Pentoxifylline reduces plasma tumour necrosis factor-alpha concentration in premature infants with sepsis

Increased plasma tumour necrosis factor (TNF) concentration correlates with mortality in sepsis. We suggested that pentoxifylline (PTXF), which is known to inhibit TNF production, may improve survival and attenuate clinical symptoms of sepsis in neonates. Plasma TNF levels were evaluated in 29 newborn infants with sepsis. Patients were randomly assigned into two groups, receiving PTXF in a dose of 5 mg/kg per hour for 6 h or placebo (saline), on 3 successive days. Both groups were subjected to the same conventional therapy. TNF was evaluated before and after PTXF or placebo administration on the 1 st and 3rd days of therapy. There was a statistically significant decrease in plasma TNF level in the PTXF group when the values before the first and after the last PTXF infusion were compared [mean: 671.5 pg/ml; SD: 438; med: 729.6 vs mean: 41.0 pg/ml; SD: 64.1; med: 11.5;P<0.000004]. In the placebo group, decrease was not significant [mean: 633.0 pg/ml SD: 488.6; med: 618.9 vs 246.9 pg/ml; SD: 243.9; med: 191.0]. A significantly higher plasma TNF level, evaluated after the last PTXF infusion, was found in the placebo group [246,9 pg/ml vs 41.0 pg/ml;P<0.001]. Only one of four infants with signs of shock in the placebo group survived, whereas all of five newborns with symptoms of shock in the PTXF group survived [P<0.04]. An increased incidence of metabolic acidosis [P<0.05], necrotizing enterocolitis [P<0.04] and renal insufficiency [P<0.05] was observed in infants in the placebo group.Conclusion PTXF inhibits production of TNF and may have therapeutic value in the treatment of premature infants with sepsis complicatea by shock.     

Further studies on the action of 5-hydroxytryptamine on lumbar motoneurones in the rat isolated spinal cord

Summary Using the hemisected spinal cord of the neonate rat, the effects of altered external Ca, thyrotrophin-releasing hormone (TRH) and a number of antagonists were tested on depolarizations evoked by 5-hydroxytryptamine (5-HT). Responses of populations of motoneurones were recorded via a ventral root. 5-Hydroxytryptamine depolarizations were not Ca-dependent but were enhanced in amplitude in Ca-free solutions. Raised Mg reversed this enhancement. 5-Hydroxytryptamine depolarizations persisted in the presence of Mn (1.53 mmol/l). TRH depolarized motoneurones; there was no evidence of modulation of 5-HT responses on concurrent application of TRH. Ritanserin (0.1 mol/l) had a modest blocking action on 5-hydroxytryptamine depolarizations reducing the maximum; 1mol/l ritanserin caused a greater antagonism which was unsurmountable (pIC₅₀ 5.2). Ritanserin (0.1 or 1 mol/l) did not depress responses to noradrenaline (NA). Ketanserin (0.1 mol/l) caused a blockade of slow onset, equilibrium with the receptors requiring 1 h. Blockade by 0.01, 0.1 and 1 mol/l ketanserin was concentration-dependent (pIC₅₀ 6.2). Ketanserin 1 mol/l, but not at lower concentrations, depressed noradrenaline responses. Mianserin (0.1 mol/l) also caused a blockade of slow onset; 0.1 or 1 mol/l produced a flattening of the 5-hydroxytryptamine concentration-response curve but did not depress noradrenaline responses (pIC₅₀ 4.7). The pIC₅₀ for spiperone was 8.0. DOI (10–100 mol/l) had no detectable agonist action but at concentrations of 0.01 and 0.1 mol/l it acted as an antagonist. Equilibration with the receptors occurred over 2 h. DOI (0.01 mol/l) depressed 5-hydroxytryptamine but not noradrenaline responses; higher concentrations of DOI also depressed noradrenaline responses. The pharmacological profile of the 5-hydroxytryptamine receptor mediating depolarization of spinal and facial motoneurones suggests that it belongs to the 5-HT_1C-5-HT₂, group of 5-hydroxytryptamine receptors but is not identical to 5-HT_1C or the 5-HT₂ CNS binding sites. Alternatively, the response might arise from a mixed population of 5-HT₁-like and 5-HT₂ receptors. Send offprint requests to D. I. Wallis at the above address     

Serum α1-microglobulin and β2-microglobulin for the estimation of fetal glomerular renal function

As proteins cannot cross the placenta levels of the microproteins ₁-microglobulin (₁MG) and ₂-microglobulin (₂MG) can be used to assess fetal glomerular renal function. ₁MG, ₂MG and creatinine were routinely determined in cord and maternal blood of 133 newborns [gestational age (GA) 25–42 weeks]. Twenty-nine patients with suspected impaired maternal or fetal renal function were studied separately and two fetuses were studied in utero. The mean fetal ₂MG concentration fell from 3.87±0.56 mg/l in the 25–31 weeks GA group to 2.60±0.50 mg/l in the mature newborn group. ₁MG concentration fell from 3.10±0.51 to 2.25±0.49 mg/dl. In contrast, the mean maternal ₁MG concentration rose from 1.73±0.69 mg/l in the 25–31 weeks GA group to a mean of 1.83±0.48 mg/l in the mature newborn group; ₁MG rose from 3.96±0.58 to 4.33±1.6 mg/dl. Maternal and fetal creatinine levels were identical. Fetal microprotein levels fall during intra-uterine development as glomerular filtration rate (GFR) rises. There is no correlation between cord blood and maternal ₁MG or ₂MG concentrations. In 13 children with urological anomalies only 1 had elevated microprotein levels and he later developed renal insufficiency. Determination of microprotein levels in fetal serum can be used to detect severe renal function disturbances and to estimate GFR independently of maternal renal function.     

孕母患自身免疫性甲状腺疾病对新生儿出生体重及甲状腺功能的影响

目的　探讨孕母患自身免疫性甲状腺疾病对新生儿出生体重及甲状腺功能的影响。方法　通过浙江省新生儿疾病筛查网络系统 ,自 1999年 8月至 2 0 0 2年 6月对 12 2例母亲患有自身免疫性甲状腺疾病的新生儿出生体重、甲状腺功能进行追踪观察。结果　 (1)格雷夫斯病母亲的新生儿出生体重为 (32 2 4 4± 330 2 )g ,明显低于健康母亲及慢性淋巴细胞性甲状腺炎母亲的新生儿 ;(2 ) 12 2例新生儿中 ,甲状腺功能正常 97例 ,暂时性促甲状腺激素 (TSH)升高 2 1例 ,先天性甲状腺功能减低症 3例 ,甲状腺功能亢进症 1例 ,与同期健康母亲的新生儿相比有显著差异 (P <0 0 1) ,且 4例甲状腺功能异常的新生儿 ,其母亲妊娠期甲状腺功能均不正常。结论　孕母患自身免疫性甲状腺炎 ,尤为妊娠期甲状腺功能不正常对新生儿出生体重及甲状腺功能影响较大 ,加强对患自身免疫性甲状腺疾病的母亲及其孩子的管理十分重要。     

广州市新生儿卡介苗接种质量监测

目的　了解 2 0 0 1～ 2 0 0 3年广州市新生儿卡介苗接种质量。方法　对 2 0 0 1～ 2 0 0 3年广州市越秀、荔湾、东山、海珠区 2 4个接种单位的新生儿卡介苗接种报表和质量监测结果进行分析。结果　新生儿卡介苗接种率、接种后1 2周结核菌素纯蛋白衍化物 (TB -PPD)阳转率、PPD反应平均直径、卡痕率、卡痕平均直径等指标均较稳定。结论　广州市新生儿卡介苗接种工作质量较高并保持稳定。     

Immunohistochemical examination of the INK4 and Cip inhibitors in the rat neonatal cerebellum: cellular localization and the impact of protein calorie malnutrition

Expression of the cyclin-dependent kinase inhibitors (CKIs) has been linked to the inhibition of cellular proliferation and the induction of differentiation. Based on structure function analysis, two distinct families of CDKIs, the INK4 and the Cip/Kip family have been identified. The INK4 family member p16(Ink4), and the Cip/Kip protein p27(Kip1) have been implicated in normal development of the CNS and cerebellum. Recent studies have suggested a functional inter-dependence between the CKI and the abundance of cyclin D1 in orchestrating growth factor-induced cellular proliferation. The neonatal rat cerebellum undergoes proliferative growth and differentiation, localized to distinct topographical regions and cell types. The cell type and the temporal profile of CKI expression during postnatal cerebellar development had not been described. The current studies determined the specific cerebellar cell types in which the CKIs were expressed during post natal development by co-staining for cell-type specific markers. p16(Ink4a) and p27(Kip1) immunostaining was identified in both neurons and glial cells, increasing progressively between postnatal days 6 to 13 into adulthood. By contrast, neuronal and glial cell p21(Cip1) staining was prominent at days 6-11 and decreased thereafter. Cyclin D1 was expressed in the proliferating external granular cells, with occassional staining in the molecular, and internal granular layers. Dual immunostaining demonstrated cyclin D1 within cells expressing CKI (p16(Ink4a), p21(Cip1),p27(Kip1)). Cerebellar cellular growth arrest, induced by protein-calorie malnutrition, inhibited cyclin D1 protein levels without affecting CKI immunostaining suggesting CKI do not mediate the developmental arrest. These results demonstrate that the CKIs are induced by differentiation cues in specific cell types with distinct kinetics in the developing cerebellum in vivo.     

新生儿筛查健康教育适宜方式探讨

目的 :探讨广州地区 13个区县新生儿健康教育适宜方式的需求状况 ,根据需求 ,提供最适宜的健康教育方式。方法 :以定性问卷方式调查 13个区县新生儿健康教育适宜方式的需求状况并统计分析。结果 :各区县对健康教育的总需求为 10 0 % ,但需求的各种健康教育方式有显著性差异。结论 :根据不同的需求 ,提供最适宜的健康教育方式 (各种教材及各种教学方式 ) ,使达到“知、信、行”的 〔1〕目的 ,对促进新生儿筛查工作的开展 ,提高出生人口素质有着积极的作用     

现代复苏技术在危重新生儿转运中的应用体会

目的：探讨现代复苏技术在危重新生儿转运中的应用及其临床价值。方法:对我院2000年3月-2004年2月危重新生儿转运中接受心肺脑复苏(CPCR)的26例息儿进行回顾性分析，总结出危重新生儿转运中CPCR程序及其要点。结果：在26例息儿中，转运前给予CPCR 18例，占69.2％；转运途中给予CPCR 8例，占30.8％；除2例息儿复苏失败于转运途中死亡外，其余24例均复苏成功，成功率为92.3％。结论：危重新生儿转运中的CPCR程序具有临床实用价值。     

MR imaging of the neonatal brain at 3 Tesla

3 Telsa MR scanners are now becoming more widely available and 3 Telsa is likely to become the filed strength of choice for clinical imaging of the brain. The neonatal brain can be safely and successfully imaged at 3 Telsa. The improved signal to noise afforded by a higher field strength may be used to improve image quality or shorten acquisition times. This may be exploited for conventional T1 and T2 weighted imaging and also for advanced techniques such as diffusion tensor imaging, angiography and functional magnetic resonance studies.     

无菌性发热新生儿单个核细胞肠道病毒基因表达的研究

目的　探讨无菌性发热新生儿外周血单个核细胞 (PBMC)中肠道病毒 (EV)基因表达情况和临床表现特点。方法　采用逆转录聚合酶链反应 (RT PCR)、原位杂交和病毒分离技术检测了 2 9例发热待查组和 18例中枢感染组新生儿PBMC、脑脊液及血清中EVRNA ,并对其临床特点进行总结分析。结果　发热待查组EV感染 14例 (48 3% ) ,9例PBMC中EVRNA阳性者 ,血清中全部阳性 ,其中 4例脑脊液中同时阳性 ;中枢感染组EV感染 11例 (6 1 1% ) ,5例外周血PBMC中EVRNA阳性者 ,血清和脑脊液中也全部阳性。两组比较 ,只有RT PCR法检测中枢感染组脑脊液中EVRNA阳性数高于发热组 ,而不同方法检测PBMC和血清中EVRNA两组间差异均无显著性。EV感染的主要症状有喂养困难 (71% )、易激惹 (6 4 % )、腹泻 (6 1% )、嗜睡 (5 4 % )、肝脏肿大 (46 % )及皮疹(36 % )等。结论　EV可感染新生儿的PBMC ;新生儿感染后EV易在全身播散 ;临床表现不典型 ,早期、快速病原诊断可缩短住院天数和减少抗生素的应用 ,有较高的社会和经济效益。