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Biomedical subjects

G M Chan

Publications and source records attributed to G M Chan.

At least 55 records · Page 3Linked to original sources

Cefoperazone pharmacokinetics in preterm infants.

The elimination pharmacokinetics of cefoperazone, a new cephalosporin, were studied in 15 preterm infants ranging in gestational age from 32 to 36 weeks and in postnatal age from 1 to 6 days. The infants received a single dose of either 50 or 250 mg of cefoperazone per kg by intravenous infusion. Blood samples were collected at specified times after completion of the drug infusion and then assayed for cefoperazone. Pharmacokinetic parameters were determined by noncompartmental analysis. Mean values for plasma half-life, elimination rate constant, apparent steady-state volume of distribution, and total body clearance were 5.53 h, 0.15 h-1, 124 ml/kg, and 36 ml/h per kg, respectively, for the group receiving a 50-mg/kg dose and 5.76 h, 0.14 h-1, 111 ml/kg, and 35 ml/h per kg, respectively, for the group receiving a 250-mg/kg dose. Positive correlations between gestational age and clearance and elimination rate were detected. A 50-mg/kg dose every 12 h ensured adequate serum levels for most of the common neonatal pathogens. Other than a transient rise in eosinophils in four subjects, no adverse effects were noted.

Anti-Bacterial Agents↗

Bone mineral status of lactating mothers of different ages.

To determine the effect of age on the bone mineralization of lactating mothers, 48 healthy mothers were evaluated at 2 and 16 weeks post partum. All mothers were divided into three age groups: less than or equal to 18 years, 19 to 30 years, and greater than 31 years old. At 2 and 16 weeks post partum, blood was drawn for measurement of serum calcium, phosphorus, alkaline phosphatase, and 25-hydroxy vitamin D. Bone mineral content was measured by photon absorptiometry. Dietary history was also recorded. At both 2 and 16 weeks, there were no differences in the serum values or bone mineral content among the three age groups. However, there was a decrease in the bone mineral content between the 2 and 16 weeks' values in the less than or equal to 18 years age group, 1.049 +/- 0.088 versus 0.895 +/- 0.051 gm/cm (p less than 0.05). Dietary intakes were similar among the three groups, but only one of seven mothers less than or equal to 18 years of age met the recommended dietary allowance for calcium or phosphorus, as compared to six of seven older mothers who met the recommended dietary allowance for calcium or phosphorus (p less than 0.01). We conclude that young lactating mothers less than or equal to 18 years old at risk for bone demineralization because of low dietary intakes of calcium or phosphorus.

Adolescent↗

Decreased bone mineral status in lactating adolescent mothers.

To determine the calcium and bone mineral status of lactating adolescents, we compared 12 lactating adolescents with 11 nonlactating adolescents, 11 lactating adults, and 11 nulliparous adolescent control subjects. At two and 16 weeks, there were no differences in maternal serum concentrations of calcium, phosphorus, alkaline phosphatase, or calcidiol (25-hydroxyvitamin D). The bone mineral content at two weeks among the four groups was not different, but at 16 weeks the lactating adolescents' bone mineral content was lower than that in the other groups. The lactating adolescents' bone mineral content was decreased between two and 16 weeks (1.049 +/- 0.088 vs 0.887 +/- 0.054 gm/cm; P less than 0.02). Dietary intakes were similar among the groups for calories, protein, vitamin D, calcium, and phosphorus. However, only three of ten lactating adolescents met the recommended dietary allowance for calcium or phosphorus (1,600 mg/day), whereas eight of ten nonlactating adolescents, six of seven lactating adults, and seven of ten adolescents control subjects met the recommended dietary allowance for calcium or phosphorus (P less than 0.05). Our data suggest that during 16 weeks of lactation, the adolescent mother may be at risk for bone demineralization because of low dietary intakes of calcium or phosphorus.

25-Hydroxyvitamin D 2↗

Growth and bone mineralization of normal breast-fed infants and the effects of lactation on maternal bone mineral status.

To determine if human milk provides for adequate growth and bone mineralization during the lst yr of life, 91 term infants were evaluated. Infants were divided into three groups human milk alone, human milk with supplemental vitamin D, and Similac. Lactating mothers who were receiving supplements of calcium and vitamin D were also studied to determine the effects of lactation on their bone mineral status. Blood was drawn from infants and mothers for measurements of serum calcium, phosphate, alkaline phosphatase, and 25-hydroxyvitamin D. Bone mineral content was measured by photon absorptiometry. Growth was similar between breast-fed and formula-fed infants. Regardless of type of feeding, male infants grew heavier and longer than corresponding female infants. Serum calcium and phosphate levels were similar among the three infant groups: only 25-hydroxyvitamin D levels at 4 months and serum alkaline phosphatase at 2 wk and 6 months of age were different among the three infant groups. Biochemical and vitamin D values were similar among the lactating mothers. There were no differences in infant bone mineral content among the three groups, but male infants had higher bone mineral content than female infants. There were no effects of the duration of lactation of maternal bone mineral content or vitamin D status.

Aging↗

Human milk calcium and phosphate levels of mothers delivering term and preterm infants.

Human milk calcium (Ca) and phosphate (P) content from mothers of 10 term and 15 preterm infants was evaluated during the first month of lactation. Ionized Ca of preterm milk was higher than term milk on day 14, 6.70 +/- 0.26 (mean +/- SEM) vs. 5.47 +/- 0.09 mg/dl, and on day 30, 6.35 +/- 0.14 vs. 5.67 +/- 0.13 mg/dl (t test, p less than 0.05). Total Ca and P levels of term and preterm milk were not different, and decreased during the first month of lactation. Nursing preterm infants had higher serum P than term infants on day 14 and 30. Serum Ca and 25-OH D values were not different between nursing preterm and term infants or between the lactating mothers.

Breast Feeding↗

Calcium and phosphorus compatibility in parental nutrition solutions for neonates.

Factors affecting calcium-phosphate solubility in parenteral nutrition solutions used in neonates were studied. Six neonatal parenteral nutrition solutions were prepared using either Aminosyn or FreAmine III and various amino acid and dextrose concentrations. Phosphorus (as mono- and dibasic potassium phosphate) and calcium (as 10% calcium gluconate) were added in concentrations of calcium 2.5-100 meq/liter and phosphorus 2.5-100 mmol/liter. Duplicate samples were prepared and analyzed either after they were heated in a water bath (37 degrees C) for 20 minutes or after 18 hours at 25 degrees C followed by 30 minutes in a water bath (37 degrees C). Precipitation was detected visually and spectrophotometrically, and pH was measured. Lipid emulsion was added to two Fre-Amine III solutions in a ratio of 7.5:1 (parenteral nutrition solution:lipid) and the resulting pH was measured. Time and temperature affected calcium-phosphate solubility in all solutions tested. Precipitation curves of amount of calcium versus amount of phosphate added were prepared for each solution. Amino acid and dextrose concentrations affected the pH of the solutions, and when a lipid emulsion was added, the pH rose more in the 1% than in the 2% FreAmine III solution. In selected solutions, as much as 120 mg/kg/day calcium and 55 mg/kg/day phosphate can be administered, approximating daily third-trimester accumulation of these minerals. Use of the precipitation curves in this paper, with attention to their limitations, should aid in the safe delivery of calcium and phosphorus intravenously to neonates.

Amino Acids↗

Adequate bone mineralization in breast-fed infants.

To determine if human milk provides sufficient nutrients for adequate bone mineralization in healthy term infants, 76 term Caucasian infants were evaluated at 2 and 16 weeks of age. The infants and their mothers were divided according to the infant's diet into three groups: human milk alone, human milk with supplemental vitamin D, and Similac. At 2 and 16 weeks of age, bone mineral content was measured by photon absorptiometry and blood was drawn for measurement of serum calcium, phosphate, alkaline phosphatase, and 25-OH vitamin D. At both 2 and 16 weeks of age, BMC was similar among all three feeding groups. At 16 weeks of age there was no difference in serum total Ca, ionized Ca, P, or alkaline phosphatase values. At 16 weeks of age the serum 25-OH D concentration was lower in the infants fed human milk alone (P less than 0.05), but was within the normal adult range. Maternal BMC and serum 25-OH D values are similar among the three groups. No seasonal effect on BMC was observed. Our data suggest that during the first 16 weeks of life, routine vitamin D supplementation for breast-fed term Caucasian infants may not be necessary.

25-Hydroxyvitamin D 2↗

Reserve bilirubin binding capacity assessed by difference spectroscopy: assay statistics and results on newborn sera.

Bilirubin binding properties of newborn sera and assay parameters have been investigated using a difference spectroscopy procedure [9]. Reserve bilirubin binding capacity, serum bilirubin and the total bilirubin binding capacity can be determined using only 40 microliters of serum. The measured total binding capacities agreed with the theoretical binding capacities calculated from serum albumin concentrations assuming a 1 : 1 molar binding ratio of bilirubin to albumin; in 102 assays on newborn sera, the ratio of experimental to theoretical total binding capacity was 1.04. Bilirubin binding capacity measurements were linear over the range 0--600 mg/l. Day to day precision of binding capacity determinations on 6 albumin controls yielded coefficients of variation between 4.1 and 7.2%. Recovery for the reserve bilirubin binding capacity determinations was 99.6%. In a study of 22 newborns, reserve bilirubin binding capacities showed an inverse relationship with the changes in serum bilirubin concentrations. None of the newborns included in our study appeared to be in dange of bilirubin encephalopathy.

Bilirubin↗

Glucose perturbation in experimental hyperviscosity.

Hyperviscosity was produced in one member of each of 7 sets of twin newborn lambs by an exchange transfusion with 500 ml maternal packed red blood cells. The remaining seven control twin lambs underwent an identical exchange with maternal whole blood. Postexchange hematocrits were 63 +/- 6 and 29.0 +/- 3% (mean +/- S.E.), respectively (P less than 0.01). Whole blood viscosity measured at 3 rpm increased from 3.2 +/- 0.4 centipoise (cps) to 14.4 +/- 6.1 cps in the lambs made hyperviscous (P less than 0.01) and remained unchanged in the control lambs (2.2 +/- 0.1 versus 2.8 +/- 0.3 cps). A 2-hr steady state glucose infusion was performed on each lamb before and after the packed cell or whole blood exchange transfusion. Mean steady state plasma glucose concentrations were significantly decreased from pre-exchange steady state glucose infusion levels in the same lambs made hyperviscous (P less than 0.05), whereas steady state glucose levels increased from preexchange levels in the twin lambs exchanges with maternal whole blood. Mean plasma insulin and glucagon values for the hyperviscous and control lambs remained unchanged during the glucose infusion.

Animals↗

1,25-Dihydroxyvitamin D3 in childhood hepatic osteodystrophy.

Osteodystrophy frequently accompanies severe childhood hepatobiliary disease. Proposed causes include malabsorption of vitamin D and calcium, and diminished 25-hydroxylation of vitamin D. Two children, ages 23 and 35 months, with radiographic and biochemical evidence of rickets with extrahepatic biliary atresia, were treated with 1,25-dihydroxyvitamin D3. The minimal effective therapeutic dose and efficacy of 1,25-(OH)2D3 in the treatment of rickets associated with severe childhood hepatic disease were determined. Oral 1,25-(OH)2D3 was ineffective at doses of 0.10 microgram/kg/day. Parenteral doses of 0.20 microgram/kg/day effectively produced radiographic, bone mineral (photon absorptiometric), and biochemical evidence of healing. The need for four times the physiologic dose of 1,25-(OH)2D3 by the parenteral route suggested enhanced catabolism of, or end-organ resistance to, 1,25-(OH)2D3 in our patients with severe cholestatic liver disease treated with phenobarbital.

Bile Ducts↗

An easy and accurate method of estimating newborn birthweight for resuscitation.

Emergency administration of medication based on birthweight is often required in newborn resuscitation. Actual weighing is often delayed because of the emergency situation. Therefore drugs are given according to weight estimates by physicians or nurses. The purposes of this study were to develop a measuring tape using the infant's length and head circumference to determine body weight and to evaluate the performance of the tape measurements to staffs' estimates. Weight, length, and head occipitofrontal circumference (OFC) measurements of 200 newborn infants were collected. By regression analyses, the best log curve for both length and OFC versus weight was determined. From these data, a measuring tape was constructed with the corresponding weights marked for both length and OFC. Forty-five newborn infants with gestational ages of 26 to 40 weeks were studied. Prior to actual weighing, estimates of the birthweights were obtained and recorded from the tape measurements using both the length and OFC and staffs' estimates. For infants less than 2 kg, the average percent error was less by the tape length (1.2%) and OFC (0.7%) compared with staffs' estimates (-7.2%). The tape was also useful in estimating weights of small for gestational age infants. The tape OFC (7.8% error) was more accurate than staffs' estimates (26% error) in these growth-retarded infants. The clinical precision of the tape was 3% with an intrameasurer variability of 5%. We conclude that estimating the birthweight in infants using our tape method is a practical and more accurate way than staff estimates, especially for low birthweight and small for gestational age infants.

Anthropometry↗

Effects of increased calcium and phosphorous formulas and human milk on bone mineralization in preterm infants.

By photon absorptiometry, extrauterine bone mineralization was evaluated in preterm infants (less than 1,600 g birth weight) fed either a commercial premature formula containing 117 mg calcium, 58.5 mg phosphorus/100 kcal, the same formula containing higher phosphorus (82 mg/100 kcal), the same formula with higher calcium (140 mg Ca) and phosphorus (82 mg/100 kcal), or their own mother's milk. All infants had serum protein, albumin, calcium, phosphorus, bicarbonate, 25-hydroxyvitamin D, and alkaline phosphatase levels done at the start of the study and every 2 weeks until they weighed 1,900 g. At the start of the study, birth weight and gestational ages were similar in all four groups. There were no biochemical differences among the four groups except for a lower serum P in the human milk group. The human milk group had lower bone mineralization rate compared with the three formula groups. Bone mineral content was similar in the three formula-fed groups. However, only formulas containing 117 mg Ca and 58.5 mg P or 140 mg Ca and 82 P mg/100 kcal approximated intrauterine bone mineralization. Human milk fed infants did not approximate and were significantly different from the intrauterine rate.

Body Weight↗

Comparison of macronutrient concentration of preterm human milk between two milk expression techniques and two techniques for quantitation of energy.

Generally, when newborns in intensive care units receive human milk, we do not know the quantity of nutrients in that milk because such analysis is time-consuming and expensive. In our study, however, we sought to compare fat, protein, lactose, and energy concentration of a three-times-a-day sampling with a 24-h expression and to measure the difference between the calculated energy yield from protein, fat, and carbohydrate measurements and bomb calorimetry. At 14-18 days postpartum, 20 mothers of premature infants (30-34 weeks' gestation) expressed milk three times a day: 8 a.m., 12 p.m., and 8 p.m. At these three times, each mother expressed 3-5 ml of fore-milk and 3-5 ml of hind-milk for the sampling; the result was pooled for a 24-h expression. Only fat concentration differed significantly between fore- and hind-milk samples. Protein, fat, lactose, and energy concentration did not differ significantly between the two collection methods, 24-h expression and sampling. Moreover, we found no significant difference between the calculated number for energy content and the bomb calorimetry method of energy determination. The average fore- and hind-milk samples at 12 p.m. matched the 24-h milk expression. For clinical use, a milk sample obtained around 12 p.m. can predict macronutrient concentration, therefore allowing us to calculate an infant's approximate nutrient consumption.

Calorimetry↗

Agreement between capillary and arterial serum gentamicin concentrations in neonates.

Due to inherent difficulties in blood sampling in neonates, specimens for laboratory analyses are often obtained by heel puncture technique. While agreement between venous or arterial and capillary concentrations of some substances has been reported, that for gentamicin, when obtained by heel stick, has not. Simultaneously obtained heel stick (capillary) and umbilical artery (arterial) serum samples were analyzed for gentamicin concentrations in 20 preterm neonates. Further, 14 subjects underwent manual manipulation of the heel to encourage blood flow before sampling to test the effect of such manipulation on gentamicin concentration. The agreement between capillary and arterial serum concentrations of gentamicin was found to be excellent in infants greater than 1000 g body weight. Manipulation of the heel had no effect on this agreement.

Arteries↗