LEFT VENTRICULAR SYSTOLIC TIME INTERVALS IN PRETERM INFANTS WITH PATENT DUCTUS ARTERIOSUS

ABSTRACT. Left ventricular systolic time intervals were recorded by a non-invasive technique, from the axillary artery, in 13 preterm infants with patent ductus arteriosus. At the onset of clinical symptoms, consistent with a large left-to right ductal shunt, the preejection intervals were shorter than in a control group of nine preterm infants without a patent ductus. The most pronounced difference was found in the shortening of the isovolumic contraction time, 10.7 msec in the ductus group compared with 22.4 msec in the control group. Ductal closure normalized the isovolumic contraction time to 22.1 msec. The very short preejection intervals, associated with a large ductal shunt, are suggested to reflect a combination of reduced aortic diastolic pressure and increased left ventricular filling pressure. In spite of increased volume load to the left ventricle there were no detectable changes in the systolic time intervals indicating impaired left ventricular function. The left ventricle seems to be competent to handle increased volume load in the presence of reduced afterload in preterm infants with symptomatic left-to right ductal shunts.     

DIGOXIN THERAPY AND LEFT VENTRICULAR PERFORMANCE IN PREMATURE INFANTS WITH PATENT DUCTUS ARTERIOSUS

ABSTRACT. Left ventricular systolic time intervals were assessed in 16 preterm infants with symptomatic left-to-right ductal shunts, before, during and after digoxin therapy. An intravenous loading dose of digoxin, 20 μg/kg, resulted in a serum digoxin concentration of 1.94±0.44 nmol/1 (mean ± 1 SD) but in no significant change in heart rate or systolic time intervals. Digoxin maintenance, 2.5 μg/kg/12 h, led 3–7 days later to serum concentrations of 2.57±1.06 nmol/1 with an associated shortening of left ventricular ejection time ( p <0.05) which probably reflected a reduced ductal shunt. Digoxin therapy was withdrawn after ductal closure. The terminal serum half-life was 87±17 h. Decreasing digoxin concentrations were associated with prolongation of left ventricular ejection time ( p <0.01). Digoxin therapy did not seem to influence left ventricular systolic time intervals while ductal patency persisted. This may be attributed to limitations of the method or the left ventricle already working at its maximum.     

EARLY CLOSURE OF PATENT DUCTUS ARTERIOSUS WITH INDOMETHACIN IN PRETERM INFANTS WITH IDIOPATHIC RESPIRATORY DISTRESS SYNDROME

ABSTRACT. Thirty-seven preterm infants with idiopathic respiratory distress syndrome were prospectively studied for the effect of the early closure of patent ductus arteriosus with indomethacin on the course of idiopathic respiratory distress syndrome. Serial retrograde aortograms were performed in all infants in order to visualize the ductus arteriosus, apart from three patients, who died early and were evaluated aortographically only once. The ductus was initially open in 27 infants and closed in 10 infants. The infants with open ductus arteriosus were randomly divided into two groups. The first group consisted of 13 infants, in whom the ductus was closed with indomethacin at a median age of 18 hours. The other 14 infants served as controls. Total time on assisted ventilation and duration of exposure to additional oxygen were significantly shorter in medicated infants than in controls. Oxygenation of infants with an initially closed ductus was better from birth and duration of their ventilatory assistance and oxygen exposure were shorter than in infants with initial ductal shunting. The data suggest that the early closure of the patent ductus arteriosus with indomethacin in distressed preterm infants has a favourable effect on the course of idiopathic respiratory distress syndrome.     

CHANGES IN CEREBRAL HEMODYNAMICS IN PRETERM INFANTS WITH AND WITHOUT PATENT DUCTUS ARTERIOSUS

ABSTRACT. We compared anterior cerebral pulsatility index (ACPI), anterior cerebral mean flow velocity (ACMFV), common carotid pulsatility index (CPI) and common carotid mean flow velocity (CMFV) in three groups of preterm infants with birth-weights less than 1500 grams: 6 without evidence of PDA (group A), 6 with PDA treated with fluid restriction, diuretics or digoxin (group B) and 6 with surgical ligation of PDA (group C). Infants were assessed in three time periods: the first four days of life, five days before surgical ligation and five days post-ligation. Analyses of variance showed no significant differences in the three groups for the four measures in time 1. In time 2, ACPI was 0.61 for group A, 0.58 for group B, 0.78 for group C ( p <0.01). ACMFV was 9.22 for group A, 7.71 for group B, 6.37 for group C ( p <0.05). CPI was 0.84 for group A, 0.83 for group B, 0.90 for group C (NS); CMFV was 7.80 for group A, 5.63 for group B, 4.28 for group C ( p <0.01). In time 3, significant differences ( p <0.01) were found only for CMFV.     

PLASMA CONCENTRATIONS OF DIAZEPAM AND N-DESMETHYLDIAZEPAM IN NEWBORN INFANTS AFTER INTRAVENOUS, INTRAMUSCULAR, RECTAL AND ORAL ADMINISTRATION

ABSTRACT. Five newborn infants (birth weight 2900–3600 g) were given diazepam (Valium®, LaRoche) for convulsive disorders in 4 equal doses intravenously, intramuscularly, rectally and orally with at least 24 hours intervals. Three infants were given doses of 1 mg diazepam/kg body weight, and 2 0.5 mg/kg. The parenteral solution of the drug was given intravenously, intramuscularly and rectally. Powder of tablets was given orally. After intravenous administration very high peak values of plasma-diazepam concentration were obtained (5775–10800 ng/ml after 1 mg/kg, 2750 and 6450 ng/ml after 0.5 mg/kg). Next to intravenous administration rectal administration caused the most rapid increase in plasma-diazepam concentration. Presumed anticonsulsive concentrations (150–300 ng/ml) were obtained within 5 min with 1 mg/kg as well as 0.5 mg/kg rectally. Rectal administration therefore could be a suitable treatment for seizures in the newborn infant. Accumulation of the main depressive metabolite N-desmethyldiazepam occurred in all infants. This phenomenon must be taken into account when repeated doses of diazepam are administered.     

Intravenous Indomethacin therapy in preterm neonates with patent ductus arteriosus

This study examined the response of the patent ductus arteriosus (PDA) to intravenous Indomethacin using serial two dimensional and Doppler echocardiography and documented the complications associated with therapy. Thirty-six preterm neonates who were oxygen and ventilator dependent were studied when they were aged 3-7 days. The PDA initially closed in 22 (61%) and constricted in seven (19%) of the infants. It was non-responsive in five (14%) and the treatment was stopped because of complications in two (6%). Only three (43%) of seven neonates given a second course had PDA closure. In the 25 instances where there was PDA closure following Indomethacin, re-opening was documented echocardiographically on three (12%) occasions. Overall, Indomethacin therapy was successful in 29 (81%) neonates, PDA ligation was required in four (11%) and three died from unrelated causes. Three (8%) neonates developed major complications: multiple gastric perforations in the first, focal ileal perforation in the second, and necrotizing enterocolitis in the third. Treatment failure, PDA ligation and major complications occurred exclusively in neonates less than 28 weeks gestation. In view of the relatively low efficacy and high major complication rate in these extremely preterm infants, a randomized clinical trial needs to be conducted using two dimensional and Doppler echocardiography to allow accurate assessment of the PDA response to intravenous Indomethacin.     

SERUM CONCENTRATIONS OF THYROXINE-BINDING GLOBULIN, PREALBUMIN AND ALBUMIN IN HEALTHY FULLTERM, SMALL-FOR-GESTATIONAL AGE AND PRETERM NEWBORN INFANTS

Abstract. Jacobsen, B. B., Peitersen, B., Andersen, H. J. and Hummer, L. (The University Clinic of Paediatrics, Children's Hospital Fuglebakken and the Departments of Nuclear Medicine, Rigshospitalet, Copenhagen, Denmark). Serum concentrations of thyroxine-binding globulin, prealbumin and albumin in healthy fullterm, small-for-gestational age and preterm newborn infants. Acta Paediatr Scand, 68: 49, 1979.—Simultaneous serum concentrations of thyroxine-binding globulin (TBG), prealbumin (TBPA) and albumin (Alb) were measured in 130 fullterm, 32 small-for-gestational age and 25 preterm infants during their first six days of life. In all infants serum concentrations of TBG were higher and serum TBPA and Alb were lower than in male adults. Even higher serum TBG levels wer found in the mothers. There was no correlation between serum concentrations in paired maternal and cord sera. In infants with birth weights appropriate for gestation serum TBG, TBPA, and Alb concentrations increased progressively with gestational age. In small-for-gestational age infants born at term serum concentrations of TBG and Alb were lower than those in full-term, but higher than those in premature newborns. Serum TBPA in small-for-gestational age babies was evne lower than seen in prematures. A positive correlation was found between thyroid hormones and TBG concentrations, not between serum TBPA and thyroid hormones. The ratios between serum concentration of thyroid hormones and proteins might indicate that more thyroid hormonebinding sites are occupied in fullterm than in low birth-weight newborns. However, the main reason for the different serum levels of thyroid hormones in fullterm, small-for-gestational age and preterm babies is probably the various serum TBG concentrations demonstrated in these infants.     

静脉注射和口服吲哚美辛治疗早产儿动脉导管未闭疗效比较

目的　探讨静脉注射和口服吲哚美辛治疗早产儿动脉导管未闭 (PDA)的疗效。方法　经心脏彩超确诊的有症状PDA早产儿 4 9例 ,按给药剂型及途径分为静注组 (2 1例 )和口服组 (2 8例 )。剂量及给药间隔时间相同。比较两组PDA关闭率和不良反应。结果　两组单纯PDA闭合、并其他疾病PDA闭合均无显著差异。静注组立即闭合率明显高于口服组 (P <0 .0 5 )。两组较快闭合、迟缓闭合和总闭合虽有差别 ,但无统计学意义。静注组胃肠出血、肾功能减低及高胆红素血症与口服组比较均无显著差异。静注组不良反应总人次明显低于口服组 (P <0 .0 5 )。结论　一定剂量范围内静脉注射或口服吲哚美辛治疗早产儿PDA均具一定有效性和安全性 ,但口服给药不良反应相对较多     

IMMUNOELECTROPHORETIC DETERMINATION OF SERUM GLOBULINS 1N NEWBORN INFANTS OF DIABETIC MOTHERS

ABSTRACT. Davidsen, Otto (Diabetes Centre, Royal Maternity Department B, Rigshospitalet and Department of Clinical Chemistry, Sundby Hospital, Copenhagen, Denmark) Immunoelectrophoretic Determination of Serum Globulins in Newborn Infants of Diabetic Mothers. Acta Paediatr Scand, 63: 833, 1974.—Serum globulins were investigated by means of crossed immunoelectrophoresis in the cord blood from 40 infants of diabetic mothers and 92 infants with non-diabetic mothers. In infants of non-diabetic mothers the concentration of most globulins was lower than in adults and positively correlated to the gestational age of the infant. For α₂-HS-glycoprotein and an unidentified α₂-glob-uEn, however, a negative correlation to the gestational age was observed. Infants of diabetic mothers had a higher Concentration of transferrin and lower concentrations of α₂-macroglohulin and α₁-lipoprotein as compared with infants of the reference group. In the diabetes group the globulin concentrations were correlated neither to the gestational age nor to their increased birth weight, but the ratio α₂,-macroglobulin/α₂-HS-glycoprotein, which was expected to be independent of variations in the degree of hydremia of the infants, was significantly correlated to the gestational age. As judged from this parameter, infants of diabetic mothers are comparable to infants of non-diabetic mothers of about 4 weeks lower gestational age.