Neonatal resuscitation: in the public domain or private decision?
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Biomedical subjects
Publications and source records attributed to A D Bedrick.
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Prostaglandins are present in breast milk and may protect and maintain intestinal epithelial cell integrity in developing mammals. In view of their very short half-life in other body tissues and fluids, studies were performed to determine prostaglandin stability in milk and gastric fluid. Tritiated prostaglandins E2 and F2 alpha were incubated for 30 min in whole milk, milk cells, and milk plasma obtained from mothers delivering at term and prematurely, and in preterm infant gastric fluid. Radioactivity chromatographic analysis revealed minimal degradation of PG in milk preparations and gastric fluid. Thus, milk may serve as an effective natural medium for PG delivery to the gastrointestinal tract. The cytoprotective effect of prostaglandins on the gastrointestinal tract may be related to their stability and lack of degradation in milk and gastric digestive juices.
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Tritium-labeled prostaglandin F2 alpha was administered via orogastric tube to bile duct-cannulated suckling and weanling rats to determine if maturational differences were present in the biliary excretion of prostaglandin F2 alpha and metabolites. Animals were killed 2 h after radioactivity administration. Characterization of radioactivity present in bile revealed age-related differences in biliary prostaglandin F2 alpha excretion. Suckling rats had a greater proportion of radioactivity migrating in chromatographic regions of greater polarity than prostaglandin F2 alpha. Compared with the weanling, a significantly greater amount of radioactivity cochromatographed with intact, unmetabolized prostaglandin F2 alpha (33.08 +/- 1.99 vs. 21.38 +/- 1.46). These results indicate that orogastrically administered prostaglandin F2 alpha can be absorbed from the gastrointestinal tract, transported to the liver, and subsequently excreted into bile and detected in an unmetabolized form in suckling and weanling rats. The enterohepatic circulation of milk-derived prostaglandin present in bile may contribute to the overall content of intestinal prostaglandins.
Two premature neonates who suffered severe perioperative methemoglobinemia are reported. Simultaneous transcutaneous oxygen monitoring revealed adequate blood oxygen tension. Continuous transcutaneous monitoring may give a false sense of security by reflecting normal blood oxygen tension in the absence of adequate oxygen unloading capacity.
Little is known about the role of oral prostaglandins and maintenance of intestinal epithelial cell membrane integrity in suckling animals. The presence of prostaglandins in milk suggests that they may have potential cytoprotective effects. Thus, experiments were performed to determine whether indomethacin causes inflammation in the gastrointestinal tract of suckling animals. Rats were treated with daily intraperitoneal injections of indomethacin (10 mg/kg) starting on the 1st day of life. Unlike adult animals which develop intestinal lesions within 72 h, these rats did not develop intestinal ulcerations until weaning started on days 15 to 16. Indomethacin-treated suckling animals prevented from weaning did not develop intestinal lesions until they had access to solid food on day 23. Indomethacin-treated rats had large reductions in jejunal prostaglandin E2 content. In addition, prostaglandin E2 was present in rat milk in relatively large concentration as determined by radioimmunoassay. These studies suggest that exogenous prostaglandins present in milk may protect the intestine of suckling rats from indomethacin-induced inflammation; however, once weaning commences, prostaglandin insufficiency may develop leading to intestinal lesions. We speculate that suckling rats treated with indomethacin did not develop ulcerative lesions, despite a marked reduction in intestinal prostaglandin content, possibly due to prostaglandins present in milk.
Suckling (12- to 14-day-old) and weanling (30-day-old) rats were sacrificed 2 h after oral administration of 3H-labeled prostaglandin F2 alpha. Although radioactivity recovered from the stomach and small intestine (including contents) was slightly higher in sucklings (28.3 +/- 3.7%; n = 10) than in weanling rats (21.3 +/- 5.3%; n = 7), the liver of sucklings contained significantly higher amounts of counts (11.0 +/- 1.1 vs. 3.3 +/- 0.5%). Combined column and thin-layer chromatography of liver extracts showed more authentic prostaglandin F2 alpha in sucklings (11.0 +/- 0.5% of the liver counts) than in weanlings (7.0 +/- 1.1%). The liver of suckling rats contained a higher percentage of more polar metabolites (43.3 +/- 1.6 vs. 34.3 +/- 3.0%). These studies demonstrate differences in processing of oral prostaglandin F2 alpha in the early postnatal period.
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Four hundred computerized tomographic scans of the brain in infants and children from birth to 15 years of age were reviewed. Of these, 142 were judged to exhibit normal ventricular dimensions as determined by the biventricular (V/H) index, the length of a line drawn between the heads of the caudate nuclei (V) relative to the width of the cerebral hemispheres (H) at the same level. When all scans were analyzed collectively, the V/H index followed a Gaussian distribution (mean, .11 +/- .03) [SD]; range, .00 to .20). The index did not increase with advancing age within the pediatric population (0 to 15 years), as it does in adults.