Biomedical subjects

Shaul Dollberg

Publications and source records attributed to Shaul Dollberg.

At least 19 recordsLinked to original sources

PubMed2004

Nucleated red blood cells in concordant, appropriate-for-gestational age twins.

OBJECTIVES: The purpose of this study was to test the hypothesis that neonatal nucleated red blood cell (RBC) counts are elevated in nondiscordant twins compared with singletons. STUDY DESIGN: We compared absolute nucleated RBC counts taken after birth in 2 groups of term, appropriate-for-gestational age infants; 74 concordant twins, and 29 singleton control infants. We excluded infants with factors associated with a potential increase in absolute nucleated RBC counts. RESULTS: Birth weight and gestational age were significantly lower in twins than in singletons (P < .01). Hematocrit, absolute nucleated RBC count, and corrected lymphocyte counts were significantly higher in twins (P < .01). In multiple regression, the significantly higher absolute nucleated RBC count in twins remained significantly higher even after taking into account gestational age and Apgar scores. CONCLUSION: Concordant, appropriate-for-gestational age twins have increased nucleated RBCs at birth compared with singleton control infants.

Apgar Score↗

PubMed2004

Nucleated red blood cells in preterm infants who have necrotizing enterocolitis.

Absolute nucleated red blood cell counts for 23 preterm newborn infants who subsequently had development of necrotizing enterocolitis were significantly higher than for 23 control infants. These infants may have been exposed to relative intrauterine hypoxemia, a possible risk factor for the development of necrotizing enterocolitis.

Case-Control Studies↗

PubMed2004

Decreased bone ultrasound velocity in large-for-gestational-age infants.

BACKGROUND: Bone speed of sound is a measure of bone breakability. There are few reports on bone mineral content in large for gestational age infants; most of them in infants of diabetic mothers. There are no data on bone speed of sound in large for gestational age infants of nondiabetic mothers. OBJECTIVE: To test the hypothesis that large for gestational age infants of nondiabetic mothers have lower bone speed of sound than appropriate for gestational age infants. DESIGN/METHODS: Bone speed of sound was measured within the first 96 hours of life at the right tibial midshaft in 25 singleton large for gestational age infants of non diabetic mothers and compared to appropriate for gestational age controls. RESULTS: Bone speed of sound measured in large for gestational age infants of nondiabetic mothers was lower than in controls. CONCLUSIONS: Large for gestational age infants of nondiabetic mothers have lower bone speed of sound than controls.

Birth Weight↗

PubMed2004

Gastric residual in growing preterm infants: effect of body position.

Studies of the effect of body position during and after bolus feeding upon gastric emptying or gastric residual have not had consistent results. We tested the hypotheses that right lateral decubitus leads to less gastric residual than left lateral decubitus and that the prone position leads to less gastric residual than the supine position. A prospective randomized clinical trial with triple crossover of healthy growing, appropriate for gestational age preterm infants. Each infant was successively studied while fed in the four different positions. Gastric residuals were measured at 1 and 3 hours after initiation of feeding and returned. Thirty-one patients were studied. At 1 hour, right lateral decubitus led to less significant residuals than the left lateral decubitus and the prone position led to less residual than the left lateral decubitus. The amount of gastric residuals 1 hour after a meal appears to be in the following decreasing order: left, supine, prone, right.

Cross-Over Studies↗

PubMed2004

Energy expenditure in infants weaned from a convective incubator.

Small preterm infants usually require a heated environment to survive. After weaning, some infants become hypothermic, and eventually require external thermal support for an additional period. We hypothesized that preterm infants respond to weaning from an incubator by increasing their resting metabolic rate. Thermally stable infants were studied when they had reached a weight of at least 1600 g. Resting energy expenditure was measured 2 hours before weaning and at 6, 23, 30, and 53 hours after weaning. Two-way analysis of variance for repeated measures was used for analysis. Sixteen infants with mean birthweight of 1270 +/- 375 g and gestational age 31 +/- 2.3 weeks were studied. After weaning, there was a significant increase in energy expenditure from 95.0 +/- 21.9 kcal/d in the incubator, to a 30-hours peak of 111.9 +/- 10.5 kcal/d after weaning. Weaning from a convective incubator results in an increase in metabolic rate in very low birth weight infants. We speculate that the infants' ability to increase metabolic rate might influence weaning success.

Analysis of Variance↗

PubMed2004

Indomethacin-induced early patent ductus arteriosus closure cannot be predicted by a decrease in pulse pressure.

Wide pulse pressure is considered to be a sign of patent ductus arteriosus (PDA). We tested the hypothesis that, following indomethacin therapy, PDA closure is associated with a significant decrease in pulse pressure. Thirty-two ventilated preterm infants were echocardiographically diagnosed within the first 24 hours of life with PDA. Systolic, diastolic, and mean arterial blood pressures were measured prior to indomethacin treatment and after echocardiographically confirmed PDA closure. Following PDA closure, systolic and diastolic blood pressures and mean arterial pressure increased significantly without a significant change of pulse pressure (17 +/- 7 to 20 +/- 12 torr). We conclude that in preterm infants with PDA, systolic, diastolic, and mean arterial blood pressures increase significantly within first few days of life. Pulse pressure does not appear to be affected by early PDA closure. We speculate that high pulmonary resistance in the first days of life prevents significant diastolic aortic runoff and leaves pulse pressure unaffected by PDA, as well as by its closure.

Blood Pressure↗

PubMed2004

Bone ultrasound velocity of appropriately grown for gestational age concordant twins.

In neonates, quantitative ultrasound has been shown to be predictive of bone breakability and an index of biophysical property of bone. There are no data on bone speed of sound (SOS) in appropriate for gestational age (AGA) twins. The purpose of this study was to test the hypothesis that AGA twins who had normal intrauterine growth have bone SOS similar to that of AGA singletons. We measured tibial midshaft bone SOS within the first 96 hours of life in 25 pairs of AGA twins, 27 to 40 weeks gestation, and compared them with our data of 73 singletons. There were no significant differences in bone SOS between twin and singleton infants in any of the parameters studied. We found no significant difference in bone SOS between twins of the same pair. AGA twins have bone SOS very similar to that of AGA singletons. We suggest that intrauterine weight sparing occurs also in terms of biophysical properties of bone.

Bone Development↗

PubMed2004

Neonatal nucleated red blood cells in discordant twins.

The objective of this study was to test the hypothesis that in discordant twins, the smaller infant has higher absolute nucleated red blood cell (RBC) count than the larger sibling. We compared absolute nucleated RBC counts, hematocrits, absolute leukocyte counts, absolute granulocyte counts, absolute lymphocyte counts, RBC counts and platelet counts obtained in the first 12 hours of life in 30 discordant twin sets. The smaller infant had a higher absolute nucleated red blood cell count and lower platelet counts than its larger sibling. Platelet counts correlated inversely with absolute nucleated RBC counts ( R(2) = 24.5%; p < 0.001) and absolute nucleated RBCs correlated directly with percent intertwin weight differences ( R(2) = 17.8%; p = 0.02). In discordant twins, the smaller infant has higher absolute nucleated RBC count and lower platelet counts than the larger sibling. We speculate that the hematologic alterations in the smaller fetus are linked to relative fetal hypoxia.

Birth Weight↗

PubMed2004

The effect of positioning on energy expenditure in preterm infants: a feasibility study.

The aim of this study was to determine the feasibility of a study of the effect of positioning on energy expenditure in preterm infants. We performed a prospective, randomized, clinical cross-over pilot study of eight healthy, appropriate weight for gestational age, gavage-fed, clinically stable preterm infants at the postmenstrual age of 30 weeks. Prior to the study and in accord with our feeding protocol, infants uniformly received either their own mother's milk or a preterm formula. Each infant was studied in four different positions after randomization to eight different sequences. Infants were studied asleep, 90 minutes after feeding, after 20 minutes of being nursed in a given position. They were cared for in a servo-controlled convective incubator during the metabolic measurements, which were performed by indirect calorimetry. Energy expenditure was not significantly affected by the body position in which the infant was studied. The difference between the highest and the lowest mean energy expenditure was 3.7% of the highest one. We conclude that attempts to minimize energy expenditure by modifying infant positioning are likely to be insignificant, from a practical standpoint, because of the nonsignificant or minimal differences in energy expenditure.

Calorimetry, Indirect↗

PubMed2004

[Prevention and pain management in term and preterm infants].

Pain in the neonatal period is frequently experienced by 6-10% of newly born infants, preterm and term, who require neonatal intensive care. Repetitive painful procedures without adequate analgesia provided by the medical staff may bear long-term or even life-long adverse consequences. The use of pharmacological and non-pharmacological modalities in the management of pain may change this undesirable situation. The use of opioid analgesia for very painful procedures and the use of non-opioid medications in combination with opioids are essential. A change in the sensory environment of the sick infant is an important additional analgesic effect. In addition to pain management in the neonatal intensive care units, neonatal circumcision is the most frequent surgical procedure performed in males, and is frequently conducted without appropriate analgesia. The simple available methods of analgesia for neonatal circumcision are discussed and should be employed in order to avoid painful circumcision. Many pediatric medical associations in the developed world consider failure to provide proper routine analgesia for neonatal circumcision to be an unethical and sub-optimal medical practice.

Analgesics↗

PubMed2004

Increased serum potassium and intraventricular hemorrhage revisited.

BACKGROUND: Increased serum potassium and intraventricular hemorrhage occur frequently in preterm infants. OBJECTIVE: To retrospectively analyze data obtained on infants with severe IVH in relation to blood K+ concentrations. METHODS: We identified all patients with severe IVH bom between July 1997 and July 2000. Each patient was pair-matched with a control infant of the same gestational age (+/- 1 week) without IVH in terms of head ultrasound findings on day 5 and whole blood K+ on days 3-5. RESULTS: There were 24 infants in each group. The IVH group had significantly lower 1 minute Apgar scores and pH and higher blood K+ than the control group. Blood pH and K+ were inversely correlated. Stepwise regression analysis, taking into account blood pH and 1 minute Apgar score, showed a correlation only between blood K+ and IVH status. CONCLUSIONS: Severe IVH is significantly associated with higher blood K+ concentrations. A causal relationship cannot be ascertained at this point.

Cerebral Hemorrhage↗

PubMed2004

Effect of bicarbonate on neonatal serum ionized magnesium in vitro.

Sodium bicarbonate is used to treat metabolic acidosis, or to induce metabolic alkalosis in sick neonates. The aim of this study was to quantify the decrease in serum concentration of ionized magnesium ([Mg2+]) when sodium bicarbonate is added to neonatal serum in vitro. Sodium bicarbonate was added to 30 cord serum samples of term infants to reach incremental concentrations of 0 to 2.0 mEq/L and [Mg2+] was measured. Serum [Mg2+] decreased significantly with the addition of sodium bicarbonate. At incremental sodium bicarbonate concentrations of 1.0 to 2.0 mEq/L, which is within the range of the desired aim in the treatment of metabolic acidosis, the magnitude of the decrease in serum [Mg2+] was approximately 0.084 to 0.158 mmol/L (18% to 34%) from the average baseline value. The addition of sodium bicarbonate causes a significant decrease in [Mg2+]. From this in vitro study we speculate that fast infusion of sodium bicarbonate in human neonates may potentially cause a clinically significant decrease in serum [Mg2+].

Bicarbonates↗

PubMed2003

Evaluation of a new thermometer for rapid axillary temperature measurement in preterm infants.

Mercury-in-glass thermometers are considered the "gold-standard" for temperature measurements, but require at least 4 minutes for accuracy. Electronic thermometers sample temperature measurements over a shorter period. The objective of this study was to evaluate the accuracy and reproducibility of the Penguin (Medisim, Jerusalem, Israel) and the IVAC (San Diego, CA) Temp plus II thermometers in preterm infants. Axillary temperature was obtained in 50 thermally stable preterm infants each time with the mercury-in-glass, the IVAC, and the Penguin thermometers. Analysis of variance F-test, and linear regression analyses were used to test correlation of each electronic thermometer with the mercury-in-glass one, and the effect of body weight. Temperature measurement taken with the Penguin thermometer was significantly higher than that measured with the two other ones, p < 0.001. The differences in means and in variances were not significantly different between IVAC and mercury-in-glass, while the variance of the Penguin measurement was higher than that of the two other instruments (p < 0.001). The IVAC instrument correlated more tightly with the mercury-in-glass (r = 0.89, p < 0.001) than did the Penguin (r = 0.54, p < 0.001). There was an inverse correlation between the deviation of the Penguin measurement from the mercury-in-glass and the weight of the patient ( p < 0.08), while no significant correlation was found between the deviation of the IVAC measurement from the mercury in glass and the patient's weight (p = 0.56). Measurements of axillary temperature using the Penguin thermometer in incubated preterm infants are less accurate and less reproducible than those obtained using the IVAC or the glass thermometers.

Axilla↗

PubMed2003

Labor does not affect the neonatal absolute nucleated red blood cell count.

We investigated whether the presence or absence of physiologic labor may affect the neonatal nucleated red blood cell (RBC) count. We compared absolute nucleated RBC counts taken at approximately 6 hours of life in term infants born by elective cesarean delivery without trial of labor ( n = 32) and in vaginally delivered infants ( n = 28). Venous blood samples were analyzed and differential cell counts were performed manually; absolute nucleated RBC were counted and expressed as an absolute number. There were no significant differences between groups in birth weight, gestational age, maternal age, gravidity, parity, maternal analgesia during labor, 1- and 5-minute Apgar scores, and infant sex. There was a significantly higher hematocrit and RBC count in the vaginally delivered group as compared with the cesarean group. The absolute nucleated RBC, corrected leukocyte and lymphocyte, and platelet counts were strikingly similar in both groups. We conclude that labor does not affect the neonatal nucleated RBC count. This finding supports the speculation that physiologic labor does not induce a fetal hypoxemia severe or prolonged enough to produce hematological evidence of increased erythropoiesis.

Adult↗

PubMed2003

Nucleated red blood cells in polycythemic infants.

OBJECTIVE: This study was undertaken to evaluate whether the absolute nucleated red blood cell (RBC) count is elevated in term, appropriate-for-gestational-age (AGA) polycythemic infants. STUDY DESIGN: We compared absolute nucleated RBC counts taken during the first 12 hours of life in term, AGA infants with neonatal polycythemia (n = 29), and in control, nonpolycythemic infants (n = 37). We excluded infants of women with diabetes, hypertension, and alcohol, tobacco, or drug abuse, and those with fetal heart rate abnormalities or low Apgar scores, hemolysis, blood loss, or chromosomal anomalies. RESULTS: There were no differences between groups in birth weight, gestational age, or other demographic or perinatal factors. The hematocrit, RBC count, and absolute nucleated RBC counts were significantly higher and the platelet counts significantly lower in the polycythemic group. Regression analysis that included Apgar scores and gestational age showed a significant correlation of absolute nucleated RBC count with the polycythemia status only (P =.017). CONCLUSION: At birth, term AGA polycythemic infants have increased indices of active erythropoiesis. We speculate that this finding is suggestive of subtle fetal hypoxemia.

Apgar Score↗

PubMed2003

Nucleated red blood cells in infants of mothers with asthma.

OBJECTIVE: The purpose of this study was to evaluate whether the absolute nucleated red blood cell and lymphocyte count is elevated in term, appropriate-for-gestational-age infants born to women with asthma. STUDY DESIGN: We compared absolute nucleated red blood cell counts taken during the first 12 hours of life in two groups of term, vaginally delivered, appropriate-for-gestational-age infants; one group was born to mothers with active asthma during pregnancy (n = 28 infants), and the other group was born to control mothers (n = 29 infants). Asthma severity was classified according to the National Asthma Education and Prevention Program. We excluded infants of women with diabetes mellitus, hypertension, alcohol, and tobacco or drug abuse and infants with fetal heart rate abnormalities, hemolysis, blood loss, or chromosomal anomalies. RESULTS: There were no differences between groups in birth weight, gestational age, maternal age, gravidity, parity, maternal analgesia during labor, 1- and 5-minute Apgar scores, and infant sex. The hematocrit level, red blood cell count, absolute nucleated red blood cell count, and corrected leukocyte and lymphocyte counts were significantly higher in the asthma group than in the control group. The platelet count was not significantly different between groups. The absolute nucleated red blood cell count correlated significantly with the asthma severity score (r (2) = 28%, P <.001). Backward stepwise multiple regression that included Apgar scores and gestational age showed a significant correlation of absolute nucleated red blood cell count with the presence of asthma and its severity (P <.001). CONCLUSION: At birth, term appropriate-for-gestational-age infants born to mothers with asthma have increased circulating absolute nucleated red blood cell and lymphocyte counts compared with control infants.

Adult↗

PubMed2003

Energy expenditure in human milk- versus formula-fed preterm infants.

OBJECTIVE: We compared energy expenditure (EE) of preterm infants fed their mother's milk versus preterm infant formula. Study design A prospective, randomized crossover study of 13 healthy, appropriate weight for gestational age, gavage-fed, preterm infants. Before the study and according to our feeding protocol, infants uniformly received alternate feeds of human milk and formula. Each infant was randomly assigned to 24 hours of formula feeding followed by 24 hours of breast milk or the reverse. Infants were studied asleep, at the end of each 24-hour period. EE was measured by indirect calorimetry 1 hour before feeding, 20 minutes during feeding, and 1 hour after feeding in a servo-controlled convective incubator. Energy content of human milk was analyzed by bomb calorimetry. RESULTS: EE was significantly lower in breast milk-fed infants during prefeeding (52+/-6 vs 57+/-10 kcal/kg per 24 hours) (P<.05), per feeding (55+/-6 vs 60+/-10 kcal/kg per 24 hours) (P<.05), and at the postfeeding measurement (60+/-7 vs 65+/-7 kcal/kg per 24 hours) (P=.059). After correction of the results for the actual measured energy intake, all statistical differences reached the <.05 level. CONCLUSIONS: Preterm infants have lower EE when they are fed breast milk than when they are fed preterm infant formula.

Calorimetry, Indirect↗

PubMed2003

Bone ultrasound velocity curves of newly born term and preterm infants.

BACKGROUND: Ultrasound velocity (speed-of-sound [SOS]) has been proposed as a non-invasive method of evaluation of bone status in infants. We hypothesized that SOS correlates with both gestational age and birth weight. METHODS: We measured SOS within the first 96 hours of life at the right tibial midshaft location in 73 neonates ranging in gestational age from 25 to 41 weeks, and in birth weight from 825 to 3880 grams. We used the Sunlight Omnisense 7000p device (Tel Aviv, Israel). Results are expressed as meanS +/- 1 SD; statistical analyses included linear regression and computation of 95% CI regression lines; p<0.05 was considered significant. RESULTS: There was, as hypothesized, a significant correlation between gestational age (or birth weight) and SOS. There were no significant differences between males and females. Ninety-five percent confidence intervals were established. CONCLUSIONS: These data may be used as reference ranges for further studies.

Birth Weight↗