Evaluation of a new glucose reflectance meter for use in the neonatal intensive care unit

In this study, a new glucose reflective meter was compared with a conventional laboratory measure of glucose concentration. The excellent correlation found (r = 0.988) simplicity and economic cost make the new method suitable for use in the neonatal intensive care (NICU) environment. The authors believe that the physician dealing with premature or small-for-dates infants, or infants of diabetic mothers, can base emergency therapy on the results obtained by this bedside method of blood glucose measurement pending confirmation by the clinical laboratory.

Endotoxin-induced prostanoid production by the burn wound can cause distant lung dysfunction

We injected Escherichia coli endotoxin, 2 micrograms/kg, beneath the eschar of sheep with 25% total body surface full-thickness burns to determine whether burn tissue in the presence of endotoxin releases prostanoids, particularly thromboxane A2, (TxA2), and if increased local TxA2 production can lead to distant lung dysfunction. We compared this response to the lung injury produced by the same dose given intravenously. We noted a marked increase in burn tissue TxA2 production after subeschar endotoxin as reflected in significant increases in burn lymph and pulmonary artery TxB2 levels. Pulmonary artery pressure increased from 22 to 38 mm Hg and PaO2 decreased from 89 to 71 torr while lung lymph flow (QL) increased only modestly with no evidence of increased lung permeability. The TxA2 production and the lung response were prevented by the subeschar injection of ibuprofen, 12.5 mg/kg. Circulating endotoxin was noted in only one of five sheep. After intravenous (endotoxin), a significant increase in lung TxA2 production was noted and a characteristic two-phase lung injury was seen with an initial phase basically identical to that seen with the subeschar injection followed by an increase in lung protein permeability. Burn tissue endotoxin can stimulate local TxA2 production leading to distant lung dysfunction without the need for circulating endotoxin. The source of the TxA2 is the burn, while with endotoxemia the source is the lung.

Topical ibuprofen decreases thromboxane release from the endotoxin-stimulated burn wound

A full-thickness burn wound in adult sheep releases prostanoids when they are injected locally with E. coli endotoxin, 2 micrograms/kg, resulting in an increase in pulmonary artery pressure (Ppa) from 20 +/- 3 to 34 +/- 5 mm Hg, and a decrease in mean arterial oxygen tension (PaO2) from 88 +/- 6 to 70 +/- 5 torr; this corresponds to an increase in venous plasma TxB2 content from a baseline of 220 +/- 79 pg/ml to 440 +/- 90 pg/ml. Burn prostanoid production, measured in lymph, increased ten- to fifteen-fold for both thromboxane A2, measured as TxB2, and prostacyclin, 6-keto-PGF1 alpha. The intravenous administration of ibuprofen, 12.5 mg/kg, eliminated both the increase in Ppa and decrease in PaO2 as well as the increase in burn lymph prostanoids. However, plasma prostanoids were also decreased below baseline, a potentially deleterious effect. A topical ibuprofen cream, 5% ibuprofen in a water-soluble ester, was applied to the burn hide every 6 hrs x 4 after which endotoxin was again injected below the hide. The pulmonary dysfunction was prevented as was the increase in plasma TxB2 with the value remaining at baseline. Burn lymph levels were only increased three- to five fold. Ibuprofen levels in burn lymph were maintained at 1-2 mcg/ml. The addition of the cream to the burn, however, did increase the wound bacterial content to 10(5)-10(7) bacteria/gram of tissue compared to 10(2)-10(3) for the dry, untreated burn, probably due to softening of the burn. Topically applied ibuprofen, therefore, can decrease burn wound prostanoid production from local endotoxin, preventing lung dysfunction.(ABSTRACT TRUNCATED AT 250 WORDS)

Early lung dysfunction after major burns: role of edema and vasoactive mediators

We determined the effect of a body burn on pulmonary function. Full-thickness burns varying in size from 25 to 70% of total body surface (TBS), were produced in sheep. Resuscitation was performed with lactated Ringer's. We noted an increase in lung transvascular fluid flux as measured by lymph flow, Q1, during the resuscitation period, varying from one- to threefold over baseline with the degree of increase directly proportional to the burn size. The increase in QL could be totally explained by the degree of hypoproteinemia which was also proportional to burn size. Transient pulmonary hypertension 20 +/- 4 to 26 +/- 5 mm Hg and a decrease in PaO2 from 90 +/- 5 to 83 +/- 6 torr occurred in the 50 and 70% burns as well as a significant decrease in lung compliance. These alterations were not due to pulmonary edema as there was no increase in measured lung water. Also, the increase in QL could be prevented by using a combination of Dextran and protein for resuscitation but this had no effect on the hypertension or hypoxia. Burn lymph and venous plasma thromboxane levels were increased during this period of lung dysfunction. Ibuprofen 12.5 mg/kg preburn and 12.5 mg/kg every 2 hours postburn decreased the degree of dysfunction suggesting a cause and effect relationship.

Vitamin B6, vitamin C and folacin levels in milk from mothers of term and preterm infants during the neonatal period

Studies of the composition of milk from mothers who deliver prematurely have focused primarily on macronutrients and trace elements while its vitamin composition has received little attention. This study focused on vitamin B6, vitamin C and folacin in preterm (PT) and term (T) milk which are critical to early growth and development. Fifteen PT and twelve T mothers were studied for five 24-h periods during the first month of lactation. Vitamin C levels were higher in PT milk during the first week of lactation whereas folacin levels were similar to T milk. Vitamin B6 levels in PT milk were lower than in T milk throughout the first month postpartum. These findings suggested that the use of PT milk as the sole source of these nutrients is open to question and that during the neonatal period PT infants need supplements of certain micronutrients.

Factors affecting visitation of sick newborns

A study of visiting patterns to an intensive care nursery over a 6-month period was undertaken. Data on visits were obtained from 167 admissions, 99 of which were from infants transferred from other towns. In addition, the parents were interviewed to determine factors precluding visiting. Inborn (Group A) and out-of-town (Group B) data were analyzed. For Group A, the mean number of weekly visits was 6.59 (range, 1.7-16.5) and the total cost of visiting during hospitalization was $135.00 (range, 5.76-649.36); for Group B, the figures were 3.6 (range, 0.1-12.4) and $328.00 (range, 12.96-1523.36), respectively. Parents in Group B visited less often, made fewer telephone inquiries, and earned a lower salary than parents in Group A. Frequency of visits was correlated to social class. The most commonly identified factors limiting visiting were care of siblings, demands of work, cost of the trip, and distance.

Effect of storage time and temperature on folacin and vitamin C levels in term and preterm human milk

A survey of infant feeding practices indicated that 40% of the mothers who breast-fed their infants frequently expressed and stored their milk in the home refrigerator/freezer prior to feeding. Effects of different lengths of storage time on the levels of folacin and vitamin C in both term (T) and preterm (PT) human milk were examined. Folacin and vitamin C intakes of most mothers were such that the levels of these vitamins in milk appeared to have reached saturation. Folacin levels in T and PT milk were similar but were lower in both after three months of freezer storage compared to one week of storage. Vitamin C content in PT milk was significantly higher than that in T milk and did not change after three months of freezer storage, whereas the vitamin C level in T milk decreased significantly. After 24 hr refrigeration of T milk, vitamin C content was lower but the folacin level was similar to that observed prior to refrigeration. The findings indicated that T or PT human milk, stored for 3 months in the freezer, would provide the recommended allowance of vitamin C but not of folacin for infants.

Rapid turnover transport proteins, plasma albumin, and growth in low birth weight infants

The purpose of this investigation was to establish normative data and to determine the value of measuring rapid plasma turnover proteins in low birth weight infants during the neonatal period. Forty-three premature, adequate for gestational age infants were divided in three groups according to their birth weight: group A less than 1000 g, group B 1001 to 1500 g, group C 1501 to 2000 g. Weekly anthropometric measurements and biochemical determinations were obtained. Anthropometric measurements included weight, crown heel length, midtricipital skinfold thickness, and midarm circumference. Biochemical studies in plasma included total proteins, albumin, prealbumin, and retinol-binding protein. A significant increase in prealbumin concentration preceded weight gain. The elevation in prealbumin concentration was statistically significant (p less than 0.02) for the combined data from all groups and for infants included in group B and C (p less than 0.05). No concomitant changes were demonstrated in plasma retinol-binding protein, or total proteins. The transient rise in prealbumin plasma concentrations remains unexplained, but may be related to the infant's nutritional status.

Polymorphonuclear leukocyte regulation of lymphocyte proliferation and differentiation

The polymorphonuclear neutrophil (PMN) regulates in vivo and in vitro immune responses. We report that the immunoenhancing properties of PMN culture supernatants from PMN recruited by the bacterium Actinomyces viscosus (AV) show its exclusive effects on the T cell lymphocyte population. A study of the effect of PMN supernatants on normal Balb/c splenocytes to T and B cell mitogens showed enhancing effects on T cell mitogens, but no effect on B cell mitogen responses when compared to a control. Adherent cells (macrophages) were not required for the enhancing effect, indicating that the supernatant worked directly on the T cell. Proliferation of El-4, a Lyt-1.2 positive lymphoma helper cell, was directly affected by these supernatants. Functionally, T cell-dependent plaque-forming cell responses to sheep red blood cells (SRBC) were enhanced. The polyclonal, T cell-independent plaque-forming cell response was unaffected when generated with LPS as assayed with Protein-A-SRBC. These results indicate that PMN supernatants from cells recruited by AV act on a helper T cell population to enhance both proliferation and differentiation in lymphocyte populations. These interactions provide insight into local inflammatory responses of PMN-lymphocyte infiltration with altered cell-mediated immunity.

Performance of a level II nursery in a neonatal regional program: part I. Patient population and role of the general pediatrician

We examined the performance of a level II nursery in a regional neonatal program during a 30-month period. Of 3,851 live-born infants, 527 (13.7%) were admitted to the special care nursery and 70 (1.8%) were transferred to a level III nursery. There were 23 neonatal deaths, ten of them in the level II facility; the other 13 infants had been transferred to a level III center and died there. Three hundred eleven (59%) of the admissions to the special care nursery were infants whose birth weights exceeded 2,500 gm, and 241 (46%) were of more than 37 weeks' gestation. There were 262 infants admitted with respiratory distress. In an additional 55 infants, respiratory distress was part of their clinical presentation. Procedures done by the professional staff reflected these needs. A total of 3,476 days of care were provided in the special care nursery, with a mean duration of 6.6 +/- 5.91 days (+/- 1 SD). Physician time required in the special care unit was 2,317.3 hours, an average of 4.4 hours per admission. These data support the contention that general pediatricians operating level II nurseries within a regionalized program can provide care of the majority of newborns, including care of the majority of ill neonates.

Increment-decrement tables for human reproduction

This paper illustrates the application of increment—decrement life table methods to the study of family building patterns among women. Here age at the oocurrence of a specified birth is considered the principal duration variable. Data from a sample of currently married women from the 1965 US National Fertility Study were used to illustrate the method.

Importance of initiation factor preparations in the translation of reovirus and globin mRNAs lacking a 5'-terminal 7-methylguanosine

Reovirus and globin mRNAs which lack a 5'-terminal 7-methylguanosine are translated in a fractionated cell-free protein-synthesizing system. Efficient translation occurs only at optimal concentrations of reticulocyte initiation factor preparations and does not occur at optimal concentrations of ascites initiation factor preparations or at suboptimal concentrations of reticulocyte initiation factor preparations. The translation of "uncapped" mRNA in vitro, therefore, appears to be related to the efficiency of initiation of protein synthesis. At optimal concentrations of reticulocyte initiation factors, mRNA containing a 5'-terminal 7-methylguanosine is preferentially translated in the presence of mRNA which lacks a "cap." These results indicate that the 5'-terminal 7-methylguanosine on mRNA has a facilitatory rather than obligatory role in translation.

Sterility testing: how appropriate for the hospital

In the hospital the need to test for sterility is as vital as in industry. However, the means of accomplishing this are quite different. The sterile "products" produced are used prior to a final sterility certification and this time-honored concept presents interesting challenges. Associated with the techniques of monitoring sterility are numerous problems. The difficulty of the hospital attempting to sterility-test sterile disposable devices they have purchased and shortcomings involved in culturing techniques used to evaluate the hospital's internal sterilization program are reviewed, A program for assurance of sterility based on proper monitoring ot the sterilizer and adequate preparation of the goods being processed are given.