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Biomedical subjects

B V Kirkpatrick

Publications and source records attributed to B V Kirkpatrick.

At least 19 recordsLinked to original sources
PubMed1995

A balanced curriculum?

Particular emphasis in the United States has been placed on deficiencies in science education. These deficiencies have been widely publicized and the importance must be emphasized; however this is not an isolated problem. Similar deficiencies exist in the area of humanities and social sciences and this study among medical students demonstrates the need for an improved and balanced curriculum. When compared to the top quartile (25%) of the high school group used as a standard, 11.2% of the medical students tested scored below the mark on the humanities subtest and 9.8% on social sciences. Some scores were abysmally low: one with 25 of 115 questions on Form A and another with 19 of 115 questions on Form B.

Curriculum↗
PubMed1987

Extracorporeal membrane oxygenation following repair of congenital diaphragmatic hernias.

From 1981 through 1986, 8 newborns with congenital diaphragmatic hernia required herniorrhaphy in the first 8 hours of life. Extracorporeal membrane oxygenation (ECMO) was employed in 7 after they met local criteria predictive of 95% mortality. These criteria were an alveolar-postductal arterial oxygen gradient greater than 600 mm Hg for 12 hours or hemodynamic instability. Four of these 7 patients had unremitting hypoxemia after herniorrhaphy (no "honeymoon" period), 3 of whom survived. One additional patient died, producing a mortality of 29%. ECMO used for 68 to 241 hours (mean, 163 hours) provided reliable oxygenation in all. Deaths resulted from disseminated intravascular coagulation and bleeding, and bleeding and pulmonary failure after ligation of a patent ductus arteriosus. Complications occurred in 6 patients and included bleeding (3), hernia recurrence (3), and air embolism (1). Follow-up ranging from 1 year to 6 years after discharge of the 5 survivors shows normal growth and development in 4. The reported mortality without ECMO following congenital diaphragmatic herniorrhaphy in the first 8 hours of life ranges between 60 and 80%. While bleeding may present problems, survival of newborns with refractory hypoxemia after diaphragmatic repair has improved with ECMO.

Extracorporeal Circulation↗
PubMed1985

Asphyxia and hyaline membrane disease in neonatal monkeys.

An animal model for studying the relationship between perinatal asphyxia and hyaline membrane disease (HMD) is described. The HMD developed in these Macaca mulatta (rhesus) and M. arctoides (stump tail) monkeys was clinically, physiologically, and histologically similar to that seen in human infants. The monkeys were delivered by cesarean section at a gestational age of 85-91% of term when surfactant, though present, was less than mature levels. Asphyxia at birth proved to be an important factor in disease development. Five minutes of asphyxia immediately before the first breath greatly increased the incidence and severity of HMD when compared to nonasphyxiated controls of a similar gestational age. Amniotic fluid L/S ratios did not differ significantly in the asphyxiated and control groups but data based on static pressure-volume studies of the excised lungs indicated that the surfactant activity of the asphyxiated group was significantly less. Lung maturity with regard to surfactant production appears to be a critical factor. The data from these experiments, together with data cited in the literature, strongly suggest that the lung and its surfactant system is most vulnerable to hypoxia and/or acidosis during the early stages of surfactant production. The asphyxiated non-human primate model used here should prove valuable for studying the pathogenesis of HMD and especially for further clarifying the relationship between perinatal asphyxia and HMD.

Amniotic Fluid↗
PubMed1984

The early evaluation of survivors after extracorporeal membrane oxygenation for neonatal pulmonary failure.

Excluding mortality data, there is little information regarding patients' development after extra corporeal membrane oxygenation (ECMO). In six of nine neonates surviving ECMO for predictably fatal pulmonary failure, examination 15 to 21 months afterward showed (1) physical growth and development, normal in six; (2) chest x-ray, normal pulmonary parenchyma; (3) average arterial blood gases, PO2 80, Pco2 35, pH 7.35; (4) echocardiogram, normal, without evidence of pulmonary hypertension; (5) cerebrovascular dopplers, normal ophthalmic artery flow in five patients, retrograde in one; (6) CT scan, EEG, neurologic survey, normal in five, cerebral atrophy in one patient who had an air embolus during decannulation; (7) psychologic examination, normal in all. This early evaluation of ECMO survivors should encourage its further application in those newborns who would otherwise die.

Child Development↗
PubMed1984

Alveolar-arterial oxygen gradients versus the Neonatal Pulmonary Insufficiency Index for prediction of mortality in ECMO candidates.

Current selection criteria necessary for intelligent application of extracorporeal membrane oxygenation (ECMO) in hypoxic neonates remains controversial. Both the Neonatal Pulmonary Insufficiency Index (NPII) and serial alveolar-arterial oxygenation gradient measurements (A-a)Do2 have been recommended. Accordingly, an analysis of 50 consecutive severely hypoxic neonates was undertaken to assess the predictive value of (A-a)Do2 determinations and NPII in discriminating survivors from non-survivors. These infants with meconium aspiration syndrome (MAS), congenital diaphragmatic hernia (CDH), or persistent pulmonary hypertension of the newborn (PPHN) required maximum mechanical ventilation for hypoxia. Pharmacologic manipulation of pulmonary vascular resistance was attempted in 83%. If postductal (A-a)Do2 remained greater than or equal to 620 torr despite 12 hours of maximum medical therapy, mortality was 100%; however, 35% of nonsurvivors were unfortunately excluded. (A-a)Do2 greater than or equal to 600 torr for 12 hours demonstrated 93.8% mortality, and only 12% of all mortalities were thus excluded. Among nonsurvivors successfully hyperventilated, the NPII could not predict mortality. Ideal selection criteria must exclude those who would otherwise survive without ECMO, yet allow early accurate identification of the neonate certain to die. It would appear that serial (A-a)Do2 determinations best permit this identification and thus orderly application of ECMO.

Extracorporeal Circulation↗
PubMed1984

Renal tubular acidosis type 4 in neonatal unilateral kidney diseases.

Three neonates, two with unilateral renal vein thrombosis and one with unilateral dysplastic kidney, developed type 4 renal tubular acidosis, manifested by nonazotemic hyperkalemic metabolic acidosis with alkaline urine pH and reduced potassium excretion. Normal plasma concentrations of sodium, aldosterone, and renin activity, together with normal renal fractional excretion of sodium, supported the diagnosis of renal tubular acidosis type 4, subtype 5. Arginine HCl loading studies showed that despite their ability to bring the urine pH to less than 5.8, net acid excretion was inadequate relative to the corresponding plasma bicarbonate concentration. Treatment with oral bicarbonate resulted in sustained normalization of blood acid-base status and accelerated linear growth in the first two infants, in whom spontaneous recovery occurred by ages 8 and 15 months, respectively. At that time, the affected kidneys were extremely small with distorted collecting systems; the contralateral kidneys showed compensatory hypertrophy. In the third infant, persistent acidosis and growth failure resulted from medical noncompliance; the removal of the dysplastic kidney at 7 months of age was followed by the return to normal blood acid-base status and normalized tubular hydrogen and potassium excretion. We conclude that neonatal unilateral kidney disease can result in renal tubular subtype 5. Spontaneous recovery can be expected, presumably because of " autonephrectomy " of the affected kidney plus the compensatory hypertrophy of the contralateral kidney.

Acidosis, Renal Tubular↗
PubMed1983

Use of extracorporeal membrane oxygenation for respiratory failure in term infants.

Eight infants with intractable respiratory failure were treated with extracorporeal membrane oxygenation. Intractable respiratory failure was defined as alveolar-arterial oxygen gradient of more than 620 torr for six to 12 hours that did not respond to hyperventilation and the use of tolazoline. Infants with overt sepsis, CNS damage, or other debilitating conditions were not considered for extracorporeal membrane oxygenation. Six of the eight infants survived after a mean extracorporeal membrane oxygenation time of 164 hours. Five of the six survivors were normal neurologically and developmentally when examined at 1 year of age.

Blood Gas Analysis↗
PubMed1982

Clinical use of an extracorporeal membrane oxygenator in neonatal pulmonary failure.

Pulmonary failure is the most frequent cause of mortality in newborns, accounting for 15,000 deaths yearly. It may be the result of the respiratory distress syndrome (RDS), meconium aspiration syndrome (MAS), or persistent fetal circulation (PFC), including infants with congenital diaphragmatic hernia (CDH). Early identification of patients with predictably fatal but potentially reversible respiratory failure refractory to conventional management protocols would permit orderly application of extracorporeal membrane oxygenation (ECMO) as a final resuscitative measure. Eight neonates with severe pulmonary failure manifested by A-a DO2 of greater than 620 torr for greater than 12 hr, persistent cardiovascular instability, and relentless progression of acidosis and hypoxemia were predicted to have a 100% mortality in spite of maximal medical therapy. Four patients presented with MAS and 4 others had PFC, including 2 with CDH. All were supported with ECMO using the internal jugular vein and common carotid artery for access to the right atrium and aortic arch. Following support for 77-313 hr, 6 were successfully weaned from ECMO and then from the ventilator. In these few patients the use of extracorporeal membrane oxygenation after exhaustion of standard therapy was accomplished safely and successfully without untoward short-term sequelae. Extracorporeal ventilatory support may purchase the critical time necessary for resolution of the underlying parenchymal disease, including the pulmonary hypertension associated with CDH.

Female↗
PubMed1980

Nutritive sucking in high-risk neonates after perioral stimulation.

Five high-risk neonates were selected from the population of newborns in the Neonatal Intensive Care Unit of the Medical College of Virginia Hospitals to investigate the effect of perioral stimulation on nutritive suckling ability. A polygraph and pressure transducer were used to record sucking activity over a four-minute interval for three successive feedings. During the first and third feedings, the infants received no stimulation. During the second feeding, infants received perioral stimulation whenever they stopped sucking for a two-second period. An analysis of variance showed a statistically significant effect from the stimulation sequence as well as a trend of decreasing sucking activity during the four-minute interval. The study indicated that perioral stimulation may be an effective method for increasing nutritive sucking ability of infants who are poor feeders.

Feeding Behavior↗
PubMed1980

Grand round series: hypoglycemia and unilateral pulmonary edema in a newborn.

A case of cardiomegaly with unilateral pulmonary edema is presented. The predisposing etiologies were severe hypoglycemia and a hypertonic glucose infusion into a branch of the left lower lobe pulmonary vein. Resolution resulted following maintenance of adequate glucose levels, vigorous cardiopulmonary support, and repositioning of the catheter tip in the inferior vena cava. The pathophysiologic mechanism was direct endothelial injury with an osmotic diuresis. The role of the release of a vasoactive substance was postulated.

Female↗
PubMed1979

Central nervous system maturation in the stressed premature.

The developmental sequence of sleep cycles has been found to be a useful index of central nervous system maturation in premature infants. To determine the effects of severe reversible stress on the maturation of sleep cycles, 6- to 8-hour sleep studies were done on 10 premature infants with severe hyaline membrane disease (HMD) and 10 healthy premature babies. The studies were done in the neonatal intensive care unit and included patients from 30 weeks' gestation to term and in all stages of the disease. Prior studies were confirmed showing that percentage of quiet sleep increases, transitional sleep changes little, and active sleep decreases from 30 weeks' gestation to term. In infants with severe HMD, the percentage of quiet sleep was less and active sleep higher than in unstressed infants of similar age who acted as controls. Once the infants recovered from HMD, sleep patterns became similar to those found in the control group. These data suggest that when respiratory distress occurs in the premature infant, there is a transient delay in central nervous system maturation as measured by sleep cycle analysis.

Brain↗
PubMed1979

Pelvic exsanguination following umbilical artery catheterization in neonates.

Umbilical artery catheterization in 400 newborns was followed by umbilical or hypogastric artery perforation with massive extra- and intraperitoneal bleeding in 7 infants. Common predisposing factors were multiple attempts and insertion against resistance. A characteristic clinical picture developed, including hypotension, abdominal distention, and lower abdominal wall induration and ecchymosis, often extending into the genitalia and upper thighs, with absent femoral pulses. Treatment is immediate transfusion and bilateral umbilical and hypogastric artery ligation. One of seven patients survived.

Catheterization↗