Coordinated ultrasound screening of infants: Hungary experience.

OBJECTIVE: In 1990, three hospitals (the Madarász Street Children's Hospital in Budapest and the general hospitals in Cegléd and Zalaegerszeg) organised a coordinated ultrasound (US) screening programme. The screening was aimed at detecting a predefined series of developmental and acquired disorders. MATERIAL: In 9 years, a total of 46,858 infants were screened by the three hospitals: 20,185 in Budapest, 13,258 in Cegléd and 12,415 in Zalaegerszeg. RESULTS: Disorders were detected in 4068 cases. Most (2885) involved abdominal or renal disorders; intracranial anomalies were found in 1062, and the remaining discoveries were of cysts or tumours in the liver, spleen or ovaries. CONCLUSIONS: Many disorders were detected (8.7%) needing either follow-up, or some form of treatment.

[Postnatal screening of renal developmental anomalies. Classical diagnostic methods, risk factors and routine screening]. / Vese fejlödési rendellenességek újszülöttkori szürövizsgálata. Klasszikus diagnosztika, rizikócsoport és rutinszürés.

During a 6 years' period (2 years of control, 2 years of risk group and 2 years of routine screening) the authors examined the effect of different diagnostical methods on the frequency of detected renal developmental anomalies. The incidence of documented renal malformations was 1.1% during the use of classical diagnostical methods, 8.3% during the application of intrauterine routine and postnatal risk group screening, and 10.3% after the introduction of postnatal routine screening in 2 years' periods. The advantage of both postnatal risk group and postnatal routine screening was that the greatest part of renal anomalies could have been diagnosed before the appearance of the symptoms of urinary infection. On the basis of effectivity of postnatal routine screening and decrease of uncertainty of postnatal risk group screening authors suggested the introduction of the postnatal routine screening as general practice under our own circumstances.

[Subscapular liver hematoma and liver hemorrhage in neonatal age]. / Subcapsularis májhaematoma és májvérzés újszülöttkorban.

By analysing their newborn patients of 15 years the authors confirm the earlier observation, that the subcapsular haematoma is a common finding at postmortem examination of the newborns dying during neonatal period. The association of the pathological symptoms of hypoxic origin of the other organs observed at autopsy and the decreasing incidence of subcapsular haematoma as a results of obstetrical and neonatal intensive care make this disease of hypoxic origin probable. In spite of common subcapsular haematoma the haemorrhage of liver causing haemascos is relatively uncommon. In their five patients suffering from liver rupture they observed two types of this (immediate and delayed rupture of liver's capsule), which also differed from one another in their clinical picture. They are drawing attention to general use of ultrasound in diagnostics which means a new chance to diagnosis in alive of both types.

[Neonatal adrenal gland hemorrhage]. / Ujszülöttkori mellékvesevérzés.

During a six-month period the authors have been diagnosing 25 neonatal adrenal haemorrhage by 870 ultrasound screening examinations. This frequency (28.7%) is surprisingly high in comparison with earlier postmortem estimated literature data (1.7-6.0%). In 24 survived neonates the adrenal haemorrhage was absorbed between 6 weeks and 4 months, no disturbances in the electrolyte levels were found, and the haemorrhage did not require any treatment. However, the authors observed pathological neurological symptoms or intracranial haemorrhage as more than 30% of the newborn infants suffering from adrenal haemorrhage. On the basis of ultrasound signs of adrenal haemorrhages the authors distinguish three groups, namely, cortical, medullar and apoplectiform haemorrhages. By analysing the history, clinical symptoms and follow up study of adrenal haemorrhages in the newborn period the authors conclude that infants born as "large for date babies", suffered from intrauterine asphyxia, forceps or vacuum extractions can be taken the risk of adrenal haemorrhage.

[Diagnostic and therapeutic changes in renal developmental anomalies detected in childhood]. / Gyermekkorban felfedezett renális fejlödési rendellenességek diagnosztikus és therapiás változásai.

The authors diagnosed 40 renal malformations during 2 years investigated and 2 years control period. On the basis of analysing their patients they came to the conclusion that after the introduction of intrauterine routine ultrasound examinations and screening of childhood risk group the number of recognised renal malformations increased significantly (32 in the investigated and only 8 in the control period). Furthermore the age of patients at the time of diagnosing shifted to the early postnatal period, and the number of patients diagnosed on the basis of the positive urinary investigations decreased significantly. But the intrauterine routine ultrasound investigation at presently applied examination system can consider only one-third of fetal renal malformations. And also an important fact that the increased number of considered patients came from the increasing of patients who have needed operation and did not increase the number of infants who have needed only conservative therapy. According to the small surgical complications they concluded that the risk of the early surgical intervention does not seem to be higher than in case of postponed ones. On the basis of clinical observation with childhood risk group arising the necessarity of the non invasive postnatal routine screening.

Postprandial thermogenesis in human milk-fed very low birth weight infants.

Postprandial thermogenesis in 10 human milk-fed very low birth weight infants was studied by indirect calorimetry at thermoneutrality. Throughout a period of 5-6 weeks each infant was tested once weekly which enabled the authors to explore the relationship between postprandial metabolism and postnatal age as well as growth rate. A feed of human milk caused, on the average, a 15% increase in metabolism. The effect reached its peak value between 50 and 80 min; thereafter it began to fall and approached the preingestion level at 120 min. The response obtained in the 4th, 5th and 6th postnatal week was more pronounced than in the first 3 weeks. Analysis based on growth rate showed that infants exhibiting a rapid weight gain responded by a larger increase in postprandial metabolism than the non- or slow-growing infants.

Food-induced thermogenesis in obese children.

In 11 obese children aged 12.5 (+/- 0.7) years with normal glucose tolerance and 7 lean, control children aged 11.9 +/- 0.7 years the preload resting energy expenditure and thermogenic response to a standardised meal was measured by indirect calorimetry. Preload energy expenditure was higher in obese children when expressed in absolute terms than in controls, but was not different when corrected for lean body weight. Four children with obesity of recent onset had lower food-induced thermogenesis and insulin response then seven overweight children with long-standing obesity. Food-induced thermogenesis and insulin response showed a significant positive correlation. It is concluded that food-induced thermogenesis is reduced in the early phase of childhood obesity but increased in the later phase when hyperinsulinaemia develops, pointing towards an important role of insulin in food-induced thermogenesis.

Absence of responses in energy metabolism and respiratory quotient to carnitine infusion in premature infants.

Plasma levels of total, free and acylcarnitine, as well as oxygen consumption and respiratory quotient were determined in premature infants maintained at neutral temperature. The effects on these parameters of intravenous infusion of 24 mg/kg/day carnitine were studied. Total, free and acylcarnitine increased and the acyl/free carnitine ratio decreased significantly during the four-hour study period. Resting heat production and respiratory quotient remained practically unchanged throughout the study period, indicating that in the face of carnitine sufficiency exogenous carnitine did not influence whole body heat production and substrate utilization pattern in premature infants. Further examinations in carnitine depleted infants will be required to clarify the regulatory role of carnitine in neonatal fatty acid metabolism and non-shivering thermogenesis.

Blood levels of total carnitine and lipid utilization with and without carnitine supplementation in newborn infants.

Postnatal changes of the plasma carnitine level were compared in orally and parenterally fed newborn infants. As expected, in contrast to the increasing plasma level of carnitine in infants fed with human milk, a gradual and significant fall was observed during parenteral feeding. Next, the effect of carnitine supplementation on the elimination rate of an Intralipid load was tested. The increased disappearance rate of triglycerides associated with the exogenously administered carnitine suggested an increased lipid utilization during the carnitine supplemented period of parenteral nutrition.

Energy metabolism, substrate utilization, metabolite and hormone levels in infants fed various parenteral solutions.

Previous observations on the effects of various types of parenteral nutrition on changes in oxygen consumption, respiratory quotient, total heat production, distribution of nutrient utilization, metabolic and hormonal levels in infants during the neonatal and postneonatal periods are reviewed. The relevant findings obtained in fifty-two newborn infants infused with different types of metabolic solutions were as follows. Oxygen consumption increased during Aminosol-glucose and Intralipid-glucose infusion. The respiratory quotient varied according to the oxidation of the nutrients. A significant elevation was observed during Aminosol-glucose infusion, which tended to fall in response to Intralipid. Total heat production was increased during all types of parenteral nutrition, and substrate utilization depended on the quality and amount of nutrient intake. The magnitude of the changes in concentrations of metabolites (glucose, free fatty acids, alpha-amino-nitrogen) and insulin and growth hormone were smallest when the parenteral nutrition consisted of glucose, amino acids and lipid and the total caloric intake did not exceed the maintenance energy expenditure. On the basis of the results, during the neonatal period it seems advisable to administer as parenteral nutrition, about 70--75 kcal/kg/day in the form of 7.0--8.0 g/kg/day glucose, 1.7--2.0 g/kg/day amino acids and 3.0--4.0 g/kg/day lipid.

Growth and metabolic and hormonal profiles during transpyloric and nasogastric feeding in preterm infants.

The effect of transpyloric and nasogastric feeding on the blood concentration of glucose, lactate, pyruvate, glycerol, hydroxybutyrate, acetoacetate, alanine, insulin, pancreatic and total glucagon was determined in 20 preterm infants. The babies were studied on the last day of transpyloric feeding and the first and fifth days of ensuing nasogastric feeding. In 9 infants hourly measurements of hormones and metabolites were made at 1000, 1100, 1200, 1300 and 1400 hours. The blood concentrations of glucose, alanine, pancreatic and total glucagon were stable, the concentration of the other metabolites and insulin, less so. No significant difference in mean metabolite or hormone concentration was noted by time of day or type of feeding. Measurements made on the fifth day of nasogastric feeding showed no significant differences from those at the time of changeover. The infants were clinically well and growing normally at the time of study, but had low plasma insulin and high plasma glucagon concentrations. We conclude (i) the site of presentation of milk in the gastrointestinal tract has no effect on the circulating concentration of selected metabolites and hormones in the preterm infants, (ii) the preterm infant grows at a normal rate with a plasma insulin/glucagon ratio that in the adult would be expected to favour catabolism.

Energy metabolism, substrate utilization, and nitrogen balance in parenterally fed postoperative neonates and infants. The effect of glucose, glucose + amino acids, lipid + amino acids infused in isocaloric amounts.

In ten postoperative neonates and young infants the effect of three isocaloric, isovolemic intravenous nutritional regimens (glucose alone, amino acids + glucose, amino acids + lipid) on nitrogen balance, energy, and substrate metabolism were tested. Each regimen was given for 24 hours to each infant through three consecutive days, providing the same daily amino acid intake when the amino acid mixture was combined with glucose or lipid. Oxygen consumption and RQ were followed through three or four hours during each study period. The participation of three main nutrients in energy metabolism was calculated from the urinary N excretion and nonprotein RQ. Administration of glucose infusion alone was associated with a negative N balance. Addition of amino acids with glucose produced a marked N retention. This positive N balance remained unchanged when lipid was substituted for glucose as a nonprotein energy source. Alpha amino-nitrogen excretion and participation of protein catabolism in total energy metabolism were found to be identical during the three nutritional regimens, indicating that the amino acids together with glucose or lipid were either retained in nonprotein pools or were utilized for protein synthesis.