Deficient Antibody Formation to Oral Protein in Premature Infants

Abstract

The dilemmas of providing i n t e n s i v e c a r e f o r extremely low b i r t hweight i n f a n t s stem from high m o r t a l i t y and morbidity r a t e s , and t h e high c o s t of s u r v i v a l , both i n human and economic terms. Where resources a r e l i m i t e d , p r e d i c t i o n of outcome e a r l y i n t h e course may h e l p i n determining p r i o r i t i e s . I n t h i s study we used m u l t i p l e l o g i st i c r e g r e s s i o n a n a l y s i s t o determine t h e v a r i a b l e s i n d i c a t i n g s e v e r i t y of i l l n e s s i n t h e f i r s t 24 hours of l i f e which made an independent c o n t r i b u t i o n t o t h e p r e d i c t i o n of s u r v i v a l t o 28 days. The p a t i e n t m a t e r i a l consisted of 106 outborn i n f a n t s of birthweight < 801 g admitted between 1980 and 1984. A t 8 hours of age, birthweight (p= 0.041) and FiO (p=0.002) were independent v a r i a b l e s p r e d i c t i n g survival. At 16 an3 24 hours of age, body temperature (p=0.002 and 0.004). pH ( p 0 . 0 0 2 and 0.047), and presence of spontaneous b r e a t h s (p=0.046 and 0.007) independently p r e d i c t e d s u r v i v a l . A s t a t i s t i c a l model based on t h e method of maximum l i k e l i h o o d was computed on t h e b a s i s of t h e s e v a r i a b l e s . Accuracies of p r e d i c t i o n of s u r v i v a l and of death were i n t h e range 77-83 per c e n t a t each of t h e above ages. A l l 7 i n f a n t s whose p r e d i c t e d chances of s u r v i v a l were 0.5 a t 1 6 hours of age had handicapping sequelae by 3 months of age, o r d i e d between 28 days and 3 months of age. Only 3 of 49 i n f a n t s with chances of surv i v a l 5 0.5 had t h e s e outcomes. I t i s concluded t h a t 1. Use of meas u r e s of s e v e r i t y of i l l n e s s can g i v e p r e d i c t i o n s of s u r v i v a l and of death with about 80% accuracy. 2. Survival "against t h e odds" i s a s s o c i a t e d with severe sequelae of prematurity. Antibodies t o Casein (Ca), Lactalbumin (LA), Lactoglobulin (LG) and Bovine Serum Albumin (BSA) were determined by d i r e c t ELISA a t 4 weeks and a t 24 weeks of age i n premature i n f a n t s . Controls were age matched term i n f a n t s . A t 4 weeks, antibody concentrations were s i g n i f i c a n t l y lower i n preterm i n f a n t s . Although a t 24 weeks t h e response t o a l l 4 antigens was s t i l l lower i n preterm i n f a n t s t h e d i f f e r e n c e was only s i g n i f i c a n t f o r a n t i B5A ( a < 5 %, 'ELISA Units 2cr c 0 . 1 % 3a < 1 5 4a < 5 % Antibody formation i n premature i n f a n t s was found t o be deficient a g a i n s t a l l 4 antigens a t 4 weeks and a g a i n s t BSA even a t 6 months of age. ESPR-Abstracts for 39 MOLECULAR PROPERTIES OF C3 CONVERTING FACTOR (C3 COF)V Wahn, C Rieger, W Muller, U Rother (introduced by H G Lenard). Univ. C h i l d r e n ' s Hosp., Dusseldorf , FRG, Univ. Children's Hosp., Marburg, FRG, Univ. Children's Hosp., Hannover, FRG, I n s t . f o r lnununology and ...