Hellfried Rosegger

Human cytomegalovirus load in various body fluids of congenitally infected newborns

BACKGROUND Congenital human cytomegalovirus (hCMV) infection is the most common intrauterine viral disease in western countries. Little is known about hCMV virus load in various body fluids of congenitally infected children. OBJECTIVES To determine virus load in various body fluids. To assess the impact of hCMV virus load to predict the outcome of congenitally infected newborns and efficacy of antiviral therapy. STUDY DESIGN Cord vein blood, urine, and cerebrospinal fluid (CSF) of congenitally hCMV-infected children were investigated and hCMV load was determined by quantitative polymerase chain reaction (PCR). Fourteen of 30 children had clinical symptoms and/or pathological laboratory results and 16 had none of them at birth. Ganciclovir was given to 21 children (10 of them with symptoms, 11 of them without symptoms). Viral load before and after therapy was measured. RESULTS There was a significant difference between median virus load in cord vein blood (2.3 x 10(3) copies per ml) and in urine (4.2 x 10(5) copies per ml; P<0.001) at diagnosis of congenital hCMV infection. At that time, no significant difference of virus load was found between the various groups (symptomatic vs. asymptomatic; with therapy vs. without therapy), neither in serum nor in urine. Comparing median virus load in urine before (3.0 x 10(5) copies per ml) and after therapy (2.0 x 10(3) copies per ml), a significant decrease was observed (P<0.001). Virus load in CSF was always found to be less than 400 copies per ml, and only those children with symptoms showed a positive result. CONCLUSION At birth, virus load in urine seems to be superior to that in cord vein blood to reflect the situation in the organs precisely. As predicting factor for the risk of developing symptoms, only hCMV detection in the CSF appears to be promising. The significant decrease of virus load in children with therapy may reflect the efficacy of therapy. Studies including a greater number of children are needed.

Screening and Diagnosis of Congenital Cytomegalovirus Infection: A 5-y Study

Although cytomegalovirus infection is the most common infection transmitted via the placenta, there are no guidelines for routine screening to detect children congenitally infected with cytomegalovirus. From 1993 to 1997, maternal serum and cord vein blood of newborns was screened for HCMV-IgM (n = 21,183). Urine was examined for HCMV-excretion during the first postnatal week to prove HCMV infection in children who expressed HCMV-IgM in cord vein blood (n = 13) or who were born to mothers positive for HCMV-IgM in the serum (n = 234), or when both cord vein blood and maternal serum were positive for HCMV-IgM (n = 6). Congenital HCMV infection was detected in 17 newborns. To determine the incidence of congenital HCMV infection, only those mother/child pairs were selected in whom serum and cord vein blood were investigated (n = 5967 mother/child pairs). In this group 13 newborns were infected. The observed incidence for congenital HCMV infection is 0.21%. It is concluded that that this screening programme will detect those children at risk for congenital HCMV infection. These children have to be examined for virus excretion in the urine. Although the observed incidence is only 0.21%, congenital HCMV infection is a problem that can no longer be neglected because of its long-term sequelae.Although cytomegalovirus infection is the most common infection transmitted via the placenta, there are no guidelines for routine screening to detect children congenitally infected with cytomegalovirus. From 1993 to 1997, maternal serum and cord vein blood of newborns was screened for HCMV-IgM (n=21,183). Urine was examined for HCMV-excretion during the first postnatal week to prove HCMV infection in children who expressed HCMV-IgM in cord vein blood (n=13) or who were born to mothers positive for HCMV-IgM in the serum (n=234), or when both cord vein blood and maternal serum were positive for HCMV-IgM (n=6). Congenital HCMV infection was detected in 17 newborns. To determine the incidence of congenital HCMV infection, only those mother/child pairs were selected in whom serum and cord vein blood were investigated (n=5967 mother/child pairs). In this group 13 newborns were infected. The observed incidence for congenital HCMV infection is 0.21%. It is concluded that that this screening programme will detect those children at risk for congenital HCMV infection. These children have to be examined for virus excretion in the urine. Although the observed incidence is only 0.21%, congenital HCMV infection is a problem that can no longer be neglected because of its long-term sequelae.

Infrared Thermography in Newborns: The First Hour after Birth

Objective: It was the aim of this study to investigate the surface temperature in newborns within the first hour after delivery. Furthermore, the influence of different environmental conditions with regard to surface temperature was documented. Methods: Body surface temperature was recorded under several environmental conditions by use of infrared thermography. 42 newborns, all delivered at term and with weight appropriate for date, were investigated under controlled conditions. Results: The surface temperature immediately after birth shows a uniform picture of the whole body; however, it is significantly lower than the core temperature. Soon after birth, peripheral sites become cooler whereas a constant temperature is maintained at the trunk. Bathing in warm water again leads to a more even temperature profile. Radiant heaters and skin-to-skin contact with the mother are both effective methods to prevent heat loss in neonates. Conclusions: Infrared thermography is a simple and reliable tool for the measurement of skin temperature profiles in neonates. Without the need of direct skin contact, it may be helpful for optimizing environmental conditions at delivery suites and neonatal intensive-care units.

Color-Coded Duplex Doppler (CDD) Vs. Blind Transcranial Doppler (TCD) Measurements in Newborns

Color-Coded Duplex Doppler (CDD) Vs. Blind Transcranial Doppler (TCD) Measurements in Newborns

RESPONSE OF TERM NEWBORNS WITH PROLONGED POSTNATAL DYSPNEA TO EARLY OXYGEN, MASK CPAP, AND VOLUME EXPANSION. |[dagger]| 1432

In a prospective randomized trial, 103 term newborns with persisting dyspnea, tachypnea and/or cyanosis were treated in the delivery room with oxygen for 5-10 min and then with oxygen plus mask CPAP for another 5-15 min. Cases with overt prenatal or intrapartum obstetric pathology were excluded from the study. 41/103 infants (40%) responded to this procedure within 10-25 min. The remaining 62 infants (60%) were randomly allocated to one of 3 forms of further treatment: continuation of mask CPAP for 20 min (group A, n=24), volume expansion with 9 mL of 3 mL albumin, 3 mL glucose, and 3 mEq NaHCO3 (group B, n=24), or volume expansion with 4.5 mL albumin and 4.5 mL glucose (group C, n=14). There was no statistical difference in birth weight, gestational age, or Apgar scores at 1 and 5 min between groups.

THE INFLUENCE OF RESUSCITATION PROCEDURES ON CEREBRAL BLOOD FLOW VELOCITIES IN PRETERM INFANTS

Aim: To assess cbfv in preterm infants immediately after birth, during cardiopulmonary adaptation, and during resuscitation procedures.Methods: In a prospective-descriptive study maximum and mean velocities are measured in anterior cerebral arteries with a 5.5 Mhz short focused colour flow transducer. Hewlett Packard Sonos 1000. Patients: n = 18 preterm infants delivered abdominally, n= 9/9 - vertex /breech presentation. bw. 1210 ± 210 g, ga: 30.4 ± 2.1 wks.Results: Changes of cbfv were classified in low (< 30%, n = 4), medium (30-80%, n = 7) and high (> 80%, n = 5). High changes (up to 350%) were observed in infants with low heartrate within the first min of life, during intubation and surfactant application. These infants needed almost 15 minutes to regain primary cbfv patterns.Conclusion: Our study shows that during cardiopulmonary adaptation changes of cbfv are much higher than those reported so far, and major alterations of cbfv are caused by resuscitation proceduresSupported by Pediatric Research Foundation of the Department of Pediatrics, University ol Graz, Austria