High-frequency ventilation.
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High-Frequency Ventilation↗
Biomedical subjects
Frank Pohlandt
Publications and source records attributed to Frank Pohlandt.
Calcium and phosphorus balance of extremely preterm infants with estradiol and progesterone replacement.
Infants born extremely prematurely are deprived of the placental supply of estradiol (E2) and progesterone (Prog) at an earlier developmental stage compared to an infant born at term. We hypothesized that the retention of Ca (calcium) and P (phosphorus) would be improved by an E2 and Prog replacement. Twenty female infants with a mean gestational age of 26.6 weeks (+/-1.5 SD) and a mean birth weight of 744 g (+/-156) were enrolled in a randomized controlled pilot study. One group received an E2 and Prog replacement to maintain intrauterine plasma concentrations of E2 and Prog and the other group served as control. When intake of formula was at least 100 mL/kg/d, a 3-day Ca and P balance study was performed. Ca and P intake was increased individually until both elements were excreted in the urine. The mean Ca and P retention was 4.21 (+/-1.75) mMol/kg/d (58% of intake) and 2.66 (+/-1.01) mMol/kg/d (80%) in the replaced group and 3.39 (+/-1.69) mMol/kg/d (56%) and 2.03 (+/-0.79) mMol/kg/d (71%) in the control group, respectively. In this pilot study the retention of Ca and P was not improved by an E2 and Prog replacement.
Calcium↗
Growth of the uterus and mammary glands and vaginal cytologic features in extremely premature infants with postnatal replacement of estradiol and progesterone.
OBJECTIVE: Growth of the uterus and the mammary glands and changes in vaginal cytologic features are known to be estrogen dependent and were evaluated to proof the biologic effectiveness of a postnatal replacement of estradiol and progesterone in extremely premature infants. STUDY DESIGN: Thirty female infants with a mean gestational age of 26.4 weeks (24.1-28.7 weeks) and a mean birth weight of 708 g (370-990 g) were investigated. Fifteen infants received postnatal replacement of estradiol and progesterone for 6 weeks to maintain intrauterine plasma levels of estradiol and progesterone. Uterine size and the diameter of mammary glands were assessed repeatedly by ultrasound scans and palpation. Vaginal smears were also obtained. RESULTS: The uterus and mammary glands showed significant growth during the hormone replacement, but growth was not observed in nontreated infants. Vaginal smears showed high karyopyknotic and eosinophilic indices in both groups at birth; the indices remained significantly higher at 3 and 6 weeks in the hormone-treated infants. CONCLUSION: The biologic effectiveness of postnatal estradiol and progesterone replacement in extremely premature infants was proved.
Breast↗
Acute respiratory failure and short-term outcome after premature rupture of the membranes and oligohydramnios before 20 weeks of gestation.
OBJECTIVES: To study the effect of premature rupture of membranes and oligohydramnios before 20 weeks of gestation (PROM20) on acute respiratory morbidity and on short-term outcome in infants with a gestational age >or=24 weeks. STUDY DESIGN: A historic cohort study was performed of all infants born after PROM20 with a gestational age greater-than-or-equal24 weeks between 1990 and 1999. Control infants were matched for year of birth, gestational age, and birth weight. RESULTS: PROM20 infants had an increased acute respiratory morbidity (higher ventilator settings and increased incidence of hypoxemia, hypercapnia, and pulmonary hypertension) and a trend to more air leaks. Although not statistically different, PROM20 infants had more complications (neonatal survival, 68% vs 95%; severe intracranial hemorrhage, 31% vs 6%; chronic lung disease in surviving infants, 46% vs 17%). The relative risk for combined morbidity (death, intracranial hemorrhage, chronic lung disease) was increased (3.0, P =.019) when compared with matched control infants. However, 31% of the surviving PROM20 infants were discharged without apparent morbidity. CONCLUSIONS: Expectant treatment in women with PROM20 and present neonatal intensive care has improved the survival of PROM20 infants despite severe initial respiratory failure. However, chronic morbidity still occurred.
Apgar Score↗
Pulse oximetry during low perfusion caused by emerging pneumonia and sepsis in rabbits.
OBJECTIVE: This study tested the effects of low perfusion caused by emerging sepsis on the reliability of a new pulse oximetry technology (Masimo SET; IVY 405T) compared with a standard pulse oximeter (Nellcor N-200). DESIGN: Randomized trial. SETTING: University animal research facility. SUBJECTS: Twenty-six anesthetized, ventilated (Fio, 1.0), adult rabbits. INTERVENTIONS: Pneumonia/sepsis was induced by tracheal instillation of Escherichia coli. Oxygen saturation was measured by pulse oximetry (Spo ) and recorded continuously until death. Arterial oxygen saturation (Sao2) was measured hourly by oximetry and whenever Spo dropped to </=95%, or whenever a difference of >/=5% between devices occurred. Spo2 sensors were positioned at both forelegs and switched hourly. MEASUREMENTS AND MAIN RESULTS: The total time of signal loss was longer with the N-200 vs. the IVY: 65 (4-299) mins vs. 7 (0-97) mins [median (range)], p < 0.001. Signal loss was more prevalent during the first 80% of the experimental time with the N-200 compared with the IVY. Nineteen of 26 animals had a total of 62 episodes of a falsely low Spo2 value with either one of the two devices associated with hemodynamic deterioration. Median bias (Spo2 - Sao2) was small, but variability of bias values increased toward the end of the experimental time with both devices. CONCLUSIONS: The pulse oximeter equipped with Masimo SET was less prone to signal loss than the standard pulse oximeter in this sepsis model. Episodes of falsely low Spo2 readings may occur, and deviation of Spo2 from Sao2 may be increased with deteriorating hemodynamics with both devices.
Animals↗
Early feeding advancement in very low-birth-weight infants with intrauterine growth retardation and increased umbilical artery resistance.
BACKGROUND: To investigate whether intrauterine growth retardation (birth weight <10th percentile), increased umbilical artery resistance (resistance index >90th percentile measured by Doppler velocimetry), or brain sparing (increased umbilical artery resistance and decreased middle cerebral artery resistance index <5th percentile) were associated with early feeding intolerance in very low-birth-weight (VLBW, <1,500 g) infants. METHODS: From July 1999 to December 2000, 124 inborn VLBW infants were enrolled in a prospective trial evaluating early enteral nutrition after a standardized feeding protocol (daily feeding advancement, 16 mL/kg birth weight). Feeding tolerance was assessed as the age at which full enteral feeds (150 mL/kg daily) were achieved. Data are shown as median, 25th, and 75th percentiles. RESULTS: Full enteral feeds were achieved at 15 days (range, 12-21 days) of age for all infants. Intrauterine growth retardation (full enteral feeding achieved at 14 days; range, 12-21 days), increased umbilical artery resistance (full enteral feeding achieved at 14 days; range, 11-16 days), and brain sparing (full enteral feeding achieved at 15 days; range, 14-20 days) were not associated with early feeding intolerance. CONCLUSION: Very low-birth-weight infants with intrauterine growth retardation, increased umbilical artery resistance, and brain sparing tolerated enteral feeding as well as appropriate-for-gestational-age VLBW infants.
Cerebral Arteries↗
The significance of gastric residuals in the early enteral feeding advancement of extremely low birth weight infants.
OBJECTIVE: To evaluate whether the mean gastric residual volume (GRV) and green gastric residuals (GR) themselves are significant predictors of feeding intolerance in the early enteral feeding advancement in extremely low birth weight (ELBW; <1000 g) infants. DESIGN: Ninety-nine ELBW infants were fed following a standardized protocol (day 3--14). At 48 hours of age, milk feeding was started (12 mL/kg/d increments, 12 meals per day). GR were checked before each feeding, and a GRV up to 2 mL/3 mL in infants less-than-or-equal750 g/>750 g was tolerated. In cases of increased GRV, feedings were reduced or withheld. The color of GR was assessed as clear, milky, green-clear, green-cloudy, blood-stained, or hemorrhagic. Multiple regression analysis was used to study the effect of the mean GRV and the color of GR on the feeding volume on day 14 (V14). RESULTS: The median V14 was 103 mL/kg/d (0--166). V14 increased with an increasing percentage of milky GR, whereas the mean GRV and the color green did not have a significant effect. CONCLUSIONS: 1) Early enteral feeding could be established in ELBW infants. The critical GRV seems to be above 2 mL/3 mL because there was no significant negative correlation between the mean GRV and V14. 2) Green GR were not negatively correlated with V14 and should not slow down the advancement of feeding volumes in absence of other clinical signs and symptoms.
Algorithms↗
Hydrolyzed protein accelerates feeding advancement in very low birth weight infants.
BACKGROUND: Feeding intolerance is common in very low birth weight (VLBW; <1500 g) infants. Hydrolyzed protein preterm infant formula (HPF) has been shown to accelerate the gastrointestinal transit of formula. The aim of this study was to investigate whether HPF improves early feeding tolerance compared with standard preterm infant formula (SPF). We hypothesized that HPF would accelerate early enteral feeding advancement. METHODS: Primary outcome was the time from initiation of milk feeds until full feeds (150 mL/kg birth weight/d) were achieved in infants who received <10% human milk (HM) to exclude HM as a confounder. Because the availability of HM was not predictable at the time of enrollment, all eligible VLBW infants (n = 129) were randomly assigned in a randomized, controlled trial to receive HPF or SPF if HM was not available. Infants who received >10% HM (n = 42) were excluded. Milk bolus feeding every 2 to 3 hours was started at the discretion of the attending physician and advanced by 16 mL/kg/d. Preprandial gastric residuals were tolerated up to 5 mL/kg; otherwise, feedings were reduced or withheld. Data are shown as median (5th and 95th percentile). RESULTS: Forty-six and 41 (HPF vs SPF) infants received <10% HM. There was no significant difference with regard to birth weight, gestational age, and onset of milk feeds (day 3 [1-8] vs 4 [2-6]). The time from initiation of milk feeds to full feeds was significantly shorter with HPF feeding (10 [9-27] vs 12 [9-28] days). CONCLUSION: HPF improved the feeding tolerance and enabled a more rapid establishment of full enteral feeding in VLBW infants compared with SPF.
Double-Blind Method↗