Association of low vitamin D level and full-term early-onset neonatal sepsis; a case-control study.

BACKGROUND: Sepsis is one of the main causes of death in newborns worldwide. Vitamin D levels during fetal and neonatal periods have a significant role in the development of the immunological system. The study aims to evaluate the association between vitamin D levels and the risk of early-onset neonatal sepsis in full-term neonates in a developing country. METHODS: This case-control study was conducted at the Neonatal Intensive Care Units (NICUs) of Kasr Alainy Hospital, Cairo, Egypt. The study was composed of two groups; the sepsis group involved full-term neonates appropriate for gestational age with sepsis-related clinical signs. The control group included newborns with no signs of clinical/laboratory infection within 72 h of life. Blood samples were collected on admission during the first three days of life in both groups for the measurement of 25-hydroxyvitamin D levels, Complete Blood Count (CBC), C reactive protein (CRP), and blood culture. RESULTS: Forty-five newborns with clinical and laboratory findings of early-onset neonatal sepsis within 72 h of life were enrolled, and the control group included forty-five newborns with no evidence of sepsis. Vitamin D levels in the sepsis group were significantly lower than in the control group. Apgar score at the first minute was significantly lower in the sepsis group. 57.8% of neonates with sepsis had positive blood cultures. There was a statistical difference between deficient, insufficient, and sufficient vitamin D levels regarding the duration of the NICU stay, which was longer in neonates with deficient vitamin D levels. CRP was significantly higher in neonates with deficient vitamin D levels. The area under the receiver operating characteristic curve for serum vitamin D in the prediction of neonatal sepsis was 0.76 at a cutoff < 19.7(ng/ml). CONCLUSION: In the current study, full-term newborns with EOS had considerably lower vitamin D levels than healthy controls. Through appropriate vitamin supplementation of the mothers during pregnancy, it could be possible to ensure adequate vitamin D levels for newborns. This may contribute to the reduction of the risk of EOS, together with the other well-known preventive measures (i.e. breastfeeding and intrapartum antibiotic prophylaxis).

Cannabinoid CB2 receptor gene (CNR2) polymorphism is associated with chronic childhood immune thrombocytopenia in Egypt.

Immune thrombocytopenia (ITP) is a heterogeneous autoimmune disorder characterized by thrombocytopenia with or without mucocutaneous bleeding manifestations. ITP patients have significant defects in immune self-tolerance: autoreactive T-lymphocyte clones are capable of directly damaging platelets and possibly megakaryocytes and are likely to proliferate under the influence of Th lymphocytes. The CB2 receptor is thought to be the principal cannabinoid receptor that mediates immune modulation by endocannabinoid. The later has shown a complex range of immunomodulatory effects, primarily suppressive effects on leukocytes and immune functions, including modulation of Th cell development, chemotaxis and cytokine secretion. In this study, we investigated the association between cannabinoid CB2 receptor gene (CNR2) Q63R polymorphism and the susceptibility to childhood ITP in Egyptian population. CNR2 genotyping in ITP patients revealed that 41% of patients had the QR(AA/GG) heterotype and 49% had the RR(AA/AA) homotype. There was a significantly higher frequency of homomutant genotype (RR) in ITP patients than in controls, which conferred more than two-fold increased risk of ITP among Egyptian children [odds ratio (OR) 2.352, 95% confidence interval (CI) 1.313-4.215]. There was a significant statistical difference in the distribution of CNR2 Q63R genotypes between chronic ITP patients group and the control groups. The homomutant genotype carried nearly three-fold increased risk for chronic ITP (OR 2.701, 95% CI 1.462-5.009). In conclusion, CNR2 Q63R polymorphism may represent a novel genetic risk factor in the pathophysiology of chronicity development of ITP in Egyptian children.

Echocardiogram done early in neonatal sepsis: what does it add?

BACKGROUND: One of the major organs affected in neonatal sepsis is the heart. Echocardiogram provides real-time information on the cardiovascular performance rather than dependence on the clinical signs alone, which might lead to misjudgment. AIM OF THE WORK: To assess left ventricular (LV) functions in septic neonates early after admission using transthoracic color Doppler Echocardiography. PATIENTS AND METHODS: Echocardiography was done to 30 septic and 30 nonseptic newborns who were divided among 4 groups (septic full-term, 14; septic preterm, 16; nonseptic full-term, 21; and nonseptic preterm, 9). Comparisons were made among the 4 groups using analysis of variance and post hoc test regarding the systolic function (using ejection fraction and fractional shortening), the diastolic function (using the early patrial peak/atrial peak flow velocity ratio), and the global LV function (using myocardial performance index). RESULTS: The E-wave and the early peak flow velocity/atrial peak flow velocity ratio were significantly lower in the septic neonates, whether full-term or premature, compared to their corresponding age groups in the nonseptic newborns, suggesting LV diastolic dysfunction (P < 0.001 and P < 0.014, respectively). No difference was found in the diastolic function between the full-term and the preterm neonates whether lying within the septic group or in the nonseptic group. Myocardial performance index was significantly higher in the septic neonates who died than in the survivors (P < 0.001). CONCLUSION: Neonatal sepsis is associated with LV diastolic dysfunction.