Circulating anti-angiogenic factors during hypertensive pregnancy and increased risk of respiratory distress syndrome in preterm neonates.

OBJECTIVE: To test the hypothesis that high circulating concentrations of maternal anti-angiogenic factors are associated with increased risk of respiratory distress syndrome (RDS). STUDY DESIGN: This is a nested case-control study of nulliparous women who delivered less than 37 weeks of gestation within the Calcium for Preeclampsia Prevention (CPEP) trial. The study included 116 women with preeclampsia or gestational hypertension and 323 normotensive controls. Soluble fms-like tyrosine kinase 1 (sFlt1), placental growth factor (PlGF) and soluble endoglin (sEng) in maternal serum were measured at 21-32 weeks of gestation. RESULTS: Preterm infants born to hypertensive mothers were more likely to develop RDS (22.5% vs. 20.9%, p = 0.03). After adjustment for gestational age at delivery, the odds ratio for the relationship between hypertension in pregnancy and RDS was 2.18 (95% CI 1.08-4.39). In hypertensive pregnancies women whose infants developed RDS had significantly higher circulating mean sFlt1 levels during midpregnancy (21-32 weeks of gestation) even after adjustment for gestational age at delivery (21,516 pg/mL vs. 7,000 pg/mL, p = 0.01). CONCLUSIONS: Preterm preeclampsia and gestational hypertension, characterized by high circulating levels of sFlt1, are associated with a twofold increased risk of RDS in infants delivered before 37 weeks. Among women with these hypertensive pregnancies circulating sFlt1 concentrations during midpregnancy were substantially higher in women whose infants developed RDS.

Transplacental passage of the non-ionic contrast agent iopamidol in twins.

Premature dizygotic twins, exposed in utero to iopamidol (Isovue-370®) 4 days prior to delivery, were born with abdominal radiopaque densities that made exclusion of necrotizing enterocolitis difficult when they developed abdominal distention and feeding intolerance. This is a unique case report of transplacental passage of iopamidol.

Circulating angiogenic factors in gestational proteinuria without hypertension.

OBJECTIVE: Our goal was to determine whether obstetric outcomes and serum angiogenic factors are altered in women with gestational proteinuria without hypertension. STUDY DESIGN: We performed a nested case-control study of 108 women with gestational proteinuria and compared them with 1564 randomly selected women with normotension without proteinuria during pregnancy (control subjects) and with 319 women who experienced preeclampsia. RESULTS: Women with gestational proteinuria had greater body-mass index and higher blood pressure at study enrollment. Adverse obstetric outcomes were infrequent. Levels of free placental growth factor were lower than control levels beginning early in gestation. Compared with gestational-age matched control subjects, free placental growth factor was reduced beginning 6-8 weeks before proteinuria. Although soluble fms-like tyrosine kinase 1 and soluble endoglin concentrations were elevated 1-2 weeks before proteinuria, these elevations were modest and transient. After the onset of proteinuria, angiogenic factor levels generally did not differ significantly from control levels. CONCLUSION: Gestational proteinuria in healthy nulliparous women appears to be a mild variant of preeclampsia.

Primary lung abscess caused by multidrug-nonsusceptible Streptococcus pneumoniae in a child.

We report a 21-month-old boy with primary lung abscess caused by multidrug-nonsusceptible Streptococcus pneumoniae. A computed tomography-guided aspirate obtained on admission grew penicillin-, ceftriaxone-, erythromycin- and clindamycin-nonsusceptible S. pneumoniae. The patient was treated for 10 days with parental rifampin and cefotaxime and then for 4 weeks with oral cefpodoxime and recovered without complications.