Packed red blood cell transfusion (PRBC) attenuates intestinal blood flow responses to feedings in pre-term neonates with normalization at 24 hours

Objective: To determine whether packed red blood cell (PRBC) transfusion affects post-prandial superior mesenteric artery blood flow velocities (SMA BFVs) in very-low birth weight (VLBW) neonates and if so, at what time point after transfusion restoration of previous SMA BFV patterns occurs.

Design/Methods: VLBW pre-term neonates, older than 14 days and tolerating bolus enteral feedings administered every 3?h were enrolled in this prospective observational study. Pulsed Doppler ultrasound was used to measure pre- and post-prandial (at 45?min) time-averaged mean, peak and end diastolic velocities (TAMV, PSV, EDV) immediately before and after 15?ml/kg of PRBC transfusion was given over 3?h; patent ductus arteriosus (PDA) status was also evaluated. Subsequent pre- and post-prandial SMA BFVs were recorded 24 and 48?h after the transfusion.

Results: Pre- and post-prandial measurements were obtained for 21 out of 25 enrolled infants. Post-prandial SMA BFVs were attenuated during the feedings immediately after transfusion; at 24 and 48?h after transfusion, changes in post-prandial SMA BFVs were similar to those measured prior to transfusion; the presence of the PDA did not affect results.

Conclusions: PRBC transfusion blunted SMA BFV responses to feedings immediately after the transfusion with normalization observed 24?h post-transfusion.     

Intussusception in a premature neonate: A rare and often misdiagnosed clinical entity

Intussusception is a very rare cause of intestinal obstruction in neonates. It is of extremely rare occurrence among premature neonates. We present a case of 11-day-old premature neonate who presented with abdominal distension, intolerance to feeds, vomiting, significant bilious aspirate and bleeding per rectum. The initial diagnosis of necrotizing enterocolitis (NEC) led to a delay in the diagnosis. On exploratory laparotomy, it turned out to be a case of ileo-colic intussusception with Meckel''s diverticulum as a lead point. This site of intussusception (ileo-colic) and presence of a lead point among premature neonate is of exceedingly rare occurrence and very few such cases have been reported.In this article, the published work about clinical features and management on intussusceptions in premature neonates has been reviewed. The authors intend to highlight the difficulty in distinguishing the NEC and intussusception. Subtle clinical and radiological features which can help in differentiating the two conditions have been emphasized. This can avoid the delay in diagnosis and management which can prove critical. High index of suspicion with timely intervention is the key for optimizing outcome. A diagnosis of intussusception should always be considered in any preterm infant with suspected NEC.     

EFFECT OF CROSS-FOSTERING ON NEONATAL SODIUM BALANCE AND ADULT BLOOD PRESSURE IN THE SPONTANEOUSLY HYPERTENSIVE RAT

1. The aim of the present study was to compare electrolyte handling in naturally reared neonatal spontaneously hypertensive rats (SHR) with those reared by a Wistar-Kyoto (WKY) rat foster mother (denoted SHRX), as cross-fostering SHR pups to a WKY rat dam lowers adult blood pressure in the SHR. 2. The electrolyte content of WKY rat and SHR dams’ milk was determined and electrolyte intake and urinary excretion rates were calculated in both naturally reared and cross-fostered WKY rat and SHR pups. 3. The milk sodium concentration fell in both strains (WKY rat: 31.8 ± 2.0 to 15.2 ± 1.2 mmol/L; SHR 31.9 ± 2.5 to 18.2 ± 1.6 mmol/L; P < 0.001), as did potassium (P < 0.001), over lactation, but there were no differences between strains. Calcium and magnesium concentrations increased (P< 0.001), although SHR dam's milk contained less calcium (P < 0.001) than that of WKY rat dams during the third week of lactation. 4. Spontaneously hypertensive rat pups ingested less milk (P<0.05) than WKY rat pups; therefore, their cumulative sodium intake over postnatal days 4–15 was significantly lower than that of WKY rat pups (WKY rat vs SHR: 84.4 ± 3.6 vs 59.7 ± 2.6 μmol/g bodyweight, respectively; P < 0.05) and fostered SHRX pups (77.7 ± 7.0 μmol/g bodyweight; P < 0.05). Potassium and magnesium intakes were comparable between SHR, WKY rat and SHRX pups, but SHR pups ingested significantly less calcium than either WKY rat pups (136.1 ± 6.4 vs 200.1 ± 9.5p, mol/g bodyweight, respectively; P<0.05) or SHRX pups (200.0 ± 18.0 μmol/g bodyweight; P<0.05). 5. These data show that the neonatal SHR experiences a period of sodium deficiency during the developmental stage when cross-fostering is effective in lowering blood pressure. This is consistent with the reported up-regulation of the renin-angiotensin system observed in SHR at this time and may have a long-term influence on blood pressure.     

新生儿胃穿孔14例治疗体会

目的　探讨新生儿胃穿孔的发病特点和治疗方法。方法　对我院近 10年治疗的 14例新生儿胃穿孔进行回顾性分析。结果　 14例新生儿胃穿孔皆行手术治疗 ,术后死亡 7例。结论　新生儿胃穿孔多因先天性胃壁肌层发育不良及胃内张力增高缺血缺氧所致。早期诊断 ,及时手术 ,减少并发症及术后加强支持疗法是提高本病治愈率的关键     

妊高征患者胰岛素样生长因子水平及对胎儿生长发育的影响

目的：探讨妊娠高血压综合征(妊高征)患者血清胰岛素样生长因子(IGF-1)和胰岛素样生长因子结合蛋白-3(IGFBP-3)水平与疾病程度及新生儿出生体重之间的关系。方法：用放射免疫方法测定33例妊高征和32例正常血压妊娠妇女的血清IGF-1、IGFBP-3的水平。结果：重度妊高征组IGF-1显著低于正常组，IGFBP-3在各组间的水平浓度差异均无显著性，但IGF-1与IGFBP-3之间呈正相关。新生儿出生体重随妊高征严重程度的加剧而降低，各组间比较差异有显著性(F=5．453，P=0．002)。结论：妊高征患者的发病及严重程度与IGF-1有明显的关系，IGF-1与胎儿的发育及新生儿出生体重有明显的相关性。     

危重新生儿应激性高血糖及其预后分析

目的探讨危重新生儿预后与应激性高血糖之间的关系。方法对85例危重新生儿入院后即采静脉血用葡萄糖氧化酶法测血糖,血糖>7mmol/L诊断为高血糖,此后应用微量血糖仪进行动态监测。结果入院时高血糖者56例,占65.9%,治愈组与死亡组的血糖值分别为7.38±2.70、17.8±8.50mmol/L(P<0.01);无脏器功能衰竭、单器官及多器功能衰竭患儿的血糖分别为6.02±2.82、10.8±3.85、14.1±4.80mmol/L(P<0.01)。高血糖与器官功能衰竭关系密切,血糖越高,病情越严重,预后越差。结论危重新生儿血糖水平可作为预后判断的一项依据。     

Plasma thrombomodulin level in very low birthweight infants at birth

Objective: Plasma soluble thrombomodulin level reflects endothelial damage. The plasma thrombomodulin level at birth is increased in asphyxiated full-term infants. There is no report of plasma thrombomodulin level in premature infants. To determine the thrombomodulin level in premature infants and whether it might reflect endothelial damage, we examined the plasma thrombomodulin level in very low birthweight (VLBW) infants at birth. Methods: Forty-five VLBW infants, of whom 14 had perinatal asphyxia complications, were recruited. As a control, 50 full-term infants wimout complications were also studied. Plasma thrombomodulin concentration, pH, base deficit, serum creatinine and D-dimer concentration, platelet count and fibrinogen concentration were measured within 1 hour after birth. Results: There were significant differences in plasma pH, creatinine concentration, platelet count, antithrombin in activity and D-dimer concentration between VLBW infants and full-term infants. Plasma thrombomodulin concentration (39. 0 (16. 6–93. 7) vs 27. 0 (16. 6–39. 1) μg/L, p < 0. 0001) and plasma taombomodulin-to-serum creatinine ratio (0. 82 (0. 19–2. 65) vs 0. 47 (0. 24–0. 70) μg/μmol, p < 0. 0001) were significantly higher in VLBW infants than those in full-term infants. By univariate analyses for all neonates, there were significant relations between plasma thrombomodulin concentration and gestational age, birthweight, plasma pH, creatinine concentration, platelet count and antithrombin in activity. A stepwise multiple linear regression model using the above variables as dependent factors showed only birthweight contributed significantly to plasma thrombomodulin concentration (plasma thrombomodulin concentration (μg/1) = 45. 677–0. 006 (birthweight; g), r²= 0. 323, p < 0. 0001, n= 94). Plasma thrombomodulin concentration and plasma thrombomodulin-to -serum creatinine ratio in VLBW infants with asphyxia were higher than in those without asphyxia, but not significantly different (43. 2 ± 17. 7 vs 38. 3 ± 8. 5 μg/1 and 0. 92 ± 0. 60 vs 0. 83 ± 0. 37 μg/μmol). Conclusion: Plasma thrombomodulin level in VLBW infants shows a high value at birth, and we consider the main factor responsible for this elevation may be endothelial damage or low clearance rate of thrombomodulin, which may be related to early gestational age.     

Reversible changes in cerebral activity associated with acidosis in preterm neonates

Murdoch Eaton DG, Wertheim D, Oozeer R, Dubowitz LMS, Dubowitz V. Reversible changes in cerebral activity associated with acidosis in preterm neonates. Acta Paediatr 1994;83:486–92. Stockholm. ISSN 0803–5253
Computerized online EEG monitoring in ventilated preterm infants less than 32 weeks' gestation enabled evaluation of the effect of acidosis on cerebral function. All episodes of acidosis were found to be associated with changes in the levels of cerebral activity. In 21 of the 32 episodes, EEG activity returned to pre-acidosis levels after therapeutic intervention. The duration of EEG abnormality was related to the severity of acidosis. However, the time to recovery of the EEG after therapeutic procedures was not related to duration of the EEG change.     

Autopsy findings in two cases of neonatal herpes simplex virus infection: detection of virus by immunohistochemistry, in situ hybridization and the polymerase chain reaction

We describe the pathological findings in two fatal cases of neonatal infection with herpes simplex virus. One had an encephalitis caused by herpes simplex virus type 2 (HSV-2); the other had a disseminated infection with herpes simplex virus type 1 (HSV-1). Confirmation of the diagnosis was obtained by use of the polymerase chain reaction to amplify viral DNA from paraffin sections of autopsy tissues. By using primers which amplify fragments of the HSV-1 thymidine kinase gene and HSV-2 glycoprotein gene respectively it was possible to discriminate between infection with HSV-1 and HSV-2. In contrast, immunohistochemistry and in situ hybridization using commercially available reagents did not distinguish between HSV-1 and HSV-2 infection. However, immunohistochemistry and in situ hybridization are probably more reliable than the polymerase chain reaction for assessment of the distribution of virus in different tissues.     

中国蒙古族新生儿体格发育的研究

１９８８～１９９１年对内蒙古锡盟地区３８９例蒙古族新生儿进行了活体观察测量，取得了２２项总体发育指标及相应的各项性别指标的均值数据，并以其中体重、身长、顶臀长（坐高）、头围、胸围及上臂围等６项指标与国内外有关资料作了比较和性别间的对比分析，从结果来看，体重高于本地区平均水平１１０ｇ，高于国内某些城市１４０～２０２ｇ；身长及坐高分别矮于本地区平均水平５．１３ｃｍ及６．５４ｃｍ，分别矮于国内某些城市４．８８～４．８９ｃｍ及６．６０ｃｍ。呈圆头型、手足宽短、身躯宽短的粗壮体型。