External validation of bedside prediction score for diagnosis of late-onset neonatal sepsis.

OBJECTIVE: To prospectively validate performance of a prediction score for diagnosis of late-onset neonatal sepsis (LNS) in a new patient population. STUDY DESIGN: Data were prospectively collected from March 2003 to May 2004. Newborns were enrolled if they were in the neonatal intensive care unit (NICU) between 2 and 90 days, and during the first episode of clinical sepsis suspected. LNS was defined as a positive blood or cerebrospinal fluid (CSF) culture, which became the criterion standard. RESULTS: A total of 105 neonates were evaluated for sepsis. Demographic characteristics were as follows: (mean (s.d.)) were gestational age (GA) 29 (3) weeks; birth weight (BW) 1232 (620) g and postnatal age 17.5 day (12). Thirty-five (33%) neonates had LNS (35 positive blood cultures; 2 positive CSF). No significant differences in GA, BW, gender, age and central line utilization were found between LNS positive and LNS negative groups. Using a cut-off score of < or = 3, the score predicted positive culture with sensitivity of 0.97 (95% confidence interval 0.85, 0.99) and a negative likelihood ratio of 0.07. The discrimination and calibration ability of LNS score was acceptable. CONCLUSIONS: A simple clinical decision rule previously developed to predict LNS performs equally in an independent population and NICU.     

Amifostine pretreatment for protection against topotecan-induced hematologic toxicity: results of a multicenter phase III trial in patients with advanced gynecologic malignancies

OBJECTIVE: To determine if amifostine could reduce the hematologic toxicity associated with topotecan. METHODS: Thirty patients with recurrent/refractory gynecologic malignancies were randomized to receive topotecan (TOPO) (1.5 mg/m(2)/day days 1-5) with or without amifostine (AMI/TOPO) (500 mg/m(2)/day days 1-5) every 3 weeks for six cycles. The primary study endpoints were the incidence of grade 3 and 4 neutropenia. RESULTS: Fifteen patients were randomized to each arm for a total of 49 TOPO and 53 AMI/TOPO cycles. Patient characteristics and pretreatment ANC were similar between groups. Topotecan 1.5 mg/m(2)/day days 1-5 was initially administered to seven patients. Five developed neutropenic fevers, one an uncomplicated grade 4 neutropenia, and the other an uncomplicated grade 3 neutropenia. There were two treatment-related deaths due to sepsis (one in each treatment arm). The starting dose was thereafter reduced to 1.25 mg/m(2)/day days 1-5 every 21 days. No treatment related deaths occurred after this dose reduction. The incidence of combined grade 3/4 neutropenia was reduced from 67% (33/49 cycles) to 38% (20/53 cycles) with the addition of amifostine (P = 0.003; OR 0.29; 95% CI 0.12-0.71). CONCLUSIONS: Topotecan at 1.5 mg/m(2)/day days 1-5 in heavily pretreated patients resulted in excessive toxicity not manageable with amifostine. At the reduced topotecan dose (1.25 mg/m(2) x 5 days), pretreatment with amifostine reduced the hematologic toxicity associated with topotecan chemotherapy in women with recurrent/refractory gynecologic malignancies.     

Renal function during the first 72 hours of life in sick infants with birthweight less than 1250 grams

Renal function was evaluated by inulin clearance (Cin) in infants weighing less than 1250 g (N = 16) during the first 72 hours of life. Their mean +/- SD gestational age (GA) was 28.5 +/- 2.2 weeks and the birthweight (BW) was 990 +/- 158 g. Eleven studies were performed on day 1, 9 on day 2, and 11 on day 3. Mean Cin were 0.27 +/- 0.23, 0.37 +/- 0.13, and 0.46 +/- 0.44 mL/kg/min on days 1, 2, and 3, respectively, but the changes were not significant. Individual Cin values ranged from 0.039 to 1.54 mL/kg/min. The Cin was lower than that observed in larger and more mature infants. There was no correlation between Cin and fractional sodium excretion (FeNa), GA, BW, or fluid intake. Fe Na did not correlate with serum sodium or sodium intake.     

Improved outcome of extremely low birth weight infants with Tegaderm application to skin.

OBJECTIVE: Significant fluid and electrolyte disturbances occur in extremely low birth weight (ELBW) infants in the first few days of life. We investigated the effect of semipermeable polyurethane membrane (Tegaderm) applied to the skin shortly after birth on fluid and electrolyte status and the clinical outcome in these infants. STUDY DESIGN: We reviewed charts of ELBW infants (BW<1.0 kg) born during 24 months prior to Tegaderm application and 19 months after starting Tegaderm. Data were collected daily from the first week of life and additional clinical morbidities were compared. RESULTS: A total of 39 infants from pre-Tegaderm period (NOTEG) (mean+/-SD, BW 756+/-158 g, GA 26.1+/-1.9 weeks) were compared to 30 infants with extensive Tegaderm application to chest, abdomen and extremities (TEG) (BW 802+/-160 g, GA 26.3+/-1.8 weeks). The groups were similar in maternal demographics as well as postnatal surfactant use. Throughout the first week of life, serum Na levels, daily fluid intake and daily weight loss were significantly higher in the NOTEG infants (all P< or =0.04) while BUN/Serum creatinine levels were similar. Hypernatremia (Na>150 mEq/l) developed in 51% of NOTEG infants compared to 17% of TEG (P=0.0005) and daily fluid intake > or =170 ml/kg/day was required in 54 vs 13% (P=0.0008), respectively. The mean time to regain BW was significantly longer in NOTEG vs TEG infants, 20.7+/-7.4 vs 15.8+/-6.3 days, respectively (P<0.02). There were no statistical significant differences among the groups in incidence of IVH, NEC, PDA or nosocomial sepsis; however, respiratory outcome was better in TEG infants. They had significantly less BPD (58% in NOTEG vs 22% TEG (P=0.01)) and fewer infants in the TEG group required supplemental oxygen at discharge (58% vs 22% (P=0.01)). Survival was significantly higher in TEG 90% vs 64% in NOTEG infants (P=0.02). CONCLUSIONS: Semipermeable polyurethane membrane application to skin of ELBW infants shortly after birth decreased postnatal fluid and electrolyte disturbances and significantly improved their outcome by reducing severity of lung disease and decreasing mortality.     

Recombinant erythropoietin in the prevention of late anaemia in intrauterine transfused neonates with Rh-haemolytic disease.

OBJECTIVE: To evaluate the efficacy of recombinant human erythropoietin (rHuEPO) in prevention of late anaemia due to Rh-haemolytic disease in neonates subjected to one or more intrauterine transfusions (IUTs). STUDY DESIGN: Six neonates (GA 28-38 weeks, BW 980-3,360 g), subjected to one or more IUTs for Rh-haemolytic disease, were treated for 3 weeks with rHuEPO (200 U/kg/day, s.c.) after the second week of life to prevent late anaemia and consequently reduce the need for blood transfusions. All treated neonates were supplemented weekly with iron, vitamin E and folinic acid, intramuscularly. RESULTS: Of the 6 patients studied, 4 preterm neonates, after commencement of rHuEPO treatment, showed a decrease in Hct values with persistent reticulocytopenia, and consequent need for one or more transfusions with packed and filtered red cells (PFRC). These 4 neonates had received a greater blood volume with IUTs than the 2 other term neonates, who, after starting rHuEPO treatment, showed an increase in Hct values and in reticulocyte count, with no transfusion requirements after birth (247 +/- 47 vs. 84 +/- 76 ml). CONCLUSIONS: Our results seem to correlate the efficacy of erythropoietin treatment in prevention of late anaemia resulting from Rh-haemolytic disease to the severity of intrauterine anaemia and to gestational age. Erythropoietin, in fact, was less effective in cases of severe intrauterine anaemia requiring a high volume of PFRC; it was also less effective in the preterm babies, because of the simultaneous presence of anaemia of prematurity and other major diseases.     

Serum creatinine in very low birth weight infants during their first days of life.

OBJECTIVES: Little is known about the relationship between gestational age (GA) or birth weight (BW) and serum creatinine (SCr) in very low birth weight (VLBW) infants. We sought to study postnatal SCr changes and determine if there is a correlation between GA or BW and SCr in VLBW infants, during their first days of life. STUDY DESIGN: Medical records of all VLBW infants, who were admitted to our neonatal intensive care unit (NICU) between 1 May 1998 and 1 May 2001, were reviewed. Medical records were reviewed for: BW, GA, gender, race, APGAR scores, mechanical ventilation, use of medications, fluid intake, urinary output, protein intake, blood urea nitrogen (BUN) and SCr during the first days of life. Patients with anuria/oliguria, major congenital anomalies, low APGAR scores at 5 min, on high ventilator settings (on the oscillator), hemodynamically unstable (on pressors, inotropes) and on indomethacin and diuretics were excluded. RESULTS: In total, 138 infants met our inclusion criteria. SCr was found to decrease postnatally, reaching a plateau on day 5 of life in all VLBW infants (repeated measure analysis of variance; P=0.004); however, there was a delay in the decrease of SCr in the subgroup of infants <29 weeks GA, and <1000 g BW. SCr (on day 5 of life) was also found to decrease with increasing GA and BW (Pearson correlation coefficient: -0.206 (P=0.05) and -0.236 (P=0.05) respectively). CONCLUSION: In VLBW infants SCr decreases significantly during the first days of life; however, in infants younger than 29 weeks GA or smaller than 1000 g BW there is a delay in the decrease of their SCr that extends beyond the first days of life. We also conclude that during the first days of life, and in VLBW infants SCr decreases with advancing GA and BW.     

Interleukin-6 in preterm premature rupture of membranes as an indicator of neonatal outcome

BACKGROUND: The aim of this study was to investigate whether the levels of interleukin-6 (IL-6) can be used as markers of adverse outcome in preterm neonates born after preterm premature rupture of membranes (PPROM). METHODS: This study involved 109 preterm neonates and their mothers. The PPROM group consisted of 58 neonates who were born after PPROM, and the control group consisted of 51 neonates. IL-6 levels were measured in umbilical cord blood, maternal blood sampled during delivery and in neonatal blood taken on the fourth day of life. RESULTS: In the PPROM group, IL-6 concentrations in maternal blood, cord blood, and neonatal blood were significantly higher in neonates with sepsis, compared with those without sepsis (P < 0.001). Choosing 108.5 pg/ml as a cut-off concentration of IL-6 in umbilical cord blood for neonatal sepsis resulted in sensitivity 95%, specificity 100%, positive predictive value 100%, and negative predictive value 97.4%. Concerning IL-6 in maternal blood, a cut-off concentration of 81 pg/ml showed sensitivity 90%, specificity 97.4%, positive predictive value 94.7%, and negative predictive value 94.9%. Eighteen of 20 neonates with early sepsis and seven of nine neonates, who died in the PPROM group, were born of mothers with IL-6 levels above the cut-off concentration in their blood during delivery. CONCLUSIONS: IL-6 in umbilical cord blood was the most significant variable for predicting early onset sepsis in preterm neonates. IL-6 in maternal blood was indicative of intrauterine environmental threats and might be used to identify pregnancies where intervention would be appropriate.     

胎儿感染乙型肝炎病毒的临床研究

目的　探讨临床诊断胎儿感染乙型肝炎病毒 (HBV)的方法 ,及其与各种临床因素的相互关系。方法　采用聚合酶链反应 (PCR)及斑点杂交法 ,检测 14 1例HBV携带者孕妇及其分娩的 14 4例新生儿静脉血HBVDNA、HBV标志物及肝功能。其中 4 0例新生儿同时留取脐带血及出生后 2 4～4 8h外周静脉血用于检测HBVDNA。 14 4例新生儿根据有无HBV感染分为胎儿感染组及对照组 ,比较两组新生儿的临床资料及其肝转氨酶水平。结果　 (1) 14 4例新生儿中有 33例发生宫内HBV感染(胎儿感染组 ) ,感染率为 2 2 9% ;无宫内HBV感染 111例 (对照组 )。 4 0例新生儿脐血与外周静脉血HBVDNA阳性率相比 ,脐血的假阳性率为 2 0 0 % ,其敏感性、阳性预测值分别为 10 0 0 %、80 0 %。追踪HBV携带者孕妇所分娩的新生儿出生 6～ 9个月后 ,HBVDNA持续阳性者 7例 (7/2 8) ,抗 HBs转阳率为 85 3% ;出生时HBsAg阳性者 5例 ,均于 1个月后转为阴性。 (2 )在HBeAg或HBVDNA阳性孕妇中 ,其胎儿感染率分别为 70 5 %、6 1 1% ,显著高于HBeAg或HBVDNA阴性者的 2 0 % (2 /10 0 )、0 0 %(P <0 0 1)。胎儿感染组与对照组孕妇 ,在年龄、孕周、分娩方式、出生体重、身长、出生 1分钟Apgar评分等比较 ,差异均无显著性 (P >0 10 )。 (3)胎儿感染组天     

Postpartum disappearance of chorionic gonadotropin from the maternal and neonatal circulations

The disappearance of chorionic gonadotropin from the circulation was studied in a group of 10 healthy mothers and their offspring following vaginal delivery. Kinetic analysis revealed the following biexponential clearance characteristics: in mothers the rapid half-life component averaged 4.75 +/- 0.58 (SE) hours (n = 6), and the slow half-life component averaged 32.2 +/- 1.35 hours (n = 6); in neonates the respective overall means were 1.32 and 55.2 hours. Total elimination of chorionic gonadotropin (less than 0.005 IU/ml) occurred at a median time of 14 days following birth (range, 8 to 24 days) in mothers and at 1.5 days (range, 0 to 4 days) in neonates.     

Practice variation in suspected neonatal sepsis: a costly problem in neonatal intensive care.

OBJECTIVE: The most common admission to intensive care nurseries is the infant with suspected neonatal sepsis. To determine the clinical practice of neonatologists with respect to this diagnosis, we examined a large neonatal database during a 2-year period of time. The goal of this study was to define whether there were optimal practice strategies that could identify a "benchmark" clinical approach for this diagnosis. DESIGN: The PROACT database of ParadigmHealth was examined for all term infants with an admitting ICD - 9 code for suspected neonatal sepsis between January 1, 2001 and December 31, 2002. Infants had to be asymptomatic by 24 hours of life with no significant respiratory signs and receiving oral feedings. All infants had negative blood cultures. Maternal risk factors were examined to determine if they influenced the duration of therapy. The impact of treatment upon subsequent length of stay was also evaluated. Several areas of the country were individually examined to see if possible regional variations existed with respect to treatment of suspected sepsis. RESULTS: There were no significant differences noted in the management when maternal risk factors for suspected sepsis were assessed. In general, neonates were treated for 3.3+/-1.8 to 3.5+/-2.1 days, regardless of the number of maternal risk factors present at birth (p=NS). Length of stay ranged from 4.2+/-2.1 to 4.4+/-1.9 days in these groups (p=NS). The duration of treatment ranged from 1 to 10 days, even though all infants were clinically well and feeding by 24 hours of life. A total of 170 infants (17.0%) were treated for 4 to 6 days and 116 (11.6%) neonates received antibiotics for 7 to 10 days, even with negative blood cultures. One region of the country appeared to treat infants for a longer period of time than the other four regions examined, increasing the mean length of stay by 1.8 days (p<0.05). CONCLUSIONS: Treatment of neonates with suspected sepsis appears to be influenced by considerations other than maternal risk factors or the infant's clinical condition beyond the first day of life. There appears to be a great deal of practice variation among neonatologists confronted by patients with suspected sepsis. Awareness of this unnecessary variation may be of great value in reducing the duration of antibiotic therapy in the NICU and shortening the length of stay.     

Angiopoietin 2 concentrations in infants developing bronchopulmonary dysplasia: attenuation by dexamethasone.

OBJECTIVES: To study the association between angiopoietin 2 (Ang2) concentrations in tracheal aspirates (TAs) and adverse outcome (bronchopulmonary dysplasia (BPD)/death) in ventilated premature infants (VPIs) and modulation of Ang2 concentrations with dexamethasone (Dex) use. STUDY DESIGN: Serial TA samples were collected on days 1, 3, 5 and 7, and Ang2 concentrations were measured. Ang2 TA concentrations were compared prior to and after 48 to 72 h of using Dex. RESULT: A total of 151 TA samples were collected from 60 VPIs. BPD was defined as the oxygen requirement at 36 weeks postmenstrual age (PMA). Twelve infants (mean+/-s.d.) (gestational age (GA) 26.5+/-2.1 weeks, birth weight (BW) 913+/-230 g) had no BPD, 32 infants (GA 25.8+/-1.4 weeks, BW 768+/-157 g) developed BPD and 16 infants (GA 24.5+/-1.1 weeks, BW 710+/-143 g) died before 36 weeks PMA. Ang2 concentrations were significantly lower in infants with no BPD (median, 25th and 75th percentile) (157, 16 and 218 pg mg(-1)) compared with those who developed BPD (234, 138 and 338 pg mg(-1), P=0.03) or BPD and/or death (234, 157 and 347 pg mg(-1), P=0.017), in the first week of life. Twenty-six VPIs (BW 719+/-136 g, GA 25.1+/-1.3 weeks) received 27 courses of Dex. Ang2 concentrations before starting Dex were 202, 137 and 278 pg mg(-1) and significantly decreased to 144, 0 and 224 pg mg(-1) after therapy (P=0.007). CONCLUSIONS: Higher Ang2 concentrations in TAs are associated with the development of BPD or death in VPIs. Dex use suppressed Ang2 concentrations.     

The effect of gender and gestational diabetes mellitus on cord leptin concentration

OBJECTIVE: The purpose of this study was to determine the relationship of neonatal sex and gestational diabetes mellitus on cord leptin concentration and to determine whether cord leptin has a stronger correlation with fat mass compared with birth weight or lean body mass. We hypothesized that there are no significant differences in fetal leptin concentration between male and female or between neonates of mothers with gestational diabetes mellitus and control neonates, when adjusted for body composition. STUDY DESIGN: Cord blood leptin concentrations were measured in newborn infants of 78 women (44 control neonates and 34 gestational diabetes mellitus). Of the 78 neonates, 32 babies were female, and 46 babies were male. Birth weights were measured with a calibrated scale, and body compositions were measured by total body electrical conductivity. RESULTS: Estimated mean gestational age at delivery was 39.1 +/- 1.1 weeks for control neonates versus 38.6 +/- 1.3 weeks for neonates of mothers with gestational diabetes mellitus (P =.01). The fat mass for the control neonates and neonates of mothers with gestational diabetes mellitus was 0.36 +/- 0.15 kg versus 0.48 +/- 0.21 kg (P =.01); the percent body fat for the control neonates and neonates of mothers with gestational diabetes mellitus was 10.5% +/- 3.8% versus 13.2% +/- 4.3% (P =.006), respectively. There was no significant difference in cord leptin concentration between male and female neonates (16.0 +/- 13.8 ng/dL vs 12.7 +/- 12.8 ng/dL, P =.24). Cord leptin concentrations (18.1 +/- 16.2 ng/dL vs 10.9 +/- 9.5 ng/dL, P =.02) were significantly greater in neonates of mothers with gestational diabetes mellitus than in control neonates. In all subjects, cord leptin was significantly correlated with percent body fat (r = 0.51, P <.0001), fat mass (r = 0.49,P <.0001), and birth weight (r = 0.25, P =.03). After the adjustment for fat mass, there was no significant difference in cord leptin concentration between control neonates and neonates of mothers with gestational diabetes mellitus (P =.20), but there was a significant difference between male and female neonates (P =.04). However, when an adjustment was made for both fat mass and lean body mass, there was no longer a significant difference between male and female neonates (P =.12) CONCLUSION: The differences in cord leptin concentration between male and female neonates and between infants of women with gestational diabetes mellitus and control neonates are related to differences in body composition.     

Maternal and cord serum glycosylated protein in neonatal macrosomia and correlation with birth weight

Maternal glycosylated hemoglobin and glycosylated protein and cord glycosylated protein were measured at delivery in 20 normal mothers of 20 macrosomic neonates over 4000 g (group I) and compared with values in two groups of mother/infant pairs: 20 normal/20 appropriate for gestational age (group II) and nine diabetic mothers/ten neonates (group III). Infants in group I, by design, weighed more (mean +/- SD 4403 +/- 337 g) than those in group II (2902 +/- 278 g) or group III (3365 +/- 898 g) (P less than .001). There was no significant difference in weight between group II and group III infants. Birth weight ratio was greater (P less than .001) in group I than in group II or group III (1.39 +/- 0.1, 0.9 +/- 0.08, and 1.08 +/- 0.25, respectively); group III infants had a higher birth weight ratio (P less than .05) than those in group II. Hematocrit (%) was higher (P less than .05) in group III (62 +/- 3) than in group I (59 +/- 5) or group II (57 +/- 6) infants. Glycosylated hemoglobin values were similar in all three groups. Mean serum glycosylated protein was higher (P less than .001) in group III (13.8 +/- 2%) than in group I (10 +/- 2%) or group II (9.8 +/- 2.5%) mothers. Cord glycosylated protein was also higher (P less than .001) in group III (12.3 +/- 1.9%) than in group I (9 +/- 1.3%) or group II (8.6 +/- 1.7%) neonates.(ABSTRACT TRUNCATED AT 250 WORDS)     

Manual neonatal ventilation training: a respiratory function monitor helps to reduce peak inspiratory pressures and tidal volumes during resuscitation

Abstract Aims: The aim of this study was to examine the applicability of the definitions of the systemic inflammatory response syndrome (SIRS) and sepsis to neonates during the first 3 days of life. Methods: This is a retrospective study of all term neonates hospitalized within the first 24 h of life from 2004 to 2010 at our neonatal intensive care unit. Results: Of 476 neonates, 30 (6%) had a diagnosis of culture-proven early-onset sepsis (EOS) and 81 (17%) had culture-negative clinical EOS or suspected EOS. SIRS and sepsis criteria were applied to 116 (24%) and 61 (13%) neonates, respectively. Of 30 neonates with culture proven, EOS 14 (53%) fulfilled SIRS and sepsis criteria. The single diagnostic criterion of SIRS applied to 20% (hypothermia or fever), 43% (white blood cell count/immature-to-total neutrophil ratio), 87% (respiratory symptoms), and 33% (cardiocirculatory symptoms) of all neonates with culture-proven EOS. Conclusions: The definitions of SIRS and sepsis did not apply to about half of all cases of culture-proven EOS. An evidence-based approach to find the appropriate criteria for defining EOS in the neonate is needed.     

Bilirubin exposure is associated with neonatal sepsis in the eight days preceding symptoms: a retrospective study

Objective: To compare levels of bilirubin (using the area under the curve, AUC) in preterm infants before the onset of sepsis with healthy matched-controls.

Methods: Preterm infants born between January 2011 and December 2015 with late-onset sepsis were enrolled in our retrospective study and were matched with healthy controls (sex, birth weight and gestational age). Levels of bilirubin were registered in the eight days preceding the onset of sepsis and the AUC was calculated for both groups.

Results: Eighty-eight neonates (44 cases) were studied. GA and BW did not differ between cases and controls. In cases, we found a higher value of AUC (30.7 versus 22.5; p?=?0.021).

Conclusion: In our retrospective cohort, we found that the levels of bilirubin and the AUC in the first eight days before the onset of sepsis in preterm infants were significantly higher than the healthy controls. These data suggest that the prolonged exposition to high levels of bilirubin could increase the infection susceptibility in preterm infants.     

Neutrophil function in neonates born to gestational diabetic mothers.

OBJECTIVE: To examine neutrophil functional activity in the cord blood of term neonates born to gestational diabetic mothers, in association with the type of diabetes and the development of neonatal hypoglycemia. METHODS: Neutrophil chemotaxis, random motility, and chemiluminescence was evaluated in the cord blood of 30 healthy term neonates: 12 were born to gestational diabetic mothers who received no-insulin (GDM-NI), eight to gestational diabetic mothers who received insulin (GDM), and 10 to mothers without diabetes (neonatal controls). In addition, the neutrophil functional activity in the peripheral venous blood of 10 healthy adults was analyzed. RESULTS: Neutrophil functional activity in the cord blood of the neonates with and without maternal gestational diabetes was significantly lower than that in adults. As compared to neonatal controls, neonates born to both groups of GDM had decreased chemotaxis, random motility, and chemiluminescence (GDM-NI: 52.8+/-2.1 microm, p<0.001, 42.1+/-4.4 microm, p<0.001, and 140.1+/-6.9 counts per minute (cpm) x 10(3), p<0.01, respectively, and GDM: 53.0+/-1.9 microm, p<0.01, 41.8+/-4.0 microm, p<0.001, and 143.0+/-6.8 cpm x 10(3), p<0.01, respectively). Unlike controls, a tight correlation was identified between the tested neutrophil parameters in the cord blood of neonates born to diabetic mothers (r=0.70 to 0.91). The prevalence of hypoglycemia after birth was almost equal (50.0 to 41.7%) in the two groups of neonates born to diabetic mothers. There were differences in the neutrophil functional activity in the cord blood of the neonates with and without hypoglycemia. CONCLUSION: Maternal gestational diabetes leads to impairment of cord blood neutrophil motility and postphagocytic bactericidal capacity independently from the insulin requirements for the maintenance of normoglycemia during pregnancy.     

Preeclampsia does not increase the risk for culture proven sepsis in very low birth weight infants

The risk of sepsis associated with neutropenia in infants born to mothers with preeclampsia remains controversial. The objective of this study is to investigate the incidence of culture-proven sepsis along with changes in the complete blood count in very-low-birth-weight infants born to mothers with preeclampsia. We conducted a retrospective cohort study of infants cared for at a single tertiary care neonatal intensive care unit during a 4-year period. Infants born to mothers with preeclampsia (n = 88) were compared to infants born to mothers without preeclampsia (n = 416) by univariate and multivariate analysis. Although infants born to mothers with preeclampsia had lower absolute neutrophil and platelet counts throughout the first week of life, they were no more likely to have a platelet count <100,000 /mm3, and only more likely to be neutropenic at 24 and 72 hr of life compared to infants born to mothers without preeclampsia. After controlling for potential confounding variables, there was no increase in the odds of culture proven sepsis in infants born to mothers with preeclampsia (odds ratio 1.6, 95% confidence intervals 0.7-3.6, p = 0.3) compared to those infants born to mothers without preeclampsia. We conclude that very-low-birth-weight infants born to mothers with preeclampsia are not at increased risk of culture proven sepsis despite a reduction in absolute neutrophils.     

Effect of antenatal dexamethasone on neonatal leukocyte count

The leukocyte count and differential white blood cell count during the first hour of life was determined in 164 neonates born of mothers receiving antenatal steroids and compared to 171 neonates of mothers randomly assigned to a placebo group. A leukemoid reaction (greater than 40,000 WBC/mm3) was seen only once each in the neonates born of placebo or steroid treated mothers. In addition, maternal steroid treatment had no general effect, except in a small subgroup of neonates born 3 to 7 days after the mother had been treated with 20 mg dexamethasone, where the total leukocyte and the absolute neutrophil counts were higher than the placebo group and other subgroups.     

Birth weight for gestational age centiles for Italian neonates.

OBJECTIVE: To provide centiles for birth weight (BW) according to gestational age (GA) and sex for infants born in Italy. METHODS: We used records of the whole neonatal population of Tuscany, a region in Italy, from July 1991 to June 2002 as resulting from the database of the cystic fibrosis neonatal screening program (n=290129). We excluded as unlikely for GA those BW that were more than two interquartile ranges above the 75th centile or below the 25th centile for each GA and gender group. RESULTS: We present the 3rd, 10th, 25th, 50th, 75th, 90th and 97th centiles of BW for GA from the 24th to 43rd week of gestation for male and female Italian neonates, as both tables and smoothed curves. CONCLUSIONS: The large size of the examined population allows us to provide up-to-date, reliable BW for GA centiles for Italian newborns, especially for lower GAs.