The role of fever on cerebrospinal fluid glucose concentration of children with and without convulsions

In febrile convulsions glucose concentrations are known to increase both in the blood and cerebrospinal fluid (CSF). The reason behind this increase is, however, incompletely understood. We have studied the effects of convulsion and fever on the CSF and blood glucose concentrations in four different groups of children: febrile and non-febrile children, with and without convulsions. The concentration of glucose in the CSF was significantly higher in febrile children with (4.4 ± 0.1 mmol/1, mean ± SEM n = 35, p < 0.01, ANOVA, Duncan's test) and without convulsions (3.9 ± 0.2mmol/1, n = 22, p < 0.05) than in non-febrile, non-convulsive children (3.3 ±0.1 mmol/1, n = 21). In non-febrile convulsive children, the CSF glucose concentration was 3.7 ± 0.2mmol/l (n = 10). Both fever and seizures increased the CSF glucose levels (p < 0.0001 and p = 0.028, respectively, analysis of covariance). There was a linear correlation between the body temperature and concentration of glucose in the CSF (r = 0.454, p < 0.0001, n = 88, Pearson's correlation analysis). The changes in blood glucose concentrations between the groups parallelled those found in the CSF. Our results show that hyperglycaemia and an increase in the CSF glucose concentration in febrile convulsions is not explained just by a stress reaction, evoked by the seizure, as has been hypothesized earlier, but by the influence of increased body temperature as well.     

Physical effects of growth hormone treatment in children with Prader-Willi syndrome

A randomized, controlled study of 54 children (age, 4-16 years) with Prader-Willi syndrome was conducted to assess the potential beneficial effects of growth hormone (GH) treatment. After observation for 6 months, the children were randomized to receive GH at a dose of 3 IU/m²/day (1 mg/m²/day) ( n = 35) or no intervention ( n = 19). The effects of GH treatment on linear growth, body composition, muscle strength, pulmonary function and resting energy expenditure were assessed. The levels of GH secreted in resonse to clonidine stimulation were universally low, and mean (± SD) insulin-like growth factor I SDS was -1.2 ± 0.8 pretreatment. In children treated for 1 year, mean height velocity SDS significantly increased from -1.0 ± 2.5 to 4.6 ± 2.9 ( p < 0.0001), mean percentage body fat decreased from 46.3 ± 8.4% to 38.4 ± 10.7% ( p < 0.001), mean lean body mass increased from 20.5 ± 6.3 kg to 25.6 ± 4.3 kg ( p <0.01) and respiratory muscle function and physical strength imporved. Mean respiratory quotients significantly decreased from 0.81 to 0.77 ( p < 0.001); however, resting energy expenditure did not change. Therefore, GH therapy appears to reduce some of the physical disabilities experienced by children with Prader-Willi syndrome.     

Decreased ferritin levels, despite iron supplementation, during erythropoietin therapy in anaemia of prematurity

Erythropoietin (rHuEPO) therapy has been shown to be beneficial in preventing and treating anaemia of prematurity and to decrease the need for blood transfusions. There is, however, only scanty data on the effect of rHuEPO therapy on iron metabolism. We studied 29 preterm infants (age 34 ± 14 days) who were randomly assigned to receive either rHuEPO 900 U kg^-1 week^-1 with 6 mg kg^-1 day^-1 of iron for 4 weeks ( n= 15) or no therapy. The following parameters were evaluated and compared between and within groups at the beginning, during and at the end of the study: Haematocrit (SI), reticulocytes (10⁹μgl^-1), serum ferritin (μg1^-1) and iron (μmol 1^-1). The results were as follows. At the baseline, erythropoietin levels were similar in both groups: 7.2 ± 5.6 versus 6.2 ± 3.2 mU ml^-1 (NS). In the treated infants the haematocrit remained stable during the study and was significantly higher than in the control group by the end of the study: 0.34 ± 0.03 versus 0.28 ± 0.05 ( p = O.001). rHuEPO therapy increased the reticulocyte count from 130 ± 70 to 430 ± 200 ( p = 0.0002). However, rHuEPO therapy depleted both serum ferritin and it-on levels from 321 ± 191 to 76 ± 58 $uMgl^-1 ( p = 0.04) and from 18 ± 5 to 13 ± 4 μmoll^-1 ( p = 0.03), respectively. We conclude that rHuEPO therapy prevented anaemia and its sequelae; however, serum ferritin and iron levels were depleted. We suggest that the effect of rHuEPO may be further increased by higher iron supplementation.     

Osmolality and electrolytes in cerebrospinal fluid and serum of febrile children with and without seizures

Abstract During acute febrile diseases mild disturbances of water and electrolyte balance occur frequently. It has been suggested that changes in electrolyte balance, in particular hyponatraemia, might predispose a child to convulsions during febrile illness; however, the changes of electrolytes in the CSF are not known.We have studied the effects of fever and convulsions on water and electrolyte balance in CSF and serum by measuring osmolality and electrolyte concentrations in children. The febrile population consisted of 60 children, 36 of whom had seizures during fever. Twenty-one children without convulsions and nine children with epileptic symptoms were nonfebrile controls. We noticed that CSF is subject to changes in osmolality and electrolyte concentration during fever, while convulsions do not exhibit such changes. CSF osmolality and sodium concentrations were lower in febrile children than in nonfebrile controls. The osmolality in febrile children with convulsions was 3.8% (P<0.01) and without seizures 3.5% (P<0.01) lower than in nonfebrile nonconvulsive children. The changes in CSF sodium concentration, and to a lesser extent potasium and chloride concentrations, paralleled those of CSF osmolality. A positive correlation was observed between the CSF and serum osmolatities (r=0.73,P<0.0001), and sodium concentrations (r=0.63,P<0.0001). A negative correlation between the body temperature and both CSF osmolality (r=–0.66,P<0.0001) and sodium concentration (r=–0.59,P<0.0001) exhibits also the important regulative role of increased body tmeperature.Conclusion Fever is an important factor for disturbances in fluid and electrolyte balance. The alterations in CSF osmolality and sodium concentration do not, however, give an unambiguous explanation for the susceptibility to simple febrile seizures.     

Absorption of macronutrients and nitrogen balance in children with dysentery fed an amylase-treated energy-dense porridge

The aim of this study was to determine the absorption of macronutrients and energy from an energy-dense diet liquefied with amylase from germinated wheat (ARF) in children suffering from acute dysentery. Thirty-male children aged 6–35 months presenting with acute dysentery were randomly assigned to receive either an ARF-treated porridge or a standard porridge liquefied with water to make its consistency similar to the ARF porridge. After 24-h stabilization a 72-h metabolic balance was performed. Sixteen children received an ARF-treated porridge and 14 received a standard porridge liquefied with water. The mean ± SD coefficients of absorption (%) of carbohydrate, fat. protein and energy (ARF porridge vs regular porridge) were 81.4 ± 11 vs 86.9 ± 7. 86.1 ± 10 vs 82.8 ± 15, 57.3 ± 12 vs 48.4 ± 24 and 81.4 ± 9 vs 83.1 ± 8, respectively. The stool loss of carbohydrate, protein, fat and energy was similar in the two groups. The net absorption of energy was substantially greater in the ARF-fed than regular porridge-fed children (by 28%, p = 0.01). The nitrogen balance was 6.9 ± 3.4mgkg^-1 d^-1 in the ARF porridge group and 1.1 ± 6.7mgkg^-1 d^-1 in the regular porridge group ( p = 0.01). These results show that, despite being hyperosmolar, an amylase-treated liquefied energy-dense porridge is absorbed as well as a regular porridge by malnourished children with severe dysentery. Consequently, its use substantially increased the absorption of a net amount of macronutrients and resulted in a better nitrogen balance. These results further support this innovative approach of feeding sick children in developing countries.     

Persisting Glomerular Hyperfiltration in Short-term Diabetic Children without Microalbuminuria

ABSTRACT. The renal function in a group of diabetic children ( n =29; age: 4–17 yr; IDDM duration: 1.5–13 yr) was studied with a 3 year interval. At the first evaluation glomerular filtration rate (GFR) as assessed by inulin clearance was significantly increased compared to control values (167±32 vs. 124±18 ml/min/1.73 m²; p ≤0.01). Eighteen out of 29 children exhibited a glomerular hyperfiltration (GFR ≥ 160). Three years later mean GFR was identical (169±25 ml/min/1.73 m²) and 16 children were hyperfiltrating. Among them, 11 have had a persisting glomerular hyperfiltration over the 3-year period. Renal plasma flow (RPF) was positively correlated to GFR ( r =0.7; p ≤0.01) and remained elevated at both evaluations (794±163 and 812±157 ml/min/1.73 m², p ≤0.01 vs. control values). When the children were separated into 3 groups according to IDDM duration no significant differences were observed in the results for GFR and RPF. Mean urinary albumin excretion was comparable at the 3-year interval, and not significantly different from the control values (5.2±3.7 and 8.2±6.6 respectively vs. 8.65±4 |ig/min). None of the children demonstrated a persistent microalbuminuria. This study reveals a high proportion of diabetic children with a persisting glomerular hyperfiltration, without any other symmptom of incipiens nephropathy. If elevated GFR plays an important role in the development of diabetic nephropathy, this study emphasizes the value of regular evaluation of renal function in diabetic children.     

Birth stress increases adrenomedullin in the newborn

Adrenomedullin is a peptide that induces pulmonary vasodilation in experimental animals. Adrenomedullin was measured in blood samples from cord artery and vein from 41 term newborns. In 23 of the newborns delivered vaginally, levels of adrenomedullin in the cord artery, 71.8 ± 45.8 pg ml^-1 (mean ± SD), and vein, 75.6 ± 45.2 pg ml^-1, were significantly higher than in 18 newborns delivered by elective Caesarean section (40.7 ± 14.6pgml^-1 and 32.4 ±10.3 pgml^-1, respectively; both p < 0:01). A significant correlation existed between the concentration of adrenomedullin and pH in the cord artery ( r = - 0:545, p = 0:002). The fetus responds to birth stress by secreting high concentrations of adrenomedullin. As a potent vasodilator, the peptide may play a role in postnatal cardiovascular adaptation.     

Iron status at 1 and 6 years versus developmental scores at 6 years in a well-nourished affluent population

Aim: To examine the association between iron status at 1 and 6 years with development at 6 years.
Methods: In a longitudinal study of children (n = 77), iron status was measured at 1 and 6 years and the Icelandic Developmental Inventory, which evaluates children's motor and verbal development, was filled in by mothers near the children's sixth birthday.
Results: Children, iron-deficient at 1 year (n = 10), had lower fine motor development scores at 6 years than non–iron-deficient (n = 56) (46.7 ± 4.1 vs. 49.3 ± 2.0; p = 0.011). Fine motor scores were also lower in children with depleted iron stores at 1 year (n = 26) than non–iron-depleted children (n = 40) (48.0 ± 3.3 vs. 49.5 ± 1.8; p = 0.045). Multiple regression analyses, with iron status indices at 6 years, showed that mean corpuscular volume along with male gender predicted significantly positively for expression (adj. R ²= 0.15; p = 0.018; n = 73), while regression analyses, including iron status at 1 and 6 years, showed that haemoglobin at 6 years was positively associated with gross motor (adj. R ²= 0.05; p = 0.038; n = 63).
Conclusions: In an affluent society, iron deficiency and depleted iron stores at 1 year may contribute to worse fine motor developmental scores at 6 years, while low mean corpuscular volume and haemoglobin at 6 years might affect subsequent expression and gross motor scores negatively.
Sponsorship: The Icelandic Research Council.     

Practical management of diabetic ketoacidosis in childhood and adolescence

Diabetic ketoacidosis results from insulin deficiency and insulin resistance and is marked by hyperglycaemia, ketoacidosis, dehydration and electrolyte losses. Management includes correction of shock, dehydration, electrolyte deficits, hyperglycaemia, acidosis and sepsis (if present). Warning signs include severe dehydration, shock, pH <7.0, hypokalaemia, hypernatraemia, hyperosmolality, hyperlipidaemia, deterioration in consciousness and diabetic ketoacidosis in very young patients. The principles of treatment include (i) admission to a unit with paediatric experience, (ii) treatment of shock, (iii) rehydration over 24-36 h, or longer if the osmolality is >360 mmoll⁻¹, (iv) normal saline for rehydration unless the patient is hypernatraemic, (v) avoidance of bicarbonate unless acidosis is interfering with myocardial contractility, (vi) insulin infusion to achieve a fall in blood glucose levels of 5 mmol h⁻¹, (vi) potassium, (vii) use of 5% glucose when the blood glucose level falls <12 mmol 1⁻¹, (ix) treatment of any complications and (x) change to subcutaneous insulin when diabetic ketoacidosis is controlled.     

Oral desmopressin treatment of central diabetes insipidus in children

To assess the efficacy of treatment with oral desmopressin (DDAVP), 20 patients, aged 5–20 y, with central diabetes insipidus were studied during 3 d of hospitalization and for 3 months at the outpatient clinic. At baseline the median rate of diuresis was 12. 7 ml kg^-1 h^-1. Urinary output decreased significantly under treatment with an increase in urinary osmolality, normalization of plasma osmolality and absence of nocturia. Patients were discharged from hospital with a median dose of 500μg d^-1 (100–1200μg d^-1). An adjustment in dosage was necessary in seven patients during follow-up, resulting in a final dose of 600μg d^-1. Body weight and DDAVP doses ( r = 0. 75, p = 0. 001) and body surface and DDAVP doses ( r = 0. 72, p < 0. 001) were significantly correlated. The average dosage was 474 ± 222μg m^-2 d^-1 (mean ± SD). The oral DDAVP treatment remained effective during the 3 months of follow-up. This therapy offers an alternative for the treatment of central diabetes insipidus in children.     

Serum levels of CD14 in neonatal sepsis by Gram-positive and Gram-negative bacteria

The purpose of this study is to measure soluble CD14 (sCD14) levels in sera from newborn with sepsis, to compare it with other markers, and to study its evolution in Gram-negative and Gram-positive sepsis. Forty normal newborns were included (26 were full term and 14 were preterm infants), 20 babies had a positive blood culture (11 Gram-positive and 9 Gram-negative) and 16 cases were suspected of having sepsis based on clinical and laboratory findings, but a negative blood culture. Interleukin-6 (IL-6), sCD14, and tumour necrosis factor-α (TNFα) were measured by enzyme immunoassay, and fibronectin (FN) and C-reactive protein (CRP) by radial immunodiffusion. Neonates with a positive blood culture had increased levels of sCD14(3.20 ± 1.26μgml^-1, p < 0.001), CRP(69 ± 46 μgml^-1, p < 0.001)and IL-6 (134 ± 150 pg ml^-1, p < 0.001), and decreased values of FN (12.3 ± 6.6 mg ml^-1, p < 0.001). TNFα levels were also high (160 ± 37 pg ml^-1), but this increase was not statistically significant. Newborn infants suspected of having sepsis but a negative blood culture had similar but milder abnormalities. Soluble CD 14 levels correlated with CRP values; however, there was no correlation between sCD 14, TNFα and IL-6. Neonates with sepsis by Gram-positive bacteria had lower sCD14 levels than patients with Gram-negative sepsis (2.63 ± 1.2 versus 4.04 ± 1.0μgml^-1, p < 0.05). In conclusion, the sCD14 level is increased in newborn infants with sepsis, and this is higher in infections by Gram-negative bacteria, suggesting a different contribution of monocyte and macrophage cells. In contrast, IL-6, TNFα, CRP and FN values are similar in infections by Gram-positive and Gram-negative bacteria.     

INCREASED FRACTIONAL EXCRETION OF PHOSPHATE AND BETA2-MICROGLOBULIN IN UNILATERAL RENAL DISEASE

ABSTRACT. Following progressive nephron loss tubular reabsorption in the remaining nephrons will fall to preserve solute and electrolyte excretion. We have examined the fractional excretion (FE) of phosphate, sodium, beta₂-microglobulin (β²M)and tubular glucose reabsorption (T_glucose) in children with unilateral renal disease to find 1) the threshold for this response and 2) whether intrinsic renal mechanisms can elicit this response. Separate renal function studies were performed using unilateral ureteral compression. Total glomerular filtration rate (GFR) was 93.7 ± 2.99 ml/1.73(m²)^-1.min^-1, and 110.25 ± 5.40 in control children. GFR in the scarred kidney (SK) was 22.4 ± 2.46 and in the contralateral kidney (CIK) 67.2 ± 4.60 ml. 1.73 (m²)^-1. min^-1. The kidney area was reduced in proportion to GFR in SK. FE phosphate and β₂M were significantly higher in SK than in CIK (sign test), but absolute values for FE_phosphate and β₂M were not higher in SK than in control kidneys. FE_sodium and T_glucose were the same in SK and CIK. Conclusion: Following moderate unilateral reduction of GFR selective depression of tubular reabsorption can occur without extrarenal impulses.     

Antiphospholipid antibodies in children

Sera from children ( n = 173) were tested for antiphospholipid antibodies (aPL) using an enzyme immunoassay detecting IgG anti-cardiolipin antibodies (GPL). Sera from adults ( n = 100) were also tested. GPL were detected more frequently and at higher levels in children than in adults. Eighty-two percent of the children and 27% of the adults tested positive (≥ 10 GPL Uml^-1) for aPL ( p <0.001). Values of 45 GPLUml^-1 or higher were detected in about 5% of the children, and 25 GPLUml^-1 or higher in about 5% of the adults. Normal values should be adjusted accordingly.     

Randomized trial comparing natural and synthetic surfactant: increased infection rate after natural surfactant?

The efficacy of a natural porcine surfactant and a synthetic surfactant were compared in a randomized trial. In three neonatal intensive care units, 228 neonates with respiratory distress and a ratio of arterial to alveolar partial pressure of oxygen <0.22 were randomly assigned to receive either Curosurf 100mgkg⁻¹ or Exosurf Neonatal 5 ml kg⁻¹. After Curosurf, the fraction of inspired oxygen was lower from 15min (0.45 ± 0.22 vs 0.70 ± 0.22, p = 0.0001) to 6 h (0.48 ± 0.26 vs 0.64 ± 0.23, p = 0.0001) and the mean airway pressure was lower at 1 h (8.3 3.2 mmH₂O vs 9.4 ± 3.1 mmH₂O β= 0.01). Thereafter the respiratory parameters were similar. The duration of mechanical ventilation (median 6 vs 5 d) and the duration of oxygen supplementation (median 5 vs 4 d) were similar for Curosurf and Exosurf After Curosurf, C-reactive protein value over 40 mg r¹ occurred in 45% (vs 12%; RR 3.62, 95%CI 2.12-6.17, p = 0.001), leukopenia in 52% (vs 28%; RR 1.85, 95%CI 1.31-2.61, β= 0.001) and bacteraemia in 11% (vs 4%; RR3.17, 95%CI 1.05-9.52, p < 0.05).
We conclude that when given as rescue therapy Curosurf had no advantage compared with Exosurf in addition to the more effective initial response. Curosurf may increase the risk of infection.     

Factors triggering the first febrile seizure

The symptomatology of infections as well as immunological and virological findings were analysed using a logistic model in a survey of 58 children experiencing their first febrile seizures. These were then compared with findings in 116 age– and sex–matched controls with infections but no seizures. There were no statistically significant differences in the aetiology of infections between patients and controls. High temperature was the only variable to explain the occurrence of febrile seizures in the logistic model after adjusting for duration of symptoms (partial correlation coefficient in logistic model, r = 0.31). The duration of symptoms before hospitalization was shorter in patients than in controls (mean 1.0 and 3.6 days). With a longer duration of symptoms, the likelihood of seizures diminished (r =–0.34). Patients in the seizure group had a significantly higher temperature at home than controls before hospitalization (39.4 versus 38.8^°C). Our finding of higher temperatures in children with febrile seizures supports its importance as the most important triggering factor in febrile convulsions.     

Renal magnesium handling in infants and children

Renal handling of magnesium (Mg) has been incompletely studied during infancy and childhood due to the difficulty, until recently, of measuring the diffusible fraction of plasma Mg. In the present investigation this methodology has been used to assess Mg homeostasis in 45 healthy infants, aged 1 to 12 months, and in 63 healthy children, aged 1 to 15 years. When compared to children, infants had significantly higher plasma values (mean ± SD) for both total (0.76 ± 0.08 versus 0.70 ± 0.06 mmol 1 ¹; p <0.001) and ultrafilterable Mg (0.51 ±0.07 versus 0.49±0.04mmol l^-1; p <0.05). No significant correlations were present between values of plasma Mg and plasma concentrations of calcium, creatinine, total protein or albumin. The ratio U _Mg/ U _Cr, calculated in the second morning urine (median, 3rd-97th centiles), was also significantly higher during infancy (0.023, 0.009-0.07 versus 0.015,0.006-0.04;p < 0.001). On the contrary, fractional excretion of Mg (median, 3rd-97th centiles) was identical in both age groups and did not correlate significantly with age (infants: 3.2, 1.0-7.8%, children 3.4, 1.6-8.1%; p = NS). During a Mg infusion, carried out in six children, we could establish an approximative value for renal Mg threshold (plasma ultrafilterable Mg = 0.50 mmoll^-1) close to that found in adults. These results indicate that no functional immaturity is present during infancy for renal tubular reabsorption of Mg and that the high U _Mg/ U _Cr ratio observed in this age group is a phenomenon not dependent on a higher urinary Mg excretion but probably related to a lower urinary creatinine excretion per unit of lean body mass.     

Randomized trial comparing intravenous immunoglobulin with methylprednisolone pulse therapy in acute idiopathic thrombocytopenic purpura

Forty-three children with newly diagnosed idiopathic thrombocytopenic purpura (ITP), platelet count (PC) below 20 × 10⁹ 1⁻¹, and either continued bleeding or failure to show a spontaneous rise in the PC after a 3 day observation period were randomized to treatment with either intravenous immunoglobulin (IVIG) infusions I gkg⁻¹ (n = 23) or intravenous methylprednisolone pulse therapy (MPPT) 30mgkg¹ (n = 20) on two consecutive days. After 72h, IVIG had induced greater platelet responses (mean PC 188 × 10⁹ versus 77 × 10⁹1⁻¹ 2p < 0.001) and raised the PC to a haemostatically safe level above 50 × 10⁹1⁻¹ more frequently (91 versus 50%, one-sided e×act p = 0.003). Children responding poorly were then given the alternative treatment in addition. After 6 days, a normal PC of over 150 × 10⁹1⁻¹ had been obtained more frequently in the group given first-line IVIG (70 versus 50%, p = 0.16). The relapse rates during 6 months of follow-up were not significantly different (26 versus 40%, p = 0.26). Cross-over treatment in 11 children with relapse confirmed the superior response to IVIG. The treatment given was restricted to the two initial infusions more often in the IVIG group (70 versus 35%, p = 0.05). These results indicate that IVIG may be preferable to MPPT as the initial treatment for ITP.     

Evaluation of full-term infants fed an evaporated milk formula

The objective of this prospective, cohort study was to compare the nutritional status of full-term infants who were fed human milk (BF, n = 29). formula (FF, n = 30) or evaporated milk formulae (EM, n = 30) for at least 3 months. Infants were seen at enrollment, 3 and 6 months, at which times a blood sample, diet record and anthropometric data were collected. Infants in the EM group received solids earlier (12 ± 5 weeks) than did FF infants (15 ± 4 weeks), and both were earlier than BF infants (19 ± 4 weeks). Only 26% of the EM fed group received iron supplements as ferrous sulphate drops. Seven BF, 12 FF and 20 EM had abnormal ferritin values (<10ngml^-1) at 6 months. Copper intake was lower in the EM infants at 3 and 6 months. However, plasma copper and erythrocyte copper zinc superoxide dismutase (ZnCuSOD) levels did not differ between groups. Selenium intake was lower in the EM group (5 ± 1 and 10 ± 5 μg d^-1; 3 and 6 months) than in the FF infants (13 ± 4 and 19 ± 7 μgd^-1; 3 and 6 months). Erythrocyte SeGHSPx levels in EM infants were lower at 6 months (EM, 33.2 ± 3.4; FF, 35.2 ± 3.9; BF, 36.1 ± S.SmUmgHb^-1). Thiamin intake (0.99 ± 0.08 and 1.24 ± 0.32; 3 and 6 months, mg 1000 kcal^-1) was higher in the FF group than in EM infants (0.38 ± 0.39 and 0.66 ± 0.38; 3 and 6 months). There were more (13%) abnormal thiamin assays in the EM group at 6 months than in the BF and FF infants (0%). In conclusion, infants fed evaporated milk formula receive adequate copper but may not receive enough thiamin or selenium. Unless supplemented from birth with medicinal iron, intakes of iron will be inadequate.     

Endogenous nitric oxide in the upper airways of premature and term infants

Concentrations of endogenous nitric oxide (NO) were measured in premature ( n = 18) and term infants ( n = 7). Nasal gas was aspirated continuously and after timed occlusions, 15 s and 60 s, by a fast-response chemiluminescence analyser. The sampling flow rate was 20 ml min^-1. Typical NO recordings consisted of plateaux and postocclusive peaks. In term infants peak NO concentrations (60 s occlusion) were 2. 71 ± 0. 44 parts per million (ppm) within lOmin after birth, increasing ( p < 0. 05) to 3. 81 ± 0. 25 ppm at 4–7 d postnatally. Peak NO values (15 s occlusion) averaged 1. 22 ± 0. 16 ppm in premature infants (postconcep-tional age 25–37 weeks, body weight 623–2844 g) and the NO concentrations increased significantly with postconceptional age ( p < 0. 05). Nasal excretion rate, estimated from plateau NO concentrations and sampling flow rate, was 0. 10 ± 0. 01 nmol min^-1 kg^-1 in both groups. We conclude that premature and term newborn infants excrete considerable amounts of NO in the upper airways, with hitherto not fully known functions.     

Fibronectin in Meningococcal Sepsis

ABSTRACT. Plasma fibronectin was measured with Laurell's immunoelectroassay in 44 patients with meningococcal sepsis. The average value (15.0±7.9 mg/dl) was lower than that in normal children (27.4±8.7 mg/dl) (p<0.001). Fibronectin in patients correlated positively with antithrombin III (AT-III) values (p<0.02), but not with protein C (0.05+), than in those without DIC (DIC⁻) (p<0.02), but were lower in both groups than in a normal control group. A negative correlation between fibronectin and protein C was only present in DIC⁻ patients (r:-0.773=p<0.01). Fibronectin varied independent of AT-III and protein C in DIC⁺ patients. The study was repeated in 11 patients 24 hours after admission when fibronectin had decreased in 7/11 cases (mean decrease: -2.7±8.7 mg/dl). This variation correlated in a negative way with AT-III (r:-0.659=p<0.05). In meningococcal sepsis fibronectin decreases very early, even in DIC⁻ patients and its relationship to AT-III and protein C is different, depending on the presence of DIC and on the stage of evolution of the disease.