Prolonged intermittent positive pressure ventilation by nasal prongs in apnea of prematurity.
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Biomedical subjects
Publications and source records attributed to J Neu.
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The effect of oral gentamicin on lactase, the major disaccharidase of the neonatal intestine, was studied using the suckling Wistar rat as a model. The jejunal lactase-specific activity of asphyxiated animals given oral gentamicin at a dose of 20 mg/kg/day for two days was significantly decreased compared to that of nonasphyxiated animals given oral saline (P less than 0.01). Although the intestinal lactase-specific activity of nonasphyxiated animals given oral gentamicin at a dose of 20 mg/kg/day for two days was not significantly different from that of animals given oral saline, a high dose of oral gentamicin (160 mg/kg/day) was associated with decreased lactase-specific activity in both the jejunum and ileum. Intramuscular administration of gentamicin was not associated with decreased intestinal lactase-specific activity. More information is needed regarding the mechanism of the biochemical injury associated with the oral use of aminoglycosides and its clinical significance, if any, in the human infant. Until this is known, the potential for such injury should be of special concern where prophylaxis against necrotizing enterocolitis is being considered, particularly in view of the increased tendency for treated infants to become colonized with gram negative organisms resistant to the antibiotic being used.
Over a two year period, 52 infants were found to have clinical signs of patent ductus arteriosus (PDA). Twenty-seven responded to fluid restriction and furosemide; the remaining 25 infants entered the Indomethacin (IN) study protocol. Their mean (+/- SE) gestational age was 29.3 (+/- 0.6) weeks and birth weight was 1,142 (+/- 80) gm. Either a placebo or IN (0.25 mg/kg) orally was given for two doses, 24 hours apart; if no response occurred, the patient was crossed over to the opposite medication. Using Chi-square analysis, a significant response rate to IN was found. There were no significant differences in birth weights, gestational ages, or fluid intake between responders and nonresponders. However, both responders and nonresponders required a prolonged ventilator course, suggesting factors other than PDA causing prolonged ventilatory requirements in these babies.
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Determinations of C3, C4, and C5 concentrations by radial immunodiffusion, and assays for the activation products of C3, C3c and C3d by counterimmunoelectrophoresis, were performed on 80 infants. Seven nonbacteremic preterm infants with necrotizing enterocolitis (NEC) or probable NEC (PNEC) were found at the time of diagnosis to have a significantly lower mean concentration of C3 (P less than 0.05, 1-tailed) without C3 activation when compared to other noninfected preterm infants. Ten full-term and 63 preterm infants were studied prospectively during the first days of life, and were then followed for the postnatal development of localized or systemic infection. Assays for the detection of C3 activation products were negative in all these infants. Four preterm infants who developed PNEC after 5 or more days without clinical illness had low original concentrations of complement components. The pathogenesis of NEC may not involve primarily complement activation, and susceptibility to this condition may be related to pre-existing deficiencies in complement component concentrations relative to gestational age, or to defective activation of C3 in the presence of certain bacterial species and strains.
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The purpose of this study was to assess the usefulness of the white cell ratio of immature neutrophils (PMNs) to total (immature plus mature) PMNs as an indication of infection in the very small premature infant. We retrospectively reviewed the charts of 59 premature infants less than or equal to 1,250 g admitted to our Newborn Intensive Care Unit over a one-year period who had at least one white count determined. Twenty-three were born after rupture of membranes for greater than or equal to 24 hours (PROM), 47 had a one-minute Apgar score less than or equal to 6 and 31 had a five-minute Apgar scores less than or equal to 6, 38 had respiratory distress syndrome (RDS), and 4 had confirmed infection. Thirty-one of the infants had a ratio greater than or equal to .15 in the first day of life, a value which has been suggested in the literature as being abnormal and an indication to suspect sepsis. This ratio bore no statistical relationship to PROM, low Apgar scores, or RDS. We analyzed these same relationships using a ratio greater than or equal to .25, another ratio derived from data in the literature which has been said to suggest infection. No statistical correlation was found for low Apgars or RDS, but there was a significant relationship between PROM and attainment of a ratio greater than or equal to .25 (p less than .005). It is notable that 2 out of the 4 infants with infection had a ratio less than .15. We wish to cast doubt on the applicability of the currently defined WBC ratios in the literature as they apply to the infant with birth weight less than 1,250 g and emphasize the apparent effect of PROM as a factor upon these ratios.
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The timing of the first meconium stool has been considered a marker for proper gastrointestinal functioning in the term infant. There is limited information on the meconium passage patterns of very-low-birth-weight infants of less than 32 weeks' gestation. It is unknown whether feeding practices influence the timing of the first stool in these infants. We retrospectively studied 47 very-low-birth-weight infants with birth weights of 1250 g or less who were previously enrolled in a study of gastrointestinal (GI) priming. Infants whose mothers desired to breast feed (n = 7) were given GI priming with their own mother's milk. The remaining infants had been randomly assigned to receive total parenteral nutrition alone (n = 21) or GI priming with infant formula (n = 19) during the first 14 days of life. We attempted to advance all infants to full enteral nutrition by 21 days of age. There was no statistically significant difference in timing of the first stool among the three groups. The overall median age at first stool was 43 hours, and the 75th percentile was 10 days. The range was 1/2 hour to 27 days. There was no concordance between time of first stool and birth weight within the range studied. There was no concordance between time of first stool and necrotizing enterocolitis, although there was little statistical power to detect this. There was also very little concordance with feeding tolerance. Other than necrotizing enterocolitis, no significant GI disease developed in any of the infants studied.(ABSTRACT TRUNCATED AT 250 WORDS)