Background: Cardiac troponins T (cTnT) and I (cTnI) are well-established markers in detecting myocardial ischemic damage in adults. Perinatal asphyxia is associated with cardiac dysfunction. Objectives: To evaluate serum concentrations of cTnI in asphyxiated neonates and to investigate whether cTnI is correlated with the traditional markers of asphyxia. Methods: Blood samples were collected from 13 asphyxiated neonates (umbilical artery pH <7.18 and either a 1-min Apgar score <4 or a 5-min Apgar score <7) and 39 controls. Data on gestation, birth weight, sex, Apgar scores, mode of delivery, umbilical pH, creatinine, serum activity of aspartate and alanine aminotransferase, and QTc interval were investigated. Results: Median (range) cTnI concentrations were significantly higher in asphyxiated neonates with respect to healthy infants: 0.36 µg/l (0.05–11) versus 0.04 µg/l (0.04–0.06); p < 0.01. In asphyxiated babies, no statistically significant correlations were found between concentrations of cTnI and the other markers of asphyxia. Conclusions: In asphyxiated neonates, cTnI concentrations are higher with respect to healthy infants, suggesting the presence of myocardial damage in this group of high-risk patients. cTnI does not correlate with the traditional markers of asphyxia.

Breast-fed infants have higher bilirubin levels than formula-fed infants, possibly because of variations in the composition of the breast milk. The aim of this study was to investigate whether there is a relationship between cytokine levels in the colostrum of nursing mothers and neonatal jaundice (NJ). Breast milk samples were collected from breast-feeding mothers of healthy fullterm neonates, 32 with NJ and 29 without jaundice. The concentrations of IL-1␤, IL-6, IL-8, IL-10, and tumor necrosis factor (TNF)-␣ were measured by chemiluminescence enzyme immunometric assays. Mothers of infants with NJ had a higher concentration of IL-1␤ in colostrum, compared with those feeding neonates without NJ, and similar trends were seen for IL-6, IL-8, IL-10, and for TNF-␣. The concentrations of IL-1␤ significantly correlated with IL-6, IL-8, IL-10, and TNF-␣ concentrations, but not with serum bilirubin levels of infants with NJ. In conclusion, the concentrations of IL-1␤ were increased in colostrum from breast-feeding mothers whose infants had NJ. The correlation between the concentrations of cytokines involved in the function of hepatic uptake and excretory systems and in the enterohepatic circulation of bilirubin provides additional data to the delineation of the cascade of pathophysiological events that can lead to NJ. B reast-fed infants have higher bilirubin levels than formula-fed infants (1). The jaundice of breast-fed infants is commonly of undetermined etiology (2-4). Suggested mechanisms for these findings include insufficient milk transfer to the neonate (5), inhibition of hepatic excretion of bilirubin (6), and increased intestinal absorption of bilirubin (7,8).Inhibition of hepatic excretion of bilirubin could explain the jaundice associated with human milk consumption, and early studies suggested that exposure to acquired cholestatic injury such as drugs, hormones, proinflammatory cytokines, or biliary obstruction or destruction results in an altered expression and function of hepatic uptake and excretory systems, changes that may maintain and contribute to cholestasis and jaundice (9). In particular, increased production of IL-8 and IL-10 has been reported in patients with biliary obstruction and jaundice (10,11). Moreover, the cholestatic effect of cytokines (e.g. IL-1␤, IL-6) is believed to result from the repression of genes that normally mediated the hepatic uptake, metabolism, and biliary excretion of bile salts and various nonbile salt organic anions such as bilirubin (12,13). In addition, IL-1␣, IL-6, and tumor necrosis factor (TNF)-␣ were found to decrease the glucuronidation activities dose dependently (14).Intestinal absorption is a key step in the enterohepatic circulation of bilirubin because bilirubin is more easily absorbed from the intestine than are bilirubin glucuronides. Increased intestinal absorption of bilirubin (15), facilitated by breast milk rich in ␤-glucuronidase (16) or via some other mechanisms such as delayed passage of meconium, the establishment of a population of inte...

Hypoglycemia is a frequent complication of preterm birth and may lead to later CNS damage. The hypoglycemia incidence and the relative risk factors for the affected preterm infants were assessed. We examined 1,500 preterm infants (<37 weeks of gestational age) consecutively admitted between January 1994 and December 1996 at the Department of Pediatrics of Padua University, and screened for hypoglycemia by Dextrostix within the first hour of life. Hypoglycemia was defined as blood glucose levels <40 mg% at Dextrostix. Among study prematures, 35% had hypoglycemia; while the incidence was 9% at levels of Dextrostix <20 mg%. The relative risk for hypoglycemia (odds ratio, OR) was computed assuming a 99% confidence interval (CI). We found 5 risk factors for hypoglycemia: cesarean section (OR 2.24, CI 1.66–3.03), intrauterine malnutrition (SGA) (OR 1.65, CI 1.08–2.53), NICU hospitalization (OR 1.45, CI 1.09–1.93), gestational age between 30 and 33 weeks (OR 1.93, CI 1.34–2.78), and twinning (OR 2.49, CI 1.77–3.56). At levels of Dextrostix <20 mg%, 3 more risk factors were found: cardiopulmonary resuscitation at birth (OR 4.06, CI 2.52–6.54), neonatal respiratory distress syndrome (OR 2.21, CI 1.34–3.36) and gestational age between 26 and 29 weeks (OR 2.16, CI 1.02–4.25). The identification of relative risk factors could be useful in improving the hypoglycemia prophylaxis, and in reducing related later CNS abnormalities.

(English) Sonographic cardiac evaluation of newborns with suspected aortic coarctation (AoC) should tend to demonstrate a good phasic and pulsatile flow and the absence of pressure gradient along a normally conformed aortic arch from the modified left parasternal and suprasternal echocardiographic views; these findings, however, may not necessarily rule out a more distal coarctation in the descending aorta. For this reason, the sonographic exam of newborns with suspected AoC should always include a Doppler evaluation of abdominal aortic blood flow from the subcostal view. Occasionally, however, a clearly pulsatile Doppler flow trace in abdominal aorta may be difficult to obtain due to the bad insonation angle existing between the probe and the vessel. In such suboptimal ultrasonic alignment situation, the use of Tissue Doppler Imaging instead of classic Doppler flow imaging may reveal a preserved aortic pulsatility by sampling the aortic wall motion induced by normal flow. We propose to take advantage of the TDI pattern as a surrogate of a normal pulsatile Doppler flow trace in abdominal aorta when the latter is difficult to obtain due to malalignment with the insonated vessel.Keywords Tissue Doppler Imaging Á Neonatology Á Aortic coarctation Á Newborn Á Pediatric cardiology Á Echocardiography Abstract (Italian) La valutazione ecocardiografica del neonato con sospetta coartazione aortica deve poter dimostrare, dalle proiezioni parasternale sinistra alta e soprasternale, un arco aortico normoconformato con traccia Doppler normale (flusso fasico) in assenza di gradiente transistmico; tali rilievi, tuttavia, non escludono la possibilità di una coartazione aortica più distale, sita in aorta discendente toracica. Per tale motivo, la valutazione ecografica neonatale nel sospetto di coartazione aortica deve sempre includere un'analisi Doppler del flusso in aorta discendente, visualizzata tramite approccio sottocostale. Talvolta, tuttavia, l'angolo che si viene a creare tra il fascio ultrasonoro e il vaso a questo livello può risultare subottimale ai fini di un adeguato campionamento Doppler che dimostri la presenza di flusso fasico e privo di run-off diastolico in aorta addominale. In tale situazione di allineamento non ottimale per l'analisi Doppler classica, la metodica TDI (Tissue Doppler Imaging) può rivelare una preservata pulsatilità aortica tramite l'analisi della motilità di parete del vaso indotta dal normale flusso fasico. Tale metodica di valutazione della pulsatilità di parete aortica potrebbe, se validata attraverso studi di numerosità adeguata sul neonato sano, rappresentare un adeguato surrogato di una traccia Doppler normale in aorta addominale nei casi in cui quest'ultima fosse difficoltosa da ottenere a causa di un malallineamento tra il vaso ed il fascio ultrasonoro esplorante.

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