Serum and urinary NGAL in septic newborns.

Neutrophil gelatinase-associated lipocalin (NGAL) is postulated to be a potentially new and highly specific/sensitive marker of acute kidney injury (AKI). The aim of this study was to assess the impact of inflammation on serum and urine NGAL in newborns that were treated due to infection. We determined serum and urine NGAL concentrations in 73 infants (51 with sepsis; 22 with severe sepsis) admitted to the Intensive Care Unit in the first month of life, for three consecutive days during the course of treatment for infection. 29 neonates without infection served as the control group. Septic patients, in particular, severe sepsis patients, had increased serum and urinary NGAL levels in the three subsequent days of observation. Five septic patients who developed AKI had elevated serum and urinary NGAL values to a similar extent as septic neonates without AKI. A strong correlation was found between the concentration of serum and urinary NGAL and inflammatory markers, such as CRP and procalcitonin. Serum and urinary NGAL levels were also significantly associated with NTISS (neonatal therapeutic intervention scoring system) values. We conclude that increased serum and urinary NGAL values are not solely a marker of AKI, and more accurately reflect the severity of inflammatory status.

Is serum cystatin C a better marker of kidney function than serum creatinine in septic newborns?

INTRODUCTION: Several studies have claimed that the estimation of serum cystatin C could be a better marker of kidney excretory function than serum creatinine. However, its role in the diagnosis of reduced kidney function was not unquestionably confirmed. The aim of this study was to analyze the concentrations of serum cystatin C in neonates with sepsis. MATERIAL/METHODS: Thirty-two neonates (gestational age from 34 to 40 weeks) admitted to the NICU during the first 14 days of life were enrolled. Serum cystatin C concentrations were estimated by ELISA during three successive days in neonates treated for infection. The study group consisted of 9 newborns with sepsis, 14 with severe sepsis and 9 with septic shock. RESULTS/DISCUSSION: At the beginning of the observational period the mean serum concentration of cystatin C in the study group was 1.35 mg/L (95% CI 1.20-1.49). Surprisingly, the lowest concentration of cystatin was observed in patients with septic shock (1.23 mg/L; 95%CI 0.92-1.54) within the observation period. Higher concentrations were found in neonates with sepsis (1.47 mg/L; 95%CI 1.04-1.90) and severe sepsis (1.50; 1.12-1.87). There was no correlation between serum cystatin C concentration and serum creatinine or gestational age. A significant correlation was discovered between chronological age and cystatin C (R=-0.439, p=0.01). There was a tendency for cystatin C to decline during the second observational day in patients with sepsis (to 1.53 mg/L; 95%CI: 1.19-1.86) and severe sepsis (to 1.32 mg/L; 95%CI: 1.07-1.57), while a slight insignificant increase in patient with septic shock (to 1.28 mg/L; 95%CI: 0.88-1.68) was revealed. The interrelation between age and cystatin C concentration disappeared in the following days of stay in the NICU. Even in patients who died in the course of septic shock the observed changes in cystatin C levels were small and did not exceed those of serum creatinine. CONCLUSIONS: Cystatin C is not a useful marker of kidney function in neonates with sepsis.

Beyond purely ethical understanding of responsibility: a phenomenological approach.

BACKGROUND: The assumption that moral responsibility is a constitutive feature of the human person could almost be considered as the raison d'être of ethics and consequently of bioethics. In fact, the concept of"common morality", which is becoming ever more popular within the mainstream of bioethics, assumes that certain, even if elementary, experience of moral responsibility (and understanding of it) is shared by all the people of every cultural (moral) tradition. Although the phenomenon of (moral) responsibility is seen as a moral question, its ultimate explanation needs reflection which goes beyond purely ethical considerations. MATERIAL AND METHODS: The phenomenological ontology as elaborated by R. Ingarden is accepted as the theoretical background of deliberations in this study. Methods of reasoning appropriate to this approach to phenomenology are used. RESULTS AND DISCUSSION: The phenomenon of human responsibility is analyzed--according to Ingarden's suggestion--from the point of view of the four "situations" in which responsibility appears: (I) to be responsible for something, (II) to accept responsibility for something, (III) to be called to responsibility for something, and (IV) to be acting responsibly. The ontological foundation of responsibility in each of these situations is then inquired. Ingarden's philosophical reflection leads to discovery of the ultimate ontological foundation of responsibility in: (I) objective axiology, (II) structure of an acting subject, and (III) a causality structure of reality. We discuss whether Ingarden's analyses are coherent with the concept of "common morality". CONCLUSION: Although R. Ingarden is best known, especially to English-speaking readers, for his work in aesthetics, it should be emphasized that his phenomenological ontology can provide interesting insights into the understanding of the concept of responsibility which is fundamental to ethics/bioethics.

[Physicians' attitudes toward pain in newborn infants. Preliminary results of a cross-sectional national survey]. / Postawy lekarza wobec bólu noworodków. Wstepne wyniki ogólnopolskiego badania sondazowego.

BACKGROUND: Since 1980s, the problem of pain experienced by newborns has met with increasing interest both in research work and in clinical practice. It is worth noting that significant progress in neurophysiologic basis of pain and in diagnostic and therapeutic methods have occurred during that time. AIM: This study primarily aims at describing opinions of the doctors who work in the neonatal wards and neonatal intensive care units in Poland regarding the management of pain in newborns. MATERIAL AND METHODS: The respondents of this survey were heads (or persons appointed by them) of 302 neonatal and paediatric intensive care hospital wards, in Poland. The questionnaire prepared for this purpose was used. RESULTS: The respondents demonstrated that essentially they possessed correct knowledge regarding the neurophysiology of pain, the diagnostic and therapeutic methods used in the management of pain in the newborns. The majority of respondents claimed that adequate pain management was used in their daily practice. They felt responsible for the parents' health education concerning the problem of pain in newborns. On the other hand, they complain about the lack of adequate training courses for physicians regarding this subject matter. CONCLUSIONS: It is recommended to organize specialized courses for doctors regarding pain in the newborn, and, in particular, regarding the principles of using opioids in the pain management of newborns.