Potential of neonatal organ donation and outcome after transplantation

Organ transplantation is limited by access to suitable organs. Infant recipient waitlist mortality is increased due to the scarcity of size-matched organs. Neonatal organ donors have been proposed as an underutilized source of donor organs. However, the literature on the actual prevalence and outcome of neonatal organ donation and transplantation is fragmented and not well analyzed. This literature review aims to summarize the available literature on the potential of neonatal organ donation and to analyze published cases of neonatal organ transplantation. A systematic search of the Medline and Cochrane databases yielded 2964 articles, which were screened for eligibility. In total, 86 articles were considered eligible, of which 34 were included in the literature review: 8 articles describing the potential of neonatal organ donation programs, and 26 articles describing clinical transplantation. Current evidence suggests there is a large pool of potential neonatal organ donors. In contrast, the literature on neonatal organ donor utilization is sparse. However, case series of successful kidney, heart, liver, hepatocyte, and multivisceral transplantation using organs from neonatal donors are summarized. Although good posttransplant organ function was achieved, the use of neonatal organs is associated with increased risk of thrombosis in both kidney and liver transplantation. Neonatal organ donation is a promising alternative for expanding the current donor pool. Experience is limited, but reported patient and graft survival are acceptable and more research on the subject is warranted.     

新生儿缺氧缺血性脑病的发生原因及护理

阐述了新生儿缺氧缺血性脑病的病因及临床诊断依据 ,重点综述了新生儿缺氧缺血性脑病的护理。     

Sonographic assessment of clubfoot

PURPOSE: This study was performed to develop a standardized methodology for the sonographic assessment of clubfoot at birth and at the end of both conservative treatment and surgical correction. METHODS: Forty-two congenital clubfeet and 42 normal feet were examined sonographically in the position of spontaneous alignment and during passive manual correction. Scans along 4 planes provided information relevant to the assessment: sagittal posterior, sagittal anterior, coronal lateral, and transverse. RESULTS: Sagittal posterior sonograms demonstrated the progressive gain of dorsiflexion ability during the different steps of treatment for clubfoot. Sagittal anterior sonograms could not demonstrate the normal alignment of the navicular in clubfeet because of the bone's medial displacement. On transverse sonograms, the talar head and the medially displaced navicular may lie on the same plane, depending on the severity of the deformity. Coronal lateral sonograms provided for estimation of the relationships between the calcaneus and cuboid, which were described by the calcaneal-cuboid angle. CONCLUSIONS: Sonography is a promising technique for assessment and monitoring of clubfoot during treatment. The method described here yields accurate and reproducible information about the anatomy of the nonossified clubfoot, helping the orthopedic team decide on appropriate treatment steps.     

新生儿舒适护理研究进展

阐述了体位对早产儿呼吸系统、胃肠道功能及心理的影响，沐浴、体温测量对新生儿皮肤有影响。提出保护性措施可减轻对患儿的伤害，提高其舒适度。     

Candida tropicalis brain abscess in a neonate: An emerging nosocomial menace

Fungi are a relatively uncommon cause of brain abscess in neonates and early infancy. They are usually associated with predisposing factors like prematurity, low birth weight, use of broad-spectrum antibiotics, and prolonged stay in the intensive care unit. Candida tropicalis (C. tropicalis) is rapidly emerging as a nosocomial threat in the neonatal intensive care settings. This case report describes a neonate with C. tropicalis brain abscess who was diagnosed early and managed aggressively with a favorable outcome. Inadvertent use of intravenous antibiotics can have serious complications such as invasive fungal infection. Correct microbiological diagnosis is the key to successful treatment of deep-seated pyogenic infection. Fungal etiology should always be studied in relevant clinical settings.     

The effects of milrinone in the neonatal pig heart

Summary Milrinone, a selective inhibitor of phosphodiesterase (PDE), was examined in neonatal hearts and in ventricular myocytes. Isolated, paced (180 beats/min), isovolumically beating hearts from pigs, <3 days of age, were perfused with an erythrocyte-enriched solution. In one group (control, n=6), milrinone was studied at perfusate concentrations of 1, 10, and 100 g/ml. In a second group (postischemia, n=10), hearts were subjected to 30 minutes of no-flow ischemic arrest, prior to the addition of milrinone. Left ventricular peak systolic pressure (PSP) and end-diastolic pressure, coronary flow (CF), heart rate (HR), and myocardial oxygen consumption (MVO₂) were measured. The PSP averaged 100 mmHg during the baseline periods for both groups and decreased to 85 mmHg in those hearts subjected to ischemic arrest. In both groups, PSP increased 14% at the 1g/ml concentration of milrinone. No additional increases in PSP were observed in the control group at the higher concentrations. However, PSP increased 28% and 41% (p<0.05), in the postischemia group at the 10 and 100 g/ml concentrations, respectively. The CF averaged 3 ml/min/g during the baseline periods of both groups and increased significantly at each milrinone concentration. The HR in both groups increased to 200 and 250 beats/min at the 10 and 100 g/ml concentrations, respectively. Additionally, milrinone's effects in intact hearts were found to be comparable to those of isobutylmethyl xanthine (IBMX), a nonspecific PDE inhibitor. In isolated myocytes, however, milrinone produced only modest increases in cAMP levels, compared to IBMX. We conclude that milrinone has positive inotropic, coronary vasodilatory, and chronotropic effects in the neonatal pig heart. In particular, milrinone also was capable of reversing the contractile dysfunction that resulted when these immature hearts were subjected to 30 minutes of normothermic, no-flow ischemic arrest. Thus, milrinone may be a useful agent in the treatment of neonates with contractile dysfunction.Grant support has been supplied by The Louisiana Board of Regents, Louisiana Education Quality Support Fund, 150 Riverside Mall, Suite 129, Baton Rouge, LA 70801-1303.     

Presence of pancreatic glucagon in the portal plasma of human neonates. Differences in the insulin and glucagon responses to glucose between normal infants and infants from diabetic mothers

Summary Human neonates have been studied during the first hours of life. Blood glucose, portal plasma insulin and glucagon have been determined both at regular intervals up to 24 h after birth and during an intravenous glucose load performed at the 24th h. A material presenting the immunological characteristics of pancreatic glucagon has been found in the portal plasma of both normal infants and infants from diabetic mothers (IDM). The intravenous glucose load did not suppress plasma glucagon in the normal neonates nor in the IDM. Higher portal plasma glucagon values were observed in the late phase of the intravenous glucose load in normal neonates compared to IDM. Portal plasma insulin has been found higher in IDM both at the 24th h of life and during the early phase of the intravenous glucose tolerance test. The hypothesis is put forward that the behaviour difference in glucagon secretion might be a consequence of the relative nyperinsulinism of IDM with insulin facilitating the entry of glucose into the cell thus permitting a more effective glucagon suppression.Chargé de Recherches du Fonds National de la Recherche scientifique, Belgium.