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Biomedical subjects

D V Eitzman

Publications and source records attributed to D V Eitzman.

16 recordsLinked to original sources
PubMed1990

Neonatal ethics: development of a consultative group.

Experience of a neonatal ethics advisory group in a tertiary care setting was reviewed to identify which aspects of the experience have been most valuable in the development of a consultative group. Consultations were requested for 31 patients seen from August 1984 through December 1988. Review of these patients indicated that 21 of 31 infants were born after full-term gestations, 11 of 31 infants were seen beyond the neonatal period, and some type of congenital anomaly was the principal diagnosis for 64.7% of the patients. The reasons for seeking consultation primarily involved decisions regarding withdrawal or withholding of treatment. For 22 of the 31 patients, the consensus of the group supported the decision of the health care team. In the remaining consultations, the recommendation of the group was that more information and/or communication was needed. In the analysis of the neonatal ethics advisory group's experience with consultations the characteristics of neonatal patients were identified and the value of having a forum for discussing the difficult ethical issues facing members of the health care team were validated.

Abnormalities, Multiple↗
PubMed1987

Developmental intervention for low birth weight infants: improved early development outcome.

This prospective longitudinal study was designed to evaluate the effects of a multidisciplinary infant development program (IDP) on the mental and physical development of low birth weight infants (less than 1,800 g). Infants in the neonatal intensive care were randomly assigned to the IDP or to traditional care (control group). IDP infants received developmental interventions in the hospital and at home through the first 2 years of life. Counseling and parenting education were provided to their parents during this same period. The control group received all the postnatal care and referrals customarily given in traditional care. Both IDP and control infants were enrolled in an independent follow-up program, which used the Bayley Scales of Infant Development in a blind evaluation design. The IDP group had a significantly lower incidence of developmental delay (P less than .05) and scored significantly higher than the control group (P less than .05) on mean mental and physical indices at 12 and 24 months of adjusted age.

Counseling↗
PubMed1979

Cerebral blood flow during acute acidosis in perinatal goats.

Changes in cerebral blood flow in response to three states of acute acidosis, posthypoxic, lactic acid, and respiratory, were estimated by the microsphere technique. In all three states, the fraction of the systemic blood flow reaching the brain and the rate (ml/min) of blood flow to it increased. The increase in flow was linearly related both to the PaCO2 and to H+. Others have shown the flow rate to increase with hypercapnia, but the increase associated with an increase in hydrogen ion concentration while the PaCO2 was maintained at control levels does not appear to have been observed in mature animals.

Acidosis↗
PubMed1979

Intrahepatic cholestasis associated with parenteral nutrition in premature infants.

Sixty-two premature infants less than 2,000 gm birth weight received parenteral nutrition (PN) during periods of respiratory distress with feeding intolerance. Intrahepatic cholestasis (direct bilirubin greater than or equal to 1.5 mg/dl) associated with PN developed in 14 or 23% of these infants. The mean time on PN to onset of cholestasis was 42 days, and the cholestasis persisted as long as the infants continued to receive PN. All five infants who had serial follow-up laboratory studies showed an eventual return of direct bilirubin levels to normal. The direct bilirubin level appeared to be the best clinically available test to monitor for the onset and to follow the resolution of this complication. The very low birth weight infants less than 1,000 gm appeared to be at an increased risk of developing cholestasis with an incidence of 50%. However, there was no correlation between the length of time PN was administered to onset of cholestasis and the gestational age or birth weight of the infants. These tiny premature infants also received PN for significantly longer periods of time, and the longer the infusions were administered the greater was the risk of cholestasis developing.

Age Factors↗
PubMed1977

Increased hypoxemia in neonates secondary to the use of continuous positive airway pressure.

Five neonates are presented who, while receiving continuous transpulmonary pressure, developed increased systemic arterial hypoxemia, which was relieved when this therapeutic modality was decreased or discontinued. Three of the five had chest radiographs consistent with hyaline membrane disease: the other two had atypical radiographs. None had evidence of air leaks. Levels of positive airway pressure utilized when the hypoxemia was noted ranged from 5 to 15 cm H2O. Calculated shunt fractions (Qs/Qt) improved from a mean of 73% to 37% when the continuous positive airway pressure was lowered. The site of shunting in these infants could have been in the lung or through anatomic extrapulmonary shunts. Improvement in total cardiac output may also have contributed to the improved oxygenation. This paradoxical effect of continuous transpulmonary pressure appears to be mediated through changes in the pulmonary vascular resistance brought about by the continuous transpulmonary pressure.

Cardiac Output↗
PubMed1977

Transient tricuspid insufficiency of the newborn: a form of myocardial dysfunction in stressed newborns.

Fourteen term newborn infants have been recognized as having transient tricuspid insufficiency associated with significant perinatal stress. Five of these infants underwent cardiac catheterization for presumed congenital heart disease, but had only massive tricuspid valve insufficiency. The other nine infants were diagnosed on the basis of a murmur characteristic of tricuspid valve insufficiency and on other clinical grounds. All had a history of significant perinatal stress in the form of asphyxia with or without hypoglycemia. Frequently, congestive heart failure, persistent cyanosis, and ECG evidence of myocardial ischemia were present. Twelve of the 14 survived, and in each of them all cardiac signs and symptoms, including the murmur, spontaneously resolved. The two patients who died had histopathologic evidence of necrosis in the anterior papillary muscle of the tricuspid valve. The constant features of perinatal stress, ST-T wave abnormalities on the ECG, and spontaneous resolution of the transient tricuspid insufficiency strongly suggest that this syndrome is secondary to a reversible form of myocardial dysfunction, perhaps by affecting papillary muscle specifically. We believe that hypoxia with or without hypoglycemia precipitates the events leading to this clinical syndrome which is distinguishable from other cardiac abnormalities in the newborn by the history, distinctive murmur, and the ECG abnormalities.

Asphyxia Neonatorum↗
PubMed1976

Persistence of fetal cardiopulmonary circulation: one manifestation of transient tachypnea of the newborn.

Five cyanotic newborn infants underwent cardiac catheterization between 8 and 36 hours of age with a tentative diagnosis of cyanotic congenital heart disease. All had normal cardiovascular anatomy. Cyanosis was the result of persistence of fetal cardiopulmonary circulation with right-to-left shunting across the ductus arteriosus. In all infants, cyanosis resolved spontaneously and the infants survived without sequelae. Admission chest roentgenograms of all infants showed marked hyperinflation of the lungs. Except for severe hypoxemia, the clinical presentation, chest films, and course of illness of these infants were consistent with transient tachypnea of the newborn. It is proposed that an increase in pulmonary vascular resistance, due to hyperinflation of the lungs, was the mechanism which reopened the fetal cardiopulmonary circulatory channels and produced hypoxemia, and that these infants suffered from a rare manifestation of a usually benign newborn respiratory condition. Further, given these pathophysiologic mechanisms, the use of continuous transpulmonary pressure gradients in the management of such infants would be contraindicated.

Blood Circulation↗
PubMed1975

Role of hand contamination of personnel in the epidemiology of gram-negative nosocomial infections.

Gram-negative organisms, responsible for a high rate of colonization and infection in an intensive care nursery, were recovered frequently from hands of personnel, despite regular hand antisepsis. In sequential hand cultures contamination of hands by gram-negative organisms was transient in some nurses, but active multiplication of the organisms occurred on the hands of others and in a few nurses a temporary carrier state appeared to exist. The results of this study suggest that the hands of hospital personnel may serve not only as a passive vehicle in the nosocomial transmission of gran-negative bacteria, but also may constitute a reservoir of nosocomial organisms.

Animals↗