A simple device for reducing insensible water loss in low-birth-weight infants

Insensible water loss (IWL) was measured in five premature infants, 1 to 4 days old, by multiple weighings on an electronic balance inside an incubator. The babies were studied naked before and after being covered with a transparent thermal blanket. The use of the thermal blanket produced a mean reduction of 70% in IWL and a net caloric saving of 27 kcal/kg/day. There was minimal interference with nursing care. The important caloric saving achieved from reduced vaporization of water and evaporative heat loss may be an important determinant of intact survival in the high-risk infant.

Perinatal asphyxia and renal failure in neonatal patients

Herein we discuss oliguria and azotemia in neonatal patients associated with perinatal complications, including difficult labor and delivery, and respiratory asphyxia. Renal failure in these patients is accompanied by proteinuria, microscopic hematuria and red blood cell casts, and it generally resolves in 7 to 10 days. Umbilical aortography can be helpful in determining the presence of normal kidneys in these patients.

Multiple joint infections with Enterobacter cloacae

An infant with multiple joint infections from Enterobacter cloacae seems not to have been reported previously. The infant survived, incurred a pathologic dislocation of the left hip, but at 18 months of age was well with all other joints functioning normally.

Spongy degeneration of the central nervous system (van Bogaert-Bertrand type?) in a newborn infant. A light and electron microscopic study

Autopsy findings on a 5 day old infant with hypotonia from birth showed extensive spongy changes of the myelinating tracts within the cerebrum, cerebellum and brain stem. The spongy changes, similar to Van Bogaert-Bertrand disease, resulted from intramyelinic edema. However, unlike the typical forms of this disease, swollen astrocytes with abnormal mitochondria were not found. The relationship of this case to typical forms of Van Bogaert-Bertrand disease is discussed. This case may represent a very early form of Van Bogaert-Bertrand disease or a new pathological entity.

Orotracheal intubation in the newborn

One hundred consecutive cases of orotracheal intubation in the premature and term newborn at the Hersehy Medical Center were studied retrospectively. The reason for intubation was for respiratory failure most commonly associated with hyaline membrane disease. The duration of intubation ranged from six hours to 63 days. Seventy-nine percent required intubation for more than 24 hours and 28 percent required intubation for more than one week. No tracheotomies were performed. There were 56 survivors, 50 of which were seen in follow-up examination at three, six or 18-month intervals. There were no cases of clinically evident upper airway damage or obstruction in this group. Post mortem examinations were carried out on 35 infants with tracheal necrosis found in one case. The authors feel that orotracheal intubation is superior to nasotracheal intubation and tracheotomy in this age group. This method of management should be carried out where there is adequate trained personnel and professional staff and equipment capable of proper orotracheal tube placement and management.

Unsuspected pulmonary vascular abnormalities associated with diaphragmatic hernia

The pulmonary vasculature of 12 newborn infants who died with unilateral diaphragmatic hernias was studied. Four developed severe ventilatory insufficiency after birth and promptly died. Their lungs were both hypoplastic and airless dur to compression by displaced abdominal viscera and mediastinal shift. Corrective surgery permitted lung expansion and adequate ventilation for one to two hours in five infants. Subsequently, ventilatory insufficiency supervened and they died. Postoperative blood gases revealed a right-to-left ductus arteriosus shunt in one infant. Ten of the infants with hernias had a significantly greater mass of muscle in pulmonary arteries than did matched controls. This may partially explain the fetal-type circulatory infants.

Correction of essential fatty acid deficiency in newborn infants by cutaneous application of sunflower-seed oil

Two newborn infants receiving long-term, fat-free parenteral nutrition developed essential fatty acid (EFA) deficiency. Biochemical evidence of EFA deficiency was documented in plasma, red blood cells, and adipose tissue and included a decrease in arachidonic and linoleic acids, an increase in 5,8,11-eicosatrienoic acid, palmitoleic and oleic acids and a trienoic/tetraenoic ratio of more than 0.4. Cutaneous application of sunflower-seed oil, a source rich in the essential fat linoleic acid, rapidly reversed the clinical and biochemical manifestations of deficiency in plasma.

Jansen's metaphyseal dysostosis

A case of Jansen's metaphyseal dysostosis, a rare disorder of endochondral ossification, is described. This is the first case in which the severe radiographic manifestations of this disease were detected at birth. Linear growth is significantly retarded at 2 years of age. Nevertheless, because full ossification with trabeculae is anticipated, early recognition and appropriate management during the phase of active growth should minimize deformities.

Endogenous production of carbon monoxide in normal and erythroblastotic newborn infants

The endogenous production of carbon monoxide ( V(CO)) in newborn infants was measured by serial determinations of blood carboxyhemoglobin during rebreathing in a closed system. Mean V(CO) in nine full-term infants was 13.7 +/-3.6 mul CO/kg per hr (SD), and in four erythroblastotic infants V(CO) ranged from 37 to 154 mul CO/kg per hr preceding exchange transfusion. Mean red cell life-span (MLS) and total bilirubin production were calculated from V(CO). MLS in normal newborns was 88 +/-15 days (SD), and bilirubin production was 8.5 +/-2.3 mg/kg per 24 hr. This is more than twice the amount of bilirubin normally produced in the adult per kilogram of body weight. Normal infants achieved a net excretion of bilirubin of at least 5.6 +/-2.3 mg/kg per 24 hr (SD) as calculated from the bilirubin production and the measured rise in serum bilirubin concentration.The measurement of V(CO) should prove valuable in the study of red blood cell survival and bilirubin metabolism in the newborn infant.