pituitrin and Infant--Newborn--Diseases

Arginine vasotocin, arginine vasopressin, and oxytocin play a critical role in the stimulation of labor and delivery and in salt and water homeostasis in the newborn infant. The authors present information on their chemistry, secretion, and metabolism, and discuss the clinical effects upon target organs of their presence or absence.

Topics: Animals; Arginine Vasopressin; Diabetes Insipidus; Female; Fetus; Humans; Inappropriate ADH Syndrome; Infant, Newborn; Infant, Newborn, Diseases; Oxytocin; Pituitary Gland; Pituitary Gland, Posterior; Pituitary Hormones, Posterior; Pregnancy; Vasopressins; Vasotocin

Pneumonia is one of the most serious infections in the neonate and is responsible for a large percentage of neonatal mortality. Pneumonia in a premature or term infant who is debilitated by an underlying problem such as hyaline membrane disease carries an extremely high morbidity and mortality. Since most of the bacterial pneumonias are treatable, early recognition and diagnosis and vigorous treatment are essential. X-ray findings, though helpful, serve only as a guideline. Prognosis is adversely affected if pneumonia results in generalized sepsis, leading to meningitis, disseminated intravascular coagulation, and osteomyelitis. Prompt antibiotic treatment should be begun before the etiologic agent or drug susceptibility is known.

Topics: Acute Disease; Ampicillin; Bacterial Infections; Gentamicins; Humans; Infant, Newborn; Infant, Newborn, Diseases; Kanamycin; Penicillins; Pneumonia; Pneumonia, Aspiration; Pneumonia, Viral; Syphilis, Congenital; Tuberculosis, Pulmonary; Vasopressins

Topics: Acids; Acute Kidney Injury; Angiotensin II; Bicarbonates; Diuretics; Glomerular Filtration Rate; Hematuria; Homeostasis; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Infant, Premature, Diseases; Kidney; Kidney Function Tests; Kidney Tubules; Phosphates; Potassium; Renal Veins; Renin; Sodium; Uric Acid; Vasopressins

This chapter has sought to gather together the background information on systems controlling homoeostasis of salt and water and their clinical derangement. The temptation to adopt an all-embracing approach to the management of these problems is strong but such an approach is difficult to achieve and indeed dangerous. The circumstances of each sick infant are unique and plans for treatment must be individually tailored and flexible, dependent upon clinical and biochemical progress. Future developments in this field are likely to involve further understanding of renal and hormonal control of fluid and electrolyte and it might be expected that as new methods of management emerge they will be accompanied by their own peculiar risks of inducing secondary homoeostatic disturbances. With regard to infant feeding each advance appears to underline the desirability of breast feeding and support current moves toward provision of low solute feeds for those who are artificially fed. Paediatricians should be vocal in their advocation of breast feeding and ensure that the major principles of salt and water handling are understood by all who work with small infants. An extra scoop of powdered milk can be more of a poison than a food.

Topics: Aldosterone; Angiotensin II; Blood Volume; Diabetes Insipidus; Humans; Infant, Newborn; Infant, Newborn, Diseases; Kidney; Metabolism; Natriuresis; Nutritional Requirements; Osmolar Concentration; Potassium; Prolactin; Renin; Sodium; Vasopressins; Water-Electrolyte Balance

Despite its increasing use in neonates, the literature on the use of vasopressin (VP) in neonates is limited. The aim of this study is to evaluate the systemic and pulmonary effects of VP in neonates and to assess its safety among them.. This retrospective study enrolled all neonates in two level III neonatal intensive care units in Winnipeg, Manitoba, who had received VP therapy between 2011 and 2016. Infants with congenital malformations/chromosomal disorders were excluded. The changes in cardiovascular and pulmonary parameters were collected from patient charts. The primary outcome was the mean blood pressure (MBP) post-VP initiation. Secondary outcomes included systolic blood pressure (SBP) and diastolic blood pressure (DBP), vasoactive inotropic score (VIS), pH, urine output, lactate, base deficit (BD), mean airway pressure (MAP), and oxygen requirement.. A total of 33 episodes from 26 neonates were analyzed. The postnatal age at VP initiation was 14 days (interquartile range [IQR]: 4-25), and the median starting dose was 0.3 mU/kg/min (IQR: 0.2-0.5). MBP improved significantly after VP initiation from 28 to 39 mm Hg 24 hours after VP initiation (. VP appears to be a promising rescue therapy in catecholamine resistant shock or refractory pulmonary hypertension in neonates.

Topics: Blood Pressure; Female; Hemodynamics; Humans; Hypertension, Pulmonary; Hypotension; Infant, Newborn; Infant, Newborn, Diseases; Lung; Male; Retrospective Studies; Urine; Vasoconstrictor Agents; Vasopressins

The release of vasopressin (AVP) was assessed by measuring urinary excretion of the hormone in ten neonates who had an acute and symptomatic pneumothorax in the first three days after birth. AVP excretion rose significantly (paired t analysis) after the pneumothorax occurred. When apparent re-expansion of the lungs occurred after treatment, excretion of AVP returned to prepneumothorax levels within eight to 16 hours. If the pneumothorax persisted or worsened. AVP excretion remained elevated. Urine osmolality rose significantly (paired t analysis) after pneumothorax, presumably in response to the increased AVP levels. Two of the ten infants had hyponatremia in the period studied, while in a state of sodium balance. It was concluded that AVP release is increased after a pneumothorax occurs. This increase is apparently not due to osmoregulatory requirements. Fluid intake in these infants may need adjustment to prevent an inappropriate positive water balance.

Topics: Drinking; Humans; Hyponatremia; Infant, Newborn; Infant, Newborn, Diseases; Osmolar Concentration; Pneumothorax; Respiration, Artificial; Urine; Vasopressins

Vasopressin concentrations were measured in the cord blood of thirty infants, thirteen delivered vaginally and seventeen by Caesarean section. There was no correlation with maternal values but the concentration following vaginal delivery (13.5 microunits/ml +/- 7.9 SD) was significantly higher than that following Caesarean section (4.2 microunits/ml +/- 6.6 SD). Gestational age did not affect the concentrations, which fell during the first week of life and then rose gradually in term and pre-term infants. High levels were found in seven sick babies. There was no correlation in the first 3 weeks of life between plasma vasopressin and plasma or urine osmolality in well and sick babies.

Topics: Cesarean Section; Female; Fetal Blood; Gestational Age; Humans; Infant, Newborn; Infant, Newborn, Diseases; Osmolar Concentration; Pregnancy; Respiratory Distress Syndrome, Newborn; Sodium; Vasopressins

Topics: Blood Circulation; Enterocolitis, Pseudomembranous; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Newborn, Diseases; Vasopressins

Topics: Brain Diseases; Cerebral Ventricles; Diabetes Insipidus; Female; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Vasopressins

Topics: Animals; Haplorhini; Humans; Hypoxia; Infant, Newborn; Infant, Newborn, Diseases; Vasopressins

We describe 11 premature infants with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). The syndrome is far more common than the single case report in the literature would indicate. All the infants had either asphyxiation at birth, intracranial hemorrhage, or meningitis. Of the nine children available for follow-up observation, seven demonstrated serious neurological sequelae. The diagnosis of SIADH in the premature neonate may be difficult to establish due to the complexity of precipitating factors.

Topics: Brain Diseases; Humans; Infant, Newborn; Infant, Newborn, Diseases; Pituitary Diseases; Syndrome; Vasopressins

Nine episodes of the syndrome of inappropriate antidiuretic hormone secretion occurred in five newborn infants following atelectasis or pneumothorax. All infants had pre-existing lung disease and were being treated with positive pressure ventilation. The mean interval between acute atelectasis or pneumothorax and the development of diagnostic hyponatremia, hypo-osmolal serum, hyperosmolal urine, and oliguria was 13.4 hours. Fluid restriction and removal of the triggering event resulted in resolution of the abnormalities within 1.5 to 4 days. Infants who develop atelectasis or pneumothorax should be evaluated for the subsequent occurrence of SIADH; the administration of a water load to them may result in dilutional hyponatremia, for which fluid restriction, not sodium infusion, is the proper therapy.

Topics: Acute Disease; Humans; Infant, Newborn; Infant, Newborn, Diseases; Osmolar Concentration; Pneumothorax; Pulmonary Atelectasis; Sodium; Syndrome; Vasopressins

Topics: Chlorothiazide; Dehydration; Diabetes Insipidus; Fever of Unknown Origin; Humans; Hypernatremia; Infant, Newborn; Infant, Newborn, Diseases; Male; Renal Tubular Transport, Inborn Errors; Specific Gravity; Vasopressins

Topics: Diabetes Insipidus; Disseminated Intravascular Coagulation; Humans; Infant, Newborn; Infant, Newborn, Diseases; Listeria monocytogenes; Listeriosis; Male; Osmolar Concentration; Sodium; Specific Gravity; Vasopressins; Water Deprivation; Water-Electrolyte Balance

Topics: Adrenal Glands; Adrenal Insufficiency; Blindness; Bradycardia; Brain; Electrolytes; Female; Glucagon; Glucose; Glucose Tolerance Test; Growth Hormone; Humans; Hypoglycemia; Hypopituitarism; Infant; Infant, Newborn; Infant, Newborn, Diseases; Insulin; Intellectual Disability; Male; Pituitary Gland; Seizures; Vasopressins

Topics: Hormones, Ectopic; Humans; Hyponatremia; Infant, Newborn; Infant, Newborn, Diseases; Male; Meningitis; Natriuresis; Osmolar Concentration; Pituitary Gland, Posterior; Vasopressins; Water-Electrolyte Balance

Topics: Biological Assay; Blood Specimen Collection; Cesarean Section; Chromatography, Paper; Delivery, Obstetric; Female; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Kidney Concentrating Ability; Maternal-Fetal Exchange; Methods; Pregnancy; Stress, Physiological; Thioglycolates; Time Factors; Umbilical Veins; Vasopressins

Topics: Angiotensins; Aortic Diseases; Brain; Brain Damage, Chronic; Dehydration; Diabetes Insipidus; Diabetes Insipidus, Neurogenic; Hexamethonium Compounds; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Kidney Function Tests; Norepinephrine; Physiology; Renal Artery Obstruction; Vasopressins; Water-Electrolyte Balance

Topics: Cataract; Child; Diabetes Insipidus; Diabetes Insipidus, Neurogenic; Diabetes Mellitus; Eosinophilia; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Toxoplasmosis; Toxoplasmosis, Congenital; Vasopressins