RESUMO
To assess the influence of protein intake on renal excretion of calcium and amino acids and on bone mineralization in preterm infants, we randomly selected within weight group strata 27 infants who weighed < 1500 gm at birth (nine per group) to be fed a high-mineral (calcium, 940 mg/L; phosphorus, 470 mg/L) premature formula with one of the following protein contents: formula A, 3.0 gm/100 kcal; formula B, 2.7 gm/100 kcal; and formula C, 2.2 gm/100 kcal. Mean (+/- SD) daily weight gain was greater in infants receiving the higher protein intakes for the first 30 days (formula A, 24.8 +/- 5.1 gm; formula B, 20.5 +/- 3.8 gm; formula C, 16.2 +/- 5.9 gm (analysis of variance: p < 0.01; C < A, p < 0.05)). Bone mineral content did not differ at any time point, and all groups had a high prevalence of generalized aminoaciduria (4 weeks: formula A, 56%; formula B, 71%; formula C, 75%). Urinary calcium corrected for creatinine (in milligrams per milligram) increased as protein content decreased (2 weeks: formula A, 0.16 +/- 0.10; formula B, 0.20 +/- 013; formula C, 0.44 +/- 0.33 (C > A, C > B, p < 0.05); 4 weeks: formula A, 0.23 +/- 0.15; formula B,0.34 +/- 0.47; formula C, 0.49 +/- 0.22 (C > A, p < 0.01). We conclude that the high mineral content and other components of premature formulas result in a higher growth rate and may increase protein requirements. Failure to meet protein requirements may result in underutilization of absorbed calcium and increased renal excretion of calcium. In preterm infants, higher protein intake probably supports rather than jeopardizes bone mineral accretion, and reduces rather then increases calciuria.
Assuntos
Aminoácidos/urina , Cálcio/urina , Proteínas Alimentares/administração & dosagem , Alimentos Infantis , Recém-Nascido de Baixo Peso/urina , Minerais/administração & dosagem , Acetilglucosaminidase/metabolismo , Densidade Óssea , Humanos , Recém-Nascido de Baixo Peso/fisiologia , Recém-Nascido , Microglobulina beta-2/urinaRESUMO
We report four patients with methylmalonic acidemia who developed acute extrapyramidal disease after metabolic decompensation. The neurologic findings resulted from bilateral destruction of the globus pallidus with variable involvement of the internal capsules. This complication was unrelated to a specific gene defect responsible for methylmalonic acidemia or to cyanocobalamin administration. These lesions constitute a "metabolic stroke," probably because of the accumulation of toxic organic acid metabolites, because they cannot be accounted for by hypoxemia or vascular insufficiency.
Assuntos
Erros Inatos do Metabolismo dos Aminoácidos/complicações , Doenças dos Gânglios da Base/patologia , Encefalopatias Metabólicas/patologia , Transtornos Cerebrovasculares/patologia , Globo Pálido/patologia , Malonatos/sangue , Ácido Metilmalônico/sangue , Adolescente , Erros Inatos do Metabolismo dos Aminoácidos/patologia , Atrofia , Córtex Cerebral/patologia , Pré-Escolar , Feminino , Humanos , Masculino , Tomografia Computadorizada por Raios XAssuntos
Beriberi/diagnóstico , Encefalopatias Metabólicas/diagnóstico , Doença de Leigh/diagnóstico , Beriberi/metabolismo , Beriberi/patologia , Encéfalo/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Lactente , Doença de Leigh/metabolismo , Doença de Leigh/patologia , Masculino , Tiamina/sangue , Tiamina/uso terapêutico , Tomografia Computadorizada por Raios XRESUMO
We measured serum concentrations of thyroxine (T4), triiodothyronine (T3), reverse T3, free T4, thyroid-stimulating hormone, and cortisol in 62 victims of sudden infant death syndrome (SIDS) in 30 infants who died of known causes and in 15 living controls. The mean T3 value was elevated in 69% of those with SIDS. 37% of the others who died, and in no control infants. After excluding those who died of known cause who had abnormal thyroid function (abnormal postmortem concentrations of T4, free T4, or reverse T3), the T3 values were elevated in 63% of those remaining. When the data were analyzed on the basis of case histories and autopsy findings, those infants who were in good health and died suddenly of accidental causes had an elevation in mean T3 similar to that seen in SIDS victims; those who died under conditions known to alter thyroid metabolism did not. The T4, free T4, reverse T3, thyroid-stimulating hormone, and cortisol values were not useful in differentiating those with SIDS from the living controls, or those who were healthy at the time of death. We were unable to find any difference in T3 serum concentrations between the total group who had SIDS and those who had SIDS with minor infections, with petechiae on intrathoracic organs, with premature birth, or those who were resuscitated. Our data point out the importance of using appropriate controls when evaluating SIDS. The normal reverse T3 values in SIDS, as well as confirmation of the normal T4 and free T4 values, constitute evidence against chronic persistent alveolar hypoventilation or prolonged episodes of hypoxia immediately preceding death from SIDS.
Assuntos
Morte Súbita do Lactente/sangue , Tri-Iodotironina/sangue , Feminino , Humanos , Hidrocortisona/sangue , Lactente , Masculino , Tireotropina/sangue , Tiroxina/sangue , Tri-Iodotironina Reversa/sangueRESUMO
Growth failure may be associated with low serum somatomedin concentrations despite normal to increased concentrations of serum growth hormone. We have recognized five patients who responded to GH administration with an increase in serum Sm and an acceleration in skeletal growth, and have characterized the circulating GH in an homologous human GH radioreceptor assay employing the IM-9 lymphocyte as a source of human GH receptor. These five prepubertal children, who had a mean height 7.8 SD below the mean for age, had a mean RIA-GH of 34.2 +/- 3.5 ng/ml in response to stimulation, a basal Sm activity by hypophysectomized rat cartilage bioassay of less than 0.3 IU/ml, and a mean peak Sm of 0.9 +/- 0.1 IU/ml in response to 48 hours of GH therapy. During a one-year trial of GH therapy, four of these children significantly increased their growth velocity as compared to their growth rate before GH therapy. These children had a mean RIA-GH/RRA-GH ratio of 2.f. The fifth patient had a low RIA-GH/RRA-GH ratio and had no increase in growth rate. These studies suggest that growth in certain growth retarded children may be dependent on exogenous GH, even though they are not GH deficient by standard criteria.
Assuntos
Estatura/efeitos dos fármacos , Transtornos do Crescimento/tratamento farmacológico , Hormônio do Crescimento/farmacologia , Criança , Pré-Escolar , Feminino , Hormônio do Crescimento/biossíntese , Hormônio do Crescimento/sangue , Humanos , Masculino , Radioimunoensaio , Somatomedinas/sangueAssuntos
Acetil-CoA C-Aciltransferase/deficiência , Aciltransferases/deficiência , Cardiomiopatias/complicações , Insuficiência Cardíaca/complicações , Cardiomiopatias/fisiopatologia , Criança , Ecocardiografia , Ácidos Graxos/metabolismo , Feminino , Humanos , Isoleucina/metabolismo , Mitocôndrias Cardíacas/enzimologiaRESUMO
Seven infants developed mepivacaine intoxication secondary to accidental injection during paracervical or pudental blocks or both. All presented with unexplained neonatal depression at birth, tonic seizures (often with apnea) within six hours, and characteristic neurologic findings. Twenty-four-hour urinary excretion produced 12.7 to 37.4 mg, exchange transfusions less than 1.02 to 3.5 mg, and gastric drainage or lavage or both 0.63 to 1.26 mg of mepivacaine. Thus promotion of urinary excretion is the treatment of choice. All six survivors are seizure free and neurologically and developmentally normal at one to 4 1/2 years. With early diagnosis and prevention of severe perinatal hypoxia, the prognosis from intoxication alone is very good.
Assuntos
Anestesia Local/efeitos adversos , Anestesia Obstétrica/efeitos adversos , Doenças do Recém-Nascido/induzido quimicamente , Trabalho de Parto , Mepivacaína/efeitos adversos , Adulto , Feminino , Seguimentos , Humanos , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/terapia , Mepivacaína/metabolismo , Gravidez , Convulsões/induzido quimicamente , Convulsões/terapiaAssuntos
Biotina/uso terapêutico , Refluxo Gastroesofágico , Propionatos/sangue , Adulto , Feminino , Humanos , Lactente , Síndrome , VômitoRESUMO
Bathing with soap containing hexachlorophene was instituted during two major staphylococcal epidemics in a Neonatal Intensive Care Unit. Infants who weighed less than 1,200 gm, those with a postconceptional age of less than 35 weeks, and those with large areas of abraded skin were at highest risk to achieve elevated blood HCP concentrations. T 1/2 of HCP ranged from 6.1 to 44.2 hours and appeared to follow first order kinetics. Time of peak blood concentrations of HCP following a bath ranged from 6 to 10 hours. One infant with liver disease achieved a concentration of HCP of 4,350 ng/ml after seven baths and developed clinical symptoms consistent with HCP toxicity.
Assuntos
Hexaclorofeno/metabolismo , Recém-Nascido , Autopsia , Banhos , Peso ao Nascer , Surtos de Doenças/prevenção & controle , Feminino , Idade Gestacional , Meia-Vida , Hexaclorofeno/efeitos adversos , Humanos , Doenças do Recém-Nascido/prevenção & controle , Unidades de Terapia Intensiva , Cinética , Hepatopatias/etiologia , Berçários Hospitalares , Infecções Estafilocócicas/prevenção & controleRESUMO
A fatal case of mepivacaine poisoning in a newborn infant is reported. Regional brain tissue concentrations of mepivacaine were determined by a sensitive and specific gas chromatographic-mass spectrometric method. The brain tissue levels in this patient were higher than those previously reported, possibly due to alkalosis occurring several hours prior to the infant's death.