How to manage neonatal tuberculosis.

This article reports the recommendations for managing neonatal tuberculosis (TB) drawn up by a group of Italian scientific societies. The Consensus Conference method was used, and relevant publications in English were identified through a systematic review of MEDLINE and the Cochrane Database of Systematic Reviews from their inception until 31 December 2014. Group experts concluded that if suspicion is aroused, it is necessary to undertake promptly all of the investigations useful for identifying the disease not only in the newborn, but also in the mother and family contacts because a diagnosis of TB in the family nucleus can guide its diagnosis and treatment in the newborn. If the suspicion is confirmed, empirical treatment should be started. Breast-fed newborns being treated with isoniazid should be given pyridoxine supplementation at a dose of 1 mg kg(-1) day(-1). Mothers with active-phase TB can breast-feed once they have become smear negative after having received appropriate treatment.

Development and validation of an enzyme linked immunosorbent assay for palivizumab serum determination.

Palivizumab (Synagis) is a humanized monoclonal antibody (IgG1K) composed of 95 percent human and 5 percent murine sequences. It is directed to an epitope in the A antigenic site of the F protein of respiratory syncytial virus (RSV). Palivizumab is used for prevention of serious lower respiratory tract disease caused by RSV in pediatric patients who are at increased risk of severe disease and is administered intramuscularly (IM) for a total of 5 monthly doses. Herein, we report on the development and validation of a very sensitive enzyme-linked immunosorbent assay (ELISA) to measure serum concentrations of palivizumab by a rabbit polyclonal antibody specifically produced against the murine sequence. The method was developed and validated according to the guidelines "Guidance for Industry" (1998) and has proved suitable for the determination of palivizumab serum levels in the target infant population. The ELISA assay was successfully applied to test the serum samples in an infant population who received palivizumab intramuscularly; thus, the assay could be used to determine serum levels in palivizumab-treated infants to optimize dosing and scheduling and to study the relationship between dose and clinical response.

Cerebral and somatic rSO2 in sick preterm infants.

Near infrared spectroscopy (NIRS) measures the regional tissue oxygen saturation (rSO2) of various organs and provides a reflection of the balance between tissue oxygen supply and demand. Oxymetry assessed via NIRS has been proposed as a 'standard of care' and today it is already widely used in the NICU. This approach allows detection of any acute change in cerebral haemodynamics and continuous monitoring of cerebral and somatic oxygenation. This work describes three clinical cases of preterm VLBW infants which showed special points of interest during both cerebral and somatic NIRS monitoring.

Preterm newborns are provided with triggering receptor expressed on myeloid cells-1.

Triggering receptor expressed on myeloid cells-1 (TREM-1) and soluble fraction (sTREM-1) are useful markers of infection in adults. Neonates, especially preterm infants, are exposed to high risk of sepsis due to the immature immune system and few data are available regarding TREM-1, mainly focused on the soluble form. We therefore decided to investigate the baseline assessment of TREM-1, membrane and soluble receptors, in preterm newborns without clinical or microbiological evidence of infection, in order to precociously measure the possible changes due to sepsis and compare them to the obtained reference values. Fifty-nine newborns were enrolled in the study. Median and Interquartile range of TREM-1 were: in monocytes 96 percent with 71 Mean Fluorescence Intensity (50-94); in PMNs: 80 percent (68-87); soluble TREM-1: 29.1 pg/ml (14.55-103.93). Monocyte expression and soluble TREM-1 concentrations appeared comparable to healthy adults, while not all PMNs expressed this receptor, possibly due to their immaturity. Birth weight negatively correlated with sTREM-1, while there were no statistical significances with gestational age, maternal age, gender, mode of delivery, patent ductus arteriosus, intrauterine growth restriction, premature rupture of membranes and TREM-1 or sTREM-1. We also reported a statistical relationship between monocyte TREM-1 and surfactant administration and between sTREM-1 and antenatal steroid prophylaxis. Even if untrained, the neonatal immune system of preterm newborns is equipped with TREM-1 system, but further studies are needed to evaluate the functionality in newborns.

Breastfeeding and cytomegalovirus infections.

Perinatal cytomegalovirus (CMV) infection has recently become a matter of some debate. It is acquired by the newborn mainly via breast milk and though this has practically no consequences in term newborns, it may cause severe symptomatic disease in preterm newborns. Almost all CMV-seropositive women eliminate the virus via their milk; freezing breast milk at -20 degrees C and pasteurization may respectively reduce or eliminate the viral load. No evidence has yet been found in preterm neonates for sequelae related to CMV infection acquired via breast milk. The administration of fresh breast milk to very premature neonates who constitute a population at risk is controversial.

Breastfeeding duration and current neonatal feeding practices in Emilia Romagna, Italy.

A cohort of 1567 infants was studied at birth and at 3 mo of age to elucidate factors possibly affecting feeding policies in the maternity ward and the relationship with subsequent feeding patterns. During their stay in the maternity wards 89.6% of infants were breastfed, with 28.1% receiving formula in addition to mother's milk. Independent predictors of receiving a formula supplement in the maternity wards as a result of multivariate analyses were the separation of the newborn from the mother, a birthweight lower than 3000 g and a gestational age lower than 38 wk. At 3 mo of age, 66.1% infants were still at least partially breastfed and 48.9% were exclusively breastfed. An increased risk of not being breastfed at 3 mo of age was related to supplementary feeding at birth and birthweight. A weak relationship was found between the prevalence of breastfeeding at 3 mo of age and the magnitude of routine formula supplement use in the maternity ward. Given the present trends for early discharge from maternity wards and the National Health System facility for free paediatric assistance after discharge, in Italy paediatricians should be the main actors to support the continuation of breastfeeding.

Partial deletion 10p syndrome. Report of two patients.

Two patients with partial deletion of the short arm of chromosome 10 are described. They showed most of the features observed in twenty other known patients, including growth retardation, mental deficiency, abnormally shaped skull, distinct facial dysmorphisms, cardiac and genitourinary malformations, and limbs anomalies. One of our patients also had features of the DiGeorge sequence, which has been found in five other cases with this imbalance.

[Congenital telangiectasic (pyogenic) granuloma of the anus: a rare location of a benign neonatal tumor]. / Granuloma teleangectasico ("piogenico") congenito dell'ano: una rara sede di "tumore" benigno neonatale.

The neonatal anus is an unusual anatomic site for granuloma pyogenicum (GP). Several synonisms exist for GP (at least 16). It is a tumor of soft tissues (benign vascular tumor). Both a maternal variant (the epulis) and a hamartomatous perinatal one are known. The terms teleangiectasic granuloma and pyogenic or infected granuloma have been used to describe respectively the early and late stages of the lesion. In the anal site it appears as a sessile or peduncolated, red-wine, soft little tumor of the size of a millet or barley grain. Histologically it is a capillary haemangioma with inflammatory infiltrates in its soft connective tissue stroma and covered with thinned epidermis. During 1988 we have seen two cases in 2000 consecutive newborns, both in females.

[Blood testosterone in cryptorchid newborn infants: does it have a prognostic significance?]. / La testosteronemia nel neonato criptorchide, ha significato prognostico?

Testosterone, LH, FSH, blood levels at birth were determined in 40 Italian true cryptorchid , 12 pseudo-cryptorchid and 71 healthy newborns. Testosterone concentrations were interpreted according to the localisation of the retained testicles. A greater incidence of spontaneous remission of the cryptorchidism was found in those subjects with: 1) testosterone plasma levels overlapping the neonatal range; 2) testicles placed in proximity to the external orifice of the inguinal tunnel. Follow-up of these infants up to 2 years of age will test the hypothesis.

[The phenomenon of a permanent spontaneous articular vacuum (or anti-vacuum effect) in neonatology]. / Il fenomeno del "vacuum" articolare (o effetto antivacuum) spontaneo, duraturo in neonatologia.

Natural permanent pneumarthrography (NPP) is due to entrance of gases in-to the joint spaces following a sudden increase in intra articular volume and lowering of intra articular pressure by sudden stresses. A case of N.P.P. of the hip occurred in one of two stillborn twins (breech delivery); the causes of death were some amniotic bridles of the cord with consequent stop in the blood flow.

An unusual variant chromosome 9 with an extra C-negative, G-dark segment in the short arm.

An unusual variant chromosome 9 is described in a mother and a daughter: an extra G-dark, C-negative and G-11 negative chromosomal segment is present in the short arm in the absence of apparent phenotypic effects. This extra material is also Ag-As negative and exhibits a fluorescence similar in intensity to that of band 9q21 when stained by QFQ and DAPI/AMD, and to that of band 9p13 in RBA-banded preparations; it is slightly less fluorescent when R-banded by chromomycin A3. The possibility of an association with an increased risk of spontaneous abortion is presented.

[Green milk: a contribution to the study of iatrogenic pollution of human milk?]. / Latte verde: un contributo allo studio degli inquinamenti iatrogenici del latte di donna?

An heterozygotic beta-thalassemic pregnant woman after a treatment with ferritin produced green milk for many days. Bivalent iron was found in that green human milk.