Search PubMed⌕ Search

Biomedical subjects

J V Aranda

Publications and source records attributed to J V Aranda.

At least 91 records · Page 5Linked to original sources
PubMed1983

Factors associated with adverse drug reactions in the newborn.

Risk factors associated with the occurrence of adverse drug reactions were evaluated in 1,200 neonates in an intensive care setting. Three-hundred-and-twenty-six neonates (27.1%) developed at least one ADR, 153 of whom had moderate to severe (fatal or life threatening) ADR. Severe prematurity (less than 28 weeks) gestation and diseases of prematurity (eg, RDS, apnea, and necrotizing enterocolitis) as well as the use of mechanical ventilation and parenteral nutrition were associated with highly significant increase in ADR occurrence. Impairment of liver and renal function both predisposed neonates to develop ADR.

Drug-Related Side Effects and Adverse Reactions↗
PubMed1982

Epidemiology of adverse drug reactions in the newborn.

A prospective study on the epidemiology of adverse drug reactions (ADR) in the 200 neonates consecutively admitted to a newborn intensive care unit had shown that 136 ADR occurred in 60 babies (incidence = 30%). 20 of these ADR (14.7%) were major (life-threatening), 34 (25%) were moderate (prolonged hospital stay) and 82 (60.3%) were minor (resolved spontaneously, no therapy required). Respiratory depression, cardiac arrhythmias, renal failure, metabolic abnormalities (hyperglycemia, electrolyte imbalance) and gastrointestinal bleeding were the most common major and moderate ADR. Hematologic (eosinophilia, thrombocytopenia) and metabolic (lipemia, hyperglycemia) were the most frequent minor ADR. The case fatality rate is 5%. Most commonly suspected drugs associated with the ADR were cardiovascular drugs (tolazoline, digoxin, methoxamine), antibiotics, diuretics and components of intravenous nutrition solutions.

Gestational Age↗
PubMed1981

Vasodilator response and prediction of survival in congenital diaphragmatic hernia.

In an effort to find an accurate prediction of survival in congenital diaphragmatic hernia (CDH) patients with severe respiratory distress and persistent pulmonary hypertension, we reviewed the response to vasodilators and te clinical course of 13 patients with this condition. All patients had been operated upon within the first 24 hr of life and had postoperative descending aortic PaO2 values less than or equal to 50 torr on maximum ventilatory support. The only significant change in standard blood gas values after an intravenous test dose of 2 mg/kg of tolazoline was in the PaO2 (p less than 0.05). Patients with good response (PaO2 increase greater than 100 torr) survived. Patients with fair response (PaO2 increase between 20 and 100 torr) had equivocal survival. Patients with poor response (PaO2 increase less than 20 torr) died. There was a postoperative period up to several weeks of marked fluctuations in arterial oxygen tension in survivors before stability occurred. Vasodilator responsiveness appears to be an accurate, therapeutic indicator of the chances for survival in CDH patients with persistent pulmonary hypertension and right to left shunting.

Hernia, Diaphragmatic↗
PubMed1981

Pharmacologic considerations in the therapy of neonatal apnea.

Theophylline and caffeine are both effective stimulants of the central nervous system for the therapy of neonatal apnea. Both drugs are slowly eliminated from the body, and doses should be adjusted to account for this slow elimination. Interconversion of theophylline and caffeine occurs in the newborn infant, with the methylation of theophylline to caffeine as the probable predominant pathway. Caffeine may offer advantages over theophylline: wider therapeutic index, case of administration, less need for therapeutic drug monitoring, less fluctuation in plasma concentrations, and fewer peripheral effects. A major disadvantage of caffeine is in the lack of a readily available commercial preparation. Both drugs exert many pharmacologic actions that require further evaluation in the newborn infant. Long-term effects of these drugs administered during a critical period in the developing human remains an area of concern.

Apnea↗
PubMed1981

Blood transfusion: a possible risk factor in retrolental fibroplasia.

The effect of blood transfusion on the occurrence of RLF was evaluated in 58 infants who weighed less than 1001 g at birth (Group I) and 70 oxygen treated infants of various birth weights (Group II). Although there was no significant difference between Group I infants with or without exchange transfusion as to birth weight, gestational age, duration of oxygen therapy, peak Pa02's, or multiple births, there was a significantly increased incidence of pre-retrolental fibroplasia in transfused over non-transfused Group II infants. When Group II infants were stratified for prematurity and oxygen duration, this difference persisted in those not already at risk for RLF. This increased incidence of retinopathy in transfused infants suggests that blood transfusion may be a risk factor in the pathogenesis of RLF.

Apnea↗
PubMed1981

Congenital diaphragmatic hernia: pathophysiology and pharmacologic support.

The incidence of death from congenital diaphragmatic hernia appears to be unchanged in recent years despite advances in resuscitation, transport, and ventilatory support. Bilateral lung hypoplasia and abnormal pulmonary vascular reactivity as developmental consequences of the defect appear to play a major role in the continued high mortality rate. Recent advances in pharmacologic support have further elucidated the mechanisms of ventilatory failure in these patients and may represent means of improving survival in the future.

Animals↗
PubMed1981

Adverse effects of caffeine and theophylline in the newborn infant.

The desirable effects of methylxanthine use in the neonate, appropriately prescribed and monitored, outweigh the importance of adverse effects. This view assumes that pharmacologic manipulation of apnea of prematurity is in itself a desirable goal and clearly superior to treatment of apneic episodes when they occur. While a considerable body of evidence supports this current practice, conclusive documentation awaits long-term follow-up studies.

Apnea↗
PubMed1980

Pharmacokinetics of diuretics and methylxanthines in the neonate.

The elimination of diuretics and methylxanthines is considerably slower in the neonate than in the adult. Dose guidelines, especially during long term maintenance, must be adjusted to account for this slower drug elimination. Pharmacokinetic studies and the requisite pharmacologic evaluation on diuretics such as hydrochlorothiazide, spironolactone, ethacrynic acid and others should be done. Furosemide undergoes biotransformation in the newborn producing an acid metabolite and a glucuronide conjugate. Methylxanthines are effective in the treatment of neonatal apnea. Plasma elimination of theophylline is exceedingly slow, more so with caffeine. Decreased elimination is partly explained by decreased oxidative biotransformation. Caffeine is excreted in the urine of the newborn mainly unchanged (85%) in contrast to the adult where caffeine is a minor portion of urinary excretion (2%). Theophylline is methylated to caffeine and may possibly exert additive pharmacologic effects.

Bilirubin↗
PubMed1980

Tolazoline therapy for persistent pulmonary hypertension after congenital diaphragmatic hernia repair.

To determine whether vasodilators are useful in persistent pulmonary hypertension associated with congenital diaphragmatic hernia, we reviewed the clinical course, laboratory data, and outcome of 37 patients with respiratory distress and diaphragmatic hernia requiring an operation before 24 hours of life. These patients were divided into two groups, Group I (n = 17) included patients treated prior to the use of tolazoline; Group II (n = 20) included those treated after tolazoline became available. Postoperative severe respiratory distress was observed in ten patients in Group I, and all died. In Group II, 16 patients had severe postoperative respiratory distress and four survived; 12 of these 16 patients received tolazoline, including all four survivors. Treated survivors had significantly higher increase in Pao2 after a test dose of tolazoline than did nonsurvivors. A transient "honeymoon period" of adequate oxygenation correlated with good response to tolazoline, and the presence of both was predictive of survival. No patient survived with the combination of no "honeymoon period" and no response to tolazoline, whereas response to tolazoline without a honeymoon period was sometimes followed by survival. All nonsurvivors had severe lung hypoplasia at autopsy.

Blood Gas Analysis↗
PubMed1980

Drug monitoring in the perinatal patient: uses and abuses.

Measurements of concentrations for drugs from plasma or biological fluids taken together with the clinical status of the newborn infant may provide better assurance of avoiding potentially dangerous over- or underdosing. They are also useful as guidelines in requisite clinical trials and study designs. To the developmental biologist and pharmacologist, they serve as potent biological probes for various events underlying biochemical differentiation or maturation in the human fetus and newborn infant. Future research developments in neonatal drug monitoring should include improvement of micro-methods for drug assays and refinement of noninvasive techniques for monitoring drug concentrations from biological fluids and for evaluation of drug effects.

Aging↗
PubMed1980

Risk factors in retrolental fibroplasia.

Possible determinant factors that may increase the risk of the occurrence of retrolental fibroplasia (RLF) were analyzed in 80 infants born in 1975 and 1976 with birth weights between 501 and 1,500 gm and who survived. Active and/or cicatricial RLF occurred in 27 (33.8%) infants and the factors significantly associated with RLF were: gestational age (P less than .001); apnea requiring bag and mask resuscitation with oxygen (P less than .001); septicemia (P less than .005); degree of illness; blood transfusion; and mechanical ventilation. Severe cicatricial RLF developed in eight (10%) infants (grades 2 to 5). In the group of infants all of whom had apnea which required resuscitation, septicemia was also significantly associated with RLF (P less than .01). A highly significant association between RLF and severe myopia (P less than .001) was found in follow-up in all infants. Data show a resurgence and high incidence of RLF in low birth weight infants who survived. Infants with these factors should be considered to have greater risk for the occurrence of RLF and ophthalmologic examination prior to, and within three months following discharge is recommended.

Apnea↗
PubMed1979

Metabolism of theophylline to caffeine in human fetal liver.

Caffeine (1,3,7-trimethylxanthine) is a biotransformation product of theophylline (1,3-dimethylxanthine) in the human fetus. Liver explants, obtained from human fetuses with gestational ages of 12 to 20 weeks, were incubated with theophylline and produced caffeine and, in lesser amounts, 1,3-dimethyluric acid and 3-methylxanthine. These findings suggest that the predominant pathway in theophylline metabolism in the fetus and newborn infant is the methylation reaction producing caffeine. This may contribute to the neonate's exceedingly slower elimination of caffeine relative to theophylline. Caffeine produced from theophylline may add to the pharmacologic effects of theophylline in newborn infants with apnea.

Apnea↗