Intravenous immunoglobulin to treat neonatal alloimmune haemolytic disease

Objective: To compare the efficacy of intravenous immunoglobulin (IVIg) and exchange transfusion (EXT) on rhesus haemolytic disease of the newborn (Rh-HDN) and evaluate treatment-related side effects. Methods: Retrospective chart review of two cohorts of newborns with Rh-HDN, treated with (Group 2) or without (Group 1) IVIg. Length of phototherapy, number of EXT, IVIg infusions, intrauterine and top-up red blood cells transfusions, need and permanence of umbilical venous catheter, and length of hospital stay, as well as treatment-related adverse events, were evaluated. Results: Charts of 88 newborns were reviewed (34 in Group 1, 54 in Group 2). Infants in Group 2 received a significantly lower number of EXT, had a lower risk of neurological impairment and needed an umbilical venous catheter for shorter, but required longer phototherapy, longer length of hospital stay, and more top-up transfusions. EXT was associated with a high number of adverse events. Two newborns treated with IVIg developed necrotizing enterocolitis (NEC). Conclusions: IVIg appear as an effective alternative to EXT, reducing the risk of neurological impairment and complications related to EXT. However, side effects of IVIg treatment (higher need of top-up transfusions and longer hospital stay) should be taken into account and the risk of NEC should be carefully monitored during treatment.     

Hypoplastic left heart syndrome: to treat or not to treat.

OBJECTIVE: To review our experience in managing infants with hypoplastic left heart syndrome (HLHS) and to establish a consistent approach in counseling families based on our experience and on review of medical literature. METHODS: Infants were divided into three group periods based on significant changes in the approach to treatment. After a diagnosis of HLHS was made, a multidisciplinary team met the family to discuss different management options: compassionate care, active treatment by heart transplantation, or Norwood staged surgery. RESULTS: Parents of 58 infants (58%) opted for compassionate care, and 41 (42%) opted for active treatment. Seven infants underwent heart transplantation and all remain alive. A total of 27 infants underwent Norwood stage I, and 19 (70%) survived. There was a significant increase in parental choice for active treatment over the three time periods. CONCLUSION: These results indicate that HLHS can no longer be regarded as a uniformly fatal congenital anomaly. However, due to uncertainty about long-term outcome, discussion with parents should be open, and compassionate care should be presented as a management option until long-term data are available.     

Urinary tract infections in pregnancy: when to treat, how to treat, and what to treat with

Urinary tract infections (UTI) in pregnant women are a relatively frequent occurrence and the spectrum of these infections ranges from lower urinary tract disease (asymptomatic bacteriuria, acute cystitis) to upper urinary tract disease (acute pyelonephritis). Anatomical and functional changes in the urinary tract in pregnancy result in significantly higher susceptibility to progression of the infection from asymptomatic bacteriuria to the stage of acute pyelonephritis. Untreated asymptomatic bacteriuria in pregnancy leads, in as much as 40%, to the development of acute pyelonephritis with all the subsequent negative effects not only for the woman herself, but particularly for the fetus. Bacteriuria in pregnancy accounts for a significantly higher number of newborns with a low birth weight, low gestational age and higher neonatal mortality rate. Therefore, it is necessary to perform screening for bacteriuria in pregnant women and, when the finding is positive, to treat this bacteriuria. The selection of an appropriate antimicrobial agent to treat urinary tract infection in pregnancy is limited by the safety of a given drug not only for the woman, but particularly for the fetus. The article provides an overview of medications that can be safely used throughout the pregnancy or only in certain stages of pregnancy. The selection of an appropriate antibiotic should always be preceded by the result of urine culture. The article presents the principles and rules for treating asymptomatic bacteriuria, acute cystitis and acute pyelonephritis in pregnant women.     

Biochemistry of neonatal cord blood following intrapartum glucose and oxytocin infusion

The effect of intrapartum glucose and oxytocin infusion on the biochemical values of umbilical cord blood including Na, K, Cl, Ca, P, glucose, BUN and osmolality was studied in 246 newborns. The newborns were divided into 4 groups: Group 1 consisted of 162 babies whose mothers did not receive any intravenous infusion. Group 2. 53 babies, Group 3. 16 babies and Group 4.15 babies whose mothers received infusion of oxytocin in glucose (5U/L). The total amounts of infusion were less than 500 ml in Group 2. 500ml in Group 3. 500-1,000 ml in Group 4. Group 3 were delivered with forceps. In comparison with Group 1, the serum K+ in Group 2 and Cl- values in Group 4 were lower while the glucose values were higher in Groups 2, 3 and 4 (highest in Group 3). The other values were not significantly different.     

The effect of oxytocin infusion and misoprostol on neonatal bilirubin levels

Purpose  

To investigate the association of neonatal bilirubin levels with oxytocin and misoprostol use for labour induction.     

The effect of oxytocin infusion and misoprostol on neonatal bilirubin levels

Purpose

To investigate the association of neonatal bilirubin levels with oxytocin and misoprostol use for labour induction.

Methods

A total of 100 neonates were included in the study. The first group consisted of 50 healthy babies of women who had received oxytocin infusion, and the second group consisted of 50 healthy babies of women who had received 25 μg misoprostol every 4 h placed in the posterior fornix for labour induction. Bilirubin and haematocrit levels were measured in all on days 1 and 4 of the neonatal period.

Results

The levels of bilirubin in the oxytocin group were significantly higher than those in the misoprostol group on day 1 [4.42 ± 0.27 vs. 3.55 ± 0.28 mg/dl (P = 0.035)] while they were higher also on day 4 but not significantly so [7.47 ± 0.63 vs. 6.86 ± 0.65 mg/dl (P = 0.525)]. The mean haematocrit levels on day 1 were 50.62 ± 1.23 and 58.04 ± 1.30 in groups 1 and 2, respectively, with a significant difference between them. The levels were 52.31 ± 1.27 and 58.96 ± 1.14 on day 4 and the difference was again significant. P < 0.05 indicated statistical significance.

Conclusions

Labour induction with misoprostol and oxytocin does not seem to have harmful effects on bilirubin levels in the neonate.     

Short-term responses in neonatal lambs after infusion of group B streptococcal extract

Short-term (0 to 30 minutes) physiologic responses of neonatal lambs infused with a trichloroacetic extract of a type III (strain 878) group B streptococcus (878-TCA) were studied. Bolus injections of 878-TCA were associated with pulmonary hypertension, peripheral arterial hypoxemia, and reductions in circulating white blood cell and platelet counts. These events were associated with a rise in plasma levels of prostaglandins F2 alpha and E and could be prevented by proper treatment with ibuprofen. Continuous infusions of 878-TCA were associated with a dose-dependent rise in systemic and pulmonary arterial pressures and a fall in arterial PO2. During infusion, inhibition of prostaglandin synthesis resulted in a return toward preinfusion values. The authors conclude that venous infusions of extracts of 878-TCA induce significant pulmonary and systemic arterial vascular perturbations in the neonatal lamb and that some of these alterations are associated with the release of prostaglandins or other arachidonic acid metabolites.     

Cardiopulmonary resuscitation and epinephrine infusion in extremely low birth weight infants in the neonatal intensive care unit.

BACKGROUND: Survival of extremely low birth weight (ELBW) infants has improved significantly; however, the aggressiveness of treatment in these infants remains controversial. Critical appraisal of the benefits of cardiopulmonary resuscitation (CPR) and intravenous epinephrine infusion (IV EPI) has not been studied in this population. OBJECTIVE: To determine if either CPR or continuous IV EPI in NICU is of benefit for surviving in a selected population of infants weighing 1.0 mcg/kg/hour intravenously died. CONCLUSIONS: In view of the poor survival after either CPR or high-dose IV EPI in infants 相似文献   

How to treat IUD complications

Contraindications to the use of an IUD are pregnancy, uterine malformation, nulliparity, and genital infection. IUD users must see a doctor regularly. Short-term complications are uterine perforations at time of insertion, a very rare occurrence in the hands of a skilled clinician. Long-term complications are pregnancy, ectopic pregnancy, and genital or pelvic infection, the most serious of all complications, and one which must be immediately treated, usually with antibiotics. Expulsion or translocation of the device are also possible; in this last case the IUD must be located and surgically removed. The most common side effect of IUD use is excessive bleeding, which can be successfully treated with ergot alkaloids.     

Iatrogenic neonatal and maternal hyponatraemia following oxytocin and aqueous glucose infusion during labour

Summary. Maternal and umbilical cord serum sodium and osmolality were studied prospectively in 140 deliveries to investigate whether transplacental hyponatraemia, seen following oxytocin infusion during labour, was due to the antidiuretic effect of oxytocin or was secondary to the infusion of aqueous glucose used as a vehicle for oxytocin, or both. Forty-five women received oxytocin in aqueous glucose for induction or augmentation of labour (oxytocin group), 43 received aqueous glucose infusion alone (glucose group) and 52 did not receive any intravenous infusions (control group). Mean cord sodium levels were significantly lower in the oxytocin (131·4, SD 3·6 mmol/l) and glucose groups (132·5, SD 3·2 mmol/l) than in the control group (135·0, SD 3·0 mmol/l). Hyponatraemia (Na <130 mmol) was seen in 47% and 30% of the infants in the oxytocin and glucose groups respectively, in contrast to only 5.8% of the infants in the control group. Significant negative linear correlations were seen between serum sodium and the dose of oxytocin ( P <0·01) and log of the volume of glucose solution infused ( P <0·001). The hyponatraemic newborn infants had a significantly higher incidence of transient neonatal tachypnea (7/37, 19%) than the normonatraemic infants (2%). Our results strongly suggest that infusion of oxytocin and glucose both cause maternal and transplacental hyponatraemia, even in recommended doses. This should be taken in account while planning a safe dose of oxytocin and glucose for infusion during labour.     

Iatrogenic neonatal and maternal hyponatraemia following oxytocin and aqueous glucose infusion during labour

Maternal and umbilical cord serum sodium and osmolality were studied prospectively in 140 deliveries to investigate whether transplacental hyponatraemia, seen following oxytocin infusion during labour, was due to the antidiuretic effect of oxytocin or was secondary to the infusion of aqueous glucose used as a vehicle for oxytocin, or both. Forty-five women received oxytocin in aqueous glucose for induction or augmentation of labour (oxytocin group), 43 received aqueous glucose infusion alone (glucose group) and 52 did not receive any intravenous infusions (control group). Mean cord sodium levels were significantly lower in the oxytocin (131.4, SD 3.6 mmol/l) and glucose groups (132.5, SD 3.2 mmol/l) than in the control group (135.0, SD 3.0 mmol/l). Hyponatraemia (Na less than 130 mmol) was seen in 47% and 30% of the infants in the oxytocin and glucose groups respectively, in contrast to only 5.8% of the infants in the control group. Significant negative linear correlations were seen between serum sodium and the dose of oxytocin (P less than 0.01) and log of the volume of glucose solution infused (P less than 0.001). The hyponatraemic newborn infants had a significantly higher incidence of transient neonatal tachypnea (7/37, 19%) than the normonatraemic infants (2%). Our results strongly suggest that infusion of oxytocin and glucose both cause maternal and transplacental hyponatraemia, even in recommended doses. This should be taken in account while planning a safe dose of oxytocin and glucose for infusion during labour.     

Current knowledge of transient hypothyroxinemia of prematurity: to treat or not to treat?

Background: Thyroid hormones (THs) play a critical role in normal maturation of the developing brain in the fetus and infant. Continuing advances in neonatal medicine have contributed to an increased survival of extremely premature infants with neonatal morbidities. In these infants, thyroid system immaturities, as well as morbidity-related thyroid dysfunction, contribute to transient hypothyroxinemia of prematurity (THOP), which is characterized by very low total and free thyroxine and normal or low thyroid-stimulating hormone (TSH) levels.

Review: Undoubtedly, low levels of THs with elevated TSH are associated with poor neurodevelopmental outcome. However, continuing debate exists regarding whether THOP is harmful to the developing brain. Moreover, no clear effects of TH treatment on neurodevelopmental outcome in preterm infants with THOP have been demonstrated. THs could have unpredictable effects if given unnecessarily.

Conclusion: The current recommendation is to treat THOP with TH only if THOP is accompanied with TSH elevation.     

Intrapartum infusion of aqueous glucose solution, transplacental hyponatraemia and risk of neonatal jaundice

Summary. Cord serum sodium levels in three groups of 278 singleton infants, born vaginally at term, were correlated with the incidence of jaundice (serum bilirubin ≥85 μmol/1) in the first 3 days of life. Of the 278 infants, 87 were born to mothers who were given infusions of 5% or 10% glucose in water during labour (group I), 90 were born to mothers who received glucose solution as a vehicle for oxytocin (group II), and 101 to mothers who did not receive any intravenous fluid therapy (control group). Jaundice was seen significantly more frequently in groups I (28/87, 32%) and II infants (30/90, 33%) than in the control group (12/101, 12%) (P<0.01), but when analysed in relation to cord serum sodium levels, the prevalence of jaundice in the normonatraemic infants (serum sodium ≥131 mmol/1) was similar in the three groups. On the other hand, in groups I and II jaundice occurred about 3.5 times more frequently in the hyponatraemic infants [group I (17/32, 53%) and II (20/39, 51%)] than in the normonatraemic infants (P<0.01). The difference was not associated with any other perinatal or neonatal characteristic.     

Thermal balloon endometrial ablation to treat menorrhagia in high-risk surgical candidates.

OBJECTIVE: To evaluate the safety and efficacy of thermal balloon therapy in a subset of women with menorrhagia considered to be high-risk surgical candidates for hysteroscopic endometrial ablation or hysterectomy. DESIGN: Prospective, observational study (Canadian Task Force classification II-2). SETTING: University-affiliated teaching hospital. PATIENTS: Women with menorrhagia, at high risk because of bleeding disorders (12), morbid obesity (6), heart-lung transplantation (2), cardiac pacemaker (2), postmenopausal bleeding (8), bowel disease with extensive adhesions and ileostomies (3), cervical stenosis (3), and other medical disorders (9). INTERVENTION: Treatment consisted of controlled heating to 87 degrees C of 5% dextrose in water within an intrauterine latex balloon pressurized to 170 mm Hg for 8 minutes. General anesthesia was used in 28 patients (60%) and local anesthesia with or without intravenous sedation in 18 (40%). MEASUREMENTS and MAIN RESULTS: No intraoperative complication occurred and postoperative morbidity was minimal. Follow-up of 43 women ranged between 6 and 30 months. Overall success of the procedure was 79% (34 patients), with 33% reporting amenorrhea, 19% hypomenorrhea, 28% eumenorrhea, and 21% menorrhagia. CONCLUSION: Thermal balloon endometrial ablation is safe and effective in treating menorrhagia when other therapies are contraindicated or difficult to perform.     

经导管动脉栓塞术治疗子宫腺肌病的临床观察

目的探讨经导管动脉栓塞术(TAE)治疗子宫腺肌病的临床疗效及副反应.方法选择14例子宫腺肌病患者,以Seldinger's技术完成双子宫动脉或双髂内动脉前干超选择插管,造影证实后,用携带有抗生素的新鲜明胶海绵颗粒进行栓塞.术后1、3、6、12个月观察其疗效.结果TAE治疗后全部病例临床症状缓解率达100%.月经量减少33.3%～70.0%,平均减少(52.6±20.1)%(P＜0.01);13例患者在术后2个月内痛经完全消失,1例治疗后明显缓解,至术后第11个月痛经消失,术后疼痛评分及评级比术前明显降低(P＜0.01);子宫、病灶体积缩小显著;彩色超声显示子宫肌层及病灶内血流信号明显减少.结论TAE治疗子宫腺肌病的近期疗效显著.     

Use of immunomodulators to treat endometriosis

Both animal and human studies have demonstrated that endometriosis involves numerous levels of immune dysfunction. From aberrant cytokine signaling to shifts in immune cell populations, it is clear that endometriosis develops in the setting of an elevated pro-inflammatory state. This elevated level of inflammation could exacerbate the morbidity seen in this chronic disease. Consequently, numerous immunomodulating therapies have been tested in both animal models and limited human trials. This review seeks to summarize the in vitro and in vivo studies used to test these agents for the treatment of endometriosis. These agents include small-molecule and antibody-based disease-modifying antirheumatic drugs (DMARDs), cytokines, mTOR inhibitors, nucleotide analogs, and various other small molecules. Although many of these agents have had promising results in in vitro and animal studies, few of them have been tested in humans. For the agents that were studied in women with endometriosis-associated pain, little benefit has been seen in symptom control to date. Nevertheless, there remains the potential that these agents may offer a new pathway in the treatment of the chronic, costly, and debilitating disease.     

Using acupuncture to treat premenstrual syndrome

More than 60% of the women in both groups suffered from premenstrual syndrome (PMS) symptoms, such as anxiety, mastalgia, insomnia, nausea and gastrointestinal disorders, whereas a smaller number of women suffered from phobic disorders, premenstrual headaches and migraines. There were three women from the first group and seven women from the second group who continued the medication treatment with progestins, whereas one woman from the first group and nine women from the second group continued to take fluoxetine. In the first group, nine women stopped having PMS symptoms after two AP treatments, eight women stopped having them after three treatments and one woman stopped having them after four treatments. In four women from the first group and 16 women from the second group, PMS symptoms appeared during the following period (cycle) or continued even after four treatments, so the medication was continued. In the first group, one woman had a smaller subcutaneous hematoma after the AP acupoint Ren 6. There was a statistical and relevant reduction in PMS symptoms with the AP treatments in the first group (P<0.001), whereas their reduction was irrelevant in the placebo AP group (P>0.05). The success rate of AP in treating PMS symptoms was 77.8%, whereas it was 5.9%. in the placebo group. The positive influence of AP in treating PMS symptoms can be ascribed to its effects on the serotoninergic and opioidergic neurotransmission that modulates various psychosomatic functions. The initial positive results of PMS symptoms with a holistic approach are encouraging and AP should be suggested to the patients as a method of treatment. Received: 23 July 2001 / Accepted: 8 October 2001 Correspondence to D. Habek