Jan Winberg

Development of hypertension and uraemia after pyelonephritis in childhood: 27 year follow up.

OBJECTIVE--Determination of the long term incidence of uraemia, hypertension, and toxaemia in pregnancy associated with non-obstructive focal renal scarring after pyelonephritis in childhood 25-35 years earlier. DESIGN--27 Year follow up of patients with non-obstructive focal scarring identified from a retrospective review of intravenous urograms performed in childhood between 1951 and 1967. SETTING--Paediatric primary referral centre and urological clinic in tertiary referral centre. PATIENTS--30 Patients (mean age 33 (range 22-41] with non-obstructive focal renal scarring first detected between 1951 and 1967 and a history of febrile urinary tract infection. MAIN OUTCOME MEASURE--Hypertension and complications of renal damage. RESULTS--Three patients had developed end stage renal disease, seven had developed hypertension, two of 16 women had a history of toxaemia during pregnancy, and seven patients had undergone renal surgery during follow up. Of the 20 patients who had neither had renal surgery nor had end stage renal disease, all had a significantly lower glomerular filtration rate and renal plasma flow and higher diastolic blood pressure, mean arterial blood pressure, plasma renin activity, and serum beta 2 microglobulin concentration than 13 healthy age matched controls. Diastolic blood pressure and plasma renin activity were positively correlated (r = 0.50, p less than 0.05) and so were fractional sodium excretion and both systolic and diastolic blood pressures (r = 0.54, p less than 0.01, r = 0.51, p less than 0.01 respectively). The progress of renal damage was unrelated to the incidence of recurrent infections. CONCLUSIONS--Children with focal renal scarring due to pyelonephritis are at high risk of serious long term consequences. It is essential that they are given adequate attention and care during adolescence and pregnancy.

OCCURRENCE OF P-FIMBRIATED ESCHERICHIA COLI IN URINARY TRACT INFECTIONS

The occurrence of Escherichia coli possessing P blood-group-specific adhesins (P-fimbriae) was examined in 97 children with urinary tract infections and 82 healthy controls. P-fimbriae were present in 91% (33/35) of the urinary strains causing acute pyelonephritis. Among strains causing cystitis and asymptomatic bacteriuria P-fimbriae were found in 19% and 14% of cases, respectively. Only 7% of faecal isolates from healthy controls carried P-fimbriae. The results were similar in three different studies. In most of the children with acute pyelonephritis the urinary pathogen was the predominant E. coli strain of the periurethral and faecal flora.

Vaccination with FimH Adhesin Protects Cynomolgus Monkeys from Colonization and Infection by Uropathogenic Eschevichia coli

Escherichia coli FimH adhesin mediates binding to the bladder mucosa. In mice, a FimH vaccine protects against bacterial challenge. In this study, 4 monkeys were inoculated with 100 microgram of FimCH adhesin-chaperone complex mixed with MF59 adjuvant, and 4 monkeys were given adjuvant only intramuscularly. After 2 doses (day 0 and week 4), a booster at 48 weeks elicited a strong IgG antibody response to FimH in the vaccinated monkeys. All 8 monkeys were challenged with 1 mL of 108 E. coli cystitis isolate NU14. Three of the 4 vaccinated monkeys were protected from bacteruria and pyuria; all control monkeys were infected. These findings suggest that a vaccine based on the FimH adhesin of E. coli type 1 pili may have utility in preventing cystitis in humans.

Temperature, metabolic adaptation and crying in healthy full‐term newborns cared for skin‐to‐skin or in a cot

The aim of the present study was to compare temperatures, metabolic adaptation and crying behavior in 50 healthy, full‐term, newborn infants who were randomized to be kept either skin‐to‐skin with the mother or next to the mother in a cot “separated”. The babies were studied during the first 90 min after birth. Axillary and skin temperatures were significantly higher in the skin‐to‐skin group; at 90 min after birth blood glucose was also significantly higher and the return towards zero of the negative base‐excess was more rapid as compared to the “separated” group. Babies kept in cots cried significantly more than those kept skin‐to‐skin with the mother. Keeping the baby skin‐to‐skin with the mother preserves energy and accelerates metabolic adaptation and may increase the well‐being of the newborn.

Separation distress call in the human neonate in the absence of maternal body contact

Few studies have used the babys cry as a means of evaluating the quality of neonatal care. In this randomized trial the newborns cry was registered during the first 90 min after birth when infants were cared for either: (a) skin–to–skin with the mother; (b) in a cot; or (c) in a cot for the first 45 min of the 90–min observation period and then skin–to–skin with the mother. The results suggested that human infants recognize physical separation from their mothers and start to cry in pulses. Crying stops at reunion. The observed postnatal cry may be a human counterpart to the “separation distress call” which is a general phenomenon among several mammalian species, and serves to restore proximity to the mother. Our results suggest that in human newborns this cry is not dependent on earlier social experience and may be a genetically encoded reaction to separation. The findings are compatible with the opinion that the most appropriate position of the healthy full–term newborn baby after birth is in close body contact with the mother.

Different patterns of oxytocin, prolactin but not cortisol release during breastfeeding in women delivered by Caesarean section or by the vaginal route

The aim of this study was to find out whether the hormonal patterns of oxytocin, prolactin and cortisol differed between women delivered by emergency section or by the vaginal route and if these patterns show any relation to the duration of breastfeeding. Seventeen mothers with emergency section (C.S.) and 20 mothers with normal vaginal deliver (V.D.) were blood sampled in connection with breastfeeding on day 2 post partum for oxytocin, prolactin and cortisol. The number of oxytocin pulses as calculated with the PULSAR program occurring during the first 10 min of the breastfeeding session varied between 0 and 5. The V.D. mothers had significantly more pulses than the C.S. ones. Furthermore the C.S. women lacked a significant rise in prolactin levels at 20-30 min after the onset of breastfeeding. Logistic regression analysis revealed mode of delivery and infants age at first breastfeed to be the most important, independent variables showing a relation to the release pattern of oxytocin on day 2. Correlations between oxytocin pulsatility on day 2 and the duration of the exclusive breastfeeding period in the V.D. group suggest that development of an early pulsatile oxytocin pattern is of importance for breastfeeding.

The composition of the faecal microflora in breastfed and bottle fed infants from birth to eight weeks.

ABSTRACT. Recent technical advances have improved the possibilities to classify anaerobic bacteria. The aim of the present study was to examine the validity of the time‐honoured opinion that the faecal flora is dominated by bifidobacteria in breastfed infants but not in bottle fed ones. The compositon of the faecal flora of 15 breastfed and of 7 bottle fed infants was followed from birth to 8 weeks. Strictly anaerobic conditions were carefully applied. At 5 days and 3 weeks the incidence of Staph, epidermidis was significantly greater in the breastfed group compared to the bottle fed one. We were unable to confirm earlier reports of difference in the anaerobic flora between breastfed and bottle fed infants. In both feeding groups Bacteroides dominated among the anaerobic bacteria and bifidobacteria occurred in less than half of the faecal specimens. The results of the study add to other recent observations that it has been increasingly difficult to demonstrate bifidobacteria in babies delivered in large, urban hospitals. We found different frequencies of bifidobacteria in infants from different wards, suggesting the importance of environmental factors in gut colonization after delivery.

Clinical Pyelonephritis and Focal Renal Scarring: A Selected Review of Pathogenesis, Prevention, and Prognosis

This article considers the pathogenesis of acute pyelonephritis; determinants of focal renal scarring; prevention of renal damage by early recognition of urinary tract infection in childhood; and renal growth patterns in kidneys damaged during early childhood.

Does the newborn baby find the nipple by smell

We studied the involvement of naturally occurring odours in guiding the baby to the nipple. One breast of each participating mother was washed immediately after delivery. The newborn infant was placed prone between the breasts. Of 30 infants, 22 spontaneously selected the unwashed breast. The washing procedure had no effect on breast temperature. We concluded that the infants responded to olfactory differences between the washed and unwashed breasts.

Activation of Olfactory Cortex in Newborn Infants After Odor Stimulation: A Functional Near-Infrared Spectroscopy Study

In mammals, perception of smells during the first hours of life is an essential prerequisite for adaptation of the newborn to the new extrauterine world. Functional magnetic resonance studies have shown that olfactory impression is processed in the lateral and anterior orbito-frontal gyri of the frontal lobe. Near-infrared spectroscopy (NIRS) can detect changes in oxygenated [Hb O2], and deoxygenated [Hb H] Hb during cortical activation. The aim of this study was to assess by NIRS olfactory cortex activity in newborn infants receiving olfactory stimuli. Twelve males and 11 females were studied when awake at 6 h to 8 d after birth. NIRS monitoring was carried out using two optodes placed above the left anterior orbito-frontal gyri. Each newborn was exposed for 30 s to two different smell stimuli—mothers colostrum and vanilla—and to a negative control, distilled water. Changes in Hb concentration were measured over the orbito-frontal region. During exposure to vanilla, [Hb O2] increased significantly over the left orbito-frontal area in all babies. The magnitude of the [Hb O2] increase over the illuminated region during colostrum exposure was inversely related to postnatal age. We conclude that monitoring Hb changes by NIRS can be valuable in assessing olfactory responsiveness in infants.