Effects of red blood cell transfusions on acid base balance, glucose and electrolytes in preterm infants

Preterm neonates comprise the most heavily transfused group of patients, and about 85% of extremely low birth weight newborns receive a transfusion by the end of their hospital stay. The aim of this study was to assess the possible metabolic effects of RBC transfusion on preterm infants especially during the first 2 weeks of life, and its relation to blood volume. This study was conducted on 40 preterm neonates with gestational age of less than or equal to 34 weeks. They received RBCs transfusion during first 2 weeks of life. Venous blood samples of infants were collected 2 to 4 hours before and 1 hour after the end of transfusion to evaluate hemoglobin [Hb] level, hematocrit, acid-base, electrolytes, and glucose status. Then infants were classified into two main groups: those who received RBCs volume less than or 20 ml/kg and those who received RBCs volume more than 20 ml/kg. Infants received a mean volume of 20.38 +/- 3.2 ml per kg RBCs [range 10.9 -26.6 ml/kg] at a median age of 9.8 +/- 3.6 days. After transfusion, a significant increase of mean Hb [p<0.001], mean Hct [p<0.001], pH [p<0.001], pO2 [p<0.05] and a significant decrease of the pCO2 [41.46 +/- 8.8torr vs. 35.4 +/- 9.34torr; p<0.001] were observed. In addition, there was a significant increase of serum K[+] [p<0.001], and a significant decrease of Ca[+2] [p<0.001].A positive correlation was found between the K[+] intake and the changes of kalemia [r=0.99; p=0-00]. Furthermore we observed an inverse correlation between the patients calcium intake and the changes of calcemia [r=-0.35; p=0.02]. On comparing the changes in clinical and biochemical variables between two groups after transfusion, we observed a significant increase in mean Hb and Hct associated with a significant decrease in mean serum Ca[+2] [p<0.001] in the group receiving the larger blood volume. RBCs transfusion was effective in improving anemia, oxygenation, increasing pH and decreasing CO2 and Ca[+2]. However, from a more clinically relevant point of view we demonstrated the development of hyperkalemia, especially in infants with a previously borderline hyperkalemia

Longitudinal study for prediction of type 1 diabetes in siblings of patients: an initial step for prevention of disease

The aim of this study was identification of cut off points of positivity of different antibodies [Ab] against islet cell antigens [ICA, Anti GAD Ab, Anti IA2 Ab] in Egyptian children and adolescents who are sibs of patients with type 1 diabetes as well as determination of their insulin secretory capacity and identification of HLA-DQB1 alleles known to predispose to or protected against type 1 diabetes. The ultimate aim is to identify those at high-risk of the disease to enroll them in preventive trials. This study was a longitudinal one that lasted for five years and include seventy-two sibs of type 1 diabetic patients recruited from the Diabetic Endocrine Metabolic Pediatric Unit [DEMPU] at Cairo University Children's Hospital. Thirty sex healthy subjects; age and sex matched with patients and with negative family history of autoimmune diseases were included as controls. Serum samples from all subjects and controls were analyzed for GAD[65], IA2 Ab using radioimmunoassay and ICA Ab using ELISA technique. Sibs who were positive for one or more Ab were further subjected to the assessment of first phase insulin response and HLA studies for detecting DQB1 alleles known to predispose or protect against type 1diabetes using SSP DNA-based technique. The results showed that 36 sibs [50%] were GADAb positive, 10 sibs [13.9%] were IA2 Ab positive while 14 sibs [19.4%] were ICA positive with overlap. Mean FPIR in 41 sibs positive for one or multiple Ab was 41.407 mU/L +/- 28.73 which was statistically significantly less than that in controls 79.414 mUL +/- 44.316 [P<0.001]. Thirty-four sibs [38%] lied in the high-risk group defined by FPIR less than 5[th] percentile. HLA studies done in 32 sibs showed that 17/32 sibs [54.84%] had the predisposing alleles DQB1 [0201, 0202, 0302, 0303, 0401] while 7 sibs [22.28%] had protective alleles DQB1 [0301, 0601]. Prevention of type 1diabetes will require reliable methods for early diagnosis of predisposition to the disease, using improved genetic and serological screening on a side scale and identification of the primary antigenic target[s] for specific tolerance. Those at risk [multiple positive antibodies and reduced insulin secretory response] in absence of HLA protective alleles are to be enrolled in preventive trials

Effect of storage of breast milk on its chemical composition

The aim of this work was to study the effect of storage of breast milk on some of its chemical constituents. Three expressed breast milk samples were collected from each of 61 healthy lactating mothers for determination of total proteins, fat, lactose and zinc content as well as vitamins C, A and E concentrations. The first sample was analyzed immediately without storage, the second after storage for 24 hours in first shelf of refrigerator [4C], while the third after storage for one week in a home freezer [-4 to -8C]. The results revealed that storage of expressed breast milk [EBM] for 24 hours in first shelf of refrigerator [4C] and for one week in home freezer [-4 to -8C] caused a statistically significant decline in all of the studied nutrients, except for zinc content. Despite this decline after storage, the composition of the stored breast milk was still within the ranges of the international reference of mature breast milk composition

Gastrointestinal motility disorders in type 1 diabetes: a pilot study

This work aimed to study gastric and esophageal motility by scintigraphy and gallbladder contractility by scintigraphy and ultrasonography in type 1 diabetic patients and to assess any association with demographic data, GIT symptoms, metabolic control or chronic complications of diabetes. A case control study including 30 patients more than 9 years of age and more than 5 years duration of type I diabetes as well as 15 healthy controls age and sex matched with patients was carried out. All patients were subjected to thorough history including gastrointestinal symptoms, insulin dosing, glycemic control and diet pattern and history of chronic complications as peripheral or autonomic neuropathy. Physical examination included blood pressure measurement, signs of peripheral neuropathy and fundus examination to exclude retinopathy. Mean glycosylated hemoglobin [HbAlc] was estimated in diabetic patients in the preceding five years before testing. Albumin/creatinine ratio was determined to detect microalbuminuria. Real-time ultrasonography was performed to evaluate gallbladder volume and ejection fraction in diabetic and control groups, while scintigraphic studies were done to detect the esophageal emptying rate, the gastric emptying time and the gallbladder ejection fraction. Compared with mean values of controls as well as reference values, there was reduction in gallbladder ejection fraction in 76.7% of diabetics by scintigraphy and in 53.3% by ultrasonography, decreased esophageal emptying rate in 43.3% of diabetics and abnormal gastric emptying in 56.7% of diabetics [20% had delayed gastric emptying and 36.7% had accelerated gastric emptying]. The above findings were more pronounced in patients having chronic diabetic complications, especially autonomic neuropathy

value of insulin-like growth factor binding protein-3 in growth assessment of juvenile rheumatoid arthritis patients

This study was carried out on 40 children having juvenile rheumatoid arthritis [JRA], their mean age was 8.5 +/- 2.8 with a range of 3-18 years. Two hundred and ninety healthy children, age and sex matched with the patients, were included as controls. History, clinical examination and full anthropometry were performed. The basal levels of insulin like growth factor 1 [IGF1] and IGF binding protein 3 [IGFBP3] were assessed. Growth hormone assessment was performed in patients with compromised growth and in those having low IGF1 values. Mean height standard deviation score [SDS] of the patients was significantly lower compared with the controls. Mean IGF1 and IGFBP3 values as well as their Z scores were significantly lower in patients than in controls whether pre or post pubertal. IGF1 Z scores were positively correlated to IGFBP3 Z score in a statistically significant manner. IGF1 Z score was also positively correlated to height SDS and negatively correlated to steroid therapy. The group of patients who received glucocorticoids was shorter, showed less IGF1 Z score and IGFBP3 Z score than the group who did not receive steroid therapy. GH stimulation tests in patients with compromised growth showed normal values [mean +/- SD was 21.0 +/- 5.7 ng/ml, with a range of 10-30]. IGF1 and IGFBP3 Z scores were less in the group with compromised growth than in that with fair growth [-2.40 + 1.58 and -2.34 + 1.85 versus -1.41 + 0.86 and -1.11 + 1.49, respectively] and the difference was statistically significant