The immune system of neonates has been considered functionally immature, and due to their high susceptibility to infections, the aim of this study was to analyse the phenotypic differences in leucocyte populations in healthy preterm and fullterm newborns. We evaluated the absolute numbers and frequencies of dendritic cells (DCs) and DC subsets, monocytes and T and B lymphocytes and subsets in the cord blood of healthy moderate and very preterm (Group 1), late preterm (Group 2) and full-term (Group 3) newborns and in healthy adults, as controls, by flow cytometry. The analyses revealed statistically higher absolute cell numbers in neonates compared with adults due to the characteristic leucocytosis of neonates. We observed a lower frequency of CD80 + myeloid and plasmacytoid DCs in Group 1 and reduced expression of TLR-4 on myeloid DCs in all neonates compared with adults. TLR-2 + monocytes were reduced in Group 1 compared with Groups 2 and 3, and TLR-4 + monocytes were reduced in Groups 1 and 2 compared with Group 3. The frequencies and numbers of na€ ıve CD4 + T and CD19 + B cells were higher in the three groups of neonates compared with adults, while CD4+ effector and effector memory T cells and CD19 + memory B cells were elevated in adults compared with neonates, as expected. Our study provides reference values for leucocytes in cord blood from term and preterm newborns, which may facilitate the identification of immunological deficiencies in protection against extracellular pathogens.

SUMMARY BACKGROUND: To determine the concentration of the Lipid Peroxidation Marker: Malondialdehyde (MDA), and Antioxidant Markers: Superoxide Dismutase (SOD), Glutathione Peroxidase (GPX), Catalase (CAL) in umbilical cord blood and in unstimulated saliva in the first 24 and 48 hours of life in the PTNB of mothers with and without risk factors for early-onset neonatal sepsis. METHODS: Cross-sectional study with the signing of informed consent by the pregnant women and application of a standard questionnaire classifying the PTNB in Group 1 or 2. RESULTS: Twenty-one PTNB were studied. Regarding gender, birth weight, need for oxygen, use of phototherapy, diagnosis of assumed sepsis, presence of fetal distress, number of pregnancies, type of delivery, use of corticosteroids, premature rupture of membranes, maternal fever, chorioamnionitis, APGAR at the 5th and 10th minute of life. Statistical analysis was performed with the Mann-Whitney test (p = 0.019) on the GPX variable of umbilical cord blood in the group of mothers with risk factors for early-onset neonatal sepsis. There was no statistical difference in the MDA, SOD, and CAT variables of the group with risk factors and in any variable of the group without risk factors. CONCLUSION: There was an increase of the GPX concentration in the blood from the umbilical vein in the group with risk factors for early-onset neonatal sepsis. There was no statistical significance in the comparison of saliva and umbilical cord blood. There was no statistically significant difference in MDA, SOD, CAT.

The study aimed to verify the application and performance of triggers for adverse drug events in hospitalized newborns. This prospective cohort study was conducted in the neonatal care units of a university hospital from March to September 2015. A list of triggers was developed for the identification of adverse drug events in this population. The list included antidote, clinical, and laboratory triggers. A total of 125 newborns who had received drugs during the hospitalization were included. Neonatal patient charts were screened to detect triggers. When a trigger was found, the patient chart was reviewed to identify possible adverse drug events. Each trigger's yield in the identification of adverse drug events was calculated and then classified according to its performance. Nine hundred and twenty-five triggers identified 208 suspected adverse drug events. The triggers' overall yield was 22.5%. The most frequently identified triggers were: drop in oxygen saturation, increased frequency of bowel movements, medications stop, and vomiting. The triggers with the best performance in the identification of adverse drug events were: increased creatinine, increased urea, necrotizing enterocolitis, prescription of flumazenil, hypercalcemia, hyperkalemia, hypernatremia, and oversedation. The triggers identified in this study can be used to track adverse drug events in similar neonatal care services, focusing on the triggers with the best performance and the lowest workload in the identification.

RESUMO: A introdução da imunoglobulina anti-D diminuiu a incidência da doença hemolítica neonatal por isoimunização Rh, porém persiste este diagnóstico por outros anticorpos mais raros e o avanço tecnológico tornou possível a detecção destes anticorpos.OBJETIVOS. Verificar a prevalência de marcadores imuno-hematológicos, representados pelos testes de Coombs indireto, direto e de eluição com identificação do anticorpo detectado; incidência de doença hemolítica e de tratamento entre os recém-nascidos sensibilizados.MÉTODOS. Estudo do tipo Coorte retrospectiva, de janeiro de 1996 a julho de 1998, consistiu na descrição da análise dos perfis imuno-hematológicos de 1698 pares de mães e recém-nascidos como fator de risco para doença hemolítica, subdivididos de acordo com os marcadores. A metodologia empregada para identificação dos marcadores foi o da microplaca com hemácias de triagem, soro antiglobulina humana e gel centrifugação. Para tipagens e fenotipagens utilizou-se o método de microplaca com soros monoclonais. Para o estudo da incidência e seguimento neonatal foram realizadas bilirrubinas totais e frações, por méto-do enzimático colorímetro, hemoglobina e hematócrito, automatizado e reticulócitos, por coloração supra vital, azul cresil brilhante e leitura por microscopia óptica. RESULTADOS. A prevalência de marcadores imuno-hematológicos INTRODUÇÃOOs avanços na assistência obstétrica têm mudado o perfil da isoimunização Rh, porém continua havendo quadros hemolíticos com hiperbilirrubinemias significativas que podem levar a "kernicterus" e que na maioria dos serviços neonatais ficam sem diagnóstico. Na atualidade, utilizando técnicas mais sensíveis, consegue-se diagnosticar anticorpos raros e outras doenças potencialmente hemolíticas.Mas, apesar dos avanços, a hemólise no recém-nascido é de difícil documentação, porque a hiperbilirrubinemia indireta é comum e os níveis de hemoglobina são estáveis durante a primeira semana de vida. Neste contexto, o parâmetro mais confiável é o número de reticulócitos, que embora alto no recém-nascido (4,1% a 6,3%) se normaliza ao terceiro dia de vida. E a persistência desta reticulocitose é compatível com o processo hemolítico, embora reticulopenia não o exclua.Acreditamos que para realizar um diagnóstico preciso de doença hemolítica no RN é necessária a realização de testes que detectem anticorpos antieritrocitários como o teste de Coombs indireto, direto e o teste de eluição.Os objetivos deste estudo foram: verificar a prevalência de anticorpos eritrocitários maternos imunodetectáveis na população estudada e relacioná-los com a evolução clínica dos recém-nascidos quanto à manifestação de doença hemolítica neonatal e necessidade de tratamento com fototerapia e/ou exsangüíneotransfusão.

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