[Osmolality of oral liquid dosage forms to be administered to newborns in a hospital]

OBJECTIVE

Oral administration of hypertonic solutions can contribute to intestinal damage in the initial stages of neonatal necrotizing enterocolitis. The purpose of this study is to determine the osmolality of oral liquid dosage forms used in a division of neonatology and to establish some recommendations for their dilution.

METHOD

The osmolality of 26 oral liquid dosage forms has been measured using the freezing-point depression method.

RESULTS

Oral liquid dosage forms used in the division of neonatology present an osmolality greater than 350 mOsm/kg H2O. 19.2% of all the analysed forms presented an osmolality lower than 1500 mOsm/kg H2O, 80.7% were over that figure, while 23% presented an extremely high osmolality (> 5,000 mOsm/kg H2O).

CONCLUSIONS

Knowledge of osmolality of oral liquid dosage forms in the division of neonatology enables the risk of intestinal aggression caused by enteral administration of the medication to be assessed.

[Recommendations for inhaled nitric oxide treatment in the newborn]

The recommendations in this document describe the current indications for inhaled nitric oxide (iNO) treatment in the newborn and clearly distinguish between those supported by scientific evidence and those for which evidence is still lacking, such as its use in preterm infants. The methodology for iNO administration, its dosage and the main secondary effects are discussed, and the reasons for lack of response to this treatment are analyzed.

[Continuous arteriovenous hemofiltration in the newborn infant]

OBJECTIVE

We present 12 newborns with acute renal failure (ARF) of different etiologies that were treated with continuous arterio-venous hemofiltration (CAVH).

PATIENTS AND METHODS

Gestational age and birth weight ranged from 26-42 weeks and 700-4, 700 grams, respectively. The umbilical artery and vein were most frequently used as vascular accesses. Two types of filters were used: Gambro FH 22 and Amicon Minifilter.

RESULTS

Treatment lasted from 8 to 120 hours. We obtained an ultrafiltration median of 25 ml/h ranging from 10.75 mL/h to 82.8 mL/h (4.1-31.8 mL/k/h). The volume balance was negative in all patients. Treatment was well tolerated. Complications included hypotension when the system was started and hypoglycemia. CAVH was stopped because of normalization of renal function in 6 cases and death in the other 6. In the latter, cardiac malformation was the cause of death in 3 cases and multiple organ failure in the other 3.

CONCLUSIONS

CAVH is useful is the treatment of ARF in the oligoanuric newborn.

[Granulocyte colony-stimulating factor in the newborn neutropenic patient]

OBJECTIVE

To assess the therapeutic effect of G-CSF in newborns with neutropenia.

METHODS

Newborn with evidence of both peripheral neutropenia and decreased granulocytic precursors in tibial bone marrow aspirate were included in the study. G-CSF was perfused intravenously over 2 hours at dose of 10 micrograms/kg/day, during 4-8 days. CBC were obtained immediately before each dose of G-CSF.

RESULTS

Neutropenia followed neonatal sepsis in four cases and maternal pre-eclampsia in three. Prior to treatment, peripheral blood granulocyte (PMNL) counts ranged from 420 to 1,073/mm3. Once G-CSF infusion was started, counts returned to normal within 24-48 hours. No adverse effects related to G-CSF administration were noticed.

CONCLUSIONS

G-CSF induces a significant increase in peripheral PMNL counts in newborn with neutropenia, in the absence of significant toxic effects. Our date suggest a potential role for G-CSF in the prophylaxis and treatment of sepsis in the neutropenic newborn, although widespread recommendation must await further, controlled studies.

[Evolution and treatment of 19 cases of pertussis in infants under 4 months of age]

We present 19 cases of pertussis in infants under 4 months of age. In all cases, Bordetella pertussis was isolated from nasopharyngeal swabs. A whooping cough, cyanotic episodes and eating disturbances were the most characteristic clinical findings. Treatment included: supportive care, salbutamol, beclomethasone, and josamycin. Lymphocyte counts higher than 40,000/mm2 were associated with a greater severity of illness. The most frequent complications were: recurrent cough and pneumonia. None of the patients died.

[Intracranial arteriovenous malformations in children and adolescents]

Six children, ranging in age from 5 years to 13 years, with a history of intracranial arteriovenous malformation were studied from 1980 to 1989. The more frequent clinical presentation was the intracranial bleeding. The brain angiography was performed on five patients who were all diagnosed with cavernous hemangioma the diagnosis was anatomopathologic. Three patients were treated with neurosurgery and two patients were treated with radiosurgery. Only one patient died after the operation and the other five had a satisfactory recovery.

[Nutritional support of premature newborn infants with birthweight below 1.500 g]

16 preterm babies with birthweights between 738 and 1,390 g (mean: 1,105. SD: +/- 176.7) and with gestational ages between 27 and 31 weeks (mean: 29.5. SD: +/- 1.32), were fed according to a combined scheme: parenteral nutrition, for a period of 12 days, plus enteral feedings of chemically defined diet, given by nasogastric tube through a continuous infusion, until the 35th week of postconceptional age. All 16 babies had a satisfactory course, with no significant side-effects. Their weight gain was between 9 and 22 g/day (mean: 13.8. SD: +/- 4.2). No significant blood biochemical abnormalities were detected. Our results showed that this combined feeding scheme (enteral & parenteral) worked satisfactorily in this group of newborn premature babies.

[Six-month treatment of pulmonary tuberculosis in children. Review of 11 cases]

Between April 1987 and April 1988, 11 children with the diagnosis of pulmonary tuberculosis, have been treated with a short-course chemotherapy consisting in the administration of isoniacid (10-20 mg/kg, maximum 300 mg), rifampicin (10-20 mg/kg, maximum 600 mg), ethambutol (15-25 mg/kg, maximum 2.5 g) and pyraxinamide (15-30 mg/kg, maximum 2g) daily for two months, followed by the administration of isoniacid and rifampicin at the same dosage, daily, for the next four months. The results were excellent, symptoms cleared in few days and laboratory values and radiographic alterations cleared in few weeks. Only one of the children had to discontinue the therapy for a pyrazinamide intoleration. The advantages of this treatment are evident, short-course suppose greater comfort for the patient, a better observance of the therapy and less cost with a similar efficacy and without a larger incidence of adverse effects. We conclude that this therapy could be in children so useful than in adults, although more studies with larger series are needed.