Tracking changes of lymphocyte subsets and pre-inflammatory mediators in full-term neonates with suspected or documented infection.

Investigation was made of changes in immune system parameters during the course of neonatal infection. The study population consisted of 95 full-term neonates matched for chronological age and sex, divided into three groups: suspected infection (n=20), sepsis (n=25), infection-free control subjects (n=50). Serial measurements were made of the cytokines interleukin-6 (IL-6), interleukin-1b (IL-1b) and tumour necrosis factor-α (TNF-α), lymphocyte subsets [CD3+, CD4+, CD8+, natural killer (NK) cells and B cells], the immunoglobulins (Ig) (IgG, IgM and IgA), C-reactive protein (CRP), and the total blood count, before, 2 days after initiation of treatment and after stopping treatment (time periods first, second and third, respectively). IL6, TNF-α, IL1-b and CRP were higher at the first time period in the sepsis group, and IL6 and TNF-α continued to be higher in this group at the second period. IL-6 and TNF-α were precise sepsis predictors with sensitivity and specificity of 0.92, 0.98 and 0.91, 0.92, respectively. NK cells, B cells, CD3+, CD4+, CD8+ were higher in the sepsis and suspected infection groups, but the ratios CD3+/CD4+, CD3+/CD8+, CD4+/CD8+ showed no difference from the controls. IgG was lower and IgM higher in the sepsis group. In the control subjects CD3+, CD4+, CD8+ lymphocytes increased with increasing age. It is concluded that IL-6 and TNF are good diagnostic markers of sepsis in full-term neonates. Lymphocyte subsets were affected by both the clinical condition and the chronological age. NK and B cells may be elevated in suspected and documented sepsis, and further studies are needed to determine their clinical significance.

Perinatal and neonatal mortality in Northwest Greece (1996-2004).

OBJECTIVE: An improvement in perinatal mortality is reported in various countries. This is a retrospective analysis of perinatal and neonatal mortality in Northwest (NW) Greece. METHODS: Analysis was made of the births and deaths register in NW Greece and records of the regional referral tertiary care center and the National Hospitals at the same area for the period 1996-2004. Perinatal mortality was analysed according to birthweight (BW) and gestational age (GA) for two separate periods, 1996-1999 (I) and 2000-2004 (II), corresponding to an increase in antenatal steroid use from 20% to 63%. RESULTS: Neonatal mortality improved between the two periods in infants with very low BW [very low birth weight (VLBW), <1500 g] and the very preterm infants (<28 weeks GA). Severe respiratory distress syndrome (RDS) decreased (p<0.001) for infants with GA≤34 weeks and those with BW 751-1500 g (p<0.02), and perinatal asphyxia is no longer a leading cause of death. Intrauterine transfer increased (p<0.001) for infants with BW≤1500 g. The main cause of death as derived from birth records and neonatal intensive care unit records is prematurity, alone or with complications. CONCLUSIONS: With the introduction of antenatal steroids and increase in intrauterine transfer there has been a decrease in neonatal mortality of VLBW infants in NW Greece.

Retinopathy of prematurity and other ocular problems in premature infants weighing less than 1500 g at birth.

PURPOSE: To estimate the incidence of retinopathy of prematurity and other ocular problems in a population of preterm infants. METHODS: This retrospective study included all infants with gestational age (GA) <32 weeks and birth weight (BW) <1500 g cared for in the neonatal intensive care unit (NICU) over a period of nine years (1992-2000). Ophthalmological examination was started the 4th week of life and included refractive examination, examination of the cornea and funduscopy under mydriasis. An ocular motility test was done after the 2nd month. RESULTS: The study included 194 infants. Stage I and II retinopathy occurred in 51 infants but regressed spontaneously. Five of the 194 (2.5%) had to undergo cryopexy. Optic disc atrophy was observed in association with peri-intraventricular hemorrhage (PIIVH) (grade IV) in seven infants. Fifteen infants (7.7%) had retinal hemorrhages which were absorbed by three months of age. Almost 20% of the study infants developed high refractive errors and 13.4% strabismus. CONCLUSIONS: Not only retinopathy of prematurity, but other serious ocular problems were observed in this population of preterm infants. The role of PIIVH III-IV in the pathogenesis of certain ocular problems needs further elucidation.