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Biomedical subjects

G Kirsten

Publications and source records attributed to G Kirsten.

16 recordsLinked to original sources
PubMed1999

The use of dexamethasone in women with preterm premature rupture of membranes--a multicentre, double-blind, placebo-controlled, randomised trial. Dexiprom Study Group.

OBJECTIVE: To assess whether administration of dexamethasone in women with preterm premature rupture of membranes (PPROM) has an effect on the prevalence of maternal sepsis, neonatal respiratory distress syndrome (RDS), perinatal mortality and neonatal sepsis in a developing country. SETTING: Six public hospitals in South Africa that deal mainly with indigent women. METHOD: A multicentre, double-blind, placebo-controlled, randomised trial was performed on women with PPROM and fetuses of 28-34 weeks' gestation or clinically estimated fetal weight between 1,000 and 2,000 g if the gestational age was unknown. Women were randomised to receive either dexamethasone 24 mg intramuscularly or placebo in two divided doses 24 hours apart. All women received amoxycillin and metronidazole and were managed expectantly. Hexoprenaline was administered if contractions occurred within the first 24 hours after admission to the trial. OUTCOME MEASURES: The maternal outcome measures were clinical chorio-amnionitis and postpartum sepsis. The outcome measures for infants were perinatal death, RDS, mechanical ventilation, necrotising enterocolitis, and neonatal infection within 72 hours. RESULTS: One hundred and two women who delivered 105 babies were randomised to the dexamethasone group and 102 women who delivered 103 babies, to the placebo group. The groups were well balanced with regard to clinical features. There was a trend towards fewer perinatal deaths in the dexamethasone group: 4 compared with 10 (P = 0.16, odds ratio 0.37, 95% confidence intervals 0.09-1.34). A subanalysis of mothers who delivered more than 24 hours after admission to the study and their infants revealed a significant reduction in perinatal deaths; 1 death in the dexamethasone group and 7 in the placebo group, P = 0.047 (Fisher's exact test). No woman in either group developed severe sepsis, and the incidence of sepsis in the women did not differ significantly. Eleven infants in each group developed sepsis. CONCLUSION: This is the first randomised trial in women with PPROM to compare the effects of the use of corticosteroids with placebo, where all women received prophylactic antibiotics concomitantly with the corticosteroids. A trend towards an improved perinatal outcome was demonstrated in the women who received dexamethasone. There was no increased risk of infection in the women or their infants where dexamethasone was administered. Administration of corticosteroids to women with PPROM has more advantages than disadvantages in developing countries.

Anti-Inflammatory Agents↗
PubMed1996

Immune deficiency in familial duodenal atresia.

The familial occurrence of duodenal atresia is uncommon. This study evaluated the inheritance patterns, the nature and associations, and the presence of immunologic deficits in duodenal atresia recurring in at least three siblings each in two nonrelated families. In the first family, an association with Fanconi's anemia was observed in three of seven pregnancies (2 boys, 1 girl) suggesting an autosomal recessive mode of transmission. Patients died as a result of overwhelming (fungal) septicemia in association with pancytopenia. In a second family, identical multiple atresias occurred in two female siblings born 18 months apart and a third child with a duodenal stenosis. Overwhelming sepsis and a T-cell dysfunction was seen in the postoperative period, which had partially corrected by follow-up at 5 months. A history of family occurrence of duodenal atresia should alert the physician to the possibility of associated pathology including immune deficiency states.

Abnormalities, Multiple↗
PubMed1995

Relationship between the fetal heart rate pattern and perinatal mortality in fetuses with absent end-diastolic velocities of the umbilical artery: a case-controlled study.

Fetal decompensation is usually diagnosed by the onset of late decelerations and decreased fetal heart rate (FHR) variability and is associated with fetal hypoxemia and acidemia and has a high perinatal mortality. Objective analysis of the FHR pattern can be performed using the Fischer score and a score of less than 6 correlates with fetal decompensation. Fetuses with absent end-diastolic velocities (AEDV) of the umbilical artery have severe placental disease and coupled with this a high perinatal mortality and morbidity. Importantly, AEDV is usually observed before the occurrence of fetal decompensation. In fetuses with AEDV, delivery before decompensation may improve the perinatal mortality and morbidity. To test this hypothesis, the perinatal outcome of fetuses with AEDV delivered before decompensation (Fischer score of 6 or more), were compared with similar fetuses delivered after decompensation (Fischer score of less than 6). All FHR pattern records of fetuses who had AEDV with a birthweight greater than 750 g and a gestational age of 28 weeks or more were evaluated using Fischer's score by a single observer unaware of the perinatal outcome. Fifty-seven fetuses qualified for the study and 17 of these babies subsequently died. The babies who died had significantly lower mean Fischer scores during the preceding 6 hours before delivery (5.9 +/- 1.8 SD) than the survivors (7.7 1.9; p < 0.05), but also had lower birthweights and gestational ages.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Ampicillin and metronidazole treatment in preterm labour: a multicentre, randomised controlled trial.

OBJECTIVE: To ascertain whether adjuvant ampicillin and metronidazole given to women in preterm labour with intact membranes would prolong pregnancy and decrease the perinatal mortality and morbidity. DESIGN: A multicentre, prospective, randomised controlled trial. SETTING: Three perinatal centres serving an indigent population. SUBJECTS: Eighty-one women in active preterm labour with otherwise uncomplicated singleton pregnancies between 26 and 34 weeks gestation or an ultrasound fetal weight estimate of 800 g to 1500 g. INTERVENTIONS: The study group received ampicillin and metronidazole for five days. The control group received no antibiotics. In all women contractions were suppressed with hexoprenaline and indomethacin for 24 h, and betamethasone was given for fetal lung maturity. MAIN OUTCOME MEASURES: Days gained and perinatal mortality and morbidity. RESULTS: The study (n = 43) and control groups (n = 38) were comparable at entry. In those receiving ampicillin and metronidazole the pregnancy was significantly prolonged (median 15 days versus 2.5 days, P = 0.04) with significantly more women still pregnant after seven days (63% versus 37%, P = 0.03, OR 0.34 95% CI 0.13-0.94). Significantly more infants in the control group developed necrotising enterocolitis than in the study group (5 versus 0, P = 0.02). CONCLUSION: Adjuvant ampicillin and metronidazole in the management of women in preterm labour with intact membranes significantly prolonged the pregnancy and decreased neonatal morbidity.

Adult↗
PubMed1993

Does hypoxemia prevent brain damage in birth asphyxia?

The clinical syndrome of hypoxic ischemic encephalopathy (HIE) which occurs in association with birth asphyxia, is thought to represent a reperfusion injury consequent upon the generation of cytotoxic oxygen derived free radicals. It has recently been suggested that resuscitation of asphyxiated infants with unrestricted oxygen may aggravate the brain damage by causing hyperoxia and increased free radical production. To determine whether sustained hypoxemia may be protective in birth asphyxiated infants, we investigated the relationship between HIE and persistent pulmonary hypertension of the neonate (PPHN). The latter condition is also related to intrauterine and intrapartum birth asphyxia but is associated with persistent hypoxemia in the infant. In a retrospective analysis of 39 asphyxiated neonates admitted to the neonatal intensive care unit, we found that 28 had HIE, 10 had PPHN and only 1 had both HIE and PPHN. We therefore suggest that the hypoxemia due to PPHN may limit the production of oxygen derived free radicals in asphyxiated neonates and hence protect against the development of HIE. These findings lend support to current research into air vs. oxygen resuscitation for infants with birth asphyxia.

Asphyxia Neonatorum↗
PubMed1993

The relationship between absent end-diastolic velocities of the umbilical artery and perinatal mortality and morbidity.

To determine the perinatal mortality and neonatal morbidity of fetuses with absent end-diastolic velocities (AEDV) of the umbilical artery, the outcome of 120 fetuses, with a gestational age of 24 weeks or more and a birth weight of 500 g or more, with AEDV at the last Doppler examination, were analyzed. The study population came from 348 women who had pregnancies at high risk of placental insufficiency and had had Doppler velocimetry examinations. In all the women, the Doppler velocimetry result was withheld from the clinician managing the woman. Of the fetuses with AEDV, 57 (52%) died and only 26 (22%) babies had minimal or no neonatal morbidity. All 24 fetuses with AEDVs delivering before 28 weeks gestation and having a birth weight less than 750 g died. When compared with fetuses from the study population with end-diastolic velocities present, the gestational age and birth weight at delivery was significantly lower, and the perinatal mortality, neonatal morbidity and number of light for gestational age (LGA) babies was significantly higher in the AEDV group. The LGA babies from both groups were compared by gestational age category and the LGA babies with AEDV still had a significantly higher perinatal mortality. There was no difference in the pattern of neonatal complications or causes of neonatal deaths between the two groups.

Birth Weight↗
PubMed1992

Umbilical artery Doppler velocimetry in the prediction of intrapartum fetal compromise.

The value of early intrapartum umbilical artery Doppler velocimetry in the prediction of fetal compromise was studied. One hundred patients were recruited into the study and fetal compromise was diagnosed by abnormal first- or second-stage fetal heart rate traces, a 5-minute Apgar score less than 7, or the development of hypoxic ischaemic encephalopathy. Fetal compromise developed in 30 patients. An umbilical artery resistance index (RI) of 0.66 or less did not predict fetal compromise (sensitivity 13%, specificity 89%, positive predictive value 25%, negative predictive value 70%). Since the mean umbilical artery RI was identical in the compromised and the non-compromised groups, we conclude that early intrapartum Doppler velocimetry is of very little clinical value in predicting fetal compromise at term.

Female↗
PubMed1989

Increased placental resistance and late decelerations associated with severe proteinuric hypertension predicts poor fetal outcome.

The flow velocity wave forms generated by Doppler ultrasound examination of the umbilical artery were correlated with fetoplacental blood flow and numerically expressed as a ratio between the systolic (A) and the end-diastolic point (B). The technique is non-invasive and simple to perform. A cohort analytical study was done to see whether useful information could be obtained from the A/B ratio that could help in the management of patients with severe proteinuric hypertension. Fifty patients with severe proteinuric hypertension at less than 34 weeks' gestation were studied and serial Doppler ultrasound examinations of the umbilical artery were performed. No ultrasound results were made available to the clinician. An A/B ratio of 6 or greater was regarded as increased. Twenty-eight of the patients had an increased A/B ratio; in this group these 14 infants were small for gestational age, 14 developed late decelerations and there were 12 perinatal deaths. The remaining 22 patients had an A/B ratio of less than 6 and only 3 produced infants which were small for gestational age; 2 fetuses developed late decelerations and there was 1 perinatal death. A significant difference was found between the two groups in respect of these results. The group with an abnormal A/B ratio also experienced more neonatal morbidity. The A/B ratio of the umbilical artery wave form may assist in planning delivery of patients with severe proteinuric hypertension more accurately.

Blood Flow Velocity↗
PubMed1986

Ferritin levels in human milk.

Ferritin was detected and quantitated in breast milk from 24 mothers of healthy fullterm infants 3 days, 7 days, 6 weeks and 3 months after delivery. Highest concentrations were found at day 3 and demonstrated a marked decline at day 7, with negligible levels at 6 weeks and 3 months. The values in breast milk were compared with mother's serum ferritin concentration at delivery and a significant but weak correlation (r = 0.475, P less than 0.05) was found between the paired values of maternal serum ferritin at delivery and breast milk ferritin at day 3. The possible biological significance of ferritin in breast milk is discussed.

Ferritins↗
PubMed1983

Diagnosis of iron deficiency: mean corpuscular hemoglobin (MCH) as a predictor of iron deficiency in infants.

Hematologic variables were measured in 240 apparently healthy infants ranging from 1-12 months of age attending a well baby clinic. There were 20 infants for each month of age. Hematologic parameters were measured in each infant by Coulter Counter Model S. Serum iron, total iron binding capacity, free erythrocyte protoporphyrin (FEP) and serum ferritin levels were measured in most infants. Their weights together with their serum iron, total iron binding capacity, and serum ferritin were judged to be independent variables of iron status, whereas the hematologic variables were considered to be response variables indicative of iron status. The correlation coefficients among these variables, after excluding redundant variables and transforming to logarithms, were computed. Canonical correlation analysis was applied to the matrix of correlation coefficients to yield the linear function of the independent variables most highly correlated with a linear function of the response variables. The linear function of the response variables was found to be well approximated by the logarithm of the mean corpuscular haemoglobin, which was highly correlated with each of the independent variables.

Anemia, Hypochromic↗
PubMed1981

Measurement of zinc and copper levels in breast milk.

Zinc and copper levels in breast milk were measured to assess the accuracy of the analysis and to obtain a range of values for the local population. Samples were collected 7 days after delivery from 48 well-nourished mothers who had given birth to healthy full-term infants. The method was found to be accurate and reproducible provided precautionary measures were taken to avoid sample contamination. A wide variation in values was found in samples from different mothers, however, ranging from 155 to 680 microgram/dl for zinc and from 27 to 90 microgram/dl for copper.

Copper↗