THE INFLUENCE OF DIFFERENT ENVIRONMENTAL TEMPERATURES ON PULMONARY GAS EXCHANGE and BLOOD GAS CHANGES AFTER BIRTH

Abstract. Tunell, R. (Department of Paediatrics, Karolinska Sjukhuset, Stockholm, Sweden). The influence of different environmental temperatures on pulmonary gas exchange and blood gas changes after birth. Acta Paediatr Scand, 64:57, 1975.–The oxygen uptake (V_o2) and respiratory exchange ratio (R) was determined during the first 20 min and at one and at 2 hours after birth in 16 healthy full-term newborn infants studied in different environmental temperatures. Arterial blood gases and acid-base balance were determined on repeated blood samples from the abdominal aorta. The infants were grouped in a “warm” group (n= 10) where efforts were made to avoid cooling after birth, and a “cold” group (n=6) where a decrease in rectal temperature to a mean value of 35.4^oC at 2 hours occurred. Irrespective of environmental temperature, V_o2 was approximately 10 ml/kg min during the first 8 min after birth, thereafter decreasing to about 6–7 ml/kg min. During the first 8 min the main increase in P_a02 occurred and about 2 ml/kg min of the V₀ was accounted for by changes in oxygen stores after birth. At 16–20 min and at 60 min after birth a negative relationship was found between V_o2 and P_ao2 During the period 8–120 min after birth a close relationship was found between V_o2 and the degree of muscular activity. Within 4–16 min after birth, R values above 1.0 were regularly found simultaneously with the main decrease in P_aco2. In infants kept “cold” a tendency to hyperventilate was found, probably elicited by cold stimuli. The rapid drop in deep body temperature regularly seen after birth could thus not be explained by a limited ability to increase pulmonary gas exchange. A high degree of evaporative heat loss, a relatively low “basal” metabolic rate and a limited response in “non-shivering thermogenesis” seem to be the main reasons for the heat loss after birth.     

AN ENZYME INDUCTOR COMBINATION FOR THE PREVENTION OF HYPERBILIRUBINEMIA IN PREMATURE INFANTS

Abstract. Hinkel, G. K., Kintzel, H.-W., Schwarze, R. and Hiindel, A. (Paediatric Hospital, Medical Academy "Carl Gustav Carus", Department of Neonatology, Dresden, GDR). Enzyme inductor combination to prevent hyperbilirubinaemia in premature infants. Acta Paediatr Scand, 63: 393, 1974.–In the management of physiologic hyperbilirubinemia in newborn infants, phenobarbital and nicethamide (diethylnicotinamide), as an enzyme inductor combination, are found to have a cumulative effect and, consequently, are clearly superior to the use of phenobarbital alone. Four different dosages were compared and the most favourable variant proved to be phenobarbital, 10 mg/kg body weight pro die from day 1 to day 3 (after birth), combined with nicethamide, 100 mg/kg per diem from day 1 to day 4. Exchange transfusion was no longer necessary in 400 premature infants who had received this type of prophylactic combination and thus the routine use of this inductor regimen can now be recommended.