Maria Lúcia Silveira Ferlin

Early-onset Bacterial Infection in Brazilian Neonates with Respiratory Distress: A Hospital-based Study

We investigated infants with respiratory distress within 4 days of birth whose mothers had not received antibiotic prophylaxis to evaluate the frequency and etiology of bacterial infection and associated risk factors. The study was conducted on 261 infants suffering respiratory distress admitted to a Brazilian neonatal intensive care unit, 94 per cent of whom were born prematurely. Gestational and delivery history; bacteriological cultures of blood, cerebrospinal fluid, tracheal aspirates and urine; complete and differential blood counts; a urinary group B streptococcal latex antigen test; and a chest radiograph were analysed. Indications of infection were found in 38.7 per cent and confirmed in 11.9 per cent of the neonates. Gram-positive (70.9 per cent) and gram-negative bacteria (29.1 per cent) were found in 31 cases of confirmed early bacteremia. Group B Streptococcus was the predominant causative agent (19.4 per cent) in infants exhibiting confirmed infection. Culture-proven infection was more frequent among infants delivered vaginally (adjusted OR = 2.53, p = 0.05) or born to mothers with signs of intra-amniotic infection (adjusted OR = 2.83, p = 0.04). Preventive measures against early bacterial infection in preterm infants from this population are strongly warranted.

Total nitrogen and electrolyte levels in colostrum and transition human milk.

The objective of this research was to study the composition of human milk in terms of protein levels and levels of the electrolytes sodium, potassium, calcium, magnesium, phosphorus and chloride in colostrum 48-72 hours post-partum, and in the transition milk (96 +/- 9 hours, 120 +/- 9 hours and 144 +/- 9 hours post-partum) of mothers who had fullterm and pre-term deliveries. The mothers were kept in the hospital with the objective to control a few important lactation parameters such as exercising or resting conditions, sleep, nutrition and suckling stimulation. Only low socioeconomic level mothers took part in the study. The initial period of lactation was studied because this is the time when secretion suffers rapid changes, going from colostrum to transition milk, and then to mature milk. The results observed for the different times and for the two groups were compared both within and between groups. No significant differences were obtained for any of the comparisons, except for transitory oscillations in potassium, calcium, chloride and phosphorus levels observed within groups. In general, it can be said that there was no variation between colostrum and transition milk for the mothers who delivered at full term or pre-term. No differences were found either when the groups were compared at the different times post-partum. This means that, under the conditions used in this study, milk did not vary as its type naturally changed (from colostrum to transition milk) for the two groups and that the levels of the constituents studied also remained unchanged when studied as a function of full-term or pre-term delivery.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of supplementation of preterm formula with long chain polyunsaturated Fatty acids on mineral balance in preterm infants.

Background Incorporation of long chain polyunsaturated fatty acids (LCP) into formulas may interfere with mineral metabolism. We investigate mineral balance in preterm infants who were fed a formula with LCP. Methods Infants were randomized in a double-blind manner, 20 infants in each group, to receive a formula with LCP (F+LCP) or without LCP (F) for 30 days. Plasma levels (at the beginning and after 30 days) and nutritional balance (after 1 week) for Ca, P, Mg, Zn, and Cu were obtained for all infants. Results Groups were similar regarding birth weight, gestational age, weight, and corrected age at study start. During the 30-day study period, the groups had comparable milk intake and reached similar and satisfactory weight gains and longitudinal growth. Within each group, there was no change in plasma mineral concentrations over the course of the study, and there were no differences at each time point between groups. All values were within the normal range for age. No differences in mineral balance were detected between the F and F+LCP groups, with both groups demonstrating comparable intake, net retention, and fecal losses of each mineral. Conclusions Adding a content of LCP blend similar to that of human milk to a preterm formula caused no disturbance in Ca, P, Mg, Zn, or Cu nutritional balance.

Growth and nitrogen balance in preterm infants fed formula with long chain polyunsaturated fatty acids

A decrease in nitrogen retention and growth rate has been observed in some formulas supplemented with LCP. In the present study we report on the growth and nitrogen balance of preterm infants fed formula supplemented with or without a blend of LCP containing both ω-3 and ω-6 fatty acids. A prospective study was conducted on 58 VLBW-infants with a mean ± SEM weight of 1245±21g. The infants were divided into 3 groups. If the mother had milk, the infant received human milk fortified (18 infants). If the mother had no milk, the infant received one of two identical formulas except for the fat component in a double-blind manner (20 infants each group). Infants were followed up for 30 days on their diets. Initial and final anthropometric parameters, BUN, total protein, and albumin were normal and similar in the three groups. Both, protein intake and protein excretion through urine and feces, were similar for the three groups. Mean percent protein absorption was 71%. Plasma amino acid levels were similar at the beginning of the study and after 30 days were similar for the infants fed the two formulas. The infants that received fortified human milk presented significantly higher proline levels and significantly lower lysine, aspartic acid, threonine, glutamic acid, and methionine levels compared to the infants fed the two formulas. We conclude that the addition of LCP to preterm infant formula did not affect protein absorption or plasma amino acid profile. The formulas did not mimic fully the amino acid profile of preterm infants fed enriched human milk.

Early anemia of prematurity

Abstract The objective of the present investigation was to study the effect of early prophylactic enteral administration of elemental iron, as ferrous sulfate, at the dose of 4 mg/kg/day to preterm neonates with a birth weight of less than 1600 g and a gestational age of 35 weeks, on early anemia of prematurity, and to determine the need for vitamin E supplementation (25 IU/day). Forty neonates were divided into 4 groups respectively receiving the following supplementations starting at 15 days of life: Group I, placebo; Group II, iron; Group III, iron + vitamin E; Group IV, vitamin E. Between 24 and 72 hours of life and at 2 months ± 5 days, each infant was evaluated for weight, length, head circumference, hemoglobin, hematocrit, reticulocytes, platelets, and red cell resistance to hydrogen peroxide. No significant differences were observed between groups for any of the parameters studied, suggesting that the dose of 4 mg/kg/day of iron and the use of vitamin E, 25 IU/day, had no effect on early anemia of prematurity.

Antenatal corticosteroid use and clinical evolution of preterm newborn infants

OBJECTIVES To describe the use of antenatal corticosteroid and clinical evolution of preterm babies. METHODS An observational prospective cohort study was carried out. All 463 pregnant women and their 514 newborn babies with gestational age ranging from 23 to 34 weeks, born at the Brazilian Neonatal Research Network units, were evaluated from August 1 to December 31, 2001. The data were obtained through maternal interview, analysis of medical records, and follow-up of the newborn infants. Data analysis was performed with the use of chi-square, t Student, Mann-Whitney, and ANOVA tests and multiple logistic regression, with level of significance set at 5%. RESULTS Treatment was directly associated with the number of prenatal visits, with maternal hypertension and with the antenatal use of tocolytic agents. Babies from treated pregnant women presented better Apgar scores at the 1st and 5th minute, reduced need for intervention in the delivery room and lower SNAPPE II. They were born with higher birth weight, longer gestational age and needed less surfactant use, ventilation, and oxygenation time. After multiple logistic regression, the use of antenatal corticosteroid independently improved birth conditions, decreased ventilation time, being related to increased occurrence of neonatal sepsis. CONCLUSIONS The use of corticosteroid was associated with better prenatal care and birth conditions, better preterm evolution but higher risk of infection.Hospital Das Clinicas Faculdade de Medicina de Ribeirao Preto Universidade de Sao Paulo (USP), Ribeirao Preto, SP

Prematurity anemia: effect of iron supplementation

Abstract The study was designed to assess the effect of prophylactic iron administration on the occurrence of early and late prematurity anemia and on iron deposits in an attempt to determine the recommendable time for the initiation of enteral supplementation and the effectiveness of the dose used (2 mg/kg/day). We used 25 preterm newborns with 30 to 35 weeks of gestational age and birth weight of 1000 to 1800 g. The infants were divided into two groups according to the beginning of supplementation: Group I at 15 days of life, and Group II at 2 months. Weight, length, skull circumference and levels of hemoglobin, hematocrit, reticulocytes, ferritin, serum iron, vitamin E/total lipid ratio and globular resistance to hydrogen peroxide were determined for each infant at 0–5 days and at 2 months ± 15 days, 6 months ± 15 days, 9–10 and 12 months ± 15 days. The groups did not differ (p>0.05) in terms of the various parameters studied, except for higher ferritin levels and lower vitamin E levels in Group I at 2 months of age. The alternative of offering iron to these children at 15 days of life is justified because no higher incidence or greater severity of early prematurity anemia was detected, and because, at 2 months of age, infants who had not been supplemented were already showing depleted iron stores. The prophylactic dose of 2 mg/kg/day administered by the enteral route, even when started at 15 days of age, was not sufficient to prevent late anemia in a significant contingent of these infants.

Central diabetes insipidus: alert for dehydration in very low birth weight infants during the neonatal period. A case report.

CONTEXT Central diabetes insipidus (CDI) is a rare cause of hypernatremia during the neonatal period. The diagnosis is particularly difficult in very low birth weight (VLBW) newborns. CASE REPORT We report on a preterm newborn who presented CDI soon after birth. On the third day of life, signs of dehydration were present despite normal fluid supply. The diuresis rate was 4.4 ml/kg/h. Although the fluid supply was then increased, the dehydration continued, with hypernatremia, normal glycemia, diuresis of 7.4 ml/kg/h and urine density of 1005 mOsmol/l. Thus, a diagnostic hypothesis of diabetes insipidus was raised. A test with a nasal vasopressin analogue (dDAVP) was performed and CDI was confirmed. Reduction of the fluid supply became possible through appropriate treatment. CONCLUSION The diagnosis of CDI is rarely made during the neonatal period, especially in VLBW newborns, because of the difficulty in detecting elevated diuresis. Persistent hypernatremia, usually accompanied by hyperthermia despite abundant fluid supply, weight loss and low urine osmolality are important signs of alert.

Uso antenatal de corticosteóide e evolução clínica de recém-nascidos pré-termo

Hospital Das Clinicas Faculdade de Medicina de Ribeirao Preto Universidade de Sao Paulo (USP), Ribeirao Preto, SP

Nitrogen, Fat, Ca, P, Mg and Cu Plasma Levels and Balance of VLBW-Infants Fed with Formula or Own Mother's Milk Enriched with Evaporated Human Milk or Commercial Human Milk Fortifier (HMF) 1512

We developed an evaporated human milk (EHM) that can be used as a fully homologous human milk fortifier (Nutr. Res. 1996; 16: 769-72). After human milk evaporation the nutrient levels increased an average of 3 to 4 times, except for fat and lactose. A prospective study was conducted on 56 VLBW-infants (birth weight <1500g) to evaluate the plasma levels and nutrient balance of N, fat, Ca, P, Mg, Zn and Cu. Infants were included in the study as soon as they were tolerating full feds on 160 ml/kg/d. They were divided in 3 groups. Those whose mother had enough breast milk were randomly divided into two groups, each receiving one of two fortifiers: EHM (1/4 EHM, 3/4 own mothers milk, 18 infants) or a commercial HMF (Eoprotin 4%, Milupa GmbH & Co. Kg, Germany, 18 infants). If the mother had no milk they received preterm formula [FOR group]: (Prematil, Milupa GmbH & Co. Kg, Germany, 20 infants). Blood was collected on the 1st and after 30 days of study. 72hs balance was performed after one week. The team that provided care for the infants and administered the different formulas was unaware of the type of diet that was being offered. Regarding plasma levels, the EHM group showed lower levels of P (4.4± 0.6 mg/dl vs 7.2±1.0mg/dl [HMF] and 6.7±1.1mg/dl [FOR] and higher levels of alkaline phosphatase(1312±783 IU vs 611±182 IU [HMF] and 531±171IU[FOR]. Other plasma levels were similar between groups. Infants fed own mothers milk presented similar retention of nutrients with different fortifiers and better nutrient retention as compared to formula for fat, Ca, P and Cu. Formula and commercial HMF fed infants presented adequate plasma levels and nutrient retention. EHM as used,was inadequate regarding P levels. The use of higher volumes of the evaporated human milk or addition of P must be analyzed before the use of this absolutely homologous way of feeding VLBW-infants is recommended.