RESUMO
Introduction: Mortality due to sepsis is still prevalent, peaking at extreme ages of life including infancy. Despite many efforts, the peculiarity of the infant immune system has limited further advances in its treatment. Indeed, neonates experience a dramatic physiological transition from immune tolerance to the maternal antigens to functional maturity. Such a transition is extremely dynamic, as is the pathophysiology of infant sepsis, which is dependent on many infant, maternal, and environmental factors.Areas covered: In this review, the authors critically update and summarize the current paradigm of immunomodulation in infant sepsis. They confirm how exogenous stimulation of the immune system through intravenous immunoglobulin, colony stimulating factors, and granulocyte transfusion have failed to impact on the prognosis of infant sepsis. They also strongly support the beneficial effects of supplementation/replacement therapies with products naturally contained within maternal milk as well as antioxidant compounds.Expert opinion: Breastfeeding is beneficial against sepsis. Knowledge of the neonatal immune system is indeed too limited to effectively strengthen immune response by exogenous interventions, especially in preterm and low-birth-weight infants. Awareness of this limitation should pave the way for future studies (e.g. gender- and omics-based) aimed at better characterizing the infant immune system and promoting a more tailored approach.
Assuntos
Doenças do Prematuro/tratamento farmacológico , Sepse Neonatal/tratamento farmacológico , Imunidade Adaptativa/efeitos dos fármacos , Antioxidantes/uso terapêutico , Aleitamento Materno , Humanos , Imunidade Inata/efeitos dos fármacos , Imunoglobulinas/uso terapêutico , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/imunologia , Leite Humano/imunologia , Sepse Neonatal/imunologia , Caracteres Sexuais , Resultado do TratamentoRESUMO
Human milk and breastfeeding represent the nutritional normative standards for term and preterm newborns. With the term "surgical infants" we refer to all newborns who undergo surgery during the first days of life and who are assisted in the neonatal intensive care unit during the postoperative period and then in the neonatal surgery unit. There are many obstacles to breastfeeding these newborns. The "barriers" include the unstable clinical conditions before and after surgery, the period of separation between the mother and child, and often the lack of attention to breastfeeding. Few studies have assessed if newborns with surgical diseases are breastfeed and if human milk is beneficial for their outcome. We believe that the best option is to offer them their own mother's milk through the promotion and support of breastfeeding. A specific program focused on the needs of these vulnerable children should be created. Furthermore the surgical and pediatric staff of the neonatal surgery unit should be informed and trained to increase such a program's feasibility.
Assuntos
Aleitamento Materno/métodos , Enterocolite Necrosante/prevenção & controle , Doenças do Prematuro/cirurgia , Terapia Intensiva Neonatal , Leite Humano , Extração de Leite , Colostro/imunologia , Enterocolite Necrosante/dietoterapia , Feminino , Promoção da Saúde , Humanos , Lactente , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/imunologia , Método Canguru , Masculino , Leite Humano/imunologia , Educação de Pacientes como Assunto , Gravidez , Procedimentos Cirúrgicos Operatórios , Fatores de Tempo , Resultado do Tratamento , CicatrizaçãoRESUMO
Early breast milk, known as colostrum ("liquid gold") provides immune benefits to infants, offering potential risk reduction for nosocomial infection (NI) and necrotizing enterocolitis (NEC), a serious gastrointestinal emergency. Provision of colostrum is recognized as oral immune therapy (OIT) and is valuable to all NICU infants unable to feed orally. A quality improvement project was initiated by the multidisciplinary NICU Quality Care Council at London Health Sciences Centres-Victoria (LHSC-VH) to obtain mothers' colostrum for early OIT. The initiative was driven by the Canadian EPIQ (Evidence-based Practice for Improving Quality) group as a means of reducing the rates of NEC and NI, two major morbidities in the NICU. The overall aim was to facilitate the availability of OIT to preterm and critically ill neonates as soon as possible after birth.
Assuntos
Colostro/imunologia , Infecção Hospitalar/imunologia , Infecção Hospitalar/enfermagem , Enterocolite Necrosante/imunologia , Enterocolite Necrosante/enfermagem , Imunoterapia/enfermagem , Doenças do Prematuro/imunologia , Doenças do Prematuro/enfermagem , Enfermagem Neonatal , Melhoria de Qualidade/organização & administração , Administração Oral , Comportamento Cooperativo , Estado Terminal , Infecção Hospitalar/prevenção & controle , Enterocolite Necrosante/prevenção & controle , Prática Clínica Baseada em Evidências , Feminino , Fidelidade a Diretrizes , Humanos , Recém-Nascido , Doenças do Prematuro/prevenção & controle , Mães/educação , Gravidez , Relações Profissional-FamíliaRESUMO
OBJECTIVES: The aim of this study was to investigate the effects of massage therapy (MT) on the immune system of preterm infants. The primary hypothesis was that MT compared with sham therapy (control) will enhance the immune system of stable premature infants by increasing the proportion of their natural killer (NK) cell numbers. METHODS: A randomized placebo-controlled trial of MT versus sham therapy (control) was conducted among stable premature infants in the NICU. Study intervention was provided 5 days per week until hospital discharge for a maximum of 4 weeks. Immunologic evaluations (absolute NK cells, T and B cells, T cell subsets, and NK cytotoxicity), weight, number of infections, and length of hospital stay were also evaluated. RESULTS: The study enrolled 120 infants (58 massage; 62 control). At the end of the study, absolute NK cells were not different between the 2 groups; however, NK cytotoxicity was higher in the massage group, particularly among those who received ≥5 consecutive days of study intervention compared with control (13.79 vs 10 lytic units, respectively; P = .04). Infants in the massage group were heavier at end of study and had greater daily weight gain compared with those in the control group; other immunologic parameters, number of infections, and length of stay were not different between the 2 groups. CONCLUSIONS: In this study, MT administered to stable preterm infants was associated with higher NK cytotoxicity and more daily weight gain. MT may improve the overall outcome of these infants. Larger studies are needed.
Assuntos
Imunocompetência/imunologia , Doenças do Prematuro/imunologia , Doenças do Prematuro/terapia , Células Matadoras Naturais/imunologia , Contagem de Linfócitos , Massagem , Linfócitos B/imunologia , Peso Corporal , Infecção Hospitalar/imunologia , Testes Imunológicos de Citotoxicidade , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Tempo de Internação , Subpopulações de Linfócitos/imunologia , Masculino , Michigan , Linfócitos T/imunologiaRESUMO
BACKGROUND: Better understanding of the clinical characteristics of ABO haemolytic disease in neonates helps optimise care. OBJECTIVE: To assess the morbidity associated with maternal-neonatal ABO incompatibility. METHODS: Neonates with blood groups A or B born to mothers with blood group O with simultaneous rhesus blood factor compatibility were studied prospectively. Maternal and neonatal details, direct Coomb's test (DCT) on the cord blood, onset and progression of jaundice, and requirement and duration of phototherapy were studied. Neonates requiring phototherapy were considered to have significant hyperbilirubinaemia, and peripheral smear, reticulocyte count and haematocrit values were obtained. ABO haemolytic disease of the newborn (ABO HDN) is defined as a newborn with a positive DCT and/or laboratory evidence of haemolysis such as reticulocytosis and spherocytes on blood smear. RESULTS: Of 878 deliveries, 151 (17.3%) neonates were ABO incompatible with their mothers. The proportions who were O-A and O-B incompatible were 50.4% and 49.6%, respectively. Forty-six (30.4%) had significant hyperbilirubinaemia (119.7-256.5 mmol/L) and required phototherapy, 26 (34.2%) of them in the O-A group and 20 (26.6%) in the O-B group. None required exchange transfusion. Jaundice was detected within the first 24 hours in 47.8%. Of 46 newborns who required phototherapy, 25 (54.3%) had laboratory evidence of haemolysis. DCT was positive in 1.9% of ABO-incompatible newborns. There was no significant difference in the incidence and severity of haemolysis between the O-A and O-B-incompatible neonates. Neonates with haemolysis required phototherapy significantly earlier and for longer than neonates without haemolysis (P<0.001). CONCLUSIONS: ABO incompatibility was observed in 17.3% of pregnancies with almost equal O-A and O-B frequency. About a third of infants had significant hyperbilirubinaemia. There was no difference in severity between those with O-A and O-B HDN.
Assuntos
Sistema ABO de Grupos Sanguíneos/imunologia , Incompatibilidade de Grupos Sanguíneos/complicações , Hiperbilirrubinemia Neonatal/complicações , Doenças do Prematuro/imunologia , Doenças do Prematuro/terapia , Icterícia Neonatal/complicações , Teste de Coombs , Feminino , Humanos , Hiperbilirrubinemia Neonatal/terapia , Incidência , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Icterícia Neonatal/terapia , Masculino , Morbidade , FototerapiaRESUMO
Despite the use of modern broad spectrum antibiotics nosocomial infections are an unsolved problem, especially in the field of neonatal intensive care (preterm babies and newborns). In patients with septic shock human monoclonal antibodies in combination with appropriate antibiotics have proven effective and compatible for children older than one year. So far, there have been no reports in the literature on the application of such kind of antiendotoxin immunotherapy for pre-term babies and newborns. We describe the effectiveness of monoclonal antibodies in two newborns. Already 12 respectively 16 hours after application of the human monoclonal IgM antibodies (Centoxin) and appropriate antibiotics, the clinical condition of our patients stabilized. Consecutively further clinical symptoms improved rapidly.