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Biomedical subjects

Dennis M Super

Publications and source records attributed to Dennis M Super.

15 recordsLinked to original sources
PubMed2006

Increased neonatal fat mass, not lean body mass, is associated with maternal obesity.

OBJECTIVE: The purpose of this study was to compare body composition measures in neonates of women who were overweight/obese (body mass index, > or = 25 kg/m2) versus women who were lean/average (body mass index, < 25 kg/m2), all of whom had normal glucose tolerance levels. STUDY DESIGN: Seventy-six neonates (34 female and 42 male) of singleton pregnancies of pregravid overweight/obese women and 144 neonates (67 female and 77 male) of lean/average women were assessed with anthropometric measures and total body electrical conductivity evaluation of body composition at birth. RESULTS: There was a borderline increase in birthweight (3436 +/- 567 g vs 3284 +/- 534 g; P = .051) but not lean body mass (3020 +/- 410 g vs 2950 +/- 400 g; P = .23) in the overweight/obese versus lean/average weight groups. However, there were significant increases in percent body fat (11.6% +/- 4.7% vs 9.7 +/- 4.3%; P = .003) and fat mass (420 +/- 220 g vs 380 +/- 170 g; P = .01) in neonates of overweight/obese women versus lean/average weight women. CONCLUSION: Overweight/obese women with normal glucose tolerance levels have neonates who are heavier than lean/average weight women because of increased adiposity. We speculate that this increased obesity in offspring of obese women with normal glucose tolerance levels is a significant risk for adolescent obesity and components of the metabolic syndrome.

Adiposity↗
PubMed2006

Improving compliance with postpolypectomy surveillance guidelines: an interventional study using a continuous quality improvement initiative.

BACKGROUND: Despite guidelines, physicians tend to perform postpolypectomy surveillance colonoscopies too frequently. OBJECTIVE: The objective of the study was to determine the baseline compliance rate with postpolypectomy guidelines in our unit and to determine the influence of a continuous quality improvement (CQI) intervention on improving the compliance rate and on decreasing the potential additional costs because of the scheduling of postpolypectomy surveillance colonoscopies earlier than indicated. DESIGN: This was a single-arm, pretest-posttest design. SETTING: This study took place at a tertiary care, academic medical center. PATIENTS: The medical records of all patients who underwent colonoscopy with polypectomy in our unit retrospectively during 6 months preceding (baseline period) and prospectively for 6 months after an intervention (postintervention period) were reviewed for patient demographics, colonoscopy findings, and scheduling of repeat colonoscopies. INTERVENTION: We used 3 components: (1) distribution of a wallet-size card with a summary of postpolypectomy guidelines to all endoscopists, (2) placement of guideline charts near computers used for typing endoscopy reports, and (3) distribution and reinforcement of the guidelines in a monthly continuous quality improvement meeting. MAIN OUTCOME MEASURES: The main outcome measures were compliance rates, mean times to repeat colonoscopy, and additional costs from surveillance colonoscopies being scheduled earlier than indicated were compared between the two periods. RESULTS: There were 278 patients in the baseline period and 242 in the postintervention period, with similar patient and polyp characteristics. After the intervention, the compliance rate with guidelines improved from 57.2% to 81% (p < 0.001). The mean time to a repeat colonoscopy increased from 4.5 to 5.2 years (p = 0.003) (i.e., a 14% reduction in the number of postpolypectomy surveillance colonoscopies performed per year). This would result in a reduction of a total of 73 surveillance colonoscopies per year in our unit, with a projected cost savings of 171,331 dollars per year (cost of a colonoscopy assumed at 2347 dollars). LIMITATIONS: The limitation of the study was possible enhanced performance secondary to being observed (Hawthorne effect). Because more than 1 intervention was used, we do not know which one is more effective. CONCLUSIONS: Relatively simple and easy-to-implement quality improvement initiatives can significantly enhance compliance with postpolypectomy guidelines and result in cost savings because of a reduction in the number of postpolypectomy surveillance colonoscopies being scheduled earlier than recommended guidelines.

Colonoscopy↗
PubMed2006

Use of the Broselow tape may result in the underresuscitation of children.

OBJECTIVES: The purpose of this study was to determine the concordance of the Broselow tape with the measured heights and weights of a community-based population of children, especially in light of the increase in obesity in today's children. METHODS: The authors examined more than 7,500 children in a cross-sectional, descriptive study in two different cohorts of children to compare their actual weight with their predicted weight by a color-coded tape measure. RESULTS: In all patients, the percent agreement and kappa values of the Broselow color predicted by height versus the actual color by weight for the 2002A tape were 66.2% and 0.61, respectively. The concordance was best in infants, followed by school-age children, toddlers, and preschoolers (kappa = 0.66, 0.44, 0.39, and 0.39, respectively; percent agreement, 81.3%, 58.2%, 60.7%, and 64.0%, respectively). The tapes accurately predicted (within 10%) medication dosages for resuscitation in 55.3%-60.0% of the children. The number of children who were underdosed (by > or =10%) exceeded those who were overdosed (by > or =10%) by 2.5 to 4.4 times (p < 0.05). The tapes accurately predicted uncuffed endotracheal tube sizes when compared with age-based guidelines in 71% of the children, with undersizing (> or =0.5 mm) exceeding oversizing by threefold to fourfold (p < 0.05). CONCLUSIONS: The Broselow tape color-coded system inaccurately predicted actual weight in one third of children. Caregivers need to take into consideration the accuracy of this device when estimating children's weight during the resuscitation of a child.

Anthropometry↗
PubMed2004

Predicting outcome in neonatal hypoxic respiratory failure with the score for neonatal acute physiology (SNAP) and highest oxygen index (OI) in the first 24 hours of admission.

OBJECTIVE: To determine the clinical utility of SNAP score versus the highest oxygen index (OI) in first 24 hours of admission in predicting outcome of HRF. STUDY DESIGN: All admissions (1991 to 1999) > or =36 weeks gestation, ventilated for > or =12 hours with FiO(2)> or =0.50, without congenital anomalies were reviewed. Primary outcome measure was survival (without ECMO) versus ECMO and/or death. RESULTS: From 184 infants with HRF, 148 survived (without ECMO) versus 36 died and/or received ECMO. SNAP score and highest OI were similar in predicting outcome of HRF (area under ROC curve: 0.813+/-0.037 versus 0.814+/-0.041; P=0.72). Death and/or ECMO requirement were best predicted by a SNAP score of 19 (Sensitivity 75.0%, Specificity 71%) or an OI of 28 (Sensitivity 75.0%, Specificity 76.4%). CONCLUSION: Although both, the SNAP score and highest OI, are useful and similar in predicting outcome of HRF, OI is preferable because of its ease of use. We believe the predictive value of these parameters should be evaluated in a multicenter setting.

Airway Resistance↗
PubMed2003

Prenatal cocaine/polydrug exposure and infant performance on an executive functioning task.

Executive functioning in cocaine/polydrug (marijuana, alcohol, tobacco) exposed infants was assessed in a single session, occurring between 9.5 and 12.5 months of age. In an A-not-B task, infants searched, after performance-adjusted delays, for an object hidden in a new location. Overall, the cocaine-exposed (CE) infants did not differ from non-CE controls recruited from the same at-risk population. However, comparison of heavier-CE (n = 9) to the combined group of lighter-CE (n = 10) and non-CE (n = 32) infants revealed significant differences on A-not-B performance, as well as on global tests of mental and motor development. Covariates investigated included socioeconomic status, marital status, race, maternal age, years of education, weeks of gestation, birth weight, as well as severity of prenatal marijuana, alcohol, and tobacco exposure. The relationship of heavier-CE status to motor development was mediated by length of gestation, and the relationship of heavier-CE status to mental development was confounded with maternal gestational use of cigarettes. The relationship of heavier-CE status to A-not-B performance remained significant after controlling for potentially confounded variables and mediators, but was not statistically significant after controlling for the variance associated with global mental development.

Alcohol Drinking↗
PubMed2002

Heart rate variability in healthy newborn infants.

In adults and older children, heart rate variability (HRV) is frequently used to study autonomic function noninvasively. Normal values of HRV in newborn infants, however, are not widely available. This problem may be partially attributed to the lack of standardization of different methods. This study assessed HRV in normal newborn infants using 24-hour Holter monitoring. From 1997 to 2000, we prospectively evaluated frequency- (spectral analysis), geometric-, and time-domain indexes of HRV in normal term infants. Ninety-six asymptomatic infants who were <72 hours old were studied. Frequency-domain parameters (power in the high, low, very low, ultra low, and total frequency domains), a geometric parameter (HRV triangular index), and time-domain parameters (SDNN, SDANN, SDNNi, r-MSSD, s-NN50) are reported as means +/- SD, medians, and 5th and 95th percentiles to establish the normative values for newborns. A high degree of correlation (r > or = 0.85, p <0.0001) was noted among the 3 vagal tone dependent parameters, such as high-frequency power (frequency domain), r-MSSD, and s-NN50 (time domain). Our study supports the use of vagal dependent time-domain parameters like r-MSSD and sNN50 as surrogates for high-frequency power in newborns. Because the data are reported as means +/- SD, medians, and 5th and 95th percentiles, their use facilitates the study of parasympathetic and sympathetic activity in comparable populations.

Electrocardiography, Ambulatory↗
PubMed2002

Autonomic alterations in cocaine-exposed infants.

BACKGROUND: Heart rate variability (HRV) reflects autonomic control of the heart. After intrauterine cocaine exposure, asymptomatic newborn infants within 72 hours of life have decreased HRV. It is unknown whether these alterations are transient (acute effect) or persist in older infants and possibly reflect a teratogenic effect of cocaine. METHODS: This study prospectively evaluated HRV in 2- to 6-month-old infants who were exposed to cocaine in-utero (Group 1, n = 71). Their data were compared to normal controls (Group 3, n = 77) and to newborns exposed to drugs other than cocaine (Group 2, n = 89). Based on our previous study, heavy and light cocaine exposure was also defined a priori as the amount of cocaine used during the pregnancy that was more than or less than the 70th percentile, respectively. RESULTS: At the age of 2 to 6 months, infants with in-utero cocaine exposure had higher vagal tone and higher HRV (total power) than normal controls (no exposure to drugs). Most of this increase in vagal tone occurred in the light-cocaine-exposure group. HRV and vagal tone in the heavy-cocaine-exposure group were similar to the noncocaine-exposed group. CONCLUSIONS: At 2 to 6 months of age, asymptomatic infants exposed to cocaine in-utero have recovered from lower HRV seen within 72 hours of age. Infants exposed to light cocaine recovered by a rebound by increasing their vagal tone to above-normal levels. A similar response was blunted in heavily-cocaine-exposed infants. These alterations noted at follow up suggest a possible teratogenic effect of cocaine on the developing autonomic system.

Autonomic Nervous System↗
PubMed2002

Quantification of regional left ventricular wall motion in newborns by color kinesis.

BACKGROUND: Normal values for regional left ventricular wall motion, although documented in adults, have not been reported in healthy newborns. METHODS: This study prospectively evaluated global and segmental systolic and diastolic cardiac function by color kinesis in clinically asymptomatic healthy newborns. RESULTS: Eighty-eight asymptomatic infants who were less than 48 hours old were studied. Systolic and diastolic parameters of global and regional left ventricular function are reported as means +/- SD, medians, 5th and 95th percentiles to establish the normative values for newborns. The reported fractional area changes during systole and diastole are similar to the reported normal values for older subjects. Higher body surface area significantly correlated with an increased peak velocity during systole, and fractional area changes during filling of the lateral wall. CONCLUSIONS: Our report of left ventricular regional wall-motion characteristics of healthy newborns, as evaluated by color kinesis, may help in the objective evaluation and management of newborns suspected to have global or segmental ventricular dysfunction.

Body Surface Area↗
PubMed2002

Diastolic filling abnormalities by color kinesis in newborns exposed to intrauterine cocaine.

Because cocaine crosses the placenta, we prospectively evaluated global and segmental systolic and diastolic cardiac function by color kinesis in clinically asymptomatic newborns who were exposed to cocaine in utero (group 1, n = 82). Their data were compared with normal controls (group 3, n = 87) and newborns exposed to drugs other than cocaine (group 2, n = 108). During left ventricular filling, newborns exposed to cocaine, compared with groups 2 and 3, had significantly (P <.05) higher global fractional area change (%) (76 +/- 10.3 vs 72 +/- 9.4 and 72 +/- 9.1, respectively), regional fractional area changes (%) for the anterior, septal, inferior, and lateral wall, and in the index of asynchrony (at 50% filling 13.2 +/- 5.8 vs 11.3 +/- 4.1 and 11.6 +/- 4.2, respectively). There were no significant differences in systolic function among the 3 groups. Prenatal cocaine exposure in asymptomatic infants leads to higher global and segmental fractional area changes and asynchrony during diastole. The significance and course of these alterations require further investigation.

Cocaine↗
PubMed2002

Diastolic alterations in infants exposed to intrauterine cocaine: a follow-up study by color kinesis.

BACKGROUND: During the first 48 hours of life, newborn infants exposed to cocaine in utero have left ventricular diastolic segmental abnormalities. It is unknown whether these abnormalities are transient because of short-term effects or persist in older infants, possibly reflecting a teratogenic effect of cocaine. METHODS: This study prospectively evaluated global and segmental systolic and diastolic cardiac parameters by color kinesis. The patients were 2- to 6-month-old infants who were exposed to cocaine in utero (N = 56). Their data were compared with normal control patients with no intrauterine drug exposure (N = 60) and newborns exposed to drugs other than cocaine (N = 72). RESULTS: At the age of 2 to 6 months, there was no significant difference in the measured color kinesis parameters among the cocaine-exposed and the 2 control groups (infants prenatally exposed to other drugs and no drugs). Infants exposed to heavy cocaine prenatally, as compared with the noncocaine-exposed group, had a significant (P =.007) increase in septal fractional area change during left ventricular filling. CONCLUSIONS: At 2 to 6 months of age, infants have recovered from initial left ventricular diastolic segmental alterations seen in the first 48 hours of life except for the septal wall in the heavily cocaine-exposed group.

Cocaine↗
PubMed2002

The "air leak" test around the endotracheal tube, as a predictor of postextubation stridor, is age dependent in children.

OBJECTIVES: The airleak test is measured with a manometer as the pressure necessary to generate an audible airleak around the endotracheal tube. Our objectives were to determine whether the airleak test predicts postextubation stridor in children and if age affects its sensitivity and specificity. DESIGN: A retrospective study. SETTING: Pediatric intensive care unit. PATIENTS: We studied all intubated patients admitted to our pediatric intensive care unit between July 1998 and December 1999. Patients were excluded if they had acute viral croup, tracheal surgery, hypotonic airway, or vocal cord paralysis or if they died before extubation. INTERVENTIONS: Medical records were reviewed for patient demographics, presence of an airleak on the day of extubation, airleak values, presence of postextubation stridor, and extubation failure secondary to upper airway obstruction. MEASUREMENTS AND MAIN RESULTS: One hundred and five patients met our inclusion criteria and had an airleak test at the time of extubation. In children <7 yrs of age, the incidence of postextubation stridor was similar in patients with or without an airleak at >20 mm Hg (50% vs. 67.7%; >.05) with a sensitivity of 65.6% (95% confidence interval, 46.9-80.8). In children >or=7 yrs of age, the incidence of postextubation stridor was greater in patients with an airleak at >20 mm Hg (55.5% vs. 5.8%; p=.01) with a sensitivity of 83.3% (95% confidence interval, 36.8-99) in predicting postextubation stridor. CONCLUSIONS: Our study suggests that the airleak test has a low sensitivity when used as a screening test to predict postextubation stridor in young children (<7 yrs old), whereas in older children (>or=7 yrs old) the airleak test may predict postextubation stridor.

Adolescent↗
PubMed2002

Heart rate variability by triangular index in infants exposed prenatally to cocaine.

BACKGROUND: In adults, heart rate variability triangular index (HRVi) is a highly reproducible measure of heart rate variability (HRV), which makes it more suitable for use in longitudinal studies. Although normative data have been published for newborns, studies in infants with pathological conditions are lacking. METHODS: From 1997 to 2000, within the first 4 days of life, we prospectively evaluated HRVi in cocaine-exposed asymptomatic newborns (N = 97) by Holter monitoring. Their data were compared with infants from two control groups (one with no in utero drug exposure, N = 102; the other with exposure to alcohol, nicotine, or marijuana but no cocaine, N = 111). RESULTS: In assessing concordance between and within operators for HRVi, the intraclass correlations were 0.983 (95% CI: 0.958, 0.994) and 0.997 (95% CI: 0.984, 0.999), respectively. Infants with in utero cocaine exposure had significantly (P < 0.0001) lower HRVi than those exposed to other drugs and to no drugs in utero. If abnormal HRVi is defined as < fifth percentile for the no drug exposed group (HRVi < 8), 10% of the cocaine-exposed newborns, in contrast to 2% in each of the control groups (P = 0.003) had abnormal values. CONCLUSION: HRVi is a reliable measure to study heart rate variability in newborns. Asymptomatic infants with in utero cocaine exposure have lower HRVi. Our study supports the clinical use of an abnormal HRVi as a value < 8 for newborn infants.

Birth Weight↗
PubMed2002

The use of the air leak test and corticosteroids in intubated children: a survey of pediatric critical care fellowship directors.

INTRODUCTION: Uncertainties exist regarding the value of the air leak test or use of steroids for preventing post-extubation stridor and extubation failure in children. OBJECTIVE: Determine the practice preferences of pediatric critical care physicians regarding the air leak test and administration of glucocorticosteroids to prevent airway edema. METHODS: A 14-question survey regarding the value of the air leak test, use of glucocorticosteroids, and management of airway edema in intubated children was sent to all North American pediatric critical care fellowship directors affiliated with medical school teaching hospitals. RESULTS: The response rate was 85% (58/68). Seventy-six percent (44/58) routinely check for air leak prior to extubation. The physicians who check for air leak were more likely to delay extubation in order to administer glucocorticosteroids (60% [26/43] vs 15% [2/13], p = 0.01). An air leak of >or= 30 cm H(2)O was more likely (than >or= 20 cm H(2)O) to result in delaying extubation (95% [35/37] vs 51% [19/37], p <0.001). Of the respondents who use steroids for airway edema prophylaxis, 73% (24/33) give steroids based on the air leak test. CONCLUSIONS: The majority of surveyed pediatric critical care fellowship program directors rely on the air leak test and use corticosteroids to prevent post-extubation stridor and extubation failure. At an air leak of >or= 30 cm H(2)O most of the surveyed physicians would delay extubation and initiate glucocorticosteroids.

Algorithms↗