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Biomedical subjects

R H Merchant

Publications and source records attributed to R H Merchant.

At least 55 records · Page 3Linked to original sources
PubMed1992

Exchange transfusions via peripheral vessels.

During a 15 month period, partial exchange transfusions (ET) were done in 40 neonates with polycythemia, and double volume ET attempted in 7 neonates with hyperbilirubinemia via peripheral vessels. The procedure was effective and not associated with any complications for partial ET. During double volume ET minor complications were noted in 2 cases, both of whom recovered and subsequently successfully underwent supraumbilical ET. Of the 5 cases who had uneventful double volume exchanges, there was a significant drop in indirect serum bilirubin following the procedure. The mean pre-ET serum indirect bilirubin in these 5 cases was 334 mumol/L and mean post-ET level was 179 mumol/L with a mean drop of 155 mumol/L (46% drop). Technical difficulties in catheterization may be overcome with greater expertise and use of heparin to flush arterial catheters.

Arteries↗
PubMed1992

Therapy of symptomatic patent ductus arteriosus in preterms using mefenemic acid and indomethacin.

Mefenemic acid (MA) was given in three doses of 2 mg/kg/dose at 12 hourly intervals in 16 cases clinically suspected of having symptomatic patent ductus arteriosus (PDA). All babies were 35 weeks gestation (mean 30.1 weeks) and weighed less than or equal to 1700 g at birth (mean 1320 g), the mean age of administration of MA being 16 days. Of the 16 cases, two did not respond to therapy. One non-responder was subsequently shown to have an endocardial cushion defect without PDA on 2-D Echo and Doppler study. The other was 29 days old at the initiation of therapy. In once case, the ductus reopened after an initial closure, however, it closed on repeating a second course of the drug. Thirty preterms (less than or equal to 34 weeks) who were earlier treated with three doses of indomethacin (0.25 mg/kg/dose) formed the comparative study group. The closure rate of PDA on treatment with indomethacin was 70% and that with MA was 93.3% (p greater than 0.05). Two neonates treated with MA and two treated with indomethacin had feeding intolerance and vomiting, perhaps attributable to the drug therapy. We recommend the use of MA for closure of symptomatic PDA in preterms, especially in those cases where indomethacin is not tolerated or when minute titration of its dosage is impracticable.

Ductus Arteriosus, Patent↗
PubMed1990

Diagnostic and prognostic value of CT brain scan in term neonates with moderate and severe birth asphyxia.

Twenty term neonates with moderate (stage II) and 5 with severe (stage III) hypoxic ischemic encephalopathy (HIE) were prospectively studied to determine diagnostic and prognostic value of CT brain scan. Three neonates expired, 4 were lost to follow up while 18 were followed up to 18 months of age. Cerebral hypodensities were noted in 20 and intracranial hemorrhage (ICH) in 8, of which 6 had both ICH and hypodensity. Twelve of 14 infants with hypodensities and 5 of 6 with ICH who were followed up were handicapped at 18 months. Thirteen of 18 babies followed up were subjected to repeat CT scans between 9 and 18 months of age for assessing extent and severity of brain damage. Major abnormality noted on repeat CT scans was cerebral atrophy. All 6 infants whose follow-up scans were abnormal had neurological sequelae, while of 7 infants who had normal repeat CT scans, 5 had neurological sequelae. We do not recommend repeat CT scans in patients with HIE as a parameter to predict neurologic outcome.

Asphyxia Neonatorum↗
PubMed1989

Late hemorrhagic disease of infancy.

Over a period of 1 1/2 years, 9 infants ages ranging between 3 weeks and 7 months presented with the syndrome of late hemorrhagic disease related to vitamin K deficiency. All were exclusively breast fed and had not received vitamin K at birth. Four of these had acute intracranial hemorrhage, of which 2 expired and the surviving 2 have residual neurologic handicap. Of the remaining 5 who had skin and mucosal bleeds, all recovered on administration of vitamin K.

Blood Coagulation Tests↗
PubMed1989

Infants of diabetic mothers--an analysis of 50 cases.

In a prospective study of 50 infants of diabetic mothers, 40% were large, 44% appropriate and 16% small for gestational age, 36% were preterm, 24% of the mothers were managed by dietary modification, 62% received insulin, 10% were treated with oral hypoglycemic agents while 4% did not receive any treatment as they were diagnosed postpartum, 58% mothers, underwent cesarean section (38% elective and 20% emergency procedures), 34% had normal vaginal deliveries, 6% were delivered by forceps and 2% by vacuum. Sixty-four per cent were infants of gestational diabetic (IGDM) and 36% of preconceptional diabetic mothers (IPDM). The morbidity and mortality was lesser in IGDM compared to IPDM. Hypoglycemia was documented in 50%, polycythemia in 20%, birth asphyxia in 18%, respiratory distress syndrome and hypocalcemia in 14% each, transient tachypnea of the newborn in 12%, hyperbilirubinemia in 8%, congenital anomalies in 4% and cardiomyopathy, birth trauma and meconium aspiration in 2% each. Pretherapy serum insulin levels were estimated in 10 babies, and 6 babies were subjected to 2D-echocardiography. The overall mortality was 20%. Infants born to mothers on oral hypoglycemic agents had a poor outcome.

Female↗
PubMed1989

Systemic lupus erythematosus in Indian children.

Twenty cases of systemic lupus erythematosus (SLE) in prepubertal children (less than 14 years of age) were seen over a period of 14 years. The male:female ratio was 1:2.3, and the mean age at onset was 9.37 years. Fever with joint involvement was the commonest presenting manifestation (60%), followed by nephrotic syndrome (25%). Notable clinical features included a high incidence of renal involvement (75%), significant hypertension (45%) and reversibility of acute renal failure (2 cases). The other organs and systems involved included: mucocutaneous manifestations (60%), cardiovascular system (30%), respiratory system (25%), neuropsychiatric manifestations (45%), and anemia (75%). Raynaud's phenomenon and thrombocytopenia were rare while leucopenia was not seen in a single patient. Immunological abnormalities noted were 100% positivity for antinuclear antibodies, and 87.5 and 75% positivity for antibodies to double-stranded and single-stranded DNA, respectively. Hypocomplementemia was seen in 75% of patients tested.

Adolescent↗
PubMed1989

Clinical significance of serum and cerebro spinal fluid bilirubin indices in neonatal jaundice.

To assess the value of unbound bilirubin (UB) and saturation index (SI) in serum and CSF as indicators of Kernicterus, we studied 50 icteric neonates (serum indirect bilibrubin (IB) greater than or equal to 7 mg/dl) and 20 controls (IB less than 7 mg/dl) during the first week of life. Serum and CSF were obtained simultaneously in all neonates. Of 36 neonates with IB greater than 12 mg/dl 19 had evidence of kernicterus. UB was estimated by Sephadex gel filtration and SI by salicylate displacement technique. Positive correlation (r = +0.85) was obtained between serum and CSF UB levels. There was a significant difference (p less than 0.05) between mean serum and CSF UB levels in kernicterus and non-kernicterus neonates (kernicterus serum UB = 0.71 +/- 0.22) mg/dl, CSF UB = 0.16 +/- 0.06 mg/dl: non-kernicteric serum UB = 0.40 +/- 0.10 mg/dl, CSF UB = 0.10 +/- 0.03 mg/dl). A critical serum UB level 0.5 mg/dl and a danger zone of CSF UB (0.1 to 0.15 mg/dl) was observed in presence of kernicterus. Neonates with kernicterus and 30% non-kernicteric had serum SI greater than or equal to 8. Mean values of serum and CSF SI were comparable in all neonates. The serum and CSF UB and SI, and the mean percentage cross over of UB from serum to CSF when statistically compared were not significantly influenced by risk factors.

Bilirubin↗
PubMed1988

Long QT syndrome.

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Arrhythmias, Cardiac↗
PubMed1987

Hb H disease.

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Child, Preschool↗