Factors affecting the intestinal-barrier permeability of newborns, such as body mass index (BMI), nutrition and antibiotics, are assumed to affect intestinal-barrier permeability in the first two years of life. This study assessed 100 healthy, full-term newborns to 24 months old. Faecal zonulin/calprotectin concentrations were measured at 1, 6, 12, 24 months as gut-permeability markers. Zonulin concentrations increased between 1 and 12 months (medians: 114.41, 223.7 ng/mL; respectively), whereas calprotectin concentrations decreased between one and six months (medians: 149. 29, 109.28 µg/mL); both then stabilized (24 months: 256.9 ng/mL zonulin; 59.5 µg/mL calprotectin). In individual children, high levels at one month gave high levels at older ages (correlations: calprotectin: between 1 and 6 or 12 months: correlation coefficient (R) = 0.33, statistical significance (p) = 0.0095; R = 0.28, p = 0.032; zonulin: between 1 and 24 months: R = 0.32; p = 0.022, respectively). Parameters which gave marker increases: antibiotics during pregnancy (calprotectin; six months: by 80%, p = 0.038; 12 months: by 48%, p = 0.028); vaginal birth (calprotectin: 6 months: by 140%, p = 0.005); and > 5.7 pregnancy-BMI increase (zonulin: 12 months: by 74%, p = 0.049). Conclusions: “Closure of the intestines” is spread over time and begins between the sixth and twelfth month of life. Antibiotic therapy, BMI increase > 5.7 during pregnancy and vaginal birth are associated with increased intestinal permeability during the first two years of life. Stool zonulin and calprotectin concentrations were much higher compared with previous measurements at older ages; clinical interpretation and validation are needed (no health associations found).
The aim of this study was to assess the clinical usefulness of blood procalcitonin (PCT) levels for the diagnosis and therapeutic monitoring of early-onset neonatal sepsis (EONS). PCT as well as C-reactive protein (CRP) levels and white blood cell (WBC) count were measured in venous blood from 57 infected and 72 uninfected neonates. Differences between groups for PCT, CRP, and WBC levels were significant. The threshold value on the receiver operating characteristic curve in the prediction of EONS was 5.33 ng/mL for PCT, 9.3 mg/L for CRP, and 14.9 × 10/L for WBC. There was no effect of antibiotic administered to the mother on PCT, CRP, and WBC levels in neonatal blood sampled before treatment of EONS. Evidently reduced PCT levels are observed after 2 days of treatment. The authors conclude that prenatal antibiotic therapy does not reduce the value of PCT levels in blood for the diagnosis of EONS.
Objective The aim of the study is to evaluate the efficacy of noninvasive high-frequency ventilation (nHFV) in respiratory-deficient infants. Study Design Retrospective analysis of 32 cases of nHFV in 30 term (n = 4) and preterm (n = 26) newborns using a noninvasive ventilation (NIV) device. nHFV avoided intubation of children performed with NIV and reintubation after long-term mechanical ventilation (MV). Patients were divided into three groups: Group 1: NIV from birth (n = 18, mean birth weight [BW]: 1,987 g, gestational age [GA]: 33.1 weeks); Group 2: MV, also used temporarily, and NIV (n = 10, BW: 1,074 g, GA: 28.2 weeks); and Group 3: two cases with nHFV avoided reintubation after long-term MV (BW: 725 g, GA: 24.5 weeks). Results From 32 episodes of nHFV application, positive effect was achieved 26 times (81%) (24 of 30 children). All newborns had a significant increase in pH (7.23–7.27) and reduction in partial pressure of CO2 (66.7–58.9 mm Hg, over 1–2 hours). Failures in application of nHFV reported only in Group 1 (6/18, 33%) (failures primarily due to increasing demand for oxygen). There were two reports of pneumothorax in preterm infants with congenital pneumonia. No other nHFV-related complications were noted. Conclusion nHFV is a promising NIV mode which can be also used with NIV devices.
Sirs,We read with great interest the paper by Acosta and Hogg published in Pediatric Nephrology [1]. The authors described a case of hemolytic uremic syndrome and accelerated recovery of renal function with the use of rasburicase (Ras), a uric acid (UA)-lowering agent. In our opinion, this report should receive special attention, because it expands the group of patients with acute kidney injury (AKI) who might benefit from such therapy. According to translational studies concerning destructive influence of UA on renal tubular structure and function [via intratubular precipitation, crystals internalization, cell necrosis, interstitial inflammation, and vasoconstriction mediated by endothelin-1-nitric oxide (ET1-NO) imbalance] and data from studies on cancer patients with acute tumor lysis syndrome, one could hypothesize that there is a positive effect of reduce UA blood concentration on shortening the course of AKI also in patients without malignancies [2,3]. Since the first article of Hobbs et al. on Ras in infants [4], few case reports have been published that consistently proved that therapy with Ras is efficacious in terms of decreasing serum UA and reversing AKI [5][6][7]. Given the increasing interest in Ras as a novel therapy of AKI in children, we would like also to share our institutional experience with four patients.In all below-reported patients, AKI of prerenal origin [according to the pediatric Risk, Injury, Failure, Loss, and End-Stage (pRIFLE) criteria] was accompanied by hyperuricemia, which probably resulted from diminished glomerular filtration and might have negatively, simultaneously with other factors, affected renal function (Table 1). As in previous case series, after single intravenous injection of Ras (Fasturtec®, Sanofi Aventis) at a dose of 0.18-0.22 mg/kg body weight, a rapid fall in serum UA concentration (11.68±2.83 mg/dl vs 0.43±0.71 mg/dl) and concomitant decrease in serum creatinine and urea (1.63 ± 1.09 mg/dl vs 1.33±1.08 mg/dl and 139.25±60.25 mg/dl vs 117.50±54.73 mg/dl, respectively) were noticed. Moreover, the urine output significantly increased compared with the 24-h periods before and after Ras injection (0.73 ± 0.41 ml/kg/h vs 3.03±3.53 ml/kg/h). In patient 1, continuous venovenous hemodiafiltration (CVV-HDF) was initiated because of anuria, severe fluid overload, and hyperkalemia. As polyuria appeared quickly after administration of Ras, renal replacement therapy (RRT) was discontinued after 10 h. In patient 2 AKI was preceded by gastroenteritis; however, renal failure was not reversed by fluid resuscitation. Kidney function started to improve quickly after lowering serum UA level. Patients 3 and 4 had AKI in the course of relapsing nephrotic syndrome (NS). They were severely edematous; thus, treatment with plasma expanders, diuretics, and dopamine was started before Ras injection and then continued for the next 24 h. Nevertheless the intensity of this therapy was decreased after Ras injection so that we hypothesize that the immediate positive effect on recovery of renal...
Objectives Treacher Collins syndrome (TCS), also known as mandibulofacial dysostosis and Franceschetti-Zwahlen- Klein syndrome, is an autosomal dominant disorder of soft tissue and the craniofacial bones. In most cases, TCS is the result of a mutation in the TCOF1 gene. The incidence is estimated to be between 1/10,000 and 1/50,000 live births. Our purpose was to describe a case report of patient with TCS born in the Department of Neonatology at the Pomeranian Medical University in Szczecin (Poland) and his family with short review of literature. Case presentation Clinical abnormalities which were found after birth mainly affect the head – hypoplasia of the cheek bones and the zygomatic bones, micrognation, deformed auricles with undeveloped external auditory canals, retrognathia of the mandible, cleft hard and soft palate and narrow palpebral fissure. Conclusions The treatment of children with TCS is long-term. Patients require a series of reconstructive and plastic surgical procedures. Our patient presented the complete form of TCS. There are multiple surgeries awaiting him, which, eventually, will improve his quality of life.
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