Potential treatment of theophylline toxicity by high surface area activated charcoal.
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Adsorption↗
Biomedical subjects
H D Modanlou
Publications and source records attributed to H D Modanlou.
Transient plasma cholinesterase deficiency in preterm infants.
Plasma cholinesterase (ChE) activity was determined shortly after birth in 39 healthy preterm and 20 term infants using a commercially available screening assay. 40 samples of adult blood were analyzed for comparison purposes. There were no statistically significant differences in abnormally low enzyme levels in preterm or term infants and adults. Furthermore, in the preterm infants, ChE activity could not be correlated to gestational age, sex or race. Initially low ChE levels rose to normal adult levels within 2 weeks in all but 2 preterm infants. When muscle relaxant use is deemed necessary in hospitalized preterm infants, measurement of enzyme activity or use of drugs other than succinylcholine may be indicated on the basis of transient ChE deficiency.
Adult↗
Perinatal events and intraventricular/subependymal hemorrhage in the very low-birth weight infant.
One hundred nineteen very low-birth weight infants were studied to see whether intrapartum fetal distress with or without acidosis correlated with the development of intraventricular and subependymal hemorrhage. Of 112 infants studied prospectively, 24% (27/112) had intraventricular/subependymal hemorrhage documented by real-time ultrasound studies shortly after birth; only 4.4 (5/112) had severe hemorrhage (grade 3/4). Ominous fetal heart rate patterns occurred in 50% of monitored infants with severe intraventricular/subependymal hemorrhage compared to 8% of matched controls (p less than 0.01). Reassuring fetal heart rate patterns were more predominant in infants without intraventricular/subependymal hemorrhage (p less than 0.05). Neonatal depression and the need for assisted ventilation beyond the immediate delivery period were more frequent in infants who developed intraventricular/subependymal hemorrhage. Antepartum and intrapartum complications, fetal presentation, cesarean section, duration of labor, hyaline membrane disease, and volume expansion appeared to play no role in the incidence of intraventricular/subependymal hemorrhage. Preliminary data presented here suggest that intrapartum fetal distress and acidosis may be significant factors in predicting which very low-birth weight infant will develop intraventricular/subependymal hemorrhage. The condition of the infant at birth may be more significant with respect to the extent of intraventricular/subependymal hemorrhage than a variety of obstetric variables. Aggressive management of appropriately selected patients and judicious resuscitation of the very low-birth weight infant may keep the incidence of severe intraventricular/subependymal hemorrhage at a minimum, thereby optimizing neurological outcome for this high-risk group.
Acidosis↗
Theophylline toxicity in a preterm infant: selected clinical aspects.
A case of parent-induced theophylline toxicity in a preterm infant is described. Despite a theophylline level of 97 mcg/ml no clinical seizure activity was apparent. Pharmacokinetic data suggested that use of oral activated charcoal may have enhanced drug clearance. Further study is necessary before such therapy can be routinely advocated. Additional clinical features are discussed, including avoidance of dosing errors through careful instruction of all caretakers prior to discharge.
Adult↗
Developmental pattern of gentamicin kinetics in very low birth weight (VLBW) sick infants.
Kinetic studies were carried out in 15 very low birth weight (VLBW) infants during three courses of gentamicin (G) therapy for suspected sepsis. All received two courses but only 6 required a third course. G dosage was 2.0 +/- 0.2 mg/kg/24 h for the first and second course and 2.5 mg/kg/12 h for the third course. G dosage was adjusted to maintain serum peak G concentration of 4-8 micrograms/ml and trough concentration of 0.5-2 micrograms/ml. On the third day of therapy, a 24-hour collection of urine for creatinine (C) and G concentrations was performed in 28 of 36 cases. G clearance and G elimination rate constant were calculated based on chronological age (CA) of less than or equal to 7 (I), 8-30 (II) and greater than or equal to 31 (III) days. The mean BW and GA were 1,002 +/- 206 g and 28.4 +/- 1.5 weeks, respectively. Mean CA for the starting of therapy for each course was the first day, 19 +/- 9 and 68 +/- 26 days of life, respectively. Mean serum G peak and trough concentrations were 5.9 +/- 1.1 and 1.6 +/- 0.6 micrograms/ml for the first; 5.7 +/- 1.2 and 1.3 +/- 0.6 micrograms/ml for the second; 5.1 +/- 0.8 and 1.1 +/- 0.6 micrograms/ml for the third course of therapy. Mean apparent volume of distribution of G were 0.53 +/- 0.10 liter/kg for the first and 0.50 +/- 0.11 liter/kg for the second and third courses. Mean clearances for the three CA groups were 6.4 +/- 1.9; 7.6 +/- 3.2; 24.1 +/- 8.0 ml/min/1.73 m2 for G and 6.4 +/- 2.2; 7.7 +/- 3.1; 23.3 +/- 8.8 for C with serum C of 1.3 +/- 0.4, 1.2 +/- 0.6 and 0.6 +/- 0.4 mg%, respectively. There were no statistically significant differences for serum C, G and C clearance between CA I and II but significant differences were found for the above between CA III vs. CA I and II (p less than 0.005). G clearance closely correlated with C clearance (r = 0.99, p less than 0.001). The elimination rate constant was significantly higher after 30 days of life when CA III is compared to CA I and II or combined (p less than 0.001). This study shows that during the first month of life, VLBW sick infants still have decreased renal function and poor G clearance, therefore, G should be given every 24 h and the dose be adjusted based on individual patient serum G levels.
Age Factors↗
Sinusoidal fetal heart rate pattern: its definition and clinical significance.
A review was made of the available literature on the sinusoidal heart rate (SHR) pattern. A specific definition of SHR was made in order to elucidate its clinical significance. According to this definition 41 tracings from 23 publications were classified as being either true SHR, equivocal, or a heart rate pattern other than SHR. On the basis of this definition, 27 tracings were classified as true SHR patterns and all were associated with significant fetal or neonatal morbidity or mortality, except in two cases after administration of alphaprodine. Three tracings were judged to be equivocal. In two other cases the fetal heart rate tracings were classified as nonsinusoidal premortem patterns associated with poor perinatal outcome. As for the other nine tracings that did not meet the proposed definition, the perinatal outcome was normal. Therefore, because of a stricter definition of jeopardy, except when the SHR pattern appears after induction of analgesia with alphaprodine.
Alphaprodine↗
Congenital heart disease and respiratory distress syndrome. Reversal of indomethacin closure of patent ductus arteriosus by prostaglandin therapy in a preterm infant.
Two relatively large premature newborn infants with respiratory distress syndrome and ductus-dependent congenital heart disease were treated. In one, pharmacologic closure of the ductus arteriosus resulted in severe hypoxemia. The patency of the ductus as reestablished with the infusion of alprostadil (PGE1), until palliative surgery was performed. In the second case, persistent pulmonary hypertension was clinically suspected, and pharmacologic therapy was initiated without adequate cardiac evaluation. In large premature infants with respiratory distress syndrome, closure of the ductus arteriosus should not be attempted before ruling out the presence of ductus-dependent congenital heart disease. Furthermore, pharmacologic closure of ductus arteriosus can be reversed by the infusion of prostaglandin.
Alprostadil↗
Large-for-gestational-age neonates: anthropometric reasons for shoulder dystocia.
From 1960 to 1980 at Memorial Hospital Medical Center--Miller Children's Hospital, the mean birth weight for term-size neonates increased from 3381 to 3458 g inspite of increases in ethnic groups known to have smaller neonates. More significantly, the incidence of macrosomic neonates (birth weight greater than 4000 g) increased from 7.0 to 10.7%. Because of this marked increase in the incidence of neonatal macrosomia, prospective study was designed to characterize the macrosomic neonate anthropometrically. The results of this study revealed that neonates experiencing shoulder dystocia had significantly greater shoulder-to-head and chest-to-head disproportions than did macrosomic neonates delivered by cesarean section for failed progress in labor or macrosomic neonates delivered without shoulder dystocia. In addition, neonates of diabetic mothers also showed significantly greater shoulder-head and chest-head size differences than did neonates of nondiabetic mothers of comparable weight. These data suggest that antenatal ultrasonic measurements to compare chest-head size difference in fetuses suspected to be macrosomic and in diabetic pregnancies could be of value in selecting patients for the appropriate route of delivery.
Adult↗
Mean airway pressure--significance during mechanical ventilation in neonates.
Variations in PEEP with concomitant changes of DPP while MAP, PIP, flow, FIO2, and ventilator rate remained constant were investigated in nine neonates with RDS during the first and second days of life. After stabilization on baseline ventilator settings, PEEP was increased by 3 cm of H2O and DPP decreased in order to maintain balance MAP. Following a return to baseline settings, the PEEP was decreased by 3 cm of H2O and DPP increased sufficiently to maintain constant MAP. Arterial PaO2, PaCO2, pH, blood pressure, heart rate and a/APO2 ratios were measured before, during, between, and after the experimental conditions. Analysis revealed no significant changes in PaO2, a/APO2, blood pressure, or heart rate during baseline or experimental conditions. PaCO2 decreased significantly when PEEP was decreased and DPP increased, both on day 1 (37.2 +/- 2.4 vs 41.4 +/- 2.3 torr; P less than 0.025) and day 2 (42.1 +/- 2.6 vs 46.8 +/- 2.0 torr; P less than 0.05). Changes in pH were inversely related to PaCO2 changes. This study confirms the importance of MAP in determining oxygenation in newborn infants with RDS. However, ventilation was significantly affected by variation in PEEP and DPP despite a constant MAP.
Blood Gas Analysis↗
Thrombocytopenia in neonatal infection.
Serial platelet counts by phase microscopy were done for three groups of neonates who were admitted to the Special Care Unit of the Miller Children's Hospital, Group 1 (78 neonates) was evaluated for septicemia. Group 2 (28 neonates) was randomly selected sick neonates whose working diagnosis was not septicemia. Group 3 (16 neonates) was clinically normal preterm neonates (28 to 36 weeks gestation). For group 1 and 2, platelet counts were done serially, at the time blood and cerebrospinal fluid cultures were obtained and then 12, 24, 48 and 72 hours later. For group 3, plasma counts were done on the second, seventh, fourteenth, twenty-first, and twenty-eighth day of life. Sixteen of the group 1 infants were found to have septicemia; ten of these 16 had thrombocytopenia (platelets less than 100,000/mm3). In group 2, five infants had thrombocytopenia, one because of isoimmune disease and four as a result of possible disseminated intravascular coagulation. Thrombocytopenia persisted for 1 to 10 days; platelet counts of group 3 were the same as those of older children and adults.
Female↗
Perinatal transport to a regional perinatal center in a metropolitan area: Maternal versus neonatal transport.
A prospective study was undertaken to evaluate antenatal maternal referral, acute maternal transport, and neonatal transport to a regional perinatal center in a metropolitan area. During an 18-month period, there were 143 antenatal maternal referrals, 254 antenatal maternal transports, and 506 neonatal transports. Indications for the antenatal referrals were maternal diseases of a chronic nature. This group had a 28.7% incidence of delivery by primary cesarean section, a 15.8% incidence of low-birth weight infants, and a 30.8% incidence of neonatal admissions to the Neonatal Intensive Care Unit (NICU). The perinatal mortality rate was 13.7 per thousand which compares favorably with that of low-risk obstetric patients. Indications for the antenatal maternal transports were mainly premature labor and/or premature rupture of the membranes and third-trimester bleeding. There was a 37% incidence of delivery by primary cesarean section and a 71.5% incidence of low-birth weight infants, and 77.4% of the newborn infants were admitted to the NICU. The perinatal mortality rate was 137.4 per thousand live births. Compared to postnatal neonatal transports, the neonates transported antenatally had a slightly higher mortality rate which was not statistically significant. One hundred thirty-one neonates transported antenatally could be matched in sequential order of admission with 131 neonates transported postnatally of comparable birth weights and gestational ages. Although there was a significant increase in the incidence of delivery by cesarean section among the mothers transported antenatally, the neonates in this group had a significantly lower incidence of respiratory distress syndrome and other morbidity and a shorter hospitalization. This study suggests that antenatal referral and transport of high-risk parturient patients to a regional perinatal center may significantly decrease neonatal morbidity and length of hospitalization.
California↗
Significance of fetal and neonatal sinusoidal heart rate pattern: Further clinical observatons in Rh incompatibility.
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Erythroblastosis, Fetal↗
Early onset group B streptococcus neonatal septicemia and respiratory distress syndrome: characteristic features of assisted ventilation in the first 24 hours of life.
Clinical features and assisted ventilation (AV) aspects of 10 neonates with early onset group B streptococcus (GBS) septicemia were compared with those of 12 randomly selected newborns with severe respiratory distress syndrome (RDS). Initial chest radiograph in the GBS group was interpreted as RDS in seven of 10 cases. Although 9 of the 10 neonates with early onset GBS were preterm, they were of a significantly higher mean birth weight (p < 0.01) and the mean gestational age (p < 0.005). The duration of rupture of fetal membranes was not significantly different between the two groups. Contrary to neonates with severe RDS, who gradually developed hypoxia necessitating AV, the neonates with early onset GBS required AV because of persistent apnea, shock, and respiratory insufficiency. During the first 24 h of life, neonates with early onset GBS were more acidotic, had significantly higher PaCO2 and lower PaO2 values, and required significantly higher peak inspiratory pressure (PIP) on the respirator (po < 0.01) while on AV, although the oxygen requirement was similar.
Birth Weight↗
Macrosomia--maternal, fetal, and neonatal implications.
Perinatal morbidity and mortality are known to be higher for the macrosomic neonate whose birth weight is 4500 g or more, compared with that of appropriate-weight term-size neonates. In a retrospective study comparing 287 macrosomic neonates with 284 appropriate-weight term-size neonates, we found that macrosomia occurred in 1.3% of our annual deliveries, with a male-to-female ratio of 2.3:1. Factors that occurred significantly more frequently in the mothers of macrosomic infants were maternal obesity, multiparity, diabetes mellitus, and previous delivery of an infant heavier than 4000 g. During the intrapartum period the incidence of labor augmentation by oxytocin, shoulder dystocia, and cesarean section was significantly greater in fetal macrosomia. Most significantly, this study revealed that macrosomia. Most significantly, this study revealed that macrosomic fetuses do not experience greater fetal distress in biophysically monitored labor than appropriate-weight term-size fetuses. Twenty-nine (10%) of the macrosomic infants required admission to the neonatal intensive care unit (NICU) compared to 9 (3%) of the control patients (P less than 0.01). This excess neonatal morbidity in the macrosomic neonates was predominantly caused by the delivery process.
Adult↗
Effectiveness of neonatal transport.
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California↗
Antenatal versus neonatal transport to a regional perinatal center: a comparison between matched pairs.
Fifty randomly selected newborn infants of maternal transports admitted to the neonatal intensive care unit (NICU) at Long Beach Memorial Hospital in 1976 and 1977 were matched by birth weight, gestational age, and outcome with 50 transported neonates. The factors compared included type of delivery, 5-minute Apgar score, length of hospital stay, distance of transport, admitting diagnosis, need for assisted ventilation, and length of time on assisted ventilation. Only 2 factors were found to be statistically different between the 2 groups. There was an increased cesarean section rate in transport mothers but a lower morbidity among preterm neonates born to maternal transports.
Birth Weight↗
Intrauterine diagnosis of an omphalocele by diagnostic ultrasonography.
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Adult↗
An unusual complication of fetal blood sampling during labor.
A female infant was delivered at term after biophysical and biochemical monitoring during the intrapartum period. At birth excessive bleeding was noted from the scalp incision sites, leading to severe anemia. The infant was also found to have congenital syphilis. The clinical course was complicated by the development of disseminated intravascular coagulation leading to death despite intensive management. Identification and appropriate management of excessive pre- and postnatal bleeding from a sampling incision is emphasized.
Adult↗