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Transient Tachypnea of the Newborn, Or RDS T

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Transient Tachypnea of the Newborn, Or RDS T I CLINICAL EVALUATION OF A SIMPLE, RAPID, MICROMETHOD TO DETERMINE BILIRUBIN, BILIRUBIN BINDING CAPACITY, AN0 RESERVE BINDING CAPACITY. Audrey K. Brown, Gerard Boyle, Angelo Lamola, Jorge Flores, A new pulmonary disease distinct from either respiratory dis- William Blumbere, and Joseph Eisenger. Dept. of Ped., SUNY- tress syndrome (RDS), transient tachypnea of the newborn, or RDS Downstate Medical School. B'klyn, N.Y. and Bell Labs., Murray type 11, has been studied in 7 infants of diabetic mothers (IDM) I Hill, N.J. Both standard A-P and lateral, and magnification (mag.) chest Assessment of the risk of kernicterus would be aided greatly x-rays revealed a segmentally distributed coarse reticulogranula pattern and increased lung volumes but no significant increase i by the availability of a rapid, accurate, micromethod for the frequent measurement of bilirubin, non-albumin bound bilirubin, perihilar bronchovascular markings or thickened fissures. All We have mothers were insulin dependent and 617 had C-sections. Clinical albumin binding capacity and reserve binding capacity. profile of patients (means): wt. 3.1 kg., gestational age 37 evaluated such a method using the Bell Labs hematofluorometer which requires only three drops of whole blood (150~1)to mea- Wks., mechanical ventilation 2/7. CPAP 4/7. sure these parameters in 77 infants, birth weight 737 to 3950 gms . Values for albumin-bound bilirubin by this method compared PCOZ 50 50 44 favorably with total serum bilirubin values obtained by the Jen FiOz .63 .63 .50 drassik-Grof method (r=0.78). Albumin binding capacity ranged 1 patients survived and most were in FiOZ 5 .25 by day 6. 3 from 14 mg/dl in the smallest infant (737 gm) to 25.6 mg/dl in s. had pulmonary function tests on day 3: Mean compliance 3.2 l/cm Hz0. Mean insp. and exp. lung resist. were 32 and 30 cm an infant over 3 kg. Reserve binding capacity ranged from 5 to and correlated directly with HABA binding capacity 2O/L/sec. respectively. Funct. residual cap. was low in 2 pts. 35 mg/dl mean 17 ml/kg) and normal in 1 pt. (38 mllkg). A new clinical (r=0.76). When bilirubin was released from red cells by addi- yndrome in large IDM's is described. It is characterized by a tion of a drop of blood (50~1)to detergent, an increment of ild clinical course (hypercapnia, tachypnea, and hypoxemia) and 1.2 to 3.7 mg/dl was found in the bilirubin values and probably segmental coarse reticulogranular lung infiltrate confirmed by represents red cell bound bilirubin. The method promises a new approach to simple rapid evaluation of the distribution of g. chest radiographs. Although x-rays showed increased lung bilirubin between albumin and other binding sites in whole bloo LATIVE ALKALOSIS IN MILDLY DISTRESSED TERM NEONATES vid R. Brown, Brian R. Swenson, Ian R. Holzman, and 1J. Nelson, G. Peter, W_. Oh. Brown Univ. Program in ul M. Taylor. Univ. of Pittsburgh Sch. of Med. Med., Women & Infants Hosp., Dept. of Ped., Providence, R.I. The buffering reserve of mildly distressed term neonates was Oral Kanamycin prophylaxis may protect premature infants from studied in 15 tachypneic babies with a clinically suspected aspi- NEC presumably by suppressing enteric colonization. In a random ration syndrome, 8 of whom received HCO3 therapy (Rxt) and 7 of ized double-blind study, 49 infants received 5 mg/kg t.i.d. of whom did not (Rx-). Both groups had mean I-min Apgar scores 15 Kanamycin orally 24 hrs. prior to the first feed and continued and remained more tachypneic than controls (CON, N=17) during for 24 days and 50 were given placebo. The gestational ages Days 1-4 of life. There were no differences in wt loss, birth (31.9 5 2.1 wk M + SEM) and birth weights (1.6 5 0.4 kg) were wt, gestational age or 02 requirement among the 3 groups and comparable between the 2 groups. Treated infants had significan there was no difference in respiratory rate between Rxt and Rx-. reduction (p <0.05) in the rate of coliform colonization on day (See TABLE) Rxt had a lower Day 1 pH than Rx- (p<0.05) or CON 3-5 (12 vs. 42%). 10 (32 vs. 60%). 17 (50 vs. 82%) and 24 (57 vs (p<0.01) but had corrected to normal by Day 2. On Day 2 Rx- had 87%). Three of 49 treated infants with negative flora developed a higher pH than CON (p<0.05). This relative alkalosis in Rx- NEC, compared to 9 of 50 controls, 7 of whom had significant en- can in part be explained by Day 1 respiratory compensation, when teric colonization. The prophylaxis did not significantly alter PC02 for Rx- is <CON (p<0.001 and <Rx+ (p<0.02). This compen- the incidence of NEC but suggests a partial protection. Prophy- sation was augmented by endogenous generation of HC03 (AHC03=wt laxis also produced a significant increase in the prevalence of x 0.6[lowest Day 2 serum HC03 - lowest Day 1 serum HC031 - Hc03 Kanamycin resistant coliforms in treated infants by day 17 and therapy). Rx- AHC03 was >CON (pi0.01) and Rx+ AHCO) was also 24 (48 vs. 24%. (p <0.05). Because of proportionately small >CON but not statistically significant. number of treated infants relative to nursery population (no nor These tachypneic term neonates generated a mean of 2-3 mEqlkg 1 than 5 of 35 were being treated) nursery epidemiologic surveil- 3C03 during the first day of life. Intravenous HC03 in the lance revealed no increase in Kanamycin resistant organisms treatment of similar babies mav thus be unnecessarv. during the study period. Thus, Kanamycin prophylaxis may be re- (meantSEM) CON -Rx- Rx+ ii*,ndedfor partial protection f, NEC, but due to the emer- Lowest pH, Day 1 7.3E.01 7.35t0.03 7.1G.08 gence of potentially pathogenic Kanamycin resistant coliforms. Lowest pH, Day 2 7.40i0.01 7.43i0.01 7.42t0.01 should be used only in a limited group of high risk infants to Lowest PC02, Day 1 33.5il.1 24.6t2.0 30.4t1.7 maintain a low proportion of treated infants within the nursery on AHCO? (mEa) -0.7i1.4 9.4t3.2 6.?+L.6 EARLY DIAGNOSIS OF EARLY ONSET NEONATAL SEPSIS. R. PHYSIOLOGICAL AND PATHOLOGICAL FACTORS AFFECTING Boyle, B. Chandler, B. Ross, W. oh. Brown Univ. HEART RATE VARIABILITY IN PRETERM INFANTS. Luis A. Program in Medicine, Women and Infants Hospital, -Cabal, --Bijan Siassi, Bernardino Zanini, Feix- Department of Pediatrics, Providence, Rhode Island. --Waffarn, Joan E. Hodgman. Univ. of So. Calif. Sch. of Med., LAC- Early onset neonatal sepsis often presents as respiratory dis USC Medical Center, Oept. of Pediatrics. tress. To prospectively define the criteria for its early diag- Decreased Neonatal Heart Rate Variability (NHRV) was observed nosis, a battery of laboratory tests and duplicate blood cul- in infants dying of RDS over a decade ago; however, only recentl, tures wereperEormed within the first 12 hrs of life in 116 con- instrumentation for itsmeasurement has become available to the secutive infants presented with respiratory distress. Nine in- clinician. To establish the value of monitoring NHRV, 92 preterm fants were septic (6 with group B Streptococcus, 1 each with P. infants were studied (B.W. 750-2500 g., G.A. 28-36 wks.). Each in Pneumonea, E. Coli and P. Aerogenosa). There was no significant fant was monitored continuously during first 6 hours and for 1 difference between septic and non septic infants in gestational hour at 24, 48 and 168 hours of life. During each hour, NHRV was age, birth weight, duration of ruptured membranes, platelet quantified and related to the following parameters: sex, G.A., count, band count, micro sedimentation rate or roentgenographic respiratory rate, arterial blood pressure, skin, ambient and con findings. Septic infants had significantly higher incidence of temperatures, blood gases, serum lactic acid, qlucose and calciun positive gastric gram stains for bacteria and polymorphonuclear levels, and the presence and severity of ROS. Discriminant ana- cells, lower white blood count (<~o,ooo/~~),lower absolute neL lysis of data revealed that NHRV in healthy preterm infants was trophil count (<4500/m3) (all p ~0.05), and positive buffy inversely related to heart rate level and directly related to th~ coats for bacteria (4 of 4). Six of 7 infants had nitroblue infant's post-natal age. In healthy babies whose range of gesta- tetrazolium (NBT) incorporation of >60% (normal in newborn <30%) tion was limited to 32-36 wks., there was no significant correla or no neutrophils on the NBT smear. Using criteria of leuko- tion between NHRV and G.A. Decrease in NHRV was significantly rr. penia and neutropenia defined above, all septic infants would lated to the severity of RDS. Decreased NHRV significantly dif- have been identified and 23% of non-septic infants would be fal- ferentiated the infants with RDS from normal controls from the sely identified. Though tedious, addition of buffy coat and NB1 first hour of life and patients with RDS who died from the pa- test to the diagnostic regimen would have identified all septic tients with RDS who survived after the fourth hour of life. This infants without false identification of non septic infants. data reveals that NHRV a) should be corrected for heart rate White blood count and differential is the simplest and most re- level and postnatal age, b) is decreased in ROS, and c) can be used as a predictor of course and outcome from RDS.
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