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Volume 6, No. 1, Jan., 2005
EFFECT OF PHOTOTHERAPY ON CYTOKINES IN NEONATAL JAUNDICE
Prof. Amina Abd El Wahab, M.D. *Prof. Taher El Serafy, M.D. **Prof. Ahmad Atef, M.D. *Ass. Prof. Ashraf Nabil Eissa, M.D. *Mohammed O. Hussein, M.D. ***
* Pediatric Department, Faculty Of Medicine, Suez Canal University ** Biochemistry Department, Faculty Of Medicine, Suez Canal University *** Port Saiid, El-Nasr General Hospital, Pediatric Dept, Ministry. Of Health
ABSTRACT
Jaundice is a common problem in the neonatal period. Phototherapy is, so far, the most effective and safe management of neonatal jaundice. Cytokines are proteins synthesized and secreted by T, B, and NK cells, and by the cells with which they interact. They have the ability to promote and facilitate differentiation and proliferation of the cells of the immune system.
The aim of this work is to highlight the effect of phototherapy, if any, on certain types of Cytokines (IL – 1B, IL – 2r, IL– 6, IL – 8 and TNF –?) in cases of neonatal jaundice.
The results of this case controlled study revealed that the level of IL- 1B was below 5 pg/ml in all the studied sample, whereas, the level of IL– 2r was higher in infant exposed to phototherapy than the other group. The levels of IL – 6 and IL – 8 did not vary between the two groups. The level of TNF –? was high in both groups compared to the start studied sample.
We concluded that, phototherapy although it is a safe tool of management, yet, it has an effect on the immune system of the neonates through the impact on certain types of cytokines. So it is recommended that phototherapy should be applied to indicated cases only and for limited period to avoid known and unknown hazards untoward effects.
THYMIC INDEX AS A PARAMETER FOR EVALUATION OF NEONATAL SEPSIS
M. Shalabi, F. Sedeek, N. Abdou, A. El-Fakharany*, L.El mahroky.**
Pediatric, Radiology* and Clinical pathology** Departments, Benha Faculty of Medicine, Benha University.ABSTRACT
Background: In various stressful conditions, the thymus subjected to incidental involution, mostly due to the thymocytolytic effect of secreted glucocorticosteroids. The thymus gland play a key role in the body's defense against infection. Objective: this study aimed at assessing the variations of thymic size by ultrasonography in normal and diseased neonates with proven sepsis and to find whether there is a significant correlation between thymic index (Ti) and several variables. Study design: This cross-sectional, case-control study included 30 neonates with sepsis, 17 males and 13 females. Their mean gestational age was (38.93 ± 1.91) weeks and their mean weight was (2.93 ± 0.55) kg. Thirty cases of healthy neonates, 16 males and 14 females, their mean gestational age was (39.6 ± 1.23) weeks and their mean weight was (3.25± 0.55) kg., Served as controls. Every case underwent complete history taking and thorough physical examination with special emphasis on anthropometric measurements and a full evaluation for sepsis including complete blood count (CBC), C-reactive protein (CRP) and blood culture.Thymic sonography was done for every case to detect the thymic index (Ti) which indicates the size of thymus as a volume estimate. Results: The results of this study showed a significantly lower value of Ti (P < 0.001) and significantly higher level of CRP (P < 0.001), in patients compared to controls. Also, the value of Ti was positively correlated with birth weight of healthy controls (P < 0.05). Ti showed positive predictive value of 87%, while that of CRP was 66%. A highly significantly increase was found, regarding Hb, platelet, immature neutrophils and I/T ratio, (p < 0.001), and significantly increase as regards RBCs, (p < 0.05), in patients compared to controls. While, no significant difference was found between the two groups as regard absolute neutrophils count ( ANC) and total leucocytic count (TLC). Also, there was no significant correlation between Ti and gestational age, body length, head circumference and different blood indices in both groups. Conclusion: We concluded that sonographic estimate of the thymus in infants less than one month of age seems to be an easy, reliable and safe diagnostic modality for assessment of thymic size. Thymic index could be considered as a sensitive predictor of neonatal sepsis and reflects the immune competence status of infants. Keywords: thymic index (Ti), neonatal sepsis and thymic sonography.
Late-Onset Neutropenia in Neonatal Intensive Care Unit In Children's Hospital,Cairo University
Rasha M.Gamal EI-Din
Department of Pediatrics, Faculty of Medicine,Cairo University,EgyptABSTRACT
Neutropenia, defined as absolute neutrophil count (ANC) <1500/mm3, affects 6% to 58% of premature infants in the first week of life. This early-onset neutropenia in premature infants has previously been correlated with sepsis, maternal hypertension, severe asphyxia, and periventricular hemorrhage. Late-onset neutropenia, defined as ANC <1500/mm3 at a postnatal age of =3 weeks, has been recently reported. The purpose of this study is to determine the prevalence of late-onset neutropenia in low birth weight (LBW) infants and to examine the factors that may be associated with this phenomenon.The study comprised 150 premature infants who were admitted to our tertiary-level neonatal intensive care unit(NICU) from August 2003 to June 2004 . A weekly complete blood cell count (CBC) was performed routinely at day 1, and then weekly until discharge in all premature infants with birth weight =1500 g (n=86) who survived until discharge.Results: Late-onset neutropenia was detected in 18 infants (21%). In both neutropenic (n=18) and nonneutropenic infants (n= 68), ANC increased postnatally, remained above 5000/mm3 for the first 3 weeks of life, and had a marked decrease at 4 weeks of age. Thereafter, ANC decreased to a level of 1300/mm3 in the neutropenic infants and 4000/mm3 in the nonneutropenic infants. The neutropenic infants had a significantly lower hemoglobin, than did the nonnentropenic infants with similar platelet counts. None of the study infants received erythropoietin during their hospitalization. This late-onset neutropenia occurred at postnatal age of 4.5±1.8 weeks (range: 3-10 weeks). The duration of neutropenia was 1.2±.7weeks (range: 1-3weeks). The neutropenic infants were stable, growing on full oral feedings, and had no signs or symptoms of sepsis. No adverse effects of late-onset neutropenia were apparent in these infants. Conclusion: Late-onset neutropenia appears to be a benign condition that is not associated with any particular complication and does not require specific treatment. Reference ranges after the early neonatal period and during the first few months of life in LBW and VLBW infants should probably be set at lower values.
Urinary 8-Isoprostane and S100B Protein Concentrations as Predictors of Hypoxic-Ischemic Brain Damage in Asphyxiated Neonates
Nehal M. El-Raggal*, Mona F. Youssef** and T. I. Menecie***
*Pediatric and **Clinical Pathology Departments, Ain Shams University; and ***Neurology Department, Al-Azhar UniversityABSTRACT
Newborn infants with perinatal asphyxia are prone to the development of hypoxic-ischemic encephalopathy (HIE). To date, there are no reliable methods for proper identification of infants who are at high risk of HIE after asphyxial insult. Objective: We sought to evaluate urinary levels of a lipid peroxidation marker, 8-isoprostane, and a brain specific protein, S100B protein, as non-invasive tools that might help early identification of postasphyxial hypoxic-ischemic brain damage and prediction of its outcome. Methods: Thirty term neonates with perinatal asphyxia were evaluated in comparison to 15 matched healthy controls. Urinary concentrations of 8-isoprostane (by ELISA) and S100B protein (by immunoluminometric technique) were determined at first urination (time 1) and repeated in a second sample obtained 24-48 hours postnatally (time 2). Asphyxiated neonates were clinically monitored for their neurological pattern over the first two postnatal weeks and were subsequently classified as mild (grade I, n=8), moderate (grade II, n=12) and severe (grade III, n=10) HIE. Eleven of these neonates (36.7%) died in the NICU. The results obtained were interpreted in relation to the grade of HIE severity and mortality. Results: Urinary concentrations of 8-isoprostane and S100B protein were significantly higher in asphyxiated neonates at both monitored times, as compared to controls. Levels of both markers were related to the grade of HIE severity being significantly higher in neonates who developed grade II as compared to grade I, while highest levels were found in grade III. A significant increase in urinary 8-isoprostane from time 1 to time 2 was only found in grade III (p<0.05) while S100B protein increased over that time period in grades II and III ((p<0.01, respectively). Survivors showed significantly lower mean level of each marker as compared to those with fatal outcome (p<0.001, respectively), at both monitored times. Diagnostic performance tests revealed that S100B protein was superior to 8-isoprostane, at the two monitored times, for prediction of HIE severity and mortality. At first urination, a cut-off value for S100B protein of 0.3 µg/L could best predict development of grades II and III HIE with a positive predictive value (PPV) of 100% and an efficacy of 95.5%. Meanwhile, an optimum cut-off value of 6.89 µg/mg creatinine for 8-isoprostane, had a PPV of 90.48% and an efficacy of 88.89% for grades II and III prediction. As predictors of mortality at first urination, an optimum cut-off value for S100B protein of 2.12 µg/L and for 8-isoprostane of 10.4 µg/mg creatinine had corresponding PPVs of 90.9% and 90%, respectively and efficacies of 93.3% and 90%, respectively. There was no significant difference in the overall diagnostic performance of each of the two markers either for disease severity or mortality prediction between both monitored times (p>0.05, respectively). Conclusion: 8-isoprostane and S100B protein levels are increased in urine following birth asphyxia. S100B protein is superior to 8-isoprostane for prediction of both HIE severity and mortality. It could be speculated that measurement of urinary concentrations of these markers, soon after birth, could serve as a clinically useful and relatively simple non-invasive tool to predict the risk for developing HIE following birth asphyxia and its short-term outcome.
Prenatal onset infantile cortical hyperostosis (Caffey disease): an Egyptian report
Ezzat Elsobky, Solaf Elsayed
Genetics unit, pediatrics hospital, Ain shams university
ABSTRACT
Prenatal onset infantile cortical hyperostosis (prenatal form of Caffey disease) is an uncommon disease characterized by polyhydramnios, pulmonary hypoplasia, hepatomegaly, bowed hyperostotic long bones, and a poor prognosis [1]. We report a fetus of 33 weeks of gestation whose clinical and radiological findings are compatible with the severe form of this disease. The occurrence of this form in two siblings provides further evidence for the recessive form of inheritance.
Transient Tachypnea of the Newborn
Review Article
Quated by: Prof. Khaled Taman MD,Ph.D
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