Alterations in blood coagulation of newborn infants with severe depression (one-minute Apgar score three or less) consequent to intrauterine asphyxia

Abstract

Eight normal children (N) and 8 with chemical diabetes (CD) were given intravenous glucose or tolbutamide; the resulting changes in blood glucose and insulin were studied. T he CD children all had family histories of diabetes and abnormal oral glucose tolerance tests ( O G T T ) . The control group consisted of children without family history of diabetes and with normal OGTT. Neither the CD nor the N group included children with clinical manifestations of illness at the t ime they were studied. The mean age was 10.6 • 1.8 years in the CD group and 10.6 + 1.1 years in the control group. Weight was normal for height in all the children. Venous blood samples were taken with a Perfus 11/10 catheter after a 12 hour overnight fast and at 1, 3, 5, 10, 15, 30, 45, 60, 75, and 90 minutes af ter the intravenous infusion of glucose (0.4 Gm. per kilogram of body weight) or tolbutamlde (Rastinon 20 rag. per kilogram). Blood glucose was determined by the Somogyi-Nelson method and insulin by an immunoreactive technique. The glucose infusion produced a maximum rise in blood glucose up to 248 • 14.8 mg. per 100 ml. at one minute in the CD children and 215 +14.7 mg. per 100 ml. in the N group. The blood glucose fell similarly in both groups, although it remained at statistically higher levels in the CD patients at 45, 60, and 75 minutes. Insulin secretion was greater in the N group at 1, 3, and 5 minutes (47 + 7.64, 50 • 7.78, and 45 + 7.31 #U per milliliter) than in the CD group (28 • 5.40, 27 + 6.48, and 25 + 4.67 #U per milliliter) (P < 0.05). Intravenous tolbutamide produced a fail in blood glucose, which reached its lowest point a t 30 minutes in both groups, then gradually rose throughout the test; it was statistically higher in the CD group (P < 0.05) at 5 and 10 minutes. Insulin response was maximum one minute after the injection of tolbutamide (CD, 46 • 6.86; N, 58 • 5.73 #U per milliliter). By 30 minutes blood insulin had returned to its basal level in both groups, having been statistically higher in the N group at 5 and 10 minutes.