Relationship of CSF Beta Endorphin Concentrations to One Minute Apgar Score

Abstract

(Spon. by John Kattwinkel) . University of V i r g i n i a Medical Center, Department of P e d i a t r i c s , C h a r l o t t e s v i l l e . D e t e r i o r a t i o n of Doppler-derived a n t e r i o r c e r e b r a l a r t e r y flow v e l o c i t i e s has been described i n newborns with evidence of b r a i n death (Ann. Neurol. 14:302-307, 1983). Since these changes suggest a progressive decrease i n c e r e b r a l perfusion, we c o r r e l a t e d s e q u e n t i a l Doppler flow v e l o c i t i e s with technetium c e r e b r a l angiograms i n 2 asphyxiated neonates.Case 1 was a 3800 gram term baby who developed l e t h a r g y and s e i z u r e s within 24 h r s . of a d i f f i c u l t d e l i v e r y . CT scan revealed c e r e b r a l edema and m a l l subdural hemorrhage. Doppler flow s t u d i e s (Medasonics D-10, 5 MHz probe) performed on day 3 showed r e t r o g r a d e d i a s t o l i c flow. Peak s y s t o l i c flow diminished on day 4. A technetium angiogram on day 4 showed markedly diminished c e r e b r a l perfusion and repeat study on day 9 a f t e r l o s s of a l l brainstem f u n c t i o n s showed absence of i n t r a c r a n i a l circul a t i o n . Case 2 was a 3400 gram baby with severe b i r t h asphyxia and s e i z u r e s . CT scan revealed small v e n t r i c l e s and subarachnoid hemorrhage. Doppler flows were normal on day 1. Over the next 4 days, d i a s t o l i c flow reversed and peak s y s t o l i c flow diminished. Technetium study on day 6 showed absence of i n t r ac r a n i a l flow. Both p a t i e n t s expired.These p a t i e n t s confirm the e a r l i e r a s s o c i a t i o n between a d e t e r i o r a t i o n of Doppler flow v e l o c i t i e s and c l i n i c a l evidence of b r a i n death. Lack of c e r e b r a l perfusion was documented with technetium angiograms. The Brindled mouse mutant i s a model f o r t h e Kinky Hair syndrome. Male Brindled hemizygous s u c k l i n g mice demonstrate poor growth and neurologic d e t e r i o r a t i o n beginning during the f i r s t week of l i f e and ending w i t h d e a t h by t h e end of t h e second week. Newborn Brindled c a r r i e r s a r e asymptomatic with normal b r a i n copper c o n c e n t r a t i o n ; l i v e r copper c o n c e n t r a t i o n is low and t h e r e n a l copper i s high. Newborn c a r r i e r pups suckled by Brindled dams p u t on low copper d i e t s on t h e day of p a r t u r i t i o n , however, show d e f i c i e n t weight g a i n by t h e age of 6 days and by 12 days weigh approximately one-half t h e i r normal l i t t e r -m a t e s . Neurologic symptoms developed i n t h e copper-deficient young c a r r i e r s by age 12-14 days w h i l e t h e i r normal l i t t e r -m a t e s remained asymptomatic. Tissue copper s t u d i e s demonstrate t h a t t h e l i v e r and b r a i n copper c o n c e n t r a t i o n i n t h e c a r r i e r is no d i f f e r e n t from t h a t of t h e normals, although the r e n a l copper is g r e a t e r than twice a s high. On copper-deficie...

The Pharmacokinetics of Naloxone in the Premature Newborn

“…These compounds have been shown to play a role in the depression of respiration in newborn animals, an effect that is mitigated or reversed by naloxone [3, 4, 7-9]. Elevated levels of endorphins have been documented in premature infants [10], asphyx iated newborns [11,12], infants with severe apneic episodes [13], and in stressed neonates [14], all of whom suffer from disorders of respiratory control. Preliminary studies in human newborns demonstrated that nalox one significantly decreased the incidence of periodic breathing and im proved pneumocardiogram abnormalities in infants with apnea [5,6], The pharmacokinetics of naloxone have been studied in adults and in full-term newborns, but no data are available in premature neonates [15][16][17][18].…”