bluuebunny/crossref_metadata_2025 huggingface dataset:
Impaired Chemical Coupling of Cerebral Blood Flow Is Compatible with Intact Neurological Outcome in Neonates with Perinatal Risk Factors
Authors: Baenziger Oskar , Moenkhoff Marion , Morales Cleo G. , Waldvogel Katharina , Wolf Martin , Bucher Hans-Ulrich , Fanconi Sergio
Published: April 2003

Early detection of pathophysiological factors associated with permanent brain damage is a major issue in neonatal medicine. The aim of our study was to evaluate the significance of the CO2 reactivity of cerebral blood flow (CBF) in neonates with perinatal risk factors. Fourteen ventilated neonates with perinatal risk factors (pathological cardiotocogramm, low cord pH, postpartal encephalopathy) were enrolled into this prospective study. The study was performed 18–123 h after birth. CBF was measured using the nonivasive intravenous 133Xe method. Two measurements were taken with a minimal PaCO2-difference of 5 mm Hg. From the two CBF values the CO2 reactivity was calculated. Outcome was evaluated 1 year after birth. The CBF values at a lower PaCO2 ranged from 6.6 to 115.2 ml/100 g brain issue/min (median = 18.2) and at a higher PaCO2 level from 7.1 to 125.7 ml/100 g brain tissue/min (median = 18.75). The calculated CO2 reactivity ranged from –9.6 to 6.6% (median 1.1%) change in CBF/mm Hg change in PaCO2. CO2 reactivity correlated with lowest pH (r2 = 0.35, p = 0.02). Two infants died, one of neonatal sepsis, the other of heart failure. Neurological outcome at the age of 1 year was normal in 11 patients, 1 had severe cerebral palsy. From the 12 surviving patients the patient with severe neurological deficit showed
the highest CBF values (125.7 ml/100 g/min). Impaired chemical coupling of cerebral blood flow is compatible with intact neurological outcome in neonates with perinatal risk factors. CO2 reactivity in these newborns correlates with the lowest pH and may reflect the severity of perinatal asphyxia.
Inhaled Budesonide in Ventilator- Dependent Preterm Infants: A Randomized, Double-Blind Pilot Study
Authors: Merz U. , Kusenbach G. , Häusler M. , Peschgens T. , Hörnchen H.
Published: April 2003

The aim of this randomized, double-blind pilot study was to evaluate the short-term efficacy of early inhalation therapy with budesonide in ventilator-dependent preterm infants. The primary outcome variable was the duration of artificial ventilation; secondary outcome variables were the need for supplemental oxygen and the release of several inflammatory mediators in the tracheobronchial aspirate fluid. The infants of the budesonide group could not be weaned earlier from the ventilator. The ventilatory parameters on day 14 of life and the need for supplemental oxygen were similar in both groups. The release of inflammatory mediators was not reduced in the budesonide group. No adverse side effects were observed in either group. In conclusion, aerosolized budesonide failed to demonstrate significant short-term pulmonary improvement in ventilator-
dependent preterm infants.
Thrombopoietin Concentration in Umbilical Cord Blood of Healthy Term Newborns Is Higher than in Adult Controls
Authors: Walka M.M. , Sonntag J. , Dudenhausen J.W. , Obladen M.
Published: April 2003

Thrombopoietin (TPO) concentrations were determined in umbilical cord plasma of 121 healthy term newborns. The lower detection limit of the enzyme immunoassay employed was 32.5 pg/ml. Median cord plasma TPO concentration was 78 (interquartile range 55–107) pg/ml. 95th percentile was 255 pg/ml. In only 8% (10/121), TPO was below the detection limit compared to 81% of healthy adults (25/31). In cord blood and adult controls, there were no significant correlations of TPO with platelet count or mass.
Effect of Repeated Doses of Sucrose during Heel Stick Procedure in Preterm Neonates
Authors: Johnston C. Celeste , Stremler Robyn , Horton Linda , Friedman Allison
Published: April 2003

The purpose of this randomized clinical trial was to test the efficacy of repeated versus single dose sucrose to decrease pain from routine heel stick procedures in preterm neonates. Infants (n = 48) in the first week of life with a mean gestational age of 31 weeks received 0.05 ml of 24% sucrose solution or sterile water by mouth (1) 2 min prior to actual lancing of the heel; (2) just prior to lancing, and (3) 2 min after lancing. The single-dose group received sucrose for the first dose and water for the second and third dose; the repeated-dose group received sucrose three times, and the placebo group received only water. The Premature Infant Pain Profile (PIPP) scores were obtained for five 30-second blocks from lancing. Both sucrose groups had lower PIPP scores (single sucrose pain scores, 6.8–8.2, p = 0.07; repeated sucrose pain scores, 5.3–6.2, p < 0.01) than water (pain scores 7.9–9.1), and in the last block, the repeated dose had lower scores than the single dose (6.2 vs. 8.2, p < 0.05).
Effects of Neonatal Undernutrition and Binaural Ear Occlusion on Neuronal Development of the Superior Olivary Complex of Rats
Authors: Torrero Carmen , Regalado Mirelta , Perez Esther , Loranca Angelica , Salas Manuel
Published: April 2003

Golgi-Cox-impregnated neurons of the superior olivary complex were investigated in control, binaural ear-occluded control, undernourished, and binaural ear-occluded undernourished Wistar rats of 12, 20, and 30 days of age. In neonatally undernourished and binaural ear-occluded animals, a significant reduction in the number of dendrites and dendritic intersections in the medial trapezoid body neurons was observed. Inconsistent effects upon the dendritic arbor lateral superior olivary cells were also detected. Control and undernourished rats with binaural ear occlusion exhibited a significant increase in the dendritic arbor measurements of lateral superior olivary neurons as compared with the cells of the medial trapezoid body. The cytoarchitectonic imbalance between the modulatory efferent control of these systems and the sensory auditory input to the cochlea may be important for the integration of complex auditory physiological phenomena.
Lead Effects on Offspring Depend on When Mouse Mothers Were Exposed to Lead
Authors: Epstein HermanT. , Newton JamesT. , Fenton Kimberly
Published: April 2003

Target mice were nursed by mothers given lead starting (1) when target mice were born; (2) after conception of target mice, or (3) during the mothers’ own pre-weaning age. These target mice are called, respectively, POSTNATAL, GESTATIONAL, and PRE-MATING. Compared to developments in control mice, postnatal lead slowed brain weight development, lowered asymptotic brain weight, decreased DNA per brain somewhat, but had no effect on protein per brain. Gestational lead similarly slowed brain weight development, lowered asymptotic brain weight, greatly decreased DNA per brain, but had no effect on protein per brain. In contrast, pre-mating lead significantly increased brain weight and protein per brain and lowered DNA per brain substantially. These effects of pre-mating lead on brain weight and protein per brain could be due to the effects of lead on developing maternal reproductive systems or to lead’s presence during the rarely studied ovulation-to-fertilization period.
Sodium Nitroprusside Prevents Oxygen-Free-Radical-Induced Pulmonary Vasoconstriction in Newborn Piglets
Authors: Yu Xiang-Qing , Medbø Sverre , Saugstad OlaDidrik
Published: April 2003

The aim of the present study was to test whether hypoxanthine-xanthine oxidase (XO) induced a pulmonary vasoconstriction in newborn piglets, and whether this vasoconstriction could be attenuated or abolished by pretreatment of nitric oxide (NO) donor sodium nitroprusside (SNP). Twenty-five anesthetized newborn piglets (1–3 days old) were randomly assigned to the following four groups: the control group received saline intravenously only; the XO group received 0.1 mmol/kg of hypoxanthine subsequent with XO (1.5 U/kg); the SNP group received the same dosages of hypoxanthine/ XO together with SNP intravenously, allopurinol (ALP) group received ALP intravenously prior to hypoxanthine and XO injection. After giving XO, the pulmonary arterial pressure (PAP) and vascular resistance (PVR) increased, while the cardiac index decreased significantly in the XO group. By contrast, these variables were not significantly modified by XO injection in the SNP and ALP groups. The data suggest that oxygen free radicals induce a pulmonary vasoconstriction in newborn piglets, and this vasoconstriction can be prevented by infusion of the NO donor SNP.
Remodeling of Rat Neonatal Pulmonary Artery: Role of Matrix Metalloproteinases
Authors: Tozzi Carol A. , Thakker-Varia Smita , Dice Margaret S. , Riley David J.
Published: April 2003

We studied whether rapid thinning of large pulmonary arteries of neonatal rats is associated with breakdown of collagen. Pulmonary artery extracts from fetal to 21 days of age were assayed for collagen content and matrix metalloproteinases. Within 3 days postpartum, no changes in collagen content, collagenolytic activity, or levels of stromelysin-l or gelatinase A were observed. After day 3, collagen content and total proteolytic activity increased with little change in matrix metalloproteinase expression. Thus, collagen was not degraded, and the late increases in collagen and total proteolytic activity were probably growth related. Unlike adult rats in which collagen is broken down after reversal of hypoxic pulmonary artery remodeling, collagen is not broken down in neonatal pulmonary arteries during adaptation to extrauterine life.
Erythropoietin Blood Level Is Increased in Sudden Infant Death
Authors: Le Cam-Duchez V. , Coquerel A. , Chevallier F. , Vaz E. , Menard J.-F. , Basset C. , Lahary A. , Vannier J.P.
Published: April 2003

Erythropoietin (EPO) is the main red cell growth factor and its release into the blood stream is stimulated by anemia and also by various kinds of hypoxia. We studied the blood EPO concentration in a population of 96 infants who died suddenly and compared their mean EPO levels to control infants. The normal values were low at birth and progressively increased during the first 2 years. In the sudden infant death (SID) group the EPO level was significantly higher (p = 0.001) for the entire population and particularly in the youngest group (0–2 months): 14.7 ± 2.4 IU/l (mean ± SEM) in SID group vs. 3.6 ± 0.4 IU/l in control group (p < 0.001). Although we could not analyze the blood hemoglobin concentration after death, the anemia hypothesis was refuted by an assay of the percentage of fetal hemoglobin which was normal for age in the control and SID groups. Moreover, there was no significant difference in EPO levels between explained and unexplained deaths. We also observed an increase in the stress hormones, cortisol and β-endorphin, in the entire SID group. These SID results suggest a profound and long-lasting hypoxia at least during terminal agony.
In vivo Measurements of Glucose Absorption in Preterm Infants
Authors: Shulman Robert J.
Published: April 2003

Few data are available regarding the kinetics of glucose absorption in the preterm infant. In order to ascertain the kinetics of glucose absorption in the premature infant and how rate of infusion and concentration affect absorption, jejunal glucose absorption kinetics were measured in 16 preterm infants by infusing 1, 10, and 100 mM glucose solutions in random order. Seventeen infants were perfused with glucose (100 μmol/min) by infusing 67 mM glucose at 1.5 ml/min and 133 mM glucose at 0.75 ml/min to determine the effect of changes in rate of infusion vs. concentration on glucose absorption. Km and Vmax were related to postnatal age. Km was correlated inversely with the percentage of feedings received as human milk. Antenatal administration of glucocorticoids appeared to increase Vmax. The higher infusion rate resulted in greater glucose absorption than the higher concentration glucose solution. Conclusions: The characteristics of glucose absorption in the preterm infant change with age and are affected by diet, glucocorticoids, and the method of infusion. These data have implications for the feeding of preterm infants.
Characteristic Transfer of Colostral Components into Cerebrospinal Fluid via Serum in Neonatal Pigs
Authors: Harada Etsumori , Sugiyama Akihiko , Takeuchi Takashi , Sitizyo Kiitiro , Syuto Bunei , Yajima Takaji , Kuwata Tamotsu
Published: April 2003

In order to evaluate the possibility of modification of brain function by colostral suckling, the characteristic transfer of colostral components into serum and cerebrospinal fluid (CSF) has been studied by SDS electrophoresis, immunoblot and ELISA methods in nonsuckling pigs. Total protein concentrations in the serum increased immediately after oral administration of bovine colostrum, reaching a peak value (7.0 ± 0.7 g/dl) at 24 h after administration, corresponding to a 3-fold increase compared to preinfusion levels. IgG and other macromolecular components (MW 19,000–58,000) were recognized in serum by electrophoretic and ELISA analysis. Total protein concentrations in the CSF collected from the cisterna magna also increased steeply after colostral administration, reaching a maximal value (54.1 ± 5.0 mg/dl) at 4 h, corresponding to a 4-fold increase compared to preinfusion levels. Two colostral components (MW 19,000 and 31,000) in serum were confirmed to be present in the CSF by electrophoresis. The component of MW 19,000 was identified by immunoblot as β-lactoglobulin. IgG in serum transferred from colostrum could not be detected in the CSF by ELISA. Lactoferrin administered into the intestine was also detected in the CSF via serum. These results indicate that some components of colostrum can be transported into the CSF via the serum, suggesting the possibility of modification of immature brain functions by colostral suckling in neonatal pigs.
Effects of Caffeine on Heart Mitochondria in Newborn Rats
Authors: Wink Carole S. , Rossowska Magdalena J. , Joseph Jr. Fred , Yazdani Malektaj , Nakamoto Tetsuo
Published: April 2003

Caffeine consumption has been implicated in the development of cardiovascular disease. Therefore, in the present study, litters of rats were combined upon birth, and 8 pups were randomly assigned to each dam. Dams with pups were divided into 2 groups: group 1 received a 20% protein diet as a control, and group 2 received the 20% protein diet supplemented with caffeine (4 mg/100 g body weight). Pups from both groups were killed on days 11 and 15. Transmission electron microscopy revealed swollen, disrupted, degenerating mitochondria and intracellular edema in the hearts of rats in the caffeine groups when compared with those of the controls. Plasma Cu concentration was significantly decreased. These results indicate that early exposure to caffeine through maternal milk adversely affects cardiac mitochondria of rat pups and may be associated with decreased plasma Cu levels. It is unclear whether these results apply to the human infant. Interspecies extrapolation from rat to human must be made with caution.
Do Cry Features Reflect Pain Intensity in Preterm Neonates?
Authors: Johnston C. Celeste , Sherrard Adam , Stevens Bonnie , Franck Linda , Stremler Robyn , Jack Anne
Published: April 2003

The purpose of this study was to investigate if cries from preterm neonates would reflect changes in pain intensity following interventions. The cries from 25 preterm neonates from an original sample of 122 were audiorecorded while the infant was undergoing heelstick during a randomized crossover design testing the efficacy of: pacifier with sucrose or water, or prone position as compared to standard care. Both pacifier conditions reduced procedural pain according to a validated composite pain measure (the Premature Infant Pain Profile). There were proportionately fewer cries in the two pacifier groups compared to the prone positioning and standard care groups, and cry duration was positively correlated with PIPP scores. However, neither cry duration nor fundamental frequency reflected group differences. Further research is needed to determine if cry is a sensitive and valid indicator of pain in preterm infants.
Functional and Antigenic Concentrations of Alpha-1-Proteinase Inhibitor after Administration for the Prevention of Chronic Lung Disease of Prematurity
Authors: Stiskal Joseph A. , Ito Shinya , Cox Diane W. , Shennan Andrew T. , O’Brien Karel K.E. , Kelly Edmond N. , Longley Teresa B. , Rabinovitch Marlene , Dunn Michael S.
Published: April 2003

Objective and Methods: Alpha-1-proteinase inhibitor (A1PI) supplementation has been used in adults with inherited alpha-1-antitrypsin (A1AT) deficiency to impede the development of emphysema. A1PI supplementation may also be useful for protecting premature neonates who receive mechanical ventilation from the development of chronic lung disease (CLD). However, the pharmacokinetics of exogenous A1PI in this population are unknown. We attempted to determine the disposition of A1PI in premature infants with birth weight 600–1,250 g who received 60 mg/kg on days 0, 4, 7 and 14 in a randomized, placebo-controlled, double-blind trial. Functional and antigenic plasma concentrations of A1PI were measured at specified time points. Results: On both functional and antigenic assays, concentrations began in the normal adult range and rose from day 0 to 10 then fell slightly, but remained above initial values. The concentrations were not significantly different between the treatment and placebo groups. Conclusions: The results of this study indicate that neonatal pharmacokinetics of A1PI differ markedly from those of the adult. Total plasma clearance of exogenous A1PI seems high in the ventilated premature neonate. Higher or more frequent doses may be necessary to maintain A1PI plasma concentrations above baseline.
Influence of Maternal Age and Duration of Pregnancy on Serum Concentrations of Polychlorinated Biphenyls and Hexachlorobenzene in Full-Term Neonates
Authors: Lackmann Gerd M. , Angerer Jürgen , Salzberger Ulrich , Töllner Uwe
Published: April 2003

Polychlorinated biphenyls (PCBs) and hexachlorobenzene (HCB) are ubiquitous carcinogenic and teratogenic compounds that are transplacentally transferred from mother to fetus during pregnancy. It was the aim of the present study to evaluate the possible influence of maternal age and duration of pregnancy on the neonatal burden with these substances. Blood samples were taken from 80 full-term German neonates within the first 12 h of life, before the first oral feeding. The serum concentrations of six PCB congeners (28, 52, 101, 138, 153, and 180) and HCB were determined with capillary gas chromatography with electron capture detection. The concentrations of the lower chlorinated PCB congeners (28, 52, and 101) were below the detection limit. PCB 153 showed the highest serum concentration (median 0.42 μg/l), followed by PCB 138 (0.34 μg/l) and PCB 180 (0.17 μg/l). Total PCB concentration was 0.96 μg/l, HCB concentration 0.61 μg/l. All detectable PCB congeners and the total PCB concentration correlated significantly with the gestational age of the newborns (r = 0.2639; p < 0.01), with 50–140% higher serum levels in children born at 42 weeks of gestation as compared with neonates born in the 38th week. HCB concentration correlated with maternal age (r = 0.249; p < 0.01), with 2.7-fold higher serum levels in offspring of 40-year-old as compared with 20-year-old women. It is concluded that the neonatal burden with organochlorine compounds depends on maternal age and duration of pregnancy, thereby reflecting the increase in body pollution with these substances during human life as well as a continuous transplacental transfer from mother to fetus during pregnancy.
Effects of Ibuprofen and Indomethacin on the Regional Circulation in Newborn Piglets
Authors: Speziale Mark V. , Allen Robert G. , Henderson Christopher R. , Barrington Keith J. , Finer Neil N.
Published: April 2003

We investigated the effects of clinically comparable doses of ibuprofen and indomethacin on renal, gastrointestinal and cerebral perfusion in newborn piglets, and hypothesized that ibuprofen would have less effect on regional circulation. Animals were randomly assigned to receive ibuprofen (20 mg/kg, n = 8), indomethacin (0.3 mg/kg, n = 7) or vehicle (n = 6). Fluorescent microspheres were injected prior to and at 20, 40, 60, 90 and 120 min after drug administration. Regional blood flow was measured and vascular resistances were calculated. Cardiovascular and respiratory variables were not significantly affected by either study drug or vehicle. Ibuprofen increased renal cortical and medullary resistance by 44 and 52% (p < 0.05). However, ibuprofen had no significant effects on gastrointestinal or cerebral resistance. Indomethacin raised renal cortical and medullary resistance by 66 and 71% at 60 min postinjection, respectively (p < 0.05). Indomethacin increased duodenojejunal, ileal and colon resistance by 97, 102 and 75% at 60 min, respectively (p < 0.05). Indomethacin increased cerebral cortical and cerebellar resistance by 92 and 86% at 90 min (p < 0.05). While indomethacin and, to a lesser extent, ibuprofen both increase renal vascular resistance, indomethacin vasoconstricts the gastrointestinal and cerebral circulations which are unaffected by ibuprofen.
Expression of the Genes of Arginine-Synthesizing Enzymes in the Rat Kidney during Development
Authors: Goutal I. , Fairand A. , Husson A.
Published: April 2003

The expression of two genes, coding for argininosuccinate synthetase (ASS) and argininosuccinate lyase (ASL), enzymes which synthesize arginine, was studied by Northern analysis in various tissues of fetal rats. The highest expression of both genes was seen in the small intestine, liver and kidney of the fetus. The developmental expression was observed in the kidney where both mRNA levels remained low during the fetal period and they increased concomitantly in both kidney and liver throughout the perinatal life, suggesting that the aptitude to synthesize arginine appeared and developed within the same period in both organs. This developmental activation of the ASS and ASL genes expression corresponded, at least in part, to a transcriptional mechanism in both tissues, as measured by run-on assay. Bilateral adrenalectomy showed that glucocorticoids did not appear to control the developmental expression of both genes in the kidney, in contrast to the situation observed in the liver.
Associations of IGF-I, IGFBP-1 and IGFBP-3 on Intrauterine Growth and Early Catch-Up Growth
Authors: Özkan Hasan , Aydın Adem , Demir Namık , Erci Tayfun , Büyükgebiz Atilla
Published: April 2003

Fetal cord blood IGF-I, IGFBP-1 and IGFBP- 3 levels of appropriate-for-gestational-age (AGA) and intrauterine growth retardation (IUGR) babies are studied and followed up for 6–9 months, reevaluated for anthropometric measures and the effects of IGF-I, IGFBP-1 and IGFBP-3 on fetal growth and early catch-up growth is investigated. 23 AGA and 21 IUGR babies, totally 44 newborns, were included in the study protocol. IGF-I and IGFBP-3 levels were found to be high in AGAs with respect to IUGR babies and IGFBP-1 is found to be high in IUGR with respect to AGAs. IGF-I was significantly lower in IUGR babies without catch-up growth (group 2b) with respect to AGAs (group 1) and neonates with IUGR and catch-up growth (group 2a) and group 2a infants had higher IGF-I values than group 2b infants (p < 0.05). IGFBP-3 levels in group 1 were significantly higher than in the other two groups (p < 0.05), but not significantly different in group 2a with respect to group 2b (p > 0.05). IGFBP-1 values showed no statistically significant difference with respect to the three different groups (p > 0.05). A good correlation was found between birth weight, postnatal weight and postnatal height and IGF-I and IGFBP-3 levels (p < 0.05) but not with IGFBP-1 levels. Aside from the height of the 3 groups of infants which were similar to each other after the follow-up period, IGF-I was significantly high in IUGR infants with catch-up growth with respect to IUGR infants without catch-up growth, indicating its importance in early catch-up growth of IUGR babies.
Prenatal Stress and Immune Recognition of Self and Nonself in the Primate Neonate
Authors: Coe Christopher L. , Lubach Gabriele R. , Karaszewski Joseph W.
Published: April 2003

The capacity of the neonate to respond to nonself antigens was evaluated in infant monkeys born after normal and disturbed pregnancies. Mixed lymphocyte cultures were used to test the infants’ proliferative responses to mitomycin-treated stimulator cells, either from a genetically unrelated animal or from a virally transformed monkey cell line. Periods of daily stress for 6 weeks in mid-late pregnancy (months 3.0–4.5) resulted in a significant decrease in proliferative responses, whereas the same stressor early in pregnancy (months 1.5–3.0) increased responses by the neonate’s cells. Similar to the late stress effect, an inhibition of proliferative responses by neonatal cells was induced by dexamethasone administered for 2 days late in pregnancy at 4.5 months after conception, 1 month before term. These findings demonstrate that certain immune responses at birth are extremely sensitive to prior prenatal events. Further, the bidirectional changes indicate that there may be critical periods in gestation when the same extrinsic events have radically different effects on the fetus.
Prediction of Respiratory Distress Syndrome by the Level of Pulmonary Surfactant Protein A in Cord Blood Sera
Authors: Cho Kazutoshi , Matsuda Tadashi , Okajima Satoru , Matsumoto Yoshinori , Sagawa Tadashi , Fujimoto Seiichiro , Kobayashi Kunihiko
Published: April 2003

The purpose of this study was to determine the utility of measuring the level of pulmonary surfactant protein A (SP-A) in cord blood sera to predict for respiratory distress syndrome (RDS). SP-A levels in cord blood sera from 48 infants born at gestational ages < 32 weeks were measured by a sandwich ELISA system. Mean value of SP-A in cord blood was 5.8 ng/ml in cases with RDS and 15.1 ng/ml in those without RDS (p = 0.002). The best cut-off point of cord blood SP-A to predict RDS was determined as 10 ng/ml. The sensitivity and the specificity of the cut-off point for predicting RDS were 81 and 76%, respectively. Multivariate regression analysis showed that high SP-A level in cord blood, premature rupture of the membranes longer than 24 h and heavy birth weight were all significantly related to the non-RDS outcome.
Treatment of Gram-Negative Bacterial Meningitis in Term Neonates with Third Generation Cephalosporins plus Amikacin
Authors: Dellagrammaticas H.D. , Christodoulou Ch. , Megaloyanni E. , Papadimitriou M. , Kapetanakis J. , Kourakis G.
Published: April 2003

The aim of this retrospective study was to evaluate the clinical efficacy in terms of mortality and long-term morbidity of third generation cephalosporins and amikacin in combination for the treatment of gram-negative bacterial meningitis in a homogeneous group of neonates. A 15-year experience (1983–1997) with 72 term neonates without central nervous system anomalies and with gram-negative organisms grown in their cerebrospinal fluid treated with the above combination of antibiotics is presented. All isolated organisms were sensitive to cefotaxime or ceftazidime and to amikacin but 80% were resistant to ampicillin. The predominant infecting organism was Escherichia coli (68.0%) which was sensitive to both cefotaxime and amikacin in all cases but resistant to ampicillin in 48% of cases. Survival at discharge was 97.2% but ultimate survival was reduced to 94.4%, as 2 patients died a few months following discharge of conditions unrelated to meningitis. Ventriculitis was diagnosed in 10 neonates (13.8%). Among survivors, 1 neonate (1.3%) developed hydrocephalus needing shunting and 1 neonate (1.3%) with Proteus mirabilis developed a brain abscess with relapse of meningitis which was successfully treated with a 6-week course of chloramphenicol. At follow-up at an age greater than 6 months, 91.1% of the surviving infants were normal, while 92.3% of survivors at an age greater than 6 years were normal and attended normal school. These results, despite any reservations due to the nature of the study (retrospective, uncontrolled study), strongly support the use of third generation cephalosporins and amikacin in combination for the treatment of neonatal gram-negative bacterial meningitis.
Is a Standard Protocol Necessary for Oscillometric Blood Pressure Measurement in Term Newborns?
Authors: Sarıcı S. Ümit , Alpay Faruk , Okutan Vedat , Gökçay Erdal
Published: April 2003

Objective: The necessity of taking only one randomized blood pressure measurement or averaging three repeated measurements and, the effects of various stages of the restful state and body position on blood pressure measurements obtained with the oscillometric technique were investigated in 138 healthy term newborns. Methods: The Athena oscillometer was used to measure blood pressure. Three successive measurements with a 5-min interval were made in each of two positions, prone and supine, in random order 30 min after the last feeding if newborns were in very quiet or quiet sleep. During routine recording of vital signs, another (single) measurement was obtained before feeding the infant regardless of the body position of the newborn, provided that they were not struggling, crying or moving. Results: For all systolic, diastolic and mean blood pressures measured, there were no significant differences among either prone, supine and single measurements or among three successive measurements in each position. Conclusions: We conclude that, in the routine care of term newborns, blood pressure measurements with the oscillometric technique may be made without the need of a special position or sleep state, provided that the measurements are made with an appropriate sized cuff in the absence of struggling, crying and movement of the newborn. Taking only one randomized measurement under these conditions would be enough and practical in daily newborn care practice instead of repeating and averaging many measurements.
The Efficacy of Pentoxifylline as an Anti-Inflammatory Agent in Experimental Escherichia coli Meningitis in the Newborn Piglet
Authors: Park Won Soon , Chang Yun Sil , Lee Munhyang
Published: April 2003

This study was done to evaluate the anti-inflammatory effect and the ensuing neuroprotective effect of pentoxifylline in neonatal experimental bacterial meningitis. Newborn piglets were divided into three groups: 10 in the control group (CG), 13 in the meningitis group (MG), and 13 in the meningitis with pentoxifylline group (PG). Meningitis was induced by intracisternal injection of 108 colony-forming units of Escherichia coli in 100 μl of saline. In PG, 20 mg/kg of pentoxifylline was given as a bolus intravenous injection 30 min before induction of meningitis and 6 mg/kg/h was given continuously throughout the experiment. In PG, the increase of CSF TNF-α level observed in MG was abolished. Reduced brain glucose and ATP concentrations observed in MG were significantly increased in PG. However, other parameters of inflammatory responses such as increased intracranial pressure, reduced glucose and increased lactate concentrations in the CSF observed in MG were not significantly down-modulated. The extent of CSF leukocytosis was even higher in PG than in MG. Increased cerebral cortical cell membrane lipid peroxidation products and decreased Na+,K+-ATPase activity observed in MG, indicative of meningitis-induced brain cell membrane dysfunction, tended to improve without statistical significance in PG. In summary, although some anti-inflammatory effects have been observed, the overall anti-inflammatory effects of pentoxifylline was very weak, and it failed to significantly reduce the brain damage in experimental neonatal bacterial meningitis.
Glutathione Ethyl Ester Supplementation Prevents Mortality in Newborn Rats Exposed to Hyperoxia
Authors: Singhal Rakesh K. , Jain Ajey
Published: April 2003

Human premature neonates suffer from respiratory distress syndrome due to immature lungs and require assisted ventilation with high concentrations of oxygen. Hyperoxic exposure and/or antioxidant deficiency causes an increase in the lung levels of reactive oxygen species (ROS) leading to oxidative stress-induced cellular damage. In this study, we explored the protective role of the nonenzymatic antioxidant glutathione, by administering glutathione ethyl ester (GSHEE), in newborn rats exposed to hyperoxia (>95% FiO2). Our results show that GSHEE supplementation (5 mmol/kg/day) prevents mortality in newborn rats exposed to hyperoxia. We further show that delayed GSHEE supplementation in newborn rats, pre-exposed to hyperoxia for 4 days, also prevents death. Electron microscopic studies on the lung of GSHEE-treated hyperoxic rats showed normal histology and an absence of the marked swelling and degeneration of mitochondria and lamellar bodies, which are typically observed in the hyperoxic lungs of newborn rats. Furthermore, there were no apparent differences in weight gain or general appearance/activity among room air and hyperoxic GSHEE-supplemented animals when monitored, post-treatment, in room air for 30 days. Our results show a preventive/therapeutic role of GSHEE supplementation against mortality caused in newborn rats due to hyperoxic exposure, and may further be applicable to a variety of degenerative diseases that are caused as a result of ROS accumulation.
Maturational Changes of Lymphocyte Surface Antigens in Human Blood: Comparison between Fetuses, Neonates and Adults
Authors: Schultz C. , Reiss I. , Bucsky P. , Göpel W. , Gembruch U. , Ziesenitz S. , Gortner L.
Published: April 2003

The objective of this study was to investigate the maturational changes of lymphocyte surface antigens during ontogeny from fetuses to adults using the proven whole blood lysis technique. Two-color flow cytometric analysis of lymphocyte surface markers was performed on 20 fetal blood samples obtained by cordocentesis, 70 cord blood and 30 adult blood samples. The leukocyte count and all T-cell subsets were highest in neonates compared to fetuses and declined into adulthood. In contrast, the percentage of CD2+ T cells (fetal blood 57% versus adult blood 82%; p ≤ 0.001), CD3+ T cells (fetal blood 52% versus adult blood 77%; p ≤ 0.001), CD4+ T cells (fetal blood 39% versus adult blood 50%; p ≤ 0.05) and CD8+ T cells (fetal blood 15% versus adult blood 24%; p ≤ 0.001) showed a significant increase from fetuses to adults. The absolute and relative amounts of B cells were highest in fetuses (fetal blood 547 × 106/l, 18%) followed by a steady decline to adulthood (adult blood 243 × 106/l, 13%; p ≤ 0.001). The discordance between the absolute and relative size of lymphocyte subpopulations emphasizes the consideration of both variables in the assessment of lymphocyte maturation. The presented data may contribute to a better knowledge of the maturation of the immune system.
A Comparison of Arginine Vasopressin Levels and Fluid Balance in the Perinatal Period in Infants Who Did and Did Not Develop Chronic Oxygen Dependency
Authors: Kavvadia V. , Greenough A. , Dimitriou G. , Forsling M.L.
Published: April 2003

Arginine vasopressin (AVP) levels on days 1, 3 and 5 and fluid balance in the perinatal period were assessed in 60 infants, median gestational age 27 weeks (range 24–33). Fluid input and output, urine osmolality and episodes of hyponatraemia were recorded on a daily basis. Forty-one infants subsequently developed chronic lung disease (CLD), they were more immature, of lower birthweight and had higher AVP levels on days 3 and 5 (p < 0.05) than the rest of the cohort. Despite similar levels of fluid input, compared to the non-CLD infants, those who developed CLD had higher urine osmolalities on days 1, 5, 6 and 7 (p < 0.05), but there were not significant differences between the two groups regarding urine output or episodes of hyponatraemia. Logistic regression analysis revealed AVP levels on day 3 were significantly correlated with the duration of oxygen dependency independent of other factors. We conclude elevated AVP levels in the perinatal period are associated with CLD development, but our results suggest they have little functional significance.
High Prevalence of Factor V Leiden Mutation in Mothers of Premature Neonates
Authors: Erhardt E. , Stankovics J. , Molnár D. , Adamovich K. , Melegh B.
Published: April 2003

The prevalence of the Leiden mutation was tested in 50 mothers of premature infants and in 56 mothers of intrauterine-growth-retarded neonates. The prevalence of the Leiden mutation was 7.2% in the mothers of growth-retarded neonates and 18% in the group of mothers of premature infants, the latter being significantly higher than the 6.3% prevalence of this mutation in healthy Hungarian subjects (p < 0.01). In spite of the relatively small number of mothers examined, the unexpected finding may call attention to a hitherto unknown relationship.
Duration of Home Monitoring for Infants Discharged with Apnea of Prematurity
Authors: Tauman Riva , Sivan Yakov
Published: April 2003

Sixty-four preterm infants with apnea of prematurity (AOP) discharged with cardiorespiratory home monitoring (HM) were prospectively followed. For each monitor alarm the parents recorded the occurrence of apnea, bradycardia or color change, and the type of assistance provided. The mean gestational age at birth was 28.8 (26–34) weeks, and the mean birth weight was 1,180 (730–2,390) g. The parents of 61/64 infants (95%) reported a total of 185 true AOPs with a mean of 3 (1–12) events/infant. The mean postconceptional age (PCA) at the last apnea was 41.0 (37–44) weeks. In 80%, AOP terminated between 40 and 44 weeks PCA. There was no correlation between the degree of prematurity and the PCA of the last apnea. We conclude that in preterm infants with AOP discharged with HM, HM may be discontinued at 45 weeks PCA.
Adenosine and ATP CauseNitric Oxide-Dependent PulmonaryVasodilation in Fetal Lambs
Authors: Konduri G. Ganesh , Mital Seema
Published: April 2003

We investigated the hypothesis that the purine nucleotide ATP and its nucleoside adenosine cause pulmonary vasodilation in fetal lambs by the release of nitric oxide (NO). We also investigated the potential role of K+ATP channels in mediating the effects of ATP and adenosine on NO. We surgically prepared 28 fetal lambs to measure pulmonary and systemic pressures and pulmonary flow. We investigated the effects of glibenclamide and pinacidil (inhibitor and agonist, respectively, for K+ATP channels), N-nitro-L-arginine (N-LA) and its methyl ester, N-nitro-L-arginine methyl ester (L-NAME) (inhibitors of endothelium-derived NO synthesis), and U46619 (a thromboxane mimetic) on pulmonary vasodilation caused by adenosine and ATP. Adenosine decreased the pulmonary artery pressure and pulmonary vascular resistance (PVR) at doses of 0.08–2.5 μM/kg/min and increased the left pulmonary flow at doses of 0.3–2.5 μM/kg/min in control experiments. N-LA, L-NAME and glibenclamide attenuated the effects of adenosine at doses of < 2.5 μM/ kg/min and pinacidil potentiated its effects. ATP decreased the pulmonary artery pressure and PVR and increased the pulmonary flow at doses of 0.15–2.5 μM/kg/min in control experiments. N-LA and L-NAME attenuated the effects of ATP at doses of < 2.5 μM/kg/min, whereas glibenclamide and pinacidil had no effect on the response to ATP. U46619 increased the basal pulmonary vascular tone, but did not significantly alter the vasodilative responses to ATP and adenosine. In conclusion, adenosine and ATP cause NO-dependent pulmonary vasodilation in fetal lambs. The activation of K+ATP channels plays a role in adenosine-induced pulmonary vasodilation. The mechanism by which ATP causes NO release and pulmonary vasodilation requires further investigation.
Effects of Treatment of Secondary Hyperparathyroidism on the Lipid Profile in Patients on Hemodialysis
Authors: Lim Paik-Seong , Hung Tung-Shiao , Yeh Chi-Hsiang , Yu Mei-Huri
Published: April 2003

Abnormalities in circulating lipoprotein concentrations are a characteristic finding in patients undergoing dialytic therapy. A substantial number of these patients display type IV hyperlipoproteinemia. Certain data suggest that secondary hyperparathyroidism may induce disturbances in lipid metabolism. To evaluate the effects of pulse calcitriol therapy on the lipid profile in these patients, we undertook a prospective study in 12 patients on stable bicarbonate hemodialysis. Lipid parameters comprising cholesterol and the low- as well as the high-density lipoprotein subfractions, triglycerides, apolipoproteins A and B, serum parathyroid hormones (iPTH), alkaline phosphatase, calcium, phosphorus, hematocrit, and blood urea were obtained prior to commencement of pulse calcitriol therapy and again 8–10 weeks later. Calcitriol therapy was associated with a decrease in serum iPTH levels (701 ± 103.9 vs. 220.3 ± 50.5 pmol/l; p < 0.001). Significant increases in high-density lipoprotein cholesterol (32.8 ± 2.7 vs. 38.8 ± 2.3 mmol/l; p < 0.05) and apolipoprotein A-I (107.8 ± 6.1 vs. 121.8 ± 5.8 g/l; p < 0.05) were noted during the course of the study. Moreover, serum iPTH correlated inversely with high-density lipoprotein cholesterol and apolipoprotein A-I. There were no changes in other lipid parameters except for low-density lipoprotein cholesterol which showed a tendency to increase. We conclude that in short-term study, pulse oral calcitriol therapy is associated with an improvement in the lipid profile in patients with secondary hyperparathyroidism. However, it remains to be established whether ameliorating the uremic dyslipidemia results in any long-term clinical benefits.
Effects of Cascade Apheresis in Patients with Psoriasis and Psoriatic Arthropathy
Authors: Jørstad S. , Bergh K. , Iversen O.J. , Johnsson M. , Lysvand H. , Fjærtoft H. , Widerøe T.-E. , Rødsjø J.Å. , Næss T. , Bolsø M. , Kværnes S.
Published: April 2003

Eight patients with psoriasis, all with skin scales and 7 with disabling psoriatic arthritis, were subjected to cascade apheresis starting with three treatments per week for 2 weeks, followed by one treatment a week, comprising ten treatments in all. Six out of 7 patients (86%) with arthropathy and 3 out of 8 patients (38%) with scales experienced a beneficial effect. There was a large drop in the levels of circulating immune complexes (CIC) due to the treatment, and the removal of CIC was followed by reduced inflammatory activity in skin lesions and joints as evaluated by pain, morning stiffness, grip strength, plaque score, and PASI index. However, there was no correlation between the level of CIC, disease activity, or treatment response. From the present results it is concluded that CIC may play a more significant role regarding psoriatic arthropathy than in skin manifestations, and apheresis may be beneficial in patients not responding to conventional therapy.
Elimination of Drugs by the New Polyamide Hemofilter FH77H during Various in vitro Conditions
Authors: Kroh Udo F. , Dinges G.K. , Lukasewitz P. , Steinhäusser W.U. , Holl T.J. , Lennartz H.
Published: April 2003

Background/Aims: Multiple organ failure alters the dosage of drugs during hemofiltration. To separate factors, we utilized in vitro hemofiltration to investigate different blood flows, protein concentrations and intracellular drug partition with the FH77H polyamide membrane. Methods: One liter of warm heparinized fresh human blood was hemofiltrated in two series: (1) with digoxin, netilmycin, phenobarbital, ceftriaxone and teicoplanin, and (2) with amikacin, theophylline, ceftazidim, phenytoin and vancomycin and, in addition, with cell-free fresh frozen plasma. Results: The increased volumes of distribution of aminoglycosides and theophylline were a combined result of partition into cells and adsorption into the filter membrane. The deviations of drug sieving from predicted values were due to different affinities of the drugs on whole blood binding sites. Conclusion: The in vitro composition of drugs and blood improved the detection of factors that influence drug elimination during hemofiltration. The FH77H polyamide hemofilter facilitates more precise predictions of drug dosages by low adsorption rates to the membrane.
Heparin and Vasoactive Peptides in Hemodialysis Patients
Authors: Hegbrant Jörgen , Ekman Rolf , Thysell Hans
Published: April 2003

Plasma concentrations of vasoactive peptides have been reported to be influenced by various procedural features of hemodialysis (HD), such as ultrafiltration and isovolemic diffusion, dialysate buffer and dialysate temperature, but also by sham HD thus reflecting an effect of the extracorporeal circulation per se. In the present study the effect of heparin administration was investigated in 9 stable HD patients, and compared with that of saline. Blood samples were taken from the arteriovenous fistula before and 45 min after the administration of heparin or saline. After an interval of 2 weeks, the procedure was repeated with the exception that the patients who received heparin on the first occasion were given saline and vice versa. Plasma concentrations of the vasoactive peptides were measured by radioimmunoassay. Regardless of whether heparin was given or not, the plasma concentrations of the vasodilators atrial natriuretic peptide, β-endorphin and vasoactive intestinal peptide did not change, nor did the concentration of the vasoconstrictor neuropeptide Y. The plasma motilin concentration decreased significantly when heparin was given, and that of substance P increased, both these peptides being vasodilators. Mean arterial blood pressure decreased regardless of whether heparin was given or not, and no difference between the two regimens was noted. Heart rate was unchanged with both regimens. To sum up, administration of heparin but not of saline affected the plasma concentrations of motilin and substance P. However, the decrease in blood pressure during the procedure seemed not to be related to the changes in these peptides, as it also occurred in the absence of heparin.
Impact of Recombinant Human Erythropoietin Treatment on Left Ventricular Hypertrophy and Cardiac Function in Dialysis Patients
Authors: Massimetti Carlo , Pontillo Daniele , Feriozzi Sandro , Costantini Stefano , Capezzuto Aldo , Ancarani Enzo
Published: April 2003

The results of anemia correction by recombinant human erythropoietin (rHuEPO) therapy with regard to cardiac function and left ventricular hypertrophy in dialysis patients are controversially discussed. The aim of the study was to assess the effects of therapy rHuEPO on cardiac morphology and function in dialysis patients. We studied 11 clinically stable hemodialysis patients with severe renal anemia (hematocrit <27%) and increased left ventricular mass index (LVMi) with no history of coronary or valvular heart disease, systemic disease, severe hyperparathyroidism, hypertension stage 2 or higher, transfusion-dependent anemia, and concurrent rHuEPO treatment. The patients were treated with rHuEPO administered subcutaneously once or twice weekly at a mean dose of 80 ± 31 IU/kg week until the hematocrit was >30% and underwent a complete Doppler echocardiographic study at baseline and at follow-up (after 12.2 ± 2.9 months). At follow-up, ejection fraction and fractional shortening significantly increased from 62.7 ± 13.8 to 67.8 ± 9.7% (p < 0.05) and from 35.5 ± 9.8 to 39.4 ± 7.1% (p < 0.05), respectively, whereas mean velocity of circumferential fiber shortening demonstrated a trend towards amelioration from 1.18 ± 0.23 to 1.27 ± 0.27 circ/s (n.s.). LVMi and morphological data remained unchanged throughout the study. Nevertheless, LVMi changes showed two different behaviors with respect to baseline values: in 6 patients with higher baseline values, LVMi decreased from 229 ± 36 to 191 ± 45 g/m2 (p < 0.05), while it worsened in 5 patients with less marked LVMi, increasing from 141 ± 32 to 186 ± 40 g/m2 (p < 0.05). Our data demonstrate that partial correction of renal anemia with rHuEPO therapy seems to improve cardiac performance and to induce a regression of left ventricular hypertrophy, particularly in patients with greater baseline hypertrophy, ultimately confirming the multifactorial pathogenesis of left ventricular hypertrophy.