High-versus low-dose erythropoietin in extremely low birth weight infants. The European Multicenter rhEPO Study Group

OBJECTIVE

To investigate whether a weekly 1500 IU/kg dose of recombinant human erythropoietin (rhEPO) is more effective than a dose of 750 IU/kg/week in preventing anemia and reducing the transfusion need in infants with birth weights less than 1000 gm.

STUDY DESIGN

In a randomized, double-blind, multicenter trial, 184 infants with birth weights between 500 and 999 gm were treated with either rhEPO 750 (low-dose group) or 1500 IU/kg/week (high-dose group) from day 3 of life until 37 weeks' corrected age.

RESULTS

Thirty-two percent of the infants in each group did not receive any transfusion during the treatment period. The total volume of erythrocytes received was similar in each group. The success rate, defined as no transfusion needed and hematocrit value 0.30 L/L or greater, was 27.6% in the low-dose and 29.5% in the high-dose group (p = 0.96).

CONCLUSION

Doubling the rhEPO dose of 750 IU/kg/week is not indicated in infants with birth weights less than 1000 gm.

Concentration of purine compounds in the cerebrospinal fluid of infants suffering from sepsis, convulsions and hydrocephalus

Catabolites of purine nucleotides were measured in the cerebrospinal fluid (CSF) of newborn infants with sepsis, seizures and hydrocephalus using isocratic reversed-phase HPLC. The inosine levels in the CSF of the infants with any of the illnesses were significantly higher when compared with the controls. There was a tendency for hypoxanthine levels to be higher in the group of children with hydrocephalus. No significant differences in the concentrations of xanthine, adenine and uric acid were found. The inosine concentration in the CSF is proposed to be a more sensitive indicator of brain injury than the levels of other CSF purines. The levels of all purine metabolites measured in the CSF showed large individual variations. The ratio between hypoxanthine (as an indicator of ATP breakdown) and uric acid (as a scavenger of oxygen free radicals) concentration is proposed as a new criterion to be used in the evaluation of brain injury.

[Clinical significance and fetal outcome in end-diastolic decreased flow in the umbilical artery and/or fetal aorta: analysis of 51 cases]

The AEDV in the umbilical artery or the foetal aorta is considered to be the most severe waveform abnormality. Using pulsed Doppler, we found such a waveform in 51 foetuses out of 954 high-risk pregnancies (33/51 in both vessels, 17/51 aorta only and 1/51 umbilical artery only). A reverse flow was registered in 24 foetuses. The outcome was compared with that of a control group (n = 72) showing normal Doppler findings. The following parameters were highly significant (p less than 0.001): Rate of Caesarean section owing to foetal distress (85.3% to 4.8%), of growth retardation (IUGR) (66.7% to 6.0%), of premature delivery (73.5% to 7.5%), of low postnatal pH- and Apgar score (73.5 to 12.1%), of admission to the neonatal intensive care unit (94.1% to 8.6%), of morbidity (35.3% to 2.3%) and of mortality (41.1% to 0%). We observed 17/51 intrauterine and 4/51 postnatal deaths. The rate of malformations was 35.3% with 4 cases of aneuploidy. Considering the malformations, the rate of corrected mortality was 23%. We found, that the association of an AEDV and the absence of severe IUGR is highly suspicious of malformation. We also observed, that congenital heart diseases (CHD) could lead to an AEDV too. An AEDV precedes a pathological cardiotocogram (CTG) with a latency of 0 to 35 days (mean 9.5 days). This latency is not predictable, but we think, that a reliable assessment of jeopardy is possible by analysing further vessels (Aa. arcuatae, A. renalis, A. carotis interna): 72.5% of the foetuses with AEDV had high indices in the carotid artery and 93.1% among these showed a pathological CTG pattern.(ABSTRACT TRUNCATED AT 250 WORDS)

[Caroli syndrome in childhood. Review and report of a patient with an unbalanced karyotype]

This paper describes the clinical symptomatology, the pathogenesis, diagnosis and therapy of the Caroli'Syndrome with a special reference to differences to other congenital hepatic diseases with similar manifestations. We report on a male infant with a Caroli'Syndrome, which is associated with a chromosomal imbalance and other malformations and discuss the genetical background.

[Enterococci as pathogens of severe infections in newborn infants and young infants]

We report about severe perinatal infections caused by enterococci during a 5 year-period. Between January 1983 and December 1987 8 infants were treated in the Department of Neonatology of the Charité-Hospital, 5 of them died. In 4 of the infants this infection was of the early onset type and in 4 infants the infection had a late onset. The clinical course of the four infants with early onset type was very similar to that of infants with group-B-streptococcus disease. The increase of severe infections caused by enterococci in 1987 (7 cases) is unclear. One cause of the increase could be, that the chemotherapy of septicemia and meningitis in the Department of Neonatology of the Charité is the combination cefotiam and gentamicin or cefotaxime and gentamicin. Enterococci are resistant to all cephalosporins and a selection of these pathogens after this therapy is possible. In vitro and clinical experience has demonstrated, that a ampicillin-gentamicin combination constitutes effective therapy for enterococcal infection.

Nosocomial infections due to Serratia marcescens--clinical findings, antibiotic susceptibility patterns and fine typing

We report on nosocomial infections caused by Serratia marcescens occurring in a neonatal intensive care unit and a children's ward for cardiac intensive care. According to the plasmid pattern analysis, all isolated epidemic strains belonged to one clone. Multi-drug resistance, even to cephalosporins of the third generation and amikacin, was characteristic for all strains. Certain markers of S. marcescens (haemolysin, proteases, siderophores) which are thought to be related to virulence were studied but will require further investigation.

[Fibronectin concentrations in the plasma of newborn infants and their mothers and various plasma preparations]

The article describes a method for the quantification of plasma fibronectin (FN) by means of electroimmunodiffusion after Laurell. By this means the fibronectin concentrations of healthy, mature newborns as well as of their mothers were determined. The average FN-level of the newborns lies at 33% related to the value for adults and at 48%, respectively, related to the maternal FN-content. There is no difference between male and female newborns. The FN-concentrations of the adults stated by us with 330 and 314 mg/l, respectively, for males and females correspond to the data in literature. Furthermore, the FN-content in plasma preparations was determined, with an average value of 2,356 mg/l this was highest in the factor-VIII-concentrate. The expediency and the prerequisites for a possible fibronectin substitution are discussed.

The concentration of hypoxanthine and lactate in the blood of healthy and hypoxic newborns

This work examines the correlation between the concentration of hypoxanthine and lactate, the clinical course, and the parameters of the acid-base metabolism in newborns. In order to obtain normal values in mature, healthy newborns (Group A) 136 determinations of hypoxanthine and 126 determinations of lactate in blood were performed in the first five postnatal days. In well prematures (Group B) hypoxanthine was determined 18 times and lactate 16 times. In newborns requiring oxygen therapy including ventilator support (Group C) hypoxanthine and lactate were determined 36 and 31 times respectively. Hypoxanthine levels in the blood of mature healthy newborns decreased with increasing age. A similar course is known for lactate levels. In the group of well prematures (Group B), hypoxanthine and lactate levels have an age dependent course similar to that in group A. Correlations between hypoxanthine and lactate concentrations were observed in all three groups but were not noted to be as well defined as has been seen experimentally (e.g., by SAUGSTAD) and thus confirm the clinical results of other authors. Among the newborns requiring oxygen therapy (Group C) 7 of 36 hypoxanthine values were more than two standard deviations above those in the normal group. For lactate group C infants were in 12 of 31 cases above the two standard deviation range. The hypoxanthine and lactate concentrations of group C newborns were correlated with clinical and biochemical indicators of hypoxia. Infants with unequivocal signs of hypoxia showed elevated as well as normal hypoxanthine and lactate levels. Conversely, infants without clinical, pathological or biochemical hypoxia indicators showed in some cases elevated hypoxanthine and lactate values.(ABSTRACT TRUNCATED AT 250 WORDS)

Separation and characterization of red blood cells from newborns and infants during the first trimenon of life using a dextran density gradient: mean cellular volume and mean cellular haemoglobin concentration

The adaptation of cell physiological parameters of erythrocytes of the newborn to erythrocytes in later life was studied by cell separation in an isopycnic dextran density gradient. The cell characteristics during the first trimester of life were followed by repeated determinations. The mean cellular haemoglobin concentration of the lightest cells is remarkably less than that of the cells of median density. This is probably due to the ongoing synthesis of haemoglobin in reticulocytes, which are highly concentrated in the top fractions. It was shown that the young cells released from the bone marrow become progressively smaller during this period with a decrease of mean cellular volume (MCV) from 104 micrometer3 at birth to 85 micrometer3 at the end of the first trimester. It has been established that this process commences during the first week of life. No difference concerning the alterations of cell parameters, especially MCV, in premature and mature infants was found. It is therefore probable that these alterations are due to changes in the external milieu following birth.

Separation and characterization of red blood cells from newborns and infants during the first trimenon of life by means of a dextran density gradient. Density distribution curves of erythrocytes and reticulocytes

Longitudinal studies on the density of erythrocytes and reticulocytes were performed by means of the isopyknic density gradient centrifugation in dextran on three mature newborns and six premature infants during the first 3 months of life. Striking changes of the density distribution curves of red blood cells took place during the first trimenon. Median density (D50) reached its maximum between the 7th and 28th day of life. D50 of reticulocytes was lower than that of the total red blood cell population and shows similar changes to the whole cell population during the first trimenon after birth. Based on the close relationship between D50 and the percentage of lightest cells, the evaluation of the percentage of the lightest cells was recommended as a simple test to study the changes in median density.