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PubMed2001

Modulation of calcium oxalate monohydrate crystallization kinetics by urine of preterm neonates.

Preterm neonates frequently develop nephrocalcinosis (NC). However, the cause has not yet been elucidated. This study focuses on the effects of urine from preterm neonates on crystallization kinetics. Urine samples were collected and renal ultrasound examinations of preterm neonates (gestational age < 32 weeks) were performed during the first weeks of life, at term, and ages 6, 12, and 24 months. The effect of urine on crystallization was determined using a seeded crystal growth system, which measures the square root of solubility product ( radicalLc), percentage of growth inhibition (GI), and agglomeration inhibition ([tm]) of calcium oxalate crystals. Data for preterm neonates in the first weeks of life (n = 19) were compared with those for full-term neonates (n = 17) and healthy adults. Moreover, the correlation between [tm] and urinary (U)citrate level was studied. Mean radicalLc (0.27 +/- 0.1 versus 0.36 +/- 0.08 mmol/L) and mean [tm] (81 +/- 32 versus 143 +/- 97 minutes) were lower and mean Ucalcium-creatinine (2.20 +/- 1.74 versus 0.46 +/- 0.73 mol/mol) and Uoxalate-creatinine ratios (0.39 +/- 0.21 versus 0.16 +/- 0.09 mol/mol) were greater in preterm neonates in the first weeks of life compared with full-term neonates (p < 0.05). Furthermore, [tm] was less than the lower limit for healthy adults for all but one preterm neonate; [tm] increased and Ucalcium-creatinine and Uoxalate-creatinine ratios decreased with age (p < 0.005). There was a correlation between [tm] and citrate excretion (coefficient of 38; P < 0.001). Patients with and without NC at term did not differ statistically in mean radicalLc, percentage of GI, or [tm]. In conclusion, urine from preterm neonates in the first weeks of life is highly supersaturated and has a defective ability to inhibit calcium oxalate crystal agglomeration. This ability improves with age and is citrate mediated. We suggest that both the high level of supersaturation and defective ability to inhibit calcium oxalate crystal agglomeration contribute to the high incidence of NC.

Adult↗
PubMedDate not supplied

[Echocardiographic post-neonatal progress of preterm neonates with patent ductus arteriosus].

OBJECTIVE: To identify clinical and echocardiography predictors of the spontaneous closure of patent ductus arteriosus in preterm neonates. METHODS: Sixty-one consecutive preterm neonates (gestational age 30+/-2 weeks, birth weight 1.2+/-0.2 kg) were evaluated by echocardiogram on their third day of life and those with patent ductus arteriosus were selected for a prospective cohort. Echocardiography was repeated weekly until they reached term. Based on their progress, the sample population was divided into two groups, depending on whether spontaneous closure of patent ductus arteriosus took place (Group A) or not (Group B). The prevalence of clinical signs of patent ductus arteriosus and echocardiography findings at baseline were compared between the groups. RESULTS: Patent ductus arteriosus was found in 21 neonates (34%). Spontaneous closure was observed during follow-up of seven patients (Group A, 33% of those with patent ductus arteriosus), in contrast with the remaining 14 patients (Group B, 67%). Clinical signs of patent ductus arteriosus were present in 14% of the patients in Group A, compared with 71% in group B (p = 0.01). At baseline, Group B had a larger ductus diameter in relation to Group A (2.6+/-0.6 mm vs. 1.4+/-0.6 mm; p = 0.003). The area under the ROC curve in relation to ductus diameter was 0.93 (p = 0.003) and 100% sensitivity for identifying cases without spontaneous closure was obtained at the cutoff point of 1.7 mm, while 100% specificity was observed taking 2.2 mm as the cutoff. CONCLUSIONS: In preterm neonates, a patent ductus arteriosus greater than 2.2 mm on the third day of life predicts no spontaneous closure and suggests a need for early treatment, especially when associated with clinical signs.

Birth Weight↗
PubMed1999

Analgesia and sedation in preterm neonates who require ventilatory support: results from the NOPAIN trial. Neonatal Outcome and Prolonged Analgesia in Neonates.

BACKGROUND: Preterm neonates are exposed to multiple painful procedures after birth and exhibit acute physiological responses to pain. Occurrence of early intraventricular hemorrhage within 24 to 72 hours after birth suggests a role of pain and stress in the multifactorial causation of severe intraventricular hemorrhage and periventricular leukomalacia. We proposed that such neurologic outcomes in preterm neonates who require ventilatory support may be reduced by morphine analgesia or midazolam sedation compared with a placebo. OBJECTIVES: To define the incidence of clinical outcomes in the target study population, to estimate the effect size and adverse effects associated with analgesia and sedation, and to calculate the sample size for a definitive test of this hypothesis. METHODS: Sixty-seven preterm neonates were randomized in a pilot clinical trial from 9 centers. Neonates of 24 to 32 weeks gestation were eligible if they had been intubated and required ventilatory support for less than 8 hours and if they were enrolled within 72 hours after birth. Exclusion criteria included major congenital anomalies, severe intrapartum asphyxia, and participation in other research studies. Severity of illness was assessed by the Clinical Risk Index for Babies, and neonates were randomized to receive continuous infusions of morphine sulfate, midazolam hydrochloride, or 10% dextrose (placebo). Masked study medications were continued as long as clinically necessary, then weaned and stopped according to predefined criteria. Levels of sedation (COMFORT scores) and responses to pain (Premature Infant Pain Profile scores) were measured before, during, and 12 hours after discontinuation of drug infusion. Cranial ultrasound examinations were performed as part of routine practice, and poor neurologic outcomes were defined as neonatal death, severe intraventricular hemorrhage (grade III or IV), or periventricular leukomalacia. RESULTS: No significant differences occurred in the demographic, clinical, and socioeconomic variables related to mothers and neonates in the 3 groups or in the severity of illness at birth as measured by Clinical Risk Index for Babies scores. Two neonates in the placebo group and 1 neonate in the midazolam group died; no deaths occurred in the morphine group. Poor neurologic outcomes occurred in 24% of neonates in the placebo group, 32% in the midazolam group, and 4% in the morphine group (likelihood ratio chi2 = 7.04, P = .03). Secondary clinical outcomes and neurobehavioral outcomes at 36 weeks' postconceptional age were similar in the 3 groups. Responses elicited by endotracheal tube suction (Premature Infant Pain Profile scores) were significantly reduced during the morphine (P<.001) and midazolam (P = .002) infusions compared with the placebo group. CONCLUSIONS: This pilot trial suggests that preemptive analgesia given by continuous low-dose morphine infusion may reduce the incidence of poor neurologic outcomes in preterm neonates who require ventilatory support. Limitations in the sample size of this pilot study suggest that these results should be confirmed in a large multicenter randomized trial.

Analgesia↗
PubMed1993

Massage effects on cocaine-exposed preterm neonates.

Thirty preterm cocaine-exposed preterm neonates (mean gestational age 30 wks, mean birth weight = 1212 g, mean intensive care unit duration = 18 days) were randomly assigned to a massage therapy or a control group as soon as they were considered medically stable. Group assignment was based on a random stratification of gestational age, birth weight, intensive care unit duration, and entry weight into the study. The treatment group (N = 15) received massages for three 15-minute periods 3 consecutive hours for a 10-day period. Findings suggested that the massaged infants (1) averaged 28% greater weight gain per day (33 vs 26 g) although the groups did not differ in intake (calories or volume), (2) showed significantly fewer postnatal complications and stress behaviors than did control infants, and (3) demonstrated more mature motor behaviors on the Brazelton examination at the end of the 10-day study period.

Adult↗
PubMed1998

Impaired phagocytosis and opsonisation towards group B streptococci in preterm neonates.

AIMS: To study the chemiluminescence response in polymorphonuclear leucocytes (PMNL) at different stages of maturity and the opsonic capacity of sera with defined titres of anti-capsular type III antibodies, after exposure to serotype III group B streptococci (GBS). The influence of GBS type III capsule expression on PMNL chemiluminescence response was also investigated. METHODS: Two clinical isolates of serotype III GBS and two serotype III reference strains which form isogenic variants with high and low amounts of capsule substance, respectively, were used. PMNL and sera were obtained from adult healthy blood donors, full term neonates, and preterm neonates. RESULTS: PMNL from premature infants showed a significantly lower chemiluminescence response (p < 0.0001) than the PMNL from adults and neonates, while the chemiluminescence response with adult, neonatal, and preterm sera gradually diminished. In the presence of a serum pool with a standardised complement value, raised (> 10 mg/l), rather than low (< 1.0 mg/l) anti-III antibody titres induced a higher chemiluminescence response to the capsule expressing variant. When GBS were cultured at pH 5.0, the bacteria had a higher buoyant density, reflecting decreased expression of capsule substance compared with bacteria grown at pH 7.4. Concomitantly, there was a substantial increase in chemiluminescence response for all isolates cultured at the lower pH, except for the capsule deficient mutant. CONCLUSIONS: PMNL function and opsonic capacity are significantly impaired in neonates and correlate with maturation of the newborn child. The combined defect in cellular and humoral defences in preterm neonates may contribute to their increased susceptibility to GBS infection. Growth conditions for GBS, simulating different in vivo environments, greatly affect capsule expression and resistance to phagocytosis.

Adult↗
PubMed2000

Ultrasonographic features of nephrocalcinosis in preterm neonates.

Nephrocalcinosis (NC) in preterm neonates has been reported frequently and small studies suggest an unfavourable effect on renal function. Data on ultrasonic features are limited and the reproducibility of ultrasonography (US) in detecting NC in preterm neonates is unknown. In this study, interobserver and intraobserver agreement of US was determined through videotape recordings of US examinations of preterm neonates. Furthermore, a prospective US study was performed in 215 preterm neonates (gestational age < 32 weeks) to evaluate ultrasonic characteristics, incidence, time course and effect on kidney length of NC. Patients were studied at 4 weeks after birth and at term. Patients with NC were followed for 2 years. NC was defined as bright reflections in the medulla or cortex seen in both transverse and longitudinal direction. The length of the kidneys was noted. The kappa value was 0.84 for intraobserver and 0.46 for interobserver agreement, whereas the overall agreement was 73%. NC was found in 50 of 150 (33%) patients at 4 weeks and in 83 of 201 patients (41%) at term. NC was localized mainly in the medulla. At 1 and 2 years, NC had persisted in 36% and 26%, respectively, of the patients with NC at term. Kidney length was comparable with normal values. In conclusion, US has a very good intraobserver agreement but a moderate interobserver agreement in detecting NC. Medullary NC is common among preterm neonates. During the first 2 years of life, the incidence decreases spontaneously and NC does not influence kidney length.

Follow-Up Studies↗
PubMed2002

Magnesium sulfate and neonatal outcomes of preterm neonates.

OBJECTIVE: To determine whether in utero exposure to magnesium sulfate was associated with increased neonatal morbidity and mortality among premature neonates, and secondarily to determine the relationship, if any, between duration of magnesium sulfate exposure and neonatal morbidity and mortality. METHODS: We studied 401 neonates at our institution who were born between 23 and 34 weeks' gestation following preterm labor or preterm premature rupture of membranes. The population was stratified by exposure to magnesium sulfate and compared by various neonatal outcome variables. Similarly, the magnesium-exposed population was stratified by duration of exposure and compared for various neonatal outcome variables. Student's t test, chi2 test, Fisher's exact test and logistic regression were used for analysis. RESULTS: A total of 190 neonates were exposed to magnesium sulfate, while 211 neonates were not. The magnesium-exposed neonates were delivered at a significantly lower gestational age compared to the unexposed neonates (28.2 +/- 3.0 vs. 29.3 +/- 3.1 weeks, p = 0.001). Univariate analysis revealed no differences between groups with regard to rates of respiratory distress syndrome, intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, patent ductus arteriosus, histological and clinical chorioamnionitis, neonatal sepsis or neonatal death. However, magnesium-exposed neonates were more likely to have received antibiotics (71.6% vs. 45.0%, p = 0.0001) and antenatal steroids (95.8% vs. 61.6%, p = 0.0001), factors known to affect perinatal morbidity and mortality. Controlling for antenatal confounding factors, magnesium sulfate use was not independently associated with neonatal mortality (odds ratio (OR) = 0.66; 95% confidence interval (CI) = 0.28, 1.54; p = 0.34). Seventy-nine neonates were exposed to magnesium sulfate therapy for more than 24 h, while 111 neonates were exposed for 24 h or less. There were no significant differences between groups with respect to neonatal outcomes, with the exception of an increased rate of clinical chorioamnionitis in the group exposed to magnesium for more than 24 h (22% vs. 8.2%, p = 0.005). After adjusting for gestational age at delivery, magnesium sulfate exposure for over 24 h was independently associated with a 2.8-fold increased rate of clinical chorioamnionitis (OR = 2.8, 95% CI = 1.14, 6.90; p = 0.02). CONCLUSION: Prenatal exposure to magnesium sulfate was not associated with increased neonatal morbidity or mortality. However, prolonged exposure to magnesium sulfate may be associated with an increased risk of clinical chorioamnionitis.

Adult↗
PubMed1990

Cerebrospinal fluid and plasma beta-endorphin-like immunoreactivity in full-term neonates and in preterm neonates with and without apnea of prematurity.

Beta-endorphin-like immunoreactivity (B-ELI) was measured in cerebrospinal fluid (CSF) and plasma from infants of postnatal age 24 h to 70 days. Three groups were examined: 17 were of postconceptual age greater than or equal to 37 weeks, 16 were postconceptual age less than or equal to 35 weeks without apnea and 10 were of postconceptual age less than or equal to 35 weeks with apnea. All infants were clinically stable. Two-way analysis of variance between groups showed no difference in the concentration of B-ELI in CSF or plasma, or in the CSF/plasma B-ELI ratio. Concentrations of B-ELI in plasma were significantly higher in infants of postnatal age 1-3 weeks and greater than or equal to 4 weeks, than in infants of postnatal age less than 1 week. We conclude that, in nonstressed infants, there is no relationship between the concentration of B-ELI in CSF or plasma and a concurrent diagnosis of apnea of prematurity. Our data indicate that a significant developmental increase occurs in the plasma concentration of B-ELI after the first week of life.

Aging↗
PubMed2002

Influence of dietary cholesterol on vitamin d metabolism in formula-fed preterm neonates.

OBJECTIVES: Supplementation of preterm formulas with cholesterol could help to mimic the fat composition of human milk. However, this could possibly influence vitamin D 25-hydroxylation because this reaction is catalyzed in part by the mitochondrial cytochrome P-450, the enzyme responsible for the 27-hydroxylation of cholesterol. The purpose of this study was to verify whether the addition of cholesterol to preterm formulas could interfere with vitamin D metabolism in preterm neonates. METHODS: In a prospective study, 30 preterm neonates were randomly assigned to a low (< 0.03 g/L), medium (0.15 g/L), or high (0.30 g/L) cholesterol-content preterm formula until theoretical term (i.e., 40 weeks post-conceptional age). Anthropometric data and serum hydroxy-vitamin D and 1,25 dihydroxy-vitamin D concentrations were measured at study entry and theoretical term. In a subgroup of 14 subjects, serum cholesterol and lymphocyte 3-hydroxy-3-methylglutaryl coenzyme A reductase mRNA were also assessed. RESULTS: (median [25, 75 centiles]): At theoretical term, there were no significant differences in serum hydroxy-vitamin D concentrations among the three groups, even after adjustment for confounding variables (65 [50, 78] nmol/L, 79 [59, 86] nmol/L, and 67 [43, 103] nmol/L, respectively, = 0.65) or 1,25 dihydroxy-vitamin D ( = 0.88). Furthermore, there were no significant differences in 3-hydroxy-3-methylglutaryl coenzyme A reductase mRNA copy numbers. CONCLUSIONS: In preterm neonates fed formulas with a cholesterol content similar to or higher than that of human milk, we did not observe deleterious effects on vitamin D metabolism. However, long-term effects of cholesterol supplementation require further studies.

Bottle Feeding↗
PubMed1999

Detection of secretory immunoglobulin A (SIgA) in saliva of ventilated and non-ventilated preterm neonates.

The very young preterm neonate has multiple immune deficiencies which may increase his or her vulnerability to infection. Secretory Immunoglobulin A (SIgA) plays an important role in the protection of epithelial surfaces exposed to the external environment; nevertheless controversy exists with regards to the ontogeny of SIgA in newborns and especially the preterm neonate. The objective was to investigate if SIgA could be detected in the saliva of very/extremely low birthweight neonates (V/ELBW). A total of 707 samples which were collected twice daily (morning and afternoon) for three consecutive days were obtained from sixty-eight preterm neonates (mean gestational age 28 weeks; conceptional age ranged from 25-35 weeks). A repeated measures design was used. Total concentration of SIgA was determined from unstimulated saliva by an Enzyme Linked Immunosorbant Assay technique. Results indicated that SIgA was detectable in the early postnatal period in the saliva of both ventilated preterms who were receiving intravenous total parenteral nutrition (TPN) and non-ventilated preterms. A 3-way repeated measures Analysis of Variance (ANOVA) showed no significant effect from 'before' and 'after' samples during a period of spontaneous activity, time and day of sampling. A significant effect of mode of nutrition was found; neonates who were receiving expressed breast milk had significantly higher concentrations of SIgA than those infants receiving TPN (df=3, F=14.27, p<0.0001). These results have implications for the care of the preterm neonate in intensive care.

Journal Article↗
PubMed2002

Diversification of Ig heavy chain genes in human preterm neonates prematurely exposed to environmental antigens.

Preterm neonates are exposed to extrauterine environmental Ags during the time period that corresponds to the last trimester of normal intrauterine development. To study whether this precocious exposure to Ags accelerates the Ig repertoire diversification, we compared IgH chain genes of preterm neonates (gestational age, 25-29 wk) during their first postnatal months with those of term neonates. Preterm infants approaching their expected date of delivery after 8-13 wk of extrauterine life used a similar V(H), D(H), and J(H) gene segment repertoire as term neonates born after intrauterine development. Furthermore, the length increase of the NDN region between V(H) and J(H) by 0.25 nt per gestational week (r = 0.556, p < 0.0001) was not accelerated. Thus, the generation of the V(H) region gene repertoire is developmentally controlled and independent of environmental influences. However, exposure to extrauterine Ags induced class switch and somatic mutations in IgH chain genes within 2 wk after premature birth and IgG transcript diversity and mutational frequency increased with the duration of extrauterine life. Three-month-old preterm infants expressed a heterogeneous IgG repertoire at their expected date of delivery with V(H) region genes carrying significant numbers of somatic mutations with evidence for Ag selection. Term neonates, however, had no such IgG repertoire. We conclude that restrictions in the neonatal Ig V(H) region gene repertoire persist until term despite exposure to environmental Ags. Yet, many weeks before term the immune system of the preterm neonate can already support germinal center reactions in response to environmental Ags.

Antigens↗
PubMed2001

Ultradian and circadian activity-rest rhythms of preterm neonates compared to full-term neonates using actigraphic monitoring.

During the first weeks of life, preterm neonates show fewer circadian rhythms in their physiological parameters than full-term neonates. To determine whether preterm neonates differ in their temporal adaptation to the day-night cycle from full-term neonates at the early age of 1 week, we compared activity-rest behavior of both groups. Activity-rest behavior of 10 neurologically healthy preterm neonates (born in 34th to 36th week of gestation) and 10 neurologically healthy full-term neonates (born in 37th to 42nd week of gestation) was monitored longitudinally for 8 successive days in the first 2 weeks of life. Actigraphy was used to register and display time patterns of activity and rest in neonates by using small actometers, which resemble a wristwatch. Nursing/feeding was recorded using the actometer's integrated event marker button. Recordings for preterm neonates were conducted in the hospital, recordings for full-term neonates were carried out in the hospital and in their homes. In addition to the actigraphic recordings, a standardized diary was kept regularly. To assess periodic characteristics, frequency components of activity-rest behavior were analyzed using fast Fourier transformation (FFT). Amounts of daily sleep time, nightly sleep time, and sleep time during 24h were compared. Nursing/feeding epochs were also analyzed for 5 preterm and 5 full-term neonates to compare their food intake behavior. The majority of preterm neonates showed a multitude of ultradian frequencies in their spectra. In contrast, several full-term neonates showed a distinct circadian frequency. In preterm neonates, average nightly sleep and average daily sleep of all recorded days were very similar, but after the fourth day of life, only average nightly sleep increased. In full-term neonates, average nightly and daily sleep time of all recorded days differed by about 1h. Average sleep time during 24h for preterm and full-term neonates was similar. Preterm neonates showed longer intervals between events of food intake than full-term neonates. The circadian peaks in the frequency spectra of full-term neonates may indicate the initial adaptation in the first week of life to a 24h day. This is in agreement with our results concerning the different durations of nightly and daily sleep. The increase in nightly sleep time of preterm neonates may be attributed to the progressing adaptation to a circadian activity-rest pattern.

Activity Cycles↗
PubMed2006

Does citrate prevent nephrocalcinosis in preterm neonates?

Nephrocalcinosis (NC) occurs frequently in preterm neonates. A high U-calcium/citrate is one of the contributing factors to the development of NC. In stone-forming children and adults citrate supplementation is a successful preventive therapy. In this randomized controlled trial the effect of citrate therapy was studied on the development of NC in preterm neonates with a gestational age <32 weeks. Thirty-eight preterm neonates (mean gestational age 29.8 weeks (SD 1.6), mean birth weight 1,300 g (SD 351) were treated with sodium citrate (0.52 mmol/kg/day in four doses) from day 8 of life until at term and 36 preterm neonates (mean gestational age 29.6 weeks (SD 1.6), mean birth weight 1,282 g (SD 256) were not treated. U-calcium, U-creatinine, U-citrate and U-pH were measured at day 7, 14, 21, 28 of life and at term. Renal ultrasonography (US) was performed at term. U-citrate/creatinine and U-pH were significantly higher and U-calcium/citrate was significantly lower in the citrate group at day 14, 21 and 28 compared with the control group (P<0.05). Complications of citrate administration were not encountered, however the incidence of NC was not significantly different in the treated (34%) compared with the control group (44%), P=0.37. Preterm neonates treated with citrate in the first months of life have higher U-citrate/creatinine and lower U-calcium/citrate compared with controls. Sodium citrate therapy in a dosage of 0.52 mmol/kg/day is safe but does not prevent NC. Whether a higher dose or potassium citrate decreases the incidence of NC should be evaluated in further studies.

Citric Acid↗
PubMed1998

Clinical importance of pain and stress in preterm neonates.

Clinical and laboratory investigations of neonatal pain suggest that preterm neonates have an increased sensitivity to pain and that acute painful stimuli lead to the development of prolonged periods of hyperalgesia. Non-noxious stimuli during these periods of hyperalgesia may expose preterm neonates to established or chronic pain. Acute physiologic changes caused by painful or stressful stimuli can be implicated as important factors in the causation or subsequent extension of early intraventricular hemorrhage (IVH) or the ischemic changes leading to periventricular leukomalacia (PVL). Therapeutic interventions that provide comfort/analgesia in preterm neonates were correlated with a decreased incidence of severe IVH. Long-term follow-up studies of preterm neonates may substantiate the preliminary data associating repetitive painful experiences with some of the neurobehavioral and developmental sequelae resulting from neonatal intensive care.

Analgesics, Opioid↗
PubMed2003

Approaches to the initial respiratory management of preterm neonates.

Newly born preterm infants often require respiratory support. Various approaches have been taken to provide this support, including elective intubation and ventilation, prophylactic surfactant and continuous positive airway pressure (CPAP). Elective intubation and ventilation allow the clinician to take control of the baby's airway and reduce the support as tolerated. Surfactant can be administered prophylactically to prevent lung injury and respiratory complications. Many neonatologists, however, advocate a less aggressive approach to the provision of support, which includes the application of early nasal CPAP with intubation and ventilation only if necessary. Avoiding intubation may be effective in minimising ventilator-induced lung injury, but withholding surfactant may be detrimental to the infant. In this paper, we examine the advantages and disadvantages of the different approaches that can be taken in providing respiratory support to preterm neonates shortly after birth and examine some strategies that integrate them.

Humans↗
PubMed2006

Expression of select immune genes (surfactant proteins A and D, sheep beta defensin 1, and toll-like receptor 4) by respiratory epithelia is developmentally regulated in the preterm neonatal lamb.

Preterm infants experience enhanced susceptibility and severity to respiratory syncytial virus (RSV) infection. Terminal airway epithelium is an important site of RSV infection and the extent of local innate immune gene expression is poorly understood. In this study, expression of surfactant proteins A and D (SP-AD), sheep beta defensin 1 (SBD1), and toll-like receptor 4 (TLR4) mRNA were determined in whole lung homogenates from lambs. SP-AD and TLR4 mRNA expression increased (p < 0.05) from late gestation to term birth. In addition, gene expression of LCM-retrieved type II pneumocytes (CD208+), adjacent epithelium (CD208-) and bronchial epithelium demonstrated that bronchiole-alveolar junction epithelium (combined CD208 +/-) had significant (p < 0.05) developmental increases in SP-AD, SBD1 and TLR4 mRNA, whereas CD208+ cells had statistically significant increases only with SP-A mRNA. Using immunofluorescence, SP-AD antigen distribution and intensity were also greater with developmental age. These studies show reduced SBD1, SP-AD, and TLR4 expression in the preterm lung and this may underlie enhanced RSV susceptibility.

Animals↗
PubMedDate not supplied

A sonographic study of the morphology of the preterm neonatal hip.

Preterm and low-birth-weight infants are reported to have an increased risk of late presentation of congenital dislocation of the hip (CDH). A sequential sonographic study of hip morphology was made of 82 live preterm infants. Eighty-two matched, term controls were scanned for comparison. The morphology of the hips was similar at birth. The increase in missed CDH cannot be explained in simple morphological terms. Abnormal birth sonograms resolved rapidly in the absence of clinical instability, casting doubt on the role of static sonographic appearances to predict the need for treatment in the immediate newborn period.

Female↗
PubMedDate not supplied

Pseudomembranous colitis in a preterm neonate.

This preterm female infant abruptly developed diarrhea and bowel distention at 25 days of age and died within 60 h with fulminating pseudomembranous colitis and proctitis. Toxin-producing C. difficile was recovered from the stool. The pseudomembranous colitis developed 12 days after the last dose of ampicillin was given to the baby. Necrotizing enterocolitis, a condition pathologically distinct from pseudomembranous colitis, was also present.

Ampicillin↗