PLASMA FERRITIN CONCENTRATIONS IN PRETERM INFANTS IN CORD BLOOD AND DURING THE EARLY ANAEMIA OF PREMATURITY

Abstract. Hågå, P. (Department of Paediatrics and Paediatric Research Institute, National Hospital of Norway, and Department of Paediatrics, Oslo City Hospital, Ullevål, Oslo, Norway). Plasma ferritin concentrations in preterm infants in cord blood and during the early anaemia of prematurity. Acta Paediatr Scand, 69: 637, 1980.—Ferritin concentrations in cord blood were determined in 22 normal term and 32 preterm infants (birth weights 600–2000 g). Eight of the preterms were SGA infants. AGA preterm infants had significantly lower concentrations than term infants, and the SGA preterm newborn had even lower levels. Plasma ferritin in cord blood of the term and AGA preterm infants correlated positively with plasma iron and transferrin saturations, but not with the transferrin level, while plasma iron and transferrin concentrations correlated positively. In a longitudinal study, 17 AGA preterm infants (birth wights 850–1500 g) were followed during the early anaemia of prematurity. Iron was supplemented from 4 weeks of age. Plasma ferritin rose rapidly during the first days after birth, peak levels being reached at 1–4 weeks. Thereafter linear falls (semilog) occurred with similar slopes in different infants. Transferrin concentrations showed a slow progressive increase from 0–8 weeks. Plasma ferritin, after reaching the peak value, correlated negatively with weight gain. No infant had low ferritin values indicating iron deficiency during the early anaemia.     

PHENYTOIN AND IgA CONCENTRATIONS IN PLASMA AND SALIVA IN EPILEPTIC CHILDREN

ABSTRACT. Modéer, T., Tomson, G., Falk, O. and Rane, A. (Departments of Pedodontics, Clinical Pharmacology and Paediatrics at the Karolinska Institute (Odontological clinics and Huddinge University Hospital), Sweden). Phenytoin and IgA concentrations in plasma and saliva in epileptic children. Acta Paediatr Scand, 70:373, 1981.–The concentrations of immunoglobulin A (IgA) and phenytoin were determined in 36 epileptic children with a mean age of 11 years. There was a good correlation between the plasma and saliva concentrations of phenytoin ( r =0.94). The concentration of phenytoin and IgA showed little variation during the dosage interval. The phenytoin treated children did not differ with respect to the concentration of IgA in saliva in comparison to the controls.     

COLLOID OSMOTIC PRESSURE OF CORD BLOOD IN RELATION TO NEONATAL OUTCOME AND MODE OF DELIVERY

Kero, P., Korvenranta, H., Alamaakala, P., Selänne, P., Kiilholma, P., and Välimäki, I. (Department of Paediatrics, Department of Obstetrics and Gynaecology, and Cardiorespiratory Research Unit, University of Turku, Turku, Finland). Colloid osmotic pressure of cord blood in relation to neonatal outcome and mode of delivery. Acta Paediatr Scand, Suppl. 305: 88–91, 1983.—Colloid osmotic pressure (COP) of umbilical cord blood was measured in 184 infants, 113 of whom were delivered vaginally and 71 by Caesarean section, 152 were born at term and 32 were preterm (gestational age <37 weeks). Thirteen infants developed RDS, 20 had transient tachypnoea (TT) and 13 had perinatal asphyxia. There was a significant linear correlation between COP and total protein in cord blood ( r =0.91). Such a correlation was also found between COP of cord blood and gestational age in the non–RDS group ( r =0.49). COP was higher (19.6 mmHg) in the infants delivered vaginally than in those delivered by Caesarean section (16.8 mmHg, p <0.001). In the RDS group COP was 13.2 mmHg, in the TT group 15.6 mmHg and in the asphyctic group 16.9 mmHg (normal 18.3 mmHg). COP appeared to be of diagnostic assistance in babies developing neonatal pulmonary maladaptation syndromes.     

PLASMA CONCENTRATIONS OF PHENOBARBITAL IN THE TREATMENT OF SEIZURES IN NEWBORNS

ABSTRACT: Jailing, B. (Departments of Paediatrics and Clinical Pharmacology, Karolinska Hospital, Stockholm, Sweden). Plasma concentrations of phenobarbital in the treatment of seizures in newborns. Acta Paediatr Scand, 64:514, 1975.–The plasma concentration of phenobarbital given as anticonvulsive treatment in the newborn period has been followed in 18 infants. With constant daily doses, the drug accumulated for at least 5 days. After intramuscular injection of a single dose, 90 % of the peak concentration was reached within 4 hours in 8 of the 10 infants. The peak concentration (in µg/ml) approximately equalled 1.3 × the dose (in mg/kg). Absorption after oral administration was less reliable. In 12 of the infants the clinical course allowed attempts to evaluate the anticonvulsive effect of phenobarbital. In 4 cases the convulsions continued. In those 8 infants where phenobarbital seemed to be effective, the approximate range of phenobarbital concentration when convulsions ceased was 12–30 µg/ml. Phenobarbital half-life ranged between 59 and 182 hours. In some infants the rate of phenobarbital disappearance from the plasma varied considerably from day-to day. The pathological conditions causing seizures probably influence the distribution, metabolism and excretion of the drug. For the often seriously ill infants with convulsions it is therefore difficult to construct rational maintenance dose schedules, and optimal dosage must be based on repeated determinations of the plasma concentration.     

TIME STUDIES ON FREE AMINO ACID LEVELS OF VENOUS PLASMA DURING THE NEONATAL PERIOD

A simplified method of ion-exchange chromatography of essential amino acids on small amounts of human plasma is described. The precision of the instrument and the reproducibility was to be compared with those achieved with automatic amino acid analyzers. The method has been applied in a survey of venous plasma free amino acid levels and urinary concentrations during the neonatal period. A considerable general decrease of the free amino acid levels was seen already during the first postnatal day. This was most marked in the branch-chained amino acids, where levels that were low for infants were seen already after the first hours of starvation. The well known high urinary excretion of amino acid nitrogen was found to be due to a high excretion of a limited number of amino acids.     

SIMULTANEOUS DETERMINATION OF PLASMA VOLUME AND TRANSCAPILLARY ESCAPE RATE WITH 131 I-LABELLED ALBUMIN AND T-1824 IN THE NEWBORN

A new micro method for plasma volume determination with T-1824 was investigated in 10 newborn infants. Dye concentration was measured with a two wavelength spectrophotometric method. The method was found to be easy, rapid to perform and requires only 150 μl plasma. Thus several plasma samples could be obtained and the dye loss during mixing time calculated and corrected for. This is of special importance in the newborn due to the high transcapillary albumin loss mentioned below. Plasma volume was determined with ¹³¹I human serum albumin (RIHSA) serving as reference. Identical results were obtained, mean 43 ml/kg. Consequently it is concluded that the dye method, being a non-radioactive method, should be preferred for plasma volume determination in the newborn. Transcapillary escape rate of albumin (fraction of intra-vascular mass of albumin escaping to the extravascular space per unit time) was determined from the disappearance of intravenously injected RIHSA and T-1824 during the first hour after the injection. The mean transcapillary escape rate with RIHSA was: 18.4%/hour, with T-1824: 20.7%/hour (p<0.1). These values are 3 to 4 times higher than those obtained in adults thus indicating a high capillary permeability to albumin in newborns.     

PLASMA APOPROTEIN AND LIPID PATTERNS IN NEWBORNS: INFLUENCE OF NUTRITIONAL FACTORS

Abstract. Van Biervlict, J. P., Vinaimont, N., Vercaemst, R., Caster, H. and Rosseneu, M. (Departments of Paediatrics and Clinical Chemistry, A. Z. Sint-Jan, Brugge, Belgium). Plasma apoprotein and lipid patterns in newborns. Influence of nutritional factors. Acta Paediatr Scand, 70: 851, 1981.-In this study the plasma lipid and apoprotein concentrations have been assayed in 80 full-term newborns, at 0, 7 and 30 days of life, and the data have been analyzed as a function of the composition of the diet. The total cholesterol, HDL cholesterol, the apo A-I, A-II and B protein concentrations were followed in 4 groups of infants receiving respectively breast-feeding, adapted formulae I, II with a P/S ratio close to that of maternal milk and a formula HI enriched with polyunsaturated fatty acids. After 7 and 30 days the infants receiving the adapted formulae I and II have plasma lipid and apoprotein values similar to those of the breast-fed infants indicating a parallel evolution of the lipids and apoproteins in the three groups. The lipid and apoprotein patterns were significantly different in the group of infants receiving a diet enriched with polyunsaturated fatty acids. The total and VLDL-LDL cholesterol and the apo B protein concentrations are significantly lover than in the breast-fed infants after 7 days, and these differences become more pronounced after 30 days. These results suggest that the fatty acid composition of the diet influences the lipid and lipoprotein synthesis in newborns, specially by decreasing the lipid and apopro'sin concentrations of the VLDL-LDL fraction.     

CONCENTRATIONS OF DIGOXIN IN PLASMA AND URINE IN NEONATES, INFANTS, AND CHILDREN WITH HEART DISEASE

ABSTRACT. Wettrell, G., Andersson, K.-E., Bertler, Å. and Lundström, N. R. (Departments of Paediatrics and Clinical Pharmacology, University Hospital, Lund, Sweden). Concentrations of digoxin in plasma and urine in neonates, infants, and children with heart disease. Acta Paediatr Scand, 63: 705, 1974.—By means of radioimmunoassay and ⁸⁶Rb-uptake inhibition assay, concentrations of digoxin in plasma and urine have been determined in different paediatric age groups. On equal daily maintenance doses (0.012–0.013 mg digoxin/kg b.w./day) a higher mean plasma digoxin level was found in full term neonates (3–30 days), 2.1 ng/ml, than in infants (1–12 months) and children (1–10 years), 1.2 and 1.4 ng/ml, respectively. On a maintenance dose of 0.019 mg/kg b.w./day, one group of infants had an average plasma digoxin level of 2.1 ng/ml (range 1.1–2.9 ng/ml). No signs of toxicity were found. A gradual increase in the renal clearance of digoxin during the first few months of life was demonstrated. There was a highly significant correlation between the clearances of digoxin and creatinine (r=0.87, p<0.001). It is concluded that the high mean plasma digoxin level in full-term neonates could be explained by low renal elimination of the glycoside.     

THE EFFECT OF L-DOPA ON THE BLOOD CONCENTRATIONS OF GROWTH HORMONE, THYROTROPHIN, GONADOTROPHINS, CORTISOL AND GLUCOSE IN CHILDREN WITH SHORT STATURE

ABSTRACT. Nilsson, K. O. and Thorell, J. I. (Department of Paediatrics, Endocrinology and Nuclear Medicine, University Clinics, Malmö General Hospital, Malmö, Sweden). The effect of L-dopa on the blood concentrations of growth hormone, thyro-trophin, gonadotrophins, cortisol and glucose in children with short stature. Acta Paediatr Scand, 63: 812, 1974.—Studies were performed in nine constitutionally short children to evaluate the diagnostic usefulness of oral L-dopa as compaired to insulin induced hypoglycemia as a provocative agent for the stimulation of growth hormone production. In addition the effect of L-dopa on the blood concentrations of thyro-trophin, gonadotrophins, cortisol and glucose was investigated. The mean growth hormone concentration was 4.8±1.6 (S.E.M.) ng/ml before L-dopa and 2.9±1.0 ng/ml before insulin. The mean peak growth hormone concentration was 20.7±2.6 ng/ml after L-dopa and 17.5±3.1 ng/ml during insulin induced hypoglycemia. AU children showed peak growth hormone concentrations at or above 8 ng/ml both after L-dopa and insulin, although in one patient this level was reached only after priming with testosterone. No significant changes in the blood concentrations of thyrotrophin, gonadotrophins, cortisol or glucose were observed. It is concluded that L-dopa is an effective stimulus for the release of growth hormone in young subjects.     

FREE AND BOUND TRYPTOPHAN IN HUMAN PLASMA DURING THE PERINATAL PERIOD

Abstract. The concentration of tryptophan and the degree of binding of the amino acid to protein were examined in human plasma during the perinatal period. Both total and unbound (free) tryptophan were higher in cord vein plasma than in the maternal circulation, the concentration gradient being approximately 1: 2. The proportion of the total plasma tryptophan concentration that was not bound to protein was less in cord vein plasma than in the maternal circulation. After birth the proportion in infant plasma fell significantly. Both total and free tryptophan fell during the first 24 hours of postnatal life. Total tryptophan returned to the cord vein plasma level 6–8 days after birth whilst free tryptophan failed to increase during the period of the observations. In premature infants total and free tryptophan also declined in concentration 12–24 hours after birth, suggesting the phenomenon to be related to birth rather than to gestational age. Phenylalanine remained unchanged whilst tyrosine increased in concentration during the first 80 hours of postnatal life. Thus, the availability of tryptophan to the tissues appears to decline during the immediate postnatal period and the results suggest that the requirement for tryptophan during this time may exceed the supply from standard artifical milk preparations.     

INFLUENCE OF MATERNAL GUT FLORA AND COLOSTRAL AND CORD SERUM ANTIBODIES ON PRESENCE OF ESCHERICHIA COLI IN FAECES OF THE NEWBORN INFANT

ABSTRACT. From 29 healthy newborn infants and their mothers faecal, serum and milk specimens were obtained on several occasions from one to nine weeks after delivery. Predominant faecal E. coli were serotyped with regard to the O antigen and milk and serum were analysed for their content of E. coli O antibodies by the enzyme-linked immunosorbent assay. In five cases the babies acquired the same O serotype as was found in the stools of their mothers but in 12 out of 29 cases infant and mother never had any dominating faecal E. coli O type in common. There was no apparent correlation between the patterns of feeding and interchange of bacteria. Klebsiella/Enterobacter was the dominating facultative organism on at least one occasion in half the infants. The newborns received coiostral IgA and transplacental circulating IgG antibodies against a great number of E. coli O serotypes. These antibodies did not prevent intestinal colonization, as judged from cultures of faeces.     

ERYTHROPOIETIN LEVELS IN CORD BLOOD OF CONTROL INFANTS AND INFANTS WITH RESPIRATORY DISTRESS SYNDROME

Erythropoietin levels (ESF) were measured in premature infants with and without the respiratory distress syndrome in an effort to define the role of intrauterine hypoxia in the genesis of the disease. No difference in levels could be detected between infants with and without the: respiratory distress syndrome. This suggests that either intrauterine hypoxia plays no role in the genesis of the respiratory distress syndrome or that the hypoxia is (1) of short duration, (2) of relatively long duration, or (3) remote with respect to the time of birth. The higher levels found in full-term infants suggested that hypoxia before birth is a more common feature of the term delivery than the premature delivery.     

SERUM LIPIDS IN MATERNAL/CORD BLOOD PAIRS FROM NORMAL AND LOW BIRTHWEIGHT INFANTS IN DAR ES SALAAM, TANZANIA

Abstract. Boersma, E. R. (Department of Child Health, Muhimbili Medical Centre, incorporating the Faculty of Medicine, University of Dar es Salaam, Tanzania). Serum lipids in maternal/cord blood pairs from normal and low birthweight infants in Dar es Salaam, Tanzania. Acta Paediatr Scand, 69:747, 1980.—Serum total cholesterol and triglyceride were determined in the cord blood of 54 term appropriate for gestational age, 14 preterm appropriate for gestational age and 17 small-for-dates infants and their mothers immediately after delivery in Dar es Salaam, Tanzania. The mean serum level of total cholesterol in cord blood of term appropriate for gestational age infants was 1.9 mmol/l, whereas that from their mothers 6.3 mmol/l. Cord serum triglyceride values in term appropriate for gestational age infants were 0.29 mmol/l and from their mothers 1.91 mmol/l. Results of these maternal cord serum lipids in the normal and low birthweight groups are similar to those of Western countries.     

EFFECT OF SEASON AND VITAMIN D SUPPLEMENTATION ON PLASMA CONCENTRATIONS OF 25-HYDROXYVITAMIN D IN NORWEGIAN INFANTS

ABSTRACT. Plasma concentrations of 25-hydroxyvitamin D (250HD) were determined in 81 vitamin D supplemented or unsupplemented infants at the end of winter. The values were compared with maternal levels and with concentrations found in 22 unsupplemented infants at the end of summer. The 250HD levels of the neonates were lower, but closely related to maternal values ( r =0.95, p <0.0005). Unsupplemented breast-fed infants had lower 250HD levels at 6 weeks than at 4 days (16±7 vs. 32±15 nmol/l, mean ±1 SD, p <0.0005). The mean 250HD level of vitamin D supplemented 6-12 months old infants was intermediate between those of the unsupplemented nursed groups and the unsupplemented children studied during summer (53±28 vs. 85±28 nmol/l, p <0.0005). Six weeks old infants who had received a milk formula containing 400 IU vitamin D₃ per liter had levels similar to the latter group (92±21 nmol/l). The data suggest that the vitamin D stores acquired during fetal life, or from ultraviolet light exposure during the summer, may be inadequate to maintain safe levels of 250HD throughout the winter, but that a daily supplement of 400 IU is adequate to establish concentrations in the summer range.     

EFFECT OF MATERNAL PARITY AND INFANT SEX UPON THE HAEMATOLOGICAL VALUES OF CORD BLOOD

Abstract. Coulter Counter (Model S) analysis of 400 cord blood samples are presented, together with differential white cell counts for 249 of these. The mean values for haemoglobin and red cell count are somewhat higher than previous values determined by manual methods, while those for haematocrit and mean cell volume are slightly lower. An unexpected finding was that the red cell count, haemoglobin concentration, and haematocrit, are significantly higher in male than in female infants. A parity effect was also demonstrated: infants of both sexes born as second or subsequent births had lower values for total white cell count, haemoglobin concentration and haematocrit, than first-born infants.     

PLASMA EXCHANGE IN THE TREATMENT OF SEVERE, CHILDHOOD ONSET SYSTEMIC LUPUS ERYTHEMATOSUS

ABSTRACT. Plasma exchange was used in the treatment of a 10-year-old girl with acute systemic lupus erythematosus. The patient was in a life-threatening condition, and treatment with high dose corticosteroids did not control the disease. The patient's condition improved dramatically during the second day of plasma exchange therapy. It also appeared to have a long-lasting effect in combination with immunosuppressive drugs. This is, to our knowledge, the first report of plasma exchange in a child with systemic lupus erythematosus.     

THE SIMULTANEOUS DETERMINATION IN CHILDREN OF GLOMERULAR FILTRATION RATE AND EFFECTIVE RENAL PLASMA FLOW BY THE SINGLE INJECTION CLEARANCE TECHNIQUE

The performance of over 1000 clearances with the single injection method allows a retrospective review on the value of this new technique. The choice of the indicator substance, the reproducibility of the method and the irradiation dosimetry do not bring up very exciting problems. The theoretical basis of the justification of the single injection method has not been proven so far and the inexactitude which may happen because of the empirical assumption that the substances used behave as in an open mamillary bicompartimental model is discussed. The author comes to the conclusion that although the rightness of the model has never been proven, the method will give sufficient precise results in practice and is proposed to a large extension because of its technical simplicity as well as for the patient as for the physician and the laboratory technician. The irradiation dose is so small that it will practically never be considered as a contra-indication.     

SCREENING OF CORD BLOOD LOW-DENSITY-LIPOPROTEIN CHOLESTEROL IN THE DIAGNOSIS OF FAMILIAL HYPERCHOLESTEROLAEMIA: A STUDY OF 2000 INFANTS

Abstract. A prospective follow-up study of infants selected by cord blood total cholesterol (TC) and low-density-lipoprotein cholesterol (LDL-C) levels from 2000 consecutive live births was undertaken to reassess the role of cord blood screening in the diagnosis of familial hypercholesterolaemia (FH). Mean values for serum cholesterol were (mmol/l ± S.D.): TC, 1.83 ± 0.56; LDL-C, 0.90 ± 0.49; HDL-C, 0.70 ± 0.33; TG, 0.38 ± 0.16. Seventy-three of 117 infants who had had a cord TC and/or LDL-C >95th percentile, and 373 control group children (cord TC and/or LDL-C >95th percentile) were followed up at age 3–12 months. Six of the 117 were hypercholesterolaemic (HC), and one child had an HC parent: positive detection rate ≥0.05%; false positive rate ≥3.7%. Four control-group children were HC and had an HC parent; false negative rate ≥1.1%. With the possible exception of detecting FH in a child with a known affected parent, cord blood screening appears to be unreliable for the diagnosis of FH.     

脐血输注后再生障碍性贫血、白血病患者造血祖细胞体外培养及血浆造血刺激活性变化

为探讨脐血输注的疗效机理，评价脐血输注的实用价值，我们用新鲜脐血静脉输注（ＵＣＢＴ），治疗慢性再生障碍性贫血（ＣＡＡ）１０例和急性白血病（ＡＬ）８例，观察ＵＣＢＴ前后患者粒单细胞系集落形成单位（ＣＦＵ－ＧＭ）、红系爆式集落形成单位（ＢＦＵ－Ｅ）、集落刺激活性（ＣＳＡ）、爆式集落刺激活性（ＢＰＡ）及外周血象变化。结果提示：ＵＣＢＴ后①可迅速升高ＣＦＵ－ＧＭ和ＢＦＵ－Ｅ；②可改善外周血象，尤其是ＷＢＣ、及ＡＮＣ和Ｈｂ；③可使病理性增高的ＣＳＡ、ＢＰＡ降至正常。结果提示可能系脐血中的祖细胞和造血因子刺激病人骨髓，并使造血功能得到改善。在某些病理情况下ＣＳＡ和ＢＰＡ的增高是机体的一种生物代偿反应，ＵＣＢＴ使病理增高的ＣＳＡ和ＢＰＡ显著下降并趋于正常可能是通过反馈调节作用而使细胞因子水平下降。     

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.