Necrotizing enterocolitis prophylaxis.
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Biomedical subjects
Publications and source records attributed to L Grylack.
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Fifteen newborn babies with azotemia without oliguria were studied. Group A infants had increased BUN levels and decreased creatinine clearance (Ccr) for gestational and postnatal age, and were compared with group B infants, who had increased BUN levels and normal Ccr. The Ccr was 0.35 mL/min in group A and 0.76 mL/min in group B. Urine volume during the same period was 2.45 mL/kg/hr in group A and 4.66 mL/kg/hr in group B. No significant differences in fractional sodium excretion; urine to plasma ratios of creatinine, osmolality, and sodium; and renal failure index were present between the two groups. The results suggest that nonoliguric acute renal failure is a diagnostic entity in the newborn. The Ccr is the most useful indicator for defining renal function in the presence of azotemia and normal urine volume.
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The effects of orally administered gentamicin and colistin on stool bacterial flora and overall antibiotic sensitivity patterns were evaluated in 100 newborns at risk for neonatal necrotizing enterocolitis. Gentamicin (2.5 mg/kg q6h) and colistin (1 mg/kg q6h) were administered to randomly selected groups of 50 newborns for 3 wk after birth during an 11-month study period. Stools were collected on days 1, 11, and 21 and cultures were grown under aerobic conditions on three different media. Staph. epidermidis was the most common predominant organism in both antibiotic groups, whereas E. coli and Klebsiella were the most common Gram-negative bacteria isolated. Seventeen % of these Gram-negative species were resistant to colistin and 9% to gentamicin, with a gradual increase occurring during the 3-wk period. On the basis of 980 positive cultures from all sites in babies in the nursery during the 11-month study, E. coli sensitivity to kanamycin and gentamicin ranged between 92% and 100% except for one month midway through the study when sensitivity to kanamycin was at 80% and then returned to the 92-100% range. Klebsiella sensitivity to both aminoglycosides remained greater than 95% throughout. The incidence of neonatal sepsis remained consistent at seven to nine per 1000 live births during the study. One baby of 50 in the gentamicin group developed necrotizing enterocolitis at 5 wk of age; 0/50 in the colistin group had necrotizing enterocolitis (not significant).
Serum gentamicin concentration was measured in 31 newborn babies who received oral gentamicin for prophylaxis of necrotizing enterocolitis in order to determine the presence and degree of gastrointestinal absorption and its relationship to birth weight, gestational age, postnatal age and perinatal asphyxia. A dose of 2.5 mg/kg every 6 h by nasogastric tube was administered during a 3-week course after birth. The mean birth weight was 1,269 +/- 489 g; mean gestational age 29.6 +/- 3.7 weeks. The mean serum gentamicin levels were: 0.06 +/- 0.03 microgram/ml at 30 min after the first dose; 0.29 +/- 0.48 microgram/ml at 4 h; 1.62 +/- 1.43 microgram/ml at 24 h, and 0.33 +/- 0.57 microgram/ml at 7 days. The 24-hour and 7-day samples were taken before the next dose. The mean 24-hour level was significantly (p less than 0.001) higher than the other levels. There was no significant (p less than 0.05) relationship between the 24-hour serum gentamicin level and birth weight, gestational age or umbilical venous pH.
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