Population kinetics of gentamicin in neonates

A population kinetic analysis was carried out on sparse plasma gentamicin (GE) concentration data from 469 neonates obtained as part of a routine therapeutic drug monitoring (TDM) programme in the hospital neonatology unit.The best predictors of the kinetic parameters of the monoexponential model, volume of distribution (Vd) and clearance (CL), were the weight (WT) and gestational age (GA). Vd of the neonates was only related to WT, whereas the half-life was only related to the GA.     

THE NEONATAL EVOKED HEART RATE RESPONSE AND THE LAW OF INITIAL VALUE

Two-second long square wave tones at frequencies of 125 and 1000 Hz and 75 db sound pressure were presented to six newborn infants. Mean heart rates were computed for the 10 sec prior to and the 10 sec following stimulus onset, i.e. the prestimulus and stimulus heart rate values respectively. LIV was shown to operate strongly only in the case of the 125 Hz stimulus. Even for this stimulus, LIV depended upon the state of the infant, showing an appropriate negative correlation between prestimulus and stimulus values in regular sleep and quiet wakefulness but a slightly positive correlation in irregular sleep. In randomly selected control periods, the first 5 sec served as prestimulus values and the second 5 sec as stimulus values. Regression coefficients for these control periods did not differ significantly from those during which the stimulus was actually present. In view of the special conditions required for its demonstration, the generality of Wilder's “law” seems to be seriously questioned.     

An Attempt to Elk it Cardiac Orienting and Defense Responses in the Newborn to Two Types of Facial Stimulation

Cardiac and behavioral reactivity of the human newborn to facial stimulation eliciting approach and escape responses were compared in order to test the distinction between cardiac orienting and defensive reactions. Each infant received 8 trials each of check stimulation (stroking near the mouth) and ear stimulation (pinch on the ear lobe). HR response to both tactile stimuli were accelerations of different amplitude when motor responses were also present. When no overt behavioral response was observed, stroking on the check elicited cardiac deceleration while ear stimulation again elicited acceleration. Thus, cardiac orienting was demonstrated in newborns when a rooting stimulus was presented that did not elicit overt head turning. The HR response to ear stimulation on trials unaccompanied by observed movements was a larger acceleration than to cheek stimulation when movement was present. This finding suggests that movement itself does not produce the observed HR increase, but rather that central processing of the signal value of the stimulus determines both overt and cardiac responding.     

新生儿败血症休克预测模型的构建——1 695例患儿回顾性研究

目的 筛选新生儿发生败血症休克的危险因素,建立新生儿败血症休克临床预测模型。方法 选取2016年1月1日—2019年12月31日重庆医科大学7家附属医疗机构中患有败血症的新生儿,根据是否发生败血症休克分为研究组和对照组。采用单因素分析、LASSO和logistic回归分析筛选危险因素。采用logistic、极端梯度提升（XGBoost）、随机森林（RF）、分类回归树（CART）和人工神经网络（ANN）建立新生儿败血症休克预测模型,根据灵敏度、特异度、曲线下面积等指标评估模型性能。结果 本研究中,共有339名败血症新生儿发生败血症休克,1 356名败血症新生儿未发生败血症休克。单因素分析筛选出31项差异指标,多因素分析筛选出12项独立危险因素。测试集中,logistic、XGBoost、RF、CART、ANN模型的曲线下面积分别为0.856 (0.809～0.903),0.861 (0.819～0.904),0.880 (0.838～0.922),0.835 (0.790～0.881),0.808 (0.756～0.860)。结论 本文构建的五种预测模型相对稳定,其中,RF模型的预测性能最佳,能为新生儿败血症休克提供较好的预测。     

Vertebral level of the ending of the spinal cord and its relationship to the length of the vertebral column in Northern Turkish neonates

Summary Racial and sex differences in the level of ending of the spinal cord of the adult have been reported. It is lower in Africans and in females. Since such differences may affect even fetuses and newborns we aimed to study in Northern Turkish neonates. The study was made on 40 full-term newborn still-births (23 male, 17 female). In all cases, the length of the vertebral column, the length of the spinal cord and the body weight were measured and the vertebral level of ending of the spinal cord was noted. It was found that the termination of the spinal cord varied from the first lumbar to the second sacral vertebra, with a mean level between L2 and L3. In female neonates, it was observed that the spinal cord ended at a slightly lower level (0.2 vertebra) than in males. Our findings approximately agreed with those of Barson [2] who studied neonates in England and of Jit and Charnalia [5] in North India. However, we found that the spinal cord ended one and half vertebrae lower in Northern Turkish neonates than in South African and South Indian subjects. The correlations between body-weight and length of the spinal cord, weight and length of the vertebral column, length of the spinal cord and length of vertebral column, length of the vertebral column and level of ending of the cord were statistically highly significant for males, females and both sexes together (p<0.001). The longer the vertebral column, the higher the termination of the spinal cord.

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Niveau vertébral de la terminaison de la moelle épinière et sa relation avec la longueur de la colonne vertébrale chez le nouveau-né en Turquie du Nord

Résumé Selon la race et le sexe, les différences de niveau de la terminaison de la moelle épinière ont été rapportées chez l'adulte. Elle est plus basse chez les Africains et chez les femmes. Dès lors il se peut qu'il existe déjà des différences raciales et selon le sexe, chez le foetus et le nouveau-né. Nous nous proposons d'étudier une population de nouveau-nés du Nord de la Turquie. Cette étude est faite à partir de 40 nouveau-nés à terme, décèdes (23 garçons et 17 filles). Chez tous ces nouveau-nés, la longueur de la colonne vertébrale, la longueur de la moelle épinière et le poids ont été mesurés. Le niveau vertébral de la terminaison de la moelle épinière variait entre la première vertèbre lombaire et la deuxième vertèbre sacrée. Le niveau moyen de cette terminaison était situé entre L2 et L3. Chez les filles nouveau-nés, il était observé que la moelle épinière se terminait légèrement plus bas (0,2 vertèbre) que chez les garçons nouveaunés. Nos observations rejoignent celles de Barson [2] qui étudia des nouveaunés d'Angleterre et celles de Jit et Charnalia [5] qui étudièrent des nouveau-nés du Nord de l'Inde. Cependant, nous avons trouvé que la moelle épinière se terminait une vertèbre et demie plus bas chez les nouveau-nés de la Turquie du Nord que chez les nouveau-nés d'Afrique du Sud et d'Inde du Sud. La corrélation entre le poids des spécimens et la longueur de la moelle épinière; le poids et la longueur de la colonne vertébrale, la longueur de la moelle épinière et la longueur de la colonne vertébrale, la longueur de la colonne vertébrale et le niveau vertébral de la terminaison de la moelle épinière parmi les garçons, les filles, et dans les deux sexes, étaient statistiquement très significatifs (p<0.001). Plus la colonne vertébrale était longue, plus haute était située la terminaison de la moelle épinière.

     

Urinary excretion of adenosine deaminase binding protein in neonates treated with tobramycin

The potential tubulotoxicity of tobramycin and cefotaxim were assessed in neonates by measuring the urinary level of adenosine deaminase binding protein (ABP) and urinary ₁-microglobulin and ₂-microglobulin. In a prospective study, 33 neonates who received tobramycin and cefotaxim for suspected neonatal sepsis were compared with 48 untreated newborns during the first 10 days of life. The urinary concentrations of ABP and its excretion rates, corrected for body weight and body surface area, were significantly increased from the 1st day of treatment. Urinary ₁-microglobulin and ₂-microglobulin were not elevated under tobramycin and cefotaxim during the first 2 days of treatment. We conclude that ABP may be a sensitive marker for the detection of proximal renal tubular injury during tobramycin and cefotaxim treatments of neonates. The increase in urinary ABP which occurs before an elevation of urinary ₁-microglobulin and ₂-microglobulin may reflect earlier structural than functional alterations. However, since none of the treated infants had signs of electrolyte disorders or glomerular dysfunction, the clinical relevance of ABP measurement should be reevaluated.     

Intracerebral haemorrhages in surfactant treated neonates with severe respiratory distress syndrome: age at diagnosis,severity and risk factors

Within a randomized European multicentre trial the time of onset, severity and progression of intracerebral haemorrhages (ICH) were investigated prospectively by serial cranial ultrasonography in 343 ventilated infants with severe respiratory distress syndrome (RDS) following instillation of single or multiple doses of a natural porcine surfactant (Curosurf). In 148/343 infants (43%) ICH was diagnosed (grade I or II: 22%, grade III or IV: 21%). In 26 cases (8%) ICH was present on the ultrasound scan prior to surfactant instillation at a median age of 6h. Incidence and severity of ICH was similar after single- or multiple-dose surfactant treatment. Using a logistic regression model the following risk factors predictive of ICH were defined: low birth weight, allocation to certain hospitals, vaginal delivery, Apgar score6, rectal temperature on admission 36°C, primary anaemia, acidosis prior to treatment, RDS grade IV in pre-treatment chest films and poor response to surfactant treatmentOur study provides supportive evidence that multiple doses of Curosurf do not increase the risk for ICH as compared to single-dose administration.A preliminary report of this work was presented at 8th International Workshop on Surfactant Replacement, Oslo, Norway, May 21 1993. The study was supported by grants of the German government (BMFT 93 607 27) and the German Research Council (Deutsche Forschungsgemeinschaft He 2072: 1–2). The surfactant used in the trial was prepared ang tested in Stockholm with the skilful technical assistance of Elin Arvesen, Bim Linderholm. Eva Lundberg, Gunhild Nilsson and Petru Popa (supported by the Swedish Medical Research Council (Project No. 3351) and Oscar II:s Jubileumsfond)Dedicated to the memory of Edgar (Eddi) Laufkötter, one of the most active trial collaborators, who died under tragic circumstances on April 10, 1994.     

Extreme hyperbilirubinaemia in Zimbabwean neonates: neurodevelopmental outcome at 4 months

As part of a prospective study of severely jaundiced Zimbabwean infants, the relationship between maximum total serum bilirubin (TSB) concentration in the neonatal period and neurodevelopmental outcome at the corrected age of 4 months was studied. Fifty infants with a TSB of >400 μmol/l (23.4 mg/dl) were enrolled and screened with a neonatal neurological examination (NNE). The cause of jaundice was low birth weight in 22 (44%), ABO incomptability in 8 (16%), sepsis in 8 (16%) and congenital syphilis (6%) in 3 infants. In 9 infants a cause could not be determined. At 4 months, 2 infants had died and 3 were lost to follow up, leaving 45 infants for the infant motor screen (IMS) at 4 months of age. Mean TSB in the neonatal period was 485 μmol/l (28.2 mg/dl), and 7 infants received an exchange transfusion. Mean TSB of the infants with an exchange transfusion was 637 μmol/l (37.2 mg/dl) (range 429–865 μmol/l (25–50.3 mg/dl)) and of the infants without transfusion 459 μmol/l (26.8 mg/dl) (range 400–740 μmol/l (23.4–43 mg/dl)) (P < 0.0001). The TSB was not associated with birth weight, gestational age, gender or head circumference of the baby. On the IMS, 6 of 45 (13.3%) infants scored abnormal, 6 (13.3%) suspect and 33 (73%) scored normal. Three of the six (50%) remaining infants who received an exchange transfusion scored abnormal on the IMS while only 3 of the 39 (8%) infants without exchange transfusion were abnormal. Conclusion More than 25% of infants with a TSB of >400 μmol/l (23.4 mg/dl) scored abnormal or suspect at 4 months of age and half of these infants already showed irreversible neurological symptoms. All infants who scored abnormal or suspect on the IMS with bilirubin levels between 400 and 500 μmol/l (23.4 and 29.2 mg/dl) had haemolytic disease or were premature. Received: 4 October 1996 / Accepted: 5 February 1997     

Hypothyroldism in a neonate following excision of a cervical teratoma

Hypothyroidism developed in a neonate following the excision of a large cervical teratoma. This finding supports the observation that cervical teratomas commonly arise from thyroid tissue. Thyroid function tests should be performed routinely in all patients in whom identifiable residual thyroid tissue is not demonstrated at the conclusion of the operation. Accepted: 19 December 1997     

The Histology of the Lung in Neonates with Tricuspid Valve Disease and Gross Cardiomegaly Due to Severe Regurgitation

Lung autopsies from four neonates with Ebstein's anomaly or tricuspid valve dysplasia and gross cardiomegaly were examined. The mean cardiothoracic ratio was 92 ± 0.5%. The degrees of pulmonary hypoplasia and pulmonary artery muscularization were assessed and were compared with those in lungs from four controls and four patients with diaphragmatic hernias. Lung and body weight ratios and radial alveolar counts, which reflect pulmonary hypoplasia and immaturity, were significantly decreased only in patients with diaphragmatic hernia. The thickness of the medial muscle layer in small pulmonary arteries was greater in patients with diaphragmatic hernia; however, in patients with tricuspid valve disease, it was relatively small. Abnormal vascular muscle extension was seen only in patients with diaphragmatic hernia. In the cases of tricuspid valve disease, although cardiomegaly and lung compression were severe, lung hypoplasia and immaturity were not, and neither abnormal medial thickening nor extension were found. Our results suggest that, at least in full-term infants with tricuspid valve disease, surgical relief of lung compression may improve respiratory function, even if the cardiomegaly is severe.