Value of Arterialized Capillary Blood Gas Analysis in Lower Respiratory Tract Infection in Childhood

Blood gas analysis on arterialized capillary blood in 70 young infants yielded satisfactory information about oxygen therapy. Inspired oxygen concentrations above 40% are often required to raise the capillary Po₂ of hypoxic infants above 70 mmHg. Oxygen concentrations above 40% are difficult to achieve and maintain in presently available oxygen tents, though not in modern incubators, or oxygen chairs. A raised Pco₂ has frequently been found in infants with severe respiratory infections, but oxygen therapy has not resulted in CO₂ narcosis in these acute emergencies.     

Malondialdehyde Level in the Cord Blood of Newborn Infants

Objective

In this study, we aim to demonstrate that measurement of the malondialdehyde (MDA) level in the umbilical cord blood of newborn infants born via cesarean section (C/S) and normal vaginal delivery (NVD) is indicative of oxidative stress during the perinatal period.

Methods

The study was conducted at Bakirkoy Training and Research Hospital between January 2006 and April 2006 on 15 newborns born via elective C/S, 15 newborns born via emergency C/S, and 15 newborns born via normal vaginal delivery. Complete blood count, total bilirubin, glucose, creatinine phosphokinase (CPK), uric acid, iron, blood gas, and malondialdehyde levels were measured in the umbilical cord blood

Findings

Malondialdehyde levels in the umbilical cord blood in the emergency C/S and NVD groups were found to be statistically and significantly higher than those in the elective C/S group. In the emergency C/S group, it was determined that the malondialdehyde level increased as the oxygen saturation of the umbilical cord blood increased. In the NVD group, a positive correlation was detected between the total bilirubin and malondialdehyde levels in the umbilical cord blood. In the emergency C/S group, the malondialdehyde level was recorded to be high in the infants with high level of uric acid in the umbilical cord blood.

Conclusion

We concluded that the malondialdehyde level in umbilical cord blood could serve as an indication of perinatal oxidative stress and that it could thus help in preventing permanent damage.     

Persistent Pulmonary Hypertension of the Newborn due to Alveolar Capillary Dysplasia

Three unrelated female term infants died when less than 1 month old from intractable pulmonary hypertension associated with deficient capillaries in airspace walls, anomalous small pulmonary veins in bronchiolar-arterial rays, and medial thickening in small pulmonary arteries together with peripheral muscularization. This complex uascular abnormality in the lungs has been termed alveolar capillary dysplasia and/or misalignment of lung uessels in seven previously reported cases. Each infant also showed abnormally immature parenchymal development in the lungs, as was noted in four of the seven prior cases. One had phocomelia; four of the seven prior cases had a variety of congenital anomalies. The primary pulmonary uascular anomaly is likely to be a failure of fetal lung uascularization dating from the second trimester and to be due to action of an unknown teratogen. Centroacinar veins may represent bronchial veins that do not normally develop beyond the ends of cartilaginous bronchi. Pulmonary arterial occlusive changes are interpreted, as reactive to obstruction at the level of pulmonary arterioles.     

Venous and Capillary Hematocrit in Newborn Infants and Placental Transfusion

Hematocrit values were measured on one hundred and eleven sets of capillary (from unwarmed and warmed heels) and venous blood samples obtained simultaneously during the first 5 days of life from 60 full term newborn infants, 40 of which the umbilical cords were clamped late, and 20 clamped early a t the time of birth. In the late clamped infants, the capillary hematocrits showed an initial rise during the first 6 hours of life seemingly due to fluid transudation in the capillary beds, followed by a fall a t 12 to 24 hours of age due to a subsequent fluid reabsorption into the vascular space in response to increasing circulatory demands in the visceral organs. In the early clamped infants, the capillary hematocrits remained stable during the first 6 hours, but a slight decline was observed a t 12 to 24 hours of age. The simultaneously measured venous hematocrits of both late and early clamped infants plotted against age revealed a strikingly similar pattern of alterations. A marked capillary venous hematocrit difference was observed in the late clamped infants and to a much lesser extent in the early clamped infants during the first 5 days of life, with the venous being lower than the capillary values. Warming the heels prior to capillary sampling improves the capillary venous hematocrit correlations in the late clamped infants and the improvement achieved by this procedure increases as the infant becomes older. In the early clamped infants heel warming produces relatively less effects because there was less capillary venous hematocrit discrepancy initially. In infants over 12 hours of age where venipuncture is difficult or inadvisable, capillary blood samples obtained from warmed heels could be used for hematocrit measurements. However, the hematoples do not exactly correspond with the venous values and the approximate venous reading could be estimated by using the regression lines derived from our samples, and their 95% confidence limit could be calculated from the appropriate formulas.     

Leucocyte Blood Picture in Ill Newborn Babies

Serial blood leucocyte counts were made on 35 ill preterm and term babies during the first 28 days of life.