Evaluation of systemic inflammatory indices in the diagnosis of early onset neonatal sepsis in very low birth weight infants.

BACKGROUND: Previously, not six systemic inflammatory indices were evaluated in the diagnosis of early onset sepsis (EOS) in very low birth weight (VLBW, <1500g) premature infants. OBJECTIVES: We evaluated the effectiveness of systemic inflammatory indices in the diagnosis of EOS in VLBW infants. METHODS: Premature infants with birth weight <1500 g were included in the study. Six systemic inflammatory indices including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), pan-immune-inflammation value (PIV), and systemic inflammation response index (SIRI) were compared in patients with EOS (treatment group) and without EOS (control group). RESULTS: Of 917 infants enrolled, 204 infants were in the EOS group and 713 infants comprised the control group. NLR, MLR and SIRI values were significantly higher in the EOS group than in the control group (p < 0.001). The AUC value of SIRI for the predictivity of EOS was 0.803. CONCLUSIONS: The SIRI can be used together with other parameters as both an easily accessible and the reliable systemic inflammatory indices in the diagnosis of EOS in VLBW preterm infants.

A human monoclonal anti-TNF alpha antibody (adalimumab) reduces airway inflammation and ameliorates lung histology in a murine model of acute asthma

BACKGROUND: A few experimental studies related to asthma have unveiled the beneficial effects of TNF alpha blocking agents on the airway histology, cytokine levels in bronchoalveolar lavage and bronchial hyper-responsiveness. In the current study, we aimed to assess the effect of adalimumab on the inflammation and histology of asthma in a murine model. METHOD: Twelve-week-old BALB/c (H-2d/d) female rats (n = 18) were allocated into three groups, including (group I) control (phosphate-buffered saline was implemented), (group II) asthma induced with OVA (n = 6), and (group III) asthma induced with OVA + treated with adalimumab (n = 6). Rats were executed on the 28th day of the study. The lung samples were fixed in 10% neutral buffered formalin. Lung parenchyma, alveolus, peribronchial and perivascular inflammation were assessed. Lung pathological scoring was performed. RESULT: Severity of lung damage was found to be reduced significantly in the asthma induced with OVA + treated with adalimumab group. When compared with the untreated group, adalimumab significantly reduced the inflammatory cells around the bronchi and bronchioles, and reduced inflammation of the alveolar wall and alveolar wall thickness as well (median score = 1, p = 0.52). Peribronchial smooth muscle hypertrophy and oedema were significantly reduced after adalimumab administration. CONCLUSION: Adalimumab (a human monoclonal anti-TNF alpha antibody) therapy significantly reduced the severity of lung damage by decreasing cellular infiltration and improvement on the lung histology in a murine model of acute asthma

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A human monoclonal anti-TNF alpha antibody (adalimumab) reduces airway inflammation and ameliorates lung histology in a murine model of acute asthma.

BACKGROUND: A few experimental studies related to asthma have unveiled the beneficial effects of TNF alpha blocking agents on the airway histology, cytokine levels in bronchoalveolar lavage and bronchial hyper-responsiveness. In the current study, we aimed to assess the effect of adalimumab on the inflammation and histology of asthma in a murine model. METHOD: Twelve-week-old BALB/c (H-2d/d) female rats (n=18) were allocated into three groups, including (group I) control (phosphate-buffered saline was implemented), (group II) asthma induced with OVA (n=6), and (group III) asthma induced with OVA+treated with adalimumab (n=6). Rats were executed on the 28th day of the study. The lung samples were fixed in 10% neutral buffered formalin. Lung parenchyma, alveolus, peribronchial and perivascular inflammation were assessed. Lung pathological scoring was performed. RESULT: Severity of lung damage was found to be reduced significantly in the asthma induced with OVA+treated with adalimumab group. When compared with the untreated group, adalimumab significantly reduced the inflammatory cells around the bronchi and bronchioles, and reduced inflammation of the alveolar wall and alveolar wall thickness as well (median score=1, p=0.52). Peribronchial smooth muscle hypertrophy and oedema were significantly reduced after adalimumab administration. CONCLUSION: Adalimumab (a human monoclonal anti-TNF alpha antibody) therapy significantly reduced the severity of lung damage by decreasing cellular infiltration and improvement on the lung histology in a murine model of acute asthma.

Well-known but rare pathogen in neonates: Listeria monocytogenes.

Listeria monocytogenes is a very important life-threatening bacteria in certain risk groups such as neonates, pregnant women, elderly people, transplant recipients and others with impaired cell-mediated immunity. However, its infections are very rare in healthy children. Reports of listeriosis in newborn period are limited. We report a case of neonatal listeriosis with erythematous rash, intractable convulsions, severe early neonatal sepsis, disseminated intravascular coagulation, multiple organ dysfunction syndrome and death. Although an empirical antibiotic therapy including ampicillin (semisentetic penicillin) and aminoglycoside combination is effective by the means of a probable Listeria infection, the progression of the very early-onset disease may be fatal, despite vigorous treatment efforts as in our case.

Quantification of amikacin in bronchial epithelial lining fluid in neonates.

Amikacin efficacy is based on peak concentrations and the possibility of reaching therapeutic levels at the infection site. This study aimed to describe amikacin concentrations in the epithelial lining fluid (ELF) through bronchoalveolar lavage (BAL) in newborns. BAL fluid was collected in ventilated neonates treated with intravenous (i.v.) amikacin. Clinical characteristics, amikacin therapeutic drug monitoring serum concentrations, and the concentrations of urea in plasma were extracted from the individual patient files. Amikacin and urea BAL fluid concentrations were determined using liquid chromatography with pulsed electrochemical detection (LC-PED) and capillary electrophoresis with capacitively coupled contactless conductivity detection (CE-C(4)D), respectively. ELF amikacin concentrations were converted from BAL fluid concentrations through quantification of dilution (urea in plasma/urea in BAL fluid) during the BAL procedure. Twenty-two observations in 17 neonates (postmenstrual age, 31.9 [range, 25.1 to 41] weeks; postnatal age, 3.5 [range, 2 to 37] days) were collected. Median trough and peak amikacin serum concentrations were 2.1 (range, 1 to 7.1) mg/liter and 39.1 (range, 24.1 to 73.2) mg/liter; the median urea plasma concentration was 30 (8 to 90) mg/dl. The median amikacin concentration in ELF was 6.5 mg/liter, the minimum measured concentration was 1.5 mg/liter, and the maximum (peak) was 23 mg/liter. The highest measured ELF concentration was reached between 6 and 14.5 h after i.v. amikacin administration, and an estimated terminal elimination half-life was 8 to 10 h. The median and highest (peak) ELF amikacin concentrations observed in our study population were, respectively, 6.5 and 23 mg/liter. Despite the frequent use of amikacin in neonatal (pulmonary) infections, this is the first report of amikacin quantification in ELF in newborns.

Anaphylactic reaction due to cyclopentolate in a 4-year-old child.

Ophthalmologists frequently use mydriatics both for diagnosis (retinal exploration, refraction tests) and for treatment. Cyclopentolate is used to induce quick and successful mydriasis for pediatric eye examination. Hypersensitivity reaction to cyclopentolate is very uncommon, especially in children. We report the case of a child who experienced a hypersensitivity reaction to cyclopentolate during preparation for an eye examination under cycloplegia.

Determinants of variability in clearance of exogenous compounds in neonates.

Although the general principles of disposition and elimination of exogenous compounds apply in neonates, their specific characteristics warrant a tailored approach. Children display maturation in drug disposition, and these maturational changes are most prominent in the first year of life. Elimination clearance is mainly either through metabolic or renal elimination clearance. Almost all phase I and phase II metabolic processes display ontogeny in a iso-enzyme specific pattern. Variation in phenotypic metabolic clearance is based on constitutional, environmental and genetics factors. In early life, it mainly reflects ontogeny, but other covariates may also become relevant. The impact of various covariates like postmenstrual age, postnatal age, disease state characteristics and polymorphisms are illustrated based or 'probe' drugs (paracetamol, tramadol, propofol) administered as part of their medical treatment in critically ill neonates. Renal elimination clearance in early life is low and almost completely depends on glomerular filtration. Despite this overall low clearance, interindividual variability is already extensive and can be explained by covariates like postmenstrual age, postnatal age, co-administration of a non-selective cyclo-oxygenase inhibitor or growth restriction. These findings are illustrated by observations on amikacin, vancomycin and cefazolin disposition in perinatal life. These maturational changes all have impact on the pharmaco/toxicokinetics and -dynamics. We hereby would like to extent the adagio of Paracelsus that 'all is toxic, it only depends on the dose' by making the point that the 'patient' is also relevant.