We evaluated four ventilator patterns after the administration of 80 mg/kg bovine lipid extract surfactant (LES) to anesthetized, paralyzed, saline-lavaged New Zealand white rabbits. Two ventilator types were compared: high frequency oscillatory ventilation (HFO) versus conventional mechanical ventilation (CMV), each at high (HI) and low (LO) end-expiratory lung volumes (EELV); n = 6, each group; treatment duration = 4 h. Target PaO2 ranges were > 350 mm Hg for groups with high EELV (i.e., HFO-HI and CMV-HI) and 70 to 100 mm Hg for those with low EELV (i.e., HFO-LO and CMV-LO). Ventilator pressures were limited to < or = 39/9 cm H2O in the CMV-HI group. Five of six CMV-HI-treated animals did not maintain target PaO2 levels. Both ventilator type and strategy influenced outcome significantly. Animals managed with HFO had higher mean arterial pressures (p = 0.004), lower mean airway pressures (Paw) (p < 0.00008) and HCO3- requirements (p < 0.02), larger inflation (p = 0.003) and deflation (p < 0.00001) respiratory system volumes at 10 cm inflation pressure, and higher lung lamellar body (p = 0.0006) and lavage fluid (p = 0.003) phospholipid quantities than did CMV-treated animals. The deflation P-V curve (p = 0.0004), lamellar body (p < 0.00001) and lavage fluid (p = 0.0002) phospholipid levels were superior after the high EELV strategy. We conclude that ventilator pattern strongly influences exogenous surfactant efficacy. Benefits arise from keeping EELV high enough to prevent atelectasis and using small (approximately 2 ml/kg) tidal volumes to prevent overdistension.(ABSTRACT TRUNCATED AT 250 WORDS)

Serum adiponectin levels were investigated in 28 small-forgestational-age (SGA) and 34 appropriate-for-gestational-age (AGA) term neonates to examine how fetal growth correlates with adiponectin levels. A blood sample for determination of adiponectin was obtained during the first 24 h of life. The levels of serum adiponectin were significantly higher in all newborn infants than in healthy children (28.7 Ϯ 17.0 versus 9.3 Ϯ 6.1 g/mL; p Ͻ 0.01). There was a significant difference in adiponectin levels between SGA and AGA infants (23.2 Ϯ 14.8 versus 33.2 Ϯ 17.5 g/mL; p ϭ 0.02). For all of the newborn groups, serum adiponectin levels correlated positively with birth weight (r ϭ 0.27, p Ͻ 0.05) and head circumference (r ϭ 0.30, p Ͻ 0.05). There was no relationship between serum adiponectin levels and gestational age, birth length, blood glucose levels, or blood sampling time after birth. There was no gender difference in adiponectin levels in the entire newborn group (30.0 Ϯ 19.7 versus 28.0 Ϯ 15.5 g/mL, in male and female infants). Our results suggest that hyperadiponectinemia and a positive relationship between the serum levels of adiponectin and birth weight in newborns cannot be explained by the low percentage of body fat alone. Lower adiponectin levels in SGA infants than in AGA infants are unlikely to suggest insulin resistance in intrauterine growth-retarded infants in early postnatal life but may be a predisposing factor in the future development of insulin resistance or type 2 diabetes. Adiponectin is a protein derived from adipose tissue in humans, and serum adiponectin levels are paradoxically reduced in obese individuals (1). Decreased concentrations of adiponectin are also seen in patients with insulin resistance or type 2 diabetes (2). Insulin-sensitizing agents such as thiazolidinediones increase adiponectin concentrations in humans (3) and in animals (4), whereas administration of adiponectin increases insulin sensitivity in animals (4). However, intrauterine growth retardation is associated with an increased risk of developing type 2 diabetes and cardiovascular disease (5,6). To explain this association, the concept of "reprogramming" was introduced (7): fetal adaptation to an adverse intrauterine environment determines an altered programming of endocrine pathways, leading to permanent metabolic changes, including insulin resistance. The present study was undertaken to examine how different intrauterine growth patterns relate to adiponectin secretion in early neonatal life. METHODS Infants.Thirty-four newborns (20 boys and 14 girls) with appropriate-for-gestational-age (AGA) birth weight (relative birth weight below ϩ2 or above Ϫ2 SD) and 28 (16 boys and 12 girls) with small-for-gestational-age (SGA) birth weight (relative birth weight, Ϫ2 or less SD) were included in the study (Table 1). All neonates had no asphyxia at birth and were found to be well on physical examination performed at the time of blood sampling. All infants in both groups were breast-fed, with similar frequencies ranging from 3 to...

Aims-To test the hypothesis that lavage with exogenous surfactant before partial liquid ventilation in meconium aspiration syndrome (MAS) would improve debris removal, and therefore the eVectiveness of partial liquid ventilation. Methods-12 newborn piglets were randomised into 4 groups, partial liquid ventilation or gas ventilation, with and without surfactant lavage. Physiological and blood gas data were compared between groups by analysis of variance. Results-Arterial oxygen pressure (PaO 2 ) was improved in the group treated with surfactant lavage when compared with the group not receiving surfactant. PaO 2 in the group receiving surfactant lavage followed by partial liquid ventilation was further improved when compared with the group treated with surfactant lavage followed by gas ventilation and the group receiving partial liquid ventilation alone. Conclusion-The eVectiveness of partial liquid ventilation in MAS might be enhanced by pretreatment with exogenous surfactant bronchial lavage. (Arch Dis Child Fetal Neonatal Ed 2000;82:F160-F162)

FLAIR appeared to detect subtle white matter injury related with neuro-developmental disorders at school-age, whereas T2-weighted imaging seemed to identify relatively more severe injury. FLAIR is a potentially sensitive screening tool that is readily available and easily interpretable.

We report on a 12-month-old Japanese boy with an interstitial deletion of the long-arm of chromosome 1 and meningomyelocele, hydrocephalus, anal atresia, atrial septal defect, left renal agenesis, bilateral cryptorchidism, talipes equinovarus, low birth weight, growth/developmental retardation, and many minor anomalies. By conventional GTG-banding, his karyotype was first interpreted as 46,XY,del(1)(q23q24), but it was corrected as 46,XY.ish del(1)(q24q25.3) by fluorescence in situ hybridization using 11 known cosmid clones as probes. His serum levels of apolipoprotein A-II (gene symbol: APOA2, previously assigned to 1q21-q23) and coagulation factor V (F5, 1q21-q25) were normal, while serum concentration and activity of antithrombin III (AT3, 1q23-q25.1) was low. The results indicated that localization of APOA2 and F5 are proximal to the deleted region and AT3 is located within the deletion extent in the patient.