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Biomedical subjects

A A Fanaroff

Publications and source records attributed to A A Fanaroff.

At least 19 recordsLinked to original sources
PubMed1992

Elevation of fibronectin levels in lung secretions of infants with respiratory distress syndrome and development of bronchopulmonary dysplasia.

To determine whether the level of fibronectin in lung secretions correlates with the severity of lung injury or with the development of bronchopulmonary dysplasia, or both, serial tracheal aspirate samples were collected from 32 preterm infants with severe respiratory distress syndrome. Levels of total fibronectin, cellular fibronectin, plasma fibronectin, albumin, and secretory component of IgA (SC) were determined for the first 1 to 2 weeks of life in the 14 infants who recovered without pulmonary sequelae, and for weeks 1 to 4 in the 18 infants in whom bronchopulmonary dysplasia developed. Secretory component was chosen as the reference protein because its concentration in lung secretions is minimally influenced by capillary leak and does not vary with gestational or postnatal age. Albumin/SC and plasma fibronectin/SC ratios in tracheal aspirates were significantly higher (p less than 0.05) during the first 2 weeks of life in infants in whom bronchopulmonary dysplasia developed, suggesting greater capillary permeability in these infants. Cellular fibronectin/SC ratios in aspirates from infants with bronchopulmonary dysplasia were also significantly higher in the first 2 weeks, 9.0 +/- 1.7 and 7.4 +/- 2.0 micrograms/microgram SC in weeks 1 and 2, respectively, in comparison with values from infants without bronchopulmonary dysplasia, 1.6 +/- 0.4 and 1.1 +/- 0.8 micrograms/microgram SC (p less than 0.01), suggesting increased synthesis of fibronectin in the lungs of infants with subsequent bronchopulmonary dysplasia. Elevated levels of both plasma and cellular fibronectin in tracheal aspirate samples may provide an early index of the severity of lung injury in infants with severe respiratory distress syndrome.

Albumins↗
PubMed1992

Fibronectin: role in respiratory distress syndrome and bronchopulmonary dysplasia.

Further investigation is required to delineate the biochemical and cellular interactions that influence lung injury and fibrosis. The results from studies in adults, neonates, and animals suggest that fibronectin may play a key role in the development of pulmonary fibrosis following acute lung injury. Fibronectin as well as other pulmonary cytokines are essential participants in efficient and orderly wound repair; however, the excessive production of these mediators may result in an exaggeration of the normal healing process with the eventual outcome of pulmonary fibrosis. The potential role of fibronectin and other cytokines as mediators and markers of BPD may thus allow for earlier detection and identification of those infants with RDS who are at greatest risk to develop BPD, as well as aiding in the development and selection of therapeutic interventions that can more effectively treat and possibly prevent the deleterious consequences of bronchopulmonary dysplasia.

Bronchopulmonary Dysplasia↗
PubMed1992

Interventricular septal thickness in fetuses of diabetic mothers.

Sixty-four diabetic women had their fetuses studied by M-mode echocardiogram between 20-41 weeks of gestation. The mean septal size during both diastole and systole increased in a linear fashion with advancing gestational age in both the normal and diabetic groups. Ventricular septal hypertrophy (ie, more than 2 standard deviations above the normal mean) was present in 48 of 64 (75%) of the fetuses of diabetic women. The ratio of septal size to the anteroposterior cardiac dimension was significantly greater in the diabetic than in the normal group (12 versus 8%; P less than .05). The anteroposterior cardiac dimension indexed to the estimated fetal weight was also greater in the diabetic group. Because both septum and cardiac dimension are larger with maternal diabetes, there may be a specific diabetic cardiomyopathy that originates in utero.

Echocardiography↗
PubMed1991

Necrotizing enterocolitis in very low birth weight infants: biodemographic and clinical correlates. National Institute of Child Health and Human Development Neonatal Research Network.

We studied the occurrence of necrotizing enterocolitis in 2681 very low birth weight infants during an 18-month period to characterize the biodemographic and clinical correlates. Proven necrotizing enterocolitis (Bell stage II and beyond) occurred in 10.1% of study infants; necrotizing enterocolitis was suspected in 17.2% of study infants. Positivity of blood cultures was related to necrotizing enterocolitis staging. The mortality rate increased only for stage III necrotizing enterocolitis (54% died). Logistic regression identified medical center of birth, race, gender, birth weight, maternal hemorrhage, duration of ruptured membranes, and cesarean section as significant risk factors. For one center the odds ratio was 3.7, whereas for another center it was only 0.3. For black boys, the odds ratio was 2.3 relative to nonblack boys; for girls, race did not affect prevalence of necrotizing enterocolitis. Age at onset was related to birth weight and gestational age. Intercenter differences in necrotizing enterocolitis prevalence were related to time required to regain birth weight and other indicators of fluid management. Gram-positive organisms predominated in positive blood cultures for stage I and II necrotizing enterocolitis; enteric bacteria were isolated more frequently in infants with stage III disease. We conclude that necrotizing enterocolitis prevalence varies greatly among centers; this may be related to early clinical practices of neonatal care.

Birth Weight↗
PubMed1990

Infant survival following delayed postmortem cesarean delivery.

A 19-year-old multipara was delivered of a living infant by postmortem cesarean 22 minutes after documented maternal cardiac arrest and 47 minutes from the fatal injury. Neonatal follow-up at 18 months of age demonstrated no evidence of neurologic damage.

Adult↗
PubMed1989

Outcomes of extremely-low-birth-weight infants between 1982 and 1988.

Infants with birth weights under 750 g are disproportionately represented in perinatal mortality and morbidity rates. We reviewed the outcomes of 98 infants delivered at our perinatal center between July 1982 and June 1985 (period 1) whose lengths of gestation were 20 or more weeks and whose birth weights were under 750 g, and compared them with the outcomes of 129 such infants born between July 1985 and June 1988 (period 2). The frequency of cesarean section increased from 12 to 19 percent between the two periods. During the entire six-year period, 12 percent of the infants with birth weights under 500 g were intubated, as compared with 28 percent of those between 500 and 599 g, 60 percent of those between 600 and 699 g, and 90 percent of those between 700 and 749 g. The frequency of endotracheal intubation increased between the two periods only for infants with birth weights above 500 g (P less than 0.02). Despite more aggressive treatment, survival did not change, although the mean time to death among infants transferred to the neonatal intensive care unit increased from 73 to 880 hours. Among all live-born infants with birth weights under 750 g, the rate of survival was 20 percent during period 1 and 18 percent during period 2, but 48 and 43 percent of those transferred to the neonatal intensive care unit survived in the two periods reviewed. Neonatal morbidity also did not change. Among survivors at a corrected age of 20 months, 4 of 18 born during period 1 and 7 of 14 born during period 2 had moderate-to-severe neurodevelopmental impairment. When all live-born infants of less than 28 weeks' gestation were considered, only 8 percent of those born at 23 weeks survived, as compared with 16 percent of those born at 24 weeks, and 53, 63, and 72 percent of those born at 25, 26, 27 weeks, respectively. Thus, despite a tendency to perform more cesarean sections and active resuscitations, no improvement in the survival of babies with lengths of gestation below 25 weeks or birth weights under 750 g was observed. The probability of survival is very poor if the length of gestation is less than 24 weeks or the birth weight less than 600 g.

Birth Weight↗
PubMed1989

Differential effects of intrauterine and postnatal brain growth failure in infants of very low birth weight.

We investigated the contribution of brain growth failure to outcome in infants of very low birth weight (VLBW; less than 1.5 kg) who were appropriate for gestational age (AGA; n = 379) or small for gestational age (SGA; n = 102). Growth was assessed at birth, term, and 8 and 20 months' corrected age and results of a Bayley Mental Developmental Index (MDI) and neurologic examination were evaluated at 20 months of age. Both groups had similar 20-month MDI scores (93 vs 90) and similar rates of neurologic impairment (14% vs 10%). More SGA infants (25%) than AGA infants (14%) had a subnormal head circumference at 8 months' corrected age, indicating failure to catch up in head growth. Subnormal head size at 8 months predicted the 20-month MDI score for both groups. However, multivariate analysis indicated that, whereas subnormal 8-month head size was directly associated with the MDI score in AGA children, in SGA children 8-month head size was not significantly related to the MDI score when neonatal illness, neurologic impairment, socioeconomic status, and race were controlled for. We conclude that in AGA VLBW infants, subnormal head size at 8 months results from major neonatal illness and has adverse later effects. In SGA infants, subnormal head size at 8 months has many causes, including growth retardation in utero, which may not have an adverse effect on outcome; if subnormal head size is superimposed with neonatal illness, a poorer outcome is likely.

Brain↗
PubMed1989

Use of intravenously administered immune globulin to prevent nosocomial sepsis in low birth weight infants: report of a pilot study.

To evaluate the use of intravenously administered immune globulin (IVIG) for prevention of sepsis in preterm infants, we administered IVIG in a protocol designed to maintain a therapeutic serum "target level" of 700 mg/dl. The 200 patients who were eligible for the study (600 to 2000 gm birth weight) were monitored throughout their initial hospitalization. Of these, 115 patients were randomly assigned in a double-blind, controlled trial to treatment and placebo groups. The remaining 85 infants were not randomly assigned to a group, by parental request, but were followed and analyzed separately. In one patient who received IVIG, transient tachycardia and a decrease in blood pressure developed during an infusion; resolution occurred promptly after the infusion was discontinued. No persistent hepatic or renal abnormalities were noted in either the IVIG- or the placebo-treated group. There were seven episodes of sepsis in the placebo group and nine in the group whose parents refused consent to the study. No infant who received IVIG acquired nosocomial sepsis (p less than 0.01). All patients in the placebo group in whom sepsis developed had serum IgG levels less than 400 mg/dl at the time sepsis developed. Serum IgG levels were maintained near 700 mg/dl in patients who received IVIG. These data indicate that administration of sufficient IVIG to maintain target serum IgG levels throughout hospitalization may decrease the incidence of nosocomial sepsis in preterm infants.

Cross Infection↗
PubMed1988

How small is too small? Considerations in evaluating the outcome of the tiny infant.

An aggressive approach to the obstetric and neonatal care of the pregnant mother and her infant in the late second trimester has led to an increase in survival. Surviving infants have a high rate of neonatal morbidity, including bronchopulmonary dysplasia and intraventricular hemorrhage. No long-term follow-up reveals handicap rates of 22 to 35 per cent, with multiple sensory and neurodevelopmental handicaps. With current methods of care, the biologic threshold of extrauterine survival is 23 to 24 weeks' gestation, or a birth weight of 500 to 600 gm. There is no simple arithmetical answer to the question of "how small is too small?" It should be apparent from the information presented in this article that the state of the art is constantly in flux. New developments have, to date, continued to decrease the threshold of viability. Application of the full weight of the available technology results in only a few infants of less than 23 to 24 weeks' gestation or with birth weights of less than 500 to 600 gm surviving. The future continues to lie in the development of the methodology to prolong the sojourn in utero, rather than in dramatic biophysical, biochemical, and technologic advances.

Birth Weight↗
PubMed1987

Carbon dioxide elimination during high-frequency jet ventilation.

The effects of frequency, tidal volume, and inadvertent positive end-expiratory pressure (PEEP) on CO2 elimination were studied in rabbits during high-frequency jet ventilation by measuring CO2 concentration of expired gas using a mass spectrometer. Increasing tidal volume augmented CO2 elimination (P less than 0.01 to 0.001) at each frequency, but when larger tidal volumes were associated with high inadvertent PEEP, CO2 elimination decreased despite the increase in minute ventilation. For constant minute ventilation, CO2 elimination decreased with increasing frequencies. Occurrence of inadvertent PEEP was related to increases in both frequency and tidal volume. If PEEP was controlled, no decrease in CO2 elimination was observed at the larger tidal volume. When PEEP was controlled, changes in tidal volume explained 67.1% to 95.4% of the variance in CO2 elimination not attributable to frequency. Frequency explained very little additional variance (0.1% to 13.8%). CO2 elimination comparable to estimated CO2 production occurred when tidal volumes equal to or smaller than the equipment dead space were used. We conclude that although tidal volume has a greater effect than frequency on CO2 elimination, mechanisms of gas exchange other than bulk gas transport occur during high-frequency jet ventilation.

Analysis of Variance↗
PubMed1986

Effect of maturation on oral breathing in sleeping premature infants.

To evaluate the influence of postnatal maturation on oral breathing, we measured nasal and oral ventilation during sleep and the ventilatory response to nasal occlusion in 11 preterm infants. Studies were repeated at 31-32, 33-34, and 35-36 weeks postconceptional age. Premature infants had rare episodes of spontaneous oronasal breathing during sleep. The frequency of oral breathing in response to nasal occlusion increased with advancing postconceptional age, from 8% +/- 8% at 31-32 weeks to 26% +/- 18% at 33-34 weeks and 28% +/- 33% at 35-36 weeks. Oral breathing in preterm infants, unlike that in term infants, was characterized by intermittent airway obstruction leading to a significant decrease in respiratory rate, tidal volume, minute ventilation, and tcpo2 (P less than 0.005). When inspiratory (Rl) and expiratory (RE) resistances during nasal and oral breathing were compared, Rl increased from 41 +/- 30 to 234 +/- 228 (P less than 0.004) and RE from 62 +/- 16 to 145 +/- 43 cm H2O X L-1 X sec (P less than 0.004). The ability of preterm infants to use the oral route of breathing thus increases with advancing postnatal maturation, but its effectiveness may remain limited by high oral airway resistance.

Female↗
PubMed1986

Epidemiology and management of severe symptomatic neonatal hypertension.

Symptomatic neonatal hypertension, defined as a mean arterial blood pressure (MAP) greater than 70 mm Hg for 3 separate determinations, was observed in 2% of all admissions (20 of 988) to the intensive and intermediate care nurseries. Evidence of renal dysfunction occurred in 85% of these infants, including increased plasma renin, abnormal renal scintiscans, and pathologic evidence of renal vascular embolism or thrombus in 13 of 20. Cardiac complications were present in 55% of affected patients, and features of hypertensive retinopathy were noted in 53% of those examined. Medical management during the neonatal period successfully controlled hypertension in all infants. Higher than usual doses of three or more antihypertensive medications were necessary in 15 of 18 treated patients. The infants requiring these high doses did not develop adverse side effects. In light of the fact that 80% of our affected patients had indwelling umbilical arterial catheters whose tips were in the thoracic aorta, the possible role of catheter management, position, or placement in the pathogenesis of this disorder is suggested.

Antihypertensive Agents↗