Late-onset bloodstream infections of Very-Low-Birth-Weight infants: data from the Polish Neonatology Surveillance Network in 2009-2011.

BACKGROUND: Late-Onset Bloodstream Infections (LO-BSI) continue to be one of the most important complications associated with hospitalization of infants born with very low birth weight (VLBW). The aims of this study were to assess the epidemiology of LO-BSI together with the risk factors and the distribution of causative pathogens at six Polish neonatal intensive care units that participated in the Polish Neonatology Surveillance Network from January 1, 2009 to December 31, 2011. METHODS: The surveillance covered 1,695 infants whose birth weights were <1501 grams (VLBW) in whom LO-BSI was diagnosed >72 hours after delivery. Case LO-BSI patients were defined according to NeoKISS. RESULTS: Four hundred twenty seven episodes of LO-BSI were diagnosed with a frequency of 25.3% and an incidence density of 6.7/1000 patient-days (pds). Results of our multivariate analysis demonstrated that surgical procedures and lower gestational age were significantly associated with the risk of LO-BSI. Intravascular catheters were used in infants with LO-BSI significantly more frequently and/or for longer duration: Central venous cathters (CVC) (OR 1.29) and Peripheral venous catheters (PVC) (OR 2.8), as well as, the total duration of total parenteral nutrition (13 vs. 29 days; OR 1.81). Occurrence of LO-BSI was significantly associated with increased the length of mechanical ventilation (MV) (OR 2.65) or the continuous positive airway pressure (CPAP) (OR 2.51), as well as, the duration of antibiotic use (OR 2.98). The occurrence of more than one infection was observed frequently (OR 9.2) with VLBW with LO-BSI. Microorganisms isolated in infants with LO-BSI were dominated by Gram-positive cocci, and predominantly by coagulase-negative staphylococci (62.5%). CONCLUSIONS: Independent risk factor for LO-BSI in VLBV infants are: low gestational age and requirement for surgery. The incidence rates of LO-BSI especially CVC-BSI were higher in the Polish NICUs surveillance than those of other national networks, similar to the central- and peripheral utilization ratio.

[Perinatal transmission of Chlamydia trachomatis and its complication in preterm infants]. / Czestosc perinatalnej transmisji Chlamydia trachomatis i powiklania z nia zwiazane u noworodków przedwczesnie urodzonych.

INTRODUCTION: Chlamydia trachomatis is the most common agent of sexually transmitted infections. In pregnant women it can cause premature delivery. In newborns the clinical manifestation are pneumonia and conjunctivitis. AIM: The aim of the study was to estimate the perinatal transmission of Chlamydia trachomatis and the prevalence of neonatal complications. MATERIAL AND METHODS: The study included 82 mothers with delivery < 34 weeks of gestation and 100 of their newborns. All patients were hospitalized at the Poznan University of Medical Sciences Gynecology and Obstetrics Hospital between 2004 and 2009. Polymerase chain reaction (PCR) method in AMPLICOR CT/NG test was used for the detection of Chlamydia trachomatis infection. RESULTS: Chlamydia trachomatis was identified in 8 pregnant women among 82 tested patients (10%) and in 6 neonates. Perinatal transmission was 75%. All infected infants developed respiratory disorders. Five of them needed respiratory support such as nCPAP or mechanical ventilation. Three newborns presented apneic spells. CONCLUSIONS: Asymptomatic chlamydial infection is frequently detected in women with preterm delivery. There is high risk of perinatal transmission of the infection from the mother to the newborn, which leads to perinatal complications such as neonatal pneumonia which in preterm infants can develop just after the delivery and give rise to life-threatening respiratory disorders.

[Antibiotic consumption and its costs of purchase in Polish neonatology networks units]. / Zuzycie antybiotyków i koszty ich zakupu w oddzialach Polskiej sieci neonatologicznej.

AIM: The study presents the results of the analysis of antibiotic consumption and its direct costs in selected neonatal units. MATERIAL AND METHODS: Data were collected retrospectively (the year 2007) in five hospitals, during the pilot phase of the Polish Neonatal Network . Antibiotic consumption was assessed using the Defined Daily Dose (DDD). The costs were assessed as the costs of purchase of one DDD. RESULTS: The study included 11 922 children hospitalized in the period from 1.01 to 31.12.2007. In this group, 731 infants have birth weight < 1500 grams (from 2.2% to 64.2% in individual units, median--7.3%). The mean consumption of antibacterial drugs was 48.52 DDD/1 000 person-days (P-D) of stay among the entire study population (median--42,52), and varied from 23.13 to 85.82 DDD/1,000 P-D. However, this difference has not been statistically significant. The most commonly used group of antibiotics were beta-lactams--in four out of five units the percentage of its usage ranged from 48.71% to 74.67%. Next group were aminoglicosides--in one unit its usage reached 56.97% and in other ranged from 5.01% to 22.53%. Glycopeptides and macrolides were also used in every unit of the studied group. The usage of glycopeptides ranged from 1.7% to 10.81% and of macrolides from 1.32% to 15.71%. Different kinds of antibiotics were used occasionally. The differences of costs of purchase of one DDD between hospitals were greater and varied from 17,64 PLN/ DDD to 84,58 PLN/ DDD (average costs). A considerable range of costs index values was also noted for different groups of antibiotics. The costs of purchase of one DDD of beta-lactams varied from 19.54 PLN/ DDD to 68.35 PLN/ DDD; for aminoglicosides the cost varied from 4.61 PLN/ DDD to 122.9 PLN/ DDD, for glycopeptides--from 31.40 PLN/ DDD to 283.13 PLN/ DDD and in case of macrolides: from 12.05 PLN/ DDD to 90.77 PLN/ DDD. This differentiation of the cost of purchasing a single defined daily dose, taking into account the specific groups of antibiotics, did not have the characteristics of statistical significance. CONCLUSIONS: As expected, the antibiotic regimens in the studied wards were similar. This is due to a homogeneous population of hospitalized patients. However, the differences of costs of purchase of antibiotics observed in the study, indicate the considerable variety of the treatment patterns in Polish neonatology units and the need to develop and implement recommendations of effective pharmacotherapy for patients in intensive neonatal care units and the implementation of a unified model of infections surveillance.

Two factors of the lectin pathway of complement, l-ficolin and mannan-binding lectin, and their associations with prematurity, low birthweight and infections in a large cohort of Polish neonates.

Ficolins and one collectin, mannan-binding lectin (MBL), are the only factors known to activate the lectin pathway (LP) of complement. There is considerable circumstantial evidence that MBL insufficiency can increase susceptibility to various infections and influence the course of several non-infectious diseases complicated by infections. Much less information is available concerning l-ficolin. We report the results of a prospective study to investigate any association between either MBL deficiency or l-ficolin deficiency with prematurity, low birthweight or perinatal infections in a large cohort of Polish neonates, representing an ethnically homogenous population (n=1832). Cord blood samples were analysed to determine mbl-2 gene variants, MBL concentrations and MBL-MASP-2 complex activities (MBL-dependent lectin pathway activity) as well as l-ficolin levels. Median concentrations of l-ficolin and MBL were 2500 and 1124 ng/ml, respectively, while median LP activity was 272 mU/ml. After genotyping, 60.6% of babies were mbl-2 A/A, 35.4% were A/O and 4% were O/O genotypes. We found relative l-ficolin deficiency to be associated with prematurity, low birthweight and infections. l-Ficolin concentration correlated with gestational age and with birthweight, independently of gestational age. Preterm deliveries (<38 weeks) occurred more frequently among neonates with low LP activity but not with those having low serum MBL levels. Similarly, no association of serum MBL deficiency with low birthweight was found, but there was a correlation between LP activity and birthweight. Genotypes conferring very low serum MBL concentrations were associated with perinatal infections, and high-MBL-conferring genotypes were associated with prematurity. Our findings suggest that l-ficolin participates in host defence during the perinatal period and constitute the first evidence that relative l-ficolin deficiency may contribute to the adverse consequences of prematurity. Some similar trends were found with facets of MBL deficiency, but the observed relationships were weaker and less consistent.

[Prophylaxis of vitamin D deficiency--Polish recommendation 2009]. / Stanowisko Zespolu Ekspertów. Polskie zalecenia dotyczace profilaktyki niedoborów witaminy D - 2009.

Adequate vitamin D intake and its status are important not only for bone health and Ca-P metabolism, but for optimal function of many organs and tissues throughout the body. Due to documented changes in dietary habits and physical activity level, both observed in growing children and adults, the prevalence of vitamin D insufficiency is continuously increasing. Basing on current literature review and opinions of National Consultants and experts in the field, polish recommendations for prophylactic vitamin D supplementation in infants, toddlers, children and adolescents as well as in adults, including pregnant and lactating women have been established.

[Prophylaxis of vitamin D deficiency--Polish recommendations 2009]. / Polskie zalecenia dotyczace profilaktyki niedoborów witaminy D--2009.

Appropriate state procurement system for vitamin D is important not only for the proper functioning of the skeletal, maintaining calcium and phosphorus homeostasis, but also for a number of other organs and tissues in our body. In connection with the change in lifestyle including dietary habits change, the widespread use of UV filters and less outdoor activity, observed an increase in the percentage of vitamin D deficiency, both in population and developmental age and adults. Based on the results of recent scientific research team of experts provides recommendations for preventive Polish supply of vitamin D in infants, children, adolescents and adults, including pregnant women and nursing mothers.

Mannan-binding lectin genotypes and genotype-phenotype relationships in a large cohort of Polish neonates.

Circulating mannan (or mannose)-binding lectin (MBL) is genetically determined. Low MBL concentrations are associated with certain point mutations in the human MBL2 gene. Here we report the full MBL2 genotypes of 1800 Polish neonates and relate individual genotypes to serum MBL and MBL-dependent activity of the lectin pathway of complement activation. The seven acknowledged common haplotypes were found, plus the uncommon LYPD haplotype, combining to form 33 genotypes in this population. As expected, a strong correlation existed between genotypes and serum MBL or lectin pathway activity, and the latter two entities correlated strongly with each other. However, serum MBL values varied up to greater than 90-fold within genotypes. Unexpectedly, higher lectin pathway activity was found in association with the P allele relative to the Q allele. These data from a large cohort of neonates, representing an ethnically homogenous population, suggest that the current knowledge of the genetics of MBL2 is inadequate to predict serum MBL concentration and MBL-dependent lectin pathway activity in individual subjects.

Long-term effects of diabetes during pregnancy on the offspring.

BACKGROUND: Many epidemiological and experimental studies have proven that some adult diseases might have their origin in fetal life. It has been also hypothesized that intra-uterine environment in pregnancy complicated with diabetes might influence the development of obesity, type 2 diabetes, and cardiovascular diseases in the offspring. OBJECTIVES: To assess glucose metabolism, insulin secretion, and prevalence of obesity in the offspring of mothers with pregestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM) and to evaluate the relationship between maternal metabolic control during pregnancy and metabolic disturbances in children. SUBJECTS: Children of mothers with PGDM (n = 43) and GDM (n = 34) were examined at 4-9 yr of age and compared with the control group (n = 108; metabolic parameters available for n = 29). METHODS: The incidence of overweight and obesity, impaired glucose tolerance, and insulin resistance were analyzed based on anthropometric and biochemical measurements. Statistical analysis was performed with statistica package. RESULTS: In children of GDM mothers, body mass index z-score (0.81 +/- 1.01 vs. -0.04 +/- 1.42 PGDM vs. 0.07 +/- 1.28 control group) and insulin resistance indices (homeostasis model assessment index - insulin resistance 1.112 vs. 0.943 PGDM vs. 0.749 control group) were significantly higher than in other groups. Obesity and insulin resistance were also most frequent in GDM group [not significant (NS)]. In addition, we observed the relationship between maternal hemoglobin A1c and mean glycemia in perinatal period and insulin resistance in children. There was not such correlation for the class of maternal diabetes. CONCLUSION: Children born to mothers with gestational diabetes seem to be at risk for obesity and metabolic disturbances.

[Do abnormal results of Doppler examinations in fetuses with growth restriction increase the frequency of postnatal complications of the central nervous system and gastrointestinal tract?]. / Czy nieprawidlowe wyniki badania dopplerowskiego u plodów z wewnatrzmacicznym ograniczeniem wzrastania zwiekszaja czestosc powiklan pourodzeniowych ze strony osrodkowego ukladu nerwowego i przewodu pokarmowego?

OBJECTIVES: The aim of the work was to assess the correlations between the results of antenatal Doppler examinations in fetuses with growth restriction (IUGR) and the frequency of postnatal complications of central nervous system and gastrointestinal tract. MATERIAL AND METHODS: 47 pregnant women and 47 fetuses and newborns from singleton pregnancies with diagnosed intrauterine growth restriction. Two groups of fetuses (newborns) were distinguished based on serial Doppler examinations of fetal umbilical and middle cerebral arteries: 1) newborns with IUGR and abnormal results of antenatal Doppler examinations (group 1); 2) newborns with IUGR and normal results of antenatal Doppler examinations (group 2). The analysis concerned such neonatal complications as intraventricular hemorrhages (IVH) of III and IV degree, leucomalacias and necrotizing eneterocollits (NEC). RESULTS: Among 47 neonates, the abnormal results of Doppler examinations were found in 21 of them, and in the rest of the newborns (26) there were no abnormalities in Doppler antenatal examinations. The frequency of intraventricular hemorrhages of III and IV degree, neonatal leucomalacias and necrotizing eneterocollits did not differ significantly between the groups. The mean time of hospitalization in newborns with abnormal results of antenatal Doppler examinations was significantly longer than in neonates whose antenatal Doppler tests were normal (14 days vs 10 days). The newborns from group 1 required parenteral feeding significantly more often than the newborns from group 2 (28.9% vs 12%). CONCLUSIONS: The comparable frequency of central nervous system complications in newborns with abnormal and in neonates with normal results of antenatal Doppler examinations may indicate on effective role of brain sparing effect in fetuses with IUGR as a mechanism which reduces the likelihood of hypoxemic complications in the developing fetal brain. The newborns with IUGR and abnormal results of antenatal Doppler test require both a longer hospitalization and the necessity of parenteral feeding when compared with newborns with IUGR and normal antenatal Doppler test results. Newborns who were diagnosed with absent or reversed end-diastolic flow in umbilical artery are particularly at risk of central nervous system complications.

Effects of oral probiotic supplementation on gut Lactobacillus and Bifidobacterium populations and the clinical status of low-birth-weight preterm neonates: a multicenter randomized, double-blind, placebo-controlled trial.

AIM: Probiotic bacteria administered directly after birth to preterm neonates may improve gastrointestinal function and may reduce the incidence of late-onset sepsis, which is a frequent complication in this group. PURPOSE: The main objective of this study was to evaluate whether a new probiotic bacterial mixture of Lactobacillus rhamnosus KL53A and Bifidobacterium breve PB04 given to preterm, low-birth-weight neonates would influence composition of their gut microbiota and sepsis rates. PATIENTS AND METHODS: This study was a multicenter, randomized, double-blind, placebo-controlled trial conducted in clinical centers of neonatal care in Poland. A probiotic or placebo preparation was given twice daily to 181 preterm low-birth-weight neonates who were eligible for enteral feeding between July 2012 and July 2013. The probiotic was given to 90 neonates, while placebo was given to 91 neonates. The gut microbiota was monitored by microbiological analysis of stool samples. Sepsis episodes were detected on the basis of clinical and laboratory findings and confirmed by blood cultures. RESULTS: Tested probiotic administration resulted in continuous increase of the Lactobacillus and Bifidobacterium counts in the gut microbiota. The applied tested strains successfully colonized the neonates gut since they were present in over 90% of stool samples, which was confirmed by molecular analysis. Regardless of the study group (probiotic or placebo), B. breve colonization correlated with lower staphylococcal sepsis incidence, which was irrespective of whether probiotics were given. No sepsis case caused by strains included in study probiotic was recorded. CONCLUSION: Appropriately selected and characterized probiotic bacteria may be safely given to preterm neonates to normalize their distorted gut microbiota and may contribute to lower staphylococcal sepsis rates.

Introduction of Infant Flow nasal continuous airway pressure as the standard of practice in Poland: the initial 2-year experience.

OBJECTIVE: The aim of this prospective study was to evaluate whether a change in the standard of newborn care for respiratory insufficiency by widely introducing more aggressive use of nasal continuous airway pressure (nCPAP) and including Infant Flow technology would result in satisfactory outcomes. DESIGN: Prospectively defined analysis. SETTING: Fifty-seven secondary and tertiary care neonatal centers in Poland. PATIENTS: Patients were 1,299 newborns. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We carried out a prospectively defined analysis of 1,299 newborns included in the program between August 1, 2003, and April 30, 2005. The inclusion criterion was the occurrence of symptoms of respiratory failure irrespective of its etiology. Respiratory support was provided with the use of the Infant Flow Advance Driver. The analysis was made on data from prospectively designed questionnaires completed following each infant's treatment. Infants were placed into categories based on clinical indication for use. The primary end point was avoiding tracheal intubation. A high rate of acceptance of the new practice was observed across the substantial demographic and clinical diversity of newborns. Tracheal intubation was avoided in 78% of infants treated electively with nCPAP. Of those being weaned from mechanical ventilation, 61.2% were successfully weaned. Related complications were low (1.4% pneumothorax, 12% nasal injuries). CONCLUSIONS: The new method of nCPAP with Infant Flow was adopted as standard practice in Poland. We monitored its safety and effectiveness over a 2-yr period and found it to be safe and effective as implemented. Additional research is still needed to determine the optimum patient population, strategy for use, and devices.

[Management of neonatal sepsis and septic shock]. / Postepowanie w posocznicy i wstrzasie septycznym u noworodków.

The paper presents contemporary definitions and guidelines for management of severe sepsis and septic shock in neonates. We discuss main directions of hemodynamic resuscitation, antibacterial and supportive treatment. Pathophysiological differences of septic shock in this group of patients were described.

Components of the lectin pathway of complement activation in paediatric patients of intensive care units.

Infections are a major cause of childhood mortality. We investigated components of the lectin pathway of complement activation in the context of sepsis at both genetic and protein levels in neonates, infants and older children. Major components of the lectin pathway and two genes for Toll-like receptors were studied in 87 neonates with confirmed sepsis and compared with 40 babies with infections who did not develop sepsis (disease controls) and 273 infection-free neonatal controls. A second cohort comprised 47 older children with sepsis and 87 controls. Low MBL-conferring genotypes (LXA/O+O/O) were more frequent in sepsis patients than in healthy controls but no significant differences in the frequency of SNPs of other lectin pathway genes (FCN1, FCN2, FCN3, MASP1/3, MASP2) or TLR receptor genes (TLR2, TLR4) were found. One case of primary MASP-2 deficiency was found among healthy pre-terms and one neonate suffering from SIRS was heterozygous for the rare FCN1 gene mutation, +6658 G>A. Generally, sepsis was associated with low serum MBL and low ficolin-2 concentrations on admission. Among neonates, ficolin-1 and MASP-2 levels were elevated in sepsis relative to healthy, but not disease, controls. Unlike neonates, ficolin-3 and MASP-2 levels were lower in older patients than in healthy controls while no difference was found for ficolin-1. With the possible exception of MBL, inherited lectin pathway insufficiencies do not seem to predispose to sepsis, rather changes in protein concentrations reflect alterations in disease course.

The results of newborn hearing screening by means of transient evoked otoacoustic emissions.

OBJECTIVE: The incidence of sensorineural hearing loss is between 1 and 3 per 1000 in healthy neonates and 2-4 per 100 in high-risk children. Transient evoked otoacoustic emissions (TEOAEs) represent a method which can be applied to all newborns prior to hospital discharge, enabling early identification of hearing loss. The aim of the study was to evaluate the results of newborn hearing screening by means of TEOAEs. METHODS: Between 01.10.2002 and 30.09.2003, 5601 newborns born in the University Hospital in Poznan, Poland were screened with ERO SCAN (MAICO). Healthy neonates were screened in the second or third day of life and children treated in pathology unit--when their general condition was stable. The risk factors of hearing loss were recorded in a questionnaire. Children who failed the screening test or had risk factors of hearing impairment were referred to the outpatient clinic for further evaluation. RESULTS: Risk factors were identified in 739 newborns. The most often risk factors were: use of ototoxic drugs, low Apgar score and prematurity. Positive test result was obtained in 219 (3.91%) children unilaterally and in 137 (2.45%) bilaterally. In healthy children the prevalence of positive results was 3.56% and in high-risk infants 24.9%. The relative risk of positive test results was the highest in infants with positive family history (RR=7.5), congenital malformations (RR=6.7) and low Apgar score (RR=5). Of the group of 912 children, who were referred to the specialist, only 218 turned up to be assessed during the observation period and had the additional otoacoustic emission test performed. There was not any significant difference in the percentage of children with and without risk factors who turned up for the second test and in whom the result was positive (39.7% versus 40.3%). In 41.9% children with risk factors whose screening test was negative, the second exam gave positive result. CONCLUSIONS: The incidence of positive results in newborn hearing screening is much higher than the prevalence of hearing loss in general population and these results need verification by more precise methods. However, TEOAEs enable to select children who should be referred for audiological evaluation.

Extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a neonatal unit: control of an outbreak using a new ADSRRS technique.

Extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae (EPKP) strains are frequently implicated in outbreaks in neonatal units. From April 2002 to January 2003, 149 neonates were colonized/infected with EPKP in the Neonatal Clinic of the Teaching Hospital at the Medical University of Gdansk, Poland. A novel assay based on suppression of PCR, ADSRRS-fingerprinting, was successfully evaluated for typing EPKP isolates. The results showed that the genotypes of all outbreak-related strains were identical, which suggested that the outbreak originated from a single clone. This conclusion was confirmed by using different methods--RAPD and PFGE. The outbreak was stopped by adopting improved hygiene and instituting outbreak control measures.

[The significance of -174G/C polymorphism of the gene coding for interleukin-6 in neonatal infections]. / Znaczenie polimorfizmu -174G/C promotora genu interleukiny-6 w zakazeniach u noworodków.

OBJECTIVE: Interleukin-6 (IL-6) is a specific marker of early onset infections in the newborns. In recent years it has been suggested that in regulations of IL-6 activity could play a role the genetic polymorphism (-174G/C) in the promoter region of the gene coding for IL-6. The aim of our study was to analyse the frequency of -174G/C polymorphism of interleukin-6 gene as a genomic marker for individuals at an increased risk of early onset neonatal infection as result of intra-amniotic infection (IAI). MATERIAL AND METHOD: A prospective study was conducted in 62 newborns treated in University Hospital tertiary neonatal intensive care unit. Intrauterine infection was diagnosed in 21 children and 41 neonates comprised control group. In the both groups we have analysed -174G/C polymorphism in the gene coding IL-6 using PCR/RFLP (polymerase chain reaction/restriction fragment length polymorphism) assays. RESULTS: We have observed the overrepresentation of homozygous genotypes -174C/C in the investigated group (9.5% vs. 7.3% in the controls). The frequency of heterozygous genotypes -174G/C was higher in investigated group 61.9% than in controls 56.1%. Homozygous wild type genotypes for -174G/G were detected in 28.6% and 36.6% in investigated group and controls, respectively. These proportions were consistent with the Hardy-Weinberg equilibrium. Analysing allelic frequency we have noticed overrepresentation of -174C alleles in the investigated group (40.5% vs. 35.4% in the controls, O.R. = 1.24, n.s.). CONCLUSION: The presence of the C allele in the -174 position in the gene coding for IL-6 could play a role in the pathology of neonatal infection following IAI in the mother and probably is connected with decreased of immunological reaction.

[Cord blood leptin concentration and somatic parameters of smoking mother's newborns]. / Palenie papierosów w ciazy a poziom leptyny w krwi pepowinowej i parametry somatyczne noworodków.

Leptin is a peptide synthesised in white fat tissue adipocytes. It plays a key role in appetite regulation and body mass development. The leptin's concentration is correlated with body fat magazines. This hormone has also anorectic and sympatheticomimetic function. Leptin's concentration measured early after birth is strictly connected with birth-weight. Smoking during pregnancy leads to decrease of plasma leptin concentration in newborn. The aim of the study was estimation of the leptin level in umbilical cord blood of children born from smoking and no-smoking women. Some other somatic parameters were also analysed. A cohort of 210 women and their children born in the Institute of Obstetrics and Gynaecology Medical University of Gdansk was examined. The estimation of frequency of smoking during pregnancy was analysed by questionnaire done in this group. Samples of the umbilical cord blood were collected after birth and leptin concentration was analysed by standard RIA method. Significantly lower leptin concentration in smoking mothers' newborns was stated. Children born from smoking mothers had significantly lower birth weight and length. The frequency of smoking during pregnancy in analysed region is lower in compare to previous years.

[Reliability of polymorphonuclear elastase for the diagnosis of neonatal sepsis]. / Elastaza granulocytarna jako wczesny wskaznik posocznicy u noworodków.

UNLABELLED: Infections are a major problem in neonatal intensive care units throughout the world, and early diagnosis and therapy would certainly reduce associated morbidity and mortality as well as decrease unnecessary antibiotic treatment. OBJECTIVES: To evaluate the usefulness of polymorphonuclear elastase (PMN-E) serum concentration as an early indicator of neonatal sepsis in comparison with routinely used infection markers. METHODS: PMN-E was measured in 74 newborns with suspicion of systemic bacterial infection treated in a tertiary intensive care unit. The measurements were performed with commercially available enzyme immunoassay (Milenia). RESULTS: Mean PMN-E value in non-infected newborns was 38.85 ng/ml, and for infected 184.12 ng/ml (p < 0.05) (t-student test). The sensitivity to the diagnosis of culture--proven bacterial systemic infection was 76% for PMN-E, 60% for C-reactive protein, 59% for the immature to total neutrophil ratio and 56% for the total white blood cell count. The corresponding specificity amounted to 81%, 86%, 100% and 80% respectively. CONCLUSION: Serum PMN-E level determination yields diagnostic advantages in comparison with infection markers routinely used in sepsis screen and may serve as a valuable early indicator of neonatal systemic bacterial infection.

[Smoking mothers and symmetry of growth in newborns born in 2000 in the Pomeranian region]. / Palenie papierosów w ciazy, a symetria wzrastania noworodków urodzonych w regionie pomorskim w 2000 roku.

In many publications concerning norms of weight in adults and child population the appropriate body weight is defined in connection to its stature. PI initiated in 1970 by Miller seems to be of a great value. Relative risk of morbidity and mortality in full term newborns with low value of nutrition index increases from 1.9 to 4.2 times. The aim of this paper was evaluation of symmetry of intrauterine development based on PI calculation. The particular remarks was paid to newborns from mothers smoking during the time of pregnancy. 10770 children born in 2000 in 8 hospitals of Pomeranian Region and 2119 newborns from 1990 born in Institute of Obstetrics and Gynecology Medical University of Gdansk were analyzed. The estimation of frequency of smoking during pregnancy was randomized on questionnaire done in the group of 2627 mothers from 1990, 1999, 2002, 2004. The mean value of PI in the group of full term newborns from 19990, was 2.19 +/- 0.27. In 2000 this value was 2.05 +/- 0.25 and was significantly lower than previous. Newborns from smoking mothers had significantly lower PI than those from women who did not smoke during pregnancy. Estimating harmonious of intrauterine growth in the group of newborns from smoking mothers I stated the greater lack of body mass than its length, so it is more asymmetric. It is similar to pathology which act on fetus in the 3rd trimester of the pregnancy. Now the newborns are slimmer as mean PI shows. I notice a disproportionate intrauterine growth in the cohort of newborns from smoking mothers. In this group the estimation of PI is advisable.