Randomised controlled trial of the effect of cisapride on the pyloric muscle in preterm infants.

UNLABELLED: In this study we determined the effects of cisapride on the pyloric muscle in preterm infants. To perform a randomised, double blind, placebo controlled study, two groups each of 16 preterm newborns were given either cisapride (0.2 mg/kg every 8 h) or a placebo for at least 7 days. Infants were studied first on the day when treatment with cisapride or placebo was to be initiated (time 0), and then after 3 (time 1) and 7 days (time 2). In each group, the following parameters were studied by ultrasonography: cross-sectional diameter of the entire pylorus, muscle thickness, and length of the pyloric canal. Also, the mean daily total gastric aspirate volume was studied for the entire week of the study. At time 0, we observed no significant differences between the two groups with respect to diameter, muscle thickness and length of the pyloric muscle. At time 1 and time 2, both diameter and muscle thickness were significantly greater in the cisapride group than in the placebo group. Furthermore, the length of the pyloric canal was significantly greater in the cisapride group than in placebo group at time 2, though not so at time 1. For the entire week of the study, we found a significantly larger mean daily total gastric aspirate volume in the group of infants treated with cisapride compared to the placebo treated group. CONCLUSION: Cisapride significantly affects all of the main measurements of the pyloric muscle and causes a significantly larger amount of daily total gastric aspirate volume. Its use to promote feeding intolerance in preterm newborns cannot be recommended.

Vertical transmission of HCV.

BACKGROUND: Knowledge about vertical transmission of HCV is still limited. In this study we followed up the virological status of a series of offspring born to anti-HCV positive, anti-HIV negative mothers. METHODS: Between January 1993 and January 1995, 5000 consecutive, anti-HIV negative pregnant women were screened for anti-HCV (ELISA III) and all positive samples were confirmed by RIBA III and analyzed for HCV-RNA by polymerase chain reaction (PCR). Babies born to anti-HCV positive mothers were followed from birth to two years by testing for ALT levels, anti-HCV antibodies and HCV-RNA. RESULTS: Of 5000 mothers 80 (1.6%) were anti-HCV positive (ELISA III) and RIBA III positive. Of these, 56 (70%) were HCV-RNA positive. We examined 80 babies, born to anti-HCV positive mothers: 56 with HCV-RNA positive mothers and 24 with HCV-RNA negative mothers. Two babies (3.6%) of 56 were anti-HCV and HCV-RNA positive, with normal liver function tests. Seventy-eight babies (97.5%) of 80 (54 with HCV-RNA positive mothers and 24 with HCV-RNA negative mothers) were HCV-RNA negative, with normal liver function tests and detectable levels of anti-HCV antibodies that gradually disappeared between 8-12 months. CONCLUSION: Mother-to-infant transmission of HCV is possible only in the case of HCV-RNA positive mothers. In our study the rate of transmission is 3.6%, (2/56 babies with HCV-RNA positive mothers). HCV transmission may occur without evident association with breast-feeding or vaginal delivery.

Intestinal flora in breast- and bottle-fed infants.

We verified whether an adapted formula, which presents poly-oligosaccharides containing maltose, promotes intestinal implantation of bacterial microflora to the extent that breast milk does, as an epidemiological link exists between newborn feeding methods and infant health. Stool specimens were taken and cultured at the fourth day of life from vaginally born neonates. Twenty-two were breast-fed and 20 were fed with formula. In breast-fed infants, the Bifidobacterium was significantly prevalent expressed in percentage (47.6% vs 15%) and in mean bacterial fecal counts/g (7.1 +/- 0.8 vs 5.3 +/- 0.6). Enterococci prevailed in formula-fed infants (mean counts 6.7 +/- 0.9 vs 7.4 +/- 0.5). Of interest is the significant and simultaneous presence of Bifidobacteria and Bacteroides in breast-fed infants. Our study indicates that flora with a diet-dependent pattern is present from the fourth day of life. These results support a preference for breast feeding over formula feeding, even though renewed.

[Zinc blood levels in 73 puerperal women. Correlation with obstetric and neonatal complications]. / Livelli ematici di zinco in 73 puerpere. Correlazione con complicanze ostetriche e neonatali.

BACKGROUND: Low plasma zinc concentrations in pregnant women have been associated with certain obstetric and foetal complications. However, there is no agreement in previous studies and mediterranean populations have not been extensively studied. METHODS: The plasmatic zinc was tested in 73 mothers, within 24 hours post-partum, in order to evaluate an association between plasmatic zinc and various obstetric and fetal complications. The women were all from the Florence province and were admitted for delivery at the II Maternity Ward of the University of Florence (Third level Center); mothers of twins and foreign mothers were excluded. Subjects were consecutively included in the study. The values pointed out in a control group (n = 28) were compared with the hematic zinc of a) women who delivered by cesarean section (CS) for acute fetal distress or by operative delivery with vacuum extractor (n = 9), b,c) mothers whose children weighted over the 90th (LGA: n = 11) or under the 10th percentile (SGA: n = 13), and d) mothers who delivered prematurely (n = 12). The subjects included in two or more groups, were not considered. RESULTS: The plasmatic zinc of the control group has been significantly higher than that of mothers who delivered by vacuum extractor or by urgent CS (p < 0.0001) and than that of mothers whose newborns were LGA (p < 0.0024). The hematic zinc of the control group is not higher than that of mothers with SGA or premature children. CONCLUSIONS: The conclusions is drawn that even a relative zinc deficiency may negatively potentiate certain obstetric abnormalities in fetal development or in delivering.

[Influence of the early mother-infant contact in the delivery room on short or long term breast feeding]. / Influenza del contatto precoce madre-figlio in sala parto sull'allattamento al seno a breve e lungo termine.

Two groups of mothers and their children were followed up in order to assess the influence of early mother-child contact on breast-feeding; a first control was carried out at discharge from the nursery and a follow-up 6 months later. All the mothers were in good health and pregnancy was physiological with uncomplicated eutocic delivery; none of the babies presented pathologies during the period of their stay in the nursery and in the subsequent 6 months. Group A comprised 126 mothers who had had contact with their babies in the delivery room for at least one hour; group B comprised 109 mothers whose first contact with their baby was only 3-6 hours after birth. Significant differences between the 2 groups were observed as early as the first control which took place at discharge from the nursery: 69.1% of the babies in group A against 51.3% in group B had taken mother's milk exclusively (p < 0.01). Equally significant differences emerged from the subsequent control at 6 months: 70 babies out of 116 (60.4%) were breast fed exclusively or partially, against 42 out of 101 (42.4%) in group B (p < 0.01). Furthermore, important data emerged from the duration of breast-feeding, whether this was exclusive or otherwise, in the first 6 months of life: group A differed significantly from group B (p < 0.002). Our figures suggest a positive influence of early mother-child contact on breast-feeding and on its duration. Notwithstanding the fact that there is no unanimous confirmation in the literature, it is considered that such behaviour will bring benefits to both mother and child.

[Acute fetofetal transfusion in dichorionic twins: a clinical case report]. / Transfusione feto-fetale acuta in gemelli bicoriali: descrizione di un caso clinico.

Fetofetal transfusion is due to the twin to twin blood shunt caused by vascular anastomoses. It has been suggested that two types of FFT exist: a chronic form existing during pregnancy, and an acute form occurring only during parturition. Cross-circulation may be demonstrated in monochorionic as well as dichorionic placentas. However, such communications were found in 85-100% of monochorionic placentas, compared with one of 68 dichorionic fused placentas. Authors describe one case of acute feto-fetal transfusion in dichorionic twins.

[Experience with anti-viral hepatitis B vaccine at an institution for handicapped children]. / Esperienza di vaccinazione anti-epatite virale di tipo B in un istituto per bambini handicappati.

This study, conducted in an institute for handicapped children, is part of an overall effort to extend the anti-HBV vaccine to all high risk categories. Out of 50 patients, 24 (48%) registered negative results for all HBV markers. Twenty-three of these 24 (95.8%) were vaccinated with the Hevac-B Pasteur vaccine s.c. Of 66 employees tested, 51 resulted negative for all HBV markers (77.3%). Of these, 45 (88.2%) were vaccinated: 20 with Hevac-B vaccine s.c., 25 with HBVAX vaccine i.m. via intragluteal injection. Of the 42 who completed the study with Hevac-B, 41 showed an antibody response greater than or equal to 10 mUI (serum conversion of 97.6%). Of the 25 subjects vaccinated with HBVAX, 17 showed an immunological antibody response greater than or equal to 10 mUI (serum conversion of 68%) (p less than 0.001). This differing effectiveness is probably due to the method of injection used in administering HBVAX. It should also be noted that an intense health-education program, stressing high sanitary standards, was instrumental to the project.

Glycosilated fetal hemoglobin in neonates of diabetic mothers.

In diabetic patients, the correlation between glycosilated adult hemoglobin (HbA1c) levels and average glucose concentration over the preceding weeks is well known. We have, therefore, sought the possibility to identify newborns at risk measuring cord blood levels of fetal glycosilated hemoglobin (HbF1) in neonates of diabetic mothers. HbF1 was tested by the isoelectrofocusing method. Mean values of HbF1 have been proven to be higher in in infants born to diabetic mothers as compared to normal newborns. The highest levels were encountered in those babies whose mothers had shown a poor glycemic control during the last few weeks of pregnancy.

[Inhibiting effect of low density lipoproteins (LDL) on neutrophil function (author's transl)]. / Inibizione della funzionalità dei neutrofili mediata da lipoproteine a bassa densità (LDL).

LDL preparations obtained from normal individuals of known genetic type have been added to neutrophils from healthy donors. After incubation at 37 degrees C for 30 min, and washing in Hank's solution, in order to evaluate metabolic and bactericidal activities neutrophils were assayed by the nitroblue tetrazolium (NBT) quantitative test, using latex particles, and by E. coli killing test. LDL in aliquots of 100-500 microgram/2 x 10(6) neutrophils, inhibited NBT reduction and reduced neutrophil killing of E. coli by more than 50%. No difference was observed in the degree of inhibition using LDL and neutrophils obtained from donors of either the same or of different Ag phenotype. These data suggest that the immunoregulatory activity of LDL affects lymphocyte as well as neutrophil function.

[Increase of the "null cells" in children with persistent hepatitis (author's transl)]. / Aumento delle cellule "nulle" im bambini con epatite persistente.

Some membrane and functional properties of lymphocytes have been examined in a group of children affected with persistent hepatitis. Both absolute and percentage values of B lymphocytes (cells bearing surface Ig) were normal, whereas T lymphocytes (E rosette technique) were decreased in percentage but not as absolute numbers. Only in a close range of mitogen concentration PHA responsiveness was altered, and no modification was found in the percentage of EA and EAC rosettes. A marked increase in lymphocytes lacking both T and B cell markers was observed, which may be related to an increase in precursors of mature cells or to a masking of receptors on the membrane of lymphocytes, but which is probably independent of an increase in the number of K cells, since cells bearing receptors for the Fc fragment were normal.

[Neutrophil function in children with acute lyphoblastic leukemia]. / La funzione dei neutrofili nel bambino con leucemia linfoblastica acuta.

Neutrophil function has been studied in 12 patients with acute lymphoblastic leukemia by means of the NBT test and bactericidal assay against E. coli. Tests have been performed before and during treatment. In untreated patients the bactericidal activity of neutrophils was normal, in spite of the decreased number of cells reducing the NBT dye after activation with immuno-complexes. In remission, those patients showed normal reduction. No correlation was observed between the bactericidal power registered after cranial irradiation and the NBT test.

[Effect of the serum of patients with cholestasis on lymphocyte E rosette formation]. / Influenza del siero di pazienti con colestasi sulla formazione di rosette linfocitarie "E".

Sera from cholestatic patients have been found to interfere with lymphocyte rosette formation (E rosettes). Lymphocytes from patients with cholestasis showed a lower percentage (42.36%) of cells binding sheep red blood cells in comparison with a control group (62%). In the presence of cholestatic serum the number of E rosettes formed by lymphocytes from normal subjects declined to 44.16%. This behaviour, however, can reverse, since lymphocytes from cholestatic patients previously incubated with normal serum, showed a nearly normal capability of forming E rosettes (57.90%). Therefore, it is conceivable that among the several factors which are present in sera from patients with either chronic or acute hepatitis and which are able to interfere with T-lymphocyte function, there may be included also the factor which is present in sera from cholestatic patients. The possible role of bile salts and hyperlipoproteinaemia present in those patients requires further investigation.