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Biomedical subjects

A D Rothberg

Publications and source records attributed to A D Rothberg.

At least 73 records · Page 4Linked to original sources
PubMed1987

Effect of Intralipid infusion on transcutaneous oxygen and carbon dioxide tension in sick neonates.

We evaluated the change in transcutaneous oxygen (tcPo2) and carbon dioxide (tcPco2) tension in response to 60 minutes' infusion of Intralipid (Kabi Vitrum (Saphar] (mean dose (0.16 +/- 0.07 g/kg/h) in neonates with lung disease (hyaline membrane disease or bronchopulmonary dysplasia). The tcPo2 was 10% lower following Intralipid infusion (P less than 0.05), whereas no significant change occurred in tcPco2 measurements. The data confirm the need for limited use of Intralipid in this category of patients.

Blood Gas Monitoring, Transcutaneous↗
PubMed1987

Neurodevelopmental predictors of short-term outcome in very-low-birth-weight infants.

Having previously confirmed a lower developmental quotient (DQ) in very-low-birth-weight infants identified by physiotherapists as being at risk, a retrospective analysis was undertaken to ascertain which of the neurodevelopmental tests were of value in predicting subsequent poor outcome. At 3 months corrected age, 9 tests differentiated normal from at-risk infants, and infants with abnormal test results were assessed as having a 56% (mean) risk of subsequent DQ less than 100. At the 6-month assessment, 7 neurodevelopmental tests differentiated normal from at-risk infants; infants with abnormal test results had a 73% (mean) risk of subsequent DQ less than 100. At 12 months, 3 tests differentiated normal from at-risk infants; infants with abnormal test results had a 79% (mean) risk of DQ less than 100. We believe the identification of predictive tests may assist doctors and developmental therapists in assessing need for intervention and response to treatment in high-risk infants. However, it must be noted that the tests studied relate to DQ at 1 year; we are not yet in a position to comment on the relationship between 1 year DQ and subsequent neurodevelopmental outcome.

Age Factors↗
PubMed1987

Needs for special-care beds for the newborn in the Witwatersrand area.

The requirements for different levels of neonatal care in the Witwatersrand area were estimated from a review of neonatal unit records of all infants born at Johannesburg Hospital during 1983 and 1984. When extrapolating these figures to the greater population of the Witwatersrand and referral areas, adjustments were made for the increased number of low-birth-weight and complicated deliveries at Johannesburg Hospital. Given the low-birth-weight rate of 8% for this population, it was calculated that 3.3 intermediate-care beds and 1.2 intensive-care beds were justified per 1,000 annual live births. A total of 25 beds for mechanical ventilation of neonates were required over this study period, approximately double the number available. Facilities for other population groups, who have higher rates for low birth weight, were even less adequate. For the country as a whole it is recognised that postneonatal mortality is a greater problem amenable to less costly intervention than neonatal mortality; nevertheless, existing facilities for neonatal care should be used more efficiently, and a co-ordinated regional service for all population groups in the area should be established.

Bed Occupancy↗
PubMed1987

Postnatal regression of the tunica vasculosa lentis.

Previous studies have shown a good correlation between appearance of the tunica vasculosa lentis (TVL) at birth and gestational age in 27-34 week premature infants. We studied the effect of postnatal age on the rate of regression of the TVL in premature infants to assess whether this occurred at a similar rate to that in utero. Fifty-eight premature infants were enrolled into the study. Gestational age was assessed using the method described by Ballard. Lens examination was by direct ophthalmoscopy within 36 hours of birth and then on a weekly basis. Regression of the TVL was graded according to the system described by Hittner; grade IV being the most immature (vascularity covering virtually the entire anterior surface of the lens) to grade I (vascular regression to a point at which only occasional vessels are visualized). Results were analyzed and compared according to postconceptional age. No significant differences were found in the rate of disappearance of the TVL when infants were studied at equivalent postconceptional ages irrespective of postnatal age. Thus, premature delivery was not associated with accelerated regression of the TVL. These findings may be useful in assessing gestational age of a preterm infant who has not had an assessment of gestational age within the first days after birth or who is transferred to a high-care centre beyond the stage when other gestational aging systems are considered reliable.

Gestational Age↗
PubMed1986

Apgar scores and asphyxia. Results of a study and proposal for a clinical grading system.

The Apgar score (AS) was devised in 1953 as a simple system for classifying neonatal condition at 1 minute and was later modified to include status at 5 minutes. However, studies have documented pitfalls, e.g. a poor correlation between AS and acid-base status. We studied 35 infants born at term. ASs were assigned by two nurses not involved in the delivery, and antepartum and postpartum events were noted. We confirmed the following: (i) labour ward staff tend to overestimate ASs; (ii) there is a poor correlation between the AS and acid-base status; and (iii) the labour ward staff's decision to resuscitate with intermittent positive-pressure respiration (IPPR) correlates with the AS but not with blood gas status. Infants with initially low ASs and/or a brief requirement for IPPR may be recorded by medical or nursing staff as being asphyxiated at birth. Our results show that low ASs may be associated with normal acid-base status and vice versa. In order further to define asphyxia, we therefore propose that a grading system which incorporates clinical data and the AS be used. Use of such a system would facilitate inter-area comparisons of grades of asphyxia encountered, efficacy of intervention programmes and developmental outcome of asphyxiated neonates.

Apgar Score↗
PubMed1986

Tracheal aspirate cytology and bronchopulmonary dysplasia.

Sequential tracheal aspirates from 39 neonates with hyaline membrane disease were examined to correlate cytological findings with the development of bronchopulmonary dysplasia (BPD). A total of 224 tracheal aspirates were examined from these infants, 15 of whom developed BPD as diagnosed by conventional clinical and radiological criteria. Hyperplastic and metaplastic epithelial changes were observed in all infants studied. Dysplastic changes occurred in 14 of 15 who developed BPD, and 14 of 24 who had a normal outcome (P less than 0.02). The exfoliation of dysplastic metaplastic bronchial cells was thus 95% specific and 71% sensitive for the subsequent development of BPD. Factors associated with the development of BPD were very low birth weight and gestational age, persistence of a patent ductus arteriosus, high peak inspiratory pressure (cm of H2O/kg), prolonged assisted ventilation, and rapidity of development of class III (dysplastic) changes in tracheal aspirates.

Birth Weight↗
PubMed1985

Effect of early neurodevelopmental therapy in normal and at-risk survivors of neonatal intensive care.

At a corrected age of 3 months, 80 low birth-weight infants were assigned to normal or at-risk groups on the basis of a neurodevelopmental assessment scale. Both groups were further divided into intervention and non-intervention sub-groups (20 infants in each). Intervention consisted of monthly hospital-based neurodevelopmental therapy in addition to a home exercise programme. Infants were re-assessed by a physiotherapist at 6, 9, and 12 months, and were tested at 12 months by an independent psychologist blinded for infant group. Mean birthweight and gestational age were similar for normal and at-risk groups. At-risk infants had higher mean neurodevelopmental scores throughout the study period and lower 1-year development quotients (DQ) than normals. In neither normal nor at-risk groups did neurodevelopmental therapy alter the pattern of development or the outcome.

Child Development↗
PubMed1985

Threshold for initiation of phototherapy in infants with non-haemolytic hyperbilirubinaemia.

The effect of initiating phototherapy at three different bilirubin concentrations in infants with physiological jaundice was studied in 98 clinically jaundiced term infants. Phototherapy was initiated at levels of 170, 257 and 300 mumol/l in groups A, B and C respectively. There was no difference between the groups in terms of days in hospital and bilirubin levels at entry or at exit from the study. Of group A, 97% received phototherapy v. 47% and 18% in groups B and C respectively. Peak bilirubin in those infants in group C receiving phototherapy was 318 mumol/l v. 282 mumol/l and 229 mumol/l in groups A and B. Two group C infants suffered complications of hyperbilirubinaemia. Rebound hyperbilirubinaemia was noted in infants with more severe jaundice after cessation of phototherapy. The threshold for toxicity in non-haemolytic hyperbilirubinaemia may be higher than the still widely accepted 340 mumol/l value, but pending definitive studies phototherapy will continue to be initiated at levels of greater than 257 mumol/l in term infants with hyperbilirubinaemia.

Bilirubin↗
PubMed1985

A comparison of two resuscitators in the management of birth asphyxia.

Twenty newborn infants with birth asphyxia were alternately assigned to ventilation with either the Samson or the Laerdal infant resuscitator. During resuscitation significantly greater percentage changes in pH (1,1% v. 0,2%; P less than 0,05), hydrogen ion concentration (-15,6% v. -2,1%; P less than 0,05) and partial arterial carbon dioxide pressure (-24,5% v. -11,9%; P less than 0,02) were seen in the Laerdal group. There was also a tendency towards improved oxygenation and lung compliance and quicker establishment of spontaneous respiration in the Laerdal group. We therefore conclude that the Laerdal resuscitator is superior to the Samson one in the management of infants with birth asphyxia.

Asphyxia Neonatorum↗
PubMed1985

Feeding of very-low-birth-weight infants with special formula--continued use beyond 2000 g and effects on growth to 1 year.

Ten very-low-birth-weight (VLBW) infants fed a premature formula up to a weight of 2 000 g were randomized either to continue on the premature formula for a further 8 weeks or to change to a standard infant formula. Four infants in each group completed the 8-week study period, while growth and biochemical data were available on the other 2 infants for half the study period. No significant differences were seen at the end of the study. Infants on the premature formula showed a trend towards more rapid growth during the 8-week period, but this was no longer evident at a corrected age of 3 months. All infants were followed up to a corrected age of 1 year, during which time growth curves were similar to those previously described for VLBW infants. No long-term tendency towards obesity was evident in these infants, who had gained weight up to 2 000 g at a rate equivalent to the intra-uterine rate.

Growth↗
PubMed1985

Johannesburg Hospital neonatal statistics--1983.

An analysis of Johannesburg Hospital neonatal admissions and deaths is presented for the period 1 January-31 December 1983. Infants weighing less than 1 500 g accounted for 25% of admissions and 47% of deaths. Compared with a previous report, a 68% increase in the admission of neonates weighing less than 1 000 g is shown. This increase probably reflects a more aggressive approach to the treatment of infants in this weight category. Despite a protracted period of hospitalization for survivors and some of those who did not survive, intensive care of the infant of very low birth weight (VLBW) appears to be justified, since: the major causes of death in this group are related to prematurity and are potentially preventable; and preliminary studies of VLBW survivors suggest a favourable outcome.

Humans↗
PubMed1985

Precursor prothrombin status in patients receiving anticonvulsant drugs.

Protein induced by vitamin K absence (PIVKA) is the circulating prothrombin precursor found in considerable concentrations when carboxylation of prothrombin is impaired. In this study PIVKA-positivity was assessed in adult epileptic patients receiving a variety of anticonvulsant drugs. Mean PIVKA (+/- SD) concentration was 4.6 +/- 2.3% in 16 epileptics vs 1.1 +/- 0.7% in 10 age-matched controls (p less than 0.001). 13 of the 16 (81%) epileptics had PIVKA values above the highest value recorded for the controls (Fisher exact test, p less than 0.001). Other indices of coagulation were normal. There was no correlation between PIVKA concentration and the particular anticonvulsant taken. This study therefore shows that most epileptics on anticonvulsant therapy have a subclinical coagulation defect. These data, together with previous findings of raised PIVKA concentrations in maternal-infant pairs exposed to gestational anticonvulsants and reports of neonatal haemorrhage in infants of epileptics, strengthen the case for antenatal vitamin K supplementation in pregnancies complicated by anticonvulsant therapy.

Adult↗
PubMed1985

Comparative growth and biochemical response of very low birthweight infants fed own mother's milk, a premature infant formula, or one of two standard formulas.

Very low birthweight (VLBW) infants weighing less than 1,600 g at birth were fed their own mother's milk (OMM) or randomly assigned to receive one of three formulas: a "humanized" formula (SF), a partially modified casein-predominant cow's milk formula (CF), or a premature formula (PF). All infants were fed at 120 kcal/kg/day where possible. PF infants had significantly greater weight increments (28.0 g/day) than those on OMM (19.4 g/day), SF (18.9 g/day), and CF (18.2 g/day). Those on PF also had greater increments of length, head circumference, and skin-fold thickness than those on the other two formulas and greater length increments than those on OMM. Dynamic skinfold measurements suggested that no infants accumulated excessive amounts of interstitial fluid. Infants on the two standard formulas had significantly greater base deficits, whereas those on CF also had higher urea values. Those on OMM had lower phosphate and higher alkaline phosphatase values than the other groups. Thus VLBW infants fed a premature formula had better growth and fewer biochemical problems than those on standard formulas, whereas supplementation of OMM may be necessary to ensure optimal growth and bone mineralization.

Alkaline Phosphatase↗
PubMed1984

Piroxicam poisoning in a 2-year-old child. A case report.

This report describes the severe multisystem toxicity which followed ingestion of 5 piroxicam capsules (100 mg) by a 2-year-old child. Gastro-intestinal symptoms developed within 2 hours, resulting in severe fluid and electrolyte imbalance, mental confusion and a generalized seizure. Evidence of liver and renal dysfunction developed within 3 days. Haemopoietic toxicity was manifested by progressive peripheral pancytopenia, bone marrow aplasia and coagulopathy. Pseudomonas septicaemia developed during the period of neutropenia. Clinical, biochemical and haematological abnormalities slowly resolved over 3-4 weeks. In view of the increasing use of piroxicam as an anti-inflammatory agent it seemed important to draw attention to the potentially serious effects of accidental overdosage.

Anti-Inflammatory Agents↗
PubMed1984

Hypertension as the major problem of idiopathic arterial calcification of infancy.

We describe two infants with severe hypertension associated with idiopathic arterial calcification of infancy. In both children, blood pressure control was refractory to aggressive antihypertensive therapy. There was radiologic and laboratory evidence of renovascular disease requiring the use of specific renin antagonists and later nephrectomy, resulting in moderate improvement of hypertension. Although on occasion there is a familial incidence, in the vast majority of cases the diagnosis hinges on a high index of suspicion.

Arteries↗
PubMed1984

Mother-infant prothrombin precursor status at birth.

Previous work from this laboratory has suggested there is a risk of hemorrhagic disease of the newborn (HDNB) in approximately one-third of term neonates, presumably as a result of vitamin K deficiency. Using the same assay for PIVKA (protein induced by vitamin K absence, prothrombin precursor), we studied 46 normal mother-infant pairs at term to investigate the relationship between neonatal and maternal PIVKA status. PIVKA was found in 13 infants (28%) and in seven mothers (15%). Maternal PIVKA status correlated with infant status (p less than 0.03). These data suggest that fetal vitamin K deficiency and risk of HDNB may be a consequence of maternal deficiency of the vitamin.

Adult↗
PubMed1984

Growth and biochemical response of premature infants fed pooled preterm milk or special formula.

This study compared growth of a group of very low birth weight infants fed a formula specifically developed for such infants (Formula) with another group fed expressed breast milk (EBM). The Formula contained 2.4 g/dl of protein (lactalbumin:casein ratio, 60:40); 4.1 g/dl of fat (40% medium-chain triglycerides); 8.8 g/dl of carbohydrates; and 81 kcal/dl, with more calcium, phosphorus, and electrolytes than are in human milk. Premature babies with birth weights between 1,200 and 1,500 g and gestational age less than 36 weeks were eligible for the study and were fed either pooled EBM or Formula until they reached a weight of 1,800 g. Twenty infants fed EBM and 19 infants fed Formula completed the trial. Weight gain was faster in the Formula-fed infants after a caloric intake of 100 kcal/kg/day was achieved (Formula 27.7 g/day vs. EBM 17.2 g/day; p less than 0.001). Time to reach 1,800 g was 27 days for the Formula group and 39 days for those on EBM (p less than 0.001). Increments in head circumference and skinfold thickness were also greater in the Formula-fed group. Laboratory studies in the two groups of infants showed higher alkaline phosphatase levels, which were not due to vitamin D deficiency, in the EBM-fed infants.

Alkaline Phosphatase↗