AIM: The specific aim of the study was to determine the correlation between the severity of pathology, the amount of blood removed for diagnostic purposes in the 1st week of life and the incidence of early anaemia in very low birth weight (VLBW) infants. METHODS: We recorded the level of haemoglobin (Hb) and haematocrit (Ht) in each of the 50 infants entered in the study at their admission in our neonatal intensive care unit (NICU) and at the age of 8 days. We quantified for each infant the blood drawn for clinical purpose during the 1(st)week of life, using microanalytic techniques for all types of analysis performed. Using the neonatal therapeutic intensive score system (NTISS) we divided all patients into 2 groups: group A= mild light pathology; group B= severe pathology. RESULTS: There was statistically significant difference between the percent decrease of Hb and Ht with reference to the birth weight in the 2 groups. Logistic regression analysis indicated a strong correlation (P = 0.009) between higher degree of illness severity and higher percent decrease of Hb and Ht. The difference due to the amount of phlebotomy losses was not significant. CONCLUSIONS: To our knowledge, this study is the first that strongly suggest that phlebotomy losses is not the main cause of anaemia in VLBW preterm infants in the 1st week of life, when a policy of strictly attention to the amount of blood removed is performed.

Age Factors↗

PubMed2005

Potential risk factors for the development of acute renal failure in preterm newborn infants: a case-control study.

AIMS: To determine in a case-control study possible associations between the development of acute renal failure in preterm newborns and therapeutic interventions, particularly drug treatments. METHODS: The study population was 172 preterm infants of <38 weeks gestation; 71 had acute renal failure and 101 were controls closely matched for gestational age and birth weight. Maternal and neonatal information was collected for both groups through questionnaires and interviews. Routine data on renal variables were also collected. Univariate and multivariate logistic regression analyses were performed. RESULTS: Very low birthweight infants were at high risk of acute renal failure (79% of cases were <1500 g). However, the acute renal failure was transient. Mothers of infants with acute renal failure received more drugs during pregnancy and delivery (mainly antibiotics and non-steroidal anti-inflammatory drugs). Of the possible therapeutic interventions, intubation, catheterisation, and phototherapy were mainly applied to case subjects. A low Apgar score and patent ductus arteriosus were diagnosed in a greater percentage of neonates with acute renal failure. Moreover, in the first few days of life and before diagnosis of acute renal failure, case subjects received more drugs (antibiotics, non-steroidal anti-inflammatory drugs, and diuretics) and for a longer time. In the multivariate logistic analysis, medullary hyperechogenicity (odds ratio (OR) 4.491; 95% confidence interval (CI) 1.879 to 10.731) and ceftazidime administration (OR 5.082; 95% CI 1.493 to 17.297) were associated with a greater risk of acute renal failure. CONCLUSIONS: The results suggest the need for careful monitoring of very low birthweight infants and attention to drug treatments, as it is difficult to differentiate between normality and renal failure in the first few days of life.

Acute Kidney Injury↗

PubMed2005

Antibiotic therapy in pregnancy and lactation.

When considering whether to administer drugs to women during pregnancy and lactation, we have to take into account that these substances may expose the fetus or neonate to multiple effects. This occurs because there is a unique situation where the maternal compartment is connected with the fetal or neonatal compartment through, respectively, the placental barrier or breast milk. The fetus in utero and the breast-fed neonate are to be considered as organisms exposed and sensitive to the effects of drugs that cross the placenta or enter the breast milk. This review focuses on the most frequently used antibiotics during pregnancy and lactation and presents useful suggestions for daily practice. Drugs that must be avoided are clearly underlined.

Abnormalities, Drug-Induced↗

PubMed2005

Acute encephalopathy associated with respiratory syncytial virus infections in childhood. A literature review.

Respiratory syncytial virus (RSV) has been described as the single most important virus causing acute respiratory infections, especially bronchiolitis and pneumonia, in children. The most severe infections affect the youngest infants and well-defined high-risk groups, including infants with a history of premature birth, and those with chronic lung disease, congenital heart disease, cystic fibrosis and immunodeficiency. It has been reported that approximately 1/3 of high-risk children hospitalized with RSV infection are admitted to the intensive care unit, while the need for mechanical ventilation and mortality rate are increased in infants with underlying cardiac disease or chronic lung disease. The majority of infants hospitalized for RSV lower respiratory tract infection develop one complication or more, which have an impact on hospital length of stay and costs. A relatively uncommon complication consisting of seizures and other neurologic abnormalities such as lethargy, irritability and abnormal tone has been sporadically reported in infants and children with RSV respiratory infection. A recent study first focused on the association between RSV bronchiolitis and an encephalopathic process occurring in the form of a seizures disorder. This transient neurologic complication seems to be frequently associated with an abnormal EEG pattern, but no anatomic brain damages have been shown. Little is known about the long-term neurodevelopmental outcomes of children developing RSV-related encephalopathy, so a prolonged period of neurologic follow up can be recommended.

Acute Disease↗

PubMed2003

Rare urological abnormalities in 2 cases of Menkes' syndrome.

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Humans↗

PubMed2002

Role of renal PGE2 in the adaptation from foetal to extrauterine life in term and preterm infants.

Urinary PGE(2) concentrations were assayed using a new EIA method, in 16 preterm and 18 term neonates at birth and 3 days later, since there is evidence that PGE(2) in urine are likely to reflect their renal generation and then could be correlated with kidney maturation or renal problems. PGE(2) concentrations were not different at birth (1.50+/-1.12 vs 1.56+/-1.94 ng/day), while resulted significantly higher in preterms, compared to terms, three days after birth (2.22+/-1.23 vs 1.39+/-0.79 ng/day). This increase in daily PGE(2) excretion observed only in preterm neonates could be due to an increased renal biosynthesis as a mechanism of compensatory response to prevent further decrements in renal plasma flow, since prostanoids play an important role in protecting the immature kidney from high levels of angiotensin II. Otherwise, the passive reabsorption of PGE(2) along the distal nephron could be altered because of kidney immaturity. The measurement of PGE(2) in urine of neonates, particularly prematures, could be useful to provide a better understanding of the homeostatic function of the kidney in the phase of adaptation to extra-uterine life.

Adaptation, Physiological↗

PubMed2002

Netilmicin effect on urinary retinol binding protein (RBP) and N-acetyl-beta-D-glucosaminidase (NAG) in preterm newborns with and without anoxia.

The study aim was to evaluate urinary excretion of Retinol Binding Protein (RBP), compared with urinary excretion of N-acetyl-beta-D-glucosaminidase (NAG), in preterm infants with anoxia and netilmicin treatment. Urinary RBP and NAG were evaluated in 83 preterm newborns divided in 4 groups: 37 healthy preterm newborns (controls); 14 with neonatal anoxia; 16 treated with ampicillin + netilmicin; 16 with neonatal anoxia and treated with ampicillin + netilmicin. RBP was determined by an automated nephelometric technique and NAG by a colorimetric method on 5-h urine samples in the first week of life. Results showed that urinary excretion of RBP (average from first week values) was 1.06+/-0.67 g/mol creatinine (mean +/- SD) in controls, 1.99+/-1.41 in antibiotic-treated newborns, 3.99+/-4.57 in anoxic newborns and 3.75+/-3.48 in anoxic newborns under antibiotic treatment. When gestational age was not considered, a marked effect of anoxia (P<0.001) and a borderline effect of netilmicin (P<0.059) on RBP excretion were detected by ANOVA. However when gestational age was also considered by analysis of covariance, it appeared as the strongest predictor of RBP excretion (P<0.001), while the effect of netilmicin was no longer significant (P=0.181). The effect of anoxia persisted, although less remarkable (P=0.010). Conversely anoxia did not affect urinary NAG excretion, which was rather correlated with gestational age and netilmicin administration. The authors conclude that RBP and NAG urinary excretion may be used to discriminate between neonatal anoxia and netilmicin treatment, respectively as etiologic factors of renal tubular damage in the newborn.

Acetylglucosaminidase↗

PubMed2002

Unresolved questions regarding the mediaeval child.

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Child↗

PubMed2001

Urinary PGE(2) concentrations measured by a new EIA method in infants with urinary tract infections or renal malformations.

In this work PGE(2)concentrations were measured by a new EIA method in the urine of infants (mean age: 9.35+/-4.24 months) with recurrent urinary tract infections or renal malformations. Compared to healthy subjects, PGE(2)excretion rates resulted significantly higher in both pathological groups, in particular in subjects with obstructive uropathies (29.55+/-8.12 vs 18.37+/-4.64 pg/ml). We did not find any age- or pH-dependent difference in urinary excretion of PGE(2); none of the examined indices of renal function showed any significant relationship to PGE(2). These results suggest that this parameter, measured non-invasively in the urine, could help in the differential diagnosis between obstructive vs non-obstructive dilatation and in monitoring renal function in presence of recurrent UTI episodes.

Age Factors↗

PubMed2001

Cefixime in urinary tract infections with special reference to pediatrics: overview.

Cefixime is a third-generation oral cephalosporin that is highly active against a broad range of gram-negative and some gram-positive aerobic bacteria. In non-complicated urinary tract infections it is at least as effective as other usual treatments, and has a low rate of side effects. Several clinical studies have been performed on cefixime in urinary tract infections both in adults and children. On the basis of the literature data, cefixime could be indicated in the treatment of non-complicated urinary tract infections in children either as monotherapy or as switch therapy.

Bacterial Infections↗

PubMed2001

Renal transport of antibiotics and nephrotoxicity: a review.

The renal excretion of a drug can essentially be divided schematically into three functional processes: glomerular filtration, tubular reabsorption and tubular secretion. When assessing nephrotoxicity, the tubular secretion system, which allows transport of the drug from the blood to the urine via the tubular cells, is particularly important. Historically, two distinct tubular secretion mechanisms have been described for drugs: one via organic cations and the other via organic anions. More recently, a third tubular secretion mechanism has been identified, mediated by P-glycoprotein. In the present review, a number of examples will be given relating to antibiotic-induced kidney damage determined via the tubular reabsorption mechanism (aminoglycosides, amphotericin B) and via the tubular secretion mechanism (cephalosporins, vancomycin), respectively. Drug transport within the tubular cells is the first fundamental stage in the onset of the nephrotoxic process. Knowledge of these concepts is important for the prevention of iatrogenic kidney damage, particularly in patients with underlying disease receiving concomitant treatment with several potentially nephrotoxic molecules.

Absorption↗

PubMed2001

NSAID-induced nephrotoxicity from the fetus to the child.

In this review we report data available from the literature on the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and the development of nephrotoxicity in the fetus, neonates and children. Up to the present day, several cases of severe and sometimes irreversible renal insufficiency have been described in neonates exposed to indomethacin prenatally or in the first days of life for treatment of patent ductus arteriosus (PDA). Until now, very few studies have been carried out on alternative treatments for PDA in preterm infants; ibuprofen has been shown to be as effective as indomethacin in closing the ductus in this patient group without affecting renal function. In children, NSAID-induced renal failure is a rare event and is usually reversible after discontinuation of the drug. However, caution should be taken when NSAIDs are administered to individuals with preexisting renal problems or with other potentially nephrotoxic drugs. In these situations, new approaches such as cyclo-oxygenase-2 selective inhibitors or prostanoid receptor selective antagonists could lead to alternative therapies for use in paediatrics.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2001

Multicystic dysplastic kidney and contralateral vesicoureteral reflux. Renal growth.

BACKGROUND: To evaluate if vesicoureteral reflux (VUR) contralateral to the multicystic dysplastic kidney can interfere with the compensatory renal hypertrophy. METHODS: Twenty-seven patients (17 males, 10 females) with multicystic dysplastic kidney (MDK) (14 on the right, 13 on the left) have been treated at the Nephrology Unit of the Pediatric Department of the University of Verona from birth up to the second year of life. All these patients were diagnosed as having MDK by prenatal ultrasonography. Seven children (4 males and 3 females) had VUR (5 monolateral, 2 bilateral), diagnosed at the end of the first month of life. After diagnosis children underwent antibiotic prophylaxis with beta-lactam compounds at low doses. Four patients underwent a surgical correction of VUR associated with nephrectomy within the second year of life. The remaining 3 patients were treated with antibiotic prophylaxis; a progressive resolution or downgrading of reflux grade took place respectively in 1 and in 2 of them. Only 6 children with MDK underwent nephrectomy. Renal growth was studied by serial echographic measurements of the longitudinal renal lenght (performed at birth, at 6 months, and at 2 years of life). RESULTS: Renal length was 5.68+/-1.24 cm, 6.72+/-0.88 cm, 8.56+/-1.27 cm in children without VUR, respectively at birth, 6 months and 2 years of life. Renal length was 4.65+/-0.63 cm, 6.70+/-0.64 cm, 7.07+/-1.14 cm in children with VUR, respectively at birth, 6 months and 2 years of life. A statistically significant difference was observed between the two groups at birth (p<0.05) and at 2 years of life (p<0.01). CONCLUSIONS: The conclusion is that VUR contralateral to the MDK is associated with small kidneys and reduced renal growth both at birth and at 2 years of life.

Age Factors↗

PubMed2000

Multicystic kidney dysplasia and Turner syndrome: two cases and a literature review.

Renal malformations occur in 33%-70% of cases of Turner syndrome (chromosome 45 and variants). We describe two cases of multicystic dysplastic kidney in Turner syndrome. A literature review of renal abnormalities in Turner syndrome shows the frequency of cystic disease to be 1.76%. In multicystic dysplastic kidney, diagnostic investigation of the contralateral kidney, including voiding cystourethrography, is necessary in view of the high incidence of associated diseases (15%-20% of cases, vesicoureteric reflux) and other anomalies.

Female↗