Early urinary changes in Tamm-Horsfall protein and epidermal growth factor in diabetic children.

Both glomerular and tubular markers have been used to follow diabetic nephropathy. However, neither albumin nor proximal tubular markers have proven useful in prepubertal diabetes. Hence we studied two markers derived from the distal tubular cells, Tamm-Horsfall protein (THP) and epidermal growth factor (EGF). The urinary excretion of THP and EGF was examined in samples obtained during the first 20 days and 1 year after diagnosis of diabetes in children aged 4-15 years. Fourteen children without and 18 with ketonuria were examined, and 17 age-matched healthy children participated as controls. The excretion rate of EGF was increased at diagnosis, while that of THP was not. After 20 days of treatment the excretion of EGF had normalized, while the excretion of THP was decreased. Similar results were obtained after 1 year. In conclusion, in spite of good metabolic control a reduced excretion of THP persisted for at least 1 year after the diagnosis of diabetes. Whether the finding of reduced excretion of THP has any biological significance awaits further study.

Nursing role innovations: improved outcomes in a trauma center.

Trauma systems operate on the principle that people with severe injuries require special medical capabilities if they are to have their best chance of recovery. However, optimal trauma care is threatened by the problems of inadequate financial reimbursement. This threatens the ability to deliver trauma patient care. A variety of strategies is necessary to continue to provide care. Two specific nursing role innovations provide the opportunity to improve the ability to provide coordinated, efficient, and cost-effective quality care.

Fetal and infant outcome of pregnancies with very early rupture of membranes.

Fetal and infant outcome was studied in 38 singleton pregnancies complicated by very early rupture of membranes (PROM), in gestational weeks 19-29, over a 4-year period, in a Swedish population. The pregnancies were managed according to a specified protocol, including postponement of delivery until 34 weeks of gestation if possible. Stillbirth occurred in 10 cases (26.3%), all with PROM before 26 completed weeks, while 6 other infants died in the neonatal period. Respiratory distress syndrome was evident in half (50.0%) of the 28 liveborn infants. The surviving 22 infants (57.9%) were followed up to 2 years of age. The rate of neurological sequelae at follow-up was 22.7% (5/22). The fetal outcome of the 20 pregnancies with rupture of membranes before 26 completed weeks was poor; only 7 infants of the 10 born alive survived the neonatal period. The short-term fetal outcome in the group with rupture of membranes in 26-29 completed weeks was better: 15 of the 18 infants survived, but 4 had neurological sequelae. PROM before 29 completed weeks of gestation is associated with severe short-term and long-term fetal complications, in cases where the pregnancy is prolonged for several weeks.

Intrapartum fetal monitoring in preterm deliveries: prospective study.

Fetal heart rate (FHR) and fetal acid-base status were prospectively studied in 61 patients in preterm labor of unknown etiology. Tachycardia (43%), decreased variability (39%), and variable decelerations (61%) were often recorded. Fetal acidosis (pH less than 7.25 in scalp blood) occurred in 52% of patients delivered in weeks 28 to 33 and in 8% of patients delivered in weeks 34 to 36 of gestation. Ominous FHR changes considered classic for fetal distress were very frequently associated with fetal acidosis, but among the most immature infants with fetal acidosis several had tachycardia and decreased variability combined with variable decelerations of innocent appearance. Patients treated with a beta-receptor agonist (terbutaline) for inhibition of preterm labor had fetal tachycardia and decreased variability more often than nontreated patients. No positive correlation with fetal acidosis for these FHR changes could be demonstrated in the terbutaline-treated patients. The results indicate that fetal acidosis can appear rapidly and frequently among the most immature infants during labor, and emphasize the value of considering the gestational age and the administration of beta-receptor stimulators in the assessment of the FHR pattern in preterm labor.