Persistent pulmonary hypertension in newborn infants

On the basis of a review of the literature, a survey is presented concerning persistent pulmonary hypertension of the newborn. In this article the authors focus on the pathophysiology, diagnostic criteria and treatment, including mechanical ventilation, pharmacological vasodilation and extracorporal membrane oxygenation. Particular emphasis is placed on the treatment of the condition with inhaled nitric oxide. Nitric oxide is a selective pulmonary vasodilator and able to improve ventilation/ perfusion mismatching in cases where there is an affection of the pulmonary parenchyma. Data from randomized trials with close long-term follow-up is necessary before routine nitrogen oxide treatment can be recommended.     

Familial persistent hyperinsulinemic hypoglycemia of infancy and mutations in the sulfonylurea receptor

BACKGROUND: Corneal HLA-DR antigens are going to be lost during organ culture storage. This study investigated if this phenomenon is based on down-regulation of the HLA-DR antigen, or on a loss of the HLA-DR-positive corneal Langerhans cells (LCs). MATERIAL AND METHODS: Corneal LCs were stained in situ by the method of fluorescence-associated immunohistochemistry, and the organ culture mediums underwent flow cytometric analysis for HLA-DR-positive corneal LC at the end of the storage period. RESULTS: All stored corneas were negative for HLA-DR after 14 days and HLA-DR antigens could be detected in culture medium at the end of the storage time. CONCLUSION: Flow cytometry showed that organ culture storage leads to loss of HLA-DR-positive cells and not only to a loss of antigen presentation.     

Immuno-prevention in newborn infants and infants

The author describes two cases of ambulatory iliac phlebitis occurring in young women, one pregnant, the other taking synthetic oestrogen-progestogen drugs. Anti-coagulants were contraindicated because of the pregnancy in the first case, and because of practical obstacles to their correct use in the second. In consequence both cases were treated as outpatients by physical compression (Nard's method), without any anticoagulant medication : the results were striking and lasting.     

Loss of functional KATP channels in pancreatic beta-cells causes persistent hyperinsulinemic hypoglycemia of infancy

Persistent hyperinsulinemic hypoglycemia of infancy (PHHI) is a disorder of childhood associated with inappropriate hypersecretion of insulin by the pancreas. The pathogenesis of the condition has hitherto remained controversial. We show here that insulin-secreting cells from a homogeneous group of five infants with PHHI lack ATP-sensitive K+ channel (KATP) activity. As a consequence, PHHI beta-cells are spontaneously electrically active with high basal cytosolic Ca2+ concentrations due to Ca2+ influx. Our findings define the pathogenesis of this disease as a novel K+ channel disorder.     

Eosinophilia in newborn infants

To evaluate the clinical significance of eosinophilia in newborn infants, 261 admissions to the neonatal unit over a 12-month period were studied retrospectively; 33 babies with eosinophilia (> 1.0 x 10(9)/l) were studied. Clinical and laboratory data for the first month of life were compared, where available, between gestational age-matched pairs with and without eosinophilia. Of the 33 babies with eosinophilia, 23 were > 26 weeks' gestation and all had age-matched controls; 10 were < or = 26 weeks' gestation but had no appropriate gestational age-matched controls. Babies > 26 weeks' gestation with eosinophilia had a significantly higher number of septic episodes than controls: 20 of 23 versus 4 of 23. All 10 babies < or = 26 weeks' gestation with eosinophilia developed sepsis. Infections with gram-negative organisms and necrotizing enterocolitis occurred only in babies who developed eosinophilia. In 5 babies no cause for the eosinophilia was found. In conclusion, eosinophilia in the newborn is usually explainable and is most often associated with infection.     

Pigmented lesions in newborn infants

1058 newborn infants were examined. Forty-one (3-9%) had clinically discernible pigmented lesions compatible with melanocytic naevi. Biopsy was performed on thirty-four of the forty-one and of these; eleven, representing 1-01% of the infants, proved to be melanocytic naevi. No giant (garment) naevi were seen in this series. Two of the eleven naevi pathologically examined showed histological changes similar to those that have been reported in some giant naevi, but the remaining nine were not only different from criteria usually assigned to giant naevi, but they also differed from the usual adult naevi, in that most were predominantly junctional. None of the melanocytic naevi in this series showed any suggestion of malignant change. In newborn infants it is often impossible clinically to distinguish naevi from other types of pigmented lesions, as only eleven out of the thirty-four pigmented lesions were melanocytic naevi. Seven of the eleven melanocytic naevi were under 1-5 cm in diameter. No pigmented lesions were found on the palms, soles or genitalia.     

Retinal hemorrhage in newborn infants

The fundi of the 527 infants born within one week were investigated. The results showed that 54 cases (78 eyes) had retinal hemorrhage. Among them, 23 cases (28 eyes) accompanied macular hemorrhage. The retinal hemorrhage in newborn infants was higher in vaginal delivery than in cesarean section, and the incidence of the fetal distress was higher in the newborn infants with macular hemorrhage. The essential causes of the retinal hemorrhage in newborn infants, development of infant macular and the mechanism of amblyopia induced by macular hemorrhage were discussed.     

Lymphocyte markers in newborn infants

Purified peripheral blood lymphocytes from 20 newborn infants and 12 adults have been studied for the presence of surface markers. Adults and infants did not differ in the percentage of sheep RBC-binding cells (means 58-65%) or in Ig-bearing cells measured by the mixed antiglobulin reaction (means 7.2-11.6%). However, newborn infants had a significantly lower percentage of lymphocytes binding Fc of IgG (mean 10.4%) as compared to adults (mean 17.2%). No overall correlation between plasma Ig levels and Ig-bearing lymphocytes was found but a single infant with increased plasma IgA also showed the highest level of Ig-bearing lymphocytes among all infants.     

Pseudocysts of the adrenal glands in newborn infants

With diagnostic aims the author used direct laryngeal tomography in patients with median stenosis of the larynx. Tomography made it possible to define the width of the lumen of the sumplica area. Depending on the change of the subplica area the author varied the extent of surgical intervention. He used the extralaryngeal method of vocal plica laterification in all patients. With narrow subglottis he practiced complete mobilization of the elastic cone and its subsequent laterification; with wide subglottis he mobilized only the uper edge of the elastic cone. He succeeded in obtaining good functional results concerning respiration in all patients.     

Dexamethasone levels in treated pregnant women and newborn infants

Dexamethasone concentration was measured in plasma and amniotic fluid by radioimmunoassay using a rabbit antiserum raised against DX-hemisuccinate-albumin. Recoveries of added tracers averaged 70% after paper chromatography. The within- and between-assay coefficients of variation averaged 10%. The lower limit of detection was 0.2 mug/dl when 0.4 ml of plasma was assayed. Ten healthy pregnant women at term had cesarean sections 8 to 11 hours following administration of 8 mg of DX orally. DX levels in maternal vein, in umbilical vein and artery, and in amniotic fluid averaged 2.2, 2.9, 2.6, and 2.5 mug/dl, respectively. Although cortisol levels were markedly suppressed, the total relative glucocorticoid activity in blood of fetuses treated with DX far exceeded that of the untreated group.