American journal of perinatology
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Comparative Study Clinical Trial Controlled Clinical Trial
Neonatal tumor necrosis factor, interleukin-1 alpha, interleukin-1 beta, and interleukin-6 response to infection.
Various studies have shown that in vitro production of cytokines by leukocytes from the newborn are normal, decreased, or increased. We investigated the blood levels of tumor necrosis factor-alpha (TNF-alpha) interleukin-1 alpha, interleukin-1 beta (IL-1 beta), and interleukin-6 (IL-6) simultaneously to assess the cytokine response to systemic infection during the neonatal period. One or more cytokine levels were elevated in all of the newborns with sepsis. ⋯ Gram-negative bacteria were the main causative agents in these patients, although one of them was infected with gram-positive bacteria, besides one premature infant (29 weeks) with Candida sepsis also had significantly elevated TNF, IL-1 beta, and IL-6 levels. Our data show that both mature and premature neonates were able to produce and significantly increase the blood levels of the cytokines in response to sepsis. Because the biologic relevance of cytokine levels is not known, further prospective and sequential studies on cytokine levels simultaneously and correlation with clinical parameters are needed to clarify the biological role of this important component of the host defense system.
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In 410 consecutively admitted mechanically ventilated neonates (gestational age, 34.8 +/- 4.0 weeks', birthweight, 1930 +/- 890 g) anion gap [(Na + K) - (HCO3 + Cl)] was calculated at admission to the neonatal intensive care unit. Within their first week of life, 47 neonates died and 113 neonates were extubated; in the remaining 250 neonates anion gap was also calculated at day 7. ⋯ Mechanically ventilated neonates exhibited during their first week of life a much larger anion gap than critically ill adults in recent studies. The individual critically ill newborn might be too frequently subject to metabolic disturbances as detected by anion gap to allow any prognostic information.
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I report a case of a low-birthweight infant delivered by cesarean section because of maternal preeclampsia and breech presentation. The infant developed pneumoretroperitoneum and perirenal air associated with tension pneumothorax.
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Uterine retroversion during the first trimester is quite common. However, as the uterus increases in size, self-correction usually occurs and the second trimester pregnant uterus becomes an abdominal organ. ⋯ The prevalence of late first and early second trimester uterine impaction is approximately 1 in 3000 pregnancies. Our case documents sonographically the spontaneous resolution of a markedly retroverted uterus at 26 weeks' gestation.
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The neurodevelopmental outcome of premature infants with persistent apnea of prematurity (AOP) is reported. Sixty premature infants (birthweight [BW], 1469 +/- 533 gm; gestational age [GA , 31 +/- 3 weeks) with AOP were compared to 47 control infants (BW, 1586 +/- 581 gm; GA, 31 +/- 3 weeks) matched for gestational age and degree of neonatal illness. The infants were enrolled in a multidisciplinary follow-up program, and outcome data between 12 and 24 months are reported. ⋯ Delays in motor development were seen in both premature groups, although a greater percentage of premature infants with persistent apnea had mild motor delays than did control infants. There was a comparable incidence of cerebral palsy (8% vs 11%), speech delays (20% vs 23%), retinopathy (8% vs 13%), and esotropia (7% vs 4%) between the infants with AOP and the premature control infants. The presence of persistent neonatal apnea without additional adverse perinatal events did not appear to be associated with a higher incidence of significant developmental problems.