- Email: [email protected]
Investigation of broncho-alveolar lavage fluid (BAL) in neonates with chronic lung disease
PEDIATRIC
LABORATORY
(EC-SOD). In this study 55 neonates with c]~mmc Imtg disease had BAL coltcctedby the method of non bronchoscopic broncho-alveolar lavage. Specimens coUected weoe amdysed for s.pcro~dd¢ dL~nutos¢ (SOD) a.d total protein, albumin and m~a as markers of d~lution. Control samples we,re co~eoted from 28 age matched pati¢=ds unde~omg geaersl anaesthesia. A positive correlation (p<0.05) was found betwe~ SOD and total protein, albumin and urea. Comparison of patients with controls showed that neonateswith lungdiseasehad significantlyhighcr(p<0.001)levelsof protein, albumin and u r ~ than controls, however, SOD levels were not significa~ly different (p=0.073).This s.ggestsincreased vascular pe~neability in neonates with chronic lung disease. W h ~ SOD was expressed in terms of protein , , d albumin, neonates with lung
diseasehad significantlylower(p
MEDICINE
CONGRESS
>2.0 ng/mL in one patient with multi-organ failure/shock with a normal echo, and in seven critically ill patients with a variety of cardiac abnormalities, cTnl values did not correlate with the degree of cyanosis in malformation syndromes. Two children with echoproven cardiac contusions had elevated values; in the child which survived, cTnl values decreased toward the unaffected range over several days. These data indicate that cTnl values are generally not elevated in children with cardiac disease. Elevations o f cTnl may have diagnostic value in children suspected of cardiac contusion. The prognostic importance of elevated cTnl in children with severe cardiac disease rernalns to be elucidated.
chronic lung dL~as¢.
16 Pediatric
14
Reference
Ranges for
U s i n g t h e Beckman A r r a y
SERUM LEVELS OF NEURON.SPECIFICENOUtSE (NSE) IN N ~ N S (NB) WITH HYPOXICASCHAEMICENCEPHALOPATHY(HIE) P.Ramos', J.Palminha=, M,A.Bispo=, M.T.Leranjeira', J.Mexia~, M.J.Carneiroz, P.Cabralz, J.RuefP 1 - FCM/UNL-Gen6tica 2 - H.S.F.X.-Pediatria 3 - FCTIUNL AIM- TheauthomstudiedNSEin asphl0dstedNBwith HIE andnommlNB (controls)in orderto find out if NSE b e u~@ulmarkerof neufeostlemons=rodif It couldpredictseqL~aeof ~ dlffem~statesof HIE. PATIENTS AND METHODS. NSE was studiedin eofd b4oodm~d 24 hour= by RIA-kabl, PHARMACIAinthe=emmof 10 normalNBand21 NB wnhdlffere~stste=of HIE (~:co~lingto SamatmdSarmt). ~ = r a w w e e ~ . l u d ~ l . Dmwemmalyzedststlstlcstlybyvadance ~ andb"emutlple~ me~d of Scheffe. Thesurvlvo~hads follow-~ptwoyearn ~tef. RESULTS ENOLASE (pg/I..) (A)Honnals {~HIEmild (C)HIE (D] HIE mo~nde Seve~ N.Cases (10) [6) (10) (5) Co~blood 22,3=10,47 1(~.5.33,89 122,4t60,02 24h
120~
Fisher 11,77
A<<8.C.D ~0.05 25,5~9,12' 129,33*i%,47 140,~t46,35 IT/,5,47,54 28,88 A
Ofthef~e NBwth uvere HIE.threeof themdiedin the neeoatalperiod,two developedcerebral palsy,whilethe mmalnderhadnosequs~ae. OISCUSSIONANO~ S . NSE increasesstgnlflcantlyIn cordbleedand 24 hoursin NB with HIE comparedto nonnalsb~ ld ~ st the sod of ~te I~ld day of life in differentstateoogHIE. ~Kleslueouldnotlxllxedlctedlmthe follow-upproved. NSE nsteoly e~dStsInthe brain,but steoin PNS,neuro-endocllnesystemand bloodandthe serumIncreases couldbe 8 eonr~queoceof bothneureoldleskm=m~l damageto othertilmues. A ~ i n NE affedsmanyq,slmns~neously butthemostknpodantlstheCNS, ThusNSEeouldbeof ~erestrnixefclion of ~dYny~atedNB st dskof HIE but,st the endof the firstday,the ststesof yawingseverity~ couldnotbediffererdlsted.
CA R D I A C T R O P O N I N I FOR A S S E S S M E N T O F PEDIATRIC CA R D I A C INJURY. Ruseel Hirech, Y v o n n e Landt, S h a r o n Porter, C h a r l e s E. Canter, Allan S. Jaffe, J a c k H. L a d e n s o n , J a m e s Grant, a n d Michael Landt. D e p t s o f Pediatrics, P a t h o l o g y a n d Medicine, W a s h i n g t o n U n l v e r a i t y S c h o o l o f Medicine, St. Louis, MO, USA. Studies in adults have demonstrated the sensitivity and specificity of measurement of cardiac troponln I (cTnl) for detection of acute cardiac injury, but its use in pediatric patients is less well established. We measured cTnl levels with a preliminary research immunoassay in plasma of outpatient children (without apparent cardiac disease) and in hospitalized children undergoing echosonographlc imaging (echo) for suspected cardiac disease. oTnl in outpatient children (n=120) was <2.0 ng/mL and generally undetectable; no age dependence was discemable. Hospitalized children with normal echo findings (n=14) and children with a vadety of proven cardiac abnormalities (n=70) had similar median cTnl values (both less than the limit of detection, 1.5 ng/mL) and were not statistically significantly different (p=0.45). cTnl values were 360
360 System.
Bette 14essmer. Wendl Nichols, Cathy Austin Kt.chael D a v i s ,
Ktchael Bennett
Children's Medlcal Center of Dallas, TX 75235 Pediatric reference ranges are characteristically difficult to obtain due to a combination of small patient numbers and small sample sizes. Here we present age and sex related normal ranges for the following serum proteins in a pediatric population using the Beckman Array 360 nephelometer: Immunoglobins G, A, and M, prealbumin, ceruloplasmln, a-l-antltrypsln, haptoglohin, transferrin, complements C3 and C4. Patlent's serum in excess of routine requirements were utilized in this study. Samples from patients with a history likely to effect protein status, i.e. those with a history of immune, hepatic, or nutritional disease were excluded. Data from approximately 300 subjects will be presented for each protein in age and sex related formats.
17 I/L~ASmqSZTZQ3E ~gZYME ZI~INO/~SAY FOR AHTZBODZES TO DZ~ARY PRO~ZNS K. N i r o t a , M. S a £ t o , S . B a s h i d a * , E. Z a h i k a w a * a n d M. T o t n n i Dev. Mater.
Nutr., *Dept.
Child
Health
Sci.,
Natl.
Znat.
Health
1 - 2 3 - 1 T o y a m a , S h i n j u k u , T o k y o 162 a n d B i o c h e m . , Mad. C o l . M ~ y a s a k l , Kiyotaka,
Miyazaki
15
Serum Protelns
889-16,
Japan
Conventional measurements of specific antibodies to food antigens were affected by the large amount of non-specific immunoglobulins in serum. Although many modifications to correct sensitivity have been described, more sensitive and more reliable method was desirable to be developed especially for noninvasive diagnosis. Our new sensitive enzyme i~nunoassay method as the immune complex transfer enzyme i n m ~ n o a s s a y m e t h o d for antibodies to two food antigens, ~-lactoglobulin and ovalbumin, was developed. For anti-~lactoglobulin antibody, serum specific antibody was reacted simultaneously with 2,4-dinitrophenylbovine serum albumin-~-lactoglobulin conjugate and ~-lactoglobulin-peroxidase conjugate. The complex formed of the three components was trapped onto polystyrene balls coated with anti 2,4dinitrophenyl group IgG, eluted with e N-2,4dinitrophenyl-L-lysine and transferred to polystyrene balls coated with IgG against human IgG.¥-chain for IgG class antibody and human IgA-a-chain for I g A c l a s s antibody. Bound peroxidase activity was determined by fluor~netry. For anti-ovalbumin antibody, ovalbumin conjugates were used instead of ~-lactoglobulin conjugates. This assay method was 100- to 1,000-fold more CLINICAL
BIOCHEMISTRY,
VOLUME
28, JUNE
1995
LABORATORY
(EC-SOD). In this study 55 neonates with c]~mmc Imtg disease had BAL coltcctedby the method of non bronchoscopic broncho-alveolar lavage. Specimens coUected weoe amdysed for s.pcro~dd¢ dL~nutos¢ (SOD) a.d total protein, albumin and m~a as markers of d~lution. Control samples we,re co~eoted from 28 age matched pati¢=ds unde~omg geaersl anaesthesia. A positive correlation (p<0.05) was found betwe~ SOD and total protein, albumin and urea. Comparison of patients with controls showed that neonateswith lungdiseasehad significantlyhighcr(p<0.001)levelsof protein, albumin and u r ~ than controls, however, SOD levels were not significa~ly different (p=0.073).This s.ggestsincreased vascular pe~neability in neonates with chronic lung disease. W h ~ SOD was expressed in terms of protein , , d albumin, neonates with lung
diseasehad significantlylower(p
MEDICINE
CONGRESS
>2.0 ng/mL in one patient with multi-organ failure/shock with a normal echo, and in seven critically ill patients with a variety of cardiac abnormalities, cTnl values did not correlate with the degree of cyanosis in malformation syndromes. Two children with echoproven cardiac contusions had elevated values; in the child which survived, cTnl values decreased toward the unaffected range over several days. These data indicate that cTnl values are generally not elevated in children with cardiac disease. Elevations o f cTnl may have diagnostic value in children suspected of cardiac contusion. The prognostic importance of elevated cTnl in children with severe cardiac disease rernalns to be elucidated.
chronic lung dL~as¢.
16 Pediatric
14
Reference
Ranges for
U s i n g t h e Beckman A r r a y
SERUM LEVELS OF NEURON.SPECIFICENOUtSE (NSE) IN N ~ N S (NB) WITH HYPOXICASCHAEMICENCEPHALOPATHY(HIE) P.Ramos', J.Palminha=, M,A.Bispo=, M.T.Leranjeira', J.Mexia~, M.J.Carneiroz, P.Cabralz, J.RuefP 1 - FCM/UNL-Gen6tica 2 - H.S.F.X.-Pediatria 3 - FCTIUNL AIM- TheauthomstudiedNSEin asphl0dstedNBwith HIE andnommlNB (controls)in orderto find out if NSE b e u~@ulmarkerof neufeostlemons=rodif It couldpredictseqL~aeof ~ dlffem~statesof HIE. PATIENTS AND METHODS. NSE was studiedin eofd b4oodm~d 24 hour= by RIA-kabl, PHARMACIAinthe=emmof 10 normalNBand21 NB wnhdlffere~stste=of HIE (~:co~lingto SamatmdSarmt). ~ = r a w w e e ~ . l u d ~ l . Dmwemmalyzedststlstlcstlybyvadance ~ andb"emutlple~ me~d of Scheffe. Thesurvlvo~hads follow-~ptwoyearn ~tef. RESULTS ENOLASE (pg/I..) (A)Honnals {~HIEmild (C)HIE (D] HIE mo~nde Seve~ N.Cases (10) [6) (10) (5) Co~blood 22,3=10,47 1(~.5.33,89 122,4t60,02 24h
120~
Fisher 11,77
A<<8.C.D ~0.05 25,5~9,12' 129,33*i%,47 140,~t46,35 IT/,5,47,54 28,88 A
Ofthef~e NBwth uvere HIE.threeof themdiedin the neeoatalperiod,two developedcerebral palsy,whilethe mmalnderhadnosequs~ae. OISCUSSIONANO~ S . NSE increasesstgnlflcantlyIn cordbleedand 24 hoursin NB with HIE comparedto nonnalsb~ ld ~ st the sod of ~te I~ld day of life in differentstateoogHIE. ~Kleslueouldnotlxllxedlctedlmthe follow-upproved. NSE nsteoly e~dStsInthe brain,but steoin PNS,neuro-endocllnesystemand bloodandthe serumIncreases couldbe 8 eonr~queoceof bothneureoldleskm=m~l damageto othertilmues. A ~ i n NE affedsmanyq,slmns~neously butthemostknpodantlstheCNS, ThusNSEeouldbeof ~erestrnixefclion of ~dYny~atedNB st dskof HIE but,st the endof the firstday,the ststesof yawingseverity~ couldnotbediffererdlsted.
CA R D I A C T R O P O N I N I FOR A S S E S S M E N T O F PEDIATRIC CA R D I A C INJURY. Ruseel Hirech, Y v o n n e Landt, S h a r o n Porter, C h a r l e s E. Canter, Allan S. Jaffe, J a c k H. L a d e n s o n , J a m e s Grant, a n d Michael Landt. D e p t s o f Pediatrics, P a t h o l o g y a n d Medicine, W a s h i n g t o n U n l v e r a i t y S c h o o l o f Medicine, St. Louis, MO, USA. Studies in adults have demonstrated the sensitivity and specificity of measurement of cardiac troponln I (cTnl) for detection of acute cardiac injury, but its use in pediatric patients is less well established. We measured cTnl levels with a preliminary research immunoassay in plasma of outpatient children (without apparent cardiac disease) and in hospitalized children undergoing echosonographlc imaging (echo) for suspected cardiac disease. oTnl in outpatient children (n=120) was <2.0 ng/mL and generally undetectable; no age dependence was discemable. Hospitalized children with normal echo findings (n=14) and children with a vadety of proven cardiac abnormalities (n=70) had similar median cTnl values (both less than the limit of detection, 1.5 ng/mL) and were not statistically significantly different (p=0.45). cTnl values were 360
360 System.
Bette 14essmer. Wendl Nichols, Cathy Austin Kt.chael D a v i s ,
Ktchael Bennett
Children's Medlcal Center of Dallas, TX 75235 Pediatric reference ranges are characteristically difficult to obtain due to a combination of small patient numbers and small sample sizes. Here we present age and sex related normal ranges for the following serum proteins in a pediatric population using the Beckman Array 360 nephelometer: Immunoglobins G, A, and M, prealbumin, ceruloplasmln, a-l-antltrypsln, haptoglohin, transferrin, complements C3 and C4. Patlent's serum in excess of routine requirements were utilized in this study. Samples from patients with a history likely to effect protein status, i.e. those with a history of immune, hepatic, or nutritional disease were excluded. Data from approximately 300 subjects will be presented for each protein in age and sex related formats.
17 I/L~ASmqSZTZQ3E ~gZYME ZI~INO/~SAY FOR AHTZBODZES TO DZ~ARY PRO~ZNS K. N i r o t a , M. S a £ t o , S . B a s h i d a * , E. Z a h i k a w a * a n d M. T o t n n i Dev. Mater.
Nutr., *Dept.
Child
Health
Sci.,
Natl.
Znat.
Health
1 - 2 3 - 1 T o y a m a , S h i n j u k u , T o k y o 162 a n d B i o c h e m . , Mad. C o l . M ~ y a s a k l , Kiyotaka,
Miyazaki
15
Serum Protelns
889-16,
Japan
Conventional measurements of specific antibodies to food antigens were affected by the large amount of non-specific immunoglobulins in serum. Although many modifications to correct sensitivity have been described, more sensitive and more reliable method was desirable to be developed especially for noninvasive diagnosis. Our new sensitive enzyme i~nunoassay method as the immune complex transfer enzyme i n m ~ n o a s s a y m e t h o d for antibodies to two food antigens, ~-lactoglobulin and ovalbumin, was developed. For anti-~lactoglobulin antibody, serum specific antibody was reacted simultaneously with 2,4-dinitrophenylbovine serum albumin-~-lactoglobulin conjugate and ~-lactoglobulin-peroxidase conjugate. The complex formed of the three components was trapped onto polystyrene balls coated with anti 2,4dinitrophenyl group IgG, eluted with e N-2,4dinitrophenyl-L-lysine and transferred to polystyrene balls coated with IgG against human IgG.¥-chain for IgG class antibody and human IgA-a-chain for I g A c l a s s antibody. Bound peroxidase activity was determined by fluor~netry. For anti-ovalbumin antibody, ovalbumin conjugates were used instead of ~-lactoglobulin conjugates. This assay method was 100- to 1,000-fold more CLINICAL
BIOCHEMISTRY,
VOLUME
28, JUNE
1995