Twice weekly plasma and urine measurements were made in 24 very low birth weight infants. Intravenous feeding was given whilst infants required respiratory support. Subsequently they received breast milk or formula milk with a vitamin D supplement of 400 U/day. Fourteen babies required intravenous feeding for more than 10 days. Six developed radiological rickets or severe osteoporosis, and these infants had plasma phosphate levels < 1.2 mmol/L on breast milk or < 1.8 mmol/L on formula milk. Babies without radiological rickets had plasma phosphate levels > 1.2 mmol/L on breast milk and > 1.8 mmol/L in all but one on formula milk. Successful treatment of rickets was associated with a rise in plasma phosphate to the above levels. Untimed urine calcium and phosphate concentrations expressed as creatinine ratios were not helpful in detecting babies with rickets, but may be useful in monitoring therapy.
As part of a survey of the causes of perinatal mortality at Mpilo Maternity Hospital, 220 neonatal deaths and the mothers of 221 stillbirths were tested for HIV-1 antibodies. The HIV positive rate in neonatal deaths was 23-6% (95% confidence interval (CI) 18-0 to 29-2%), significantly higher than 15-4% (95% CI 10-6 to 20.1%) in stillbirths. Perinatal deaths from congenital malformations, birth asphyxia, pregnancy induced hypertension, placental abruption, and other non-infectious causes had similar low HIV positive rates averaging 8-1% (95% CI 3-9 to 12-3%). Deaths from septicaemia had a significantly greater rate of 39-3% (95% CI 27-0 to 51-6%) and the highest rate of 72-2% (95% CI 51 5 to 92-9%) was found in deaths from congenital infection other than syphilis, indicating that maternal HIV infection predisposes to neonatal septicaemia and congenital infection. Unexplained stillbirths also had a significantly greater rate of 22-4% (95% CI 10*7 to 34-1%), presumably because some died from unrecognised infection. The rate in deaths from congenital syphilis was 17-4% (95% CI 9-6 to 25-2%), indicating a significant but weak association between these two sexually transmitted diseases in Bulawayo. The rate in deaths from hyaline membrane disease was not significantly greater at 15-0% (95% CI 6-0 to 24-0%). By predisposing to infection, maternal HIV infection was estimated to increase the stillbirth rate by 1-6 times and the neonatal mortality rate by 2-7 times. It predisposed equally to early and late onset neonatal septicaemia, but more to infection from streptococci and staphylococci than from Gram negative enterobacteria. HIV positive deaths from congenital infection had respiratory distress and usually intrauterine growth retardation, hepatosplenomegaly, and congenital pneumonia on lung histology.
Mineral balance studies were performed in 61 sick preterm infants given parenteral fluids only. Their gestational ages varied from 24 to 35 weeks, and 50 required mechanical ventilation. Two consecutive balance studies were performed; the first from admission to 48 hours in all babies given maintenance fluids of 10% Dextrose, and the second from 48 hours to 7 days in those babies given intravenous feeding (IVN). At the beginning and end of each balance period, the baby was weighed and an arterial blood sample taken for blood gases, electrolyte, urea, creatinine and protein determinations. During the balance period all urine was collected and analysed for electrolyte, urea, and creatinine composition, and all fluid intake was recorded. The balance of a mineral was calculated as the difference between parenteral intake and urine output. Infants requiring IVN were allocated alternatively to regimen X or regimen Y, which had the same calcium content of 9.5 mmol/L, but different phosphate contents, regimen X containing 7.3 mmol/L and regimen Y 11.6 mmol/L. In those infants requiring prolonged IVN, 12–24 hour balance studies were performed at weekly intervals after day 10. 1. Phosphate deficiency developed in infants given regimen X, who had higher urine calcium excretion, lower percentage calcium retention and lower plasma phosphate levels than those given regimenY. These differences were apparent by day 7 and persisted after day 10. In infants given regimen Y, mean calcium retention from admission to day 7 was 3.9 mmol/kg, and after day 10 was 0.9 mmol/kg/day. 2. In the first 48 hours, urine output and creatinine clearance varied widely and were lower in infants with higher oxygen requirements at 48 hours. Ten babies had severe oliguria with outputs less than 10 mL/kg/day. Creatinine clearance was directly related to gestational age, mean arterial blood pressure, and plasma protein concentrations on admission. After 48 hours, urine output and creatinine clearance increased considerably. 3. In the first 48 hours, metabolic acidosis was produced by increased plasma non‐protein metabolisable acid concentrations, which were associated with low creatinine clearances, and were thought to be due to lactic acid accumulation in response to decreased tissue perfusion. At 7 days, metabolic acidosis was of similar severity but was produced by decreased plasma non‐metabolisable base concentrations, caused by increased urine loss of net base, and not directly by IVN. 4. A simple model was constructed for either estimating the net movement of a substance into or out of the extracellular fluid (ECF) space, referred to as production or uptake respectively, or for estimating change in the fraction of body weight made up by ECF, referred to as ECF fraction. 5. Hyperkalaemia developed in 5 infants at 48 hours, and was caused by a combination of severe oliguria and high rates of potassium production. Potassium production was directly related to urea production, which varied widely over the first 48 hours, low rates being found i...
Three very low birth weight infants, treated with frusemide for broncho-pulmonary dysplasia are described. They all developed medullary nephrocalcinosis identifiable by real time ultrasound. The sonographic findings of diffuse medullary hyper-echogenicity appears to be specific for nephrocalcinosis.
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