RESUMEN
OBJECTIVE: To examine the consequences of antenatal betamethasone (AB) exposure on postnatal stress regulation. STUDY DESIGN: Fourteen AB exposed infants born at 28-30 weeks' gestation were assessed in the NICU during postnatal week 1 and at 34 weeks postconception. Nine infants born at 34 weeks gestation without AB treatment were evaluated as a postconceptional age comparison group. Salivary cortisol, heart rate, and behavior were measured at baseline and in response to a heelstick blood draw. RESULTS: Repeated measures ANOVAs revealed that both groups displayed an increase in heart rate and behavioral distress in response to the stressor. The cortisol response, however, was blunted in AB-treated infants at both assessments. CONCLUSION: AB treatment has consequences for hypothalamic-pituitary-adrenal (HPA) axis regulation that persist for at least four to six weeks after birth, indicating that studies of long-term effects are warranted.
Asunto(s)
Betametasona/efectos adversos , Recien Nacido Prematuro , Sistema Hipófiso-Suprarrenal/efectos de los fármacos , Efectos Tardíos de la Exposición Prenatal , Análisis de Varianza , Puntaje de Apgar , Betametasona/uso terapéutico , Estudios de Casos y Controles , Estudios de Cohortes , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Femenino , Estudios de Seguimiento , Edad Gestacional , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Hidrocortisona/metabolismo , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Masculino , Pruebas de Función Adreno-Hipofisaria , Sistema Hipófiso-Suprarrenal/fisiopatología , Embarazo , Valores de Referencia , Estrés Psicológico , Factores de TiempoRESUMEN
Fosphenytoin, a phosphorylated prodrug of phenytoin, is useful for acute seizures, is given by parenteral administration, and has few cardiac and local irritation adverse effects. There is limited experience in the administration of this new agent to newborns, and concern has been raised regarding the conversion of the prodrug to phenytoin. In two low--birth-weight infants, it was observed that fosphenytoin was converted adequately with varying effects on seizure control.
Asunto(s)
Anticonvulsivantes/uso terapéutico , Recién Nacido de muy Bajo Peso , Fenitoína/uso terapéutico , Convulsiones/tratamiento farmacológico , Anticonvulsivantes/administración & dosificación , Electroencefalografía , Humanos , Recién Nacido , Masculino , Fenitoína/administración & dosificación , Fenitoína/análogos & derivados , Convulsiones/diagnósticoRESUMEN
Congenital mesoblastic nephroma is a rare tumor of infancy that usually presents as an asymptomatic abdominal mass. A full-term newborn infant with an atypical variant of this neoplasm developed hemorrhagic shock and disseminated intravascular coagulation. The stormy course was complicated by persistent fetal circulation and then the inability to withdraw ventilatory support due to the mass effect of the tumor. After the removal of the tumor at 10 days of age, transient conjugated hyperbilirubinemia developed. At 15 months of age, the infant was thriving without evidence of recurrence of the tumor.
Asunto(s)
Coagulación Intravascular Diseminada/etiología , Neoplasias Renales/congénito , Choque Hemorrágico/etiología , Tumor de Wilms/congénito , Humanos , Recién Nacido , Neoplasias Renales/complicaciones , Neoplasias Renales/diagnóstico , Masculino , Tumor de Wilms/complicaciones , Tumor de Wilms/diagnósticoAsunto(s)
Enfisema/congénito , Enfisema Pulmonar/congénito , Espacio Retroperitoneal/diagnóstico por imagen , Enfisema/complicaciones , Enfisema/diagnóstico por imagen , Femenino , Humanos , Enfermedad de la Membrana Hialina/complicaciones , Recién Nacido , Enfisema Pulmonar/complicaciones , Enfisema Pulmonar/diagnóstico por imagen , RadiografíaRESUMEN
Metabolic acidosis occurs frequently in newborns. Net acid excretion (NAE) in 34 preterm and 12 term infants was measured during the first week of life. Twenty preterm infants received breast milk or formula; the remaining infants received total parenteral nutrition (TPN) -- synthetic amino acids or casein hydrolysate solution. NAE for breast milk vs formula fed infants was 5.4 +/- 0.4 and 7.8 +/- 0.6 muEq/min/m2 (mean +/- SEM). The corresponding values for the two TPN solutions in preterm infants were significantly higher at 12.5 +/- 1.4 and 19.4 +/- 3.5 muEq/min/m2. Term infants produced even greater amount of net acid, 20.6 +/- 2.9 and 35 +/- 3.7 muEq/min/m2 respectively for the two TPN solutions. Milk fed infants are less prone to acidosis because of base generated from milk consumption. Due to its inherent acidogenic effect, TPN solutions induce acidosis more readily. Infants receiving TPN are therefore required to generate a higher NAE rate to maintain acid-base homeostasis compared to milk fed infants.
Asunto(s)
Acidosis/orina , Hidrógeno/orina , Enfermedades del Recién Nacido/orina , Equilibrio Ácido-Base , Amoníaco/orina , Lactancia Materna , Electrólitos/sangre , Nutrición Enteral , Humanos , Recién Nacido , Enfermedades del Prematuro/orina , Nutrición Parenteral TotalAsunto(s)
Calcio de la Dieta/uso terapéutico , Enfermedades del Prematuro/etiología , Recién Nacido Pequeño para la Edad Gestacional , Raquitismo/complicaciones , Calcio/metabolismo , Calcio/orina , Colecalciferol/uso terapéutico , Femenino , Alimentos Fortificados , Humanos , Hidroxicolecalciferoles/sangre , Lactante , Recién Nacido , Absorción Intestinal , Raquitismo/tratamiento farmacológicoRESUMEN
Renal function during indomethacin treatment was studied in 12 premature infants with patent ductus arteriosus. Decreases in urinary flow rate, GFR, and CH2O by 56, 27, and 66%, respectively, occurred during Indo therapy. Urinary excretion rates of ions were also reduced: Na by 70%, Cl by 79%, K by 40%. These changes were accompanied by slight decreases in plasma sodium concentration and osmolality. Except for GFR and urinary Na and osmolality, all these functions returned to pretreatment values one to two weeks after stopping the drug.
Asunto(s)
Conducto Arterioso Permeable/fisiopatología , Indometacina/farmacología , Enfermedades del Prematuro/fisiopatología , Riñón/fisiopatología , Conducto Arterioso Permeable/tratamiento farmacológico , Tasa de Filtración Glomerular/efectos de los fármacos , Humanos , Indometacina/uso terapéutico , Recién Nacido , Enfermedades del Prematuro/tratamiento farmacológico , Riñón/efectos de los fármacosRESUMEN
Five patient groups of VLBW infants with the same P-intake but varying Ca and Na intake were examined as to their urinary excretion of P and Na and on their renal clearance of P. The effect of increasing the Na intake from 1.5 to 3 mEq/kg/24 h on C(P) was also examined. In the control group of infants with an intake of 210 mg Ca and 80 mg P/kg/24 h, the C(P) was significantly correlated with postnatal, but not postconceptional age. A relatively low Ca intake of 100 mg/kg/24 h led to age-related values two to three times as high, whereas Ca supplementation to a total intake of 250 mg/kg/24 h decreased the C(P) significantly. A Ca intake of 175 mg/kg/24 h led to C(P) similar to those seen with one of 100 mg/kg/24 h. Changing the Na intake from 1,5 to 3 mEq/kg/24 h did not influence the C(P). There was no correlation between UP and UNa in any of the patient groups examined.