Syndrome Infants Research Articles

Reproductive system infections in women: upper genital tract, fetal, neonatal and infant syndromes.

Lower genital tract infection and bloodborne spread of infection are the two principal modes for infection of the upper genital tract or for infection of the fetus, neonate or infant. Treponema pallidum and human immunodeficiency virus (HIV) are the two most common bloodborne pathogens that infect the fetus, neonate or infant. Most infections of the upper genital tract, however, spread along epithelial surfaces from the vagina or cervix to the upper genital tract or chorioamnion, fetus, neonate or infant. These infections are caused by either pathogens associated with a dysbiotic vaginal microbiome or those that are sexually transmitted. The clinical syndromes that these pathogens produce in the lower genital tract were discussed in part one of this review. We now discuss the syndromes and pathogens that affect the upper genital tract of both non-pregnant and pregnant women as well as fetus, neonate and infant.

Memory CD8 T cell responses are impaired during Zika virus infection in mice

Abstract Nearly half the world’s population is at risk for infection by Zika virus (ZIKV), the causative agent of congenital Zika syndrome in infants and Guillain-Barre syndrome in adults. ZIKV vaccination strategies are currently focused on neutralizing antibody (Ab) generation, yet recent evidence suggests that Abs may contribute to pathogenesis under certain conditions. In contrast, increasing evidence supports a key role for T cells in protecting against ZIKV. We have begun to evaluate the generation of memory T cell responses to ZIKV infection in unmanipulated immunocompetent mice. Four-week-old wild-type C57BL/6 mice were infected with ZIKV for 30 days, followed by challenge with ZIKV and evaluation of memory CD4 and CD8 T cell responses at day 3 after secondary ZIKV infection. As expected, total numbers of CD4 and CD8 T cells expanded during secondary ZIKV challenge when compared to primary ZIKV responses at 7 days post-infection. However, only antigen-experienced CD4 T cells (CD11a+CD49d+) and not antigen-experienced CD8 T cells (CD11a+CD8lo) were similarly expanded in secondary infection. These CD8 T cell responses were comprised of short-lived effector cells and not memory precursors, indicating that CD8 T cells memory responses are impaired after primary ZIKV infection. These data suggest potential mechanisms of immune-evasion by ZIKV, and ongoing studies are focused on defining the mechanisms by which ZIKV inhibits the generation of memory CD8 T cell responses. Our findings should offer new strategies for developing ZIKV vaccines that enhance protective T cell responses and avoid pathogenic Ab responses.

Mechanical Ventilation after Surfactant Treatment for Respiratory Distress Syndrome in Preterm Infants

This study аims to compаre the need of mechаnicаl ventilаtion аfter surfаctаnt treаtment for respirаtory distress syndrome in preterm infаnts between the two groups of technique: LISА аnd INSURE. One hundred аnd six pаtients treаted by surfаctаnt replаcement therаpy were included in the study. Pаtients were divided into 2 groups; group А consists of pаtients who were treаted by LISА method аnd group B consists of pаtients who were treаted by INSURE method. There wаs not difference in need of mechаnicаl ventilаtion between two groups. Surfаctаnt replаcement therаpy hаd а lower chаnce for re-intubаtion, less durаtion of totаl oxygen аdministrаtion аnd less hospitаl stаy.

Mechanical Ventilation after Surfactant Treatment for Respiratory Distress Syndrome in Preterm Infants

This study аims to compаre the need of mechаnicаl ventilаtion аfter surfаctаnt treаtment for respirаtory distress syndrome in preterm infаnts between the two groups of technique: LISА аnd INSURE. One hundred аnd six pаtients treаted by surfаctаnt replаcement therаpy were included in the study. Pаtients were divided into 2 groups; group А consists of pаtients who were treаted by LISА method аnd group B consists of pаtients who were treаted by INSURE method. There wаs not difference in need of mechаnicаl ventilаtion between two groups. Surfаctаnt replаcement therаpy hаd а lower chаnce for re-intubаtion, less durаtion of totаl oxygen аdministrаtion аnd less hospitаl stаy.

Surfactant Protein D Is Associated With Severe Pediatric ARDS, Prolonged Ventilation, and Death in Children With Acute Respiratory Failure

Elevated surfactant protein D (SP-D) is a relatively specific indicator of lung injury and is associated with both acute and chronic lung disease in adults and respiratory distress syndrome in premature infants. The relationship between plasma SP-D and lung injury in children with acute respiratory failure is unclear. Is plasma SP-D associated with lung injury or outcome in children with acute respiratory failure? This was a prospective cohort study in children 2weeks to 17 years of age with acute respiratory failure who participated in the BALI multi-center study. Analyses were done using SP-D levels in plasma from the first sample taken on either the day of intubation or one of the following 2days. SP-D level was measured by enzyme-linked immunosorbent assay. Plasma samples from 350 patients were used in the analysis; 233 had pediatric ARDS (PARDS). SP-D levels varied across primary diagnoses (P< .001). Elevated SP-D levels were associated with severe PARDS after adjusting for age, pediatric risk of mortality III (PRISM-III), and primary diagnosis (OR= 1.02; CI= 1.01-1.04; P= .011). Multivariable analyses also indicated that elevated SP-D levels were associated with death (OR= 1.02; CI= 1.01-1.04; P= .004), duration of mechanical ventilation (P= .012), PICU length of stay (P= .019), and highest oxygenation index (P= .040). SP-D levels also correlated with age (rs= 0.16, P= .002). Elevated plasma SP-D levels are associated with severe PARDS and poor outcomes in children with acute respiratory failure. Future studies will determine whether SP-D can be used to predict the degree of lung injury or response to treatment and whether SP-D is useful in identifying PARDS endotypes.

Differentiation of food protein-induced enterocolitis syndrome and necrotizing enterocolitis in neonates by abdominal sonography

ObjectivesTo summarize and differentiate abdominal ultrasound findings of necrotizing enterocolitis and food protein-induced enterocolitis syndrome. MethodsFrom January 2017 to December 2018, the abdominal ultrasound results of 304 cases diagnosed necrotizing enterocolitis or food protein-induced enterocolitis syndrome were retrospectively analyzed. The presence of pneumatosis intestinalis, portal venous gas, bowel wall thickening, intestinal motility, focal fluid collections and hypoechoic change of gallbladder wall were calculated, and the results were compared and analyzed. ResultsPneumatosis intestinalis, portal venous gas, bowel wall thickening, intestinal motility weakened/absent, focal fluid collections and hypoechoic change of gallbladder wall can be found in both necrotizing enterocolitis and food protein-induced enterocolitis syndrome infants. However, in infants with necrotizing enterocolitis, intestinal motility was weakened/absent in whole abdomen, and in food protein-induced enterocolitis syndrome, it only involved isolated segment of bowel. The positive rates of above signs in necrotizing enterocolitis infants were significantly higher than those in food protein-induced enterocolitis syndrome (p<0.01). Moreover, it was observed that the rate of weakened intestinal motility besides the lesion segment of bowel in necrotizing enterocolitis infants was 100%, and in food protein-induced enterocolitis syndrome infants, it was 0%, which is supposed to be a main sign for identification. ConclusionIn the early stage, abdominal ultrasound can be used to differentiate necrotizing enterocolitis and food protein-induced enterocolitis syndrome.

Biochemical predictors for metabolic syndrome in preterm infants according to weight ratio.

Prematurity and low birth weight predispose preterm infants to cardiovascular disease in later life. Is the metabolic profile of these children impacted by the relation between birth weight and gestational age (GA)? This study aimed to evaluate whether the relationship between birth weight and GA of preterm infants has a positive correlation with the metabolic profile from birth to the sixth month of corrected age. This is a longitudinal, prospective study with a cohort of 70 preterm and 54 term infants, who were enrolled in the study and shared into two groups: Appropriate for GA (AGA) and Small for GA (SGA), both classified at birth by Fenton and Kim curves. Longitudinal evaluation of anthropometry measures and blood samples of total cholesterol, glucose, triglycerides, and insulin were collected at birth, NICU discharge, and the sixth month of corrected age. Data were analyzed using descriptive and inferential statistical analysis (ANOVA, Fisher test, Shapiro-Wilk, and Cochran test). The effect size was 0.15, power was 0.92, and confidence interval 95%. No significant statistical differences were observed in relation to biochemical tests between AGA and SGA groups. However, a significant increase in triglyceride results above the reference values for age in the SGA group was observed throughout the follow-up. Changes observed in the preterm infant metabolic profile show no correlation with adequacy of birth weight. Preterm lipid profile requires continuous evaluation at follow-up, due to the increased cardiovascular risk in later life.

Chemosensory Event-Related Potentials and Power Spectrum could be A Possible Biomarker in 3M Syndrome Infants?

3M syndrome is a rare disorder that involves the gene cullin-7 (CUL7). CUL7 modulates odour detection, conditions the olfactory response (OR) and plays a role in the development of the olfactory system. Despite this involvement, there are no direct studies on olfactory functional effects in 3M syndrome. The purpose of the present work was to analyse the cortical OR through chemosensory event-related potentials (CSERPs) and power spectra calculated by electroencephalogram (EEG) signals recorded in 3M infants: two twins (3M-N) and an additional subject (3M-O). The results suggest that olfactory processing is diversified. Comparison of N1 and Late Positive Component (LPC) indicated substantial differences in 3M syndrome that may be a consequence of a modified olfactory processing pattern. Moreover, the presence of delta rhythms in 3M-O and 3M-N clearly indicates their involvement with OR, since the delta rhythm is closely connected to chemosensory perception, in particular to olfactory perception.

Clinical analysis of vitamin D and respiratory distress syndrome in preterm infants

Clinical analysis of vitamin D and respiratory distress syndrome in preterm infants

Management of Respiratory Distress Syndrome in Preterm Infants In Wales: A Full Audit Cycle of a Quality Improvement Project

Respiratory Distress Syndrome (RDS) is the commonest diagnosis after premature birth. We aimed to audit clinical practices before and after introduction of a national guideline in Wales on RDS management. Anonymised, prospective data on all infants born at <34 weeks of gestation and cared for at one of the participating neonatal units in Wales were collected in two six-month time periods in 2015 and 2018. A national guideline was introduced in 2016 by the Wales Neonatal Network. Data collection included areas of antenatal management, delivery room stabilisation, invasive and non-invasive respiratory support, surfactant treatment and elements of supportive care. Univariate and multivariate methods were used to compare data between the two epochs. Comparing care before and after introduction of the national guideline, areas of significant improvement include use of targeted tidal volume ventilation, use of caffeine therapy, oxygen therapy post-surfactant and increasing early use of parenteral nutrition. Areas of poorer management included levels of positive end expiratory pressures and timing of introduction of enteral feeds. Little variation was seen between level two and three units, although gestational age was a significant independent variable for several practices, including delayed cord clamping, stabilisation with intubation, early enteral feeding and caffeine administration. A national guideline for management of RDS in Wales has significantly improved practice in several areas. However, despite a large volume of high-quality evidence and robust guidance, there remains a significant variation in some elements of best practice for RDS management. Further work should focus on education and training, especially for elements requiring cross-departmental work.

Neuromuscular Junction Disorders and Floppy Infant Syndrome: A Comprehensive Review.

Floppy infant syndrome, also sometimes referred to as rag-doll syndrome, is characterized by hypotonia that could present as either peripheral hypotonia or central. Depending on the origin of hypotonia, the infant will present with different symptoms that ultimately have the characteristic feature of hypotonia. The clinical examination is crucial in diagnosing floppy infant syndrome in the neonate period, but the most critical factor is investigating and diagnosing the underlying cause of hypotonia. Regardless of whether the underlying cause of hypotonia is peripheral or central in origin, the presentation of floppy infant syndrome focuses on observing for the presence or absence of specific signs such as ‘frog-leg’ posture, significant head lag on traction or pull-to-sit maneuver, or the feeling of ‘slipping through the hands’ when the infant is held under the arms. Infantile botulism, transient neonatal myasthenia gravis, congenital myasthenia gravis, hypermagnesemia, and aminoglycoside toxicity are all neuromuscular junction disorders that are considered to be a differential diagnosis of floppy infant syndrome. These neuromuscular junction disorders ultimately impact the presence of acetylcholine within the neuromuscular junction. While some of these disorders may impact the acetylcholine receptors, others may cause a depletion within the end-plate anticholinesterase enzyme. A deficiency within the anticholinesterase deficiency may cause desensitization to acetylcholine, which could also cause present with floppy infant syndrome as well. Depending on the underlying causative disorder leading to the presence of floppy infant syndrome, the treatment will vary considerably. Treatment of the underlying causative syndrome resulting in the presentation of floppy infant syndrome deals with the symptoms of hypotonia, and as a result, the decreased muscle tone, diminished tendon reflexes, any feeding or respiratory difficulties diminish.

Human Parechovirus: an Emerging Cause of Sepsis-Like Syndrome in Infants Aged under 3 Months

목적: 이번 연구의 목적은 human parechovirus (HPeV)로 유발된 패혈증 의증을 보였던 3개월 미만의 영아를 대상으로 임상적 특징 및 경과를 조사하는 것이다. 방법: 2018년 7월 1일부터 8월 31일까지 패혈증 의증으로 입원한 3개월 미만 영아들의 의무기록을 확인하였다. 환자들은 뇌척수액을 이용하여 역전사 중합효소 연쇄반응 검사를 시행하고 결과에 따라 HPeV 감염군(1군, 11명), 장바이러스 감염군(2군, 13명), 바이러스가 검출되지 않은 군(3군, 15명)으로 구분하였다. 결과: 1군은 빈맥, 빈호흡, 무호흡, 저혈압, 피부 변화를 보이는 환자가 2, 3군 보다 많았다(P<0.05). 또한 1군은 혈중 총 백혈구수가 다른 군에 비해 낮았다(5,622±2,355/μL, 9,397±2,282/μL and 12,312±7,452/μL, P=0.005). 뇌척수액 백혈구 수도 1군은 2, 3군에 비하여 낮았다 (0.9±1.7/μL, 85.1±163.6/μL, and 3.7±6.9/μL, P=0.06). 치료에서도 1군은 2, 3군 보다 승압제 보조(36.6% vs. 0% and 6.6%), 기계 환기 적용(18.1% vs. 0% and 0%)과 고유량 산소 사용(45.4% vs. 15.3% and 6.6%)이 더 많았다. 모든 환자들은 합병증 없이 회복 되었다. 결론: HPeV 감염은 심각한 임상 경과를 보이고, 3개월 미만의 영아에서 패혈증 유사 증후군의 원인이 될 수 있다. 따라서, HPeV 감염 여부를 조기에 진단하고 적절한 치료를 시작하는 것이 필요하다.

Rare Double Aneuploidy in Down Syndrome (Down-Klinefelter Syndrome)

Background: The chromosomal aneuploidy described as Cytogenetic condition characterized by abnormality in numbers of the chromosome. Aneuploid patient either trisomy or monosomy, can occur in both sex chromosomes as well as autosome chromosomes. However, double aneuploidies involving both sex and autosome chromosomes relatively a rare phenomenon. In present study, we reported a double aneuploidy (Down-Klinefelter syndrome) in infant from Saudi Arabia. Materials and Methods: In the present investigation, chromosomal analysis (standard chromosomal karyotyping) and fluorescence in situ hybridization (FISH) were performed according to the standard protocols. Results: Here, we report a single affected individual (boy) having Saudi origin, suffering from double chromosomal aneuploidy. The main presenting complaint is the obvious dysmorphic features suggesting Down syndrome. Chromosomal analysis and FISH revealed 48,XXY,+21, show the presence of three copies of chromosome 21, two copies of X chromosome and one copy of Y chromosome chromosomes. Conclusion: Patients with Down syndrome must be tested for other associated sex chromosome aneuploidies. Hence, proper diagnosis is needed for proper management and the cytogenetic tests should be performed as the first diagnostic approach.

Major Septal Defects: Comparative Study of Down Syndrome and Non-Down Syndrome Infants, Before and After Surgery.

Objective:To compare pre-operative, intra-operative, and post-operative parameters in Down syndrome (DS) and non-DS patients with atrioventricular septal defects (AVSD) and inlet ventricular septal defects (VSD) in a tertiary care hospital in Pakistan.Methods:We conducted a retrospective study at Aga Khan University, Pakistan. All complete atrioventricular septal defect (CAVSD), partial atrioventricular septal defect (PAVSD), and VSD with inlet extension surgical cases from January 2007 to January 2019 were included. Patients with congenital heart diseases other than those listed above were excluded.Results:In 61 cases, 18 had DS. Median age, mean body surface area (BSA), and height were lower in DS patients compared to non-DS patients: 7.0 vs 23.0 months, 0.311 vs 0.487 m2, and 63 vs 82 cm, respectively. Bypass duration, aortic cross clamp time, post-operative ventilator hours, dose of inotropes, CICU stay, and total hospital stay were all significantly higher in the DS group. The odds ratio (955% CI) for mortality in DS babies was 6.2 (1.4, 27.1), p=0.015, after adjusting for age, weight, and height. The overall morbidity was comparable between the two groups, demonstrating no significant difference after adjusting for confounders.Conclusion:DS babies with AVSD and inlet VSD are at a greater risk of mortality compared to non-DS babies, particularly those with CAVSD. Furthermore, DS babies undergo surgery at a younger age and require more aggressive post-operative therapy and monitoring due to the development of complications.

501: Antenatal Corticosteroids in Early Term Cesarean Sections (ACS ET CS)

Neonates born at term by Cesarean section (CS) are more likely to develop respiratory complications than those delivered vaginally. Risk of these complications is greater in the early term period, 37-39 weeks. Antenatal corticosteroids (ANCS) are given to mothers to reduce neonatal respiratory distress syndrome (NRDS) in preterm infants. Evidence suggests administration of betamethasone prior to CS at 37-39 weeks may similarly benefit fetal lung maturity. However, this is not standard practice in the United States. This study examines the effect of ANCS on the outcomes of early term neonates born by CS. A retrospective cohort study of patients who underwent planned early term CS at a single tertiary care center from 2016-19. Demographics, steroid administration, and neonatal outcomes were collected from the EMR. NRDS was the primary outcome. Data was separated by singleton vs. twin gestation, stratified by gestational age 37-37+6 vs. 38-38+6 weeks, and grouped by steroid vs. no steroid exposure. Categorical measures were compared using Chi-square or Fisher’s exact tests. Continuous measures were compared using Student’s T or Mann-Whitney U tests. 223 patients underwent planned early term CS for singleton pregnancy. 113 (50.7%) received ANCS, consisting of IM betamethasone 12mg x2 doses 24 hours apart. Baseline maternal demographics were comparable. In the 37-week subset, NRDS was less prevalent in babies who had received steroids (Table 1, p = 0.04). After adjusting for neonatal sex and birth weight, a trend for decreased NRDS with ANCS remained (Table 2, OR:0.22, 95% CI:0.05-1.01). No difference in NRDS was found in the 38-week subset. No other neonatal outcomes such as hypoglycemia, infection, and transient tachypnea of the newborn were significantly different regardless of gestational age. Data regarding twin pregnancies was gathered, but numbers were not sufficient to allow analysis. This study suggests ANCS may be an asset in reducing NRDS after planned CS at 37-37+6 weeks. Further study is required to determine long-term effects, and benefit to twin gestations.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

In The Differential Diagnosis of Wheezy infant, Chilaiditi Syndrome Caused by Empty Bottle Absorption

Chilaiditi syndrome is defined as hepatodiaphragmatic interposition of colon or small intestine. Wheezy infant and Chilaiditi syndrome are not described in the literature. Radiographs of the lung taken for differential diagnosis should be fully evaluated. We emphasize the importance of air under the right diaphragm in the wheezy infant.

Coexistencia de desórdenes gastrointestinales funcionales en lactantes y preescolares latinoamericanos

Introducción: se ha descrito la coexistencia de trastornos gastrointestinales funcionales (c-TGF) en lactantes y preescolares (LactPre); sin embargo, hay poca literatura sobre los principales c-TGF y sus características.&#x0D; Objetivo: describir la prevalencia y posibles asociaciones de c-TGF en un mismo LactPre latinoamericano.&#x0D; Metodología: estudio de prevalencia en LactPre de Colombia, Ecuador, Nicaragua y Panamá de consulta externa y urgencias, a quienes, según los criterios de Roma III en español, se identificaron regurgitación, síndrome de rumiación, síndrome del vómito cíclico, cólico, diarrea funcional, estreñimiento funcional y disquecia. Se tuvieron en cuenta la edad, el sexo y el origen. La estadística incluyó t de Student, chi cuadrado, prueba exacta de Fisher, análisis uni y multivariados y el cálculo de los OR e IC 95%, siendo una p &lt;0,05 significativa.&#x0D; Resultados: se analizaron 2417 niños (2,419,8 meses de edad, 51,3% masculinos, con diagnóstico de por lo menos algún TGF del 35,7%). Se presentó c-TGF en el 3,6%, siendo el principal el síndrome de rumiación del lactante (SRL) más estreñimiento funcional (EF). Hubo predomino del género masculino en los lactantes y ser colombiano.&#x0D; Conclusión: la principal c-TGF en este grupo de LactPre de Latinoamérica es el SRL más EF, presentándose principalmente en el sexo masculino y en lactantes menores de 24 meses.

Improved diagnostic algorithm for gastrointestinal food allergy in infants

Objective:The objective is to improve non-invasive diagnostic algorithm (NDA) to identify food allergy (FA) in infants since their first months of live.Methods:We have done clinical and anamnestic examination and subsequent follow-up of 26 infants aged from 1 week old to 9 months old having admitted with complaints about colics, diarrhea, abdominal distension and skin rashes. Primary screening was performed using CoMiss tool, then anamnesis data was collected according NDA.Results:FA was diagnosed in 34.6 % of infants due to improved NDA. Case follow-up suggested the presence of FA in 46.1% of patients.Conclusions:The questionnaire showed a high clinical effectiveness and uniqueness, exceeding current alternatives for non-invasive diagnostics of malabsorption syndrome in infants.

Zika virus utilises the ubiquitin-proteasome pathway during infection of mosquito and human cells

Arthropod-borne viruses are able to infect vertebrate and invertebrate hosts. One such arbovirus is Zika virus (family Flaviviridae) that is mainly transmitted to humans by Aedes mosquitoes causing febrile illness and congenital Zika syndrome in infants. An interplay between host and virus proteins enables ZIKV to manipulate its host's cellular machineries in order to facilitate infection and evade antiviral responses. A possible mechanism it utilises is the ubiquitin-proteasome pathway (UPP) where target proteins are ubiquitinated and subsequently degraded by the proteasome. Results of proteomics analysis of Ae. aegypti cell lines (AF5) stably expressing V5-tagged ZIKV capsid (C), anchored capsid (AC) or non-structural 3 (NS3) proteins revealed that these viral proteins interact with effector proteins of the UPP. One of these proteins is TER94 an AAA-ATPase that acts as a chaperone segregating ubiquitinated proteins to the proteasome complex. Knockdown experiments of TER94 or its human ortholog VCP using dsRNA or siRNAs showed reduced virus replication in AF5 or A549 cells. Using small molecule inhibitors of UPP proteins also diminished ZIKV replication. Inhibiting different stages of the pathway have identified critical steps during early stages of infection. The ubiquitination of lysine-rich ZIKV C and its interaction with TER94/VCP could be one of the many universal strategies that the virus employs when it switches between mosquito and human hosts. Understanding how ZIKV is able to infect both human and insect species could provide novel strategies for prevention and therapeutics. Keywords: Zika virus, Aedes aegypti, ubiquitin-proteasome pathway, mosquito, virus-host interaction

Contribution of 99M TC-HMDP Bone Scintigraphy in the Diagnosis of Fibrous Dysplasia of Mccune Albright Syndrome in Infant: A Case Report

McCune Albright syndrome is a rare congenital disorder, which is classically defined by a triad associating a Fibrotic Dysplasia (DF) most often polyostotic, 'café au lait' skin pigmentation and a hyperfunctioning endocrinopathy.