Immunoglobulin and anti-Escherichia coli antibody in lower respiratory tract secretions from infants weighing less than 1500 g at birth

Article Abstract:

Premature infants often need assistance with breathing, and may develop respiratory infections during this period of respiratory support. Respiratory tract infections increase the risk of developing systemic infection, or infection of the entire body, which contributes to a high rate of disease and death among infants with low birth weights. Antibodies, or immune proteins, present in the secretions of infants protect against infection by preventing the attachment of foreign particles or by inactivating bacteria and their products. There is limited knowledge about the defense mechanisms present in the respiratory systems of newborns and older infants. The levels of the immune proteins called immunoglobulin A (IgA) and IgM in secretions from the airways increase with time after birth. Premature infants were shown to produce IgM antibody in the blood, which specifically acted against bacteria in the lower respiratory tract. The presence of specific antibodies in secretions of the lower respiratory tract and the relationship between antibody levels and time after birth are not known. In this study, the levels of various classes of Ig and specific antibodies to Escherichia coli (E. coli) were assessed in secretions from the lower respiratory tract of 33 premature newborns, born at an average of 27 weeks gestation. IgG was detected in 100 percent, IgA in 93 percent, and IgM in 79 percent of samples taken at birth. IgG antibodies to E. coli were present in 90 percent of samples, whereas IgM antibodies to E. coli were detected in 30 percent of samples at birth. IgA antibodies to E. coli were detected in 11 percent of samples at birth and in 50 percent by six weeks of age. IgA and IgM associated with secretory component were detected at birth and four weeks of age, whereas antibodies to E. coli associated with secretory component were detected in three of nine newborns at four weeks of age, but in none at birth. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Measurement, Growth, Immunoglobulins, Respiratory system, Respiratory organs

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Outcome after acute osteomyelitis in preterm infants

Article Abstract:

Eight preterm infants (born at an average age of 29 gestational weeks) with skeletal infections were studied, and their course followed for a period of several years thereafter. All had abnormally high levels of white blood cells, in addition to sepsis (systemic infection), as shown by the presence of bacteria in the blood. The patients were diagnosed as having skeletal sepsis (acute osteomyelitis); five were treated by drainage, and all were given antibiotic drugs. Although symptoms improved, concentrations of the antibiotic in the patients' blood did not rise to the therapeutic level and the number of bacteria did not decline to the desired point. At follow-up (between two and six years later), no signs of skeletal sepsis were detected. The X-ray records of six patients, taken at the time of initial disease, showed signs of skeletal infection, while those of two appeared normal. Such abnormalities have not been reported previously in the medical literature. Five patients developed long-term consequences, including different limb lengths, joint stiffness, or angular deformities. The magnitude of these changes was not associated with the severity of the initial infection or delay in treating it, which had been, on average, three days. Osteomyelitis in a well-nourished, full-term infant does not cause the systemic disease and sepsis that it does in premature neonates. In such cases, the long-term damage to bone is primarily the result of sepsis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Complications and side effects, Osteomyelitis

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Markers of serious illness in infants under 6 months old presenting to a children's hospital

Article Abstract:

Generally accepted standards of identifying and screening for serious illness in infants have not been established. This problem persists because precise definitions of symptoms of illness are not used when questioning parents about an infant's health. Over 50 signs and symptoms, noted in 641 infants taken to emergency rooms, were evaluated to determine which are most predictive of serious illness, that is, requiring hospital admission. The six symptoms most often associated with serious illness were: drowsiness, difficulty breathing, decreased activity, eating less than half the normal amount in 24 hours, having fewer than four wet diapers in 24 hours, and feeling hot while looking pale. Parents infrequently mentioned changes in babies' activity levels as reasons for needing medical care; they were more likely to report convulsions, coughing, vomiting, and other graphic symptoms. Other important signs found on the physical examinations of seriously ill infants included moderate to severe chest wall retraction when inspiring air, respiratory grunting (a sound associated with difficulty breathing), cold calves, and a tender abdomen. These results suggest that parents need to be taught that behavioral responses are more significant indicators of illness than coughing, vomiting, or diarrhea. The applicability of these markers of illness in other populations of children should be evaluated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Diagnosis, Testing, Education, Pediatric emergencies, Infants, Identification and classification, Parents, Critically ill children, Triage (Medicine)

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