Doxapram for apnea of prematurity.
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Apnea↗
Biomedical subjects
R T Hall
Publications and source records attributed to R T Hall.
Selective bronchial intubation in infants with lobar emphysema: indications, complications, and long-term outcome.
Thirteen infants underwent selective intubation of a mainstem bronchus (SBI) for lobar emphysema of varying etiologies. Seven infants had pulmonary interstitial emphysema (PIE) with lobar hyperinflation secondary to hyaline membrane disease and mechanical ventilation. Six of these improved with SBI and five maintained permanent resolution upon cessation of SBI. Two infants with localized areas of emphysema who were subsequently shown to have histologic evidence of bronchopulmonary dysplasia had unsuccessful SBI. SBI was also unsuccessful in permanently resolving congenital lobar emphysema although temporary collapse of the affected lobe occurred during SBI. Complications including hypoxia, bradycardia, right upper lobe atelectasis, pneumonia, and additional air leaks occurred during SBI in six cases. Follow-up xenon ventilation scans in four infants in whom SBI was successful revealed normal ventilation of the previously diseased lobes. SBI can be a useful alternative to surgical excision of the affected lobe in patients with localized lobar hyperinflation secondary to PIE. SBI is generally unsuccessful in permanently correcting congenital lobar emphysema, nor should it be used when chronic diffuse parenchymal damage is present.
Bronchi↗
Exchange transfusion in neonatal sepsis.
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Exchange Transfusion, Whole Blood↗
Clinical indications for the use of blood products in potentially infected neonates.
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Animals↗
Neonatal pulmonary hypoplasia with premature rupture of fetal membranes and oligohydramnios.
We assessed pulmonary function and compression deformities in 76 preterm infants less than or equal to 34 weeks gestation who had premature rupture of membranes (PROM) for longer than 5 days (mean +/- SD 18.8 +/- 15.4 days, range 6 to 90 days). Twenty-one of the 76 infants had oligohydramnios and positional deformities at birth; however, only two infants met all the criteria for the oligohydramnios tetrad. All 21 required assisted ventilation from the moment of birth. Twenty infants had clinical evidence of pulmonary hypoplasia; 18 of these died. Pulmonary hypoplasia was confirmed by significantly low wet lung weights, low lung DNA content, or low radial alveolar counts in the 13 infants with postmortem examinations. Fifty-five infants with PROM for longer than 5 days did not have positional deformities. Twenty-one required assisted ventilation, of whom 10 had severe oligohydramnios. Eleven of the 21 died; autopsies were performed. All had normal wet lung weights, but seven had significantly decreased radial alveolar counts, implying a less severe but still fatal form of pulmonary hypoplasia. None of the remaining 34 infants had lung disease, and only three had oligohydramnios. We conclude that pulmonary hypoplasia can result from PROM associated with severe oligohydramnios of as short as 6 days duration. Furthermore, fatal pulmonary hypoplasia can occur with little or no external deformation.
Amniotic Fluid↗
Incidence of hyperbilirubinemia in breast- vs. formula-fed infants.
A retrospective study of 233 consecutively born full-term infants was performed to determine the effect of several variables on the development of hyperbilirubinemia. Thirty-five (15%) of the infants developed peak bilirubin levels greater than 12 mg/dl in the first week of life. Step-wise multiple regression analysis revealed that breast-feeding was the most predictive of a group of eight variables for the development of hyperbilirubinemia greater than 12 mg/dl. The correlation between type of feeding and hyperbilirubinemia was significant (p less than 0.02). None of the other factors evaluated was significantly associated with hyperbilirubinemia. Breast-fed infants also were found to have a significantly higher incidence of hyperbilirubinemia greater than 15 mg/dl; 12 of 101 (12%) infants compared with 2 of 117 (2%) formula-fed infants (p less than 0.002). This group of infants accounted for the increased incidence of hyperbilirubinemia greater than 12 mg/dl in breast-fed infants. There was no significant correlation between weight loss and development of hyperbilirubinemia in the breast-fed infants.
Birth Weight↗
Postasphyxial lung disease in newborn infants with severe perinatal acidosis.
The pulmonary course and respiratory management of 65 asphyxiated infants with at least one arterial pH less than or equal to 7.00 within the first 2 hours of life was determined. Asphyxia in the preterm and term infants in the absence of respiratory distress syndrome or meconium aspiration syndrome was associated with a transient respiratory insufficiency requiring assisted ventilation which markedly improved in the first 24 hours of life. In contrast, infants with asphyxia complicated by respiratory distress syndrome or meconium aspiration syndrome developed profound lung disease including pulmonary hemorrhage and persistence of the fetal circulation. The course of their illness was significantly worse than control infants without asphyxia. Ineffective neonatal resuscitation allowing for the development of meconium aspiration syndrome and persistent respiratory acidosis contributed to the severity of illness in more than 50% of the infants. Central nervous system pathologic conditions were present in asphyxiated infants with and without severe pulmonary disease. We conclude that severe asphyxia in the absence of underlying lung disease results in a predictable postasphyxial transient respiratory insufficiency, with marked improvement in the first 24 hours of life.
Acidosis↗
Postnatal diuresis and respiratory distress syndrome in infants receiving mechanical ventilation.
Measurements of body water homeostasis and pulmonary function were obtained in 24 infants with respiratory distress syndrome requiring mechanical ventilation during the first five days of life to determine the relationship of diuresis to improvement in pulmonary function. Initial diuresis (output intake ratio greater than 0.8) occurred at 24 hours, maximum diuresis (output intake ratio greater than or equal to 1.6) at 40 hours, and initial improvement in pulmonary function (fall in AaDO2 greater than 50 mm Hg) at 48 hours. Urine flow rates over four-, eight-, or 12-hour periods were quite variable and correlated poorly with improvement in pulmonary function. Reduction in body weight was a more accurate indicator of total changes in body water than urine output, output intake ratio, or fractional excretion of sodium. Although there was a temporal relationship of loss of body water and improvement in pulmonary function by analysis of means, no cause-and-effect relationship could be found on a case-by-case analysis. Five of 24 infants demonstrated improvement in pulmonary function prior to diuresis or reduction in body weight. Nine infants had a diuresis more than 24 hours prior to pulmonary improvement, and two infants had a diuresis without pulmonary improvement during the five-day study period. These data indicate that factors other than body water are associated with improvement in pulmonary function in infants with respiratory distress syndrome.
Age Factors↗
Calculation of mean airway pressure during mechanical ventilation in neonates.
Mean airway pressure (Paw) calculated by 4 methods was compared with measured Paw, using 833 observations on 16 infants requiring constant-flow, pressure-limited mechanical ventilation. Measured Paw was most accurately predicted by determining a waveform constant for each infant every 12 h, and then using the waveform constant in a general Paw equation for the ensuing 12 h. However, this method is impractical for clinical use. A square-waveform equation more accurately predicted Paw than did triangular or sine-like waveform equations. Because there was considerable interindividual variation in the accuracy of all methods, due to different individual respiratory waveforms and waveform constants, Paw should be measured and not calculated.
Humans↗
Comparison of calcium- and phosphorus-supplemented soy isolate formula with whey-predominant premature formula in very low birth weight infants.
In a random, controlled study of very low birth weight (VLBW) infants from 3 to 8 weeks of age, 17 infants were fed soy isolate formula supplemented with calcium (92 mg/kg/day), phosphorus (44 mg/kg/day), and vitamin D (500 IU/kg/day), and 15 were fed a new whey-predominant, low osmolality formula designed for small preterm infants. Mean birth weight (1,206 g, SD 178) and gestational age (30 weeks, SD 1.9) of the soy-fed group were not significantly different from the whey formula group (1,143 g, SD 158, and 30 weeks, SD 1.8, respectively). Caloric and protein intakes were not different between the formula groups throughout the study period. However, mean weight gain in g/kg/day was significantly greater for the whey formula group: 15.3 g, SD 2.5, vs. 11.3 g, SD 2.3, p less than 0.0001. Serum protein and albumin were higher in the whey formula-fed group during the latter 2 weeks of the study (p less than 0.05). The incidence of vomiting, gastric residual, abdominal distension, diarrhea, and constipation was low and not different between the two groups. No infant developed necrotizing enterocolitis. Serum calcium, phosphorus, alkaline phosphatase, 25-hydroxy vitamin D and parathyroid hormone were similar in both groups, and no infant developed radiographic evidence of rickets. Although soy isolate formula supplemented with calcium, phosphorus, and vitamin D was not associated with rickets, no fewer complications were observed with this lactose-free, low solute formula.(ABSTRACT TRUNCATED AT 250 WORDS)
Blood Proteins↗
Neonatal pneumopericardium: analysis of ventilatory variables.
Case reports of all infants admitted to the NICU from 1971 to 1982, who developed a pneumopericardium (PPC) while receiving intermittent positive-pressure ventilation, were reviewed in order to determine those variables of assisted ventilation associated with the occurrence of PPC. Of 19 infants seen during the 11-yr period, 16 had respiratory distress syndrome (RDS) and 3 had other forms of severe pulmonary disease. Mean birth weight was 1720 g, gestational age 32 wk, and age at occurrence 59 h. Peak inspiratory pressure (PIP) (mean 32 cm H2O), inspiratory time (IT) (0.74 sec), and mean airway pressure (MAP) (mean 17 cm H2O) were significantly elevated just before occurrence of the PPC, compared with values 6 h previously. PEEP (mean 3.8 cm H2O), ventilator rate (mean 40/min), PaCO2 (mean 41 torr), P(A-a)O2 (mean 443 torr), and inspired oxygen concentration (FIO2, 0.77) were unchanged. MAP was significantly lower (mean 11 cm H2O) 6 h after the event compared with just before (mean 14 cm H2O) in infants who died, suggesting that lowering airway pressure does not improve survival. These data indicate that high PIP, prolonged IT and elevated MAP are associated with the development of PPC. MAP provides a composite of pressure transmitted to the airways and may be the more useful index in preventing barotrauma and pulmonary air leak.
Female↗
Prediction of neonatal hypoglycemia in infants of diabetic mothers by glucose disappearance in the first hour of life.
Whole blood glucose determinations were obtained in the first hour of life in 44 infants of diabetic mothers in order to predict the occurrence of subsequent hypoglycemia by means of the calculated glucose disappearance rate. Hypoglycemia (whole blood glucose less than 20 mg/dl) occurred in 10 infants with linear glucose disappearance of whom 9 had a glucose disappearance rate greater than or equal to 3.0% per min (90% sensitivity). Nine of 11 infants with glucose disappearance rates greater than or equal to 3.0% per min had hypoglycemia (82% specificity). This relatively simple procedure offers an accurate method for prediction of neonatal hypoglycemia due to reactive hyperinsulinemia in infants of diabetic mothers.
Blood Glucose↗
Diagnosis and treatment of right Bochdalek hernia associated with group B streptococcal pneumonia and sepsis in the neonate.
Neonatal sepsis due to group B beta-hemolytic Streptococcus (GBS) is reported to occur in about 1 out of 330 live births. Right-sided Bochdalek hernia (RBH) occurs in about 1 of 20,000 live births. The combination of group B streptococcal sepsis and delayed appearance of a right Bochdalek hernia is an infrequently reported phenomenon--18 patients have been previously reported in the English literature. We add four patients from our own experience to these previous reports. Since approximately 10% to 15% of the newborn population are exposed to group B Streptococcus we suspect that the inadequate diaphragmatic motion on the side of the Bochdalek hernia predisposes the child to development of septicemia and/or pneumonitis. Once the etiology has been established and appropriate antibiotic therapy instituted, progressive improvement in the patient's course should be seen. This is in contrast to a very significant mortality rate in many of the patients having early onset GBS. Any child, therefore, surviving early onset GBS only to deteriorate again, should be suspected of having an associated right Bochdalek hernia, and diagnostic steps should be taken to evaluate the integrity of the right diaphragm.
Female↗
Hyperbilirubinemia in breast-versus formula-fed infants in the first six weeks of life: relationship to weight gain.
Bilirubin determinations were obtained at weekly intervals from 1 to 6 weeks of age in 27 breast-fed and 12 formula-fed term, average size infants. Mean bilirubin levels were significantly higher in breast-fed infants at each age studied. The highest mean bilirubin level in each group was present at 1 week of age, 10.6 (+/- SD 4.6) mg/dl in breast-fed and 4.7 (+/- SD 3.0) mg/dl in formula-fed infants. Thereafter, values gradually fell in both groups. Mean birthweight was not different between the two groups; however, breast-fed infants lost significantly more weight (4.8%) by the time of discharge than formula-fed infants (2.2%). Breast-fed infants remained significantly lighter in weight at 6 weeks of age. Analysis of variance and covariance revealed no significant correlation between body weight, weight change in grams or percent weight change, and bilirubin levels in either group. These data indicate that mean bilirubin levels are significantly higher in breast-fed infants compared with formula-fed infants from 1 to 6 weeks of age. Breast-fed infants also have a significantly greater weight loss during the first four days of life and remain lighter at 6 weeks of age; however, there is no relationship of weight loss to bilirubin levels.
Bilirubin↗
The psychiatry of vertebro-basilar insufficiency with the report of a case.
Vertebro-basilar insufficiency produces a rich spectrum of psychological and neurological symptoms. Where psychological symptoms dominate the picture, the patient may be presented first to a psychiatrist. The phenomenology of vertebro-basilar insufficiency is discussed with special reference to hallucinatory syndromes, memory disturbance, affective disorders, akinetic mutism, 'unusual reports', cortical blindness, agitated delirium, the Capgras syndrome and normal pressure hydrocephalus. Finally, the case of a 61-year-old man illustrating a variety of the neurological and psychological features described in this paper is presented.
Agnosia↗
Neonatal resuscitation in high-risk deliveries. A prospective study.
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Adolescent↗
Septicemia and hernia.
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Hernias, Diaphragmatic, Congenital↗
Scrotal ecchymosis: sign of intraperitoneal hemorrhage in the newborn.
Ecchymosis of the scrotum and lower abdominal wall occurred in four newborn boys. All were anemic. Three had coagulation abnormalities and evidence of sepsis. In two, group B streptococcal septicemia was documented. Intraperitoneal hemorrhage from a ruptured subcapsular hematoma of the liver was the source of blood in the scrotum in three, and most probably in the fourth as well. Two infants died in spite of antibiotics, vigorous blood replacement, including exchange transfusion, and desperation laparotomies for continued intraperitoneal hemorrhage. Newborns with scrotal ecchymosis should be examined for intraperitoneal hemorrhage, ruptured subcapsular hematoma of the liver being the most probable source. Their coagulation status should also be evaluated, and sepsis should be suspected, especially in those with a demonstrated coagulopathy. Group B Streptococcus is a likely primary etiologic agent in these critically ill neonates. Nonoperative treatment, as given the two survivors in this experience, is preferred.
Anti-Bacterial Agents↗