Nicotine and its metabolites in amniotic fluid at birth--assessment of prenatal tobacco smoke exposure.

Amniotic fluid was collected from 78 pregnant women at birth additionally with their urine prior to delivery as well as neonatal urine and meconium. The smoking markers, nicotine and its metabolites cotinine and trans-3'-hydroxycotinine (OH-cotinine), were determined using high-performance liquid chromatography (HPLC). The self-reported smoking status during pregnancy determined by means of a questionnaire was verified by measurement of maternal urine. In all smokers, nicotine metabolites were detected in amniotic fluid and in 80% of them nicotine as well. However, the sum of the nicotine metabolites (Sum(met)) was significantly lower (p < .001) in amniotic fluid (704 +/- 464 nmol/L) than in meconium (921 +/- 588 nmol/L), neonatal urine (1139 +/- 813 nmol/L) and maternal urine (4496 +/- 3535 nmol/L). Concentrations of nicotine metabolites in amniotic fluid correlated well (p < .001) with that in the other specimen types. After environmental tobacco smoke (ETS) exposure, no nicotine or nicotine metabolites were detectable in amniotic fluid but only in maternal and neonatal urine. Analysis of amniotic fluid at birth lends itself to verifying smoking habits during pregnancy and clearly discriminating from ETS exposure, but it is not a suitable approach to differentiating between ETS exposure and non-exposure.

[Congenital abdominal wall defects--an analysis of prevalence and operative management by means of gastroschisis and omphalocele]. / Ventrale Bauchwanddefekte--Darstellung der Entwicklung in Prävalenz und operativem Vorgehen anhand von Gastroschisis und Omphalozele.

The management of congenital abdominal wall defects is one of the main characteristics of quality for a department of paediatric surgery. The results of treatment in the early years were the reason for a continuous improvement of procedures, operation strategies and the kinds of -material that had been used. During the last years there has been a great discussion about the presumed increase in the incidence of gastroschisis and the preterm delivery of such cases. On the basis of our own first results (2006-2009) and details from the literature, we survey these two topics.

Lung deposition after inhalation with various nebulisers in preterm infants.

AIM: To compare pulmonary deposition after inhalation with three different nebulisers in preterm infants under conditions relevant to practice. METHODS: The relative lung deposition (bioavailability) was estimated by inhalation of the marker substance, sodium cromoglycate (SCG), and measurement of urinary excretion of SCG. Seventeen spontaneously breathing preterm infants received 20 mg of SCG as nebuliser solution by means of (a) an LC Star jet nebuliser; (b) an LS 290 ultrasonic nebuliser; and (c) a Projet ultrasonic nebuliser in a randomised three-period, crossover design. Serial urine samples were collected until about 12 hours after inhalations, and the excreted SCG was determined by high-performance liquid chromatography. RESULTS: The mean (SD) total amounts of SCG excreted in urine measured after inhalation with the LC Star nebuliser (0.089 (0.036) mg) were significantly higher than those obtained with the LS 290 (0.055 (0.019) mg) or the Projet nebuliser (0.046 (0.025) mg). The average pulmonary deposition after inhalation using the LC Star, LS 290 and Projet devices was estimated as 0.89%, 0.55% and 0.46% of the nominal dose, respectively. CONCLUSION: Inhalation with the LC Star jet nebuliser producing the greatest proportion of droplets <2 mum yielded a higher lung deposition in preterm infants than the LS 290 and Projet ultrasonic nebulisers.

Assessment of prenatal tobacco smoke exposure by determining nicotine and its metabolites in meconium.

Meconium samples collected from 115 neonates were analysed for nicotine, cotinine and trans -3-hydroxycotinine (OH-cotinine) by means of high-performance liquid chromatography (HPLC) to identify prenatal smoke exposure. The self-reported maternal smoking status during pregnancy was determined by means of a questionnaire and verified by measurements in urine prior to childbirth. The total sum of nicotine and its metabolites (Sum(tot)) of the first passed meconium samples was 1560 +/- 1024 pmol/g in newborns of smoking mothers. Smoking of less than five cigarettes was clearly detected. Sum(tot) remained constant in all meconium samples passed by a neonate in succession. However, the proportion of nicotine decreased with the time of passage after birth and the OH-cotinine proportion increased, whereas cotinine hardly changed. Nicotine or its metabolites were not detectable in meconium (detection limit < 20 pmol/g), when the mothers were only exposed to environmental tobacco smoke (ETS) using the HPLC method. The hypothesis that the content of nicotine metabolites in meconium reflects long-term smoke exposure could not be confirmed in newborns whose mothers had quit smoking during the latter half of pregnancy. Determining Sum(tot) enables the intensity of continuous smoking during pregnancy to be estimated in all meconium samples passed by a newborn.

Skin-to-skin contact improves gas exchange in premature infants.

OBJECTIVE: Skin-to-skin contact (kangarooing) is regarded as an important method to improve intensive care in premature infants. There is still demand for investigations of its impact on physiological parameters. STUDY DESIGN: We examined 53 preterm infants of < 1800 gm in a prospective, pretest-test-posttest design study during incubator care (60 minutes), skin-to-skin contact (90 minutes), and incubator care again (90 minutes). Heart rate, respiratory rate, oxygen saturation (SaO2), transcutaneous pO2 (tcpO2), transcutaneous pCO2, rectal temperature, and fraction of inspired oxygen were measured. RESULTS: The heart rate increased during skin-to-skin contact by 5 beats per minute (p < 0.001), the respiratory rate dropped by 5/minute (p < 0.01), the SaO2 improved by 0.4% (p < 0.05) accompanied by an increase of tcpO2 of 4.8 mm Hg (p < 0.001), the tcpCO2 dropped by 1.2 mm Hg (p < 0.001), and the rectal temperature increased by 0.3 degree C (p < 0.001). Analyzing three groups separately by postnatal weight, we observed the smallest increase in heart rate and the highest decrease in respiratory rate in infants of < 1000 gm (p < 0.001). The increase in SaO2 and in the tcpO2 doubles in infants of < 1000 gm compared with infants of > 1000 gm (p < 0.001). All changes were independent of postnatal age. CONCLUSION: During skin-to-skin contact, preterm infants not only remain clinically stable but also show a more efficient gas exchange. Although the patient is removed (transferred) from the incubator, there is no risk of hypothermia even in infants of < 1000 gm.

Risk factors for intraventricular hemorrhage in a birth cohort of 3721 premature infants.

AIMS: In our study we determined possible risk factors for intraventricular hemorrhage grade III to IV (IVH) based on a regional German neonatal data base and tried to build a logistic-regression model to predict the risk of IVH according to gestational age. MATERIALS: We identified 3721 premature infants, 22 to 36 completed weeks of gestational age, born from 1994 through 1997. 136 (3.7%) IVH were diagnosed sonographically. 60 (44%) infants with IVH died. We examined the following variables as risk factors for IVH: gestational age, sex, blood pH of 7.2 or less, body temperature of 35 degrees C or less, multiple birth, small-for-gestational age, intubation after birth, transport to another hospital. RESULTS: In the full logistic regression model sex, blood pH of 7.2 or less, multiple birth, and small-for-gestational age were not associated with a significant risk of IVH. Body temperature of 35 degrees C or less was associated with an increased risk of IVH (adjusted odds ratio, 1.92; 95% confidence interval, 1.09 to 3.40). Intubation after birth increased the risk of IVH in neonates under 28 weeks of gestational age (OR, 3.72; 95% CI, 1.65 to 8.38) only to a moderate extent, but significantly in neonates 32 to 36 weeks of gestational age (OR, 16.51; 95% CI: 7.35 to 36.18). The risk of IVH was mainly related to gestational age. Neonates delivered before 28 weeks of gestation (OR, 75.72; 95% CI, 46.14 to 124.30) faced the highest risk of IVH. Transport to another hospital was connected with an increased risk of IVH regardless of gestational age (adjusted OR, 1.95; 95% CI, 1.07 to 2.56). CONCLUSION: The frequency of IVH could be reduced significantly, if extremely premature infants, the vast majority of patients suffering from IVH, did not have to be transferred postnatally to another hospital.

Female pseudohermaphroditism caused by caudal dysgenesis.

We report on two cases of female pseudohermaphroditism associated with anorectal, Müllerian duct, and urinary tract malformations. We suggest that this form of female pseudohermaphroditism is an extreme manifestation of the caudal type of VATER association.