Septicaemic low birthweight neonates treated with human antibodies to endotoxin.

Abstract

positive mouth cultures (31 C albicans, five C parapsilosis) and in 25 of these dummy cultures also grew candida (20 C albicans, five C parapsilosis). Only eight children without dummies had candida positive mouth cultures (using Yates' correction: x2=7.5 P<0*01). Only four of the children using dummies who had negative mouth swabs had positive dummy cultures.Ten children who used dummies had mouth swabs which were positive for candida on more than two occasions (repeatedly positive) and dummy cultures were also repeatedly positive for all except one of these children. No child who did not suck a dummy had repeatedly positive mouth swabs. DiscussionOur study suggests that dummy sucking in early childhood is associated with greater prevalence of thrush and with more frequent and more persistent mouth colonisation by candida. Where candida is present in the mouth, it is usually cultured from the dummy also. Objects placed in the mouth are likely to reflect oral flora but we were surprised that dummy sucking predisposed to oral colonisation and infection with candida.Candida is a common mouth commensal and its prevalence in our study is no more than that found in other studies.2 3 Positive cultures may reflect the density as well as the prevalence of candida colonisation. Thus our finding of a greater prevalence of Candida in the mouths of children with dummies may indicate either an absolute increase in prevalence of colonisation or, possibly, denser colonisation. Low density colonisation may explain why the correlation between dummy and mouth cultures in children who used dummies was not total. The finding of clinical thrush in only a minority of infants with positive mouth swabs suggests that gastrointestinal contamination from dummies should be considered in infants with candida napkin rash when there is no clinical evidence for oral thrush.Foreign bodies in the mouth such as dummies and false teeth4 predispose to candidal infection.Abramovits5 described a child in whom oral thrush did not respond to treatment until the child's dummy was confiscated. Our study also suggests that persistent oral and dummy infection go together. The dummy's role as pacifier may be more important to mothers than its aesthetic and health disadvantages. If this is the case, mothers need advice on effective treatment for infected dummies as well as for their children's thrush.

Pathophysiology of Neonatal Sepsis

“…The TLRs, β 2integrins, and C-type lectin receptors detect pathogens both on neonates with sepsis (n = 16) with serum endotoxin present reduced the time to recovery but not mortality as compared with the values in placebo-treated neonates. 107 Reduction of serum LPS levels by exchange transfusion in infected neonates (n = 10) was associated with improved survival. 108 Bacterial cell wall components (such as lipoteichoic acid) signal primarily through TLR1, TLR2, and TLR6, flagellin signals through TLR5, and CpG double-stranded DNA signals through TLR9.…”

Potential of immunomodulatory agents for prevention and treatment of neonatal sepsis

“…Experimentally and theoretically sound methods of immunomodulation directed at improving sepsis outcomes by correcting some neonatal immune deficits have been attempted without major improvement (Table 3) 21–33 . Therapies that enhance the quantity and/or quality of neutrophils, including granulocyte transfusions, GM-CSF, and G-CSF have been studied in human neonates 34–38 .…”

Effects of immunotherapy on mortality in neonates with suspected or proven sepsis: a systematic review and network meta-analysis

“…We divided the immunotherapies into four groups and placebo based on their therapeutic agent to compare the effects of all immunotherapy agents that have been clinically studied to date. A type of human antibody to endotoxin was used on neonates with sepsis and low birthweight [26]; however, at present, only one study has reported on this type of immunotherapy. Thus, we did not evaluate this immunotherapy in the present study.…”