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1.
Cord serum sodium concentrations in two groups of vaginally delivered, singleton term infants were correlated with the incidence of transient neonatal tachypnoea. Hyponatraemia (cord serum sodium less than 130 mmol/l) was seen in 71 of 180 (39%) infants born to mothers who received an intravenous infusion of aqueous glucose solution during labour (study group) compared with 6 of 103 (6%) infants born to mothers who did not receive any intravenous fluid treatment (controls). The incidence of transient neonatal tachypnoea was 4.5 times higher for hyponatraemic infants in the study group (11 of 71) than for normonatraemic infants in the same group (3 of 109) and the control group (3 of 97). The difference was not attributable to other perinatal or neonatal characteristics. Our findings suggest an increased risk of transient neonatal tachypnoea in term infants who suffer from transplacental hyponatraemia after their mothers received intrapartum infusion of aqueous glucose solutions.  相似文献   

2.
AIM: To compare the breathing patterns of infants born by elective caesarean section to those infants delivered by caesarean section after a failed trial of labour. METHODS: Healthy term infants born by caesarean section were studied. The study group (n = 13) had no trial of labour, whereas infants in the control group (n = 13) failed a trial of labour. Polysomnographic study was performed at 36 h of age. Heart and respiratory rate, type and duration of apnoeas, arterial oxygen saturation and lower limb movements were analysed. RESULTS: Term infants born by elective caesarean section had a shorter duration of pregnancy and weighed less. Their heart rate was faster, they had more mixed apnoeas, and during quiet sleep they had more central apnoeas of longer duration. CONCLUSION: Cardiorespiratory patterns in infants delivered by elective caesarean section are different from those delivered by caesarean section after a failed trial of labour.  相似文献   

3.
Nineteen preterm infants born at or before 32 weeks of gestation were studied to determine the dose of calcitriol that would be effective in the prophylaxis of early neonatal hypocalcemia (serum calcium level, less than 7.0 mg/dL [less than 1.75 mmol/L]). In these infants the course of early neonatal hypocalcemia was not modified by calcitriol administration. Serum 1,25-dihydroxyvitamin D level rose in response to intramuscular administration of calcitriol. The incidence of hypocalcemia in these infants was 37% by 12 hours, 83% by 24 hours, and 89% by 36 hours. Thus, in extremely preterm infants, the incidence of early neonatal hypocalcemia is higher and the onset earlier than in larger preterm infants; furthermore, in these infants the hypocalcemia is refractory even to high doses of calcitriol.  相似文献   

4.
Dale, G., Goldfinch, M. E., Sibert, J. R., and Webb, J. K. G. (1975). Archives of Disease in childhood, 50, 731. Plasma osmolality, sodium, and urea in healthy breast-fed and bottle-fed infants in Newcastle upon Tyne. Plasma osmolality, sodium, and urea were measured on samples from 50 healthy infants, aged between 18 and 125 days, attending child health clinics in Newcastle upon Tyne. 3 infants had osmolalities greater than 300 mOsm/kg, a lower incidence of hyperosmolality than that previously reported. There was a difference (P less than 0-001) between the plasma urea levels of breast-fed and bottle-fed infants, but not between the osmolalities of these groups. The mean plasma urea of bottle-fed babies was 53 mg/100 ml (SD 12-47), 50-1 mg/100 ml (SD 10-9) if additional solids were being given, and 18-4 mg/100 ml (SD 7-81) for breast-fed babies. There was little difference between the plasma sodium levels of each group. The mean plasma sodium for all groups combined was 135-2 mmol/1 (SD 2-3); no plasma sodium exceeded 140 mmol/1.  相似文献   

5.
To test the hypothesis that restriction of sodium intake during the first 3 to 5 days of life will prevent the occurrence of hypernatremia and the need for administration of large fluid volumes, we prospectively and randomly assigned 17 babies (mean +/- SD: 850 +/- 120 gm; 27 +/- 1 weeks of gestation) to receive in blind fashion either daily maintenance sodium or salt restriction with physician-prescribed parenteral fluid intake. Maintenance-group infants received 3 to 4 mEq of sodium per kilogram per day; restricted infants received no sodium supplement other than with such treatments as transfusion. Sodium balance studies conducted for 5 days demonstrated that maintenance salt intake resulted in a daily sodium balance near zero, whereas sodium-restricted infants continued to excrete urinary sodium at a high rate, which promoted a more negative balance (average daily sodium balance -0.30 +/- 1.78 SD in maintenance group vs -3.71 +/- 1.47 mEq/kg per day in restriction group; p less than 0.001). Care givers tended to prescribe daily increases in parenteral fluids for the salt-supplemented infants, perhaps because serum sodium concentrations were elevated in these infants after the first day of the study (p less than 0.001). Hypernatremia developed in two sodium-supplemented infants (greater than 150 mEq/L), and hyponatremia developed in two sodium-restricted infants (less than 130 mEq/L); however, the restricted infants were more likely to have normal serum osmolality (p less than 0.05). Both groups of infants produced urine that was neither concentrated nor dilute, with a high fractional excretion of sodium; renal failure was not observed. The mortality rate was not affected, but the incidence of bronchopulmonary dysplasia was significantly less in the sodium-restricted babies (p less than 0.02). We conclude that in tiny premature infants, a fluid regimen that restricts sodium may simplify parenteral fluid therapy targeted to prevent hypernatremia and excessive administration of parenteral fluids.  相似文献   

6.
Recent data suggest that early loss of brain tissue water content, ie, decreased extravascular cerebral tissue pressure, may play a role in the pathogenesis of germinal matrix/intraventricular hemorrhage in the premature newborn. This study examines the relationship between the concentration of serum sodium and germinal matrix/intraventricular hemorrhage in 299 premature infants with birth weights of less than 1500 g during the first 4 days of life. Intraventricular hemorrhage developed in 34 (32%) of the 106 infants with maximum serum sodium levels of 145 mmol/L or less and in 54 (28%) of 193 infants whose highest serum sodium levels were greater than 145 mmol/L (chi 2 = 0.37). These data suggest that concentrations of serum sodium greater than 145 mmol/L are not associated with an increased risk of germinal matrix/intraventricular hemorrhage in the premature newborn. Consequently, more liberal administration of fluids to maintain extravascular cerebral tissue pressure is unlikely to reduce the incidence of germinal matrix hemorrhage/intraventricular hemorrhage.  相似文献   

7.
One of the main targets of fluid therapy in premature infants is to avoid variations in osmolality, which mainly means providing a stable sodium, glucose, and acid-base balance. Water, sodium, and acid-base balance were measured in 20 infants appropriate-for-gestational age with a gestational age less than or equal to 34 weeks. The infants were randomly assigned to one of two treatment groups. Fluid intake was restricted and air humidity in the incubator was high in order to minimize insensible water loss. Sodium intake in Group 1 was 2 mmol/kg/day and consisted of sodium chloride. Sodium intake in Group 2 was 4 mmol/kg/day and consisted of both sodium chloride and acetate. Weight loss was appropriate in both groups. In the high sodium intake group there was a tendency towards a more stable plasma sodium concentration than in the low sodium intake group. The use of sodium acetate was efficient and practical as normal acid-base balance was maintained. The protocol with restricted fluid intake (1st day 50 ml/kg, 2nd day 70 ml/kg, 3rd day 90 ml/kg, and 4th day 110 ml/kg), high air humidity, a sodium supply of 3 to 4 mmol/kg/day, and a slow correction of metabolic acidosis with sodium acetate, yields suitable guidelines in planning fluid and electrolyte therapy in premature infants less than or equal to 34 weeks' gestation.  相似文献   

8.
Water, electrolyte, and endocrine homeostasis in infants with bronchiolitis   总被引:6,自引:0,他引:6  
Twenty-two of 23 consecutive infants with bronchiolitis, 5.5 +/- 3.5 mo of age, showed a 1.9 +/- 1.4% increase in body weight, increased urinary osmolality of 737 +/- 193 mmol/L with low plasma osmolality of 275 +/- 4 mmol/L, and markedly elevated plasma antidiuretic hormone (ADH) levels of 114 +/- 225 pg/mL. Increased ADH, which usually suppresses plasma renin activity, was associated with increased plasma renin activity of 11-55 ng angiotensin 1/mL/h (normal for age less than 10 ng angiotensin 1/mL/h). Hyperaldosteronism was evident from the low fractional excretion of sodium of 0.27 +/- 0.2% and high fractional excretion of potassium of 21 +/- 15%. Serum sodium concentrations were normal. All of the pathologic findings returned to normal when the bronchiolitis subsided. A control group of 10 infants with nonrespiratory febrile illness did not show any of the above abnormalities. Thus, bronchiolitis of infancy is characterized by both increased ADH secretion and hyperreninemia with secondary hyperaldosteronism, which induce water retention but counterbalance each other with respect to serum sodium. Increased ADH secretion as well as increased plasma renin activity are not "inappropriate," but rather suggest a response to the perception of hypovolemia by intrathoracic receptors. We therefore conclude that the clinical management of bronchiolitis requires close monitoring of body wt and plasma osmolality-urinary osmolality relationship; serum sodium levels may be misleading.  相似文献   

9.
ABSTRACT. In order to find out whether arterial and venous cord levels of vasopressin (VP) and oxytocin (OT) might be linked to one or more obstetric parameters and to beta-endorphin (BEP) secretion, 42 successively delivered neonates were studied. Arterial and venous cord blood levels of these peptides were not statistically different whenever the neonates were born vaginally with or without foetal distress, after induction of labour by oxytocic drugs, or by elective caesarean section. BEP levels in cord and maternal blood do not seem to be linked with AVP or OT. The results of the group of infants born after uncomplicated vaginal delivery analyzed with regard to obstetric parameters, led to the following conclusions: 1) arterial cord VP correlated with venous cord VP, with arterial cord OT and with the duration of membrane rupture; 2) arterial cord OT correlated with venous cord OT and with the time taken by the cervix to dilate from 5 to 10 cm, suggesting that the foetal pituitary gland is sensitive to the evolution of labour.  相似文献   

10.
In order to find out whether arterial and venous cord levels of vasopressin (VP) and oxytocin (OT) might be linked to one or more obstetric parameters and to beta-endorphin (BEP) secretion, 42 successively delivered neonates were studied. Arterial and venous cord blood levels of these peptides were not statistically different whenever the neonates were born vaginally with or without foetal distress, after induction of labour by oxytocic drugs, or by elective caesarean section. BEP levels in cord and maternal blood do not seem to be linked with AVP or OT. The results of the group of infants born after uncomplicated vaginal delivery analyzed with regard to obstetric parameters, led to the following conclusions: arterial cord VP correlated with venous cord VP, with arterial cord OT and with the duration of membrane rupture; arterial cord OT correlated with venous cord OT and with the time taken by the cervix to dilate from 5 to 10 cm, suggesting that the foetal pituitary gland is sensitive to the evolution of labour.  相似文献   

11.
OBJECTIVE--To determine the relationship between measured serum osmolality (MsOsm) and calculated osmolality and to examine factors that may affect the osmolal gap. RESEARCH DESIGN--Longitudinal cohort study. SETTING--Regional tertiary neonatal intensive care nursery in a university-affiliated hospital. PATIENTS--Sixty low-birth-weight infants (birth weight, 540 to 1500 g), studied daily during the first week of life. SELECTION PROCEDURE--Consecutive sample. INTERVENTIONS--None. MEASUREMENTS AND RESULTS--The MsOsm was significantly higher than the calculated osmolality for the first 6 days of life. The MsOsm was significantly higher during the first 6 days of life in infants with birth weights less than 1000 g than in those with birth weights greater than 1000 g, but the calculated osmolality was similar in both groups. Intraventricular hemorrhage, preservative additives in drugs, and packed red blood cell transfusions did not contribute significantly to osmolal gap or MsOsm. In 19 patients, peak MsOsm was greater than or equal to 320 mmol/kg (mean, 336 +/- 13 mmol/kg; calculated osmolality, 298 +/- 20 mmol/kg; osmolal gap, 38 +/- 19 mmol/kg). Six of these 19 patients died (all with birth weights less than 1000 g). CONCLUSIONS--A significant proportion of patients with very low birth weights (mostly less than 1000 g) have large osmolal gaps and/or an MsOsm greater than 300 mmol/kg during the first week of life. The relationship between increased MsOsm in infants with very low birth weights and effective osmolality requires further study. Therapeutic intervention based solely on elevated MsOsm is ill advised.  相似文献   

12.
We describe a new technique of collecting sweat for measurement of osmolality and sodium concentrations. Eighty two subjects were studied--39 controls and 43 patients with cystic fibrosis. Adequate amounts of sweat were obtained in 81 subjects and sweat was analysed for both osmolality and sodium concentrations in 73 subjects. The 34 controls gave sweat osmolality and sodium values ranging from 62 to 196 mmol/kg and 9 to 72 mmol/l respectively. The 39 cystic fibrosis patients gave osmolality values ranging from 220 to 416 mmol/kg and sodium concentrations ranging from 60 to 150 mmol/l. Sweat osmolality alone was determined in eight infants under 50 days of age--four later developed the clinical features of cystic fibrosis and four, in whom cystic fibrosis was suspected, were later excluded. Sweat osmolality values in these two groups ranged from 255 to 345 mmol/kg and 87 to 123 mmol/kg respectively. The simplicity of collecting sweat and the measurement of osmolality offer distinct advantages over techniques previously described.  相似文献   

13.
OBJECTIVE: To determine whether umbilical cord blood glucose correlates with subsequent hypoglycaemia after birth in infants of well-controlled diabetic mothers. METHODOLOGY: Thirty-eight term infants of well-controlled diabetic mothers were enrolled. Five mothers had pre-existing diabetes. Of the 33 gestational diabetic mothers, 16 were managed on insulin and 17 on diet. Maternal blood glucose was maintained between 4 and 8 mmol/L during labour and delivery. Infants' plasma glucose levels were measured from venous cord blood and serially, at less than 30 min, 1 h and 2 h of life by glucose hexokinase method. Blood glucose levels were further monitored by bedside Dextrostix for 24 h. RESULTS: Eighteen (47%) infants developed hypoglycaemia (blood glucose level less than 2 mmol/L) during the first 2 h of life. There was no difference in the cord blood glucose levels between infants with or without hypoglycaemia (3.7 +/- 1.1 vs 4.5 +/- 1.1 mmol/L, respectively). Infants of mothers with diabetes diagnosed prior to 28 weeks gestation were at a higher risk of developing hypoglycaemia (8 of 10 vs 10 of 28, OR 7.2, 95%CI 1.3-40.7). Hypoglycaemic infants were of significantly higher birthweight, and were more likely to be born to Caucasian mothers and by Caesarean section. Raised maternal fructosamine blood level, the need for insulin treatment or the infant's haematocrit were not different between infants with or without hypoglycaemia. CONCLUSIONS: In well-controlled diabetic mothers, the incidence of early hypoglycaemia in infants is still high, particularly in those mothers who had a longer duration of diabetes. Cord blood glucose level did not identify the infants with hypoglycaemia.  相似文献   

14.
Plasma renin activity was determined in 25 healthy, full-term, newborn infants aged 1 day to 9 weeks. High values were found, the mean level at 1-2 days of life (24.8 +/- 8.4 ng/ml/hr, SE) being significantly higher than the mean levels at 7-9 days (5.8 +/- 1.5) and at 4-9 weeks (8.1 +/- 1.3) (P less than 0.05). No correlation was found between plasma renin activity and systolic blood pressure, hematocrit, creatinine clearance, serum sodium, or serum potassium. Plasma renin activity (log values) was inversely correlated with sodium intake (r = -0.58) or with urinary sodium (r = -0.44), and positively with urinary osmolality (r = 0.67). The correlations reached higher coefficients if only infants aged less than or equal to 9 days were considered. In addition, vasopressin was measured by radioimmunoassay in the urine. The daily excretion was lower in newborn infants (9.4 +/- 1.6 ng/m2/day, SE, at 1-2 days of postnatal life) than in healthy children (37.1 +/- 5.6), and was significantly correlated with creatinine clearance (r = 0.69), but not with urinary osmolality.  相似文献   

15.
We calculated new birthweight and head circumference centiles for boys and girls between 24 and 42 weeks'' gestation from 20,713 singleton live births at our hospital between 1978 and 1984. Among the 803 babies born at or before 34 weeks'' gestation, 28% were delivered electively for fetal problems; they were considerably lighter than babies born after spontaneous preterm labour. In contrast, they showed only a small deficit in head circumference, possibly due to a brain sparing effect in growth retarded infants. Electively delivered preterm infants cause a bias in birthweight and head circumference centiles and we recommend that these babies should be excluded when these centiles are calculated.  相似文献   

16.
The purpose of this study was to determine whether the early artificial rupture of the amniotic membranes performed to shorten the duration of an otherwise normal labor and delivery might have potentially deleterious effects on the fetus that would be reflected in the neonate. In 38 infants delivered at term, acid-base balances and O2 and CO2 pressures were obtained in umbilical arterial and venous blood at birth, prior to the first inspiration. For the purpose of the study the infants were divided into two groups: group I infants were born after a normal labor in which the amniotic membranes were permitted to rupture spontaneously at full cervical dilatation; group II infants were born after a labor in which the membranes were ruptured artificially when cervical dilatation was 4 to 5 cm. There was no evidence of fetal distress, and all infants were vigorous at birth. The pH of umbilical venous blood was greater in the group with late rupture of the membranes (fiftieth percentile [P50] = 7.36) than in those born after early amniotomy (P50 = 7.30) (p less than 0.01). The pH values of umbilical arterial blood were also higher in the group I infants (P50 = 7.31) than in those born after amniotomy (P50 = 7.25)(p less than 0.025). These differences were also observed in the 19 neonates in whom the cord was not encircled around the neck at the time of birth. The PCO2 in umbilical venous blood was less, and the hemoglobin saturation was greater (P less than 0.05) in group I infants than in those of group II. It is possible that the influence of early amniotomy on fetal pH may be deleterious in infants born after high-risk pregnancies in which the uteroplacental circulation is impaired.  相似文献   

17.
A study of 887 consecutively born immigrant Greek and 220 Anglo-Saxon Australian infants has shown that serum bilirubin concentrations are influenced by these factors: breast feeding, delivery with forceps, gestation, birthweight, sex of the infant, presence of hypoxia, presence of blood group incompatibility, a positive direct Coombs''s test, maternal sepis, and administration to the mother of promethazine hydrochloride, reserpine, chloral hydrate, barbiturates, narcotic agents, diazepam, oxytocin, aspirin, and phenytoin sodium. Apart from the administration of promethazine hydrochloride, reserpine, chloral hydrate, and quinalbarbitone sodium, only two factors, breast feeding and delivery by forceps, occured with different frequencies in the immigrant Greek and the Australian infants. Among the Greek infants with jaundice, there were few where the cause of the jaundice was inapparent. The immigrant Greek and Australian newborn populations were therefore remarkably similar. Since differences of frequency and severity of jaundice do exist in infants born in Greece, this difference must be lost when the parents emigrate, and therefore an environmental factor must be incriminated as the causative agent for jaundice of unknown origin in Greece.  相似文献   

18.
We studied morphine pharmacokinetics after a single intravenous dose of 0.1 mg/kg in 20 newborn infants, who were born at 26 to 40 weeks of gestation and were less than 5 days of age. In the 10 infants whose gestational age was less than or equal to 30 weeks, the mean (+/- SD) distribution half-life was 50 +/- 35 minutes, elimination half-life was 10 +/- 3.7 hours, and clearance was 3.39 +/- 3.28 ml/kg/min; the corresponding values for the three term infants were 19 +/- 8 minutes, 6.7 +/- 4.6 hours, and 15.5 +/- 10 ml/kg/min, respectively. The data suggested a trend of decreasing values for distribution and elimination half-lives with increasing gestation, but a considerable degree of variation was seen. The morphine clearance rate increased as a function of gestational age at a rate of 0.9 ml/kg/min per week of gestation. Between 18% and 22% of the drug was found to be protein bound. Four hours after the dose, the drug level remained greater than or equal to 12 ng/ml in 8 of 10 infants born at greater than or equal to 31 weeks of gestation. In 8 of 10 infants born at less than or equal to 30 weeks of gestation, similar levels were maintained at 8 hours after the initial dose. We conclude that (1) there is a marked degree of variation in morphine pharmacokinetics during the neonatal period, (2) nearly 80% of the intravenously infused drug remains free, which might explain the high sensitivity to morphine in this age group, and (3) during the first week of age, adequate blood levels can be maintained by administration of morphine at 4- to 6-hour intervals in term infants and at less frequent intervals in very premature infants (less than or equal to 30 weeks of gestation).  相似文献   

19.
《Early human development》1997,47(3):287-296
In developing countries, birth asphyxia is frequently associated with hypoxic ischaemic encephalopathy. This has been attributed to inadequate obstetric care but poor nutrition may also be important. This study determines the association between magnesium stores and hypoxic ischaemic encephalopathy. The level of red blood cell magnesium was measured on 572 women in labour and on selected offspring in a teaching hospital in South Africa. Fifty five of the 572 women delivered infants with hypoxic ischaemic encephalopathy and had significantly lower red blood cell magnesium levels (1.40 mmol/l) than controls. In the latter the levels varied somewhat with the mode of delivery, vertex births 1.76 mmol/l, Caesarean sections 1.67 mmol/l and vacuum extractions 1.61 mmol/l. Infants with hypoxic ischaemic encephalopathy had a significantly lower red blood cell magnesium level (1.39 mmol/l) than normal infants (1.61 mmol/l). Fifty four of 55 babies were black and from poor social circumstances and nutritional deficiency may be relevant. Maternal height, age and the duration of labour did not influence the chance of hypoxic ischaemic encephalopathy and affected infants were more likely than normal ones to be meconium stained (50%), to have a low Apgar score (58%) and to need endotracheal intubation at birth (54%). An intervention study in early pregnancy may determine magnesium's role in hypoxic ischaemic encephalopathy associated with asphyxia.  相似文献   

20.
The 95th percentile value of cord serum triglyceride concentration in 82 consecutively live born infants was found to be 0.79 mmol/l. This level was arbitrarily used to define neonatal hypertriglyceridemia. A comparison between 78 normotriglyceridemic and 61 hypertriglyceridemic newborn infants showed a significant association between elevated cord serum triglyceride concentration and insufficiency of the placenta, fetal bradycardia, meconium-stained amniotic fluid and one-minute Apgar score less than or equal to 7. A significantly (p less than 0.001) greater number of infants with one or several of these four factors, indicating antepartum and/or intrapartum fetal stress were found to be hypertriglyceridemic at birth. This finding suggests that estimation of cord serum triglyceride which is easy and inexpensive might be of value for a more complete evaluation of the newborn infant, and can serve as a supplement to the Apgar Score system.  相似文献   

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