[Interleukin-6 and tumor necrosis factor-alpha as markers of vertically-transmitted neonatal bacterial infection]. / Interleucina-6 y factor de necrosis tumoral-alpha como marcadores de infección neonatal de transmisión vertical.

INTRODUCTION: Neonatal infection is a major cause of morbidity in the neonatal period. Several parameters have been used to assess neonatal sepsis. C-reactive protein (CRP) shows high specificity for bacterial infections, but an increase in CRP is often not detected until 12 to 24 hours after onset of the infection. OBJECTIVE: To evaluate the usefulness of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) in the early diagnosis of vertically-transmitted neonatal bacterial infection. METHODS: Thirty-four newborns admitted to the neonatal intensive care unit with an initial diagnosis of respiratory distress were included. Twelve newborns presented the criteria for clinical sepsis or pneumonia (group I) and six had positive blood culture. The remaining patients did not present the clinical criteria for infection (group II). IL-6, TNF-alpha, CRP levels and the ratio between immature and mature neutrophil count were assessed at 8.8 +/- 7.3 hours of life. In 17 patients the same parameters were assessed at 67.4 +/- 24.8 hours of life. The statistical analysis was performed using the Mann-Whitney test. The sensitivity and specificity of these markers were assessed. RESULTS: No differences were found in the perinatal features of either group. Analysis of markers of infection revealed the following significant differences: ratio between immature and mature neutrophil count: (0.25 +/- 0.21 vs 0.12 +/- 0.09; p=0.048), CRP first determination (1.4 +/- 0.8 mg/dL vs 1 +/- 0.5 mg/dL; p=0.036), CRP second determination: (3.8 +/- 1.8 mg/dL vs 1.4 +/- 1.1 mg/dL; p=0.008), IL-6 first determination: (582.2 +/- 810.5 pg/mL vs 31.3 +/- 24.2 pg/mL; p=0.000). Sensitivity/specificity (%): ratio between immature and mature neutrophil count: 41.6/83.6; CRP first determination: 16.6/90.9; CRP second determination: 83.3/87.5; IL-6 (optimum cut-off value: 55 pg/mL): 100/72.7, and TNF-alpha: 16.6/85. CONCLUSIONS: IL-6 determination in the first hours of life is a more sensitive early marker of neonatal infection than other classical markers because of its early elevation. Like CRP, early TNF-alpha determination has high specificity but low sensitivity.

[Inhaled nitric oxide in the treatment of persistent pulmonary hypertension in a newborn]. / Oxido nítrico inhalado en el tratamiento de la hipertensión pulmonar persistente del RN.

OBJECTIVE: Our aim was to assess from a clinical and analytical point of view the response to inhaled nitric oxide in patients with persistent pulmonary hypertension of the newborn (PPHN). PATIENTS AND METHODS: A retrospective study was analyzed in ten patients with PPHN who received inhaled nitric oxide. The ventilatory and gasometric data were reviewed before treatment, during the first hours and afterwards, in all patients, in the surviving group and in the most common associated disease group (intrauterine pneumonia). The parameters analyzed to assess the response to NO treatment were the oxygenation index (IO) and the PaO2 increase. Statistical analysis was performed by using a comparison of means. RESULTS: The mean oxygenation index before starting the treatment with inhaled NO was 39 +/- 7.3 in the total group and 38.4 +/- 8.8 in the surviving patients. At 2.9 +/- 1.1 hours after treatment a mild improvement was observed in the total group and it was more evident in the surviving group (32.4 +/- 15.2 and 26.4 +/- 7.8, respectively; p < 0.05). After treatment was discontinued, the IO was 24.7 +/- 21.9 (p < 0.05) and 12.8 +/- 7.5 (p < 0.001). The PaO2 increment in both groups was 51.2 +/- 55.5% and 66.8% +/- 28.1%. The patients with intrauterine pneumonia showed the highest PaO2 increase after treatment was discontinued (78.3% +/- 41.9%). CONCLUSIONS: Early treatment with inhaled NO in term newborns with PPHN produced a sustained improvement in oxygenation. This treatment might reduce the number of patients who need extracorporal membrane oxygenation.

[Isolated congenital aplasia of the anterior hypophysis and neonatal hypoglycemia. Report of a case with review of the literature]. / Aplasia congénita aislada de la hipófisis anterior e hipoglucemia neonatal. Comunicación de un caso con revisión de la literatura.

We describe a female newborn infant who became severely hypoglycaemic (0.73 mg %), cyanosed and collapsed at five hours of age. After this episode she developed new hypoglycaemia and convulsions and did not tolerate short fasting periods. Physical examination revealed macrocephalia (PC 36 cm), prominent frontal bone and flat face. Hormonal tests showed normal insulines, a relative secondary hypothyroidism and GH, ACTH and cortisol deficiencies (GH, 0.15 and 11 ng/ml; cortisol, 3.5 and 2 mg %). The baby died at the age of 3 months after pulmonary aspiration. The findings at necropsy showed a normally developed brain and flat sella turcica with fragments of neurohypophysis without evidence of adenohypophysis and adrenals and thyroid markedly hypoplastic. Diagnosis of this entity as well as cases reported in pediatric literature are reviewed.