Cocaine: A Neonatal Perspective

This paper focuses on cocaine misuse as it impacts on neonates born at Grady Memorial Hospital in Atlanta, Georgia. The majority of infants of cocaine-using mothers (ICAM) appear clinically normal and pass through the “normal nursery.” However, the longer hospital stay for the smaller, sicker ICAMs means that many cocaine-exposed sick infants are in the hospital at any time. The misperceptions of the pregnant cocaine-misusing woman often cause the ICAM to be born prematurely. The prematurity then superimposes other potential threats on the infant. Further, the environmental chaos into which these mothers and infants return following discharge may also contribute to the difficulties seen among these children. Finally, there are unanswered questions that have to be confronted by the hospital staff. These include ethical questions related to the “costs” of care to the cocaine-exposed infant     

A case report of a congenital left subcostal hernia in a neonate

We present an unusual case of a congenital left subcostal hernia in a female born at 39 weeks by caesarean delivery to a 39 year-old gravida₂para_1-2abortus₀ mother. The pregnancy was complicated by gestational diabetes, although she had normal prenatal imaging. After an uneventful caesarean delivery, the patient's initial physical examination was normal although subsequently was found to have a left subcostal hernia. During surgical evaluation, a reducible hernia was found along with left renal agenesis and no underlying masses. At 4 weeks of age, the patient's hernia was successfully repaired with no sequela. We present the first reported case of a congenital subcostal hernia, evaluation, and treatment.     

髓样分化因子88的表达变化在新生儿窒息后多器官功能障碍综合征的意义

目的:研究窒息新生儿外周血单个核细胞(Peripheral blood monocytes,PBMCs)髓样分化因子88(Myeloid dif-ferentiation factor88,MyD88)的表达变化与新生儿窒息后多器官功能障碍综合征(Multiple organ dysfunction syndrome,MODS)的关系及其与病情预后的关系。方法:窒息后24h之内入院的足月新生儿50例,采集生后第1天及第3、7天的外周血及10例正常健康足月新生儿的外周血,分离单个核细胞。用免疫组化的方法检测单核细胞内MyD88的表达情况。所有新生儿均常规进行经皮血氧饱和度和心电监测3天,同时作血肝功、肾功、心肌酶、电解质、血常规、尿常规、血气分析及心电图和头颅CT等检查,结合临床表现统计窒息后全身炎症反应综合征(Systemic inflammmory response syndrome,SIRS)和MODS的发生情况及其疾病的转归情况。结果:①新生儿窒息后SIRS的发生率是80%,轻度窒息组有71%发生了SIRS,重度窒息组有91%发生了SIRS。MODS的发生率是72%,轻度窒息组有61%发生MODS,重度窒息组有86%发生MODS。50例窒息新生儿有46例治愈出院,2例病情危重放弃治疗,2例抢救无效死亡。②正常健康足月新生儿的单个核细胞MyD88的表达比较弱。窒息新生儿单个核细胞内的MyD88在窒息后第1天的表达增强,3天开始减弱,7天左右恢复正常。③在窒息后第1天,MyD88表达与新生儿危重症评分呈显著负相关关系(r=-0.73,P<0.01),与SIRS和MODS的发生率呈显著正相关关系;发生了SIRS和MODS的病例,其MyD88的表达呈(++)～(+++)的比例增多,差异具有统计学意义(P<0.01);预后差的病例,MyD88的表达呈(++)～(+++)的比例增多,差异具有统计学意义(P<0.05)。结论:新生儿窒息后SIRS和MODS的发生率都很高,窒息早期可能激活了Toll样受体转导通路中的转载分子MyD88,引起单核-巨噬细胞系统释放一系列炎症因子导致了SIRS和MODS的发生。MyD88可以作为诊断新生儿窒息后SIRS和MODS的早期指标和估计预后的指标之一。     

流式细胞术检测新生儿网织红细胞多参数参考范围的探讨

目的建立流式细胞术（flow cytometry，FCM）检测新生儿网织红细胞（reti culocyte，Ret）多参数的参考范围。方法选取2012年12月至2013年1月人住新生儿普通病区，排除感染、窒息和先天畸形，日龄≤12h的53例新生儿为研究对象。采用FCM检测生后1、3、7dRet百分率（Ret％）、网织红细胞成熟指数（reticulocyte maturityindex，RMI）及Ret平均荧光强度，并将Ret％与手工法比较。结果53例新生儿中早产儿36例，足月儿17例。早产儿生后1、3、7d流式Ret％分别为（5．18±1．34）％、（4．77±1．45）％、（1．84±0．64）％，RMI分别为（6．08±3．14）％、（5．43±3．08）％、（22．54±10．58）％，Ret平均荧光强度分别为（2626．06±808．63）、（2692．00±865．87）、（4422．37±1668．98）；足月儿生后1、3、7d流式Ret％分别为（4．53±0．98）％、（4．01±1．62）％、（1．55±0．29）％，RMI分另0为（11．17±6.31）％、（8．66±4．49）％、（24．09±5_38）％，Ret平均荧光强度分别为（3522．50±1398．45）、（3888．00±1814．06）、0731．53±1771．59）。随胎龄增加，足月儿1、3dRMI和Ret平均荧光强度明显高于早产儿（P〈0．05），而两组不同日龄Ret％和7dRMI、Ret平均荧光强度之间差异无统计学意义。结论不同日龄和胎龄Ret多参数分析能更全面地了解新生儿Ret变化规律，为新生儿贫血的鉴别诊断、治疗和监测带来新的研究方向和发展前景。，     

甘露醇对缺氧缺血性脑病的抗氧化疗效研究

目的探讨甘露醇对新生儿缺氧缺血性脑病(HIE)的抗氧化疗效.方法将HIE患者分为两组用甘露醇静脉注射Ⅰ组在诊断6h内无前囟张力感时,甘露醇剂量按0.4g*kg-1*次-1,q6h.Ⅱ组在诊断24h后有前囟张力感时,按0.75g*kg-1*次-1,q6h.两组均在用药2～3d后开始减量,至5～6d停药,其他治疗相同.全部患者在治疗前后查血超氧化物歧化酶(SOD)和丙二醛(MDA).结果Ⅰ组治疗前SOD(83.0±4.1)NU*mL-1,MDA(24.2±3.6)nm*mL-1,治疗后SOD(141.0±6.5)NU*mL-1,MDA(9.8±1.7)nm*mL-1;Ⅱ组治疗前SOD(81.0±3.7)NU*mL-1,MDA(23.6±3.1)nm*mL-1,治疗后SOD(102.0±4.2)NU*mL-1,MDA(17.0±2.8)nm*mL-1.Ⅰ组治愈84/86(97.7%),死亡2/86(2.3%),致残2/84(2.4%);Ⅱ组治愈41/49(83.7%),死亡8/49(16.3%),致残8/41(19.5%).结论早期、小剂量、多次甘露醇治疗HIE能及时清除氧自由基对脑细胞的损伤,缓慢减轻脑细胞水肿、平稳降低颅内压、对提高HIE的治愈率、降低病死率和致残率具有重要意义.     

Circulating interleukin-1 receptor antagonist levels in neonates

Abstract Circulating interleukin-1 receptor antagonist (IL-1 Ra) levels have been shown to reflect disease activity in certain conditions in adults. We determined circulating IL-1Ra references values for healthy neonates (healthy preterms and term infants with mild disease only) on days 2 (n=17) and 4 of life (n=23). Mean gestational age was 35±2.6 weeks. On the 2nd day of life IL 1-Ra levels were 0.78 ng/ml (0.49/2.65), on day 4 0.38 ng/ml (0.20/0.48) (median, 25th/75th percentile,P=0.01). The values were not influenced by gender. In neonates with severe illness (septicaemia, asphyxia, neonatal respiratory distress syndrome), who received invasive intensive care, circulating IL-1Ra levels were significantly higher than in the reference group of healthy newborns. On the 2nd day of life 14.72 ng/ml (4.38/18.67) versus 0.78 ng/ml (0.49/2.65),P<0.0001; on day 4 of life, 3.38 ng/ml (0.80/11.99) versus 0.38 ng/ml (0.20/0.48),P<0.005 (values are median; 25th/75th percentile, Mann-Whitney U-Wilcoxon Rank Sum W Test, two-tailedP).Conclusion Compared to healthy individuals beyond the neonatal period, IL-1Ra concentrations are physiologically elevated within the first days of life and decline to low levels within days. In contrast, IL-1Ra levels are strikingly elevated in sick neonates.     

Four cases of lactobezoar in neonates

Four cases of lactobezoar, an unusual cause of vomiting in the neonatal period, are described and illustrated. From our experience with the first case we were able to diagnose the next three cases from the plain radiographs. The condition is likely to resolve spontaneously on intravenous feeding.     

Lack of effectiveness of dexamethasone in neonatal bacterial meningitis

A clinical trial was conducted to determine whether dexamethasone as adjunctive therapy alters the outcome of bacterial meningitis in neonates. Fifty-two full-term neonates with bacterial meningitis were enrolled in a prospective study. Infants were alternately assigned to receive either dexamethasone or not. Twenty-seven received dexamethasone in addition to standard antibiotic treatment and 25 received antibiotics alone. Dexamethasone therapy was started 10–15 min before the first dose of antibiotics in a dose of 0.15 mg/kg per 6 h for 4 days. Baseline characteristics, clinical and laboratory features in the two groups were virtually similar. Both groups showed a similar clinical response and similar frequency of mortality and sequelae. Six (22%) babies in the treatment group died compared to 7 (28%) in the control group (P = 0.87). At follow up examinations up to the age of 2 years, 6 (30%) of dexamethasone recipients and 7 (39%) of the control group had mild or moderate/severe neurological sequelae. Audiological sequelae were seen in two neonates in the dexamethasone group compared to one in the control group. Conclusion Adjunctive dexamethasone therapy does not improve the outcome of neonatal bacterial meningitis. Received: 22 December 1997 / Accepted: 14 March 1998     

Comparative assessment of clinical,roentgenological and anatomicopathological pulmonary findings in prematures and newborns

The clinical, roentgenological and pathologicanatomical findings in 101 deceased premature and newborn infants, delivered in the years 1968–1971, have been studied by transferring the data on to punch cards for the purposes of comparison and analysis. A full or partial conformity of the X-Ray findings with the pathologic-anatomic diagnosis was found in 72 cases. It has been concluded that a distinct radiomorphologic substrate is often caused by a combination of various pathologic-anatomical changes.