Search PubMed⌕ Search

Biomedical subjects

R E McClead

Publications and source records attributed to R E McClead.

34 records · Page 2Linked to original sources
PubMed1987

Prolonged intubation of neonates.

As the capabilities of modern medicine allow the survival of babies with increasingly lower gestational ages and birth weights, there is an increasing concern regarding the development of subglottic stenosis in those infants subjected to prolonged intubation. In this study, the general safety of neonatal intubation is assessed by a retrospective analysis of neonates who required intubation at Columbus (Ohio) Children's Hospital during a three-year period from 1977 to 1980. Of 343 surviving neonates, five (1.5%) developed clinically significant subglottic stenosis. The conclusion of this study is that endotracheal intubation is a safe method of airway management in neonates, even when used for extended periods.

Humans↗
PubMed1986

Clinical application of DNA analysis in a family with OTC deficiency.

We describe the clinical application of DNA restriction fragment analysis to the genetic evaluation of a family with a child deficient in ornithine transcarbamylase (OTC). The results of protein loading studies and the interpretation of the DNA haplotype profiles for the human OTC gene are reported. DNA restriction fragment analysis may be a reliable technique for the prenatal diagnosis of OTC deficiency and identification of obligate carriers of this gene.

Amino Acid Metabolism, Inborn Errors↗
PubMed1985

Comparison of the clinical and biochemical effect of increased alpha-linolenic acid in a safflower oil intravenous fat emulsion.

We report the results of a randomized comparison of two intravenous safflower oil (fat) emulsions in neonates who required total parenteral nutrition. The fat emulsions differed only in their content of alpha-linolenic acid: in one emulsion the alpha-linolenic acid content of the oil was 0.1% of fatty acids, while in the other emulsion the alpha-linolenic acid content of the oil was 3.0 +/- 1.5% (SD) of fatty acids. Group 1 and 2 patients received the "low" and "high" alpha-linolenic acid emulsions, respectively. Ten patients were studied in each group. The mean daily fat dosage was 1.70 g/kg in patients of Group 1 and 1.56 g/kg in those of Group 2. No significant difference in the clinical effects of either fat emulsion could be detected between the two study groups. Both emulsions prevented or corrected biochemical signs of essential fatty acid deficiency. The major statistically significant difference between study groups was in the level of alpha-linolenic acid and its metabolite, eicosapentaenoic acid. After 2 weeks of fat therapy, these fatty acids were increased in the high alpha-linolenic acid group; however, another metabolite of linolenic acid, docosahexaenoic acid, decreased during intravenous fat therapy in both study groups. Both study groups had significantly decreased arachidonic acid levels and increased linoleic to arachidonic acid ratios.

Dietary Fats↗
PubMed1984

Resistance of bovine colostral anti-cholera toxin antibody to in vitro and in vivo proteolysis.

Pregnant cows immunized with cholera enterotoxin produce an immunoglobulin G class 1 antibody that enters the colostrum in high titer. After exposure to intestinal enzymes, this antibody remains immunologically reactive and inhibits intestinal fluid secretion in infant and adult rabbits exposed to cholera enterotoxin. Specific bovine colostral antibodies may be a source of passive immune protection for human infants and adults at risk for cholera and other enteric diseases.

Animals↗
PubMed1982

Congenital central alveolar hypoventilation syndrome in six infants.

Six infants with congenital alveolar hypoventilation syndrome (CCHS) were seen and observed over several years. Two had an association of CCHS with Hirchsprung's disease. All infants were treated by tracheostomy and mechanical ventilation. Three infants have survived (including one with CCHS and Hirchsprung's disease). However, all survivors have required frequent rehospitalization. The infant with the longest survival (now 4 years of age) has developed significant daytime problems involving the "behavioral control" of ventilation. One infant was considered as a "near miss for sudden infant death syndrome" and became significantly symptomatic after establishment of delta (stage 3-4 non-rapid eye movement) sleep, which normally develops between 2 and 4 months of age. CCHS involves autonomic nervous system dysfunction, and the question of a defect involving the integration of chemoreceptor information more than a direct defect of the central chemoreceptor is discussed.

Chemoreceptor Cells↗
PubMedDate not supplied

Budd-Chiari syndrome in a premature infant receiving total parenteral nutrition.

A premature infant who developed Budd-Chiari syndrome as a complication of total parenteral nutrition through an inferior vena cava catheter is presented. A novel approach to the treatment of this otherwise lethal condition is described. This very unusual complication in pediatric patients may be seen with increased frequency as more premature infants are treated with central vein total parenteral nutrition.

Budd-Chiari Syndrome↗
PubMedDate not supplied

Comparison of three major antigen detection methods for the diagnosis of Group B streptococcal sepsis in neonates.

Because of the difficulty encountered in diagnosing early onset Group B streptococcal disease (GBS) in neonates and because of the proliferation of tests to detect the antigen in urine, we made qualitative and quantitative comparisons among the three major, commercially available, antigen detection systems. The methods compared were Wellcogen latex agglutination, Phadebact coagglutination, and counterimmunoelectrophoresis (CIE). We tested urine, with or without serum, and tracheal or gastric aspirates from 176 neonates admitted to Columbus Children's Hospital, with suspected GBS disease. Wellcogen and Phadebact were equally sensitive indicators of neonatal GBS sepsis (100%) as compared to CIE which was only 30% sensitive. CIE, however, did not produce any false-positives (100% specificity) while Phadebact coagglutination and Wellcogen latex agglutination were approximately 98% specific. As a side bar to the main study, we also set out to determine whether tracheal or gastric aspirates would be consistent and convenient sources of antigen as compared to urine. Consequently we determined that neither aspirate is a good source of antigen as performed by our method.

Antigens, Bacterial↗
PubMedDate not supplied

Risk factors for neonatal acquired subglottic stenosis.

Endotracheal intubation has proven to be a relatively safe and effective means of securing the airway in neonates. Some concern remains, however, regarding airway management in critically ill infants who require assisted ventilation for extended periods. Among the various risk factors associated with the complication of acquired subglottic stenosis in neonates, the one most frequently cited has been "prolonged" intubation, although opinion varies regarding the definition of this term. Various recommendations exist that attempt to establish the limits of "safe" periods of intubation for infants. Some feel that tracheotomy is indicated when airway support is required beyond those limits. In an attempt to define important risk factors involved in the development of neonatal subglottic stenosis, a retrospective analysis of infants admitted to the Neonatal Intensive Care Unit of Columbus Children's Hospital who required intubation during a 3-year period from 1977 to 1980 was undertaken. Of 343 infants who survived hospitalization, five patients were identified as having acquired subglottic stenosis. The average duration of intubation for these five patients was 56.2 days. The incidence of subglottic stenosis for infants whose duration of intubation ranged from 3 to 50 days was 0.4% (1/245). Infants with birth weights less than 1,500 g appeared more susceptible to the development of intubation-related laryngeal injury. The conclusion of this study is that endotracheal intubation is an appropriate means of long-term airway management in neonates hospitalized in a pediatric intensive care unit, providing other known risk factors are minimized.

Birth Weight↗
PubMedDate not supplied

Estimation of CO2 production in enterally fed preterm infants using an isotope dilution stable tracer technique.

BACKGROUND: Estimates of the rate of CO2 production may be useful in preterm infants, but assessment of the rate of respiratory excretion of CO2 (VCO2) may not always be practical in infants requiring constant care. We hypothesized that the rate of dilution of 13CO2 (RaCO2) would be a valid index of CO2 production in preterm infants. METHODS: Twelve studies of RaCO2 and VCO2 were performed in six enterally fed preterm infants. RaCO2 was measured using a 2-hour, primed, constant, orogastric infusion of NaH13CO3 with formula and an assessment of the plateau 13C enrichment of expired CO2. VCO2 was measured over two 10-minute intervals during the infusion using a flow-through system. Energy expenditure was estimated from these data and the food quotient. RESULTS: Mean (+/- SD) rate of CO2 production using RaCO2 (348 +/- 32 mumol/kg/min) was 114% of that estimated using VCO2 (304 +/- 51 mumol/kg/min). The ratio of VCO2/RaCO2 is equal to the fractional recovery of tracer CO2 in the expired air during the course of the tracer infusion. In studies of short duration, this ratio is generally less than 100% because of isotope exchange. For five pairs of studies performed on consecutive days, each individual value of RaCO2 on day 2 was multiplied by the mean of the individual ratios of VCO2/RaCO2 on day 1 (0.78); corrected RaCO2 was 306 +/- 19 mumol/kg/min compared with 307 +/- 59 mumol/kg/min for VCO2. CONCLUSIONS: Thus, RaCO2, particularly when corrected for isotope recovery, may be a useful index of group mean CO2 production and energy expenditure in preterm infants.

Carbon Dioxide↗
PubMedDate not supplied

Human milk fortifiers.

Explore the source record for details and available documents.

Food, Fortified↗