Megacystis, microcolon, intestinal hypoperistalsis syndrome and bilateral streak gonads.

Megacystis, microcolon, intestinal hypoperistalsis is an uncommon condition presenting in neonatal age with features of intestinal obstruction and bladder evacuation abnormalities. We present here an infant girl with the diagnosis consistent with this entity.

Feed intake, milk production and composition of crossbred cows fed with insect-protected Bollgard II® cottonseed containing Cry1Ac and Cry2Ab proteins.

Twenty crossbred lactating multiparous cows were used in a 28-day study to compare dry matter intake (DMI), milk yield, milk composition and Bacillus thuringiensis (Bt) protein concentrations in plasma when fed diets containing Bollgard II(®) cottonseed (BGII) or a control non-genetically modified isogenic cottonseed (CON). Bollgard II cottonseed contains the Cry1Ac and Cry2Ab insecticidal proteins that protect cotton plants from feeding damage caused by certain lepidopteran insects. Cows were assigned randomly to the BGII or CON treatments after a 2-week adjustment period. Cows consumed a concentrate containing 40% crushed cottonseed according to milk yield and green maize forage ad libitum. All cows received the same diet but with different crushed cottonseed sources. Cottonseed was included to provide approximately 2.9 kg per cow daily (dry matter basis). The ingredient composition of the concentrate was 40% crushed cottonseed, 15% groundnut cake, 20% corn, 22% wheat bran, 1% salt and 2% mineral mixture. Milk and blood plasma were analyzed for Cry1Ac and Cry2Ab proteins. DMI, BW, milk yield and milk components did not differ between cows on the BGII and CON treatments. Although milk yield and milk fat percentage were not affected by treatment, 4% fat-corrected milk (FCM) production and FCM/kg DMI for cows on the BGII treatment (14.0 kg/cow per day, 1.12 kg/kg) were significantly improved compared with cows on the CON treatment (12.1 kg/cow per day, 0.97 kg/kg). Gossypol contents in BGII cottonseed and conventional cottonseed were similar. Cry1Ac and Cry2Ab2 proteins in Bollgard II cottonseed were 5.53 and 150.8 µg/g, respectively, and were not detected in the milk or plasma samples. The findings suggested that Bollgard II cottonseed can replace conventional cottonseed in dairy cattle diets with no adverse effects on performance and milk composition.

Management of 168 neonates weighing more than 2000 g receiving intrapartum chemoprophylaxis for chorioamnionitis. Evaluation of an early discharge strategy.

OBJECTIVE: To determine whether sequential laboratory and clinical evaluations during the first 3 days of postnatal life can be used to safely limit the duration of antibiotic therapy for term neonates whose mothers received intrapartum antibiotic treatment for intra-amniotic infection (ie, chorioamnionitis). METHODS: Since postpartum neonatal body fluid cultures can be falsely negative because of transplacental passage of maternal antibiotics, we prospectively followed up 6620 pregnancies for 28 months (December 1991 through March 1994) for the occurrence and treatment of chorioamnionitis. Neonatal antibiotic therapy was initiated and limited to 3 days or continued for 7 days or more in neonates with abnormal laboratory values or clinical signs that were consistent with sepsis on day 3 of postnatal age. Both groups were observed in the hospital for 24 to 48 hours after antibiotics were discontinued. RESULTS: Of the 6620 pregnancies, 158 infants (2.4%) born to 155 mothers received intrapartum antibiotics for chorioamnionitis; 10 additional neonates diagnosed as having chorioamnionitis were transported from other hospitals (N = 168). Because of the absence of signs and negative cultures, 82% (137/168) were treated with antibiotics for 3 days, while 18% (31/168) received 7 days or more of therapy. In 84% of the 3-day group, discharge was accomplished by postnatal day 4 or 5, whereas all of the 7-day or more group were discharged after day 8. Follow-up calls placed 1 month after discharge disclosed no adverse outcomes or hospital readmissions in any of the infants in this survey. CONCLUSIONS: Neonates with infection who are born to mothers pretreated with antibiotics for intra-amniotic infection can be reliably identified less than 72 hours after birth and treated appropriately. As 82% of at-risk patients are asymptomatic and have a negative body fluid culture, our data support the position that a full course of antibiotic therapy can be restricted to only those patients with clinical or laboratory signs of sepsis (18%). This will effective reduce the average length of hospital stay for intrapartum-treated neonates by a minimum of 3 to 4 days compared with a commonly used empiric therapy approach of continuing medication for 7 days or more. Perhaps hospital discharge can be further shortened if a 1- to 2-day posttreatment observation period is eliminated for all patients except those with a positive body fluid culture.

Plasminogen activator activity in preterm infants with respiratory distress syndrome: relationship to the development of bronchopulmonary dysplasia.

Respiratory distress syndrome (RDS) is characterized by the presence of fibrin-rich exudates in the alveoli. Fibrin and its degradation products may play an important role in the pathogenesis of bronchopulmonary dysplasia (BPD). The purpose of this study was to test the hypothesis that preterm neonates with RDS have depressed alveolar fibrinolytic activity and that those with RDS progressing to BPD have an even greater impairment in alveolar fibrinolysis. Serial tracheal aspirate (TA) samples from intubated neonates--9 control and 46 with RDS--were analyzed for fibrinolytic activity. In neonates with RDS, 26 resolved, 18 progressed to BPD, and 2 died before 28 d. Plasminogen activator (PA) and its inhibitor (PAI) were identified in TA by reverse fibrin autography and immunoblotting. Net PA/plasmin activity in TA was significantly depressed on d 1 of life in patients with self-resolved RDS (median = 20.85 ng/mL, p < 0.05) and RDS progressing to BPD (median = 4.97 ng/mL, p < 0.001) compared with control patients (median = 87.1 ng/mL). In addition, neonates progressing to BPD had significantly lower PA/plasmin activity on day one of life compared with neonates with self-resolved RDS (p < 0.001). ELISA for specific PA and PAI were not significantly different. We speculate that depressed fibrinolytic activity may place preterm neonates at risk for RDS and that the degree of this depression may predict the progression to BPD. In infants < or = 30 wk of gestation at birth with RDS, a PA/plasmin activity < or = 10.0 ng/mL on the 1st d of life had a positive predictive value of 80% (12/15) and a negative predictive value of 82% (9/11) for the progression to BPD.