Central catheter removal timing and growth patterns in preterm infants.

BACKGROUND: Early discontinuation of total parenteral nutrition (TPN) at 100 ml/kg/day of enteral feeds, compared with 140 ml/kg/day, led to significant delay in time to regain the birth weight in very low birth weight infants (birth weight < 1500 g, VLBW). Our aim was to compare the growth of infants in relation with timing of TPN discontinuation up to 2 years corrected gestational age (CGA). METHODS: Posttrial follow-up study using review of paper medical records. Participants of the randomized controlled trial studying effect of early parenteral nutrition discontinuation on time to regain birth weight in VLBW infants were included. Growth parameters inclusive of weight, length, and occipital-frontal circumference (OFC) were collected. Z-scores were calculated at five predefined time points-birth, 0-11 weeks CGA, 12-35 weeks CGA, 36-60 weeks CGA, and 61-96 weeks CGA and compared for control and intervention groups. RESULTS: Regarding weight, we found lower mean Z-score in the intervention group between 0 and 11 weeks CGA, with larger difference in extremely low birth weight infants (birth weight < 1000 g, ELBW), but this did not reach the statistical significance. Regarding length, the same difference, slightly delayed to 35 weeks CGA was observed and reached statistical significance for ELBW infants between 12 and 35 weeks CGA. There was no difference in OFC mean Z-scores at any timepoint. CONCLUSIONS: The discontinuation of TPN at 100 ml/kg/day showed significantly lower Z-score for length in ELBW infants between 12 and 35 weeks CGA. There were no differences in Z-scores by 2 years CGA.

A conservative treatment of patent ductus arteriosus in very low birth weight infants.

BACKGROUND: Treatment of the patent ductus arteriosus (PDA) in the preterm infant remains contentious. There are numerous options of the PDA management from early targeted treatment, late (symptomatic) treatment to no treatment at all. AIMS: To evaluate a three different PDA management approaches in very low birth weight (VLBW) infants. STUDY DESIGN: A retrospective observational time series study of three cohorts of VLBW infants born between 2004 and 2011. SUBJECTS: Infants in Symptomatic Treatment Group (STG) were echocardiographically evaluated when clinical signs suggestive of a PDA were present and treated if a haemodynamically significant PDA was confirmed. Early Targeted Group (ETG) underwent echocardiography within the first 48h and infants received ibuprofen if a large PDA was present. Conservative Treatment Group (CTG) was screened by echocardiography on day seven of life; patients with PDA were managed with increased positive end expiratory pressure and fluid restriction as a first line intervention. OUTCOMES: The primary outcome was medical and surgical treatment in the three time periods. Secondary outcomes included mortality, severe periventricular and intraventricular haemorrhage, respiratory distress syndrome and chronic lung disease. RESULTS: There were 138 infants diagnosed with PDA; 52 infants in STG, 52 infants in ETG and 34 infants in CTG. Ibuprofen therapy and ligation were less frequent in CTG. There was significantly decreased incidence of chronic lung disease in CTG compared to STG (18% vs. 51%; p=0.003) and to ETG (18% vs. 46%; p=0.02). There was no difference in the other short term outcomes. CONCLUSION: Conservative treatment of persistent ductus arteriosus in VLBW infants is a feasible option and future randomized trials of conservative management are warranted.

Inhaled nitric oxide in preterm infants with prolonged preterm rupture of the membranes: a case series.

The available evidence does not support the routine use of inhaled nitric oxide (iNO) in the care of premature infants. We present a case series of 22 preterm infants born after prolonged preterm premature rupture of membranes and oligohydramnios with respiratory failure. Oxygenation index decreased significantly after commencement of iNO.

The immune status in situ of recurrent tonsillitis and idiopathic tonsillar hypertrophy.

OBJECTIVE: To analyze the immune status in situ of tonsils of patients with recurrent tonsillitis (RT) and idiopathic tonsillar hypertrophy (ITH) with the aim to discuss the indications of tonsillectomy (TE) and tonsillotomy (TT) in young children. METHODS: The histological and immunohistological study of tonsillar tissue of RT and ITH in correlation with immunological parameters in peripheral blood in 13 patients with RT and 16 patients with ITH. RESULTS: In the RT group, we found a higher degree of fibrosis with a higher density of memory lymphocytes (CD45R0+), B-lymphocytes (CD20+) and cytotoxic T-lymphocytes (CD8+) in surface epithelium of tonsils compared to the ITH group (NS). The density of immunoglobulin IgG in the crypt epithelium in RT was significantly higher than in the ITH group (p = 0.041). We also measured a higher sera concentration of immunoglobulines (IgG, IgM, IgA) and TNF-α in RT compared to the ITH group (NS) and TH-1 immune response in tonsillar tissue based on differences between local cytokine concentration TNF-α and IL-4. CONCLUSIONS: RT has a higher inflammatory reaction in tonsillar tissue as a result of persistent bacterial antigenic stimulation. In patients with RT, the tonsillectomy might be the only option for surgical treatment. In patients with ITH with mild symptoms, the tonsillotomy should be preferred (Tab. 3, Ref. 24).

A new case of ALG8 deficiency (CDG Ih).

UNLABELLED: Congenital disorders of glycosylation (CDG) represent an expanding group of inherited diseases. One of them, ALG8 deficiency (CDG Ih), leads to protein N-glycosylation defects caused by malfunction of glucosyltransferase 2 (Dol-P-Glc:Glc1-Man(9)-GlcNAc(2)-P-P-Dol glucosyltransferase) resulting in inefficient addition of the second glucose residue onto lipid-linked oligosaccharides. So far, only five patients have been described with ALG8 deficiency. We present a new patient with neonatal onset. The girl was born at the 29th week of gestation complicated by oligohydramnios. Although the early postnatal adaptation was uneventful (Apgar score 8 and 9 at 5 and 10 min), generalized oedema, multifocal myoclonic seizures, and bleeding due to combined coagulopathy were present from the first day. Diarrhoea progressing to protein-losing enteropathy with ascites and pericardial effusion developed in the third week of life. Pharmacoresistant seizures and cortical, cerebellar and optic nerve atrophy indicated neurological involvement. No symptoms of liver disease except coagulopathy were observed; however, steatofibrosis with cholestasis was found at autopsy. The girl died at the age of 2 months owing to the progressive general oedema, bleeding and cardio-respiratory insufficiency. Molecular analysis revealed two heterozygous mutations in the ALG8 gene: c.139A>C (p.T47P) and the novel mutation c.1090C>T (p.R364X). CONCLUSION: The prognosis of patients with ALG8 deficiency is unfavourable. The majority of affected children have early onset of the disease with heterogeneous symptoms including multiple organ dysfunction, coagulopathy and protein-losing enteropathy. Neurological impairment is not a general clinical symptom, but it has to be taken into consideration when thinking about ALG8 deficiency.

[Detection of chlamydia antibodies in non-standard biological fluids in women with fertility disorders]. / Urcení antichlamydiových protilátek v nestandardních biologických tekutinách u zen s poruchami plodnosti.

OBJECTIVE: Detection of IgA and IgG antibodies against Chlamydia trachomatis in various biological materials in patients with fertility disorders. DESIGN: Retrospective study. SETTING: Department of Gynecology and Obstetrics, Medical Faculty of Charles University and Faculty Hospital, Plzen. METHODS: Antichlamydial antibodies IgA and IgG were detected in 73 patients. Examination of sera was performed in all 73 women, peritoneal fluid was examined in 20 patients who underwent diagnostic laparoscopy, follicular fluid samples in 22 women from IVF programme and antibodies in cervical ovulatory mucus were examined in 31 patients of the Division of Immunology of Reproduction. Results were compared with clinical findings and data of personal histories. Blood donors sera examination were used as a control group. RESULTS: High number of chlamydial antibody positivity was found in follicular fluid--in IgA (18/22, 82%) and IgG (16/22, 73%) and also in ovulatory cervical mucus in IgA (13/31, 42%). Examinations of sera did not differ significantly from the control group. CONCLUSION: High levels of chlamydial antibodies in follicular fluid samples could display connection between chlamydia infection and infertility, mainly as its organic cause (adhesions, tubal factor). IgA positivity in cervical ovulatory mucus is caused by local antibody production. Serologic examination of chlamydial antibodies is one of the most suitable examinations of entry in infertile patients as well as in pregnant women.

[Penetration of cervical mucus by native and cryopreserved sperm--the Kremer test]. / Penetrace nativních a kryokonzervovaných spermií ovulacním hlenem--Kremeruv test.

OBJECTIVE: The penetration of native and cryopreserved human spermatozoa into cervical mucus--the Kremer's test. DESIGN: Retrospective study. SETTING: Department of Obstetrics and Gynaecology, Medical Faculty, Charles University and Faculty Hospital, Plzen. METHODS: Human cervical mucus was collected from 73 women visiting the Division of immunology of reproduction, Department of Obstetrics and Gynaecology in Plzen. Native spermatozoa was obtained from the patients of the Division of Immunology of Reproduction as well. Cryopreserved only in its seminal plasma was obtained from the spermabank of our department. The distance of penetration in centimetres from the start was examined in inverse microscopy after 30, 60, 90 and 90 minutes. Also the character and duration of the sperm motility was analyzed. RESULTS: The penetration of native spermatozoa was higher than the penetration of cryopreserved spermatozoa in each case. The native spermatozoa had a higher penetrability, motility and life-ability. Spermatozoa preserved only in its seminal plasma had the parameters demonstrably lower. Nevertheless these spermatozoa can be successfully used for homologue or heterologue insemination or for IVF because these spermatozoa do not loose its enzymatic and remaining energetic equipment by penetration the cervical canal. CONCLUSION: The Kremer's test belongs to the reliable methods of penetration ability of native and cryopreserved sperms.

[Is allergy a contraindication for tonsillectomy?]. / Je alergia kontraindikáciou tonzilektómie?

Many immunologists indicate that tonsillectomy (TE) performed in patients with allergy has an unfavourable impact on the development of allergy and asthma. This warning has significantly decreased the number of TE in children, and resulted in an increase in the occurrence of peritonsillar abscesses, and high incidence of obstructive breathing disturbances during sleep associated with developmental physical and mental consequences in children. The subjective of this study was to find out the influence of TE on the development of allergy in 29 children, in whom their allergy was confirmed 1-5 years after TE. The allergic disease has improved or disappeared in 24 children (82.8%), no changes were recorded in 4 children (13.8%), deterioration has occurred only in 1 child (3.4%) who developed asthma, while in common population, asthma occurs in 10% of children. The results of this study confirm that TE does not have an unfavourable impact on the development of allergy, and therefore allergy does not represent a contraindication for tonsillectomy. (Fig. 1, Ref. 22.)