Comparing sulindac with indomethacin for closure of ductus arteriosus in preterm infants

Objectives: A prospective study comparing the efficiacy and side-effects of oral sulindac with intravenous indomethacin in clinically stable preterm infants (<1750 g) requiring non-invasive closure of haemodynamically significant patent ductus arteriosus.
Methodology: As maturity and birthweight are the two major determinants of ductal closure, infants were matched as closely as possible for these parameters. An eligible patient was first assigned to the sulindac group and a subsequent patient with similar gestational age (± 1 week) and birthweight (±100 g) to the previously recruited infant would automatically receive indomethacin. A total of eight infants were enrolled in each group.
Results: The ductus arteriosus was successfully closed in all eight infants receiving indomethacin, and in seven of eight infants receiving sulindac. No significant differences were found with regards to the ductal size between the two groups at diagnosis or on each of the consecutive days of treatment ( P >0.25). More renal adverse effects were encountered in the indomethacin group. Significant differences in changes from baseline value for urine output, plasma sodium, urea and creatinine concentrations were noted at 24, 48 and 72 h after commencement of treatment between the two groups ( P <0.05). All the parameters returned to normal or pre-treatment levels 48 h after stopping therapy. Unexpectedly, severe gastrointestinal complications were encountered in the sulindac group.
Conclusions: Sulindac is capable of promoting ductal constriction in clinically stable preterm infants without compromising the renal function. The spectrum of gastrointestinal complications observed in sulindac treated infants were similar to those described for indomethacin. The use of sulindac for ductal closure in the preterm infant should remain experimental.     

Erythromycin treatment for gastrointestinal dysmotility in preterm infants

To report our clinical experience on the use of oral erythromycin for the treatment of severe gastrointestinal dysmotility in preterm infants.

Methodology:

A case series study of seven preterm infants (six were very low birthweight) with severe intestinal dysmotility in a tertiary neonatal centre.

Results:

All responded favourably without adverse effects and tolerated full enteral feeding within 1–2 weeks of the commencement of the drug.

Conclusions:

As prolonged total parenteral nutrition carries significant risk of complications, this therapy could be considered in selected preterm infants who fail to establish enteral feeding after an extended period, and in whom an anatomically obstructive lesion of the gastrointestinal tract has been excluded. Meanwhile, we would caution against the widespread implementation of this therapeutic approach until formal evaluation by randomized controlled trials have established the exact role of erythromycin, or its analogues, in the treatment of intestinal dysmotility in preterm infants.     

循证医学对现代儿科学的意义

桂永浩教授:循证医学(evidence based medicine, EBM)是20世纪后期迅速发展起来的一门新兴的交叉学科。他之所以引起西方现代医学的高度重视是因为EBM 提出:医务人员在对患者进行的诊治中必须基于当前可得到的最佳的临床证据,并结合医生个人的经验和来自患者的临床资料,在充分尊重患者的选择和意愿的基础上,使患     

LC-MS/MS测定人血浆中对乙酰氨基酚及其人体药动学和生物等效性研究

目的 建立一种快速、灵敏的高效液相色谱-串联质谱（HPLC-MS/MS）方法以测定人血浆中对乙酰氨基酚浓度,并应用于两种对乙酰氨基酚制剂的人体药代动力学和生物等效性研究。方法 以替硝唑为内标,200μL血浆样品经5倍于其体积的乙酸乙酯液液萃取,再经Waters XBridge? C18柱等度洗脱分离后导入串联质谱,以正离子多反应监测模式进行定量分析,对乙酰氨基酚和内标的选择性反应离子对分别是m/z 152→110和248→121。方法经验证后应用于19名健康受试者单剂量空腹口服两种对乙酰氨基酚制剂500mg后药代动力学和生物等效性的研究。结果 血浆中对乙酰氨基酚在0.1～8.0 μg·mL-1范围内线性良好（r2 > 0.99）,最低检测限为 0.1 μg·mL-1,提取回收率为91.0%～98.7%,日内和日间准确度分别为98.8%～111.3% （精密度：CV ? 9.03%）和94.9%～102.6% （精密度：CV ? 10.68%）。生物等效性试验中,受试制剂与参比制剂的主要药代动力学参数Cmax、AUC0-t和AUC0-∞ 几何均值比的90%置信区间分别为83.50%～105.79%,94.25%～101.54%和93.24%～101.02%,均落在生物等效可接受标准80.00%～125.00%范围内。结论 所建立测定人血浆中对乙酰氨基酚浓度的HPLC-MS/MS法具有快速灵敏、回收率高、选择性好的特点,适用于对乙酰氨基酚片人体药代动力学和生物等效性研究。受试制剂与参比制剂在人体内吸收速度和程度相似,两种制剂生物等效。     

Neonatal jaundice: Its prevalance in Chinese babies and associating factors

A prospective study of 1238 full-term Chinese newborn infants was conducted to determine the incidence of neonatal jaundice and associated factors. A significantly more severe degree of hyperbilirubinaemia was present in infants whose ABO blood group was incompatible with that of their mothers and those who were deficient in the enzyme glucose-6-phosphate dehydrogenase (G6PD). Among the remainder, clinical jaundice was present in 87% and 23.9% had a peak serum bilirubin (SB) concentration greater than 204 mol/l. Factors that were found to have an association with a higher peak SB concentration included: male infants; elder siblings who had a history of neonatal jaundice; and breast-fed infants with or without supplementation with formula feed. Factors that were found to have no significant association with the peak SB concentration were: gestational age; birthweight; the mode of delivery of the infants; maternal consumption of Chinese herbs and syntocinon induction or augmentation of labour.     

Incidence of ABO haemolytic disease of the newborn in a group of Hong Kong babies with severe neonatal jaundice

Two methods were used to determine the incidence of ABO haemolytic disease of the newborn (ABO-HDN) among Hong Kong Chinese infants. The first method employed the Lui elution technique to elute anti-A,B from cord blood of Group A and B babies with a Group O mother, and set out to correlate the titration score of the eluate with the serum bilirubin of the neonates. This method proved to be a failure because of the poor correlation. The second method was mathematical. By comparing the 'expected' frequency of various mother-infant ABO combinations (based on the ABO distribution of our local population) with the 'observed' frequency of a cohort of infants with severe neonatal jaundice, it was found that only two combinations (O-A and O-B mother-infant pairs) were responsible for ABO-HDN, for which the incidence was 1 in 5 among infants with a serum bilirubin level of 300 mumols/L or more.     

Isolated congenital tricuspid valve dysplasia: A rare condition mimicking persistent pulmonary hypertension of the newborn

ABSTRACT Isolated congenital tricuspid valve dysplasia is a rare and potentially lethal congenital heart disease that can be easily confused with persistent pulmonary hypertension of the newborn. We describe a neonate with isolated congenital tricuspid valve dysplasia who did not respond to mechanical ventilation but improved by tolazoline. Clinicians should be aware that the initial fulminant course of this condition may be reversed by reducing the pulmonary vascular resistance, thereby allowing time for spontaneous recovery.     

高浓度氧对早产鼠肺一氧化氮合酶基因表达的影响

目的　探讨高浓度氧 (简称高氧 )对早产鼠肺一氧化氮合酶 (NOS)分布及基因表达的影响。方法　将 2 1d孕早产鼠随机分为高氧暴露组 (简称高氧组 )和空气对照组 (对照组 ) ,分别置于常压高氧仓中 (氧体积分数 >0 95 )和正常空气中暴露 7d ,采用逆转录 聚合酶链反应 (RT PCR)、免疫蛋白分析和免疫组织化学染色观察NOS分布及基因表达。此外对肺组织干 /湿重比值 ,支气管肺泡灌洗液 (BALF)成份和肺病理组织变化也进行了对比分析。结果　高氧组与对照组比较 ,早产鼠肺组织有明显水肿、出血和炎症 ;高氧组支气管肺泡灌洗液中蛋白含量 (中位数为 1 4 9g/L)、细胞数 (中位数为 139 70× 10 7/L)和肺组织干 /湿重比值 (5 5 7± 0 2 9)较对照组 (分别为 :0 32g/L、16 30× 10 7/L、5 2 9± 0 2 5 )均明显增加 (t=2 8、2 1、2 2 9,P均 <0 0 5 ) ;高氧组肺组织内皮细胞型一氧化氮合酶 (eNOS)mRNA、eNOS和诱导型一氧化氮合酶 (iNOS)蛋白表达 (分别为 :1 0 2± 0 0 6、8 77± 0 75、4 6 1± 0 6 5 )较对照组 (分别为 :0 70± 0 12、4 5 2± 1 0 2、3 2 4± 0 5 5 )明显增加 (t =6 36、8 14、3 2 1,P <0 0 1、P <0 0 1、P <0 0 5 )。iNOSmRNA也显示有增加的趋势 ,但差异无统计学意义 ,同时免疫组织化     

Vascular air embolism: A rare complication of nasal CPAP

Abstract: A preterm infant developed bilateral tension pneumothoraces and extensive vascular air embolism 6 h after being commenced on nasal continuous positive airway pressure (CPAP). Neonatal clinicians should be aware that catastrophic vascular air embolism could occur in infants receiving nasal CPAP, a modality of respiratory support conventionally considered non-invasive and 'safe'.     

A study of periventricular haemorrhage, post-haemorrhagic ventricular dilatation and periventricular leucomalacia in Chinese preterm infants

Serial cranial ultrasound scans were performed in 178 preterm Chinese infants (gestation less than 35 weeks, birthweight less than 2000 g) to study the incidence, age of onset and associating risk factors of periventricular haemorrhage (PVH), and also the occurrence of post-haemorrhagic ventricular dilatation and periventricular leucomalacia (PVL). Sixty-four infants developed haemorrhage, giving an incidence of 36%. Among infants of birthweight less than 1500 and less than 1000 g the respective incidence was 52 and 69%. Seventy-two per cent (46 of 64) of haemorrhages were initially detected within the first 3 days of life, but delayed haemorrhage occurring after 1 week of age occurred in nine infants. In eight of these infants PVH had been shortly preceded by a major clinical disaster. Eleven perinatal factors were found to be significantly associated with PVH but only systemic hypotension showed a significant independent association. Post-haemorrhagic ventricular dilatation developed in 17 (46%) of the 37 infants who survived for more than 1 month after PVH. This was transient in 41%, persistent but stable in 29% and progressive in 29%. PVL was detected in eight infants who survived the initial period following PVH.