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Biomedical subjects

J P Relier

Publications and source records attributed to J P Relier.

At least 37 records · Page 2Linked to original sources
PubMed1989

Neonatal diagnosis of respiratory distress syndrome.

After a brief historical recall, this review states the needs for an accurate diagnosis of the neonatal respiratory distress syndrome (RDS). The clinical features consist of disturbances of respiratory rate, grunting, intercostal retractions, and cyanosis, but early mechanical ventilation tends to suppress most of them. Laboratory findings include hypoxemia, hypercapnia, and mixed acidosis. Positive radiological diagnosis remains an important criterion but early ventilation with positive end-expiratory pressure has made grading obsolete. The biochemical diagnosis addresses the basic lung surfactant deficiency, by determination of the lecithin/sphingomyelin ratio and phosphatidylglycerol ("modified lung profile") in lung effluents at birth. If clinical and radiological diagnosis remains adequate for daily practice and epidemiological studies, biochemical diagnosis should be mandatory for therapeutic trials. However, the problem of atypical RDS in very low birth weight infants has not been totally solved. RDS has now been known for more than 80 years; yet its diagnosis is still a matter of controversy.

Humans↗
PubMed1988

Neurodevelopmental outcome in cystic periventricular leukomalacia (CPVL) (30 cases).

Thirty infant survivors had a wide spectrum of neonatal cystic periventricular leukomalacia (CPVL) diagnosed by ultrasound scans: 11 minor forms, 12 moderate forms, 7 major forms (categorized by both sagittal extent and coronal thickness). Eight cases were pure CPVL and 22 were associated with minor to moderate peri-intraventricular haemorrhage (PIVH), i.e. from (0-I) to (II-II). Mean gestational age: 31 +/- 2 weeks; mean birthweight: 1,532 +/- 356 g. The length of neurodevelopmental (ND) follow-up ranged from 13 months to 3 years and eight months. Of 11 children with minor CPVL, 9 were normal and two had moderate sequelae. Of 12 moderate CPVL, one was lost to follow-up, one had no motor disturbance but did have severe mental retardation (partial 7 p-), two were normal, one had a minor sequela, three had moderate and four had severe sequelae. Of the 7 major CPVL, one had moderate and 6 had severe sequelae. Cases including posterior lesions or presenting solely with such lesions had a worse outcome. In that range of PIVH, the outcome was related to the severity of CPVL and not to PIVH grade. All major late dilatations were associated with severe ND sequelae. Of 29 infants with early EEG tracings, the 7 children with early severe EEG abnormalities all had severe ND sequelae; 17 persistent EEG abnormalities, even mild, were associated with 9 severe and five moderate ND sequelae, and three normal outcomes. Combining US scans and EEG gives valuable prognostic information in minor and major CPVL, but less in the moderate forms.

Brain↗
PubMed1988

Comparison of antihypertensive efficacy and perinatal safety of labetalol and methyldopa in the treatment of hypertension in pregnancy: a randomized controlled trial.

Labetalol was compared with methyldopa in a randomized controlled trial involving 176 pregnant women with mild to moderate hypertension. Diastolic blood pressure below 86 mmHg was obtained in a similar proportion of women given labetalol or methyldopa. Intrauterine death occurred in four women treated with methyldopa, and the one neonatal death on day 1 occurred in the labetalol group. The average birthweight and the proportion of preterm or small-for-gestational-age babies were similar in both groups. Heart rate, blood pressure, blood glucose, respiratory rate, and Silverman score of the babies did not differ between the two treatment groups, whether the comparison was made for all the infants, or only for those that were preterm or small-for-gestational-age. These data indicate that maternal beta-blockade with labetalol is as safe as methyldopa for the fetus and the newborn.

Adult↗
PubMed1988

Urocytogram, an index of maturity in premature infants.

Cellular material found in urinary sediment stems essentially from exfoliated cells of the vesical triangle whose morphology is under the influence of the sex hormones. The study of cellular modifications forms the basis of a cytological procedure--the urocytogram. The urocytograms of 103 newborns, both premature and full term, made in the intensive care unit of the Department of Neonatal Medicine, Port-Royal Hospital, Paris, showed that marked changes in hormonal impregnation occur as a function of gestational age and permitted the establishment of a maturation index for the epithelium of the vesical triangle. In boys, the percentage of basal cells varied from 17.30 at 28 weeks' gestational age to 31.64 at term; while in girls the variation were less marked: 0.20 at 28 weeks to 1.37 at term. The oestrogen index (OI) was higher in a girl at 28 weeks (OI = 45.20) than in a girl born at term (OI = 13.50). The lower the gestational age the higher the pyknotic index (PI = 52.80 at 28 weeks), and the latter decreased as gestational age rose (PI = 23.12 at term). In boys, the oestrogen and pyknotic indices showed less variation (18.50 at 28 weeks and 15.29 at term). It thus appears that the urocytogram, a totally nontraumatic examination of urine samples obtained by simple miction, has its place among the tests of fetal maturity.

Cell Nucleus↗
PubMed1988

[Neonatal cystic leukomalacia. Perinatal case histories of 30 survivors].

In 30 surviving neonates, close prolonged ultrasonographic brain studies demonstrated cystic periventricular leucomalacias (CPVL) of varying degree (11 minor forms, 12 moderate forms, 7 severe forms). Clinical histories were reviewed for each case. There were 18 boys, 4 twins, 2 small-for-dates. Mean gestational age was 31 +/- 2 weeks, mean birthweight was 1532 +/- 356 g. No pregnancy was normal, but prenatal events were of a common occurrence in 26/30 cases (premature labor, toxaemia, twins...). Immediate perinatal events included cord difficulties in 5 cases (3 tight cords around the neck, 1 prolapse, 1 case where loose cord around the neck came down with the head), abruptio placentae (2), acute fetal distress (10, of which 8 were severe), Apgar scores 0-1 (9, of which 7 occurred after fetal distress and 2 were unexpected). In four cases, CPVL were of antenatal origin (already in the cystic stage on days 1-2). In 2 cases, CPVL occurred postnatally (infective shock on day 1 and day 46). Plausible mechanisms for anoxic-ischaemic lesions could only be found in 13 cases and remained unknown in the other 17. However, clinical histories suggested the following; cumulative minor events might become as damaging as single major events; "minor" fetal distresses should be scrutinized; pregnant women should be taught not to wait until late to arrive at hospital because this results in non-monitored delivery. No obvious relationship was found between the severity of known events and the degree of CPVL, but a number of pre- and perinatal periods were poorly monitored. The legal importance of early ultrasonographic studies was stressed.

Encephalomalacia↗
PubMed1987

[Maternal effects and perinatal safety of labetalol in the treatment of hypertension in pregnancy. Comparison with methyldopa in a randomized cooperative trial].

Labetalol was compared with methyldopa in a randomised trial involving 176 pregnant women with mild to moderate hypertension. Effective blood pressure control (diastolic pressure below 86 mmHg) was obtained in a similar proportion of mothers given labetalol or methyldopa, but the addition of a complementary treatment to achieve control was less frequently needed in the labetalol than in the methyldopa group (12/91 vs 22/85 p less than 0.05). Side effects were mild and resulted in discontinuation of the randomised treatment in 1 mother given labetalol. Pregnancy was terminated by intrauterine death in 4 mothers given methyldopa, and one neonate born to a patient allocated to labetalol died at day 1. The average birthweight and the proportion of premature delivery or of small for gestational age newborns were similar in both treatment groups. Heart rate, blood pressure, respiratory rate and blood glucose did not differ between infants born to the mothers of the labetalol and the methyldopa groups, irrespective of gestational age at birth or birthweight. Blood pressure control is more frequently achieved in hypertensive pregnancies with labetalol than with methyldopa as a first line treatment. Labetalol is safe to the fetus and newborn and might offer a better prevention of intrauterine death than methyldopa.

Adult↗
PubMed1987

[Evaluation of peri-intraventricular hemorrhages in newborn infants taking into account laterality and parenchymal location. Application to 323 consecutive cases].

An abbreviated scoring system for PIVH was derived from Papile's one: completed by a 0 for normal pattern, abcd divisions of each cerebral hemisphere for localization of parenchymal haemorrhages, and scoring of each side separately. The scoring system was applied to a consecutive series of 323 PIVH (1981-1984). Unilateral haemorrhages (123) accounted for 38% of all PIVH; they were almost exclusively grade I and II, and more frequently left-sided: 90 left and 33 right H. Of 200 bilateral haemorrhages, 127 were of equal severity on both sides, but left H. were more severe than right ones in 46/73 asymmetrical bilateral H. The survival rate was 91% in overall grade I H., 84% in overall grade II H., with little difference between uni- and bilateral H., 43% in overall grade III H. (34% in bilateral grade III), 28% in overall grade IV H. (1/11 in bilateral grade IV H). The extent of parenchymal H. only bore a partial relationship to the severity of the associated SEH-IVH, only half of the parenchymal haemorrhages being associated with grade III IVH on the same side, and only half of the unilateral PH being associated with a more severe SEH-IVH on the same side. The various former scoring systems have been reviewed. The interest of assessing both cerebral hemispheres separately and of evaluating the extent and location of PH is stressed.

Cerebral Hemorrhage↗
PubMed1987

[Short, middle and long-term outcome of major peri-intraventricular hemorrhages].

Within 4 years 10 months (1981-1985), the Port-Royal Neonatal Intensive Care Unit admitted 2,400 neonates, one third with a birthweight below 1,501 g; 4,631 cranial ultrasound studies were performed in 1,488 of those neonates, mostly less than 1,501 g, detecting 392 consecutive peri-intraventricular hemorrhages (PIVH), of which 130 were major forms (from unilateral grade III to bilateral grade IV PIVH). Overall survival rates were 91% in grade I, 85% in grade II, 42% in grade III, 26% in grade IV; survival rate was significantly lower in bilateral than in unilateral grade II and III PIVH. In major PIVH, deaths occurred early (58% in the first week after birth). Post-hemorrhagic dilatation was constant but mostly regressive; true active hydrocephalus appeared in 1 unilateral grade III PIVH and 8 bilateral grade III PIVH, with ventriculo-peritoneal shunt in the second month of life in 5 infants (2 died), and 4 deaths (surgery not feasible). The neurological and developmental outcome of 42 of 46 survivors (4 losts to follow-up) was evaluated beyond one year of age in 12 unilateral grade III PIVH (10 normal children, 1 minor sequela, 1 moderate sequela), 16 bilateral grade III PIVH (7 normal children, 3 minor sequelae, 1 moderate sequela, 5 major sequelae), 13 unilateral grade IV PIVH (8 normal children, 1 minor sequela, 3 moderate sequelae, 1 major sequela), 1 bilateral grade IV PIVH (major sequela). A persistent major dilatation after 6-9 months of age bore an ominous prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Cerebral Hemorrhage↗
PubMed1987

[Cardiovascular and digestive effects of 2 mydriatics in the low-birth-weight newborn infant].

We studied the pupillary cardiovascular and gastrointestinal effects of two parasympathetic blocker mydriatics. Thirty-four neonates were randomly assigned into 3 groups: A: Atropine sulfate 0.3%, B: Tropicamide 0.5%, C: placebo. Mydriasis was obtained in groups A and B (p less than 0.001). No hypertension was observed and only an increase in heart rate with atropine was significant (p less than 0.001). Gastrointestinal side-effects studied in 25 children revealed a disturbance in groups A and B as compared to placebo (p less than 0.01). Tropicamide is therefore a more useful drug in low birth weight infants due to the absence of cardiovascular and hypertensive side-effects. Those infants with gastrointestinal disease should be treated with caution due to the side-effects which may be encountered.

Atropine↗
PubMed1987

[Sudden infant death. Family and socio-cultural state and psycho-affective balance].

This analysis presents 400 cases of children at risk for sudden infant death syndrome (SIDS) who were followed at the Port-Royal SIDS-clinic from 1981 to 1984. The 400 cases included: 107 children seen after a severe accident ("near-miss"), 20 twins from pairs stricken by 1 SIDS and 9 twins from near-miss pairs, 264 SIDS-siblings. The following risk factors were searched for: a) low socioeconomical level, b) marital difficulties, c) psychological or psychiatric disturbances in mother and/or father, d) pathological gynecologic and/or obstetric history (sterility, gestational and/or delivery accidents), e) unwanted pregnancy, f) perinatal morbidity. In deaths from SIDS or near-miss infants, 34% cumulated 2 factors, 26% 3 factors, 8% 4 factors; only 2% had no known factor. In addition, a few deaths or severe accidents occurred within a short delay after a travel or a change in daycare; the role of these coincidences should be studied; meanwhile, the authors emphasize the need for a special attention to the quality of the child's environment, as a basic factor for a harmonious development.

Diseases in Twins↗
PubMed1986

Degree of dependence on the ventilator according to sleep states in artificially ventilated premature infants.

Polygraphic recordings were performed in 14 sleeping premature infants receiving ventilation for respiratory distress syndrome. All were clinically stabilized, with normal EEG and neurologic status and differentiated sleep states (coded according to EEG and REM criteria). They all had two respiratory patterns: passive, completely dependent on the ventilator, and active, with autonomous respiratory movements and/or inspiratory diaphragmatic activity added to passive respiration. We found that in infants ventilated at the rate of 18-54/min, respiration was more active and autonomous in active REM sleep and more passive and dependent on the machine in quiet NREM sleep (P less than 0.005). Within the limits of the values observed in our study, differences between sleep states were not due to other factors that could possibly interfere with and modify the degree of respiratory autonomy. We found no significant correlation between the percentage of time passed with active respiration on one hand and age (gestational, postnatal, conceptional) or diagnostic or physical parameters of artificial ventilation and blood gas levels on the other hand. Our results suggest that in artificially ventilated but neurologically normal premature infants, differences between respiratory control in both sleep states exist as early as 28 weeks conceptional age (lower limit of our study).

Age Factors↗
PubMed1986

Neonatal electroencephalography during the first twenty-four hours of life in full-term newborn infants.

Analysis of 84 EEGs recorded during the first 24 hours of life in 80 full-term newborns admitted in intensive care unit for different reasons. - 35 died, 45 survived (normal outcome: 30, minor sequelae: 6, major sequelae: 9). Extremely abnormal EEGs (27 cases) demonstrated singly or in combination: electrical discharges - isoelectric activity (after 10 hours of life) - Permanent discontinuous activity with longest interval greater than 40 seconds, shortest interburst interval greater than 3 seconds, longest burst shorter than 6 seconds. These abnormalities were observed in babies with unfavourable outcome. Normal or minimally abnormal EEGs (31 cases) were observed in babies with normal outcome (21 cases), minor sequelae (3) or in babies died without cerebral injury at autopsy. Twenty-two EEGs could not be classified easily after a single recording, most of then obtained before the 10th hour of life. Sleep state organization was assessed in 56 neonates; sleep state organization was present in 11 infants (normal outcome or minor sequelae). The EEG of the first day of life can be a useful tool in assessing the degree of early cerebral injury in infants requiring intensive care.

Brain↗
PubMed1986

[Comparison of 2 semi-quantitative methods for evaluating blood glucose in newborn infants].

Blood glucose levels were assessed in 49 neonates, using 2 blood glucose test strips. Results were compared to blood glucose levels. Correlations between values from the test strips and values from the laboratory were better using the Haemo-Glukotest (r = 0.91) than using the Dextrostix (r = 0.82). As compared to values from the laboratory, however, both glucose test strips gave higher values and did not properly identify all cases of hypoglycemia.

Blood Glucose↗
PubMed1986

Influence of breathing pattern on functional residual capacity in sleeping newborn infants.

The present study was designed to assess the influence of breathing pattern on the variations of functional residual capacity during sleep in newborn infants. Functional residual capacity was measured by the He-dilution method. Neurophysiologic criteria were used to identify sleep states. Movements of chest and abdomen were monitored. Twenty-six healthy newborn infants were studied. Sixteen were premature and 10 were at term. Functional residual capacity did not change in relation to changes in sleep states. In active sleep it was 1.48 +/- 0.07 ml/cm compared with 1.50 +/- 0.06 ml/cm in quiet sleep. Functional residual capacity decreased when rib cage and abdomen moved out-of-phase with a value of 1.38 +/- 0.09 ml/cm as compared to 1.56 +/- 0.09 ml/cm when in phase (P less than 0.01), in the 7 infants who displayed these two opposite patterns.

Functional Residual Capacity↗
PubMed1985

Comparative efficacy of theophylline and caffeine in the treatment of idiopathic apnea in premature infants.

The purpose of our prospective randomized study was to compare the efficacy of theophylline ethylenediamine and caffeine sodium citrate in the treatment of idiopathic apnea in premature infants. Sixteen infants with three or more severe apneic attacks were studied. Twenty-four-hour cardiorespiratory recordings immediately before and after randomization and four days later showed similar significant decreases of the apnea frequency in both theophylline- (group 1, n = 8) and caffeine-treated infants (group 2, n = 8). No undesirable side effects were observed, except for tachycardia in one infant in group 1. We suggest reasons for preferring caffeine to theophylline in the control of idiopathic apnea in premature infants: caffeine is as efficient and easier to administer.

Apnea↗
PubMed1985

Seizures and electrical discharges in premature infants.

Electro-clinical seizures or electrical discharges are described in fifty premature infants divided in two groups: group A (GA twenty-six to thirty-two weeks) = thirty cases - group B (GA thirty-three to thirty-six wks) = twenty cases. In both groups, electrical discharges were shorter than electro-clinical seizures; during seizures ocular manifestations were frequent; bradycardia occurred only in group A. Discharges were associated with other abnormalities (absence of normal EEG pattern, presence of rolandic positive spikes) more frequently in group B than in group A; they occurred without clinical manifestations or coma in nine cases. After anticonvulsant therapy during EEG recording, disappearance of clinical manifestations was observed in four cases with persistence of electrical discharges. In two cases, complete depression of electric activity occurred, lasting less than fifteen minutes. Relatively favourable outcome (15%) was observed with discharges lasting less than five minutes, and, in six cases out of seven, with presence of normal inter-ictal EEG background. EEG helps in recognition of atypical seizures and in assessment of therapeutic effect and prognosis.

Anticonvulsants↗