Diseases and Developmental Immunology
B Jonsson, M Rylander, (Karolinska Hosp, Stockholm)
Ureaplasma urealyticum, Erythromycin and Respiratory Morbidity in High-Risk Preterm Neonates.
Acta Paediatr 87: 1079-1084, 1998.
Ureaplasma urealyticum (Uu) often colonizes the lungs of very premature infants (less than 30 weeks’ gestation). The relationships between Uu colonization and respiratory morbidity or chronic lung disease (CLD) in very premature infants were studied; whether Uu treatment with erythromycin would have an effect on morbidity was also assessed.
Findings: Compared with infants without Uu colonization, infants colonized with Uu were significantly younger (25 vs 26 weeks’ gestation), and their mothers were significantly more likely to have premature rupture of membranes (PROM 48% vs 12%), chorioamnionitis (46% vs 17%), and vaginal delivery (71% vs 29%). Use of supplemental oxygen at 36 weeks’ postconceptual age was also significantly more common in the colonized infants.
Conclusion : Ureaplasma urelayticum colonization was related to immaturity, PROM, chorioamnionitis, and vaginal delivery. However Uu colonization was not a significant independent predictor of the need for supplemental oxygen at 36 weeks’ postconceptual age. Similarly, treatment of colonized infants with erythromycin tended to eradicate their infection but had no effect on their supplemental oxygen needs. Thus, if Uu does play an important role in the development of chronic lung disease in very premature infants, its influence probably occurs very early in lung development and would have to be treated early, possibly in utero.
Editorial comments: Uu is somehow related to prematurity and chorioamnionitis but should not necessarily be implicated in chronic lung disease. Furthermore, administration of erythromycin reduces colonization but not duration of oxygen therapy.
TA Joseph, SP Pyati, (Cook County Children’s Hosp, Chicago; Finch Univ, North Chicago; Univ of Illinois, Chicago)
Neonatal Early-Onset Escherichia coli Disease: The Effect of Intrapartum Ampicillin.
Arch Pediatr Adolesc Med 152: 35-40, 1998.
One of the most organisms responsible for sepsis during the newborn period is E.coli. Ampicillin has been increasingly used by obstetricians for intrapartum chemoprophylaxis for group B streptococcal disease. However the consequences of this practice are unknown. The clinical characteristics and outcomes associated with early-onset neonatal E.coli disease were delineated, and the effect of increased use of intrapartum ampicillin during recent years on the rate of early-onet E.coli infection and case fatalities was assessed.
Methods: Intrapartum ampicillin use increased since 1988 and infection and case fatality rates were compared before 1988 and afterwards.
Results: Early-onset E.coli infection was diagnosed in 30 of the 61498 liver births, and the infected neonates had a clinical syndrome that was indistinguishable from early-onset group B streptococcal infection. The single most frequent finding in 73% of the infected neonates was respiratory distress.
Ampicillin resistant infection was found in a higher proportion of neonates born to ampicillin treated women. In mothers with sensitive organisms and resistant organisms, the difference between the prevalence of intrapartum fever was significiant in proportionate cases. Ampicillin resistant organisms caused all 6 early onset E.coli related deaths; of these 4 of the 6 mothers received intrapartum ampicillin.
Conclusion : There has been a shift of early-onset E.coli infection from a less fulminant disease caused by ampicillin-sensitive organisms to a more fulminant disease caused by organisms that are resistant to ampicillin.
Editorial comment: The concern that attempts to eradicate the group B streptococcus (GBS) will result in the reemergence of resistant gram-negative organisms may be well justified.
Towers et al have also written on this particular subject and they observed that the incidence of early-onset neonatal sepsis with group B streptococci decreased during their study periods, whereas the incidence of early-onset sepsis with non-group B streptococcal organisms, especially E.coli, increased. It is important that the recommendations for the use of intrapartum penicillin G, rather than ampicillin, for prophylaxis against group B streptococci be followed.
M Adhikhari, T Pillay, DG Pillay (Univ of Natal, Kwa-Zula Natal, South Africa)
Tuberculosis in the Newborn: An Emerging Disease.
Pediatr Infect Dis J 16: 1108-1112, 1997.
Introduction: Despite the global increase of tuberculosis, which has been fueled, in part, by the HIV infection pandemic, it is rare to see tuberculosis in the perinatal period.
Methods: Seventy-seven neonates, with a differential diagnosis of tuberculosis, were studied during a 1-year period in a province with epidemics of tuberculosis and HIV infection. For neonates with a confirmed diagnosis of tuberculosis, the clinical profiles, short-term outcome, and relationship to maternal tuberculosis and HIV infection were determined.
The clinical characteristics of tuberculosis and HIV coinfection in the adult have been well characterized. In contrast to immunologically normal patients, in whom tuberculosis infection remains subclinical in the overwhelming majority, HIV infected patients develop a clinical disease much more frequently. There is a marked predilection for extra pulmonary spread of the mycobacteria, particularly to the lymph nodes, central nervous system, bone marrow, and genitourinary and gastrointestinal tracts.
Conversely, it also has been noted that tuberculosis can accelerate clinical deterioration in the HIV-infected patient independent of the morbidity caused by the tuberculosis infection itself.
The cause for this deterioration are speculative, but cytokines produced after M tuberculosis infection, particularly tumor necrosis factor and interleukin-1, promote HIV replication in vitro and may do so in vivo as well.
In the United States there is aggressive screening for HIV infection among tuberculosis clinic patients, and tuberculosis screening among HIV clinic patients; this results in early diagnosis and treatment of both. Moreover, intragestational prophylaxis to prevent vertical transmission of HIV to the newborn is highly effective and has resulted in a dramatic diminution in the number of neonates born with HIV and its resultant severe immunologic impairment.
ME O’Connor, W Schmidt, et al (Case Western Reserve Univ, cleveland, Ohio)
Relaxation Training and Breast Milk Secretory IgA
Arch Pediatr Adolesc Med 152:1065-1070, 1998.
A study was undertaken to determine whether relaxation training and suggestion to breast feeding women would increase the secretory IgA (sIgA) levels in their breast milk to improve the immunity of breast-fed infants.
It was concluded that breast milk sIgA levels were increased with self-reported stress. sIgA levels were inversely related to success at relaxation in the group learning to relax.
Editorial comments: However, as all new mothers are sleep deprived and stressed, it should be of some comfort and consolation for them to learn that this is beneficial for their babies.