A high neonatal serum eosinophil cationic protein level is a risk factor for atopic symptoms.

AIM: To show whether neonatal eosinophil counts (EC) and eosinophil cationic protein (ECP) can be used in assessing the risk of atopy, alone or in combination with family history of atopy (FHa). PATIENTS AND METHODS: A group of 63 newborns was included: 38 with FHa, 25 without FHa. A blood sample was collected on the 4th day of life for EC and ECP evaluation. Clinical follow-up was conducted after 1, 3, 6, 12, 18, 24 and 36 mo. The chi2 test and the Student's t-test were used to compare dichotomic and continuous variables, respectively. Variables shown to be significant by univariate analysis were evaluated with a multivariate regression model and the relative risks (RR) were estimated. RESULTS: Twenty-six newborns (41%) displayed atopic manifestations during the follow-up. Twenty-one (55%) of 38 newborns with FHa displayed atopic symptoms versus 5/25 (20%) without FHa (p 0.012). Neither EC nor serum ECP levels were significantly different between newborns with FHa and newborns without. ECP levels did not differ between newborns with single heredity and newborns with dual heredity. EC did not differ significantly between newborns who developed atopy and those who did not. Instead, serum ECP levels were significantly higher in newborns who developed atopy (mean 27.9 microU/l vs 16.8 microU/l). Atopic manifestations appeared in 16 (62%) of 26 newborns with ECP > or = 18 microU/l compared with 10 (27%) of 37 with ECP < 18 microU/l (p = 0.006). In the multivariate regression model, with ECP < 18 microU/l and no FHa as reference class, the class 1 (no FHa and ECP > or = 18 microU/l) has a low RR (1.4), class 2 (FHa and ECP < 18 microU/l) an intermediate RR (2.7) and class 3 (FHa and ECP > or = 18 microU/l) a very high RR (16.3). CONCLUSIONS: Neonatal serum ECP levels, in contrast with EC, were significantly higher in newborns who developed atopic manifestations during follow-up. The risk of atopy was about twice as great when ECP was > or = 18 microU/l (and four times as great in multivariate analysis). When serum ECP was combined with FHa, the RR for newborns with FHa and ECP > or = 18 microU/l was 16 times greater than for those without FHa and ECP < 18 microU/l. The identification of newborns at "extremely high atopic risk" (FHa and ECP > or = 18 microU/l) may be expecially useful--in clinical practice--in newborns with only one atopic parent or sibling, for whom it is not universally agreed that dietary and environmental prevention measures should be applied.

Delleman syndrome: report of a case with a mild phenotype.

Delleman syndrome is a rare disorder characterised by orbital cysts, micro/anophthalmia, malformations of the central nervous system, focal aplasia cutis, and multiple skin appendages (oculocerebrocutaneous syndrome). Although cutaneous findings provide the main clues for the diagnosis, the syndrome has received little attention in the dermatological literature. A new case of oculocerebrocutaneous syndrome with predominant and typical cutaneous involvement is reported.

[Insulin-dependent diabetes and pregnancy. A model of coordinated approach]. / Diabete insulino-dipendente e gravidanza. Un modello di approccio coordinato.

A historical account of the relation between diabetes and pregnancy is followed by the presentation of a personal series of 10 insulin-dependent diabetic pregnant women (3 White's class B, 2 class C, 3 class D and 2 class F/R) treated in accordance with a newly applied quarterly and fortnightly protocol. Nearly normal blood sugar (HbA1 maintained around 8% in the second and third trimester) was achieved through home blood glucose self-monitoring, in keeping with the Karen Bruni Centre's educational programme. This includes self-management of intensified insulin treatment in the form of 2-3 injections per day (Monotard MC and HM, Actrapid MC and HM), as well as the use of Novo Pen (100 U/ml Actrapid HM) for supplementary insulinisation. Average insulin initial dose: 0.51 U/Kg/day (range 0.2-0.7); final dose 0.83 U/Kg/day (range 0.6-1.2). Delivery was by caesarean section on obstetric indication: 9 at the 36th week, 1 at the 34th for trisymptomatic gestosis. There were no foetal nor neonatal death. All children were subjected to intensive neonatological care. There were 3 cases of macrosomia and 1 tetralogy of Fallot, which followed a benign course. Despite their absence of statistical value, these data show that optimised multidisciplinary treatment can be of utility in preventing neonatal morbidity and mortality in an insulin-dependent diabetic pregnancy. They also indicate that a coordinated treatment model can equally be put into effect even in a non centralised structure, provided certain facilities exist: in our case, voluntary support on the part of Karen Bruni Diabetic Association, obstetric interest in diabetology and a neonatological background for treatment of the offspring of diabetic mothers. Lastly, this series substantiate the effectiveness of the programme of self-checking and self-management of diabetes in the accomplishment of "optimised" blood glucose control and containment of costly hospitalisation at the time of delivery.

[Importance and usefulness of transcutaneous PO2 in neonatology. Experience with the healthy and sick neonate]. / Importanza ed utilita' della PO2 transcutanea in neonatologia. Esperienze nel neonato sano e in quello malato.

The authors have checked transcutaneous PO2 in newborns in the Neonatology Department of Maria Vittoria Hospital, Torino, Italy. 39 full-term newborns (healthy, Apgar score more than 7) have been monitorized during their first minutes. The results have been divided in four groups: spontaneous birth or caesarean section with fetal suffering or not. Significant differences have been shown between newborns with fetal suffering whether they were born by caesarean section or not, and between born by caesarean section with or without fetal suffering. 27 newborns with gestational age of 32 weeks or less have been monitorized all the time they were in need of oxygen therapy. 29,6% of these babies have shown, during the first week of life, at least one peak of tcPO2 more than 100 torr. The authors insist on the importance of tcPO2 monitoring during the first moments of life, on the influence of labour conditions and type of birth. In preterm neonates treated with oxygen therapy, tcPO2 is now the best method to evaluate hypoxia (leading to cerebral lesions) and hyperoxia (with risk of retinal and pulmonary damage).

[Perinatal mortality in various weight classes: evaluation of data of the Ospedale Maria Vittoria, Turin 1977-1981]. / Indagine sulla mortalita' perinatale per classi di peso: valutazione dei dati dell'Ospedale Maria Vittoria di Torino negli anni 1977-1981.

The authors have studied stillbirth, early neonatal death rate, perinatal death rate following weight classes, weight distribution in live born and death causes between 1977 and 1981. These data permit to evaluate the degree of efficiency in the obstetrical and neonatological department. Weight distribution pattern has been fairly constant and low-weight incidence similar to that found by other authors. Perinatal death rate has remained stable in time around 11,4%. Still births have increased particularly in weight classes between 1001 and 2000 g. Early newborn death rate has decreased in weight classes between 2001 and 2500 and over 4000 g. Asphyxia was the most frequent death cause in weight classes between 1501 and 2000 g and between 2501 and 4000 g. These data are similar to those found in british and swedish studies. The authors insist that every effort must be made to reduce not only perinatal death rate but also to prevent future handicaps.

[Rubella epidemic of 1977 in Turin. Virological studies]. / L'epidemia di rosolia del 1977 a Torino. Ricerche virologiche.

During the outbreak of rubella in Turin in 1977, 1,041 newborns, whose mother's pregnancy coincided with the epidemic, were studied for the elimination of rubella virus through inoculation in primary cultures of African green monkey kidney cells. Additional 10 embryos or fetuses of therapeutic abortion from women with rubella early in pregnancy were studied through cultivation of material of abortion and inoculation in monkey cells. Only one strain was isolated, from the placenta of an embryo whose mother suffered rubella in the 2nd month of pregnancy. The hypothesis is proposed of a particularly benignity, from a teratogenic point of view, of the virus involved in the outbreak.

[Rubella epidemic in Piemonte in 1977: assay of specific antibodies in the umbilical cord blood and clinical follow-up (author's transl)]. / Epidemia di rosolia in Piemonte nel 1977: ricerca di anticorpi specifici nel sangue del cordone ombelicale di neonati e controllo clinico.

Following a rubella epidemic in 1977; 1,133 samples of umbilical cord blood and 532 samples of maternal blood were assayed for specific anti-rubella haemoagglutino-inhibiting antibodies and IgM. Clinical follow-up failed to show either any increase in number of malformations and of IgM values in the malformed, or variations of mean weight and of the number of small-for-date infants. In none out of 1.031 newborns the virus was isolated from the pharynx, urine and faeces. The Authors conclude that the epidemic may have been caused by a poorly virulent virus and/or the mothers were possibly already immunized by previous infections.