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Biomedical subjects

J H Ruys

Publications and source records attributed to J H Ruys.

At least 19 recordsLinked to original sources
PubMed1992

Standardised method of follow-up assessment of preterm infants at the age of 5 years: use of the WHO classification of impairments, disabilities and handicaps. Report from the collaborative Project on Preterm and Small for gestational age infants (POPS) in The Netherlands, 1983.

A nationwide, prospective study was initiated in The Netherlands in 1983, involving 1338 liveborn infants with a gestational age less than 32 weeks and/or a birthweight less than 1500 g. Pre- and perinatal data, methods and results of follow-up until the corrected age of 2 years have been published previously. In this paper, methods of follow-up at the age of 5 years are described. At that age, 966 children were alive, of which 927 (96%) were assessed during a home visit 2 to 6 weeks after their fifth birthday by three specially trained paediatricians. A questionnaire served to collect data on medical history, respiratory function, behaviour and socio-economic factors. Standardised tests were carried out covering the following 10 areas: congenital malformations, neuromotor function, mental development, hearing, visual function, language and speech development, behaviour, musculoskeletal system, respiratory tract and ENT problems, and growth. The outcome was recorded for separate areas and for the child as a whole using the WHO classification of impairments, disabilities and handicaps.

Abnormalities, Multiple↗
PubMed1992

Evaluation of care for the preterm infant: review of literature on follow-up of preterm and low birthweight infants. Report from the collaborative Project on Preterm and Small for Gestational Age Infants (POPS) in The Netherlands.

Since the introduction of neonatal intensive care in the 1960s, mortality in very preterm and very low birthweight infants has been decreasing steadily. Consequently, interest in the outcome of surviving infants is growing. Restriction of health care resources has stressed the need for information concerning the effect of individual treatment components on mortality and morbidity. Concern about the quality in apparently normal survivors has been increasing as well. The current flood of papers on these subjects illustrates the interest in these issues. The first part of this paper reviews the methodology used in follow-up studies in the past decades. It aims at methodological problems that hamper comparison between studies and preclude unequivocal conclusions. New treatment techniques seldom were but should be evaluated by randomised trials. To monitor the combined effects of changing obstetric and neonatal techniques on perinatal outcome, studies in geographically defined populations are recommended using data from early pregnancy until at least preschool age. Comparability of outcomes could be enhanced by international agreement on standardisation of assessment methods and outcome measures. In the second part the results concerning gestational age- and birthweight-specific mortality, impairments and disabilities and the risk factors for such disorders are discussed. Increased survival of even the tiniest infants is clearly established. This increase in survival has not yet been accompanied by an apparent increase in major morbidity. However, many minor impairments are reported, occurring often in combination and predisposing these children to deviations of normal development. Important changes in the manifestation of brain damage appear to occur during development. These findings stress the importance of long-term follow-up studies.

Follow-Up Studies↗
PubMed1991

Impairments, disabilities, and handicaps of very preterm and very-low-birthweight infants at five years of age. The Collaborative Project on Preterm and Small for Gestational Age Infants (POPS) in The Netherlands.

The Project On Preterm and Small for gestational age infants (POPS) was started in the Netherlands in 1983 to investigate the relation between prenatal/perinatal factors and mortality/morbidity in very preterm and very-low-birthweight infants. Of the 1338 liveborn infants (less than 32 weeks and/or less than 1500 g) 966 were enrolled in the five-year (chronological age) follow-up programme; 96% of these children were assessed during a home visit. The overall outcome was expressed as impairments, disabilities, and handicaps according to World Health Organisation criteria. Of the assessed children, 13% had a disability and 14% were handicapped, which are much higher frequencies than those found in the general population. Handicaps were due mainly to abnormalities of neuromotor function, mental development, or language and speech development. Compared with the handicap frequency in the same cohort at two years of age, a more favourable outcome at five years of age was seen in 10%, and a less favourable outcome in 7% of the children. The findings show that most of those high-risk children survived without handicap or serious disability at preschool age.

Child, Preschool↗
PubMed1991

Maternal hypertension and very preterm infants' mortality and handicaps.

In a nationwide survey on liveborn very preterm and/or very low birthweight infants in The Netherlands, mortality and handicaps at the corrected age of 2 years were studied in infants born to mothers with or without hypertensive disorders during pregnancy. The neonatal and in-hospital mortality was significantly lower in infants born to hypertensive mothers. In surviving infants, a similar handicap rate was found at the corrected age of 2 years for both groups.

Congenital Abnormalities↗
PubMed1991

Early metabolic response to high energy shock waves in a human tumor kidney xenograft monitored by 31P magnetic resonance spectroscopy.

The effects of electromagnetically generated high-energy shock waves (HESW, Siemens Lithostar) on the phosphate metabolite levels of the NU-1 human kidney cancer xenograft implanted under the skin of the hind limb of nude mice were monitored by 31P magnetic resonance spectroscopy (MRS). Administration of 200 and 800 HESW (18.1 kV, P(+) = 37.5 MPa, P(-) = 5.2 MPa, tr = 30-120 nsec, tw = 340 nsec, freq. = 1.25 Hz), focused on the tumor centre, resulted in an immediate tumor decline; 2 h after exposure to the HESW, the high-energy phosphate resonances had decreased drastically. This decline in energy rich molecules was accompanied by a concomitant increase in the inorganic phosphate resonance and a decrease in pH of the tumor. During the following period, a dose-time dependent recovery of the original high-energy phosphate resonance intensities was observed. These changes are qualitatively similar to those produced by ischemic inhibition of energy metabolism and are correlated with early histological features like vascular disruption, stasis within capillaries, and focal thrombosis. These results demonstrate that experimental HESW treatment of the NU-1 kidney tumor is effective in provoking a temporary reduction of both high-energy phosphate metabolism and tissue pH of the tumor. The data presented here strongly suggest that these effects are predominantly indirect by affecting tumor vascularity. Overall, this study shows that MRS is a powerful technique for longitudinal investigations of HESW-induced effects and can provide information about its mode of action.

Animals↗
PubMed1991

Is it correct to correct? Developmental milestones in 555 "normal" preterm infants compared with term infants.

To determine whether correction for preterm birth should be applied during developmental assessment, we conducted a prospective national survey of very premature infants (born at less than 32 weeks of gestation); neurodevelopment in the first 2 years was studied with the Dutch child health care developmental assessment. In 555 preterm children who had no evidence of handicap at 2 years of age, the age at which developmental milestones were reached was established. The results were compared with the results of the same assessment in Dutch children born at term. During the first year, the development of the very premature children equaled the development of normal children when full correction was applied. At 2 years of age, development was equal to or better than normal children's development without correction. We conclude that full correction for prematurity should be applied in the first year to avoid overreferral for developmental stimulation, whereas at 2 years of age correction is not necessary.

Age Factors↗
PubMed1991

The use of health services in the first 2 years of life in a nationwide cohort of very preterm and/or very low birthweight infants in The Netherlands: rehospitalisation and out-patient care.

In a prospective collaborative survey on very preterm (less than 32 weeks) and/or very low birthweight (VLBW) infants (less than 1500 g) in The Netherlands, the use of health services was studied by examining the incidence of and reasons for rehospitalisation and the use of out-patient care, i.e. visits to medical specialists and physical therapists. Out of 1338 liveborn infants originally enrolled in the survey, 998 survived the initial hospital stay. Their use of health services was studied during four period: discharge-3 months, 3-6, 6-12 and 12-24 months corrected for expected date of delivery. A total of 320 infants (34%) was readmitted on 481 occasions. The main reasons for rehospitalisation were surgical procedures, of which inguinal herniorrhaphy was the most prominent, and respiratory tract disorders: 149 admissions (31%) and 147 (31%) admissions respectively. The remaining reasons for rehospitalisation occurred less frequently. In a multivariate analysis, both sex and the length of the initial hospital stay were shown to be significantly associated with an increased risk of rehospitalisation. During the study period, 671 children (67%) attended a medical specialist other than their paediatrician, and 313 children (31%) attended a physical therapist. The use of out-patient services was higher in the first than in the second year of follow-up. The use of health services depended very much on the neurodevelopmental status of the child. In the second year of life, a similar rehospitalisation rate and use of out-patient services was found in the non-impaired children as in children from the general Dutch population.

Ambulatory Care↗
PubMed1990

Vitamin K1 levels and K1-dependent coagulation factors II and X in preterm and small-for-date neonates.

In 17 preterm neonates and 7 small-for-date neonates, all formula-fed, vitamin K-dependent coagulation factors II and X remained near 45% of adult values from the moment of birth until 28 days postnatally. Vitamin K1 levels, however, showed a remarkable rise from below the detection limit of 0.022 ng/ml in umbilical cord blood, to serum levels with a range of 0.99-7.29 ng/ml vitamin K1 on day 3, with a further rise on days 7 and 28 postnatally. Vitamin K1 (Konakion) parenterally given to a third group of four preterm neonates as a 1 mg dose resulted in very high serum levels of vitamin K1 (64.08-157.10 ng/ml), but without any significant increase in plasma levels of vitamin K-dependent coagulation factors II and X, compared to the group without any extra vitamin K1. It is concluded that in healthy preterm and small-for-date neonates no correlation is seen between serum levels of vitamin K1 and plasma levels of coagulation factors II and X. After administration of 1 mg Konakion no accelerated increase is seen in coagulation factor activities.

Factor X↗
PubMed1990

Neonatal seizures in very preterm and very low birthweight infants: mortality and handicaps at two years of age in a nationwide cohort.

In a nationwide, prospective survey on very preterm and/or very low birthweight infants (less than 32 weeks of gestational age and/or less than 1500 g birthweight) we studied the outcome at the corrected age of two years of children with neonatal seizures. Of the 1338 infants, originally enrolled in the study, 72 had neonatal seizures; of these 44 died and 11 developed a major handicap. Using a multivariate statistical method, a significantly increased risk of death as well as handicap was found in infants with seizures compared to infants without seizures. Nevertheless, 16 of the 28 survivors with neonatal seizures were considered normal at the corrected age of two years.

Gestational Age↗
PubMed1990

Neonatal neurological dysfunction in a cohort of very preterm and/or very low birthweight infants--relation to other perinatal factors and outcome at 2 years.

Neonatal neurological dysfunction was found in only a small part of 1192 infants enrolled in an epidemiologic survey on very preterm (less than 32 weeks) and very low birthweight (less than 1500 gram) infants. A routine neurological examination was performed in the neonatal period by the attending paediatrician throughout all levels of care. The incidence of obvious neurological dysfunction was 8.1% and incidence of suspect neurological dysfunction was 6.1%. Multivariate analysis showed that gestational age, birthweight, low Apgar score, IRDS and, most of all, ICH were significantly associated with neonatal neurological dysfunction (N.D.). The mortality rate was very high in obvious and suspect ND infants (81.1% and 35.6% respectively) compared to neurologically normal infants (17.8%). This phenomenon was also found regarding the handicap rate at two years of age. Only 6% (n = 6) of the 96 infants with obvious ND survived without handicap. Using routine physical examination, a quarter of the very preterm or VLBW infants with later neurological disturbances were identified. A more standardized neurological examination, incorporated in the routine examination of newborns in all levels of care, might improve early identification of infants at risk for handicaps.

Brain Diseases↗
PubMed1990

Management of severe hemolytic disease with ultrasound-guided intravascular fetal transfusions.

Between January 1987 and March 1989, 22 fetuses with severe hemolytic disease were treated with 64 ultrasound-guided intrauterine intravascular transfusions. Eighteen infants survived and are doing well. In 12 fetuses, hydropic changes were present at the first transfusion; 9 of these survived. In 8 of the 10 fetuses with a gestational age less than 26 weeks, intrauterine treatment was successful.

Blood Transfusion, Intrauterine↗
PubMed1990

Serum CK-BB activity in the preterm infant and outcome at two and four years of age.

The relationship between serum creatine kinase brain-specific isoenzyme (CK-BB) activity immediately after birth and neurodevelopmental outcome at two and four years corrected age was studied prospectively in 45 preterm infants (less than 34 weeks gestation). Nine infants died during the neonatal period and one was lost to follow-up. Of the 35 children available for follow-up, seven had motor disabilities: four severe diplegia, two mild to moderate diplegia and one hemiplegia. No relationship existed between these motor disabilities and serum CK-BB activity after birth. There seemed to be a relationship between increased serum CK-BB after birth and low scores on the Bayley Scales of Mental Development, but this did not reach statistical significance. At the age of four years, four of the five survivors with high serum CK-BB activity after birth (greater than 25U/L) needed special schooling because of mental retardation. Increased serum CK-BB activity after birth may be associated with delayed mental development, but further study is needed, especially of asphyxiated infants.

Brain Diseases↗
PubMed1989

[Mortality risk after intrauterine and after neonatal transport].

In a Dutch national collaborative study of 1338 newborn infants born in 1983 with a gestational age of less than 32 weeks and (or) a birth weight of less than 1500 g, a comparison was made of maternal transport to university perinatal centres and delivery in local general hospitals on the one hand, and neonatal transport to those centres and treatment in regional general hospitals on the other. The mortality risk was investigated by means of logistic regression analysis. The results show that maternal transport was accompanied by a statistically significantly lower mortality risk. The mortality risk after neonatal transport, compared with that after treatment in regional hospitals, was also lower although not significantly. Mortality risk after neonatal transport was significantly associated with increasing transportation distance. The results of the study confirm that referral by maternal transport offers the best prospects for high risk preterm babies.

Female↗
PubMed1989

Morbidity of very low birthweight infants at corrected age of two years in a geographically defined population. Report from Project on Preterm and Small for gestational age infants in The Netherlands.

In a nationwide prospective survey on very preterm and very-low-birthweight infants in the Netherlands, a neurodevelopmental assessment was made at the corrected age of two years in a virtually complete population. The study achieved a 97.4% follow-up rate. A major handicap was found in 59 children and a minor handicap in 111 children (4.4% and 8.3% of liveborn infants, respectively). Unlike mortality, handicap was apparently unrelated to gestational age or birthweight.

Age Factors↗
PubMed1989

The male disadvantage in very low birthweight infants: does it really exist?

In a nationwide collaborative study in the Netherlands, perinatal and follow up data were collected on 1338 liveborn very preterm (less than 32 weeks) and/or very low birthweight (VLBW) infants (less than 1500 g). In this group, the mortality risk was similar for both male and female infants. The handicap risk, however, was significantly greater for boys than for girls. This finding could not be explained as being due to the well-known delay in lung maturation in male infants as in idiopathic respiratory distress syndrome and need of assisted ventilation.

Birth Weight↗
PubMed1989

The viability of the preterm infant.

Viability is the capability of the liveborn infant to survive without major handicaps. Although opinions differ in the Netherlands as to the justification of starting treatment in infants of less than 26 weeks gestation, our preliminary results indicate that mortality and major-handicap rate do not differ in infants of less than 26 weeks compared to infants of 26 and 27 weeks. However, we should encourage preventive perinatal medicine in order to reduce the alarming high rate of major handicaps in all extremely preterm infants.

Gestational Age↗
PubMed1989

Twenty-two years of intra-uterine intraperitoneal transfusions.

Over a period of 22 years, 154 fetuses were treated with 270 intra-uterine intraperitoneal transfusions. The patients were divided into three groups, according to the period they were treated. The overall percentage of surviving infants increased from 33% during the first period to 58% in the last period. In the group of infants that were not hydropic at the time of the first transfusion, the survival rate increased from 35 to 83%. In the group of children that were hydropic during the first transfusion, the survival rate during the first and last period was 24 and 42%, respectively. The percentage of fetuses that needed their first transfusion before the 26th week of pregnancy increased from 15 to 32% during the study period. Only 13% of these children survived. Lately, the intravascular approach has been introduced. Intravascular transfusions seem to be very effective, especially in early pregnancies and in hydropic fetuses. Application of the two techniques each in the most appropriate situation might offer optimal results for the near future.

Blood Transfusion, Intrauterine↗