IgA secretora total e específica no colostro e leite de mães da cidade do Natal-Rio Grande do Norte, Brasil / Total and specific IgA in colostrum and milk of mothers of Natal-Rio Grande do Norte, Brasil

PURPOSE: To determine the concentration of total secretory IgA and evaluate the repertoire of IgA antibodies to enteropathogenic Escherichia coli and Shigella flexneri antigens in colostrums and milk from mothers in Natal, RN. METHODS: The sample was constituted by 22 healthy clinically women whose babies were born at public hospital in Natal, RN. To determine total secretory IgA a radial immunedifusion tecnique (Mancini et al, 1965), was employed and to detect specific antibodies, immuneenzimatic assays, ELISA was used. RESULTS: The median values of total secretory IgA concentration presented individual variations with high levels in colostrums samples, decreasing during lactation, it was observed a p < 0.001 among the samples from the first day of lactation, to the thirtieth for total IgA concentration. All the donators present in colostrum and milk specific antibodies to Escherichia coli enteropathogenic (EPEC) and Shigella flexneri with titles higer in colostrum. There was parallel and directional pattern between total IgA and IgA anti-EPEC and Shegella flexneri, during period. CONCLUSION: The concentrations of total SIgA and specific antibodies to enteropathogenic Escherichia coli and Shigella flexneri in colostrums and milk in our study do not differ from others accomplished among populations with the same social and econimic features, stressing the importance of human milk as a protector agent against pathogens.

Vancomycin monitoring in term newborns: comparison of peak and trough serum concentrations determined by high performance liquid chromatography and fluorescence polarization immunoassay.

INTRODUCTION: Peak and trough serum concentrations of vancomycin were determined in term newborn infants with confirmed or suspected Staphylococcus sp sepsis by high performance liquid chromatography and flourescence polarization immunoassay. OBJECTIVE: To statistically compare the results of the high performance liquid chromatography and flourescence polarization immunoassay techniques for measuring serum vancomycin concentrations. METHODS: Eighteen peak and 20 trough serum samples were assayed for vancomycin concentrations using high performance liquid chromatography and flourescence polarization immunoassay from October 1995 to October 1997. RESULTS: The linear correlation coefficients for high performance liquid chromatography and flourescence polarization immunoassay were 0.27 (peak, P = 0.110) and 0.26 (trough, P = 0.1045) respectively, which were not statistically significant. CONCLUSION: There was wide variation in serum vancomycin concentrations determined by high performance liquid chromatography as compared with those determined by flourescence polarization immunoassay. There was no recognizable pattern in the variability; in an apparently random fashion, the high performance liquid chromatography measurement was sometimes substantially higher than the flourescence polarization immunoassay measurement, and at other times it was substantially lower.

A risk factor for early-onset infection in premature newborns: invasion of chorioamniotic tissues by leukocytes.

The authors report a prospective study of correlation between histopathological alterations of the placenta, risk factors and early-onset bacterial infections in 224 premature newborns. They used a mathematical model for evaluation and prediction of neonatal bacterial infection according to the localization in chorioamniotic tissues (chorioamniotic plate, amniotic membranes and umbilical cord) invaded by leukocytes. Septicemia, pneumonia or omphalitis were documented in 45 (20%) infected premature newborns and inflammatory lesions in the placenta were observed in all of them. In order of statistical significance, the most important variables for early-onset bacterial neonatal infection were invasion of the chorioamniotic plate, amniotic membranes and umbilical cord tissues by PMNL (P < 0.0000), premature rupture of membranes (P < 0.0000), birthweight lower than 1500 g (P < 0.0000), gestational age under 34 weeks (P < 0.0001), foul smell (P < 0.0038), no antibiotics before delivery (P < 0.0066) and intrapartum fever (P < 0.0087). By logistic stepwise multiple regression analysis, invasion of fetal chorioamniotic plate and of amniotic membranes by leukocytes were the only statistically significant variables. The probability of neonatal infection in premature newborns, when polymorphonuclear neutrophils were present in chorioamniotic plate and in amniotic membranes, was 62.5%, while the probability was 0.5% when these tissues were normal. These data suggest that histological chorioamnionitis has to be considered as an important risk factor for early-onset infection in premature newborns.

Progress in phototherapy.

The purpose of this article is to present a recent advance in phototherapy employed on newborn babies with jaundice. The efficacy of this treatment depends on the intensity of emitted light; it is believed that a dose between 6-12 nm is necessary. The usefulness of phototherapy in healthy, full-term infants is currently being questioned. Therefore, the adequate use of this therapy should be emphasized until a consensus is reached on its advantages and disadvantages.

A case-control study of histological chorioamnionitis and neonatal infection.

The authors report a prospective study of the correlation between histopathological alterations in the placenta and the umbilical cord and neonatal infection in 223 newborns. The pathological studies were specifically concerned with the presence of infection as shown by a polymorphonuclear infiltrate at these sites. Inflammatory lesions were demonstrated in 26.9% of specimens and were highest in those with prolonged premature rupture of membranes and in the least mature placentas. Among the cases of histological chorioamnionitis, only 23.3% of infants had documented infection. Neonatal infection was diagnosed in 7.2% of the newborns and was 10 times more frequent in preterm newborns. Among the cases of infected newborns, 87.5% of placentas had histological chorioamnionitis. Pneumonia and septicemia were the most frequent conditions found among infected newborns. There was a strong correlation between histological chorioamnionitis and neonatal infection. The data obtained in this investigation suggest that histological chorioamnionitis is an important indicator of neonatal infection.

[Premature rupture of membranes and its relation to infection in newborn infants]. / Rotura prematura de membranas e sua relação com infecção no recém-nascido.

The authors made a retrospective analysis of 136 cases of premature rupture of membranes (RPM) to check for the presence of neonatal infection, anoxia, and prematurity according to the latency period between rupture of membranes and parturition. Neonatal infection due to RPM has been the cause of 8.8% of clinically and laboratorily confirmed cases; in 6.6% of the cases, laboratorial confirmation was not possible. Neonatal infection was not influenced by the latency period between RPM and parturition. Maternal symptoms of infection were more frequent in the group with latency period longer than 24 hours and there was a significant relationship between maternal infection symptoms and neonatal symptoms. Prematurity and anoxia were detected in 20% of the cases, but no relation to RPM was observed.