Biomedical subjects

Cynthia D Downard

Publications and source records attributed to Cynthia D Downard.

5 recordsLinked to original sources

PubMed2003

Analysis of an improved survival rate for congenital diaphragmatic hernia.

BACKGROUND/PURPOSE: Congenital diaphragmatic hernia (CDH) is a condition associated with significant mortality. This study examines the survival rate of neonates with CDH treated by a multidisciplinary team in a single pediatric hospital. Actual survival rate is compared with predicted outcome based on severity of illness. METHODS: A consecutive series of neonates with CDH was evaluated beginning January 1, 2000. There were no excluded patients. A treatment protocol emphasizing minimal barotrauma and control of pulmonary hypertension was used. Predicted survival rate was estimated using birth weight and Apgar score at 5 minutes per the logistic regression equation published by the CDH Study Group. Actual survival rates were calculated and compared with predicted values using a one sample binomial test with significance deemed to be present at P less than.05. RESULTS: Thirty-six of 39 (93%) neonates with CDH survived, whereas the predicted survival rate for this cohort was 68% (P <.001). Twelve of 14 (86%) neonates requiring extracorporeal membrane oxygenation (ECMO) survived, despite a predicted survival rate of 52% for this subset (P <.01). Twenty-five percent of survivors required supplemental oxygen at home. CONCLUSIONS: Using a simple analysis, centers may now objectively compare their CDH survival rates with predicted outcomes adjusted for disease severity. This technique confirmed that a consecutive series of neonates with CDH, treated in one hospital, had a significantly higher than predicted survival rate. Thus, it may be possible to identify other centers with higher than expected survival rates and to define common therapeutic strategies associated with decreased mortality.

Actuarial Analysis↗

PubMed2003

Impact of AMICAR on hemorrhagic complications of ECMO: a ten-year review.

PURPOSE: Preliminary studies have shown aminocaproic acid (AMICAR), an inhibitor of fibrinolysis, reduced the incidence of intracranial hemorrhage and significant surgical site bleeding in patients on extracorporeal membrane oxygenation (ECMO). The purpose of this analysis is to determine if these benefits remain when AMICAR is used in a large population. METHODS: ECMO patients from a single pediatric institution, with routine use of AMICAR for "high-risk" patients, were evaluated retrospectively from 1991 to 2001. Data including diagnosis, duration of support, significant complications, and survival were recorded. These variables were compared with those of the Extracorporeal Life Support Organization (ELSO), an international ECMO registry, using a chi2 test. P less than.05 was deemed significant. RESULTS: ECMO was used 431 times during the 10-year study period. A total of 298 patients received AMICAR, most frequently for surgical procedures. The survival rate was not statistically different in the study group when compared with the ELSO Registry (P =.06). The rate of neonatal intracranial hemorrhage was not significantly different between the 2 groups (P =.133); however, the rate of surgical site bleeding was significantly reduced in the study population (P =.005). Decrease in surgical site bleeding was particularly evident in cardiac patients (P <.001). CONCLUSIONS: In this large experience, use of AMICAR for high-risk patients on ECMO did not appear to alter the rate of neonatal intracranial hemorrhage, but did significantly reduce the incidence of surgical site bleeding. AMICAR remains a valuable tool for the prevention of hemorrhage in patients undergoing operation prior to or while on ECMO.

Adult↗

PubMed2003

Clostridium botulinum toxin inhibits myometrial activity in vitro: possible application on the prevention of preterm labor after fetal surgery.

BACKGROUND/PURPOSE: The current study aimed to analyze the effects of Clostridium botulinum toxin (Botox) on pregnant myometrium activity in vitro. METHODS: Strips of myometrium were obtained from pregnant Wistar rats on gestational day 13 through 15 and placed under controlled conditions within tissue baths containing DeJalon solution. Muscular activity, including amplitude and frequency of contractions, was recorded by a force transducer connected to a polygraph. After stable baseline values were recorded, different concentrations of Botox were added to the tissue baths. Myometrial activity data points for each drug concentration were entered as mean percentual variations of the baseline. A total of 26 uterine samples from 13 animals were studied. Statistical analysis was by single-factor analysis of variance (ANOVA) with P <.05 considered significant. RESULTS: Except for a narrow concentration range, when the effects were nonmonotonic, both amplitude and frequency of myometrial contractions were significantly depressed (P <.05) and eventually totally abolished at most concentrations studied, albeit in a potentially biphasic pattern. Those effects could be reversed by a complete washout of the tissue bath. CONCLUSIONS: Within appropriate concentrations, Botox consistently inhibits or completely arrests myometrial activity in potentially reversible fashion. This agent may prove valuable in premature labor prevention after fetal surgery.

Animals↗

PubMed2002

Abdominal wall defects.

Survival for newborns with congenital abdominal wall defects (primarily omphalocele and gastroschisis) has improved, but controversy remains regarding etiology, anatomy and embryology, the role of prenatal diagnosis and mode of delivery, and initial management. A number of recent studies have added to our knowledge and understanding of several of these topics, while several others have raised questions regarding traditional initial management of these infants. Continued improvement in the survival of these infants can be anticipated with further understanding of the in utero and antepartum diagnosis and management of infants with these common congenital abnormalities.

Abdominal Muscles↗

PubMed2002

Postnatal outcome of fetuses with the prenatal diagnosis of gastroschisis.

OBJECTIVE: To assess the postnatal outcome and complications that arise in infants with the prenatal diagnosis of gastroschisis. METHODS: Prenatal sonograms with the diagnosis of gastroschisis were identified. Maternal age, indication for sonography, gestational age at diagnosis, other sonographic abnormalities, and postnatal outcome were recorded. RESULTS: Twenty-six fetuses at 16 to 36 weeks' gestational age had gastroschisis diagnosed on sonography. In 5 cases, other fetal anomalies were identified, including hydronephrosis and asymmetric hydrocephalus. In 9 of 21 cases followed by serial prenatal sonography, bowel dilatation developed, prompting delivery in 2. Two of the 26 study fetuses were electively terminated. The remaining 24 were born live and had immediate repair of the gastroschisis after birth. Nineteen infants (79%) had postnatal complications, some with multisystem complications, including 3 deaths, 10 with gastrointestinal complications, 6 with infectious complications, and 6 with anomalies involving other systems (genitourinary, cardiac, central nervous system, and respiratory). Only 5 infants (21%) had completely uncomplicated postsurgical courses. Hospital stays for survivors ranged from 10 to 98 days (mean, 38 days; median, 33 days). CONCLUSIONS: Although reported survival rates are good for gastroschisis, the postoperative hospital stay is often lengthy, and complications are very common, especially those related to the gastrointestinal tract. Other anomalies are uncommon but not rare.

Female↗