Assessment of the Environmental Impact of a Car Tire throughout Its Lifecycle Using the LCA Method.

There are numerous threats to the natural environment that pose a significant risk both to the environment and to human health, including car tires. Thus, there is a need to determine the impact of the life cycle of car tires on the environment, starting with the processes of raw materials acquisition, production, and ending with end-of-life management. Therefore, the authors of this study chose to do research on passenger car tires (size: P205/55/R16). As part of the research, the life cycle assessment (LCA) of traditional car tires was performed with the use of the Eco-indicator 99, cumulative energy demand (CED), and Intergovernmental Panel on Climate Change (IPCC) methods. The level of negative effects was determined for the life cycle of a tire and its particular stages: Production, use, and end of life. The negative impact on the atmosphere, soil, and water, as well as on human health, the environment, and natural resources was also investigated. The results show that the most energy-absorbing stage of a car tire life cycle is the use stage. It was found that the most harmful impact involves the depletion of natural resources and emissions into the atmosphere. Recycling car tires reduces their negative environmental impact during all their life cycle stages.

The Determination of Procalcitonin Concentration in Early-Onset Neonatal Infection.

The aim of this study was to assess the clinical usefulness of blood procalcitonin (PCT) levels for the diagnosis and therapeutic monitoring of early-onset neonatal sepsis (EONS). PCT as well as C-reactive protein (CRP) levels and white blood cell (WBC) count were measured in venous blood from 57 infected and 72 uninfected neonates. Differences between groups for PCT, CRP, and WBC levels were significant. The threshold value on the receiver operating characteristic curve in the prediction of EONS was 5.33 ng/mL for PCT, 9.3 mg/L for CRP, and 14.9 × 109/L for WBC. There was no effect of antibiotic administered to the mother on PCT, CRP, and WBC levels in neonatal blood sampled before treatment of EONS. Evidently reduced PCT levels are observed after 2 days of treatment. The authors conclude that prenatal antibiotic therapy does not reduce the value of PCT levels in blood for the diagnosis of EONS.

The Impact of rs3762271 and rs930557 Polymorphisms of ASPM and MCPH1 Genes on the Anatomy and Function of the Brain.

The ASPM and MCPH1 genes are involved in early neurogenesis and are thus potential candidates for affecting the formation of the anatomical and functional characteristics of the brain. However, the results of studies to date have been conflicting, an issue for which the factor of ethnicity may be responsible. We aimed to examine whether the rs3762271 and rs930557 polymorphisms of these two genes can influence brain anatomy and function. We enrolled 97 Caucasian neonates, with males predominating (53.6%). The anatomy of the brain was examined using ultrasound, while Doppler ultrasound was used to establish the blood flow indices in particular brain blood vessels. Genetic analysis was carried out using the polymerase chain reaction-restriction fragment length polymorphism method. The CC and AA homozygotes of rs3762271 were more common in males. The CC genotype of rs3762271 was significantly associated with birth weight (pRE = .03) and body length (pRE = .02). One mutant allele of rs3762271 was significantly associated with higher values of maximum (Vmax, p = .04), minimum (Vmin, p = .04), and average (Vmean, p = .02) speed in the pericallosal artery in newborns of both genders. Similar relationships were found in females only (Vmax p = .03, Vmean p = .02). The CC genotype of rs930557 was more frequently observed in male infants, but no impact on any anthropometric indices or anatomical and functional parameters of the brain was established. The ASPM gene may play a role in shaping the functional parameters of the brain in Caucasians.

Clinical Evaluation of the Safety and Feasibility of Whole Autologous Cord Blood Transplant as a Source of Stem and Progenitor Cells for Extremely Premature Neonates: Preliminary Report.

OBJECTIVES: This is a preliminary, single-center, prospective study in the field of autologous cord blood transplant. We investigated the feasibility, safety, and tolerability of autologous whole cord blood transplant in extremely premature infants as a potential therapeutic modality to prevent developing complications related to prematurity. MATERIALS AND METHODS: This preliminary prospective study (ClinicalTrials.gov identifier NCT02050971) included preterm infants born at less than 32 weeks of gestational age who developed anemia because of prematurity. Infants were assigned to 2 groups: (1) those receiving an autologous cord blood transfusion within 5 days postpartum (n = 5) and (2) those who obtained only an allogeneic red blood cell transfusion when necessary (n = 9; control group). Vital measurements were performed during and after transfusion, and peripheral blood pH, hematocrit, glucose, and calcium and potassium ion levels were measured over the next 4 days. RESULTS: Oxygen saturation was significantly increased throughout the cord blood transfusion and in the subsequent 48 hours. No significant differences were found in vital measurements, such as arterial blood pressure (mean, systolic, and diastolic) or heart rate over the first 48 hours posttransfusion. Similarly, no significant differences were found in biochemical analyses of blood with the exception of pH level. We found initial pH level to be significantly augmented in the cord blood recipient group by the first day after transplant, which remained significantly higher for next 24 hours compared with that shown in the control group. CONCLUSIONS: Collection, preparation, and short-term storage of unfrozen cord blood are feasible for clinical use. Our results showed general safety and tolerability of the procedure of whole autologous cord blood transplant in recruited preterm newborns. However, because our study group was small, these results need to be confirmed in further investigations with a larger patient cohort.

[The 2nd conference 'Rare diseases not only in the curriculum', Szczecin - Wroclaw, 26 and 30 May 2015].

The 2nd conference 'Rare diseases not only in the curriculum', that took place on 26th May, 2015 in Pomeranian Medical University in Szczecin and 30 May in Wroclaw Medical University. In accordance with the convention adopted at the first conference in 2014 in Szczecin participants of the meeting realized the idea expressed in the title of the conference by presenting issues of commonly known rare diseases and those that are not discussed in the course of medical studies. The active participants of the meeting were scientific workers medical schools in Szczecin, Wroclaw and Bialystok, medical students and PhD students. The significance of newborn screening in the early diagnosis of rare diseases in children, possibilities of supporting children with genetically conditioned rare diseases and their caregivers, application of guidelines of evidence-based medicine in the process of diagnosing non-routine patients and methods of physiotherapy of children with spinal muscular atrophy were discussed. Detailed issues of diagnosing and treatment of many rare diseases were also presented, among others Wilson disease, Alström syndrome, Cohen syndrome, Rubinstein-Taybi syndrome, Cornelia de Lange syndrome, Poland syndrome, Netherton syndrome, inborn aniridia and congenital arhinia - very rare defect requiring further scientific studies.

Usefulness of estimation of blood procalcitonin concentration versus C-reactive protein concentration and white blood cell count for therapeutic monitoring of sepsis in neonates.

AIM: This study was intended to assess the clinical usefulness of blood procalcitonin (PCT) concentrations for the diagnosis and therapeutic monitoring of nosocomial neonatal sepsis. MATERIAL/METHODS: The enrolment criterion was sepsis clinically manifesting after three days of life. PCT concentrations were measured in venous blood from 52 infected and 88 uninfected neonates. The results were interpreted against C-reactive protein (CRP) concentrations and white blood cell counts (WBC). RESULTS: Differences between the two groups in PCT and CRP concentrations were highly significant. No significant differences between the groups were noted for WBC. The threshold value on the receiver operator characteristic curve was 2.06 ng/mL for PCT (SE 75%; SP 80.68%; PPV 62.22%; NPV 88.75%; AUC 0.805), 5.0 mg/L for CRP (SE 67.44%; SP 73.68%; PPV 42.02%; NPV 88.89%; AUC 0.801), and 11.9 x109/L for WBC (SE 51.16%; SP 50.68%; PPV 23.16%; NPV 78.13%; AUC 0.484). Procalcitonin concentrations decreased 24 hours after initiation of antibiotic therapy and reverted to the control level after 5-7 days. C-reactive protein concentrations began to decline after two days of antibiotic therapy but were still higher than in the control group after 5-7 days of treatment. No significant changes in WBC during the treatment were observed. CONCLUSIONS: Procalcitonin concentrations in blood appear to be of use for the diagnosis and therapeutic monitoring of nosocomial infections in neonates as this parameter demonstrates greater sensitivity and specificity than C-reactive protein. White blood cell counts appear to be of little diagnostic value in the early phase of infection or for therapeutic monitoring.

Congenital candidiasis as a subject of research in medicine and human ecology.

Congenital candidiasis is a severe complication of candidal vulvovaginitis. It occurs in two forms,congenital mucocutaneous candidiasis and congenital systemic candidiasis. Also newborns are in age group the most vulnerable to invasive candidiasis. Congenital candidiasis should be considered as an interdisciplinary problem including maternal and fetal condition (including antibiotic therapy during pregnancy), birth age and rare genetic predispositions as severe combined immunodeficiency or neutrophil-specific granule deficiency. Environmental factors are no less important to investigate in diagnosing, treatment and prevention. External factors (e.g., food) and microenvironment of human organism (microflora of the mouth, intestine and genitalia) are important for solving clinical problems connected to congenital candidiasis. Physician knowledge about microorganisms in a specific compartments of the microenvironment of human organism and in the course of defined disorders of homeostasis makes it easier to predict the course of the disease and allows the development of procedures that can be extremely helpful in individualized diagnostic and therapeutic process.

Association of 1936A > G in AKAP10 (A-kinase anchoring protein 10) and blood pressure in Polish full-term newborns.

OBJECTIVE: The 1936G AKAP10 allele is associated with increased adult basal heart rate (HR) and decreased variability, markers of low cholinergic/vagus sensitivity associated with hypertension. Blood pressure (BP) values in newborns are important measurable markers of cardiovascular risk later in life. The question was whether decreased vagal function-related 1936A > G AKAP10 is associated with newborn BP. STUDY DESIGN: 114 healthy Polish newborns born after 37th gestational week to healthy women with uncomplicated pregnancies. At birth, newborn cord blood obtained for isolation of genomic DNA. BP and HR measured on days 1 and 3 after delivery. RESULTS: Diastolic BP on day 3 and absolute and relative differences between diastolic BP values, as well as between mean BP values on day 3 and on day 1 after birth, in carriers of 1936G AKAP10 allele, were significantly higher as compared with wild-type homozygotes. CONCLUSION: Results demonstrate possible association between 1936G AKAP10 variant and BP in Polish newborns.

Circulating hematopoietic stem cell count is a valuable predictor of prematurity complications in preterm newborns.

BACKGROUND: The frequency of preterm labour has risen over the last few years. Hence, there is growing interest in the identification of markers that may facilitate prediction and prevention of premature birth complications. Here, we studied the association of the number of circulating stem cell populations with the incidence of complications typical of prematurity. METHODS: The study groups consisted of 90 preterm (23-36 weeks of gestational age) and 52 full-term (37-41 weeks) infants. Non-hematopoietic stem cells (non-HSCs; CD45-lin-CD184+), enriched in very small embryonic-like stem cells (VSELs), expressing pluripotent (Oct-4, Nanog), early neural (ß-III-tubulin), and oligodendrocyte lineage (Olig-1) genes as well as hematopoietic stem cells (HSCs; CD45+lin-CD184+), and circulating stem/progenitor cells (CSPCs; CD133+CD34+; CD133-CD34+) in association with characteristics of prematurity and preterm morbidity were analyzed in cord blood (CB) and peripheral blood (PB) until the sixth week after delivery. Phenotype analysis was performed using flow cytometry methods. Clonogenic assays suitable for detection of human hematopoietic progenitor cells were also applied. The quantitative parameters were compared between groups by the Mann-Whitney test and between time points by the Friedman test. Fisher's exact test was used for qualitative variables. RESULTS: We found that the number of CB non-HSCs/VSELs is inversely associated with the birth weight of preterm infants. More notably, a high number of CB HSCs is strongly associated with a lower risk of prematurity complications including intraventricular hemorrhage, respiratory distress syndrome, infections, and anemia. The number of HSCs remains stable for the first six weeks of postnatal life. Besides, the number of CSPCs in CB is significantly higher in preterm infants than in full-term neonates (p < 0.0001) and extensively decreases in preterm babies during next six weeks after birth. Finally, the growth of burst-forming unit of erythrocytes (BFU-E) and colony-forming units of granulocyte-macrophage (CFU-GM) obtained from CB of premature neonates is higher than those obtained from CB of full-term infants and strongly correlates with the number of CB-derived CSPCs. CONCLUSION: We conclude that CB HSCs are markedly associated with the development of premature birth complications. Thus, HSCs ought to be considered as the potential target for further research as they may be relevant for predicting and controlling the morbidity of premature infants. Moreover, the observed levels of non-HSCs/VSELs circulating in CB are inversely associated with the birth weight of preterm infants, suggesting non-HSCs/VSELs might be involved in the maturation of fetal organism.

Circulating endothelial progenitor cells in premature infants: is there an association with premature birth complications?

BACKGROUND: The most common morbidities in preterm infants are associated with vascular pathology. Endothelial progenitor cells (EPCs) have been implicated in repair of the vasculature, but their role in the pathogenesis of prematurity complications is not clear. OBJECTIVES: We prospectively investigated an association between the number of EPCs circulating in blood during delivery as well as 2 and 6 weeks afterwards, the level of growth factors regulating their migration/homing, and the incidence of premature birth complications. PATIENTS AND METHODS: The study groups consisted of 90 preterm and 52 full-term infants. Early-EPCs (CD133+CD34+CD144+) and late-EPCs (CD133-CD34+CD144+) were analysed in cord blood (CB) and peripheral blood (PB). RESULTS: We found higher early- and late-EPC counts in the CB of premature infants compared with full-term babies. The number of circulating early- and late-EPCs was inversely associated with the Apgar score of preterm infants. A positive association between the early-EPC count and the risk of respiratory distress syndrome, retinopathy of prematurity, bronchopulmonary dysplasia, and infections was found. Nevertheless, multivariate analysis revealed that a higher number of EPCs was not an independent predictor of prematurity complications, which were directly related to lower gestational age. The EPC count in full-term infants maintained a constant, relatively low level over the 6-week follow-up, whereas the EPC population in preterm infants gradually decreased during this period. Furthermore, the number of CB late-EPCs in preterm infants positively correlated with VEGF concentration. CONCLUSIONS: EPCs may play a considerable role in vascular development in preterm infants.

EEG, brain maturation, and the development of retinopathy of prematurity.

OBJECTIVES: The factors that influence the central nervous system (CNS) development can affect either the retina or the brain cortex. Immaturity of the brain cortex reflects immaturity of the retina and vice versa. The immature retina is more vulnerable than the mature retina, and is therefore more likely to develop retinopathy of prematurity (ROP). The aim of this study was to compare electroencephalographic brain maturity with ROP severity. METHODS: Twenty-one prematurely born infants were divided into two groups according to the severity of ROP. The first group included 12 infants with ROP stage 3 or more and the second group included nine infants with ROP stage 2 or less. We have proposed an index of CNS maturity (M) as a percentage of interburst interval elongation compared with the norm using video-electroencephalography (vEEG). RESULTS: The median M value was 1.07 (range = 0.43-4.44) for infants with severe ROP and -0.1 (range = -1.0 to 1.45) for infants with mild or no ROP (p = 0.000948). CONCLUSIONS: The study revealed that CNS maturation delay expressed as M value was higher among infants with severe ROP than among infants with mild or no ROP. EEG examination in prematurely born infants may prove to be a useful tool for predicting ROP development.

Recording of amplitude-integrated electroencephalography, oxygen saturation, pulse rate, and cerebral blood flow during massage of premature infants.

OBJECTIVE: Stimulation of the nervous system plays an important role in brain function and psychomotor development of children. Massage can benefit premature infants, but has limitations. STUDY DESIGN: The authors conducted a study to verify the direct effects of massage on amplitude-integrated electroencephalography (aEEG), oxygen saturation (SaO(2)), and pulse analyzed by color cerebral function monitor (CCFM) and cerebral blood flow assessed by the Doppler technique. RESULTS: The amplitude of the aEEG trend during massage significantly increased. Massage also impacted the dominant frequency δ waves. Frequency significantly increased during the massage and return to baseline after treatment. SaO(2) significantly decreased during massage. In four premature infants, massage was discontinued due to desaturation below 85%. Pulse frequency during the massage decreased but remained within physiological limits of greater than 100 beats per minute in all infants. Doppler flow values in the anterior cerebral artery measured before and after massage did not show statistically significant changes. Resistance index after massage decreased, which might provide greater perfusion of the brain, but this difference was not statistically significant. CONCLUSION: Use of the CCFM device allows for monitoring of three basic physiologic functions, namely aEEG, SaO(2), and pulse, and increases the safety of massage in preterm infants.

The role of hemoglobin variant replacement in retinopathy of prematurity.

OBJECTIVE: To conduct tests of relationships between different factors that could influence the course of retinopathy of prematurity (ROP) and ROP, particularly the role of hemoglobin variant replacement in adult blood transfusions. METHODS: A retrospective, observational study of 83 infants born between 23 and 34 wks gestation was conducted. RESULTS: The infants without ROP, with 1 and 2 stage of ROP and with ≥ 3 stage of ROP received Q 28 (12-134); 51 (14-149); 156 (38-244) ml/kg of transfused blood, respectively, and the factor Qt was 1,545 (560-10,045); 3,093 (614-13,419); 11,907 (1,288-20,638) (ml/kg)·day, respectively. For the same groups MCV(35) (mean cell volume at the arbitrary time of the 35(th) wk post-conception) was 92.3 (82.9-110.5); 91.0 (79.3-101.4); 87.1 (80.2-94.8) fl, respectively, and factor P(MCV)/t was 99.5 (89.2-108.8); 96.3 (84.6-106.3); 90.7 (85.3-96.5) fl, respectively. There is high influence on the stage of ROP of the amount of transfused blood and MCV, both with or without the time factor. The statistical differences between P(MCV)/t were more significant than the differences between MCV(35), for different stages of ROP. CONCLUSIONS: The influence of the time factor on the statistical differences of MCV but not on the amount of transfused adult blood suggests that HbF - HbA replacement may play a role in ROP development.

Does prenatal antibiotic therapy compromise the diagnosis of early-onset infection and management of the neonate?

AIM: To assess the impact of prenatal antibiotic treatment on procalcitonin (PCT) and C-reactive protein (CRP) concentrations in cord blood, and on the rate of positive neonatal blood cultures. METHODS: Neonates with early-onset infection (Group A; n=46) were compared with healthy controls (Group B; n=240). We evaluated the relationship between prenatal antibiotic therapy and early-onset infection, and for interactions with antibiotic therapy in the neonate immediately after birth. RESULTS: In the Group A antibiotics were administered significantly more often prenatally and more often to neonates just after birth. The percentage of negative blood cultures in infected neonates was higher when antibiotic treatment was instituted prenatally. Differences in cord blood PCT and CRP concentrations were significant between both groups and were independent of prenatal antibiotic treatment. Streptococcus agalactiae was the most frequent species. CONCLUSIONS: Almost one-third of neonates present with early-onset infection in spite of prenatal antibiotic therapy. Cord blood PCT and CRP measurements may be helpful in the diagnosis of infection also in cases when antibiotic therapy was started prenatally. Prenatal antibiotic administration reduced the number of positive blood cultures in neonates with early-onset infection and was associated with a greater rate of antibiotic treatment after birth in neonates without infection.

[The role of circulating endothelial progenitor cells in the progression of retinopathy of prematurity--a prospective study]. / Rola krazacych komórek progenitorowych sródblonka w rozwoju retinopatii wczesniaczej--badanie prospektywne.

PURPOSE: Retinopathy of prematurity (ROP) is the primary cause of visual impairment in preterm infants. There are available data confirming that circulating endothelial progenitor cells (EPCs) are involved in forming the growing network of blood vessels in the developing retina. In this study we sought to explore potential relationship between concentration of circulating bone marrow-derived EPCs and development of ROP in prospective study. MATERIAL AND METHODS: The study groups consisted of 90 preterm (23-36 weeks of gestational age), and 52 full-term control infants. EPCs were analyzed in cord blood (CB) and subsequently in peripheral blood (PB) in second and sixth week since delivery. The incidence and stage of ROP was prospectively documented in the preterm infants. RESULTS: EPC concentration in CB was considerably higher in the preterm infants developing ROP. In the preterm infants a noticeable decrease in PB EPC concentration within six weeks of the follow up was found, whereas in full-term infants EPC concentration was maintained at invariable level. Of note, in the sixth week since delivery, EPC concentration in preterm infants with ROP was lower compared to preterm infants without ROP. CONCLUSIONS: Increase in CB EPC concentration in preterm infants, including those developing ROP, indicates that the circulating EPC cells contribute to the process of blood vessel formation, and their number in CB reflects the degree of prematurity. Impaired blood vessel formation within retina in the course of ROP may result from decrease in circulating EPC number observed at the sixth week since delivery.

Circulating stem cell populations in preterm infants: implications for the development of retinopathy of prematurity.

OBJECTIVE: To investigate the association among different circulating stem cell (SC) populations, the levels of selected growth factors and chemokines regulating SC migration in the peripheral blood, and the incidence of retinopathy of prematurity (ROP). METHODS: We evaluated 88 participants in this study: 29 preterm infants with ROP, 29 preterm infants without ROP, and 30 healthy full-term infants. Peripheral blood samples collected 10 weeks after delivery were analyzed using flow cytometry, immunofluorescence, real-time reverse transcriptase-polymerase chain reaction, and enzyme-linked immunosorbent assay. The following cell populations were analyzed: (1) lin⁻CXCR4(+)CD45⁻ (enriched in very small embryonic-like SCs), (2) lin⁻CXCR4(+)CD45(+) (enriched in hematopoietic SCs), and (3) CD34(+)CD133(+)CD144(+) (early endothelial progenitor cells) [lin indicates lineage]. The concentrations of vascular endothelial growth factor, basic fibroblast growth factor, hepatocyte growth factor, and stromal cell-derived factor 1 were measured in the plasma. RESULTS: The very small embryonic-like SCs and early endothelial progenitor cells expressing neural and endothelial markers were significantly increased in the preterm infants. The number of early endothelial progenitor cells in the peripheral blood was significantly greater in the preterm infants with ROP than in the preterm infants without ROP. An accompanying increase in the concentrations of vascular endothelial growth factor and hepatocyte growth factor was found in the peripheral blood of the preterm infants with ROP. No significant associations were found between hematopoietic SCs and ROP or prematurity. CONCLUSIONS: The increased number of early endothelial progenitor cells along with elevated levels of vascular endothelial growth factor and hepatocyte growth factor in preterm infants with ROP suggest that circulating vasculogenic factors may play a role in the development and progression of ROP. The increased number of very small embryonic-like SCs in preterm infants suggests that the development of immature tissues and organs, including the retina, may require a contribution of circulating SCs.

[Role of the nurse and midwife in educating parents of neonates treated at intensive care units]. / Rola edukacyjna pielegniarek i poloznych wobec rodziców noworodków przebywajacych na intensywnej terapii.

INTRODUCTION: Health education is an important element in the therapeutic process of every patient. If the patient is a neonate at an intensive care unit (ICU), the parents or legal guardians become the object of education. Knowledge and skills learned by parents at neonatal ICUs are later reflected in the quality of their childcare. The nursing and midwifery staff at ICUs plays an important role in the process of parental education. The aim of this study was to define educational needs of parents of neonates in intensive care and the impact of education on future parental childcare skills. MATERIAL AND METHODS: We used the diagnostic poll method and the research tool was a questionnaire, which was addressed to parents of neonates treated at the neonatal intensive care unit of the Second University Hospital and the SPSZOZ Zdroje Hospital in Szczecin. The study was carried out in December-January of 2004/2005 and the group comprised 53 persons. The results were subjected to mathematical analysis. CONCLUSIONS: The following conclusions were drawn: (1) As all the parents wished to stay with their children at the neonatal ICU, special facilities for this purpose should be created at hospitals possessing such units. (2) Parents of neonates weighing more than 1000 g reported that their need to help their children was satisfied through participation in diagnostic, therapeutic, and nursing activities, which also gave them a sense of proximity with their offspring. extremely low birthweight to participate in the therapeutic process. (3) Parents expected to be taught by nurses and midwives and were interested in the activities of support groups. (4) Participation by parents in nursing activities is of importance for their unassisted childcare exercised later at home.

Prematurity and protracted mechanical ventilation as risk factors for Pneumocystis jiroveci infection in HIV-negative neonates in an intensive care unit.

This work was undertaken to elucidate some aspects of the epidemiology of Pneumocystis pneumonia (PP). We studied 42 mechanically ventilated, human immunodeficiency virus (HIV)-negative, severely ill neonates treated at an intensive care unit. The study group included 40 premature neonates and two mature neonates with lethal congenital defects. Progressive respiratory dysfunction in PP necessitated mechanical ventilation. Infection was usually noticeable on the 22nd day of life or after 12 days of ventilation. The usual manifestations included apnea, pallor, copious frothy sputum, seizures, and feeding difficulties. The diagnosis was established by detecting Pneumocystis jiroveci cysts in bronchial lavage fluid specimens (88.1% sensitivity). PP was managed with cotrimoxazole and pentamidine combination therapy administered over 14 days. No clinical improvement was noted in four neonates and three of them died during therapy. Prematurity and protracted mechanical ventilation are two risk factors for P. jiroveci infection in severely ill neonates in an intensive care unit.

Maternal serum proinflammatory cytokines in preterm labor with intact membranes: neonatal outcome and histological associations.

Our aim was to compare maternal serum concentrations of interleukin(IL)-1alpha IL-1beta, IL-6 and IL-8 in pregnancies complicated by preterm labor (PTL), with the levels in healthy controls at comparable gestational age, and to determine if these assays have any value in the prediction of early-onset neonatal infection or histological chorioamnionitis. The study population consisted of 65 women with new-onset PTL, and 31 healthy controls. Maternal serum concentrations of IL-6 (8.40 versus 3.30 pg/mL; p = 0.002) and IL-1beta (2.20 versus 0.50 pg/mL; p = 0.003) were significantly higher in patients with PTL as compared to healthy pregnant women. The IL-1beta concentration (13.60 versus 1.20 pg/mL; p = 0.02) was significantly higher in the serum of mothers whose babies developed early-onset infections, than in mothers of newborns that were healthy. However, its predictive value, and the value of the other cytokines studied, was poor. In addition, IL-1beta levels (28.79 versus 5.19 pg/mL; p = 0.001) were significantly higher in patients with histological chorionamnionitis, than in those without the condition,. The cut-off value of >or= 14 pg/mL predicted inflammatory changes with a sensitivity of 80%, specificity of 86%, PPV of 80% and NPV of 86%. IL-1beta seems to be of moderate value in the prediction of histological chorioamnionitis.

Value of vaginal fluid proinflammatory cytokines for the prediction of early-onset neonatal infection in preterm premature rupture of the membranes.

The usefulness of vaginal fluid proinflammatory cytokine assays in the prediction of neonatal congenital infection was evaluated. Sixty-two women between 24 and 34 weeks of pregnancy, complicated by premature rupture of the membranes, were divided into those who delivered newborns with (n = 21) and without (n = 41) signs of infection. Concentrations of all studied cytokines were higher in women who delivered babies with infection. The cutoff values of interleukin-1alpha (IL-1alpha) and IL-1beta > or = 400, IL-6 > or = 2000, and IL-8 > or = 2100 pg/mL predicted infection with a sensitivity of 57%, 57%, 33%, and 76%, a specificity of 73%, 73%, 93%, and 59%, a positive predictive value of 52%, 52%, 70%, and 48%, and a negative predictive value of 77%, 77%, 73%, and 83%, respectively. Receiver operating characteristic (ROC) curve analysis revealed that the predictive performance of the four studied cytokines was comparable. In conclusion, vaginal fluid cytokines after premature rupture of the membranes have moderately predictive value of whether or not a neonate will develop early sepsis.