Antenatal betamethasone treatment has a persisting influence on infant HPA axis regulation.

OBJECTIVE: To examine the consequences of antenatal betamethasone (AB) exposure on postnatal stress regulation. STUDY DESIGN: Fourteen AB exposed infants born at 28-30 weeks' gestation were assessed in the NICU during postnatal week 1 and at 34 weeks postconception. Nine infants born at 34 weeks gestation without AB treatment were evaluated as a postconceptional age comparison group. Salivary cortisol, heart rate, and behavior were measured at baseline and in response to a heelstick blood draw. RESULTS: Repeated measures ANOVAs revealed that both groups displayed an increase in heart rate and behavioral distress in response to the stressor. The cortisol response, however, was blunted in AB-treated infants at both assessments. CONCLUSION: AB treatment has consequences for hypothalamic-pituitary-adrenal (HPA) axis regulation that persist for at least four to six weeks after birth, indicating that studies of long-term effects are warranted.

Calcitonin and CGRP block bombesin- and substance P-induced increases in airway tone.

Calcitonin gene-related peptide (CGRP) and calcitonin (C) are two peptides that are cocontained and probably coreleased with the potent bronchocontrictors, bombesin (B) and substance P (SP), within the lung. Although CGRP and C have a wide intrapulmonary distribution, their actions have not been well defined. By the use of a computerized lung mechanics analyzer, changes in response to 10-min infusions of these agents were measured in spontaneously breathing, anesthetized guinea pigs. Infusion of 0.3 nmol.kg-1.min-1 CGRP and 2 nmol.kg-1.min-1 C caused little change in lung mechanics. Infusion of 0.06 nmol.kg-1.min-1 B and 0.3 nmol.kg-1.min-1 SP caused a marked increase in inspiratory, expiratory, and total pulmonary resistance (RT), from base-line values (P less than 0.02), with a maximal effect at 10 min postinfusion (PI) [RT = 326 +/- 20% (SE) (B), 490 +/- 73% (SP)]. Coinfusion of C or CGRP with B or SP at the above concentrations caused a marked reduction in SP - [RT = 189 +/- 28% (C), 142 +/- 16% (CGRP) at 10 min PI] and B - [RT = 157 +/- 18% (C), 158 +/- 10% (CGRP) at 10 min PI] induced changes in resistance (P less than 0.015). The mode of action of C and CGRP is unknown, but these peptides may antagonize the effects of B and SP via autonomic pathways by interfering with B- or SP-induced changes in intracellular calcium concentrations or by increasing intracellular cAMP levels by binding to specific cellular receptors linked to adenylate cyclase.

Radiology casebook. Unusual misplacement sites for central venous catheters: three case reports.

Umbilical venous catheters and percutaneously placed central venous lines play an integral role in the management of critically ill newborn infants. Health care providers involved with the placement of these catheters must be familiar with, and able to diagnose, subtle sites for catheter misplacements. Three cases are presented illustrating potential sites of misplacement. The indications, placement, and associated complications of central venous lines reported in the literature are briefly reviewed.

Unusual misplacement sites of percutaneous central venous lines in the very low birth weight neonate.

Percutaneously placed central venous lines have become an intricate part of the medical management of the very low birth weight infant. It is critically important that health care providers involved with the placement of these catheters be familiar with the possible subtle sites for catheter misplacement. We present two case reports of inadvertent ascending lumbar vein catheterization with a percutaneously placed Silastic catheter where the saphenous vein was used for venous access. The literature is reviewed with regard to the history of use, indications, placement, and associated complications of these catheters.