RESUMEN
BACKGROUND: While cytochrome P4501A2 is the primary pathway for theophylline (aminophylline ethylenediamine) metabolism in adults, it is developmentally immature in the newborn. OBJECTIVE: To report the developmental differences in theophylline toxicokinetics of neonates. DESIGN: Case series. Three premature neonates received inadvertent intravenous overdoses of theophylline for apnea of prematurity while in newborn intensive care. Maximum serum concentrations ranged from 55 to 123 mg/L. Theophylline-derived caffeine levels plateaued at 8.4 to 13 mg/L and did not decline during the sampling period. All newborns experienced sinus tachycardia and agitation. Sequential theophylline and caffeine serum levels were obtained periodically for 62 to 100 hours. In contrast to older children and adults, in whom theophylline disposition follows zero-order kinetics at high concentrations, a monoexponential function best described theophylline elimination in the premature newborn, with half-lives ranging from 24.7 to 36.5 hours and estimated clearance from 0.02 to 0.05 L/kg per hour. These values are consistent with those previously reported in neonates. All patients were treated with supportive care without invasive procedures. No seizures or apparent sequelae occurred. CONCLUSION: Developmental differences in the balance between nonrenal (ie, metabolic) and renal elimination pathways produce the unique toxicokinetics of theophylline in the neonate.
Asunto(s)
Apnea/tratamiento farmacológico , Broncodilatadores/efectos adversos , Enfermedades del Prematuro/tratamiento farmacológico , Síndrome de Dificultad Respiratoria del Recién Nacido/tratamiento farmacológico , Taquicardia Sinusal/inducido químicamente , Teofilina/efectos adversos , Apnea/diagnóstico , Broncodilatadores/administración & dosificación , Broncodilatadores/farmacocinética , Relación Dosis-Respuesta a Droga , Estudios de Seguimiento , Humanos , Recién Nacido , Enfermedades del Prematuro/diagnóstico , Infusiones Intravenosas , Unidades de Cuidado Intensivo Neonatal , Masculino , Síndrome de Dificultad Respiratoria del Recién Nacido/diagnóstico , Medición de Riesgo , Taquicardia Sinusal/diagnóstico , Teofilina/administración & dosificación , Teofilina/farmacocinéticaAsunto(s)
Enfermedades del Prematuro/tratamiento farmacológico , Infecciones Estafilocócicas/tratamiento farmacológico , Vancomicina/administración & dosificación , Vancomicina/farmacocinética , Coagulasa , Humanos , Recién Nacido , Recien Nacido Prematuro , Estudios Prospectivos , Vancomicina/sangreAsunto(s)
Bacillus cereus/aislamiento & purificación , Bacillus/aislamiento & purificación , Infecciones Bacterianas/diagnóstico , Enfermedades del Sistema Nervioso Central/microbiología , Antibacterianos/uso terapéutico , Infecciones Bacterianas/líquido cefalorraquídeo , Infecciones Bacterianas/tratamiento farmacológico , Enfermedades del Sistema Nervioso Central/líquido cefalorraquídeo , Humanos , Recién Nacido , Enfermedades del Prematuro/microbiología , MasculinoRESUMEN
Neonatal pulmonary venous air embolism (arising as a consequence of ventilator therapy) remains at present an almost invariably fatal occurrence. We present a case that illustrates that it is possible for an infant to survive the immediate cardiovascular consequences of such an event; however, we demonstrate that embolic extension into the central nervous system (CNS) can occur as an associated sequela, and we offer the first published documentation (cranial ultrasonography) of this potentially pivotal complication. The temporal relationships between our patient's initial (but resolving) systemic embolism and his subsequent (and persistent) CNS event are documented and the implications discussed. Based on these observations, we caution that CNS involvement is difficult to recognize clinically and suggest that such involvement may contribute to a fatal outcome. Importantly, it appears that it may be possible to intervene in future cases to improve outcome, and we offer suggestions in this regard.
Asunto(s)
Embolia Aérea/etiología , Embolia y Trombosis Intracraneal/etiología , Síndrome de Dificultad Respiratoria del Recién Nacido/terapia , Ventiladores Mecánicos/efectos adversos , Embolia Aérea/diagnóstico , Humanos , Recién Nacido , Embolia y Trombosis Intracraneal/diagnóstico , Masculino , UltrasonografíaRESUMEN
A review of 13 cases of suspected child abuse in which radionuclide (RN) scans, radiographic skeletal surveys, and sufficient follow-up were available showed that the RN scans were insensitive, even though fractures were more than 48 hours old at the time of the scan. Frequently missed lesions included skull and extremity fractures. Furthermore, soft tissue and visceral abnormalities that were identified on radiographic examination went undetected on RN scan. We conclude that, although the RN scan may augment the radiographic examination, it should not be used alone to screen for the battered child.