Hydrops fetalis with supraventricular tachycardia and cytomegalovirus infection.
Explore the source record for details and available documents.
Cytomegalovirus Infections↗
Biomedical subjects
C L Bose
Publications and source records attributed to C L Bose.
Phospholipids in tracheal effluent from infants with severe respiratory distress syndrome.
The physiologic aberration that causes abnormal alveolar surface tension in the lungs of infants with RDS was investigated by measuring relative quantities of surfactant-related phospholipids in tracheal effluent from infants with RDS. A preliminary study in premature lambs demonstrated that the percent DSPC (molar ratio of DSPC to total phospholipid) is similar in tracheal effluent and lung lavagate. The percent DSPC in tracheal effluent from human infants with RDS was similar to the percent DSPC in effluent from non-RDS infants on the first day of life (47.4% +/- 2.9 vs 46.7% +/- 1.2), and remained constant during the first 8 days of life. Phosphatidylglycerol (PG) was universally absent in effluent from RDS infants on the first and second day of life but appeared by the eighth day of life in all infants who remained intubated. PG was present in tracheal effluent from only 10 of 16 non-RDS infants on the first day of life. These findings suggest that, in regard to the surface-active lecithin content, surfactant from RDS infants is qualitatively normal and that the absence of RDS is not dependent on the presence of PG.
Animals↗
Oxygen consumption of infants with respiratory distress syndrome.
The objective of this research was to determine the oxygen consumption of newborn infants with respiratory distress syndrome in the first 4 days of life. Serial determinations of oxygen consumption were made in 14 infants with respiratory distress syndrome receiving positive end-expiratory pressures. The mean (+/- SE) oxygen consumption determined at 24, 48, 72, and 96 h postnatal age were 8.3 +/- 0.9, 6.5 +/- 0.8, 5.5 +/- 0.5, and 5.3 +/- 0.6 ml/min/kg, respectively. The level of oxygen consumption at 24 h postnatal age was significantly greater than the levels determined at 48, 72, and 96 h (p less than 0.03). The oxygen levels found at 72 and 96 h of age were comparable to those determined for healthy preterm infants. A linear regression of serial oxygen consumption and weight loss yielded a 'fair' (r = 0.5) correlation with a significant inference (p less than 0.01).
Body Weight↗
Serum somatomedin-C concentrations in a rabbit model of diabetic pregnancy.
We have developed and validated a method for measuring immunoreactive somatomedin-C (Sm-C) in serum of rabbits, and have shown that during midgestation (11-26 days; gestation = 31 days) serum Sm-C concentrations are higher in normal pregnant animals than in pregnant diabetic animals. Sm-C concentrations in the serum of 28-day gestation fetuses of diabetic rabbits (3.14 +/- 0.25 U/ml) were significantly higher than in the fetuses of nondiabetic rabbits (2.31 +/- 0.23 U/ml; P less than 0.05). Fetuses from litters of the most severely hyperglycemic diabetic mothers (glucose greater than 250 mg/dl) had higher serum Sm-C (3.66 +/- 0.41 U/ml) than those of mothers who were mildly hyperglycemic (2.71 +/- 0.2 U/ml). Although these differences were not statistically significant, fetuses from the former litters accounted in great part for the difference between the fetuses of diabetic and normal pregnancy. The diabetes-related increment in Sm-C does not appear to be due to insulin, since fetal insulin concentrations were not different between the normal and diabetic litters (normal, 50.0 +/- 3.6 microU/ml versus diabetic, 49.6 +/- 7.6 microU/ml). Despite their elevation in serum Sm-C, fetuses from litters of diabetic rabbits were growth retarded in weight (26.8 +/- 6.9 g and 33.8 +/- 6.9 g, diabetic versus normal pregnancy; P less than 0.05) and in length (7.9 +/- 0.7 cm and 8.6 +/- 0.7 cm, diabetic versus normal pregnancy; P less than 0.025). We speculate that these discrepancies between growth and Sm-C might be secondary to the toxic effects of glucose on embryonic growth and that later in gestation, the excessive energy provided to the fetus might stimulate Sm-C synthesis.
Animals↗
Dissimilar manifestations of intrauterine infection with echovirus 11 in premature twins.
Echoviruses cause neonatal disease following intrauterine and intrapartum acquisition of the organism or by nosocomial infection. Dizygous twins apparently became infected following transplacental transmission of echovirus 11. At 5 days of age, both twins experienced poor feeding, lethargy and hypothermia, and evidence of coagulopathy and hepatitis. During the sixth week of illness, the convalescence of twin A was complicated by peritonitis and sepsis, and the infant died. Pathologic findings included scattered foci of dystrophic myocardial calcification, distortion of hepatic architecture with fibrous connective tissue surrounding regenerative nodules and large foci of dystrophic calcification, and adrenal hemorrhagic necrosis and calcification. Twin B recovered without sequelae. The disease in twin A was unusual because of the extensive myocardial involvement. Also of interest was the variability of disease in twins who presumably had received a similar inoculum of organism by the same route.
Adult↗
Back transport of neonates: improved efficiency of tertiary nursery bed utilization.
Neonatal back transport is defined as the return of previously critically ill neonates from Level III newborn intensive care units to Level II and Level I nurseries for intermediate and/or convalescing care. During 1980, 172 infants (65% of eligible infants) were back transported from a Level III nursery to both Level I and Level II community hospitals. Infants who were returned to Level II hospitals tended to be smaller at the time of transfer, were less frequently nipple fed, and more frequently required oxygen supplementation compared with infants returned to Level I hospitals. Back transport permitted physicians to defer 3,892 days of hospitalization for these infants to community hospitals, an equivalent savings of approximately ten hospital beds at full occupancy. This resulted in a 44% reduction in the need for services in the newborn intensive care unit. Back transport is an efficient means of dealing with overcrowding of Level III nurseries.
Cost-Benefit Analysis↗
The University of Utah Perinatal Center. An innovative design.
Explore the source record for details and available documents.
Computers↗
Percutaneous insertion of silastic central venous catheters in newborn infants.
Percutaneous insertion of a very narrow (0.635-nm outside diameter) Silastic catheter for delivery of central hyperalimentation was performed on infants in the Newborn Intensive Care Center. Insertion of the catheter into the external jugular or basilic vein was successful in 15/17 (88%) infants, including four weighing less than 1,000 gm. Catheters remained in place for 446 patient-days (mean 24.8 +/- 15.9 days). Culture-proven infection, thrombophlebitis, or caval obstruction did not occur. Percutaneously placed central Silastic catheters proved to be a safe and effective alternative to surgically placed catheters.
Arm↗
Relactation by mothers of sick and premature infants.
Relactation, the induction of lactation at any time beyond the immediate postpartum period, has received minimal scientific investigation. In this study, one adoptive mother and six mothers ten to 150 days postpartum, who for a variety of reasons did not initiate or maintain lactation after delivery, attempted relactation. Each suckled her infant at regular feeding intervals. Prior to milk production, formula was provided during suckling through an artificial device. Serum prolactin responses to thyrotropin-releasing hormone infusion and to suckling were measured at the start of the study and to suckling at approximately weekly intervals thereafter. All mothers produced milk; three completely nourished their infants and two others provided at least half of their infants' nutritional needs. The adoptive mother and one other failed to provide significant quantities of milk. Mothers reached their maximum potential for milk production in varying periods of time (eight to 58 days). Shorter postpartum interval and less postpartum breast involution correlated with the likelihood of successful relactation and the rapidity of the onset of lactation. Basal prolactin levels and stimulation tests were of no additional predictive value. Each mother, regardless of milk production, expressed positive feelings about nurturing her infants in this manner. We conclude that relactation frequently is possible and may offer the mother of a sick or premature infant who desires to breast-feed an alternative if she does not maintain lactation in the immediate postpartum period.
Breast Feeding↗
Delayed fetal pulmonary maturation in a rabbit model of the diabetic pregnancy.
A rabbit model for the diabetic pregnancy was used to investigate the etiology of delayed pulmonary maturation observed in infants of diabetic mothers. Pregnant rabbit does were made glucose intolerant and insulinopenic by injection of alloxan, a pancreatic beta-cell cytotoxin. At 28 d (term approximately 31 d) fetuses of these animals were hyperglycemic, but were not hyperinsulinemic and did not demonstrate tissue overgrowth. Fetal pulmonary maturity was assessed by measurement of pressure-volume relationships on the fetal lungs. Fetuses of glucose-intolerant does demonstrated less retention of air on deflation. Phospholipid components of pulmonary surfactant were assayed on fluid obtained from lavage of the fetal lungs. Levels of disaturated phosphatidylcholine (per-cent total-lavage phospholipids) were diminished in fetuses of glucose-intolerant does compared to control fetuses (20.5 +/- 4.2 vs. 38.0 +/ 4.3%; P less than 0.01). Lecithin/sphingomyelin ratios were similar in both groups and phosphatidylglycerol was not detected in either group. There was a direct correlation between the percentage of alveolar disaturated phosphatidylcholine and retention of air on lung deflation. These findings suggest that in this model pulmonary instability was a result of diminished alveolar disaturated phosphatidylcholine, and this diminution did not result from fetal hyperinsulinemia.
Animals↗
Cardiopulmonary function of cats with respiratory distress induced by N-nitroso N-methylurethane.
The purposes of this study were to determine the effects of positive end-expiratory pressure (PEEP) and end-expiratory lung volume on systemic blood flow, whether PEEP levels yielding maximum systemic oxygen transport are associated with maximum lung compliance, and the effects of end-expiratory lung volume on pulmonary resistance to gas flow, in an animal model of respiratory distress. Twelve cats were inoculated with 12 mg/kg N-Nitroso N-Methylurethane (NNNMU) to induce respiratory distress. The NNNMU caused a 76% decrease in disaturated phosphatidyl-choline of lung lavage, a 34% decrease in functional residual capacity (FRC), an 80% decrease in lung compliance, an 88% increase in pulmonary resistance to gas flow, a 43% decrease in PaO2, and a 37% decrease in oxygen consumption. Systemic blood flow and systemic oxygen transport were not significantly altered by the chemically induced respiratory distress. PEEP levels of 5.1 +/- 0.8 cm H2O returned end-expiratory lung volume to normal FRC levels. Increases in PEEP caused systemic blood flow to decrease even when end-expiratory lung volume was below or equal to normal FRC levels but did not significantly affect systemic oxygen transport, lung compliance, or pulmonary resistance. We conclude that in cats with NNNMU-induced respiratory distress: PEEP causes decreases in systemic blood flow, lung compliance and systemic oxygen transport are not clear indicators of optimal PEEP level, and returning end-expiratory lung volume to normal FRC does not significantly reduce pulmonary resistance to gas flow.
Airway Resistance↗
The incidence and effects of motion sickness among medical attendants during transport.
Motion sickness is a common and often debilitating problem. The purpose of this study was to determine the incidence and effects of the motion sickness syndromes, the Nausea and Sopite Syndromes, among medical transport personnel. Members of the Transport Teams of the University of North Carolina Hospitals completed a questionnaire to identify a history of susceptibility to motion sickness. An additional questionnaire evaluated each individual for symptoms of motion sickness during transport. The Digit Span Test portion of the Mini-Mental Status Examination (DST-MMSE) was used to evaluate cognitive function after transport. Control data on each subject were obtained by testing during nontransport shifts. The Nausea Syndrome was observed during transport in 46% of subjects; 65% experienced symptoms consistent with the Sopite Syndrome. Pretransport surveys were predictive of the Nausea Syndrome, but not of the Sopite Syndrome. The Nausea Syndrome was related to subjective assessments of the severity of motion experienced; the Sopite Syndrome did not correlate with the severity of motion. The DST-MMSE scores after transport were significantly lower than scores during nontransport periods in 85% of personnel. We conclude that transport personnel are susceptible to motion sickness manifested by both the Nausea Syndrome and the Sopite Syndrome. The presence of motion sickness is associated with a significant decline in performance on tests of attention and concentration.
Air Ambulances↗
Improving survival of the very premature infant.
Knowledge of current data on survival and morbidity for premature infants is essential for perinatal decision making and accurate counseling of families. Survival and severe morbidity were reviewed for liveborn infants of less than 28 weeks' gestation. Between July 1989 and August 1991, in a cohort of 93 infants with a mean birth weight of 887 gm, survival until hospital discharge to home was 73%. Twenty-eight percent of survivors had either grade 3 or 4 intraventricular hemorrhage or an oxygen requirement at hospital discharge. In the subset of infants of less than 26 weeks' gestation, survival has significantly improved without a rise in morbidity when the data from the study period were compared with data from 1986 through 1988. Survival and morbidity were similar between black and white infants and between girls and boys. These data, along with reports from other tertiary centers, indicate a generalized improvement in the outcome of infants of very low birth weight.
Cohort Studies↗