Hematocrit in relation to Apgar scores in SGA infants.

SGA infants have an increased incidence of low Apgar scores. At the same time they frequently have a high hematocrit. Since both affect outcome, it is important to know if a relationship exists between these two factors. In a study of 139 SGA newborns many had low Apgar scores at one minute: 63% of the preterms and 29% of the fullterms. Frequent abnormal hematological findings included high hematocrit. We found a positive correlation between hematocrit and the Apgar score at one minute of life that was statistically significant. The babies with a high hematocrit had significantly more often good Apgar scores. The correlation was present in preterm babies (r = 0.55) as well as in fullterms (r = 0.32). It is concluded that a high hematocrit probably protects the SGA newborn against acute perinatal asphyxia. It is possible that both low Apgar scores and "normal" hematocrit are signs of a chronically impaired SGA fetus.

Severity of growth retardation and physical condition at birth in small for gestational age infants.

Ponderal index divides small for gestational age (SGA) infants into two categories, based upon proportional and disproportional growth retardation. The latter group supposedly suffered from unfavorable intrauterine conditions. The aim of the study was investigation of the value of the ponderal index in the discrimination of underlying fetal disorders and its dependency upon the severity of the intrauterine growth retardation (IUGR). In a cohort of 142 SGA infants we found 12 newborns with congenital anomalies; most of the newborns were disproportionally small. Fourteen newborns expired in the Neonatal Intensive-Care Unit for various reasons, in general not directly related with the IUGR. All of them were disproportionally small. The newborns were divided into two groups according to the severity of IUGR. Proportionality was independent of this severity, indicating that most SGA fetuses remain disproportionally small during long-standing IUGR. It is likely, however, that the proportionally small ones adjust better to the poor intrauterine conditions, since they all survived.

Acute hemiparesis as the presenting sign in a heterozygote for ornithine transcarbamylase deficiency.

Strokes in children occur in conjunction with cardiac disease, hematological disorders, trauma, intracranial infections and migraine. Recently several inborn errors of metabolism have been recognized as possible causes of stroke-like symptoms. We describe a female heterozygote of ornithine transcarbamylase deficiency, who presented with convulsions and right sided hemiplegia. MR-imaging of the brain demonstrated an acute ischemic lesion in the left hemisphere. In addition to other known metabolic causes of stroke like attacks urea cycle defects should be considered in the differential diagnosis of acute hemiplegia in childhood.

A girl treated with growth hormone presenting with neuromyopathy as first sign of acute lymphoblastic leukemia.

An 11-year-old girl being treated with DNA-recombinant growth hormone therapy presented with proximal limb weakness. Laboratory studies were negative. A few months later she presented with acute lymphoblastic leukemia (ALL). A diagnosis of carcinomatous neuromyopathy was made. After successful treatment of the leukemia the symptoms subsided and did not recur.

Fetal growth retardation in rats from different levels of hypoxia.

Three groups of pregnant Wistar rats were subjected to 3 different levels of hypoxia: 11.6, 10.7 and 9.0%, respectively. Pair-fed and ad libitum fed control groups were included to control for the reduced food intake due to hypoxia. Within the range studied, fetal body weights decreased with decreased oxygen availability. Liver weights were more, brain weights less markedly reduced than body weights. Pair-fed but normally oxygenated animals showed slight reductions in body and organ weights compared to ad libitum fed controls. The fetuses subjected to hypoxia showed a placental hypertrophy relative to their body weights, while the least hypoxic fetuses showed an absolute placental hypertrophy. Placenta-fetal body ratios that were 150% greater than those observed in control animals were documented. In contrast, the fetuses of food-deprived animals were associated with abnormally small placentas.