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Signa Vitae

A Journal In Intensive Care And Emergency Medicine

Tag: newborn (Page 1 of 2)

The role of nitric oxide in apoptosis modulation in newborns with pneumonia


Introduction. Nitric oxide (NO) is an important diagnostic marker and mediator in the inflammatory process, which plays a key role in the mechanism of programmed cell death, thus, forming the basis of many pathological diseases.

Methods. The study involved 73 newborns with pneumonia (moderate severity in 44 neonates (group 1), severe pneumonia in 29 (group 2)). The intensity of neutrophil apoptosis and necrosis was determined by flow cytometry, whereas nitric oxide metabolites were measured by spectrophotometry.

Results. The level of nitric oxide metabolites (NO2+NO3) in newborns with pneumonia was higher than in healthy children (16.93 (15.82; 17.79) μmol/ml) and correlated with disease severity (in group 1 – 22.65 (21.42; 23.40) μmol/ml in group 2 – 26.82 (25.81; 27.91) μmol/ml). The level of NO3 increased moderately, while NO2 generation was more intense, exceeding control indexes in both groups (рc1<0.001; рc2<0.001; р12<0.001).

The occurrence of intensive neutrophil apoptosis was revealed in newborns with pneumonia of moderate severity (рc1<0.001), while necrosis prevailed in severe pneumonia (рc2<0.001).

Inverse correlation (R=-0.63; р<0.05) was found between the level of nitric oxide metabolites and neutrophil apoptosis; and direct correlation (R=0.68; р<0.05) was revealed between NO metabolites and neutrophil necrosis indices.

Conclusions. Increased generation of nitric oxide metabolites, that directly correlated with disease severity in newborns with pneumonia, was found. NO2 has multidirectional effects on neutrophil apoptosis and necrosis, leading to toxic accumulation of neutrophils in the organism, thus enhancing the inflammatory and intoxication process that impact disease severity.

Key words: nitric oxide, apoptosis, necrosis, neutrophils, pneumonia, newborn

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Clonidine for neonatal abstinence syndrome: a single neonatology department’s experience


Clonidine has been shown effective in reducing sympathetic hyperactivity in neonatal abstinence syndrome (NAS). The aim of this study was to analyze clinical and laboratory characteristics of a group of newborns treated with clonidine for NAS due to maternal drug addiction and due to withdrawal from opioid analgesic therapy. Only one full–term newborn presented with metabolic acidosis and hyperkalemia; in others no clinical or laboratory adverse effects were detected. This report emphasizes the importance of alertness to potential adverse effects of clonidine therapy, and discusses possible pathophysiological aspects of hyperkalemia and metabolic acidosis during treatment for NAS.

Key words: newborn, sympathetic hyperactivity, metabolic acidosis, hyperkalemia

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Uncommon manifestations of neonatal group b Streptococcus infection: case report and literature review


Streptococcus agalactiae, also called Group B Streptococcus (GBS), is a common pathogen in the neonatal period that can cause early- and late-onset infections. The most common manifestations are bacteremia without an apparent focus of infection, pneumonia and meningitis. Additionally, GBS can rarely cause early- and late-onset infections with uncommon manifestations. If they go unrecognized, they may lead to inappropriate treatment and increased neonatal morbidity and mortality. In this article, a case report of an infant with early-onset GBS bullous impetigo is presented together with a short review of other uncommon manifestations of GBS infection.

Key words: Streptococcus agalactiae, infection, newborn

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Neonatal early onset sepsis due to Moraxella osloensis: Case-report and revision of the literature


We report the first case of early-onset systemic neonatal infection associated with Moraxella osloensis bacteriemia in a full term baby. The genus Moraxella is constituted by a group of pleomorphic bacteria obligate aerobes, Gram-negative, oxidase positive and indole negative infrequently isolated from clinical specimens. The organism is rarely reported in the literature as the causative agent of infection in humans, mostly in immunocompromised patients. Only 12 cases of M. osloensis-related infections during childhood have been reported in the literature so far. This unique report of M. osloensis infection, during the neonatal period, concerns the isolation of the bacteria in purulent secretions from the eyes of a 3-week-old baby with opthalmia. In our patient, the precocity of the onset of symptoms allows us to hypothesize a vertical transmission of the bacteria.

Key words: Moraxella, newborn, sepsis

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Umbilical Vein Catheterization – When Complications Occur A Case Report


Although umbilical venous catheterization is a routine procedure in premature newborns, it is associated with various, potentially life threatening, complications. We present a case of a premature baby diagnosed with a hepatic parenchymal liquid collection as a complication of umbilical vein catheterization in our Neonatal Intensive Care Unit.

The child was born in the 25th gestational week (GW) and was doing well until the12th day of life when his general condition deteriorated. He appeared anxious and his oxygen saturation (SaO2) decreased. There was slight abdominal distension and tenderness over the abdominal wall, with weak bowel movements, and a palpable liver. Abdominal ultrasound (US) showed an enlarged liver with a well-defined hypoechoic area, with inhomogeneous echogenicity. Such findings were suggestive of fluid extravasation to the liver through a malpositioned umbilical venous catheter. The umbilical catheter was withdrawn, antimicrobial treatment initiated, and eventual complete regression of the collection was seen eleven days after extravasation. Rapid, unexplained clinical deterioration of a newborn with an umbilical vein catheter should always raise the suspicion of a complication due to catheterization. Such a catheter should be carefully revised and, if there is any doubt, removed. Timely diagnosis and adequate treatment is essential, and potentially life-saving.

Key words: newborn, umbilical vein catheterization, complication, malposition, liver

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