Pharmacokinetics of vitamin K1 in low-birth-weight neonates

The pharmacokinetics of vitamin K1 was studied in 21 newborn infants. 11 neonates had received no parenteral loading dose prior to the study (group I), while 10 had been injected 5-10 mg vitamin K1 at birth (group II). At postnatal age 2-9 h, 1 mg of vitamin K1 was injected intravenously, and small samples of blood (less than or equal to 500 microliter) were collected at different times during 6 h. Serum vitamin K1 and its epoxide were assayed by high-performance liquid chromatography (HPLC). In both groups, the disappearance curve showed two exponential components: a fast distribution component during the 1st h and a slower elimination component during the next 5 h. In group I, the plasma half-life of the first component was between 18 and 52 min (median 23 min), and the half-life of the second was between 67 and 179 min (median 109 min). Both half-lives were significantly higher in group II. The volumes of distribution were suggestive of distribution into plasma during the first phase and roughly into the extracellular water for the second component. Epoxide was detected in most patients 15 min after vitamin K1 injection, and after 3 h its concentration was higher than the concentration of vitamin K1. These data suggest that the kinetics of vitamin K1 in neonates is not very different from that in adults. The newborn infant is able to oxidize vitamin K1, a phenomenon in keeping with the gamma carboxylation of glutamic acid.

Evolution of serum prealbumin, C-reactive protein, and orosomucoid in neonates with bacterial infection

The simultaneous changes in serum prealbumin, orosomucoid (alpha-acidglycoprotein, AGP), and C-reactive protein (CRP) were evaluated in 36 newborn infants with septicemia (n = 20), meningitis (n = 10), arthritis (n = 5), and peritonitis (n = 1). In 29 patients with a favorable outcome the values for serum prealbumin and CRP showed a rapid return toward normal: in 2 to 3 days serum prealbumin increased by 84% from the basal value and remained at (mean +/- 1 SD) 0.11 +/- 0.02 gm/L. Serum CRP decreased from 85 +/- 75 mg/L (range 0.15 to 206 mg/L) to 49 +/- 64 mg/L (2 to 210 mg/L) at 3 to 4 days of evolution and to normal values at day 13 to 16. The changes in serum orosomucoid values were slower, from 1.33 +/- 0.75 gm/L to 1.16 +/- 0.75 gm/L at day 13 to 16, with normalization after 20 to 30 days. Serum orosomucoid values returned to the normal range with the clinical improvement. In some patients the orosomucoid/prealbumin ratio decreased earlier than the serum orosomucoid concentration. Seven patients died, and in four of these in whom at least three values could be determined serum CRP and orosomucoid remained very high, whereas serum prealbumin did not increase or subsequently decreased. These data show an inverse change in serum CRP and prealbumin concentrations in infected neonates. The immediate decrease in CRP reflects the effect of treatment, whereas the later decrease in serum AGP parallels the clinical course of the infection. Thus the determination of these proteins can help to guide the treatment of infection in newborn infants.

[The Antley-Bixler syndrome. Review of the literature. Apropos of a personal case]

A female newborn presenting multiple congenital anomalies with acrocephalosynanky, external auditory canals atresia, vertebral anomalies, is described as being affected of an Antley-Bixler Syndrome. The authors compare this case with the eight others reported with this disorder, of whom two are sisters.

[Course of inflammatory and nutrition proteins in bacterial infections in newborn infants]

A study of 214 neonates (with 87 premature infants) reveals that C-reactive protein (CRP), orosomucoid and prealbumin are the most interesting proteins for the diagnosis of neonatal sepsis and for studying its follow-up. Orosomucoid is high in 85% of bacterial infections and CRP in 75%. Early type strep B infections give often false negative results. The evolution of CRP and of prealbumin corresponds to the effects of treatment and the evolution of orosomucoid is parallel to the healing of the patients. The ratio orosomucoid/prealbumin allows an earlier appreciation of the healing.

Severe ornithine transcarbamylase deficiency. Two and a half years' survival with normal development

The clinical course and management of a boy with severe ornithine transcarbamylase deficiency are described. In addition to treatment with sodium benzoate and amino acid keto analogues, mannitol may be useful in hyperammonaemia and nocturnal gavage feeding aids maintenance treatment.

Open-angle glaucoma associated with posterior polymorphous dystrophy. A clinicopathologic study

Clinical and histopathologic features of a 62-year-old black man with posterior polymorphous dystrophy and open-angle glaucoma requiring trabeculectomy are reported. The surgical procedure was modified to allow en bloc resection of the deep limbal tissue and peripheral iris. Light and electron microscopy of the specimen revealed a high insertion of the iris into the posterior portion of the trabecular meshwork with compression of the intertrabecular spaces. These findings are similar to changes that have been reported in primary congenital glaucoma and suggest a developmental anomaly of the anterior chamber angle in this form of glaucoma associated with posterior polymorphous dystrophy.

[Syndrome of terminal deletion of the long arm of chromosome 4. Apropos of a personal case with a review of the literature]

With one personal case and thirteen cases from literature about distal deletion of the long arm of chromosome 4 (4 q-), authors try to describe a clinical syndrome related to deletion of segment 4 q 31 leads to q ter. This syndrome includes a normal intrauterine growth, a growth and mental retardation. Morphological abnormalities consist in microcephaly, palato-cheiloschisis with micrognathia, hypertelorism with epicanthald folds, large nose bridge with anteverted nases, various anomalies of ears; clinodactily of Vth finger and toe, various cardiac defects. New banding techniques (prometaphase) have led to more precise delineation of break point, but this very distal deletion could not bring any new information for the gene mapping.

[Acquired neonatal herpes]

The authors report a case of neonatal herpes simplex infection with favourable outcome, without any sign of meningo-encephalitis or dissemination. The child was given antiviral treatment with Acyclovir from the first day of rash. Vesicle scraping and a complete serologic study of both child and mother proved infection was due to herpes simplex virus type I, transmitted to the neonate during primary maternal infection with gingivostomatitis beginning on the day of delivery. The different routes of postnatal contamination of the neonate by herpes virus and the risks of dissemination are reviewed. The importance of preventing contamination and dissemination of a known herpetic infection in maternity-hospitals and in nurseries for newborns is emphasized. Antiviral treatment should be used in all neonates with localized herpetic infection.

[Neonatal ulcero-necrotizing enterocolitis and aspergillosis]

A preterm infant of 33 weeks of gestation and very small birthweight 1040 g developed on the third day of life a necrotizing enterocolitis with spontaneous perforation. Peritoneal fluid and small bowel meconium was cultured and revealed Aspergillus Niger. The literature is reviewed with seven cases of aspergillosis in newborn period. The infant is dead on the tenth day of life from periventricular haemorrhage. Necropsy was performed and revealed no secondary aspergillosis localisation.

[Prolonged curarization in the newborn infant under assisted ventilation for idiopathic respiratory distress]

We studied the effects of prolonged pancuronium administration in 10 neonates under assisted ventilation for hyaline membrane disease. Pancuronium bromide was administered from the time of intubation with a load dose of 0.1 mg/kg followed by a continuous infusion of 0.03-0.07 mg/kg/h. Tolerance, especially cardiovascular, was excellent after 72 to 525 h of therapy (mean 173 h). Oxygen needs, incidence of mechanical complications and the general evolution of idiopathic respiratory distress were not significantly affected by muscle relaxation. The benefits of systematic pancuronium administration during respiratory intensive care in neonates with hyaline membrane disease appear to be of little value when considering the necessary constraints (corneal, cutaneous, vesical and tracheal supervision).

[Hyperextension of the fetal head associated with hyperextension of the dorso-lumbar spine. Apropos of a case diagnosed in utero]

The authors report a case where hypertonicity resulted in extension of the cerebral spine in a fetus. They think that they are reporting a case of congenital hyperextension of the lumbar spine, which is otherwise called "the newborn stiff-man syndrome". The outlook for this child is good in spite of the gross abnormality that is revealed on the X-rays of the fetus. Caesarean section is therefore indicated.

[Hyponatremia and theophylline in very low birthweight premature infants]

A retrospective study of the occurrence of hyponatremia (i.e. less than 135 mmol/l) was carried out in 17 control preterm neonates and 25 infants treated with theophylline. These infants had a birthweight lower than 1,301 g and a gestational age less than 36 weeks. Despite a similar sodium and water intake in both groups, hyponatremia was detected at the age of 7-8 days in 37% infants treated with theophylline and none of the control infants. Their mean weight loss was 11% with theophylline and 5% in the controls. These data suggest that theophylline may play a role in the occurrence of hyponatremia of very low birthweight infants.

[Necrotizing enterocolitis and cytomegalovirus infection (author's transl)]

During an 18-month period, 11 cases of necrotizing enterocolitis (NEC) were diagnosed in infants treated in Neonate Department. This represents 1% of total admissions. Six cases occurred during hospitalization. Clinically, the disease took three different forms: surgical form, medical form responding well to exclusive parenteral feeding and isolated haemorrhagic form, which deserves discussion. Seven of these infants had cytomegalovirus (CMV) infection. NEC accounted for 22% of clinical symptoms in CMV infection. These data suggest that the cytomegalovirus may act as aggravating factor in NEC.