Congenital toxoplasmosis: efficacy of maternal treatment with spiramycin alone.

PROBLEM: The evidence supporting an additional benefit of a combined regimen of pyrimethamine-sulfonamides compared with spiramycin alone in the secondary prevention of congenital toxoplasmosis was critically evaluated. METHOD OF STUDY: We reviewed the series of cases published in the English literature on antiparasitic treatment of acute toxoplasmosis infection in pregnancy, using spiramycin until fetal infection is documented, then using cycles of spiramycin alternated with combined pyrimethamine-sulfonamide therapy. We then compared the occurrence of overt disease among infected offspring (both severe, represented by ophthalmologic or cerebral abnormalities, and mild occurrences, represented by asymptomatic intracranial calcifications and retinal scars without visual impairment) between the published case series and our consecutive series of cases treated during a 10-year period (January 1986-December 1995) with spiramycin alone. RESULTS: The prevalence of fetal infection in our series was 7.8% (12/154), similar to that reported after alternated regimens (7.0%). The rate of overt disease among infected fetuses is not different after treatment with alternated regimens than after continuous antibiotic spiramycin therapy [23% (19/82) vs. 10% (1/10); relative risk, 2.3; 95% confidence interval, 0.4, 47.0]. The pharmacokinetics of the drugs used may account for this finding. CONCLUSION: The treatment of acute toxoplasmosis in pregnancy with an alternated antibiotic regimen of pyrimethamine-sulfonamide is not more efficacious at preventing overt neonatal disease than treatment with continuous spiramycin alone.

Multicenter trial on mother-to-infant transmission of GBV-C virus. The Lombardy Study Group on Vertical/Perinatal Hepatitis Viruses Transmission.

Evidence indicates that the GBV-C or hepatitis G virus can cause persistent infection in humans, but little is known on the importance of vertical transmission. To assess the risk of mother-to-infant transmission and the clinical outcome of infected babies, we investigated 175 anti-HCV positive mothers and followed-up their children for 3-33 months. GBV-C RNA was detected by RT-PCR and anti-E2 antibody was assayed by EIA. Thirty-four (19.4%) women were GBV-C RNA positive and transmission occurred to 21 (61.8%) babies; 20 (95.2%) acquired GBV-C alone, and one (4.8%) GBV-C and HCV. Maternal factors such as intravenous drug use, HIV coinfection, HCV-RNA positivity, and type of feeding were not correlated with GBV-C transmission. GBV-C RNA remained persistently positive in all infected babies but one baby who seroconverted to anti-E2. Seven (35%) babies with GBV-C alone developed marginally elevated ALT; the baby with HCV and GBV-C co-infection had the highest ALT peak value (664 IU/l). Seven of the 141 (5%) babies born to the GBV-C RNA negative mothers acquired HCV and six (85.7%) had abnormal ALT. The mean ALT peak value was significantly higher (P < 0.05) for babies with HCV than for those with GBV-C. None of the children with GBV-C or with HCV became icteric. GBV-C is frequently present in anti-HCV positive women. The infection is transmitted efficiently from mother to baby and rate of transmission is much higher than that for HCV. GBV-C can cause persistent infection in babies but usually without clear evidence of liver disease.

[Support for the parents after the death of a newborn infant]. / Supporto ai genitori dopo la morte di un neonato.

The neonatologist in NICU has many duties, first of all caring the baby and supporting the parents in facing stressing situations. When the baby dies most doctors think their job is over, and only in few hospitals there is the opportunity for the parents to meet the staff again. We report our recent experience to meet parents after baby's death. We offer them this possibility when they are leaving the hospital and, after about one month, we call them by phone to arrange an appointment. We have realized that they need to talk at least once with the staff (doctors and nurses) to examine and solve doubts about cares and to relieve their sufferance. In our experience, even limited, we found that nobody refuses this opportunity and that in most instances parents required more than one meeting and, finally, that talking of the baby with people who took care of him helps them in accepting baby's death. We found this experience very useful both for parents and staff, so we hope this opportunity will extend to other hospitals.

[Obstetric/neonatological integration and care of healthy newborn infants]. / L'integrazione ostetrico/neonatologica e l'assistenza al neonato sano.

We report how we changed the model of the organization and the assistance in our Department of healthy newborns (2200-2400/years). After we have realized that mothers were not satisfied of the rules of the hospital and personnel was not satisfied of the job, we decided to begin a process of analysis and review of the procedures on full term newborn. During this process we found out that the most important thing was to have clear in mind the problems and the needs of the mother and the baby, and not those of nurses and doctors. A similar process took place in the Department of Obstetrics. In this way we, Obstetrics and Neonatologist together, began to offer a more human approach to birth, and rooming-in began. We stopped to attend every normal delivery, to separate immediately mother and baby, to feed the baby at fixed time, to give him supplementations. We tried to have with the mother a better relationship, visiting the baby in presence of the mother an receiving grom Obstetrics as soon as possible every information about pregnancy. We realized that this was possible only if the Neonatologist and the Obstetric were of the same opinion about a more human approach to birth. We stress this point, well aware that it's impossible to reach this goal unless everybody in any way involved in birth work in great harmony with all the others. A further result of this "new" way of working has been the program of early discharge: if desired, and whenever possible, the mother and the baby go home 48-72 hours after delivery. We report here preliminary data.

[Evaluation of some inflammatory and immune parameters in juvenile rheumatoid arthritis during the acute phase and in remission]. / Valutazione di alcuni parametri flogistici ed immunitari nell'artrite reumatoide infantile in fase di acuzie e di remissione.

A serologic study was carried out in 27 children.-- 12 females and 15 males -- affected with juvenile rheumatoid arthritis (JRA), systemic and polyarticular type, in active phase and in remission. Beside the routine assays (ESR and haemometry), a dosage of serum immunoglobulins (IgA, M, G) and complement components (C3 and C4) was carried out; antinuclear antibodies with immunofluorescence, rheumatoid factors with classical method (latex test and Waaler-Rose reaction) and antigamma factors (AGGF) according to modified Schur's method were looked for. Polymorphonuclear function was assayed employing NBT test, phagocytosis and killing with Klebsiella. The results confirmed that the most reliable activity index is the ESR, while the WBC count is move variable and that the rheumatoid factors according to the usual techniques are almost always absent. As a whole, in JRA the levels of IgM, IgG, IgM-AGGF, C4 assayed higher than in controls. In the different subgroups, the systemic disease is characterized by higher serum IgA and IgG-AGFF. The PMN function was globally normal.