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Case Reports 2008; 29(5): 635-638 PubMed PMID: 18987611 Citation  Keywords:  Adult, Amniocentesis, Blood Gas Analysis, Cordocentesis, Echocardiography, Electrocardiography, Female, Fetal Growth Retardation:diagnostic imaging, Heart Rate:physiology, Heart Rate, Fetal:physiology, Humans, Hypoxia:etiology, Infant, Newborn, Infant, Pr.   

OBJECTIVES: Intrauterine growth retardation (IUGR) is associated with fetal adverse conditions. The most important cause of growth restriction and poor perinatal outcome is chronic fetal hypoxemia (CFH). Adaptation to CFH can be studied by Doppler velocity waveform on umbilical and fetal arteries and cardiotocography (CTG).

METHODS: Preterm delivery, as an elimination of CFH, has to be confronted with the risks of prematurity. A special situation may occur when CTG is normal at the absence of end-diastolic velocity (AEDV). AEDV in the umbilical artery precedes the onset of abnormal CTG, whose duration differs considerably among the fetuses. The time after the onset of AEDV in pregnancy may be utilized for performing exact diagnosis by fetal blood analysis.

CASE: Primigravida at 30 gestational weeks was referred because of IUGR. IUGR, AEDV, oligohydramnion, and normal fetal anatomy were revealed. CTG was normal. Indication for cordocentesis was to perform cord blood gases analysis and to obtain fetal caryotype. Cordocentesis revealed normal caryotype, values of pH, and fetal blood gases were considered satisfactory. Continuation of pregnancy was decided in spite of persistent AEDV. At 33 gestational weeks pathological CTG was an indication for induction of labor. Labor, delivery, umbilical blood gases, postpartal and neonatal outcome were normal.

CONCLUSION: In the case of fetal monitoring controversy assessment of umbilical blood analysis may be crucial. This examination is significant and independent of the interval between cordocentesis and the onset of CTG pathology. This interval may be utilized for intrauterine treatment and for optimizing obstetric management....

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Case Reports 2008; 29(5): 627-630 PubMed PMID: 18987586 Citation  Keywords:  Asphyxia Neonatorum:enzymology, Cardiopulmonary Resuscitation, Carnitine O-Palmitoyltransferase:deficiency, Heart Failure:etiology, Humans, Infant, Newborn, Male, Respiratory Insufficiency:etiology, Tandem Mass Spectrometry,.   

OBJECTIVES: To present a term newborn with severe asphyxial status due to dysrrhythmia induced by the neonatal form of carnitine palmitoyltransferase II deficiency (CPT II).

RESULTS: Term newborn delivered spontaneously (birth weight 3450 grams, birth length 52 cm, values of Apgar score 10/10) with good direct adaptation, on second day of life he manifested severe asphyxial status followed by cardiorespiratory insufficiency with circulatory failure. After prolonged resuscitation of 3 hours, the child was admitted to our neonatological department. Diagnosis of CPT II was confirmed (free carnitine level in blood 12.2 micromol/l; ratio (C16+C18):1/C2 was 0.760 by tandem mass spectrometry; activity of CPT II in leukocytes was 0.082 micromol/min x gram protein). After appropriate treatment the patient survived the critical period.

CONCLUSIONS: Neonatal form of CPT II deficiency is the most severe form and is considered to be invariably fatal. This kind of metabolic disease is congenital, but cardiac problems are not detectable during the prenatal period. Fasting in the early newborn period is a main trigger of CPT II deficiency signs. The authors emphasise the relevance of investigating acylcarnitine profiles and carnitine in serum in all cases of severe postnatal asphyxia and in cases of unusual newborn arrhythmias since some forms of disturbances in beta oxidation of fatty acids are partially treatable....

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Journal Article 2008; 29(4): 522-528 PubMed PMID: 18766163 Citation  Keywords:  Asphyxia Neonatorum:diagnosis, Brain:pathology, Electroencephalography, Humans, Hypoxia-Ischemia, Brain:diagnosis, Infant, Infant, Newborn, Prognosis,.   

INTRODUCTION: This study was based on foreign studies which confirmed the importance of amplitude-integrated electroencefalographic monitoring (aEEG) in the early prediction of the future neurological development of newborn infants with hypoxic syndrome. Our aim was to confirm the correlation between the type of aEEG trace and the level of brain damage in newborn infants in the early hours after the hypoxic event and to introduce this method into routine practice.

MATERIAL AND METHODS: With 56 newborn infants having suffered a perinatal hypoxic event (the average umbilical arterial pH was 6.95, the average BE value -17.3) and in 2 newborn infants after early postnatal hypoxia, aEEG monitoring was performed continually. The aEEG records of brain activity obtained were analyzed using the Hellström-Westas classification. The level of hypoxic-ischemic encephalopathy was evaluated according to the Sarnat-Sarnat classification. Assessment of future neurological development is not included in this work.

RESULTS: 12 (21%) of the 56 newborn infants did not develop any hypoxic-ischemic encephalopathy, 8 (14%) newborn infants had hypoxic-ischemic encephalopathy (HIE) grade I, 19 (35%) had HIE grade II and 17 (30%) had HIE grade III. The newborn infants without hypoxic-ischemic encephalopathy had normal or slightly abnormal aEEG trace. In the case of newborn infants who had HIE grade I, we recorded a normal or slightly abnormal aEEG trace. In the case of newborn infants who had HIE grade II, we recorded all types of aEEG trace--from normal to seriously pathological. Of the newborn infants who had HIE grade III, all had a pathological aEEG trace of "burst suppression patterns", low voltage pattern or flat trace pattern. The results show that if a newborn infant had a pathological type of aEEG trace in the early hours after a hypoxic event he or she later developed at least HIE grade II. 53% of the newborn infants with a flat aEEG trace later had HIE grade III.

CONCLUSION: Cerebral function monitoring is a non-invasive method used for the early assessment of the severity of a hypoxic event. As it could be used in the first few hours after birth, this method could be applied to select patients suitable for therapeutic hypothermia....

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Journal Article 2008; 29(4): 475-481 PubMed PMID: 18766148 Citation  Keywords:  Adult, Animals, Female, Humans, Infant, Newborn, Male, Neuroprotective Agents:metabolism, Reaction Time:physiology, Rh-Hr Blood-Group System:metabolism, Testosterone:blood, Toxoplasma:metabolism, Toxoplasmosis:physiopathology,.   

BACKGROUND: The biological function of RhD protein, a major component of the Rh blood group system, is largely unknown. No phenotypic effect of RhD protein, except its role in hemolytic disease of newborns and protective role against Toxoplasma-induced impairment of reaction times in men, has been described.

METHODS: Here we searched for a protective effect of RhD positivity against Toxoplasma-induced prolongation of reaction times in a set of 110 male and 226 female students of the Faculty of Science tested for latent toxoplasmosis and concentration of testosterone in saliva.

RESULTS: RhD-positive subjects have been confirmed to be less sensitive to the influence of latent toxoplasmosis on reaction times than Rh-negative subjects. While a protective role of RhD positivity has been demonstrated previously in four populations of men, the present study has shown a similar effect in 226 female students. Our results have also shown that the concentration of testosterone in saliva strongly influences (reduces) reaction times (especially in men) and therefore, this factor should be controlled in future reaction times studies.

CONCLUSIONS: The observed effects of RhD phenotype could provide not only a clue to the long-standing evolutionary enigma of the origin of RhD polymorphism in humans (the effect of balancing selection), differences in the RhD+ allele frequencies in geographically distinct populations (resulting from geographic variation in the prevalence of Toxoplasma gondii), but might also be the missing piece in the puzzle of the physiological function of the RhD molecule....

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Journal Article 2008; 29(4): 447-450 PubMed PMID: 18766145 Citation  Keywords:  Chorioamnionitis:pathology, Female, Fetal Membranes, Premature Rupture:pathology, Humans, Infant, Newborn, Infant, Newborn, Diseases:pathology, Inflammation:pathology, Perinatal Mortality, Placenta:pathology, Pregnancy, Pregnancy Complications, Infectious.   

BACKGROUND: PROM and pPROM and early onset neonatal sepsis negatively affect the neonatal perinatal mortality and morbidity.

OBJECTIVES: The target of the work was to evaluate the relationship between chorioamnionitis, funisitis and PROM, pPROM and the risk of early onset neonatal sepsis.

METHODS: We examined 152 samples of the placenta and umbilical cord, histologically and microbiologically, in 53 women without PROM, 52 women with PROM and 47 women with pPROM.

RESULTS: We demonstrated a statistically significant relationship of chorioamnionitis and funisitis to the risk of early-onset neonatal sepsis. We demonstrated no relationship between pathological findings in the placenta and PROM or pPROM.

CONCLUSIONS: The histological findings of an amniotic-type placentitis can particularly be used for supporting or possibly excluding the diagnosis of early onset neonatal sepsis....

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Journal Article 2008; 29(3): 292-294 PubMed PMID: 18580844 Citation  Keywords:  Abnormalities, Multiple:surgery, Adult, Amoxicillin:therapeutic use, Anti-Bacterial Agents:therapeutic use, Cesarean Section, Female, Humans, Infant, Newborn, Infant, Premature, Ischium:abnormalities, Kidney Function Tests, Laparotomy, Male, Pelvis:abnorm.   

: We present a case of a pregnancy in a 24 year old woman who was born with ectopia vesicae, split pelvis and hypoplasia of ischial bones. From childhood to adulthood she had undergone reconstructive surgeries of the abdomen and perineum, as well as urine diversion surgery. During pregnancy she experienced recurrent urinary tract infections which were treated with antibiotics. In spite of tocolysis, she delivered by cesarean section a premature baby boy at 35th week of gestation due to premature uterine contractions. The postoperative period was uneventful and they were discharged from the hospital in a good general condition....

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Journal Article 2008; 29(3): 303-311 PubMed PMID: 18580842 Citation  Keywords:  Adult, Amniotic Fluid:physiology, Bayes Theorem, Biomarkers, Cesarean Section, Cytokines:blood, Delivery, Obstetric, Female, Fetal Blood:chemistry, Humans, Infant, Newborn, Intercellular Adhesion Molecule-1:blood, Interleukin-6:blood, Interleukin-8:blood,.   

BACKGROUND: Intraamniotic infections negatively affect the mortality and morbidity in parturients and newborns. The prognosis of the disease is associated with a timely diagnosis of these conditions. One of approaches to providing timely information on the risk of the initiation of intra-amniotic infection and early-onset neonatal sepsis is the examination of cytokine levels.

OBJECTIVES: The purpose of the work was to evaluate the importance of the cytokines, IL-6, IL-8, and TNF-alpha, and the adhesive molecule, sICAM-1, as risk factors for early-onset neonatal sepsis and intra-amniotic infections.

METHODS: In a group of 152 women we sampled the blood from the umbilical cord vein immediately after delivery for the determination of the cytokines IL-6, IL-8 and TNF-alpha, and the adhesive molecule, sICAM-1, in newborns.

RESULTS: The sensitivity and specificity results are as follows, respectively: IL-6, 0.800 and 0.972; TNF-alpha, 0.364 and 0.943; IL-8, 0.875 and 0.965; and sICAM-1, 0.833 and 0.952.

CONCLUSIONS: For screening purposes, it is suitable to determine levels of IL-8, IL-6, and sICAM-1. For the screening examination, one of the cytokines mentioned is sufficient, i.e., IL-8 or IL-6, or the level of the adhesive molecule, sICAM-1. It is unnecessary to combine these markers....

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Journal Article 2008; 29(2): 201-204 PubMed PMID: 18404141 Citation  Keywords:  Adolescent, Adult, Aged, Aged, 80 and over, Aging:blood, Alopecia:blood, Child, Child, Preschool, Cohort Studies, Czech Republic, Dihydrotestosterone:blood, Humans, Infant, Infant, Newborn, Longevity:physiology, Male, Middle Aged, Prostatic Diseases:blood.   

OBJECTIVE: The dihydrotestosterone:testosterone ratio seems to be an important factor in the expression of androgenic activity, especially in the prostate and pilosebaceous unit. Whereas the decline of testosterone (T) in aging men is well known, controversial data can be found in literature concerning the age dependence of dihydrotestosterone (DHT) levels. Data from the database of the Institute of Endocrinology served as the basis for the definition of the life span curve for the ratio dihydrotestosterone : testosterone.

METHODS: The results of testosterone and dihydrotestosterone obtained immunoassays from 10 251 male patients were used in the construction of the curve.

RESULTS: The data show that after a peak of DHT:T in infancy and a subsequent decrease in puberty, the ratio of both androgens remains practically without change from approx. 20 years of age till old age.

CONCLUSION: High DHT:T ratio in infancy decreases at puberty and throughout the entire reproductive period of life this ration remains practically constant....

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