Transient tachypnea in neonates of mothers receiving glucose 5% and oxytocin during labour

The aim of this work was to study the frequency of transient tachypnea of the newborn [TTN] and the possible relation to the use of oxytocin and glucose 5% during labour Subjects investigated were enrolled into two groups: the first [study] group consisted of 100 newborn infants born to mothers who have received IV infusion of aqueous glucose solution 5% and oxytocin. The second [control] group consisted of 30 newborns whose mothers did not receive any IV infusion. In the study group, the amount and rate of infusion of oxytocin and glucose 5% were calculated. The blood samples [maternal and cord] were drawn just after delivery in the study and control groups. Newborns were diagnosed as having TTN if they fulfilled the following criteria: persistent tachypnea with onset within 1/2 hour after birth, minimal grunting and retractions, with or without cyanosis in room air, necessity for oxygen therapy, spontaneous improvement starting within 24 hours after birth, Fi02 not more than 0.4 and suggestive radiological findings. Our results showed that maternal and cord serum sodium levels of the study group were significantly lower than those of the control group with a significant negative correlation between the maternal and cord serum sodium and the amount of oxytocin and glucose 5%. No significant difference between maternal and related cord serum sodium in both groups. Hyponatremia developed in 25 out of 100 cases of the study group and in 2 out of 30 cases of the control group with a significant difference. TTN developed in 17% of the study group and in none of the control group. The difference was significant. Serum sodium in the newborns who developed TTN was lower than in those who did not develop TTN. Out of 25 cases with hyponatremia, 8 developed TTN [32%] while out of 75 cases without hyponatremia, only 9 [12%] developed TTN with a significant difference. The amount and rate of infusion of oxytocin were higher in the TTN group than the non-TTN group. TTN was more frequent when the amount of oxytocin exceeded 10 units and the rate of infusion exceeded 25 mu/min. The amount and rate of infusion of glucose 5% did not differ in the TTN group from the non-TTN group. We concluded that the amount of oxytocin and glucose 5% infusion are related to the development of maternal and neonatal hyponatremia and the amount and rate of infusion of oxytocin are related to the occurrence of TTN. To decrease the incidence of TTN, We recommend that the dose of oxytocin should not exceed 10 units at a rate of infusion of less than 25 mu/min

Pulse methylprednisolone therapy in children with resistant nephrotic syndrome

This study was conducted on 26 children with steroid-resistant idiopathic nephrotic syndrome [NS], 14 males and 12 females, ranging in age at the start of pulse methylprednisolone therapy from 14/12 to 9 10/12 years, admitted to Alexandria University Children's Hospital starting from 1-4-1996. All cases of idiopathic NS admitted during this period were treated by prednisone 2 mg/kg/day divided into 3-4 doses. If the child continues to have proteinuria [2+ or greater] after one month of this treatment, the nephrosis was considered steroid-resistant and renal biopsy was indicated to determine the precise etiology of the disease. All the 26 cases were still edematous with nephrotic proteinuria after one month of prednisone therapy. The diagnoses were: minimal-change disease [MCD], 8 cases, diffuse mesangial proliferation [DMP], 12 cases, and focal segmental glomerulosclerosis [FSGS], 6 cases. All cases received multiple infusions of high dose intravenous methylprednisolone as described by Mendoza and Tune. Many of the children also received cyclophosphamide according to the criteria of the previous authors. The period of follow up [from the start of therapy till 30-6-99] ranged from 4 to 38 months. At the last follow up, the results were as follows: In MCD, all cases responded with disappearance of edema and nephrotic-range proteinuria, 50% with complete remission and 50% with non-nephrotic proteinuria [partial response]. All maintained normal GFR. In DMP, normal GFR was maintained in 75% [9 cases]. Complete remission was found in 7 cases and partial response in 2 cases. End-stage renal failure [ESRF] occurred in one case and 2 cases died [one from septicemia and one from thromboembolic complications]. In FSGS, GFR was normal in 50% [3 cases], two cases with complete remission and one case with partial response. GFR was decreased in one case and ESRF developed in one case. One case died from septicemia. We concluded that pulse methyl prednisolone therapy with or without cyclophosphamide has better results than those reported for cyclophosphamide alone or cyclosporine. However, newer protocols are still needed to achieve better results