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Biomedical subjects

F Gold

Publications and source records attributed to F Gold.

At least 55 records · Page 3Linked to original sources
PubMed1995

[Fetal cerebral accident due to massive fetomaternal hemorrhage. A case report].

Massive fetomaternal haemorrhage (FMH) occurs in 0.12 to 0.5% of pregnancies. It is most often spontaneous and involves uncomplicated near-term pregnancies. It causes fetal anaemia, with or without fetal distress and hydrops fetalis. To our knowledge only one paper has reported a neurological complication (hemiplegia). We describe one case of FMH (maximal Kleihauer test = 6.5%) at 28 weeks gestation, which was spontaneous, reversible, associated with sinusoidal fetal heart rare (FHR) and hydrops fetalis; and complicated by an intraventricular antenatal haemorrhage at 30 weeks gestation. Echographic abnormalities decreased. The infant was born at 40 weeks gestation. Clinical examination was normal during the first week of life. At the age of 4 1/2 months, examination showed axial hypotonia and moderated dilatation of intracerebral lateral ventricules without any other brain damage. At the age of 24 months, the child had retarded walking and hypotonia. The outcome was spontaneously favourable with disappearance in utero of the intraventricular haemorrhage (HIV), without hydrocephalia or ischaemic lesions. Three cases of similar FMH have been reported but none of them described cerebral complications. Intrauterine intravascular transfusion should be proposed early. No single pathophysiological mechanism of FMH has been universally accepted and there is no aetiological treatment. The risk of recurrence of FMH in later pregnancies requires careful follow-up.

Adult↗
PubMed1995

[Ethical problems with the current French practice in therapeutic abortions. Part 2: survey by questionnaire in 15 french university hospitals].

OBJECTIVE: Determine the circumstances and conditions concerning ethical problems raised by medical abortions treated in a certain number of University Hospitals. METHODS: Survey using a questionnaire during the first three months of 1993 in 15 gynaecology-obstetrics wards in University Hospitals in France. RESULTS: Fourteen responses were analysed. Usually with complementary open comments. CONCLUSION: Situations raising ethical problems concerning fetal medicine were encountered in approximately 5% of the pregnancies followed at the university Hospitals. Medical abortion was performed in 2% of the pregnancies. Gynaecologist-obstetricians prefer maintaining their control over prenatal diagnosis, especially when the outcome in medical abortion.

Abortion, Therapeutic↗
PubMed1995

[Ethical problems with the current French practice in therapeutic abortions. Part 3: resolving moral dilemmas in fetal medicine].

OBJECTIVE: Based on the information acquired in the first two parts of this study and the data in the literature, to propose ethic codifications for solving moral dilemmas concerning fetal medicine. METHODS: Identification of situations where the object of the conflict is ethics: general methodology propositions for making individual decisions. RESULTS: In all cases a rigorous method is required, based on three main elements: a complete and well documented medical file; the opinion of the couple after appropriate participative communication; case by case collegial discussion. CONCLUSION: The methodology proposed underscores the roles played by health carers: obtain a medical file as complete as possible with prime emphasis on the infant; establish active communication with the parents giving greater value to their free examination of the situation; collegial discussion in order to be pertinent social partners.

Abortion, Therapeutic↗
PubMed1995

[Ethical problems raised by the current French practice of therapeutic abortions. Part I: prospective study for 24 months at the University Hospital of Tours (76 cases)].

OBJECTIVE: Determine the circumstances and conditions concerning ethical problems raised by medical abortions treated in a University hospital. METHODS: Prospective study for 2 years (1 Sept 1991--31 Aug 1993) conducted with a consulting Committee for the antenatal diagnosis and fetal medicine at the University Hospital at Tours. Each discussion of the medical file for proposed medical abortions, the conditions leading to the decision and the ethical recommendations formulated were registered as well as the outcome of the pregnancy and for the infant. RESULTS: There were 76 cases raising ethical problems. They were divided into 3 categories of recommendations: medical abortion (55 cases), abstention with acceptation of possible fetal death in utero (11 cases), conservation of the pregnancy (10 cases). CONCLUSION: A practical attitude could usually be decided after discussion between parents and physicians. A few cases of disagreement were observed which led to uncertainty [correction of incertainty] and diverging opinions concerning the diagnosis and prognosis for the fetal pathology.

Abortion, Therapeutic↗
PubMed1994

[Post-natal weight gain in the premature: the reference curves of Dancis (1948) can still be used].

BACKGROUND: Post-natal growth curves for low birth-weight infants published in 1948 by Dancis et al are still used in many neonatal units. The aim of this study is to determine whether these curves are still valid or not. POPULATION AND METHODS: Thirty or more infants whose birthweights were 1000 +/- 125, 1250 +/- 125, 1500 +/- 125, 1750 +/- 125, 2000 +/- 125, 2250 +/- 125 and 2500 +/- 125 g were included in the study from September 1989 to September 1992. Inclusion criteria were: gestational age (GA) less than 37 weeks, absence of intra-uterine growth retardation, enteral feeding during the first post-natal week, absence of severe post-natal disease. The curves of weight were compared to those obtained by Dancis. RESULTS: The six curves established for those infants having a birthweight from 1250 +/- 125 to 2500 +/- 125 g were quite similar to Dancis' curves. The number of infants weighing 1000 +/- 125 g at birth was not sufficient to be included in the study. CONCLUSIONS: The curves established by Dancis from low birth-weight infants of all types (including intra-uterine growth retardation) are still valid to follow post-natal growth of appropriate weight for GA premature infants.

Body Weight↗
PubMed1994

[Newborn resuscitation in the delivery room: evaluation of a regional training program conducted in 1990 in the Centre region].

OBJECTIVE: To evaluate the regional programme designed to train personnel for resuscitation of the neonate in the delivery room and organized in the district of Centre, France in 1990. STUDY: Transversal study. SITE: The different maternities of the district. POPULATION: 31 maternities, 156 persons in charge of neonates in the delivery room including medical personnel (doctors, mid-wives) and paramedics, with or without any special training in 1990. METHOD: A single evaluator visited each maternity and met the personnel involved. The modalities of the evaluation were not given in advance and included a census of the personnel who had participated in the training programme and changes in material. The success of the training programme was evaluated on a theoretical and practical basis for the personnel and on the number of severe meconium aspirations observed. RESULTS: The training programme had reached 53% of the personnel involved. It had a wide impact both in terms of changed material and in neonatal resuscitation rates compared with untrained personnel. The number of severe meconium aspirations fell from 3 in 1989 to 0 in 1990.

Cross-Sectional Studies↗
PubMed1993

Delayed interval delivery in quadruplet pregnancy: a case report.

A case report of delayed delivery of a quadruplet pregnancy is presented. This quadruplet pregnancy resulted from in-vitro fertilization. To our knowledge, this case represents the first report of quadruplets delivered on three separate days using the technique of delayed interval delivery. All infants survived and are healthy 2 years later.

Adult↗
PubMed1993

[The birth and subsequent hospitalization of premature infants born before 32 weeks of gestation: what do parent remember after one year? Survey on 94 cases].

The birth and subsequent hospitalization of very low birth weight premature infants can be a psychological shock for parents which may disturb further relationships between infant and parents. The parents' memories from the birth period of 94 very low birthweight premature infants (< 32 weeks of gestational age) have been analyzed by way of an interview. This study has shown the painful aspect of the birth and of the parents' first meeting with the infant. However, despite these first difficulties, the relationship normally improves with time.

Gestational Age↗
PubMed1992

[Enteropathy in premature newborn infants. Prospective study over one year].

BACKGROUND: In neonatal units, there is a tendency to assume that any acutely sick infant with gastro-intestinal symptoms has necrotizing enterocolitis (NEC). This prospective study was conducted to find a better definition of enteropathy in preterm neonates and their risk factors. MATERIAL AND METHODS: All the 351 preterm neonates admitted to a neonatal unit from 1 August 1988 to 31 July 1989 were included in the study. A chart including 45 items was established for each infant, with special attention to data on the pregnancy, delivery, any early ischemic and/or infectious problem, nutrition and any gastro-intestinal (GI) problem. All the neonates were fed similarly, depending their maturation, gestational age and GI status. Each infant was assigned to one of 5 categories: 1) no GI problem; 2) transient obstruction; 3) NEC with pneumatosis; 4) hemorrhagic colitis without obstruction or pneumatosis; 5) other GI disease. RESULTS: 267 infants had no GI problem during their stay in the neonatal unit. 53 developed GI symptoms: 23 transient obstructions, 6 NEC, and 24 hemorrhagic colitis. The mean age at onset of symptoms in these last 3 categories was 7 days, 14 days and 23 days, respectively. Ten risk factors were found to be significantly correlated with GI disturbances: umbilical venous catheter, benzodiazepines, birth weight < 1,500 g, patent ductus arteriosus, ventilatory assistance, abnormal amniotic fluid, gestational age < 32 weeks, early antibiotic treatment, passage of meconium > 48 hours, episodes of apnoea and/or bradycardia. CONCLUSION: This follow-up shows that the GI disturbances of preterm neonates admitted to a neonatal unit, specially those having one or more risk factors, can be separated into 3 groups: 1) isolated intestinal obstruction, seen in the most immature babies during the first week of life with the risk of developing NEC; 2) frank blood in the stool, indicating colitis and possibly minor forms of NEC; 3) combined obstructive and hemorrhagic symptoms, typical of NEC.

Digestive System Diseases↗
PubMed1992

[Surveillance of antibiotic therapy in a pediatric intensive care unit].

Since 1982, a pediatric intensive care unit for neonates and pediatric patients up to 15 years of age has prospectively recorded every instance of use of antimicrobials, with the reasons for use, clinical and bacteriological parameters, and outcome. This approach encourages strict adherence to established protocols and provides a basis for discussing the rationale of each antimicrobial course. Effectiveness of protocols is evaluated annually and modifications or additions are introduced, as appropriate. Patterns in the proportion and nature of antimicrobials used to treat hospital-acquired infections can be monitored on the basis of the data collected. Changes in the nature of antimicrobials used, which may have repercussions on pathogen resistance to antimicrobials, are also monitored. Reasons for use of antimicrobials are categorized as follows: A = primary infection: B = secondary infection acquired in the ICU; C: secondary infection acquired in another unit or in another hospital; D = prophylaxis. In 1987, 46% of neonates and 59% of patients above one month of age were given antimicrobial agents; these figures are similar to those recorded during the previous years. Reasons for antimicrobial therapy were as follows in neonates: A = 48.5%; B = 40%; C = 1.2%; D = 10.3%; in patients above one month of age corresponding figures were: A = 23%; B = 44%; C = 0.9%; D = 31.9%. Among the neonates, the ampicillin-aminoglycoside combinations accounted for 41.5% of treatments (1/4th of these treatments were continued); in the older patients, penicillin G and ampicillin were the most commonly used antibiotics. In all age groups, hospital-acquired infections were mainly respiratory tract infections (approximately 50% in neonates and 80% in patients above one month of age). Staphylococcus aureus was the most prevalent organism; Pseudomonas was seen virtually only among the patients above one month of age with very prolonged endotracheal intubation. From 1983 through 1987, use of third-generation cephalosporins increased from 4.5% to 28.3% in neonates and from 5.5% to 9% for patients above one month of age. The changes identified over time should be interpreted in the light of changing patterns of disease; in particular, hospital-acquired infections among neonates increased twofold, probably as a result of the rising number of very-low-birth-weight infants.

Adolescent↗
PubMed1992

[Bacterial infection of the newborn by maternal fetal contamination: one can depend on the anamnesis].

All babies born in a University maternity unit over a period of four months had bacteriological swabs taken in the labour ward. This was to see whether a list of criteria in the history for bacterial infection of the newborn could be relied on. The criteria were: premature rupture of the membranes (before labour had started at all), rupture of the membranes for more than 12 hours, stained liquor, prematurity, fetal tachycardia of more than 160 per minute or abnormal rhythm of the heartbeat, an Apgar score of less than 7 after 1 minute, maternal genital or urinary tract infection (not cured) in month before delivery, maternal temperature above 38 degrees C in labour. During the study there were: 570 live births of which 222 (39%) were at risk of infection according to the above list of criteria, 35 had bacterial colonies present and 4 were definitely infected. More cultures from the placenta, the gastric fluid and the skin came back positive when there was a recognised risk of infection. Both the clinical and bacteriological results show that the risk was 5.24 of colonisation when the risk of infection had been recognised. These prospective results when checked against the retrospective results already obtained in the same department, suggest that this kind of screening for infection is worthwhile without being too expensive, and one can rely on the history to screen for neonatal bacterial infection.

Apgar Score↗
PubMed1991

Intraoperative measurements of cerebral haemodynamics during ductus arteriosus ligation in preterm infants.

Intraoperative Doppler sonographic examinations were carried out on seven preterm neonates to measure cerebral blood flow velocity changes in the anterior cerebral arteries during ductus arteriosus ligation. Age at surgery was 12 +/- 6 days. Continuous recordings during the operative procedure showed a rapid increase in diastolic blood pressure (P less than 0.01), whereas systolic blood pressure was not significantly higher compared with pre-occlusion values. In the anterior cerebral arteries, ductal closure led to a decrease in resistance index of Pourcelot (mean = 1.02 +/- 0.08 vs 0.65 +/- 0.07 (P less than 0.001)) and to an increase in area under the velocity curve (mean = 3.64 +/- 0.38 vs 8.16 +/- 1.07 (P less than 0.001)). These changes were associated with a corresponding increase of the end diastolic flow velocity (P less than 0.001) but no change in the peak systolic velocity. The heart rate did not change significantly during ductal closure. TcPO2, TcPCO2 remained normal during the study period. These data indicate that changes in cerebral blood flow velocity during surgical ligation are principally determined by changes in systemic diastolic pressure. Systolic blood pressure and peak systolic flow velocity remain unchanged or slightly higher than preligation values, thereby restoring normal cerebral blood flow velocity pattern without increasing the stress on the wall of cerebral vessels and thus the risk of peri-intraventricular haemorrhage.

Blood Flow Velocity↗
PubMed1991

[Newborn bacterial infection caused by materno-fetal contamination. Retrospective epidemiologic study at a maternity unit].

A retrospective epidemiological study of neonatal bacterial infection due to contamination from the mother was carried out in maternity unit. We analysed the results of taking bacterial swabs from the skin and GI tract in newborn children when there was a possibility, or even probability, from the criteria given that there would be infection. These results compare with different criteria. In 19 months there were 2,622 live born children; 40.6% of those had swabs taken; the infection rate was 0.61% of newborns, but 16% of the newborns, had asymptomatic colonisation by bacteria. The high risks of finding positive swabs as shown by increased infection rates by colonisation occurred where the mothers had high temperatures. Our results led us to change the criteria for antibiotic treatment immediately after birth, in newborn babies.

Bacterial Infections↗