Effect of postnatal malnutrition on hyperoxia-induced newborn lung development.

Several factors are associated with bronchopulmonary dysplasia. Among them, hyperoxia and lung immaturity are considered to be fundamental; however, the effect of malnutrition is unknown. Our objective was to evaluate the effects of 7 days of postnatal malnutrition and hyperoxia on lung weight, volume, water content, and pulmonary morphometry of premature rabbits. After c-section, 28-day-old New Zealand white rabbits were randomized into four groups: control diet and room air (CA, N = 17), control diet and > or = 95% O2 (CH, N = 17), malnutrition and room air (MA, N = 18), and malnutrition and > or = 95% O2 (MH, N = 18). Malnutrition was defined as a 30% reduction of all the nutrients provided in the control diet. Treatments were maintained for 7 days, after which histological and morphometric analyses were conducted. Lung slices were stained with hematoxylin-eosin, modified orcein-resorcin or picrosirius. The results of morphometric analysis indicated that postnatal malnutrition decreased lung weight (CA: 0.83 +/- 0.19; CH: 0.96 +/- 0.28; MA: 0.65 +/- 0.17; MH: 0.79 +/- 0.22 g) and water content, as well as the number of alveoli (CA: 12.43 +/- 3.07; CH: 8.85 +/- 1.46; MA: 7.33 +/- 0.88; MH: 6.36 +/- 1.53 x 10-3/mm) and elastic and collagen fibers. Hyperoxia reduced the number of alveoli and increased septal thickening and the mean linear intercept. The reduction of alveolar number, collagen and elastic fibers was intensified when malnutrition and hyperoxia were associated. These data suggest that dietary restriction enhances the magnitude of hyperoxia-induced alveolar growth arrest and lung parenchymal remodeling. It is interesting to consider the important influence of postnatal nutrition upon lung development and bronchopulmonary dysplasia.

Effect of postnatal malnutrition on hyperoxia-induced newborn lung development

Several factors are associated with bronchopulmonary dysplasia. Among them, hyperoxia and lung immaturity are considered to be fundamental; however, the effect of malnutrition is unknown. Our objective was to evaluate the effects of 7 days of postnatal malnutrition and hyperoxia on lung weight, volume, water content, and pulmonary morphometry of premature rabbits. After csection, 28-day-old New Zealand white rabbits were randomized into four groups: control diet and room air (CA, N = 17), control diet and ¡Ý95% O2 (CH, N = 17), malnutrition and room air (MA, N = 18), and malnutrition and ¡Ý95% O2 (MH, N = 18). Malnutrition was defined as a 30% reduction of all the nutrients provided in the control diet. Treatments were maintained for 7 days, after which histological and morphometric analyses were conducted. Lung slices were stained with hematoxylin-eosin, modified orcein-resorcin or picrosirius. The results of morphometric analysis indicated that postnatal malnutrition decreased lung weight (CA: 0.83 ¡À 0.19; CH: 0.96 ¡À 0.28; MA: 0.65 ¡À 0.17; MH: 0.79 ¡À 0.22 g) and water content, as well as the number of alveoli (CA: 12.43 ¡À 3.07; CH: 8.85 ¡À 1.46; MA: 7.33 ¡À 0.88; MH: 6.36 ¡À 1.53 x 10-3/mm) and elastic and collagen fibers. Hyperoxia reduced the number of alveoli and increased septal thickening and the mean linear intercept. The reduction of alveolar number, collagen and elastic fibers was intensified when malnutrition and hyperoxia were associated. These data suggest that dietary restriction enhances the magnitude of hyperoxia-induced alveolar growth arrest and lung parenchymal remodeling. It is interesting to consider the important influence of postnatal nutrition upon lung development and ronchopulmonary dysplasia.

Prediction of length of hospital stay in neonatal units for very low birth weight infants.

OBJECTIVE: To develop models for estimating the length of hospital stay (LOS) of very low birth weight infants (VLBW), based on perinatal risk factors present during the first week of life and during the entire hospitalization period. STUDY DESIGN: The files of 155 VLBW were analyzed, and the influence of individual risk factors were initially evaluated by univariate analysis, using multiple-regression. Two mathematical models were built to estimate the LOS. RESULTS: The first model, using risk factors present during the first 3 days of life, is as follows: LOS = -0.074A + 22.06B + 22.85C - 16.78D - 2.07E + 10.51F + 203.12 (R2 = 0.63). (The letters are added to show what each number represents: A: birth weight; B: occurrence of respiratory distress syndrome; C: endotracheal intubation during resuscitation; D: 1-minute Apgar score; E: gestational age; F: presence of complications during delivery.) The second model, using factors present during the entire hospitalization period, is: LOS = 0.61G + 29.19H + 24.68I + 14.21J + 23.56K + 9.54L + 7.41M + 20.43 (R2 = 0.82). (G: age receiving nutritional support of > or = 120 kcal/kg per day; H: occurrence of systemic candidiasis; I: birth weight < 1000 gm; J: presence of delivery complication; K: occurrence of bronchopulmonary dysplasia; L: birth weight > or = 1000 gm and < or = 1249 gm; M: occurrence of anemia). CONCLUSION: Both models are applicable for estimating the hospitalization period, and the addition of variables present during the entire hospitalization period improved the accuracy of the model.

[Respiratory distress in low birth weight: influence of intrauterine growth retardation]. / Insuficiência respiratória em recém-nascidos de baixo peso: influência do retardo de crescimento intra-uterino.

The aim of this study is to evaluate the influence of intra-uterine growth retardation (IUGR), as well as it's types and severity on the development of respiratory distress among low-birth-weight infants. A total of 673 neonates were studied, the small-for-dates infants (SFD), 40% of total, were divided according to the type of IUGR, in proportionate and disproportionate, and according to the severity, in birth weight below 3rd and between 3rd and 10th percentile. Respiratory distress was more frequent among the appropriate for gestational age (57.3%) compared to the SFD infants (33.7%), (p < 0.0001), and among males (52.6%) compared to females (47.4%) (p = 0.01). There was an inverse relationship between gestational age, as well as birth weight and respiratory distress. It occurred in 90.6% of very-low-birth-weight infants and in 39% of the others, with a predominance among the appropriate for gestational age newborns. Respiratory distress occurred in 80% of neonates below 34 weeks of gestational age and in 26% of the neonates above it (p < 0.0001). Regarding to the small-for-dates infants, respiratory distress occurred more frequently among the disproportionate (42.5%), when compared to proportionate infants (28.1%) (p = 0.03). The severity of IUGR had no influence on these results. The authors concluded that among low birth weight infants, the groups with increased risk for respiratory distress are the appropriate for gestational age and, among small-for-dates and disproportionate infants, those weighing less than 1500 g.

[Ceftriaxione associated biliary lithiasis in newborns-report of two cases]. / Calculose biliar associada com o uso de ceftriaxone em recém-nascidos. Relato de dois casos.

The occurrence of biliary calculosis as a complication of the use of ceftriaxone was first described in an 18-year-old patient with chronic granulomatosis. Since then many reports have been published on this type of complication both in children and in adults, but until the present moment, this complication had never been reported in pre-term neonates.The authors describe two cases of biliary calculosis associated with the use of ceftriaxone in preterm-newborns, emphasizing that due to the frequent use of this type of antibiotic in neonatal I.C.U., routine ultrasonographic control exams should be performed to diagnose this possible complication in all neonates receiving ceftriaxone.

Sindrome da brida amniotica / Amniotic band syndrome

Os autores descrevem um caso de sindrome da brida amniotica com comprometimento facial, cranial e pe torto congenito. As manifestacoes clinicas principais e a etiologia da sindrome sao discutidas, ressaltando o cuidado com o amniocentese no primeiro trimestre. A sindrome da brida amniotica (S.B.A.) tem varias sinonimias: constricao anular congenita, bandas amniogenicas, banda de tecido aberrante "adam complex" ("amniotic deformaty, adhesions, mutilations") e sequencia da brida amniotica. Ela e constituida por uma serie de anomalias anatomicas do recem-nascido, associadas a estrangulamento de partes feitas "in utero" levando a deformacoes, malformacoes ou roturas. A apresentacao deste caso clinico tem o objetivo de alertar os pediatras e obstetras para esta patologia pouco frequente e cujo diagnostico e muitas vezes feito erroneamente, em vista das multiplas caracteristicas que a sindrome da brida amniotica pode assumir.

Utilizacao do retalho de lingua nas lesoes labio-palatinas. / Use of tongue flaps in cleft palate

Os autores apresentam quatro casos em que foi realizado retalho de lingua, sendo tres para fechamento de fistulas palatinas e um caso para correcao de atrofia de labio superior pos-irradiacao. Discutem a indicacao desta tecnica e a sua vantagem em relacao a outros metodos de tratamento destas patologias. O retalho e confeccionado na regiao dorsal mediana da lingua, com base anterior. O segundo tempo e realizado apos 15 dias, para liberacao do pediculo e modelagem do retalho, com os retoques necessarios para o completo fechamento da area a ser preenchida pelo retalho. Os autores acreditam que a imobilizacao da lingua com sua fixacao tanto a arcada dentaria como ao labio inferior sao necessarios somente quando nao houver compreensao por parte do paciente ou se este apresentar baixa idade. Finalmente apresentam e discutem os resultados obtidos com o metodo empregado