P. Kero

Citalopram in pregnancy and lactation.

Although citalopram has gained wide acceptance in the treatment of depression and anxiety disorders, its use during pregnancy and lactation has been poorly characterized. The aim of this study was to examine the efficacy and safety of citalopram in relation to concentrations of citalopram and its metabolites during pregnancy and lactation.

Factors Affecting the Occurrence of Acute Otitis Media during the First Year of Life

ABSTRACT. A regional birth cohort of 5356 infants was enrolled into a follow‐up study in order to investigate the determinants of the development of infectious diseases in children. The infants were examined at three months, six months and twelve months of age by the physicians at the well‐baby clinics. At these occasions the number of episodes of acute otitis media in the infants, the duration of breast‐feeding, the number of siblings, the type of day care, parental smoking, the presence of animal pets at home and the number and type of other illnesses than otitis were registered. Two thirds of the infants had no episodes of acute otitis media. The median age for the first episode of acute otitis media was eight months. About 10% of the infants had experienced recurrent otitis media (three episodes or more) during their first year of life. Significant associations were found between the occurrence of acute otitis media and the number of siblings, the type of day care, the sex of the infant, the duration of breast feeding, maternal socioeconomic status and prematurity.

Growth of 519 Small for Gestational Age Infants during the First Two Years of Life

ABSTRACT. The physical growth of 519 small for gestational age infants (SGA), with a birth weight below the 10th percentile on our own growth curve, born in the region of University Central Hospital of Turku during the period June 1,1981‐May 31, 1982, was studied. The study population consists of 4 517 term, appropriate for gestational age (AGA) infants, 488 term SGA infants, 320 preterm AGA infants and 31 preterm SGA infants. The degree of intrauterine growth retardation (IUGR) seemed to have an effect on physical growth in term SGA infants. Those term SGA infants with a low Ponderal Index (PI) (type II) were taller and had a larger head circumference at the age of 24 months than term SGA infants with adequate PI (type I). Among the preterm SGA infants the degree of IUGR seemed to have no effect on later growth. Smoking is still one of the main risk factors associated with poor intrauterine growth. In this study we also found that smoking has an effect on later growth; the children of smoking mothers were smaller than those of non‐smoking mothers in the AGA group. Among the SGA infants the infants of non‐smoking mothers were bigger than those of smoking mothers. This difference could be explained by other factors associated with SGA. We found that in spite of the catch‐up growth during the first months, 26% of the severely SGA infants (birth weight below the 2.5th percentile) still had a weight below the 2.5th percentile at the age of 24 months.

Pulmonary hemodynamics after synthetic surfactant replacement in neonatal respiratory distress syndrome

To evaluate the acute effects of surfactant replacement therapy on pulmonary circulation in neonatal respiratory distress syndrome, we studied 25 infants before and for 1 hour after either synthetic surfactant administration (n = 15) or endotracheal suctioning (n = 10). The noninvasive Doppler method was used to estimate systolic pulmonary artery pressure from tricuspid regurgitant flow velocity and to measure blood flow velocity of the left-to-right shunt through the ductus arteriosus. Pulmonary artery pressure decreased significantly within 15 minutes after surfactant administration and remained low throughout the study period, whereas suctioning did not change pulmonary artery pressure levels. No changes in systemic pressure were found in either group. Velocity of the ductal left-to-right shunting increased and remained elevated for 1 hour only in surfactant-treated infants. In addition, right-to-left ductal shunting disappeared in four infants after surfactant administration. Our data thus indicate that administration of synthetic surfactant to infants with respiratory distress syndrome reduces pulmonary vascular resistance, resulting in a decrease in pulmonary artery pressure and an increase in ductal flow velocity.

Tracheostomy in pediatric patients

From 1978 to 1987, tracheostomy was performed on 33 children, 13 boys and 20 girls, with a male to female ratio of 0.65: 1. The mean age at the time of tracheostomy was 726 days, 76% of the children being under the age of two years. The incidence of pediatric tracheostomy per hospital admissions was 0.05%. Subglottic stenosis (13 children) and respiratory distress syndrome with prolonged endotracheal ventilation (11 children) were the most common indications for tracheostomy. The mean duration of prolonged endotracheal intubation before tracheostomy was 64 days, and that of tracheostomy treatment 117 days. During the tracheostomy period, five children died, but only one death was related to tracheostomy. The total rate of complications was 30%. We emphasize the importance of strict indications for pediatric tracheostomy.

Comparison between clinical and radiological classifications of infants with the respiratory distress syndrome (RDS)

Clinical and radiological classifications of the severity of the respiratory distress syndrome (RDS) were made in 55 infants. According to the clinical classification 17 infants belonged to the first class (mild RDS), 22 to the second (moderate RDS), and 16 to the third class (severe RDS). In the classification based on radiological findings the numbers of infants in classes 1, 2 and 3 were 18, 19 and 18 respectively. On the basis of both the clinical and radiological findings, 11 infants belonged to the mild RDS class, 11 to the moderate, and 12 to the severe RDS class. Thus, 34 infants had the same clinical and radiological classification. In 21 infants there were discrepancies between the clinical and the radiological classifications, but only one infant with the most severe radiological findings belonged to the mild RDS class and only one infant with mild radiological findings belonged to the worst RDS class.

Elevated arterial blood pressure is associated with peri-intraventricular haemorrhage

In a prospective study, brain ultrasound scans were performed in 42 newborns (median birth weight 1700g, range 1020–3720 g; gestational age 32 weeks, 26–36) to reveal peri-intraventricular haemorrhage (PIVH) (grades I–IV) as well as echodensities (ED) and/or periventricular leucomalacia (PVL). ECG and arterial blood pressure were recorded on magnetic tape at 8h intervals during the first 24 h of life for further computer analysis. Heart rate (HR) and its variability (HRV) indices RMSM (long-term variability) and RMSSD (short-term variability), together with their coefficients of variation, were computed. Systolic (SBP), diastolic (DBP), and mean blood pressures (MBP) were detected as average values for 2-min stationary segments together with the respective minima and maxima. The indices of variability and their coefficients of variation were computed for the arterial pressure. PIVH was found in 12 newborns and ED in 8 (of whom two developed PVL). The remaining 22 served as controls. Neither HR, HRV nor BP variability differed between the groups. DBP was higher in the group with PIVH (39 mmHg) when compared to both the controls (33 mmHg,P<0.05) and the ED group (32 mmHg,P<0.01). MBP behaved respectively (45 mmHg, 38 mmHg, 37 mmHg,P<0.01). SBP behaved also similarly when gestational age and birth weight were used as covariates (57 mmHg, 48 mmHg, 47 mmHg,P<0.01).Our results suggest that elevated diastolic, mean and systolic blood pressure are significantly associated with peri-intraventricular haemorrhage in preterm newborn infants.

Excitatory amino acids in cerebrospinal fluid in neonatal asphysia

Abstract Of the excitatory amino acids, glutamic and aspartic acid were studied in the cerebrospinal fluid of six infants 4–32 hours after a documented episode of severe neonatal asphyxia. Aspartic acid concentration was definitely increased in the cerebrospinal fluid of these patients, whereas glutamic acid concentration varied considerably. Aspartic acid was always increased, even hours after the period of asphyxia, but values were greater in samples taken less than 12 hours after the asphyxial event. The patients with the highest cerebrospinal fluid aspartic acid concentrations had more severe outcomes.

Perinatal events and neonatal morbidity: An analysis of 5380 cases

The associations between perinatal events and neonatal morbidity were examined in a regional population of 5 380 newborns weighing 500 g or more. Perinatal mortality was 6.9%, and neonatal mortality was 3.0%. The low birth weight (less than 2500 g) rate was 3.8%. The incidence of prematurity (gestational age less than 37 weeks) was 6.6%. Respiratory distress syndrome was found in 0.9%, nonhaemolytic hyperbilirubinaemia in 16.5%, hypoglycaemia in 0.5%, septic infection in 0.8%, asphyxia in 4.0%, intracerebral haemorrhage in 0.3%, and cerebral symptoms in 0.7%. Maternal toxaemia, multiple pregnancy and maternal short stature were associated with spontaneous prematurity and a birthweight below the 10th percentile. Prematurity was associated with respiratory distress syndrome, hyperbilirubinaemia, hypoglycaemia, infection, low Apgar scores, asphyxia and intracerebral haemorrhage. Placental complications were associated with spontaneous prematurity, low Apgar scores and asphyxia. Premature rupture of the membranes was associated with spontaneous prematurity, infection, low Apgar scores and asphyxia.

Meconium aspiration induces ARDS-like pulmonary response in lungs of ten-week-old pigs.

To investigate whether aspiration of meconium induces a hemodynamic and histologic pulmonary response similar to that frequently seen in experimental acute respiratory distress syndrome, twelve 10‐week‐old pigs with postnatally adapted lungs were studied. Six 10‐week‐old pigs received 3 ml/kg 20% human meconium via the endotracheal tube. Six control pigs of the same age were given sterile saline. Ventilator settings were adjusted to keep PaO2 above 8 kPa and PaCO2 below 5 kPa. The pulmonary hemodynamic response to aspiration consisted of two separate hypertensive components. An initial peak in pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) was followed by a progressive increase in PAP and PVR in the meconium group, whereas in the saline group these parameters returned to baseline levels. The distribution of PVR, determined by pulmonary artery occlusion, was characterized by an increase in the postarterial resistance immediately after meconium aspiration and a progressive increase in both arterial and postarterial resistances during the later phase. On histological examination, marked neutrophil sequestration was seen in the meconium lungs. In addition, lung edema formation was significantly enhanced in the meconium group, as shown by an increased lung wet/dry weight ratio. Thus, meconium aspiration resulted in a biphasic pulmonary pressor response and severe pulmonary inflammation. This response resembled that of models of experimental acute respiratory distress syndrome following diverse types of precipitating insults; this suggests that similar pathophysiologic mechanisms are elicited and cause similar pulmonary dysfunction following different forms of lung injury. Pediatr. Pulmonol. 1997; 23:205–211