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Biomedical subjects

H W Kilbride

Publications and source records attributed to H W Kilbride.

34 records · Page 2Linked to original sources
PubMed1989

Neurodevelopmental follow-up of infants with birthweight less than 801 grams with intracranial hemorrhage.

The incidence and severity of intracranial hemorrhage (ICH) were determined in a group of surviving infants with birthweights less than 801 g born during the period of 1983 through 1985. Neurodevelopmental status was assessed at 2 and 3 years of age to determine the relationship between neonatal ICH and later outcome in these infants. Forty-four of 77 neonatal survivors (57%) had ICH. Infants with ICH were less mature than those without (25.7 weeks' vs 26.5 weeks' gestation, P less than .05). There were no other perinatal factors that significantly differed between groups. At both 2 and 3 years of age, there were no significant differences between groups of infants with no or mild ICH and those with severe ICH regarding frequency of developmental delay, cerebral palsy, or visual impairment. Persistent ventriculomegaly in infants with ICH was associated with the highest incidence of neurodevelopmental disabilities. For extremely low birthweight infants, the presence and severity of neonatal ICH, in itself, did not adequately predict neurodevelopmental outcome at 2 or 3 years of age. Among infants with ICH, ventriculomegaly persisting to hospital discharge may indicate the greatest risk for neurologic and visual disabilities.

Cerebral Hemorrhage↗
PubMed1989

Intrapartum and delivery room management of premature rupture of membranes complicated by oligohydramnios.

Intrapartum management of PROM is affected as much by quantity of amniotic fluid remaining in the uterine cavity as gestational age at which PROM occurs. Strategies for PROM must take into account the unique mechanical and developmental fetal risks, as well as greater infectious morbidities associated with severe oligohydramnios. Perinatal management should include close fetal monitoring, timely intervention, and the provision of skilled neonatal resuscitation once the infant is delivered. Etiology of cardiopulmonary distress in the neonate may initially be difficult to determine. Surfactant deficiency (RDS), congenital pneumonia, cardiopulmonary asphyxia, and pulmonary hypoplasia should be included in the differential diagnosis. The duration and severity of oligohydramnios, plus clinical, radiographic, and laboratory data, should provide clues for accurate diagnosis and appropriate treatment.

Amniotic Fluid↗
PubMed1988

Early onset hyperkalemia in extremely low birth weight infants.

The incidence of hyperkalemia and associated clinical features in extremely preterm infants were determined by reviewing medical records of 32 infants with birth weights of less than or equal to 800 g born during a 1-year period. Hyperkalemia, defined as serum potassium concentration of greater than 6.5 mEq/L, occurred in 12 infants on the first day of life and in four others on the second day. Six infants (38%) had electrocardiographic abnormalities associated with hyperkalemia. Infants with hyperkalemia were less mature than infants with normal potassium levels. All infants of less than 25 weeks' gestation developed hyperkalemia. Fluid intakes and urine flow rates were lower and body weight loss greater during the first 24 hours of hospitalization for hyperkalemic infants. Hyperkalemia frequently occurs within the first 48 hours of life in extremely immature infants. Serum potassium should be monitored closely to avoid life-threatening cardiac arrhythmias in these infants.

Humans↗
PubMed1986

Candida chorioamnionitis diagnosed by amniocentesis with subsequent fetal infection.

Isolation of Candida albicans from the vaginal secretions of pregnant women occurs with an incidence of 5-23%. Intrauterine infection caused by Candida during pregnancy is relatively rare; only 81 cases, all diagnosed after delivery, have been reported. We report six cases of candidal chorioamnionitis diagnosed by amniocentesis and confirmed by histologic studies, associated with preterm labor and delivery of five viable infants. Three of the six maternal patients had intrauterine contraceptive devices in situ. Three infants had a diagnosis of congenital cutaneous candidiasis and two had congenital systemic candidiasis, one with monilial pneumonia, and one with meningitis and septicemia. All viable neonates were treated successfully. The sixth, a very immature infant, died soon after delivery. Torulopsis (Candida) glabrata was isolated from this amniotic fluid. C. Albicans is a pathogen that potentially may cause chorioamnionitis and has been associated with high mortality (94%) in infants weighing less than 1500 gm. Use of amniocentesis in patients with preterm labor may allow early detection of subclinical candidal chorioamnionitis, thus guiding appropriate perinatal management.

Adolescent↗
PubMed1984

Continuous transcutaneous oxygen monitoring in acutely ill preterm infants.

Twenty preterm infants in respiratory distress, each with an umbilical catheter in place, were studied during their first 24 h of hospitalization, to determine the effects of continuous transcutaneous oxygen (PtcO2) monitoring on the frequency of arterial blood gas (ABG) determinations and on the incidence of hypoxia and hyperoxia. PtcO2 was measured continuously in all infants during the 24-h period. By random allocation, PtcO2 data were withheld during either the 1st or 2nd 12-h period of hospitalization from clinicians caring for the infant. Comparison of the 12-h period in which PtcO2 data were available (open TcM) with the period in which they were withheld showed no difference in the number of ABG determinations (6.3 +/- 0.6 vs 7.4 +/- 1.0/12 h). During the open TcM period, there was significantly less hypoxia (PtcO2 less than 50 torr) (9.0 +/- 3.7% vs 16.3 +/- 4.2%, p less than .025) but no difference in hyperoxia (PtcO2 greater than 100 torr). Although continuous PtcO2 monitoring in acutely ill newborns did not decrease the frequency of ABG determinations, it may lessen morbidity by decreasing the amount of hypoxia infants experience while being stabilized early in hospitalization.

Acute Disease↗
PubMed1977

Social class, birth order, and newborn experience.

Early home experiences of a group of 32 2-week old infants, equally divided according to social class, birth order, and sex, were studied. Naturalistic observations were taken on 2 consecutive days for a total of 6 hours. Compared with later-borns, firstborns received significantly more caretaker interaction on all variables studied. Compared with lower-SES infants, those from higher-SES homes received significantly more direct verbal interaction although the 2 groups did not differ on total periods of other types of caretaking interaction. The findings are consistent with birth order and social class differences reported in home environments of older infants and children.

Birth Order↗
PubMedDate not supplied

Growth patterns for infants weighing less than 801 grams at birth to 3 years of age.

Anthropometric measurements of infants weighing < 801 gm were monitored to evaluate growth patterns from birth to 36 months chronologic age, using both standard growth percentiles and Z score descriptors. Mean gestational age was 25.8 weeks, and birth weight was 708.4 gm. The infants had growth delay at hospital discharge with some catch-up growth occurring in the first year. Discrete changes in body growth using the Z score as a descriptor showed movement from a negative SD at 12 months toward the reference mean of zero at 36 months. However, mean length remained < 5th percentile, and mean weight was at approximately the 10th percentile for chronologic age. At 36 months 45% of infants had a head circumference smaller than the 5th percentile for chronologic age. Birth weight < 701 gm was a significant predictor of smaller occipital-frontal circumference at 3 years (p = 0.03). Interruption of intrauterine growth after extremely premature birth appears to have long-term effects on growth outcome much like prenatal growth retardation.

Anthropometry↗
PubMedDate not supplied

Cocaine detection in neonatal gastric aspirate samples.

We prospectively analyzed the feasibility and sensitivity of gastric fluid detection of cocaine compared with standard meconium analysis. Cocaine was detected in nearly half (45.5%) of gastric aspirate samples tested from infants in whom meconium was positive for cocaine. The time to sample acquisition was substantially shorter for gastric aspirate sampling versus meconium analysis. The possible ramifications of the presence of cocaine in amniotic fluid are discussed.

Adult↗
PubMedDate not supplied

Survival and subsequent outcome to five years of age for infants with birth weights less than 801 grams born from 1983 to 1989.

OBJECTIVE: To determine the neurodevelopmental status for 5-year-old survivors with birth weights (BW) <801 gm born in the 1980s and to assess differences in outcome for those born from 1986 to 1989 compared with those born from 1983 to 1985. STUDY DESIGN: This investigation was a longitudinal follow-up of all infants with BW from 450 to 800 gm born at one of two hospitals in Kansas City, Mo., between January 1983 and December 1989. Medical records were reviewed at discharge to determine obstetric and neonatal interventions and complications. Neurodevelopmental outcome was assessed by a multidisciplinary evaluation at 60 +/- 3 months old. Multiple logistic regression analyses were used to determine factors statistically associated with survival and long-term outcome. RESULTS: The percentage of infants surviving to hospital discharge was not different between periods. From 1986 to 1989, there were more infants with BW <601 gm and <26 weeks' gestational age. Survival was greater for gestational age categories > or = 24 weeks. BW, gestational age, female gender (p < 0.0001), and birth era (p < 0.01) were each independently significantly associated with improved survival. At 5 years of age, there were no significant outcome differences between birth era cohorts. Overall, approximately 21% of infants had severe disabilities. Long-term outcome was significantly influenced by the occurrence of intracranial hemorrhage and socioeconomic status. CONCLUSION: For infants with BW <801 gm, survival of infants > or = 24 weeks' gestational age was greater in 1986 to 1989 compared with 1983 to 1985, although the 5-year neurodevelopmental outcome was not different between groups. The significant impact of social risk status on outcome suggests that factors outside the intensive care nursery must be addressed to improve long-term outcome.

Brain Damage, Chronic↗