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Volume 5, No. 2, April, 2004
CLINICAL SIGNIFICANCE OF SERUM PROLACTIN LEVEL IN NEONATAL SEIZURES
Nayera I. Attia and Heba S. Ali*
Institute of Postgraduate Childhood Studies (Medical Department), NICU and Biochemistry Department*, Faculty of Medicine Ain Shams University, Cairo, Egypt
Abstract
Abdominal sonography may be of great value in the evaluation and early detection of sequel of neonatal sepsis. A significant number of neonates develop clinical signs compatible with necrotizing enterocolitis, cholecystitis but with inconclusive plain radiographs, which may result in delayed, inappropriate or unnecessary therapy. Therefore, this prospective study is an attempt to assess the abdominal ultrasonographic abnormalities in neonatal sepsis, correlate it with the clinical findings and evaluate its impact on the early diagnosis of sequel of neonatal sepsis.
This study was conducted on 56 consecutive neonates (36 males and 20 females) with sepsis admitted to the NICU of the Obstetric and Gynecology Department, Ain Shams University Hospitals. Their mean gestational age was 34±4.5 weeks; their mean birth weight was 2.2±0.530kg. All patients were subjected to history taking, clinical evaluation, laboratory investigations and radiological evaluation, including plain chest and abdominal x-rays as well as abdominal ultrasonographic examination.
The study showed that 59% of patients had hepatomegaly, 25% had splenomegaly, and 7% had ascitis. Specific findings of necrotizing enterocolitis (NEC) were detected in 14 patients (25%), while gall bladder abnormalities per se were detected in 57% of septic patients. Mixed abdominal ultrasonographic findings were recorded in 20 cases (35.71%). Specific findings of NEC included pneumatosis intestinalis (17.9%), thickened intestinal wall (25%) and air in portal vein (7.14%). As regards gall bladder affection the following sonographic abnormalities were detected: thickened gall bladder wall (28.5%), biliary sludge / mud (17.9%), pneumobilia (7.14%) and hydrops (3.57%). Risk factors for developing NEC included sepsis, prematurity, total parentral nutrition (TPN), umbilical vein catheterization and birth asphyxia. The most frequent risk factors for gall bladder affection were sepsis, nothing per os (NPO), TPN, blood or blood products transfusion as well as mechanical ventilation.
In conclusion, NEC, gall bladder affection and hepatosplenomegaly are complications of neonatal sepsis in NICU and could be detected early by ultrasound examination prior to plain radiography. Abdominal ultrasound is a simple, quick, easy and cost effective method, therefore it is recommended to be used for the evaluation and follow up of septic infants in NICU.APOLIPOPROTEIN E EPSILON ALLELES IN RELATION TO SERUM LIPIDS, LIPOPROTEINS AND APOLIPOPROTEINS IN INFANTS OF DIABETIC MOTHERS
Ismail S Ismail*, Safaa S Imam*, Karim Y Shahin**, Helmy Motawa***, Ghada I Gad*, Hoda El Mahmody*,
*Pediatric, **Clinical pathology and ***Gynecology Departments, Faculty of Medicine, Ain Shams University.
Abstract
Objectives: To determine whether infants of diabetic mothers have altered lipoprotein metabolism, whether these alterations persist or regress after one month of life and whether these alterations are genetically determined through Apolipoprotein E genotypes.
Methods: The present study was performed in Ain Shams University, Neonatal Intensive Care Unit Children’s Hospital, and the follow up was done in the Newborn Clinic in the period from March 2002 to March 2003. The subjects were classified into the following groups: Group I: included 81 newborns of diabetic mothers (gestational or pregestational), 40 females and 41 males. Group II: included 76 full term healthy newborns to healthy mothers, 43 males and 33 females. They were subjected to: full history taking, thorough clinical examination, cord Serum lipid profile (total cholesterol, triglyceride, HDL-c, LDL-c, Serum ApoA1, and ApoB100) serum glucose level, and serum insulin level for IDM. Follow up of only 33 newborns of group I and 23 newborns of group II after 1 month for repeating lipid profiles. ApoE genotyping by PCR was performed for 20 hyperlipidemic newborns of diabetic mothers (those with more than 2 SD increase in lipid profiles in the follow up samples after one month).
Results: There was a significantly higher cord blood lipids, lipoproteins and apolipoproteins concentrations in the patients group compared to the control group. Both groups whether IDM and control group showed significant rise in lipid, lipoproteins and apolipoproteins levels at one month of life compared to their cord blood levels. But still there were significant higher levels in IDM group than the control group. Comparison between infants of gestational diabetic mothers and those of initially diabetic mothers as regard their lipid profiles at birth and at day 30 of life showed non significant difference. The frequency prevalence of ApoE alleles E2, E3 and E4 were 0, 75 and 25 % respectively with Apo E 3 being the commonest allele followed by E4. No significant difference was detected as regards allele frequencies between the studied patients. No significant difference was detected between IDMs with ApoE 4/3 genotype and those with ApoE 3/3 genotype as regard their lipid profiles whether at birth or after one month of life.
Conclusion: IDM had altered lipid metabolism at birth, some of which persisted after one month and might play a role in the pathogenesis of diabetes and
atherosclerosis in adulthood, however, these changes could not be related to ApoE genotyping as lipid metabolism is influenced by variety of environmental and physical factors.
Recommendations: Longitudinal studies with prolonged follow up of lipid profile in IDM are needed to determine whether hyperlipidemia persists or disappears later in life.Neurodevelopmental Assessment of Infants with Neonatal Subtle Seizures
El Metwally D*. Abdel Rahman A*. Sharkawi S*,*Pediatric Department. Faculty of Medicine. Suez Canal University.
Abstract
Objectives: 1) - Neurodevelopmental outcome assessment among preterm infants with subtle seizures (SSz). 2) –Comparison of NDO among preterm infants with SSz and No Sz (No Sz). Detection of Factors associated with poor NDO.
Methods: A prospective analytic study of 44 preterm: 22 with history of subtle SSz in their neonatal period, and developed no other type of Sz. compared to 22 control No Sz. Neurodevelopmental assessment was conducted at 9-12 months corrected age, using neurological exam and CAT-CLAMS scale, abnormal developmental quotient (DQ) was defined as DQ< 70. Multiple regression analysis was run to detect factors associated with unfavorable outcome.
Results: Abnormal/suspect neurological examination occurred among 81.8% of the SSz infants compared to 50% among the control preterm infants (No Sz), p<.026. Mean CAT-DQ among the SSz infants was 67.7±9.8 compared to 76.1±8.4 among the No Sz, p< .004. Mean CLAM-DQ among the SSz infants was 64.4±11.2 compared to 75±9.2 among the No Sz, p< .001. Multiple regression analysis revealed that subtle seizures were significantly associated with abnormal neuro-exam and CAT/CLAMS-DQ< 70,(OR:2.62,CI:[1.25-6.87]), p<.031 and (OR:5.71,CI:[1.56-20.92]) p< .008/(OR:3.75,CI:[1.07-13.07]) p<.038 respectively, Sepsis was significantly associated with abnormal neuro-exam and CAT-DQ< 70. There was also a significant inverse relationship between birth weight and CAT/CLAMS-DQ< 70.
Conclusion: Subtle seizures are associates with delayed neurodevelopment in the first year. Subtle seizures, low birth weight and sepsis are the main determinants of poor outcome. Further follow-up of this cohort is recommended.Serum Arginine and Glutamine concentrations in neonates with Necrotizing Enterocolitis
Mohamed M Farid, Safaa S Shafik, Ahmed M Abd El Tawab*, Neshwa Fathy
Pediatric and Pharmacology*departments, Faculty of Medicine, Ain Shams University
Abstract
Objectives: TO determine if glutamine and arginine, which are essential for intestinal integrity, are deficient in infants developing necrotizing enterocolitis (NEC). Methods:This study was conducted on 44 preterm newborns (= 35 weeks of gestation). The patients group comprised 17 infants who developed NEC between postnatal days 3 and 11. According to Bell’s staging criteria , the patients were subdivided into 3 subgroups: 6 at stage I (suggestive), 8 at stage II (definitive), 3 at stage III (advanced). The remaining 27 newborns served as a control group and consisted of neonates without detectable signs of NEC by day 11. Serum arginine (ARG) and glutamine (GLN) levels were measured by high pressure liquid chromatography (HPLC) of samples obtained on postnatal days 3 and 11. Results: Significantly lower levels of serum ARG and GLN were encountered on day 11 compared with day 3 in the patient group (P<0.05).There was no significant difference in both amino acids levels between the NEC group compared with the control group. Serum ARG and GLN correlated positively with gestational age in the control group (rho=0.48 P<0.05 for ARG and 0.41 P<0.05 for GLN). There was a significant positive correlation between ARG and GLN serum levels (rho=0.772, 0.645, 0.743 P<0.05 for ARG and rho=0.642, 0.772, 0.605 P<0.05 for GLN). The results revealed also that ARG and GLN significantly decreased on day 11 compared to day 3 at stage II and but was statistically comparable at stage I and did not reach significance at stage III. Conclusion: In conclusion, the diminished concentration of serum ARG and GLN in preterms with NEC may play an important role in the pathogenesis of the disease. Recommendations: Further studies on the efficacy and safety of higher doses of parenteral ARG and GLN are needed to be studied in premature infants. A trial investigating the benefits and risks of selective amino acid supplementation in the prevention of NEC is needed.
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