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Biomedical subjects

G P Giacoia

Publications and source records attributed to G P Giacoia.

At least 19 recordsLinked to original sources
PubMed2000

Incentive to study drugs in children and other governmental initiatives: will patients with asthma benefit?

This article summarizes current regulations that have been developed to facilitate the performance of pediatric drug trials and their impact on children, particularly those children affected with asthma. In addition, other initiatives that have been developed by the federal government in response to the unexplained increase of asthma occurrence during the last 15 years will be reviewed. In the face of an asthma epidemic, a comprehensive approach is needed to determine the causes for the increase in the prevalence rate and the role of aeroallergens and other environmental and genetic factors and to identify effective preventive measures. Clearly, facilitating drug trials to prove the safety and effectiveness of drugs is of paramount importance.

Adolescent↗
PubMed1997

Follow-up of school-age children with bronchopulmonary dysplasia.

OBJECTIVE: To investigate the outcome of school-age children with bronchopulmonary dysplasia (BPD) in terms of nutrition, pulmonary function, and intelligence, and to compare the results with a preterm cohort matched for gestational age and birth weight, and with a term control group. DESIGN: Cross-sectional. SETTING: Follow-up clinic at level III neonatal intensive care unit, university-affiliated hospital, Children's Hospital. SUBJECTS: Twelve children who had BPD as infants and 2 control groups of 12 children each. MAIN OUTCOME VARIABLES: Anthropometric measurements, dietary intake, resting energy expenditure, pulmonary function, body composition measurements by dual energy x-ray absorptiometry, and Weschler intelligence test scores. RESULTS: Children with BPD had decreased forced expiratory volume at 1 second, decreased forced expiratory flow between 25% and 75% of vital capacity, and decreased maximal expiratory flow velocity at 50% of vital capacity compared with age-matched normal inborn subjects (p = 0.025, p = 0.005, and p = 0.0013, respectively). Both children with BPD and matched preterm control children were shorter than infants in the term control group (p = 0.018). There were no significant differences in the other anthropometric parameters studied. The groups did not differ in resting energy expenditure. Lean body mass was lower in the BPD group compared with the term control groups (p = 0.017). Bone mineral content was lower in the BPD group compared with both the preterm and term control infants (p = 0.050 and p = 0.059, respectively). The mean performance intelligence quotient (IQ) and full-scale IQ scores in the BPD group were lower than in the term control group (p = 0.011 and p = 0.029, respectively). The proportion of children with borderline or intellectually deficient scores was significantly higher in the preterm group compared with the term group for verbal, performance, and full-scale IQ scales (p = 0.046, p = 0.018, and p = 0.048 respectively). The proportion of children with BPD who had borderline or deficient performance IQ scores was higher than for the term group (p = 0.046). CONCLUSIONS: The lower height and intelligence scores in children with BPD may be related to prematurity and perinatal events rather than pulmonary disease. Subclinical pulmonary dysfunction in children with BPD persists at school age. The lower amount of lean body mass and possible decrease in bone mineral content in children with BPD may be related to their smaller size.

Body Composition↗
PubMed1997

Severe fetomaternal hemorrhage: a review.

The etiology, clinical presentation, obstetrical antecedents, and outcome of pregnancies complicated by large fetomaternal hemorrhage (FMH) were reviewed by doing a MEDLINE search from 1966 to the present and manual search before 1966. One hundred thirty-four infants with FMH > 50 dl were reported in the literature. The primary variables: birth weight, gestational age, presence of sinusoidal fetal heart rate pattern, decrease or absent fetal body movements (FBM) estimated the amount of fetomaternal bleeding and the pretransfusion hemoglobin. Other variables included the condition of the infants at birth, erythroblasts, and reticulocyte blood counts at birth, as well as the year of publication. Thirty-five of the 134 cases were preterm. Twenty infants born to mothers reporting decreased or absent FBM survived. FBM was absent in 17 cases for a period ranging between 24 hours and 7 days. In this group, six infants survived, five were stillborn, and five died in the neonatal period. A sinusoidal heart rate (SHR) pattern was reported in 21 cases. A SHR pattern was associated with decreased FBM in 13 cases (39.3 percent). Fifteen cases with sinusoidal fetal heart rate pattern survived (71.4 percent). Both decreased or absent FBM and SHR patterns were reported more often in 1990 or later than before 1990 (P < .0017 and P < .008, respectively). The cause of FMH was not known in 82 percent of the cases. The most common presenting symptoms of FMH were anemia at birth (35.2 percent), decreased or absent FBM (26.8 percent), and unexpected stillbirths (12.5 percent). Seventeen intrauterine transfusions were performed in nine cases (eight survived). A negative correlation was found between pretransfusion hemoglobin and FMH (r = -0.35; P = .0019). No significant difference was found between the cases with FMH of > 200 ml or < 200 ml. Thus, decreased or absent FBM, SHR pattern, or hydrops fetalis are late signs of FMH. Other means of early detection are needed. The role of intrauterine transfusion (IUT) needs to be better defined. The inadequate outcome data indicate the need to follow infants born with large FMH into childhood to document the effect on the central nervous system.

Adult↗
PubMed1995

Tracheal TDx fetal lung maturity test for assessing lung maturity in newborns with respiratory distress.

We evaluated a modified TDx-fetal lung maturity (FLM) test for estimating surfactant in small volume tracheal aspirates in 140 infants requiring mechanical ventilation. Respiratory distress syndrome was present in 75 infants, and 68 had TDx FLM less than 60 mg/dL (sensitivity, 90.6%). Respiratory distress was absent in 65 infants, 56 had TDx FLM more than 60 mg/dL (specificity, 86.1%). The modified TDx-FLM assay is highly automated, has a fast turn-around time (less than 30 minutes), has high reproducibility, and is less expensive than other available methods. This method has potential routine application in the diagnosis of surfactant deficiency, and the assessment of surfactant replacement and mechanical ventilation therapies.

Fetal Organ Maturity↗
PubMed1995

Vitamin B-6 adequacy in neonatal nutrition: associations with preterm delivery, type of feeding, and vitamin B-6 supplementation.

Concerns about vitamin B-6 adequacy in neonatal nutrition relate to critical functions of the vitamin in development. Vitamin B-6 status was assessed in six groups of neonates: two groups each of breast-fed term and preterm infants whose mothers were supplemented with 2 or 27 mg pyridoxine-hydrochloride (PN-HCl); a subgroup of term infants (2-mg maternal group) supplemented with 0.4 mg PN-HCl/d; and a formula-fed preterm group. During the 28-d experimental period, weekly assessments showed lower concentrations of total vitamin B-6 and percentages of pyridoxal in milk from mothers of preterm infants than in milk from mothers of term infants, even when maternal PN-HCl supplementation was 27 mg/d. The vitamin B-6 concentration of milk and estimated intakes of the vitamin by breast-fed infants paralleled maternal supplements (ie, 2 and 27 mg). Plasma and erythrocyte measurements of infants correlated with their vitamin B-6 intakes; values were highest for infants given vitamin B-6 supplements and those that wee formula-fed. Vitamin B-6 adequacy was questionable for unsupplemented breast-fed infants of mothers in the 2-mg supplemented groups.

Adolescent↗
PubMed1995

Nitric oxide: a selective pulmonary vasodilator.

Nitric oxide (NO) has recently been found to be the endothelium-derived factor that produces profound relaxation of the vascular smooth muscle. This discovery has led to the experimental use of inhaled NO as a selective pulmonary vasodilator without concomitant systemic vasodilation. Currently, clinical trials of inhaled NO in persistent pulmonary hypertension of the newborn (PPHN) are in progress. Inhaled NO has also been used in the adult respiratory distress syndrome (ARDS). The therapeutic role, if any, of inhaled NO in other diseases featuring pulmonary hypertension remains unknown. Further research is needed to determine potential toxic effects of NO, development of delivery systems, and monitoring techniques applicable to routine clinical care.

Adult↗
PubMed1995

Rectal bleeding due to nonspecific colitis in premature infants.

Rectal bleeding is not uncommon in newborn infants. Anal fissures are regarded as the most common cause. We report two cases in which the presence of an anal fissure delayed the diagnosis of nonspecific colitis in premature infants. Rectosigmoidoscopic and biopsy findings are discussed with regard to the heterogeneous group of disorders associated with isolated rectal bleeding in young infants. These procedures may be helpful in ruling out necrotizing enterocolitis in premature infants.

Colitis↗
PubMed1995

Nitric oxide: an environmental pollutant as a therapeutic agent.

There is no effective treatment for patients with pulmonary hypertension because of the lack of a selective pulmonary vasodilator. Recently, nitric oxide (NO) has been found to be the endothelium-derived factor that produces relaxation of the vascular smooth muscle. This discovery has led to the experimental use of inhaled NO as the first selective pulmonary vasodilator. This review summarizes the development of NO inhalation for pulmonary hypertension, including the essential aspects of basic research, which identified NO as a potent endogenous vasodilator. The use of inhaled NO in animal studies of experimental pulmonary hypertension, as well as in the clinical experience so far reported in newborns, children, and adults are summarized. It is concluded that inhaled NO remains experimental and that controlled clinical trials and further studies on potential toxicity are needed before this new therapy can be accepted for routine clinical use.

Administration, Inhalation↗
PubMed1994

Right-sided diaphragmatic hernia associated with superior vena cava syndrome.

The term "hydrops fetalis" denotes generalized fetal edema, a condition that differs from localized edema confined to head, extremities, or body cavities. This report illustrates a case of right-sided diaphragmatic hernia associated with severe edema of the head, polyhydramnios, small hydrothorax, and ascites with an antenatal diagnosis of hydrops fetalis. At autopsy, edema was confined to the head and neck and the peritoneal sac. The mechanisms responsible for these forms of localized edema were obstruction of the superior vena cava and hepatic veins, respectively. Localized fetal edema may be confused with hydrops fetalis. Fetal edema of the head and neck may result from obstruction of the superior vena cava by abnormal mediastinal structures.

Adult↗
PubMed1993

Acrodermatitis enteropathica-like syndrome secondary to isoleucine deficiency during treatment of maple syrup urine disease.

We describe a patient with maple syrup urine disease in whom an acrodermatitis enteropathica-like syndrome developed while he was receiving a branched-chain amino acid-free formula. Iatrogenically induced isoleucine deficiency developed and resulted in a decreased protein accretion and persistent increase in the plasma concentrations of leucine. A rapid clinical response to isoleucine supplementation was noted. This observation underscores the risks of using amino acid-free formulas without adequate supplementation of deficient amino acids.

Acrodermatitis↗
PubMed1993

Asphyxial brain damage in the newborn: new insights into pathophysiology and possible pharmacologic interventions.

New insights into the pathophysiology of the hypoxic-ischemic insult have opened the possibility of pharmacologic intervention in neonatal hypoxic-ischemic encephalopathy. It is now known that many neurons survive a hypoxic-ischemic insult but remain dysfunctional for hours, with profound alterations in cell function. A cascade of biochemical alterations occurs as a consequence of cellular ionic shifts, energy depletion, degradation of cell membrane phospholipids, and increased release of neurotransmitters. In addition, there are alterations in the metabolism of arachidonic acid and prostanoids and an excessive production of oxygen free radicals. The new therapeutic modalities are aimed at preventing or arresting the biochemical changes that occur in the period after hypoxia-ischemia. This review details the biochemical alterations associated with neonatal hypoxic-ischemic encephalopathy and discusses the possible use in newborns of pharmacologic agents currently undergoing extensive investigations in experimental animals and adult humans.

Asphyxia Neonatorum↗
PubMed1993

High-dose urokinase therapy in newborn infants with major vessel thrombosis.

The effectiveness of urokinase therapy for thrombosis in children, particularly in newborn infants, has not been established. We report our experience with the local administration of high-dose intrathrombus urokinase in two newborn infants. One infant had aortic thrombosis and the other, thrombosis of the right femoral artery. The known abnormalities in the newborn's fibrinolytic mechanism provide the rational basis for the therapeutic use of high doses of plasminogen activators. No significant abnormalities of our patients' fibrinolytic systems were found, and effective thrombolysis was achieved. A literature review of the use of urokinase therapy for thrombosis in children reveals great disparities in dosage and outcome. We believe that fixed-dose regimens should be replaced by individually adjusted thrombolytic therapy and that the need for higher doses of urokinase in newborns should be studied further.

Aorta, Abdominal↗
PubMed1993

Congenital herpes infection: placental and umbilical cord findings.

BACKGROUND: Herpes simplex virus (HSV) fetal infections are rare, and the routes through which the virus reaches the fetus are insufficiently documented. CASE: We describe a case of congenital HSV ascending infection in an infant whose membranes were intact until cesarean delivery. The pathologic findings were remarkable for a mild lymphoplasmocytic funisitis and the presence of positive viral staining of cells in the subamniotic connective tissue, amniotic epithelium, and umbilical cord. Antigen-positive cells within the extraplacental membranes were mostly located in an area presumably adjacent to the cervix before birth. In the umbilical cord, positive viral staining was confined to cells in the subamniotic mesenchyma away from the perivascular mesenchyma of the central portion of the cord. CONCLUSION: Immunohistochemistry using herpes-specific antibodies, coupled with routine histologic examination, allows early diagnosis of congenital HSV infection and documentation of the ascending route of infection when the membranes are intact.

Adolescent↗
PubMed1992

Measured vs calculated plasma osmolality in infants with very low birth weights.

OBJECTIVE: To determine the relationship between measured serum osmolality (MsOsm) and calculated osmolality and to examine factors that may affect the osmolal gap. RESEARCH DESIGN: Longitudinal cohort study. SETTING: Regional tertiary neonatal intensive care nursery in a university-affiliated hospital. PATIENTS: Sixty low-birth-weight infants (birth weight, 540 to 1500 g), studied daily during the first week of life. SELECTION PROCEDURE: Consecutive sample. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: The MsOsm was significantly higher than the calculated osmolality for the first 6 days of life. The MsOsm was significantly higher during the first 6 days of life in infants with birth weights less than 1000 g than in those with birth weights greater than 1000 g, but the calculated osmolality was similar in both groups. Intraventricular hemorrhage, preservative additives in drugs, and packed red blood cell transfusions did not contribute significantly to osmolal gap or MsOsm. In 19 patients, peak MsOsm was greater than or equal to 320 mmol/kg (mean, 336 +/- 13 mmol/kg; calculated osmolality, 298 +/- 20 mmol/kg; osmolal gap, 38 +/- 19 mmol/kg). Six of these 19 patients died (all with birth weights less than 1000 g). CONCLUSIONS: A significant proportion of patients with very low birth weights (mostly less than 1000 g) have large osmolal gaps and/or an MsOsm greater than 300 mmol/kg during the first week of life. The relationship between increased MsOsm in infants with very low birth weights and effective osmolality requires further study. Therapeutic intervention based solely on elevated MsOsm is ill advised.

Apgar Score↗
PubMed1992

Fetal rhabdomyoma: a prenatal echocardiographic marker of tuberous sclerosis.

Little is known about the intrauterine course of tuberous sclerosis (TS) and the fetal age at which specific abnormalities may be detected. A case of neonatal TS diagnosed prenatally by the echocardiographic finding of a cardiac rhabdomyoma is presented. Literature review revealed that 50% of prenatally diagnosed rhabdomyomas are asymptomatic. Although cardiac rhabdomyomas tend to regress during the first year of life, they may for months be the only manifestation of TS. The number of new mutations may have been overestimated. The combination of computed tomography, echocardiography, and renal sonograms allows for the detection of other family members with latent TS. The incidence of TS in cases of cardiac rhabdomyomas is probably higher than previously reported.

Adult↗