No abstract

Tumour necrosis factor-alpha (TNF-alpha) is an important mediator in the pathogenesis of Gram-negative shock. In order to assess the role of TNF-alpha as a marker of the severity of infections in the neonates, serum TNF-alpha concentrations were determined at the time of septic work-up in 69 newborns (gestational age: 28-40 weeks). Nine patients had systemic infection (group A), four of them with signs of circulatory failure. Eleven patients had positive cultures of gastric aspiration or placental smears (group B) and 49 patients had completely negative septic work-up. Patients of group A had significantly more elevated serum TNF-alpha levels than patients of group B and C. Within group A, patients with circulatory failure had mean serum TNF-alpha concentration of 2165 +/- 817 pg/ml versus 27 +/- 8 pg/ml in newborns without shock. Serum TNF-alpha concentrations of more than 15 pg/ml detected systemic infections in eight out of nine patients. The specificity was 98% (1 elevated TNF-alpha concentration out of 60 non infected patients). These data indicate that premature neonates and term newborns are able to produce TNF-alpha when they are infected. Highly elevated TNF-alpha concentrations are found in severe systemic infections causing cardiovascular impairment.

Cord serum IgE has been shown to be a valuable marker for the prediction of atopy. Our study was designed to verify these findings for possible systematic screening recommendation. Our study consisted of 338 children who were followed from birth to 18 months. Cord serum IgE was measured by paper immunosorbent test and radioimmunoassay. All other data (sex, family history and environment, diet, occurrence of atopic manifestations) were recorded. Of the 338 children, 118 (34.9%) developed obvious clinical symptoms of atopy during the study period. Using the receiver operator curve we found an IgE level of 1.20 IU/ml to be the best cut-off point as a predictor of atopy with 95% specificity but 13% sensitivity. Combination with other predictors such as sex, family history, environmental factors and diet did not increase the predictive value of the test. Because of this low sensitivity we conclude that cord serum IgE is insufficient to detect individuals at risk for atopy even if associated with genetic and environmental factors. Thus it should not be recommended for routine screening purposes; more sensitive markers are needed.

Recombinant human erythropoietin (rHuEPO) was administered subcutaneously three times a week to 18 infants with the anaemia of prematurity at doses of 75, 150, 300, or 600 units/kg per week for 4 weeks, starting at 3-4 weeks of postnatal age. A significant and dose-dependent increase in reticulocyte count was observed from a mean baseline value of 71 x 10(9)/l to 200 x 10(9)/l after 3 weeks of therapy, compared with a change from 69 to 97 x 10(9)/l in 66 historical controls. The haematocrit value remained unchanged during rHuEPO treatment, whereas it steadily declined until 9 weeks of postnatal age in the controls. These effects were accompanied by a marked reduction in serum iron concentration and transferrin saturation in patients receiving standard-dose iron supplements, but not in those given larger doses. Only 3 of 18 patients required a red blood cell transfusion. These infants were among the most anaemic at entry into the study and 2 of them were unable to complete rHuEPO therapy, while the third developed iron deficiency anaemia. These data indicate that rHuEPO with appropriate iron supplementation may accelerate the recovery from anaemia of prematurity. Larger scale placebo-controlled studies are now needed to confirm these findings and verify their impact on transfusion requirements of premature infants.

A longitudinal study was undertaken in 21 newborns to determine cardiac growth pattern by echocardiography over the course of the first year of life. Most cardiac structures increased in size as a linear function of age and weight; however, the right ventricular end-diastolic diameter remained unchanged so that the RV/LV ratio decreased as a parabolic function of age. Left and right ventricular systolic time intervals (RVSTI, LVSTI) after birth were also studied. The ratio of left ventricular preejection period (LVPEP) to left ventricular ejection time (LVET) decreased markedly immediately after birth and subsequently remained at a constant mean value (0.30 +/- 0.04) for the rest of the study period. Right ventricular systolic time interval ratios (RVPEP/RVET) decreased rapidly and significantly during the first day of life (from a mean value of 0.39 +/- 0.08 in the first 24 hours to 0.28 +/- 0.05 on the 6th day of life). Constant values of 0.24 +/- 0.03 were found from the 3rd month of life onwards. The decrease in RVPEP/RVET in the first days of life followed a parabolic function reflecting the physiological decrease of pulmonary vascular resistance after birth.