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Biomedical subjects

A Fanaroff

Publications and source records attributed to A Fanaroff.

At least 19 recordsLinked to original sources
PubMed1999

A randomized, double-blind, placebo-controlled trial of prophylactic recombinant human granulocyte-macrophage colony-stimulating factor to reduce nosocomial infections in very low birth weight neonates.

OBJECTIVE: We carried out a randomized placebo-controlled trial in very low birth weight neonates (VLBWNs), comparing the incidence of nosocomial infections after the prophylactic use of recombinant human granulocyte-macrophage colony-stimulating factor (rhu GM-CSF) versus placebo in VLBWNs. STUDY DESIGN: VLBWNs (n = 264), weighing 501 to 1000 g, </=72 hours of age were randomly assigned to receive rhu GM-CSF (8 microg/kg/d), administered intravenously (n = 134) over 2 hours daily x 7 days and every other day for 21 days, or placebo (n = 130). The safety, incidence of nosocomial infections, days of absolute neutrophil count >/=4000/mm,3 peripheral blood progenitor studies, and 24-hour polymorphonuclear leukocyte C3bi receptor expression were compared between the 2 treatment groups. RESULTS: No (grade III/IV) toxicity or adverse events were associated with rhu GM-CSF. The absolute neutrophil count and absolute eosinophil count were significantly elevated in the rhu GM-CSF group on days 7 (P =.001), 14 (P =.001), and 21 (P =.007) and on days 7 and 28 (P =.012 and P =.001, respectively). However, there was no difference in the incidence of confirmed nosocomial infections between the 2 treatment groups in this trial (40% vs 39%, rhu GM-CSF vs placebo; P = NS). CONCLUSION: In a large randomized placebo-controlled trial, prophylactic administration of rhu GM-CSF in VLBWNs does not appear to decrease the incidence of nosocomial infections.

Cross Infection↗
PubMed1997

Neonatal morbidity after elective repeat cesarean section and trial of labor.

OBJECTIVE: To evaluate neonatal outcomes after an elective repeat cesarean section (ERCS) compared with a trial of labor (TOL). POPULATION AND METHOD: All mothers who underwent previous cesarean section and delivered singleton infants at term gestation were identified during a 1-year period. Neonatal outcomes were compared between infants delivered by ERCS (n = 497) and those delivered by TOL (n = 492), and between infants delivered by a successful (n = 336) and a failed (n = 156) TOL. A cohort of mothers and their term infants delivered by routine vaginal delivery were also identified. RESULTS: Infants delivered by ERCS had an increased rate of transient tachypnea compared with infants born by TOL (6% vs 3%). Compared with routine vaginal deliveries, the adjusted odds ratio of developing any respiratory problem after an ERCS was 2.3 (95% confidence interval [CI]: 1.4, 3.8), and for developing transient tachypnea was 2.6 (CI: 1.5, 4.5). In addition, two infants delivered by ERCS developed respiratory distress syndrome. Infants delivered after a TOL had increased rates of suspected and proven sepsis (5% vs 2% and 1% vs 0.1%, respectively). Compared with a successful TOL, the infants delivered by cesarean section after a failed TOL had more neonatal morbidity and had a longer hospital stay (4.8 +/- 2 vs 3.1 +/- 2 days). The odds ratio for developing any respiratory illness after a failed TOL was 2.1 (95% CI: 1.1, 4.1), for suspected sepsis was 4.8 (95% CI: 2.6, 9.0), and for proven sepsis was 19.3 (95% CI: 2.0, 187). Neonatal outcomes after a successful TOL were similar to routine vaginal births. CONCLUSION: Infants born by ERCS are at increased risk for developing respiratory problems compared with those born by TOL. However, TOL is associated with increased rates of suspected and proven sepsis. This appears to be limited to infants delivered by cesarean section after a failed TOL.

Cesarean Section, Repeat↗
PubMed1984

Distribution of enamel defects and the association with respiratory distress in very low birthweight infants.

Although dental defects have long been observed among surviving pre-term infants, only few systematic studies address this problem. In a clinic limited to recall of infants of very low birthweight (less than 1.5 kg), enamel hypoplasia of primary incisors was found in 14/67 (21%) children, and enamel opacities were found in an additional 31% of the children. In contrast, enamel hypoplasia and opacities were found in 4% and 22%, respectively, of a control group of 46 normal birthweight children. The difference was significant (p less than 0.05) for the hypoplasia but not for the opacities. Primary incisor enamel hypoplasia was more commonly noted in maxillary central incisors than in lateral incisors (X2 = 28.0, p less than 0.01). Furthermore, hypoplasia was more common in maxillary incisors than in mandibular incisors (X2 = 48.4, p less than 0.01). In infants with dental defects, there was no significant correlation with pregnancy risk factors, gestational age, birthweight, septicemia, first-week caloric intake, serum bilirubin, or calcium. Infants with enamel hypoplasia were more likely, however, to have severe respiratory distress syndrome (X2 = 7.2, p less than 0.01), than infants with unaltered enamel. Central incisor edge involvement may indicate post-natal processes and/or a systemic disturbance extending back to the middle trimester of pregnancy.

Child, Preschool↗
PubMed1981

Photoisomerized bilirubin in blood from infants receiving phototherapy.

A pigment different from (Z,Z)bilirubin-IX alpha was detected by fluorometric methods in blood specimens from newborn infants undergoing blue-light therapy for unconjugated hyperbilirubinemia; it was not detected in specimens from infants not under therapy. The phototherapy-associated pigment has fluorescence, solubility, and photochemical properties that are identical to those exhibited by what are thought to be configurational (Z leads to E) isomers of bilirubin. It is concluded that isomerized bilirubin in the blood of neonates under phototherapy can reach as high as 15% of the total.

Bilirubin↗
PubMed1980

Folate compartments during gestational maturation.

Studies on 41 healthy preterm infants and 53 term infants revealed that almost 70% of the total folate is present in the bound form. Beyond the enonatal period the increase in bound folate with increasing gestational maturity reflects fetal demands placed on folate transport and affords an explanation for the loss of folate and corresponding increase in unsaturated binder during pregnancy. With the knowledge of folate biology gained from radioligand data, it is reasonable to postulate that effective folate metabolism depends upon a metabolically active transport mechanism.

Biological Transport↗
PubMed1979

Effect of supine and prone positions on arterial oxygen tension in the preterm infant.

To determine the optimal position for the preterm infant, arterial oxygen tension (Pao2) was monitored in 16 preterm infants by the transcutaneous method with the infants in both supine and prone positions. When the infants were prone, Pao2 rose by a mean of 7.4 mm Hg (P less than .001), an increase of 15%. In those infants with residual cardiopulmonary disease a 25% increase was noted. The higher Pao2 in the prone position was accompanied by a significant decrease in the amount of time the chest wall moved asynchronously. This improved oxygenation in the prone position appears to be the result of enhanced ventilation/perfusion ratios and not merely secondary to an alteration in sleep state with positioning of the infant. These findings may have important implications in the management of preterm infants, requiring neonatal intensive care.

Arteries↗
PubMed1978

Echographic ventricular systolic time intervals in normal term and preterm neonates.

Right ventricular and left ventricular systolic time intervals (RVSTIs and LVSTIs) were measured in normal term and preterm infants from 1 hour to 90 days of life. LVSTIs in both term and preterm infants were similar in the first five days of life. The ratio of left pre-ejection period (LPEP) to left ventricular ejection time (LVET) was lower in preterm infants older than age 5 days. Estimated gestational age had no influence on LVSTI. The ratio of right pre-ejection period (RPEP) to right ventricular ejection time (RVET) was lower in preterm infants (0.32) than in term newborns (0.37). The preterm RPEP/RVET ratio decreased with age, but at a slower rate than in term babies. This was consistent with the lower pulmonary vascular resistance present in preterm infants.

Echocardiography↗
PubMed1977

Persistence of fetal circulation syndrome: an echocardiographic study.

Serial echocardiograms were performed on 17 infants with persistence of fetal circulation syndrome to measure right ventricular systolic time intervals from pulmonic valve echograms and left ventricular systolic time intervals from aortic valve echograms. Right ventricular pre-ejection period/right ventricular ejection time ratio was prolonged in PFCS when compared to that in normal newborn infants, and diminished with clinical improvement. Left ventricular pre-ejection period/left ventricular ejection time ratio was prolonged in infants with PFCS. Echographic RPEP/RVET was consistent with the elevated pulmonary artery pressure and pulmonary vascular resistance of PFCS; elevated LPEP/LVET suggested left ventricular dysfunction.

Blood Circulation↗
PubMed1977

Neonatal circulatory changes: an echocardiographic study.

Serial echocardiograms were performed in the first three days of life on 38 normal full-term infants. Right ventricular systolic time intervals were measured from the pulmonic valve echogram and left ventricular systolic time intervals were determined from the aortic valve echogram. The heart rate, left ventricular pre-ejection period (LPEP), left ventricular ejection time (LVET), and LPEP/LVET ratio showed insignificant variation with increasing postnatal age. The right ventricular pre-ejection period (RPEP) shortened, the right ventricular ejection time (RVET) lengthened, and the RPEP/RVET ratio decreased with increasing age. The findings suggested that alterations in the RPEP/RVET ratio reflected the decreasing pulmonary artery diastolic pressure and pulmonary vascular resistance of the early neonatal period and may be valuable in the noninvasive evaluation of the newborn's pulmonary vascular bed.

Age Factors↗
PubMed1977

Respiratory distress syndrome: echocardiographic assessment of cardiovascular function and pulmonary vascular resistance.

Echocardiograms were performed for 82 preterm infants comprising 22 normal infants, 29 with mild respiratory distress syndrome (RDS), and 31 with severe RDS. Left ventricular systolic time intervals were measured from aortic valve echograms and right ventricular systolic time intervals from pulmonic valve echograms. Left ventricular performance seemed to be altered early in postnatal adaptation of preterm infants, but played no demonstrable role in the outcome of RDS. The right ventricular preejection period/right ventricular ejection time (RPEP/RVET) ratio was prolonged in 17 out of 31 patients with severe RDS, consistent with increased pulmonary vascular resistance or right ventricular dysfunction. Prolonged RPEP/RVET identified a subgroup with increased mortality and morbidity.

Echocardiography↗
PubMed1976

Massive intracerebellar hemorrhage in low-birth-weight infants.

The clinical and pathologic observations of massive intracerebellar hemorrhage (destruction of at least one-third of cerebellar tissue) are described in six low-birth-weight infants. In all infants, severe progressive apnea associated with a falling hematocrit were the prominent clinical features. Four infants were asphyxiated at birth. Some degree of cerebellar hemorrhage (macroscopic or microscopic) was observed in 21% of 157 newborn brains examined at autopsy. The cause of massive intracerebellar hemorrhage is unknown, but may result from deforming pressures on the skull secondary to perinatal trauma. A close follow-up of cerebellar function in low-birth-weight infants is important.

Birth Weight↗