Cortisol and 17-a-hydroxy-progesterone levels in infants with refractory hypotension born at 30 weeks of gestation or less

Refractory hypotension is frequent in very low-birth weight infants, whose hypothalamic-pituitary-adrenal axis has been suggested to be immature. The objective of the present study was to evaluate basal cortisol and 17-a-OH-progesterone in the first 36 h of life in preterm infants with and without refractory hypotension (mean arterial blood pressure below the lower limit for gestational age throughout the study despite aggressive volume expansion and use of vasopressors). Thirty-five infants with ú30 weeks of gestation and a birth weight ú1250 g, with no postnatal use of corticosteroid or death in the first 48 h were studied. Mean arterial pressure was measured every 4 h during the first 48 h. Cortisol and 17-a-OH-progesterone were determined at 12 and 36 h and patients were divided into refractory hypotensive (N = 15) and control (N = 20) groups. The groups were not different regarding type of delivery, use of prenatal corticosteroid, requirement of mechanical ventilation, use of vasopressor drugs, morphine, fentanyl, prophylactic indomethacin, and mean sample timing. Although refractory hypotensive newborns were more immature, were smaller, suffered more deaths after 48 h of life and had a higher SNAPPE-2 score, their cortisol and 17-a-OH-progesterone levels were not different from controls at 12 h and at 36 h. The increase of cortisol in newborns with refractory hypotension 36 h after birth was significantly higher than in controls. Despite the fact that refractory hypotensive very low-birth weight neonates were submitted to a very stressful condition, their cortisol and 17-a-OH-progesterone levels were similar to controls.

Umbilical cord blood and neonatal endothelin-1 levels in preterm newborns with and without respiratory distress syndrome

Increased pulmonary vascular resistance in preterm newborn infants with respiratory distress syndrome is suggested, and endothelin-1 plays an important role in pulmonary vascular reactivity in newborns. We determined umbilical cord blood and neonatal (second sample) levels of endothelin-1 in 18 preterm newborns with respiratory distress syndrome who had no clinical or echocardiographic diagnosis of pulmonary hypertension and 22 without respiratory distress syndrome (gestational ages: 31.4 ± 1.6 and 29.3 ± 2.3 weeks, respectively). Umbilical cord blood and a second blood sample taken 18 to 40 h after birth were used for endothelin-1 determination by enzyme immunoassay. Median umbilical cord blood endothelin-1 levels were similar in both groups (control: 10.9 and respiratory distress syndrome: 11.4 pg/mL) and were significantly higher than in the second sample (control: 1.7 pg/mL and respiratory distress syndrome: 3.5 pg/mL, P < 0.001 for both groups). Median endothelin-1 levels in the second sample were significantly higher in children with respiratory distress syndrome than in control infants (P < 0.001). There were significant positive correlations between second sample endothelin-1 and Score for Neonatal Acute Physiology and Perinatal Extension II (r = 0.36, P = 0.02), and duration of mechanical ventilation (r = 0.64, P = 0.02). A slower decline of endothelin-1 from birth to 40 h of life was observed in newborns with respiratory distress syndrome when compared to controls. A significant correlation between neonatal endothelin-1 levels and some illness-severity signs suggests that endothelin-1 plays a role in the natural course of respiratory distress syndrome in preterm newborns.

O valor do hemograma no diagnostico de infeccao neonatal precoce em recem-nascidos de termo. / The value of blood-count in the diagnosis of early neonatal infection in newborn infants at term

Investigou-se o valor do leucograma no diagnostico precoce na sepse neonatal. O grupo-controle (n = 46) apresentou un numero total de neutrofilos bastonados e uma relacao neutrofilos imaturos/neutrofilos totais significativamente menores do que os grupos de recem-nascidos infectados sem sinais clinicos e com sinais clinicos de infeccao.A especificidade de ambos os testes foi alta, entretanto, a sensibilidade foi baixa. Sugerimos que recem-nascidos de termo com menos de 72 horas de vida que apresentam uma contagem de neutrofilos bastonados maior do que 1.265 por mm3 e (ou) uma relacao neutrofilos imaturos/neutrofilos totais maior do que 0,14 sejam considerados altamente suspeitos de infeccao

Influencia de fatores neonatais sobre o aleitamento materno. / Influence of neonatal factors on breast feeding

Foi estudada a influencia de alojamento conjunto e tipo de parto na ocorrencia de aleitamento materno. Um grupo de gestantes (156) foi dividido aleatoriamente em alojamento conjunto e enfermaria convencional Outro grupo (95) foi dividido em parto vaginal e parto cesariano. Em ambos os estudos os grupos eram comparaveis quanto a dados sociais, economicos, obstetricos e neonatais. Concluiu-se que tanto as maes cuidadas em enfermaria convencional como aquelas que tiveram parto cesariano tendem a amamentar menos seus filhos

Tratamento da insufuciencia respiratoria da doenca de membrana hialina. / Treatment of respiratory insufficiency of hyaline membrane disease

As diferentes modalidades de tratamento da insuficiencia respiratoria sa doenca de membrana hialina sao discutidas. Baseado em experiencia pessoal e com auxilio de revisao bibliografica o autor sugere indicacoes para as diferentes tecnicas, de acordo com o peso dos pacientes ao nascimento