Acute systemic organ injury in term infants after asphyxia.

The systemic manifestations of "asphyxia" were evaluated prospectively in 35 consecutively intubated term newborn infants. The following systemic organ injuries were identified most often: (1) renal, ie, oliguria less than 1 mL/kg per hour for at lest 24 hours (40%), an elevated urinary beta-2-microglobulin concentration (57%), azotemia (11%), and an elevated serum creatinine level (17%); (2) central nervous system, ie, hypoxic-ischemic encephalopathy (including seizures) (31%) or an abnormal cranial ultrasound scan, ie, diffuse parenchymal echogenicity, slitlike ventricles, and poor visualization of the sulci, and/or intracranial hemorrhage (26%); (3) cardiovascular, ie, an abnormal echocardiogram (25%) or abnormal electrocardiogram (11%); (4) pulmonary complications, including persistent pulmonary hypertension (23%); and (5) gastrointestinal complications, which were rare. Traditional markers of fetal distress were not related to the frequency and/or distribution of systemic organ injury. An important implication of this study relates to the recognition of the extent and distribution of organ injury in the "asphyxiated" infant.

Renal injury in the asphyxiated newborn infant: relationship to neurologic outcome.

The relationship of renal and central nervous system injury was prospectively evaluated in 120 asphyxiated infants. Renal evaluation findings were considered abnormal if there was oliguria (urine output less than 1 ml/kg/hr), which was designated transient if present in the first 24 hours only and persistent if present for at least 36 hours, or if the urinary beta 2-microglobulin concentration from first-void urine was elevated: (1) Thirteen infants had persistent oliguria; the urinary beta 2-microglobulin level was elevated in all. The six term infants had clinical signs consistent with hypoxic-ischemic encephalopathy (HIE); all six had ultrasonographic abnormalities. The outcome was poor (i.e., death or long-term neurologic deficits) in five of six infants. The seven preterm infants with persistent oliguria had clinical evidence of HIE, and three infants had intraventricular hemorrhage; all seven infants died. (2) Fifteen infants had transient oliguria (beta 2-microglobulin level was elevated in eight infants). Two of the eight term infants had evidence for HIE; the cranial ultrasound scan was normal in all. At follow-up, seven term infants are normal and one is abnormal. Six of the seven preterm infants with transient oliguria had clinical evidence of HIE; three infants had intraventricular hemorrhage. Three infants died, and the four survivors are normal at follow-up. (3) Ninety-two infants had normal urine output. Of the 22 term infants, two developed signs of HIE, and the ultrasound scan was abnormal in three infants. Of the 70 preterm infants, eight (11%) had clinical signs consistent with HIE, the ultrasound scan was abnormal in 20 of 64 (31%) infants scanned, and 14 (20%) infants died. Most of the followed infants are normal. Thus oliguria was significantly associated with clinical signs of HIE, including seizures, death (specifically in the premature infant), and long-term neurologic deficits. These data suggest that oliguria in the perinatal period is a sensitive indicator of infants at risk for long-term neurologic deficits.

Levodopa addiction. A case study.

A case is presented of a young woman with a serious addiction to levodopa who over the years developed an extrapyramidal syndrome and chronic paranoid psychotic behaviour. The possible pathophysiological mechanism is discussed.

Measurement of true calcium absorption in premature infants using intravenous 46Ca and oral 44Ca.

We have developed a method for measuring true fractional calcium absorption (alpha) in premature infants using two stable isotopes of calcium and tested it in seven studies in seven infants (birth weight 1543 +/- 65 g, gestation 32.8 +/- 7 wk). A total of 7.5 micrograms/kg 46Ca was given as a single intravenous bolus. Immediately thereafter 1.25 mg/kg of 44Ca was given in a single gavage feeding of standard infant formula (Enfamil). A metabolic isolette was used to obtain 4-h collections of urine for 24 h total. 46Ca and 44Ca were measured in urine by thermal ionization mass spectroscopy and expressed as the ratio to naturally occurring 48Ca. The differences in the 46Ca/48Ca and 44Ca/48Ca ratios from natural levels (delta % excess 46Ca and delta % excess 44Ca) were calculated. Percent absorption (alpha) equals a constant times cumulative delta % excess 44Ca/delta % excess 46Ca. The calculation of alpha is independent of urine volume or concentration. The delta % excess 46Ca, showed the expected multiexponential decline as a function of time, and delta % excess 44Ca usually peaked during a 4- to 8-h urine collection. Calculations of alpha using increasingly long sampling times showed that a plateau had been reached by 12 h. alpha values calculated after 16-24 h in the seven infants at 2 wk of age were 41, 48, 45, 46, 25, 55, and 51%. Repeat studies at 3 wk of age were 46, 60, and 54%. These values are somewhat higher than net percent calcium absorption values reported for standard formula and thus appear very appropriate.(ABSTRACT TRUNCATED AT 250 WORDS)

Renal failure in sick hypertensive premature infants receiving captopril therapy.

A retrospective study of nine sick premature infants with chronic lung disease who received captopril for control of systemic hypertension (systolic blood pressure (BP) greater than 113 mm Hg) was carried out to determine efficacy of therapy and associated complications. All nine infants had markedly elevated peripheral renin values, 134.3 +/- 128.1 ng/mL/hr (mean +/- SD). Five infants had abnormal renal sonographic and perfusion scans with evidence of renal artery thrombosis, parenchymal disease, or both. Captopril therapy (0.3 mg/kg) was instituted at a postnatal age of 123 +/- 108 days. After the initial dose, the systolic BP decreased significantly in all infants, the decrease ranging from 21% to 58% of the pretreatment value. Dosage was subsequently halved in all infants. Seventeen episodes of unpredictable decreases in BP more than 40% from baseline occurred during the reduced maintenance therapy. Four infants had a total of seven episodes during which the BP decreased by 57 +/- 10% from baseline; this decrease persisted for 17 +/- 6 hours and was unresponsive to volume reexpansion and inotropic therapy. All seven episodes were accompanied by oliguria (urine output less than 1 mL/kg/hr) that persisted for 18 +/- 12 hours. These episodes were accompanied by neurologic signs (subtle seizures, lethargy, and/or apnea) within 18 +/- 6 hours after the onset of oliguria. The remaining five infants had a total of 13 episodes of decreased BP of 50 +/- 8% of baseline, which were of significantly shorter duration and responded to volume reexpanders, inotropic therapy, or both and were unaccompanied by oliguria. These data suggest the need for close observation of BP in infants receiving maintenance captopril therapy.

Renal injury in sick newborn infants: a prospective evaluation using urinary beta 2-microglobulin concentrations.

Urinary concentrations of beta 2-microglobulin and creatinine were measured serially in 140 sick infants, of whom 109 were asphyxiated, and in 35 healthy preterm and term infants. First voided urines and samples from days 3 and 7 postpartum were studied. Urinary beta 2-microglobulin concentrations in healthy infants averaged 1.34 +/- 1.34 mg/L (mean +/- SD) in first voided specimens and 1.32 +/- 0.98 mg/L in day 3 samples; the calculated upper limit of normal (95% confidence limit) was 4.00 mg/L. Elevated values (those exceeding the 95% confidence limit) occurred most often in the sick asphyxiated patients (56%); the first voided sample value in these patients was 10.0 +/- 10.4 mg/L. The equivalent value in the sick nonasphyxiated infants was 8.32 +/- 7.27 mg/L. Values were significantly and persistently elevated in the sick infants on days 3 and 7. Factoring beta 2-microglobulin levels by urinary creatinine concentration did not affect the significance of the findings. The increased urinary beta 2-microglobulin levels were not (1) related to gestational age; low beta 2-microglobulin values occurred at all gestational ages for both healthy and sick infants; (2) a consequence of urine flow rate; urinary beta 2-microglobulin did not correlate with urinary creatinine concentration or with urine to plasma creatinine ratio; and (3) a consequence of increased production of beta 2-microglobulin; urinary and serum beta 2-microglobulin values did not correlate (r = .03). Thus, we propose that the elevated levels of urinary beta 2-microglobulin in the sick infants were the consequence of tubular injury. This was associated with hematuria but not with a high incidence of azotemia or oliguria.(ABSTRACT TRUNCATED AT 250 WORDS)

Pyloric stenosis in the sick premature infant. Clinical and radiological findings.

The clinical and radiographic features of five sick premature infants with idiopathic hypertrophic pyloric stenosis are presented. Clinical features were nonspecific, the common findings being recurrent nonbilious emesis, persistent abdominal distention, and the inability to place a nasojejunal feeding tube through the pylorus. Plain abdominal radiographs demonstrated persistent gastric dilatation in four of the infants. Idiopathic hypertrophic pyloric stenosis should be considered in the differential diagnosis of premature infants with upper gastrointestinal tract symptoms.

Sonography of focal foveolar hyperplasia causing gastric obstruction in an infant.

A young infant is presented with a mass partially obstructing the distal stomach. Sonography demonstrated the superficial origin of the lobulated lesion which proved to be focal foveolar hyperplasia, the most common cause of a gastric polypoid mass in adults but rare in children.

Sonographically detectable cysts in polycystic kidney disease in newborn and young infants.

Autosomal dominant (adult type) and autosomal recessive (infantile type) polycystic kidney disease are 2 distinct forms of hereditary cystic renal disease with differing pathologic and clinical features. Glomerulocystic kidney disease is probably a separate entity, whose pathologic features may closely resemble those of autosomal dominant polycystic kidney disease, especially in small infants. An example of each of these conditions in a small infant is presented, all of which had sonographically detectable cysts. Pathologic correlation was available in each case. While there are typical sonographic features of autosomal dominant and autosomal recessive polycystic kidney disease in newborn and young infants, there is no specific appearance of either condition, and glomerulocystic kidney disease can apparently resemble either one. Other investigations, particularly family studies and pathologic verification, are important in order to establish the correct diagnosis.

Steroid treatment in acute ischaemic stroke. A comparative retrospective study of 556 cases.

The files of 556 patients with a history of ischaemic stroke were reviewed. The disability and mortality rates were compared between 277 patients with a steroid treatment in the acute stage and 279 without. Comparison of the whole group showed that the steroid-treated patients had less improvement of their disability and a higher mortality rate than the non-steroid group. However, in the former more patients with a severe stroke were present. Statistical analysis of a subset of 208 patients with completed stroke in the middle cerebral artery territory showed no marked difference in the outcome and the adverse reactions between the steroid- and non-steroid-treated patients.

Tracheal stenosis. Lethal malformation in two infants of diabetic mothers.

In two infants of diabetic mothers, severe respiratory distress developed at birth and the infants died shortly thereafter. Autopsy revealed tracheal stenosis and significant cardiac abnormalities.

The use of bromocriptine in parkinsonism after carbon monoxide poisoning.

Parkinsonism is a well known complication of carbon monoxide poisoning. Pharmacological treatment has been regarded as being not successful, as far as levodopa alone is concerned. Three cases are presented with symptomatic parkinsonism after carbon monoxide exposure, who have been treated with bromocriptine (in one case in combination with levodopa). The results are surprisingly good. A possible explanation is discussed.

A case of isolated partial auditory agnosia associated with coiling of the left internal carotid artery.

A 64-year-old bilingual lawyer complained of an abrupt loss of comprehension of spoken words and much less severe loss of recognition of various sounds. An isolated partial auditory agnosia, due to a left-sided, temporal dysfunction was confirmed by the clinical neuropsychological and logopedic examination. Only a minimal left cortical, peri-insular hypodensity was suspected on CT-scan of the brain, while the NMR-scan was inconclusive. Arteriography showed a large coiling internal carotid artery on the left side, as a possible source of thrombo-embolism.

Enterogenous cyst of the cauda equina. A case report and a review of the literature.

The clinico-pathological findings in a 38-year-old man with a progressive cauda equina syndrome and with a dorsal dermal fistula in the lower back are presented. The X-rays of the spine revealed fusion of the vertebrae L4-L5 and L5-S1, and the myelogram showed an intradural tumour, extending upto the level of L2. An enterogenous cyst, adherent to the right third lumbar radix was completely removed. The clinical and pathological data are compared to previous published cases and discussed in relation to the origin of the tumour.