Michele Mancuso

Circulating thrombopoietin levels in neonates with infection

Thrombocytopenia is a commonly encountered hematologic complication in neonates with sepsis. Thrombopoietin (TPO) is the principal physiologic regulator of megakariocytopoiesis and platelet production. This study was carried out to determine whether variations in circulating TPO levels would occur in infected neonates and/or if they would correlate with platelet counts. In a prospective study of 36 sick neonates (gestational age 24–42 wk) admitted to a regional Neonatal Intensive Care Unit (NICU), blood was collected for TPO measurements and platelet counts on admission to the NICU, if infection was inferred, and at recovery before discharge. An additional group of 15 apparently healthy neonates was also studied (median postnatal age at the time of blood sampling for TPO assessment: 4 d, range 1–10) as control. TPO was measured on plasma samples using a commercially available enzyme‐immunosorbent assay (ELISA). On admission, the majority (21/36) of the sick neonates had non‐infectious diseases, 2 had early onset sepsis, and 13 had infection (defined as the presence of clinical signs of sepsis, abnormal leukocyte counts or C‐reactive protein values, and positive results on local cultures, but negative blood culture results). During the hospital stay, 5 neonates developed sepsis (positive blood culture) and 6 had infection (as previously defined) or necrotizing enterocolitis (NEC). The median TPO level (1704pg/ml, range 51–3912) was higher during sepsis (either early or late) than during infection (included NEC) (198pg/ml, range 21–2504), or non‐infectious disease (659 pg/ml, range 0–2533), while platelet counts (median value 37,000 cells/μl, range 15,000‐486,000) were lower than during either infection (included NEC) (median value 238,000 cells/μl, range 49,000‐655,000) or noninfectious disease (median value 110,000 cells/μl, range 45,000‐549,000). When infants had recovered from these illnesses, TPO concentrations markedly dropped (median value 59 pg/ml, range 0–825). These values were similar to those found in the control neonates (median TPO level 85 pg/ml, range 43–620). In infected neonates (sepsis plus infection), TPO levels inversely correlated with platelet counts (r= ‐0.634, p= 0.001) as did those of infants with non‐infectious disease (r= ‐0.574, p= 0.006), while there was no significant correlation between TPO levels and platelet counts in the samples obtained after recovery or in the control infants. We conclude that infected neonates have high circulating TPO levels in the face of low platelet counts. Whether larger TPO concentrations following exogenous administration of recombinant TPO would restore the number of circulating platelets warrants further investigation.

Effectiveness and safety of propofol in newborn infants.

To the Editor .— We welcome the recent contribution by Ghanta et al,1 which showed the efficacy of propofol as an induction agent to facilitate neonatal endotracheal intubation. Their article provided convincing evidence that in neonates, as in adults and children, propofol without muscle relaxants provides optimal conditions for endotracheal intubation. Hence, skilled or less experienced physicians may be encouraged to sedate infants before semiurgent endotracheal intubation, a procedure that is still underused in most NICUs. Nevertheless, we would like to raise a note of caution regarding the use of propofol as a single agent before intubation in newborn …

What's new in the treatment of neonatal shock

Shock is a clinical disorder that challenges caregivers in the neonatal intensive care unit. The predominant cause of shock in neonates is sepsis. This article provides an overview of the current treatment of septic shock with particular emphasis on newer vasoactive drugs (milrinone, levosimendan and vasopressin) to support cardiovascular dysfunction.

Usefulness of Routine Bronchoalveolar Lavage (BAL) Cultures for Discriminating Ventilated Neonates who Develop Nosocomial Pneumonia

Usefulness of Routine Bronchoalveolar Lavage (BAL) Cultures for Discriminating Ventilated Neonates who Develop Nosocomial Pneumonia

Thrombopoietin (Tpo) Levels are High in the Plasma of Thrombocytopenic Sick Neonates and Correlate Inversely with the Number of Platelets (PLT) † 1388

Thrombopoietin (Tpo) Levels are High in the Plasma of Thrombocytopenic Sick Neonates and Correlate Inversely with the Number of Platelets (PLT) † 1388

Routine Bronchoalveolar Lavage (BAL) Cultures for the Prediction of Ventilator-Associated Pneumonia 1437

Routine Bronchoalveolar Lavage (BAL) Cultures for the Prediction of Ventilator-Associated Pneumonia 1437

Chronic Inflammation of the Airways is Associated with Prolonged Fibrin Turover in Infants Developing Chronic Lung Disease |[dagger]| 1497

Intraalveolar fibrin deposition is a prominent histologic feature of neonatal respiratory distress syndrome (RDS). We hypothesized that in infants in whom RDS progresses into CLD, chronic inflammation of the airway would derarrange alveolar-capillary integrity and lead to prolonged fibrin deposition in the alveolar spaces. To test this hypothesis, we determined concentrations of inflammatory cells (neutrophils,N, and macrophages, M,) and products of fibrin turnover (D-dimers) in the bronchoalveolar lavage (BAL) fluid of infants who initially had RDS and developed CLD than infants who had uncomplicated RDS. Methods: twenty-three preterm infants who required mechanical ventilation because of RDS underwent BAL on day 1 of life and thereafter every other day during endotracheal intubation. The samples collected on dexamethasone admninistration were not included. After cell counts were made, BAL fluids were centrifuged and D-dimers measured (ELISA).Results: Fourteen patients (EG: 27wks±2, BW:805g±187) developed CLD (02≥28 days) and 9 did not (EG:28wks±2, BW: 899g±166). Median values ± SD of N and D-dimers are shown below. M counts did not statistically differ between the two groups of infants.*p<0.05 Table