Tenderfoot Preemie vs a manual lancet: a clinical evaluation.

PURPOSE: To compare the amount of time required to collect a blood specimen, the number of heel punctures required, and the rate of hematology re-collections required when using a Monolet lancet vs a Tenderfoot Preemie device. DESIGN: Randomized, two-group, quasi-experimental. SAMPLE: Neonates with a birth weight >800 gm were eligible to participate in the study. Twenty subjects were randomized to the Monolet lancet (control) group and 20 to the Tenderfoot Preemie (experimental) group. A total of 157 blood specimens was collected, 89 of which were for hematology testing. RESULTS: For this sample population of preterm infants, less collection time was required, fewer heel punctures were necessary, and a lower re-collection rate occurred with use of the Tenderfoot Preemie than with use of the Monolet lancet.

Massive orbital and intracranial teratoma in the newborn: a case report.

Severe hydrocephalus secondary to a massive teratoma occupying the left lateral ventricle and protruding from the left orbit was diagnosed in a newborn infant. A craniofacial mass had been initially detected during labor by ultrasound examination. The pathophysiology of teratomas and the clinical course and ethical issues in management of this child are discussed.

Cerebral metabolic response and mitochondrial activity following insulin-induced hypoglycemia in newborn lambs.

We evaluated the newborn lamb's cerebral cellular activity and metabolism following acute insulin-induced hypoglycemia. Eleven animals received an insulin bolus followed by a continuous infusion to maintain a plasma glucose of 1 mM/l for 2 h, while 8 other animals received an equivalent dose of saline. Following the induction of hypoglycemia, the animals became quiet and transient seizures were observed in 3 animals. A significant increase in heart rate (p less than 0.01), and a decrease in arterial PaCO2 at 30 min (p less than 0.01), and pH at 2 h (p = 0.02), following hypoglycemia, were observed in the experimental group. Hypoglycemia did not significantly alter the cerebral blood flow, mitochondrial respiratory control ratio or the state-3 activity. The cerebral arteriovenous difference (CAVD) for oxygen did not change, while the glucose CAVD was significantly reduced from 0.47 +/- 0.21 to 0.24 +/- 0.16 mM/l (p less than 0.05) at the end of the hypoglycemia period, suggesting consumption of alternate substrates of energy by the brain. Insulin-induced hypoglycemia was associated with a significant increase in arterial lactate (p less than 0.01), and a significant correlation (p less than 0.01) between arterial and CAVD for lactate and beta-hydroxybutyrate (BOB) was observed. Cerebral consumption of alternate substrates of energy was inconsistent, and only observed for lactate in 5 and for BOB in 3 experimental animals following hypoglycemia. These data indicate that the newborn lamb's cerebral cellular activity is not affected by the degree of hypoglycemia achieved in these studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Management of gastroschisis.

Twenty consecutive cases of gastroschisis are presented. One patient died before surgery and 19 were managed with no surgical mortality. Both delayed closure with Silastic material and primary closure were used. The relationship of increased intra-abdominal pressure to the ease of abdominal wall closure is discussed and related to the prolonged gut dysfunction noted in this condition. The technique for both primary closure and silastic staging is presented. The technique selected for each case should be based on intragastric pressure measurements. Results suggest that either technique can be used with low mortality and that some of the morbidity and mortality reported for silastic closure is related to adaptation of a technique developed for closure of omphalocele to gastroschisis closure, without making allowances for the different pathophysiology of the two entities. Abdominal wall cellulitis seen following primary closure is discussed. The series studied suggests that the cellulitis is traumatic in origin and related to manual stretching of the abdominal wall.

Red cell glycolytic intermediates and adenosine triphosphate in preterm infants on the first day of life.

Red cell glycolytic intermediates and ATP were evaluated in 47 appropriate for gestational age preterm infants on the 1st day of life who were divided into three groups on the basis of gestational age: 28-30, 31-33, and 34-36 wk. The results were compared to those previously obtained in term infants. The concentrations of glucose-6-phosphate, total triose phosphates, and ATP were significantly higher than in term infants but appeared to be appropriately elevated for the young mean age of the red cell population. The concentration of red cell 2,3-diphosphoglycerate (2,3-DPG) was significantly decreased when compared to term infants and was lowest at 28-30 wk gestation. The content of red cell 3-phosphoglycerate was increased in term infants and was inappropriately elevated for the age of the red cell population at 28-30 wk gestation. This pattern of glycolytic intermediates was suggestive of a young red cell population metabolizing at an increased glycolytic rate with increased flow through the phosphoglycerate kinase step rather than the 2,3-DPG bypass in "normal" preterm infants. Two preterm infants of 28-30 wk gestation with low red cell intracellular pH were also evaluated and had markedly decreased concentrations of red cell 2,3-DPG and ATP and all phosphorylated intermediates distal to the phosphofructokinase reaction, indicative of a cross-over at the phosphofructokinase step secondary to acidosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Mitochondrial respiration following acute hypoxia in the perfused rat heart.

Mitochondria isolated from tissues of hypoxic animals have increased respiratory capacity (State 3 respiration) when assayed in vitro at ambient oxygen tensions. The present study utilized the isolated perfused rat heart to determine whether or not this change could be produced in the absence of the neural and hormonal changes that accompany hypoxia in vivo. Following 10-min single pass retrograde perfusion with normoxic Krebs-Henseleit buffer (PO2 greater than or equal to 600 mmHg), perfusion was continued for up to 15 min with either normoxic or hypoxic buffer (PO2 less than or equal to 150 mmHg). After 10 min of hypoxic perfusion State 3 respiration of the mitochondria from the hypoxic hearts was 13 to 15% higher (P less than or equal to 0.05) than that of normoxic hearts when assayed with either glutamate/malate or succinate as substrate but was unchanged when TMPD and ascorbate was the substrate. Succinate-supported State 4 respiration of the hypoxic mitochondria also showed a small (10%) but significant (P less than or equal to 0.05) increase. These changes were not abolished by preperfusing the heart with propranolol (10(-7), 10(-6), or 10(-5) M) indicating that the response was not attributable to release of local stores of catecholamines. Respiratory control and ADP/O ratios as well as contents of cytochrome c and aa3 of the mitochondria from the hypoxic hearts were similar to those of normoxic hearts indicating that the mitochondria remained intact and tightly coupled. We concluded that the hypoxia-induced increase in mitochondrial State 3 respiration, while independent of neural and hormonal influences from the body requires an intracellular event, since they cannot be reproduced by subjecting isolated mitochondria to hypoxia in vitro.

Congenital chylothorax presenting as hydrops fetalis. A case report.

A case of congenital chylothorax presented as polyhydramnios and massive fetal edema. The diagnosis was suspected prior to delivery on the basis of ultrasonography. Ultrasound was helpful in localizing the fluid for postnatal thoracentesis. Congenital chylothorax is part of the differential diagnosis of nonimmune hydrops fetalis.

Surface cultures and isolation procedures in infants born under unsterile conditions.

Umbilical and axillary skin cultures for bacteria and yeast were obtained within two hours of birth from 108 term infants born vaginally under sterile (52) and nonsterile (56) conditions. The skin of infants born under nonsterile conditions was more frequently colonized (91%) than that of infants born under sterile conditions (66%). The most common skin flora of both groups was Staphylococcus epidermidis, diphtheroids, and Escherichia coli. A significantly higher frequency of colonization with gram-positive cocci and diphtheroids was noted in infants born under nonsterile conditions. Cultures obtained on day 3 or 4 from infants born under sterile conditions revealed a higher frequency of colonization with E coli, enteric organisms, and potential pathogens than cultures obtained immediately after delivery. Cultures did not aid in clinical management, since in this sample no overt infection developed. Culture and isolation procedures in clinically well term infants born under nonsterile conditions are not warranted.

Retrolental fibroplasia and blood transfusion in very low-birth-weight infants.

The relative contribution of transfusions of adult blood to the development of retrolental fibroplasia (RLF) in very low-birth-weight infants was examined. Five years of experience with the expanded use of replacement and exchange transfusions in 90 infants with birth weight less than or equal to 1,250 gm was reviewed. Twenty percent of the infants developed cicatricial RLF. Exchange transfusion was not related to development of cicatricial RLF. The incidence of RLF in infants receiving greater or equal to 130 ml of packed red blood cells per kilogram of birth weight as replacement blood transfusion (RBT) was significantly higher (42.9%) than that in infants receiving 61 to 131 ml of packed red blood cells per kilogram (15.4%) and infants receiving less than or equal to 60 ml of packed red blood cells per kilogram (0%), P less than .001. The need for RBT, however, was strongly correlated (r = .85, P less than .001) with increasing duration of O2 therapy. When O2 therapy was controlled for, the association between RBT and RLF did not achieve statistical significance (P = .07). The association between RBT and RLF remained significant when adjusted for duration of therapy in fractional inspired oxygen (FIO2) greater than 0.4. Further detailed studies of large numbers of susceptible infants are warranted to assess the magnitude of the contribution of transfusions of adult blood to development of RLF.

Follow-up studies of very low birth weight infants (1,250 grams or less) born and treated within a perinatal center.

The growth and development of inborn very low birth weight infants was evaluated in 50 of 60 survivors from 132 babies weighing less than or equal to 1,250 gm born July 1974 to December 1977. Mean +/- SE birth weight and gestation was 1,066 +/- 19.3 gm and 29.5 +/- 0.3 weeks, respectively, with 13 infants small-for-gestational age. Of the survivors, 26% weighed less than or equal to 1,000 gm. Male to female ratio was 1:1.4. Apgar scores less than or equal to 5 at five minutes occurred in 16% of the infants. Respiratory distress syndrome occurred in 56%, but only 10% (5/50) required mechanical ventilation. At 1 year, 46% small for gestational age (SGA) and 8% appropriate for gestational age (AGA) infants were less than the third percentile for weight. Major neurologic abnormality occurred in three infants (6%), one of whom is also blind. Grade V retrolental fibroplasia occurred in two others. Severe developmental delay (development quotient < 80, Gesell) occurred in these five infants and two other neurologically normal babies. Of 15 infants weighing less than or equal to 1,000 gm, two had major handicaps. Eight percent of the AGA infants and 30% of the SGA infants had major handicaps. These data indicate that infants born and treated in a perinatal center have a decreased incidence of asphyxia and severe respiratory distress syndrome and that the incidence of major handicaps is reduced, especially in the appropriate for gestational age baby.