The effect of a prebiotic supplemented formula on growth and stool microbiology of term infants.

BACKGROUND: The intestinal flora of breast-fed infants is generally dominated by bifidobacteria which have beneficial properties. Their presence is due to various compounds of breast milk including prebiotic substances. AIM: This prospective, double blind, study compared the growth, acceptability and the proportion of bifidobacteria and clostridia in the stool flora of bottle-fed infants randomized to receive a formula with a specific mixture of 0.4 g/100 ml prebiotic galacto- and long-chain fructooligosaccharides or the same formula without added prebiotics. METHODS: Within 0-14 days after birth at term, healthy bottle-fed infants were enrolled to receive either a prebiotic formula or a standard formula. At recruitment anthropometric measurements were done. These were repeated at the age of 6 and 12 weeks. Stool samples were taken at inclusion and at the age of 6 weeks. The number of bifidobacteria and clostridia was determined by fluorescent in situ hybridization. RESULTS: There was good tolerance of the prebiotic formula. Somatic growth was similar in the two groups. Stool frequency was significantly higher in the prebiotic group (P=0.031). Infants in the prebiotic group had also softer stools as compared to the control group (P=0.026). Baseline values of microorganisms at study entry were similar. The percentage of faecal clostridia at the completion of the study was significantly lower in the prebiotic group (P=0.042), while the proportion of faecal bifidobacteria was higher in the prebiotic group as compared to the control group. However this difference did not reach statistical significance (P=0.262). The percentage of E. coli was lower in the prebiotic group but again this did not reach statistical significance (P=0.312). CONCLUSION: An infant formula containing prebiotic oligosaccharides is well tolerated, leads to normal somatic growth and suppresses the numbers of clostridia in the faeces with a trend for higher percentage of stool bifidobacteria and lower percentage of E. coli.

Genetic variants of surfactant proteins A, B, C, and D in bronchopulmonary dysplasia.

BPD_28D (O2 dependency at 28 days of life) and BPD_36W (O2 dependency at 36 wks post-menstrual age) are diseases of prematurely born infants exposed to mechanical ventilation and/or oxygen supplementation. In order to determine whether genetic variants of surfactant proteins (SPs-A, B, C, and D) and SP-B-linked microsatellite markers are risk factors in BPD, we performed a family based association study using a Greek study group of 71 neonates (<30 wks gestational age) from 60 families with, 52 BPD_28D and 19 BPD_36W, affected infants. Genotyping was performed using newly designed pyrosequencing assays and previously published methods. Associations between genetic variants of SPs and BPD subgroups were determined using Transmission Disequilibrium Test (TDT) and Family Based Association Test (FBAT). Significant associations (p

Growth velocity during the first postnatal week of life is linked to a spurt of IGF-I effect.

There is adequate evidence that growth during the perinatal period is linked to the risk of several adult onset diseases, and recent findings indicate that the insulin-like growth factor (IGF) system is involved in prenatal growth, as reflected in birthweight. However, whether major components of the IGF system are involved in the immediate post-natal growth has not been studied. Maternal questionnaires were completed, and laboratory measurements of several variables, including IGF-I, IGF-II and IGF-binding protein-3 (IGFBP-3), were made for a total of 331 apparently healthy full-term newborns, from whom routine blood samples were taken during the first 5 days of their life. Birthweight and weight at the time of bleeding were among the recorded variables, and the difference divided by the age in days of the newborn was considered as reflecting immediate postnatal growth velocity. Immediate postnatal growth velocity was strongly positively associated with IGF-I. The squared adjusted correlation coefficient was 0.29 when IGF-I was incorporated in the model predicting postnatal growth velocity but was only 0.08 when IGF-I was excluded. In contrast, IGF-II and IGFBP-3 had no effect on postnatal growth velocity. It thus appears that IGF-I underlies growth during the immediate postnatal period. To the extent that perinatal growth may affect adult onset diseases, the findings of this study suggest that the action of IGF-I during the immediate postnatal period may represent a process of major importance.

Congenital tuberculous lymphadenitis in a preterm infant in Greece.

UNLABELLED: Congenital tuberculosis is a rare disease. The risk of tuberculosis in pregnancy has increased owing to recent changes in the epidemiology of the disease, which have led to an increased risk of congenital tuberculosis. We present a case report on a 6-d-old premature infant with tuberculous lymphadenitis. Smears of the lymphatic tissue contained acid-fast bacilli, and cultures were positive for Mycobacterium tuberculosis hominis. Polymerase chain reaction (PCR) assay of the suppurative material of the lymph node was positive for M. tuberculosis. Twenty days before onset of labour, the mother developed miliary tuberculosis and meningitis. CONCLUSION: The atypical clinical manifestations of congenital tuberculosis and the devastating consequences in the absence of early therapy signify the importance of early diagnosis and treatment during the neonatal period. PCR assay is a useful technique for prompt diagnosis in neonates with clinically suspected infection.

Are operative delivery procedures in Greece socially conditioned?

Caesarean section rates have increased in Greece by almost 50% during the last 13 years. We conducted a study in Athens, Greece, to assess the importance of a series of medical and socioeconomic factors in the use of Caesarean section or operative vaginal procedures, rather than a non-operative process, for the delivery of singleton, liveborn babies of primiparous mothers. We used a case control approach to compare 444 babies delivered through a Caesarean section and 130 delivered through operative vaginal delivery with 1235 normally delivered babies in a public and a private hospital. Data were analysed through multiple logistic regression. Caesarean section was more commonly performed in older, shorter or overweight mothers and for high and low birth-weight babies, as well as in response to several obstetric complications and following in-vitro fertilization. A similar pattern was noted with respect to operative vaginal delivery, except that this procedure was not unusually frequent among overweight women and was not encountered in this study among children born after in-vitro fertilization. Caesarean section was performed twice as often in the public teaching hospital as in a private maternity hospital, and operative vaginal delivery was several times more common in the former than in the latter, after controlling for biomedical risk factors. The unequal distribution of operative delivery procedures between the public and the private hospital raises questions about the justification of their performance in a substantial fraction of deliveries, and indicates that social factors condition their use.

Modulation of birthweight through gestational age and fetal growth.

Several factors are known to affect birthweight and their effects are variously mediated through gestational duration or through fetal growth conditional on this gestation. In order to quantify independent associations of birthweight conditional and unconditional on gestational age, all 2538 mothers of singleton babies delivered during 1993 in two Maternity Hospitals in Athens were interviewed and their obstetric records abstracted. Birthweight was modelled as outcome variable through multiple regression including 32 potentially predictive factors. The regression model was fitted with and without gestational age as an additional independent variable in order to apportion birthweight associations into those independent of, or mediated through, gestational length. The factors studied were found to be classifiable into the following categories: factors associated with birthweight mostly through increases in gestational duration, either positively (age at menarche, long menstrual cycles, parity 4 or higher), or negatively (single motherhood, maternal age, tobacco smoking); those associated with birthweight mostly through increase of birthweight conditional on gestational duration, either positively (male gender, short menstrual cycles, maternal pre-pregnancy weight, anaemia, oedema) or inversely (employment during pregnancy, stillbirth, primiparity, pregnancy induced hypertension, coffee drinking); and those associated with birthweight through apparently dual effects, either positively (maternal education) or inversely (perceived stress, bleeding during pregnancy). The other studied factors were not demonstrably related to birthweight in this data set. Identification and quantification of these relations is useful for understanding underlying physiological and pathophysiological processes and for increasing specificity in exploring the association of birthweight with adult onset diseases, like coronary heart disease or cancer.

Neonatal cerebral venous flow velocity measurement using a color flow Doppler system.

Color flow Doppler provides a simple means for studying blood flow velocity from the central cerebral veins in newborn infants. Twenty-two term infants were examined during the first four days of life to establish a normal range for velocity from the vein of Galen. A wide range of velocities was found between individuals (2.3 cm.s-1 to 9.5 cm.s-1), but short-term intraindividual variation was small (root mean square variation 1.1 cm.s-1). Light bilateral jugular venous compression was performed in 17 of the infants and produced a fall of up to 63% in venous flow velocity in 12 infants (p = 0.0005).

The use of a calcium-channel blocker, nicardipine, for severely asphyxiated newborn infants.

A continuous infusion of nicardipine was given to four severely asphyxiated fullterm infants who were at high risk for adverse outcome and had abnormal cerebral Doppler haemodynamic studies. The heart rate increased in all four infants and mean arterial blood pressure (MAP) fell in three. Two infants had a sudden and marked fall in MAP, together with severe impairment of skin blood-flow and a concurrent fall in cerebral blood-flow velocity. The serum level of nicardipine was less than 40ng/mL in all cases. The use of nicardipine, and possibly other calcium-channel blockers, may be associated with marked hypotension, and if there is no cerebral autoregulation, may cause further cerebral hypoperfusion, so use of these drugs in asphyxiated newborn infants should only be attempted if blood pressure is carefully monitored.

Normal range for blood flow velocity in cerebral arteries of newly born term infants.

A cross-sectional study of 128 healthy full term infants was made using duplex Doppler ultrasonography in order to establish a normal range for cerebral blood flow velocity (CBFV) in the first week of life. Recordings were made from both the anterior (ACA) and middle cerebral arteries (MCA). There was a statistically significant increase in CBFV in both the ACA and MCA over the first four days of life, which was particularly obvious in the first 24 h. There is a close relationship between measurement of CBFV from the ACA and the MCA, although the velocity tends to be higher in the MCA.

Digoxin levels in the serum of healthy neonates.

The possible existence of a chemical substance with cross-reactivity to digoxin antibodies in the neonatal serum or plasma was investigated in this study. Our data show that in contrast to previous reports, the levels of a "digoxin-like substance" in the serum or plasma of healthy newborns are negligible and probably would not affect the reliability of digoxin radioimmunoassay tests.