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Biomedical subjects

A A Fanaroff

Publications and source records attributed to A A Fanaroff.

At least 19 recordsLinked to original sources
PubMed1995

Very-low-birth-weight outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, May 1991 through December 1992.

OBJECTIVES: Our goals were to determine the mortality risk for infants weighing 501 to 1500 gm according to gestational age, birth weight, and gender and to document birth weight-related changes in mortality and morbidity over a 5-year time period. STUDY DESIGN: In this observational study perinatal data were prospectively collected by the 12 participating centers of the National Institute of Child Health and Human Development Neonatal Research Network from May 1991 through December 1992 and compared with the corresponding data from 1987 through 1990. Standard definitions were used to record sociodemographic factors, perinatal events, and the neonatal course to 120 days of life, discharge, or death. RESULTS: The 1991 and 1992 cohort included 4279 in-born infants. Among their mothers 10% were < 18 years old; 55% were black, 31% were white, and 11% were Hispanic; 14% had received no prenatal care; and 20% had received antenatal corticosteroids. Multiple gestations accounted for 20% of the births. Fifty percent of the infants were delivered by cesarean section. During 1991 and 1992 the overall survival for infants weighing 501 to 1500 gm at birth was 81%, compared with 74% in 1987 and 1988. Survival at birth weight 501 to 750 gm was 44%; it was 81% at 751 to 1000 gm, 92% at 1001 to 1250 gm, and 95% between 1251 and 1500 gm. Female infants had a significantly greater chance of surviving than male infants at similar birth weights and gestational ages. At any given gestational age, smaller infants were less likely to survive. Survival in all birth weight categories increased between 1987 and 1992, without accompanying increases in medical morbidity. Major morbidity increased with decreasing birth weight and included late-onset septicemia 22%, chronic lung disease (oxygen dependence at 36 weeks' corrected age) 18%, severe intraventricular hemorrhage (grades III and IV) 11%, and necrotizing enterocolitis 5%. Twelve percent of all infants were treated with corticosteroids for chronic lung disease, including 36% of infants who were oxygen dependent at age 28 days. The mean length of hospital stay was 69 days for survivors and 18 days for infants who died. CONCLUSIONS: Mortality for infants between 501 and 1500 gm at birth has declined over the past 5 years. There are interactions between birth weight, gestational age, gender, and survival rate. This increase in survival was not accompanied by an increase in medical morbidity.

Apgar Score↗
PubMed1994

A controlled trial of intravenous immune globulin to reduce nosocomial infections in very-low-birth-weight infants. National Institute of Child Health and Human Development Neonatal Research Network.

BACKGROUND: Nosocomial infections are a major cause of morbidity and mortality in premature infants. As a rule, their low serum gamma globulin levels at birth subsequently decline to hypogammaglobulinemic values; hence, prophylactic administration of intravenous immune globulin may reduce the rate of hospital-acquired infections. METHODS: In this prospective, multicenter, two-phase controlled trial, 2416 infants were stratified according to birth weight (501 to 1000 g and 1001 to 1500 g) and randomly assigned to an intravenous immune globulin group (n = 1204) or a control group (n = 1212). Control infants were given placebo infusions during phase 1 of the study (n = 623) but were not given any infusions during phase 2 (n = 589). Infants weighing 501 to 1000 g at birth were given 900 mg of immune globulin per kilogram of body weight, and infants weighing 1001 to 1500 g at birth were given a dose of 700 mg per kilogram. The immune globulin infusions were repeated every 14 days until the infants weighed 1800 g, were transferred to another center, died, or were sent home from the hospital. RESULTS: Nosocomial infections of the blood, meninges, or urinary tract occurred in 439 of the 2416 infants (18.2 percent): 208 (17.3 percent) in the immune globulin group and 231 (19.1 percent) in the control group (relative risk, 0.91; 95 percent confidence interval, 0.77 to 1.08). Septicemia occurred in 15.5 percent of the immune globulin recipients and 17.2 percent of the controls. During phase 1 the rate of nosocomial infections was 13.4 percent in the immune globulin group and 17.8 percent in the control group; the respective rates during phase 2 were 21.0 percent and 20.4 percent. The predominant organisms included gram-positive cocci (53.0 percent), gram-negative bacilli (22.4 percent), and candida species (16.0 percent). Adverse reactions were rarely observed during the infusions. Immune globulin therapy had no effect on respiratory distress syndrome, bronchopulmonary dysplasia, intracranial hemorrhage, the duration of hospitalization, or mortality. The incidence of necrotizing enterocolitis was 12.0 percent in the immune globulin group and 9.5 percent in the control group. CONCLUSIONS: Prophylactic use of intravenous immune globulin failed to reduce the incidence of hospital-acquired infections in very-low-birth-weight infants.

Adult↗
PubMed1994

Semiportable electrochemical instrument for determining carbon monoxide in breath.

Measurements of carbon monoxide (CO) in breath can be used for the diagnosis of hemolytic disease. A small, semiportable, easy-to-operate CO instrument was developed at Stanford University and tested at 12 Neonatal Research Network Centers of the National Institute of Child Health and Human Development. A syringe pump delivers 7.7 mL of sample per minute through an activate carbon filter to an electrochemical (EC) sensor having a sensitivity of 0.10 +/- 0.01 V per 1 microL/L CO in air. The electronically processed sensor signal is displayed on a digital multimeter. For a typical end-tidal CO measurement, corrected for inhaled CO, three 10- to 12-mL breath and room air samples are manually or mechanically collected and analyzed. CO determination in breath samples from 108 healthy, 1-day-old infants of nonsmoking mothers compared favorably with determinations by gas chromatography (GC), 1.3 +/- 0.8 vs 1.2 +/- 0.8 (mean +/- SD), respectively, with a regression equation of EC = 0.95 GC+0.13 (r2 = 0.98). The results demonstrate that the EC-CO instrument yields results that are comparable with those obtained by the more difficult to perform GC assay.

Breath Tests↗
PubMed1994

Bilirubin production in healthy term infants as measured by carbon monoxide in breath.

To describe total bilirubin production in healthy term infants, we measured the end-tidal breath CO, corrected for ambient CO (ETCOc), with an automated sampler and electrochemical (EC) CO instrument. For infants of mothers with a negative Coombs' test, the ETCOc was 1.3 +/- 0.7 microL/L (n = 397) and the serum bilirubin on day 3 postpartum was 73 +/- 35 mg/L (n = 381). In contrast, the ETCOc for infants with ABO or Rh incompatibility, a positive direct Coombs' test, and bilirubin > 130 mg/L (n = 9) was significantly higher, 1.8 +/- 0.8 microL/L, than for those who had a positive Coombs' test result but whose bilirubin was < or = 130 mg/L (n = 12), 1.0 +/- 0.5 microL/L (P < 0.05). At 2 to 8 h postpartum seven term babies from mothers with insulin-dependent diabetes had ETCOc of 1.8 +/- 0.7 microL/L, significantly higher than that in the other term infants [1.3 +/- 0.7 microL/L (n = 390), P < 0.04]. Their bilirubin concentration at 72 +/- 12 h was also higher: 121 +/- 45 mg/L (n = 7) vs 73 +/- 34 mg/L (n = 374; P = 0.03). We conclude that ETCOc measurements may be helpful in understanding the mechanisms of jaundice in healthy term infants in a variety of conditions.

Asian↗
PubMed1993

A multicenter randomized trial comparing two surfactants for the treatment of neonatal respiratory distress syndrome. National Institute of Child Health and Human Development Neonatal Research Network.

OBJECTIVE: To compare the efficacy of two surfactants, Exosurf Neonatal (Burroughs Wellcome Co.) and Survanta (Ross Laboratories), for the treatment of neonatal respiratory distress syndrome. DESIGN: Multicenter randomized trial. SETTING: Eleven tertiary care university neonatal intensive care units participating in the National Institute of Child Health and Human Development Neonatal Research Network. PATIENTS: Newborn infants (n = 617) weighing 501 to 1500 gm with respiratory distress syndrome who were receiving assisted ventilation with 30% oxygen or more within 6 hours of birth were enrolled between January 1991 and January 1992. INTERVENTIONS: Infants were randomly assigned to receive up to four intratracheal doses of either Exosurf Neonatal (n = 309) or Survanta (n = 308). MAIN OUTCOME MEASURES: The occurrence of death or bronchopulmonary dysplasia 28 days after birth and the average fraction of inspired oxygen (FIO2) and mean airway pressure (MAP) during the first 72 hours after treatment. RESULTS: Death or bronchopulmonary dysplasia occurred in 67% of the infants in the Exosurf group and 62% of those in the Survanta group (adjusted relative risk, 1.07; 95% confidence interval, 0.96 to 1.20). During the 72 hours after the first surfactant dose, the average FIO2 (+/- SEM) was 0.50 +/- 0.01 for Exosurf and 0.42 +/- 0.01 for Survanta (difference, 0.08; 95% confidence interval, 0.05 to 0.11); the average MAP (+/- SEM) was 7.64 +/- 0.21 cm H2O for Exosurf and 6.93 +/- 0.21 cm H2O for Survanta (difference, 0.71 cm H2O; 95% confidence interval, 0.13 to 1.29 cm H2O). There was no difference between the groups in the incidence of other neonatal morbidities or in the duration of hospitalization, assisted ventilation, or supplemental oxygen administration. CONCLUSION: We found no difference between treatment groups in the incidence of death or bronchopulmonary dysplasia, although we did observe a difference in the initial response to treatment as measured by FIO2 and MAP.

Biological Products↗
PubMed1993

Catecholamine response at birth in preterm newborns.

We compared the extrauterine adaptation of preterm with term newborn infants, by sequentially measuring plasma catecholamine (CAT) levels at birth and during the first 24 h of life. Twenty-seven preterm appropriate-for-gestational-age (AGA) infants, less than 35 weeks gestation, were compared with 26 healthy near-term AGA infants. Modes of delivery and umbilical arterial pH (mean 7.28) did not differ. Infants with asphyxia, presumed sepsis or hypoglycemia were excluded. CAT (norepinephrine, epinephrine, dopamine) levels were measured by radioenzymatic assay in blood samples from maternal vein, cord vein, cord artery and blood samples obtained at 1, 2 and 24 h of postnatal age. At birth, the cord arterial CAT levels were significantly higher than maternal venous CAT levels in both groups of neonates. Plasma epinephrine levels (mean +/- SD) at 1 and 2 h of postnatal age were significantly higher in preterm than in near-term newborns (0.98 +/- 0.82 nmol/l vs. 0.30 +/- 0.21 nmol/l at 1 h; 0.98 +/- 0.68 nmol/l vs. 0.28 +/- 0.29 nmol/l at 2 h; p < 0.05). The norepinephrine and dopamine measurements did not differ between the two groups studied at birth, 1, 2 and 24 h of postnatal age. These data indicate that the preterm infants (25-35 weeks gestation) are capable of mounting a catecholamine response at birth similar to near-term newborns. The persistent elevation of epinephrine in preterm infants at 1 and 2 h of life may be attributed to either slower clearance of epinephrine or continued stimulation during clinical care in the NICU.

Delivery, Obstetric↗
PubMed1992

Elevation of fibronectin levels in lung secretions of infants with respiratory distress syndrome and development of bronchopulmonary dysplasia.

To determine whether the level of fibronectin in lung secretions correlates with the severity of lung injury or with the development of bronchopulmonary dysplasia, or both, serial tracheal aspirate samples were collected from 32 preterm infants with severe respiratory distress syndrome. Levels of total fibronectin, cellular fibronectin, plasma fibronectin, albumin, and secretory component of IgA (SC) were determined for the first 1 to 2 weeks of life in the 14 infants who recovered without pulmonary sequelae, and for weeks 1 to 4 in the 18 infants in whom bronchopulmonary dysplasia developed. Secretory component was chosen as the reference protein because its concentration in lung secretions is minimally influenced by capillary leak and does not vary with gestational or postnatal age. Albumin/SC and plasma fibronectin/SC ratios in tracheal aspirates were significantly higher (p less than 0.05) during the first 2 weeks of life in infants in whom bronchopulmonary dysplasia developed, suggesting greater capillary permeability in these infants. Cellular fibronectin/SC ratios in aspirates from infants with bronchopulmonary dysplasia were also significantly higher in the first 2 weeks, 9.0 +/- 1.7 and 7.4 +/- 2.0 micrograms/microgram SC in weeks 1 and 2, respectively, in comparison with values from infants without bronchopulmonary dysplasia, 1.6 +/- 0.4 and 1.1 +/- 0.8 micrograms/microgram SC (p less than 0.01), suggesting increased synthesis of fibronectin in the lungs of infants with subsequent bronchopulmonary dysplasia. Elevated levels of both plasma and cellular fibronectin in tracheal aspirate samples may provide an early index of the severity of lung injury in infants with severe respiratory distress syndrome.

Albumins↗
PubMed1992

Fibronectin: role in respiratory distress syndrome and bronchopulmonary dysplasia.

Further investigation is required to delineate the biochemical and cellular interactions that influence lung injury and fibrosis. The results from studies in adults, neonates, and animals suggest that fibronectin may play a key role in the development of pulmonary fibrosis following acute lung injury. Fibronectin as well as other pulmonary cytokines are essential participants in efficient and orderly wound repair; however, the excessive production of these mediators may result in an exaggeration of the normal healing process with the eventual outcome of pulmonary fibrosis. The potential role of fibronectin and other cytokines as mediators and markers of BPD may thus allow for earlier detection and identification of those infants with RDS who are at greatest risk to develop BPD, as well as aiding in the development and selection of therapeutic interventions that can more effectively treat and possibly prevent the deleterious consequences of bronchopulmonary dysplasia.

Bronchopulmonary Dysplasia↗
PubMed1992

Interventricular septal thickness in fetuses of diabetic mothers.

Sixty-four diabetic women had their fetuses studied by M-mode echocardiogram between 20-41 weeks of gestation. The mean septal size during both diastole and systole increased in a linear fashion with advancing gestational age in both the normal and diabetic groups. Ventricular septal hypertrophy (ie, more than 2 standard deviations above the normal mean) was present in 48 of 64 (75%) of the fetuses of diabetic women. The ratio of septal size to the anteroposterior cardiac dimension was significantly greater in the diabetic than in the normal group (12 versus 8%; P less than .05). The anteroposterior cardiac dimension indexed to the estimated fetal weight was also greater in the diabetic group. Because both septum and cardiac dimension are larger with maternal diabetes, there may be a specific diabetic cardiomyopathy that originates in utero.

Echocardiography↗
PubMed1991

Necrotizing enterocolitis in very low birth weight infants: biodemographic and clinical correlates. National Institute of Child Health and Human Development Neonatal Research Network.

We studied the occurrence of necrotizing enterocolitis in 2681 very low birth weight infants during an 18-month period to characterize the biodemographic and clinical correlates. Proven necrotizing enterocolitis (Bell stage II and beyond) occurred in 10.1% of study infants; necrotizing enterocolitis was suspected in 17.2% of study infants. Positivity of blood cultures was related to necrotizing enterocolitis staging. The mortality rate increased only for stage III necrotizing enterocolitis (54% died). Logistic regression identified medical center of birth, race, gender, birth weight, maternal hemorrhage, duration of ruptured membranes, and cesarean section as significant risk factors. For one center the odds ratio was 3.7, whereas for another center it was only 0.3. For black boys, the odds ratio was 2.3 relative to nonblack boys; for girls, race did not affect prevalence of necrotizing enterocolitis. Age at onset was related to birth weight and gestational age. Intercenter differences in necrotizing enterocolitis prevalence were related to time required to regain birth weight and other indicators of fluid management. Gram-positive organisms predominated in positive blood cultures for stage I and II necrotizing enterocolitis; enteric bacteria were isolated more frequently in infants with stage III disease. We conclude that necrotizing enterocolitis prevalence varies greatly among centers; this may be related to early clinical practices of neonatal care.

Birth Weight↗
PubMed1990

Infant survival following delayed postmortem cesarean delivery.

A 19-year-old multipara was delivered of a living infant by postmortem cesarean 22 minutes after documented maternal cardiac arrest and 47 minutes from the fatal injury. Neonatal follow-up at 18 months of age demonstrated no evidence of neurologic damage.

Adult↗
PubMed1989

Outcomes of extremely-low-birth-weight infants between 1982 and 1988.

Infants with birth weights under 750 g are disproportionately represented in perinatal mortality and morbidity rates. We reviewed the outcomes of 98 infants delivered at our perinatal center between July 1982 and June 1985 (period 1) whose lengths of gestation were 20 or more weeks and whose birth weights were under 750 g, and compared them with the outcomes of 129 such infants born between July 1985 and June 1988 (period 2). The frequency of cesarean section increased from 12 to 19 percent between the two periods. During the entire six-year period, 12 percent of the infants with birth weights under 500 g were intubated, as compared with 28 percent of those between 500 and 599 g, 60 percent of those between 600 and 699 g, and 90 percent of those between 700 and 749 g. The frequency of endotracheal intubation increased between the two periods only for infants with birth weights above 500 g (P less than 0.02). Despite more aggressive treatment, survival did not change, although the mean time to death among infants transferred to the neonatal intensive care unit increased from 73 to 880 hours. Among all live-born infants with birth weights under 750 g, the rate of survival was 20 percent during period 1 and 18 percent during period 2, but 48 and 43 percent of those transferred to the neonatal intensive care unit survived in the two periods reviewed. Neonatal morbidity also did not change. Among survivors at a corrected age of 20 months, 4 of 18 born during period 1 and 7 of 14 born during period 2 had moderate-to-severe neurodevelopmental impairment. When all live-born infants of less than 28 weeks' gestation were considered, only 8 percent of those born at 23 weeks survived, as compared with 16 percent of those born at 24 weeks, and 53, 63, and 72 percent of those born at 25, 26, 27 weeks, respectively. Thus, despite a tendency to perform more cesarean sections and active resuscitations, no improvement in the survival of babies with lengths of gestation below 25 weeks or birth weights under 750 g was observed. The probability of survival is very poor if the length of gestation is less than 24 weeks or the birth weight less than 600 g.

Birth Weight↗
PubMed1989

Differential effects of intrauterine and postnatal brain growth failure in infants of very low birth weight.

We investigated the contribution of brain growth failure to outcome in infants of very low birth weight (VLBW; less than 1.5 kg) who were appropriate for gestational age (AGA; n = 379) or small for gestational age (SGA; n = 102). Growth was assessed at birth, term, and 8 and 20 months' corrected age and results of a Bayley Mental Developmental Index (MDI) and neurologic examination were evaluated at 20 months of age. Both groups had similar 20-month MDI scores (93 vs 90) and similar rates of neurologic impairment (14% vs 10%). More SGA infants (25%) than AGA infants (14%) had a subnormal head circumference at 8 months' corrected age, indicating failure to catch up in head growth. Subnormal head size at 8 months predicted the 20-month MDI score for both groups. However, multivariate analysis indicated that, whereas subnormal 8-month head size was directly associated with the MDI score in AGA children, in SGA children 8-month head size was not significantly related to the MDI score when neonatal illness, neurologic impairment, socioeconomic status, and race were controlled for. We conclude that in AGA VLBW infants, subnormal head size at 8 months results from major neonatal illness and has adverse later effects. In SGA infants, subnormal head size at 8 months has many causes, including growth retardation in utero, which may not have an adverse effect on outcome; if subnormal head size is superimposed with neonatal illness, a poorer outcome is likely.

Brain↗
PubMed1989

Use of intravenously administered immune globulin to prevent nosocomial sepsis in low birth weight infants: report of a pilot study.

To evaluate the use of intravenously administered immune globulin (IVIG) for prevention of sepsis in preterm infants, we administered IVIG in a protocol designed to maintain a therapeutic serum "target level" of 700 mg/dl. The 200 patients who were eligible for the study (600 to 2000 gm birth weight) were monitored throughout their initial hospitalization. Of these, 115 patients were randomly assigned in a double-blind, controlled trial to treatment and placebo groups. The remaining 85 infants were not randomly assigned to a group, by parental request, but were followed and analyzed separately. In one patient who received IVIG, transient tachycardia and a decrease in blood pressure developed during an infusion; resolution occurred promptly after the infusion was discontinued. No persistent hepatic or renal abnormalities were noted in either the IVIG- or the placebo-treated group. There were seven episodes of sepsis in the placebo group and nine in the group whose parents refused consent to the study. No infant who received IVIG acquired nosocomial sepsis (p less than 0.01). All patients in the placebo group in whom sepsis developed had serum IgG levels less than 400 mg/dl at the time sepsis developed. Serum IgG levels were maintained near 700 mg/dl in patients who received IVIG. These data indicate that administration of sufficient IVIG to maintain target serum IgG levels throughout hospitalization may decrease the incidence of nosocomial sepsis in preterm infants.

Cross Infection↗