Maternal/neonatal vitamin D deficiency: a risk factor for bronchopulmonary dysplasia in preterms?

OBJECTIVE: The objective of this study was to investigate the possible association between maternal/neonatal 25-hydroxy vitamin D (25-OHD) levels and development of bronchopulmonary dysplasia. STUDY DESIGN: One hundred and thirty-two preterm infants ⩽32 weeks of gestation who were diagnosed with respiratory distress syndrome were enrolled. 25-OHD levels were determined in maternal/neonatal blood samples that were obtained at the time of admission to the neonatal intensive care unit. RESULT: A total of 100 infants were included and 31 (31%) developed bronchopulmonary dysplasia (BPD). Both maternal and neonatal 25-OHD levels in the BPD group were significantly lower compared with those in the no-BPD group (P=0.0001). A positive correlation was detected between maternal and neonatal 25-OHD levels. All of the infants with BPD had a 25-OHD level <10 ng ml(-1), which represented severe deficiency. Univariate logistic regression analysis revealed that maternal/neonatal vitamin D levels were a significant predictor of BPD (odds ratio (OR): 0.76 and 0.61, respectively, P<0.001). CONCLUSION: We demonstrated for the first time that lower maternal and neonatal vitamin 25-OHD levels were associated with BPD development in preterm infants. However, further studies with larger sample sizes are needed to delineate the possible link between vitamin D deficiency and BPD.

Lower vitamin D levels are associated with increased risk of early-onset neonatal sepsis in term infants.

OBJECTIVE: To evaluate the effect of vitamin D levels on early-onset sepsis (EOS) in term infants. STUDY DESIGN: Fifty term infants with clinical and laboratory findings of EOS (study group) and 50 healthy infants with no signs of clinical/laboratory infection (control group) were enrolled. Blood was drawn at the time of admission during the first 3 postnatal days of life in both groups for measurement of 25-hydroxyvitamin D (25-OHD) levels. RESULT: Maternal and neonatal 25-OHD levels (22.2/8.6 ng ml(-1), respectively) in the study group were significantly lower than those of the control group (36.2/19 ng ml(-1), respectively, P<0.001). A positive correlation was detected between maternal and neonatal 25-OHD levels. Severe vitamin D deficiency was significantly more common in the sepsis group. CONCLUSION: Lower maternal and neonatal 25-OHD levels are associated with EOS. These data suggest that adequate vitamin D supplementation during pregnancy may be helpful to prevent EOS in term neonates.

Adiponectin and visfatin levels in extremely low birth weight infants; they are also at risk for insulin resistance.

AIM: The aim of this study was to assess adiponectin, visfatin, HOMA-IR, glucose and triglyceride levels in term, preterm and extremely low birth weight (ELBW) babies. Each of these three groups was subdivided into two groups as small-for-gestational age (SGA), and appropriate-for-gestational age (AGA). 30 term, 30 preterm and 30 extremely low birth weight infants were included into the study. RESULTS: There was no significant difference in term and preterm infants for serum adiponectin, visfatin, and HOMA-IR levels. There were also no significant differences between term and preterm infants for glucose and triglycerides. The serum visfatin, insulin and HOMA-IR levels (p = 0.001, p = 0.001 and p < 0.05, respectively) were higher in ELBW group than preterm group. Comparing the subgroups as SGA and AGA in all main groups, only in ELBW group there were no significant differences in serum adiponectin, visfatin, HOMA-IR and insulin levels. CONCLUSIONS: We suggest that visfatin can be used as an early indicator of insulin resistance. Independent of being SGA, ELBW itself may be a risk factor for insulin resistance. In the follow-up of these babies the risk of obesity, metabolic syndrome and cardiovascular diseases may be increased as in SGA babies.  

Mean platelet volume in very preterm infants: a predictor of morbidities?

BACKGROUND: Mean platelet volume [MPV] is an important predictor for many diseases and larger platelets are more reactive and associated with shortened bleeding time. Although elevated MPV values are related to respiratory distress syndrome [RDS] in neonates, there are, to our knowledge, no data investigating the relationship between MPV and other diseases of preterm infants. AIM: To assess the correlation between MPV and the occurrence of various morbidities of prematurity such as necrotizing enterocolitis [NEC], bronchopulmonary dysplasia [BPD], sepsis, retinopathy of prematurity [ROP], and intraventricular hemorrhage [IVH] in a cohort of very preterm infants. SUBJECTS: We studied infants with a gestational age of < 34 weeks and a birth weight of < 1500 g admitted to a third level Neonatal Intensive Care Unit. Enrolled infants were divided into NEC and non-NEC, sepsis and non-sepsis, ROP and non-ROP, BPD and non-BPD and IVH and non-IVH groups. MPV was evaluated at birth [cord blood] and repeated at 48-72 hours of life. RESULTS: Two hundred and seventy two infants were studied. MPV measured at birth was similar between sepsis and non-sepsis, and ROP and non-ROP groups. MPV values were higher in infants with BPD [9.08±1.3 fl], IVH [8.4±1.1fl] and NEC [8.6±0.7 f] when compared to the control group [7.6±0.6 fl] in the first day of life. CONCLUSIONS: High MPV in the first hours of life may reflect the presence of a risk factor for the development of NEC, BPD and IVH in extremely preterm infants. This might be associated with inflammatory and oxidative process. However, our data indicate that higher MPV values are not associated with the development of sepsis or ROP in this study population.        

Importance of epicardial adipose tissue thickness measurement in obese adolescents, its relationship with carotid intima-media thickness, and echocardiographic findings.

AIM: The aim of the present study was to analyze the relationship between epicardial adipose tissue thickness (EATT) and echocardiographic parameters, such as carotid intima-media thickness (cIMT), myocardial performance index (MPI), left ventricular (LV) systolic and diastolic function, and LV mass index in adolescents with obesity. PATIENTS AND METHODS: One hundred and thirty eight obese adolescents and 63 lean subjects were enrolled in the study. The body mass index standard deviation scores (BMI-SDS) between 1.65-2.49 and 2.50-2.99 were considered as mild-moderate and severe obesity, respectively. All of the subjects underwent transthoracic echocardiographic examination for determination of LV function, LV structure, LV mass index, and MPI. Epicardial adipose tissue thickness and cIMT were also measured during echocardiography. RESULTS: The EATT measurements were increased significantly in patients with severe obesity compared to lean subjects (7.38±1.76 vs 4.28±0.79 mm, respectively; p = 0.001), but there was no significant difference between the obesity groups. The average LV mass index measurements were higher in both mild-moderately and severely obese patients in comparison with the lean children (87.5±34.8, 88.5±23.0, and 62.4±18.2 g/m2, respectively; p < 0.01), but there was no significant difference between the obesity groups. EATT was positively correlated with BMI-SDS, waist and hip circumference, blood pressure, fasting glucose, insulin, HOMA-IR, hs-CRP (high-sensitivity C-reactive protein), triglyceride levels, cIMT, LV mass index, and MPI in the severe obesity group. EATT was the only independent predictor of cIMT in the multivariate analysis (standardized ß coefficient = 0.70, p < 0.001). CONCLUSIONS: The present study demonstrates a close relationship between EATT and cIMT, and LV functions and LV mass index in obese adolescents. Assessments of EATT and cIMT in particular during routine echocardiographic examinations might be used as a feasible and reliable method for the evaluation of obesity and its related cardiovascular risks during childhood.

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.

An infant with congenital fibula deficiency accompanying with deafness.

Congenital longitudinal deficiency of the fibula (CLDF) is the most common congenital defect involving the long bones. There have been many different classifications developed for fibula deficiency. Achterman and Kalamchi's classification is most commonly used and will be described. Our case was complied with type II. Other anomalies includes cardiac anomalies, thrombocytopenia absent-radius (TAR) syndrome, thoracoabdominal schisis, spina bifida and renal anomalies, but most associated anomalies are skeletal. We here presented firstly in literature an infant with congenital fibula deficiency accompanying with deafness.

Rapid progression to diabetes in a four-year-old girl with cystic fibrosis.

Cystic fibrosis (CF) results from mutations in the gene that encodes the CF transmembrane conductance regulator protein located on chromosome 7. This gene encodes a protein that functions as a cyclic adenosine monophosphate-regulated chloride channel. Abnormal function of the channel results in aberrant conductance across the apical