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Biomedical subjects

A B Fletcher

Publications and source records attributed to A B Fletcher.

17 recordsLinked to original sources
PubMed1991

Vitamin B-6 metabolism in premature infants.

The response of premature infants to intravenous pyridoxine or pyridoxal was studied by measuring serum and erythrocyte pyridoxal 5'-phosphate (PLP). In the first study serum PLP was measured in 28 infants periodically through day 28. Infants less than 30 wk gestational age (GA) had no serum PLP response to the administration of pyridoxine. Infants greater than or equal to 30 wk GA had significantly greater concentrations of PLP by day 3. In the second study there was a negligible response of serum PLP in nine infants less than or equal to 28 wk GA to supplementation of pyridoxine or pyridoxal. However, erythrocyte PLP and whole-blood total vitamin B-6 concentrations increased in both groups, indicating the presence of a substantial amount of the vitamin in the circulation of the infants. Whereas the functional significance of these observations is not known, it appears that in premature infants, serum PLP may not be an appropriate indicator of vitamin B-6 status.

Erythrocytes↗
PubMed1987

Withholding of nutrition and fluids in the hopelessly ill patient.

This article is a review of recent court cases concerned with appropriate treatment of dying or irreversibly comatose patients, specifically, withholding of nutrition and fluids. In these cases the various courts relied on the advice first found in the Hippocratic corpus and expanded on through the centuries. The statement found in the exhortation of the California Court of Appeal in Bouvia: "Provide as large a measure of dignity, respect, and comfort as possible to every patient for the remainder of his days, whatever be their number" should be our guide in caring for the infants entrusted to us.

Ethics, Medical↗
PubMed1985

Controlled trial of dexamethasone in respirator-dependent infants with bronchopulmonary dysplasia.

A randomized trial was conducted of dexamethasone therapy in infants with bronchopulmonary dysplasia who were dependent on respirators and were not progressing clinically despite conventional treatment. Babies were admitted to the study if they had a roentgenogram and clinical diagnosis of bronchopulmonary dysplasia, were 2 to 6 weeks in age, weighed less than 1,500 g, had made no progress in weaning for the preceding five days, and were free of sepsis, patent ductus arteriosus, and congenital heart disease, and had had no intravenous fat for at least 24 hours. After parental consent was obtained, infants were randomly assigned to control or treatment groups. The study hypothesis was that with steroid treatment, babies could be weaned from the respirator within 72 hours and would show a significant improvement in lung compliance within that time. Sequential analysis exceeded criterion (P less than .05) when seven consecutive untied pairs showed weaning with dexamethasone and failure to wean in control infants. Pulmonary compliance improved by 64% in the treated group and 5% in the control group (P less than .01). No significant intergroup differences were noted in mortality, length of hospital stay, sepsis, hypertension, hyperglycemia, or electrolyte abnormalities. Study design permits the conclusion that dexamethasone can produce substantial short-term improvement in lung function, often permitting rapid weaning from the respirator, but long-term efficacy and safety must be demonstrated by further investigations.

Bronchopulmonary Dysplasia↗
PubMed1984

Nutrition for full-term and preterm infants. Meeting normal and exceptional needs.

Providing adequate nutrition for the healthy full-term newborn is relatively easy; breast milk or formula is sufficient for the first six months of life. Although the full-term infant's organ systems are relatively mature, the gastrointestinal tract is often stressed by the demands of rapid growth, and feeding difficulties, such as gastroesophageal reflux, colic, milk allergy, and constipation, may occur that necessitate special handling. The small preterm infant, however, has many urgent nutritional needs; management is usually complicated by the fact that the infant's immature organs may be unable to cope with enteral feedings. Thus, total parenteral nutrition is necessary, with extensive laboratory monitoring of metabolic functions and precise attention to detail to avoid a prolonged period of partial starvation.

Animals↗
PubMed1982

Parenteral galactose therapy in the glucose-intolerant premature infant.

Blood galactose concentrations were measured in 55 neonates consuming at least 80 ml/kg/day of lactose-containing formula. The range of galactose concentration immediately after feeding was 0.8 to 4.2 mg/dl, with a mean of 1.5 +/- 0.2 mg/dl. Galactose concentration fell rapidly after feeding, and normal values for the population fell with a half-life of 45 minutes. Considering galactose as a potential intravenous nutrient, six glucose-intolerant premature infants were given galactose-containing solutions intravenously using a double-blind randomized crossover protocol. Infants were chosen who had sustained hyperglycemia (150 mg/dl) and glucosuria (2+ Clinitest) requiring glucose infusion at a rate below 7 mg/kg/minute for more than 24 hours. Compared to the control glucose period, intravenous alimentation with a solution containing carbohydrate as 50% glucose and 50% galactose resulted in a 65% increase in total carbohydrate infusion rate, normalization of the blood glucose concentration, and decreased glucosuria. Blood galactose concentration averaged 15 mg/dl, and no clinical or biochemical evidence of galactose toxicity was noted.

Blood Glucose↗
PubMed1981

A prospective study of infant zinc nutrition during intensive care.

Zinc nutritional status was evaluated during intensive care for 55 infants. Plasma zinc, serum albumin, alkaline phosphatase, growth, nutrient intake, and clinical data were examined. The more premature infants (less than 32 wk gestational age) had higher zinc levels on admission, but their levels declined more rapidly than in more mature infants. Zinc level did not correlate with albumin or alkaline phosphatase. Low zinc levels (45 microgram/dl or less) occurred at about 6 wk in 14 of 39 premature infants. True zinc deficiency occurred in two premature infants; it was manifest by increased gastric residuals, poor suck, and decreased growth, but neither infant had the skin or gastrointestinal signs generally expected with zinc deficiency. There was evidence that sick premature infants may need more zinc than is currently recommended to supplement parenteral nutrition and more than the amount supplied in premature infant formulas currently available.

Critical Care↗
PubMedDate not supplied

The potential toxicity to neonates of multivitamin preparations used in parenteral nutrition.

This study compares two groups of infants weighing less than 1500 g at birth. In the propylene glycol (PG) group, 30 infants received MVI-Concentrate containing 300 mg of PG daily with their intravenous nutrition (ivn), and vitamin E, 50 mg/week by intramuscular injection. In the mannitol group, 30 infants received MVI-Pediatric (containing 245 mg mannitol), 65% of a vial/day. Serum and urine osmolality, serum PG, blood-urea-nitrogen, creatinine, sodium, and glucose were measured on days 0, 2, 5, 12, 19, 26, 33 and 40 of ivn. Weight, urine output, and fluid intake were measured daily. Vitamin E levels were measured on days 5, 26, and 33 of ivn. There were no significant differences between the groups in birth weight, gestational age, sex, age, or weight at start of ivn. Our results indicated that neither MVI-Concentrate nor MVI-Pediatric was associated with a clinically significant diuresis. MVI-Pediatric, 65% of a vial/day, may produce higher than desirable blood levels of vitamin E, and use of drugs containing PG can produce significant blood levels of PG, in very low birth weight infants.

Diuresis↗
PubMedDate not supplied

Preparation for neonatal emergencies: a neonatal emergency medication sheet.

Safe and timely administration of emergency medications and infusions is crucial when caring for critically ill neonates. A neonatal emergency medication sheet can enhance preparation, calculation, and administration of medications during emergency situations in neonatal intensive care units (NICUs).

Drug Therapy↗