Correlation between early neonatal diet and atopic symptoms up to 5-7 years of age in very low birth weight infants: follow-up of randomized, double-blind study

The influence of early feeding on the risk of atopic diseases has been studied in full-term newborns, not in very low birth weight infants (VLBW). The study evaluated effect of early feeding of VLBW infants with either cow's milk-based formula (CMF) or extensively hydrolyzed milk formula (HF) on incidence of atopic diseases and markers of atopy at 5-7 years of age. This was a follow-up of the randomized, double-blind study evaluating the influence of different enteral feeding protocols on the early morbidity of VLBW infants. In the original study 80 children were randomly allocated into 2 groups receiving during first month of life HF (experimental group) or CMF (control group). At the age of 5-7 years, 62 children among 74 available (84%) with mean birthweight 1124g were evaluated according to standardized ISAAC (International Study of Asthma and Allergies in Childhood) protocol. Total IgE level, specific IgE, lymphocyte CD4+CCR4+/CD4+CXCR3+ ratio and skin prick tests (SPT) were done. Prevalence of obvious allergic diseases was not significantly different between the studied groups (HF: 12/33; CMF: 6/29; RR [relative risk] HF vs CMF: 1.76; 95%CI [confidence interval]: 0.76-4.09). Comparison of atopic status across groups revealed similar rate of positive markers of atopy: IgE (RR: 2.57 95%CI: 0.91-8,08), SPT (RR: 5.13; 95%CI: 0.93-31.6), lymphocyte CD4+CCR4+/CD4+CXCR3+ ratio (OR: 2.32; 95%CI: 0.78-7.53) in the both studied groups. Based on the carried out follow-up study we were unable to confirm the usefulness of hydrolyzed formula in prevention of allergy in an unselected cohort of very low birth weight infants.

Additional genetic risk factor for death in children with acute lymphoblastic leukemia: a common polymorphism of the MTHFR gene

BACKGROUND

The presence of metabolically important genetic polymorphisms may affect treatment efficacy in patients with malignancies. The objective of this prospective multicenter study was to evaluate the role of selected polymorphisms of genes associated with metabolism of chemotherapeutic drugs as prognostic markers in children with acute lymphoblastic leukemia.

PROCEDURE

Genotyping for the presence of 7 genetic variants in 403 patients and analysis of death cases were performed.

RESULTS

Thirty-one children died before reaching remission maintenance phase. Genetic analysis revealed in this group increased frequency of homozygosity for c.677C>T polymorphism of the MTHFR gene (26% vs. 8% in the survivors; OR 4.09; 95% CI 1.67-10; adjusted for multiple testing P = 0.028).

CONCLUSION

Our data suggest that modification of anti-leukemic treatment should be considered in patients homozygous for c.677C>T polymorphism.

[Health status at the age of 5-7 years of preterm infants with and without bronchopulmonary dysplasia]

BACKGROUND AND AIM

Bronchopulmonary dysplasia (BPD) is one of the most common late complications of prematurity. The study aimed to evaluate: 1) somatic development, 2) psychomotor development, 3) parental opinion of health status of the child and 4) prevalence of bronchial hyperreactivity among 5-7 years old children with history of BPD.

METHODS

Case-control study included 56 newborns born < or =32 weeks of gestation with mean birthweight (SD) 1057+/-218g. BPD was defined as at least 28 days of oxygen therapy and oxygen or positive pressure support at 36 weeks postmenstrual age. The control group consisted of newborns matched by sex, birthweight (+/-100g), gestational age (+/-1 weeks) and year of hospitalization. Somatic and psychomotor developments were prospectively evaluated up to age of 5-7 years. Parents were asked to complete two questionnaires: one assessing normal daily activity of the child and the standardized questionnaire used by International Study of Asthma and Allergies In Childhood (ISAAC). Peak expiratory flow rates (PEFR) before and after the inhalation of betamimetic were evaluated.

RESULTS

No significant difference in somatic development was found between the study group and the control group. Normal psychomotor development was diagnosed in 11 (39%) children with BPD and in 13(46%) children without BPD. Mild or moderate impairment was diagnosed in 12 (43%) cases and 13 (36%) controls, and severe impairment in 5 (18%) and 2 (7%) children. At the age of 5-7 years children with BPD presented lower IQ as compared to children without BPD (94+/-25 vs. 103+/-16, p= 0.2). Parents of children with BPD more often declared that their child's development is impaired (39% vs. 11%, OR: 4.96; 95%CI: 1.2-20). Wheezing in past history was noted in 18 cases (64%) and only in 10 (35%) children without BPD (OR: 3.24; 95% CI: 1.09-9.67). Mean PEFR did not differ significantly between the studied groups (80.5+/-16.3% vs 84.5+/-15.4%; p=0.4). Moreover, changes of PEFR after a dose of betamimetic were similar in both groups (21% vs. 19%, p=0.7).

CONCLUSION

The intellectual development of children with BPD at the age of 5-7 is worse than in the control group, especially as declared by their parents. Episodes of wheezing in infancy occurred more frequently in the group of children with BPD. However, bronchial hyperreactivity at the age of 5-7 is not significantly more frequent.

[Respiratory syncytial virus prophylaxis among preterm infants--four seasons' experience]

BACKGROUND

Respiratory syncitial virus (RSV) is the main reason of hospitalizations due to respiratory tract infection in children within the first year of life. The course of infection is more severe in children from a risk group, which includes children who were born preterm, these with bronchopulmonary dysplasia (BPD), children with heart defects significantly influencing their hemodynamics, and immunocompromised children. Palivizumab is a humanized monoclonal antibody class IgG-1 used to prevent RSV infection.

AIM

To assess the results of treatment and to evaluate factors influencing the efficacy of RSV infection prophylaxis in preterm newborns.

METHODS

The study included 55 preterm newborns (mean birth weight-970g, mean gestational age-27 weeks), who were given a dose of palmivizumab of 15mg per kg body weight every four weeks in autumn and winter from season 2004/ 2005 to season 2007/2008.

RESULTS

Ten children (18%) required hospitalization between the doses and within 28 days after the last dose of palmivizumab. Among these, 2 children (3.6%) were hospitalized because of very severe RSV infection. Eight children (16%) were hospitalized due to respiratory tract infection within 12 months after completing the prophylaxis; none of them was infected with RSV. The episodes of respiratory tract infection between the doses and within 28 days after the last dose occurred in 19 children (31%), and in 26 patients included in the follow-up (51%) within 12 months after completing the prophylaxis. The effect of treatment was most beneficial in preterm neonates with extremely low birth weight and in children who did not require respiratory medications at the moment of discharge from the neonatal unit.

CONCLUSION

RSV infection prophylaxis is of most benefit in children born with extremely low birth weight. In this group of children the prophylaxis should be considered both for children suffering from BPD and in children free of this disease.

[Prevalence and risk factors of bronchopulmonary dysplasia among extremely low birth weight newborns of regional birth cohort of south-east Poland]

BACKGROUND

Advances in intensive health care within the last 30 years have resulted in increased survival of most immature neonates. The results of epidemiological studies indicate, however, that late complications of prematurity, including bronchopulmonary dysplasia (BPD), have become more frequent since the late 1990s. The identification of risk factors predisposing to severe BPD might help in developing treatment methods directed at the group of children with high risk of developing the disease.

AIM

Analysis of prevalence and risk factors of bronchopulmonary dysplasia among extremely low birth weight newborns of regional birth cohort of south-east Poland.

METHODS

The study included newborns of birth weight < or = 1000g born in south-east district of Poland within one calendar year. The data assessed were: the need of oxygen therapy of at least 28 days' duration and the need of oxygen therapy at 36 weeks of postmenstrual age (PMA).

RESULTS

During the study period 109 newborns with birth weight < or = 1000g) were hospitalized in three third-level departments of neonatology in south-east Poland. The final assessment for BPD included 56 children (51%), whose mean birth weight was 839g (SD: 128) and mean gestational age was 27.3 weeks (SD: 2.2). Thirty-nine children (70%) required oxygen therapy for at least 28 days, and 27 children (48%) required oxygen therapy at 36 weeks of PMA. Gestational age of the newborn, the need of respiratory support at birth, and the need of surgical treatment of PDA were found to be independent risk factors of oxygen therapy lasting for at least 28 days. Only the need of respiratory support at 7 days of life and the need for surgical treatment of PDA were found to be independent risk factors of oxygen therapy at the 36 weeks of PMA.

CONCLUSION

The analysis of several risk factors of BPD in children with birth weight < or =1000g revealed that the need for respiratory support at seven days of life is a major risk factor of developing chronic respiratory disease. The risk of BPD may be significantly reduced by adequate care aimed at shortening the time of conventional respiratory support and at limiting the persistence of ductus arteriosus.

Can early echocardiographic findings predict patent ductus arteriosus?

BACKGROUND

Prophylactic treatment with prostaglandin synthetase inhibitors (PSI) is potentially harmful. Moreover, long-term benefits of prophylactic use of indomethacin or ibuprofen are not proven. Early treatment of a high-risk population is alternative to the routine prophylactic use of PSI, but it remains unclear which newborn is at greatest risk for patent ductus arteriosus (PDA).

OBJECTIVE

Evaluation of the prognostic value of early echocardiographic studies with respect to PDA in later life.

METHODS

Sixty preterm infants with a mean birth weight of 1,087 g and mean gestational age of 28.5 weeks were included in a prospective study. Cardiac scans were performed in all newborns on entry into the study (within 12-48 h after birth) and further in case of clinical suspicion of PDA or obligatorily on the 7th and 28th days of life. There was no prophylactic or treatment use of any PSI during the study period. Newborns were divided into 2 cohorts: with significant left to right shunt requiring surgical ligation of PDA (n = 16) or without significant PDA during follow-up (control group, n = 44).

RESULTS

On entry, the mean internal diameter of the ductus arteriosus (2.6 vs. 0.91 mm/kg; p < 0.01), mean cardiac index across aortic valve (2.96 vs. 2.37 l/min/m(2); p < 0.01) and early filling peak velocity (43.1 vs. 33.7; p = 0.01) were significantly higher in babies who later needed surgical ligation of PDA. There was no difference in the mean values of the other echocardiographic parameters studied. An early ductal diameter of >1.5 mm/kg predicted symptomatic PDA with a sensitivity of 94% and a specificity of 73%, and its positive predictive value equaled 57% and negative predictive value amounted to 97%.

CONCLUSIONS

Early echocardiographic studies possess negative predictive value and may decrease unnecessary surgical ligation of PDA in very low birth weight infants.

Genetic risk factors of bronchopulmonary dysplasia

The aim of the study was to assess the association between bronchopulmonary dysplasia (BPD) and polymorphisms of genes coding for vascular endothelial growth factor (VEGF), transforming growth factor (TGF-[beta]1), insulin-like growth factor (IGF-1), and 5,10-methylenetetrahydrofolate reductase (MTHFR). A sample of 181 newborns with mean gestational age of 28 wk was prospectively evaluated. Molecular analysis of TGF-[beta]1 -800G>A, -509C>T, 10T>C, 25G>C, VEGF -460T>C and 405G>C and MTHFR 677C>T polymorphisms were performed and the number of CA repeats in the promoter region of IGF-1 gene was assessed. The frequency of all TGF-[beta]1, IGF-1, and MTHFR polymorphisms, as well as the frequency of VEGF 405G>C polymorphism was similar in all groups. The newborns with -460TT and -460CT genotypes were significantly overrepresented in the BPD groups compared with the no BPD group. Multivariate analysis revealed that carrying T allele increased the risk of BPD by 9% (95%CI: 2-14%) above the baseline risk established for given gestational age, length of oxygen therapy, and sex. Based on our data from a single center, we propose that VEGF -460T>C polymorphism may influence the risk of BPD.

Association between X-linked lissencephaly with ambiguous genitalia syndrome and lenticulostriate vasculopathy in neonate

X-linked lissencephaly with ambiguous genitalia syndrome (XLAG) (OMIM #3000215) is a rare, severe malformation of the brain cortex with abnormal neuronal migration caused by mutations of the ARX gene. All the reported patients with lissencephaly are males who presented with a posterior-to-anterior gradient, moderately increased thickness of the brain cortex, agenesis of corpus callosum, micropenis, and cryptorchidism. We describe the neurosonographic findings associated with the XLAG syndrome. To our knowledge, the association between XLAG and lenticulostriate vasculopathy has not been reported before.

[Wheezing in very low birth weight infants: sequence of early neonatal lung injury or increased susceptibility for allergic reactions? Follow-up study up to age of 5-7 years]

BACKGROUND

Prevalence of wheezing during infancy and pre-school age among very low birth weight (VLBW) infants is high. There is too little data to determine exactly the cause of wheezing in this group of children--it may result from early neonatal lung injury or increased susceptibility for allergic reactions.

AIM

Analysis of wheezing episodes up to 5-7 years of age in a group of VLBW infants and recognition of risk factors.

METHODS

A sample of 104 children aged 5-7 years with birth weight < or = 1500g was prospectively evaluated. The standardized ISAAC (International Study of Asthma and Allergies in Childhood) protocol was used to evaluate the number and quality of wheezing episodes. Total IgE level, specific IgE, lymphocyte Th1/Th2 ratio and skin prick tests (SPT) were performed. Children were divided into 3 groups: without wheezing, with episodes of wheezing in the history (more than 12 months previously), and with persistent episodes of wheezing.

RESULTS

Episodes of wheezing were diagnosed in 52 (50%) cases: 27% of children showed signs of wheezing during 12 previous months and 23% of children reported wheezing only in their past history. Children with persistent wheezing presented more frequently than other groups: positive family history for atopy, allergic rhinitis, and positive allergic laboratory markers. Children with wheezing only during early infancy had bronchopulmonary dysplasia and more severe respiratory distress syndrome after birth.

CONCLUSION

Prevalence of wheezing during infancy and preschool age among VLBW infants is high. Chronic and recurrent episodes of wheezing are more directly related to atopy than derive from neonatal problems.

[Body mass index (BMI) or bioimpedance analysis (BIA) --which method enables a better assessment of fat mass in children?]

A comparison of accuracy between electrical bioimpedance analysis (BIA) and body mass index (BMI) for fat mass evaluation in children was the aim of the study. One-hundred and ninety three healthy children (90 females, 103 males) were enrolled. The mean age of the studied population was 11.8 years (+/- 2.2), mean weight equalled to 42.6 (+/- 12.8) kg and mean height-151.1 (+/- 13.5) cm. BIA measurments were performed by multifrequency (1; 5; 50; 100 kHz) BIA 2000M analyzer using BIANOSTIC electrods. Calculations of free fat mass and fat mass were performed using Nutri 4 Data Input Software (Germany). The LMS method for percentile charts of FFM and FM acording to height has been applied and results for boys and girls were drawn separatelly. Percentile charts of FM and BMI were compared. Different shape of curves of FM content and BMI for boys during puberty was noticed. BIA allows for precise fat mass content evaluation in children and its use should be disseminated.

[Somatic and psychomotor development of preterm infants at the age of 2 years, with and without bronchopulmonary dysplasia]

OBJECTIVE

The assessment of psychomotor and somatic development at the age of 2 years of preterm infants with and without bronchopulmonary dysplasia (BPD).

DESIGN

Case -- control study.

SETTING

Neonatal Intensive Care Unit, University Hospital.

MATERIAL AND METHODS

62 preterm infants born before 32 weeks of gestation, with mean birth weight equaled to 1112 g were included into 2 groups: group A -- with BPD (n=31), group B (control) -- matched by sex, birth weight, gestational age (n=31).

INTERVENTIONS

Evaluation of reaching milestones, neurological examination at 3, 9, 12, 18-24 months, Psyche-Cattel tests at 12 and 24 months, hearing and visions examinations, head, chest circumference, length and weight at 3, 6, 9, 12 and 24 months.

MAIN OUTCOME MEASURES

Age of unsupported sitting and walking, intelligence quotient (IQ), cerebral palsy, hearing and sight impairment.

RESULTS

Reaching motor milestones were similar in the both groups (unsupported sitting (mean) 10.4 vs. 8.7 months, unsupported walking: 15.1 vs. 13.9 months). Cerebral palsy occurred more (non-significantly) frequently in group A than in group B (7/31 vs. 2/31, p=0.15). Significantly lower IQ was found in group A at the age of 1 year in comparison with group B (x +/- SEM: 79.9 +/- 2.1 vs. 86.1 +/- 1.5, p=0.03) and at the age of 2 years (x +/- SEM: 89.2 +/- 2.7 vs. 96.0 +/- 2.1, p=0.06). Weight, length, head and chest circumferences at the term of delivery were similar in the both groups, but at the age of 9 and 24 months the group A children weighted less than group B (respectively: 7432 vs. 8128 g, 10010 vs. 11116; p<0.05) and at the age of 24 months were significantly shorter (816 vs. 848 mm, p=0.04).

CONCLUSIONS

Bronchopulmonary dysplasia significantly influences intellectual and somatic development of preterm newborns.

[Developmental dysplasia of the hip: the problems in the diagnosis process in our own experience]

BACKGROUND

The diagnosis and prophylaxis of developmental dysplasia of the hip (DDH) is still controversial. In particular the role of the clinical examination and US scan of the hip is discussed in the medical literature.

AIM

The aim of the study is to present our experience with diagnostic problems in DDH, and especially to present the value of the clinical examination in diagnosing patients with DDH requiring orthopedic treatment.

MATERIAL AND METHODS

During 36 months clinical and ultrasonographic examination with Graf's method was performed in 972 infants (1944 hips, 511 girls, 461 boys) at the mean age of 9 weeks. The sensitivity, specificity, positive and negative predictive values (PPV, NPV) of clinical examination of the hip in the diagnosis of DDH requiring orthopedic treatment were assessed.

RESULTS

The diagnosis of pathologic dysplasia according to Graf's criteria was made in 5.7% of patients. More than half of them (3.5% of all investigated group) had no obvious clinical signs of dysplasia, even among children with most advanced dysplasia (0.25% of the cohort). Sensitivity of the clinical examination in detecting patients with DDH requiring treatment was 46%, specificity -- 92%, PPV -- 28%, NPV -- 96%.

CONCLUSIONS

Clinical examination alone has little value in DDH diagnosis and screening. Large percentage of treated DDH had no obvious pathologic signs in clinical examination -- were clinically 'silent'. We postulate performing US scan screening in all infants with positive risk factors and positive for DDH clinical examination up to the 6th week of life. In all other children US scan of the hips should be advised up to the end of 12th week of life.

[Congenital brain tumor in neonate--case report and review of literature]

The paper describes a case of prenatally diagnosed congenital brain tumor of an extremely rare histological type--oligodendrocytoma. The intrauterine ultrasound scans were interpreted as intracranial hemorrhage. The initial physical examination of the newborn revealed symptoms of mild increase of intracranial pressure. The diagnosis of brain tumor was based on computed tomography of the head performed on the 4th day of life. The tumor was totally (as histological and radiological test indicated) removed on the 9th day of life. At the age of 2 months, relapse of tumor was diagnosed. Reoperation and subsequent chemiotheraphy were introduced. At present, the child is 9 months old and no neurological impairment is visible. The discussion presents data on congenital brain tumor epidemiology and differences in location, histology and outcome between neonates and older children. Moreover, recent surgical and medical management is described.

[Intracranial hemorrhage in term newborn]

BACKGROUND

The improvements in perinatal care during last decade have changed clinical presentation of intracranial hemorrhage (ICH) among full-term newborns. New imaging techniques allow for diagnosis of ICH even in asymptomatic babies.

AIM

Analysis of prevalence and risk factors of ICH among full-term newborns requiring intensive care.

MATERIAL AND METHOD

397 full-term newborns hospitalized in tertiary Neonatal Intensive Care Unit were analyzed. Detailed neurological evaluation, head ultrasound and/or cerebrospinal fluid were done.

RESULTS

ICH was diagnosed in 40 newborns. The most common clinical presentation was subarachnoid hemorrhage (n = 24). Multifocal bleeding was more frequent (28/40) than bleeding only to one brain compartment (12/40). In the first week of life bleeding to different compartments was observed, but in the 2nd week of life there was no bleeding to posterior fossa. Eleven newborns died due to ICH (parenchymal and subarachnoid ICH). Significant, independent ICH risk factors were: delivery complications (OR: 10.4: 95% CI: 3.7-29.6), scull bone fractures (OR: 44.4: 95% CI: 4-495), nuchal cord (OR: 6.4: 95% CI: 2.2-18.8), hemorrhagic diathesis (OR: 4.5: 95% CI: 1.2-17.5).

CONCLUSIONS

Significant risk factors of ICH among full-term newborns requiring intensive care are: mechanical (scull bone fractures, labor complications) trauma, nuchal cord, hemorrhagic diathesis. In such cases the detailed neurological evaluation and imaging techniques should be used to exclude bleeding. Multifocal bleeding is the most common form of ICH. Because subarachnoid and subdural space are not easy visible by head ultrasound, the CT or MRI scans are recommended in babies with ICH.

[The role of videoelectroencephalography in diagnostics of seizures in neonates and infants]

OBJECTIVES

The clinical characteristic of attack is frequently difficult to unequivocal establishment by observation. It refers especially to seizures in youngest children, due to complicated attack morphology. VideoEEG as a diagnostic tool makes possible more precise establishment of seizures type and derivation.

THE AIM

The aim of this analysis was to establish an importance of videoEEG for the differentiation of epileptic and non-epileptic attacks in neonates and youngest infants.

MATERIALS

20 children, 10 girls and 10 boys from the Neurological Division, the Neonatal Intensive Care Unit, the Intensive Care Unit, and the Division of Cardiology, admitted for examination between the 2000 and 2004 years in the Lab of Clinical Electrophysiology of the Department of Pediatric Neurology were included. The age of children, including 7 neonates, was at the moment of examination between 3 and 10 weeks. The first attack occurred between the first day of life and 7th week. In 15/20 of children features of encephalopathy were present.

METHODS

The videoEEG recordings were provided in identical conditions, including place and personnel as well, using apparatus PL. 270 video option MedtronicDantec and camera Samsung with movable focus. The visual analysis was provided by two licensed in electrophysiology physicians and results were averaged.

RESULTS

In 15/20 children clinical attacks were registered, including stereotypical seizures in 7 children and polimorphic seizures in 8 children. The most frequent attacks were apneic (11/ 20) and the registered seizures were generalised tonic (6/20) and focal (5/ 20). In 5 children attacks were not registered during examinations. In 2 children of this group the bioelectrical activity was also unchanged, whereas in 3 children the significant pathology was detected. Among 15 children with registered in videoEEG attacks, in 9 children ictal discharges were recorded, in 2 children burst-suppression discharges and in the remaining 4 children ictal changes of bioelectrical activity were not recorded. Interictal activity similar to ictal was detected in 2 children with burst-suppression discharges only, and in other cases it was differentiated. 2 of 4 children without discharges during attacks had also normal interictal activity, whereas in the remaining 2 children the immature low voltage flat activity was recorded. Among 9 children with ictal discharges, in 5 children interictal discharges were detected as well, whereas in 2 children only low-voltage activity with pathological features of sleep was detected, but in 2 children interictal activity was normal. The results of videoEEG and other tests allowed to recognized nn epileptic attacks in 5 children, probably epileptic in 1, epileptic seizures in 8 and epilepsy with genetic and hypoxic-ischaemic disorders in 6 children.

CONCLUSION

The videoEEG allowed to register clinical seizures in the majority of youngest children with paroxysmal events, contributing to the diagnosis of tonic and polimorphic seizures and to the correct classification of apnoea. In 25% of children with and without registered clinical attacks, this examination allowed to diagnose non-epileptic attacks. To establish epilepsy, the ictal changes of bioelectrical activity were important and interictal as well.

[Proinflammatory cytokines in children with idiopathic headache]

OBJECTIVES

The pathogenesis of primary headaches is differential, with a neurogenic inflammation participation.

THE AIM

The aim of this research was to establish whether inflammation participates in the pathogenesis of migraine and tension-type headaches (ETTH). In order to establish this, the levels of interleukin-6 (IL-6), interleukin-1 beta (IL-1beta), tumor necrosis factor (TNF) and soluble TNF receptor type I (sTNFRI) were detected in groups with headaches during headache-free interval and in controls and in the blood of children with idiopathic headaches to detect changes during headache attack.

MATERIAL AND METHODS

30 children with migraine were included (16 with aura and 14 without aura), 17 boys and 13 girls aged 10-17 years (mean 13.5). The group with ETTH consisted of 31 patients, 24 girls and 7 boys, aged 6-17 years (mean 13.5). The control group, 28 children without headache, diagnosed with non-inflammatory orthopedic diseases, consisted of 15 boys and 13 girls, aged 7-17 years (mean 13.0). When the pain started during hospitalization, the blood was sampled in the first hour of the headache, then 3 hours and 6 hours since headache started (if headache persisted), and 6 hours after its termination. Two days after the pain termination, the blood samples were collected in children suffering from headaches, as the headache-free measurements and in controls under the same conditions at 7 a.m. after awakening. The cytokine level was established using Biosource kits, all 326 samples were processed. The statistical assessment was conducted.

RESULTS

No differences were detected in cytokine levels between the groups with migraine and ETTH and with comparison to controls during headache-free interval and during headache attack as well. However, it was established that in 12/30 children with migraine there was a significant increase in IL-6 level in the first hour of the migraine attack. This group consisted of 12 children with TNF level higher and the tendency toward decrease in sTNFRI was established, 3 hours since headache started, as compared to 18/30 children with migraine but without increase in IL-6. The correlation between the level of cytokines and age and weight was not detected. Also no correlation was established between cytokine levels and leukocyte and thrombocyte count.

CONCLUSION

1. Changes of the level of IL-6, IL-1beta, TNF and sTNFRI in the blood of children with idiopathic headache do not indicate a significant role of inflammatory process in its pathogenesis. 2. Although the significant increase in IL-6 levels observed in several children in the first hour of the migraine attack may suggest that neurogenic inflammation participates in the pathogenesis of migraine.

[Psychomotor development at the age of 5-7 years of very low birth weight infants]

BACKGROUND

Very low birth weight (VLBW) infants are at greater risk for neurodevelopmental delay, cerebral palsy (CP), vision and hearing impairment, and cognitive and emotional problems. The aim of the study was assessment of neurodevelopmental outcomes at the age of 5-7 years among VLBW infants and evaluation of prognostic value of selected perinatal risk factors.

MATERIAL AND METHODS

A sample of 73 VLBW infants with mean birtweight 1075g and mean gestational age 28.9 weeks were evaluated. Infants were divided into 3 groups: (A) normal development (n = 35; 48%), (B) mild-to-moderate impairment (IQ 68-83, or mild to moderate hearing loss or visual problems, or mild/moderate CP or ADHD) (n = 25; 36%) and (C) severe impairment (IQ < 68, deafness, blindness or severe CP) (n = 13; 18%)

RESULTS

The studied groups differ in respect to: gestational age (mean +/- SEM: 29.7 +/- 2.3 vs 28.1 +/- 2.5 vs 28.5 +/- 2.3 wks; p = 0.03), prevalence of retinopathy (ROP) (17 vs 28 vs 69%; p < 0.01), bronchopulmonary dysplasia (BPD) (31 vs 17 vs 62%; p = 0.03) and periventricular leukomalacia (PVL) (3 vs 0 vs 23%; p < 0.02). Maximum bilirubin concentration was higher in children with severe impairment (mean +/- SEM: 177 +/- 60 vs 193 +/- 45 vs 229 +/- 48 micromol/l; p < 0.05). On multivariate logistic regression analysis, factors associated with developmental impairment were serum bilirubin > or = 200 micromol/ I and ROP.

CONCLUSIONS

The significant risk factors of poor neuro-developmental outcomes at the age of 5-7 years among VLBW infants are: gestational age, PVL, ROP, BPD and serum bilirubin concentration > 200 micromol/I.

[Diagnostic and prognostic reliability of interleukin-10 measurements in very low birth weight infants with late-onset sepsis]

BACKGROUND

There exists little data on releasing Interleukin-10 (IL-10) and on the clinical usefulness of its measurements in very low birth weight (VLBW) infants.

AIM

The evaluation of diagnostic and prognostic reliability of IL-10 measurement in VLBW infants with sepsis.

METHODS

87 newborns with the median birth weight (BW) 1060 g and median gestational age (GA) 28 wks were divided into 3 groups: A) with no clinical signs of sepsis in the first month of life-control group (n = 28), B) with clinical signs of sepsis but with negative blood cultures (n = 13), and C) with clinically and microbiologically confirmed sepsis (n = 46). In the control group IL-10 was measured on admission and in the 10th, 20th and 30th day of life. The remaining newborns had IL-10 measured when sepsis was suspected.

RESULTS

IL-10 levels did not correlate with GA (R = -0.01) or BW (R = -0.04). In the control group there was no correlation between IL-10 levels and the calendar age. IL-10 levels were statistically higher in the group C than in the remaining ones (Me: 0 vs 1.32 vs 99.8 pg/ml). IL-10 level > 20 pg/ml allowed to distinguish between the group B and C with 79% sensitivity and 82% specificity. The highest levels of IL-10 were detected in the newborns who died of sepsis (Me = 889 pg/ml). IL-10 level > 680 pg/ml predicted the death of a newborn with 80% sensitivity and 100% specificity.

CONCLUSIONS

IL-10 measurements possess a great diagnostic and prognostic reliability and allow the detection of newborns with poor outcome, thus the measurement of IL-10 may be useful in clinical practice.

[Influence of the lactose free and lactose containing diet on prevalence of gram-negative sepsis and feeding intolerance in very low birth weight infants: double-blind randomized trial]

OBJECTIVE

VLBW infants have a developmental lactase deficiency in the gut. The aim of the study was to evaluate the influence of lactose containing and lactose free diets on prevalence of feeding intolerance and Gram negative sepsis in VLBW infants.

METHODS

80 newborns with mean (+/- SEM) birth weight 1091 +/- 25 g and gestational age 28.5 +/- 0.24 wks were randomized into 2 groups fed during 1st month of life with 1) formula containing lactose (Bebilon Nenatal--BN group; n = 40) or 2) lactose free formula (Pregestimil--PG group; n = 40). The end points of the study were: feeding intolerance episodes, Gram negative sepsis, weight gain and the length of parenteral nutrition.

RESULTS

The birthweight (1112 vs 1114 g), gestational age (28.8 vs 28.3 wks), 5th min. Apgar score (5 vs 6 pts), sex (52% vs 55% male), type of delivery (65 vs 58% vaginal delivery) did not differ between the groups. Thirty (75%) newborns of the BN group and 31 (77.5%) newborns of the PG group completed the study (RR = 1.11; 95% CI: 0.54-2.44). The prevalence of Gram negative sepsis were similar in both groups (2/40 vs. 3/40; RR = 0.67; 95% CI: 0.12-3.78). Also a comparable number of children had at least one episode of feeding intolerance (14/40 vs. 12/40; RR = 1.17; 95% CI: 0.69-2.20) The weight gain (11.7 vs 10.9 g/day) and the length of parenteral nutrition did not differ between the groups (16 vs 15 days).

CONCLUSION

The inclusion of lactose into feeding formula does not influence feeding tolerance in VLBW infants.

[Risk factors of retinopathy of prematurity in newborns treated in neonatal intensive care unit of University Children's Hospital Collegium Medicum Jagiellonian University]

BACKGROUND

A persistent progress in perinatal care and a large increase in infants' survival rate have been observed recently. As a result, the number of neonates requiring ophthalmologic examinations due to retinopathy of prematurity (ROP) increased as well.

METHOD

A retrospective survey including 206 neonates with mean birth weight 1342 g and mean gestational age 30 weeks.

MATERIAL

Three groups: 1) without ROP--165 infants (80.1%); 2) with ROP not requiring treatment--13 infants (6.3%); 3) with prethreshold and threshold ROP requiring cryotherapy--28 infants (13.6%) were analysed.

RESULTS

Threshold ROP was not observed in infants with gestational age > 32 weeks and/or birth weight > 1500 g. Cryotherapy was applied between the 6th and 18th weeks of life (Mo: 12). The procedure was applied at postmenstrual age between the 34th and 45th weeks of life (Mo: 38). The correlation of ROP with the following factors was observed: length of mechanical ventilation (Me in the studied groups: 6; 22; 33 days respectively; p < 0.01), length of oxygen therapy (Me: 27; 58; 70 days; p < 0.01), number of blood transfusions in first month of life (Me: 2; 4; 4; p < 0.01), minimum pO2 (average: 37.2; 30.2; 29.2 mmHg p < 0.01), pO2 oscillation (measured as SD) (Me: 10.25; 13.2; 15.4 mmHg p < 0.016) and maximal pCO2 (average: 52.5; 56.8; 66.5 p < 0.01) between the 2nd and 4th weeks of life.

CONCLUSION

Monitoring of pO2 and pCO2 in infants in the 1st month of life reduce the risk of ROP development. Infants born before the 32nd week of gestational age belong to high risk group and require very systematic ophthalmologic examination. The current prophylactic examination schedule for ROP for more mature infants may be changed.

[Postnatal growth of very low birth weight infants. Anthropometry at two year of age: a longitudinal study]

BACKGROUND

The growth rate is an important indicator of the child's health state. Premature newborns require an especially exact and reliable assessment of their growth which should include, above all, their maturity.

AIM

The evaluation of the influence of newborn's maturity on its growth rate during 2 first years of life.

MATERIAL AND METHODS

Prospective, longitudinal cohort study. 159 newborns born < or = 32 weeks of gestation discharged from 3rd level NICU were divided into 2 cohorts: A) born between 24-28 weeks (n = 83) and B) born between 29-32 weeks (n = 76). Before discharge and then every month in the 1st year of life and every 3 months in the 2nd year of life weight, length, head circumference and chest circumference were measured.

RESULTS

Median length in 6th month was 622 mm in group A and 650 mm in group B (p < 0.05), after 1 year 720 mm vs 745 mm (p < 0.05), and after 2 years 819 mm vs 853 mm (p < 0.05). Median weight was 6010 vs 7160 g (p < 0.05), 8210 vs 9410 g and 9965 vs 11,260 g (p < 0.05), median chest circumference 40 vs 42 cm (p < 0.05), 44 vs 46 cm (p < 0.05) and 46 vs 47.5 cm (p < 0.05) and median head circumference 42 vs 43 cm (p < 0.05), 45 vs 46 cm (p < 0.05) i 47 vs 48 cm (p = 0.06). The results were also presented as growth charts.

CONCLUSIONS

The newborns born between 29-32 week of gestation have faster growth rate than newborns born between 24-28 week of gestation. The assessment of development of extremely premature newborns should be based on growth charts prepared separately for a given gestational age.

[Bronchial asthma: do boys or girls have the highest incidence?]

The aim of the study was to assess the gender related prevalence of asthma and asthma symptoms in schoolchildren. The survey was performed using standardized ISAAC questionnaire in two age groups: 6-7 yr. (n = 2281; girls 49.7%) and 13-14 yr. (n = 4849; girls 49.8%). It was revealed that in older group the prevalence of ever diagnosed asthma was lower in girls than in boys (2.0% versus 3.3%; odds ratio [OR] = 0.58; p = 0.004). But the prevalence of symptoms: wheeze ever (OR = 1.16; p = 0.056), current wheeze (last 12 mo) (OR = 1.26; p = 0.029), current exercise wheeze (OR = 1.40; p = 0.0008), current night cough (OR = 1.67; p = 0.0001) were higher in girls than in boys. However, in younger group of schoolchildren the prevalence of ever diagnosed asthma and asthma symptoms were higher in boys (5.1% male versus 3.5% female). The girls in comparison to boys revealed lower risk of ever asthma diagnosis (OR = 0.66; p = 0.056) and symptoms: wheeze ever (OR = 0.63; p = 0.0001), current wheeze (OR = 0.69; p = 0.003), current exercise wheeze (OR = 0.59; p = 0.008) and current night cough (OR = 0.70; p = 0.0003).