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Biomedical subjects

S Dollberg

Publications and source records attributed to S Dollberg.

At least 37 records · Page 2Linked to original sources
PubMed1999

Placing the newborn on the maternal abdomen after delivery increases the volume and CD34 cell content in the umbilical cord blood collected: an old maneuver with new applications.

OBJECTIVE: Our purpose was to increase the number of the progenitor cells in umbilical cord blood collected for transplantation. STUDY DESIGN: We randomly assessed the effect of "upper" and "lower" positions of the newborn on the volume and progenitor cell (CD34(+)) content of the umbilical cord blood collected from 49 healthy, vaginally delivered, term neonates. RESULTS: Twenty-two collections were performed in the "upper" and 27 in the "lower" position. The volume of umbilical cord blood obtained in the "upper" position was 108.1 +/- 19.1 mL compared with 42.6 +/- 19.5 mL in the "lower" position (P <.0001). Mononuclear cell separation revealed significantly higher numbers of cells in umbilical cord blood obtained in the "upper" group (P <.01). Although the percentage of CD34(+) cells was comparable, the absolute number of CD34(+) cells was significantly higher in the "upper" group because of the larger volume collected (P <.02). At 24 hours after delivery the hemoglobin levels were not significantly different between newborns of the 2 groups. CONCLUSIONS: Placing the newborn on the maternal abdomen after delivery and before cord clamping may significantly increase the volume of umbilical cord blood collected and therefore the CD34(+) counts that improve transplantation success without placing the mother or the newborn at risk.

Antigens, CD34↗
PubMed1999

Effect of pulsed dexamethasone therapy on tolerance of intravenously administered lipids in extremely low birth weight infants.

We investigated the effect of dexamethasone on parenteral lipid tolerance in 7-day-old extremely low birth weight infants (n = 28) in a randomized, double-blind trial. Serum triglycerides were measured before and after 3 days of dexamethasone or placebo treatment. Infants treated with dexamethasone responded with higher triglyceride concentrations and greater sensitivity to incremental increases in the intravenous lipid dose.

Dexamethasone↗
PubMed1999

Nucleated red blood cells in infants of smoking mothers.

OBJECTIVE: To evaluate whether the absolute nucleated red blood cell (RBC) count is elevated in term, appropriate for gestational age (AGA) infants born to smoking women. METHODS: We compared absolute nucleated RBC counts taken during the first 12 hours of life in two groups of term, vaginally delivered, AGA infants, one group born to mothers who smoked during pregnancy (n = 30) and the other born to mothers who did not smoke (n = 30). We excluded infants of women with diabetes, hypertension, or alcohol or drug abuse, and infants with heart rate abnormalities, hemolysis, blood loss, or chromosomal anomalies. RESULTS: There were no differences between the groups in birth weight, gestational age, maternal age, gravidity, parity, maternal analgesia during labor, 1- and 5-minute Apgar scores, corrected white blood cell counts, lymphocyte counts, or hematocrits. The median absolute nucleated RBC count in infants of smoking mothers was 0.5 x 10(9)/L (range 0 to 5.0) versus 0.0005 x 10(9)/L (range 0 to 0.6) in nonsmoking controls (P < .002). Regression analysis that included Apgar scores, gestational age, and number of cigarettes smoked per day showed a significant correlation of absolute nucleated RBC count only with the number of cigarettes smoked per day (P < .001). CONCLUSION: At birth, term AGA infants born to smoking mothers have increased circulating absolute nucleated RBC counts compared with controls. The absolute nucleated RBC count in newborns correlates with the number of cigarettes smoked during pregnancy.

Adult↗
PubMed1999

Effects of antenatal corticosteroids on blood pressure in very low birth weight infants during the first 24 hours of life.

OBJECTIVE: We tested the hypothesis that prenatal glucocorticoids significantly increase mean arterial blood pressure in very low birth weight preterm infants during the first 24 hours after birth. STUDY DESIGN: Prospectively collected data from 178 inborn infants with birth weights between 500 and 1499 gm were examined. A total of 80 infants were born to mothers treated with corticosteroids (birth weight: 1057 +/- 271 gm, gestational age: 28.0 +/- 2.6 weeks), and 98 infants were untreated controls (birth weight: 1030 +/- 280 gm, gestational age: 28.0 +/- 2.8 weeks). The study setting was a university-based tertiary care center for newborn intensive care. RESULTS: Mean blood pressures on admission and at 3, 6, 12, 18, and 24 hours were significantly higher in steroid-treated infants. Steroid-treated infants received significantly less volume expansion (3.8 +/- 8.5 ml/kg versus 14.4 +/- 20.7 ml/kg; p < 0.001) than controls. Vasopressor support was also reduced in the steroid group (2.5% versus 11.5%; p < 0.05). CONCLUSION: Antenatal steroids are associated with both a higher mean systemic blood pressure and a decreased use of vasopressors and plasma expanders in very low birth weight infants during the first 24 hours after birth. This effect is not limited to infants of < 1000 gm; it is also significant in infants with a birth weight between 1000 and 1499 gm, and is already detectable in the first hours of life. We speculate that this finding may contribute to the mechanism of steroid protection against conditions such as intraventricular hemorrhage.

Adrenal Cortex Hormones↗
PubMed1999

Tumor necrosis factor-alpha is decreased in the umbilical cord plasma of patients with severe preeclampsia.

We investigated the role of the fetal immune system in pregnancies complicated by preeclampsia by assessing umbilical cord plasma levels of the cytokines tumor necrosis factor-alpha (TNF-alpha) and interleukin-1beta (IL-1beta). Nineteen nulliparous patients with severe preeclampsia composed the study group (group A). A comparison group was comprised of 19 healthy nulliparous patients with uneventful pregnancies (group B). Mixed umbilical cord blood was collected immediately after delivery. Plasma was prepared and all samples were assayed for TNF-alpha and IL-1beta by specific enzyme-linked immunoassays (ELISAs). Data are presented as the median with range of values. The length of labor was similar in both groups. TNF-alpha was detected less frequently in the umbilical cord plasma of preeclamptic patients than in the umbilical cord plasma of control patients (57.9 vs. 89.5%, p < 0.05), and the concentrations of TNF-alpha were significantly lower in the umbilical cord plasma of the preeclamptic patients [20 pg/ml (0-80 pg/mL) vs. 50 pg/mL (0-310 pg/mL), p < 0.05]. Umbilical cord plasma IL-1beta detection rates and concentrations from the preeclamptic and control patients were similar, [15.8 vs. 5.3%, 0 pg/mL (0-40 pg/mL) vs 0 pg/mL (0-10 pg/mL)]. The lower concentrations of TNF-alpha in umbilical cord plasma of patients with severe preeclampsia suggest that release of TNF-alpha by the fetus and mother are independent and may reflect adaptation of the fetus to reduced placental perfusion in preeclampsia.

Adult↗
PubMed1999

Incidence and clinical significance of echogenic vasculature in the basal ganglia of newborns.

Cranial sonography has become the main modality of the investigation and diagnosis of a wide variety of neonatal intracranial abnormalities. Occasionally, cranial sonograms reveal basal ganglia and thalami bright echoes. It is believed that these lesions are indicative of vasculitis due to intrauterine infections, in particular with cytomegalovirus (CMV). We hypothesized that the incidence of proven neonatal intrauterine TORCH infection is low and that screening of all asymptomatic infants with bright lenticulostriate echodensities would not be cost-effective. We reviewed brain sonograms of 3700 infants, performed over a period of 3 1/2 years. Echogenic basal ganglia vasculature were observed in 75 patients (2%). Chart review performed for clinical presentation and TORCH studies showed that only one infant had confirmed intrauterine congenital infection, which was by CMV. This infant had no signs or symptoms of CMV. In addition, there were 4 patients with chromosomal anomalies among the 75 patients (5%), of these one had trisomy 13 and another-trisomy 21. Our results indicate that echogenic basal ganglia blood vessels are not an exceptional finding on cranial sonograms, and are seldom associated with intrauterine infection. We conclude that it is not cost-effective to screen infants with echogenic basal ganglia blood vessels for intrauterine infection, unless clinical suspicion exists.

Basal Ganglia↗
PubMed1999

Financial impact of the introduction of erythropoietin in the treatment of anemia of premature infants in Israel.

BACKGROUND AND OBJECTIVE: Very low birthweight infants (< 1,500 g birthweight) often develop significant anemia that requires multiple blood transfusions, which carry a significant risk. Erythropoietin therapy is known to reduce the need for blood transfusions in preterm VLBW infants. Analysis of cost had been reported in prospective studies with conflicting results. No studies comparing the cost-effectiveness of EPO have been reported during routine use in preterm VLBW infants. METHODS: We compared the cost of treating anemia of prematurity in two consecutive 12-month periods: before and after the introduction of EPO therapy in our unit. The cost of blood bank charges as well as disposable items and the cost of EPO were compared. RESULTS: A significantly smaller number of infants required blood transfusions in the EPO group (2 of 25 vs. 9/21 before EPO was introduced). The cost of therapy for anemia of prematurity was significantly smaller in the EPO group (128 +/- 168 US$ per infant vs. 151 +/- 189 US$ per infant before the introduction of EPO). CONCLUSION: We conclude that EPO is an efficient and cost-effective alternative to blood transfusions in VLBW infants.

Anemia↗
PubMed1998

Changes in skin blood flow over the foot with warming of the contralateral heel.

Vasospasm in one leg is a common complication of umbilical artery catheterization in preterm infants. It is a common practice to wrap the contralateral leg in a warm washcloth. The rationale for this intervention is to induce reflex vasodilatation of the affected extremity, thereby avoiding the necessity to remove or replace the catheter. This study tested the hypothesis that heating the contralateral extremity in preterm infants would increase peripheral blood flow to the contralateral foot. Ten stable preterm infants who had had no umbilical catheter inserted for at least 2 weeks were studied. Skin perfusion was measured using the laser Doppler method in the distal leg after heating of the opposite foot to 40.5 degrees C. Blood flow to the skin of the contralateral foot was measured before and after warming the ipsilateral one. The skin blood flow measured with and without heat application to the contralateral foot was not significantly different. Direct heat does not induce contralateral reflex vasodilatation in the foot of preterm infants.

Catheterization↗
PubMed1997

Nitric oxide synthase activity in umbilical and placental vascular tissue of gestational diabetic pregnancies.

OBJECTIVE: Nitric oxide (NO) synthase activity in the fetal-placental vasculature of gestational diabetic pregnancies was compared to non-diabetic controls. METHODS: Placentae were collected from non-diabetic deliveries (n = 5) and from patients with gestational diabetes (n = 8). Umbilical cord and chorionic plate arteries and veins and stem villous vessels were quickly dissected out, cleaned of contaminating tissue, snap frozen in liquid nitrogen and stored at -80 degrees C. NO synthase activity was measured in the homogenate of these vessels by the arginine to citrulline conversion assay using 5 microM 3H-L-arginine with 1 mM NADPH, 100 microM free calcium, 50 units/ml calmodulin, 10 microM tetrahydrobiopterin and 2 microM flavin adenine dinucleotide with 45-min incubation at 27 degrees C. Enzyme activity was expressed as picomoles of 3H-L-citrulline formed per milligram of protein per minute. RESULTS: No significant differences in NO synthase activity were found between non-diabetic and gestational diabetics for umbilical cord artery (0.58 +/- 0.22 vs. 0.19 +/- 0.06), cord vein (0.39 +/- 0.21 vs. 0.07 +/- 0.03), chorionic plate artery (0.32 +/- 0.14 vs. 0.26 +/- 0.19) or vein (0.41 +/- 0.15 vs. 0.22 +/- 0.06), respectively (mean +/- SEM). Significantly greater activity was found in stem villous vessels of non-diabetic placentae (5.64 +/- 2.0) compared to those of gestational diabetic placentae (0.48 +/- 0.19; p < 0.01). CONCLUSION: The reduced blood flow and increased vascular resistance observed in diabetic pregnancies may be due to decreased NO synthesis and activity in the stem villous vessels which are the major determinants of resistance in the fetal-placental vasculature.

Diabetes, Gestational↗
PubMed1995

Effect of different phototherapy lights on incubator characteristics and dynamics under three modes of servocontrol.

Phototherapy is one of the most common therapeutic interventions in modern neonatal medicine. Analysis of physiological responses to phototherapy requires understanding the physical effects of incident light under different modes of environmental control. In this study, we tested the effect of initiation of phototherapy under laboratory conditions in a convective incubator maintained in three clinically used servocontrol modes. Under conditions of air servocontrol, the initiation of phototherapy resulted in an abrupt sustained increase in the surface temperature of an infant simulator (a blackened aluminum disc). In contrast, when the surface (skin) temperature was the controlled variable, there was a profound drop in the incubator air temperature. An algorithm that simultaneously controlled both the skin and the air temperatures showed intermediate effects. Under conditions of skin servocontrol, fluctuations in air and environmental temperatures were observed for a period of 3 hours before steady state was reached. These findings are most clearly demonstrated using phase plane plotting techniques. We conclude that wide, abrupt, and sustained changes in the thermal environment of an incubator occur after phototherapy is initiated. Such changes must be anticipated in physiological studies using phototherapy.

Algorithms↗
PubMed1995

Urinary nitrite and nitrate concentrations in patients with idiopathic persistent pulmonary hypertension of the newborn and effect of extracorporeal membrane oxygenation.

Persistent pulmonary hypertension of the newborn (PPHN) often requires extracorporeal membrane oxygenation (ECMO), during which time pulmonary vascular resistance gradually declines. Nitric oxide (NO) is a recently recognized pulmonary vasodilator, but its role in PPHN is unknown. We tested the hypothesis that the concentrations of the urinary metabolites of NO, i.e. nitrite and nitrate, are reduced in patients with PPHN and increase during ECMO as the PPHN resolves. Eight newborn infants with PPHN on ECMO were studied. Daily urinary concentrations of nitrite/nitrate were measured. We found that mean urinary concentrations of nitrite/nitrate were lower in patients with PPHN than in 47 controls without pulmonary disease (p < 0.005). Urinary nitrite/nitrate concentration showed an initial increase after initiation of ECMO. However, a decrease to concentrations still lower than controls occurred on the day before decannulation. We conclude that intrinsic NO production is significantly lower in patients with PPHN than in controls but increases with oxygenation. We speculate that decreased urinary NO metabolite concentrations imply a role for NO deficiency in the pathogenesis of PPHN.

Extracorporeal Membrane Oxygenation↗
PubMed1994

Are multiple cesarean sections safe?

To assess the maternal and neonatal risk associated with high-order cesarean sections, a case-control study was carried out in two university affiliated maternity wards. The outcome of 154 pregnancies of women undergoing cesarean section for the 4th time or more was compared with 148 women sectioned for the 2nd or 3rd time and 132 women of similar age and parity after spontaneous birth. The main outcome measures were maternal operative and postoperative morbidity and neonatal prematurity and its complications, Apgar scores, and the need for intensive care. Women undergoing multiple (> or = 4) cesarean sections had significantly more intra-abdominal adhesions (P < 0.0001) than women sectioned for the 2nd or 3rd time. However, the time interval from incision to delivery and the total duration of operation were similar. The postoperative course was not adversely affected by multiple cesarean sections. A high incidence (16.2%) of preterm cesarean deliveries was noted in the study group. This was due to non-elective repeat cesarean delivery rather than to poor timing of scheduled cesarean sections. The significantly increased (P < 0.05) need for neonatal intensive care was explained by the higher occurrence of prematurity. Low Apgar scores (< or = 7) at 1 and 5 min were significantly (P < 0.01) related to multiple cesarean sections, even after controlling for the effect of gestational age. We conclude that multiple cesarean sections pose little risk for the mother, but may be associated with increased neonatal risk, attributed mainly to preterm non-elective cesarean sections.

Adult↗