Can ficolin-2 (L-ficolin) insufficiency be established by a single serum protein measurement?

Serum ficolin-2 was measured in multiple (2-27) samples from 68 paediatric sepsis patients. Fourteen individuals (21%) gave values that included a change in status from 'normal' to 'insufficient' or vice versa. Therefore, if possible, ficolin-2 concentration should be determined in samples obtained when a disease is inactive.

Impact of the shift to neonatal noninvasive ventilation in Poland: a population study.

OBJECTIVE: This study was undertaken to document the real impact of a directed shift in the standard of neonatal practice to a pervasive use of noninvasive respiratory support. DESIGN: Before-after observational study. SETTING: All 18 neonatal ICUs in the capital region of Poland. PATIENTS: Every infant admitted to a neonatal ICU who received respiratory pressure support over a 7-year period of interest (12-month transition to the new noninvasive standard and 36 months before and after). INTERVENTION: Education as to the benefits of noninvasive respiratory support and widespread availability of Infant Flow noninvasive ventilation systems. MEASUREMENTS AND MAIN RESULTS: Five thousand five hundred fifty-one infants required respiratory support in this period. Of these, 14% were less than 28 weeks estimated gestational age, 33% between 28 and 32 weeks, 31% between 33 and 36 weeks, and 22% more than 36 weeks. The use of noninvasive support, as the first form of respiratory support, increased by 19% (p < 0.001). The use of noninvasive support, for weaning following extubation, increased by 32% (p = 0.06). The increased use in weaning was the most pronounced in infants younger than or equal to 32 weeks estimated gestational age (p < 0.001). There were two prospective primary endpoints, mortality and bad outcome among survivors younger than or equal to 32 weeks estimated gestational age. Mortality decreased from 11% to 7%, and the difference remained statistically significant after controlling for baseline factors (p < 0.001). The reduced mortality was more apparent in infants younger than or equal to 32 weeks estimated gestational age. In infants younger than or equal to 32 weeks estimated gestational age, bad outcome in survivors (grade III bronchopulmonary dyplasia and retinopathy of prematurity requiring laser treatment) did not increase (p = 0.669) after controlling for significant baseline variables. CONCLUSIONS: We believe that the adoption of an approach emphasizing noninvasive ventilation in Poland resulted in decreased mortality without an increase in significant pulmonary or retinal morbidity.

Factors affecting outcomes in very low birth weight infants treated electively with nasal continuous positive airway pressure.

OBJECTIVE: Although interest in nasal continuous positive airway pressure (nCPAP) to avoid intubation is increasing, there is limited data regarding patient selection and outcome. We sought to determine the baseline parameters associated with failure. STUDY DESIGN: In all, 938 cases of elective nCPAP use were extracted from our registry. Two primary end points, Treatment Failure (need for intubation) and Bad Outcome (death, need for respiratory support at 40 weeks post conceptual age, grade 4 intraventricular hemorrhage or periventricular leucomalacia), and 12 potentially predictive baseline parameters were prospectively defined and evaluated using logistic regression. RESULT: Intubation occurred in 31%, and Bad Outcome occurred in 11%. Besides estimated gestational age (EGA), only a few variables were significant predictors in the multivariate models: Intubation (PaO(2)/FiO(2)<150 or pH< 7.25) and Bad Outcome (FiO(2), low weight for EGA). The relative risk doubled between infants of 34 and 26 weeks EGA and increased by about 50% for those meeting the other criteria. CONCLUSION: We hope these findings will help those using elective nCPAP to refine their practice and those considering its use in establishing reasonable guidelines, as well as be useful for designing clinical research.

Bathing and cleansing in newborns from day 1 to first year of life: recommendations from a European round table meeting.

BACKGROUND: Development of the skin barrier continues up to 12 months after birth; therefore, care must be taken when cleansing and bathing infants' skin. Available guidelines for skin care in newborns are, however, limited. In 2007, the 1st European Round Table meeting on 'Best Practice for Infant Cleansing' was held, at which a panel of expert dermatologists and paediatricians from across Europe aimed to provide a consensus on infant bathing and cleansing. OUTCOMES: Based on discussions at the meeting and a comprehensive literature review, the panel developed a series of recommendations relating to several aspects of infant skin care, including initial and routine bathing, safety while bathing, and post-bathing procedures. The panel also focused on the use of liquid cleansers in bathing, particularly relating to the benefits of liquid cleansers over water alone, and the criteria that should be used when choosing an appropriate liquid cleanser for infants. Alkaline soaps have numerous disadvantages compared with liquid cleansers, with effects on skin pH and lipid content, as well as causing skin drying and irritation. Liquid cleansers used in newborns should have documented evidence of their mildness on skin and eyes, and those containing an emollient may have further benefits. Finally, the panel discussed seasonal differences in skin care, and issues relating to infants at high risk of atopic dermatitis. The panel further discussed the need of clinical studies to investigate the impact of liquid cleansers on skin physiology parameters on newborns' and infants' skin. CONCLUSIONS: Bathing is generally superior to washing, provided basic safety procedures are followed, and has psychological benefits for the infant and parents. When bathing infants with a liquid cleanser, a mild one not altering the normal pH of the skin surface or causing irritation to skin or eyes should be chosen.

Threshold values of maternal blood glucose in early diabetic pregnancy--prediction of fetal malformations.

BACKGROUND: The prevention of congenital malformations in the newborns of diabetic mothers still constitutes one of the main problems in this group of patients. AIM: The aim of this study was to analyze the prevalence of fetal malformations in diabetic pregnancies, as well as detection of the cut-off points for the first-trimester glycemia levels, relating to diabetes-induced fetal malformations. METHODS: The data for analysis were collected retrospectively from the case histories of diabetic pregnant women and their newborns, treated in our departments. For the evaluation of maternal diabetes control, the whole-day glycemia profiles as well as glycated hemoglobin (HbA1C) levels were registered. To establish the glucose cut-off values for malformations, we have used receiver operating characteristic (ROC) curves for fasting, 1-hr, and 2-hr postprandial glucose levels. To determine how metabolic control influences the risk of giving birth to a malformed infant, we followed 198 newborns of diabetic mothers and 4700 infants born of healthy mothers (control group). RESULTS: We detected malformations in the infants of 8.6% (n = 17) of diabetic mothers and 3.8% of the control (odds ratio: 2.35, 95% CI = 1.40-3.96). We compared this group of diabetic patients to another diabetic pregnancy group, analyzed over a period of 1988-93 (n = 209), in which 13 newborns (6.2%) manifested congenital malformations (odds ratio: 1.41, 95% CI = 0.67-2.99) (the difference was statistically insignificant). HbA1C level during organogenesis was not significantly higher in women whose infants were malformed. We proved, however, that the risk of malformations was higher, when HbA1C value exceeded 9.3%. The malformation rate in diabetes classes D-H (according to White) was higher than in classes B and C, but the difference was not significant. A wide spectrum of anomalies has been observed in the newborns of diabetic mothers. CONCLUSIONS: Our results confirm the view that diabetic pregnancy, despite the improved metabolic control, is still a strong risk factor for alterations in fetal development, particularly in patients with a tendency to brittle glycemia during first trimester of pregnancy. It seems that keeping fasting glucose levels in first trimester below 5.8 mmol/l and postprandial glucose levels below 9.1 mmol/l can contribute to decreasing number of fetal malformations in pregestational diabetes mellitus (PGDM) pregnancy. The ROC curves appear to be useful and adequate tool for the analysis of factors influencing fetal development in diabetic pregnancy.

Prevalence of congenital Toxoplasma gondii infection among newborns from the Poznan region of Poland: validation of a new combined enzyme immunoassay for Toxoplasma gondii-specific immunoglobulin A and immunoglobulin M antibodies.

We determined the value of a new serological assay detecting Toxoplasma-specific immunoglobulin M (IgM) and IgA antibodies at birth for use in mass neonatal screening. The incidence of congenital infection in newborns was compared with data from an epidemiological investigation on the seroprevalence of Toxoplasma in the studied population. Peripheral blood was collected on Guthrie cards during the first 3 days of life and tested for anti-Toxoplasma IgA and IgM using a noncommercial immunocapture enzyme-linked immunosorbent assay (ELISA). When the screening assay was positive, serum samples from the child and the mother were collected for use in Western blotting comparative immunological profile analysis and traditional serological tests for determination of specific IgG, IgM, and IgA antibodies. From December 1998 to April 2000, 17,653 filter paper samples from live-born neonates were successively screened. Congenital T. gondii infection was finally confirmed in 19 newborns. In traditional assays, 13 of 19 infants were IgM and IgA positive using filter paper eluates at birth, 1 child was positive only for IgM, 1 patient was positive for IgM and borderline for IgA, 1 had an equivocal level of IgA, and 3 cases were confirmed only by the Western blot assay. The prevalence of Toxoplasma-specific IgA and/or IgM in filter paper samples at birth was 1 per 929 live-born neonates (1.08/1,000) or about 1 per 523 children (1.9/1,000) born to nonimmune women with a potential risk of primary T. gondii infection during pregnancy, compared to the actual seropositivity rate of 43.7%. The diagnostic sensitivity of the combined IgA-IgM ELISA using neonatal filter paper specimens was not more than 95%, the positive predictive value of the test was 82.6%, and the diagnostic specificity was calculated to be 99.9%. The combined IgA-IgM ELISA is a valuable method for the diagnosis of congenital toxoplasmosis at birth and fulfills criteria for neonatal screening programs. The method showed a good diagnostic sensitivity in neonates untreated prenatally who were born in an area of high seroprevalence of T. gondii infection.

[Evaluation of the postnatal treatment efficacy in congenital toxoplasmosis identified by the newborn screening programme]. / Ocena skutecznosci leczenia toksoplazmozy wrodzonej rozpoznanej na podstawie wielkopolskiego programu badan przesiewowych noworodków.

The effectiveness of neonatal screening for anti-Toxoplasma IgM or IgA and IgM specific antibodies followed by an intensive anti-parasitic therapy for a prevention of clinical and immunological reactivations of congenital infection was studied. Thirty-five congenitally infected infants were included into clinical and serological follow-up. The children were mostly asymptomatic at birth or they expressed some non-specific reversible clinical abnormalities in neonatal period. Clinically overt toxoplasmosis occurred in 10 patients, including one infant with a severe form; 2 children had co-existing CMV infections. During the follow-up period, no clinical relapses were reported. Asymptomatic immunological rebounds of IgG or of IgG and IgA specific antibodies were observed in 16 patients. Anti-parasitic treatment initiated soon after birth seems to be promising in a prevention of early clinical sequelae of congenital T. gondii infection.

[Central nervous system infections in neonates caused by multiresistant Klebsiella pneumoniae]. / Zakazenia osrodkowego ukladu nerwowego wywolane przez wielooporne szczepy Klebsiella pneumoniae u noworodków.

OBJECTIVE: To evaluate the incidence, clinical course and outcome of central nervous system (CNS) infections caused by multiresistant Klebsiella pneumoniae (MRKP) in critically ill neonates. METHODS: Retrospective study of neonates treated in Neonatal Department of Poznan University of Medical Science during a three years period from 1st January 1997 to 31st December 1999. Isolates were identified as Klebsiella pneumoniae with the ID32Gn test (bioMerieux), and antibiotic susceptibility was determined with ATBG test (bioMerieux) and with disc-diffusion technique. RESULTS: In this period there were 27 cases of CNS infections in our Department 17--65.4% of which (16 meningitis, one ventriculitis and one brain abscess), were caused by Klebsiella pneumoniae. 81.25% occurred in prematures (< 31 weeks of gestational age and < 1500 grams). In 10 (58.8%) cases CNSI developed in the course of sepsis. 9 children died. In all the isolates ESBL expression in vitro was detected. Only carbapenems and fluoroquinolones were active in all the cases. Ventriculitis was treated successfully with imipenem administered intraventrically and brain abscess surgically. CONCLUSIONS: CNS infections in neonates caused by MRKP are quite frequent, severe and possibly life threatening. Eradication of these strains from hospital environment by introducing adequate sanitary regime and reasonable antibiotic policies is the only method of conquering the infections.

Neonatal screening for congenital toxoplasmosis in the Poznan region of Poland by analysis of Toxoplasma gondii-specific IgM antibodies eluted from filter paper blood spots.

OBJECTIVES: The aims of the study were to determine the prevalence of congenital toxoplasmosis at birth in the Poznan region of Poland, the value of the serologic examination of filter paper blood specimens collected from newborns for the diagnosis of congenital Toxoplasma infection and the duration of anti-Toxoplasma-specific IgM antibodies in infants' sera. MATERIALS AND METHODS: All neonates born in the maternity wards of the University Hospital of Gynaecology and Obstetrics in Poznan and in 10 selected obstetrics wards in the district hospitals were included. Blood samples were collected on filter paper cards, between the first and sixth day of life, screened for anti-Toxoplasma-specific IgM antibodies by an immunocapture enzyme-linked immunosorbent assay and if positive further analyzed for specific IgG and IgA antibodies. RESULTS: Between June, 1996, and October, 1998, filter paper samples from 27,516 liveborn infants were tested, which constituted approximately 75% of all births and 83% of liveborn neonates from the Poznan region. Anti-T. gondii-specific IgM antibodies were found in 13 newborns, equivalent to a prevalence of Toxoplasma-specific IgM in newborns of 1 per 2,117 liveborn children (0.47 per 1,000) or 1 per 870 children (1.15 per 1,000) born to seronegative women at risk of primary T. gondii infection during pregnancy. We identified two congenitally infected infants who were IgM-negative at birth, had a classic triad of clinical symptoms during the first year of life and had high levels of specific IgG. The birth prevalence of congenital toxoplasmosis in the Poznan region was at least 1 per 1,834 live births (0.55 per 1,000) or 1 per 754 live neonates born to seronegative women (1.33 per 1,000). The sensitivity of the IgM assay on eluate from filter paper was not more than 86.7%, and the mean duration of IgM detectable by enzyme-linked immunosorbent assay in serum samples was the first 4.8 weeks of life. CONCLUSION: In Poland the screening for congenital toxoplasmosis detecting one case per each 2,000 live births could be considered for inclusion in existing national neonatal screening programs for phenylketonuria and congenital hypothyroidism.

[Congenital toxoplasmosis in the Poznan region]. / Toksoplazmoza wrodzona w województwie poznanskim.

Among 3,734 women, hospitalized for giving birth, 58.9% had a positive Toxoplasma serological test (DA). No clinical expression of congenital toxoplasmosis was observed in 4,311 newborns; seven had a false positive ISAGA test with cord blood. Only 24% of the women were aware of congenital toxoplasmosis and only 3% were serologically examined before. Health education should be intensified and serological tests more commonly performed especially in the risk groups.

[Incidence and antibiotic resistance of coagulase-negative staphylococci in a neonatal intensive are unit]. / Wystepowanie oraz antybiotykoopornosc gronkowców koagulazo-ujemnych w Oddziale Intensywnej Terapii Noworodka.

Coagulase-negative Staphylococci (CNST) are among the most common microorganisms found colonizing the skin and mucous membranes of neonates. They are also the most common cause of bacteremia in neonatal intensive care units. We analyzed the occurrence of CNST and antibiotic resistance of CNST strains. We have found 731 strains of CNST isolated from 428 intensive treated babies. Above 50% of CNST strains were resistant to: Erythromycin, Lincomycin, Tobramycin, Gentamycin, Kanamycin, Tetracyclines and Penicillins. We have observed the very high incidence of multiresistant strains. Majority of our strains were sensitive to vancomycin. However 8% of strains showed the resistance to vancomycin.

[Analysis of unsuccessful outcomes in a group of pregnancies with diabetes from the intensive care clinic of the Institute of Obstetrics and Gynecology in Poznan during the years 1988-1993]. / Analiza niepowodzen polozniczych w grupie ciezarnych z cukrzyca w KIN IGIP AM w Poznaniu w latach 1988-1993.

In the present paper we analysed 416 diabetic pregnant women, treated in the Intensive Care Clinic--Poznan, between 1988-93. We found in this period 8 (1.93%) stillbirth, 6 (1.44%) perinatal deaths and 4 (0.96%) deaths in neonatal period. It was together 18 fetal and neonatal deaths, which gives 4.33 per cent of perinatal and neonatal mortality rate. Four newborns died because of RDS, 2 with congenital anomalies (pulmonary hypoplasia), 3 with heart defects and 1 with oesophagus anomaly. Only 3 diabetic pregnant women of the total 18, were under special care from the I trimester, and almost all been difficult to normalize the glycemia. Only in 6 cases this group glycemia profile was below 100 mg/dl, in other 8 cases this value was above 120 mg/dl. Unsuccessful outcomes mostly occurred in women with long--lasting diabetes and with vascular complications. This study prove, that despite substantial reduction of perinatal mortality rate in children of diabetic mothers, diabetes still is a cause of congenital anomalies, as well as fetal anoxia. Special adverse impact of diabetes on the development of the fetus is observed in long--lasting diabetes and uncontrolled metabolism.

[Effect of intraventricular hemorrhage in newborns on levels of certain prostanoids in blood plasma]. / Wplyw krwawienia dokomorowego u wczesniaków na stezenie niektórych prostanoidów w osoczu krwi.

Recent studies suggest that eicosanoids might be involved in pathogenesis of vascular problems in preterm infants. The aim of the study was determine the concentrations most potent occurring vasoactive substances: Thromboxane A2 (TxA2) promoting vasoconstriction and prostacyclin (PGI2) causing vasodilation of vascular smooth muscles. We assessed the concentrations of stable metabolites TxA2-TxB2 and PGI2-6 keto PGF1 alpha in blood plasma by RIA method. It was found that neonates with RDS + IVH had significantly elevated TxB2 and 6 keto PGF1 alpha compared to healthy newborns, with transient tachypnoea and with RDS. High concentrations of thromboxane and prostacyclin metabolites in newborns plasma with IVH suggest a causative role of eicosanoids in pathogenesis of haemorrhage. The cells of impaired blood vessels may be probable source of these eicosanoids.