Yo Kinoshita

Auditory brainstem response in neonates with asphyxia and intracranial haemorrhage

Auditory brainstem response (ABR) was used to assess possible brainstem damage in 76 neonates with asphyxia and intracranial haemorrhage (ICH). Fifty-eight neonates had ICH, 52 had neonatal asphyxia and 34 of these patients had both. Eighty-nine percent of the patients with neonatal asphyxia showed some abnormal patterns in response, the major one being an increase in the threshold of wave V. In the ICH group, abnormal patterns were observed in 62.5%, among whom the prolongation of the I–V interpeak latency (IPL) and of wave V latency was seen more frequently than the increase of threshold of wave V. In the case of neonatal asphyxia associated with ICH, both the prolongation of the latency and the increase of threshold were observed equally. These abnormalities of ABR were associated with worsening clinical condition and conversely normalized gradually following the improvement of the underlying disease. Especially the I–V IPL, wave V latency and the threshold of wave V could serve as indicators of the treatment.

Effect of immunoglobulin therapy on phagocytosis by polymorphonuclear leucocytes in whole blood of neonates

There has been some disagreement as to the clinical effect of intravenous immunoglobulin (IVIG) therapy on neonatal bacterial infections. We therefore evaluated the effect of IVIG therapy on neonatal polymorphonuclear leucocyte (PMN) functions by monitoring phagocytosis and hydrogen peroxide (H2O2) production. Subjects were 10 mature neonates who had normal plasma levels (i.e. equal to adult plasma levels) of IgG and nine premature neonates who had lower plasma levels of IgG. Phagocytosis by PMN was measured using flow cytometric analysis of whole blood. Addition of γ‐globulin to the whole blood of mature neonates increased phagocytosis, but not significantly. Higher doses of added γ‐globulin (> 2.0 mg/ml, the concentration was expressed as that in the final reaction volume) decreased phagocytosis to under baseline level. In premature neonates addition of γ‐globulin increased phagocytosis and the significant maximum effect was observed with 0.5 mg/ml of the additional γ‐globulin. Higher doses of additional γ‐globulin (2.5 mg/ml) decreased phagocytosis to baseline level. Phagocytosis in four mature and four premature neonates was compared before and after 1 g/kg of IVIG therapy. Phagocytosis in mature neonates after IVIG therapy did not change compared with the pretreatment level. On the other hand, phagocytosis in premature neonates after IVIG therapy significantly increased compared with its pretreatment level. In both mature and premature neonates H2O2 production following phagocytosis varied in parallel with changes of phagocytosis. The patterns of H2O2 production following phagocytosis were essentially similar to those observed with phagocytosis. The above results are expected to form the basis for a rational indication for IVIG therapy against bacterial infections in neonates with low plasma IgG levels.

Heterogeneity in F-actin polymerization of cord blood polymorphonuclear leukocytes stimulated by N-formyl-methionyl-leucyl-phenylalanine.

Abstract Background: To elucidate the mechanism responsible for defects of polymorphonuclear leukocyte (PMNL) chemotaxis of neonates, we determined actin polymerization of NBD (7‐nitrobenz‐2‐oxa‐diazol)‐phallacidin‐stained PMNL following stimulation with either N‐formyl‐methionyl‐leucyl‐phenylalanine (fMLP) or phorbol myristate acetate (PMA) in cord blood and adult controls.

Heterogeneity of Fc Receptor Expression in Chemotaxis and Adherence of Neonatal Neutrophils

ABSTRACT: Chemotaxis and adherence to polymorphonuclear neutrophils (PMN) subpopulations from cord blood of 13 healthy neonates and blood of 16 healthy adults as control subjects were determined using the rosetteforming procedure, the modified Boyden method, and 51Cr adherence assay. The percentage of rosette-forming neutrophils (RFN) (Fc receptor expression) of cord PMN (35 ± 8%) was significantly lower than that of adult PMN (60 ± 4%, p<0.01). Differences in chemotaxis of PMN subpopulations between cord and adult PMN after stimulation by their own endotoxin-activated plasma were as follows: (i) unfractionated adult PMN (A) (n=10) versus adult RFN (B) (n=5) versus adult nonRFN (C) (n=5); (A)<(B), p<0.01 and (A)>(C), p<0.01; (ii) unfractionated cord PMN (a) (n=5) versus cord RFN (b) (n=5) versus cord non-RFN (c) (n=5); (a)<(b), p<0.01 and (a) versus (c), NS; (iii) (A)>(a), p<0.01; (iv) (B)>(b), p<0.05 and (C) versus (c), NS. Similarly, differences in adherence were as follows: (i) (A) (n=13) versus (B) (n=4), NS and (A)>(C) (n=4), p<0.01; (ii) (a) (n=4) versus (b) («=4), NS and (a)>(c) («=4), p<0.01; (iii) (A)>(a), p<0.05; (iv) (B) versus (b), NS and (C) versus (c), NS. These results suggest that differences in chemotaxis and adherence between cord and adult PMN may relate in part to differences of PMN subpopulations.

Effects of interview on mood status of pregnant women with high‐risk delivery

Background:  Expectant mothers at high risk for preterm labor admitted to the Mother and Child Health Centers (MCH) often have psychological problems and mood disturbances. The purpose of the present study was to evaluate the effects of an interview by health professionals on their mood status.

Management of Intraventricular Hemorrhage in Preterm Infants with Low Birth Weight

The management of posthemorrhagic hydrocephalus is difficult and not well standardized. We evaluated our management protocol for infants with intraventricular and/or periventricular hemorrhage (IVH and PVH, respectively). There were four deaths and two significant treatment-related complications in our series. We also observed two cases of isolated ventricle in patients treated with reservoir placement. After evaluating our series, we modified our protocol from reservoir placement to either cerebrospinal fluid (CSF) drainage or ventriculosubgaleal shunt directly. We will reevaluate this new protocol in the near future.

Cerebral blood flow monitoring using a novel laser Doppler flowmeter in asphyxiated infants

Background:  The aim of the present study was to investigate the role of early changes in cerebral blood flow (CBF) predicting the severity of neurological outcome in asphyxiated infants.

Relationship between plasma atrial natriuretic peptide concentrations and cardio-thoracic ratio during the early neonatal period.

ABSTRACT. Twenty‐seven neonates were examined at 2.6±1.5 hours of age (stage 1) and 21 ±4.9 hours of age (stage 2) to clarify the relationship between cardio‐thoracic ratio (CTR) on chest roentgenograms and plasma atrial natriuretic peptide (ANP) concentration. Among 22 infants who showed elevated plasma ANP, 14 had gained body weight (group A), while 8 other infants had lost weight (group B) at stage 2. The remaining 5 infants had decreased plasma ANP concentrations combined with weight loss at stage 2 (group C). All infants of group B had a patent ductus arteriosus. The plasma ANP concentration and CTR of groups A and B increased during the study period, while those of group C decreased. A linear relation was found between plasma ANP concentration and CTR in all cases (p<0.02). This study indicates that increased plasma levels of ANP are associated with an increased CTR.