Lula O. Lubchenco

Thick blood syndrome.

Twenty cases of hyperviscosity were studied prospectively to determine the presence and incidence of radiological findings and whether or not exchange transfusion had an appreciable effect on these findings. Serial chest radiographs revealed increased pulmonary vascularity, hyperaeration, and mild, bilateral alveolar infiltrates (perihilar and/or lower lobe). Ten patients were treated with partial plasma exchange transfusions which resulted in improvement of radiological findings. Hyperviscosity is more common than previously recognized. This entity may have profound significance as a potentially treatable cause of central nervous system damage in the neonate.

Interrelationships in the urinary excretion of creatine, creatinine, free alpha amino acid nitrogen, and total nitrogen in premature infants.

Summary 1. The urinary excretion in milligrams per kilogram per 24 hours for creatine, creatinine, free alpha amino acid nitrogen, and total nitrogen have been recorded for a group of premature infants 2 to 12 weeks of age in both single voidings and in 24-hour pools. 2. A considerable range was noted in the excretion coefficients (milligrams per kilogram per 24 hours) of all the components of urinary nitrogen investigated, not only between different infants but between single voidings and 24-hour pools of the same infant. The only significantly constant interrelationship was between free alpha amino nitrogen and total nitrogen in the 24-hour samples. 3. The practice of expressing the urinary excretion of a substance of premature infants in terms of the creatinine ratio is likely to lead to erroneous conclusions, particularly where this is done on single voidings.

1363 OUTCOME OF INBORN VS. TRANSPORTED HIGH-RISK INFANTS

The outcome of 694 births of infants weighing <1500 grams from two sources was compared. 301 births occurred in 5 metro area hospitals (MH) with Level I nursery facilities; the high-risk infants were transported to Level III nurseries. 393 infants were born in University Hospital (UH) where Level III intrapartum and neonatal care are available. Fetal deaths were twice as frequent in the MH population as in the UH group, 25 vs. 12.5% (p <.01). Neonatal deaths were slightly increased in the MH, 37 vs. 30% but not to a significant degree. Infant deaths occurred in 3 and 4% respectively in MH and UH. Outcome at approximately 12-24 months was the same in both groups. Because 61% of the UH population in this weight group comes from in utero transport patients from the region, this population was reviewed. Fetal deaths occurred in 9.5% of total maternal transport births. Neonatal deaths were similarly reduced (27%) and outcome slightly improved 33%. When the in utero transport patients from the MH were credited back to these hospitals the fetal death rate was 22% compared to the UH rate of 17% (p=NS). Maternal transport patients constitute a population which differs from that of the MH and UH. Data on maternal complications, neonatal morbidity, birth weight, gestational age, socioeconomic status, type of transport and long-term outcome in relation to these factors is in preparation.

Toxicity of non-ionic detergents for the chick embryo.

Summary Two non-ionic detergents, Tween 80 and Triton X-100, have been compared with respect to their toxicity to chick embryos. Tween 80 was found to be 20 times less toxic than Triton X-100. The possibility is considered that with the increasing age of the embryos there is a decrease in the toxicity of both detergents. The authors are indebted to Dr. John C. krantz, Jr., University of Maryland, Baltimore, for his ciritical and constructive comments concerning the manuscript and the reported experiments.

DEFINING POLYCYTHEMIA: A REAPPRAISAL

The first cases of neonatal polycythemia were described over 25 years ago. To date, controversy still exists as to what critical level of hematocrit (hct) should be utilized to define this syndrome. The most common definition has been a venous hct of 65% or greater. Values as low as 60% or as high as 70% have also been suggested. In addition, the relationship between polycythemia and hyperviscosity is poorly described. We re-evaluated the definition of polycythemia based on neonatal symptoms and long-term outcome at 1-2 yrs of age and evaluated the relationship between hct and viscosity. The subjects were infants referred for further screening because of high hcts. Viscosity measurements were made using the methods and standards of Gross et al. (1973). Viscosity and venous hct were coded for 225 infants. Follow-up was available on 158 (70%). Among infants studied, elevated viscosity measurements were not limited to those with venous hct of 65% or greater. Eleven percent of infants had an abnormal viscosity, although hct was less than 65%. The enrollment mechanism did not permit identification of the lowest hct at which abnormal viscosity could be found. Infants whose venous hcts were between 65 and 69% were as likely to have neonatal symptoms as infants with hcts between 60 and 64%. Infants with markedly abnormal hcts (>69%) had similar neonatal courses. Infants with symptoms in more than one organ system varied from 26-30% of each group. Similarly, outcome measurements were not different among the three groups. No evidence of long-term sequelae was found in 44-65% of the children. In conclusion, determinations of a critical level of hct does not fully account for the effects of neonatal hyperviscosity. It is also likely that additional factors influence peripheral blood flow and must be considered when attempting to predict which infants with elevated hcts will have neonatal symptoms or long-term sequelae.

835 RELATIONSHIP BETWEEN DEXTROSTIX, PLASMA AND WHOLE BLOOD GLUCOSE IN THE RANGE 0 - 100 MG|[sol]|DL

Two laboratory measurements frequently made in the newborn period are Dextrostix (Ames) and hematocrit; yet the relationship between Dextrostix, plasma glucose and whole blood glucose values has not been described. Umbilical vein and peripheral vein blood samples were studied for whole blood, plasma and red cell glucose (YSI Model 23A) and were compared to values obtained using the Dextrostix read by eye. Dextrostix predicted whole blood glucose (R = .83, slope of regression = 1.1, not significantly different from 1.0). Plasma glucose was underestimated by the Dextrostix (R = .64, slope = .70 in the range measured in vivo (30-100 mg.dl−1). Measurements in vitro were carried out using umbilical vein blood during incubation with and without added glucose to determine the relationship between plasma and whole blood glucose at the lower glucose levels. No statistically significant difference was observed between plasma and whole blood glucose at these low levels. Dextrostix reflected both of these levels. No clinically significant error would have been made using the Dextrostix.In vivo, red cell glucose fell more quickly than plasma glucose at values greater than 100. Below that level, plasma and red cell glucose fell at similar rates. However, preliminary data from infants with polycythemia/hyperviscosity reveal red cell glucose values lower than would be predicted by the plasma glucose value alone.

243 THE MECHANISM OF ACTION OF DRUGS ON BILLIRUBIN BINDING TO ALBUMIN STUDIED BY FLUORESCENCE QUENCHING

Fluorescence quenching as a technique for studying the binding of bilirubin to albumin was reported to the Society in 1977 by Dr. R. Levine. The technique is sensitive enough to measure the two parameters of binding (affinity and capacity) needed to determine the influence of a drug on the binding of bilirubin to albumin. Hence, fluorescence quenching was used to determine the mechanism of action of drugs on bilirubin binding.The influence and mechanism of action of diazepam (Valium - Roche), furosemide (Lasix - Hoechst-Roussel), sodium diphenyl-hydantoin (SDPH - Rachelle) and theophylline (Slo-Phyllin - Dooner) on the binding of bilirubin to albumin were studied. Valium, a drug previously shown to alter the binding of bilirubin to albumin, exerted its influence mainly by affecting the binding affinity, reducing this by 49%. Valium also affected the capacity but to a lesser extent, reducing it by 13%. Lasix also influenced both parameters, reducing the affinity by 56%. and the capacity by 23%. SDPH reduced only the affinity; this being reduced by 56%. Slo-Phyllin had no detrimental influence on the binding of bilirubin to albumin.Since Valium, Lasix and SDPH all reduce the binding parameters of bilirubin to albumin, they all increase the free bilirubin concentration and hence the clinician is warned as to the possible risks of these drugs in jaundiced newborn infants. The influence of other drugs is currently being investigated.

Perinatal — Newborn Care

were expected to manifest significantly lower moral maturity than nondelinquent adolescents and their mothers, as Hudgins and Prentice reported. This study used global ratings of affective and cognitive components of family interaction, which can be easily linked to clinically meaningful variables of personality. The primary focus of the dimensions selected for rating was o n the mothers interaction with her s o n . The first three dimensions represent characteristics of negative interaction: (1) Conflict, (2) Maternal Dominance, and (3) Maternal Hostility. T h e remaining three dimensions represent characteristics of positive interaction: (4) Maternal Complexity, (5) Maternal Encourage ment, and (6 ) Maternal Warmth. Contrary to prediction, the level of moral judgment was not significantly different in delinquent and nondelinquent families. Although the mean moral maturity score of the delinquent group, sons and mothers combined, was lower than that of t h e nondelinquent group, t h e difference was not statistically significant. Specifically, in this study t h e difference in the score of moral maturity between delinquent and nondelinquent adolescents was only 23 points, in contrast to the 42-point spread reported by Hudgins and Prentice for the same comparison. Since delinquency is not a homogeneous syndrome, one source of such variability, apart f rom psychometric bases, may be the d i s p a r a t e c h a r a c t e r o f t h e samples of delinquents. As predicted, interactions in delinquent families showed significantly higher evidence of dominance, hostility, and conflict. Interactions in nondel inquent families, as anticipated, s h o w e d s i g n i f i c a n t l y higher evidence of warmth, while the significance of evidence for encouragement was minimal. Ratings of cornplexity, however, did not differ significantly for each type of family, a finding consistent with the nonsignficant difference in moral reasoning between mothers of delinquents and nondelinquents. Evidence suggests negative types of parent-child interaction limits cognitive and moral development. The presence of positive or negative family interaction determines in part whether sons with the same, relatively low level of moral judgment become delinquent. Negative maternal interactions may have inhibited the deve lop ment of moral reasoning in some adolescents, Family relationships based on mutual affection, trust, and loyalty are important factors in t h e childs attainment of more advanced levels of moral judgment.

Pediatrics in General Practice

For general practitioners, in whose practice is included a major proportion of the medical management of infants and children, and for the specializing pediatrician as well, Postgraduate Medicine presents this special regular department devoted to brief discussions by recognized authorities on their preferred methods of the treatment and management of diseases and problems of infancy and childhood.