Multilocus sequence types of invasive and colonizing neonatal group B streptococci in Poland

OBJECTIVES

The present study aimed to investigate the molecular characterization of Streptococcus agalactiae (group B streptococcus; GBS) strains isolated from newborns with invasive neonatal infections and healthy newborns in Poland.

MATERIALS AND METHODS

Forty-two GBS isolates were characterized by combining different typing methods, i.e. multilocus sequence typing (MLST), molecular serotyping and protein gene profiling.

RESULTS

Using MLST, a total of 16 sequence types (STs) were identified, and among these, 11 were clustered into the following 5 clonal complexes (CCs): CC23 (20; 49%), CC19 (7; 17%), CC17 (4; 10%), CC10 (4; 10%) and CC1 (1; 2%). A statistically significant relationship between ST-17 and invasive isolates (p = 0.0398) and ST-23 and colonizing strains (p = 0.0034) was detected. Moreover, 2 novel STs were detected (ST-637 and ST-638). Molecular serotyping showed that in the invasive isolates serotype III was predominant (11; 50%), followed by serotypes II (6; 27%), V (3; 14%) and Ia (2; 9%). In healthy newborns, serotype III was also dominant (12; 60%), followed by serotypes Ia (4; 20%), II (2; 10%), V (1; 5%) and Ib (1; 5%). Protein gene profiling indicated that the rib gene was predominant in the invasive strains (11; 59%), followed by bca (5; 22%), alp2 (2; 9%), alp3 (1; 5%) and epsilon (1; 5%), while in colonizing strains the alp2 gene was most common (10; 50%), followed by epsilon (5; 25%), rib (2; 10%), bca (2; 10%) and alp3 (1; 5%). A statistically significant relationship was noted between the rib gene and invasive GBS (p = 0.0329), whereas alp2 was related to the colonizing strains (p = 0.0495).

CONCLUSIONS

The investigated GBS isolates originating from infections in newborns and healthy neonates represented serotype III in more than half of the cases and differed from one another in terms of resistance to macrolides, ST type affiliation and the presence of genes encoding surface proteins from the Alp family. Further comparative genetic research on a larger number of strains is necessary for epidemiological investigation and vaccine development.

Advancing neurologic care in the neonatal intensive care unit with a neonatal neurologist

Neonatal neurology is a growing subspecialty area. Given the considerable amount of neurologic problems present in the neonatal intensive care unit, a neurologist with expertise in neonates is becoming more important. We sought to evaluate the change in neurologic care in the neonatal intensive care unit at our tertiary care hospital by having a dedicated neonatal neurologist. The period post-neonatal neurologist showed a greater number of neurology consultations (P<.001), number of neurology encounters per patient (P<.001), a wider variety of diagnoses seen, and an increase in the use of video electroencephalography (P=.022), compared to the period pre-neonatal neurologist. The neonatologists expressed appreciation for having a dedicated neurologist available. Standardized protocols for treating hypoxic-ischemic encephalopathy and neonatal seizures were also developed. Overall, by having a neonatal neurologist, neurology became part of the multidisciplinary team providing focused neurologic care to newborns.

Identifying potential kidney donors among newborns undergoing circulatory determination of death

BACKGROUND

Over 96,000 patients await kidney transplantation in the United States, and 35,000 more are wait-listed annually. The demand for donor kidneys far outweighs supply, resulting in significant waiting list morbidity and mortality. We sought to identify potential kidney donors among newborns because en bloc kidney transplantation donation after circulatory determination of death (DCDD) may broaden the donor pool.

METHODS

We reviewed discharges from our 84-bed NICU between November 2002 and October 2012 and identified all deaths. The mode of death among potential organ donors (weight ≥ 1.8 kg) was recorded. Patients undergoing withdrawal of life support were further evaluated for DCDD potential. After excluding patients with medical contraindications, those with warm ischemic time (WIT) less than 120 minutes were characterized as potential kidney donors.

RESULTS

There were 11,201 discharges. Of 609 deaths, 359 patients weighed ≥ 1.8 kg and 159 died after planned withdrawal of life support. The exact time of withdrawal could not be determined for 2 patients, and 100 had at least 1 exclusion criterion. Of the remaining patients, 42 to 57 infants were potential en bloc kidney donors depending on acceptance threshold for WIT. Applying a 40% to 70% consent rate range would yield 1.7 to 4 newborn DCDD donors per year.

CONCLUSIONS

A neonatal DCDD kidney program at our institution could provide 2 to 4 paired kidneys for en bloc transplantation each year. Implementing a DCDD kidney donation program in NICUs could add a new source of donors and increase the number of kidneys available for transplantation.

Pre-eclampsia affects cord blood NK cell expression of activation receptors and serum cytokine levels but not CB monocyte characteristics

PROBLEM

Maternal immunopathology in pre-eclampsia is well studied; however, less is known regarding the immunological effects on the newborns. Increased inflammation and activation of immune cells at the fetal-maternal interface in pre-eclampsia could influence the neonatal immune compartment.

METHOD OF STUDY

Monocytes and natural killer (NK) cells from cord blood (CB) of children with pre-eclamptic or healthy mothers were analyzed by flow cytometry for surface markers and intracellular cytokines. In addition, serum cytokine profiles were investigated using ELISA or cytometric bead array.

RESULTS

Neonates born to pre-eclamptic mothers had an inflammatory serum cytokine profile. While CB monocyte characteristics seemed unaffected, CB NK cells from pre-eclamptic pregnancies had higher NKp30, but borderline lower NKG2D expression.

CONCLUSION

In utero inflammatory priming of neonatal innate immunity taking place in pre-eclamptic pregnancies might influence specific NK cell functions in newborns.

The specific characteristics of DIC syndrome vary with different clinical settings in the newborn

Abstract Two hundred fourteen newborns with serious perinatal pathology (posthypoxic syndrome, sepsis, surgical intervention, etc.) were examined in progress, according to 27 parameters including coagulative, trombocitic, anti-coagulative and fibrinolitic parts of hemostasis system. It was proved, that neonatal disseminated intravascular coagulation (DIC) syndrome had different hemostasiological patterns, which were connected with the genesis: sepsis, surgical intervention or posthypoxic syndrome. Precise periods of DIC syndrome are not always presented in newborns. DIC syndrome with neonatal sepsis has two different patterns (overcompensated and decompensated). The manifestation of trombo-hemorrhagic disorders and their characteristics depend on the genesis of DIC syndrome (e.g. an infection process and hyperbilirubinemia can provide the appearance of hemorrhagic syndrome).

Reflection-based imaging of macular pigment distributions in infants and children

We have developed a reflection-based capability of the RetCam(®) platform, an FDA-cleared pediatric retinal-imaging instrument, for the purpose of measuring macular pigment levels as well as their spatial distributions in infants and children. Our modifications include narrow-band blue-wavelength excitation of the macular pigment absorption in combination with spectrally selective blue-wavelength readout of the reflection signals received by the instrument's CCD detector array. Furthermore, an algorithm is developed that allows the computation of optical density maps for the macular pigment relative to peripheral retinal areas. This made it possible for the first time to directly measure macular pigment levels and their spatial features in the developing human retina. In contrast to adults, infants with measurable pigment levels had almost exclusively a narrow, circularly symmetric, pigment distribution. The described methodology holds promise for future investigations into the role of macular pigment in the developing human retina and the effect of dietary interventions in diseases resulting from a lack of normal carotenoid levels.

Resonance Raman based skin carotenoid measurements in newborns and infants

We describe Resonance Raman based skin carotenoid measurements in newborns and infants. Skin- and serum carotenoid levels correlate with high statistical significance in healthy newborns and infants, and with reduced accuracy also in prematurely born infants, who in general feature very low carotenoid levels and thin transparent skin giving rise to large background absorption effects. Skin carotenoid levels can be easily compared among subjects and/or tracked in longitudinal studies with the highly molecule-specific Raman method. It therefore holds promise as a rapid, non-invasive, carotenoid antioxidant assessment method for newborns and infants in the field of pediatrics.

Music processing similarities between sleeping newborns and alert adults: cause for celebration or concern?

[This corrects the article on p. 492 in vol. 4, PMID: 23966962.].

Clinical, biochemical, and radiological manifestations of vitamin D deficiency in newborns presented with hypocalcemia

INTRODUCTION

The Clinical and radiological manifestations of newborns with severe VDD have not been studied well.

MATERIALS AND METHODS

We studied the clinical, biochemical, and radiological manifestations of 10 full-term (FT) newborns (6: M, 4: F) infant presented to with symptomatic hypocalcemia (seizure) secondary to vitamin D deficiency (VDD) during the first 10 days of life are described. All were exclusively breastfed since birth. All their mothers have low 25 hydroxy vitamin D (25OHD) level <10 ng/mL and were not taking vitamin supplements during pregnancy.

RESULTS

FT newborns with hypocalcemia secondary to VDD presented with generalized convulsions (10/10) and craniotabes (8/10), but none had rachitic chest rosaries or joint broadening. Cranial ultrasonographic evaluation was normal. Serum 25OHD concentrations were low in these newborns (13.2 ± 3.8 ng/mL) and their mothers (8.1 ± 1.5 ng/mL). A total of 60% of them had increased parathormone (PTH) concentrations (>60 ng/mL) and 60% had decreased magnesium (Mg) concentrations (<0.7 mmol/L). Their alkaline phosphatase (ALP) concentrations were significantly higher than normal newborns. All other laboratory results (liver function tests, urea and electrolytes, C reactive protein, lumbar puncture, blood culture, and lactate) were normal. In all patients, seizures ceased within 2 days of starting treatment with alphacalcidol and calcium. Radiological manifestations included metaphyseal band of relative lucency (osteopenia), just under the line of provisional calcification, within distal radius (7/10), femur (4/10), and tibia (3/10), mild cupping and haziness of distal radius (2/10).

DISCUSSION

Newborns with VDD had significantly lower serum calcium, ALP and PTH and higher phosphate concentrations, compared to older infants with VDD rickets. In newborns with VDD, serum calcium levels were correlated significantly with 25OHD (r = 0.597, P < 0.001), Mg concentrations (r = 0.436, P < 0.001) and negatively with ALP concentrations (r = -0.451, P < 0.001). Serum PTH concentrations were correlated significantly with serum Mg (r = 0.78, P < 0.0001) but not with serum calcium (r = -0.103, P = 0.3) or 25OHD (r = -0.03, P = 0.7) concentrations.

CONCLUSION

The clinical, biochemical, and radiological manifestations of VDD in newborns indicate that they are less adapted to VDD compared to older infants. VD supplementation for mothers and newborns should be considered to avoid short-term complications of VDD in the neonatal period and on the growing infants especially in countries with high prevalence of VDD.

Acetaldehyde involvement in ethanol's postabsortive effects during early ontogeny

Clinical and biomedical studies sustains the notion that early ontogeny is a vulnerable window to the impact of alcohol. Experiences with the drug during these stages increase latter disposition to prefer, use or abuse ethanol. This period of enhanced sensitivity to ethanol is accompanied by a high rate of activity in the central catalase system, which metabolizes ethanol in the brain. Acetaldehyde (ACD), the first oxidation product of ethanol, has been found to share many neurobehavioral effects with the drug. Cumulative evidence supports this notion in models employing adults. Nevertheless very few studies have been conducted to analyze the role of ACD in ethanol postabsorptive effects, in newborns or infant rats. In this work we review recent experimental literature that syndicates ACD as a mediator agent of reinforcing aspects of ethanol, during early ontogenetic stages. We also show a meta-analytical correlational approach that proposes how differences in the activity of brain catalase across ontogeny, could be modulating patterns of ethanol consumption.

Establishing reference intervals for electrolytes in newborns and infants using direct ISE analyzer

BACKGROUND

To generate clinically applicable reference intervals (RIs) for commonly requested electrolytes in Ethiopian newborns and infants that can help in early detection, close monitoring and correction of electrolyte abnormalities. Cord blood (from newborns, n = 60) and venous blood samples (from infants, n = 57) were collected and analyzed using direct ISE analyzer, AVL (9181). MedCalc® software was applied to determine the robust upper and lower end points covering 95% of the reference values of each electrolyte with respective 90% CIs.

FINDINGS

This is an extension report of our recent study; and hence is resulted from the same data source. The level of Na+ and K+ showed difference in newborns and infants even though combined RIs were suggested by the Haris and Boyd rule as 126-143 mmol/l and 4.0-7.9 mmol/l respectively. However, Cl- values failed to show such a difference and thus a combined RI was determined to be 100-111 mmol/l. Almost all maternal, neonatal and infantile factors were not able to affect the values of the electrolytes.

CONCLUSION

Combined RIs are suggested for the interpretation of electrolyte values in newborns and infants without taking the effect of maternal, neonatal and infantile factors into account. Since the RIs were different from previously reported values, it will be appropriate to apply such RIs for the interpretation of electrolyte values in Ethiopian pediatric population.

Endoscopically placed rectourethral guidewire facilitates the reconstruction of anus in children with anorectal malformations: a case report

The aim of this report is to present a technical detail of use in the management of an anorectal malformation (ARM). A boy with ARM and a fistula to the urethra was operated on with a posterior sagittal anorectoplasty (PSARP). Before the PSARP operation, a videoendoscopy was performed through the distal stoma down to the distal end of the rectum. The rectourethral fistula was identified and a guidewire was passed through the endoscope, through the fistula, and out through the urethra. The endoscopically placed rectourethral guidewire was used as a landmark and facilitated the PSARP operation.

Longitudinal changes in CD4(+) T-cell memory responses induced by BCG vaccination of newborns

BACKGROUND

Improved vaccination strategies against tuberculosis are needed, such as approaches to boost immunity induced by the current vaccine, BCG. Design of these strategies has been hampered by a lack of knowledge of the kinetics of the human host response induced by neonatal BCG vaccination. Furthermore, the functional and phenotypic attributes of BCG-induced long-lived memory T-cell responses remain unclear.

METHODS

We assessed the longitudinal CD4 T-cell response following BCG vaccination of human newborns. The kinetics, function, and phenotype of these cells were measured using flow cytometric whole-blood assays.

RESULTS

We showed that the BCG-specific CD4 T-cell response peaked 6-10 weeks after vaccination and gradually waned over the first year of life. Highly activated T-helper 1 cells, predominantly expressing interferon γ, tumor necrosis factor α, and/or interleukin 2, were present at the peak response. Following contraction, BCG-specific CD4 T cells expressed high levels of Bcl-2 and displayed a predominant CD45RACCR7 central memory phenotype. However, cytokine and cytotoxic marker expression by these cells was more characteristic of effector memory cells.

CONCLUSIONS

Our findings suggest that boosting of BCG-primed CD4 T cells with heterologous tuberculosis vaccines may be best after 14 weeks of age, once an established memory response has developed.

Miniinvasive interventional bridge to major surgical repair of critical aortic coarctation in a newborn with severe multiorgan failure

We present a case of a severely ill newborn with complex coarctation, multiorgan failure and massive oedema, who was treated with emergency stenting of the isthmus on the second day of life, which was followed by surgical stent removal and repair of the arch on the 29^th day, after stabilization of his general status. Interventional percutaneous direct stent implantation was performed, using a coronary stent (Abbott Multi-Link Vision Coronary Stent 3.5 mm/15 mm, USA) to cover the area of the aortic isthmus in the newborn. The area from the origin of the left subclavian artery to the beginning of the descending thoracic aorta beneath the isthmus was widely expanded. Control angiography showed normal size of the isthmus without a systolic gradient in the area. In the next 3 weeks the boy improved his general status, with normalization of liver and renal parameters, as well as resolution of the oedema, and underwent surgery on his 29^th day of life. The procedure of stent removal with aortic extended end-to-end anastomosis was performed without complications, and the infant was transferred to general paediatrics for further treatment. The strategy of miniinvasive interventional bridge to postpone major surgical repair was effective in the presented infant, with positive final results of both cardiological intervention and subsequent surgical repair.

Improving adherence rates to a cocooning program: a pilot experience in Italy

Cocoon is defined as a strategy to reduce the risk for transmission of pertussis to newborn infants by vaccinating household members including parents and siblings. Programmatic challenges make implementation of cocooning program complex. At the local health care unit “ASL Napoli 1 Centro,” a one-year pilot project to evaluate the newborn contacts adherence to a cocoon strategy was started on May, 1st 2011. Healthcare providers (HCPs) offered for free a dTpa booster dose to newborns parents (mothers were immunized after delivery) and household contacts. Until June 30th, overall only 7 dTpa booster doses out of 261 newborns (2.6%) were administered for cocooning. Then, an improvement in communication strategy to the families was introduced by preparing specific information leaflets, increasing the HCPs devoted to the cocoon, and focusing the interaction with families during the visiting time at the maternity ward. Overall, 601 out of 762 (78,8%) contacted new mothers received dTpa booster. Cocoon high acceptance rates could be reached providing that proper communication tools and enough skilled HCPs were engaged in the interaction with the families. This report is, to our knowledge, the first to document successful implementation of pertussis cocooning in an Italian setting.

Chlorhexidine or povidone-iodine: Which solution is more effective on skin colonization in neonates?

BACKGROUND

Infection control should be an integrated part of patient care, especially to ensure safety and survival in hospitalized neonates. Although povidone-iodine (PVP-I) solution has been used as the most common antiseptic in hospitals of Iran, chlorhexidine is currently used in some wards for skin disinfection. However, there is no evidence about the superiority of either antiseptic solution over the other one. This clinical trial carried out in two university hospitals affiliated to Isfahan University of Medical Sciences, Isfahan, Iran, aimed to compare the effects of chlorhexidine and PVP-I solutions on skin bacterial colonization in hospitalized neonates.

MATERIALS AND METHODS

The participants were 98 hospitalized infants. In each infant, one area on the skin was disinfected by chlorhexidine while the contralateral site was disinfected by PVP-I. Skin cultures were taken before and after disinfection. Microorganisms were determined and colony count was performed based on a standard method. The collected data were analyzed using descriptive and inferential statistical methods in SPSS v. 14.

RESULTS

The mean of microorganism colony count before and after disinfection by either solution was statistically different (P < 0.001). There was no significant difference between the two groups in terms of mean microorganism colony count before disinfection. However, a significant difference was observed after disinfection.

CONCLUSIONS

PVP-I is more efficacious than chlorhexidine for skin disinfection. Consequently, it seems better to use PVP-I for skin preparation before invasive procedures.

Epidemiological survey on newborns born at the obstetric departments in hospitals in mid-southern region of China in 2005

OBJECTIVE

To investigate the situations at birth of newborns in the mid-southern region of China by performing a survey on the newborns born at urban hospitals.

METHODS

A total of 23 hospitals in the mid-southern region of China were selected to participate in this survey. The data of 15,582 newborns who were born at the obstetric departments from January 1, 2005 to December 31, 2005 were retrospectively investigated.

RESULTS

The male to female ratio among newborns was 1.16:1. The incidence of preterm birth was 8.11%, while very low birth weight (VLBW) infants accounted for 0.73%. The rates of spontaneous vaginal delivery and cesarean section ware 57.52% and 40.82%, respectively, while the other delivery modes accounted for 1.66%. The incidence of neonatal asphyxia was 3.78% (0.75% for heavy asphyxia). The mortality of newborns was 0.55% (5.56% for preterm infants).

CONCLUSIONS

The incidences of preterm birth and neonatal asphyxia are relatively high in the mid-southern region of China. The rate of cesarean section is abnormally high, which is due mainly to social factors.

Association of BMPR1A polymorphism, but not BMP4, with kidney size in full-term newborns

BACKGROUND

A correlation between renal mass and nephron number in newborns allows the use of total kidney volume at birth as a surrogate for congenital nephron number. As the bone morphogenetic protein type 4 (BMP4), and its receptor type 1A (BMPR1A, ALK3), play an important role in renal development, we hypothesized that common, functional polymorphisms in their genes might be responsible for variation in kidney size among healthy individuals.

METHODS

We recruited 179 healthy full-term newborns born to healthy women. Kidney volume was measured sonographically. Total kidney volume (TKV) was calculated as the sum of left and right kidneys, and normalized for body surface area (TKV/BSA). Genomic DNA was extracted from umbilical cord blood leukocytes, and c.455T > C (rs17563) BMP4 and c.67 + 5659A > T (rs7922846) BMPR1A genotypes were identified by PCR-RFLP.

RESULTS

TKV/BSA in newborns carrying at least one A BMPR1A allele (AA + AT) was significantly reduced by approximately 13 % as compared with TT homozygous newborns (106.7 ± 21.5 ml/m(2) vs. 122.7 ± 43.8 ml/m(2), p < 0.02). No significant differences in TKV/BSA were found among newborns with different BMP4 genotypes.

CONCLUSIONS

Results suggest that rs7922846 BMPR1A polymorphism may account for subtle variation in kidney size at birth, reflecting congenital nephron endowment.

Congenital malformations among newborns admitted in the neonatal unit of a tertiary hospital in Enugu, South-East Nigeria--a retrospective study

BACKGROUND

Congenital abnormalities are not uncommon among newborns and contribute to neonatal and infant morbidity and mortality. The prevalence and pattern of presentation vary from place to place. Many a time the exact etiology is unknown but genetic and environmental factors tend to be implicated.

METHODS

The objective of this study was to determine the prevalence of congenital malformations among newborns admitted in a tertiary hospital in Enugu, the nature of these abnormalities and the outcome/prognosis. For purposes of this study, congenital abnormalities are defined as obvious abnormality of structure or form which is present at birth or noticed within a few days after birth. A cross-sectional retrospective study in which a review of the records of all babies admitted in the Newborn Special Care Unit (NBSCU) of the University of Nigeria Teaching Hospital (UNTH), Ituku/Ozalla, Enugu over a four year period (January 2007-April 2011) was undertaken.All babies admitted in the unit with the diagnosis of congenital abnormality were included in the study. Information extracted from the records included characteristics of the baby, maternal characteristics, nature/type of abnormalities and outcome.Data obtained was analyzed using SPSS 13. Rates and proportions were calculated with 95% confidence interval. The proportions were compared using students T-test. Level of significance was set at P < 0.05

RESULTS

Seventeen (17) out of a total of six hundred and seven newborn babies admitted in the newborn unit of UNTH over the study period (Jan 2007-March 2011) were found to have congenital abnormalities of various types, giving a prevalence of 2.8%. Common abnormalities seen in these babies were mainly surgical birth defects and included cleft lip/cleft palate, neural tube defects (occurring either singly or in combination with other abnormalities), limb abnormalities (often in combination with neural tube defects of various types), omphalocoele, umbilical herniae, ano-rectal malformations and dysmorphism associated with multiple congenital abnormalities.

CONCLUSIONS

The results of this study show that 2.8% of babies admitted to a Newborn Special Care Unit in a teaching hospital in Enugu had congenital abnormalities and that the commonest forms seen were mainly surgical birth defects and includes cleft lip/cleft palate and neural tube defects.

Exogenous surfactant in the treatment of neonatal meconium aspiration syndrome

Dysfunction of pulmonary surfactant is one of the key pathogenic features in meconium aspiration syndrome. Surfactant function may be affected by components of meconium, by inflammatory mediators (e.g., tumor necrosis factor alpha and interleukin-1), proteolytic enzymes, phospholipase A2, reactive oxygen species, and by plasma proteins leaking into the alveolar space. Administration of exogenous surfactant may at least partially alleviate the inactivation of pulmonary surfactant present in meconium aspiration syndrome. In experimental and clinical studies, intratracheal administration of a surfactant bolus significantly improved both lung function and survival. However, some patients are non-responders and there is only transient improvement in oxygenation. A repeat dose of surfactant may be required in these patients. Bronchoalveolar lavage with diluted exogenous surfactant is another technique for surfactant administration that may be more effective in partially removing meconium from the lungs, and thereby reducing surfactant inhibition, inflammation and mechanical obstruction of the airways. There is also a growing body of evidence suggesting that exogenous surfactant may be more effective when combined with pulmonary vasodilators, anti-inflammatory and antioxidant treatment.

Maternal and gestational factors and micronucleus frequencies in umbilical blood: the NewGeneris Rhea cohort in Crete

BACKGROUND

The use of cancer-related biomarkers in newborns has been very limited.

OBJECTIVE

We investigated the formation of micronuclei (MN) in full-term and preterm newborns and their mothers from the Rhea cohort (Crete), applying for the first time in cord blood a validated semiautomated analysis system, in both mono- and binucleated T lymphocytes.

METHODS

We assessed MN frequencies in peripheral blood samples from the mothers and in umbilical cord blood samples. We calculated MN in mononucleated (MNMONO) and binucleated (MNBN) T lymphocytes and the cytokinesis block proliferation index (CBPI) in 251 newborns (224 full term) and 223 mothers, including 182 mother-child pairs. Demographic and lifestyle characteristics were collected.

RESULTS

We observed significantly higher MNBN and CBPI levels in mothers than in newborns. In newborns, MNMONO and MNBN were correlated (r = 0.35, p < 0.001), and we found a moderate correlation between MNMONO in mothers and newborns (r = 0.26, p < 0.001). MNMONO frequencies in newborns were positively associated with the mother's body mass index and inversely associated with gestational age and mother's age, but we found no significant predictors of MNBN or CBPI in newborns.

CONCLUSIONS

Although confirmation is needed by a larger study population, the results indicate the importance of taking into account both mono- and binucleated T lymphocytes for biomonitoring of newborns, because the first reflects damage expressed during in vivo cell division and accumulated in utero, and the latter includes additional damage expressed as MN during the in vitro culture step.

Nelfinavir and Lamivudine pharmacokinetics during the first two weeks of life

BACKGROUND

There are no previous data describing nelfinavir and lamivudine pharmacokinetics in neonates treated with weight-band dosing regimens.

DESIGN

Pharmacokinetic study of nelfinavir and lamivudine pharmacokinetics in infants during the first 2 weeks of life treated with weight-band dosing regimens.

METHODS

Intensive 12-hour pharmacokinetic profiles were performed between either days 4-7 or days 10-14 of life in 26 Brazilian infants.

RESULTS

Pharmacokinetic data were obtained from 26 infants who received median (range) per kg doses of 58.8 (48.4-79.0) mg/kg for nelfinavir and 2.0 (1.5-3.2) mg/kg for lamivudine. Median nelfinavir 12-hour AUC (AUC0-12) was 25.5 (1.7-183.5) μg*h/mL and median 12-hour concentration (C12h) was 1.09 (<0.04-14.44) μg/mL. AUC0-12 was less than 15 μg*h/mL (the 10% for adults) in 12 infants (46%). Median lamivudine AUC0-12 was 7.8 (2.7-15.6) μg*h/mL and median C12h was 0.23 (<0.04-0.74) μg/mL.

CONCLUSIONS

: Lamivudine pharmacokinetic parameters observed in this study were consistent with those seen in other studies of neonates. While median nelfinavir AUC and C12h in these neonates were above the exposure targets, interindividual variability in nelfinavir exposure was large and nelfinavir exposure failed to meet the exposure targets in 46% of infants.

Early assessment of the severity of asphyxia in term newborns using parameters of blood count

Acute perinatal asphyxia is a major cause of death and neurological injury in newborn infants. Severe asphyxia can occur in infants around the time of birth for several reasons. The aim of our study was to find the most sensitive, easily obtainable and fast assessable parameter of the presence and quantification of asphyxia.

In our study 39 term newborns (15 healthy term newborns and 24 asphyxial term newborns), from vaginal deliveries admitted within 24 hours of life were monitored and parameters of blood count from venous blood were assessed. Laboratory findings of blood count parameters revealed significant differences between term asphyxial and healthy newborns in erythrocyte count and hemoglobin and hematocrit values.

Hematological changes observed early after delivery can determine the duration of hypoxemia (acute vs. chronic) and asphyxia of short duration may be accompanied without occurrence of polyglobulia.

Near-infrared spectroscopy: a report from the McDonnell infant methodology consortium

Near-infrared spectroscopy (NIRS) is a new and increasingly widespread brain imaging technique, particularly suitable for young infants. The laboratories of the McDonnell Consortium have contributed to the technological development and research applications of this technique for nearly a decade. The present paper provides a general introduction to the technique as well as a detailed report of the methodological innovations developed by the Consortium. The basic principles of NIRS and some of the existing developmental studies are reviewed. Issues concerning technological improvements, parameter optimization, possible experimental designs and data analysis techniques are discussed and illustrated by novel empirical data.

Earliest appropriate time for administering neurobehavioral assessment in newborn infants

OBJECTIVE

To assess the effect of examination time on newborn neurobehavioral examinations administered within 48 hours of delivery and to identify the earliest appropriate time for performing the assessment.

METHODS

We analyzed data from neurobehavioral examinations on 324 newborns using the NICU Network Neurobehavioral Scale (NNNS). Trends over examination time and cumulative percentage within published normal ranges were analyzed to identify the earliest appropriate time for administering the examination. Ordinal logistic regression and multivariate regression were used for testing and defining the earliest appropriate time for administering the examination without being influenced by acute effects of labor and delivery while controlling for several potential confounding factors.

RESULTS

The arousal, excitability, lethargy, quality-of-movement, hypotonicity, and nonoptimal-reflexes scales were sensitive to timing of the examination. Results of ordinal logistic regression showed that 20 hours after delivery seemed to be the earliest appropriate time for administering newborn NNNS examinations. The proportion of NNNS scores within the normal range increased with time significantly when the examination was made less than 20 hours after delivery (n = 148) (odds ratio: 1.12 [95% confidence interval: 1.02-1.23]), but there was no longer significant association with time of examination after 20 hours (n = 176) (odds ratio: 1.04 [95% confidence interval: 0.99-1.09]). This result was confirmed by multivariate regression.

CONCLUSIONS

We recommend 20 hours after delivery as the earliest appropriate time for administering newborn NNNS examinations to obtain results reflecting outcomes that are a representative assessment of newborn neurobehavior and not contaminated by acute effects of labor and delivery.

Cigarette smoking during pregnancy: chromosome translocations and phenotypic susceptibility in mothers and newborns

The effects of maternal cigarette smoking during pregnancy on structural chromosome aberrations were evaluated in peripheral lymphocytes from 239 mothers and their 241 newborns to determine whether smoking during pregnancy, genetic susceptibility, and race are associated with chromosome aberrations including translocations. Demographic information and cigarette smoking data were obtained via questionnaire. There were 119 Caucasian Americans, 118 African Americans, and 2 Asian Americans. The average maternal age was 24.9+/-5.8 (mean+/-S.D.) years. Thirty-nine percent of the Caucasian Americans and 45.4% of the African Americans self-reported that they were active smokers during the index pregnancy. The average number of cigarettes smoked per day was 2.65+/-5.75 and 1.37+/-3.17 for Caucasian and African American mothers, respectively. Peripheral blood lymphocytes from the mother and from the fetal side of the placenta were evaluated for chromosome aberrations by whole chromosome painting. Aliquots from the same blood samples were also used to assess genetic susceptibility with an in vitro bleomycin challenge assay. Spontaneous translocation frequencies in both maternal and newborn lymphocytes were not associated with cigarette smoking, socioeconomic status, or education. The absence of a smoking effect may be attributable to the low level of cigarette usage in these subjects. The average bleomycin-induced damage in the maternal and newborn populations was 0.37+/-0.27 and 0.15+/-0.14 breaks per cell, respectively, a difference that was highly significant (p<0.0001). In newborns there was a positive association between bleomycin sensitivity and the frequencies of aberrations as measured by chromosome painting: p Collapse

Key Words

• cigarette smoking
• pregnancy
• newborns
• mothers
• chromosome translocations
• genomic susceptibility

Collapse

MESH Headings

• Adolescent
• Adult
• Black or African American
• Chromobacterium
• Female
• Humans
• Infant, Newborn
• Male
• Maternal-Fetal Exchange
• Pregnancy
• Smoking/adverse effects
• Translocation, Genetic/genetics
• White People

Collapse

Grants

• ZIJ BC011218-01 Intramural NIH HHS
• R01 HD33016 NICHD NIH HHS

Collapse

Affiliation(s)

L Michelle Bennett Physical and Life Sciences Directorate, L-452, Lawrence Livermore National Laboratory, Livermore, CA 94550, United States.
Yun Wang
Marilyn J Ramsey
Gail F Harger
William L Bigbee
James D Tucker

Collapse

Deconstruction junction: how to separate the good evidence from the bad (from the ugly)

In this column, the author reprises recent selections from the Lamaze International research blog, Science & Sensibility. Each selection discusses a new study that demonstrates the need to look closely at research articles to avoid being misled. Examples include new research on the effectiveness of intrapartum antibiotics for preventing early onset Group B streptococcal disease in newborns, a recent study on the incidence of infection after cesarean surgery and vaginal birth, and a new study demonstrating long-term benefits of skin-to-skin contact between the mother and infant after birth.

Simplified dosing of gentamicin for treatment of sepsis in Bangladeshi neonates

Extended-interval dosing of gentamicin has several advantages over conventional multiple-daily dosing for the treatment of sepsis. The study was conducted to evaluate the pharmacokinetics of gentamicin for the treatment of neonatal sepsis in predetermined doses at 24- or 48-hour intervals, according to weight category, and to develop a simplified protocol for use in peripheral healthcare settings in developing countries. This prospective observational study was conducted among 59 neonates admitted to the Special Care Nursery at Dhaka Shishu Hospital, Bangladesh, with suspected sepsis and treated with antibiotics, including gentamicin. Intravenous dosing of gentamicin according to weight category was: 10 mg every 48 hours if the infant weighed < 2,000 g (n = 23), 10 mg every 24 hours if the infant weighed 2,000-2,249 g (n = 12), or 13.5 mg every 24 hours if the infant weighed 2,500-3,000 g (n = 24). Peak and trough concentrations of gentamicin and the presence of signs of nephrotoxicity and ototoxicity were determined. The mean +/- standard deviation peak concentration of gentamicin was 12.3 +/- 3.7 microg/mL in infants weighing < 2,000 g, 9.6 +/- 3.1 microg/mL in infants 2,000-2,249 g, and 10.0 +/- 3.4 microg/mL in infants 2,500-3,000 g. Initial peak concentration of gentamicin was > 12 microg/mL in 28.8% and initial trough concentration was > 2 microg/mL in 6.8% of the subjects. No signs of nephrotoxicity or ototoxicity were detected. Favourable pharmacokinetic parameters found with the simplified dosing regimen suggest that it is safe for the treatment of neonatal sepsis.

Epidemiology of neonatal sepsis in South Korea

BACKGROUND

Neonatal sepsis is a severe clinical syndrome characterized by systemic signs of infection, shock and system organ failure; diagnosis is confirmed on positive culture from a normally sterile site(s). There are few reports comparing incidence, mortality, and risk factors between clinically diagnosed sepsis and that confirmed by culture.

METHODS

All infants diagnosed with early- (within first 72 h after birth) or late-onset (72 h-4 weeks after birth) neonatal sepsis between 1997 and 1999 from four neonatal centers in South Korea, were investigated.

RESULTS

The estimated incidence rate of neonatal sepsis during the 3 years was 30.5 per 1000 live births for clinical sepsis and 6.1 per 1000 live births for sepsis with positive culture, with case-fatality rates of 4.7% and 2.2%, respectively. When only early-onset sepsis was considered, the incidence and fatality rates were 25.1 per 1000 live births and 6.1% for clinical sepsis, and 4.3 per 1000 live births and 2.5% for culture-confirmed sepsis, respectively. For the 179 patients (185 causative organisms) of proven sepsis, Staphylococcus spp. including S. aureus were the most frequent isolates. In early-onset clinical sepsis, having very low birthweight (<or=1500 g), a low Apgar score at 5 min (<or=7), and being male were related to higher rates of case-fatality (relative risk: 11.3, 6.8 and 2.5, respectively).

CONCLUSIONS

Clinical sepsis was more common than culture-confirmed sepsis and had a higher case-fatality rate. It seems prudent to take rapid and decisive steps toward better management of the high-risk group whether the sepsis is clinically diagnosed or culture confirmed.

Role of the "rooming-in" on efficacy of universal neonatal hearing screening programmes

Sensorineural hearing loss is one of the most common congenital abnormalities in infants and it affects approximately one to two neonates in every 1000 births. Early identification of hearing loss in the newborn is the first step for a successful rehabilitation programme. The introduction of Otoacoustic Emission responses as a useful tool in hearing screening programmes, allowed the identification of hearing loss in the well-baby nursery and in targeted populations of the neonatal intensive care unit. Recently, a new concept of breastfeeding during hospitalization after birth has been developed. Indeed, the so-called "rooming-in" allows a mother to stay with her child in the same room, located in the nursery. This new trend has been developed to avoid any psychological adverse consequences of birth on the child-mother relationship. To enhance how "rooming-in" could affect the Universal Neonatal Hearing Screening (UNHS) programmes, an analysis has been made of the data coming from two maternity wards using different breastfeeding protocols. Data obtained demonstrate a worse performance on obtaining essential benchmark in the UNHS in the maternity ward where rooming-in is adopted (60% of newborns tested). UNHS programme efficacy could be affected by the wider adoption of the "rooming-in" regimen in the maternity wards and early detection of hearing loss revealed by UNHS could be vanished by dispersion of patients. In fact, more data are necessary to evaluate the impact of rooming, even though our data show a worsening in the UNHS results.

Neonatal jaundice and stool production in breast- or formula-fed term infants

It has remained unclear whether the amount of fecal fat excreted in the stool and stool production influences the severity of neonatal jaundice. We determined the relationship between stool production, fecal fat excretion and jaundice in healthy breast-fed (BF) or formula-fed (FF) (near-)term neonates. From postnatal day 1-4, we quantitatively collected stools from 27 FF and 33 BF infants in daily fractions. Stool production and fecal fat contents were related to unconjugated bilirubin (UCB) levels, as determined by transcutaneous bilirubinometry (TcB). Bilirubin concentrations and stool production did not differ between FF and BF neonates during the study period. Neonatal bilirubin levels were not inversely correlated with stool production. FF and BF infants had similar fecal fat excretion rates. The stool production of FF infants was profoundly lower in the present study than in a 1985 study by De Carvalho et al. [J Pediatr (1985) 107:786-790]. We conclude that increased jaundice during the first postnatal days in healthy term neonates can no longer be attributed to breast-feeding and speculate that improved absorbability of formulas since 1985 has contributed to similar fat excretion and stool production in FF and BF neonates in 2007.

Comparison between qualitative and semiquantitative catheter-tip cultures: laboratory diagnosis of catheter-related infection in newborns

This prospective study evaluated semiquantitative and qualitative catheter-culture methods for diagnosis of catheter-related infection (CRI) in newborns. Catheter tips from newborns admitted to the Neonatal Unit of the University Hospital of the Botucatu Medical School, UNESP were included in the study. Catheter cultures were performed with both semiquantitative and qualitative techniques. For CRI diagnosis, microorganisms isolated from catheter cultures and from peripheral blood cultures were identified and submitted to agent susceptibility test. The gold standard was the certain CRI diagnosis when same microorganism (specie and profile of susceptibility to agents) was isolated from both catheter tips and peripheral blood culture. A total of 85 catheters from 63 newborns were included in the study. The semiquantitative culture method, despite presenting lower sensitivity (90%), showed higher specificity (71%) when compared to 100% of sensitivity and 60% of specificity in the qualitative method. The identification of the microorganisms obtained from the catheter cultures showed a prevalence of coagulase-negative staphylococci (CNS) species. The specie Staphylococcus epidermidis (77.5%) was the prevalent in the catheters with positive semiquantitative cultures. Among 11 episodes with CRI diagnosis, 8 (72.7%) were associated with CNS species, of which 6 were S. epidermidis. Two episodes of CRI by S. aureus and one by Candida parapsilosis were also detected. The semiquantitative catheter-culture method showed advantages for CRI diagnosis in newborns when compared to the conservative qualitative method.

Conditional knock-out of beta-catenin in postnatal-born dentate gyrus granule neurons results in dendritic malformation

Neurons are continuously added to the brain throughout life, and these neurons must develop dendritic arbors and functional connections with existing neurons to be integrated into neuronal circuitry. The molecular mechanisms that regulate dendritic development of newborn neurons in the hippocampal dentate gyrus are still unclear. Here, we show that beta-catenin is expressed in newborn granule neurons and in neural progenitor cells in the hippocampal dentate gyrus. Specific knock-out of beta-catenin in newborn neurons, without affecting beta-catenin expression in neural progenitor cells, led to defects in dendritic morphology of these newborn neurons in vivo. Majority of newborn neurons that cannot extend dendrites survive <1 month after they were born. Our results indicate that beta-catenin plays an important role in dendritic development of postnatal-born neurons in vivo, and is therefore essential for the neurogenesis in the postnatal brain.

High prevalence of vitamin D deficiency in newborn infants of high-risk mothers

OBJECTIVE

To determine the prevalence of vitamin D deficiency in newborn infants of mothers at risk of vitamin D deficiency because of dark skin or the wearing of concealing clothes (such as a veil) compared with a group presumed not to be at risk. A second aim was to correlate these newborn infants' vitamin D concentrations with biochemical parameters of vitamin D metabolism and bone turnover at birth.

DESIGN

A prospective study conducted between April 2004 and February 2006 including women delivering during this period and their newborn infants.

SETTING

The outpatient clinic of the obstetrics department, Sint Franciscus Gasthuis, Rotterdam, the Netherlands.

PATIENTS

Eighty seven newborn infants of healthy mothers with either dark skin and/or concealing clothing (risk group) or light skin (control group).

RESULTS

We found a significant difference in the prevalence of vitamin D deficiency (25-hydroxyvitamin D(3) <25 nmol/l) between newborn infants of mothers at risk and those of mothers in the control group (63.3% vs 15.8%; p<0.001). Mean alkaline phosphatase concentrations were significantly higher in the at risk group.

CONCLUSIONS

Newborn infants of mothers with dark skin or wearing concealing clothes are at great risk of vitamin D deficiency at birth. The clinical implications are unknown. Further research is necessary to determine the long-term consequences of maternal and neonatal vitamin D deficiency so that guidelines on vitamin D supplementation during pregnancy can be issued.

Accuracy of pulse oximetry in screening for congenital heart disease in asymptomatic newborns: a systematic review

OBJECTIVE

To evaluate the accuracy of pulse oximetry as a screening tool for congenital heart disease in asymptomatic newborns. DESIGN, DATA SOURCES AND METHODS: Systematic review of relevant studies identified through MEDLINE, EMBASE, Cochrane Library, MEDION, and bibliographies of retrieved primary and review articles. Two reviewers independently extracted data on study characteristics, quality and results to construct 2x2 tables with congenital heart disease as the reference standard. A random-effects bivariate model was used to meta-analyse estimates of sensitivity and specificity. Logit pairs of sensitivity and specificity of each study were analysed in a single model, accounting for their correlation due to differences in threshold between studies.

RESULTS

Eight studies were included with a total of 35 960 newborns. Pulse oximetry was performed on asymptomatic newborns in all studies; three studies excluding newborns with an antenatal diagnosis of congenital heart disease. Either functional or fractional oxygen saturation was measured by pulse oximetry with oxygen saturation below 95% as the cut-off level in most studies. On the basis of the eight studies, the summary estimates of sensitivity and specificity were 63% (95% CI 39% to 83%) and 99.8% (95% CI 99% to 100%), respectively, yielding a false positive rate of 0.2% (95% CI 0% to 1%).

CONCLUSION

Pulse oximetry was found to be highly specific tool with very low false positive rates to detect congenital heart disease. Large, well-conducted prospective studies are needed to assess its sensitivity with higher precision.

Relationships among polycyclic aromatic hydrocarbon-DNA adducts, proximity to the World Trade Center, and effects on fetal growth

Polycyclic aromatic hydrocarbons (PAHs) are toxic pollutants released by the World Trade Center (WTC) fires and various urban combustion sources. Benzo[a]pyrene (BaP) is a representative member of the class of PAHs. PAH-DNA adducts, or BaP-DNA adducts as their proxy, provide a measure of chemical-specific genetic damage that has been associated with increased risk of adverse birth outcomes and cancer. To learn whether PAHs from the WTC disaster increased levels of genetic damage in pregnant women and their newborns, we analyzed BaP-DNA adducts in maternal (n = 170) and umbilical cord blood (n = 203) obtained at delivery from nonsmoking women who were pregnant on 11 September 2001 and were enrolled at delivery at three downtown Manhattan hospitals. The mean adduct levels in cord and maternal blood were highest among newborns and mothers who resided within 1 mi of the WTC site during the month after 11 September, intermediate among those who worked but did not live within this area, and lowest in those who neither worked nor lived within 1 mi (reference group). Among newborns of mothers living within 1 mi of the WTC site during this period, levels of cord blood adducts were inversely correlated with linear distance from the WTC site (p = 0.02). To learn whether PAHs from the WTC disaster may have affected birth outcomes, we analyzed the relationship between these outcomes and DNA adducts in umbilical cord blood, excluding preterm births to reduce variability. There were no independent fetal growth effects of either PAH-DNA adducts or environmental tobacco smoke (ETS), but adducts in combination with in utero exposure to ETS were associated with decreased fetal growth. Specifically, a doubling of adducts among ETS-exposed subjects corresponded to an estimated average 276-g (8%) reduction in birth weight (p = 0.03) and a 1.3-cm (3%) reduction in head circumference (p = 0.04). The findings suggest that exposure to elevated levels of PAHs, indicated by PAH-DNA adducts in cord blood, may have contributed to reduced fetal growth in women exposed to the WTC event.

The effects of the World Trade Center event on birth outcomes among term deliveries at three lower Manhattan hospitals

The effects of prenatal exposure to pollutants from the World Trade Center (WTC) disaster on fetal growth and subsequent health and development of exposed children remain a source of concern. We assessed the impact of gestational timing of the disaster and distance from the WTC in the 4 weeks after 11 September on the birth outcomes of 300 nonsmoking women who were pregnant at the time of the event. They were recruited at delivery between December 2001 and June 2002 from three hospitals close to the WTC site. Residential and work addresses of all participants for each of the 4 weeks after 11 September 2001 were geocoded for classification by place and timing of exposure. Average daily hours spent at each location were based on the women's reports for each week. Biomedical pregnancy and delivery data extracted from the medical records of each mother and newborn included medical complications, type of delivery, length of gestation, birth weight, birth length, and head circumference. Term infants born to women who were pregnant on 11 September 2001 and who were living within a 2-mile radius of the WTC during the month after the event showed significant decrements in term birth weight (-149 g) and birth length (-0.82 cm), compared with infants born to the other pregnant women studied, after controlling for sociodemographic and biomedical risk factors. The decrements remained significant with adjustment for gestational duration (-122 g and -0.74 cm, respectively). Women in the first trimester of pregnancy at the time of the WTC event delivered infants with significantly shorter gestation (-3.6 days) and a smaller head circumference (-0.48 cm), compared with women at later stages of pregnancy, regardless of the distance of their residence or work sites from the WTC. The observed adverse effects suggest an impact of pollutants and/or stress related to the WTC disaster and have implications for the health and development of exposed children.

Protective effect of neonatal BCG vaccines against tuberculous meningitis

Neonatal BCG vaccination reduces the risk of tuberculosis and provides protection higher than 80% against the development of meningeal and miliary tuberculosis in newborns. Tuberculosis meningitis remains a major problem and also an important cause of death in some countries. In countries with high and moderate incidence of tuberculosis, prevention from the most severe complications of tuberculosis can be achieved only with a high coverage of the universal BCG neonatal immunization, being higher than 98% in the cohort of newborns. The decrease in BCG immunization coverage within immunization program during the year 2003 in Bosnia and Herzegovina influenced the increase in tuberculous meningitis. During 2002, when coverage with BCG vaccination in cohort of newborns was 90%, the incidence rate of tuberculous meningitis was 19. 04%oo. With the 68% decrease in BCG immunization coverage in the cohort of newborns in Bosnia and Herzegovina during the year 2003, the incidence of tuberculous meningitis raised to 33 33%oo. It has been proven that the 22% decrease of the neonatal BCG immunization coverage in the cohort of newborns /vaccination program of children/ caused 175 times higher number of the tuberculous meningitis cases. Newborns affected by the tuberculous meningitis were not BCG vaccinated. BCG vaccine provided effective protection against tuberculous meningitis, as well against the death of newborns caused by tuberculosis.

Pancreatic lipase-related protein 2 is the major colipase-dependent pancreatic lipase in suckling mice

Suckling mice express colipase before the expression of pancreatic triglyceride lipase. Yet, efficient fat digestion in newborns requires colipase, suggesting that colipase may act as a cofactor for another lipase such as pancreatic lipase-related protein 2 (PLRP2). We determined whether PLRP2 or another lipase depends on colipase for maximal activity in newborn mice by analyzing extracts from the pancreas of 4-d-old colipase-deficient and PLRP2-deficient mice. Pancreatic extracts from colipase-deficient pups had lipase activity that was stimulated onefold by the addition of exogenous colipase (P<0.001). The activity was completely inhibited by an antibody against pancreatic triglyceride lipase that also recognizes PLRP2. In contrast, pancreatic extracts from PLRP2-deficient pups had significantly lower baseline activity and no colipase-dependent activity. The baseline activity was not inhibited by the anti-pancreatic triglyceride lipase antibody or an antibody against carboxyl ester lipase. We next separated the extracts into two fractions, one containing PLRP2 and the other devoid of PLRP2. All of the colipase-dependent activity segregated with the PLRP2-containing fraction, consistent with the conclusion that PLRP2 is the major colipase-dependent lipase in the pancreas of newborns.

Thirty-five year mortality following receipt of SV40- contaminated polio vaccine during the neonatal period

Early poliovirus vaccines, both inactivated and live attenuated, were inadvertently contaminated with simian virus 40 (SV40), a monkey virus known to be oncogenic for newborn hamsters. Although large epidemiologic studies have not identified an elevated cancer risk in persons who received SV40-contaminated vaccines, fragments of SV40 DNA have recently been identified in certain human tumours. We report the follow-up of a cohort of 1073 persons, unique because they received SV40-contaminated poliovirus vaccines as newborns in 1961-63. A previous report of the status of these subjects as of 1977-79 identified 15 deaths, none due to cancer. The present study utilized the National Death Index to identify deaths in the cohort for the years 1979-96. Expected deaths were calculated from Cleveland area sex-, age-, race- and year-specific mortality rates. Increased mortality from all causes was not found. 4 deaths from cancer were found compared to 3.16 expected (P = 0.77). However, 2 deaths from testicular cancer occurred, compared to 0.05 expected (P = 0.002), which may be a chance finding due to multiple comparisons. There were 2 deaths due to leukaemia, a non-significant finding, and no deaths due to tumours of the types putatively associated with SV40. Although these results are, for the most part, consistent with other negative epidemiologic investigations of risks from SV40-contaminated vaccines, further study of testicular cancer may be warranted, and it will be important to continue monitoring this cohort which is now reaching middle-age.

Femoral vein size in newborns and infants: preliminary investigation

BACKGROUND

The femoral vein is an important site for central venous access in newborns and infants. The objectives of this study are to determine whether age or weight can be used clinically to predict the size of the femoral vein in newborns and infants, and to compare the size of the vein in each individual in both the supine and reverse Trendelenburg positions.

RESULTS

Analysis was done in 24 euvolemic individuals, each studied in both the supine and reverse Trendelenburg positions. Twelve of these individuals were newborns and 12 were infants. We used two-factor analysis of variance to explore differences between groups and multiple linear regression analysis to estimate the strength of the relationship between variables. In the infant group, there was a correlation between femoral vein diameter and weight. There was no correlation between weight and vessel size in newborns. In both the newborn and infant groups, vessel diameter increased with subjects in the reverse Trendelenburg position (P < 0.01).

CONCLUSION

Weight is predictive of femoral vein diameter in infants, but not in newborns. In infants, weight might serve as a more sensitive index for estimating size of the femoral vein in order to determine accurately the size of intravascular catheter appropriate for cannulation. The diameter of the femoral vein increases in the reverse Trendelenburg position compared with that in the supine position in both newborns and infants. A large prospective study is required to validate these findings.

Protective cellular immunity against influenza virus induced by plasmid inoculation of newborn mice

Neonate organisms display an intrinsic disability to mount effective immune responses to infectious agents or conventional vaccines. Whereas low doses of antigens trigger a suboptimal response, higher doses are frequently associated with tolerance induction. We investigated the ability of a plasmid-expressing nucleoprotein of influenza virus to prime a specific cellular immune response when administered to newborn mice. We found that persistent exposure to antigen following plasmid inoculation of neonates leads to a vigorous priming of specific CTLs rather than tolerance induction. The CTLs were cross-reactive against multiple strains of type A influenza viruses and produced IFNgamma but no IL-4. The immunity triggered by plasmid inoculation of neonates was protective in terms of pulmonary virus clearance as well as survival rate following lethal challenge with influenza virus. Whereas the persistence of the plasmid at the site of injection was readily demonstrable in adult mice at 3 months after inoculation, mice immunized as newborns displayed no plasmid at 3 months and very little at 1 month after injection. Thus, DNA-based immunization of neonates may prove an effective and safe vaccination strategy for induction of cellular immunity against microbes that cause serious infectious diseases in the early period of life.