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High doses of dexamethasone (Fortecortin) for the prophylaxis of cerebral oedema were administered to 19 children aged 3 to 14 years because of head injury of varying degrees of severity. In order to assess possible suppression of the hypothalamic-pituitary-adrenocortical activity an insulin tolerance test and an intravenous tetracosactid (Synacthen) test was performed 1 to 26 weeks after the last dexamethasone dose. There was no evidence from the insulin tolerance test of inadequate cortisol excretion. After intravenous Synacthen injection satisfactory serum cortisol increase was found. However, from this test there was evidence of a lesser increase of serum cortisol depending on the time elapsed since cessation of dexamethasone. Investigation of circadian cortisol values showed 7 cases with subnormal serum cortisol at 18 o'clock independent of the time elapsed. The hypothalamic-pituitary-adrenocortical axis was functioning again during induced stress 7 days after withdrawal of dexamethasone. Subsequent stress situations do not require treatment with corticoids.

The authors studied in the Paediatric Department of the Leverkusen Municipal Hospital retrospectively the influence of an early dose of antibiotics (broad-spectrum penicillin combined with an aminoglycoside) in respect of the manifestation of bacterial newborn infections in infants with an increased risk of infection, during a period of 3 years (1981-1983). Among the infants born in the Gynaecological Department of the Leverkusen Municipal Hospital (exact data were available on the number of births and referrals) the incidence of bacterial newborn infections was 3.3% referred to the total number of deliveries (n = 3598); 0.7% of these newborn has sepsis. In the total group of children treated for newborn infection, the infection mortality was 5.5%; the mortality of the manifest newborn sepsis was 16.2%, i.e. lower than reported in literature. Early administration of antibiotics proved particularly effective in preventing purulent bacterial meningitis of newborn; this disease did not occur with any of the infants observed during the study period. Diagnosis of newborn infection included discolouration of the skin, respiratory disturbances, fever, shift to the left in the differential blood picture, and anaemia; these signs proved particularly suitable for arriving at a correct diagnosis. Identification of the pathogens was most frequently successful in gastric juice culture and anal smear. The latency period of more than 24 hours between rupture of the amnion and delivery does not represent an increased risk of infection for the newborn, as our results confirm, and this is, therefore, not an indication for initiating prophylaxis with antibiotics if there are no other abnormal findings.

Among twelve patients with homozygous alpha1-antitrypsin deficiency (Pi-type Z), five cases of infantile liver disease were diagnosed. The course of the disease was extremely variable; only one patient died of liver cirrhosis at the age of fourteen. In four cases the clinical, biochemical and histological (2 cases) findings became normal over a follow-up period of one to fifteen years. The results of these observations demonstrate that in alpha1-antitrypsin deficiency even when associated with proven liver disease the prognosis need not be unfavorable.

ZusammenfassungEs wird über Untersuchungen der Plasminogenspiegel in Plasmen gesunder Frühgeborener und solcher mit Atemnotsyndrom berichtet. Die Bestimmungen erfolgten mit der radialen Immundiffusion unter Verwendung eines Anti-Plasminogenserums. Vergleichende Untersuchungen zeigten eine annähernde Übereinstimmung der im immunologischen Test gefundenen Plasminogenwerte mit dem durch Streptokinase aktivierten Plasminogenproaktivator : Im Falle der unauffälligen Frühgeborenengruppe fanden sich im funktionellen Test jedoch jeweils höhere Werte als bei der immunologischen Bestimmung. Dies könnte als Ausdruck einer besonderen Reaktionsweise des Plasminogens im Neugeborenenplasma gedeutet werden.Die bei unauffälligen Frühgeborenen im Alter von 6 Stunden immunologisch bestimmten Plasminogen werte zeigten keine Korrelation mit dem Geburtsgewicht. Bis zur 48. Lebensstunde stiegen in dieser Gruppe die Plasminogen werte signifikant an. Auch in der Gruppe der an RDS erkrankten, überlebenden Frühgeborenen war ein allerdings nicht signifikanter Anstieg bis zum 2. Lebenstag nachweisbar. Bei den beiden Gruppen von an RDS erkrankten Kindern, die verstarben, lagen die Plasminogenwerte bereits im Alter von 2 Stunden erheblich unter den bei der unauffälligen Vergleichsgruppe gefundenen Werten: Im Falle der ohne Hirnblutung verstorbenen Kinder sank der Wert von 22,9% im Alter von 2 Stunden bis zur 24. Lebensstunde weiter auf 17,8% ab; bei denjenigen Frühgeborenen, die außer dem Atemnotsyndrom noch zusätzlich eine Hirnblutung auf wiesen, schwankten die Werte innerhalb der ersten 24 Lebensstunden nur unwesentlich um niedrigste Werte (17,5% im Alter von 2 Stunden, 17,2% im Alter von 24 Stunden).

Summary Measurement of the elimination of small quantities of 125I-fibrinogen (5–15 μCi) demonstrates shortened half-life and higher catabolic rates in premature infants, and particularly in those infants suffering from IRDS compared with adults. Turnover in the adult is 15%, in the premature 25 % and in the premature with IRDS 33 % per day. Equilibrium between intravascular and extravascular fibrinogen is not achieved before the third day of life. Later, elimination is linear. There is a highly significant difference between 32rT-fibrinogen catabolism in the adult and the premature infant with and without the IRDS between the third and twelfth day. Measurement of activity over various organs demonstrates that slow efiux of 125I-fibrinogen into the extravascular compartment causes a continuous fall in plasma activity during the first 2–3 days. In premature infants with IRDS the activity over the lungs rises during the first day of life. These results allow the conclusion that accelerated fibrinogen synthesis in infants with IRDS compensates for losses into the hyaline membranes and intravascular clots and even allows the physiological rise in plasma fibrinogen level during the first three days to take place.

Es werden Ergebnisse von Plasmafibrinogenbestimmungen bei gesunden Fruhgeborenen mitgeteilt. Die Untersuchungen erfolgten mittels der radialen Immundiffusion. Es wird gezeigt, das die zunachst niedrigen Fibrinogenwerte rasch ansteigen und bereits im Alter von 12 Std Erwachsenenwerte erreicht werden.