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Volume 4, No. 1, Jan., 2003
Antioxidant Value of Bilirulin In Sick And Healthy Neonates
Ahmed Khashaba, MD; Mohamed El-Sherbini, MD, Ahmed EI-Sabbagh, MD; Ghada El-Refaie MSC And *Osama El-Shaer, MD
The Pediatric and *Clinical Pathology Departments Benha Faculty of Medicine, Zagazig UniversityAbstract
To identify the beneficial role of bilirubin as an antioxidant, this study was carried out on 44 sick neonates suffering form respiratory distress syndrome, sepsis, meconium aspiration and birth asphyxia; in addition to 11 healthy ones as controls. The results showed that the mean values of total bilirubin levels in controls (4.4 ? 0.3) , (9.1 ? 0.5) and (12.8 ? 10.7 mg/dl) in 1st , 2nd and 3rd days of life respectively, were significantly higher than (3.9 ? 1.1), (6.3 ? 1.5) and(8.2 ? 2.1 mg/dl) values observed in sick group in 1st, 2nd, and 3rd days of life respectively. The rate of serum bilirubin rise was 4.2 mg/dl/day in control group which was significantly higher than (2.2 mg/dl /day) in sick group. The serum lipid peroxide in controls (14.5 ? 1.3 nmol/ml) was significantly lower than (19.3? 1.05) n mol/ml in sick group. The serum lipid peroxide correlated negatively with the rate of bilirubin rise. We can conclude that jaundice is not simply an accumulation of a potentially toxic waste product but may serve a beneficial role in providing high concentration of a free radical absorbing antioxidant.
GLUTATHIONE PEROXIDASE AND SELENIUM STATUS: RELATION TO OUTCOME IN NEONATAL SEPSIS WITH JAUNDICE
FARIDA EL BAZ MOHAMAD , AMANI OSMAN , SAYEDA A SALEH * AND E SALAH ,Pediatrics and Clinical Pathology * Departments , Faculty of Medicine , Ain Shams UniversityAbstract
To detect changes in serum levels of glutathione peroxidase (GPx ) selenium (Se ) and their relation to outcome of jaundiced septic neonates , the following study was conducted on thirty neonates . They were subdivided into group I ( 12 fullterms= FT ) and group II (18 preterms=PT ). Twenty two age and sex matched apparently healthy neonates served as the control group . Results revealed that the difference between GPx and Se in FT jaundiced septic neonates (group I) versus FT controls was statistically nonsignificant (p >0.05) while the difference between them as regards total serum bilirubin was statistically highly significant (p< 0.001 ) Statistical comparison between results of GPx , Se and total serum bilirubin levels in PT jaundiced septic neonates (group II) compared to PT controls revealed a highly significant decrease of GPx and Se and increase in serum bilirubin ( P < 0.001 respectively). Of the studied group of septic preterms , six neontes died while no mortalities were reported in the studied group of septic fullterms during the period of the study. GPx and Se were statistically significantly lower in group II (= PT ) than in group I (=FT ) .In conclusion , statistically significant GPx and Se decrease in PT jaundiced septic neonates (group II) can be used as predictors of outcome as regards mortality .
Lipofuscin; A New Lipid Peroxidation Markers Among Jaundiced Neonates With Oxygen Free Radical Induced DiseasesKarima Abdel Khalek*, Nayera I. Attia**, Hesham Awad*, Abla Galal***
Pediatric Department*, Institute of Postgraduate Childhood Studies (Medical Department)**, Ain Shams University and National Research Center***Abstract
This study was an attempt to investigate the lipid peroxidation represented by lipofuscin in correlation to some serum antioxidants levels such as vitamins A & E, ceruloplasmin and bilirubin in jaundiced neonates suffering from oxygen free radical induced diseases (ORD) in comparison to a control group.
This case-control study was conducted in the NICU, Gynecology and Obstetric Department, Ain Shams University Hospitals in the period from December 1999 to January 2002. This study included 107 jaundiced neonates diagnosed as necrotizing enterocolitis, chronic lung disease, hypoxic-ischemic encephalopathy and neonatal sepsis. They were classified into two main groups: group I, (51 term and preterm babies) with non pathological level of bilirubin i.e not needing interference and group II,(56 newlyborn term and preterm infants) with pathological level of bilirubin i.e needing interference. One hundred and seven apparently healthy neonates were enrolled in this study as a control group.
The results of this study revealed that the mean serum levels of vitamins A & E, ceruloplasmin, and hemoglobin were highly significantly decreased while, the mean serum of lipofuscin and bilirubin levels were highly significantly increased in the ORD patients group compared to controls (p = 0.001). Similar results were obtained on comparing ORD patients groups (subgroup I and subgroup II) to each other and on comparing preterms to fullterms in both groups except for serum bilirubin which was significantly lower in preterm Vs fullterm patients.
Serum lipofuscin correlated negatively with serum vitamins A & E, ceruloplasmin, and hemoglobin, and positively with total serum bilirubin level.
Serum lipofuscin at a level of 94.22 ArU for preterms and 91.47 ArU for full term neonates predicted the occurrence of oxygen free radical diseases with specificity of 95% and a sensitivity of 100% in both preterm and full term neonates. The positive and negative predictive values were 100% in both preterms and fullterm neonates. The positive and negative predictive values were 100% for preterms. On the other hand, the positive and negative predictive values were 96.5% and 100% respectively for fullterm neonates.
In conclusion, this study signifies lipofuscin not only as a new lipid peroxidation marker in newborns with ORD but also, it has higher sensitivity, specificity and predictive values. Moreover, the study revealed that serum bilirubin is markedly increased in patients with oxidative stress indicating its possible role as antioxidant besides vitamins A & E and ceruloplasmin. Hence, it is recommended to further study the significance of lipofuscin as an indicator of the severity as well as the further outcome of ORD.
Study of the Effect of Maternal Iron Depletion on Neonatal Iron MetabolismSahar M.A. Hassanein, Mohammed F. Moustafa, Hanaa El-Sayed Afifi*, Wael Abbas**, Mohamed S ED El Sahhar
Departments of Pediatrics, Clinical Pathology*, and Neonatal Intensive Care Unit**, Ain Shams University, Cairo, Egypt
Abstract
Background: Maternal nutritional and hormonal state from as early as the first few days after fertilization can influence the growth rate of the fetus and also the length of gestation .
Aim: was firstly; to study iron indices (serum iron, ferritin, and soluble transferrin receptors “STFR”) in neonates, and their relation with gestational age, birth weight and gender. Also, to assess the value of utilization of STFR and STFR/ Log ferritin index to measure the effects of maternal anemia, iron status, and iron supplementation, on neonatal iron indices at birth.
Methods: Iron, ferritin, STFR, and haemoglobin (Hb) concentration were measured and STFR-Log ferritin index was calculated in 40 cord serum (20 preterm “PT”, and 20 full term “FT” neonates), and from their maternal serum.
Results: Seventeen mothers were anemic “Hb < 10 gm %”, (5 mothers of FT, and 12 of PT babies). Twelve mothers had depleted iron stores “serum ferritin <10 µg/l” (4mothers of FT, and 8 PT babies). Non of FT babies had anemia, while 9 PT had anemia. Fullterm neonates and neonates weighing > 2.5 Kg had significantly higher cord blood Hb, serum iron and ferritin, compared to PT neonates and neonates weighing < 2.5 Kg. Neonates weighing ? 2.5 Kg had significantly lower STFR/Log ferritin, compared to neonates weighing < 2.5 Kg. No difference in iron indices was found between male and female neonates, also, between neonates delivered to mothers with iron supplementation during pregnancy and those without, and between neonates delivered vaginally and those by cesarean section. There was no difference in iron indices between neonates with either maternal anemia or depleted iron stores, and those with normal maternal indices.
Conclusions: There is no relation between maternal iron status and neonatal iron indices, except for serum ferritin. Cord serum ferritin correlates positively with maternal ferritin. So, cord serum ferritin, but neither STFR nor STFR/Log ferritin, is a good indicator of neonatal iron stores at birth. Maternal iron depletion is not associated with neonatal anemia. The fetus has normal iron indices on the expense of his mother’s iron stores. So, maternal supplementation with iron during pregnancy is a must.Early Onset Neonatal Sepsis, Role Out Viral Infection
Hamed El Khayat*, Mohamed Fathalla*, Nayera I Attia**, Wael Abbas*** and TantawyAmin****
Pediatric Department*, Institute of Postgraduate Childhood Studies** (Medical Department), Neonatal Intensive Care Unit***, Ain Shams University and NAMRU-3**** (Virus Isolation Section) Cairo, Egypt
Abstract
This cross-sectional prospective study was an attempt to define the frequency of viral infections and to estimate its incidence in early onset neonatal sepsis. It was conducted on 260 septic neonates with different diagnoses admitted to Neonatal Intensive Care Unit, affiliated to Obstetric and Gynecology Department, Ain Shams University Hospitals throughout one year from November 2001 to October 2002. Their mean gestational age was 39.3 ± 3.7 weeks, their mean birth weight was 2.4 ± 1.8 kg and their mean postnatal age was 12.35 ± 10.34 days. They included 148 males and 112 females.
The results of this study revealed that 49 out of 260 septic neonates (19%) were diagnosed as virus infected using different cell cultures. Seven viruses were identified by indirect fluorescent antibody tests (IFA) which were in order of frequency; cytomegalovirus (5%), respiratory syncytial virus (3.4%), Echo-11 (3.1%), Echo-14 (2.7%), Coxsackie B5 (2.7%), mumps (1.2%) and parainfluenza type 3 (0.8%).
Most of virus infected cases presented with low Apgar score, low birth weight and very low birth weight, prematurity, jaundice, peticheal rash, in addition to signs of sepsis. Meanwhile, respiratory viruses (respiratory syncytial virus, parainfluenza virus) were the major pathogens among respiratory distressed infants, enteroviruses, cytomegalovirus and mumps were implicated in neonates with multiple congenital malformation.
Cytomegalovirus was the most prevalent single virus isolated. Thirteen cases out of 260 septic neonates proved to be CMV positive. 77% were congenitally acquired, while 23% were postnatally acquired. These neonates presented with various clinical presentations, the most common were prematurity (85%), very low birth weight (62%), jaundice (54%) and hepatosplenomegaly (46%), meanwhile congenital malformations were recorded in 23% of cases (microcephaly, congenital hernia and congenital cataract). Mortality rate was 46%.
It is concluded from this study that viral infections is significantly implicated in the etiopathogenesis of neonatal sepsis. So, this study should raise the awareness of the neonatologists for the diagnosis and anticipation of the potential implications of virus infection on the subsequent growth and development of the newborn infants.
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