Maternal antibiotic prophylaxis affects Bifidobacterium spp. counts in the human milk, during the first week after delivery.

Human milk is an important source of microorganisms for infant gut colonisation. Although the maternal antibiotic prophylaxis is an important strategy to prevent maternal/neonatal sepsis, it has to be investigated how it may affect the human milk microbiota, especially the genus Bifidobacterium, which has been associated to health benefits. Here, we investigated the impact of the maternal antibiotic prophylaxis on the human milk Bifidobacterium spp. and total bacteria counts, in the first week (short-term) and first month (medium-term) after delivery. Human milk samples were collected from 55 healthy lactating women recruited from the University Hospital of the University of São Paulo at days 7±3 and 30±4 after vaginal delivery. Twenty one volunteers had received maternal antibiotic prophylaxis (MAP group) and 34 had not received MAP (no-MAP group) during or after labour. Total DNA was isolated from milk samples, and the bacterial counts were estimated by quantitative PCR (qPCR). We found lower levels of Bifidobacterium in the MAP group in the first week after delivery (median = 2.1 vs 2.4 log of equivalent cells/ml of human milk, for MAP and no-MAP groups, respectively; P=0.01), although there were no statistical differences in total bacteria count. However, no differences were found in Bifidobacterium counts between the groups at day 30±4 (median = 2.5 vs 2.2 log of equivalent cells/ml of human milk, for MAP and no-MAP groups, respectively; P=0.50). Our results suggest that MAP has a significant impact on Bifidobacterium counts in human milk, reducing this population in the first week after delivery. However, throughout the first month after delivery, the Bifidobacterium counts tend to recover, reaching similar counts to those found in no-MAP group at day 30±4 after delivery.

Surfactant protein B gene polymorphism in preterm babies with respiratory distress syndrome

The etiology of respiratory distress syndrome (RDS) is multifactorial and multigenic. Studies have suggested that polymorphisms and mutations in the surfactant protein B (SP-B) gene are associated with the pathogenesis of RDS. The objectives of this study were to determine and compare the frequencies of SP-B gene polymorphisms in preterm babies with and without RDS. We studied 151 neonates: 79 preterm babies without RDS and 72 preterm newborns with RDS. The following four SP-B gene polymorphisms were analyzed: A/C at -18, C/T at 1580, A/G at 9306, and G/C at nucleotide 8714. The polymorphisms were detected by PCR amplification of genomic DNA and genotyping. The genotypes were determined using PCR-based converted restriction fragment length polymorphisms. The control group consisted of 42 (53 percent) girls and 37 (47 percent) boys. Weight ranged from 1170 to 3260 g and mean gestational age (GA) was 33.9 weeks (range: 29 to 35 weeks and 6 days). The RDS group consisted of 31 (43 percent) girls and 41 (57 percent) boys. Weight ranged from 614 to 2410 g and mean GA was 32 weeks (range: 26 to 35 weeks). The logistic regression model showed that GA was the variable that most contributed to the occurrence of RDS. The AG genotype of the A/G polymorphism at position 9306 of the SP-B gene was a protective factor in this population (OR = 0.1681; 95 percentCI = 0.0426-0.6629). We did not detect differences in the frequencies of the other polymorphisms between the two groups of newborns.

Surfactant protein B gene polymorphism in preterm babies with respiratory distress syndrome.

The etiology of respiratory distress syndrome (RDS) is multifactorial and multigenic. Studies have suggested that polymorphisms and mutations in the surfactant protein B (SP-B) gene are associated with the pathogenesis of RDS. The objectives of this study were to determine and compare the frequencies of SP-B gene polymorphisms in preterm babies with and without RDS. We studied 151 neonates: 79 preterm babies without RDS and 72 preterm newborns with RDS. The following four SP-B gene polymorphisms were analyzed: A/C at -18, C/T at 1580, A/G at 9306, and G/C at nucleotide 8714. The polymorphisms were detected by PCR amplification of genomic DNA and genotyping. The genotypes were determined using PCR-based converted restriction fragment length polymorphisms. The control group consisted of 42 (53%) girls and 37 (47%) boys. Weight ranged from 1170 to 3260 g and mean gestational age (GA) was 33.9 weeks (range: 29 to 35 weeks and 6 days). The RDS group consisted of 31 (43%) girls and 41 (57%) boys. Weight ranged from 614 to 2410 g and mean GA was 32 weeks (range: 26 to 35 weeks). The logistic regression model showed that GA was the variable that most contributed to the occurrence of RDS. The AG genotype of the A/G polymorphism at position 9306 of the SP-B gene was a protective factor in this population (OR = 0.1681; 95%CI = 0.0426-0.6629). We did not detect differences in the frequencies of the other polymorphisms between the two groups of newborns.

Comparison of surfactant protein B polymorphisms of healthy term newborns with preterm newborns having respiratory distress syndrome.

Polymorphisms and mutations in the surfactant protein B (SP-B) gene have been associated with the pathogenesis of respiratory distress syndrome (RDS). The objective of the present study was to compare the frequencies of SP-B gene polymorphisms between preterm babies with RDS and healthy term newborns. We studied 50 preterm babies with RDS (inclusion criteria - newborns with RDS and gestational age between 28 and 33 weeks and 6 days), and 100 healthy term newborns. Four SP-B gene polymorphisms were analyzed: A/C at nucleotide -18, C/T at nucleotide 1580, A/G at nucleotide 9306, and G/C at nucleotide 8714, by PCR amplification of genomic DNA and genotyping by cRFLP. The healthy newborns comprised 42 female and 58 male neonates; 39 were white and 61 non-white. The RDS group comprised 21 female and 29 male preterm neonates; 28 were white and 22 non-white. Weight ranged from 640 to 2080 g (mean: 1273 g); mean gestational age was 31 weeks and 2 days (range: 28-33 weeks and 6 days). When white children were analyzed separately, a statistically significant difference in the G/C polymorphism at 8714 was observed between groups (P = 0.028). All other genotype frequencies were similar for both groups when sex and race were analyzed together. Analysis of the SP-B polymorphism G/C at nucleotide 8714 showed that among white neonates the GG genotype was found only in the RDS group at a frequency of 17% and the GC genotype was more frequently found in healthy term newborns. These data demonstrate an association of GG genotype with RDS.

Comparison of surfactant protein B polymorphisms of healthy term newborns with preterm newborns having respiratory distress syndrome

Polymorphisms and mutations in the surfactant protein B (SP-B) gene have been associated with the pathogenesis of respiratory distress syndrome (RDS). The objective of the present study was to compare the frequencies of SP-B gene polymorphisms between preterm babies with RDS and healthy term newborns. We studied 50 preterm babies with RDS (inclusion criteria - newborns with RDS and gestational age between 28 and 33 weeks and 6 days), and 100 healthy term newborns. Four SP-B gene polymorphisms were analyzed: A/C at nucleotide -18, C/T at nucleotide 1580, A/G at nucleotide 9306, and G/C at nucleotide 8714, by PCR amplification of genomic DNA and genotyping by cRFLP. The healthy newborns comprised 42 female and 58 male neonates; 39 were white and 61 non-white. The RDS group comprised 21 female and 29 male preterm neonates; 28 were white and 22 non-white. Weight ranged from 640 to 2080 g (mean: 1273 g); mean gestational age was 31 weeks and 2 days (range: 28-33 weeks and 6 days). When white children were analyzed separately, a statistically significant difference in the G/C polymorphism at 8714 was observed between groups (P = 0.028). All other genotype frequencies were similar for both groups when sex and race were analyzed together. Analysis of the SP-B polymorphism G/C at nucleotide 8714 showed that among white neonates the GG genotype was found only in the RDS group at a frequency of 17 percent and the GC genotype was more frequently found in healthy term newborns. These data demonstrate an association of GG genotype with RDS.

Clinical course of premature infants intubated in the delivery room, submitted or not to porcine-derived lung surfactant therapy within the first hour of life.

OBJECTIVES: The aim of this study was to perform a comparative analysis of the clinical outcome, gasometric course and ventilatory indices of premature infants with a gestational age of < or = 34 weeks who were intubated in the delivery room, owing to respiratory insufficiency, according to whether or not they were submitted to porcine-derived lung surfactant therapy within the first hour of life. METHODS: The study was randomized and controlled. A total of 75 premature infants were classified into two groups: group A, comprising 35 neonates who were submitted to surfactant within the first hour of life; and group B, comprising 40 neonates who were not submitted to surfactant within the first hour of life. RESULTS: Exogenous surfactant therapy after establishment of respiratory distress syndrome (RDS) was necessary in eight neonates of group A (22.9%) and 31 neonates of group B (77.5%) (p < 0.001). The neonates in group A presented higher levels in relation to group B for the variables: partial pressure of arterial oxygen (PaO2)/fraction of inspired oxygen (FiO2) and PaO2/partial pressure of alveolar oxygen (PAO2), while neonates in group B presented higher levels for FiO2, PAO2 and difference D(A - a)O2 in relation to group A. Weight affected the oxygenation index (OI) parameter, in that neonates with lower weight presented greater values of the OI. CONCLUSIONS: In premature infants with established RDS, the need for exogenous surfactant was lower in the group that received surfactant within the first hour of life. Furthermore, the gasometric parameters and ventilatory indexes presented a better course in the first 24 h of life among premature infants who received exogenous surfactant within the first hour of life, in relation to those who did not.

Clinical and laboratory study of newborns with lower respiratory tract infection due to respiratory viruses.

OBJECTIVES: To determine the prevalence of lower respiratory tract infection due to respiratory viruses in the neonatal period at admission to the neonatal intensive care unit and to compare the clinical, laboratory and radiological aspects of the clinical course, according to the etiological agent, in the neonatal period. METHODS: Ninety newborns were studied, from January 1999 to January 2001, with bronchiolitis and/or pneumonia. The newborns were classified into three groups, according to the etiological agent identified initially: viral infection (group A), mixed viral-bacterial infection (group B), and bacterial infection (group C). RESULTS: The virus was identified in 72 newborns (80.0%); the most prevalent was respiratory syncytial virus (RSV) (44.4%), followed by influenza A virus (22.2%). Coughing, wheezing and an interstitial infiltrate were significantly more frequent in newborns with viral infection. Mixed infection was more associated with sepsis. There was a correlation between viral infection and low values of initial and subsequent white blood cell count and C-reactive protein. RSV was the most important virus in these patients. CONCLUSIONS: It was observed that, although the majority of viral respiratory infections had a favorable course, some patients presented a serious and prolonged clinical manifestation, especially when there was concomitant bacterial infection.

Infecçäo por Chlamydia trachomatis no período neonatal: aspectos clínicos e laboratoriais. Experiência de uma década: 1987-1998 / Chlamydia trachomatis infection in neonatal period: clinical and laboratorial aspects. Experience of a decade: 1987-1998

A infecção por C. trachomatis é adquirida pelo recém-nascido (RN) principalmente durante sua passagem pelo canal parto; 25 por cento a 50 por cento destes deverão desenvolver conjuntivite e 10 por cento a 20 por cento pneumonia. Objetivos. Verificar a incidência de infecção ocular por C. trachomatis nos RN internados com diagnóstico de conjuntivite, num período de 10 anos. - Observar a associação entre infecção ocular é pneumonia intersticial - Estudar os aspectos epidemiológicos e os métodos utilizados para o diagnóstico laboratorial. Casuística e Metodologia. Foram analisados os RN internados com diagnóstico de conjuntivite e/ ou pneumonia interticial internados na UCINE no período de 1987-1998. Os métodos de diagnóstico utilizados foram: a pesquisa direta do agente etiológico em raspado de conjuntiva, radiografia de tórax, sorologia para C. trachomatis no sangue pelo método de imunofluorescência para anticorpos IgG e IgM. Resultados. Estudamos as características de 20 RN que apresentaram infecção por C. trachomatis: 15 eram de termo (75 por cento) e cinco, pré-termos (25 por cento); houve predominância da infecção no sexo feminino (60 por cento); a pneumonia esteve presente em 15 dos 20 RN (75 por cento) e 12 apresentaram associação de conjuntivite e pneumonia. Não houve relação significante entre tipo de parto, idade materna, número de parceiros e a infecção, sendo que o antecedente materno de leucorreia esteve presente em 50 por cento dos casos. O diagnóstico sorológico esteve relacionado com a presença de pneumonia e a pesquisa direita com a conjuntivite. A incidência de conjuntivite por C. trachomatis entre os RN internados com esse diagnóstico durante o período de estudo foi de 17/100 (17 por cento). Conclusões. A. C. trachomatis é um importante agente patogênico e sua pesquisa é muito importante em RN com conjuntivite e/ou pneumonia intersticial mesmo na ausência de fatores de risco para doença sexualmente transmissível. A pesquisa direta em raspado de conjuntiva e o exame sorológico se mostraram importantes como métodos auxiliares do diagnóstico.

Indicadores imunológicos (IgM e proteína C-reativa) nas infecçöes neonatais / Immunological indicators (IgM and C-reactive protein) in neonatal infections

A sepse, no período neonatal, está associada com a presença de fatores de risco para infecçao e com o estado imunológico do recém-nascido. Objetivo. Verificar, em recém-nascidos com fatores de risco para infecçao, o papel da proteína C reativa (PCR) e da imunoglobulina M (IgM) como indicadores de infecçao. Casuística e Metodologia. Foram estudados 57 recém-nascidos que apresentavam, como fatores de risco para infecçao: ruptura prematura de membranas, associada ou nao a amniotite clínica ou a infecçao de trato urinário. Estes foram classificados em três grupos, de acordo com a idade gestacional <34 semanas, entre 34-36 6/7 semanas e (>37 semanas). O diagnóstico de infecçao foi baseado em critérios clínicos e laboratoriais, e foram incluídos entre os métodos de diagnóstico e dosagem de PCR e de IgM. Os exames laboratoriais foram colhidos ao nascimento e no quinto dia de vida. Resultados. Dos 57 recém-nascidos estudados, 18 (31,5 por cento) apresentaram sepse, sendo 13 (22,8 por cento) a forma precoce e cinco (8,7 por cento) a forma tardia. Houve associaçao estatisticamente significante entre idade gestacional, peso e presença de infecçao, constituindo o grupo com idade gestacional inferior a 34 semanas o mais acometido e o que apresentou também maior número de óbitos relacionados com o processo infeccioso. Nao se observou associaçao estatisticamente significante entre sexo e infecçao nos três grupos estudados. Em relaçao à IgM, houve diferença estatisticamente significante entre níveis séricos médios de IgM dos RNs infectados que se mostraram superiores aos dos nao-infectados nos três grupos de idade gestacional, tanto ao nascimento como no quinto dia, sendo esta diferença mais evidente no quinto dia. Constatou-se forte associaçao estatística entre níveis de PCR > 10mg/litro e presença de infecçao nos três grupos estudados. Conclusoes. Nesta casuística, a PCR foi o melhor indicador de infecçao, revelando-se esta prova confiável para seguimento clínico no quinto dia de vida, e naqueles casos que apresentaram infecçao tardia foi a primeira prova a se mostrar alterada.

Transfusäo de hemocomponentes em recém-nascidos de termo e prematuros / Blood transfusion in term and premature infants

Objetivo. Comparar o consumo de hemocomponentes entre recém-nascidos (RN) de termo (RNT) e pré-termo (RNPT) e correlacionar esse consumo ao tipo de tratamento dispensado à sua patologia: clínico ou cirúrgico; acidentes hemorrágicos e sobrevida. Casuística e Metodologia. 48 Rns classificados em dois grupos: 26 RNT e 22 RNPT receberam 251 unidades de hemocomponentes: 177 unidades de concentrado de hemácias (CH), 36 de concentrado de plaquetas (CP), 30 de plasma fresco congelado (PFC) e oito de sangue total (ST), no período de 186 dias. Foi analisado o consumo de hemocomponentes em cada grupo, e na razao do número de Rns vivos por dia, até o 120 dia. Resultados. O consumo médio de hemocomponentes foi de 7,31 unidades para RNPT e 3,46 para RNT. A análise de consumo diário revelou que a maior parte ocorreu em RNs sob tratamento clínico antes do 60 dia de vida (d.v.) e que um aumento após o 86 d.v. pode ser atribuído a um aumento de cirurgias nessa fase. Os acidentes hemorrágicos predominaram em RNPT com plaquetometria inferior a 60.000/mm3. Foi constatada uma tendência inversamente proporcional entre o número de transfusoes e a sobrevida. Conclusoes. Os RNPT consumiram mais hemocomponentes que os RNT. Esse consumo estava ligado à patologia de base. Foi sugerido que a transfusao profilática de CP em RNPT poderia reduzir o número de hemorragias, além do consumo de CH nesse grupo. Mais de dez transfusoes de hemocomponentes nos primeiros 120 d.v., em ambos os grupos, parece constituir marcador de mau prognóstico.

Síndrome do risco de morte súbita infantil / Near sudden infant death syndrome. A case report

A síndrome da morte súbita infantil, ou morte durante o sono, se dá em uma criança normal, após adormecer bem, sem causa aparente. É considerada, como a causa isolada, a mais frequente de morte no primeiro ano de vida, em estatísticas do exterior. Acredita-se ocorrer a morte por um distúrbio funcional dos centros respiratórios levando à apnéia. Em crianças encontradas flácidas em apnéia reversível após estimulaçäo ou ao despertar, denomina-se em "risco" da morte súbita infantil. Apresentamos um caso desta síndrome, com crises de cianose e apnéia durante o sono a partir do oitavo dia de vida. O paciente foi internado, feita a monitorizaçäo respiratória, submetido a registro polissonográfico de 24 horas. Näo foram detectadas causas justificando as apnéias. Foi medicado com aminofilina e constatou-se o desaparecimento das crises de apnéias no segundo mês de vida. Este trabalho permite evidenciar um caso de entidade pouco diagnosticada em nosso meio