The effect of inhaled nitric oxide therapy on bleeding time and platelet aggregation in neonates.

The effect of inhaled nitric oxide (iNO) on bleeding time and platelet aggregation was studied in nine newborn infants with resolving pulmonary hypertension. Infants treated with iNO at 40 ppm for 30 minutes had bleeding times that were nearly twofold longer than those obtained 24 hours after iNO was discontinued. iNO had no effect on in vitro platelet aggregation studies.

Addition of metolazone to overcome tolerance to furosemide in infants with bronchopulmonary dysplasia.

A decreased response to the loop diuretic furosemide develops within a few doses in young infants. We tested the hypothesis that the use of the thiazide-like diuretic metolazone, in combination with furosemide, would inhibit water and electrolyte reabsorption and overcome pharmacologic tolerance to furosemide alone. Infants with bronchopulmonary dysplasia of similar gestational and postnatal ages were randomly assigned to one of three groups. Group 1 (n = 6) received furosemide (1 mg/kg per dose) intravenously every 24 hours for a total of five doses. Group 2 (n = 8) received the same treatment as group 1, but in addition metolazone (0.2 mg/kg per dose) was given enterally with doses 3 and 4 of furosemide. Group 3 (n = 8) received metolazone (0.2 mg/kg per dose) enterally every 24 hours for five doses. Urine was collected before the first diuretic dose and throughout the study for determination of the urine flow rate; urinary excretion of sodium, chloride, and potassium; and creatinine clearance. Urinary flow rate and urinary sodium and chloride excretion increased after the first dose in all groups. In the infants treated with either furosemide or metolazone, urinary flow rate and urinary and chloride excretion returned to baseline values after the last three doses. In contrast, when furosemide was administered with metolazone, urinary flow rate and urinary excretion of sodium, chloride, and potassium were greater than the values for baseline and for the previous dose, as well as for the corresponding doses of furosemide in group 1 and metolazone in group 3. Tolerance to furosemide (group 1) and metolazone (group 3) appeared to be explained by compensatory increased sodium and chloride reabsorption without changes in creatinine clearance. We conclude that the administration of metolazone with furosemide enhances diuresis, natriuresis, and chloruresis and overcomes the rapid development of tolerance to furosemide in infants with bronchopulmonary dysplasia by blocking the compensatory increase in renal sodium and chloride absorption.

Effects of tunicamycin on retinoic acid induced respecification of positional values in regenerating limbs of the larval axolotl, Ambystoma mexicanum.

Urodele amphibians possess a remarkable ability to regenerate limbs following experimental or accidental amputation. Since only those parts of the limb distal to the plane of amputation usually regenerate, this suggests the existence of level-specific positional values within the cells of the limb. Vitamin A and other retinoids respecify the positional values of regenerating limbs such that structures proximal to the actual plane of amputation are formed in the regenerating limb producing proximodistal duplications. Regenerating limbs of larval axolotls (Ambystoma mexicanum) treated with sufficient retinoic acid to induce proximodistal duplication were also treated via implantation with tunicamycin, a drug which blocks the synthesis of glycoproteins by blocking N-glycosylation of proteins. Tunicamycin was shown to inhibit the proximalizing effects of retinoic acid. This indicates that asparagine-linked glycoproteins may be essential to the process through which retinoic acid induces these effects in the regenerating limb and that glycoproteins may be responsible for specifying positional values in regeneration blastema cells.