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Biomedical subjects

G R Cutter

Publications and source records attributed to G R Cutter.

At least 37 records · Page 2Linked to original sources
PubMed1996

Impact of maternal group B streptococcal screening on pediatric management in full-term newborns.

BACKGROUND: The American Academy of Pediatrics strategy to prevent early-onset neonatal sepsis with group B streptococcus (GBS) relies on maternal antepartum GBS cultures, while the American College of Obstetrics and Gynecology strategy does not. OBJECTIVE: To evaluate the impact of the 2 strategies on the care of asymptomatic full-term newborns. DESIGN/SETTING: Self-administered survey mailed to a national random sample of US pediatricians who were members of the American Academy of Pediatrics. PARTICIPANTS: A total of 461 members of the American Academy of Pediatrics who routinely care for newborns. MAIN OUTCOME MEASURE: Self-report of diagnostic and treatment strategies for asymptomatic full-term newborns who were born under different clinical scenarios. Maternal risk factors, antepartum maternal GBS screening status, and maternal treatment with intrapartum antibiotics were varied across the scenarios. RESULTS: Pediatricians treating asymptomatic full-term newborns born to risk factor-negative mothers reported ordering tests (63.3% in GBS-positive cases vs 6.7% with GBS unknown; P = .001) and antibiotics (21.5% in GBS-positive cases vs 0.9% with GBS unknown; P = .001) more frequently when presented with a positive maternal GBS screening result. Maternal intrapartum treatment had little impact on pediatric practice when risk factors were absent. In risk factor-positive mothers, pediatricians reported an increase in their antibiotic usage in response to a positive maternal GBS screen (61.8% in GBS-positive cases vs 36.9% with GBS unknown; P = .001). In risk factor-positive mothers with unknown results of GBS screening, use of intrapartum antibiotics increased the number of pediatricians who reported that they would prescribe antibiotic therapy. CONCLUSIONS: Obstetrical strategies to decrease the risk of neonatal GBS sepsis increase pediatric services provided to full-term healthy newborns. This increase in services by pediatric practices is likely to be greater with the screening-based strategy recommended by the American Academy of Pediatrics.

Adult↗
PubMed1996

The clinical presentation, prevalence, and risk factors of focal corneal infiltrates in soft contact lens wearers.

PURPOSE: We evaluated the clinical presentation, prevalence, and associated risk factors for focal corneal infiltrates with overlying fluorescein staining in a population of soft contact lens wearers. METHODS: We measured the prevalence of focal stromal infiltrates with overlying fluorescein staining among contact lens wearers in a large cross-sectional, masked, multicenter study. RESULTS: The practice-based occurrence of infiltrates with overlying staining was 1.6%, or 38 of 2,324 patients examined. The events were milder than those reported in studies conducted in specialty eye care centers; were usually noted during unscheduled office visits; and were accompanied by symptoms of redness, photophobia, pain, and foreign body sensation. The infiltrates were located in all corneal zones, with 44.7% of the infiltrates involving the central zone, none of which caused significant loss of acuity at follow-up. The risk factors of overnight wear, lens modality (e.g., conventional, disposable), and smoking have been confirmed. Overnight wear showed a prevalence ratio of 1.88 compared with daily wear (P < 0.055, chi-square); lens modality showed an increased risk for disposables compared with conventional lenses of 2.1 (P = 0.036, chi-square). Smoking was associated with an increased prevalence of events; 1.2% of "never" and 2.2% and 2.4% of "former" and "current" smokers, respectively, experienced an infiltrate, for a prevalence ratio of 2.0 (P < 0.04). Smoking and lens modality also interacted positively with extended wear, amplifying the risk associated with those factors. CONCLUSIONS: We found a 1.6% practice-based prevalence and a wide range of clinical presentation of focal infiltrates in soft contact lens wearers, and we measured the relative risks of extended wear, lens modality, and smoking in a general practice population. In these cases, there was no distinct pattern in location or severity of corneal infiltrates, and visual acuity following the events was not compromised.

Adult↗
PubMed1995

Who are the weight maintainers?

To characterize people who maintain weight over long periods of time, normal weight and obese adults (n = 385) were studied over five annual visits. Subjects were classified using a +/- 5 lb change between the first and the fifth year visits to determine overall maintenance (M), with gain (G) or loss (L) being any change outside this range. This MGL status was cross-tabulated with a Fluctuation Index which counted the number of successive year-to-year weight changes of more than +/- 5 lbs (F0 through F4). True maintainers were defined as those having all weight changes within +/- 5 lbs during the 5-year period (M and F0). Nineteen percent (n = 73) of the subjects were classified as True Maintainers and included three times as many normal weight as obese subjects. Obese subjects comprised only 25% of the True Maintainer group but 60% of the Non-Maintainer group. Age had no association with Maintainer status. Standard measures of weight variability were lowest among True Maintainers and highest in Non-Maintainers. In addition, True Maintainers had lower BMI, Percent Body Fat, and Waist-Hip Ratios than Non-Maintainers. Subjects classified as Non-Maintainers were more likely to engage in dieting, by a variety of measures, than True Maintainers--this was particularly true among obese subjects. Finally, changes in total cholesterol, LDL and HDL cholesterol, and systolic and diastolic blood pressure were not reliably associated with Maintainer status, although the ordering of the group means suggested that True Maintainers had slightly healthier levels of "risk" variables. Overall, the results suggest that True Maintainers comprise a potentially important and interesting group of individuals who need further study.

Adult↗
PubMed1995

Maternal serum thromboxane B2 reduction versus pregnancy outcome in a low-dose aspirin trial.

OBJECTIVE: Our purpose was to determine whether in a low-dose aspirin trial a longitudinal decrease in maternal serum thromboxane B2 is associated with improvement in pregnancy outcomes. STUDY DESIGN: A total of 606 healthy nulliparous women with singleton gestations were randomized at 24 weeks to either 60 mg of aspirin or a placebo. Maternal serum thromboxane B2 was measured at randomization, at 29 to 31 weeks, at 34 to 36 weeks, and at delivery. After delivery, and without knowledge of patient outcome or group assignment, patients were categorized as having had either a longitudinal twofold or greater (> or = 50%) or less than twofold reduction (< 50%) in thromboxane B2 from baseline levels at randomization. RESULTS: Of 606 entrants, 92% had sufficient thromboxane B2 determinations to allow categorization. Whether patients were assigned to aspirin or placebo, birth weight was significantly greater in women who had a twofold or greater reduction in maternal serum thromboxane B2 levels. When the aspirin and placebo groups were combined, women with a twofold or greater reduction in thromboxane B2 levels had less preeclampsia, 1.9% (6/314) versus 5.7% (14/244) (p = 0.016), less preterm delivery (5.7% vs 10.7%, p = 0.032), fewer small-for-gestational-age newborns, 9 of 314 (2.95) versus 17 of 244 (7%) (p = 0.023), and a higher mean birth weight, 3314 gm versus 3121 gm (p = 0.0001). CONCLUSION: Women with a twofold or greater longitudinal reduction in maternal serum thromboxane B2 had less preeclampsia and prematurity, fewer small-for-gestational-age newborns, and higher birth weights than women with less than a twofold reduction.

Aspirin↗
PubMed1995

Cervical examination and tocodynamometry at 28 weeks' gestation: prediction of spontaneous preterm birth.

OBJECTIVE: We determined the value of cervical examination and tocodynamometry in identifying nulliparous women at risk for spontaneous preterm delivery. STUDY DESIGN: At 27.5 +/- 0.8 weeks' gestation 589 women underwent 30 minutes of tocodynamometry, and 570 of these had a cervical examination. Positive findings on these examinations were compared to the rate of spontaneous preterm delivery, defined as those deliveries following the onset of spontaneous labor or premature rupture of membranes. RESULTS: The two best predictors of spontaneous preterm birth were two or more contractions in 30 minutes and the presence of a soft or medium consistency on cervical examination. As the contractions increased from zero to four or more, the rate of spontaneous preterm delivery rose from 4.2% to 18.2%. CONCLUSION: In nulliparous women at 28 weeks' gestation, uterine contractions and several components of the cervical examination predicted spontaneous preterm birth.

Adolescent↗
PubMed1995

Differences in the detection and enumeration of mutans streptococci due to differences in methods.

Different methods reported for assessing mutans streptococci (MS) make the direct comparisons of results across studies difficult. To quantitate the variations of MS estimates attributable to differences in method, stimulated and unstimulated saliva samples and oral swab samples were compared with pooled dental-plaque samples. Detection of MS in stimulated saliva samples was in excellent agreement with the presence of MS in pooled plaque samples. MS detection in unstimulated saliva samples, however, was significantly discordant with that in either pooled plaque or oral swab samples. When caries status was used as the criterion of validity of MS estimates, stimulated saliva samples demonstrated a sensitivity (94%) similar to that of pooled plaque samples, but exhibited a lower specificity (11%) than that of pooled plaque samples (17%). As a result, the measure of association between MS and caries was biased (towards null) when MS status was based on stimulated saliva samples. Interestingly though, in enumerating MS, stimulated saliva samples yielded significantly higher levels of MS (about 1.5 log10 increase) with a lower variability compared to unstimulated saliva samples. The use of different culture media for detection of MS gave different results as well. MS detection was poor (kappa = 0.31) and MS levels were lower (p = 0.0001) when samples were grown on glucose-sucrose-potassium tellurite-bacitracin agar compared to mitis-salivarius-bacitracin agar. Together with the relative ease of sampling and processing, these findings collectively justify the use of plaque samples for the qualitative assessment of MS and stimulated saliva samples for the quantitative assessment of MS, while providing a basis for adjustment of estimates when comparing results across studies.

Analysis of Variance↗
PubMed1995

The relationship between maternal and neonatal anthropometric measurements in term newborns.

OBJECTIVE: To determine whether measures of maternal lean mass, fat reserves, or a combination of both best predict the various measures of newborn size at birth. METHODS: The population consisted of 1205 multiparous, predominantly black women at high risk for fetal growth retardation, who delivered at term at the University of Alabama at Birmingham. Maternal body mass index (BMI) was calculated using the reported pre-pregnancy weight. Maternal anthropometric measurements taken at mid-pregnancy included skinfold thicknesses, lean body mass, and mid-arm, calf, and wrist circumferences. Weight and 11 other neonatal measurements were made within 24 hours of birth and related to various maternal anthropometric measurements. RESULTS: Reported maternal pre-pregnancy weight was the best predictor of all neonatal size measures except for the neonatal skinfold thicknesses, which were better predicted by the pre-pregnancy BMI. For example, the range between the tenth and 90th percentiles of maternal pre-pregnancy weight (46.3-86.4 kg) was associated with 295 g birth weight compared to only 188 g birth weight for a measure of lean body mass. CONCLUSION: Most maternal anthropometric measurements were significantly associated with most neonatal measurements. However, for nearly every neonatal measurement considered, the maternal pre-pregnancy weight was the best predictor.

Adult↗
PubMed1995

The effect of cigarette smoking on neonatal anthropometric measurements.

OBJECTIVE: To estimate the effect of maternal cigarette smoking on birth weight, crown-heel length, and ten other neonatal anthropometric measurements. METHODS: Data are from a cohort study on risk factors for fetal growth retardation (FGR) in multiparous women conducted from December 1985 through October 1988. Information on smoking status was collected four times during pregnancy. Data analysis included 1205 singleton infants of women delivering at term. Neonatal anthropometric measurements were obtained within 48 hours of birth, including birth weight, crown-heel length, ponderal index, head and abdominal circumferences, arm length and circumference, femur length and thigh circumference, and triceps, thigh, and subscapular skinfold measurements. Analysis of covariance models were used to assess the independent effect of smoking on each neonatal measurement. RESULTS: Neonates born to women who reported smoking during the first trimester had a 0.6-1.9% reduction in most neonatal anthropometric measurements, resulting in an overall reduction of birth weight of 130 g (4%). Neonates born to women who continued to smoke throughout pregnancy had an average adjusted reduction in birth weight of 189 g (5.9%), compared with a 55 g (1.7%) reduction for neonates born to women who stopped smoking after the first trimester. For women who continued to smoke throughout pregnancy, an increased number of cigarettes smoked was associated with increased reductions in birth weight and neonatal chest and abdominal circumferences. For women who stopped smoking after the first trimester, stopping was a better predictor of neonatal anthropometric measurements than the number of cigarettes smoked early in pregnancy. CONCLUSIONS: Except for the ponderal index, all neonatal anthropometric measurements studied showed some negative effect of maternal cigarette smoking. Head circumference is the measurement least reduced. Smoking cessation is a better predictor of infant size than the number of cigarettes smoked in the first trimester.

Adult↗
PubMed1995

Low-dose aspirin: lack of association with an increase in abruptio placentae or perinatal mortality.

OBJECTIVE: To perform a meta-analysis determining the association of low-dose aspirin treatment with subsequent abruptio placentae or perinatal mortality. DATA SOURCES: Studies were identified and selected using the MEDLINE bibliographic data base of entries from January 1985 through April 1994. In addition, a manual search was performed using the references from all retrieved reports, review articles, and chapters from textbooks. METHODS OF STUDY SELECTION: Three criteria were used to select studies for inclusion: 1) Studies were designed as randomized or double-blind clinical trials; 2) aspirin was administered in doses of less than 200 mg/day; and 3) outcome data included the incidence of abruptio placentae and perinatal mortality. Three studies did not report the occurrence of abruptio placentae, but the authors of those papers answered written requests for such data. A total of 11 studies met our inclusion criteria. DATA EXTRACTION AND SYNTHESIS: We independently evaluated the study methods for each trial and abstracted quantitative outcome data. For each outcome, relative risk, risk differences, and 95% confidence intervals were calculated. The diagnosis of abruptio placentae was taken as self-reported in each trial. No trial of low-dose aspirin in pregnancy had predefined criteria for the diagnosis of abruptio placentae, and abruption was not a primary outcome in any of the 11 trials. We combined data from all studies and compared the data from the randomized trials to those from the double-blind studies. CONCLUSION: We found no increased risk for abruptio placentae or increased perinatal mortality in women taking low-dose aspirin.

Abruptio Placentae↗
PubMed1995

A new device for collecting cord blood.

Safe sampling of cord blood can reduce the risk of exposure to infectious agents by obstetric personnel. We developed a new device for collecting umbilical cord blood. Using a modified closed-cup instrument, gravity drainage within the sealed device allows for guarded-needle vacuum tube blood collection. The mean (+/- standard deviation) volume of blood collected with the device was 6.1 +/- 3.1 mL. Adding heparin into the device increased the volume collected by approximately 2 mL. The diameter and length of the cord were also related to the amount obtained. Only two of 122 samples (1.6%) had less than 1 mL of blood. The introduction of a closed container, umbilical cord sampling device offers a clear potential for risk reduction, particularly the risk of needle-stick injuries but also direct blood contamination. The device is simple to use, offers easy and safe disposal, and can be operated by physicians or nurses.

Blood Specimen Collection↗
PubMed1994

Strategies for the prevention of early-onset neonatal group B streptococcal sepsis: a decision analysis.

OBJECTIVE: To perform a decision analysis to understand better the implications of 19 potential group B streptococcus screening and treatment strategies. METHODS: We searched the literature to locate appropriate articles from which to derive probability estimates. Using decision analysis, we determined the likely outcomes of 19 group B streptococcus screening and treatment strategies and focused on three main outcomes: 1) number of expected cases of early-onset neonatal group B streptococcal sepsis, 2) percentage of gravidas treated with intrapartum antibiotics, and 3) total costs. RESULTS: The strategy recently recommended by two committees of the American Academy of Pediatrics (universal 28-week maternal rectovaginal group B streptococcal culture and treatment of culture-positive, high-risk patients in labor) is among the least effective at reducing neonatal sepsis and the most costly. Strategies based on the currently available rapid streptococcus identification tests are ineffective at reducing neonatal sepsis and are costly. Three strategies outperform the rest: 1) Universal intrapartum maternal antibiotic treatment is the most effective strategy in reducing early-onset neonatal group B streptococcal sepsis (6% of expected) and is also the least costly; 2) intrapartum treatment based solely on risk factors (recently endorsed by ACOG) lowers the rate of neonatal sepsis to 31% of expected with an 18% maternal treatment rate and low total costs; and 3) universal 36-week maternal culture, and treatment of all patients experiencing preterm birth and all culture-positive patients results in 14% of expected neonatal sepsis, with a 27% maternal treatment rate and low total costs. CONCLUSION: Given the present state of knowledge, three strategies emerge from this decision analysis as most optimal for the prevention of early-onset neonatal group B streptococcal sepsis: universal treatment, treatment based on risk factors, and treatment based on preterm delivery and 36-week culture status.

Anti-Bacterial Agents↗
PubMed1994

Bed rest in pregnancy.

OBJECTIVE: To summarize existing data about the effectiveness of bed rest when used to improve various pregnancy outcomes and to determine how often bed rest is used and the cost associated with its use. DATA SOURCES: We used the MEDLINE data base to search for all English language papers evaluating the effectiveness of bed rest in pregnancy. We also reviewed a number of textbooks and the 1988 National Infant Mortality Survey. METHODS OF STUDY SELECTION: We reviewed these sources for recommendations about using bed rest in various obstetric conditions. We used the 1988 National Infant Mortality Survey to determine how often bed rest was used either to prevent or to treat various obstetric conditions and estimated the costs associated with its use. DATA EXTRACTION AND SYNTHESIS: Bed rest is used in nearly 20% of all pregnancies to prevent or treat a wide variety of conditions, including spontaneous abortion, preterm labor, fetal growth retardation, edema, chronic hypertension, and preeclampsia. There is little evidence of effectiveness. The estimated costs associated with bed rest, including hospitalization, lost wages, and lost domestic productivity, range from more than $250 million to billions of dollars per year. CONCLUSIONS: Bed rest is used extensively to treat a wide variety of pregnancy conditions, at substantial cost but with little proof of effectiveness. We recommend that because this intervention has failed the test of effectiveness, its use during pregnancy should be curtailed unless randomized trials demonstrate improvement in a specific outcome.

Bed Rest↗
PubMed1993

Low-dose aspirin therapy to prevent preeclampsia.

OBJECTIVE: Our aim was to test the hypothesis that acetylsalicylate (aspirin) treatment reduces the incidence or severity of pregnancy-associated hypertension. STUDY DESIGN: Patients were nulliparous, healthy, and with a singleton gestation at between 20 and 22 weeks' gestation. A sample size of 600 patients was calculated on the basis of p < or = 0.05 and 90% power of observation. A 2-week placebo-controlled "run-in" was used to select compliant patients. Randomization occurred at 24 weeks, with 60 mg of aspirin or placebo treatment from randomization to delivery. RESULTS: Follow-up was maintained on 99% of the patients. The randomized patients had a 94% pill compliance index. At randomization, serum thromboxane medians were similar in both groups. Thromboxane B2 levels in the aspirin group decreased significantly from baseline at 29 to 31 weeks, 34 to 36 weeks, and at delivery as compared with an overall increase in the placebo group. Preeclampsia developed in five of 302 women (1.7%) who received aspirin versus 17 of 302 (5.6%) who received the placebo (p = 0.009). Preeclampsia was severe in one aspirin and in six placebo recipients (p = 0.06). CONCLUSION: Daily ingestion of 60 mg of aspirin beginning at 24 weeks' gestation significantly reduced the occurrence of preeclampsia.

Adult↗
PubMed1993

Maternal risk factors and their influence on fetal anthropometric measurements.

OBJECTIVE: Our purpose was to determine if and when maternal risk factors and fetal sex have an impact on specific fetal anthropometric measurements assessed by ultrasonography. STUDY DESIGN: Serial ultrasonographic examinations were performed on 1205 fetuses of indigent multiparous women who ultimately gave birth at term. Femur length, abdominal circumference, and head circumference measurements were obtained at mean gestational ages of 18, 25, 31, and 36 weeks, and an estimated fetal weight was calculated. At birth the infant was weighted and head circumference, abdominal circumference, femur length, and crown-heel length measurements were made. Regression analyses were used to determine the effect on each measurement of maternal race, height, body mass index, hypertension, weight gain, smoking, previous low birth weight, and fetal sex. RESULTS: Acting through their effect on head circumference, abdominal circumference, and fetal length, each of the risk factors and female sex were shown to have a negative effect on fetal weight. The timing of the impact, its magnitude, and the specific anthropometric measurement affected were different for each of the risk factors. CONCLUSIONS: The impact of maternal risk factors and fetal sex on estimated fetal weight has been demonstrated to occur first in specific gestational age windows and is mediated through effects on specific fetal anthropometric measurements.

Anthropometry↗
PubMed1993

Radiographic changes associated with tracheal isolation of Ureaplasma urealyticum from neonates.

Recent studies show an association between the presence of Ureaplasma urealyticum in tracheal aspirates and bronchopulmonary dysplasia. We hypothesized that among infants with birth weights < or = 1,250 g and respiratory disease, those with U. urealyticum in their tracheal aspirates would have radiographic evidence of more-severe pulmonary disease more often than would those without this organism. A total of 292 low-birth-weight infants who had endotracheal aspirate cultured within 7 days of birth were enrolled. The radiographic outcome variables were pneumonia, early severe bronchopulmonary dysplasia (precocious), and chronic lung disease. Microorganisms were isolated from 128 infants (44%); U. urealyticum was isolated from 44 (15%). Pneumonia was significantly more common in infants with than without U. urealyticum (30% vs. 16%, P = .03). U. urealyticum also was associated with precocious bronchopulmonary dysplasia independent of prematurity, race, and sex (odds ratio, 2.2; P < .05). Tracheal isolation of U. urealyticum within 7 days of birth is associated with pneumonia and precocious bronchopulmonary dysplasia.

Bronchopulmonary Dysplasia↗