Fluid and electrolyte management in preterm infants with patent ductus arteriosus

Optimal fluid management of preterm babies with suspected or confirmed diagnosis of patent ductus arteriosus (PDA) is frequently challenging for neonatal care physician because of paucity of clinical trials. There is wide variation in practice across neonatal units, resulting in significant impact on outcomes in Extremely Low Birth Weight (ELBW) babies with hemodynamically significant PDA. A delicate balance is required in fluid management to reduce mortality and morbidity in this population. The purpose of this review is to lay out the current understanding about fluid and electrolyte management in ELBW babies with hemodynamically significant PDA and highlight areas for future research.

Pituitary iron and volume imaging in healthy controls

BACKGROUND AND PURPOSE

Patients with transfusional iron overload develop iron deposits in the pituitary gland, which are associated with volume loss and HH. The purpose of this study was to characterize R2 and volumetric data in a healthy population for diagnostic use in patients with transfusional iron overload.

MATERIALS AND METHODS

One hundred healthy controls without iron overload between the ages of 2 and 48 were recruited to have MR imaging of the brain to assess their pituitary R2 and volume. Pituitary R2 was assessed with a 8-echo spin-echo sequence, and pituitary volumes, by a 3D spoiled gradient-echo sequence with 1-mm(3) resolution. A 2-component continuous piecewise linear approximation was used for creating volumetric and R2 nomograms. Equations were generated from regression relationships for convenient z-score calculation.

RESULTS

Pituitary R2 rose weakly with age (r(2) = 0.19, P < .0001). Anterior and total pituitary volumes increased steadily up to 18 years of age, after which volume slightly decreased. Females had larger pituitary glands, most likely representing their larger lactotroph population.

CONCLUSIONS

From these data, a clinician can calculate the z scores for R2 and pituitary volume in patients with iron overload. Normal ranges are well-differentiated from values previously associated with endocrine disease in transfusional siderosis; this finding suggests that preclinical iron overload can be recognized and appropriately treated.

Cyclocryotherpay and noncontact Nd:YAG laser cyclophotocoagulation in cats

PURPOSE

To investigate physiological and histologic alterations of the cat eye in response to cyclocryotherapy (CCT) and noncontact transscleral Nd:YAG laser cyclophotocoagulation (TSNYC).

METHODS

One eye of 29 cats was treated with 12 applications (1 minute, -80 degrees C) of CCT or 80 applications of noncontact TSNYC (7 to 9 J, retrofocus 3.6 mm). Blood-aqueous barrier function was studied measuring aqueous protein and fluorescein concentration after intravenous dye injection. Ocular blood flow was determined using 85Sr microspheres.

RESULTS

Intraocular pressure after CCT was 29% lower in the treated than in the control eye after 3 and 12 weeks. After TSNYC, pressure was reduced by 34% at 3 weeks and by 27% after 12 weeks. Aqueous protein concentration was elevated in all treated eyes. Neither technique altered tonographic outflow facility or episcleral venous pressure. Calculated aqueous flow was lower in the treated eye than in the control eye 3 and 12 weeks after each cyclodestructive procedure. After CCT, anterior chamber fluorescein concentration was 2.5 times greater in 3-week and 3 times greater in 12-week eyes. After TSNYC, fluorescein concentration was 3 and 3.5 times greater at 3 and 12 weeks, respectively. Ciliary body blood flow in control eyes was similar to CCT and TSNYC eyes. Histopathology 12 weeks after CCT and TSNYC showed pigment dispersion, disorganized architecture, and cystic elevation of the nonpigmented ciliary epithelium. Areas of absent pigmented and nonpigmented epithelium at the ciliary process base were more discrete in TSNYC eyes. Electron microscopy demonstrated normal junctional complexes.

CONCLUSIONS

CCT and TSNYC lower pressure by reducing aqueous formation. Ciliary body blood flow is not altered after either technique. Both techniques result in similar histologic disruption of the ciliary epithelium, resulting in breakdown of the blood-aqueous barrier.

Prolonged intraocular pressure reduction following intravitreal barium injection in rabbits

The isolated ciliary epithelium contains barium-inhibitable potassium channels. The present study was aimed at testing the in vivo effects of barium on aqueous humor dynamics in rabbits. BaCl2 was administered to one eye by topical delivery or intravitreal injection. Dynamic measurements included intraocular pressure, outflow facility, episcleral venous pressure and aqueous flow (fluorophotometry). Barium dynamics were studied using 133Ba. Intraocular pressure was not altered after topical administration of BaCl2. 133Ba was not detected in the aqueous after delivery of eyedrops containing the radiochemical. Intraocular pressure decreased following intravitreal injection of BaCl2 (0.15 microgram). The onset of this pressure reduction was 12 to 16 hr, the maximum decrease (-11.3 mmHg) occurred at 2 days, and the effect persisted (-4.2 mmHg) for approximately 12 days after the injection. Outflow facility and episcleral venous pressure were not altered. However, aqueous humor flow 5 to 6 days after the injection was decreased by 42% to 63% as determined by fluorophotometry or calculated tonographic data. The injection was not associated with findings of intraocular inflammation. Radioactivity was detected in the vitreous within the first 3 days after the injection; however, activity was present in the ciliary body, equally distributed between the cell membrane and soluble fractions, seven days after the injection. Intravitreally injected BaCl2 results in a prolonged intraocular pressure decrease relating to reduced aqueous formation. While the mechanism(s) for the BaCl2-induced decrease in pressure are not clear, possibilities include a Ba2+ interaction with ciliary epithelial K+ or N-type Ca2+ channels.