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Biomedical subjects

A N Krauss

Publications and source records attributed to A N Krauss.

At least 19 recordsLinked to original sources

Ascorbic acid prevents oxidative stress in glutathione-deficient mice: effects on lung type 2 cell lamellar bodies, lung surfactant, and skeletal muscle.

Glutathione deficiency in adult mice leads to lung type 2 cell lamellar body and mitochondrial damage; as reported here, these effects are associated with marked decrease of the levels of phosphatidylcholine (the main component of lung surfactant) in the lung and the bronchoalveolar lining fluid. Severe mitochondrial damage was also found in skeletal muscle. Treatment with ascorbate (1-2 mmol per kg of body weight per day), which led to greatly increased (approximately 2-fold) levels of lung and muscle mitochondrial glutathione, prevented damage to lamellar bodies and mitochondria as well as the decline of phosphatidylcholine levels in lung and alveolar lining fluid. The findings indicate that glutathione deficiency leads to depletion of lung surfactant and that this can be prevented with ascorbate. Administration of ascorbate spares glutathione and prevents cellular damage. Lamellar body degeneration in glutathione deficiency appears to be associated with oxidative damage to the perilamellar membrane, which contains the enzymes required for phosphatidylcholine synthesis. It is notable that although severe glutathione deficiency is lethal to newborn rats, which apparently do not synthesize ascorbate, adult mice are better able to survive such a deficiency because they can synthesize ascorbate. The present studies, which suggest that high doses of ascorbate may be of therapeutic value, emphasize that ascorbate and glutathione have actions in common and that they function together in a physiologically significant antioxidant system.

Animals

Aortic root blood flow increases after pancuronium in neonates with hyaline membrane disease.

OBJECTIVE: To determine the effects of muscle paralysis on aortic root blood flow in preterm infants with hyaline membrane disease. DESIGN: Each patient served as his/her own control in a prospectively controlled trial. SETTING: Neonatal ICU in a university hospital. PATIENTS: Ten ventilator-dependent preterm infants weighing 800 to 2820 g, 0 to 8 days of age, with hyaline membrane disease and seven control patients. INTERVENTIONS: Noninvasive measurement of aortic root blood flow by Doppler echocardiography 30 min before and 60 min after respiratory paralysis with 0.1 to 0.5 mg/kg of iv pancuronium, or following ventilator changes in control subjects. RESULTS: Mean aortic root blood flow increased significantly (p less than .001), from 212 to 276 mL/min.kg, accompanied by significant increases in stroke volume and heart rate. CONCLUSIONS: Pancuronium bromide may have a direct beneficial effect on the circulation of preterm infants with hyaline membrane disease.

Aorta

Ventilation-perfusion abnormalities in the preterm infant with hyaline membrane disease: a two-compartment model of the neonatal lung.

Arterial-alveolar differences for oxygen, carbon dioxide, and nitrogen were measured in 7 non-distressed preterm infants and 21 ventilator-dependent preterm infants with hyaline membrane disease. The preterm infants with hyaline membrane disease had a significantly lower average arterial pH (7.34 vs. 7.44; P less than 0.001), and significantly higher arterial-alveolar differences for oxygen (286 mm Hg vs. 34 mm Hg; P less than 0.005) and nitrogen (118 mm Hg vs. 7 mm Hg; P less than 0.005). Both groups had elevated arterial-alveolar differences for PCO2 (9 mm Hg in infants with hyaline membrane disease, 5 mm Hg in nondistressed infants; P less than 0.2). When acute changes in mean airway pressure were produced in 14 distressed infants, arterial-alveolar CO2 and N2 differences moved in opposite directions in 11 infants. This observation suggests that changes in mean airway pressure do not acutely recruit atelectatic alveoli, but cause redistribution of ventilation within alveoli already ventilated.

Carbon Dioxide

Pulmonary function in preterm infants following treatment with intravenous indomethacin.

Pulmonary function tests, including measurements of arterial blood gas levels, total pulmonary compliance, and arterial-alveolar oxygen ratios, were performed in 38 ventilator-dependent preterm infants with respiratory distress syndrome who weighed less than 1500 g at birth. Twenty-seven had a physiologically significant patent ductus arteriosus (PDA). Twelve were assigned at random to receive three doses of intravenous indomethacin, 0.2 mg/kg per dose, on the fourth day of life. This treatment resulted in ductal closure in seven infants by the seventh day of life. Another concurrently observed group of 15 infants with PDA received no indomethacin. A third group of 11 infants lacked evidence of a PDA. Pulmonary function in the infants who received indomethacin did not differ significantly from that in the other two groups.

Ductus Arteriosus, Patent

Discrepancies between transcutaneous and end-tidal carbon dioxide monitoring in the critically ill neonate with respiratory distress syndrome.

PaCO2, transcutaneous PCO2 (PtcCO2), and end-tidal PCO2 (PetCO2) measurements were studied in 12 critically ill neonates. PtcCO2 was measured using a combination CO2/O2 sensor during the routine care of these patients. End-tidal sidestream sampling was performed during blood gas measurement as dictated by the patient's clinical condition. There was a linear correlation between PtcCO2 and PaCO2 (n = 51, r = .71, slope = 0.90). PetCO2 and PaCO2 did not correlate as well (n = 51, r = .52, slope = 0.42). Acidosis negatively affected the correlation between PtcCO2 and PaCO2. When pH was greater than 7.30, r = .75 and slope = 1.28 (n = 38), whereas when pH was less than 7.30, r = .62 and slope = 0.73 (n = 13). The presence or absence of a metabolic acidosis did not have a significant effect on the slopes obtained. PtcCO2 monitoring using combined sensors is a useful and practical means of monitoring in the neonatal ICU, although acidosis affects the ability to correlate transcutaneous and arterial values. End-tidal sidestream measurements are not as clinically useful because they vary due to different ventilation/perfusion relationships in the sick neonate.

Blood Gas Monitoring, Transcutaneous

Baroreceptors in preterm infants: their relationship to maturity and disease.

Using passive tipping to a 45 degrees head-up position, an attempt was made to elicit reflex vasoconstriction in 13 non-distressed preterm infants and 27 infants with hyaline membrane disease, all between 26 and 38 weeks gestation. An increase in vascular tone associated with a significant reduction in peripheral blood-flow was found in 11 of the 13 non-distressed infants, while the same response was lacking in 23 of the 27 distressed infants. No infant demonstrated significant tachycardia with tilting, and the non-distressed infants failed to maintain their mean aortic blood-pressure during tilting. The results suggest that reflex control of vascular tone is present in non-distressed infants as early as 26 weeks gestation, but not in infats with hyaline membrane disease, possibly because of a maximal increase in vascular tone as a response to illness. This is indicated by the findings of significantly higher resting peripheral vascular resistance and lower peripheral blood-flow in infants with this diesease.

Aging

Osteomyelitis in a neonatal intensive care unit.

Neonatal osteomyelitis presents with few clinical signs despite multiple sites of involvement. Four cases of osteomyelitis due to Staphylococcus aureus or Candida albicans were encountered in a neonatal intensive care unit. Three were unsuspected clinically and were detected as incidental radiologic findings. The fourth presented with soft-tissue abscesses. Long bone metaphyses were most frequently affected. Other sites included iliac bones, clavicles, and spine. On follow-up the bones healed, but one patient was left with hip deformity secondary to destruction of the cartilaginous femoral heads and another patient developed obstructive hydrocephalus due to Candida ventriculitis. Complete skeletal survey is indicated in any infant with osteomyelitis at one site to seek additional silent areas of involvement.

Abscess

Pulmonary function following feeding in low-birth-weight infants.

Determination of functional residual capacity, arterial gas tensions and pH, and arterial-alveolar differences was carried out in a group of nondistressed premature infants to determine if significant alterations in lung volumes or ventilation perfusion relationships sufficiently large to cause cyanosis could be detected after feeding. The only statistically significant changes observed in these parameters were immediately following feeding, a fall of .01 pH units and a fall of 6 mm Hg in arterial oxygen tension; and 15 minutes after feeding, a fall of .01 pH units and a rise in arterial PCO2 of 3 mm Hg. In addition, significant falls in peripheral blood flow were observed five minutes after feeding in association with marked elevations in peripheral vascular resistance. The mild impairment in pulmonary function in association with the more profound changes in limb blood flow are consistent with other studies in premature and full-term infants. These data suggest that cyanotic attacks following feeding may have a complex etiology and require an aggressive multisystem approach for adequate diagnosis and therapy.

Apnea

Alterations in state in apneic pre-term infants receiving theophylline.

The present study is a report on 9 premature infants treated with aminophylline for relief of apnea. With serum theophylline levels of 2 to 10 microgram/ml, all infants experienced significant decrease of apneic episodes in association with increased wakefulness and increased amounts of active (REM) sleep. These effects may occur independently, but it is possible that the alteration of sleep states may be partially responsible for the decrease in apneic episodes in these infants.

Aminophylline

Noninvasive estimation of arterial oxygenation in newborn infants.

Two noninvasive methods of estimating arterial oxygenation were compared in a group of 48 infants ranging in birth weight from 870 to 4,000 gm, with diagnoses including apnea of prematurity, hyaline membrane disease, meconium aspiration, and congenital heart disease. Both transcutaneous oxygen measurements and ear oximetry gave reasonably accurate estimations of arterial oxygen levels within commonly used clinical ranges (PO2 50 to 70 mm Hg, arterial saturation 90 to 98%). Infants with shock demonstrated a wide range of values for transcutaneous oxygen levels, suggesting that this method has limited usefulness in this situation. Ear oximetry had limited ability to distinguish high, but safe, levels of arterial oxygen from excessively elevated levels. While neither method can be recommended for replacement of arterial oxygen sampling, both methods may be useful in a clinical setting if care is exercised in interpretation of the results and if the values obtained are checked against those from arterial blood.

Apnea

Evaluation of methods of assisted ventilation in hyaline membrane disease.

Two methods of providing assisted ventilation were compared in infants severely ill with hyaline membrane disease (HMD). 10 infants were assigned to each group. One group received ventilation with a volume-cycled respirator, and the other was ventilated using a pressure-limited ventilator and reversed I:E ratio. Both groups were well matched for severity of illness in terms of pH and blood gases. pH and PO2 were quickly corrected by both ventilators. However, the pressure-cycled ventilator group had higher survival and lower complication rates. PAO2 after one hour was substantially improved at the same FIO2 in the pressure-limited group and after 8 hours the FIO2 required to maintain a PaO2 of 50--70 mmHg (6.6--9.3 kPa) was significantly decreased compared with the volume-cycled group. No effects on blood pressure were detected in either group. The study shows that the pressure-limited method is significantly better.

Evaluation Studies as Topic

Serial determinations of oxygen profiles in infants with respiratory distress.

Serial oxygen profiles were determined for 20 newborn infants by measuring arterial tensions at low (20--40%), intermediate (60--80%), and high (95--100%) levels of inspired oxygen. These points were plotted on a graph which estimated the percentage of venous admixture at any particular level of inspired oxygen. The infants' oxygen profiles were then determined. As much as 25% of venous admixture could be attributed to the presence of diffusion and distribution abnormalities in infants with hyaline membrane disease. A substantial number of infants showed increased shunting at high levels of oxygen, even in the presence of continuous distending airway pressure. It is hypothesised that a rising shunt is due to complete absorption of gas in poorly ventilated alveoli at high concentrations of inspired oxygen, resulting in the presence of atelectasis and redistribution of blood to poorly ventilated areas.

Humans

Sleep state, apnea and bradycardia in pre-term infants.

Respiratory pattern and heart rate were studied in 28 pre-term infants and four full-term infants during the first weeks of life. Sleep state was identified by standard neurological and EEG criteria. Apneic spells lasting 10 seconds or more were most frequent in the least mature infants, and their frequency tended to diminish with increasing maturity. When these apneic attacks were related to sleep state they were found to occur more frequently during non-REM sleep in infants of 30 to 33 weeks gestation. This was the only statistically significant difference found. No over-all pattern relating sleep state to frequency of apnea could be detected for individual infants. It was also difficult to relate the occurrence of bradycardia to apnea in terms of sleep state or gestational age. It is concluded that no simple relationship between sleep state, apnea and bradycardia exists and that a complex interrelation between central and peripheral factors is involved in these events.

Apnea

Quantitative estimation of ventilation in newborn infants using the impedance pneumogram.

Impedance pneumography is potentially a non-invasive method of measuring infant tidal volumes. In order to evaluate the accuracy of impedance pneumography, eight healthy infants (weighing from 709 to 3506 grams) were randomly chosen and studied. Simultaneous measurements of tidal volumes were made by calibrated spirometry and by transthoracic impedance pneumography. The results were statistically compared. Transthoracic impedance pneumography provided a reliable estimate of tidal and minute volumes in these newborn infants.

Humans