ABSTRACT
The third most frequent agent of perinatal bacterial meningitis is Listeria monocytogenes, in Hungary, its occurrence is, however, uncommon. This raises the possibility of diagnostical mistakes. A connatal listeriosis case validated microbiologically referred to in this report calls attention to Listeria, as a rare but relevant pathogen of neonatal infections. If clinical background suggests infection, the pathogenic role of L. monocytogenes should be taken into consideration. The etiological significance of the agent has to be verified by a competent clinical microbiology laboratory, since maternal listeriosis should be treated and the serious connatal manifestations should be prevented. Epidemiology of perinatal infection by L. monocytogenes, and its diagnostic tools especially the use of selective media are discussed.
Subject(s)
Listeria monocytogenes/isolation & purification , Listeriosis/diagnosis , Female , Humans , Hungary , Infant, Newborn , Male , Pregnancy , Pregnancy Complications, Infectious/microbiologyABSTRACT
INTRODUCTION: Retrospective analysis on some factors possibly influencing survival rate of very low birthweight infants on respiratory life support has been carried out. AIM: The aim was to find out about roles played by prenatal steroid prophylaxis, neonatal surfactant therapy and methods of reduction of complication risk emanating from respiratory life support in the outcome of treatment. METHOD: The frequency rate of pneumothorax, pneumomediastinum and bronchopulmonary dysplasia was comparatively examined for all very low birthweight (less than 1500 g) neonates treated by respiratory life support in the I. Department of Obstetrics and Gynecology, Semmelweis University in 1999 (n = 178) and in 1989 (n = 78). Corresponding data were compared using t-tests. RESULTS: In 100% of the 1999 patients in the focus of the current investigation (178 newborn infants) have received prenatal steroid prophylaxis and 55% of them (98 neonates) have received neonatal surfactant therapy. Respiratory life support resulted in pneumothorax in 7.8% of them (14 patients) and bronchopulmonary dysplasia in 12.3% of them (22 neonates). Frequency rate of complications for the neonates under investigation attributable to respiratory support or initial illness decreased from 38.6% in 1989 to 19.6% in 1999, a difference proven significant by t-test (p < 0.05). Survival rate increased from 34.6% in 1989 to 63.5% in 1999, which is again a significant difference indicated by t-test (p < 0.05). The differences are especially consequential considering that the average gestation age of the infants in the 1999 group was lower than that of the infants in the 1989 group. CONCLUSION: Decrease in complication rate emanating from respiratory support and increase in survival rate over the 10 year period between 1989 and 1999 can be attributed to the combined effect of improvement in respiratory support therapy applied (aiming to minimise its adverse effects like barotrauma and volutrauma more effectively by refined technological means) and of the introduction of administering prenatal steroid prophylaxis and (if judged necessary) neonatal surfactant therapy. A considerable limitation of this study is the lack of separation of independent variables (the separate effects due to the separate treatments applied), but it is reasonable to believe that improvement was due to a combined effect of all changes in treatments indicated above. It is deemed probable that results can be further improved by finding ways to decrease barotrauma and volutrauma even more effectively than now.
Subject(s)
Adrenal Cortex Hormones/administration & dosage , Infant, Very Low Birth Weight , Lung Diseases/prevention & control , Prenatal Care/methods , Pulmonary Surfactants/administration & dosage , Respiration, Artificial/adverse effects , Bronchopulmonary Dysplasia/etiology , Bronchopulmonary Dysplasia/prevention & control , Female , Humans , Infant, Newborn , Lung Diseases/etiology , Lung Diseases/mortality , Male , Pneumothorax/etiology , Pneumothorax/prevention & control , Primary Prevention , Survival Analysis , Treatment OutcomeABSTRACT
Preterm birth may be associated with hypoxic-ischaemic encephalopathy (HIE) showing a well recognised number of patterns, including neuronal karyorrhexis/eosinophilia mostly at the diencephalon and brain stem and leukomalacia at the periventricular white matter. To investigate whether programmed cell death or apoptosis plays a role in HIE, we examined human brains of preterm infants. Brain tissue samples from 12 consecutive infants (24-34 weeks of gestation) were available at post-mortem examination (1998-2000) after approval of the Ethics Committee. Two tissue sections were stereologically localised after brain fixation, slice preparation, and comparison with ultrasound imaging. We studied the periventricular white matter and the corresponding cortical region in each brain. Conventional histological stains were used. In addition, apoptosis was detected using a neuronal-specific terminal deoxynucleotidyl transferase-mediated nick end-labelling (TUNEL) method (NeuroTACS). A semiquantitative evaluation was performed to compare regions close to brain lesions with injury-free areas. Neuronal apoptosis was low in both cortical and in periventricular regions. No glial apoptosis was detected. Apoptosis in neurones was, however, detected in preterm brains with bacterial or mycotic infection. These results point out to the ambiguity of the TUNEL-reactive neurons in the diseased premature infants using fine-tuned ultrasound-guided neuropathological analysis, support the probable coexistence of neuronal TUNEL-reactivity and infection, and suggest that the association between apoptosis and HIE should overall be viewed with more caution.
