Phototherapy and plasma immunoreactive prostaglandin A values. Its effect in premature infants.

Plasma immunoreactive prostaglandin A (iPGA) values were determined for 14 premature infants before and after 48 hours of phototherapy and in a control group of six age-matched premature infants. At 4 to 8 days of life, the infants who had received phototherapy for 48 hours had significantly lower iPGA values compared with controls. At 2 to 3 days of life, four infants with a clinically apparent patent ductus arteriosus were found to have significantly elevated iPGA values compared with controls. After 48 hours of phototherapy, these infants likewise had a significant decrease in iPGA values compared with controls; in all four infants, the ductus closed spontaneously. Phototherapy is an effective method for decreasing plasma iPGA values in premature infants.     

Urinary uric acid excretion in term and premature infants

Objective : To clarify postnatal changes in urinary uric acid (UA) excretion in normal term infants and to examine the effects of prematurity or illness on the UA excretion.
Methodology : Measurements of urinary UA were performed in term and premature infants at the ages of 1 and 7 days and at 1 and 4 months, as well as at 7 months in term infants.
Results : Urinary UA levels were lowest on day 7 in term infants. The levels were highest on day 1 in premature infants and remained significantly higher compared to term babies during the first month of life. Respiratory failure requiring ventilation and oxygen supply resulted in further significant elevation of urinary UA in premature infants.
Conclusions : With the reference values obtained in the study reported here, urinary UA can now be used for the diagnosis and monitoring of inherited disorders of purine metabolism and for the assessment of oxygen radical insult to sick infants.     

The EC randomised controlled trial of prophylactic ethamsylate for very preterm neonates: early mortality and morbidity. The EC Ethamsylate Trial Group.

Immature infants are at increased risk of death and disability, often related to haemorrhagic and ischaemic brain damage. Two controlled trials have suggested that a policy of prophylactic ethamsylate may reduce this damage. The aim of the trial reported here was to assess the effects of such a policy in respect of death, disability, and the use of health service resources up to 2 years of age. Short term findings are reported here. Three hundred and thirty four immature (< or = 32 weeks' gestation) infants were recruited into the trial within four hours of birth from four centres in France and six in Greece. Almost all 165 infants allocated to the ethamsylate group received the drug, compared with one of the 169 infants in the control group. By about 3 months of age the trial groups were similar in terms of death (20% in the two groups), any diagnosis of periventricular or intraventricular haemorrhage (35% in the ethamsylate v 37% in the control group), or major cerebral abnormality assessed by ultrasound (13% v 12%). The trial provides little evidence to support the use of ethamsylate for routine prophylaxis. The confidence intervals are wide, however, and so these results alone cannot rule out a clinically useful benefit or a harmful effect. A follow up study of the surviving children at the age of 2 years is in progress.     

Electroretinography: application to clinical studies of infants

The electroretinographic (ERG) responses of normal human infants have been studied in scotopic conditions. The relation of stimulus intensity to the amplitude of the b-wave of the ERG undergoes developmental changes during infancy. The maximum amplitude that can be obtained gradually increases to approach adult values by age 12 months. Sensitivity, however, is equivalent to that of adults at age five to six months. Latencies reach adult values at the end of the first year. Some results of ERG testing of infant patients with retinal disorders are compared to the normal results. As previously reported for animals and human adults with retinal disorders, amplitude, sensitivity and latency are not always equally compromised by the retinal diseases of infants.     

Assessment of skeletal development in preterm and term infants by quantitative ultrasound

Assessment of skeletal development using a nonionizing method would be desirable in critically ill preterm infants. We investigated the second metacarpus by quantitative ultrasound (QUS). Cross-sectional data were collected in 132 preterm or term infants measured within 24 h from birth and in 142 term infants up to the age of 18 mo. Longitudinal data were collected in 150 preterm infants up to the age of 14 mo. Cross-sectional data were used to devise reference curves for metacarpal speed of sound (mcSOS) and metacarpal bone transmission time (mcBTT). Both parameters increase during the last trimester of gestation. After birth, mcSOS declines up to the 6 mo and then increases up to 18 mo of life. McBTT values remain stable after birth. At birth, QUS values of preterm infants are lower than those observed at birth in term infants. In the longitudinal study, mcSOS showed a trend similar to that observed among term infants, nevertheless, values are lower up to 4-6 mo of life. Among preterm infants, mcBTT increases until it reaches values observed in term infants. Preterm infants in their first months of life have lower QUS values compared with term infants of same weight or length. This study demonstrates that it is possible to follow skeletal development and maturation by QUS in preterm infants. More specifically, the mcBTT values may provide information on bone tissue that is independent of length and weight of the preterm infant. The method here described is safe, repeatable, and reliable.     

INTRAVENOUS GLUCOSE TOLERANCE, PLASMA INSULIN, FREE FATTY ACIDS AND β-HYDROXYBUTYRATE IN UNDERWEIGHT NEWBORN INFANTS

Blood glucose, plasma insulin, FFA and β-hydroxybutyrate values during intravenous glucose tolerance were reported in 20 small for gestational age (SGA) and 15 appropriate for gestational age (AGA) low birthweight infants. The babies were divided into three groups according to their age when tested; <24 hours, 24–48 hours and >48 hours. Both the SGA and AGA infants cleared glucose more rapidly with increasing age. The change was more marked in the SGA babies. The clearance rates were similar to those reported in normal full-sized infants. The insulin values before the glucose load were similar in all groups and comparable to those reported in normal newborn infants. The insulin response to glucose was variable. There were no significant differences with increasing age or between the two groups of infants. The insulin curve of the individual infant followed one of three patterns. Most commonly seen was a double-peak curve. The infants who showed a single-peak insulin response had a better but not significantly different glucose tolerance than that of the other babies. Infants with no appreciable insulin response still removed glucose from plasma at a rate similar to those with a double-peak insulin curve. It is concluded that insulin as measured in peripheral plasma could not explain the rate of removal of glucose from the plasma of the newborn low birthweight infant. Infants of low birthweight had higher plasma FFA values as compared to that reported in normal full term infants. The FFA values in SGA infants were higher than those in AGA babies. In both groups of infants, the jS-hydroxybutyrate values were comparable to those reported in normal full-term babies. Thus there was an unexpected discrepancy between the high FFA and relatively low β-hydroxybutyrate levels in plasma. The fall in plasma FFA and β-hydroxybutyrate after glucose was minimal but similar in both groups of infants. The findings are compatible with a decreased sensitivity to insulin in the infants studied.     

Down's syndrome and infant gaze. Gaze behavior of Down's syndrome and nondelayed infants in interactions with their mothers.

The study reported here compared the gaze behavior of infants with Down syndrome (DS) and nondelayed infants during interactions with their mothers. The subjects were 10 DS infants and 11 nondelayed infants. Five of the DS infants and 6 of the nondelayed infants were 4 months old; the rest were 9 months old. The results support the expectation that infants with DS gazed at their mothers longer than did nondelayed infants during face-to-face play, and also indicate that all the infants visually attended to their mothers less at 9 months than at 4 months of age. It is conjectured that the increased gaze of the infants with DS may well facilitate attachment in the 1st year of life.     

The impact of jaundice in newborn infants on the length of breastfeeding

OBJECTIVES:

To examine the breastfeeding prevalence among infants aged three and six months who were previously hospitalized because of hyperbilirubinemia, and to determine whether jaundice in newborn infants increases the risk of breastfeeding discontinuation.

METHOD:

Surveys were mailed to mothers of all eligible infants admitted over a two-and-a-half year period to the paediatric ward of a tertiary care children’s hospital with a diagnosis of hyperbilirubinemia. A total of 127 mother-patient pairs were included in the study. Breastfeeding rates at three and six months were compared with those of a city-wide survey (Infant Care Survey) conducted by Ottawa’s Public Health Department. Risk factors for early breastfeeding discontinuation were examined.

RESULTS:

Breastfeeding rates at three and six months were not different between the study group and those reported in the Infant Care Survey (75.5% in the study group versus 71.2% in the Infant Care Survey group, at three months; and 59.1% in the study group versus 50.8% of the Infant Care Survey group, at six months). None of the previously reported risk factors for early weaning had an impact on breastfeeding duration in the study population.

CONCLUSION:

Breastfeeding rates following the discharge of infants diagnosed with jaundice were not significantly different from those reported for the general population. Different patient characteristics may have inflated the breastfeeding rates in the study population, as evidenced by a very high education level among the mothers of enrolled patients. Larger prospective studies in diverse populations are needed to determine the rates of early breastfeeding discontinuation in jaundiced infants.     

Adverse reactions in healthy and immunocompromised children under six years of age vaccinated with the Danish BCG vaccine, strain Copenhagen 1331: implications for the vaccination policy in Sweden

A retrospective analysis of the adverse reactions reported between 1979 and 1991, in the 139000 children under six years of age vaccinated in Sweden with the Danish BCG vaccine, strain Copenhagen 1331, showed an incidence of I.9 per 1000 vaccinated children. Regional lymphoglandular swellings and/or abscesses were most commonly reported in 1.4 per 1000. Serious, disseminated, BCG infections developed in four infants vaccinated neonatally. Three of the infants suffered from severe, combined, immunodeficiency syndrome, undiagnosed at the time of vaccination. The incidence of severe, combined, immunodeficiency syndrome was higher in the BCG-vaccinated population (4 per 100000 infants vaccinated within a year of their births), compared with all newborns in Sweden (1 per 100 000). The mean age at the onset of symptoms was 2.4 months for the seven non-BCG-vaccinated infants versus 1.3 months for the four BCG-vaccinated ones, while the immunodeficiency syndrome was diagnosed at an average age of 7.6 months in those who were not vaccinatedversus 5.3 months in those BCG-vaccinated. It is recommended that the selective BCG vaccination of infants at high risk of exposure to tuberculosis should be postponed to six months of age to reduce the risk of inoculating infants suffering from immunodeficiency syndromes.     

Late infantile tetany and secondary hyperparathyroidism in infants fed humanized cow milk formula. Longitudinal follow-up

Five full-term infants with birth weights appropriate for gestational age presented with hypocalcemic tetany at 5 to 9 days of age. All infants had been fed Similac 20, a cow milk formula. Initial mean serum calcium (Ca), phosphorus (P), and magnesium (Mg) levels of the tetanic infants were 6.8, 9.5, and 1.6 mg/dL, respectively. The mean serum parathyroid hormone (PTH) level was elevated at 79 mu LEq/mL (adult normal values, less than or equal to 57 mu LEq/mL). Following restoration of normocalcemia with Ca supplements, feeding was reinstituted with Similac 20 in two infants and Similac PM 60/40 in three infants. Serum biochemical and hormonal values were compared with those of 18 exclusively breast-fed infants followed up from three weeks to six months and 14 Similac 20-fed full-term infants followed up from one week to six months. In tetanic infants, serum Ca concentrations became elevated (10.4 +/- 0.05 mg/dL; mean +/- SEM) by six weeks (vs 9.2 +/- 0.3 mg/dL in breast-fed infants) (P less than .001) and serum Mg concentrations (2.26 +/- 0.01 mg/dL) by four weeks (vs 1.92 +/- 0.07 mg/dL in breast-fed infants) (P less than .01). Mean serum P concentrations declined progressively. Mean serum PTH concentrations were elevated and ranged from 74 to 143 mu LEq/mL at two to 16 weeks (vs mean 28 to 35 mu LEq/mL in breast-fed infants (P less than .0001). In 14 formula-fed-nontetanic full-term infants, serum PTH concentrations were intermediate between formula-fed-tetanic and breast-fed infants, mean serum Ca concentrations ranged from 10.2 to 10.4 mg/dL, and mean serum P concentrations declined from 8.3 to 7.1 mg/dL. We speculate that acute hypocalcemic tetany in the study infants was induced by the relatively high P load in cow milk formulas (vs human milk); with the continued P load, secondary hyperparathyroidism continued, maintaining P, Ca, and Mg homeostasis.     

Platelet serotonin concentration in children under 5 years of age]

High platelet serotonin concentrations have been reported in children with early infantile autism. However, as yet there are no reference values regarding platelet serotonin in normal infants and young children so that it remains difficult to define the exact significance of this finding. We report here with the platelet serotonin concentration found in 57 infants and children (20 girls, 37 boys) ranging in age from 10 days to 5 years old. Our results show that mean platelet serotonin concentrations in infants and young children are significantly greater than mean values obtained in older children (+11%) and neonates in the umbilical cord (+64%). No significant variations were found relating to sex, leucocyte count and platelet count. There therefore appears to be a physiological elevation of platelet serotonin concentration in infants and young children, and this has to be taken into consideration in the interpretation of the elevated values found in cases of infantile autism.     

Formula intake of 1- and 4-month-old infants

This study was designed to estimate energy intake in exclusively formula-fed infants. Formula intake of twenty-four 1- and 4-month-old infants was studied for 5 consecutive days; six boys and six girls were in each age group. Intake was estimated by laboratory-determined weights of formula consumed, spilled, and regurgitated. Two additional methods were used to estimate intake in the first nine infants during the 1st day of observation: test-weighing the infant at each feeding and mother's weighing of formula consumed, regurgitated, and spilled at each feeding. No consistent differences were detected among methods, but test-weighing appeared to have the greatest feed-to-feed variability. Intake was estimated to be 747 +/- 100 g or 125.5 +/- 17 kcal/kg, and 958 +/- 131 g or 94.0 +/- 13 kcal/kg for 1- and 4-month-old infants, respectively. The day-to-day variability (expressed as the coefficient of variation) was 13 and 15% (CV, g/kg) for 1- and 4-month-old infants, respectively. Between-infant variability of intake was approximately 8% (CV, g/kg) for both age groups. Energy intakes of 1-month-old formula-fed infants were similar to published values of breast-fed infants of similar age, but the energy intakes of 4-month-old formula-fed infants were significantly higher than values published for 4-month-old breast-fed infants.     

Evaluation of infectious episodes in neonates using a new procedure for the nitroblue tetrazolium test

A new procedure for the NBT slide test for peripheral blood neutrophils has been tested. 255 neonates were studied of which 63 served as control cases. Among the 114 term infants, 37 were patently infected, 30 suspicious and 47 non-infected. The latter did not significantly differ from control cases, whereas suspicious and infected infants were credited with significantly higher NBT scores.78 infants were preterm, 31 of which were patently infected, 22 suspicious and 25 non-infected. NBT scores of infected and suspicious infants were significantly higher than those of non-infected infants, but, as previously reported, scores of preterm infants were systematically and significantly lower than those of full-term infants of the same bacteriological class.Threshold values are suggested; they could represent an accurate diagnostic aid in the early differentiation of healthy infants from high-risk infants regarding bacterial infections.     

Tryptase and IgE concentrations in the respiratory tract of infants with acute bronchiolitis.

It has been proposed that a specific IgE response contributes to the immunopathology of acute respiratory syncytial virus (RSV) bronchiolitis but previous work has been difficult to replicate. Indirect evidence that might support this contention was sought by measuring total IgE concentrations in bronchoalveolar lavage (BAL) samples obtained from intubated infants and by attempting to detect mRNA for IgE in cells obtained from both the upper and lower respiratory tract. Evidence of significant mast cell activation was sought by measuring tryptase concentrations in BAL fluid and serum. Detectable concentrations of IgE were found in two of seven BAL samples obtained more than five days after intubation and mRNA for IgE was demonstrated in three of six BAL samples and three of six samples obtained from the upper respiratory tract. Tryptase was detectable in 11 of 12 BAL samples with the two highest values detected on day 1. These values were raised compared with control samples but were not such to suggest that mast cell degranulation is the major contributor to the inflammatory process. These results suggest that IgE may be produced in the airways of infants in response to RSV infection. The relationships between IgE production, RSV infection, and symptoms of acute bronchiolitis remain obscure.     

Hypotension and bradycardia associated with airblock in the neonate. Preliminary report.

The hospital courses of 19 infants were analyzed retrospectively to determine if there was a relationship between hypotension and extra-alveolar air: interstitial emphysema, pneumomediastinum, and penumothorax. Of the 16 infants who subsequently developed PT, 12 had hypotension with IE/PM from one to 86 hours prior to the onset of PT (median 6.5 hours). When compared to blood pressure values obtained before the development of IE/PM, the decrease was statistically significant (p less than 0.001). Four of the six infants of greater than or equal to 38 weeks' gestation had bradycardia throughout the duration of EAA. Hypotension and bradycardia appear to be associated with airblock and thus may alert the physician to those infants who are at greatest risk for developing PT.     

Chronic idiopathic bronchiolitis of infancy

The clinical and morphological features are presented of eight infants who developed a chronic respiratory illness in the first year of life characterised by tachypnoea and inspiratory crackles on auscultation. The median age at the onset of symptoms was 1 month (range 1 day to 7 months). Five of the infants required supplemental oxygen. Chest radiographs showed only non-specific perihilar alveolar shadowing and generalised hyperinflation. Investigations into the cause of the illness in these infants, including studies for infection, cardiac disease, and gastro-oesophageal reflux, were negative, and an open lung biopsy sample was subsequently taken from each infant. Histological examination showed mild lymphocytic bronchiolar infiltration only in six of the eight infants. The other two biopsy samples were normal. Seven of the infants were given a trial of steroids by mouth (mean duration of treatment four months) without any apparent benefit. These infants have now been followed up for a median duration of 21 months (range 1-9 years). All have shown continuous improvement, with either the end of oxygen treatment (three patients) or the use of low flow oxygen only at night (two patients). All have normal development and all but one have normal growth. Chest examination has become normal in four subjects. In the remainder the inspiratory crackles have persisted, although they have decreased markedly in all patients. It is proposed that these infants have a previously unreported respiratory entity and that the clinical and lung biopsy sample findings reported here predict a favourable medium term prognosis.

     

NEONATAL HYPOGLYCEMIA II. A Clinical Study of 44 Idiopathic Cases with Special Reference to Corticosteroid Treatment

Forty-four newborn infants with significant hypoglycemia, i. e. with two or more true blood glucose values of 20 mg/100 ml or less, have been studied. Two thirds of the patients were males, and a similar proportion had low birth weight for gestation, mostly associated with maternal toxemia. Hypoglycemia was diagnosed during the first day of life in 34 cases. Only three infants were asymptomatic, whereas the others exhibited various nonspecific symptoms, which generally were more severe in patients aged two or three days. A therapeutic test with glucose was positive in only 20 infants, and mostly negative before 24 hours of age. The hypoglycemia was transient in all cases. Mental retardation with spasticity and infantile spasms has developed in four infants by the age of six months, and one of them died at the age of eight months. The others appear normal after 4–26 months of observation. A significant effect of hydrocortisone in shortening the duration of hypoglycemia was demonstrated. On the basis of experience with the patients reported, it is suggested that all infants with significant hypoglycemia should be efficiently treated, regardless of symptomatology.     

早产儿脑组织CT值测定(英文)

目的：早产儿脑组织CT值普遍较低，难以判断是否为正常范围。该文探讨早产儿正常脑组织CT值与足月儿脑组织CT值的差异。方法：对76例早产儿(按胎龄分为28～33+6周早产儿36例及34～36+6周早产儿40例)及50例正常足月新生儿(胎龄为37～42足周)进行头颅CT检查并测定各部位脑组织CT值。结果：28～33+6周早产儿和34～36+6周早产儿小脑、脑干、基底节、丘脑、白质、灰质CT值均低于足月儿相应部位脑组织CT值，其差异有显著性(P<0.01)。28～33+6周早产儿不同部位脑组织CT值均低于34～36+6周早产儿相应部位脑组织CT值，其差异有显著性(P<0.01)。结论：早产儿脑组织CT值明显低于足月新生儿，故早产儿脑组织CT值有自己的正常值范围     

Quantitation of T cells in venous blood of healthy neonates

Quantitation of T Cells in blood is the part of the diagnostic workup for cellular immunity. Specimens of venous blood were collected within 24 hours of birth from 51 healthy, appropriate for gestational age infants. T lymphocytes were identified on the basis of their ability to form rosettes with sheep erythrocytes. The lymphocytes were harvested from peripheral venous blood, which is considered to be more representative of the immune status in the newborn than the cord blood. In the newborn infants the proportion in T cells was found to be considerably diminished in comparison to previously reported values for adults. Preterm infants, especially those with gestational age of 34 wk or less had significantly lower percentage of T cells in their blood as compared with term infants. The proportion of T cells was statistically reduced in infants weighing 2000g or less in contrast to those weighing 2500 g or more.