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Biomedical subjects

J E Hodgman

Publications and source records attributed to J E Hodgman.

At least 19 recordsLinked to original sources
PubMed2003

Infection as a cause of death in the extremely-low-birth-weight infant.

OBJECTIVE: To determine the causes of neonatal death for extremely-low-birth-weight (ELBW) infants. METHODS: All liveborn infants below 1000 g birth weight born from 1994 to 1998 who died and were autopsied were included. Maternal and infant characteristics, placental histology, autopsy material and culture results were obtained. RESULTS: A total of 263 ELBW infants were born alive, 104 (40%) died and 44 (42%) were autopsied. Placentas were available for 41 (93%). Infection was the leading cause of death in the autopsied babies (25/44; 57%). Sixteen (64%) of these deaths occurred within the first 48 h and were classified as being due to congenital infections. Twenty-two of 41 (54%) placentas showed evidence of infection. Infection as a cause of death peaked at 22 weeks. Other causes of death were lethal anomalies (20%), respiratory distress and its complications (9%) and immaturity, intraventricular hemorrhage and other conditions (14%). CONCLUSION: Congenital infection is the leading cause of death in ELBW infants.

Autopsy↗
PubMed2001

Nursery survival for infants of birth weight 500-1500 grams during 1982-1995.

OBJECTIVE: To evaluate nursery survival of very low birth weight infants (VLBW) over time, born in the same large inner-city hospital with a predominantly Hispanic population. METHODS: All liveborn VLBW infants weighing 500-1500 g at birth were included in four time periods of 2 years' duration during 1982 to 1995. Demographics were collected for the obstetric population. Clinical data were collected including maternal and infant perinatal factors. All infants were assigned a cause of death and infants dying with lethal anomalies were then excluded from further evaluations. RESULTS: Overall survival improved progressively (p = 0.0001) with dramatic improvement in survival of infants 500-750 g birth weight (BW) in period 4 (1994-1995). The number of lethal anomalies did not increase but accounted for a larger portion of deaths in period 4. Decreases in other causes of death over time reflected changes in perinatal care. Although the mothers were high-risk, none of the maternal factors evaluated showed any consistent effect on infant survival. Improved labor and delivery care was associated with improvement in Apgar scores, a decrease in intracranial hemorrhage/intraventricular hemorrhage as a cause of death and an improvement in survival between the first two periods. In spite of the increase in Cesarean sections for infants of 500-750 g BW and their improved survival in period 4, no clear advantage for Cesarean section could be demonstrated. The marked improvement seen in period 4 was associated with three changes in care: increased use of maternal steroids, administration of surfactant, and the use of newer ventilatory methods including high-frequency oscillatory ventilation. Although female gender has been reported to confer a protective influence for survival, this was not found in the final period. Black mothers comprised only about 2.5% of the total obstetric population but delivered approximately 10% of the VLBW infants. Despite the increased incidence of small for gestational age (SGA) among black infants, there were no differences in survival between blacks and Hispanics. Mean birth weight and gestational age in both survivors and nonsurvivors decreased significantly over the four time periods. In period 4, 50% survival occurred at a birth weight of 600-700 g and a gestational age of 23 weeks. CONCLUSION: Nursery survival improved throughout the period of the study from 1982 to 1995 but especially during period 4 (1994-1995). Improved survival was associated with changes in both maternal and infant care. In infants of BW 500-750 g, gestational age rather than birth weight was more closely associated with survival.

Black or African American↗
PubMed2000

Treatment decisions for newborns at the threshold of viability: an ethical dilemma.

The major ethical issues involved in decision-making in the care of extremely low birth weight newborns are analyzed here. We propose a schema for assessment and management of these infants that is consistent with ethical principles broadly accepted by the pediatric community, and which takes into account mortality risk at any given institution rather than arbitrary weight limits, with a major decision-making role for the infant's parents. When possible, the decision of whether or not to resuscitate should be made before delivery; when not possible, delivery room resuscitation is recommended, and the decision to continue or withdraw care should be made subsequently based on likelihood of survival and the wishes of the parents.

Critical Illness↗
PubMed1999

Causes of death in the extremely low birth weight infant.

OBJECTIVE: To present primary and secondary causes of death confirmed by autopsy for the extremely low birth weight infant. METHODS: A total of 111 infants weighing between 300 and 1000 g at birth who died and were autopsied at our hospital during the 4-year period 1990-1993 were retrospectively reviewed. Clinical, pathologic, and laboratory data were retrieved including results of placental examinations and autopsy cultures. Primary and secondary causes of death were assigned by the authors. RESULTS: Infection was the most common primary cause (56/111) followed by respiratory distress syndrome/bronchopulmonary dysplasia (24/111) and congenital defect (15/111). Immaturity as an only cause appeared almost exclusively in infants weighing <500 g at birth. Infection was significantly underdiagnosed clinically with most of these deaths attributed to immaturity or respiratory distress syndrome. In only 1 case was intraventricular hemorrhage considered the primary cause of death although it was present as a secondary cause in 19/111. Infections were divided into congenital (30/56) and acquired (26/56) by time of death. The congenital infections (</=48 hours) consisted of pneumonia and chorioamnionitis/funisitis attributable to maternal enteric organisms. Causative bacteria were obtained in pure culture in a number of these cases. The acquired infections were mainly caused by yeasts and nosocomial bacteria. Sixty-seven percent of the deaths occurred in the first 2 days and 12% were beyond the neonatal period at 29 to 104 days. Care was not initiated or was withdrawn in 50% of the infants, usually within the first 4 hours. CONCLUSIONS: Infection of the amniotic fluid leading to pneumonia was the major cause of death in the extremely low birth weight infant. Accurate cause of death can not be reliably ascertained without an autopsy accompanied by examination of the placenta in the early deaths. Antibiotic treatment of the mother and infant may have reduced the deaths from infection. Early failure to respond to neonatal intensive care may well indicate presence of a congenital pneumonia.

Amniotic Fluid↗
PubMed1993

Episodes of bradycardia during early infancy in the term-born and preterm infant.

OBJECTIVE: To document the incidence of transient episodes of bradycardia in a group of healthy term and preterm infants during the first 1 to 6 months of life. DESIGN: Longitudinal polysomnographic study. SETTING: Sleep laboratory in a university-affiliated urban medical center. PARTICIPANTS: Fourteen healthy term-born infants, nine preterm infants with apnea in the nursery, and 10 preterm infants without apnea. Infants with neonatal morbidity except apnea were excluded. MEASUREMENTS: Transient episodes of bradycardia (< or = 100 beats per minute) were identified in 2- to 4-hour early evening polysomnographic tracings. The relationship with apnea, transcutaneous oxygen levels, and sleep state was determined. RESULTS: Transient episodes of bradycardia to 60 to 70 beats per minute were common, but there were no drops below 50 beats per minute. The incidence of transient episodes of bradycardia was inversely related to heart rate. Results for apneic and nonapneic premature infants were similar. CONCLUSIONS: Transient episodes of bradycardia are considered normal reflex responses and are not related to risk for sudden infant death syndrome. These results have implications for the setting of monitor alarms.

Age Factors↗
PubMed1993

Obstructive apnea, associated patterns of movement, heart rate, and oxygenation in infants at low and increased risk for SIDS.

Repetitive polysomnograms were recorded between 40 weeks post-conceptional age and 6 months in a total of 49 infants, 19 healthy preterm infants, 14 normal term infants, and 16 subsequent siblings of infants who died of sudden infant death syndrome (SIDS). These nighttime recordings lasted 2-4 hours, except at 3 months when an overnight 12-hour recording was performed. Obstructive apneas (OA) > 3 seconds were divided into 3 categories: 1) clear obstructive, 2) mixed and 3) unclear because of movement artifacts. More than half belonged in category 3 and were excluded from further analysis unless accompanied by a transient episode of bradycardia (TEB), defined as heart rate < or = 100 beats per minute. Each OA with TEB was also examined for changes in transcutaneous oxygen tension (PtcO2). Most pauses were brief (median, 4 seconds), the longest (27 seconds) seen only once in the youngest premature infant. The majority of OA were accompanied by heart rate accelerations. The number of clear obstructive and mixed apneas was similar. The scores were combined to calculate a density (number per 100 minutes of recording). OA were not common: Their density decreased from 2 in 100 minutes at 40 weeks in the preterm to once every 300 minutes (5 hours) in the 6-month-old term infant. Ten percent of the OA were accompanied by TEB. Of these, 10% were accompanied by a PtcO2 decrease of > 10 mm Hg. OA with TEB followed a nonmonotonic curve, the highest percentage of infants showing this pattern at the age of highest risk for SIDS. Minor differences among study groups were confined to less movements with OA in subsequent siblings and an earlier peak incidence of OA with TEB in prematures, compared to normal term infants. OA were seen in all study groups, were self-limited, and apparently were devoid of pathological consequences.

Blood Gas Monitoring, Transcutaneous↗
PubMed1992

Polygraphy after discharge in preterm infants with and without apnea in the nursery.

Nine of nineteen infants in this study exhibited two or more central apnea greater than or equal to 20 seconds when they were older than one week and between 32-36 weeks postconceptional age (PCA). We focused on the sequelae of these apneas. Apnea was separated from other morbidity associated with immaturity by the selection of consistently healthy infants. Following discharge, polygraphic tracings were obtained at 40, 44 and 52 weeks PCA in these non-apneic and previously apneic infants. Sleep states, minute by minute values for heart and respiratory rate, skin temperature and transcutaneous O2 (PtcO2) and CO2 (PtcCO2), apnea and transient decreases in PtcO2 were determined. Polygraphic measurements did not differentiate preterm infants with late apnea in the nursery from non-apneic ones. However, the apneic group exhibited a transient decrease in awakenings at 44 weeks PCA.

Brain↗
PubMed1992

Transcutaneous oxygen and carbon dioxide during the first half year of life in premature and normal term infants.

Repetitive polysomnograms were recorded from a total of 33 infants, 19 healthy preterm infants, and 14 term controls between 40 wk postconceptional age and 6 mo of age. These nighttime recordings lasted 2-4 h, except at 52 wk in preterm infants and at 3 mo of age in term infants when an overnight 12-h recording was performed. Minute by minute values of transcutaneous PO2 (PtCO2) and transcutaneous PCO2 (PtcCO2) levels and variability during the awake state, active sleep, and quiet sleep were obtained through computer analyses of the polygraphic data. The results from preterm infants at corrected postconceptional age could not be differentiated from those of control infants. PtCO2 levels rose between 40 wk and 3 mo, and PtcCO2 levels declined. Sleep states modulated only the variability of PtcO2, not the level; in contrast, state modulation was seen in both variability and level of PtcCO2 throughout the age span studied. During sleep the number of transient declines in PtCO2 greater than 2.03 kPa (15 mm Hg) decreased with advancing age. Hypercapnic PtcCO2 values decreased with age as well, but their prevalence in healthy, young infants suggests the need for reevaluation of criteria for hypercapnia based on transcutaneous measurements. The data demonstrate that ventilatory regulation continues to undergo changes between 1 and 3 mo, the age of highest risk for sudden infant death syndrome.

Age Factors↗
PubMed1991

Prediction of neurodevelopmental outcome in infants with and without bronchopulmonary dysplasia.

In a group of 236 very low birth weight (VLBW) surviving infants, 60 had developed bronchopulmonary dysplasia (BPD) in the nursery. When compared with the 176 infants without BPD, infants with BPD were smaller, more immature, with lower one- and five-minute Apgar scores. Infants with BPD had a greater incidence of cardio-pulmonary and central nervous system (CNS) complications in the nursery. On follow-up, 25 (42%) of these infants were abnormal developmentally compared to 7% of infants without BPD (p less than .001). When comparisons were made within the group of infants with BPD, very few differences were found in maternal or infant risk factors between the normal and abnormal infants. The infants with BPD who had poor outcome more often had seizures and severe intraventricular hemorrhage (IVH). The infants with BPD who had good outcome were more often small for gestational age (SGA) and resuscitated with intubation at birth. They had apnea in the nursery more frequently than did abnormal infants with BPD. We conclude that VLBW infants with BPD are at greater risk for poor neurodevelopmental outcome than those without BPD. The risk for the infant with BPD relates to CNS complications rather than to chronic lung disease.

Aging↗
PubMed1990

Neonatology.

Explore the source record for details and available documents.

Humans↗
PubMed1990

Apnea, transient episodes of bradycardia, and periodic breathing in preterm infants.

The occurrence of central apnea of 15 seconds or longer, transient episodes of bradycardia (TEB), and periodic breathing were studied in 66 healthy premature infants when at least 1 week old and between 32 and 36 weeks postconceptual age. Eight-hour cardiorespiratory recordings were visually scanned for the presence of these patterns. Central apnea of 15 seconds or longer was seen in almost half of the infants. The TEB were numerous, and the majority were not associated with central apnea; however, all but five of the apneic episodes that lasted 15 seconds or longer were accompanied by a TEB. Infants spent as much as 40% of their time in periodic breathing. The frequency with which these patterns are seen in healthy premature infants strongly suggests that they are normal findings. Our results do not support the opinion that brief periods of apnea are abnormal when accompanied by a TEB.

Apgar Score↗
PubMed1990

Cardiovascular changes in infants with beta-hemolytic streptococcus sepsis.

Sequential hemodynamic and biochemical changes were studied in 24 infants with sepsis due to beta-hemolytic streptococcus to define the temporal patterns of physiologic events and to compare them in surviving (n = 11) and nonsurviving (n = 13) infants. Septicemia was documented by positive blood culture in all. Biophysical and biochemical measurements were obtained before and hourly, for 11 h after antibiotic therapy was initiated. Surviving infants had significantly higher Hct and systolic and mean arterial pressures than nonsurvivors. In nonsurvivors, low BP was associated with a concomitant rise in CVP and severe metabolic acidosis refractory to therapy. Although there were no differences in PaO2 or PaCO2 between survivors and nonsurvivors, arterial-alveolar oxygen gradients were significantly greater in nonsurviving infants. These data show cardiorespiratory and metabolic alterations that differentiate surviving and nonsurviving infants with beta-hemolytic streptococcal septicemia.

Anti-Bacterial Agents↗
PubMed1989

Cardiopulmonary and intracranial pressure changes related to endotracheal suctioning in preterm infants.

Although endotracheal (ET) suctioning is performed frequently in sick newborn infants, its effects on cardiorespiratory variables and intracranial pressure (ICP) have not been thoroughly documented in neonates greater than 24 h who were not paralyzed while receiving mechanical ventilation. This study evaluates these changes in preterm infants who required ventilatory assistance. We measured transcutaneous PO2 and PCO2 (PtcO2 and PtcCO2, respectively), intra-arterial BP, heart rate, ICP, and cerebral perfusion pressure (CPP) before, during, and for at least 5 min after ET suctioning in 15 low birth weight infants less than 1500 g and less than or equal to 30 days of age. One infant was studied twice. A suction adaptor was used to avoid disconnecting the patient from the ventilator and to attempt to minimize hypoxemia and hypercapnia during suctioning. The patients were studied in the supine position and muscle relaxants were not used. PtcO2 decreased 12.1% while PtcCO2 increased 4.7% 1 min after suctioning; however, greater increases in mean BP (33%) and ICP (117%) were observed during suctioning. CPP also increased during the procedure. ICP returned to baseline almost immediately, whereas BP remained slightly elevated 1 min after suctioning. Our findings demonstrate that ET suctioning significantly increases BP, ICP, and CPP in preterm infants on assisted ventilation in the first month of life. These changes appear to be independent of changes observed in oxygenation and ventilation.

Blood Pressure↗