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Of 95 infants treated with the synthetic surfactant, Exosurf, under a Treatment Investigational New Drug protocol, 17 received one dose, 40 received two, and 38 received three doses. Seventy-six (80%) of the infants were treated by rescue protocol. We retrospectively reviewed the clinical course of the 67 surviving rescue infants. We found that, compared to one- and two-dose infants, those treated with three doses of Exosurf were more premature, smaller, required a longer ventilator course, and had more frequent complications, including patent ductus arteriosus (PDA), intraventricular hemorrhage, nosocomial pneumonia, and apnea. They required higher oxygen concentrations starting 8 hr after their first dose and higher mean airway pressure (MAP) from the time of their second dose. These trends continued during all subsequent time points, as compared to infants treated with two doses. The third dose was administered an average of 17 hr after the second, resulting in little change of MAP, but some reduction in oxygen requirements. By 24 hr after the last dose, only 4% of three-dose infants were extubated compared with 30% of the two-dose and 71% of one-dose infants. In conclusion, repeated administration of Exosurf is not equally effective in every treated infant with respiratory distress syndrome (RDS) and complications of prematurity may affect or accompany poor response.(ABSTRACT TRUNCATED AT 250 WORDS)

Relationships of neonatal glycemia and birthweight to antecedent fetal glycemia and insulinemia have been examined in the offspring of 63 insulin-dependent diabetic and 29 nondiabetic mothers. Glycosylated hemoglobin levels in maternal and cord blood were measured by the thiobarbituric acid (TBA) colorimetric technique to estimate antecedent fetal and maternal glycemia; cord serum C-peptide was assayed to estimate fetal insulinemia. Glycosylated hemoglobin levels were significantly elevated in the diabetic mothers and their offspring as compared with controls (P < 0.001), and maternal and cord blood levels were highly correlated in the diabetic group (r = 0.61, P < 0.001). Cord serum C-peptide and glycosylated hemoglobin levels tended to be associated (r = 0.43, P < 0.10). Hypoglycemic infants of diabetic mothers (IDM) had significantly higher glycosylated hemoglobin levels (A443 nm/10 mg hemoglobin hemolysate) in cord blood (0.173 ± 0.009) than did IDM without hypoglycemia (0.153 ± 0.005, P < 0.01). Macrosomic and nonmacrosomic IDM, on the other hand, did not differ as to their glycosylated hemoglobin levels (0.162 ± 0.005 versus 0.161 ± 0.006, respectively). The occurrence of hypoglycemia was not associated with that of macrosomia (X2 = 0.24, P > 0.10). These data strongly suggest that neonatal hypoglycemia is the result of maternal hyperglycemia in pregnancy and consequent fetal hyperglycemia and hyperinsulinemia. However, maternal hyperglycemia in late pregnancy may not be a sufficient explanation for the development of macrosomia in IDM.

We describe the results of metabolic studies in a woman who exhibited the characteristic clinical and pathological features of a malignant somatostatinoma and who had, in addition, several novel manifestations of this syndrome: metastases to many organs other than the liver (including skin and bone), the presence of an immunoglobulin G K-type M-component, and marked hyperglycemia and ketonuria, necessitating insulin therapy. The M-component and the metastases to bone led to the erroneous diagnosis of multiple myeloma. The plasma level of somatostatin-like immunoreactivity (SLI) rose after therapy with streptozotocin and 5-fluorouracil and then fell toward the previous level. These changes were associated with variations in the hormonal responses to oral glucose and to iv arginine and with variations in hormone secretion and fuel flow during insulin withdrawal. When the SLI level rose, the immunoreactive insulin (IRI) response to oral glucose was reduced. Progressively higher basal SLI levels were associat...