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Biomedical subjects

J W Scanlon

Publications and source records attributed to J W Scanlon.

At least 19 recordsLinked to original sources
PubMed1994

Effect of surfactant on morbidity, mortality, and resource use in newborn infants weighing 500 to 1500 g.

BACKGROUND: The administration of surfactant decreased mortality, morbidity, and costs of care for very-low-birth-weight infants in clinical trials. The extent to which these benefits can be achieved in the usual clinical settings is not known. METHODS: We analyzed clinical and financial data obtained from 1985 to 1990 at 14 perinatal centers in the United States on 5629 neonates weighing 500 to 1500 g. The infants were divided into groups according to whether they were born before or after surfactant was introduced into clinical practice. Regression models controlling for race, sex, and birth weight were used to assess mortality, morbidity, and use of resources. Mortality rates specific for these variables were projected to the nation as a whole with reference to the 1985 U.S. birth cohort. RESULTS: The odds of death in the hospital for very-low-birth-weight infants were reduced by 30 percent after surfactant was introduced. Among infants with bronchopulmonary dysplasia, mortality declined 40 percent. Projections of mortality nationwide declined 5 percent. Eighty percent of the decline in the U.S. infant mortality rate between 1989 and 1990 could be attributed solely to the use of surfactant. Among the survivors, the overall odds of morbidity did not change, whether or not we adjusted for changes in race, sex, and birth weight. The odds of respiratory distress syndrome and pulmonary interstitial emphysema among the survivors declined by 20 percent and 40 percent, respectively, with surfactant. Inflation-adjusted charges per survivor declined by 10 percent, or $5,800, whereas the cost of care for each infant who died declined by 31 percent, or $4,400. CONCLUSIONS: The introduction of surfactant has led to decreased mortality and morbidity in very-low-birth-weight infants and to decreased use of resources both for infants who survive and for those who die.

Female↗
PubMed1990

Protective apathy, a hypothesis about the behavioral organization and its relation to clinical and physiologic status of the preterm infant during the newborn period.

This article describes the behavioral organization and its change in relation to physiologic and clinical variables in a group of infants whose birthweight was less than 1.5 kg and who were experiencing and recovering from acute cardiorespiratory illness. The authors used the Brazelton Premature Sale, which was designed for use with a wide range of gestational ages (27 to 35 weeks). Examinations began 1 week after birth and were obtained serially during the initial recovery period of these infants.

Child Behavior↗
PubMed1989

Dexamethasone therapy for chronic lung disease in ventilator- and oxygen-dependent infants: a controlled trial.

To determine whether dexamethasone therapy altered the outcome of chronic lung disease in neonates, we conducted a prospective, randomized, placebo-controlled trial. Twenty-one 30-day-old oxygen- and ventilator-dependent infants were enrolled. The mean (+/- SD) birth weight was 808.1 +/- 141 gm and the mean gestational age was 26.0 +/- 1.5 weeks. There were 17 black and 12 male infants. Twelve received placebo and nine received dexamethasone. Neither severity of early illness, birth weight, gestational age, age when treated, gender and race distribution, nor frequency of diuretic therapy differed significantly between groups. The age at extubation, 57.2 days (placebo) versus 39.4 days (steroid), was significantly different. The average oxygen requirements of the steroid-treated patients was significantly lower than for placebo-treated patients during the first 10 days of treatment. There were no differences for placebo-versus steroid-treated patients in age when weaned to room air (95.5 days vs 74.9 days), age at discharge (119 days vs 111 days), or number of deaths (2 (17%) vs 1 (11%]. Dexamethasone therapy was associated with a significantly increased incidence of hyperglycemia (89% vs 8%) but did not influence the incidence of hypertension, intracranial hemorrhage, infection, or retinopathy of prematurity. The steroid-treated patients had a significant delay in weight gain during the first 3 weeks of treatment but recovered by discharge. Our results suggest that dexamethasone produces acute improvement in infants with lung disease but no long-term effect on mortality rate, duration of oxygen requirement or age at discharge.

Bronchopulmonary Dysplasia↗
PubMed1984

Neonatal preference for visual patterns: modification by prenatal anesthetic exposure?

Exposure to anesthetic drugs during gestation has been shown to cause behavioral changes in rats, and exposure during labor and delivery also affects human neonatal behavior. In this preliminary study, nine neonates who had been exposed to anesthetic agents during gestation were tested for visual-pattern preference. These nine infants looked at the stimuli for statistically significantly longer periods compared with 30 non-exposed infants, and had significantly different preferences for some pairs of patterns. The results suggest that prenatal exposure to anesthetic agents may contribute to behavioral alterations in human neonates.

Adult↗
PubMed1984

Results of controlled double-blind study of thyroid replacement in very low-birth-weight premature infants with hypothyroxinemia.

The nature of hypothyroxinemia in sick very low-birth-weight (VLBW) infants was evaluated by assessment of the hypothalamic-pituitary axis and by the clinical response to thyroxine (T4) therapy. Twenty-three very low-birth-weight infants of gestational age 26 to 28 weeks, whose serum T4 concentrations were 4 micrograms/dL on two occasions, and thyrotropin less than 20 microU/mL, were included in a double-blind study. Following a thyrotropin-releasing hormone stimulation test, babies were given either T4 or placebo. Nine babies were thyrotropin-releasing hormone tested prior to therapy; four babies, two from each group, were tested 1 to 2 weeks after therapy. In 11 untreated babies, mean base line serum thyrotropin of 7.0 +/- 1.4 rose to 23.7 +/- 4.1 microU/mL in 30 minutes. This response was not significantly greater than the observed response in full-term babies, 23.7 +/- 4.1 v 16.6 +/- 0.97 microU/mL, respectively, P greater than .05. In two babies treated with T4 the thyrotropin response to thyrotropin-releasing hormone was completely suppressed. Serial serum T4 determinations showed normalization in both groups after a similar time interval. There was no beneficial effect of T4 therapy on growth of head circumference, length, or weight. Developmental data revealed no significant differences in the mental, motor, or gross neurologic outcome in the treated and nontreated infants after 1 year of follow-up. These observations imply that hypothyroxinemia in sick preterm infants is not a direct consequence of hypothyroidism. Despite the lack of demonstrable short-term beneficial effects of T4 therapy, follow-up studies are necessary to resolve the question of long-term benefits.

Body Height↗
PubMed1984

Use of intravenous fluids before cesarean section: effects on perinatal glucose, insulin, and sodium homeostasis.

Perinatal glucose, insulin, and sodium homeostases were assessed in relation to antepartum intravenous infusions administered to 59 normal mothers undergoing cesarean section at term without labor under epidural anesthesia. Group A (N = 20) received 1 L of Ringer's lactate without dextrose during one hour; group B (N = 20), 1 L of 5% dextrose in water during one hour; and group C (N = 19), 1 L of 5% dextrose in water during two and one half hours. Mean maternal and fetal serum glucose and insulin and sodium concentrations at delivery differed among all groups in direct relationship to the rate of glucose infusion. Neonatal hypoglycemia (30 mg/dL or less) correlated with the presence of a glucose infusion, a maternal glucose concentration of 117 mg/dL or greater, and an umbilical venous insulin concentration of 26 microU/mL or greater. Among group A patients who received sodium, and group B and C patients who did not, fetal hyponatremia (umbilical venous sodium 130 mEq/L or less) correlated with the absence of sodium in the prepartum infusion. The results suggest that the antepartum administration of a balanced electrolyte solution without excess glucose infusion can minimize the incidence of fetal hyperglycemia and hyponatremia and neonatal hypoglycemia.

Blood Glucose↗
PubMed1984

The impact of perinatal and neonatal events on the early behavior of the extremely premature human.

Observations were performed on 45 very low birth weight (VLBW) newborns at 7 and 21 days of life, using a Neonatal Behavioral Assessment Scale specifically modified for the extremely premature infant. Findings were analyzed using multiple and stepwise regression techniques to determine the influence of intrapartum and neonatal factors which might influence neurobehavior . Perinatal asphyxial descriptors accounted for significant variance on day 7 behavior; however, their impact was muted for day 21. At this time, jaundice and postnatal nutrition revealed a prominent and independent behavioral influence on the VLBW survivor.

Asphyxia Neonatorum↗
PubMed1983

Effect of theophylline on neurotransmitters in preterm infants with apnea.

Urinary excretion of various catecholamine metabolites (4-hydroxy-3-methoxymandelic acid, homovanillic acid, 3-methoxy-4-hydroxphenylglycol) was studied in preterm infants with idiopathic apnea treated with theophylline. Relief of apnea in these infants was not associated with significant increase in the urinary excretion of various metabolites. We suggest that theophylline does not seem to relieve apnea of prematurity by the stimulation of peripheral catecholamine systems.

Apnea↗