Serum amyloid A, procalcitonin, tumor necrosis factor-alpha, and interleukin-1beta levels in neonatal late-onset sepsis.

BACKGROUND: Sepsis is an important cause of mortality in newborns. However, a single reliable marker is not available for the diagnosis of neonatal late-onset sepsis (NLS). The aim of this study is to evaluate the value of serum amyloid A (SAA) and procalcitonin (PCT) in the diagnosis and follow-up of NLS. METHODS: 36 septic and healthy newborns were included in the study. However, SAA, PCT, TNF-alpha, IL-1beta, and CRP were serially measured on days 0, 4, and 8 in the patients and once in the controls. Töllner's sepsis score (TSS) was calculated for each patient. RESULTS: CRP, PCT, and TNF-alpha levels in septic neonates at each study day were significantly higher than in the controls (P = .001). SAA and IL-1beta levels did not differ from healthy neonates. The sensitivity and specificity were 86.8% and 97.2% for PCT, 83.3% and 80.6% for TNF-alpha, 75% and 44.4% for SAA on day 0. CONCLUSION: Present study suggests that CRP seems to be the most helpful indicator and PCT and TNF-alpha may be useful markers for the early diagnosis of NLS. However, SAA, IL-1beta, and TSS are not reliable markers for the diagnosis and follow-up of NLS.

Clinical and laboratory findings of two newborns with Wiedemann-Rautenstrauch syndrome: additional features, evaluation of bone turnover and review of the literature.

Wiedemann-Rautenstrauch syndrome (WRS) is a rare autosomal recessive condition which represents a complex of symptoms and laboratory findings with unknown cause and pathogenesis. Approximately 30 patients with WRS have been reported. We report here two newborns with WRS from Turkey with clinical and laboratory findings including bone marker evaluation. Our two patients had characteristic features of WRS, including intrauterine growth retardation, aged appearance, near absence of subcutaneous fat, gluteal fat pads, also labial pad in the first infant, wrinkled thin skin, sparse scalp hair, prominent scalp veins and facial dysmorphism. They also have severe osteopenia and elevated urinary deoxypyridinoline levels which have not been previously described in patients with WRS. Impaired lipid and hormone profiles including elevated prolactin and triglyceride level have been reported in patients with WRS. Our first patient also has excessive joint contractures, persisting thrombocytosis and rectal prolapse. We evaluated bone mineral findings in our two patients with WRS and recommend caution when handling children with WRS.

Cord blood IGF-1 and IGFBP-3 levels in asphyxiated term newborns.

OBJECTIVE: Determination and pathogenesis of perinatal asphyxia is still an important problem. During the asphyxial insult and recovery phase, alteration of the growth factors has been demonstrated and there is evidence that expression of insulin-like growth factors (IGF) and their insulin-like growth factor binding proteins (IGFBP) in injured sites in experimental studies. Aim of this study was to evaluate relationship between serum IGF-1, IGFBP-3 levels and perinatal asphyxia. PATIENTS AND METHODS: 18 term-newborn who defined as perinatal asphyxia and 12 term-healthy newborn were enrolled. Umbilical cord IGF-1 and IGFBP-3 levels were detected and searched correlation with apgar scores and umbilical artery gas analysis as pH, pC02, pO2, base excess, HCO3, ctO2, SO2 and lactate levels. RESULTS: Cord blood IGF-1 and IGFBP-3 levels for asphyxiated newborns were lower than normal group (27.8+/-2.6 ng/ml, 55.1+/-2.8 ng/ml respectively, p<0.01 for IGF-1; 1107.7+/-320.4, 1682.5+/-364.1, p<0.001 for IGFBP-3). Cord blood IGF-1 levels were positively correlated with birth weight; first and 5th minute Apgar score, cord blood arterial pH, ABE, HCO3, SO2 levels. Cord blood IGFBP-3 levels were positively correlated with first and 5th minutes Apgar scores, cord blood arterial pH, pCO2, ABE, HCO3, sO2, and also negatively correlated with cord CO2 and cord lactate levels. CONCLUSION: Our study demonstrates that exposure to hypoxia and acidosis at birth strongly correlated with a fall in IGF-1 and IGFBP-3 levels in cord blood.

Blood lead levels of maternal-cord pairs, children and adults who live in a central urban area in Turkey.

Lead levels were measured in blood samples of 99 adults, 180 children and 143 pregnant women living in Eskisehir, an urban area in Turkey. One hundred and twenty 120 cord blood and 93 breast-milk samples were also obtained. Mean lead level in blood of adults, children, pregnants, cord blood and in breast-milk samples were 3.13 +/- 1.4 microg/dl, 3.56 +/- 1.7 microg/dl, 2.8 +/- 1.5 microg/dl, 1.65 +/- 1.4 microg/dl and 2.34 +/- 1 microg/L, respectively. It was higher in men than in women in adults (p<0.05) and in iron-deficient children than in those not deficient (p<0.01), and was negatively correlated with body weight (BW) and hemoglobin (Hb) in children (p<0.05 for both). Maternal lead level was strongly related with cord blood and breast-milk lead contents (p<0.001, p<0.0001, respectively). The lead exposure in this region is much lower than the critical level defined for lead poisoning as >10 microg/dl by the Centers for Disease Control and Prevention iron deficiency poor nutrition are the risk factors to lead exposure in children.

Low-mannose-binding lectin levels in susceptibility to neonatal sepsis in preterm neonates with fetal inflammatory response syndrome.

AIM: In this study, we aimed to evaluate cord blood mannose binding levels (MBL), to evaluate possible relationship between cord blood MBL levels with neonatal sepsis and culture confirmed neonatal sepsis in preterm newborn with gestational age below 34 weeks with fetal inflammatory response syndrome (FIRS). METHODS: Forty-four randomly selected < or =34 weeks gestational age newborns with FIRS were evaluated. MBL deficiency was described as cord blood levels were below 400 ng/ml. RESULTS: Mean value of umbilical cord MBL was significantly lower in newborns with culture confirmed sepsis (p < 0.01) and also all cases with sepsis (including culture negative or positive) (p < 0.05) than newborns without sepsis. Culture-confirmed sepsis was statistically common in MBL deficient premature newborns with FIRS. Univariate analysis showed that gestational age, birth weight, low serum MBL level and poor obstetric history were all significantly associated with the risk of neonatal sepsis. A subsequent multivariate analysis showed that the association between serum MBL level and the risk of suspected sepsis and culture confirmed sepsis independently from gestational age and birth weight. CONCLUSION: Here in, we report firstly lower MBL levels were found related with sepsis in neonates, especially in newborns with culture proven sepsis. Low MBL levels may help to identify neonates with FIRS at high risk of developing sepsis.

Severe fatal course of axial mesodermal dysplasia spectrum associated with complex cardiac defect in an infant of a mother with insulin dependent diabetes.

Axial mesodermal dysplasia spectrum (AMDS) includes the features of other malformation complexes or sequences, such as oculo-auriculo-vertebral spectrum (OAVS) and sacral dysgenesis. We describe a new patient, an infant born to a type 1 diabetic mother, with the phenotype of AMDS as well as severe congenital cardiac anomalies including transposition of the great arteries and an atrioventricular septal defect. Congenital heart defects had been reported with OAVS, sacral dysgenesis, and in an infant born to a diabetic mother and combinations of these findings have been reported in the same patient. To our knowledge, this is the first patient with AMDS with transposition of great arteries and an atrioventricular septal defect and the second patient with AMDS who had history of parental consanguinity. The mechanism through which maternal diabetes mellitus leads to malformations is not entirely clear, but the glycemic control is essential in the care of mothers.