Helen Mandyla

Circulating levels of adiponectin in preterm infants

Objective: To determine circulating levels of adiponectin in preterm infants and examine possible associations with anthropometric measurements, weight gain, and leptin and insulin levels. Design: Prospective study. Setting: A university hospital neonatal care unit. Study population: 62 preterm (mean (SD) gestational age 32.0 (2.1) weeks) and 15 full-term infants (reference group). Interventions: Blood samples taken at discharge (40.9 (14.8) days of life) from the preterm infants and at a comparable postnatal age in full-term infants. All infants were fed the same commercial formula, but in nine preterms the formula contained long-chain polyunsaturated fatty acids (LCPUFAs). Main outcome measures: Serum levels of adiponectin, leptin and insulin. Associations of adiponectin levels were tested only in the preterm group. Results: Serum levels of adiponectin were lower in preterm (40.9 (14.8) μg/ml) than full-term infants (53.1 (16.0) μg/ml, p<0.01). However, after adjustment for body weight, the influence of prematurity on adiponectin levels was no longer significant. In preterm infants, adiponectin levels independently correlated with being born small for gestational age (SGA) (β = −0.35, p = 0.01), weight gain (β = 0.28, p = 0.03) and LCPUFA-supplemented formula (β = 0.34, p = 0.009). Serum adiponectin levels did not correlate with insulin or leptin levels. However, insulin levels were higher in preterm than in full-term infants after adjustment for body weight. Conclusions: Adiponectin levels are lower in preterm infants at discharge than full-term infants probably due to decreased adiposity. The levels are influenced by being born SGA, weight gain and, possibly, by dietary LCPUFAs. The importance of these findings in the development of insulin or leptin resistance in children born prematurely needs to be further studied.

Eosinophilic gastroenteritis complicated with perforation and intussusception in a neonate.

Eosinophilic gastroenteritis (EG) is a disease characterized by marked eosinophilic infiltration of the gastrointestinal tract, an absence of vasculitis, and a peripheral eosinophilia in approximately 50% of patients (1). EG is included in a standardized diagnostic classification scheme of gastrointestinal diseases of infants and children resulting from adverse immunologic reactions to foods (1). Kaijser originally described this disorder in 1937. The prevalence of this disease in the general population is unknown. Clinical symptoms are related to the gastrointestinal region involved (esophagus, stomach, small intestine, colon) and to the predominant layer affected (mucosa, muscularis, serosa). Eosinophilic infiltration of the mucosal layer causes inflammation; that of the muscular layer leads to thickening and rigidity, provoking symptoms of obstruction; whereas infiltration of the serosa results in ascites (2). The disease is distinguished into allergic eosinophilic esophagitis, gastritis, or gastroenterocolitis according to the anatomic region affected (1). Eosinophilic infiltration of the gastric antrum is typical in eosinophilic gastritis or gastroenterocolitis and may result in gastric outlet obstruction (1). Intestinal perforation and intussusception are rare complications of the disease (3). Even though patients of all ages can be affected, a few cases of neonates with EG, without complications, have been reported (4–6). We describe a male neonate who presented typical symptoms of EG on the first day of life and whose condition was complicated by perforation of the antral wall and ileoileal intussusception.

Circulating Adiponectin in Preterm Infants Fed Long-Chain Polyunsaturated Fatty Acids (LCPUFA)-Supplemented Formula—A Randomized Controlled Study

Adiponectin has potent insulin-sensitizing effects, improves lipid metabolism, and potentially protects against the development of metabolic syndrome. Thus, increasing adiponectin levels in preterm infants at risk for developing metabolic syndrome may be of special interest. The aim of this study was to examine the effects of dietary long-chain polyunsaturated fatty acids (LCPUFA) on serum adiponectin and lipid concentrations in preterm infants. Adiponectin and lipid levels of 60 healthy preterm infants [gestational age 32.7 (1.9) wk] randomly assigned to be fed either 1) a formula containing LCPUFA [arachidonic and docosahexanoic] (+LCPUFA group) or 2) the same formula without LCPUFA (−LCPUFA/control group), were determined at mean (SD) 33.8 (11.7) d. Adiponectin and HDL-C concentrations were significantly higher in the +LCPUFA group than in controls (p = 0.002 and p = 0.01, respectively); whereas, triglyceride levels were lower (p = 0.06). Adiponectin correlated positively with HDL-C levels and negatively with triglyceride levels in the +LCPUFA group but not in the controls. In conclusion, circulating adiponectin concentrations were higher in preterm infants fed a formula containing LCPUFA than infants fed an LCPUFA-free formula and they correlated with lipidemic profile.

Serum lipids in preterm infants fed a formula supplemented with nucleotides.

Background The effect of dietary nucleotides on lipid metabolism has been the subject of clinical studies with conflicting results. We measured serum triglycerides, total cholesterol (total-C), and lipoprotein cholesterol levels (HDL-C, LDL-C, and VLDL-C) in preterm neonates fed formula with and without nucleotide supplements. Methods This prospective, randomized, controlled study included 150 healthy preterm neonates (gestational age, 33.0 ± 1.9 weeks) matched for gestational age, birth weight, and gender. Subjects were assigned at birth to receive either a standard milk formula supplemented with nucleotides (group F-NT) or the same formula without nucleotides (group F). Serum was obtained before discharge (29.1 ± 10.0 days of life) and triglycerides, total-C, and HDL-C were determined enzymatically. LDL-C and VLDL-C were estimated by the Friedewald formula. For statistical analysis t test, Mann Whitney-U test, two-way ANOVA, and &khgr;2 test were used, as appropriate. The influence of several factors on serum lipid levels was evaluated by linear regression analysis. Results Serum triglycerides, total-C, and VLDL-C levels did not differ between groups. HDL-C levels (median; 25th–75th percentiles) were significantly higher (P < 0.001) in group F-NT (48.0 mg/dL; 40.5–57.0 mg/dL) than in group F (34.5 mg/dL; 27.2–44.0 mg/dL). On the contrary, LDL-C levels (median; 25th-75th percentiles) were significantly lower (P < 0.001) in group F-NT (39.0 mg/dL; 26.0–54.0 mg/dL) than in group F (65.0 mg/dL; 41.0–73.0 mg/dL). In the multiple regression analysis, nucleotide supplementation was identified as one of the controlled independent factors influencing serum HDL-C and LDL-C levels. Conclusions Preterm neonates fed from birth with formula supplemented with nucleotides have significantly higher HDL-C and lower LDL-C serum levels than do neonates fed unsupplemented formula. The clinical relevance of these results remains to be elucidated.

Late recurrence of herpes simplex virus meningoencephalitis in two infants

Abstract. Two infants with recurrence of herpes simplex virus (HSV) encephalitis are reported. Both patients developed HSV encephalitis during their neonatal period and were treated with iv acyclovir. Long-term oral acyclovir prophylaxis was given thereafter. At the age of 8 and 11 months respectively, both babies, while under oral acyclovir prophylaxis, presented a second episode of HSV encephalitis. An inadequate dose of suppressive oral acyclovir therapy may be responsible for the recurrence of encephalitis in these two babies. Conclusion: the present observations emphasise the need for very long follow-up of any infant who has suffered from neonatal herpes simplex virus encephalitis and the need for careful prospective controlled studies in order to define the appropriate treatment regimen (initial plus prophylaxis) for neonates with herpes simplex virus infections.

Hyperglycaemia and insulinopenia in a neonate with cystic fibrosis.

UNLABELLED Abnormal glucose tolerance is a frequent late complication of cystic fibrosis (CF), but the prevalence of CF-related diabetes mellitus (CFRD) in children less than 10 y old is less than 2%. The youngest child with CFRD reported to date was 6 mo of age. Insulinopenia is the primary cause of abnormal glucose tolerance/CFRD, but it is unknown whether it may begin in the neonatal period. We describe a case of a neonate with CF who presented with hyperglycaemia in the diabetic range and marked insulinopenia. Insulinopenia and impaired glucose tolerance were permanent findings at 6 and 15 mo of age. CONCLUSION This case suggests that abnormal glucose tolerance/diabetes may occur much earlier in the course of CF, even during neonatal age. Careful follow-up and further studies in CF infants could reveal that the real incidence of glucose intolerance and diabetes in this age group has been underestimated.

Neuroendocrine abnormalities in a neonate with congenital toxoplasmosis.

The central nervous system is often affected in patients with congenital toxoplasmosis. However, hypothalamo-pituitary dysfunction has rarely been reported in children with congenital toxoplasmosis, and no case with prolonged fever of central origin has been documented so far. We describe a newborn with congenital toxoplasmosis who presented with fever due to hypothalamo-pituitary dysregulation and combined hypothalamo-pituitary deficiencies consisting of central diabetes insipidus, hypothyroidism and ACTH deficiency.

Disparity in circulating adiponectin multimers between term and preterm infants

Abstract Aims: To study circulating levels and distribution of adiponectin multimers [low molecular weight (LMW)-, medium molecular weight (MMW)- and high molecular weight (HMW)-adiponectin] in preterm and full-term infants. Methods: Total serum adiponectin and its multimers were measured in 40 healthy infants at the age of one month and associations with anthropometric parameters [body weight and length, body mass index (BMI)], weight gain and metabolic indices (glucose, insulin) were examined. Twenty of the infants were born preterm (gestational age 33.2±1.6 weeks). Results: LMW-adiponectin level and its fractional ratio to total adiponectin were significantly higher in full-term than in preterm infants (P<0.001 and P<0.01, respectively), whereas, MMW-adiponectin level and its ratio were significantly lower (P=0.03 and P=0.01, respectively). HMW-adiponectin did not differ significantly between full-term and preterm infants and accounted for almost 60% of total adiponectin levels in both groups. HMW-adiponectin, but not MMW adiponectin or LMW adiponectin, correlated significantly with anthropometric measurements, similarly to total adiponectin; in addition, HMW adiponectin correlated significantly with weight gain. Conclusions: HMW adiponectin is the most prevalent form in infants. Circulating levels and distribution of MMW- and LMW-adiponectin differ between full-term and preterm infants, but the role of these adiponectin multimers needs to be studied further.

Circulating adipocyte fatty acid binding protein levels in healthy preterm infants: Positive correlation with weight gain and total-cholesterol levels

BACKGROUND Adipocyte fatty acid binding protein (a-FABP) has been suggested to play an important role in the pathogenesis of metabolic syndrome. Preterm infants are at risk for the later development of insulin resistance, and, possibly, other components of metabolic syndrome. AIM To determine circulating levels of a-FABP in preterm infants and examine possible associations of a-FABP with metabolic indices (serum lipids, glucose, and insulin levels, and homeostasis model assessment index of insulin resistance [HOMA-IR]), levels of leptin and adiponectin, anthropometric parameters and weight gain. STUDY DESIGN Prospective cohort study. SUBJECTS 55 healthy preterm (mean [SD] gestational age 32.8 [1.8] weeks) and 23 fullterm infants (reference group). OUTCOME MEASURES Serum a-FABP, lipids, glucose, insulin, leptin and adiponectin levels at 31.9 [10.4] days of life. RESULTS Serum a-FABP levels did not differ significantly between preterm and fullterm infants. A-FABP levels correlated positively with total-cholesterol [total-C] in both preterm and fullterm infants (beta=0.33; p=0.01 and beta=0.33; p=0.04, respectively). In addition to total-C, weight gain correlated independently with a-FABP levels in preterm infants (beta=0.36, p=0.01). CONCLUSIONS An association between a-FABP levels and indices of insulin resistance was not present in infants studied. As the development of insulin resistance in children born prematurely is possibly associated with weight gain in early postnatal life, follow-up of our study population is necessary to demonstrate whether a-FABP levels, shown to correlate with weight gain in preterm infants, are a predictive marker for the later development of insulin resistance in these infants.

Plasma and Urine Elastase Alpha-1-Proteinase Inhibitor Levels in Neonatal Urinary Tract Infection

Objective: To examine whether plasma or urine elastase α1-proteinase inhibitor (E-α1-PI) levels could be used as a diagnostic marker of urinary tract infection (UTI) in neonates. Subjects and Methods: Plasma and urine E-α1-PI levels were measured by immunoassay in 23 neonates with UTI at the time of admission and 72 h after the onset of treatment and in 10 ‘normal’ neonates (i.e. with trivial problems). Additionally E-α1-PI plasma levels were measured in 15 neonates with septicemia. Results: E-α1-PI plasma levels did not differ between normal neonates and those with UTI. Urine E-α1-PI levels were significantly higher in neonates with UTI on admission compared to normal neonates. A significant decrease in urine E-α1-PI levels was noticed 72 h after the onset of treatment in all but 2 neonates in whom infection persisted. In this study, we have found that the urine E-α1-PI concentration at a cutoff level of 48 µg/l had a sensitivity of 83%, a specificity of 90%, a positive predictive value of 95% and a negative predictive value of 69% for the diagnosis of neonatal UTI. Conclusion: Elevated levels of E-α1-PI in urine seem to be a useful tool for the diagnosis of UTI in neonates (even in those that have already been started on antibiotics) and possibly a valuable marker for early recognition of treatment failure.