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Biomedical subjects

D Z Myerberg

Publications and source records attributed to D Z Myerberg.

15 recordsLinked to original sources
PubMed1995

Reducing postneonatal mortality in West Virginia: a statewide intervention program targeting risk identified at and after birth.

OBJECTIVES: Excessive postneonatal mortality in West Virginia has been associated with inadequate health care. This paper describes two interventions aimed at those infants at greatest risk of dying. METHODS: Two systems of risk-related intervention were simultaneously introduced and funded statewide from 1985 through 1987. Risk status was determined by a multifactorial score at birth or clinical risk factors later. At-risk infants were linked with physicians who provided specified care plans. All infants were followed for 1 year for mortality. RESULTS: Of 4570 infants with a high Sheffield Birth Score, 45%, together with 1003 infants with clinical risk factors, received specified care plans. High-risk infants constituted 7.6% of total resident births. Odds ratios for overall postneonatal mortality and sudden infant death syndrome in high-birth-score infants compared with low-birth-score infants were 6.2 (95% confidence interval [CI] = 4.2, 9.3) and 11.2 (95% CI = 5.4, 23.2), respectively. The relative risks of postneonatal mortality were similarly significant for infants with most clinical risk factors. During the program there was a 21.4% reduction in the trend of yearly standardized mortality ratios, which differed markedly from the trend in surrounding states. The data suggest that 33 lives were saved at a cost of $36,363 per infant. CONCLUSION: Ensuring affordable, available, accessible, and acceptable care for a small group of at-risk infants was associated with a dramatic drop in overall postneonatal mortality in West Virginia.

Adult↗
PubMed1991

Prolonged travel time to neonatal intensive care unit does not affect content of parental visiting: a controlled prospective study.

Decreased local obstetric care appears to be increasing the rate of premature births to rural populations. With increased numbers of premature and complicated births in rural populations, understanding the impact of the Neonatal Intensive Care Unit (NICU) environment on the development of parent-child relationships becomes critical. NICU infants appear to be at increased risk for failure to thrive, child abuse, and neglect. Some reports suggest that the frequency of parental visits to the NICU can predict infants likely to be at risk. Because rural parents visiting infants hospitalized in urban centers are likely to visit less often, understanding this possible relationship is critical. In this controlled prospective study, three groups of parents were observed visiting their hospitalized infants: (1) those visiting "in house" while the mother was still hospitalized; (2) those whose visits required one hour or less in travel time; and (3) those whose visits required more than one hour in travel time. Results showed that travel time influenced the frequency of visits, with fewer visits from those living furthest from the NICU. However, those visiting from greater distances stayed with their infants longer so that there was no difference in the total visiting time over a two-week period. Direct observations of the visits by both mothers and fathers showed no differences in the content of parent-child interactions among groups. Thus, visit frequency alone must be viewed cautiously as a potential indicator of failure to bond with a hospitalized infant, especially in settings serving rural populations.

Adult↗
PubMed1989

Daily sequential changes in plasma atrial natriuretic factor concentrations in mechanically ventilated low-birth-weight infants. Effect of surfactant replacement.

Plasma atrial natriuretic factor (ANF) concentrations are elevated in mechanically ventilated infants. To test the hypothesis that changes in pulmonary compliance affect ANF concentration, we measured plasma ANF concentrations sequentially in low-birth-weight, ventilated infants who either received surfactant replacement or placebo on day 1. ANF concentrations were elevated as compared to adult controls on day 1 and increased significantly on days 2 and 3 before declining. Day 5 concentrations were not different from day 1. Several infants had ANF concentrations greater than 1,280 pg/ml on days 2-4. There were no significant differences in ANF concentrations between surfactant-treated and non-treated infants on any day. ANF concentrations increased in parallel with changes in salt and water balance, but no significant relationships were apparent between absolute ANF concentrations and parameters of salt and water balance. The results suggest that ANF secretion is elevated in infants with pulmonary disease. While the temporal relationship between the initial rise in ANF concentration and increase in salt and water excretion suggest that ANF is involved in this diuresis, the role it may play is unclear from the present data.

Atrial Natriuretic Factor↗
PubMed1987

Dietary carbohydrate assimilation in the premature infant: evidence for a nutritionally significant bacterial ecosystem in the colon.

Carbohydrate energy absorption and breath hydrogen concentration were measured in 12 premature infants 28-32 wk gestational age and 2-4 wk postnatal age. Each of two groups of six infants were randomly assigned to receive one of two formulas that differed only in carbohydrate source: 100% lactose (LAC) or 50% lactose: 50% glucose polymer (LAC + GP). In 11 infants the peak breath hydrogen concentration suggested extensive colonic fermentation (range 44-239 ppm/5% CO2 or 44-239 microL/L per 50 mL/L CO2). An approximate 100% increase in lactose intake in the LAC group was associated with a similar increase in breath hydrogen concentration at 30, 60, and 120 min. None of the infants exhibited diarrhea or vomiting or developed delayed gastric emptying. Carbohydrate energy absorption (mean +/- SD) was, respectively, 86 +/- 5% and 91 +/- 3% in the LAC and the LAC + GP groups (p greater than 0.05). Thus, colonic bacterial fermentation may be critical to energy balance and to the prevention of osmotic diarrhea in premature infants fed lactose.

Bacteria↗
PubMed1982

Indomethacin for closure of patent ductus arteriosus in prematures.

A controlled, double blind trial of indomethacin versus placebo was conducted in prematures of birth weight less than 1750 g, with a murmur of patent ductus arteriosus (PDA). The dose of indomethacin was 0.2 mg/kg for 2 doses, orally, 24 hours apart. Forty-seven patients entered the trial. Twenty-four received indomethacin and 12 of these met the criteria for response; 23 received the placebo and two met the criteria for response (p less than 0.01). Subsequent surgical ligation for symptomatic PDA was required in 13 of 23 in the placebo group and 4 of 24 in the indomethacin group (p less than 0.01). When administered early, indomethacin is moderately effective in closing PDA in premature infants.

Clinical Trials as Topic↗
PubMed1980

Comparison of noninvasive and direct measurements of intracranial pressure.

After creating "fontanelles" in infant rhesus monkeys, we measured intracranial pressure of these monkeys directly with an indwelling cannula and indirectly with a Ladd 1700 sensor. Values obtained with the Ladd sensor placed over the shaven fontanelle closely approximate directly measured pressure in acute experiments in these animals and in human cadavers. Application of the device is simple and application pressure need not always be the same for multiple determinations. The response time is 1.6 cm H2O/sec, which is adequate to record changes in intracranial pressure caused by changes in the partial pressure of CO2 in arterial blood.

Animals↗
PubMed1980

Posthemorrhagic hydrocephalus in the preterm infant.

Between 1969 and 1978 we treated 22 low birth weight infants for delayed onset posthemorrhagic hydrocephalus. All developed clinical signs of hydrocephalus after 2 weeks of age. The diagnosis was determined in 12 infants before August 1974, and they were treated by surgical placement of a shunt. In the ten infants born after September 1974, an attempt was first made to control the hydrocephalus with repeated lumbar puncture and diuretics prior to placing a shunt. In seven of the ten the hydrocephalus was successfully arrested by medical therapy alone. Follow-up assessments at 1 to 8 years of age were done on 18 infants. Two of the 12 treated by permanent shunts and three of six treated medically had an IQ score of 85 or greater. These results indicate a poor long-term outlook for the low birth weight infant who develops clinically overt hydrocephalus after intracranial bleeding.

Acetazolamide↗
PubMedDate not supplied

Effects in premature infants of normalizing breath H2 concentrations with CO2: increased H2 concentration and reduced interaliquot variation.

Interval sampling of expired breath samples from the anterior nares is a feasible and noninvasive method for detecting elevated breath H2 and thus colonic carbohydrate fermentation, especially in nontherapeutic research studies of healthy premature infants. However, there may be a risk of falsely low breath H2 concentration and an unacceptable experimental error due to contamination with room air as well as with dead space air. We studied ten premature infants (28-32 week gestational age and 2-4 weeks postnatal age) who were receiving either a proprietary formula containing equal proportions of lactose and glucose polymer, or a similar formula in which lactose was the sole carbohydrate. In 70 breath samples (obtained 30-180 min after feeding) we assessed the coefficient of variation in breath hydrogen concentration among three aliquots obtained over a 3-5 min interval. Breath was collected from the anterior nares. The interaliquot coefficient of variation averaged 11% when expressed as parts per million per 5% CO2, compared to 19% when expressed as parts per million (Wilcoxon, p less than 0.001). Mean breath hydrogen concentration at each time period using the former method (parts per million per 5% CO2) was about 100% higher than when using the latter method. Although ventilation rate can alter alveolar CO2, normalizing for CO2 concentration reduces a major source of experimental error.

Analysis of Variance↗