Biomedical subjects
Publications and source records attributed to A Y Sweet.
Necrotizing enterocolitis of newborn infants virtually vanished from our nurseries during the four years since the introduction of a slowly progressive feeding regimen. This cautions approach to feeding has been applied to selected infants whose condition during labor and delivery or whose neonatal problems indicate that they are at risk.
Blood pressure changes as a function of the rates of blood withdrawal and infusion were determined during exchange blood transfusion in 2 preterm newborn infants. 10 ml blood withdrawal and infusion completed within 3 minutes resulted in reversible changes in aortic pressure, whereas the same procedure completed within 45 to 60 seconds resulted in a progressive fall in the systolic pressure and in narrowing of the pulse pressure. In one of the cases this was associated with respiratory arrest. An exchange rate of 5 ml/kg per 3 minutes is recommended.
A technique is described in which paper chromatoelectrophoresis is used to measure the bilirubin binding capacity of albumin in serum. It is equivalent to the Sephadex G-25 method and its results are highly reproducible. From a single pool of serum, multiple determinations indicated the mean bilirubin binding capacity to be 23.7 +/- 0.76 (SD) mg/dl and the greatest difference between any two values was 2 mg/dl. This new technique can determine the bilirubin binding capacity of a serum sample in 15 min. Highly skilled technicians are not needed and very small quantities of serum are required, which gives it a definite advantage over the Sephadex G-25 method.
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Mean aortic blood pressure volume were measured in true premature infants with respiratory distress syndrome. Seven infants had Type I RDS (hyaline membrane disease) and ten had transient tachypnea of the newborn (Type II RDS). Blood volume in the infants with Type I RDS was significantly lower than in the infants with Type II RDS. The difference was due to a low red cell volume. Mean aortic blood pressure was within the range of normal in all infants and therefore did not reflect the low blood volume of infants with Type I RDS. Normal mean aortic blood pressure does not indicate normal blood volume or normal circulation in infants with RDS.
Infants with IRDS were treated with CPAP early (0.40 FIO2; WITH PaO2 less than 60 mm Hg) or late (0.70 FIO2; with PaO2 less than 60 mm Hg). There was no difference in survival, duration of CPAP therapy, total time of oxygen administration, or complications. The early treated infants needed a lower FIO2 (maximum 0.55) and had a less severe clinical course. The late treated infants were subjected to 0.70 or more FIO2 for an average of 24 hours and were in greater than 0.40 FIO2 significantly longer than those given CPAP early. Infants who weighed less than 1,500 gm and had severe disease did not do well regardless of when CPAP was applied.