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A case of severe, acute accidental theophylline intoxication in a 6-week old preterm infant treated with peritoneal dialysis is reported. Theophylline concentrations in plasma, urine and in the peritoneal lavage fluid were measured during all the procedure. With dialysis theophylline half-life was reduced to 14.8 hours, despite a plasmatic peak level of 133 micrograms/ml, and a significative amount of the drug was removed from the body, leading to a rapid and complete recovery of the child. In our experience peritoneal dialysis can be regarded as a first line emergency procedure in very sick infants with severe theophylline intoxication when more sophisticated methods are not available.

We describe a premature baby with X pentasomy, having a severe pulmonary hypertension secondary to perinatal asphyxia and hyaline membrane disease which appeared to be refractory to conventional treatments (hyperventilation, tolazoline, prostacyclin). Oxygenation and pulmonary hypertension rapidly improved after starting magnesium sulphate infusion (loading dose: 20 mg/kg e.v. of elementary Mg, followed by continuous infusion of 2-4 mg/kg/hr during 6 days). The therapy was associated with hypermagnesemia (5-7 mg/100 ml) and transitory side effects (hypocalcemia, muscular and bladder paresis, bradycardia without hemodynamic decompensation). We suggest that magnesium therapy might be considered in newborns with severe and persistent pulmonary hypertension.

The serum concentrations of 5 "nutritional" and 5 "acute phase" proteins were prospectively studied in 3 groups of newborns with nephelometric methods. Group A: 22 healthy breast fed term newborns aged 4 days; group B: 28 healthy enterally fed preterm newborns (mean gestational age 33.3 weeks); group C: 49 preterm newborns (mean gestational age 29.5 weeks) on parenteral nutrition (PN). Infants with surgical procedures, sepsis and liver or renal diseases were excluded. The serum concentrations of almost all proteins were similar or only slightly different among the 3 groups and never related to the weight and chronological or post-conceptional age. Only prealbumin, apolipoprotein A and B and C4 levels were significantly different between term and preterm newborns. Enterally fed preterm infants had lower concentrations of alpha 1 acid glycoprotein and higher albumin, transferrin and apolipoprotein A than PN fed infants. Since the observed differences were usually quite small, we suggest that--at least in clinical practice--common serum reference values of these proteins should be adopted for all healthy growing newborns, whether preterm or at term, enterally or parenterally fed. The inter-relationships between different proteins were studied. Four of the five nutritional proteins were highly correlated one with another and the same was observed for the 5 acute phase proteins. Nutritional proteins as a group did not correlate with acute phase proteins, with the only exception of alpha 1 acid glycoprotein and apolipoprotein A. Thus, the 2 groups of proteins seem to be regulated by different metabolic systems.