Tomris Turmen

Oral Lactoferrin to Prevent Nosocomial Sepsis and Necrotizing Enterocolitis of Premature Neonates and Effect on T-Regulatory Cells

OBJECTIVE Lactoferrin (LF) is effective in the prevention of sepsis in very low birth weight (VLBW) neonates. T-regulatory cells (Tregs) are important subsets of T lymphocytes that control pathogen-specific immune responses and are essential for intestinal immune homoeostasis. The aim of the present study is to determine whether oral LF at a dosage of 200 mg/d reduces nosocomial sepsis episodes and necrotizing enterocolitis (NEC) in premature infants and to evaluate the possible effects of LF on Treg levels. STUDY DESIGN In this prospective, placebo-controlled, double-blind, randomized trial, infants either VLBW or born before 32 weeks were assigned to receive either placebo (n = 25), or 200 mg LF (n = 25) daily throughout hospitalization. Episodes of culture proven nosocomial sepsis and NEC were recorded. The level of FOXP3 + CD4 + CD25hi lymphocytes was studied by flow cytometry at birth and discharge. A third comparison was made with healthy term neonates (n = 16). RESULTS Fewer sepsis episodes were observed in LF-treated infants (4.4 vs. 17.3/1,000 patient days, p = 0.007) with none developing NEC, without statistical significance. Treg levels at birth and discharge were similar, while preterm infants showed significantly lower levels than term controls. However, individual increases in Treg levels were higher in the LF group. CONCLUSION LF prophylaxis reduced nosocomial sepsis episodes. Treg levels in preterm infants were lower than in term infants and an increase of Treg levels under LF prophylaxis was observed. Increase in Treg levels can be the mechanism for protective effects of LF on nosocomial sepsis.

Does individual room implemented family-centered care contribute to mother-infant interaction in preterm deliveries necessitating neonatal intensive care unit hospitalization?

The aim of the study was to investigate the effect of individual room care in the neonatal intensive care unit (NICU) on the factors that influence mother-preterm infant interaction. Mothers in group I had hospitalization with their preterm infants in an individual room in the NICU. Mothers in group II were not hospitalized but had opportunity to visit their babies and spend time with them whenever they wanted. On the postdischarge third month, mothers were assessed for parental stress, postpartum depression, and perception of vulnerability. Although the mean depression, stress, and vulnerability scores were higher in group II, there was no significant difference between the groups (P > 0.05). Postpartum depression rate was more than double in group II, but this difference was not statistically significant (P = 0.06). Individual room care in the NICU cannot prevent maternal stress, postpartum depression, and perception of vulnerability related to having a high-risk preterm infant by itself alone.

Effect of Sodium Alginate on Acid Gastroesophageal Reflux Disease in Preterm Infants: A Pilot Study

The objective of this study was to evaluate the effect of the antireflux barrier formed by Na alginate on pH‐metry‐defined acid reflux events in preterms. Four times/day, 1 mL/kg of Na alginate was administered as an intervention to the preterm infants whose gastroesophageal reflux disease was confirmed by 24‐hour pH monitoring, and the measurement was repeated after 48 hours. The major outcomes were improvement in the number of reflux events per 24 hours, the duration of the longest episode, the number of episodes >5 minutes per 24 hours, and reflux index on pH‐metry. Thirty‐four (83%) of 41 preterm infants who completed the study had pathologic measurement on 24‐hour pH monitoring; 27 (83%) of the patients responded to treatment, whereas 7 patients (17%) did not. Na alginate treatment significantly improved the number of episodes with pH <4 per 24 hours, the reflux index, the number of episodes >5 minutes with pH <4, and the duration of longest episode with pH <4. Patients showed significant improvement in 2 evaluated clinical symptoms, which were vomiting and weight gain after the treatment. No side effect except thickening of stool in 3 patients was observed. Na alginate treatment for gastroesophageal reflux disease in preterm infants seems to be safe and effective.

Efficacy and safety of sodium alginate for GERD in preterm infants

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Hand intubation of a tiny neonate with a large obstructive mass in the oral cavity.

with airway obstruction caused by rhabdomyosarcoma of the tongue. Br J Anaesth 1999; 83: 951–955. 4 Holm-Knudsen R, Eriksen K, Rasmussen LS. Using a nasopharyngeal airway during fiberoptic intubation in small children with a difficult airway. Pediatr Anesth 2005; 15: 839–845. 5 Thomas ML, McEwan A. The anaesthetic management of a case of Kawasaki’s disease (mucocutaneous lymph nose syndrome) and Beckwith–Weidemann syndrome presenting with a bleeding tongue. Paediatr Anaesth 1998; 8: 500–502. 6 Thompson BM, Welna JO, Kasperbauer JL et al. Childhood airway manifestations of lymphangioma: a case report. AANA J 2004; 72: 280–283.

Oral Lactoferrin Prophylaxis to Prevent Sepsis and Necrotising Enterocolitis of Very Low Birth Weight Neonates in Neonatal Intensive Care Unit and Effect on T-Regulatory Cells

Aim of the study is to evaluate whether oral administration of lactoferrin (LF) can enhance host defense and reduce late onset sepsis and NEC in VLBW infants, and to determine its effect on regulatory-T cells. The study was designed as a prospective, placebo-controlled, randomized trial in VLBW infants, who were randomly assigned to receive orally either 200 mg LF (n=25) or placebo (n=25) daily. Episodes of suspected and culture proven late onset sepsis and NEC were recorded. CD4+25+ FOXP3+ lymphocytes were determined by flow cytometry at birth and discharge. Prenatal, natal and postnatal characteristics of the groups were similar. Mean gestational ages of groups were 30,3±2,5 and 29,5±1,6 weeks, and birth weights were 1307±262,1g and 1290±346,7g, respectively. During hospitalization period 14 vs 4 culture proven sepsis were observed in control and study group, respectively (p< 0,05). In group 2, none of the patients experienced grade 2 and 3 NEC, while 5 babies from Group 1 (p>0,05). Regulatory-T cell levels at birth and at discharge were similar in two groups. The increase in FOXP3 expression at discharge was significantly higher in oral LF group (p< 0,05).In this study, oral LF significantly lowered culture proven sepsis rate. Similar effect was observed in NEC rate but without statistical significance. The treated group took shorter time to reach full enteral feedings and no adverse effect was observed. The significant higher increase in FOXP3 expression in the LF group can be the mechanism for protective effects of LF on late onset sepsis and NEC.

497 Role of Cord Stress Hormone Levels for Developing Transient Tachypnea of Newborn in Cesarean Delivered Late Preterm and Term Infants

Background and aims: Failure of adequate and timely clearance of fetal lung fluid results in transient tachypnea of newborn (TTN). Of the several factors that have been proposed to effect sodium reabsorption some have been investigated including glucocorticoids, oxygen, catecholamines, thyroid hormones, surfactant. The aim of this study was to investigate the role of cord stress hormones; ACTH, cortisol, adrenalin, sT3, sT4, TSH in the development of TTN in CS delivered late preterm and term infants. Methods: Study was designed as a prospective and sectional study. The information about all of the deliveries taking place in our center between September 2008-July 2009 were recorded. Study group consisted of 37 CS delivered late preterm and term infants with the diagnosis of TTN. Thirty three gestational age matched CS delivered consecutive infants without the diagnosis of TTN delivered after each study case constitutes the control group. At birth 10 ml of cord blood were collected from all CS deliveries of late preterm and term infants for analysis of serum cortisol, ACTH, sT3, sT4, TSH and adrenalin levels. Results: Though there was no significant demographic difference between our patient and control groups, cord ACTH, cortisol, sT3 were significantly low and adrenalin was high in the study group (p< 0.05). Conclusions: Lower cord cortisol, ACTH, sT3 in patients with TTN indicate the possible role of these hormones in fetal lung fluid clearance and postnatal pulmonary adaptation through their modulatory effect on ENaC and NaK ATPase.

295 Evaluation of the Efficacy and Safety of Autologous Cord Blood Transfusions in Very Low-Birth-Weight Premature Newborns

295 Evaluation of the Efficacy and Safety of Autologous Cord Blood Transfusions in Very Low-Birth-Weight Premature Newborns

A rare cause of jaundice in a newborn not predicted by maternal blood typing (Case Presentation)

tion yielded pus, with no organisms grown on culture. After a course of antibiotics, the node was excised and drained. Histopathological examination of the node showed acute and chronic inflammation with a florid granulomatous pattern. The granulomas were filled with neutrophils and had histiocytic walls, but there was no evidence of mycobacterial, other bacterial or fungal infection. The patient was discharged from surgical follow-up since the wound healed promptly. During subsequent years, he was seen by a number of primary care and surgical teams for purulent nasal discharge, recurrent otitis media, tonsillitis and gingivitis. He also developed intermittent urticarial rashes and outbreaks of scaly skin affecting his scalp and hair. Between these episodes he was relatively healthy and attained all expected developmental and growth milestones. Despite his history of recurrent infections and the development of a granulomatous abscess, no unifying diagnosis had been made for his symptoms prior to his final illness. Histopathological examination of post-mortem samples showed evidence of a severe disseminated infection with an unusual, granulomatous phenotype. Numerous necrotizing granulomas, pigmented macrophages and palisading lymphocytes were present in the lung tissue, along with an absence of neutrophilic inflammation (Fig. 2). No evidence of mycobacterial or fungal infection was seen. The family history is complex, being significant for autoimmune disease on the maternal side. His mother has vitiligo, pernicious anaemia and autoantibody-positive hypothyroidism, her brother being similarly affected. Detailed questioning elicited a history of deaths in infancy of male members of the maternal family in two previous generations.

A rare cause of jaundice in a newborn not predicted by maternal blood typing (Discussion and Diagnosis)

considered. Carriage of CGD mutations has been associated with a higher frequency of autoimmune diseases, hence the significance of the mother’s medical history. This is postulated to be because deficient phagocyte function, as evident in the mother, predisposes to persistent stimulation by antigens, leading to the development of autoimmunity (5). Early presentation in this patient may have been prevented by the administration of prophylactic trimethoprim for the suspected renal anomaly. The pustular rash in the neonatal period is not uncommon in CGD but is nonspecific. However, the history of recurrent ear, gum and chest infections, the development of a granulomatous lymph node abscess, and to a lesser extent the family history of autoimmunity should have raised the question of primary immunodeficiency as a possible diagnosis. CGD is believed to be significantly underdiagnosed in the United Kingdom population despite the availability of simple diagnostic tests. Unlike many severe immunodeficiencies it may not be apparent in infancy. In this case, the patient presented on several occasions to different medical teams but the lack of positive microbiology and the resolution of symptoms on each occasion led to a formal paediatric immunology review not being triggered. The mother’s phagocyte function was subsequently tested and she was shown to be a carrier of X-linked CGD, thus reinforcing the clinical and histopathological diagnosis. This case illustrates the need to consider primary immunodeficiency when children present with recurrent infections, with or without a microbiological diagnosis. It also highlights the need for discussion and review of unusual cases across the multidisciplinary paediatric team, especially where a child has presented separately to several clinical specialities.