Evaluation of selected parameters of immune response to rubella virus, hepatitis B virus and varicella-zoster virus infections in children born to mothers after kidney or liver transplantation.

BACKGROUND: The immune status of children exposed prenatally to immunosuppressants is not fully understood. MATERIAL AND METHODS: A single-center study evaluated possible differences in antibody levels between children prenatally exposed to immunosuppressants born to mothers after hepatic or kidney transplantation (study group) compared to children without prenatal exposure to immunosuppressants (control group). Children from the study and control group were age-matched at the time of the examination and gestational age-matched, so as to obtain similar stages of the vaccination schedule and to enable reliable comparison of the results. The selection of children was made in a 1:1 ratio. The study population, a total of 138 children, was divided according to the age of the children at the time of the study into three age groups: newborns, infants (from 29 days to 1 year) and children aged >1 year. Immunoenzymatic tests were used to analyze the titers of the chickenpox virus (VZV-IgG), rubella (RuV-IgG) and hepatitis B virus (HBV, HBsAb). The studied differences were compared depending on the age group and the immunosuppressive regimen used by the pregnant mother. RESULTS: In neonates born to mothers after liver transplantation, significant differences were found in HBsAb levels (>250 mIU/ml) compared to newborns without prenatal exposure to immunosuppressants taken by pregnant mothers (11/16, 69% vs. 4/14, 29%, respectively; p = .028). A similar difference in the level of HbsAb was no longer noted at later stages of children's lives. In infants, these values were 80% (4/5) vs. 33% (2/6), and in children over 1 year of age 15% (7/48) vs. 12% (6/49), respectively. No other significant differences were noted when compared the distribution of measured parameters of VZV and RuV in both analyzed groups (children of mothers after kidney or liver transplantation chronically treated with immunosuppression and children without prenatal exposure to immunosuppression). CONCLUSIONS: Prenatal exposure to immunosuppressive therapy does not appear to affect VZV, RuV and HBV antibody levels in children of mothers who have had a kidney or liver transplant. Initially elevated HBSAb levels in newborns of mothers after liver transplantation are not observed in later stages of life.

Low Content of Cyclosporine A and Its Metabolites in the Colostrum of Post-Transplant Mothers.

The rate of post-transplant mothers who breastfeed while on immunosuppression is progressively increasing. Data on breastfeeding while on cyclosporine-based regimens are limited. Therefore, we assessed the amount of cyclosporine and its metabolites that might be ingested by a breastfed infant by measuring the concentration of cyclosporine and its metabolites in the colostrum of seven post-transplant mothers. The mean concentration of cyclosporine in the colostrum was 22.40 ± 9.43 mcg/L, and the estimated mean daily dose of the drug was 1049.22 ± 397.41 ng/kg/24 h. Only three metabolites (AM1, DHCsA, and THCsA) had mean colostrum amounts comparable to or higher than cyclosporine itself, with the daily doses being 468.51 ± 80.37, 2757.79 ± 1926.11, and 1044.76 ± 948.56 ng/kg/24 h, respectively. Our results indicate a low transfer of cyclosporine and its metabolites into the colostrum in the first two days postpartum and confirm the emerging change to the policy on breastfeeding among post-transplant mothers. A full assessment of the safety of immunosuppressant exposure via breastmilk will require further studies with long-term follow-ups of breastfed children.

Selected Biochemical Parameters in Children of Mothers After Kidney Transplantation.

INTRODUCTION: The number of pregnant kidney graft recipients receiving immunosuppressive drugs is increasing yearly. All potentially nephrotoxic and hepatotoxic immunosuppressive drugs penetrate through the placenta, which raises questions about their long-term effects on offspring. OBJECTIVES: The study aimed to evaluate the influence of immunosuppressive drugs used by pregnant women after kidney transplantation on the biochemical parameters of their children. MATERIALS AND METHODS: Forty children born to mothers after kidney transplantation (KTx) and 40 children of healthy mothers from the control group were included in the study. All graft-recipient mothers received immunosuppressive treatment during pregnancy. The study compared biochemical parameters, including urea, creatinine, potassium, and sodium, in both groups. RESULTS: Elevated creatinine level was observed in 1 newborn in the KTx group and none of the children from the control group (P = .500). All KTx children had normal urea levels, while in the control group, 2 newborns had an increased level of urea (P = .247). Elevated potassium levels were observed in 10% of children in the KTx group and 20% of children in the control group (χ2 = 0.881; P = .348). Elevated sodium levels were observed in 22.5% of children in the KTx group and 32.5% of children in the control group (χ2 = 1.001; P =.317). No child in the KTx group had hyponatremia; mild hyponatremia was observed in 5% of children in the control group (P = .247). CONCLUSION: There was no increased risk of an abnormal concentration of urea, creatinine, sodium, and potassium in the offspring of mothers after kidney transplantation using immunosuppressive drugs during pregnancy.

Evaluation of Lipid Profile in Children Born to Female Transplant Recipients.

INTRODUCTION: Being aware of the nephro- and hepatotoxic effects of most immunosuppressants, assessing their potential effects on the health of the offspring is an important aspect of deliberate family planning after organ transplantation. AIM: The aim of the study was to evaluate the influence of immunosuppressive drugs used by pregnant women after kidney or liver transplantation on the lipid profile of their children. MATERIALS AND METHODS: Ninety-one children born to mothers after kidney or liver transplantation (study group) and 91 children of healthy mothers from the control group (control group) were included in the study. Transplant donors received immunosuppressive treatment in monotherapy or combination regimens during pregnancy. The study compared lipidogram values including total cholesterol, high-density lipoprotein, low-density lipoprotein, and triglycerides. The lipidogram was analyzed depending on the following 3 most commonly used immunosuppressive regimens: study group 1: CI (calcineurin inhibitors); study group 2: CI + GCs (glucocorticosteroids); and study group 3: CI + GCs + AZA (azathioprine). RESULTS: There were no significant differences between study group and control group in mean total cholesterol, high-density lipoprotein, low-density lipoprotein, and triglyceride levels (P > .05). In each of the studied subgroups, at least 1 abnormal lipidogram fraction was noted. Frequency of these deviations in study group 1, study group 2, and study group 3 were 31%, 57%, and 26%, respectively. However, no statistically significant differences were found between these obtained results (P > .05). CONCLUSIONS: Prenatal exposure to immunosuppressants taken by the mother after liver or kidney transplantation does not appear to significantly affect the occurrence of lipid disorders in these children.

[Severe hemolytic disease of the newborn as a result of late and undiagnosed alloimmunization--case report]. / Ciezka choroba hemolityczna noworodka w wyniku póznej i nierozpoznanej immunizacji--opis przypadku.

We report a case of a hemolytic disease in a newborn from the first pregnancy due to anti-D antibodies. The maternal blood group was A Rhesus negative. She had an antibody screening test twice during the pregnancy (in the second trimester) and it was negative. The pregnancy was uneventful, without any invasive procedures and bleeding. The infant was born at 39 weeks of gestation in good overall condition. After the delivery the blood group of the neonate was indicated - A Rhesus positive, BOC positive. Anti-D antibodies were detected in maternal blood. Neonatal blood tests revealed severe anemia (hemoglobin level: 6.0g/dl, hematocrit: 22.2%, erythrocytes: 2.01T/L). During the first day of neonatal life, the newborn received two transfusions of red blood cells. Bilirubin level and rate of rise were not recommendation enough for exchange transfusion. The newborn was treated with continuous phototherapy since the delivery The perinatal period was complicated with intrauterine infection and respiratory failure. Hematopoietic vitamins and iron supplementation was initiated in the second week of neonatal life due to persistent anemia. The child remained under medical care of a hematologic clinic and received human recombinant erythropoietin treatment.

Ultrasonography of the brain, abdomen, and heart in neonates born to liver or renal transplant recipient mothers.

BACKGROUND: Pregnancies in graft recipients are associated with increased risk of a number of pathologies. The aim of the study was to analyze results of brain and abdominal ultrasonography and echocardiography (ECHO) in neonates born to liver (LTx) or renal recipients (RTx). MATERIAL/METHODS: The study group consisted of 82 neonates born to transplanted women (46 neonates of liver recipients and 36 neonates of renal recipients), enrolled in a retrospective study. The control group consisted of 74 neonates from the general population. Sonographic examination of the brain was performed to check for the presence of intra-/periventricular hemorrhage (IVH/PVH) according to Papile, and periventricular leukomalacia (PVL).The results of abdominal ultrasonography and 2-dimensional echocardiography (ECHO) were compared between the groups. The immunosuppressive therapy used during pregnancy was also analyzed. RESULTS: No significant differences were observed between the frequency of IVH in LTx and RTx groups and LTx, RTx, and control groups. Abdominal ultrasonography revealed 1 case of suprarenal hemorrhage, 1 case of cystic kidney, and 3 cases of pyelocalyceal system dilatation in the study group. There were no abnormalities in the echocardiography in 97.8% of children born to mothers after LTx and in 94.4% after RTx. There were significant differences in the immunosuppressive therapy between the pregnant women after LTx and RTx. CONCLUSIONS: The risk was not increased in intra-/periventricular hemorrhage and congenital abnormalities of the gastrointestinal tract and heart in neonates of mothers after organ transplantation, regardless of the immunotherapy used, and risk was similar to that of the general population.

The creamatocrit, fat and energy concentration in human milk produced by mothers of preterm and term infants.

OBJECTIVE: The objective of this study was to investigate the composition of breast milk which had been gathered from mothers for over first 2 weeks of lactation and to compare the changes in composition of preterm and term milk. METHODS: A prospective, single center study was provided in Warsaw, Poland. The samples of breast milk from 22 mothers who had delivered prematurely and 39 mothers who had given birth to term infants were collected. The creamatocrit, energy and fat concentration were estimated in each participant's breast milk sample twice a day (morning and night hours). RESULTS: The lowest creamatocrit, calories and fat concentration was indicated in the preterm milk obtained in the morning (4.86%, 663.8 kcal/L and 33.6 g/L, respectively). The highest milk parameters were observed in the night samples of full-term milk and measured (9.6%, 919.7 kcal/L, and 60.7 g/L, respectively). No significant differences in analysed parameters were observed between preterm and full-term milk (p>0.05). In summary, creamatocrit, calories and lipid concentration in breast milk shows the daily differences. Colostrum and mature milk from mothers of preterm neonates differed from colostum and mature milk from mothers of term neonates. They had lipid contents, creamatocrit level and calorific value.

[Life threatening conditions in premature infants]. / Stany zagrozenia zycia u noworodków urodzonych przedwczesnie.

UNLABELLED: The aim of the study was to analyze life-threatening conditions of the premature neonates who required hospitalization in The Neonatal Intensive Care Unit (NICU). Postnatal mortality was also taken into consideration. MATERIAL AND METHODS: The study group consisted of the neonates born prematurely in the Obstetrics and Gynecology Clinic of Medical University in Warsaw in the period from 1st January, 2002 to 31st December, 2002. Birth weight, gestational age, reasons of respiratory insufficiency, co-existing diseases, complications and causes of postnatal death were analyzed. RESULTS: 44 out of 174 prematures were admitted to NICU because of the necessity of mechanical ventilation. There were several main pulmonary reasons of respiratory insufficiency: respiratory distress syndrome, primary pneumonia, and transient tachypnoe of neonates. Primary infection was the most frequent co-existing problem. The serious complications of the prematurity included retinopathy and persistent arterial duct (requiring surgical procedures). All deaths in the study group were noted in infants with birth weight below 1250 g. CONCLUSIONS: Prematurity and its complications were the main causes of life-threatening conditions in newborns that lead to hospitalization in NICU. The postnatal mortality rate was the highest in premature neonates with birth weight below 1000 g (33.3%).