Body composition and metabolic consequences of antibiotics most frequently administered to newborns in intensive care units: an experimental study in healthy newborn rats.

Introduction: The increasing overuse of antibiotics in recent years has led to antibiotics being the most prescribed drugs for pediatric patients, and 72% of patients in the neonatal intensive care unit are treated with antibiotics. One effect of antibiotic use is the alteration of the microbiota, which is associated with metabolic disorders, including obesity. Methods: This experimental study in newborn rats compared the administration of ampicillin/meropenem (Access/Watch groups) at 100/10 µg/g every 12 h, cefotaxime 200 µg/g every 24 h (Watch group), and amikacin 15 µg/g every 24 h (Access group) versus saline solution as the control. Each antibiotic was adjusted to the required dosages based on weight, and the doses were administered intraperitoneally daily for 5 days to 10-14 newborn male rats per group. A comparison of the morphometric and biochemical parameters registered on day 28 was performed using ANOVA. Results: Amikacin had the largest effect on morphometric measurements, and low-density lipoprotein cholesterol, while cefotaxime had the largest effect on glucose and triglycerides, whereas ampicillin/meropenem produced the weakest effect on the measured parameters. Discussion: The administration of antibiotics in the neonatal stage can affect the body composition of rats as well as the lipid and carbohydrate serum levels. Future studies should evaluate the toxicity of antibiotics in immature neonatal organs and could help to improve therapeutic decisions and prevent the unjustified use of antibiotics in newborns, thereby reducing metabolic consequences.

Effect of Oropharyngeal Administration of Colostrum in Premature Newborns ≤32 Weeks of Gestation on the Immune Response and Neonatal Morbidity: A Double-Blind Randomized Clinical Trial.

Introduction: The mother's colostrum carries immunological components, such as cytokines and immunoglobulins (Igs), derived from the maternal circulation with bacteriostatic properties. Objective: The objective of this study was to evaluate the effect of oropharyngeal administration of colostrum (OPAC) vs. placebo in the first 4 days of life in premature newborns ≤32 weeks of gestation on serum Ig concentration, neonatal morbidity, and total days of hospitalization. Hypothesis: The OPAC increases serum Igs and decreases morbidity and total days of hospitalization. Materials and Methods: A double-blind randomized controlled trial was carried out. Participants were randomly assigned to one of the two groups, namely, group 1: placebo (P) (n = 50) and group 2: colostrum (C) (n = 46). A blood sample was obtained at baseline and 7 and 28 days of life to quantify immunoglobulin G (IgG), immunoglobulin A (IgA), and IgM. Results: The C group showed an increase in serum IgA on day 28 expressed as median and [interquartile range]; C: 25 [12-35] vs. P: 11 [8-18], p < 0.001. There were no significant differences in neonatal morbidity. Newborns in the colostrum group showed the completed enteral feeding earlier (days), C: 13.9 ± 7 vs. P: 17.4 ± 8.4, p < 0.04; they reached the birth weight earlier, C: 10.9 ± 2.8 vs. P: 12.9 ± 4, p < 0.01, and had less days of hospitalization, C: 60.2 ± 33.8 vs. P: 77.2 ± 47.3, p < 0.04. Neonatal mortality was lower in the colostrum group than the placebo group 0% vs. 12%, respectively, without a statistical difference (p = 0.06). Conclusion: In premature newborns ≤32 weeks of gestation, the OPAC within 4 days after birth increases serum IgA concentration at day 28 compared to placebo. Similarly, OPAC decreased the days to complete enteral feeding and reach the birth weight and total days of hospitalization. Clinical Trial Registration: [https://clinicaltrials.gov/ct2/show/NCT03578341], identifier: [NCT03578341].

Inflammatory Response in Preterm and Very Preterm Newborns with Sepsis.

The response of the adaptive immune system is usually less intense in premature neonates than term neonates. The primary objective of this study was to determine whether immunological parameters vary between preterm (PT) neonates (≥32 weeks of gestational age) and very preterm (VPT) neonates (<32 weeks of gestational age). A cross-sectional study was designed to prospectively follow PT and VPT neonates at risk of developing sepsis. Plasma concentrations of IFN-γ, TNF-α, IL-6, IL-4, and IL-10 were detected using flow cytometry. C-reactive protein (C-RP) and the complex SC5b-9 were detected in the plasma using commercial kits. A total of 83 patients were included. The laboratory results and clinical histories showed that 26 patients had sepsis; 14 were VPT, and 12 were PT. The levels of C-RP, SC5b-9 (innate immune response mediators), and IL-10 or IL-4 (anti-inflammatory cytokines) were elevated during sepsis in both groups. IFN-γ, TNF-α, and IL-6 (proinflammatory cytokines) were differentially elevated only in PT neonates. The VPT neonates with sepsis presented increases in C-RP, SC5b-9, and anti-inflammatory cytokines but not in proinflammatory cytokines, whereas PT neonates showed increases in all studied mediators of inflammation.

Blood SC5b-9 complement levels increase at parturition during term and preterm labor.

We explored the hypothesis that complement, an innate and adaptive immune effector, is active in the plasma of parturient women and is deposited on fetal membranes collected after delivery. A cross-sectional study was designed to evaluate complement activity at parturition. Pregnant women (n = 97) between 15 and 41 years of age were enrolled in a hospital protocol during the perinatal period to assess both SC5b-9 complement activity in blood and complement deposition on fetal membranes during parturition. Soluble SC5b-9 complement activity in plasma fractions was measured using a standard enzyme-linked immunosorbent assay (ELISA) that included specific anti-complement antibodies. Complement deposition on membranes was analyzed using immuno-dot blots and immunohistochemistry. Soluble SC5b-9 complement complex levels were increased in the plasma of women during term labor (TL; median 3361; range 1726-5670 ng/mL), preterm labor (PL; median 2958; range 1552-7092 ng/mL), and preterm premature rupture of membranes (PPROM; median 2272; range 167-6540 ng/mL) compared with pregnant women who were not in labor (P; median 1384; range 174-4570 ng/mL; P < 0.001, Kruskal-Wallis test). Active complement, as assessed by the C9 neo-antigen in C5b-9 complexes, was deposited on fetal membranes, with no difference between term and preterm delivery. The deposition of active complement on fetal membranes was confirmed by immunohistochemistry. Women who underwent non-labor-indicated Cesarean sections did not exhibit complement deposition. Soluble SC5b-9 complement complex levels increased in the plasma of women during parturition, and complement C5b-9 complexes were deposited on fetal membranes.

Transplacental transmission of cutaneous Leishmania mexicana strain in BALB/c mice.

The vertical transmission of leishmaniasis has been reported in species that cause visceral leishmaniasis. However, this condition has scarcely been documented in species that cause cutaneous leishmaniasis. The aim of this study was to determine experimentally whether L. mexicana is transmitted vertically. A control group of BALB/c mice and a group infected with L. mexicana were mated, the gestation was monitored, and females were killed before delivery. Four resorptions (P = 0.023) and eight fetal deaths (P = 0.010) were observed in the infected female group; furthermore, the offspring body weight of the infected group was lower than the body weight of the healthy group (P = 0.009). DNA amplification by polymerase chain reaction (PCR) revealed that all placentas and maternal spleens as well as 39 of 110 fetal spleens obtained from the offspring of infected mothers tested positive for Leishmania. In conclusion, L. mexicana is transmitted transplacentally and causes fetal death, resorption, and reduction in offspring body weight.

[Neurodevelopment at one year of age [corrected] in preterm newborns with history of maternal chorioamnionitis]. / Neurodesarrollo al año de edad en recién nacidos pretérmino con antecedente de corioamnionitis materna.

BACKGROUND: Recent clinical and epidemiological researches indicate that in preterm infants exposed to chorioamnionitis increases the risk of neurological disorders. OBJECTIVE: To know the neurological development in prematures newborn whose mothers suffered chorioamnionitis during pregnancy and to compare them with newborns without chorioamnionitis. MATERIAL AND METHOD: Is a prospective, comparative, cohort study, which included newborn infants with < 34 weeks of gestacional age and with weight < 1,500 g at birth, born in the Instituto Nacional de Perinatologia from August 1, 2005 to December 31, 2006. Two groups were divided (with and without antecedents of maternal chorioamnionitis), paired by weight and gestacional age, with complete neurological assessment at one year of age with the following instruments: Amiel Tison and Vojta assessment, audiological and prelanguage evaluations. RESULTS: 104 patients were included; 23 belonged to the group with chorioamnionitis, and 81 to the group without chorioamnionitis. With the Amiel Tison assessment at one year of age we found a major alteration risk in active tone of the exposed children to chorioamnionitis (RR: 3.73, CI 95%: 1.05-13.3). The exploration of Vojta at the year of age was abnormal in the children exposed (RR: 1.64, CI 95%: 1.06-2.53). There were no differences in: hearing assessment, prelanguage skills, electroencephalography, visual and auditory evoked potentials of brain steam. CONCLUSIONS: In the exposed group to chorioamnionitis there were a major number of patients (56.5%) with neurological alterations versus the one without chorioamnionitis (29.6%, RR: 1.90, CI 95%: 1.16-3.11). Motor alterations were found with more frequency in this study.

Mortalidad neonatal en 2007 y 2008 en un centro de tercer nivel de atención / Newborn mortality in 2007 and 2008 in a tertiary level care center

Introducción. La mortalidad neonatal es un indicador sensible y específico que nos permite conocer el estado de salud de un país y plantear estrategias para mejorarlo. Resulta de una cadena compleja de determinantes como los biológicos, los socioeconómicos y los de salud. El objetivo de este trabajo fue conocer la tasa de mortalidad neonatal general, por peso y edad gestacional, en un instituto de tercer nivel de atención durante 2007 y 2008. Métodos. Se analizaron todos los casos provenientes del comité de mortalidad perinatal y neonatal, de 2007 y 2008, desde 22 semanas de gestación en adelante. El análisis estadístico se realizó mediante medidas de tendencia central y dispersión para las variables cuantitativas y para las variables cualitativas frecuencia, porcentaje, χ² y razón de momios con nivel de significación estadística < 0.05. Resultados. La tasa de mortalidad para el año 2007 fue de 17.7 × 1000 nacidos vivos y para el 2008 de 19.7 × 1000 nacidos vivos. En relación con el peso y con la edad gestacional no se encontró aumento de riesgo al comparar los resultados de ambos años. Las malformaciones ocuparon el mayor porcentaje entre las causas de defunción. Conclusiones. Las tasas de mortalidad en 2007 y 2008 fueron de 17.7 y 19.7 × 1000 nacidos vivos, respectivamente. Las principales causas de defunción fueron las malformaciones cardiacas.

Background. Mortality is a sensitive and specific indicator for determining the health status of a country in order to implement improvement strategies. It is the result of biological, social, economic and health factors. The aim of this study was to determine neonatal general mortality and its relationship with weight and gestational age at a third-level health institution from 2007 to 2008. Methods. We analyzed all patients >22 weeks of gestational age from the perinatal mortality service. Statistical analysis was done using measures of central tendency and dispersion for quantitative variables and χ2, percentage and frequency for qualitative variables; odds ratios were calculated with significance level <0.05. Results. The mortality rate for 2007 was 17.7 per 1000 live births, and for 2008 it was 19.7 per 1000 live births. When we compared both years, we did not find an increased risk for weight and gestational age. Malformations occupied the largest causes of death. Conclusions. For years 2007 and 2008, mortality rates were 17.7 and 19.7 per 1000 live births, respectively, and the main cause of deaths were cardiac malformations.

Neurodesarrollo en infantes con antecedente de hipotiroidismo congénito / Neurodevelopment in infants with congenital hypothyroidism antecedents

Introducción: Los estudios de seguimiento de infantes con hipotiroidismo congénito con tratamiento temprano, muestran que no existen diferencias con respecto al coeficiente intelectual que se encuentra en la población general. Material y métodos: Estudio de cohorte retrospectivo. Veinticuatro hipotiroideos fueron detectados a través del Programa de Tamiz Neonatal y comparados con un grupo testigo. Los recién nacidos fueron valorados entre los seis meses y los siete años de edad mediante el índice de desarrollo (ID) de Bayley, el coeficiente intelectuales (Cl) de Terman Merril y la prueba Hiskey Nebraska para detectar infantes con hipoacusia. Resultados: Dieciocho infantes hipotiroideos mostraron Cl o ID normal o alto. Uno con ID de Bayley porabajo del promedio, dos con Cl por abajo del promedio y uno con hipoacusia y capacidad de aprendizaje baja. No se encontraron diferencias con respecto al grupo control. El uso de ototóxicos, prematurez e hiperbilirrubinemia, fueron las causas que explicaron los coeficientes bajos entre los hipotiroideos y el grupo control. Conclusiones: El Cl y el ID en el grupo de hipotiroidismo tratado tempranamente no difirió con los resultados del grupo testigo.

Introduction: Follow-up studies of hypothyroid infants who received early treatment evidence the presence of the same IQ vs. the general population. Material and methods: Retrospective cohort study. Twenty-four hypothyroid infants detected in neonatal screening were compared to a control group. The newborns were assessed from six months to seven years based on Bayley's infant development scales (ID), the Terman-Merril IQ (Cl) and the learning aptitude of the heard of hearing with the Hiskey-Nebraska test (CA). Results: Twenty hypothyroid infants showed a normal or high Cl or ID. One of the infants with a ID result below the mean, two with an Cl below the mean, one hearing impaired infant with low learning aptitude. No differences were found vs. the control group. The use of ototoxic medications, prematurity and hyperbilirubinemia explain the low coefficients between the hypothyroid individuals and the control. Conclusions: The Cl and the ID results in the hypothyroid group who received early treatment showed no difference vs. the control group.

[Clinical and demographic profile of patients with gyneco-obstetric disease colonized by Streptococcus agalactiae]. / Perfil clínico y demográfico de pacientes con patología gineco-obstétrica colonizadas por Streptococcus agalactiae.

OBJECTIVE: To describe demographics and clinical features in women with vaginal colonization with Streptococcus agalactiae attended in a gyneco-obstetric hospital. METHODS: Descriptive study of 118 women with isolation of Streptococcus agalactiae in cervical swab during January 1992 to December 1998. Major patient features were obtained in retrospective revising their chart and were classified in demographic, gyneco-obstetrical and clinical characteristics. Statistical analyses were performed with descriptive statistics using central tendency measurements and dispersion, frequencies, rates and proportions with all different variables. RESULTS: Mean age was 31 +/- 11 years; 44 (37.3%) received attention because of sterility, 37 (31.4%) were pregnant, 26 (22%) had any other gynecological disease and, 11 (9.3%) were in a group of high pregestational risk. One hundred eleven (94.1%) were sexually active, starting at a mean age of 20.9 +/- 4.3. GBS was the only microorganism isolated in 70 patients (59.3%). A concomitant cervicovaginal infection was identified in 22 (18.6%) patients. A sexual transmitted disease was present in 25 (21.2%) patients, with isolation of human papilomavirus (HPV), M. hominis, C. trachomatis y T. vaginalis. Fifty-five patients had a concomitant illness: 24 with endocrine disease, 12 cardiovascular pathology and 10 with oncologic disease. CONCLUSIONS: Vaginal colonization of mexican women by GBS is low. However, clinical and demographics characteristics are required to identify these women easily, because of the importance of maternal and infant infection by this organism.

Fiebre tifoidea durante la gestación: curso clínico, tratamiento y repercusión perinatal / Typhoid fever guring gestion: clinical sourse, treatment an perinatal repercussion

La prevalencia de fiebre tifoidea (FT) en nuestro país es alta, afectando principalmente a niños y adultos jóvenes. El número de informes en la literatura acerca de la asociación de FT y embarazo son escasos, no obstante, la mayoría de autores coinciden que la gestación no modifica la presentación clínica ni las alteraciones de laboratorio de las pacientes con FT. Por otra parte, se ha demostrado que la FT influye desfavorablemente en el curso del embarazo, asociándose a abortos y a partos pretémino. En el presente artículo se informa cinco casos de pacientes embarazadas complicadas con FT; una de ellas abortó, una presentó un parto pretérmino con la muerte neonatal de su producto y las tres restantes tuvieron un curso normal del embarazo, sin anormalidades en sus recién nacidos. La morbi-mortalidad tanto martena como fetal se encuentra en estrecha relación al tratamiento adecuado de esta infección. Durante la gestación está contraindicado el uso de cloranfenicol, pero tanto la ampicilina como ceftriaxona son opciones terapéuticas adecuadas para el tratamiento de la FT en esta etapa

Etiologías de la septicemia neonatal en una unidad de perinatología: informe de siete años / Neonatal septicemia etiology in a perinatology unit: seven years report

Se realizó un estudio para conocer la etiología de la infección sistémica neonatal durante el periodo de enero de 1986 a diciembre de 1992. Se estableció el diagnóstico de septicemia corroborada bacteriológicamente en 685 pacientes. Se observó un incremento de los microorganismos antiguamente considerados como comensales reportándose para Staphylococcus aureus una tasa que ha variado de 1.5/1000 a 6.5/1000 nacidos vivos; Staphylococcus epidermidis, se encontró una tasa de 2.3 a 10.2/1000 nacidos vivos; Candida sp se vio incrementada de 0.3/1000 a 1.3/1000. Otros microorganismos patógenos como Streptococcus del grupo B y D, así como Listeria monocytogenes, presentaron tasas similares a las de otras enterobacterias aisladas y consideradas en conjunto. De acuerdo al tiempo de presentación clínica en los casos de infección temprana (menos de 72 horas), se documentó Escherichia coli como el principal agente con 53 casos, seguido del género Streptococcus con 34 casos. En los casos de presentación tardía (mayor de 72 horas) predominaron S. aureus con 166 casos, seguido de S