Acute postnatal increase of extracellular antioxidant defence of neonates: the role of iron metabolism.

UNLABELLED: In this study we investigated the extracellular antioxidant capacity of neonates during the first two postnatal days and its association with iron metabolism. Cord blood and blood samples at 47+/-6 postnatal hours were taken from 10 healthy neonates and their antioxidant capacity was determined using Randox Antioxidant kits and the heme-specific antioxidant activity (HSAA). Randox indicates the chain-breaking antioxidant capacity; HSAA corresponds to the ability to limit lipid peroxidation. Iron, ferritin and transferrin levels were also measured. Randox and HSAA values were 30% higher, ferritin was 100% higher and iron was 60% lower postnatally. The amount of change in HSAA values correlated with the change in ferritin level (r= 0.67, p < 0.05). CONCLUSION: These results suggest that extracellular antioxidant capacity (both chain-breaking and heme-specific antioxidant activities) increases shortly after birth. Lower iron and higher ferritin levels could also be responsible for this phenomenon.

Randomized clinical trial of enteral yeast-selenium supplementation in preterm infants.

There are no data in the literature on effects of supplementing infants with yeast-selenium. We therefore studied the impact of selenium-enriched yeast on the serum selenium concentration of preterm infants living in a selenium-low area (Hungary). Twenty-eight preterm infants with a mean +/- SD birthweight of 962 +/- 129 g and a gestational age of 27 +/- 1 weeks were randomized into two groups at birth with respect to selenium supplementation. In the supplemental group (n = 14) infants received 4.8 mg yeast containing 5 microgram selenium daily with naso-gastric drip during the first 14 postnatal days. The nonsupplemented infants were used as a reference group. In the supplemented group the serum selenium concentration increased from 32.1 +/- 8.5 microgram/l to 41.5 +/- 6.5 microgram/l and in the nonsupplemented group it decreased from 25.9 +/ 6.8 microgram/l to 18.2 +/- 6.4 microgram/l within two weeks. The serum glutathione peroxidase activity increased from 2.97 +/- 0.73 U/20 microliter to 6.42 +/- 3.11 U/20 microliter in the supplemented group, and it did not change significantly (from 3.53 +/- 0.94 U/20 microliter to 3.85 +/- 0.95 U/20 microliter) in the nonsupplemented group. We did not observe any complications or side effects in connection with enteral yeast-selenium supplementation. It is concluded that selenium-enriched yeast is a safe and an effective form of short term enteral selenium supplementation for preterm infants.

Enteral yeast-selenium supplementation in preterm infants.

AIM: To study the bioavailability of selenium enriched yeast in preterm infants living in a low selenium area (Hungary). METHODS: Thirty six preterm infants were randomly assigned to two groups at birth with respect to selenium supplementation. In the supplemented group (n = 18) infants received 4.8 mg of selenium enriched yeast containing 5 micrograms selenium daily. RESULTS: In the supplemented group the serum selenium concentration increased from 36.1 (+/- 12.8) micrograms/l to 43.5 (7.9) micrograms/l and in the non-supplemented group it decreased from 34.4 (20.4) micrograms/l to 26.1 (16.6) micrograms/l from birth in two weeks. No complications or side effects as a result of supplementation were observed. CONCLUSIONS: Selenium enriched yeast is a safe and an effective form of short term enteral selenium supplementation for preterm infants.

Bioavailability of enteral yeast-selenium in preterm infants.

There is no data or literature on the effects of supplementing infants with yeast selenium, although its intestinal absorption and bioavailability are higher in adults compared with other selenium compounds. The aim of the present investigation was to study the impact of selenium enriched yeast on the serum selenium concentration of preterm infants living in a low selenium area (Hungary). Twenty-eight preterm infants with mean+/-SD birth weight of 962+/-129 g and gestational age 27+/-1 wk were randomized into two groups at birth with respect to selenium supplementation. In the supplemented group (n=14) infants received 4.8 mg yeast selenium containing 5 microg selenium daily via nasogastric drip during the first 14 postnatal days. The nonsupplemented infants were used as a reference group. In the supplemented group, the serum selenium concentration increased from 32.1+/-8.5 microg/L to 41.5+/-6.5 microg/L and in the nonsupplemented group it decreased from 25.9+/-6.8 microg/L to 18.2+/-6.4 microg/L from birth in two weeks time. Compared with previous studies, our results suggest that the bioavailability of selenium in the form of yeast selenium is higher than that of other selenium compounds used for preterm infants. We did not observe any complications or side-effects owing to enteral yeast selenium supplementation. We conclude that selenium enriched yeast is a safe and an effective form of short-term enteral selenium supplementation for infants.

[Diagnosis of neonatal liver hemangioma]. / Az újszülöttkori májhaemangioma diagnosztikája.

The hepatic hemangiomas of infancy are rare, benign vascular tumours, differentiated in their morphologic and clinical appearances. They may manifest either as asymptomatic liver masses, or with the potentially fatal complication of congestive heart failure. They can be large in infancy, act as arteriovenous fistulas and may result in massive arteriovenous shunt. Multiple imaging modalities have been employed in the diagnosis, including ultrasonography (US), computed tomography (CT), radionuclide studies, angiography, magnetic resonance (MR) imaging. Generally the US, Doppler and CT appearances of hepatic hemangiomas may be diagnostic. Biopsy in often needed for diagnosis, especially if classic signs and symptoms are lacking. The diagnostic possibilities and difficulties in three patients are discussed. Different US images were present in all three cases, with atypical CT appearance in one. Doppler signals were lacking in two cases. Sonographic appearance of infantile hepatic hemangioma is variable, non-specific, but Doppler US is useful as a non-invasive method in the follow-up of hemangiomas.

[Prenatal diagnosis of left cardiac abnormality]. / Bal szívfél rendellenességek méhen belüli diagnosztikája.

We found out of 1500 prenatal cardiac ultrasound examinations very small left heart in 14 cases. Six of the 14 cases were hypoplastic left heart syndrome and eight functional-secondary left heart hypoplasia. The most important signs the echocardiography in cases of hypoplastic left heart are as follow: hypoplasia of mitral valve with or without measurable flow, absence of the anterograde flow through the aortic valve, retrograde flow in the isthmus. In cases of functional left heart hypoplasia the size of the left ventricle, aorta and mitral valves were under the 3rd percentile but there were measurable anterograde flow through the aorta. In eleven cases there were other malformations: hygroma colli, diaphragmatic hernia and omphalokele. The differentiation of the hypoplastic left heart from the secondary left heart hypoplasia has a great importance because of the therapic planning and prognosis.

[Correlation between neonatal mortality and hyperinsulinema]. / A neonatális morbiditás és a hyperinsulinaemia kapcsolata.

The authors investigated the correlation among the severity of maternal diabetes, the tight control of the maternal blood glucose concentration and the neonatal morbidity. Umbilical cord insulin level were measured in 115 newborns, 40 of them have diabetic mother. There were significant different in the serum insulin level between the low and high morbidity group. The authors suggest the importance of the tight blood glucose control during pregnancy, the diagnostic value of cardiological ultrasound to decrease the neonatal morbidity.

[Transient neonatal myasthenia gravis]. / Transitorikus újszülöttkori myasthenia gravis.

Authors reported about their experiences with newborn infants, who had transient myasthenia gravis; one disease developed in the fetal, others 10 in the early neonatal age. Direct correlation was found between the development of maternal polyhydramnios and the severity symptoms in newborns: risk of neonatal myasthenia gravis increased at these infants. Specific treatment included blood exchange transfusions and pyridostigmin (Mestinon) medication for 2-10 weeks. Five transient myasthenia gravis responded readily to blood exchange transfusions. Authors pointed out that in the early neonatal period the aetiology of an obscure respiratory inadequacy and hypoventilation might be regarded as transient myasthenia gravis.

[A successfully treated case of congenital hydrops by Kell-alloimmunization]. / Kell-alloimmunizáció okozta congenitalis hydrops gyógyult esete.

The authors report a successfully treated case of congenital hydrops caused by Kell alloimmunization. It is very important the early proper therapy and to make difference between the non immune hydrops fetus and the hydrops caused by alloimmunization. It seems to be indicated--also in Hungary, as the other European countries--the introduction of the screening of irregular antibodies during the pregnancy.

Atrial natriuretic peptide, volume and blood pressure regulation during exchange transfusion of the neonates.

Plasma concentrations of atrial natriuretic peptide (ANP) and hemodynamic parameters were investigated in five premature infants undergoing exchange transfusion. Baseline values of ANP were elevated being 51.7 +/- 21.2 fmol/ml. Volume depletion by withdrawal of 10 ml blood did not cause changes in systolic blood pressure (79.4 +/- 4.3 vs 71.4 +/- 5.6 mmHg) and heart rate (115 +/- 5.2 vs 115 +/- 2.4 l/min). ANP levels in plasma remained unaltered (53.4 +/- 24.9 fmol/ml). Volume load of 10 ml blood transfusion increased central venous pressure by 33 per cent and ANP concentration in the plasma nearly by 30 per cent, while heart rate and blood pressure remained unchanged. Our data indicated that the heart of premature infant responds to acute volume load by increased ANP-release, while volume depletion seems not to influence hormone regulation.

Prevention of pulmonary complications during neonatal resuscitation.

The pulmonary functions were measured during resuscitation of eight critically ill newborns by the "Pulmonary Evaluation and Diagnostic System" (PEDS UNIT-M.A.S. Inc.) The asphyxiated infants (Apgar score 0-3; PH 6, 9) required more aggressive ventilator support than "traditional" cases. The danger of the pulmonary injuries was larger in this period. In spite of this, there were no signs of air leaks syndrome and the oxygenation was improved in every case. Worsening or improving the pulmonary mechanics it is possible to change the ventilator settings immediately. This method seems to be advisable to introduce in the everyday routine to prevent iatrogenic pulmonary complications in such critical situation--the reanimation.

[Continuous respiratory therapy of newborn and premature infants with respiratory disorders]. / Légzészavarban szenvedö újszülöttek és koraszülöttek tartós respirációs kezelése.

2216 newborns and prematures with respiratory distress of different underlying diseases were treated with long term respiratory therapy from 1. Jan. 1975 to 31. Dec. 1985. One part of the patients were born in our hospital, the other part of them were transported from outside. The rate of prematures was 81.2%. The respiratory therapy was applied in 1813 cases because of pulmonary diseases (group 1.), while in 403 cases the respiratory troubles were extrapulmonary in origin (group 2.). The diseases in the first group were as follows: hyaline membrane disease in 482 cases (27.30%), intrauterine pneumonia in 634 cases (34.64%), postnatal pneumonia in 291 cases (15.90%), meconium aspiration syndrome in 110 cases (6.01%), severe RDS-II in 158 cases (8.63%), pulmonary immaturity in 116 cases (6.35%), persistent fetal circulation in 21 cases (1.15%) and pulmonary aplasia on the left in 1 case (0.021%). In the second group the greatest part of the cases were treated for neurological disturbances. We discuss the indications of different types of respiratory therapy and the complications as well. The survival rate was in the first group 59.3%, while in the second only 16.9%. Therefore the respiratory therapy seems to be more effective in the pulmonary diseases of the newborns. The mortality rate and the rate of severe complications were lower among inborn babies because of the early application of the respiratory therapy.

High-frequency oscillatory ventilation (HFOV) in the treatment of neonatal respiratory disturbances: case reports of two infants.

The technique of high-frequency oscillatory ventilation (HFOV) was successfully used in a preterm infant with severe hyaline membrane disease and in a term neonate presenting with intrauterine pneumonia and associated severe pneumomediastinum. None of the infants could adequately be ventilated by conventional ventilation; both of them deteriorated owing to severe hypoxaemia and hypercapnia. In the preterm infant with HMD a rapid and progressive improvement of oxygenation had been observed immediately after the beginning of HFOV, and he was successfully weaned off the ventilator after 71 hours on HFOV. His recovery was uncomplicated and definitive. In the term neonate presenting with IUP and associated severe PM, an improvement in oxygenation was detected, whereas the retention of paCO2 remained unaltered. On leaving the MAP unchanged but doubling the flow rate, paCO2 and arterial pH also normalised. No sign of PM was seen on the X-ray picture 17.5 hours after the start of HFOV. This patient was weaned off the ventilator after 29 hours on HFOV and his recovery was also uncomplicated. It is believed that recovery of the PM was secondary to the low MAP and to the higher arterial pO2 levels, and that HFOV may also have a direct role in the treatment of preexisting air leaks and perhaps also in their prevention. In our patients HFOV resulted in a definitive recovery, while no improvement had occurred on using conventional ventilation. To determine the exact mechanism of action, the clear cut fields of indications and the possible side effects of HFOV, further investigations are needed.

Cardiovascular response to dopamine in hypotensive preterm neonates with severe hyaline membrane disease.

The effect of low dose (2, 4, and 8 micrograms/kg per min) dopamine infusion on blood pressure, heart rate and renal function was studied in 18 hypotensive, preterm infants with severe hyaline membrane disease (HMD). Significant dose-related effects found during dopamine infusion were systolic and diastolic blood pressure elevation and diuretic effect, while heart rate increase occurred only with 8 micrograms/kg per min of the drug. This indicates, that in the preterm neonate, dopamine at low doses has a pronounced effect on the alpha- and dopamine-receptors, while its beta-receptor stimulating activity is minimal. We demonstrated a significantly decreased metabolic clearance rate of dopamine in preterm infants. Thus, beside the differences in the vascular receptors' maturation, the decreased metabolic clearance rate should also be taken into account when explaining the cardiovascular and renal effects of low dose dopamine infusion in these babies. Dopamine was found to be useful in normalizing low arterial blood pressure, in improving impaired peripheral circulation, and in producing a marked diuresis in hypotensive preterm neonates with severe hyaline membrane disease.

[Tolazoline and dopamine in the treatment of the persistent fetal circulation syndrome]. / Tolazoline und Dopamin bei der Behandlung des persistierenden fetalen Zirkulationssyndroms.

The combined application of Tolazoline and Dopamine for the treatment of the persistent fetal circulation syndrome showed that Dopamine prevented the most common side effects of Tolazoline i.e. systemic hypotension and oliguria. The authors emphasize the importance of continuous monitoring of the systemic blood pressure in infants during this treatment.

Effects of dopamine on renal functions in premature neonates with respiratory distress syndrome.

The renal effects of dopamine have been studied in preterm infants with RDS. Dopamine has been given in doses of 0.5-2.0 microgram/kg/min as a continuous intravenous infusion in cases of peripheral circulatory disturbances. As a result, the circulation became stable and some renal parameters improved. There was a + 106% increase of urine output as well as a + 73%, + 140%, + 21% increase in Na-excretion, FeNa, creatinine clearance respectively. In accordance with the marked increase in phosphorus excretion the titratable acidity was also increased. There was a significant decrease in the renal urea excretion and free water clearance. These alterations were probably caused by an intrarenal hemodynamic redistribution. The possible mechanism of the renal changes are also discussed. The observations demonstrate the functional maturity of renal dopaminergic receptors in the preterm infants.