Delayed episode of necrotising enterocolitis in an ex-preterm infant after intravitreal administration of low-dose ranibizumab for the treatment of retinopathy of prematurity.

Retinopathy of prematurity (ROP) and necrotising enterocolitis (NEC) are complications of prematurity. Despite being quite different in terms of incidence, pathogenesis and consequences, both share a pathogenic role of aberrant vascularisation: increased in ROP, deficient for NEC. Current therapy for ROP includes the use of anti-vascular endothelial growth factor (anti-VEGF) agents, which are able to interrupt retinal hypervascularity. Despite being delivered intravitreously, anti-VEGF used in ROP can be absorbed into circulation and exert systemic effects. We present here a case of an ex-27 weeks gestational age infant, presenting multiple NEC risk factors, treated at 2 months of age with low-dose ranibizumab, who developed a large bowel NEC episode in the first week after treatment. We believe that this further report of an association between anti-VEGF agents and NEC could be interesting for the identification of children at risk of severe adverse events and stimulating further research on the topic.

[Ready-to-use parenteral nutrition in a preterm infant with necrotizing enterocolitis and related complications: case report]. / Nutrizione parenterale con sacche precostituite nel nato pretermine con enterocolite necrotizzante complicata: un caso clinico.

INTRODUCTION: Necrotizing enterocolitis (NEC) is a very aggressive, destructive and sometimes lethal disease, which mainly affects infants born with severe prematurity. These patients need a complex multidisciplinary approach. The clinical course is often long and complicated, and nutritional approach should ensure a balance between the need for nutrients and the risk of complications. CLINICAL CASE: We describe the case of a preterm female infant born at 24 weeks and 5 days of gestational age transferred to our intensive care unit for NEC complicated with intestinal perforation. Subsequently, she developed short bowel syndrome. In terms of nutrition, the baby was treated with the use of standard parenteral nutrition (PN) solutions for preterm infants, which were prescribed immediately after passing the critical and metabolically unstable phase of disease. It was possible to use these standard PN solutions also during a period of cholestasis and after the hospital discharge. CONCLUSIONS: The use of ready-to-use bags with standard solutions for PN in preterm infants complicated with surgical pathology is possible, feasible, safe and effective; it is recommendable to perform periodic clinical and laboratory evaluations.

Antibiotics for the newborn.

Because of the high susceptibility to infections, antibiotics are the most widely used drugs in newborns. The result of antibiotic use, however, may be strongly influenced by the peculiar physiology of the neonate, characterized by the delicate process of adaptation from intra- to extra-uterine life. Additional important factors that may affect antibiotic therapy are gestational age, birth weight, the intrauterine growth restriction, chronological age and, especially, the kidney and liver function immaturity. Dosing, timing and route of administration must, therefore, take in careful consideration the neonatal variability of bioavailability, distribution, metabolism, biotransformation, and excretion. The fine adjustment of dosing and duration of therapy should be based on pharmacokinetic and pharmacodynamic parameters. In spite of significant variations of sepsis etiology, the best initial empiric therapy of a suspected systemic infection still remains, as several years ago, the association of ampicillin and gentamicin. Other very effective and useful antibiotics, as cephalosporins, carbanepems or glycopeptides should be administered judiciously to infants, following the recommendations of a restricted use, to obtain maximal efficacy and minimal toxicity. Finally, because of their peculiar features, macrolide antibiotics have recently been proposed for different indications than the antibacterial activity. Use of oral erythromycin for the treatment of gastrointestinal dysmotility in preterm infants could reduce the incidence of parenteral nutrition-associated cholestasis by almost 50%, while azithromycin because of the combined antibiotic and anti-inflammatory effects, has been successfully used in a pilot study in the extremely low birth weight infant for the prevention of bronchopulmonary dysplasia.

Bioprocess applied to the treatment of residual waters of coffee wet processing for the incorporation of selected yeast strains / Desenvolvimento de bioprocesso aplicado ao tratamento de águas residuais do beneficiamento úmido do café pela incorporaçäo de linhagenm selecionada de leveduras

The aim of the present work was to isolated yeast strains able to degrade the degomming water originated from the wet processing of coffee, characterizing the formed metabolities, The drink prepared from the treated grains by wet processing is considered of better quality when compared with the grains treated by dry process. However, the great polluent potential of the residual water from this processing represents serious concern for the environment. The degumming water essentially presents organic contamination, with Oxygen Biochemical Demand (OBD) and Oxygen Chemical Demand (OCD) rates supeior to 20.000 mg O2/L. Candida tropicalis, C. lypolitica, C. guillermondii, C. parapsilopsis, Kloeckera apiculata e Rhodotorula rubra, isolated from coffee cheeries wew inoculated in flasks containing the degumming water and then submitted to constant agitation (120 rpm) for 48 hours at 28§C. The isolated species revealed capacity to degrade the substrate, however C. parapsilopsia showed reduction percentages of OBD and OCD rates of 50.14 ppor cento e 29.81 por cento, respectivelly, showing the viability of the use of those microorganisme as biological depollutants.