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Biomedical subjects

N Linder

Publications and source records attributed to N Linder.

86 records · Page 5Linked to original sources
PubMed1986

Vacuum extraction at cesarean section--neonatal outcome.

The use of the vacuum extractor at cesarean section has been advocated in order to avoid extension of the uterine incision and to facilitate the delivery of a floating head. We have evaluated, prospectively and retrospectively, the neonatal outcome of vacuum extraction at cesarean section in comparison with regular cesarean section. The interval between the final uterine incision and complete delivery (U-D interval) was significantly prolonged (P less than 0.01) in 8 cases of vacuum extraction (Group A) when prospectively compared with 10 cases of regular cesarean section (Group B). The Apgar scores, the acid-base values at delivery and the clinical course of the two groups were not significantly different. Although analysis of our prospective data suggests a trend of an association between prolongation of the U-D interval and neonatal depression, our retrospective data of 34 neonates delivered by vacuum extraction at cesarean section and 44 neonates delivered by regular cesarean section, showed no significant untoward effect when the vacuum extractor was utilized. Since prolongation of the U-D interval may have an undesireable effect on the fetus, we advocate extra caution in the use of this method.

Apgar Score↗
PubMed1985

Papular acrodermatitis of childhood associated with hepatitis A virus infection.

A 2-year-old girl developed an erythematous papular eruption on her face and extremities a week after an epidemic of hepatitis A had occurred in her school. Clinical and laboratory signs of acute hepatitis, together with serologic verification, confirmed hepatitis A infection. That diagnosis should be considered in the etiology of papular acrodermatitis of childhood.

Acrodermatitis↗
PubMed1984

Trimethoprim sulphamethoxazole in neonatal Flavobacterium meningosepticum infection.

During an outbreak of Flavobacterium meningosepticum septicaemia in a neonatal intensive care unit 9 infants were treated with intravenous trimethoprim sulphamethoxazole. Bacteriological cure was achieved in 8 patients; one infant died of massive intraventricular haemorrhage on the first day of treatment. Apart from prolonged persistence of pre-existing thrombocytopenia there was no evidence of side effects. Trimethoprim sulphamethoxazole should be considered in the treatment of neonatal F meningosepticum sepsis in view of its activity against this organism, good penetration of the blood brain barrier, and the absence of serious side effects.

Bacterial Infections↗
PubMed1984

Plasma haptoglobin levels in vacuum extracted neonates.

In order to examine the pathogenesis of neonatal hyperbilirubinemia associated with vacuum extraction, we have compared plasma haptoglobin and bilirubin levels and blood hematocrits of vacuum extracted neonates with those of newborns who underwent a normal vaginal delivery. Plasma haptoglobin and blood hematocrits of the 12 vacuum patients measured on the third day of life were significantly lower (21.7 +/- 5.3 vs. 46.5 +/- 7.5 mg%; p value less than 0.01 and 52.3 +/- 1.3 vs. 59.7 +/- 1.8%; p value less than 0.005, respectively) than the 12 control patients (values are mean +/- SEM). This trend was apparent whether or not cephalhematoma was present after vacuum extraction: However, the mean bilirubin level was significantly higher than the controls only when cephalhematoma was present. Those results suggest that the higher incidence of neonatal hyperbilirubinemia previously observed after vacuum extraction, is the result of an increased hemolysis of blood sequestered in scalp lesions. Since evidence for enhanced RBC destruction has been demonstrated whether or not cephalhematoma was present, the possibility of hyperbilirubinemia should be anticipated in any case of vacuum delivery.

Bilirubin↗
PubMedDate not supplied

Ventriculitis caused by Klebsiella pneumoniae successfully treated with pefloxacin in a neonate.

Pefloxacin was applied to a newborn suffering from ventriculitis caused by Klebsiella pneumoniae after failure of routine antibiotics. Treatment was successful. Blood and CSF levels were high, thus documenting good CSF penetration. In addition to this case report, a review of the literature regarding seven neonates with CNS infection treated with fluoroquinolones and from whom CSF levels were obtained, is presented. In conclusion, due to their excellent activity against gram-negative microorganisms, fluoroquinolones may be considered in the treatment of neonatal CNS infections if the pathogen is resistant to routinely used antibiotics. Only limited experience is available with fluoroquinolones in pediatric patients given their potential for cartilage toxicity in young animals.

Cerebral Ventricles↗
PubMedDate not supplied

Decline of hepatitis A antibodies during the first 7 months of life in full-term and preterm infants.

In a previous study we have shown that transplacental transfer of hepatitis A antibodies to preterm infants does not differ from that observed in full-term infants. This follow-up study was designed to investigate the decline of hepatitis A virus (HAV) antibodies during the first 7 months of life in full-term and preterm infants, in an endemic region for hepatitis A. Two hundred and fifty newborn infants--147 full-term and 103 preterm infants--were enrolled. Blood samples from the infants were taken at birth, and at 3 and 7 months of age. Anti-HAV titers were determined by ELISA. A concentration of > or = 1:20 mlU/ml was considered protective. Protective hepatitis A antibodies were present at birth in 48.3% of all full-term and 49.5% of all premature infants. By the age of 7 months only 13% of full-term and 21.7% of preterm infants still had protective titers. For the seropositive full-term infants the geometric mean titers (GMT) were 15,698, 6,107 and 345 at birth, 3 months and 7 months, respectively, and for preterm infants, 10,378, 2,307 and 225 at birth, 3 months and 7 months, respectively. Significant differences in GMT between preterm and full-term infants were found at birth and at 3 months of age (P < 0.05). In a region endemic for hepatitis A, low levels of anti-HAV at 7 months of age may justify trials on infant vaccination since this is the most effective way to eliminate hepatitis A from circulation.

Enzyme-Linked Immunosorbent Assay↗
PubMedDate not supplied

Placental transfer of maternal rubella antibodies to full-term and preterm infants.

Premature infants are vulnerable to infections, partly because of the low transplacental transfer of maternal antibodies. The present study investigated the placental transfer of maternal rubella-specific antibodies to full-term and preterm infants. The study group consisted of 133 healthy, native Israeli mothers and their 159 newborns. Of these, 69 were full-term infants (gestational age > 37 weeks) of 69 mothers, and 90 were preterm infants (gestational age < 35 weeks) of 64 mothers. Antibody titers against rubella were measured in maternal and umbilical cord blood samples by hemagglutination inhibition and microneutralization techniques. There was no significant difference in the level of protection and in geometrical mean titers by hemagglutination between the full-term and preterm groups. Conversely, significant differences in geometric mean titers of neutralizing antibodies were found between full-term and preterm infants, e.g., 65.9 and 39.8, respectively (P < 0.001). Very low birth weight preterm infants are at greater risk of rubella infection during the first year of life, due to the diminished transfer of neutralizing maternal antibodies. Therefore, earlier vaccination of this group may be beneficial.

Antibodies, Viral↗
PubMedDate not supplied

Liposomal amphotericin B (AmBisome) in the treatment of neonatal candidiasis in very low birth weight infants.

UNLABELLED: AmBisome (2.5-7 mg/kg/day as a continuous 1 h infusion) was evaluated prospectively from September 1994 to January 1998 in 24 very low birth weight infants (mean birth weight 847+/-244 g, mean gestational age 26 weeks) with systemic candidiasis. Mean age at onset of candidemia was 17 days. One patient had two episodes of candidiasis. Thirteen infants failed previous antifungal therapy with amphotericin B (with or without 5-flucytosine). Candida spp. were isolated from the blood in all 25 episodes and from skin abscesses and urine in four infants each, respectively. There were 13 isolates of Candida albicans, ten of Candida parapsilosis, two of Candida tropicalis and one of Candida glabrata. One infant had a mixed infection with C. albicans and C. parapsilosis. The mean duration of therapy was 21 days; the cumulative AmBisome dose was 94 mg/kg. Fungal eradication was achieved in 92% of the episodes; mean duration of AmBisome therapy until achieving eradication was 9 days. Twenty (83%) infants were considered clinically cured at the end of treatment. No major adverse effects were recorded; one infant developed increased bilirubin and hepatic transaminases levels during therapy. Four (17%) infants died; in two of them (8%) the cause of death was directly attributed to systemic candidiasis. CONCLUSION: AmBisome represents an effective, safe and convenient antifungal agent in the therapy of systemic fungal infections in very low birth weight infants.

Age of Onset↗
PubMedDate not supplied

Neonatal auditory brain-stem response threshold and latency: 1 hour to 5 months.

Auditory brain-stem evoked responses were recorded in normal neonates and infants ranging in age from less than 1 h to 5.5 months. The average threshold in neonates 0-5 h old was 29 dB greater than that in adults, reaching the adult threshold range within 2 weeks. The latency of wave I in 0-5 h neonates was 1.81 msec and reached the adult range within 2 weeks. The V-I interpeak latency in 0-5 h neonates was 5.3 msec and did not reach adult values within the period of this study.

Brain Stem↗
PubMedDate not supplied

Placental transfer of maternal poliovirus antibodies in full-term and pre-term infants.

This study was designed to investigate the placental transfer of maternal poliovirus antibodies in full-term and pre-term infants. Two hundred healthy, Israeli born mothers and their infants, were enrolled immediately after birth. The study population comprised two groups: a full-term group of 150 mothers and their infants, and a pre-term group of 50 mothers and their infants (gestational age < 35 weeks). Maternal and umbilical cord blood samples were taken in all cases. Antibody titers against the three poliovirus serotypes and a polio virus type 1 strain that caused an outbreak in 1988 (epidemic strain 1) were measured by a microneutralization system. The proportion of individuals with protective titers against each of the poliovirus types tested was slightly lower in the infants compared with their mothers. When protection to all strains combined was tested, the difference between mothers and infants was significant (P < 0.05). Transplacental transfer to epidemic strain 1 was less effective--12% of the premature infants were not protected against it at birth. The geometric mean titers against poliovirus types 1, 3 and epidemic type 1 strain were significantly lower in the pre-term group than in the full-term group. In both the full-term and pre-term groups there were significant linear correlations between the maternal and neonatal antibody titers for each of the polio viruses tested. For all poliovirus types, the transfer of maternal antibodies to the full-term infant was significantly higher than the transfer of maternal antibodies to the pre-term infant (P < 0.001). Owing to diminished transfer of maternal antibodies, pre-term infants are at greater risk of poliovirus infection.

Adult↗
PubMedDate not supplied

Reported exposure to chickenpox: a predictor of positive anti-varicella-zoster antibodies in parturient women.

OBJECTIVE: To determine the positive and negative predictive values of recalled exposure to chickenpox for identifying anti-varicella-zoster virus (VZV) seropositive parturient women. METHODS: Blood samples were taken from laboring women during February 1998: All women completed questionnaires concerning a history of chickenpox in themselves and their children. Anti-VZV antibodies were determined by the immunofluorescent antibodies to membrane antigen (IFAMA) technique. RESULTS: Three hundred and twenty-seven women formed the study population; 239 women (73.1%) recalled chickenpox in themselves or their children, of which 229 (95.8%) were seropositive for anti-VZV antibodies. Of the 88 women who gave a negative/uncertain history of chickenpox 82 (93.2%) were seropositive and 6 (6.8%) were seronegative. All 87 mothers who were certain their children had had chickenpox were seropositive, including all 16 mothers who had a negative personal history. Thus, a woman with a history of chickenpox had a positive predictive value of 95.8%, and a woman with a lack of history had a negative predictive value of 6.8% (sensitivity 73.6%, specificity 37.5%), while a positive history of chickenpox in a child had a positive predictive value of 100%. CONCLUSIONS: Most women with no known history of VZV infection have evidence of prior exposure by serologic testing. Moreover, 100% of women with a negative history who were exposed to VZV in their children were protected from the disease. Therefore, mothers exposed to VZV during pregnancy can be reassured that most likely they are protected. However, the practice of testing all pregnant women exposed to the disease should be continued.

Adolescent↗
PubMedDate not supplied

The incubator as a chemical warfare protective device in neonatal intensive care units.

During the Persian Gulf war chemical warfare (CW) protective devices were distributed to the entire population of Israel. Neonates were to be placed in a protective infant carrier (PIC) or an improved PIC ("active PIC") to which filtered air was actively introduced by a blower. The specific needs of low birthweight babies hospitalized in intensive care units and treated in incubators were not adequately addressed. Transfer to a PIC meant disconnecting the infants from life-supporting systems and monitoring devices and exposing them to changes in ambient temperature. To overcome this difficulty the original incubator was used as a CW protective device. Its ports were sealed and low-grade positive pressure was created. This avoided transfer of the neonates from their controlled environment, reduced physiological stress, and improved medical supervision.

Air Pollution↗
PubMedDate not supplied

Neonatal sepsis after prolonged premature rupture of membranes.

The objective of this study was to prospectively evaluate the incidence of neonatal sepsis after prolonged premature rupture of membranes (PROM), to correlate sepsis with gestational age and with the duration of PROM, and to evaluate the necessity for prophylactic antibiotic therapy in neonates born after PROM. Of 12,182 infants, 135 (1.1%) were delivered after PROM with a latency period of > 24 hours. Neonatal sepsis occurred in 11 infants (8.1%), 10 of whom were premature. The only term, septic newborn was a small-for-gestational-age infant. A latency period > 72 hours was not associated with an increased incidence of sepsis. Maternal fever, neonatal signs of infection including leukopenia, leukocytosis, thrombocytopenia, and positive gastric aspirate cultures, were not good predictors of sepsis. Of premature infants with PROM, 15% had sepsis, and thus the administration of prophylactic antibiotic therapy in these cases may be warranted. However, it may be unnecessary to administer prophylactic antibiotics to term, appropriate-for-gestational-age infants born after PROM.

Anti-Bacterial Agents↗