digoxin and Birth-Weight

The twin-twin transfusion syndrome is a rare but severe complication in monozygotic twins. A total of 172 twin pregnancies were investigated in our hospital between January 1990 and August 1993. The patients were divided into 4 groups: Group I: Normal twin pregnancy, treatment only in our hospital. Group II: Twin-twin transfusion syndrome, treatment only in our hospital. Group III: Normal twin pregnancy, delivery in another hospital. Group IV: Twin-twin transfusion syndrome, after treatment and therapy delivery in another hospital. These cases were analysed concerning prenatal management and perinatal outcome. The perinatal mortality rate in group I-IV was 17%, 58%, 18% and 60%, respectively. A benefit of aggressive amniocentesis in case of polyhydramnios, administration of digoxin and timing of labour could be demonstrated.

Topics: Adult; Amniocentesis; Birth Weight; Combined Modality Therapy; Congenital Abnormalities; Digoxin; Female; Fetofetal Transfusion; Gestational Age; Humans; Infant, Newborn; Male; Pregnancy; Tocolysis; Ultrasonography, Doppler, Color; Ultrasonography, Prenatal

Topics: Bilirubin; Birth Weight; Blood Proteins; Cardenolides; Digoxin; Humans; Infant, Newborn; Reference Values; Saponins

Multiple-dose kinetics of digoxin were studied over a 7-day period in five neonates receiving intravenous digoxin therapy (one initial digitalizing dose followed by single daily doses). Their weights ranged from 1.04 to 2.68 kg (means = 1.61 kg), gestational ages from 28 to 39 weeks (means = 31.8 weeks), and postnatal ages from 2 to 19 days (means = 8.0 days). The 24-hour serum digoxin levels and urinary creatinine and digoxin excretion after the 1st and 7th doses on days 1 and 7 were employed to derive the kinetic parameters. Values of each following parameter (mean +/- SD) were obtained on days 1 and 7, respectively: (1) creatinine clearance (ml/min/1.73 m2) 12 +/- 6, 13 +/- 8; (2) renal digoxin clearance (ml/min/1.73 m2) 13 +/- 8, 15 +/- 10; (3) total body digoxin clearance (ml/min/1.73 m2) 35 +/- 14, 39 +/- 24; (4) volume of distribution (L/kg) 7.2 +/- 1.0, 6.9 +/- 1.1; and (5) half-life (hours) 48 +/- 19, 49 +/- 27. No consistent changes of the above kinetic parameters from days 1 to 7 were observed in these five neonates (P greater than 0.05, paired student's t-test).

Topics: Birth Weight; Creatinine; Digoxin; Female; Gestational Age; Humans; Infant, Newborn; Kidney; Kinetics; Male; Time Factors

Digoxin serum concentrations were measured by a routine radioimmunoassay in 30 neonates not receiving digoxin; nonetheless, digoxin levels were between 0.17 nM and 1.64nM (means = 0.64nM +/- 0.27 nM). There was a negative correlation between gestational age and concentration of an endogenous digoxin-like substance (EDLS). Neonates less than or equal to 32 wk gestational age had higher levels of EDLS than neonates greater than 32 wk old. EDLS concentrations were compared in 22 mothers and their 24 offspring and were higher in all newborn infants (0.34nM +/- 0.09nM and 0.15nM +/- 0.08nM). EDLS was shown to inhibit Na+-K+-adenosinetriphosphatase activity by measurement of 86Rb uptake in erythrocytes exposed to sera samples from 30 infants in the study. EDLS levels greater than 0.6 ng/ml were associated with lesser 86Rb uptake. Simulation kinetics suggest that the presence of 0.6nM EDLS would lengthen the digoxin t1/2 by 64%, reduce the volume of distribution by 23%, and lower clearance by 53% if the peak "true" digoxin level were 2 ng/ml. EDLS concentrations of 1.5 ng/ml would increase the t1/2 by 207% while reducing the volume of distribution by 43% and clearance by 81%. These considerations cast serious doubts on the validity of currently accepted digoxin kinetics and dosing in preterm infants.

Topics: Birth Weight; Blood Proteins; Cardenolides; Digoxin; Female; Fetal Blood; Gestational Age; Half-Life; Humans; Infant, Newborn; Infant, Newborn, Diseases; Kinetics; Prospective Studies; Radioimmunoassay; Radioisotopes; Rubidium; Saponins

Serial serum digoxin concentrations were measured over a 10-day period in 15 low birth weight infants requiring digoxin therapy. The calculated total body digoxin clearance (TBDC) was found to be highly dependent on gestational age and body weight, with dose-normalized, steady-state digoxin concentrations inversely related to the same factors. Because of the decreased TBDC in low birth weight infants, our data support the recent recommendations in the literature to reduce maintenance doses of digoxin in these infants. Our study has further demonstrated that the reduction should be proportional to both gestational age and body weight.

Topics: Birth Weight; Body Weight; Digoxin; Female; Heart Failure; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Infant, Small for Gestational Age; Male

One hundred and twenty-two patients with cardiac disease were compared with 250 controls with respect to the duration of pregnancy and labour, birth weight percentile and Apgar score. The babies of the patients with cardiac disease were light-for-dates (18% below the 10th percentile); the mothers, if multiparous, delivered at an earlier gestational age. The patients with cardiac disease did not have shorter labours than the control group. Digoxin administration and the severity of heart disease had no significant effect on these variables.

Topics: Apgar Score; Birth Weight; Digoxin; Female; Heart Defects, Congenital; Heart Diseases; Humans; Infant, Low Birth Weight; Infant, Newborn; Labor, Obstetric; Parity; Pregnancy; Pregnancy Complications, Cardiovascular; Rheumatic Heart Disease

The pharmacokinetics and pharmacodynamics of digoxin in premature infants was studied. During maintenance therapy, after a total digitalizing dose of 30 microgram/kg, the measured digoxin level was related inversely to body weight at birth and to estimated gestational age. The serum digoxin levels found in the immature and smaller infants were two to three times the values usually reported to be toxic in older children. Based on these findings, a second group of premature infants was digitalized with 20 microgram/kg; in this group, the serum digoxin levels were below the toxic range, irrespective of gestational age or birth weight. The cardiac effects of digoxin, i.e., shortened left ventricular pre-ejection period and ejection time as determined by echocardiography, were similar in the two groups. For both groups, the half-life of digoxin in the serum was twice that reported for term infants and children. Since digitalis effect is obtained with lower dose and serum concentration, we recommend that this dose be used in premature infants.

Topics: Birth Weight; Digoxin; Echocardiography; Gestational Age; Half-Life; Heart Failure; Heart Ventricles; Humans; Infant, Newborn; Infant, Premature, Diseases; Kinetics; Prospective Studies

A prospective 2 1/2 year study of 50 infants with combined respiratory distress syndrome (RDS) and patent ductus arteriosus (PDA) was undertaken to determine whether echocardiographic measurements combined with clinical assessment could be used to select those infants who needed cardiac treatment. From a pilot study, criteria were adopted to use digoxin in the treatment of infants with evidence of congestive cardiac failure and/or a left atrial dimension 1.5 times normal size, and to ligate the PDA in those with unremitting congestive cardiac failure and a left atrial dimension persistently twice normal. Left atrial, left ventricular, and aortic dimensions, left atrial to aortic ratio, and mean Vcf were echocardiographically determined. Forty-six per cent of the 50 infants with PDA required digoxin administration, and 18 per cent of the total group was operated. The long-term mortality for the total group was 12 per cent (6 of 50) and mortality was 33 per cent (3 of 9) for the operated group. Results showed that absolute left atrial dimension, particularly if recorded in two dimensions, most accurately predicted those infants who would develop congestive cardiac failure or failure that would become medically unmanageable.

Topics: Aorta; Birth Weight; Digoxin; Ductus Arteriosus, Patent; Echocardiography; Heart Atria; Heart Failure; Heart Ventricles; Humans; Infant, Newborn; Prospective Studies; Respiratory Distress Syndrome, Newborn

Ten infants who had paroxysmal atrial tachycardia in utero or at birth are reported. Because of apparent fetal distress, caesarean section was performed in 4 cases and labour was induced in 1. Birthweight was generally large for gestational age. Severe ascites and hydrops at birth were manifestations of cardiac failure. Atrial flutter was recorded in 4 infants and supraventricular tachycardia in 5. The WoLff-Parkinson-White syndrome became evident later in 2. Digoxin was given to all 10 infants, and cardioversion was required and was effective in 4. Known recurrences in childhood have occurred in only 1 patient. Congenital atrial tachyarrhythmias may be commoner than generally believed, and fetal electrocardiography may help to avoid unnecessary termination of pregnancy. Blood sugar determinations are important, since neonatal hypoglycaemia was found. Cardioversion should be performed promptly in severely ill infants or if there is no response to digoxin. Care is required to avoid digoxin toxicity.

Topics: Birth Weight; Digoxin; Female; Gestational Age; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Tachycardia, Paroxysmal

Topics: Aorta; Aortic Arch Syndromes; Aortic Valve; Autopsy; Birth Weight; Chlorothiazide; Digoxin; Ductus Arteriosus, Patent; Electrocardiography; Heart Auscultation; Heart Defects, Congenital; Heart Failure; Heart Septal Defects, Ventricular; Humans; Infant; Male; Mitral Valve; Oxygen; Pulmonary Artery; Pulse

Topics: Atrial Flutter; Birth Weight; Body Weight; Digoxin; Edema; Electrocardiography; Female; Fetal Diseases; Fetal Heart; Furosemide; Heart Failure; Heart Rate; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Pregnancy

Topics: Birth Weight; Cataract; Cesarean Section; Chloramphenicol; Digoxin; Drug-Related Side Effects and Adverse Reactions; Ductus Arteriosus, Patent; Female; Humans; Infant; Infant, Newborn; Penicillins; Pregnancy; Pregnancy Complications, Infectious; Rubella virus