Biomedical subjects

A D Rothberg

Publications and source records attributed to A D Rothberg.

At least 91 records · Page 5Linked to original sources

PubMed1984

Can captopril cause fetal and neonatal renal failure?

We present a case of neonatal renal failure following a pregnancy complicated by hypertension treated with captopril. Clinical investigations showed structurally normal kidneys, suggesting a renal dysfunction other than that seen with the more common causes of neonatal renal failure. Recent animal and human data would support our hypothesis that transplacental captopril could have produced the clinical picture seen in our patient. Our findings do not unequivocally implicate captopril as the offending agent; however, since captopril is not considered to be teratogenic, a more widespread use may be anticipated in pregnancies complicated by severe hypertension. Surveillance of such pregnancies may yield more information regarding the above association.

Acute Kidney Injury↗

PubMed1984

Precursor prothrombin status in two mother-infant pairs following gestational anticonvulsant therapy.

Protein in vitamin K absence (PIVKA) is the prothrombin precursor found in plasma when carboxylation to prothrombin is impaired. We report on two cases in which mother-infant PIVKA concentrations were measured at birth after chronic anticonvulsant therapy during pregnancy. Maternal values were 2.4 and 4%, and infant values 20.0 and 18% in cases 1 and 2, respectively. This demonstrates that, despite the normal coagulation profiles previously described, mothers on chronic anticonvulsant therapy may have a subclinical carboxylation defect, while their infants are at risk for hemorrhagic disease. Estimation of maternal PIVKA levels may be of value for predicting risk of hemorrhage in the neonate.

Adult↗

PubMed1984

Effect of tobramycin on fractional sodium excretion in neonates.

Fractional sodium excretion (FENa) was measured in 25 neonates during and after treatment with tobramycin. Mean birthweight of infants was 1.83 kg and mean gestational age was 34.3 weeks. Tobramycin therapy was initiated within 48 hours of birth and levels were maintained within the therapeutic range. Mean FENa values were persistently elevated during treatment and decreased to the normal range within 2 days of stopping antibiotics. Blood urea and creatinine concentrations were normal throughout the period of study. Exposure to the aminoglycoside appears to delay the previously described postnatal decline in FENa, most likely reflecting subtle renal tubular dysfunction.

Aminoglycosides↗

PubMed1983

The spectrum of clinical problems and outcome in infants in a neonatal unit.

We report on a retrospective analysis of admissions to the neonatal unit at the Johannesburg Hospital during the 18-month period September 1980 - February 1982. There were 451 admissions during this period, and 47% of the total group required assisted ventilation; 38% were referred from other hospitals (outborn), of whom 74% required ventilation. Hyaline membrane disease (HMD) accounted for 30% of all major diagnoses and was the most common single diagnosis made in infants weighing less than 2 500 g at birth. HMD also occurred in 20 infants weighing more than 2 500 g at birth, in many cases being the result of elective delivery. The neonatal survival rate (first 28 days) according to birth weight was as follows: 751-1 000 g - 76%; 1 001-1 500 g - 83%; 1 501-2 000 g - 93%; and greater than 2 000 g - 89%. Mortality was higher among ventilated outborn infants than among ventilated inborn infants in all weight groups, but the differences were not statistically significant. Long-term follow-up of these infants is in progress.

Humans↗

PubMed1983

Eosinophilia in premature neonates. Phase 2 of a biphasic granulopoietic response.

Eosinophilia within the first 6 weeks of life was studied prospectively in 10 premature neonates. Mean birthweight was 1229 +/- 314 g, and mean gestational age 31.5 +/- 1.8 weeks. Simultaneous changes in eosinophil, neutrophil, total lymphocyte, suppressor and helper T-cell counts and IgE levels were monitored. Infants were designated as responders (eosinophils greater than 1000/microliter for greater than 5 days) and non-responders. In the 6 responders eosinophils increased from 353 +/- 76 (mean +/- SEM) at birth to a peak of 2783 +/- 430/microliter at 20-25 days. Responders had significantly lower neutrophil counts at birth (P less than 0.05), and in 5 of the 6 responders neutrophils increased by more than 100% within 10-15 days; this did not occur in any of the 4 non-responders (P less than 0.025). Lymphocytes and suppressor and helper T cells increased progressively in both groups over the period of study with no differences between responders and non-responders. Birthweight and gestational age were similar in both groups, and there were no apparent causes for the lower neutrophil counts in responders at birth. Eosinophilia was not related to an IgE response. The incidence of eosinophilia in this study is similar to that reported previously, and appears to be part of a biphasic granulopoietic response.

Eosinophilia↗

PubMed1983

Early introduction of parenteral nutrition in premature infants and its effect on calcium and phosphate homeostasis.

Calcium and phosphate homeostasis was evaluated in two matched groups of sick premature neonates. Parenteral nutrition in the form of an amino acid solution was administered to 10 infants (group A), and a dextrose-electrolyte-calcium solution was administered to 11 infants (group B). The infants did not demonstrate the immediate phosphaturia previously described following infusion of amino acids and/or glucose. In both groups, phosphate excretion was directly related to phosphate intake (r = 0,45; P less than 0,001). In group A infants infusion of the amino acid solution was associated with a significantly greater fall in serum calcium levels on the 2nd day of life (P = 0,02 v. group B), despite similar intake and excretion of calcium in the two groups. We suggest that the phosphate content of the amino acid solution may aggravate the neonate's tendency to hypocalcaemia, although frank hyperphosphataemia was not observed.

Calcium↗

PubMed1983

Hypertrophic osteoarthropathy in biliary atresia.

This case report describes a child with biliary atresia and hypertrophic osteoarthropathy (HO), the second such case report of HO in a child with biliary atresia. Suggested pathogenetic mechanisms are discussed. Surgical intervention in the treatment of biliary atresia has clearly increased survival in affected children. The relationship between surgical intervention, either successful or unsuccessful, and hepatic HO remains speculative.

Bile Ducts↗

PubMed1983

Infants weighing 1,000 grams or less at birth: developmental outcome for ventilated and nonventilated infants.

The neurodevelopmental outcome at a mean age of 40 months was investigated in 23/25 surviving infants of birth weights less than or equal to 1,000 gm. Eight infants required intubation and assisted ventilation and 17 were not ventilated. One ventilated infant was lost to follow-up and one nonventilated infant was a victim of sudden infant death syndrome at age 6 months. Fifteen (65%) had a good outcome but the differences between ventilated and nonventilated infants were striking. Thirteen (81%) of the nonventilated group were normal, but only two ventilated survivors (28%) were normal (P less than 0.05). Cicatricial retrolental fibroplasia occurred in three (43%) of the ventilated survivors and in none of the nonventilated infants (P less than .02). The requirement for assisted ventilation in these very low-birth-weight infants is associated with significant morbidity. Improvement in outcome may depend as much upon better understanding and management of prenatal events as upon improvements in neonatal care.

Developmental Disabilities↗

PubMed1983

Sustained ventilation: perfusion imbalance during hemodialysis.

Five children between the ages of 6 and 15 years, who required chronic hemodialysis (HD) for renal failure, were studied to evaluate the central and pulmonary effects of HD on gas exchange. Acetate dialysate was used, and dialysate pO2 and pCO2, arterial pO2 and pCO2, endtidal CO2 and minute ventilation were measured pre-HD and 15, 30, 60, 120 and 240 minutes after commencement of HD. Arterial-alveolar CO2 gradient (aADCO2) was calculated to determine the ventilation: perfusion (V/Q) status. Minute ventilation did not change significantly from the pre-HD value of 8.9 +/- 1.1 l/min (mean +/- SD). The aADCO2 increased significantly from 3.2 +/- 3.7 mmHg to 8.4 +/- 2.4 mmHg at 15 mins (p less than .01) and was still elevated at 120 mins. (9.1 +/- 3.4 mmHg, p less than .02). There was a weak but significant inverse relationship between aADCO2 and arterial pO2 (r -0.42, p less than 0.05). The results suggest that, in these children, dialysed at altitude, dialysis-related hypoxemia appears to be the result of a sustained V/Q mismatch, possibly related to a decrease in pulmonary perfusion.

Adolescent↗

PubMed1982

Non-immunological hydrops fetalis: report of 6 cases and a review.

Six consecutive cases of non-immunological hydrops fetalis (NIHF) seen by the authors over a 3-year period are presented. Two cases were due to haematological causes and 3 to cardiac anomalies; in 1 case trisomy-21 with a possible associated cardiac anomaly was present. No infant survived. On the basis of this experience and a review of the literature the associated conditions, diagnosis and management of NIHF are discussed.

Adult↗

PubMed1982

Effect of a new neonatal maintenance solution on potassium, calcium and phosphate homeostasis in sick neonates.

A new neonatal maintenance solution (Neonatalyte; Sabax) was administered to 12 newborn infants with respiratory distress. Under closely controlled conditions, the infusion was commenced at a mean age of 12 +/- 10 hours. The mean serum potassium level increased from 4,6 +/- 0,6 mmol/l to 5,6 +/- 1,4 mmol/l (P less than 0,02), while in 5 infants (42%) hyperkalaemia (greater than or equal to 6,5 mmol/l) occurred within 8 hours of commencement of Neonatalyte infusion. The mean serum calcium level decreased from 2,1 mmol/l on day 1 to 1,7 mmol/l on day 2 (P less than 0,001) and was 1,8 mmol/l on day 3 (P less than 0,01), despite mean calcium intakes of 18,33 and 45 mg on days 1, 2 and 3 respectively. The early hypocalcaemia may be related to the phosphate content of Neonatalyte. We conclude that Neonatalyte is not an ideal solution for sick newborn infants who cannot be fed orally for the first few days of life.

Calcium↗

PubMed1982

Transient neonatal hyperammonaemia. A case report.

A case of transient neonatal hyperammonaemia (TNH) is described. The entity of TNH has only recently been identified and awareness of the condition may reveal that it is, in fact, not exceedingly rare in premature infants. The presentation of TNH mimics the neurological damage associated with asphyxia, sepsis or intraventricular haemorrhage, all of which occur frequently in premature infants. However, while the latter conditions are associated with a poor prognosis, the outcome for infants with TNH appears to be favourable if aggressive treatment is instituted at an early stage. Treatment consists of dialysis and/or exchange transfusion. A brief review of the literature on TNH is included.

Ammonia↗

PubMed1982

Maternal-infant vitamin D relationships during breast-feeding.

To evaluate the effect of maternal dietary vitamin D intake on infant vitamin D status in a country with a temperate climate, but where the commercial milk supply is not vitamin D fortified, this randomized, double-blind study was conducted on term mother-infant pairs during the winter months. Well-nourished, white nursing mothers were given a placebo, 500 IU vitamin D/day or 1,000 IU vitamin D/day; their infants were not given supplemental vitamin D. After six weeks, mothers receiving supplemental vitamin D had higher levels of 25-hydroxyvitamin D than had mothers receiving placebo. A direct relationship was observed between maternal and infant levels of 25-hydroxyvitamin D at six weeks, implying that maternal vitamin D intake directly affects the vitamin D concentration in breast milk. A control group of infants who had received 400 IU vitamin D/day had even higher concentrations of 25-hydroxyvitamin D, suggesting that infant supplementation with vitamin D is more efficacious than maternal supplementation. Despite the favorable climate in South Africa, during winter breast-fed infants have low serum vitamin D values if maternal dietary vitamin D intake is low.

Alkaline Phosphatase↗

PubMed1981

Outcome for survivors of mechanical ventilation weighing less than 1,250 gm at birth.

We investigated the outcome in 28 survivors of mechanical ventilation weighing less than 1,250 gm at birth. Fifteen infants (54%) had neurodevelopmental sequelae, of whom eight had major handicaps. These eight infants differed significantly from the rest of the infants studied in the following manner: lower mean birth weight and gestational age, delay in transportation to our Neonatal Intensive Care Unit, and high incidence of bacterial sepsis. The remaining seven infants with NDS were functionally normal or minimally impaired at the time of the study, although significant problems may yet emerge with continued follow-up. Retrolental fibroplasia was diagnosed in 11 infants (39%) and resolved in two. The development of RLF was associated with prolonged oxygen exposure and the presence of bacterial sepsis. However, since major handicap, RLF, and sepsis were all problems observed in the smallest infants, a cause-and-effect relationship between sepsis and these sequelae remains speculative.

Bacterial Infections↗

PubMed1981

Changes in mean esophageal pressure during early recovery in mechanically-ventilated neonates--evidence for airway-closure and gas-trapping?

We studied transmission of a constant mean airway pressure through the lungs to the pleural space in nine mechanically-ventilated neonates with low-compliance lung disease. Infants were studied for 3.1 +/- 1.6 hr during a period of clinical improvement, but at a time when lung compliance was still markedly reduced. Two of our infants were studied during recovery from fluid overload, while seven infants with hyaline membrane disease were studied at a stage of disease during which maximal diuresis has been found to occur. During the study period, mean esophageal pressure decreased in all infants from 5.6 +/- 1.3 to 4.2 +/- 1.8 cm H2O (P less than 0.001) while total compliance increased slightly.

Esophagus↗

PubMed1981

The metabolic effects of caffeine in the newborn infant.

We studied the effects of intravenous administration of 20 mg/kg caffeine citrate on glucose homeostasis, cardiorespiratory status, and urinary excretion of catecholamines and electrolytes in 12 premature infants with recurrent apnea. Six infants received intravenous dextrose (5% or 10% in 0.225% saline) during the study, and six were fed formula every 3-4 hours. In the intravenously fed infants, the plasma glucose concentration postcaffeine did not vary significantly from the precaffeine level of 73 +/- 3.2 mg/dl (mean +/- SEM) at 0.5, 1, and 1.5 hours. However, in the formula-fed infants, there was a consistent fall in plasma glucose levels after caffeine administration. This decrease from a precaffeine level of 99 +/- 12 mg/dl (mean +/- SEM) approached statistical significance at 0.5 hours (P = 0.07), and was significantly lower at 1 and 1.5 hours (P less than 0.02). In five infants, cardiorespiratory status and urinary excretion of catecholamines and electrolytes were evaluated for 12-hour periods before and after caffeine administration. There was a significant reduction in the number of apneic episodes following caffeine administration; however, caffeine did not appear to affect mean heart rate or urinary excretion of sodium, potassium, epinephrine, norepinephrine, or dopamine. Our data suggest that the effects of caffeine on glucose homeostasis may vary with the nature and/or route of substrate administration.

Apnea↗

PubMed1981

Understanding the Pleurevac.

The infant nonmetered Pleurevac was studied under laboratory conditions. Evacuation of a spirometer was measured at various negative pressures through the infant thoracostomy tubes routinely used in the clinical setting. In addition, a tension pneumothorax model was designed, and factors affecting its evacuation rate were studied. In accordance with Poiseuille's law, the evacuation rate was proportional to the negative pressure applied to the thoracostomy tube, and the radius of the tube. The airflow rate (bubble rate) through the Pleurevac was found to be of minor importance in affecting evacuation.

Evaluation Studies as Topic↗

PubMed1977

A laboratory investigation into bilirubin binding in neonates.

The presence of free bilirubin the serum of 59 Black neonates was studied at the time of exchange transfusion with an electrophoretic technique. It was observed that 32 infants had detectable free bilirubin in their serum and that these infants had a significantly greater bilirubin/albumin ratio that infants without free serum bilirubin.

Bilirubin↗