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Biomedical subjects

M C Hermansen

Publications and source records attributed to M C Hermansen.

16 recordsLinked to original sources

Evaporation from reusable cloth diapers exposed to radiant heat.

This study determined the rate of evaporation from four sets of diapers: disposable diapers with and without a heat shield, and cloth diapers with and without a heat shield. The evaporation was greatest from the cloth diaper without the heat shield (51% after 1 hour, 81% after 2 hours) and the least from the disposable diaper covered by a heat shield (15% after 1 hour, 30% after 2 hours). We recommend that if cloth diapers are used to monitor urine output from sick neonates that (1) the diaper should be weighed promptly after urination with accurate and precise scales, and (2) a heat shield should cover the diaper.

Hot Temperature

Diminished splenic function in asphyxiated term infants.

The effect of birth asphyxia on splenic function has not previously been investigated. We performed quantification of pocked erythrocytes to assess splenic function in 10 term infants with abnormally low Apgar scores and clinical symptoms of birth asphyxia and in 10 healthy term control infants. The mean pocked erythrocyte count of the asphyxiated infants at day 1 (33.9% +/- 6.8 [SD]) was greater than that of the control infants (21.4% +/- 6.3) (P less than .01). By day 3 the mean pocked erythrocyte count of the asphyxiated infants (25.2% +/- 8.4) was still elevated but approaching that of the control infants (18.8% +/- 5.5) (.05 less than P less than .10). In summary, birth asphyxia was associated with an elevation of pocked erythrocytes and decreased splenic function.

Apgar Score

A validation of a scoring system to evaluate the condition of transported very-low-birthweight neonates.

A scoring system was developed to objectively evaluate the condition of transported preterm infants. The "transport score" used five variables: blood glucose, blood pressure, pH, pO2, and temperature. Each variable was scored 0, 1, or 2, with a total achievable score from 0 to 10. Twenty-one matched pairs of infants included one infant who lived and one who died. The transport scores upon admission of infants who lived was significantly greater than the scores of those who died (P less than 0.01). Scores less than eight were predictive of death (sensitivity 62%, specificity 81%). The system was then applied prospectively to 106 different infants after stabilization by the hospital-of-origin (pre-transport) and upon admission to the neonatal intensive care unit (post-transport). Although 75 (76%) of the 99 surviving infants had both stabilization and admissions scores of eight or more, only 2 (29%) of the 7 infants who died had both scores of eight or more. Of 85 infants with a stabilization score of eight or greater, only 3 (3.5%) died, while of 21 infants with stabilization scores less than eight, 4 (19%) died. Similarly, of 90 infants with an admission score of eight or more, only 4 (4.4%) died, while of 16 with an admission score of less than eight, 3 (19%) died. We conclude that transport scores provide a valid indication of the condition of preterm infants and may be used to provide quality assurance for stabilization and transport efforts.

Academic Medical Centers

Urine output determination from superabsorbent and regular diapers under radiant heat.

The rate of water evaporation from diapers was determined by sequential weights of open and closed regular diapers and of open superabsorbent diapers in three different environments--radiant heater at 100% heater output, radiant heater at 50% heater output, and room air. In all three environments, evaporation was greatest with open regular diapers, less with open superabsorbent diapers, and least with closed regular diapers. Evaporation was greatest under the radiant heater with 100% heater output, less under the radiant heater with 50% heater output, and least in room air. An open, regular diaper under 100% heater output lost 45% of its water after one hour and 85% had evaporated after two hours. Smaller volumes of water demonstrated a larger percentage of evaporation than larger volumes. Recommendations are made for the use of (1) either open, superabsorbent diapers or closed, regular diapers, (2) prompt weights after urination, and (3) accurate and precise scales.

Clothing

Development of lumbar spinal cord and cortical evoked potentials after tibial nerve stimulation in the pre-term newborns: effects of gestational age and other factors.

Pre-term neonates are at increased risk for neurological dysfunction. Several investigators have found scalp recorded somatosensory evoked potential studies (SSEPs) after median nerve stimulation useful in the evaluation of newborn infants with asphyxiation and the effects of other adverse prenatal and perinatal factors. In order to evaluate the entire developing neuraxis, we undertook SSEPs after tibial nerve stimulation (PTN-SSEP) in pre-term neonates. Using bilateral simultaneous stimulation, potentials were recorded from the following sites: PF-spT6 (N5), spL1-spT6 (N16), spC7-Fpz (N27), Cz' (1 cm behind the vertex)-Fpz (P55). In all newborns studied, the N5 and N16 were reliably recorded. The N5 appeared relatively independent of the length of the newborns. The N16 correlated inversely with length. The N27 and P55 were recorded in 52% and 65% of the newborns, respectively. N27 inversely correlated modestly with length. The P55 was independent of most factors and probably reflects variable rates of cerebral myelination, neuronogenesis, varying states of alertness, and possibly subclinical encephalopathies. These results demonstrate the feasibility of obtaining such data in pre-term newborns.

Brain

An evaluation of a computer program to predict the outcome of hyaline membrane disease.

A computerized model was developed to predict the severity of hyaline membrane disease. This study compared the program's predictive ability with that of three neonatologists. Blood gas and respiratory support data of 33 infants were entered into the computer which then predicted the severity of disease. The computer predicted 18 outcomes correctly. The neonatologists, provided with the same data, predicted 24 outcomes correctly. Both sets of predictions--computer and physician--found that patients predicted to have mild outcomes had the shortest oxygen requirements, duration of mechanical ventilation, and length of hospitalization, and infants predicted to have severe outcomes had the greatest oxygen requirements, duration of mechanical ventilation, and length of hospitalization. While actual severity was linked to birth weight, the model did not utilize birth weight in its predictive algorithm. Consequently, although the computer program predicted the outcomes with moderate success, it was less accurate than the neonatologists.

Blood Gas Analysis

The prenatal diagnosis of ventral abdominal wall defects.

Ventral abdominal defects are frequently diagnosed by prenatal ultrasonography. This review of 47 infants with ventral defects was designed to determine the effect of prenatal diagnosis on neonatal outcome. All nine infants with prenatal diagnosis were delivered by cesarean section at tertiary level hospitals. Only 13 (34%) of 38 infants with unsuspected defects were delivered by cesarean section and 15 (39%) were delivered at tertiary level hospitals. There was no difference in mortality between infants with prenatal diagnosis (44%) and those with unsuspected defects (37%). Increased mortality correlated with the presence of other major anomalies (79% mortality), with birth weight less than 1500 gm (80%), and with omphaloceles (65%). We conclude that infants with other associated defects or with birth weight less than 1500 gm have poor outcomes and cesarean section may not be justifiable. However, in larger infants without other anomalies, prenatal diagnosis was followed by cesarean section and a good prognosis.

Abdominal Muscles

Importance of using standardized birth weight increments to report neonatal mortality data.

Neonatal mortality statistics are frequently reported in 100-g increments of birth weight. We tabulated our mortality statistics using two methods of incrementation: 500 to 599 g, 600 to 699 g, 700 to 799 g, etc. (method A) and 501 to 600 g, 601 to 700 g, 701 to 800 g, etc (method B). In each 100-g weight group, the mortality was less using method B. The average reduction in mortality using method B was 4.1%. Use of the two different methods creates difficulty in making meaningful comparisons of various published reports. We recommend that all future studies use method A, as that method is more consistent with previous recommendations of the World Health Organization.

Birth Weight

Feeding intolerance following ophthalmologic examination.

Reports of isolated cases of necrotizing enterocolitis following administration of mydriatric medication and ophthalmologic examination prompted a comparison of the incidence of feeding difficulties 24 hours before and 24 hours after the ophthalmologic examination of 50 newborns. All infants had received cyclopentolate hydrochloride and phenylephrine hydrochloride before the examination. A critical review of the nursing notes showed more abdominal distention and gastric aspirates in the period following the examination than in the period preceding the examination. One infant developed necrotizing enterocolitis during the 24-hour postexamination period. This study demonstrates the risk of feeding intolerance following the ophthalmologic examination of neonates. These risks may be due to the known side effects of the mydriatics, to the physical stress of the examination, or to a combination of both factors.

Animals

Caroli disease: the diagnostic approach.

Two new pediatric examples of Caroli disease are reported; one was diagnosed by operative cholangiography and one by percutaneous transhepatic cholangiography. Although a variety of approaches may lead one to suspect the diagnosis, percutaneous transhepatic cholangiography is now the method of choice to establish the diagnosis.

Bile Ducts, Intrahepatic

Abolition of feeding intolerance following ophthalmologic examination of neonates.

Administration of mydriatic medication and ophthalmologic examination have previously been associated with feeding intolerance, characterized by large retained gastric aspirates and abdominal distention. In an attempt to eliminate this problem, we instituted a policy of withholding feedings for four hours following ophthalmologic examination. A prospective series of 50 consecutive patients was then followed to determine the incidence of feeding intolerance 24 hours prior to and 24 hours following the examination. All infants had received cyclopentolate hydrochloride and phenylephrine hydrochloride prior to the examination. A critical review of the nursing notes revealed no increased incidence in feeding intolerance during the 24-hour period following examination. There were no cases of necrotizing enterocolitis during either period. This study provides evidence that the incidence of feeding intolerance following ophthalmologic examinations might be reduced by withholding feeding for four hours after the examinations.

Cyclopentolate