We prospectively determined serum concentrations of soluble intercellular adhesion molecule 1 (sICAM-1) in the first 2 weeks of life in 32 preterm newborns in an attempt to assess whether these concentrations are reliable markers of sepsis in newborns at risk of infection. Ten of the study group were normal and had been hospitalized only for low birth weight. The remaining 22 presented respiratory distress (RDS) and were at even higher risk of infection because they required assisted mechanical ventilation and central venous catheterisation for parenteral feeding and infusion therapy. Sepsis was diagnosed in 11/22 newborns with RDS: in 3 on day 3 and in 8 on day 7. Circulating sICAM-1 concentrations were significantly elevated in neonates with RDS (group II) and associated infection (group III) compared with normal newborns (group I). However, after day 3 of life sICAM-1 values were significantly higher in group III than in group II.

Systemic Candida A. infections are increasing in Neonatal Intensive Care Units. For many years, Amphotericin B, alone or in combination with 5-fluorocytosine, have been used. Recently a search for new and less toxic drugs has been started. In this study we report the case of hepatic candidosis in a preterm newborn. The patient has been treated with itraconazole, an oral antifungal agent with broad spectrum activity. Its tolerance has been good. No severe side effects were observed and biochemical parameters showed no consistent drug induced effects.

Plasma fibronectic (pFN) is a high molecular weight multifunction glycoprotein, which augments neutrophil and macrofage phagocytosis and acts as a nonspecific opsonin for the reticuloendothelial system. In this study we have determined pFN concentrations in fifty eight preterm infants to discriminate infected from non infected ones. Concentrations of pFN decreased from baselin in babies with early or late onset infections. The changes in pFN concentrations were not found before sepsis, but on day 1. By day 5 pFN concentrations have increased and have been no longer different from controls. We have calculated sensitivity (73.68%), specificity (74.36%), positive (58.35%) and negative (85.29%) predictive values of pFN and of other markers of infections (C-reactive protein--CRP-, Immature/Mature neutrophil ratio--I/M n. ratio-). Adding these tests to pFN, provided equal specificity and positive predictive value, but increased sensitivity (94.73%) and negative predictive value (96.43%). Thus, low concentrations of pFN may be a valuable but not early marker for neonatal infections. The combination of pFN, CRP and I/M n. ratio increase the precision of diagnostic testing.

Systemic Candida Albicans infections in premature newborns are characterized by high morbidity; early diagnosis and immediate treatment are therefore necessary. In this study we report the cases of fourteen newborns admitted to our Newborn Care Unit in a three-year period, in whom candidiasis was diagnosed. The mycetes was isolated from blood, liquor, peritoneal fluid, urine, oesophageal aspirate. Treatment was undertaken immediately with fluconazole, administered through the parenteral route or locally into peritoneal cavum and oesophageal stump. Duration of treatment varied from five to twenty-one days. All cases underwent complete negativization of cultures and no systemic or local side effects.