Tzipora Dolfin

Quantitative ultrasound measurements of bone speed of sound in premature infants.

Abstract. We measured bone speed of sound in premature infants by quantitative ultrasound. A total of 44 neonates participated in the study including 29 premature infants (median birth weight 1264 g, range 578–2420 g; median gestational age 31 weeks, range 24–36 weeks) and 15 full-term infants (median birth weight 3360 g, range 2700–3730 g; median gestational age 40 weeks, range 37–41 weeks). The left tibial speed of sound (SOS) was measured by quantitative ultrasound. Bone SOS was successfully measured in all infants. We found a significant correlation between tibial SOS and gestational age (r=0.78, P<0.0005), but a significant inverse correlation between tibial SOS and post-natal age (r=–0.78, P<0.0005). Bone SOS was significantly (P<0.05) higher in full-term infants (3101 m/s, range 2899–3314 m/s) compared to premature infants (2821 m/s, range 2516–3139 m/s), and compared to a subgroup of the premature infants who reached corrected age of full-term infants (2706 m/s, range 2516–2892 m/s, n=13). Bone SOS was lower (2745 m/s, range 2533–3036 m/s, n=16) in very low birth weight premature infants (birth weight <1500 g). Conclusion: the results indicate that tibial speed of sound was reduced in premature infants (in particular very low birth weight) compared to full-term infants even when premature infants reached the corrected age of their full-term peers. The potential role of this technique in assessing osteopenia in premature infants warrants further exploration.

Serum amyloid A: an early and accurate marker of neonatal early-onset sepsis

Objectives:To evaluate the accuracy of serum amyloid A (SAA), an acute phase protein in the detection of neonatal early-onset sepsis, by means of a fast automated SAA kit.Study Design:Full-term infants <72u2009h of age, who had risk factors and/or were suspected of having sepsis, were eligible for study. The levels of SAA were taken at 0, 24 and 48u2009h post sepsis evaluation. Thirty matched infants served as a control group for comparing SAA concentrations.Results:Of 104 infants eligible for entry to the study, 23 had sepsis and 81 had not sepsis. The SAA levels of the septic group were significantly higher than those of the nonseptic group at 0, 24 and 48u2009h (P<0.01 for all time points). In comparison with C-reactive protein (CRP), SAA levels rose earlier and in a sharper manner, had higher levels and returned faster to normal values in infants with early onset sepsis. At 0u2009h post-sepsis evaluation, serum SAA had an overall better diagnostic accuracy for predicting early onset sepsis than CRP (sensitivity (96 vs 30%), specificity (95 vs 98%), positive predictive value (85 vs 78%), negative predictive value (99 vs 83%), positive likelihood ratio (19 vs 12), and negative likelihood ratio (0.05 vs 0.71).Conclusions:SSA is advocated as an inflammatory marker of neonatal early-onset sepsis.

Spontaneous Activity in Premature Infants Affects Bone Strength

OBJECTIVE: Determination of bone strength of lower extremities in very low birth weight (VLBW) premature infants with central nervous system pathology resulting in reduced unilateral spontaneous leg movements.STUDY DESIGN: Quantitative ultrasound (QUS) measurements of speed of sound (SOS) of the tibiae of both legs in three VLBW premature infants with brain insult and unilateral reduced spontaneous activity. Results were compared to QUS measurements of both legs in healthy premature infants. Measurements were performed by the same investigator who was blinded to the clinical course of the participants.RESULTS: Reduced spontaneous activity of one leg due to brain pathology resulted in decreased tibial SOS in the affected side. There was no difference in bone SOS between the legs of the healthy controls.CONCLUSION: Spontaneous movements (mainly antigravity flexion and extension) are important for bone structure and mineralization in VLBW premature infants. QUS may become an important diagnostic modality for the evaluation, treatment, and follow-up of bone strength and osteopenia in this unique population.

High Beta-Palmitate Formula and Bone Strength in Term Infants: A Randomized, Double-Blind, Controlled Trial

We aimed to compare the effect of 12-week feeding of commercially available infant formulas with different percentages of palmitic acid at sn-2 (beta-palmitate) on anthropometric measures and bone strength of term infants. It was hypothesized that feeding infants with high beta-palmitate (HBP) formula will enhance their bone speed of sound (SOS). Eighty-three infants appropriate for gestational age participated in the study; of these, 58 were formula-fed and 25 breast-fed infants, serving as a reference group. The formula-fed infants were randomly assigned to receive HBP formula (43xa0% of the palmitic acid is esterified to the middle position of the glycerol backbone, study group; nxa0=xa030) or regular formula with low-beta palmitate (LBP, 14xa0% of the palmitic acid is esterified to the middle position of the glycerol backbone, nxa0=xa028). Sixty-six infants completed the 12-week study. Anthropometric and quantitative ultrasound measurements of bone SOS for assessment of bone strength were performed at randomization and at 6 and 12xa0weeks postnatal age. At randomization, gestational age, birth weight, and bone SOS were comparable between the three groups. At 12xa0weeks postnatal age, the mean bone SOS of the HBP group was significantly higher than that of the LBP group (2,896xa0±xa0133 vs. 2,825xa0±xa079xa0m/s respectively, Pxa0=xa00.049) and comparable with that of the breast-fed group (2,875xa0±xa085xa0m/s). We concluded that infants consuming HBP formula had changes in bone SOS that were comparable to those of infants consuming breast milk and favorable compared to infants consuming LBP formula.

Dilemma of trisomy 20 mosaicism detected prenatally: Is it an innocent finding?

The clinical significance of mosaicism trisomy 20 detected prenatally following amniocentesis remains uncertain, due to the rarity of liveborn cases with inconsistent clinical findings, the short postnatal follow-up, and failure in evaluating other fetal tissues for the presence of the trisomy. We report on a 15 month-old 46,XX chromosome constitution in white blood cells, while skin fibroblasts demonstrated trisomy 20 mosaicism (54%) by fluorescence in situ hybridization (FISH) analysis. Clinical examination of the baby showed only minor phenotypic signs (bilateral epicanthal folds, delayed closure of fontanel with no other gross anomalies), but demonstrated a considerable developmental delay in gross and fine motor skills along with hypotonicity. This is the second oldest described liveborn with trisomy 20 mosaicism confirmed in skin fibroblasts. This cytogenetic aberration along with her developmental delay suggests that the two findings are related and that aberration affects various fetal tissues and is not confined to extra-embryonic tissue as suggested previously. Yet, an undiagnosed condition may be the cause of the childs developmental delay. Based on this case and following a review of the literature we suggest that when mosaic trisomy 20 is identified in amniocytes, further evaluation is required. Cord blood should be analyzed preferably by FISH. During counseling the parents should be advised of an additional risk, such as developmental delay, even when fetal cord karyotype and detailed ultrasonic scan are normal.

Meconium periorchitis: intrauterine diagnosis and neonatal outcome: case reports and review of the literature

Meconium periorchitis (MP) is a rare disorder caused by fetal meconium peritonitis with subsequent spillage of meconium into the scrotal sac. The condition is seldom diagnosed correctly during fetal life and the ultrasonographic diagnoses reported vary from no diagnosis to hematoma or hydrocele. It is usually diagnosed clinically during the first year of life when a scrotal mass is an incidental finding. Here, we describe two cases of MP that were diagnosed during routine intrauterine ultrasound examination for fetal growth assessment, and confirmed after birth. One infant underwent a surgical excision of the scrotal mass, confirming the histological diagnosis of meconium periorchitis. The other was managed conservatively. Neither had cystic fibrosis. Thus, we believe that a diagnosis of MP should be considered when prenatal ultrasonographic findings are suspicious for the problem. The awareness of the ultrasonographer and the neonatologist are important for immediate postnatal management, as congenital scrotal masses may have other etiologies.

The Effects of Exercise on Body Weight and Circulating Leptin in Premature Infants

OBJECTIVE: To assess the effect of daily movements on weight gain, serum leptin, and insulin-like growth factor I (IGF-I) in premature infants.STUDY DESIGN: Twenty very-low-birth-weight premature infants were matched and randomized to a daily movement (n=10) and control groups (n=10). Daily movement consisted of passive range of motion with gentle compression of both the upper and lower extremities 5 days per week for 4 weeks.RESULTS: Daily movements led to a significant increase in weight gain (784±51 vs 608±26 g in movements and controls, respectively, p<0.02), and to a significant increase in leptin (0.60±0.19 vs 0.13±0.06 ng/ml in movements and controls, respectively, p<0.05). Changes in body weight correlated with changes in serum leptin (r=0.48, p<0.03). IGF-I also increased following daily movements (18.8±4.1 vs 9.2±4.1 ng/ml in movements and controls, respectively); however, this increase was not statistically significant.CONCLUSION: A relatively brief range of motion daily movement intervention was associated with greater weight gain and increased leptin levels in very-low-birth-weight premature infants. This may suggest that at least part of the daily movements associated with increase in body weight resulted from an increase in adipose tissue.

Acinetobacter septicemia: a threat to neonates? Special aspects in a neonatal intensive care unit.

SummaryAcinetobacter is one of the organisms responsible for nosocomial infections in intensive care, neurosurgery, burn and hemodialysis units. There are only a few reports on Acinetobacter infections in neonatal intensive care units. Over a 31 month period, nine cases of Acinetobacter sepsis occurred in our unit, with four deaths. There was a cluster of four cases within 3 days. In this study the English literature on this pathogen is reviewed and it is suggested that Acinetobacter should be added to the list of organisms causing severe nosocomial infection in neonatal intensive care units.ZusammenfassungAcinetobacter ist einer der für nosokomiale Infektionen in Intensivpflegestationen, in der Neurochirurgie, in Verbrennungs- und Hämodialyseeinheiten verantwortlichen Erreger. Über Acinetobacterinfektionen auf Neugeborenenintensivpflegestationen liegen nur wenige Berichte vor. Auf unserer Station traten im Verlauf von 31 Monaten neun Fälle von Acinetobacter-Sepsis mit vier Todesfällen auf. Innerhalb von drei Tagen kam es zu einem Ausbruch mit vier Fällen. Wir geben eine Übersicht über die englischsprachige Literatur zu diesem Erreger. Acinetobacter sollte in die Liste von Erregern schwerer nosokomialer Infektionen auf Neugeborenenintensivstationen aufgenommen werden.Acinetobacter is one of the organisms responsible for nosocomial infections in intensive care, neurosurgery, burn and hemodialysis units. There are only a few reports on Acinetobacter infections in neonatal intensive care units. Over a 31 month period, nine cases of Acinetobacter sepsis occurred in our unit, with four deaths. There was a cluster of four cases within 3 days. In this study the English literature on this pathogen is reviewed and it is suggested that Acinetobacter should be added to the list of organisms causing severe nosocomial infection in neonatal intensive care units. Acinetobacter ist einer der für nosokomiale Infektionen in Intensivpflegestationen, in der Neurochirurgie, in Verbrennungs- und Hämodialyseeinheiten verantwortlichen Erreger. Über Acinetobacterinfektionen auf Neugeborenenintensivpflegestationen liegen nur wenige Berichte vor. Auf unserer Station traten im Verlauf von 31 Monaten neun Fälle von Acinetobacter-Sepsis mit vier Todesfällen auf. Innerhalb von drei Tagen kam es zu einem Ausbruch mit vier Fällen. Wir geben eine Übersicht über die englischsprachige Literatur zu diesem Erreger. Acinetobacter sollte in die Liste von Erregern schwerer nosokomialer Infektionen auf Neugeborenenintensivstationen aufgenommen werden.

Continuous lumbar/thoracic epidural analgesia in low-weight paediatric surgical patients : practical aspects and pitfalls

PurposeContinuous epidural anaesthesia attenuates perioperative stress and avoids the need for systemic opioids. In addition, it may prevent the need for postoperative mechanical ventilation. The aim of the study was to prospectively follow the perioperative course of young infants treated with continuous thoracic/lumbar epidural anaesthesia for major surgery.MethodsData were collected prospectively from 44 epidural anaesthetics in 40 infants (18 premature or former premature) weighing 1,400–4,300xa0g who underwent major abdominal surgery (33 cases), thoracic surgery (5), or both (1), or ano-rectal surgery (5) at our centre.ResultsEpidural placement was achieved easily in all cases, with high quality analgesia for 24–96xa0h. Tracheal extubation was delayed after 4 anaesthetics due to muscle relaxant overdose (nxa0=xa01), surgeon’s request (nxa0=xa02), and systemic opioid administration before epidural anaesthesia was considered (nxa0=xa01). Intraoperative complications included haemodynamic instability (nxa0=xa01) and vascular catheter placement (nxa0=xa05). Postoperative complications included meningitis (nxa0=xa01), insertion site erythema (nxa0=xa07), apnoea (nxa0=xa06; 4 premature and 2 full-term infants) and tracheal re-intubation (nxa0=xa06).ConclusionsContinuous epidural analgesia is effective in low-weight infants undergoing major surgery. The trachea may be extubated immediately after surgery. Attention should be paid to the unique anatomical, physiological, and pharmacological aspects. The patients should be monitored carefully for pain, respiratory failure, and meningitis (an extremely rare complication).

Progressive liver calcifications in neonatal coxsackievirus infection

Abstract Coxsackievirus group B can cause a severe systemic disease in the perinatal period. Severe manifestations like meningitis, encephalitis, hepatitis, and myocarditis have been previously reported. A case of a twin neonate infected by coxsackievirus group B is described, who developed progressive extensive hepatic calcifications demonstrated by ultrasound and computed tomography with follow-up. Hepatic calcifications in coxsackievirus infection have not been previously reported.