Cholelithiasis in a neonate with chylous ascites.

A case of a neonate with congenital chylous ascites resulting from primary lymphatic dysplasia is described. The baby also presented with a sludge ball in the gallbladder that eventually progressed to gallstones. The association of chylous ascites with cholelithiasis in this neonate is discussed.

Subcutaneous fat necrosis associated with severe hypocalcaemia in a neonate.

Subcutaneous fat necrosis (SFN) of the newborn is an uncommon disorder of the adipose tissue, mostly affecting full-term or post-term newborns who experience perinatal distress. The lesions of SFN typically occur during the first six weeks of life; they are usually self-limited and no specific therapy is required. The disorder may be rarely complicated with hypercalcaemia. We present the case of a neonate with perinatal asphyxia who manifested SFN followed by hypocalcaemia instead of hypercalcaemia and a biochemical profile of pseudohypoparathyroidism four weeks after the eruption of skin lesions. The infant was treated with alfacalcidiol. Blood biochemistry was normalized within one week and serum parathyroid hormone levels declined to normal over the next two months. It is suggested that perinatal asphyxia was the common etiopathogenetic factor for the development of both SFN and pseudohypoparathyroidism.

Plasma and urine elastase alpha-1-proteinase inhibitor levels in neonatal urinary tract infection.

OBJECTIVE: To examine whether plasma or urine elastase alpha(1)-proteinase inhibitor (E-alpha(1)-PI) levels could be used as a diagnostic marker of urinary tract infection (UTI) in neonates. SUBJECTS AND METHODS: Plasma and urine E-alpha(1)-PI levels were measured by immunoassay in 23 neonates with UTI at the time of admission and 72 h after the onset of treatment and in 10 'normal' neonates (i.e. with trivial problems). Additionally E-alpha(1)-PI plasma levels were measured in 15 neonates with septicemia. RESULTS: E-alpha(1)-PI plasma levels did not differ between normal neonates and those with UTI. Urine E-alpha(1)-PI levels were significantly higher in neonates with UTI on admission compared to normal neonates. A significant decrease in urine E-alpha(1)-PI levels was noticed 72 h after the onset of treatment in all but 2 neonates in whom infection persisted. In this study, we have found that the urine E-alpha(1)-PI concentration at a cutoff level of 48 microg/l had a sensitivity of 83%, a specificity of 90%, a positive predictive value of 95% and a negative predictive value of 69% for the diagnosis of neonatal UTI. CONCLUSION: Elevated levels of E-alpha(1)-PI in urine seem to be a useful tool for the diagnosis of UTI in neonates (even in those that have already been started on antibiotics) and possibly a valuable marker for early recognition of treatment failure.

Late recurrence of herpes simplex virus meningoencephalitis in two infants.

UNLABELLED: Two infants with recurrence of herpes simplex virus (HSV) encephalitis are reported. Both patients developed HSV encephalitis during their neonatal period and were treated with iv acyclovir. Long-term oral acyclovir prophylaxis was given thereafter. At the age of 8 and 11 months respectively, both babies, while under oral acyclovir prophylaxis, presented a second episode of HSV encephalitis. An inadequate dose of suppressive oral acyclovir therapy may be responsible for the recurrence of encephalitis in these two babies. CONCLUSION: The present observations emphasise the need for very long follow-up of any infant who has suffered from neonatal herpes simplex virus encephalitis and the need for careful prospective controlled studies in order to define the appropriate treatment regimen (initial plus prophylaxis) for neonates with herpes simplex virus infections.

Blood-brain barrier permeability in "healthy" infected and stressed neonates.

The assessment of the blood-brain barrier permeability (BBBP) showed that BBBP values were higher in stressed neonates and those with bacterial meningitis than in "healthy" infants or neonates with aseptic meningitis. The BBBP determination may be helpful in differentiating bacterial from aseptic meningitis; the high BBBP should be considered in the management of stressed neonates.

Antibody dependent cytotoxicity of human colostrum phagocytes.

Monocytes and polymorphonuclear neutrophils of human colostrum were identified using cytochemical staining procedures. The ability of colostral phagocytes to function in antibody dependent cellular cytotoxicity was found to be satisfactory at high effector/target cells ratio (20:1) Colostral monocytes showed a diminished cytotoxicity when compared to monocytes of adult or neonatal peripheral blood at low effector/target cells ratio (1:1). This could be due to the extensive fat ingestion by these cells or other inhibitory factors found in colostrum.

Parental nutrition in sick low-birth-weight neonates.

T. P. N. (aminoacids-glucose-fat) or aminoacids and glucose (A-G.) was given to 49 premature low-birth-weight neonates through peripheral veins for 7--42 days. The T. P. N. infusate contained glucose 12--20.5 g/kg/day and a standard dose of 2 g/kg/day for aminoacids and fat. The patients formed 4 groups: Twenty neonates were healthy but unable to tolerate oral feeding. Ten of them (group A) received T. P. N. and ten (Group B) received only A-G. Twenty nine neonates suffered from serious illness: 14 of them (Group C) received T. P. N. and 15 (Group D) A-G. In healthy neonates the weight gain was significantly higher in those who received T. P. N. than in those who took the same amount of calories but with A-G only. The addition of fat in parenteral nutrition is necessary in order to achieve a weight gain similar to that of intrauterine period. Fat is even more necessary in sick low-birth-weight neonates because they were found to be unable to tolerate high doses of glucose. Only part of the energy intake of the sick neonates could be covered with A-G. The present study has shown that parenteral nutrition can safely be given to sick low-birth-weight neonates without serious complications.

Chlorpromazine and lidocaine inhibit antibody-dependent cell-mediated cytotoxicity but not erythrocyte antibody rosette formation.

Pretreatment of human peripheral blood mononuclear cells with chlorpromazine and lidocaine reduces their ability to induce lysis of antibody-coated target cells. This effect of local anesthetics was not due to a reduction of binding of antibody-coated red cells to the mononuclear cells, but it was rather probably due to the inhibition of mobility of the Fc receptor on the cell membrane.