Search PubMed⌕ Search

Biomedical subjects

A A Fanaroff

Publications and source records attributed to A A Fanaroff.

At least 91 records · Page 5Linked to original sources
PubMed1984

Disseminated fungal infections in very low-birth-weight infants: clinical manifestations and epidemiology.

In 1979 and 1980, an apparent increase in the occurrence of disseminated fungal infections was observed. The clinical features of such infections in very low-birth weight infants are poorly described, and diagnosis is often delayed. Over a 24-month period, a discrete group of ten clinically diagnosed and four autopsy-diagnosed cases of systemic fungal infections in very low-birth-weight infants was observed. Prior to developing systemic fungal illness, these infants required prolonged total parenteral nutrition, central arterial or venous catheters, and multiple courses of broad-spectrum antibiotics for documented or suspected bacterial sepsis. The clinically diagnosed disseminated fungal infection (ten infants) was noted at a mean age of 33 days with one or more of the following: respiratory deterioration, abdominal distension, guaiac positive stools, carbohydrate intolerance, candiduria, endophthalmitis, meningitis, abscesses, erythematous rash, temperature instability, and hypotension. These signs and symptoms were seen as chronic or were intermittent in clinical course. In contrast, the autopsy-diagnosed disseminated fungal infection (four infants) was present at an earlier age with fewer recognizable predisposing factors and a more acute onset of infection. Nevertheless, in both groups the diagnosis of systemic candidal infection was delayed, due to an inability to consistently recover the organism from blood, CSF, or urine. The neonatologist caring for the very low-birth-weight infant needs to become more aware of these clinical entities. A high index of suspicion and ancillary diagnostic evaluation, such as retinoscopy or tissue biopsy, may be indicated in the critically ill, culture-negative patient.

Anti-Bacterial Agents↗
PubMed1984

Disseminated fungal infections in very low-birth-weight infants: therapeutic toxicity.

The improved survival of very low-birth-weight infants, who require prolonged hospitalization and many invasive procedures, increases the risks for nosocomial illnesses, such as disseminated fungal infections. In a 2-year period, systemic fungal infections were clinically diagnosed in ten infants. This necessitated the institution of antifungal therapy in extremely premature infants (mean birth weight 788 g, mean gestational age 28 weeks) despite the paucity of knowledge about the pharmacokinetics and toxicity of these drugs in the very immature patient. Despite the absence of reported toxicity in infants and older children, severe nephrotoxicity was commonly observed with oliguria/anuria, temporally related to the administration of amphotericin B in seven of these infants. Additional evidence of nephrotoxicity included either a rise in creatinine levels (greater than or equal to 1.3 mg/dL), an increase in BUN (greater than or equal to 30 mg/dL), hypokalemia (less than or equal to 2.9 mEq/L), or hyperkalemia (greater than or equal to 6.0 mEq/L). Six of these seven drug-toxic infants died. Interruption of amphotericin B therapy, with reinstitution at a lower dose, was the most successful factor in alleviating the anuria. There is an urgent need for detailed pharmacokinetic and toxicity studies of antifungal agents in immature infants.

Acute Kidney Injury↗
PubMed1983

Decreased ventilation in preterm infants during oral feeding.

As respiratory difficulty may accompany nipple feeding in preterm neonates, we studied the effect of oral feeding on ventilation in 23 preterm infants. The infants composed two groups based on their postconceptional age at the time of study: Group A comprised 12 infants 34 to 35.9 weeks of age, and group B, 11 infants 36 to 38 weeks. Ventilation was measured via a nasal mask pneumotachometer, and sucking pressure via a nipple that also permitted milk delivery; transcutaneous PO2 and PCO2 were continuously monitored. The feeding pattern comprised an initial period of continuous sucking of at least 30 seconds, followed by intermittent sucking bursts for the remainder of the feed. When compared with an initial semi-upright control period, minute ventilation (V1) during continuous sucking fell by 52 +/- 6% (P less than 0.001) and 40 +/- 2% (P less than 0.001) in groups A and B, respectively. This was the result of a decrease in respiratory frequency and tidal volume and was associated with a fall in TcPO2 of 13 +/- 4 mm Hg (P less than 0.01) in group A and 10 +/- 2 mm Hg (P less than 0.01) in group B. During intermittent sucking, V1 and TcPO2 recovered partially only in the more mature infants (group B). At the end of the feed, TcPCO2 have risen by 3 +/- 1 mm Hg (P less than 0.001) in group A and by 2 +/- 2 mm Hg (P less than 0.05) in group B. Thus oral feeding results in an impairment of ventilation during continuous sucking and the subsequent recovery during intermittent sucking is dependent on postconceptional age.

Drinking↗
PubMed1983

Hypertensive retinopathy in the newborn infant.

Hypertension (blood pressure greater than 70 mm Hg on three days) was noted in 1.2% of all neonatal admissions to the intensive and intermediate care nurseries. During this investigation of neonatal hypertension, a retinopathy identical to that seen in hypertensive adults was noted. Indirect ophthalmoscopy was performed in 21 neonates with elevated blood pressure. Eleven of these patients demonstrated some or all of the following abnormalities: increased ratio of venous to arterial caliber, vascular tortuosity (including arteriovenous crossing changes), superficial and deep hemorrhages, and exudates. These findings appeared to resolve after control of the hypertension. The specificity of this constellation of lesions for hypertensive retinopathy and their possible clinical significance are explained in light of what is known about hypertensive retinopathy in adults.

Exudates and Transudates↗
PubMed1983

Optimal position for a spinal tap in preterm infants.

Inasmuch as spinal taps in preterm infants are frequently accompanied by clinical deterioration, the optimal position for this procedure was investigated. Three positions were each randomly assigned for five minutes to 17 healthy preterm infants without a spinal tap actually being performed: (1) lateral recumbent with full flexion (flexed position), (2) lateral recumbent with partial neck extension (extended position), and (3) sitting with head support and spine flexion (upright position). Transcutaneous PO2 and PCO2 were monitored in all infants, minute ventilation (VI) in seven, and heart rate and blood pressure in ten infants. Mean transcutaneous PO2 decreased in each of the three positions. This decrease was significantly greater in the flexed (28 +/- 8 mm Hg) as compared with the extended (18 +/- 8 mm Hg, P less than .001) and upright (15 +/- 11 mm Hg, P less than .001) positions. Mean transcutaneous PCO2 increased only in the flexed position (3 +/- 4 mm Hg, P less than .005) and levels were still elevated five minutes after that position had been discontinued. The consistent decrease in transcutaneous PO2 was accompanied by a variable effect of positioning on VI and there were no episodes of airway obstruction or apnea greater than 10 seconds. Heart rate increased in each position whereas blood pressure remained unchanged. These data suggest that although hypoventilation may contribute to the observed decrease in transcutaneous PO2, ventilation/perfusion imbalance appears to be the major mechanism. As spinal taps performed in the widely accepted flexed position carry the greatest risk of potential morbidity, it is recommended that this position be modified with neck extension or that spinal taps be performed in the upright position.

Carbon Dioxide↗
PubMed1983

The very low birth weight infant: the broader spectrum of morbidity during infancy and early childhood.

Neonatal intensive care has improved very low birth weight (less than 1.5 kg) outcome. To evaluate the spectrum of morbidity related to this care, 505 survivors born between 1975 and 1979 were followed during the first three years of life. Transient neurological abnormalities of muscle tone which resolved by two years of age were seen in 40% of children. The incidence of chronic physical disease (lung disease, sequelae of necrotizing enterocolitis, and cholestatic jaundice) was 23% at term, 12% by 8 months, and 3.3% by 20 months. Subnormal weight for age at three years was found in 17% of infants born appropriate for gestational age and 46% of those born small for gestational age. Thirty-three percent of children were rehospitalized during infancy, 10% during their second year, and 10% during their third year of life. Mean IQ was 92.0. In the total population 80.6% were considered normal, 1.7% had major congenital malformations, 10.1% had neurosensory abnormalities, and 7.6% had developmental delay (DQ or IQ less than 80). Close followup care is essential to ensure the eventual adaptation and functional normalization which occurs in the majority of these high-risk infants.

Body Height↗
PubMed1983

Alae nasi activation (nasal flaring) decreases nasal resistance in preterm infants.

The effect of alae nasi activation on nasal resistance in a group of healthy preterm infants was measured. Alae nasi activity was determined via the alae nasi electromyogram obtained from skin surface electrodes during both active and quiet sleep. Nasal resistance was calculated from airflow measured with a mask pneumotachograph and transnasal pressure drop obtained by simultaneous measurement of nasal pressure via a catheter inserted in one nostril and mask pressure. The percentage of breaths accompanied by phasic alae nasi activity was higher during active sleep than during quiet sleep (43% +/- 10% v 14% +/- 6%; P less than .005), and hypercapnic stimulation (4% CO2 inhalation) significantly increased the incidence of phasic alae nasi activity to comparable levels in both sleep states (82% +/- 8% in active sleep and 82% +/- 9% in quiet sleep). Elevation of tonic alae nasi activity also occurred more frequently during active sleep (P less than .05). The presence of either phasic or elevated tonic alae nasi activity decreased nasal resistance by 23% +/- 4% during active sleep and 21% +/- 3% during quiet sleep. This reduction in nasal resistance resulted in either a lower transnasal pressure during inspiration, a higher peak inspiratory airflow, or a combination of the two. Alae nasi activity may be an important mechanism that facilitates ventilation by reducing nasal resistance, and it may help stabilize the upper airway by preventing the development of large negative pharyngeal pressure during inspiration.

Airway Obstruction↗
PubMed1982

The prognostic significance of postnatal growth in very low--birth weight infants.

To examine the relative importance of intrauterine growth failure, extrauterine growth failure before or after term, and the prognostic significance of catch-up growth, 192 very low--birth weight infants (less than 1.5 kg) were followed prospectively to 8 months corrected age. One hundred fifty-four appropriate--for--gestational age (AGA) and 38 small--for--gestational age (SGA) infants were categorized into normal and subnormal (less than -2 SD) weight for age groups at term (40 weeks) and at 8 months corrected age. By term, 71 AGA infants had subnormal weight; 41 of these caught up by 8 months, and an additional 13 AGA infants failed to thrive between term and 8 months. Of the SGA infants, three caught up in weight by term, and an additional 16 caught up by 8 months. Significant correlates of subnormal weight included neonatal risk score, incidence of chronic disease, and extended hospitalization. The AGA and SGA infants who failed to thrive or failed to catch up in weight by 8 months had lower mean Bayley developmental quotients (p less than 0.005), smaller head circumferences (p less than 0.005), and a higher rate of neurosensory impairment (p less than 0.01) than the AGA infants with normal fetal and postnatal growth. Intrauterine and/or postnatal growth failure prior to term was not of sinister prognostic significance if catch up occurred thereafter.

Adult↗
PubMed1982

Neonatal necrotizing enterocolitis in the absence of pneumatosis intestinalis.

Necrotizing enterocolitis (NEC) may be diagnosed radiologically when pneumatosis intestinalis or hepatic-portal gas are present on abdominal roentgenograms. Of 136 patients with strictly documented NEC, 19 (14%) never demonstrated specific roentgenographic evidence of NEC. The diagnosis in these 19 patients was, however, confirmed by a histopathologic examination of tissue obtained at the time of laparatomy or autopsy. In 13 of these infants gastrointestinal (GI) perforation developed 12 hours to eight days following the onset of symptoms, while in five patients ascites developed as the only roentgenographic sign of potential intra-abdominal disease. We do not suggest that the vast majority of infants with mild abdominal distention or positive for occult blood have NEC. However, differentiating NEC from these other more common GI problems (such as feeding intolerances) is presently difficult in the absence of definitive roentgenographic evidence of pneumatosis intestinalis or histologic examination of the involved tissue.

Enterocolitis, Pseudomembranous↗
PubMed1982

Epidemiologic study of necrotizing enterocolitis among low-birth-weight infants. Absence of identifiable risk factors.

Necrotizing enterocolitis has been associated with a variety of perinatal problems which have been purported to be risk factors predisposing the neonate to NEC. The present investigation compares the perinatal histories of 48 low-birth-weight infants (less than 1,500 gm) with NEC to those of 553 high-risk infants of equivalent birth weight who did not have NEC but who were present in the nursery during a four-year observation period. The two populations were equivalent with regard to maternal factors such as socioeconomic status, education, race, and age. Both the antenatal and intrapartum risk scores were similar, as were the position of presentation and mode of delivery. The incidence of pre-eclampsia, prolonged rupture of the membranes, and placenta previa was also equivalent. Birth weight and gestational age were identical, as well as intrauterine growth retardation and low Apgar scores. The placement of umbilical artery catheters or the performance of exchange transfusions were not more frequent among patients with NEC. Infants who developed NEC demonstrated significantly different incidences of only three variables. Mothers of these infants were usually married, and their infants had less respiratory distress syndrome; the only adverse factor present more frequently was abruptio placenta. These data raise further questions concerning the significance of previously reported risk factors of NEC.

Adult↗
PubMed1982

A perinatal approach to the diagnosis and management of gastrointestinal malformations.

Ultrasonography now offers the opportunity to evaluate selected high-risk pregnancies for the presence of fetal malformations that are amenable to corrective measures as well as of those that remain incompatible with life. The authors observed major fetal malformations in 1% of 6050 cases that underwent antenatal ultrasonographic evaluation. A series of 9 prenatally diagnosed gastrointestinal tract anomalies, including the first documented instances of esophageal atresia diagnosed in utero, is presented in detail. Abdominal wall defects were those most commonly encountered in this series and were diagnosed as early as 16 weeks' gestation. The gastrointestinal system is not only one of the most common sites of birth defects, but it is also the one wherein lies the greatest hope for a successful neonatal outcome. The value of prenatal diagnosis in a comprehensive perinatal approach to congenital gastrointestinal lesions is emphasized. Forewarning the obstetrician and altering the pediatric-surgical team for resuscitation, immediate postnatal evaluation, and timely intervention decrease neonatal mortality and increase the chance of long-term infant survival.

Abnormalities, Multiple↗
PubMed1982

Vertebral agenesis: comprehensive care and outcome.

There is little information concerning long-term outcome of vertebral agenesis. In this series of eight patients with variable severity of vertebral agenesis, three died during infancy, two of associated congenital anomalies involving the cardiorespiratory system and one of unknown causes. The remaining five have had no life-threatening problems. They have normal intellect, and the developmental achievements are adequate for their age. The five patients with the highest lesions were those born to diabetic mothers. We also discuss current concepts of comprehensive team management of such infants.

Adult↗
PubMed1981

Rehospitalization of the very-low-birth-weight infant. A continuum of perinatal and environmental morbidity.

To evaluate ongoing morbidity, a prospective follow-up study was undertaken of the frequency and causes of rehospitalization of very-low-birth-weight infants (less than 1,500 g) during the first year of life. In 1977, 90 very-low-birth-weight infants were discharged after an average of 62 days' hospitalization. Thirty required rehospitalization on 51 occasions during the first year, for reasons including continuing care of chronic conditions related to the initial neonatal hospitalization (16), respiratory and other infections (14), inguinal herniorrhaphy (13), caretaking disorders (five), and other causes (three). Infants at highest risk for rehospitalization included those with chronic conditions and/or those with poor neurodevelopmental outcomes. These data reconfirm the continuing toll of perinatal morbidity among very-low-birth-weight infants and emphasize the medical and social responsibility for a systematic program of follow-up for these high-risk infants.

Adolescent↗
PubMed1981

Neonatal necrotizing enterocolitis: a nine-year experience.

To gain an epidemiologic perspective on necrotizing enterocolitis (NEC), nine years' experience with 123 patients was reviewed. Mean gestational age was 31 weeks, and mean birth weight, 1,460 g; 7.3% were full-term and 10.5% were small for gestational age. Eighty infants had umbilical artery catheters, of which 50% were placed below L4-5. There was no identifiable risk factor in 11.4%; in half of these infants, NEC developed during an epidemic. Clustering of cases occurred in seven of the 108 months studied. Cases during epidemics had a lower incidence of respiratory distress syndrome. Average age at onset of NEC was 12 days; however the most common agd (mode) was 3 days, and in 13.8% onset was after the third week. On the survivors, 4% had recurrent disease one to 20 days after reinitiation of enteric feeding. The occurrence of NEC in low-risk patients and in older neonates raises serious questions about the proposed pathogenesis of NEC.

Birth Weight↗
PubMed1981

Neonatal necrotizing enterocolitis: a nine-year experience. II. Outcome assessment.

Mortality was assessed in a nine-year experience with 123 patients with necrotizing enterocolitis. Overall mortality was 45%. Despite intestinal perforation among surgically treated patients, there was no difference in mortality between surgically or medically treated patients(46% vs 54%). Patients with only hematochezia or abdominal distention has a lower mortality than those who appeared "septic" (35% vs 68%). Similarly, those with bacteremia and disseminated intravascular coagulation had high mortality as well as those in whom peritonitis with ascites developed. When the entire patient population is considered, prior therapy with ascites developed. When the entire patient population is considered, prior therapy with systemic antibiotics or concomitant therapy with oral aminoglycosides had no effect on severity of the disease, occurrence of intestinal perforation, or mortality.

Birth Weight↗