Biomedical subjects
V Bhutani
Publications and source records attributed to V Bhutani.
Vitamin E prophylaxis to reduce retinopathy of prematurity: a reappraisal of published trials.
OBJECTIVE: We conducted a meta-analysis of the published randomized clinical trials of vitamin E prophylaxis designed to reduce retinopathy of prematurity (ROP) to determine whether increased serum concentrations of vitamin E reduced the incidence of severe, threshold (Stage 3+) ROP in the very low birth weight (VLBW) infant subset. STUDY DESIGN: Among the six trials considered eligible for analyses, the incidence for all stages of ROP and for Stage 3+ ROP was computed for all randomly assigned infants (intention-to-treat analysis) and for those infants completing the trials. Odds ratios (ORs) and pooled estimates for event rate reductions (and the respective 95% confidence intervals [CIs]) were calculated for these outcome end points. RESULTS: There were 704 VLBW infants in the vitamin E prophylaxis groups and 714 in control groups; 536 (76.1%) infants in the vitamin E and 551 (77.2%) in the control groups completed the trials. In all trials the mean serum vitamin E concentrations were within or above the physiologic range in the vitamin-treated groups and at or below the physiologic ranges in the control groups. The overall incidence of any stage ROP was similar between the groups: 39.8% in the vitamin E group and 43.5% in the control group. The overall incidence for Stage 3+ ROP was lower in the vitamin E-treated groups than in the control group (2.4% in vitamin E vs 5.3% in control). The pooled OR for developing Stage 3+ ROP with vitamin E prophylaxis was 0.44 (95% CI, 0.21, 0.81, p < 0.02). The reciprocal of the pooled estimate of mean risk reduction (2.8%, 95% CI: 0.55%, 5.1%) for Stage 3+ ROP revealed that on average, vitamin E prophylaxis given to 35 VLBW infants would prevent one case of threshold, Stage 3+ ROP. CONCLUSIONS: Considering that there was a 52% reduction in the incidence of Stage 3+ ROP, we suggest that the role of vitamin E in reducing severe ROP be re-evaluated. We could not assess the adverse effect rates from vitamin E therapy in the trials analyzed; therefore, we recommend a well-controlled and focused trial in which the issues of benefit, adverse effects, and cost can be assessed with vitamin E prophylaxis in extremely low birth weight (< 1000 gm) infants.
Evolution of neonatal and pediatric critical care in India.
During the last decade, the disciplines of neonatal and pediatric critical care have rapidly progressed in India. The growth of Neonatal Intensive Care has paced the growth of Pediatric Critical Care. The substantial growth of discipline and the positive improvements in neonatal outcomes are the results of the concerted efforts of the National Neonatal Forum and commitment of expatriate physicians residing in the United States. This article provides the background information regarding perinatal, neonatal, and infant mortalities in India. It also describes the maternal child health care delivery system in the Indian subcontinent.
Effects of sweet taste stimulation on growth and sucking in preterm infants.
OBJECTIVE: To evaluate the effect of sweet taste stimulation in augmenting the reported growth-enhancing effects of nonnutritive sucking in preterm infants who are gavage-fed. DESIGN: Random assignment of preterm infants to receive stimulation by one of three methods during each feeding until totally orally fed. SETTING: Hospital intensive-care and infant transitional units. PATIENTS: Eligibility criteria included body weight greater than or equal to 1,250 g, gestational age younger than 34 weeks, growth parameters appropriate for gestational age, tolerating at least 100 kcals/kg/day by gavage feeding with evidence of weight gain, and no clinical evidence of health complications. Data are presented for 42 infants who completed 14 days of treatment. INTERVENTIONS: Exposure to a sweet pacifier, a latex pacifier, or maternal heartbeat sounds during gavage feedings. MAIN OUTCOME MEASURES: Growth, time to total oral feeding, and sucking responses. RESULTS: No significant differences in sucking measures were noted among treatment groups. Differences in progression time to total oral feedings and weight gain favored the sweet-pacifier group but were not statistically significant. CONCLUSIONS: Oral stimulation of gavage-fed, preterm infants during a 2-week hospitalization was not sufficient to elicit a significant improvement in growth efficiency, progression to total oral feedings, or sucking maturation. Additional studies may show a beneficial effect of chemosensory stimulation in preterm infants.
Severe retinopathy of prematurity in infants with birth weights less than 1250 grams: incidence and outcome of treatment with pharmacologic serum levels of vitamin E in addition to cryotherapy from 1985 to 1991.
OBJECTIVE: To determine the effect of vitamin E prophylaxis and treatment on the sequelae of severe (threshold) retinopathy of prematurity (ROP) in infants treated with cryotherapy at Pennsylvania Hospital from 1985 to 1991. STUDY DESIGN: Beginning on day 0, all infants with birth weights < or = 1250 gm received supplements of vitamin E using standard preparations. Serum E levels of 23 to 58 mumol/L (1 to 2.5 mg/dl) were targeted for infants with immature retinal vasculature or ROP of stage 2 or less in severity, and levels of 58 to 81 mumol/L (2.5 to 3.5 mg/dl) for infants with prethreshold ROP. At diagnosis of threshold ROP, treatment with a parenteral investigational new drug preparation of alpha-tocopherol was begun to raise serum levels to the pharmacologic range (93 to 116 mumol/L or 4 to 5 mg/dl). Within 3 days of diagnosis, and at the discretion of the retinal specialist, one or both eyes were treated with cryotherapy. Visual outcome at 4 years was compared with the 42-month outcome reported for eyes in the infants randomly assigned to treatment in the 1986-1987 Multicenter Trial of Cryotherapy for ROP (CRYO-ROP). RESULTS: Threshold ROP developed in 22 of 450 surviving infants (age 3 months). All were treated with pharmacologic serum levels of vitamin E; 17 infants were also treated with cryotherapy (10 in one eye and 7 in both eyes). These 17 infants, in comparison with infants in the CRYO-ROP trial (n = 187), were at least at equal risk for poor visual outcome on the basis of birth weight, gestational age, the percentage of zone 1 ROP, and mean interval from appearance of ROP to diagnosis of prethreshold ROP, which was shorter at Pennsylvania Hospital (4.1 days for the Pennsylvania Hospital group, 10.3 days for the CRYO-ROP group). However, on the basis of the mean number of days from diagnosis of prethreshold to threshold ROP (12.5 days for Pennsylvania Hospital, 10.5 days for CRYO-ROP) and the extent of extraretinal neovascularization at threshold (mean 7.9 sectors for Pennsylvania Hospital, 9.7 for CRYO-ROP), progression of retinopathy beyond the prethreshold stage had slowed and visual outcome in the eyes of infants at Pennsylvania Hospital treated with both cryotherapy and vitamin E (worse eye used for those treated with bilateral cryotherapy) was better than that reported for the treated eye of infants in the CRYO-ROP group (percentage of favorable visual acuity, 76% vs 48%, p = 0.04; percentage of normal structure posterior retinal pole, 71% vs 38%, p < or = 0.02). CONCLUSIONS: In this small case series, the combination of cryotherapy with anti-oxidant prophylaxis and treatment appeared to decrease the severity and sequelae of threshold ROP. This hypothesis deserves testing in a large, randomized clinical trial.
Estimation of body composition changes during weight cycling by bioelectrical impedance analysis in rats.
The effects of body weight cycling (WC) in rats on body composition (BC) and feeding efficiency were studied. The usefulness of estimating BC by bioelectrical impedance analysis (BIA) was also examined. Female Sprague-Dawley rats were divided into high-fat ad libitum feeding, either noncycling or cycling, or restricted feeding (75% of control feed) cycling groups. Control rats were fed a regular laboratory ad libitum diet and did not cycle. All rats were killed at the end of week 61. A BIA unit was used at each stage of WC to obtain resistance and reactance readings. Final BC was determined by chemical analysis. On the basis of the final chemical analysis and BIA measurements, an equation was established and applied to estimate BC at each stage of WC: fat-free mass (g) = 0.38 x body wt (g) + 13.8 x [length (cm)2/resistance] + 70.9 (r = 0.95, P < 0.001). High-fat ad libitum feeding induced rapid body weight and fat gains as well as an elevated feeding efficiency and an internal fat-to-subcutaneous fat ratio, regardless of whether the rats cycled. This change in fat mass was clearly detected by the BIA. Although rats fed restricted diets had similar body weights as did control rats, they had a significantly higher internal fat-to-subcutaneous fat ratio. Thus, not only the amount of food but also the composition of the diet is important for proper weight management. The BIA method is capable of detecting the body fat mass change during WC.
Function of microtubules under inadequate protein diet.
Microtubules from pancreas have been isolated and estimated. It was found that rats fed with lysine and threonine deficient diet have profoundly lowered levels of microtubules as compared to rats fed either with lysine and threonine supplemented diet or a casein diet at 20% protein level, implicating the role of dietary protein in microtubule assembly. Levels of microtubules in turn may influence the turnover of phosphatidyl inositol as well as release of insulin from pancreas.
Turnover of pancreas phospholipids in rats fed inadequate dietary protein.
Effect of feeding rice diets with and without lysine and threonine supplementation has been studied on phospholipid turnover of rat pancreas and compared to rats fed casein diet at 20% protein level. Rice diet without amino acid supplementation significantly reduced the levels of pancreas PC, PE, PI, PS and Sph and increased that of total cholesterol and TG. Incorporation of palmitate-1-14C, labelled choline, labelled methionine and NaH2(32)PO4 into PC and of palmitate-1-14C into TG was significantly reduced in rats fed unsupplemented rice diet. Incorporation of NaH2(32)PO4 into pancreas PI, DPI, TPI, PA, LPA and into IP, IP2', IP3 and GPI was significantly reduced in rats fed unsupplemented rice diet.
Liver cAMP levels in rats under inadequate protein nutrition.
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Intestinal parasites and other infections during pregnancy in Southeast Asian refugees.
An influx of Indochinese refugees into the Philadelphia area prompted a review of their reproductive performance as related to parasitic diseases and other infectious complications. A total of 100 infants were delivered of 97 women over an 18-month period (41 Vietnamese, 28 Laotian, 26 Cambodian, 2 Thai). Intestinal parasites were present in 65% of the mothers. Additional infections included 1 case of malaria, 1 of gonorrhea, 4 of syphilis, 5 of hepatitis B surface antigen and 12 of positive tuberculin (5-tuberculin-unit) skin tests. When comparing Southeast Asian gravidas with and without parasites, there were no significant differences between mean hemoglobin values, mean gestational age at delivery and mean birth weights of their infants. Although the Southeast Asian refugees had a high rate of infectious complications, they proved to have favorable pregnancy and neonatal outcomes.
Use of caffeine in infants unresponsive to theophylline in apnea of prematurity.
Eleven premature infants with severe apnea unresponsive to therapeutic theophylline levels were studied to determine if caffeine is an effective treatment in such cases. Apnea was documented and quantitated with thermistor-pneumocardiograms measuring heart rate, thoracic impedance, and nasal air flow. Infants with prolonged central or mixed apnea were then treated with caffeine and restudied. Caffeine reduced the total number of apneic episodes of greater than 10 sec duration by 80% (P less than 0.01) and prolonged episodes of apnea (greater than 20 sec) by 88% (P less than 0.05). These data suggest that caffeine may be effective in the management of apnea of prematurity, particularly the prolonged type, unresponsive to theophylline.
Care of the neonate with erythroblastosis fetalis.
Erythroblastosis fetalis, hemolytic disease of the newborn, occurs when an isoimmunized mother produces antibodies that cross the placenta and cause hemolysis of fetal red blood cells. This hemolysis can be accompanied by severe anemia, ascites, pleural and pericardial effusions, congestive heart failure, and neurological damage with resultant perinatal mortality. Rh isoimmunization in pregnancy still occurs in spite of the advent of Rh immune globulin. This article describes the complex management and nursing implications associated with caring for the neonate with erythroblastosis fetalis.