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Volume 4, No. 2, April, 2003
STUDY OF LEPTIN AND METABOLIC HORMONES IN INFANTS OF DIABETIC MOTHER
Sonia Elshakawy*, Ola Leheta**, Mamdoh El Nahas # Pediatric* and Clinical Pathology** Departments, Faculty of Medicine, Suez Canal University. # Medicine (Endocrinology) Faculty of El Mansora University.
Abstract
The serum leptin concentration reflects the amount of adipose tissue in the body. Leptin in children and adults can be influenced by metabolic hormones such as corticosteroids and insulin, most newborn studies have concentrated on the relation of leptin on fetal growth and anthropometric measurements at birth, but the effect of insulin dependent diabetic mothers on leptin and other metabolic hormones in the newborns have not been evaluated. So our study was undertaken to investigate the effect of maternal diabetes on leptin in term newborns, to detect the inter-relation between leptin and other metabolic hormones and to determine whether leptin correlates with insulin and its associated biochemical parameters in support of the hypothesis that a functional “adipoinsular axis” might exist at this stage of development. METOHDS: A total of 70 fullterm newborns who were at risk and admitted to the neonatal unit in Suez Canal University between May 1999, and February 2000. They were prospectively enrolled and classified into two groups. (34) Newborns were admitted have risk of infection and proved to be non-infectect (group A), 36 newborns born to diabetic mother. Estimation of serum leptin, glucose, cortisol, insulin, FT 4, ACTH and HbAic, were carried out. Anthropometrical measurements including body length, weight, BMT were calculated.
RESULTS: No significant difference in serum leptin was observed between the to two groups; the results of the study population were therefore pooled and analyzed. Serum leptin correlated significantly with serum insulin, insulin: glucose ratio, birth weight, body length, body mass index, and maternal HbAIc. All parameters except body length remained significantly associated with serum leptin when multivariate stepwise regression was applied. Subgroup analysis revealed a significant correlation between serum leptin and cortisol in-group B. CONCLUSIONS: There was no significant difference in serum leptin between infants born to diabetic and non-diabetic mothers, though infants born to mothers requiring insulin treatment had the highest median serum leptin concentrations. The significant association between serum leptin and insulin or insulin: glucose ratio supports the hypothesis that a functional adipoinsular axis might exist in term newborns. Furthermore, the significant correlation between maternal HbAIc and circulating leptin of the studied infants suggests that the right clinical control of maternal diabetes could affect the regulation of serum leptin in these infants.
HLA-DR Expression On Circulating Monocytes In Healthy and Sick Neonates
Gehan A. Mostafa, Khaled S. Awwad , Amal Z Abd El-Halim* and Hany M Eraky
Departments of Pediatrics and *Clinical Pathology, Ain Shams University, Cairo, EgyptAbstract:
Objective: This study was conducted to measure monocyte HLA-DR expression in neonatal sepsis in comparison to other diseases with systemic inflammation and high risk of infection (respiratory distress syndrome “RDS” and peronatal asphyxia) as this may be helpful in early diagnosis of infection and therapeutic intervention. Methods: This study was carried out on 38 sick neonates, 22 neonates with proven sepsis diagnosed clinically and by positive blood culture and 16 neonates (8 had RDS and 8 had perinatal asphyxia) with possible infection i.e. they had 2 or fewer clinical signs of sepsis ? positive CRP and negative blood culture. Forty healthy age and sex-matched newborns were studied as controls. After history taking and clinical examination, the following laboratory investigations were performed; complete blood count, CRP and flow cytometric measurement of monocyte HLA-DR expression. Patients with possible infection were followed up clinically and laboratory (CRP and blood culture were repeated after 48 hours). Seven out of those 16 patients (all had RDS) developed sepsis later on as evidenced clinically and by positive blood culture and they were considered as patients with early sepsis at the time of admission. Results: Neonates with proven sepsis and those with early sepsis had significantly lower HLA-DR% (15.95 ? 7.77 and 11.4 ? 5.88 respectively) than controls (61.03 ? 20.61). HLA-DR% was reduced below the lowest cut-off value in all septicemic neonates (neonates with proven and those with early sepsis), while CRP was positive in 90.9% of neonates with proven sepsis and in only 57.1% of the neonates with early sepsis (at the time of admission).
Neonates with RDS had significantly lower HLA-DR% than controls, as 7 out of those 8 patients developed sepsis after 48 hours. In contrast, there was insignificant difference between HLA-DR% level of neonates with perinatal asphyxia and healthy controls.
Monocyte HLA-DR% had higher sensitivity (100%), specificity (85.9%), positive (87.5%) and negative (100%)) predictive values than CRP (57.1%, 77.8%, 66.7% & 70% respectively) for sepsis at its early stages before evident clinical and laboratory diagnosis. Conclusion: The assay of monocyte HLA-DR% expression is a rapid and sensitive test both diagnosis of neonatal sepsis and its early stage and exclusion of neonatal infection in high risk neonates to reduce the unnecessary antibiotic use and the costs of neonatal intensive care units.
EVALUATION OF SOLUBLE E-SELECTIN AS A MARKER FOR NEONATAL SEPSIS Hesham E. Abdel-Hady, Maysaa E. Zaki*
Dept. of Pediatrics, Mansoura Faculty of Medicine Departments of Pediatrics and Clinical Pathology*, Mansoura Faculty of Medicine,
Abstract
Sarnat Clinical Staging Compared to Serum Creatine Phosphokinase and Nucleated Red Blood Cells in Assessing the Severity of Neonatal Hypoxic Encephalopathy
Amina Abdel Wahab *, Alaa Zeitoun A*, Hana Abdel Aziz **, Dina El Metwally DE,* Ahmed Islam El Metwally***. * Pediatrics Department. Faculty Of Medicine. Suez Canal University. Ismailia. ** Clinical Pathology Department. Faculty of Medicine. Suez Canal University. Ismailia. ***. Pediatrics Department. Naser Institute. Cairo
Abstract
Objective:To relate serum levels of Creatine- Phosphokinase (CPK) and Nucleated red blood cell (NRBC) count to the clinical severity of Hypoxic Ischemic Encephalopathy (HIE) using Sarnat clinical staging. Study Design: A Prospective analytic study, conducted on term 40 newborn: HIE [Stage I (SI): 10, Stage II (SII): 11, Stage III (SIII): 9] and 10 normal control. Results: Mean CPK levels among HIE infants with SIII was 637.9?696.2, six folds the levels among the SI and II HIE infants, p<.0001. There was no statistical or clinical differences between SI and SII HIE. P <0.55. Using the Receiver Operator Chacteristic (ROC) analysis, the sensitivity of serum CPK to detect HIE is 83% with a specificity of 80 % at a discriminating value of 90 IU/L Mean. NRBC counts among HIE infants with SIII was 3138?3123, ten folds the levels among the SI and SII. The difference between SI and SII HIE, and SI and SIII HIE was statistically significant. The sensitivity was 70 % with a specificity of 80 % at a discriminating count of 680. Conclusion:CPK and NRBC counts are important as a differentiating marker between mild and severe HIE, in the first 24 hours of life. Yet they fail to determine moderate levels of asphyxia,if used sepaparetely.
A STUDY ON RETINOPATHY OF PREMATURITY IN LOW BIRTH WEIGHT INFANTS IN ZAGAZIG UNIVERSITY NEONATAL CARE UNIT
Ahmad H. Sherif*, Azza A. Khalil*, Hanaa A. Mostafa*, Ayman A. Alkawas** and Walid A. El Ghamry*
Departments of Pediatrics* and Ophthalmology**, Zagazig University, EgyptAbstract
Background: Despite the marked improvement in the neonatal care, monitoring and treatment, Retinopathy of prematurity (ROP) continues to be an important problem in premature infants.
Aim: To study the incidence and the possible risk factors for development of retinopathy of prematurity (ROP) in a high risk group of premature infants with birth weight = 1500 grams and with gestational age = 34 weeks.
Method: This study was carried out on all premature infants, whose birth weight was = 1500 grams or whose gestational age was = 34 weeks, delivered at Zagazig University hospital and admitted to neonatal intensive care unit (NICU) from the period of March 2002 to March 2003. The study included 100 premature infants but only 40 cases continued to the time of the first ophthalmological examination at 28 days, other cases either died (48 cases) or did not come for follow up (12 cases). All the studied cases were subjected to full history taking, complete medical examination, routine laboratory investigations and retinal examination at 4-6 weeks postnatally and follow up was done every 2 weeks if there was no ROP changes and weekly if ROP changes were detected until full vascularization of the retina occurred.
Results: ROP changes occurred in 25 cases (62.5%) out of the 40 studied cases. The ROP positive cases were 11 cases in stage I, 6 cases in stage II, 6 cases in stage III, and 1 case in stage IV and one case in stage V. The severity of cases was categorized into less than threshold 55% (22/40) and threshold 7.5% (3/40). Regression of ROP changes occurred in 88% (22/25) while progression occurred in 12% (3/25). Univariate analysis of the risk factors for ROP development revealed a highly significant association between ROP and low birth weight, low gestational age, sepsis, respiratory distress syndrome (RDS), and blood transfusion > 2 times while a significant association was found with the duration of oxygen > 15 days, apnea, exchange transfusion, mechanical ventilation and Apgar score at 1 minute. There were a non-significant association with hyperbilirubinemia, some drugs used, some maternal risk factors, sex and other neonatal problems as anemia, pneumonia and convulsions. The multivariate analysis of the significant risk factors showed that blood transfusion was found to be highly significant while birth weight, gestational age, exchange transfusion, sepsis, exposure to oxygen > 15 days, and RDS were found to be significant risk factors whereas apnea and Apgar score at 1 minute were found to be non-significant.
Conclusion: Prematurity, per se, remains a significant risk factor for ROP development due to ocular immaturity and increased risk of neonatal complications especially blood transfusion, sepsis, RDS and prolonged requirement for mechanical ventilation and oxygen supplementation > 15 days.
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