Infant Serum Levels Research Articles

Correlation between maternal milk and infant serum levels of chlorinated pesticides (CP) and the impact of elevated CP on bleeding tendency and immune status in some infants in Egypt

Chlorinated pesticides (CP) are environmentally persistent pollutants that (prenatally through the placenta and post-natally via breastfeeding) are transferred from mother to child. Considering the significant bleeding tendency noted in infants of CP-intoxicated mothers in Egypt, this study aimed to investigate any correlation between levels of these xenobiotics in mothers’ milk and bleeding tendencies of their infants, as well as a possible role of any related immunosuppression in this phenomenon. This study examined 180 newborns presenting with altered bleeding tendencies and their mothers, and 180 normal newborns and their mothers (serving as a controls), selected from the Breastfeeding Unit, Center for Social and Preventive Medicine at the Cairo University Pediatric Hospital. Chlorinated pesticides (e.g., hexachlorocyclohexane, DDT, hepta-chloroepoxide, α- and β-endosulfan, aldrin, endrin, dieldrin) levels and their derivatives were measured in mothers’ milk as well as in serum of neonates using gas chromatography/high resolution mass spectrometry. To link bleeding tendency with lactational intoxication of neonates by CP, newborns’ blood was assessed for: platelet count, bleeding and prothrombin time, liver enzymes, Vitamin K, TNFα, and IL-10. Breast milk CP levels were associated with a higher incidence of bleeding in infants. Interference with the coagulation cascade was supported by changes in prothrombin time (prolonged), platelet counts (decreased), liver enzymes (increased), and serum Vitamin K concentrations (decreased). Moreover, the significant decrease in WBC count and lymphocytes added to depressed cytokine secretion, i.e., TNFα and IL-10, suggested an organochlorine-induced immunotoxicity in infants developmentally exposed to the agents. We conclude that maternal transfer of CP, via breastfeeding or across the placenta, was sufficient to achieve similar CP levels in the serum of their infants; this correlated with a manifesting of altered bleeding tendencies and perturbed cytokine biology in these infants.

Role of Protein Z and Protein C in Neonates with Respiratory Distress Syndrome in Egypt (Experience of One Centre)

The aim of this study is to evaluate Protein Z (PTZ) and protein C (PTC) levels in newborns suffering from RDS, healthy preterm and full term newborns and to compare PTZ serum levels in RDS preterm infants with healthy preterm before and after recovery. Sixty newborn infants, recruited from the neonatal unit, were enrolled in the study and divided into 3 groups: Group (I): 20 preterm with RDS, Group (II): 20 healthy preterm control newborns (CPT) and Group (III): 20 healthy full term control newborns (CFT). Protein Z and C were measured using ELISA kits. The results of the study showed lower levels of protein Z were obtained in RDS group compared to preterm controls whose levels were significantly lower than in full-term controls. A significant increase in PTZ levels in RDS' group after recovery, when compared to preterm controls. In RDS, no significant correlations existed between PTZ levels (before and after recovery) and routine investigations except for a significant negative correlation with platelets count. No significant differences were found in PTC levels between the 3 studied groups. To conclude: premature newborns suffering from RDS showed decreased serum protein Z levels than normal preterm control newborns with further increase in its pattern after recovery. Further studies are recommended to evaluate the role of PTZ on outcome in premature newborns with RDS and to evaluate the relationship between protein PTZ and PTC and other coagulation factors incriminated in the development of RDS.

Clara cell protein 16 (CC16) serum levels in infants during respiratory syncytial virus infection

Clara cell protein 16 (CC16) serum levels in infants during respiratory syncytial virus infection

Is Urine Interleukin-8 Level a Reliable Laboratory Test for Diagnosing Late Onset Sepsis in Premature Infants?

The present study is aimed to determine serum and urine interleukin-8 (IL-8) levels in premature infants with late onset sepsis (LOS) and to evaluate if urine IL-8 is a useful test for LOS diagnosis. Fifty-six premature infants admitted to the NICU over 1 year had serum and urine IL-8 determined by ELISA. They were divided into three groups: I definite sepsis, II probable sepsis and III non-infected. Results were expressed as mean or median. Differences between groups were assessed by ANOVA, Kruskal-Wallis ANOVA and Dunn's Method. Sensitivity, specificity and positive and negative predictive values were calculated and a receiver operator characteristic curve was constructed to determine serum and urine IL-8 accuracy. There were no differences between groups for birth weight, and gestational and post-natal age. Median serum and urine IL-8 levels were significantly higher in GI and GII: 929 x 906 x 625 pg/ml; P = 0.024, and 249 x 189 x 42 pg/mgCr; P < 0.001. Optimal cut-off point was 625 pg/ml for serum IL-8 with 69% sensitivity and 75 pg/mgCr for urine IL-8 with 92% sensitivity. IL-8 can be determined in urine from premature infants with LOS and is an accurate and feasible diagnosis method.

IGF-I, VEGF y bFGF, como factores pronósticos de la aparición de la retinopatía de la prematuridad

To determine if IGF-I, VEGF and bFGF, present in the serum of premature infants, are independent risk factors of the development of ROP. It was also our objective to design a multivariate model that included these three cytokines as indicator parameters in the ROP screening, in addition to the other parameters already in existence. 74 patients were recruited with a birth weight below 1500g or gestational age below 32 weeks. These were classified into those who developed ROP (N = 37) and those without ROP (N = 37). We obtained serum from each infant at the time of the first examination at 4-6 postnatal weeks. These samples were frozen until the time of analysis. The roles of gestational age and birth weight were also evaluated. There were significant differences in the amount of the cytokines IGF-I and VEGF between the groups with or without ROP, but there were no significant differences for bFGF. The differences enabled us to establish a multivariate model including IGF-I and VEGF for the prediction of risk of ROP. Cytokine serum levels in premature infants can be useful as an indicator in ROP screening, as well as being used to predict the probability of suffering the illness.

Postpartum Depression

Symptom reduction and improvement in functioning in women with postpartum major depression treated with a tricyclic antidepressant versus a serotonin reuptake inhibitor were compared. The design was a double-blind, 8-week comparative trial of nortriptyline (NTP) versus sertraline (SERT) with a 16-week continuation phase. Women aged 18 to 45 years with postpartum major depression and a 17-item Hamilton Rating Scale for Depression score of 18 or more were eligible. Subjects were randomized to NTP or SERT and treated with a fixed-dosing strategy. Of 420 women interviewed, 109 eligible women received medication, and 95 provided follow-up data. The proportion of women who responded and remitted did not differ between drugs at 4, 8, or 24 weeks. Times to response and remission also did not differ. Psychosocial functioning improved similarly in both drug-treated groups of mothers. The total side effect burden of each drug was similar, although side effect profiles differed between agents. No clinical or demographic variables differentiated responders by drug. Women who were responders and remitters at week 8 could be identified earlier if they were treated with SERT than with NTP. Breast-fed infant serum levels were near or below the level of quantifiability for both agents.

High-Dose Indomethacin for Patent Ductus Arteriosus Closure: How Strong Is the Evidence?: In Reply

In Reply.—We appreciate Dr Manzar's comments on our high-dose indomethacin treatment strategy for the closure of symptomatic patent ductus arteriosus (sPDA) in premature infants1 and thank the editor for the opportunity to reply. Our initial rationale for treating infants suffering from sPDA with high doses of indomethacin was based less on reports that overdosages of indomethacin did not lead to severe adverse effects and more on the opportunity to closely follow-up on adverse effects and on the treatment success (measured by daily echocardiography). In addition, it has to be emphasized that our strategy does not consist of a high-dose approach per se. High doses of the drug were used only in those infants who had insufficient closure of the duct during standard treatment. This resulted in a surprisingly low number of infants who actually received high doses of the drug. We have to admit (having the Western Australian report on spontaneous ductal closure in mind2) that our approach may include indomethacin-treated infants who otherwise would have recovered by spontaneous closure of the ductus. However, in view of the serious complications that may develop in infants with untreated sPDA, we prefer to start early treatment in all premature infants suffering from sPDA. We do not treat prophylactically.From the nonresponders we have learned that a prolonged low-dose indomethacin treatment strategy did not lead to appreciable echocardiographic changes, which we attribute to an insufficient rise in serum indomethacin levels, which most likely does not exceed the threshold level necessary to induce ductal closure.We agree with Dr Manzar that close monitoring of indomethacin serum levels (in conjunction with daily echocardiography) would be the best approach for monitoring indomethacin therapy. We are currently investigating an association between low serum indomethacin levels and nonresponders, because we have found inadequately low indomethacin serum levels in several infants (some are included in the high-dose study group) who received high doses of indomethacin. This led us to speculate that indomethacin is handled differently in responders and nonresponders.Concerning concomitant use of other drugs during indomethacin treatment, we did not give dexamethasone or dopamine to premature infants during indomethacin treatment. However, we treated those infants with furosemide (0.5 mg/kg per hour) when their urine output decreased below 1 mL/kg per hour.Using the escalating, stepwise indomethacin-treatment strategy, we have treated >200 premature infants under 33 weeks of gestation suffering from sPDA. Only 3 of them had to undergo surgical closure of the PDA. It will be of great interest to exclude any long-term effects caused by this therapeutic approach. This prompted us to initiate a follow-up study on the neurodevelopmental outcome of our study groups, which is currently ongoing.

Troponin I as a Biomarker of Cardiac Injury in Neonates with Idiopathic Respiratory Distress

Troponin I (TnI), an inhibitory protein complex located on the actin filament of cardiac muscle, has become a specific marker of myocardial damage. Troponin has been studied in a wide range of clinical settings. However, many questions are still unanswered, especially in preterm neonates with the most common pathology at birth, such as idiopathic respiratory distress syndrome (IRDS). The aim of this study was to establish a reference range for cardiac TnI for healthy preterm infants and serum levels in sick preterm infants with IRDS. Echocardiography was performed and TnI serum levels were measured at a median age of 62 hours of life in three groups of healthy preterm infants (n = 10), and ventilated infants with moderate (n = 15) and severe IRDS (n = 15). Ventilated infants with idiopathic moderate IRDS had significantly different cardiac parameters (R/L ejection fraction, R/L stroke volume, R/L cardiac output; p < 0.05) and significantly higher cardiac TnI levels than healthy infants (0.037 versus 0.01 microg/mL; p < 0.05). Furthermore, infants with severe IRDS had higher TnI concentrations than infants with moderate IRDS (0.26 versus 0.037 microg/mL; p < 0.05). The results of this study show that increased TnI serum levels in sick preterm infants with IRDS are explained by myocardial injury or dysfunction due to impaired arterial oxygenation or reduction in cardiac output during treatment with mechanical ventilation. These results suggest that cardiac TnI may be a useful, specific marker for myocardial damage in preterm neonates with IRDS.

The Effect of High-Dose Vitamin D Supplementation on Serum Vitamin D Levels and Milk Calcium Concentration in Lactating Women and Their Infants

Improve vitamin D status in lactating women and their recipient infants, and measure breast milk calcium concentration [Ca] as a function of vitamin D regimen. Fully breastfeeding mothers were randomized at 1 month postpartum to 2000 (n = 12) or 4000 (n = 13) IU/day vitamin D for 3 months to achieve optimal vitamin D status [serum 25(OH)D > or =32 ng/mL (80 nmol/L)]. Breast milk [Ca], maternal and infant serum 25(OH)D and serum Ca, and maternal urinary Ca/Cr ratio were measured monthly. Mothers were similar between groups for age, race, gestation, and birth weight. 25(OH)D increased from 1 to 4 months in both groups (mean +/- SD): +11.5 +/- 2.3 ng/mL for group 2000 (p = 0.002) and +14.4 +/- 3.0 ng/mL for group 4000 (p = 0.0008). The 4000 IU/day regimen was more effective in raising both maternal and infant serum levels and breast milk antirachitic activity than the 2000 IU/day regimen. Breast milk [Ca] fell with continued lactation through 4 months in the 2000 and 4000 IU groups. Decline in breast milk [Ca] was not associated with vitamin D dose (p = 0.73) or maternal 25(OH)D (p = 0.94). No mother or infant experienced vitamin D-related adverse events, and all laboratory parameters remained in the normal range. High-dose vitamin D was effective in increasing 25(OH)D levels in fully breastfeeding mothers to optimal levels without evidence of toxicity. Breast milk [Ca] and its decline in both groups during 1 to 4 months were independent of maternal vitamin D status and regimen. Both the mother and her infant attained improved vitamin D status and maintained normal [Ca].

Effects of Ketamine on Serum and Tracheobronchial Aspirate Interleukin-6 Levels in Infants Undergoing Cardiac Surgery

Corrective surgery for congenital heart defects in children frequently requires cardiopulmonary bypass (CPB). Serum and bronchoalveolar levels of interleukin-6 (IL-6) may be useful in assessing the severity of the systemic inflammatory response after CPB. In the present study, the authors aimed to compare the effects of ketamine anesthesia and isoflurane anesthesia with respect to serum and tracheobronchial aspirate (TBA) IL-6 levels in infants undergoing CPB for cardiac surgery. Prospective and randomized controlled study. University-based teaching hospital. Thirty-four infants aged 2 to 24 months were randomized into 2 groups. In group K (n = 17), anesthesia was induced with intravenous (IV) ketamine, 1 to 2 mg/kg, and fentanyl, 1 to 2 microg/kg, and was maintained with infusions of ketamine, 25 to 75 microg/kg/min, and fentanyl, 10 microg/kg/h. In group I (n = 17), induction was achieved with IV thiopental sodium, 3 to 5 mg/kg, and fentanyl, 1 to 2 microg/kg, and was maintained with 1% isoflurane and fentanyl, 10 mug/kg/h. Blood and TBA samples were obtained at 6 and 4 stages, respectively. Serum IL-6 and TBA IL-6 levels were similar in the 2 groups at all stages (p > 0.05). The present results show that ketamine anesthesia does not provide superiority over isoflurane anesthesia with respect to serum and TBA IL-6 levels.

Valores de IGF-I séricos en la ROP. Buscando nuevas indicaciones para su screening

To determine the IGF-I serum levels in premature infants with the objective of being able to use these levels as an indicator of the need for exploration in a screening program for retinopathy of prematurity (ROP). This was a comparative study in which IGF-I levels were measured in every infants' serum during the first exploration in the 4 to 6 postnatal weeks. The degree of ROP and a variety of morbidity factors were evaluated, including the presence of intraventricular haemorrhage, sepsis, need for blood transfusion and the number of days of mechanical ventilation. The average IGF-I values during the first 4 to 6 postnatal weeks were lowest in the ROP cases (10.75 microg/L SD 16.053) while the NO-ROP cases yielded higher values (29.75 microg/L, SD 13.022). The Mann-Whitney U test showed a value of P for the IGF-I values of 0.004, indicating significant differences between the groups with or without ROP. The low IGF-I serum levels in ROP infants in comparison with the NO-ROP cases, suggest that this marker could be used as an indicator in the screening for ROP.

Influence of Smoking on Serum and Milk of Mothers, and Their Infants’ Serum Insulin-Like Growth Factor-I and Insulin-Like Growth Factor Binding Protein-3 Levels

Objective: To investigate the serum and milk in active-smoking and nonsmoking mothers, and their infants’ insulin-like growth factor-I (IGF-I) and insulin-like growth factor binding protein-3 (IGFBP-3) levels. Design and Setting: A cohort study conducted at a tertiary medical center. Subjects: Forty-four mothers (age range: 21–34 years) and their newborns (7 days old) were enrolled in the study. Mothers were interviewed and classified according to their smoking status into one of two groups: the active-smoking mothers (n = 21) and the nonsmoking mothers (n = 23). Results: There was no difference noted in either IGF-I, IGFBP-3 or IGF-I/IGFBP-3 ratios in serum and milk of mothers, and their infants’ serum samples according to maternal smoking. Conclusion: This study demonstrated that maternal smoking (5–10 cigarettes/day) did not influence the maternal and infant serum levels of IGF-I and IGFBP-3 as well as the breast milk levels of these peptides.

Postnatal evaluation of vitamin D and bone health in women who were vitamin D‐deficient in pregnancy, and in their infants

To determine the postnatal vitamin D status and bone health of women identified as vitamin D-deficient in pregnancy, and of their infants. Retrospective audit conducted between 27 August and 5 November 2003. The study included women delivering between August and October 2002 at the Royal Women's Hospital, Melbourne, who had had a 25-hydroxyvitamin D (25-[OH]D) level < 30 nmol/L in pregnancy, and their infants at age 4-10 months. The outpatient clinic at the Royal Children's Hospital, Melbourne. Maternal and infant serum levels of vitamin D, total alkaline phosphatase (tALP), parathyroid hormone (PTH), calcium and phosphorus; x-ray results in children with clinical or laboratory findings suggestive of rickets. Of 69 mother-infant pairs invited to participate, 47 (68%) attended. All 47 women had 25-(OH)D levels < 50 nmol/L, and 39 (83%) had levels < 30 nmol/L. Vitamin D supplements had been prescribed in pregnancy for 35 women (74%), and 19/35 reported having taken them as prescribed. None had continued to take supplements postnatally, but one had recently started taking them again. Among 45 infants from whom blood samples were successfully obtained, 18 (40%) had 25-(OH)D levels < 50 nmol/L, and 14 (31%) had levels < 30 nmol/L. Twelve of 16 breastfed infants had 25-(OH)D levels < 30 nmol/L, compared with 2/29 fed formula milk (P = 0.001). Most mothers who had been vitamin D-deficient in pregnancy were also deficient postnatally, indicating that treatment offered, counselling and/or treatment compliance were inadequate. Their infants, especially if breastfed, were at high risk of vitamin D deficiency and increased bone formation. Breastfed infants of mothers at high risk of vitamin D deficiency should receive vitamin D supplements.

Postpartum Depression

Postpartum Depression

Soluble Intercellular Adhesion Molecule 1 in Umbilical Cord Serum: Potential for the Diagnosis of Neonatal Infections

Objective: To evaluate the diagnostic relevance to neonatal infections of the soluble intercellular adhesion molecule 1 (sICAM-1) cord serum level. Methods: The case-control study included 66 term newborn infants with and without risk factors for neonatal infections. Cord blood serum determinations of white blood cell count, C-reactive protein, fibrinogen, and sICAM-1 were systematically performed associated with bacterial cultures from placenta, ears, and gastric fluids. Results: 6 of 33 infants (18.2%) with risk factors were infected, and 13 (39.4%) were colonized. Two infants included in the group without infection risk factors (n = 33) were colonized. No difference in sICAM-1 cord serum levels was found according to the presence of premature rupture of membrane, fetal tachycardia >160 bpm, meconial amniotic fluid, and duration of labour >10 h. No difference in sICAM-1 was noted between infected and non-infected infants. The cord serum levels of sICAM-1 were significantly higher in infants after forceps extraction (p = 0.01). A correlation was observed between sICAM-1 and C-reactive protein cord serum levels (p = 0.004, r = 0.371) and between sICAM-1 level and neutrophil count (p = 0.01, r = 0.489). Conclusions: Our results suggest that cord serum sICAM-1 determinations have no diagnostic relevance to neonatal infection. The increase of sICAM-1 cord serum levels in infants after forceps extraction suggests its potential to evaluate cerebral trauma or hypoxia.

Serum valproate levels in 6 breastfeeding mother-infant pairs.

Women with bipolar disorder are at high risk for recurrence of an affective episode in the postpartum period, and treatment with a mood stabilizer may be indicated. Few data are available to inform the risk-benefit decision regarding the use of valproate for women with bipolar disorder who elect to breast-feed. Serum valproate levels were obtained from 6 breastfeeding mother-infant pairs. All mothers had a diagnosis of bipolar disorder (Research Diagnostic Criteria) and were taking divalproex sodium as prophylaxis for or treatment of a recurrent affective episode. None of the mothers received valproate during pregnancy. The mothers had serum valproate levels near or within the therapeutic range (39.4 to 79.0 microg/mL). Infant serum levels were low, ranging from 0.7 to 1.5 microg/mL (0.9%-2.3% of maternal serum levels). No adverse clinical effects were observed in the infants. Serum valproate levels were low in nurslings of mothers treated with valproate. These data can be used to inform clinical decisions regarding the use of valproate during breastfeeding.

Mood stabilizers during breastfeeding: a review.

The postpartum period is an exceptionally high-risk time for recurrence of depression, mania, or psychosis for women with bipolar disorder. Puerperal prophylaxis with mood stabilizers decreases this risk. To allow patients and clinicians to make informed decisions about mood-stabilizer use during breastfeeding, there is a need for a critical review and analysis of the data. A search of MEDLINE (1966-1998) and the Lithium Database, Madison Institute of Medicine, was conducted to obtain articles about lithium, valproate, carbamazepine, gabapentin, or lamotrigine use during lactation. Search terms used were pregnancy, teratogenesis, breastfeeding, lactation, breast milk levels and lithium, anticonvulsants, mood stabilizers. No other search restrictions were used. Unpublished data on gabapentin and lamotrigine were provided by the manufacturers. The search revealed 11 cases of lithium use during breastfeeding, 8 of which reported infant serum levels. Two cases reported symptoms consistent with lithium toxicity in the infants. Thirty-nine cases of valproate use during breastfeeding were found, 8 of which reported infant serum levels. There was 1 report of thrombocytopenia and anemia in an infant. Fifty cases of carbamazepine use during breastfeeding were found, 10 of which reported infant serum levels. Two infants experienced hepatic dysfunction. One unpublished study of gabapentin in breast milk was found. Three reports of lamotrigine use during breastfeeding were found. Available information remains limited to uncontrolled studies and case reports. Carbamazepine and valproate, but not lithium, have generally been considered compatible with breastfeeding. The overall paucity of data, data confounded by polypharmacy and infant age differences, and adverse reactions reported with all established mood stabilizers dictate a reassessment of these recommendations. We propose that a woman's historical response to medication and the clinical circumstances be the primary considerations when choosing a mood stabilizer during breastfeeding, rather than strict adherence to categorical assignments.

Postpartum psychiatric illness: the role of the pediatrician.

PPD occurs in 10% to 20% of postpartum women. Maternal depression can affect a child's development significantly. Pediatricians can screen for maternal psychiatric illness with little effort; of all the health care professionals, they may be in the best position to do so. Pediatricians can help affected mothers obtain appropriate treatment and help mobilize social resources. This simple process can minimize morbidity to pediatric patients.

Management of Nonobstetric Pain During Pregnancy and Lactation

Management of Nonobstetric Pain During Pregnancy and Lactation

Management of nonobstetric pain during pregnancy and lactation.

Management of nonobstetric pain during pregnancy and lactation.