Biomedical subjects

S Baumgart

Publications and source records attributed to S Baumgart.

82 records · Page 5Linked to original sources

PubMed1981

Insensible water loss in the critically III neonate. Combined effect of radiant-warmer power and phototherapy.

To quantitate radiant power and insensible water loss under phototherapy, 12 neonates were studied under radiant warmers for one hour each with and without phototherapy. Warmer power was measured by wattmeter and thermopile. Power density received from phototherapy was 4.4 mW/sq cm. Addition of phototherapy to the servocontrolled warmer caused a disease in power density received from the warmer (17.1 to 12.9 mW/sq cm). However, the total radiant-power density received with phototherapy and the warmer combined (17.3 mW/sg cm) did not differ from net power density received without phototherapy (17.1 mW/sq cm). Insensible water loss, measured with a metabolic balance, increased from 2.54 to 3.73 mL/kg/hr, with addition of phototherapy. Since the total radiant-power density did not change, mechanisms other than increased radiant-power delivery must exist to explain the increased insensible water loss observed with phototherapy.

Female↗

PubMed1981

Effect of heat shielding on convective and evaporative heat losses and on radiant heat transfer in the premature infant.

Ten premature infants nursed on servocontrolled radiant warmer beds were studied in three environments designed to alter one or more factors affecting heat transfer (convection, evaporation, and radiation). In the control environment, infants were nursed supine on an open warmer bed. The second environment (walled chamber) was designed to reduce convection and evaporation by placing plastic walls circumferentially around the bed. In the third environment convection and evaporation were minimized by covering infants with a plastic blanket. Air turbulence, insensible water loss, and radiant warmer power were measured in each environment. There was a significant reduction in mean air velocity in the walled chamber and under the plastic blanket when compared to the control environment. A parallel decrease in insensible water loss occurred. In contrast, radiant power demand was the same for control and walled environments, but decreased significantly when infants were covered by the plastic blanket. This study suggests that convection is an important factor influencing evaporation in neonates nursed under radiant warmers. The thin plastic blanket was the most effective shield, significantly reducing radiant power demand.

Bedding and Linens↗

PubMed1981

The diuretic phase of respiratory distress syndrome and its relationship to oxygenation.

To determine the relationship between improvement in pulmonary function and diuresis in respiratory distress syndrome, ten consecutive premature infants requiring mechanical ventilation for severe RDS were studied. Every infant had a diuresis (output/intake greater than 80%), which began at 26 to 34 hours of life and which lasted for an additional 64-72 hours. The diuresis preceded significant improvement in AaDo2 and ventilator settings (IMV, PIP, PEEP) by 52 hours. There was a significant decrease in body weight among all study infants during the first four days of life despite an increase in fluid intake. This study suggests a relationship in RDS between improvement in oxygenation and removal of interstitial lung edema.

Body Weight↗

PubMed1981

Radiant warmer power and body size as determinants of insensible water loss in the critically ill neonate.

Twelve critically ill neonates mechanically ventilated for respiratory failure (mean weight 1.33 kg, mean gestation 31 wk) were studied to quantitate the effects of radiant power from a radiant warming device, body weight, and body surface area on insensible water loss. Radiant power density (Mw/cm2) was measured using a wattmeter and thermopile transducer. Insensible water loss was measured using a Potter Baby Scale. Weight correlated inversely with insensible water loss, (r = -0.86, P less than 0.001). Radiant power density correlated inversely to weight, (r = -0.71, P less than 0.001). There was a significant increase in insensible water loss as radiant power density increased, (r = 0.54, P less than 0.05). Net radiant power received (W/kg) by infants over their exposed surface area, correlated directly to insensible water loss, (r = 0.67, P less than 0.01) irrespective of body weight. Critically ill neonates ventilated for respiratory failure and nursed under radiant warmers incurred greater insensible water losses than previously reported for well infants. The magnitude of this increased insensible water loss is inversely related to body size and is determined directly by the radiant power density required to maintain body temperature.

Apnea↗

PubMed1981

Use of umbilical cord blood culture for detection of neonatal bacteremia.

Rapid and accurate detection of neonatal bacteremia is an important part of the management of the neonate with suspected sepsis. This study compared the incidence of positive umbilical cord blood cultures (UCBCs) to the incidence of positive peripheral venous blood cultures and determined whether a meticulous UCBC technique prevented contamination of culture specimens. Six UCBCs of the 200 sampled were positive. Three cultures exhibited delayed growth (more than 48 hours) and were not considered clinically significant. In 2 of the 3 remaining positive cultures were organisms considered contaminants; the third culture correlated to the infant's peripheral venous blood culture (alpha-hemolytic streptococcus), showing evidence of bacteremia. From these data the authors conclude that 1) meticulous and fastidious collection of UCBCs prevents contamination of culture specimens, and 2) the UCBC may prove to be a satisfactory alternative to the postnatal peripheral venous blood culture for detection of neonatal bacteremia.

Blood Specimen Collection↗

PubMed1980

Monitoring radiant power in the critically ill newborn under a radiant warmer.

To evaluate radiant power received by infants under radiant warmers, 11 neonates (mean gestational age 32.2 weeks, mean weight 1.50 kg) were monitored. A wattmeter was used to evaluate warmer power (watts), and a thermopile placed at bed level was used to correlate warmer power to radiant power density received (mw/cm2). Warmer power ranged from 133-301 watts. A linear relationship existed between warmer power and radiant power density received (r = 0.97, p < 0.001). After establishing that radiant power delivery could be monitored with a wattmeter, this technique was used to quantitate radiant power in a small series of infants with and without a plastic shield. Radiant power density received decreased in all infants when shielded (mean 14.6-11.2 mw/cm2, p < 0.01). This study demonstrates: (1) radiant warmer power can be monitored with a wattmeter; (2) warmer power correlates to radiant power density received; and (3) radiant power monitoring can be used to evaluate radiant power demands in specific clinical situations.

Apnea↗

PubMedDate not supplied

When combined, early bedside head ultrasound and electroencephalography predict abnormal computerized tomography or magnetic resonance brain images obtained after extracorporeal membrane oxygenation treatment.

Definitive neuroimaging of the brain using computerized tomography (CT) or magnetic resonance imaging (MRI) in extracorporeal membrane oxygenation (ECMO)-treated infants must be delayed until after this therapy is completed. Bedside head ultrasound (HUS) and electroencephalography (EEG) studies during ECMO, if highly correlated with later definitive neuroimaging, might be used to affect the acute clinical care and early parental counseling of infants with severe cardiorespiratory failure. One hundred and sixty ECMO-treated patients had both bedside EEG and HUS studies performed during ECMO, as well as a later CT or MRI study prior to hospital discharge. There was a significant difference in CT or MRI findings among patients having normal studies on both the HUS and EEG, compared to those having an abnormality on either the HUS or the EEG, and compared to those having abnormalities on both studies. In ECMO-treated infants, the combination of a normal bedside HUS and an EEG without marked abnormalities is highly predictive of normal post-ECMO CT and MRI neuroimaging studies.

Brain↗

PubMedDate not supplied

The hematofluorometer: a rapid assay for bilirubin and bilirubin binding.

Serum bilirubin measurement is extremely important to clinicians caring for newborn infants. These infants are at risk for kernicterus (bilirubin staining of brain matter) due to their immature clearance mechanism and increased bilirubin load. The hematofluorometer is a newly available device that uses the fluorescent properties of bilirubin to measure 1) albumin-bound bilirubin, 2) reserve binding capacity, and 3) total whole blood bilirubin. Since it is an easy and rapid assay, it provides the clinician with immediate information regarding the infant's level of unbound bilirubin. This information permits rapid assessment of the patient's risk for bilirubin encephalopathy. Clinicians and researchers could readily use this device in several clinical situations.

Bilirubin↗

PubMedDate not supplied

Aortic dissection in a neonate associated with arterial cannulation for extracorporeal life support.

The purpose of this paper is to describe the authors' approach to the diagnosis and treatment of aortic intimal dissection encountered as a complication of the arterial cannulation procedure employed routinely during neonatal venoarterial ECMO. A case report is provided. Recognition of this entity clinically was based on diminished pulses in the lower extremities with dampening of an umbilical arterial catheter transduced pressure wave form one day after decannulation from ECMO. Confirmation was achieved using a phased array echocardiographic Doppler system (ECHO). Successful surgical repair was achieved under deep hypothermic circulatory arrest on cardiopulmonary bypass, with partial resection of the affected aorta, and with sutures placed through the intimal flap and the aortic wall. Aortic continuity was established by end-to-end anastamosis posteriorly, and the aortic arch was reconstructed anteriorly with an aortic homograft. To the author's knowledge, this is the first case of this problem being identified and treated in an ECMO treated neonate.

Aorta, Thoracic↗

PubMedDate not supplied

Hypertrophic obstructive cardiomyopathy in an infant of a diabetic mother: support by extracorporeal membrane oxygenation and treatment with beta-adrenergic blockade and increased intravenous fluid administration.

In infants with hypertrophic obstructive cardiomyopathy (HOCM) on extracorporeal membrane oxygenation (ECMO), conventional treatment with inotropes, fluid restriction, and diuretics may be detrimental. This case reports an infant of a diabetic mother with HOCM on ECMO illustrating beneficial effects of beta adrenergic blockade and increased fluid administration.

Adrenergic beta-Antagonists↗