To determine the incidence and risk factors for neonatal hypertension we studied the entire population of 3179 infants admitted to our neonatal intensive care unit over a 6-year period. We report a 0.81% (26/3179) incidence of hypertension in this population. In 13 patients (50%) the hypertension was renal in origin. In four patients (15.4%), the etiology of hypertension could not be determined. Significant risk factors for neonatal hypertension included: bronchopulmonary dysplasia (5.9% in affected infants v 0.5% in unaffected infants, P less than .001); patent ductus arteriosus (3.07% in affected v 0.5% in unaffected infants, P less than .001); intraventricular hemorrhage (2.89% in affected infants v 0.56% in unaffected infants, P less than .001); and umbilical arterial catheterization (8.8% v 0.2% in infants with and without catheterization, respectively, P less than .001).
Gram-negative sepsis/septic shock causes significant mortality in newborns. However, there has been no established method for newborn endotoxic shock treatment. Prostaglandins play a role in endotoxic shock. Cepharanthine is a biscoclaurine alkaloid that primarily inhibits phospholipase A2. Therefore, the effects of cepharanthine have been studied on endotoxic shock in newborn rats. Cepharanthine decreased the 24 h mortality of endotoxic shock in a dose-related manner. At the dose of 0.2 mg kg-1 it effectively reduced the mortality from 90 to 21% in newborn rats. It also induced hyperglycaemia in control rats and blunted the hypoglycaemia of endotoxic shock. Cepharanthine did not suppress body weight gain nor did it delay death as seen with glucocorticoid treatment. We conclude that cepharanthine is beneficial in the treatment of newborn endotoxic shock.
Sepsis in newborns and infants is a major pediatric problem often associated with renal dysfunction. The present report deals with changes in renal tissue induced by Salmonella enteritidis endotoxin in 10- and 28-day-old Sprague-Dawley rats. Our studies revealed a 90% lethality within 24 h of 0.1 mg/kg and 35 mg/kg S. enteritidis endotoxin injection in 10- and 28-day-old rats, respectively. The 10- and 28-day-old animals received a single intraperitoneal injection of the 90% lethality dose and were sacrificed at different intervals for histopathological evaluation of kidneys by light and electron microscopy. The glomeruli showed visceral epithelial and endothelial cell swelling and polymorphonuclear leukocyte and platelet accumulation in the capillary lumina. Cortical and medullary tubules showed edematous separation, mild focal epithelial cell damage and focal intertubular hemorrhage. Renal sections of 28-day-old experimental rats showed increased numbers of polymorphs in the glomerulus and enlarged mesangial matrix. These sections also showed an increase in the number of hemorrhagic foci in 10 x field compared with the 10-day-old experimental rats. Endothelial cells of renal vasculature showed cytoplasmic swelling, vacuolization, autophagic vesicle formation and presence of secondary lysosomes. Changes in the endothelial cells of peritubular microvasculature were extensive, resulting in focal degeneration and partial loss of endothelial lining. These studies show that infant rats are extremely sensitive to S. enteritidis endotoxin requiring 1/350 the dose given to young adults to induce histopathological changes in kidney; the endothelial cells of microvasculature appear to be the primary targets of endotoxic injury irrespective of age.
The differentiation between night and day wetting allows the application of practical developmental and behavioral approaches to the diagnosis, evaluation, and therapy of each problem. Wetting the bed is mainly a developmental issue, and wetting the pants is a behavioral one.
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