Parental smoking and neonatal serum levels of polychlorinated biphenyls and hexachlorobenzene.

Polychlorinated biphenyls (PCB) and hexachlorobenzene (HCB) are ubiquitous compounds that have tumor-promoting properties if applied together with tobacco-specific carcinogens. It was the purpose of the present study to investigate whether parental smoking by itself will increase the prenatal uptake of such organochloric compounds. With the informed consent of the parents, blood samples were taken from 80 full-term neonates before the first oral feeding. Six PCB congeners (PCB 28, 52, 101, 138, 153, and 180) and HCB were analyzed with capillary gas chromatography. Information about parental smoking behavior, the geographic origin of the parents, and their actual and previous working places was recorded. We composed three study groups for statistical analyses: active smoking mothers (n = 12), passive smoking mothers (n = 33), and nonsmoking families (n = 35). Neonates born to active smoking mothers had the highest PCB and HCB concentrations compared with children of passive or nonsmoking mothers. These differences were statistically significant (p < 0.01) in the cases of PCB 138, total PCB, and HCB. Newborns of passive smoking mothers had higher PCB and HCB concentrations than children of nonsmoking families but lower values than those of active smoking mothers. These differences were statistically significant for all compounds with the exception of PCB 180. It is concluded that active and passive maternal smoking increases the neonatal burden with PCB and HCB.

Influence of maternal age and duration of pregnancy on serum concentrations of polychlorinated biphenyls and hexachlorobenzene in full-term neonates.

Polychlorinated biphenyls (PCBs) and hexachlorobenzene (HCB) are ubiquitous carcinogenic and teratogenic compounds that are transplacentally transferred from mother to fetus during pregnancy. It was the aim of the present study to evaluate the possible influence of maternal age and duration of pregnancy on the neonatal burden with these substances. Blood samples were taken from 80 full-term German neonates within the first 12 h of life, before the first oral feeding. The serum concentrations of six PCB congeners (28, 52, 101, 138, 153, and 180) and HCB were determined with capillary gas chromatography with electron capture detection. The concentrations of the lower chlorinated PCB congeners (28, 52, and 101) were below the detection limit. PCB 153 showed the highest serum concentration (median 0.42 microg/l), followed by PCB 138 (0. 34 microg/l) and PCB 180 (0.17 microg/l). Total PCB concentration was 0.96 microg/l, HCB concentration 0.61 microg/l. All detectable PCB congeners and the total PCB concentration correlated significantly with the gestational age of the newborns (r = 0.2639; p < 0.01), with 50-140% higher serum levels in children born at 42 weeks of gestation as compared with neonates born in the 38th week. HCB concentration correlated with maternal age (r = 0.249; p < 0.01), with 2.7-fold higher serum levels in offspring of 40-year-old as compared with 20-year-old women. It is concluded that the neonatal burden with organochlorine compounds depends on maternal age and duration of pregnancy, thereby reflecting the increase in body pollution with these substances during human life as well as a continuous transplacental transfer from mother to fetus during pregnancy.

Metabolites of a tobacco-specific carcinogen in urine from newborns.

BACKGROUND: Cigarette smoking during pregnancy can result in fetal exposure to carcinogens that are transferred from the mother via the placenta, but little information is available on fetal uptake of such compounds. We analyzed samples of the first urine from newborns whose mothers did or did not smoke cigarettes for the presence of metabolites of the potent tobacco-specific transplacental carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK). METHODS: The urine was collected and analyzed for two metabolites of NNK, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and its glucuronide (NNAL-Gluc). Gas chromatography and nitrosamine-selective detection, with confirmation by mass spectrometry, were used in the analyses, which were performed without knowledge of the origin of the urine samples. RESULTS: NNAL-Gluc was detected in 22 (71%) of 31 urine samples from newborns of mothers who smoked; NNAL was detected in four of these 31 urine samples. Neither compound was detected in the 17 urine samples from newborns of mothers who did not smoke. The arithmetic mean level of NNAL plus NNAL-Gluc in the 27 newborns of smokers for which both analytes were quantified was 0.14 (95% confidence interval [CI] = 0.083-0.200) pmol/mL. The levels of NNAL plus NNAL-Gluc in the urine from these babies were statistically significantly higher than those in the urine from newborns of nonsmoking mothers (geometric means = 0.062 [95% CI = 0.035-0.110] and 0.010 [considered as not detected; no confidence interval], respectively; two-sided P<.001). NNAL plus NNAL-Gluc levels in the 18 positive urine samples in which both analytes were quantified ranged from 0.045 to 0.400 pmol/mL, with an arithmetic mean level of 0.20 (95% CI = 0.14-0.26) pmol/mL, about 5%-10% of the levels of these compounds detected in the urine from adult smokers. CONCLUSIONS: Two metabolites of the tobacco-specific transplacental carcinogen NNK can be detected in the urine from newborns of mothers who smoked cigarettes during pregnancy.

Reduced iron-associated antioxidants in premature newborns suffering intracerebral hemorrhage.

Oxygen radical injury may be a common pathogenic mechanism in several neonatal diseases. The term "oxygen radical disease of prematurity" has been proposed in the face of the greater incidence of intracerebral hemorrhage, bronchopulmonary dysplasia, and retinopathy in premature neonates. To test the hypothesis that overload with ionic iron due to decreased concentrations of iron-oxidizing and iron-binding proteins induces free radical damage in premature asphyxiated newborns suffering periventricular-intraventricular hemorrhage (PIVH), blood plasma of newborns with PIVH (n = 7) was compared with that of controls (n = 10) within the first 12 h of life. We found reduced transferrin (2.05 vs. 2.24 g/l; p < 0.05) and ceruloplasmin (89.9 vs. 126.3 mg/l; p < 0.01) levels and an increased transferrin saturation (54.2 vs. 38.4%; p < 0.05) in those newborns who later developed PIVH. These findings support the theory that iron-catalyzed lipid peroxidation of the brain during reoxygenation after perinatal asphyxia may be involved in the pathogenesis of PIVH.

The predictive value of elevation in specific serum enzymes for subsequent development of hypoxic-ischemic encephalopathy or intraventricular hemorrhage in full-term and premature asphyxiated newborns.

Serum lactate dehydrogenase (LDH), aspartate aminotransferase (ASAT), and hydroxybutyrate dehydrogenase (HBDH) activities are significantly elevated in asphyxiated newborns within the first days of life. The approach of the present study was to evaluate firstly if serum levels of these enzymes correlate with the development of hypoxic-ischemic encephalopathy (HIE) and periventricular-intraventricular hemorrhage (PIVH) in full-term and premature asphyxiated newborns, and secondly if postnatally elevated enzyme activities could be predictive for these disorders. ASAT, LDH and HBDH activities were measured in 98 asphyxiated newborns. Blood samples were taken serially at five fixed times: 0 (cord), 12, 24, 72, and 144 hours post partum. All newborns were examined for the development of HIE and PIVH using standardized scoring systems. Fifty percent of the newborns were full-term and 50% were premature. Ten of the full-term (20.4%) and 21 (42.8%) of the premature newborns developed HIE. Nineteen newborns (19.4%) suffered PIVH (full-term/premature, 7/12). The full-term asphyxiated newborns with HIE or PIVH showed significantly elevated ASAT, LDH, and HBDH activities within the first 72 hours of life. In case of the premature asphyxiated newborns, the enzyme activities did not differ significantly between the study groups. The overall predictive values showed a high sensitivity (HIE/PIVH, 90.0%/71.4%), a high specificity (71.0%/88.1%), an acceptable negative predictive value (44.9%/50.0%), and a high positive predictive value (96.5%/94.9%) for the development of HIE and PIVH in full-term asphyxiated newborns. It is concluded that measurements of ASAT, LDH, and HBDH activities are reliable predictors for the development of HIE and PIVH in full-term asphyxiated newborns.(ABSTRACT TRUNCATED AT 250 WORDS)

[Fatal course of infectious mononucleosis in an 11-month-old girl]. / Tödliche Verlaufsform einer infektiösen Mononukleose bei einem 11 Monate alten Mädchen.

Fatal infectious mononucleosis is vary rare in the human population. Only two case reports of girls suffering an Epstein-Barr virus-associated lymphoproliferation without evidence of an underlying immunodeficiency came to our knowledge. We report on the case of an 11-months-old girl with fatal infectious mononucleosis. Some findings allow distinct delineation from previous reports. Firstly, the present "pulmonary lymphoid hyperplasia" has been formerly described in patients with HIV infection exclusively. Secondly, only the EBV surface antigen LMP was expressed on infected B-cells. The nuclear antigen complex EBNA could not be demonstrated. Overall, the results suggest a so far unrecognised type of EBV-associated lymphoproliferation in a female infant.

[Aneurysmal bone cyst of the petrous bone. A rare cause of recurrent bacterial meningitis]. / Aneurysmale Knochenzyste des Felsenbeins. Seltene Ursache einer rekurrierenden bakteriellen Meningitis.

Occult malformations of the skull base are very rare disorders which cannot initially be diagnosed clinically. They become first symptomatic, if complications arise. The most frequent clinical manifestation is a recurrent bacterial meningitis. Based on the unique case of a presumably congenital aneurysmal bone cyst of the petrosal bone, which imposed clinically as hearing loss and recurrent bacterial meningitis, we have evaluated the extensive literature on this theme. Considering mostly atypical clinical findings, solely coronal thin-section computed tomographic scans of the skull base allow a reliable diagnosis. The possible risks of this investigation (necessary sedation up to insufflation anesthesia and the radiation exposure of the child's lens) are justifiable and subordinate to the diagnostic importance.

Aneurysmal cyst of the petrosal bone.

An aneurysmal cyst of the petrosal bone presenting as hearing loss and recurrent bacterial meningitis is reported. None of the clinical or radiographic signs described previously were present. Because other diagnostic methods are not reliable, it is recommended that coronal thin section computed tomography be performed in every case of suspected malformation of the skull base and in the diagnosis of recurrent bacterial meningitis.

Serum enzyme activities in full-term asphyxiated and healthy newborns: enzyme kinetics during the first 144 hours of life.

Little is known about the kinetics of most serum enzymes during the first hours of life, and even less about the effect on such enzyme activities of perinatal hypoxia-ischaemia. It was the aim of the present study to evaluate the serum kinetics of seven differently located cell enzymes in healthy and asphyxiated newborns during the 1st week of life. The serum activities of cytoplasmic and mitochondrial [aspartate aminotransferase (ASAT), creatine kinase (CK), glutamate dehydrogenase (GLDH), lactate dehydrogenase (LDH), and hydroxybutyrate dehydrogenase (HBDH)] and membrane-bound (gamma-glutamyl-transferase and leucine arylaminidase) enzymes were prospectively measured in full-term asphyxiated (n = 49) and healthy (n = 87) newborns during the first 144 h of life. The blood samples were taken serially at five fixed times: 0 (cord), 12, 24, 72, and 144 h postpartum. The asphyxiated newborns had significantly increased serum activities of ASAT, LDH, and HBDH up to 72 h postpartum, whereas healthy newborns showed higher CK and GLDH activities. Only the activities of ASAT, LDH, and HBDH seemed to depend on the oxygen supply of the fetus or newborn. If other causes of increased serum enzyme activities, e.g. liver diseases, haemolytic disorders, tumours, or inborn errors of metabolism, are excluded, elevated serum activities of ASAT, LDH, and HBDH should draw one's attention to a perinatal hypoxic-ischaemic insult of the newborn.

[Etiology and diagnosis of cerebral infarcts after the neonatal period]. / Atiologie und Diagnostik von Zerebralinfarkten jenseits der Neugeborenenperiode.

QUESTION: After the neonatal period, cerebral infarctions are very rare in childhood. In the present study we aim to evaluate the etiology and diagnostic procedures of this disorder on the basis of our own experience. METHODS: We saw four children aged 3 2/12 to 11 4/12 years with a cerebral infarction at our hospital. Three children were followed up until 6 months after the infarction. The case reports are presented. On the background of the literature, the etiology and diagnostic possibilities and requirements are discussed. RESULTS: As the underlying cause, we saw a hemolytic-uremic syndrome in one case, and a (post-)infectious vasculitis following measles resp. scarlet fever in two cases. CCT, NMR, and transcranial Doppler sonography are the diagnostic methods of choice, although none of these by itself is able to diagnose this disorder with any certainty. Therapeutic measures are restricted to the causative disease. The prognosis is good quoad vitam, although serious regarding neurologic sequelae. CONCLUSIONS: An early diagnosis of this disorder is essential, because the only known effective therapy is the management of a possibly underlying disorder. Intensive physiotherapy as an additional measure is helpful to avoid neurological sequelae.

[Enzyme activity in serum of healthy newborn infants. Normal values of CPK, gamma-GT, GOT, GLDH. LAP, LDH and HBDH in the first 144 hours of life]. / Enzymaktivitäten im Serum gesunder Neugeborener. Normalwertbereiche von CPK, gamma-GT, GOT, GLDH, LAP, LDH und HBDH in den ersten 144 Lebensstunden.

QUESTION: There are no available enzyme determinations for the neonatal period taking in account the considerable changes during the first hours of life. Moreover, in former studies the number of probands has been small and no standardized and optimized methods have been used for the determinations. It was the aim of the presented study to evaluate reference ranges for these enzymes in healthy newborns for the first week of life. METHODS: We realized a controlled-prospective study about the serum activities of CPK, GGT, GOT, GLDH, LAP, LDH, and HBDH in healthy newborns (n = 87). The enzyme determinations were done for the first time in a serial manner at five fixed times: post partum (cord), 12, 24, 72, and 144 hours post partum with optimized test-kits. RESULTS: The evaluated serum enzyme activities are stated with median, 25th, and 75th percentile by rank. We propose these results as reference ranges for these enzyme activities during the first 144 hours of life. CONCLUSION: For the first time reference ranges for serum enzyme activities concerning the striking activity changes during the first hours of life are evaluated for healthy newborn infants. These results enable comparative investigations in the case of newborn diseases.

Surgical treatment of facial dog bite injuries in children.

Although today most injuries of face and head are the result of car and motorcycle accidents, dog bites are a frequent cause of facial injuries in children. In recent years, general guidelines have been established concerning the surgical treatment of facial dog bite injuries in children. We have seen 16 children with such lesions at our hospital in the last 4 years. All children have been treated surgically, under general anaesthesia, by primary closure of the wound with interrupted sutures after having adapted the margins by subcutaneous sutures. In addition, all children have been evaluated 3 months-5 years after the accidents in order to objectify the results of our treatment. Special attention has been attached to the functional and aesthetic outcome. In all cases, we saw good-to-excellent results. Based on this experience we suggest a clinical classification of these injuries in regard to a special therapeutic regime for each stage. In this way, guidelines may be established for the surgeon dealing with these injuries.

General anaesthesia versus epidural anaesthesia for primary caesarean section--a comparative study.

Forty-seven healthy parturients undergoing elective Caesarean section were randomly allocated to either general anaesthesia (n = 24) or epidural anaesthesia (n = 23) under standardized anaesthetic and surgical conditions. Seven women of the epidural group required additional systemic analgesia or sedation following delivery of the neonate. Nine of 24 newborns obtained 1-min Apgar scores below 7 after general anaesthesia compared to only 3/23 after epidural anaesthesia. The time period to establish normal colour in the babies was 2.2 min after epidural and 4.9 min after general anaesthesia. Three of the 24 general-anaesthesia newborns demonstrated a tendency to hypotonia compared to only one in the epidural group. Twenty-four hours and 7 days after delivery all infants of both groups were completely normal. At the time of delivery maternal PO2 was higher in the general anaesthesia compared to the epidural group, due to higher inspired oxygen concentrations. Comparable results were obtained in umbilical PO2 venous values; lower pH values, however, were observed in the umbilical artery after general anaesthesia. There were no significant differences in the glucose levels between the groups. A significant correlation was established between uterine incision-delivery interval and 1-min neonatal Apgar scores in the general-anaesthesia group, but not in the epidural group. Our investigation did not show either the incision-delivery interval or the start of operation-delivery interval to play a role in neonatal outcome. Epidural anaesthesia is superior to general anaesthesia in Caesarean section under normal conditions with regard to neonatal outcome. Whether this is also true for critical conditions cannot be concluded from this study.

[Neonatal focal seizures and transitory inappropriate ADH secretion syndrome due to an infarction in the region of the middle cerebral artery]. / Fokale Neugeborenenkrämpfe und transitorisches Syndrom der inadäquaten ADH-Sekretion durch Infarkt im Bereich der A. cerebri media.

Cerebral arterial infarction is a very rare condition during the neonatal period. In recent times, cerebral infarctions with an atypical bland course are reported in healthy, unsuspected newborns. For the first time, we saw focal seizures and a transient syndrome of inappropriate ADH secretion in a full-term, male newborn with an infarction of the middle cerebral artery as the first sign of this disorder. On the basis of these rare clinical manifestations, the literature about neonatal cerebral infarction is reviewed. The diagnostic possibilities and prognostic expectations are discussed. It is the aim of this case report to call attention to this rare disease in order to avoid a delay in diagnosis and therapy, even if the initial manifestations are atypical.

[Serum potassium level in healthy neonates and infants with asphyxia in the first 144 hours of life]. / Serumkaliumspiegel bei asphyktischen und gesunden Neugeborenen in den ersten 144 Lebensstunden.

Postpartal increase in the plasma potassium concentration of asphyxiated newborn infants is a very rare complication with possibly deleterious outcome. In a group of 98 asphyxiated and 87 healthy infants we have not seen either a case of severe hyperkalemia or rhythm disturbances. We found lower reference-ranges for plasma potassium concentration in the group of healthy infants than previously published, which we would like to introduce. The pathogenesis of hyperkalemia in hypoxia is not yet fully understood. Further experimental investigations will be necessary.