[The macrosomic newborn in the maternity ward: practical attitude].
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Female↗
Biomedical subjects
E de Gamarra
Publications and source records attributed to E de Gamarra.
Heliox tolerance in spontaneously breathing neonates with bronchopulmonary dysplasia.
The use of a gas mixture in which helium is substituted for nitrogen allows a decrease in pulmonary resistances and in resistive work of breathing. This treatment might allow a reduction in energy expenditure in infants with bronchopulmonary dysplasia (BPD) and spare calories for growth. In a preliminary study designed to assess tolerance to Heliox(R), 4 infants with BPD and 4 controls were studied firstly when breathing air and secondly when breathing Heliox(R), at 10, 20 and 30 min exposure (T10, T20, T30). The following parameters were recorded: respiratory and cardiac rates, room (RT) and skin temperatures (ST) and transcutaneous (Tc) blood gases. When breathing air, TcPO2 was normal in the two groups (mean +/- SEM: 70 +/- 4 mm Hg in BPD vs. 78 +/-4 in controls). TcPCO2 was higher in the BPD group (41 +/- 2 vs. 35 +/- 1 mm Hg in controls; p = 0.028). Spontaneously breathing Heliox had immediate consequences such as wakening, crying, decrease in ST and hypoxia. Hypoxia was more serious and more rapid in the BPD group. At the 10-min exposure, mean TcPO2 was 39 +/- 4 mm Hg in BPD vs. 69 +/- 7 in controls (p = 0.042). Hypoxia was immediately corrected when breathing room air. TcPCO2 was unchanged in both groups.
Behavior↗
Congenital chylothorax with hydrops: postnatal care and outcome following antenatal diagnosis.
We consecutively managed 25 cases of fetal chylothorax with hydrops (pleuroamniotic shunting in 20/25 cases). Three of the 16 liveborn infants died before day 5 from malformations (n = 1) or complications of antenatal origin (n = 2). Eleven of the 13 survivors were treated in our unit. Four infants whose chylothorax had resolved before birth following antenatal shunting were delivered at term, and had no respiratory disease. Seven infants, whose chylothorax persisted, were delivered prematurely and required intensive respiratory care (with mechanical ventilation for a median duration of 34 days). The 11 infants were maintained on total parenteral nutrition for a median duration of 31 days. They were discharged home after complete clinical recovery at a median age of 64 days. Antenatal pleuroamniotic shunting may improve the prognosis of congenital chylothorax with hydrops. Chylothorax persisting at birth resolves progressively with medical management.
Birth Weight↗
Energy expenditure in premature newborns with bronchopulmonary dysplasia.
Five premature newborns (birth weight, mean +/- SD, 960 +/- 145 g; gestational age 28 +/- 1 weeks) with bronchopulmonary dysplasia (BPD) according to the criteria of Bancalari, and 6 controls (birth weight 1,320 +/- 210 g; gestational age 30 +/- 2 weeks) were studied for energy expenditure (EE) by indirect calorimetry. The measurement of total EE was performed when the intake of the infants in both groups was the same and when the respiratory condition had stabilized (control group: postnatal age 31 +/- 6 days, 1,950 +/- 200 g; BPD group: postnatal age 105 +/- 45, postnatal weight 2,440 +/- 380). The BPD group had a higher VO2 (11.15 vs. 8.04 ml/kg/min, p less than 0.01), VCO2 (9.13 vs. 7.74 ml/kg/min, p less than 0.02) and total EE (76 vs. 61 kcal/kg/day, p less than 0.02). The highest values were encountered in the 3 more severely ill infants: mean VO2 11.03 ml/kg/min, mean EE 82 kcal/kg/min. In these cases, administration of medium chain triglycerides limits the increase in VCO2 and lowers the respiratory quotient (0.87 vs. 0.96 in controls.
Bronchopulmonary Dysplasia↗
[Corticotherapy: too dangerous a treatment for bronchopulmonary dysplasia?].
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Betamethasone↗
Comparative efficacy of theophylline and caffeine in the treatment of idiopathic apnea in premature infants.
The purpose of our prospective randomized study was to compare the efficacy of theophylline ethylenediamine and caffeine sodium citrate in the treatment of idiopathic apnea in premature infants. Sixteen infants with three or more severe apneic attacks were studied. Twenty-four-hour cardiorespiratory recordings immediately before and after randomization and four days later showed similar significant decreases of the apnea frequency in both theophylline- (group 1, n = 8) and caffeine-treated infants (group 2, n = 8). No undesirable side effects were observed, except for tachycardia in one infant in group 1. We suggest reasons for preferring caffeine to theophylline in the control of idiopathic apnea in premature infants: caffeine is as efficient and easier to administer.
Apnea↗
Necrotizing enterocolitis in full-term newborns.
During a 17-month period, 19 full-term newborn infants were hospitalized for necrotizing enterocolitis (NEC). 10 of these infants had no apparent risk factors. Only 7 suffered acute fetal distress. 16 of the 19 infants were born in the same hospital. Toxicological and bacteriological investigations of possible cause revealed no specific agent. Virological analysis of 8 stool samples revealed the presence of corona virus in 5 of the 8.
Bacteroides↗
[Arterial pressure in newborn infants during the first 72 hours of life].
Arterial pressure (AP) (systolic, mean and diastolic) was recorded during the first 72 hours of life in 93 neonates, 27 to 42 weeks of gestational age and weighing 800 to 4,600 g, i.e. in stable hemodynamic and respiratory conditions. 4,464 measurements were performed. Results show that the 3 AP parameters increase with gestational age and birth weight and that AP increases with age after birth in full term as well as premature children. The physiologic variability of AP in full term and premature children accounts for the difficulty of establishing standards and for the need of a permanent recording of this parameter.
Age Factors↗
[Glucose and insulin blood levels in low birth weight neonates under exclusive parenteral nutrition (author's transl)].
In 31 low birth weight neonates under exclusive parenteral nutrition, insulin levels were studied and compared to blood glucose levels. Mean birth weight was 1,261 g (950 to 1,500). Gestational age was 30 weeks (27 to 40). Before the 48th hour of life, mean blood glucose level (+/- standard error) was 3.61 (+/- 0.24) mmol/l. Insulin level was 116 (+/- 30) pmole/l. After the 48th hour, the values were 4.36 (+/- 0.58) and 158 (+/- 46) respectively. There is a significant correlation between blood glucose and insulin levels (r = 0.62 p < 0.001). Hyperglycemia was present in 4 cases (> 7 mmol/l) and revealed severe pathology. These 4 children were those with the highest insulin levels. There was no significant relationship between insulin level, gestational age, postnatal age or birth weight.
Blood Glucose↗
[The value of fibrinogen concentrations in neonatal bacterial infections of maternal origin (author's transl)].
The changes of fibrinogen levels in the neonatal period have been systematically studied in the neonatal intensive care unit at Port-Royal Hospital. A prospective study has been performed in 29 children with bacterial infections which were definitely of maternal origin. High fibrinogen levels persist as long as the infection remains active. Return of fibrinogen levels to normal could be considered as a criterion, if not of cure, at least of the efficacy of treatment.
Bacterial Infections↗
[To what extent can acute complications during the neonatal period be prevented?].
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Acute Disease↗
[Nitrogen fractions of human milk during the first week of lactation. Comparison of milk from mothers of term and premature newborn infants].
Nitrogen fractions in human milk (total nitrogen, non protein nitrogen, casein nitrogen and soluble protein nitrogen) were determined by direct dosage or by calculation during the first 7 days of lactation in 61 mothers feeding artificially. Twenty-five delivered at term and 36 prematurely. In all cases a decrease in all nitrogen fractions was observed. The amounts of total nitrogen and soluble proteins were similar in both groups. A difference in the distribution of the nitrogen fractions occurs only on the 8th day following delivery. Milk from mothers who deliver prematurely contains more casein and less non protein nitrogen amounts.
Caseins↗
[Role of fibrinogen among the inflammatory proteins in neonatal infections].
The increase of the fibrinogen level appears to be an important feature in the neonatal infection as well for diagnosis as for prognosis. Levels above 3,50 g per liter during the first days after birth is in favor of bacterial materno-foetal infection and will return to normal in the next 3 days after antibiotics therapy. Conversely high fibrinogen levels persist as long as the infection remains active and must be an indication to modify antibiotics prescription even when bacteriological results are not known.
Acute-Phase Proteins↗
[Percutaneous catheterization. Experience in a neonatal intensive care unit].
157 percutaneous catheterizations were performed in 114 neonates. Besides the advantages of a central catheter, this easier technique allows to save the large vessels. However, the risks of severe complications (5 septicemias, 5 intrathoracic effusions of which 5 deaths) lead to strictly restrict its indications. Complications should be avoided with a perfect technique: strict asepsis and positioning of the end of catheter.
Catheterization↗
[Unilateral interstitial emphysema in the newborn (apropos of 4 case reports)].
Four prematurely born neonates who where mechanically ventilated with CPAP for respiratory distress have developed severe unilateral pulmonary interstitial emphysema. Some particular circumstances can be pointed out in these cases. Spontaneous worsening is usual. Selective bronchial intubation protects the overinflated lung. It allowed total improvement of the lung function for the 3 cases who underwent this treatment. Although no major complications have been noticed, it is mandatory to suck out regularly bronchial secretions accumulated in the excluded lung.
Female↗