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Biomedical subjects

I M Hiatt

Publications and source records attributed to I M Hiatt.

At least 19 recordsLinked to original sources
PubMed1995

Efficacy of surfactant therapy in infants managed with CPAP.

Surfactant rescue therapy can be utilized effectively early in the course of respiratory distress syndrome (RDS) in infants weighing > 1,000 g and treated exclusively with continuous positive airway pressure (CPAP) therapy. Thirteen infants (BW, 1,774 +/- 580 g; GA, 31 +/- 3 weeks) comprising the CPAP/SURFACTANT group were compared with 12 infants (BW, 1,753 +/- 556 g; GA, 31 +/- 2 weeks) who comprised the intermittent mandatory ventilation (IMV)/surfactant group, and with 14 infants (BW, 1,776 +/- 332 g; GA, 32 +/- 2 weeks) treated with CPAP before surfactant was clinically available. A 5 mL/kg dose of Exosurf Neonatal (Burroughs-Wellcome) was administered to infants intratracheally when the FiO2 requirement reached 0.40 to maintain the PO2 above 50 torr. Infants in the CPAP/surfactant group were intubated solely for surfactant administration and extubated within 18 +/- 6 min of treatment. The CPAP/surfactant group was treated at a mean age of 12.3 +/- 9.3 h, and the IMV/surfactant group at 10.2 +/- 9.8 h. Alveolar-arterial oxygen gradient (AaDO2), oxygenation index (OI), and mean airway pressure (MAP) were determined immediately before and after surfactant therapy, and at comparable times for the CPAP-only group. A significant difference was found in pre-treatment AaDO2, OI and MAP between the CPAP/surfactant group and IMV/surfactant group, but not between the CPAP/surfactant group and the CPAP-only group. Similarly, a significant difference in AaDO2, OI and MAP continued post-treatment was noted. However, a significant difference was also found at this time between the CPAP/surfactant group and the CPAP-only group. In addition, a significant difference was noted in AaDO2 and OI pre- and post-treatment within each surfactant-treated group. Furthermore, in the CPAP-only group AaDO2 and OI actually worsened (212 +/- 70 vs. 239 +/- 68; 4.0 +/- 1 vs. 4.5 +/- 2, respectively). There was a significant reduction in the duration of oxygen therapy (3 +/- 2 vs. 5 +/- 2 vs. 4.5 +/- 2 days, respectively) as well as in the total days of hospitalization (30 +/- 10 vs. 42 +/- 15 vs. 43 +/- 12 days, respectively). We conclude that in this small group of infants surfactant administration was effective and safe. It appeared to improve the course of RDS and shorten the duration of oxygen exposure and days of hospitalization.

Combined Modality Therapy↗
PubMed1993

Incidence and timing of germinal matrix/intraventricular hemorrhage in low birth weight infants.

Incidence and time of onset of germinal matrix/intraventricular hemorrhage (GM/IVH) were prospectively ascertained in 1,105 infants weighing < or = 2,000 g at birth, a cohort comprising about 85% of all births of that weight born from September 1984 to June 1987 in the central New Jersey counties of Ocean, Monmouth, and Middlesex. Cranial ultrasonography was performed as nearly as possible to age 4 hours, 24 hours, and 7 days. Each scan was reviewed by two independent readers and, if necessary, a third; consensus was achieved on scan of first diagnosis of GM/IVH in 965 of the 1,079 infants with assessable scans. The cumulative incidence of GM/IVH in the first week of life was 24.6% (265/1,079). In the 965 infants with consensus diagnoses, the first scan, at 4.9 +/- 2.2 hours, yielded the highest incidence--10.6% (95/899). Incidence by the second scan (25.1 +/- 4.9 hours) was 6.0% (49/813), and by the third scan (7.2 +/- 0.8 days), 9.0% (64/715). The iterative algorithm for interval-censored data developed by Turnbull (J R Stat Soc [B] 1976;8:290-5) was used to estimate the most likely time of onset based on time of first diagnosis. From 34% to 44% of hemorrhages were present at the first opportunity to scan, which in these data was at age 1 hour. At least a third of GM/IVH in infants < or = 2,000 g appears to be of congenital or immediate postnatal onset.

Age Factors↗
PubMed1991

Undetected apnea and bradycardia in infants.

Despite routine monitoring, a number of prolonged apneic and bradycardic episodes were undetected in a group of infants in the neonatal intensive care unit (NICU). Sixty-one infants were evaluated by 12-hour pneumocardiograms at a post-conceptional age of 35 +/- 3 (SD) weeks. Nursing documentation failed to detect 11 infants with prolonged apnea and bradycardia. Three of these infants were not detected in spite of increased awareness following in-service education. Such a lack of documentation may lead to improper medical management of infants at risk for pathologic apnea and suggests the need for more accurate documentation at the time of discharge.

Apnea↗
PubMed1991

Visitation to a neonatal intensive care unit.

Preterm newborns may experience extended periods of hospitalization which disrupt the normal early contact between the newborn and its family. Variations in the frequency of visits to 164 preterm neonates in a neonatal intensive care unit were examined in relation to infant and family status variables and compliance with follow-up appointments at 3 months postterm. The mean number of visitors decreased from day 2 to day 12 of hospitalization and then remained stable through day 21. There was a corresponding increase in the number of days with no visitors through day 12, and then stabilization. Neonates who had intraventricular hemorrhages, whose parents did not live together, and who were not firstborn had the most days with no visitors. While the mother was hospitalized herself, her condition was the only variable related to percentage of no-visitor days. The sicker the mother, the more likely the newborn had no visitors. The greater the number of days with no visitors, the poorer the likelihood that the infant was brought to a 3-month follow-up clinic appointment.

Child Health Services↗
PubMed1991

The four-channel pneumogram in infants with recurring apneas and bradycardias.

The two-channel pneumocardiogram (PCG) is frequently used for evaluating infants at risk for infantile apnea. In this study, the two-channel PCG failed to identify a significant number of symptomatic infants that were diagnosed by a four-channel pneumocardiogram. Nine infants suffering from either apparent life-threatening events (ALTE) or persistent apnea of prematurity were evaluated with two- and four-channel PCGs. The four-channel PCGs consisted of the standard two-channel evaluations, ECG and impedance pneumography, expanded by the addition of pulse oximetry and nasal thermistry. The PCGs were evaluated in a blinded manner by three trained observers. Each PCG was evaluated in both the two- and four-channel mode. A PCG was considered abnormal when any of the following was present: (1) a heart rate deceleration greater than one third of the baseline and lasting more than 8 seconds, (2) an apneic pause, either by impedance or by airflow, of greater than 20 seconds, (3) evidence of obstructive apnea less than 20 seconds but associated with cardiac deceleration, and (4) evidence of oxygen desaturation below 85% and lasting more than 8 seconds. All nine of the infants studied had recurrent apneic episodes at home. The four-channel PCGs were abnormal in all of the infants studied, whereas only four of the two-channel PCGs were abnormal (P less than .02). In this population, over 50% of the infants were incorrectly evaluated by the standard two-channel PCG and correctly identified by the four-channel PCG.

Apnea↗
PubMed1990

Surfactant replacement therapy.

The field of neonatology has experienced exceptional growth in recent years, and several excellent facilities exist in New Jersey for the care of premature and sick newborn infants. This article describes important advances made in the management of neonatal respiratory distress syndrome.

Humans↗
PubMed1988

Prenatal lidocaine and the auditory evoked responses in term infants.

We examined the effects of maternal lidocaine hydrochloride anesthesia on the brain-stem auditory evoked responses (BAERs) in neonates born by cesarean delivery. Sixteen term neonates were enrolled in the study. Eight neonates were delivered by cesarean section following lidocaine anesthesia, and eight were delivered by spontaneous vaginal delivery without maternal anesthesia. A BAER was obtained on all of the neonates on the first day of life. A significant delay was noted in the central neural component of the BAER at 90 dB. The wave I through V interpeak latency for both ears was noted to be 5.3 ms for the neonates exposed to lidocaine and 4.9 ms for the controls.

Anesthesia, Epidural↗
PubMed1987

Prevention of hypoxia and hyperoxia during endotracheal suctioning.

A new suction catheter, designed to deliver alternately oxygen or suction, prevented episodes of hypoxia and hyperoxia in a group of infants during endotracheal suctioning. Twenty infants received both conventional endotracheal suctioning and suctioning by the new catheter. The infants had a maximal change from a presuctioning transcutaneous oxygen (PtcO2) of 12 +/- 8 torr and required 3.1 +/- 2 min to regain their presuctioning oxygenation level compared to a maximal change of 21 +/- 10 torr (p less than .05) and a stabilization time of 5.3 +/- 2.6 min (p less than .05) in the conventionally treated group. Three study infants experienced an abnormal PtcO2 (either less than 40 or greater than 90 torr), while 13 control infants suffered these abnormalities (p less than .01). The use of this new suction device effectively reduced the exposure of this group of infants to episodes of aberrant oxygen states and allowed for a shorter recovery time.

Blood Gas Monitoring, Transcutaneous↗
PubMed1987

Evaluation of routine lumbar punctures in newborn infants with respiratory distress syndrome.

Infants with respiratory distress syndrome are routinely evaluated for infection which commonly includes a lumbar puncture. In this study cerebrospinal fluid (CSF) examination failed to elicit evidence for meningitis in 238 consecutively admitted infants with respiratory distress syndrome evaluated during the first 24 hours of life. Blood cultures were obtained in all; suprapubic or catheterized urine was obtained in 163 infants; CSF was collected successfully in 203 infants. Seventeen infants demonstrated positive blood cultures: 7 Streptococcus, 5 Staphylococcus, 3 Haemophilus influenzae, 1 Bacillus subtilis and 1 diphtheroid infection. CSF obtained from 14 of those infants had normal examinations and sterile cultures. Factors associated with bacteremia were birth weight (P less than 0.01), gestational age (P less than 0.01), prolonged rupture of membranes (P less than 0.05) and leukopenia below 10 000/mm3 (P less than 0.05). In view of the negative CSF examinations in infants with positive blood cultures and the potential complications of lumbar puncture (hypoxia, trauma, infection, epidermoid tumor), the potential risks of CSF evaluation may exceed the assessed benefit for the infant with respiratory distress syndrome.

Humans↗
PubMed1987

The pharmacokinetics of naloxone in the premature newborn.

We examined the pharmacokinetic properties of naloxone in a group of premature infants infused with an intravenous bolus of the drug. Ten infants with a mean birth weight of 1,328 +/- 402 g and a gestational age of 29.4 +/- 2.8 weeks were studied at an age of 4.5 +/- 3.2 days of life. Following administration of 0.4 mg/kg of naloxone, we obtained blood samples at specific time intervals, and stored the serum for later analysis by a radioimmunoassay method. Calculations from the serum concentration versus time relationship resulted in an elimination rate constant of 0.75 +/- 0.39/h, a half-life of 70.5 +/- 35.2 min, a systemic clearance of 39.13 +/- 14.53 ml/min/kg, and an apparent volume of distribution of 3.52 +/- 1.20 liters/kg.

Humans↗
PubMed1987

The course of hyperbilirubinemia in the very low birth weight infant treated with phenobarbital.

We examined the effect of early phenobarbital therapy on the course of jaundice in 57 infants with birth weight below 1,500 g. The study group of 28 infants was treated with a phenobarbital loading dose of 20 mg/kg at 4.2 (3.6) [mean (SD)] hours of age, followed by a maintenance dose of 5 mg/kg/day for one week; 29 infants served as controls. Seventeen study and 19 control infants suffered from periventricular-intraventricular hemorrhage (IVH). The two groups had comparable risk factors that can potentially affect the course of hyperbilirubinemia. Peak serum bilirubin concentration was 7.9 (1.8) mg/dl in the treated group and 8.6 (2.2) mg/dl in the control group. Three infants in the treated group and seven infants in the control group had peak serum bilirubin concentration above 10 mg/dl. These differences in the peak serum bilirubin concentration or in the number of infants with peak serum bilirubin concentrations above 10 mg/dl are not statistically significant. However, treated infants achieved peak serum bilirubin concentration earlier (mean age 90 hours as compared to 138 hours in control infants), and required phototherapy for a shorter duration of time (5.5 days in the treated group as compared to 7.5 days in the control group). While these differences in the two groups with regard to age of peak serum bilirubin concentration and duration of phototherapy are statistically significant, they do not seem to be clinically important. Thus, in our group of very low birth infants phenobarbital failed to show any clinically important effects on the course of jaundice when used in conjunction with phototherapy.

Bilirubin↗
PubMed1986

Transcutaneous bilirubinometry. III. Dermal bilirubin kinetics under green and blue light phototherapy.

Using the transcutaneous bilirubinometer, we studied the response of cutaneous bilirubin to different colors of light during phototherapy. Three groups of ten infants were exposed to blue, green, and blue-green lights at a mean postnatal age ranging from 50 to 77 hours. Patched areas served as controls. Every 15 minutes during four hours of phototherapy, we obtained simultaneous measurements from exposed and covered areas. After the onset of phototherapy, transcutaneous bilirubinometer values from the covered areas in all groups remained stable. The overall rate of bleaching was lowest in the green light group and highest in the blue-green combination group. In this group of infants, green light appeared to enhance the effectiveness of blue light in reducing dermal bilirubin concentrations as measured by the transcutaneous bilirubinometer.

Bilirubin↗
PubMed1986

Management of posthemorrhagic hydrocephalus in the preterm infant.

We studied the use of a subcutaneous ventricular catheter reservoir in 19 preterm infants with birth posthemorrhagic hydrocephalus. These infants were a poor risk for insertion of ventriculoperitoneal shunt due to their small size and hemorrhagic ventricular fluid at the time of diagnosis. The age at reservoir insertion was 29 +/- 9 days and the weight was 1,217 +/- 414 g. The reservoir was kept in place for 51 +/- 29 days with the removal of 527 +/- 421 mL of fluid by 57 +/- 42 taps. All infants tolerated the procedure well. Only two infants developed infection despite multiple reservoir taps. One infant expired due to unrelated causes. Three infants did not require a permanent shunt, while 15 infants had a ventriculoperitoneal shunt inserted prior to discharge at 3 to 4 months of age. We conclude that ventricular catheter reservoir is a safe and effective palliative procedure in the management of post hemorrhagic hydrocephalus in small preterm infants.

Apgar Score↗
PubMed1986

Ventilatory responses to carbon dioxide in infants at risk for sudden infant death syndrome.

We examined the ventilatory response to inhaled CO2 in 77 infants at postconceptional ages ranging from 31 to 50 wk, 43 of whom were also evaluated with a 12-h pneumocardiogram (PCG). Infants were tested after sedation with chloral hydrate, and monitored with ECG and transcutaneous oxygen and CO2 monitors. Sleep state was evaluated by visual inspection of the infant's behavior. Among the 43 infants examined with the PCG, 22 had abnormal PCGs. Of these, 27% had significantly (p less than .05) abnormal CO2 response slopes, compared to 9% of those with normal PCGs. Breathing frequency did not change after CO2 inhalation in 82% of the abnormal PCG and in 33% of the normal PCG groups.

Apnea↗
PubMed1986

Phenobarbitone prophylaxis of intraventricular haemorrhage.

Thirty preterm infants (birthweight under 1500 g) were treated with phenobarbitone to examine its effectiveness in reducing the incidence of intraventricular haemorrhage (IVH), the control group comprising 28 infants. The treated group had 57% incidence of IVH and mortality of 13% compared with 68% and 14%, respectively, in controls.

Cerebral Hemorrhage↗
PubMed1986

Pharmacokinetics of theophylline in premature infants on the first day of life.

The disposition of theophylline in premature infants on the first day of life was studied in nine preterm infants after intravenous administration of the drug. Theophylline concentrations in the blood were measured by means of high-pressure liquid chromatography. Theophylline's apparent volume of distribution (mean +/- SD) was 1.02 +/- 0.13 L/kg, a value similar to those previously reported, but the half-life (16.9 +/- 6.2 hr) was considerably shorter. The elimination rate constant (0.046 +/- 0.020/hr) and the clearance rate (46 +/- 14 ml/kg/hr) were faster than in older infants. Follow-up studies in three infants on the third day of life showed lower clearance rates than were obtained on the first day. The newborn preterm infants in this study eliminated theophylline at an unexpectedly rapid rate. Dosage calculations for therapy at this age should be based on these kinetic data.

Birth Weight↗
PubMed1986

Effects of postnatal aminophylline on the course of respiratory distress syndrome in premature infants.

The effect of postnatally administered aminophylline on the development of respiratory distress syndrome was evaluated in 25 premature infants weighing less than 1,500 gm. By random allocation, 14 infants were treated with aminophylline intravenously, and 11 infants served as controls. In the treated infants, a loading dose of 6 mg/kg of aminophylline was administered on the first day of life, and maintenance dosages of 4 mg/kg/day were given for the next three days. Respiratory distress syndrome developed in seven infants in the treated group and seven infants in the control group. Ten infants in each group required mechanical ventilation. More cases of intraventricular hemorrhage were diagnosed in the control group, but more deaths occurred in the treated group. These findings led to the conclusion that aminophylline administered postnatally did not appreciably modify the course of respiratory distress syndrome.

Aminophylline↗