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Biomedical subjects

J W Reynolds

Publications and source records attributed to J W Reynolds.

17 recordsLinked to original sources
PubMed1989

Insulin infusion with parenteral nutrition in extremely low birth weight infants with hyperglycemia.

From Nov. 7, 1983, to Nov. 6, 1986, all infants with birth weight less than or equal to 1000 gm admitted to Oregon Health Sciences University who had persistent hyperglycemia and glycosuria were treated with graded insulin infusion while energy intake was increased to at least 100 kcal/kg/day (419 kilojoules/kg/day). The records of these infants were reviewed to define the clinical characteristics of infants likely to develop hyperglycemia and to see whether insulin administration would allow goals for energy intake to be met. There were 76 surviving infants; 34 received insulin and 42 did not. Treated infants were smaller (767 +/- 161 vs 872 +/- 98 gm; p = 0.0004), were more immature (26.8 +/- 1.4 vs 27.7 +/- 2.0 weeks; p = 0.0115), and required mechanical ventilation longer (28 +/- 19 vs 17 +/- 15 days; p = 0.0196). There were no significant differences between the groups at 3, 7, 10, or 14 days for intravenously administered glucose or for total nonprotein energy intake at 3, 7, 10, 14, 28, or 56 days. Treated infants achieved an intake of 100 kcal/kg/day (419 kilojoules/kg/day) at 15 +/- 8 vs 17 +/- 11 days and regained birth weight at 12 +/- 6 vs 13 +/- 6 days (NS). There was no difference in percent change from birth weight at 7, 14, 28, or 56 days. Treated infants had a glucose concentration of 195 +/- 60 mg/dl (10.8 +/- 3.3 mmol/L) while receiving 7.9 +/- 3.0 mg/kg/min (43 +/- 17 mumol/kg/min) of glucose at the start of insulin infusion on days 1 to 14. Insulin was given for 1 to 58 days. The initial dose was 40 to 100 mU/gm of dextrose infused (57 to 142 nmol/mol) and then gradually decreased. Less than 0.5% of blood glucose values were 25 to 40 mg/dl (1.4 to 2.2 mmol/L). We conclude that insulin infusion improves glucose tolerance in extremely low birth weight infants and allows hyperglycemic infants to achieve adequate energy intake similar to that of infants who do not become hyperglycemic.

Blood Glucose↗
PubMed1989

Nutritional balance studies of VLBW infants fed their mothers' milk fortified with a liquid human milk fortifier.

This article reports the results of a study designed to compare human milk fortified with a liquid human milk fortifier to a preterm infant formula by analyzing the metabolic balances of certain nutrients when these milks are fed to premature infants. Ten very low birth weight (VLBW) infants were studied during 4-day equilibration periods, then 4-day metabolic balances of N, fat, Ca and P, while each consumed a 1:1 mixture of a pool of its own mother's milk and the liquid human milk fortifier (HM/LF). For comparison, another 10 VLBW infants were studied in similar fashion while consuming the preterm infant formula (PF). Percent nitrogen retentions were 77 +/- 4% (+SD) and 79 +/- 4%, and fat absorptions were 94 +/- 7% and 92 +/- 5% in the HM/LF and PF groups, respectively, and did not differ between the groups. Calcium retention was 86 +/- 21 mg/kg/day (51 +/- 12%) in the HM/LF group and 104 +/- 43 mg/kg/day (45 +/- 19%) in the PF group. The percent Ca retentions did not differ. Phosphorus retentions were 56 +/- 7 mg/kg/day (67 +/- 9%) and 77 +/- 18 mg/kg/day (61 +/- 14%) in the HM/LF and PF groups, respectively. Increases in weight, length, and occipitofrontal circumference (OFC) were similar and normal in both groups. We conclude that VLBW infants fed the HM/LF, mixed 1:1 with their mothers' milk, had rates of absorption and retention of Ca, P, N, and fat similar to rates found in the concurrent study of VLBW infants fed a commercially available PF.

Food, Fortified↗
PubMed1986

Benzyl alcohol toxicity: impact on neurologic handicaps among surviving very low birth weight infants.

Benzyl alcohol preservative in solutions used to flush intravascular catheters has been linked with increased mortality and incidence of intraventricular hemorrhage in small preterm infants. This study evaluated the outcome of surviving very low birth weight infants exposed to benzyl alcohol while in our neonatal intensive care unit. Surviving infants, less than 1,250 g birth weight, admitted during the 12 months prior to discontinuation of benzyl alcohol (period I), were compared with those infants admitted during the 12 months after discontinuation of benzyl alcohol (period II). Survivors were enrolled in a follow-up program. Results of the study demonstrated that infants from period II had fewer neurologic handicaps. The incidence of cerebral palsy decreased from 50% to 2.4% (P less than .001), and the presence of cerebral palsy and developmental delay combined decreased from 53.9% to 11.9% (P less than .001). Several factors other than benzyl alcohol exposure were examined for their importance on outcome but were found not to be related to it. It is concluded that the dramatic improvement in outcome could be the result of discontinuation of benzyl alcohol.

Benzyl Alcohols↗
PubMed1979

Lactobezoars.

Explore the source record for details and available documents.

Animals↗
PubMed1978

Transient hyperammonemia of the preterm infant.

We report on five preterm infants (34 to 36 weeks' gestation) in whom an overwhelming illness developed within the first 48 hours of life. Each had mild respiratory distress that progressed within 48 hours to deep coma requiring ventilatory assistance. Ammonia concentrations in the plasma ranged from 844 to 7640 microgram per deciliter. Four received exchange transfusion and peritoneal dialysis; ammonia values returned to the normal range (less than 150 mug per deciliter) within 72 hours and remained there even after protein challenge. These four subsequently fed and developed normally. The fifth infant died without an attempt to lower plasma ammonia. In this infant (and two of the others) urea-cycle enzymes measured in liver tissue were in the normal range. Transient hyperammonemia of unknown cause may be a relatively common variety of neonatal hyperammonemia; it responds well to prompt diagnosis and aggressive therapy.

Ammonia↗
PubMed1978

Serum cortisol and dehydroepiandrosterone sulfate responses to adrenocorticotropin stimulation in premature infants.

ACTH stimulation tests were performed in 15 premature infants in a serial fashion at the ages of 5--10 days and 27--31 days. Six of the 15 had subsequent ACTH stimulation tests at 6--8 weeks and/or 12--13 weeks. The pre- and post-ACTH serum cortisol and dehydroepiandrosterone sulfate (DHAS) levels were determined by radioimmunoassay. The mean basal levels of cortisol, 55 ng/ml, and DHAS, 4108 ng/ml, were significantly higher (P less than 0.05 and P less than 0.025, respectively) at 5--10 days than those of 24 ng/ml and 1858 ng/ml, respectively, at 27--31 days. The mean net change (delta) of cortisol after ACTH at 5--10 days, 95 ng/ml, increased significantly to 148 ng/ml at 27--31 days. However, deltaDHAS did not differ significantly between the two periods (1514 ng/ml vs. 972 ng/ml). Therefore, deltaDHAS/deltacortisol was lower (P less than 0.05) at 27--31 days than at 5--10 days. No further significant changes were observed after 4 weeks of age in the levels of the two steroids. There was little correlation of basal levels between cortisol and DHAS, nor between deltacortisol and deltaDHAS at any age period we studied. There were four infants whose mothers had prenatal steroid treatment for the prevention of hyaline membrane disease and their values were not different from the other infants.

Adrenocorticotropic Hormone↗
PubMed1976

Prolonged apnea of prematurity: Treatment with continuous airway distending pressure delivered by nasopharyngeal tube.

Five premature infants experiencing frequent episodes of apnea and bradycardia were treated with continuous positive airway pressure delivered by nasopharyngeal tube. A significant decrease in the frequency and severity of apneic spells was observed. Premature withdrawal from end expiratory pressure resulted in an increase in both the incidence and the duration of the apneic episodes. We suggest that hypoventilation and a reduced functional residual capacity (FRC) are related to the development of prolonged apnea. Expansion and stablization of FRC with small amounts of end expiratory pressure appears to be beneficial.

Apnea↗
PubMed1976

Serum dehydroepiandrosterone sulfate in premature infants and infants with intrauterine growth retardation.

Serum dehydroepiandrosterone sulfate (DHAS) was measured by radioimmunoassay in blood samples obtained in 128 ill newborn infants. Serial sampling was carried out in 40 infants. There were wide ranges found in the values in all gestational age groups, and there were not significant differences in the first day of life between DHAS levels in less than 30 week gestation prematures, 6819 +/- 4631 (SD) ng/ml, and near term or term infants, 4307 +/- 1498 ng/ml. Mean DHAS concentrations did not decline over the first three weeks of life in prematures less than 36 weeks gestation. In six infants, age 35-73 days, and 29-34 weeks gestation at birth, the DHAS concentration was 1068 +/- 138 ng/ml. High concentrations were frequent in prematures less than 33 weeks gestation and could be correlated to epiodes of severe clinical stress. There were no significant differences in serum DHAS levels, on the first day of life, between infants with no hyaline membrane disease, nonfatal hyaline membrane disease and fatal hyaline membrane disease. Intrauterine growth retarded (IUGR) infants, who were greater than 35 weeks gestation, had significantly lower (P less than .032) DHAS levels in the first day of life than normally grown infants. The results show that there is a persistence during the postnatal period of the prominent delta5-3beta-hydroxysteroid production by the adrenal cortex characteristic of the fetus. Low concentrations of serum DHAS in IUGR infants suggest that the fetal zone of the neonatal adrenal cortex is a major source of circulating DHAS in the newborn period.

Dehydroepiandrosterone↗
PubMed1975

Phospholipid composition and cardiolipin synthesis in fermentative and nonfermentative marine bacteria.

Twenty biochemically distinct isolates of marine bacteria, comprising a collection of gram-negative, motile, straight and curved rod-shaped organisms, were separated into fermentative and nonfermentative groups. The isolates were analyzed fro phospholipid composition and the activities of the enzymes, cardiolipin synthetase, and a phosphilipase were determined. The phospholipid compositions of all isolates were generally similar. Phosphatidylethanolamine and phosphatidylglycerol were the major phospholipid classes detected. The absence of cardiolipin in most of the nonfermentative isolates was the most striking observation noted. This was verified chromatographically and by the absence of cardiolipin synthetase activity. In isolates which had cardiolipin, it apparently was synthesized by the condensation of two molecules of phosphatidylglycerol, a mechanism similar to that observed in terrestrial bacteria. Possible correlations between the presence of cardiolipin and Mg-2+ requirements for growth are discussed.

Bacteria↗
PubMed1975

Hyaline membrane disease treated with early nasal end-expiratory pressure: one year's experience.

This report describes one year's experience treating hyaline membrane disease (HMD) with nasal end-expiratory pressure (NEEP). During the 12 months from July 1, 1973 through June 30, 1974, 119 children with HMD were admitted to the Intensive Care Unit of St. Paul Children's Hospital. Sixty-nine infants were treated early in the course of their disease with NEEP. The survival, incidence of complications, and the number of endotracheal intubations are reported and compared to our experience during a similar time period prior to the use of NEEP (1971-1972). Since the advent of the early application of modest amounts of end-expiratory pressure by nasopharyngeal tube, there has been an increase in the survival of all admissions with HMD, but the increase was statistically significant (P less than .01) only in those weighing 1,501 to 2,000 gm. There was a significant decrease (P less than .025) in the total number of children with HMD requiring endotracheal intubation. There was no change in the incidence of pneumothoraces or bronchopulmonary dysplasia. NEEP is a simple and effective technique for creating continuous airway distending pressure. Its effectiveness and ready availability make the routine endotracheal intubation of infants requiring only continuous airway distending pressure no longer justifiable.

Blood Gas Analysis↗
PubMed1975

Reduced thrombus formation with silicone elastomere (silastic) umbilical artery catheters.

This report describes clinical experience with a radiopaque silicone elastomere (Silastic) umbilical artery catheter. Twenty infants, ten with polyvinyl chloride (PVC) umbilical artery catheters and ten with Silastic umbilical artery catheters, all positioned at the aortic bifurcation, had aortograms performed at the time of catheter removal. Catheter-associated thrombus formation was observed in nine of the ten infants (90%) with PVC umbilical artery catheters and in one of the ten infants(10%) with Silastic catheters. The incidence of lower extremity vasospasm associated with the two catheters was not significantly different. Aortic pressure tracing recorded through Silastic catheters were accurate, but slightly damped. Autopsies were performed on five additional infants who died with indwelling Silastic umbilical artery catheters. None of the catheters, nor their surrounding tissues, showed evidence of thrombus formation on either gross or microscopic examination. It is our experience that radiopaque silicone elastomere tubing can be used as an umbilical artery catheter and appears to have the advantage of being less thrombogenic than the standard PVC tubing currently in general use.

Catheterization↗