Renal injury in the asphyxiated newborn infant: relationship to neurologic outcome

The relationship of renal and central nervous system injury was prospectively evaluated in 120 asphyxiated infants. Renal evaluation findings were considered abnormal if there was oliguria (urine output less than 1 ml/kg/hr), which was designated transient if present in the first 24 hours only and persistent if present for at least 36 hours, or if the urinary beta 2-microglobulin concentration from first-void urine was elevated: (1) Thirteen infants had persistent oliguria; the urinary beta 2-microglobulin level was elevated in all. The six term infants had clinical signs consistent with hypoxic-ischemic encephalopathy (HIE); all six had ultrasonographic abnormalities. The outcome was poor (i.e., death or long-term neurologic deficits) in five of six infants. The seven preterm infants with persistent oliguria had clinical evidence of HIE, and three infants had intraventricular hemorrhage; all seven infants died. (2) Fifteen infants had transient oliguria (beta 2-microglobulin level was elevated in eight infants). Two of the eight term infants had evidence for HIE; the cranial ultrasound scan was normal in all. At follow-up, seven term infants are normal and one is abnormal. Six of the seven preterm infants with transient oliguria had clinical evidence of HIE; three infants had intraventricular hemorrhage. Three infants died, and the four survivors are normal at follow-up. (3) Ninety-two infants had normal urine output. Of the 22 term infants, two developed signs of HIE, and the ultrasound scan was abnormal in three infants. Of the 70 preterm infants, eight (11%) had clinical signs consistent with HIE, the ultrasound scan was abnormal in 20 of 64 (31%) infants scanned, and 14 (20%) infants died. Most of the followed infants are normal. Thus oliguria was significantly associated with clinical signs of HIE, including seizures, death (specifically in the premature infant), and long-term neurologic deficits. These data suggest that oliguria in the perinatal period is a sensitive indicator of infants at risk for long-term neurologic deficits.     

Cardiopulmonary adaptation in large for gestational age infants of diabetic and nondiabetic mothers

AIM: To compare cardiopulmonary adaptation in large for gestational age infants of diabetic and nondiabetic mothers. METHODS: Color Doppler echocardiography was performed in 113 (22 large for gestational age infants of diabetic mothers, 21 of nondiabetic mothers and 70 adequate for gestational age newborns) full-term infants. RESULTS: Pulmonary arterial pressure was significantly higher in infants of diabetic mothers than in those of nondiabetic mothers and normal infants at 24 h (38.5 vs. 32.5, and 35.5 mmHg, respectively). However, slow fall in this parameter was shown in all large for gestational age infants. Open ductus arteriosus was frequent in all large for gestational age infants, but its closure was significantly delayed in infants of diabetic mothers. Septal hypertrophy was higher in infants of diabetic mothers than in large for gestational age infants of nondiabetic mothers. CONCLUSION: Large for gestational age infants born from nondiabetic mothers showed delayed fall in pulmonary arterial pressure similar to those born from diabetic mothers but showed lower proportion of septal hypertrophy. Patent ductus arteriosus persisted for longer period of time in all large for gestational age infants than in normal infants, but its closure was significantly delayed in infants of diabetic mothers.     

Serum cholesterol concentrations in newborn infants with gestational ages of 28-42 weeks

Serum total cholesterol, HDL-cholesterol and VLDL-LDL-cholesterol were determined in 53 newborn infants with gestational ages of 28-42 weeks. In pre-term infants (gestational age less than 37 weeks) the total cholesterol concentration in cord blood was higher than in term infants. Mean values were 2.4 and 1.7 mmol/l, respectively. The HDL-cholesterol/VLDL-LDL-cholesterol ratio was 1.8 in pre-term and term infants. In 11 pre-term and 17 term infants a second determination was made 3-4 days after birth. Total cholesterol had increased more in term than in pre-term infants and the difference found at birth and already levelled out. Mean value was 3.0 mmol/l in pre-term and term infants. The HDL-cholesterol/VLDL-LDL-cholesterol ratio had changed to 0.6 in pre-term and term infants. Six-pre-term infants who received intravenous fluids only were also studied. Their values did not differ from those in pre-term infants fed orally. Free and esterified cholesterol were determined in 26 infants of varying gestational ages. About one-third of the total cholesterol was in the free form in pre-term and term infants at birth and during the first days of life.     

TRANSEPIDERMAL WATER LOSS IN NEWBORN INFANTS: IV. Small for Gestational Age Infants

Abstract. Hammarlund, K. and Sedin, G. (Department of Paediatrics, University Hospital, Uppsala, Sweden). Transepidermal water loss in newborn infants. IV. Small for gestational age infants. Ada Paediatr Scand, 69: 377, 1980.—Using a method described earlier, the evaporation rate (ER) from the skin was studied at different ambient humidities in 14 full-term and 10 pre-term small for gestational age (SGA) infants. Transepidermal water loss (TEWL) was estimated in 25 SGA infants born after 30–40 weeks of gestation. Comparisons were made with infants appropriate for gestational age (AGA). A linear relationship was found between ER and ambient humidity in full-term SGA infants, but with lower ER values than in AGA infants. Lower ER values were also found in moderately pre-term SGA infants at different ambient humidities. ER was higher at lower ambient humidities in both SGA and AGA infants. In full-term and moderately pre-term SGA infants TEWL was lower than in corresponding AGA infants.     

Posture,spontaneous movements,and behavioural state organisation in infants affected by brain malformations

Posture, quantity of spontaneous movement patterns, quality of general movements (GMs), and behavioural state organisation were studied in nine infants affected by documented brain malformations. A single 1 h video recording of five infants and two or more serial video recordings of another four infants were performed after birth. The graphic representation of single movement patterns (actogram) and of behavioural states of one video recording was performed in eight out of nine infants. The quality of GMs was assessed according to Prechtl's method in all video recordings. All nine infants showed a less variable posture than normal newborn infants and an unusual resting posture was detected in seven infants. Poor behavioural state organisation without sleep cycles was common to the nine infants and excessive wakefulness was observed in six infants. As for the quantity of single movement patterns, six infants lacked one or two movement patterns normally present in healthy newborn infants. An abnormal quality of GMs was noted in all nine infants and distinct motor abnormalities were observed in single infants. A monotonous and sometimes stereotyped sequence of different body parts involved in the movement (i.e. poor repertoire GMs) was common to all infants. In the four infants of whom two or more video recordings were available, initial poor repertoire GMs were followed by a further deterioration in movement quality. No relationship was found between the quantity of defective brain tissue, lack of a specific part of the brain, type and severity of GM and posture abnormalities.     

Effect of oral lipid administration on glucose homeostasis in small-for-gestational-age infants

The metabolic effect of feeding with 1.3 g/kg bw lipids (67% medium chain triglycerides) was studied in 15 small-for-gestational age (SGA) term infants. It was compared to a control group of 7 SGA term infants, to 7 term infants with an appropriate birth weight (AGA) and to 7 AGA preterm infants. Plasma glucose concentration rose from (M +/- SE) 3.6 +/- 0.2 to 4.4 +/- 0.3 mmol/l at 30 min in SGA term infants (p less than 0.01). A similar increase was observed in AGA term and preterm infants. The lipid load produced no change in plasma glucagon concentration but a significant increase in insulin/glucagon molar ratio was observed in AGA term infants only. In term SGA infants, the disappearance rate of glucose in plasma after the lipid load was similar to the control: 1.24% per min. The evolution of blood pyruvate and lactate concentration was not modified by the lipid load. Despite lower concentrations of free fatty acids and ketone bodies (KB) in SGA infants than in AGA term infants, the lipid load induced a 120% increase of ketone bodies in SGA infants and a 40% increase only in AGA infants. These data show that these lipids produce a hyperglycemic response in SGA infants as in AGA infants without any change of the disappearance rate of glucose. They suggest that these lipids can stimulate gluconeogenesis and ketogenesis in SGA infants.     

早产儿振幅整合脑电图的影响因素

目的探讨早产儿振幅整合脑电图(aEEG)的影响因素。方法在出生12 h内采用NicoletOne脑功能监测仪对71例早产儿进行aEEG描记。根据aEEG背景活动的方式及有无惊厥样活动,将aEEG结果判断为正常和异常aEEG(包括轻度异常及重度异常)。床旁颅脑超声监测脑损伤的发生。分析胎龄、出生体质量、窒息、低氧血症、辅助通气及脑损伤对早产儿aEEG的影响。结果 1.早产儿71例中,正常aEEG 40例,异常aEEG 31例。2.胎龄<34周者54例,正常aEEG 25例,异常aEEG 29例(53.7%);≥34周者17例,正常aEEG 15例,异常aEEG 2例(11.8%);2组aEEG异常率比较差异有统计学意义(χ2=9.245 2,P<0.01)。3.出生体质量<1.5 kg者25例,正常aEEG 8例,异常aEEG 17例(68.0%);出生体质量≥1.5 kg者46例,正常aEEG 32例,异常aEEG14例(30.4%);2组aEEG异常率比较差异有统计学意义(χ2=9.291 9,P<0.001)。4.产时有窒息者36例,正常aEEG 15例,异常aEEG 21例(58.3%);无窒息者35例,正常aEEG 25例,异常aEEG 10例(28.6%);2组aEEG异常率比较差异有统计学意义(χ2=6.390 4,P<0.05)。5.低氧血症24例,正常aEEG 16例,异常aEEG 8例(33.3%);无低氧血症者47例,正常aEEG 24例,异常aEEG 23例(48.9%);2组aEEG异常率比较差异无统计学意义(χ2=1.572 4,P>0.05)。6.辅助通气者19例,正常aEEG 8例,异常aEEG 11例(57.9%);未辅助通气者52例,正常aEEG 32例,异常aEEG 20例(38.5%);2组aEEG异常率比较差异无统计学意义(χ2=2.136 4,P>0.05)。7.有脑损伤者51例,正常aEEG 24例,异常aEEG 27例(52.9%);无脑损伤者20例,正常aEEG 16例,异常aEEG 4例(20.0%);2组aEEG异常率比较差异有统计学意义(χ2=6.337 5,P<0.05)。结论胎龄和出生体质量对早产儿aEEG有显著影响。小胎龄、低出生体质量以及出生时窒息和脑损伤的早产儿异常aEEG的发生率高。在分析早产儿aEEG时应考虑胎龄、出生体质量、窒息及脑损伤等生理病理因素的影响。     

Serum immunoglobulin G subclasses and serum immunoglobulin A in acute bronchiolitis in infants

Serum IgG subclasses and Serum IgA were studied in 43 infants with acute bronchiolitis and 20 healthy infants. IgG subclasses were determined by a capture ELISA and IgA was quantified by turbidimetry. IgG1 concentrations were significantly lower in infants with bronchiolitis than in normal infants. The other IgG subclasses and IgA did not differ between the groups. The subgroups of infants with bronchiolitis who had previously suffered from otitis media or bronchitis, had significantly lower IgG2 than the other infants with bronchiolitis. The same was found for infants with bronchiolitis who had suffered from three or more lower respiratory tract infections. In infants who had suffered from upper or lower respiratory infections before the acute bronchiolitis, IgA was significantly higher than in infants without previous respiratory infections. Ten infants with bronchiolitis (23%) had IgGl deficiency, that is values below the lower reference limit calculated in a population of healthy Norwegian infants. No healthy infants had any IgGl deficiency. No infant with bronchiolitis had IgG2 or IgG3 deficiency. The low IgGl values found in infants with acute bronchiolitis, may be one cause for infants to be more susceptible to RS virus infections.     

Development of the intestinal flora in very low birth weight infants compared to normal full-term newborns

Development of faecal flora was studied in seven very low birth weight (VLBW) infants, who were fed on human milk and whose birth weights ranged from 810–1350 g. The intestine of the VLBW infants was first colonised by enterobacteria and streptococci, as it was in full-term infants. VLBW infants differed, however, from full-term infants in that both types of organism continued to be predominant for a longer period, and establishment of bifidobacterial flora was retarded. Bifidobacteria first appeared in the stools of VLBW infants at a mean age of 10.6±2.7 days and became predominant at a mean of 19.8±8.9 days, in contrast to full-term, breast-fed infants in whom bifidobacterial flora appeared at as early as 4 days of age. The delay seemed to be related to the low milk intake of the VLBW infants.The number of viable staphylococci in the stools of VLBW infants was generally higher than that in full-term infants. Although emergence of Bacteroides, Clostridium and lactobacilli was delayed compared with full-term infants, differences in their occurrence and prevalence between VLBW and fullterm infants were not remarkable.Abbreviation VLBW very low birth weight     

EFFECT OF ORAL LIPID ADMINISTRATION ON GLUCOSE HOMEOSTASIS IN SMALL-FOR-GESTATIONAL-AGE INFANTS

ABSTRACT. The metabolic effect of feeding with 1.3 g/kg bw lipids (67% medium chain triglycerides) was studied in 15 small-for-gestational age (SGA) term infants. It was compared to a control group of 7 SGA term infants, to 7 term infants with an appropriate birth weight (AGA) and to 7 AGA preterm infants. Plasma glucose concentration rose from ( M ±SE) 3.6±0.2 to 4.4±0.3 mmol/1 at 30 min in SGA term infants ( p <0.01). A similar increase was observed in AGA term and preterm infants. The lipid load produced no change in plasma glucagon concentration but a significant increase in insulin/glucagon molar ratio was observed in AGA term infants only. In term SGA infants, the disappearance rate of glucose in plasma after the lipid load was similar to the control: 1.24% per min. The evolution of blood pyruvate and lactate concentration was not modified by the lipid load. Despite lower concentrations of free fatty acids and ketone bodies (KB) in SGA infants than in AGA term infants, the lipid load induced a 120% increase of ketone bodies in SGA infants and a 40% increase only in AGA infants. These data show that these lipids produce a hyperglycemic response in SGA infants as in AGA infants without any change of the disappearance rate of glucose. They suggest that these lipids can stimulate gluconeogenesis and ketogenesis in SGA infants.     

Early postnatal growth of Basotho infants in the Mantsonyane area, Lesotho

The records of 814 infants born in a rural hospital in Lesotho were analysed. It was calculated that on average Basotho infants regained their birthweight between 3 and 4 days of age and the average weight loss amounted to 3%. Compared with Caucasian infants, Basotho infants regained their birthweight sooner. Of 289 infants in whom the gestational age was assessed, small-for-dates infants showed an increased mean growth rate compared with pre-term and appropriate-for-dates full-term infants.     

Cow milk protein antigens and antibodies in serum of premature infants during the first 10 days of life

Antigenic beta-lactoglobulin and alpha-casein were measured in the sera of 45 formula-fed infants of 31 to 41 weeks of gestation at 5 days and at 10 days of age. Quantitation was performed by a sensitive ELISA inhibition assay. On day 5 of life antigenic lactoglobulin was detected in 14 of 19 infants of less than 37 weeks gestation, but in only one of 10 infants of more than 36 weeks gestation. On day 10 of life the sera of all infants contained antigenic lactoglobulin. In contrast, on day 5 antigenic casein was present in four of 17 infants of less than 37 weeks gestation, but in 10 of 12 infants of the more mature group. On day 10 casein was detected in seven of 28 infants, with no difference between groups; anti-casein was found in eight of 12 infants. Infants of less than 37 weeks gestation have different absorption patterns than more mature infants do. "Gut closure" is an unlikely explanation for these findings.     

Changes in pulmonary arterial pressure in preterm infants with chronic lung disease

BACKGROUND: Pulmonary arterial pressure (PAP) is raised in preterm infants with respiratory distress syndrome who subsequently develop chronic lung disease. The natural history of pulmonary hypertension in infants with chronic lung disease is unknown. OBJECTIVES: To investigate changes in PAP, assessed non-invasively using Doppler echocardiography, in infants with chronic lung disease during the 1st year of life. METHODS: Serial examinations were performed in infants with chronic lung disease and healthy preterm infants. The Doppler derived acceleration time to right ventricular ejection time ratio (AT/RVET) was calculated from measurements made from the pulmonary artery velocity waveform. RESULTS: A total of 248 examinations were performed in 54 infants with chronic lung disease and 44 healthy preterm infants. The median AT/RVET was significantly lower in infants with chronic lung disease than in healthy preterm infants (0.31 v 0.37). AT/RVET significantly correlated with age corrected for prematurity in both infants with chronic lung disease (r = 0.67) and healthy infants (r = 0.55). There was no significant difference between the rate of change in AT/RVET between the two groups. In infants with chronic lung disease, multivariate analysis showed that AT/RVET was significantly independently associated with age and inversely with duration of supplemental oxygen treatment. Median AT/RVET was significantly lower in infants with chronic lung disease until 40-52 weeks of age corrected for prematurity. CONCLUSIONS: Although PAP falls with increasing age in both infants with chronic lung disease and healthy preterm infants, it remains persistently raised in infants with chronic lung disease until the end of the 1st year of life.     

Concentrations of antimony in infants dying from SIDS and infants dying from other causes.

OBJECTIVES: Raised concentrations of antimony have been found in infants dying of sudden infant death syndrome (SIDS). The presumed source of this antimony is toxic gases generated from fire retardants that are present in cot mattresses. The aim of this study was to determine the role of antimony in SIDS. DESIGN: Samples of liver, brain, serum, and urine were collected from all patients dying from SIDS and a group of aged matched control infants who had died of other causes. SETTING: Nationwide study in Ireland. SUBJECTS: 52 infants dying from SIDS and 19 control infants aged > 7 days and < 1 year. RESULTS: The median concentration of antimony in the liver and brain of infants dying of SIDS was < 1 ng/g, with no difference detected between the infants dying from SIDS and the control infants. The range of antimony in the serum of infants dying of SIDS was 0.09-0.71 microg/litre (median, 0.26). Although no difference was found between infants dying from SIDS and control infants, SIDS infants were found to have higher concentrations when compared with healthy infants in the 1st year of life, probably as a result of release of antimony into serum after death. Urine antimony concentrations in infants dying from SIDS were < 3.91 ng/mg (corrected for creatinine) and similar to values found both in control infants and healthy infants. CONCLUSION: There is no evidence to support a causal role for antimony in SIDS.     

Low thymic size in preterm infants in the neonatal intensive care unit,a possible marker of infection? A prospective study from birth to 1 year of age

Aim: To study the growth of the thymus in preterm infants. Methods: Ultrasonographic thymic size (Ti) was studied in 80 preterm infants (gestational age 24–36 weeks) from birth to discharge from the neonatal intensive care unit (NICU). Thirty‐three of these infants were followed to 1 year of age. Results: At birth, the median Ti was 5.2 compared with 11.8 in term infants. At discharge, the median Ti was 10.0 and not significantly different from Ti in term infants at birth (p = 0.22). The size of the thymus was significantly associated with postmenstrual age and weight (both p < 0.01). Infections during admission were negatively associated with the size of the thymus (p < 0.01). During the first 3 months after discharge, preterm infants had a significantly higher frequency of infections than did term infants (p = 0.002); hereafter, the preterm infants had significantly fewer infections than term infants (p = 0.002). The median Ti in preterm infants and term infants at 1 year of age was 21.1 and 17.3, respectively. This difference was not statistically significant (p = 0.41). Conclusions: Growth of thymus was not compromised by preterm birth. Ti is negatively associated with the frequency of infections in preterm neonates submitted to NICU.     

Decreased bone mineral content in small-for-gestational-age infants compared with appropriate-for-gestational-age infants: normal serum 25-hydroxyvitamin D and decreasing parathyroid hormone

Bone mineral content was determined by photon absorptiometry, adapted for use in neonates, in 23 small-for-gestational-age (SGA) infants of 31 to 42 weeks of gestational age, for 12 weeks. At birth, term SGA infants had lower bone mineral content than term appropriate-for-gestational-age (AGA) infants; postnatal increase in bone mineral content was slow and lagged significantly behind that of term AGA infants. Preterm SGA infants had bone mineral content that was similar to that of preterm AGA infants at birth; postnatal bone mineral content was similar to that of preterm AGA infants, but was decreased compared with the expected intrauterine bone mineral content. Serum 25-hydroxyvitamin D concentrations and parathyroid hormone levels were the same for SGA and AGA infants. Serum 25-hydroxyvitamin D concentrations decreased slightly with postnatal age and remained within normal limits. Serum parathyroid hormone concentrations decreased in both SGA and AGA infants and reached undetectable levels at 10 to 12 weeks of age.     

Urinary excretion of epidermal growth factor in the newborn

Urinary epidermal growth factor (EGF) excretion was studied serially in 36 newborn infants, from 26 to 40 weeks gestation, from birth to three months of age. All infants excreted EGF from birth. Excretion was significantly higher in term infants than in preterm infants at birth; in term infants excretion rose steadily in early infancy and there was a similar but delayed rise in EGF excretion by preterm infants. Urinary EGF excretion appears to be related to age from conception and birth does not influence it. There was no correlation between urinary EGF excretion and the rapid maturation of the lungs and skin which occurs in preterm infants in the early neonatal period.     

Thymic size in uninfected infants born to HIV-positive mothers and fed with pasteurized human milk

AIM: To examine the size of the thymus in uninfected infants born to HIV-positive mothers and to study the effects of feeding by human donor milk on the size of the thymus in these infants. METHODS: The absolute and relative thymic size was assessed by sonography as thymic index (Ti), and the Ti/weight-ratio (Ti/w) at birth and at 4 mo of age in 12 healthy uninfected infants born to HlV-infected mothers. All infants were exclusively fed pasteurized donor milk. The results were compared with those obtained from a previous cohort of exclusively breastfed, partially breastfed and exclusively formula-fed infants. RESULTS: At birth the Ti was reduced in infants born to HIV-infected mothers in comparison with that in control infants but this difference disappeared when their birthweights were taken into consideration (Ti/w-ratio). At 4 mo of age the geometric mean Ti of infants fed donor milk was 23.8 and the mean Ti/w-ratio was 4.2. Compared with those of exclusively breastfed infants, the Ti and Ti/w-ratio of infants fed donor milk were significantly reduced (p < 0.01). The Ti/w-ratio increased in donor-milk-fed infants compared with that in the formula-fed infants (p = 0.02). CONCLUSION: At birth the size of the thymus was smaller in uninfected infants of HIV-positive mothers compared with infants of HIV-negative mothers but when birthweight was taken into account this difference disappeared. Feeding by human donor milk seemed to result in an increased size of the thymus at 4 mo of age compared with thymic size in infants that were exclusively formula fed.     

Beta-2-microglobulin, an indicator of renal tubular maturation and dysfunction in the newborn.

The urinary excretion and proximal tubular reabsorption of beta-2-microglobulin was studied in 17 healthy newborn infants in relation to gestational and post-natal age. The effect of IRDS and non-conjugated hyperbilirubinemia on the tubular reabsorption of the protein was evaluated in 10 IRDS infants and 14 infants with non-conjugated hyperbilirubinemia. The urinary excretion of beta-2-microglobulin was determined under standardized conditions. When GFR was determined, the single injection clearance method was used. The filtered load of beta-2-microglobulin was found to increase with increasing gestational age. This was due to a rise in plasma beta-2-microglobulin concentration as well as to a rise in the GFR. Although the smallest filtered load was recorded in infants with a mean GA of 32.4 weeks, these infants had a lower fractional reabsorption of the protein (88%) than infants with a mean GA of 35.0 weeks or more (98%). In infants with a GA of 35 weeks or more a glomerulo-tubular balance for beta-2-microglobulin apparently was established. In these infants the filtered load of beta-2-microglobulin increased rapidly during the first days of life. This was paralleled by an increase in the reabsorptive capacity for the protein. In infants with IRDS and in infants with non-conjugated hyperbilirubinemia the fractional reabsorption of beta-2-microglobulin was lower than in control infants of a corresponding gestational and postnatal age. This indicates, that in the neonatal period, the proximal tubular transporting capacity is more vulnerable than the glomerular filtration rate in states of hypoxia and hyperbilirubinemia.     

Hyperglycemia in stressed small premature neonates.

The metabolic responses to a constant glucose infusion were measured in 30 premature infants, 700 to 1,550 gm. The study included 18 stressed premature infants who needed assisted ventilation, and 12 control premature infants. Metabolic measurements were similar in both groups in the cord and preinfusion samples. In the first postinfusion sample, glucose, cortisol, and glycerol values were higher in stressed than in control premature infants. Hyperglycemia was seen in 13 of stressed and in only one of control premature infants. Stressed infants who became hyperglycemic in the first postinfusion sample were then compared to stressed euglycemic infants. Insulin levels were higher, glycerol levels similar, but cortisol levels lower in stressed hyperglycemic than in stressed euglycemic premature infants. The etiology of hyperglycemia in stressed premature infants cannot be attributed to hypoinsulinemia or to hypercortisolemia, and is not associated with increased glycerol levels. There was no difference in mortality between stressed hyperglycemia and stressed euglycemic infants; stress, rather than hyperglycemia, was related to mortality.