salicylates and Heart-Defects--Congenital

Although the conditions that cause hypoglycemia in adults may also be present in infants and children, there are many entities unique to the pediatric age group. This reflects the delicate balance that exists in the newborn and young child between glucose production and utilization. During fasting in infants and children, hepatic glucose production is normally two to three times that of adults when expressed on the basis of weight. In the newborn and young infants, hypoglycemia usually presents with irritability, feeding difficulties, lethargy, cyanosis, tachypnea, and/or hypothermia rather than the typical adrenergic or neuroglucopenic symptoms seen in the adult. The hypoglycemia may be due to abnormalities in hormone secretion, substrate interconversion, or mobilization of metabolic fuels. The hypoglycemia associated with hyperinsulinemia may be transient neonatal, sustained, or drug-induced. Inborn errors of metabolism caused by enzymatic defects are responsible for hypoglycemia associated with abnormalities of production and utilization of metabolic fuels. These can involve carbohydrate, protein, and fat metabolism. In addition, there may be acquired or transient defects in carbohydrate metabolism secondary to other diseases or ingestion of certain substances. Finally ketotic hypoglycemia appears to be due to abnormalities in substrate availability. A variety of tests are useful for establishing the etiologic basis of the hypoglycemia, and the appropriate treatment depends upon the underlying cause.

Topics: Child; Endocrine System Diseases; Ethanol; Fatty Acids; Glucose; Heart Defects, Congenital; Homeostasis; Humans; Hyperinsulinism; Hypoglycemia; Infant; Infant, Newborn; Infant, Small for Gestational Age; Ketosis; Metabolism, Inborn Errors; Reye Syndrome; Salicylates

Topics: Amphetamines; Animals; Cardiovascular Diseases; Estrogens; Ethanol; Female; Fetal Hypoxia; Heart Defects, Congenital; Heart Function Tests; Heart Septal Defects; Humans; Infant, Newborn; Lithium; Lithium Carbonate; Persistent Fetal Circulation Syndrome; Phenytoin; Pregnancy; Pregnancy in Diabetics; Progesterone; Salicylates; Tricuspid Valve; Trimethadione

Aspirin ingestion in humans and animals has been reported to lead to a range of undesirable outcomes, including fetal death, growth retardation, and congenital abnormalities. Rat embryos were cultured for 48 h in 100-300 micrograms/ml of salicylic acid, a metabolite of aspirin, days 9.5-11.5 of gestation. When compared to growth in control embryos, a significant dose-dependent decrease in crown-rump lengths, somite numbers, and yolk sac diameters was observed. There was also a significant increase in overall dysmorphology, including eye, brachial arch, and heart anomalies, and an absence of forelimb buds. The neural tube was especially vulnerable and had frequently failed to close. Cellular and ultrastructural examination revealed extensive cell death in the neuroepithelium, with a lesser effect on the mesenchymal cells. Large condensed blebs projected into the ventricular lumen, and cell membranes as well as the basal lamina were severely disrupted, with all cytoplasmic organelles affected in dying cells. It is likely that the extensive cell necrosis and blebbing in the developing neuroepithelium at the site of neural tube fusion may be involved in failed neurulation, while necrosis at other sites in the cranial neuroepithelium may be linked with previously reported intellectual and behavioural abnormalities.

Topics: Abnormalities, Multiple; Animals; Culture Techniques; Embryo, Mammalian; Face; Female; Heart Defects, Congenital; Microscopy, Electron; Nervous System; Rats; Rats, Sprague-Dawley; Salicylates; Salicylic Acid; Skull; Teratogens

The babies of 144 mothers who took salicylates regularly in pregnancy are described. These babies had a significantly reduced birth-weight compared with controls; many of them had a raised cord-blood salicylate level but had no clinical evidence of bleeding or hypoglycaemia. Their perinatal mortality was increased, but the incidence of congenital anomalies was not significantly raised.

Topics: Abnormalities, Multiple; Birth Weight; Female; Fetal Death; Fetus; Gestational Age; Hand Deformities, Congenital; Heart Defects, Congenital; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Intestinal Perforation; Male; Maternal-Fetal Exchange; Pregnancy; Salicylates

Topics: Abnormalities, Drug-Induced; Abnormalities, Multiple; Anencephaly; Arm; Cleft Lip; Cleft Palate; Craniofacial Dysostosis; Drug Interactions; Female; Fetus; Fingers; Foot Deformities, Congenital; Gestational Age; Hand Deformities, Congenital; Heart Defects, Congenital; Humans; Infant, Newborn; Male; Maternal-Fetal Exchange; Metacarpus; Pregnancy; Salicylates; Thumb; Toes; Umbilical Cord; Urethra