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Biomedical subjects

I Arad

Publications and source records attributed to I Arad.

At least 19 recordsLinked to original sources
PubMed1999

Neonatal outcome of inborn and transported very-low-birth-weight infants: relevance of perinatal factors.

OBJECTIVE: To compare the neonatal outcome (survival, intraventricular hemorrhage and bronchopulmonary dysplasia) of inborn and outborn very-low-birth-weight infants accounting for sociodemographic, obstetric and perinatal variables. STUDY DESIGN: Ninety-one premature infants with birth weights of 750-1250 g delivered between 1990 and 1994 in a hospital providing neonatal intensive care were compared with 76 premature babies delivered in a referring hospital. In the statistical analysis, variables with a statistically significant association with the outcome variables and dissimilar distributions in the two hospitals were identified and entered together with the hospital of birth as explanatory variables in a logistic regression. RESULTS: No statistically significant differences between the outcome variables of the two populations examined were observed, whether before or after accounting for the covariates. The odds ratios (outborns relative to inborns) were 1.18 for mortality, 1.25 for bronchopulmonary dysplasia and 1.53 for severe intraventricular hemorrhage. In the multivariate analyses, respiratory distress syndrome was significantly associated with mortality; both low birth weight and the presence of respiratory distress syndrome were associated with the development of bronchopulmonary dysplasia; the evolvement of severe intraventricular hemorrhage was associated with respiratory distress syndrome, initial low Apgar score, advanced multiparity and delivery at the 28-29th week compared to the 23rd-27th week. Antenatal steroid administration had a protective effect. CONCLUSION: Our results concur with the notion that a tertiary center is the optimal location for delivery of the high risk neonate. Improvement in medical and nursing care prenatally and at delivery and transportation, including frequent administration of antenatal steroids and earlier administration of surfactant prior to transportation, may minimize the disadvantage of delivery in a referring hospital.

Hospitals, General↗
PubMed1998

Coma in a premature infant associated with the transdermal absorption of propylene glycol.

A case of propylene glycol intoxication in a premature infant is reported. The infant went into a state of coma after treatment for burns with antiseptic dressings. Cessation of the topical treatment resulted in complete recovery. An exceptionally high level of the dressings' solvent, propylene glycol, found in the urinary chromatogram, was believed to be the causative agent. It is suggested that topical preparations containing propylene glycol should not be used in premature infants during the first weeks of life.

Coma↗
PubMed1997

Late-appearing diaphragmatic hernia following resolution of right pleural effusion.

A case of late-appearing congenital diaphragmatic hernia in a premature infant with previously normal chest X-ray is reported. Pleural effusion accumulation and resolution preceded herniation of the liver to the right hemithorax and development of respiratory symptoms. Chest X-ray, ultrasound and computed tomography of the chest were useful in establishing the correct diagnosis. Pleural effusion without obvious cause should alert the paediatrician to the possibility of this rare condition.

Female↗
PubMed1995

[Rehospitalization of very-low-birth-weight infants after discharge from neonatal intensive care units].

The higher survival rate of very-low-birth-weight (VLBW) infants is associated with an increasing rehospitalization load, especially during the first year after discharge from neonatal intensive care units. This was evaluated in a sample of 86 VLBW infants born during 1989-1990, compared with 120 normal term newborns delivered during 1990. 34 (39.5%) VLBW infants were rehospitalized, compared with 16 (13.3%) term newborns (2.9:1; p < 0.001). The ratio of hospitalizations between the groups was even higher, 4:1. Of the 49 VLBW infants hospitalized, 25 had respiratory complications (in 15 bronchiolitis), 15 required inguinal herniorrhaphy, 6 had acute gastroenteritis and in 4 there were other causes. Rehospitalized VLBW infants were more frequently of birth weight less than 1000 g and their initial stay in the neonatal intensive care unit tended to be longer. There was no significant correlation between rehospitalization and: gender, gestational age below or above 28 weeks, multiple pregnancy, need for mechanical ventilation, presence of bronchopulmonary dysplasia, or parental socioeconomic status. Hospitals should be adequately prepared to meet the special challenge of frequent rehospitalization of VLBW infants.

Female↗
PubMed1995

Carboxyhemoglobin levels in neonatal immune hemolytic jaundice treated with intravenous gammaglobulin.

In order to examine the effect of intravenous immunoglobulin (IVIG) on the rate of hemolysis in immune hemolytic hyperbilirubinemia, we measured the carboxyhemoglobin levels of 5 newborn infants who were subjected to IVIG treatment. The pretreatment rate of hemolysis, in the 5 patients with isoimmune hemolytic jaundice (3 patients with Rh hemolytic disease of the newborn and 2 patients with ABO hemolytic disease of the newborn), as reflected by carboxyhemoglobin levels was higher than the rate of hemolysis in normal newborn infants. In 4 out of the 5 patients treated with IVIG, there was a rapid decline ( > 30%) of carboxyhemoglobin levels, a pattern which was different from that observed in normal newborn infants with no hemolytic jaundice and in 3 untreated patients with ABO hemolytic disease of the newborn. None of the treated patients required an exchange transfusion. Our preliminary results support the theory that the attenuation of jaundice observed following IVIG treatment in patients with immune hemolytic hyperbilirubinemia is caused, at least in part, by the reduction in hemolysis.

ABO Blood-Group System↗
PubMed1995

Neonatal limb ischemia following maternal indomethacin treatment in twin pregnancies.

The prenatal administration of indomethacin in obstetric management has been implicated as a cause of neonatal cardio-pulmonary, gastrointestinal and renal complications. The present report describes two cases of twin pregnancy resulting in premature delivery at the 33rd and 30th week following prolonged maternal indomethacin treatment for 9 and 4 weeks respectively. Neonatal cardiovascular and renal complications were observed and an unusual severe ischemia of a lower limb occured in each of the first twins following insertion of an umbilical arterial line. It is suggested that prolonged antenatal exposure to the drug may increase the systemic arterial constrictive reactivity in some newborn infants and that special caution should be exercised during arterial catheterization of susceptible cases.

Cyclooxygenase Inhibitors↗
PubMed1994

Hyperbilirubinemia in premature infants: relevance to blood transfusion.

The rate of hemolysis of transfused adult red blood cells in the premature circulation may be higher than in the native circulation and produce a significant bilirubin load on the immature liver during the first days of life with consequent hyperbilirubinemia. The association between the transfusion of packed red blood cells and consequent change of serum bilirubin level was evaluated in 35 premature infants with birth weight of < 1,250 g during the first 10 days of life, using the analysis of variance method. There was a significant increase of bilirubin level with a mean of 24.3 mumol/l following packed red blood cells transfusion. Birth weight had a significant negative effect and mechanical ventilation for > 2 days had a significant positive effect on bilirubin levels; however, the changes were of small magnitude. The results of our study indicate that a rise of bilirubin level following blood transfusion to very low birth weight infants during the early neonatal period should be anticipated.

Birth Weight↗
PubMed1994

Basal ganglia and thalamic calcification following intrauterine intravascular transfusion.

In recent years intrauterine intravascular transfusion has become the method of choice for the treatment of severe fetal erythroblastosis. Despite the association of the procedure with fetal complications such as bradycardia and overtransfusion, later neonatal neurological consequences have been only rarely reported. A case is described of a neonate who underwent repeated intrauterine intravascular transfusion for treatment of erythroblastosis and who later developed calcification in the thalamus and the basal ganglia. The possible pathogenetic mechanisms are discussed.

Basal Ganglia Diseases↗
PubMed1993

Intravenous immunoglobulin therapy in neonatal immune hemolytic jaundice.

Nine cases of newborn patients who developed hyperbilirubinemia due to blood group incompatibility and were treated with high dose (1 gram/Kg) intravenous immunoglobulin (IVIG) are described. In 7 of the 9 patients the rise of bilirubin level was attenuated and exchange transfusion was not required following treatment with IVIG. Of the two patients who did require an exchange transfusion despite IVIG treatment, one had the exchange performed immediately following the IVIG infusion, allowing no time for observation of the therapy effect. Our results suggest that IVIG administration may be efficacious in the treatment of immune hemolytic hyperbilirubinemia of the newborn but further studies are required to validate the efficacy of this treatment.

Bilirubin↗
PubMed1993

Treatment of neonatal hyperbilirubinemia with repetitive oral activated charcoal as an adjunct to phototherapy.

The efficacy of multiple dose oral activated charcoal (OAC) therapy for neonatal hyperbilirubinemia was prospectively studied in 30 jaundiced newborns receiving phototherapy, randomly assigned to a study group (n = 14) or control group (n = 16). The study group received OAC before meals with a total amount of 8.5 +/- 0.85 gms (M +/- SEM). Serum bilirubin levels upon initiation of phototherapy were (M +/- SEM) 265 +/- 8 and 253 +/- 4 mumol/L respectively. After 24 hours there was no significant decrease in serum bilirubin levels in the control group (M +/- SEM = 240 +/- 8 mumol/L) but bilirubin levels of the study group decreased (M +/- SEM = 235 +/- 7 mumol/L, p < 0.02). At 48 hours serum bilirubin levels were significantly lower than baseline values in both groups. However, the decline in bilirubin levels in the study group (M +/- SEM = 56 +/- 10 mumol/L) was greater than that of the controls (M +/- SEM = 21 +/- 10 mumol/L p < 0.02). Oral activated charcoal seems to be an effective adjunct to phototherapy in the treatment of neonatal hyperbilirubinemia.

Administration, Oral↗
PubMed1992

Measurement of systolic blood pressure in the follow-up of low birth weight infants.

Systolic blood pressure was measured using the Doppler technique in 149 infants who attended the neonatal follow-up clinic. One hundred and six of these infants were graduates of the neonatal intensive care unit and 81% were prematurely delivered. Most of the participants were examined only once and their postnatal age ranged between 2-191 weeks at the time the blood pressure was measured. During the first weeks of life the blood pressure in infants whose birth weight was > 2000 grams appeared to be higher than that of infants of lower birth weight infants (< 2000 grams), but the difference disappeared within the first months of life. Almost all measurements after 6 months of age were of lower birth weight infants (< 2000 grams) and their systolic blood pressure level of 101.1 +/- 6.4 mm Hg (mean +/- S.D.; n = 38) appeared to remain unchanged in later infancy. Using analysis of variance, four perinatal factors were found to be associated by analysis of variance with elevated blood pressure values recorded in the clinic. These were instrumental vaginal delivery, prolonged ventilatory support, presence of patent ductus arteriosus and high blood pressure during the neonatal period. However, when multiple regression analysis was applied, only neonatal hypertension was significantly associated with subsequent elevated values measured in the clinic.

Age Factors↗
PubMed1991

cAMP increases synthesis of surfactant-associated protein A by perfused rat lung.

Synthesis and secretion of surfactant-associated protein were studied in isolated rat lungs perfused with [3H]phenylalanine or [35S]methionine in synthetic medium. Surfactant was isolated by lung lavage and density-gradient centrifugation followed by dialysis to remove unincorporated amino acid and extraction with ethanol-ether to yield a delipidated protein fraction. Incorporation of [3H]phenylalanine into the delipidated surfactant protein fraction showed a lag phase of approximately 3 h followed by progressive increase over the next 3 h at a rate of 1.6 nmol.mg protein-1.h-1. With 8-bromoadenosine 3',5'-cyclic monophosphate (8-BrcAMP, 0.1 mM) added to the perfusate, the incorporation rate between 3 and 6 h was increased by 75%. 3H specific activity in a delipidated lamellar body-rich fraction isolated from lung homogenates was unchanged by 8-BrcAMP at 3 h but was increased by 45% at 6 h. The major peak of radioactivity on sodium dodecyl sulfate-polyacrylamide gel electrophoresis of surfactant and lamellar bodies corresponded to proteins of 27-36 kDa that were identified as surfactant protein A (SP-A) by immunoblot. In the presence of 8-BrcAMP during 6 h of perfusion, specific activity of 35S-labeled SP-A in immunoprecipitated protein was increased by 93% and the SP-A mRNA content of lung was increased 145%. These results show that isolated perfused lungs synthesize and secrete surfactant-associated proteins and that the presence of a permeable cAMP analogue in the lung perfusate leads to increased secretion followed by induction of synthesis for SP-A.

8-Bromo Cyclic Adenosine Monophosphate↗
PubMed1991

Cerebrospinal fluid ascorbic acid levels during the neonatal period.

Corresponding plasma and cerebrospinal fluid ascorbic acid levels were determined in 13 term and 17 preterm newborn infants during the neonatal period. On the first day of life preterm C.S.F ascorbate value of 5.2 +/- 0.8 mg/dl (mean +/- S.E.) was higher than the 3.8 +/- 0.3 mg/dl value in term infants (P less than 0.1). Later determinations during the neonatal period did not demonstrate a difference between term and preterm C.S.F ascorbate values and levelled at 2.9 +/- 0.2 mg/dl. There was a significant negative correlation between the C.S.F/plasma ascorbate ratio and the plasma ascorbate levels and the shape of the regression line was suggestive of a saturable active ascorbate transport from the plasma into the cerebrospinal fluid. Ascorbic acid in the C.S.F of additional six neonates with a neurological disorder was lower than expected on the basis of their plasma levels, the C.S.F/plasma ascorbate ratios being 8.3 +/- 0.9 in the apparently normal infants and 3.7 +/- 0.6 in the neurological patients, (P less than 0.025). The possible mechanism of ascorbate loss from the central nervous system is discussed and it is speculated that ascorbic acid administration following a neurological insult may prove beneficial.

Ascorbic Acid↗
PubMed1990

[Growth and development of very-low-birth-weight infants].

Of 291 very-low-birth-weight (less than 1,500 g) premature infants treated during the years 1983-6, 178 (61.2%) survived. Of these, 103 (57.9%) were reexamined between 1 and 2 years of corrected age. 67% were functioning at normal level, 23.3% were mildly to moderately affected, while 9.7% showed severe delay or handicap. Factors significantly associated with development were clinical course and neurological sequelae during hospitalization, and the quality of the parent-infant relationship. There was no significant association between development and sex, multiple gestation, birthweight relative to gestational age, socioeconomic status of family, and attendance at the follow-up clinic. Birth-weight was a significant factor correlated with development by the chi-square test but not by stepwise multiple regression analysis. Growth parameters (weight, length, and head circumference) were associated with birth-weight. Our ability to modify the factors associated with development may improve the outcome of very-low-birth-weight infants.

Child Development↗
PubMed1989

Gallbladder distention in premature neonates receiving parenteral nutrition.

Contraction of the gallbladder is mediated through the release of cholecystokinin from duodenal cells secondary to enteral feedings. Premature infants are often nourished by parenteral hyperalimentation leading to prolonged inactivation of the gallbladder. Such inactivation probably accounts for the increased incidence of gallbladder distention observed in premature neonates. Two cases of premature infants are described in whom distention of the gallbladder occurred during parenteral hyperalimentation. The distention resolved spontaneously secondary to the introduction of enteral feedings. A trial period of oral or tube feeding is recommended in such cases prior to any attempt to release the distention by a surgical intervention.

Gallbladder↗