Premature infants are at risk for severe sepsis and meningitis, both infections associated with high mortality and morbidity. Cerebro-spinal fluid (CSF) culture is the gold standard method for ...meningitis diagnosis, but interpretation of biochemical parameters of CSF is essential at the moment of the analysis in order to start the appropriate treatment. The main objective of this study was to determine whether levels of CSF beta-2-microglobulin (B2M) were elevated in preterm infants with CNS infections or other inflammatory processes, and to establish if there were differences in B2M concentrations amongst various inflammatory settings (sepsis, meningitis, and progressive post-hemorrhagic ventricular dilatation (PHVD)).
This is a retrospective study of all very preterm and extremely preterm infants (< 32 weeks of gestation) admitted to our NICU between 2012 and 2017. All those who underwent a lumbar puncture during their stay as part of a sepsis work-up or PHVD were considered for inclusion. CSF biochemical parameters and B2M were tested in all of the patients.
Fifty-nine patients were included in the study. In patients with CNS infections, the median value of B2M was 8.69 mg/L (3.92-18.5). B2M levels above 3.92 mg/L showed greater sensitivity and specificity than leukocyte levels in discriminating between patients with CNS infections or other inflammatory processes and those without CNS inflammation.
In this population, CSF B2M proved to be an effective biomarker to discriminate between patients with CNS infections and other inflammatory processes and those without CNS inflammation.
Abstract Background The role of chorioamnionitis in neurodevelopment of preterm infants is not fully understood. Aim To examine the association between different indicators of intrauterine ...inflammation (clinical chorioamnionitis, histological chorioamnionitis and funisitis) and neurodevelopmental impairment in very preterm infants. Methods Preterm infants with a birth weight of < 1500 g or a gestational age of < 32 weeks were included. Follow-up evaluation up to 2 years of age consisted of neurological examination, neurodevelopmental assessment and visual and audiologic tests. Outcome data were compared between the chorioamnionitis and the control groups, controlling for gestational age, birth weight and Apgar score at 5 min. Results One hundred seventy-seven patients comprised the study population (mean gestational age 29 ± 2 weeks, mean birth weight 1167 ± 344 g). Histological chorioamnionitis was present in 49% of placentas, whereas funisitis was observed in 25%. In 57% cases clinical maternal chorioamnionitis was suspected. Follow-up was available for 130 (82%) patients. Infants with funisitis, compared with controls, had a significantly higher incidence of moderate to severe disability (18% vs 5%, OR 4.07; 95% CI 1.10–15.09). Conclusion The results of this study suggest that, unlike a broad definition of histological chorioamnionitis including inflammation of maternal or fetal placental tissues, funisitis may entail a higher risk of moderate to severe disability at 2 years of age in preterm infants.
Congenital anomalies are the fifth leading cause of death in children <5 years of age globally, contributing an estimated half a million deaths per year. Very limited literature exists from low and ...middle income countries (LMICs) where most of these deaths occur. The Global PaedSurg Research Collaboration aims to undertake the first multicentre, international, prospective cohort study of a selection of common congenital anomalies comparing management and outcomes between low, middle and high income countries (HICs) globally.
The Global PaedSurg Research Collaboration consists of surgeons, paediatricians, anaesthetists and allied healthcare professionals involved in the surgical care of children globally. Collaborators will prospectively collect observational data on consecutive patients presenting for the first time, with one of seven common congenital anomalies (oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation and Hirschsprung's disease).Patient recruitment will be for a minimum of 1 month from October 2018 to April 2019 with a 30-day post-primary intervention follow-up period. Anonymous data will be collected on patient demographics, clinical status, interventions and outcomes using REDCap. Collaborators will complete a survey regarding the resources and facilities for neonatal and paediatric surgery at their centre.The primary outcome is all-cause in-hospital mortality. Secondary outcomes include the occurrence of post-operative complications. Chi-squared analysis will be used to compare mortality between LMICs and HICs. Multilevel, multivariate logistic regression analysis will be undertaken to identify patient-level and hospital-level factors affecting outcomes with adjustment for confounding factors.
At the host centre, this study is classified as an audit not requiring ethical approval. All participating collaborators have gained local approval in accordance with their institutional ethical regulations. Collaborators will be encouraged to present the results locally, nationally and internationally. The results will be submitted for open access publication in a peer reviewed journal.
NCT03666767.
Encephalomyopathic mitochondrial DNA (mtDNA) depletion syndrome 13 (MTDPS13) is a rare genetic disorder caused by defects in F-box leucine-rich repeat protein 4 (FBXL4). Although FBXL4 is essential ...for the bioenergetic homeostasis of the cell, the precise role of the protein remains unknown. In this study, we report two cases of unrelated patients presenting in the neonatal period with hyperlactacidemia and generalized hypotonia. Severe mtDNA depletion was detected in muscle biopsy in both patients. Genetic analysis showed one patient as having in compound heterozygosis a splice site variant c.858+5G>C and a missense variant c.1510T>C (p.Cys504Arg) in
. The second patient harbored a frameshift novel variant c.851delC (p.Pro284LeufsTer7) in homozygosis. To validate the pathogenicity of these variants, molecular and biochemical analyses were performed using skin-derived fibroblasts. We observed that the mtDNA depletion was less severe in fibroblasts than in muscle. Interestingly, the cells harboring a nonsense variant in homozygosis showed normal mtDNA copy number. Both patient fibroblasts, however, demonstrated reduced mitochondrial transcript quantity leading to diminished steady state levels of respiratory complex subunits, decreased respiratory complex IV (CIV) activity, and finally, low mitochondrial ATP levels. Both patients also revealed citrate synthase deficiency. Genetic complementation assays established that the deficient phenotype was rescued by the canonical version of
, confirming the pathological nature of the variants. Further analysis of fibroblasts allowed to establish that increased mitochondrial mass, mitochondrial fragmentation, and augmented autophagy are associated with FBXL4 deficiency in cells, but are probably secondary to a primary metabolic defect affecting oxidative phosphorylation.
To evaluate the feasibility and efficacy of a continuous glucose monitoring system (CGMS) in a population of infants of very low birth weight (VLBW).
Infants weighing <or=1,500 g and of <or=32 weeks ...of gestation were recruited within 24 h of delivery. A subcutaneous sensor connected to a CGMS was inserted and maintained for 7 days or until dysfunction. Therapeutic management followed the usual standard protocols.
38 patients (21 male) were included over 17 months. Their mean gestational age was 27.5 +/- 2.0 weeks and their mean birth weight was 958.3 +/- 205.5 g. Their perinatal histories and complications during admission were unremarkable for extremely premature babies. Continuous monitoring lasted an average of 7.84 +/- 1.99 days per patient. Hyperglycaemia was detected in 22 (57.90%) patients and it lasted a mean of 20.33 +/- 30.13 h, while 14 (36.8%) presented with hypoglycaemia for a mean of 2.45 +/- 2.3 h.
The CGMS gave a safe and useful estimate of glucose levels in VLBW infants, revealing abnormal glucose levels at a much higher rate than expected by usual sampling. However, it was not able to provide real-time glucose concentration data. CGMS may be very useful in providing information on the role of hyper- and hypoglycaemia on short- and long-term outcomes in VLBW infants.
Iatrogenic bronchial complications in intubated premature infants are rare. The authors present one case of rupture of a closed-tube endotracheal suction catheter. Clinical presentation was a ...persistent pneumothorax that required chest tube placement in several days. A foreign body was confirmed in x-ray and computed tomography (CT) scan. Flexible bronchoscopy showed a piece of catheter in the left bronchus and using a rigid bronchoscope was possible to remove. No perforation was found. There are a few reports in the literature of iatrogenic bronchial complication in premature infants caused by closed-tube endotracheal suctioning catheters. Endobronchial rupture of this catheter has never been reported. J Pediatr Surg 37:1483-1484. Copyright 2002, Elsevier Science (USA). All rights reserved.
Protocols for the prevention of group B streptococcal disease are being widely used with proven efficacy. The aim of this study was to assess compliance with a culture-based approach recommending ...universal culture screening at 35-37 weeks' gestation, established in our hospital. A retrospective cohort study was undertaken from January 2003 to January 2004. Compliance with the culture-based approach was considered to be good (92.1%) and only partially amenable to improvements. Effectively, there are inherent limitations to the protocol that can be resolved with the use of other strategies, such as tests for quick identification of genital carrier status.
The Paraná River reaches the Atlantic Ocean in a 300
km long and 80
km wide littoral complex. Most of its evolution occurred during the Holocene. The development of the delta comprises four phases: ...(1) A fluvial period represented by river flood deposits; (2) A marine ingression with development of a sand barrier, a lagoon, minor tributary deltas and estuaries and well-developed regression deposits; (3) An estuarine phase characterized by extensive tidal deposits in the central area; and (4) The present fluvial period, with channel deposits and deltaic deposits advancing into the Rı́o de la Plata. The present dynamics of the deltaic complex is dominated by the Paraná floods, the floods of the Uruguay and Gualeguay rivers, tides and floods produced by the southeast wind.
There is a need for a better etiologic classification of preterm births and for tools to help to determine the possible etiologies of these births.
Having previously developed the Barcelona Etiology ...of Prematurity (BEP) algorithm, based on a new classification for preterm births, we sought to validate this algorithm in clinical studies whereby doctors retrospectively assigned the etiology of preterm birth according to principal cause and associated causes.
In phase 1 of the study, 91 preterm neonates consecutively admitted to a tertiary hospital were etiologically classified by doctors using the BEP algorithm. In phase 2, another 29 cases, representing the full spectrum of standard clinical scenarios, were classified by 20 doctors randomly divided into two groups of 10: one group used the algorithm and the other did not.
In phase 1, the doctors were able to assign the etiology of all 91 clinical cases using the BEP algorithm, showing a 95.6% level of agreement with the etiologies set by the authors. In phase 2, for the 572 total evaluations, the group that used the BEP algorithm had significantly fewer errors in assigning the principal cause of prematurity than the group that did not use the algorithm (4.51 vs. 16.20%, respectively; p < 0.0001), and also demonstrated a higher level of correlation in assigning the associated causes.
The proposed classification may be used to retrospectively categorize the etiology of preterm births, and the BEP algorithm facilitates this task enabling greater accuracy and precision in clinical data.
Large wetlands are important landscapes in South America, where today they cover one million square kilometers. Such environments probably were as important in the Quaternary of other continents. ...Tensional tectonic processes in the Andean foreland and other lowlands result in the sinking of blocks several thousand square kilometers in surface. Under humid climates, such depressions become occupied by shallow waters and a dense paludal vegetation. These features are a special case of wetlands, which owing to their areal extension, complexity, internal fluxes of sediments and salts, must be considered as macrosystems (Neiff et al., Large tropical South American wetlands: a review UNESCO Ecotones Workshop, Seattle, UNESCO, Paris, 1994, 15pp.) and are a major depositional environment in South America. Such areas are plains, characterized by more or less periodic flooding and complex ecosystems adapted to large water fluctuations. Such water bodies have frequent anaerobic conditions and accumulate organic matter in various degrees of decomposition. South America contains 14 wetlands with areas larger than 10000
km
2. Other somewhat smaller wetlands appear in abandoned fluvial belts inside megafans. Examples of this type can be found in the Pilcomayo river system in Argentina, where an old belt is at present a swamp 250
km long and 7–12
km wide. Large inland wetlands in South America can be grouped in two types: Pantanales, or sandy swamps; and Mud Wetlands. Both are clearly different in geomorphology, sediments, types of salts, and ecology.
From the point of view of Quaternary Science, the degree of knowledge of the large wetlands is really poor. In general, it is restricted to the survey of the present conditions, which is itself important because similar environments have generally been reclaimed for agriculture since hundreds of years in other continents. An example of a large wetland of Late Pleistocene age (the Tapebicuá Fm, Argentina) is presented in this article. It is also clear that tropical swamps did exist throughout the Quaternary, and they very probably were “hot spots” for evolution of plants and animals and refuges for particular ecosystems.
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