RESUMEN
To investigate the possible role of sepsis with endotoxemia in kernicterus, we studied the effect of endotoxin on accumulation of bilirubin and albumin in rat brain. Male Sprague-Dawley rats were given Escherichia coli endotoxin i.v. After 150 min 10 microCi 125I-bovine serum albumin was given intravenously, followed by a 1-hour bilirubin infusion. Brain bilirubin was significantly higher in the endotoxin group than in the controls (1.34 +/- 0.47 vs. 0.83 +/- 0.31 microgram/g, p < 0.05). However, the difference between the ratios of brain bilirubin to total serum bilirubin at the time of sacrifice were not significant. Total and unbound bilirubin values were significantly higher in the endotoxin-treated group at 165 min. Endotoxemia increased the net accumulation of bilirubin in rat brain, but this increase was probably secondary to an increase in total and unbound bilirubin, rather than an increase in the transfer per se of bilirubin across the blood-brain barrier.
Asunto(s)
Bilirrubina/metabolismo , Encéfalo/metabolismo , Endotoxinas/sangre , Toxemia/metabolismo , Albúminas/metabolismo , Animales , Bilirrubina/sangre , Escherichia coli , Lipopolisacáridos/sangre , Masculino , Ratas , Ratas Sprague-Dawley , Albúmina Sérica/análisisRESUMEN
Samples of meconium from 28 neonates born to women suspected of drug abuse were tested for drugs of abuse (ie, cocaine, morphine, codeine, and marijuana). In each case, testing of urine from the mother, the newborn, or both had been ordered by the attending physician because of suspected maternal drug abuse. Seventeen (61%) of 28 meconium samples tested positive; 28 (60%) of 47 urine samples were positive. Meconium test results were concordant with the results of maternal or newborn urine testing in 24 (86%) of the 28 cases. In three cases, meconium was positive for cocaine when newborn urine was negative; in one case, meconium was negative when maternal urine was positive for cocaine. Compared with the combination of maternal and newborn urine testing, meconium testing had an 82% positive predictive value (14/17) and a 91% negative predictive value (10/11). Collection of meconium is simpler and more reliable than collection of urine, and testing of meconium was easily incorporated into routine procedures at a busy commercial laboratory. Meconium is a useful sample for drug detection in newborns.
Asunto(s)
Drogas Ilícitas/análisis , Meconio/química , Cocaína/análisis , Femenino , Humanos , Recién Nacido , Valor Predictivo de las Pruebas , Embarazo , Complicaciones del Embarazo/diagnóstico , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/orinaRESUMEN
A prospective study of maternal drug use during pregnancy and newborn outcomes provided us with an opportunity to assess the relationship between prenatal cocaine use and respiratory distress syndrome among premature infants. Women were consecutively recruited from the prenatal clinics at Boston (Mass) City Hospital between 1984 and 1988 and were interviewed during the prenatal and postpartum period by trained bilingual interviewers. Urine specimens were collected at the time of each interview and were analyzed for marijuana and cocaine metabolites. Following delivery, one of five pediatricians who were "blinded" to the mothers' prenatal and drug history performed a physical examination and abstracted medical information, including the diagnosis of respiratory distress syndrome from the medical record. The study sample consisted of 33 infants born at 34 weeks' or less gestation who were appropriate for gestational age and not exposed to heroin or methadone prenatally. Eight of the mothers of these 33 infants used cocaine prenatally. One (12%) of eight cocaine-exposed infants was diagnosed as having respiratory distress syndrome compared with 13 infants (56%) not exposed to cocaine prenatally. Infants not exposed had an odds ratio of 8.9 (95% confidence interval: 0.9, 83.5) for respiratory distress syndrome compared with infants exposed to cocaine prenatally. When the analysis was controlled for prolonged rupture of membranes, black race, infant gender, or gestational age, the adjusted odds ratio was essentially unchanged. This preliminary observation of a decreased incidence of respiratory distress syndrome among premature infants prenatally exposed to cocaine appears to be biologically plausible and needs to be confirmed in future studies with larger numbers of subjects to control for potentially confounding variables.
Asunto(s)
Cocaína , Complicaciones del Embarazo , Síndrome de Dificultad Respiratoria del Recién Nacido/epidemiología , Trastornos Relacionados con Sustancias , Adulto , Cocaína/farmacología , Femenino , Madurez de los Órganos Fetales/efectos de los fármacos , Edad Gestacional , Humanos , Recién Nacido , Pulmón/embriología , Masculino , Intercambio Materno-Fetal , EmbarazoAsunto(s)
Serodiagnóstico del SIDA , Hospitales Urbanos , Hospitales , Femenino , Encuestas Epidemiológicas , Humanos , Recién Nacido , Embarazo , Estados UnidosAsunto(s)
Cocaína , Dependencia de Heroína/epidemiología , Complicaciones del Embarazo/epidemiología , Efectos Tardíos de la Exposición Prenatal , Trastornos Relacionados con Sustancias/epidemiología , Femenino , Humanos , Incidencia , Recién Nacido , Embarazo , Detección de Abuso de Sustancias , Estados Unidos/epidemiologíaRESUMEN
A very low birthweight infant developed pericardial tamponade secondary to leakage of fat emulsion through a catheter lodged in the right atrial appendage. At autopsy examination a thrombus was lodged in the appendage, which presumably resulted in immobilization of the catheter and leakage of the fluid through an attenuated and necrotic myocardial wall.