Search PubMed⌕ Search

Biomedical subjects

R L Schreiner

Publications and source records attributed to R L Schreiner.

At least 19 recordsLinked to original sources
PubMed1995

Down syndrome: a multidisciplinary perspective.

Trisomy 21, a genetic disorder resulting from a chromosomal abnormality, is one of the most common forms of mental disability in the United States. Individuals with Down syndrome frequently present with a constellation of medical problems including conductive hearing loss and, to a lesser degree, sensorineural hearing loss. As part of a health care team, audiologists must be sensitive to and aware of medical conditions prior to establishing intervention strategies. Medical conditions, by necessity, precede audiologic interventions and, therefore, a close working relationship among team members is critical. Yet, audiologic and communication interventions should be established at the earliest possible time for maximizing an individual's development potential. This article stresses the importance of a multidisciplinary team in the provision of services so that prevention of further disabilities, improved outcomes of medical interventions, and appropriate habilitative and educational planning may ensue.

Down Syndrome↗
PubMed1985

Significance of portal vein air in necrotizing entercolitis: analysis of 53 cases.

Fifty-three of 177 infants with necrotizing enterocolitis (NEC) developed portal vein air (PVA). These infants were evaluated for prenatal, perinatal, therapeutic, clinical, laboratory, radiographic, and operative factors as they related to infants with and without PVA. A significantly higher incidence of PVA was seen in infants with NEC who weighed less than 2400 g (P less than 0.025). The use of Vitamin E (P less than 0.01), aminophylline, and high-density premature formula (P less than 0.001) was associated with an increased incidence of PVA. NEC totalis was seen in 55% of the infants with NEC and PVA (P less than 0.001). The presence of PVA was associated with a 58% mortality rate (P less than 0.05). Infants with NEC and PVA operated on prior to 1983 had a 71% mortality. Since 1983, seven of nine infants with NEC and PVA survived early operation using PVA as an indication for surgical intervention. In infants at risk for this highly lethal form of NEC, the avoidance of enteral feedings or altered dietary intake, cautious placement of arterial catheters and the judicious application of pharmacologic agents (eg, Vitamin E, aminophylline) is of importance in regard to prevention. These observations suggest that PVA is a sign of advanced disease and that these high-risk patients should be considered candidates for early surgical intervention.

Air↗
PubMed1985

Indomethacin therapy on the first day of life in infants with very low birth weight.

To investigate the optimal timing for treatment of small premature infants, we performed a double-blind, controlled trial of indomethacin therapy on the first day of life in 104 infants weighing between 700 and 1300 gm. Infants were given indomethacin or placebo at a mean age of 15 hours. Eleven of the 56 infants given placebo developed large left-to-right shunts through a patent ductus arteriosus. In contrast, only two of the 51 infants given indomethacin developed large shunts (P less than 0.025). There were no significant differences in incidence of surgical ligation, duration of oxygen therapy, duration of endotracheal intubation, days required to regain birth weight, or incidence of complications. However, the power of the tests of significance was low because of the small number of patients. Thus, although the incidence of large left-to-right ductus shunts was decreased in the indomethacin group, morbidity was not otherwise altered for the entire group of patients, possibly because of the relatively low incidence (21%) of large shunts in the placebo group. We conclude that although treatment with indomethacin on the first day of life appears to be safe, there is little advantage to its use in centers where the incidence of large shunts through a patent ductus arteriosus is relatively low.

Double-Blind Method↗
PubMed1985

VATER association: analysis of growth and development.

The growth and development of 15 patients with VATER association were prospectively followed for 1-4 years. Prenatal growth retardation was frequent but at least 50% of children with early growth deficiency demonstrated long-term catch-up growth. Mental development was normal in 12 of 15 children but 8 of 13 children had delayed motor skill development. Early postnatal growth deficiency was an indicator of children at risk for developmental problems. Parents should be reassured that most children with VATER association display normal development.

Abnormalities, Multiple↗
PubMed1984

Fetal and maternal amino acid concentrations during fasting in the ewe.

The present investigation was undertaken to quantitate the whole-blood amino acid concentrations of the mother and fetus over an extended period of fasting using a chronic sheep preparation. Fetal amino acid levels generally increased or remained relatively high during the fast (e.g., alanine, glycine, valine, leucine). In contrast to the situation in the fetus, most amino acids (alanine, glycine, glutamine, serine, and threonine) decreased in concentration in the ewe with fasting. Alanine levels changed most dramatically in the ewe, decreasing to less than 50% of the fed state values within 72 h of fasting. Therefore, while the supply of gluconeogenic amino acids becomes limited within the maternal circulation during fasting, levels of these amino acids remain high or increase in the fetal arterial blood.

Alanine↗
PubMed1984

Metabolic balance of the ovine fetus during the fed and fasted states.

The present study was performed in order to quantitate the uptake and excretion of a number of metabolic substrates by the sheep uterus as well as the fetus during the fed and fasted states within the same animals. 5 dated Suffolk sheep were studied initially at least 7 days after surgical placement of catheters in the fetal umbilical artery and vein, as well as the uterine veins and maternal artery. During the fed state and after 5 days of complete maternal fasting, measurements were made of uterine and umbilical blood flow by the steady-state antipyrine method, and the concentrations of whole blood glucose, oxygen, ammonia, 23 amino acids and plasma urea nitrogen were assessed. The results indicate that free amino acids and glucose comprise the major substrates required by the fetal lamb during both the fed and fasted states. While a number of amino acids changed in concentration in both the maternal and fetal circulations, few amino acids demonstrated a significant change in uptake in either the umbilical or uterine circulations. Similarly, no changes were observed in the uptake of oxygen by either the fetus or the uterus, while glucose consumption by the fetus decreased substantially with a concomitant increase in urea production. Consumption of both glucose and oxygen by the uteroplacenta remained unchanged during fasting. Leucine is one of several amino acids which is metabolized to a significant extent within the uteroplacenta, and theoretically may play a role in modulating glucose metabolism within the placenta and fetus.

Amino Acids↗
PubMed1984

Necrotizing enterocolitis: factors affecting mortality in 101 surgical cases.

One hundred one infants requiring operative treatment for necrotizing enterocolitis were evaluated for prenatal, perinatal, therapeutic, clinical, laboratory, radiographic, and operative factors as they relate to mortality. Infants less than 28 weeks gestation and those with birth weight less than 1500 gm had an increased mortality rate. The use of umbilical arterial catheters, high-density premature formulas, and aminophylline (for apnea) had an adverse effect on survival. Persistent acidosis, oliguria, and abdominal wall erythema resulted in a significantly worse outcome. The presence of portal vein air on abdominal radiograph was associated with a 71% mortality rate. The survival rate in infants with localized involvement was 70%. Thirty-eight percent of patients had extensive bowel involvement and a greater than 95% mortality rate. Avoidance of enteral feedings, cautious use of umbilical artery catheters, and judicious application of pharmacologic agents in infants at risk for necrotizing enterocolitis is of importance with regard to prevention. While medical management is feasible in some cases, persistent acidosis, oliguria, abdominal wall erythema, and portal vein air are associated with advanced disease. Infants with these risk factors should be candidates for prompt operative intervention.

Aminophylline↗
PubMed1983

Incidence of retinopathy of prematurity in a tertiary newborn intensive care unit.

This study determined the incidence of retinopathy of prematurity (ROP) in 2,958 admissions to the Newborn Intensive Care Unit of the James Whitcomb Riley Hospital for Children, Indianapolis, between January 1976 and December 1979. Among 2,484 survivors, acute ROP developed in 72 (2.9%); 60 (83%) of these newborns had birth weights of less than 1,500 g. The incidence of acute ROP among survivors with birth weights of less than 1,000 g (28%) was approximately three times that of the survivors with birth weights between 1,001 and 1,500 g (10.1%). The overall incidence of blindness was 4.5% of surviving infants less than 1,000 g and 1.2% of those surviving with birth weights of 1,000 to 1,500 g. Evidence of the strong influence of immaturity and low birth weight on the risk of development of ROP is reaffirmed. Increasing survival of the most susceptible infants may be the factor contributing most to the overall incidence of ROP.

Birth Weight↗
PubMed1983

Absence of dermal ridge patterns: genetic heterogeneity.

An apparently new form of complete absence of dermal ridge patterns was transmitted as an autosomal dominant trait through five generations in an Irish-American family. Affected individuals lacked dermatoglyphic patterns, sweat pores, and ability to sweat in the volar areas of the fingertips, palms, and soles. They also had congenital milia and blisters on the fingertips and soles at birth, abnormal nails, single transverse palmar creases, increased heat tolerance, and painful fissures in adult life around the fingernails in cold weather.

Dermatoglyphics↗
PubMed1983

Bibliotherapy: a tool to help parents mourn their infant's death.

A hospital in Indianapolis has used the gift of a book, The Bereaved Parent, as part of the follow-up program of support for families whose newborn has died. Through questionnaires sent to bereaved families, the authors gained information to help them assess the value of this "bibliotherapy" and determined that this portion of the follow-up program was worth continuing.

Bibliotherapy↗