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Biomedical subjects

D Vidyasagar

Publications and source records attributed to D Vidyasagar.

At least 145 records · Page 8Linked to original sources
PubMed1976

Interruption of patent ductus arteriosus in premature infants with respiratory distress syndrome.

In infants with respiratory distress syndrome (RDS) hypoxemia inhibits closure of the patent ductus arteriosus (PDA), resulting in increased pulmonary blood flow with subsequent increased hypoxemia. In an attempt to interrupt this cycle 42 consecutive premature infants with RDS and PDA, weighing between 550 and 2,000 gm (average, 1,383 gm) and with an average gestational age of 31 weeks, were arbitrarily treated either medically (13 patients) or by interruption of the PDA (20 patients). Eleven patients who were initially treated medically could not be weaned from the respirator and later underwent operation. There were no operative or anesthetic deaths; late survival was 65% (20 patients). The last 31 patients were randomly divided into operative and nonoperative groups. Preliminary results revealed no significant differences in late survival between the two groups. Since the operative risk is minimal, further investigative efforts are indicated to settle this issue.

Digoxin↗
PubMed1976

Cholestasis associated with administration of L-amino acids and dextrose solutions.

Infants of very low birth weight who require prolonged assisted ventilation are unable to tolerate oral feedings. To provide and maintain nutrition in these infants, a modified form of parenteral nutrition (dextrose 10% and crystalline L-amino acids, 1.7-3.4 g%) is used in our nursery. Intrahepatic cholestasis was diagnosed at autopsy in four infants who received modified peripheral alimentation and in a fifth infant who received total parenteral alimentation (dextrose 20%, L-amino acids 3.8 g%) via a central venous catheter. These infants weighed less than 1,250 g at birth (range 943-1,247 g) and were appropriate for gestational age. They required assisted ventilation for over 2 weeks. Three infants did not receive any oral feedings. L-Amino acids were given for a mean of 36.8 +/- 10 days (range, 22-76 days). The diagnosis of cholestasis was suspected clinically in only one infant, in whom persistent elevation of direct bilirubin was detected at 4 weeks of age. Pathologic findings in four infants included the presence of bile casts in bile canaliculi and, in one case, in ductules and canaliculi. Liver architecture was well preserved. Inflammatory infiltrate in the portal tract was either absent or minimal, consisting of lymphocytes, and only in one of five cases a few eosinophils. Cholestasis may be regarded as a possible complication of parenteral alimentation even if the fluids are modified and given peripherally. High direct bilirubinemia may be the earliest clinical manifestation.

Amino Acids↗
PubMed1976

Insulin and growth-hormone responses in neonatal hyperglycemia.

Glucose, insulin, and growth hormone values were studied prospectively in 75 premature infants during the first five days after birth. Intravenous glucose was given at a mean rate of 4.7-4.9 mg./kg./min. (range 3-7). Mean birth weight was 1,394+/-47 gm. (mean+/-S.E.M.). Blood glucose values were significantly higher on days 1 and 2 than on days 3 to 5. Hypoglycemia (blood glucose less than 20 mg./100 ml.) occurred in two SGA and one AGA infants. On the other hand, hyperglycemia (greater than 125 mg./100 ml.) was found in 32 of the 75 (42.7 per cent) infants. A significantly greater number of deaths occurred in infants with hyperglycemia (19/32) than in those with normoglycemia (19/32) than in those with normoglycemia (5/43). Mean plasma insulin values were significantly higher on days 1 and 2 (15+/-3 and 18+/-4 muU./ml.) than on days 3 and 4-5 (6+/-1 and 7+/-2 muU./ml.). In addition, mean insulin levels were significantly higher during hyperglycemic than during normoglycemic glucose levels at similar postnatal age. Growth hormone values were higher during the first three days than subsequently, but the values were similar in normoglycemic and hyperglycemic groups. Significant negative correlations were seen between glucose values on the first two days of postnatal life and birth weight, gestational age, and Apgar scores, whereas positive correlations were found with FiO2 and respiratory distress score (RDS).

Acidosis, Respiratory↗
PubMed1975

Effect of metopirone on the synthesis of lung surfactant in does and fetal rabbits.

The possible role of endogenous corticosteroids in the induction of synthesis of lung surfactant in both maternal and fetal rabbits was investigated. Metopirone (SU 4885), which specifically inhibits B hydroxylation in the adrenal gland, thus preventing endogenous cortisol production was used in this study. Pregnant rabbits received one of four treatment regimens: saline, metopirone, cortisone or metopirone plus steroid for 6 days before delivery. Studies of the lungs of the adult rabbits revealed that lung weights and percent dry weight were not influenced by drug injection. However, lung DNA content (mg/g) in the metopirone-treated group was higher than the control group, indicating an increase in cell number. Compared to the saline-treated group there was a significant decrease in lung phospholipid content in the other three groups (p smaller than 0.005). A decrease in lung lecithin and phosphatidylethanolamine was also noted in these three groups indicating that the inhibition was in the early steps of biosynthesis of lung lecithin. The specific activity of 14C-labelled palmitate in lung lecithin was not altered by drug treatment indicating that saturated fatty acid incorporation into lung lecithin is not influenced by metopirone, steroid or a combination of both drugs. Quasi-static deflation pressure-volume characteristics of the lung were also similar in all groups. However, lungs of animals receiving both metopirone and steroid had a small but statistically significant decrease in minimum surface tension (p smaller than 0.05). The change in surface tension did not correlate with a change in lung retractive forces or with lung lipid content and was, therefore, of dubious biological significance. Metopirone administration to pregnant rabbits did not alter surface active properties in the fetus from the 26th to the 29th day of gestation when compared to control fetuses. At day 30-31 gestation the offsprings of metopirone-treated rabbits had lung total phospholipid and lecithin contents, and deflation pressure-volume curves similar to control group, but minimum surface tension of minced lung extracts were high in about 60% of the fetal lungs studied (p smaller than 0.05). These results suggest that endogenous steroid production may play a significant role in the maturation of the fetal lung.

Animals↗
PubMed1975

Effect of maternal heroin addiction on 67 liveborn neonates. Withdrawal symptoms, small body size, and small head circumference were frequent findings.

It is apparent that maternal addiction affects the fetus and causes serious problems in the neonatal period. Whether intrauterine exposure to heroin has far-reaching, long-term residual effects remains to be determined. We believe that prospective studies are indicated in order to evaluate the incidence of small head circumference, the pattern of intrauterine growth retardation, and the correlation of these findings with later neurologic and behavioral development.

Abnormalities, Drug-Induced↗
PubMed1975

Assisted ventilation in infants with meconium aspiration syndrome.

In a retrospective analysis of infants born with meconium staining over an 18-month period at Cook County Hospital, 32 infants met two of the three criteria for the diagnosis of meconium aspiration syndrome: (1) history of meconium in the oropharynx or trachea; (2) clinical evidence of respiratory distress; and (3) x-ray evidence of aspiration pneumonia. Seventeen infants developed respiratory failure; nine of these infants died. One infant without respiratory failure died of sepsis. Analysis of sequential arterial blood pH and gas tension showed that nonsurviving infants had persistently high PCO2 and A-a gradient in spite of initiation of assisted ventilation. These changes seem to be related to severe right-to-left shunting and ventilation perfusion abnormalities. The data further suggest that asphyxia and acidosis occur well before the infant is born and that intrapartum monitoring to recognize fetal asphyxia may help in improving morbidity and mortality from meconium aspiration syndrome.

Blood Gas Analysis↗