The Influence of Labor and Delivery on Preterm Fetal Adrenal Function

ABSTRACT. The influence of labor and route of delivery upon umbilical cord serum levels of Cortisol and dehydroepiandrosterone sulfate in one hundred sixty-nine preterm infants not exposed prena-tally to corticosteroids was studied. Vaginally born infants (group A, n=89) presented a higher mean cord Cortisol and dehydroepiandrosterone sulfate concentrations than those delivered by cesarean section (group B, n=80). Although there were no differences in Cortisol and dehydroepiandrosterone sulfate levels between infants delivered by cesarean section after spontaneous onset of labor (group B-I, n=42) and those without labor (group B-II, n=38), the mean Cortisol and dehydroepiandrosterone sulfate concentrations were higher in group A than in group B-I. There was a correlation between umbilical cord Cortisol and dehydroepiandrosterone sulfate levels. It is concluded that there is no association between the presence of labor and high cord serum levels of Cortisol and dehydroepiandrosterone sulfate and there is an association between vaginal delivery and high cord Cortisol and dehydroepiandrosterone sulfate levels in preterm infants. It is suggested that the stress of vaginal delivery stimulates the secretion of fetal Cortisol and dehydroepiandrosterone sulfate in preterm infants.     

Fetal Adrenal Development During the Second Trimester of Gestation

Four hundred and fifty pairs of adrenals were studied from human fetuses ranging in age from 15 to 27 weeks of gestation (menstrual age). They were collected from spontaneous and medical abortions. The adrenal weight increased from 0.2 to 1.5 g during the second trimester. The left adrenal was significantly heavier than the right for the same gestational age. The length (L₁), the height (L₂) and the thickness (L₃) of the adrenals were measured. The index of length (L₁ X L₂ X L₃) correlated well with the fetal age, except for the Potter Syndrome in which it was decreased. This index could be a useful indicator for ultrasonographic and pathologic studies of the fetal adrenal gland. The cells of the fetal cortex contained lipid droplets during the first weeks of the mid-trimester, and this storage progressively decreased after 20-21 weeks. The fatty transformation that is used as an indicator of the mode of death of stillborn infants cannot be applied to abortions during the second trimester. In a few instances, hypoxia was associated with adrenal hypertrophy.     

Flow Cytometry of Fetal Adrenal Glands with Adrenocortical Cytomegaly

Adrenal glands from four autopsied fetuses of 18 to 36 weeks gestation showed varying degrees of cortical cytomegaly. Formalin'fixed, paraffin-embedded sections from these four pairs of glands were studied by flow cytometry to analyze their DNA content and cell cycle parameters. Flow cytometry of Case 1, which had diffuse bilateral cytomegaly, demonstrated a major diploid peak, an increased percentage of tetraploid cells, and a decrease in S phase compared to an age-matched control with no evidence of cytomegaly (Case 2). Cases 3, 4, and 5 showed focal and/or unilateral adrenocortical cytomegaly and were diploid by flow cytometry with no differences in synthetic or tetraploid fractions compared to the control tissues. The focal distribution of the lesions or the limits of resolution of the instrumentation could account for some of these results. However, the findings in Case 1 suggest that the cytomegalic cells are tetraploid in DNA content and may have decreased DNA synthetic activity. A current hypothesis that these cells have undergone a period of sustained hyperactivity followed by exhaustion in reaction to an unknown stimulus is supported by our observations.     

Adrenal Cortical Tumors in Childhood

In a 41-year period, 18 children with a diagnosis of an adrenal cortical tumor were identified (14 carcinoma : 4 adenoma). The majority of patients had clinical signs of endocrine dysfunction at presentation, with virilization (11 patients) and a cushingoid appearance (8 patients) the commonest findings. Abnormal biochemical activity was identified in 16 tumors (94%). The primary treatment in 17 patients was surgical. In addition, 12 children, all with carcinomas, had radiotherapy. Of those children with a carcinoma, 12 are dead, with a median survival of 52 months (range 1–317 months). The three second primary tumors all developed at sites within the field of previous radiotherapy, and proved fatal at 127, 176, and 317 months (median 207 months). This series confirms the poor prognosis in adrenocortical carcinoma in childhood, but a complete resection is compatible with cure of the primary disease. The frequency of second, fatal, primary tumors is of particular concern and long-term follow-up is mandatory in survivors, especially if radiotherapy was part of the treatment protocol.     

Role of Asphyxia and Feeding in a Neonatal Rat Model of Necrotizing Enterocolitis

Necrotizing enterocolitis (NEC) is a common gastrointestinal disorder affecting premature infants. To investigate critically the importance of the purported risk factors of NEC (formula feeding, asphyxia, bacteria, and prematurity), we developed a neonatal rat model that closely mimics the human disease. Full-term and premature newborn rats were stressed with formula feeding, asphyxia, and/or exogenous bacterial colonization and subsequently evaluated grossly and histologically for the development of intestinal injury. We found that most animals treated with asphyxia, formula feeding, and bacteria developed NEC (77%) and died (86%) by 96 h. All maternally fed animals treated with asphyxia and bacterial colonization survived and had normal intestinal histology. Furthermore, asphyxia was a critical instigating factor, because formula and bacterial exposure without asphyxia resulted in normal intestine and minimal mortality (12%). Enteral bacterial colonization was not a significant determinant of NEC in this model. We conclude that the neonatal rat model is an excellent test system for the study of NEC. As in the human disease, asphyxia and formula feeding play an important role in the pathophysiology of experimental NEC.     

Adrenal Cortical Adenoma in a 13-Year-Old Girl with Neurofibromatosis

ABSTRACT. We describe the occurrence of an adrenocortical adenoma causing Cushing's syndrome in a 13-year-old girl with neurofibromatosis (NF). Three further cases of adrenocortical tumours in patients with NF have been reported previously, suggesting that there may be an association between NF and tumours of the adrenal cortex.     

Myocardial Dysfunction and Cerebral Blood Flow Velocity Following Birth Asphyxia

ABSTRACT. Birth asphyxia often leads to left ventricular myocardial dysfunction. To assess the effect of myocardial dysfunction on cerebral perfusion, we evaluated cardiac output and cerebral blood flow velocity in the anterior cerebral and internal carotid arteries in 20 asphyxiated term newborn infants during the first 4 days of life using 2-dimensional/pulsed Doppler ultrasound. In 8 infants with myocardial dysfunction cardiac output was reduced on days 1 and 2 and within normal limits thereafter. In these infants changes in mean cerebral blood flow velocity and pulsatility index were passively related to changes in mean arterial pressure and cardiac output. In 12 infants without myocardial dysfunction a stable cerebral blood flow velocity pattern was found, which was unaffected by changes in mean arterial pressure. We conclude that infants presenting with a reduced cardiac output after deliveries associated with severe asphyxia may be at risk for additional ischemic or hemorrhagic cerebral damage because of lack of autoregulation.     

Adrenal Function in Asthmatic Children Treated with Inhaled Budesonide

Bisgaard, H., Pedersen S., Damkjær Nielsen M and Østerballe O. (Department of Paediatrics, University Hospital of Copenhagen, County of Gentofte, Copenhagen; Department of Paediatrics, County Hospital of Kolding; Department of Clinical Physiology, University Hospital of Copenhagen, County of Glostrup, Copenhagen; Department of Paediatrics, County Hospital of Viborg, Denmark). Adrenal function in asthmatic children treated with inhaled budesonide. Acta Paediatr Scand 80: 213, 1991
The effect of the inhaled topical steroid budesonide on adrenal function was evaluated in 33 children (aged 7–15 years) with moderate bronchial asthma. The trial was designed as a prospective single-blind study of the effect of budesonide in daily doses of 200 μg through 400 μg to 800 μg in three randomized consecutive periods of 8 weeks. The unstimulated diurnal production of cortisol was assessed by measurement of free cortisol in 24-hour urine samples at the end of each period. No significant dose-related suppression was found. The cortisol production did not differ significantly during treatment with 800 μg budesonide as compared to treatment with 200 μg budesonide (95% confidence interval: 74%–112%). It is concluded, that budesonide is a topical steroid with a favourable ratio between topical and systemic effects in asthmatic children.     

Diseases Causing Fetal and Neonatal Ascites

Causes of fetal ascites are reviewed, and 3 new cases are reported. A protocol is suggested for intrauterine investigation of the spectrum of diseases causing fetal ascites. There is some overlap with causes of hydrops fetalis.     

宫内窒息对胎鼠脑组织型纤溶酶原激活物表达的影响

目的观察宫内窒息后胎鼠脑内组织型纤溶酶原激活物(tPA)的表达情况。方法妊娠18 d孕鼠随机分为宫内窒息组和假手术组,通过结扎子宫动脉和胎盘分支血管15 min使胎鼠宫内窒息。分别在术后不同时间点取出胎鼠脑组织,进行tPA免疫组织化学染色。结果术后4、72 h宫内窒息组tPA阳性细胞数与假手术组相比均无统计学差异(P均>0.05),术后12、24、48 h组间比较均有统计学差异(P均<0.05);且术后24 h宫内窒息组阳性细胞表达达高峰。结论宫内窒息可诱导胎鼠脑内tPA表达增加。     

基质金属蛋白酶对新生鼠窒息后心肌重塑的影响

目的探讨新生鼠窒息后心肌组织基质金属蛋白酶(MMPs)表达对心肌重塑的影响。方法将7~10日龄Wistar小鼠60只,随机分成窒息A、B、C 3组(分别为窒息复氧后1、7、14 d,各组15只)、对照组(D组,n=15)。模拟新生鼠常压窒息模型。免疫组织化学法测定心肌组织MMP-3、MMP-9活性;氯胺T法测定心肌胶原水平。结果心肌组织MMP-3活性为一过性增高,以B组最高(P<0.05),且MMP-3活性表达早于MMP-9;MMP-9活性窒息后逐渐增高(P<0.05);心肌胶原水平窒息后逐渐增高,d14时最高;MMP-3、MMP-9与胶原水平呈正相关(r=0.482,0.679 P均<0.05)。结论新生鼠窒息后心肌MMP-3、MMP-9激活,继发胶原水平增高,可能是导致心肌间质重塑的因素之一。     

窒息对新生大鼠肾组织一氧化氮和一氧化氮合酶含量的影响

目的探讨一氧化氮合酶(NOS)和一氧化氮(NO)在窒息后肾损伤中的作用。方法Wistar新生大鼠48只,随机分为对照组、窒息后复氧2h组、24h组和48h组,制备常压窒息模型。窒息30min后在上述时间点处死动物,测定肾脏NOS和NO含量,并在光镜下对肾小管损伤程度进行评分。结果窒息复氧2h肾脏NOS和NO即显著升高,持续时间达24h,肾小管评分在窒息后24h和48h明显增高。结论NOS和NO在新生大鼠窒息后的肾损伤中起重要作用。     

Mediastinal Foregut Cyst Containing an Intramural Adrenal Cortical Rest: A Case Report and Review of Supradiaphragmatic Adrenal Rests

We present a case of a baby girl with a congenital cystic mediastinal mass which was excised at 20 months of age and was found to be a developmental foregut cyst of the gastroenteric type. Within the cyst wall was an adrenal cortical rest. Adrenal cortical rests arising above the diaphragm are exceedingly rare and previous cases are reviewed.     

胎儿宫内窘迫孕妇静脉血及脐血孤啡肽的变化

目的探讨宫内窘迫脐血孤啡肽(OFQ)的变化及其临床意义。方法采用放射免疫法测定30例正常妊娠妇女(对照组)及23例胎儿宫内窘迫孕妇(缺氧缺血组)静脉血及脐血OFQ的含量,同时行脐动脉血血气分析。结果1.缺氧缺血组脐血OFQ(23.46±6.72)ng/L,对照组为(13.29±4.14)ng/L,两组相比有显著差异(P<0.05)。2.脐动脉血血气分析,pH 为(7.00±0.15),p(O2)为(1.70±0.42)kPa,p(CO2)为(8.80±0.69)kPa;OFQ与脐血pH、p(O2)呈显著负相关(r= -0.418,-0.437 P均<0.05),与p(CO2)呈显著正相关(r=0.442 P<0.05)。3.缺氧缺血组及对照组母血浆OFQ含量分别为(9.23±3.01)ng/L及(8.57±2.83)ng/L,两组相比无显著差异(P>0.05).4.脐血OFQ含量与母血OFQ含量无显著相关(r=0.287 P>0.05)。结论OFQ与缺氧缺血导致的胎儿窘迫及新生儿窒息的发生发展密切相关。     

Umbilical Cord Dehydroepiandrosterone Sulfate and Cortisol Levels in Preterm Infants Born to Pre-Eclamptic Mothers

ABSTRACT. The influence of early-onset pre-eclampsia upon the umbilical cord serum levels of Cortisol and dehydroepiandrosterone sulfate was studied in fifty-one preterm infants not exposed prenatally to corticosteroids. Preterm infants born to pre-eclamptic mothers (group A) presented lower dehydroepiandrosterone sulfate levels than preterm infants born to non-pre-eclamptic mothers (group B). The umbilical cord serum levels of Cortisol were similar between both groups. It is suggested that the decrease in the cord serum levels of dehydroepiandrosterone sulfate in preterm infants of pre-eclamptic mothers plays an important role in the pathogenesis of the subnormal maternal urinary estriol excretion, and that the accelerated pulmonary and cerebral maturation of preterm infants born to pre-eclamptic mothers is not explained by an increased fetal serum Cortisol concentration.     

窒息新生儿心脏收缩时间间期的变化及其与临床和预后的关系

目的观察窒息新生儿心脏收缩时间问期(STI)的变化,探讨其与临床及预后的关系。方法采用二维及多普勒超声对轻度窒息27例、重度窒息18例及正常新生儿14例行二维超声及STI测定,并分析其与临床表现及预后的关系。结果与正常新生儿比较;轻、重度窒息组心脏的腔室大小和室壁厚度无变化(P>0.05)。轻、重度窒息组与正常新生儿相比,急性期右室射血时间(RVET)显著缩短(P<0.05);重度窒息组右室射血前期时问(RPEP)延长。重度窒息组RPEP/RVET急性期和恢复期均较正常和轻度窒息组明显增大(P<0.05)。急性期重度窒息组较正常新生儿的左室射血前期时间(LPEP)显著延长(P< 0.05)。急性期和恢复期重度窒息组RPEP/RVET增大患儿较轻度窒息组增多,急性期RPEP/RVET增大患儿心衰发生及远期致残率较RPEP/RVET正常增加。结论窒息对新生儿心功能的影响右心重于左心,RPEP/RVET增大者临床表现较重,致残可能性较大。     

Unusual Adrenal Cortical Tumor of Unknown Biologic Potential: A Nodule in a Nodule in a Nodule

Adrenocortical tumors are uncommon neoplasms in childhood. Most pediatric adrenal tumors are virilizing and carcinomas are more common than adenomas. Recent molecular data suggest an adenoma-to-carcinoma progression sequence in adrenal cortical neoplasms. We report a case of a 5-year-old boy who presented with virilizing symptoms secondary to an adrenal tumor that was resected laparoscopically. The bulk of the tumor was a large, yellow mass with typical features of an adrenal cortical adenoma. In the center was a well-circumscribed tan-brown nodule that was distinct from the adenoma and had oncocytic features. A third minute focus (3.0 mm) was noted that was not circumscribed or encapsulated, but showed marked pleomorphism and abundant mitoses, including atypical forms and increased Ki67 compared with the outer 2 nodules. Molecular analysis to assess the clonality and mutation rates of the 3 distinct areas showed only 2 genetic loci with allelic imbalances.     

围生期窒息发生率和死亡率近10年变迁及相关因素

目的 分析近10年来围生期窒息发生率和死亡率的变迁，探讨围生期窒息相关因素及开展新法复苏对围生期窒息发生率和死亡率的影响。方法对近10年郑州大学第三附属医院分娩的所有活产新生儿的病历资料进行回顾性分析，计算窒息的发生率、死亡率、病死率，观察上述指标的逐年变化趋势及季节变化的情况，并探讨性别、双／多胎、出生体质量、胎龄分娩方式对这些指标的影响。结果轻度窒息发生率在开展新法复苏后明显下降，并稳定在1．5％左右，而重度窒息的发生率和病死率均无明显变化。窒息儿的发生率以4月份最高，但死亡率和病死率以7月份最高。窒息的发生还与性别、双／多胎、出生体质量、早产以及阴道助产有关。结论围生期窒息的发生与性别、双／多胎、出生体质量、胎龄密切相关；新法复苏能显著降低轻度窒息的发生率，对重度窒息的发生率和窒息病死率无明显影响；窒息儿的死亡率和病死率与季节有关。