<p>Glucose is the most important fetal nutrient and the production of this substrate increases in the pregnant woman. In the last trimester the increased insulin resistance directs energy substrates to the fetus. Fetal growth is sometimes disturbed, often without an obvious explanation.</p><p>After birth the newborn infant must produce its own glucose, primarily for the brain. Fatty acids from lipolysis are also important energy substrates. Hypoglycaemia can be a problem, occurring frequently in preterm infants and infants born small for gestational age (SGA). In addition, SGA infants are at risk of developing the metabolic syndrome in adulthood. Neonatal medication can influence energy metabolism. One such medication is theophylline, administered in preterm infants to prevent apnoea. </p><p>We investigated energy substrate production in women with normal and IUGR pregnancies, in preterm neonates, before and after theophylline treatment and in newborn SGA infants, using stable isotope-labelled compounds and gas chromatography-mass spectrometry. </p><p>We found that late pregnancy was associated with an almost twofold increase in the rate of lipolysis. This provides substrates for maternal energy metabolism, which may spare glucose for the fetus. Even though glucose production was comparable in the two groups of pregnant women, those with IUGR had a lower rate of lipolysis. A reduced supply of energy substrates could be one factor underlying IUGR. In spite of the insulin resistance of late pregnancy, insulin still had a regulatory role in energy substrate production in the women with normal pregnancies, but not in those with IUGR. </p><p>Although infants born preterm and/or SGA have limited energy stores, we demonstrated that they are capable of both lipolysis and glucose production. Theophylline had no adverse effects on energy substrate production. Data on insulin and IGFBP-1 in the SGA infants indicate that in such infants insulin sensitivity is increased peripherally but reduced in the liver.</p>

<p><b>Background. </b>Newborn infants, especially preterm infants, have an increased susceptibility to serious and overwhelming bacterial as well as fungal infections. Symptoms of septicaemia in especially the very preterm neonates are vague and unspecific. No really good biochemical parameter exists today that can confirm or exclude the existence of neonatal septicaemia. The access to such a test in neonates would be most valuable, not only to assure early institution of effective antibiotic therapy when needed, but also to avoid unnecessary use of antibiotics, thereby reducing the risk of further development of antimicrobial resistance. </p><p><b>Aim. </b>To investigate the possible use of the expression of the phagocyte receptor CD64 (FcγRI) on neutrophils for early diagnosis of bacterial infections with special reference to neonatal septicaemia. </p><p><b>Results. </b>Neutrophils from preterm and term newborn infants, older infants, children, and adults examined during the early phase of a bacterial infection showed a significantly higher expression of CD64 compared with non-infected controls (p<0.001). Neutrophils from even extremely preterm infants expressed CD64 to the same extent as did neutrophils from children and adult patients. The expression of CD64 was not affected by the respiratory distress syndrome (RDS) or by such factors as premature rupture of the membranes, gestational age, steroid treatment before delivery, method of delivery, birth weight or postnatal age.</p><p>Major surgery in adults (total hip replacement) did not affect the CD64 expression to an extent comparable to that found during bacterial infections. Indirectly CD64 was found to be at least equal to CRP for differentiation between Influenza A infection and bacterial infections in adults.</p><p><b>Conclusion.</b> CD64 was found to be a specific and reliable marker for early detection of bacterial infections in preterm and term newborn infants, as well as after surgery. For differentiation between bacterial and viral infections it is probably at least as effective as CRP.</p>

Until first half of the XX century, sickle cell disease was practically limited to the malaria endemic areas and countries having known an important surge of African slaves. Today, migratory flows and progress of medicine have modified considerably the distribution of sickle cell disease which is from now on a frequent affection in Western Europe. The preventive implementation of medical care makes it possible to reduce morbidity and mortality associated with this pathology. Stake of a medical policy and economic interests, neonatal screening for hemoglobin disorders justifies then fully the implementation of powerful and adapted means. In order to initiate a newborn screening programme in our centre, we developed various immunological tests allowing to identify the sickle hemoglobin. We first of all developed an indirect immunoassay and led a population study on 46082 Belgian newborns and 1825 neonates from Central Africa. The performances of this assay were improved thereafter by conceiving a competitive test. Next, for reasons independent of our will, we had unfortunately to abandon the immunological approach. This methodology was thus supplanted in our center by an innovative method for this indication: the mass spectrometry. Our promising results currently authorize us to perennialize our policy in the neonatal screening for sickle cell disease and open the way for new developments in other fields. / Jusquà la première moitié du XXe siècle, la drépanocytose se limitait pratiquement aux zones dendémie palustre et aux pays ayant connu un important afflux desclaves dorigine africaine. Aujourdhui, les flux migratoires et les progrès de la médecine ont considérablement modifié la distribution de cette maladie qui est désormais une affection fréquente en Europe occidentale. La prise en charge précoce permet de réduire la morbidité et la mortalité associées à cette maladie. Enjeu dune politique sanitaire et dintérêts économiques, le dépistage néonatal de la drépanocytose justifie donc ainsi pleinement la mise en uvre de moyens performants et adaptés. Afin dinitier un programme de dépistage au sein de notre centre, nous avons initialement développé divers tests immunologiques permettant didentifier lhémoglobine anormale. Nous avons tout dabord mis au point un immunoessai indirect et conduit une étude de population sur 46082 nouveau-nés belges et 1825 bébés originaires dAfrique centrale. Les performances de lessai ont par la suite été améliorées en concevant un test compétitif. Lapprovisionnement laborieux danticorps nécessaires aux tests de détection a par la suite entravé notre programme. En effet, la commercialisation en a été interrompue et la production danticorps monoclonaux par nos moyens propres na pas été couronnée du succès escompté. Lapproche immunologique du dépistage néonatal de la drépanocytose a ainsi été supplantée dans notre centre par une méthode novatrice pour cette indication : la spectrométrie de masse. Nos résultats prometteurs nous autorisent actuellement à pérenniser notre nouvelle façon de faire dans le dépistage néonatal de la drépanocytose et ouvre la voie pour de nouveaux développements dans dautres domaines.

Glucose is the most important fetal nutrient and the production of this substrate increases in the pregnant woman. In the last trimester the increased insulin resistance directs energy substrates to the fetus. Fetal growth is sometimes disturbed, often without an obvious explanation. After birth the newborn infant must produce its own glucose, primarily for the brain. Fatty acids from lipolysis are also important energy substrates. Hypoglycaemia can be a problem, occurring frequently in preterm infants and infants born small for gestational age (SGA). In addition, SGA infants are at risk of developing the metabolic syndrome in adulthood. Neonatal medication can influence energy metabolism. One such medication is theophylline, administered in preterm infants to prevent apnoea. We investigated energy substrate production in women with normal and IUGR pregnancies, in preterm neonates, before and after theophylline treatment and in newborn SGA infants, using stable isotope-labelled compounds and gas chromatography-mass spectrometry. We found that late pregnancy was associated with an almost twofold increase in the rate of lipolysis. This provides substrates for maternal energy metabolism, which may spare glucose for the fetus. Even though glucose production was comparable in the two groups of pregnant women, those with IUGR had a lower rate of lipolysis. A reduced supply of energy substrates could be one factor underlying IUGR. In spite of the insulin resistance of late pregnancy, insulin still had a regulatory role in energy substrate production in the women with normal pregnancies, but not in those with IUGR. Although infants born preterm and/or SGA have limited energy stores, we demonstrated that they are capable of both lipolysis and glucose production. Theophylline had no adverse effects on energy substrate production. Data on insulin and IGFBP-1 in the SGA infants indicate that in such infants insulin sensitivity is increased peripherally but reduced in the liver.

<b>Background. </b>Newborn infants, especially preterm infants, have an increased susceptibility to serious and overwhelming bacterial as well as fungal infections. Symptoms of septicaemia in especially the very preterm neonates are vague and unspecific. No really good biochemical parameter exists today that can confirm or exclude the existence of neonatal septicaemia. The access to such a test in neonates would be most valuable, not only to assure early institution of effective antibiotic therapy when needed, but also to avoid unnecessary use of antibiotics, thereby reducing the risk of further development of antimicrobial resistance. <b>Aim. </b>To investigate the possible use of the expression of the phagocyte receptor CD64 (FcγRI) on neutrophils for early diagnosis of bacterial infections with special reference to neonatal septicaemia. <b>Results. </b>Neutrophils from preterm and term newborn infants, older infants, children, and adults examined during the early phase of a bacterial infection showed a significantly higher expression of CD64 compared with non-infected controls (p&lt;0.001). Neutrophils from even extremely preterm infants expressed CD64 to the same extent as did neutrophils from children and adult patients. The expression of CD64 was not affected by the respiratory distress syndrome (RDS) or by such factors as premature rupture of the membranes, gestational age, steroid treatment before delivery, method of delivery, birth weight or postnatal age. Major surgery in adults (total hip replacement) did not affect the CD64 expression to an extent comparable to that found during bacterial infections. Indirectly CD64 was found to be at least equal to CRP for differentiation between Influenza A infection and bacterial infections in adults. <b>Conclusion.</b> CD64 was found to be a specific and reliable marker for early detection of bacterial infections in preterm and term newborn infants, as well as after surgery. For differentiation between bacterial and viral infections it is probably at least as effective as CRP.

Thesis (M.Sc.)--Memorial University of Newfoundland, 2000. / Bibliography: leaves 66-77.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009. / Härtill 4 uppsatser.

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2010. / Härtill 3 uppsatser. På spikbladet med titel : Inflammation in experimental neonatal brain injury and in a clinical study of preterm birth : involvement of galectin-3 and free radical formation.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009. / Härtill 4 uppsatser.

Dissertation (Ph.D.)--University of South Florida, 2008. / Includes vita. Includes bibliographical references. Also available online.