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Biomedical subjects

M Koivisto

Publications and source records attributed to M Koivisto.

At least 19 recordsLinked to original sources
PubMed1992

Pharmacokinetics and pharmacodynamics of intravenous meperidine in neonates and infants.

The pharmacokinetics of meperidine (pethidine) was studied in 21 infants who received a single intravenous dose of 1 mg/kg after surgery (n = 18) or during mechanical ventilation because of respiratory distress (n = 3). Eleven patients were younger than 1 week old, 10 patients were aged from 3 weeks to 5 months, and five of the patients were premature. The pharmacokinetics of meperidine varied greatly between the subjects, with a median elimination half-life of 10.7 hours (range, 3.3 to 59.4 hours), median clearance of 8.0 ml/kg/min (range, 1.8 to 34.9 ml/kg/min), median volume of the central compartment of 2.4 L/kg (range, 0.5 to 4.8 L/kg), and median steady-state volume of distribution 7.2 L/kg (range, 3.3 to 11.0). The great interindividual variability in meperidine pharmacokinetics should be taken into consideration when meperidine is administered to neonates. Although no life-threatening or serious side effects were observed in this study, appropriate care should be exercised when prescribing meperidine for this age group.

Aging↗
PubMed1992

Splenic abscess. Imaging and intervention.

We reviewed the imaging findings of 14 splenic abscesses in 13 patients. All patients underwent chest radiography, 12 ultrasonography (US), 9 CT, 4 plain abdominal radiography, 2 99mTc-HMPAO leukocyte scan and 2 99mTc-HIG scan. Three patients were treated with percutaneous catheter drainage, and 5 with diagnostic or therapeutic fine-needle aspiration (FNA). At US the abscess was hypoechoic (n = 9), anechoic (n = 2), or anechoic with gas-bubbles (n = 1), or the entire spleen was inhomogeneous with gas-bubbles (n = 1). At CT the abscesses appeared as low density (18-30 HU) lesions with (n = 2) or without (n = 7) gas. In 2 cases 99mTc-HMPAO leukocyte scan, and in one case 99mTc-HIG scan showed an intrasplenic defect, and in one case 99mTc-HIG scan was considered normal. At plain abdominal radiography extraintestinal gas was suggested in 2 patients, and the findings were normal in 2. US-guided FNA confirmed infectious etiology of the lesion in 4 patients, and a necrotic specimen suggested infection in one. One patient was cured with repeated aspirations. Catheter drainage was successful in all 3 patients who underwent the procedure. We conclude that US and CT are accurate in detecting splenic abscesses. Our results in splenic interventions advocate wider use of the procedures.

Abscess↗
PubMed1989

Circulating sex hormone-binding globulin and testosterone in newborns and infants.

The concentrations of sex hormone-binding globulin (SHBG) and testosterone (T) were measured in the cord blood of full-term newborns (14 boys, 15 girls) and pre-term newborns (10 boys, 5 girls), and in the venous circulation of 100 full-term infants aged 1-204 days. The ratio of T to SHBG (the 'free androgen index', FAI) was calculated to reflect the level of unbound T (the free, biologically active fraction). In boys' umbilical cord sera, T concentrations were significantly greater in arterial than in venous sera, while there was no such difference in the concentration of SHBG. Levels of SHBG in cord sera were considerably lower than those seen in the maternal circulation at term, but they were significantly greater in boys' than in girls' cord sera. Levels of T, and the FAI, were significantly greater in boys' arterial cord sera than in girls'. In early infancy, SHBG concentrations rose in both sexes, the highest values being seen in girls. In infant girls, levels of T and the FAI were constantly low. In infant boys, the expected peak in serum T concentrations was observed at 1-3 months the values approaching those seen in men. In contrast, values of the FAI at this age were relatively low, similar to those seen in women. This suggests that the elevation of male serum T during the first months of life lacks biological significance. However, it is important to realise that the FAI in male infants is about one order of magnitude larger than that in female infants at this time.

Androgens↗
PubMed1989

Comparison of the effects of general and epidural anaesthesia for caesarean section on the neurobehavioural responses of newborn infants.

Thirty-one neonates delivered by elective caesarean section were evaluated at the ages of 3 h, 1 day, 2 days and 4-5 days using Scanlon's Early Neonatal Neurobehavioural Scale and tests for orientation. Thirteen of the mothers received general anaesthesia and 18 epidural anaesthesia. All the mothers were healthy and not in labour. All the neonates weighed 2500 g or more and had Apgar scores of 7 or more at 1, 5 and 15 min. The neonates delivered with epidural anaesthesia scored significantly lower on rooting at the age of 3 h than those delivered with general anaesthesia, but the latter scored significantly lower on habituation to sound and orientation to both animate and inanimate visual stimuli. General anaesthesia seemed to depress the infants' interactive processes (orientation items), and their ability to make an appropriate response to repetitive stimuli (habituation) more than did epidural anaesthesia, indicating greater global depression. This depression was short-lived, however, and there were no differences between the groups on any of the parameters after 24 h.

Adult↗
PubMed1989

Neonatal septicaemia in Finland 1981-85. Predominance of group B streptococcal infections with very early onset.

A survey of blood culture-confirmed neonatal septicaemia was carried out in seven delivery hospitals in 1981-85, for a second successive five-year period. The total number of cases was 377, to compare with 410 in the previous five-year period. Group B streptococcus (GBS) was throughout the major pathogen (29%), followed by Staphylococcus aureus (15%) and Escherichia coli (14%), while Staphylococcus epidermidis (10%) has emerged as a significant new causative agent. Septicaemia with very early onset was predominant: 49% of the cases had onset within the first 24 hours; in the majority the symptoms were present from birth. GBS was responsible for 49% of the cases detected in the first 24 hours of life. The overall mortality was 20% as compared to 23% in the previous five-year period, whereas in the very early onset septicaemia mortality was now 18%, down from the preceding 30%. Despite the modest progress, GBS septicaemia with very early onset remains a significant problem, and effective preventive measures are needed.

Finland↗
PubMed1988

Two cases of large placental chorioangioma with fetal and neonatal complications.

Two cases of infants born from pregnancies complicated by large placental chorioangiomas causing congestive heart failure in the neonate as the main complication are presented. Chorioangiomas may be diagnosed early in pregnancy by ultrasound examination. Since both their maternal and their neonatal complications may indicate premature termination of the pregnancy or be conducive to premature birth, repeated ultrasound examinations, including fetal echocardiography, are suggested in order to optimize the timing of the delivery.

Adult↗
PubMed1987

Cry analysis in infants with Rh haemolytic disease.

The influence of hyperbilirubinaemia on the infants' cries and the feasibility of the use of cry analysis for the early identification of developing kernicterus were studied by analyzing the cries of 100 healthy one-day-old infants and 31 infants with Rh haemolytic disease of the newborn (Rh-HDN) by using sound spectrographic methods. The newborn infants with Rh-HDN were divided into three subgroups according to the findings in a neurological examination: an evident group (10 infants), a transient group (13 infants) and an asymptomatic group (8 infants) and followed up until one year of age. Cry recording and a neurological examination were carried out once for each of the healthy one-day-old infants and twice a day during the first week of life for the infants with Rh-HDN, and thereafter once a day until discharged and at the ages of 1 and 3 months. Additional neurological examinations were performed on the Rh-HDN infants at the ages of 6 and 12 months. Bilirubin determination was carried out in connection with the cry recordings during the first week of life. The effect of blood exchange transfusion on the cry sound was investigated in infants with a bilirubin level above 250 mumol/l (n = 12) and below this level (n = 15) before the procedure. An electroencephalography (EEG) was recorded once during the neonatal period and once during the follow-up. The cries of the healthy infants were used to develop a cry score comprising 16 characteristics (latency, duration of phonation, maximum and minimum pitch of fundamental frequency, occurrence and maximum pitch of shift, glide, melody form, biphonation, furcation, noise concentration, voice quality, double harmonic break, glottal plosives, vibrato and glottal roll), which was then applied to the analysis of the cries of the 31 infants with Rh-HDN. In addition, maximum pitch of fundamental frequency, furcation and combination of biphonation and/or furcation were studied. The cry score and maximum pitch of fundamental frequency increased most obviously in the infants in the evident group as compared with the values after birth in the various subgroups and with the values of the healthy one-day-old infants or the infants in the asymptomatic group day by day. Both parameters also increased in the asymptomatic group between days 2 and 3 as compared with the initial value after birth and with the healthy infants.(ABSTRACT TRUNCATED AT 400 WORDS)

Crying↗
PubMed1987

Pharmacokinetics of clonidine during pregnancy and nursing.

Pharmacokinetics of clonidine were examined in ten women during pregnancy, in nine during nursing, and in the newborns of these women. Clonidine crosses the placenta easily, and its concentrations were equal in maternal serum and umbilical cord serum. Amniotic fluid concentrations were up to four times that found in serum. Clonidine concentrations in milk were roughly twice that in maternal serum; in the serum of the newborns the concentrations were about half those of the mothers. All concentrations corresponded well to the doses of the drug. The neurologic examinations and assessments of serum electrolytes and blood glucose showed results parallel with those of newborns of nontreated mothers.

Amniotic Fluid↗
PubMed1985

Metoclopramide and breast feeding: efficacy and anterior pituitary responses of the mother and the child.

The purpose of this randomized, double-blind clinical study was to evaluate the efficacy of the antidopaminergic agent metoclopramide (MC) in the treatment of puerperal lactational insufficiency, and prolactin, TSH and free thyroxine responses of the mother and the child to this therapy. Therefore, 11 women received MC (10 mg 3 times daily orally) and 14 a placebo for 3 wk. MC increased the serum concentration of PRL from 57.5 + 45.5 U/l to 315.0 + 300.0 U/l (P less than 0.001), and the amount of daily milk yield in 8 women with established lactational deficiency rose from 285 + 75 ml to 530 + 162 ml (P less than 0.01) while the placebo was ineffective. Serum concentrations of TSH and free thyroxine did not change during either of the treatments. Serum concentrations of PRL, TSH and free thyroxine in the infants were similar in both groups and remained unchanged throughout the study. Our results suggest that MC is useful in the treatment of deficient puerperal lactation, and it does not stimulate the pituitary lactotropes or thyrotropes of the nursing infants.

Adult↗
PubMed1985

Neonatal septicaemia.

A total of 410 proved cases of neonatal septicaemia from seven Finnish hospitals seen between 1976 and 1980 were reviewed. The annual incidence of neonatal septicaemia was 3 per 1000 births, and overall mortality was 23%. Onset was early in most patients. Symptoms of septicaemia occurred within the first 24 hours of life in 44% and within the first week of life in 90%. In the very early onset disease (within 24 hours) mortality was 30%, compared with 17% in all other cases. Group B streptococcus was the leading cause in very early onset disease (52%) but mortality from infection with this organism was similar to that in other very early onset cases. It is concluded that very early onset neonatal septicaemia, probably of intrauterine origin and caused by group B streptococcus in one half of the cases, constitutes the major form of neonatal septicaemia in Finland and should receive the highest priority in preventive measures.

Enterococcus faecalis↗
PubMed1984

Hormonal changes during the perinatal period: FSH, prolactin and some steroid hormones in the cord blood and peripheral serum of preterm and fullterm female infants.

Fetoplacental endocrine function during the last third of gestation, and first 5 days post partum, was studied by hormone measurements of umbilical cord arterial and venous serum in preterm (31-37 weeks gestation) and fullterm (39-42 weeks gestation) female newborn. Furthermore, hormones were measured in peripheral serum of fullterm female infants of 1, 3 and 5 days of age. The data were compared with those obtained previously in corresponding age groups of males. FSH was significantly (P less than 0.05) higher in the cord serum of preterm females (5.4 +/- 1.8 IU/I, SE, n = 30) than in males (1.5 +/- 0.08 IU/l, n = 27), and decreased significantly (P less than 0.05) in preterm females towards fullterm. PRL levels increased in both sexes towards the end of gestation (P less than 0.01), and decreased post partum, but no sex differences could be detected. Testosterone was significantly higher in the male serum samples (P less than 0.01-0.05), but only minor sex differences were seen in cord serum, or post partum, concentrations of the other steroids measured, pregnenolone, progesterone, 17-hydroxyprogesterone and androstenedione. Significant arterio-venous difference (higher in the vein) were seen at term in progesterone and 17-hydroxyprogesterone. The levels of these two steroids also decreased most clearly after birth. Female serum testosterone peaked at d 1 post partum (0.084 +/- 0.014 microgram/l, SE, n = 11), decreased thereafter, but remained at the intrauterine level, suggesting that the low female levels of this steroid are of fetal, rather than placental/maternal origin. The same seems to be true for androstenedione. Our data suggest that the fetal ovary is quiescent during the last weeks of gestation.

Androstenedione↗
PubMed1983

Metoclopramide and breast feeding: transfer into milk and the newborn.

The pharmacokinetics and endocrinological effects of metoclopramide were investigated in 5 mothers with deficient lactation and in their children soon after delivery. In addition, the transfer of metoclopramide into breast milk was evaluated in 18 mothers during the 8th to 12th puerperal weeks. Metoclopramide was detected in all the milk samples studied, generally at a higher concentration than in maternal plasma. Metoclopramide was found in plasma from only 1 of the 5 neonates studied. Exposure of the child to metoclopramide, estimated by multiplying the daily breast milk volume by the concentration of metoclopramide in the milk, ranged from 6 to 24 micrograms/kg/day for the 5 children in the early puerperium to 1 to 13 micrograms/kg/day for the 18 children during the late puerperium. These quantities are considerably less than the therapeutic dose of 500 micrograms/kg/day recommended for children. However, the plasma concentration of prolactin in 4 out of 7 neonates sampled taken during administration of metoclopramide to the mother were higher than the highest plasma prolactin level in children of same age of untreated mothers. The plasma concentration of thyrotrophin in the newborns remained within the normal range.

Female↗
PubMed1983

Seasonal variation in serum-25-OH-D3 in mothers and newborn infants in northern finland.

Two groups, each consisting of twenty Finnish mother-neonate pairs and ten non-pregnant controls were studied for serum calcium, serum phosphate, serum alkaline phosphatase, parathormone index (PTHind) and S-25-OH-D3. The first series was collected in winter and the other in summer. The serum samples were taken on the third day after delivery. The concentrations of S-25-OH-D3 were significantly lower in the mothers than in the non-pregnant controls in winter, but the difference was not significant in summer. The concentrations of S-25-OH-D3 in the serum of the mothers were similarly significantly lower in winter than in summer, ten mothers exhibiting a value below the detection line in winter, but only two in summer. The concentrations of S-25-OH-D3 in the mothers and their newborn infants showed a close relationship, but when extremely low values existed in the mothers, the infant concentrations were slightly higher. The seasonal variation in S-25-OH-D3 was also significant in the neonates. Although calcium was decreased and alkaline phosphatase elevated when compared with the non-pregnant controls in the mothers in both groups, these values showed no seasonal variation, and the mean levels of serum calcium, phosphate, alkaline phosphatase and PTHind in the neonates also remained unaltered between the two groups. The results indicate that additional vitamin D should be supplied during pregnancy in the winter months at this latitude.

Adult↗
PubMed1983

Early closure of patent ductus arteriosus with indomethacin in preterm infants with idiopathic respiratory distress syndrome.

Thirty-seven preterm infants with idiopathic respiratory distress syndrome were prospectively studied for the effect of the early closure of patent ductus arteriosus with indomethacin on the course of idiopathic respiratory distress syndrome. Serial retrograde aortograms were performed in all infants in order to visualize the ductus arteriosus, apart from three patients, who died early and were evaluated aortographically only once. The ductus was initially open in 27 infants and closed in 10 infants. The infants with open ductus arteriosus were randomly divided into two groups. The first group consisted of 13 infants, in whom the ductus was closed with indomethacin at a median age of 18 hours. The other 14 infants served as controls. Total time on assisted ventilation and duration of exposure to additional oxygen were significantly shorter in medicated infants than in controls. Oxygenation of infants with an initially closed ductus was better from birth and duration of their ventilatory assistance and oxygen exposure were shorter than in infants with initial ductal shunting. The data suggest that the early closure of the patent ductus arteriosus with indomethacin in distressed preterm infants has a favourable effect on the course of idiopathic respiratory distress syndrome.

Clinical Trials as Topic↗