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Biomedical subjects

A Erenberg

Publications and source records attributed to A Erenberg.

At least 37 records · Page 2Linked to original sources

In utero bladder diversion--problems with patient selection.

Based upon the concept that an obstruction-maldevelopment sequence is reversible after diversion, it has been suggested that the fetus with a bladder outlet obstruction is a potential candidate for in utero intervention. We report an infant who had both renal and pulmonary dysplasia at birth despite a technically successful diversion at 22 weeks' gestation. The poor outcome suggests that the organ damage either occurs so early that it precludes corrective surgery, or that the maldevelopment is not the result of obstruction, but rather a primary mesodermal defect.

Abdomen↗

Evaluation of an extension set for intermittent intravenous drug delivery to infants.

An intravenous administration set designed for delivery of drug doses to pediatric patients was tested in vitro for the effect of fluid density and flow rate on drug delivery, and delivery of drug by this extension set was compared in vivo with delivery by other methods. Gentamicin (as the sulfate salt) and penicillin G potassium were used to represent low-density and high-density drugs, respectively; a 1-mL solution of each drug, labeled with carbon 14, was tested with each of two primary infusion solutions: 0.45% sodium chloride injection and 10% dextrose injection. The drug dose was injected via a port into a piston-containing chamber from which an equivalent amount of the primary fluid was displaced. Serial samples collected from the end of the filter-containing extension set were analyzed for drug concentration using a liquid scintillation technique. In 12 infants receiving i.v. gentamicin, this delivery method was compared in a randomized crossover trial with delivery by a syringe pump and by i.v. push. Each delivery system was used on one of three consecutive days, and serum gentamicin concentrations were measured by enzyme-multiplied immunoassay. The time required for in vitro delivery of the dose was dependent on flow rate. Density of the drug solution or the primary i.v. fluid did not significantly affect drug delivery. Serum gentamicin concentrations were not significantly different for the three delivery methods, but variability of drug delivery was greatest with the pediatric extension set. This pediatric extension set provides accurate and reliable drug delivery at primary infusion flow rates slower than 10 mL/hr when the drug dosage volume is 2-3 mL or less.

Evaluation Studies as Topic↗

Palatal groove formation in neonates and infants with orotracheal tubes.

Long-term use of orotracheal tubes has been associated with palatal groove formation, acquired cleft palate, and defective primary dentition. To determine the incidence of palatal groove formation, maxillary impressions were made of 63 neonates and infants who required orotracheal intubation for one to 62 days. A palatal groove was present in 47.6% of these neonates and infants. The incidence of palatal groove formation increased with a longer use of tubes, being 87.5% in those neonates and infants requiring tubes for more than two weeks.

Body Weight↗

Appliance for stabilizing orogastric and orotracheal tubes in infants.

The long-term use of orotracheal tubes in infants has been associated with airway damage, palatal groove formation, acquired cleft palate, and defective primary dentition. Nasotracheal intubation is associated with trauma to the nasal septum and deformities of the nares. Because the infant is an obligatory nose-breather, nasogastric feeding tubes obstruct the nares and cause mucosal edema. We have developed an intraoral appliance designed to stabilize orogastric feeding and orotracheal tubes, and prevent obstruction to the nares and trauma to the palate and alveolar ridge.

Enteral Nutrition↗

Postnatal increase in airway surfactant in the premature rabbit exposed in utero to betamethasone.

In utero exposure to betamethasone on days 26 and 27 of gestation resulted in a significant increase in lung lavage phospholipid after 24 h of air breathing in rabbit pups delivered at 29 days of gestation. At 6 h of age, the proportion of type II epithelial cells in betamethasone-exposed newborns was nearly twice the saline-exposed control value. Phospholipid composition and pressure:volume analysis of compliance were both unaffected by betamethasone treatment. The betamethasone-associated increase in airway phospholipid content was observed only in female pups. These data support the conclusion that antenatal betamethasone treatment elicits an increase in airway phospholipid which is dependent on breathing and confined to the female newborn.

Animals↗

Effect of epidural anesthesia and surgery on serum thyroid hormone and cortisol levels in the gravid ewe.

The effects of epidural anesthesia and surgery on serum iodothyronine and cortisol levels were studied in 10 gravid ewes during the last trimester. The mean serum T3 concentration was significantly decreased 24 h after surgery, returning to the preanesthesia level at 48 h. The mean serum rT3 and cortisol levels were significantly increased after the start of anesthesia and surgery, returning to baseline levels after 48 h. There was a significant positive correlation between the rT3/T3 ratio and serum cortisol values. In the chronic ovine fetal-maternal model, studies which may be affected by corticosteroids of thyroid hormones should be delayed for at least 48 h following surgery to allow maternal serum iodothyronine and cortisol concentrations to return to baseline values.

Anesthesia, Epidural↗

Pulmonary superoxide dismutase activity in the euthyroid and hypothyroid ovine fetus.

Pulmonary superoxide dismutase (SOD) activity was measured in 11 euthyroid and 15 hypothyroid ovine fetuses at 130 days gestation. In the euthyroid fetus, the mean pulmonary SOD activity was similar in saline- and thyroxine-infused groups. Compared to the euthyroid fetus, the mean pulmonary SOD activity was significantly lower in the noninfused or saline-infused athyrotic fetus. Administration of thyroxine to the hypothyroid fetus results in a normalization of pulmonary SOD activity to control values. Thus, thyroxine appears to influence the maturation of pulmonary SOD activity in the ovine fetus during the third trimester.

Animals↗

Placental impermeability to parathormone 125I in the ewe.

Placental permeability and metabolism of parathyroid hormone (PTH) 125I was studied in 5 gravid ewes during the last trimester. The mean plasma half-life was 38 +/- 0.8 and 22.6 +/- 2.7 min in the fetus and ewe, respectively. There was minimal placental transfer of PTH 125I in either the fetal to maternal and maternal to fetal directions. Fetal calcium homeostasis is probably not affected directly by changes in maternal serum PTH levels, and maternal calcium homeostasis probably is not affected directly by changes in fetal serum PTH concentrations.

Animals↗

The neonatal neurobehavioral effects of bupivacaine, mepivacaine, and 2-chloroprocaine used for pudendal block.

The neonatal neurobehavioral effects of bupivacaine, mepivacaine, and 2-chloroprocaine used in random sequence for pudendal block anesthesia were studied. The neurobehavioral status of 54 infants was studied 4 and 24 hours after delivery. Except for a significant difference in the responses to pinprick, there was no significant effect of any of these agents on infant neurobehavior, and no differences were found among the agents themselves. Mean mepivacaine levels in neonatal capillary blood at 4 hours of age were low (0.10 +/- .02 microgram/ml) compared with those in previous studies because of the short interval between maternal injection and delivery (13 +/- 3 min). Bupivacaine gave higher neonatal capillary blood levels (0.15 microgram/ml at 4 hours of age) than previously reported, but the drug still produced no detectable neonatal neurobehavioral effects.

Adolescent↗

Effects of changes in maternal--fetal pH on the transplacental equilibrium of bupivacaine.

Increases in the maternal-fetal pH gradient that may occur during labor and delivery may increase the fetal concentration of local anesthetics. The authors evaluated effects of pH changes on the transplacental concentration equilibrium of bupivacaine. They increased the maternal-fetal pH gradient in each of six pregnant ewes from a control value of 0.15 to 0.54 by hyperventilating the lungs of the ewe and infusing lactic acid into her fetus. After infusion of bupivacaine, 0.15 mg/kg, intravenously into the mother, the drug rapidly appeared in fetal blood, with values significantly increased over control values at 1 and 5 min. The fetal/maternal (f/m) ratios were increased significantly at 5, 15, and 30 min. The f/m ratios had stabilized by 15 min in both control and experimental states, suggesting that equilibrium had been achieved. The consistently low f/m ratios are explained by the presumed similarity of the ovine maternal and fetal protein binding rates to those of man. It is concluded that the maternal and fetal pH values are major factors in the determination of the f/m ratios.

Alkalosis, Respiratory↗

Lactobezoar in the low-birth-weight infant.

Lactobezoar is an unusual complication associated with infant feeding. Seven low-birth-weight infants developed lactobezoars, including one whose case was complicated by gastric perforation. Six of these infants were fed formulas specifically designed for the low-birth-weight infant. Abdominal distention or regurgitation were the most frequent symptoms. The diagnosis was confirmed or made prospectively on supine or cross table lateral chest roentgenograms that included the upper abdomen. Treatment consisted of withholding feeding for 24 hours. There was no recurrence of symptoms following resumption of feedings.

Animals↗

The effect of perinatal factors on cord thyroxine concentration.

Cord blood thyroxine (T4) concentrations were measured in 4,068 infants from 28 wk gestation to term. Each chart was reviewed for the following factors: delivery by cesarean section, prolonged rupture of membranes, neonatal asphyxia, meconium-stained amniotic fluid, maternal diabetes mellitus and twinning. Each neonate was evaluated for the Idiopathic Respiratory Distress Syndrome, and low (SGA) or high (LGA) birthweight for gestational age. Within each gestational age group, the mean cord T4 value was similar except for a significantly lower mean cord T4 concentration for the term SGA subgroup. Thus, inclusion of the infant with a complicated neonatal course or the infant born to a high-risk mother in mass screening programs for congenital hypothyroidism using cord serum will not increase the number of false-positive T4 values.

Birth Weight↗