RESUMO
Colloid osmotic pressure (COP) was measured serially in 81 critically ill neonates with hyaline membrane disease (HMD) during the first five days of life, and these changes were correlated with the birth weight, gestational age, serum protein level, clinical status, and outcome. Colloid osmotic pressure correlated better with the total protein level (n = 81; r = 0.54) than with birth weight (r = 0.23) and gestational age (r = 0.31; n = 81). Seventy-one of 81 neonates survived. Among the survivors, COP increased significantly by day 5, whereas changes in the total protein level were not significant during the same period. Colloid osmotic pressure decreased significantly in nine of ten nonsurvivors (mean +/- SE, 11 +/- 0.5 to 8 +/- 0.55 mm Hg), whereas the total protein level did not show a similar change. Thus, COP cannot be accurately predicted by measuring serum protein during acute illness. Serial measurement of COP was a better prognostic indicator than the total protein level in infants with HMD.
Assuntos
Permeabilidade Capilar , Doença da Membrana Hialina/diagnóstico , Peso ao Nascer , Proteínas Sanguíneas/análise , Coloides , Idade Gestacional , Humanos , Doença da Membrana Hialina/fisiopatologia , Recém-Nascido , Pressão Osmótica , Estudos ProspectivosRESUMO
Clinical usefulness of colloid osmotic pressure (COP) measurements in adults has been well established. However, data in healthy and sick neonates are sparse. The present study established the COP changes in healthy term and preterm infants and in critically ill neonates. COP in healthy term (16.9 +/- 1.9 mm Hg) and preterm (15.4 +/- 1.3) infants was significantly lower than adults (21.6 +/- 3.6). Even in sick neonates, COP correlated with gestational age (n = 78, r = 0.63, p less than 0.001 , birth weight (r = 0.58, p less than 0.001) and total protein (n = 71, r = 0.58, p less than 0.001). Critically ill preterm infants with hyaline membrane disease had the lowest COP (11.5 +/- 1.2). Administration of 10% albumin failed to increase the COP significantly. In critically ill preterm infants who survived, the COP increased during the first postnatal week, whereas in nonsurvivors COP decreased significantly to less than 10 mm Hg.