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Biomedical subjects

A G Philip

Publications and source records attributed to A G Philip.

At least 19 recordsLinked to original sources
PubMed1992

Risk factors for early intraventricular hemorrhage in low birth weight infants.

Because earlier studies suggested that preterm infants with germinal matrix hemorrhage or intraventricular hemorrhage or both (GMH/IVH) present within the first 12 postnatal hours are at greatest risk for the development of high-grade hemorrhage and neurodevelopmental disability, we examined the risk factors for this insult among 229 neonates of 600 to 1250 gm birth weight in a multicenter study. All had echoencephalography (ECHO) within the first 11 hours and serially for the next 20 days; risk factor data were collected prospectively. Forty-three infants had GMH/IVH within the first 5 to 11 hours (mean age at ECHO 7.7 hours): 18 GMH and 21 grade II, 1 grade III, and 3 grade IV IVH. One hundred eighty-six infants did not have GMH/IVH at a mean age of 7.9 hours. Both groups of infants were similar in birth weight, gestational age, maternal risk factors, cord pH values, and surfactant therapy before ECHO. The group with early IVH had more vertex presentations than the group without early IVH (79% vs 55%, p = 0.043), less maternal tocolytic use (42% vs 60%, p = 0.029), and more vaginal deliveries (67% vs 44%, p = 0.005). In the first 21 days, severe IVH developed in 12 infants with early IVH and in 6 infants without early IVH (p < 0.001). There were more neonatal deaths (16% vs 6%, p = 0.035) and more deaths at any time during the primary hospitalization (23% vs 9%, p = 0.010) among the early IVH group than among the group without early IVH. Multivariate analysis indicated that the mode of delivery, fetal presentation, and birth weight were important and independent prognostic indicators of IVH.

Birth Weight↗
PubMed1992

Prolonged dexamethasone therapy reduces the incidence of cryotherapy for retinopathy of prematurity in infants of less than 1 kilogram birth weight with bronchopulmonary dysplasia.

To determine whether prolonged dexamethasone therapy, used in the treatment of bronchopulmonary dysplasia (BPD), affects the incidence of cryotherapy for retinopathy of prematurity, the authors conducted a retrospective review of all infants admitted to a neonatal intensive care unit between October 1988 and October 1990 (n = 957) whose birth weights were less than 1 kg (n = 90). All admissions were reviewed to determine birth weight, gestational age, survival, incidence of BPD and cryotherapy, use and duration of dexamethasone therapy, length of mechanical ventilation, continuous positive airway pressure, and additional supplemental oxygen. Of all neonatal intensive care unit admissions, 9.4% weighed less than 1 kg, and 64% survived for greater than 28 days (n = 58). Of the survivors, 82% had BPD. Cryotherapy for retinopathy of prematurity was used only in those with birth weights of less than 1 kg and with BPD. All those treated with dexamethasone (n = 23) had BPD and significantly lower gestational ages (25.6 vs 26.4 weeks) (P = .05) and birth weights (759 vs 824 g) (P < .05) than those not treated (n = 25). Dexamethasone was used in 23 of 48 infants (9 for < or = 24 days, 14 for > 24 days). Eleven required cryotherapy: 5 of 25 with no dexamethasone, 5 of 9 treated for 24 days or less, and 1 of 14 treated for longer than 24 days (P < .04). In those treated with prolonged (> 24 days) dexamethasone, cryotherapy was significantly reduced compared with those treated for shorter periods. Although the probability was significant, the 95% confidence intervals were wide.(ABSTRACT TRUNCATED AT 250 WORDS)

Bronchopulmonary Dysplasia↗
PubMed1979

The protective effect of acute phase reactants in neonatal sepsis.

Phase reactants were evaluated prospectively in babies suspected of having sepsis. Among 318 babies, there were 22 proven and 10 "very probable" cases of neonatal sepsis. Of the proven cases 14 survived and 8 died. The survivors had a positive latex C-reactive protein (CRP) in 11 cases and an alpha1-acid glycoprotein (AGP) level greater than 0.5 g/l in 12 cases. Among those who died, one had a positive latex CRP and none had AGP greater than 0.5 g/l. These findings were supported by positive CRP and elevated AGP in almost all "very probable" cases, all of whom survived. These data in newborn infants support the hypothesis that acute phase reactants have a functional role in combating infection.

C-Reactive Protein↗
PubMed1979

Noninvasive monitoring of intracranial pressure: a new approach for neonatal clinical pharmacology.

Measurements taken with the pressure-activated fiberoptic sensor should provide better insight into the relative usefulness of various agents such as glycerol and corticosteroids in the reduction of intracranial pressure. It is also useful in monitoring pressure changes during asphyxia-hypoxia, convulsions, and anesthesia, and in demonstrating the effects of drugs such as furosemide on intracranial pressure.

Animals↗
PubMed1979

Failure of conventional monitoring to detect apnea resulting in hypoxemia.

In summary, our findings support and confirm the concerns of many investigators that present methods of cardiorespiratory monitoring are inadequate for the detection of many forms of apnea. Nurses underrecord both the frequency and duration of apneic episodes. Bradycardia is an unreliable index of hypoxemia. Thoracic impedance monitors are unreliable because they detect only a fixed duration of respiratory pause and are sensitive to many artifacts unavoidable in a clinical setting. Finally, ineffective breathing patterns such as disorganized breathing, obstructive apnea, and paradoxical breathing are undetectable by thoracic impedance monitoring. We warn against the reliance on heart rate and thoracic impedance monitoring alone for infants with recurrent apnea.

Apnea↗
PubMed1978

Early increase in intracranial pressure in preterm infants.

Noninvasive measurement of intracranial pressure is now available via the anterior fontanel in newborn infants. We measured intracranial pressure during the first week of life in 18 preterm infants and found a statistically significant increase from birth to age 24 hours and a significant decrease by 48 hours (13.8 vs. 24.4 vs. 14.3 cm H2O). This did not seem to be the result of postnatal head shrinkage. There were no other apparent correlations. We suspect that hypoxia may play an important role in the etiology of increased intracranial pressure. We believe that these findings may have important implications for intracranial hemorrhage in preterm infants.

Humans↗
PubMed1978

Fetal growth retardation: femurs, fontanels, and follow-up.

Sixty-three term newborn infants with fetal growth retardation were evaluated within three days of birth. They were classified by length and head circumference. In group 1, both length and head circumference were less than the tenth percentile; in group 2, either length or head circumference was less than the tenth percentile; and in group 3, both length and head circumference were greater than the tenth percentile. Ponderal index (weight/length ratio), anterior fontanel size, and amount of epiphyseal ossification were also determined. Significantly lower birth weights and decreased ossification were found when groups 1 or 2 were compared separately with group 3. These differences were most marked when the weight/length ratio was less than 2.25. When the ponderal index was less than 2.0, epiphyseal ossification was usually absent (suggesting a chronic process). Epiphyseal ossification was positively correlated with birth weight and length but was unrelated to anterior fontanel size. Ossification was more often absent in males than females. There was a negative (inverse) correlation between birth weight and anterior fontanel size. Follow-up of 32 of these infants at age 1 year showed marked individual variations, but there were significant differences in incremental linear growth between groups 1 and 3, a finding which supports results of animal studies showing that catch-up growth may be related to skeletal immaturity. Physical measurements at birth in the individual baby with fetal growth retardation do not reliably predict subsequent growth.

Birth Weight↗
PubMed1978

Transcutaneous oxygen monitoring in aminophylline-treated apneic infants.

Transcutaneous PO2 (tcPO2) monitoring offers a new approach to the evaluation of drug effects. We investigated the effect of theophylline on ten premature infants with apnea. Theophylline was administered as aminophylline, 8 mg/kg per rectum every 12 hours for two doses and 4 mg/kg every 12 hours for a total of two or five days (short and long courses). The tcPO2, heart rate (beat-to-beat), and thoracic impedance were continuously monitored during each of three 4-hour study periods: 12 hours before theophylline administration, 12 hours after initiation of theophylline therapy, and 24 to 48 hours after discontinuing the drug's use. Plasma levels were measured by a radioimmunoassay developed in our laboratory. Polygraphic recordings were analyzed without knowledge of treatment for frequency of apneic spells, mean duration of apneas, total duration of hypoxemia (tcPO2 less than or equal to 40 torr), total duration of hyperoxemia (tcPO2 greater than or equal to 100 torr), basal tcPO2, heart rate, and respiratory rate. In each case during theophylline use, cardiorespiratory patterns were altered, respirations were more regular, apneic spells were reduced, PO2 was stabilized with less hypoxia and hyperoxia, and bradycardic episodes were decreased. There was considerable variation in the response of the ten infants and a significant difference in the frequency of return of symptoms between those receiving short-term therapy and those receiving the longer course.

Aminophylline↗
PubMed1977

Role of respiration in effecting transfusion at cesarean section.

The transfer of blood from placenta to baby (placental transfusion) was examined in 29 full-term babies delivered by elective Cesarean Section. Events surrounding the delivery were carefully monitored using a stopwatch. Residual placental blood volume (RPBV) and change in hematocrit (Hct) were measured. In 13 infants held above the level of the placenta, the mean RPBV was significantly greater, and the change in Hct significantly lower, than in 16 infants held below the level of the placenta. Increasing duration of respiration resulted in increasing amounts of placental transfusion, even in those babies held just above the placenta. These results indicate that there are separate effects of gravity and respiration which facilitate a placental transfusion at Cesarean Section.

Blood Volume↗
PubMed1976

Orogastric supplementation in small premature infants requiring mechanical respiration.

Very small premature infants with severe respiratory disease were managed with early intermittent orogastric feedings combined with infusion of 10% dextrose. Nine infants weighing less than 1,350 gm at birth (mean, 990 gm) who required endotracheal intubation and respirator therapy and who remained in the hospital for at least 40 days were studied retrospectively. The mean weight gain per day was 10.8 gm for the first 40 days of life, 14.1 gm while an endotracheal tube was in place (sometimes longer than 40 days), and 15.7 gm during the growth phase, after initial weight loss. Individual growth curves compared favorably with those reported by others using total parenteral nutrition. The technique described deserves wider application for initial management of the small premature infant receiving mechanical respiration.

Body Weight↗