Oral supplementation with Lactobacillus casei subspecies rhamnosus prevents enteric colonization by Candida species in preterm neonates: a randomized study.

BACKGROUND: Colonization by Candida species is the most important predictor of the development of invasive fungal disease in preterm neonates, and the enteric reservoir is a major site of colonization. We evaluated the effectiveness of an orally supplemented probiotic (Lactobacillus casei subspecies rhamnosus; Dicoflor [Dicofarm spa]; 6 x 10(9) cfu/day) in the prevention of gastrointestinal colonization by Candida species in preterm, very low birth weight (i.e., < 1500-g) neonates during their stay in a neonatal intensive care unit. METHODS: Over a 12-month period, a prospective, randomized, blind, clinical trial that involved 80 preterm neonates with a very low birth weight was conducted in a large tertiary neonatal intensive care unit. During the first 3 days of life, the neonates were randomly assigned to receive either an oral probiotic added to human (maternal or pooled donors') milk (group A) or human milk alone (group B) for 6 weeks or until discharge from the NICU, if the neonate was discharged before 6 weeks. On a weekly basis, specimens obtained from various sites (i.e., oropharyngeal, stool, gastric aspirate, and rectal specimens) were collected from all patients for surveillance culture, to assess the occurrence and intensity of fungal colonization in the gastrointestinal tract. RESULTS: The incidence of fungal enteric colonization (with colonization defined as at least 1 positive culture result for specimens obtained from at least 1 site) was significantly lower in group A than in group B (23.1% vs. 48.8%; relative risk, 0.315 [95% confidence interval, 0.120-0.826]; P = .01). The numbers of fungal isolates obtained from each neonate (P = .005) and from each colonized patient (P = .005) were also lower in group A than in group B. L. casei subspecies rhamnosus was more effective in the subgroup of neonates with a birth weight of 1001-1500 g. There were no changes in the relative proportions of the different Candida strains. No adverse effects potentially associated with the probiotic were recorded. CONCLUSIONS: Orally administered L. casei subspecies rhamnosus significantly reduces the incidence and the intensity of enteric colonization by Candida species among very low birth weight neonates.

Fungal and bacterial sepsis and threshold ROP in preterm very low birth weight neonates.

OBJECTIVE: To determine whether an association exists between either fungal or bacterial sepsis and retinopathy of prematurity (ROP). STUDY DESIGN: Retrospective cohort study on all neonates with birth weight <1500 g admitted to a large Italian third Level Neonatal Intensive Care Unit in the years 1997-2001 and screened for ROP. Univariate analysis and multiple logistic regression were used to detect significant associations with ROP (all grades and threshold) in neonates with birth weight<1000 g (extremely low birth weight (ELBW)) and 1000-1500 g. RESULTS: Among 301 enrolled neonates, ROP (all grades), threshold ROP, fungal and bacterial sepsis occurred in 31.9, 12.9, 11.6 and 40.5% of the infants, respectively. At multivariate analysis, only gestational age (P=0.03), colonization by Candida non-albicans spp (P=0.03) and fungal sepsis (P=0.03) were independent predictors of threshold ROP, and only in ELBW neonates. CONCLUSIONS: Fungal (but not bacterial) sepsis is significantly and independently associated with ROP, but only in ELBW neonates and only with threshold ROP.

[G-CSF, neutropenia and candidiasis in VLBW patients]. / G-CSF, neutropenia e candidiasi nel VLBW.

OBJECTIVES: Relationships among Early Onset Neutropenia (EON), i.e. neutropenia in the first week of life, treated with Filgrastim, and subsequent colonization by Candida spp. with eventual systemic fungal infection in ELBW patients are not clear. We tried to analyze these features in a retrospective study on a selected population of a large tertiary NICU. METHODS: By a database search, we identified a group of VLBW patients who were diagnosed a systemic fungal infection (SFI) during their stay in NICU (n=52), and divided them in two subgroups: those who had presented Early Onset Neutropenia (EON) and thus had been treated with a 3-day course of Filgrastim (n=14)(group A), and those who had not presented EON and thus had not undergone Filgrastim therapy (n=38) (group B). We investigated in both subgroups the following variables: neutrophil count monitoring during the first 2 weeks of life, colonization by Candida spp, day of onset of SFI, outcome. Statistical analysis was performed by Chi-square test, ANOVA and T-test using SPSS 8.0 for Windows. RESULTS: Absolute neutrophil number was obviously lower in group A at recruitment (354/mmc vs 2910\mmc, Chi-square = 9.776, p <0.005), but became normal at the end of G-CSF treatment, thus detecting no significant differences between the two groups at day 8 (p<0.12) and 14 (p<0.34). The onset of SFI occurred significantly earlier ( 9.6 dol vs 14.6 dol., p<0.004) in group A neonates. Fungal Colonization rate in the 2nd week of life was significantly higher in previously neutropenic patients (71% vs. 37%, p< 0.005), who had also a significantly higher number of sites involved (p<0.003). CONCLUSIONS: Neutropenia in the first days of life in VLBW neonates, even if adequately and succesfully treated, heavily influences rates and severity of colonization by fungal spp., and is associated with an earlier onset of a SFI.

The diagnosis of so-called "constitutional" bone dysmorphias (embryonal osteochondropathies).

The authors review the diagnosis of so-called "consitutional" bone diseases. They criticise the international nomenclature and classification of the latter and propose a diagnostic classification for embryonal osteochondropathies, which is virtually independent of the structural and metabolic criteria, based on the criterion of site and the extent of pathological manifestations. They also examine the term "dysmorphia" given that it is the shape of the bone segment which first attracts attention and guides the clinical diagnosis of embryonal osteochrondropathies.

Some objections to the international nomenclature for constitutional diseases of the bone.

The International Nomenclature of Constitutional Diseases of Bone is criticised and the concept of embryonic osteochondropathy is proposed as an alternative approach. It is claimed for example that the term "constitutional" has no real scientific or, above all, medical meaning. The defects of this "official" nomenclature are highlighted and a slimmer classification system of use in the diagnosis of osteochondroblastic mesenchymopathies is recommended.

Criticism of the International Nomenclature of Constitutional Diseases of Bone.

The International Nomenclature of Constitutional Diseases of Bone is criticised and the concept of embryonic osteochondropathy is proposed as an alternative approach. It is claimed for example that the term "constitutional" has no real scientific or, above all, medical meaning. The defects of this "official" nomenclature are highlighted and a slimmer classification system of use in the diagnosis of osteochondroblastic mesenchymopathies is recommended.

Dubowitz' syndrome with special characteristics.

The Authors describe the main characteristics of Dubowitz' syndrome: retarded growth, microcephaly, cranio-facial deformations and dysmorphia of the extremities, psycho-motor development varying between normal and retarded, thin hair, cryptorchism, hyperactivity and others. They report a case which was brought to their attention in which, in addition to numerous anomalies and dysmorphia which justify its inclusion in Dubowitz' syndrome, there was marked bilateral metacarpal hypoplasia with strongly and permanently adducted thumbs. The aim of this report was to add to the mosaic of data relating to this highly polymorphous syndrome.

Prion-induced neuro-psychiatric syndromes.

Although further research is needed, the most recent thinking is that prions are tiny protein particles without DNA or RNA which have the ability to infect humans or animals. Prions cause slow infections which are fatal, experimentally transmissible, evoke no immune resistance from the infected host and are more resistant to disinfectants and chemical or physical agents than the other micro-organisms that proliferate in the infected host. Update no evidence of possible passage by mouth from cows to men with consequent illness.

Harlequin fetus: a case report.

The authors report a case of "harlequin fetus" which was brought to their attention. The report was justified not only by the rarity of the disease, but above all because, after having examined the literature on the topic, this appears to be the third case treated with etretinate. The case in question was a female affected by congenital ichthyosis in its total form and by initial necrosis of the extremities. Etretinate treatment gave good results in terms of cutaneous modifications: reduction of hyperkeratosis, disappearance of ectropion and eclabium. Therefore, although the patient died when 16 days old due to sudden renal insufficiency, the case confirms the two previous reports on the value of this therapy.

Poland syndrome: a case with a combination of syndromes.

The case of Poland syndrome reported incorporates a number of previously unrecorded features: hypoplasia of the left lung and agenesia of the epiglottis in addition to the standard symptoms. The case also presents certain features typical of the Moebius Syndrome.

A father and son with visceral leishmaniasis. A description of the pediatric case.

The paper reports a case of a 6-year-old boy affected by visceral leishmaniasis. In addition to clinical and anamnestic findings, diagnosis was made on the basis of the rapid increase in the titer of anti-Leishmania antibodies (16-fold), while the marrow smear was negative. A complete recovery was obtained using antimonial drugs.

[Cranial acupuncture in the treatment of spasticity. Neurophysiological findings]. / L'agopuntura cranica nel trattamento della spasticitá. Considerazioni neurofisiologiche

On the basis of a study of the innervation of the cutaneous areas stimulated in cranial acupuncture, a neurophysiological classification of the technique is proposed, considering the bulbar level as the first site of integration of the afferent vessels activated by cranial acupuncture.

[Cranial acupuncture in the treatment of spasticity. Clinical results]. / L'agopuntura cranica nel trattamento della spasticitá. Risultati clinici

Hospitals in communist China perfected a new acupuncture technique about 3 yrs ago, whereby needles are placed in the scalp to stimulate the cortical centres below. This method is particularly indicated in subjects with neurological damage. Results observed in 45 subjects with cerebral vasculopathy at the neurological clinic of Pisa University and the reflexotherapy service of the University of Turin were encouraging and suggest that clinical experimentation should be attempted on a wider scale.

[Study of serum ferritin in a population of 3-month-old breast feeding children]. / Valutazione della ferritina serica in una popolazione di lattanti al seno all'età di tre mesi.

The evaluation of serum ferritin level in a population of 30 three months old babies is made by the Authors following a radioimmunological method. The reckoned average values reflect exactly the wellknown elements of iron kinetics during the first months of life. The Authors underline that those values show how complete is breast-feeding; moreover they emphasize the importance of a referring value which, together with those already known in subjects of different ages, allows on early diagnosis of syndromes due to iron decrease and subsequent check-up after therapeutic trial.

Neonatal cutaneous disseminated aspergillosis in a preterm extremely-low-birth-weight infant with favourable outcome at 3-year follow-up: a case report.

Invasive disseminated neonatal aspergillosis is an uncommon disease, with only scattered reports in literature in the last few years. Here we report on a 25-week gestational age, 730 g at birth preterm female infant who developed on day-of-life 10 multiple cutaneous exhulcerative lesions in her right arm, trunk and abdomen. Early recognition and diagnosis of these lesions as a due to cutaneous initial symptom of cutaneous disseminated aspergillosis, as well as prompt treatment with Liposomal amphotericin B + Itraconazole, secured successful recovery from the systemic infection. Skin lesions healed without any surgical treatment. The infant was discharged in good health. Long-term follow-up at three years of age revealed normality of all neurodevelopmental and cognitive parameters. To our knowledge, this is one of the very few cases of survival, free from sequelae, for a preterm infant affected by neonatal cutaneous disseminated aspergillosis.

Mode of delivery and threshold retinopathy of prematurity in pre-term ELBW neonates.

BACKGROUND: Retinopathy of prematurity (ROP) is a multifactorial disease, but little is known about its relationship with perinatal risk factors. We tested the hypothesis that the mode of delivery may be associated with threshold ROP as defined by CRYO-ROP. METHODS: We conducted a prospective, cohort analysis of a database of all extremely low birth weight (ELBW) neonates (= birth weight < 1000 g) admitted over a 8-year period from 1997 to 2004 to a large tertiary neonatal intensive care unit in a urban area of northern Italy and screened for ROP. Incidence of threshold ROP was calculated for the whole studied population. The definition of threshold ROP was as defined by the CRYO-ROP study. Univariate analysis was performed to look for significant associations between threshold ROP and several possible associated factors, and among them, the mode of delivery (vaginal delivery or caesarean section). When an association was indicated by p < 0.05, multiple logistic regression was used to determine the factors significantly associated with ROP. RESULTS: Enrolled ELBW neonates were 174, and 46 of them (26.4%) displayed threshold ROP. Threshold ROP occurred in 40.9% (27 of 66) of the neonates vaginally delivered and in 17.5% (19 of 108) of those born via caesarean section (R.R. 3.35; 95% CI 1.230-4.855; p = 0.008 at univariate analysis, and = 0.04 at multivariate logistic regression after controlling for birth weight, gestational age, intraventricular haemorrhage grade 2 or more, days on supplemental oxygen, systemic fungal infection). Birth by vaginal delivery was not significantly associated with other major sequelae of prematurity (intraventricular haemorrhage, bronchopulmonary dysplasia, necrotizing enterocolitis). CONCLUSIONS: In our Institution birth by vaginal delivery is a significant and independent predictor of threshold ROP in ELBW infants. We suggest to consider closely ophthalmological surveillance for pre-term ELBW infants born this mode.