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Biomedical subjects

H R Boer

Publications and source records attributed to H R Boer.

16 recordsLinked to original sources
PubMed1984

The influence of asphyxia on phenobarbital dosing requirements in neonates.

phenobarbital dosing requirements and plasma clearance were examined for asphyxiated and nonasphyxiated neonates. The gestational age, postnatal age, duration of phenobarbital therapy and plasma phenobarbital concentrations were similar for the two groups. The plasma phenobarbital clearance was 4.1 +/- 1.0 (SD) and 8.7 +/- 3.9 (SD) ml/kg/h for asphyxiated and nonasphyxiated neonates, respectively. Asphyxiated neonates only require about half the maintenance dose of nonasphyxiated neonates to achieve similar plasma concentrations.

Aging↗
PubMed1982

Early discontinuation of anticonvulsants after neonatal seizures: a preliminary report.

Seizures in the neonatal period generally respond well to anticonvulsant therapy, but exposure to anticonvulsant medication during the first few months of life may have a detrimental influence on growth and development. The optimal length of therapy is not known, though there are indications that treatment can be discontinued shortly after seizure control. We report a protocol in which anticonvulsant agents are discontinued before discharge from our neonatal unit. Follow-up of these infants has shown no recurrence of seizures.

Child Development↗
PubMed1982

Effect of asphyxia on theophylline clearance in newborns.

The effect of asphyxia on theophylline clearance was studied in 30 newborns who were matched for gestational age, postnatal age, and the presence or absence of asphyxia. Asphyxiated newborns cleared theophylline at approximately half the rate of nonasphyxiated newborns. We found that, in order to achieve a steady-state plasma concentration of 8 mg/L of theophylline, asphyxiated neonates should receive 2.1 mg/kg/day, while nonasphyxiated neonates should receive 3.9 mg/kg/day.

Asphyxia Neonatorum↗
PubMed1982

Neonatal seizures: a survey of current practice.

A nationwide survey of neonatologists and pediatric neurologists was conducted to ascertain their methods of evaluating and managing neonatal seizures. Of the sampled 750 physicians, 284 (38%) responded to the single mailing. Most respondents use a routine for seizure workup which includes glucose, calcium and electrolyte determinations, and a lumbar puncture. On the other hand, there was a great variation in the use of an EEG, CT scan skull x-ray, and a drug and metabolic screen. Phenobarbital was the initial drug of choice and phenytoin usually the second drug. Neurologists used higher loading doses for phenobarbital and phenytoin. Most physicians monitored blood levels to adjust maintenance doses. Drug therapy was usually continued for two months to one year after seizure control. Criteria for discontinuation were often arbitrary but included a normal electroencephalogram and the absence of seizures. The results demonstrate a lack of consensus in the evaluation and management of neonates with seizures.

Blood Glucose↗
PubMed1982

Efficacy of phenobarbital monotherapy in treatment of neonatal seizures -- relationship to blood levels.

Seventy-one neonates were observed for the relationship between phenobarbital plasma concentrations and elimination of seizures. Sixty neonates (85%) had seizures controlled by phenobarbital alone. Effective plasma concentrations were 10.1 to 46.4 mg per liter. Although 36 neonates had seizures controlled by phenobarbital concentrations below 20 mg per liter, 7 neonates required levels above 30 mg per liter. We recommend that plasma phenobarbital concentrations should equal or surpass 40 mg per liter before additional anticonvulsants are used for neonates with seizures.

Humans↗
PubMed1981

Epidemic nosocomial meningitis due to Citrobacter diversus in neonates.

Five infants born at one hospital over a two-year period developed meningitis due to a serotype O2 strain of Citrobacter diversus; four infants developed brain abscesses due to this organism. The initial prevalence of stool colonization in infants was 79%; eventually 140 infants (10%) and six nurses (6%) were found to be colonized. One colonized infant remained in the hospital for the entire two-year period. The strains were of two biotypes marked by the presence (biotype d) or absence (biotype a) of fermentation of sucrose and dulcitol. The biotype d strain was found in the five infants with meningitis, 110 asymptomatic infants, and five nurses. The biotype a strain, which was isolated from 30 infants and one nurse, did not cause disease. Colonized infants were distinguished by intensive care therapy (P = 10-31), gavage feeding (P = 0.036), and prenatal intrauterine monitoring (P = 0.037). These findings suggest a fecal reservoir and person-to-person transmission of C. diversus. Measures to control the outbreak cost about $110,000.

Birth Weight↗
PubMed1981

Bacterial colonization of human milk.

Because human milk is being used more and more for feeding neonates, many hospitals are struggling with the issue of culturing. The literature indicates that human milk is hardly ever sterile. Since there has been much debate concerning protocols and frequency of culturing milk specimens, we evaluated our facility's protocol, the aim of which was to assure clean collection and transportation of the mothers' milk. We studied two large sectors of patients; private and nonprivate (service). Both sectors had a similar contamination rate with the same type of organisms. Private pediatricians generally ordered more cultures per patient than did the service (nonprivate) pediatrician. We challenge the need for all these cultures, which increase the patients' cost.

Bacteria↗
PubMed1978

Do we support parents of high-risk infants? A survey.

The establishment of regional neonatal intensive care units has reduced physical and mental handicaps in premature infants, but has caused emotional and psychological strain on parents because of frequently lengthy separation of mother and child. The study was undertaken to learn what is currently being done to support parents of high-risk infants. A questionnaire survey showed that prenatal screening was performed by only a few institutions. Not all nurseries employed full-time social workers. Such full-time status was no guarantee that all parents were interviewed and given support. Furthermore, requests for public health nurses to make predischarge and postdischarge home visits were not universally made.

Child Abuse↗