Methemoglobinemia is an uncommon clinical problem generally caused by inherited disorders of hemoglobin metabolism or environmental toxicity from oxidizing agents. Since methemoglobin has no oxigen carrying capacity, patient with severe methemoglobinemia may have dangerous hypoxia even when arterial oxygen tension is normal. Degree of exposure to oxidants which are benign for older individuals may produce severe methemoglobinemia I Fetal hemoglobin has increased susceptibility to oxidatin. NADH diaphorase activity is reduced to 60% of adult levels in newborn erythrocytes. Low pH further reduces the activity of the enzyme. We report our experience with 5 unrelated nweborns, ranging in age from 9 to 33 days, who presented with diarrhea, dehydration, acidosis and transient methemoglobinemia. No history of toxin exposure could be elicited. On admission, all patients weighted less than their birth weights. All were mild to severely dehydrated, acidotic and methemoglobin levels ranged from 14.7% to 49.1%. In one cases Pseudomonas aeruginosa was isolated in the stool. Rehydration and correction of acidosis were done. Three of them were trated with 2mg/kg of methylene blue and improved immediately. Two patient improved without methylene blue injection. Methemoglobinemia under acidosis may be a common phenomenon in newborn period.
Acidosis* ; Adult ; Anoxia ; Birth Weight ; Natural Resources ; Dehydration ; Diarrhea ; Dihydrolipoamide Dehydrogenase ; Erythrocytes ; Fetal Hemoglobin ; Fluid Therapy ; Humans ; Hydrogen-Ion Concentration ; Infant, Newborn* ; Metabolism ; Methemoglobin ; Methemoglobinemia* ; Methylene Blue ; Oxidants ; Oxygen ; Pseudomonas aeruginosa

No abstract available.
Atrial Natriuretic Factor ; Body Weight ; Humans ; Infant, Newborn*

Sick neonates often require periodic small volume transfusion (10mg/kg) to replace blood draw for laboratory monitoring during their hospital stay. The effect of packed red cel transfudion on the hematocrit, potassium, ionized calcium, acid base status, glucose and indirect bilirubin was investigated in 25 transfusions. Analysis of transfused blood by the age of the red cells, older red cells (more than 5 days old, 13+/-7 days) showed increased potassium (27.2+/-14.1mEq/L vs 11.3+/-4.9mEq/L), decreased bicarbonate (14.4+/-2.6mEq/L) and glucose (130+/-28mg/dl vs 203+/-93mg/dl) compared with newer red cells (less than 5 days)(p<0.05). No significant changes occured in hematocrit and pH. Inspite of these results, the transfusion of the older red cells did not affect the older red cells did not affect the serum potassium, ionized calcium, pH, bicarbonate, glucose and indirect bilirubin level in neonates. The hematocrit of infants increated significantly after transfusion from 29.6%+/-4.3% to 38.3%+/-6.1%(mean+/-SD)(P<0.05). Transfusion of older red cells seemed to be as equally effective as newer ones. The valus of hematocrit obtained immediately after transfusion does not show any differences compared to those obtained 30 min, 1, 2, 4, 6 and 24 hours after transfusion. The result in the study indicate that there was no adverse effect after transfusion with packed red cell more than 5 days old and no significant difference in hematocrit observed between 0 to 24 hours following transfusion. Therfore old red cell more than 5 days can be used safely for sick neonatal transfusion and the stored donor blood can be optimzed for repeated blood transfusion.
Bilirubin ; Blood Transfusion ; Calcium ; Glucose ; Hematocrit* ; Humans ; Hydrogen-Ion Concentration ; Infant ; Infant, Newborn* ; Length of Stay ; Potassium ; Tissue Donors

This study was conducted to evaluate the postnatal changes of serum creatine kinase (CK) and its isoenzymes in normal and asphyxiated newborns. In normal newborns total CK, CK-MM and CK-MB reached a plateau between 2 and 24 hr after birth whereas the serum CK-BB remained stable after birth. CK-MM, CK-MB and CK-BB respectivily composed 90~94%, 5~7% and 1~5% of total CK during study period. In asphyxiated newborns total CK, CK-MM and CK-MB reached maximal value at 12 hr after birth whereas CK-BB decreased after birth. There were no significant differences between normal and asphyxiated newborns in total CK, CK-MM and CK-MB during study period (up to 24 hrs after birth). But CK-BB of asphyxiated newborn was elevated significantly (p<0.05) within 6 hrs after birth compared to normal newborns. There were no significant differences of CK and its isoenzymes between patients evaluated by 5 min Apgar scores(0~3, 4~6 and 7~10) or degree of HIE (HIE stage 0~I, II and III). According to these results, the serum CK-BB is elevated in asphyxiated newborns during 1st 6hrs after birth but has no predictive values of the extent of cerebral damage.
Creatine Kinase* ; Creatine* ; Humans ; Infant, Newborn* ; Isoenzymes ; Parturition

No abstract available.
Asphyxia* ; Phenobarbital* ; Seizures*

PURPOSE: Arterial blood gas and pH measurements are the standard by which adequacy of oxygenation and ventilation are assessed. The major problem with arterial punctures is that they can rarely be done without disturbing the neonates. Crying during arterial puncture usually results in change in respiratory patten and thus may result in significant changes in blood gas values. METHODS: Fifteen neonates admitted to NICU during Jan. to Aug. 1997 with pre-existing arterial lines undergoing arterial puncture for blood culture were studied. Only the neonates who cried vigorously during procedure were selected. Neonates were monitored for O2 saturation by pulse oximeter, for heart rate, respiratory rate and non-invasive blood pressure before and during crying. Arterial blood obtained through arterial lines before crying and arterial blood obtained on crying induced by arterial punctures were analyzed. Vital signs, O2 saturation by pulse oximeter before and during arterial punctures were also evaluated. Body weight of the baby patients examined was 1,750-3,090g, gestational age was 34-42 weeks and blood-sampling was performed during the 1st week of life. RESULTS: In the analysis of arterial blood, all data obtained before and during crying were in normal range. Crying decreased PaCO2 38.6+/-5.6mmHg into 30.6+/-6.7mmHg(P<0.05), HCO3 2.8+/-2.1mmol/L into 19.5+/-3.0mmol/L(P<0.01), and O2 saturation 95.1+/-5.6% into 91.0+/-5.6%(P<0.05), respectively. O2 saturation by pulse oximeter also diminished from 98.3+/-3.1% to 88.8+/-7.8%(P< 0.05) during crying. CONCLUSION: The results of this study imply that blood gases obtained by intermittent arterial punctures may provide data that do not accurately reflect the neonates' respiratory status.
Blood Pressure ; Body Weight ; Crying* ; Gases ; Gestational Age ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Infant, Newborn* ; Oxygen ; Punctures ; Reference Values ; Respiratory Rate ; Vascular Access Devices ; Ventilation ; Vital Signs

No abstract available.
Phototherapy*

PURPOSE: Kangaroo care is the practice of holding a small premaure infant, naked except for a diaper and hat, against a parent's chest. The purpose of this study is to determine the safety and feasibility of kangaroo care in a NICU as defined by physiological variables. MEHTODS: Ten stable, spontaneously breathing preterm infants, weighing less than 2,000gm were included in this 60-min. Kangaroo care (kc) study. Physiological variables, including heart and respiratory rates, blood pressure, skin and core temperature, pulse oximetry oxygen saturation and maternal serum prolactin were measured before, during and after kc. RESULTS: Kc did not significantly affect any of these infants' physiological variables before and during kc. Maternal core temperature rose significantly during kc (36.7+/-0.4 degree (C) vs 37.0+/-0.2 degree (C), P< 0.05). After kc, the mean prolactin level (233.3+/-240.6ng/ml) of mothers was higher than the preceding day(81.9+/-94.2ng/ml) and before kc (71.2+/-96.3ng/ml) (P<0.05). CONCLUSION: For stables preterm infants weighing less than 2,000gm, 60min of kc is safe and well tolerated. The beneficial effects of kc such as stability of the preterm infants receiving kc and increase of maternal prolactin after kc suggest the need to incorporate it into standards of care.
Blood Pressure ; Heart ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Macropodidae* ; Mothers ; Oximetry ; Oxygen ; Parents* ; Prolactin ; Respiration ; Respiratory Rate ; Skin ; Standard of Care ; Thorax

No abstract available.
Electrodes* ; Humans ; Infant, Newborn*

No abstract available.
Blood Glucose* ; Humans ; Hypoglycemia ; Infant, Newborn* ; Plasma*