1508 Weight Gain and Serum Bilirubin in Newborns With RDS Treated With Pancuronium Bromide

Abstract

All infants under 1001 gms were studied prospectively with ECHO within 24 hrs of admission to the Stanford ICN between 1/1/80 and 6/30/83. They were re-evaluated at least twice weekly, and scored by Papille's classification for ICH and for atrophy and hydrocephalus (HC). Of the 150 infants, 92 (61%) were discharged and examined yearly. Seven were excluded (4 deaths, 1 encephalocele, 1 lost to followup, 1 late non-neonatal neurologic iniurv).(t SD) (PBr, +42?14g vs. noPBr, p<0.01). Edema was present in 27 PBr treated infants and in 13 of those not treated with PBr (p<0,05). In addition, hyperbilirubinemia was more severe and more prolonged in patients treated with PBr. The t m groups had similar serum bilirubin on days 1 to 5 but serum bilirubin was significantly greater in the treated group on days 6 to 10 (d. 6 PBr 10.5k0.6 vs. noPBr 8.62 0.4 mg/dl, p.02).The use of PBr was associated with edema, excessive weight gain in the first week of life, and a higher, more prolonged peak of serum bilirubin. These findings remained valid when subgroups matched for severity of hypoxia on day one were examined in order to control for severity of underlying lung disease. . . 179 infants with BPD and 112'matched controls were compared in terms of perinatal factors and long-term outcome (1-8 yrs).Perinatal factors significantly (p < .001) more common in cases were, gestational agek29 weeks, hyaline membrane disease, episodes of hypoxia and acidosis, interstitial emphysema, pneumothorax, patent ductus arteriosus, long duration of assisted ventilation, episodes of endotracheal tube plugging, atelectasis, post extubation airway obstruction,),lO blood transfusions and the need for parenteral nutrition. 20 cases and 1 control (p <.001) died after discharge from hospital. Significant differences in outcome (p < .002) included increased frequency of lower respiratory illness, rehospitalization during the first year of life, abnormal physical findings on chest exam, growth deficits and the occurrence of retrolental fibroplasia. Neurodevelopmental outcomes, hearing and speech disorders, were more frequent in cases, but differences were not significant. 24/99 (24.2%) of cases and 7/49 (14.3%) of controls had cognitive delays, 28/141 (19.9%) or cases and 8/66 (12.1%) of controls had abnormalities on the Test of Gross Motor and reflex development, and 15/141 (10.6%) of cases and 5/66 (7.6%) of controls had cerebral palsy. Infants with BPD had higher post discharge mortality and morbidity rates in some areas, but differences in neurodevelopmental outcome were not significantly different in the two groups. Bilirubin (B) toxicity was investigated in 2 neural cell lines NBRlOA and N115 using a quantitative dye assay (MTT) as a measure of cell viability and 3H-Thymidine incorporation as a measure of DNA synthesis. The c e l l s are adapted t o grow in a protein free medium. Bilirubin concentration varying between 0.3 and 0.003 mM a t bilirubin/albumin molar r a t i o (B/A) of 0.5 t o 1.5 are introduced t o the media and incubated f o r 2 ...