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Biomedical subjects

L S James

Publications and source records attributed to L S James.

At least 55 records · Page 3Linked to original sources
PubMed1981

Premature rupture of membranes, preterm delivery, and group B streptococcal colonization of mothers.

In a prospective study of colonization with group B streptococci (GBS) among 6,706 parturients, we found statistically increased incidences of premature rupture of membranes (PROM) and preterm delivery at less than 32 weeks' gestation among women colonized with GBS. PROM occurred in 8.1% of the total population but in 15.3% of the colonized population (p less than 0.005). Preterm delivery at less than 32 weeks' gestation occurred in 1.8% of the total population but among 5.4% of women colonized with GBS (p less than 0.005). The data suggest a causal relationship between GBS colonization and events leading to preterm birth. The possible impact of eradication of colonization with GBS on prematurity is considered.

Female↗
PubMed1981

Bradycardia in the fetal baboon following paracervical block anesthesia.

In order to define the causal relationship between the use of local anesthetics and fetal bradycardia, paracervical block anesthesia (PCB) with lidocaine of 2-chloroprocaine was induced on 52 occasions to 27 pregnant baboons. The dosages were comparable to those used clinically on the basis of maternal body weight. On 40 occasions, PCB was induced with nonasphyxiated (normal) fetuses, 33% of which developed fetal bradycardia after PCB. Fifty percent of these episodes of fetal bradycardia were accompanied by a decrease in PaO2. The other 12 fetuses had pHa less than 7.25, and SaO2 less than 25%, and all exhibited bradycardia with further decreases in pHa and PaO2. A transient increase in uterine activity with a significant reduction in uterine blood flow occurred in 73% of the mothers after PCB. Peak concentrations of lidocaine of 2.3 +/- 0.2 (SE) micrograms/ml in the maternal blood and 0.8 +/- 0.2 micrograms/ml in the fetal blood were found at 8 min after PCB. These levels were far below those associated with myocardial toxicity. The conclusion is that the fetal bradycardia subsequent to PCB is, in part, caused by a decrease in the oxygen available to the fetus secondary to an increase in uterine activity and a reduction in uteroplacental perfusion. This manifestation may occur at drug concentrations in both the mother and fetus that are far below toxic levels.

Anesthesia, Local↗
PubMed1981

Continuous monitoring of PO2 during apnea of prematurity.

We studied the changes in PO2 during 72 isolated episodes of apnea of prematurity in 20 low-birth-weight infants. A stable PO2 prior to the onset of apnea was observed in 65% of the episodes. A falling PO2 was noted in only 18% of the cases. The mean initial PO2 was 75 mm Hg and no infant was hypoxic (PO2less than 40 mm Hg) immediately prior to apnea. The mean PO2 fell to 60 mm Hg at the end of apnea and continued to fall to a mean low PO2 of 46 mm Hg. The mean PO2 at recovery was 79 mm Hg. We concluded that in this group of premature infants, hypoxia is not the initiating even in the apnea of prematurity. Furthermore, we noted that arterial oxygen tension continues to fall despite the reestablishment of respiratory efforts, that the rate of recovery from apnea is slower than the rate of fall, and that bradycardia associated with apnea is not initiated by hypoxemia.

Apnea↗
PubMed1981

Continuous measurement of minute ventilation and gaseous metabolism of newborn infants.

A system of instrumentation for continuous measurement of gaseous metabolism and minute volume (VI) in the human newborn is described. O2 uptake and CO2 production are measured by open-circuit techniques utilizing a Servomex OA184 differential paramagnetic O2 analyzer and a BEckman LB-2 infrared CO2 analyzer. VI is measured with bias-flow pneumotachometry. Bench performance is described, methodological errors are defined, and clinical data are presented. The instrumentation is capable of safe, accurate, and continuous measurement of respiratory and metabolic variables in low-birth-weight infants.

Calorimetry↗
PubMed1981

Spontaneous variability in minute ventilation oxygen consumption and heart rate of low birth weight infants.

Continuous measurements of minute ventilation (VI), oxygen consumption (VO2), heart rate (HR), activity, and temperature were made in eleven low birth weight infants during the interval between feedings. Significant increases in VI, VO2, and HR were noted between quiet and active sleep. (VI Active - VI Quiet/VI Quiet) X 100 = 18.4% VO2 Active - VO2 Quiet/VO2 Quiet) X 100 = 10.1% and HR Active - HR Quiet/HR Quiet) X 100 = 6.4%. Significant differences were also noted within epochs of the same state of sleep: mean slope VI versus time in epoch (t) = -156 ml/kg . min/hr, VO2 versus t. = 1.49 ml/kg . min/hr and HR versus t = -15.0 beats/min/hr. Differences between successive epochs of the same state of sleep were also observed: VI, +5.9 to 46.6%; VO2, 4.7 to 24.6%; HR, 1.0 to 9.7%. These differences were related to the length of time after feeding. These data indicate that steady state conditions do not occur in growing low birth weight infants and that the design of studies of respiration and metabolism in these infants should include continuous assessment of the state of sleep or activity and time after feeding to ensure that experimental and control periods are truly comparable.

Heart Rate↗
PubMed1981

Release of vasopressin by the fetal lamb during premature parturition induced with corticotropin.

These studies were implemented to assess the relationship between fetal vasopressin secretion and the progression of parturition as well as the contribution of specific stimuli to vasopressin release during labor. In chronically catheterized fetal lamb preparations, labor was induced by infusion of adrenocorticotropin (12.5 mg/kg/hr) to seven fetuses at 130 +/- 1 day of gestation. Before labor, fetal plasma vasopressin concentrations were 2.1 +/- 1.4 pg/ml and remained low (5.3 +/- 3.4 pg/ml) during prodromal and early phases of labor, but rose significantly in the active and expulsive phases (39.6 +/- 27.5 and 173.3 +/- 152.9 pg/ml) to reach peak values at delivery (584.2 +/- 433 pg/ml) and decrease by 30 min after birth (359.8 +/- 90.0 pg/ml). At delivery, fetal plasma vasopressin concentrations were strongly correlated (P less than 0.001) with hormone values obtained during the latter phases of labor. Fetal arterial pH and oxygen tension was inversely correlated with plasma vasopressin (P less than 0.01). No similar correlations were found with arterial PCO2, K, Na, Cl, osmolality, or packed cell volume. Unexpectedly, we observed a significant (P less than 0.001) and progressive decrease in fetal oxygen tension during the induction process. Other characteristics of adrenocorticotropin-induced parturition seemed to mimic those of spontaneous labor.

Adrenocorticotropic Hormone↗
PubMed1981

Postnatal adjustment in renal function.

Renal function was studied serially in 17 healthy term infants during the hours immediately following birth. Of 14 infants delivered vaginally eight received placental blood transfusion and six did not. The remaining three infants were delivered by cesarean section and received placental blood transfusion. Results indicate that the general pattern of change in urine output (V), clearance of inulin (CIN), and p-aminohippuric acid (CPAH), was similar in all infants despite a wide range in each of the functions measured. The pattern showed an initial increase in V, CIN, and CPAH followed by a decline to low values in all infants by 3 hours of age. Urine osmolality and output generally changed in opposite directions. During the first hour the values for V ranged from 0.02 to 0.47 ml/min; for CIN, from 0.5 to 9.1 ml/min; for CPAH, from 1.4 to 21.8 ml/min; and for osmolality, from 98 to 457 mOsm/kg. By 4 hours of age the values for V ranged from 0.01 to 0.15 ml/min; for CIN, from 0.8 to 3.7 ml/min; for CPAH, from 0.8 to 7.5 ml/min; and for osmolality, from 240 to 520 mOsm/kg. The initial values of V, CIN, and CPAH, as well as the changes, were greatest in those infants who received a placental transfusion; however, there were no statistical differences among the means of the various groups. By 4 hours of age, the range of values observed in the initial measurement was much less pronounced. This probably reflects the achievement of stability of renal circulation following adaptation to a variety of stresses during the intrapartum period.

Adaptation, Physiological↗
PubMed1981

Response to rapid volume expansion during the postnatal period.

This study was designed to test the hypothesis that the postnatal diuresis observed in healthy neonates during the second hour of life is due to an expansion of their extracellular volume as a result of a purposeful or spontaneous placental blood transfusion. Seven healthy infants were given infusions of a 5% glucose solution, 0.3 to 2.5 ml/kg/min, over a period of 14 to 70 minutes during the third or fourth hour of life. Plasma and urine were analyzed for osmolality, inulin, and p-aminohippuric acid in order to estimate osmolal and free water clearances as well as glomerular filtration rate and renal plasma flow. Despite individual variation in initial values and in response, glucose infusion caused a prompt two- to fourfold increase in urine output with a similar increase in glomerular filtration rate and renal plasma flow but no consistent change in urine osmolality. The response was of short duration, subsiding within less than 30 minutes following the end of infusion. The fraction of exogenous fluid load excreted was less than 5% in five of seven infants. This study indicates that during the first few hours of postnatal life, the kidney of the newborn infant is capable of responding to a water load in a fashion similar to the kidney of the neonate aged a few days. It can also be concluded that the transient postnatal diuresis observed in these infants could, in part, be due to the expansion of extracellular volume by placental blood transfusion.

Blood Volume↗
PubMed1980

Amniotic fluid fluorescence polarization value as a predictor of respiratory distress syndrome.

Fluorescence polarization of 1,6-diphenyl-1,3,5-hexatriene in amniotic fluid lipid aggregates was measured to determine the ability of this technique to prospectively predict respiratory distress syndrome. Prior retrospective studies have shown that an FP value of less than or equal to 0.336 correlated best with a lecithin to sphingomyelin ratio of greater than 2.0. Fluorescence polarization values of amniotic fluid samples obtained within 48 hours of birth from 161 pregnancies were correlated with neonatal outcome. Samples from 149 pregnancies had FP values of less than or equal to 0.336 and samples from 12 pregnancies had FP values of greater than or equal to 0.336. No infants delivered from the former group developed RDS and eight of 12 infants from the latter group developed RDS (P less than 0.001). In the entire population the test had a sensitivity of 100% and a specificity of 97%. When 37 infants with birth weights less than 2,500 gm were studied, the FP value remained a highly reliable predictor of the infant at risk for developing RDS (P less than 0.001). In this subset the test had a sensitivity of 100% and a specificity of 90%. L-S ratios were performed on 96 samples and the results correlated well with FP values (P less than 0.001). We conclude that the amniotic fluid FP value is a reliable index of fetal lung maturity and the risk for developing RDS. The FP value also has specific technical and diagnostic advantages over the L-S ratio.

Amniotic Fluid↗
PubMed1979

Human fetal oxygenation following paracervical block.

To test the hypothesis that fetal heart rate (FHR) changes following paracervical block may be secondary to fetal hypoxia, human fetal oxygenation was measured continuously using a transcutaneous electrode. Following the block, each fetus demonstrated a decline in oxygen tension (tcPO2) at 5 minutes, which reached its lowest value at a mean of 11.5 minutes and remained at this level for an average of 3 minutes. Following the block, FHR variability increased at 5.2 minutes. reaching its maximal level by a mean of 7.5 minutes. By 11 minutes, a decrease in FHR variability was noted, which lasted for approximately 17 minutes. Decreased variability was not uniformly associated with low tcPO2. On some occasions, fetal tcPO2 declined even in the absence of increased uterine activity, which was noted at times following the block. The severity of the tcPO2 decline appears related to the analgesic effectiveness of the block.

Anesthesia, Local↗
PubMed1979

Reduced uterine blood flow and fetal hypoxemia with acute maternal stress: experimental observation in the pregnant baboon.

The effects of maternal hyperexcitability on the fetus were studied in 17 baboons. In the period of agitation, induced by stressful stimulus such as exposure to bright light or by clamping of the toe, the mother exhibited an increase in arterial blood pressure and, in some instances, arrhythmia. These changes were accompanied by an increased uterine activity and reduced uterine blood flow, and resulted in a decrease in heart rate and arterial oxygenation in all fetuses. Fetal recovery was prompt after maternal agitation was terminated, either by removal of the stimulus or by sedation with pentobarbital or nitrous oxide. This sedation also prevented a decrease in uterine blood flow when stress was repeated.

Animals↗
PubMed1979

Relationship of fetal bradycardia to maternal administration of lidocaine in sheep.

The casual relationship between the use of lidocaine and fetal bradycardia and the effect of the drug on maternal and fetal hemodynamics were studied on 13 chronically instrumented pregnant sheep. Lidocaine was infused intravenously to the mother for 60 minutes during arterial lidocaine concentrations were maintained at 2 to 5 microgram per milliliter in the mother and at less than 2 microgram per milliliter in the fetus. A decrease in uterine blood flow and an increase in uterine vascular resistance and uterine activity occurred immediately following the administration of lidocaine to the ewe. These changes were followed by a transient fetal bradycardia in 12 out of 17 experiments, accompanied by a decrease in fetal PaO2 values. These phenomena were seen in the absence of such predisposing conditions as maternal hypotension and fetal acidosis. It would appear that the mechanism responsible for a transient fetal bradycardia following regional obstetric anesthesia, particularly paracervical block anesthesia, in the initially nonasphyxiated fetus may in part be related to a brief decrease in perfusion of intervillous spaces. The bradycardia can occur at low lidocaine concentrations in both the maternal and fetal blood in a range similar to that observed in clinical practice.

Anesthetics, Local↗
PubMed1979

Arginine vasopressin during gestation and parturition in sheep fetus.

The possible correlation between plasma arginine vasopressin (AVP) concentration and the processes leading to parturition was assessed in 11 chronically catheterized pregnant ewes. Samples of blood withdrawn intermittently during a 20-day period preceding labor and during parturition were analyzed for AVP by a specific radioimmunoassay, as well as for pH, PaCO2 and PaO2. Fetal AVP was 1.74 +/- 1.55 pg/ml and maternal AVP 1.47 +/- 0.74 pg/ml (mean +/- SD). No preparturient rise in fetal vasopressin was noted, but levels increased progressively during labor to reach peak levels in cord blood (range 7.5--8,000 pg/ml). There was no consistent rise in maternal vasopressin during the same interval. A relationship between prolonged antepartum intrauterine asphyxia and increases in fetal vasopressin was noted. It is concluded that the markedly elevated levels of vasopressin observed in cord blood are the result of intrapartum 'stress', but are not related to the initiation of parturition.

Animals↗
PubMed1979

Amniotic fluid microviscosity determined by fluorescence polarization: methodology and relation to gestational age.

The fluorescence polarization of 116 amniotic fluid specimens obtained from 22 isoimmunized pregnant women was determined. The degree of fluorescence polarization of amniotic fluid provides an index of microvisocity in lipid aggregates that is dependent on the lecithin-to-sphingomyelin ratio and the degree of saturation of fatty acid side chains. We confirmed the reproducibility of the measurement of amniotic fluid microviscosity (coefficient of variation, 2.0%). The measurements are not effected by bilirubin concentration of amniotic fluid dilution. The pattern of change of amniotic fluid microviscosity during gestation parallels the expected development of the surfactant system. Amniotic fluid microviscosity is high during early gestation and abruptly and sequentially decreases between the 28th and 36th week of gestation. Since the measurements are an accurate reflection of the biochemical properties of amniotic fluid lipids and parallel the development of the surfactant system, we conclude that amniotic fluid microviscosity may well serve as an indicator of the process of fetal lung maturation.

Amniotic Fluid↗
PubMed1978

Effects of endotoxin on the pregnant baboon and fetus.

Effects of E. coli endotoxin upon uterine activity and maternal and fetal condition were studied in four pregnant baboons and their fetuses. Uterine activity increased significantly following administration of endotoxin to the mother. Endotoxin also produced maternal circulatory collapse, severe acidosis, and profound fetal asphyxia resulting in death. Death also occurred in three of the four mothers within 24 hours without amelioration of their conditions.

Acidosis↗