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Biomedical subjects

J A Bier

Publications and source records attributed to J A Bier.

14 recordsLinked to original sources
PubMed1998

The vulnerable preschool child: the impact of biomedical and social risks on neurodevelopmental function.

The scope of preschool children with biological risk and social disadvantage is large and includes over 1 million (28%) newborns per year. Currently in 1996, 7% of children are born with low birth weight, 1% are born with very low birth weight, 20% have alcohol exposure, and 10% have other drug exposure. Poverty is dynamic and impacts on 25% of children less than 6 years old with increased frequency in children who are minority, have mothers with less than a high school education, or are unmarried. There has been a markedly increased survival in very low birth weight and extremely low birth weight infants in the past 10 years. Outcomes of these neonatal populations reveals that parenchymal brain injury is the major predictor of cerebral palsy which occurs in 7% to 10% of very low birth weight survivors. However, poverty is the major predictor of low IQ. Fetal alcohol syndrome occurs in 1.9 per 1,000 births and is most often associated with mild mental retardation and educational underachievement. Studies investigating cocaine revealed that it is a multifactorial problem overlapping with polysubstance abuse and other risk factors for social disadvantage. The overwhelming number of children do not have cerebral palsy or severe mental retardation. The long-term impact is more subtle and needs more systematic analysis as well as critical evaluation of cognitive impairments and educational under-achievement. Hypoxic ischemic encephalopathy (HIE) cannot be determined by one biological measure. Though multiple disability occurs in 70% of children with Sarnat stage 3 HIE, 30% of survivors are not disabled. Children with mild to moderate HIE have long-term outcomes that are influenced by 9- to 12-month neurodevelopmental status and social disadvantage. By combining strategies to lessen biological risks and enhance developmentally appropriate environments, long-term outcomes of preschool children can be optimized.

Asphyxia Neonatorum↗
PubMed1998

Congenital talonavicular coalition. Review of the literature, case report, and orthotic management.

Talonavicular coalition is a rare entity and is often discovered as a secondary radiographic finding. Today, orthoses are as varied as the patients for whom they are prescribed; however, in cases of symptomatic talonavicular fusion, the use of a shallow U-shaped dispersion within the high medial flange of an orthosis can prove beneficial to the pediatric patient. This article encourages podiatric physicians to return to utilizing basic diagnostic tools (gait analysis, biomechanical examination, and radiographs) to detect and treat talonavicular coalition, a significant but rare anomaly of the foot.

Child, Preschool↗
PubMed1997

Medical and social factors associated with cognitive outcome in individuals with myelomeningocele.

The interrelationship between biological and social risk factors and cognitive outcome in individuals with myelomeningocele was examined. The Kaufman Brief Intelligence Test (K-BIT) was administered to 65 children and young adults, age range 4 to 29 during a recent clinic visit. Unshunted individuals had scores in the average range and individuals with uncomplicated hydrocephalus in the low-average range. Although the level of lesion was found to be most strongly associated with total K-BIT score, examination of subscores indicated that socioeconomic status was the factor most strongly associated with Vocabulary score. The importance of both social and biological factors in predicting cognitive outcome in this population is useful in planning intervention strategies.

Adolescent↗
PubMed1996

Comparison of skin-to-skin contact with standard contact in low-birth-weight infants who are breast-fed.

OBJECTIVE: To evaluate the effects of maternal-infant skin-to-skin contact (SSC) vs standard contact (SC) on low-birth-weight infants' physiological profile, maternal milk production, and duration of breast-feeding. DESIGN: Prospective, randomized, interventional study with cohort followed up for 6 months after discharge from the hospital. SETTING: Special care nursery with follow-up telephone calls after discharge from the hospital. PATIENTS: Fifty infants, with birth weights less than 1500 g and whose mothers planned to breast-feed, randomized to 2 groups: SSC (experimental) and SC (control). INTERVENTION: In the SSC group, infants were clothed in diaper and held upright between mothers' breasts; both mother and infant were covered with a blanket. In the SC group, infants were clothed, wrapped in blankets, and held cradled in mother's arms. MAIN OUTCOME MEASURES: Infant physiological data, ie, oxygen saturation, heart rate, respiratory rate, and axillary temperature; maternal milk production; and duration of breast-feeding. RESULTS: Oxygen saturation was higher during SSC than during SC (P < .001); 11% of the oxygen saturation recordings during SSC vs 24% during SC indicated the values less than 90% (P < .001). A more stable milk production was noted in the SSC group. No differences were noted in infant temperature, heart rate, or respiratory rate. Ninety percent of mothers in the SSC group vs 61% in the SC group continued breast-feeding for the duration of the infants' hospitalization (P < .05), and 50% in the SSC group vs 11% in the SC continued breast-feeding through 1 month after discharge (P < .01). CONCLUSIONS: During SSC with their mothers, low-birth-weight infants maintain a higher oxygen saturation and are less likely to have desaturation to less than 90% oxygen than are infants exposed to SC. Mothers in the SSC group are more likely to continue breast-feeding until 1 month after discharge.

Adult↗
PubMed1993

The oral motor development of low-birth-weight infants who underwent orotracheal intubation during the neonatal period.

OBJECTIVE: To investigate the potential development of oral motor problems following prolonged orotracheal intubation in low-birth-weight infants. DESIGN: Prospective observational. SETTING: Tertiary-care hospital. PATIENTS: Fifty-one low-birth-weight infants and 10 full-term infants divided into three groups--group 1 with 15 low-birth-weight infants (< or = 1250 g) who had been intubated for more than 1 week; group 2 with 36 low-birth-weight infants who had been intubated for 1 week or less; and group 3 with 10 full-term control infants. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Oral motor assessments of nutritive sucking were compared at corrected ages of term and 3 months. The results showed that low-birth-weight infants with prolonged intubation had significantly poorer sucking abilities at both term and 3 months. The number of days of oxygen use and the postnatal age (weeks) at which nipple feeding was begun were the most powerful predictors of sucking ability at term (P < .001), whereas the number of days of orotracheal intubation and gestational age at birth were the most powerful predictors of sucking ability at 3 months (P < .001).

Apgar Score↗
PubMed1993

An abstract error?

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Anesthesia, Dental↗
PubMed1993

Anti-amalgamism.

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Anti-Bacterial Agents↗
PubMed1977

State's rights.

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Licensure, Dental↗
PubMedDate not supplied

The frequency of chromosomal abnormalities in patients referred for fragile X analysis.

The present paper summarizes our existing database on chromosomal abnormalities found in patients referred because of a question of the Fragile X Syndrome during the period from January 1, 1990 to June 30, 1995. Cytogenetic results were derived from testing performed at the cytogenetics laboratory at Rhode Island Hospital. All positive fragile X individuals detected among our sample population represent index patients from separate kindreds. Of a total of 327 cases referred for fragile X testing, 10 (3.06 percent) were found to be positive for fragile X by either cytogenetics alone or by both cytogenetics and DNA testing, 12 (3.60 percent) were found to be positive for either a numerical or structural chromosomal abnormality, while 10 (3.06 percent) were found to exhibit a heteromorphism. Positive chromosomal findings included numerical chromosomal abnormalities of the sex chromosomes and autosomes, deletions, and translocations. Heteromorphism mostly involved an increase in the length of heterochromatic regions of certain chromosomes as well as a pericentric inversion of a chromosome 9, usually considered normal variants. It is concluded that chromosomal abnormalities other than fragile X are found with equal and, in some cases, higher frequency than the frequency of fragile X positivity in patients referred for a question of the Fragile X Syndrome. Our figures, consistent with those reported in the literature, underscore the value of routine karyotyping in this population of patients. Except under special circumstances, it is important that GTG-banding analysis be performed so that the entire human genome be examined in addition to scoring for the fragile X mutation on Xq27.3. Especially in view of the recent finding of the relative rarity of this condition, the exclusive use of DNA analysis is not advised.

Chromosome Aberrations↗
PubMedDate not supplied

Disappearing trisomy 8 mosaicism.

A case is presented of a patient with disappearing trisomy 8 mosaicism initially thought to have stigmata of the fragile X syndrome. This case is interesting for two reasons. First, it demonstrates the occurrence of "disappearing mosaicism," a phenomenon first described by LaMarche et al, in 1967. Our patient, initially studied in 1991 by two laboratories and found to be mosaic for chromosome 8 trisomy, was apparently normal by both GTG-banding and fluorescent in situ hybridization (FISH) when studied in 1996. Second, this case further underscores the fact that except under special circumstances, it is important that GTG-banding analysis be performed so that the entire human genome be examined in addition to scoring for the fragile X mutation on Xq27.3. In a recent review of the existing database at Rhode Island Hospital on chromosomal abnormalities found in patients referred because of a question of the fragile X syndrome during the period from January 1, 1990 to June 30, 1995, it was found that the frequency of other chromosomal abnormalities in patients referred because of a question of fragile X syndrome equaled or exceeded that of patients found to be positive for fragile X. Our figures, consistent with those reported in the literature, underscore the value of routine karyotyping in this population of patients.

Child↗