Color-coded prescription labeling.
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Color↗
Biomedical subjects
J A Kerner
Publications and source records attributed to J A Kerner.
Use of the conjugated polyene fatty acid, parinaric acid, in assaying fatty acids in serum or plasma.
We describe a method for rapidly assaying fatty acid concentrations in plasma or serum. This method is particularly appropriate for monitoring increased concentrations of fatty acids that may be present during intravenous lipid infusion, especially in neonates. Binding cisparinaric acid (9, 11, 13, 15-cis-trans-trans-cis-octadecatetraenoic acid) to albumin shifts the absorption spectrum of the acid. If fatty acids are present in serum, they will compete with parinaric acid for binding, changing the extent of this absorption shift. The measurement requires a spectrophotometer, 30 microL of serum or plasma, and knowledge of the sample's albumin concentration.
Bilirubin↗
Late morbidity among survivors of necrotizing enterocolitis.
Of 40 survivors of necrotizing enterocolitis 19 were completely normal children at the time of follow-up, one to three years later. Among the other 21 children, only six had moderate to severe neurologic impairment, representing 15% of all survivors. Despite the fact that intestinal injury is the main feature of the neonatal disease, only four children were symptomatic from gastrointestinal sequelae, and none of these suffered failure to thrive. Thus, 81% (17) of the children with late morbidity had problems unrelated to the gastrointestinal tract. The nongastrointestinal morbidity was associated with prematurity and the degree of perinatal stress.
Child, Preschool↗
Cervical dilation by vibration.
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Abortion, Spontaneous↗
Hepatic failure following ingestion of multiple doses of acetaminophen in a young child.
A 7-month-old male developed hepatic failure following the mistaken administration of multiple excessive doses of acetaminophen. Hepatic toxicity following multiple dose ingestion has been reported infrequently. Risk factors for hepatic toxicity following multiple dose ingestion are discussed.
Acetaminophen↗
Relationship between breath and total body hydrogen excretion rates in neonates.
Our study examined the relationship of H2 excreted in breath to total body H2 excreted by neonates. We report simultaneously measured end-tidal H2 concentrations, plus breath H2 and total body H2 (breath H2 plus flatus H2) excretion rates in 10 neonates. End-tidal H2 concentrations varied from 2.4 to 192 ppm. Breath H2 excretion rates ranged from 0.20 to 6.5 and total body H2 excretion rates from 0.29 to 15.0 ml/h. The fractional breath H2 excretion in these infants was 48% (range 33-69%), compared with 21% reported in adults. The correlation coefficient for end-tidal derived H2 excretion and directly measured breath H2 excretion rates was 0.95 (p less than 0.001). We conclude that the proportion of total H2 excreted in the breath of neonates is increased compared with adults, suggesting that caution must be exercised when interpreting newborn breath H2 measurements and using adult norms.
Adult↗
Oral correction of essential fatty acid deficiency in cystic fibrosis.
A combination of pancreatic insufficiency and inadequate caloric intake may produce essential fatty acids (EFA) deficiency in patients with cystic fibrosis. Seventy-five percent of the adolescents and young adults with poor weight gain in our clinic were EFA-deficient by total plasma linoleic acid criteria. Twenty of these patients were placed on an oral hyperalimentation regimen containing 230% of calories required for basal energy expenditure, 40% as fat. Forty percent of these (8/20) achieved normal EFA levels on this diet. Eight of the nonresponding patients were given an additional 5% of their caloric intake as linoleic acid monoglyceride. All who maintained caloric intake achieved normal EFA levels. Normalization of EFA levels was associated with a number of clinical benefits including increase in weight and activity and, in five teenage girls, regulation of menses. The 16 control patients who received standard pancrelipase therapy and nutritional supplements remained fatty acid deficient. We conclude that oral hyperalimentation can restore EFA levels in cystic fibrosis patients if adequate calories are available to provide energy needs.
Cystic Fibrosis↗
Monitoring intravenous fat emulsions in neonates with the fatty acid/serum albumin molar ratio.
Weekly determinations of the fatty acid/albumin molar ratio (FA/SA) were obtained 136 times on 50 neonates (birthweight range, 675-4300 grams; median, 1360 grams) to determine if our use of intravenous fat (IVF) was putting these newborns at risk for kernicterus. The FA/SA was measured using a convenient spectrophotometric technique which we have previously described (Berde CB, Kerner JA, Johnson JD: Clin Chem 26:1173-1177, 1980). Twenty-nine infants received IVF with doses from 0.5 to 3.3 gram/kilogram/day (mean 1.5 gram/kilogram/day), given over 24 hours whenever possible, most commonly begun in the second week of life when the bilirubin level was less than one half of the potential exchange level. Twenty-one infants received no IVF. Previous studies show that fatty acids do not begin to displace bilirubin from albumin until the FA/SA is greater than 6 in vivo, and greater than 4 in vitro. All our infants had safe values with mean FA/SA values of approximately 1.0. Continuous IVF as we administer it does not place neonates at risk for kernicterus. Centers administering IVF in the first week of life or by bolus should consider close monitoring of their infants with the FA/SA.
Fat Emulsions, Intravenous↗
Limited value of nephelometry in monitoring the administration of intravenous fat in neonates.
To evaluate the usefulness of nephelometry in predicting hyperlipidemia in neonates receiving intravenous fat (IVF), 23 infants in our neonatal intensive care nursery had simultaneous measurements of the serum IVF level (as determined by nephelometry), triglyceride, cholesterol, and free fatty acid/albumin molar ratio. There was a positive correlation between the serum IVF level and triglycerides, but the IVF level did not reliably predict elevated triglycerides, cholesterol, or free fatty acid-albumin molar ratio. Thus, neonates receiving IVF emulsions cannot be monitored by nephelometry alone. Adequate monitoring requires measurement of specific lipid fractions.
Cholesterol↗
Calcium and phosphorus in neonatal parenteral nutrition solutions.
Due to calcium and phosphorus solubility problems in parenteral nutrition solutions, it is difficult to provide the premature infant with enough of these two minerals for adequate bone mineralization. In order to determine the maximum amounts of both Ca and P soluble in neonatal parenteral nutrition solutions, we employed the following procedure: (1) using concentrations of dextrose 10 to 25% and amino acid 0.5 to 4.0% with standard electrolyte and vitamin concentrations, Ca and P additions were sequentially made to determine the critical concentrations at which precipitates formed; (2) the pH of each test solution was determined; (3) all test solutions were incubated for 30 hr at room temperature; (4) following incubation, all tests were visually observed for calcium-phosphate crystals; (5) the solutions not obviously precipitated were filtered using black Millipore filters to determine the presence of any microprecipitates. Multiple graphs of Ca and P solubility in various dextrose/amino acid solutions were prepared from data generated by the study. The Ca and P interaction is primarily pH sensitive. Factors affecting the solution pH include both dextrose and amino acid concentrations. Our study showed that increases in amino acid concentrations enabled us to increase both Ca and P in the solutions.
Amino Acids↗
Improved growth and disease activity after intermittent administration of a defined formula diet in children with Crohn's disease.
Growth failure is the most common extraintestinal manifestation of Crohn's disease in childhood, occurring in up to 50% to 88% of affected patients. Previous studies have shown malnutrition to be the most likely cause of the decrease in height and weight velocities in these children. The purpose of this study was to determine the effect of an intermittent defined formula diet on growth and disease activity in children with Crohn's disease and growth failure. Six Tanner stage I-II patients, mean age 13.6 years with height less than the 5th percentile or height velocity less than the 3rd percentile were enrolled in a 1-year prospective study. An isotonic, hydrolyzed whey, medium-chain triglyceride formula was given by nocturnal nasogastric infusion at a caloric equivalent of 50th percentile for age, as the exclusive nutrient source 1 out of 4 months during a 1-year period. A 2-week exclusion diet and a 2-week low-residue diet followed the defined formula diet before resuming the regular diet for 2 months. Patients served as their individual control based on observations of at least 1 year before the study. Height and weight velocity significantly increased. Prednisone intake significantly decreased, and significant improvement was seen in disease activity, albumin, and somatomedin C. The results indicate that an intermittent defined formula diet can improve growth failure and significantly decrease disease activity in children with Crohn's disease.
Adolescent↗
High serum vitamin E levels in premature infants receiving MVI-Pediatric.
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Humans↗