Subclinical histologic chorioamnionitis and related clinical and laboratory parameters in preterm deliveries.

BACKGROUND: Histologic chorioamnionitis (HCA) is associated with preterm delivery and with neonatal morbidity and mortality. Because HCA is usually subclinical, histologic examination of the placenta is essential for confirmatory diagnosis. In the present study, the correlations between subclinical HCA and relevant clinical and laboratory parameters were analyzed. METHODS: This was a retrospective study. We reviewed the placental histopathologic findings and the charts of patients who were admitted to our neonatal intensive care unit after delivery and their mothers between January 2007 and March 2008. A total of 77 preterm infants [gastational age (GA): 32.2 3.4 weeks, birth weight (BW): 1718 +/- 554 g] were categorized as group A with histologic evidence of placental inflammation (n=27) or group B without histologic evidence of placental inflammation (n=50). Placental histology was studied to identify the presence of inflammatory states such as chorioamnionitis, funisitis and deciduitis. Laboratory parameters including complete blood count, differential count, and C-reactive protein (CRP) level of mothers and initial arterial blood gas, glucose Level and mean blood pressure of the infants were documented. Gestational age, Apgar score, history of prolonged premature rupture of membrane (prolonged PROM), gestational diabetes mellitus, meconium-stained amniotic fluid, pregnancy-induced hypertension and signs of pre-eclampsia were also collected as clinical parameters. All data were analyzed using independent t tests and Fisher's exact test, as appropriate. RESULTS: Group A newborns had a significantly lower gestational age (30.8 +/- 4.1 weeks vs. 33.0 +/- 2.6 weeks, p < 0.05) and higher CRP level (0.56 +/- 0.92 mg/dL vs. 0.12 +/- 0.14 mg/dL, p < 0.05), together with higher maternal WBC count (13,002 +/- 4344/microL vs. 10,850 +/- 3722/microL, p < 0.05) and higher rate of prolonged PROM [14/27 (51.85%) vs. 8/37 (21.62%), p < 0.05] compared with group B newborns. CONCLUSION: We found that HCA was significantly correlated with lower gestational age, higher CRP level of preterm infants, higher maternal WBC count, and a higher rate of prolonged PROM. Our results demonstrate a significant association between HCA with an elevated CRP level in preterm infants. These findings further confirmed the association between maternal inflammation and preterm deliveries.

Congenital dacryocystocele with acute dacryocystitis: report of two cases.

Congenital dacryocystocele is an uncommon lesion of the nasolacrimal drainage system of newborns. The lesion often develops secondary infection due to the obstruction of both distal and proximal nasolacrimal ducts. Early recognition by experienced pediatrician might initiate effective therapy to prevent the progression to possible secondary infection. However, there is no standard criteria for optimal treatment. Hence, we review the literature and report two newborns with congenital dacryocystocele in one of which progressed to secondary infection, dacryocystitis.

Risk factors for severe hyperbilirubinemia in neonates.

The incidence of severe neonatal hyperbilirubinemia is higher in Asians than in whites. A case-control study was designed to investigate the effects of eight known risk factors [breast feeding, ABO incompatibility, premature birth, infection, cephalohematoma, asphyxia, glucose-6-phosphate dehydrogenase (G6PD) deficiency, and variant UDP-glucuronosyltransferase 1A1 (UGT1A1) gene] and a suspicious analog [organic anion transporter 2 (OATP 2) gene] on severe hyperbilirubinemia in Taiwanese neonates. The 72 study subjects and 100 hospital control subjects consisted of neonates with peak serum bilirubin levels > or =342 microM and <256.5 microM, respectively. The PCR-restriction fragment length polymorphism method was applied to detect the UGT1A1, OATP 2, and G6PD genes. The results of multivariate logistic regressions, adjusted for covariates, revealed odds ratios (ORs) of 4.64 [95% confidence interval (CI): 2.25-9.57; p < 0.001], 3.36 (95% CI: 1.54-7.35; p=0.002), and 3.02 (95% CI: 1.30-6.99; p=0.010) for neonates who were fed with breast milk, and carry the variant UGT1A1 gene at nucleotide 211 and the variant OATP 2 gene at nucleotide 388, respectively. The ORs, adjusted for covariates, for the other six risk factors were not statistically significant. The ORs in neonates who had one, two, and three significant risk factors were 8.46 (95% CI: 2.75-34.48; p < 0.001), 22.0 (95% CI: 5.50-88.0; p < 0.001), and 88.0 (95% CI: 12.50-642.50; p < 0.001), respectively. In conclusion, neonates who carry the 211 and 388 variants in the UGT1A1 and OATP 2 genes, respectively, as well as feed with breast milk are at high risk to develop severe hyperbilirubinemia.

Effect of nucleotides on diarrhea and immune responses in healthy term infants in Taiwan.

OBJECTIVES: The aim of this study was to compare the effects of an infant formula fortified with nucleotides (NF) with those of a control formula (CF) on the incidence of diarrhea, respiratory tract infections (RTIs), and immune responses in healthy term infants. METHODS: This 12-month, double-blind study was conducted on 1- to 7-day-old infants randomized to receive NF or CF exclusively until 12 weeks of age, and fed the assigned formula with solid food until 12 months. NF was supplemented with 72 mg/L of nucleotides, based on the total potentially available nucleotide content of human milk. Subjects were evaluated within 1 week of birth, at 4 weeks, and every 4 weeks thereafter until 48 weeks of age. The primary outcome variable was the incidence of diarrhea. Secondary variables included RTIs, serum immunoglobulin concentrations, and response to hepatitis B vaccine. RESULTS: Compared with subjects fed CF (n = 170), those fed NF (n = 166) had a trend toward reduced risk of diarrhea from 8 to 48 weeks of age and a significantly lower risk of 25.4% (P = 0.05) between 8 and 28 weeks. NF subjects had significantly higher serum immunoglobulin A concentrations ( P < 0.05) throughout the 48-week study. The NF group had an increased risk of upper RTIs, the same incidence of lower RTIs, and the same antibody response to hepatitis B vaccination as the CF group, based on one-sided tests. Growth was normal in both groups, and no adverse events were considered to be formula-related. CONCLUSIONS: Healthy term infants from 8 to 28 weeks of life are less likely to experience diarrhea and have higher serum immunoglobulin A concentrations with NF compared with formula without added nucleotides.