Interleukin-1 receptor antagonist and interleukin-6 for early diagnosis of neonatal sepsis 2 days before clinical manifestation.

BACKGROUND: Neonatal sepsis is a common and life-threatening disorder, particularly among preterm infants. Early initiation of antibiotic therapy is frequently delayed because the first clinical signs of sepsis are non-specific and there are no reliable early laboratory indicators. We investigated the time course of expression and the prognostic power of the early inflammatory mediators interleukin-1 receptor antagonist (IL-1ra), interleukin-6 (IL-6), and circulating intercellular adhesion molecule-1 (cICAM-1) before clinical diagnosis of sepsis. METHODS: In a prospective multicentre study, we monitored 182 very-low-birthweight infants in six intensive-care units for occurrence of sepsis. During routine or clinically indicated blood sampling, an additional sample was collected for measurement of IL-1ra, IL-6, cICAM-1, and C-reactive protein (CRP). Infants were grouped into those with proven sepsis, no infection, or unclassified. The mean study duration was 34 days. Whenever sepsis occurred, a study period of 10 days was defined: day 0 was the day of clinical diagnosis of sepsis; days -4 to -1 were the 4 days before diagnosis; days +1 to +5 were the 5 days after. We compared the concentrations of the immune mediators during the 10-day study period with group-specific baseline values from before day -4. FINDINGS: 101 infants were included in the analysis: 21 with proven sepsis, 20 with no infection, and 60 unclassified. We excluded 57 because of incomplete datasets and 24 who had early-onset sepsis. IL-1ra and IL-6 increased significantly 2 days before diagnosis of sepsis; maximum median increases within the study period were 15-fold for IL-1ra and 12-fold for IL-6. The diagnostic sensitivities of IL-1ra, IL-6, and CRP concentrations on day 0 of diagnosis were 93%, 86%, and 43%, respectively; corresponding values on day -1 were 64%, 57%, and 18%. The specificities of IL-1ra, IL-6, and CRP concentrations were 92%, 83%, and 93%. cICAM-1 had a specificity of only 64%. INTERPRETATION: IL-1ra and IL-6 are superior to cICAM-1 and CRP as predictors of sepsis 1 or more days before clinical diagnosis. Ad-hoc measurement of these cytokines could allow earlier initiation of antibiotic therapy with corresponding improvement in outcome in very-low-birthweight infants with sepsis.

[The effect of a high-altitude climate on the function of the respiratory system in children with asthma]. / Vliv vysokohorského klimatu na funkci dýchacího ústrojí u detských astmatiku.

In 108 asthmatic children (age 6-15 years) an effect of the 6-8 weeks stay in the High Tatra mountains (Children's Lung Institute, Dolný Smokovec) on lung function was studied in the years of 1985-1988. The patients consisted of groups followed-up in different periods of the latter years. Indications for the stay was airway obstruction (a.o.) in symptom-free period or bronchial hyperreactivity (b.h.) before starting the stay. The effect of climate on a.o. and b.h. was assessed from the parameters, measured from maximum expiratory flow-volume (MEFV) curves. Mean MEFV curves and their areas were considered as indices of the climate effect on a.o. and b.h. in the studied groups of asthmatics during the stay in the Institute. B.h. was assessed according to the induced a.o. after 5 min. free running outdoors. Mean MEFV curves and their areas did not differ significantly at the start and end of the stay in this high mountains climate. However, the MEFV curves significantly differed after the induced a.o. by 5 min. free running at the start and end of this climate therapy. The descendent parts and areas under the curves were reduced much less after the induced a.o. during and the end of stay than at the start of stay. They proved a decrease of bronchial hyperreactivity in all studied groups of asthmatics in the climate of High Tatra. The degree of bronchial hyperreactivity, tested as a magnitude of a.o. following 5 min. free running outdoors, on the basis of parameters from MEFV curves, appeared as an objective measure of climate therapy effect on lung function in our asthmatic children.

[Prevention of post-exertion airway obstruction in children and adolescents with bronchial asthma]. / Moznosti prevence pozátezové obstrukce dýchacích cest u detí a mladistvých s bronchiálním astmatem.

In 86 asthmatics (age 8-16 years), divided into several groups, the protective effects of pharmacological and non-pharmacological agents on the exercise-induced airway obstruction (e.i.a.o.) by 5 minutes free running were studied. There were studied the preventive inhalations of bronchodilators, i.e. fenoterol (0.2 mg), ipratropium-bromide (0.06 mg) and both combined of 0.15 mg of fenoterol and 0.06 mg of ipratropium-bromide on the exercise-induced airway obstruction. The protective effects of breathing through nose as well as the effect of the temperature in the surrounding environment on the e.i.a.o. were studied too. The exercise-induced airway obstruction was assessed on the basis of parameters measured from maximum expiratory flow-volume curves. Maximum expiratory flow at 25% of vital capacity was most sensitive in the assessment of e.i.a.o. The studied bronchodilators protected all patients against e.i.a.o. The textile face mask (surgical mask) put on the nose and mouth during 5 min. free running outdoors and in a closed room protected some asthmatics completely against e.i.a.o. or reduced substantially e.i.a.o. in others. The nose breathing had a similar effect on e.i.a.o. as the textile face mask. The surrounding temperature of air was not decisive in the induction of post-exercise airway obstruction. Non-pharmacological agents ought to be thus more included among the therapeutical means in pediatric and adolescent asthmatics.

[Exercise-induced airway obstruction in asthmatic children and adolescents]. / Zkusenosti s vysetrováním ponámahové obstrukce dýchacích cest u detských a mladistvých astmatiku.

In 115 asymptomatic asthmatic children and adolescents (age 6-18 years) there was studied the magnitude of airway obstruction, induced by various physical efforts and assessed from the recording of maximum expiratory flow-volume curves and in some patients by "specific" airway conductance measurement in a body plethysmograph. The effects of 5 minutes free running outdoors, 5 minutes of exercise on a bicycle ergometer (2 watts/kg of body weight), routine swimming training in swimming pool and of forced expiration maneuver on the magnitude of airway obstruction were assessed. The most frequent and largest degree of airway obstruction was observed after 5 min. free running outdoors (heart rate after running 160-200/min). The obstruction was revealed in 80-100% asthmatics in various groups. The chosen lung function parameters showed exercise-induced airway obstruction in the same patients in various proportions as well as the magnitude of the obstruction. Following free running outdoors the values of maximum expiratory flow at 25% of vital capacity and "specific" airway conductance were most reduced. Spontaneous retreat of obstruction was observed in the course of 2 hours. The physical exercise on a bicycle ergometer was a small stimulus in inducing of airway obstruction. The swimming in a pool did not provoke any obstruction. In 10% of our asthmatics airway obstruction was observed following forced expiration maneuver. Airway obstruction induced by 5 minutes free running outdoors and assessed best by flow-volume curves appeared as a suitable test in the assessment of airway hyperresponsiveness.

[Persistent pulmonary hypertension in a neonate]. / Perzistujúca pl'úcna hypertenzía u novorodenca.

The author gives an account of recent findings on the pathophysiology and treatment of persisting pulmonary hypertension in a neonate. His own experience with treatment is documented in case-histories. He emphasizes the marked therapeutic effect of hyperoxic hyperventilation.

[Claforan in the treatment of serious infections in children]. / Claforan v liecbe závazných infekcií u detí.

To 63 critically sick patients on account of serious infection Claforan was administered. Forty-six patients were hospitalized at the intensive care and resuscitation unit and 17 patients suffered from oncological conditions. Claforan treatment was successful in 69.56% of the patients treated at the intensive care and resuscitation unit and in 30.44% in the group of oncological patients.

[Hyperosmolar hyperglycemic coma in a 10-year-old patient]. / Hyperosmolárna hyperglykemická kóma u desat'rocného pacienta.

A ten-year-old patient referred to a child ambulatory for preoperative examination suddenly falls unconscious. The physical finding and laboratory results suggest hyperosmolar hyperglycaemic coma. The authors describe the clinical course and therapeutic procedure. They draw attention to adequate fluid and ion repletion, to the importance of their balancing and to possible complications of treatment.