Aberrations in sucking behavior of low-birthweight infants.
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Biomedical subjects
Publications and source records attributed to W Oh.
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Haemoglobin AIc (Hb AIc), a glycohaemoglobin present in normal human blood, is elevated in glucose intolerant individuals. In non-pregnant diabetic subjects, a direct relationship has been established between per cent Hb AIc and blood and urinary glucose levels over weeks and months. In this study, Hb AIc level and mean random blood glucose concentration in the third trimester of pregnancy were found to correlate directly in 12 diabetic women without vascular disease (P less than 0.001). In this same group of women, third trimester Hb AIc levels also correlated significantly with infant birth weight (P less than 0.05) and birth weight adjusted for gestational are (P less than 0.01). Finally, third trimester mean blood glucose concentrations also correlated directly with birth weight (P less than 0.05) and adjusted birth weight (P less than 0.001). In pregnancies complicated by diabetes, rigid glucose control has been recommended to achieve optimal fetal and maternal outcomes. Hb AIc is a new tool with which to assess blood glucose control during diabetic pregnancy.
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Total bilirubin-binding capacity was measured by Sephadex G-25 gel filtration in 43 clinically well and 45 clinically ill newborn infants between 26 and 41 weeks' gestation. In the well patients, bilirubin-binding capacity, serum albumin concentration, and the molar-binding ratio of bilirubin to albumin were directly related to gestational age. In the sick patients, serum bilirubin-binding capacity and albumin concentration also correlated with gestational age; however, from 32 to 41 weeks' gestation, the mean values for the sick infants were significantly lower than for the well infants. In the sick infants, the molar binding ratio of bilirubin to albumin was also lower than in the well patients and did not correlate with gestational age. The data are in agreement with previous clinical findings indicating an increased risk for low-bilirubin kernicterus among immature infants and suggest that some critically ill term infants may be at risk for kernicterus at serum bilirubin levels below 20 mg/100 ml.
During a one-year prospective survey to determine the incidence of hyperviscosity in small-for-gestational age infants, we found a significant increase in the incidence of necrotizing enterocolitis in SGA infants with HV. Of the 14 SGA infants with HV, five developed NEC, and of 65 SGA infants with normal blood viscosity,one had NEC (p less than 0.005). Comparison of clinical features of the five HV infants with NEC with those reported in the literature showed that the infants with HV and NEC had had longer gestational periods and higher weights and, in contrast to those reported in the literature, were free of clinical evidence of asphyxia distress. The respiratory disorders have been proposed as the clinical events that might lead to ischemia of the intestine and subsequently to NEC. It is proposed that HV may be another factor leading to ischemia in the gastrointestinal tract with subsequent development of NEC.
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The purpose of this study was to evaluate the need for permanent pacing in patients who have survived the effects of anterior myocardial infarction with complete heart block and have returned to sinus rhythm but who are left with impairment of intraventricular conduction. We have reviewed 52 patients with complete heart block complicating recent anterior myocardial infarction. Temporary pacing was instituted in all patients. There were 25 hospital survivors who were followed for an average of 49 months. Long-term pacing was established in 4 patients. Of the 21 patients in sinus rhythm, 14 had partial bilateral bundle-branch block with either right bundle-branch block and left anterior hemiblock or right bundle-branch block and left posterior hemiblock; at the end of the follow-up period, 10 of these 14 were alive and well. Furthermore, permanent pacing failed to prevent sudden death in 2 patients. At the present time, therefore, we conclude that long-term pacing is not justified in patients, otherwise asymptomatic, with partial bilateral bundle-branch block persisting after transient complete heart block in anterior myocardial infarction.
Serial determinations of bilirubin-binding capacity were performed in 61 newborn infants during the first 10 days of life. 27 infants were classified as term (gestational age greater than or equal to 36 weeks) and 34 as preterm (gestational age less than or equal to 33 weeks); 34 were classified as 'sick' and 27 as 'well'. Bilirubin-binding capacity was measured by Sephadex gel filtration. In relation to postnatal age, total bilirubin-binding capacity (TBBC) remained stable in well term and preterm infants, decreased slightly in sick preterm infants, and decreased significantly in sick term infants. TBBC, serum albumin, and molr binding ratio (B/A) were significantly higher in well than in sick infants in both term and preterm groups; there were no significant differences between sick term and sick preterm infants. Clinical recovery in 16 infants was associated with a significant rise in TBBC and in B/A. The data suggest that in healthy infants, the serum bilirubin-binding capacity remains relatively unchanged during the first 10 days of life. Clinically ill infants show wide patient-to-patient variability in TBBC. Because of the tendency of TBBC to decrease with postnatal age in sick infants, repeated determinations of TBBC may be indicated for the management of sick jaudiced newborns.
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