Search PubMed⌕ Search

Biomedical subjects

R L Poland

Publications and source records attributed to R L Poland.

At least 37 records · Page 2Linked to original sources
PubMed1985

Analysis of the effects of applying federal diagnosis-related grouping (DRG) guidelines to a population of high-risk newborn infants.

Length of stay data collected for high-risk newborn infants admitted to a tertiary care children's hospital neonatal unit over a 6-year period were compared with mean and outlier lengths of stay published in the Federal Register as part of a proposed system for prospective payment of hospital cost by diagnosis-related groupings (DRGs). We found that the classification system for newborns markedly underestimated the number of days required for the treatment of these infants. The use of the geometric mean instead of the arithmetic mean as the measure of central tendency was a significant contributor to the discrepancy, especially in those subgroups with bimodal frequency distributions of lengths of stay. Another contributor to the discrepancy was the lack of inborn patients in the children's hospital cohort. The system of prospective payments, as outlined, does not take into account several factors that have a strong influence on length of stay such as birth weight (which requires more than three divisions to serve as an effective predictor), surgery, outborn status, and ventilation. Implementation of the system described in the Federal Register would severely discourage tertiary care referral hospitals from providing neonatal intensive care.

Birth Weight↗
PubMed1985

Neonatal hyperviscosity: randomized study of effect of partial plasma exchange transfusion on long-term outcome.

The use of partial plasma exchange transfusion in newborns with polycythemia and hyperviscosity was evaluated. Ninety-three infants with polycythemia and hyperviscosity were randomly assigned to receive either partial plasma exchange transfusion or symptomatic treatment; the infants were matched with control infants without polycythemia. Neonatal course and outcome at 1 and 2 years were evaluated for each of the three groups. Polycythemic infants had more fine motor and speech problems at 1 year of age than did control infants. At 2 years of age, polycythemic infants had more gross motor delays, neurologic diagnoses, fine motor abnormalities, and speech delays than did the control infants. There was no significant difference at 1 year between the polycythemic infants who had received partial plasma exchange transfusion and those given only symptomatic care. At 2 years, the group receiving partial plasma exchange transfusion had fewer neurologic diagnoses and fine motor abnormalities.

Blood Viscosity↗
PubMed1984

Intracranial hemorrhage in the hypoxic-ischemic infant: ultrasound demonstration of unusual complications.

Seven neonates (four preterm and three term) with severe hypoxic-ischemic parenchymal brain changes are presented to illustrate the kinds of parenchymal lesions demonstrable on ultrasound, to show the similarity of parenchymal lesions in preterm and term infants, and to correlate the severe neurologic deficits with the parenchymal changes. The lesions demonstrated are periventricular leukomalacia, large-vessel infarction, isolated parenchymal hemorrhage, multiple cystic encephalomalacia, and parenchymal atrophy. Parenchymal changes should be sought in such infants during any stage of their disease.

Brain↗
PubMed1984

Effect of prophylactic phenobarbital on intraventricular hemorrhage in high-risk infants.

Forty-two premature infants less than 24 hours of age, with normal admission echoencephalograms, were randomly assigned to control or phenobarbital treatment groups. Infants in the treated group received two loading doses of 10 mg/kg of phenobarbital 12 hours apart, followed by a maintenance dose of 2.5 mg/kg every 12 hours for 6 days. Serial echoencephalograms were obtained in both groups. The groups were comparable with regard to birth weight, gestational age, and potential risk factors for subependymal-intraventricular hemorrhage. Ten infants (48%) in each group developed hemorrhage. The hemorrhages in the phenobarbital-treated group were significantly less severe than those in the control group. The phenobarbital-treated infants who bled, however, were also significantly larger and more mature than control infants who bled. The results of this study indicate no effect of phenobarbital on the incidence of subependymal-intraventricular hemorrhage, but a possible beneficial effect on the severity of hemorrhage.

Cerebral Hemorrhage↗
PubMed1982

Sonographic classification of intracranial hemorrhage. A prognostic indicator of mortality, morbidity, and short-term neurologic outcome.

Sixty-two neonates diagnosed to have periventricular-intraventricular hemorrhage were classified by sonographic findings as follows: mild, confined to the subependymal region or accompanied by a small amount of blood in the normal-sized lateral ventricle (10); moderate, intermediate amount of blood in the enlarged lateral ventricle (26); and severe, hemorrhage filling the entire ventricle forming a cast (12) or intraventricular hemorrhage with an intracerebral extension (14). Twenty-six of 35 surviving neonates had posthemorrhagic hydrocephalus, and 11 infants required shunt insertion. The survival rate of neonates with periventricular-intraventricular hemorrhage and the incidence of posthemorrhagic hydrocephalus correlated with the severity of the hemorrhage (P less than 0.05). The highest mortality rate was seen in the group with ventricular casts. All surviving neonates with casts developed hydrocephalus. All surviving neonates with intracerebral hemorrhage developed porencephaly. The severity of the hemorrhage correlated with short-term neurologic outcome (P less than 0.05), the group most severely affected being the one with intracerebral extension of hemorrhage. The severity of the hemorrhage also correlated with abnormal ventricular size by sonography on follow-up (P less than 0.05). However, posthemorrhagic hydrocephalus and abnormal ventricular size on follow-up did not correlate with neurologic outcome in the moderate and severe hemorrhage groups.

Cerebral Hemorrhage↗
PubMed1982

Indomethacin and bilirubin-albumin binding.

We studied the effects of indomethacin on the bilirubin binding of albumin using the hydroxybenzene azobenzoic acid (HBABA) dye binding method, the estimation of unbound bilirubin concentration (UBC) by the horseradish peroxidase assay and the whole blood fractionation (WBF) technique. The addition of up to 2 micrograms/ml of indomethacin, which is the level obtained with an 0.2 mg/kg dose, did not decrease the mean HBABA dye binding capacity of 29 icteric sera or increase the mean UBC of 11 icteric sera. There was also no additional displacement of bilirubin in 5 icteric sera measured by the WBF technique. However, the addition of 10-40 micrograms/ml of drug, which is the level that would be achieved if a 2 mg/kg dose of indomethacin were administered, resulted in a significant reduction of HBABA in 15 icteric sera (81.74-57.3%, p less than 0.005) and a significant increase of UBC in 11 icteric sera (6.17-37.2 nM/l, p less than 0.001). Therefore, no displacement of bilirubin from albumin occurred in the presence of usual therapeutic level of indomethacin; higher levels displaced bilirubin.

Bilirubin↗
PubMed1980

High milk lipase activity associated with breast milk jaundice.

Human milk samples that inhibit bilirubin-UDP-glucuronyl transferase (UDPGT) activity in vitro have been associated with prolonged unconjugated hyperbilirubinemia in newborn infants. We measured the concentration of nonesterified fatty acids (total and individual fatty acids), total fat and protein, and lipase activities (with and without bile salt stimulation) in milk samples from two groups of women. Women whose infants had prolonged unconjugated hyperbilirubinemia and whose milk inhibited the activity of UDPGT were in the first group (N = 9). Volunteers with healthy infants acted as controls. Inhibitory milk contained significantly more nonesterified fatty acids (total, palmitic, and oleic) than did controls. Fat and protein concentrations and bile salt-stimulated lipase activities were similar in the two groups. Unstimulated lipase activity was higher in the inhibitory milks (11.9 +/- 0.8 mM x min-1 x ml-1) than in the controls (6.0 +/- 0.1 mM x min-1 x ml-1) (P less than 0.01). The specific activity (mM x min-1 x mg protein) of unstimulated lipase was also significantly higher in the inhibitory milks (P less than 0.0001). The high nonesterified fatty acid levels in inhibitory milks is accounted for by the elevated unstimulated lipase activities. How these circumstances lead to jaundice in the infants remains to be shown.

Adult↗
PubMed1978

Monitoring critically ill newborn infants with digital capillary blood samples: an alternative.

Capillary blood samples obtained from a warmed distal phalanx of the right hand were compared with either temporal or right radial arterial blood samples for PO2, PCO2, and pH in 33 critically ill newborn infants. The blood pressure and skin temperatures of each infant and the ambient oxygen concentration were recorded at the time the blood was sampled. Sixty-eight paired PO2 analyses yielded a regression line close to the line of identity. The mean difference between digital capillary and arterial PO2 was 11.3 +/- 1.4 mm Hg (r = 0.92). The results were similar for the paired PCO2 analyses (r = 0.84) and for the paired pH analyses (r = 0.94). The correlation between arterial PO2 and digital capillary PO2 deteriorated when the systolic blood pressure of the patient was below 35 mm Hg. There was no correlation between skin temperature and capillary-arterial PO2 differences. The frequency of retrolental fibroplasia leading to blindness was not different from that in nurseries that sample umbilical arterial blood routinely.

Arteries↗
PubMed1977

The displacement of bilirubin from albumin by furosemide.

Since furosemide, a sulfonamide diuretic, has been recommended for use in the newborn infant, a study was made of its effect on the bilirubin-binding capacity of albumin. Furosemide was compared to sulfisoxazole, a known displacer of bilirubin, by means of three methods. First, aliquots of whole blood from 20 icteric infants were diluted in phosphate buffer along with expected clinical concentrations of furosemide and sulfisoxazole. The red cells and globulins were then isolated and bilirubin concentrations were measured in these two fractions. The addition of Furosemide resulted in the displacement of bilirubin from albumin to red cells and globulins. Mole for mole, furosemide displaced bilirubin about as well as sulfisoxazole. Second, the hydroxybenzeneazobenzoic acid dye binding test of Porter and twaters was performed using the sera of eight jaundiced newborn infants. The mean dye binding capacity of the sera was significantly reduced with the addition of furosemide to a final concentration of 2 mug/ml. Third, the administration of furosemide (5 mg/kg) or sulfisoxazole (50 mg/kg) to adult Gunn rats resulted in a significant fall in mean serum bilirubin concentration compared to saline controls. Furosemide, like sulfisoxazole, is a potent displacer of bilirubin and should be used with caution in jaundiced infants.

Animals↗
PubMed1977

The influence of fatty acids on the binding of bilirubin to albumin.

The influence of free fatty acids (FFA's) on the albumin binding of bilirubin was studied in vitro in the plasma of infants with neonatal hyperbilirubineamia and in solutions employing crystalline albumin to which bilirubin and FFA (oleic acid) were added. The bilirubin saturation index (SI) was utilized to distinguish between that fraction of bilirubin bound at the primary (high-affinity) site of albumin and bilirubin bound at secondary sites from which it is easily dissociated by salicylate. The relative saturation of albumin with bilirubin was also measured by addition of salicylate to whole blood samples where bilirubin was also measured by addition of salicylate to whole blood samples where bilirubin dissociated from the albumin could be sequestered by the red cells. The present studies indicate that FFA's influence the binding of bilirubin in two ways. At molar ratios of FFA to albumin (2:1 to 4:1), the FFA's compete with bilirubin for binding at the high-affinity site so that a significant portion of the bilirubin is transported at secondary sites, making it susceptible to displacement by water-soluble organic anions. At high molar ratios (greater than 5:1) FFA's compete with bilirubin for albumin binding at the secondary sites as well. In contrast to crystalline albumin where the first two molar equivalents of FFA do not influence the binding of bilirubin to albumin, all FFA concentrations in hyperbilirubinemic plasma reduce the affinity of albumin for bilirubin at its high-affinity site even though there is a molar excess of albumin over bilirubin.

Bilirubin↗