Use of hyperbaric oxygen therapy of purpura fulminans in an extremely low birth weight preterm: A case report.

Purpura fulminans (PF) is a rare and fatal complication of septic shock or diffuse intravascular coagulation (DIC) resulting in skin and soft tissue necrosis. PF can be caused by congenital or acquired protein C (PC) or protein S (PS) deficiency. The most common cause of PF in a neonate is sepsis. In our extremely low birth weight preterm case, due to PF that started in the right-hand fingers, examination was made and protein S deficiency was detected as well as MTHFR (A1298C) and Factor V Leiden (R506Q) homozygous mutations. While being unresponsive to fresh frozen plasma (FFP) and unfractionated heparin (UFH) therapy, we want to highlight the curative treatment with hyperbaric oxygen (HBOT), which has not previously been used in extremely low birth weight preterm infants for this purpose.

Cardiac effects of a single course of antenatal betamethasone in preterm infants.

AIM: To show the effects of a single course of antenatal betamethasone on cardiac measurements and systolic functions in premature newborn infants. METHODS: Seventy six newborn infants with a gestational age of 25-33 weeks were included in the study. They were first classified according to their gestational age: 25-29 weeks (n = 28) and 30-33 weeks (n = 48). They were then reclassified as betamethasone positive (mother received one course of betamethasone) or betamethasone negative (mother did not receive any antenatal glucocorticoid treatment). Cross sectional M mode echocardiographic scans were performed during the first three postnatal days and at the end of the first and third weeks. Left interventricular septum (IVS), left ventricular posterior wall (LVPW), left ventricular end diastolic (LVED), and left ventricular end systolic (LVES) dimensions, aortic root (AO), and left atrial diameters (LAs) were measured. The IVS to LVPW ratio was calculated to identify asymmetrical septal hypertrophy. RESULTS: In neither group was any statistically significant difference noted in IVS, LVED, LVES, LVPW, LA, and AO measurements during the three cardiac ultrasonography scans. Systolic function, as assessed by fractional shortening, was not significantly different in infants who received betamethasone antenatally, in either age group. There was no difference in the IVS/LVPW ratios between those who received antenatal steroid and those who did not for the 25-29 week and 30-33 week groups during these three consecutive scans. CONCLUSION: One course of antenatal betamethasone did not affect the cardiac wall thicknesses and systolic function in premature infants.

International Child Care Practices Study: infant sleeping environment.

BACKGROUND: The International Child Care Practices Study (ICCPS) has collected descriptive data from 21 centres in 17 countries. In this report, data are presented on the infant sleeping environment with the main focus being sudden infant death syndrome (SIDS) risk factors (bedsharing and infant using a pillow) and protective factors (infant sharing a room with adult) that are not yet well established in the literature. METHODS: Using a standardised protocol, parents of infants were surveyed at birth by interview and at 3 months of age mainly by postal questionnaire. Centres were grouped according to geographic location. Also indicated was the level of SIDS awareness in the community, i.e. whether any campaigns or messages to "reduce the risks of SIDS" were available at the time of the survey. RESULTS: Birth interview data were available for 5488 individual families and 4656 (85%) returned questionnaires at 3 months. Rates of bedsharing varied considerably (2-88%) and it appeared to be more common in the samples with a lower awareness of SIDS, but not necessarily a high SIDS rate. Countries with higher rates of bedsharing appeared to have a greater proportion of infants bedsharing for a longer duration (>5 h). Rates of room sharing varied (58-100%) with some of the lowest rates noted in centres with a higher awareness of SIDS. Rates of pillow use ranged from 4% to 95%. CONCLUSIONS: It is likely that methods of bedsharing differ cross-culturally, and although further details were sought on different bedsharing practices, it was not possible to build up a composite picture of "typical" bedsharing practices in these different communities. These data highlight interesting patterns in child care in these diverse populations. Although these results should not be used to imply that any particular child care practice either increases or decreases the risk of SIDS, these findings should help to inject caution into the process of developing SIDS prevention campaigns for non-Western cultures.

Passive immunity of premature infants against measles during early infancy.

The aim of this study was to evaluate the presence of transferred measles antibodies and seronegativity rates during early infancy in premature newborns whose mothers had infection-induced immunity. The premature group was composed of 22 and 35 newborns of gestational ages < 32 wk and > 32 wk, respectively, and the control group consisted of 28 term newborns. Enzyme-linked immunosorbent assay (ELISA) was used for the qualitative detection of IgG antibodies to measles virus. Mean cord blood relative values were significantly lower in both premature groups, < or = 32 wk (p < 0.0001) and > 32 wk (p < 0.001), when compared with term infants. No seronegative infant was found in the premature group at 2 mo of age. At 4 mo, the seronegativity rate was 27% for premature infants < or = 32 wk and 35% for those > 32 wk. At 6 mo, seronegativity increased to 86% and 74% for premature infants born at gestational ages < or = 32 wk and > 32 wk, respectively. Forty-six percent of the term infants became seronegative at that age. The differences between term infants and those in the two premature groups were statistically significant (p < 0.05 and p < 0.005). Premature infants, regardless of their prematurity degree, were thought to be more susceptible to measles infection than term ones at the age of 6 mo. Policies for their protection from measles infection are still to be investigated.

Intraventricular hemorrhage in preterm newborns.

Intraventricular hemorrhage (IVH) originating from germinal matrix is the major brain injury of the premature. We studied IVH incidence and risk factors which are implied in this pathology in newborns, hospitalized in the neonatal intensive care unit (NICU) of istanbul University Cerrahpasa Faculty of Medicine. Ninety-seven premature newborns with a birth weight of less than 2500 g were examined systematically with cranial ultrasonography (CU). Mean birthweight was 1540 +/- 430 g (720-2450) and gestational age 31.6 +/- 2.4 weeks (26-37). IVH was diagnosed in 40 cases (41%). The significant risk factors are prematurity (gestational age < 33 weeks), artificial ventilation and infusion of fresh frozen plasma.

Selective unresponsiveness to HBsAg vaccine in newborns related with an in utero passage of hepatitis B virus DNA.

Thirty four out of 158 (22%) newborns to mothers chronically infected by the hepatitis B virus (HBV) did not produce antibodies (Ab) to HBsAg 1 month after the last injection of the HBV vaccine supplemented with HBV specific immunoglobulins. At birth, HBV genome was detected by polymerase chain reaction (PCR) in the peripheral blood mononuclear cells (PBMC) of a large majority (28 out of 34) of these non-responder newborns but never in the other newborns who responded to the HBsAg vaccine. HBV genome was detected in serum, only in some cases (nine out of 34) and never in the absence of HBV DNA in PBMC. For nine out of 14 followed newborns, the absence of response was transitory since anti-HBs Abs appeared after 15 months, without booster, while the HBV genome had disappeared. Unresponsiveness was specific to the HBV envelope protein since all late responders and 15-months-non-responders to the HBsAg vaccine produced normal levels of Abs to the three poliovirus serotypes, to tetanus toxoid and to the pneumococcus polysaccharides. An in utero induced immune tolerance to low doses of HBsAg appears as the most plausible hypothesis to explain this unresponsiveness to HBV vaccine.

Transient hepatitis B surface antigenemia after neonatal hepatitis B immunization.

Following immunization with hepatitis B vaccine, 39 infants were followed prospectively for hepatitis B surface antigen (HBsAg). A total of 69.2% of the infants tested positive for antigenemia at least once. Antigenemia was identified most often at 2-3 days (43.5%) and 5-6 days (43.5%) after immunization. The longest documented duration of antigenemia was 21 days. In all cases the antigenemia was transient and cleared by 28th day post-vaccination.