Urinary antimony in infancy

Accepted 6 January 1997
OBJECTIVE—To determine whether antimony may be detected in the urine during infancy and early childhood and its association with passive exposure to tobacco smoke, as assessed by urinary cotinine.
DESIGN—Analysis of spare aliquots of urine collected from infants participating in studies of respiratory function and passive smoking. Urinary antimony was assayed using inductively coupled plasma mass spectroscopy in 201 urine specimens collected at different ages throughout the first two years of life from 122 term and 26 preterm infants. Urinary cotinine was measured using gas liquid chromatography.
MAIN OUTCOME MEASURE—Urinary antimony concentrations.
RESULTS—Absolute antimony concentrations varied widely between infants, being below the laboratory detection limit of 0.02 µg/l in 7% of samples, below 0.5 µg/l in 90.5%, and above the reference value of 1 µg/l reported for non-occupationally exposed UK populations in 4%. Creatinine standardised antimony values were unrelated to postnatal age or urinary cotinine concentrations and were highest in urine collected from preterm infants within 24 hours of birth (geometric mean (95% confidence interval): 2.3 ng/mg (1.5 to 3.4)).
CONCLUSION—Although antimony is present at very low concentrations in urine during infancy and early childhood, the relevance to health is uncertain. The higher levels found in preterm infants may reflect prematurity or fetal assimilation of antimony. Tobacco is unlikely to be an important source of environmental exposure to antimony during infancy and early childhood.

     

Urinary ascites in infancy: varied etiologies

Three cases of urinary ascites are presented, each with a different underlying aetiology. The age and modes of presentation also varied and management strategies were accordingly tailored to each patient's clinical requirements. All 3 patients survived and subsequently were discharged with good renal function. Although a rare condition, infants with urinary ascites can present as clinical emergencies in need of prompt resuscitation with subsequent drainage of the urine and decompression of the urinary tract. The ultimate management regime will vary and depend upon site of urinary extravasation and underlying aetiology.     

Urinary infection and malformations of urinary tract in infancy.

One hundred and forty infants with their first urinary tract infections were studied and pronounced differences in age and sex were found. Two thirds of the patients had their first urinary tract infection during the first three months of life, and boys were significantly younger. There was a predominance of boys from 1-3 months old, but of girls thereafter. Obstructive uropathies occurred more often in boys, and during the first two months of life. The incidence of vesicoureteric reflux was similar for both sexes. Malformations recognised after urinary tract infections were compared with urinary tract malformations recognised prenatally. Fetal urinary tracts were evaluated in just over half of all pregnancies during the study period. Obstructive uropathies and multicystic dysplastic kidneys were more often diagnosed prenatally, and most refluxes were diagnosed after the urinary tract infection. In conclusion age and sex differences are common in urinary tract infection, and even though many urinary tract malformations were diagnosed prenatally this did not influence the high incidence of malformations recognised after urinary tract infection in infancy.     

Urinary glucose unreliable as test for urinary tract infection in infancy

We tested the reliability of a paper strip test for urinary glucose in the diagnosis of urinary tract infection in babies. Though the number of false positive results (0·7%) was acceptable, 36% false negative results was regarded as unsatisfactory for a screening test for urinary tract infection, and its use cannot be recommended in this age group. This finding, however, is applicable only to urines collected from infants and in no way reflects upon the merits of the test when used in older children or adults.     

Urinary ascites with uremia and electrolyte imbalance: a delayed presentation of intraperitoneal bladder rupture in infancy

We report two infants with increasing abdominal distension, anuria, uremia, and electrolyte imbalance 4 and 8 days following intraperitoneal rupture of the urinary bladder. Awareness and early diagnosis by means of a urethrocystogram followed by surgical repair of the bladder may minimize the complication of this rare and easily missed injury in infants and small children.     

Staring in infancy

Staring in the infant is a condition of complete immobility typically accompanied by a lack of active posture. In 14 healthy infants seen in their homes from 3 to 18 weeks, it occurred for periods of 11-84 s in 2 situations: with infant alone lying supine and in face-to-face interaction with the mother. No clear heart rate and respiration patterns were noted during staring. Appearing when the infant is alone, questions a previous assumption that this condition serves to protect the immature infant from overstimulation. This neglected but well-defined condition needs to be considered in the context of the behavioural state concept.     

Botulism in infancy

The authors describe a case of botulism in a 3-month-old infant infected with Clostridium botulinum type A. Symptomatology developed within four days, persisted for two weeks, then regressed. Symptoms were paresis of face muscles, hyporeactive pupils, loss of succion and deglutition, axial hypotonia, weakness of peripheral muscles, lability of the autonomic nervous system with acute episodes of bradycardia and constipation. Anomalies of the electroen-cephalogram and of the auditory evoked responses suggest that the toxin penetrated the central nervous system. Treatment was symptomatic, without need for assisted ventilation. It was not possible to detect the source of infection.     

Jaundice in infancy

Jaundice in infancy may be physiologic or due to a pathologic cause. Fractionation of the serum bilirubin level is the first step in the evaluation. Unconjugated hyperbilirubinemia if left untreated may reach toxic levels. Primary hepatobiliary disorders, as well as infectious, toxic, genetic, and metabolic diseases, may manifest with conjugated hyperbilirubinemia. A carefully organized diagnostic evaluation in a timely fashion allows early identification of treatable disorders. Medical management of the complications of cholestatic liver disease remains a major challenge. Early surgical intervention for biliary atresia and significant advances in hepatic transplantation offer the opportunity for long-term survival for infants with previously fatal liver disorders.