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Biomedical subjects

M F Epstein

Publications and source records attributed to M F Epstein.

At least 37 records · Page 2Linked to original sources
PubMed1986

Heparin use as a risk factor for intraventricular hemorrhage in low-birth-weight infants.

In a systematic review of data on drug use and adverse clinical events in infants with birth weights under 2000 g, we observed an association between germinal matrix-intraventricular hemorrhage and the use of heparin to maintain the patency of vascular catheters. Sixty-six infants with germinal-matrix (periventricular) or intraventricular hemorrhage or both (cases) were matched with 254 infants with other conditions (controls), and analysis, taking the matching factors into account, yielded an odds ratio of 14.0 (95 percent confidence interval, 5.4 to 34). When potential confounding factors were taken into account, the odds ratio was 3.9 (1.4 to 11). The association did not appear to vary according to the severity of hemorrhage or to the method of administration or dose of heparin. The data suggest that the routine use of heparin in neonatal intensive care units is associated with a four-fold increase in the risk of germinal matrix-intraventricular hemorrhage. Because of the possibility that confounding may have been incompletely controlled for, the true risk cannot be determined from these data, and a controlled clinical trial of heparin use in low-birth-weight infants is recommended.

Catheterization↗
PubMed1985

Risk factors for neonatal hyperglycemia associated with 10% dextrose infusion.

As part of an intensive drug surveillance program, we identified rates and associated risk factors for hyperglycemia related to intravenous 10% dextrose solution in a population of 1,157 newborns in two neonatal intensive care units. Hyperglycemia related to 10% dextrose solution was observed in 64 exposed infants (5.5%), a rate similar to that observed for hypoglycemia (6.7%) in this population. There was a highly significant trend toward an increasing risk of hyperglycemia with decreasing body weight, such that the risk of hyperglycemia among infants weighing less than 1,000 g was 18 times greater than the risk among infants weighing more than 2,000 g. The risk of hyperglycemia also increased with increasing dextrose dose. The effects of weight and dose were independent. Certain measures of disease severity also were associated with increased risks of hyperglycemia. Because increases in blood glucose levels may affect renal function or possibly lead to intraventricular hemorrhage, it is important that glucose levels in neonates receiving 10% dextrose solution be carefully monitored, and the total dextrose dose be adjusted accordingly.

Birth Weight↗
PubMed1985

Estimation of PaCO2 by two noninvasive methods in the critically ill newborn infant.

Simultaneous measurements of arterial, transcutaneous, and peak expired carbon dioxide were obtained in 24 newborn infants receiving mechanical ventilation during the first week after birth. Two calibration algorithms designed to estimate PaCO2 from the noninvasive measurements were then examined. Both approaches entailed finding a statistical relationship by which future noninvasive measurement could be used to estimate the arterial value rather then measuring it directly. The first utilized the difference between the initial paired measurements (an in vivo calibration); the second used the mean difference between all measurements in the population. Adjusted tcPCO2 measurements by either the in vivo calibration or by the population-based factor led to estimates of PaCO2 with 95% confidence limits of +/- 6 to +/- 8 torr. In contrast, this degree of precision for the peak expired CO2 measurement was only possible using the in vivo calibration method. The use of an airway adaptor for PCO2 measurement led to CO2 retention in more than half of the infants. Transcutaneous monitoring had no significant effects on the infants, but was hampered by excessive drift and erratic sensitivity of the electrodes.

Blood Gas Analysis↗
PubMed1985

Maternal and perinatal morbidity resulting from placenta previa.

One hundred forty-seven cases of partial or complete placenta previa from 1975 to 1982 were reviewed. A history of prior cesarean section was associated with a significant increase in maternal morbidity, including massive hemorrhage, placenta accreta, and hysterectomy. Despite tocolysis and transfusions to delay delivery, nearly two-thirds of the patients were delivered before 36 weeks' gestation. Onset of bleeding before 20 weeks' gestation was associated with a very poor fetal prognosis. The perinatal mortality rate was 81 of 1000. The overall incidence of respiratory distress syndrome was 22%; this was a major cause of neonatal mortality and morbidity. There was a statistically significant correlation between antepartum maternal hemorrhage and the need for neonatal transfusion, and between the neonatal anemia and the amount of intrapartum maternal blood loss.

Adolescent↗
PubMed1984

Necrotizing enterocolitis and hemolysis associated with Clostridium perfringens.

Two newborns had necrotizing enterocolitis (NEC) and severe hemolytic anemia. Clostridium perfringens was identified in the peritoneal fluid of both infants, supporting the previous association of C perfringens with hemolysis reported in adult patients. Infants with NEC and hemolytic anemia should be aggressively treated with surgical debridement and high-dose parenteral penicillin G potassium. Similarly, Gram's stain of peritoneal fluid and resected bowel at laparotomy for NEC may be useful for early identification of the primary organism.

Anemia, Hemolytic↗
PubMed1982

Biofeedback for headache.

Biofeedback has proven effective in treatment of vascular and muscle contraction headache. However, many factors have not yet been explored. Research into personality and psychologic aspects that can predict success or failure with biofeedback is necessary, as is research into the applicability of skills learned in the laboratory to nonlaboratory situations. The possibility of symptom substitution should be investigated, and the problem of using study volunteers who do not adequately represent the headache population must be dealt with. Biofeedback represents a significant step forward in control of migraine and muscle contraction headache. Further experience with biofeedback techniques is necessary, but the future seems to promise continued success with this new method of treatment.

Biofeedback, Psychology↗
PubMed1981

Effect of maternal diabetes on response to hypoxia in the newborn rabbit.

We tested the hypothesis that maternal diabetes is associated with a decreased ability of the newborn to tolerate hypoxia by measuring the time to last gasp of rabbit pups born to diabetic and control does and placed in 100% N2. Rabbits were made diabetic by injection of 100 mg/kg alloxan i.v. The alloxan-treated mothers had significantly elevated blood glucose during pregnancy and at delivery (132 vs. 90 mg/dl, p less than 0.001). Pups were delivered at 30 day's gestation by hysterectomy under local anesthesia. Half of each litter were immediately sacrificed and the remaining pups placed in 100% Ns. The pups from the alloxan-treated mothers showed a higher pre-asphyxial mean blood glucose (97 vs. 73 mg/dl, p less than 0.025) and a lower mean survival time (18.4 vs. 21.1 min, p less than 0.005).

Animals↗
PubMed1981

Effect of exchange transfusion on serum gentamicin concentrations.

To determine whether an exchange transfusion increases the rate of elimination of gentamicin, we measured drug (and bilirubin) concentration either before and during, or during and after a standard two-volume exchange procedure in 7 newborns. In an additional 5 infants, serum was obtained only on initiation and conclusion of the procedure. The mean decrement in serum gentamicin concentration with the procedure was 2.2 micrograms/ml; this was 25.7% of the original mean concentration. The mean elimination rate constant during the procedure was 0.342 h-1, a value significantly greater (p = 0.013) than the mean rate before or after the procedure, 0.104 h-1. We conclude that the exchange transfusion procedure significantly increases the rate of gentamicin elimination. The decrement produced by the procedure may result in subtherapeutic concentrations, if the initial values are marginally efficacious.

Analysis of Variance↗
PubMed1980

Phospholipid synthesis in lung slices from fetuses of alloxan diabetic rabbits.

To investigate the effect of maternal diabetes on pulmonary phospholipid metabolism, we studied fetuses of rabbit does made diabetic with alloxan. Incorporation of radiolabeled choline into total and saturated phosphatidylcholine was measured in vitro in lung slices from 27.5 days gestation fetuses. No difference in choline incorporation was found between the diabetic and control groups even when disaturated phosphatidylcholine was measured. It was concluded that the previously described physiologic differences (i.e., decreases in lung deflation stability and surface activity of lung lavage) between fetuses of alloxan-diabetic and control rabbits must be due to some mechanism other than imparied phosphatidylcholine biosynthesis by the choline incorporation pathway.

Animals↗
PubMed1980

Effect of isoxsuprine on fetal lung surfactant in rabbits.

To examine the effect of beta adrenergic drugs on fetal lung development, we administered isoxsuprine to pregnant rabbits for 24 hr and measured indices of pulmonary surfactant synthesis, storage, and release in rabbit fetuses at 26 days gestation. Incorporation of radiolabeled choline into total and disaturated phosphatidylcholine was measured in vitro in fetal lung slices. There was a significant increase in the rate of choline incorporation into disaturated phosphatidylcholine in the isoxsuprine-treated group and a tendency toward an increased incorporation into total phosphatidylcholine as well. We also observed an increase in the pulmonary phospholipid reservoir as evidenced by a significant increase in total lung disaturated phosphatidylcholine and a trend toward higher total lung phosphatidylcholine in the isoxsuprine group. In addition, there was a significant increase in lung lavage L/S ratio in the treated fetuses and in lung deflation stability determined by pressure volume curve. We conclude that isoxsuprine increases synthesis, storage, and release of surfactant in rabbit fetuses at 26 days gestation.

Animals↗
PubMed1979

Neonatal hypoglycemia after beta-sympathomimetic tocolytic therapy.

The effect of oral beta-sympathomimetic tocolytic therapy on neonatal serum glucose concentrations in the first several hours after delivery was examined in 12 babies. Hypoglycemia was noted in eight babies, and was sustained over at least a 30-minute period in five. The group with sustained hypoglycemia had a higher cord serum insulin concentration, a lower serum glucose nadir, and a more rapid initial rate of serum glucose disappearance than those babies with normoglycemia or transient hypoglycemia. Sustained hypoglycemia was observed in five of six babies delivered within two days of the termination of tocolytic therapy, but was not present in any of six babies delivered five or more days after the end of tocolytic therapy. Speculations as to the interaction between beta-sympathomimetic tocolytic drugs administered to the mother and fetal and neonatal glucose metabolism are made.

Ethanolamines↗