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Biomedical subjects

A A Fanaroff

Publications and source records attributed to A A Fanaroff.

At least 73 records · Page 4Linked to original sources
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↗
PubMed1986

Efficacy of computer-assisted management of respiratory failure in neonates.

We modified an algorithm for mechanical ventilation of infants with respiratory distress syndrome to create an interactive user-friendly computer program. To determine the effectiveness of this computer program, we evaluated the correction of deranged arterial blood gases in three groups of neonates: group I, treated before the introduction of the computer into the nursery; group II, managed by pediatric residents with the guidance of the computer program; group III, treated after the introduction of the computer into the nursery but managed without consideration of the computer output. Arterial blood gas values improved more frequently in the neonates managed with computer consultation (group II, 65/75, 87%) than in both control groups (group I, 37/57, 65%, P less than .005; and group III, 46/63, 73%, P less than .05). Furthermore, increases in ventilatory support in the presence of normal arterial blood gas values occurred only in patients managed without computer guidance. In a teaching institution, more effective care of neonates with respiratory failure may be facilitated by computer-assisted management of mechanical ventilators.

Blood Gas Analysis↗
PubMed1986

Fungal colonization in the very low birth weight infant.

In the neonate, fungal infections result in significant morbidity and mortality. For very low birth weight (less than 1,500 g) infants, we prospectively determined the fungal colonization rate to be 26.7%. In one third of infants with fungal colonies, mucocutaneous candidiasis developed, and in 7.7%, systemic disease developed. Two thirds of the infants had colonies in the first week of life. This colonization was probably acquired during labor and delivery, because those infants who had colonization were more often delivered vaginally than by cesarean section. Early colonization, commonly from the gastrointestinal or respiratory tract, featured Candida albicans and Candida tropicalis. Late colonization, occurring after 2 weeks of life (15.0% of patients), was more likely to be cutaneous and was associated with either Candida parapsilosis or such poor growth that the organism could not be identified. Infants with colonization only rarely had budding yeasts (6.1%), whereas more than half of the infants with either a urinalysis showing budding yeasts or a urine culture growing fungi had invasive disease. Fungal contamination was not found on either thoracotomy tubes or catheter tips. In the low birth weight infant, fungal colonization represents a significant risk factor for cutaneous or systemic candidiasis in these infants.

Candida↗
PubMed1985

Oral breathing in newborn infants.

Newborn infants are considered obligate nasal breathers, hence dependent on a patent nasal airway for ventilation. The conditions under which oral breathing could occur and the contribution of oral ventilation to total ventilation were studied in 30 healthy term infants (aged 1 to 3 days). Nasal and oral airflow were measured using two resistance-matched pneumotachometers, and heart rate, tcPO2, etCO2, and sleep state were continuously recorded. In three of 10 infants studied in undisturbed sleep, spontaneous oronasal breathing was noted during both active and quiet sleep (mean duration 19 +/- 25 minutes), the distribution of tidal volume being 70% +/- 12% nasal and 30% +/- 12% oral. Episodes of oronasal breathing were also observed after crying in six infants (mean duration 21 +/- 19 seconds). In an additional 20 infants, multiple 15-second end-expiratory nasal occlusions were performed; eight (40%) of these infants initiated and sustained oral breathing in response to nasal occlusion. Respiratory rate, tidal volume, heart rate, and tcPO2 did not change when oral breathing occurred in response to nasal occlusion, although minute ventilation decreased from 265 to 199 ml/min/kg (P less than 0.05). These results demonstrate that newborn infants may use the oral airway for ventilation, both spontaneously and in response to complete nasal occlusion.

Airway Obstruction↗
PubMed1985

Altered urinary excretion of elastin cross-links in premature infants who develop bronchopulmonary dysplasia.

In order to determine whether elastin degradation is increased in infants whose respiratory insufficiency requires ventilation with high concentrations of O2, we quantitated, by amino acid analysis, the elastin degradation products (desmosines) excreted in the urine of 14 premature male infants during the first 3 wk of life. Eight of these infants, the "low-O2" infants, did not have severe lung disease and did not require more than 40% O2 beyond the first 8 h of life. The other 6 infants, selected retrospectively because they developed bronchopulmonary dysplasia (BPD), were ventilated with more than 60% O2 for at least the first 72 h of life. The pattern of desmosine excretion observed in infants who developed BPD differed significantly (p less than 0.05) from the excretion pattern seen in "low-O2" infants during the first 3 wk of life. At the end of the first week of life, desmosine excretion was significantly greater (p less than 0.05) in the infants who later developed BPD than in the "low-O2" infants without severe lung disease. From Days 7-9 to 20-22, desmosine excretion increased in the "low-O2" infants from 6.9 +/- 1.7 micrograms/kg to 9.0 +/- 3.5 micrograms/kg. In contrast, desmosine excretion did not remain elevated in the BPD infants, decreasing from 10.6 +/- 2.2 micrograms/kg to 6.1 +/- 2.9 micrograms/kg during the same period. In the BPD infants, elevated desmosine excretion through Day 9 is likely to reflect lung injury, whereas decreased desmosine excretion beyond Day 9 suggests that elastin synthesis and turnover is impaired, possibly as a result of nutritional deficiencies.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1985

Preschool performance of children with normal intelligence who were very low-birth-weight infants.

Children who were very low-birth-weight infants (less than 1,500 g), beneficiaries of modern neonatal intensive care, are now of school age. To evaluate their school performance 80 children born in 1976 who had very low-birth-weight (mean birth weight 1.2 kg, mean gestational age 30 weeks) were examined at age 5 years. Sixty-five children were neurologically intact and had normal IQ (greater than or equal to 85) on the Stanford-Binet; five children were neurologically abnormal and ten had IQ below 85. Of the 65 children with normal intelligence and no neurologic impairments, 46 were single births and enrolled in preschool. These 46 children were matched by race, sex, and family background with classmate control children who had been born at full term. Outcome measurements included the Slosson Intelligence Test, the Woodcock-Johnson Psycho-Educational Battery (including subscales of Picture Vocabulary, Spatial Relations, Memory for Sentences, Visual Auditory Learning, Quantitative Concepts, and Blending) and the Beery Developmental Test of Visual-Motor Integration. No significant differences in IQ were found between children who were very low-birth-weight infants and control children; however, children who were very low-birth-weight infants performed significantly less well on the Spatial Relations subtest of the Woodcock-Johnson and on the Visual-Motor Integration test. Similar results were found for nine sets of twins and their control children. Recognition of these perceptual and visual-motor problems may permit appropriate early remedial intervention and prevent the compounding of these difficulties.

Child Development↗
PubMed1984

Catch-up growth in very-low-birth-weight infants. Clinical correlates.

Clinical correlates of catch-up growth were documented in 182 very-low-birth-weight (VLBW) infants (less than 1.5 kg) followed up prospectively until a corrected age of 33 months. At birth, 147 infants had weights appropriate for gestational age (AGA), and 35 were small for gestational age (SGA). The infants in each group were categorized as small if body weight was 2 SDs below the mean for age or appropriate if body weight was within 2 SDs of the mean at birth and at corrected ages of 40 weeks and 8, 21, and 33 months. Of the 147 AGA infants, 67 (46%) weighed less than 2 SDs of the mean for age at a corrected age of 40 weeks, 40 (27%) at 8 months, 28 (19%) at 21 months, and 25 (17%) at 33 months. Of the 35 SGA infants, 32 (91%) had subnormal weight at 40 weeks, 17 (49%) at 8 months and 21 months, and 16 (46%) at 33 months. Significant correlates of poor catch-up growth in the AGA group were birth weight, gestational age, severity of neonatal complications, poor neonatal head growth, and chronic physical and neurologic sequelae. In the infants in the SGA group, the correlates of poor catch-up growth were birth weight, multiple birth, and social class.

Adult↗
PubMed1984

Torulopsis glabrata sepsis appearing as necrotizing enterocolitis and endophthalmitis.

Torulopsis glabrata causes an increasingly frequent infection in immunocompromised adults. In a 1,910-g, 36-week, small-for-gestational-age neonate, T glabrata caused necrotizing enterocolitis and endophthalmitis. The fungus was not grown from cultures obtained from four blood specimens but was seen microscopically in methenamine silver-stained sections of resected bowel.

Candida↗
PubMed1984

Decrease in airway pressure during high-frequency jet ventilation in infants with respiratory distress syndrome.

Using a crossover study design, we compared a system of high-frequency jet ventilation with appropriate humidification to pressure-limited conventional ventilation in 12 preterm infants with a birth weight of 1.9 +/- 0.6 kg and gestational age of 32 +/- 2 weeks who had severe respiratory distress syndrome. After a control period of conventional ventilation, high-frequency jet ventilation was administered for 1 to 3 hours at a constant rate (250/min) and inspiratory to expiratory time (1:3 or 1:4) in the same fraction of inspired oxygen as during conventional ventilation. Average peak inspiratory pressure decreased from 29 +/- 3 cm H2O during conventional ventilation to 20 +/- 4 cm H2O during high-frequency jet ventilation (P less than 0.001), whereas positive end expiratory pressure was unchanged, resulting in a reduction in mean airway pressure from 14 +/- 3 to 10 +/- 2 cm H2O (P less than 0.001). There was a simultaneous decrease in PaCO2 (39 +/- 4 to 34 +/- 4 mm Hg, P less than 0.01), but PaO2 did not change. These data indicate that short-term high-frequency jet ventilation maintains gas exchange in infants with respiratory distress syndrome despite a lower PIP and Paw, and results in smaller airway pressure swings than during conventional ventilation. Thus, high-frequency jet ventilation may offer hope for reducing barotrauma in this population.

Blood Gas Analysis↗