INFLAMMATORY RESPONSE STATUS IN INFANTS WITH INTRAUTERINE INFECTION FROM MOTHERS WITH IDENTIFIED TORCH INFECTION.

OBJECTIVE: The aim: To investigate the status and possibilities of markers of the inflammatory response of organism in infants with identified IUI born to mothers diagnosed with TORCH infection. PATIENTS AND METHODS: Materials and methods: The study group included: infants diagnosed with IUI (n = 40), born to mothers (age 31.31 ± 2.08 years) with the diagnosis of TORCH infection and a control group (n = 25 infants). Childbirth in all newborns was physiological. The average weight of newborns was 1877.69 ± 981.78 g (min - 600 g; max - 4000 g). Gestational age: 32.25 ± 5.15 weeks. Observation and treatment of newborns lasted up to 7 days (included stay in the emergency department of the Uzhhorod maternity hospital in the Zakarpattia region). Cytokine profile, γ-IFN, TNF-α, Pg E2, serum neopterin and procalcitonin levels were studied. RESULTS: Results: The values of the parameters of the cytokine profile (IL-1, IL-6, IL-8, IL-10) varied within the reference values, but with significant differences with the values of the control group, which was 1,2; 4; 10; 6 times, respectively. The levels of inflammatory mediators (γ-IFN Procalcitonin Neopterin TNF-α Pg E2) differed significantly from the data of the control group of infants and exceeded the upper limit of the reference values by 1,3; 3; 25; 4 times, respectively. According to the correlation analysis, there are positive correlations of medium level: IL 1 and procalcitonin (r = 0.33); IL 6 and IL10 (r = 0.44); IL 10 and prostaglandin E2 (r = 0.44); neopterin and prostaglandin E2 (r = 0.39), which indicates synergism in the performance of biologically active processes. Negative correlations of moderate degree were observed between the following parameters: IL 1 and gestational age of infants (r = -0.36); IL 6 and IL 8 (r = -0.34); γ-IFN and TNF-α (r = -0.43), which indicates the diversity of interactions between participants in the inflammatory response of the organism. CONCLUSION: Conclusions: Various infectious agents can act as «primary affect¼ of sepsis as a complex pathological process involving the organism, and each of the infections has its own characteristics of the pathological process, therefore curent changes in infectious circumstances make new demands on research. It has been proven that intrauterine infection has a negative effect on the homeostatic parameters of infants, in particular, on the indicators of the inflammatory response of the child's organism. Symptomatic inflammatory biomarkers can be used to identify the pathological condition of the infant, in addition to routine laboratory tests, for early correction of VUI. This delay in identifying affected infants can lead to long and unnecessary therapy, the emergence of resistant strains of microorganisms, increased treatment costs and, in particular, a higher risk of complications such as cerebral palsy or intraventricular hemorrhage.

Congenital infections in Hong Kong: beyond TORCH.

Congenital infections refer to a group of perinatal infections that are caused by pathogens transmitted from mother to child during pregnancy (transplacentally) or delivery (peripartum) which may have similar clinical presentations, including rash and ocular findings. TORCH is the acronym that covers these infections (toxoplasmosis, other [syphilis], rubella, cytomegalovirus, herpes simplex virus). Other important causes of intrauterine/perinatal infection include human immunodeficiency virus, varicella-zoster virus, Treponema pallidum, Zika virus, and parvovirus B19. This overview aims to describe various congenital infections beyond TORCH with a Hong Kong perspective. Intrauterine and perinatal infections are a major cause of in utero death and neonatal mortality, and an important contributor to childhood morbidity. A high index of suspicion for congenital infections and awareness of the prominent features of the most common congenital infections can help to facilitate early diagnosis, tailor appropriate diagnostic evaluation, and initiate appropriate early treatment. Intrauterine infections should be suspected in newborns with clinical features including microcephaly, seizures, cataract, hearing loss, congenital heart disease, hepatosplenomegaly, small for gestational age, and/or rash. Primary prevention of maternal infections during pregnancy is key to the prevention of congenital infection, and resources (if available) should focus on public health promotion and pre-marital counselling.

[Serological diagnosis of congenital infections and algorithms to improve diagnostic efficacy]. / Diagnóstico serológico de las infecciones congénitas y algoritmos para mejorar la eficacia diagnóstica.

Congenital infection is those transmitted by the mother to the fetus before delivery. It can occur transplacentally or by direct contact with the pathogen during birth or in the immediate postnatal period. Congenital infection can be due to viruses (rubella, cytomegalovirus, herpes simplex, varicella-zoster, hepatitis B and C virus, human inunodeficiencia, erythrovirus B19) as bacteria (Treponema pallidum) and parasites (Toxoplasma gondii and Trypanosoma cruzi). Serological diagnosis of congenital infection is based on both the knowledge of infectious serology in the mother, including the systematic serological screening and diagnostic aspects of the determination of IgM and confirmatory methods, IgG avidity tests, establishment of antibody profiles, and in the diagnosis the neonate. Serological diagnosis of congenital infection in the newborn is mainly based on the detection of specific IgM usually by immunoenzymatic assays or immunochemiluminescence techniques. In some instances it is important to perform the serological follow up of the newborn to confirm the congenital infection.

[Diagnosis of congenital infection]. / Diagnóstico de infección congénita.

In general, congenital diagnosis is based on: a) maternal serologic assays; b) microbiologic study of amniotic fluid or fetal blood sampling; and c) serology in children and microorganism detection by polymerase chain reaction (PCR) or culture. Congenital infections due to cytomegalovirus, herpes simplex, varicella, B19 erythrovirus and toxoplasmosis are usually the result of primary infection in the mother. Therefore, when IgG antibodies are detected before pregnancy, these infections are ruled out. Definitive serologic diagnosis of acute infection in pregnant women requires the demonstration of seroconversion (i.e., from seronegative to seropositive). In these cases, amniotic fluid or fetal blood sampling should be performed to determine the presence of intrauterine congenital infection. Cytomegalovirus, rubella and toxoplasmosis can be diagnosed by detection of specific IgM antibodies in fetal blood. However, PCR in amniotic fluid has replaced conventional prenatal diagnostic techniques, including fetal blood sampling, in the diagnosis of these infections. In the newborn, these infections may be confirmed by measuring IgM specific antibodies. B19 erythrovirus can be detected by PCR in amniotic fluid or fetal blood. Congenital varicella-zoster infection may be diagnosed on the basis of persistence of IgG antibodies after birth. Definitive diagnosis of herpes simplex virus infection requires viral isolation. Swabs or scraping from clinical specimens can be inoculated into susceptible cell lines for isolation.

Nonimmune hydrops fetalis part II: does etiology influence mortality?

Hydrops fetalis is a condition in which there is an excess of total body fluid, primarily within the fetal interstitial spaces. Etymologically, hydrops fetalis is a Latin term meaning "edema of the fetus." In addition to generalized edema, the fetus has at least one of the following: ascites, pericardial effusion, pleural effusion(s), and an abnormally thick (>6 cm) placenta. Hydrops is classified as nonimmune hydrops fetalis (NIHF) when it occurs without evidence of isoimmunization.

Role of Regulatory T Cells in Infection and Vaccination During Early Infancy.

Reducing infant mortality due to infectious diseases is one of the most important public health goals worldwide. Several approaches have been implemented to reach this goal and vaccination has been an effective strategy for reducing infant and newborn mortality. However, the immunological features of neonates and infants represent a significant barrier to the effectiveness of vaccination. Since regulatory T cells (Treg cells) are known to play an active role in contributing to various mechanisms of suppression of the immune cell function. It has been proposed that these immune cells could decrease the immunogenicity of vaccines administered in newborns and infants. In this article, we discuss the various types of Treg cells, along with their suppressing and inhibitory mechanisms, which are used by these cells in the context of infectious and immunization processes in newborns and infants.

The effectiveness of e-learning in pediatric medical student education.

BACKGROUND: Electronic learning allows individualized education and may improve student performance. This study assessed the impact of e-modules about infection control and congenital infections on medical knowledge. METHODS: A descriptive study was conducted involving third-year medical students on pediatric clerkship. e-Module content in three different formats was developed: a text monograph, a PowerPoint presentation, and a narrated PowerPoint lecture. Students' use of the e-modules was tracked, as was participation in the infectious disease rotation and the order of pediatric rotation. Pre- and posttests specific to the e-module content and National Board of Medical Examiners (NBME) pediatric exam scores were recorded. RESULTS: Among 67 participants, 63% of them visited at least one e-module. Neither accessing any e-modules, timing of pediatric clerkship, nor assignment to ID rotation resulted in improved posttest nor NBME scores. Seventy percent of students rated the e-modules as satisfactory and reported usage improved their confidence with the congenital infections topic. DISCUSSION: e-Modules did not improve student performance on NBME or posttest; however, they were perceived as satisfactory and to have improved confidence among those who used them. This study underscores the importance of formally evaluating electronic and other innovative curricula when implemented within existing medical education frameworks.

Long-term neurodevelopmental outcome in high-risk newborns in resource-limited settings: a systematic review of the literature.

BACKGROUND: Improving outcomes beyond survival for high-risk newborns in resource-limited settings is an emerging challenge. Global estimates demonstrate the scale of this challenge and significant gaps in morbidity outcome data in high mortality contexts. A systematic review was conducted to document the prevalence of neurodevelopmental impairment in high-risk newborns who were followed up into childhood in low- and middle-income countries. METHODS: High-risk newborns were defined as low, very or extremely low birthweight, preterm infants or those surviving birth asphyxia or serious infections. Electronic databases were searched and articles screened for eligibility. Included articles were appraised according to STROBE criteria. Narrative review was performed and median prevalence of key neurodevelopmental outcomes was calculated where data quality allowed. RESULTS: 6959 articles were identified with sixty included in final review. At follow-up in early childhood, median estimated prevalence (inter-quartile range) of overall neurodevelopmental impairment, cognitive impairment and cerebral palsy were: for survivors of prematurity/very low birthweight 21.4% (11.6-30.8), 16.3% (6.3-29.6) and 11.2% (5.9-16.1), respectively, and for survivors of birth asphyxia 34.6% (25.4-51.5), 11.3% (7.7-11.8) and 22.8% (15.7-31.4), respectively. Only three studies reporting outcomes following newborn serious bacterial infections were identified. There was limited reporting of important outcomes such as vision and hearing impairment. Major challenges with standardised reporting of key exposure and developmental outcome variables and lack of control data were identified. CONCLUSION: Understanding the limitations of the available data on neurodevelopmental outcome in newborns in resource-limited settings provides clear direction for research and efforts to improve long-term outcome in high-risk newborns in these settings.

Analysis of spiral ganglion cell populations in children with normal and pathological ears.

This study analyzed features of total and segmental spiral ganglion cell populations in children with normal ears and those with various pathological conditions. Sixty-three human temporal bone specimens, obtained from 43 children 4 days to 9 years of age, were studied histopathologically. These specimens were divided into 5 diagnostic groups: group 1, normal ears (13 ears); group 2, congenital infectious diseases (13 ears); group 3, chromosomal aberrations (11 ears); group 4, multiple craniofacial anomalies with hereditary or genetic causes (21 ears); and group 5, perinatal and postnatal asphyxia (5 ears). Eighteen of the 63 ears had documented profound deafness. In either normal ears (group 1) or those with various pathological conditions (groups 2 through 5), the total number of ganglion cells did not change as a function of age during the first 10 years. The total number of ganglion cells was significantly larger in group 1 (33,702) than in each of groups 2, 3, 4, and 5 (p < .01), and the number was significantly larger in group 2 than in each of groups 4 and 5 (p < .01 and p < .05, respectively). The ratio of basal to apical ganglion cell populations remained constant in both normal and pathological ears. Each ratio of the number of basal and apical ganglion cells in groups 2, 3, 4, and 5 to the mean number in group 1 (basal and apical survival ratios) was at least approximately 40%. There was no statistical difference between these two ratios in groups 2, 3, 4, and 5. The mean (+/-SD) total number of ganglion cells in ears with documented profound deafness was 15,417 +/- 5,944, which is approximately 40% of those present in normal ears. Our results suggest that normally, cochlear neurons are completely present at birth and minimally regress during the first decade of life. In addition, although intergroup differences among various pathological groups were present, the majority of pathological ears had more than 10,000 spiral ganglion cells present. Cochlear implantation has gradually been recognized as an effective and reliable tool for rehabilitation of children who have profound deafness, even congenitally or prelingually deafened children. On the basis of the results obtained in this study, we discuss the implications for cochlear implantation in children.

[The prevention of congenital damage: the infectious aspects]. / La prevenzione del danno connatale: aspetti infettivologici.

During the intrauterine life or at birth, the product of conception is exposed to a lot of different and mostly still unknown risk factors among which the infective agents take on great importance owing to the proportion of the problem and to the fact that most of them can be avoided. Depending on the cases, for the baby welfare, measures of primary or secondary prevention are enforced; they are mainly based on serologic tests to the mother. After recalling the frequency and the effects of connatal injury of each infective pathology, the Authors examine the ways of infection of the coming or newborn baby according to the period of growth subsequently, the ways of avoiding the infection and the preventive treatments available or under study are examined.

[Pathogenic basis of intrauterine infections]. / Patogeneticheskie osnovy vnutriutrobnykh infektsii.

The literature and the authors' own results on pathogenesis of intrauterine infections are reviewed. Special attention is paid to the mechanisms of contamination, disease stages and cellular-humoral responses of the fetus. Implications of the above factors in the formation of multiple clinicomorphological manifestations of the intrauterine infections are pointed out.

[The role of mass morphological study of placenta for prognosis of infectious processes in newborns]. / Rol' massovykh morfologicheskikh issledovanii posledov dlia prognozirovaniia proiavlenii infektsionnykh protsessov u novorozhdennykh.

The results of the long-term morphological study of a great number of placentas in the cities of St. Petersburg and Novgorod have been summarized. These results show frequent occurrence of infection of various etiology. The efficiency of revealing the risk groups among newborns is documented by a considerable decrease of infant mortality in Novgorod (from 20.6 in 1986 to 11.9 in 1996). The same phenomenon is demonstrated in St. Petersburg where a decrease in the incidence of intrauterine infections was noted at the autopsy material. A detailed study of catamnesis of children infected in utero showed an increase of minor neurological symptoms and higher incidence of acute respiratory viral infections.

Overview of congenital infections: the prominence of cytomegalovirus.

Congenital infections are those that are acquired transplacentally by the fetus from an infected mother. They constitute a major public health burden, affecting millions of infants and children worldwide. Despite significant advances in medical diagnostics, the majority of newborns with congenital infections are not recognized, since many of these infections may not cause clinically - apparent disease in the newborn period. Nonetheless, these infections - whether they are apparent or silent - have the potential to adversely impact the neurodevelopmental outcomes of these vulnerable children.

Evaluation of the Role of FMLF chemotaxic peptide receptors in umbilical cord blood granulocytes from newborns at risk of infectious inflammatory diseases.

We studied the role of receptors with high and low affinity for fMLF chemotaxic peptide in the generation of active oxygen species by umbilical cord blood granulocytes from newborns with normal neonatal period, born after normal or complicated gestation, in children with manifestations of bacterial infection born after complicated pregnancy, and in granulocytes of non-pregnant women with normal reproductive function. Granulocytes of children born after complicated pregnancy exhibited high reactivity in induction of respiratory burst in a wide range of fMLF concentrations. The presentation of receptors with high and low affinity on granulocytes during initiation of the respiratory burst differs in children born after complicated pregnancy and in healthy babies born after normal gestation. Presumably, the detected differences result from high expression of receptors with low affinity for fMLF and disorders or immaturity of mechanisms responsible for receptor inactivation.