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R S Procianoy

Publications and source records attributed to R S Procianoy.

At least 19 recordsLinked to original sources
PubMed2005

Umbilical cord blood and neonatal endothelin-1 levels in preterm newborns with and without respiratory distress syndrome.

Increased pulmonary vascular resistance in preterm newborn infants with respiratory distress syndrome is suggested, and endothelin-1 plays an important role in pulmonary vascular reactivity in newborns. We determined umbilical cord blood and neonatal (second sample) levels of endothelin-1 in 18 preterm newborns with respiratory distress syndrome who had no clinical or echocardiographic diagnosis of pulmonary hypertension and 22 without respiratory distress syndrome (gestational ages: 31.4 +/- 1.6 and 29.3 +/- 2.3 weeks, respectively). Umbilical cord blood and a second blood sample taken 18 to 40 h after birth were used for endothelin-1 determination by enzyme immunoassay. Median umbilical cord blood endothelin-1 levels were similar in both groups (control: 10.9 and respiratory distress syndrome: 11.4 pg/mL) and were significantly higher than in the second sample (control: 1.7 pg/mL and respiratory distress syndrome: 3.5 pg/mL, P < 0.001 for both groups). Median endothelin-1 levels in the second sample were significantly higher in children with respiratory distress syndrome than in control infants (P < 0.001). There were significant positive correlations between second sample endothelin-1 and Score for Neonatal Acute Physiology and Perinatal Extension II (r = 0.36, P = 0.02), and duration of mechanical ventilation (r = 0.64, P = 0.02). A slower decline of endothelin-1 from birth to 40 h of life was observed in newborns with respiratory distress syndrome when compared to controls. A significant correlation between neonatal endothelin-1 levels and some illness-severity signs suggests that endothelin-1 plays a role in the natural course of respiratory distress syndrome in preterm newborns.

Analysis of Variance↗
PubMed2003

Effect of perinatal asphyxia on thyroid-stimulating hormone and thyroid hormone levels.

AIM: To compare serum concentrations of thyroid hormones--T4, T3, free T4 (FT4) and reverse T3 (rT3)--and thyroid-stimulating hormone (TSH) found in the umbilical cord blood of term newborns with and without asphyxia and those found in their arterial blood collected between 18 and 24 h after birth. A further aim of the study was to assess the association between severity of hypoxic-ischemic encephalopathy and altered thyroid hormone and TSH levels, and between mortality and FT4 levels in the arterial blood of newborns between 18 and 24 h of life. METHODS: A case-control study was carried out. The case group comprised 17 term newborns (Apgar score < or = 3 and < or = 5 at the first and fifth minutes; umbilical cord blood pH < or = 7.15) who required bag and mask ventilation for at least one minute immediately after birth. The control group consisted of 17 normal, term newborns (Apgar score > or = 8 and > or = 9 at the first and fifth minutes; umbilical cord blood pH > or = 7.2). Cord blood and arterial blood samples were collected immediately after birth and 18 to 24 h after birth, respectively, and were used in the blood gas analysis and to determine serum concentrations of T4, T3, FT4, rT3 and TSH by radioimmunoassay. All newborns were followed-up until hospital discharge or death. RESULTS: Gestational age, birthweight, sex, size for gestational age, mode of delivery and skin color (white and non-white) were similar for both groups. No differences were found in mean levels of cord blood TSH, T4, T3 and FT4 between the groups. In the samples collected 18 to 24 h after birth, mean levels of TSH, T4, T3 and FT4 were significantly lower in the asphyxiated group than in the control group. Mean concentrations of arterial TSH, T4 and T3 between 18 and 24 h of life were lower than concentrations found in the cord blood analysis in asphyxiated newborns, but not in controls. In addition, asphyxiated newborns with moderate/severe hypoxic-ischemic encephalopathy presented significantly lower mean levels of TSH, T4, T3 and FT4 than those of controls. None of the asphyxiated newborns with FT4 > or = 2.0 ng/dl died; 6 out of the 11 asphyxiated newborns with FT4 < 2.0 ng/dl died. CONCLUSIONS: Serum concentrations of TSH, T4, T3 and FT4 are lower in asphyxiated newborns than in normal newborns between 18 and 24 h of life; this suggests central hypothyroidism secondary to asphyxia. Asphyxiated newborns with moderate/severe hypoxic-ischemic encephalopathy present a greater involvement of the thyroid function and consequently a greater risk of death.

Asphyxia Neonatorum↗
PubMed2001

A randomized, double-masked, placebo-controlled trial of recombinant granulocyte colony-stimulating factor administration to preterm infants with the clinical diagnosis of early-onset sepsis.

OBJECTIVE: We performed a randomized, double-masked, parallel-groups, placebo-controlled trial of recombinant granulocyte colony-stimulating factor (rG-CSF) administration to 44 preterm neonates who had blood cultures obtained and antibiotics begun because of the clinical diagnosis of early-onset sepsis. Two primary outcome variables were tested 1) mortality and 2) development of nosocomial infections over the 2-week period after dosing. DESIGN AND METHODS: The treatment group (n = 22) received 10 microgram/kg/day of intravenous rG-CSF once daily for 3 days and the placebo group (n = 22) received the same volume of a visually indistinguishable vehicle. Mortality and culture-proven nosocomial infections were recorded. Immediately before the first, second, and third doses, and again 10 days after the first dose, serum concentrations were determined for tumor necrosis factor-alpha, interleukin 6, granulocyte-macrophage colony stimulating factor, and G-CSF, and blood leukocyte counts, absolute neutrophil counts, immature/total neutrophil ratios, platelet counts, and hemoglobin concentrations were measured. RESULTS: The treatment and placebo groups were of similar gestational age (29 +/- 3 vs 31 +/- 3 weeks) and birth weight (1376 +/- 491 vs 1404 +/- 508 g), and had similar Apgar scores and 24-hour Score for Neonatal Acute Physiology scores. The mortality rate was not different between treatment and placebo groups. However, the occurrence of a subsequent nosocomial infection was lower in the rG-CSF recipients (relative risk:.19; 95% confidence interval:.05-.78). rG-CSF treatment did not alter the serum concentrations of the cytokines measured (except for G-CSF). Serum G-CSF levels and blood neutrophil counts were higher in the treatment than in the placebo group 24 hours and 48 hours after dosing. CONCLUSIONS: Administration of 3 daily doses of rG-CSF (10 microgram/kg/day) to premature neonates with the clinical diagnosis of early-onset sepsis did not improve mortality but was associated with acquiring fewer nosocomial infections over the subsequent 2 weeks.

Bacterial Infections↗
PubMed2001

[Hypoxic-ischemic syndrome]

OBJECTIVE: To review the literature on the hypoxic-ischemic syndrome, emphasizing its physiopathology, clinical manifestations, and treatment. SOURCES: Electronic search in the Medline and LILACS databases, with selection of the most relevant articles. SUMMARY OF THE FINDINGS: The hypoxic-ischemic syndrome is a multisystem disease with generalized manifestations. The physiopathology is based on hypoxic-ischemic brain injury and reperfusion with cellular injury caused by failure of ATP production secondary to ischemia, and overproduction of oxidative substances caused by reperfusion. Neurological, cardiovascular, respiratory, metabolic, gastrointestinal, renal, and hematological manifestations are frequent. Multisystem clinical management is complex; the neuroprotective approach is still experimental; and the prognosis is not good for those patients with severe hypoxic-ischemic encephalopathy. CONCLUSIONS: The management of the hypoxic-ischemic syndrome is a great challenge to pediatricians., since treatment requires multisystem intervention.

Journal Article↗
PubMed1999

Evaluation of interleukin-6, tumour necrosis factor-alpha and interleukin-1beta for early diagnosis of neonatal sepsis.

The objective of this study was to assess the contribution of interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-alpha) and interleukin-1beta (IL-1beta) to an early diagnosis of early-onset neonatal sepsis. A cohort of 117 newborn infants delivered during a 1-y period had IL-6, TNF-alpha and IL-1beta, blood and cerebrospinal fluid (CSF) cultures, leucocyte and platelet count collected on the initial evaluation of possible early-onset sepsis. They were divided into four groups: I, positive blood and/or CSF cultures; II, probably infected with clinical sepsis but negative cultures; III, same as group II but mother received antibiotic antepartum; and IV, newborn infants that did not receive any antibiotic therapy. There were no differences among the four groups with respect to mean gestational ages and birthweights, median Apgar scores, type of delivery, or number of newborn infants with leucocyte count <5000 mm(-3) or >25000 mm(-3), platelet count <100000 mm(-3), immature/total neutrophil ratio >0.2, absolute neutrophil count <1000mm(-3) and median IL-1beta levels. Median IL-6 and TNF-alpha levels were significantly higher in groups with patients with a diagnosis of clinical sepsis than in controls. The optimal cut-off point was 32 pg ml(-1) for IL-6 and 12 pg ml(-1) for TNF-alpha. The combination of both provided a sensitivity of 98.5%. In conclusion, the combination of IL-6 and TNF-alpha is a highly sensitive marker of sepsis in the immediate postnatal period.

Age Factors↗
PubMed1999

[Neonatal sepsis: diagnosis and treatment]

OBJECTIVE: Review the literature on diagnosis and treatment of neonatal sepsis. METHODS: The most important articles on neonatal sepsis were selected through MEDLINE. RESULTS: The present review analyzes the different methods of diagnosis, laboratory and clinical, as well as the different therapeutic managements of neonatal sepsis. CONCLUSION: Neonatal sepsis is a severe disease that must be diagnosed early and properly treated in order to avoid lethal outcome.

Journal Article↗
PubMed1998

[Bronchopulmonary dysplasia]

OBJECTIVE: To review the literature on bronchopulmonary dysplasia. METHODS: The most important articles on bronchopulmonary dysplasia were selected through MEDLINE. RESULTS: The present review analyzes the different concepts, pathogenesis, clinical presentation, treatment and prophylaxis of bronchopulmonary dysplasia. CONCLUSIONS: bronchopulmonary dysplasia is a frequent condition of very low birth weight infants with hyaline membrane disease who require mechanical ventilation. The pathogenic factors are prematurity, oxygen therapy, mechanical ventilation, pulmonary edema, and infection. Treatment is based on good oxygenation, fluid restriction, nutritional support, diuretics, betamimetic drugs, xanthines, and steroids. Prophylaxis includes avoiding prematurity and using pre-natal steroids, superoxide dismutase, and post-natal steroids.

Journal Article↗
PubMed1997

Transient elevation of aldosterone levels in perinatal asphyxia.

We measured plasma aldosterone levels in cord blood and peripheral blood collected 18-24 h after birth in 19 asphyxiated and 19 normal term newborn infants. The asphyxiated newborn infants had significantly higher aldosterone levels in cord blood than the normal newborn infants. At 18-24 h after birth there was no difference between the groups with respect to aldosterone levels. There was a positive significant correlation between aldosterone levels and PCO2 in cord blood by multiple linear regression analysis. There is a transient elevation of aldosterone levels in perinatal asphyxia.

Aldosterone↗
PubMed1996

Aldosterone cord levels in preterm newborn infants.

We measured umbilical cord aldosterone concentrations in 64 premature newborn infants. The median serum aldosterone level was 74.5 ng dl-1 (range 22-280 ng dl-1). Of the studied perinatal factors, only gestational age and birthweight presented a significant influence on the umbilical cord aldosterone levels. Newborn infants with a gestational age of over 34 weeks and a birthweight of over 2000 g had a significantly higher aldosterone cord level than those aged 34 weeks or younger and 2000 g or less in weight.

Aldosterone↗
PubMed1988

Fetal and neonatal cortical adrenal function in birth asphyxia.

Eighteen newborn infants, gestational age between 36 and 42 weeks with birth asphyxia were compared with 23 normal newborn infants to determine serum cortisol and dehydroepiandrosterone sulfate levels in cord blood and in venous blood samples collected 12-18 hours after birth. Both groups were similar in gestational age, birthweight, proportion of small for gestational age and large for gestational age infants, proportion of infants delivered by cesarean section with and without labor, and proportion of mothers with pre-eclampsia. There was no antenatal exposure to corticosteroid. The asphyxiated newborn infants had a significantly higher mean cord serum level of cortisol, and a significantly lower mean cord serum level of dehydroepiandrosterone sulfate than the control group. Mean serum cortisol and dehydroepiandrosterone sulfate levels collected 12-18 hours after birth were similar between both groups. It is suggested that elevated cord serum level of cortisol is related to birth asphyxia stress stimulating the adrenal definitive zone, and the low cord serum level of dehydroepiandrosterone sulfate is secondary to a transient hypoxemic-ischemic insult to the adrenal fetal zone.

Adrenal Cortex↗
PubMed1987

Early diagnosis of ABO haemolytic disease of the newborn.

To assess the usefulness of cord blood tests in diagnosing ABO-haemolytic disease of the newborn (ABO-HDN), 132 term, adequate for gestational age (AGA) neonates were evaluated. The tests studied and their significant results were: quantitative elution test (greater than or equal to 1/16), direct Coombs test (positive), bilirubin concentration (greater than or equal to 4 mg/dl). In none of the 56 O+ newborn infants delivered by O+ women were the results of any test positive. Of the 76 A+ and B+ newborn infants delivered by O+ women, 17 (22%) developed ABO-HDN. When the combined result of any two tests was positive, the sensitivity, the specificity and the positive predictive accuracy for the diagnosis of ABO-HDN was higher than for any one of the isolated tests. The probability that ABO-HDN was present when the results of at least two cord blood tests were positive was 70%, and the probability that ABO-HDN was not present when less than two cord blood tests gave positive results was 93%. It is suggested that the combination of quantitative elution test, bilirubin concentration and direct Coombs test in the cord blood is useful for an early diagnosis of ABO-HDN.

ABO Blood-Group System↗
PubMed1986

Congenital Wilms' tumor associated with consumption coagulopathy and hyperbilirubinemia.

A case of a term newborn infant with a congenital Wilm's tumor who developed severe jaundice and consumption coagulopathy is reported. After the removal of the tumor, the clotting factors became normal and the jaundice resolved. It is suggested that there was an association between the presence of the tumor and hemolysis and consumption coagulopathy.

Disseminated Intravascular Coagulation↗
PubMed1986

Umbilical cord dehydroepiandrosterone sulfate and cortisol levels in preterm infants born to pre-eclamptic mothers.

The influence of early-onset pre-eclampsia upon the umbilical cord serum levels of cortisol and dehydroepiandrosterone sulfate was studied in fifty-one preterm infants not exposed prenatally to corticosteroids. Preterm infants born to pre-eclamptic mothers (group A) presented lower dehydroepiandrosterone sulfate levels than preterm infants born to non-preeclamptic mothers (group B). The umbilical cord serum levels of cortisol were similar between both groups. It is suggested that the decrease in the cord serum levels of dehydroepiandrosterone sulfate in preterm infants of pre-eclamptic mothers plays an important role in the pathogenesis of the subnormal maternal urinary estriol excretion, and that the accelerated pulmonary and cerebral maturation of preterm infants born to pre-eclamptic mothers is not explained by an increased fetal serum cortisol concentration.

Adrenal Glands↗
PubMed1985

The influence of labor and delivery on preterm fetal adrenal function.

The influence of labor and route of delivery upon umbilical cord serum levels of cortisol and dehydroepiandrosterone sulfate in one hundred sixty-nine preterm infants not exposed prenatally to corticosteroids was studied. Vaginally born infants (group A, n = 89) presented a higher mean cord cortisol and dehydroepiandrosterone sulfate concentrations than those delivered by cesarean section (group B, n = 80). Although there were no differences in cortisol and dehydroepiandrosterone sulfate levels between infants delivered by cesarean section after spontaneous onset of labor (group B-I, n = 42) and those without labor (group B-II, n = 38), the mean cortisol and dehydroepiandrosterone sulfate concentrations were higher in group A than in group B-I. There was a correlation between umbilical cord cortisol and dehydroepiandrosterone sulfate levels. It is concluded that there is no association between the presence of labor and high cord serum levels of cortisol and dehydroepiandrosterone sulfate and there is an association between vaginal delivery and high cord cortisol and dehydroepiandrosterone sulfate levels in preterm infants. It is suggested that the stress of vaginal delivery stimulates the secretion of fetal cortisol and dehydroepiandrosterone sulfate in preterm infants.

Adrenal Glands↗