Alberto Chiara

Intravenous gammaglobulin therapy for prophylaxis of infection in high-risk neonates

The safety and effectiveness of intravenously administered gammaglobulin therapy for prophylaxis of infection was evaluated in 133 high-risk neonates. The infants were stratified into two groups: infants with birth weight less than or equal to 1500 g and gestational age less than or equal to 34 weeks, and infants with birth weight greater than 1500 g and receiving intensive care and assisted ventilation. Forty-three infants in group 1 and 25 in group 2 were given gammaglobulin at a dose of 0.5 g/kg/wk, for 1 month in group 1 and during intensive care in group 2. Forty infants in group 1 and 25 in group 2 served as controls. Serum total IgG and group B streptococcus-, Escherichia coli-, and CMV-specific IgG levels similar to those in adult controls were observed in the treated infants 2 hours after gammaglobulin administration. In the treated infants in group 1, the incidence of infection was 51%, and of septicemia 5%; in the controls the incidence of infection was 77% (P less than 0.02), and of septicemia 20% (P less than 0.05). Infection was the main cause of death in one treated and six control infants in group 1 (P less than 0.04). In the infants with birth weight greater than 1500 g receiving intensive care and assisted ventilation, no significant differences were observed in the incidence of infection or septicemia in treated and control infants. No side effects were observed after intravenous gammaglobulin administration. These data show that intravenously administered gammaglobulin is both safe and effective for prophylaxis of infection in preterm very low birth weight infants.

Activity of Classical and Alternative Pathways of Complement in Preterm and Small for Gestational Age Infants

Summary: Complement activity was compared in 50 low birth weight infants divided into appropriate and small for gestational age groups; the influence of birth weight and gestational age on complement development was also investigated. CH50 and kinetics (tH50) of both classical and alternative pathway activity of complement, C3, and Factor B levels were significantly higher in small for gestational age infants (classical pathway CH50, 630 HU/ml ± 184 SD; CP tH50, 77 min ± 47; aternative pathway CH50, 44.8 HU/ml ±11.3; AP tH50, 56 min ± 43; C3, 73.98 mg/dl ± 12.68; and Factor B, 13.17 mg/dl ± 3.67) than in weight-matched appropriate for gestational age infants (CP CH50, 523 HU/ml ± 152; CP tH50, 105 min ± 49; AP CH50, 38.8 HU/ml ± 13; AP tHs50, 90 min ± 53; C3, 58.14 mg/dl + 9.43; and Factor B, 9.32 mg/dl ± 1.73). Complement values were lower in low birth weight infants than in adult controls (P < 0.001 in all cases). All complement parameters were mainly correlated with gestational age; CH50 values of the classical and alternative pathways were also highly correlated with each other (r= 0.64; P < 0.001).Low birth weight infants, especially preterm infants, have an important defect of complement activity. Complement factors increase gradually during gestation and intrauterine growth retardation does not affect complement development. Classical and alternative complement pathway activities have a similar development pattern.

Deficiency of neutrophil phagocytosis in premature infants: effect of vitamin E supplementation

ABSTRACT. In 20 healthy premature infants, 10 of whom were administered a total dose of 120 mg/kg vitamin E intramuscularly during the first 13 days after birth, polymorphonuclear leukocyte (PMN) bactericidal activity, frequency and index of phagocytosis, NBT reduction, random movement, chemotaxis and metabolic activity were evaluated within the first 48 hours and again at 5, 14 and 30 days of age. PMN function was also assessed in 30 adult controls. In the treated and untreated infants no differences were found in PMN function before treatment with vitamin E; however phagocytosis, bactericidal activity and chemotaxis were significantly lower than in the adult controls. At 5 days of age, in the untreated infants both index and frequency of phagocytosis remained low but in the treated groups increased significantly. At 14 and 30 days phagocytosis was normal in both treated and untreated infants. No differences were found in the bactericidal activity, NBT reduction, random movement, chemotaxis or metabolic activity of the treated and untreated infants at the ages studied. This preliminary report suggests that vitamin E may be used in premature newborns for accelerating normalization of phagocytic function in the neonatal period.

Increased renal echogenicity in the neonate.

We report data on newborn infants with increased renal echogenicity observed at the Division of Neonatal Intensive Care of Pavia during a five-year period. Review of 1600 abdominal ultrasonic evaluations revealed 103 newborn infants (56 females and 47 males, with birth weight from 560 to 3700 g and gestational age from 25 to 42 weeks) whose kidneys showed increased echogenicity. Three patients with infantile polycystic kidney disease, two with renal candidiasis, three with dysplastic kidney and two with renal vein thrombosis showed diffuse hyperechogenicity. Three patients with hemolytic-uremic syndrome showed cortical hyperechogenicity. Increased medullary echogenicity was observed in 90 infants with renal disease secondary to perinatal asphyxia. In 76 of these patients the evaluation of renal echogenicity and the renal function improved, while in the remaining 14 newborns the renal alteration persisted until death.

Ultrasonic evaluation of kidney length in term and preterm infants

Kidney length was evaluated by ultrasound in 132 healthy neonates with gestational ages from 27 to 42 weeks and birth weights from 790 to 4200g. A highly significant correlation was found between the length of the kidneys and gestational age or birth weight.

Obstetric risk factors and persistent increases in brain parenchymal echogenicity in preterm infants

Objective  To assess the risk of persistent (>7 days) increases in brain parenchymal echogenicity in preterm infants and their association with known obstetric risk factors.

Fetal growth and infant neurodevelopmental outcome after preterm premature rupture of membranes.

OBJECTIVE: To evaluate the prognostic values of fetal size before birth and fetal growth during the latency period in patients with preterm premature rupture of the membranes (PROM). METHODS: A prospective cohort study of 69 singleton pregnancies complicated by prolonged (14 days or more) PROM (24 to 31 weeks of gestation). Measures of fetal size and growth were compared with corresponding expected values from our reference curves. The correlations between deviations from expected measures of fetal size and growth, short-term neonatal complications, and infant neurodevelopmental outcome at 2 years were studied by univariate methods and logistic regression. RESULTS: The mean gestational ages and standard deviations at membrane rupture and at birth were 27.9 ± 2.4 and 31.5 ± 2.1 weeks. At a corrected age of 2 years, of the 65 (94.2%) survivors, 3 infants (4.6%) had cerebral palsy, 13 (20%) had minor neurodevelopmental impairment, and 49 (75.4%) were judged to have had normal development. Compared with surviving infants without a major handicap, the group of infants who died and those with cerebral palsy had lower proportions of expected birth weight (0.766 ± 0.1 as compared with 0.859 ± 0.13, P = .029), head (0.869 ± 0.07 as compared with 0.950 ± 0.07, P = .05), and abdominal (0.793 ± 0.04 as compared with 0.888 ± 0.1, P = .001) circumference growth during latency period. In logistic regression analysis, lower-than-expected ultrasound measures of fetal abdominal circumference before birth (odds ratio 1.09; 95% confidence interval 1.01, 1.18) or of abdominal circumference growth during the latency period (odds ratio 1.1; 95% confidence interval 1.01, 1.2) were significantly associated with an increased likelihood of an infant neurodevelopmental abnormality at 2-year follow-up. CONCLUSION: In pregnancies complicated by preterm PROM, lower-than-expected measures of fetal size and fetal growth were associated with an increased rate of infant neurodevelopmental outcome at 2-year follow-up. LEVEL OF EVIDENCE: II-2

Serum growth-promoting activity in human newborns. Relationship of thymidine activity with birth weight and the length of gestation.

ABSTRACT. Thymidine Activity (TA) was measured by the effect of serum upon incorporation of 3H‐thymidine into human lectin‐activated lymphocytes in 54 newborns: 32 full‐term, 11 pre‐term and 11 with intra‐uterine growth retardation (IGR). Capillary blood was collected at 0‐6 hours, with routine samplings. TA values were lower in preterm (0.476±0.079 U/ml) than in IGR (0.910±0.118 U/ml, p<0.01) and in full‐term neonates (1.237±0.60, p<0.001), and also in IGR newborns than in newborns of normal weight (p<0.025). In preterm neonates TA was significantly correlated with gestational age (r=0.715, p<0.02), but no such correlation existed in IRG and full‐term neonates. When TA values were plotted against birth weight, a correlation was found in preterm (r=0.715, p<0.02) and in IGR newborns (r=0.714, p<0.02), but not in full‐term neonates. Longitudinal study up to 21 days did not show significant changes in full‐term newborns, while in preterm and IGR neonates TA increased progressively to reach normal values at the 21th day. The correlations observed in newborns between TA, birth weight and gestational age, and the postnatal normalization in newborns with low birth weight, show that TA directly reflects the nutritional state of the fetus.

Developmental dysplasia of the hip: to screen or not to screen with ultrasound

Abstract Early diagnosis is critical for the prompt implementation of treatment and to ensure the best results in developmental dysplasia of the hip (DDH). Clinical DDH screening with a search for Ortolanis sign does not detect all cases affected by DDH. Universal ultrasound screening is currently the most viable strategy to identify dysplastic hips including subjects with negative results at clinical examination and in the absence of risk factors.

Intravenous Gammaglobulin Replacement for Prophylaxis of Infection in Preterm Neonates

Despite the improvements made in medical care in recent years, infection remains a major problem in newborn infants, because rapid diagnosis is difficult and therapy is not always effective (Eisenfeld et al. 1983). Preterm infants with gestational age ≤ 34 weeks and birth weight ≤ 1500 g are particularly at risk: the incidence of systemic infection in these infants, in fact, is about 32%, with a mortality rate of 11% (Usher 1981). The high susceptibility to infections is mainly due to the neonatal impairment of host defenses; both the aspecific and antigen-specific components of the immune system are deficient in the preterm neonate. The antibody deficiency is one of the most important contributory factors in the neonate’s high susceptibility to infections: levels of IgG, all acquired via transplacental passage from the mother, are, in fact, definitely low and often similar to those found in patients with congenital agammaglobulinemia. This is because the transplacental passage occurs almost exclusively during the last 6 weeks of gestation (Hobbs and Yeung 1968; Pilgrim et al. 1975).