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Biomedical subjects

I Holzman

Publications and source records attributed to I Holzman.

13 recordsLinked to original sources
PubMed2001

Bacterial colonization of endotracheal tubes in intubated neonates.

OBJECTIVE: To obtain in vivo bacterial colonization profiles on endotracheal tubes at different sites in the neonatal airway in an attempt to better characterize one potential element of chondritis. DESIGN: A case series in which cultures were obtained from calculated segments of 33 endotracheal tubes immediately following extubation. This allowed for sampling at specific levels of the airway corresponding to the trachea, the subglottis, and the oropharynx. Data collected included gender, race, duration of intubation, use of antibiotic therapy, comorbidities, gestational age at birth and extubation, crown-rump length, weight, radiographic distance from tube tip to carina, and culture results. SETTING: Newborn intensive care unit at a tertiary care medical center. PATIENTS: Twenty-nine neonates intubated for longer than 24 hours (range, 24 hours to 15 days). MAIN OUTCOME MEASURES: Bacterial and fungal cultures obtained from 3 endotracheal tube segments for each extubation. RESULTS: A statistically significant difference (P < .05) was found in colonization rates between patients intubated for less than 4 days and those intubated for longer periods. No significant difference was noted in bacterial profile between the 3 sites. CONCLUSIONS: Data demonstrate that bacterial colonization of an indwelling object in the neonatal airway increases with the duration of intubation. Furthermore, 4 days seems to represent a critical period in the formation of such colonization (possibly in the form of a biofilm). These bacteria may contribute to the chondritis known to precede the development of subglottic stenosis. Further studies are indicated to suggest ways to interrupt this process and reduce the incidence of airway injury.

Bacteria↗
PubMed2001

Coxsackie virus infection of the placenta associated with neurodevelopmental delays in the newborn.

OBJECTIVE: To determine if viral infection of the placenta was associated with long-term neurodevelopmental delays in the newborn. METHODS: Placental tissue from seven newborn infants with severe respiratory failure and subsequent neurodevelopmental abnormalities as well as ten normal controls and five cases of known placental infection (cytomegalovirus, herpes simplex virus, and parvovirus) were tested by in situ hybridization or reverse transcriptase in situ polymerase chain reaction (PCR) for adenovirus, coxsackie virus, cytomegalovirus, Epstein Barr virus, herpes simplex virus, influenza A virus, picornavirus, polyoma virus, parvovirus, respiratory syncytial virus, rotavirus, and varicella zoster virus. RESULTS: Coxsackie virus RNA was detected in six of the seven cases, and in none of the ten normal controls or five cases with known viral infection. Viral RNA localized primarily to the Hofbauer cells and trophoblasts of the terminal villi. Immunohistochemical analysis for the coxsackie virus antigen VP1 yielded equivalent results. CONCLUSIONS: In utero coxsackie virus of the placenta is associated with the development of severe respiratory failure and central nervous system sequelae in the newborn. This underscores the importance of detailed pathologic and viral examination of the placenta in cases of systemic illness in the newborn.

Adolescent↗
PubMed1998

Alterations in respiratory status: early signs of severe necrotizing enterocolitis.

BACKGROUND: Necrotizing enterocolitis (NEC) presents with well-recognized signs of intestinal inflammation such as bilious vomiting, bloody stool, abdominal distension, and tenderness. The authors observed otherwise unexplained changes in the respiratory status requiring increased respiratory support during the 24 hours before direct evidence of the intestinal disorder in patients with severe NEC. METHODS: To study this observation the authors collected data on 10 consecutive patients in whom NEC required an operation. RESULTS: Eight of these patients were recovering from respiratory distress syndrome (RDS). During the 24 hours before any direct sign of intestinal dysfunction seven of these eight had a respiratory prodrome needing increased respiratory support. Two patients required intubation and mechanical ventilation. Five needed increased supplemental oxygen. This prodrome included decreased oxygenation in seven, increased respiratory rate in five, and increased PCO2 in five, preceded by hypocarbia in three. CONCLUSIONS: These changes in the respiratory condition revisit the concept of high output respiratory failure. This term was introduced to describe the respiratory failure in adult patients who suffer acute intestinal illness. Increased metabolic demand from the intestinal illness was thought to stress the ability of the patient to delivery oxygen and remove carbon dioxide. The ability of the respiratory system to meet the increased demands is limited by the intestinal dysfunction itself (abdominal pain and distension). In our patients recovering from RDS the pulmonary reserve is inherently limited. Because they are carefully monitored, it is easy to retrieve evidence of respiratory changes that precede the direct signs of intestinal disease. In the earliest stages of intestinal illness before the direct signs of intestinal dysfunction, these patients often manifest unexplained signs of respiratory compensation and decompensation and require increased respiratory support. Regardless of the pathophysiology, these alterations in respiratory status represent an early warning sign of NEC.

Enterocolitis, Pseudomembranous↗
PubMed1994

Fractured clavicle in the neonate: a retrospective three-year review.

A hospital-based case-controlled study was undertaken to determine maternal and neonatal characteristics associated with fractured clavicle. A total of 11,604 consecutive vaginal deliveries of liveborn infants in vertex presentation at the Mount Sinai Hospital from 1988 to 1990 were reviewed. Maternal and neonatal characteristics were compared for the neonates with and without a diagnosis of a fractured clavicle. Compared to controls, mothers of neonates with a fractured clavicle were more likely to be nulliparas or primiparas, to have had an operative vaginal delivery, and to have been delivered by an attending as opposed to a resident physician. The fractured clavicle group also had a longer gestational age, greater birthweight, and higher frequency of macrosomic infants. After controlling for maternal parity, type of delivery and infant birthweight, experience of the delivering physician, and gestational age at delivery were not significantly different. Fracture of the clavicle in the neonate is related to maternal parity, mode of delivery, and infant birthweight but not to the level of experience of the delivering physician.

Adult↗
PubMed1992

New approach to the management of airway obstruction in "high risk" neonates.

Epignathus is a rare tumor of newborns that is associated with a high mortality secondary to airway obstruction in the neonatal period. Due to recent advances in prenatal ultrasound and magnetic resonance imaging techniques, accurate in utero diagnosis of this rare teratoma will enable the health care team to prepare for "emergency" management of a difficult airway. We present a case of a newborn with a large epignathus diagnosed prenatally who underwent tracheotomy with intact maternal-fetal circulation. After airway stabilization, maternal-fetal circulation was interrupted and the epignathus was successfully removed. To our knowledge, this is the first extrauterine surgical procedure successfully performed using this technique. A new approach to airway management in "high risk" neonates involving the cooperative efforts of pediatricians, neonatologists, anesthesiologists, and otolaryngologists is presented.

Airway Obstruction↗
PubMed1992

Zidovudine pharmacokinetics during pregnancy.

As the indications for zidovudine (ZDV) treatment in human immunodeficiency virus-infected individuals expand, we anticipate an increased use of this drug during pregnancy. We report pharmacokinetics data from a patient studied both in the third trimester and intrapartum. ZDV peak-plasma levels and serum half-lives were comparable to nonpregnant adults. High concentrations of ZDV and its glucuronide metabolite were found in umbilical cord blood and in amniotic fluid.

Adult↗
PubMed1990

Contemporary management of a potentially lethal fetal anomaly: a successful perinatal approach to epignathus.

Prenatal diagnosis of epignathus (a teratoma originating in the oropharynx) has been reported previously. However, in many of these cases the neonates succumbed to acute respiratory distress secondary to airway obstruction at the time of birth. We describe a case of antepartum diagnosis of epignathus using ultrasonography and magnetic resonance imaging as complementary techniques. The ability to accurately define the fetal anomaly permitted us to plan a unique strategy for peripartum management. After cesarean delivery of the infant from the uterus, the umbilical cord was not clamped and the fetoplacental circulation was left undisturbed. A tracheostomy was then performed, after which the umbilical cord was clamped and the infant was stabilized. Several hours later, a debulking procedure was performed in the operating room to remove the tumor from its attachment to the bony palate. Both mother and infant did well postoperatively. The ability to plan and perform a controlled tracheostomy while the infant remained oxygenated and ventilated proved to be lifesaving in this case.

Adolescent↗
PubMed1985

Cause of hearing loss in the high-risk premature infant.

Bilateral hearing loss occurred in 9.7% of infants who survived despite very low birth weight (less than or equal to 1500 gm), 16.7% of infants who survived neonatal seizures, and 28.6% of infants who survived both low birth weight and neonatal seizures. All neonates received treatment in a single neonatal intensive care unit between 1976 and 1980. Twenty-two of 36 hearing-impaired children were normal physically and mentally, with IQ scores of greater than or equal to 85. Significant neonatal predictors of hearing loss in high-risk premature infants (less than or equal to 36 weeks gestation), as determined by multivariable testing, were prolonged respirator care, high serum bilirubin concentration, and hyponatremia. Exchange transfusions were associated with a decreased risk of hearing loss.

Audiometry, Evoked Response↗
PubMed1981

Effects of acute ethanol exposure upon in vivo leucine uptake and protein synthesis in the fetal rat.

Tritiated L-leucine ((3H)L-leu) was injected into the amniotic sacs of 19-day gestation rat fetuses during a brief (4-hr) period of elevation in maternal serum ethanol. The pregnant rats received 47.5% ethanol at "high dose" (0.29 to 0.33 g/100 g body weight) or "low dose" (0.12 to 0.14 g/100 gm body weight) by intraperitoneal injection. Fetal brain and liver were removed and analyzed for tissue uptake (TU) and protein incorporation (PI) of (3H)L-leu. Relative protein synthesis, independent of alterations in TU, was expressed by the ratio PI/TU x 100. Delayed fetal effects of acute maternal ethanol exposure were studied by injecting the fetal amniotic sacs with (3H)L-leu 24 hr after maternal ethanol administration. Both TU and PI were decreased in high dose fetal brain. Liver PI, but not TU, was depressed. High dose ethanol treatment caused a reduction in protein synthesis (PI/TU x 100) in fetal brain but not liver. Low dose ethanol enhanced brain PI and both liver and brain PI/TU x 100. Utilization of (3H)L-leu was related to fourth-hour (sacrifice) maternal serum ethanol levels. Fetal brain was more strikingly affected than liver. Ethanol concentrations greater than 200 mg/dl caused a decrease in brain TU (control, 1879 +/- 185 versus ethanol, 1219 +/- 123 dpm/mg protein) and PI/TU x 100 (control, 48.9 +/- 3.3 versus ethanol, 31.5 +/- 2.9). At levels less than 100 mg/dl, PI/TU x 100 was enhanced in both brain (control, 48.9 +/- 3.3 versus ethanol, 67.3 +/- 2.8) and liver (control, 45.3 +/- 4.2 versus ethanol, 62.3 +/- 1.7). Tissue uptake of (3H)L-leu 24 hr after high dose maternal ethanol exposure was increased in fetal brain. The results support the hypothesis that a brief period of maternal/fetal ethanol exposure, similar to that found in "social" drinking humans, alters normal fetal metabolism.

Animals↗
PubMed1981

Effect of ethanol upon placental uptake of amino acids.

The effect of ethanol infusion upon placental uptake of amino acids was studied in pregnant sheep. Blood ethanol levels of 150-260 mg/dl obliterated the normal uptake of amino acids by the in vivo placenta. However, when human placental villi were incubated in vitro with ethanol at 300 mg/dl, there was no inhibition of uptake of 14C alpha-amino isobutyric acid (AIB). In contrast, 2-20 mM, but not 50 or 200 micro M, acetaldehyde significantly inhibited AIB uptake (% inhibition at 90 min: 2 mM, 23.5 +/- 9.6%; 5 mM, 33.8 +/- 4.7%; 10 mM, 54.6 +/- 2.9%; 20 mM, 61.5 +/- 7.5%; p less than 0.01 for all 4 concentrations). When human placental villi were preincubated with 10 micro M acetaldehyde, washed, and incubated with 14C-AIB in the absence of acetaldehyde, there was significant residual inhibition of AIB uptake. The data suggest that ethanol-associated placental injury may contribute to the pathophysiology of the fetal alcohol syndrome.

Acetaldehyde↗
PubMed1977

Fructose-1,6-diphosphatase deficiency.

A girl aged 3 years and 11 months, with recurrent episodes of unexplained metabolic acidosis, hepatomegaly, and fasting hypoglycemia unresponsive to glucagon, showed profound falls in blood glucose levels in response to oral fructose and glycerol challenge. In vitro analysis of her hepatic glycolytic and gluconeogenic enzymes demonstrated absent fructose-1,6-diphosphatase activity. A therapeutic trial of orally given folic acid, 30 mg daily, did not improve her tolerance for fructose and glycerol. Over the next two years she showed improvement in tolerance to fasting, and to fructose and glycerol loading on dietary management.

Acidosis↗