Neonatal sepsis at Mount Hope Women's Hospital: early detection for prevention by prophylaxis - abstract

The objective of the present study was to test the hypothesis that serum c-reactive protein (CRP) in neonates is a valid indicator of early noenatal sepsis. Two hundred and twenty-seven neonatal sera were collected within 6 hours of birth from a random selection of neonates who were delivered at the Mount Hope Women's Hospital, Trinidad, between April and September, 1989. Sera were examined for the presence of CRP by radial immunodiffusion using monoclonal antibodies to CRP. CRP was detected in 26 neonates of whom 3 remanined well until their discharge on the third day. There were 9 neonates with a positive blood cluture but CRP was not detected in the sera. The test, therefore, had a sensitivity of 72 percent, specificity of 98.5 percent, false-negative rate 28.0 percent, false-positive rate 1.5 percent, positive predictive value 88.5 percent, negative predictive value 95.5 percent, and an accuracy of 95 percent. Of 44 symptomatic neonates, CRP was found in 12, while of 183 asymptomatic neonates 14 had CRP, yielding a relative risk of 2.8:1. In developing countries, therefore, examination of neonatal sera for CRP combined with prompt prophylaxis of neonates with CRP may contribute to a decrease in neonatal morbidity and mortality (AU)

The Importance of determining levels of immunoglobulin and IgG subclasses in neonates in Trinidad - abstract

The occurence of multiple outbreaks of contagious diseases in Trinidad over the past decade led to an investigation of the role of immunoglobulin levels and IgG subclasses in neonates for whom there had hitherto been no established baseline. The mean immunoglobulin levels obtained for Trinidad were as follows: IgG 1,232 ñ 225 mg/d, IgA 1.4 ñ 3 mg/d, IgM 12 ñ 11 mg/d. For the IgG subclass determinations, the values obtained were IgG1 840 ñ 182 mg/d, IgG2 21 ñ 115 mg/d, IgG 364 ñ 62 mg/d and IgG4 111 ñ 94 mg/d. The mean G, A, M, G1, Gs and G4 concentrations differed significantly from those obtained in the USA. When our IgG subclass means were compared with those in a Swedish study, IgG1 and IgG4 were elevated. During the course of the study, baseline values were also determined for beta 2 microglobulin (0.44 ñ 1.6 mg/d) and C reactive protein. Normal neonates showed no production of CRP. However, 4 apparently normal neonates gave values ranging from 0.2 to 6.1 mg/d. Within 72-96 hours, all 4 developed pneumonia, jaundice and/or sepis. This suggests that CRP can be employed as an indicator for infection in neonates in the absence of overt clinical symptoms (AU)

Characterisation of mixed connective tissue disease - abstract

Of sixteen patients with MCTD, 10 62 percent) presented with the clinical features of systemic lupus erythematosus (SLE) and 6 (37 percent) with SLE-scleroderma. Ninety-four per cent had a speckled antinuclear factor pattern and 100 percent had IgG deposits in a speckled pattern within the epidermal cell nuclei of the skin. Seventy per cent of these patients had nRNP antibodies. These characteristics are more typical of the mixed connective tissue syndrome than of SLE or scleroderma. The low incidence of Raynaud's phenomenon in our group of patients (18 percent) with MCTD is probably due to the tropical climate. The IgM deposits in the skin of a significant number (67 percent) of the patients with the clinical picture of SLE-scleroderma probably represent an early stage in the development of the disease. The significance of high serum IgA in the clinically diagnosed SLE group is not understood and is now being further investigated. This study strongly suggests that laboratory investigations are of primary importance in distinguishing MCTD from SLE and other forms of collagen vascular diseases (AU)