Hepatobiliary effects of cholic and lithocholic acids: experimental study in hamsters

Etiopathogenesis of biliary atresia remains unknown. Among several theories, one proposes that the disorder may be caused by the toxic effect of monohydroxy bile acids on fetal and neonatal hepatobiliary system. In this paper we evaluated toxic effects produced by ingestion of cholic acid, a trihydroxy bile acid, and lithocholic acid, a monohydroxy bile acid in the hepatobiliary system of a hamster during gestational and perinatal periods. A diet composed by 0.5% cholic acid and 0.25% lithocholic acid was administrated to pregnant hamsters. Liver and bile ducts of the adult and newborn animals were analyzed to point out the changes induced by these acids after birth. Because hamsters and humans have a similar bile metabolism, these animals were eligible for the study. The ingestion of 0.5% lithocholic acid, during hamster’s gestation, caused maternal intense ductal/ductular proliferation, inflammatory signs, hepatic cells degeneration and regeneration, hyperplasia of extra hepatic ducts epithelium, and abortion. Both 0.5% cholic acid and 0.25% lithocholic acid ingested by pregnant hamsters, caused ductal/ductular proliferation and hepatobiliary inflammatory damage in a different degree of intensity in adult animals and mild intensity in the young; and also the number of the young was reduced in the litter. We found that the ingestion of these bile acids by hamsters, during gestational period caused different degrees of toxicity on maternal and neonatal hepatobiliary systems. The histopathologic findings observed in biliary atresia patients could not be found in newborn hamsters. New experimental models are needed in the attempt to establish a correlation of these acids with neonatal cholestatic diseases.     

Energy expenditure in very low birth weight newborns: a comparison between small and appropriate‐for‐gestational‐age

Aims: To compare resting energy expenditure (REE) in small‐ and appropriate‐for‐gestational‐age very low birth weight newborns after reaching corrected at‐term age. Methods: Observational study that included all clinically stable very low birth weight newborns admitted to a neonatal intensive care unit. The newborns were classified as small‐for‐gestational‐age (SGA) and appropriate‐for‐gestational‐age (AGA). Resting energy expenditure was measured using indirect calorimetry when the newborns reached at‐term age. Results: A total of 51 newborns, of which 23 were SGA and 28 AGA, were included. There was no statistically significant difference in REE between the two groups, although the observed levels were higher than the reference values. Conclusion: There is no statistical difference in resting expenditure energy between SGA and AGA infants when they reached term. The higher energy expenditure found in both groups may be explained by other factors related to prematurity and its complications and requires further investigation.     

Motor delay in cystic fibrosis infants: an observational study

Objective

To verify the prevalence of delay in gross motor development in cystic fibrosis (CF) patients.

Study design

This is a cross-sectional observational study. A total of 15 children with CF were included in the analyses. The selection criteria was age between 6 and 42 months. Data on demographic, anthropometric, clinical characteristics and severity score (Shwachman) were obtained from patient records. The Bayley Scales of Infant and Toddler Development® - III Edition (BSITD-III) was used to assess motor abilities.

Results

Motor development delay was observed in 26.7% (n = 4) of the children and, in 75% of these, there were statistically significant differences between gross and fine motor scores. Low stature, low weight and periods longer than 60 days at hospital showed statistically significant association with motor delay (p = 0.025, 0.032, 0.003, respectively).

Conclusion

The prevalence of motor delay in the studied sample was high, suggesting that biological and ambient conditions of risk present in CF contribute to early motor deficits. Thus, the observation of the motor development in these patients is important for planning an adequate intervention.     

Normal neonatal cerebral ultrasonography in preterm infants - Is it possible to calm down the parents?

OBJECTIVE: To verify the predictive values of neonatal cerebral ultrasonography for motor and cognitive development of very low birth weight preterm babies after twelve months correct age. METHODS: The population studied was a cohort of preterm babies with birth weight less than 1,500g, who had been admitted in the Neonatal Intensive Care Unit of Instituto Fernandes Figueira, and were followed to 12-30 months corrected age for prematurity. A cerebral ultrasonography was performed before discharge. The results were classified as normal and abnormal (parenchymal hemorrhage, porencephaly, periventricular leucomalacia, ventricular dilatation). The babies were followed in the Follow-up Clinic and between 12-30 months correct age they underwent a neurological assessment with observation of the acquisition of motor milestones and submitted to Bayley Scales of Development. RESULTS: We studied 83 babies. Cerebral ultrasonography was normal in 68 babies (81.9%) and abnormal in 15 (18.8%). With a mean age of 21 months, 63 children (75.9%) had normal motor development and 20 (24.0%) had motor abnormalities. The cognitive development was normal in 68 children (81.9%). The negative predictive value of the cerebral ultrasonography for motor development was 85.3%, and for cognitive development, 86.8%. The positive predictive value of the cerebral ultrasonography for motor development was 66.7% and for cognitive development, 42.9%. CONCLUSIONS: The negative predictive values were greater than the positive predictive values in both areas of development. The probability for children with normal neonatal ultrasonography to have normal motor and cognitive development is greater than 85%.     

Mental performance of very low birth weight preterm infants: assessment of stability in the first two years of life and factors associated with mental performance

The aim of this study was to investigate the stability of mental performance of very low birth weight premature infants during the first two years of life, and to identify factors associated with mental performance.The study included 109 children. The Mental Scale of Bayley Scales of Infant Development - Second Edition was administered at 6, 12 and 18-24 months of corrected age. The stability of the scores between assessments was verified by the analysis of variance for repeated measures.The association of the major social and neonatal characteristics with mental development was confirmed using multivariate analysis by linear regression, considering the following outcomes: mental development indices at 6 months, 12 months and between 18-24 months of corrected age. The mean Mental Developmental Index (MDI) was 83.4 (SD: 12.4) at 6 months, 86.4 (SD: 13.9) at 12 months, and 73.4 (SD: 14.5) at 18-24 months. A significant decrease in the mental developmental index (13 points) at 18-24 month corrected age was observed. The Mental development index did not show stability during the first two years of life in this population of preterm infants, except for children with neonatal pneumonia whose performance was unsatisfactory in all assessments. Among the risk factors investigated only male gender and neonatal pneumonia were associated with outcomes.