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Biomedical subjects

E N Kraybill

Publications and source records attributed to E N Kraybill.

At least 19 recordsLinked to original sources
PubMed1998

Ethical issues in the care of extremely low birth weight infants.

This article examines the difficulties in making decisions about the medical treatment of infants who have uncertain viability because of extremely low birth weight. The advantages and disadvantages of three systematic approaches are reviewed. An approach called "provisional intensive care for all" may offer the most benefit and cause the least harm. With this approach, all liveborn infants would be presumed viable and would receive intensive care, at least initially. After further assessment of the infant, the parents would be informed as fully as possible about the possible outcome of continuing intensive care. The treating physicians would offer the parents the options of continuing intensive care or withdrawing it and providing basic care. Although the physicians would provide recommendations based on their best medical judgment, they would be prepared to support and carry out the parents' decision.

Decision Making↗
PubMed1995

Double-blind evaluation of developmental and health status to age 2 years of infants weighing 700 to 1350 grams treated prophylactically at birth with a single dose of synthetic surfactant or air placebo.

In a previously published article, we reported results of a two-center study of outcome to 28 days of 385 infants with birth weights from 700 to 1350 gm who were assigned randomly to receive a single 5 ml/kg intratracheal dose of either synthetic surfactant or air placebo. Infants treated with surfactant had a higher rate of survival to 28 days without bronchopulmonary dysplasia than did control subjects given an air placebo. The present study assessed survivors in early childhood to determine neurodevelopmental outcome and late morbidity. Two hundred fifty-eight surviving infants from both centers were evaluated at 1-year adjusted age; medical histories were obtained, standard physical and neurologic examinations were performed, and Bayley Scales of Infant Development were administered. Ophthalmologic examinations were performed at various times between 28 days and 1-year adjusted age. At 2-years adjusted age, 118 infants from one center were reevaluated with the same procedures and also had hearing and speech evaluations. Neither the 1-year assessment of the entire population nor the 2-year assessment of the one center's cohort revealed physical or neurodevelopmental differences between treatment groups. We conclude that administration of a single prophylactic dose of synthetic surfactant to premature infants with birth weights from 700 to 1350 grams results in improved survival rates to 28 days without bronchopulmonary dysplasia and is not associated with adverse health or neurodevelopmental effects at 1-year or 2-years adjusted age.

Air↗
PubMed1991

Neurodevelopmental, health, and growth status at age 6 years of children with birth weights less than 1001 grams.

The neurodevelopmental, health, and growth outcomes for 28 six-year-old extremely low birth weight (ELBW) (birth weight less than 1001 gm) children were compared with those of 26 control children born at term. The two groups did not differ in mean weight or height, but the ELBW group had smaller head circumferences (p = 0.015). Kaufman mental processing scores correlated with head circumference (p = 0.0003). Significantly more of the ELBW children (61%) had mild or moderate to severe neurologic problems compared with control children (23%) (p = 0.003). Three ELBW children had mild spastic diplegia; one was blind. Eighteen (64%) of the ELBW children had required rehospitalization versus five (20%) of the comparison group. The mean Kaufman Mental Processing Composite was lower for the ELBW group, but when the data were analyzed by maternal education, only those children whose mothers had a twelfth-grade education had significantly lower scores (p = 0.0001). A similar pattern of group differences was seen for scores on visual-motor function (p = 0.0045), visual-perceptual abilities (p = 0.003), and attention span (p = 0.0001). No group differences were seen regarding hyperactivity or parental stress. Overall functional disability among the ELBW children was considered absent in 46%, mild in 36%, and moderate to severe in 18%. There was a significant association (p = 0.029) between classification of handicap at 12 to 34 months and classification at 6 years. No neonatal factors correlated with 6-year outcome. A significant proportion of ELBW children had no severe disabilities, but many had dysfunctions likely to affect learning and behavior in school.

Attention Deficit Disorder with Hyperactivity↗
PubMed1989

Risk factors for chronic lung disease in infants with birth weights of 751 to 1000 grams.

We performed a multicenter, historical-cohort analysis to identify factors associated with chronic lung disease (CLD) in extremely low birth weight infants. The 235 infants who were born in 1984 with birth weights of 751 to 1000 gm and admitted to any of 10 participating neonatal intensive care units comprised the study population. We analyzed demographic characteristics, status at birth, severity of acute atelectasis, and early respiratory treatment in relation to CLD, which we defined as having received oxygen at age 30 days. By univariate analysis, CLD was associated with lower gestational age (p less than 0.001), male sex (p = 0.004), more severe acute atelectasis as indicated by a higher roentgenographic score (p less than 0.001), a higher ventilation rate at 96 hours (p = 0.012), and lower PaCO2 at 48 hours (p = 0.04). Infants receiving mechanical ventilation whose highest PaCO2 levels at 48 or 96 hour were less than 40 mm Hg were 1.45 times as likely to develop CLD as those whose highest PaCO2 levels were greater than 50 mm Hg (95% confidence interval 1.04 to 2.01). CLD rates by center were inversely related to mean PaCO2 levels in infants receiving mechanical ventilation at 48 and 96 hours (Spearman rank correlations 0.60 and 0.55; p less than 0.001). A logistic risk model that included sex, PaCO2 at 48 hours, roentgenographic score, gestational age, and race showed only male sex (p = 0.009) and lower PaCO2 at 48 hours (p = 0.04) to be independent predictors of CLD. We conclude that mechanical ventilation that results in PaCO2 levels above the physiologic range may decrease the risk of CLD in extremely low birth weight infants.

Carbon Dioxide↗
PubMed1988

Variability in 28-day outcomes for very low birth weight infants: an analysis of 11 neonatal intensive care units.

A retrospective study of all infants weighing 701 to 1,500 g born at 11 neonatal intensive care centers during 1983 and 1984 was performed to determine whether two specific 28-day outcomes, survival and survival without the need for supplemental oxygen, varied among the centers. Survival without the need for supplemental oxygen was chosen as a reflection of infants surviving without chronic lung disease. There were 1,776 live-born infants delivered during the 2-year study period. Of these infants, 85% (1,512) survived 28 days, a range of 80% to 92% at the individual centers. A total of 60% (1,056) of the infants were alive without supplemental oxygen on day 28, a range of 51% to 70% at the individual centers. Multivariate analysis demonstrated that both survival on day 28 (chi 2 = 23.9, P less than .01) and survival without supplemental oxygen on day 28 (chi 2 = 44.2, P less than .0001) varied significantly among centers after the effects of birth weight, gender, and race were taken into account. Female gender, nonwhite race, and increased birth weight were factors associated with improved rates of survival and survival without supplemental oxygen. The magnitude of outcome variation among centers was estimated by using the logistic regression models to predict what the outcomes would be if each center were to treat a standardized population consisting of all 1,776 study infants.(ABSTRACT TRUNCATED AT 250 WORDS)

Birth Weight↗
PubMed1987

Chronic lung disease in infants with very low birth weight. A population-based study.

We surveyed outcome in 1095 (95.5%) of 1147 very-low-birth-weight infants born in North Carolina in 1984 to determine the incidence of chronic lung disease (CLD) and to learn whether there are differences in incidence among newborn intensive care units (NICUs). At 30 days of age, 39% of surviving infants who had received mechanical ventilation for more than 48 hours were still respirator dependent; 15% were only oxygen dependent. By 3 months, the rates had fallen to 8% and 7%, respectively. By 6 months of age, only 1.6% were respirator dependent but 3% were oxygen dependent and 9% had died. The NICUs differed widely in incidence of CLD, without relation to number of very-low-birth-weight infants treated or to whether treatment was by pediatric residents. Rates of CLD among survivors at 30 days were not inversely related to prior mortality rates. Incidence varied inversely by birth weight, but differences among NICUs were only partly due to differing weight distributions.

Chronic Disease↗
PubMed1986

Retrolental fibroplasia: a five-year experience in a tertiary perinatal center.

During a five-year period, 565 premature infants in a tertiary perinatal center were evaluated by binocular indirect ophthalmoscopy. One-hundred-ten infants had retinopathy of prematurity. Ten of these infants developed grade 5 cicatricial retrolental fibroplasia, whereas two fellow eyes remained stable at grade 2 retrolental fibroplasia. Surgical lensectomy and vitrectomy failed to improve vision or reattach the retina in any of those with grade 5 retrolental fibroplasia. In three operated eyes and two unoperated eyes secondary glaucomas developed. Five vitrectomized eyes are now known to have phthisis. The factors that modulate the transition from the benign, acute retinopathy of prematurity lesions to cicatrizing (scarring) lesions characteristic of retrolental fibroplasia remain unclear. Birth weight (less than 1000 g), multiple apneic episodes with concomitant ventilatory assistance with 100% oxygen, and inadvertent hyperoxemia during general anesthesia may be significant cicatrization factors.

Follow-Up Studies↗
PubMed1985

Scanning electron microscopy of the ocular vasculature in retinopathy of prematurity.

Clinicoanatomopathologic correlations in a case of the retinopathy of prematurity are reported. A premature infant delivered at 28 weeks of gestation (weight, 900 g) was hospitalized for a number of health problems, including bronchopulmonary dysplasia and respiratory distress syndrome. Ophthalmic examination, at the age of 5 months, disclosed stage 1B retinopathy of prematurity. The patient died at the age of 161 days; both eyes were taken for scanning electron microscopy and histopathologic studies. Scanning electron microscopy findings included absence of retinal capillaries, anterior uveal neovascularization originating from the venous side, and a coincidental typical coloboma of the optic nerve and choriocapillaris. Histopathologic findings confirmed iris stromal neovascularization, showed retinal neovascularization with proliferation into the vitreous and avascular areas between the midperiphery and ora serrata.

Blood Vessels↗
PubMed1984

Infants with birth weights less than 1,001 g. Survival, growth, and development.

Of 56 infants weighing less than 1,001 g who were born in 1980, 30 (54%) survived the neonatal period and 29 (52%) survived the first year. At 12 to 16 months of age, 44% of the measured survivors were below the fifth weight percentile and 32% were below the fifth head circumference percentile for their adjusted ages. Of the first-year survivors, 21 (72%) were developmentally normal, four (14%) were mildly handicapped, and four (14%) were moderately to severely handicapped at 12 to 34 months of age. Handicapped infants differed significantly from normal infants in their neonatal requirements for mechanical ventilation, but did not differ in birth weight, gestational age, route of delivery, Apgar scores, maternal age or marital status, maternal education or income, gender, race, place of birth, or proportions below the tenth percentile in weight or head circumference at birth.

Age Factors↗
PubMed1984

Clinical course to 1 year of age in premature infants with patent ductus arteriosus: results of a multicenter randomized trial of indomethacin.

Reported are 1-year follow-up results of a randomized clinical trial comparing three strategies of managing clinically significant patent ductus arteriosus at the time of diagnosis in premature infants: (1) immediate administration of a three-dose course of intravenously administered indomethacin in addition to usual medical therapy (fluid restriction and use of diuretics or digitalis or both), with surgery as a backup measure, (2) usual medical therapy alone initially, with indomethacin as the first and surgery as the final backup measure, and (3) usual medical therapy alone initially, with surgery alone as backup. Of primary concern were the relative merits of these three managements strategies in the terms of the long-term occurrence of a wide range of health problems. Although at the time of neonatal hospitalization there was a significant excess of bleeding episodes in infants receiving indomethacin as part of initial treatment, and a significantly higher rate of retrolental fibroplasia in the those given usual medical therapy with surgery as backup, there were no statistically significant differences at 1 year of age related to these intermediate outcomes. In other regards, too, the treatment strategies appeared interchangeable in terms of the 1-year outcome.

Bronchopulmonary Dysplasia↗
PubMed1984

Pleural effusion in the first days of life: a prospective study.

In a thirty-month prospective study pleural effusions were found on chest radiographs in 33 of 1482 newborns admitted to intensive care units. Congenital heart disease was the most common cause, accounting for eleven cases. Meconium aspiration was the most common respiratory disease associated with neonatal pleural effusion. Infants whose effusions were first noted after the second day of life were likely to have heart disease (p = 0.02). Infants with moderate or large effusions were unlikely to have heart disease (p = 0.04). Prolonged pleural effusion was associated with a prolonged need for supplemental oxygen. Survivors whose effusions lasted three or more days were at increased risk for needing supplemental oxygen for more than twenty-one days (p = 0.07). The overall mortality was 48 percent (sixteen of thirty-three infants died).

Cardiovascular Diseases↗
PubMed1983

Overall prognosis as the primary criterion of outcome in a clinical trial.

In a randomized trial on premature infants, with follow-up to 1 year of age only, the goal is to identify which one among the compared strategies of intervention affords the best outcome throughout life. This requires the assessment of lifetime prognosis at the end of follow-up as the primary criterion of outcome. Moreover, with the treatments potentially influencing a variety of organ systems, it is necessary to combine their separate prospects into an overall prognosis as a basis for identifying the preferable mode of intervention. The development of the scheme of rating overall prognosis posed considerable challenges, in theory as well as in application.

Clinical Trials as Topic↗
PubMed1980

Transplacental ampicillin: inhibitory concentrations in neonatal serum.

Concentrations of ampicillin were measured in maternal serum at delivery, in cord serum, and in neonatal serum sampled at 1, 4, and 8 hours after ampicillin had been administered prophylactically to 22 mothers who were undergoing cesarean section. The concentrations of ampicillin in maternal serum at delivery ranged from 4.6 to 50 micrograms per milliliter and were inversely related to the time between administration of the drug and delivery. Concentrations in cord serum ranged from 4.4 to 23 micrograms/ml and were lower than those in corresponding maternal samples in all but two cases. The ratios of cord/maternal concentrations of ampicillin ranged from 0.16 to 1.3 and were directly related to the time which had elapsed between administration of ampicillin and delivery. The mean concentration of ampicillin in cord and neonatal serum declined exponentially in the 8 hours after infusion; it exceeded the minimal inhibitory concentration against Escherichia coli for 4 hours and against Listeria monocytogenes and group B streptococcus for at least 8 hours.

Ampicillin↗
PubMed1978

Assessing fetal lung maturation by the foam stability index test.

An assay has been developed and evaluated that quantifies the surface tension lowering ability of amniotic fluid surfactant. The formation of stable foam following vigorous shaking of amniotic fluid was evaluated by the addition of various amounts of dipalmitoyl lecithin in a solution of ethanol and saline and by fine adjustments of the ethanol volume fraction in the final assay mixture. The foam stability index (FSI) for a particular sample of amniotic fluid was defined as the highest ethanol volume fraction that would permit the formation of stable foam after vigorously shaking a mixture of ethanol and amniotic fluid. The assay is referred to as the FSI test. We report the FSI values in amniotic fluid specimens from 59 patients obtained within 72 hours of delivery. The L/S ratio was measured in 50 of the same 59 specimens. We observed 6 cases of neonatal hyaline membrane disease (HMD) and 2 cases of transient tachypnea of the newborn (TTNB) in this study. No cases of HMD or TTNB occurred with FSI values of greater than 0.47, while 2 cases of HMD were recorded in association with L/S ratios of 2.5 and 2.8, respectively. The potential clinical value of the FSI test is discussed.

Amniotic Fluid↗
PubMed1978

Antecedents of child abuse and neglect in premature infants: a prospective study in a newborn intensive care unit.

Families of premature and ill newborns admitted to a regional newborn intensive care unit were studied prospectively to assess the incidence of reported child abuse and neglect. Of the 255 infants discharged to their parents, ten were subsequently reported as victims of maltreatment during the first year of life. The high incidence of maltreatment (3.9%) in these premature and ill newborns supports the findings of retrospective studies that there is an increased risk of maltreatment in these special infants. Thirteen family psychosocial characteristics, assessed by admission interview, showed significant association with later maltreatment. These family characteristics included social isolation, a family history of child abuse and neglect, serious marital problems, inadequate child care arrangements, apathetic and dependent personality styles, and inadequate child spacing. Maltreated infants were less mature at birth and had more congenital defects than their nursery mates. There was also less family-infant contact during the prolonged nursery hospitalization in families in which maltreatment eventually occurred.

Adult↗