Banu Aydin

The propre-save study: effects of probiotics and prebiotics alone or combined on necrotizing enterocolitis in very low birth weight infants.

OBJECTIVEnTo test the efficacy of probiotic and prebiotic, alone or combined (synbiotic), on the prevention of necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants.nnnSTUDY DESIGNnA prospective, randomized, controlled trial was conducted at 5 neonatal intensive care units in Turkey. VLBW infants (n = 400) were assigned to a control group and 3 study groups that were given probiotic (Bifidobacterium lactis), prebiotic (inulin), or synbiotic (Bifidobacterium lactis plus inulin) added to breastmilk or formula for a maximum of 8 weeks before discharge or death. The primary outcome was NEC (Bell stage ≥2).nnnRESULTSnThe rate of NEC was lower in probiotic (2.0%) and synbiotic (4.0%) groups compared with prebiotic (12.0%) and placebo (18.0%) groups (P < .001). The times to reach full enteral feeding were faster (P < .001), the rates of clinical nosocomial sepsis were lower (P = .004), stays in the neonatal intensive care unit were shorter, (P = .002), and mortality rates were lower (P = .003) for infants receiving probiotics, prebiotics, or synbiotic than controls. The use of antenatal steroid (OR 0.5, 95% CI 0.3-0.9) and postnatal probiotic (alone or in synbiotic) (OR 0.5, 95% CI 0.2-0.8) decreased the risk of NEC, and maternal antibiotic exposure increased this risk (OR 1.9, 95% CI 1.1-3.6).nnnCONCLUSIONSnIn VLBW infants, probiotic (Bifidobacterium lactis) and synbiotic (Bifidobacterium lactis plus inulin) but not prebiotic (inulin) alone decrease NEC.

Sex Hormone-Binding Globulin in Children and Adolescents

Sex hormone-binding globulin (SHBG) is a circulating glycoprotein that transports testosterone and other steroids in the blood. Interest in SHBG has escalated in recent years because of its inverse association with obesity and insulin resistance, and because many studies have linked lower circulating levels of SHBG to metabolic syndrome, type 2 diabetes, nonalcoholic fatty liver disease, polycystic ovary syndrome, and early puberty. The purpose of this review is to summarize molecular, clinical, endocrine, and epidemiological findings to illustrate how measurement of plasma SHBG may be useful in clinical medicine in children.

Umbilical cord asymmetric dimethylarginine levels and ultrasound assessment of carotid arteries in neonates born small for gestational age

Abstract Background: To examine asymmetric dimethylarginine (ADMA) level as an endothelial function parameter in addition to ultrasonographic evaluation of carotid arteries in babies born small for gestational age (SGA). Methods: Twenty-six neonates born SGA and 34 appropriate for gestational age (AGA) controls were included in the study. The serum levels of ADMA were measured. Intima-media thickness (cIMT) and resistive index (cRI) of the both carotid arteries were determined by ultrasonography. Results: The mean ADMA level was higher in SGA neonates compared to AGAs (16 267.7u2009±u20096050 versus 12 810.2u2009±u20093302u2009ng/L; pu2009=u20090.01). The mean cIMT (0.34u2009±u20090.02 versus 0.31u2009±u20090.03u2009mm; pu2009=u20090.001) and cRI (0.66u2009±u20090.07 versus 0.61u2009±u20090.04, pu2009=u20090.003) were also higher in SGAs. Serum ADMA levels were positively correlated to the mean cIMT (ru2009=u20090.41, pu2009=u20090.001). Although there was a weak correlation between cIMT and mean cRI (ru2009=u20090.26, pu2009=u20090.04), no correlation was found between ADMA and mean cRI (ru2009=u20090.17, pu2009=u20090.18). Conclusions: Neonates born SGA have elevated cord blood ADMA level in addition to thicker IMT and higher RI of carotid arteries at birth. ADMA was correlated to cIMT, suggesting that higher ADMA levels might influence vascular health in later life in these neonates.

Mean Platelet Volume and Uric Acid Levels in Neonatal Sepsis: Authors' Reply

To the Editor: We would like to thank authors for their voluminous contributions to the literature in general and to our article in particular. The comprehensive criticism on methodological and pathophysiological issues presented in their letters provides illuminating framework on our study. We would like to offer some clarifications regarding to the points they have raised in the letters for their interest in our manuscript [1]. In our study, blood samples were obtained into blood collection tubes with ethylene diamine tetra acetic acid (EDTA). Platelet count and mean platelet volume (MPV) measurements were performed within approximately 60 min after blood sampling by CoulterLH 780 Analyzer (Beckman Coulter, Inc. CA, USA) with original method and reagents. Therefore, there was no time delay in the measurement ofMPVafter sampling. As stated by Prof Varol, hypothyroidism may increase the MPV values [2]. In our unit, all newborns are screened for congenital hypothyroidism. There was no patient diagnosed with hypothyroidism in our study population. Despite many screening tests being employed in early diagnosis of sepsis, there is still no single test that satisfies the criteria as being the ideal marker for the early diagnosis of neonatal sepsis [3]. In our study, C-reactive protein (CRP) was shown to be more sensitive and specific than MPV and uric acid; the combined use of CRP and MPV has the highest predictive values for diagnosis of sepsis. In their letter, Kartal O and Kartal AT have commented that procalcitonin is a promising biomarker for early diagnosis of sepsis. In a recent meta-analysis, Wacker et al., revealed that procalcitonin is a helpful biomarker for early diagnosis of sepsis in critically ill patients [4]. However the infants younger than 28 d were excluded from their study. The authors have also stated that the results of the test must be interpreted carefully with regards to medical history, physical examination, and microbiological assessment. While nonspecific screening tests are employed in the diagnosis of NS so as to investigate the possibility of infection, specific diagnostic tests are employed to confirm the presence of a specific pathogen in body fluids. Ideally, a screening test should have a high positive predictive value and a high negative predictive value. Unfortunately, none of the screening tests is capable of attaining this ideal. Even though a positive blood culture still remains the gold standard in the diagnosis of neonatal sepsis, considerable effort continues to be devoted to the development of methods of measurement intended to support culture-based diagnosis by evaluating the host-response.