The role of high-dose oral iron supplementation during erythropoietin therapy for anemia of prematurity

OBJECTIVE

To assess whether a high intake of oral iron would increase the effect of recombinant human erythropoietin (rHuEPO) on hemoglobin synthesis.

METHODS

We studied 30 preterm infants (gestational age 29+/-1.8 weeks, birth weight 1161+/-200 g, at age of 28+/-10 days) who were randomly assigned to receive either 8 mg/kg per day (n=15) or 16 mg/kg per day of oral iron during a course of rHuEPO therapy (900 microg/kg per week) for a duration of 4 weeks. Both groups were comparable in regard to clinical and laboratory data at the time of enrollment.

RESULTS

rHuEPO caused a significant increase in reticulocyte count in the low- and high-dose iron groups, 17.1+/-5.3 to 34.7+/-9.2 and 16.3+/-3.3 to 42.5+/-5.6 (10(9)/l), respectively (p<0.05). However, in both groups, hematocrit values remained stable at the end of the study as compared to baseline (0.35+/-0.03% vs. 0.30+/-0.03%, 0.35+/-0.05% vs. 0.30+/-0.03%, NS) and in both groups there was a comparable and significant decrease in ferritin level (259+/-109 to 101+/-40 and 168+/-54 to 69+/-38 microg/l, respectively; p<0.01). The rates of bloody stools without any evidence of necrotizing enterocolitis were not significantly different between the two treatment groups (1/15 vs. 4/15, NS).

CONCLUSION

We conclude that a higher dose (16 mg/kg per day) of oral iron is not more beneficial when compared to a lower dose (8 mg/kg per day) during rHuEPO therapy for anemia of prematurity. Further studies will define the optimal dosage and route of administration of iron supplementation during rHuEPO therapy.

Doppler echocardiographic study of the pulmonary artery and its branches in 114 normal neonates

It has been shown that there are pressure gradients between the main pulmonary artery (MPA) and its two branches in infants undergoing catheterization. This study investigated the blood flow velocities and pressure gradients in the right and left pulmonary arteries (RPA and LPA, respectively) in normal neonates. The MPA and its two branches were examined echocardigraphically in 114 term consecutive healthy neonates aged 1-6 days. The pressure gradients between the MPA and RPA or LPA were calculated. Thirty neonates with pressure gradients above 2.5 mmHg were followed by 3-6 months. The peak velocities in the RPA and LPA (1.16 +/- 0.19 and 1.01 +/- 0.18 m/s) were significantly higher than that in the MPA (0.84 +/- 13 m/s) (both p < 0.001), with that in the RPA slightly higher than in the LPA (p < 0.001). There was an estimated pressure gradient of 2.5-8.3 mmHg between the MPA and RPA in 43% and of 2.5-6.6 mmHg between the MPA and LPA in 16.7% of all neonates. The gradients disappeared within 3-6 months in 12 (40%) of the 30 neonates with an initial gradient above 2.5 mmHg. The differences in blood flow velocities or pressure gradients in the RPA or LPA were probably attributable to the variations in pulmonary arterial pressure, cardiac output, age, and birth weight and can be considered physiologically characteristic in neonates.

High prevalence of muscular ventricular septal defect in neonates

OBJECTIVES

This study sought to use echocardiography to evaluate the prevalence of muscular ventricular septal defect in neonates.

BACKGROUND

Ventricular septal defect is usually asymptomatic and closes spontaneously. An increase in its prevalence has been noted recently. One reason is the improved detection of small defects, especially with the increased used of echocardiography. Therefore, one would expect a higher prevalence in neonates on the basis of echocardiographic screening.

METHODS

Color Doppler echocardiography was performed in 1,053 consecutive neonates 6 to 170 h old at Western Galilee Hospital, Israel. Data on the neonates, parents and family were obtained to analyze the influencing factors. The identified patients were followed up for 1 to 10 months or until ventricular septal defect closure.

RESULTS

Muscular ventricular septal defect was found in 56 (25 male, 31 female) of the 1,053 neonates, a prevalence of 53.2/1,000 live births. All neonates were asymptomatic. Six had a systolic murmur. Electrocardiographic findings were normal in 44 (97.8%) of 45 neonates followed up, and left ventricular hypertrophy occurred in 1 (2.2%). By echocardiography, 50 ventricular septal defects (89.3%) were single and 6 (10.7%) were multiple. The defects (range 1 to 5 mm in diameter, mean [+/- SD] 2.3 +/- 0.8) occurred anywhere along the muscular septum; 43 (76.8%) were detectable only on color Doppler imaging. The left atrium and left ventricle were mildly dilated. Of 45 neonates who were followed up for 6 to 10 months or until closure of the defects, 40 (88.9%) had defects that closed spontaneously. The risk of ventricular septal defect was not significantly associated with gestational age, birth weight, birth order, maternal age, diabetes, smoking, exposure to drugs or infection, paternal age, familial congenital heart disease, religion or consanguinity.

CONCLUSIONS

There is a prevalence of muscular ventricular septal defect in neonates of 53.2/1,000 live births. The patients were asymptomatic, and 88.9% had defects that closed spontaneously within 1 to 10 months. These defects may be caused by environmental factors. In many cases, muscular ventricular septal defect may also result from delayed physiologic development.

Electrical stimulation effect on extensor lag and length of hospital stay after total knee arthroplasty

The effects of electrical stimulation in conjunction with traditional physical therapy, on knee extensor lag and length of hospital stay among patients recovering from total knee arthroplasty were assessed. Forty patients who underwent total knee replacement (TKR) were randomly assigned to either an electrical stimulation group (16 females, 5 males), or a control group (15 females, 4 males). Both groups received conventional physical therapy including continuous passive motion (CPM) to the affected limb, ambulation training, range of motion exercises, and activities of daily living (ADL) training. The experimental group additionally received electrical stimulation during CPM treatment. Experimental group subjects reduced their extensor lag from 7.5 to 5.7 degrees, whereas control group extensor lag increased from 5.3 to 8.3 degrees. These trends were significantly different (p < .01). Rehabilitation discharge criteria were reached in 6.7 days in the experimental group and 7.4 days in the control group. These differences were also significant (p < .05). The results of this study indicate that the application of electrical stimulation during recovery from TKR can effectively reduce extensor lag and decrease the length of hospital stay.

Familial congenital micromelic dysplasia with dislocation of radius and distinct face: a new skeletal dysplasia syndrome

Recently Maroteaux et al. [Am J Med Genet 32:371-375] described omodysplasia as a new distinct congenital bone disorder in 3 cases; autosomal dominant inheritance was suggested. In this same report, 2 other cases (patients 4 and 5) presented with the same facial and upper limb anomalies, but were also noted to have severe shortness of lower limbs. The authors considered all 5 cases to represent variable expressivity of the same disorder, namely, omodysplasia. Here we report 4 patients (3 survivors), offspring of consanguineous Arabic-Moslem couples. All presented at birth with severe short limb dwarfism and facial and radiologic appearance quite distinct from the first 3 patients of Maroteaux et al. [1989] with so-called omodysplasia. Thus, we suggest that our 4 cases and patients 4 and 5 of Maroteaux et al. [1989] represent a distinct, previously unpublished bone dysplasia.

Spinal empyema in Crohn's disease

A 19-year-old man with a 1-year history of Crohn's disease of the ileum and rectosigmoid developed back and leg pain with neurological deficits. He proved to have an epidural and subdural spinal empyema originating from a rectal fistula. Drainage of the empyema, a diverting sigmoid colostomy, and appropriate antibiotics allowed full recovery of neurologic function and resolution of infection. We review the applicable literature.

The use of a synthetic skin covering as a protective layer in the daily care of low birth weight infants

Skin damage is often seen as a result of the use of adhesive ECG electrodes. The protective quality of a new synthetic dressing, Omiderm, was tested on 34 infants weighting 800-3850 g. In a controlled trial the amount of skin damage caused by heart monitoring electrodes was evaluated after 48 h in which Omiderm protected the infants' chest and after an additional 48 h without protection. Omiderm did not interfere with the heart monitoring process. Results showed significantly less damage in the protected areas. No toxic or allergic reactions were observed.

Molecular motion of DNA as measured by triplet anisotropy decay

We have used triplet anisotropy decay techniques to measure the internal flexibility and overall rotational motion of DNA, covering a time range from 15 ns to 200 mus. Nearly monodisperse DNA fragments 65--600 base pairs long were studied by using the intercalating dye methylene blue as a triplet probe. We found that the slow end-over-end tumbling of short DNA fragments (less than or equal to 165 base pairs) is as predicted for a rigid rod. As expected, a longer DNA fragment (600 base pairs) experiences slow segmental motion of its helix axis. We found that, at the earliest times, anisotropy decays more rapidly than expected for a rigid rod, suggesting that, when bound, methylene blue monitors fast internal motion of the helix. Since the rod-like end-over-end tumbling of short fragments rules out fast bending motions, we conclude that the fast components of DNA anisotropy decay are due to twisting motion of the helix, occurring with a time constant near 50 ns.