Serum 5'-nucleotidase and alkaline phosphatase activities after high dose chemotherapy and bone marrow transplantation in cases of malignancy in children.

After bone marrow transplantation in children, it is essential to detect secondary liver diseases and hepatotoxic effects of immunosuppressive therapy. These can be revealed by cytolytic syndromes sometimes associated with cholestasis. It is therefore important to find an early and specific cholestasis enzymatic marker. A retrospective study of the changes in levels of biological parameters has been carried out in 13 children who underwent one or more bone marrow transplantations. During the 3 months following bone marrow transplantation, all patients developed liver injury characterized by an early and very elevated 5'-nucleotidase activity (sometimes more than 40 times the upper reference limit), a moderate increase in alkaline phosphatase activity, a variable increase in alanine aminotransferase activity and inconstant changes in total bilirubin levels. These results show that cytolytic syndrome and cholestasis are often associated with increases in 5'-nucleotidase and alkaline phosphatase activities. These increases are not correlated, probably due to the influence of therapy on the synthesis and release of both enzymes in the liver. 5'-nucleotidase seems to be the best marker for the detection and follow-up of liver disease in this patient group.

Neonatal hypercalcemia in preterm infants fed with human milk.

Hypercalcemia (serum Ca greater than or equal to 2.83 mmol/l) was detected in 10 premature infants (gestational age: 31-37 weeks and birthweight: 1100-1950 g). All were fed with pooled human breast milk. Urinary Ca excretion was high (greater than 0.200 mmol/kg/24 h) in all but one infant while serum phosphorus (P) concentration and urinary P excretion were low. Serum immunoreactive parathyroid hormone and plasma 25-hydroxyvitamin-D concentrations were normal. A significant positive correlation was found between serum Ca concentration and urinary Ca excretion, and a negative correlation between serum Ca concentration and serum P concentration or urinary P excretion. Hypercalcemia disappeared spontaneously in two patients, was corrected by a humanized milk in three patients and by P supplementation in five patients. These data suggest that neonatal hypercalcemia is related to P depletion induced by human breast milk in premature infants.

[Humoral factors of immunity in maternal milk. Comparison of their levels in the breast milk of mothers with premature and at-term delivery]. / Les facteurs humoraux de l'immunité du lait maternel. Comparaison de leur concentration dans le lait de mère accouchant prématurément ou à terme.

Eight proteins (Immunoglobulin A, G, M, C3 and C4 fractions of complement, alpha 1-glycoprotein, lactoferrin and alpha 1- antitrypsin) were measured by immuno-diffusion or laser nephelometry in 50 milk samples. Thirty nine were heated thrice at 62 degrees C for 20 minutes. Twenty six came from mothers who delivered prematurely (less than 37 weeks) and 13 from mothers who delivered at term. Eleven samples were, used to determine the effect of the heating process. There was no significative difference of the concentrations of the eight proteins between the breast milk obtained at term or prematurely, even when the comparisons were made between colostral milks or transitional milks. The heating process reduced the concentration by 47 % for IgA, more than 88 % for IgG and IgM, 41 to 74 % for the other proteins; only orosomucoid seemed little affected (-16 %). These data suggest that the heating process impairs the immunologic effect of breast milk. This effect must be particularly considered in regard to the absence of any significant difference between the milks obtained at term or prematurely.

Late evolution of serum immunoreactive parathyroid hormones, calcitonin and plasma 25-hydroxy cholecalciferol concentrations in very low birthweight infants.

The plasma concentrations of 25-hydroxycholecalciferol (25-OH-CC), immunoreactive parathyroid hormone (iPTH) and calcitonin (iCT) were measured at the age of 30 and 66 days in thirteen preterm neonates (birthweight: 970 to 1300 g). At the age of 30 days when all infants were fed only with breast milk (BM) serum iCT and iPTH levels were normal. During the second month 7 infants were fed with BM only (control group) and 6 infants were supplemented with formula (supplemented group). At the age of 66 days, mean +/- S.D. serum iPTH concentration was higher in the supplemented group than in the control group: 169 +/- 79 vs. 60 +/- 33 microliterEq/ml (p less than 0.01). Serum iCT levels remained undetectable (less than 150 pg/ml) in both groups. Plasma 25-OH-CC concentrations were normal and similar in both groups. Serum iPTH concentrations were positively correlated with phosphorus intake and negatively correlated with calcium intake from BM only. The results suggest that secondary hyperparathyroidism can be detected in very low birthweight infants supplemented with a formula, probably because of a phosphorus load or decreased intestinal absorption of calcium.