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Biomedical subjects

R S Pildes

Publications and source records attributed to R S Pildes.

At least 37 records · Page 2Linked to original sources
PubMed1986

Indomethacin therapy in premature infants with patent ductus arteriosus and oliguria.

Simultaneous administration of one dose of indomethacin (0.3 mg/kg, i.v.) and furosemide (1 mg/kg, i.v.) was given to 8 consecutive premature infants who had patent ductus arteriosus (PDA), and oliguria because of prerenal failure. Four infants responded with ductus closure and 2 infants showed improvement in echocardiogram and clinical distress. There was a significant increase in U/O, GFR, FENa and FECl following drug administration. This study suggests that simultaneous administration of indomethacin and furosemide can be safely used in infants with PDA and oliguria.

Anuria↗
PubMed1986

Hypoglycemia and hyperglycemia in tiny infants.

When the maternal supply of glucose is removed, endogenous hepatic glucose production and enteral or parenteral nutrition become the primary source of glucose supply. Because of this, the 1000-gm infant has special problems with glucose homeostasis. This article reviews these particular difficulties.

Blood Glucose↗
PubMed1986

Indomethacin therapy in infants with advanced postnatal age and patent ductus arteriosus.

A trial of intravenous indomethacin therapy was performed on 11 premature infants whose postnatal age was 8 weeks or more (mean 65.3 days). In an attempt to maintain the desired plasma level, indomethacin was given at a dosage of 0.3 mg/kg, at 8-hour intervals (total dose 0.9 mg/kg) for a total of 3 doses. In spite of desirable plasma indomethacin levels (which ranged from 280-870 ng/ml) and area under the curve (24.1 micrograms/hr/ml), calculated from time 0 to 24 hrs after the initial dose, none of the infants responded to indomethacin with ductus closure. There were a transient significant decrease in urine output, creatinine clearance, and fractional excretion of sodium. The present study confirms the clinical impression that Indomethacin is ineffective for the closure of ductus arteriosus in infants with advanced postnatal age.

Cardiovascular System↗
PubMed1985

Prevention of gastric inflation during mask ventilation in newborn infants.

Ten premature infants who had recovered from the respiratory distress syndrome were subjected to cricoid compression during mask ventilation. Each infant was ventilated with an AMBU face mask for 3 min with the nasogastric (NG) tube, without the NG tube, and without the NG tube but applying cricoid pressure during ventilation. The results of the study indicated that, similar to insertion of an NG tube, cricoid compression can prevent gastric inflation during mask ventilation.

Cricoid Cartilage↗
PubMed1985

Renal response to frusemide in preterm infants with respiratory distress syndrome during the first three postnatal days.

The renal effects of frusemide treatment in infants with respiratory distress syndrome shortly after birth and during the first three postnatal days were evaluated. Eighty five infants were randomly assigned to two groups. Forty two received three doses of intravenous frusemide (1 mg/kg) starting at age, mean (SD) 7.5 (4.1) hours and given at approximately 24 hour intervals. Forty three control infants were treated similarly but were not given frusemide. The groups were comparable in birthweight, gestational age, and Apgar score and in pulmonary status, blood gases, serum electrolytes, and postnatal age. Infants who received frusemide had significantly higher fractional excretion of sodium and chloride at 12 to 24, 24 to 48, and 48 to 72 hours, and higher calcium excretion at 24 to 48 and 48 to 72 hours after entry into the study than control infants. The study group had a significantly higher urine output and greater weight loss than the control group at 48 to 72 hours after entry into the study. There was no significant difference between groups in serum sodium, potassium, and calcium and in fractional excretion of potassium and the glomerular filtration rate. Infants with an Apgar score of more than 3 had higher urine output and had a better diuretic response to frusemide than those with a lower score. The results suggest that perinatal hypoxia may play an important role in renal function and in diuretic response to frusemide shortly after birth and early in the postnatal life of infants with respiratory distress syndrome.

Apgar Score↗
PubMed1985

Decreased plasma glucose following indomethacin therapy in premature infants with patent ductus arteriosus.

The effect of indomethacin on carbohydrate metabolism was studied in six premature infants with significant patent ductus arteriosus (mean +/- S.D., birth weight 1,066 +/- 244 gm, gestational age 30 +/- 1.6 weeks). All infants were in a glucose steady state between 50 and 100 mg/dl over a 2-hour period before indomethacin administration. There was a significant fall in plasma glucose at 1, 6, 12, and 24 hours following intravenous indomethacin infusion. Since there was no significant change in insulin levels from the baseline, the mechanism of indomethacin-mediated lack of prostaglandin inhibition of insulin release was not substantiated. Based on this study, plasma glucose levels should be followed closely in the first 24 hours following intravenous indomethacin administration.

Birth Weight↗
PubMed1984

Early furosemide therapy in premature infants (less than or equal to 2000 gm) with respiratory distress syndrome: a randomized controlled trial.

Pulmonary edema has been demonstrated in the early stages of respiratory distress syndrome in premature infants. To evaluate whether early furosemide therapy (0 to 8 hours after birth) would affect the electrolyte balance, pulmonary status, and outcome, 57 infants (less than or equal to 2000 gm) with respiratory distress syndrome who required mechanical ventilation shortly after birth were randomized into two groups: 29 given furosemide (1 mg/kg/day intravenously for three doses) and 27 control. The clinical, biochemical, and laboratory characteristics of the groups were comparable before entry into the study. Administration of furosemide significantly enhanced the urinary excretion of Na and Cl at 0 to 24, 24 to 48 and 48 to 72 hours and of Ca at 24 to 48 and 48 to 72 hours after drug administration. There was no significant difference between the groups in urinary excretion of K and in serum Na, Cl, K, and Ca values. A spontaneous increase in urine output occurred in the control group at 48 to 72 hours after the initiation of the study (mean +/- SD 7.0 +/- 3.5 hours postnatal age), along with a decrease in mean airway pressure for mechanical ventilation. The use of furosemide (7.3 +/- 3.5 hours postnatal age) enhanced urine output at 24 to 48 and 48 to 72 hours after medication, resulting in further decrease in mean airway pressure and facilitating extubation. There was, however, no significant difference between the groups with respect to incidence of patent ductus arteriosus, morbidity from bronchopulmonary dysplasia, and mortality.

Bronchopulmonary Dysplasia↗
PubMed1984

Rotavirus infection in normal nursery: epidemic and surveillance.

Human rotavirus (HRV) epidemics have not been reported in normal full-term newborn nurseries in the US. This report describes an epidemic from April 27 to May 6, 1982 in which 23 infants were infected. Diagnosis was confirmed with Rotazyme (Abbott) in 82% (23/28) of the neonates screened. Five were asymptomatic; in the remaining 18 cases, the symptoms were usually mild and self-limited. Transient shedding of the virus was found in 8% (4/52) of personnel screened, and only one of them was symptomatic. Control measures included the following: strict cohorting, closure of transitional nursery, enteric precautions and wiping of horizontal surfaces with 95% ethyl alcohol which has been shown to be an effective virucidal agent for rotavirus in laboratories. Follow-up in 80 of 108 contact neonates born during the epidemic showed only two mildly symptomatic cases after discharge. During an 11-month period of surveillance, 33% of neonates (1,688/5,054) born at Cook County Hospital were screened for excretion of virus in stools; only 3.6% of infants (61/1,688) were positive by Rotazyme and none were symptomatic. This report suggests that strict measures are helpful in control of HRV epidemic gastroenteritis and asymptomatic shedding need not be as high as the previously reported incidence of 40% to 50%.

Chicago↗
PubMed1984

Increased O2 consumption and energy loss in premature infants following medical care procedures.

Oxygen consumption (VO2) and CO2 production (VCO2) were measured continuously for 24 h in 10 premature infants during their ongoing nursing care. Using a flow-through technique, the total VO2 and VCO2 over a given period of time were determined from the area under the O2-and CO2-concentration-time curve of the mixed expired gas. Following chest physiotherapy, heel stick and i.v. needle insertion, there was a significant (p less than 0.01) increase in VO2 and VCO2. When measured for 24 h, the total daily increase of VO2 attributed to these procedures ranged from 2.1 to 11.7% of total daily VO2, equivalent to an estimated energy loss of 0.6-4.1 kcal/kg/day.

Birth Weight↗
PubMed1983

Penicillin in infants weighing two kilograms or less with early-onset Group B streptococcal disease.

We studied the effect of penicillin on early-onset Group B streptococcal disease over a 52-month period in neonates who were at high risk of infection. Shortly after birth, 1187 neonates weighing 2000 g or less had blood samples taken for cultures and were randomized into an early-treatment group (given intramuscular penicillin G within 60 minutes of birth) or a control group. The incidence of early-onset disease was 20 per 1000 live births (24 of 1187); the number of infants in the early-treatment group who had disease (10 of 589) was similar to that in the control group (14 of 598). The fatality rates were similar in both groups (6 of 10 vs. 8 of 14). Cultures from blood obtained with one hour of birth were positive in 21 of the 24 infants with disease; 22 of the 24 were symptomatic within four hours of birth. Thus, infection was well established before the first hour of postnatal life. At autopsy, gram-positive cocci were seen in lung sections of four infants in whom cultures of blood obtained after treatment had been sterile; this indicates that giving routine antibiotic therapy before culture samples are obtained can obscure bacteriologic diagnosis. We conclude that penicillin given at birth to neonates weighing 2000 g or less does not prevent early-onset streptococcal disease or reduce excess mortality associated with disease.

Clinical Trials as Topic↗
PubMed1983

Retinopathy of prematurity (ROP) and indomethacin therapy in premature infants with patent ductus arteriosus (PDA).

Recent studies suggested that prostaglandins (PGs) may play a role in the pathogenesis of retinopathy of prematurity (ROP). To evaluate if PGs inhibitor, indomethacin, would affect the incidence or severity of the ROP, an analysis was performed on 47 infants who participated in a double-blind controlled study of indomethacin for the closure of PDA. Twenty-three were in the control group and 24 in the indomethacin group. Indirect ophthalmoscopic examinations were performed from about 4 weeks of postnatal age and onward as needed. There was no significant difference between the groups with respect to birth weight, gestational age, postnatal age, Apgar score, and cardiopulmonary status shortly after birth and at the time of study. Six in the control and 2 in the indomethacin group (p = 0.58) developed active ROP; one in each group developed cicatricial ROP. It appears that with current doses of therapy, indomethacin does not increase the incidence or severity of ROP.

Clinical Trials as Topic↗
PubMed1983

Indomethacin treatment in small versus large premature infants with ductus arteriosus. Comparison of plasma indomethacin concentration and clinical response.

An analysis of clinical response and plasma indomethacin concentration was performed on 10 small (less than or equal to 1000 g) and 12 large (greater than 1000 g) premature infants who had symptomatic ductus arteriosus and required intravenous indomethacin therapy (0.3 mg/kg per day). The postnatal age, daily fluid intake, and cardiopulmonary status of the two groups at time of study were comparable, The small premature infants had a significantly lower peak plasma indomethacin concentration and lower concentration in the first four hours after infusion, and lower plasma concentration X time integral than that of the larger premature infants. There was a significant difference between the groups in proportion of response (2/10 vs 9/12) after one dose of indomethacin; this difference was not seen after two to three doses. The results of the study suggest that small premature infants do respond to indomethacin treatment, but compared to the larger infants may require repeated doses.

Birth Weight↗
PubMed1982

Intravenous indomethacin therapy in premature infants with patent ductus arteriosus. Causes of death and one-year follow-up.

Fifty-five infants participated in a double-blind study of indomethacin therapy for the closure of patent ductus arteriosus. Seventeen infants died. There was no significant difference in autopsy findings between the groups with respect to pneumonia, disseminated intravascular coagulopathy, necrotizing enterocolitis, sepsis, intraventricular hemorrhage, hydrocephalus, kernicterus, brain softening, and renal damage. For those infants who survived and returned for follow-up at approximately 1 year of age, there was no significant difference between the control (n = 17) and indomethacin (n = 13) groups with respect to physical growth, Bayley scores, respiratory infection, abnormal eye ground, neurological defects, and abnormal EEG. Four in the control group (24%) and three in the indomethacin group (23%) had moderate to severe neurological defects and/or scored less than 80 on the Bayley Mental Development Index or Psychomotor Development Index. It appeared that indomethacin therapy did not have a long-term adverse effect on premature infants.

Double-Blind Method↗
PubMed1982

Furosemide prevents the renal side effects of indomethacin therapy in premature infants with patent ductus arteriosus.

To determine if furosemide would prevent the renal side effects of indomethacin therapy in premature infants with patent ductus arteriosus, 19 premature infants were randomized into two groups: nine received indomethacin alone, and ten received indomethacin followed immediately by furosemide. There was no significant difference between the groups in birth weight, gestational age, postnatal age, and in cardiopulmonary or renal status at the time of study. Infants who received indomethacin and furosemide had significantly higher urine output (P less than 0.05), higher FENa and FECl (P less than 0.01), and higher glomerular filtration rate (P less than 0.05) than those of infants who received indomethacin alone. Seven infants in each group responded to indomethacin therapy with disappearance of PDA murmur and improvement of cardiovascular status. The results of this study suggest that furosemide may prevent the renal side effects of indomethacin therapy and yet not affect the efficacy of indomethacin in the closure of a PDA.

Drug Therapy, Combination↗
PubMed1982

Simple daily technique to calculate total and interim changes of daily O2 consumption and CO2 production in premature infants.

A simple method to calculate oxygen consumption (VO2) and CO2 production (VCO2) over a 24-h period is described. VO2 and VCO2 were measured using flow-through technique and the total VO2 and VCO2 over a given period of time were determined from the area under the O2 and CO2 concentration-time curve of the mixed expired gas. The system was tested in vitro by burning 100% ethyl alcohol. The average error between measured and theoretical values for VO2 was 4.9% and for VCO2 was 4.7%. With a flow rate greater than 5340 ml/min through the system, the correlation coefficient between theoretical VO2 or VCO2 and measured VO2 or VCO2 was 0.99. The method was tested in vivo in 5 premature infants who were nursed under neutral thermal environment and received routine medical care. The results indicate that this simple method can be used to study the total and interim changes of daily VO2 and VCO2 in infants during their ongoing nursery care.

Carbon Dioxide↗
PubMed1982

Lung volume, dynamic lung compliance, and blood gases during the first 3 days of postnatal life in infants with meconium aspiration syndrome.

Serial measurements of pulmonary function and arterial blood gases during the first 3 postnatal days of life were obtained in 12 infants with meconium aspiration syndrome (MAS). Nine normal neonates with similar weight and gestational age were studied as controls. Infants with MAS has significantly lower pH on day 1, and had greater P(A-a)O2 throughout the study period than that of normal controls. The PCO2 was comparable between the groups. Both dynamic lung compliance (Cdyn) and specific lung compliance (C/VL) were lower in infants with MAS as compared with those of normal infants. The functional residual capacity (FRC) for normal infants on days 1, 2, and 3 were 2.0 +/- 0.3, 2.1 +/- 0.3, and 2.2 +/- 0.3 ml/cm, respectively, and for infants with MAS were 1.8 +/- 0.4, 2.3 +!- 1.1, and 2.2 +/- 0.6 ml/cm, respectively. Radiographic hyperinflation of the lungs was seen in 6 infants with MAS on day 1; 3 were associated with high FRC (greater than 2 SD of normal) and 2 with low FRC, indicating air trapping. The early use of PEEP should be cautious if hyperinflation or air trapping is present.

Blood Gas Analysis↗