Pregnancy outcome in North American women. II. Effects of diet, cigarette smoking, stress, and weight gain on placentas, and on neonatal physical and behavioral characteristics.

This study evaulated the effects of diet, weight gain (low = LWG, less than or equal to 15 lb; adequate greater than 15 lb), smoking, and stress on the pregnancy outcomes of 60 women. LWG mothers, compared to adequate weight gain, had lower calorie intakes, shorter gestations (0.5 wk, Dubowitz) smaller placentas (345 +/- 65 versus 373 +/- 75 g), and infants with lower birth weight 2640 +/- 329 versus 3192 +/- 307 g), ponderal indices (2.37 versus 2.62), and growth rates. Mothers who smoked had increased calorie intake, but showed no alterations in gestational age of infants or placenta weights. Infants of smokers weighed less than those of nonsmokers (2875 +/- 522 versus 309 +/- 511 g), but had a normal ponderal index. LWG or smoking were associated with impaired motor performance, visual habituation and orientation, and reflexes. Smoking adversely affected auditory habituation and orientation, and autonomic regulation. LWG and smoking have significant, but separate, detrimental effects on pregnancy outcome.

Treatment of severe theophylline toxicity with hemodialysis in a preterm neonate.

Theophylline, a drug frequently used to treat apnea of prematurity, has a prolonged half-life of 30 h in neonates. Severe overdoses of theophylline have an associated 10% mortality and significant morbidity. We describe a 1,220-g neonate who developed status epilepticus due to a theophylline overdose. Hemodialysis was instituted to increase elimination of theophylline. The patient tolerated the procedure without complication. The half-life of theophylline was 0.7 h during dialysis. No reported therapies used in neonates have achieved this magnitude of clearance. In fact, the clearance of theophylline in this neonate approached that obtained with hemoperfusion, the standard therapy for theophylline overdose in adult patients. This case demonstrates that hemodialysis is a safe and effective means of enhancing theophylline elimination for neonatal theophylline overdose.

Peritoneal dialysis for acute renal failure in children.

Fifty infants and children with acute renal failure were treated with acute peritoneal dialysis between 1987 and 1990. The patients were dialyzed using either a catheter introduced percutaneously over a guide-wire (n = 40) or a Tenckhoff catheter (n = 10). The cause of the acute renal failure was primary renal disease in 17 children, cardiac disease in 19, and trauma/sepsis in 14. Peritoneal dialysis succeeded in controlling metabolic abnormalities, improving fluid balance, and relieving the complications of uremia. The procedure had few major complications. Overall mortality was 50%, reflecting the serious nature of the underlying diseases. We conclude that acute peritoneal dialysis is a safe and effective treatment in most pediatric patients with acute renal failure. Our series of patients treated with acute peritoneal dialysis serves as a basis of comparison for the evaluation of new modalities of therapy in childhood acute renal failure.

Symptomatic cholelithiasis in pediatric renal transplant recipients.

We report two cases of symptomatic cholelithiasis in pediatric renal transplant recipients immunosuppressed with cyclosporine (CsA), prednisone and azathioprine. CsA was present in the bile and in the cholesterol gallstones of one patient. The diagnosis of cholelithiasis was established in both cases by abdominal ultrasound examination.

A limited sampling strategy for the estimation of Neoral AUCs in pediatric patients.

The improved pharmacokinetics of Neoral allows the development of an accurate estimate of the full area under the concentration time curve (AUC) from a limited sampling strategy. As no such strategy has been derived from pharmacokinetic data obtained from children on 12-hourly dosing, and as patient convenience demands shorter sampling times, we derived a limited sampling strategy from 45 AUCs obtained from 19 pediatric renal transplant patients by stepwise forward multiple regression, and prospectively tested them on a separate group of 49 AUCs obtained from 18 pediatric renal transplant patients. Full cyclosporine (CsA) AUCs were obtained from samples drawn pre dose (C0) and at 2, 4, 6, 8 and 12 h post dose (C2, C4, C6, C8, and C12). High-precision predictions of full AUC were obtained based on the formula: AUC = 444 + 3.69 x C0 + 1.77 x C2 + 4. 1 x C4 (mean prediction error +/- SD = 0.3 +/- 6.4%, 95% confidence interval=-1.7% to 1.9%.) In conclusion, CsA exposure in pediatric renal transplant patients on 12-hourly Neoral dosing can be reliably predicted by an early time point-based limited sampling strategy in children. This formula has the advantage of obtaining trough as well as AUC from one brief, convenient sampling period.