Maternal reproductive history and the risk of isolated congenital malformations.

We examined the relationship between maternal reproductive history and the newborn's risk of isolated congenital malformations in a large case-control cohort from the Polish Registry of Congenital Malformations. Congenital malformations were classified into four categories: isolated congenital heart defects (n=1673), isolated cleft palate (n=255), cleft lip with or without cleft palate (n=448) and renal agenesis (n=103). The case groups were compared with a shared group of 2068 controls recruited in the same time period and geographic area. Multivariable logistic regression was used to assess the risk associated with maternal gravidity and of previous miscarriages after accounting for maternal age and other potential risk factors. In unadjusted analyses, maternal gravidity was significantly associated with increased risk of all four classes of congenital malformations. After adjustment, a significant association persisted for congenital heart defects [odds ratio (OR)=1.22, [95% confidence interval (CI) 1.09, 1.36], P=0.0007] and cleft lip with or without cleft palate (OR=1.21, [95% CI 1.09, 1.36], P=0.0005). A similar trend existed for isolated cleft palate (OR=1.18, [95% CI 1.02, 1.37], P=0.03). There was no appreciable increase in the risk of congenital malformations associated with a maternal history of miscarriages, but a trend for a protective effect on the occurrence of cleft lip with or without cleft palate was observed (OR=0.72, [95% CI 0.52, 0.99], P=0.045). Based on our data, maternal gravidity represents a significant risk factor for congenital heart defects and cleft lip with or without cleft palate in the newborn infant. Our data do not support an increase in risk because of past history of miscarriages.

[The influence of severe infections on the natural killer cells in neonates with vary gestational age]. / Wplyw ciezkich zakazen na naturalne komórki cytotoksyczne u noworodków o róznym stopniu dojrzalosci plodowej.

UNLABELLED: In 27 infected neonates (16 boys and 11 girls) with birth weight ranged from 1200 to 4500 g (mean 2670 +/- 827 g) and gestational age from 31 to 41 weeks (mean 36.7 +/- 4.1), among them 11 (41%) with birth asphyxia, between 1 and 7 day of life flow cytometric immunophenotyping of the relative sizes of natural killer cells (CD3-/CD16-56+) using monoclonal antibodies of Becton Dickinson were made. The following infections were diagnosed in the neonates: bacterial septicemia (gram-positive in 13 cases, gram-negative in 5 cases), pneumonia in 6 cases and purulent meningitis in 3 cases. Control group consisted of full-term, healthy, eutrophic neonates born in Military Medical Academy in Lódz between 1994-95 years, in which immunological studies were made with the same method and dr Banasik, agreed for using her results for statistical analysis. It was stated, that in infected full-term neonates the mean relative size of NK cells was 10.7 +/- 5.1% and in prematures 12.8 +/- 7.2% and did'n differ significantly from the control. Kind of infection had no significant influence on the mean relative size of these cells, because in septic neonates was 11.7 +/- 5.7% and in other infected babies 11.6 +/- 7.2%. It was found that infected neonates without respiratory insufficiency and shock had significantly higher (13.2 +/- 6.4%) relative size of NK cells than healthy. The lowest value (7.0 +/- 4.8%) of NK cells during infections in dead neonates were noted (4 cases, among them 2 septic with shock and 2 pneumonic prematures with intraventricular haemorrhages). CONCLUSION: The severity and bad results of the treatment in neonatal infections may be due to deficit of NK cells.

[The influence of perinatal risk factors on the number of CD3+ lymphocytes and CD25+ cells in full-term neonates]. / Wplyw perinatalnych czynników ryzyka na liczbe limfocytów T i komórek CD25+ u noworodków donoszonych.

In 39 full-term neonates aged from 1 to 7 days of life, among them 24 with perinatal risk factors and 15 healthy as the control group, immunophenotyping of CD3+ and CD25+ cells using Becton Dickinson flow cytometer and monoclonal antibodies and CD3+ and CD25+ was performed. It was stated, that the mean relative and absolute number of CD3+ T lymphocytes in high risk neonates did not differ from the mean values in control group. The premature rupture of fetal membranes in mothers caused a significant increase of mean relative number of CD3+, whereas it did not influence on the absolute number of these cells. Significant increase of mean relative and absolute number of CD25+ cells in neonates with perinatal risk factors in comparison with the control group was noted. Mean relative and absolute number of CD25+ cells were significantly higher in neonates with non-infectious risk factors than in neonates with infectious risk factors. Authors emphasize that, evaluation of CD25+ cells is useful in the assessment of immunological changes in high risk neonates.

Lymphocyte subpopulations in full-term septic neonates.

PURPOSE: To estimate the absolute leukocyte and lymphocyte counts and relative and absolute sizes of CD19+ B lymphocytes, CD3+, CD4+, CD8+ and CD3+/HLA-DR+ T lymphocytes in full-term septic neonates and the influence of some perinatal risk factors on these lymphocyte subsets. METHODS: Twenty-one septic and mechanically ventilated full-term neonates (13 boys and eight girls) and 15 healthy full-term neonates born vaginally with an Apgar score > 9 and without hyperbilirubinemia were investigated. Two-color flow cytometric immunophenotyping with appropriate antibody panels using lysed whole vein blood was performed. RESULTS: The mean relative and absolute sizes of CD19+ B lymphocytes, CD3+/CD8+ and CD3+/HLA-DR+ T lymphocytes in septic neonates did not differ significantly from control. In contrast, the mean relative sizes of CD3+ and CD3+/CD4+ T lymphocytes and the CD4+/CD8+ ratio in septic neonates were significantly higher than in healthy neonates. With regard to the absolute size in septic neonates, only CD4+ T cells were significantly higher compared with the control group. Perinatal risk factors (birth asphyxia, gestation and delivery complications) had no significant effect on the relative and absolute counts of all estimated lymphocyte subpopulations in septic neonates. CONCLUSIONS: Increases in the relative sizes of CD3+ and CD3+/CD4+ T lymphocytes and the CD4+/CD8+ ratio in full-term septic neonates provides important information about changes in cell-mediated immunity during the early neonatal period.

[Effect of perinatal risk factors on treatment outcome in newborns with hypoxic-ischemic encephalopathy]. / Wplyw perinatanalnych czynników ryzyka na wyniki leczenia noworodków z encefalopatia niedotlenieniowo-niedokrwienna.

In 99 newborns with hypoxic-ischemic encephalopathy (22 with mild, 53 with moderate and 24 with severe stage) correlation between birth weight, low Apgar score, high-risk pregnancy and delivery and stage of encephalopathy and results of the treatment was made. Low Apgar score (< 3) had significantly influence on the development of severe encephalopathy. Most important perinatal risk factor was abnormal delivery. Especially high mortality because of moderate and severe stage of encephalopathy in prematures with intracranial hemorrhage and congenital infection was noted. Full-term babies died because of others causes. It was shown, that unfavourable outcome of neonatal encephalopathy depends mainly on high-risk delivery.

[Evaluation of selected lipid metabolism parameters in premature infants with infections]. / Ocena wybranych parametrów gospodarki lipidowej u wczesniaków w przebiegu zakazen.

In 49 prematures (25 infected and 24 healthy) serum cholesterol and triglycerides concentrations, value of alpha, pre-beta and beta serum lipoproteins (by electrophoresis) and activity of AspAt, AlAt and GGTP were estimated. It was stated, that the mean serum cholesterol concentration at the beginning of infection was significantly lower than in healthy babies, but in 2-3 week of disease the mean value of this parameter was significantly higher than in first week of life. Mean value of alpha lipoprotein was significantly lower, mean value of pre-beta and beta lipoproteins were higher in sick prematures than in control. In septic prematures positive correlation between the high serum cholesterol concentration and activity of GGTP and AspAt was found. In 30% of all septic neonates hepatitis and in 65% of dead infected prematures structural damage of liver were noted.

[Use of vancomycin in treating staphylococcal septicemia in newborns]. / Zastosowanie vankomycyny w leczeniu pasocznic gronkowcowych u noworodków.

The authors report the results of vancomycin treatment of staphylococcal septicemia in 26 newborns, including 17 prematures and 9 full-term. It was found, that all coagulase-negative strains and 91% of Staphylococcus aureus were sensitive to this antibiotic. Complete cure in 65% and clinical improvement in 10% were obtained. Death (12%) in very low birth weight prematures were due to secondary complications of septicemia, congenital malformations and intracerebral haemorrhages. Administration of vancomycin in generally accepted doses caused no side effects and is worth in newborns, in which other antibiotics has been given unsuccessfully.

[Usefulness of the phototherapy lamp in treating hyperbilirubinemia in newborn infants]. / Przydatnosc lampy do fototerapii w modyfikacji wlasnej w leczeniu hiperbilirubinemi u noworodków.

An efficiency of the treatment of jaundice with the lamp for phototherapy in own modification has been discussed. The lamp was used for the treatment of 82 neonates divided into three groups depending on the type of therapy: group I included 43 neonates treated with phototherapy alone; group II--32 neonates treated with phototherapy combined with blood transfusions, and group III--7 neonates treated with exchange blood transfusions alone. A mean time of irradiation in neonates of group I did not differ significantly from that used in group II (combined therapy) and did not depend on the cause of the jaundice. The number of blood transfusions decreased markedly with the use of phototherapy carried out with the lamp in own modification. This lamp proved highly effective in the treatment of the jaundice of various etiology and is the method of choice in case of life-threaten neonates.

[Evaluation of the results of the treatment of infections in newborn infants with developmental anomalies of the facial bones]. / Ocena wyników leczenia zakazen u noworodków z wadami rozwojowymi czaszki twarzowej.

A clinical course and the results of treatment of infections in 53 neonates with visceral cranium defects are discussed. The analysis included the type of defect, immunity and the causes of therapeutical failures. Developmental defects of other organs coexisted with visceral Cranium defects in 45% of the neonates. High incidence of aspiration pneumonia (in 57%) with unfavourable prognosis (40%) was observed despite an intensive respiratory therapy including assisted ventilation. Therapeutical failures were caused by the coexistence of other developmental anomalies (found in 80% od deceased neonates) and low body weight at birth (35% of deaths). No immunological disorders were found except sporadic deficit of immunoglobulins and T-cells. Prophylaxis is of utmost importance. It includes: early orthodontic correction and introduction of the appropriate feeding technique at the neonatal wards.