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Biomedical subjects

J J Pomerance

Publications and source records attributed to J J Pomerance.

At least 37 records · Page 2Linked to original sources
PubMed1987

Maternally administered antenatal vitamin K1: effect on neonatal prothrombin activity, partial thromboplastin time, and intraventricular hemorrhage.

Infants weighing 1500 g or less at birth are susceptible to intraventricular hemorrhage. This may be due in part to low concentrations of vitamin K-dependent clotting factors. Women in labor between 24-34 weeks' gestation were selected, according to their hospital registration number, to receive 10 mg vitamin K1 intramuscularly at least four hours before delivery. Control women received no vitamin K. The study included only infants born of mothers who were in hospital more than four hours before delivery, who weighed 1500 g or less at birth, and were less than 34 weeks' gestation. Twenty vitamin K1 and 33 control infants qualified for the study. Infants in both groups received routine postnatal vitamin K1. On admission, the infant's prothrombin activity and partial thromboplastin time (PTT) were measured. A head ultrasound was done between days 2 and 4 of life. Results demonstrated significantly improved prothrombin activity, a nonsignificant trend toward improved PTT, and a significantly decreased frequency of intraventricular hemorrhage in infants whose mothers had received vitamin K1. The effect of antenatal vitamin K1 on prothrombin activity and PTT appeared to be more pronounced in female infants.

Blood Coagulation↗
PubMed1986

Alternative to diagnosis-related groups for newborn intensive care.

Clinical and billing data were collected on all admissions to six California newborn intensive care units during a 6-month period. Charges were adjusted to costs using Medicaid cost to charge ratios and for inflation, and patients were classified by the diagnosis-related group (DRG) system. Costs were from 97% to 708% more than the proposed DRG reimbursement levels. Regression analysis showed that DRGs explained 22% of the variation in costs. An alternative model using binary variables to control for birth weight, assisted ventilation, surgery, survival, multiple births, and mode of discharge explained 42% of the variation in costs. In contrast to other proposed DRG alternatives, this simple model does not require special training or subjective decision-making.

Birth Weight↗
PubMed1985

Cholecalciferol metabolites in polycythemic newborns.

Metabolites of cholecalciferol were measured in the sera of healthy and polycythemic newborns at 15.5 and 10.5 h of age (median), respectively. The serum concentrations of 1,25-dihydroxyvitamin D and 24,25-dihydroxyvitamin D were lower in the polycythemic group (P less than 0.003 and P less than 0.001, respectively). As the kidney is the main site of conversion of 25-hydroxyvitamin D to its dihydroxylated metabolites, it is possible that hyperviscosity and subsequent decrease in renal blood flow interfere with the efficiency of the process.

24,25-Dihydroxyvitamin D 3↗
PubMed1981

Successful surgical repair of iatrogenic lung perforation in a neonate.

Iatrogenic lung perforation during closed tube thoracostomy for pneumothorax in neonates apparently occurs with disturbing frequency. This potentially lethal complication may be minimized by strict adherence to proper technique. In addition, an added margin of safety may be established by allowing some air to remain in the pleural space prior to placement of a chest tube. If iatrogenic perforation of the lung occurs despite appropriate precautions, surgical intervention may be indicated.

Drainage↗
PubMed1981

Nonimmunologic hydrops fetalis.

Eight cases of nonimmunologic hydrops fetalis (HF) were seen at Cedars-Sinai Medical Center over a 3.5-year period. The etiology of the HF included 2 cases of fetal-maternal hemorrhage and 1 each of sacral teratoma, tachyarrhythmia, diaphragmatic hernia, neuroblastoma, and heart disease. For 1 infant, the cause was never found. These cases involved various diagnostic and therapeutic dilemmas. Only 4 were anticipated ant partum by ultrasound scanning. Two of the 8 fetuses died in utero, whereas 4 others died in the neonatal period. Earlier diagnosis and evaluation are likely to improve these outcomes.

Edema↗
PubMed1981

Differentiating environmental from disease-related fevers in the term newborn.

It is often difficult to differentiate environmental overheating from disease-related fever in the newborn. The purpose of this study was to establish the normal relationship between peripheral skin temperature and rectal temperature in normal newborn infants whose rectal temperatures were in the upper range of normal (99.0 to 99.6 F) and to compare it with that relationship in infants with fevers known to be disease related. Seventy-eight paired rectal and anterior mid-lower leg skin temperatures were obtained from 41 normal 2-day-old infants. Thirteen similar paired temperatures were measured in 13 full-term infants admitted from home with fever (greater than 100.0 F). The rectal temperature-leg temperature (RT-LT) difference in the normal infants ranged between -1 and +4 F, with a mean of +1.14 F, whereas in the febrile infants it ranged between +5.7 and 12.9 F with a mean of 7.90 F. In febrile infants there was no trend in RT-LT difference as rectal temperatures rose whereas normal infants showed a tendency toward a decreasing RT-LT difference with increasing temperatures. When an RT-LT difference of +3 F is chosen as an arbitrary boundary between environmentally overheated infants and infants with disease-related fevers, it is estimated that 0.5% of infants with disease-related fevers would be incorrectly classified. The RT-LT difference adds an objective guideline for evaluation of temperature elevation in the full-term, appropriate for gestational age neonate.

Body Temperature↗
PubMed1980

Womb rent.

The relationship between gestational age at delivery and the cost of neonatal care was analyzed for 137 infants of 24 to 34 weeks' gestation born between 1973 and 1977. Cost estimates were based on hospital charges actually collected, adjusted to 1977 rates and weighted according to a smoothed survival curve. The cost estimates varied according to gestational age, development of RDS, and both in turn were related to survival. The estimated cost per infant without regard to survival status was as follows: 24 weeks' gestation, $7,000/infant; a bimodal peak cost of $36,000/infant at 26 and again at 29 weeks' gestation; 34 weeks' gestation, $9,000/infant. Between 29 and 34 weeks' gestation the average cost of hospital care fell about $5,400/week or $772/day. At certain periods of gestation, safe postponement of delivery for even a few days may result in significant financial benefits.

Birth Weight↗
PubMed1980

The antepartum diagnosis of conjoined twins.

This is a case report in which the diagnosis of conjoined twins was made in a woman by ultrasonography in her eigth month of pregnancy. With this diagnosis, the mother-to-be was transported to a hospital with sophisticated obstetrical, neonatal, and pediatric surgical facilities. The twins were delivered by elective caesarian section and were seen to have anomalies requiring immediate surgery. Following stabilization and basic investigations, surgery was performed on the infants at 3 hr of age. This resulted in a condition that permitted a thorough postoperative work-up and elective separation several months later.

Adult↗
PubMed1978

Cost of living for infants weighing 1,000 grams or less at birth.

This article reports the in-hospital cost of caring for 75 infants weighing 1,000 gm or less at birth who were born during the 2 1/2-year period between January 1973 and June 1975. Thirty infants (40%) survived. Nineteen of 27 infants tested (70%) appear to be neurologically and developmentally "normal" at 1 to 3 years of age. Hospital charges were adjusted to September 1976 rates and corrected for a 94% collection rate. Physicians' fees represented less than 5% of the total bill and were not included. The average adjusted daily and total costs for the 45 infants who died were $825 and $14,236, respectively. The average adjusted daily and total costs for the 30 survivors were $450 and $40,287, respectively. The average adjusted total cost per "normal" survivor was $88,058. It is our belief that the outcome justifies this expense. Society, however, must be the ultimate judge.

Child Development↗
PubMed1977

A new approach to congenital posterolateral diaphragmatic hernia.

The theory is advanced that increased pulmonary vascular resistance, resulting in a state of fetal circulation, with right-to-left shunting through the ductus arteriosus, is the main reason that many patients do not survive after repair of a diaphragmatic hernia. Three patients are presented (who, by Raphaely's criteria, were destined for a fatal outcome) in whom the ductus was ligated, and vasodilator drugs were infused into the pulmonary artery. All three demonstrated definite improvement in oxygenation. Two expired after 6 days, one of whom was found at autopsy to have intestinal volvulus and gangrene, and the other multiple plumonary emboli. One case, so managed, survived. The suggestion is made that pulmonary hypoplasia is not the main reason for the high mortality rate after diaphragmatic hernia repair, and that additional laboratory and clinical investigation of the pulmonary circulation may lead to significant improvement in results.

Acetylcholine↗