Maternal antibiotic prophylaxis affects Bifidobacterium spp. counts in the human milk, during the first week after delivery.

Human milk is an important source of microorganisms for infant gut colonisation. Although the maternal antibiotic prophylaxis is an important strategy to prevent maternal/neonatal sepsis, it has to be investigated how it may affect the human milk microbiota, especially the genus Bifidobacterium, which has been associated to health benefits. Here, we investigated the impact of the maternal antibiotic prophylaxis on the human milk Bifidobacterium spp. and total bacteria counts, in the first week (short-term) and first month (medium-term) after delivery. Human milk samples were collected from 55 healthy lactating women recruited from the University Hospital of the University of São Paulo at days 7±3 and 30±4 after vaginal delivery. Twenty one volunteers had received maternal antibiotic prophylaxis (MAP group) and 34 had not received MAP (no-MAP group) during or after labour. Total DNA was isolated from milk samples, and the bacterial counts were estimated by quantitative PCR (qPCR). We found lower levels of Bifidobacterium in the MAP group in the first week after delivery (median = 2.1 vs 2.4 log of equivalent cells/ml of human milk, for MAP and no-MAP groups, respectively; P=0.01), although there were no statistical differences in total bacteria count. However, no differences were found in Bifidobacterium counts between the groups at day 30±4 (median = 2.5 vs 2.2 log of equivalent cells/ml of human milk, for MAP and no-MAP groups, respectively; P=0.50). Our results suggest that MAP has a significant impact on Bifidobacterium counts in human milk, reducing this population in the first week after delivery. However, throughout the first month after delivery, the Bifidobacterium counts tend to recover, reaching similar counts to those found in no-MAP group at day 30±4 after delivery.

Surfactant protein B gene polymorphism in preterm babies with respiratory distress syndrome

The etiology of respiratory distress syndrome (RDS) is multifactorial and multigenic. Studies have suggested that polymorphisms and mutations in the surfactant protein B (SP-B) gene are associated with the pathogenesis of RDS. The objectives of this study were to determine and compare the frequencies of SP-B gene polymorphisms in preterm babies with and without RDS. We studied 151 neonates: 79 preterm babies without RDS and 72 preterm newborns with RDS. The following four SP-B gene polymorphisms were analyzed: A/C at -18, C/T at 1580, A/G at 9306, and G/C at nucleotide 8714. The polymorphisms were detected by PCR amplification of genomic DNA and genotyping. The genotypes were determined using PCR-based converted restriction fragment length polymorphisms. The control group consisted of 42 (53 percent) girls and 37 (47 percent) boys. Weight ranged from 1170 to 3260 g and mean gestational age (GA) was 33.9 weeks (range: 29 to 35 weeks and 6 days). The RDS group consisted of 31 (43 percent) girls and 41 (57 percent) boys. Weight ranged from 614 to 2410 g and mean GA was 32 weeks (range: 26 to 35 weeks). The logistic regression model showed that GA was the variable that most contributed to the occurrence of RDS. The AG genotype of the A/G polymorphism at position 9306 of the SP-B gene was a protective factor in this population (OR = 0.1681; 95 percentCI = 0.0426-0.6629). We did not detect differences in the frequencies of the other polymorphisms between the two groups of newborns.

Surfactant protein B gene polymorphism in preterm babies with respiratory distress syndrome.

The etiology of respiratory distress syndrome (RDS) is multifactorial and multigenic. Studies have suggested that polymorphisms and mutations in the surfactant protein B (SP-B) gene are associated with the pathogenesis of RDS. The objectives of this study were to determine and compare the frequencies of SP-B gene polymorphisms in preterm babies with and without RDS. We studied 151 neonates: 79 preterm babies without RDS and 72 preterm newborns with RDS. The following four SP-B gene polymorphisms were analyzed: A/C at -18, C/T at 1580, A/G at 9306, and G/C at nucleotide 8714. The polymorphisms were detected by PCR amplification of genomic DNA and genotyping. The genotypes were determined using PCR-based converted restriction fragment length polymorphisms. The control group consisted of 42 (53%) girls and 37 (47%) boys. Weight ranged from 1170 to 3260 g and mean gestational age (GA) was 33.9 weeks (range: 29 to 35 weeks and 6 days). The RDS group consisted of 31 (43%) girls and 41 (57%) boys. Weight ranged from 614 to 2410 g and mean GA was 32 weeks (range: 26 to 35 weeks). The logistic regression model showed that GA was the variable that most contributed to the occurrence of RDS. The AG genotype of the A/G polymorphism at position 9306 of the SP-B gene was a protective factor in this population (OR = 0.1681; 95%CI = 0.0426-0.6629). We did not detect differences in the frequencies of the other polymorphisms between the two groups of newborns.

Computer modeling of Ba(2)RE(3+)NbO(6) (RE(3+) = rare-earth and Y) compounds.

In this work we have performed atomistic simulations in Ba(2)RE(3+)NbO(6) (RE(3+) = La, Ce, Nd, Pr, Pm, Sm, Eu, Gd, Tb, Dy, Y, Ho, Er, Tm, Yb and Lu) compounds in order to predict their physical properties and behavior under lanthanide substitutions. The potential model adopted describes very well the structural and dielectric properties of these materials. The dependence of the tolerance factor on their physical properties was investigated and the results indicate that the lattice energy, sound velocities and bulk modulus do not show morphotropic phase boundaries between the three phases in which these compounds crystallize. These observables have a linear dependence on the tolerance factor. Only the elastic constant shows morphotropic phase boundaries.

Comparison of surfactant protein B polymorphisms of healthy term newborns with preterm newborns having respiratory distress syndrome.

Polymorphisms and mutations in the surfactant protein B (SP-B) gene have been associated with the pathogenesis of respiratory distress syndrome (RDS). The objective of the present study was to compare the frequencies of SP-B gene polymorphisms between preterm babies with RDS and healthy term newborns. We studied 50 preterm babies with RDS (inclusion criteria - newborns with RDS and gestational age between 28 and 33 weeks and 6 days), and 100 healthy term newborns. Four SP-B gene polymorphisms were analyzed: A/C at nucleotide -18, C/T at nucleotide 1580, A/G at nucleotide 9306, and G/C at nucleotide 8714, by PCR amplification of genomic DNA and genotyping by cRFLP. The healthy newborns comprised 42 female and 58 male neonates; 39 were white and 61 non-white. The RDS group comprised 21 female and 29 male preterm neonates; 28 were white and 22 non-white. Weight ranged from 640 to 2080 g (mean: 1273 g); mean gestational age was 31 weeks and 2 days (range: 28-33 weeks and 6 days). When white children were analyzed separately, a statistically significant difference in the G/C polymorphism at 8714 was observed between groups (P = 0.028). All other genotype frequencies were similar for both groups when sex and race were analyzed together. Analysis of the SP-B polymorphism G/C at nucleotide 8714 showed that among white neonates the GG genotype was found only in the RDS group at a frequency of 17% and the GC genotype was more frequently found in healthy term newborns. These data demonstrate an association of GG genotype with RDS.

Comparison of surfactant protein B polymorphisms of healthy term newborns with preterm newborns having respiratory distress syndrome

Polymorphisms and mutations in the surfactant protein B (SP-B) gene have been associated with the pathogenesis of respiratory distress syndrome (RDS). The objective of the present study was to compare the frequencies of SP-B gene polymorphisms between preterm babies with RDS and healthy term newborns. We studied 50 preterm babies with RDS (inclusion criteria - newborns with RDS and gestational age between 28 and 33 weeks and 6 days), and 100 healthy term newborns. Four SP-B gene polymorphisms were analyzed: A/C at nucleotide -18, C/T at nucleotide 1580, A/G at nucleotide 9306, and G/C at nucleotide 8714, by PCR amplification of genomic DNA and genotyping by cRFLP. The healthy newborns comprised 42 female and 58 male neonates; 39 were white and 61 non-white. The RDS group comprised 21 female and 29 male preterm neonates; 28 were white and 22 non-white. Weight ranged from 640 to 2080 g (mean: 1273 g); mean gestational age was 31 weeks and 2 days (range: 28-33 weeks and 6 days). When white children were analyzed separately, a statistically significant difference in the G/C polymorphism at 8714 was observed between groups (P = 0.028). All other genotype frequencies were similar for both groups when sex and race were analyzed together. Analysis of the SP-B polymorphism G/C at nucleotide 8714 showed that among white neonates the GG genotype was found only in the RDS group at a frequency of 17 percent and the GC genotype was more frequently found in healthy term newborns. These data demonstrate an association of GG genotype with RDS.

Clinical course of premature infants intubated in the delivery room, submitted or not to porcine-derived lung surfactant therapy within the first hour of life.

OBJECTIVES: The aim of this study was to perform a comparative analysis of the clinical outcome, gasometric course and ventilatory indices of premature infants with a gestational age of < or = 34 weeks who were intubated in the delivery room, owing to respiratory insufficiency, according to whether or not they were submitted to porcine-derived lung surfactant therapy within the first hour of life. METHODS: The study was randomized and controlled. A total of 75 premature infants were classified into two groups: group A, comprising 35 neonates who were submitted to surfactant within the first hour of life; and group B, comprising 40 neonates who were not submitted to surfactant within the first hour of life. RESULTS: Exogenous surfactant therapy after establishment of respiratory distress syndrome (RDS) was necessary in eight neonates of group A (22.9%) and 31 neonates of group B (77.5%) (p < 0.001). The neonates in group A presented higher levels in relation to group B for the variables: partial pressure of arterial oxygen (PaO2)/fraction of inspired oxygen (FiO2) and PaO2/partial pressure of alveolar oxygen (PAO2), while neonates in group B presented higher levels for FiO2, PAO2 and difference D(A - a)O2 in relation to group A. Weight affected the oxygenation index (OI) parameter, in that neonates with lower weight presented greater values of the OI. CONCLUSIONS: In premature infants with established RDS, the need for exogenous surfactant was lower in the group that received surfactant within the first hour of life. Furthermore, the gasometric parameters and ventilatory indexes presented a better course in the first 24 h of life among premature infants who received exogenous surfactant within the first hour of life, in relation to those who did not.

Clinical and laboratory study of newborns with lower respiratory tract infection due to respiratory viruses.

OBJECTIVES: To determine the prevalence of lower respiratory tract infection due to respiratory viruses in the neonatal period at admission to the neonatal intensive care unit and to compare the clinical, laboratory and radiological aspects of the clinical course, according to the etiological agent, in the neonatal period. METHODS: Ninety newborns were studied, from January 1999 to January 2001, with bronchiolitis and/or pneumonia. The newborns were classified into three groups, according to the etiological agent identified initially: viral infection (group A), mixed viral-bacterial infection (group B), and bacterial infection (group C). RESULTS: The virus was identified in 72 newborns (80.0%); the most prevalent was respiratory syncytial virus (RSV) (44.4%), followed by influenza A virus (22.2%). Coughing, wheezing and an interstitial infiltrate were significantly more frequent in newborns with viral infection. Mixed infection was more associated with sepsis. There was a correlation between viral infection and low values of initial and subsequent white blood cell count and C-reactive protein. RSV was the most important virus in these patients. CONCLUSIONS: It was observed that, although the majority of viral respiratory infections had a favorable course, some patients presented a serious and prolonged clinical manifestation, especially when there was concomitant bacterial infection.

Necrotizing fasciitis in a newborn infant: a case report.

We report the case of a one-day-old newborn infant, female, birth weight 1900 g, gestational age 36 weeks presenting with necrotizing fasciitis caused by E. coli and Morganella morganii. The newborn was allowed to fall into the toilet bowl during a domestic delivery. The initial lesion was observed at 24 hours of life on the left leg at the site of the venipuncture for the administration of hypertonic glucose solution. Despite early treatment, a rapid progression occurred resulting in a fatal outcome. We call attention to the risk presented by this serious complication in newborns with a contaminated delivery, and highlight the site of the lesion and causal agents.

Monitoring the treatment of sepsis with vancomycin in term newborn infants.

UNLABELLED: A prospective study was conducted to determine if standardized vancomycin doses could produce adequate serum concentrations in 25 term newborn infants with sepsis. PURPOSE: The therapeutic response of neonatal sepsis by Staphylococcus sp. treated with vancomycin was evaluated through serum concentrations of vancomycin, serum bactericidal titers (SBT), and minimum inhibitory concentration (MIC). METHOD: Vancomycin serum concentrations were determined by the fluorescence polarization immunoassay technique, SBT by the macro-broth dilution method, and MIC by diffusion test in agar. RESULTS: Thirteen newborn infants (59.1%) had adequate peak vancomycin serum concentrations (20 - 40 mg/mL) and one had peak concentration with potential ototoxicity risk (>40 microg/mL). Only 48% had adequate trough concentrations (5 - 10 mg/mL), and seven (28%) had a potential nephrotoxicity risk (>10 microg/mL). There was no significant agreement regarding normality for peak and trough vancomycin method (McNemar test : p = 0.7905). Peak serum vancomycin concentrations were compared with the clinical evaluation (good or bad clinical evolution) of the infants, with no significant difference found (U=51.5; p=0.1947). There was also no significant difference between the patients' trough concentrations and good or bad clinical evolution (U = 77.0; p=0.1710). All Staphylococcus isolates were sensitive to vancomycin according to the MIC. Half of the patients with adequate trough SBT (1/8), also had adequate trough vancomycin concentrations and satisfactory clinical evolution. CONCLUSIONS: Recommended vancomycin schedules for term newborn infants with neonatal sepsis should be based on the weight and postconceptual age only to start antimicrobial therapy. There is no ideal pattern of vancomycin dosing; vancomycin dosages must be individualized. SBT interpretation should be made in conjunction with the patient's clinical presentation and vancomycin serum concentrations. Those laboratory and clinical data favor elucidation of the probable cause of patient's bad evolution, which would facilitate drug adjustment and reduce the risk of toxicity or failing to achieve therapeutic doses.

[Extracorporeal membrane oxygenation (ECMO) in a neonate with respiratory distress due to meconium aspiration syndrome: Effect of the administration of exogenous surfactant] / Circulação extracorpórea prolongada (ECMO) em recém-nascido com insuficiência respiratória por Síndrome de Aspiração Meconial: efeitos da administração de surfactante exógeno.

OBJECTIVES: To present the clinical outcome of a newborn with severe respiratory distress secondary to meconium aspiration syndrome and treated by extracorporeal membrane oxygenation (ECMO); and to present the effect of the use of exogenous surfactant in this case and the cost of the procedure. METHODS: Case report of a newborn with meconium aspiration syndrome and treated at the neonatal ICU of the Instituto da Criança Prof. Pedro de Alcantara, Hospital das Clínicas of the Universidade de São Paulo. RRESULTS: ECMO was carried out for 5 days with no clinical or mechanical complications. On the 4th day of ECMO, we administered porcine exogenous surfactant; a significant improvement in lung compliance was observed and the newborn was decannulated shortly after that. Treatment costs were compatible with the situation of healthcare in Brazil for treatment of critically ill newborn patients. CONCLUSIONS: ECMO is indicated in cases of neonatal respiratory distress not responding to other treatments. The technique should be made available in neonatal Intensive Care Units (ICUs) of tertiary hospitals according to well-established protocols. The use of exogenous surfactant apparently allowed for earlier decannulation of the patient and should be considered in similar cases. The treatment costs do justify the organizing of ECMO teams in this type of ICUs.

[Use of blood and blood components and derivatives in newborn infants] / Uso de sangue, hemocomponentes e hemoderivados no recém-nascido.

OBJECTIVE: To describe the current rationale for the transfusion of blood, blood components, and plasma derivatives in term and preterm infants. SOURCES: Selection of relevant medical articles published within the last ten years. SUMMARY OF THE FINDINGS: Peculiar characteristics and special care concerning exchange transfusion, transfusion of red blood cells, platelets, granulocytes, and fresh frozen plasma were described. The recommendations for the use of hematopoietic growth factors, and plasma derivatives such as fibronectin, immunoglobulins, and albumin were also evaluated. CONCLUSIONS: The authors comment on the recommendations and contraindication of blood transfusions, and warn against the limitations and hazards involved.

Vancomycin monitoring in term newborns: comparison of peak and trough serum concentrations determined by high performance liquid chromatography and fluorescence polarization immunoassay.

INTRODUCTION: Peak and trough serum concentrations of vancomycin were determined in term newborn infants with confirmed or suspected Staphylococcus sp sepsis by high performance liquid chromatography and flourescence polarization immunoassay. OBJECTIVE: To statistically compare the results of the high performance liquid chromatography and flourescence polarization immunoassay techniques for measuring serum vancomycin concentrations. METHODS: Eighteen peak and 20 trough serum samples were assayed for vancomycin concentrations using high performance liquid chromatography and flourescence polarization immunoassay from October 1995 to October 1997. RESULTS: The linear correlation coefficients for high performance liquid chromatography and flourescence polarization immunoassay were 0.27 (peak, P = 0.110) and 0.26 (trough, P = 0.1045) respectively, which were not statistically significant. CONCLUSION: There was wide variation in serum vancomycin concentrations determined by high performance liquid chromatography as compared with those determined by flourescence polarization immunoassay. There was no recognizable pattern in the variability; in an apparently random fashion, the high performance liquid chromatography measurement was sometimes substantially higher than the flourescence polarization immunoassay measurement, and at other times it was substantially lower.

Brain abscess by citrobacter diversus in infancy: case report.

Citrobacter diversus is closely related to brain abscess in newborn infants. We describe a case of brain abscess by this bacteria in a newborn infant and his clinical and cranial computed tomographic evaluation until the fourth month of life and discuss therapeutic management of this patient.

Infecçäo por Chlamydia trachomatis no período neonatal: aspectos clínicos e laboratoriais. Experiência de uma década: 1987-1998 / Chlamydia trachomatis infection in neonatal period: clinical and laboratorial aspects. Experience of a decade: 1987-1998

A infecção por C. trachomatis é adquirida pelo recém-nascido (RN) principalmente durante sua passagem pelo canal parto; 25 por cento a 50 por cento destes deverão desenvolver conjuntivite e 10 por cento a 20 por cento pneumonia. Objetivos. Verificar a incidência de infecção ocular por C. trachomatis nos RN internados com diagnóstico de conjuntivite, num período de 10 anos. - Observar a associação entre infecção ocular é pneumonia intersticial - Estudar os aspectos epidemiológicos e os métodos utilizados para o diagnóstico laboratorial. Casuística e Metodologia. Foram analisados os RN internados com diagnóstico de conjuntivite e/ ou pneumonia interticial internados na UCINE no período de 1987-1998. Os métodos de diagnóstico utilizados foram: a pesquisa direta do agente etiológico em raspado de conjuntiva, radiografia de tórax, sorologia para C. trachomatis no sangue pelo método de imunofluorescência para anticorpos IgG e IgM. Resultados. Estudamos as características de 20 RN que apresentaram infecção por C. trachomatis: 15 eram de termo (75 por cento) e cinco, pré-termos (25 por cento); houve predominância da infecção no sexo feminino (60 por cento); a pneumonia esteve presente em 15 dos 20 RN (75 por cento) e 12 apresentaram associação de conjuntivite e pneumonia. Não houve relação significante entre tipo de parto, idade materna, número de parceiros e a infecção, sendo que o antecedente materno de leucorreia esteve presente em 50 por cento dos casos. O diagnóstico sorológico esteve relacionado com a presença de pneumonia e a pesquisa direita com a conjuntivite. A incidência de conjuntivite por C. trachomatis entre os RN internados com esse diagnóstico durante o período de estudo foi de 17/100 (17 por cento). Conclusões. A. C. trachomatis é um importante agente patogênico e sua pesquisa é muito importante em RN com conjuntivite e/ou pneumonia intersticial mesmo na ausência de fatores de risco para doença sexualmente transmissível. A pesquisa direta em raspado de conjuntiva e o exame sorológico se mostraram importantes como métodos auxiliares do diagnóstico.

Endocardite bacteriana como complicaçäo de sepse neonatal: relato de caso / Bacterial endocarditis as a complication of neonatal sepsis: a case report

Os autores relatam um paciente com 11 dias de vida, internado em Unidade de Terapia Intensiva Neonatal devido a múltiplas malformações congênitas, apresentando sepse e endocardite bacteriana. Entre os fatores de risco para endocardite foram destacados o cateterismo venoso central, hemocultura com crescimento de Staphylococcus aureus e ventilação mecânica. O diagnóstico foi realizado no 61§ dia de internação devido a presença de febre persistente e aparecimento de sopro cardíaco sistólico. O ecocardiograma mostrou trombo em átrio direito, medindo 1,9 x 0,7mm sendo realizada antibioticoterapia e ressecção cirúrgica, com melhora clínica. No 125§ dia de internação ocorreu óbito devido à sepse e abscesso cerebral. Na necrópsia não foram observados malformações cardíacas. Os autores concluem ser de grande importância o conhecimento das complicações potenciais das técnicas invasivas utilizadas em recém-nascidos criticamente doentes. A suspeita clínica de endocardite deve ser realizada em todos os neonatos com sepse, internados em Unidade de Terapia Intensiva Neonatal por tempo prolongado.

Fetal cataract in congenital toxoplasmosis.

We report a case of the prenatal diagnosis of fetal cataract due to congenital toxoplasmosis. To the best of our knowledge, this is the first report of such a case. We discuss the long-term ocular sequelae of the condition and how they should affect prenatal counselling.

[Diagnostic of congenital syphilis: a comparison between serological tests in mothers and their newborns]. / Diagnóstico de sífilis congênita: comparação entre testes sorológicos na mãe e no recém-nascido.

For the purpose of establishing the incidence of maternal and congenital syphilis among pregnant women at delivery and their respective newborns, a study was carried out to determine treponemic and non-treponemic serology in one thousand (1,000) parturient women and their children at Santa Marcelina Hospital - São Paulo, between June 95 and July 96. All blood samples (maternal venous, umbilical cord and newborn venous) were VDRL-tested, treponemic tests (TPHA, ELISA IgG, ELISA IgM) being applied whenever one of the samples from mother or newborn proved positive. Further, an anti-HIV search was run through ELISA among VDRL-positive mothers. Among the 1,000 parturients, 24 (2.4%) were found to be VDRL-reactive; 18 (1.8%) newborn children of these 24 mothers presented positive serology in their umbilical cord blood and 19 (1.9%) in venous blood. No positive newborns were found for negative mothers. From the high occurrence of maternal and congenital syphilis in this group of patients, we propose a VDRL maternal test as a way of selecting gestational and congenital syphilis cases, since this test appeared to be sufficiently capable of such diagnoses. Of the treponemic tests, the ELISA test did not enhance diagnostic sensitivity.