de que la frecuencia de reacciones adversas a vacunas en prematuros sea mayor que en niños de término. Aunque en prematuros extremos la respuesta inmune a vacunas puede ser menor, generalmente es suficiente para una adecuada protección contra infecciones graves. El esquema de inmunización debe ser similar al del niño de término, según edad cronológica. En prematuros debieran considerarse vacunas especiales como anti-neumocócicas conjugadas, anti-influenza. Otras estrategias para proteger a estos niños serían la adherencia rigurosa de los contactos intra domiciliarios al esquema del Programa Ampliado de Inmunizaciones así como el uso de vacunas especiales como la anti-influenza y pertussis acelular en niños mayores y adultos.

BCG vaccination reaction in low birth weight infants.

BACKGROUND & OBJECTIVES: About 30 per cent newborns (preterm and term) weigh < 2500 g at birth. The immunological system is less mature in low birth weight (LBW) babies compared to term and normal birth weight (NBW) babies. Bacille Calmettee Guerin (BCG) vaccine is given at birth under the national immunization programme. There is a paucity of information on the immunogenicity of BCG vaccine in preterm and LBW babies. It was, therefore, proposed to study the reaction of BCG vaccination in LBW, preterm and normal birth weight newborns. METHODS: A total of 143 newborns (90 term and 53 preterm; of these 78 were LBW) received during March to September 1998, 0.1 ml of BCG vaccine (Danish 1331 strain) intradermally on the left arm just above the insertion of the deltoid muscle within 7 days of life. At the same time trivalent oral polio vaccine was administered as per the national immunization programme. These babies were followed up in the immunization clinic at 4, 6, 8, 10 and 12 +/- 1 wk to observe reactions at the BCG vaccination site. RESULTS: After 4 wk reaction at the vaccination site was significantly (P < 0.001) delayed in preterm babies as compared to term infants, and in the LBW babies (P < 0.05) as compared to NBW babies. The reaction at the site of vaccination was not found to be different at 6, 8, 10, 12 wk. BCG scar was seen in 47.5 per cent infants (45.4% in < 2500 g birth weight and 50% in > or = 2500 g birth weight infants) at 12 wk. But 33 (42.3%) LBW and 24 (36.9%) NBW infants also showed papule, pustule, ulceration or scab at the BCG vaccination site. INTERPRETATION & CONCLUSION: The BCG reaction was seen in the sequential order from papule to scar formation. No significant difference was seen in the scar formation in infants studied with varying gestation and birth weights after 12 wk of BCG vaccination. Fifty seven (40.4%) babies still showed different stages of BCG reaction at 12 wk. BCG vaccine along with OPV administered in early neonatal life showed successful BCG reaction in 95.5 per cent infants.

Hepatitis B vaccination in premature and low birth weight (LBW) babies.

OBJECTIVE: To assess the immune response of preterm and low birth weight babies (LBW) to hepatitis B (HB) vaccine. SETTING: Neonatal Intensive Care Unit (NICU), postnatal ward and follow up clinics of KEM Hospital, Pune. DESIGN: Open trial. METHODS: 100 babies were enrolled in four study groups. Group I - preterm, gestational age (GA) < 34 weeks; Group II - GA 34 to 36 weeks; Group III full term <2.5 kg (LBW babies); and Group IV full term >2.5 kg (controls). A recombinant DNA HB vaccine was given at 0, 1, 2 and 12 month schedule. The first injection was administered as soon as the neonate was stabilized. Immune response in terms of anti HBs titres (AUSAB EIA Diagnostic kit) was measured one month after each of the first three injections and at the time of one year booster. Adverse events were monitored. RESULTS: 88 and 62 babies completed the study till the third dose and one year booster dose respectively. Immune response of HB vaccine was uniformly good in all the study groups with 100 % sero-conversion after the second dose itself. By one year (i.e. before the booster dose), very high titres were recorded in all 100%, with 85% demonstrating titres >1000 mIU/ml. Preterm and LBW babies had higher GMT as compared to full term babies till one month after third dose. By one year (before booster), full term babies had higher GMT than preterm and LBW babies. However, these differences were not statistically significant. The vaccine was well tolerated and safe and there were no adverse reactions. CONCLUSION: Immune response of preterm, LBW and full term babies to the new generation recombinant DNA HB vaccine was uniformly good. High and long term seroprotective levels were achieved after the second dose itself.

Adenosine deaminase in cord blood as an immunoenzyme marker in low birth weight neonates.

Adenosine Deaminase (ADA) levels were estimated in cord blood of 30 neonates born with birth weight less than or equal to 2.5 kg and 30 neonates born with birth weight greater than 2.5 kg. The mean ADA levels in low birth weight (LBW) group was found to be 6.94 U/L and in normal birth weight group the mean ADA levels were 14.37 U/L which was statistically significant. Therefore ADA may be useful in assessing CMI status in low birth weight infants.

Meningitis neonatal / Neonatal meningitis

La menngitis neonatal es un problema frecuente en las unidades de cuidado intensivo neonatal (UCIN). Los agentes etiológicos cambian en diversas poblaciones, instituciones y también con el paso del tiempo. En esta sección se hacen consideraciones con respecto a la incidencia, etiología, fisiopatología y cuadro clínico de meningitis neonatal, y se hace énfasis en la experiencia que se ha tenido con esta infección en los pacientes que se atienden en la UCIN del Hospital Infantil de México federico Gómez; así mismo, se presentan modalidades terapéuticas de meningitis y sus complicaciones (ventriculitis y abceso cerebral)

Humoral immunity status in neonates born to pre-eclamptic toxaemia mothers.

A prospective study on 90 neonates born to age matched normal mothers (set I) and mothers (set II) with pre-eclamptic toxaemia (PET) was undertaken to assess and compare the humoral immunity status of the neonates. All of them had normal vaginal delivery. IgG, IgA and IgM were estimated by radial immunodiffusion technique from cord blood of neonates. It was observed that IgA and IgM levels were insignificant in the cord blood. IgG level was low in normal birth weight (NBW) neonates born to PET mothers, when compared to that of NBW neonates born to normal mothers. Again low birth weight (LBW) babies of both the sets showed lower values of IgG than that of NBW babies. Apgar scoring showed direct relationship with IgG levels e.g., higher the Apgar score higher the level of IgG. Thus the IgG level was directly related to the birth weight of the neonates of the respective sets as well as with the Apgar scoring of the neonates.

Efecto in vitro de la tuftsina (L-prolil-L-arginina) en la capacidad oxidativa de los polimorfonucleares en niños recién nacidos pequeños para su edad gestacional / Tuftsin (L-prolil-L-arginina) has the function of activating cellular macrophages and polymorphonucleras in newborns

Se comunican los resultados de un trabajo realizado para determinar el efecto de la tuftsina sintética en la capacidad oxidativa de células polimorfonucleares de niños recién nacidos pequeños para su edad gestacional, ya que se ha demostrado que está disminuida la actividad fagocítica de macrófagos y polimorfonucleares (PMNs) comparada con las células de niños con peso adecuado para su edad gestacional. En los resultados se observó un efecto de estimulación de la capacidad oxidativa de los PMNs con tuftsina sintética a través de incrementar la reducción de nitroazul de tetrazolio, lo que sugiere que la baja capacidad oxidativa de las células de recién nacidos pequeños para su edad gestacional no se relaciona con un defecto intrínseco celular

Comparison of immunogenicity of hepatitis B vaccine between low and normal birth weight infants.

A comparative study was conducted to evaluate the immunogenicity of hepatitis B vaccine in low and normal birth weight infants. Hepatitis B vaccine (Hevac B Pasteur) was given to 50 low birth weight infants and 50 controls, matched by sex and date of delivery. The vaccine was given at birth, 1, 2 and 12 months of age. HBsAg and anti-HBs were assessed at birth, 4, 9 and 13 months of age by the micro-ELISA technique. Using the geometric mean titre of anti-HBs and the seroconversion rate as indicators, the immunogenicity of hepatitis B vaccine in low birth weight infants was as good as in normal birth weight infants.

Intravenous immunoglobulin prophylaxis for infection in very low birth-weight infants.

The effectiveness of intravenous immunoglobulin for prevention of sepsis in very low birth weight infants was studied on 102 neonates at the Children Hospital, Bangkok from February 1988 to February 1990. Infants were randomly allocated into 3 groups of 35 each. Group I and group II received 250 mg/kg and 500 mg/kg of immunoglobulin intravenously respectively within four hours of life. Group III was not given immunoglobulin and served as the control group. It was found that during the early neonatal period the infection rate of group I (14.7%) and group II (14.7%) was significantly lower than that of group III (38.2%). There was no difference in the infection rate of group I and group II. The mortality rate was also higher in group III than in group I and group II. It suggested that the intravenous immunoglobulin dosage of 250 mg per kilogram body weight is effective as well as dosage of 500 mg per kilogram body weight in prevention of sepsis in very low birth weight infants during the early neonatal period.