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Biomedical subjects

J M Perlman

Publications and source records attributed to J M Perlman.

88 records · Page 5Linked to original sources
PubMed1985

Episodes of apnea and bradycardia in the preterm newborn: impact on cerebral circulation.

The effect of episodes of apnea with bradycardia on cerebral circulation was studied during 101 episodes in 15 premature infants. The objectives of the study were to determine whether important alterations occur in cerebral hemodynamics with apnea and bradycardia and whether such alterations relate to systemic hemodynamic events. The transcutaneous Doppler technique was used to measure blood flow velocity in the anterior cerebral arteries. With episodes of apnea complicated by mild-to-moderate bradycardia (heart rate less than 120 or greater than 80), a decrease in diastolic flow velocity was noted with little or no change in systolic flow velocity. With episodes complicated by severe bradycardia (heart rate less than 80), the diastolic flow velocity fell to the electronic base line, and a progressive decrease in systolic flow velocity also was observed. Accompanying the changes in cerebral blood flow velocity were similar changes in arterial blood pressure. These data suggest potential deleterious hypoxic-ischemic effects on brain from apnea with severe bradycardia in the preterm infant.

Apnea↗
PubMed1984

Hypoxic-ischemic encephalopathy in term infants: diagnosis and prognosis evaluated by ultrasound.

The results of cranial ultrasonography in 32 term infants who had hypoxic-ischemic encephalopathy (HIE) and in 26 control infants were reviewed. Small or nonvisualized ventricles were present in 94% of the patients with HIE and in 62% of the control subjects. In 20 of the 32 patients (63%) with HIE, ultrasound demonstrated parenchymal abnormalities; the most common finding was periventricular hyperechogenicity (12/32 patients). There was a single false positive result in the control group. Fifty per cent of patients with HIE who had abnormalities demonstrated on ultrasonograms died (within 15 days of birth), whereas none of the infants who had normal ultrasound findings died. Moreover, 80% of surviving patients who had abnormal ultrasound findings had residual neurological deficits versus only 11% of those with normal ultrasound findings. Our results indicate that ultrasound is effective in detecting parenchymal changes in patients with HIE, parenchymal echoes are a more reliable sign of HIE than ventricular size, and the finding of parenchymal lesions on ultrasound scans appears to be predictive of abnormal motor development.

Brain Ischemia↗
PubMed1983

Fluctuating cerebral blood-flow velocity in respiratory-distress syndrome. Relation to the development of intraventricular hemorrhage.

We studied whether changes in cerebral blood-flow velocity occur during the respiratory-distress syndrome and whether, if present, they are related to the subsequent occurrence of intraventricular hemorrhage. Fifty infants weighing less than 1500 g at birth who required mechanical ventilation for the respiratory-distress syndrome were studied from the first hours of life. Blood-flow velocity in the anterior cerebral artery was measured at the anterior fontanel by means of the Doppler technique. At 12 hours of age, the infants had blood-flow velocity patterns that were either stable or fluctuating and that reflected the patterns of simultaneously recorded blood pressure. Intraventricular hemorrhage subsequently developed in 21 of 23 infants with the fluctuating pattern (in most of them, within the next 24 hours), but in only 7 of 27 infants with the stable pattern. Preliminary data suggest that the cerebral hemodynamic fluctuations are related to the respiratory disease and particularly to the mechanics of respiration. We conclude that the fluctuating pattern of cerebral blood-flow velocity in infants with the respiratory-distress syndrome indicates an extreme risk of the development of intraventricular hemorrhage and may represent a major and potentially preventable etiologic factor.

Blood Flow Velocity↗
PubMed1983

Seizures in the preterm infant: effects on cerebral blood flow velocity, intracranial pressure, and arterial blood pressure.

The relationship of neonatal seizures to changes in the cerebral circulation was studied in 12 premature newborn infants. The objectives of the study were to determine whether important alterations in cerebral hemodynamics occur with neonatal seizures and whether such alterations relate to systemic hemodynamic events. Blood flow velocity in the anterior cerebral arteries was measured by a transcutaneous Doppler technique. A marked increase in cerebral blood flow velocity was documented with seizures in every patient. The prominent changes in the cerebral circulation occurred despite the fact that 10 of the 12 infants had only subtle seizures and all 12 were receiving mechanical ventilation at the time of the seizures. Accompanying the increase in cerebral flow velocity was a marked increase in intracranial pressure. The cerebral hemodynamic changes appeared to reflect directly changes in systemic hemodynamic events, that is, a marked increase in blood pressure at the time of seizures. The increase in cerebral blood flow velocity with seizures, an apparent adaptive physiologic response in older individuals, may be maladaptive in the newborn infant with certain vulnerable capillary beds, such as the germinal matrix in the premature infant or the margins of an infarct in the asphyxiated infant.

Blood Flow Velocity↗
PubMed1983

Positron emission tomography in the newborn: extensive impairment of regional cerebral blood flow with intraventricular hemorrhage and hemorrhagic intracerebral involvement.

Of all patients with intraventricular hemorrhage, those with hemorrhagic intracerebral involvement exhibit the highest rates of mortality and neurologic morbidity and, indeed, account for the vast majority of all neurologic impairment in infants with intraventricular hemorrhage. Insight into the basic nature of the critical cerebral involvement requires determination of regional cerebral blood flow, previously not possible. Positron emission tomography (PET) now provides the capability of measuring regional cerebral blood flow with high resolution and little risk. In this study, we utilized PET in six premature infants (920 to 1,200 g) with major intraventricular hemorrhage and hemorrhagic intracerebral involvement to measure regional cerebral blood flow during the acute period (5 to 17 days of age). Cerebral blood flow was determined after intravenous injection of H2O, labeled with the positron-emitting isotope, 15O (oxygen 15). Findings were similar and dramatic in all six infants. In the area of hemorrhagic intracerebral involvement, little or no cerebral blood flow was detected. However, in addition, surprisingly, a marked two- to fourfold reduction in cerebral blood flow was observed throughout the affected hemisphere, well posterior and lateral to the intracerebral hematoma, including cerebral white matter and, to a lesser extent, frontal, temporal, and parietal cortex. In the one infant studied a second time, ie, at 3 months of age, the extent and severity of the decreased cerebral blood flows in the affected hemisphere were similar to those observed on the study during the neonatal period. At the three autopsies, the affected left hemisphere showed extensive infarction, corroborating the PET scans. These observations, the first demonstration of the use of PET in the determination of regional cerebral blood flow in the newborn, show marked impairments in regional cerebral blood flow in the hemisphere containing an apparently restricted intracerebral hematoma, indicating that the hemorrhagic intracerebral involvement is only a component of a much larger lesion, ischemic in basic nature, ie, an infarction. This large ischemic lesion explains the poor neurologic outcome in infants with intraventricular hemorrhage and hemorrhagic intracerebral involvement.

Acute Disease↗
PubMed1983

Intracerebellar hemorrhage in a premature newborn: diagnosis by real-time ultrasound and correlation with autopsy findings.

The identification of intracerebellar hemorrhage in a living premature infant by real-time ultrasound scan and confirmation of the findings at autopsy are described. This represents the first demonstration of the value of this noninvasive, convenient, and safe means of brain imaging in diagnosis of this lesion. Previous studies have described the role of the computed tomography (CT) scan in identification of intracerebellar hemorrhage in the newborn. Because infants with intracerebellar hemorrhage are usually critically ill, a means of identification of the lesion that could be utilized at the bedside rather than an approach that requires transport to a CT scanner is needed. This study indicates that portable real-time ultrasound scanning can satisfy that need.

Cerebellar Diseases↗
PubMed1983

Suctioning in the preterm infant: effects on cerebral blood flow velocity, intracranial pressure, and arterial blood pressure.

The relationship of suctioning to changes in the cerebral circulation was studied in 35 premature newborn infants. The objectives of the study were to determine whether important alterations occur in cerebral hemodynamics with suctioning and whether such alterations relate to systemic hemodynamic events. A transcutaneous Doppler technique was used to measure blood flow velocity in the anterior cerebral arteries. A prominent increase in cerebral blood flow velocity was documented in nearly all patients. Accompanying the increase in cerebral flow velocity was a marked increase in blood pressure; thus, the increased cerebral flow velocity appeared to reflect directly changes in systemic hemodynamic events. Also accompanying the increase in cerebral flow velocity was a marked increase in intracranial pressure. These data suggest potentially deleterious effects of suctioning in the preterm infant at risk for the occurrence of intraventricular hemorrhage and raise questions regarding the advisability of routine suctioning of such infants.

Blood Flow Velocity↗
PubMed1982

Cerebral blood flow velocity in relation to intraventricular hemorrhage in the premature newborn infant.

The relation of IVH to blood flow velocity in the anterior cerebral arteries has been studied in the premature newborn infant. The objectives of the study were to determine the effect of IVH on cerebral blood flow velocity, measured by a noninvasive Doppler technique, and to assess the reliability of this technique in the diagnosis of the hemorrhage. Thirty-two premature newborn infants with IVH were identified by real-time ultrasound scanning: IVH was present in the first 24 hours of life in approximately 50%, progressed postnatally in approximately 20%, and was severe in approximately 50%. Cerebral blood flow velocity, determined daily in the first five days of life, was compared to the time of occurrence of IVH and to simultaneous measurements of systemic blood pressure and blood gases. No consistent relationship between timing or severity of IVH and cerebral blood flow velocity could be discerned. We conclude that cerebral blood flow velocity in the anterior cerebral arteries is not likely to be affected by IVH and that the noninvasive Doppler technique for measurement of this velocity is not reliable for diagnosis of the lesion.

Blood Flow Velocity↗
PubMed1982

Relationship of pneumothorax to occurrence of intraventricular hemorrhage in the premature newborn.

The relationship of pneumothorax to the occurrence of intraventricular hemorrhage (IVH) has been studied in the premature newborn. The major objective of the study was to determine whether the systemic hemodynamic changes that occur with pneumothorax are reflected in the cerebral circulation and whether these changes play a role in pathogenesis of IVH. Blood flow velocity was measured in the anterior cerebral arteries by a transcutaneous Doppler technique in nine infants who developed pneumothorax in the first 3 days of life. At the time of pneumothorax there was a marked increase in flow velocity, especially during diastole, and, with resolution of pneumothorax, flow velocity returned to normal levels over the ensuing hours. The changes in flow velocity correlated closely with systemic hemodynamic changes that occurred with pneumothorax, ie, and increase in mean systemic blood pressure, especially diastolic pressure. IVH, documented by serial ultrasound scans, was observed shortly after pneumothorax in the nine infants. The data thus demonstrate a marked increase in flow velocity in the cerebral circulation at the time of pneumothorax. This increase is of importance in the genesis of IVH as is suggested further by the occurrence of IVH soon after the cerebral hemodynamic changes.

Birth Weight↗
PubMed1981

The effect of patent ductus arteriosus on flow velocity in the anterior cerebral arteries: ductal steal in the premature newborn infant.

Marked changes in blood flow velocity in the anterior cerebral arteries, measured by a Doppler technique, have been related to PDA in premature infants. Thus, 55 premature infants of birth weight less than 2,000 gm were studied. Ten developed PDA between days three and ten of life. A sharp decrease in diastolic flow velocity and an increase in pulse amplitude in the ACA was observed with the occurrence of PDA. Return of these values to normal occurred promptly following closure of the lesion. These changes in flow velocity and pulse amplitude in the ACA appear to be determined principally by changes in systemic diastolic pressure which accompany PDA. There was no consistent relationship between the changes in flow velocity and arterial PCO2 values. These data suggest that PDA may be involved in the genesis of ischemic and hemorrhagic cerebral injury in the premature newborn infant. Thus, the decrease in flow velocity appears to represent a "steal" of blood from the cerebral arteries, analogous to other documented steal phenomena observed in older patients. Major fluctuations of blood flow velocity in the ACA, with opening and closure of the PDA, and the increase in amplitude of each pulse with PDA may, in the presence of disturbed autoregulation, cause rupture of the capillaries of the germinal matrix and thus, IVH.

Blood Flow Velocity↗
PubMedDate not supplied

Brain death secondary to arteriovenous hemangioma of the forearm.

We describe the association of brain death in an infant with a large cutaneous hemangioma of the forearm. The irreversible cerebral injury is presumed to be secondary to cerebral hypoperfusion as a result of a combination of systemic hypotension and a systemic vascular "steal" phenomenon caused by the cutaneous hemangioma.

Brain Death↗
PubMedDate not supplied

Severe fetal acidemia: neonatal neurologic features and short-term outcome.

The objectives of this study were to determine if infants delivered with severe acidemia (cord umbilical arterial pH < 7.0) had short-term neurologic effects and whether infants with persistent bradycardia who received cardiopulmonary resuscitation (CPR) in the delivery room would be at greatest risk for subsequently developing neonatal seizures. Forty-seven infants (39 term, 8 preterm) delivered with severe fetal acidemia were studied. The mean (+/- S.D.) for pH, PaCO2, and base deficit for the 47 infants was 6.86 +/- 0.11, 97 +/- 22 mm Hg, and -17 +/- 4, respectively. Labor complications were common and included placental abruption in 8, ruptured uterus in 4, cord prolapse in 3, fetal heart rate decelerations in 12, and other (n = 14). Most infants were delivered via emergency cesarean section (n = 29). Delivery room interventions included oxygen and bag/mask ventilation only (n = 20) and intubation and ventilation (n = 22); 7 of 22 infants received CPR and epinephrine for persistent bradycardia (heart rate < 80 beats/min despite ventilatory support). Five infants required no intervention. Eight infants (17%) had seizures; 6 of these infants received CPR in the delivery room. Short-term outcomes were abnormal in 7 of 8 infants (i.e., death in 5, abnormal neurologic examination at discharge in 2). In 39 infants without seizures, 32 had transient neurologic abnormalities (i.e., irritability, hyperreflexia, proximal hypotonia) which resolved by discharge, and 2 had abnormal and 5 normal examinations.(ABSTRACT TRUNCATED AT 250 WORDS)

Acid-Base Equilibrium↗
PubMedDate not supplied

Intraventricular hemorrhage and fetal heart rate in very low birth weight infants.

OBJECTIVE: This study was designed to investigate the relationship between fetal heart rate patterns before delivery and periventricular-intraventricular hemorrhage in the very low birth weight infant. STUDY DESIGN: The last 30 minutes of electronic fetal heart rate data preceding delivery were analyzed for 84 singleton infants weighing between 700 and 1500 gm. All these infants received serial cranial ultrasonographic examinations commencing within 24 to 48 hours of birth. RESULTS: Thirty-three fetuses had normal heart rate patterns, and 51 had fetal heart rate abnormalities. Periventricular-intraventricular hemorrhage was not associated with fetal heart rate abnormalities. Univariate and multivariate regression analysis demonstrated that only gestational age < 28 weeks was a significant contributing factor to periventricular-intraventricular hemorrhage (odds ratio 2.2, 95% confidence interval [CI], 1.0 to 4.8). CONCLUSION: Fetal heart rate patterns immediately preceding delivery are not predictive of periventricular-intraventricular hemorrhage in the very low birth weight infant.

Adult↗