[show abstract][hide abstract] ABSTRACT: BACKGROUND: The frequency of preterm labour has risen over the last few years. Hence, there is growing interest in the identification of markers that may facilitate prediction and prevention of premature birth complications. Here, we studied the association of the number of circulating stem cell populations with the incidence of complications typical of prematurity. METHODS: The study groups consisted of 90 preterm (23--36 weeks of gestational age) and 52 full-term (37--41 weeks) infants. Non-hematopoietic stem cells (non-HSCs; CD45-lin-CD184+), enriched in very small embryonic-like stem cells (VSELs), expressing pluripotent (Oct-4, Nanog), early neural (beta-III-tubulin), and oligodendrocyte lineage (Olig-1) genes as well as hematopoietic stem cells (HSCs; CD45+lin-CD184+), and circulating stem/progenitor cells (CSPCs; CD133+CD34+; CD133-CD34+) in association with characteristics of prematurity and preterm morbidity were analyzed in cord blood (CB) and peripheral blood (PB) until the sixth week after delivery. Phenotype analysis was performed using flow cytometry methods. Clonogenic assays suitable for detection of human hematopoietic progenitor cells were also applied. The quantitative parameters were compared between groups by the Mann--Whitney test and between time points by the Friedman test. Fisher's exact test was used for qualitative variables. RESULTS: We found that the number of CB non-HSCs/VSELs is inversely associated with the birth weight of preterm infants. More notably, a high number of CB HSCs is strongly associated with a lower risk of prematurity complications including intraventricular hemorrhage, respiratory distress syndrome, infections, and anemia. The number of HSCs remains stable for the first six weeks of postnatal life. Besides, the number of CSPCs in CB is significantly higher in preterm infants than in full-term neonates (p < 0.0001) and extensively decreases in preterm babies during next six weeks after birth. Finally, the growth of burst-forming unit of erythrocytes (BFU-E) and colony-forming units of granulocyte-macrophage (CFU-GM) obtained from CB of premature neonates is higher than those obtained from CB of full-term infants and strongly correlates with the number of CB-derived CSPCs. CONCLUSION: We conclude that CB HSCs are markedly associated with the development of premature birth complications. Thus, HSCs ought to be considered as the potential target for further research as they may be relevant for predicting and controlling the morbidity of premature infants. Moreover, the observed levels of non-HSCs/VSELs circulating in CB are inversely associated with the birth weight of preterm infants, suggesting non-HSCs/VSELs might be involved in the maturation of fetal organism.
[show abstract][hide abstract] ABSTRACT: Objective. The 1936G AKAP10 allele is associated with increased adult basal heart rate (HR) and decreased variability, markers of low cholinergic/vagus sensitivity associated with hypertension. Blood pressure (BP) values in newborns are important measurable markers of cardiovascular risk later in life. The question was whether decreased vagal function-related 1936A > G AKAP10 is associated with newborn BP. Study design. 114 healthy Polish newborns born after 37th gestational week to healthy women with uncomplicated pregnancies. At birth, newborn cord blood obtained for isolation of genomic DNA. BP and HR measured on days 1 and 3 after delivery. Results. Diastolic BP on day 3 and absolute and relative differences between diastolic BP values, as well as between mean BP values on day 3 and on day 1 after birth, in carriers of 1936G AKAP10 allele, were significantly higher as compared with wild-type homozygotes. Conclusion. Results demonstrate possible association between 1936G AKAP10 variant and BP in Polish newborns.
[show abstract][hide abstract] ABSTRACT: Objectives: The factors that influence the central nervous system (CNS) development can affect either the retina or the brain cortex. Immaturity of the brain cortex reflects immaturity of the retina and vice versa. The immature retina is more vulnerable than the mature retina, and is therefore more likely to develop retinopathy of prematurity (ROP). The aim of this study was to compare electroencephalographic brain maturity with ROP severity. Methods: Twenty-one prematurely born infants were divided into two groups according to the severity of ROP. The first group included 12 infants with ROP stage 3 or more and the second group included nine infants with ROP stage 2 or less. We have proposed an index of CNS maturity (M) as a percentage of interburst interval elongation compared with the norm using video-electroencephalography (vEEG). Results: The median M value was 1.07 (range = 0.43-4.44) for infants with severe ROP and -0.1 (range = -1.0 to 1.45) for infants with mild or no ROP (p = 0.000948). Conclusions: The study revealed that CNS maturation delay expressed as M value was higher among infants with severe ROP than among infants with mild or no ROP. EEG examination in prematurely born infants may prove to be a useful tool for predicting ROP development.
The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 05/2012; 25(11):2381-4. · 1.36 Impact Factor
[show abstract][hide abstract] ABSTRACT: Stimulation of the nervous system plays an important role in brain function and psychomotor development of children. Massage can benefit premature infants, but has limitations.
The authors conducted a study to verify the direct effects of massage on amplitude-integrated electroencephalography (aEEG), oxygen saturation (SaO(2)), and pulse analyzed by color cerebral function monitor (CCFM) and cerebral blood flow assessed by the Doppler technique.
The amplitude of the aEEG trend during massage significantly increased. Massage also impacted the dominant frequency δ waves. Frequency significantly increased during the massage and return to baseline after treatment. SaO(2) significantly decreased during massage. In four premature infants, massage was discontinued due to desaturation below 85%. Pulse frequency during the massage decreased but remained within physiological limits of greater than 100 beats per minute in all infants. Doppler flow values in the anterior cerebral artery measured before and after massage did not show statistically significant changes. Resistance index after massage decreased, which might provide greater perfusion of the brain, but this difference was not statistically significant.
Use of the CCFM device allows for monitoring of three basic physiologic functions, namely aEEG, SaO(2), and pulse, and increases the safety of massage in preterm infants.
American Journal of Perinatology 04/2012; 29(7):561-6. · 1.57 Impact Factor
[show abstract][hide abstract] ABSTRACT: The most common morbidities in preterm infants are associated with vascular pathology. Endothelial progenitor cells (EPCs) have been implicated in repair of the vasculature, but their role in the pathogenesis of prematurity complications is not clear.
We prospectively investigated an association between the number of EPCs circulating in blood during delivery as well as 2 and 6 weeks afterwards, the level of growth factors regulating their migration/homing, and the incidence of premature birth complications. Patients and methods: The study groups consisted of 90 preterm and 52 full-term infants. Early-EPCs (CD133+CD34+CD144+) and late-EPCs (CD133-CD34+CD144+) were analysed in cord blood (CB) and peripheral blood (PB).
We found higher early- and late-EPC counts in the CB of premature infants compared with full-term babies. The number of circulating early- and late-EPCs was inversely associated with the Apgar score of preterm infants. A positive association between the early-EPC count and the risk of respiratory distress syndrome, retinopathy of prematurity, bronchopulmonary dysplasia, and infections was found. Nevertheless, multivariate analysis revealed that a higher number of EPCs was not an independent predictor of prematurity complications, which were directly related to lower gestational age. The EPC count in full-term infants maintained a constant, relatively low level over the 6-week follow-up, whereas the EPC population in preterm infants gradually decreased during this period. Furthermore, the number of CB late-EPCs in preterm infants positively correlated with VEGF concentration.
EPCs may play a considerable role in vascular development in preterm infants.
Journal of Perinatal Medicine 01/2012; 40(4):455-62. · 1.95 Impact Factor
[show abstract][hide abstract] ABSTRACT: Cyclic adenosine monophosphate/protein kinase A (PKA) is important in embryonic development. The human AKAP10 gene is polymorphic: 1936A>G results in changes to a PKA-binding domain and increased targeting to mitochondria. Previous studies found G1936 as 'deleterious' in adults, and this study investigates whether this holds true in preterm birth.
Study group consisted of 80 preterm newborns (PTNs) born before the 38th gestation week. Control group consisted of 123 full-term healthy newborns born after the 37th gestation week with uncomplicated pregnancies. Genomic DNA was extracted from umbilical blood and AKAP10 genotypes were identified by PCR/restriction enzyme.
Significant differences in frequencies of 1936A>G genotypes/alleles between both groups were found. PTNs had increased frequency (55%) of AA homozygotes (odds ratio, AA versus AG+GG: 2.63 (95% confidence interval: 1.33 to 5.20), P=0.006) after adjustments: mothers with previous PTNs, smoking, first pregnancy, first delivery and Cesarean section.
Results suggest G1936 is preventative factor against preterm birth, in contrast with previously asserted negative effects in adults.
Journal of perinatology: official journal of the California Perinatal Association 06/2011; 32(3):230-4. · 1.59 Impact Factor
[show abstract][hide abstract] ABSTRACT: To conduct tests of relationships between different factors that could influence the course of retinopathy of prematurity (ROP) and ROP, particularly the role of hemoglobin variant replacement in adult blood transfusions.
A retrospective, observational study of 83 infants born between 23 and 34 wks gestation was conducted.
The infants without ROP, with 1 and 2 stage of ROP and with ≥ 3 stage of ROP received Q 28 (12-134); 51 (14-149); 156 (38-244) ml/kg of transfused blood, respectively, and the factor Qt was 1,545 (560-10,045); 3,093 (614-13,419); 11,907 (1,288-20,638) (ml/kg)·day, respectively. For the same groups MCV(35) (mean cell volume at the arbitrary time of the 35(th) wk post-conception) was 92.3 (82.9-110.5); 91.0 (79.3-101.4); 87.1 (80.2-94.8) fl, respectively, and factor P(MCV)/t was 99.5 (89.2-108.8); 96.3 (84.6-106.3); 90.7 (85.3-96.5) fl, respectively. There is high influence on the stage of ROP of the amount of transfused blood and MCV, both with or without the time factor. The statistical differences between P(MCV)/t were more significant than the differences between MCV(35), for different stages of ROP.
The influence of the time factor on the statistical differences of MCV but not on the amount of transfused adult blood suggests that HbF - HbA replacement may play a role in ROP development.
The Indian Journal of Pediatrics 06/2011; 78(12):1498-502. · 0.72 Impact Factor
[show abstract][hide abstract] ABSTRACT: To assess the impact of prenatal antibiotic treatment on procalcitonin (PCT) and C-reactive protein (CRP) concentrations in cord blood, and on the rate of positive neonatal blood cultures.
Neonates with early-onset infection (Group A; n=46) were compared with healthy controls (Group B; n=240). We evaluated the relationship between prenatal antibiotic therapy and early-onset infection, and for interactions with antibiotic therapy in the neonate immediately after birth.
In the Group A antibiotics were administered significantly more often prenatally and more often to neonates just after birth. The percentage of negative blood cultures in infected neonates was higher when antibiotic treatment was instituted prenatally. Differences in cord blood PCT and CRP concentrations were significant between both groups and were independent of prenatal antibiotic treatment. Streptococcus agalactiae was the most frequent species.
Almost one-third of neonates present with early-onset infection in spite of prenatal antibiotic therapy. Cord blood PCT and CRP measurements may be helpful in the diagnosis of infection also in cases when antibiotic therapy was started prenatally. Prenatal antibiotic administration reduced the number of positive blood cultures in neonates with early-onset infection and was associated with a greater rate of antibiotic treatment after birth in neonates without infection.
Journal of Perinatal Medicine 05/2011; 39(3):337-42. · 1.95 Impact Factor
[show abstract][hide abstract] ABSTRACT: Retinopathy of prematurity (ROP) is the primary cause of visual impairment in preterm infants. There are available data confirming that circulating endothelial progenitor cells (EPCs) are involved in forming the growing network of blood vessels in the developing retina. In this study we sought to explore potential relationship between concentration of circulating bone marrow-derived EPCs and development of ROP in prospective study.
The study groups consisted of 90 preterm (23-36 weeks of gestational age), and 52 full-term control infants. EPCs were analyzed in cord blood (CB) and subsequently in peripheral blood (PB) in second and sixth week since delivery. The incidence and stage of ROP was prospectively documented in the preterm infants.
EPC concentration in CB was considerably higher in the preterm infants developing ROP. In the preterm infants a noticeable decrease in PB EPC concentration within six weeks of the follow up was found, whereas in full-term infants EPC concentration was maintained at invariable level. Of note, in the sixth week since delivery, EPC concentration in preterm infants with ROP was lower compared to preterm infants without ROP.
Increase in CB EPC concentration in preterm infants, including those developing ROP, indicates that the circulating EPC cells contribute to the process of blood vessel formation, and their number in CB reflects the degree of prematurity. Impaired blood vessel formation within retina in the course of ROP may result from decrease in circulating EPC number observed at the sixth week since delivery.
[show abstract][hide abstract] ABSTRACT: To investigate the association among different circulating stem cell (SC) populations, the levels of selected growth factors and chemokines regulating SC migration in the peripheral blood, and the incidence of retinopathy of prematurity (ROP).
We evaluated 88 participants in this study: 29 preterm infants with ROP, 29 preterm infants without ROP, and 30 healthy full-term infants. Peripheral blood samples collected 10 weeks after delivery were analyzed using flow cytometry, immunofluorescence, real-time reverse transcriptase-polymerase chain reaction, and enzyme-linked immunosorbent assay. The following cell populations were analyzed: (1) lin⁻CXCR4(+)CD45⁻ (enriched in very small embryonic-like SCs), (2) lin⁻CXCR4(+)CD45(+) (enriched in hematopoietic SCs), and (3) CD34(+)CD133(+)CD144(+) (early endothelial progenitor cells) [lin indicates lineage]. The concentrations of vascular endothelial growth factor, basic fibroblast growth factor, hepatocyte growth factor, and stromal cell-derived factor 1 were measured in the plasma.
The very small embryonic-like SCs and early endothelial progenitor cells expressing neural and endothelial markers were significantly increased in the preterm infants. The number of early endothelial progenitor cells in the peripheral blood was significantly greater in the preterm infants with ROP than in the preterm infants without ROP. An accompanying increase in the concentrations of vascular endothelial growth factor and hepatocyte growth factor was found in the peripheral blood of the preterm infants with ROP. No significant associations were found between hematopoietic SCs and ROP or prematurity.
The increased number of early endothelial progenitor cells along with elevated levels of vascular endothelial growth factor and hepatocyte growth factor in preterm infants with ROP suggest that circulating vasculogenic factors may play a role in the development and progression of ROP. The increased number of very small embryonic-like SCs in preterm infants suggests that the development of immature tissues and organs, including the retina, may require a contribution of circulating SCs.
Archives of ophthalmology 10/2010; 128(10):1311-9. · 3.86 Impact Factor
[show abstract][hide abstract] ABSTRACT: The premature child with active retinopathy was submitted to regular ophthalmologic control including evaluation of the anterior as well as fundus of the eye by employing RetCam apparatus and Fisson ophthalmoscope with 28.0 Dptr lens. Additionally, at all events the B mode ultrasonographic examination of the eye bulb was performed using Echo Scan 300 Oculus apparatus. The Ocu-Light SL diode laser (Iris Medical) of 810 nm wave length was employed in the treatment. Regular ophthalmologic observations revealed the limited success in laser therapy and cryotherapy within one eye. Unfortunately, the administration of BCG vaccine occurred to be the triggering factor responsible for initiation of inflammatory response and final failure of the treatment with the following detachment of retina in this eye. BCG vaccination, which seems to be the potential cause of the deterioration of the active retinopathy in preterm infants, should be delayed until the ophthalmologic status is improved.
Journal of Experimental Marine Biology and Ecology - J EXP MAR BIOL ECOL. 01/2008; 83(3):290-294.
[show abstract][hide abstract] ABSTRACT: The usefulness of vaginal fluid proinflammatory cytokine assays in the prediction of neonatal congenital infection was evaluated. Sixty-two women between 24 and 34 weeks of pregnancy, complicated by premature rupture of the membranes, were divided into those who delivered newborns with (n = 21) and without (n = 41) signs of infection. Concentrations of all studied cytokines were higher in women who delivered babies with infection. The cutoff values of interleukin-1alpha (IL-1alpha) and IL-1beta > or = 400, IL-6 > or = 2000, and IL-8 > or = 2100 pg/mL predicted infection with a sensitivity of 57%, 57%, 33%, and 76%, a specificity of 73%, 73%, 93%, and 59%, a positive predictive value of 52%, 52%, 70%, and 48%, and a negative predictive value of 77%, 77%, 73%, and 83%, respectively. Receiver operating characteristic (ROC) curve analysis revealed that the predictive performance of the four studied cytokines was comparable. In conclusion, vaginal fluid cytokines after premature rupture of the membranes have moderately predictive value of whether or not a neonate will develop early sepsis.
Journal of Interferon & Cytokine Research 06/2007; 27(5):393-8. · 3.30 Impact Factor
[show abstract][hide abstract] ABSTRACT: Our aim was to compare maternal serum concentrations of interleukin(IL)-1alpha IL-1beta, IL-6 and IL-8 in pregnancies complicated by preterm labor (PTL), with the levels in healthy controls at comparable gestational age, and to determine if these assays have any value in the prediction of early-onset neonatal infection or histological chorioamnionitis. The study population consisted of 65 women with new-onset PTL, and 31 healthy controls. Maternal serum concentrations of IL-6 (8.40 versus 3.30 pg/mL; p = 0.002) and IL-1beta (2.20 versus 0.50 pg/mL; p = 0.003) were significantly higher in patients with PTL as compared to healthy pregnant women. The IL-1beta concentration (13.60 versus 1.20 pg/mL; p = 0.02) was significantly higher in the serum of mothers whose babies developed early-onset infections, than in mothers of newborns that were healthy. However, its predictive value, and the value of the other cytokines studied, was poor. In addition, IL-1beta levels (28.79 versus 5.19 pg/mL; p = 0.001) were significantly higher in patients with histological chorionamnionitis, than in those without the condition,. The cut-off value of >or= 14 pg/mL predicted inflammatory changes with a sensitivity of 80%, specificity of 86%, PPV of 80% and NPV of 86%. IL-1beta seems to be of moderate value in the prediction of histological chorioamnionitis.
European cytokine network 06/2007; 18(2):102-7. · 1.90 Impact Factor
[show abstract][hide abstract] ABSTRACT: ROP--retinopathy of prematurity is a disease of the retina and the vitreous body of premature infants, especially born before 28 weeks of intrauterine life (71%), rare till 33 weeks of pregnancy (7.6%). The pathogenesis is involved with damage of immature vessels of the retina. The disease seems to self-regress in 80%. According to stage of changes of the retina there could be some complications of the organ of vision like: refractive errors, disturbances of eyeball movement, poor vision or even blindness (19.01%). ROP is now second (after atrophy of the optic nerve) cause of blindness in children (3). Aim of our study was the analysis of the results of laser-treatment in ROP in West Pomeranian region in years 2003-2005 and estimation of the risk factors of advanced stages of ROP.
Since January 2003 to June 2005 in Outpatients Clinic for Premature Infants of the Ophthalmology Department of The West Pomeranian Medical University in Szczecin we have examined 708 children. 40 premature infants (78 eyes) were treated with panphotocoagulation of the retina because of advanced ROP We have used the Ocu-Lights SL laser, manufactured by Iris Medical.
Laser treatment caused regression of ROP in 88.5% of children. In 11.5% the progression of ROP caused secondary retina detachment.
Respiratory failure, anemia, infections and multi-organ inflammations increase the risk of ROP Good results of laser treatment depend of beginning of the therapy in the right stage of ROP On the final results of treatment could have got the influence both: immaturity of the child and the showed risk of factors.
[show abstract][hide abstract] ABSTRACT: Pneumocystis jiroveci (P. jiroveci) is the etiological agent of pneumocystis pneumonia (PCP) in immunodeficient patients. The increased interest of clinicians in this particular pathogen during the past decade was prompted by rising numbers of patients with immunosuppression caused by AIDS, chemotherapy, or organ transplantation. Premature, seriously ill infants at intensive care units constitute a potential risk group for infection with P. jiroveci. Recent advances in medical sciences, owing mainly to developments in molecular biology, permitted the verification of the taxonomic position of pathogens and contributed to a better understanding of new aspects of pathophysiology and pathogenesis of PCP. It has been demonstrated that the genus Pneumocystis represents a heterogeneous group of opportunistic fungi exhibiting narrow host specificity. Pneumocystis jiroveci is the species which is specific for humans. The present paper outlines the clinical symptoms of PCP in infants, currently used diagnostic methods, and treatment procedures in PCP.
Annales Academiae Medicae Stetinensis 02/2006; 52(2):65-70; discussion 70.
[show abstract][hide abstract] ABSTRACT: The authors described the rare case of the progression of changes in the retina of child in course of retinopathy of prematurity. It happened after finished laser-treatment and full regression of changes of the retina. It seems that BCG vaccination done in 3-th month of life could reactivate the disease of the retina which caused total retina detachment of both eyes.
The ophthalmologic examination included: indirect ophthalmoscopy using Fisson ophthalmoscope, slit-lamp examination and USG B-mode examination, using USG Echo Scan 3300 Oculus with the head 10 MHz--performed during all control visits.
The regular ophthalmologic examination enabled estimation of the dynamic of changes in the retina and correctness of treatment. In author's opinion, the secondary retina detachment in 3-th month of life could be associated with reaction post BCG vaccination.
Probably secondary inflammation after BCG vaccination could be the reason of reactivation of earlier treated with good results ROP Possible vision complications should incline to take special ophthalmologic care of premature infants from high risk group (very low mass of the body or fetal immaturity). Decision of changing time of BCG vaccination in such group should be made by attending physician.
[show abstract][hide abstract] ABSTRACT: Background: Red blood cell (RBC) transfusions performed over 5 years in a neonatal ward were retrospectively analyzed. Despite the fact that �fresh� RBC smallvolume transfusions given to preterm infants are called �traditional� or even �historic�, this method of treatment is still used in all neonatal wards in Poland. Patients and Methods: A total of 846 RBC units were transfused to 216 patients, including 26 term and 190 preterm neonates. The transfusion rate and donor exposure rate were calculated. The same parameters were calculated for hypothetical use of blood satellite packs for transfusions in the analyzed patients and compared with the original data. Results: Application of a limited donor program could diminish the donor exposure rate more than twofold, from 3.5 to 1.63, in the very-low-birth-weight infants group and reduce the maximum number of donors from 11 to 3, at the same transfusion rate of 5.35. Conclusion: Introduction of strict RBC transfusion guidelines and a limited-donor blood program would improve transfusion therapy.
Transfusion Medicine and Hemotherapy - TRANSFUS MED HEMOTHER. 01/2006; 33(6):515-519.