Gary R. Gutcher

Relationship of vitamin A (retinol) status to lung disease in the preterm infant

Plasma concentrations of retinol and retinol-binding protein were measured at birth in 91 preterm infants. In 64% of these babies retinol values were less than 20 micrograms/dl, suggestive of vitamin A deficiency. Forty-seven of these infants were observed with sequential measurements of retinol and retinol binding protein through 21 days of age. In babies with respiratory distress syndrome retinol values were similar to those in babies without respiratory distress syndrome. The retinol binding protein levels were lower on the third day of life in babies with respiratory distress syndrome. Babies who developed bronchopulmonary dysplasia had lower concentrations of retinol at birth (P less than 0.05) and on day 21 (P less than 0.05) than did babies who did not develop bronchopulmonary dysplasia, despite receiving recommended intakes of vitamin A. Many preterm infants are deficient in vitamin A at birth, and failure to correct this deficiency may contribute to the development of chronic lung disease.

Combined immunodeficiency and vaccine related poliomyelitis in a child with cartilage hair hypoplasia

Patients previously described with cartilage-hair hypoplasia, a distinctive form of short-limbed dwarfism, have been found to have deficient cell-mediated immunity with intact antibody-mediated immunity. The patient with cartilage-hair hypoplasia described in the present report is unusual in that she had both deficient antibody-mediated immunity and deficient cell-mediated immunity. In addition, she developed severe, vaccine-related paralytic poliomyelitis. This complication suggests that live viral vaccines should not be administered to children with short-limbed dwarfism until the form of short-limbed dwarfism is established and immunologic evaluation is performed when indicated.

Enteral Administration of Agar as an Effective Adjunct to Phototherapy of Neonatal Hyperbilirubinemia

Summary: Phototherapy increases the biliary excretion of unconjugated bilirubin. In this form, bilirubin would be subject to enterohepatic circulation, and the true efficacy of phototherapy would be blunted. We tested the hypothesis that sequestration of lumenal unconjugated bilirubin by enteral agar administration would enhance the efficacy of phototherapy in jaundiced infants. Fifty-two infants were studied, 21 control and 31 agar-supplemented. The birth weights, sex distribution, and postnatal age at onset of phototherapy did not differ between the two groups of infants; pre- and postphototherapy bilirubin concentrations also did not differ between the groups. The bile acid concentrations and bilirubin saturation indices were also similar. The rate of declination of the plasma bilirubin concentrations after 24 h of phototherapy was greater and significantly more uniform in the agar-supplemented infants (—1.59 ± 2.3 versus −2.51 ± 1.44). Stool frequencies were greater in control infants (5.5 versus 4.3 per 24 h) whereas fecal bilirubin excretions were greater in agar-supplemented infants during the second day of phototherapy (1.32 versus 3.29 mg·kg-1·24 h-1). Agar supplementation reduced the duration of phototherapy by 23% (37.6 ± 3.2 versus 48.1 ± 5.0 h).

latrogenic Rickets As a Complication of a Total Parenteral Nutrition Program

This 1,588 git white infant was born after a 32-week uncomplicated gestation to a 24-year-old mother. Respiratory distress syndrome was diagnosed on the fir-st day of life. The infant was treated with continuous positive airway pressure and increased ambient oxygen for three days with gradual inrprcwetnent. Symptomatic hypocalcemia (serum level 5.3 rng/100 ml) at one day of age responded to intermittent infusions of ! 50 mg calcium gluconate given days 1 through 12. Nasqjejunal feedings of commercial formula

Effect of Hydrocortisone on the Metabolism of Phosphatidylcholine in Maternal and Fetal Rabbit Lungs and Livers

Summary: It has been observed that glucocorticoids stimulate fetal lung maturation. This study examined the effects of glucocorticoids on the phosphatidylcholine (PC) metabolism in maternal and fetal lungs and livers. At 24 days of gestation, pregnant does were injected im with either hydrocortisone or an equal volume of saline. At 27 days of gestation, the maternal and fetal lungs and livers were removed for study. Maternal hydrocortisone treatment significantly decreased the fetal body weight and lung weight, but had no effect on the weights of fetal liver or the ratios of maternal lung/body or liver/body weights. Concentrations of protein, total phospholipids, or PC of fetal lung and liver and of maternal liver were not affected by hydrocortisone. However, the amounts of maternal lung protein, total phospholipids, and PC were significantly increased. No stimulation by hydrocortisone was seen in the specific activities of the enzymes: choline kinase, phosphocholine cytidyltransferase, and choline phosphotransferase of cytidine 5′-diphosphocholine (CDP-choline) pathway and lysoPC-lysoPC acyltransferase, lysophospholipase, and acyl-CoA lysoPC acyl-transferase of PC-lysoPC cycle pathway.Maternal administration of hydrocortisone stimulated the incorporation of [methyl-14C] choline into fetal lung PC. Additionally, hydrocortisone also accelerated the secretion of PC from maternal lung tissue. The acceleration of the secretion of PC was not observed in the fetal lung tissue, possibly because of a low basal secretory rate. The acceleration of PC secretion by hydrocortisone in maternal lung may suggest a relation of this mechanism to the fetal lung maturation affected by steroids.Speculation: One biochemical effect of antenatal maternal hydrocortisone is the acceleration of choline incorporation into fetal lung PC. Maternally administered glucocorticoids, in addition to affecting fetal lung, might also affect maternal lung and liver PC metabolism by alteration of enzyme activity or changing turnover or transfer rates. Though studied indirectly, hydrocortisone might stimulate the secretion of lung PC onto the alveolar surface.

Early intravenous correction of vitamin E deficiency in premature infants

Summary We undertook to determine the efficacy of intravenousα tocopheryl acetate in rapidly correcting the vitamin E deficiency of the premature infant. Twenty nine infants were assigned to either a control or treatment group. The latter group received a median intravenous dose of 3 IU/kg/day α tocopheryl acetate as MVI 12 (USV Pharmaceuticals, Inc.). On days 1, 2, 3, 7, 14, and 21, plasma tocopherol isomers and peroxide induced hemolysis were analyzed. While all but one control infant with initial tocopherol deficiency were still deficient on day 3, all but two of the treatment infants were normal. Rapid, safe correction is possible with an intravenous multivitamin preparation.

The in Vitro and in Vivo Photoreactivity of Bilirubin: I. Laser-Defined Wavelength Dependence

Summary: Monochromatic light was provided by a continuous wave Argon ion laser. We chose to study the in vitro effects of light at 457.9, 465.8, 476.5, 488.0, 501.7, and 514.5 nm as representative of a reasonably evenly spaced sampling across the blue-green spectrum. The in vivo experiments were conducted at 457.9, 476.5, 488.0, and 514.5 nm.In vitro light at 488.0 nm appeared to be more effective than the others studied.After 24 h of irradiance, the in vivo decline in serum bilirubin concentration produced by light at 488.0 nm was one-and-one-half, two, and four times as effective as light at 457.9, 476.5 and 514.5 nm, respectively. By 48 h of exposure, the declines produced by light at 457.9 nm and 488.0 nm are significantly superior to that at 476.5 nm and 514.5 nm, but they do not differ from one another.

Analysis of subcellular phosphatidyl choline in developing rabbit lung.

Phosphatidyl choline is a major lung surfactant. Insufficient development of the surfactant in neonates is often associated with the Respiratory Distress Syndrome. The concentration and fatty acid composition of phosphatidyl choline have not been studied in the subcellular organelles of the developing lung. This study has investigated the development of the concentration and fatty acid composition of phosphatidyl choline in subcellular fractions of 28-day and 30-day fetal and maternal New Zealand rabbit lungs. The concentration of total phospholipids in lamellar bodies increased four to five fold from 28-day fetus to 30-day fetus which, in turn, was similar to the maternal level. Total phospholipid content increased only about 50% in mitochondria and microsomes. The percentage of phosphatidyl choline among total phospholipids in lamellar bodies increased successively from 60% at 28 days gestation to 84% at 30 days gestation and leveled at 84% in maternal lamellar bodies. Microsomal PC increased steadily from 52% in the 28-day fetus to 65% in the adult. Analysis of the fatty acid composition of phosphatidyl choline in lamellar bodies confirmed 16∶0 as the major fatty acid, and its content remained constant from 28 days gestation to adult. In contrast, the content of 16∶0 of the microsomal phosphatidyl choline decreased with increasing gestation. Changes of several unsaturated fatty acid components were observed in both lamellar bodies and microsomes in the developing lungs. Maturational development of phosphatidyl choline is reflected in an increase in the concentration of this surfactant, particularly in lamellar bodies, and possibly in remodeling of fatty acid composition in both lamellar bodies and microsomes.

HYPOCALCEMIA ASSOCIATED WITH PHOTOTHERAPY IN NEWBORN RATS: LIGHT SOURCE DEPENDENCE

Littermate pups of the congenitally jaundiced Gunn rat were studied at 4 days of age. Control animals were shaded from irradiation by opaque cardboard while littermates were exposed to daylight, blue, green or pink fluorescent light. Initially no significant differences were demonstrable between irradiated and control animals with reference to body weight, sex distribution, blood hematocrit, or serum bilirubin and serum calcium concentration. In all control groups, serum bilirubin values were unchanged or increased by the end of the study and serum calcium values were also unchanged. In the light‐exposed groups, serum bilirubin values decreased significantly in all except those exposed to pink light. The serum calcium level was decreased significantly only in pups exposed to fluorescent daylight at 5.00 μW/cm2/nm but in none of the other irradiated groups.

Tissue Levels of Vitamin E (α-Tocopherol) in Response to Continuous Intravenous Multivitamin Infusion

Weanling rats were made vitamin E deficient over a 10-week course. Vitamin E was then provided at 4 IU/kg/day as a continuous infusion of the alpha-tocopherol in Berocca PN. Tissue samples of heart, lung, liver, and perinephric fat and plasma were analyzed for vitamin E levels at 24 and 72 hr. Compared to experimental controls that received a rat chow containing 372 IU/g mixed tocopherol, normal levels were achieved in the test group within 24 hr in plasma and liver. Lung and heart muscle levels were within the normal range by 24-72 hr, although significantly below the control level; fat levels did not normalize. Continuous infusion of vitamin E as tocopherol in a multivitamin preparation results in normal tissue levels in lung and liver in a fashion similar to that achieved by previously described methods of single bolus intravenous infusion or repeated subcutaneous injection.